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Drugs that increase cardiac output Cardiac glycosides(digoxin) act by inhibiting sodium and potassium ATP and then making more calcium available to activate contracted proteins. Cardiac contractility and cardiac output are increased. Onset, peak, and duration vary widely among products. Most products are metabolized in the liver and excreted by the kidneys. The most common side effects are cardiac disturbances, headache, hypotension, and GI symptoms. Also common are blurred vision and yellow-green halos. Assess: Cardiac system: B/P, pulse, respirations, and increased urine output Apical pulse for 1 min before giving product; if pulse ,60 bpm, take again in 1 hr; if still ,60 bpm, notify prescriber Electrolytes: K, Na, Cl, Mg; renal function studies, including BUN and creatinine; and blood studies Evaluate: Therapeutic response: decreased weight, edema, pulse, respiration; increased urine output
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INTRODUCTION Sulfonamides were the first effective, synthetic antibacterial agents to be used systemically in man. They were introduced by Domagk in 1935 and in the next few years several of them were synthesized and widely used. Currently their role in therapeutics is limited because of their toxicity, development of resistance availability of safer drugs. CLASSIFICATION Short acting: Sulfisoxazole, Sulfadiazine Intermediate acting: Sulfamethoxazole Long-acting: Sulfamethoxypyridazine, sulfadoxine Poorly absorbed: Sulfasalazine Topical: Sulfacetamide, mefedine Silver sulfadiazine. ANTIBACTERIAL SPECTRUM It is wide spectrum antibiotic. It inhibits many gram positive and some gram negative bacteria including streptococci, H. influenza, Norcardia, E. coli, proteus, V. cholerae, some stains of staphylococci, gonococci, memingococci and pneumococci. They are also effective against Chlamydia, plasmodium falciparum and toxoplasma gondii. MECHANISM OF ACTION PABA (Para-aminobenzoic acid) Folic acid synthesis DIHYDROFOLIC ACID Bacteria synthesize their own folic acid from PABA with the help of the enzyme folic acid synthetase. Sulfonamides are structurally similar to PABA and competitively inhibiting the enzymes folic acid synthetase. They inhibit the enzyme folic acid synthase so folic acid is not synthesized (which is essential bacterial growth). PHARMACOKINETICS Sulfonamides are well absorbed, extensively bound to plasma proteins and are well distributed to all tissues. They are metabolized in the liver and excreted in urine. They can cross placental barriers. COMMON USES SYSTEMIC USES : sulfamethoxazole is used in combination with cotrimoxazolein many bacterial infections. It is the drug of choice in pneumocystitis in AIDS patient. Treatment of nocardiosis, toxoplasmosis, ulcerative colitis and rheumatoid arthritis. TOPICAL USES: ocular sulfacetamide sodium is used in trachoma/inclusion conjuctivitis. Topical silver sulfadiazine is used for preventing infection on burn surfaces. Mefinide is active in the presence of pus and against pseudomonas, clostridia which are not inhibited by topical sulfonamides. USES Because of the development of resistance and availability of better antimicrobials, which are more effective and less toxic, these are not commonly used now except in a few cases: UTI NOCARDIOSIS TOXOPLASMOSIS TRACHOMA AND INCLUSION CONJUCTIVITIS MALARIA TOPICAL ULCERATIVE COLLITIS Contraindication & Precautions: Children younger than 2yrs, Pregnant and breast feeding mother, Renal and hepatic diseases, Hypersensitivity to sulphonamides drug. Adverse effect: Fever, Rash, Nausea/vomiting, Aplastic Anemia. DRUG INTERACTIONS Sulphonamides can increasing the blood thinning effect of warfarin, possibly leading to abnormal bleeding. Increases blood level of potassium may occur when Sulfamethoxazole trimethoprim is combined with ACE inhibitors. Su
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1.
Anti-Infective Agents Antibiotics:
Sulfonamides Penicillins Cephalosporins Tetracyclines Aminoglycosides Quinolones Macrolides
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