Drugs

• Theophylline


  Belongs to Methylated Xanthine Class (theophylline, caffeine, theobromine)
• Theophylline

  • Relaxes bronchial smooth muscle and works on bronchodilation
  • Used to treat patients with chronic obstructive lung disease and also neonatal apnea
• HPLC is the confirmatory test for Theophylline
• Theophylline Therapeutic Range


  10-20 μg/ml
• Theophylline Half life


  • Neonates: 28 hours
  • Children/Older children/adult: 4 hours, 9 hours
• Digoxin


  A cardiac glycoside that has been used for many years from the leaves of foxglove plant to treat a disease termed "dropsy" or pedal edema
• Digoxin

  • Inhibits membrane NA-K-ATPase pump, which increases the release of calcium for improvement of myocardial contraction
  • Used for the treatment of CHF and Atrial fibrillation or flutter
• Digoxin

  is 1/5 bound to protein
• Digoxin Therapeutic Range


  0.5-2 ng/ml
• Digoxin Half life


  1 ½ days
• Disopyramide


  • Used to treat ventricular arrythmias, but is also exhibits some anticholinergic effects
  • Commonly used as a quinidine (toxic) substitute, when its adverse effects are excessive
• Disopyramide Side Effects


  • Dryness of mouth, nose, throat and eyes
  • Urinary retention
  • Blurred vision
  • Mental depression
• Disopyramide Therapeutic Range 3-5 ng/ml
• Disopyramide Half life

  4 to 10 hours
• Lidocaine


  Local anesthetic for minor operations
• Lidocaine

  • Used to treat ventricular arrhythmias that arise after AMI
  • anti-arrythmic drug and local anesthetic
• Monoethylglycinexylidide (MEGX)


  Primary product of hepatic metabolism of lidocaine, should be considered in TDM
• Cinchona bark


  Source of plant alkaloid quinidine
• Quinidine toxicity

  Causes cinchonism syndrome including blurred vision, tinnitus, vertigo and nervous tremor
• Procainamide


  Very potent in controlling supraventricular and ventricular arrhythmias
• Amiodarone


  Treats life threatening ventricular tachy arrhythmias that have been unresponsive to less toxic agents
• Amiodarone


  • Toxic range 1.0-2.5 ug/ml
• Aminoglycosides


  Interfere with bacterial protein synthesis, not well absorbed from GI tract so commonly IV or IM
• Aminoglycosides


  • Cause ototoxicity and nephrotoxicity
• Vancomycin


  Inhibits bacterial cell wall synthesis, effective only if the bacteria has a cell wall
• Vancomycin


  • Toxicities include "red man syndrome" (erythemic flushing of extremities)
• Procainamide


  is converted by acetylation in the liver to N-Acetylprocainamide (NAPA), which is also fully active and recirculates in the blood
• Quinidine


  has a cardiac depressant properties that limit cardiac excitability and conduction
• Quinidine


  is employed for supraventricular and ventricular arrythmias
• Aminoglycosides


  1. Trough Levels - is used to measure nephrotoxicity
  2. Peak Levels - for adequacy of therapy
• Phenytoin


  Anticonvulsant used to control seizure disorders and to treat "status epilepticus"
• Phenytoin

  • Long term adverse effects include skin changes (acne and hirsutism), gingival hyperplasia, lymphoid hyperplasia, interference with metabolism of vitamin D, teratogenic action, causing cleft lip and cleft palate
• Phenytoin


  In the blood, 90% of phenytoin is protein bound
• Diazepam


  Sedative drug and a member of the benzodiazepine class of tranquilizers, Used as a hypnotic agent, antianxiety agent or as a muscle relaxant, Also used as an immediate "rapid" control of seizures in emergency situations
• Diazepam


  It is metabolized to be active compound nordiazepam and oxazepam, Detection of Oxazepam glucuronide in urine is used as a screening method
• Phenobarbital, Primidone


  Barbiturates, frequently used to treat tonic-clonic seizures, psychomotor seizures and focal epileptic seizures
• Primidone


  Converted in the body to Phenobarbital
• Phenobarbital, Primidone


  • Their action is a decrease in the threshold of nerve cell stimulation in the motor cortex, thereby inhibiting spread of electrical activity from a focus epilepsy
• Carbamazepine


  Effective for controlling grand mal and psychomotor seizures, but its advantage is in relieving pain with trigeminal neuralgia
• Carbamazepine


  • Its action is related to a reduction in synaptic transmission in the spinal cord