La tétracycline, connue sous le nom commercial Sumycin, agit en bloquant la fixation de l’ARNt sur la sous-unité 30S ribosomale, interrompant l’élongation de la chaîne protéique bactérienne. Ce mécanisme confère une activité sur un spectre large, incluant bactéries Gram positives, Gram négatives, rickettsies et spirochètes. Sa biodisponibilité digestive varie selon la prise alimentaire et les interactions avec les ions divalents comme calcium et magnésium. Sa diffusion tissulaire est importante, notamment dans les voies respiratoires et génito-urinaires. L’élimination se fait par voie rénale et biliaire. Les effets indésirables incluent photosensibilisation, troubles digestifs et coloration dentaire en cas d’administration précoce. Les guides thérapeutiques mentionnent sumycin prix, en soulignant la nécessité de restreindre son utilisation afin de limiter les résistances acquises.

Microsoft word - bag o medsbest.doc

Deborah J McCoy-Freeman, BS, RN, NREMT-P Objectives
• Discuss a variety of commonly prescribed medications • Discover the relationship between certain medications and their indication leading to more information of the past • Describe interviewing techniques for achieving better assessment results 70 yo female, C/O dizziness and light headedness. Poor historian. S: dizziness, confusion A: none known M: Patient hands you her bag ‘o meds P: unknown L: unknown E: dizziness, called 911 Additional information will be difficult to obtain Without family or bystander input, this may be all you get The information you get in a patient’s past medical history (PMH) may be crucial to your treatment What to do
• Many medical conditions/diseases are treated with a single med or a group of meds • Certain meds can point to definite diagnoses Solution?
• … to take a close look at the “bag ‘o meds”! 3 Simple Rules
• The medication list should never replace a good interview or assessment • Is an augmentation of your history and physical How to learn to be a Bag ‘o Meds
Private Eye
• Review the most common medications prescribed for that problem • Take a look at the “multi-taskers” • Drugs used for more than one medical malady Pulmonary
• *Albuterol: Ventolin, Proventil, Combivent
• *Metaproterenol: Alupent
• Salmetrol: Serevent, Advair
• Ipratoprium: Atrovent, Combivent
• TheoDur

*rescue inhalers
• Fluticasone: Advair, Flovent
• Triamcinolone: Azmacort
• Flunisolide: Aerobid
• Budesonide: Pulmicort
• Methylprednisolone: Medrol
• Cromolyn: Intal
• Nedocromil: Tilade
• Montelukast: Singulair
• Zafirlukast: Accolate
Allergies
• Loratidine: Claritin, Alavert
• Fexofenadine: Allegra
• Cetirizine: Zyrtec
• Fluticasone: Flonase
• Budesonide: Rhinocort
• Triamcinolone: Nasacort
• Beclomethasone: Beconase, Vancenase
Allergies
• Non-Steroidals
• Cromolyn: Nasacrom
• Montelukast: Singulair
Hypertension
• Propranolol: Inderal
• Atenolol: Tenormin
• Carvedilol: Coreg
• Metoprolol: Lopressor
• Acebutolol: Sectral
• Labetalol: Normodyne
Hypertension
• Clonidine: Catapres
• Methyldopa: Aldomet
• Terazosin: Hytrin
• Prazosin: Minipres
• Doxazosin: Cardura
• Hydrochlorothiazide (HCTZ): Thiazide • HCTZ/Triamterene: Maxide, Dyazide
• Indapamide: Lozol
Hypertension
• Diltiazem: Cardizem, Dilacor, Tiazac
• Verapamil: Isoptin, Calan, Verelan, Covera
• Amlodipine: Norvasc
• Felodipine: Plendil
• Isradipine: DynaCirc
• Nicardipine: Cardene
• Nifedipine: Procardia, Adalat
Hypertension
• Benazepril: Lotensin
• Captopril: Capoten
• Enalapril: Vasotec
• Fosinopril: Monopril
• Lisinopril: Prinivil, Zestril
• Moexipril: Univasc
• Quinapril: Accupril
• Ramipril: Altace
• Trandolapril: Mavik
• Losartan: Cozaar
• Valsartan: Diovan
• Irbesartan: Avapro
Hypertension
• Atenolol/chlorthalidone: Tenoretic
• Bisoprolol/HCTZ: Ziac
• Metoprolol/HCTZ: Lopressor HCT
• Propranolol/HCTZ: Inderide
• Benazepril/HCTZ: Lotensin HCT
• Captopril/HCTZ: Capozide
• Enalapril/HCTZ: Vaseretic
• Lisinopril/HCTZ: Prinzide, Zestoretic
• Losartan/HCTZ: Hyzaar
• Amlodipine/benazepril: Lotrell
Congestive Heart Failure
• Carvedilol: Coreg
• Nadolol: Corgard
• Labetalol: Normodyne
Congestive Heart Failure
• Nitroglycerin: Minitran, Nitro-DUR, Nitrolingual,Transderm-Nitro, Nitrostat
• Isosorbide mononitrate: Imdur, Ismo
• Isosorbide dinitrate: Isordil
Congestive Heart Failure
• Furosemide: Lasix
• Metolazone: Zaroxolyn
• Bumetanide: Bumex
• Torsemide: Demadex
• Potassium Replacement: KDur, KLyte
• Digoxin: Lanoxin
Vascular Diseases
Vascular Disease
• Warfarin: Coumadin
• Enoxaparin: Lovenox
Vascular Disease
• Rosuvastatin: Crestor
• Fluvastatin: Lescol
• Atorvastatin: Lipitor
• Lovastatin: Mevacor
• Pravastatin: Pravachol
• Simvastatin: Zocor
• Cholestyramine: Questran
• Colestipol: Colestid
• Nicotinic Acid: Niacin
• Fenofibrate: TriCor
• Gemfibrozil: Lopid
Cardiovascular Disease
•Diltiazem: Cardizem, Dilacor, Tiazac
•Verapamil: Isoptin, Calan, Verelan, Covera
•Amlodipine: Norvasc
Cardiovascular Disease
• Amiodarone: Cordarone
• Procainamide: Procan
• Mexiletine: Mexitil
• Quinidine: Quinidex
• Flecainide: Tambocor
• Clopidogrel: Plavix
Peripheral Vascular Disease
• Pentoxifylline: Trental
• Cilostazol: Pletal
Cerebrovascular Disease
• Ticlopidine: Ticlid

• Meds for causative problems
Remember Case #1?
Gastrointestinal Disease
Peptic Ulcer Disease
• Sucralfate: Carafate
• Ranitidine: Zantac
• Cimetidine: Tagamet
• Nizatidine: Axid
• Famotidine: Pepcid
• Omeprazole: Prilosec
• Lansoprazole: Prevacid
• Pantoprazole: Protonix
• Rabeprazole: Aciphex
• Esomeprazole: Nexium
Gastroesophageal Reflux Disease
• Metoclopramide: Reglan
• Omeprazole: Prilosec
• Lansoprazole: Prevacid
• Pantoprazole: Protonix
• Rabeprazole: Aciphex
• Esomeprazole: Nexium
Renal Failure
• Phosphate Binders: Phoslo, Phosex
• Furosemide: Lasix (usually very high doses)
Diabetes Mellitus
• Ultrashort acting: Humalog, Novolog
• Short acting: Humulin R, Novolin R
• Long acting: Humulin N, Novolin N
• Mixed: Humulin 70/30, Novolin 70/30
• Longer acting: Lente, Ultralente, Lantus
• Pramlintide: Symlin
• Glipizide: Glucotrol
• Glyburide: Micronase, Diabeta, Glynase
• Glimepiride: Amaryl
• Metformin: Glucophage
• Metformin/Glyburide: Glucovance
• Acarbose: Precose
• Miglitol: Glyset
• Pioglitazone: Actos
• Rosiglitazone: Avandia
• Repaglinide: Prandin
• Nateglinide: Starlix
Parkinson’s Disease
• Amantadine: Symmetrel
• Levodopa/Carbidopa: Sinemet
• Bromocriptine: Parlodel
• Ropinirole: Requip
• Selegiline: Eldypryl
• Benzatropine: Cogentin
Alzheimer’s Disease
• Donepezil: Aricept
• Galantamine: Reminyl
• Rivastigmine: Exelon
Seizure Disorders
• Carbamazepine: Tegretol
• Gabapentin: Neurontin
• Levetiracetam: Keppra
• Lamotrigine: Lamictal
• Phenytoin: Dilantin
• Topiramate: Topamax
• Valproic Acid: Depakote
Migraines
• Non-specific: Inderal, Tenormin
• Valproic acid: Depakote
• Topiramate: Topamax
• Gabapentin: Neurontin
• Verapamil: Calan
• Amlodipine: Norvasc
• Amitriptyline: Elavil
• Fluoxetine: Prozac
• Ibuprofen: Motrin
• Ergotamine/Caffeine: Cafergot
• Sumatriptan: Imitrex
• Naratriptan: Amerge
• Almotriptan: Axert
• Zolmitriptan: Zomig
Psychiatric Diagnoses
Mood Disorders
• Nortriptyline: Pamelor
• Imipramine: Tofranil
• Fluoxetine: Prozac
• Sertraline: Zoloft
• Paroxetine: Paxil
• Bupropion: Wellbutrin
• Citalopram: Celexa
• Escitalopram: Lexapro
• Fluvoxamine: Luvox
• Trazodone: Desyrel
• Venlafaxine: Effexor
• Mirtazapine: Remeron
• Nefazodone: Serzone
• Diazepam: Valium
• Alprazolam: Xanax
• Lorazepam: Ativan
• Clonazepam: Klonopin
• Buproprion: BuSpar
• Lithium: Lithobid, Eskalith
Psychosis
• Chlorpromazine: Thorazine
• Fluphenazine: Prolixin
• Haloperidol: Haldol
• Thiothixene: Navane
• Trifluoperazine: Stelazine
• Perphenazine: Trilafon
• Thioridazine: Mellaril
• Risperidone: Risperdal
• Clozapine: Clozaril
• Quetiapine: Seroquel
• Ziprasidone: Geodon
• Olanzapine: Zyprexa
• Benztropine: Cogentin
Musculoskeletal Problems
• Ibuprofen: Motrin, Advil
• Naproxen: Naprosyn
• Diclofenac: Voltaren
• Flurbiprofen: Ansaid
• Ketorolac: Toradol
• Ketoprofen: Orudis
• Etodolac: Lodine
• Nabumetone: Relafen
• Oxaprozin: Daypro
• Piroxicam: Feldene
• Sulindac: Clinoril
• Celecoxib: Celebrex
• NSAIDs- Indomethacin: Indocin
• Allopurinol: Zyloprim
Multi-Tasker Medications/Common Multi-Tasks
Other Multi-Taskers
• Prevention of movement complications • Testosterone Blocker in Transgender patients The MEGA Multi-Taskers
The MEGA Multi-Taskers
3rd PLACE
The MEGA Multi-Taskers
2nd PLACE
The MEGA Multi-Taskers
THE #1 MULTI-TASKER

85 yo male, wife C/O “I can’t take care of him anymore”. Poor historian. S: Confusion, can’t assist in care A: none known M: Wife hands you his bag ‘o meds P: “Demented” L: Hours ago E: Violent behavior, worsening confusion His bag ‘o meds included: •Aricept 48 yo female, with confusion and fever, found on the floor of her house, drooling. S: Confusion, fever, vomiting A: none known M: Patient’s meds are sprawled all over the floor P: unknown L: unknown E: Found by neighbor confused and ill on floor Her bag ‘o meds included: Atenolol Humalog Symlin Lisinopril Pepcid Synthroid Lipitor Aspirin Claritin Singulair What is most likely in her PMH?

Source: http://www.emsedsem.org/Conference%20Handouts/2006/PHM_Dont_Forget_the_Bag_O_Meds_(McCoy-Freeman).pdf