Term
Appetite Suppressants (can cause Pulmonary Hypertension) |
|
Definition
Fenfluramine; Dexfenfluramine |
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|
Term
Drugs that cause pulmonary hypertension |
|
Definition
Fenfluramine, Dexfenfluramine, L-tryptophan, Methamphetamine, Cocaine |
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|
Term
Treatment of underlying heart disease (Left heart disease) for PH |
|
Definition
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|
Term
Anticoagulation (PH: idiopathic, heritable, PAH due to anorexigens and chronic thromboembolic type) |
|
Definition
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|
Term
Manage right ventricular volume overload (PH) |
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Definition
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|
Term
Goal is saturation above 90%; Primary/Supportive Therapy in PH |
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Definition
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|
Term
Patients with PAH who develop atrial tachyarrhthmias |
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Definition
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|
Term
Used for vasoreactivity testing (PH) |
|
Definition
Inhaled nitrous oxide, IV epoprostenol, IV adenosine |
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|
Term
CCB: primarily affects arteriolar vasculature, due to gradual onset reflex tachycardia does not occur |
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Definition
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|
Term
CCB: dilation of pulmonary and systemic arteries, decreased peripheral resistance, systemic BP, and afterload; increased pulmonary flow |
|
Definition
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|
Term
Used if positive acute vasoreactivity test (PH) |
|
Definition
Long acting nifedipine, diltiazem, amlodipine |
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|
Term
CCB: primarily affects arteriolar vasculator; only use long acting formulations in PH |
|
Definition
Nifedipine (Procardia XL) |
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|
Term
Common side effects include headache, flushing, hypotension, peripheral edema, constipation |
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Definition
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|
Term
Serious Side effects include hypotension, syncope, right ventricular failure |
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Definition
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|
Term
Block receptors that cause vasoconstriction and smooth muscle cell proliferation |
|
Definition
Endothelin Receptor Antagonists |
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|
Term
ERAs: treatments of PAH to improve exercise capacity and decrease the rate of clinical deterioration |
|
Definition
Ambrisentan (Letairis), Bosentan (Tracleer) |
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|
Term
Selective for endothelin-A receptor |
|
Definition
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|
Term
Nonselective endothelin receptor antagonist (A and B) |
|
Definition
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|
Term
Adverse reactions include edema, palpitation/flushing, HA, hemoglobin decrfease, hepatotoxicity, transaminases increase, respiratory tract congestion/infection |
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Definition
Endothelin Receptor Antagonists |
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Term
Adverse Reaction (25%): Spermatogenesis inhibition |
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Definition
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|
Term
Pregnancy is a major contraindication with use of these drugs |
|
Definition
Endothelin Receptor Antagonists |
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|
Term
Only available through the Letairis Education and Access Program (LEAP) |
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Definition
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|
Term
Only available through the T.A.P. |
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Definition
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|
Term
The serum concentration of it is decreased if combined with Bosentan |
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Definition
Conctraceptives (Estrogens and Progestins) |
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|
Term
May increase the serum concentration of Bosentan and it's serum concentration may also be decreased |
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Definition
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|
Term
May enhance hepatotoxic effect of Bosentan |
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Definition
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|
Term
Avoid these if using Bosentan |
|
Definition
Contraceptives, Cyclosporine, Glyburide |
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|
Term
Phosphodiesterase-5 Inhibitors used in PH |
|
Definition
Sildenafil (Revatio), Tadalafil (Adcirca) |
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|
Term
responsible for the degradation of cGMP |
|
Definition
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|
Term
increased concentrations of this results in pulmonary vasculature relaxation; vasodilation in the pulmonary bed and the systemic circulation (to a lesser degree) may occur |
|
Definition
cyclic guanosine monophosphate (cGMP) |
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|
Term
Prolong the vasodilatory effect of nitric oxide |
|
Definition
phosphodiesterase-5 inhibitors |
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|
Term
Treatment of pulmonary arterial hypertension (WHO Group I) to improve exercise ability and delay clinical worsening |
|
Definition
Sildenafil (Revatio), Tadalafil (Adcirca) |
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|
Term
Taken orally once daily; may need dosing adjustments with CYP 3A4 inhibitors |
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Definition
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|
Term
Adverse Reactions include HA, Dyspepsia, Flushing, Pyrexia, dizziness, diarrhea, UTI, increased LFTs, myalgia, paresthesia, abnormal vision, epistaxis, nasal congestion |
|
Definition
PDE-5 Inhibitors (Sildenafil and Tadalafil) |
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|
Term
|
Definition
Epoprostenol, Treprostinil, Iloprost |
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|
Term
Strong vasodilator of all vascular beds; decreases thrombogenesis by inhibiting platelet aggregation |
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Definition
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|
Term
Used IV; avoid abrupt withdrawal or sudden large dose reductions (PH) |
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Definition
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|
Term
Used IV, SubQ, or Inhalation (PH) |
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Definition
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|
Term
|
Definition
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|
Term
Adverse Reactions include anxiety, diarrhea, flu-like syndrome, flushing, HA, jaw pain, N/V, nervousness, pump malfunction, local sit infection, catheter obstruction, sepsis |
|
Definition
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|
Term
Contraindicated in pts with severe left ventricular systolic dysfunction; pts who develops pulmonary edema during dose initiation |
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Definition
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|
Term
Epoprostenol Drug Interactions |
|
Definition
Anticoagulatns and antiplatelets; Antihypertensives |
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|
Term
Preferred Agents WHO Class II (PH) |
|
Definition
Ambrisentan, Bosentan, Sildenafil |
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|
Term
Alternative Agents WHO Class II (PH) |
|
Definition
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|
Term
Preferred Agents WHO CLASS III (PH) |
|
Definition
Ambrisentan, bosentan, Sildenafil, IV Epoprostenol, IV or SubQ Treprostinil, Inhaled Iloprost |
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|
Term
Alternative Agents WHO CLASS III (PH) |
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Definition
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|
Term
Preferred Agents WHO CLASS IV (PH) |
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Definition
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|
Term
Alternative Agents WHO CLASS IV (PH) |
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Definition
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|
Term
Preferred Agents Refractory Cases (PH) |
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Definition
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|
Term
Anticholinergic Agent; Duration 4-6 hours (COPD) |
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Definition
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|
Term
Anticholinergic; DPI: Duration 24 hours; may be steroid sparing |
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Definition
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|
Term
Beta2Agonists; Combination Inhalers (COPD) |
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Definition
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|
Term
Risks may outweigh benefits (COPD); Increases clearance of smoking, phenytoin, Rifampin |
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Definition
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|
Term
Theophylline decreases clearance |
|
Definition
erythromycin, quinolones, beta-blockers, CCBS |
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|
Term
Indicated for Stage III-IV disease, frequent exacerbations (COPD) |
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Definition
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|
Term
PD4 Inhibitor; small decrease in rate of exacerbation (COPD) |
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Definition
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|
Term
ADRs include N/V, weight loss, psychiatric effects |
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Definition
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|
Term
Respiratory Stimulant (COPD) |
|
Definition
Medroxyprogesterone acetate |
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|
Term
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Definition
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|
Term
VTE prophylaxis (Pulmonary embolism in COPD) |
|
Definition
Heparin, Enoxaparin, Fondaparinux |
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|
Term
Drugs that energize the heart |
|
Definition
epinephrine, atropine, vasopressin, digoxin |
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|
Term
most important drug (ACLS); A1, A2, B1, and B2 receptor agonist |
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Definition
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|
Term
Natural: nightshade; jimsonweed |
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Definition
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|
Term
increased SA node discharge; nerve gas/organophosphate antidote |
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Definition
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|
Term
Promotes kidney water absorption; vasoconstriction and increased BP |
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Definition
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|
Term
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Definition
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|
Term
slows heart but increases contractility; Na/K pump inhibitor --> increased calcium |
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Definition
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|
Term
Anti-arrhythmic drugs (ACLS) |
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Definition
lidocaine; amiodarone; procaine amide |
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|
Term
blocks sodium channels in neuron cell membrane; no action potential propagation |
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Definition
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|
Term
Toxicity: initial CNS excitation.... seizure; higher dosage CNS depression (ACLS) |
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Definition
Lidocaine (amide anesthetic) |
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Term
prolongs refractory period; blocks potassium channels |
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Definition
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|
Term
Side effects: interstitial lung disease; thyroid, eye, and skin changes (ACLS) |
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Definition
Amiodarine (antiarrythmic) |
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Term
ester agent breakds down PABA; blocks nerve impulses; decreases hearat irritability |
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Definition
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|
Term
Anti-ischemic drugs (ACLS) |
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Definition
Nitroglycerin, morphine, oxygen |
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Term
vasodilator (veins > arteries); 24 hour use causes tolerancce |
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Definition
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|
Term
mimics endorphins; dilates blood vessels |
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Definition
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|
Term
|
Definition
Aspirin, thrombolytics, Plavix, GIIB/IIA inhibitors |
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|
Term
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Definition
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|
Term
Blocks formation of thromboxane A which causes platelets to aggregate and arteries to constrict |
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Definition
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|
Term
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Definition
tPA, reteplase, streptokinase, tenecteplase |
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Term
protein that breaks down blood clots; enzyme converts plasminogen to plasmin |
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Definition
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|
Term
Irreversible bind to P2Y. Prevents platelet aggregation and cross linkage |
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Definition
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|
Term
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Definition
Glycoprotein IIB/IIIA Inhibitors |
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Term
Glycoprotein IIB/IIIA Inhibitors |
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Definition
Abciximab (irreversible); Eptifibatide/Tirofiban (reversible) |
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|
Term
Drugs to decrease blood pressure (ACLS) |
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Definition
BBs, Furosemide, CCBs, Nitroprusside, ACEIs |
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|
Term
does not cross BBB: test anxiety |
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Definition
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|
Term
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Definition
Metoprolol, Atenolol, Propranolol, Esmolol, Labetalol |
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|
Term
Blocks Na/K/Cl symporter in ascending loop of Henle |
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Definition
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|
Term
|
Definition
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|
Term
Calcium channel blockers used in ACLS |
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Definition
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|
Term
Vasodilator/AV block; decrease contractility and heart rate; danger with BB; somewhere reverse with calcium |
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Definition
Calcium Channel Blockers (Diltizem/Verapamil) |
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|
Term
potent dilator of veins an arteries; breaks down to cyanide |
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Definition
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|
Term
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Definition
Enalapril, Captopril, Lisinopril, Ramikpril |
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|
Term
Drugs that increase BP (ACLS) |
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Definition
Dopamine, Dobutamine, Isoproterenol, Norepinephrine |
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|
Term
Neurotransmitter; increases HR and BP |
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Definition
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|
Term
Stimulate heart (B1); less increase BP (pressor) |
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Definition
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|
Term
Increases heart rate (pressor) |
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Definition
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|
Term
more alpha stimulus; increase vascular resistance; septic or neurogenic shock (Pressor) |
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Definition
Norepinephrine (Levophed) |
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|
Term
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Definition
Naloxone, Flumazenil, Glucagon |
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|
Term
Blocks opiate receptors; half life shorter than most opiates; can cause sudden withdrawal |
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Definition
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|
Term
competitive inhibitor or gamma amino butyric acid (GABA); can't treat seizures with benzodiazepine; can cause withdrawal and short half life |
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Definition
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|
Term
opposite of insulin; releases glucose from liver glycogen; from the alpha islets of langerhans |
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Definition
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|
Term
increases cyclic AMP in heart which reverses effects of beta blocker and calcium channel blockers; also relaxes LES |
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Definition
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|
Term
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Definition
Electrolytes, adenosine, mannitol |
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Term
used in Torsades de pointes; blocks calcium entry into cells shortening QT interval; bronchodilator; relaxes uterus/eclampsia |
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Definition
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|
Term
reverses acidosis and helps with the toxicity of TCA/ASA (either by binding or urinary excretion) |
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Definition
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|
Term
Multiple receptors; blocks AV node and re-entrant SVT; caffeine blocks same receptors-- blunts effect |
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Definition
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|
Term
filtered by glomeruli but not reabsorbed; osmotic diuresis; decreased intracranialpressure |
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Definition
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|
Term
Natural sugar alcohol... biblical manna |
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Definition
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|
Term
Solubilizes cholesterol and decreases cholesterol secretion into bile; Used for Radiolucent (cholesterol) stones |
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Definition
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|
Term
Side effects include GI complaints, increased serum cholesterol, increased AST/ALT |
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Definition
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|
Term
Management for Cholangitis |
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Definition
Fluid + electrolyte replacement; pain management; ERCP; antibiotics |
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|
Term
Treatment of choice for many cases of acute cholecystitis |
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Definition
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|
Term
Management for Cholecystitis |
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Definition
Fluid + electrolyte replacement; pain management; cholecystectomy, "cool down" period; antibiotics |
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Term
mild-moderate choleccystitis: |
|
Definition
Cefazolin; Cefuroxime; Ceftriaxone; Duct anastomosis: (Clostridium Bacteroides) add Metronidazole |
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Term
severe, advanced age, immunocompromised cholecystitis |
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Definition
Imipenem/Mero/Dori/Pip-Tazo/cefepime/Levo/Cipro; each in combination with Metro |
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|
Term
associated biliary sludge; usually occurs > 9 days |
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Definition
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|
Term
healthcare-associated biliary infection |
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Definition
same as severe cholecystitis; add vancomycin |
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|
Term
Drug induced pancreatitis (rare): Definite Association |
|
Definition
corticosteroids, furosemide, estrogens, opiates, SMX/TMP, valproic acid/salts |
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Term
Acute pancreatitis: 4-7 years of abuse |
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Definition
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|
Term
pain management in acute pancreatitis |
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Definition
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|
Term
Acute pancreatitis medical management |
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Definition
Decrease exocrine stimulation: D/C oral intake, nasal gastric suction, enteral feeding vs TPN; Pain management: Hydromorphone; ERCP; cholecystectomy if associated w/ gallstones |
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|
Term
Sphincter of Oddi preferred agent (potent + long half life; less clinical data) |
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Definition
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|
Term
|
Definition
Meperidine, Morphine, Hydromorphone |
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|
Term
Used in sphincter of oddi: causes seizures |
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Definition
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|
Term
increased common bile duct pressure |
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Definition
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|
Term
Acute Pancreatitis Supportive Therapy |
|
Definition
H2 blockers/PPIs; Octreotide |
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|
Term
reduce pancreatic exocrine secretion; no more effective than nasal gastric suction |
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Definition
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|
Term
0.5 mcg/kg/hr IV continuously; inhibits pancreatic secretion; conflicting clinical results; maybe in severe pancreatitis |
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Definition
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|
Term
Prophylactice use considered for necrotizing pancreatitis |
|
Definition
Imipenem; Meropenem; Doripenem |
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|
Term
malabsorption (S/S of chronic pancreatitis) |
|
Definition
decreased fat and protein absorption, weight loss, Vitamin B12 |
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|
Term
Pain control in chronic pancreatitis |
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Definition
Initially NSAIDs or APAP; Narcotics around the clock sustained release forms |
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|
Term
|
Definition
creon, pancreaze, pancrelipase, zenpep |
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|
Term
dosed based on lipase content; uncertain place in therapy (mild to moderate disease); supplementation of fat soluble vitamins |
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Definition
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|
Term
|
Definition
Aspartate transaminase (AST) |
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|
Term
|
Definition
Alanine transaminase (ALT) |
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|
Term
Normal: 40-120 U/L (varies with assay); also elevated in bone disorders, tumors |
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Definition
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|
Term
Normal: 0-50 U/L (Varies with assay); sensitivity about 70% EtOH liver disease |
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Definition
Glutamyl transpeptidase (GGT) |
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|
Term
Normal: 100-220 U/L (varies with assay); not specific: hemolysis, MI, trauma, cancer |
|
Definition
Lactate dehydrogenase (LDH) |
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|
Term
Drug induced liver disease |
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Definition
HMG-CoA inhibitors; Antimycobacterial agents (Isoniazid, Rifampin, Pyrazinamide), azoles; APAP and Alcohol; Phenytoin |
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Term
Medications causing centrolobular necrosis (liver disease) |
|
Definition
acetaminophen, halothane, aspirin, valproate |
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Term
Medciations causing Steatohepatitis |
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Definition
Alochol, tetracycline, valproate |
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Term
Medications that cause Phospholipidosis (liver disease) |
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Definition
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|
Term
Medications that cause Hepatocellular Necrosis (Liver disease) |
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Definition
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|
Term
Medications causing Toxic Cirrosis |
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Definition
Methotrexate, Vitamin A (high dose) |
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Term
Medications causing cholestatic injury |
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Definition
estrogens, chlorpromazine, amox-clav, erythromycin, SMX-TMP |
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Term
Medications causing liver vascular disorders |
|
Definition
androgens, estrogens, tamoxifen, azathioprine |
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|
Term
Treats Amebic liver disease |
|
Definition
Metronidazole 750 mg TID x 7-10 days |
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|
Term
Empiric therapy for pyogenic liver abscess |
|
Definition
broad spectrum antibiotics; piperacillin/tazobacta, carbapenems, 3rd or 4th gen ceph + metro, FQ + metro, 2-3 weeks IV then 2-3 weeks PO |
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|
Term
Normal serum peak 1.5-2 hrs; Overdose: up to 4 hours |
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Definition
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|
Term
Highly toxic---> hepatic necrosis; usually formed in small amounts |
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Definition
N-acetyl-p-benzoquinoneimine |
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|
Term
treatment of acute acetaminophen overdose |
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Definition
activated charcoal (if <4 hrs of ingestion); acetylcysteine |
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Term
reduces conversion of APAP to NAPQI (increased glutathione stores, combines directly with NAPQI, Increased nontoxic sulfate conjugation) |
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Definition
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|
Term
best if given within 24 hours of APAP overdose (<8 hrs ideal) |
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Definition
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|
Term
Adverse drug reactions include anaphylactoid reactions |
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Definition
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|
Term
Adverse drug reactions include nausea and vomiting |
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Definition
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|
Term
only given in low risk situations; (function GI tract and no evidence of hepatotoxicity); readmister if dose vomited w/in 1 hr |
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Definition
Oral acetylcysteine (mucomyst) |
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|
Term
moderate-high risk situations; evidence of hepatotoxicity or APAP overdose likely |
|
Definition
IV acetylcysteine (Acetadote) |
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|
Term
alcohol withdraw: reduce potential for seizures, titrate over 3-5 days |
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Definition
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|
Term
"banana bag" given in alcohol withdrawal |
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Definition
thiamine, magnesium, multivitamins, folic acid |
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|
Term
|
Definition
complication of thiamine (vitamin B1) deficiency |
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|
Term
Alcohol withdrawal: No metabolite, rapid onset, ok in liver insufficiency, higher abuse potential, more frequent |
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Definition
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|
Term
Alcohol withdrawal: rapid onset, less frequent dosing, accumulation, higher abuse potential |
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Definition
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|
Term
Alcohol withdrawal: intermediate onset, less frequent dosing, accumulation, PO only |
|
Definition
Chlordiazepoxide (Librium) |
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|
Term
Alcohol withdrawal Alternative Treatments |
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Definition
Barbiturates (Phenobarbital); Propofol; Anticonvulsants (Carbamazepine, gabapentin) |
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|
Term
Alcohol withdrawal Adjunctive treatments (rarely used) |
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Definition
Alpha 2 agonists (clonidine, dexmedetomidine); beta blockers (atenolol), haloperidol |
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|
Term
Hepatic impairment; Newer medications--> Child-Pugh score |
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Definition
Caspofungin, Voriconazole, Atomoxetine, Letrozole |
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|
Term
restricted drug distribution systems (RDDS) |
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Definition
Gefitinib, dofetilide, bosentan, iloprost, clozapine, buprenorphine tabs, cisapride, isotretinoin, lenalidomide, thalidomide |
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|
Term
drug-induced seizures: majority are singular events that occurred within 24 hrs after ingestion of toxic dose; of these, chronic use predisposed this group to seizure |
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Definition
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|
Term
often used to treat refractory status epilepticus; case reports some pts experienced EEG changes during induction, emergence and recovery from anesthesia |
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Definition
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|
Term
High incidence of seizures; pts with hyperventilation and hypocapnia predisposed |
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Definition
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|
Term
drug-induced seizures; incidence higher when used idn combo with other antibiotics |
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Definition
penicillins and carbapenems |
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|
Term
drug-induced seizures; renally dose adjusted, elderly |
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Definition
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|
Term
OD accounts for 40% of seizures in ER; incidence varies at therapeutic doses |
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Definition
Antidepressants (TCAs, Bupropion) |
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|
Term
highest incidence of older agents (drug-induced seiures)--- antipsychotics (dose dependent!) |
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Definition
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|
Term
highest risk of drug-induced seizures of atypical agents |
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Definition
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|
Term
Children at risk for ADHD inherently have higher risk for seizures |
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Definition
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|
Term
causes corneal deposits, halo vision, lens opacities, optic neuropathy |
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Definition
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|
Term
Causes corneal desposits, maculopathy, retinopathy, blurred vision, nyctalopia, oculogyric crisis |
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Definition
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|
Term
Cataracts, increased intraocular pressure, decreased vision, proptosis, mydriasis, myopia, optic neuropathy, papilledema, pseudotumor cerebri |
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Definition
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|
Term
corneal deposits, maculopathy, retinopathy |
|
Definition
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|
Term
blurred vision, diplopia, nystagmus |
|
Definition
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|
Term
blurred vision, color vision changes, increased brightness, NAION, reduced visual acuity, retinal vein occlusion, thrombosis |
|
Definition
Sildenafil, tadalafil, vardenafil |
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|
Term
formation of reactive oxygen species, loss of hair cells, loss of spiral ganglion (drug-induced ototoxicity) |
|
Definition
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|
Term
changes in mitochondrial function, direct cell death, decreased number of hair cells (drug-induced ototoxicity) |
|
Definition
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|
Term
disruption of endocochlear fluid homeostasis, endolymph changes (drug-induced ototoxicity) |
|
Definition
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|
Term
decreased cochlear blood flow (drug-induced ototoxicity) |
|
Definition
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|
Term
activation of NMDA receptors (drug-induced ototoxicity) |
|
Definition
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|
Term
rapid injection can cause ototoxicity |
|
Definition
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|
Term
Drug-induced bronchospasm: predominant in women, bronchospasm preceded by rhinorrhea, flushing of head and neck, conjunctivitis |
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Definition
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|
Term
IgE mediated anaphylaxis (drug-induced bronchospasm) |
|
Definition
penicillins, sulfonamides, cephalosporins |
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|
Term
drug induced bronchospasm; all have been associated with causing asthma attacks |
|
Definition
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|
Term
drug-induced bronchospasm: anaphylactoid mast cell degranulation |
|
Definition
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|
Term
drug-induced bronchospasm: bradykinin production |
|
Definition
ace inhibitor induced cough |
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|
Term
most widely reported non-cytotoxic drug to cause pulmonary fibrosis; unique molecular structure |
|
Definition
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|
Term
strong oxidizer of iron and oxygen; "bronchiolitis obliterans with organization pneumonitis (BOOP) |
|
Definition
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|
Term
Management pulmonary fibrosis |
|
Definition
discontinuation of offending agents; corticosteroids-- standard of therapy |
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|
Term
Fluid retention, increased vascular permeability, older age and advanced DM higher risk--> drug induced heart failure |
|
Definition
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|
Term
high incidence of drug-induced exacerbated HF; Amiodarone and Dofetilide have not shown to adversely affect survival of patients |
|
Definition
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|
Term
has been shown to adversely affect survival of pts with heart failure |
|
Definition
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|
Term
dependent on mean cumulative dose; generally considered irreversible; drug-induced heart failure |
|
Definition
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|
Term
drug-induced heart failure; antagonize action of diuretics and ace inhibitors |
|
Definition
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|
Term
drug-induced heart failure; long term therapy beneficial to heart failure pts--- start low, go slow |
|
Definition
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|
Term
drug-induced heart failure; more likely to occur in patients with lower EF; due ot strong negative inotropy |
|
Definition
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|
Term
treatment of acute HF exacerbations |
|
Definition
Diuresis; vasoactive medications in severe cases |
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|
Term
Hemodynamic mediated AKI: reduction of intravascular volume and effective hemodynamic pressures |
|
Definition
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|
Term
drug-induced hemodynamic mediated AKI; vasoconstriction of afferent arterioles |
|
Definition
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|
Term
Primary agents in drug-induced acute tubular necrosis |
|
Definition
aminoglycosides, radiocontrast media |
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|
Term
primary agents causing interstitial nephritis |
|
Definition
beta lactams, NSAIDs, rifampin, lithium, allopurinol, thiazide diuretics |
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|
Term
management of interstitial nephritis |
|
Definition
discontinuation of drug; administration of corticosteroids |
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|
Term
primary agents causing nephrolithiasis |
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Definition
acyclovir, forcarnet, furosemide, indinavir, topiramate, sulfonamides, zonisamide |
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Term
Management of Glomerulonephritis |
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Definition
discontinuation of drug, steroids and diuretics, dialysis |
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Term
Alternative agents for anticoagulation (if HIT) |
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Definition
lepirudin, argatroban, fondaparinux, bivalirudin |
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Term
direct thrombin inhibitor; considerations: renal dosing |
|
Definition
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|
Term
direct thrombin inhibitor; considerations: hepatic dosing; interference with INR |
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Definition
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|
Term
direct Xa inhibitors; considerations: renal dosing; still a heparnoid molecule |
|
Definition
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|
Term
direct thrombin inhibitor; considerations: renal dosing |
|
Definition
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|
Term
Can start when platelet count reaches 150,000; venous limb gangrene if used alone prior to platelet count reaching 150.000 |
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Definition
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