High tryglycerides

"Sometimes high triglycerides are a sign of poorly controlled type 2 diabetes, low levels of thyroid hormones (hypothyroidism), liver or kidney disease, or rare genetic conditions that affect how your body converts fat to energy. High triglycerides could also be a side effect of taking medications such as beta blockers, birth control pills, diuretics, steroids or the breast cancer drug tamoxifen."

Common examples of adverse reactions to excipients

Excipient: Tartrazine
Function: Colouring agent
Caution in practice: Reported cases of hypersensitivity, and hyperkinetic activity in children

Excipient: Aspartame
Function: Sweetener
Caution in practice: Caution in patients with phenylketonuria

Excipient: Benzalkonium chloride
Function: Preservative
Caution in practice: Bronchoconstriction (nebuliser solutions) and ocular toxicity (soft contact lens solutions)

Excipient: Sodium metabisulphite
Function: Antioxidant
Caution in practice: Hypersensitivity, including bronchospasm and anaphylaxis, are reported for all sulphites

Excipient: Propyl gallate
Function: Antioxidant
Caution in practice: Contact sensitivity and skin reactions

Excipient: Lactose
Function: Tablet filler
Caution in practice: Caution in patients with galactosaemia, glucose-galactose malabsorption syndrome, or lactase deficiency

Excipient: Sesame oil
Function: Oil (injections)
Caution in practice: Hypersensitivity reactions reported

Excipient: Lanolin (wool fat)
Function: Emulsifier (topical products)
Caution in practice: Skin hypersensitivity reactions, caution in patients with known sensitivity



http://www.australianprescriber.com/upload/pdf/articles/1207.pdf

Statins administration

"... Given that cholesterol is biosynthesized in the early morning hours, the US Food and Drug Administration (FDA) has recommended evening administration for statins with shorter half-lives (lovastatin 2 hours, simvastatin < 5 hours, and fluvastatin < 3 hours). In contrast, the FDA suggested daytime administration for statins with longer half-lives (atorvastatin 14 hours, rosuvastatin 19 hours, and pravastatin 22 hours). Atorvastatin also has active metabolites with half-lives ranging from 20 to 30 hours, which may contribute to the fact that it can be taken at any time."

http://www.medscape.com/viewarticle/552756?src=mp

Aluminum- and magnesium-based antacids

Aluminum-based antacids cause constipation, and magnesium-based products cause diarrhoea. When combination products are used, diarrhoea tends to predominate as a side effect. Although these are termed 'non-absorbable', a proportion of aluminum and magnesium is absorbed and the potential for toxicity exists, particularly with coexistent renal failure.

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Source: Clinical Pharmacy and Therapeutics, 4th ed. by Roger Walker and Cate , p. 164

Drugs causing dyspepsia

NSAIDs including aspirin

Corticosteroids

Bisphosphonates

Potassium chloride

Iron

Antibiotics

Calcium channel blockers

Nitrates

Theophylline

Drugs with antimuscarinic effects, e.g. tricyclic antidepressants



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Source: Clinical Pharmacy and Therapeutics, 4th ed. by Roger Walker and Cate Whittlesea, p. 152.

Acidosis and dopamine

"If you're monitoring a patient receiving dopamine (Intropin) and the dopamine isn't raising his blood pressure as expected, check the patient's pH. A pH level below 7.1, which can happen in severe metabolic acidosis, causes resistance to vasopressor therapy. Correct the pH level and the dopamine may be more effective."


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Source: Expert LPN Guides: Fluids & Electrolytes (2007), p.169.

Challenges to raising potassium level

If you're having difficulty raising a patient's potassium level, reevaluate his fluid and electrolyte status and ask yourself the following questions:

• Is the patient still experiencing diuresis or suffering losses from the GI tract or the skin? If so, he's losing fluid and potassium.

• Is the patient's magnesium level normal or does he need supplementation? Keep in mind that low magnesium levels make it difficult for the kidneys to conserve potassium.

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Source: Expert LPN Guides: Fluids & Electrolytes (2007), p. 91.

Causes of hypokalemia

Shift of potassium to the intracellular compartment

Acute alkalosis

Following correction of metabolic acidosis (e.g., diabetic acidosis)

Hypokalemic periodic paralysis

Insulin administration

Administration of beta 2-agonists

Conditions of catecholamine excess

• Cardiac surgery
• Myocardial infarction
• Delerium tremens

Barbiturate intoxication

Vitamin B12 therapy

Thyrotoxicosis (rare)

Inadequate potassium intake (uncommon because of renal conservation of potassium)

Starvation

Postoperative state without replenishment

Gastrointestinal potassium loss

Diarrhea

Laxative abuse

Villous adenoma of rectum

Vomiting

Fistulas

Renal potassium loss (renal cause of hypokalemia should be sought if the urinary loss of potassium exceeds 20mEq/day)

Osmotic diuresis

Magnesium depletion

Acute leukemia

Antimicrobial agents (such as carbenicillin, gentamicin, amphotericin B)

Cisplatin administration

Renal conditions with metabolic acidosis

• Distal renal tubular acidosis
• Proximal renal tubular acidosis
• Ureterosigmoidostomy
• Administration of acetazolamide

Conditions with metabolic acidosis

• Cushing's syndrome
• Exogenous corticosteriod administration
• Primary aldosteronism
• Licorice usage
• Renovascular hypertension
• Malignant hypertension
• Renin-producing renal tumor
• Diuretics (thiazides, furosemide)
• Liddle's sydrome
• Bartter's sydrome

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Source: the portable internist by Anthony J. Zollo Jr., MD (1995), p. 328-329.