NEET MDS Lessons
Pharmacology
Loop (High Ceiling) Diuretics
Loop diuretics are diuretics that act at the ascending limb of the loop of Henle in the kidney. They are primarily used in medicine to treat hypertension and edema often due to congestive heart failure or renal insufficiency. While thiazide diuretics are more effective in patients with normal kidney function, loop diuretics are more effective in patients with impaired kidney function.
Agent: Furosemide
Mechanism(s) of Action
1. Diuretic effect is produced by inhibit of active 1 Na+, 1 K+, 2 Cl- co-transport (ascending limb - Loop of Henle).
o This produces potent diuresis as this is a relatively important Na re-absorption site.
2. Potassium wasting effect
a. Blood volume reduction leads to increased production of aldosterone
b. Increased distal Na load secondary to diuretic effect
c. a + b = increase Na (to blood) for K (to urine) exchange which produces indirect K wasting (same as thiazides but more likely)
3. Increased calcium clearance/decreased plasma calcium
o secondary to passive decreases in loop Ca++ reabsorption.
o This is linked to inhibition of Cl- reabsorption.
o This is an important clinical effect in patients with ABNORMAL High Ca++
Tetracycline
Tetracycline is an antibiotic produced by the streptomyces bacterium
Mechanism and Resistance Tetracycline inhibits cell growth by inhibiting translation. It binds to the 30S ribosomal subunit and prevents the amino-acyl tRNA from binding to the A site of the ribosome. This prevents the addition of amino acids to the elongating peptide chain, preventing synthesis of proteins. The binding is reversible in nature.
Example: Chlortetracycline, oxytetracycline, demethylchlortetracycline, rolitetracycline, limecycline, clomocycline, methacycline, doxycycline, minocycline
Source: Streptomyces spp.; some are also semi-synthetic
Spectrum of activity: Broad-spectrum. Exhibits activity against a wide range of Gram-positive, Gram-negative bacteria, atypical organisms such as chlamydiae, mycoplasmas, rickettsiae and protozoan parasites.
Effect on bacteria: Bacteriostatic
Cells become resistant to tetracyline by at least two mechanisms: efflux and ribosomal protection.
Contraindications Tetracycline use should be avoided during pregnancy and in the very young (less than 6 years) because it will result in permanent staining of teeth causing an unsightly cosmetic result.
Tetracyclines also become dangerous past their expiration dates. While most prescription drugs lose potency after their expiration dates, tetracyclines are known to become toxic over time; expired tetracyclines can cause serious damage to the kidneys.
Miscellaneous: Tetracyclines have also been used for non-antibacterial purposes, having shown properties such as anti-inflammatory activity, immunosuppresion, inhibition of lipase and collagenase activity, and wound healing.
Routes of Drug Administration
Intravenous
- No barriers to absorption since drug is put directly into the blood.
- There is a very rapid onset for drugs administered intravenously. This can be advantagous in emergency situations, but can also be very dangerous.
- This route offers a great deal of control in respect to drug levels in the blood.
- Irritant drugs can be administer by the IV route without risking tissue injury.
- IV drug administration is expensive, inconvenient and more difficult than administration by other routes.
- Other disadvantages include the risk of fluid overload, infection, and embolism. Some drug formulations are completely unsafe for use intravenously.
Intramuscular:
- Only the capillary wall separates the drug from the blood, so there is not a significant barrier to the drug's absorption.
- The rate of absorption varies with the drug's solubility and the blood flow at the site of injection.
- The IM route is uncomfortable and inconvenient for the patient, and if administered improperly, can lead to tissue or nerve damage.
Subcutaneous
Same characteristics as the IM route.
Oral
- Two barriers to cross: epithelial cells and capillary wall. To cross the epithelium, drugs have to pass through the cells.
- Highly variable drug absorption influenced by many factors: pH, drug solubility and stability, food intake, other drugs, etc.
- Easy, convenient, and inexpensive. Safer than parenteral injection, so that oral administration is generally the preferred route.
- Some drugs would be inactivated by this route
- Inappropriate route for some patients.
- May have some GI discomfort, nausea and vomiting.
- Types of oral meds = tablets, enteric-coated, sustained-release, etc.
- Topical, Inhalational agents, Suppositories
Azithromycin
Azithromycin is the first macrolide antibiotic belonging to the azalide group. Azithromycin is derived from erythromycin by adding a nitrogen atom into the lactone ring of erythromycin A, thus making lactone ring 15-membered.
Azithromycin has similar antimicrobial spectrum as erythromycin, but is more effective against certain gram-negative bacteria, particularly Hemophilus influenzae.
azithromycin is acid-stable and can therefore be taken orally without being protected from gastric acids.
Main elimination route is through excretion in to the biliary fluid, and some can also be eliminated through urinary excretion
Dissociation constants
|
Local anesthetic |
pKa |
% of base(RN) at pH 7.4 |
onset of action(min) |
|
Lidocaine |
7.8 |
29 |
2-4 |
|
Bupivacaine |
8.1 |
17 |
5-8 |
|
Mepivacaine |
7.7 |
33 |
2-4 |
|
Prilocaine |
7.9 |
25 |
2-4 |
|
Articaine |
7.8 |
29 |
2-4 |
|
Procaine |
9.1 |
2 |
14-18 |
|
Benzocaine |
3.5 |
100 |
- |
CARDIAC GLYCOSIDES
Cardiac glycosides (Digitalis)
Digoxin
Digitoxin
Sympathomimetics
Dobutamine
Dopamine
Vasodilators
α-blockers (prazosin)
Nitroprusside
ACE-inhibitors (captopril)
Pharmacology of Cardiac Glycosides
1. Positive inotropic effect (as a result of increase C.O., the symptoms of CHF subside).
2. Effects on other cardiac parameters
1) Excitability
2) Conduction Velocity; slightly increased in atria & ventricle/significantly
reduced in conducting tissue esp. A-V node and His-Purkinje System
3) Refractory Period; slightly ^ in atria & nodal tissue/slightly v in ventricles
4) Automaticity; can be greatly augmented - of particular concern in ventricle
3. Heart Rate
-Decrease due to 1) vagal stimulation and 2) in the situation of CHF, due to improved hemodynamics
4 Blood Pressure
-In CHF, not of much consequence. Changes are generally secondary to improved cardiac performance.
-In the absence of CHF, some evidence for a direct increase in PVR due to vasoconstriction.
5. Diuresis
-Due primarily to increase in renal blood flow as a consequence of positive inotropic effect (increase CO etc.) Possibly some slight direct diuretic effect.
Mechanism of Action of Cardiac Glycosides
Associated with an interaction with membrane-bound Na+-K+ ATPase (Na-K pump).
Clinical ramifications of an interaction of cardiac glycosides with the Na+ K pump.
I. Increase levels of Ca++, Increase therapeutic and toxic effects of cardiac glycosides
II. Decrease levels of K+ , Increase toxic effects of cardiac glycosides
Therapeutic Uses of Cardiac Glycosides
- CHF
- CHF accompanied by atrial fibrillation
- Supraventricular arrhythmias
ISOPRENALINE
It is beta-receptor stimulant, which stimulates the heart and causes tachycardia.
It relaxes the smooth muscles particularly the bronchial and GIT. It is mainly used in bronchial asthma, in the treatment of shock and as a cardiac stimulant in heart block.
ORCIPRENALINE
Is a potent β-adrenergic agonist.
Receptor sites in the bronchi and bronchioles are more sensitive to the drug than those in the heart and blood vessels.
AMPHETAMINE
increases the systolic and diastolic blood pressure. Amphetamine is a potent CNS stimulant and causes alertness, insomnia, increased concentration, euphoria or dysphoria and increased work capacity.
Amphetamines are drugs of abuse and can produce behavioural abnormalities and can precipitate psychosis.
PHENYLEPHRINE
It is used as a nasal decongestant and mydriatic agent and also in the treatment of paroxysmal supraventricular tachycardia.
UTERINE RELAXANTS (TOCOLYTICS)
ISOXSUPRINE
Isoxsuprine has a potent inhibitory effect on vascular and uterine smooth muscle and has been used in the treatment of dysmenorrhoea, threatened abortion, premature labour and peripheral vascular diseases.