Drugs

What factors determine if a drug is effectively removed by extracorporeal therapies? There are clinical situations where an overdose or intoxication with certain drugs warrants removal with an extracorporeal therapy such as hemodialysis (HD) or continuous venovenous hemofiltration (CVH). Efficient drug removal by extracorporeal therapies is determined primarily by: • Drug characteristics associated with efficient removal …

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Risk of lactic acidosis with metformin acute or CKD What is the risk of lactic acidosis with metformin therapy in patients with acute or CKD? Metformin can be rarely associated with lactic acidosis, with an incidence of 3 to 10 per 100,000 person-years. Metformin binds to complex I of the mitochondrial respiratory chain, inhibiting oxidative …

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Which drugs cause crystalline induced nephropathy? Acute Kidney Injury from drug-induced crystalline nephropathy requires the presence of a significant amount of drug crystal within tubular lumens that favor crystal insolubility in a low urinary flow state. This is accomplished by supersaturation of constituent molecules, low or high urine pH (depending on the drug), volume depletion, …

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Emergency drugs for severe agitation in the acute setting What emergency medications should be considered for severe agitation in the acute setting?  A commonly used emergency treatment of agitation (sometimes called the B52 cocktail ) is a combination of diphenhydramine (Benadryl) 50 mg (for dystonia prophylaxis) per os or intramuscularly, haloperidol 5 mg, and lorazepam 2 mg. …

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Which benzodiazepines are metabolized by glucuronidation and may be preferred in situations in which liver function may be compromised (such as alcoholic cirrhosis)?  Lorazepam, temazepam, and oxazepam are metabolized by glucuronidation and not by the hepatic CYP450 system.

First line therapies for PTSD What are the recommended first-line therapies for PTSD? What pharmacotherapeutic options are FDA approved for treatment of PTSD? What medications may be effective at reducing the nightmares associated with PTSD?  PTSD treatment guidelines typically recommend prolonged exposure therapy, cognitive processing therapy, and/or trauma-focused CBT as first-line treatments with pharmacotherapy as …

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Treatment of OCD What are the known effective pharmacologic interventions for OCD?  Clomipramine is a serotonin reuptake inhibitor (SRI), with a side-effect profile similar to TCAs (anticholinergic, antihistaminergic, alpha-blocking) and also including SSRI-like anorgasmia, which has established efficacy in OCD. Several SSRIs (fluoxetine, fluvoxamine, paroxetine, and sertraline) are FDA approved for OCD, and other SSRIs …

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