Marlene Hernandez

Antidepressants

šŸŒ§ļøĀ Major depressive disorder (MDD) is a mood disorder characterized by persistent feelings of sadness and loss of interest that interferes with normal daily functioning.ā 
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ā­ļøĀ The exact chemical basis for depression is poorly understood but is thought to be linked to decreased levels of the neurotransmitters, serotonin, dopamine, and norepinephrine. This cause is also known as the monoamine hypothesis.ā 
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šŸ‘‰šŸ»Ā Because of this, the drugs developed to treat MDD selectively target the reuptake of serotonin and norepinephrine, increasing levels of these neurotransmitters in the synapse and enhancing NT signaling.ā 
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ā­ļøĀ SSRIs are generally first-line due to their improved tolerability compared to the others (TCAs and MOAIs) and relative safety in cases of overdose.ā 
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ā­ļøĀ Studies have shown equivalent efficacy among antidepressants, therefore the initial choice is made empirically based on patient factors and the nuances of each drug.ā 

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5-HT3 Inhibitors

šŸ’Š 5-HT3 Inhibitors (ex: ondansetron) ā 
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šŸ¤¢šŸ¤® Nausea and vomiting are two of the most common presenting complaints ā 
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5-HT3 inhibitors (such as ondansetron) are one of the top 200 drugs prescribed and are used for the prevention of:ā 
šŸŒŸĀ chemotherapy-induced nausea and vomitingā 
šŸŒŸĀ radiation-induced nausea and vomitingā 
šŸŒŸĀ postoperative nausea and vomitingā 
šŸŒŸĀ off-label for nausea and vomiting associated with pregnancy

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Vancomycin ā 

šŸ’Š Vancomycin belongs to a class of antibiotics called glycopeptides. Drugs in this class are composed of a cyclic peptide bound by two sugar molecules (glycogen), hence the name glycopeptides! ā 
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šŸŒŸ MOA: binds to D-alanyl-D-alanine on the outer surface of cell membranes preventing cross-linking. This interferes with cell wall synthesis and results in bacterial cell death. ā 
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šŸ§  Another way to think of it: cell walls are like LEGO pieces linking together. The more that are linked, the stronger the structure is. Vancomycin prevents this cross-linking leading to an unstable structure. ā 
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šŸŒŸ Vancomycin = think mainly gram-positive coverage including MRSA! (gram-negatives do NOT have a thick cell wall and lack the D-ala-D-ala sequence, making vancomycin useless against them)ā 

šŸŒŸ NOTE: Recently, the term ā€œred man syndrome (RMS)ā€ has been replaced and is now recognized as ā€œvancomycin flushing syndromeā€ or “vancomycin infusion reaction”. 
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Anion Gap Acidosis -

Mind the Gap- HAGMA

Anion Gap Acidosis -
ā­ļø High anion gap metabolic acidosis (HAGMA) occurs when the body produces too much acid, or when the kidneys are not removing enough acid from the body.ā 
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šŸ’Š Several drugs and toxins have been implicated as direct or indirect causes of HAGMA. The three most common ones to consider are methanol, ethylene glycol and salicylates.ā 
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šŸŒ¬ļø Symptoms are generally non-specific, with dyspnea being common secondary to stimulation of the central respiratory center. Screening for toxic ingestions, including over-ingestion of aspirin and acetaminophen, is important. ā 
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šŸŒŸ Additionally, screening for features suggestive of diabetes (e.g., polyuria, polydipsia, polyphagia) or renal failure (e.g., nocturia, pruritus, anorexia) is essential.ā 
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šŸŒŸ Primary treatment of high anion gap metabolic acidosis requires correction of the underlying cause

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Antiretrovirals

Antiretrovirals

Antiretrovirals

ā­ This is a great way to remember the names of antiretrovirals ā­ Antiretroviral medications are used to treat HIV by blocking different stages of the virus’s life cycle (e.g., blocking entry into the host’s CD4 lymphocyte, inhibiting viral DNA from replicating, etc.)ā  ā šŸ˜– However, learning the names of antiretroviral medications is horribly difficult. There are lots of drugs, with a dizzying array of names, abbreviations, and combination tablets.ā  Hopefully, this will help you not to completely BLANK on which drug belongs to which type of antiretroviral! šŸ¤“

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IV Fluids Review

šŸ’¦ ā  IV fluids – What the tonic? āœļøThe human body is composed of 60% water šŸ’¦ ā  -Two-thirds of it is available INTRAcellularly (space INside cells)ā  -One-third of it is stored EXTRAcellularly (EXTERNAL space in blood vessels and around cells)ā  ā  ā­ There are different types of fluids with varying chemical compositions of salt and electrolytes that are designed to bring fluid into cells or keep fluid within the bloodstream.ā  ā  šŸ”‘ Key Tips:ā  -Water flows where sodium (or particles) goes!ā  -Solutions want to have the same ratio or balance of solvents (water) to solute (particles such as salt)ā  -Water will flow from an area of low particles to an area of high particlesā  -Semi-permeable membranes allow water to pass through but not particlesā  ā  ā­ First, think of the starting point as the space within blood vessels (or intravascular space) since IV fluids are infused directly into the bloodstream šŸ©øā  ā  ā­ ISOtonic fluids: ā€œISOlated in the vasculatureā€ā  -Equal amounts of water and particles so there is no movement between the compartmentsā  -Water from IV fluids stay ISOlated in the vasculature ā€“ used in situations where there is fluid loss and replacement is needed (ex: hemorrhage, diarrhea, vomiting)ā  -Examples include: 0.9% sodium chloride (normal saline), dextrose 5% in water (D5W), lactated ringer (LR)ā  ā  ā­ HypOtonic fluids: ā€œOut of the vasculatureā€ā  -Low amounts of particles compared to waterā  -Water flows OUT of the vascular into the cellsā  -Used in situations where we have intracellular dehydration (ex: DKA, HHS)ā  -Examples include: 0.45% sodium chloride (1/2 normal saline), 2.5% dextrose in water ā  ā  ā­ HypErtonic fluids: ā€œEnter the vasculatureā€ā  -High amounts of particles compared to water ā  -Water ENTERS the highly concentrated vasculature from cellsā  -Used in situations where there are swollen cells (ex: cerebral edema) or hyponatremiaā  -Examples include: 3% sodium chloride (hypertonic saline), dextrose 10% in water (D10W) ā 

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Vasopressors and inotropes

Vasopressors and Inotropesā 

Vasopressors and inotropes
Vasopressors and Inotropesā 

Vasopressors and Inotropesā 
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Vasopressors and inotropes OH NO! šŸ™‡šŸ»ā€ā™€ļø These medications are commonly used in the critical care setting in patients with shock (or those with extremely low blood pressure) leading to end-organ damage (acute kidney injury, increased LFTs, etc.). ā 
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šŸ‘‰šŸ» Vasopressors are drugs that cause vasoconstriction, therefore increasing mean arterial pressure (MAP). Vaso refers to blood vessels and pressor means to put pressure on or constrict making up the word ā€“ VASO-pressor. šŸ©øā 
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Examples of vasopressors include:ā 
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ā­ Norepinephrineā 
ā­ Epinephrineā 
ā­ Vasopressinā 
ā­ Phenylephrineā 
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šŸ‘‰šŸ» Inotropes are drugs that affect cardiac contractility (or the force of muscular contractions). They can also be used as chronotropes (drugs that increase heart rate). THINK: Ino = strength; Chrono = time. Some vasopressors may also have effects on contractility and are called inopressors. ā 
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Examples of positive inotropic agents include: ā 
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ā­ Milrinoneā 
ā­ Dobutamineā 
ā­ Dopamineā 
ā­ Isoproterenoneā 
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šŸ§  With the many different types of vasopressors and inotropes, it is important to understand how they work to use them effectively. Choosing the wrong agent or using it inappropriately, can harm the patient. ā 

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IV chemotherapy agents with high emetic risksā 

šŸŒŸ Chemotherapy agents are notorious for causing many side effects such as nausea and vomiting and are classified according to their emetic risk. šŸ¤¢šŸ¤®ā  ā  šŸŒŸ High-risk agents cause emesis in more than 90% of patients and require pre-treatment with medications such as 5HT3 antagonists (ex: ondansetron), neurokinin-1 receptor antagonists (ex: aprepitant), and dexamethasone. ā  ā  šŸ§  A fun way to learn which IV chemotherapy agents have high emetic risk – think of this story: ā  ā  ‘The car had motion sickness and threw up, making splat sounds”ā  ā  šŸ¤” Can you imagine it in your head? This story will help you remember the medications DACARbazine, Mechlorethamine, Streptozotocin, and ciSPLATin. ā  ā  šŸŒŸ Other IV chemotherapy agents that have high emetic risk at higher doses or in combination with other medications include:ā  ā  -Carboplatin AUC>4ā  -Carmustine >250 mg/m2ā  -Cyclophosphamide >1500 mg/m3ā  -Doxorubicin >60 mg/m2ā  -Epirubicin >90 mg/m2ā  -Ifosfamide >2 g/m2/doseā  -AC (any combo that contains an anthracycline + cyclophosphamide)

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Antipsychotics

šŸ’Š Antipsychotics, also known as neuroleptics, are a class of medications primarily used to manage psychosis in schizophrenia or bipolar disorder, hence the name anti-PSYCHOTICS or anti-PSYCHOSIS (including delusions, hallucinations, paranoia, or disordered thought) šŸ‘¹ā  ā  They are broken down into two generations which differ by their side effect profiles: ā  ā  1ļøāƒ£ 1st generation also called typical antipsychotics are associated with significant extrapyramidal side effects (movement disorder). ā  2ļøāƒ£ 2nd generation also called atypical antipsychotics have decreased risks of EPS side effects as compared to 1st generation antipsychotics but are associated with significant weight gain and the development of metabolic syndrome.ā  ā  In addition, all of the antipsychotics block the following receptors with varying degrees leading to the common side effects seen: ā  ā  ā­ Dopamine: EPS symptomsā  ā­ Alpha: hypotensionā  ā­ Muscarinic: anticholinergic side effects ā­ Histamine: sedationā  ā  šŸ§  MOA: In schizophrenia, dopamine is tied to hallucinations and delusions. Certain areas in the brain that ‘run off’ of dopamine may become overactive leading to symptoms of psychosis. Both generations block dopamine receptors, but second generations tend to act on serotonin receptors as well.

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