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Pharmacy and
Drugs |
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Anti-Arrhythmics
Anti-Epileptic Drugs
Thrombolytic DrugsReturn
to Peripheral Brain Directory
Anti-Arrhythmics
Classes
IA- quinidine, procainamide, disopyramide, tricyclics
IB- tocainide, mexilitine, phenytoin, lidocaine
IC- flecainide, ecainide, propafenone, moricizine
II- beta blockers
III- sotalol, amiodarone,bretyllium, dofetilide, ibutilide
IV- verapimil, diltiazem
Mechanisms of Action
Anti-Epileptic Drugs
see Seizure Classification
|
Anti-Epileptic Drugs |
| Name |
Dose |
Approved for Monotherapy or Adjunctive therapy |
Approved for Partial Seizures |
Approved for Generalized Seizures |
Seizure Types treated |
Carbamazepine
(Tegretol®, Tegretol XR®) |
|
Monotherapy |
Yes |
Yes |
Tonic-Clonic, Mixed, Psychomotor |
Clonazepam
(Klonopin®) |
|
Monotherapy |
|
|
Absence, Myoclonic, Akinetic |
| Clorazepate |
|
|
Yes |
|
Partial- adjunctive use only |
| Diazepam |
|
|
|
Yes |
Status Epilepticus, adjunct to all convulsive
forms |
| Ethosuximide |
|
|
|
Yes |
Absence |
Felbamate
(Felbatol®) |
|
Monotherapy |
Yes |
Yes |
Add on only for Partial(adult), Partial/Gen
with Lennox-Gastaut in children |
Fosphenytoin
(Cerebyx®) |
|
Monotherapy given IV |
|
|
Tonic-Clonic, Status Epilepticus |
Gabapentin
(Neurontin®) |
|
Adjunctive Therapy |
Yes |
|
Partial w/w/o secondary gen. |
Lamotrigine
(Lamictal®) |
|
Monotherapy or adjunctive |
Yes |
Yes |
Partial(adult), Lennox-Gastaut in children |
Levetiracetam
(Keppra®) |
|
Adjunctive Therapy |
Yes |
|
Partial(adult) |
| Methsuximide |
|
|
|
Yes |
Absence |
Oxcarbazepine
(Trileptal®) |
|
Monotherapy |
Yes |
|
Partial |
| Phenobarbital |
|
Monotherapy |
|
|
Status Epilepticus, Cortical Focal,
Tonic-Clonic |
| Phensuximide |
|
|
|
Yes |
Absence |
Phenytoin
(Dilantin®) |
|
Monotherapy |
|
|
Status Epilepticus, Psychomotor, Tonic-Clonic |
Primidone
(Mysoline®) |
|
Monotherapy |
|
|
Tonic-Clonic, Psychomotor, Focal |
Tiagabine
(Gabatril®) |
|
Adjunctive Therapy |
Yes |
|
Partial |
Topiramate
(Topamax®) |
|
Adjunctive Therapy |
Yes |
Yes |
Partial, Tonic-Clonic, Lennox-Gastaut |
Trimethadione
(Tridione®) |
|
Monotherapy |
|
Yes |
Absence refractory to other drugs |
Valproic Acid
(Depakote®,
Depakote ER®, Depakene®) |
|
Monotherapy |
|
Yes |
Absence |
Zonisamide
(Zonegran®) |
|
Adjunctive Therapy |
Yes |
|
Partial, but works well in myoclonic |
|
Last update 04/23/04 |
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Iron Replacement
Venofer 100 mg: 5ml vial (20mg/ml) mixed
in 100 ml 0.9% NaCl, infused IV over ≥15',
from 1-3x/week x10 doses
Thrombolytic Drugs
see JAMA 2001; 286:442-449
Facts and Comparisons 2004
Alteplase (Activase®): tissue plasminogen
activator of recombinant DNA origin
|
Labeled Uses |
|
Acute ST elevation MI |
Accelerated infusion |
Weight >67 kg |
15 mg bolus IV, then 50 mg over 30', then 35 mg over the
last 60', use with heparin and aspirin |
| Weight <=67kg |
15 mg bolus, then 0.75 mg/kg over 30' (50mg max), then
0.5 mg/kg over 60' (35 mg max), use with heparin and aspirin |
| Death 6.1-7.5%, CVA
1.53-1.79%, IC Hemorrhage 0.81-0.94% all over 30 days, if over 75 yo
then rate of CVA is 4% |
| Pulmonary Embolism |
100 mg IV over 2°, begin heparin when
alteplase complete |
| Acute Ischemic CVA |
0.9 mg/kg IV (max 90 mg) over 60', give 10%
of dose as bolus over 1' initially |
|
Unlabeled Uses |
| Frost Bite of limbs |
0.075 mg/kg/hr for 6 hours |
| Peripheral Arterial Thromboembolism |
0.5-1.0 mg/hr intraarterially |
| Small Vessel Occlusion by Microthrombi |
|
| Unstable Angina |
See above for Acute MI |
| Central Venous Catheter Occlusion |
2 mg injected into the catheter |
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Streptokinase (Streptase®):
enzyme from group C streptococci that forms activator complex with plasminogen
to create plasmin which splits fibrin and fibrinogen. Fibrinogen decreases for
24-36°
|
Labeled Uses |
| Acute ST elevation MI |
1.5 million units IV infusion over 60',
heparin not required |
| Arterial Thrombosis and Embolism |
Loading dose of 250,000 units IV over 30
minutes |
100,000 units/hr for 24-72° |
| DVT |
100,000 units/hr for 72°, follow with heparin without
loading dose |
| Pulmonary Embolism |
100,000 units/hr for 24°, but give for 72° if DVT
present, follow with heparin without loading dose |
| Occluded Arteriovenous Cannulae |
Try to clear with heparinized solution
first, if not effective then instill 250,000 units slowly, clamp, let
sit for 2° then aspirate line and flush with saline and reconnect
cannula. |
|
Death 9.5%, CVA 1.0%, IC Hemorrhage 0.37% |
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Tenecteplase (TNKase®): genetically
modified tPA to try and be more specific for fibrin
|
Give Tenecteplase as a single bolus dose
over 5 seconds very rapidly intravenously in a
line without Dextrose in it, flush any dextrose with
normal saline before giving this drug. |
| Indications: Acute ST
elevation MI |
| Patient Weight (kg) |
Tenecteplase (mg) |
Volume administered (ml) |
| <60 |
30 |
6 |
| >=60 to <70 |
35 |
7 |
| >=70 to <80 |
40 |
8 |
| >=80 to <90 |
45 |
9 |
| >=90 |
50 |
10 |
In studies heparin was
given initially at :
> 67 kg: 5000 unit bolus with 1000 units/hr IV
<=67 kg: 4000 unit bolus with 800 units/hr IV |
| Death 6.18%, Stroke 1.78%,
IC Hemorrhage 0.93% all over 30 days |
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