Diazepam

Diazepam ( /daɪˈæzɨpæm/), first marketed as Valium ( /ˈvæliəm/) byHoffmann-La Roche, is a benzodiazepine drug. Diazepam is also marketed in Australia as Antenex.


 It is commonly used for treating anxiety, insomnia, seizuresincluding status epilepticus, muscle spasms (such as in cases of tetanus),restless legs syndrome, alcohol withdrawal, benzodiazepine withdrawal andMénière's disease.


Adverse effects
Adverse effects of diazepam include anterograde amnesia (especially at higher doses) and sedation, as well as paradoxical effects such as excitement, rage or worsening of seizures in epileptics. 
Benzodiazepines also can cause or worsendepression. 

Long-term effects of benzodiazepines such as diazepam include tolerance, benzodiazepine dependence and benzodiazepine withdrawal syndrome upon dose reduction; additionally, after cessation of benzodiazepines, cognitivedeficits may persist for at least six months and may not fully return to normal; however, it was suggested that longer than six months may be needed for recovery from some deficits.^[4] 


Diazepam also has physical dependence potential and can cause serious problems of physical dependence with long term use. 

im route

antihypertensive in pregnancy

ACEI 2

ACEI

Captopril 6.25 mg tid 50 mg tid

Enalapril 2.5 mg bid 10 mg bid

Lisinopril 2.5 mg daily 20 mg daily

Quinapril 2.5-5 mg daily 20 mg bid

Perindopril 2 mg daily 8 mg daily

Ramipril 1.25 - 2.5 mg daily 5 mg daily

Fosinopril 10 mg daily 20 mg daily

Major adverse effects of ACEI are:

·      cough

·      hypotension

·      renal insufficiency

·      hyperkalaemia

·      angioedema

beta blocker

Beta blocker in heart failure

In initiating β-blocker therapy the following should be considered:

·        The initial dose should be low.

·        The dose should be slowly titrated upwards till target dose or maximum tolerated dose is achieved.

Contraindications include the following:

·        acute HF

·        bronchial asthma or severe chronic obstructive airway disease

·        symptomatic bradycardia or hypotension

·        second or third degree heart block without a pacemaker

·        a requirement for beta agonist therapy or positive inotropic support

Fondaparinux

Fondaparinux

Fondaparinux: Fondaparinux [fawn-da-PEAR-eh-nux] is the first in

a new class of pentasaccharide anticoagulants that is synthetically

derived with no variable biologic activity.

Usage

·       It is FDA approved for use

in the prophylaxis of deep vein thrombosis that could lead to pulmonary

embolism in patients undergoing hip fracture surgery, hip

replacement surgery, or knee replacement surgery.

·       It is also used

in conjunction with warfarin for the treatment of acute pulmonary

embolism and acute deep vein thrombosis.

Mode of action

·       This agent selectively

inhibits only Factor Xa.

·       By selectively binding to antithrombin III,

fondaparinux potentiates (300- to 1000-fold) the innate neutralization

of Factor Xa by antithrombin III.

·       It is well absorbed from the

subcutaneous route with a predictable pharmacokinetic profile.

Monitoring

Fondaparinux requires less monitoring than heparin.

Fondaparinux

is eliminated in urine mainly as unchanged drug with an elimina tion

half-life of 17 to 21 hours.

Contraindications

·       It is contraindicated in patients with

severe renal impairment (creatinine clearance less than 30 mL/min).

Side effects

Bleeding episodes are the major side effect of fondaparinux therapy.

Thrombocytopenia, in particular Type II thrombocytopenia, is not a

problem, and this agent may be used in patients with HIT.

ACEI

ACEI in heart failure

In the initiation of ACEI, the following steps are recommended:

Care should be exercised in the following patients for whom referral to a specialist may be considered.

·        SBP <100mmHg

·        Creatinine >250 μmol/L (normal 130 micromol and less)

Avoid excessive diuresis before treatment. If patients are on large doses of diuretics, the blood pressure and renal function should be monitored.

Start with a low dose. Patients should not remain on the initial low dose indefinitely. The dose should be increased gradually to the target dose (Table

VI) or maximum tolerated dose.

What to monitor?

·        Monitor blood urea, creatinine and serum potassium at 7-14 days, especially in patients with impaired renal function.

·        If the rise in serum creatinine level is

      >20% compared to baseline, then ACEI therapy may      need to be stopped.

Things to avoid

·        Avoid potassium sparing diuretics during initiation of therapy.

·        Avoid non steroidal anti-inflammatory drugs

Major adverse effects of ACEI are:

·        cough

·        hypotension

·        renal insufficiency

·        hyperkalaemia

·        angioedema

progestogen only pills

Pop(progestogen only pills)

What?

Example

·       --Noriday

Mode of action

Side effects

·       menstrual irregularities (see also notes

·       above);

·       nausea, vomiting,

·       headache, dizziness,

·       breast discomfort, depression, skin disorders, disturbance of

·       appetite, weight changes,

·       changes in libido

·       Breast cancer

Contraindication?

·       pregnancy;

·       undiagnosed vaginal

·       bleeding;

·       severe arterial disease;

·       liver tumour;

·       acute

·       porphyria

·       history of breast cancer but

·       can be used after 5 years if no evidence of disease and

·       non-hormonal contraceptive methods unacceptable

Dose

·       . 1 tablet daily at same time each day, starting on day 1of cycle then continuously;

·       if administration delayed for 3 hours (12 hours for Cerazettec) or more it should be regarded as a ‘missed pill’, see notes above

example- noriday

Syntometrine

http://en.wikipedia.org/wiki/Oxytocin/ergometrine

http://www.mims.com.my/Malaysia/drug/info/Syntometrine/Syntometrine%20inj

Syntometrine

What?

·        Oxytocin/ergometrine (trade name Syntometrine) is an obstetric combination drug.

·        The components are synthetically produced oxytocin, a human hormone produced in the hypothalamus, and ergometrine, an alpha-adrenergic, dopaminergic and serotonin (5-HT₂) receptor agonist.

·        Both substances cause the uterus to contract.

Indication?

 An injection of syntometrine is given in the third stage of labor, just after the birth of the child, to facilitate delivery of the placenta^[1] and to prevent postpartum hemorrhage^[1] by causing smooth muscle tissue in the blood vessel walls to narrow, thereby reducing blood flow.

Interaction with other drugs

Prostaglandins increase the effect of oxytocin and vice-versa. The contractions should be carefully monitored if oxytocin is given after a prostaglandin dose.

Contraindications

Syntometrine should not be used in:

§  Allergy to one or any of its ingredients^[1]

§  First stage of labor^[1]

§  Second stage of labor before crowning of the baby's head^[1]

§  Uterine atony during labor^[1]

§  Severe kidney disorders^[1]

§  Severe liver disorders^[1]

§  Severe heart disorders^[1]

§  Vascular diseases^[1]

§  Severe hypertension^[1]

§  Pre-eclampsia or eclampsia^[1]

§  Sepsis^[1]

It should be used with caution in:

§  Decreased kidney function^[1]

§  Decreased liver function^[1]

§  Mild heart disease^[1]

§  Mild hypertension)^[1]

§  Porphyria^[1

Possible side effects include:

§  Nausea and vomiting^[1][2]

§  Abdominal pain,^[1] feeling different than labor pains^[2]

§  Headache^[1][2]

§  Dizziness^[1][2]

§  Skin rashes^[1], itching or hives^[2]

§  Swelling of face, lips, tongue or other body parts^[2]

§  Hypertension^[1]

§  Arrhythmias (abnormal heart beats)^[1][2]

§  Chest pain^[1][2]

§  Fall in blood pressure (causing dizziness and lightheadedness)^[1]

§  Difficulty in breathing

Contents:

Per mL Synthetic oxytocin 5 iu, ergometrine maleate 0.5 mg

Dosage

Active management of the 3rd stage of labour :

·        1 mL IM following delivery of the anterior shoulder or immediately after delivery of the child. 

Prevention & treatment of postpartum haemorrhage  :

·        1 mL IM following expulsion of the placenta or when bleeding occurs; may be repeated after 2 hr. Total dose w/in 24 hr should not exceed 3 mL.