[N-clex] 엔클렉스 정리-medication(약)

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MED

● Sulfa계열(광범위항생제, UTI 때 자주 사용, 잘 들음)

S/E

-BMD, nephrotoxicity, photosensitivity

복용법 : empty stomach

상승 효과

- warfarin, sulfonyluria(당뇨약, gli-,gly-), penytoin

cross react(알러지)

- sulfonyluria, thiazide, loop

 

● Nitrofurantoin

- long term UTI

- S/E) : G-I distress(with meal), pul reaction → stop(2~3일 뒤 소실), BMD, peripheral neuropathy

- urin-brown(기대증상)

 

● 반코마이신 S/E

- ototoxicity : tinnitus

- nephrostoxicity

- BMD

- G-I distress

- photosensitivity

- K↓

- redman syndrome(IV투여시 60분이상 천천히 투여)

●골다공증med : ~dronate

S/E)

- G-I(esophagitis)

- bone joint pain(jaw)

복용)

- empty stomach with 물

- sit 30min after

 

● Epogen : BM자극 hemoglobin 생성

- Hb 12이상 시 hold : clot에 의한 sudden death 가능

 

● psyllium

: bulk forming laxative(변 부피↑), mild laxative 물 섭취 多 필요

 

● raloxifene

- 골다공증 약 : non bisphosphonate 계통 SERM, 공복에 복용

- antiestrogen 역할 : Hot flush 사라지지 X, Breast cancer 예방 및 화학요법

● DMARD's 자가면역치료제(ex 류마티스 등)

- Adalmumab, Etenercept, Infliximab

 

● baclofen : skeleton muscle relaxaion(근골격계 이완, 진통)

 

● Clonidine : BP↓

 

● tyrenol overdose : 4g/d

 

●Med

- GERD : pantoprazole, 40mg/d, Max 240mg/d

- atorvastatin(고지혈증) : 10~20mg/d, Max 40mg/d

- metformin(당뇨약) : 500mg BID/d, 850mg QD/d

- Isinopril(ACE inhibitor) : 20~40mg/d

 

● metformin(당뇨약)

- Cr(0.6~1.3) 정상

- lactic acidosis주의(kidney function)

- angiography 48hr 전/후 중단 → 신장과부화(lactic acidosis)

- 500mg BID/d, 850mg QD/d

ㄱ

● Mg 투여

- siezure 예방

- CNS depression : DTR↓(+2가 정상/ 0,+1 : hyporeflex / +3,+4 : hypereflex), RR↓주의관찰7

 

● Metronidazole

기대증상 : metallic taste, uring dark, reddish brown

S/E

- G-I, N/V/D, with milk, meal

- nephrotoxicity

- neurotoxicity(peripheral neuropathy) : notify if numbness, tingling → conversion

- disulfiram같은 효과 : 술 끊는약(심한 두통) X alcohol

- Allergic reaction

- X preg, breat feeding

 

 

● PUD med (Peptic ulcer disease)

Antiacid : neutrolize HCl

- Mg : S/E diarrhea

- Ca : S/E constipation

- Al : S/E constipation

- NaHCO3 : S/E metabolic alkalosis

mucosal protectant

H2 antagonis(~tidine) : HCl 분비↓

proton pump inhibitor(~prazole) : HCl 분비↓

● Thrombolytic

금기)

- intracranial, spinal OP 2month 이내

- thoracic, Pelvic, abd OP 10day 이내

- Hx of hepatic, renal Dz

- uncontrolled HTN

med)

- Alteplase

- Tenecteplase

- Drotrecogin alfa

MI 4~6hr 이내 투여 : 투여 후 bleeding 관찰

CVA(cerebrovascular accident) 3hr 이내 투여 : BP↓, RR↑, PR↑, BT↑

 

● Heparin, Warfarin

Heparin	warfarin
기대효과) PTT 28~35 sec INR 1.5~2.5배 antidote : protamin sulfate	기대효과 PT 11~12.5sec INR 1.5~2배 antidote : Vit K preg. 금기 4G : ginseag, ginko, garlic, ginseag ↑ clot factor : 2,7,9,10 작용 onset : 12~24hr peak : 1.5~4d duration : 3~5d q3 month f/u 피검사 필요

wafarin, heparin : INR(0.8~1.2sec)

● enoxaparin : heparin 유사제

- SQ, antidote(protamin sulfate), pork allergy (투여 X)

● sulfonylurea(당뇨약)

- glimepried, glipizide, glyburide

S/E)

- N/V/D, HA, hepatotoxicity, photosensitivity, disulfiram 효과(alcohol X)

cross act) sulfa 항생제

 

● antiplatelet(clopidogel)

indicate)

- stroke, MI, unsatble angina

S/E)

- G-I distress(with meal, QD)

- hepatotoxicity(LFT f/u)

- bleeding(hold 5~7d before operation)

- not with PPIs(~prazole) 약효과 감소시킴

 

● loop diuretics

- Bumetamide, furosemide(lasix)(onset : 5min / peak : 30min / duration : 2hr)

S/E)

- Na, K, Ca, Mg ↓

- PLT↓

- ototoxicity

- photosensitivity

- morning with food (밤에 복용시 수면 방해)

- K↓ : digoxin, lithium toxicity 주의

Diet)

- K 多 : baked potato, avocado etc.

● thiazide(~thiazide)

S/E)

- K, Na↓, Ca↑, glucose↑(인슐린 민감도↓)

- photosensitivity

- K : digoxin, lithium toxicity 주의

- cross react with sulfa

- BUN/Cr : UO

- take with food(아침)

 

● K retaining diuretics

- amiloride, spironolactone(Aldacton), Triamterene

S/E)

- G-I distress(with meal)

- photosensitivity

- BMD

● ACE inhibitor(~pril)

- HF, HTN 적용

- steroid의 반대작용(Na+H2O ↓, K↑)

S/E)

- HF

- angioedema(얼굴, 눈), allergic react 비슷(ER) Tx) antihistamine, epinephrine, steroid

- dysrhythmia, nephrotoxicity

- BP↓, BST↓, taste↓(입맛↓)

- K↑, PR↑, BMD, HA, Dz, fatigue

- insomnia

- persistence cough : ARB's(유사약) ~sartan

 

- empty stomach, crushing 가능

- preg X

● CCB(~dipine)

- diltiazam, verapamil

- Ca(말초혈관수축), CCB(말초혈관이완, 심수축력 약화)

효과)

- vasodilation, ↓ cardiac contractility, slow SA-AV conduct(서맥)

indication)

- A-fib, flutter, HTN, unstable angina

S/E)

- dysrhythmia

- peripheral edema

- hepatotoxicity

- G-I distress

- ↓BP(SBP 90↓ noti), ↓PR(50↓ noti)

- HA, Dz, confusion, drowsiness

 

- with or without food, but! 같은시간에 복용 crush X, grape X

 

interact med)

- CCB가 med효과를 ↑는 약들 : theophyll~, β-blocker, digoxin, lithium, cyclosporin, ~statin, steroid

- CCB의 효과를 올려주는 med : cimetidine, H2 blocker

 

● β-blocker(~lol)

β1 : 심장자극 blocker : HR↓(50↓ stop)

β2 : bronchodilator blocker : bronchospasm(caution Asthma)

indicate)

- HTN, prevent migraine HA

- bronchospasm (caution Asthma)

- mask Sx of hypoglyemia (DM 주의)

- impotence, libido↓

- avoid OTC, alcohol

- 식사전, 자기전(같은시간), crush괜찮

 

● α : 말초혈관수축

α-blocker : 말초혈관이완, doxazosin

Tx) for BPH(생식기순환↑)

 

S/E)

- tarchycardia

- GI N/D/V/C

- drowsiness

- nasal congestion

- edema, wt gain

- HA, dry mouth

- nightmare

● digoxin

- cardiac contractility↑, pump 수축력↑ : CO↑, UO↑, HR↓(noti 60↓)

indication)

- HF, cardiogenic shock, A-fib, A-flutter

contradiction(금기)

- vent. dysrhythmia

caution)

- kidney dz

- K↓ 지연 toxicity

S/E)

- HA, drowsiness, confusion, BP↓

toxocity

- dysrhythmia

- G-I(A/N/V/D~~)

- neuro(특히 시신경, blurred vision, halo vision)

 

 

- 절대 mix X

- q12hr

- empty stomach

- pulse Infant 100↓, Toddler90↓, child↓ (hold)

- refil(2일전에는 미리준비)

- 정확한 용량 투여위해 syringe

- digoxin toxicity(K↓) : visual disturbance, G-I distress

 

● NTG 혈관확장제

형태

acute) : sl, spray, IV

chronic) : PO(imdur), patch, ointment

sl)

- sting(찌릿), burn(후끈) : 정상(fresh), 5분간격/3회

- 차광병 보관, expire 6month

S/E)

- HA(발현시 tyrenol복용), orthostatic hypotension, Dz, weakness, N/V, confusion, hepatotoxicity(alcohol X)

 

- ↑ effect of β-blocker(~lol), diuretics, CCB(~dipine), 혈압약 : BP↓ 주의

 

patch)

- 10~12hr 정도 patch fee hour 필요, prevent tolerance (주로 낮에 붙임, stress 多 )

붙이는 순서 (patch류들 다 이럼)

1) clean & dry skin

2) remove old patch

3) apply new patch & press palm 10 sec

4) date & time 기록

 

ointment)

- 가슴, 복부, thigh 등(움직임↓, 흡수속도떄문), 털없는곳

● Nesiritde(Natracor) : vasodilator

indiacation) : HF

S/E) : BP↓, dysrhythmia, Dz, confusion, insomnia

 

● amiodarone

indication) : A-fib,flutter, V-tach,fib, SVT(supraventricula tachycardia) : 빠른 부정맥

S/E)

- bradycardia

- N/V

- pul. fibrosis(dyspnea, cough)

- photosensitivity

- corneal deposit(각막침전물)

- hepatotoxity

- peripheral neuropathy

- blurred vision

 

● Dopamin : adrenargic (CO↑ → UO↑)

α : vasoconstraction : BP↑

β1 : cardiac stimulation : PR↑

- BP↑, BP↓(너무 자극되서 부정맥), PR↑(palpitaion)

 

● ~statin : chol synthesis↓ In liver(주로 밤에 합성→ evening에 복용)

HMG-CoA(cholesterol 전구체, 환원효소)억제

S/E)

- G-I(N/V/D/C)

- blurred vision(cataract)

- photosensitivity, photophobia

- hepatotoxicity

- muscle toxicity

- not with grape fruit

- X alcohol, preg

 

● orlistant : 살빼는 약, manage obesity

- lipase inhibitor( with each meal)

- fat free, skip meal시 복용 X

- low fat diet (30%↓)

- vit. mineral ↑

- 2hrs apart 다른 약

● ezetimibe(zetia) : 소장에서 chol 흡수억제

- 공복에 복용

S/E) : G-I distress

 

● cholestyramine(questran) : LDL, chol ↓ 역할, bind with bile in GI

- QD or BID (식사랑 상관 X 복용), pruritus ↓ 효과도 있음, preg X

S/E) : N/V/C, PUD, steatorrhea, vit K↓(bleeding,tarry stool)

 

● migraine pain med

abate, Sx) PRN)

- ~triptan

- vasodilator, inflammation↓, pain transmission↓

- ASAP

- SQ, nasal spray, oral多(repeat가능 2hr 증상완화X)

- preg, MI, chest pain X (brest feeding 가능, but SQ인 경우 8hr 간격)

- 같이 사용 X : SSRI, MAOI inhibitor, St joint herb

 

예방적 prevent

- ~Inderal(SSRI, TCA)

 

● methylphenidate(Ritalin)

- ADHD med : CNS stimulant (norepi-,dopamin 영향)

- 아침에 복용(insomnia)

- with meal or before meal

- Wt 주기적으로 측정(성장문제)

 

● benzodiazepine계

- antianxiety : CNS GABA↑ 진정효과

- short term(2wk)

- CNS depression : drowsiness, sedation, dizziness, ataxia(운동실조)

S/E) : dry mouth, blurred vision, constipation, urine retention (antilcholinergic, 정신과약 대부분)

- antagonist : flumazenil(IV)

- ~zepam(lorazepam etc.), ~zolam(alprazolam etc.)

 

● non-benzo계

- zolpidem, busprione : dependent X(장기사용 가능, 3wk정도 사용해야 효과 발현)

● 자몽(grape fruit) X med

- barium, SSRI, 항경련제(tegretol)

- CCB, ~statin, amiodarone, cyclosporin(면역억제제), antiviral(~vir)

 

● SSRI : fluoxetine, paroxetine, citalopram, sertraline, fluvoxamine, escitalopram

 

● morphine

S/E) : CNS depression : DTR, BP, RR ↓ (12회 이하면 길항제:알케인)

 

● Lithium

- mood stablizer

- PO ( IV X)

- 하루 2·~3회

- GI 흡수 / kidney 배출

- not addicted(장기간 사용 가능)

- thyroid방해(6~18month사용시 hypothyrodism가능)

- 1~2wk 뒤 효과(shorterm으로 haloperidol과 같이 사용)

- Na과 경쟁관계(Na 평소대로 섭취) / peanut butter Na多

- 물 2~3L

- preg X / breast feeding O

S/E)

- body image : wt. gain

- cardiac : EKG

- CNS : fine motor tremor, fatigue, HA, lethargic, dullness

- Skin : acne

- Endo : hypothyroidism

- renal : polyuria, polydipsia, edema

- GI : irritation(anorexia), abd.cramp, mild N/V/diarrea

- 조혈방해 : CBC 초기 자주 이후 q3month f/u

lithium 신장 재흡수↑or분비↓	toxicity↑	diuretic SSRI(fluroxetine) NSAIDs
재흡수↓or분비↑	효과↓	acetazolamide(고산병) aminophyline(이뇨제) sodium bicarbonate salt intake↑