:: Sindhu's Medical News ::
News
:: Tuesday, March 23, 2004 ::
Pavan Grover is THE HOTTEST MAN...No Doubt
:: Sindhu's Medical News @ 11:07 PM [+]
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Pavan Grover is THE HOTTEST MAN...No Doubt:: Friday, November 14, 2003 ::
ladies: dr. sanjay gupta has been featured in cosmo magazine since 1999 and has twice been named as one of people magazine's sexiest guys while being a medical correspondent for CNN, i do think that dr. grover will eventually become world famous just like sanjay should his career as an actor take off as well as his career as a writer.
:: Sindhu's Medical News @ 11:01 PM [+]
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:: Sindhu's Medical News @ 8:40 PM [+]
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="http://i.cnn.net/cnn/2002/HEALTH/parenting/08/19/school.anxiety.otsc/story.gupta3.jpg"
:: Sindhu's Medical News @ 8:27 PM [+]
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http://i.cnn.net/cnn/2002/HEALTH/diet.fitness/10/30/gupta.fat.gene.otsc/story.gupta.gif:: Saturday, September 27, 2003 ::
:: Sindhu's Medical News @ 8:05 PM [+]
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preventing organ rejection continued:: Friday, September 26, 2003 ::
mycophenolate motefil (cellcept) http://www.rocheusa.com/products/cellcept/pi.pdf
used in combination with cyclosporine and glucocorticoids.
major adverse effects include diarrhea, severe neutropenia, vomiting and sepsis.
associated with an increased risk of infection and malignancies.
absorption is decreased by the use of magnesium and aluminum antacids and by cholestyramine (questran, prevalite)
contraindicated in pregnancy.
muromonab-CD3 (orthoclone OKT3) http://www.orthobiotech.com/pdfs/okt3.pdf
used to prevent acute allograft rejection of kidney transplants
adverse reactions include fever, chills, dyspnea, chest pain and nausea and
vomiting.
antithymocyte globulin (atgam) http://www.pfizer.com/download/uspi_atgam.pdf
used to prevent rejection of renal transplants
usually administered with glucocorticoidss and azathioprine
adverse reactions include chills, fever, leukopenia, and skin reactions.
:: Sindhu's Medical News @ 2:31 PM [+]
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preventing organ rejection continued
dacliximab (zenapax) http://www.rocheusa.com/products/zenapax/pi.pdf
basiliximab (simulect) http://www.pharma.us.novartis.com/product/pi/pdf/simulect.pdf
used to prevent acute rejection of transplanted kidneys
used in combination iwth other immunosuppressants such as cyclosporine and glucocorticoids
administered by the IV route
contraindicated in the client with an allergy to protein
dacliximab (zenapax)
initial dose administered within 24 hours before transplanation
side effects include chest pain, GI distress, edema, shortness of breath, pain in the joints, and slow wound healing.
basiliximab (simulect)
initial dose administered within 2 hours before transplantation
side effects are similar to those of zenapax; additionally, headache, insomnia, dizziness can occur.
:: Sindhu's Medical News @ 6:56 PM [+]
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anticoagulants
oral anticoagulants
anisinidione (miradon) http://www.rxlist.com/cgi/generic/miradon.htm
warfarin sodium (coumadin) http://www.rxlist.com/cgi/generic/warfarin.htm
parenteral anticoagulants
ardeparin (normiflo) http://www.drugdigest.org/DD/DVH/Uses/0,3915,46%7CNormiflo+%252D+No+longer+available,00.html
dalteparin (fragmin) http://www.rxlist.com/cgi/generic2/daltep_cp.htm
danaproid (orgaran) http://www.orgaran.com/
enoxaparin (lovenox) http://www.lovenox.com/
description
prevent the extension and formation of clots by inhibiting factors in the clotting cascade and decreasing blood coaguability
used for thrombosis, pulmonary embolism, and myocardial infarction (MI)
contraindicated with active bleeding, except for disseminated intravascular coagulation (DIC), bleeding disorders or blood dsycrasias, ulcers, liver, and kidney disease and spinal cord or brain injuries
side effects
hemorrhage
hematuria
epitaxis
ecchymosis
bleeding gums
thrombocytopenia
hypotension
:: Sindhu's Medical News @ 6:16 PM [+]
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heparin sodium (liquaemin sodium)
description
prevents thrombin from converting fibrinogen to fibrin
prevents thromboembolism
the therapeutic dose does not dissolve clots, but prevents new thrombus formation
blood levels
normal activated partial thromboplastin time (APTT) is 20 to 36 seconds
maintain APTT at 1.5 to 2.5 times normal
at therapeutic levels, heparin will increase the APTT by a factor of 1.5 to 2
APTT therapy shuld be measured every 4 to 6 hours during initial therapy, then on a daily basis
if the APTT is too long -- more than 80 seconds--the dosage should be lowered
if aPTT is too short-- less than 60 seconds-- the dosage should be increased
normal clotting time is 8 to 15 minutes; maintain the clotting time at 15 to 20 minutes
implementation
monitor clotting time and APTT
monitor platelet count
observe for bleeding gums, bruises, nosebleeds, hematuria, hematemesis, occult blood in the stool and petechiea
when administering heparin subcutaneously, inject into the abdomen using a small needle (25 to 28 gauage) at a 90 degree angle and do not aspirate or rub the injection site
instruct the client regarding measures to prevent bleeding
antidote:protamine sulfate
:: Sindhu's Medical News @ 5:58 PM [+]
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anticoagulants
decreases prothrombin activity and prevents the use of vitamin K by the liver
used for long term anticoagulation
prolongs clotting time and is monitored by prothrombin time
used mainly to prevent thromboembolytic conditions such as thrombophlebitis, pulmonary embolism, and embolism formation caused by atrial fibrillation, thrombosis, myocardial infarction, or heart valve damage.
usually given for 2 to 3 months after an MI to decrease the incidence of deep vein thrombosisi and thromboembolism.
blood levels
average PT is 9.6 to 11.8 seconds
warfarin sodium prolongs the PT
international normalized ratio (INR)
the normal INR is 1.3 to 2.0
the INR is determined by multiplying the observed PT ratio (the ratio of the client's PT to a control PT) by a correction factor specific to a particular thromboplstin preparation used in the testing.
the treatment goal is to raise the INR to an appropriate value
an INR of 2 to 3 is appropriate fo rmost clients, although for some clients, the target INR is 3.0 to 4.5
if the INR is below the recommended level, warfarin sodium dose should be increased.
if the INR is above the recommended range, warfarin sodium dose should be reduced.
implementation
monitor PT and INR
observe for a bleeding gums, bruises, nosebleeds, hematuria, hematemesis, occult blood in the stool in the petechiae
instruct the client regarding measures to prevent bleeding
antidote: vitamin K phytonadione (aquamephyton)
:: Sindhu's Medical News @ 5:46 PM [+]
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thromboembolytic medications:: Monday, September 22, 2003 ::
alteplase (activase, TPA, tissue plasminogen activator) http://www.gene.com/gene/products/information/cardiovascular/activase/index.jsp
anistrepteplase (eminase) http://www.drugdigest.org/DD/DVH/Uses/0,3915,6027%7CEminase,00.html
reteplase (retavase) http://www.retavase.com/retavase_pi.pdf
streptokinase (kabikinase, streptase) http://www.drugdigest.org/DD/DVH/Uses/0,3915,6238%7CKABIKINASE,00.html
urokinase (abbokinase) http://www.abbotthosp.com/prod/pdf/abbo.pdf
description
activate plasminogen; plasminogen generates plasmin (the enzyme that dissolves clots)
used early in the course of myocardial infarct (within 4 to 6 hours of the onset of the infarct) to restore blood flow, limit myocardial damage, preserve left ventricular function and prevent death.
contraindications
active internal bleeding
history of cerebrovascular accidents
intracranial problesm
intracranial surgery or trauma within the two previous months
history of thoracic, pelvic or abdominal surgery in the previous ten days.
history of hepatic or renal disease.
uncontrolled hypertension
recently required, prolonged cardiopulmonary resuscitation.
side effects
bleeding
dysrhythmias
fever
allergic reactions
implementation
obtain APTT, PT, fibrinogen level, hematocrit, and platelet count.
monitor vital signs
assess pulses
monitor for bleeding
monitor all excretions for occult blood.
monitor for neurological changes usch as slurred speech, lethargy, confusion and hemiparesis.
monitor for hypotension and tachycardia
avoid injections if possible
apply direct pressure over a puncture site for 20 to 30 minutes
handle teh client as little as possible when moving
instruct teh client to use an electric razor for shaving and to brush teeth gently.
:: Sindhu's Medical News @ 2:00 AM [+]
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antiplatelet medications
abciximab (ReoPro) http://pi.lilly.com/reopro.pdf
aspirin (acetylsalicylic acid, ASA) http://www.nursespdr.com/members/database/ndrhtml/acetylsalicylicacid.html
clopidrogel bisulfate (plavix) http://www.sanofi-synthelabous.com/products/pi_plavix/pi_plavix.html
eptifibatide (integrilin) http://www.millennium.com/images/INTEGRILIN(r)insert.pdf
ticlopidine Hydrochloride (ticlid) http://www.rocheusa.com/products/ticlid/pi.pdf
description
inhibits the aggregation of platelets in teh clotting process, thereby prolonging the bleeding time.
may be used in conjunction with anticoagulants
used in the prophylaxis of long term complications after MI, coronary revascularization and CVAs.
contraindicated in bleeding disorders and known sensitivity.
side effects
gastrointestinal bleeding
bruising
hematuria
tarry stools
implementation
determine sensitivity before administration
monitor vital signs
instruct teh client to take medication with food if GI upset occurs
monitor bleeding time
monitor for side effects related to bleeding
instruct the client in the use of the medication
instruct the client to monitor for side effects related to bleeding and in the measures to prevent bleeding.
:: Sindhu's Medical News @ 6:17 PM [+]
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positive inotropic/cardiotonic medications
amrinone (inocor):- used for short term managment of congestive heart failure in those who have not responded adequately to cardiac glycosides, diuretics, and vasodilators
http://www.drugs.com/xq/cfm/pageID_0/htm_001901/type_pros/bn_Inocor/micrpro_medex/qx/index.htm
milrinone (primacor):- used for short term management of congestive heart failure or may be given before heart transplantation.
http://www.primacor.com/
description
stimulates myocardial contractility and produces a positive inotropic effect
the increase in myocardial contractility increases cardiac, peripheral and kidney functions by increasing cardiac output, decreasing preload, improving blood flow to the periphery and kidneys, decreasing edema, and increasing fluid excretion; as a result, fluid retention in the lungs and extremities is decreased.
side effects
dysrhythmias
hypotension
thrombocytopenia
adverse reactions
hepatoxicity manifested by elavated liver enzyme levels
hypersensitivity manifested by wheezing, shortness of breath, pruritis, urticaria, clammy skin, and flushing.
implementation
monitor apical pulse and blood pressure
monitor for hypersensitivity
check lung sounds for wheezing and rales
monitor for edema
monitor for relief of congestive heart failure as noted by reduction in edema, lessening of dyspnea, orthopnea and fatigue
monitor electrolytes, liver enzymes, platelet count, and renal function studies, may decrease potassium and increase liver enzymes.
:: Sindhu's Medical News @ 4:54 PM [+]
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cardiac glycosides:: Wednesday, September 17, 2003 ::
digoxin (lanoxin, lanoxicaps) http://www.rxlist.com/cgi/generic/dig.htm
digitoxin (crystodigin) http://www.usadrug.com/IMCAccess/ConsDrugs/Digitoxincd.shtml
description
inhibit sodium potassium pump, thereby increasing intracellular calcium, which causes the heart muscle fibers to contract more efficiently.
produces a positive inotropic action, which increases teh force of myocardial contractions
produces a negative chronotropic action which depresses the sinoatrial node (SA), reduces conduction of the impulse through the atrioventricular (AV) node, and slows the heart rate.
produces a negative dromotropic action that decreases the condution of the heart cells.
the increase in myocardial contractility increases cardiac, peripheral, and kidney functions by increasing cardiac output, decreasing preload, and improving blood flow to the periphery and kidneys, decreasing edema, and increasing fluid excretion, as a result; fluid retention in the lungs and extremities is decreased.
used for CHF, atrial tachycardia, atrial fibrillation, and atrial flutter
contraindicated in ventricular dysrhythmias and second or third degree heart block
used with caution in clients with renal disease, hypothyroidism, and hypokalemia
side effects
anorexia, nausea vomiting,
headache
visual disturbances:-diplopia, blurred vision, yellow-green halos
photophobia
drowsiness
bradycardia
fatigue, and weakness
implementation
monitor for toxicity as evidenced by anorexia, nausea, vomiting, visual disturbances, confusion, bradycardia, heart block, premature ventricular contractions (PVCs), and tachydysrhythmias
monitor serum digoxin level, electrolyte balances and renal function tests
therapeutic digoxin range is 0.5 to 2.0 mg/ml and levels above 2.0 are toxic.
:: Sindhu's Medical News @ 4:13 PM [+]
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thiazide diuretics:: Tuesday, September 16, 2003 ::
bendroflumethiazide (naturetin) htttp://www.drugdigest.org/DD/DVH/Uses/0,3915,6343%7CNadolol+and+Bendroflumethiazide,00.html
benzthiazide (exna) http://www.usadrug.com/IMCAccess/ConsDrugs/Benzthiazidecd.shtml
chlorothiazide (diuril) http://www.merck.com/product/usa/pi_circulars/d/diuril/diuril_orlsus_pi.pdf
hydrochlorothiazide (hydrodiuril) http://www.drugdigest.org/DD/DVH/Uses/0,3915,325%7CHydroDIURIL,00.html
hydroflumethiazide (saluron, diucardin) http://www.pharmacynetworkgroup.com/d/diucardin-description.htm
methyclothiazide (aquatensen, enduron) http://www.drugdigest.org/DD/DVH/Uses/0,3915,435%7CAquatensen,00.html
polythiazide (renese) http://www.pharmacynetworkgroup.com/d/renese-description.htm
thiazide like diuretics
chlorthalidone (hygroton, thalitone) http://www.pharmacynetworkgroup.com/i/hygroton-indications-dosage.htm
indapamide (lozol) http://www.pharmacynetworkgroup.com/d/lozol-description.htm
metolazone (zaroxolyn) http://www.drugdigest.org/DD/DVH/Uses/0,3915,445%7CZaroxolyn,00.html
quinethazone (mykrox, hydromox) http://www.usadrug.com/IMCAccess/ConsDrugs/Quinethazonecd.shtml
description
increased sodium and water excretion by inhibiting sodium reabsorption in the distal tubule of the kidney.
used for hypertension and peripheral edema.
used in clients with normal renal function
not effective for immediate diuresis
contraindicated in renal failure
used with caution in the client taking lithium because lithium toxicity can occur
used in caution in the client taking digoxin, corticosteroids, and hypoglycemic medications
side effects
hypercalcemia, hyperglycemia, hyperuricemia
hypokalemia, hyponatremia
hypovolemia
hypotension
headaches
nausea, vomiting
constipation
rashes
photosensitivity
blood dyscrasias
implementation
monitor vital signs
monitor weight
monitor urine output
monitor electrolytes, glucose, calcium and uric acid levels
check peripheral extremities for edema
instruct the client to take medication in the morning to avoid nocturia and sleep interruption
instruct the client how to record the BP
instruct the client to eat foods rich in potassium
instruc the client on how to take potassium supplements if prescribed
instruct the client to take medication with food to avoid GI upset
instruct the client to change positions slowly to prevent orthostatic hypotension
instruct the client to use sunscreen when in direct sunlight
instruct the client with diabetes mellitus to have the blood glucose checked periodically.
:: Sindhu's Medical News @ 8:07 PM [+]
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loop diuretics
furosemide (lasix) http://www.aventis-us.com/PIs/lasix_TXT.html#
bumetanide (bumex) http://www.rocheusa.com/products/bumex/pi.pdf
torsemide (demadex) http://www.rocheusa.com/products/demadex/pi.pdf
ethacrynic acid (edecrin) http://www.merck.com/product/usa/pi_circulars/e/edecrin/edecrin_pi.pdf
description
inhibit sodium and chloride reabsorption from the loop of henle and the distal tubule
they have little effect on the blood glucose; however, they cause marked depletion of water and electrolytes, increased uric acid levels, and cause the excretion of calcium
are more potent than the thiazide diuretics causing rapid diuresis thus decreasing vascular fluid volume, decreasing cardiac output and blood pressure.
used for hypertension, edema associated with CHF, hypercalcemia, and renal disease,
used with caution in the client taking digoxin and lithium
used with caution in the client taking aminoglycosides, anticoagulants, corticosteroids, and amphoterecin B
side effects
hypokalemia, hyponatremia, hypocalcemia, hypomagnesemia
hypochloremia
thrombocytopenia
hyperuricemia
orthostatic hypotension
skin disturbances
ototoxicity and deafness
thiamine deficiency
dehydration
implementation
monitor vital signs
monitor weight
monitor urine output
monitor electrolytes, calcium, magnesium, and uric acid levels
check the peripheral extremities for edema
monitor for signs of digoxin and lithium toxicity if the client is on these medications
instruct the client to take the medicaiton in the morning to prevent nocturia and sleep disruption
instruct the client on how to record the BP
instruct the client to eat foods rich in potassium
instruct the client to take potassium supplements as prescribed
instruct the client to take medication with food to prevent GI upset
instruct the client to change positions slowly to prevent orthostatic hypotension
:: Sindhu's Medical News @ 6:43 PM [+]
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osmotic diuretics
mannitol (osmitrol) http://www.drugs.com/xq/cfm/pageID_0/brand_Mannitol/qx/index.htm
urea (ureaphil) http://www.drugs.com/xq/cfm/pageID_0/htm_001673/type_pros/bn_Ureaphil/micrpro_medex/qx/index.htm
description
increase osmotic pressure of the glomerular filterate, inhibiting reabsorption of water and electrolytes.
used for oliguria and to prevent renal failure
used to decrease intracranial pressure
used to decrease intraocular pressure in narrow angle glaucoma.
mannitol is used with chemotherapy to induce diuresis
side effects
fluid and electrolyte imbalances
pulmonary edema from the rapid shifts of fluid
nausea and vomiting
tachycardia from rapid fluid loss
hyponatremia and dehdyration
implementation
monitor vital signs
monitor weight
monitor urine output
monitor electrolyte levels
monitor lung and heart sounds for pulmonary edema
monitor for signs of dehydration
monitor neurological status
assess for signs of decreasing intracranial pressure if appropriate
change the client's position slowly to prevent orthostatic hypotension
:: Sindhu's Medical News @ 4:46 PM [+]
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carbonic anyhydrase inhibitors
acetazolamide (diamox) http://www.wyeth.com/content/ShowLabeling.asp?id=96
dichlorphenamide (daranide) http://www.drugdigest.org/DD/DVH/Interactions/0,10923,550569%7CDaranide,00.html
methazolamide (neptazane) http://www.wyeth.com/content/ShowLabeling.asp?id=120
description
block the action of the carbonic enzyme anyhydrase needed to maintain acid-base balance.
inhibition of this enzyme, carbonic anyhydrase, cause increased sodium, potassium, and bicarbonate excretion
metabolic acidosis can occur with prolonged use
used to decrease intraocular pressure in open angle (chronic) glaucoma, to produce diuresis, and produce epilepsy
used to treat metabolic alkalosis
contraindicated in narrow angle or acute glaucoma.
side effects
hyperglycemia, hyperuricemia, hypercalcemia
hypokalemia
anorexia, nausea, vomiting
orthostatic hypotension
renal calculi
hemolytic anemia.
implementation
monitor vital signs
monitor weight
monitor urine output
monitor electrolytes, glucose, calcium and uric acid levels
monitor mental status
instruct the client to monitor for signs of renal calculi
:: Sindhu's Medical News @ 3:41 PM [+]
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potassium sparing diuretics
spironolactone (aldactone) http://www.pfizer.com/download/uspi_aldactone.pdf
amiloride (midamor) http://www.merck.com/product/usa/pi_circulars/m/midamor/midamor_pi.pdf
triamterene (dyrenium) http://www.pharmacynetworkgroup.com/d/dyrenium-description.htm
amiloride hydrochloride and hydrochlorothiazide (moduretic) http://www.merck.com/product/usa/pi_circulars/m/moduretic/moduretic_pi.pdf
spironolactone and hydrochlorothiazide (aldactazide) http://www.pharmacynetworkgroup.com/d/aldactazide-description.htm
description
act on the distal tubule to promote sodium and water excretion and potassium retention
used for edema and hypertension; to increase urine output; to treat fluid retention and overload associated with CHF, hepatic cirrhosis, or nephrotic syndrome; and for diuretic induced hypokalemia.
contraindicated in severe kidney or hepatic disease or in severe hyperkalemia
used with caution in the client with diabetes mellitus
used with caution in the client taking antihypertensives and lithium.
used with caution in the client taking angiotensin converting enzyme inhibitors, because hyperkalemia can result
used with caution in the client taking potassium supplements
side effects
hyperkalemia
nausea, vomiting, diarrhea
rash
dizziness
headache
dry mouth
photosensitivity
anemia
thrombocytopenia
implementation
monitor vital signs
monitor urine output
monitor for signs and symptoms of hyperkalemia such as nausea, diarrhea, abdominal cramps, tachycardia followed by bradycardia, peaked narrow T wave on the electrocardiogram (ECG) or oliguria
monitor for a potassium level greater than 5.1 mEq/L which indicates hyperkalemia
instruct the client to avoid foods high in potassium
instruct teh client to avoid exposure to direct sun-light
instruct the client to monitor for signs of hyperkalemia
instruct the client to avoid salt substitutes because they contain potassium
instruct the client to take with or after meals to decrease GI irritation
:: Sindhu's Medical News @ 10:19 AM [+]
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peripherally acting alpha-adrenergic blockers
doxazosin mesylate (cardura) http://www.pfizer.com/download/uspi_cardura.pdf
prazosin (minipress) http://www.pharmacynetworkgroup.com/i/minipress-indications-dosage.htm
terazosin (hytrin) http://www.rxabbott.com/pdf/hytrin.PDF
guanadrel (hylorel) http://www.drugdigest.org/DD/DVH/Uses/0,3915,551674%7CHylorel,00.html
guanethidine (ismelin) http://www.pharmacynetworkgroup.com/i/ismelin-indications-dosage.htm
reserpin (serpasil) http://www.drugdigest.org/DD/DVH/HowToTake/0,3919,591%7CSerpasil,00.html
phenoxybenzamine (dibenzyline) http://www.drugdigest.org/DD/DVH/Uses/0,3915,538%7CDibenzyline,00.html
phentolamine mesylate (regitine) http://www.pharmacynetworkgroup.com/d/regitine-description.htm
tolazoline (priscoline) http://www.drugs.com/xq/cfm/pageID_0/htm_001658/type_pros/bn_Priscoline/micrpro_medex/qx/index.htm#citec00165809
description
decrease sympathetic vasoconstriction by reducing the effects of norepinephrine at peripheral nerve endings, resulting in vasodilation and decreased BP.
used to maintain renal blood flow
used to treat hypertension.
side effects
orthostatic hypotension
reflex tachycardia
sodium and water retention
GI disturbances
nasuea
vomiting
edema
weight gain
serpasil can cause depression, GI irritation, and impotence.
implementation
monitor vital signs
monitor for fluid retention and edema
instruct the client to change positions slowly to prevent orthostatic hypotension
instruct teh client how to monitor the BP
instruct the client to monitor for edema
instruct the client to decrease salt intake
instruct the client to avoid over the counter medications
:: Sindhu's Medical News @ 9:50 AM [+]
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