Question

Find for any evidence based practice the following medications : 11) Cleviprex 12) Atropine 13) Digoxin (4) Mannitol 15) Propofol 16) versed (17) Calcium Gluconate 18) Fentanyl 19 Narcan 20) Romazicon

Answer 1

1) Cleviprex ( clevidipine)

Class: dihydropyridine ( calcium channel blocker)

Evidence:

• The ECLIPSE trials - Clevidipine as safe as nicardipine, sodium nitroprusside, nitroglycerine in the management of acute hypertension in cardiac surgery.
• ESCAPE-1 trial - Clevidipine effective in treating preoperative hypertension in patients undergoing cardiac surgery
• ESCAPE-2 trial - Clevidipine effective in treating postoperative hypertension in patients undergoing cardiac surgery.
• VELOCITY-1 trial - prolonged infusion of clevidipine resulted in a safe and predictable fall in blood pressure in case of acute hypertension.

Mechanism of action - dilatation of systemic and coronary blood arteries, by inhibiting influx of calcium into myocytes

Uses- Acute hypertension

2) Atropine -

Class - Antimuscarnic agent

Evidence -

• LAMP study - Atropine 0.05% was more efficacious in reducing the progression of myopia than 0.01% atropine
• ATOM 1 - Atropine 1% slowed the progression of myopia
• ATOM 2 - Atropine 0.01% was as effective as 0.1% and had a better side effect profile
• MOSAIC trial - first-ever trial to study the use of atropine in the control of myopia in European subjects.

Mechanism of action - Blocks the cholinergic receptors ( muscarinic receptors) and inhibits the parasympathetic effect of acetylcholine

Uses -

1. Myopia
2. Sialorrhea
3. Pylorospasm

Digoxin - Antiarhythmia drug

Evidence -

1. AFFIRM trial - rhythm control strategies offered no benefit over rate control strategies ( digoxin) in atrial fibrillation
2. DIG trial - neutral effect on mortality and admission to hospital with digoxin compared with placebo

Mechanism of action

1. Inhibition of Na+-K+ ATPase inhibition > increase the intracellular availability of Ca - this increase the force of contraction
2. Improve the sensitivity of the blood vessel to endogenous and exogenous catecholamines.

Uses -

1. Atrial fibrillation
2. Heart failure

Mannitol

Evidence - In an RCT, use of mannitol with dextran was more efficacious than mannitol alone in the management of increased intracranial pressure

Class - Osmotic diuretic

Mechanism of action

1. Increase intravascular osmolarity, this stimulates fluid to move from the intracellular space to the intravascular compartment - In simple words reduces cellular edema
2. It promotes the excretion sodium and chloride and water from the nephrons

Uses

1. Increased intraocular pressure
2. Increased intracranial pressure.

Propofol

Class - anesthetic

Evidence

1. ACCEPTS study - a study of anethestic controlled vs patient-controlled targetted propofol sedation in lower limb arthroplasty performed under spinal anesthesia

Mechanism of action - Acts of GABA receptors and depresses the central nervous system.

Uses

1. Short anesthesia
2. Conscious sedation ( monitored anesthesia)
3. As a paralytic for an intubated patient in intensive care unit

Versed ( Midazolam)

Class - Benzodiazepine

Evidence - RCT should moderate sedation provided by midazolam and ketamine combination and midazolam. The side effect profile was

Mechanism of action - Acts on the GABA receptor and enhances the effect of GABA

Uses

1. Anxiolytic agent
2. Preoperative sedation
3. Anesthesia
4. As a sedative in an intubated patient.

Calcium gluconate

Class - Calcium

Mechanism - several functions

1. part of the bone
2. Involved in neuro-transmission
3. Involved in muscle contraction
4. Enzymatic action
5. Secretion of hormones

Uses -

1. Calcium supplementation
2. Hypocalcemia
3. Hyperkalemia
4. Hypermagnesemia
5. Calcium channel blocker overdose

Fentanyl

Evidence -

1. An RCT placebo-controlled trial showed Oral transmucosal fentanyl was effecting in controlling breakthrough pain in cancer

Class - Opioid analegesic

Mechanism of action - agonist of opioid receptors, reduces pain and increase pain threshold

Uses -

1. preoperative
2. anesthesia
3. pain relief

Narcan

Class - Opioid antagonist

Evidence

1. An RCT showed that intranasal naloxone was as effective as i.v. naloxone in reversing the CNS depressant and respiratory depressant effects of opioid drugs

Mechanism of action - a competitive opioid antagonist

Uses

1. treatment of opioid overdose
2. to reverse the respiratory depressant effect of medical opioid usage.

Romazicon

Class - Benzodiazepine antidote

Mechanism of action -Inhibits the action of benzodiazepine receptor by acting on GABA/ benzodiazepine receptor complex

Uses -

1. treatment of benzodiazepine overdose
2. Reversal of conscious sedation