Clopidogrel is associated with diffuse alveolar hemorrhage

 -IkaN

Mnemonic for Toxicity of loop diuretics | Mnemonic

 For toxicity of loop diuretics, mnemonic is as follows:

keep the word Hypo 

so now count down all hypos:

• hyponatremia
• hypokalemia'
• hypocalcemia
• hypomagnesemia
• hypovolemia

and from word (hypo) letters:

H..................

y (if you write it in small case letter on paper, its upper part resembles u) = uric acid (and removing the o from hypo makes hyp = hyperuricemia)

p (rhymes with b) = B1 deficiency (which actually worsens in heart failure)

and O = ototoxicity 

this is makes easier for me to remember the toxicities of loop diuretics easier than cramming them all or making a sentence or word unrelated to loop diuretics, so word hypo is quite relevant for loop diuretics so it can be a good anchor in your mind

I hope it works for you all 

InShaAllah

Thank you 💓

Loop diuretics Mnemonic | Clinical Indications of Loop diuretics

 Mnemonic for clinical indications of loop diuretics is as follows

From the word loop diuretics, my mind first thinks about loop as wave like thing and diuretic to be water related

So mnemonic is also related to it like that

HEEHA........ (as if you are skating on sea waves)

H = heart failure

E = edema  (pulmonary)

E = edema (peripheral)

H = hypertension (in case of renal failure and you are trying to treat fluid overload)

A = onion overdose 

I hope it works for you all

InShaAllah

Thank you 💓

Mnemonic for Ototoxic drugs

Some of the ototoxic drugs are presented to you here with a mnemonic 

Think about a situation when you got deaf due to some ototoxic drugs and now you go to a pandet named Adam for cure

So Pandet Adam is our mnemonic 

P = Propranolol, platins(cisplatin, carboplatin)

A = aminoglycosides

N = NSAIDs (ibuprofen, salicylate, indomethacin)

D = Diuretics (furosamide, ethacrynic acid, bumetanide)

E = eryhtromycin 

T = tobacco 

A = Alcohol

D = defroxamide 

A = ampicllin 

M = anti Malarial (quinine, chloroquine, hydroxychloroquine)

And that's it. 

I hope it works for you all

InShaAllah!

Thank you❤

Different routes of administration of pencillin

-Shreya HA 

Atropine dose for bradycardia (ACLS) mnemonic

It's 1 mg. 

-IkaN (Nakeya Dewaswala) 

Parkinson's disease medication taper sequence mnemonic

 In Parkinson's disease, how do you taper off medications to reduce psychotic symptoms? This is a step 3 question.

Nadolol mnemonic

-IkaN (Nakeya Dewaswala Bhopalwala) 

Atenolol in pregnancy and breastfeeding

Atenolol is contraindicated in pregnancy.

Where does this data come from?

DRESS syndrome and Dressler's syndrome - what's in a name?

 Hello

DRESS syndrome and Dressler's syndrome - what's in the name?

MCQ: Carbamazepine

Q1) Which of the following statements is true about carbamazepine:-

A) It is indicated in complex partial seizures.

B) It is an enzyme inhibitors

C) It can cause megaloblastic anaemia

D) It is the drug of choice for status epilepticus.

#recentNEET

#NEETPG 

#Medicowesome

#pharmacology 

So, the answer to the above question is an option 

A) It is indicated in complex partial seizures.

Let's get started with Carbamazepine:-

It is an antiepileptic drug that acts by lengthening the inactivated state of the Na+ channel. 

Uses:-

1) DOC for Partial seizure/trigeminal neuralgia.

2) Bipolar disorder.

3) Acute mania

4) GTCS.

Let's rule out other options:-

Option B) It's an enzyme inducer. It is a substrate as well as inducer for CYP3A4 and CYP2C9. Oxcarbazepine is a less powerful CYP enzyme inducer.

Option C) Carbamazepine causes agranulocytosis or aplastic anaemia and not megaloblastic anaemia.

Other side effects include:

1) Hyponatremia: Delayed and more common in the elderly. Risk is higher in Oxcarbazepine.

2) Hypersensitivity

4) Hepatoxicity 

3) Steven Johnson syndrome (Associated with HLA-B 1502 gene)

4) Ataxia 

4) Blurred vision/ Diplopia 

For the last two side effects, we need TDM for adjusting the dose. Remember, Ataxia and Blurred vision is not a Idiosyncratic reactions.

Let's do questions related to Carbamazepine!

Q1) What adverse effect is risked to ongoing valproate therapy?

-Hepatotoxicity.

Q2) A cancer patient is on anticancer drugs (vincristine etc) and develops multiple episodes of seizures, refractory to diazepam and lidocaine. Blood tests show elevated ADH and euvolemic hyponatremia. Which drug can be used to treat this patient?

- You can't use Carbamazepine because it causes increase sensitivity of renal tubules to ADH levels. 

In this case, we use Phenytoin which causes a decrease in ADH secretion and corrects hyponatremia.

~Ojas

Metoprolol tartrate vs succinate dosing mnemonic

Metoprolol tartrate is short acting. 

Metoprolol succinate is long acting. 

Mnemonic succinate single dose, tartrate two doses.

-IkaN (Nakeya Dewaswala Bhopalwala) 

Cardiovascular drugs that can cause digoxin toxicity

A number of cardiovascular drugs predispose patients to digoxin toxicity, including verapamil, quinidine, and amiodarone. The dosage of digoxin must be reduced if given concomitantly with these drugs. The presumed mechanism underlying this interaction involves the ability of these drugs to inhibit the P-glycoprotein transporter.

Mnemonic: These drugs cause you to go whack! VAQ - Verapamil, Amiodarone, Quinidine

Other drugs to keep in mind are Diltiazem, Spironolactone, Flecainide.

Mnemonic by Huzefa Bhopalwala

References:

Waldorff S, Hansen PB, Egeblad H, Berning J, Buch J, Kjaergård H, Steiness E. Interactions between digoxin and potassium-sparing diuretics. Clin Pharmacol Ther. 1983 Apr;33(4):418-23. doi: 10.1038/clpt.1983.56. PMID: 6831820.

Andrejak M, Hary L, Andrejak MT, Lesbre JP. Diltiazem increases steady state digoxin serum levels in patients with cardiac disease. J Clin Pharmacol. 1987 Dec;27(12):967-70. doi: 10.1002/j.1552-4604.1987.tb05598.x. PMID: 3437068.

Lewis GP, Holtzman JL. Interaction of flecainide with digoxin and propranolol. Am J Cardiol. 1984 Feb 27;53(5):52B-57B. doi: 10.1016/0002-9149(84)90502-2. PMID: 6695818.

Koren, G., MacLeod, S. CHARACTERISTICS OF DIGOXIN INTERACTION WITH QUINIDINE, VERAPAMIL AND AMIODARONE: IN VIVO AND IN VITRO STUDIES. Pediatr Res 18, 154 (1984). https://doi.org/10.1203/00006450-198404001-00367

Overview of methods of haemostasis in surgery

Fact of the day - halothane hepatotoxicity

 Hi!

A patient with biliary stones who's undergone laparoscopic cholecystectomy may develop signs of hepatotoxicity between 2 days - three weeks post-op. due to halothane. The mechanism is this anesthetic's biotransformation to reactive metabolites through P450.

At risk category of patients are females more than 40 years of age.
Labs show elevated AST and ALT.
Hepatitis is relatively rare.

Other effects:

- Cardiac arrhythmias

- malignant hyperthermia

- hypertension


That's all

- Jaskunwar Singh

Levetiracetam - pregnancy considerations

 Hi!

Levetiracetam, used primarily for seizures control, is also used off-label for SAH, status epilepticus, seizure prophylaxis in craniotomy and traumatic brain injury.

Dosing is increased in pregnancy and closely monitored regularly due to various physiologic effects, especially in third trimester. (levitate dose of levetiracetam) :-

- increased volume of distribution, Vd (increase in plasma volume, CO)

- increased renal excretion (increase in GFR; levitate the rate)

- rapid and almost complete absorption via GIT  (unlike other drugs with decreased absorption in pregnancy)

- low risk of adverse effects and fetal malformations when used in monotherapy. (low with mono, high with poly)

- Levetiracetam is NOT metabolized by liver; Cyt P450 independent. Bioavailability 100%. (unlike other antiepileptics - hepatic metabolism increases in pregnancy)

Levetiracetam crosses placenta and can be detected in the newborn. (leve leaves mother)

The newborns are at greater risk of SGA and low APGAR score.

Protein-binding of the drug is low (<10%). So, decrease in albumin concentration during pregnancy does not significantly affect the drug concentration. (low pro)

That's all

- Jaskunwar Singh

Belimumab mnemonic

What is belimumab?

Belimumab is a  monoclonal antibody directed against soluble B lymphocyte stimulator (BLyS).

Belimumab is used in the treatment of? 

Systemic Lupus Erythematosus (SLE)

Mnemonic: Belly Selly SLE (rhymes! sing it enough times and you will never forget)

At present, belimumab is indicated as add-on therapy in adults with active, antinuclear antibody or anti-dsDNA-positive SLE with a high degree of disease activity in the skin and/or musculoskeletal systems that remain moderately to severely active despite optimized standard immunosuppression. 

Patients with severe lupus nephritis or active CNS lupus are not the candidates for belimumab.

That's all!

-IkaN

Direct oral anticoagulants (DOACs) dosing for stroke prevention in atrial fibrillation mnemonic

Hi everyone!

Here are some DOAC dosing mnemonics for atrial fibrillation! 

RivarOxaban: Once daily

Apixaban: Twice daily 

Dabigatran: Twice daily

EdOxaban: Once daily

Mnemonic: Drugs with O have Once-daily dosing. 

Rivaroxaban: 20 mg once daily with the evening meal (creatinine clearance [CrCl] >50 mL/minute); or 15 mg once daily with the evening meal (CrCl ≤50 mL/minute).

Mnemonic: R without the straight line | looks like 2 to me for 20 mg!

Apixaban: 5 mg twice daily (CrCl >50 mL/minute); or 2.5 mg twice daily for those with any two of the following: age ≥80 years, body weight ≤60 kg, or serum creatinine ≥1.5 mg/dL.

Mnemonic: Apixa has 5 letters for 5 mg!

Dabigatran: 110 mg BID or 150 mg BID (CrCl >30 mL/minute).

European labeling suggests dose reduction in patients older than 75 years (eg, 150 mg orally once per day or 110 mg orally twice per day).

Edoxaban: 30 mg (weight ≤60 kg) or 60 mg (weight >60 kg) orally once daily.

That's all!

Remember that the dosing varies for VTE treatment and prophylaxis so do not apply these mnemonics for VTE.

-IkaN

Formulation, absorption and associated side effect of dabigatran

Did you know that the absorption of dabigatran etexilate is dependent on an acid environment in the stomach?

This is why it is formulated together with tartaric acid pellets. These pellets provide an acidic environment, which increases drug dissolution and absorption, regardless of variations in gastric pH. This is also why the absorption is not affected by the coadministration of a proton pump inhibitor.

A lower pH is associated with dyspepsia, esophagitis, and plays a part in the increased risk of gastrointestinal bleeding.

-IkaN

Simvastatin combination with fibrates in clinical practice

 Hi!

High-yield in clinical practice:

DO NOT combine simvastatin with gemfibrozil (class-X interaction; high risk of acute liver damage and rhabdomyolysis). Inhibition of CYP450 enzyme by gemfibrozil plays the role in increasing levels of simvastatin 2-3x.

Combination of simvastatin with fenofibrate is relatively safer, although close observation and regular monitoring is required (class-C interaction). Serum levels of simvastatin remain unchanged.

- Jaskunwar Singh