Acetaminophen NAPQI Toxicity
A simple overview of acetaminophen (Tylenol) toxicity:
Category: Pharmacology
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Context-Sensitive Half-Time
In any basic pharmacology course, we’re taught the concept of an “elimination half-life,” or the time it takes to reach 50% of a drug’s initial concentration. However, with more advanced multi-compartmental models of pharmacokinetics, the concept of a “context-sensitive half-time” more accurately describes the interplay between a drug’s distribution in the…
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Vasopressin
Vasopressin, otherwise known as antidiuretic hormone (ADH), is a peptide hormone synthesized in the hypothalamus and released by the posterior pituitary gland. Its physiologic effects include vascular smooth muscle constriction (via V1 receptors, PLC-IP3 and calcium pathway) and free water retention (via V2 receptors, cAMP/PKA pathway).
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What Does Gtt Mean?
Medical jargon is riddled with abbreviations, many of which are universally understood and some of which are very specialized. Yes, I’m looking at you, ophthalmology and OB/GYN. :-P
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Furosemide
Furosemide (Lasix) is a loop diuretic that works on the Na/K/2Cl cotransporter in the thick ascending loop of Henle. It’s a medication I routinely use for patients with congestive heart failure (CHF) exacerbations who are retaining extra fluid in their distal extremities, lungs, abdomen, and other dependent areas. In the…
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Intravenous Lidocaine To Reduce Propofol Burning And Response To Laryngoscopy
Lidocaine (1 – 1.5 mg/kg) is often given intravenously prior to the induction of general anesthesia for a dual purpose – to mitigate the burning sensation of propofol (attributed to its glycerol additive) and to blunt the response to performing laryngoscopy. Let’s discuss this common practice.
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Anesthesia For Awake Craniotomies
Asleep-awake-asleep craniotomies aim to preserve portions of the eloquent cortex – parts of the brain that are critical for speech, language, motor function, and localization. Patients are awake for brain surgery. I wanted to give a play-by-play of the anesthetic considerations.
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Combining Vasoactive/Inotropic Agents
Epinephrine (adrenaline). Norepinephrine (noradrenaline). Isoproterenol. Vasopressin. Dopamine. Phenylephrine. Dobutamine. Milrinone. Calcium.
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Local Anesthetics Are Off-Label For Spinals
At the time of this writing, there are only three drugs approved by the U.S. Food and Drug Administration (FDA) for the intrathecal (“spinal”) route of administration: ziconotide, morphine, and baclofen.
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Dosing Acetaminophen For Inpatient Pain Management
Many years ago, the FDA set the recommended maximum daily dose of acetaminophen (“Tylenol”) at 4,000 mg. During my training, I’ve seen two common ways to write for scheduled acetaminophen around-the-clock: 650 mg every 4 hours (total of 3900 mg per day) and 1000 mg every 6 hours (total of…