BradyKinin

An endogenous vasodilator occurring in blood vessel walls. 
At least two distinct receptor types, B1 and B2, appear to exist for BradyKinin

Roles of bradykinin:

1) Mediator of inflammation and pain.
2) Regulation of microcirculation.
3) Their production is interrelated with clotting and fibrinolysin systems.
4) Responsible for circulatory change after birth.
5) Involved in shock and some immune reactions.

Itraconazole:

The drug may be given orally or intravenously.

Aminoglycoside

Aminoglycosides are a group of antibiotics that are effective against certain types of bacteria. They include amikacin, gentamicin, kanamycin, neomycin, netilmicin, paromomycin, streptomycin, and tobramycin. Those which are derived from Streptomyces species

Aminoglycosides work by binding to the bacterial 30S ribosomal subunit, causing misreading of t-RNA, leaving the bacterium unable to synthesize proteins vital to its growth.

Aminoglycosides are useful primarily in infections involving aerobic, Gram-negative bacteria, such as Pseudomonas, Acinetobacter, and Enterobacter. In addition, some mycobacteria, including the bacteria that cause tuberculosis, are susceptible to aminoglycosides. Streptomycin was the first effective drug in the treatment of tuberculosis, though the role of aminoglycosides such as streptomycin and amikacin have been eclipsed (because of their toxicity and inconvenient route of administration) except for multiple drug resistant strains.

Infections caused by Gram-positive bacteria can also be treated with aminoglycosides, but other types of antibiotics are more potent and less damaging to the host. In the past the aminoglycosides have been used in conjunction with penicillin-related antibiotics in streptococcal infections for their synergistic effects, particularly in endocarditis.

Because of their potential for ototoxicity and renal toxicity, aminoglycosides are administered in doses based on body weight. Blood drug levels and creatinine are monitored during the course of therapy.

There is no oral form of these antibiotics: they are generally administered intravenously, though some are used in topical preparations used on wounds.

Aminoglycosides are mostly ineffective against anaerobic bacteria, fungi and viruses.

Phenoxymethylpenicillin (penicillin V) Phenoxymethylpenicillin, commonly known as penicillin V, is the orally-active form of penicillin. It is less active than benzylpenicillin

Indications:

infections caused by Streptococcus pyogenes, tonsillitis, pharyngitis, skin infections, prophylaxis of rheumatic fever, moderate-to-severe gingivitis (with metronidazole)

Meperidine (Demerol)

Meperidine is a phenylpiperidine and has a number of congeners. It is mostly effective in the CNS and bowel

• Produces analgesia, sedation, euphoria and respiratory depression.
• Less potent than morphine, 80-100 mg meperidine equals 10 mg morphine.
• Shorter duration of action than morphine (2-4 hrs).
• Meperidine has greater excitatory activity than does morphine and toxicity may lead to convulsions.
• Meperidine appears to have some atropine-like activity.
• Does not constrict the pupils to the same extent as morphine.
• Does not cause as much constipation as morphine.
• Spasmogenic effect on GI and biliary tract smooth muscle is less pronounced than that produced by morphine.
• Not an effective antitussive agent.
• In contrast to morphine, meperidine increases the force of oxytocin-induced contractions of the uterus.
• Often the drug of choice during delivery due to its lack of inhibitory effect on uterine contractions and its relatively short duration of action.
• It has serotonergic activity when combined with monoamine oxidase inhibitors, which can produce serotonin toxicity (clonus, hyperreflexia, hyperthermia, and agitation)

 Adverse reactions to Meperidine

• Generally resemble a combination of opiate and atropine-like effects.

- respiratory depression, - tremors, - delirium and possible convulsions, - dry mouth

• The presentation of mixed symptoms (stupor and convulsions) is quite common in addicts taking large doses of meperidine.

Estimation of the risk of anesthesia (American Society of Anesthesiologists scale)

• ASA 1: healthy patient.

• ASA 2: patient with stable, treated illness like arterial hypertension, diabetes melitus, asthma bronchiale, obesity

• ASA 3: patient with systemic illness decreasing sufficiency like heart illness, late infarct

• ASA 4: patient with serious illness influencing his state like renal insuficiency, unstable hypertension, circulatory insuficiency

• ASA 5: patient in life treatening illness

• ASA 6: brain death- potential organ donor