Lifestyle Modifications: Maintain sleep schedule Do not go to bed unless tired Sleep long enough, but not too much Optimize bedroom lighting, temp and sound Develop a ritual Do not stay in bed for more than 15 minutes if you can’t sleep Don’t go to bed hungry. Only use the bedroom for sleep Avoid naps Avoid […]
Guideline Materials and Tips
Skeletal Muscle Relaxants
baclofen – seizure in overdose
Research Study Subjects -Informed Consent
Expedited IRB Review: Minimal or no risk Involve data, documents, specimens etc that have been collected for non-research purposes. IRB Exempt: Research in established or commonly accepted educational settings Use of educational tests where subjects cannot be IDed The use of texts and surveys if the subject is a public official under FOIA. Collecting or […]
QT Prolongation
Low Mg, Ca or K can all cause QT prolongation
Pulmonary HTN
Stages: No symptoms Symptoms with strenuous daily activities Symptoms with normal daily activities Symptoms at rest. Treatment: High dose CCBs Inhaled nitric oxide IV epoprostenol and IV adenosine ambrisentan, bosentan, macitentan, riociguat, sildenafil, tadalafil
Medication Errors
Medication Error Definitions: Mild: enhanced monitoring, no harm Moderate: active treatment required, enhanced monitoring, but no lasting harm Severe: patient harm that requires enhanced treatment and increased patient stay FDA’s Adverse Event Reporting System (FAERS): FAERS is a database that contains adverse event reports, medication error reports and product quality complaints resulting in adverse events that […]
Laws and Regulations to Know
This section is tricky. I recommend knowing a few laws and what they do. Food, Drug and Cosmetic Act (1938) – Give authority to the U.S. Food and Drug Administration (FDA) to oversee the safety of food, drugs, medical devices, and cosmetics. Covers orphan drugs. The introduction of this act was influenced by the death of more […]
Depression
Diagnosis: MDD – Major Depressive Disorder/Unipolar DisorderAt least five symptoms every day for at least 2 weeks.Depressed mood = SIG E CAPS Sleep disturbances Interest in activities lost Guilt or worthlessness feelings Energy decreased Concentration decreased Appetite and weight changes Psychomotor retardation Suicidal ideation Rating Scales: HAM-D: Hamilton rating scale for depression – 18 moderate, 7 […]
Dementia
Cognitive Screening Mini – Mental Status Exam – MMSE Montreal Cognitive Assessment – MOCA St Louis University Mental Scale – SLUMS Mood screening: Geriatric Depression.ScaleIADL: Instrumental Activities Of Daily Living Diagnosing Dementia: Rule out delirium and drug-related causes. Other causes: vitamin B12 deficiency, hypothyroidism, depression, NPH, opioids, sedative-hypnotics, antidepressants, anticholinergics, antiparkinson’s drugs Treatment: Initiate a cholinesterase inhibitor in […]
Chemo Induced Nausea and Vomiting
Prophylactic therapy should be given prior to moderately to highly emetogenic agents or radiation They should be scheduled for after chemo to prevent delated N/V Lorazepam is useful for anticipatory nausea/vomiting, but can also just change routine Chemo agents with high emetic risks: Day 1 = 3 agents neurokinin-1 antagonist (fosaprepitant) serotonin 3 antagonist (ondansetron) […]