http://learn.genetics.utah.edu/content/addiction/drugs/mouse.html

The drug is Truvada, an antiretroviral medication made by Gilead Sciences, Inc., which was already approved by the FDA in 2004 to help control HIV infection.

Truvada is a combination of two HIV medications – emtricitabine (Emtriva) andtenofovir (Viread) – into one pill that is taken once a day.  As a treatment for HIV, it is always used in combination with other HIV drugs.

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Post by: Saundra Young – CNN Medical Senior Producer

http://thechart.blogs.cnn.com/2012/07/16/fda-approves-truvada-for-prevention-of-hivaids/?hpt=hp_bn12

The benefit of this new drug over Coumadin is that there isn’t a need to have international normalized ratio (INR) monitored on a regular basis. The INR is a measurement of the bloods clotting tendencies. Based on the patients ratio, the doctor will determine the amount of Warfarin to prescribe and adjust as the ratio’s change.

Dabigatran benefits includes being a more predictable pharmokinetic, one size dose for all patients and no need for INR monitoring.  It is a direct thrombin inhibitor that works more directly on Thrombin (IIa). Compared to Warfarin it is as well found to be equal and in some cases better at preventing strokes.

While Warfarin is being shown as a more difficult medications to prescribe compared to Dabigatran it is easier to reverse. By providing blood plasma and vitamin K , the anticoagulation effects can be reversed. Therefore in the event of a major bleed treatment options are readily available in the emergency room.

This being said, there are treatment options for Dabigatran patients with a hemorrhage. It is recommended by Hennepin Medical Center has a protocol that can lead to treatment to include fresh frozen plasma, factor VIIa and dialysis. As Nathaniel L. Scott, MD says that:

“Many unanswered questions still exist. For example most speculation of what reversal agents may work is exactly that, speculation. The proposed agents are grounded in their physiologic basis, but in terms of what actually works clinically is not known.”

Learn more from the references below. I would recommend watching the Reversal of Dabigatran video first.

References:

• Warfarin
• Dabigatran
• ICE PACS Video (Dr. Cheskes)
• Reversal of Dabigatran video

While not on the market for cardiac patients yet, there is speculations of its release as early as September.

The answer to last weeks question: Gravol (Dimenhydrenate)

Read more:

• Bag of Drugs Guide
• Antihistamine
• Tricyclic Antidepressants

Tricyclic Antidepressants were initially synthesized with synthetic antihistimine’s which makes it apparent why an overdose of this brand of antidepressent would be contraindicated.

While this drug has antihistimine attributes, this isnt the drug of choice for a PCP to relieve a moderate allergic reaction.

Last weeks drug was: Sublinox (zolpidem tartrate)

The answer to last weeks drug is: Ebixa (Memantine)

10 Signs of Alzheimers Disease

Stages of Alzheimers Disease

Efficacy of Ebixa in Alzheimers Disease

Alzheimers Society: Ebixa

Continuous brachial plexus blockade in combination with the NMDA receptor antagonist memantine prevents phantom pain in acute traumatic upper limb amputees

In the moderate stages, you may see patients exhibiting an inability to recognize friends and family, tremors, and confusion with person, place or time.

Severe stages, may show you: loss of ability to communicate; loss of verbal skills; and extreme problems with mood, behavior, hallucinations, and delirium. This requires intensive support and care.

This NMDA antagonist helps prevent the concurrent clinical worsening of cognitive, global and functional domains. This medication is also being studied with brachial plexus anesthesia’s for traumatic amputations in the effort to prevent phantom limb pain.

Image provided by the Wikimedia Commons by Thomas Quine

The answer to last weeks drug was: Digoxin (Digitalis, Lanoxin)

The image you saw, was the Fox Glove plant, which is the plant which the drug is extracted. As per the title ‘Bloody Fingers’, this is what the Scottish call the plant.

Potassium-sparing diuretics: interaction with digoxin in elderly men.

Digitalis Toxicity

Supraventricular Arrhythmias – Atrial Fibrillation

Top Ten Dangerous Drug Interactions in Long-Term Care – Take note of the interactions with Warfarin

This drug if mixed with Amiodarone may cause toxicity which can result in ventricular tachy-arrhythmias. Should this drug be mixed with Amiodarone, typically the dosage needs to be reduced by 50% to observe the interaction.

This drug relies on normal serum potassium levels in order to function normally. With lowered levels of potassium, signs of toxicity increases. This makes potassium sparing diuretics such as spironolactone the drug of choice when it comes to patients with heart failure. Excess of this drug, may result in AV blocks, SA Blocks and dangerous rhythms such as ventricular tachycardia and fibrillation.

Image provided by Wikimedia Commons

The answer to last weeks drug: Quetiapine (Seroquel)

Learn More:

http://www.drugs.com/ppa/quetiapine-fumarate.html

Unlabeled uses may include OCD, Alcohol Dependence and Tourette’s Syndrome.

The answer to last weeks drug: Amitriptyline

The mechanism of action of tricyclic antidepressants (efficacy)

Healthy Canada on Amitriptyline

Tricyclic antidepressants and tetracyclic antidepressants

CEPCP Toxidrome Study Package

One side effect that is more pronounced in this drug is weight gain.

In combination with an MAOI, this drug may result in hyperpyretic crises, severe convulsions, and death.

With an overdose of this drug, you should be thinking:

• Hot as a Hare
• Blind as a Bat
• Dry as a Bone
• Red as a Beet
• Mad as a Hatter

Mad Hatter

The answer to last weeks drug: Ezetimbe

The combination of Simvastatin and Ezetimbe is: Vytorin

Check out the study: http://www.strokecenter.org/trials/TrialDetail.aspx?tid=935

Mad Hatter image by: Omnitographer