DAILY REVISION

Dr David M Paton

UMHS, 2013

Calculation of Loading Dose

We want to achieve a plasma level of 15 mg/L. The Vd for the drug is 40L. What dose will we have to administer IV? Vd = Dose/Co Dose = Vd X Co = 40L X 15mg/L = 600 mg

Calculation of Loading Dose

We want to achieve a plasma level of 15 mg/L. The Vd for the drug is 40L. The drug has a F = 0.25 What dose will we have to administer orally? Vd = Dose/Co Dose = Vd X Co = 40L X 15mg/L = 600 mg BUT is being given orally; what is F? 0.25 So Dose = 600 mg / 0.25 Oral Dose = 600mg X 4 = 2400 mg

Effects of Autonomic Nervous System

We want to administer a drug that is a muscarinic antagonist at M2 & M3 receptors. What will be its effects? On the pupil: It will dilate it Why? The SNS is left unopposed On reading: It will make reading difficult. Why? Because accommodation is only controlled by the PNS On heart rate: It will increase Why? because in most people the rate is mainly under vagal influence On salivation: There will be less so may complain of dry mouth On bowels: May complain of constipation because PNS drive to GIT is blocked On bladder: May develop urinary retention if have BPH because PNS drive to bladder is blocked

On Beta Blockers
We want to administer a beta blocker that has minimal effects on the bronchi but is selective for the heart. We also want to give first a short-acting one by IV route, then replace it with beta blocker know to prolong life in cardiac failure

First we need to list cardio-selective beta blockers Atenolol; metoprolol; esmolol Which of these is short-acting and given by IV?: Esmolol Which of these is known to prolong life in cardiac failure?: Metoprolol What about poor old atenolol? It must be good for something surely?: It could be used in hypertension; it would have less effect on the bronchi than a beta blocker like propranolol But suddenly we are asked to prescribe a beta blocker for a woman with hyperthyroidism! Would we use a cardio-selective one? NO!! Why? Because we will also need to reduce the tremor that is bothering her! So she needs propranolol!