MISCELLANEOUS

DRUGS

Protocol
Immunosuppressants

and

immunostimulants
Vitamins
Minerals
Vaccines and antisera
Drugs used in Cardio-pulmonary
resuscitation (CPR) & emergency
Drug therapy in scabies & pediculosis
Enzymes in therapy
Alternative systems of medicine

Immunosuppressants
Suppress the immune system (cell
mediated or humoral or both)
Classification:
1. T-Cell inhibitors cyclosporine,
tacrolimus
2. Cytotoxic drugs Methotrexate,
cyclophosphamide
3. Glucocorticoids - Prednisolone
4. Antibodies Muromonab, Infliximab

Immunosuppressants
Glucocorticoids:
Immunosuppressant and anti-

inflammatory
Treat graft rejections, myasthenia gravis,
RA, SLE, IBD
Azathioprine:
Suppresses cell mediated immunity.
It is anti inflammatory
RA
Bone marrow suppression,

Immunosuppressants
Cyclophosphamide
Alkylating agent
MS, Hemolytic anemia
Nephrotoxicity and hepatotoxicity

Cyclosporine
Organ transplantation liver, kidney, bone marrow
Myasthenia gravis, RA, SLE
Nephrotoxicity, hepatotoxicity, gingival hyperplasia

Tacrolimus

Immunosuppressants
Nursing Implications
Personal

hygiene patients and

attenders
Sterile techniques (Injection, wound
dressing)
Persons with infection prevent
patient contact
Teach patient to report signs of
infection like fever
Monitor renal function, liver function,
blood counts

Immunostimulants
Enhance

immune response.

Drug

Uses

BCG vaccine

Urinary bladder carcinoma

Thalidomide

Multiple myeloma

Interferons

Malignant melanoma,
Hepatitis B and C

Levamisole

Colon cancer

Vitamins
Vitamins

are organic substances that

are needed in small quantities for
meeting the metabolic demands of
the body
Mostly serve as cofactors for
enzymes involved in metabolism
Classification
1. Fat soluble A,D,E and K
2. Water soluble B-complex, C

Fat soluble vitamins

Vitamins

Source

Role

Deficiency
symptoms

Uses

A (Retinol)

Carrot
Cabbage
Pumpkin
Mango
Orange
Papaya
Fish
Liver oil

Vision (dark
adaptation)
Bone
development
Maintain the
integrity of
epithelial
cells
Cell
mediated
immunity

Night
blindness

RX: 50000100000 IU PO
for 3 days

Stimulates
Ca, po4
absorption
from git,
kidney &

Rickets in
children
Osteomalacia
in adults

Daily req:
4000 IU

D
(Calciferol)
100-200 IU

Produced in
skin by action
of sunlight
Fish
Liver oil

Xerophthalmia
Faulty bone
modelling

PX: 4000 IU
PO/day

Dryness of
skin
(phrynoderma)
Rx-4000
IU/day
Px-400
IU/day

Fat soluble vitamins

(contd.,)
Vitamins

Source

Role

Deficiency
symptoms

Uses

Vegetable
E
(Tocopherol) seed oil
5-15 mg
Nuts
Cereals
Green leaves

Antioxidant
protection
against
cancer,
coronary
artery
disease

Peripheral
neuropathy
Abortion
Male sterility
Degenerativ
e changes in
skeletal
muscles

Nocturnal
muscle
cramps
Fibrocystic
breast
disease

K (K1
Phytonadio
ne)
70-140 mcg

Synthesis of
clotting
factors
(II,VII,IX,X)

Bleeding

Bleeding
associated
with vitamin
k def.
Warfarin
toxicity

Liver
Leafy
vegetable(spi
nach,
cabbage,
tomato)

Water soluble vitamins

Vitamins

Role

Deficiency symptom & uses

B Complex Meat, milk, cereals, pulses and vegetable products except B 12

(only meat, fish, egg, milk). Occur together in food
B1 (Thiamine)
(1-2 mg)

B2 (Riboflavin)
2-3 mg

Coenzyme in
various redox
reactions
involving
carbohydrate and
fat metabolism

B3 (Niacin)
15-20mg

B6 (Pyridoxine)
2 mg

Beri-beri (neuropathy, heart

failure)
Require for pt on reg. hemodialysis
In alcoholics
Glossitis, stomatitis
Angular cheilitis
Pellagra (diarrhoea, dermatitis,
dementia)
Use as a hypolipidaemic agent

Carbohydrate, fat,
protein
metabolism

Peripheral neuritis, anemia,

convulsions
With INH

Vitamins

Role

Deficiency symptom & uses

Folic acid
500-800mcg

THF(active form) DNA,

purines, pyrimidines,
amino acids synthesis

Megaloblastic anaemia
Px in pregnancy
MTX toxicity

B12
1mcg

C
(Ascorbic
acid)
30-50 mg
Citrus fruit

Along with folic acid Megaloblastic anaemia

require for DNA
Peripheral neuritis
synthesis
Pernicious anaemia
(synthesized in the
colon by bacteria. Meat,
liver, eggs fish)
Formation of
haemoglobin and
maturation of RBCs
Formation of collagen,
bone, teeth

Scurvy (fatigue,
swollen spongy
bleeding gums,
loose teeth,
conjunctival and
subperiosteal
hemorrhages,

Used in common
cold and viral
infection

 Uses:
Scurvy

Rx 500-1500 mg/day
Px 50-100 mg/day
To acidify urine in alkaline drug
poisoning
Help in healing of wound
Use in common cold
cancer

Key points
Vitamin

A avoided in pregnancy
Vitamin A,D, E, K can cause
hypervitaminosis
Niacin itching, flushing on oral
administration can be prevented by
aspirin

MINERALS
Elements

essential for normal body

functions
Needed

in large quantities:

Calcium, sodium, potassium,

magnesium, phosphorus, chloride,

sulphur
Needed

in small quantities:

Iron, zinc, manganese, copper, iodine,

Sodium
Widely

distributed in ECF (130-145 mEq/L)

Daily requirement 5-10 g/day
Common salt
Lost through sweat and urine
Hyponatremia cramps, hypotension,
tachycardia. 0.9% NS or salt
supplementation
Hypernatremia CCF, renal failure.
Oedema, altered mentation, rise in BP.
Loop diuretics, salt restriction

Potassium
ICF

important constituent
Normal level 3.5 to 5 mEq/L
Maintenance of muscular and neuronal activity
Source - Tender coconut, banana, orange, nuts
<3mEq/L sweating, vomiting, diarrhea, DKA,
diuretics
Oral potassium salt diluted in tumbler full
of water. I.V slow
>5mEq/L NSAIDs, ACEs, renal failure, burns
10% calcium gluconate, salbutamol, insulin
with glucose

Magnesium
Bone

and teeth
0.3 0.35 g/day
Fish, green leafy vegetables, coconut.
Actions:
i.m and i.v CNS, Cardiac depressant,

Uterine relaxant
Oral Antacid and osmotic purgative
Rectal reduce intracranial tension
Topical oedema
Hypermagnesaemia

gluconate

10% Calcium

Zinc
Cofactor

CA, LDH, ALK

Sources Egg, meat, cereals, fruits, nuts
Deficiency dermatitis, delayed wound
healing, alopecia, growth retardation
Zinc Oxide Astringent and antiseptic.
Eczema, haemorrhoids, skin infection
Zinc Sulphate Helps in healing of
ulcers. To treat diarrhea
Zinc Carbonate in calamine lotion. In
eczema, sunburns, skin rashes.

Phosphorus
Sources

egg, meat, fish, pulses,

cereals
Daily requirement 0.8 to 1 g/day
Hypophosphataemia Chronic
antacid use, hyperparathyroidism, vit
D def, DKA.
Hyperphosphataemia renal failure.
Calcium carbonate and aluminium
hydroxide to decrease absorption of
phosphorus from intestine

Minerals Key points

Monitor patient being treated for electrolyte

disturbances

Oral potassium salts should be mixed with

sufficient water and then administered to prevent
intestinal ulceration

I.V. KCl is administered after mixing with i.v fluids

I.V. potassium should be administered slowly and

patient be monitored

Calcium should not be administered in fluids

containing bicarbonates as it will be precipitated

Vaccines and antisera

Vaccines are biological products
which increase the immunity of the
body. They are antigenic materials.
Types

Constituent

Killed
(Inactivated)

Micro-organisms killed by heat,

chemicals

Live attenuated Live micro-organisms rendered

avirulent
Toxoid

Modified bacterial exotoxins so that

toxicity is lost but antigenicity is
retained

Types of Immunization
Active

immunization administration
of antigen to host in order to induce
antibody production
eg:- Vaccines

Passive

immunization providing
immunity to a host passively by
transfer of antibodies.
eg:- antisera, immunoglobulins(Ig)

BACTERIAL VACCINES
KILLED VACCINES
CHOLERA

TYPHOID- PARATYPHOID
WHOOPING COUGH( PERTUSSIS)
MENINGOCOCCAL
HAEMOPHILUS INFLUENZAE TYPE b
PLAGUE

LIVE VACCINES
BCG
(Bacilli Calmette Guerin )
TYPHORAL- Ty 21 a

VIRAL VACCINES
KILLED VACCINES
POLIOMYELITIS, INACTIVATED
(IPV, Salk)

ALL RABIES VACCINES

LIVE VACCINES
POLIOMYELITIS, LIVE ORAL
( OPV, Sabin)

MEASLES

INFLUENZA

RUBELLA

HEPATITIS B

VARICELLA

HEPATITIS A

TOXOIDS
TETANUS TOXOID
(FLUID/ADSORBED)
DIPTHERIA
(ADSORBED)

COMBINED
VACCINES
TYPHOIDPARATYPHOIDCHOLERA (TABC)
MEASLES- MUMPS
RUBELLA (MMR)

Live attenuated vaccine

Killed vaccine

Single dose is sufficient

Repeated doses

Long lasting immunity

Short lasting immunity

More efficacious

Less efficacious

Less stable at room temp

Require proper storage

More stable at room temp

e.g. : BGC, Oral polio, MMR,

chicken pox

e.g. : typhoid, cholera,

pertussis, rabies, polio,
hepatitis B

 BCG

(Bacilli Calmette Guerin

Vaccine)
Live attenuated
Single dose i.m at upper arm at birth or

within 6 weeks of age.

It may cause ulceration and
lymphadenitis

 Polio

vaccine

Oral Polio Vaccine (Sabin): live

attenuated virus
Injectable Polio Vaccine (Salk):

inactivated virus

Oral polio

Injectable polio

Live attenuated

Killed virus

orally

s.c. or i.m. route

Less expensive

expensive

Require storage in
freezer
Suitable for controlling
epidemics

Not require storage

Not suitable for
epidemics

 Diphtheria

Pertussis Tetanus
Toxoid Triple Antigen
Mixed vaccine.
Vial not to be frozen
Given deep i.m at lateral aspect of thigh

in infants
Redness, irritability, fever etc
Paracetamol to control fever

 Measles

Mumps Rubella (MMR)

Vaccine
Mixed vaccine
i.m at age 15 months and 4-5 years.
Pain, swelling, redness. Irritability, fever

etc.

Antisera
Antisera are purified and concentrated
preparations of serum of horses actively
immunized against a specific antigen.
Cause allergic reactions.
Tetanus

antitoxin (ATS)
Diphtheria antitoxin (ADS)
Gas gangrene antitoxin (AGS)
Antirabies serum (ARS)
Antisnake venom polyvalent (ASV)

Snake bite
Reassure
Symptomatic

treatment = clean site

- PCM for pain
- tetanus toxoids
- Immobilize the limbor splinting
Monitor BP, HR, urine output and
respiration
Establish IV line polyvalent anti
snake venom
(20 ml/kg/hour in NS slowed later) after

 Antibiotics

prophylactically
Blood transfusion and packed cell if
necessary
IV neostigmine - in cobra bite
- to reverse neuromuscular
blockade

Vaccines Nursing
Implications

Do not administer if patient has signs of acute

infection, because vaccines exacerbate infections

History: allergy to any vaccines or immunoglobulins,

recent blood transfusion, use of immunoglobulins,
rule out pregnancy in females

Supportive care injection discomfort (local heat

application, resting arm). Flu like symptoms (rest,
paracetamol)

Patient teaching immunization card, explain warning

signs of adverse events, need for booster doses

Key points
All

nurses should be immunized with

hepatitis B vaccine
Live vaccine not given in pregnant
women
Storage proper and protected from
sunlight
Once vaccine vials are opened used
within 1 hour
Check expiry date
Adrenaline, diphenhydramine,

DRUGS USED IN CPR AND

EMERGENCY
BASIC

LIFE SUPPORT

Call for help

Airway
Breathing
Circulation

Advanced Life Support

Oxygen

to correct hypoxia

Endotracheal
Establish
ECG

intubation if necessary

i.v line if necessary

monitoring

Advanced Life Support

(contd,.)

Drug treatment of medical

emergencies
Condition
Anaphylactic
Shock

Hypoglycemia
Adrenal crisis

Acute Angina /
MI

Drug Treatment
Inj. Adrenaline (1:1000) 0.3 to 0.5 ml
i.m
Inj. Hydrocortisone 200mg i.v
Inj. Diphenhydramine 25-50 mg i.v/i.m
Oral glucose or fruit juice or
50ml of 50% glucose i.v
Inj.hydrocortisone 200mg i.v
I.V normal saline with 5% glucose
Fluid and electrolyte imbalance
Tab. Nitroglycerine 0.5mg sublingually
Not more than 3 tablets in 15 mins
If not relieved Aspirin 300mg and
refer to cardiologist

Drug treatment of medical

emergencies
Condition
Status
Asthmaticus

Drug Treatment
Humidified Oxygen
Salbutamol 5-10mg + ipratropium
bromide 0.5mg continuous
nebulization
Inj. Hydrocortisone hemisuccinate
200mg iv stat and every 6th hourly till
attack subsides
Cap.Amoxicillin 500mg PO TDS
Acute Bronchial Salbutamol MDI 100mcg/puff. 1 to 2
Asthma
puffs stat and as and when required
(not >8 puffs/day)
Seizures
Inj. Diazepam 5 10mg i.v slowly or

Drug treatment of medical

emergencies
Condition
Severe
bleeding after
dental
procedures
Tetany
Status
Asthmaticus

Drug Treatment
Pressure + Ice pack
Topical haemocoagulase or
Cotton pad soaked in 0.1% adrenalin
sol or
Inj. Tranexaemic acid 500mg slow i.v
10ml of 10% calcium gluconate slow
i.v
Humidified Oxygen
Salbutamol 5-10mg + ipratropium
bromide 0.5mg continuous
nebulization
Inj. Hydrocortisone hemisuccinate

DRUG THEPAPY OF SCABIES

AND PEDICULOSIS
Scabies
Sarcoptes scabiei
Burrows along the skin and lays eggs
Webs of fingers, hands. Genitalia,

trunk
All the members of family has to be
treated simultaneously

 Pediculosis
They thrive on head (Pediculosis capitis)
Pubic hair (Pediculosis pubis)
Body (Pediculosis corporis)
Eggs (nits) get attached to hair

Drugs for Scabies and

Pediculosis
Drug
Permethrin

Formulati
on
Cream,
lotion, gel

Details
Most efficacious
Scabies: 5% - applied neck to toe, hot
water bath after 12hrs to wash off
drug
Pediculosis: 1% - applied on scalp
and pubis and washed after 10min
Repeated after 1 week
Skin rashes, redness, itching, burning

Drug

Formulati
on

Details

Gamma
Benzene
Hexachlorid
e (Lindane)

Emulsion,
lotion,
cream,
ointment,
soap

Scabies: 1%
Pediculosis: 1%

Benzyl
Benzoate

Emulsion,
Applied twice in a gap of 12 hrs. Scrub
lotion (25%) bath 12 hrs after second application.

Crotamiton

Lotion,
Cream
(10%)

Contraindicated in children, pregnant,

epileptics

Less efficacious. Antipruritic activity

also
Applied after scrub bath. Repeated
after 24 hrs.
Used in children

Drug

Formulati
on

Details

Sulphur

10%
ointment

Bad odour. Rarely used

Less efficacy

DDT
(Dicophane)

Ointment,
lotion (12%)

Applied twice in a gap of 12 hrs. Scrub

bath 12 hrs after second application.

Ivermectin

Tablet(0.2
mg/kg)

Single dose.
Contraindicated in children, pregnant
and lactating women

Scabies and Pediculosis

Key

points

All contacts should be treated

Drugs avoid contact with eyes and

mouth

Enzymes in therapy
Enzymes

proteins secreted by living

cells, which are capable of causing or
accelerating biochemical reactions
Can cause allergic reaction
e.g. hyaluronidase
chymotrypsin
serratiopeptidase
urokinase
t-PA
L- asparaginase

Enzyme

Sources

Availabilit Actions
y & route

Hyaluronida Mammali Topical,

se
an testes sc, im,
intraarticu
lar
Vial
1500U/mL

Uses

Depolymeri promote
the
zes
absorption
hyaluronic
of drugs &
acid &
fluids
increases
resorption
the
of
permiability
extravasat
of the
ed fluid or
tissue
blood in
hematoma
or edema
diffusion
of local
anaestheti
c in
opthalmol
ogy

Enzymes

Sources

Chymotryps Ox
in
pancreas

Availabilit Actions
y & route
Tablet and Proteolytic
topical
enzyme

Uses
reduces
post
operative
oedema
During
cataract
surgery to
facilitate
removal of
lens

Ox
chymotrypsi pancreas
n

Injectable
and tablet

Mucolytic
and
proteolytic
activity

Serratiopept Serratia
idase
species

Tablet

Urokinase

IV

AntiTo relieve
inflammato pain and
ry activity
inflammati
on
Fibrinolytic Acute MI,
DVT, PE

Human
fetal

Enzymes

Sources

Availabili Actions
ty &
route
Tissue
Recombi i.v.
Fibrinolyti
Plasminog nant DNA
c
en
technolo
(dissolves
Activator
gy
clot)
LE. coli
i.V
Asparine
Asparagina

se
Aspartic
acid

Uses

Ac. MI,
DVT, PE

ALL

ALTERNATIVE SYSTEMS OF
MEDICINE
Ayurveda
Ayu life and veda science
Vata
Pitta
Kapha
Aims to treat person as a whole and

prevent disease

 Homeopathy
Samuel Hahnemann
Minute doses of drug which in large

doses produce same symptoms of

disease in healthy individuals
Dilute drug stimulates immunity

 Siddha
Tamil Nadu
Basic concept resembles Ayurveda

Unani
Four humors: Blood, phlegm, yellow bile,

black bile.
Drugs restore humoral balance to retain
health