Preface A: Anatomy of a Flash Card
Medication Name
Both generic an common bran names are listed .
Class
Medications are grouped into classes (“families”) base on their chemical, pharmacological, or clinical properties. It is often useful to study medications on a class-by-class basis, identifying similarities and differences among members of each class.
Controlled Substance Schedule
Title 21 of the Unite States Co e (USC) is the Controlled Substances Act of 1970. It regulates medications with potential for abuse. These Federal regulations are overseen by the Drug Enforcement A ministration, but many States have enacted more strict regulations base on them. Medications are place into schedules base on their clinical use an their risk of abuse and dependence. It is important to note that some States change the Federal scheduling of certain medications. Under Federal law, a State cannot place a medication in a lower schedule than where it is place by the Federal government (eg, States cannot change a rug place in Federal Schedule II to Schedule III, IV, or V), but States can and do place certain medications in higher schedules (eg, changing a drug place in Federal Schedule V into Schedule II, III, or IV, or changing a drug which is not a controlled substance under Federal law into a controlled substance within that State).
• Schedule I: No medical use, high abuse, and dependence potential.
• Schedule II: Legitimate medical use, high abuse, and dependence potential.
• Schedule III: Legitimate medical use, abuse, and dependence potential somewhat less than Schedule II.
• Schedule IV: Legitimate medical use, abuse, and dependence potential less than Schedule III.
• Schedule V: Legitimate medical use, limited abuse, and dependence potential.
Dosage Forms
The most common dosage forms an strengths are listed. Other dosage forms may exist, an may be reference in the Clinical Pearls section.
Both generic an common bran names are listed .
Class
Medications are grouped into classes (“families”) base on their chemical, pharmacological, or clinical properties. It is often useful to study medications on a class-by-class basis, identifying similarities and differences among members of each class.
Controlled Substance Schedule
Title 21 of the Unite States Co e (USC) is the Controlled Substances Act of 1970. It regulates medications with potential for abuse. These Federal regulations are overseen by the Drug Enforcement A ministration, but many States have enacted more strict regulations base on them. Medications are place into schedules base on their clinical use an their risk of abuse and dependence. It is important to note that some States change the Federal scheduling of certain medications. Under Federal law, a State cannot place a medication in a lower schedule than where it is place by the Federal government (eg, States cannot change a rug place in Federal Schedule II to Schedule III, IV, or V), but States can and do place certain medications in higher schedules (eg, changing a drug place in Federal Schedule V into Schedule II, III, or IV, or changing a drug which is not a controlled substance under Federal law into a controlled substance within that State).
• Schedule I: No medical use, high abuse, and dependence potential.
• Schedule II: Legitimate medical use, high abuse, and dependence potential.
• Schedule III: Legitimate medical use, abuse, and dependence potential somewhat less than Schedule II.
• Schedule IV: Legitimate medical use, abuse, and dependence potential less than Schedule III.
• Schedule V: Legitimate medical use, limited abuse, and dependence potential.
Dosage Forms
The most common dosage forms an strengths are listed. Other dosage forms may exist, an may be reference in the Clinical Pearls section.
Common FDA Label Indication, Dosing, and Titration
The US Foo an Drug A ministration (FDA) approves medications for market, an also approves specific indications for use an the doses for those uses. Some medications are approve for only one indication, while others are approve for many indications. In most cases, all FDA-approve (“labeled”) indications are listed with their approve doses.
O -Label Uses
While every medication must be approve by the FDA for at least one indication before it is marketed, FDA approval is not always sought for subsequent indications. Prescribers are legally entitle to prescribe medications for any indication they feel is appropriate an clinically justified. In most cases, prescribers limit their use of medications to indications for which evidence supports safety an efficacy, as demonstrate in published clinical trials. While these may not be FDA-approve indications, “off-label” use is common an often completely appropriate. Common off-label uses are inclu e , along with dosing recommendations.
MOA (Mechanism o Action)
The MOA is a succinct summary of the pharmacological properties of each me ication.
Drug Characteristics
Each car includes a table summarizing key rug parameters, as outline below.
Dose Adjustments Hepatic
A Child-Pugh Score can be use to assess hepatic dysfunction. The score employs five clinical measures of liver disease. Each is score 1-3, with 3 indicating the most severe derangement of that measure. Base on the number of points for each measure, liver disease can be classified into Chil -Pugh class A, B, or C.
The US Foo an Drug A ministration (FDA) approves medications for market, an also approves specific indications for use an the doses for those uses. Some medications are approve for only one indication, while others are approve for many indications. In most cases, all FDA-approve (“labeled”) indications are listed with their approve doses.
O -Label Uses
While every medication must be approve by the FDA for at least one indication before it is marketed, FDA approval is not always sought for subsequent indications. Prescribers are legally entitle to prescribe medications for any indication they feel is appropriate an clinically justified. In most cases, prescribers limit their use of medications to indications for which evidence supports safety an efficacy, as demonstrate in published clinical trials. While these may not be FDA-approve indications, “off-label” use is common an often completely appropriate. Common off-label uses are inclu e , along with dosing recommendations.
MOA (Mechanism o Action)
The MOA is a succinct summary of the pharmacological properties of each me ication.
Drug Characteristics
Each car includes a table summarizing key rug parameters, as outline below.
Dose Adjustments Hepatic
A Child-Pugh Score can be use to assess hepatic dysfunction. The score employs five clinical measures of liver disease. Each is score 1-3, with 3 indicating the most severe derangement of that measure. Base on the number of points for each measure, liver disease can be classified into Chil -Pugh class A, B, or C.
| measure | 1 point | 2 point | 3 point |
|---|---|---|---|
| total bilirubin, mg/dL | <2 | 2,0-3,0 | >3 |
| Serum albumin, g/L | >35 | 28-35 | <28 |
| INR | <1.7 | 1.71-2.20 | >2.20 |
| Ascites | None | Mil | Severe |
| Hepatic encephalopathy | None | Gra e I-II | Gra e III-IV |
Dose Adjustments Renal
Dose adjustments for some (but not all) of medications that are renally eliminate are necessary in patients with renal dysfunction and hepatically eliminate medications in patients with hepatic dysfunction. Dose adjustments are ma e by either lowering the dose or dosing less frequently (eg, reducing from ti to daily dosing). The degree of renal dysfunction usually determines the degree of the dose adjustment. Definitions of renal an hepatic dysfunction are often inconsistent, but the recommended dose adjustments included in these flash car s are drawn from product package inserts an other sources. Clinicians should always exercise caution when treating patients with liver an /or kidney disease, an monitor carefully for signs of toxicity, even if dose adjustments are made.
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