Pharmacology

PHARMACOLOGY: New Drugs Update

Update of New Drugs & DOC with Reference :-
REFERNCE:
Harrisons 19/ed
Adams Neurology 10/ed
CMDT 2015
Williams OBG 24/Ed
Mania Treatment Update:
1. DOC Acute Mania – Atypical AP (Bzd may be used for symptomatic management)
2. Prophylaxis of mania – Lithium
3. DOC BPD – Lithium
4. DOC Rapid Cycler – Valproate
*Lithium can be used in unipolar depression prophylaxis.
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Gonorrhoea Treatment Update:
1. Drug of Choice – Ceftriaxone
2. Treatment of choice – Ceftriaxone + Azithro 1 gram or Doxy (Bcs Chlamydia is frequently associated)
3. TOC in pregnancy – Ceftriaxone + Azithro 1 gram
4. TOC of Ceftriaxone allergy in pregnancy – Azithromycin 2 grams.
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Pseudomembranous enterocolitis
Treatment Update:
Facts:
1. Metronidazole is not approved by FDA for pseudomembranous enterocolitis.
2. Oral Vancomycin is much more effective than metronidazole.
3. Metronidazole is only used as initial drug in case of mild disease, in mod to severe disease – Vancomycin is preferred.
4. Fidoxamicin – Latest drug approved for pseudomembranous enterocolitis.
Thus drug of choice in pseudomembranous enterocolitis is Oral Vancomycin.
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Harrison’s 19th E update on PD
Treatment:
1. Drug of choice for PD – Levodopa
2. Drug of choice in young onset PD – Pramipexole
3. Drug of choice to reduce motor fluctuation of levodopa – Pramipexole
4. Drug of choice for ON-OFF phenomena – Rasageline
5. Carbidopa : Levodopa ratio = 1:4 or 1:10
6. COMT inhibitor like Entecapone combined with Levodopa – To increase Levodopa bioavailability and duration of action.
7. Only disease modifying drug class or neuroprotective – MAO inhibitor.
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Pseudomonas Treatment Update:
1. DOC – Ceftazidime or Cefepime
2. DOC in Multidrug Resistance – Colistin
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Harrison 19th E and CMDT 2015 Update on Enterococcus TOC:
• E.faecalis – Ampicillin + AG
• E.faecium – Vancomycin + AG
• Toxicity to AG – Ampicillin + Ceftriaxone
• Resistance to Ampicillin or Vancomycin -Daptomycin + AG
• Other drugs for VRE – Linezolid, Streptogramins,
Fosfomycin (UTI), Tigecycline
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EPILEPSY – DRUG OF CHOICE  UPDATE:
1. Generalized Epilepsy
• GTCS, MS – Lamotrigine or Valproate
• AS – Valproate or Ethosuximide (child < 2years) or Lamotrigine
2. Partial Seizures – Lamotrigine or Carbamazepine
3. Pregnancy – Lamotrigine > Levetiracetam
4. Seizures associated with ecclampsia – MgSO4
5. Neonates – Phenobarbital
6. Status epilepticus – Lorazepam
7. Mixed seizure syndromes (e.g. LGS) – Valproate
8. Dravet syndrome (Severe Myoclonic Epilepsy Of Infancy ) – Valproate
9. Infantile spasm – ACTH
10. West Syndrome (Infantile spasm + hypsarrythmia in EEG + MR) – ACTH
11. Rolandic epilepsy (Bening Epilepsy of Childhood with Centrotemporal Spikes) – Nocturnal Partial onset GTCS – Carbamazepine
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MRSA and VRSA Treatment Update:
1. MRSA – Vancomycin or Daptomycin
2. VRSA – Daptomycin
3. Emperical Rx of staph aureus – Vancomycin or Daptomycin
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Typhoid Treatment Update:
1. Drug of Choice for Typhoid – Ciprofloxacin > Azithromycin
2. Drug of choice for MDR Typhoid – Ceftriaxone > Azithromycin
3. Emperical drug of choice for Typhoid – Ceftriaxone > Azithromycin
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H.Influenza Treatment Update:
1. DOC for meningitis – Ceftriaxone
2. DOC for pneumonia – Cotrimoxazole
3. DOC for prophylaxis – Rifampicin

Resistance mechanism to Ampicillin – Beta lactamase production > Altered penicillin binding protein (Asked in AIIMS May 2015).
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Tularemia Treatment Update:
Drug of Choice – Gentamicin > Streptomycin
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PLAGUE Treatment and Prophylaxis Update:
1. TREATMENT
Drug of choice is Gentamicin > Streptomycin
2. PROPHYLAXIS
Drug of choice is Ciprofloxacin > Doxycycline
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New Drugs 2015:
• Edoxaban – Oral factor Xa inhibitor approved for DVT, pulmonary embolism and stroke prophylaxis in atrial fibrillation.
• Secukinumab – Anti IL 17 Ab approved for Psoriasis
• Isavuconazonium – Azole approved for invasive Aspergillosis and mucormycosis
• Avibactam – With Ceftazidime
• Panobinostat – Histone deacetylase inhibitor for multiple myeloma.
• Cobicistat – Its a CYP3A4 inhibitor approved for use with Atazanavir and Darunavir to increase their half life.
• Palbociclib – Cyclin dependent kinase inhibitor approved for ER/PR positive breast in post menopausal female in combination with aromatase inhibitor.
• Lenvatinib – VEGFR TK inhibitor approved for recurrent or metastatic thyroid ca refractory to I131.
• Nivolumab – Anti PD1 receptor Ab approved for metastatic squammous non small cell ca lung.
• Dinutuximab – Anti GD2 glycolipid Ab approved for neuroblastoma.
• Ivabridine – Inhibitor of If current in SA node… Approved for CHF and angina.
• Sacubitril – Inhibitor of neutral endopeptidase (neprilysin), combined with ARB for treatment of CHF.
• Alirocumab – Anti PCSK 9 Ab used to decrease LDL in familial hypercholesterolemia and CVS atherosclerotic disorders. PCSK 9 is a protein responsible for LDL receptors degradation in liver.
• Sonidegib – Hedgehog pathway inhibitor used for treatment of basal cell carcinoma recurrence after surgery and radiotherapy.
• Flibanserin – 5HT 1A agonist and 5HT 2C antagonist for hypoactive sexual desire disorder (HSDD).
• Paritaprevir – It is a Hep C virus protease inhibitor.
• Daclatasvir, Ombitasvir – NS5A protein inhibitors of hep C virus.
1. Daclatasvir is approved to be used with sofosbuvir for Hep C infection.
2. Ombitasvir is approved to be used with paritaprevir and ritonavir for Hep C virus infection.
• Brexpiprazole – Atypical antipsychtic approved for treatment of schizophrenia and depression.
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