Tuesday February 9, 2010
On Vimpat (lacosamide)
Lacosamide is a medication for the adjunctive treatment of partial-onset seizures and diabetic neuropathic pain.
The precise mechanism underlying the anti-epileptic effects of lacosamide is not fully clear but it is said that lacosamide selectively enhances slow inactivation of voltage-gated sodium channels, resulting in stabilization of hyperexcitable neuronal membranes. lacosamide is found to significantly reduce seizure frequency when given in addition to other antiepileptics, at doses of 400 and 600 milligrams a day. In diabetic neuropathy, lacosamide also provided significantly better pain relief when compared to placebo.
The apparent lack of sedative effects makes this agent attractive for patients who are prone to develop somnolence with other anti-epileptic drugs(AEDs). On the other hand, reports of potential electrocardiogram changes with lacosamide suggest that caution is needed before using this drug in patients with pre-existing cardiac disease and in those taking drugs known to cause PR prolongation.
Tuesday, February 9, 2010
Monday, February 8, 2010
Monday February 8, 2010
Q; Patient with C. Diff. Colitis is having no improvement with PO Flagyl. You ordered PO Vancomycin. Pharmacy informed you that PO Vancomycin is not available. What would be your trick of trade here?
A; Actually, IV Vancomycin can be given via oral route. It works just as well, and a lot cheaper. The ordered dose may be diluted in water and given to the patient to drink. Common flavoring syrups may be added to the solution to improve taste.
Q; Patient with C. Diff. Colitis is having no improvement with PO Flagyl. You ordered PO Vancomycin. Pharmacy informed you that PO Vancomycin is not available. What would be your trick of trade here?
A; Actually, IV Vancomycin can be given via oral route. It works just as well, and a lot cheaper. The ordered dose may be diluted in water and given to the patient to drink. Common flavoring syrups may be added to the solution to improve taste.
Sunday, February 7, 2010
Sunday February 7, 2010
Picture Diagnosis
CT scan with a mass, round with well defined borders. Note: thick-walled cavity with low attenuation center and contrast-enhanced periphery
Answer: Amebic liver abscess
Amebic liver abscess is the most frequent extraintestinal manifestation of Entamoeba histolytica infection. This infection is caused by the protozoa E histolytica, which ascends the portal venous system. Amebic liver abscess is an important cause of space-occupying lesions of the liver, mainly in developing countries
Picture Diagnosis
CT scan with a mass, round with well defined borders. Note: thick-walled cavity with low attenuation center and contrast-enhanced periphery
Answer: Amebic liver abscess
Amebic liver abscess is the most frequent extraintestinal manifestation of Entamoeba histolytica infection. This infection is caused by the protozoa E histolytica, which ascends the portal venous system. Amebic liver abscess is an important cause of space-occupying lesions of the liver, mainly in developing countries
Saturday, February 6, 2010
Saturday February 6, 2010
Q: All of the following can be use as treatment of hyponatremia in Cerebral salt wasting (CSW) after Subarachnoid hemorrhage except:
A) Hypertonic saline (3%)
B) Normal Saline or Salt tablets
C) Conivaptan (Vaprisol)
D) Fluid restriction
E) fludrocortisone (Florinef)
Answer: D
Overall, the treatment for hyponatremia in CSW is aimed at restoring normovolemia with normal serum sodium levels. Often if the patient is without symptoms, aggressive treatment is unnecessary.
In general, patients with CSW will receive an order for intravenous normal saline. Depending on the sodium and fluid balance and the patient's symptoms, hypertonic 3% saline at an initial rate of 25-50 ml/hour, 325 mg salt tablets, and/or 1-2 mg daily of oral fludrocortisone (Florinef) may also be used.
In SIADH, the preferred treatment in the general population is fluid restriction. However, in patients with aneurysmal Subarachnoid hemorrhage (SAH), great care must be taken because of the risk of vasospasm in these patients. It carries risk of increased incidence of infarction in patients treated for supposed SIADH with fluid restriction. Other types of treatment include the infusion of hypertonic saline in conjunction with loop diuretics or newly available arginine vasopressin antagonist (Conivaptan).
Q: All of the following can be use as treatment of hyponatremia in Cerebral salt wasting (CSW) after Subarachnoid hemorrhage except:
A) Hypertonic saline (3%)
B) Normal Saline or Salt tablets
C) Conivaptan (Vaprisol)
D) Fluid restriction
E) fludrocortisone (Florinef)
Answer: D
Overall, the treatment for hyponatremia in CSW is aimed at restoring normovolemia with normal serum sodium levels. Often if the patient is without symptoms, aggressive treatment is unnecessary.
In general, patients with CSW will receive an order for intravenous normal saline. Depending on the sodium and fluid balance and the patient's symptoms, hypertonic 3% saline at an initial rate of 25-50 ml/hour, 325 mg salt tablets, and/or 1-2 mg daily of oral fludrocortisone (Florinef) may also be used.
In SIADH, the preferred treatment in the general population is fluid restriction. However, in patients with aneurysmal Subarachnoid hemorrhage (SAH), great care must be taken because of the risk of vasospasm in these patients. It carries risk of increased incidence of infarction in patients treated for supposed SIADH with fluid restriction. Other types of treatment include the infusion of hypertonic saline in conjunction with loop diuretics or newly available arginine vasopressin antagonist (Conivaptan).
Friday, February 5, 2010
Friday February 5, 2010
Cialis/Viagra in the treatment of cerebral vasospasm
Background The pathogenesis of cerebral vasospasm is likely to be multifactorial. Strong evidence has indicated that decreasing levels of NO after SAH seem to be important. A PDE-V inhibitor, tadalafil, theoretically increases NO levels. Our study investigated the vasodilatory efficacy of tadalafil on the cerebral arteries with measurement of basilar artery diameters on angiography.
Methods We used 42 male Wistar-Albino rats to test our hypothesis. They were assigned randomly into the following seven groups:
group 1: control (only saline),
group 2: SAH only (killed on day 2),
group 3: SAH + tadalafil (killed on day 2),
group 4: SAH only (killed on day 4),
group 5: SAH + tadalafil (killed on day 4),
group 6: saline + tadalafil (killed on day 2) and
group 7: saline + tadalafil (killed on day 4).
The three different parts of basilar artery diameters were measured angiographically.
Results
Cialis/Viagra in the treatment of cerebral vasospasm
Background The pathogenesis of cerebral vasospasm is likely to be multifactorial. Strong evidence has indicated that decreasing levels of NO after SAH seem to be important. A PDE-V inhibitor, tadalafil, theoretically increases NO levels. Our study investigated the vasodilatory efficacy of tadalafil on the cerebral arteries with measurement of basilar artery diameters on angiography.
Methods We used 42 male Wistar-Albino rats to test our hypothesis. They were assigned randomly into the following seven groups:
group 1: control (only saline),
group 2: SAH only (killed on day 2),
group 3: SAH + tadalafil (killed on day 2),
group 4: SAH only (killed on day 4),
group 5: SAH + tadalafil (killed on day 4),
group 6: saline + tadalafil (killed on day 2) and
group 7: saline + tadalafil (killed on day 4).
The three different parts of basilar artery diameters were measured angiographically.
Results
- There were statistically significant differences between the SAH and SAH groups treated with tadalafil at days 2 and 4.
- Comparison between control and tadalafil groups showed no significant differences. This result indicated that tadalafil has a vasodilatory effect on vasoconstricted arteries, but no effect on normal basilar arteries.
Conclusion Our study results showed that tadalafil has a vasodilatory effect on both acute and chronic periods of cerebral vasospasm. We also concluded that cerebral angiography can be used safely for investigation of cerebral vasospasm in animal studies.
A new approach to the treatment of cerebral vasospasm: the angiographic effects of tadalafil on experimental vasospasm - Acta Neurochirurgica, - Published online: 20 October 2009
Thursday, February 4, 2010
Thursday February 4, 2010
Q: It is well known that Keppra (levetiracetam) is eliminated via renal route. Approximately how much of levetiracetam is removed during a standard 4-hour hemodialysis procedure?
Answer: Approximately 50% of the pool of levetiracetam in the body is removed during a standard 4-hour hemodialysis procedure. Supplemental doses should be given to patients after dialysis.
Clearance of levetiracetam is correlated with creatinine clearance. Total body clearance of levetiracetam is reduced in patients with impaired renal function by 40% in the mild group (CLcr = 50-80 mL/min), 50% in the moderate group (CLcr = 30-50 mL/min) and 60% in the severe renal impairment group (CLcr less than 30 mL/min). In anuric (end stage renal disease) patients, the total body clearance decreased 70% compared to normal subjects.
Q: It is well known that Keppra (levetiracetam) is eliminated via renal route. Approximately how much of levetiracetam is removed during a standard 4-hour hemodialysis procedure?
Answer: Approximately 50% of the pool of levetiracetam in the body is removed during a standard 4-hour hemodialysis procedure. Supplemental doses should be given to patients after dialysis.
Clearance of levetiracetam is correlated with creatinine clearance. Total body clearance of levetiracetam is reduced in patients with impaired renal function by 40% in the mild group (CLcr = 50-80 mL/min), 50% in the moderate group (CLcr = 30-50 mL/min) and 60% in the severe renal impairment group (CLcr less than 30 mL/min). In anuric (end stage renal disease) patients, the total body clearance decreased 70% compared to normal subjects.
Wednesday, February 3, 2010
Wednesday February 3, 2010
Ethics in Medicine - The Rule of Double Effect (RDE)
RDE stipulates that 4 conditions must be met before an act with both good and bad consequences may be morally justified.
Ethics in Medicine - The Rule of Double Effect (RDE)
RDE stipulates that 4 conditions must be met before an act with both good and bad consequences may be morally justified.
- The nature of the act. The act itself must not be intrinsically wrong and not be in a category that is absolutely prohibited.
- The agent's intention. The agent must intend only the good and not the bad effect, although the bad effect, such as respiratory depression following administration of opiates, may be foreseen but not intended.
- The distinction between means and effects. The bad effect, such as death, must not be the means used to bring about the good effect, such as the relief of suffering.
- Proportionality between the good effect and the bad effect. An action is undertaken for a proportionally grave reason for permitting the foreseen bad effect.
Tuesday, February 2, 2010
Tuesday February 2, 2010
Silver Coated ETT?
Objective To determine whether a silver-coated endotracheal tube would reduce the incidence of microbiologically confirmed VAP.
Design Prospective, randomized, single-blind, controlled study conducted in 54 centers in North America. A total of 9417 adult patients were screened between 2002 and 2006. A total of 2003 patients expected to require mechanical ventilation for 24 hours or longer were randomized.
Main Outcome Measures Primary outcome was VAP incidence based on quantitative bronchoalveolar lavage fluid culture with 104 colony-forming units/mL or greater in patients intubated for 24 hours or longer. Other outcomes were VAP incidence in all intubated patients, time to VAP onset, length of intubation and duration of intensive care unit and hospital stay, mortality, and adverse events.
Results :
Silver-Coated Endotracheal Tubes and Incidence of Ventilator-Associated Pneumonia JAMA. 2008;300(7):805-813.
Silver Coated ETT?
Objective To determine whether a silver-coated endotracheal tube would reduce the incidence of microbiologically confirmed VAP.
Design Prospective, randomized, single-blind, controlled study conducted in 54 centers in North America. A total of 9417 adult patients were screened between 2002 and 2006. A total of 2003 patients expected to require mechanical ventilation for 24 hours or longer were randomized.
Main Outcome Measures Primary outcome was VAP incidence based on quantitative bronchoalveolar lavage fluid culture with 104 colony-forming units/mL or greater in patients intubated for 24 hours or longer. Other outcomes were VAP incidence in all intubated patients, time to VAP onset, length of intubation and duration of intensive care unit and hospital stay, mortality, and adverse events.
Results :
- Among patients intubated for 24 hours or longer, rates of microbiologically confirmed VAP were 4.8% (37/766 patients) in the group receiving the silver-coated tube and 7.5% (56/743) (P = .03) in the group receiving the uncoated tube with a relative risk reduction of 35.9%
- The silver-coated endotracheal tube was associated with delayed occurrence of VAP (P = .005)
- No statistically significant between-group differences were observed in durations of intubation, intensive care unit stay, and hospital stay; mortality; and frequency and severity of adverse events
Silver-Coated Endotracheal Tubes and Incidence of Ventilator-Associated Pneumonia JAMA. 2008;300(7):805-813.
Subscribe to:
Posts (Atom)