mention a regimen for treatment of meningitis
Naltrexone / Buproprion MOA and one SE
They work synergistically in hypothalamus and mesolimbic dopamine circuit to promote satiety, decrease food intake, and increase energy expenditure
Sleep disorder
In general, what supplements are usually needed after bariatric surgery?
- Zinc: Zinc deficiency induces hair loss, impaired sense of taste, and sexual dysfunction
- Selenium is absorbed primarily in the duodenum; therefore, patients after malabsorptive procedures are at risk of selenium deficiency
- The separation of calcium and iron supplements is recommended.
- If iron concentrations continue to remain low with oral supplementation, intravenous iron is recommended
How can bariatric surgery affect drug distribution
- Decrease in fat decreases the Vd of fat-soluble drugs
- Many patients experience hypoalbuminemia after bariatric surgery, with decreased plasma protein binding of drugs and this increases the free plasma fraction and causes decrease in the volume of distribution
(Vd).
Describe withdrawal to benzodiazepines.
It occurs more common with the short acting preparations and in case of sudden withdrawal of the drug, this will lead to withdrawal symptoms such as: Anxiety, Restlessness, Confusion, Insomnia, Orthostatic hypotension, hyperactive reflexes and generalized seizures.
Classify the following hypnotics as either suitable to improve sleep latency or sleep duration: Eszopiclone lorazepam ramelteon Suvorexant triazolam zaleplon
→Eszopiclone→ Treat Sleep Maintenance insomnia
→Lorazepam→ Treat Sleep Maintenance insomnia
→Ramelteon→ Treat Sleep onset insomnia
→Suvorexant→ Treat Sleep Maintenance insomnia
→Triazolam→ Treat Sleep onset insomnia
→Zaleplon→ Treat Sleep onset insomnia + For patient with awakening in the middle of the night
Mention three cautions with writing hypnotic prescriptions.
- A dose that does not impair mental activity or motor functions during waking hours.
- Prescriptions should be written for short periods
- Assess the efficacy of therapy from the patient’s subjective responses.
- Combinations of antianxiety agents should be avoided
- Patients should be cautioned about the consumption of alcohol and the concurrent use of over-the-counter medications containing antihistaminic or anticholinergic drugs
List antimicrobials for eradication of Group A beta Hemolytic Streptococci (GAS) for penicillin allergic and non-allergic patients.
Antibacterials:
Penicillins (drug of choice): Benzathine penicillin G Or Penicillin V
For patients allergic to penicillin:
Azithromycin Or
Clarithromycin Or
Clindamycin
Enumerate the lines of management of acute adrenal
insufficiency?
1- Steroid replacement - hydrocortisone Mineralocorticoid replacement:
fludrocortisone
2- Intravenous fluids for Shock or moderate to severe dehydration
3- To Treat hypoglycemia: Bolus: IV dextrose
4- To Treat Hyperkalemia: monitor by ECG: If Potassium is >7.0 mmol/ Treat with either calcium gluconate or insulin infusion
How can bariatric surgery affect drug distribution
- Decrease in fat decreases the Vd of fat-soluble drugs
Many patients experience hypoalbuminemia after bariatric surgery, with decreased plasma protein binding of drugs and this increases the free plasma fraction and causes decrease in the volume of distribution
(Vd).
How do benzodiazepines produce CNS depression?
They bind to GABAA receptors at a site different from where GABA binds —> increase the affinity of GABA for the GABA-binding site —►increase the frequency of the opening of the ion channel controlled by the GABAA receptor Opening of the central ion channel, allows chloride entry—► hyperpolarization of the neuron and decreases neurotransmission by inhibiting the formation of action potentials.
Mention three cautions with writing hypnotic prescriptions
- A dose that does not impair mental activity or motor functions during waking hours.
- Prescriptions should be written for short periods
- Combinations of antianxiety agents should be avoided
- Mention two alternative antibacterial therapies that can be used for the treatment of community-acquired pneumonia in absence of comorbidities and absence of risk factors for MRSA. (No doses required)
Amoxicillin every 8 hours
or
Doxycycline every 12 hours
Mention two alternative antibacterial therapies that can be used for the treatment of community-acquired pneumonia for a patient with diabetes mellitus but in absence of risk factors for MRSA. (No doses required)
Amoxicillin-clavulanate and clarithromycin
Doxycycline
Mention two alternative antibacterial therapies that can be used for the treatment of hospital-acquired pneumonia in the absence of risk for MRSA and for mortality. (No doses required)
Penicillin based antipseudomonal
or
Cephalosporin based antipseudomonal
Mention two alternative antibacterial therapies that can be used for the treatment of hospital-acquired pneumonia in the presence of risk for MRSA in the absence of mortality risk. (No doses required)
Mention two alternative antibacterial therapies that can be used for the treatment of hospital-acquired pneumonia in the presence of risk for MRSA and for high mortality risk. (No doses required)
