Antithrombin III (AT) is a protease that disrupts coagulation by inactivating thrombin. Congenital AT deficiency can be a quantitative and/or qualitative issue. Fortunately, AT concentrates like Thrombate III (pooled from human plasma) can replenish deficits. As a cardiothoracic anesthesiologist, I routinely administer large amounts of heparin to potentiate AT activity.…
Olanzapine (Zyprexa) is a second-generation (“atypical”) antipsychotic that can be administered as an oral disintegrating tablet (ODT) or intramuscular (IM) injection. Like most antipsychotics, olanzapine works by blocking postsynaptic dopamine (D2) and serotonin (5HT2) receptors in the central nervous system and is helpful in treating schizophrenia and bipolar disorder. Common…
Gentamicin is an intravenous, intramuscular, and topical aminoglycoside bactericidal antibiotic that works by interfering with bacterial protein synthesis. By binding the 30S subunit of the bacterial ribosome, proteins are improperly translated leading to bacterial death.
Promethazine (Phenergan) is an oral, intramuscular (IM), rectal, and intravenous (albeit with caution!) phenothiazine derivative that is both a first-generation antihistamine (H1 receptor antagonism) and a weak typical antipsychotic (D2 receptor antagonism). It also demonstrates antagonism of muscarinic acetylcholine receptors (anticholinergic) and NMDA receptors (similar to ketamine), conferring some degree…
Loop diuretics like furosemide (Lasix) and bumetanide (Bumex) block the reabsorption of sodium, potassium, and chloride in the thick ascending limb of the loop of Henle. This interferes with concentrating the renal medulla, and in turn, disrupts the osmotic gradient that typically moves water from within the tubules to the…
Polymyxin B is a “last-line” antibiotic primarily used to treat hospital-acquired gram-negative infections that are resistant to essentially all other conventional antibiotics. As an intensivist, I’ve had to use polymyxin B for two very resistant nosocomial bugs: Acinetobacter and Stenotrophomonas. It can also be used for resistant Enterobacteriaceae, Pseudomonas, Salmonella,…
Ceftazidime-avibactam (Avycaz) is an intravenous antibiotic combining a third-generation cephalosporin (inhibits cross-linking of peptidoglycan used to form the bacterial cell wall) with a β-lactamase inhibitor (inhibits a bacterial enzyme which degrades β-lactam antibiotics). Avycaz is used to treat complicated intra-abdominal infections (often with metronidazole), complicated urinary tract infections, and hospital-acquired pneumonia.…
Surgicel is an oxidized cellulose hemostatic agent used to control bleeding. It creates a physical barrier to blood loss while promoting localized vasoconstriction and platelet aggregation within the matrix of fibers. Furthermore, due to a localized drop in pH (acidosis), Surgicel provides some degree of bactericidal activity.
Triamcinolone acetonide (Kenalog) is a corticosteroid medication that is commonly used to treat a variety of inflammatory conditions. It is available in several forms, including oral tablets, injectable solutions, topical creams, and ointments. Triamcinolone works by reducing inflammation in the affected area. It does this by inhibiting the production of…
