Null 57

DRUG STUDY
SUBMITTED TO : MADAM S.A.D.N. PREMATHILAKA

SUBMITTED BY : S.A.U.LAKSHINI
REG. NO : 1326
SCHOOL OF NURSING KALUTARA
CONTENT
Page No.
01.) CARDIOVASCULAR SYSTEM 04
1.1 Anticoagulants
1.2 Antiplatelet agents
1.3 Angiotensin converting enzyme inhibitors
1.4 Beta blockers
1.5 Calcium channel blockers
1.6 Cholesterol lowering agents
1.7 Digitalis preparation
1.8 Vasodilators
1.9 Inotropes
1.10 Anti-arrhythmic drugs
02.) URINARY SYSTEM 38

2.1 Antibiotics
2.2 Diuretics
2.3 Carbonic anhydrates inhibitors
2.4 Cholinergic agents
2.5 Anti-cholinergic drugs
2.6 Adrenergic antagonist
2.7 Antidiuretic hormones
2.8 Urinary alkalizes
2.9 Medication for urinary incontinence
2.10 Miscellaneous renal drugs
03.) RESPIRATORY SYSTEM 71

3.1 Anti-histamine
3.2 Anti-asthmatics
3.3 Bronchodilators
3.4 Decongestants
3.5 Expectorants
3.6 Mucolytic
3.7 Steroids
3.8 Respiratory miscellaneous drugs
04.) GASTROINTESTINAL TRACT 91

4.1 Antacids
4.2 Anti-diarrheal
4.3 Digestive enzymes
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4.4 Anti-cholinergic / anti spasmodic
4.5 Gallstone solubilizing agents
4.6 gastrointestinal stimulants
4.7 helicobacter pyloric eradicating agents
4.8 H2 receptor antagonist
4.9 proton pump inhibitors
4.10 Laxatives
05.) CENTRAL NERVE SYSTEM 114

5.1 Analgesics
5.2 Anorexiants
5.3 Anti-convulsions
5.4 Anti-emetics
5.5 Anti-vertigo
5.6 Anti-Parkinson agents
5.7 anxiolytic / Sedatives
5.8 Drugs for alcohol dependence
5.9 Muscle relaxants
5.10 Choline esterase inhibiters
06.) OPTHALMIC MEDICATION 144
07.) CHEMOTHERAPY DRUGS 147
08.) ANESTHETIC DRUGS 149
09.) DRUGA USED IN GYN AND OBS 151
10.) VITAMINS 153
11.) VACCINES 154
12.) HORMONE THERAPY 155

( DRUGS USE FOR ENDOCRINE SYSTEM)
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INTRODUCTION
Pharmacology may be define as the study of drugs and their effects on life processes. It is
concerned with the processes that determine the concentration of drugs in body fluids and
tissues over time , including drug absorption, distribution, metabolism and excretion.
This includes pharmacological name , trade name , indications , action , contraindication ,

caution , dosages , preparation , side effects , nursing implications and special notes about
drugs.
Drug study will advance and the therapeutic armory of the nurses and doctors be enlarge. The
somewhat knowledge of drugs can be improve among this book.
3
01) CARDIO VASCULAR SYSTEM
1.1 ANTICOAGULANTS
Reduces expansion of already existing clot by inhibitors fibrin formation but dissolve
it.
Examples:-
(01)Warfarin.
 Pharmacological name
Warfarin
 trade name
Coumadin
 indications
 deep vein thrombosis
 pulmonary embolism
 prevention of stroke in atrial fibrillation
 prosthetic heart valves
 inherited thrombophilia
 Action
 Inhibit vitamin k
 Leading to inhibition of factor 2, 7, 9, 10
 Indirect anticoagulation action
 Contraindication
 Large esophageal varies
 Decompensated liver, kidney disease
 Risk of thromboembolism
 Uncontrolled bleeding
 Action ulcer disease
 Cautions
Do not use late pregnancy
 Dosages
Start to 5mg per day
4
 Preparetion
Various colors
 Side effects
 Bleeding (GIT AND GUT)
 Terotogenic
 Nursing implications
 Administration medication at same time each day.
 Medication requires 3-5 days to reach effective level.
 Usually begun while patient is on Heparin.
 Special notes
 Overdose – reversed by vitamin K infusion.
(02) Heparin
Heparin
 Trade name
Pocin
 Indications
 Prevent blood clot in veins, arteries or lungs.
 Used before surgery to reduce risk of blood clot.
 Action
 Stimulate naturally occurring anti co anti-co thrombin 2
 Inhibit activated factors
 Factor 10 inhibition of low doses.
 Contraindications
 Severe hypertension
 Severe liver disease
 Peptic ulcer disease
 Hemophilia
 Hypersensitivity to Heparin
 Cautions
 Bleeding risk
5
 Dosages
5000 units subcutaneous 8-12 hours
7500 units subcutaneous 12 hours
 Preparation
Commercially from bovine porcine gut
 Side effects
 Bleeding
 Thrombocytopenia
 Hypersensitivity
 Alopecia
 Administration parenteral.
 Do not inject intra muscular only intra venous or deep subcutaneous.
 Special note
 Adverse effect -hemorrhage
 Antidote- protamine sulfate
(03) Enoxaparin
Enoxaparin sodium
 Trade name
Lovenox
 Indications
 Deep vein thrombosis
 Pulmonary embolism
 Acute coronary syndrome
 Heart attacks
 Action
 Enoxaparin bind to and potentiates anti-thrombin to from a complete that
irreversibly inactivates clotting factor 10a.
 Active major bleeding.
6
 Thrombocytopenia with antiplatelet antibody in presence of enoxaparin.
 Hypersensitivity.
 Cautions
 Patient with prostatic heart valves.
 Patient with renal impairment.
 Risk of bleeding may increase in women more than 45 Kg.
 Dosages
 Multi dose – 100 mg/dl
 Prefilled syringe- 30mg/ 0.3ml
40mg/ 0.4ml
 Preparation
 The injection is specially prepared from Enoxaparin sodium, vitamin C,
L.cysteine and water for injection.
 Side effects
 Bleeding, anemia, ecchymosis.
 Elevation in serum aminotransferase
 In people undergoing abdominal or colorectal surgery
 Enoxaparin is given by injection under the skin as direct by doctor. Usually
one or two day in the abdomen
 Do not inject in to a muscle.
 Special note
 Do not share this medication with others.
1.2 ANTIPLATELET
One or more of these drugs decrease ability of blood clot to form by interfering the
platelet activation process in primary hemostasis. Antiplatelet drugs can reversible or
irreversibly inhibition the process involve in platelet activation resulting in decreases
tendency of platelet of adhere to non another and to damaged blood vessels’
endothelium.
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Examples:-
(01).Clopidogrel
Clopidogrel
 Tread name
Clomep 75
 Indications
 Recent myocardia infraction
 Recent stroke
 Established peripheral arterial disease
 Action
 Selectively inhibits the binding of ADP to it’s platelet receptors and the
subsequent ADP activation of glycoprotein GP 2b/ 2a complex. Inhibiting
platelets activation.
 Do not dive to patient’s glucose 6-po4 dehydrogenase deficiency.
 Pregnancy.
 Severe hepatic diseases.
 Cautions
 Risk of increased bleeding from surgery or other pathological condition
(particularly GI and intraocular)
 Dosages
 75mg/day
 Preparation
 Film coated tablets
 Side effects
 Diarrhea
 Skin rashes
 Less risk of GI bleeding
8
 A decision should be made whether to discontinue nursing or to
discontinue the drugs, taking in to account the importance of drug to the
nursing woman.
(02).Aspirin
Aspirin
 Trade name
ecosprin
 Indications
 Ischemic heart disease
 Prevent arterial myocardial infarction thrombus
 Action
 As irreversibly inhibit cyclooxygenase (COX1) enzyme in platelet.
 Inhibit synthesis of thromboxane as (platelet aggregation).
 Aspirin inhibit PGI2 (prostacyclin) its act by reducing the platelet activities.
 Hypersensitivity to any NSAID.
 Severe hepatic disease.
 Acute peptic ulcer disease.
 Cautions
 Patient in asthma, nasal polyps
 Gastrointestinal ulceration
 Bronchospasm in hypertensive patient
 Dosages
 Low dose in use daily 75mg.
 Side effects
 Gastritis
 Tinnitus
 Intestinal nephritis
 Anaphylaxis
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 It should be avoided during fever or viral infection in children and
adolescents
(03).Prasugrel
Prasugrel
 Trade name
Effient
 Indications
 Stent thrombosis
 Percutaneous coronary intervention
 Action
 Used to prevent the formation of blood clot. it is a platelet inhibitors and
irreversible antagonist of P2Y12 ADP receptors.
 Patient with active pathological bleeding such as peptic ulcer or a history
of transient ischemic attack or stroke.
 Cautions
 Pregnancy
 Lactation
 Dosages
 10mg/day as a single loading dose.
 Preparation
 Has one chiral atom. It is use in racemic from as the hydrochloride salt,
which is a white powder.
 Side effects
 Unusual bleeding such as nasal bleeding, bleeding gums or any bleeding
that will not stop
 Pale skin, fever
 Jaundice
 Virginal bleeding
10
 Careful monitor for and immediately report s and s of gastrointestinal
bleeding.
 Evaluate patient with unexplained fever or infection for myelotoxicity.
1.3 ACE INHIBITORS

Angiotensin converting enzyme inhibiters are medication that show the activity of
enzyme ACE, which decreases the production of angiotensin 2. As a result, blood
vessels enlarge or dilated and blood pressure is reduced.
EXAMPLES
(01).Enalapril
 Enalapril
 Trade name
 Cvosotea
 Indications
 Hypertension
 Heart failure
 Diabetic nephropathy
 Prophylaxis of cardiovascular events
 Action
 Angiotensinogen -- Renin -- angiotensin 1
 ANGIOTENSIN 1---- ACE - angiotensin 2

 ACE also breaks down bradykinin. Therefore ACE inhibitors, by blocking the
breakdown of bradikinin and increased the bradikinin level.
 Hypersensitivity to ACE inhibitors.
 Pregnancy
 Cautions
11
 First dose may cause hypotension.
 Peripheral vascular disease.
 Renovasculer disease.
 Breast feeding.
 Dosages
 Oral adults dose 2.5-5mg
 Two times a day
 Preparation
 Tablets
 Side effects
 Dizziness
 Fainting
 Rashes
 Pruritus
 Hyperkalemia
 Usual maintenance dose is 25mg two three times daily and dose should
not normally exceed 50mg three times daily.
(02).captopril
 captopril
 Trade name
 Copoten
 Indications
 Hypertension
 Heart failure
 Action
12
 Pregnancy
 Cautions
 Breast feeding.
 Dosages
 Oral adults dose 2.5-12.5mg
 Two times a day
 Preparation
 Tablets
 Side effects
 Dizziness
 Fainting
 Rashes
 Pruritus
 Hyperkalemia
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(03).Ramipril
 Ramipril
 Trade name
 Altacs
 Indications
 Hypertension
 Heart failure
 Action

 Pregnancy
 Cautions
 Breast feeding.
 Dosages
 Oral adults dose 2.5-5mg
 Two times a day
 Preparation
 Tablets
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 Side effects
 Dizziness
 Fainting
 Rashes
 Pruritus
 Hyperkalemia
1.4 BETA BLOCKERS
Beta blockers also called beta-adrenergic blocking agent, treat a variety of conditions
such as high blood pressure and migraines.
Examples:-
(01).propanalol
 propanalol
 Trade name
 inderal
 Indications
 Hypertension
 Angina
 Myocardial infarction
 Arrhythmia
 Heart failure
 Thyrotoxicosis
 Action
 Block beta 1 and beta 2 receptors. Block cardiac beta 1 receptors and low
cardiac output.
 Asthma.
 Chronic obstructive pulmonary disease.
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 Cautions
 Unstable heart failure
 Peripheral vascular disease
 Diabetes
 Dosages
 Propanalol 40mg
 Preparation
 Tablets
 Side effects
 Bronchospasm
 Reduce sympathetic out flow
 Tiredness and fatigue
 Hypoglycemia
 Measure patient’s apical and radial pulse. If patient has diabetic monitor
his blood glucose level. Monitor fluid balance.
(02).Atenalol
 Atenalol
 Trade name
 Tenomin
 Indications
 Hypertension
 Angina
 Arrhythmia
 Heart failure
 Thyrotoxicosis
 Action
cardiac output.
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 Asthma.
 Cautions
 Diabetes
 Dosages
 Atenalol 25mg
 Preparation
 Tablets
 Side effects
 Bronchospasm
 Hypoglycemia
(03).Carvedilol
 Carvedilol
 Trade name
 Coreg
 Indications
 Hypertension
 Angina
 Arrhythmia
 Heart failure
 Thyrotoxicosis
17
 Action
cardiac output.
 Asthma.
 Cautions
 Diabetes
 Dosages
 Carvedilol 3.125mg,6.25mg,12.5mg
 Preparation
 Tablets
 Side effects
 Bronchospasm
 Hypoglycemia
1.5 CALCIUM CHANNAL BLOCKERS

Calcium channel blockers from entering cell of the heart and blood vessel walls,
resulting in lower blood pressure.
EXAMPLES:-
(01).Verapamil
 Verapamil
 Trade name
 Various
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 Indications
 Supra ventricular arrhythmias
 Angina
 Hypertension
 Action
 Inhibition of influx of calcium through slow channels in the vascular
smooth muscles and myocardial tissue. This result in systemic and
coronary artery vasodilation decreased myocardial contraction.
 Hypotension
 Bradycardia
 AV/SA block
 Cardiogenic shock
 Cautions
 First degree AV block
 Acute phase of myocardial infarction
 Hepatic impairment
 Dose
 Verapamil 40mg
 Preparation
 Tablets
 Intravenous injection
 Side effects
 Constipation
 Fatigue
 Ankle edema
 Myalgia
 Arthralgia
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 Nursing implication
 Monitor blood pressure for therapeutic effectiveness. Blood pressure
reduction is greatest after peak levels of verapamil are achieved 6-9 hours
following oral deses.
(02).Amlodipin
 Amlodipine
 Trade name
 Norvasc
 Indications
 Hypertension
 Angina
 Arrhythmias
 Action
 Hypotension
 Bradycardia
 AV/SA block
 Cautions
 First degree AV block
 Acute phase of myocardial infarction
 Patient taking beta blockers
 Dosages
 5mg/ once daily
 Preparation
 Tablets 2.5mg 5mg
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 Side effects
 Constipation
 Fatigue
 Ankle edema
 Myalgia
 Arthralgia
 Special note
 Avoid drinking large amounts of grape fruit juice or eating a lot of grape
fruit while you are taking amlodipine.
(03).Diltiazem
 Diltiazem
 Trade name
 Cardizem
 Indications
 Angina and hypertension
 Action
 Bradycardia
 Left ventricular failure
 AV block
 Pregnancy
 Lactation
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 Cautions
 Hepatic and renal impairment
 Heart failure
 Bradycardia first degree
 Dosage
 Diltiazem hydrochloride 60mg, 90mg
 Preparation
 Tablets
 Side effects
 Constipation
 Fatigue
 Ankle edema
 Myalgia
 Arthralgia
1.6 CHOLESTEROL LOWERING DDRUGS

Help to control elevated level of different form of lipids in patient with
hyperlipidemia. While one group of drugs statin, resins and fibrates.
EXAMPLES:-
(01).Atovastatin (statin)
 Atorvastatin
 Trade name
 Lopitor
 Indications
 Hyperlipidaemias
22
 Action
 The statins competitively inhibit 3-hydrox-3-methylglutaryl coenzyme A
(HMG Co A) reductase .
 An enzyme involved in cholesterol synthesis, especially in the liver.
 Cautions
 With history of liver disease.
 With a higher alcohol intake.
 Dosages
 20mg
 Preparation
 Tablets
 Side effects
 Flatulence
 Myalgia
 Myopathy
 Myositis
 Head ache
 Paresthesia
 Administer as a single dose any time of day without regard to food.
Swallow tablet whole, do not crush, brake, dissolve or chew.
 Special note
 If taking bile acid sequestrates, administer atorvastatin at least two hours
before or at least nine hours after.
(02).fenofibrate (Fibrates)
 Fenofibrate
 Trade name
 Fenoglide
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 Indications
 Hyperlipidemia
 Action
 Act mainly by decreasing serum triglycerides. They have variable effects on
LDL cholesterol.
 Gall bladder disease
 Photosensitivity
 Severe hepatic impairment
 Pregnancy
 lactation
 Cautions
 Correct hypothyroidism
 Renal impairment
 Dosages
 160mg/once daily
 Preparation
 White color tablets.
 Side effects
 Gastrointestinal disturbances
 Anorexia
 Weight gain
 Dizziness
 Head ache
 Drowsiness
 Assess for muscle pain, tenderness or weakness and if present, monitor
CPK level, withdraw drug with marked elevators of CPK or if myopathy is
suspected.
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 Special note
 Done liver function test every three months for first year.
(03).Colestryramine (resin)
 Colestryramine
 Trade name
 Questran
 Indications
 Hypercholesterolemia
 Action
 Binding bile acids, preventing their reabsorption
 Biliary cirrhosis
 Renal diseases
 Pregnancy
 Gastrointestinal obstructions
 Hemorrhoids
 Cautions
 Interfere with the absorption of fat-soluble vitamin K.
 Dosages
 Typical dose is 4-8g once or twice daily
 Maximum dose is 24g/dl
 Preparation
 Tablets
 Side effects
 Constipation
 Diarrhea
 Nausea
 Vomiting
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 Gastrointestinal obstruction
 Hypertriglyceridemia
 Monitor therapeutic effect serum cholesterol level are reduce 24-48 hours
after treatment start and may continue to decline year.
1.7 DIGITALIS PREPERATION

Digitalis is used to treat congestive heart failure and heat rhythm problems.it can
reduce blood flow throughout body and reduce swelling in hand and ankles.
EXAMPLE:-
(01).Digoxin
 Digoxin
 Trade name
 Lonoxin
 Indication
 Arterial fibrillation arterial flutter heart failure
 Action
 Reduce blood flow throughout body and reduce swelling in hand and
ankles.
 Patient with ventricular fibrillation hypersensitivity to digoxin
 Cautions
 Elderly patients
 Bradycardia
 AV block
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 Dose
 Tablets 0.125mg
 Preparation
 Tablets-yellow tablets
 Injections
 Side effects
 Breast enlargement
 Loss of appetite
 Nausea
 Confusion
 Irregular heart beat
 Advice patient that digoxin is used to treat heart failure and heart
arrhythmias.
 Instruct patient to take this medicine as directed
 Take apical pulse for full minute, noting rate rhythm and quality before
administering drugs.
1.8 VASODILATORS
Vasodilators are medication that open (dilate) blood vessels. They affect the muscles
in the wall of the arteries and veins, preventing the muscles form tightening and the
walls from narrowing.
EAXAMPLES:-
(01).Nitroprussid
 Nitroprussid
 Trade name
 Nipride
 Indications
 Lower blood pressure
 Heart failure
27
 Action
 Sodium nitroprusside is relaxation of vascular smooth muscle and
consequent dilation of peripheral arteries and veins.
 Aortic coarctation
 Arteriovenous shunting
 Cautions
 Anemia
 Hyponatremia
 Hypotension
 Dosages
 10-15 mcg/min
 Preparation
 Intravenous injections
 Side effects
 Low blood pressure
 Cyanide toxicity
 Mid skin rashes
 Mid stomach pain or nausea
 Administered by continuous intravenous infusion.
 Special notes
 Not suitable for direct injection.
(02).Sildenafil
 Sildenafil
 Trade name
 Viagra
 Revatio
28
 Indications
 Erectile dysfunction
 Pulmonary arterial hypertension
 Action
 Act by inhibiting (GMP-specific phosphodiesterase type 5, an enzyme that
promotes degradation of GMP which regulates blood flow in the penis.
 Hypersensitivity to sildernafil.
 cautions
 smokers
 hepatic impairment
 hypertension
 hypovolemia
 dosages
 recommended dose 50mg
 maximum recommended dose of 100mg or decreased to 25mg
 preparation
 tablets
 side effects
 headache
 heart burn
 hearing loss
 nursing implications
 Monitor carefully for and immediately report s and s of cardiac distress.
 Special note
 Should not be taken by people who take nitrates such as nitroglycerin.
(03).Tadalafil
 Tadalafil
 Trade name
 Cialis
29
 Indications
 Pulmonary arterial hypertension.
 Action
 Tadalafil is relaxation of vascular smooth muscle and consequent dilation
of peripheral arteries and veins.
 Heart diseases
 Lactase deficiency
 Lactose intolerance
 Cautions
 Smokers
 Dosages
 Tablets 2.5mg, 5mg, 10mg and 20mg
 Pulmonary is 40mg (two 20mg tablets)
 Once daily
 Preparations
 Tablets –yellow
 Film-coated and almond shape.
 Side effects
 Headache
 Stomach discomfort or pain
 Muscle ache
 Flushing or stuffy or runny nose
 nursing implications
 Monitor carefully for and immediately reports and s of cardiac distress
1.9 INOTROPES
Inotropes agents or inotropes are medicines that change the force of heart’s contractions.
There are two kinds of inotropes, positive inotropes and negative intropes.
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(01).Digoxin
 Digoxin
 Trade name
 Lonoxin
 Indication
 Arterial fibrillation arterial flutter heart failure
 Action
 Reduce blood flow throughout body and reduce swelling in hand and
ankles.
 Patient with ventricular fibrillation hypersensitivity to digoxin
 Cautions
 Bradycardia
 AV block
 Dose
 Tablets 0.125mg
 Preparation
 Tablets-yellow tablets
 Injections
 Side effects
 Breast enlargement
 Nausea
 Confusion
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 Advice patient that digoxin is used to treat heart failure and heart
arrhythmias.
 Instruct patient to take this medicine as directed
 Take apical pulse for full minute, noting rate rhythm and quality before
administering drugs.
(02).Dopamin
 Dopamin
 Trade name
 Dopastent
 Indications
 To correct hemodynamic imbalance in shock syndrome due to myocardia
infarction, trauma, hepatic shock, open heart surgery
 Action
 Major cardiovascular effects products by direct action on alpha and beat
adrenergic receptors.
 Pregnancy and lactation
 Tachyarrhythmia
 cautions
 patient with history of vascular disease
 Diabetic endarteritis.
 Dosages
 160mg/dl
 40mg/dl
 80mg/dl
 Preparation
 Injections
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 Side effects
 Chest pain
 Painful or difficult urination
 Weak or shallow breathing
 Monitor blood pressure, pulse, peripheral pulse and urinary output at intervals
prescribe by physician.
(03).Amiodarone
 Amiodarone
 Trade name
 cordarone
 Indications
 Irregular heart rate
 Action
 Amiodarone is prolongs phase three of cardiac action potential the
repolarization phase where there is normally decreased calcium permeability
and increased potassium permeability.
 Pregnancy
 Sinus nodal
 Bradycardia
 Cautions
 Recent myocardial infarction
 Dosages
 Oral 800-1600mg
 Day for one to three weeks
 Intravenous over the first 24 hours
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 Preparation
 Tablets and injections
 Side effects
 Feeling tired
 Tremor
 Nausea
 Constipation
 Monitor blood pressure carefully during infusion and slow the infusion if
significant hypotension occurs; bradycardia.
1.10 ANTI-ARRHYTHMIC DRUGS

An anti-arrhythmia describe an irregular heartbeat, the heat may beat too fast
(tachycardia) too slowly (bradycardia). Arrhythmias occur when the electrical signals the
heart that co-ordinate heat beats are not working properly treatments for this include
beta blockers, potassium channel blockers, Na channel blockers.
EXAMPLES:-
(01).Amiodarone
 Pharmacological nameV
 Amiodarone
 Trade name
 cordarone
 Indications
 Irregular heart rate
 Action
 Amiodarone is prolongs phase three of cardiac action potential the
repolarization phase where there is normally decreased calcium permeability
and increased potassium permeability.
 Pregnancy
 Sinus nodal
 Bradycardia
34
 Cautions
 Recent myocardial infarction
 Dosages
 Oral 800-1600mg
 Day for one to three weeks
 Intravenous over the first 24 hours
 Preparation
 Tablets and injections
 Side effects
 Feeling tired
 Tremor
 Nausea
 Constipation
 Monitor blood pressure carefully during infusion and slow the infusion if
significant hypotension occurs; bradycardia.
(02).propanalol
 propanalol
 Trade name
 inderal
 Indications
 Hypertension
 Angina
 Arrhythmia
 Heart failure
 Thyrotoxicosis
35
 Action
cardiac output.
 Asthma.
 Cautions
 Diabetes
 Dosages
 Propanalol 40mg
 Preparation
 Tablets
 Side effects
 Bronchospasm
 Hypoglycemia
(03).Lidocain
 Lidocain
 Trade name
 Xylocaine
 Indications
 Acute myocardial infarction
 Cardiac surgery
 Cardiac catheterization
36
 Action
 Suppressing automatically in his-purkinje system and elevating electrical
stimulation threshold of ventricle during diastole.
 Bradycardia
 Hypovolemia
 Dosages
 300mg/3ml
 Auto-injection 0.2%, 0.4%
 L.A. 0.5%, 1%
 Topical :- oilmen, 0.5%, 0.4% cream
 Preparation
 Auto-injection
 Local anesthesia
 Solution
 Oilmen
 Gel
 Spray
 Side effect
 High blood pressure
 Swelling or redness of skin
 Confusion
 head ache
 Stop infusion immediately if ECG indicates excessive cardiac depression.
 Monitor blood pressure and ECG constantly
37
02) URINARY SYSTEM
2.1 ANTIBIOTIC
A drug used to treat bacterial infection. Antibiotic have no effect on viral infection.
Originally an antibiotic was a substance produced by one microorganism.
EXAMPLES:-
(01).Penicillin
 Penicillin G and V
 Trade name
 Bicillin L-A
 Pentids
 Indications
 Throat infection
 Otitis media
 Endocarditis
 Meningococcal disease
 Pneumonia
 Anthrax
 Prophylaxis in limb amputation
 Action
 Kill the microorganisms when used at therapeutic dose.
 The synthesis of cell wall of bacteria is completely depended upon an
enzyme name as Tran’s peptidase.
 Penicillin hypersensitivity
 cautions
 history of allergy
 false positive urinary glucose
 renal impairment
38
 Dosages
 1.2g vial
 Preparation
 Injections
 Power for reconstitution
 Penicillin G- injections
 Penicillin V- oral
 Side effects
 Hypersensitivity reactions including urticarial
 Fever
 Joint pain
 Rashes
 Angioedema
 Anaphylaxis
 Obtain an exact history of patient’s previous exposure and sensitivity to
penicillin and cephalosporin and other allergy reaction of any kind to
treatment with penicillin
 Special note
 Do not breast feed while taking this drug without consulting physianan.
(02).Ampicillin
 Ampicillin
 Trade name
 Principen
 Action
 A broad spectrum semisynthetic ampicillin is highly bactericidal even at
low concentration, but is inactivated by penicillinase.
 Penicillin hypersensitivity
39
 Cautions
 History of allergy
 Dosages
 500mg vials
 250mg, 500mg ampules
 Preparation
 Injections
 Powder for reconstitution
 Side effects
 Nausea
 Vomiting
 Diarrhea
 Rashes
 Determine previous hypersensitivity reactions to penicillin cephalosporin
and other allergens prion to therapy.
 Special notes
 Notify physician is no improvement is noted with a few days after theory is
started.
(03).Metronidazole
 Metronidazole
 Trade name
 Flagyl
 Indications
 Trichornonal vaginitis bacteria.
 Entomoeba histolytica
 Giardia lamblia infections
40
 Action
 Metronidazole is selective anaerobic bacteria due to their ability to it’s
active form. This reduce metronidazole then covalently binds to DNA,
inhibiting bacterial nucleic acid synthesis and resulting in bacterial cell
death.
 Active central nerve disease.
 First trimester of pregnancy
 Lactation
 Cautions
 Pregnancy
 Breast feeding
 Dosages
 Tablets- 500mg, 250mg
 Capsules- 750mg
 Preparation
 Tablets
 Capsules
 Vials
 Lotions
 Side effects
 Drowsiness
 Dizziness
 Head ache
 Ataxia
 Darkling of urea
 Discontinue therapy immediately if symptoms of central nerve system
toxicity.
 Monitor epically of seizures and peripheral neuropathy.
41
2.2 DIURETICS
Diuretics are drugs that include sate of increased urine flow.
Diuretics drugs are
 Thiazide
 Loop diuretics
 Potassium sparind diuretics
 Osmotic diuretics
 Carbonic anhydrase inhibition
(01).Frusamide
 Fuesamide
 Trade name
 Lasix
 Indications
 Heart failure
 Hyperkalemia
 Hypercalcemia
 Action
 Inhibits calcium transport of Na, K, and 2CL in the luminal membrane in the
ascending limp of loop of henle. Therefore the reabsorption of these ions is
decreased.
 Hepatic coma
 Pregnancy
 Lactation
 History of hypersensitivity of furosemide or sulfonamides.
 Cautions
 Impaired renal function
 Infant
 Older adults
 Nephrotic syndrome
42
 Dosages
 20mg, 40mg, 80mg tablets
 10mg/ml injections.
 Preparation
 Tablets
 Injections
 Side effects
 Ototoxicity
 Hyperuricemia
 Hypertension
 Observe patient receiving parenteral drug carefully closely monitor blood
pressure and vital signs sudden death from cardiac arrest has been
reported.
 Special notes
 Oral or parenteral available.
(02).Hydrochloro thiazide
 HCT
 Trade name
 Apo-hydro
 Aquazide
 Indications
 Hypertension
 Heart failure
 edema
 diabetic insipidius
 hyperkalemia
 Action
 Inhibit reabsorption of Na, and Cl in the distal convoluted tubule this result
in water retention.
43
 Hypersensitivity to thiazides or other sulfonamides
 Pregnancy
 Lactation
 Cautions
 Diabetic mellitus
 Bronchial asthma
 Hepatic cirrhosis
 Renal dysfunction
 Dosages
 12.5mg ampules
 25mg, 50mg, and 100mg tablets
 50mg/ 5ml oral solution
 Preparation
 Capsules
 Tablets
 Oral solitions
 Side effects
 Hyponatremia
 Hyperuricemia
 Hypercalcemia
 Monitor for therapeutic effectiveness antihypertensive effects may be
noted in 3-4 days.
 Special notes
 Hypertension used for low dose
 Not dose related
44
(03).Spironolactone
 Spironolactone
 Trade name
 T
 Indications
 Prevent potassium loss
 Cirrhosis
 Heart failure
 Action
 Spironolactone is a synthetic steroid it antagonizes aldosterone at
intracellular cytoplasmic.
 Anuria
 Acute renal insufficiency
 Progressing impairment of kidney function
 Pregnancy
 Lactation
 Cautions
 Liver disease
 Dosages
 25mg, 50mg, 100mg, tablets.
 Preparation
 Tablets
 Side effects
 Nausea
 Vomiting
 Peptic ulcer
 Hyperkalemia
 Confusion
45
 Check blood pressure before initiation of therapy and at regular intervals
throughout therapy.
2.3 CARBONIC ANHYDRATE INHIBITORS

Carbonic anhydrates inhibitor reduce the activity of carbonic anhydrates an enzyme
responsible for catalyzing the reaction between CO2 and H2O in carbonic acid and then
bicarbonate. This reduces the reabsorption of bicarbonate excretion and mild increase
in sodium and potassium excretion. Generally the electrolyte effects of carbonic
anhydrates inhibitors are mild and they are typically not used for their duration
capacity.
EXAMPLES:-
(01).Acetazolamide
 Acetazolamide
 Trade name
 Diamax
 Indications
 Seizures
 Absence or petit mal
 Generalized ronic clonic (grand mal)
 Reduction of intraocular pressure in open angle glaucoma and secondary
glaucoma.
 Action
 Acetazolamide is unknown but through to involve inhibition of central
nerve system carbonic anhydrates, which regards abnormal paroxysmal
discharge from central nerve system nerves. Diuretics effect is due to
inhibition of carbonic anhydrate activity in proximal renal tubule,
preventing formation of carbonic acid.
46
 Hypersensitivity of sulfonamide and derivations, marked renal and hepatic
dysfunction. Addison’s disease.
 Hyponatremia
 Hypokalemia
 Cautions
 History of hypercalciuria
 Diabetes mellitus
 Gout
 Patients receiving digitalis
 Obstructive pulmonary disease
 Respiratory acidosis
 Dosages
 Tablets 125mg, 250mg
 Capsules 500mg
 Powder of injection 500mg
 Preparations
 Tablets
 Capsules
 Injections
 Side effects
 Dizziness
 Light headedness
 Dry mouth
 Drowsiness
 Changes in sense of taste
 Blurred vision
 Established baseline weight before initial therapy and weight daily
thereafter when used to treat edema.
 Monitor I and O especially when used with other diuretics.
47
 Special note
 Give at a rate of 500mg or fraction therefore over one minutes.
 Intravenous infusion give as a continuous infusion over four to eight hours.
(02).Methazolamide
 Methazolamide
 Trade name
 Niptazone
 Indications
 Used concomitantly with mitotic and osmotic agents
 Action
 Methazolamide is a potent inhibitor of carbonic anhydrate in the ciliary
processes of humor section, presumably by slowing the formation of
bicarbonate ions and subsequent reduction in sodium and fluid transport.
 Hypokalemia
 Hyponatromia
 Glaucoma due to severe peripheral anterior.
 Cautions
 Pregnancy
 Lactation
 Dosages
 25mg, 50mg tablets
 Two or three times daily.
 Preparation
 Tablets
 Side effects
 Hearing dysfunction
 Tinnitus
 Fatigue
48
 Malaise
 Taste alterations
 Nausea
 Vomiting
 Supervise ambulation in order adults, since drugs may cause vertigo.
 Assess patient ability to perform ADL since drug may cause fatigue and
lethargy.
(03).Dichophenamide
 Dichophenamide
 Trade name
 daranide
 indications
 Conjunction with a miotic and osmotic agent.
 Action
 No bacteriostatic sulfonamide derivative similar to acetazolamide except
that chloride excretion is increased, and this potential for significant
metabolic acidosis is less.
 Respiratory acidosis
 Reduce respiratory capacity
 Dosages
 50mg tablets
 Preparations
 Tablets
 Side effects
 Nausea, vomiting
49
 Drowsiness
 Confusion
 Thinking problems
 Altered sense of taste
 Supervise ambulation since drug may cause dizziness and ataxia; other
safety precautions may be warranted.
 Special notes
 Take drugs with meal to reduced gastric irritation.
 Store at room temperature.
2.4 CHOLINERGIC AGONIST
Preganglionic fibers terminating in the adrenal medulla, the autonomic ganglia (both
parasympathetic and sympathetic) and the postganglionic fibers of parasympathetic
division use acetylcholine as neurotransmitters.
EXAMPLES:-
(01)Acetylcholine
 Acetylecholine
 Trade name
 Cognex
 Indications
 Improvement of memory in mild to moderate Alzheimer’s detention
 Action
 Cholinesterase inhibition, presumably elevates acetylcholine in the
cerebral cortex by slowing degradation of acetylcholine release by
remaining intake neurons. Balance pathologic changes in neurons that
result in deficiency of acetylcholine in early stages of Alzheimer’s disease.
 Hypersensitivity of tacrine, patient who developed jaundice while taking
tacrine.
50
 Cautions
 Anesthesia, sick sinus rhythm bradycardia
 History of ulcer
 Gastro intestinal bleeding
 Abnormal liver function
 Urinary tract obstruction
 Patient with asthma
 Hypotension
 Dosages
 10, 20, 30 and 40mg capsules
 Preparation
 Capsules
 Side effects
 Slow heart rate
 Flushing
 Low blood pressure
 Breathing difficulty
 Sweating
 Monitor for clinical improvement (deride as a four point improvement in
Alzheimer’s scale cognitive subscale)
 Improvement has been observed after 1-4 weeks.
(02).Ambenonium chloride
 Ambenonium chloride
 Trade name
 mytelase
 indications
Indirect acting and a slowly reversible cholinesterase inhibitor approximately six
times more potent than neostigmine.
51
 Intestinal and urinary tract obstruction
 Patient receiving mecamylamine
 Safety during pregnancy and lactation is not establish.
 Cautions
 Epilepsy
 Bradycardia
 Cardiac arrhythmia
 Recent coronary occlusion
 Bronchial asthma
 Hyperthyroidism
 Vagotonia
 Dosages
 10mg tablets
 Preparations
 Tablets
 Side effects
 Sweating or urinating more than usual
 Drooling watery eyes
 Warmth or tingly feeling
 Nausea, vomiting, stomach pain
 Blurred vision
 Anxiety
 Therapeutic effects may not be apparent for several days after initiating of
therapy.
 Monitor vital signs during dosage adjustment period.
 Special notes
 Muscle weakness beginning three hours or more after drug administration
is probably due to under dosage or drug resistant.
52
(03).Albuterol
 Albuterol
 Trade name
 Proventil / proven
 Indications
 To relieve bronchospasm associated with acute or chronic asthma,
bronchitis or other reversible obstructive airway diseases. Also used to
prevent exercise- induced bronchospasm.
 Action
 Synthetic sympathomimetic amine and selective beta two adrenergic
agonist with long action.
 Act more prominently on beta receptors(particular smooth muscles of
bronchi, uterus, and vascular supply to skeletal muscles)
 Pregnancy (category C)
 Lactation
 Cautions
 Cardiovascular disease
 Hypertension
 Hyperthyroidism
 Dosages
 4mg, 8mg extended-release tablets
 2mg/5ml syrup
 200mcg capsules for inhalation
 0.083%, 0.5% solution for inhalation
 Preparation
 tablets
 capsules
 syrup
53
 side effects
 nervousness
 irritation in throat
 head ache
 nausea
 vomiting
 cough
 muscle bone or back pain
 Monitor therapeutic effectiveness which is indicated by significant
subjective improvement in pulmonary function within 50 or 90 minutes
after drugs administration.
 Special notes
 Do not breast feeding while taking this drug without consulting physician.
 Can be dizziness or vertigo take necessary precautions.
2.5 ANTI-CHOLINEERGIC DRUGS
Anti-cholinergic agent is a substance that block the neurotransmitters acetylcholine in

the control and the peripheral neurons system. These agents inhibit parasympathetic
nerve impulses by selectively blocking the bindings of the neurotransmitter
acetylcholine to its receptor in nerve cells.
EXAMPLES:-
(01).Diphenhydramine
 Diphenhydramine hydrochloride
 Trade name
 Banophen, Belix
54
 Indications
 Temporary symptomatic relief of various allergic conditions and to treat or
prevent motion sickness, vertigo and reactions to blood or plasma in
susceptible patient.
 Treatment of intractable insomnia.
 Actions
 H1- receptor antagonist and antihistamine with significant anti cholinergic
activity. High incident of drowsiness, but gastrointestinal side effects are
minor.
 Hypersensitivity to antihistamine of similar structure.
 Prostatic hypertrophy
 Gastrointestinal obstruction
 Pregnancy
 Lactation
 Cautions
 History of asthma
 Convulsive disorders
 Hyperthyroidism
 Hypertension
 Dosages
 20mg, 50mg,capsules, tablets
 6.25mg/5ml, 12.5mg/5ml syrup
 50mg/ml injections
 Preparations
 Tablets
 Capsules
 Syrup
 Injections
 Side effects
 Drowsiness
 Dizziness
55
 Headache
 Irritability
 Dry mouth
 Stomach upset
 Monitor cardiovascular states
 Especially with pre-existing cardiovascular diseases.
 Monitor for adverse effects especially in child and the older adults.
 Special notes
 Do not breast feed while taking drugs.
(02).Trihexyphenidyl
 Trihexyphenidyl hydrochloride
 Trade name
 artana, aparkane
 Indications
 Symptomatic treatment of all forms of Parkinsonism.
 Action
 Symptomatic tertiary amine anti-cholinergic agents similar to atropine.
Through to act by blocking excess of acetylcholine at certain cerebral
synaptic sites. Relaxes smooth muscle by direct effect and by atropine like
blocking action on the parasympathetic nervous system.
 Narrow angle glaucoma
 Safety during pregnancy (category c)
 lactation
 Cautions
 History of drug hypersensitivity
 Hypertension
 Cardiac disease
 Kidney or liver disorders
56
 Dosages
 5mg sustained release capsules
 2mg/ 5ml elixir
 Preparations
 Tablets
 capsules
 Side effects
 Dry mouth
 Drowsiness or dizziness
 Nervousness
 Decreases sweating
 contipation
 Monitor vital signs. Pulse is a particularly sensitive indicator of response to
drug.
 Report tachycardia, palpitation, paradoxical bradycardia or fall in blood
pressure.
(03).Biperden
 Biperden hydrochloride
 Trade name
 Akineton
 Indications
 Adjust in all forms of Parkinsonism, also used to control drug-induced

Parkinsonism associated with reserpine and phenothiazine therapy.
57
 Action
 Synthesis tertiary amine, ant muscarinic. In with other anti-parkinsonism

drugs has atropine-like (anticholinergic) action .Anti-parkinsonism activity
is through to be caused by reducing control excitatory action of
acetylcholine on cholinergic receptors in the extrapyramidal system.

 GI or GU obstruction
 Megucolon
 Safety during pregnancy
 lactation
 Cautions
 Older adults or debilitated patients

 Glaucoma
 Epilepsy
 Dosages
 2mg tablets
 5mg/ml injectins
 Preparations
 Tablets
 injections
 Side effects
 Dry mouth
 Blurred vision
 Drowsiness
 Dizziness
58
 Constipation
 nausea
 Monitor blood pressure, pulse after intravenous administration.

 Advice patient to make position changing.
 Slowly and in stage, particularly from recumbent to upright position
 Special notes
 Patient on prolonged therapy can developed tolerance; an increase in

dosage may be required.
2.6 ADRENERGIC ANTAGONIST

An adrenergic antagonist is a drug that inhibits the function of adrenergic receptors.
The first group of receptors, which are divided in to two groups. The first group of
receptors are the beta adrenergic receptors. Antagonist reduce or block the signals of
agonist. They can be drugs, which are added to the body for therapeutic reasons, or
endogenous ligands.
EXAMPLES:-
(01).Terbutalin
 Pharmacologic name
 Terbutalin sulfate
 Trade name
 Berthair
 Indications
 Orally or subcutaneous as a bronchodilators in bronchial asthma and for
reversible airway obstruction associated with bronchitis and emphysema.
 Action
 Synthetic adrenergic stimulation with selective beta-2 and negligible beta-
1 agonist activity.
 Exerts preferential effect on beta 2 receptors in bronchial smooth muscles,
inhibits histamine release from mast cells, and increasing ciliary mobility.
 Known hypersensitivity to sympathomimetic amines.
 Coronary artery disease
 Tachycardia with digitalis intoxication.
59
 Cautions
 Angina
 Stroke
 Hypertension
 Thyrotoxicosis
 History of seizures disorders.
 Dosages
 2.5mg,5mg tablets
 0.2mg aerosol
 Preparation
 Tablets
 Aerosol
 injections
 Side effects
 Tremors
 Nervousness
 Dizziness
 Headache
 drowsiness
 palpitation
 short of breathing
 Assess vital signs and before each dose
(02).epinephrine
 epinephrine
 Trade name
 Brenkaid mist
 Indications
 Temporally relief of bronchospasm
 Acute asthma attack
 Hypersensitivity and anaphylactic reaction
 Syncope due to heart block
 Action
 Naturally occurring catecholamine obtained from animal adrenal glands; also
prepared synthetically. Acts directly on both alpha and beta receptors.
 Increases systolic blood pressure but may decrease diastolic blood pressure.
 Hemorrhage
 Traumatic or cardiogenic shock
60
 Cardiac dilatation
 Cerebral arteriosclerosis
 Arrhythmias
 Cautions
 Older adult or debilitated patients prostatic hypertrophy
 prostatic hypertrophy
 diabetic mellitus
 hypertension
 tuberculosis
 Dosages
 1:100, 1:1000, 2.25% solution for inhalation
 0.35mg, 0.2mg spray
 Preparation
 Solution
 Spray
 injections
 Side effects
 Sweating
 Headache
 Weakness
 Shakiness
 paleness
 Monitor blood pressure, pulse respiratory and urinary output and observe
patient closely following intravenous administration.
 Special notes
 Inhalation epinephrine reduce bronchial secretion and thus may make
mucous plugs more difficult to dislodge.
 Tolerance has been observe with continuous or prolong infution
(03).Dobutamine
 dobutamine hydrochloride
 Trade name
 dobutex
 Indications
 Inotropic support in short treatment of adults with cardiac compensation due

to depress myocardial contractility resulting from either the organic heart
disease or from cardiac surgery.
61
 Action
 Produce inotropic effect by acting on beta receptors and primarily on

myocardial alpha adrenergic receptors Increases cardiac output and decrease
pulmonary pressure and total little or no effect on blood pressure.
 History of hypersensitivity to other sympathomimetic amines

 Ventricular tachycardia
 Pregnancy
 lactation
 Cautions
 Preexisting hypertension
 Arterial fibrillation
 Dosages
 12.5mg/ml injections
 Preparation
 injections
 Side effects
 nervousness
 nausea
 vomiting
 low platelet count
 Correct hypovolemia by administration of appropriate volume expenders
prior or initiation of therapy.
 Special notes
 Tolerance has been observe with continuous or prolong infution.
2.7 ANTI-DIURETIC HORMONES

A relatively small molecular that is released by the pituitary gland. An anti-diuretic that
helps fluid balance in an animal’s body by reducing urination. The major endogenous
anti-diuretic hormone (ADH)and oxytocinboth of those are also used exogenous as
medication in people whose bodies needs extra help with fluid balance via suppression
of diuretic.
62
EXAMPLES:-
(01).VASOPRESSIN
 Vasopressin
 Trade name
 pitressin
 Indications
 Antidiuretic to treat diabetes insipid to dispel gas shadows in abdominal
roentgenography.
 Post a preoperative abdominal distension.
 Polyuria due to ADH deficiency.
 Action
 Polypeptide hormonal extracted from animal posterior pituitaries .possesses
presser and anti-diuretic (ADH) properties, but is relatively free of oxytocic
properties. Procedure concentrated urine by increasing tubular reabsorption
of water (ADH activity) thus preserving up to 90% of water.
 Chronic hepatitis
 Ischemic heart disease
 Pregnancy (category x)
 Cautions
 Epilepsy
 Vascular disease
 Migraine
 Asthma
 Heart failure
 Kidney disease
 Angina pectoris
 Dosages
 20 pressor units/ml injection
 Preparation
 injections
 Side effects
 Rashes
 Urticarial
 Tremor
 Sweating
 Monitor infants and children closely. They are more susceptible to volume
disturbance than adult.
 Special notes
 Avoid concentrated fluids since these increase urine volume.
63
2.8 URINARY ALKALINE
Urine PH is used to classified urine as either a dilute acid or bass solution seven in the
point of neutrality on PH scale. The lower the PH, the greater the acidity of a solution.
The higher the PH, the greater the alkalinity. Secretion of an acid or alkaline urine by
the kidney is one of the most important mechanism the body uses to maintain a
constant body PH.
EXAMPLES:-
(01).Sodium bicarbonate
 Sodium bicarbonate
 Trade name
 Sodium bicarbonate
 Indications
 Systemic alkalinize to correct metabolic acidosis (as occurs in diabetic
mellitus, shock, cardiac arrest)
 To maintain urine acid crystallization associated with uricosuric agent
 To increase the solubility of barbiturate.
 Action
 Short acting, potent systemic antacid. Rapidly neutralized gastric acid to form
sodium chloride and water. Carbon dioxide and water after absorption of
sodium bicarbonate, plasma alkaline reverse is increased and excess sodium
and bicarbonate ions are excreted in urine, thus rendering urine less acid.
 Lactation
 Older adult patients
 Cautions
 Edema
 Sodium retaining disorders
 Dosages
 320mg,520mg,650mg tablets
 4.2%, 5%, 1.5%, 8.4% injections
 Preparation
 Tablets
 injections
 Side effects
 Gastrointestinal belching
 Renal calculi or crystals
 Impaired kidney function
 Electrolytic imbalance
 hypercalcemia
 Be aware that long term use of oral preparation with milk or calcium can
cause milk-alkaline syndrome; anorexia, nausea, vomiting head ache, mental
confusion
64
(02).calcium carbonate
 Calcium carbonate
 Trade name
 Caltrate, chooz
 Indications
 Relief transient symptoms of hyperacidity as in acid ingestion
o Heart burn
o Peptic esophagitis
o Hiatal hernia
 Action
 Rapid acting antacid with high neutralizing capacity and relatively prolong of
during of action. Decrease gastric acidity, there by inhibiting protolithic acid of
pepsin on gastric mucosa.
 Hyperkalemia
 Hypercalcemia
 Hyperparathyroidism
 Calcium loss due to immunization
 Cautions
 Decreased bowel motility
 The older adult
 Lactation
 Dosages
 125mg, 250mg, 650mg, 750mg 1.25g, 1.5g tablets
 Preparation
 tablets
 Side effects
 Constipation or laxative effect
 Acid rebound
 Hypecalcemia
 Polyuria
 Renal calculi
 Note number and consistency of stools. If constipation is a problem, physician
may prescribe alternate or combination therapy with a magnesium antacid or
advice patient to take a laxative or stool softener as necessary.
65
(03).Sodium lactate
 Trade name
 Caltrate, chooz
 Indications
 Relief transient symptoms of hyperacidity as in acid ingestion
o Heart burn
o Peptic esophagitis
o Hiatal hernia
 Action
 Rapid acting antacid with high neutralizing capacity and relatively prolong of
during of action. Decrease gastric acidity, there by inhibiting protolithic acid of
pepsin on gastric mucosa.
 Hyperkalemia
 Hypercalcemia
 Calcium loss due to immunization
 Cautions
 Decreased bowel motility
 The older adult
 Lactation
 Dosages
 125mg, 250mg, 650mg, 750mg 1.25g, 1.5g tablets
 Preparation
 tablets
 Side effects
 Constipation or laxative effect
 Acid rebound
 Hypecalcemia
 Polyuria
 Renal calculi
 Note number and consistency of stools. If constipation is a problem, physician
may prescribe alternate or combination therapy with a magnesium antacid or
advice patient to take a laxative or stool softener as necessary.
66
2.9 MEDICATION FOR URINARY INCONTINENT
There are certain types of urinary incontinent. If relaxes the bladder muscle and can
increase the amount of urine the bladder can hold. It might also increase the amount
to able to urinate at one time. Helping to empty the bladder more completely.
EXAMPLES:-
(01).Oxybutyine
 Oxybutynin chloride
 Trade name
 ditropan
 Indications
 To relieve symptoms associated with voiding in patient with uninhibited
neurogenic bladder and relief neurogenic bladder. Also has been used to
relieve pain of bladder spasm.
 Action
 Synthetic tertiary amine that exerts direct antispasmodic action and inhibits
muscarinic effects of acetylcholine on smooth muscle.
 Hypersensitivity of oxybutyine narrow angle glaucoma
 Myasthenia grans
 Partial or complete gastrointestinal obstruction
 Gastric retention
 Cautions
 Older adult
 Autonomic neuropathy hiatus hernia with relief esophagitis
 Hepatic or renal dysfunction
 Urinary retention
 Dosages
 5mg tablets
 5mg,10mg sustained release tablets
 5mg/5ml syrup
 3.9mg/dl transdermal patch
 Preparation
 Tablets
 Syrup
 patch
 Side effects
 Several allergic reactions including urticarial
 Skin rashes
 Suppression of lactation
 Decreased sweating
 Fever
 Drowsiness
 Dizziness
67
 Periodic in eruptions of therapy are recommended to determine patients
need for continued treatment.
 Special notes
 Do not driver or engage in potentially hazardous activities until response to
drug is known.
(02).Tolterodine
 Tolterodine tartrate
 Trade name
 Detrol
 Indications
 Overactive bladder (urinary frequency, urgency urge ineontinence)
 Action
 Selective muscarinic urinary bladder receptor antagonist.
 Gastric retention
 Hypersensitivity to tilterodine
 Uncontrolled narrow angle glaucoma
 Pregnancy (category C)
 Cautions
 Lactation
 Liver disease
 Obstructive gastrointestinal disease
 Obstructive uropathy
 Dosages
 2mg, 4mg sustain receptor antagonist
 Preparation
 tablets
 Side effects
 Back pain
 Fatigue
 Arthralgia
 Weight gain
 Head ache
 Paresthesia
 Vertigo
68
 Monitor intraocular pressure more frequency with glaucoma patients.
 Monitor vital signs carefully.
 Special notes
 Report blurred vision, sensitivity to
(03).Derifenacin
 Derifenacin hydro bromide
 Trade name
 enablex
 Indications
 Treatment of overactive bladder with symptoms of urgent urinary
incontinence , urgency and frequency
 Action
 Derifenacin is a competitive muscarinic receptor antagonist muscarinic
receptor play an important role in contractive of the urinary bladder smooth
muscle and stimulation of salivary secretion.
 Hypersensitivity to the drug
 Cautions
 Risk of urinary retention
 Clinically significant bladder out flow obstruction
 Decrease gastrointestinal mobility
 Severe constipation
 Ulcerative colitis
 Dosages
 7.5mg and 15mg extended release tablets
 Preparation
 tablets
 Side effects
 Urinary tract infection
 Headache
 Asthenia
 Dizziness
 Constipation
 Dry mouth
 dyspepsia
 Monitor for adverse effect of concurrent use of drugs that have a narrow
therapeutic window and are metabolized by CYP26G.
69
2.10 MISCELLANEOUS RENAL DRUGS
These drugs are used to treat disorders of urinary tract.
EXAMPLES:-
(01).Temsirilimus
 sirolimus
 Trade name
 Rapamune
 Indications
 Prophylaxis of kidney transplant rejection
 Action
 Macrolide antibiotic structurally related to tacrolimus with
immunosuppressant activity. Active in reducing a transplant rejection by
inhibiting the response of helper T- lymphocyte.
 Lung or liver transplant patient
 Soya lecithin hypersensitivity
 Pregnancy
 lactation
 Cautions
 Hypersensitivity to or concurrent administration
 Impaired renal function
 Dialysis patient
 Transplant patient; viral or bacterial infection
 Dosages
 1mg/ml oral solution
 1mg tablets
 Preparation
 tablets
 solutions
 Side effects
 Asthenia
 Back pain
 Chest pain
 Fever
 Arthralgia
 Generalized edema; infection
 insomnia
 Monitor for S and S of graft rejection
 Special notes
 Do not breast feeding while taking this drug.
70
03) RESPIRATORY SYSTEM
3.1 ANTIHISTAMINE
Antihistamine reduce or block histamine, so they stop allergy symptoms. These
medicines work well to relieve symptoms of different types of allergies, including
seasonal (hay fever), indoor and food allergies. But they cannot relieve every
symptoms.
EXAMPLES:-
(01).Piriton
 Chlirpheniramine
 Trade name
 piriton
 Indications
 Allergic conditions to prevent transfusion and drug reactions in susceptible
patient.
 Action
 Antihistamine that complete with histamine for H1-receptor sites on effector
cells, these it prevents histamine action that promotes capillary permeability
and edema formation and constriction action on respiratory, gastrointestinal
and vascular smooth muscle.
 Obstructive prostatic hypertrophy
 Other bladder neck obstruction
 Pregnancy (category B in first and two trimester)
 Cautions
 Convulsive disorders
 Increase intraocular pressure
 Hyperthyroidism
 hypertension
 Dosages
 8mg, 12mg sustained-release tablets
 2mg/5ml syrup
 Preparation
 Tablets
 Syrup
71
 Side effects
 Sensation of chest tightness
 Tachycardia
 Mild hypotension
 Epigastria distress
 Anorexia
 Nausea, vomiting
 Monitor for central nerve system depression and sedation, especially when
chlopenaramine is given in combination with other central nerve depression.
 Special notes
 Avoid driving a car other potential hazardous activities until drug response
has been determined.
(02).Cetrazil
 Cetirizine
 Trade name
 Reactine
 Indications
 Seasonal and perennial allergic inhibits and chronic idiopathic urticarial.
 Action
 Cetrazil is a potent H1-receptor antagonist and thus antihistamine without
significant anticholinergic or central nerve system activity. Low lipophilicity
combined with its H2-selectervity probably accounts for its relative lack of
anticholinergic and sedative properties.
 Hypersensitivity to H2-reseptor antihistamine
 Lactation
 Cautions
 Moderate to several renal impairment
 Pregnancy
 children
 Dosages
 5mg, 10mg chewable tablets
 5mg/5ml syrup
 Preparation
 Tablets
 syrup
72
 Side effects
 Constipation
 Diarrhea
 Dry mouth
 Drowsiness
 Sedation
 Head ache
 depression
 Monitor for drug interactions. As the drug is highly protein bound, the
potential for interactions with other protein-bound drugs exists
 Special notes
 Do not used in combination with OTC antihistamine
(03).Carbinoxamide
 Dexmedetomidine hydrochloride
 Trade name
 precedex
 Indications
 Seasonal and perennial allergic inhibits and chronic idiopathic urticarial
 Action
 A selective alpha 2-adrenergic agonist with sedative properties.
Dexmedetomidine stimulates alpha 2-adrenergic receptors. sympathetic
vasomotor center of the brain
 Hypersensitivity to dexedetomidine labor and delivery including cesarean
section.
 Cautions
 Patient with arrhythmias or cardiovascular renal or hepatic insufficient; sign
of light anesthesia.
 Pregnancy
 lactation
 Dosages
 100mcg/ml in 2ml ampules or vials
 Preparation
 Ampules
 vials
 Side effects
 Pain; infection
 Hypotension
 Bradycardia
73
 Hypoxia
 Pleural effusion
 oliguria
 Monitor for hypertension during loading dose dose reduce of loading dose
may be required.
3.2 ANTIASTHMATICS
Inhaled corticosteroid. These anti-inflammatory drugs are the most effective and
commonly use long- term control medications for asthma.
EXAMPLES:-
(01).Albuterol
 Albuterol
 Trade name
 Accuneb
 Indications
 To relieve bronchospasm associated with acute or chronic asthma.
 Bronchitis
 Obstructive airway diseases
 Action
 Synthetic sympathomimetic amine and moderately selective beta 2
adrenergic agonist with comparatively long action. Acts more permeability on
beta 2 receptors than on beta 1 receptors.
 Pregnancy
Lactation
 Cautions
 Hypertension
 Hyperthyroidism
 Dosages
 2mg, 4mg, tablets
 4mg, 8mg extended- release tablets
 2mg/5ml syrup
 200mcg capsules for inhalation
 0.083%,0.5% solution for inhalation
74
 Preparation
 Tablets
 Solution
 Syrup
 Capsules
 Side effects
 Tremor
 Nervousness
 Convulsions
 Weakness
 Headache
 Hallucinations
 Monitor therapeutic effectiveness which is indicated by significant subjective
improvement in pulmonary function within 60-90 minutes after drug
administration.
 Special notes
 Preview direction for correct use of medication and inhalation.
(02).Predinisone
 Predinisone
 Trade name
 Prelone
 Indications
 Principally as an anti-inflammatory and immune suppressant agents.
 Action
 An along of hydrocortisone with 3-5 times greater potency. Mineralocorticoid
properties are minimal and potential as well as potassium loss is reduced.
 Safety during pregnancy (category C)
 Lactation
 Cautions
 Hyperthyroidism
 Dosages
 5mg tablets
 5mg/5ml, 15mg/5ml syrup
 O.12%, 0.125%, 1% ophthalmic suspension
 Preparation
 Tablets
 syrup
75
 Side effects
 Adverse effects on growth and development of the individual and on sperm
 Monitor therapeutic effectiveness which is indicated by significant subjective
improvement in pulmonary function within 60-90 minutes after drug
administration.
(03).Isoprenalin
 Isoprotenenol hydrochloride
 Trade name
 Isuprel
 Indications
 Bronchodilator in treatment of bronchial asthma and reversible
bronchospasm induced by anesthesia
 Cardiac stimulant in cardiac arrest
 Carotid sinus hypersensitivity
 Action
 Synthetic sympathomimetic amine. Acts direct on beta 1-adrenergic receptors
with little or no effect on alpha adrenergic drug induced stimulation of beta1-
adrenergic receptors result in increased cardiac output and cardiac work by
increasing strength of contraction of the hear.
 Preexisting cardiac arrhythmias
 Tachycardia
 Cautions
 Sensitivity to sympathomimetic amines
 Older adult and debilitated patients
 Hypertension
 Coronary insufficiency and other cardio vascular disorders.
 Renal dysfunction
 Dosages
 0.5%, 1% solution for inhalation
 103mcg aerosol
 0.2mg/ml, 0.02mg/ml injection
 Preparation
 Solution
 Aerosol
 injection
76
 Side effects
 Head ache
 Mild tremors
 Nervousness
 Anxiety
 Insomnia
 Fatigue
 Flushing
 Swelling of parotid
 Check pulse before during intravenous administration
 Special notes
 One tolerance has developed, continued use can result in serious adverse
effects including rebound bronchospasm.
3.3 BRONCHODIALATORS
Bronchodilator is a substance that dilate the bronchi and bronchioles and bronchioles,
decreasing resistance in the respiratory airway and increasing airflow to the lungs.
EXAMPLES:-
(01).Salmeterol
 Salmeterol xinafacte
 Trade name
 Serevent
 Indications
 Maintain therapy for asthma or bronchospasm. Prevent of exercises included
bronchospasm.
 Action
 Long acting beta 2-adrenoreceptor agonist and analog of alburerol.
Stimulation of beta –adrenoreceptor relax bronchospasm and increases ciliary
motility, thus facilitating expectoration.
 Pregnancy
 Lactation
 Cautions
 Cardiovascular disorders
 Hypertension
 History of seizuers or thyrotoxicosis
77
 Dosages
 25mcg, aerosol
 50mcg powder discus for inhalation
 Preparation
 Aerosol
 powder
 Side effects
 Dizziness
 Headache
 Tremor
 Sinus tachycardia
 rashes
 Withdraw drug and notify physician immediately if bronchospasm occur
following its use.
 Special notes
(02).Metaproterenol
 Metaproterenol
 Trade name
 Metaproterenol sulfate
 Indications
 Bronchodilator; control bronchospasm associated with bronchitis and
emphysema.
 Action
 Potent synthetic sympathomimetic amine similar to isoproterenol is chemical
structure and pharmacological action. Acts selectively on beta 2 adrenergic
receptors to relax smooth muscles of bronchi uterus and blood vessels
supplying skeletal muscle.
 Sensitivity to other sympathomimetic agents
 Cardiac arrhythmia associated with tachycardia
 Hyperthyroidism
 Pregnancy
 Lactation
 Cautions
 Older adult
 Hypertension
 Cardiovascular disorders an including coronary artery diseases
78
 Dosages
 100mg/5ml syrup
 75mg, 150mg metered dose inhalation
 0.4%, 0.6%, 5% solution for inhalation
 Preparation
 Tablets
 Syrup
 Solutions
 Side effects
 Nervousness
 Drowsiness
 Weakness
 Tremor
 Headache
 Fatigue
 Hypertension
 Monitory respiratory sates auscultation lungs before and after inhalation to
determine efficacy of drug in decreasing airway resistance.
(03).Pirbuterrol Acetate
 Pirbuterol acetate
 Trade name
 Maxair
 Indications
 Prevention and reversal of bronchospasm associated with asthma
 Action
 Exhibit preferential effect on beta 2 adrenergic receptor compaired with
isoproterenol and consequently a lengthen duration of action.stimulation of
beta 2 adrenoreceptors relaxes bronchospasm and increases ciliary motion.
 Hypersensitivity to pirbuterol or any other adrenergic agent such as
epinephrine, albuterol or isoproterenol
 Pregnancy
 lactation
 Dosages
 0.2mg aerosol
 Preparation
 Aerosol
79
 Side effects
 Nervousness
 Headache
 Dizziness
 Tremor
 Tachycardia
 Dry mouth
 Nausea
 Abdominal pain
 Anorexia
 Diarrhea
 Monitor arterial blood gas ad pulmonary function periodically
 Monitor vital signs, report tachycardia, palpitation, by pretension or
hypotension.
 Special notes
 Report palpitation, chest pain, nervousness, tremors.
3.4 DECONGESTANTS
Decongestants is a drug that is used to relieve nasal congestion in the upper
respiratory tract. The active ingredients in most decongestants is either
pseudoephedrine or phenylophria.
EXAMPLES:-
(01).Oxymetazoline.
 Oxymetazoline hydrochoride
 Trade name
 Afrin
 Indications
 Relief of nasal congestion in a various of allergic and infections disorders
of the upper respiratory tract.
 Action
 Sympathomimetic agent that acts directly on alpha receptors of
sympathetic nervous system. No effects on beta receptors.
 Use in children over 2 years old.
 Pregnancy
 Lactation
 Cautions
 Within 14 d of MAO inhibit coronary artery disease
 Hypertension
 Hyperthyroidism
80
 Dosages
 0.025%, 0.05% solutions
 Preparation
 Solution
 Side effects
 Burning
 Stinging
 Dryness of nasal mucosa
 Head ache
 Drowsiness
 Monitor for S and S of excess use. If noted, discuss possibility of rebound
congestion.
(02).Phenylephrine
 Phenylephrine hydrochloride
 Trade name
 Alconefrin
 Indications
 Parentally to maintain blood pressure during anesthesia
 To treat vascular failure in shock
 Tachycardia
 Action
 Potent synthetic tic direct acting sympathomimetic with strong alpha
adrenergic and weak beta adrenergic cardiac stimulant actions.
 Severe coronary disease
 Pregnancy
 Cautions
 Hyperthyroidism
 Bradycardia
 Myocardial disease
 Cerebral arteriosclerosis
 Dosages
 10mg chewable tablets
 0.125%, 2.5%, 10% ophthalmic solution
 10mg/ml injection
81
 Preparation
 Solution
 injection
 Side effects
 Lacrimation
 Brow ache
 Head ache
 Blurred vision
 Allergic deposit on lids
 Increased sensitivity to light
 tachycardia
 Monitor pulse, blood pressure and central venous pressure during
intravenous administration.
 Special notes
 Control flow rate and dose to prevent excessive dosage.
3.5 EXPECTORANTS
Expectorants are drugs that loosen and mucus and phlegm from the respiratory tract.
EXAMPLES:-
(01).Guaifenesin
 Guaifenesin
 Trade name
 Amonidrin
 Indications
 To combat dry nonproductive cough.
 Action
 Enhance reflex outflow respiratory tract fluids by irritation of gastric mucosa.
 Hypersensitivity to guaifenesin
 Pregnancy
 Lactation
 Dosages
 100mg/5ml syrup
 100mg/5ml, 200mg/5ml liquids
82
 Preparation
 Syrup
 Tablets
 Liquids
 capsules
 Side effects
 Low incidence of nausea
 dizziness
 Monitor of therapeutic effectiveness, persistent caught may indicate a serious
condition requiring further diagnostic work.
 Special notes
 increase fluid intake to help loosen mucus drink at least eight glasses of fluid
daily
3.6 MUCOLYTIC
Mucolytic are a glass of drugs which aid the clearance of mucus from the airway lungs,
bronchi and trachea. Such drugs can be further categorized by their mechanism of
action.
EXAMPLES:-
(01)Acetylcysteine
 Acetylcysteine
 Trade name
 Airbron
 Indications
 Adjutant therapy in patients with abnormal viscid or inspissated mucus

secretion in acute or chronic Broncho pulmonary disease and in pulmonary
complications of cystic fibrosis and surgery surgery tracheostomy and
atelectasis.
 Action
 A lower viscosity and facilitated the removal of secretion.
 Patient with asthma

 Older adult
83
 Severe hepatic disease
 Esophageal varies
 Peptic ulcer disease
 Pregnancy
 lactation
 Cautions
 Hypersensitivity to acetylcystein
 Patient at risk of gastric hemorrhage
 Dosages
 10%, 20% solution for inhalation

 20% solution for injection
 Preparation
 Inhalation
 Injection
 Side effects
 Dizziness
 Drowsiness
 Nausea
 Vomiting
 stomatitis
 During intravenous infusion, carefully monitor for fluid over load and signs of
hypernatremia.
(02).Ambroxol
 Ambroxol
 Trade name
 Ambrolex
 Indications
 Emphysema with bronchitis pneumoconiosis
 Chronic inflammation pulmonary condition
 Bronchospasm asthma
 Action
 Mucolytic which changing the structure of bronchial secretion by reduction
and fragmentation of the muco polysaccharide fibers, leading to reduce
viscosity of mucosa.
84
 Stomach and duodenal ulcers
 Pregnancy
 Lactation
 Dosages
 30-120mg/day in 2-3 divided doses
 Preparation
 Tablets
 syrup
 Side effects
 Nausea
 Vomiting
 Runny nose
 Allergic reactions
 Advice patient to drink plenty of fluids, particularly hot fluid to facilitated
moist air passages and to refrain from things that can irritate the throat such
as smoke.
3.7 STEROIDS
Steroid is biological activate compound with four rings arranged in a specific molecular
configuration. Steroid has two principle biological function; as important compound of
cell membrane which alter membrane fluidity.
EXAMPLES:-
(01). Hydrocotisone
 Hydrocortisone
 Trade name
 Alphadecim
 Indications
 Replacement therapy in adrenocortical insufficiency to reduce serum calcium

in hypercalcemia to suppress undesirable inflammatory or immune response.
 Action
 Short-acting synthetic steroid with both glucocorticoid and mineralocorticoid

properties that affect nearly all systems of the body.
85
 Idiopatic thrombocytopenic purpura

 Acute glomerulonephritis-viralor bacterial disease of skin
 Cautions
 Children; diabetic mellitus

 Chronic; active hepatitis positive for hepatitis B surface and antigen
 Dosages

 0.5%, 1%, 2.5% cream
 Preparation
 Tablets
 Cream
 Ointment
 Lotions
 spray
 Side effects
 Malaise
 Weight gain
 Urogenital frequency and urgency
 Head ache
 Establish baseline and continuing date on blood pressure weight, fluid and
electrolyte balance and blood glucose.
 Special notes
 A high protein calcium and vitamin D diet is available to reduce risk of

corticosteroid induce osteoporosis.
86
(02).Methylpredinisalon
 methylpredinisalon
 Trade name
 medrol
 Indications
 An anti-inflammatory agent in the management of acute and chronic

inflammatory disease for palliative management of neoplastic disease and
control severe acute and chronic allergic processes.
 Action
 Intermediate- acting synthetic adrenal corticosteroid with similar

glucocorticoid activity; has considerable fewer sodium and water retention
effects than hydrocortisone.
 Synthetic fungal infection

 Pregnancy
 lactation
 Cautions
 Cushing syndrome
 Ulceration
 Hypertension
 Varicella vaccine
 Dosages
 2mg, 4mg, 8mg, 16mg, 24mg, 32mg tablets
 Preparation
 tablets
 Side effects
 Euphoria
 Head ache
 Insomnia
 Confusion
 Edema
 Peptic ulcer
 Nausea & vomiting
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 Monitor diabetic for loss of glycaemia control
(03).Predinisolone
 Predinisolone
 Trade name
 Prelone
 Indications
 An anti-inflammatory agent in the management of acute and chronic

inflammatory disease for palliative management of neoplastic disease and
control severe acute and chronic allergic processes.
 Action
 Intermediate- acting synthetic adrenal corticosteroid with similar

glucocorticoid activity; has considerable fewer sodium and water retention
effects than hydrocortisone.
 Synthetic fungal infection

 Pregnancy
 lactation
 Cautions
 Cushing syndrome
 Ulceration
 Hypertension
 Varicella vaccine
 Dosages
 2mg, 4mg, 8mg, 16mg, 24mg, 32mg tablets
 Preparation
 tablets
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 Side effects
 Euphoria
 Head ache
 Insomnia
 Confusion
 Edema
 Peptic ulcer
 Nausea
 vomiting
 Monitor diabetic for loss of glycaemia control
3.8 RESPIRATORY MISCELLANEOUS DRUGS

EXAMPLES:-
(01).Proteinase
 Proteinase inhibitors
 Trade name
 Prolastin
 Indications
 Indicated for chronic replacement therapy in patient with alpha antitrypsin

deficiency and demonstrable panacinar emphysema.
 Action
 Alpha proteinase inhibitors is extracted from plasma and used in patient with
panacinar emphysema who has alpha 1- antitrypsin deficiency
 Individuals with selective IgA deficiencies

 Pregnancy
 lactation
 Cautions
 Patient with significant heart disease or other
89
 Dosages
 20mg/ml aralast
 0.5g/25ml, 1g/50ml vials
 Preparation
 Aralast
 vials
 Side effects
 Leukocytosis
 Dizziness
 Fever
 Administer with caution in patient at risk for circulatory over load.

 Monitor cardiac states.
(02).Pulmozyme
 Dornase alfa
 Trade name
 Pulmozyme
 Action
 Pulmozyme is a solution of recommended human deoxyribonucleic an

enzyme treat selectively cleaves DNA. In cystic fibrosis patients, viscous,
purulent secretions in the airway reduce pulmonary function and lead to
exacerbations of infection.
 Individuals with selective IgA deficiencies

 Pregnancy
 lactation
 Cautions
 Patient with significant heart disease or other conditions that may be

aggravated with slight increases in plasma volume.
 Dosages
 1mg/ml solution for inhalation
90
 Preparation
 inhalation
 Side effects
 Leukocytosis
 Dizziness
 Fever
 Administer with caution in patient at risk for circulatory over load.

 Monitor cardiac states.
04.) GASTRO INTESTINAL TRACT
4.1 ANTACIDS
Antacid neutralized stomach acid to cut and heart burn sour stomach, acid indigestion
and stomach upset. Some antacid contain ingredients that can cause diarrhea, such as
magnesium or constipation. Such as aluminium.
EXAMPLES:-
(01).Aluminium hydroxide
 Aluminium hydroxide
 Trade name
 Dialume
 Indications
 Symptomatic relief of gastric hyperacidity associated with gastritis esophageal

reflex, and hiatal hernia gastric and duodenal ulcer.
 Action
 Non symptomatic antacid with moderate neutralizing action decrease rate of

gastric emptying and has demulcent absorbent and mild astringent
 Prolong used of high dose in present of low serum phosphate

 pregnancy
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 Cautions
 Gastric outlet obstruction
 Older adult decreases bowel activity
 Dosages
 300-600mg tablets
 300-600mg capsules
 320mg/5ml, 450mg/5ml, 600mg/5ml suspension
 Preparation
 Tablets
 Capsules
 suspension
 Side effects
 Constipation
 Fecal impairment
 Intestinal obstruction
 Note number and consistency of stools.

 Constipation is common and dose related
 Intestinal obstruction from fecal concern has reported
 Special notes
 Antacid may cause stools to appear speckled whitish.
(02). Calcium carbonate

 Trade name
 Calson
 Indications
 Relief of transient symptoms of hyperactivity as in acid indigestion heart burn,

peptic esophagitis and hiatal hernia.
 Action
 Rapid acting antacid antacid with high neutralizing capacity and relatively
prolong duration of action.
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 Hypercalceium and hyperkaleuria

 Severe renal disease
 Renal calculi
 Gastro hemorrhage or obstruction
 Cautions
 Decrease bowel motility

 Older adult
 lactation
 Dosages
 125mg, 250mg, 650mg, 750mg, 1.25g, 1.5g tablets
 Preparation
 tablets
 Side effects
 Constipation and laxative effects

 Acid rebound
 Nausea
 Vomiting
 Fecal concretions
 Antacid may cause stools to appear speckled whitish.
(03).Magnesium hydroxide
 Magnesium hydroxide
 Trade name
 Magnesia
 Indications
 Short term treatment of occasional constipation for relief of gastrointestinal
symptoms associated with hyperacidity and, as adjunct in treatment of peptic
ulcer.
 Action
 Aqueous suspension of magnesium hydroxide with rapid and long acting
neutralizing action. May cause slight acid rebound.
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 Abdominal pain
 Nausea
 Vomiting
 Diarrhea
 Severe kidney dysfunction
 Fecal impaction
 Intestinal obstruction or perforation
 Rectal bleeding
 Dosages
 311mg tablets
 400mg/5ml, 80mg/5ml suspension
 Preparation
 Tablets
 suspension
 Side effects
 Nausea
 Vomiting
 Abdominal crams
 Diarrhea
 Alkalization of urine
 Weakness
 Lethargy
 Mental depression
 Evaluate the patient continued need for drug. Prolonged and frequent use of
laxative doses may lead to dependence.
 Special notes
 Investigate the cause of persistent or recurrent constipation or gastric distress
with physician.
4.2 ANTIDIARRHEAL DRUGS

This medication is used to treat sudden diarrhea. It works by slowing down the
movement of the gut. This decreased number of bowel movement and makes the
stool less watery.
EXAMPLES:-
(01).Loperamide
 Loperamide
 Trade name
 Imadium
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 Indications
 Acute nonspecific diarrhea chronic diarrhea, associated with inflammatory
bowel disease and to reduce fecal volume from ileostomies.
 Action
 Effective antidiarrheal synthetic piper dine derivative chemical related to
diphenoxlak and meperidine. Reportedly has longer duration of action.
 Severe colitis
 Acute diarrhea caused by broad sputum antibiotics.
 Pregnancy
 Lactation
 Cautions
 Dehydration
 Diarrhea cause by invasive bacteria
 Impaired live function
 Dosages
 2mg tablets, capsules
 1mg/ml,1mg/5ml liquids
 Preparation
 Tablets
 Capsules
 liquids
 Side effects
 Fever
 Drowsiness
 Fatigue
 Dizziness
 Abdominal dysfunction of patient
 Monitor fluid and electrolytic balance
 Discontinue of there is no improvement after 48 hours of therapy for acute
diarrhea.
 Special notes
 Record number and consistency of stools.
95
(02). Bismuth subsalicylate
 Bismuth subsalicylate
 Trade name
 Pepto-Bismol
 Indications
 Prophylaxis and treatment of travel’s diarrhea and for temperature
indigestion.
 Action
 Hydrolyzed in gastrointestinal tract a salivate which believed to inhibit
synthesis of prostaglandin response for gastrointestinal hypermotility and
inflammation.
 Hypersensitive to aspirin or other salicylate.
 Cautions
 Diabetic and gout
 Concurrent use with salicylate
 Pregnancy
 Lactation
 Dosages
 262mg tablets/ capsules
 130/15ml liquids
 Preparation
 Tablets
 Capsules
 Liquids.
 Side effects
 Temporary darkling of stools and tongue
 Metallic taste
 Bluish gum line
 Bleeding tendencies
 Tinnitus
 Monitor bowel function note that stools may darken and tongue may
appearance black. There are temporally affect and will disappear without
treatment.
 Special notes
 Temperature grayish black discoloration of tongue and stool may occure.
96
4.3 DIGESTIVE ENZYME
Digestive enzyme containing amylase or other carbohydrates digesting enzymes may
reduce the effective of a glycosidase inhibitors.
EXAMPLES:-
(01).Pancrelipase
 Pancrelipase
 Trade name
 Catazym
 Indications
 Replacement therapy in symptoms treatment of mal absorption syndrome
due to cystic fibrosis and other conditions associate with exocrine pancreatic
insufficiency.
 Action
 Pancreatic enzyme Concentrate of porcine origin standardized for lipase
content. Similar to pancreatic but on a weight basis has 12 times the impolitic
activity and at least 4 times the trypsin and amylase content of pancreatic.
 History of allergy to hog protein on enzymes esophageal strictures;
pancreatitis porcine protein.
 pregnancy
 Cautions
 Lactation
 Dosages
 Tablets or capsules containing lipase, protease and amylase.
 Preparation
 Tablets
 capsules
 Side effects
 Anorexia
 Nausea
 Vomiting
 Diarrhea
 Monitor I and O weight. Note appetite and quality of stools, weight loss,
abdominal bloating.
97
(01).Pancreatin
 Pancreatin
 Trade name
 catazym
 Indications
 Replacement therapy in symptoms treatment of mal absorption syndrome
due to cystic fibrosis and other conditions associate with exocrine pancreatic
insufficiency.
 Action
 Pancreatic enzyme Concentrate of porcine origin standardized for lipase
content. Similar to pancreatic but on a weight basis has 12 times the impolitic
activity and at least 4 times the trypsin and amylase content of pancreatic.
 History of allergy to hog protein on enzymes esophageal strictures;
pancreatitis porcine protein.
 pregnancy
 Cautions
 Lactation
 Dosages
 Tablets or capsules containing lipase, protease and amylase.
 Preparation
 Tablets
 capsules
 Side effects
 Anorexia
 Nausea
 Vomiting
 Diarrhea
 Monitor I and O weight. Note appetite and quality of stools, weight loss,
abdominal bloating.
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4.4 ANTI-CHOLINERGIC / ANTI SPASMODIC
An anti-cholinergic agent is a substance that block the neurotransmitter acetylcholine
in the parasympathetic nerve impulses by selectively blocking the binding of the
neurotransmitter acetylcholine to its receptor in nerve cells.
EXAMPLES:-
(01).Atopin
 Atopine sulfate
 Trade name
 Atropair
 Indications
 Adjunct in symptomatic treatment of gastro intestine disorders and aplastic
disorders of biliary tract. Relaxes upper gastro intestinal tract and colon
during hypotonic radiography.
 Action
 Act by selectively blocking all muscarinic responses to acetylcholine whether
excitatory or inhibitory selective response of central nerve system relives
rigidity and tumor of Parkinson’s syndrome
 Hypersensitivity to belladonna alkaloids synechiae; angle-closure glaucoma
 Cautions
 Hypertension
 Chronic heart disease
 Tachycardia
 Gastrointestinal infection
 Dosages
 0.4 tablets
 0.05 mg/dl, 0.1mg/dl, 0.3mg/dl, 0.4mg/dl, 0.5mg/dl, 0.8mg/ml. 1mg/dl
injection
 Preparation
 Tablets
 Injections
 Side effects
 Head ache
 Ataxia
 Dizziness
 Excitement
 Convolution
 Drowsiness
 Hallucination
99
 Monitor vital signs. Heart rate is a sensitive indicator of patient’s response to
atropine.
 Special notes
 Drug causes drowsiness sensitivity to light, burring of near vision and
temporally impaired ability to Jude distance.
(02).Loperamide
 Loperamide
 Trade name
 Imodium
 Indications
 Acute nonspecific diarrhea. Chronic diarrhea associated with inflammatory
bowel disease and to reduce fecal volume from ileostomies.
 Action
 Effective anti-diarrheal synthetic piperidine derivative chemically related to
diphenoxylate and to meperidine. Reportedly has longer duration of action.
 Condition in which constipation should be avoided.
 Severe colitis
 Acute diarrhea cause by broad-spectrum antibiotics or associate with
microorganisms that penetrate intestinal mucosa
 Pregnancy
 Lactation
 Cautions
 Dehydration
 Diarrhea cause by invasive bacteria
 Impaired liver function
 History of narcotics dependence
 Dosages
 2mg tablets, capsules
 1mg/ml , 1mg/5ml liquids
 Preparation
 Tablets
 Liquid
 capsules
100
 Side effects
 Skin rashes
 Fever
 Drowsiness
 Fatigue
 Dizziness
 Central nerve dependence
 Abdominal discomfort
 Nausea and vomiting
 Anorexia
 Dry mouth
 Monitor therapeutic effectiveness. Chronic diarrhea usually response within
10 days.
 Monitor fluid and electrolytic balance.
 Special notes
 Drug causes drowsiness sensitivity to light, burring of near vision and
temporally impaired ability to Jude distance.
(03).Dicyclomine
 Dicyclomin hydrochloride
 Trade name
 Antispas
 Indications
 Adjunctively in treatment of functional bowel disorders/ irritable bowel
syndrome
 Action
 Synthetic tertiary amine with antispasmodic properties
 Obstructive disease of genitourinal and gastro intestine tract
 Paralytic ileus
 Intestinal atrophy
 Biliary tract disease
 Pregnancy
 Lactation
 Severe ulcer colitis
 Toxic mega colon
 Cautions
 Glaucoma
 Autonomic neuropathy
101
 Ulcerative colitis
 Hyperthyroidism
 Coronary heart disease
 Hypertension
 Arrhythmia
 Dosages
 10mg, 20mg capsules
 20mg tablets
 10mg/5ml syrup
 Preparation
 Capsules
 Tablets
 Syrup
 injections
 Side effects
 Allergic reactions, light headed needed
 Apnea, drowsiness
 Respiratory arrest, head ache
 Decreased sweating , insomnia
 Urticarial, fever
 Monitor for adverse effect especially in infant treatment of colic with
dicyclomine included some risk.
 Special notes
 Report changers in urine volume, voiding pattern.
4.5 GALLSTONE SOLUBILIZING AGENTS

Gallstone solubilizing agents are used to dissolve non-calcified gallstone. They suppress
the amount of cholesterol synthesized by the liver or inhibit the amount of cholesterol
absorbed from the intestine.
EXAMPLES:-
(01).Chenodal
 Monoctanoin
 Trade name
 Moctanin
 Indications
 To dissolve cholesterol gallstone retained in the biliary tract after
cholecystectomy.
102
 Action
 Cholesterol solubilizing agent agent that shrinks, softens and dissolves
cholesterol gallstone, depending on size and number. An effective alternative
to gallstone removal in some patents, superior to other solvent-type
medications.
 Non cholesterol gallstone
 Obstructive jaundice
 Pancreatitis
 History of intolerance of vegetable
 Recent duodenal ulcer
 infection
 Cautions
 Bile duct obstruction
 lactation
 Dosages
 120 ml infusion
 Preparation
 infusion
 Side effects
 Drowsiness
 Depression
 Abdominal pain
 Epigastria burning
 Anorexia
 Nausea
 Vomiting
 Diarrhea
 Reversible irritability of duodenal mucosa
 Monitor vital signs. An elevated temperature with chills combine with severe
right upper quadrant abdominal pain and jaundice suggest onset of ascending
cholangitis.
103
4.6 GASTRO INTESTINAL STIMULANTS
Stimulant drugs are drugs that excite the central nerve system. There several drugs
used as stimulants. Although in large part they share the same properties, their use is
determined by how well they are absorbed from the gastro intestinal tract.
EXAMPLES:-
(01)Metoclopramides
 Metoclopramide hydrochloride
 Trade name
 Midazolam
 Indications
 Management of diabetic gastric stasis; to prevent nausea and vomiting
associated with emetogonic cancer chemotherapy. To facilitate intubation of
small bowel. Symptomatic treatment of gastro-esophageal reflex.
 Action
 Potent central dopamine receptors antagonist structurally related to
procainamide but has little anti-arrhythmic or anesthetic activity. Exact
mechanism of action not clear but appears to sensitize gastro intestine
smooth muscle to effect of acetylcholine by direct action.
 Sensitivity or intolerance to metoclopramide
 Allery to sulfating agents
 Treatment of seizure disorders
 Concurrent use of drug that can cause extrapyramidal symptoms
 Mechanical gastro intestine obstruction or perforation
 Cautions
 Chronic heart failure
 Cardiac disease
 Asthma
 Hypokalemia
 Hypertension
 Depression
 Hepatic disease
 Dosages
 5mg/5ml solutions
 Preparation
 Tablets
 Solution
 Injections
104
 Side effects
 Mild sedation
 Fatigue
 Restlessness
 Agitation
 Head ache
 Insomnia
 Disorientation
 Nausea
 Constipation
 Dry mouth
 diarrhea
 Report immediate the onset of restlessness involuntary movements, facial
grimacing, rigidity or tremors.
 Special notes
 Avoid alcohol and other central nerve system depressants.
(02).Cisapride
 Propulsid
 Trade name
 Cisopride
 Indications

 Action
 The onset of pharmacological action of cisopride is approximately 30 to 60
minutes after oral administration.
 Patient is taking macrolide antibiotics
 Cautions
 Pregnancy
 Lactation
 Dosages
 5mg/5ml suspension
 Preparation
 Tablets
 Suspension
105
 Side effects
 Diarrhea
 Abdominal pain
 Flatulence
 Nausea
 Head ache
 Dizziness
 Seizures
 Edema
 Special notes
 Patient should be warned agonist concomitant use of promethazine.
4.7 HELICOBACTER PYLORIC ERADICATING AGENTS

Helicobacter pyloric infection is the main cause of gastritis, gastro duodenal ulcers and
gastric cancer. Helicobacter pyloric eradication has been shown to have a prophylactic
effect against gastric cancer.
The optimal treatment for helicobacter pyloric infection has
not been found and routine clinical treatment are usually triple or quadruple antibiotic
therapies.
EXAMPLES:-
(01).Amoxicillin
 Amoxicillin
 Trade name
 Pentids
 Indications
 Throat infection
 Otitis media
 Endocarditis
 Meningococcal disease
 Pneumonia
 Anthrax
 Prophylaxis in limb amputation
 Action
 Kill the microorganisms when used at therapeutic dose.
 The synthesis of cell wall of bacteria is completely depended upon an
enzyme name as Tran’s peptidase.
 Amoxicillin hypersensitivity
106
 cautions
 history of allergy
 false positive urinary glucose
 renal impairment
 Dosages
 1.2g vial
 Preparation
 Injections
 Power for reconstitution
 injections
 oral tablets
 Side effects
 Hypersensitivity reactions including urticarial
 Fever
 Joint pain
 Rashes
 Obtain an exact history of patient’s previous exposure and sensitivity to
amoxiicillin and cephalosporin and other allergy reaction of any kind to
treatment with amoxicillin
 Special note
 Do not breast feed while taking this drug without consulting physician.
(02).Lanzoprazol
 lanzoprazole
 Trade name
 Prevacid
 Indications
 Short-term treatment of duodenal ulcer and erosive esophagitis
pathological hyper secretory disorders, gastric ulcer in combination with
clarithromycin and amoxicillin for helicobacter pyloric.
 Action
 Belongs to a class of anti-secretory compounds that are gastric acid pump
inhibitors. Especially it suppress gastric acid secretion by inhibiting the H,
K.
 Hypersensitivity to lanzoprezol
 Proton pump inhibitors
 lactation
107
 Cautions
 Hepatic disease
 pregnancy
 Dosages
 15mg, 30mg sustained release capsules.
 15mg, 30mg orally disintegrating tablets
 30mg powers
 Preparation
 Capsules
 Tablets
 powers
 Side effects
 Fatigue
 Dizziness
 Head ache
 Nausea
 Diarrhea
 Constipation
 Anorexia
 Increase appetite
 Monitor for therapeutic effectiveness of concurrently used drugs that require
and acid medium for absorption.
 Special notes
(03).Clarithromycin
 Clarithromycin
 Trade name
 Biaxin
 Indications
 Treatment of upper respiratory, lower respiratory infections, acute maxillary
sinusitis otitis media and skin and soft tissue infections caused by clinically
significant aerobic and anaerobic gram negative and positive organisms.
 Action
 A semisynthetic macrolide antibiotic that bind to the 50S ribosomal subunit f
susceptible bacterial organisms and thus inhibits protein synthesis of the
bacteria.
108
 Hypersensitivity to clarithromycin
 Suspected or potential bacteremia
 Acute porphyria
 Severe hepatic or biliary disease
 Pregnancy
 Cautions
 Older adult
 Lactation
 Dosages
 250mg , 500mg tablets
 500mg sustained release tablets
 125mg/5mg, 250mg /5ml suspension
 Preparation
 Tablets
 suspension
 Side effects
 Diarrhea
 Abdominal pain
 Nausea
 Abnormal taste
 Dyspepsia
 Head ache
 Urticarial
 Monitor for and report loose stools or diarrhea since pseudomembranous
colitis must be ruled out.
4.8 H2 RECEPTOR ANTAGONIST

H2 antagonist sometimes referred to as H2RA also called H2 blockers are a class of
medications that block the action of histamine of the histamine H2 receptors of the
parietal cells in the stomach. This decreases the production of the stomach acid.
EXAMPLES:-
(01).Cimetidine
 Cimetidine
 Trade name
 Novocimetine
 Indications
 Short- term treatment of active of ulcer recurrence after it is healed.
109
 Action
 Has high selectivity for histamine H2 receptors on Parietal cell of the stomach
and is H2 receptor antagonist by inhibition at histamine of the H2 receptor
sites, it suppresses all phases of daytime and nocturnal basal gastric and acid
secretion in the stomach.
 Hypersensitivity of cimetidine
 Lactation
 Cautions
 Older adult or critically ill patient
 Impaired renal or hepatic function
 Gastric ulcer
 pregnancy
 Dosages
 100mg, 200mg, 400mg, 800mg tablets
 300mg/5ml liquids
 Preparation
 Tablets
 Liquids
 injection
 Side effects
 Severe diarrhea
 Constipation
 Abdominal discomfort
 neutropenia
 Ulcer healing May occurs with in the first two weeks of therapy but generally
required of least 4 weeks in most patients.
(02).Famotidine
 Famotidine
 Trade name
 Pepcid
 Indications
 Short-term treatment of active maintenance therapy for duodenal ulcer
patients or reduce dosage after healing to an active ulcer.
 Action
 Thiazole derivative, structurally pharmacologically similar to cimetidine. A
potent competitive inhibitor of histamine at histamine receptor sites in gastric
parietal cells.
110
 Safe use during pregnancy
 Cautions
 Renal insufficiency
 Dosages
 40mg/ml suspension
 10mg/ml, 20mg/50ml injection
 Preparation
 Suspension
 injection
 Side effects
 Dizziness
 Head ache
 Confusion
 Depression
 Constipation
 Diarrhea
 Rashes
 Dry skin
 Flushing
 Monitor for improvement in gastro intestinal distress.
 Monitor for signs of gastro intestinal bleeding.
4.9 PROTON PUMP INHIBITORS

Proton pump inhibitors are group of drug whose main action is a pronounced and
long-lasting reduction of stomach acid production within the classes of medications,
there is no clear evidence better then another.
EXAMPLES:-
(01). Omeprazole
 Omeprazole
 Trade name
 Zegerid
 Indications
 Duodenal and gastric ulcer. Gastro esophageal reflux disease including severe
erosive esophagitis. Long-term treatment of pathological hypersensitivity
conditions.
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 Action
 An anti-secretory compound that is a gastric acid pump inhibitor. Suppresses
gastric acid secretion by inhibitor the H, K, ATPase enzyme system in the
parietal cells.
 Long-term use for gastro esophageal reflux disease
 Duodenal ulcer
 Cautions
 Dysphagia
 Metabolic or respiratory
 lactation
 Dosages
 10mg, 20mg 40mg capsules
 20mg powder for oral suspension
 Preparation
 Capsules
 powder
 Side effects
 Head ache
 Dizziness
 Fatigue
 Diarrhea
 Abdominal pain
 Nausea
 Hematuria
 Report any changes in urinary elimination such as pain or discomfort
associated with urination or blood in urine.
4.10 LAXATIVES
Laxatives are increase bowel movements. They are used to treat and/ or prevent
constipation.
EXAMPLES:-
(01).Bisacodyl
 Bisacodyl
 Trade name
 Dulcolax , dacodyl
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 Indications
 Tempory relief of acute constipation and for evacuation of colon before
surgery, proctoscopy, sigmoidosecopic. Also used to cleanse colon before
delivery and to relive constipation in patient with spinal cord damage.
 Action
 Expands intestinal fluid volume by increasing epithelial petmiability.
 Acute surgical abdominal
 Nausea
 Vomiting
 Abdominal cramp
 Intestinal obstruction
 Fecal impaction
 Ulcerated hemorrhoids
 proclitic
 Cautions
 lactation
 Dosages
 5mg tablets
 10mg suppository
 Preparation
 suppository
 Side effects
 Systemic effects not reported
 Mild cramping
 Nausea
 Diarrhea
 Fluid and electrolyte disturbances
 Monitor patient receiving concomitant anticoagulants, indiscriminate use of
absorption of vitamin K.
(02).Lactulose
 Lactulose
 Trade name
 Cepnulac
 Indications
 Prevention and treatment of portal-system encephalopathy, including stages
of hepatic precoma and coma and by prescribe for relied of chronic
constipation.
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 Action
 Reduce blood ammonia; appears to involve metabolism of lactose to organic
acids by resident intestinal bacteria
 Low galactose diet
 Pregnancy
 Cautions
 Concomitant use with electro cautery procedure
 Older adult
 Dosages
 10g/15ml solution ,syrup
 Preparation
 Solution
 syrup
 Side effects
 Flatulence
 Borborygmi
 Belching
 Abdominal/ cramps
 Pain and distention
 Nausea
 Vomiting
 Promote fluid intake during drug therapy for constipation.
 Special notes
05) CENTRAL NERVOUS SYSTEM
5.1 ANALGESIC
An analgesic or pain-killer is any member of the group of drugs used to achieve
analgesia, relief from pain.
Analgesic drug act in various ways on the peripheral and central nervous systems. They
are distinct from anesthetic, which temporally effect and in some intense completely
eliminate sensation.
(01).PARACETAMOL
 Acetaminophen
 Trade name
 Valadol/ abenol
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 Indications
 Fever reduction, temporary relief of mild to moderate pain. Generally as
substitute for aspirin when the latter is not tolerated or is contraindicated.
 Action
 Produces analgesia, by unknown mechanism, perhaps by action or peripheral
nervous system.
 Hypersensitivity to acetaminophen or phenacetin use with alcohol.
 Cautions
 Patient with anemia or hepatic disease
 Arthritic or rheumatoid conditions
 Alcoholism
 Malnutrition
 Pregnancy
 Lactation
 Thrombocytopenia
 Dosages
 80mg, 120mg, 125mg, 300mg, 325mg, 650mg suppositories
 80mg/0.8ml, 80mg/2.5ml, 8mg/5ml, 120mg/5ml, 100mg/5ml, 500mg/5ml
liquids.
 Preparation
 Suppositories
 Tablets
 liquids
 Side effects
 Rashes , dizziness
 Anorexia , lethargy
 Nausea , diaphoresis
 Vomiting , chills
(02).NSAID
Non steroid anti-inflammatory drugs are a drug class that reduce pain.
EXAMPLE: - Ibuprofen
 Ibuprofen
 Trade name
 Buprefen
 Indications
 Chronic symptomatic rheumatoid arthritis and osteoarthritis relied of mild to
moderate pain.
 Reduction of fever.
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 Action
 Proto type of the propionic acid NSAID and significant antipyretic and
analgesic properties. Block prostaglandin synthetic.
 Patient is who urticarial
 Severe rhinitis
 Bronchospasm
 Angioedema
 Nasal polyps
 Safe use during pregnancy and lactation.
 Cautions
 Hypertension
 History of gastro intestinal ulceration
 Impaired hepatic and renal function.
 Chronic renal failure.
 Dosages
 100mg, 200mg, 400mg, 600mg, 800mg tablets
 50mg, 100mg chewable tablets
 100mg/5ml, 100mg/2.5ml suspension
 40mg/ml drops
 Preparation
 Tablets
 Suspension
 drops
 Side effects
 Headache
 Dizziness
 Anxiety
 Emotional liability
 Monitor for therapeutic effectiveness, optimum response generally occurs
within 2 weeks of pain stiffness or swelling or improve joint.
(03).COX-2 INHIBITORS
Selective COX-2 inhibitors are a type of NSAID that directly targets cyclooxygenase-2, COX-2
an enzyme responsible for inflammation and pain.
EXAMPLE:- Celeccoxid
 Celecoxib
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 Trade name
 Celebrex
 Indications
 Relief or eliminate the pain of rheumatoid and osteoarthritis.
 Action
 NSAID that exhibits anti-inflammatory, analgesic and antipyretic activities.
 Hypersensitivity to celecoxib
 Asthmatic patient with aspirin triad
 Advanced renal disease
 Concurrent uses of diuretics.
 Cautions
 Moderate hepatic impairment
 Renal insufficient
 History of gastro intestinal bleeding or peptic ulcer disease
 Pregnancy
 Dosages
 100mg, 200mg, 400mg capsules
 Preparation
 Capsules
 Side effects
 Back pain
 Peripheral edema
 Increase risk of cardiovascular events
 Abdominal pain
 Diarrhea
 Dyspepsia
 Nausea
 Dizziness
 Insomnia
 Head ache
 Therapeutic effectiveness is indicated by relief of joint pain.
 Monitor for fluid retention and edema especially in those with a history of
hypertension and chronic heart failure.
(04).OPOIDS
Opioids are narcotics that act on opioid receptors is produce morphine like effects. Medically
they are primarily used for pain relief.
EXAMPLE:- MORPHINE
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 Morphine
 Trade name
 Roxanol
 Indications
 Morphine is indicated for the relief of severe acute and severe chronic pain.
 Action
 Binds to opioids receptors in the central nerve system. Altered the perception
of and response to painful stimuli while producing generally central nerve
system depression.
 Hypersensitivity to morphine
 Depression
 Respiratory insufficiency
 Renal failure
 Chronic lung disease
 Cautions
 Asthmatic patient
 Chronic obstructive pulmonary disease
 Dosages
 10-30mg every four hours
 Preparation
 Tablets
 injections
 Side effects
 Dizziness
 Sedation
 Nausea
 Vomiting
 Sweating
 Dry mouth
(05).ALCOHOL
Alcohol also known by its chemical name ethanol, is a psychoactive drug that is the active
ingredients in drink such as beer, wine and distilled spirits.
EXAMPLES:- ETHONOL
 Acitretin
 Trade name
 Soriantane
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 Indications
 Treatment of severe psoriasis in adults
 Action
 The mechanism of action is citrating
 Pregnancy
 Lactation
 Sensitivity to parabers
 Cautions
 Impaired hepatic function
 Hepatitis
 Obesity
 History of pancreatitis
 Dosages
 10mg, 25mg capsules
 Preparation
 Capsules
 Side effects
 Head ache
 Hyperesthesia
 Depression
 Insomnia
 Abdominal pain alopecia
 Dry skin
 Monitor S and S of pancreatitis or loss of glycaemia control in diabetic
 Report either condition immediately to physician.
 Special notes
 Dry eyes with decreased tolerance for contact lens
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(06).PSYCHOLROPIC AGENTS
Example:- Ketamine
 Menantine
 Trade name
 Namenda
 Indications
 Treatment of symptoms of moderate to severe Alzheimer’s disease.
 Action
 Glutamate activation at the NMDA receptor in needed for memory and
learning in the brain.
 Safety and efficacy in children are unknown.
 Cautions
 Moderate severe renal impairment
 Concurrent use with carbonic anhydrase inhibitors
 Pregnancy
 Lactation
 Dosages
 2mg/ml solutions
 Preparation
 Tablets
 Solutions
 Side effects
 Fatigue
 Pain
 Dizziness
 Head ache
 Confusion
 Abdominal gait
 Depression
 Anxiety
 Vertigo
 Monitor respiratory and cardiovascular status, especially with preexisting
heart disease.
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5.2 ANOREXIANTS
An anorexiants is a drug which reduces appetite, resulting in lower food
consumption, leading to weight loss.
EXAMPLES:-
(01).PHENDIMETRAZINE
 Phentermine hydrochloride
 Trade name
 Ionamine
 Indications
 Short term (8-12 weeks) adjunct for weight loss.
 Action
 Sympathetic amine with pharmacological similarity to amphetamine action
include central nerve system stimulation and blood pressure elevation.
 History of hypertension
 Moderate to severe hypertension
 Hyperthyroidism
 Pregnancy
 Cautions
 Mild hypertension
 Dosages
 8mg, 30mg, 37.5mg tablets
 15mg, 18.7mg, 30mg, 37.5mg capsules
 Preparation
 Tablets
 Capsules
 Side effects
 Chest pain
 Excessive sweating
 Chills
 Flushing
 Fever
 Myalgia
 Tachycardia
 Constipation
 Assess for tolerance to the anorectic effect of the drug; withhold drug and
report to physician when this occurs.
 Special notes
 Do not breast feeding while taking this drugs.
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(02).Methamphetamine
 Methamphetamine hydrochloride
 Trade name
 Desoxyn
 Indications
 Short term adjunct in mechanism of exogenous obesity, narcolepsy, epilepsy
 Post encephalitic Parkinsonism.
 Action
 Sympathomimetic amine chemically related to amphetamine, central nerve
system stimulant actions approximately equal to those of amphetamine.
 During pregnancy
 Lactation
 Cautions
 Mild hypertension
 History of suicide attempts
 Older adult or debilitated patients
 Dosages
 5mg tablets
 5mg, 10mg, 15mg long-acting tablets
 Preparation
 Tablets
 Side effects
 Restlessness
 Tremor
 Insomnia
 Headache
 Nervousness
 Anxiety
 Dizziness
 Arrhythmias
 Monitor weight throughout period of therapy.
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5.3 ANTI-CONVULSIANT
Anti-consultants are adverse group of pharmacological agents used in the
treatment of epileptic seizures. Anticonvulsants also prevent the spread of the
seizures within the brain.
EXAMPLES:-
(01).Carbumazepine
 Carbumazepine
 Trade name
 Carbatrol
 Indications
 Alone or concomitantly with other anticonvulsants in treatment of grand mal
and psychomotor or temporal lobe epilepsy and mixed seizures in patient
who have not responded satisfactorily to other agents.
 Action
 Structurally related to tricyclic anti-depressants but lacks anti depression
properties. Anti-convulsion actions appear qualitatively similar to those of
phenytoin.
 Hypersensitivity to carbumazepine
 History of hematologic reaction to other drugs
 Cardiac, hepatic or renal disease
 Hypertension
 Pregnancy
 Lactation
 Cautions
 The older adult
 History of cardiac disease
 Dosages
 100mg chewable tablets
 200mg tablets
 100mg, 200mg, 400mg sustain-release tablets
 100mg, 200mg, 300mg sustain release capsules
 100mg/5ml suspension
 Preparation
 Tablets
 Capsules
 suspension
 Side effects
 Myalgia
 Arthralgia
 Leg cramps
 Edema
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 Anorexia
 Abdominal pain
 Diarrhea
 Constipation
 Dry mouth
 Monitor for the following reactions, which commonly occurs during early
therapy. Dizziness light headedness, ataxia
(02).Diazepam
 Diazepam
 Trade name
 Valium
 Indications
 Drug of choice for status epileptics. Management of anxiety disorders, for
short-term relief of anxiety symptoms, treatment for restless legs.
 Action
 Psychotherapeutic agent related to chlordiazepoxid; reportedly superior in
anti-anxiety and anticonvulsant activity with somewhat short duration of
action.
 Shock
 Coma
 Acute alcohol intoxication
 Depressed vital signs
 Acute narrow angle glaucoma
 Cautions
 Epilepsy
 Psychoses
 Impaired hepatic or renal function
 Dosages
 1g/ml, 5mg/ml, 5mg/5ml oral solution
 2.5mg, 5mg, 10mg, 15mg, 20mg rectal gel
 Preparation
 Tablets
 Oral solution
 injections
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 Side effects
 Throat and chest pain
 Drowsiness
 Fatigue
 Ataxia
 Confusion
 Dizziness
 Vertigo
 Head ache
 Tremor
 Monitor for adverse reactions. Most are dose related. Physician will rely on
accurate observation and report of patient response to the drug to determine
lowest effective maintenance dose.
 Special notes
 Take drug as prescribe; do not change dose or dose intervals.
5.4 ANTI-EMETIC
An anti-emetic is a drug that is effective against vomiting and nausea. Anti-emetics
are typically use to treat motion sickness and side effects of opioids, analgesics
general anesthetics and chemotherapy directed against cancer.
EXAMPLES:-
(01).Domperidone
 Domperidone
 Trade name
 Motillium
 Indications
 Increase movement through the digestive system.it is used to treat symptoms
of stomach disorders.
 Action
 Act as a peripheral dopamine receptors blocker.
 Increase gastro intestinal motility, peristalsis a lower esophageal splinter
pressure.
 Known hypertension
 Concurrent use of Ketoconazol
 Prolactinoma
 Lactation
125
 Cautions
 History of breast cancer
 Severe renal impairment
 Dosages
 10mg tablets
 Preparation
 Tablets
 capsules
 Side effects
 Headache
 Dizziness
 Dry mouth
 Nervousness
 Flushing
 Stomach cramp
 Hot flashness
 Chest pain
 Difficulty urination
 Assess for nausea, vomiting, abnormal distension and bowel sounds before
and after administration.
 Special notes
 Laboratory tests may be done periodically which talking this medication to
monitor its effects and prevent side effects.
(02).Olanzapine
 Olanzapine
 Trade name
 Zyprexa
 Action
 Antipsychotic activity is through to be due to antagonist for both serotonin
and dopamine receptors. May inhibit the central nerve system presynaptic
neuronal reuptake of serotonin and dopamine.
 Hypersensitivity to olanzapine abrupt discontinuation, coma, severe central
nerve system depression.
 Subcutaneous or intramuscular injection of clozapine.
 Cautions
 Neurological disease
 Stroke
126
 Cerebrovascular disease
 Parkinsonism
 Dementia
 History of seizures
 Dosages
 2.5mg, 5mg, 7.5mg, 10mg, 15mg tablets
 10mg, 15mg, 20mg orally disintegrated tablets
 10mg powder for injection
 Preparation
 Tablets
 Disintegrated tablets
 Injections
 Side effects
 Weight gain
 Fever
 Back and chest pain
 Peripheral and lower extremity edema
 Joint pain
 Twitching
 Head ache
 Monitor diabetic for loss of glycaemia control.
(03).Metoclopramide
 Metoclopramide hydrochloride
 Trade name
 Midazolam
 Indications
 Management of diabetic gastric stasis; to prevent nausea and vomiting
associated with emetogonic cancer chemotherapy. To facilitate intubation of
small bowel. Symptomatic treatment of gastro-esophageal reflex.
 Action
 Potent central dopamine receptors antagonist structurally related to
procainamide but has little anti-arrhythmic or anesthetic activity. Exact
mechanism of action not clear but appears to sensitize gastro intestine
smooth muscle to effect of acetylcholine by direct action.
 Sensitivity or intolerance to metoclopramide
 Allery to sulfating agents
 Treatment of seizure disorders
 Concurrent use of drug that can cause extrapyramidal symptoms
 Mechanical gastro intestine obstruction or perforation
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 Cautions
 Cardiac disease
 Asthma
 Hypokalemia
 Hypertension
 Depression
 Hepatic disease
 Dosages
 5mg/5ml solutions
 Preparation
 Tablets
 Solution
 Injections
 Side effects
 Mild sedation
 Fatigue
 Restlessness
 Agitation
 Head ache
 Insomnia
 Disorientation
 Nausea
 Constipation
 Dry mouth
 diarrhea
 Report immediate the onset of restlessness involuntary movements, facial
grimacing, rigidity or tremors.
 Special notes
Avoid alcohol and other central nerve system depression.
128
5.5 ANTI-VERTIGO
Anti-vertigo medications that reduce the dizziness. Anti-histamine such as meclizine
May after short-term relived for vertigo.
EXAMPLES:-
(01).Promethazine
 Promethazine hydrochloride
 Trade name
 Pentazine
 Indications
 Hypersensitivity to phenothiazine narrow angle glaucoma, stenosis, peptic
ulcer, pyloric duodenal obstruction, bladder neck obstruction, epilepsy
 Action
 Long acting derivative of phenothiazine with marked anti-histamine activity
and prominent sedative, antiemetic and anti-motion sickness actions. Nausea,
vomiting.
 Hypersensitivity to phenothiazine
 Narrow angle edema
 Steno sing peptic ulcer
 Pyloroduodenal obstruction
 Lactation
 Cautions
 Asthma
 Acute or chronic respiratory impairment
 hypertension
 Dosages
 12.5mg, 25mg, 50mg tablets
 6.25mg/5ml syrup
 12.5mg, 25mg, 50mg suppositories
 25mg/ml, 50mg/ml injections
 Preparation
 Tablets
 Syrup
 Suppositories
 injection
 Side effects
 Deep sleep
 Coma
 Convulsion
129
 Cardio respiratory syndrome
 Extrapyramidal reaction
 Night mares
 Central nerve system stimulation abnormal movements
 Irregular respiration
 Sedation
 drowsiness
 confusion
 dizziness
 Monitor respiratory function inpatient’ with respiratory problem, particularly
children.
 Drug may be suppress cough relief and cause thickening of bronchial
secretion
 Special notes
 Avoid alcohol and other central nerve system depression.
(02).Clonazepam
 Clonazepam
 Trade name
 klonapin
 Indications
 In the suppress spike and wave discharge in absent seizers and decrease
amplitude frequency, duration and spread of discharge in miner motor
seizures.
 Action
 Benzodiazepine derivative with strong anticonvulsant activity and several
other pharmacologic properties characteristics of the drug class.
 Hypersensitivity to benzodiazepine
 liver disease
 acute narrow angle glaucoma
 pregnancy
 Lactation
 Cautions
 Renal disease
 COPD
 Drug controlled open angle glaucoma addition
 Patient with mixed seizures disorders
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 Dosages
 0.5mg, 1mg, 2mg tablets
 0.125mg, .25mg, 0.5mg, 1mg and 2mg orally disintegrating wafers
 Preparation
 Tablets
 Side effects
 Dry mouth
 Sore gums
 Anorexia
 Coated salivation
 Increased salivation
 Increased appetite
 Nausea
 Constipation
 Diarrhea
 Anemia
 Insomnia
 Monitor for S and S of over dose including somnolence, confusion, irritability
sweating, muscle and abnormal cramps, diminished reflexes, coma
5.6 ANTI-PARKINSON AGENTS

An anti-Parkinson medication is a type of drug which is intended to treat and relieve
the either symptoms of Parkinson’s disease. Most of these agents act by either
increasing dopamine activity in the central nerve system.
(01). Levodopa
 Levodopa
 Trade name
 Sinemet
 Indications
 Symptomatic treatment of idiopathic Parkinson’s disease post enceplitic
Parkinsonism for used with levodopa when separate titration of each agent is
indicated and for investigation purpose.
 Action
 When levodopa is given alone large doses must be administrated.
 Hypersensitivity to levodopa
131
 Narrow angle edema
 History of or suspected malaria
 Pregnancy
 Lactation
 Cautions
 Hepatic or pulmonary or renal disease
 History of peptic ulcer
 Endocrine disorders
 Seizure disorders
 Dosages
 10mg/100mg, 25mg/100mg, 25mg/250mg tablets
 25mg/100mg, 50mg/200mg, sustained release tablets and orally
disintegrating tablets
 Preparation
 Tablets
 Side effects
 Palpitation
 Arrhythmias
 Excess salivation
 Edema
 Nausea
 Anorexia
 Monitor all patients closely for behavior changes patients in depression
should be closely observed for suicide tendencies.
 Special notes
 Report muscle twitching and spasmodic winking, promptly as these may be
early signs of overdose.
(02).MAO-B inhibitors
 Phenelzine sulfate
 Trade name
 Nardil
 Action
 Potent hydrazine (mono amine oxidase) MAO inhibitors precise mode of
action is not known. Anti-depression and diverse effects believed to be due to
irreversible inhibitors of MAO.
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 Hypersensitivity to MAO
 Pheochromocytoma
 Hyperthyroidism
 Cardiovascular or cerebrovascular disease
 glaucoma
 Cautions
 Epilepsy
 Pyloric stenosis
 Diabetic
 Depression accompanying
 Alcoholism r drug addiction
 Chronic brain syndrome
 Dosages
 15mg tablets
 Preparation
 Tablets
 Side effects
 Dizziness or vertigo
 Head ache
 Drowsiness or insomnia
 Weakness
 Fatigue
 Edema
 Tremors
 Twitching
 Fainting
 Evaluate patient’s blood pressure in standing and recumbent position, prior to
initiation of treatment.
 Special notes
 Avoid drinking excessive caffeine and chocolate beverages.
133
5.7 ANXIOLYTIC/ SEDATIVES
An anxiolytic is a medication or other intervention that inhibits anxiety. This effect is
in contact to antigenic agents, which increase anxiety.
EXAMPLES:-
(01).Alprazolam
 Alprazolam
 Trade name
 Niravam
 Indications
 Management of anxiety disorders or for short term relief of anxiety
symptoms. Also used as adjunct in management of anxiety associated with
depression and agitation.
 Action
 Central nerve system depressant, mode of action not known, but appears to
act at the limbic, thalamic and hypothalamic levels of the central nerve
system. It is associated with significantly less drowsiness.
 Sensitivity to benzodiazepines
 Acute narrow angle glaucoma
 Pulmonary disease
 Use alone in primary depression or psychotic disorders
 Cautions
 Impaired hepatic function
 History of alcoholism
 Dosages
 025mg, 0.5mg, 1mg, 2mg tablets
 0.5mg, 1mg, 2mg, 3mg sustain relief tablets
 0.5mg/ 5ml, 1mg/ml oral solution
 Preparation
 Tablets
 Side effects
 Drowsiness
 Sedation
 Dizziness
 Syncope
 Depression
 Head ache
 Confusion
 Insomnia
 Nervousness
134
 Monitor for S and S of drowsiness and sedation especially in order adults or
the debilitated they may require supervised ambulation and side rails
 Special notes
 Adverse reaction that may occurs during early high dose therapy.
(02). Chloral hydrate

 Chloral hydrate
 Trade name
 Noctec
 Indications
 Short-term management of insomnia for general sedation before and after
surgery to reduce anxiety associated with drug withdrawal and alone or with
parade hydrate to prevent or suppress alcohol withdrawal symptoms.
 Action
 Produces “physiologic sleep” by mild cerebral depression with little effect on
respiration or blood pressure and little or no hangover.
 Known hypersensitivity to chloral hydrate or chronic derivatives
 Severe hepatic , renal or cardiac disease
 Rectal dosage from in patient with procititis
 Cautions
 History of intermittent porphyria
 Asthma
 History of or proneness to drug dependence
 Depression
 Suicidal tendencies
 Dosages
 500mg capsules
 250mg/5ml, 500mg/5ml syrup
 324mg, 500mg, 648mg suppositories
 Preparation
 Capsules
 Syrup
 Suppositories
 Side effects
 Angioedema
 Eosinophilia
 Breath odor
 Leukopenia
135
 Ketonuria
 Renal and hepatic damage
 Arrhythmia
 Cardiac arrest
 Monitor for S and S of which may occurs within several hours or as 10 days
after drug administration.
5.8 DRUG FOR ALCOHOL DEPENDENCE

An illness marked by consumption of alcohol beverage at a level that interferes with
physical or mental health.
EXAMPLES:-
(01).Disulfiroin
 Disulfiroin
 Trade name
 Antabuse
 Indications
 Adjunct in treatment of the patient with chronic alcoholism who sincerely
wants to maintain sobriety.
 Action
 Act as a deterrent to alcohol is ingested a complete of highly unpleasant
symptoms known as the disulfiroin reaction occurs, which severe as a
deterrent to further drinking.
 Severe myocardial disease
 Psychosis
 Pregnancy
 Lactation
 Cautions
 Epilepsy
 Hyperthyroidism
 Cerebral damage
 Chronic and acute nephritis
 Dosages
 Preparation
 Tablets
136
 Side effects
 Flushing of face
 Chest arms
 Pulsation head ache
 Nausea
 Violet vomiting
 Thirst
 Sweating
 Confusion
 Weakness
 Do a complete physical examination and careful drugs history prior to
initiation or therapy
 Special notes
 Ingestion of even small amounts of alcohol or use of external application that
contain alcohol may be sufficient to produce a reaction.
(02).Naltrexone
 Naltrexone hydrochloride
 Trade name
 Depade
 Indications
 Adjunct to the maintenance of an opioid free state in detoxified addicted who
are and desire to remain narcotic free.
 Action
 Pare opioid antagonist with prolonged pharmacologically similar to naloxone.
Mechanism of action not clearly delineated
 Patient receiving opioid analgesic or in acute opioid withdrawal
 Opioid dependence patient
 Acute hepatic , liver function
 Dosages
 50mg tablets
 Preparation
 Tablets
 Side effects
 Dry mouth
 Anorexia
 Nausea
 Vomiting
 Constipation
137
 Abdominal cramp
 Muscle and joint pain
 Difficulty sleeping
 Anxiety
 Head ache
 nervousness
 Check liver function in before the treatment is started.
 Special notes
 Na therapy may put In damage of overdose if use opiated.
5.9 MUSCLE RELAXANTS

Muscle relaxant is a drug that affects skeletal muscle function and decreases the
muscle tone. It may be used to alleviate symptoms such as muscle spasms, pain and
hyper reflexia.
EXAMPLES:-
(01).Baclofen
 Baclofen
 Trade name
 Lioresal
 Indications
 To provide symptomatic relief of painful spasms in multiple sclerosis and in
the management of detrusor sphincter dysynergic in spinal coral injury or
disease.
 Action
 Centrally acting skeletal muscle relaxant, precise mechanism of action and
determined. Depression monosynaptic activity at spinal cord level.
 Lactation
 Coagulopathy
 Bacteremia intramuscular or intratheca administration.
 Cautions
 Impaired renal and hepatic function
 Bipolar disorders
 Psychosis
 Schizophrenia
 Seizure disorders
 Stroke
 Depression
138
 Dosages
 10mg, 20mg orally disintegrating tablets
 500mcg/ml, 200mcg/ml ampules
 Preparation
 Tablets
 Ampules
 Side effects
 Vertigo
 Dizziness
 Weakness
 Fatigue
 Head ache
 Confusion
 Observe carefully for side effects; mental confusion, depression,
hallucinations, older adults are especially sensitive to this drug.
 Special notes
 Central nerve system effects will be additive to other central nerve system
depression, including alcohol.
(02).Methocarbamol
 Methocarbomol
 Trade name
 marbaxin
 Indications
 Adjunct to physical therapy and other measures in management of discomfort
associated with acute muscular skeletal disorders.
 Action
 Similar to cyclobenzaprine but it produces higher plasma levels more rapidly
and for longer periods exerts skeletal muscle relaxant action.
 Comatose states
 Central nerve system depression
 Acidosis
 Kidney dysfunction
 pregnancy
139
 Cautions
 Epilepsy
 Older adults
 Renal diseases
 Renal failure
 Seizures disorders
 Lactation
 Dosages
 Preparation
 Tablets
 Injections
 Side effects
 Anaphylactic reactions
 Flushing
 Syncope
 Convulsions
 Urticarial
 Pruritus
 Rashes
 Thrombophlebitis
 Head ache
 Monitor vital signs closely during IV infusion
 Special notes
 Do not breast feeding while taking this drug without consulting physician.
5.10 CHOLINE ESTERASE INHIBITORS

Choline esterase inhibitor is a chemical or drug that inhibits the acetylcholine
esterase
EAXMPLES:-
(01)Donepezil
 Donepezil hydrochloride
 Trade name
 Aricept
 Indications
 Mild to moderate dementia of Alzheimer’s type
140
 Action
 Donepezil is a cholesterase inhibitors, presumably elevates acetylcholine
concentration in the cerebral cortex by slowing degradation of acetylcholine
released by remaining intact neurons.
 Hypersensitivity to donepezil
 Pregnancy
 Lactation
 Gastro intestinal bleeding
 Jaundice
 Cautions
 Anesthesia
 Sick sinus rhythm
 AV block
 Bradycardia
 Cardiac arrhythmias
 Cardiac disease
 History ulcers
 Dosages
 5mg, 10mg tablets and orally disintegrating tablets
 Preparation
 Tablets
 Side effects
 Head ache
 Fatigue
 Insomnia
 Dizziness
 Depression
 Tremors
 Vertigo
 Monitor therapeutic effectiveness, improvement as noted on the Alzheimer’s
disease assessment scale.
 Special notes
 Excessive caution, fainting episodes related to slowing the heart rate may
occur, report immediately to physician.
141
(02).Rivastigmine
 Rivastigmine tartrate
 Trade name
 Exelon
 Indications
 Treatment of mild and moderate dementia of the Alzheimer’s type
 Action
 Inhibits acetylcholine esterase G1 forms of this enzyme.
 Hypersensitivity to rivastigmine , locations
 Cautions
 History of toxicity to Cl
 Gastro intestinal disorders
 pregnancy
 Dosages
 2mg/ml solutions
 Preparation
 Solutions
 Side effects
 Asthenia
 Increase sweating
 Syncope
 Fatigue
 Malaise
 Hypertension
 Diarrhea
 Abdominal pain
 Nausea
 Vomiting
 Anorexia
 Weight loss
 Monitor cognitive function and ability to perform ADLs.
142
(03).Galantamine
 Galantamine hydrochloride
 Trade name
 Razadyne
 Indications
 Treatment of mild and moderate demential of Alzheimer’s type.
 Action
 Competitive and reversible inhibitors of acetylcholine which is the enzyme
responsible for the hydrolysis of the neurotransmitters
 Hypersensitivity to galantamine .
 Not recommended with severe renal or hepatic impairment
 Pregnancy
 Lactation
 Cautions
 Bradycardia
 Heart block or other cardiac conduction disorders
 Asthma
 COPD
 Potential bladder outflow obstruction
 History of seizure or gastro intestinal bleeding
 Dosages
 8mg, 16mg, 24mg extended release capsules
 4mg/ml oral solutions
 Preparation
 Tablets
 Capsules
 Oral solution
 Side effects
 Weight loss
 Fatigue
 Rhinitis
 Dizziness
 Head ache
 Depression
 Insomnia
 Tremor
 Bradycardia
 Monitor cardiovascular states including baseline and periodic ECG and BP
reading
143
06) OPHTHALMIC MEDICATION
Ophthalmic medication is applied to the eyes.
EXAMPLES:-
(01).Ciprofloxacin
 Ciprofloxacin hydrochloride
 Trade name
 Cipro
 Indications
 Urinary tract infections, lower respiratory tract infections, skin and structural
infections, bone and joint infections, gastro intestinal infections or infections
diarrhea, chronic bacterial prostatitis, nosocomial pneumonia.
 Action
 Synthetic quinolone that is abroad spectrum bactericidal agent. Inhibits DNA-
graze, an enzyme necessary for bacterial DNA replication and some aspects of
transcription, repair recombination and transposition.
 Known hypersensitivity to ciprofloxacin or other quinolones
 Syphilis
 Viral infection
 Tendon inflammation or tendon pain
 Cautions
 Known or suspect central nerve system disorders myasthenia gravis
 Myocardial ischemia
 Arterial fibrillation
 Gastro intestinal diseases
 Colitis
 Dosages
 50mg/ml, 10mg/ml suspension
 500mg extended release tablets
 200mg, 400mg injections
 3.5mg/ml solution
 Preparation
 Tablets
 Suspension
 Injection
 Solution
144
 Side effects
 Nausea
 Vomiting
 Diarrhea
 Crams pseudo membranous colitis
 Tendon rupture
 Cartilage irruption
 Head ache
 Vertigo
 Malaise
 Seizures
 Monitor urine PH it should be less than 6.8 especially in the older adult and
patients
(02).Nedocromil
 Nedocromial sodium
 Trade name
 Alocril
 Indications
 Maintenance therapy for patients with mild to moderate asthma ocular use
for allergic.
 Action
 Inhibit activation of and mediator release from inflammation cell types
associated with asthma conjunctivitis.
 Hypersensitivity to nedocromil
 Acute bronchospasm
 Particularly states asthmatics
 Cautions
 Pregnancy
 lactation
 Dosages
 1.75mg aerosol
 2% ophthalmic solution
 Preparation
 Aerosol
 Solutions
145
 Side effects
 Abnormal bitter taste
 Nausea
 Vomiting
 Head ache
 Dizziness
 Sore throat irritation
 Cough
 Assess for coughing and bronchospasm induced by nedocromil. There are
indications for discontinuation of drug and should be promptly report
 Special notes
 Do not use it treat acute bronchospasms because nedocromil is not a
bronchodilator.
(03).Latanoprate
 Latanoprate
 Trade name
 Xalantan
 Indications
 Treatment of open angle glaucoma ocular hypertension and elevated intra
ocular pressure.
 Action
 Prostaglandin analog that is through to reduce intraocular pressure by
increasing the outflow of aqueous humor.
 Hypersensitivity to latanoprate or another component in the solution
 Pregnancy
 Lactation
 Cautions
 Acute intraocular inflammation such as iritic or uveitis
 Hepatic or renal impairment
 Patients at risk for muscle edema
 Dosages
 0.005% solutions
 Preparation
 Solutions
146
 Side effects
 Head ache
 Asthenia
 Rashes
 Growth of eye lashes
 Ocular dryness
 Visual disturbances
 Withdraw eye drop and notify physician.
07) CHEMOTHERAPY DRUGA

Chemotherapy is a type of cancer that use one or more anti-cancer drugs as part of
a standardized chemotherapy regimen.
EXAMPLES:-
(01)Doxorubicin
 Doxorubicin hydrochloride
 Trade name
 Adriamycin
 Action
 Cytotoxic antibiotic with wide spectrum of anti-tumor activity and strong
immune suppressive property blocking effective DNA and RNA transcription.
 Impaired cardiac function obstructive jaundice
 Previous treatment with complete cumulative dose of doxorubicin.
 lactation
 Cautions
 Impaired hepatic or renal function
 Pelvic irradiation or radiotherapy areas surrounding heart
 History of atopic dermatitis
 Dosages
 10mg, 20mg, 50mg, 100mg powder for injections
 20mg liposomal injections
 Preparation
 Injections
 powder
147
 Side effects
 Skin rashes
 Pruritus
 Angioedema
 Urticarial
 Fever
 Chills
 Nausea
 Vomiting
 Anorexia
 Monitor any area of extravasation closely for 3-4 weeks. If ulceration begins a
plastic surgeon should be consulted.
(02).Paclitaxel
 Paclitaxel
 Trade name
 Onxol
 Action
 Ant micro tubule agent that interferes with micro tubule network essential for
inter phase and mitosis
 Pregnancy
 Lactation
 Cautions
 Cardiac arrhythmias
 Dosages
 100mg powder for injections
 Preparation
 Injections
 Side effects
 Ventricular ectopic
 Chest pain
 Fatigue
 Head ache
 Nausea
 Vomiting
148
 Monitor vital signs frequency, especially during the first hour of infusion.
Bradycardia occurs in approximately 12% of patients.
 Special notes
 Be aware of high probability of developing hair loss.
08) ANESTHETIC DRUGS

An anesthetic is drugs to prevent pain during surgery completely blocking any
feeling as opposed to an analgesic. A wide variety of drugs are used in modern
anesthetic practice.
 Local anesthesia
Local anesthesia are agents that prevent transmission of nerve impulses without
causing unconsciousness. They act by binding to fast sodium cannel from within.
Local anesthetic can be either ester or amide based.
EXAMPLES:-
(01).Lidocain
 Lidocain hydrochloride
 Trade name
 nervocain
 Action
 Similar to those of procainamide and quinidine, but has little effects on
myocardial contractility AV and systolic arterial pressure in equivalent doses.
 History of hypersensitivity to amide type local anesthetics.
 Application or injection of lidocain anesthetic in pressure of severe trauma or
sepsis.
 Blood dyscrasias
 Pregnancy
 Lactation
 Cautions
 Liver or kidney disease
 Respiratory depression
 Shock
 Myasthenia gravis
 Older adult
 Dosages
 0.5%, 1%, 1.5%, 2%, 4% gel
 Preparation
 Gel
149
 Side effects
 Drowsiness
 Dizziness
 Light headed
 Restlessness
 Confusion
 Numbness of lips or tongue and other paresthesia
 Lidocaine blood level of 1.5-6mcg/ml are reported to provide usually effective
anti-arrhythmic activity.
 General anesthesia
Volatine agents are specially formulated organic liquids that evaporate readily into
vapo is and over given by inhalation for induction and maintenance of general
anesthesia.
Inhalation
Examples:-
(01).Halothane
 Mivacrone
 Trade name
 Halothane
 Action
 Short acting skeletal muscle relaxent that combines competitively to
cholinergic receptors on the motor neuron end-plate.
 Allergic reactions to mivaorcurium or its ingredients.
 Cautions
 Kidney function impaired
 Older adult patients
 Pregnancy
 Lactation
 Dosages
 0.5mg/ml, 2mg/ml injections
 Preparation
 injections
150
 Side effects
 Transient decrease in arterial blood pressure
 Hypotension
 Increase and decrease in heart rate
 Monitor for significant drop in blood pressure because over dose may
increase the risk of hemodynamic adverse effects.
09) DRUGS USED IN GYN AND OBS
Drugs use in obstetric; drug may be used to modify uterine contraction. These
include oxytocin drugs to stimulate uterine contraction
EXAMPLES:-
(01).Oxytocin
 Oxytocin injection
 Trade name
 Syntocinon
 Indications
 To initiate or improve uterine contraction at term only in carefully selected
patients and only after cervix is dilated and presentation of fetus has occur,
relieve pain from breast enlargement.
 Action
 Synthetic, water-soluble polypeptide consisting of eight amine acids, identical
pharmacologically to the oxytocin principles of posterior pituitary.
 Hypersensitivity to oxytocin significant cephalo pelvic disproportion
unfavorable fetal position or presentation that are undeliverable without
conversion before delivery.
 Cautions
 Concomitant use with cyclopropane anesthesia or vaso constrictive drugs
 Dosages
 10units/ml injections
 Preparation
 Injections
 Side effects
 Fetal trauma for rapid propulsion through pelvis
 Anaphylactic reactions
 Post-partum hemorrhage
 Precordial pain
 Edema
 Cyanosis or redness of skin
151
 Monitor fetal heart rate and maternal blood pressure and pulse at least 15
minutes during infusion period.
 Special notes
 Rapid sudden severe head ache immediately to inform head care provider.
(02).Prostaglandin
 Dinoproto Trade name
 Cervidil
 Indications
 To terminate pregnancy from twelfth week through second trimester as
calculated from first day of last regular menstruation period.
 Action
 Synthetically prepared member of the prostaglandin E2 series that appears to
act directly on myometrium and on gastro intestinal stimulation of gravid
uterine in early weeks of gestation is more potent than that of oxytocin.
 Acute pelvic inflammatory disease
 History of pelvic surgery
 Uterine fibroids
 Cervical stenosis
 Hepatic disease
 Pregnancy
 Cautions
 History of hypertension
 Hypotension
 Asthma
 Epilepsy
 Anemia
 Dosages
 20mg suppository
 Prepidil 0.5mg gel
 Cervidil 10mg vaginal insert
 Preparation
 Suppository
 Side effects
 Head ache
 Tremor
 Tension
152
 Hypertension
 Flushing
 Cough
 Nausea ,vomiting, diarrhea
 Monitor uterine contraction and observe for and report excessive virginal
bleeding and cramping pain. Keep paid count. Save all cloth and tissue for
physician inspection and laboratory analysis.
10) VITAMINES
A vitamin is an organic molecular which is an essential micro nutrient, that an organism
needs in small quantities for the proper functioning of its metabolism.
EXAMPLES:-
(01).Cyanocobalamin nascobal (vit B12)
 Cyanocobalamin
 Trade name
 Anacobin
 Indications
 Vitamin B12 deficiency due to mal absorption syndrome as in pernicious
anemia, gastro intestinal pathology dysfunction or surgery, fish tape worm
infestation and gluten enteropathy.
 Action
 Vitamin B 12 is a cobalt containing B complex. Vitamin provided by
Streptomyces griseus. Essential for normal growth, cell reproduction,
maturation of RBCs, nucleoprotein synthesis.
 History of sensitivity to vitamin B12, other coalmines or cobalt; early leber’s
disease.
 Cautions
 Heart disease
 Anemia
 Pulmonary disease
 Dosages
 25mcg, 50mcg, 100mcg, 250mcg tablets
 400mcg/units,500mcg/0.1ml nasal gel
 500mcg/0.1ml nasal spray
153
 Preparation
 Tablets
 Gel
 spray
 Side effects
 Feeling of swelling of body
 Pulmonary edema
 Mild transient diarrhea
 Itching
 Rashes
 Flushing
 Monitor vital signs in patients with cardiac disease and in these receiving
parenteral cyanocobalamin and be alert to symptoms of pulmonary edema,
which generally occur early in therapy.
11) VACCINES
Vaccine is a biological preparation that provides active acquired immunity to a

particular disease.
EXAMPLES:-
(01).Measles, mumps and rubella vaccine

 Measles, mumps and rubella vaccine
 Trade name
 MMR vaccine
 Indications
 Protection of measles, mumps and rubella diseases
 Pregnancy
 lactation
 Dosages
 0.5ml
 Preparation
 Powder for solution
154
 Side effects
 Fever
 Itching
 Difficulty breathing
 Reddening of skin
 swelling of eyes, face
 confusion
 Applies as MMR subcutaneous powder for injection
12) HORMONE THERAPY

Hormone therapy the use of hormones in medical treatment. Treatment with
hormone antagonist may also be referred to as hormonal therapy or anti-hormone
therapy.
EXAMPLES:-
(01).Insulin
 Insulin
 Trade name
 Velosulin
 Indications
 Emergency treatment of diabetic ketoacidosis or coma to initiate therapy in
patient with insulin dependence diabetic mellitus and combination with
intermediate acting or long acting insulin to provide better control of blood
glucose concentration in the diabetic patient.
 Action
 Short-acting, clear colorless solution of exogenous unmodified. Insulin
extraction of beta cells in pork pancreas or synthesized by recombinant DNA
technology.
 Hypersensitivity to insulin
 Cautions
 Pregnancy
 Lactation
 Older adult
 Dosages
 100units /ml
 Preparation
 Liquids
155
 Side effects
 Hypoglycemia
 Head ache
 Nausea
 Tremulousness
 Tremor
 Numb mouth
 Circumpolar pallor
 Frequency of blood glucose monitoring is determined by the type of insulin
regiment and health sates of the patient.
 Special notes
 Learn correct injection techniques.
(02). Growth hormone: - thyroxin
 Levothyroxine sodium (T4)
 Trade name
 Levoxyl
 Indications
 Specific replacement therapy for diminished or absent thyroid function
resulting from primary or secondary atrophy of glands.
 Action
 Synthetically prepared monosodium salt and lovesome of thyroxin with
similar action and uses.
 Hypersensitivity to levothyroxine
 Thyrotoxicosis
 Severe cardiovascular condition
 Adrenaline insufficient
 Cautions
 Angina pectoris
 Hypertension
 Pregnancy
 Lactation
 Dosages
 25mcg, 500mcg, 75mcg, 88mcg, 100mcg tablets
 200mcg,500mcg vials
156
 Preparation
 Tablets
 Vials
 Side effects
 Irritability
 Nervousness
 Insomnia
 Head ache
 Tremor
157
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DRUG STUDY

SUBMITTED TO : MADAM S.A.D.N. PREMATHILAKA

02.) URINARY SYSTEM 38

03.) RESPIRATORY SYSTEM 71

04.) GASTROINTESTINAL TRACT 91

05.) CENTRAL NERVE SYSTEM 114

06.) OPTHALMIC MEDICATION 144

07.) CHEMOTHERAPY DRUGS 147

08.) ANESTHETIC DRUGS 149

09.) DRUGA USED IN GYN AND OBS 151

10.) VITAMINS 153

11.) VACCINES 154

12.) HORMONE THERAPY 155

This includes pharmacological name , trade name , indications , action , contraindication ,

1.3 ACE INHIBITORS

 ANGIOTENSIN 1---- ACE - angiotensin 2

 ANGIOTENSIN 1---- ACE - angiotensin 2

1.5 CALCIUM CHANNAL BLOCKERS

1.6 CHOLESTEROL LOWERING DDRUGS

1.7 DIGITALIS PREPERATION

1.10 ANTI-ARRHYTHMIC DRUGS

2.3 CARBONIC ANHYDRATE INHIBITORS

2.5 ANTI-CHOLINEERGIC DRUGS

Anti-cholinergic agent is a substance that block the neurotransmitters acetylcholine in

 Adjust in all forms of Parkinsonism, also used to control drug-induced

 Synthesis tertiary amine, ant muscarinic. In with other anti-parkinsonism

 Narrow angle glaucoma

 Older adults or debilitated patients

 Monitor blood pressure, pulse after intravenous administration.

 Patient on prolonged therapy can developed tolerance; an increase in

2.6 ADRENERGIC ANTAGONIST

 Inotropic support in short treatment of adults with cardiac compensation due

 Produce inotropic effect by acting on beta receptors and primarily on

 History of hypersensitivity to other sympathomimetic amines

 Tolerance has been observe with continuous or prolong infution.

2.7 ANTI-DIURETIC HORMONES

 Adjutant therapy in patients with abnormal viscid or inspissated mucus

 A lower viscosity and facilitated the removal of secretion.

 Patient with asthma

 10%, 20% solution for inhalation

 Replacement therapy in adrenocortical insufficiency to reduce serum calcium

 Short-acting synthetic steroid with both glucocorticoid and mineralocorticoid

 Idiopatic thrombocytopenic purpura

 Children; diabetic mellitus

 5mg, 10mg, 20mg tablets

 A high protein calcium and vitamin D diet is available to reduce risk of

 An anti-inflammatory agent in the management of acute and chronic

 Intermediate- acting synthetic adrenal corticosteroid with similar

 Synthetic fungal infection

 2mg, 4mg, 8mg, 16mg, 24mg, 32mg tablets

 Monitor diabetic for loss of glycaemia control

 An anti-inflammatory agent in the management of acute and chronic

 Intermediate- acting synthetic adrenal corticosteroid with similar

 Synthetic fungal infection

 2mg, 4mg, 8mg, 16mg, 24mg, 32mg tablets

 Monitor diabetic for loss of glycaemia control

3.8 RESPIRATORY MISCELLANEOUS DRUGS

 Indicated for chronic replacement therapy in patient with alpha antitrypsin