الأدوية والترياقات
Antidotes, insulin types, high-alert drugs and routes.
علم الأدوية وحساب الجرعات
Antidotes
| Drug / poison | Antidote |
|---|---|
| Opioids (morphine) | Naloxone (Narcan) |
| Benzodiazepines | Flumazenil |
| Heparin | Protamine sulfate |
| Warfarin | Vitamin K (plus PCC or plasma for bleeding) |
| Magnesium sulfate | Calcium gluconate 10% |
| Digoxin | Digoxin immune Fab (Digibind) |
| Acetaminophen (paracetamol) | N-acetylcysteine |
| Organophosphates / nerve agents | Atropine + pralidoxime |
| Iron | Deferoxamine |
| Cyanide | Hydroxocobalamin; sodium nitrite + sodium thiosulfate |
| Insulin overdose (hypoglycemia) | Oral glucose, IV dextrose, glucagon |
| Beta-blockers | Glucagon |
Insulin
| Type | Onset | Peak | Duration |
|---|---|---|---|
| Rapid (lispro, aspart) | 10–15 min | 1–2 h | 3–5 h |
| Short (regular) | 30–60 min | 2–4 h | 6–8 h |
| Intermediate (NPH) | 1–2 h | 4–12 h | 12–18 h |
| Long (glargine, detemir) | 1–2 h | No peak | About 24 h |
- Mixing: draw up clear (regular) before cloudy (NPH). Never mix glargine or detemir with other insulins.
- Given subcutaneously; rotate sites to prevent lipohypertrophy. Exercise lowers glucose — have a snack before exercise.
High-yield drug points
- Digoxin: check the apical pulse for a full minute; hold if < 60 (adults), < 70 (children) or < 90–110 (infants). Hypokalemia increases toxicity.
- Lithium: keep fluid intake at 2–3 L/day and salt intake normal; heat, sweating, vomiting and diuretics raise levels.
- MAOIs: avoid tyramine (aged cheese, cured meats, red wine) — hypertensive crisis.
- Antipsychotics: watch for acute dystonia, akathisia, pseudo-parkinsonism (shuffling gait, pill-rolling), tardive dyskinesia and NMS. Clozapine → agranulocytosis (monitor WBC).
- SSRIs: 2–4 weeks for effect; sexual dysfunction; serotonin syndrome.
- Corticosteroids: give in the morning; never stop abruptly; hyperglycemia, infection risk, bone loss. Live vaccines are contraindicated on high doses.
- Nitroglycerin: sublingual every 5 min, up to 3 doses; headache and hypotension are expected; store in a dark glass bottle.
- Potassium: never IV push; dilute; usually ≤ 10 mEq/h peripherally. Loop diuretics lose K; spironolactone keeps K.
- Iron: oral with vitamin C, not with milk; stains teeth (use a straw); dark stools. IM iron dextran by Z-track.
- Anticoagulants: warfarin — monitor INR, keep vitamin K intake consistent, use an electric razor. Heparin — monitor aPTT and platelets.
- Methylergonovine: contraindicated in hypertension. Oxytocin: stop for tachysystole.
- Isoniazid: neuropathy (give B6), hepatotoxicity. Vancomycin: infuse slowly (red man syndrome); it is safe with penicillin allergy.
Routes & injection technique
| Route | Angle / needle | Notes |
|---|---|---|
| Intradermal | 10–15°, 26–27 G | Mantoux, allergy tests — a small bleb forms |
| Subcutaneous | 45–90°, 25–27 G | Insulin, heparin, MMR, varicella |
| Intramuscular | 90°, 21–23 G | Infants: vastus lateralis. Adults: ventrogluteal or deltoid |
| Z-track | IM with the skin pulled aside | Irritating drugs (iron dextran) — seals the medication in the muscle |
| Sublingual / buccal | Under the tongue / between cheek and gum | Rapid absorption; bypasses first-pass metabolism |
| Otic | Adult: pinna up and back · child < 3: down and back |
اختبر نفسك الآن
67 سؤالاً بنمط الاختبار في علم الأدوية وحساب الجرعات، مع شرح لكل خيار. حساب مجاني بدون بطاقة.
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