ixed DrLg lombunali0ns

er Sufamethoxazole -Tri methoprim

,4 August
AS his is utionat d u Monduy
Ombna tio n C0TRIMOxAZOLE
Justiftcotion
Pant amtno bCn201c a i d (PABA)
folate , . Sultornetro
Synthetase OZole
Dihydro folic acid (DHFA)
Folate Trirnethopri
Teductase
Tebrahydrofolic acid (THFA)
LotnmoxOZOle iS a combination of sulfsnethox
zole wlth trimethoprim Sulfamethoxazole blocks
heSynthesis of folic add, whereas trirnehoprim
blocks the conversion of folic acdd intO tCtrahudro
Folate Therefore .the 2 drugs when given concurr-
TLLes
ently produce q sequentlal blockingj sUUtasneTmo-
xa20le 1s chosen because the half-iFe)of sulo
mehoxC 20le iS.almoSt the same as trimetroprim
Capprox0hoursThis.1s Tecommernded. ixed -dose
Combinati on in ratio of 5:1 Both inhlbit foiiC agd
Sunthesis by pathogen,but at ditferent Stages
which results LD Pote.nEiation Ot action +1S not
only eFective against a wide rOge O SUCeptible
Organisms.but is alsoerfecHve againSt Pnewmo-
eStiSCOminiiwhich. iS.an opportuni5t Pathogen.
Causing pneumonia..in AlDS Patlents
Doseand Roulte
Strength Preparations 20
gs 5400.mg.t 8.0 mg. Oral.tv
S-800 mg.tT-160.mg Double. Strength .0,i0m
6-200mgt.T40mg ***********

Orad SuS pension

5-100 mgtT20mg PaediaEriC ta blet

Al d a M1 mchru S1Ou t h oflin mual

Penpepnr Pparailan Tov2ab ad 8- 0S
modon Hy dho chlontina el S0 1 M
dopa derbi dopo (4 1o 101) [o0-3s
Amoi l l
amsoOA ali d 250& 1Ns00 0
 ugust0T O ()Aute u OpliCatelouC.r
e ddy

WA ()Baterml C P a t o r act
OCiops
() Buctermal d larrboes and dysenfT
() Typlhoid fever
6)PneLmocyStHS jroveci infectioD pneunonid
6) NoCOrdiosts
CChancrotd
8)Nhooping COugh
) Plaque (10) TOxoplasmoSIS
Adverse_effects
LOSS Of appetite, nausea.VO MittiDg, diarrhoea
revers1ble exnthemas fevVer ,itchh,sore mouth
Hyperkalaemia.
ThromboCytopenia
Contraindications ae
()Ontuy-Aotable non- SuSceptible OrqaniSMS
the
mycoplasma and Francisella tularensis (
CCIuSaHve orqanism of tularaemla)
2 Hypersensitivity
(3) Pregnancy
a) Severe hepatic failure
6) Haematoloqicol disorders and poTphyri
6) Severe real insuficieDCU
( ) Benzoic add and
Salicyclic 2014 August
Ans This is a rational drug
acid
Wednesday
Combination
Justificatlon
218 147

Wk 12
6
Benzolc acid has anti-Fungal action
with atu:bactera properts n sligbtly
fungistatic)
acidic
medium When used in combination wTth salicy-
úc acid saliculic acid
has_keratolytic acioD
removeS infected tissue and promote.S penetTation
OfbenzolC adcl into lestion Salicydic acid also has
mild antlseptic and antifungal ackion 5ince
they help eadh other in their actions. benzoic acid
aund salicylic acid is go0d drug COmbinatian
Dose
Whitfield's ointment6 beDzoic acid +
in
*

3 Sallcylic acid
a sultable baseLoanolin.OSeline
Route * **************************************************************************

Topica On SkiD . ...

*******************

OFungal infecti ons -athleke'sfoot

*** *****************

T t of mild
superficial fung.al infections
particulady tinea. pedis.tneacorporis Cund
Ocasionallytinea.ca.pitlS:CRLngwom)
Adverse etfects (5) WaatS
and CONS **"*************.i***s**

Localized mild.. inflam.matory ******************************************

* **.*

****
Tesponse Occu
********************

****************************
***** *

*******************
*
**
,

***************
********** . .
**

**************ee .vas.
**************** *** **
'*************************** ****** *
***r************"***********p

* ********* *** ***i

August201 ) Levodopa and Ca rbidopa
This is a rational drug
Thursday AnS
Combination
219 140

Justification itself and is active

Levodopa 1s inactive by
t r a n s m i t t e r dopamine
when onverted to
peripheral dopa-
Carbidopa is extracerebral not inhibit
which does
dearboxulase tnhibitor,
in brain
eodopa conversion to dopamine
alone does not
Dopamine when administered
penetrate BBB and has no action
in parkinsoN16m
which
Therefore it is administered a s Levodopa.
enters BBB
Advantages of combination.s.
basal
09ncreased bioavailabiity of dopamine.in
ganglia. Hence.dose.caD.be reduced by T5.:
2) Polongation.ofplasma .halflife ot levodopa
Reduction ip Lncidence of GL6ide -cFfecs ike
nausea and. VOmitting ******************************************n***********ns*********** ***** *************** .*

Cardiovascular side -eFfects like tacy.candia

hypotension and cardiac.arhythmiasS are
minimized:
Better patient compliance .*******************o*********************.**************************************** *

JEPyridoxine reversal.oE levodoPa. eFfectdoes

not OcCur ********

)On- OFF eFecS minimizedSince cerebral.DA

Levels are mone sustainecd: ********************************************************re***********

DOSe *****n*e****nes*"**r*s*ve**************************************** ********************************************ssane******

Levod.opa tCabidopa 0.101 ***************************************

: e 25 g t 100 nng CO-Carel.dopalLevocarb

10m9.t100.mq *****

*******r"*****************""** **1*********'*******'***
* SAN hNke

PARCOPASINE1ET ****i**"********rn***unNm****1*mAe ***************9**sak**

 2014 August
Route
3/4 times a day Friday
Oral
Oradlu disintegrating tablet
Extended releose tablet
220-145

Wk 32
8
USes
0 Parkinson s disease
(DRD
Dopanmine responsive dystonIa
) Hadludnoqen Persisting Perception Disorder CHPPD)
Adverse effects
Contus1on conStipation, dianrboea dizzine55
dowsinessdy mou thbeadacbe, increased
Sweatig.Lass Of appetite., nausea, taste.changes
ErOuble sleeping.upset Stomach urinary tract
Uniectin VOnmiting
Contraindications
u) Histoy of allergy
NamOuD -angle glaucoma.undiagnOsed
skin grouOthS.Skin.cancer or.history ot Skin
Cancer *********

3)3F taking.resepine|tetrabenazieIMAQ
Lnbibitors ***************** *** ********

alkalod
peLA ****************************************** ***************** ******

********** ******* Y**-*****

**************** *********

**** ** *******************

***************************************

*************************************************

***********************

*************************

********************
* ******************************************-**M**

**************** l

********
* *
 August 2014(4 Ampicillin and Probenicid
Saturday An6 Th's is a rotional drug
9 221-144
Wk 2
Combination

Justi Fication
Ampicilin is a B LactuLM and acidic dug Prob-
enicid iS also an acidic drug Acidic druas are
secreted by renad tubules: Since both are acidic
drugs they compete for secretion at the renal
tubuar site Pro ben icid bei ng more compet tive
enters the renal tubuwar wumen and Ampiciin
remainS behind in plas ma Hence pro benicid COn
LncreaSe plas.ma levels of anpi.cilliD and reduce
dose Of Ampicillin_ulhengiven incombinatian
Dose_
Ampicillin (500mg) t Probenicid (10mg2
ROute i .* . .

-Oral * * * * * * * * * * * * a * * * * * * * * * * * * * * * * * . i * * ** * * * * * * * * * - * * * * * * *

Pouoder Far oral SuspensionAmpicilin 85g and

-

pro benecid ig per bottle

Uses **r******r*****nrr*****nmry** ************************* ***** .****

Oncomplicated in fections.caused by susceptible

StrainS OF N gonorrhoeae n adults ***************

10 Su72 day
************

Adverse etfects ***********************************

**************************************nns*a*****ens******* ****sneseneemeaneeneeoamnnnmseene-. ..

O Headache._dizziness ************************************************************* **** rennenre**r*ser****snavont***ssnnen*ersreeee

(2) Rash; itchibg.

(3) ADOrexia, aus.ea.MOMIEDg. diarrbo.ea, OrcuL . -.

condid[asiS Sore guum5cramps.ab patn

)Outy arthitis,dySurla renal.col.cui
ontraindications
0)PregDa.n.cy
LactOtion
 3) Hypersensitivity
2014 August
) load dyscrasias Monday
6)Chtld <2yrsb
)Renal insutfldency
22. 142
Wk
11
9nfections due to penidilinase procucung
organiSms
Precautions
Pregnancy Lactation
e) anfectious mononudeosis
8History_of Peptic ulcers
()Acute gout

..

..

***********************************rnt*** **** * .... .

***************n***-****.* *************** - ....

***********************************

****rysm******************* ***** *
.*

***'************** . ...
. **
...
*

*****
.

*********** ***

************* **********

************

.
..

*****"******'********
*******

**************
 August 20146 ) Amoxycillin and Cavulanic Acid
Acld.
Tuesday Ans This is a ratonal drug
12 COm.btnation
Penicillin antibio tic tlactamasC
SC inhilitor
inhibitor
Justi Fication
(0Addition of clavul anic aCid re-CStablishes
of amoxicillln against B-Lactanmase adivitu
resistant
poducing
Staph aureuS (but Oot 1RSA that have
altered PBPs). H:iotluenzae. N gonorrhoed.
ECOu. Proteus Klebsiella. Salmonella 3 Sbigella
.

)
Bact fraqilis and Branhamella Catarrhoadis are
not reSpOnsive to amoxlcillin alOne, but
are
)
inhibited bu_COmbination
Amoxicil|in SensitiVe Strains are not
by additon a clavulanic acid aEfe.cted.
) 9 t broadens spectruum Of activity
DOse
Amoxicillin (2.50 mg) + AUGMENTIN
lavlanic acid (125 mg) J Co-AMOXICLAV
(BAN)
Koute
ral,tm,1Y
Uses:-
Oinary tract infecdions
2)kespLYCutoy tract infections
)Skin and soft tissUe infedtions
.

a) S1nus infections
***********
*****
. **************

.*

G) Cat 5 cratchesS **********************************ap

G)Gnfections COused by bactert ad flora of mouth

Such as
dental infections **************
'******************************** ..

) iDfected anLmal bites * ***************************************"******************************

Lnfected human bites in.clu.di.nguncompli-

Coted " clen ched-fist"reverse- bite. injuries)
0Gronoboec. Cindudinq PPNG) 2014 August
Single dose anmoxicillin 3q.+ Wednesday
clavulanic acid 5 _ t
Probenecid ig is higbly curative
25 140
13
Adverse reactions
Diarrhoea, vomiting,nausea, thrush and Skin
rash: a relu PSeudomembranous collitís and
cholestatic jaundice
Bacterial anti biotic resistan.ce
HypersensTivity nS. range rom severity From
skin a shes to immediate onapbylaxl6
Ontraindications
Knoon hypersensitivity to penicillins:
ra*********:********.**. *********.** ***

Precautions *******'*************

Facilities should be available for treaEing

Ounaphyiaxis UDheneVer peicilli.ns are used
Patients shold be questioned.caretuly.about
previous allergic Teactionsbefoe first dase is
administered 9 a skim rash deveo ps during
tlt or no impro vement Occurs UlEhin2 days .

patient shouw d be transterred. to diEferent

cass ot antinmicrobial. *******.**o*.*****************************************trxe*******r***e**********

***** ************

*** *******************************"*********

r****rssne****** ******.**************.******************** ** arse

********

. :...
 2014 Ampicillin and 5ulba ctum
August 6)
A D S J U s t i f i c a f i o n

Thursday blocks the en2ume

14 SLulbactam

which breaks
douwn ampicillin
to attack a n d
ampicillir
allows
cund thereby
SL the bacterId -derived.
antibiotic) +
e) Ampicillin Cpenicillin inbibitorD
cp-lactamnase
Subactum el wal
bu
work blocking bacteria's
they the bacteria
growth, which kills
DOse intravenous 500+250mg
Ora
5-3 9
Koute
Tntravenous -OnasyD
Sultamicillin:
Ampictam
-

Oral -

U6es
O9ntia abd omina infections
2) Skin infections
Pneumania
)Gynaecologic infectio0s
Active against uwide range oE bacterial groups
Staph: aureus, EDterobactertaceae unc
unaero blc bacteia
Adverse efects
Pain at injecbion sibe ----

Thrombophlebitis
Oiarrh0e0, Tash
Contraindications
Hypersensitivity
HIStory of cholestatic jaundice or hepatic
dysfun ction
Precautions 2014 August
OPatients with mononudeoSiS
liriday
)
develop a skin rash
Possibi lity of Sper infections
19
15
CaiDOgenic Imutogenic potentiau

*************

****

..

**-*********************************

********************************* ***

. .
August 2014 )Ampicillin and doxailin
Ans JuStification i
Saturday
16 28 1
W S
) Cloxaclllin is penicillinase resist
ant as well os acid reSIStant
Broadens spectrum of activity and reduccs
the dose of b0tth
8) Ampicillin exerts its action by inhiblting synthesis
ofbacterial cell wall doOxacillin is a. pen icillinase
resistant penidllin
e) Sunergestic action
Dose
Oral
Ad uWt Ampicillin 250 mg+ UOxadlin 250 mg
Susceptible infections
Child Ampicillin 125.nmg t COxadlin 125 mg
4imes a day
2 9ntravenoUS * ********** ** .

Severe infections **********************************

500mg (AMpicillin 250 mg tCoxacillin

tn 40 ml OR 250 mg)
*************'********************** **********

1g (Ampicillin 500 mgt

20 ml Cloxacillin soo mg) in
*********** ***
*********************************y*******************************
Route
day Oral i:
*

USes
u) Coderate to Severe infections
a)Against penicl|inase producing bacteria
E Coli, H.influenzae,PToteus,
Shigela, Salmonella,
PPNT,Gonorrhoea OTI,RTI
(3) 1iddle ear infections
a Upper 4 ouer respiTatory.tract infections
(S)Grastro-intestinal infections
)Soft tissue tnfections
 2014 August
Adverse, etfects
Gl disturbances, pruritis, urtioCia, Monday
erythema, exfoliative demmatitfS 2.30 115
Wk 34
18
rashes, fever joi0t pain, eosinophilia.
bronchial asthma.angioneurotfc oedema
haemolytic aunaemia , Serum sicknesS,CN S effects
ike hyperactivity.agitation.insomnia, anxicby
behaviOural cbangesCODfusion.dizziness and
Convulsions
Contraindications
4)Lactation **.*****************

e) Penicillin allergy
) Ampicillin interfereS with 6eruum albumin
urinary aminOacid electrophoresis and_uriDe
Sugarestim.ations
)Cloxacillin interfers Oith_Bradshow's test foT
Bence -Jones protein.in urne Measurement
Ofurnany 17-OXOSteroids L OxOgeniCSteroids
Precautlons i ***
**************************************************************************************************************

0) Allergy to penicllinLcepbalospOrinS. ... - - ********-***

e)Kidney Iuverdisease ***"*********************************!*************** ***********************************

B) 9n flammatoy bouwel diseaseulcerative collitis

)iandulartever ****"1***'*********

G) Leulkaemia **************************** *** ******************'*****

*
. .*...********.******. ************r********************eee*-****

**********************

******
*nm*nrn******************************************************

*********************************"******************************* ************** *** * *****

********************************* ****** ************

.. .i.... fei*r**r*r**lssavs*****e*************r** *********************************************************w*************

*************************:"******'************************************ ** *t ****

******I**** ***** ** ************r************

**i*********'****
August 2014 () Benzthiazide Triamterene
AnS-TuStification CD.TIDE)
Tuesday a thiazide
19 31 134 0) Benzthiazide is
CCedi um efficay
diuretics)

which causes hupolcalamia

diuetic
Triarmteren e is a pottassium 6Parinq
COrrects the hypokalaemia due to
thiazides
ond the diuretid
3 The Combination increases
Untihypertensive effect of bath
O0se
Benzthiazide (25 mg.) t Triamterene (50mg)
Route
Ora ******************** ***s****************************
* .

Dses ...

4 Hupe rtensiOD Mild to moderate .

..

) Heat Disease *****************

****************************n*****************

e KidneyDiseese *********************M*n*****************************

9) Edema ****
. ...... .. . . . . *s**s*******s*es*******eee***rs*a***********************r

) Diabetes L0sipidus **1**************

Adyerse erectS . ***********s************

. ***" **
**************************** ************

NeakneSS, drou)Siness..confusio0,upset Stomadh,

nausea, vomitLng.muScde.cramps, seizures,
huperuncaem1..aggravate.renal inSuFFiciencu.
menta disturbance . rrststrest **** *** ***************** ******************************************************************

Prrecoutions *** *
* ********

Renal LDSuPFidency, miscamage, DM, Gou t

c9) FurO Semide and 2014 August
Spironolactone
Ans Justiffcatio0 Wednesday
0 FurDsemide is
diuretlC which causes
a high ceiling
hypokalaemia
.32 -1 33
Wk 4
20
e)SpImnolactone was a pottassium sparing
diuretic which counteracts the hypokalaemia.
produced bu furosemide
DOSe
Furosemide (20mg) +SpionoLactone 50.mg)
LASILACTONE(Haterpills) 50mnq26mg
Route
Oral .

Uses .

0Edema ********. ******.***-******

e) Hypertenslon ********************

8)Congestive Heart Failure

e)Cerebral edem.
) B100d.transfusion ****************************************************d***************************

6) Pulmonary edema *****************************************************

(7) Lekt yentriclar foilure. ***************:****** *********************************

AdyerSe erreCtS -.. .*.*. ***********************************rsmememrr****** **************************

Heaing oss.Saline depletion ,dilutional

Qypabtraemia..hrsLELSmgynae.comastl .. ***********

Controlndications i
** **********.************************************************** ********************************* ********************

Preanancy.Lactation.anuriasevere ***

oliguriahypersensiti.VltyAddison'sdisease
Liver failure hypotension enal tmpairment
Special Precautions *******g*******************....*

Concomitant useuith ACE unhibitoTS,monitor

fLuidsand clectrolytes.induding.chang.es.in .

Serum Klevels *i******* *1******* *

.. ...
 August 2014 (10) Phenutoih sodium and
pheno barbltone
Thursday
21 3132 Ans-Justification-
Both of them act by different
mechanisms.Pheny toin sodiuum prolongs the
duration of Na- chann el unactivation and
phenobarbltone fadlita te CrABA mediabed u
dhannel opening: They prevent 6eizu re a ttacks
e ) Combin ation decreases dose of individual druq
EFfects uwhich are toxic of ench are ninimised
Dosei
Phenytoin sodi um (loomg). +
Phenobarbitone (30 mg)
Route ********* *

Oral
USes * ******** :rehe*nspr*********************srset *.

Generaised tonic-clonic.seizures
Partialseizures *********

3) Trigeminal and.otber neUralgias . .

(4)StatuS epilepti.cus *****************

) Febrile convulsions
Adverse effects ****** ** ****'************************ -

GTum hypertrophy, huypersenS1tivlty ,hirsutism,

hypergly caemia.megalobla5tic. anaemia
0Steomalacia,Foetal hydantoin sundrome
Contraindicationsi ***** ******************

Pregnoncy.bypersensitivity ..
..

Precoltions i ***

Not to be given
-

Dith.anDtacidand sucrau fate

Phenytoin requires thcrapeutic monitori.ng
-

NOt to be given uwith OC pills Lcambamazepine.

 o c h l o r o t h i o z2014
) fropanolol and tiydrochlorothiazide4 i d - 1 4 August
A s t ification
AnSJ uJuStl fication
riday
(4) This 1S a rational
drug
e) Hydrochloro thiazide is
combination 1
a thiazide Wk
234 131
34
22
diureiC 9t caus es increases tn PLasn
enin lev els
-blocker Uke propanolol decreases plasma
renin leyels ,so comblned with hydrochlor
Othiazide 9nitta tathutcatudtie tPTop¬Aotot
OOse ****

Propanolol (4o mq) +Hydrohlorothiazide (25 mg)

Oute ********

Oral ****************

*
...

Hupetensto
Adyerse effects .
********.**************************

Eye pain 6LD elling, apid ueight gain, keeling

Short of breath uneven heartbeatcaSy bruising
nausea, VOmi Etng,dry.mouth,increased urinatioo,
fever, sore throat hegdache ec ************************************ *-

COntraindicationS ****** * * * * * * * * * * * * * * * * * * * * * * * * **

)Allergy to either ***

***********************************ossssn ..

)CongeStlve heart tailure ******************n********ssmennas

8) idney disease *******************

Heat diseaSe
6)lauOma **********

6) LOctOtion ..
 August
August 2014 (12) Etbinul estradiol and Norethi
Saturda4y Sterone (OVRAL C
23 Wk
AnsThis is a rational drug
Combination
Justi fication
)They ore derivati ves of lestrogen 4 progesterone
e estrogen and Progesterone by a negattve
Feedback mechanism decrease release oF
ganadotrophin. releasiDghormone cGn RH)
from_ bupothalamus,which causes a decrease
Lo LH and FSH from anterior pitutary, and.
hence there is no LH SuTge and loWation
3)ProgestDgen. irncreases the viscosity of Cervia
mucus making 1tthick and visctd thus making
it hoStLLe. for Sperm entry
4) Progesto gen he also decreases the motility of
Fallopiarn tube thus making it unable for the
transport of ovum and Sperm to ompulla
of Pauopian tubes uwhere fertllizaHon takes
place ******************* ********************************** *****************************************************************************

5) They may also alber the uterine endometnum

Sufficien tly so that even f an ovum is fertillzed
by Chancethe fertilised okuum..connot be
24 Sunday implanted ********** ** * ** ******

(Progestogen
of estrogen
counters the excessive effects
on endomebriu.mthus preventing
endometria.carcinoma

0-0 7