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Category Archives for "Pharmacotherapy"

Neonatal Use of Sodium Bicarbonate

Usual dosing

HCO3 needed (mEq) = 0.3 x Wt (kg) x base deficit (mEq/L)
Administer half of calculated dose, and then assess need for remainder

Usual dosage is 1 to 2 mEq/kg IV/IO slowly, with a max concentration of 0.5mEq/ml

Intravenous: Administer slow IV push. Rapid IV administration (10 mL/min) of hypertonic sodium bicarbonate may lead to serious consequences (hypernatremia, a decrease in CSF fluid pressure, and possible intracranial hemorrhage) in neonates and children younger than 2 years. MAX 8 mEq/kg/day The preferred concentration for slow IV administration in neonates is the 4.2% strength (0.5 mEq/mL). Other recommended pediatric concentrations for infusions are 0.25 mEq/mL and 1 mEq/mL.
Do not administer by the endotracheal route
Monitor ABGs, acid/base status, and serum calcium and potassium

Solution Compatibility: D5W, D10W, and NS.

References: Neofax

Potentials for Tetracyclines in the Treatment of COVID-19

Tetracyclines might be coming to help us to have some hope in a prophylaxis protocol for COVID-19. They work by Inhibition of bacterial protein synthesis by binding with the 30S and possibly the 50S ribosomal subunit of susceptible bacteria; they also cause alterations in the cytoplasmic membrane.

Tetracyclines are approved for treatment of
respiratory tract infections caused by Haemophilus influenzae (upper respiratory tract only),
Klebsiella spp. (lower respiratory tract only),
Mycoplasma pneumoniae (lower respiratory tract only),
Streptococcus pneumoniae, or Streptococcus pyogenes.

TETRACYCLINE

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Dopaminergic Post

how dopamine works?

Dopamine works on both adrenergic and dopaminergic receptors, starting from lower dosing, as you go up effects on adrenergic receptors starts to predominate.

LOWER DOSES
Mainly dopaminergic, working on renal and mesenteric vasodilation

HIGHER DOSES
Same as lower doses, but with beta1-adrenergic action and produce cardiac stimulation; larger doses stimulate alpha receptors

DOSE (ADULT)

ACTION

Low dose
1 to 5 mcg/kg/minute

increased renal blood flow and urine output

Intermediate dose
5 to 10 mcg/kg/minute

same as lower dosing + increased heart rate, cardiac output and contractility

High dose
10 mcg/kg/minute

same as intermediate dosing + vasoconstriction thus increased blood pressure

First Order Vs. Zero Order Kinetics

Trying to understand first order and zero order kinetics

{My own study points.}

First Order Kinetics

  • Higher plasma concentrations means higher metabolization rate.

  • Metabolism is directly proportional with drug concentrations.

  • Drug is eliminated from the body related to the plasma levels.

  • Constant half-life. (Metabolize 50% of drug)

Zero Order Kinetics

  • Higher plasma concentrations doesn't mean higher metabolization rate.

  • Metabolism is independent from plasma concentrations.

  • Drug concentration in the body increase with time disregarding the elimination rate leading to toxic side effects.

  • Constant rate of drug metabolism.

Conclusion:

First order is Good, Zero order is BAD.

First order is occurring with most medications.

First order: constant proportion of the drug is eliminated per unit time.
Zero order: constant amount of the drug is eliminated per unit time.

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