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
📖 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.
⭐ Methicillin-resistant Staphylococcus aureus (MRSA) is an infection caused by Staphylococcus (staph) bacteria that has an oxacillin minimum inhibitory concentration (MIC) of greater than or equal to 4 micrograms/mL.
⭐ MRSA infection is one of the leading causes of hospital-acquired infections and is commonly associated with significant morbidity, mortality, length of stay, and cost burden.
⭐ MRSA infections can be further divided into hospital-associated (HA-MRSA) infections and community-associated (CA-MRSA) infections. They differ not only in respect to their clinical features and molecular biology but also to their antibiotic susceptibility and treatment
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.
Atypical bacteria are bacteria that do not color with gram-staining but rather remain colorless, they are neither Gram-positive nor Gram-negative (they’re atypical! 😛). These include Chlamydiaceae, Legionella, and Mycoplasma; though Rickettsiaceae are also often considered atypical bacteria.
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.
Tuberculosis (TB) is caused by Mycobacterium tuberculosis (aerobic, non-spore forming bacillus). Active TB is transmitted by aerosolized droplets (sneezing, coughing, talking, etc.) and is highly contagious.
Active disease treatment is divided into two treatment phases, initial and continuation. To avoid treatment failure due to resistance, the preferred initial treatment consists of a 4 drug regimen of rifampin, isoniazid, pyrazinamide, and ethambutol (RIPE).
These 4 drugs are taken for about 8 weeks during the initiation phase. In the continuation phase, the regimen is narrowed based on susceptibilities.
Antibiotics can be bacteriostatic (static=unmoving) meaning that the agent prevents the growth of bacteria or bactericidal (rhymes with suicidal) meaning that it kills bacteria.
Keep in mind that bacteriostatic and bactericidal categorizations in clinical practice are not absolute and can vary depending on the dose and what is being treated.
❤️ Cardioselective beta-blockers work on the beta-1 receptors. Beta-1 receptors primarily are found in cardiac tissues whereas beta-2 receptors are located in the lungs (remember: 1 heart, two lungs).
❤️ Cardioselective beta-blockers exert their effect by binding to the beta-1 receptor sites selectively and inhibiting the action of epinephrine and norepinephrine on these sites. They are often preferred in patients with respiratory disease as they are less likely to cause constriction of airways or peripheral vasculature.
Brand/generics can be overwhelming to learn but a good tip is to first group the drugs into classes, starting with the ACE-inhibitors. ACE-inhibitors are antihypertensive medications that all end in ‘-pril’.
👉🏻 Cholinergic muscarinic agonists are drugs that bind to and activate muscarinic cholinergic receptors and increase the activity of the parasympathetic nervous system. They are most commonly used when it is desirable to increase smooth muscle tone, especially in the GI tract, urinary bladder, and eye. They may also be used to reduce heart rate.
👉🏻 Direct cholinergic agonists work by resisting acetylcholinesterase, thus preventing its breakdown. Drugs in this class include bethanechol, carbachol, and methacholine, and pilocarpine.
👉🏻 Indirect cholinergic agonists work by inhibiting the acetylcholinesterase enzyme preventing the degradation of acetylcholine. Drugs in this class include neostigmine, physostigmine, galantamine, donepezil, and rivastigmine.
Ever been on corticosteroids before? Due to the activation of the sympathetic system (“fight or flight”), your body responds with an increase in blood pressure, blood sugar, mood changes, and blood volume. With short term use, side effects are minor but can vary depending on their dose and how long they are taken.
👉🏻 Drugs that are inducers increase CYP450 enzyme activity by increasing enzyme synthesis.
👉🏻 A drug also may be metabolized by the same CYP450 enzyme that it induces. Carbamazepine (Tegretol), a potent enzyme inducer, must be initiated at a low dose and then increased at weekly intervals as its half-life gradually decreases over time.
The CYP450 enzymes are essential for the production of numerous agents including cholesterol and steroids. Additionally, these enzymes are necessary for the detoxification of foreign chemicals and the metabolism of drugs.
Drugs that are CYP450 inhibitors block the metabolic activity of one or more of the CYP450 enzymes. The extent to which an inhibitor affects the metabolism of a drug depends upon factors such as the dose and the ability of the inhibitor to bind to the enzyme.
Diuretics work to enhance sodium and water excretion through 4 main sites on the nephron.
1– Proximal convoluted tubule: Mannitol and acetazolamide (extends into the descending loop of Henle)
2– Ascending loop of Henle: loop diuretics
3– Distal convoluted tubule: thiazides
4– Collecting ducts: Potassium-sparing diuretic (e.g., spironolactone and triamterene)