Apologies for the long hiatus —-had bouts of personal problems including a mishap involving a loved one.

I do have a few cases to dissect. My original aims for this blog was to try and do something like what this fella Chris Partyka  (an EM registrar in NSW i think) does i.e. his blog : http://thebluntdissection.com/ 

However before that I have my primaries coming up and its daunting. Only 78 days to go !

I thought i’ll do something different….while am trying to compile cases and lessons I learnt I’ll also revise my drugs so….

…………….presenting ONE DRUG A DAY.

Today’s drug—–drumroll please

ACETAZOLAMIDE

with every drug the format will be

1. WHAT IS IT

2. PHARMACODYNAMICS

3. PHARMACOKINETICS

4. CLINICAL INDICATIONs

5. SIDE EFFECTs

• What is it ?

diuretic. sold under trade name Diamox. Carbonic anhydrase inhibitor.

• PHARMACODYNAMICS ?

inhibits carbonic anhydrase (CA) blocking NaHCO3 reabsorption,
where >>> at the Proximal convoluted tubule PCT

What is CA used for ?
see diagram below (photo taken from Katzung)

CA does 2 things :

a. Carbonic acid (H2CO3) is rapidly dehydrated by CA to carbon dioxide and water within the lumen
b. the same carbon dioxide and water (within the PCT) is rehydrated by CA to become carbonic acid again

• PHARMACOKINETICS
  well absorbed orally. Excretion by secretion in proximal tubule S2 segment.

• CLINICAL INDICATIONS

1. Glaucoma-via reduction in aqueous humor formation
2. Urinary Alkalinization -increasing urine pH for hyperuricia/cystinueia
3. Metabolic Alkalosis- esp in CHF patients
   
4. Acute Mountain Sickness-decreasing CSF and decreasing pH of CSF/brain : increases ventilation
5. Others – adjuvants in epilepsy/hypokalaemic periodic paralysis/CSF leak

• SIDE EFFECTS

1. Hyperchloremic MEtabolic Acidosis
2. Renal stones
3. Renal Potassium Wasting
4. Drowsiness + parasthesia

Worth watching this :

Youtube video on brief physiology : http://youtu.be/FmKv2qPuB4k

Lifeinthefastlane.com’s critical care manual book by Dr Paul Young : http://lifeinthefastlane.com/book/critical-care-drugs/acetazolamide/

Hello everyone.

I have finally bitten the bullet and started this blog as a means to :

a. share interesting cases (for my own record and learning/reflection purposes) as well as to trade experiences

b. express myself in a more productive way…rather than facebook.

I’m currently an unaccredited registrar (principle house officer) in a urban district ED in Queensland. I therefore very junior and humbly seek to state that whatever I share here will be as anonymous as possible.

Having not done well in my exams, hopefully whatever I write/present will encourage myself to rethink the basics of anatomy/physiology/pharm/path when I encounter every case.

(I know I know, pass the primary first…)

I  thought it would be apt to share one thought I use before I start a shift in Emergency each day.

I recite what an American Emergency Physician, Greg Henry says :

“Judgement is the providence of the Lord, patients come to us for HELP, not judgement”

quoted from his “sermon”/speech/presentation from the ICEM this year. You can listen here :

http://freeemergencytalks.net/2012/07/greg-henry-maintaining-the-excitement-in-emergency-medicine-icem2012/

It is so easy to look on the computer screen and roll our eyes/curse/sigh when you see all sorts of presentations ranging from :

the 20 year old female student presenting with dysmenorrhea (who obviously hasn’t taken any pain relief fearing side effects)

to the 70 year old man who was referred by his GP with asymptomatic BP of 180/90 despite 2 anti-hypertensives.

Keep reciting “judgement is for the Lord” ……

Smile. Always say sorry for the wait. Irregardless. Its awful waiting for 30 minutes for your dinner isn’t it ? (but then emergency departments aren’t McDonalds!)

But we need to tell ourselves…we ARE a service based industry.

Listen.

Anyway goodnight. Case coming up.