ANTIHISAYTAMINES
of the nasal mucosa.
AZELASTINE
HYDROCHLORIDE
DRUG CLASS AND
MECHANISM
Azelastine is an anti-
histamine, a chemical that
blocks the effects of
histamine, another chemical
that is responsible for some of
the symptoms in allergic
reactions.
Absorption: 40% absorbed
sytemically through the nasal
mucosa (intranasal).
Metabolism: Hepatic.
Excretion: Via faeces.
DRUG INTERACTIONS:
Azelastine can promote the
sedating effects of other
medications that cause
sedation. Such drugs include
narcotic pain relievers (e.g.,
Percocet), barbiturates,
sedatives such as
alprazolam(Xanax) or
clonazepam(Klonopin), and
ethanol.
ADVERSE EFFECT
Irritation, stinging and itching
Sneezing, nosebleeds,
headache; nausea, taste
disturbances, somnolence,
dry mouth
Additional side effects
experienced by adults being
treated for seasonal allergies
include nasal burning dry
mouth, sneezing, nausea,
fatigue, dizziness, and weight
gain .
INDICATION AND DOSAGE
Opthalmic
conjuctivitis:
Adult: Instill 1-2 drops of
0.05% solution into the
affected eye/s bid, may
increase to four times daily in
severe cases.
Child: ≥4 yr: Instill 1-2 drops
of 0.05% solution into the
affected eye/s bid, may
increase to four times daily in
severe cases.
Nasal
Rhinitis
Adult: 140 mcg by nasal
spray into each nostril bid.
Child: ≥5 yr: 140 mcg by
nasal spray into each nostril
bid.

BROMPHENIRAMINE
PHARMACOLOGY
Brompheniramine works by
acting as an antagonist of
histamine H1 receptors.It also
functions as a moderately
effective anticholinergic agent,
and is likely an agent similar
to other common
antihistamines such as
antimuscarinic
diphenhydramine.
Brompheniramine is
metabolised bycytochrome P4
50s.
The halogenated alkylamine
antihistamines all exhibit optic
isomerism and
brompheniramine products
contain racaemic
brompheniramine maleate
whereas dexbrompheniramine
(Drixoral) is the dextrorotary
(right-handed) stereoisomer.
SIDE EFFECT AND
ADVERSE EFFECT
Its effects on the cholinergic
system may include side-
effects such as drowsiness,
sedation, dry mouth, dry
throat, blurred vision, and
increased heart rate.
BRAND NAME
Allent® (containing
Brompheniramine Maleate
and Pseudoephedrine
Hydrochloride)
NSG. RESPONSIBILITY
It is important for you to keep
a written list of all of the
prescription and
nonprescription (over-the-
counter) medicines you are
taking, as well as any
products such as vitamins,
minerals, or other dietary
supplements. You should
bring this list with you each
time you visit a doctor or if
you are admitted to a hospital.
It is also important information
to carry with you in case of
emergencies.
FEXOFENADINE
HYDROCHLORIDE
BRAND NAME
Allegra, Telfast (UK)
INDICATION

Fexofenadine is indicated for
the relief from physical
symptoms associated
withseasonal allegic rhinitis
and treatment ofchronic
idiopathic urticaria. It is not a
therapeutic drug and does not
cure but rather prevents the
aggravation of rhinitisand and
reduces the severity of the
symptoms providing much
relief from repeated sneezing,
runny nose, itchy eyes and
general body fatigue caused
by rhinitis and urticaria.
DOSAGE
• Suspension: 6 mg/mL
(30 mL, 300 mL)
[raspberry cream]
• Tablet: 30 mg, 60 mg,
180 mg
SIDE EFFECT
Nausea Dizziness Vomiting
Weakness Drowsiness,
sleepiness Fatigue Diarrhea
Unusual bowel
movementsHeadache
Aggression Fever
MECHANISM OF ACTION
Blocks effects of histamine at
peripheral histamine1-
receptor sites, decreasing
allergy signs and symptoms
NSG.RESPONSIBILITY
• Tell patient to stop taking
drug 4 days before diagnostic
skin tests, to avoid
interference with test results.
• Advise patient to report signs
or symptoms of viral infection,
especially upper respiratory
tract infection.
• Caution patient to avoid
driving and other hazardous
activities until he knows how
drug affects concentration and
alertness.
• Advise female patient to
inform prescriber if she is
pregnant or breastfeeding.
• As appropriate, review all
other significant adverse
reactions and interactions,
especially those related to the
drugs, tests, and foods
mentioned above.
MECLIZINE
HYDROCHLORIDE
BRAND NAME
Antivert/25; Antivert/50;
Bonamine; Bonine;
Dramamine II; Meclicot;
Medivert.
CLASSIFICATION
Antihistamines
Antiemetic
Antivertigo agent
MECHANISM OF ACTION
Antiemetic; antivertigo agent
—The mechanism by which
meclizine exerts its
antiemetic, anti–motion
sickness, and antivertigo
effects is not precisely known
but may be related to its
central anticholinergic actions.
It diminishes vestibular
stimulation and depresses
labyrinthine function. An
action on the medullary
chemoreceptive trigger zone
may also be involved in the
antiemetic effect.
ADVERSE REACTIONS
Drowsiness, dry mouth, and
on rare occasions, blurred
vision have been reported.
DOSAGE AND ROUTE
Motion Sickness: The initial
dose of 25 to 50 mg of
meclizine, should be taken
prior to travel for protection
against motion sickness.
Thereafter, the dose may be
repeated every 24 hours for
the duration of the journey
NSG.RESPONSIBILITY
Some drowsiness may, on
occasion, occur with the use
of this drug, patients should
be warned of this possibility
and cautioned against driving
a car or operating dangerous
machinery.
Patients should avoid
alcoholic beverages while
taking this drug. Due to its
potential anticholinergic
action, this drug should be
used with caution in patients
with asthma, glaucoma, or
enlargement of the prostate
gland.
PROMETHAZINE
HYDROCHORIDE
BRAND NAME
Phenergan
Provigan
Zipan
INDICATION

• As antiallaergic
medication to combat
hay fever,allergic
rhinitis. To treat allergic
reaction it can be
given alone or in
combination with oral
decongestant.
• As an adjunc treatment
for anaphylactoid
conditions.
• Together with codeine
or dextromethorphan or
against cough.
• Also used to potentiate
any opiates. Commonly
combined with
pethidine (AKA,
meperidine, or
Demerol) in a brand
called Mepergan, a
meperidine/promethazi
ne combination. Also
frequently used in
conjunction with
codeine, in a syrup
form. The combination
leads to a more
powerful opiate than
codeine alone
MECHANISM OF ACTION
Promethazine is a
phenothiazine derivative that
competitively blocks histamine
H1 receptors without blocking
the secretion of histamine. It
also is a very weak dopamine
antagonist.It has sedative,
anti-motion-sickness, anti-
emetic, and anti-cholinergic
effects .
SIDE EFFECT
• Dry mouth
• Respiratory depression
in patients under age of
2 and in those with
severely compromised
pulmonal function
• Constipation
• Chest
Discomfort\Pressure.
(typically in cases when
patient is already taking
medication for high
blood pressure)
• Euphoria (very rare,
except with high IV
doses and/or
coadministration with
opioids/CNS
depressants)
• Restless legs
•
DOSAGE AND ROUTE
Promethazine HCl
suppositories are for rectal
administration only.
NSG. RESPONSIBILITY
Instruct the patient to avoid
prolonged exposure to the
sun.
Promethazine HCl
suppositories may cause
marked drowsiness or impair
the mental and/or physical
abilities required for the
performance of potentially
hazardous tasks, such as
driving a vehicle or operating
machinery. The use of alcohol
or other central-nervous-
system depressants such as
sedatives/hypnotics (including
barbiturates), narcotics,
narcotic analgesics, general
anesthetics, tricyclic
antidepressants, and
tranquilizers, may enhance
impairment . Pediatric patients
should be supervised to avoid
potential harm in bike riding or
in other hazardous activities.
Patients should be advised to
report any involuntary muscle
movements.
DIPHENHYDRAMINE
HYDROCHLORIDE
CLASSIFICATION
Narcotic antitussive,
Anticholinergic, Nonselective
ethanolamine
BRAND NAME
40 Winks,Banophen,Allermax
INDICATION
Symptomatic relief of
perennial and seasonal
allergic rhinitis, vasomotor
rhinitis and allergic
conjunctivitis; temporary relief
of runny nose and sneezing
caused by common cold;
dermatographism; treatment
of urticaria and angioedema;
amelioration of allergic
reactions to blood or plasma;
adjunct to epinephrine and
other standard measures in
anaphylaxis; relief of
uncomplicated allergic
conditions of immediate type
when oral therapy is
impossible or contraindicated
(parenteral form); treatment
and prophylactic treatment of
motion sickness.
DOSAGE
As an antihistamine, the
recommended dose for adults
is 25–50 mg diphenhydramine
every 4–6 hours, not to
exceed 50-100 mg every 4–6
hours
PHARMACOLOGICAL
Diphenhydramine works by
blocking the effect of
histamine atH1 receptor sites.
This results in effects such as
the increase of vascular
smooth muscle contraction,
thus reducing the redness,
hyperthermia and edema that
occurs during an inflammatory
reaction. In addition, by
blocking the H1 receptor on
peripheral nociceptors,
diphenhydramine decreases
their sensitization and
consequently reduces itching
that is associated with an
allergic reaction.
SIDE EFFECT
Orthostatic hypotension;
palpitations; bradycardia;
tachycardia; reflex
tachycardia; extrasystoles;
faintness.Drowsiness (often
transient); sedation; dizziness;
faintness; disturbed
coordination.
NSG. RESPONSIBILITY
• Monitor patient for
dizziness and excessive
drowsiness. If noted hold
therapy. Use caution when
administering
diphenhydramine by injection.
Inadvertent intradermal or
subcutaneous administration
may cause tissue necrosis.
• Advise patient using
diphenhydramine to prevent
motion sickness to take first
dose at least 30 min before
exposure to motion and take
subsequent doses after each
meal and at bedtime for
duration of journey.
• Advise patient that if a
dose is missed to take it as
soon as possible unless it is
nearing time for the next
scheduled dose, then advise
patient to skip the missed
dose and take the next dose
at the regularly scheduled
time. Caution patient not to
double the dose to catch up.

LORATADINE
BRAND NAME
Claritin® 24 Hour ,Claritin®
Hives Relief
DOSAGE
The usual dose of loratadine
is 10 mg daily for adults and
children older than six years
of age.
CLASSIFICATION
Antihistamines
INDICATION
Loratadine is indicated for
thesymptomatic relief of
allergy such as hay fever
(allergic rhinitis),urticaaria
(hives), and other skin
allergies.For allergic rhinitis
(hay fever), loratadine is
effective for both nasal and
eye symptoms: sneezing,
runny nose, itchy or burning
eyes.
MECHANISM OF ACTION
Loratadine is a tricyclic
antihistamine, which
selectively antagonizes
peripheral histamine H1
receptors.Histamine is
responsible for many features
of allergic reactions.
SIDE EFFECT
headache, psychomotor
impairment, and
antimuscarinic effects such as
urinary retention, dry mouth,
blurred vision, and
gastrointestinal disturbances
are the most common side
effects.
NSG. RESPONSIBILITY
Take Loratadine by mouth
with or without food. If you
miss a dose of Loratadine ,
take it as soon as possible. If
it is almost time for your next
dose, skip the missed dose
and go back to your regular
dosing schedule. Do not take
2 doses at once.
INSTRUCT the patient to
PREGNANCY and BREAST-
FEEDING: If you become
pregnant, contact your doctor.
You will need to discuss the
benefits and risks of using
Loratadine while you are
pregnant. Loratadine is found
in breast milk. If you are or will
be breast-feeding while you
use Loratadine , check with
your doctor. Discuss any
possible risks to your baby.

HYDROXYZINE
HYDROCHLORIDE
PHARMACOKINETICS
hydroxyzine is rapidly
absorbed and distributed in
oral and intramuscular
administration, and is
metabolised in the liver; the
main metabolite (45%)
through oxidation of the
alcohol moiety to a carboxylic
acid, is cetirizine and overall
effects are observed within
one hour of administration. It
has a half-life observed on
average of around 7–10 hours
in adults, 6–7 hours in
children, and 18–21 hours in
the elderly, or those with renal
insufficiency with higher
concentrations foundn the
skin than in the plasma.
Cetirizine, although less
sedating, is non-dialyzable
and possesses similar anti-
histaminergic properties. "In
animals, hydroxyzine and its
metabolites are excreted in
feces via biliary elimination.
INDICATION
Useful in the management of
pruritus due to allergic
conditions such as chronic
urticaria and atopic and
contact dermatoses, and in
histamine-mediated pruritus.
PHARMACOLOGY
Hydroxyzine hydrochloride is
unrelated chemically to the
phenothiazines, reserpine,
meprobamate or the
benzodiazepines.
Hydroxyzine is not a cortical
depressant, but its action may
be due to a suppression of
activity in certain key regions
of the subcortical area of the
central nervous system.
Primary skeletal muscle
relaxation has been
demonstrated experimentally.
Bronchodilator activity, and
antihistaminic and analgesic
effects have been
demonstrated experimentally
and confirmed clinically. An
antiemetic effect, both by the
apomorphine test and the
veriloid test, has been
demonstrated.
Pharmacological and clinical
studies indicate that
hydroxyzine in therapeutic
dosage does not increase
gastric secretion or acidity
and in most cases has mild
antisecretory activity.
SIDE EFFECT
deep sleep, incoordination
and dizziness have been
reported in children and
adults, as well as others such
as hypotension, and
headaches.Gastro-intestinal
effects have also been
observed, as well as less
serious effects such as
dryness of the mouth and
constipation caused by
antimuscarinic properties of
hydroxyzine
DOSAGE
The usual dose is 25
milligrams 3 or 4 times a day.
NSG. RESPONSIBILITY
THE POTENTIATING
ACTION OF HYDROXYZINE
MUST BE CONSIDERED
WHEN THE DRUG IS USED
IN CONJUNCTION WITH
CENTRAL NERVOUS
SYSTEM DEPRESSANTS
SUCH AS NARCOTICS,
NON-NARCOTIC
ANALGESICS AND
BARBITURATES. Therefore,
when central nervous system
depressants are administered
concomitantly with
hydroxyzine their dosage
should be reduced.
Since drowsiness may occur
with use of this drug, patients
should be warned of this
possibility and cautioned
against driving a car or
operating dangerous
machinery while taking
hydroxyzine. Patients should
also be advised against the
simultaneous use of other
CNS depressant drugs, and
cautioned that the effects of
alcohol may be increased.
DESLORATADINE
BRAND NAME
clarinex
CLASSIFICATION
Antihistamine,Antiallergic
MECHANISM OF ACTION
Desloratadine is a tricyclic
antihistamine which has a
selective and peripheral H1-
antagonist action. It has a
long-lasting effect and does
not cause drowsinessbecause
it does not readily enter the
central nervous system.
SIDE EFFECT
Most common side-effects are
fatigue,dry mouth, headache,
and gastrointestinal
disturbances,swelling, severe
dizziness, trouble breathing.
DOSAGE
The recommended dose for
adults and children 12 years
or older is 5 mg daily. Syrup
can be used for children two
years and older with the dose
dependent on the age of the
child. Desloratadine can be
taken with or without food
NSG. RESPONSIBILITY
• Desloratadine may
cause dizziness. This effect
may be worse if you take it
with alcohol or certain
medicines. Use Desloratadine
with caution. Do not drive or
perform other possibly unsafe
tasks until you know how you
react to it.
• Desloratadine should
not be used in
CHILDREN younger
than 12 years old;
safety and
effectiveness in these
children have not been
confirmed.
• PREGNANCY and
BREAST-FEEDING: If
you become pregnant,
contact your doctor.
You will need to
discuss the benefits
and risks of using
Desloratadine while
you are pregnant.
Desloratadine is found
in breast milk. Do not
breast-feed while
taking Desloratadine .
• Do not swallow the
tablet whole. Allow it to
dissolve in your mouth
without chewing.
• Swallow several times
as the tablet dissolves.
If desired, you may
drink water to help
swallow the dissolved
tablet.

CYPROHEPTADINE
HYDROCHLORIDE
BRAND NAME
Periactin (UK), Periactin,
PMS-Cyproheptadine (CA)
CLASSIFICATION
Piperidine (nonselective)
,Antihistamine
MECHANISM OF ACTION
Antagonizes effects of
histamine at histamine1-
receptor sites, preventing
histamine-mediated
responses. Also blocks effects
of serotonin, causing
increased appetite .
INDICATION
Allergy symptoms caused by
histamine release (including
seasonal and perennial
allergic rhinitis); chronic
urticaria; angioedema;
dermographism; cold urticaria;
adjunctive therapy for
anaphylactic reactions.
DOSAGE
Adults: Initially, 4 mg P.O. q 8
hours. Maintenance dosage is
4 to 20 mg/day in three
divided doses, to a maximum
dosage of 0.5 mg/kg/day.
ADVERSE EFFECT
Among the more serious
adverse reactions are skin
rash, hypersensitivity, and
tachycardia. Drowsiness and
dry mouth commonly occur.
NSG. RESPONSIBILITY
• Monitor patient for excessive
anticholinergic effects.
• Assess for excessive CNS
depression.
• Discontinue drug 4 days
before diagnostic skin testing.
• Advise patient to take drug
with food to minimize GI
upset.
• Caution patient not to use
other CNS depressants, sleep
aids, or alcohol during
therapy.
• Instruct patient to avoid
driving and other hazardous
activities until he knows how
drug affects concentration and
alertness.
• As appropriate, review all
other significant and life-
threatening adverse reactions
and interactions, especially
those related to the drugs,
tests, and behaviors
mentioned above.
Contraindications
• Hypersensitivity to drug
• Alcohol intolerance (syrup
only)
• Bladder neck obstruction
• Angle-closure glaucoma
• Ulcer disease
• Symptomatic prostatic
hypertrophy
• MAO inhibitor use within
past 14 days
ampicillin/sulbactam
Trade Name(s)
Unasyn
THER.CLASSIFICATION
anti-infectives
PHARM. CLASSIFICATION
aminopenicillins beta
lactamase inhibitors
Indications
Treatment of the following
infections
» Skin and skin structure
infections, soft-tissue
infections
» Otitis media
» Intra-abdominal infections
» Sinusitis
» Respiratory infections
» Genitourinary infections
» Meningitis
» Septicemia
Action
Binds to bacterial cell wall,
resulting in cell death;
spectrum is broader than that
of penicillin. Addition of
sulbactam increases
resistance to beta-
lactamases, enzymes
produced by bacteria that may
inactivate ampicillin
Contraindication/Precautions
Contraindicated in:
Hypersensitivity to penicillins
or sulbactam
Use Cautiously in:
• Severe renal insufficiency
(dosage reduction required if
CCr <30 ml/min)
• Epstein-Barr virus infection,
acute lymphocytic leukemia,
or cytomegalovirus infection
(increased incidence of rash)
Adverse Reactions/Side
Effects
CNS: SEIZURES (HIGH
DOSES) .
GI: PSEUDOMEMBRANOUS
COLITIS, diarrhea, nausea,
vomiting.
Derm: rashes, urticaria.
Hemat: blood dyscrasias.
Local: pain at IM site, pain at
IV site.
Misc: ALLERGIC
REACTIONS INCLUDING
ANAPHYLAXIS AND SERUM
SICKNESS , superinfection,
elevated liver enzymes.
Route/Dosage
• Dosage based on ampicillin
component
• IM, IV (Adults and Children
B40 kg ): 1–2 g ampicillin q
6–8 hr (not to exceed 12 g
ampicillin/day).
• IM, IV (Children B1 yr):
100–200 mg ampicillin/kg/day
divided q 6 hr;
Meningitis—200–400 mg
ampicillin/kg/day divided
every 6 hr; maximum dose: 8
g ampicillin/day.
• IM, IV (Infants >1 month):
100–150 mg ampicillin/kg/day
divided q 6 hr.
Renal Impairment
• IM, IV (Adults , Children,
and Infants):
CCr 15–29 ml/min—
Administer q 12 hr;
CCr 5–14—Administer q 24
hr.
Patient/Family Teaching
• Advise patient to report signs
of superinfection (furry
overgrowth on the tongue,
vaginal itching or discharge,
loose or foul-smelling stools)
and allergy
• Advise patients taking oral
contraceptives to use an
alternative or additional
nonhormonal method of
contraception while taking
ampicillin/sulbactam and until
next menstrual period
• Caution patient to notify
health care professional if
fever and diarrhea occur,
especially if stool contains
blood, pus, or mucus. Advise
patient not to treat diarrhea
without consulting health care
professional. May occur up to
several weeks after
discontinuation of medication
• Instruct the patient to notify
health care professional if
symptoms do not improve.