Basic Pharmacology (Steven)

BASIC PHARMACOLOGY
COMPLIED BY
MR. ADEBOWALE E. ADEYEMI

CHAPTER ONE
INTRODUCTION TO PHARMACOLOGY
Pharmacology is the study of interaction of drugs with living organisms. It also includes history,
source, physicochemical properties, dosage forms, and methods of administration, absorption,
distribution mechanism of action, biotransformation, excretion, clinical uses and adverse effects
of drugs.
Pharmacy: It is the science of identification, selection, preservation, standardization,
compounding and dispensing of medical substances.
BRANCHES OF PHARMACOLOGY:
Clinical Pharmacology: It evaluates the pharmacological action of drug, preferred route of
administration and safe dosage range in human by clinical trails.
Pharmacodynamics: The study of the biological and therapeutic effects of drugs (i.e “what the
drug does to the body”).
Pharmacokinetics: Study of the absorption, distribution, metabolism and excretion (ADME) of
drugs (“i.e what the body does to the drug”).
Pharmacotherapeutics: It deals with the proper selection and use of drugs for the prevention
and treatment of disease.
Animal Pharmacology:It deals with different properties of drugs in animals.
Pharmacy: It is the science of identification, selection, preservation, standardisation,
compounding and dispensing of medical substances.
Pharmacoepidemiology: It deals with the study of effects of drugs on a large population. It
includes trial studies on healthy and diseased individuals and collecting the opinion of physicians
prescribing a drug.
Posology: It deals with the study of dosage of drugs.
Pharmacognosy: It deals with the study of properties of drugs in crude or unprepared forms.
Pharmacoeconomics: It is the study of economic factors regarding the cost of drug therapies,
including their impact on healthcare system and society.
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Toxicology: It’s the science of poisons. Many drugs in larger doses may act as poisons. Poisons
are substances that cause harmful, dangerous or fatal symptoms in living substances.
SOURCES OF DRUGS
Drugs: Drugs are chemicals that alter functions of living organisms. Drugs are generally given
for the diagnosis, prevention, control or cure of disease.
Plant Sources: Plant source is the oldest source of drugs. Most of the drugs in ancient times
were derived from plants. Almost all parts of the plants are used i.e. leaves, stem, bark, fruits and
roots.
 Leaves: The leaves of Digitalis Purpurea are the source of Digitoxin and Digoxin, which
are cardiac glycosides. Leaves of Eucalyptus give oil of Eucalyptus, which is important
component of cough syrup. Tobacco leaves give nicotine. Atropa belladonna gives
atropine.
 Flowers: Rose gives rose water used as tonic.
 Fruits: Senna pod gives anthracine, which is a purgative (used in constipation). Calabar
beans give physostigmine, which is cholinomimetic agent.
Animal Sources: Pancreas is a source of Insulin, used in treatment of Diabetes. Urine of
pregnant women gives human chorionic gonadotropin (hCG) used for the treatment of infertility.
Sheep thyroid is a source of thyroxin, used in hypertension. Cod liver is used as a source of
vitamin A and D. Anterior pituitary is a source of pituitary gonadotropins, used in treatment of
infertility. Blood of animals is used in preparation of vaccines. Stomach tissue contains pepsin
and trypsin, which are digestive juices used in treatment of peptic diseases in the past. Nowadays
better drug have replaced them.
Mineral Sources:
i. Metallic and Nonmetallic sources:
 Iron is used in treatment of iron deficiency anemia

 Zinc is used as zinc supplement. Zinc oxide paste is used in wounds and in eczema.
 Iodine is antiseptic. Iodine supplements are also used.
 Liquid paraffin, magnesium sulfate, magnesium trisilicate, kaolin, etc.
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ii. Miscellaneous Sources:
 Fluorine has antiseptic properties.

 Borax has antiseptic properties as well.
 Selenium as selenium sulphide is used in anti-dandruff shampoos.
 Petroleum is used in preparation of liquid paraffin.
Synthetic/ Semi synthetic Sources:
i. Synthetic Sources:
When the nucleus of the drug from natural source as well as its chemical structure is altered, we
call it synthetic. Examples include Emetine Bismuth Iodide
ii. Semi Synthetic Source:
When the nucleus of drug obtained from natural source is retained but the chemical structure is
altered, we call it semi-synthetic. Examples include Apomorphine, Diacetyl morphine, Ethinyl
Estradiol, Homatropine, Ampicillin and Methyl testosterone. Most of the drugs used nowadays
(such as antianxiety drugs, anti convulsants) are synthetic forms.
Microbiological Sources: Penicillium notatum is a fungus which gives penicillin.
Actinobacteria give Streptomycin. Aminoglycosides such as gentamicin and tobramycin are
obtained from streptomycis and micromonosporas.
Recombinant DNA technology: Recombinant DNA technology involves cleavage of DNA by
enzyme restriction endonucleases. The desired gene is coupled to rapidly replicating DNA (viral,
bacterial or plasmid). The new genetic combination is inserted into the bacterial cultures which
allow production of vast amount of genetic material.
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CHAPTER TWO
PRINCIPLES OF PHARMACOLOGY
General principles of drug action that form the basis for understanding the action of specific
drugs include the following considerations
Principle 1: Drugs do not create function but rather modify existing functions within the
body
The knowledgeable health professional has an understanding of what physiologic functions are
altered by a given drug.
Principle 2: No drug has a single action
The desired action is the expected, predictable response. Side effects are actions or effects other
than those for which the drug was originally given. Side effects may be harmful, beneficial or of
little consequence; most are predictable
Untoward effects: Untoward effects develop with therapeutic dose of a drug. They are
undesirable and if very severe, may necessitate the cessation of treatment. e.g: Diarrhoea with
ampicillin and potassium loss with diuretics.
Allergic reactions: Most of the drugs used in therapeutics are capable of causing allergic or
hypersensitive reactions. These reactions may be mild or very severe like anaphylaxis. When an
individual has been sensitized to an antigen (allergen) further contact with that antigen can
sometimes lead to tissue damaging reactions.
Principle 3: Drug action is determined by how the drug interacts with the body.
There are three general ways that drugs interact with the body. First, some drugs alter body
fluids, for instance, the acidity of the stomach or urine. Second, drugs may interact
nonspecifically with cell membranes, a property primarily found with the general anaesthetics.
Third, drugs may act through specific receptors; most drugs act through a receptor mechanism.
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Receptor mechanism: The concept of drug receptors is one of the major concepts in
pharmacology. Most drugs seem to mimic a naturally occurring compound and interact with a
specific biologic molecule to produce a specific biologic response. Receptors are those molecular
entities capable of binding to very specific compounds.
PHARMACODYNAMICS
This involves how the drug act on target cells to alter cellular function.
Receptor and non-receptor mechanisms: Most of the drugs act by interacting with a cellular
component called receptor. Some drugs act through simple physical or chemical reactions
without interacting with any receptor.
Receptors are protein molecules present either on the cell surface or within the cell e.g.
adrenergic receptors, cholinoceptors, insulin receptors, etc.
The endogenous neurotransmitters, hormones, autacoids and most of the drugs produce their
effects by binding with their specific receptors.
Aluminium hydroxide and magnesium trisilicate which are used in the treatment of peptic ulcer
disease act by non-receptor mechanism by neutralizing the gastric acid.
Many drugs are similar to or have similar chemical groups to the naturally occurring chemical
and have the ability to bind onto a receptor where one of two things can happen- either the
receptor will respond or it will be blocked.
A drug, which is able to fit onto a receptor, is said to have affinity for that receptor. Efficacy is
the ability of a drug to produce an effect at a receptor.
Agonist is any compound, either natural or man-made, that binds to a specific receptor and
produces a biologic effect by stimulating the receptor.
An agonist has both an affinity and efficacy whereas antagonist has affinity but not efficacy or
intrinsic activity.
When a drug is able to stimulate a receptor, it is known as an agonist and therefore mimics the
endogenous transmitter. When the drug blocks a receptor, it is known as antagonist and therefore
blocks the action of the endogenous transmitter (i.e. it will prevent the natural chemical from
acting on the receptor). However, as most drug binding is reversible, there will be competition
between the drug and the natural stimulus to the receptor.
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PHARMACOKINETICS
Pharmacokinetics is the study of how drugs enter the body, reach their site of action, and are
removed from the body.
Biotransport of drug: It is translocation of a solute (drug) from one side of the biological barrier
to the other.
Structure of biological membrane: The outer surface of the cell is covered by a very thin
structure known as plasma membrane. It is composed of lipid and protein molecules. The
membrane proteins have many functions like
 contributing structure to the membrane
 acting as enzyme
 acting as carrier for transport of substances
 acting as receptors.
The plasma membrane is a semipermeable membrane allowing certain chemical substances to
pass freely e.g. it allows water, glucose, etc. but it won’t allow sucrose until it is converted into
glucose and fructose.
Passage of drug across membrane.
(a) Passive transfer
i) Simple diffusion
ii) Filtration
(b) Specialized transport
i) Facilitated diffusion
ii) Active transport
iii) Endocytosis
a. i) Simple diffusion: Movement of a solute through a biological barrier from the phase of
higher concentration to a phase of lower concentration. No need of energy e.g. highly
lipid soluble drugs.
ii) Filtration: Is the process by which water soluble drug of relatively low molecular
weight crosses the plasma membrane through pores as a result of hydrodynamic pressure
gradient across the membrane e.g. urea and ethylene glycol.
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b. i) Facilitated diffusion: It means the passage of drug across the biological membrane
along the concentration gradient by the protein carrier mediated system also called as
carrier mediated diffusion. It depends on number of carrier e.g. tetracycline, pyrimidine.
ii) Active transport: The process by which drugs pass across the biological membrane
most often against their concentration gradient with the help of carriers along with the
expenditure of energy e.g. alpha methyldopa, levodopa, 5-fluoro-uracil, 5 bromouracil.
iii) Endocytosis: It is the process by which the large molecules are engulfed by the cell
membrane and releases them intracellularly e.g. protein, toxins (botulinum, diphtheria)
DRUG ABSORPTION
Absorption is the process by which the drug enters into the systemic circulation from the site of
administration through biological barrier. In case of intravenous or intra-arterial administration
the drug bypasses absorption processes and it enters into the circulation directly.
Routes of drug administration (absorption):
1) Enteral route (From the alimentary tract:)
i. Oral (drug swallowed; absorbed from stomach and/or small intestine)
ii. Buccal cavity (drug dissolved between the cheek and gum): e.g. nitrates
iii. Sublingual (drug dissolved under the tougue)
iv. Rectal (drug inserted into rectum)
2) From the parenteral route:

i. Intradermal: This is given into the layers of the skin e.g. B.C.G. vaccine
ii. Subcutaneous: Non-irritant substances are given into subcutaneous tissue e.g. insulin
iii. Intramuscular: Soluble substances, mild irritants, suspensions and colloids can be
injected by this route. These injections can be given to deltoid or gluteal muscle.
Advantages: Rate of absorption is uniform, Onset of action is faster than oral and it can be given
in diarrhoea or vomiting.
Disadvantages: Pain at local site of injection. The volume of injection should not exceed 10 ml.
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iv) Intravenous: Drugs directly given into a vein, produce rapid action, no need of absorption
as they enter directly into blood, can be given as bolus e.g. furosemide, morphine, dopamine or
as continous infusion e.g. fluids during shock or dehydration.
Advantages: It can be given in large volumes; production of desired blood concentration can be
obtained with a well-designed dose.
Disadvantages: Drug effect cannot be halted once the drug is injected; expertise is needed to
give injection.
(i) Intrathecal: Injected into subarachnoid space of spinal cord e.g. spinal anaesthetics.
(ii) Intraperitonial: Injections given into the abdominal cavity e.g. infant saline,
glucose.
(iii) Intra-articular: Injected directly into a joint e.g. hydrocortisone.
3) Topical/ local route:
The absorption through skin is a passive process. The absorption occurs more easily through the
cell lining e.g. dusting powder, paste, lotion, drops, ointment, suppository for vagina and rectum.
4) Inhalation: Drugs may be administered as dry powders, and nebulized particles when sprayed
as fine droplets get deposited over the mucous membrane producing local effects and may be
absorbed for systemic effects e.g. salbutamol spray used in bronchial asthma and volatile general
anaesthetics.
BIOAVAILABILITY:
It is the rate and amount of drug that is absorbed from a given dosage form and reaches the
systemic circulation following non-vascular administration. When the drug is given IV, the
bioavailability is 100%. It is important to know the manner in which a drug is absorbed. The
route of administration largely determines the latent period between administration and onset of
action. Drugs given by mouth may be inactive for the following reasons:
a) Enzymatic degradation of polypeptides within the lumen of the gastrointestinal tract e.g.
insulin, ACTH.
b) Poor absorption through gastrointestinal tract e.g. aminoglycoside antibiotics.
c) Inactivation by liver e.g. testosterone during first passage through the liver before it reaches
systemic circulation.
FACTORS AFFECTING DRUG ABSORPTION AND BIOAVAILABILITY:
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a) Physico-chemical properties of drug
b) Nature of the dosage form
c) Physiological factors
d) Pharmacogenetic factors
e) Disease states.
a) Physico-chemical properties of drug:
i) Physical state: Liquids are absorbed better than solids and crystalloids absorbed
better than colloids.
ii) Lipid or water solubility: Drugs in aqueous solution mix more readily than those in
oily solution. However at the cell surface, the lipid soluble drugs penetrate into the
cell more rapidly than the water soluble drugs.
iii) Ionization: Most of the drugs are organic compounds. Unlike inorganic compounds,
the organic drugs are not completely ionized in the fluid. Unionized component is
predominantly lipid soluble and is absorbed rapidly and an ionized is often water
soluble component which is absorbed poorly. Most of the drugs are weak acids or
weak bases. It may be assumed for all practical purposes, that the mucosal lining of
the G.I.T is impermeable to the ionized form of a weak organic acid or a weak
organic base. These drugs exist in two forms;
Acidic drugs: rapidly absorbed from the stomach e.g. salicylates and barbiturates.
Basic drugs: Not absorbed until they reach to the alkaline environment i.e. small
intestine when administered orally e.g. pethidine and ephedrine.
b) Dosage forms:
i. Particle size: Small particle size is important for drug absorption. Drugs given in a
dispersed or emulsified state are absorbed better e.g. vitamin D and vitamin A.
ii. Disintegration time and dissolution rate: Disintegration time: The rate of breakup of
the tablet or capsule into the drug granules. Dissolution rate: The rate at which the drug
goes into solution.
iii. Formulation: Usually substances like lactose, sucrose, starch and calcium phosphate are
used as inert diluents in formulating powders or tablets. Fillers may not be totally inert
but may affect the absorption as well as stability of the medicament. Thus a faulty
formulation can render a useful drug totally useless therapeutically.
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c) Physiological factors:
a) Gastrointestinal transit time: Rapid absorption occurs when the drug is given on empty
stomach. However certain irritant drugs like salicylates and iron preparations are
deliberately administered after food to minimize the gastrointestinal irritation. But
sometimes the presence of food in the G.I tract aids the absorption of certain drugs e.g.
griseofulvin, propranolol and riboflavin.
b) Presence of other agents: Vitamin C enhances the absorption of iron from the G.I.T.
Calcium present in milk and in antacids forms insoluble complexes with the tetracycline
antibiotics and reduces their absorption.
c) Area of the absorbing surface and local circulation: Drugs can be absorbed better
from the small intestine than from the stomach because of the larger surface area of the
former. Increased vascular supply can increase the absorption.
d) Enterohepatic cycling: Some drugs move in between intestines and liver before they
reach the site of action. This increases the bioavailability e.g. phenolphthalein.
e) Metabolism of drug/first pass effect: Rapid degradation of a drug by the liver during
the first pass (propranolol) or by the gut wall (isoprenaline) also affects the
bioavailability. Thus a drug though absorbed well when given orally may not be effective
because of its extensive first pass metabolism.
d) Pharmacogenetic factors:
Individual variations occur due to the genetically mediated reason in drug absorption and
response.
e)Disease states:
Absorption and first pass metabolism may be affected in conditions like malabsorption,
thyrotoxicosis, and liver cirrhosis.
DISTRIBUTION OF DRUGS
Penetration of a drug to the sites of action through the walls of blood vessels from the
administered site after absorption is called drug distribution. Drugs distribute through various
body fluid compartments such as
a) plasma
b) interstitial fluid compartment
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c) trans-cellular compartment.
Factors determining the rate of distribution of drugs:
1. Protein binding of drug: A variable and other significant portion of absorbed drug may
become reversibly bound to plasma proteins. The active concentration of the drug is that part
which is not bound, because it is only this fraction which is free to leave the plasma and site of
action.
i. Free drug leave plasma to site of action.
ii. Binding of drugs to plasma proteins assists absorption.
iii. protein binding acts as a temporary store of a drug and tends to prevent large fluctuations
in concentration of unbound drug in the body fluids
iv. protein binding reduces diffusion of drug into the cell
1. Plasma concentration of drug (PC):
It represents the drug that is bound to the plasma proteins (albumins and globulins) and the drug
in free form. It is the free form of drug that is distributed to the tissues and fluids and takes part
in producing pharmacological effects. The concentration of free drug in plasma does not always
remain in the same level
e.g.
a) After I.V. administration plasma concentration falls sharply
b) After oral administration plasma concentration rises and falls gradually.
c) After sublingual administration plasma concentration rise sharply and falls gradually.
3. Clearance: Volume of plasma cleared off the drug by metabolism and excretion per unit
time. Protein binding reduces the amount of drug available for filtration at the glomeruli and
hence delays the excretion, thus the protein binding reduces the clearance.
4. Physiological barriers to distribution: There are some specialized barriers in the body due
to which the drug will not be distributed uniformly in all the tissues. These barriers are:
a) Blood brain barrier (BBB) through which thiopental sodium is easily crossed but not
dopamine.
b) Placental barrier: which allows non-ionized drugs with high lipid/water partition
coefficient by a process of simple diffusion to the foetus e.g. alcohol, morphine.
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5. Affinity of drugs to certain organs: The concentration of a drug in certain tissues after a
single dose may persist even when its plasma concentration is reduced to low. Thus the hepatic
concentration of mepacrine is more than 200 times that of plasma level. Their concentration may
reach a very high level on chronic administration. Iodine is similarly concentrated in the thyroid
tissue.
METABOLISM OF DRUGS
Biotransformation is the ability of living organisms to modify the chemical structure of drugs.
Drugs are chemical substances, which interact with living organisms and produce some
pharmacological effects and then, they should be eliminated from the body unchanged or by
changing to some easily excretable molecules. Most drugs are metabolized in the liver. The
process by which the body brings about changes in drug molecule is referred as drug
metabolism
Enzymes responsible for metabolism of drugs:

a) Microsomal enzymes: Present in the smooth endoplasmic reticulum of the liver, kidney
and GIT e.g. glucuronyl transferase, dehydrogenase , hydroxylase and cytochrome P450
b) Non-microsomal enzymes: Present in the cytoplasm, mitochondria of different organs.
e.g. esterases, amidase, hydrolase.
EXCRETION OF DRUGS
Excretion of drugs means the transportation of unaltered or altered form of drug out of the body.
The major processes of excretion include renal excretion, hepatobiliary excretion and pulmonary
excretion. The minor routes of excretion are saliva, sweat, tears, breast milk, vaginal fluid, nails
and hair. The rate of excretion influences the duration of action of drug. The drug that is excreted
slowly, the concentration of drug in the body is maintained and the effects of the drug will
continue for longer period.
Different routes of drug excretion
a) Renal excretion: A major part of excretion of chemicals is metabolically unchanged or
changed. The excretion of drug by the kidney involves.
i. Glomerular filtration
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ii. Active tubular secretion
iii. Passive tubular reabsorption.
b) Hepatobiliary excretion: The conjugated drugs are excreted by hepatocytes in the bile.
Molecular weight more than 300 daltons and polar drugs are excreted in the bile. Excretion of
drugs through bile provides a backup pathway when renal function is impaired. After excretion
of drug through bile into intestine, certain amount of drug is reabsorbed into portal vein leading
to an enterohepatic cycling which can prolong the action of drug e.g. chloramphenicol, oral
estrogen are secreted into bile and largely reabsorbed and have long duration of action.
Tetracylines which are excreted by biliary tract can be used for treatment of biliary tract
infection.
c) Gastrointestinal excretion: When a drug is administered orally, a part of the drug is not
absorbed and excreted in the faeces. The drugs which do not undergo enterohepatic cycle after
excretion into the bile are subsequently passed with stool e.g. aluminium hydroxide changes the
stool into white colour, ferrous sulfate changes the stool into black and rifampicin into orange
red.
d) Pulmonary excretion: Drugs that are readily vaporized, such as many inhalation
anaesthetics and alcohols are excreted through lungs. The rate of drug excretion through lung
depends on the volume of air exchange, depth of respiration, rate of pulmonary blood flow and
the drug concentration gradient.
e) Sweat: A number of drugs are excreted into the sweat either by simple diffusion or active
secretion e.g. rifampicin, metalloids like arsenic and other heavy metals.
f) Mammary excretion: Many drugs mostly weak basic drugs are accumulated into the
milk. Therefore lactating mothers should be cautious about the intake of these drugs
because they may enter into baby through breast milk and produce harmful effects in the
baby e.g. ampicillin, aspirin, chlordiazepoxide, coffee, diazepam, furosemide, morphine,
streptomycin etc.
DRUG SAFETY AND EFFECTIVENESS

Factors modifying the dosage and action of drugs
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Individuals differ both in the degree and the character of the response that a drug may elicit and
therefore the optimum dose of a drug which produces the desired therapeutic effect varies from
person to person. The important factors which influence the effect of a drug are:
1. Drug intolerance: It is a quantitative deviation from the anticipated response to a given
dose of a drug. Thus drug intolerance is inability of the individual to tolerate a drug.
2. Sex difference: Special care should be exercised when drugs are administrated during
menstruation, pregnancy and lactation.
a. Menstruation: Drugs producing pelvic congestion should be avoided during
menstruation e.g. drastic purgatives.
b. Pregnancy: During pregnancy, the use of all drugs except those essential to maintain
pregnancy should be used with caution. Drugs which may stimulate the uterine
smooth muscle, are contraindicated during pregnancy. Further, many drugs
administered to mother are capable of crossing the placenta and affecting the foetus.
Most of drugs can produce teratogenicity when they are used in pregnancy.
Teratogenicity means congenital malformation. Drugs known to produce
teratogenicity e.g thalidomide, cyclophosphamide, methotexate, tetracyclines,
phenytoin, carbamazepine etc.
c. Breast feeding: Nearly all agents received by mother are likely to be found in her
milk and could theoretically harm the infant. Most of the lipid soluble drugs get into
breast milk. Therefore the drugs, which are excreted in the milk and harm the infant
health should be avoided by breast-feeding mothers e.g. sulphonamides, tetracyclines,
nalidixic acid, isoniazid, diazepam, lithium, Indomethacin, aspirin, etc.
3. Body Weight: The average dose is mentioned either in terms of mg per kg body weight
or as the total single dose for an adult weighing between 50-100kg. However, dose
expressed in this fashion may not apply in cases of excessively obese individuals or those
suffering from
4. edema or dehydration nutritional factors can sometimes alter drug metabolizing capacity
and this should be kept in mind in malnourished patients.
4. Age: The pharmacokinetics of many drugs changes with age. Thus gastric emptying is
prolonged and the gastric pH fluctuates in neonates and infant, further the liver capacity to
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metabolize drugs is low, renal function is less developed and the proportion of body water is
higher in the newborn and the neonates. Hence children may not react to all drugs in the same
fashion as young adults. With a few exceptions, drugs are more active and more toxic in the new
born than the adults.
The paediatric doses are expressed in terms of body weight (mg/kg per dose or day) or in terms
of body surface area (mg/m2per day). The body surface area can be calculated from the height
and weight of the child. Like children, old people also present problems in dosage adjustment
and this may vary widely with different people. The metabolism of drugs may diminish in the
elderly and the renal function declines with age. Elderly are sensitive to drugs like hypnotics,
tranquilizers, phenylbutazone, diazepam, pethidine, etc.
i) Dose adjustment on the basis of age (Young’s formula)
Age in years____ x adult dose
Age in years + 12
ii) Dose adjustment on the basis of body weight (Clark’s formula) (1 Kg=2.2 pounds)
Weight of child in pound x Adult dose
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e.g. A 3 year old child having body weight of 30 pound requires to administer drug X.
The adult dose is 100mg. So
a) Using age of the child the dose will be

3 x 100 = 3 x100 = 20mg
3+12 15
b) Using body weight of the child it will be
30 x 100 = 1 x 100 = 20mg

150 5
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5. Disease state: Some antimicrobial agents penetrate the cerebrospinal fluid well across the
normal meninges while other antimicrobials penetrate well only when the meninges are
inflammed (meningitis) e.g. sulphonamides, metronidazole, chloramphenicol, isoniazid and
rifampicin penetrate well through the normal meninges and other antimicrobial agents like
benzyl penicillin, ampicillin, tetracycline, streptomycin, gentamycin and cephalosporin penetrate
only when the meninges are inflammed.
6. Pharmacogenetics: The science pharmacogenetics is concerned with the genetically mediated
variations in drug responses.
7) Drug interactions: It is usual for patients to receive a number of drugs at the same time. It is
a phenomenon which occurs when the effects of one drug are modified by the prior or concurrent
administration of another drug(s). A drug interaction may result in beneficial or harmful effects
and may be classified into:
a) Pharmaceutical drug interactions:
Serious loss of potency can occur from incompatibility between an infusion fluid and a drug that
is added to it. For example diazepam if added to infusion fluid there will be a precipitate
formation → loss of therapeutic effect.
b) Pharmacokinetic drug interactions:
i. Interaction during absorption: Drugs may interact in the gastrointestinal tract resulting
in either decreased or increased absorption. e.g. Tetracycline + Calcium → Decreased
absorption of tetracycline.
ii. Interaction during distribution: A drug which is extensively bound to plasma protein
can be displaced from its binding sites by another drug or displacement from other tissue
binding sites. e.g. (i) Sulfonamide can be displaced by salicylates from plasma proteins
and it leads to sulfonamide toxicity. (ii) Quinidine displaces digoxin from binding sites
in tissues and plasma and leads to digoxin toxicity.
iii. Interactions during biotransformation: This can be explained by two mechanisms:
i. Enzyme induction.
ii. Enzyme inhibition.
c)Pharmacodynamics interactions:
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i. Drug Synergism: When the therapeutic effect of two drugs are greater than the effect of
individual drugs, it is said to be drug synergism.
ii. Drug Antagonism: The phenomenon of opposing actions of two drugs on the same
physiological system is called drug antagonism.
Importance of drug antagonism
(i) Correcting adverse effects of drugs
(ii) Treating drug poisoning. e.g. Morphine with naloxone, organophosphate compounds with
atropine.
(iii) Predicting drug combinations which would reduce drug efficacy.
8) Repeated administration and drug cumulation:
If a drug is excreted slowly, its administration may build up a sufficiently high concentration in
the body to produce toxicity. e.g. digitalis, emetine. To avoid cumulation:
a) One must know if a drug is eliminated slowly or rapidly

b) Stop the drug administration at the appearance of the first warning
symptoms
c) Carefully select the form in which the drug is to be administered
d) Check liver and kidney function before and during drug administration, as
even an otherwise non-cumulative drug would produce cumulation in the
presence of hepatic and renal damage.
9) Drug tolerance:
When an unusually large dose of a drug is required to elicit an effect ordinarily produced by the
normal therapeutic dose of the drug, the phenomenon is termed as drug tolerance.
Tachyphylaxis: Rapid development of tolerance on repeated administration is called
tachyphylaxis
e.g. Ephedrine, amphetamine and nitroglycerine produce tachyphylaxis on repeated
administration.
10) Emotional factors. e.g. Placebo response.
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Placebo: It is a Latin word meaning “I shall please” and it is a tablet looking exactly like the
active treatment but containing no active component. It refers originally to substances merely to
please the patient when no specific treatment was available.
CHAPTER THREE
NAMING OF DRUGS
Every drug has four names:
 Code name
 Chemical name
 Non-proprietary name
 Trade name
You might ask, where are there four names for a drug? Well, it's because each name has its
advantages and disadvantages. Let's find out what they are.
1. Code name
Code name is the first name that is given to a drug by the pharmaceutical manufacturers. It may
be an abbreviation, a number, or a combination of both. For example, Ciprofloxacin has the
code name Bay-o-9867, where Bay comes from the name of the famous pharmaceutical
company that produced it, BAYER.
2. Chemical name
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Chemical name is the name used by the organic chemist to indicate the chemical structure of
the drug. When a drug with a code name is found to be effective after a preliminary screening,
then its chemical structure is studied. In the case of Bay-o-9867, the chemical structure is 1-
Cyclopropyl-6-fluoro-4-oxo-7-(1-piperazinyl)-1,4-dihydro-3-quinolinecarboxylic acid! Will
you be able to remember this name for practical purpose? Chemical names are quite long and
difficult to remember, spell, and pronounce as most of the organic drugs are complex molecules.
This name is not suitable for routine use by medical professionals or common people. However,
this name is very helpful for the discovery of new compounds.
3. Non-proprietary name: If a drug appears promising and the manufacturer wishes to sell it in
the market, then a non-proprietary name is given to it. It is wrongly called the generic name!
Generic name actually designate a family relationship among drugs. For e.g. benzodiazepines,
barbiturates, catecholamines etc. Benzodiazepines include a number of drugs like diazepam,
nitrazepam, flurazepam etc. Medical professionals choose the non-proprietary name for its
simplicity. It is always concise and meaningful. For example, the word methylnitro is
condensed to metro and nidazole (Metronidazole) which is due to its imidazole ring.
Who determines the non-proprietary name of a drug?
The non-proprietary names are chosen by some official agencies:
International Non-proprietary Names (INN)
British Approved Names (BAN)
United States Approved Names (USAN)
FDA (Food and Drugs Authority)
USP (United States Pharmacopoeia)
BP (British Pharmacopoeia)
4. Trade name
The fourth name of a drug is the trade, proprietary, or brand name. It is shorter, simpler, easier to
remember and most frequently used. A drug can have several (may be several hundreds or
thousands) trade names. e.g. GlaxoSmithKline uses its bronchodilator drug as ventolin instead
of the non-proprietary name salbutamol. Different pharmaceutical companies market the same
drug with different trade names which produce a lot of confusion.
A trade name frequently appears with the sign ® at its upper right corner which indicates that the
name is registered and its production is restricted to that pharmaceutical company as sole owner.
19
So, trade name refers to a particular company. There is great debate about the use of non-
proprietary vs trade name in the prescription. However, drugs sold under non-proprietary names
are usually cheaper than those sold under trade names.
Example of drug nomenclature
Code name: Bay-o-9867
Chemical name: 1-Cyclopropyl-6-fluoro-4-oxo-7-(1-piperazinyl)-1,4-dihydro-3-
quinolinecarboxylic acid
Non-proprietary name: Ciprofloxacin
Trade name: Baycip, Ciloxan, Ciflox, Ciplox, Cipro,Cipro XR, Cipro XL, Ciproxin, Prociflor,
Neofloxin (and many more)
CHAPTER FOUR
ANTI-MALARIALS
Malaria is transmitted through the bite of an infected, female Anopheles mosquito and
occasionally through blood transfusion. When a mosquito bites a person it sucks up blood. If the
person has malaria, some of the parasites in the blood will be sucked into the mosquito. The
malaria parasites multiply and develop in the mosquito. After 10-14 days they are mature and
ready to be passed on to someone else. If the mosquito now bites a healthy person, the malaria
parasites enter the body of the healthy person. The parasites are transported in the bloodstream to
the victim's liver where they multiply and then re-enter the bloodstream.
The malaria parasites can multiply 10 times every 2 days, destroying red blood cells and
infecting new cells throughout the body.
There are four main species of these parasites: Plasmodium falciparum which causes the severest
type of malaria, and Plasmodium vivax, ovale and malariae which cause less severe symptoms.
The person infected by the mosquito bite will become ill with malaria, symptoms appearing
anywhere from about a week to several months after infection, but usually in 7-21 days.
DRUG CLASSIFICATION OF ANTI-MALARIALS

Antimalarials act at different stages in life cycle:
Tissue schizonticides: eliminate developing or dormant liver forms;
Blood schizonticides: act on erythrocytic parasites;
Gametocides: kill sexual stages and prevent transmission to mosquitoes.
Radical cure: eliminate both hepatic and erythrocytic stages. Not available.
20
QUININE
(DIHYDROCHLORIDE, HYDROCHLORIDE, SULPHATE)
Therapeutic action
– Antimalarial
Indications
– Treatment of uncomplicated falciparum malaria
– Shift from injectable to oral quinine for the treatment of severe falciparum malaria
Presentation
– 200 mg and 300 mg quinine sulfate or bisulfate tablets
-- Quinine hydrochloride 2ml ampoules containing 150mg/ml
Quinine dihydrochloride 2ml ampoules containing 150mg/ml or 300mg/ml
Dosage and duration

Dosage is expressed in terms of salt. With the exception of quinine bisulfate, the dosage
is the same for all quinine salts (sulfate, hydrochloride, dihydrochloride):
– Child and adult ≤ 50 kg: 30 mg/kg/day in 3 divided doses at 8-hour intervals for 7 days
– Adult > 50 kg: 1800 mg/day in 3 divided doses at 8-hour intervals for 7 days
Weight 200 mg tablet 300 mg tablet

3 to 6 kg 1/4 tab x 3 –
7 to 12 kg 1/2 tab x 3 –
13 to 17 kg – 1/2 tab x 3
18 to 25 kg 1 tab x 3 –
26 to 35 kg – 1 tab x 3
36 to 50 kg 2 tab x 3 –
> 50 kg 3 tab x 3 2 tab x 3
As bisulfate tablets contain a lower concentration of quinine, a higher dose is required:
21
40 mg/kg/day in children and 2.5 g/day in adults, in 3 divided doses.
Contra-indications, adverse effects, precautions
– May cause: headache, skin rash; visual, auditory and gastrointestinal disturbances.
– Do not exceed indicated doses: risk of toxicity in the event of overdose.
– If the patient vomits within one hour after administration, repeat the full dose.
– Do not combine with chloroquine, halofantrine and mefloquine.
– Pregnancy: no contra-indication
– Breast-feeding: no contra-indication
Remarks
– 10 mg of quinine sulfate or hydrochloride or dihydrochloride = 8 mg of quinine base;
14 mg of quinine bisulfate = 8 mg of quinine base.
– Quinine should not be used for prophylaxis.
– Storage: below 30°C
ARTEMETHER/LUMEFANTRINE = COARTEMETHER
(Coartem®, Riamet®…)
Therapeutic action
– Antimalarial
Indications
– Completion treatment following parenteral therapy for severe falciparum malaria
Presentation
– 20 mg artemether/120 mg lumefantrine co-formulated tablets, in blister packs, for a
complete treatment for one individual
– Blister packs of 6, 12, 18 or 24 tablets, corresponding to 4 different categories of
age/weight
– Blister-packs of 6 and 12 tablets contain dispersible tablets.
Dosage and duration
The treatment is administered twice daily for 3 days. On D1, the first dose is given at 0
hour and the second dose at 8-12 hours. Subsequent doses on D2 and D3 are given twice daily
22
(morning and evening).
Artemether and Lumefantrine (Recommended Dosing Regimen)
Artemether (20 mg) + Lumefantrine (120 mg)
Number of Tablets To Be Given
Weight Age Day 1 Day 2 Day 3
First Second AM PM AM PM
Dose Dose
(after
8hrs)
< 5 kg < 6 mo Not recommended for patients under 5 kg
5-15 kg 6mo-3 yr 1 1 1 1 1 1
15-25 kg 3-8 yr 2 2 2 2 2 2
25-35 kg 8-12 yr 3 3 3 3 3 3
>35 kg >12 yr 4 4 4 4 4 4

– Do not combine with azole antifungals (fluconazole, itraconazole, miconazole, etc.),
tricyclic antidepressants, neuroleptics (chlorpromazine, haloperidol, etc.), macrolides,
quinolones, other antimalarials, beta-blockers.
– May cause: nausea, headache, dizziness and gastrointestinal disturbances.
– If the patient vomits within one hour of administration: repeat the full dose.
23
– Pregnancy: no contra-indication during the 2nd and 3rd trimester. Safety of
coartemether in the first trimester has not been definitely established. However, given the risks
associated with malaria, it may be used during the first trimester if it is the only effective
treatment available.
Remarks
– Take with meals.
– Coartemether should not be used for malaria prophylaxis.
– Lumefantrine is also called benflumetol.
– Leave tablets in blisters until use. Once a tablet is removed from its blister, it must be
administered immediately
ARTESUNATE + SULFADOXINE/PYRIMETHAMINE = AS + SP
(Artecospe adult®, Sulfamon®…)
Therapeutic action
– Antimalarial
Indications
– Completion treatment following parenteral therapy for severe falciparum malaria
Presentation
– Artesunate (AS) tablets and sulfadoxine/pyrimethamine (SP) tablets, in blister packs,
for a complete treatment for one individual
– There are 4 different blister packs:
• Child 2 months to 6 years: blister pack with 3 tab AS 50 mg and 1 tab SP 500/25 mg
• Child 7 to 13 years: blister pack with 6 tab AS 50 mg and 2 tab SP 500/25 mg
• Child ≥ 14 years and adult: blister pack with 12 tab AS 50 mg and 3 tab SP 500/25 mg
24
or blister pack with 6 tab AS 100 mg and 3 tab SP 500/25 mg
Dosage and duration

Artesunate is administered once daily for 3 days. Sulfadoxine/pyrimethamine is
administered as a single dose on D1, with the first dose of artesunate.
Age Blister pack D1 D2 D3
2 to 11 months 3 tab AS + 1 tab SP 1/2 tab AS + 1/2 tab SP 1/2 tab AS 1/2 tab AS
1 to 6 years 1 tab AS + 1 tab SP 1 tab AS 1 tab AS
7 to 13 years 6 tab AS + 2 tab SP 2 tab AS + 2 tab SP 2 tab AS 2 tab AS
≥ 14 12 tab AS + 3 tab 4 tab AS + 3 tab SP 4 tab AS 4 tab AS

years/adult SP
6 tab AS + 3 tab SP 2 tab AS + 3 tab SP 2 tab AS 2 tab AS

– Do not administer to patients with allergy to sulfonamides.
– May cause: see artesunate and sulfadoxine/pyrimethamine.
– Do not use in combination with cotrimoxazole.
– Do not give folic acid on the same day SP is administered, or within 15 days thereafter.
– Pregnancy: no contra-indication during the 2nd and 3rd trimester. Safety in the first
trimester has not been definitely established. However, given the risks associated with malaria,
the combination
artesunate+SP may be used during the first trimester if it is the only effective treatment
available.
25
Remarks
– Storage: below 30°C –
– Leave tablets in blisters until use. Once a tablet is removed from its blister, it must be
administered immediately.
If half tablets are used, remaining 1/2 tablets may be given to another patient if
administered within 24 hours.
SULFADOXINE/ PYRIMETHAMINE (SP) (Fansidar®…)
Therapeutic action
– Antimalarial
Indications
– Treatment of uncomplicated falciparum malaria, in combination with artesunate
– Completion treatment following parenteral therapy for severe falciparum malaria, in
combination with artesunate
Presentation
– Sulfadoxine 500 mg/pyrimethamine 25 mg co-formulated tablet
Dosage and duration

– Child and adult: 25 mg/kg sulfadoxine and 1.25 mg/kg pyrimethamine as a single dose
Age 2 months to 1 year 1 to 7 years 7 to 13 years 13 years to Adult
500/25 mg 1/2 tab 1 tab 2 tab 3 tab

tablet

– Do not administer to patients with allergy to sulfonamides.
26
– May cause: gastrointestinal disturbances; allergic reactions, sometimes severe (toxic
epidermal necrolysis and Stevens-Johnson syndrome); anaemia, leukopenia, agranulocytosis,
thrombocytopenia, haemolytic anaemia in patients with G6PD deficiency.
– Do not use in combination with cotrimoxazole.
– Do not give folic acid on the same day SP is administered, or within 15 days thereafter.
Remarks
– In stable transmission areas, intermittent preventive treatments can be given to pregnant
women as of the 2nd trimester to reduce the consequences of malaria (anaemia, low birth weight,
etc.). Check national recommendations.
– SP should not be used for malaria prophylaxis.
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CHAPTER FIVE
ANTHELMINTHICS
These are drugs used to treat parasitic worm infections: helminthic infections. Unlike protozoa,
helminths are large and have complex cellular structures. Drug treatment is very specific to the
organism
Action of Anthelmintic Drugs
Affect metabolic processes that are either different in worms than in human hosts or are not
found in humans. Cause death of the worm by interfering with normal functioning.
ALBENDAZOLE (Eskazole®, Zentel®…)
Therapeutic action
– Anthelminthic
Indications
– Ascariasis ( Ascaris lumbricoides), enterobiasis ( Enterobius vermicularis), hookworm
infections ( Ancylostoma duodenale, Necator americanus)
– Trichuriasis ( Trichuris trichiura), strongyloidiasis ( Strongyloides stercoralis)
– Trichinellosis ( Trichinella spp)
Presentation
– 400 mg tablet
Dosage and duration
– Ascariasis, enterobiasis, hookworm infections
Child over 6 months and adult: 400 mg as a single dose
Child over 6 months but under 10 kg: 200 mg as a single dose
28
In the event of enterobiasis, a second dose may be given after 2 to 4 weeks.
– Trichuriasis, strongyloidiasis
Child over 6 months and adult: 400 mg once daily for 3 days
Child over 6 months but under 10 kg: 200 mg once daily for 3 days
– Trichinellosis
Child over 2 years: 10 mg/kg/day in 2 divided doses for 10 to 15 days
Adult: 800 mg/day in 2 divided doses for 10 to 15 days
– Do not administer to children less than 6 months.
– Do not administer to patients with ocular cysticercosis.
– May cause:
• gastrointestinal disturbances, headache, dizziness;
• neurological disorders (headache, seizures) in patients with undiagnosed neuro -
cysticercosis.
– Pregnancy: avoid during the first trimester
Remarks
– Tablets are to be chewed or crushed: follow manufacturer's recommendations.
– In the treatment of strongyloidiasis, ivermectin is more effective than albendazole.
– Albendazole is also used in the treatment of cutaneous larva migrans ( Ancylostoma
braziliense and caninum), larval cestode infections (hydatid disease, certain forms of
neurocysticercosis) and in mass treatment for lymphatic filariasis (check national
recommendations).
MEBENDAZOLE (Pantelmin®, Vermox®, Wormin®...)
Therapeutic action
– Anthelminthic
Indications
– Ascariasis ( Ascaris lumbricoides), trichuriasis ( Trichuris trichiura), hookworm
29
infections ( Ancylostoma duodenale, Necator americanus), enterobiasis ( Enterobius
vermicularis), trichinel osis ( Trichinella spp)
Presentation
– 100 mg and 500 mg tablets
Dosage and duration
– Ascariasis, trichuriasis, hookworm infections
Child over 6 months and adult: 100 mg twice daily for 3 days
Child over 6 months but under 10 kg: 50 mg twice daily for 3 days
– Enterobiasis
Child over 6 months and adult: 100 mg as a single dose
Child over 6 months but under 10 kg: 50 mg as a single dose
A second dose may be given after 2 to 4 weeks.
– Trichinellosis
Child over 2 years: 5 mg/kg/day in 2 divided doses for 10 to 15 days
Adult: 400 mg/day in 2 divided doses for 10 to 15 days
– Do not administer to children less than 6 months.
– May cause: gastrointestinal disturbances, headache, dizziness.
– Pregnancy: avoid during the first trimester
Remarks
– Albendazole is easier to use and is preferred in mixed infections as it has a broader
spectrum of activity.
– Tablets are to be chewed or crushed: follow manufacturer's instructions.
– Take tablets between meals.
PRAZIQUANTEL (Biltricide®, Cysticide®…)

Therapeutic action
– Anthelminthic
30
Indications
– Urinary ( S. haematobium) and intestinal ( S. mansoni, S. japonicum, S. mekongi, S.
intercalatum) schistosomiasis
– Taeniasis ( T. saginata, T. solium, H. nana)
– Pulmonary ( P. westermani), hepatobiliary ( O. felineus, O. viverrini, C. sinensis) and
intestinal ( F. buski, H. heterophyes, M. yokogawai) flukes
Presentation
– 150 mg and 600 mg tablets
Dosage and duration
Child over 2 years and adult:
– Schistosomiasis
• S. haematobium, S. mansoni, S. intercalatum: 40 mg/kg as a single dose or in 2 divided
doses administered 4 hours apart
• S. japonicum, S. mekongi: 40 mg/kg as a single dose or 60 mg/kg in 2 to 3 divided doses
administered 4 hours apart
– Taeniase
• T. saginata, T. solium: 5 to 10 mg/kg as a single dose
• H. nana: 25 mg/kg as a single dose
– Fluke infections
• lung: 75 mg/kg/day in 3 divided doses for 2 to 3 days
• hepatobiliary: 75 mg/kg/day in 3 divided doses for 1 to 2 days
• intestinal: 75 mg/kg in 3 divided doses, 1 day
– Do not administer to patients with ocular cysticercosis.
– May cause:
• drowsiness, headache, gastrointestinal disturbances, dizziness; rarely: allergic reactions.
• neurological disorders (headache, seizures) in patients with undiagnosed neuro -
cysticercosis.
– Pregnancy: no contra-indication for the treatment of schistosomiasis and taeniasis. If
immediate treatment not considered essential for fluke infections, it should be delayed until after
delivery.
31
Remarks
– Praziquantel is not active against certain liver flukes ( Fasciola hepatica and
gigantica). For this indication, use triclabendazole.
CHAPTER SIX
ANALGESICS
Analgesics are drugs used to relieve pain- “pain killers”. Pain is one of the most common
symptoms, and one of the most frequent reasons why people seek medical care. The two groups
are:
1. Non-narcotic analgesics (for the mild to moderate pain, some of which may also have
antipyretic actions) E.g Aspirin, Paracetamol and Ibuprofen.
2. Narcotic/opioid analgesics (which are principally used in the relief of severe pain, and
may produce dependence). E.g Morphine and Pethidine
Antipyretics are used in lowering the temperature, and is considered to involve the
hypothalamus. Paracetamol, aspirin, and ibuprofen have similar antipyretic activity.
Anti-inflammatory agents are drugs that alleviate symptoms of inflammation, but do not
necessarily deal with the cause. E.g NSAIDS (Ibuprofen, Diclofenac, Indomethacin, Piroxicam)
ACETYLSALICYLIC ACID (ASPIRIN)
• DRUG SUMMARY: Acetylsalicylic Acid (ASA), Aspirin, is a salicylate that relieves
headaches, muscular and joint pains, and reduces inflammation. ASA has been considered the
drug of choice in the treatment of arthritis, but its anti-inflammatory action occurs only when
given in large doses (3-4 g/day). At these large doses, ASA produces adverse effects that are the
main disadvantage when used for arthritis conditions. NSAIDs tend to be more appropriate for
arthritis conditions.
The mechanism of action of ASA is that it inactivates cyclooxygenase irreversibly, it inhibits
prostaglandin synthesis and inhibits platelet aggregation.
INDICATIONS: Used for pain, fever, inflammatory conditions such as rheumatic fever,
rheumatoid arthritis, osteoarthritis, dysmenorrhea and symptomatic relief of the common cold
32
pain and fever. It is used for reducing the risk of recurrent Transient Ischemic Attacks
(TIA/stroke), or Myocardial Infarctions (MI/heart attack) at low doses.
CONTRAINDICATIONS: In patients with history of hypersensitivity, asthma, peptic
ulcer/dyspepsia, those with bleeding tendencies or disorders.
DOSAGE FORMS: Tablets.
RECOMMENDED DOSAGE:
Adult: 350 - 650 mg q. 4 h. for minor aches and pain. 500 - 1000 mg q. 4-6 h.; max. 4 g/24 h.,
for moderate to severe pain. 75 - 325 mg/day q.d. continued indefinitely for: Ischemic stroke &
TIA, and the prevention of recurrent MI, unstable angina pectoris, chronic stable angina pectoris.
Child: Use not recommended, unless for certain conditions.
ADVERSE EFFECTS: Dizziness, cinchonism (ringing in the ear), skin eruptions, epigastric
discomfort, peptic ulceration and bleeding, increase bleeding tendency, hypersensitivity
reactions.
DRUG INTERACTION
Anticoagulants
Anticoagulant effect enhanced. Effect of ASA on gastric mucosa and platelet function may
enhance possibility of hemorrhage.Avoid concomitant use.
NSAIDs Pharmacological effects of certain NSAIDs may be decreased. Increased risk of GI
disturbances if used concomitantly.
Oral hypoglycemic: ASA increases hypoglycemia effect of sulfonylureas. Monitor the patient’s
blood glucose, if hypoglycemia occurs, decrease sulfonylurea
NURSING IMPLICATION
1. Take drug with or after food or with milk to decrease GI irritation.
2. Assess for history of asthma and history of hypersensitivity.
3. Do not use with other anticoagulants.
4. Note any history of peptic ulcer.
5. Report signs of side effect e.g. gastric irritation if occurs.
6. Aspirin is not given 1 week before & after surgery to prevent bleeding.
7. If patient is diabetic, discuss the possibility of hypoglycemia occurring and monitor their
blood glucose level frequently.
33
8. Teach patient about the toxic symptoms (ringing in the ears dizziness, mental confusion etc
and ask him/her to report it to physician.
NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS)

All NSAIDs are antipyretic, analgesic, and anti-inflammatory, but there might be some
differences in their individual activities. Thus a patient may do well on one propionic acid (i.e.
Ibuprofen) derivative, but not on another. The reasons for such differences are not fully
understood, but differential sensitivity of enzymes in the target tissues may be the reason. When
employed as analgesics, these drugs are usually effective against pain of low-to moderate
intensity. Although their maximal effect is much lower than opioids, they lack the unwanted
effects of the opioids on the CNS, including respiratory depression and the development of
physical dependence.
In addition to sharing many therapeutic activities, current NSAIDs share several unwanted
effects. The most common is the tendency to induce gastric or intestinal ulceration that can
sometimes be accompanied by anemia from the resultant blood loss. Other reported side effects
include disturbances in platelet function, water retention, increased blood pressure, the delayed
onset and prolongation of gestation or labor, and changes in renal fu
IBUPROFEN
• DRUG SUMMARY:
Ibuprofen (IBP) is a proprionic acid derivative comparable to aspirin (ASA) in its analgesic
action, but higher doses are required for anti-inflammatory effect. It has been reported to have
less GI symptoms than aspirin in equi-effective doses. IBP inhibits platelet aggregation and
prolongs bleeding time, but does not affect prothrombin or whole blood clotting times.
INDICATION: Rheumatoid arthritis (RA), Osteoarthritis (OA) and Ankylosing spondylitis
CONTRAINDICATIONS: In patients who are hypersensitive where urticaria, severe rhinitis,
bronchospasm, angioedema, are precipitated by ASA or other NSAIDs. Active peptic ulcer or
bleeding abnormalities.
DOSAGE FORMS: Tablets, suspension (100 mg/5ml), gel 5%.
34
RECOMMENDED DOSAGE: Adult: 200-400 mg PO q. 4-6 h., max. 1800 mg/24 hours for
pain and fever. 400-800 mg t.i.d. or q.i.d.; max. 3200 mg/d for inflammation. Emulgel dose: A
thin layer of the gel is applied to affected area as needed, up to three times daily.
Child: Use is not recommended for children under 6 months;
DOSES OF IBP IN CHILDREN: 1-12 y: give 5-10 mg/kg q. 4-6 h. Maximum daily dose is 40
mg/kg/d.
ADVERSE EFFECTS: GI disturbances are most common; i.e. heartburn, nausea and
dyspepsia, abdominal distress, gastritis and ulceration. Also, dizziness, drowsiness, jaundice, and
fatigue may occur. Side effects are dose related. Incidence or aggravation of epilepsy and
parkinsonism have been reported with use of NSAIDs.
DRUG INTERACTIONS:
Oral anticoagulants, and heparin: May prolong bleeding time. Avoid concomitant use.
Lithium, digoxin and methotrexate: Increased toxicity of these drugs with concomitant
NSAIDs use. Monitor each drug serum levels and adjust dose as needed.
NURSING IMPLICATION
i. Patients with history of cardiac decompensation should be observed closely for evidence
of fluid retention and edema.
ii. Instruct patient to report immediately any passage of dark tarry stool, coffee-ground
emesis, blood or protein in urine. This can be an indication for GI bleeding. Medication
should be stopped and patient should be re-evaluated.
iii. Caution if skin rash, itching, visual disturbances or persistent headache should occur.
iv. Caution in hypertension, chronic renal failure.
v. Advise patient not to drink alcohol, to avoid increased risk of GI ulceration and bleeding.
DICLOFENAC
35
DRUG SUMMARY: An acetic acid derivative. It has analgesic, antipyretic, and anti-
inflammatory properties. At therapeutic doses it has little effect on platelet aggregation. Patients
not responding to IBP can be given diclofenac instead. Do not co-administer with other NSAIDs
or salisylates.
INDICATION: Rheumatoid arthritis (RA), Osteoarthritis (OA), Ankylosing spondylitis. It is
also used as an ophthalmic agent for cataract surgery).
CONTRAINDICATION: Same as IBP.
DOSAGE FORMS: Tablets, sustained release tablets, suppositories, emulgel and ampoules.
RECOMMENDED DOSAGE:
Adult: 75-150 mg/24h given by mouth in divided doses. Total daily dose should not exceed 150
mg/d, such doses have not been studied. Suppository form is given in a dose of 75- 100 mg each
evening. The emulgel form 1% should be applied to painful site, 2-4 gm, 3-4 times daily.
Therapy should be reviewed after 14 days.
Child: Not recommended for children < 1 y.
Child > 1 y. for RA: 1-3 mg/kg in divided doses by mouth or rectum.
ADVERSE EFFECTS: Similar to IBP, but with higher incidence.
DRUG INTERACTIONS: Lithium, digoxin and methotrexate. Increased toxicity of these
drugs with concomitant. NSAIDs use. Monitor each drug serum levels and adjust dose as
needed. Diuretics May decrease blood pressure lowering effects of diuretics. May lead to an
increase in serum K+, if using K+ sparing diuretics.
NURSING IMPLICATION: Same as IBP.
PARACETAMOL = ACETAMINOPHEN
(Doliprane®, Panadol®…)
DRUG SUMMARY:
Paracetamol or Acetaminophen (N-Acetyl-pamino-phenol-APAP) is a non-narcotic CNS agent.
It is equivalent to aspirin in relieving pain and reducing fever, but it has little effect on platelet
function, does not affect bleeding time and generally produces no gastric bleeding or ulcers. It
has no antiinflammatory action in usual doses. Paracetamol reduces fever by direct action on the
36
hypothalamus heat-regulating center with consequent peripheral vaso-dilatation, sweating and
dissipation of heat.
• INDICATIONS: Used for pain and fever. Good substitute for ASA, when ASA is not tolerated
or is contraindicated.
CONTRAINDICATIONS: In patients with history of hypersensitivity. In patients with severe
liver and kidney damage.
DOSAGE FORMS: Tablets, capsules, suspension, suppositories.
RECOMMENDED DOSAGE:
Adult: PO: 325-650 mg q. 4-6 h. as needed; max. 4 g/24 hours
Child: PO or PR: 10-15 mg/kg/dose.
AGE DOSE
0-3 mon 10mg/kg (5mg/kg if jaundiced)
3 mon-1 y 60-120 mg
1-5 y 120-250 mg
6-12 y 250-500 mg
ADVERSE EFFECTS: If used as directed it rarely causes any side effects. Heavy alcoholics
and smokers are more susceptible to liver toxicity. Skin rashes and neutropenia are very rare.
DRUG INTERACTIONS: Alcohol, Barbiturates, Carbamazepine, and Rifampin. The potential
hepatotoxicity of APAP may be increased by large doses or long term use of the these agents due
to hepatic microsomal enzyme induction
37
CHAPTER SEVEN
ANTACIDS
Antacids are useful for the short-term relief of indigestion, heartburn and excessive eating and
drinking, as well as for the long-term management of gastroesophageal reflux and peptic ulcer
disease. They give symptomatic relief, promote healing and reduce reoccurrence. There are 2
kinds of antacids.
Absorbable antacids:
These provide rapid, complete neutralization, but continuous use may cause milk-alkali
syndrome that can progress to irreversible kidney damage if unrecognized.
Examples include sodium bicarbonate, calcium carbonate.
Non-absorbable antacids are relatively insoluble salt of weak bases and have fewer side effects.
They interact with gastric HCL forming non-absorbable salts thus increasing gastric pH.
Examples like Aluminium hydroxide and Magnesium hydroxide.
Mg/Al Salt
DRUG SUMMARY:
38
Many commercially available antacid products contain a combination of aluminium (Al) and
magnesium (Mg) salts, hydroxide, trisilicate. Because constipation from Al and diarrhea from
Mg are dose related, combining these two agents allow for a potent neutralizing capacity with
lower doses of each agent. The constipating effect of Al should balance the diarrheal effect of
Mg, and vice versa. These agents do not cause alkalosis or rebound hyperacidity as NaHCO3.
INDICATIONS: Hyperacidity; symptomatic relief of stomach upset, dyspepsia, heartburn, acid
indigestion, GERD, and hyperacidity associated with peptic ulcer.
CONTRAINDICATIONS: Known sensitivity to any of the components of the products.
DOSAGE FORMS: Tablets, suspension.
RECOMMENDED DOSAGE:
Adult: For Indigestion and Heart Burn; 1 or 2 tabs or 1 or 2 tbsp. when needed.
For Ulcers; take 1-2 tabs or 1-2 tbsp.
Child: Use is not recommended.
DRUG INTERACTIONS: Patient should space doses of antacids at least 2 hrs apart from
interacting drugs.
Summary of Mg-Al Combination

Drug Interactions
DRUG Effect DRUG Effect
Benzodiazepines ↓ Ketconazole ↓
Captopril ↓ Levodopa ↑
Corticosteroids ↓ Phenothiazines ↓
Digoxin ↓ Quinidine ↑
Fluoroquinolone ↓ Salicylates ↓
H2-antagonist ↓ Sulfonylureas ↑
Hydantoins ↓ Tetracyclines ↓
Iron salts ↓ Valproic acid ↑
↓ Pharmacological effect decreased by antacid
↑ Pharmacological effect increased by antacid
ADVERSE EFFECTS: Diarrhea (usually due to Al) or constipation (due to Mg) may occur.
39
CHAPTER EIGHT
ANTI-TUSSIVES / COUGH SUPPRESSANTS
Cough is a protective reflex, which serves the purpose of expelling sputum and other irritant
materials from the respiratory airway. Anti-tussives are drugs used to suppress the intensity and
frequency of coughing.
Two Types of Anti-tussives:
1. Central antitussives
- Suppress the medullary cough center and may be divided into two groups:
 Opioid antitussive e.g. codeine, hydrocodeine, etc
 Non opioid antitussives e.g. dextromethorphan
2. Peripheral antitussives
 Decrease the input of stimuli from the cough receptor in the respiratory passage.
e.g: Demulcents e.g. liquorices lozenges, honey
CODEINE
DRUG SUMMARY: An opium derivative made by methylation of morphine. It is classified as
a CNS, narcotic agent, analgesic, and antitussive. The dose required to suppress cough is lower
than the doses required for analgesia.
INDICATIONS: For suppression of cough induced by chemical or mechanical respiratory tract
irritation. Also for relief
CONTRAINDICATIONS: Hypersensitivity to the drug, acute asthma, acute alcoholism,

premature infants or during labor when delivery of a premature infant is anticipated.
DOSAGE FORMS: Tablets. Syrup in combination products.

RECOMMENDED DOSAGE:
40
Adult: 10-20 mg PO q. 4-6 h.; max. 120 mg/24h.
Child (6-12 y): 5-10 mg q. 4-6 h.; max. 60 mg/24h.
Child (2-6 y): 2.5-5 mg q. 4-6 h.; max. 30 mg/24h.
DRUG INTREACTION: CNS depressants, and alcohol including other opiates, general
anesthetics, phenothiazines, tricyclic anti-depressants, tranquilizers; all have additive effects
when given concomitantly with codeine. Avoid, or use extreme caution.
ADVERSE EFFECTS: In usual oral antitussive doses, codeine has mild side effect. Nausea,
vomiting, sedation, dizziness, constipation are most common. Other effects may include: CNS
depression, respiratory depression, biliary tract spasms, tachycardia, palpitation, faintness,
orthostatic hypotension, urinary retention, antidiuretic effect, hallucination, disorientation,
lightheadedness, euphoria, weakness, convulsions, as well as allergic reactions have been
reported.
NURSING IMPLICATION
 Warn patients against performing tasks that require full alertness and coordination (i.e.
driving or operating machines) until the full effect of the medication is known.
 Instruct patients to make position changes slowly, particularly from recumbent to upright
posture, and to lie down immediately if light-headedness/dizziness occur, especially in
elderly patients, to avoid falling down.
ORAL REHYDRATING SALTS (ORS)

• DRUG SUMMARY: Oral Rehydrating Salt (ORS) solutions are the first line treatment in acute
diarrhea, especially in infants and in frail/elderly patients. They are a simple and effective way to
markedly reduce the number of deaths caused by diarrhea. ORS are balanced mixtures of glucose
and electrolytes. Intestinal absorption of sodium and water is enhanced by glucose, to replace
what has been lost through diarrhea, and restore acid-base balance.
Presentation
– Sachet of powder to be diluted in 1 litre of clean water.
– WHO formulation:
grams/litre mmol/litre
41
sodium chloride 2.6 sodium 75
glucose 13.5 chloride 65
potassium chloride 1.5 glucose 75
trisodium citrate 2.9 potassium 20
citrate 10
Total weight 20.5 Total osmolarity 245
Dosage
– Prevention of dehydration (WHO - Treatment plan A)
Child under 24 months: 50 to 100 ml after each loose stool (approximately 500 ml/day)
Child from 2 to 10 years: 100 to 200 ml after each loose stool (approximately 1000
ml/day)
Child over 10 years and adult: 200 to 400 ml after each loose stool (approximately 2000
ml/day)
– Treatment of moderate dehydration (WHO - Treatment plan B)
Child and adult:

Over the first four hours:
Age under 4 to 11 12 to 23 2 to 4 years 5 to 14 years 15 years
4 months months Months
Weight under 5 kg 5 to 7.9 kg 8 to 10.9 kg 11 to 15.9 kg 16 to 29.9 kg 30 kg
and over
ORS in ml 200 to 400 400 to 600 600 to 800 800 to 1200 1200 to 2200 2200 to 4000
42
After four hours:
If there are no signs of dehydration: follow Treatment plan A.
If there are signs of moderate dehydration: repeat Treatment plan B.
If there are signs of severe dehydration: start IV therapy (Treatment plan C).
– Treatment of severe dehydration (WHO - Treatment plan C)
In combination with IV therapy and only to a conscious patient:
Child and adult: 5 ml/kg/hour
After 3 hours (6 hours in infants), reassess and choose the appropriate plan A, B or C.
Duration: as long as diarrhoea and signs of dehydration persist.

– If the eyelids become puffy during the treatment: stop ORS, give plain water then,
resume ORS according to Treatment plan A when the puffiness is gone.
– If case of vomiting, stop ORS for 10 min and then resume at a slower rate (very small,
frequent, amounts); do not stop rehydration.
Remarks
– A special ORS-formula, ReSoMal, is used under medical supervision, for severely
malnourished children only. However, in malnourished children with cholera, standard ORS-
formula is used instead of ReSoMal.
– Storage:
Do not use the powder if it has turned into a yellow-brownish sticky substance.
Once prepared, the solution must be used within 24 hours.
HOME MADE ORS RECIPE - THE "SIMPLE SOLUTION"
Preparing One (1) Litre Oral Rehydration Solution [ORS] using Salt, Sugar and Water at
Home
Mix an oral rehydration solution using one of the following recipes; depending on ingredients
and container availability:
43
Ingredients:
Half (1/2) level teaspoon of Salt
Six (6) level teaspoons of Sugar
One (1) Litre of clean drinking or boiled water and then cooled
Preparation Method: Stir the mixture till the salt and sugar dissolve.
CHAPTER NINE
LOTIONS
ANTISEPTICS/ DISINFECTANTS
Antiseptics and disinfectants are generally used to destroy and inhibit the growth of pathogenic
micro-organisms. There is no clear difference between them.
The term antiseptic is used to a chemical agent that destroys or inhibits micro-organisms on
living tissues having the effect of limiting or preventing the harmful results of infection.
However a disinfectant is a chemical agent that destroys microorganisms, but it does not
necessarily kill all the microorganisms, but reduces them to a level that is not harmful. It can be
applied to the living tissues as well as inanimate objects.
ETHYL ALCOHOL (ETHANOL)

• DRUG SUMMARY:
It is a widely used antiseptic and a disinfectant that exerts bactericidal and fungicidal action in
concentrations at 70%. In concentrations above 80% its bactericidal effect is low. It has virucidal
action at 90%. It is less effective against HBV viruses.
44
Used as an antiseptic agent before injections to prevent topical infections. It is not a desirable
wound antiseptic because it causes irritation in already damaged tissues, and may delay healing.
Therapeutic action
– Antiseptic and disinfectant
Indications
– Antisepsis of intact skin prior to injections and venopunctures
– Disinfection of latex stopper of infusion bottles and drug vials (except vaccines), latex
injection sites of infusion sets
Presentation
– Mixtures of alcohol (ethanol) and water in different concentrations (e.g. 95% v/v
ethanol), sometimes containing additives to avoid their ingestion.
– Alcoholic strength is expressed:
• preferably as a percentage by volume of alcohol (% v/v); e.g. 1000 ml of 95% v/v
alcohol contains 950 ml of absolute alcohol.
– To obtain 1 litre of 70% v/v ethanol:

• take 785 ml of 90% v/v ethanol, or 730 ml of 95% v/v ethanol, or 707 ml of 99% v/v
ethanol,
• add distilled or filtered water to make up a volume of 1 litre,
• leave to cool and top up with water again to bring the volume back to 1 litre (mixing
water and ethanol together produces a reaction whereby volume is reduced).
Precautions
– Do not apply to mucous membranes, wounds or burns: it is painful, irritating and slows
the healing process.
– Do not apply on neonatal skin.
Remarks
– Ethanol can be used for disinfection of non-critical medical items (items that are in
contact with intact skin only) that are not soiled by blood or other body fluids.
45
– Critical medical items (surgical instruments, etc.) cannot, under any circumstances, be
“sterilized” by alcohol flaming, immersion in ethanol or wiping with ethanol.
Close bottles tightly to avoid evaporation. Keep away from sources of ignition (flame,
spark, incandescent material).
ALCOHOL-BASED SOLUTION OR GEL (Manugel®, Manurub®, Sterillium®...)

Therapeutic action – Antiseptic
Indications – Antiseptic hand rub, before and after procedures, whether gloves are used or not
Presentation – Ready to use alcohol-based hand rub solution or gel
Use – Alcohol-based hand rubs can only be used if hands are not visibly dirty or soiled with
organic matter. There must be no residual powder on hands (use powder-free gloves) and hands
must be dry.
– Apply 3 ml of solution or gel in a cupped hand and spread to cover the entire surface of
hands. Rub hands for 20-30 seconds, palm to palm, palm over dorsum, between fingers (fingers
interlaced), around the thumbs and nails, until hands are completely dry. Do not dilute the
product. Do not rinse off or dry hands.
– As long as hands are not visibly soiled, the product may be reapplied as many times as
necessary without handwashing before or after applying the product.
– Do not use if:
• hands are visibly dirty or soiled with organic matter (wash hands),
• there is residual powder on hands (wash hands),
• hands are wet (water dilutes alcohol and impedes drying).
– Do not use after direct contact with a patient with a parasitic skin infection (scabies,
lice): wash hands.
– Do not use simultaneously with soap or another antiseptic (antagonism, inactivation,
etc.).
46
– Do not use for disinfection of material, patient's skin or mucous membranes.
– May cause: stinging sensation on broken skin.
– In case of eye contact flush immediately with plenty of water.
Remarks
– Dose required and duration of hand rubbing may vary depending on the product used.
Read the manufacturer's instructions carefully.
– To avoid difficulty in putting on gloves, rub hands until the product is completely dry.
– Use of alcohol-based hand rubs may result in a sticky residue on hands after several
applications. In this event, wash hands.
– Some alcohol-based hand rubs can be used for surgical hand antisepsis, however the
technique is not the same as for antiseptic hand rub.
Close bottles tightly to avoid evaporation. Keep away from sources of ignition (flame,
spark, incandescent material).
POLYVIDONE IODINE = POVIDONE IODINE = PVI scrub solution (Videne scrub®,

Betadine scrub®…)
Therapeutic action
– Antiseptic
Indications
As an antiseptic and disinfectant
– Antiseptic hand wash and surgical hand antisepsis
– Preoperative skin preparation (patient preoperative showering, antiseptic cleansing of
the surgical site)
– Cleansing of contaminated wound
= disinfectant for the equipment used in the operation.
Presentation
– 7.5% scrub solution. Also comes in 4% scrub solution.
47
Use
– Antiseptic hand wash
Wet hands; pour 5 ml of solution; rub hands for 1 min; rinse thoroughly; dry with a clean
towel.
– Surgical hand antisepsis
There are different protocols, for information:
Wet hands and forearms; spread 5 ml of solution on hands and forearms and rub for 1 or
2 min (i.e. 30 seconds or 1 min for each side); brush the nails of each hand for 30 seconds; rinse.
Spread again 5 ml of solution on hands and forearms and rub for 2 min; rinse thoroughly; dry
with a sterile towel.
– Patient preoperative showering
Wet the whole body including hair; apply the solution and rub until the foam is white,
start at the head and move down, finishing with the feet. Pay special attention to hair, armpit,
hands, perineum, genitals and toes. Leave in contact a few minutes and rinse. Dry with a clean
towel; put on clean clothes.
– Antiseptic cleansing of surgical site
Rub for 1 min the surgical site, using sterile gauze soaked with sterile water and solution;
rinse with sterile water; dry with sterile gauze.
– Cleansing of contaminated wounds
Prepare a diluted solution:
With 7.5% solution: 1 part of solution + 4 parts of sterile 0.9% NaCl or water
With 4% solution: 1 part of solution + 2 parts of sterile 0.9% NaCl or water
Clean the wound; rinse thoroughly.

– Do not use with others antiseptics such as chlorhexidine-cetrimide (incompatibility) or
mercury compounds (risk of necrosis). Given the possible interactions between different groups
of antiseptics, PVI scrub solution must only be used with products of the same group (i.e. PVI
aqueous or alcoholic solutions).
– Do not use in preterm neonates and neonates < 1.5 kg (use ordinary soap).
48
– May cause: local skin reactions (contact dermatitis); exceptionally: allergic reactions.
– Pregnancy and breast-feeding: no contra-indication for brief application; no
prolonged use.
Remarks
– For preoperative skin preparation, cleansing of the surgical site is followed by the
application of 10% PVI solution.
– Storage: below 25ºC –
Povidone-Iodine also comes in (10% aqueous solution, used as disinfectant as well, powder,
ointment.
BRANDS:
Betadine (Rafa), Iodocare (Pharmacare), Iodo-Vit (Vitamed), Polydine (Fischer).
BENZYL BENZOATE
Therapeutic action: Scabicide

Indications: Scabies
Presentation: 25% lotion
Preparation and use
– Shake the bottle before application or dilution.
– Dilute the lotion, as required, according to age. Use drinking or boiled water.
Child < 2 years Child 2-12 years Child > 12 years

and adult
Preparation 1 part of 25% lotion 1 part of 25% lotion Undiluted 25% solution
+ 3 parts of water + 1 part of water
49
Contact time 12 hours (6 hours 24 hours 24 hours
in children < 6 months)
– Apply the lotion to the whole body, including scalp, post auricular areas, palms and
soles. Pay particular attention to skin creases and interdigital web spaces. Do not apply to the
face and mucous membranes.
– In children under 2 years: apply only once; wrap hands to avoid accidental ingestion;
rinse off when the recommended contact time has elapsed.
– In children ≥ 2 years and adults: a second application (e.g. after 24 hours, with a rinse
between the two applications; or two successive applications, 10 minutes apart, when the first
application has dried, with a rinse after 24 hours) reduces the risk of treatment failure.

– Do not apply to broken or infected skin. In the event of secondary bacterial infection,
administer an appropriate local (antiseptic) and/or systemic (antibiotic) treatment 24 to 48 hours
before applying benzyl benzoate.
– May cause: burning sensation; contact dermatitis in case of repeated applications;
seizures in the event of marked transcutaneous absorption (broken skin, children < 2 years).
– Avoid contact with eyes. In case of eye contact, flush immediately with plenty of water.
– DO NOT SWALLOW (risk of seizures). In case of ingestion: do not induce vomiting,
do not perform gastric lavage; administer activated charcoal.
– Pregnancy: no contra-indication; do not leave on skin longer than 12 hours; do not
repeat application.
– Breast-feeding: no contra-indication; do not apply to breasts.
Remarks
– Close contacts should be treated at the same time regardless of whether they have
symptoms or not. Decontaminate clothes and bed linen of patients and close contacts
50
simultaneously.
– Itching may persist for 1 to 3 weeks despite successful treatment. Do not re-treat during
this period. The treatment may be repeated if specific scabies lesions (scabious burrows) are still
present after 3 weeks.
– 5% permethrin cream or lotion is preferred when available, especially in children less
than 2 years and pregnant or lactating women.
CALAMINE LOTION
Therapeutics Action; Antipruritic drug

Indications: Symptomatic treatment of pruritus
Presentation: Calamine 8% or 15% lotion, bottle
Dosage: Apply a thin layer 3 to 4 times/day
Duration: According to clinical response
– Clean the skin before applying the lotion.
– Do not apply to exudative and/or superinfected lesions, mucous membranes or eyes.
– In case of contact with eyes or mucous membranes, flush immediately with plenty of
water.
– Breast-feeding: no contra-indication, do not apply on breasts.
Remarks
– Shake the lotion well before using.
To avoid contamination, close the bottle properly after opening.
CHLORHEXIDINE (Hibitane®…)
Therapeutic action: Antiseptic
51
Indications: Antisepsis of minor and superficial wounds and burns
Presentation
– 5% concentrated solution of chlorhexidine gluconate to be diluted before use
Check that the solution may be diluted with ordinary, non-distilled water (in this event
the formulation should contain a surfactant to prevent the precipitation of chlorhexidine).
Preparation
– Use as a 0.05% aqueous solution:
For one litre: 10 ml of 5% concentrated solution + 990 ml of clear water, boiled a few
minutes and cooled
– Do not use undiluted solution.
– Do not bring into contact with body cavities, eyes (risk of corneal damage), brain and
meninges, middle ear (risk of deafness if ear drum is perforated).
– Avoid applications to mucous membranes, especially to genital mucous membranes.
– Do not use with soap or other antiseptics (incompatibility).
Remarks
– Also comes in 20% chlorhexidine gluconate concentrated solutions. These solutions
usual do not contain a surfactant and must be diluted with distilled water.
– Storage:
• Concentrated solution: below 25°C
• Diluted solution: maximum one week
METHYLROSANILINIUM CHLORIDE
= GENTIAN VIOLET = GV = CRYSTAL VIOLET
Carcinogenic effects have been demonstrated in animals. As a precaution, this product
should not be used in humans if an alternative is available.
Therapeutic action
52
– Antifungal, weak antiseptic, drying agent
Indications
– Oropharyngeal candidiasis, mammary candidiasis in nursing mothers
– Certain wet skin lesions (impetigo, dermatophytosis oozing lesions)
Presentation
– Powder to be dissolved
Preparation
– Dissolve 2.5 g of powder (= one half-teaspoon) in 1 litre of clear water (boiled a few
minutes and cooled) to obtain a 0.25% solution.
– Shake well and leave to settle. Pour carefully into another bottle to eliminate any
possible sediment.
– Before preparation, carefully wash both the bottle for dilution and the storage bottle
with hot water and leave to dry.
Use – 2 applications/day for a few days

– Do not apply to wounds or ulcerations.
– Do not apply to the face or genital mucous membranes.
– May cause:
• irritation, ulcerations, allergic reactions,
• persistent staining of the skin.
– The solution should not be swallowed.
– The use of cooking oil or vaseline around lips before swabbing can limit the risk of skin
coloration.
– Stop treatment in the event of allergic reactions or if new ulcerations develop.
– In the event of product entering the eye, rinse with plenty of water.
– Avoid contact with clothes (causes permanent staining of fabrics).
Remarks
– Gentian violet is no longer included in the WHO list of essential medicines.
– Storage:
53
• Powder to be dissolved: unlimited
• Diluted solution: maximum 1 week
EYE EAR AND SKIN PREPARATIONS
OPHTALMIC PREPARATION
The eye is vulnerable to any external insult. Common problems that are seen include infections
(conjunctivitis-red eye, and trachoma), injury or burns, allergy and glaucoma (raised intraocular
pressure in the eye). Eye drops and eye ointments are the most commonly used dosage forms for
the management of eye problems. Eye drops penetrate the globe, probably through the cornea, in
order to produce their therapeutic effect.
ANTIBIOTICS .
DRUG SUMMARY: It is preferred to use antibiotics that are rarely used to treat systemic
infections. Always take in consideration the possibility of systemic absorption and systemic
effects of these antibiotics. Some of the most commonly used antibiotics have a wide spectrum
of activity, these include: Tetracycline, Chloramphenicol, Framycetin, Gentamicin , and
Neomycin.
Norfloxacin has a spectrum of activity similar to that of gentamicin. Gentamicin and tobramycin
are effective for treating infections due to Pseudomonas aeruginosa. Fusidic acid is useful in the
treatment of infections caused by Staphylococcus spp.
INDICATIONS: Trachoma, ocular infections: Treatment of superficial ocular infections

involving the conjunctiva or cornea due to strains of microorganisms susceptible to the
antibiotics.
DOSAGE FORM: Drops, ointments and tablets.
54
CONTRAINDICATIONS: Hypersensitivity to any component of these products; epithelial
herpes simplex keratitis (dendritic keratitis); vaccinia; varicella; mycobacterial infections of the
eye; fungal diseases of the ocular structure; use of steroid combinations after uncomplicated
removal of a corneal foreign body.
RECOMMENDED DOSAGES: Eye-drops: Apply at least every 2 hours; reduce frequency as

infection is controlled; continue for 48 hrs. after healing.
Eye-ointment: Apply either at night (if eye drops used during the day) or 3-4 times daily (if eye-
ointment used alone). Short-term courses with tetracyclines can be used for control of bacterial
infections during seasonal epidemics of conjunctivitis, and may be repeated annually.
Directions: Tilt the head back, place medication in conjunctival sac and close eyes. To reduce
systemic absorption, apply light finger pressure on lacrimal sac for 1 min. following instillation;
this retards passage of drops via nasolacrimal duct into areas of potential absorption, such as:
nasal and pharyngeal mucosa. Eye-ointments are often applied to lid margins for blepharitis, they
may also be used in the conjunctival sac for other conditions especially where a prolonged action
is required. To avoid contamination, do not let the tip of container touch any surface. Close cap
well after using.
Overdose Treatment: A topical overdose of any antibiotic may be flushed from the eyes with
warm tap water.
Antivirals
Herpes simplex infections are the most common ophthalmic viral infections. They produce, for
example, dendritic corneal ulcer and can be treated with acyclovir; alternatively idoxuridine may
be used. Treatment has to be started early in the for the antiviral agent to be effective and inhibit
the replicating virus.
55
TETRACYCLINE EYE OINTMENT
Therapeutic action: Antibacterial

Indications
– Conjunctivitis
– Trachoma (by preference use oral azithromycin for this indication)
– Prevention of chlamydial and gonococcal neonatal conjunctivitis
Presentation: 1% ointment, tube
Dosage and duration
– Wash the eyes with boiled and cooled water before each application. Use sterile sodium
chloride 0.9% for newborns.
– Apply tetracycline 1% into the conjunctival sac of both eyes:
• Conjunctivitis: 2 applications/day for 7 days
• Trachoma: 2 applications/day for 6 weeks
• Prevention of neonatal conjunctivitis: one single application immediately after birth
– Do not use in patients with hypersensitivity to tetracyclines.
– May cause allergic reactions; stop treatment in the event of serious reaction.
Remarks
– Tetracycline eye ointment replaces silver nitrate 1% eye drops for the prevention of
neonatal conjunctivitis.
– For the treatment of trachoma, azithromycin as single dose is as effective as a 6-week
course of tetracycline ointment.
– Gonococcal neonatal conjunctivitis must be treated systemically with ceftriaxone IM
(125 mg as a single dose). When systemic treatment cannot be given immediately, apply
tetracycline eye ointment to both eyes every hour until ceftriaxone is available.
– Oxytetracycline (Terramycin®) and chlortetracycline (Aureomycin®) are used in the
same way as tetracycline.
– In the event of eye infection, use only eye ointment; dermal ointment must never be
applied to the eyes.
56
Do not use after expiry date. To avoid contamination, close the tube properly after
opening.
OTIC PREPARATIONS
Most patients that attend a clinic with an ear problem tend to be children. The most common
diseases that affect the ears are otitis externa, otitis media and accumulation of waxy secretions
in the external ear.
CIPROFLOXACIN EAR DROPS (Ciplox®…)
Therapeutic action: Fluoroquinolone antibacterial

Indications :Chronic suppurative otitis media
Presentation: 0.3% ear drops
Dosage
– Child over 1 year: 2 to 3 drops 2 times daily in the affected ear
– Adult: 4 drops 2 times daily in the affected ear
To administer drops, pull back the auricle and maintain the head to one side for a few
minutes.
Duration: 2 to 4 weeks
– May cause: headache, local skin eruption or pruritus.
Remarks
– Do not touch let the dropper touch either hands or the ear.
– Storage: no special temperature requirements
Once the bottle has been opened, solution keeps for 4 weeks.
57
CHAPTER TEN
READING OF PRESCRIPTION AND LABELLING OF DRUG
Medicines, or drugs, come as either prescription or over the counter (OTC). Prescription drugs
are used under a doctor’s care. OTC drugs can be bought and used without a doctor’s
58
prescription, and you buy them at a drugstore or grocery store. When using any kind of drug, it’s
really important to read the drug label for instructions. Not following the instructions can hurt
your health. Read the label each time you use a new bottle of a drug, just in case there have been
changes to it since the last time you used it. See the drug label below and on the next page to
know what to look for.
Understanding Rx Terms and Symbols

The symbol Rx commonly represents the word “prescription.” This symbol originated in
medieval times as an abbreviation for the Latin word for take, which is “recipe.” The word
“prescription” is made from the prefix “pre” which means before, and the base word “script”
which means writing. A prescription is an order that must be written down before a drug can be
prepared.
ABBREVIATIONS
The following are abbreviations commonly used in general prescribing of medicines.
IV intravenous
IM intramuscular
SC subcutaneous
kg kilogram
g gram
mg milligram
L litre
dl decilitre
ml millilitre
mmol millimole
mEq milliequivalent
hr(s) hour(s)
min(s) minute(s)
sec(s) second(s)
m metre(s)
59
cm centimetre(s)
BW body weight
°C degree celcius
mmHg millimetres of mercury
a.c. ante cibum (before food)
b.d. bis die (12 hourly)
o.d. omni die (daily)
o.m. omni mane (in the morning)
o.n. omni nocte (at night)
p.c. post cibum (after food)
p.r.n. pro re nata (when required)
q.d.s quarter die sumendus (6 hourly)
q.q.h quarta quaque hora (4 hourly)
stat statim (immediately, as initial dose)
t.d.s. ter die sumendus (8 hourly)
The following should be noted when reading drug labels and prescriptions
1. Pharmacy Information
• Includes the name, address, and phone number of the issuing pharmacy, as well as a
prescription number and fill date.
• This information is important in the event that you have an adverse reaction to the medication,
or if you have to call the pharmacy with any questions.
2. Doctor/Prescriber Information
• Includes the name of the doctor or other appropriate medical professional who prescribed the
medication.
• Prescription medication can only be provided to one if ordered by doctor or other appropriate
medical professional.
• A prescription is written for one person, not for a family or group of people.
• The doctor or other appropriate medical professional decides what and how much to prescribe
based on factors unique the individual (such as symptoms, age, weight, and allergies).
60
3. Patient Information
• Includes the name and address of the person for whom the medication was prescribed.
• This information is important because the medicine was prescribed for a particular person.
• Never take a medicine prescribed for someone else.
• Never share your prescription medication with anyone.
4. Drug Information
• Includes the name and strength of the drug, along with any additional names that the drug is
called. Sometimes a description of what the drug looks like is also included.
• This information helps ensure that you receive the correct medication from the pharmacy and
that you are not taking another prescription (from a different doctor) of the same drug.
5. Directions
• Includes instructions about when and how often to take the medication.
• This information is important because not following directions can have severe consequences.
Taking the medication at the wrong time can affect whether the medication does what it is
supposed to do. Taking the wrong amount (dosage) can make you sick and can even be deadly.
6. Warnings and Cautions

• Includes special considerations about proper use, side effects, safe storage, and proper disposal.
• Always pay attention to all warning and caution messages.
7. Expiration Date
• This is the last date by which medicine should be used. Never use the medication past this date.
• Using medications past their expiration dates is dangerous.
• Remember to properly dispose of expired prescription drugs
PRESCRIPTION WRITING
61
Medicines should be prescribed only when they are necessary in treatment following a clear
diagnosis. Not all patients need a prescription for a medicine; non-pharmacological treatment
may be suitable.
In all cases the benefit of administering the medicine should be considered in relation to the risk
involved. This is particularly important during pregnancy where the risk to both mother and
foetus must be considered.
Prescriptions should
 be written legibly in ink or otherwise so as to be indelible
 be written by the prescriber and not left for another person to complete
 be dated
 state the full name and address of the patient
 specify the age and weight of the patient (especially in the case of children)
 be signed in ink by the prescriber
 bear the contact details of the prescriber (e.g. name and telephone number)
When writing a prescription the following should be noted:

 Name of medicines and preparations should be written in full. Unofficial abbreviations
should not be used because there is a high possibility of misinterpretation
 Non-proprietary (generic) names are given in the book and they should always be used in
prescribing
 Avoid the unnecessary use of decimal points, e.g. 3 mg and not 3.0 mg
 Quantities of 1 gram or more should be written 1 g
 Quantities less than 1 gram should be written in milligrams, e.g. 500 mg, and not 0.5 g
 Quantities less than 1mg should be written in micrograms, e.g. 100 microgram, not 0.1
mg
 Where decimals are unavoidable a zero should be written in front of the decimal point
where there is no other figure, e.g. 0.5 ml, and not .5ml
 'Micrograms' and 'nanograms' should not be abbreviated. Similarly, 'units' should not be
abbreviated.
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 Use the term 'millilitre' (ml or mL) not cubic centimetre (cc, or 3 cm )
 State dose and dose frequency. In the case where medications are to be given ‘as
required', a minimum dose interval should be specified, e.g. 'every 4-6 hrs as required for
pain'
 State the quantity to be supplied or indicate the number of days of treatment required
 Write directions, preferably in English without abbreviation. It is recognised that some
Latin abbreviations are used and these are detailed in the section on abbreviations. Do not
use other abbreviations
 Avoid combination drugs, unless there is a significant therapeutic advantage over single
ingredient preparations (e.g. Co-trimoxazole)
 Avoid the use of symptomatic treatments for minor self-limiting conditions
 Avoid, where possible, the prescribing of placebos. Instead, spend some time educating
and reassuring the patient.
 Avoid multiple prescribing (polypharmacy), especially when the diagnosis is not clear
 Avoid the use of the parenteral route of administration except where there are clear,
clinical indications for this route. Use the oral route whenever possible.
It is therefore very important to take into considerations the points listed above when reading
prescriptions and draw the prescriber’s attention to any error or any ambiguity on the
prescription.
MEDICATION/ DRUG ADMINISTRATION

Medication Administration Guiding Principles
 Caregiver must know about the patient’s general health and condition that is being treated
with medication.
 Caregiver must give medications accurately and safely.
 Caregiver must have basic knowledge about the medication(s) to be given.
 Caregiver must make correct observations about how a patient responds to medications,
including over-the-counter medicines, and can write down and report these observations.
 Caregiver must know about side effects that can occur with medications.
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 Caregiver must know there is no medication that is harmless.
 Caregiver must know safe, clean and proper storage of various types of medications.
 Caregiver must know his/her limitations and who to call with questions about medication
administration.
 Caregiver must know how to practice infection control and universal precautions.
 Caregiver must contact a licensed and knowledgeable person when in doubt about any
procedure or direction.
PURPOSE OF PRESCRIBING MEDICATIONS

The term drug or medication refers to a substance or mixture (other than food) that is used to do
one or more of the following:
• Maintain health
• Treat disease
• Relieve symptoms
• Prevent disease
• Alter body processes
• Diagnose disease
FORMS OF MEDICATION
Medications are found in three basic forms:
1. Liquid preparations are those containing a drug that has been dissolved
or suspended in a solvent such as water or alcohol. Liquids include elixirs,
emulsions, fluid extracts, inhalers, liniments, mixtures or suspensions,
sprays, solutions, syrups, tinctures.
2. Solid preparations are tablets, capsules, troches, or lozenges, and
suppositories.
3. Semi-solid preparations include ointments, suppositories, lotions, and
creams.
ROUTES OF MEDICATION ADMINISTRATION
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• Oral medications are given by mouth, swallowed, and then enter the stomach. These
medications are digested in much the same manner as food. After being dissolved, oral
medications are absorbed into the bloodstream and then work throughout the body.
• Buccal medications are placed in the cheek pocket, at the back of the lower jaw. The
medication is absorbed through the mucous membranes that line the inside of the cheek.
• Sublingual medications are placed under the tongue where they are held until dissolved by
saliva. The medication is absorbed by the rich blood supply within the area.
• Eye (ophthalmic) medications are put into the eye by means of a dropper (liquids) or a tube
(ointments).
• Ear (otic) medications can be placed into the ear by means of a dropper.
• Dermal patch is a method of having medicine absorbed through the skin. The patch is placed
directly on the skin in the specified area.
• Inhalation medications are sprayed or inhaled into the lungs. Medication is absorbed through
the tiny sacs (alveoli) of the lungs. Medications used for this route are in the form of gases or
fine droplets, sprays, or mists.
• Nasal medications are put into the nose by means of drops or sprays. Absorption is through the
mucous membrane lining of the nose.
• Rectal medications are administered in the form of suppositories; however, creams and
ointments may also be pre scribed. Absorption is through the mucous membrane lining.
• Vaginal medications are administered by means of creams, suppositories, tablets, or other
special applications. Medication is absorbed into the vaginal mucosal lining.
• Subcutaneous medications are injected just beneath the skin into the fatty layer. Usually a
licensed nurse administers these medications; however foster parents can receive special training
to administer them.
• Intradermal medications are those injected between the layers of the skin. Only a nurse can
administer these medications.
• Intramuscular medications are injected directly into the muscle. Only a nurse can administer
these medications.
• Intravenous medications are introduced directly into the bloodstream through a catheter. Only
a nurse can administer these medications
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RULES FOR MEDICATION ADMINISTRATION
The nurse must always
 Identify the client: In hospitals, most clients wear some sort of identification (ID), such
as a wristband with name and hospital ID number. Before giving the client any drug,
check the ID band against the MAR. As a double check, ask the client to state his name.
 Inform the client: If the client is unfamiliar with the medication, the nurse should
explain the intended action as well as any side effects or adverse effects that might occur.
 Administer the drug: Read medication orders and records carefully; check both the
client and drug name against the names on the drug packaging. If the client’s medication
is kept in a medication cart or computerized dispensary, check against this also.
 Provide adjunctive interventions as indicated: Clients may need physical assistance,
such as positioning for an injection. They may need teaching about measures to enhance
drug effectiveness, such as changes in diet and fluid intake.
 Record the drug administered: The record should also include the exact time of
administration and the signature of the nurse providing the medication. Many medication
records are designed flowchart style so that the nurse signs once on the page and initials
each medication administered. Any prn or stat medications, as well as the client’s
response to the drug, are recorded separately and should be documented in the
nursing/progress notes. Nurses must be aware of all the medications a client is taking and
be alert for interactions.
 Evaluate the client’s response to the drug: In all nursing activities, nurses need to be
aware of the medications that a client is taking and record their effectiveness as assessed
by the client and the nurse on the client’s chart. The nurse may also report the client’s
response to the RN or the physician.
FIVE RIGHTS OF MEDICATION ADMINISTRATION

Right Person/ Patient
 Look at the name on the prescription bottle to be sure it is prescribed for that child.
 Medication should be administered to one child at a time.
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 The child should remain in full view while the medication is given with a mouth check if
necessary
Right Drug
 All medication must be given from the original labeled container.
 Any special directions must be followed when giving medicines (e.g., take with food or
with a full glass of water).
Right Dose
 Look at the medication label prior to administration to make sure you are giving the right
amount of the medicine.
 One dose of the medication should be given at the correct time.
 You must be very careful when medications have different dosages ordered for different
times and these must be followed accordingly.
 Some medications are prescribed in certain dosages or strengths; in order to give the right
dose, it may be necessary to give more than one tablet or split a tablet to equal the right
dose.
Right Time
 Medications are to be given at the right times or intervals and for the right number of
days or doses.
 Always give all the medicine unless the prescribing provider says to stop.
 A missed dose cannot be “made up” at the next scheduled time without approval from the
prescribing prescriber.
Right Route
 Verify the transcriber’s order or manufacturer’s direction concerning route of
administration prior to giving the medication.
 Be careful that creams, drops, suppositories, and pills are given correctly.
Right Documentation
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 Document administration AFTER giving the ordered medication.
 Chart the time, route, and any other specific information as necessary. For example, the
site of an injection or any laboratory value or vital sign that needed to be checked before
giving the drug.
DRUG OVERDOSE FIRST AID MANAGEMENT

A drug overdose is the accidental or intentional use of a drug or medicine in an amount that is
higher than is normally used. Overdoses can occur with prescription medications, over-the-
counter (OTC) medications, and “street” drugs, and can be life threatening. Mixing certain
medications or “street” drugs with alcohol can also kill.
TYPES OF DRUG OVERDOSES

The three types of drug overdoses are classified according to how they enter the body:
• swallowed drugs – through the mouth
• inhaled drugs – through the lungs
• injected drugs – through the skin using a hollow needle
An important part of the first aid for drug overdoses is telephoning the hospital Emergency
Department or the Ambulance Service for advice on what to do. Before calling, the first aider
must quickly gather as much information about the incident as possible. Use the history of the
scene and the signs and symptoms of the casualty to gather the information you’ll need to answer
the questions asked by the hospital Emergency Department or the Ambulance Service
HISTORY OF THE SCENE

When drug overdosing occurs, act quickly but do not panic. You need to know four basic facts
to give appropriate first aid for a drug overdose:
 what drug was taken – container labels may identify the drug; otherwise, save vomit
and give it to medical help for analysis.
 how much drug was taken – estimate the quantity that may have been taken based on
what you see or are told – the number of pills originally in the container, the amount of
drug in the bottle, etc. Estimate the size/age of the casualty.
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 how the drug entered the body – first aid may differ for drugs taken by the mouth,
injected into the blood or breathed into the lungs.
 when the drug was taken – the length of time the drug has been in the body will help
determine the first aid and medical care needed.
SIGNS AND SYMPTOMS OF A DRUG OVERDOSE

If the history does not reveal what drug was taken, or by what means it was taken, signs and
symptoms may be helpful in answering these questions. All drugs may affect consciousness,
breathing and circulation. Other signs and symptoms may vary depending on how the drug was
taken. Drugs that have been:
 swallowed usually cause nausea, abdominal cramps, diarrhea and vomiting. They may
discolour the lips, cause burns in or around the mouth or leave an odour on the breath.
 injected through the skin usually irritate the point of entry and may cause an allergic or
behavioural reaction.
 inhaled may cause problems with breathing. Signs and symptoms may include coughing,
chest pain and difficulty breathing. Prolonged lack of oxygen will cause headache,
dizziness, unconsciousness, stopped breathing and cardiac arrest.
GENERAL FIRST AID FOR A DRUG OVERDOSE

1. Begin Emergency Site Management (ESM) – do a scene survey. Gather any information
about the suspected drug. Assess the casualty’s responsiveness.
 If the casualty is responsive, call the Poison Information Centre or Emergency
Department of Hospital in your region. Answer any questions and follow their
advice on first aid.
 If the casualty is unresponsive, call emergency line immediately (ambulance
service) and go to step 2.
2. Do a primary survey. If breathing is stopped begin CPR. Check for poisonous material
around the mouth first. Use a barrier device if you have one.
3. Place the unconscious breathing casualty into the recovery position.
4. Give ongoing casualty care until medical help takes over.
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DRUG OVERDOSE TREATMENT
Treatment will be dictated by the specific drug taken in the overdose. Information provided
about amount, time, and underlying medical problems will be very helpful.
 The stomach may be washed out by gastric lavage (stomach pumping) to mechanically
remove unabsorbed drugs from the stomach.
 Activated charcoal may be given to help bind drugs and keep them in the stomach and
intestines. This reduces the amount absorbed into the blood. The drug, bound to the
charcoal, is then expelled in the stool. Often, a cathartic is given with the charcoal so that
the person more quickly evacuates stool from his or her bowels.
 Agitated or violent people need physical restraint and sometimes sedating medications in
the emergency department until the effects of the drugs wear off. This can be disturbing
for a person to experience and for family members to witness. Medical professionals go
to great lengths to use only as much force and as much medication as necessary. It is
important to remember that whatever the medical staff does, it is to protect the person
they are treating. Sometimes the person has to be intubated (have a tube placed in the
airway) so that the doctor can protect the lungs or help the person breathe during the
detoxification process.
 For certain overdoses, other medicine may need to be given either to serve as an antidote
to reverse the effects of what was taken or to prevent even more harm from the drug that
was initially taken. The doctor will decide if treatment needs to include additional
medicines.
SELF-CARE AT HOME
Home care should not be done without first consulting a doctor or poison expert.
 For some accidental drug overdoses, the local poison control center may recommend
home therapy and observation. Because of the potential for problems after some
overdoses, syrup of ipecac or other therapies should not be given unless directed by a
medical professional.
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 Most people have telephone access to a local poison control center.
 Anyone who has small children at home should have the "poison line" or ambulance
service line or emergency line telephone number readily available near the telephone.
 People who take a drug overdose in an attempt to harm themselves generally require
psychiatric intervention in addition to poison management. People who overdose for this
purpose must be taken to a hospital's Emergency Department, even if their overdose
seems trivial. These people are at risk for eventually achieving a successful suicide. The
sooner you intervene, the better the success of avoiding suicide.
IMPORTANT THINGS TO KNOW ABOUT MEDICATION ADMINISTRATION

• Prescription medications are dispensed by a pharmacy and must stay in the original container
with the pharmacy label.
• Each patient’s medications should be kept in a locked container in the hospital.
• Read the label of the medication container carefully.
• Never take medicine from an unmarked or damaged container.
• Keep all containers tightly closed. If you see any change in color, consistency, or odour, call
the pharmacist or prescribing provider.
• You must be familiar with the patient’s allergies, ability to swallow, etc.
• Medication must be given exactly as ordered. Contact the prescribing provider or pharmacist
before crushing or splitting tablets or caplets, or opening capsules.
• Give the medication at the time it is scheduled and stay with the patient until the medication is
taken.
• Tell patient why they are getting medication and how it should help them.
• If a patient refuses medication, try to find out why. If the patient refuses to take the medication
for two days, you must notify the prescribing provider.
PROPER PROCEDURES FOR ADMINISTERING MEDICATIONS

GENERAL PRINCIPLES
 Wash hands and put on gloves if needed.
 Gather the medicine, medicine cup or medicine syringe, and measuring utensils needed.
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 Read the label of the container carefully to be sure you have the right medicine.
 When preparing pills, remove the cap and place it topside down on the table. Handle the
medicine in such a way that the fingers do not come in contact with it. Place the number
of tablets in the lid or cap of the bottle and then hand it to the patient.
 When preparing liquid medications, check to see that the cap of the bottle is on securely.
Shake the bottle to mix the medicine. Remove the cap and place it topside down on the
table. When pouring liquid medicine hold the bottle with the label in the palm of the palm
to avoid soiling it. Pour the medicine holding the medicine cup or medicine syringe at eye
level or pour it into a spoon. Wipe the lip of the bottle with a moist piece of clean paper
towel before recapping it. Put the cap back on securely.
 Liquid medications should be measured using accurate dosing devices like oral syringes,
medicine cups, and calibrated medicine droppers/spoons. Household flatware teaspoons
should not be used.
 Take the medicine to the patient or have them come to you.
 Remain with the patient while they take the medicine.
 Check the patient’s mouth if needed. Have the child open their mouth and stick out their
tongue to see if the medication has been swallowed.
 Note any unusual reactions or symptoms before or after the patient takes the medication.
Report this to the prescribing provider.
 Clean equipment, including pill splitters, mortar and pestles, oral syringes, etc., with
soap and water.
 Remove gloves and wash hands.
 If the patient has difficulty swallowing the medicine, check with the prescribing provider
to see if it can be crushed or added to food or liquid to make taking it easier.
ORAL TABLETS AND CAPSULES

1. Wash your hands and get the medicine container.
2. Double-check the name on the container and the name of the medication.
3. Handle the pills in such a way that you do not touch them with your fingers. Drop the
pill(s) into the cap of the container and hand it to the child.
4. Recap the container.
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5. Observe the patient as the medication is swallowed.
6. If necessary, do a check of the mouth to be sure the medication has been swallowed.
ORAL LIQUID MEDICATION

1. Wash your hands.
2. Check to see that the cap of the bottle is on securely. Shake the bottle to mix its contents
if it is a suspension. Remove the cap and place it topside down on the table.
3. When pouring liquid medications, hold the bottle with the label facing the palm of your
hand to avoid soiling it.
4. Pour the medication holding the medicine cup or medicine syringe at eye level or pour
the medication into a spoon.
5. Wipe lip of the bottle with a moist piece of clean paper towel before recapping it.
6. Replace cap, wash equipment with soap and water, and wash your hands.
TOPICAL MEDICATION
1. Wash your hands and put on gloves if available.
2. Look to see if the affected area is changed in any way before applying the medicine and
any unusual reactions or symptoms after the medicine is applied. Report these things to
the provider.
3. Clean the area if indicated. Clean from “clean to dirty” in only one direction, one time to
avoid spreading germs to the area. Use a clean wipe for each area if necessary.
4. Remove cover from medication and place cap topside down on the table.
5. Take the correct amount from the container onto a glove, tongue blade, tissue, etc. Do not
double-dip applicator back into the medication.
6. Apply to affected area.
7. Put on a bandage if ordered according to directions.
8. Replace cap, remove your gloves, and wash your hands.
NASAL MEDICATION
1. Wash your hands.
2. Position patient in a sitting position with head tilted backward or to the side.
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3. Shake the medication and draw up the medication into the dropper.
4. Make sure the dropper is not chipped, cracked or broken.
5. Aim the tip of the dropper toward the nasal passage and apply correct number of drops.
Instruct child to breathe through the mouth as the drops are put in.
6. For sprays, place the tip of the container just inside the nostril. Close off the opposite
nostril. Instruct the child to as the container is squeezed. Repeat in the opposite nostril as
required.
7. Replace cap and wash your hands.
EYE DROPS/OINTMENTS
1. Wash your hands and put on gloves if needed.
2. Look for any changes in the effected eye before applying medicine and any unusual
reaction or symptoms following the medicine application. Report them to the provider.
3. Shake the bottle and draw up the medication into the dropper.
4. Check the dropper to be sure it is not dirty, chipped or cracked.
5. Tilt the patient’s head back and have the child look at the ceiling. Gently draw lower lid
down with forefinger, steady your hand on their cheek if needed.
6. If an ointment, apply it in a thin layer along the inside of lower lid. Do not touch the tip to
eye. Hold your hand against their forehead to steady it.
7. If drops, dispense the correct number of drops gently near the center of the lower lid. Do
not touch the dropper to the eye to prevent contamination. Hold your hand against their
forehead to steady it.
8. Have the patient close their eye for 2-3 minutes.
9. Replace cap, remove your gloves, and wash your hands.
EAR DROPS
1. Wash your hands.
2. Position the patient on bed with head turned away from you. If sitting in a chair, tilt head
sideways until ear is as horizontal as possible.
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3. Look for any changes in the affected ear(s) before putting in the medicine and any
unusual reactions or symptoms following the medicine instillation. Report these to the
prescribing provider.
4. Shake the bottle and draw up the medication into the dropper.
5. Make sure the dropper is not chipped, cracked or broken.
6. Administer the eardrops by pulling the ear gently backward and upward and put the
number of drops ordered into ear canal. Do not touch any part of the ear canal with the
dropper to prevent contamination.
7. Keep ear tilted several minutes and put a soft cotton ball loosely in the ear.
8. If drops are to be put in both ears, wait at least five minutes before putting drops in
second ear.
9. Replace dropper and cap and wash your hands.
INHALANT MEDICATION
1. Wash your hands.
2. Shake the inhaler to mix the medicine in the chamber.
3. Hold inhaler between index finger and thumb and remove cap. Insert inhaler mouthpiece
or spacer.
4. Have the patient exhale or breathe out slowly through pursed lips. Insert mouthpiece and
squeeze the canister between the thumb and fingers and have the child breathe in slowly
at the same time.
5. Withdraw the mouthpiece and have the patient hold his/her breath for several seconds,
and then breathe out slowly.
RECTAL MEDICATION
1. Wash your hands and put on gloves.
2. If lubricant is needed, put it on a tissue. Open suppository foil and drop suppository into the
lubricant.
3. Have the patient lie on their side.
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4. Push the suppository or ointment gently with your forefinger into the rectum along the rectal
wall as far as you can without causing pain. Encourage the patient to relax by breathing through
their mouth.
5. While removing your finger, press a folded tissue against the anus until the urge to push the
medicine out stops.
6. Look for any unusual reactions or symptoms after inserting the suppository. Report them to
the provider.
7. Discard tissues, remove your gloves, and wash your hands.
VAGINAL MEDICATION
1. Have the girl urinate to empty the bladder; then wash her hands and put on gloves if
available. Prepare the medication for delivery following direction on the label.
2. If possible use the vaginal medication at bedtime so the medication stays in overnight.
3. Position girl on back with knees bent and legs spread. Instruct her to relax by breathing
through the mouth or taking deep breaths.
4. Separate the labia and insert the applicator in the vagina to the length recommended in
the package instructions. Push down on the plunger.
5. Remove the applicator and place it on a clean tissue or throw it away if disposable.
6. Remain lying down for at least 10 to 30 minutes.
7. Wash a reusable applicator according to manufacture instructions.
8. Recap container and have girl wash her hands.
DRUG QUALITY AND STORAGE

Drug quality influences treatment efficacy and safety. Quality depends on correct manufacturing
and storage: high-quality drugs are available when using rational buying procedures and when
suppliers are reliable. It is also essential to assure optimum transportation and storage conditions.
Quality standards: Each drug is characterised by particular norms written in pharmacopoeia or

files presented by manufacturers and recognised by competent authorities in each country. These
norms concern aspects (colour, odour, etc.), physicochemical properties, analysis procedures,
shelf life and storage conditions.
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Analysis certificates guarantee that products from one batch (products from the same production
cycle) conform to official quality standards in the country of manufacture. These certificates are
provided for each product by manufacturers.
Every unit (box and bottle) should be clearly labelled; each label should clearly indicate the:
– INN, (International Non-propriety Name)
– form and dosage,
– number of units (tablets, ampoule, etc.) or the volume (syrup, etc.),
– name and address of the manufacturer,
– batch number,
– expiry date.
STORAGE CONDITIONS
Stability of drugs depends on both environmental factors such as temperature, air, light and
humidity, and drug-related factors such as the active ingredient itself, the dosage form (tablet,
solution, etc.) and the manufacturing process. It is therefore necessary to respect storage
instructions given in this guide or by manufacturers (on notices and labels) if the
recommendations are not identical.
Storage of controlled substances

Narcotics and other controlled substances should be placed under lock and key.
Storage of products requiring a cold chain

Products needing a cold chain should be stored in a refrigerator (between 2–8°C): vaccines,
immunoglobulins, serums, insulin, ergometrine, oxytocin, dinoprostone, certain laboratory tests,
etc.
Temperature
The temperature in the store should not be above 30°C. Storage temperatures are defined by
European pharmacopoeia as follows:
Freezer - 15 to 0°C
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Refrigerator +2 to + 8°C
Cool +8 to + 15°C
Ambient temperature + 15 to + 30°C
During transit and transportation temperatures may attain 50 to 60°C inside vehicles, shipping
containers or on docks and, in this case, shelf life and expiry dates may no longer be guaranteed.
Freezing may be detrimental, particularly for solutions, leading to the precipitation of active
ingredients or the shattering of ampoules.
Vaccines, immunoglobulins and antisera are products that are sensitive to heat and light. Even
though new techniques produce vaccines that are less sensitive to heat (called "thermostable"),
they still have to be stored in the refrigerator between 2°C and 8°C, and the cold chain must be
strictly respected during transport. The vaccine vials may have a heat-sensitive monitor (VVM).
The square on the monitor changes colour when exposed to heat over a period of time: if the
square is lighter than the circle, the vaccine can be used. If the square is the same colour or
darker than the circle, the vial must be destroyed.
Vials of oral polio (OPV), measles, tuberculosis (BCG), yellow fever, hepatitis B, tetanus (TT)
and diphtheria-tetanus-pertussis (DTP) vaccines may have a VVM.
Air and humidity

In a store, relative humidity should not be above 65% (there are several devices for humidity
measurement). Air is a factor of deterioration due to its content of oxygen and humidity. All
containers should remain closed. In airtight and opaque containers (hospital type), drugs are
protected against air and light. Opening containers long before the use of drugs should be
avoided. Patients should be informed that tablets should not be removed from blisters until
immediately before administration.
Light
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Drugs should be protected from light, particularly solutions. Parenteral forms should be
preserved in their packaging. Coloured glass may give illusory protection against light.
Deterioration
It is important to be familiar with the normal aspects of each drug (colour, odour, solubility,
consistency) in order to detect changes, which may indicate its deterioration. It is important to
know that deterioration does not always lead to a detectable external modification. The principal
consequence of deterioration is a reduction of therapeutic activity, which leads to more or less
grave consequences for the individual and/or community.
For example, the use of expired antibacterials does not cure an infection and also favours the
emergence of resistant strains.
In time, certain drugs undergo a deterioration leading to the development of substances much
more dangerous, thus an increase in toxicity. Tetracycline is the principal example: the pale,
yellow powder becomes brownish and viscous, its use therefore being dangerous even if before
the expiry date.
Suppositories, pessaries, creams and ointments that have been melted under heat should not be
used. The active ingredient is no longer distributed in a homogenous manner.
Oral rehydration salts may be used as long as they keep their aspect of white powder. Humidity
transforms them into a compact mass, more or less brownish and insoluble. They are therefore
unfit for consumption, whatever their expiry date.
EXPIRATION
Drugs deteriorate progressively and according to various processes, even if stored inadequate
conditions. In most countries, regulations impose an obligation on manufacturers to study the
stability of their products in standardised conditions and to guarantee a minimum shelf life
period. The expiry date indicated by manufacturers designates the date up to and including which
the therapeutic effect remains unchanged (at least 90% of the active ingredient should be present
and with no substantial increase in toxicity).
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The expiry date indicated on the label is based on the stability of the drug in its original and
closed container. Shelf life period currently guaranteed is from 3 to 5 years. Less stable
substances are only guaranteed for 1 or 2 years. The expiry date should be indicated on the label
with storage instructions.
EXPIRED DRUGS
Expiry dates are to be respected due to legal obligations and considerations of therapeutic
responsibility. In cases where the only available drugs have expired, a doctor may be led to take
on the responsibility of using these drugs. It is evident that a drug does not become unfit for
consumption the day after its expiry date. If a product has been stored in adequate conditions
(protected from humidity and light, packaging intact and at a medium temperature) and if
modification of aspects or solubility have not been detected, it is often preferable to use the
expired drug than to leave a gravely ill patient without treatment. Expiry dates for drugs that
require very precise dosage should be strictly respected due to a risk of under-dosage. This is the
case for cardiotonic and antiepilectic drugs, and for drugs that risk becoming toxic, such as
cyclines.
CHAPTER ELEVEN
STANDARD TREATMENT GUIDELINES (MALARIA)
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Standard Treatment Guideline (STG) is systematically developed statements that assist
prescribers in deciding on appropriate treatments for specific clinical problems. They usually
reflect the consensus on the optimal treatment options within a health system and aim at
beneficially influencing prescribing behaviour at all levels of care.
Since 1998, Ghana has committed itself to the Roll Back Malaria (RBM) Initiative of the World
Health Organisation (WHO), which builds on the Global Malaria Strategy with a focus on Africa
and a goal to halve the world's malaria burden by 2010. Consequently, the country drew up a
'Medium Term Strategic Plan for Malaria Control in Ghana' (1998-2002), which sought to
improve the coverage of malaria control activities by adopting an inter-sectoral approach
involving and promoting partnership with the private sector and the community.
In spite of these initiatives, Malaria remains hyper endemic in Ghana and is the single most
important cause of mortality and morbidity especially among children under five years, pregnant
women and the poor.
Consequently, the Ministry of Health through the National Malaria Control Programme in
collaboration with the Noguchi Memorial Institute for Medical Research studied the efficacy of
chloroquine country wide in 2002 and found that treatment failure following chloroquine was in
the range between 6% and 25% and parasite clearance rates were low and in some cases below
50%.
Drug Policy changed from the use of Chloroquine to the adoption of Artesunate-Amodiaquine
combination or Artemisinin-based Combination Therapy (ACT) as the first line drug for the
management of uncomplicated malaria in 2004. This therefore, led to the introduction of new
drug policy for malaria treatment in Ghana with the objective of providing prompt, safe,
effective and appropriate anti malaria treatment to the entire population.
MANAGEMENT OF UNCOMPLICATED MALARIA
1. Artesunate-Amodiaquine Combination
81
Artesunate-Amodiaquine Combination shall be the medi-cine/drug of choice for the treatment of
uncomplicated malaria.
2. Alternative combination therapies
The Alternative combination medicines for the treatment of uncomplicated malaria shall be the
recommended strengths and dosage forms of:
i. Artemether-Lumefantrine
ii. Dihydroartemisinin Piperaquine
These additional ACTs shall be used for patients who cannot tolerate the Artesunate –
Amodiaquine.
MANAGEMENT OF UNCOMPLICATED MALARIA IN PREGNANCY

1. First Trimester
Oral Quinine or a combination of oral quinine and clindamycin shall be used. This shall remain
the drug of choice for managing malaria in the first trimester of pregnancy.
2. Second and Third Trimesters

Oral Quinine or the combination of Quinine and Clindamycin or the combination of Artesunate-
Amodiaquine or Artemether-Lumefantrine shall be used Pregnant women with co-morbidities of
HIV and sickle cell anaemia shall be treated as above for malaria.
HOME MANAGEMENT OF UNCOMPLICATED MALARIA

Artesunate-Amodiaquine shall be the medicine of choice for treating uncomplicated malaria in
the community or near-home setting for children below five (5) years of age.
TREATMENT FAILURE
Treatment Failure of Uncomplicated Malaria
For the management of treatment failures, the following options are recommended:
 an alternative ACT; Artesunate-Amodiaquine, Artemether-Lumefantrine or
Dihydroartemisinin-Piperaquine which has not been administered as first-line of
treatment.
 if for any reason ACT cannot be administered, then oral quinine could be used.
82
(oral quinine 10mg/kg body weight 8 hourly plus tetracycline 250mg 6 hourly or doxycycline
100mg twice daily or clindamycin 5mg/kg body weight (maximum 300mg)
8 hourly must all be given for a total of 7 days).
Treatment Failure should be distinguished from Inadequate Treatment.

Inadequate treatment can be defined as failure to complete the initial course of treatment for
whatever reason (e.g. vomiting, non-compliance, etc.) In case of inadequate treatment a full
course of the initial drug used should be repeated.
TREATMENT FAILURE OF UNCOMPLICATED MALARIA IN PREGNANT WOMEN

First Trimester
ACTs are not recommended for use in the first trimester, however their use shall not be with-
held in cases where they are considered to be life-saving and other anti-malarials are deemed to
be unsuitable.
Second and Third Trimesters:

Quinine or Artesunate-Amodiaquine or Artemether–Lumefantrine combination therapies shall be
given depending on which medicine was used first. A treatment option other than what was first
used shall be given where treatment failure is established.
COMPLICATED/ SEVERE MALARIA

Complicated/ Severe Malaria is caused by Plasmodium falciparum and confirmed by the
presence of the asexual parasite forms in the blood. Management of severe/complicated malaria
requires parenteral treatment to provide adequate blood-serum concentrations as quickly as
possible initially; subsequently reverting to oral treatment as soon as the patient's condition
permits.
PRE-REFERRAL TREATMENT OF MALARIA IN HOMES AND COMMUNITIES
83
All children who do not respond to treatment with Artesunate-Amodiaquine or Artemether-
Lumefantrine within 24 hours shall be referred immediately to the nearest health facility after
tepid sponging. Such children shall be given an initial dose of an artemisinin-based suppository
prior to referral to the nearest health facility.
MANAGEMENT OF COMPLICATED (SEVERE) MALARIA
Following new evidence showing the superiority of parenteral artesunate over parenteral quinine
and the recommendation by WHO, parenteral artesunate shall be used as the medicine of choice
for managing severe malaria, to be followed by full course of ACT when patient is able to take in
oral preparations.
In the event of injection artesunate not being readily available, injection quinine should be used
as an alternative to save lives.
MANAGEMENT OF COMPLICATED (SEVERE) MALARIA IN PREGNANCY
First Trimester
In the first trimester of pregnancy, perenteral quinine remains the medicine of choice for the
treatment of severe malaria until patient is able to take oral preparations.
Second and Third Trimesters

Parenteral Artesunate is the recommended medicine of choice for managing severe malaria in the
second and third trimesters of pregnancy. Pregnant women with co-morbidities of HIV and
sickle cell anaemia shall be treated as above.
INTERMITTENT PREVENTIVE TREATMENT (IPT) OF MALARIA DURING

PREGNANCY
Currently, apart from ITNs the most preferred intervention to prevent malaria in pregnancy is
Intermittent Preventive Treatment (IPT) using SP. This shall be administered in predefined
84
intervals after quickening (16 gestational weeks) to reduce malaria parasitaemia and poor
pregnancy outcomes. IPT is preferably provided as part of a comprehensive antenatal package
with other products like haematinics and anthelmintics. The medicine shall be administered
under the supervision of a qualified healthworker – “Directly Observed Therapy (DOT)”.
DRUG OF CHOICE FOR INTERMITTENT PREVENTIVE TREATMENT (IPT)

Sulphadoxine-Pyrimethamine SP (Sulphadoxine 500mg + Pyrimetha-mine 25mg) shall be
reserved for Intermittent Preventive Treatment (IPT) given under DOT.
Conditions for use of Sulphadoxine-Pyrimethamine

All pregnant women shall undergo screening before the commencement of IPT in order to
exclude those who are either G-6PD deficient or allergic to sulphonamides. Pregnant women
who cannot take the Sulphadoxine-Pyrimethamine shall be encouraged to sleep under Insecticide
Treated Nets.
ALTERNATIVE ANTIMALARIAL TO SP FOR PREVENTING MALARIA IN

PREGNANCY
 Pregnant women, especially those who are non-immune, may be put on Proguanil
beginning in the first trimester of pregnancy.
 Folic acid at a daily dose equal or above 5mg should not be given concomitantly with SP
as this counteracts its efficacy as an anti-malaria.
 Pregnant women with HIV shall receive monthly doses of Sulphadoxine-Pyrimethamine,
except when they are receiving co-trimoxazole.
85

Basic Pharmacology (Steven)

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Basic Pharmacology (Steven)

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BASIC PHARMACOLOGY

MR. ADEBOWALE E. ADEYEMI

 Iron is used in treatment of iron deficiency anemia

 Fluorine has antiseptic properties.

2) From the parenteral route:

Enzymes responsible for metabolism of drugs:

DRUG SAFETY AND EFFECTIVENESS

a) Using age of the child the dose will be

b) Using body weight of the child it will be

30 x 100 = 1 x 100 = 20mg

a) One must know if a drug is eliminated slowly or rapidly

10) Emotional factors. e.g. Placebo response.

DRUG CLASSIFICATION OF ANTI-MALARIALS

Dosage and duration

Weight 200 mg tablet 300 mg tablet

As bisulfate tablets contain a lower concentration of quinine, a higher dose is required:

Artemether and Lumefantrine (Recommended Dosing Regimen)

Artemether (20 mg) + Lumefantrine (120 mg)

Number of Tablets To Be Given

Weight Age Day 1 Day 2 Day 3

< 5 kg < 6 mo Not recommended for patients under 5 kg

Contra-indications, adverse effects, precautions

Dosage and duration

Age Blister pack D1 D2 D3

1 to 6 years 1 tab AS + 1 tab SP 1 tab AS 1 tab AS

7 to 13 years 6 tab AS + 2 tab SP 2 tab AS + 2 tab SP 2 tab AS 2 tab AS

≥ 14 12 tab AS + 3 tab 4 tab AS + 3 tab SP 4 tab AS 4 tab AS

6 tab AS + 3 tab SP 2 tab AS + 3 tab SP 2 tab AS 2 tab AS

Contra-indications, adverse effects, precautions

SULFADOXINE/ PYRIMETHAMINE (SP) (Fansidar®…)

Dosage and duration

Age 2 months to 1 year 1 to 7 years 7 to 13 years 13 years to Adult

500/25 mg 1/2 tab 1 tab 2 tab 3 tab

Contra-indications, adverse effects, precautions

ALBENDAZOLE (Eskazole®, Zentel®…)

MEBENDAZOLE (Pantelmin®, Vermox®, Wormin®...)

PRAZIQUANTEL (Biltricide®, Cysticide®…)

NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS)

Summary of Mg-Al Combination

CONTRAINDICATIONS: Hypersensitivity to the drug, acute asthma, acute alcoholism,

DOSAGE FORMS: Tablets. Syrup in combination products.

ORAL REHYDRATING SALTS (ORS)

Total weight 20.5 Total osmolarity 245

Child and adult:

Age under 4 to 11 12 to 23 2 to 4 years 5 to 14 years 15 years

4 months months Months

Weight under 5 kg 5 to 7.9 kg 8 to 10.9 kg 11 to 15.9 kg 16 to 29.9 kg 30 kg

Contra-indications, adverse effects, precautions

ETHYL ALCOHOL (ETHANOL)

– To obtain 1 litre of 70% v/v ethanol:

ALCOHOL-BASED SOLUTION OR GEL (Manugel®, Manurub®, Sterillium®...)

POLYVIDONE IODINE = POVIDONE IODINE = PVI scrub solution (Videne scrub®,

Contra-indications, adverse effects, precautions

Therapeutic action: Scabicide

Child < 2 years Child 2-12 years Child > 12 years

Contra-indications, adverse effects, precautions

Therapeutics Action; Antipruritic drug

Therapeutic action: Antiseptic

Use – 2 applications/day for a few days

Contra-indications, adverse effects, precautions

EYE EAR AND SKIN PREPARATIONS

INDICATIONS: Trachoma, ocular infections: Treatment of superficial ocular infections

DOSAGE FORM: Drops, ointments and tablets.

RECOMMENDED DOSAGES: Eye-drops: Apply at least every 2 hours; reduce frequency as