Generic Name: Albuterol

Brand Name: Salbutamol, Proventil, Ventolin, Accuneb, airet, Novo-Salbutamol,

Proventil HFA, Gen-salbutamol, Ventodisk, Ventolin HFA, Volmax, VoSpira ER

Classification: Bronchodilator (therapeutic); adrenergics (pharmacologic)

Indications

1. To control and prevent reversible airway obstruction caused by asthma or

chronic obstructive pulmonary disorder (COPD)
2. Quick relief for bronchospasm
3. For the prevention of exercise-induced bronchospasm
4. Long-term control agent for patients with chronic or persistent
bronchospasm

Mechanism of Action

It relieves nasal congestion and reversible bronchospasm by relaxing the smooth

muscles of the bronchioles. The relief from nasal congestion and bronchospasm is
made possible by the following mechanism that takes place when Salbutamol is
administered.

1. First, it binds to the beta2-adrenergic receptors in the airway of the smooth

muscle which then leads to the activation of the adenyl cyclase and
increased levels of cyclic- 3’5’-adenosine monophosphate (cAMP).
2. When cAMP increases, kinases are activated.
3. Kinases inhibit the phosphorylation of myosin and decrease intracellular
calcium.
4. Decreased in intracellular calcium will result to the relaxation of the smooth
muscle airways.

Contraindications

1. Hypersensitivity to adrenergic amines

2. Hypersensitivity to fluorocarbons

Precaution
 1. Cardiac disease including coronary insufficiency, a history of stroke,
coronary artery disease and cardiac arrhythmias
2. Hypertension
3. Hyperthyroidism
4. Diabetes
5. Glaucoma
6. Geriatric patients – older individuals are at higher risk for adverse reactions
and may require lower dosage
7. Pregnancy especially near term
8. Lactation
9. Children less than 2 years of age because safety of its use has not been
established
10.Excess inhaler use which may lead to tolerance and paradoxical
bronchospasm

Side Effects and Adverse Reactions

1. Nervousness
2. Restlessness
3. Tremor
4. Headache
5. Insomnia
6. Chest pain
7. Palpitations
8. Angina
9. Arrhythmias
10.Hypertension
11.Nausea and vomiting
12.Hyperglycemia
13.Hypokalemia

Route and Dosage

PO (Adults and Children more than 12 years): 2-4 mg 3-4 times a day or 4-8 mg of
extended dose tablets twice a day.

PO (Geriatric Patients): initial dose should not exceed 2 mg 3-4 times a day and
may be increased carefully up to 32 mg/day
PO (Children 6-12 years old): 2 mg 3-4 times a day or 4 mg as extended-release
tablets twice a day; may be carefully increased as needed but not to exceed 24
mg/day

PO (Children 2-6 years old): 0.1 mg/kg 3 times a day

Inhalation (Adults and children more than 4 years of age): 2 inhalations every 4-6
hours

Inhalation (Children 2-12 years old): 0.1-0.15 mg/kg/dose 3-4 times a day

Nursing Interventions

1. Assess lung sounds, PR and BP before drug administration and during peak
of medication.
2. Observe fore paradoxical spasm and withhold medication and notify
physician if condition occurs.
3. Administer PO medications with meals to minimize gastric irritation.
4. Extended-release tablet should be swallowed-whole. It should not be
crushed or chewed.
5. If administering medication through inhalation, allow at least 1 minute
between inhalation of aerosol medication.
6. Advise the patient to rinse mouth with water after each inhalation to
minimize dry mouth.
7. Inform the patient that Albuterol may cause an unusual or bad taste.

GENERIC NAME: Ranitidine

BRAND NAME: Zantac
CLASSIFICATION
Therapeutic:
Anti-ulcer agents
Pharmacologic:
Histamine H2 antagonists

DOSAGE

20 mg
IV q8h
8. MECHANISM OF ACTION
• Inhibits the action of histamine at the H2 receptor site located primarily in
gastric parietal cells, resulting in inhibition of gastric acid secretion.
9. • In addition, ranitidine bismuth citrate has some antibacterial action
against H. pylori.
10.INDICATION
•Treatment and prevention of heartburn, acid indigestion, and sour
stomach.

CONTRA INDICATIONS
Contraindicated in:
11.•Hypersensitivity, Cross-sensitivity may occur; some oral liquids contain
alcohol and should be avoided in patients with known intolerance.
12.Use Cautiously in:
13.• Renal impair- ment
• Geriatric patients (more
susceptible to adverse CNS reactions)
• Pregnancy or Lactation

SIDE EFFECTS/ ADVERSE EFFECTS

• CNS:
Confusion, dizziness, drowsiness, hallucinations, headache
14.• CV:
Arrhythmias
15.• GI:
Altered taste, black tongue, constipation, dark stools, diarrhea, drug-
induced hepatitis, nausea
16.• GU:
Decreased sperm count, impotence
17.• ENDO:
Gynecomastia
18.• HEMAT:
Agranulocytosis, Aplastic Anemia, neutropenia, thrombocytopenia
19.• LOCAL:
Pain at IM site
20.• MISC:
Hypersensitivity reactions, vasculitis
 21.NURSING IMPLICATIONS/RESPONSIBILITIES
• Assess patient for epigastric or abdominal pain and frank or occult blood
in the stool, emesis, or gastric aspirate.
• Nurse should know that it may cause false-positive results for urine
protein; test with sulfosalicylic acid.
• Inform patient that it may cause drowsiness or dizziness.
• Inform patient that increased fluid and fiber intake may minimize
constipation.
• Advise patient to report onset of black, tarry stools; fever, sore throat;
diarrhea; dizziness; rash; confusion; or hallucinations to health car
professional promptly.
• Inform patient that medication may temporarily cause stools and tongue
to appear gray black

Ercefuryl® [susp]

Contents
Nifuroxazide
Indications
Adult & childn Acute diarrhea; food poisoning; Salmonella infections, bacillary
dysentery; tourist diarrhea & its prophylaxis; inflammatory colitis. Ped
Gastroenteritis, enterocolitis; acute intestinal infections; post-antibiotic diarrhea;
prophylaxis in epidemics of gastroenteritis.
Dosage
CapAdult 4 cap/day in to 2-4 intakes. Childn ≥6 yr 3-4 cap/day in 2-4 intakes.
Susp Childn >2 yr660 mg/day in 3 intakes. All treatment duration is limited to 7
days.
Administration
May be taken with or without food
Contraindications
Hypersensitivity to nitrofuran derivatives. Premature & infants, <2 yr. Fructose
intolerance, glucose-galactose malabsorption syndrome or sucrase-isomaltase
deficiency.
Special Precautions
Pregnancy & lactation. Patient on a low-sodium diet. Liver disease, alcoholism,
epilepsy.
Adverse Drug Reactions
Allergic reactions, skin rash, urticaria, Quincke's edema or anaphylactic shock.
View ADR Monitoring Website
Drug Interactions
CNS depressants.
View more drug interactions with Ercefuryl
MIMS Class
Antidiarrheals

Probable Mechanism :
Studies evaluating coadministration of oral live attenuated Ty21a typhoid vaccines
and antibiotics have not been conducted. However, antibiotics active against
Salmonella typhi can reduce the effect of this vaccine and may render
immunisation ineffective. The Centers for Disease Control and Prevention (CDC)
recommends an interval of least 24 hours between administration and the World
Health Organisation (WHO) recommends an interval of 3 days before and after
vaccination.

Actions to be Taken :
1. Transfer requires waiting period (consult literature).
2. Avoid combination.

Restime drops

INDICATION
For relief of discomfort due to the accumulation of gas in the stomach and the
intestines including sensations of bloating, pressure, fullness or stuffed feelings
which can be caused by certain food (eg, carbonated drinks, legumes, potatoes,
infant formula, etc.), air swallowing and dyspepsia.

For relief of symptoms of excess gas associated with colic.

Dosage
Children 2-12 years: 40 mg (1 mL). Do not exceed total dose of 240 mg/day; <2
years: 20 mg (0.5 mL). Do not exceed total dose of 120 mg/day. Doses should be
taken 4 times daily, given after meals and at bedtime.

If a dose is missed, give the next dose and the subsequent doses at the
recommended time or schedule.

Do not double the dose unless recommended by the physician.

Consult the doctor if the patient has taken more than the recommended dose.

Administration: Shake well before use. Fill enclosed dropper to recommended

dosage level and dispense slowly into infant's mouth, toward the inner cheek.

Overdosage
Simethicone overdosage is not expected to cause any clinically important effects.
Administration
Should be taken with food (Take after meals and at bedtime.).
Contraindications
Hypersensitivity to simethicone or any ingredient of Restime.
Special Precautions
Phenylketonurics: Restime contains phenylalanine as 1 of the metabolites as
aspartame.

Reduce air swallowing by avoiding fizzy, carbonated drinks and food that may
increase gas in the stomach.

Adverse Drug Reactions

There have been no reports of undesirable effects after ingestion of simethicone.
Click to view ADR Monitoring Website
Pregnancy Category (US FDA)

Category C: Either studies in animals have revealed adverse effects on the foetus
(teratogenic or embryocidal or other) and there are no controlled studies in
women or studies in women and animals are not available. Drugs should be given
only if the potential benefit justifies the potential risk to the foetus.
Storage
Store at temperatures not exceeding 30°C.

Shelf-Life: 2 years.

Mechanism of Action
Simethicone, a water-repellant with low surface tension used to relieve bloating
and gassiness by causing small bubbles to coalesce to large bubbles, which are
passed more easily. Chemically, simethicone is inactive and has no known
interaction.
MIMS Class
GIT Regulators, Antiflatulents & Anti-Inflammatories

IMMUZINC

Contents
Zn sulfate (syr 55 mg/5 mL:equiv to elemental Zn 20 mg; drops 27.5 mg/mL: equiv
to elemental Zn 10 mg)
Indications
Helps stimulate the activities of many enzymes, promoting normal biochemical
reactions in the body. Adequate daily zinc supplementation helps strengthen the
immune system. Supports normal growth & development. Also helps in the
management of acute diarrhea in infants & chldn.
Dosage
Syr Childn 4-8 yr ¼ tsp; 9-13 yr ½ tsp. Drops Infant & childn 7 mth-3 yr 0.5 mL. All
doses to be taken once daily.
Administration
Should be taken on an empty stomach (Best taken at least 1 hr before or 2 hr
after meals. May be taken w/ meals to reduce GI discomfort.).
MIMS Class
Supplements & Adjuvant Therapy / Vitamins & Minerals (Paediatric)

CALPOL(PARACETAMOL)

Contents
Paracetamol
Indications
Treatment of mild to moderate pain and as antipyretic. Symptomatic relief of
headache, migraine, neuralgia, toothache and teething pains, sore throat,
rheumatic aches and pains, influenza, feverishness and feverish colds.
Dosage
Calpol: Tablet: Adults and Children ≥12 years: 1-2 tabs 3-4 times daily. Maximum
of 4 g/day.

Pediatric Suspension: Children 6-12 years: 10-20 mL (2-4 tsp); 1-6 years: 5-10 mL
(1-2 tsp). Infants 3-12 months: 2.5-5 mL (½-1 tsp); <3 months: Not recommended.

The doses may be repeated 3-4 times a day.

Infant Drops: Children 1-2 years: 1.2-1.8 mL. Infants 6-12 months: 0.6-1.2 mL; 0-6
months: 0.3-0.6 mL.

The doses may be repeated 3-4 times a day.

Calpol Six Plus: Adults and Children >12 years: 10-20 mL (2-4 tsp) every 4 hrs to a
maximum of 4 g/day. Children 6-12 years: 5-10 mL (1-2 tsp); 1-6 years 2.5-5 mL
(½-1 tsp).

The pediatric doses may be repeated 3-4 times a day but with an interval of ≥4 hrs
between each dose.

Overdosage
Pallor, anorexia, nausea and vomiting are frequent early symptoms of
paracetamol overdosage. Hepatic necrosis is a dose-related complication of
paracetamol overdosage. Hepatic enzymes may become elevated and
prothrombin time prolonged within 12-48 hrs but clinical symptoms may not be
apparent for 1-6 days after ingestion. Toxicity is likely in adults who have taken
>10 g.

To protect the patient against delayed hepatotoxicity, paracetamol overdosage

should be treated promptly by gastric lavage followed by N-acetylcysteine IV or
oral methionine. Additional therapy (further methionine or cysteamine IV or N-
acetylcysteine IV) is normally considered in the light of blood paracetamol
content and the time elapsed since ingestion. Fulminant hepatic failure, which
may follow paracetamol overdosage, requires specialized management.

In paracetamol overdosage with liver cell damage, paracetamol t½ is often

prolonged from around 2 hrs in normal adults to 4 hrs or longer. However, liver
cell damage has been found in patients with paracetamol half-life <4 hrs.
Diminution in 14CO2 excretion after oral 14C-aminopyrine has been reported to
correlate better with liver cell damage in paracetamol overdosage than do either
plasma paracetamol concentration or t½ or convention liver function test
measurements. Concomitant renal failure due to acute tubular necrosis may
accompany paracetamol-induced fulminant hepatic failure. The incidence is,
however, no more frequent in these patients than in others with fulminant
hepatic failure from other causes.

Administration
May be taken with or without food
Contraindications
Patients with known hypersensitivity to paracetamol.
Special Precautions
Use in pregnancy & lactation: The safe use of Calpol/Six Plus during pregnancy
has not been established. There is epidemiological evidence of safety of
paracetamol in human pregnancy. A pharmacokinetic study in 12 nursing mothers
revealed that <1% of the dose ingested by a nursing mother appears in human
breast milk, therefore, maternal ingestion of therapeutic doses does not present a
risk to the infant.
Adverse Drug Reactions
Paracetamol has been widely used and, when taken at the usual recommended
dosage, adverse effects are mild and infrequent and reports of adverse drug
reactions are rare. Skin rash and other allergic reactions occur rarely. Most
reports of adverse reactions to paracetamol relate to overdosage with the drug.

Calpol/Six Plus should be used with caution in hepatic or renal dysfunction.

Chronic hepatic necrosis has been reported in a patient who took therapeutic
doses of paracetamol for about a year and liver damage has been reported after
daily ingestion of excessive amounts for shorter periods. A review of a group of
patients with chronic active hepatitis failed to reveal differences in the
abnormalities of liver function in those who were long-term users of paracetamol
nor was the control of their disease improved after paracetamol withdrawal.
Nephrotoxic effects following therapeutic doses of paracetamol are uncommon.
Papillary necrosis has been reported after prolonged administration.
Click to view ADR Monitoring Website

Drug Interactions
Patients who have taken barbiturates, tricyclic antidepressants and alcohol may
show diminished ability to metabolize large doses of paracetamol, the plasma t <1/2

Alcohol can increase the hepatotoxicity of paracetamol overdosage and may have contributed to the acute pancreatitis reported in 1 patient

who had taken an overdosage of paracetamol.

Chronic ingestion of anticonvulsants or oral steroid contraceptives induce liver enzymes and may prevent attainment of therapeutic

paracetamol levels by increasing first-pass metabolism or clearance.

View more drug interactions for Calpol

Pregnancy Category (US FDA)

Category B: Either animal-reproduction studies have not demonstrated a foetal

risk but there are no controlled studies in pregnant women or animal-
reproduction studies have shown an adverse effect (other than a decrease in
fertility) that was not confirmed in controlled studies in women in the 1 st trimester
(and there is no evidence of a risk in later trimesters).
Storage
Store below 25°C. Protect from light.
MIMS Class
Analgesics (Non-Opioid) & Antipyretics

FORTUM

Contents
Ceftazidime
Indications
Treatment of single or multiple infections caused by susceptible organisms.

May be used alone as 1st choice drug before the results of sensitivity tests are
available.
May be used in combination with an aminoglycoside or most other β-lactam
antibiotics.

May be used with an antibiotic against anaerobes when the presence of

Bacteroides fragilis is suspected.

Severe Infections: Septicemia, bacteremia, peritonitis, meningitis; infections in

immunosuppressed patients; infections in patients in intensive care eg, infected
burns.

Respiratory tract infections including lung infections in cystic fibrosis.

Ear, nose and throat infections.

Urinary tract infections.

Skin and soft tissue infections.

Gastrointestinal, biliary and abdominal infections.

Bone and joint infections.

Infections associated with hemo- and peritoneal dialysis and with continuous
ambulatory peritoneal dialysis (CAPD).

Prophylaxis: Prostatic surgery (transurethral resection).

Dosage
Dosage depends upon the severity, sensitivity, site and type of infection and upon
the age and renal function of the patient. Adults: 1-6 g/day in 2 or 3 divided doses
by IV or IM injection. Urinary Tract and Less Severe Infections: 500 mg or 1 g
every 12 hrs. Most Infections: 1 g every 8 hrs or 2 g every 12 hrs. Very Severe
Infections Particularly in Immunocompromised Patients Including Those with
Neutropenia: 2 g every 8 or 12 hrs, or 3 g every 12 hrs. Fibrocystic Adults with
Pseudomonal Lung Infections: 100-150 mg/kg/day in 3 divided doses. In adults
with normal renal function, 9 g/day has been used without ill effects. When used
as a prophylactic agent in prostatic surgery, 1 g should be given at the induction
of anesthesia. A 2nd dose should be considered at the time of catheter removal.
Infants and Children >2 months: 30-100 mg/kg/day in 2 or 3 divided doses. Doses
up to 150 mg/kg/day (maximum 6 g/day) in 3 divided doses may be given to
infected immunocompromised or fibrocystic children or children with meningitis.
Neonates 0-2 months: 25-60 mg/kg/day in 2 divided doses. In neonates, the
serum t1/2 of ceftazidime can be 3-4 times that in adults. Elderly: In view of the
reduced clearance of ceftazidime in acutely ill elderly patients, the daily dosage
should not normally exceed 3 g, especially in those >80 years. Impaired Renal
Function: Ceftazidime is excreted unchanged by the kidneys. Therefore, in
patients with impaired renal function, the dosage should be reduced. An initial
loading dose of 1 g should be given. Maintenance doses should be based on
creatinine clearance: See Table 1.
Click on icon to see table/diagram
In patients with severe infections, the unit dose should be increased by 50% or
the dosing frequency increased. In such patients, the ceftazidime serum levels
should be monitored and trough levels should not exceed 40 mg/L. In children,
the creatinine clearance should be adjusted for body surface area or lean body
mass. Hemodialysis: The serum t1/2 during hemodialysis ranges from 3-5 hrs.
Following each hemodialysis period, the maintenance dose of Fortum
recommended in Table 1 should be repeated. Peritoneal Dialysis: Fortum may be
used in peritoneal dialysis and continuous ambulatory peritoneal dialysis (CAPD).
In addition to IV use, Fortum can be incorporated into the dialysis fluid (usually
125-250 mg for 2 L of dialysis solution). For patients with renal failure on
continuous arteriovenous hemodialysis or high-flux hemofiltration in intensive
therapy units: 1 g daily either as a single dose or in divided doses. For low-flux
hemofiltration, follow the dosage recommended under impaired renal function.
For patients on venovenous hemofiltration and venovenous hemodialysis, follow
the dosage recommendations in Table 2 and 3.
Click on icon to see table/diagram

Click on icon to see table/diagram

Overdosage
Overdosage can lead to neurological sequelae including encephalopathy,
convulsions and coma. Serum levels of ceftazidime can be reduced by
hemodialysis or peritoneal dialysis.
Contraindications
Patients with known hypersensitivity to cephalosporin antibiotics and ceftazidime
pentahydrate or to any of the excipients of the injection.
Special Precautions
General: Before beginning treatment, establish whether the patient has a history
of hypersensitivity reactions to ceftazidime, cephalosporins, penicillins or other
drugs.

Special care is indicated in patients who have experienced an allergic reaction to

penicillins or other β-lactams. If an allergic reaction to Fortum occurs, discontinue
the drug. Serious hypersensitivity reactions may require epinephrine (adrenaline),
hydrocortisone, antihistamine or other emergency measures.

Concurrent treatment with high doses of cephalosporins and nephrotoxic drugs

eg, aminoglycosides or potent diuretics (eg, frusemide), may adversely affect
renal function. Clinical experience has shown that this is not likely to be a problem
with Fortum at the recommended dose levels. There is no evidence that Fortum
adversely affects renal function at normal therapeutic doses.

Ceftazidime is eliminated via the kidneys, therefore, the dosage should be

reduced according to the degree of renal impairment. Neurological sequelae have
occasionally been reported when the dose has not been reduced in patients with
renal impairment (see Impaired Renal Function under Dosage & Administration
and Adverse Reactions).

As with other broad-spectrum antibiotics, prolonged use may result in the

overgrowth of nonsusceptible organisms (eg, Candida, Enterococci) which may
require interruption of treatment or appropriate measures. Repeated evaluation
of the patient's condition is essential.

As with other extended-spectrum cephalosporins and penicillins, some initially

susceptible strains of Enterobacter sp and Serratia sp may develop resistance
during ceftazidime therapy. When clinically appropriate during therapy of such
infections, periodic susceptibility testing should be considered.

Effects on the Ability to Drive or Operate Machinery: None reported.

Use in pregnancy & lactation: There is no experimental evidence of embryopathic

or teratogenic effects, but as with all drugs, Fortum should be administered with
caution during the early months of pregnancy and early infancy.
Ceftazidime is excreted in human milk in small quantities and should be used with
caution in breastfeeding.

Adverse Drug Reactions

Data from large clinical trials (internal and published) were used to determine the
frequency of very common to uncommon undesirable effects. The frequencies
assigned to all other undesirable effects were mainly determined using post-
marketing data and refer to a reporting rate rather than a true frequency.

The following convention has been used for the classification of frequency: Very
common ≥1/10, common: ≥1/100 and <1/10, uncommon: ≥1/1000 and <1/100,
rare: ≥1/10,000 and <1/1000, very rare: <1/10,000.

Infections and Infestations: Uncommon: Candidiasis (including vaginitis and oral

thrush).

Blood and Lymphatic System Disorders: Common: Eosinophilia and

thrombocytosis. Uncommon: Leukopenia, neutropenia and thrombocytopenia.
Very rare: Lymphocytosis, hemolytic anemia and agranulocytosis.

Immune System Disorders: Very rare: Anaphylaxis (including bronchospasm

and/or hypotension).

Nervous System Disorders: Uncommon: Headache and dizziness. Very rare:

Paresthesia.

There have been reports of neurological sequelae including tremor, myoclonia,

convulsions, encephalopathy and coma in patients with renal impairment in
whom the dose of Fortum has not been appropriately reduced.

Vascular Disorders: Common: Phlebitis or thrombophlebitis with IV

administration.

Gastrointestinal Disorders: Common: Diarrhea. Uncommon: Nausea, vomiting,

abdominal pain and colitis. Very rare: Bad taste.

As with other cephalosporins, colitis may be associated with Clostridium difficile

and may present as pseudomembranous colitis.
Hepatobiliary Disorders: Common: Transient elevations in ≥1 of the hepatic
enzymes, ALT (SGPT), AST (SOGT), LDH, GGT and alkaline phosphatase. Very rare:
Jaundice.

Skin and Subcutaneous Tissue Disorders: Common: Maculopapular or urticarial

rash. Uncommon: Pruritus. Very rare: Angioedema, erythema multiforme,
Stevens-Johnson syndrome and toxic epidermal necrolysis.

General Disorders and Administration Site Conditions: Common: Pain and/or

inflammation after IM injection. Uncommon: Fever.

Investigations: Common: Positive Coombs' test. Uncommon: As with some other

cephalosporins, transient elevations of blood urea, blood urea nitrogen and/or
serum creatinine have been observed.

A positive Coombs' test develops in about 5% of patients and may interfere with
blood cross-matching.
Click to view ADR Monitoring Website

Drug Interactions
Concurrent use of high doses with nephrotoxic drugs may adversely affect renal
function (see Precautions).

Chloramphenicol is antagonistic in vitro with ceftazidime and other

cephalosporins. The clinical relevance of this finding is unknown, but if concurrent
administration of Fortum with chloramphenicol is proposed, the possibility of
antagonism should be considered.

In common with other antibiotics, ceftazidime may affect the gut flora, leading to
lower estrogen reabsorption and reduced efficacy of combined oral
contraceptives.

Ceftazidime does not interfere with enzyme-based tests for glycosuria but slight
interference may occur with copper reduction methods (Benedict's, Fehling's
Tests and Clinitest).

Ceftazidime does not interfere in the alkaline picrate assay for creatinine.
Incompatibilities: Fortum is less stable in sodium bicarbonate injection than in
other IV fluids. It is not recommended as a diluent. Ceftazidime and
aminoglycosides should not be mixed in the same giving set or syringe.
Precipitation has been reported with vancomycin added to ceftazidime in
solution. Therefore, it would be prudent to flush giving sets and IV lines between
administration of these 2 agents.
View more drug interactions for Fortum

Pregnancy Category (US FDA)

Category B: Either animal-reproduction studies have not demonstrated a foetal

risk but there are no controlled studies in pregnant women or animal-
reproduction studies have shown an adverse effect (other than a decrease in
fertility) that was not confirmed in controlled studies in women in the 1 st trimester
(and there is no evidence of a risk in later trimesters).

Cautions For Usage

Instructions for Use & Handling: All sizes of vials of Fortum injection are supplied
under reduced pressure. As the product dissolves, carbon dioxide is released and
a positive pressure develops. Small bubbles of carbon dioxide in the constituted
solution may be ignored. (See Table 4). Solutions range from light yellow to amber
depending on concentration, diluent and storage conditions used. Within the
stated recommendations, potency of Fortum is not adversely affected by such
color variations. Ceftazidime at concentrations between 1 and 40 mg/mL is
compatible with 0.9% sodium chloride injection; M/6 sodium lactate injection;
compound sodium lactate injection (Hartmann's solution); 5% dextrose injection;
0.225% sodium chloride and 5% dextrose injection; 0.45% sodium chloride and
5% dextrose injection; 0.9% sodium chloride and 5% dextrose injection; 0.18%
sodium chloride and 4% dextrose injection; 10% dextrose injection; dextran 40
injection 10% in 0.9% sodium chloride injection; dextran 40 injection 10% in 5%
dextrose injection; dextran 70 injection 6% in 0.9% sodium chloride injection;
dextran 70 injection 6% in 5% dextrose injection. Ceftazidime at concentrations
between 0.05 and 0.25 mg/mL is compatible with intraperitoneal dialysis fluid
(lactate). Fortum may be constituted for IM use with 0.5% or 1% lignocaine HCl
injection. Both components retain satisfactory potency when ceftazidime at 4
mg/mL is admixed with hydrocortisone sodium phosphate 1 mg/mL in 0.9%
sodium chloride injection or 5% dextrose injection; cefuroxime sodium 3 mg/mL
in 0.9% sodium chloride injection; cloxacillin sodium 4 mg/mL in 0.9% sodium
chloride injection; heparin 10 or 50 iu/mL in 0.9% sodium chloride injection;
potassium chloride 10 or 40 mEq/L in 0.9% sodium chloride injection. The
contents of a 500-mg vial of Fortum for injection constituted with 1.5 mL water
for injection may be added to metronidazole injection (500 mg in 100 mL) and
both retain their activity. Preparation of Solutions for IM or IV Bolus Injection:
Introduce the syringe needle through the vial closure and inject the
recommended volume of diluent. Withdraw the needle and shake the vial to give
a clear solution. Invert the vial. With the syringe piston fully depressed, insert the
needle into the solution. Withdraw the total volume of solution into the syringe
ensuring that the needle remains in the solution. Small bubbles of carbon dioxide
may be disregarded. Preparation of Solution for IV Infusion from Fortum Injection
(mini-bag or burette-type set): Prepare using a total of 50 mL (for 1 and 2 g vials)
and 75 mL (for 3 g vials) of compatible diluent, added in 2 stages as follows (1, 2
and 3 g vials for IV infusion): Introduce the syringe needle through the vial closure
and inject 10 mL of diluent for the 1 and 2 g vials and 15 mL for the 3 g vial;
withdraw the needle and shake the vial to give a clear solution; do not insert a gas
relief needle until Fortum has dissolved; insert a gas relief needle through the vial
closure to relieve the internal pressure; transfer the reconstituted solution to final
delivery vehicle (eg, mini-bag or burette-type set) making up a total volume of at
least 50 mL (75 mL for the 3 g vial) and administer by IV infusion over 15-30 min.
Note: To preserve product sterility, it is important that the gas relief needle is not
inserted through the vial closure before Fortum has dissolved. Preparation of
Solution for IV Infusion Using Fortum Monovial: The contents of the monovial are
added to small volume infusion bags containing 0.9% sodium chloride injection or
5% dextrose injection or another compatible fluid. The 2 g monovial must be
constituted using a 100 mL infusion bag: Peel off the removable top part of the
label and remove the cap; insert the needle of the monovial into the additive port
of the infusion bag; to activate, push the plastic needle holder of the monovial
down onto the vial shoulder until a "click" is heard; holding it upright, fill the vial
to approximately 2/3 capacity by squeezing the bag several times; shake the vial
to reconstitue Fortum; on reconstitution, Fortum will effervesce slightly; with the
vial uppermost, transfer the recontituted Fortum into the infusion bag by
squeezing and releasing the bag; repeat steps 4-7 to rinse the inside of the vial,
dispose the empty monovial safely and check that the powder has dissolved and
that the bag has no leaks.
Storage
Store at a temperature not exceeding 25°C. Protect unconstituted vials from light.
The reconstituted solution will retain potency for 18 hrs if stored below 25°C and
7 days if refrigerated (4°C).
Description
Fortum for injection contains ceftazidime as pentahydrate with sodium carbonate
118 mg/g of ceftazidime. On the addition of water for injections, Fortum for
injection dissolves with effervescence to produce a solution for injection.

Fortum for injection contains approximately 52 mg (2.3 mEq) of sodium per gram
of ceftazidime.

Ceftazidime pentahydrate 116 mg is equivalent to ceftazidime free acid 100 mg.

For laboratory tests associated with ceftazidime administration, use ceftazidime
pentahydrate obtainable on request from GlaxoSmithKline.

Mechanism of Action
Pharmacology: Mechanism of Action: Ceftazidime is bactericidal in action. It acts
by inhibiting bacterial cell wall synthesis.

Microbiology: A wide range of pathogenic strains and isolates are susceptible in

vitro including strains resistant to gentamicin and other aminoglycosides.
Ceftazidime is highly stable to most clinically important β-lactamases produced by
both gram-positive and gram-negative organisms, therefore, it is active against
many ampicillin- and cephalotin-resistant strains. Ceftazidime has high intrinsic
activity in vitro and acts within a narrow MIC range for most genera with minimal
changes in MIC at varied inoculum levels. In vitro, the activities of ceftazidime and
aminoglycosides in combination are additive. There is evidence of synergy in
some strains.

Ceftazidime is active in vitro against the following organisms:

Gram-Negative: Pseudomonas aeruginosa, Pseudomonas sp (including P.

pseudomallei), Escherichia coli, Klebsiella sp (including Klebsiella pneumoniae),
Proteus mirabilis, Proteus vulgaris, Morganella morganii (formerly Proteus
morganii), Proteus rettgeri, Providencia sp, Enterobacter sp, Citrobacter sp,
Serratia sp, Salmonella sp and Shigella sp, Yersinia enterocolitica, Pasteurella
multocida, Acinetobacter sp, Neisseria gonorrhoeae, Neisseria meningitidis,
Haemophilus influenzae (including ampicillin-resistant strains) and Haemophilus
parainfluenzae (including ampicillin-resistant strains).

Gram-Positive: Staphylococcus aureus (methicillin-sensitive strains),

Staphylococcus epidermidis (methicillin-sensitive strains), Micrococcus sp,
Streptococcus pyogenes (Group A β-hemolytic streptococci), Streptococcus Group
B (S. agalactiae), Streptococcus pneumoniae, Streptococcus mitis, Streptococcus
sp [excluding Enterococcus (Streptococcus faecalis)].

Anaerobic Strains: Peptococcus sp, Peptostreptococcus sp, Streptococcus sp and

Propionibacterium sp, Clostridium perfringens, Fusobacterium sp and Bacteroides
sp (many strains of Bacteroides fragilis resistant).

Ceftazidime is not active in vitro against the following organisms: Methicillin-

resistant staphylococci, Enterococcus (Streptococcus) faecalis and many other
Enterococci, Clostridium difficile, Listeria monocytogenes and Campylobacter sp.

Pharmacokinetics: Absorption: After IM administration of 500 mg and 1 g, peak

levels of 18 and 37 mg/L, respectively, are achieved rapidly. Five min after IV
bolus injection of 500 mg, 1 or 2 g, serum levels are 46, 87 and 170 mg/L.

Distribution: Therapeutically effective concentrations are still present in the

serum 8-12 hrs after either IV or IM administration. Serum protein-binding is
about 10%. Concentrations in excess of the MIC for common pathogens can be
achieved in tissues eg, bone, heart, bile, sputum, aqueous humour, synovial,
pleural and peritoneal fluids. Ceftazidime crosses the placenta readily and is
excreted in the breast milk. Penetration of the intact blood-brain barrier is poor
resulting in low levels of ceftazidime in the CSF in the absence of inflammation.
However, therapeutic levels of 4-20 mg/L or more are achieved in the CSF when
the meninges are inflamed.

Metabolism: Ceftazidime is not metabolized in the body.

Elimination: Parenteral administration produces high and prolonged serum levels

which decrease with a t1/2 of about 2 hrs. Ceftazidime is excreted unchanged, in
active form into the urine by glomerular filtration; approximately 80-90% of the
dose is recovered in the urine within 24 hrs. Less than 1% is excreted via the bile
which limits the amount entering the bowel.
Toxicology: Preclinical Safety Data: No additional data of relevance.

Special Patient Populations: Elimination of ceftazidime is decreased in patients

with impaired renal function and the dose should be reduced (see Renal
Impairment under Dosage & Administration and Precautions).

MIMS Class
Cephalosporins

ZYRTEC

Contents
Cetirizine diHCl
Indications
Symptomatic treatment of perennial and seasonal allergic rhinitis (eg, rhinorrhea,
nasal pruritus & sneezing) acute and chronic idiopathic urticaria, allergic
dermatological disorders and allergic conjunctivitis.
Dosage
Tablet: Adults and Children 12 years: In most cases, the recommended dose is
one 10-mg tab daily.

In patients affected by side effects, the dose may be taken as 5 mg in the morning
and 5 mg in the evening.

Oral Solution: Children 6-12 years: 10 mg daily either as a single dose (2 tsp once)
or as divided doses (1 tsp in the morning and 1 tsp in the evening).

Oral Drops: Children 6-12 years: 20 drops (1 mL) daily as a single dose or 10 drops
in the morning and evening; 2-6 years: 10 drops daily as a single dose or 5 drops
in the morning and evening; 1-2 years: 5 drops twice daily.

Overdosage
Drowsiness can be a symptom of overdosage, occurring from administration of 50
mg of Zyrtec as a single dose.

To date, there is no specific antidote.

In the case of massive overdosage, gastric lavage should be performed as soon as
possible. Usual supportive measures should be provided and routine observation
carried out regularly.

Administration
May be taken with or without food
Contraindications
Patients with history of allergy to hydroxyzine or piperazine derivatives, or to any
of Zyrtec's constituents

Severe renal impairment (CrCl <10 mL/min).

Rare hereditary problems eg, galactose intolerance, Lapp-lactase insufficiency,

glucose-galactose malabsorption should not take Zyrtec tablet.

Patients with rare hereditary fructose intolerance should not take the Zyrtec oral
solution.

Special Precautions
At therapeutic doses, Zyrtec does not potentiate the effect of alcohol (at a blood
level of 0.8 g/L). Care should, however, be taken.

Effects on the Ability to Drive or Operate Machinery: Studies in healthy volunteers

on 20 or 25 mg/day have not revealed effects on alertness or reaction time.
Patient should be advised, however, to take care not to exceed the recommended
dose.

Use in pregnancy & lactation: Teratology studies in animals have not

demonstrated any special adverse effects. As a precaution, however, Zyrtec
should not be administered to pregnant women during the first 3 months of
pregnancy, nor should women who are breastfeeding take the drug.

Side Effects
When Zyrtec is administered at recommended doses any side effects that may
occur eg, agitation, dry mouth, drowsiness or headache, do not differ significantly
from placebo.

Very occasionally, symptoms of hypersensitivity have been reported.

Drug Interactions
To date, there are no known interactions with other drugs. Nevertheless, Zyrtec
should be used with caution if sedatives are also being taken.
View more drug interactions for Zyrtec
Pregnancy Category (US FDA)

Category B: Either animal-reproduction studies have not demonstrated a foetal

risk but there are no controlled studies in pregnant women or animal-
reproduction studies have shown an adverse effect (other than a decrease in
fertility) that was not confirmed in controlled studies in women in the 1 st trimester
(and there is no evidence of a risk in later trimesters).
Storage
Store below 25°C in a dry place.
Mechanism of Action
Pharmacology: In experimental animals, Zyrtec has been shown to be an anti-H1
agent devoid of any significant anticholinergic or antiserotonin effects. At
pharmacologically active doses, it induces neither sedation nor behavioral
changes. This may be explained by the fact that Zyrtec does not cross the blood-
brain barrier.

It was shown in human pharmacology studies that Zyrtec will inhibit certain
effects produced by exogenous histamine. This activity appears rapidly. Zyrtec
also inhibits the effects produced by endogenous histamine released in vivo by an
agent eg, 48/80. Finally, it inhibits the cutaneous reaction induced by VIP
(Vasoactive Intestinal Polypeptide) and substance P, neuropeptides which are
believed to take part in the allergic reaction.

Zyrtec markedly reduces bronchial hyper-reactivity to histamine in the asthmatic

patient. It also reduces the allergic reaction induced by specific allergens. These
effects are obtained without any central effects being demonstrated either by
psychometric test or by a quantified EEG.

Pharmacokinetics: Peak blood levels of the order of 0.3 mcg/mL are reached
between 30 and 60 min after administration of a 10-mg dose of Zyrtec. Its plasma
half-life is approximately 11 hrs. Absorption is very consistent from one subject to
the next. Its renal clearance is 30 mL/min and the excretion half-life is
approximately 9 hrs. Zyrtec is strongly bound to plasma proteins.

MIMS Class
Antihistamines & Antiallergics

Brand Name: Sinecod

Generic Name: Butamirate Citrate
Indications: Acute cough of any etiology. Pre and Post op cough sodation for
surgical

procedures and bronchoscopy.

Drug Classification:Antitussive
Mechanism of action: Act centrally (on brain, and specifically the vagus nerve) or
locally (on the respiratory tract) to suppress the cough reflex.

Dosage: 1-2 tab daily, 1 tbsp daily.

Special Precaution: Pregnancy and lactation.
Pregnancy Risk Category: C
Adverse reaction: CNS: dizziness. GI: Nausea and vomiting, diarrhea. Skin: rash
Contraindication: Hypersensitivity to drug
Form: Sustained release tablet and syrup
Nursing Responsibilities:

Assess cough type and frequency

Monitor the adverse reactions
Assess patient’s VS
Assess sleep pattern.

Teach patient:

-if cough persist 10 days + fever or chest pain – check with Doctor.
-Don’t exceed recommended dose
-Drink fluids but not immediately after dose
-Since the drug may cause dizziness or drowsiness, caution patient to avoid
driving or other activities requiring alertness until response to medication is
known.
-Advise patient to minimize cough by avoiding irritants (cigarette smoke, fumes,
dust)
-Instruct patient to cough effectively, sit upright and take several deep breaths
before attemting.

immuzinc
Contents

Zn sulfate (syr 55 mg/5 mL:equiv to elemental Zn 20 mg; drops 27.5 mg/mL: equiv to elemental Zn 10
mg)

Indications

Helps stimulate the activities of many enzymes, promoting normal biochemical reactions in the body.
Adequate daily zinc supplementation helps strengthen the immune system. Supports normal growth &
development. Also helps in the management of acute diarrhea in infants & chldn.

Dosage

Syr Childn 4-8 yr ¼ tsp; 9-13 yr ½ tsp. Drops Infant & childn 7 mth-3 yr 0.5 mL. All doses to be taken once
daily.

Administration

Should be taken on an empty stomach (Best taken at least 1 hr before or 2 hr after meals. May be taken
w/ meals to reduce GI discomfort.).

Mechanism of action:

An essential mineral that stimulates the activities of many enzymes, promoting

normal biochemical reactions in the body Helps strengthen the immune system,
supports normal growth and development, and helps prevent growth retardation
in young adults, children and infants.
Contraindication:

With pregnancy and lactation (recommended dietary allowance is needed but not
supplemental replacement.

Side Effects:

Nursing consideration:
Take the drug exactly as prescribe. Do not exceed prescribed dosage .Take with
food, but avoid taking it with other high ±fiber foods, dairy products that may
interfere absorption. Report severe N & V, restlessness , fatigue .