BNF DRUGS.

THEOPHYLLINE.
 Used in asthma and copd. Metabolised in d liver.
 Plasma conc increased in heart failure, cirrhosis, viral infections, elderly and by its
metabolism inhibitors.
 Plasma conc is decreased in smokers, chronic alcoholism and drugs that induce liver
metabolism.
 NTR, particular care required when introducing or withdrawing drugs that interact with
theophylline.
 Therapeutic range 10-20mg/l, frequency and severity of adverse effects increase above
this.
 Given by injection as aminophylline. Must be VERY SLOW, at least over 20 minutes.
 Serious side effects such as convulsions and arrthymias can occasionally precede other
symptoms of toxicity.

GENTAMICIN
 An aminoglycoside used for bactericidal and active against gram +ive and -ive
organisms. It is broad spectrum but is inactive against anaerobes and has poor activity
against haemolytic streptococci and pneumococci.
 Not absorbed from d gut and must be given by injection for systemic infections.
 Excretion principally by kidney and accumulation occurs in renal impairment.
 Treatment whenever possible shd not exceed 7 days. Important side effects include
ototoxicity and nephrotoxicity.
 In renal impairment, dose interval must be increased. If severe, dosed shd be reduced as
well.
 Once daily administration is more convenient.
 In patients with normal renal function, conc shd be measured after 3 or 4 doses of a
multiple dose regiment.
 For multiple dose regimens, blood samples should be taken approx 1hr after im or iv
administration (peak) and also just before d nxt dose.

DIGOXIN.
 A cardiac glycoside that increases d force of contraction and reduces conductivity
alongvd AV node. Indicated for heart failure and atrial fribillation.
 Long halflife and maintenance doses given once daily.
 Renally excreted, likelihood of toxicity increases 1.5-3mcg/l.
 Hypokalaemia predisposes to toxicity. Managed by pottasium sparing diuretic or
pottasuim supplementation.

WARFARIN.
 Oral anticoagulant. Antagonises d effects of vit K and take at least 48 to 72hrs for effect
to develop fully.
 Main indication is deep vein thrombosis.
 For patients who require rapid anticoagulation, d usual adult induction dose is 10mg on d
first day. Subsequent doses depend on INR. For patients who dont require rapid
anticoagulation, a lower loading dose can be used over 3-4 wks. Daily maintenance
usually 3-9mg taken at same time each day.
AMIODARONE.
 Treatment of arrythmias when other drugs ineffective.
 Very long half life extending to several weeks, given once daily
 Development of corneal microdeposits reversible on withdrawal. Patients may be dazzled
by headlights at night.
 Patiends shd be advised to shield skin from light during treatment and for several months
after discontinuation due to possibility of phototoxic reactions. Wide spectrum sunscreen
shd be used.
 Contains iodine and cn cause disorders of thyroid function. Lab tests shd be performed
b4 treatment and every 6 months. Also associated with hepatoxicity and treatment
should be discontinued if severe liver function abnormalities develop.
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