Drug idiosyncrasy

Drug idiosyncrasy - Part I

Pharmacogenetic variation has been identified in drug metabolism (acetylation, cytochrome P450 variants, plasma cholinesterase variants), inability to compensate for drug effects (G6PD, acute porphyrias) and in drug effects themselves (malignant hyperthermia). Each of the examples will be discussed separately.

Acetylator status

Acetylation is one of the non-microsomal phase II conjugation reactions. The gene controlling the enzyme N-acetyltransferase, exists in one of two forms that determines the acetylator status of an individual which can be slow or fast. The prevalence of slow acetylation is 60% in Caucasians and 10-20% in Asians. Drugs subject to N-acetylation include isoniazid, hydralazine, procainamide, some sulphonamides, sulphasalazine, nitrazepam, and caffeine. Slow acetylators are at higher risk of side effects of these drugs such as peripheral neuropathy with isoniazid, lupus syndrome with hydralazine and procainamide, allergic reactions and hemolysis with sulphonamides and gastroinstetinal side effects with sulphasalazine

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power injectable peripherally inserted central catheters

Clinical experience with power injectable peripherally inserted central catheters in intensive care patients Introduction In intensive care units (ICU), peripherally inserted central catheters (PICC) may be an alternative option to standard central venous catheters, particularly in patients with coagulation disorders or at high risk for infection. Some limits of PICCs (such as low flow rates) may be overcome by the use of power-injectable catheters . Method We have retrospectively reviewed all the power injectable PICCs inserted in adult and pediatric patients in the ICU during a 12-month period, focusing on the rate of complications at insertion and during maintenance. Results We have collected 89 power injectable PICCs (in adults and in children), both multiple and single lumen. All insertions were successful. There were no major complications at insertion and no episodes of catheter-related blood stream infection. Non-infective complications ...

The pressure volume loop...

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