Medscape - Patient Handout in English

Patient Handout

Beers Criteria

Beers Criteria

Potentially Inappropriate Medications for Elderly According to the Revised Beers Criteriia

Ref: Duke Clinical Research Institute

Pediatric Manual

click here


ref from UCDenver

Beta Blocker Overdose

http://www.courses.ahc.umn.edu/pharmacy/6124/handouts/Beta%20blockers.pdf

from John Gualtieri, College of Pharmacy, U of Minnesota
guideline and summary on beta blockers poisoning

Today's Hospitalist - Good resource for hospital protocols and guidelines

This website contains good number of order sets from various hospitals which I find very helpful as a quick reference.

click here

Pharmacokinetic Overview

http://www.globalrph.com/kinetics.htm

By D.McAuley, GlobalRPh Inc

Note:
changes in renal function may not reflect nephrotoxicity.
Other causes of acute renal failure occurring in hospitalized patients, include:
- Severe or prolonged hypotension (decreased renal perfusion)
- Surgery
- Other nephrotoxic drugs: amphotericin, cisplatin, etc.
- Acute cardiovascular dysfunction

Neonatal Drug Guidelines: UCSF Children's Hospital

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Great reference for neonate click here
and this is a ref for GERD in pediatric click here [from California Pacific Medical Center]

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Treatment and Management of Atrial Fibrillation [โรคหัวใจเต้นผิดจังหวะ]

Ref: US Pharmacist [health system editions] February 2010

Atrial fibrillation or AF is the most common cardiac arrhythmia in general population. AF is a supraventricular tachyarryhythmia characterized by uncoordinated atrial electrical conduction, which resulted in a deterioration of mechanical function.

Signs and symptoms are chest pain, palpitations, dyspnea, fatigue and syncope. Diagnosis of AF requires ECG which will display rapid oscillations of varying amplitude, shape and timing that replace consistent P waves.




Management
The treatment goals for AF are the restoration and maintenance of sinus rhythm and the prevention of thromboembolic complications.
Elective cardioversion
Pharmacologic cardioversion

Amiodarone
[po/iv]
for po route
Inpatient: 1.2-1.8 gm/day in divided doses until 10gm total then 200-400 mg per day.
Outpatient: 600-800 mg per day until 10gm then 200-400 mg per day
for iv route
5-7mg/kg over 30-60min then 1.2-1.8 gm/day cont iv or divided po doses until 10gm total then 200-400 mg per day

Dofetilide
for po route
500 mcg bid - must adjust if CrCl < 60 ml/min

Flecainide
[po/iv]
for po route 200-300 mg
for iv route 1.5-3 mg/kg over 10-20 min [available only in Europe]

Ibutilide
for iv route only
pt over 60 kg: 1mg over 10 min - may repeat 1mg when necessary
pt less than 60 kg: 0.01 mg/kg over 10 min and may repeat the same dose only once after 10 min if necessary

Propafenone
[po/iv]
for po route 600 mg
for iv route 1.5-2 mg/kg over 10-20 min [available only in Europe]

Chrohn's Disease [โรคลำไส้อุดตัน]

Ref U.S. Pharmacist [health system edition] January 2010

Current Management and Prospective Therapies

Basically, it happens when protective barrier for the intestinal tract is compromised from injury, bacterial products, or exogenous agents. These factors cause cell death. Then endothelial cells recruit leukocytes, fibroblasts, and epithelium into the mucosa from the vascular space, resulting in granulomas [which is a histopathologic lanmark of Chrohn's disease damage to the GI tract.]
Chronic inflamation ultimately thickens the bowel wall and eventually narrows the lumen.

Therapeutic Management Options

Aminosalicylates (5-ASA)
1st line therapy for mild - moderate CD.
Sulfasalazine, mesalamine, olsalazine, balsalazine
Be-careful with sulfasalazine since it contains sulfa so it shouldn't be used in patients who allergic to sulfa. In this case, mesalamine would be an option. Only Pentasa [controlled release cap] and Asacol [delayed release tab] are mesalamine forms used for CD treatment.
Adverse effects include headache, nausea, GI distress

Glucocorticoids
to reduce inflammatory and to induce remission of active CD.
Normally use when 5-ASA compounds are ineffective because of lack of efficacy in maintaining CD remission. Common adverse effects are moon face, acne, weight gain, dyspepsia.

Immunosuppressants
Thiopurines can maintain remission of moderate to severe CD.
Azathioprine, 6-mercaptopurine are steroid-sparing agents that induce cell apotosis.
Methotrexate inhibits cytokine synthesis. It is effective for inducing remission and preventing relapse in patients with CD. MTX treatment; 25mg per week has a slow onset [3-6 months] and requires monitoring.

Antimicrobials
mild to moderate CD associated with fistulas and abscesses.
Fluoroquinolones and metronidazole are drug of choice.
Flagyl 500mg po q12hrs
Ciprofloxacin > or equal to 20mg/kg/day

Biological
Infliximab [Remicade]
Adalimumab [Humira]
and new agents such as nataliumab, certolizumab

Pediatric Care Online

for antibiotic dosing/drugs of choice and more
http://www.pediatriccareonline.org/pco/ub/view/AAP-Textbook-of-Pediatric-Care/394061/4.1/Chapter_61:_Antimicrobial_Therapy

Principles of Drug Addiction Treatment

Pharmacotherapies for Opioids, Tobacco and Alcohol
From NIDA (National Institute on Drug Abuse)

http://nida.nih.gov/PODAT/Evidence.html#Pharm

Off-Label Drug Uses

from Hospital Pharmacy Journal Dec 09

Gabapentin: Cholestatic Pruritis
in adults with chronic, severe, refractory cholestatic pruritus
Initial dose at 100mg tid for 3 days then adjust dose based on tolerance and efficacy
Max dose = 2400mg per day in divided doses.
Total duration of therapy = 4 weeks

Drug/Substance Abuse

Drug abuse is a serious public health problem that affects almost every community and family in some way. Each year drug abuse results in around 40 million serious illnesses or injuries among people in the United States.


Factors


Trends in Drug Abuse (Ref: NIDA)

The National Survey on Drug Use and Health (NSDUH) supported by the Substance Abuse and Mental Health Services Administration also tracks drug use in populations aged 12 and older. Both surveys (MTF and NSDUH) indicate that disturbing patterns in overall drug use are still evident.

• An estimated 19.5 million Americans aged 12 or older were current users of an illicit drug in 2003. This estimate represents 8.2 percent of the population.²
  
• Over half (51%) of America’s teenagers have tried an illicit drug by the time they finish high school.¹
  
• An estimated 71 million Americans reported being current users of a tobacco product in 2003, a prevalence rate of 30% for the population 12 years and older.²
  
• Marijuana is the most widely used illicit substance in this country. In 2003, 14.6 million people were current users of marijuana.²
  
• For the second year in a row inhalant use has increased in 8th graders with 17.3% reporting use at least once in their lifetime. These drugs are particularly dangerous because they can damage the nervous system even after a single use, and they can be fatal.

Reference Cards : Hematology Lab Differentials

http://www.med-ed.virginia.edu/pda/refcards/HemLab/index.htm

All basic info about lab values.

Antibiotic dosing in CRRT patients

Continuous renal replacement therapy or CRRT is frequently used to treat patients with acute renal failure or chronic renal failure.

Ref: University of Pennsylvania Health System - Renal Electrolyte and Hypertension Division
http://www.uphs.upenn.edu/renal/important%20pdf%20II/CRRT%20antibiotic%20dosing.pdf

UCSF: Infectious Diseases Management Program

Updated antimicrobial guideline in Adults, Pediatrics.
Latest updated 03/06/09

Very good for quick reference. Click Here

The Heart dot Org - part of WebMD

contains anything from ACS, HTN, HF to surgery guideline
plus related news update quite often

http://www.theheart.org/

good for practical guidelines and cool Video CME lectures

U of Penn - Department of Medicine - Educational Resources

http://www.uphs.upenn.edu/medicine/education/residents/educationalResources/index.html [not working]
http://pennfm.pbworks.com/Intern-Survival-Guide

Intern Survival Guide
Clinical Guidelines
Textbooks and Journals
Other Links


2006

L-Carnitine in VPA overdose

L-carnitine supplementation is recommended for patients with CNS depression, evidence of hepatic dysfunction, and hyperammonemia with dosing ranging from 50 to 100 mg/kg/day up to a maximum dose of 2 g/day.
L-carnitine's mechanism of action is thought to be related to its ability to decrease elevated ammonia levels, which may contribute to development of coma in VPA toxicity. Its use remains investigational but can be considered in patients (such as ours) with coma, elevated ammonia levels, and hepatic dysfunction.[1] In our patient, we elected to start her on L-carnitine at 100 mg/kg/day in an attempt to correct her hyperammonemia and encephalopathy. This therapy was continued until her serum ammonia and VPA levels had normalized.

Other Tx for VPA overdose;
Supportive, naloxone, hemodialysis, hemoperfusion

Ref: Medscape
http://www.medscape.com/viewarticle/445062_print

Notes from Dr. RW

http://doctorrw.blogspot.com/
A hospitalist from Akansas - good blog for interesting med related news summary/review/clinical trials ect.