Too Many Meds Professional » Pharmacology

Insulin Dosing Rules

ProfJameson — Thu, 28 Jan 2010 16:53:16 +0000

Albert and I had to go into the beautiful mountains of the island of Bali to research these rules. Bali is one of many islands that make up the country of Indonesia. Somebody had to go.

Insulin Dosing Rules

Starting dose

0.5 to 1 unit / kg / day for Type 2 Diabetes
If they are already on Insulin Start with their current dose
Give 50% long acting and 50% short acting. Divide the short acting evenly for each meal.

Corrective Insulin (in addtion to meal insulin)

Estimated Blood sugar Decrease for Each Unit of Insulin

1700/ total daily insulin for Humalog and Novolog
1500/ total daily insulin for regular insulin

Insulin for Carb Counters

Number of grams of carbohydrate covered by each unit of insulin

450/ total daily insulin for Humalog and Novolog
500/ total daily insulin for regular insulin

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Antibiotics Simplified

ProfJameson — Thu, 24 Sep 2009 17:19:29 +0000

It might take a bit more than a minute, but we have created a powerpoint presentation that walks through most antibiotics and helps you see how one relates to another. This is a free resource for you called Antibiotics Oversimplified. This oversimplified approach is not good enough to make therapeutic decisions from, but what is does do, is organize these drugs according to class and type of antimicrobial activity. Of course, for patient care, you should use a local antibiogram or at very least, a Sanford or Johns Hopkins Antibiotic guide. The purpose of this one minute genius is to help you mentally structure your understanding of antibiotics, bacteria and therapeutic uses.

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Warfarin Maintenance Dose Adjustments

ProfJameson — Mon, 31 Aug 2009 20:14:16 +0000

Simple guidelines

Note: these are for maintenance doses only at steady state. Do NOT use these guidelines for starting someone on warfarin.

INR	Dosage Adjustment
Less Than 1.3	Give them an extra dose and increase by 10% (always ask them if they “might” have missed a dose)

1.3 to 1.8	Increase weekly dose by 7 – 8% (always ask them if they “might” have missed a dose

1.8 – 2.0	Repeat the INR in one week, if still <2.0 than increase by 7%

2.0 t0 3.0	Smile

3.0 to 3.5	Check for patient errors in the dose first, then repeat the INR in 2 or 3 days. IF still elevated, decrease by 7% – 8%

3.5 to 4.5	Decrease by 7% – 8% (check for patient errors in the dose first)

Over 4.5	Hold the dose for one or two days and restart at a 10 – 20% lower weekly dose

Vitamin K

Often it is NOT necessary to give vitamin K. If you want to keep the patient anticoagulated, and you cannot stop yourself from giving vitamin K … then give only 2.5 mg of phytonadione orally.

Do not give 10mg of vitamin K unless it is OK for the patient to NOT be anticoagulated for one or two weeks.

Obviously, you will usually give Vitamin K if the patient is bleeding.

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Ace Inhibitors and the Kidney

ProfJameson — Thu, 20 Aug 2009 19:00:14 +0000

We have prepared a powerpoint to demonstrate how ACE inhibitors can be either beneficial or harmful to the kidney, depending on the patients physiology:

ACE INHIBITORS AND THE KIDNEY

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Thyroid Pharmacotherapy

ProfJameson — Tue, 18 Aug 2009 18:57:13 +0000

Normal Thyroid Physiology

Laboratory Tests for Thyroid

	Total T4	Free T4	Total T3	TSH
Normal	4.5 – 12.5 mcg/dl	0.8 - 1.5 ng / dl	80 – 220 ng/dl	0.3 – µU / mL
Hyperthyroid
Hypothyroid

Thyroid Clinical Pearls

Normal levothyroxine dose is 1.6 mcg/kg/ day
Some people may benefit symptomatically from addition of 50mcg of T3 to levothyroxine
Normal TSH should probably not be above 3.5 Treated
Untreated TSH should be between 0.5 to 3.8 mU/L
100 and 300 mcg tabs have yellow dye #5 and have allergic potential

Amidarone induced hypothyroidism: 2 mechanisms :

Thyroiditis: use a steroid
Iodine induced: use Synthroid

Subclinical hyperthyroidism consequences:

Osteoporosis mostly in post-menopausal women
A. Fib. 3 fold increase in risk
Increase LV mass (diastolic dysfunction)

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Beta Blocker Pharmacology

ProfJameson — Fri, 14 Aug 2009 19:40:56 +0000

One Minute Genius

Beta Blocker Pharmacology

OK friends, to understand Beta Blocker Pharmacology:

#1 Learn the Fight or Flight Response
#2 Think opposite

Remember, Fight or Flight is the body system designed as an emergency response to help you fight an enemy or run away. If this stress response is sustained over time, it becomes harmful.

The chief mediator of the fight or flight is epinephrine. Epinephrine is highly active at Beta One, Beta Two and Alpha One receptors

Need	Fight or Flight	Beta Blocker Effect
Blood Flow	Beta One: Increased Heart Rate	Decreased Heart Rate

Blood Flow	Beta One: Increased force of Contraction Remember: Beta One, the heart is #1	Decreased force of contraction

Blood Flow	Beta Two: Vasodilation	Vasoconstriction (yes, this is counterintuitive, but true)

Oxygenation	Beta Two: Bronchodilation	Bronchoconstriction

Energy	Glycogenolysis and Gluconeogenesis in the liver	poor response to low blood sugar and decreased symptoms

Glucose in Muscles	Insulin Secretion	Decreased insulin secretion (hyperglycemia)

Adequate Blood Volume	Increase Renin Secretion	Decreased Renin secretion

Albert and I had to go mountains in the center of the island of Bali to research this one for you. Bali is one of many islands that make up the country of Indonesia.

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