SNRI
SNRI Serotonin-Norepihephrine reuptake inhibitor Little or no cholinergic or histaminergic effect Duloxetine, Venlafaxine, Desyenlafaxine has more inhibition of Serotonin uptake. Levomilnacipran preferentially block reuptake of norepinephrine Duloxetine (Cymbalta) Highly protein bound Mainly cleared by liver, <1% excreted in urine. Avoid in liver disease, and CrCl <30 Available in generic...
Azithromycin
Brand name: Z-Pak Broader spectrum than erythromycin Long intracellular half life Usual dose for community acquired pneumonia, COPD bacterial exacerbation: 250 mg tab, dispense 6: 2 tab first day, then 1 qd for 4 more days....
NOAC associated bleeding
Time Anticoagulation effect resolved 5 half live since last dose Dabigatran (Pradaxa): 2.5 to 3.5 days Rivaroxaban (Xarelto): 1-2 days Apixaban (Eliquis): 1.5 to 3 days Management Discontinue medication Specific reversal agent Dabigatran: idarucizumab (Praxbind) initial dose 2.5 g iv, repeat in 20 min, total of 5 g Apixaban,...
UsefulLinks
Useful links Drug RxList – Drug Information Neurology Reference Handbook – by Ahmed Koriesh, M.D. Good Rx – Drug price Calculators NIH Stroke scale CHA2DS2VASc Stroke Risk Modified Rankin Scale ASPECTS – Alberta Stroke Program Early CT score Phenytoin Correction RASS – Richmond agitation sedation scale Glasgow Coma Scale...
NOAC
Use of NOAC in atrial fibrillation FXa Inbibitor Eliquis (Apixaban) minimal interaction with cytochrome, 25% excreted renal Usual dose: 5 mg bid Use the lower dose of 2.5 mg bid, if 2 of following: over age 80 Creat over 1.5 weight <60 kg End stage renal disease: 5 mg...
Antiplatelet
Aspirin: • only agent established as effective for early treatment of acute ischemic stroke.• Should be given asap if no bleed• No Aspirin for 24 hours after tpa. Optimal dose not clear, 50 to 325 mg as effective as higher dose For Asian patients with high-risk TIA or minor...
Muscle relaxant
For neck and back pain – based on review by Dr S Orrange – Read original article First line: Acetaminophen, nsaid 9 popular muscle relaxant Methocarbamol (Robaxin) 750 1-2 tab q8h, less sedating, about $15 for 90 pill Cyclobenzaprine (Flexeril) 5 to 10 mg tid, may cause drowsiness, 5...
PCSK9
Alirocumab and evolocumab are fully humanized monoclonal antibodies that bind free plasma PCSK9 Mechanism = Decrease level of PCSK9= less free PCSK9 is available in plasma to bind to LDL-R= Increased LDL-R allow the liver to remove more LDL-C Alirocumab Dose Hyperlipidemia, primary:Initial: 75 mg sq every 2 weeks...
Statin Therapy
For hyperlipidemia, statin decreases the risk of stroke Lipid lowering by other means (eg, fibrates, resins, diet) has no significant impact on stroke incidence May have anti-atherothrombotic properties May have a role in plaque stabilization, reduce inflammation, slow carotid arterial disease progression, improve endothelial function, and reduce embolic stroke...
Pregabalin, Gabapentin
Gaba Analog used with opiod may cause respiratory suppression Pregabalin (Lyrica) Caution when used with opioid and benzo Excreted from urine 90% unchanged Pregnancy: category C Pregabalin Capsule: 25, 50, 75, 100, 150, 200, 225, 300 mg (generic about $30 for 60 cap) Pregabalin solution: 20 mg/ml Lyrica CR:...