A nasoenteric tube is passed through the nares into the duodenum or jejunum when it is necessary to bypass the esophagus and stomach.
Nasoenteric tubes have a
decreased risk of aspiration compared with nasogastric tubes; however, a
nasoenteric tube can become dislodged to the lungs, causing aspiration of
If a client with a feeding tube develops signs of aspiration pneumonia (diminished or adventitious lung sounds [eg, crackles, wheezing], dyspnea, productive cough), the feeding should be stopped immediately and tube placement checked (eg, measure insertion depth, obtain x-ray, assess aspirate pH).
Some facilities use capnography to determine placement; if a sensor detects exhaled CO2 from the tube, it is in the client's airway and must be removed immediately
Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that causes obstructed airflow from the lungs. Symptoms include breathing difficulty, cough, mucus (sputum) production and wheezing.
Seborrheic dermatitis is a non-contagious skin condition. It leads to scaly patches of skin with oily, dandruff-like flakes, especially on your face and scalp. It is only rarely itchy.
Cushing's syndrome is a disorder caused by the body’s exposure to an excess of the hormone cortisol. Cortisol affects all tissues and organs in the body. These effects together are known as
Cushing’s syndrome can be caused by overuse of cortisol medication, as seen in the treatment of chronic asthma or rheumatoid arthritis (iatrogenic Cushing’s syndrome), excess production of cortisol from a tumor in the adrenal gland or elsewhere in the body (ectopic Cushing’s syndrome) or a tumor of the pituitary gland secreting adrenocorticotropic hormone (ACTH) which stimulates the over-production of cortisol from the adrenal gland (Cushing’s disease).
A rate-limiting enzyme is a key enzyme of which the activity determines the overall rate of a metabolic pathway.
1. Glycolysis : phosphofructokinase
2. Gluconeogenesis : PEP (phosphoenol pyruvate) carboxylase
3. Glycogenesis : glycogen synthase
4. Glycogenolysis : glycogen phosphorylase
5. Kreb cycle : isocitrate dehydrogenase
6. Ketone body synthesis : HMG co A synthase
7. Cholesterol synthesis : HMG co A reductase
8. Porphyrin synthesis : ALA synthase
9. Fatty acid synthesis : acetyl CoA carboxylase
10. Uric acid synthesis : xanthine oxidase
A bone density test uses x-rays to measure how many grams of calcium and other bone minerals are packed into a segment of bone. The bones that are tested are in the spine, hip and forearm.
Bone density test results are reported in 2 numbers: T-score and Z-score.
The T-score is the bone density compared with what is normally expected in a healthy young adult of the same sex. The T-score is the number of units—standard deviations—that bone density is above or below the average. T-score >2.5 SD indicates the likelihood of osteoporosis and increased risk of fracture. The diagnosis of osteoporosis by DEXA scan also means that treatment
should be initiated with bisphosphonates, oral daily calcium supplementation, and vitamin D.
The Z-score is the number of standard deviations above or below what is normally expected for someone of the same age, sex, weight, and ethnic or racial origin. Z-score ≤-2 may suggest that
something other than aging is causing abnormal bone loss (consider drugs causing osteoporosis such as corticosteroids). The goal in this case is to identify the underlying problem.
Electroconvulsive Therapy is the induction of a grand mal (generalized) seizure through the application of electrical current to the brain.
Sudden deterioration of an intubated baby (DOPES)
Displacement of the tube
Obstruction of ET tube
Identify and rectify the problem urgently
Enterohepatic circulation involves substances that are metabolized in the liver, excreted into the bile, and passed into the intestinal lumen; there they are reabsorbed across the intestinal mucosa and returned to the liver via portal circulation
Extracorporeal circulation is a procedure in which blood is taken from a patient's circulation to have a process applied to it before it is returned to the circulation
The mesenteric circulation refers specifically to the vasculature of the intestines, whereas the splanchnic circulation provides blood flow to the entire abdominal portion of the digestive system that includes the hepatobiliary system, spleen, and pancreas.
collateral circulation is a network of tiny blood vessels, and, under normal conditions, not open. ... This allows blood to flow around the blocked artery to another artery nearby or to the same artery past the blockage, protecting the heart tissue from injury
Positive symptoms of schizophrenia respond
to drug therapy more readily than negative symptoms. The
secondgeneration “atypical” nonphenothiazine drugs may be slightly more
effective in treating negative symptoms of schizophrenia
• HIV-mediated direct cytopathicity (single cell killing) – infected CD4 cells die
• HIV-mediated syncytia formation
• Defect in CD4 T-cell regeneration in relation to the rate of destruction
• Maintenance of homeostasis of total T-lymphocytes (decreased CD4, increasedCD8)
• HIV-specific immune response (killing of virally infected and innocent cells)
• Auto-immune mechanism
• Programmed cell death (apoptosis)
• Qualitative abnormalities (even the existing CD4 cells are dysfunctional)
• Impaired expression of IL-2
• Defective IL-2 and INF-Alfa production
• Decreased help to B-cells in production of immunoglobulins
From superficial to deep:
Loose areolar tissue
Acute pyelonephritis is a bacterial infection that affects the renal pelvis and kidney. Use the mnemonic SCARRIN' UP to memorize the predisposing factors for acute pyelonephritis.
SCARRIN' UP mnemonic stands for;
Sex (females <40 years, males >40 years)
Age (infant, elderly)
Reflux (vesciouteral urine relux)
NIDDM, IDDM (Non-insulin dependent diabetes mellitus and insulin dependent diabetes mellitus)
"I Like To Rise So High":
Think of the IVC wanting to rise high up to the heart.
The mnemonic to master Kallman syndrome features is : KALMAN
Color blindness (K sounds like C)
Low LH, FSH, Sex hormones → delayed puberty
Midline defects (cleft palate, cleft lip)
Ataxia (cerebellar ataxia)
Imaging of Kallman Syndrome
It is easiest to appreciate the anatomical anomalies present in Kallman syndrome by comparing it to a normal patient.
The normal anatomy of the region consists of the olfactory bulbs (blue arrows) located in the olfactory grooves of the anterior cranial fossa.
The inferior surface of the frontal lobes usually consists gyrus rectus (aka straight gyrus) (R) separated from the medial orbital gyrus (M) by the olfactory sulcus (yellow arrow). These are absent in Kallman syndrome.
The duodenum has four parts; superior, descending, inferior and ascending part. Together these parts form a 'C' shape, that is usually around 25cm long, and wraps around the head of the pancreas
To rememner the length of these parts use the mnemonic;
"Counting 1 to 4 but staggered":
1st part: 2 inches
2nd part: 3 inches
3rd part: 4 inches
4th part: 1 inch
Testicular atrophy is a condition wherein the testicles gradually shrink in size. It may be caused by a number of factors
Mnemonic to master the differentials of testicular atrophy is : TESTES SHRINK:
Too little food
Sex hormone therapy
Hydronephrosis is a distention of the renal calyces and pelvis with urine as a result of a urinary outflow obstruction.
Use this mnemonic 'PACT SUPER' to memorize the differential diagnoses of hydronephrosis.
Unilateral is PACT:
Pelvic-uteric obstruction (congenital or acquired)
Aberrant renal vessels
Tumours of renal pelvis
Bilateral is SUPER:
Stenosis of the urethra
Extensive bladder tumour
Diaphragm apertures: spinal levels Medical mnemonics
Aortic hiatus = 12 letters = T12
Oesophagus = 10 letters = T10
Vena cava = 8 letters = T8
Urinary incontinence is an involuntary leakage of urine due to loss of bladder control. To master the causes of acute and reversible urinary incontinence is DRIP:
The mnemonic DRIP atands for;
Restricted mobility/ Retention
Inflammation / Infection/ Impaction [fecal]
Pharmaceuticals / Polyuria
Nephrotic syndrome is kidney disease characterized by proteinuria, hypoalbuminemia, and edema. Use the mnemonic DAVID to memorize the cayses of secondary nephrotic syndrome
The mnemonic DAVID stands for;
"Dow Jones Industrial Average Closing Stock Report":
From proximal to distal:
To include the cecum, the mnemonic will be; "Dow Jones Industrial Climbing Average Closing Stock Report".
Left Atrium: Bicuspid
Right Atrium: Tricuspid
"Spare TIRE around their abdomen":
Internal abdominal oblique
The 5-F rule refers to the mnemonic of risk factors for the development of cholelithiasis in the event of upper abdominal pain:
Thoracoacromial artery branches
This is an idiosyncratic reaction to a wide variety of phenothiazines or butyrophenones such as haloperidol.
Muscular rigidity and rhabdomyolysis may occur as well. Treatment, besides stopping the drug, is with bromocriptine or dantrolene.
Central Core Disease (CCD) is a rare non progressive myopathy with autosomal dominant inheritance, presenting in infancy and characterized by hypotonia and proximal muscle weakness.
Five ‘Rs’ of intravenous fluid administration
Diloxanide furoate is the drug of choice for asymptomatic patients with E. histolytica cysts in the faeces. Metronidazole and tinidazole are relatively ineffective.
Diloxanide furoate is relatively free from toxic effects and the usual course is of 10 days, given alone for chronic infections or following metronidazole or tinidazole treatment.
Biphasic pills are forms of COC pills containing two different dose combinations of oestrogen and
progestin usually in packets of 21 or 28 tablet e.g. in 21 active pills, 10 may contain one combination,
while 11 contain another. Examples include Biphasil, Ovanon, and Normovlar
Chvostek’s sign consists of twitching of muscles supplied by the facial nerve when the nerve is tapped about 2 cm anterior to the earlobe, just below the zygomatic arch.
When hypocalcemia develops from parathyroid disease, Chvostek’s sign, a facial spasm, may be an early symptom
Atopic dermatitis is a pruritic disease of unknown origin that usually starts in early infancy; approximately 85% of cases occur within first year of life. Usually presents with pruritus, eczematous lesions, xerosis (dry skin) and lichenification (thickening of skin)
Tactile or vocal fremitus is the palpable vibration you feel when the patient speaks (says ‘99’).
Assessment of tactile fremitus is used to evaluate airflow and density of underlying tissue. Normally, the thicker the chest wall, the more diminished the fremitus; the lower the voice pitch, the greater the fremitus.
Increased fremitus (low voice pitch): conditions causing fluid or exudates in lungs (e.g consolidating pneumonia, atelectasis, pulmonary fibrosis, pulmonary edema, or pulmonary infarction) and sometimes lung tumor depending on size and mobility.
Decreased or absent fremitus (high pich): air trapping, solid tissue, or decreased air movement (e.g. emphysema, asthma, pleural effusion, pneumothorax, or distal to airway obstruction)
The diagnosis is made by palpation and timing the length of contractions. Repeated vaginal examination will demonstrate a cervix which fails to dilate.
Contractions may be strengthened by rehydration, relaxation (e.g. by epidural anaesthesia), rupture of the membranes and the use of intravenous syntocinon.The dose of syntocinon must be titrated against the strength and duration of uterine contractions to prevent hypertonic uterine action or the formation of a constriction ring
-Only antibody that pass placental circulation causing passive immunity.
-Short term protection.
-Has an Immediate action.
–Present in all bodily secretions (tears, saliva, colostrums).
–Acute in inflammation.
–For allergic reaction.
–For chronic inflammation
These are substances that promote cell division.
Many act locally as autocrines or paracrines
Pancreatic islets (islets of Langerhans)
Posterior pituitary gland does not synthesize hormones, but it does store and release two hormones made by the hypothalamus.
Hormones of the anterior pituitary gland are;
Medications That Can Cause Acne
High progesterone oral contraceptive pills
Intrauterine growth restriction
Underdevelopment (ie, sacral agenesis, ventricular septal defect, neural tube defect, cerebral palsy)
Hypoglycemia, Hypocalcemia, Hyperbilirubinemia
Power(ie, poor or uncoordinated uterine contractions)
Passenger(ie, fetus too large or malpresentation)
Passage (ie, pelvis too small or unusual shape)
Ectopy( ie, previous ectopic pregnancy)
PID(ie, pelvic inflammatory disease)
IUD(ie, intrauterine device)
Surgery (ie, previous lower abdominal surgery)
Endometri (ie, endometriosis)
HELLP Syndrome is a severe variant of pre-eclampsia
Elevated Liver enzymes
Analgesia is adequate
Cervix is dilated
Descent past ischial spines
Ead (ie, head) presentation
Prolapse of umbilical cord
Presentation (ie, malpresentation)
Wind(ie, lung atelectasis)
Water ie, urinary tract infection)
Wow (ie, mastitis)
Wind (ie, pneumonia)
Wound (ie, C-section or episiotomy site)
Walk (ie, deep venous thrombosis)
Age extremes (mother is younger or older)
Intrauterine growth restriction
Mole (ie, hydatidiform mole)
Increased blood pressure (ie, chronic hypertension)
Tumour (eg, retinoblastoma)
Hemorrhage (eg, traumatic posterior orbital hematoma)
Endocrinopathy (eg, Graves' disease)
Infection (eg, orbital cellulitis)
3rd nerve palsy
Anti-muscarinic eye drops (eg to facilitate fundoscopy)
Myotonic pupil (Holmes Adie pupil):most commonly in young women, with absent/delayed reaction to light and
convergence, and of no pathological significance.
All extraocular muscles are innervated by the third cranial nerve except the Lateral Rectus by the 6th cranial nerve and the Superior Oblique by the 4th cranial nerve
Long eyeball is ...
Myopic, requiring ...
Minus diopter lens for correction, and the patient is ...
Trauma (eg, Colles' fracture, daily overuse at typing keyboard)
Endocrinopathy (ie, pregnancy, hypothyroidism, diabetes
Neurological (C5-C6 disk herniation can mimics a CTS)
Synovitis (eg, rheumatoid arthritis)
Passive stretching causes severe pain (moat reliable sign)
Poor capillary refill
Pulselessness (late sign)
Type I: Straight through the epiphyseal growth plate
Type II: Above the epiphyseal growth plate (ie, in a fragment of metaphysis attached to the epiphysis)
Type III: Lower (ie, through and below the epiphyseal growth plate)
Type IV: Through the epiphysis and metaphysis
Type V: Emergency (ie, crush of the epiphyseal growth plate
Muscular atrophy (i.e., spinal muscle atrophy)
Mcocutaneous syndromes (e.g., neurofibromatosis)
Arthrogryposis multiplex congenita
Illness/ Infantile febrile convulsions
Posturing (especially abnormal extensor thrusting)
Oropharyngeal problems (tongue thrusts, grimacing, W swallowing difficulties)
Tone increased or decreased in muscles
Evolutional responses (ie, persistent primitive reflexes or failure to develop equilibrium and protective responses)
Reflexes (ie, deep tendon reflexes are increased and plantar reflexes are up going.
In order to diagnose CP require four criteria in a child older than one year who has no evidence of a progressive disease by history
Hirschprung's disease, Hypothyroidism, Hypercalcemia
Neurogenic bowel (eg, spina bifida)
Congenital abnormalities (eg, ventricular septal defect)
Chromosomal abnormalities (eg, Down's syndrome)
Cow's milk protein intolerance (allergy)
Cruelty (eg, parental neglect, abuse, environmental deprivation)
Rash (ie, purpuric rash over buttocks, estensor surfaces of legs, pre-tibial region)
Triad (1. diabetes mellitus, 2. atherosclerosis, 3. hypertension)
Slipped femoral capital epiphysis
Obesity in adulthood
Hemorrhage (ie, periventricular, subarachnoid, subdural)
Infection (ie, fever, meningitis, TORCH organisms)
Cardiac abnormalities (specifically Coartication)
Ovaries underdeveloped (causing sterility, amenorrhea)
Skin color: blue or pink
Heart rate: below 100 or over 100
Irritability (response to stimulation): none, grimace or cry
Respirations: irregular or good
Tone (muscle): some flexion or active
Twisted skin (wrinkly skin)
Twisted face (Potter facies)
Renal agenesis (bilateral)
Accelerated growth (ie, height)
Cunnus (vaginal) hair
Distal hair growth (ie, axillae)
Endometrial sloughing (ie, menarche)
Mnemonic - "Randy's Black Car Goes Putt Putt and Smokes"
Nicotinic effects: MTWTF (days of week):
Mydriasis/ Muscle cramps
Renal artery stenosis
K increase (hyperkalemia)
Stop the burning process
ABCs of basic life support
Visualize the patient for all injuries
Estimate burn size and begin fluid resuscitation
Airway (intubate if inhalation injury present)
Penicillin (i.e., start antibiotics)
Topical therapy (e.g., flumazanine cream)
Wear splints at night
Entire Head: 9%
Entire trunk: 18% + 18% = 36%
Entire arm: 9%
Entire leg: 18%
Whole body: 100%
Have you ever tried to Cut down on your drinking?
Do people ever Anger you about your drinking?
Do you ever feel Guilty about your drinking?
Do you ever require an Eye opener (ie, drink of alcohol) to get going in the morning?
Heart acceleration (tachycardia)
Acute onset, then fluctuation over days
2. Inattentiveness (especially to conversation)
3. Disorganized thinking (ie, incoherent speech)
4. State of consciousness either reduced or hypervigilant
For diagnosis of delirium need both 1 and 2 + either 3 or 4 (sensitivity 94-100%, specificity 90-95%)
Appetite diminished +/- weight loss
Sleep disturbance (especially diminished number of sleep hours)
Sexual libido diminished
SuicidalitySelf-worthlessness and guilt
Thought process impaired
Scanning and vigilance
Two or more worries
Organic causes should be ruled out
Course of mood or psychotic should be ruled out
Insipidus (ie, nephrogenic diabetes insipidus)
T-wave inversion on the electrocardiogram
Heaviness (ie, weight gain), Hypothyroidism, Hyperparathyroidism
Cognitive function (calculation, concentration, insight, judgment)
Overview (appearance, attitude, level of consciousness, movements)
Memory (recent and remote)
Orientation (to person, place & time)
Emotion (affect & mood)
Speech (fluency, form, & comprehension)
Thought (process, content, & perceptual disturbances)
Attention (abstract thinking, recall, and intelligence)
Something else (that might be important to the patient)
Insomnia and nightmares
Re-experiences of traumatic event at a later date
Arousal is increaseda
Numbing of general responsiveness to the real world
Metabolic (eg, electrolyte or liver abnormality, dehydration, acute intermittent porphyria)
Endocrine (thyroid disease, diabetes mellitus)
Trauma (eg, chronic subdural hematoma)
Infection (eg, of lung or urine, AIDS, syphilis)
Affective disorder (ie, depression manifesting as pseudodementia)
Structural defect of brain (eg, infarction, tumour, abscess)
Anticholinergic (see above for Anticholinergic Drug Side Effects)
Antihistaminic (eg, sedation, weight gain)
Ani-alpha 1 adrenergic (eg, orthostatic hypotension)
Arrhythmogenic (eg, quinidine-like ventricular cardiac effects)
Fibroses of lung
Infections (e.g., lung abscess, bronchiectasis, infective endocarditis)
Neoplastic (e.g., lung adenocarcinoma)
Gastrointestinal (e.g., chronic liver disease, inflammatory bowel disease, celiac disease)
Endocrine (e.g., hyperthyroidism)
Renal disease (chronic)
Cardiac (i.e., cyanotic congenital cardiac disease)
When cough in nursery, rock the "CRADLE"
Rings, slings, and airway things (tracheal rings)/ Respiratory infections
Aspiration (swallowing dysfunction, TE fistula, gastroesphageal reflux)
Lung, airway, and vascular malformations (tracheomalacia, vocal cord dysfunction)
Edema (heart failure)
Metabolic (ie, gout, pseudogout, hemochromatosis)
Endocrine (ie, acromegaly)
Degenerative (ie, osteoarthritis)
Infectious (ie, septic joint, infectious synovitis, rheumatic fever)
Connective tissue disorders (rheumatoid factor-positive) (i.e, systemic lupus erythematosus, rheumatoid arthritis, progressive systemic sclerosis/scleroderma, polymyositis/dermatomyositis)
Inflammatory vasculitides (ie, polyarteritis nodosa, Wegener's granulomatosis, hypersensitivity vasculitis, giant cell arteritis)
Seronegative spondyloarthropathies (rheumatoid factor-negative) (ie, ankylosing spondylitis, Reiter's syndrome, psoriatic arthritis, inflammatory bowel disease)
Extra-articular rheumatism (such as polymylagia)
Space between joint diminished
Cell count and differential
Culture and Gram's stain
2. and 3. Rashes (ie, 2. Discoid rash; 3. Malar rash)
4. Ulcers in mouth
5. Neurologic (ie, seizures, psychosis)
6. and 7. Elevated blood tests (ie, 6. raised antinuclear antibody; 7. positive SLE cells seen, positive anti-double-stranded DNA antibody, positive antismooth muscle antibody, false-positive VDRL test)
8. Renal (ie, proteinuria, hematuria, cellular casts)
9. Arthritis (non-erosive)
10. Serositis (ie, pleuritis, pericarditis, peritonitis)
11. Hematologic (ie, hemolytic anemia, leukopenia, thrombocytopenia)
Note: Need 4 of 11 criteria for diagnosis of SLE
Infection of urinary tract
Endocrine (e.g., glycosuria)
Restricted mobility ("geographic incontinence" of new setting)
Restricted mobility/ Retention
Inflammation / Infection/ Impaction [fecal]
Pharmaceuticals / Polyuria
"Drip" is convenient since it is urinary incontinence, so urine only drips out.
Acid-base problems (severe acidosis or alkalosis)
Electrolyte problems (hyperkalemia)
Polycystic kidney disease
Mnemonic - PLANE
Psychogenic: performance anxiety
Libido: decreased with androgen deficiency, drugs
Autonomic neuropathy: impede blood flow redirection
Nitric oxide deficiency: impaired synthesis, decreased
Erectile reserve: can't maintain an erection
Purulence (ie, venereal disease)
Push (ie, coitus-related trauma/overuse)
Vincristine has a high neurotoxicity level and so must never be administered intrathecally, as it can cause ascending radiculomyeloencephalopathy -- which is almost always fatal.
Side Effects of corticosteroids
C - Cushing's syndrome
O - Osteoporosis
R - Retarded growth
T - Thin skin I - Immunosuppression
C - Cataracts
O - Oedema
S - Suppressed HPA axis
T - Thin gastric mucosa
E - Emotional
R - Rise in BP
O - Overweight
I - Increased hair
D - Diabetes
S - Striae
Metformin must be withheld before and for 48-hours after injection of IV contrast media - due to the increased risk of renal impairment, metformin accumulation, and lactic acidosis
Group A streptococci and S. aureus are the most common causes of impetigo
Necrotizing fasciitis is commonly associated with varicella infection, where the skin lesions are infected by Streptococcus or Staph
The right hemidiaphragm will appear higher on a lateral x-ray and a PA film because the liver pushes it upward
Interstitial Syndromes of the Lung include:
• Histiocytosis X
• IPF (interstitial pulmonary fibrosis)
• Collagen disorders
Tetracycline is an antibiotic.
Don't take with milk or other things containing calcium, bc will cause chelation and change absorption.
Also: Cholesteramine causes decreased absorption.
Quinidine is an anti-arrythmic drug.
It impairs Warfarin liver metabolism, so increases the amount of active Warfain, thus increasing INR and bleeding risk.
Also may be caused by decreased production of VitK in the gut.
Also: if taken with digoxin, binds to muscle tightly, so causes Dig Tox.
Probenecid inhibits uptake of uric acid in renal tubules.
Used in treatment of gout and to increase the action of penicillin and methotrexane (decrease excretion).
Phenobarbital is a barbituate.
It induces liver P450 enzymes that metabolize Warfarin. Thus, need to take more Warfarin when on this drug.
However, if taken patient off Penobarbital, INR rises, too much Warfarin effect.
Also: cholesteramine causes decreased abosorption.
Also: renal clearance is increased by alkalinization.
Penicillin use increase risk of bleeding when taking Warfarin.
1) change gut flora, so decrease amt of VitK, so increase action of Warfarin.
2) inhibit liver enzyme responsible for Warfarin metabolism.
Also: cholesteramine causes decreased abosorption.
Also: excretion decreased by Probenecid and salicylate.
Methotrexate is used as chemo,
It can cause gout like symptoms from cell breakdown.
However, the drug is metabolized by xantine oxidase, so dont give with Allopruinol, as that would increase the effects of chemo.
Also: renal excretion decreased by Probenecid and Salicylate.
Lidocaine is given with epinepherine to vasoconstrict and keept drug local.
Also: in CHF, increased action of the drug because decreased blood flow.
Erythromycin and other macrolides increase risk of bleeding when taking Warfarin. 2 possibilities 1) change gut flora, so decrease amt of VitK, so increase action of Warfarin. 2) inhibit liver enzyme responsible for Warfarin metabolism.
Also: increases Digoxin bioavailability by the above 2 mechanisms and also maybe inhibitin p-glycopritein transport system in kidney for Dig.
Epinephrine is given with lidocaine to vasoconstrict and keep the drug local.
Ditropan is an anticholinergic.
When taken with Amitriptyline, causes abdominal distension and constipation.
Because of a pharmacodynamic interaction : tricyclics inhibit the cholinergic system via a different mechanism.
Digoxin binds to muscle tissue, Vd=400.
If something else binds to muscle tissue, digoxin is displaced, leading to higher blood levels and lower Vd. = Digoxin toxicity. (eg, quinidine)
Also: Can cause increased bleeding if taken with Warfarin.
Also: Cholestyramine causes decreased absorption. Also: Erthromycin increases bioavail by 3 mechanisms.
Warfarin is an anti-coagulant, b/c reduces VitK dependent clotting factor production in the plasma.
It has a narrow therapeutic index: with a little Warfarin, the INR = 2, but with a little more, INR = 6+. Highly bound to plasma (95%).
Too much Warfarin leads to bleeding.
Interactions: Increased bleeding (asprin), GI bleeding (NSAIDS), Impairment of Warfarin metabolism and increased bleeding (Quinolone or phenytoin), increased bleeding, maybe bc less VitK (sulfa drugs). Bartituates like phenobarbital increase metabolism, so need more Warfarin.
Also: cholesteramine causes decreased abosorption.
Cholestyramine is an ion exchange binding resin. Used to lower cholesterol by disrupting enterohepatic circulation. It is a charged molecule, so it just sticks to the wall and blocks cholesterol absorption. Will also block the absorption of other drugs (decreased bioavail): such as digitalis, Warfarin, phenobarbitol, tetracycline, penicillin.
Calcium is found in milk etc. Ion, so can cause chelation. Ion binds to drug, gets trapped inside drug in a wierd shape.
It changes absorption of the drug (eg, Tetracycline).
Asprin works by inhibiting platlet function/ anti-thrombosis/ decreases vasoconstriction.
Pharmacokinetic: Also, is highly bound to plasma (99%), so displaces Warfarin, leading to increased levels of Warfarin that is active. Therefore increases bleeding if taken with Warfarin.
Also: decreases renal excretion of Penicillin and Methotrexate by competing for the transport mechanism.
Amitriptyline is a tricyclic antidepressant. If taken with Ditropan (an anticholinergic), causes abdominal distension and constipation. Because of a pharmacodynamic interaction: tricyclics inhibit the cholinergic system also via diff mech. Also: tricyclics affect membrane pump that moves nts and antihypertensive drugs into intracellular storage sites. So may alter anti-HTN treatments. Also: metabolized via CYP 2D6, inhibited by Prozac.
Allopurinol is used in gout, xanthine-oxidase inhibitor. Xanthane-oxidase creates uric acid, but also metabolizes methotrexane. So, dont give this with methotrexane, even though it might be tempting to decrease gout symptoms in chemo. Also: Increased absorption if taken with iron.
Alcohol Induces CYP 2E1, increasing acetominophen toxicity.