iD R U G I N D E X Generic/ Brand Name

Acetazolamide

Dosage
250-375 mg/day 250-1000 mg 24 hrly 8-30 mg/kg/day

Mode of Action
the drug forces the kidneys to excrete bicarbonate, the conjugate base of carbonic acid. By increasing the amount of bicarbonate excreted in the urine, the blood becomes more acidic. Acidifying the blood stimulates ventilation, which increases the amount of oxygen in the blood

Indications
Prophylaxis of high altitude sickness, Acute closed angle glaucoma, Epilepsy

Contraindications
Hypersensitivity to sulphonamides; sodium or potassium depletion, hepatic insufficiency; hepatic cirrhosis; hyperchloraemic acidosis; severe renal impairment; severe pulmonary obstruction; chronic noncongestive angle-closure glaucoma; adrenocortical insufficiency. Pregnancy, lactation Use with caution in patients prone to dyspepsia or known to have a lesion of the gastric mucosa. Do not administer to patients with hemophilia and is not recommended to infants <1 year. Caution is necessary when renal or hepatic function is impaired and particularly in children who are dehydrated Pregnancy & lactation. Hepatic or renal impairment (reduce dose). Initiate therapy after acute gout attack has subsided

Adverse Effects

Acetylsalicylic acid (Aspirin)

325 mg/tab or 80 mg/tab

Antithrombotic, analgesic/antipyretic Inhibits prostaglandin synthesis, resulting in analgesia, anti-inflammatory activity and platelet aggregation inhibition; reduces fever by aacting on the brains heatregulating canter to promote vasodilation and sweating.

Prophylaxis of thromboembolic disorder; prevention of MI & stroke

Drowsiness, paraesthesia, ataxia, dizziness, thirst, anorexia, headache; confusion, malaise, depression; GI distress, metabolic acidosis, polyuria, hyperuricaemia, renal calculi, nephrotoxicity, hepatic dysfunction. Potentially Fatal: Rarely, skin reactions or blood dyscrasias. Gastric hemorrhage, hypersensitivity and thrombocytopenia may occur

Allopurinol (Allomaron, Allurase, Alpurase, Elavil, Llanol, Lopric, Lopurine, Loricid, Purinase) Amikacin Amino acids (Dipeptiven) Amoxicillin

300mg / tab Adult 2-10 mg/kg BW/day. Mild 100-200 mg daily. Moderately severe 300-600 mg daily 200mg Thru IM OD 1.5-2ml/kg BW/day, max 3 wk 500 mg/ cap P.O

Absorption of most oral penicillins is impaired by food (except amoxicillin), and should be administered 1-2 hours before a meal. Intravenous route is preferred because of irritation and local pian produced by the intramuscular injection of large doses. Penicillin is rapidly excreted by the kidney into the urine, small amounts excreted via other routes Inhibits protein synthesis in susceptible bacteria by binding to 30s ribosomal subunits As a supplement to amino acid solutions or an amino acid-containing infusion regimen in parenteral nutrition for hypercatabolic or hypermetabolic patients Inhibit cell wall synthesis. Beta lactamase inhibitor and protect hydrolysable penicillins from inactivation. Inhibit cell wall synthesis. Beta lactamase inhibitor and protect hydrolysable penicillins from inactivation. Inhibit cell wall synthesis. Beta lactamase inhibitor and protect hydrolysable penicillins from inactivation.

Rash or hypersensitivity reactions (discontinue). Acute attack of gouty arthritis in early stages of therapy. GI disturbance. Blood & lymphatic system disorders. Fever, general malaise, headache, vertigo, ataxia. Ototoxicity and nephrotoxicity. Rarely, fever and paresthesia

For bacterial septicemia neonatal sepsis

including

Hypersensitivity to amino glycosides Monitor hepatic function in patients with compensated hepatic insufficiency. Pregnancy and lactation , children Contraindicated in patients with penicillin hypersensitivity. Superinfections involving pseudomonas or candida. Pregnancy and lactation. Contraindicated in patients with penicillin hypersensitivity. Superinfections involving pseudomonas or candida. Pregnancy and lactation Contraindicated in patients with penicillin hypersensitivity. Superinfections involving pseudomonas or candida. Hyperoxaluria Hypersenstivity. Pregnancy: Use only if potential benefit justifies risk to the fetus Breast Feeding: Discontinue nursing or the drug

Respiratory tract, skin & soft tissue infections

Amoxiclav Clavulanic Amoxicillin Ampicillin

1 g tab once a day

acid

100mg Thru IM Q12

Effects: diarrhea, nausea, skin rashes, urticaria, vaginitis, abdominal discomfort, flatulence, headache Diarrhea, nausea, skin rashes, urticaria, vaginitis, abdominal discomfort, flatulence, headache Diarrhea, nausea, skin rashes, urticaria, vaginitis, abdominal discomfort, flatulence, headache None Nausea, vomiting, headache, fever, abdominal pain, hyperglycaemia leading to coma, hypersensitivity, renal damge, coagulation defects, thrombosis, CNS depression or hyperexcitability, acute hemorrhagic pancreatitis

Treatment of infections caused by susceptible gm+ve and gm-ve microorganism Prevent and treat scurvy

Ascorbic acid Asparaginase (Elspar, Oncaspar, Erwinase)

500 mg/ tab Adults and children: 200 IU/KG intravenously daily for 28 days

Necessary for collagen formation and tissue repair; involved in some oxidation-reduction reactions as well as other metabolic pathways

Atorvastatin Ca Lipitor Bacillus clausal (Erceflora)

10 mg/tab

2billion/5ml Adult : 2~3 vials/day, children : 1~2vials/day Adult: 8-16mg 3x/day. Administration with meals is recommended. 1.5 mg/tab TID

Inhibitor of HMG-CoA reductase, the rate limiting enzyme in cholesterol synthesis, result in compensatory increase in expression of LDL receptors on hepatocyte membranes & stimulation of LDL catabolism Antidiarrheal

primary hypercholesterolemia.

Active liver disease, pregnancy and lactation. N/A

Betahistine (Serc)

Vestibular nerve suppressant.

Treatment of acute diarrhea with duration of 14 days due to infections, drugs or poisons or for chronic or persistent diarrhea with duration of 14 days Menieres disease, Meniere-like syndrome characterized by attacks of vertigo, tinnitus & sensorineural deafness, peripheral vertigo. Anxiety & tension state, depressive mood, nervous tension, agitation, insomnia, functional state of CV & respiratory system. Adjuvant to psychotherapy in psychoneurosis Anxiety & tension states, depressive mood, nervous tension, agitation & insomnia. Adjuvant to psychotherapy in psychoneurosis Bone & joint infection, bronchitis, gonorrhea, meningitis, otitis media, peritonitis, pharyngitis, sinusitis, skin infection, surgical infection, UTI 2nd generation cephalosporin

Nausea & vomiting, diarrhea abdominal pain, constipation, dyspepsia, flatulence, headache, myalgia, insomnia, muscle cramps, peripheral edema N/A

Phaeochromocytoma or bronchial asthma, history of peptic ulcer.

Mild gastric complains. very rarely, rash, pruritus, urticaria.

Bromazepam Lexotan

Bromazepam (Lexotan) Cefazolin

1.5-3 mg up to tid 6-12 mg bid-tid 0.5~1gram 5~12 hours Max 6g/day every

Binds to stereo specific benzodiazepine receptors on the post synaptic GABA neuron at the several sites within the CNS. Enhancement of the inhibitory effect of GABA on neuronal excitability results by increased neuronal membrane permeability to chloride ions. Bromazepam is a "classical" benzodiazepine.

Early pregnancy, lactation, myasthenia gravis

Acute anxiety, hallucinations, excitation.

Early pregnancy, lactation. Myasthenia gravis Hypersensitivity to cephalosporin

Acute anxiety, hallucinations, insomnia or excitation. Shock, hypersensitivity reaction, granulocytopenia, eosinophilia, thrombocytopenia, GI disturbance, convulsion, HA, dizziness, malaise Hypotension, phlebitis, thrombophlebitis, pseudomembranous colitis, nausea, vomiting, diarrhea, acute renal failure, transient neutropenia, dyspnea, maculopapular and erythematous rash, urticaria, hypersensitivity reactions, serum sickness, anaphylaxis, fever Hypersensitivity reaction, urticaria, eosinophilia, serum sickness-like fever, anaphylaxis, neutropenia, thrombocytopenia, ATN, acute intestinal nephritis

Bind to PBPs on bacterial cell membranes to inhibit bacterial cell wall synthesis by mechanisms similar to those of the penicillins Active against g+ cocci (pneumococci, streptococci and staphylococci) and g- organisms. Active against B fragilis and some Serratia species but less active against H influenzae. Exhibit in vitro activity against enterobacter species, but should not be used to treat infections caused by these organisms because resistant mutants constitutively express a chromosomal beta-lactamase that hydrolyzes these compounds are readily selected. Bind to PBPs on bacterial cell membranes to inhibit bacterial cell wall synthesis by mechanisms similar to those of the penicillins

Cefoxitin sodium (Monowel)

1g IV every 8 hours

Patients with transient persistent reduction of urinary output due to renal insufficiency. Precaution when used for neonates

Ceftriaxone

1~2 g once a daily

Lower respiratory tract. Acute bacterial otitis media, skin & skin structure, urinary tract, meningitis & surgical prophylaxis

Hypersensitivity to cephalosporin

Cefuroxime (Zinnat)

500mg every hours IV, oral

12

Bind to PBPs on bacterial cell membranes to inhibit bacterial cell wall synthesis by mechanisms similar to those of the penicillins

Bone & joint infection, bronchitis, gonorrhea, meningitis, otitis media, peritonitis, pharyngitis, sinusitis, skin infection, surgical infection, UTI Gram negative infection. Treatment of wide range of infections including anthrax, biliary tract infection, bone & joint infections, brucellosis, infected bites & stings, cat scratch disease, chancroid, exacerbations of cystic fibrosis, gastroenteritis, gonorrhea, legionnaires disease, otitis media & externa, peritonitis, Q fever,

hypersensitive to the drug or other nitroimidazole derivatives and in patients in 1st trimester of pregnancy

Ciprofloxacin HCl Prozine

500mg / tab Cystic fibrosis 20mg/kg, max 750mg BID Gonorrhea 500mg OD

Inhibits DNA-gyrase in susceptible organism; inhibit relaxation of supercoiled DNA and promotes breakage of double-stranded DNA

Pregnancy & lactation, methicillinresistant S.aureus infections

GI disturbances, occasionally pseudomembranous colitis; hypersensitivity reactions. Eosinophilia. Headache. Superinfection or eythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis Nausea, vomiting, diarrhea, abdominal pain, dyspepsia. Headache, dizziness, restlessness, tremor, drowsiness, rarely insomnia, visual & other sensory disturbances. Rash, pruritus, elevated liver enzyme values, jaundice, hepatitis. Eosinophilia, leucopenia, thrombocytopenia, hemolytic anemia or agranulocytosis. Transient increase in

Citicholine; cytidine 5'diphosphocholine

Clonidine (Catapres)

Co-amoxiclav (Augmentin)

200-600 mg for head injury Cerebrovascular disorders Adult: 200-600 mg daily in divided doses. Oral Parkinsonism Adult: 200-600 mg daily in divided doses. Parenteral Oral: 0.1,0.2,0.3 mg tablets Patche: release 0.1,0.2,0.3 mg/24 hrs 625mg / cap BID or TID

Citicoline increases blood flow and O2 consumption in the brain. It is also involved in the biosynthesis of lecithin

lower respiratory tract infection Head injury Cerebrovascular disorders Parkinsonism Cerebrovascular disorders

hypersensitivity reaction Parasympathetic hypertonia.

serum creatinine or BUN Stomach pain, diarrhea; hypotension, tachycardia, bradycardia.

Partial alpha-2 antagonist. Decrease preganglionic sympathetic outflow from brain resulting in decrease in blood pressure Clavunate blocks the beta lactamae enzymes, thus, rendering the organisms sensitive to the amoxicillins rapid bactericidal effect at concentrations readily attainable in the body. Clavunalate by itself has little bactericidal activity; however, in association with amoxicillin, it produces an antibiotic agent of broad spectrum Nonsteroidal Anti0inflammatory Drugs Calcium antagonist Inhibits movement of calcium ions across cell membrane in systemic and coronary vascular smooth muscle; slows calcium ion movement across cell membranes in both cardiac muscle and cardiac pacemaker cells, decreasing sinoatrial and atrioventricular conduction

Decrease dose with renal insufficiency

Orthostatic hypotension, rash, drowsiness, dry mouth, constipation, headache, impaired ejaculation Side effects are uncommon and mainly of a mild and transitory nature

Diclofenac K (Cataflam) Diltiazem HCl Dilzem

50~150mg /day 90 mg/ tab OD

Short term treatment of post-traumatic & post op pain & inflammation, dysmenorrheal, migraine, adnexitis Management of Angina pectoris & hypertension

Known hypersensitivity to diclofenac or other NSAIDs, gastric or intestinal ulcer Sick sinus syndrome, 2nd or 3rd degree AV block, hypotension, pregnancy acute MI

Diphenhydramine (Benadryl) Diphenhydramine Domperidone (Motilium)

50mg/mL injection 1mg/kg/dose 10mg, 1mg/ml 1tab TID

for

H1 receptor antagonist / Antihistamine Competes with histamine for H1-receptor sites on effector cells in the gastrointestinal tract, blood vessels, and respiratory tract Competes with histamine for H1 receptor sites on effector cells in the GIT, blood vessels & respiratory tract Peripheral dopamine receptor blocking properties. It increase esophageal peristalsis and increase lower esophageal sphincter pressure, increase gastric motility and peristalsis and enhances gastroduodenal coordination, therefore, facilitating gastric emptying and decrease small bowel transit time

Allergic reaction; motion sickness Symptomatic relief of condition like urticaria, angioedema, rhinitis, conjunctivitis, inpruritic skin disorder Allergic reactions; motion sickness Dyspeptic symptom complex associated with delayed gastric emptying, GERD, esophagitis eg epigastric sense of fullness, early satiety, feeling of abdominal distention, upper abdominal pain; bloating, erucation, flatulence; heartburn w/ or w/o regurgitations of gastric contents in the mouth. Nausea & vomiting of functional, organic, infectious or dietetic origin or induced by radio or drug therapy

GIT ulceration or inflammation

Occasionally, GI disorder, HA, dizziness, vertigo, rash, elevation of serum transaminase Peripheral edema, hypotension bradycardia, angina, AV block, abnormal ECG, arrhythmias; CNS: dizziness, lightheadedness, headache, weakness, shakiness, somnolence, asthenia; DERM: dermatitis, photosensitivity, petechiae, rash; GI: nausea, vomiting, constipation, abdominal discomfort, cramps, dyspepsia, dry mouth. GI disturbances, bleeding, drowsiness, dizziness Urticaria, rashes, anaphylactic shock, photosensitivity, excessive perspiration Rarely, increased prolactin levels. GI disorders. Very rarely, transient intestinal cramps. Galactorrhea. Gynecomastia. Amenorrhea.

Acute asthma attacks, premature infants or neonates & nursing mothers GI hemorrhage, mechanical obstruction or perforation; in patients w/ prolactinreleasing pituitary tumor (prolactinoma). Known intolerance to the drug.

Doxorubicin (Adriblastina,

Adrim,

IV 60-75 mg/m2 as single dose at 21 day interval

Doxorubicin prevents DNA replication. The exact mechanism is still being studied, but it may be a "topoisomerase inhibitor". Topoisomerases are enzymes

Close observation is required esp during initial treatment. Monitor cardiac function. Myelosuppression &

Cardiotoxicity. GI & dermatologic disturbances. Myelosuppression & leucopenia. Dehydration & facial

Axibin, Caelyx, Dactorubin, Rubidox) Enoxaparin sodium

that temporarily cut one strand of DNA during replication to help unwind the double helix.. Doxorubicin prevents the topoisomerase from reattaching the cut ends Causes higher anti-factor Xa to antithrombin activities (anti-factor IIa) ration than heparin, which may prevent thrombosis

immunosuppression. Hepatic impairment, obesity & extravasation Use with caution in patients prone to dyspepsia or known to have a lesion of the gastric mucosa. Do not administer to patients with hemophilia and is not recommended to infants <1 year. Caution is necessary when renal or hepatic function is impaired and particularly in children who are dehydrated N/A

flushing Derma: local eythema, Hema: hemorrhage, thrombocytopenia, anemia, Other: local irritation and pain; hematoma; nausea, confusion, fever, edema, peripheral edema

Erceflora Bacillus clausal

2billion/5ml Adult : 2~3 vials/day, children : 1~2vials/day 40 mg/tab

Antidiarrheal

Esomeprazole (Nexium)

suppresses gastric acid secretion by specific inhibition of the H+/K+ ATPase in the gastric parietal cell.

Treatment of acute diarrhea with duration of 14 days due to infections, drugs or poisons or for chronic or persistent diarrhea with duration of 14 days Erosive esophagitis, peptic ulcer, ZES, GERD

N/A

Hypersensitivity

Etoricoxib (Arcoxia)

90 mg/tab OD

For relief of acute or chronic pain

Ferrous sulfate Flenax forte

1 tab 550mg / tab BID

Replaces iron, found in hemoglobin, myoglobin, and other enzymes; allows the transportation of oxygen via hemoglobin Nonsteroidal Anti-inflammatory Drugs ( NSAIDs)

Prevention & treatment of iron deficiency anemia Relief of mild to moderately sever pain & fever w/ or w/o inflammation eg musculoskeletal trauma, post-op pain & post dental extraction

Advanced renal disease; preexisting edema, hypertension or heart failure; liver dysfunction; previous acute asthmatic attacks, urticaria or rhinitis precipitated by salicylates or nonselective COX inhibitors Thalassemia, Sideroblastic anemia, hemochromatosis Aspirin or other NSAIDs induced asthma, rhinitis or urticaria. Children under 2 y/o Hypotension, latent or manifest diabetes mellitus, gout, obstruction of urinary passages; hepatic cirrhosis w/ concomitant renal insufficiency; hypoproteinaemia; premature infant. Pregnancy, lactation

Headache, diarrhoea, abdominal pain, nausea, flatulence, dry mouth, constipation, hyponatraemia, photosensitivity, angioedema, anaphylaxis. Asthenia/fatigue, dizziness, lower extremity edema, hypertension, dyspepsia, heartburn, nausea, increased ALT & AST GI disturbances, allergic reactions, hyperbilirubinemia Abdominal discomfort, epigastric distress, GI reaction, peptic ulceration, HA, nausea, peripheral edema Symptomatic hypotension, dehydration, hemoconcentration; hypokalemia, hyponatremia, metabolic acidosis; increase of blood lipid levels, urea, uric acid; reduced glucose tolerance; hearing disorders, tinnitus; pancreatitis, GI symptoms; fever, vasculitis, interstitial nephritis; hemolytic or aplastic anemia, leukocytopenia, agranulocytosis, thrombocytopenia Nephritic (renal) effects, dizziness, tinnitus, vertigo, numbness, skin tingling, muscle twitching, respiratory depression, lethargy, confusion. Allergic reactions Sodium retention, fluid retention, congestive heart failure in susceptible patients, potassium loss, hypokalemic alkalosis, hypertension, increased

Furosemide (Fremid, Fretic, Frusema, Furoscan, Fusimex, Lasix)

Gentamycin

Initially 20-40 mg IV/IM. If diuretic effect is not satisfactory, dose may be increased stepwise, at 2-hrly interval by 20 mg each time until satisfactory diuresis is obtained, the dose should then be given once-bid 1~1.7mg/kg every 8 hours 5mg/kg/dose 100mg IV every 8 hours

Frusemide primarily inhibits sodium and chloride absorption in the thick ascending limb of the loop of Henle

Aminoglycoside

Hydrocortisone Hydrocortisone sodium succinate (Solu-cortef)

Decreases inflammation by suppression of migration of PMNs and reversal of increased capillary permeability Corticosteroids enter the cell and bind to cytosolic receptors that transport the steoid into the nucleus. The steroid-receptor complex alters gene expression by binding to glucocorticoid response elements (GREs) or

Bone & joint infection. CNS. Burnn & wound infection. UTI. Acute & chronic suppurative otitis media, pneumonia, septicemia * sinusitis Endocrine, hematologic, rheumatic and collagen disorders

Hypersensitivity to amynoglycosides

TB skin infections, herpes simplex, vaccinia, hypersensitivity Corticosteroids may mask some signs of infection, and new infections may appear during their use. There may be decreased resistance and inability to

mineralocorticoid-specific elements. Tissue-specific responses to steroids are made possible by the presence in each tissue of different protein regulators that control the interaction between the hormone-receptor complex and particular response elements

localize infection when corticosteroids are used. Prolonged use of corticosteroids may produce posterior subcapsular cataracts, glaucoma with possible damage to the optic nerves, and may enhance the establishment of secondary ocular infections Corticosteroids should be used cautiously in patients with ocular herpes simplex for fear of corneal perforation. Monitor hematological parameters during treatment. Chickenpox or herpes infection, active infection or dental disease, marked renal dysfunction, gout or nephrolithiasis, patients who have received radiation or cytotoxic therapy causing myelosuppression Acute GI, biliary & genitourinary spasm, including biliary & renal colic. Parenterally also as an aid in diagnostic & therapeutic procedures eg gastroduodenal endoscopy, radiology Avoid driving and operating machinery after parenteral administration

calcium excretion, steroid myopathy. Increase in alanine transaminase (ALT, SGPT), aspartate transaminase (AST, SGOT) and alkaline phosphatase, these changes are usually small, not associated with any clinical syndrome and are reversible upon discontinuation

Hydroxyurea (Hydab, Krabinex, Litalir)

Myeloproliferative disorders 20-30 mg/kg daily. Acute leukemia 50-75 mg/kg

Cuases cell death by specific inhibition of DNA synthesis. This action cuases regressions in chronic myeloid leukemia and other malignancies and psoriasis. The Sphase-specifec action of hydroxyrea can deplete bone marrow precurso cells associated with megaloblastic changes

Hyoscine-Nbutylbromide (Buscopan) Isosorbide-5mononitrate (Imdur)

10mg/tab, 20mg/amp 1~2 tab / amp IV several times 325 mg/tab or 80 mg/tab

Reversible .blockade of the actions of cholinomimetics at muscarinic receptors

Anemia, neutropenia, leukopenia, thrombocytopenia; burning, redness or pain at site of radiation therapy; erythema, maculopapular rash, sore mouth or lips, skin rash; fever or chills, cough or sore throat; constipation or diarrhea; stomatitis; difficulty in micturition, nausea, vomiting, low back pain, fatigue, hyperuricemia Xerostomia, tachycardia, urinary retention, allergic reactions, skin reactions Gastric hemorrhage, hypersensitivity and thrombocytopenia may occur

Inhibits prostaglandin synthesis, resulting in analgesia, anti-inflammatory activity and platelet aggregation inhibition; reduces fever by acting on the brains heatregulating canter to promote vasodilation and sweating

Isoxsuprine HCl (Isoxilan)

Isoxsuprine, a -adrenoceptor agonist, is an orally and perenterally active peripheral vasodilator. It has a strong relaxing action on arteries and to a certain extent, also on cutaneous blood vessels. In addition to this, it had a direct relaxant effect on the smooth muscle tissue of the uteru

Patients prone to dyspepsia or known to have a lesion of the gastric mucosa. Do not administer to patients with hemophilia and is not recommended to infants <1 year. Caution is necessary when renal or hepatic function is impaired and particularly in children who are dehydrated. Recent arterial hemorrhage, heart disease, severe anemia. Parenterally, hypotension, tachycardia, premature rupture of membranes or immediately post partum

Ketoprofen (Orudis) Ketorolac trometamol (Toradol)

100-300 mg IV daily for a max of 48 hrs 30 mg IV TID

Analgesic Analgesic, can also replace morphine in situations involving mild to moderate pot op pain

Renal impairment Special Precautions: in patients with impaired renal function. History of GIT disease, anaphylactoid reactions, elderly, coagulation disorders. Avoid driving and operating machinery Galactosemia, bowel obstruction, hypersensitivity Special concerns in lactose intolerance

After oral administration, side effects are rare; palpitations, chest pains, mild flushing, dizziness, nausea, vomiting and rash have been reported. Parenteral administration can result in tachycardia, palpitations, hypotension, dizziness and flushing which can be controlled by dose reduction and by supine position of the patient and reversed if necessary by parenteral administration of noradrenaline. GI disorders, headache, drowsiness, dizziness, edema, bullous dermatoses GI reactions, nausea, dyspepsia, drowsiness, headache, sweating edema, bradycardia, palpitation, hypotension, chest pain Initial dosing may produce flatulence and meteorism, which are usually transient and disappear under continued therapy Diarrhea

Lactulose (Duphalac)

3.3g/5ml Starting Adult : 15~45ml Child :5~15ml Maintenance Adult : 10~25ml Child :5~20ml

Laxative; the fecal bulk is increased and softened and peristalsis is stimulated, by which normal bowel action is restored. Lactulose does not irritate gut mucosa

Constipation associated with ped problems, post-op; pregnancy & postnatal period; bedridden & geriatric patients; surgical procedures; painful rectal & anal conditions; laxative dependence; barium x-ray investigation; drug-induced constipation

Loperamide (Diatabs, Imodium)

2mg/cap, 2cap followed by 1cap after unformed stool Chewtab 2~4 Susp 2~4tsp QID 0.2 g/kg over 3-5 mins 50-100 g in a 24-hr period via infusion 0.25-2 g/kg over 3060 mins

Maalox Al(OH)3 200mg, Mg(OH)2 200mg Mannitol

Directly acts on intestinal muscles to inhibit peristalsis and prolongs transit time enhancing fluid & electrolyte movement through intestinal mucosa; reduces fecal volume, increase viscosity & diminishes fluid and electrolyte loss; demonstrates antisecretory activity; exhibits peripheral action Antacids, antireflux & antiulcerants agents

Anti-diarrheal Symptomatic control of acute & chronic diarrhea, ileostomy

Constipation, acute ulcerative, pseudomembranous colitis, acute dysentery

Constipation, nausea, vomiting, tiredness, drowsiness or dizziness, dry mouth

Symptomatic relief of hyperacidity

Severe debilitation, kidney failure

Rarely, GI disturbance

Mefenamic acid Methotrexate (Biomedis Methotrexate soln, Emthexate vial, Methobax vial, Pfizer Methotrexate vial)

500 mg/cap P.O Induction 3.3 mg/m2 w/ prednisolone 60 mg/m2 daily. Maintenance therapy 30 mg/m2 IM twice wkly or 2.5 mg/kg IV every 14 days

Mannitol increases urinary output by inhibiting tubular reabsorption of water and electrolytes. It raises the osmotic pressure of the plasma allowing water to be drawn out of body tissues. Onset: Diuresis: 1-3 hr. Reduction in intracerebral pressure: around 15 min. Duration: Reduction in intracerebral pressure: 1.5-6 hr. Absorption: Small amounts are absorbed from the GI tract. Distribution: Concentrated in extracellular compartments. It does not penetrate the blood-brain barrier nor the eye. Inhibits prostaglandin synthesis by decreasing the activity of the enzyme, cyclooxygenase, which results in decrease formation of the protaglandin precursor Inhibits dihydrofolic acid reductase and therefore interferes with DNA synthesis and cell replication. Actively multiplying cells such as malignant cells, bone marrow, foetal cells, buccal and intestinal mucosa and cells in urinary bladder are more sensitive. In patients with rheumatoid arthritis, mehtotrexate reduces joint swelling and tenderness

Oliguric phase of renal failure, Raised intracranial pressure, Cerebral oedema, Transurethral prostatic resection

Pulmonary congestion or oedema; intracranial bleeding; CHF; metabolic oedema with abnormal capillary fragility; anuria due to severe renal disease; severe dehydration

Fluid and electrolyte imbalance; acidosis (with high doses). Nausea, vomiting, thirst; headache, dizziness, convulsions, chills, fever; tachycardia, chest pain; blurred vision; urticaria and hypotension or hypertension; acute renal failure; skin necrosis; thrombophloebitis.

Pain, headache, muscular and traumatic pain, dental pain, post-op & post partum pain, dysmenorrhea

GIT ulceration or inflammation Preexisting liver damage or impaired hepatic function. Malignant disease w/ preexisting bone marrow aplasia, leucopenia, thrombocytopenia or anaemia. Infection, peptic ulcer, ulcerative colitis, debility & extreme youth & old age. Monitor renal function & serum levels when giving high dose; give Ca folinate, hydration & urine alkalinisation

GI disturbances, bleeding, drowsiness, dizziness Dermatological & hypersensitivity reactions. Bone marrow depression, leucopenia, neutropenia, thrombocytopenia, decreased serum albumin, anemia, pancytopenia, hypogammaglobulinemia. Mucositis, anorexia, nausea, vomiting, diarrhea, abdominal distress, hematemesis, melena, Renal failure, azotemia, cystitis, hematuria, urogenital or menstrual dysfunction Headache, HTN, skin eruptions, abdominal pain xerostomia, tachycardia, urinary retention, allergic reactions, skin reactions

Methylergometrine hydrogen maleate (Methergin) Methylergonovine (Syntocinon)

125~250mg TID

orally

Similar smooth muscle actions as seen with ergotamine; however, affects primarily uterine smooth muscle producing sustained contractions and thereby shorten the third stage of labor Produces rhythmic uterine contractions and can stimulate the gravid uterus; has vasopressive and antidiuretic effects; can control postpartum bleeding or hemorrhage by increasing postpartum myometrial tonus

Completion of 3rd stage labor. Uterine atony/hemorrhage

Metoclopramide HCl (Reglan, Plasil)

10mg/tab, 5mg/5ml susp. 10-15mg QID, 30 minutes before food intak IV, Tab, Syrup

Metoclopramide stimulates motility of the upper GIT without stimulating gastric, biliary or pancreatic secretions. Its mode of action is unclear. It seems to sensitize tissues to the action of acetylcholine. The effect of metoclopramide on motility is not dependent on intact vagal innervation, but it can be abolished by anticholinesterase. Blocks dopamine and serotonin in the CTZ of the CNS, which is responsible for its antiemetic action. Also increases LES tone

Antiemetic, prokinetic agent Disturbances of GI motility including GERD & diabetic gastroparesis. Nausea & vomiting of central & peripheral origin associated with surgery, metabolic disease, infectious disease, migraine headache or drugs including cancer chemotherapy. Facilitate small bowel intubation & radiological procedure of

Abnormal presentation, before delivery of child is completed & in multiple birth not before the last child has bee delivered. Documented hypersensitivity; pregnant patients with severe toxemia, unfavorable fetal positions, and a contracting uterus with hypertonic or hyperactive patterns; labor in which vaginal delivery should be avoided, such as invasive cervical carcinoma, cord presentation or prolapse, active herpes genitalis, total placenta previa, and vasa previa GI hemorrhage, mechanical obstruction or perforation, pheochromocytoma, epileptics

In approximately 10% restlessness, drowsiness, fatigue and lassitude. Less frequently, insomnia, headache, dizziness, nausea or bowel disturbances may occur

GIT

Metoprolol (Neobloc)

The -blocking activity primarily affects the cardiovascular system (decreases heart rate, decreases contractility, decreases BP) and lungs (promotes bronchospasm)

Lactation: excreted in breast milk; Children: safety and efficacy not established; Anaphylaxis: Deaths have occurred; aggressive therapy may be required; AV block, slows AV conduction and may cause heart block; Bradycardia

Metronidazole

500mg every hours IV, Oral

A direct acting trichomonacide and amebecide that works at both intestinal and extraintestinal sites. Thought to enter the cells of microorganisms that contain nitroreductase. Unstable compounds are then formed that bind to DNA and inhibit synthesis, causing cell death

Amoebiasis, giardiasis, urethritis & vaginitis due to trichomonas, aerobic infection

Hypersensitive to the drug or other nitroimidazole derivatives and in patients in 1st trimester of pregnancy Acute narrow premature infants angle glaucoma,

CV: hypotension, edema, flushing; bradycardia; CNS: headache, fatigue, dizziness, depression, lethargy, drowsiness, forgetfulness; sleepiness; vertigo, paresthesia; DERM: rash, facial erythema; alopecia, urticaria, pruritus; EENT: dry eyes, visual disturbances; GI: Nausea, vomiting, diarrhea; GU: impotence, urinary retention, difficulty with urination vertigo, headache, ataxia, dizziness,syncope, confusion, irritability,weakness, depression Sedation, hypnosis, anesthesia, anticonvulsant, muscle relaxant Dizziness (3%) Nausea (7%) Diarrhea (6%) Ethambutol may produce decrease in visual acuity which appear to be due to optic neuritis and to be related to dose and duration of treatment. The effects are generally reversible when administration of the drug is discontinued promptly. Isoniazid: peripheral neuropathy is the most common toxic effect. It is doserelated, occurs most often in the malnourished and in those predisposed to neuritis, and is usually preceded by paresthesias of the feet and hand. Pyridoxine has been used successfully for prophylaxis and treatment of isoniazid induced peripheral neuritis. Severe and sometimes fatal hepatitis associated with isoniazid therapy may occur and may develop even after many months of treatment. The risk of developing hepatitis is age-related and is increased with daily consumption of alcohol. Urinary disturbance in the male, constipation and dryness of the mouth have been reported. Rifampicin: GI disturbances, headache, drowsiness, fatigue, menstrual disturbances, ataxia, dizziness, fatigue, metal disturbances. Chronic liver disease, alcoholism and old age appear to increase the incidence of severe hepatic problems when rifampicin is given alone or concurrently with isoniazid

Midazolam (Dormicum) Moxifloxacin (Avelox) Myrin (Ethambutol HCl, Rifampicin, Isoniazid)

tablet initially then tablet every 2 hours prior to operation 400mg / tab once a day 300/150/75 mg tab once a day

Inhibits DNA gyrase and Topoisomerase IV. This results in inhibition of DNA replication and translation, DNA repair, recombination and transposition, which causes bacterial cell death Oral chemotherapeutic agent which is specially effective against actively growing microorganisms of the genus Mycobacterium

Antibiotic / Quinolone

Caution for use with other QTc prolonging drugs and corticosteroids. May aggravate myasthenia gravis

Nalbuphine (Nubain) Nicardipine (Cardepine) Nifedipine (Adalat, Calchek, Nifelan)

5 mg IM 0.15-0.2 mg/kg BW Oral: 20,30 mg Parenteral: 2.5 mg/mL 10mg TID or 30mg OD (Extended release tablets) max 120-180mg/day

Binds to opiate receptors in the CNS. Alters the perception of and response to painful stimuli, while producing generalized CNS depression. Decrease in moderate and severe pain Potent peripheral vasodilator. Little depression of nodes. Causes reflex increase in heart rate and output Inhibits calcium ion from passing through slow channels on voltage sensitive areas of both smooth muscle and myocardium, causing coronary vasodilation, stabilizes cell membranes. Increases myocardial oxygen sypply

Opioid Analgesic

Impaired renal or hepatic function, biliary tract surgery, impaired respiration, MI, labour and delivery Severe aortic stenosis

Sedation, infrequently sweating, GI upsets, vertigo, dizziness, dry mouth, headache, allergic reactions Peripheral edema; dizziness, nausea, transient hypotension, MI, reflex tachycardia, pulmonary edema, fewer myocardial infarctions, more palpitations Flushing, Edema, Headache, dizziness, Weakness, transient hypotension

Calibloc, Nelapine,

Hypersensityvity to any component of nifedipine tablet or capsule. Do not use short acting nifedipine in cases of emergency, serious side effects such as0020CVD, syncope, heart block, stroke, AMI, etc.), Avoid with concurrent intake of grapefruit juice. Do not withdraw abruptly in Hypertensive patients Effective in vitro against the most virulent pathogens including: MRSA - the Methicillin-resistant Staphylococcus aureus superbug, E coli-157 (cause of food poisoning), Bacillus cereus (cause of intestinal anthrax), H. pylori (the cause of peptic ulcers), and L clostridium, that results in morning sickness, migraine and cluster headaches. Pregnancy & lactation. Not for childn <4 yr

OMX Probiotics Probiotics 12+ Professional Formula

2~10 cap per day

Normalizes the micro flora (lactic acid bacteria) in the intestinal tract, Reestablishes the colon's optimum pH level and Probiotics 12 plus, Suppresses the growth of bad bacteria, stimulates the immune system, fortifies the body's ability to absorb nutrients, provides complex B vitamins, antioxidants, minerals & amino acids.

Orofar (Benzoxonium Cl 0.5 mg, lidocaine HCl 0.5 mg) Oxytocin (Syntocinon)

Soln After morning & evening meals, gargle or rinse mouth for 30-60 sec w/ 1 tbsp of undiluted soln (do not swallow). If continued treatment is indicated, the soln may be used more often or may be replaced by loz during the day. Childn >4 yr Dose should be reduced. Max: 6 loz/day. Use only 1 tsp of soln to rinse or gargle Produces rhythmic uterine contractions and can stimulate the gravid uterus; has vasopressive and antidiuretic effects; can control postpartum bleeding or hemorrhage by increasing postpartum myometrial tonus

Isolated cases of skin rash; occasional & transient cases of mild local irritation

Documented hypersensitivity; pregnant patients with severe toxemia, unfavorable fetal positions, and a contracting uterus with hypertonic or hyperactive patterns; labor in which vaginal delivery should be avoided, such as invasive cervical carcinoma, cord presentation or prolapse, active herpes genitalis, total placenta previa, and vasa previa

Xerostomia, tachycardia, urinary retention, allergic reactions, skin reactions

Pankreatoflat (Pancreatin, dimethicone) Pantoprazole (Ulcepraz, Pantoloc)

170/80 mg tab OD

20-40mg 1x a day

Pancreatin corrects the fermentative and putrefactive process that are the main causes of pathological formation of gas. Activated dimethylpolysiloxane eliminates foam, facilitating the absorption of pathological accumulation of gas in the intestine Inhibits H+/K+ ATPase pump in parietal cells, inhibiting acid secretion. Also reduces in-vitro counts of H. pylori by more than 4x at pH of 4

Hypersensitivity reactions have been reported; these may be sneezing, lacrimation or skin rashes Proton Pump Inhibitor Safety and efficacy not established beyond 16 weeks. Prolonged treatment may lead to Vit B12 malabsorption Chest pain (I.V. < or =6%), Pain, migraine, anxiety, dizziness, headache (I.V. >1%) Rash (I.V. 6%), pruritus (I.V. 4%) Hyperglycemia (1%), hyperlipidemia, Diarrhea (4%), constipation, dyspepsia, gastroenteritis, nausea, rectal disorder, vomiting,

Paracetamol (Biogesic) Paracetamol

500mg/tab, 250mg/5ml 250~500mg every 3~6hrs 150mg/ml 2~3ml every 4 hours for adult 1~2ml every 4 hours for child

Inhibit the synthesis of prostaglandins in the CNS & peripherally blocks pain impulse generation; produces antipyresis from inhibition of hypothalamic heatregulating center Inhibit the synthesis of prostaglandins in the CNS & peripherally blocks pain impulse generation; produces antipyresis from inhibition of hypothalamic heartregulating center

Relief of fever, minor aches & pains

Anemia, cardiac & pulmonary disease. Hepatic or severe renal disease Anemia, cardiac & pulmonary disease. Hepatic or severe renal disease

abdominal pain (I.V. 12%), Urinary frequency, urinary tract infection, Liver function test abnormality, increased SGPT Injection site pain (>1%) Weakness, back pain, neck pain, arthralgia, hypertonia, Bronchitis, increased cough, dyspnea, pharyngitis, rhinitis, sinusitis, upper respiratory tract infection, Flu syndrome, infection Allergic skin reaction & GI disturbances

Pyrexia of unknown origin. Fever & pain associated with common childhood disorders, tonsillitis, upper resp tract infections post-immunization reactions, after tonsillectomy & other conditions. Prevention of febrile convulsion. Headache, cold, sinusitis, muscle pain, arthritis & toothacke For moderate to severe pain, pre op medication, analgesia

Hematological, skin & other allergic reactions

Pethidine HCl (Demerol)

25 mg IV

Exert its analegic effects by the same mechanism as morphine, by acting as an agonist at the u-opioid receptor. Inhibitor of crystallization; used in treatment of patients with renal lithiasis and hypocitraturia, chronic formers of calcium oxalate, phosphate calculi; uric acid lithiasis alone or accompanied by calcium lithiasis, and renal tubular acidosis with calcium nephrolithiasis. Inhibits DNA-gyrase in susceptible organism; inhibit relaxation of supercoiled DNA and promotes breakage of double-stranded DNA

Head injury, increased intracranial pressure, acurte asthma, atrial flutter, convulsive disorders, acute abdominal conditions Patients with altered potassium excretion mechanism, hyperpotassemia may appear. In patients with renal insufficiency, an increased risk of appearance of hyperpotassemia Pregnancy & lactation, methicillinresistant S.aureus infections

Potassium citrate (Acalka)

1080 mg / Tablet TID

Prozine Ciprofloxacin HCl

500mg / tab Cystic fibrosis 20mg/kg, max 750mg BID Gonorrhea 500mg OD

Ranitidine (Ulcin / Zantac) Rofecoxib (Vioxx)

50mg SIV TID 50mg tab BID

Inhibits action of histamine at the H2 receptor site located primarily in the gastric parietal cells Produces anti-inflammatory, analgesic and antipyretic effects, possibly by inhibiting prostaglandin synthesi

Treatment of patients with renal lithisis & hypocitraturia, chornic formers of Ca oxalate, phosphate calculi. Uric acid lithiasis alone alone or accompanied by Ca lithiasis. Renal tubular acidosis with Ca nephrolithiasis. Gram negative infection. Treatment of wide range of infections including anthrax, biliary tract infection, bone & joint infections, brucellosis, infected bites & stings, cat scratch disease, chancroid, exacerbations of cystic fibrosis, gastroenteritis, gonorrhea, legionnaires disease, otitis media & externa, peritonitis, Q fever, lower respiratory tract infection Histamine H2 Antagonist, Antiulcer

Respiratory depression, circulatory depression, resp. arrest, shock, cardiac arrest, GI disturbance. Dizziness, sedation, headache, dysphoria, tremor, agitation, hallucination, disorientation Slight gastrointestinal disorders may appear which can be palliated by means of concomitant administration with food.

Salbutamol

2mg/tab, susp.

2mg/5ml

Prevention & relief from bronchospasm associated with reversible obstructive

Renal impairment, hepatic impairment, pregnancy, lactation, or children Contraindicated in patients hypersensitive to drug or its components and in those who have experienced asthma, urticaria, allergic reactions after taking aspirin or other NSAIDs. Also contraindicated in patients with advanced renal disease or moderate or severe hepatic insufficiency and in pregnant women because it may cause ductus arteriosus to close prematurely Special precaution : coronary insufficiency, cardiac arrhythmias,

Nausea, vomiting, diarrhea, abdominal pain, dyspepsia. Headache, dizziness, restlessness, tremor, drowsiness, rarely insomnia, visual & other sensory disturbances. Rash, pruritus, elevated liver enzyme values, jaundice, hepatitis. Eosinophilia, leucopenia, thrombocytopenia, hemolytic anemia or agranulocytosis. Transient increase in serum creatinine or BUN Headache, dizziness, nausea and vomiting Headache, asthenia, fatigue, dizziness, hypertension, leg edema, sinusitis, diarrhea, dyspepsia, epigastric discomfort, heartburn, nausea, abdominal pain, UTI, back pain, bronchitis, URTI, flu syndrome

Palpation, tachycardia, increased BP, headache, nervousness, dizziness,

(Asmalin) Salbutamol (Ventolin)

1tab TID, 2.5 ~ 5ml TID Inhalant: 40 micrograms/puff aerosol Oral: 2,4 mg tablets; 2 mg/mL syrup Beta adrenergic receptor agonist bronchodilation Inhalational: Onset < 15 m, dur 3-4 h PO: onset <30m, dur 4-8 hours causes

airway disease eg bronchial asthma Treatment & prevention of bronchial asthma, bronchitis, emphysema with associated reversible airway obstruction.

hypertension, convulsive disorder, hyperthyroidism, diabetes mellitus; pregnancy, lactation. Threatened abortion during 1st or 2nf trimesters of pregnancy. Toxaemia of pregnancy, antepartum haemorrhage, placenta praevia.

heartburn, epistaxis, cough, GI discomfort, throat irritation & tremor Thyrotoxicosis, inhaled salbutamol prep are not appropriate for managing premature labour. Pregnancy, lactation. Acute severe asthma. Monitor fluid balance, cardiorespiratory function & ECG

Simvastatin (Vidastat, Zocor)

10~80mg tab OD

Sulbactam-Ampicillin (Unasyn) Tramadol (Dolotral, Silverol, TDL, Tradonal, Trama)

375 mg/tab BID

Statins inhibit the enzyme HMG-CoA reductase which is the rate limiting step in the synthesis of cholesterol. Intake of statins results in lowering of LDL and elevation of HDL. Statins have been demonstrated to be cardioprotective and reduces risk of cardiovascular events Inhibition of cell wall synthesis

The most common side effect of statins is in the gastrointestinal system, with reports of constipation and nausea. May also affect the liver, causing drug induced hepatitis Overgrowth of non-susceptible organism. Check periodically for organ system dysfunction during prolonged therapy Hypersensitivity to tramadol or any component of the tablets or Ampoule solution. Patients intoxicated with alcohol or other sedating drugs Use with extreme precaution among patients taking other CNS drugs particularly sedatives or CNS depressants Acquired defective color vision, active intravascular clotting, subarachnoid hemorrhage, Concurrent factor IX complex or anti-inhibitor coagulant concentrates, patients with cardiovascular, renal, CVD, and thromboembolic disease Patients with known hypersensitivity to Valdecoxib. Patients who have demonstrated allergic-type reactions to sulfonamides. Patient who have experienced asthma, urticaria, allergic type reactions after taking NSAIDS including other COX-2 inhibitors Should not take this drug if you have liver disease or your liver is not functioning properly, or if you have had an allergic reaction to it. GI disturbances, phlebitis, skin rashes, itching, blood disorders, anaphylaxis, superinfection Most common side effects are CNS related: Headaches, dizziness, somnolence, vertigo. May cause vasodilaton and hypotonia

50-100mg every 4-6 hours, not to exceed 400mg/day

Binds to Mu Opiate receptors in the brain and spinal cord, which alters sensation and response to pain. Also inhibits reuptake of serotonin and norepinephrine, which also results in alteration in pain signal transmission

Relief of moderate to moderately-severe pain. Extended release of formulation are indicated for patients requiring aroundthe-clock management of moderate to moderately-severe pain for an extended period of time. Menorrhagea, Metrorrhagea, valvular heart surgery, GI hemorrhage, Hereditary angioneurotic edema

Tranexamic Acid

250-500mg/cap 1-2 cap TID/QID 250-500mg IV slow push

Competitively inhibits activation of plasminogen to plasmin, which inhibits fibrinolysis. Also inhibits plasmin proteolytic activity

Gastrointestinal >10% (nausea, diarrhea, vomiting), Cardiovascular and Ocular 1% to 10% (Hypotension, thrombosis, blurred vision)

Valdecoxib (Bextra)

20mg / tab once daily

Inhibition of cyclooxygenase-2 (COX-2) pathway

Dry mouth, hypertension, peripheral edema, , abdominal fullness, abdominal pain, diarrhea, dyspepsia, nausea, anemia, sinusitis, rash

Valproic acid (Depakene)

250mg, 15ml NGT 30ml/day

Vasaltarn/ Hydroclorothiazide(Co -Diovan)

80/12.5 mg tab 160/12.5 mg tab 320/12.5 mg tab 320/25 mg tab

Valproic acid and its derivative, divalproex, are oral drugs that are used for the treatment of convulsions, migraines and bipolar disorder. The active ingredient in both products is valproic acid or valproate. Scientists do not know the mechanism of action of valproate. The most popular theory is that valproate exerts its effects by increasing the concentration of gamma-aminobutyric acid (GABA) in the brain. Gamma-aminobutyric acid is a neurotransmitter, a chemical that nerves use to communicate with one another Hydrochlorothiazide belongs to the thiazide class of diuretics, acting on the kidneys to reduce sodium (Na) reabsorption in the distal convoluted tubule. This increases the osmolarity in the lumen, causing less water

The most common side effects with valproic acid therapy are drowsiness, dizziness, nausea, vomiting, indigestion, diarrhea, weight loss and tremors. Liver injury, pancreatitis and abnormal bleeding

Hypertension

Pregnancy & severe hepatic impairment, biliary cirrhosis & cholestasis. Anuria, severe renal impairment (CrCl <30 mL/min). Refractory hypokalemia,

Headache, dizziness, fatigue. Hydrochlorothiazide: Hypokalemia, hyperuricemia, electrolyte disturbances, postural hypotension, rise in blood lipids

Vincristine (Alcavixin, Biomedis Vincristine, Nevexitin, Pfizer Vincristine)

Adult 0.4-1.4 mg/m2 BSA. Childn 1.5-2 mg/m2 BSA, <10 kg or BSA <1 m2 0.05 mg/kg wkly

to be reabsorbed from the c ollecting ducts. This leads to increased urinary output vincristine and other vinca alkaloids exert their cytotoxic effects by binding to tubulin, the protein subunit of the microtubles that form the mitotic spindle. The formation of vincristine-tublin complexes prevent the polymerization of the tubulin subunits into microtublues and induces depolymerization of microtubules resulting in inhibition of microtubule assembly and cellular metaphase arrest. In high concentrations, the drug also exerts complex effects on nucleic acid and protein synthesis. Vincristine exerts some immunosuppressive activity Supplementation Supplementation Treatment of vit A deficiency Maintains healthy skin & eyes. Protects against artherosclerosis & CV disorders. Improves nerve functions & prevents onset of neuromuscular degenerative diseases Prophylaxis and therapy of hemorrhagic disease of the newborn Severe anxiety, Insomnia associated with anxiety, Premedication before anaesthesia, Adjunct in seizures, Muscle spasms, Alcohol withdrawal syndrome, Muscle spasms, Alcohol withdrawal syndrome

hyponatremia, hypercalcemia & symptomatic hyperuricemia. Biliary obstruction, preexisting neuropathies, liver dysfunction or jaundice & elderly. Extravasation, nephrotoxicity, hepatic impairment. Pregnancy, lactation. Fatal if given intrathecally

Neurotoxicity. CNS effects eg depression, agitation, insomnia, hallucinations & episodes of altered consciousness. Rare hypersensitivity. Leucopenia, anemia, thrombocytopenia. GI effects. Hyperuricemia, uric acid nephropathy, polyuria, dysuria & urinary retention due to bladder atony. Alopecia. Increased urinary Na excretion. Hypertension, hypotension. Fever, headache

Vitamin A Retinol palmitate Vitamin E DI-a-tocopheryl acetate (Mira E ) Vitamin K New Additions: Diazepam (Valium)

25,000iu 300iu, 400iu

Special precaution in pregnancy. Excessive doses may lead to hypervitaminosis

1mg IM

Promotes liver synthesis of clotting factors (II, VII,IX,X).

Coumarin and indanedione derivatives

Allergic reactions, including anaphylactoid reaction, pain, swelling Psychological and physical dependence with withdrawal syndrome, fatigue, drowsiness, sedation, ataxia, vertigo, confusion, depression, GI disturbances, changes in salivation, amnesia, jaundice, paradoxical excitation, elevated liver enzyme values; muscle weakness, visual disturbances, headache, slurring of speech and dysarthria, mental changes, incontinence, constipation, hypotension, tachycardia, changes in libido, pain and thrombophlebitis at inj site (IV). Potentially Fatal: Respiratory and CNS depression, coma.

Adjunct in seizures Adult: 2-60 mg daily in divided doses. Elderly: Dose reduction may be required. Renal impairment: Dosage adjustments may be needed.

KCl (Kalium durule)

Adult & elderly Prophylaxis 2 durules daily. Hypokalemia Adjust dosage according to serum K level. Suggested dose: 2 durules bid or more until serum K is restored to normal, then prophylactic dosage.

Diazepam is a long-acting benzodiazepine with anticonvulsant, anxiolytic, sedative, muscle relaxant and amnestic properties. It increases neuronal membrane permeability to chloride ions by binding to stereospecific benzodiazepine receptors on the postsynaptic GABA neuron within the CNS and enhancing the GABA inhibitory effects resulting in hyperpolarisation and stabilisation. Absorption: Readily and completely absorbed from the GI tract, peak plasma concentrations after 30-90 min (oral). Rapidly absorbed, peak plasma concentrations after 10-30 min (rectal). Distribution: Readily crosses the blood-brain barrier; redistributed into fat depots and tissues. Protein-binding: 98-99%. Metabolism: Extensively hepatic; converted to desmethyldiazepam, oxazepam and temazepam. Excretion: Urine (as free or conjugated metabolites). Elimination half-life: Rapid (initial), 1-2 days (terminal), 25 days (desmethyldiazepam). Potassium is the predominant cation (approximately 150 to 160 mEq per liter) within cells. Intracellular sodium content is relatively low. In extracellular fluid, sodium predominates and the potassium content is low (3.5 to 5 mEq per liter). A membrane-bound enzyme, sodiumpotassiumactivated adenosinetriphosphatase (Na +K +ATPase), actively transports or pumps sodium out and potassium into cells to maintain these concentration gradients. The intracellular to extracellular potassium gradients are necessary for the conduction of nerve impulses in such specialized tissues as the heart, brain, and skeletal muscle, and for the maintenance of normal renal function and acid-base balance. High intracellular potassium concentrations are necessary for numerous

Hypersensitivity; myasthenia gravis, preexisting CNS depression or coma, respiratory depression; acute pulmonary insufficiency or sleep apnoea syndrome; severe hepatic impairment; acute narrow angle glaucoma; children <6 mth (oral); pregnancy and lactation.

Hypokalemia. Prophylaxis during treatment w/ diuretics.

Renal insufficiency, hyperkalemia, untreated Addison's disease, constriction of the esophagus &/or obstructive changes in the alimentary tract.

Hyperkalemia (confusion; irregular or slow heartbeat; numbness or tingling in hands, feet, or lips; shortness of breath or difficult breathing; unexplained anxiety; unusual tiredness or weakness; weakness or heaviness of legs)

PHENYTOIN (Dilantin)

Adult Initially 100 mg tid. Maintenance: 300400 mg daily in equally divided doses. Childn 6 yr Initially 100 mg tid, subsequent dosage should be adjusted according to therapeutic response. Pedia Initially 5 mg/kg/day in 2-3 equally divided doses. Max: 300 mg daily. Maintenance: 4-8 mg/kg/day. Susp Initially 125 mg/5 mL tid, subsequent dosage adjusted according to therapeutic response. An increase to 625 mg (25 mL) daily may be made if necessary.

cellular metabolic processes. Phenytoin acts as an anticonvulsant by increasing efflux or decreasing influx of sodium ions across cell membranes in the motor cortex during generation of nerve impulses; thus stabilising neuronal membranes and decreasing seizure activity. It acts as an antiarrhythmic by extending the effective refractory period and suppressing ventricular pacemaker automaticity, shortening action potential in the heart. Absorption: Slow but almost complete from the GI tract (oral); much slower absorption (IM). Distribution: Widely distributed. Protein-binding: 90%. Metabolism: Extensively hepatic; converted to inactive metabolites. Excretion: Via urine as hydroxylated metabolite; elimination half life at steady state: 22 hr.

Cap/susp: Control of grand mal & complex partial seizure, prevention & treatment of seizure during or following neurosurgery, migraine, trigeminal neuralgia, certain psychoses, cardiac arrhythmias, digitalis intoxication, postevent treatment of MI. Inj: Control of status epilepticus of the grand mal type, prevention & treatment of seizures during or post neurosurgery/severe head injury.

History of hypersensitivity to phenytoin or other hydantoins. Sinus bradycardia, SA block, 2nd- & 3rd-degree AV block. Patients w/ Adams-Stokes syndrome. Seizures due to hypoglycemia or other metabolic causes.

Hypersensitivity, rashes. Hypotension. Nystagmus, ataxia, slurred speech, decreased coordination, mental confusion. GI disturbances, hepatitis, dizziness, gingival hyperplasia, hypertrichosis, Peyronie's disease, hyperglycemia, osteomalacia. Inj: Local irritation, inflammation, tenderness, necrosis, sloughing.

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