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Have an intubation kit at bedside if patient is not intubated Alprostadil keflex 500mg with amex, Urethral Suppository (Muse) COMMON USES: Erectile dysfunction ACTIONS: Alprostadil (PGE1) absorbed through urethral mucosa discount keflex 750 mg without a prescription. Portion of administered dose transported to the corpus cavernosa where it acts as vasodilator and smooth muscle relaxant DOSAGE: 125–1000 µg system 5–10 min prior to sexual activity SUPPLIED: 125 generic keflex 750mg amex, 250, 500, 1000 µg with a transurethral delivery system NOTES: Hypotension, dizziness, syncope, penile pain, and priapism. In AMI doses of >150 mg associ- ated with intracranial bleeding Altretamine (Hexalen) COMMON USES: Epithelial ovarian cancer ACTIONS: Unknown; cytotoxic agent, possibly alkylating agent; inhibits nucleotide incorporation into DNA and RNA DOSAGE: 260 mg/m2/d in 4 ÷ doses for 14–21 d of a 28-d treatment cycle; dose ↓ to 150 mg/m2/d for 14 d in multiagent regimens. Reduction of cumulative renal toxicity associated with repeated admin- istration of cisplatin ACTIONS: Prodrug, dephosphorylated by alkaline phosphatase to the pharmacologically active thiol metabolite DOSAGE: 910 mg/m2/d as a 15-min IV inf 30 min prior to chemotherapy SUPPLIED: Vials containing 500 mg of lyophilized drug with 500 mg of mannitol, reconstituted in sterile NS NOTES: Toxicity symptoms: Transient hypotension in >60%, nausea and vomiting, flushing with hot or cold chills, dizziness, hypocalcemia, somnolence, and sneezing. Does not reduce the effective- ness of cyclophosphamide plus cisplatin chemotherapy Amikacin (Amikin) COMMON USES: Serious infections caused by gram (−) bacteria and mycobacterial infections ACTIONS: Aminoglycoside antibiotic; inhibits protein synthesis DOSAGE: See also page 620. Toxicity symptoms: Nausea and vomiting, irritability, tachycardia, ventricular arrhythmias, and seizures; follow serum levels carefully (as theophylline, see Table 22–7, pages 631–634); aminophylline is about 85% theophylline; erratic absorption with rectal doses Amiodarone (Cordarone) (Pacerone) COMMON USES: Recurrent VF or hemodynamically unstable VT ACTIONS: Class III antiarrhythmic DOSAGE: Adults. Maintenance: 600–800 mg/d PO for 1 mo, then 200–400 mg/d IV: 15 mg/min for 10 min, followed by 1 mg/min for 6 h, then a maintenance dose of 0. En- cephalopathy possible; obtain aluminum levels, especially in renal insufficiency. Alum soln often precipitates and occludes catheters Amoxapine (Asendin) COMMON USES: Depression and anxiety ACTIONS: Tricyclic antidepressant; reduces reuptake of serotonin and norepinephrine DOSAGE: Initially, 150 mg PO hs or 50 mg PO tid; ↑ to 300 mg/d SUPPLIED: Tabs 25, 50, 100, 150 mg NOTES: ↓ in elderly; taper slowly when discontinuing therapy Amoxicillin (Amoxil, Polymox, others) COMMON USES: Infections resulting from susceptible gram (+) bacteria (streptococci) and gram (−) bacteria (H. Topical: Apply bid–qid for 1–4 wk depending on in- 22 fection 22 Commonly Used Medications 497 SUPPLIED: Powder for inj 50 mg/vial, oral susp 100 mg/mL, cream, lotion, oint 3% NOTES: Monitor renal function; hypokalemia and hypomagnesemia possible from renal wasting; pretreatment with acetaminophen and antihistamines (Benadryl) help minimize adverse effects as- sociated with IV infusion Amphotericin B Cholesteryl (Amphotec) COMMON USES: Refractory invasive fungal infection in persons intolerant to conventional ampho- tericin B ACTIONS: Binds to sterols in the cell membrane, resulting in changes in membrane permeability DOSAGE: Adults & Peds. Infuse at a rate of 1 mg/kg/h SUPPLIED: Powder for inj 50 mg, 100 mg/vial NOTES: Do NOT use in-line filter, final concentration 0. If inf >2 h, manually mix contents of the bag Amphotericin B Liposomal (Ambisome) COMMON USES: Refractory invasive fungal infection in persons intolerant to conventional ampho- tericin B ACTIONS: Binds to sterols in the cell membrane, resulting in changes in membrane permeability DOSAGE: Adults & Peds. Children >1 mo: 100–200 mg/kg/24h ÷ q4–6h IM or IV; 50–100 mg/kg/24h ÷ q6h PO up to 250 mg/dose. Meningi- tis: 200–400 mg/kg/24h ÷ q4–6h IV SUPPLIED: Caps 250, 500 mg; susp 100 mg/mL (reconstituted as drops), 125 mg/5 mL, 250 mg/ 5 mL, 500 mg/5 mL; powder for inj 125 mg, 250 mg, 500 mg, 1 g, 2 g, 10 g/vial NOTES: Cross-hypersensitivity with penicillin; can cause diarrhea and skin rash; many hospital strains of E. Low-dose: 1 million KIU load, 1 million KIU for the pump prime dose, followed by 250,000 KIU/h until surgery ends. Give all patients 1-mL IV test dose to assess for allergic reaction Ardeparin (Normiflo) COMMON USES: Prevention of DVT and PE following knee replacement ACTIONS: Low-molecular-weight heparin DOSAGE: 35–50 U/kg SC q12h. Joseph, others) COMMON USES: Mild pain, headache, fever, inflammation, prevention of emboli, and prevention of MI ACTIONS: Prostaglandin inhibitor DOSAGE: Adults. Tabs Fiorinal, Lanorinal, Marnal: Aspirin 325 mg/butalbital 50 mg/ caffeine 40 mg NOTES: Butalbital habit-forming Aspirin + Butalbital, Caffeine and Codeine (Fiorinal + Codeine) [C] COMMON USES: Mild pain; headache, especially when associated with stress ACTIONS: Sedative analgesic, narcotic analgesic DOSAGE: 1–2 tabs (caps) PO q4–6h PRN SUPPLIED: Each cap or tab contains 325 mg aspirin, 40 mg caffeine, 50 mg of butalbital, codeine: No. AMI: 5 mg IV ×2 over 10 min, then 50 mg PO bid if tolerated SUPPLIED: Tabs 25, 50, 100 mg; inj 5 mg/10 mL Atenolol and Chlorthalidone (Tenoretic) COMMON USES: HTN ACTION: β-Adrenergic blockade with diuretic DOSAGE: 50–100 mg/d PO SUPPLIED: Tenoretic 50: Atenolol 50 mg/chlorthalidone 25 mg; Tenoretic 100: Atenolol 100 mg/chlorthalidone 25 mg Atorvastatin (Lipitor) COMMON USES: Elevated cholesterol and triglycerides ACTIONS: HMG-CoA reductase inhibitor DOSAGE: Initial dose 10 mg/d, may be ↑ to 80 mg/d SUPPLIED: Tabs 10, 20, 40, 80 mg NOTES: May cause myopathy, monitor LFT regularly Atovaquone (Mepron) 22 COMMON USES: Rx and prevention mild to moderate PCP 22 Commonly Used Medications 501 ACTIONS: Inhibits nucleic acid and ATP synthesis DOSAGE: Rx: 750 mg PO bid for 21 d. Prevention: 1500 mg PO once/d SUPPLIED: Suspension 750 mg/5 mL NOTES: Take with meals Atracurium (Tracrium) COMMON USES: Adjunct to anesthesia to facilitate endotracheal intubation ACTIONS: Nondepolarizing neuromuscular blocker DOSAGE: Adults & Peds. Use adequate amounts of sedation and analgesia Atropine Used for emergency care (see Chapter 21) COMMON USES: Preanesthetic; symptomatic bradycardia and asystole ACTIONS: Antimuscarinic agent; blocks acetylcholine at parasympathetic sites DOSAGE: Adults.

Respiration All three IV barbiturates rapidly produce unconscious- may be further compromised by barbiturate-induced ness buy 500 mg keflex. For jected keflex 750 mg without a prescription, especially if the injection solution is not given example cheap keflex 250 mg with amex, patients undergoing short surgical procedures slowly enough to allow the drug to be diluted by the ve- with thiopental alone may respond to surgical maneu- nous blood. If inadvertent intraarterial injection occurs vers with facial grimaces or arm and leg movements and and drug precipitates are formed, arterial thrombosis, with potentially dangerous changes in blood pressure vasospasm, local ischemia, and possibly tissue sloughing and heart rhythm. Barbiturate solutions must not thesia for short operative procedures, analgesia should be coadministered with acidic solutions, such as those be provided with other drugs. Thiopental remains the most popular IV induction Most of the adverse reactions associated with the agent. Its rapid and pleasant induction of anesthesia use of the intravenous barbiturates are predictable and and its relatively low cost are among the reasons for its therefore can be controlled or avoided. Some reactions, high acceptance rate by both the patient and the practi- such as hypersensitivity, are entirely unpredictable. Also, it does not induce obstructive secretions Particularly patients with asthma, urticaria, or an- in the airway, produces little or no emesis, and does gioedema may acquire allergic hypersensitivity to the not sensitize the myocardium to endogenous cate- barbiturates. Acute intermittent porphyria is an ab- cholamines that may be released in response to the solute contraindication to the use of barbiturates. Although the pharmacological actions of the IV bar- Benzodiazepines biturates are similar, methohexital in particular may Midazolam (Versed), diazepam (Valium), and lo- provide some advantages in selected situations. Its du- razepam (Ativan) are benzodiazepine derivatives that ration of action is only half as long, and it exerts fewer are useful in anesthesia. Its pop- requirement of intraoperative communication between ularity is related to its aqueous solubility and to its short the patient and surgeon is easily satisfied with metho- duration of action, which permits a prompt return of hexital because of its short duration of action. Unlike midazolam, lor- ample, it can be used for basal sedation in the few mo- azepam and diazepam are not water soluble and must ments that a very painful stimulus is applied, and then, be formulated in propylene glycol; the latter is irritating as consciousness is quickly regained, the surgeon can as- to the vasculature on parenteral administration. They are also used intravenously in Adverse Effects doses that produce conscious sedation rather than hyp- Cardiovascular depression may occur after the admin- nosis. Thus, use of midazolam re- sults in a more rapid return to psychomotor compe- Pharmacological Actions tence. Doses may need to be lowered by at least 30% in A primary advantage of etomidate is its ability to pre- older patients and in those premedicated with opioids serve cardiovascular and respiratory stability; both car- or other sedative drugs. Use of etomidate may offer some advantage to the pa- Pharmacological Actions tient with compromised myocardial oxygen or blood The benzodiazepines, when given by slow IV infusion to supply or both, since it produces mild coronary vasodi- induce anesthesia, have minimal influences on the car- lation. Preservation of dia- logical substitutes for barbiturates in poor-risk patients stolic perfusion pressure may be particularly important who cannot tolerate cardiovascular depression. In other when myocardial blood supply cannot be increased by respects, they appear pharmacologically similar to the autoregulation. IV administration causes unconsciousness without analgesia; skeletal muscle relaxation is inade- Adverse Effects quate for intubation or short surgical procedures.

Epinephrine given in small therapeutic doses sion of the therapeutic dose buy keflex 500 mg low cost, which is the most likely (A) Increases systolic blood pressure through 2 re- effect illustrated in the following table: increase (↑); ceptor stimulation in the left ventricle decrease (↓); no change (0)? It groups at positions 3 and 5 of the phenyl ring has causes an increase in peripheral vascular resistance generic 500mg keflex overnight delivery. Developmental Neurobiology of muscle induced by transmitter acetylcholine and a the Autonomic Nervous System discount keflex 500mg on-line. Endothelial messengers and cerebral vascular sor effect of small doses is due to greater sensitivity tone regulation. Headache Pathogenesis: Monoamines, of constrictor -adrenoceptors and a dominant ac- Neuropeptides, Purines, and Nitric Oxide. He has a family history of contractility and thus enhances cardiac output, cardiovascular disease, having lost both his father especially stroke volume, in patients with depressed and grandfather before either reached age 60. It does this by stimulating has recently noticed decreased energy, especially -adrenoceptors in the heart while producing during exercise, and had symptoms (difficulty in relatively little increase in chronotropic activity or breathing, chest pain) that took him to the any significant elevation in systemic blood pressure emergency department. Westfall DRUG LIST GENERIC NAME PAGE GENERIC NAME PAGE Acebutolol 114 Nadolol 114 Atenolol 114 Phenoxybenzamine 113 Betaxolol 114 Phentolamine 113 Bucindolol 117 Pindolol 114 Carteolol 114 Prazosin 112 Carvedilol 117 Propranolol 113 Doxazosin 111 Terazosin 112 Esmolol 112 Timolol 114 Labetalol 116 Tolazoline 112 Medroxalol 117 Trimazosin 112 Metoprolol 113 ADRENOCEPTORS effector. This occurs because norepinephrine has an Drugs that produce responses by interacting with affinity for the receptors and possesses intrinsic activity; adrenoceptors are referred to as adrenoceptor agonists that is, it has the capacity to activate the receptors. Norepinephrine and isopro- Circulating catecholamines and other directly acting terenol are examples of such compounds. Prazosin and only limited or no capacity to activate the receptors; propranolol are examples of receptor-blocking drugs. The The pharmacology of the adrenoceptor antagonists is blocking drugs compete with adrenomimetic substances described in this chapter. Thus, these agents reduce the Norepinephrine is released from the varicosities of effects produced by both sympathetic nerve stimulation the postganglionic sympathetic nerves during neural ac- and by exogenously administered adrenomimetics. This tivity and interacts with the adrenoceptors of the effec- action forms the basis for their therapeutic and investi- tor organ, producing the characteristic response of the gational use. These findings are significant, since interaction between drug and receptor depends on the a number of both agonists and antagonists have some concentration of drug in the vicinity of the receptor and degree of selectivity for either 1- or 2-receptors. Because agonist and A comparison of the effects produced by propra- antagonist have an affinity for the same receptors, the nolol, a nonselective -receptor blocking agent, with two substances compete for binding to the receptors. For the attachment of the blocking agent to the adrenocep- example, a patient who is a candidate for -blocker tor is by relatively weak forces, such as hydrophobic, hy- therapy (angina, hypertension), but who also has ob- drogen, or van der Waals bonding.

The highly aromatic intake of beer purchase keflex 250mg otc, and lack of exercise may decrease the ef- leaves and purple or red flowers are used for healing generic keflex 750 mg visa. Many species of agastache also are grown commercially in the United Resources States for landscaping cheap keflex 500 mg otc. In southern China and Taiwan, BOOKS Pogostemon cablin, a relative of Pogostemon patchouli, Chevallier, Andrew. Traditionally, agastache has been associated the OTHER treatment of several different sets of symptoms. Other cultures independently have discovered simi- lar uses for other species of agastache. Description Although rigorous scientific testing of the healing claims made for agastache is scarce, one 1999 study Agastache is a genus of plants found almost world- done at Seoul National University in Korea has shown wide. Different species are used in several native cul- that in test tube experiments an extract of the root of A. The best know of these is Agastache rugosa significantly inhibited the action of certain pro- rugosa, also called the giant hyssop, wrinkled giant hys- teins associated with the reproduction of the HIV virus. Agastache rugosa is a perennial or biennial plant that Preparations grows to a height of 4 ft (1. It grows Agastache can be prepared alone as a tea, incorpo- wild on sunny hillsides and along roads, but also can be rated into a lotion, or prepared as a pill. ORGANIZATIONS Biennial—Biennial plants take two years to com- American Association of Oriental Medicine (AAOM). Qi—Qi is the Chinese term for the vital life force Tish Davidson that permeates the body. According to traditional Chinese medicine, qi collects in channels in the body and can be moved and redirected through treatments and therapies. Aging strongly aromatic, but lose this quality with prolonged Definition boiling (over 15 minutes). Starting at what is commonly called middle age, op- erations of the human body become more vulnerable to The best know formulas using agastache are agas- daily wear and tear. There is a general decline in physical, tache formula and Huo Xiang Zheng Qi Wan, or agas- and possibly mental, functioning. It is given as treatment for er, the upward limit of the life span can be as high as 120 gastrointestinal upsets with chills, fever, and diarrhea. During the latter half of life, an individual is more Huo Xiang Zheng Qi Wan regulates qi and treats prone to problems with the various functions of the body, seasonal gastric disorders, especially those occurring and to a number of chronic or fatal diseases. This formula is commercial- vascular, digestive, excretory, nervous, reproductive, and ly available in both tablet and liquid form. Precautions Description Agastache has a long history of use with no substan- Human beings reach a peak of growth and develop- tial reported problems. Although there are quite a few age-related changes that tax the body, disability is Side effects not necessarily a part of aging.