🛑Most clinical cases of drug-induced QT prolongation occur in the presence of at least one of these risk factors, and >70%🤔 occur in the presence of two or more.
✅ • Electrolyte disorders – hypokalaemia, hypomagnesaemia, hypocalcaemia, risk increases with lower levels. (Hypokalaemia-related QTc prolongation is commonly observed in acute psychotic admissions)
✅• Drugs or conditions which may impact on electrolytes e.g., diuretics, dietary supplements, severe acute illness, gastroenteritis.

✅ • Kidney or liver disease (risk increases with increased severity) – also consider impact on metabolism of other drugs/risk of increased adverse effects
✅• Age ≥ 65 years
✅• Female sex
✅ Baseline QTc interval >480 msec
✅ Personal history/congenital or family history of long QT syndrome
✅ • Cardiac risk factors such as heart failure, left ventricular hypertrophy, bradycardia (heart rate <60), IHD, myocarditis, MI

✅Untreated thyroid disease – more common with hypothyroidism
✅ • Unexplained syncope/presyncope
✅ • Family history of sudden cardiac death or syncope
✅ • Prescribed a drug that may affect elimination of psychotropic drug e.g., affecting cytochromes or drug transporters required for elimination
✅• Drug toxicity e.g., due to patient’s metaboliser status, drug interaction or accidental or intentional overdose
✅ • Prescribed another drug with potential to prolong QTc interval
✅• Methadone dose ≥100 mg/day

#NUh

🛑Acute coronary syndrome in women

✅.Women of all ages have higher rates of in-hospital and long-term complications from ACS than men.
✅Women derive the same benefit from aspirin,P2Y12 inhibitors,anticoagulants,β-blockers,ACE inhibitors, and statins as men, but women may be at higher risk of adverse events( Women have a higher rate of bleeding complications, renal failure, and vascular complications.)

✅ Women with NSTE-ACS and high-risk features (e.g., troponin positive) should undergo an early invasive strategy.

✅ Women with NSTE-ACS and low-risk features should not undergo early invasive treatment because of the lack of benefit and the potential for harm(classIII).

#ACCP2024

🛑فائده ادويه Aldosterone receptor blockers مثل spironolactone في مريض Acute coronary syndrome بتكون افضل كلما كان البدء بها بوقت مبكر افضل من التأخير بها (بعد سبع إيام من دخول المريض في ACs)
✅

✅طبعا تضاف إلى ادويه ACEI و BET blockers  في مريض MI اذا كان لدى المريض
✅diabetes
✅Symptomatic heart failure
✅LVEF < 40%


#ACCP2024

🛑Principles of antimicrobial therapy of Pseudomonas aeruginosa infections


✅For patients who have sepsis or septic shock, have neutropenia and bacteremia, have severe burns, or are in a setting where the incidence of resistance to the chosen antibiotic class is high (eg, >10 to 15 percent), we suggest empiric therapy with a combination of two antipseudomonal agents (Grade 2C). The two agents should be from different antibiotic classes (eg, a beta-lactam with an aminoglycoside،Fluoroquinolones

✅For patients without any of these additional risk factors for mortality or resistant organisms, we suggest empiric treatment with a single antipseudomonal agent (Grade 2B)

#Uptodate 2024

#remember

✅Nearly all infections of the female genital tract that are not caused by sexually transmitted pathogens are likely to involve anaerobic bacteria
#UPTODATE2024

🛑vancomycin and anaerobes bacteria

✅Active against gram-positive anaerobes; inactive against gram-negative anaerobes except when given orally where vancomycin greatly diminishes the colon microbiota including B. fragilis

#Uptodate

Chat GPt
راح يفيدك كثير المهم رغبتك ف التعلم وطريقه الإدخال
مثال بسيط أخبرته بأن يعتبر نفسه كلينك فارمسي ويلخص لي الادوية التي تاخذ ع معده فارغه ثم طلبت منه وضعه ع شكل pdf

#remember
✅Arterial Blood Gas (ABG)

✅Arterial blood gases should be used for assessing respiratory failure in Critically ill Patients or those with Shock or Hypotension (Systolic blood pressure < 90mmHg)

(British Thoracic Society, 2017)

🛑 pulmonary embolism and Chest X-ray

✅usually normal in PE😁
✅Should be performed in all patients with symptoms or signs suggestive of PE➡️ to exclude other pathology

#Not and Note

🛑ABG Use in

1 🛑. Evaluation of Oxygenation:

✅Determine arterial oxygen (PaO₂) levels in conditions like hypoxemia or respiratory distress.

✅Assess response to oxygen therapy or mechanical ventilation.

2.🛑 Assessment of Ventilation:

✅Monitor arterial carbon dioxide (PaCO₂) levels in respiratory failure, COPD, or hyperventilation syndromes.

🛑3. Acid-Base Imbalance:

✅Diagnose and monitor metabolic or respiratory acidosis/alkalosis in conditions like diabetic ketoacidosis, renal failure, or sepsis.

🛑4. Monitoring Critically Ill Patients:

✅Track changes in pH, PaO₂, and PaCO₂ during severe illness, trauma, or after major surgery.

#remember

✅  improving glycemic  control reduce microvascular complications but this has no significant impact upon cardiovascular morbidity and mortality.

✅lowering blood pressure significantly reduced morbidity from both microvascular and macrovascular disease.

#Not and Note

🛑Heparin and thyroid function test

✅ Heparin is having an "in vitro" effect on thyroxine (T4) levels.

✅IV heparin interferes with the thyroid function tests assay on occasions displacing bound thyroid hormone.

✅ Normal TSH + high T3 and T4
#Not and Note

#remember

🛑Tricyclic overdose ➡️ give IV bicarbonate

#Not and Note

🛑Management

✅Check U&Es, looking specifically for hypokalaemia, and ABG looking for acidosis.

✅Hypokalaemia should be corrected. ECG should be done to assess the QRS interval.

✅Gastric lavage should only be considered if it is within one hour a potentially fatal overdose.

✅50 g of charcoal can be given if it is within one hour of ingestion.

✅50 ml of 8.4% sodium bicarbonate should be given if the pH is less than 7.1, QRS interval is more than 0.16 s, or there are cardiac arrhythmias or hypotension.

✅Indication for sodium bicarbonate in tricyclic poisoning includes wide QRS complex.

✅Intravenous sodium bicarbonate is the standard initial therapy for patients who develop cardiotoxicity (usually a QRS > 100ms or a ventricular arrhythmia) as a result of tricyclic antidepressant (TCA) overdose.

✅Mechanism of Sodium bicarbonate action:

✅alkalinisation of blood to a pH of 7.45-7.55 uncouples TCA from myocardial sodium channels;

✅also, additional sodium increases extracellular sodium concentration, thereby improving the gradient across the channel.

✅ Intravenous magnesium sulphate can be used as a second-line agent in refractory arrhythmias.

#Not and Note

#سؤال
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