1. Critical illnesses are often associated with circulatory, respiratory, hepatic and/or renal dys­function that may alter the pharmacokinetics and/or pharmacodynamics of drugs.
2. Decisions about routes of administration and doses of drugs used during medical emergen­cies must consider the physiological status of the patient, the pharmacokinetic and pharmacodynamic characteristics of the particular drug, and how the two interact.
3. Adverse drug reactions and interactions are more likely in critically ill patients due to the effect of the disease on drug kinetics, the decreased toxic-therapeutic ratio due to severe under­lying illness, and the large number of medications that such patients receive. Adverse reactions to drugs should be considered when unexplained deterioration or failure to respond to therapy are encountered.
4. Preservation of function of vital organs is a fundamental concept of critical care therapeutics. Preservation of cardiovascular functions requires attention to fluid and electrolyte status, prompt correction of arrhythmias and shock, and measures to preserve the myocardium against ischaemic injury.
5. Preservation of respiratory function requires protection of the airway, cautious use of fluids and oxygen, and prompt recognition and management of infection.
6. Preservation of cerebral function requires maintaining cerebral blood flow with adequate oxygen and glucose sufficient to meet the metabolic demands of the brain. This entails main­taining adequate systemic circulation, control of intracranial hypertension, and prompt control of seizures and hyperthermia.



7. Critically ill patients are particularly susceptible to infections, gastric stress erosions and ulcers, adult respiratory distress syndrome, pulmonary emboli, and haemostatic disorders. The risks of such complications may be reduced by meticulous care of catheters, pulmonary toilet, cautious use of fluids, prompt treatment of infection when it occurs, and selective prophylactic drug therapies.
8. Shock can be produced by many different processes including myocardial infarction, hypovolaemia, sepsis, drug overdose, burns, hypothermia, spinal cord transsection and anaphylaxis. Optimum treatment of shock depends on knowledge of the pathophysiology of the shock state and the pharmacology of the drugs.
9. Features of acute drug intoxication include coma, agitated delirium, seizures, hypo- and hyperthermia, shock, arrhythmias, aspiration and pulmonary oedema. Successful therapy of acute drug intoxication depends on the integration and application of knowledge of the pharmacology of both the intoxicating drug and the drugs used in therapy, as well as the principles of supportive critical care.

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• Anaesthetic Agents – Drugs Used in Anaesthesia
• Treatments Usage and Effects of Dronabinol Drug (Or Marinol )
• Angiotensin-Converting Enzyme Inhibitor – Vasotec Enalapril
• Collaboration Between Healthcare Provider and Clinical Labora­tory on Therapeutic Drug Monitoring
• Symptoms, Types and Treatment Options for Warts
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The mechanism by which anaesthetic drugs produce unconsciousness is still unknown. Meyer in 1899 and Overton in 1901 noted that within any group of drugs, anaesthetic potency correlates well with lipid solubility, and most modern theories agree that the site of action is probably the lipid bilayer of nerve cell mem­branes, or possibly a protein receptor in this sit­uation, but further knowledge is limited.

Inhalational Agents

Anaesthetic practice is unique in that a high proportion of the drugs are administered by the inhalational route. Such agents must either be gaseous, or the vapour of volatile liquids (Vari­ous Authors 1984).
Of the original three inhalational agents – ni­trous oxide, ether and chloroform – the first two are still used widely.

The greatest disadvantage of many of the volatile liquids and gases has been their flammable nature; the main reason for the decline of cyclopropane, which enjoyed wide popularity until the advent of halothane in 1956. Halothane, which has been firmly es­tablished as the basis of many general anaes­thetic techniques over the past 25 years, is not without its drawbacks, and investigation of new compounds continues. None of these is better overall than halothane, but in recent years ha­lothane has been slowly yielding popularity to enflurane and more recently to isoflurane.

Disposition and Pharmacological Properties

The uptake and distribution of inhalational anaesthetics is complex (Eger 1974). One must distinguish between an effective gas tension (partial pressure) and the total amount of drug dissolved in blood; it is the tension which de­termines the depth of anaesthesia. When a con­stant concentration of the anaesthetic is in­haled, the concentration in the alveoli rises gradually toward the inhaled level.

How quickly it rises will depend on the ventilation of the al­veoli (which may be reduced if the drug is ir­ritant or depresses respiration) and on the rate at which the drug is taken up into the blood from the alveoli. If the solubility (blood/gas sol­ubility coefficient) of the drug is high, then it will take longer for equilibrium to be attained, because (a) more of the drug needs to be dissolved in the blood for a given tension to be reached, and (b) the more rapid removal of the drug from the alveoli reduces the concentration here, and therefore reduces the gradient driving it from alveolus to capillary blood. A less sol­uble drug will likewise reach equilibrium more rapidly.

The rate of removal of drug into the blood will also depend on the cardiac output, which may be influenced by the drug itself; and finally the rate at which the tension of the drug in the blood rises toward that in alveoli will also depend on the rate at which it is distributed to other tissues, not only the target organ (brain), but also muscle, fat depots, etc. Such differences between infants and adults helps to explain the more rapid alveolar uptake of inhalational anaesthetics in the neonate. (Cook 1976; Eger et al. 1971).

The ability of the drug in the blood to pro­duce anaesthesia will depend on its anaesthetic potency. The minimal alveolar concentration (MAC) of the drug which will cause anaesthesia in 50% of patients is a measure often used to compare the potencies of different inhalational agents.

• Generalized Anxiety Disorder Treatment with Clorazepate ( Tranxene )
• Drugs Usage during Critical Medical Emergencies – Synopsis of Important Principles
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• Treating Diabetes Type2 with Miglitol ( Glyset, Acarbose, Precose )
• Treatments Usage and Effects of Dronabinol Drug (Or Marinol )
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• Pathophysiology of Circulatory Failure and Cardiopulmonary Resuscitation
• Synopsis of Important Principles – Drugs in Anaesthetic Practice
• Symptoms, Types and Treatment Options for Warts
• Cathartics, Enemas and Activated Charcoal

General Information of the drug

• Miglitol works differently from other oral antidiabetes drugs, which control blood sugar levels by increasing the production of insulin or helping the body to use the hormone more efficiently.
• Miglitol delays the digestion of carbohydrates (sugars) by acting in the cells that line the small intestine, where sugar is absorbed. This results in less sugar being absorbed into the blood and therefore, a lower blood-sugar level.
• Miglitol also has some effect against the enzyme lactase, but usually does not cause lactose intolerance. Hypoglycemia (very low blood sugar) is unlikely with miglitol because of the way the drug works in diabetes.
• Miglitol may be prescribed with another antidiabetic drug if single-drug therapy is not enough to adequately control blood sugar levels.



• People taking miglitol should have their blood sugar checked periodically to see how well the drug is working. Your blood glucose should be carefully monitored if you add or withdraw any of these drugs while taking miglitol or acarbose. It is common for patients to equip themselves with Home Glucose Monitors, which is widely available.
• Thiazides and other diuretics, corticosteroid anti-inflammatory drugs, phenothiazines, thyroid drugs, estrogens, contraceptive drugs, phenytoin, nicotinic acid, stimulants, calcium channel blockers, and isoniazid may increase blood sugar levels.
• Miglitol and acarbose add to the blood-sugar-lowering effect of sulfonylureas, insulin, and other antidiabetes drugs and may increase the risk of hypoglycemia (low blood sugar) associated with these drugs.
• Miglitol may interfere with the absorption of several drugs into the blood, including propranolol, ranitidine, digoxin, glyburide, and metformin. Seek advise with your doctor as he/she may need to adjust your dose of these drugs.
• Digestive enzyme preparations, charcoal, kaolin (an ingredient in Kaopectate), and antacids—as well as other drugs intended to absorb stomach contents—reduce the effects of miglitol and acarbose. Separate dosing of these drugs by at least 2 hours.
• Combining acarbose and digoxin may increase the effects of digoxin.
• As Miglitol prevents the breakdown of table sugar, if you take Miglitol in combination with insulin or a sulfonylurea prescription drugs, make sure to have a quick source of glucose (dextrose) with you to treat hypoglycemia ( symptoms include increased hunger, tiredness, sweating, increased heart rate, and numbness in the arms and legs ).
• Take your dose with the first bite of each meal. The drug has to be present in your intestine to prevent the absorption of sugar into your blood.
• As Miglitol cannot work unless there is food in your stomach, if you do forget to take a dose of miglitol with your meal, skip the dose you forgot. At the beginning of your next meal, continue with your regular dose .
• Before buying any nonprescription drug, seek advice with your pharmacist to be sure if it is safe for diabetics to take together with acarbose.

Cautions

• Do not take miglitol if you are sensitive or allergic to any of its ingredients
• If you have diabetic ketoacidosis, cirrhosis of the liver, inflammatory bowel disease, ulcers in the colon, intestinal obstruction, absorption or digestion diseases, or if intestinal gas, it will be a severe problem. Consult your doctor before taking this prescription.
• Acarbose may lead to liver inflammation.
• People with kidney disease retain higher levels of miglitol in the blood, but this does not affect the drug’s action because it acts locally in cells lining the small intestine. For patients with severe kidney disease should not take this drug due to drug retention in the blood.

Dosage and Possible Overdose ( This Prescription is not for Child )

• Acarbose :- Adult: 25-100 mg with breakfast, lunch, and dinner.
• Miglitol :- Adult: 25-100 mg with breakfast, lunch, and dinner.
• Miglitol must be taken with the first bite of each main meal.
• Unlike other antidiabetic medicines, a miglitol overdose does not cause hypoglycemia. Overdose symptoms are likely to include gas, diarrhea, and pain.
• Follow your doctor’s instructions especially for dietary plan, exercise, and blood- sugar testing. ( See Possible Side Effects below )

Possible Side Effects
a. Acarbose
Intestinal side effects of acarbose tend to improve or go away after a few weeks.
Most common:

• stomach gas (in 75% of people who take it),
• abdominal pain,
• and diarrhea.

( These side effects may be worse if you don’t restrict the amount of carbohydrate in your diet. Consult your doctor on proper dietary plan )

Less common or Rarely Occurs :

• skin rashes.
• swelling and itching,
• hepatitis or yellowing of the skin or whites of the eyes,
• abdominal distress,
• abdominal obstruction,
• liver irritation,
• abnormalities in blood tests.

b. Miglitol ( Most side effects of miglitol go away with continued use of the drug )
Most common:  gas, diarrhea, and abdominal pain.
Less common or Rare Effects : rash and low blood iron.

** For Unusual Side Effects that you may notice, seek your doctor advise immediately !

Pregnancy/Breast-feeding period :
Nursing Mothers who must take this drug should use infant formula, as the safety of using miglitol during pregnancy is not known, but small amounts of miglitol pass into breast milk. ( Diabetes during pregnancy is usually treated with insulin. )

Seniors Adult Consumption
Seniors with severe kidney disease should avoid this medication.

*Blood levels of acarbose are higher in older adults, but this is usually not considered important. Always consult your doctor if in doubt.

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• Anxiety,
• tension,
• symptoms of acute alcohol withdrawal,
• partial seizures,
• fatigue,
• agitation,
• irritable bowel syndrome,
• and panic attacks.

General Information of the drug

• Clorazepate dipotassium is a benzodiazepine, which directly affect the brain. This drug is a central-nervous-system depressant, and can relax you and make you more tranquil or sleepier, or they can slow nervous system transmissions in such a way as to act as an anticonvulsant.
• Many doctors prefer benzodiazepines to other drugs that can be used to similar effect because they tend to be safer, have fewer side effects.
• Clorazepate may increase blood levels of digoxin and the chances of digoxin toxicity.
• Don’t mix it with alcohol, other sedatives, narcotics, barbiturates, monoamine oxidase inhibitor and other antidepressants, and antihistamines.
• Taking clorazepate with other similar effects drugs may result in excessive depression, tiredness, sleepiness, breathing difficulties, or related symptoms.
• Combining clorazepate with phenytoin may increase phenytoin blood concentrations and the chances of phenytoin toxicity.
• Smoking may reduce clorazepate’s effectiveness by increasing the rate at which it is broken down by the body.
• Clorazepate’s effects may be prolonged when it is mixed with cimetidine, contraceptive drugs, disulfiram, fluoxetine, isoniazid, ketoconazole, metoprolol, probenecid, propoxyphene, propranolol, rifampin, or valproic acid.
• If you have to take Tranxene for a prolong period of time, your doctor will need to monitor your blood counts and liver function to be sure of your health state.
• Theophylline may reduce clorazepate’s sedative effects.
• If you take antacids, separate them from your clorazepate dose by at least 1 hour to prevent them from interfering with the absorption of clorazepate into the bloodstream.
• The effect of levodopa + carbidopa may be decreased if it is taken together with clorazepate.

Cautions ( This drug may be addictive ! )

• Clorazepate may be addictive. It should be used with caution in people with a history of drug dependence.
• Do not take clorazepate if you are allergic or sensitive to any of its ingredients or to another benzodiazepine drug, including clonazepam.
• Clorazepate can aggravate narrow-angle glaucoma, but you may take it if you have open-angle glaucoma and are receiving therapy for it.
• Clorazepate should not be taken by psychotic patients because it is not effective for them and can trigger unusual excitement, stimulation, and rage.
• Clorazepate is not intended to be used for more than 3-4 months at a time. Your doctor should reassess your condition before continuing your prescription beyond that time.
• Your dosage should always be reduced gradually to prevent drug withdrawal symptoms, which may develop if you stop taking it after as few as 4 weeks of regular use but is more likely after longer use.
• Drug withdrawal symptoms may start with anxiety and progress to tingling in the hands or feet, sensitivity to bright light, sleep disturbances, cramps, tremors, muscle tension or twitching, poor concentration, flu-like symptoms, fatigue, appetite loss, sweating. and changes in mental state.
• Other conditions in which clorazepate should be avoided are: severe depression, severe lung disease, sleep apnea (intermittent cessation of breathing during sleep), liver disease, drunkenness, and kidney disease. In each of these conditions, the depressive effects of clorazepate may be enhanced or could be detrimental to your overall condition.

Note

• This drug is for Adult Only ! It is not recommended for child.
• Clorazepate is best taken on an empty stomach, but if it upsets your stomach then it may be taken with food. Consult your doctor on this.
• Clorazepate can cause tiredness, drowsiness, inability to concentrate, or similar symptoms. Be careful if you are driving, operating machinery, or performing other activities that require concentration.
• People taking clorazepate for more than 3 or 4 months at a time may develop drug withdrawal reactions if the medication is stopped suddenly (see “Cautions” section above). Do not stop taking clorazepate or increase or decrease your dosage without first consulting your doctor.
• Do not take a double dose. If you forget a dose of clorazepate, take it as soon as you remember. If it is almost time for your next dose, skip the dose you forgot and continue with your regular schedule.

Pregnancy/Breast-feeding period :

• Clorazepate may cause birth defects if taken during the first 3 months of pregnancy.
• Avoid this drug if you are or might be pregnant, as Clorazepate may pass into breast milk. Nursing mothers who must take clorazepate should switch to use infant formula.

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• Synopsis of Important Principles – Drugs in Anaesthetic Practice
• Drug Overdosage and Poisoning – Synopsis of Important Principles
• Angiotensin-Converting Enzyme Inhibitor – Vasotec Enalapril
• Gastric Aspiration and Lavage

1. Specific antidotal therapy is available for very few poisons. The mainstay of treatment of severe poisoning is intensive supportive therapy and good nursing care.

2. The great majority of poisoned patients recover with intensive supportive therapy alone, and enthusiastic claims for the success of other treatment often cannot be justified.

3. With some important exceptions, the management of poisoning is not altered by knowledge of plasma drug concentrations. There are many pitfalls in the interpretation of drug concen­trations in poisoned patients, especially when nonspecific analytical methods are used.

4. Gastric lavage and induction of nemesis soon after ingestion may be effective in removing unabsorbed drug, but are unreliable. Adsorbents such as activated charcoal are usually ineffec­tive in limiting absorption when given more than 1 hour after ingestion.

5. Poisoned patients are often subjected to unnecessary and potentially harmful haemodialysis, haemoperfusion and diuresis. The efficacy of these measures has been established for relatively few substances in terms of reduction in morbidity and mortality or removal of toxicologically significant amounts of active drug or poison.

6. The efficacy of methods for extracorporeal removal can be predicted from pharmacokinetic principles. It depends primarily on the volume of drug distribution, plasma protein binding, rate of transfer from peripheral to central compartments, and dialysis clearance relative to the endogenous total body clearance.

7. Haemoperfusion with activated charcoal or exchange resins is more effective than haemo­dialysis in removing drugs from the blood. Peritoneal dialysis is less effective than haemodi­alysis. Drugs with large volumes of distribution cannot be removed rapidly by any of these techniques, and indications for their use are limited.

8. Forced diuresis can only increase the renal clearance of reabsorbed compounds, and clearance may be dramatically increased by appropriate manipulation of urine pH. However, the renal excretion of most drugs is insignificant in relation to the metabolic clearance. Forced alkaline diuresis is largely restricted to salicylate and phenobarbitone poisoning.

9. Repeated oral activated charcoal effectively increases the body clearance of a number of drugs. It probably acts by irreversibly binding drug diffusing from the circulation to the gut lumen and may also interrupt the enterohepatic circulation.

10. The toxicity of a few drugs and poisons can be reversed by specific antidotal therapy. Mechanisms include pharmacological antagonism, inhibition of conversion to toxic metabolites, inactivation of highly reactive alkylating intermediates, chelation and binding with drug-specific antibodies.

• Drugs Usage during Critical Medical Emergencies – Synopsis of Important Principles
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• Methods for Enhancement of Drug Elimination
• Anaesthetic Agents – Drugs Used in Anaesthesia
• Synopsis of Important Principles – Drugs in Anaesthetic Practice
• Gastric Aspiration and Lavage
• Treating Diabetes Type2 with Miglitol ( Glyset, Acarbose, Precose )
• Collaboration Between Healthcare Provider and Clinical Labora­tory on Therapeutic Drug Monitoring
• Cathartics, Enemas and Activated Charcoal
• Treatments Usage and Effects of Dronabinol Drug (Or Marinol )

• Nausea and vomiting associated with cancer chemotherapy,
• appetite stimulation and weight-loss prevention in people with acquired immunodeficiency syndrome (AIDS).

General Information

• Dronabinol is a legal form of marijuana. The psychoactive chemical in marijuana is delta-9-THC. Dronabinol has all of the psychological effects of marijuana and is therefore considered to be a highly abusable drug.
• Dronabinol increases the effects of alcohol, sleeping pills, sedatives, and other depressants.
• Dronabinol also enhances the effects of psychoactive drugs including tricyclic antidepressants, amphetamines, cocaine, and other stimulants.
• This drug is known to be potential cause of personality changes, feelings of detachment, hallucinations, and euphoria (feeling “high”).
• Younger adults have reported a greater success rate with dronabinol, probably because they are better able to tolerate these effects.
• Most people start taking dronabinol while in the hospital so their response to the drug and its possible adverse effects can be monitored.
• Dronabinol has also been studied as a glaucoma treatment. ( More information to be researched in this field )
• Dronabinol may increase the effects of fluoxetine and disulfiram.
• The effects of theophylline drugs are reduced by dronabinol.
• Combining dronabinol and antihistamines or anticholinergic drugs may cause either rapid heartbeat or excessive drowsiness.

Cautions ( This drug has serious effects ! )

• Do not take dronabinol if you are allergic or sensitive to any of its ingredients, to marijuana. or to sesame oil.
• Dronabinol should be used with caution in those with a history of seizure disorders or substance abuse.
• Dronabinol should be used with caution by people with heart disease or high blood pressure.
• Dronabinol has a profound effect on mental states, as it will impair your ability to operate complex equipment or engage in any activity that requires intense concentration, sound judgment, or coordination—such as driving a car.
• Dronabinol should not be used to treat nausea and vomiting caused by anything other than cancer chemotherapy.
• Dronabinol produces withdrawal symptoms when the drug is stopped. These may develop within 12 hours of the drug’s discontinuation and include restlessness, sleeplessness, and irritability.
• Within a day after the drug has been stopped, symptoms like stuffy nose, hot flashes, sweating, loose stools, hiccups, or appetite loss may occur. These symptoms usually subside within a few days.
• Dronabinol should be used with caution by people with a manic-depressive or schizophrenic history because it may aggravate the underlying disease.

Note :-

• Avoid alcohol and other central nervous system (CNS) depressants.
• The capsules must be stored in the refrigerator.
• Be careful when driving or performing any task that requires concentration.
  Dronabinol may cause acute psychiatric or psychological side effects. Call your doctor for advise.

Common Side Effects of the drug :-

• drowsiness,
• depression,
• loss of muscle coordination,
• unsteadiness,
• paranoia,
• depersonalization,
• disorientation,
• euphoria,
• dizziness,
• weakness,
• sluggishness,
• nausea and vomiting,
• headache,
• a separation in time and space,
• confusion,
• rapid heartbeat.
• hallucinations,
• memory lapses,
• anxiety,
• muddled thinking,
• perceptual difficulties,
• poor coordination,
• irritability,
• dizziness when rising from a sitting or lying position.

Unlikely Side Effects :-

• difficulty talking or slurred speech,
• facial flushing
• loss of bowel control,
• excessive perspiration,
• fainting,
• diarrhea,
• nightmares,
• ringing or buzzing in the ears,
• muscle pain

Usual Dose Intake ( Do not take a double dose )

1. Antiemetic :

• 5 mg 1-3 hours before starting chemotherapy treatment and repeated every 2-4 hours after treatment, for a total of 4-6 doses a day.
• Dosage may be increased up to 15 mg per dose if needed; psychiatric side effects increase greatly at higher dosages.

2. Appetite Stimulant:

• 2.5 mg before lunch or dinner, or 2.5 mg at bedtime. Dosage may be increased to 20 mg a day.

Over Dosage Effect(s)

• Overdose symptoms may occur at usual dosages or at higher dosages if the drug is being abused.
• The primary symptoms of overdose are the psychological symptoms listed above (see “Side Effects lists above”).
• In some cases, overdose may lead to panic reactions or seizure.

Pregnancy/Breast-feeding period :

• Dronabinol is known to be passes into breast milk. Nursing mothers who must take this drug should use infant formula. Animal laboratory studies have shown adverse effects on the fetus.

• Generalized Anxiety Disorder Treatment with Clorazepate ( Tranxene )
• Using Entacapone in Parkinson’s Disease Treatment
• Treating Diabetes Type2 with Miglitol ( Glyset, Acarbose, Precose )
• Drugs Usage during Critical Medical Emergencies – Synopsis of Important Principles
• Angiotensin-Converting Enzyme Inhibitor – Vasotec Enalapril
• Pathophysiology of Circulatory Failure and Cardiopulmonary Resuscitation
• Anaesthetic Agents – Drugs Used in Anaesthesia
• Symptoms, Types and Treatment Options for Warts
• Synopsis of Important Principles – Drugs in Anaesthetic Practice
• Drug Overdosage and Poisoning – Synopsis of Important Principles

Although quinidine is rarely used for this purpose today, because of the advent of DC cardioversion, this study is still almost unique because it defined a target concentration based upon both the probability of therapeutic success and of toxicity.

A concentration of 8 rag/ L was shown to have an 80% chance of converting atrial fibrillation to sinus rhythm and a 20% chance of some serious toxicity. No atten­tion was paid to pharmacokinetics, The target concentration was chosen on the basis of pharmacodynamics, i.e. the effects, both good and bad, observed at particular concentrations.

Rational therapeutics – the aim of rational ther­apeutics is to achieve the desired effect with the cor­rect dose. The foundation of decision making is based on pharmacokinetics and pharmacodynamics which provide the rational principles to link dose and effect through drug concentration.

Rational therapeutics can be defined as the administration of the correct dose to achieve the desired effect. The target concentration concept is at the centre of rational therapeutics where it links dose to effect. Pharmacokinetics is the science that links dose and concentration by defining the processes of drug distribution (volume of distribution) and elimination (clear­ance).

Pharmacodynamics, on the other hand, is the science linking concentration to effect by defining the maximum effect of the drug (Emax) and the sensitivity of the target organ (as de­termined by the EC50; M£ the concentration producing 50% of Emax).

Therapeutic drug monitoring can now be placed at the centre of this therapeutic triangle. This incorporates information about doses, concentrations, and effects in an individ­ual and integrates these data to estimate more precisely the pharmacokinetic (volume of dis­tribution, clearance) and pharmacodynamic (Emax, EC50) parameters in that individual. These new values can then be used to predict the consequences of future dosing decisions and thus enable the selection of a suitable dose to achieve the desired effect, i.e. rational therapeutics.

• Collaboration Between Healthcare Provider and Clinical Labora­tory on Therapeutic Drug Monitoring
• Drugs Usage during Critical Medical Emergencies – Synopsis of Important Principles
• Treating Diabetes Type2 with Miglitol ( Glyset, Acarbose, Precose )
• Generalized Anxiety Disorder Treatment with Clorazepate ( Tranxene )
• Drug Overdosage and Poisoning – Synopsis of Important Principles
• Anaesthetic Agents – Drugs Used in Anaesthesia
• Cathartics, Enemas and Activated Charcoal
• Methods for Enhancement of Drug Elimination
• Treatments Usage and Effects of Dronabinol Drug (Or Marinol )
• Gastric Aspiration and Lavage

This is because, unlike say sodium or glucose, the in­take of a drug is quite well known and the pro­cesses of distribution and elimination are usu­ally very simple and not under the control of a multitude of homeostatic controlling reflexes.

Given an accurate dosing history and one or more drug concentrations, it is possible to de­scribe the pharmacokinetic processes of distri­bution and elimination quite precisely in an individual patient and to make accurate predic­tions of concentrations at future points in time, whatever dosing regimen is used.

The ability to interpret drug concentrations and extract infor­mation so that future concentrations can be pre­dicted and a rational dosing scheme instituted, requires a different kind of intellectual effort from that needed to interpret, say, a serum glu­cose concentration. The latter is mostly inter­preted by reference to a so-called ‘normal range’ – usually the 95% confidence interval based upon measurements from a sample of a ‘normal’ population.

Under most circumstances, if the serum glucose concentration is within the “nor­mal range”, little further attention is paid to it If it is outside of the ‘normal range’, diagnostic efforts are made to determine what pathophys­iological process is disturbed. But the precise value will be used only in a semi quantitative fashion, eg. high, very high, or extremely high, or in reference to some previously defined diag­nostic threshold value; for example, diabetes mellitus may be diagnosed if the glucose con­centration is greater than 10 mmol/L.

On the other hand, all drug concentrations exceed the “normal” range because it would be abnormal to be able to detect any therapeutic substance in the serum of a normal, healthy individual.

The quantitative information provided by a drug concentration measurement can be use­fully applied with up to 2 significant figures in the determination of, say, drug clearance. This degree of precision is implicit in use of this in­formation because individual dosage decisions will often be made with 2 significant figures in the dose size.

The quantitative approach to therapeutic decision making is relatively new to the art of medicine. Most clinicians currently practicing medicine will not have been taught very much pharmacokinetics during their undergraduate training and may therefore have only a very hazy idea of the quantitative decisions that form the basis of rational therapeutics.

Furthermore, younger clinicians may be misled into thinking that the pharmacokinetics they were taught at medical school are irrelevant to modern medi­cine because their senior colleagues pay no at­tention to pharmacokinetic detail and make therapeutic decisions in a seemingly capricious fashion. Such a conclusion may be quite false because therapeutic decisions made by an ex­perienced clinician are founded upon a wide base of knowledge gained from treating many similar patients.

This prior knowledge of the character­istics of the population being treated provides an empirical, but nevertheless frequently satis­factory, guide to making an appropriate quan­titative and qualitative therapeutic decision. Recognition of the value of such prior infor­mation when faced with an individual patient about whom little is known is the basis of the latest techniques of rational, quantitative phar­macokinetic and pharmacodynamic forecasting.

For the person who must make a therapeutic choice on behalf of an individual patient, the application of quantitative pharmacokinetic principles can substitute for the advice of a more experienced colleague. For all clinicians, young and old, these same principles can be applied to new therapeutic entities and reduce the suf­fering of patients who would otherwise be ex­posed to the vagaries of a trial and error ap­proach.

• Drugs Usage during Critical Medical Emergencies – Synopsis of Important Principles
• Methods for Enhancement of Drug Elimination
• Achieving Desired Treatment Effect with Cor­rect Drug Dosage via Rational therapeutics
• Treating Diabetes Type2 with Miglitol ( Glyset, Acarbose, Precose )
• Drug Overdosage and Poisoning – Synopsis of Important Principles
• Synopsis of Important Principles – Drugs in Anaesthetic Practice
• Generalized Anxiety Disorder Treatment with Clorazepate ( Tranxene )
• Anaesthetic Agents – Drugs Used in Anaesthesia
• Cathartics, Enemas and Activated Charcoal
• Treatments Usage and Effects of Dronabinol Drug (Or Marinol )