Anesthetics

-
Many of the neuromuscular blocking agents are eliminated by the kidney and require dose adjustment in patients with renal dysfunction. For some of these drugs no data are available to allow development of guidelines for use in patients. Use of any of these drugs in the patient with renal failure requires caution, and it has been recommended that a peripheral nerve stimulator be employed to assess the degree of neuromuscular blockade. Short of this, the clinician must be aware that a patient with renal dysfunction may have slow recovery from anesthesia owing to both retention of anesthetic agents eliminated by the kidney or to additional factors that again are related to renal function. For example, patients with renal disease who either accumulate aminoglycoside antibiotics to high concentrations or who are potassium depleted may have prolonged respiratory suppression in the face of anesthetic agents as a result of the "curare like" effect that can occur with these antibiotics. The same principles apply to patients with liver disease and to drugs eliminated by hepatic routes.

Fazadinium appears to have only minor changes in pharmacokinetics in patients with end stage renal disease and may, therefore, be a preferred agent in patients with renal dysfunction.

Alfentanil, fentanyl, and propofol have been studied in the elderly. The disposition of the former two drugs was no different than in young patients. However, the pharmacodynamics were clearly altered such that half as much of either drug resulted in the same CNS depression as in young patients. The mechanism of this increased sensitivity is unknown. The initial volume of distribution and the clearance of propofol in elderly patients were about 75% of those in young patients. Thus, with this anesthetic, lower doses should also be used in elderly patients.


Comments

Post a Comment

Popular posts from this blog

Treatment Guidelines for Malaria Contd...

-
Treatment regimens for uncomplicated malaria in adults _ Oral quinine sulphate 600 mg/8 h for 5e7 days plus doxycycline 200 mg daily (or clindamycin 450 mg/8 h for pregnant women) for 7 days _ Atovaquoneeproguanil (Malarone_): 4 ‘standard’ tablets daily for 3 days or _ Co-artem ((artemetherelumefantrine_): if weight > 35 kg, 4 tablets  then 4 tablets at 8, 24, 36, 48 and 60 h   Child Initial dose 10 mg/kg/base then 5 mg/kg  base 6e8 h later and on days 2 and 3   However, both of these newer regimens need to be taken for only 3 days. In contrast, quinine needs to be taken for 5e7 days and is often associated with ‘‘cinchonism’’ (nausea, deafness and ringing in the ears), which often results in poor adherence. Although international recommendations suggest that quinine should be  taken for 7 days in endemic areas, 2  UK experience suggests  that 5 days treatment is adequate for the vast majority of cases. Quinine should be combined with a second drug (doxycycline for adults or clindam...
Read more

Basics of Oral Anti-diabetic drugs

-
The sulfonylureas and meglitinides increase the secretion of insulin by the pancreas. _ Metformin inhibits glucose production by the liver and decreases insulin resistance. _ The alpha-glucosidase inhibitors delay absorption of glucose by the intestine. _ The thiazolidinediones decrease insulin resistance. _ The dipeptidyl peptidase 4 inhibitors promote the release of insulin from the pancreas after eating a meal. It is  necessary  to know before starting these drugs that  all the diabetes drugs have the potential to cause side effects and lifestyle changes have benefits to your health beyond controlling blood sugar, most doctors will recommend you try diet and lifestyle modifications first — before you try a drug. Subscribe to Drugs Information Center by Email
Read more

Ranexa

-
Ranexa is an anti-anginal medication. It works by improving blood flow to help the heart work more efficiently. Ranexa is used to chronic treat angina (chronic chest pain) when other medications have not helped the condition. It should be used in combination with another medicine (eg, amlodipine, beta-blockers, nitrates). You should not take Ranexa if you have liver disease, hypokalemia (low levels of potassium in your blood), or a personal or family history of "Long QT syndrome." Ranexa should not be taken together with certain medicines to treat heart rhythm disorders, malaria, infections, mental illness, pain, cancer, or stomach disorders. Before you take Ranexa, tell your doctor about all other medications you are using. Ranexa is not for use during an acute (emergency) attack of angina. Continue using any other medicines prescribed by your doctor (such as nitroglycerin) to treat acute angina. Chronic angina is often treated with a combination of different drugs. To best ...
Read more