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Generic Name of Drug: Hydrocortisone

PNDF Section:8.3, 7.1.1, 14.1, 18.2


Page: 36, 48, 76, 98
Typical Dosage: (Pedia/Adult/Pregnant/Dialysis)
Pedia:
tablet-5 mg, 10 mg, 20 mg
Powder for injection: 100 mg, 250 mg. 500 mg, 1g
Oral: 2.5 to 10 mg/kg/day divided every 6 to 8 hours.
Inflammation:
<12 years: 2.5-10 mg/kg/day q6-8hr PO; 1-5 mg/kg/day IM/IV
divided q12-24hr
12 years: 15-240 mg PO/IM/IV/SC q12hr
Status Asthmaticus:
1-2 mg/kg IV q6hr for 24hr; PO 0.5-1 mg/kg IV q6hr
Acute Adrenal Crisis:
>1 month-1 year: 25 mg IV bolus
1-12 years: 50-100 mg rapid IV bolus

Classification: Corticosteroid
Route:
Oral

Adult:
tablet-5 mg, 10 mg, 20 mg
Powder for injection: 100 mg, 250 mg. 500 mg, 1g
Oral, Intramuscular or Intravenous: 15 to 240 mg/day.
Inflammation: 15-24 mg PO/IM/IV q12hr
Status Asthmaticus: 1-2 mg/kg IV q6hr for 24 hrs.
Acute Adrenal Crisis: 100 mg IV bolus, then 300 mg/day IV
divided q8hr
Pregnancy: Category C
Drug enters breast milk; use with caution

Intravenous

Indication/s for use:


Inflammation, Status Asthmaticus, Acute Adrenal Crisis

Mode of Action:
Glucocorticoid; elicits mild mineralocorticoid activity and moderate anti-inflammatory
effects; controls or prevents inflammation by controlling rate of protein synthesis,
suppressing migration of polymorphonuclear leukocytes and fibroblasts, and
reversing capillary permeability.
Common side effects:
Acne, Delayed wound healing, depression, Hyperglycemia, Insomnia, Tachycardia

Mode of elimination:
Half-Life: Plasma, 1-2 hr; biologic, 8-12 hr
Excretion: Urine (mainly), feces (minimally)

3 important issues you would counsel patients with:


1. Emphasize need to take medication exactly as directed. Review symptoms of adrenal insufficiency that may occur when stopping the medication and
that may be life-threatening.
2. Encourage patients on long-term therapy to eat a diet high in protein, calcium and potassium and low in sodium and carbohydrates.
3. These drugs cause immunosuppression and may mask symptoms of infection. Instruct patient to avoid people with known contagious illnesses and to
report possible infections. Advise patient to consult health care professional before receiving vaccinations.
List 3 drugs which significantly interact with this class and state what action you would take
Interaction
Corrective action
Carbamazepine will decrease the effect of hydrocortisone by affecting hepatic

Carbamazepine
enzyme CYP3AF metabolism. Monitor closely. Use alternatives if available.
Cimetidine will increase the effect of hydrocortisone by affecting hepatic enzyme

Cimetidine
CYP3A4 metabolism. Monitor closely. Use alternatives if possible.
Clarithromycin will increase the effect of hydrocortisone by affecting hepatic enzyme

Clarithromycin
CYP3A4 metabolism. Monitor closely. Use alternatives if possible.
Prepared by: Novelyn C. Agsamosam

Remarks:

Generic Name of Drug: Meropenem


PNDF Section: 3.1.3
Page: 15
Typical Dosage: (Pedia/Adult/Pregnant/Dialysis)
Pedia:
Powder for injectable solution:
500mg/vial, 1g/vial
Complicated skin/skin structure infections:
50 kg: 10 mg/kg IV q8hr
50 kg: 500 mg IV q8hr
Intra-Abdominal Infections:
50 kg: 20 mg/kg IV q8hr
50 kg: 1 g IV q8hr
Adult:
Powder for injectable solution:
500mg/vial, 1g/vial
Complicated skin/skin structure infections:
500 mg IV q8hr
Intra-Abdominal Infections:
1 g IV q8hr
Pregnancy: Category B
Unknown whether drug is excreted in breast milk; use with
caution
Indication/s for use:
Complicated skin/skin structure infections
Intra-Abdominal Infections
Mode of elimination:
Half-life: Normal renal function, 1-1.5 hr
Excretion: urine(-25% as inactive metabolites)

Classification: Carbapenems
Route:
Intravenous

Mode of Action:
Inhibits cell wall synthesis by binding to penicillin-binding proteins; resistant to most
beta-lactamases.
Common side effects:
Constipation (1-7%), Diarrhea (4-5%)
Headache (2%), Inflammation at injection site (2%)
Nausea or vomiting (1-4%)
3 important issues you would counsel patients with:
1. Advise the patient to report the signs of super infection (vaginal itch or discharge, loose or foul smelling stools) and allergy
2. May cause dizziness. Caution patient to avoid driving.
3. Caution patient to notify health care professional if fever and diarrhea occurs, especially if stool contains blood, pus, or mucus. Advise patient not to
treat diarrhea without consulting health care professional.
List 3 drugs which significantly interact with this class and state what action you would take
Interaction
Corrective action
Meropenem decreases effects of BCG live vaccine by pharmacodynamics

BCG Live vaccine


antagonism. Contraindicated unless benefits outweigh risks and no alternatives
(serious- use alternatives)
available. Never use combination. Wait until Abx Tx complete to administer bacterial
vaccine.
Meropenem will decrease the level or effect of digoxin by altering intestinal flora.

Digoxin
Applies only to oral form of both agents. Significant interaction possible, monitor
(Significant-monitor closely)
closely.
Meropenem will decrease the level or effect of pyridoxine by altering intestinal flora.

Pyridoxine
Minor or non-significant interaction.
(minor)
Prepared by: Novelyn C. Agsamosam

Remarks:

Generic Name of Drug: Omeprazole


PNDF Section: 13.4
Page: 73
Typical Dosage: (Pedia/Adult/Pregnant/Dialysis)
Pedia:
Suspension: 2mg/mL
Tablet/capsule: 10 mg, 20 mg, 40 mg
5 kg to less than 10 kg: 5 mg once daily
10 kg to less than or equal to 20 kg: 10 mg once daily
Greater than 20 kg: 20 mg once daily
Adult:
Tablet, delayed release: 20 mg
Capsule, delayed release: 10 mg, 20 mg, 40 mg
20 mg orally once a day before a meal.
Duodenal cancer:
20 mg PO qDay for 4-8 weeks
Helicobacter pylori infection:
20 mg PO q12hr for 10 days
Gastric ulcer:
40 mg PO qDay for 4-8 weeks

Classification: Proton Pump Inhibitor


Route:
oral

Intravenous

Pregnancy: Category C
Distributes into human milk; use caution
Indication/s for use:
Duodenal cancer
Helicobacter pylori infection
Gastric ulcer
Mode of elimination:
Urine (80%)
Feces

Mode of Action:
Omeprazole is a selective and irreversible proton pump inhibitor. It suppresses
stomach acid secretion by specific inhibition of the H +/K + ATPase system found at the
secretory surface of gastric parietal cells.
Common side effects:
Headache (7%)
Abdominal Pain (5%)
Nausea (4%)
Flatulence (3%)
Rash (2%)
3 important issues you would counsel patients with:
1. Swallow the capsule and tablet forms of omeprazole whole. Do not open the capsule. Do not crush, break, or chew the capsule or the tablet.
2. May cause occasional drowsiness or dizziness. Caution patient to avoid driving or other activities requiring alertnes until response to medication is
known.
3. Instruct patient to notify health care professional of onset of black, tarry stools, diarrhea; abdominal pain; or persistent headache or if fever and diarrhea
develop, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care professional.
List 3 drugs which significantly interact with this class and state what action you would take
Interaction
Corrective action
Carbamazepine
Carbamazepine will decrease the level or effect of omeprazole by affectinghepatic
(Serious- Use alternative)
enzyme CYP2C!9 metabolism. Monitor closely. Use alternatives if possible.
Ampicillin
Omeprazole will decrease the level or effect of ampicillin by increasing gastric ph.
(Significant- monitor closely)
Applies only to oral form of both agents. Potential for interaction, monitor.
Lidocaine
Omeprazole will decrease thelevel or effect of lidocaine by affecting hepatic enzyme
(Minor)
CYP1A2 metabolism. Minor or non significant interaction.
Prepared by: Novelyn C. Agsamosam

Remarks:

Generic Name of Drug: Piperacillin sodium+Tazobactam Sodium


PNDF Section: 3.1.10
Page: 20
Typical Dosage: (Pedia/Adult/Pregnant/Dialysis)
Pedia:
Dosing Range:
3.375g IV q6hr, 4.5g IV q6-8hr, not to exceed 18 g/day
Intra-Abdominal Abscess:
200-300 mg/kg/day IV divided q6-8hr
Adult:
Severe Infections:
3.375 g IV q6hr for 7 days; administer over 30 mins
Intra-Abdominal Abscess
3.375 g IV q6hr for 4-7 days
Skin and soft Tissue infection
3.375 g IV q6-8hr for 7-14 days
Pregnancy: Category B
Low concentrations of piperacillin excreted in breast milk;
tazobactam unknown; use caution.
Indication/s for use:
Severe Infections
Intra-Abdominal Abscess
Skin and soft Tissue infection
Mode of elimination:
Half life: 0.7-1.2 hr
Piperacillin: Urine (68%): feces (10-20%)
Tazobactam: Urine (80%)

Classification: Penicillins, Extended Spectrum


Route:
Intravenous

Mode of Action:
Antipseudomonal penicillin plus beta-lactamase inhibitor; inhibits biosynthesis of cell
wall mucopeptide synthesis by binding to 1 or more of the penicillin-binding proteins
and is effective during active-multiplication stage.

Common side effects:


Diarrhea (7-11%)
Constipation (1-8%)
Fever (2-7%)
Pain (2-3%)
Hypertension (2%)
3 important issues you would counsel patients with:
1. Advise patient to report rash and signs of superinfection (black furry overgrowth on tongue, vaginal itching, loose or foul smelling stools) and allergy.
2. Caution patient to notify health care professional if fever and diarrhea occur, especially if stool contains blood, pus or mucus.
3. Diabetes patients - Piperacillin/tazobactam may affect your blood sugar. Check blood sugar levels closely. Ask your doctor before you change the dose
of your diabetes medicine.
List 3 drugs which significantly interact with this class and state what action you would take
Interaction
Corrective action
Heparin
Piperacillin will decrease the level of heparin by anticoagulation. Monitor closely. Use
(Serious- Use alternative)
alternatives of available. Piperacillin can inhibit platelet aggregation.
Doxycylcine
doxycylcine decreases effects of piperacillin by pharmacodynamic antagonism. Monitor
(Significant- Monito closely)
closely. Bacteriostatic agents may inhibit the effects of bactericidal agents.
Amikacin
Piperacillin increases effects of amikacin by pharmacodynamic synergism. Minor or
(Minor)
non significant interaction.
Prepared by: Novelyn C. Agsamosam

Remarks:

Generic Name of Drug: Sodium Bicarbonate


PNDF Section: 16.2
Page: 88
Typical Dosage: (Pedia/Adult/Pregnant/Dialysis)
Pedia:
Injectable solution: 4.2%, 5%, 7.5%, 8.5%
Tablet: 325 mg, 650 mg
Cardiac Arrest:
Infant, <2years old (4.2%) 8 mEq/kg/day
Adult:
Injectable solution: 4.2%, 5%, 7.5%, 8.5%
Tablet: 325 mg, 650 mg
Cardiac arrest:
1 mEq/kg/dose IV x1
Hyperkalemia:
50 mEq IV over 5 mins
Pregnancy: Category C
Not known if excreted in breast milk
Indication/s for use:
Cardiac Arrest
Hyperkalemia
Mode of elimination:
Urine

Classification: Alkalinizing Agent


Route:
Oral

Intravenous

Mode of Action:
Bicarbonate reacts with H+ ions to form water and carbon dioxide. It acts as a buffer
against acidosis by raising blood pH.
Common side effects:
Edema, Hypernatremia, Hypocalcemia, Hypokalemia, Tetany

3 important issues you would counsel patients with:


1. Instruct the patient not to share the medication with others, even if they have the same symptoms, it may harm them.
2. Encourage patient to follow prescribed diet, medication, and exercise regimen to prevent hyperglycemic or hypoglycemic episodes.
3. Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care
professional before taking other medications.
List 3 drugs which significantly interact with this class and state what action you would take
Interaction
Corrective action
Levofloxacin
Sodium bicarbonate decreases levels of levofloxacin by inhibition of GI absorption.
(Serious- Use alternative)
Monitor closely. Use alternatives if available. Separate by 2 hours.
Celecoxib
Sodium bicarbonate decreases levels of celecoxib inhibition of GI absoption. Use
(Significant- Monitor closely)
alternatives if available. Separate by 2 hours.
Aspirin
Passive renal tubular reabsorption de to increased pH.Salicylate levels decrease at
(Minor)
large doses.
Prepared by: Novelyn C. Agsamosam

Remarks:

Generic Name of Drug: Sodium Chloride solution


PNDF Section:16.2
Page: 88
Typical Dosage: (Pedia/Adult/Pregnant/Dialysis)
Pedia:
0.45%, 0.9% & 20% intravenous,
6% inhalation, 20% oral solution*
Maximum Rate : 1 mmol/kg/h (the slower the rate the better to
minimize sudden alterations in serum osmolality)
3 - 4 mmol/kg/d
Adult:
0.45%, 0.9% & 20% intravenous,
6% inhalation, 20% oral solution

Classification: Electrolyte
Route:
Intravenous
Inhalation

Oral

0.9% Sodium Chloride Injection (sodium-54 mmol/L chloride


ions-154 mmol/L) and water.
for adults : 500 ml to 3Liters /24h
2 - 8 mmol/kg/d
Pregnancy: Category
Indication/s for use:
Intravenous solutions containing sodium chloride are indicated
for parenteral replenishment of fluid and sodium chloride as
required by the clinical condition of the patient.
Mode of elimination:

Mode of Action:
Provides moisture to dry or inflamed mucus membranes, and helps thin mucus.

Common side effects:


Intravenous solutions containing sodium chloride are indicated for parenteral
replenishment of fluid and sodium chloride as required by the clinical condition of the
patient.
3 important issues you would counsel patients with:
1. Follow all directions given to you by your doctor carefully.
2. Tell your doctor if you are taking any other medicines, including medicines that you buy at the chemist, supermarket or health food shop including
corticosteroids.
3.
List 3 drugs which significantly interact with this class and state what action you would take
Interaction
Corrective action
Lithium
Using sodium chloride together with lithium may decrease the effects of lithium. You
should avoid very high and very low sodium consumption. Contact your doctor if
your condition changes. If your doctor does prescribe these medications together,
you may need a dose adjustment or special test to safely use both medications.

Prepared by: Novelyn C. Agsamosam

Remarks:

Generic Name of Drug: Potassium Chloride


PNDF Section: 16.2
Page: 87
Typical Dosage: (Pedia/Adult/Pregnant/Dialysis)
Pedia:
Oral: 2 to 5 mEq/kg/day in divided doses; not to exceed 1 to 2
mEq/kg as a single dose
Intermittent IV infusion (must be diluted prior to administration):
0.5 to 1 mEq/kg/dose (maximum dose: 40 mEq) to infuse at 0.3
to 0.5 mEq/kg/hour (maximum dose/rate: 1 mEq/kg/hour)
Adult:
Parenteral:
10 to 40 mEq potassium chloride for injection diluted in an
appropriate amount and type of solution to be intravenously
infused once at a rate not to exceed 40 mEq/hour.
Oral:
10 to 20 mEq orally once a day given in equally divided doses
using formulations which include normal-release tablets or
capsules, extended-release tablets or capsules, dissolvable
tablets, oral solution or powder for dissolution mixed with an
appropriate volume of water or juice.
Pregnancy: Category C
Dialysis
Indication/s for use:
Hypokalemia
Mode of elimination:
Urine

Classification: electrolyte supplements


Route:
Intravenous

Oral

Mode of Action:
Essential in physiologic processes

Common side effects:


Bleeding
Diarrhea
Dyspepsia
Hyperkalemia
Nausea
3 important issues you would counsel patients with:
1. Take potassium chloride exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the
directions on your prescription label.
2. Do not crush, chew, break, or suck on an extended-release tablet or capsule. Swallow the pill whole. Breaking or crushing the pill may cause too
much of the drug to be released at one time. Sucking on a potassium tablet can irritate your mouth or throat.
3. To be sure potassium chloride is helping your condition, your blood may need to be tested often. Your heart rate may also be checked using an
electrocardiograph or ECG (sometimes called an EKG) to measure electrical activity of the heart.
List 3 drugs which significantly interact with this class and state what action you would take
Interaction
Corrective action
Furosemide
Potassium chloride increases and furosemide decreases serum potassium. Effect of
interaction is not clear, use caution. Use with caution and monitor closely.
ibuprofen
Ibuprofen and potassium chloride both increase serum potassium. Potential for
dangerous interaction. Use with caution and monitor closely.
Telmisartan
Telmisartan and potassium chloride both increase serum potassium. Significant
interaction possible, monitor closely.
Prepared by: Novelyn C. Agsamosam

Remarks:

Generic Name of Drug: Budesonide


PNDF Section: 7.1.2, 20.6
Page: 49, 108
Typical Dosage: (Pedia/Adult/Pregnant/Dialysis)
Pedia:
Suspension for nebulizer:
0.25mg/2mL
0.5mg/2mL
1mg/2mL

Classification: Corticosteroid, Gastrointestinal


Route:
oral

Powder for inhalation:


90mcg/actuation
180mcg/actuation
Tablet, enteric-coated and extended release
9mg
Asthma:
Nebulized suspension:
1-8 years: 0.5 mg once daily or divided q12hr
Inhaled powder:
>6 years: 180 mcg PO q12hr; not to exceed 360 mcg q12hr
Adult:
Capsule: 3 mg
Tablet: 9 mg
Suspension for nebulizer:
0.25mg/2mL
0.5mg/2mL
1mg/2mL
Powder for inhalation:
90mcg/actuation
180mcg/actuation
Asthma: 360 mcg PO q12hr
Pregnancy: category C
Use with caution
Indication/s for use:
Ulcerative colitis
Crohn Disease
Asthma
Mode of elimination:
Half-life: 2-3.6 hr
Excretion: Urine (60%), feces (minimal)

Inhalation

Mode of Action:
Anti inflammatory corticosterod;controls rate of protein synthesis; decreasesd
inflammation by suppressing migration of polymorphonuclear leukocytes and
reducing capillary permeability.
Common side effects:
Headache (21%)
Acne (5-15%)
Nausea (11%)
Backpain (7%)
3 important issues you would counsel patients with:
1. For tablets, swallow this medication whole. Do not crush or chew. Take this medication by mouth with or without food as directed by your doctor,
usually once daily in the morning. Take this medication by mouth with a full glass of water (8 ounces/240 milliliters) unless your doctor directs you
otherwise.
2. Suspension should be administered via jet nebulizer connected to air compressor with adequate air flow and equipped with mouthpiece or suitable
mask; ultrasonic nebulizer should be used.
3. Patient should wash mouth after inhalation to prevent oral thrush.
List 3 drugs which significantly interact with this class and state what action you would take
Interaction
Corrective action
Ergotamine
Budesonide will decrease the level or effect of ergotamine by affecting
hepatic/intestinal enzyme CYP3A4 metabolism. Monitor closely. Use alternatives if
posible.
Cilostazol
Budesonide will decrease the level or effect of cilostazol by affecting
hepatic/intestinal enzyme CYP3A4 metabolism. Significant interaction possible,
monitor closely.
Isoniazid
Isoniazid will increase the level or effect of budenoside by affecting hepatic/intestinal
enzyme CYP3A4 metabolism. Significant interaction possible, monitor closely.
Prepared by: Novelyn C. Agsamosam

Remarks:

Generic Name of Drug: Paracetamol


PNDF Section: 1.3. 1.5
Page:5, 5
Typical Dosage: (Pedia/Adult/Pregnant/Dialysis)
Pedia:
IV: Less than 2 years: 7.5 to 15 mg/kg/dose every 6 hours
Maximum daily dose: 60 mg/kg/day
IV: 2 to 12 years: 15 mg/kg every 6 hours or 12.5 mg/kg every 4
hours
Maximum single dose 15 mg/kg
Maximum total daily dose: 75 mg/kg/day not to exceed 3750
mg/day
Oral: 10 to 15 mg/kg/dose every 4 to 6 hours as needed; do not
exceed 5 doses in 24 hours
Rectal: 20 mg/kg/dose every 12 hours
Loading dose is 140
mg/kg followed in 4 hours by a maintenance dose of 70 mg/kg
orally given every 4 hours.
The dose in children is 10-15 mg/kg 4 hourly, to a maximum
of 100mg/kg/day, and no patient should receive more than 4
g/day.
Adult:
IV: Less than 50 kg: 15 mg/kg every 6 hours or 12.5 mg/kg
every 4 hours
Maximum single dose: 750 mg/dose
Maximum total daily dose: 75 mg/kg/day (less than or equal to
3750 mg/day)
IV: Greater than or equal to 50 kg: 650 mg every 4 hours or
1000 mg every 6 hours
Maximum single dose: 1000 mg/dose
Maximum total daily dose: 4000 mg/day
Oral or Rectal: 325 to 650 mg every 4 to 6 hours or 1,000 mg 3
to 4 times daily
Maximum daily dose: 4000 mg/day
Rectal: 325 to 650 mg q4-6hr
IV Loading Dose: 2 g
The maximum daily
dose is 4 grams per day (6-8 tablets, depending
on the strength of the tablets)
Pregnancy: Category B
Crosses placenta, safe to use in all stages of pregnancy short
term.
Dialysis:
Administer every 8 hours
CRRT: No adjustments necessary
Indication/s for use:
Relief of fever due to influenza, common colds, tonsilitis,
measles, chicken pox and pneumonia.
For headache, dysmenorrhea, arthritis and other muscle and
joint pains.
Mode of elimination:
Acetaminophen is eliminated from the body primarily by
formation of glucuronide and sulfate conjugates in a dosedependent manner.
Urine (9%)

Classification: Analgesic/Antipyretic
Route:
IV

Rectal

Oral

Mode of Action:
acetaminophen appears to produce analgesia by elevation of the pain threshold. The
potential mechanism may involve inhibition of the nitric oxide pathway mediated by a
variety of neurotransmitter receptors including N-methyl-D-aspartate and substance
P
Common side effects:
nausea, upper stomach pain, itching, loss of appetite;
dark urine, clay-colored stools; or
jaundice (yellowing of the skin or eyes).

3 important issues you would counsel patients with:


1. Advise patient to take medication exactly as directed and not to take more than the recommended.
2. Avoid patient to avoid alcohol (3 or more glasses per day increase the risk of liver damage) if taking more than an occasional 1-2 doses and to avoid
taking concurrently with salicylates for more than a few days.
3. Advise patient to discontinue acetaminophen and notify health care professional if rash ocurs.
List 3 drugs which significantly interact with this class and state what action you would take
Interaction
Corrective action
Epinephrine
Prilocaine can cause a condition called methemoglobinemia that reduces the
(Major)
oxygen-carrying capacity of the blood to different organs, and combining the
medication with acetaminophen may increase the risk.
You should seek immediate medical attention if you notice signs and symptoms such
as a gray discoloration of the skin, mouth, or nail bed; nausea; headache; dizziness;
lightheadedness; fatigue; shortness of breath; rapid or shallow breathing; a rapid
heartbeat; anxiety; and confusion.
Carbamazepine
Using acetaminophen together with carBAMazepine may alter the effects of
(Moderate)
acetaminophen and cause serious side effects that may affect your liver. Call your
doctor immediately if you experience a fever, chills, joint pain or swelling, excessive
tiredness or weakness, unusual bleeding or bruising, skin rash or itching, loss of
appetite, nausea, vomiting, or yellowing of the skin or the whites of your eyes.

Probenecid
(Minor)

Some minor drug interactions may not be clinically relevant in all patients. Minor
drug interactions do not usually cause harm or require a change in therapy.
However, your healthcare provider can determine if adjustments to your medications
are needed.

Prepared by: Novelyn C. Agsamosam

Remarks:

Generic Name of Drug: Salbutamol


PNDF Section: 7.1.1, 7.1.2
Page:47, 49
Typical Dosage: (Pedia/Adult/Pregnant/Dialysis)
Pedia:
ASTHMA:
Less than 1 year:
Nebulizer: 0.05 to 0.15 mg/kg/dose every 4 to 6 hours with
subsequent doses titrated based on clinical response.

Classification: Anti Asthma


Route:
Inhalation

1 year to 4 years:
Nebulizer: 1.25 to 2.5 mg every 4 to 6 hours with subsequent
doses titrated based on clinical response.
5 years or older:
Metered-dose inhaler (HFA): 2 puffs (216 mcg) every 4 to 6
hours as needed.
Inhalation capsules: 200 mcg inhaled every 4 to 6 hours.
May increase to 400 mcg inhaled every 4 to 6 hours, if
necessary.
5 years to 11 years:
Nebulizer: 2.5 mg every 4 to 6 hours with subsequent doses
titrated based on clinical response.
12 years or older:
Nebulizer: 2.5 to 5 mg every 6 hours as needed.
2 years to 5 years:
Syrup or tablets: 0.1 to 0.2 mg/kg 3 times daily. Do not exceed
12 mg a day.
6 years to 11 years:
Syrup or tablets: 2 to 6 mg orally 3 to 4 times a day. May
increase stepwise to a maximum of 24 mg/day in divided doses.
Adult:
ASTHMA:
Metered-dose inhaler: 2 puffs every 4 to 6 hours as needed.

Oral

Inhalation capsules: 200 mcg inhaled every 4 to 6 hours.


May increase to 400 mcg inhaled every 4 to 6 hours, if
necessary.
Nebulizer: 2.5 mg every 6 to 8 hours as needed. (2.5 to 5 mg
once followed by 2.5 mg every 20 minutes for acute
bronchospasm).
Tablets: 2 to 4 mg orally 3 to 4 times a day. May increase
stepwise to a maximum of 8 mg orally 4 times a day.
Syrup: 2 to 4 mg orally 3 to 4 times a day. Doses > 4 mg should
be given 4 times a day. May increase up to 8 mg orally 4 times a
day.
Pregnancy: Category C
Indication/s for use:
Bronchodilator in the symptomatic relief of bronchospasm in
obstructive airway diseases like bronchial asthma, emphysema,
and chronic bronchitis.

Mode of Action:
Salbutamol stimulates 2 adrenergic receptors which are predominant receptors
in bronchial smooth muscle of the lung. Stimulation of 2 receptors leads to the
activation of enzyme adenyl cyclase that form cyclic AMP (adenosine-monophosphate) from ATP (adenosine-tri-phosphate). This high level of cyclic AMP
relaxes bronchial smooth muscle and decreases airway resistance by lowering
intracellular ionic calcium concentrations. Salbutamol relaxes the smooth muscles

of airways, from trachea to terminal bronchioles.


Mode of elimination:
Common side effects:
Salbutamol is primarily excreted via the urine. Approximately
Fast, irregular, pounding, or racing heartbeat or pulse
50% is excreted as metabolites via the urine and about 30% is
shakiness in the legs, arms, hands, or feet
excreted as unchanged salbutamol. A small fraction is excreted
trembling or shaking of the hands or feet
through the faces.
3 important issues you would counsel patients with:
1. Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional
if you have any other types of allergies, such as to foods, dyes, preservatives, or animals.
2. Use this medicine only as directed by your doctor. Do not use more of it and do not use it more often than your doctor ordered. Also, do not stop
using this medicine or any asthma medicine without telling your doctor. To do so may increase the chance for breathing problems.
3. Givelower initial dose to elderly patients.
List 3 drugs which significantly interact with this class and state what action you would take
Interaction
Corrective action
Carvedilol
Carvedilol can sometimes cause narrowing of the airways, which may worsen
(Major)
your breathing problems or trigger severe asthmatic attacks. Your doctor or
pharmacist may be able to suggest alternatives that do not interact.
Propanolol
Propranolol can sometimes cause narrowing of the airways, which may worsen
(Major)
your breathing problems or trigger severe asthmatic attacks. Propranolol is
normally not recommended if you have asthma, a history of asthma, or severe
chronic obstructive pulmonary disease (COPD). Let your doctor know if you
experience wheezing, shortness of breath, chest tightness, or other breathing
difficulties if you do use these medications together. Your doctor or pharmacist
may be able to suggest alternatives that do not interact.
Atenolol
Atenolol can sometimes cause narrowing of the airways, which may worsen your
breathing problems or trigger severe asthmatic attacks. You may not be able to
use atenolol if you have frequent asthma attacks or severe asthma or COPD
(chronic obstructive pulmonary disease), or you may need a dose adjustment and
more frequent monitoring of your lung function to safely use both medications. Let
your doctor know if you experience wheezing, shortness of breath, chest
tightness, or other breathing difficulties while you are on these medications. Your
doctor or pharmacist may be able to suggest alternatives that do not interact.
Prepared by: Novelyn C. Agsamosam

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