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drugs & therapeutics - Coggle Diagram

- - - - disease/health status-related
        
        cognitive impairment
        
        multiple co-mobidities
        
        renal or hepatic impairment or transplant
        
        multiple hospital admissions
        
        recently discharged from hispital
      - medication-related
        
        5 or more chronic meds
        
        12 or more doses / day
        
        on high alert meds w narrow therapeutic index (according to MOH, these include warfarin, tacrolimus, carbamazepine, cyclosporine, phenytoin)
        
        meds that require therapeutic drug monitoring
        
        hx of significant changes to med regimen in last 30 days
        
        hx of med-related problem or ADE
        
        on med w complex dosing regimen
      - pt-related
        
        age: >65y/o + prof AR added children
        
        med mx issues/in need of assistance w taking meds
        
        suspected or reported non-adherence
        
        following up w 3 or more doctors for comorbidities
- - - - simple analgesics
        
        paracetamol
        
        free from side effects
        
        good antipyretic
        
        analgesic efficacy ~ to aspirin
        
        no anti-inflammatory properties
        
        safe in pregnancy, children
        
        no significant DDIs
        
        dosages
        ADULT
        
        1000mg 4 hourly PO (that's why 2 panadol tablets cos each is 500mg)
        PAEDS
        
        more commonly given as suspension
        
        1-12y/o give 250mg/ml suspension, 10–15mg/kg of body weight, 4-6hrly
        
        < 1 y/o give 150mg/5ml suspension instead
        
        suspension can also be given to adults tho less common, follow adult dosing
        
        can also be given + codeine or + caffeine
        
        Contraindications/modifiers
        
        since hepatotoxic, mild-moderate liver problems max 3g/day, liver failure absolute contra
        
        alcoholics max 2g/day, cos increases activity of CYP450 specifically CYP2E1, which metab acetaminophen to hepatotoxic by-pdt
      - NSAIDs
        
        to reduce GI effects
        COX-2 inhibitors
        
        highly selective eg.
        celecoxib
        etrocoxib
        semi-selective eg.
        diclofenac
        etodalac
        meloxicam
        
        eg.
        aspirin (but has addn antiplatelet effects due to irreversible inhibition of COX-1)
        ibuprofen
        ketoprofen
        naproxen
        
        various systemic side effects! incl
        
        prolonged bleeding time
        
        GI bleeding
        
        hypertension
        etc.etc.
        
        RENAL toxicity!!!!
        
        use w caution in
        
        asthmatics
        
        elderly
        
        peptic ulcer disease (esp elderly, corticosteroids)
        
        liver, bleeding, renal disorders, heart failure
        
        meds: prednosolone, ACE inhibitors, aspirin
        
        peripheral edema, ascites, fluid retention
        
        those at risk of vascular events (coronal, cerebrovascular)
        
        AVOID when (incl COX2 inhibit)!!
        
        3-6 mths after vascular event (cardio/cerebrovascular) or procedure (PTCA, CABG)
        
        IF USED, for 3-5 days ONLY
  - - - amides
        
        usually injectibles
        
        have "i" in name
        
        metabolised in liver
        
        lignocaine^
        prilocaine^
        mepivercaine
        articaine (FYI has ester ring but considered an amide)
        bupivacaine
        ^topical also
      - esters
        
        usually topical, because cardiotoxic
        
        metabolised in kidney
        
        benzocaine
        cocaine
        tetracaine
        procaine (this one is injectable)
    - - reversible blackade of propogation of peripheral nerve impulses by binding to Na channels --> inhibits influx of Na ions into cell --> prevention of AP
    - - most common (esp in elderly & children): syncope, psychogenic
      - systemic toxicity can arise w
        
        excessive dosing, children most susceptible
        
        IV injection (even small doses, given rapidly)
        
        CNS effects
        
        excitation: light headedness, dizziness, disorientation, localised involuntary mm activity
        
        depression: respiratory depression, unconsciousness
        
        These are opposite, how come can be either? can be either, depending on various factors eg. dose and concentration of the local anesthetic, the route of administration, the rate of absorption, and individual patient factors such as age, weight, and overall health
        
        CVS effects
        
        hypotension, depresses effect on heart
        
        Cardiac arrhythmias, bupivacaine esp
    - - BEWARE! pt w non-selective beta blockers, esp w hx of MI
        
        non-selective beta blockers eg. propanolol, nandolol, timolol, sotalol
        
        vs selective beta blockers eg. atenolol, metopralol, acebutol, betaxolol
        
        see slide 9 for diagram on pathwya of how adrenaline increases BP
        
        why?
        
        HELP IDKKKKK
      - adrenaline is added as amide LAs are vasodilators
        
        this helps for LA to last in the region longer
        
        also helps decrease bleeding