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Uterine Relaxant Drugs

👶🏻 Preterm labor occurs when labor begins too early. If this happens before the 37th week of gestation, the fetal organs, especially the lungs, might not be fully developed.⁠

💊 In these cases, labor can be suppressed with uterine relaxants that relax the uterine muscle and slow down contractions for up to 48 hours. It gives the fetus a few more days in the uterus as a corticosteroid is given to speed up the development of a preterm infant’s lungs. Steroids help the lungs mature and may promote the production of surfactant, a substance that prevents the collapse of alveoli (small sacs in the lungs where the air is exchanged). ⁠

💊 Uterine relaxants are also called tocolytics (toco = childbirth, lytic = terminate) and include several different types of drugs. ⁠

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Antibiotic Renal Dosing

Antibiotics are commonly used to treat infections. When considering what dose to prescribe to a patient, it is important to evaluate the patient’s renal function as many antibiotics are excreted by the kidney.⁠ ⁠ It is recommended to study the list of antibiotics that do NOT require renal dose adjustments rather than a list of the ones that do (as it can get very long and overwhelming). ⁠

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Diuretic Classes

There are 5 main types of diuretic classes with different mechanisms of action, site of action, and side effect profiles. ⁠ ⁠ 1) Loop diuretics work on the loop of Henle (as the name implies)⁠ 2) Osmotic diuretic work on the glomerulus⁠ 3) Thiazides work on distal convoluted tubule⁠ 4) Carbonic anhydrase work on the proximal tubule⁠ 5) Potassium-sparing diuretics (aldosterone antagonists and sodium channel blockers) work on the distal convoluted tubule⁠ and collecting ducts

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ketamine mnemonic

Ketamine Properties

ketamine mnemonic
📖 Ketamine is a medication primarily used for starting and maintaining anesthesia. It induces dissociative anesthesia, a trance-like state providing pain relief, sedation, and amnesia.⁠ ⁠ ⭐ The distinguishing features of ketamine anesthesia are preserved breathing and airway reflexes, stimulated heart function with increased blood pressure, and moderate bronchodilator.⁠

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Respiratory Fluoroquinolones

Fluoroquinolones are highly effective antibiotics with many advantageous pharmacokinetic properties including high oral bioavailability, large volume of distribution, and broad-spectrum antimicrobial activity. Some antibiotics in this class include moxifloxacin, levofloxacin, and ciprofloxacin. ⁠⠀ ⁠⠀ 💊 Fluoroquinolones act by inhibiting two enzymes involved in bacterial DNA synthesis, both of which are DNA topoisomerases that human cells lack and that are essential for bacterial DNA replication, thereby enabling these agents to be both specific and bactericidal.⁠⠀

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Metformin (Glucophage)⁠⠀

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Pharmacokinetics in Pregnancy

🤰🏻 Choosing an effective yet safe antibiotic during pregnancy requires you to weigh the risks and benefits. It can often be a gray area based on limited clinical studies in pregnant patients. ⁠⠀
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Some tips include:⁠⠀
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👉🏻 Only using antibiotics when no other treatment options are available ⁠⠀
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👉🏻 Avoid prescribing antibiotics during the first trimester if possible. ⁠⠀
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👉🏻 Chose a safe medication with available clinical studies that have been tested in pregnancy⁠⠀
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👉🏻 Dose at the lowest possible amount proven effective.⁠⠀

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Calcium Channel Blockers (Mechanism of Action)

💊 Calcium channel blockers (CCBs) are used in the treatment of many cardiovascular conditions including hypertension and angina. They are divided into subclasses, non-dihydropyridines, and dihydropyridines and differ by their pharmacokinetic properties, clinical uses, response, and selectivity. ⁠ ⁠ 💊 The name of this class, calcium channel blockers, hints at its mechanism of action – inhibits the entry of calcium into cells of the cardiac and peripheral vascular smooth muscles. ⁠ ⁠ 🗒️ Calcium entry into L-type channels of cardiac and peripheral vascular cells is needed for them to contract or constrict more strongly. ⁠ ⁠ 🗒️ By blocking calcium entry, calcium channel blockers cause:⁠ 👉🏻 peripheral vascular smooth muscle relaxation (decreases blood pressure)⁠ 👉🏻 decreased myocardial contractility (decrease myocardial demand making them effective in angina)⁠ 👉🏻 decrease heart rate and conduction velocity (useful in arrhythmias). ⁠

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Entresto® (Sacubitril/Valsartan)

📖 Angiotensin receptor-neprilysin inhibitors (ARNI) is a new class of heart failure medications. ⁠

☝🏻 The first drug in this class is Entresto® (sacubitril/valsartan). It is a combination medication comprised of a neprilysin inhibitor (sacubitril) and an angiotensin II receptor blocker (valsartan). ⁠

💊 Sacubitril is a prodrug that inhibits neprilysin thus preventing it from breaking down natriuretic peptides. This mechanism leads to an increase in vasodilation and diuresis as levels of natriuretic peptides rise. ⁠

💊 Valsartan directly blocks angiotensin II receptors inhibiting angiotensin II from binding onto the receptors and causing vasoconstriction and aldosterone release.⁠

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Antibiotics that cover Pseudomonas

Pseudomonas is a type of bacteria (bug) that is found commonly in soil and in water. Of the many different types of Pseudomonas, the one that most often causes infections in humans is called Pseudomonas aeruginosa, which can cause infections in the blood, lungs (pneumonia), or other parts of the body after surgery.⁠ ⁠ 🔺 Pseudomonas aeruginosa treatment has become increasingly difficult as bacteria become more resistant to the available antibiotics on the market. If they develop resistance to several types of antibiotics, these germs can become multidrug-resistant.⁠

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Antibiotics that cover anaerobes

Anaerobic bacteria are bacteria that do not live or grow when oxygen is present. In humans, these bacteria are most commonly found in the gastrointestinal tract. ⁠ ⁠ 🔺 They play a role in conditions such as appendicitis, diverticulitis, and perforation of the bowel so it is important to make sure we have adequate anaerobic coverage when empirically treating these infections. ⁠ ⁠ 💊 There are several antibiotics that cover anaerobes in addition to other bacteria. ⁠

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Morphine Side Effects

💊 Morphine is considered the classic opioid analgesic with which other painkillers are compared. Like other medications in this class, morphine has an affinity for delta, kappa, and mu-opioid receptors.⁠ ⁠ 💊 This drug produces the majority of its analgesic effects by binding to the mu-opioid receptor within the central nervous system (CNS) and the peripheral nervous system (PNS).⁠ ⁠ 💊 Morphine can potentially be a lethal medication when not used properly. It causes a host of symptoms related to depression of the CNS. Severe respiratory depression is the most feared complication of morphine in cases of overdose. Immediate injection of naloxone is required to reverse the effects of morphine.⁠

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