Adenosine. Pharmacologic Category: - Antiarrhythmic Agent, Miscellaneous -Diagnostic Agent

Transcription

1 by: Dr. Bagheri

2 Adenosine Pharmacologic Category: - Antiarrhythmic Agent, Miscellaneous -Diagnostic Agent Antiarrhythmic actions: Slows conduction time through the AV node, interrupting the re-entry pathways through the AV node, restoring normal sinus rhythm Myocardial perfusion scintigraphy: coronary vasodilation and increases blood flow in normal coronary arteries with little to no increase in stenotic coronary arteries. یا NS پایذاری هحل ل رلیك شذه در سزنگ : 14 ر س با LR 16 ر س پایذار با D5W

3 دی پیرادامول >10%: کاربامازپین Cardiovascular: Transient new arrhythmia (eg, atrial premature contractions, atrial fibrillation) after cardioversion (55%), facial flushing (18% to 44%) Central nervous system: Headache (2% to 18%), dizziness (2% to 12%) Gastrointestinal: GI discomfort (13%) Neuromuscular & skeletal: Discomfort of neck, throat, jaw (<1% to 15%) Respiratory: Chest pressure/discomfort (7% to 40%), dyspnea (12% to 28%)... Emphysema, bronchitis etc..

4 Amiodarone Pharmacologic Category: - Antiarrhythmic Agent Inhibits adrenergic stimulation: (alpha-beta-blocking properties) Affects sodium, potassium, and calcium channels: prolongs the action potential and refractory period in myocardial tissue Decreases AV conduction and sinus node function -پایذاری در D5W -24 ساعت در ظز ف شیشو ای فمط 2 ساعت در ظز ف PVC... جذب سطحی... پیز ی اس د س پیشنيادی استفاده اس تجيیشات PVC

5 >10%: Cardiovascular: Hypotension (I.V. 16%, refractory in rare cases) Central nervous system (3% to 40%): dizziness, fatigue, headache, malaise, impaired memory, involuntary movement, insomnia, poor coordination, peripheral neuropathy, sleep disturbances, tremor Dermatologic: Photosensitivity (10% to 75%), pigmentation. Endocrine & Metabolic: Hypothyroidism (1% to 22%) / hyperthyroidism Gastrointestinal: Nausea, vomiting, anorexia, and constipation (10% to 33%) Hepatic: AST or ALT level >2x normal (15% to 50%) Ocular: Corneal microdeposits (>90%; causes visual disturbance in <10%)

6 ا* مهار کننده قوی آنسیم های کبدی *کب ش سرعت تصفی کجدی یب کلی ی ثرخی داري بی ضد آریتمی فلکبیىید پريکبئیه آمید ي کیىیدیه *امکبن ثريز آریتمی torsade depoint در مصرف مسمبن ثب ثرخی داري بی ضد آریتمی مثل پريپبفى ن کیىیدیه پريکبئیه آمید *تشدید افت فشبر خ ن در مصرف مسمبن ثب سبیر داري بی کب ىد فشبر خ ن *سرک ة ثیش از حد عملکرد قلت ي کب ش دایت گر AV در مصرف مسمبن ثب B ثالکر ب ي CCB ب فسایش % سطح سرمی دیگ کسیه *افسایش غلظت سرمی آمی دارين ثب سبیمتیدیه ي کب ش سطح سرمی ي ویم عمر ثب کلستیرامیه... خ دداری از تج یس مسمبن *افسایش غلظت سیکل سپ ریه دکستريمت رفبن تئ فیلیه ي مت تریکسبت *کب ش متبث لیسم فىی ت ئیه *افسایش تبثیر داري بی ضد اوعقبد خ راکی ي امکبن ثريز خ وریسی مىجر ث مرگ *کب ش غلظت سرمی آمی دارين ثب فىی ت ئیه *ثريز بیپ تبوسی ن ثرادی کبردی ي کب ش ثرين د قلجی در مصرف مسمبن ثب فىتبویل * ثريز یک م رد ثرادی کبردی سیى سی ي تشىج ثب ديز زیبد IV در تج یس مسمبن ثب لیديکبئیه ث عى ان ثی حس کىىد م ضعی

7 Verapamil Pharmacologic Category: -Antianginal Agent -Antiarrhythmic Agent -Calcium Channel Blocker Inhibits calcium ion from entering the slow channels or select voltage-sensitive areas of vascular smooth muscle and myocardium during depolarization; produces relaxation of coronary vascular smooth muscle vasodilation increases myocardial oxygen delivery in patients with angina slows automaticity and conduction of AV node

8 >10%: CNS: Headache (1% to 12%) GI: Gingival hyperplasia ( 19%), constipation (7% to 12%) 1% to 10%: Cardiovascular: Peripheral edema (1% to 4%), hypotension (3%), CHF/pulmonary edema (2%), AV block (1% to 2%), bradycardia (HR <50 bpm: 1%), CNS: Fatigue (2% to 5%), dizziness (1% to 5%), lethargy (3%), pain (2%), sleep disturbance (1%) Dermatologic: Rash (1% to 2%)

9 Lidocaine: Pharmacologic Category : -Antiarrhythmic Agent, Class Ib; -Local Anesthetic *increasing electrical stimulation threshold of ventricle, His-Purkinje system, and spontaneous depolarization of the ventricles during diastole by a direct action on the tissues. *blocks both the initiation and conduction of nerve impulses by decreasing the neuronal membrane's permeability to sodium ions. هحل ل رلیك شذه با% DWS در دهای اتاق حذالل تا 24h پایذار است. بیشتزین پایذاری در pH= سذین بی کزبنات

10 Cardiovascular: Arrhythmia, bradycardia, arterial spasms, cardiovascular collapse, edema, flushing, heart block, hypotension, sinus node supression CNS: Agitation, anxiety, apprehension, coma, confusion, headache, hyperesthesia, hypoesthesia, lethargy, lightheadedness, nervousness, Gastrointestinal: Metallic taste, nausea, vomiting Local: Thrombophlebitis Neuromuscular & skeletal: Paresthesia, tremor, weakness Otic: Tinnitus

11 Dobutamine Pharmacologic Category: -Adrenergic Agonist Agent Stimulates beta1-adrenergic receptors; causing increased contractility and heart rate, with little effect on beta 2 - or alpha-receptors -هحل ل رلیك شذه بایستی تا 24 ساعت هصزف ش د هابمی د ر ریختو ش د. ** تغییز رنگ... اکسیذاسی ن

12 Cardiovascular: Increased heart rate, increased blood pressure, increased ventricular ectopic activity, hypotension, premature ventricular beats (5%, dose related), anginal pain (1% to 3%), nonspecific chest pain (1% to 3%), palpitation (1% to 3%) CNS: Fever (1% to 3%), headache (1% to 3%), paresthesia Endocrine & metabolic: Slight decrease in serum potassium Gastrointestinal: Nausea (1% to 3%) Hematologic: Thrombocytopenia Local: Phlebitis, local inflammatory changes and pain from infiltration, cutaneous necrosis (isolated cases) Neuromuscular & skeletal: Mild leg cramps Respiratory: Dyspnea (1% to 3%)

13 Dopamine Pharmacologic Category: - Adrenergic Agonist Agent Stimulates both adrenergic and dopaminergic receptors: -lower doses are mainly dopaminergic stimulating and produce renal and mesenteric vasodilation -higher doses also are both dopaminergic and beta 1 -adrenergic stimulating and produce cardiac stimulation and renal vasodilation -large doses stimulate alpha-adrenergic receptors (vasoconstriction) -هحل ل رلیك شذه تا 24 ساعت در دهای اتاق لابل نگيذاری است. تغییز رنگ) ph للیایی(... اکسیذاسی ن... عذم هصزف **

14 *Most frequent: Cardiovascular: Anginal pain, ectopic beats, hypotension, palpitation, tachycardia, vasoconstriction Central nervous system: Headache Gastrointestinal: Nausea and vomiting Respiratory: Dyspnea Concurrent use with MAOIs: prolong hypertension Use with extreme caution

15 Potassium chloride; KCl Pharmacologic Category: Electrolyte Supplement Heart failure: Inhibition of the sodium/potassium ATPase pump in myocardial cells Supraventricular arrhythmias: Direct suppression of the AV node conduction

16 Dermatologic: Rash Endocrine & metabolic: Hyperkalemia Gastrointestinal: Abdominal pain/discomfort, diarrhea, flatulence, nausea, vomiting **Drug interaction: ACE Inhibitors Angiotensin II Receptor Blockers enhance the hyperkalemic effect Potassium-Sparing Diuretics هحل ل رلیك شذه فزآ رده بایستی در طی 24 ساعت ه رد استفاده لزار بگیزد.

17 Disease/drug-related concerns: Acid/base disorder Cardiovascular disease: (eg, heart failure, cardiac arrhythmias) life-threatening cardiac effects Renal impairment Digitalis: life-threatening cardiac effects Potassium-altering therapies: ACEI, potassium-sparing diuretics, potassium containing salt substitutes

18 Nitroglycerin (TNG) Pharmacologic Category: -Antianginal Agent -Vasodilator Produces a vasodilator effect on the peripheral veins and arteries with more prominent effects on the veins. *هحل ل رلیك شذه با N/S یا DWS% در ظزف شیشو ای تا 48h در دهای اتاق تا 7 ر س در یخچال پایذار است. :PVC* 24 ساعت در دهای اتاق 14 ر س در یخچال جذب سطحی )سزعت انف سی ن غلظت هحل ل ط ل ست انف سی ن( *لزص ىای نیتز گلیسیزین

19 Cardiovascular: Flushing, hypotension, orthostatic hypotension, peripheral edema, syncope, tachycardia CNS: Headache (common), dizziness, lightheadedness Gastrointestinal: Nausea, vomiting, xerostomia Neuromuscular & skeletal: Paresthesia, weakness Respiratory: Dyspnea, pharyngitis, rhinitis PDE-5 inhibitors: sildenafil, tadalafil, vardenafil

20 Enoxaparin: Clexan Pharmacologic Category: -Low Molecular Weight Heparin

21 1% to 10%: CNS: Fever (5% to 8%), confusion, pain Dermatologic: Erythema, bruising Gastrointestinal: Nausea (3%), diarrhea Hematologic: Hemorrhage (major, <1% to 4%; includes cases of intracranial, retroperitoneal, or intraocular hemorrhage Local: Injection site hematoma (9%), local reactions Renal: Hematuria (<2%)

22 Octreotide: Pharmacologic Category: -Antidiarrheal -Antidote -Somatostatin Analog *Inhibiting serotonin release, and the secretion of gastrin, VIP, insulin, glucagon, secretin, motilin, and pancreatic polypeptide. *Decreases growth hormone and IGF-1 in acromegaly.

23 >16%: Cardiovascular: Sinus bradycardia (19% to 25%), chest pain ( 20%; non-depot formulations) CNS: Fatigue (1% to 32%), headache (6% to 30%), malaise (16% to 20%), fever (16% to 20%), dizziness (5% to 20%) Dermatologic: Pruritus ( 18%) Endocrine & metabolic: Hyperglycemia (2% to 27%) Gastrointestinal: Abdominal pain (5% to 61%), loose stools (5% to 61%), nausea (5% to 61%), diarrhea (34% to 61%), flatulence ( 38%), cholelithiasis (13% to 38%; length of therapy dependent) Local: Injection site pain Neuromuscular & skeletal: Back pain (1% to 27%), arthropathy (8% to 19%), myalgia ( 18%) Respiratory: Upper respiratory infection (10% to 23%), dyspnea ( 20%; non-depot formulations)

24 Pantoprazole: Pharmacologic Category: -Proton Pump Inhibitor -Suppresses gastric acid secretion by inhibiting the parietal cell H + /K + ATP pump -هحل ل آهاده ساسی شذه هی بایست حذاکثز 6 ساعت پس اس آهساده سساسی رلیك گزدد. -هحل ل رلیك شذه هسی بایسست حسذاکثز تسا 24 سساعت پس اس آهساده سساسی استفاده ش د.

25 >10%: CNS: Headache (adults 12%; children >4%) 1% to 10%: Cardiovascular: Facial edema ( 4%), generalized edema ( 2%) CNS: Dizziness ( 4%), vertigo ( 4%), depression ( 2%), fever (adults 2%; children >4%) Dermatologic: Rash (adults 2%; children >4%), urticaria ( 4%), photosensitivity ( 2%), pruritus ( 2%) Endocrine & metabolic: Triglycerides increased ( 4%) GI: Diarrhea ( 9%), abdominal pain (children >4%), vomiting ( 4%), constipation ( 4%), flatulence (children 4%), nausea (children 4%), xerostomia ( 2%) Hematologic: Leukopenia ( 2%), thrombocytopenia ( 2%) Hepatic: Liver function tests abnormal ( 4%), hepatitis ( 2%)

26 Stereptokinase: Pharmacologic Category: -thrombolytic -Converts plasminogen to the enzyme plasmin -محلىل آماده سازی شذه فراورده تا است. 8 ساعت در دمای کنترل شذه محیط و تا 24 ساعت در یخچال قابل نگهذاری

27 Cardiovascular: Hypotension (sometimes severe) Hematologic: Bleeding (major and minor) Respiratory: Respiratory depression

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