Medical Concepts

 IV DRUG THERAPY- SELECTION OF EQUIPMENTS AND INSERTION OF CATHETER Equipment: Canula selection: Select cannula based on purpose and duration of use and age of patient. Consider risk of infection and extravasation. Cannula made from polyurethanes are associated with decreased risk of phlebitis. Steel needles have higher risk of extravasation and should be avoided where tissue necrosis is likely if extravasation occurs.       2. Skin Prep: Antiseptic solution, use an aqueous based alternative if there is a known allergy to alcohol.       3. Other Equipment: Intravenous solution as ordered, torniquet, giving set, IV stand/pole, infusion pump, transparent occlusive dressing, tape or similar to secure cannula, gloves, paper bag.       4. Additional Equipment which may be required: Syring (5mL), sterile sodium chloride 0.9%, local anesthetics (in children), 3-way tap or triflow, short extension tube. Selection Of the Catheter Site: Generally speaking, the vein section with the straightest a

 INTRAVENOUS THERAPY Definition: "Intravenous therapy or IV therapy is the giving of liquid substances into vein".  It can be intermittent or continuous; continuous administration called an Intravenous drip.  The word intravenous simply means "within vein" but is most commonly used to refer to IV therapy. Compared to other routes of administration, the intravenous route is the fastest way to deliver fluids and medications throughout the body. Some medications, as well as blood transfusions and lethal injections can only be given intravenously. The simplest form of intravenous access is a syringe with an attached hole in needle. The needle is inserted through the skin into a vein, and the contents of the syringe are injected through the needle into the bloodstream. This is easily done with an arm vein, especially one of the metacarpal veins. Usually, it is necessary to use a constricting band first to make the vein bulge; once needle is in place, it is common to dra

 DRUG-INDUCED HEPATOTOXICITY "Hepatotoxicity is the injury or liver damage caused by exposure to certain drugs, when taken in overdoses and sometimes when administered at therapeutic ranges, may injure the organ". Drug-induced hepatotoxicity is also referred to as the Drug-Induced Liver Injury (DILI). Physiological functions of liver: Formation and sensation of bile. Nutrient and vitamin metabolism (amino acid, lipid). Detoxification and inactivation of various substances (toxin drugs). Synthesis of plasma proteins (Albumin, clotting factors). Immune systems (Kupffer cells). Hepatotoxicity is most prevalent in older patients especially in those with pre-existing hepatic impairment. The few examples of drugs that cause hepatotoxicity are listed below: 1. ACE Inhibitors: Hepatic injury occurs occasionally with ACE-Inhibitors. Captopril and Enalapril are implicated in most reported cases, but others also have similar hepatotoxic potential. Most cases show cholestatic injury, b

 DRUG-INDUCED OCULOTOXICITY Occasionally, non-specific blurred vision occurs with almost all the drugs. The drugs listed below are associated with a specific pattern of drug-induced oculotoxicity when administered systemically: 1. Allopurinol: Despite the discovery of Allopurinol in cataractous lenses taken from patients on long term (>2 years) therapy, there is no clinical evidence for an increased risk of cataracts in allopurinol-treated patients. 2. Beta-Adrenergic Blocking Agents: A reduction in tear production occurs, which can produce a hot, dry, gritty sensation in the eyes. This is rapidly reversible with drug discontinuation. 3. Contraceptives, (Oral): A variety of retinal vascular disorders have been occurred due to oral contraceptives, but the association remains unproved. Some oral contraceptives users cannot tolerate contact lenses, possibly because of ocular edema or dryness. However, a prospective study failed to show any difference in lens tolerance between oral cont

  LIVER AND THE COMPLICATIONS ASSOCIATED WITH THE PROGRESSION OF DISEASE! Liver: The liver weighs up to 1.5kg in adults and is the 2nd largest organ in the body. Hepatocytes are the functioning unit of liver. Impairment of liver may lead to: Acute liver diseases Chronic liver diseases Liver cirrhosis Acute Liver Disease (ALD): ALD is a self-limiting episode of hepatocyte damage which in most cases spontaneously without clinical sequelae, but acute liver failure (ALF) may develop. This is a rare condition in which there is a rapid deterioration in liver function with associated encephalopathy and coagulopathy. ALF carries significant morbidity and mortality and may require emergency liver transplant. Chronic Liver Disease (CLD): CLD occurs when the longstanding cell damage causes permanent structural changes within the liver, with the loss of normal liver structure and functions. In many cases, this may lead to cirrhosis where fibrosis sears divide the liver cells into areas of regenera

SUPPURATIVE PNEUMONIA (ASPIRATION PNEUMONIA) AND PNEUMONIA IN IMMUNOCOMPROMOISED PATIENTS  SUPPURATIVE PNEUMONIA Definition: "Suppurative pneumonia is characterized by destruction of the lung parenchyma by inflammatory process and although microabscessation formation is characteristic histological feature, pulmonary abscess" is usually taken to refer lesion which is a large, localized collection of pus or a cavity lined by chronic inflammatory tissue from which pus has escaped by rupture into bronchus". Etiology: Inhalation of septic material during operations on the nose, mouth, throat under general anesthesia Bulbar Vocal cord palsy Esophageal reflux Alcoholism Infecting Organism: Bacterioder melaninogenicus Anaerobic/microaerophilic cocci B. fragilis S. aureus (most common) K.pneumoniae S.pneumonia. *Leimerres Syndrome is a rare cause of pulmonary abscesses. Usually, causative agent is F.secrophorum . Illness signs include sore throat, painful swollen neck, fever, ri

 DRUG-INDUCED OTOTOXICITY What is drug Induced Ototoxicity? Drug-Induced ototoxicity can affect hearing (auditory or cochlear function0, balance (vestibular function) depending on the drug. Drugs of almost every class have been reported to produce tinnitus (sounds in ear), as have placebos. The following agents are associated with measurable changes in hearing or vestibular defect when administered systemically. 1. AMINOGLYCOSIDES: Aminoglycosides antibiotics can cause cochlear or vestibular toxicities. Cochlear toxicity: occurs as progressive hear loss, starting with highest tones and advancing to lower tones. Thus, considerable damage can occur before the patient recognizes it. S ymptoms of Vestibular damage : include;  Dizziness Vertigo Ataxia Both forms of ototoxicity are bilateral and potentially reversible, but permanent damage is common and can progress even after discontinuation of aminoglycosides. Clinically detectable ototoxicity in as many as 5% patients. Most aminoglycosid

MANAGEMENT FOR H.PYLORI ERADICATION It is known that H.pylori infection is associated with over 90% of duodenal ulcers and 80% of Gastric Ulcers. Antibiotics alone or acid-suppressing agents alone, do not eradicate H.pylori . Both therapies act synergistically as growth of the organism occurs at elevated pH and antibiotics efficacy is enhanced during growth. Additionally, increasing intragastric pH may enhance antibiotic absorption. High eradication rates are achieved by a short course of Triple Therapy consisting of:            1 .PPI                                         2. Clarithromycin                         3. Amoxicillin/Metronidazole          in a twice recommended simultaneous regimen. First-Line Therapy :  European Guidelines recommended 1 week of therapy, whereas the US Guidelines recommend 10-14 days of therapy and achieve 7-9% better eradication rates.     OCA : Omeprazole(20mg), Clarithromycin (500mg) and Amoxicillin (1g)                                         

  COMPLICATIONS OF PEPTIC ULCER DISEASE Bleeding peptic ulcer Pyloric stenosis Zollinger-Ellison Disease Stress Ulcers Bleeding peptic ulcer: Peptic ulcer is the most common cause of non-variceal upper gastro-intestinal bleeding. Most patients with bleeding peptic ulcer are clinically stable and stop bleeding without any intervention, whereas other outcomes include re-bleeding and mortality. Endoscopy allows identification of the severity of disease. Endoscopic hemostatic therapy which is successful in reducing mortality. A number of pharmacological agents have been used for endoscopic injection therapy such as 1:10000 adrenaline (epinephrine), human thrombin and fibrin glue. Mechanical endoscopic treatment options include Thermocoagulation using a heater probe or endoscopic clipping. Combination therapies are superior to monotherapy and a combination of adrenaline 1:10000 with either thermal or mechanical treatment is recommended (SIGN,2008). Pyloric Stenosis: Malignancy is the most c

MYOCARDIAL INFARCTION Definition: Myocardial Infarction is defined as " a diseased condition which is caused by reduced blood flow to the coronary artery due to atherosclerosis and occlusion of artery by embolus or thrombus." Myocardial Infarction (or Heart attack) is the irreversible damage of myocardial tissue due to prolonged ischemia or hypoxia. Universally accepted definition of MI:  Evidence of myocardial necrosis in consistent with the myocardial ischemia, in which case any of the following meets the diagnosis of Myocardial Infarction. Evidence rises and/or fall of cardiac biomarkers (preferably troponin). ECG changes indicative of new ischemia (new ST-T changes or new left bundle branch block) Development of pathological Q waves. Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality. Etiology: Tobacco smoking Diabetes Mellitus Age Hypertension Obesity Gender Stress Drug abuse Alcohol consumption Family history of ischemic heart dise

  CHRONIC ABSTRUCTIVE PULMONARY DISEASE (COPD) Definition: COPD is defined as "a disease state characterized by airflow limitation that is not fully reversible and this airflow limitation is progressive associated with abnormal inflammatory response to the noxious or gaseous particles. According to Davidson , COPD is defined as " COPD is preventable and treatable disease characterized by airflow limitation that is usually progressive and is associated with enhanced chronic inflammatory response in the airways and lungs to the noxious particles. According to National Institute for Health and Clinical Excellence (NICE) , COPD is defined as "Airflow obstruction with reduced FEV1/FEVc is less than 0.7, if FEV1 is greater than or equal to80%; so, diagnosis of COPD should be made on the presence of symptoms". Signs and Symptoms: Shortness of breathing Cough Pink puffers and Blue Blotters or Smokers Cough (classical signs of COPD). *Pink puffer is the major sign of emphyse

  ASTHMA Definition: According to WHO: "It is a disease characterized by recurring attacks of breathlessness and wheezing which vary in frequency according to the nature of allergen and these symptoms vary from hour to hour or day to day". According to Principle & Practice of Medicines by Davidson: "It is chronic inflammatory disorder of airways associated with airway hyper-responsiveness that leads to recurrent episodes of wheezing, breathlessness or coughing particularly at night or early in the morning". Etiology: Hyperresponsiveness -exaggerated response of airway to any non-specific stimulus which results in airway obstruction. Broncho-constriction- Breathlessness or spasm due to construction of bronchioles in airway stimulus. Allergens: Industrial chemicals such as paints, hairsprays or resins Drugs such as NSAIDs, Beta-blockers Food products such as dairy products, fish, etc. Environmental pollutants such as cigarette, smoke Industrial triggers such as w

SITUATIONS REQUIRING HOSPITALIZED CARE The NICE-SUGAR (Intensive versus conventional glucose in critically ill patients) trial compared intensive (81-108 mg/dL) with conventional glucose control using IV Insulin in 6104 intensive care unit patients. At 90 days, intensively controlled patients had an increased absolute risk of death of 2.6%. Significantly, more hypoglycemia was observed in intensively controlled group. Recommendations: Current recommendations call for critically ill patients to be started on IV Insulin therapy at a threshold of 180mg/dL. A goal range of 140-180mg/dL is recommended for majority of patients. More stringent goals may be considered for selected critically ill patients, but only if hypoglycemia can be avoided. Scheduled SC insulin regimens with basal, nutritional and correction components are recommended for patients who are not critically ill. Goals of less than 140mg/dL for fasting glucose and less than 180mg/dL for random glucose are recommended for non-