Warfarin (Coumadin):

• The most common oral anticoagulant.
• It is only active in vivo.
• Warfarin is almost completely bound to plasma proteins. -96% to 98% bound.
• Warfarin is metabolized by the liver and excreted in the urine.
• Coumarin anticoagulants pass the placental barrier and are secreted into the maternal milk.
• Newborn infants are more sensitive to oral anticoagulants than are adults because of lower vitamin K levels and lower rates of metabolism.

• Bleeding is the most common side effect and occurs most often from the mucous membranes of the gastrointestinal tract and the genitourinary tract.

Oral anticoagulants are contraindicated in:

• Conditions where active bleeding must be avoided, Vitamin K deficiency and severe

hepatic or renal disease, and where intensive salicylate therapy is required.

Etomidate  -Intravenous Anesthetics

- A nonbarbiturate anesthetic used primarily to induce surgical anesthesia.
- It does not produce analgesia.
- Etomidate has minimal effect on the cardiovascular system and respiration during induction of anesthesia.
- Like the barbiturates, etomidate decreases cerebral blood flow, cerebral metabolic rate and intracranial pressure.
- No changes in hepatic, renal or hematologic function have been reported.
- Myoclonic muscle movements are relatively common.
- Postoperative nausea and vomiting are more common with etomidate than with barbiturates.

Carbonic anhydrase inhibitors

Acetazolamide, Dichlorphenamide, Methazolamide, Ethoxzolamide

Mechanism of Action

1.    Carbonic anhydrase (CA) facilitates excretion of H+ and recovery of bicarbonate by the proximal renal tubule and ciliary epithelium of the eye. Sodium is recovered in exchange for H+. 
2.    Inhibitors block CA block sodium recovery. A very mild diuresis is produced (this is really a side effect of their use in glaucoma) because relatively unimportant mechanism for Na recovery and because proximal tubule site means that other sodium recovery mechansims continue to process their normal fraction of the sodium load.
 

Drugs Used in Diabetes

Goals of diabetes treatment

lower serum glucose to physiologic range
keep insulin levels in physiologic range
eliminate insulin resistance

best initial step in management: weight loss, contractile-based exercise weight loss is more important for insulin sensitivity than is a low-carb diet

Modalities of diabetes treatment

Type I DM

insulin
low-sugar diet

Type II DM
exercise
diet
insulin

6 classes of drugs 

Insulin
Sulfonylureas -    Glyburide
Meglitinides  - Nateglinide
Biguanides    Metformin    
Glitazones (thiazolidinediones)    Pioglitazone
α-glucosidase inhibitors    Acarbose
GLP-1 mimetics (incretin mimetics)    Exenatide
Amylin analog    Pramlintide

EPHEDRINE

It act indirectly and directly on α and β receptors. It increases blood pressure both by peripheral vasoconstriction and by increasing the cardiac output. Ephedrine also relaxes the bronchial smooth muscles.

Ephedrine stimulates CNS and produces restlessness, insomnia, anxiety and tremors.
Ephedrine produces mydriasis on local as well as systemic administration.
Ephedrine is useful for the treatment of chronic and moderate type of bronchial asthma, used as nasal decongestant and as a mydriatic without cycloplegia. It is also useful in preventing ventricular asystole in Stokes Adams syndrome.

Mefenamic acid

Analgesic, anti‐inflammatory properties less  effective than aspirin 

Short half‐lives, should not be used for longer  than one week and never in pregnancy and in  children. 

Enhances oral anticoagulants

Used to treat pain, including menstrual pain. It decreases inflammation (swelling) and uterine contractions.