Chapter 12: PHARMACOLOGY & DRUG PEARLS

MEDICATION PEAK

If the peak of a medication is too high, decrease the dose.

MNEMONIC: The peak of a given medication is always measured at the same time after it has been administered. Therefore, changing the interval will have no effect on the peak. You must change the dose.

MEDICATION TROUGH

If the trough of a medication is too high, increase the interval between doses.

MNEMONIC: The interval of a medication is easily changed. The wider the interval, the lower the trough. So if a trough is high, simply wait a little while longer before giving the next dose.

MISCELLANEOUS DRUGS

MISOPROSTOL

Misoprostol is a synthetic PROSTAGLANDIN. In patients with long-term NSAID use, it can help prevent GI ulcers.

PEARL: When referring to NSAIDS, the ABP might use terminology such as, “PROSTAGLANDIN SYNTHASE (AKA SYNTHETASE) inhibitor.”

SUCRALFATE (ALUMINUM HYDROXIDE COMPLEX)

Avoid use of sucralfate (aluminum hydroxide complex) in renal patients.

MAGNESIUM SULFATE

When used as a tocolytic or for preeclampsia, magnesium sulfate can cause decreased fetal respiration, hypotonia, and hypocalcemia.

PEARLS: (DOUBLE TAKE) Magnesium Sulfate Infusions (for tocolysis or preeclampsia) can result in severe hypocalcemia. Treat with calcium gluconate, but keep in mind that they may not respond as quickly as would normally be expected. So, if you are given a vignette about a hypocalcemic baby that is not responding to calcium gluconate, consider magne­sium tocolysis as the etiology.

TERBUTALINE

Terbutaline is a beta-adrenergic drug that can cause maternal hypERglycemia. This causes fetal hyperinsulinism and subsequent hypOglycemia in the neonate.

ACE INHIBITORS

ACE inhibitors are contraindicated in pregnancy because of teratogenicity. They can cause oligohydramnios, neonatal anuria, and cardiac malformations (especially a PDA).

DIAZEPAM

Diazepam is NOT contraindicated in breastfeeding, but it is used with caution. Diazepam gets secreted into breastmilk and can potentially cause babies to experience withdrawal or sedation.