Drug # 1: Adrenaline: 1. Generic & Trade Name

Drug # 1: ADRENALINE
1. Generic & Trade Name :

The generic name of Adrenaline is Epinephrine but most of the time it
is also called by this name also
2. Different brands classification:
 It is Adrenergic Agonist.
 It binds to and activates adrenergic receptors in the body.
 These receptors include alpha-adrenergic receptors and beta-adrenergic
receptors, which are found on various tissues and organs throughout the
body.
 Activation of these receptors leads to physiological responses such
as increased heart rate, dilation of airways, and mobilization of
glucose.
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3. Mechanism of Action
4. Indications :
 Adrenaline is the first-line treatment for severe allergic reactions

(anaphylaxis). It helps to reverse the symptoms of anaphylaxis rapidly,
including airway constriction, low blood pressure, and hives.
 Adrenaline is used in managing cardiac arrest as part of advanced cardiac
life support (ACLS) protocols.
 Adrenaline is used as a rescue medication in the treatment of severe
asthma attacks that do not respond adequately to other
bronchodilators.
 Adrenaline may be used in the treatment of severe

bradycardia (slow heart rate) that is causing symptoms such
as dizziness, low blood pressure, or loss of consciousness.
 Adrenaline is often added to local anesthetics to prolong their
effect and reduce bleeding during procedures such as dental
extractions, minor surgeries, and wound closure.
 Adrenaline is sometimes used in ophthalmology to induce
mydriasis (dilation of the pupil) during eye examinations and
certain surgical procedures. It is also used to reduce intraocular
pressure in conditions such as glaucoma.
5. Adverse Drug Reactions
 Tachycardia
 Hypertension
 Arrhythmias
 Severe Headache
 Nervousness & Anxiety
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 Hyperglycemia
6. Contraindications
 It is contraindicated with patients who are already cardiovascularly compromised.

 Adrenaline may induce premature uterine contractions and is
contraindicated in cases of threatened premature labor.
 Individuals with a known hypersensitivity or allergy to adrenaline
or any of its components should not receive adrenaline.
 Adrenaline's vasoconstrictive effects can decrease renal blood flow,
exacerbating renal insufficiency or acute renal failure.
 Adrenaline is contraindicated in individuals with

pheochromocytoma, a rare tumor of the adrenal gland that secretes
excessive catecholamines. Administration of adrenaline in these
individuals can precipitate severe hypertension and hypertensive
crisis.
 Adrenaline can exacerbate hyperthyroidism and thyroid storm due
to its adrenergic effects. Therefore, it should be avoided in
individuals with uncontrolled hyperthyroidism or thyroid storm.
7. Route of Administration, Dosage & Dosage Form
 Adrenaline is administered through the Intramuscular route (IM)

most commonly, but in some cases, it is also administered via the
subcutaneous route (SC).
 The dosage of adrenaline varies based on the indication, the patient's age,
weight, and clinical condition. It's crucial to follow established guidelines
and protocols for dosage determination.
 For adults and adolescents, typical initial doses for anaphylaxis range
from 0.3 to 0.5 mg/kg administered IM or SC.
 In pediatric patients, the dosage is weight-based, usually ranging from 0.01 mg/kg
to 0.3 mg/kg.
 It is available as Parenterals.
8. Pharmacokinetic Profile
 Adrenaline is rapidly absorbed following IM or SC injection, with

peak plasma concentrations typically reached within 5 to 10 minutes.
 Adrenaline distributes widely throughout the body, including to
target tissues such as the heart, lungs, and blood vessels. It
crosses the blood-brain barrier and placenta.
 Adrenaline undergoes extensive metabolism primarily in the liver
and other tissues by the enzyme catechol-O-methyltransferase
(COMT) and monoamine oxidase (MAO). Metabolism converts
adrenaline to inactive metabolites, including metanephrine and
normetanephrine.
 The elimination half-life of adrenaline is relatively short, typically
around 2 to 3 minutes. It is rapidly cleared from the bloodstream
through hepatic metabolism and renal excretion of metabolites.
9. Special considerations:
 Do not administer Adrenaline into the Gluteal region otherwise, it may cause gas
gangrene.
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 Don’t use this drug for diabetic patients.
 Don’t use adrenaline if you’ve already had cardiac problems.
 Use the best possible route with the best possible calculated dose.
Drug # 2: Aminoglycoside
Prototype
 Streptomycin
1. Generic name:
 Streptomycin
2. Trade name:
 Ambistryn-S
3. Mechanism of Action:
Inhibits bacterial protein synthesis by binding to the 30S ribosomal subunit. Disrupts the
initiation complex formation during translation. It also induces misreading of the mRNA,
leading to the synthesis of incorrect proteins.
4. Indications:
Aminoglycosides have a broad spectrum of activity covering aerobic organisms, including

gram-negative bacteria and mycobacteria. It is used in moderate to severe susceptible
infections, including plague, tularemia, and endocarditis. Second-line therapy for gram-
negative bacillary bacteremia, meningitis, pneumonia, brucellosis and UTIs. Historically used
for the treatment of tuberculosis. May be used in combination with other antibiotics for the
treatment of certain bacterial infections.
5. Pharmacokinetic Profile:
Absorption: Poor oral absorption, usually administered parenterally.
Distribution: The volume of distribution of streptomycin ranged from 30-35% body weight,
corresponding to the extracellular fluid volume. Penetrates various body tissues, including the
lungs, kidneys, and cerebrospinal fluid.
Metabolism: Minimal metabolism.
Elimination: Excreted unchanged in the urine.
6. Route of Administration:
Typically administered by intramuscular or intravenous injection.
7. Contraindications:
Hypersensitivity to streptomycin or other aminoglycosides. Concomitant live bacterial
vaccines.
8. Dosage:
Moderate-Severe Infections
 1-2 g/day IM divided every 6-12hr; no more than 2 g/day
Tuberculosis
 Daily therapy: 15 mg/kg IM every day; no more than 1 g/day
 Twice weekly therapy: 25-30 mg/kg IM 2 times/week; no more than 1.5 g/day
Tularemia
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 1-2 g IM in divided doses for 7-10 days or until patient is afebrile for 5-7 days
Plague
 15 mg/kg IM every 12hr for minimum 10 days
Streptococcal Endocarditis
1 g IM every 12hr for 7 days, THEN 500 mg q12hr for 7 days, concomitant with penicillin. If
>60 years old, 500 mg every 12hr for the entire 14 days.
9. Dosage Form:
Streptomycin is available as a powder for injection, which is reconstituted before
administration.
10. ADRs
Ototoxicity:
Streptomycin is known for its potential to cause damage to the inner ear, leading to hearing
loss and vestibular (balance) disturbances. Ototoxicity is usually dose-dependent and may be
irreversible.
Nephrotoxicity:
Streptomycin can affect the kidneys, leading to renal damage. Monitoring kidney function is
important during treatment.
Neuromuscular Blockade:
Streptomycin may interfere with neuromuscular transmission, leading to muscle weakness or
paralysis. This effect is particularly important in patients with pre-existing neuromuscular
disorders.
11. Special instruction
Reconstitution of the Drug:

Streptomycin is typically provided as a powder for injection. It must be reconstituted with the
appropriate diluent before administration. Follow the manufacturer's instructions for
reconstitution, including the type and volume of the diluent.
Slow Intravenous Administration:
If administered intravenously, it should be done slowly to reduce the risk of adverse reactions.
Rapid intravenous administration can increase the risk of ototoxicity and nephrotoxicity.
Allergy Screening:
Before administration, inquire about any history of allergies, especially to aminoglycoside
antibiotics, to prevent allergic reactions.
Drug # 3: Anti Epileptic Drug

1. Generic name: Sodium Valproate
2. Trade name: Epival ( Abbott Laboratories).
3. Classification:
They belong to the class of anti-epileptic drugs known as “valproic acid derivatives” or
“Valproate derivatives.
• Inhibition of voltage-gated sodium channels: VPA obstructs the entry of sodium ions into
neurons, leading to decreased neuron excitability and firing rate. This prevents generating and
propagating abnormal electrical impulses responsible for triggering seizures.
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• Inhibition of gamma-aminobutyric acid (GABA) transaminase: VPA inhibits the function
of the GABA transaminase enzyme, which is responsible for the degradation of GABA. This
process increases the levels and activity of GABA, thereby enhancing the inhibition of neuronal
function and ultimately diminishing the vulnerability to seizures. In cases of neuropathic pain,
VPA has been demonstrated to impede neurogenic inflammation through GABA-A receptor-
mediated inhibition.
• Enhancement of GABA synthesis: VPA stimulates the synthesis of GABA by increasing
the expression and activity of glutamic acid decarboxylase (GAD), the enzyme responsible for
converting glutamate, which is the primary excitatory neurotransmitter in the brain, into
GABA. This process also contributes to the increase in GABA levels and activity. GABA is
synthesized from α-ketoglutarate via the tricarboxylic acid (TCA) cycle and metabolized into
succinate semialdehyde. This intermediate is further transformed into succinate by GABA
transaminase and succinate semialdehyde dehydrogenase, respectively. Prior research has
indicated that VPA inhibits GABA transaminase and succinate semialdehyde dehydrogenase,
thereby elevating GABA concentration by reducing its degradation.
• Inhibition of HDACs: VPA inhibits the action of HDAC enzymes, notably HDAC1, which
are involved in the regulation of gene expression by modifying the acetylation status of
histones, which are proteins that wrap around DNA. This process leads to changes in chromatin
structure, subsequently influencing the transcription of many genes, including those linked to
neuronal plasticity, synaptic transmission, neurogenesis, neuroprotection, and inflammation.
This phenomenon could potentially elucidate a portion of the enduring effects of VPA on
mood, cognition, neurodevelopment, apoptosis, and its potential antitumor properties.
• Modulation of calcium channels: VPA modulates the activity of various calcium channels,
including T-type, L-type, and N-type calcium channels. These channels are essential in
neuronal signalling, neurotransmitter release, gene expression, and cellular survival. The exact
effects of VPA on calcium channels are complex and depend on several factors, such as channel
subtype, location, state, and co-expression with other proteins. Certain studies indicate that
VPA effectively inhibits T-type calcium channels, which have been implicated in absence
seizures and thalamocortical oscillations. Other studies suggest that VPA enhances L-type
calcium channels, which are involved in neuronal plasticity and neuroprotection. VPA may
also affect N-type calcium channels associated with neuropathic pain and migraine.
5. Indications:
• Use as monotherapy or adjunctive therapy in the management of complex
partial seizures and simple or complex absence seizures
• Adjunctive therapy in the management of multiple seizure types that include
absence seizures.
• Prophylaxis of migraine headaches.
• Acute management of mania associated with bipolar disorder.
Off-label uses include:
o Maintenance therapy for bipolar disorder.

o Treatment for acute bipolar depression.
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o Emergency treatment of status epilepticus.
Absorption:
• They are well absorbed after oral administration.

• Peak plasma concentration is usually achieved within 1-4 hours.
• Bioavailability is 90% with all oral formulations but for enteric-coated it is
100%.
Distribution:
• Volume of distribution is 11L/1.73m2 Or 0.1 - 0.41 l/kg
• Protein binding is linear at low concentrations with a free fraction of
approximately 10% at 40 mcg/mL but becomes non-linear at higher concentrations with
a free fraction of 18.5% at 135 mcg/mL. This may be due to binding at separate high
and low-affinity sites on albumin proteins. Binding is expected to decrease in the elderly
and patients with hepatic dysfunction.
Metabolism:
Sodium valproate undergoes extensive hepatic metabolism, primarily through glucuronidation
and mitochondrial β-oxidation. The major metabolite is 2-n-propyl-4-pentenoic acid (2-ene-
VPA). It is also a substrate for cytochrome P450 enzymes, particularly CYP2C9.
Excretion:
 The elimination half-life of sodium valproate is approximately 9 to 18 hours in adults.
 It is primarily eliminated renally as metabolites, with a small portion excreted
unchanged in the urine.
 The elimination half-life may be shorter in children.
7. ADR's:
Adverse drug reactions associated with sodium valproate include:
 Gastrointestinal disturbances (nausea, vomiting, diarrhea)
 Sedation and drowsiness
 Weight gain
 Tremor
 Hair loss
 Hepatotoxicity (elevated liver enzymes, hepatomegaly)
 Pancreatitis
 Teratogenic effects (increased risk of congenital malformations)
 Hyperammonemia
 Thrombocytopenia
 Bone marrow suppression
 Hyperammonemic encephalopathy (especially in patients with urea cycle disorders)
 Hypersensitivity reactions (rash, fever, eosinophilia)

 Behavioural changes (aggression, irritability, agitation)
 Cognitive impairment
 Peripheral edema
 Oral
 Intravenous
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9. Contraindication:
 Hypersensitivity to valproic acid or any components of the formulation.

 Significant hepatic impairment or hepatic disease
 Urea cycle disorders
 Mitochondrial disorders
 Pregnancy, especially in the first trimester
 Breastfeeding
 Porphyria
10. Dosage:
Inj-IV: 500 mg, Syrup 200 mg/5ml, 250 mg/5ml, 500 mg/5ml, Susp: 200 mg/5ml,
Tabs: 125 mg, 200 mg, 250 mg, 500 mg Capsules: 500mg- 1000mg/day
Dosage form:
They are available in the form of:
 Tablets
 Capsules
 Syrups
 Suspension
 Injectable (IV)
11. Special instructions/ Consideration:

 Dosage adjustments may be necessary in patients with hepatic impairment, as sodium
valproate is extensively metabolized in the liver.
 Monitoring of serum concentrations may be required to optimize therapeutic efficacy
and minimize the risk of adverse effects.
 Sodium valproate should be used with caution in patients with liver disease, bleeding
disorder, history of a brain disorder or any allergy.
 It should be used caution while driving motor vehicles or performing tasks that require
alertness.
 Before having surgery, including dental surgery, inform the doctor about the use of
drug.
 Use with caution in HIV, lupus erythrematosus risk of weight gain associated with it.
Drug # 4: Isoniazid
1. Generic name: Isoniazid
2. Trade name: Nydrazid,rifater etc
3. Class
Antimycobacterial antibiotic.
4. Mechanism of action.
Inhibit cell wall synthesis in mycobacterium tuberculosis by interfering with mycolic acid
production.
5. Indications.
 Tuberculosis (TB) in combination with other anti TB drugs.
 prevention of latent TB infection.
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 isoniazid prophylaxis therapy( reduces the risk of TB in HIV
 Positive individuals.
6. Pharmacokinetic
 Absorption.
Isoniazid easily absorbed from GIT. Absorption is decreased with food(fatty substances and
carbohydrates). So it should be taken before meal, optimally on empty stomach.
 Distribution.
Diffuses readily in body tissues, placenta and meningitis.
 Metabolism.
Metabolized by the liver by acetylation.
 Excretion.
Mainly excreted in urine.
7. Route of administration
Normally taken orally but may be administered IM and IV to critically ill patients.
8. Adverse drug reaction(ADRs)
 Hepatotoxicity
 deficiency of vitamin B6
 peripheral neuropathy (nerve damage) due to deficiency of vitamin B6
 anxiety, depression, memory loss, seizures.
 Severe liver disease
 Acute pyridoxine deficiency .
 Hypersensitive to isoniazid
10. Dosage form
Available as tablet ,capsule ,syrups and parentral form.
11. Special consideration.
 Regular liver function monitoring is necessary throughout the treatment. Patient with a
pre existing liver disease or at high risk of hepatotoxicity may require low doses.
 pyridoxine supplement may be recommended to prevent neuropathy.
 Pregnant and breastfeeding should consult with their health care professional before
taking isoniazid.
Drug # 5: ATROPINE
1. Generic name:
Atropine
2. Brand Names:
Atropine is available under various brand names, including Atropen, Atropisol, and Sal-
Tropine, among others.
3. Mechanism of Action: Atropine works as a competitive antagonist of acetylcholine at

muscarinic receptors. By blocking these receptors, it inhibits the parasympathetic
nervous system, leading to effects such as pupil dilation, increased heart rate, and
decreased secretions.
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4. Classification:
Atropine is classified as an anticholinergic agent.
5. Indication:
Atropine is used for various medical purposes, including the treatment of bradycardia,
organophosphate poisoning, and as a pre-anesthetic medication to reduce salivation and
respiratory secretions.
 Absorption: Atropine is well-absorbed after oral administration.

 Distribution: It distributes widely throughout the body, including the central nervous
system.
 Elimination: Atropine is primarily eliminated through renal excretion.
 Metabolism: Atropine undergoes hepatic metabolism.
 Protein Binding: Atropine exhibits moderate protein binding.
 Bioavailability: Oral bioavailability of atropine is variable but generally low due to
extensive first-pass metabolism.
7. Adverse Drug Reactions (ADRs):

Common adverse effects of atropine include dry mouth, blurred vision, urinary retention,
constipation, tachycardia, and confusion, palpitations, arrhythmias.
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Atropine can be administered orally, intravenously, intramuscularly, subcutaneously, or
topically (e.g., ophthalmic solution).
Atropine is contraindicated in individuals with a known hypersensitivity to the drug, glaucoma,
severe tachycardia, and in certain cases of obstructive diseases such as pyloric stenosis and
paralytic ileus.
10. Dosage and Dosage Form:

Dosage and dosage form may vary depending on the indication and route of administration.
Common dosage forms include tablets, injections, and ophthalmic solutions.
11. Special Instructions/Considerations:

Special considerations include monitoring for signs of toxicity, especially in elderly patients,
and caution in patients with underlying cardiac conditions due to the potential for exacerbating
tachycardia.
It's important to note that specific dosages, indications, and contraindications should always be
determined by a healthcare professional based on individual patient characteristics and medical
history.
Drug # 6: BENZODIAZEPINES
DIAZEPAM:
1. Trade Name:
Valium® (first marketed name)
Other names are:
Diastat, Valtoco, Dizac, Calmpose etc
2. Classification:
Diazepam -------> Benzodiazepines
Benzodiazepines --------> depressants known as sedative-hypnotics or anxiolytics
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4. Indications:
 Anxiety Disorders: including generalized anxiety disorder (GAD), panic disorder, and
social anxiety disorder. It helps alleviate feelings of tension, restlessness, and excessive
worry.
 Muscle Spasms: relieving muscle spasms and involuntary muscle contractions
associated with conditions such as muscle strains, sprains
 Seizure Disorders: as an anticonvulsant medication to treat various types of seizures,
including generalized tonic-clonic seizures, absence seizures, and febrile seizures. .
 Alcohol Withdrawal: Diazepam is often prescribed to manage symptoms of alcohol
withdrawal syndrome, including agitation, tremors, hallucinations, and seizures.
 Preoperative Sedation and Anesthesia Adjunct: Diazepam is sometimes used as a
preoperative medication to reduce anxiety and induce sedation before surgical procedures.
It may also be used as an adjunct to anesthesia to enhance muscle relaxation and reduce the
required dosage of anesthetic agents.
 Bioavailability:
 Oral = 90–100% ( 15-60 minutes onset of action )
 Rectal = 90% (5-30 minutes onset of action)
 Nasal = 75–95%
 Intravenous = 97 –100% (1-5 minutes onset of action)
 Intramuscular = slow and incomplete absorption (15-30 minutes onset of action)
 Diazepam readily crosses the blood-brain barrier and is highly protein-bound
 It is highly lipid soluble and widely distributed throughout the body.
 Diazepam is metabolized in the liver by CYP450 enzyme system (CYP3A4 – major
route )
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 Diazepam is excreted by the kidneys
 The half-life of diazepam in general is 30–56 hours.
6. Adverse drug reactions:

 Respiratory distress
 Dependency and abuse
 Loss of control of bodily movements
 Uncontrollable shaking of a part of the body
 Slurred speech
7. Dosage form and dosage:

Diazepam is available in the form of tablets, oral solutions, nasal sprays (valtaco) rectal gels
(diastat) and solutions for intravenous and intramuscular administration.
The dosage of diazepam depends on the indication being treated, the patient’s age, weight, and
medical condition.
For anxiety disorders -- 2 to 10 mg orally, two to four times daily.
For alcohol withdrawal – initial dose may be higher, ranging from 10 to 20 mg orally, followed
by smaller doses as needed.
For muscle spasms -- the typical adult dosage of diazepam is 2 to 10 mg orally, three to four
times daily.
For preoperative sedation -- the typical adult dosage of diazepam is 2 to 10 mg orally, given 1
to 2 hours before the procedure.
8. Routes of administration:
Oral, rectal , nasal , intravenous and intramuscular
 Hypersensitivity
 Myasthenia gravis
 Severe respiratory insufficiency
 Hepatic and renal insufficiency
 Sleep apnea syndrome
 Lactating women
10. Special instructions:

 Avoid alcohol and opiates
 Avoid driving and operating machinery ➢ Do not stop taking diazepam suddenly
without consulting your healthcare provider
Drug # 7: CEPHRADINE
1. Drug generic Name: CEPHRADINE
2. Drug Brand Name: Velosef (GSK), Vericef (Indus pharma), Velora(Platinum)
3. Class: Cephradine belongs to the class of antibiotics known as first-generation

cephalosporins.
4. Mechanism of action:
The mechanism of action (MOA) of cephradine involves inhibiting bacterial cell wall synthesis
by binding to penicillin-binding proteins (PBPs). This action weakens the bacterial cell wall,
leading to cell lysis and eventual death of the bacteria.
5. Indications:
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Cephradine is commonly indicated for the treatment of various bacterial infections, including
respiratory tract infections (such as pneumonia, bronchitis, and sinusitis), skin and soft tissue
infections, urinary tract infections, and certain types of bacterial meningitis. It may also be used
for prophylaxis in certain surgical procedures to prevent postoperative infections.
6. Pharmacokinetics(ADME):
The pharmacokinetics (PK) of cephradine involve absorption, distribution, metabolism, and
elimination processes in the body:
Absorption: Cephradine is usually administered orally and is well absorbed from the
gastrointestinal tract.
Distribution: It distributes widely into body tissues and fluids, achieving therapeutic
concentrations in the urine, respiratory secretions, bile, and synovial, pleural, and peritoneal
fluids.
Metabolism: Cephradine is primarily eliminated unchanged by the kidneys via glomerular
filtration and tubular secretion. It undergoes minimal metabolism in the liver.
Elimination: The elimination half-life of cephradine is relatively short, usually around 0.5 to
1 hour in adults with normal renal function. However, this may vary depending on factors such
as renal function and dosing frequency.
7. Adverse Drug Reactions:

 Gastrointestinal disturbances (nausea, vomiting, diarrhea, abdominal pain)
 Allergic reactions (rash, anaphylaxis)
 Pseudomembranous colitis
 Hematologic effects (eosinophilia, leukopenia, thrombocytopenia, hemolytic anemia)
 Renal impairment/nephrotoxicity
 Liver dysfunction
 Neurological effects (headaches, dizziness, seizures)
Cephradine can be administered via several routes :
 Oral: Cephradine is commonly available in oral dosage forms such as capsules or
tablets, which are taken by mouth.
 Intramuscular (IM) injection: Cephradine can be administered via injection into a
muscle, usually done by a healthcare professional.
 Intravenous (IV) injection: In certain situations, cephradine may be administered
directly into a vein, typically in a hospital or clinical setting.
The choice of route depends on factors such as the severity of the infection, patient's condition,
and healthcare provider's preference.
9. Dosage form and dosage
Cephradine is available in various dosage forms, including:
 Capsules: These are solid oral dosage forms containing cephradine powder enclosed in
a gelatin shell.
 Tablets: Similar to capsules, tablets contain cephradine in solid form but are
compressed into a solid dosage form without a gelatin shell.
 Powder for oral suspension: This form consists of cephradine powder, which is
reconstituted with water to form a liquid suspension for oral administration, often used
for pediatric patients or those who have difficulty swallowing tablets or capsules.
 Injection: Cephradine is available in sterile powder form for reconstitution and
administration via intramuscular or intravenous injection.
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The dosage of cephradine can vary depending on factors such as the type and severity of the
infection, patient age and weight, renal function, and other individual considerations. However,
typical dosages for adults with normal renal function are as follows:
 For mild to moderate infections:
 Oral: 250 mg to 500 mg every 6 to 12 hours.
 For severe infections or those caused by less susceptible organisms:
 Oral: 500 mg to 1 gram every 6 to 12 hours.
 For intramuscular or intravenous administration:
 500 mg to 1 gram every 6 to 12 hours.
 Dosage adjustments may be necessary in patients with impaired renal function to avoid
accumulation of the drug and potential toxicity.
10. Contraindications :
Cephradine is contraindicated in individuals with a known hypersensitivity to cephalosporin

antibiotics or any component of the formulation. Additionally, it should be used with caution
or avoided in patients with a history of severe allergic reactions (including anaphylaxis) to
penicillins or other beta-lactam antibiotics due to the potential for cross-reactivity.
Furthermore, cephradine should not be used in patients with a history of severe renal
impairment or significant renal dysfunction, as dosage adjustments may be required, and
accumulation of the drug can occur.
Special considerations for while using cephradine :
 Allergy: Assess patient history for hypersensitivity to cephalosporins or penicillins, as

cross-reactivity may occur.
 Renal impairment: Adjust dosage in patients with renal dysfunction to prevent drug
accumulation and toxicity.
 Superinfection: Monitor for signs of superinfection, especially with prolonged use, and
consider appropriate management.
 Pseudomembranous colitis: Be vigilant for symptoms of pseudomembranous colitis,
such as severe diarrhea, and discontinue cephradine if suspected.
 Injection site reactions: Monitor for local reactions such as pain or inflammation at
injection sites with intramuscular administration.
 Pediatric use: Adjust dosage based on age, weight, and severity of infection in
pediatric patients.
 Elderly patients: Use caution in elderly patients and consider renal function and
potential drug interactions.
Drug # 8: Chlorpheniramine
1. Brand name
Chlor-Trimeton, Demazin, Allerest 12 Hour, Piriton, Chlorphen-12, Tylenol Cold/Allergy.
2. Generic name
Chlorpheniramine maleate
3. Class
Chlorpheniramine is in a class of medications called antihistamines first-generation H1
4. Mechanism of action
The mechanism of action of chlorpheniramine is as a Histamine H1 Receptor Antagonist.
Chlorpheniramine binds to the histamine H1 receptor. This blocks the action of endogenous
histamine, which subsequently leads to temporary relief of the negative symptoms brought on
by histamine.
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5. Indication
histamine H1 antagonist used in
 allergic reactions
 hay fever
 rhinitis
 urticaria, and
 asthma.
6. Pharmacokinetics
 Absorption
 Well absorbed in the gastrointestinal tract.
 Volume of distribution
 Not Available
 Protein binding
 72%
 Metabolism
 Primarily hepatic via Cytochrome P450 (CYP450) enzymes.
 Route of elimination
 Not Available
 Half-life
 21-27 hours
 Clearance
 Not Available
7. ADRs (adverse drug reaction)
 Drowsiness
 Dizziness
 Constipation
 stomach upset
 blurred vision or dry mouth/nose/throat may occur.
8. Route of administration
Oral
Injectable
The injection may be given by the subcutaneous, intramuscular or intravenous route.
Interactions
Hypersensitivity to chlorpheniramine or any component of the formulation, narrow-angle
glaucoma, bladder neck obstruction, symptomatic prostate hypertrophy, during acute asthmatic
attacks, stenosing peptic ulcer, pyloroduodenal obstruction. Avoid use in premature and term
new-borns due to possible association with SIDS.
9. Dosage Forms & Strengths
Adult
Tablet
 4mg
 8mg
 12mg
Syrup
 2mg/5mL
Allergic Rhinitis
Tablets or syrup: 4 mg PO q4-6hr; not to exceed 24 mg/day
Extended-release tablets: 8 mg PO q8-12hr or 12 mg q12hr; not to exceed 24 mg/day
Extended-release capsules: 12 mg PO qDay; not to exceed 24 mg/day
Sustained-release capsules: 8-12 mg PO q8-12hr, up to 16-24 mg/day
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Pediatric
Tablet
 4mg
 8mg
 12mg
Suspension
 2mg/mL
Syrup
 2mg/5mL
Allergic Rhinitis
<2 years: Safety & efficacy not established
2-6 years: 1 mg PO q4-6hr; not to exceed 6 mg/day
6-12 years: 2 mg PO q4-6hr; not to exceed 12 mg/day or sustained release HS
>12 years
Tablets or syrup: 4 mg PO q4-6hr; not to exceed 24 mg/day
Extended-release tablets: 8 mg PO q8-12hr or 12 mg q12hr; not to exceed 24 mg/day
Extended-release capsules: 12 mg PO qDay; not to exceed 24 mg/day
Sustained-release capsules: 8-12 mg PO q8-12hr, up to 16-24 mg/day
10. Special consideration

 Chlorphenamine is unlikely to do you any harm but it's best to only take it when you
need it. Do not take for longer than 2 weeks without speaking to your doctor.
Drug # 9: Cimetidine
1. Generic Name: cimetidine (HCL)
2. Trade name : Tagamet HB ®
3. Class of drug: Cimetidine belongs to the class of drugs called H2 Blockers
4. Mechanism of Action: The H2-receptor antagonist cimetidine competitively blocks

histamine from stimulating the H2-receptors located on the gastric parietal cells (these cells are
responsible for hydrochloric acid secretion and secretion of the intrinsic factor).
➢ Indications : Cimetidine is indicated to reduce gastric acid secretion and to treat the
following
A. Duodenal ulcers, non-malignant gastric ulcers
B. gastroesophageal reflux disease
C. pathological hyper secretion associated with Zollinger-Ellison Syndrome
D. systemic mastocytosis
E. multiple endocrine adenomas
F. It is indicated for prophylaxis of recurrent gastric or duodenal ulcers G. Adjunctive therapy

in the management of cystic fibrosis in children
G. to treat NSAID-induced lesions and gastrointestinal symptoms
5. Pharmacokinetics of cimetidine :
17
Bioavailability 60 to 70 %
Protein Binding 13 to 25 %
Metabolism: liver
Metabolites: cimetidine sulfoxide, hydroxy cimetidine, Guanyl urea cimetidine
On set of action: 30 minutes
 Elimination half-life: 2 hours
 Duration of action: 4 to 8 hours
 Excretion: urine
6. Adverse Drug reactions :

 Headache
 Dizziness
 Diarrhea
 Drowsiness
 Agitation
 Confusion
 Depression
 Hallucinations
 Joint pain
 Brest swelling
 Decrease sexual ability
 Blood in cough
 Trouble breathing
 Liver problems
 Dark urine
 Kidney problems
 Yellow eyes / skin
7. Route of administration: cimetidine can be administered:
Orally : Tablets and suspension
Parenterally : IV injection
8. Contraindications: Cimetidine is contraindicated for patients known to have

hypersensitivity to the product.
9. Dosage:
Adult dose : 400mg per 12 hours oral
Neonatal dose : 20 mg / kg oral
Paediatric dose : 20 to 30 mg per kg oral
10. Dosage Form :
Tablets Syrups
18
Take with food. Food increases bioavailability.
For prophylaxis of gastric symptoms, take cimetidine 30-60minutes prior to food
administration.
Drug # 10: DIGOXIN

Digoxin is a cardiac glycoside used in the treatment of mild to moderate heart failure and for
ventricular response rate control in chronic atrial fibrillation.
1. Trade name: Linoxin.
2. Generic name: Digoxin.
3. Class: Digitalis Glycosides.
Digoxin exerts hemodynamic, electrophysiologic, and neurohormonal effects on the
cardiovascular system. It reversibly inhibits the Na-K ATPase enzyme, leading to various
beneficial effects. The Na-K ATPase enzyme functions to maintain the intracellular
environment by regulating the entry and exit of sodium, potassium, and calcium (indirectly).
Na-K ATPase is also known as the sodium pump. The inhibition of the sodium pump by
digoxin increases intracellular sodium and increases the calcium level in the myocardial cells,
causing an increased contractile force of the heart. This improves the left ventricular ejection
fraction (EF), an important measure of cardiac function.
Digoxin also stimulates the parasympathetic nervous system via the vagus nerve leading to
sinoatrial (SA) and atrioventricular (AV) node effects, decreasing the heart rate. Part of the
pathophysiology of heart failure includes neurohormonal activation, leading to an increase in
norepinephrine. Digoxin helps to decrease norepinephrine levels through activation of the
parasympathetic nervous system.
5. Indications:
 Use for the treatment of mild to moderate heart failure in adult patients.
 To increase myocardial contraction in children diagnosed with heart failure.
 To maintain control ventricular rate in adult patients diagnosed with chronic atrial
fibrillation.
6. Pharmacokinetic:
Bioavailbility:
19
Digoxin is approximately 70-80% absorbed in the first part of the small bowel. The
bioavailability of an oral dose varies from 50-90%, however, oral gelatinized capsules of
digoxin are reported to have a bioavailability of 100%.
Protein binding:
Digoxin protein binding is approximately 25%. It is mainly bound to albumin.
Half life:
Digoxin has a half-life of 1.5-2 days in healthy subjects. The half-life in patients who do
not pass urine, usually due to renal failure, is prolonged to 3.5-5 days.
Clearance:
The clearance of digoxin closely correlates to creatinine clearance, and does not depend on
urinary flow. Individuals with renal impairment or failure may exhibit extensively
prolonged half-lives. It is therefore important to titrate the dose accordingly and regularly
monitor serum digoxin levels. One pharmacokinetic study measured the mean body
clearance of intravenous digoxin to be 88 ± 44ml/min/l.73 m². Another study provided
mean clearance values of 53 ml/min/1.73 m² in men aged 73-81 and 83 ml/min/1.73 m² in
men aged 20-33 years old after an intravenous digoxin dose.
7. Adverse drug reactions:
 Digoxin toxicity ; confusion, loss of appetite, nausea, vomiting, diarrhea, change in
vision such as blurry or yellow vision, fatigue, fast or irregular heartbeat.
 Slow heartbeat—dizziness, feeling faint or lightheaded, confusion, trouble
breathing, unusual weakness or fatigue.
 Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or
throat.
8. Route of administration:
 ORAL
 IV/IM
9. Contra indications:
 Acute myocardial infarction.
 Hypersensitivity to the drug.
 Ventricular fibrillation.
 Myocarditis.
 Hypomagnesemia.
 Hypokalemia.
 Wolf-Parkinson-White syndrome.
10. Dosage:
Oral/Tablet dosage: 0.25 mg
20
IV/IM Dosage: 250mcg/ml
11. Special contraindication of Digoxin:

 POISON
Drug # 11: Dobutamine

Name of the drug:
1. Generic Name: Dobutamine
2. Trade Name: Dobutrex
3. Class of drug:
Sympathomimetic (beta-1 agonist)
Dobutamine directly stimulates beta- adrenergic receptors and is generally considered a
selective Beta-1 adrenergic agonist. Dobutamine also has mild beta-2 and alpha-1 adrenergic
receptor agonist effect.
Beta 1 receptor:
 It directly bind and stimulates beta-1 adrenergic receptor
 Stimulation of adenyl cyclase activity
 Conversion of ATP to cAMP
 Activation of protein kinase A
 Phosphorylation of intracellular proteins
 Increased calcium influx
 Enhanced myocardial contraction
 Increased stroke volume
Alpha-1 receptor:
 Stimulation of alpha-1 receptor on smooth muscle cells
 Activation of G protein
 Activation of PLC enzyme
 Cleavage of PIP2 into IP3 and DAG
 Release of Calcium
 Smooth muscle contraction
Beta-2 receptor:
 Stimulation of beta 2 receptor on smooth muscle cell
 Activation of adenylate Cyclase
 Increased of cAMP
 Activation of protein kinase A
21
 Relaxation of smooth muscle
5. Indication:
 Inotropic support
 Cardiac failure
 Open heart surgery
 Cardiac stress testing
 Atrial fibrillation
 Phaeochromocytoma
 Ventricular arrhythmia
 Hypersensitivity to dobutamine
7. Pharmacokinetic Parameters:
 Onset of action is 2 min
 Peak plasma conc of drug is 10 min after initiation of an IV infusion
 Methylation and conjugation
 Half life: 1-2 min
 Excretion mainly through urine
8. Adverse drug reaction:

 Headache
 Tremor
 Restlessness
 Feeling of anxiety
 Hypokalaemia
 Vasoconstriction
 Tachycardia
 Anginal pain
For IV use only
Because of its shorter half life it is administered as continuous IV infusion
10. Dosage :
 Initial dose: 0.5 to 1 mcg/kg/min
 Maintenance dose: 2 to 20 mcg/kg/min
22
11. Dosage form:
12. Special instruction:
 Titration and Monitoring:

 Dobutamine infusion should be titrated carefully based on the patient’s hemodynamic
response. Continuous monitoring of vital signs, cardiac output, and electrocardiogram
 Dosage adjustment:
 Dosage adjustment may be necessary in patients with hepatic or renal impairment to
prevent drug accumulation.
 Lower doses are often recommended in elderly patients or those with compromised
cardiac function.
Drug # 12: DOPAMINE

1. Generic Name: Dopamine
2. Brand Name:Intropin,Dopastat, andRevimine
3. Class: Catecholamine Neurotransmitter
At low doses it acts through the sympathetic nervous system to increase heart muscle
contraction force and heart rate, thereby increasing cardiac output and blood pressure. Higher
doses also cause vasoconstriction that further increases blood pressure.
5. Indication/Uses: Dopamine is a peripheral vasostimulant used to treat
 low blood pressure,
 low heart rate,
 and cardiac arrest.
 Low infusion rates (0.5 to 2 micrograms/kg per minute) act on the visceral vasculature
to produce vasodilation, including the kidneys, resulting in increased urinary flow.
6. Pharmacokinetic (ADME):
Absorption: Dopamine is typically administered intravenously because oral administration is

ineffective due to extensive first-pass metabolism in the liver. When given intravenously,
dopamine enters the bloodstream directly and quickly reaches its target receptors in the body.
23
Distribution: Once in the bloodstream, dopamine is distributed throughout the body, crossing
the blood-brain barrier to reach the central nervous system (CNS). It has a short half-life
meaning it is rapidly metabolized and eliminated from the body. Dopamine does not readily
cross the blood-brain barrier when administered peripherally, so its effects on the CNS are
primarily due to the endogenous dopamine produced by the brain.
Metabolism: Dopamine is primarily metabolized by two enzymes: monoamine oxidase

(MAO) and catechol-O-methyltransferase (COMT). These enzymes break down dopamine into
inactive metabolites, including homovanillic acid (HVA) and dihydroxyphenylacetic acid
(DOPAC), which are excreted in the urine.
Excretion: Dopamine and its metabolites are mainly excreted through the kidneys via urine.
The rate of excretion depends on various factors, including kidney function and urine pH.
Bioavailability: The absolute bioavailability of DA after oral administration was calculated to

be approximately 3%. Intraduodenal and mesenteric venous administration of DA revealed that
DA-SO4 was mainly produced in the intestine and DOPAC was produced in the intestine and
liver.
Half Life: Dopamine's onset of action occurs within five minutes of intravenous
administration, and with dopamine's plasma half-life of about two minutes, the duration of
action is less than ten minutes. However, if monoamine oxidase (MAO) inhibitors are present,
the duration may increase to one hour.

• chest pain
• fast, slow, or pounding heartbeats
• shortness of breath
• cold feeling, numbness, or blue-colored appearance in your hands or feet
Dopamine HCl Injection is administered (only after dilution) by intravenous infusion.
Dopamine should not be used in patients with pheochromocytoma, in patients with uncorrected
tachyarrhythmias or ventricular fibrillation.
10. Dosage and Dosage form:
Dosage Forms & Strengths

infusion solution, in D5W
• 80mg/100mL
• 160mg/100mL
• 320mg/100mL
injectable solution
• 40mg/mL
• 80mg/mL
• 160mg/mL
•
11. Special Consideration:

Dopamine may interact with triperidol, epinephrine, haloperidol, midodrine, phenytoin,
vasopressin, diuretics (water pills), antidepressants, beta blockers, cough or cold medicine that
contains antihistamines or decongestants, ergot medicines, phenothiazines. Tell your doctor all
medications and supplements you use.
24
Drug # 13: Floroquinolone
1. Generic name:- Ciprofloxacin
2. Trade name:- cipro,proquin Xr
3. Class:-
Fluoroquinolones are a class of antibiotics to which moxifloxacin belongs. They are often used
to treat bacterial infections by inhibiting the bacterial DNA gyrase enzyme.
4. Mechanism of action:- (MOA)

The mechanism of action of fluoroquinolones, including moxifloxacin, involves inhibiting
bacterial DNA gyrase and topoisomerase IV enzymes. By targeting these enzymes,
fluoroquinolones interfere with the replication, transcription, and repair of bacterial DNA,
ultimately leading to bacterial cell death.
5. Indications:-
Moxifloxacin, a fluoroquinolone, is commonly indicated for treating various bacterial
infections such as respiratory tract infections, skin and soft tissue infections, and intra-
abdominal infections. It may also be used to treat certain types of eye infections when
formulated as an ophthalmic solution. However, specific indications can vary.
6. Pharmacokinetics:-
Moxifloxacin is well absorbed orally and reaches peak plasma concentrations within a few
hours after administration. It has good tissue penetration, allowing it to distribute effectively
into various body tissues and fluids.
Metabolism of moxifloxacin is primarily hepatic, with a significant portion of the drug excreted
unchanged in the urine. The elimination half-life is approximately 12 hours, contributing to a
once-daily dosing regimen for some indications.
The duration of action can vary depending on the specific condition being treated, but the
sustained levels of moxifloxacin in the body contribute to its efficacy with once-daily dosing
in many cases.
7. Adverse drug reactions (ADRs):-
Moxifloxacin, like other Fluoroquinolones, may be associated with various adverse drug
reactions (ADRs). Common ADRs include gastrointestinal symptoms such as nausea and
diarrhea, as well as central nervous system effects like dizziness and headache.
Serious ADRs may include tendonitis or tendon rupture, especially in older adults. There may
also be an increased risk of Clostridium difficile-associated diarrhea.
8. Route of administration:-
25
It's typically taken orally in tablet form, but it can also be administered intravenously.
9. Contraindications:-
Contraindications for moxifloxacin include a history of hypersensitivity or allergic reactions to

moxifloxacin or other quinolone antibiotics. It is generally not recommended for use in
individuals with a known sensitivity to fluoroquinolones.
Caution is advised in patients with a history of tendon disorders or issues, as fluoroquinolones,
including moxifloxacin, may increase the risk of tendonitis or tendon rupture.
10. Dosage form:
The dosage of moxifloxacin can vary based on the specific infection being treated, the severity
of the condition, and individual patient factors. Standard dosages often range from 400 mg to
800 mg once daily, either orally or intravenously.
11. Special consideration:-

Special considerations for moxifloxacin use include:
 **Renal Impairment:** Adjustments may be necessary in patients with renal
impairment, as moxifloxacin is eliminated, in part, through the kidneys.
 **Tendon Disorders:** Exercise caution in individuals with a history of tendon

disorders or those taking corticosteroids, as fluoroquinolones, including moxifloxacin,
may increase the risk of tendonitis or tendon rupture.
 **CNS Effects:** Be vigilant for central nervous system effects such as dizziness or
lightheadedness, especially in elderly patients, as moxifloxacin may cause these
symptoms.
 **Pregnancy and Lactation:** Moxifloxacin is generally not recommended during

pregnancy or lactation unless the benefits outweigh the risks. Consultation with a
healthcare provider is essential in these situations.
 **Hypersensitivity:** Patients with a known hypersensitivity or allergic reaction to

moxifloxacin or other quinolone antibiotics should avoid its use.
Drug # 14: Furosemide

1. Drug Profile: Furosemide is a loop diuretic used to treat edema (fluid retention) and
hypertension (high blood pressure). It works by inhibiting the reabsorption of sodium
and chloride ions in the ascending loop of Henle in the kidneys, leading to increased
excretion of water and electrolytes.
2. Generic Name, Trade Name:
 Generic Name: Furosemide
26
 Trade Name: Lasix, Basix, Duride etc.
3. Classification:
 Furosemide belongs to a class of medications known as loop diuretics. Diuretics
are drugs that promote diuresis, which is the increased production of urine. Loop
diuretics specifically act on the loop of Henle, a part of the nephron in the
kidneys, to inhibit the reabsorption of sodium and chloride ions.
 The loop of Henle is responsible for reabsorbing a significant portion of filtered

sodium and chloride ions from the urine. By inhibiting the sodium-potassium-
chloride symporter in the thick ascending limb of the loop of Henle, loop
diuretics like Furosemide prevent the reabsorption of these ions back into the
bloodstream. This action disrupts the osmotic gradient necessary for water
reabsorption, leading to increased excretion of water and electrolytes in the
urine.
4. MOA
 Mechanism of Action: Furosemide acts primarily on the thick ascending limb
of the loop of Henle to inhibit sodium and chloride reabsorption. This results in
increased urine volume and decreased fluid retention.
 Potency: Loop diuretics are among the most potent diuretics available for
clinical use. Furosemide is particularly potent and is often used in cases where
significant diuresis is required, such as in congestive heart failure and severe
edema.
 Duration of Action: Furosemide has a relatively short duration of action
compared to other diuretics, requiring multiple daily doses for sustained diuretic
effect.
 Clinical Uses: Loop diuretics like Furosemide are commonly used in the
management of conditions characterized by fluid overload, such as congestive
heart failure, cirrhosis of the liver, renal failure, and pulmonary edema. They are
also used to manage hypertension, either alone or in combination with other
antihypertensive agents.
 Potassium Depletion: Loop diuretics can lead to significant potassium loss in
the urine, which may result in hypokalemia. Therefore, patients taking loop
diuretics may require supplementation with potassium or potassium-sparing
diuretics to prevent electrolyte imbalances.
5. Indication:
 Edema associated with congestive heart failure
 cirrhosis of the live
 renal disease
27
 Hypertension, either alone or in combination with other antihypertensive agents.
6. PK Profile (ADME):
 Absorption: Furosemide is well-absorbed orally, with peak plasma
concentrations occurring within 1-2 hours.
 Distribution: It is distributed throughout the body, including the kidneys.
 Metabolism: Furosemide undergoes minimal hepatic metabolism.
 Excretion: The majority of the drug is excreted unchanged in the urine.
 Furosemide is commonly administered orally, but it can also be given
intravenously for rapid diuresis.
 Hypersensitivity to Furosemide or any component of the formulation.
 Anuria (lack of urine production).
 Severe electrolyte depletion.
 Electrolyte imbalances (hypokalemia, hyponatremia)
 Dehydration
 Hypotension
 Dizziness
 Ototoxicity (especially with rapid intravenous administration)
10. Dose and Dosage Form:
 The dosage of Furosemide depends on the patient's condition and response to
therapy.
 Typical doses range from 20 mg to 80 mg orally, once or twice daily.
 Dosage forms include tablets and oral solutions for oral administration, and
injectable solutions for intravenous use.
11. Special Instruction Considerations:
 Patients taking Furosemide should be monitored regularly for electrolyte levels,
renal function, and blood pressure.
 It should be used cautiously in patients with hepatic impairment, as it may
exacerbate hepatic encephalopathy.
 Patients should be advised to take the medication early in the day to prevent
nocturia.
 In cases of intravenous administration, it should be given slowly to minimize
the risk of ototoxicity and hypotension.
28
Drug # 15: Lactulose
1. Generic Name: Lactulose
2. Trade Name: Duphalac, Constilac, Enulose
3. Classification: Laxative, Osmotic laxative
Lactulose is a synthetic disaccharide that is not absorbed in the small intestine. It passes into
the colon where it is broken down by bacteria into organic acids, primarily lactic acid and acetic
acid. This acidification of the colonic contents leads to an increase in osmotic pressure, which
draws water into the colon and softens the stool. Additionally, the acidic environment inhibits
the growth of ammonia-producing bacteria, making lactulose useful in the treatment of hepatic
encephalopathy.
5. Indications:
Lactulose is indicated for the treatment of constipation, particularly in patients with chronic
constipation or opioid-induced constipation. It is also used in the management of hepatic
encephalopathy to reduce serum ammonia levels.
Lactulose is contraindicated in patients with galactosemia, intestinal obstruction, or a history
of hypersensitivity to lactulose.
Lactulose is minimally absorbed from the gastrointestinal tract, with less than 3% of the dose
being absorbed. It undergoes bacterial fermentation in the colon, leading to its pharmacological
effects.
8. Adverse Reactions:
Common adverse reactions include flatulence, abdominal discomfort, cramps, and diarrhea.
Prolonged use or excessive dosage may lead to electrolyte imbalance and dehydration.
Lactulose is administered orally.
10. Dosage:
Children: The dosage for children varies depending on age and weight, typically ranging from
2.5 to 15 mL daily, divided into two or three doses.
Adults: The initial dosage for adults is usually 15 to 30 mL daily, adjusted based on individual
response. Maintenance doses may range from 15 to 60 mL daily.
11. Dosage Form:
Lactulose is available as an oral solution and oral powder for reconstitution.
12. Special Instructions:
Patients should be advised to drink plenty of fluids while taking lactulose to prevent
dehydration. It may take up to 48 hours for lactulose to produce a laxative effect, so patients
should not increase the dosage prematurely. Additionally, in patients with hepatic
encephalopathy, serum ammonia levels should be monitored regularly during treatment.
29
Drug # 16: Macrolides
Macrolides constitute a class of antibiotics distinguished by a macrocyclic lactone ring,
exhibiting a diverse spectrum of antimicrobial activity. Renowned for their efficacy,
tolerability, and broad-spectrum coverage against Gram-positive and select Gram-negative
bacteria, macrolides serve as cornerstone agents in the treatment of various bacterial infections.
This comprehensive exposition delves into the pharmacology, mechanism of action, spectrum
of activity, clinical applications, adverse effects, and notable examples of macrolide antibiotics.
1. Generic and Trade Name:

Generic Name: Macrolides
Trade Names: Examples include Erythromycin, Azithromycin, Clarithromycin
2. Classification:
Macrolides belong to a class of antibiotics characterized by a macrocyclic lactone ring.
Macrolides inhibit bacterial protein synthesis by reversibly binding to the 50S ribosomal
subunit of susceptible organisms. This impedes the translocation of peptidyl-tRNA, leading to
the inhibition of bacterial growth and reproduction. Macrolides exert a bacteriostatic effect.
4. Indication:
Macrolides are indicated for the treatment of various bacterial infections, including respiratory
tract infections (such as pneumonia and bronchitis), skin and soft tissue infections, sexually
transmitted infections (e.g., Chlamydia trachomatis), and infections caused by intracellular
pathogens (e.g., Mycoplasma pneumoniae).
Route of Administration: Oral, intravenous, or topical.
Absorption: Well-absorbed in the gastrointestinal tract.
Distribution: Attain therapeutic concentrations in various body tissues, including the
respiratory tract, skin, and soft tissues.
Metabolism: Metabolized in the liver.
Excretion: Excreted primarily via bile and feces.
Gastrointestinal Disturbances: Nausea, vomiting, diarrhea, abdominal discomfort.
Cardiac Effects: Prolongation of QT interval (especially with erythromycin).
30
Hepatotoxicity: Rare cases of reversible hepatotoxicity, with elevated liver enzymes and
hepatitis.
Allergic Reactions: Rash, urticaria, anaphylaxis.
Drug Interactions: Interaction with drugs metabolized by the cytochrome P450 system,
leading to altered drug levels and potential toxicity or decreased efficacy.
Oral, intravenous, or topical administration depending on the specific macrolide and the
indication.
Hypersensitivity to macrolides or any component of the formulation.
History of QT prolongation or ventricular arrhythmias.
Concomitant use with certain medications metabolized by the cytochrome P450 system.
9. Dosage:
Dosage varies depending on the specific macrolide, the severity of the infection, and patient
factors such as age and renal function.
10. Special Instructions/Considerations:
Monitor liver function tests periodically during therapy.
Use with caution in patients with known QT prolongation or risk factors for arrhythmias.
Assess for potential drug interactions, especially with other medications metabolized by the
cytochrome P450 system.
11. Dosage Form:
Macrolides are available in various dosage forms, including tablets, capsules, oral suspensions,
intravenous solutions, and topical formulations.
Notable Examples of Macrolides:
Erythromycin: Effective against Gram-positive and some Gram-negative bacteria, commonly
used for respiratory tract infections, skin and soft tissue infections, and certain sexually
transmitted infections.
Azithromycin: Broad-spectrum macrolide with a long half-life, used for respiratory tract
infections, including atypical pneumonia, and genital infections caused by Chlamydia
trachomatis.
Clarithromycin: Semi-synthetic macrolide with enhanced activity against Gram-negative
bacteria compared to erythromycin, frequently used for respiratory tract infections,
Helicobacter pylori eradication therapy, and skin and soft tissue infections.
31
Drug # 17: Metoclopramide
Metoclopramide is an antiemetic agent and dopamine D2 antagonist used in the treatment of
gastro esophageal reflux disease, prevention of nausea and vomiting, and to stimulate gastric
emptying.
1. Brand Name:
 Maxolon
 Clopra syrup
 Generic Name:
 Metoclopramide
2. Class of Drug:
D2 receptor antagonist; 5-HT3 receptor antagonist; 5-HT4 receptor agonist; Prolactin releaser
metoclopramide causes antiemetic effects by inhibiting dopamine D2 and serotonin 5-HT3
receptors in the chemoreceptor trigger zone (CTZ) located in the area postrema of the brain.
Administration of this drug leads to prokinetic effects via inhibitory actions on presynaptic and
postsynaptic D2 receptors, agonism of serotonin 5-HT4 receptors, and antagonism of
muscarinic receptor inhibition. This action enhances the release of acetylcholine, causing
increased lower esophageal sphincter (LES) and gastric tone, accelerating gastric emptying and
transit through the gut. Metoclopramide antagonizes the dopamine D2 receptors. Dopamine
exerts a relaxant effect on the gastrointestinal tract through binding to muscular D2 receptors.
4. Indications:
The FDA has approved metoclopramide to treat nausea and vomiting in patients with
gastroesophageal reflux disease (in patients who fail to respond to established therapy) and
diabetic gastroparesis by increasing gastric motility. Parenteral metoclopramide is also FDA-
approved to control nausea and vomiting in chemotherapy patients.
Metoclopramide is used off-label prophylactically to prevent nausea and vomiting in
postoperative patients when nasogastric suction is contraindicated or unavailable.
Metoclopramide is also used off-label to treat acute migraine in the emergency department.
5. Pharmacokinetics of Drug:
 Absorption
 Metoclopramide is rapidly absorbed in the gastrointestinal tract with an absorption rate
of about 84%.
 The bioavailability of the oral preparation is reported to be about 40.7%, but can range
from 30-100%.
 Nasal metoclopramide is 47% bioavailable. A 15mg dose reaches a Cmax of 41.0
ng/mL, with a Tmax of 1.25 h, and an AUC of 367 ng*h/mL.
 Distribution:
 Volume of distribution is approx 3.5L/kg. It is 30% bound to the plasma protein, mainly
to alpha 1-acid glycoprotein.
 Metabolism
 Metoclopramide undergoes first-pass metabolism and its metabolism varies according
to the individual. This drug is metabolized by cytochrome P450 enzymes in the liver.
CYP2D6 and CYP3A4 both contribute to its metabolism, with CYP2D6 being more
heavily involved. CYP1A2 is also a minor contributing enzyme. The process of N-4
sulfate conjugation is a primary metabolic pathway of metoclopramide.
 Elimination
 About 85% of an orally administered dose was measured in the urine within 72 hours
during a pharmacokinetic study. An average of 18% to 22% of 10-20 mg dose was
recovered as a free drug within 3 days of administration.
6. ADRs:
32
Common adverse drug reactions (ADRs) associated with metoclopramide therapy includes
restlessness (akathisia), and focal dystonia. Infrequent ADRs include hypertension,
hypotension, hyperprolactinemia leading to galactorrhea, headache, and extrapyramidal effects
such as oculogyric crisis.
Oral:
 Syrup
 Tablets
Injection
 IV administration
 IM administration
 IntrNasal Administration
Metoclopramide is contraindicated in patients with the following:
 Known hypersensitivity to metoclopramide or excipients
 Gastrointestinal bleeding
 Obstruction
 Perforation
 Other contraindications include the following:
 Pheochromocytoma
 Seizures
 Depression
 Parkinson disease
9. Dosage form:
Injectable solution
• 5 mg/mL
Syrup
• 5 mg /5 mL
Tablet
• 5 mg
• 10 mg
Dispersible tablets
• 5 mg
• 10 mg
10. Dosage:
For oral dosage forms (solution or tablets)
For diabetic gastroparesis:
 Adults—At first, 10 milligrams (mg) four times a day, taken 30 minutes before each
meal and at bedtime for 2 to 8 weeks. Your doctor may adjust your dose as needed.
However, the dose is usually not more than 40 mg.
 Children—Use and dose must be determined by your doctor.
For gastroesophageal reflux disease (GERD):
 Adults—At first, 10 to 15 milligrams (mg) four times a day, taken 30 minutes before
symptoms are likely to begin or before each meal and at bedtime, for 4 to 12 weeks.
Your doctor may adjust your dose as needed. However, the dose is usually not more
than 60 mg perday.
 Children—Use and dose must be determined by your doctor.
Usual Adult Dose for Small Intestine Intubation:

If the tube has not passed the pylorus with conventional methods in 10 minutes, a single
(undiluted) dose may be administered IV slowly over 1 to 2 minutes. Adults and pediatric
patients greater than or equal to 14 years: 10 mg IV as a single dose administered over 1 to 2
minutes.
33
Usual Adult Dose for Radiographic Exam:
Adults and pediatric patients greater than or equal to 14 years: 10 mg IV as a single dose
administered over 1 to 2 minutes to facilitate gastric emptying where delayed gastric emptying
interferes with radiological examination of the stomach and/or small intestine.
Usual Adult Dose for Nausea/Vomiting -- Chemotherapy Induced:
IV infusion: 1 to 2 mg/kg/dose (depending on the emetogenic potential of the agent) IV (infused
over a period of not less than 15 minutes) 30 minutes before administration of chemotherapy.
The dose may be repeated twice at 2 hour intervals following the initial dose. If vomiting is
still not suppressed, the same dose may be repeated 3 more times at 3 hour intervals.
For doses higher than 10 mg, the injection should be diluted in 50 mL of a parenteral solution.
Normal saline is the preferred diluent. If acute dystonic reactions occur, 50 mg of
diphenhydramine hydrochloride
may be injected IM.
Usual Adult Dose for Migraine:

Use for treatment of migraine headaches is not an FDA approved indication; however,
metoclopramide has shown efficacy in studies at a dose of 10 to 20 mg IV once (used in
combination with analgesics or ergot derivatives).
11. Special consideration:
Do not use this medicine if you've ever had muscle movement problems after using
metoclopramide or similar medicines, or if you've had a movement disorder called tardive
dyskinesia. You also should not use this medicine if you've had stomach or intestinal problems
(a blockage, bleeding, or a hole or tear), epilepsy or other seizure disorders, or an adrenal gland
tumor (pheochromocytoma).
NEVER USE METOCLOPRAMIDE IN LARGER AMOUNTS THAN

RECOMMENDED, OR FOR LONGER THAN 12 WEEKS.
High doses or longterm use can cause a serious movement disorder that may not be reversible.
Drug # 18: MORPHINE

1. Generic Name: Morphine sulphate/Morphine HCL
2. Trade Name: Magnus MR, MS Contin, Astramorph, Depodur, Duramorph, Infumorph
Manufacturer: AGP Pvt Ltd, Scotmann Pharmaceuticals, Lahore Chemical &
Pharmaceutical works, Wilshire Laboratories Pvt Ltd
3. Class: Opioid (Narcotic) Analgesic
34
4. Mechanism of action :
5. Pharmacokinetics
 Absorption:
 Morphine is absorbed in the alkaline environments of the upper intestine and
rectal mucosa.
 The bioavailability of morphine is 80-100%. Morphine reaches steady-state
concentrations after 24-48 hours.
 Parenteral morphine has a Tmax of 15 minutes and oral morphine has a Tmax
of 90 minutes, with a Cmax of 283nmol/L.
 The AUC of morphine is 225-290nmol h/L.
 Volume of distribution:
 The volume of distribution of morphine is 5.31L/kg.
 Protein binding:
 Morphine is 35% protein-bound, the metabolite morphine-3-glucuronide is 10%
protein-bound, and morphine-6-glucuronide is 15% protein-bound.
 Metabolism:
 Morphine is 90% metabolized by glucuronidation by UGT2B7 and sulfation at
positions 3 and 6. Morphine can also be metabolized to codeine, nor-morphine, and
morphine ethereal sulfate.
 Route of elimination
 70-80% of an administered dose is excreted within 48 hours. Morphine
is predominantly eliminated in the urine with 2-10% of a dose recovered
as the unchanged parent drug. 7-10% of a dose of morphine is eliminated
in the feces.
 Half-life
 Morphine has a half-life of 2-3 hours.
 Clearance
 The apparent clearance of intravenous or subcutaneous morphine is 1600
mL/min
 Toxicity
 The LD50 is 0.78µg/mL in males and 0.98µg/mL in females.
6. Route of Administration
Following are the routes of administration for morphine:
35
 Oral Route: Morphine is available in tablet and capsule form, given every 4
to 6 hours. Intermediate release and extended release.
 Intramuscular (IM) or Subcutaneous (SC): Given for faster pain relief every
4 to 6 hours.
 Transdermal Patch: Morphine is available in patch form for the relief of

continuous pain, applied every 72 hours.
 Patient Controlled Analgesia (PCA): Morphine may be administered through
this device for continuous pain and in a post-operative setting. The
 patient can administer a present dose in a specified time interval.
 Individual pain management approach.
7. Dosage Form
Dose Single Dose Frequency Route Instructions
Adult Dosage
5 to 15 mg 10 (10) 4 hourly IM
15 mg 15 (15) 4 hourly Intra Rectal
0.2 to 1 mg 0.6 (0.6) 12 hourly Intra Thecal
2.5 to 5 mg 3.8 (3.75) As IV Inf Maintenance , at

recommended. every hour
5 to 15 mg 10 (10) As IV Inf Load for half an
recommended. hour
Paedriatic
Dosage (20kg)
0.1 to 0.2 mg/kg 0.15 (0.15) 4 hourly Intra Muscular -
0.2 to 0.4 mg/kg 0.3 (0.3) 4 hourly Oral -
0.1 to 0.2 mg/kg 0.15 (0.15) 4 hourly Subcutaneous -
Neonatal Dosage
(3kg)
0.1 to 0.2 mg/kg 0.15 (0.15) 4 hourly Intra Muscular -
0.2 to 0.4 mg/kg 0.3 (0.3) 4 hourly Oral -
0.1 to 0.2 mg/kg 0.15 (0.15) 4 hourly Subcutaneous -
8. Indications
Morphine is primarily indicated for the following purposes:
 Acute Pain Management: Morphine is indicated for the relief of acute pain.
 Chronic Pain Management: It is used in the treatment of chronic pain conditions.
 Palliative Care for Breathlessness: Morphine helps manage
dyspnea(breathlessness at rest) in palliative care.
 Post-Operative Pain Relief: Morphine is administered to alleviate post-operative
pain.
 Adjunctive Therapy: It serves as an alternative drug of choice in dyspnea, dyspnea,
and pain in palliative care and surgery.
9. Contraindications of Morphine:
36
 Morphine is contraindicated in conditions like Respiratory disease, Biliary colic,
Raised intracranial pressure, Coronary perfusion disorder, and Head injury.
 Drug should not be given to patients suffering from Kidney dysfunction.
10. Special Considerations for Morphine:
 Morphine should be used with caution in patients with central nervous system (CNS)
depression, convulsive disorder, ulcerative colitis, fever, recent gastrointestinal (GI)
surgery, brady arrhythmias, supraventricular tachycardia, and pulmonary diseases.
 Patients should exercise caution while driving or performing tasks requiring alertness
because it may produce drowsiness.
Interactions of Morphine with Other Drugs:
 Central Nervous System Depressants: Increased risk of sedation and respiratory

depression.
 Monoamine Oxidase Inhibitors (MAOIs): Enhanced opioid effects, risking respiratory
depression.
 Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) and SSRIs: Risk of serotonin
syndrome.
Drug # 19: Nifedipine

Introduction
Nifedipine is used to treat high blood pressure or angina (chest pain). For high blood
pressure Nifedipine works by relaxing and expanding the blood vessels. This makes the
37
blood flow more easily and lowers blood pressure. Lower blood pressure reduces the
strain on your heart.
1. Generic Name:
Nifedipine
2. Brand Name: Adalat
3. Classification:
Nifedipine is a Dihydropyridine Calcium Channel Blocker (CCB).
 Nifedipine acts as a calcium channel blocker, specifically targeting L-type calcium
channels in vascular smooth muscle cells and cardiac myocytes.
 It inhibits calcium influx through these channels, leading to peripheral vasodilation by
preventing smooth muscle contraction, thereby reducing systemic vascular resistance
and lowering blood pressure.
 Nifedipine also promotes coronary artery vasodilation, enhancing myocardial oxygen
supply and relieving angina symptoms.
 While it exhibits negative chronotropic and inotropic effects to a lesser extent, its
primary action is centered on vasodilation and arterial compliance improvement.
 These mechanisms collectively contribute to its efficacy in managing hypertension
and angina pectoris.
5. Indications:
 Hypertension: Nifedipine is indicated for the treatment of hypertension, lowering
blood pressure by inducing peripheral vasodilation.
 Angina Pectoris: It is used to manage chronic stable angina and variant angina,
relieving angina symptoms and improving exercise tolerance.
 Raynaud's Phenomenon: Nifedipine may be prescribed to alleviate symptoms such
as cold fingers and toes associated with Raynaud's phenomenon by promoting
peripheral vasodilation and enhancing blood flow.
38
6. PK Profile
7. ADRs:
Route of
Administration Description
Commonly administered orally, often in extended-release tablet or capsule

forms for once-daily dosing. Suitable for conditions like hypertension and
Oral angina pectoris.
Extended-release Designed to provide sustained release of the medication, ensuring consistent

Formulations therapeutic effect over time.
Immediate-
release Available for specific indications or situations such as hypertensive
Formulations emergencies, although less common due to associated risks.
Generally not recommended due to the risk of serious adverse effects,

Intravenous including hypotension and reflex tachycardia.
Contraindication Description
Contraindicated in patients with known hypersensitivity to

Hypersensitivity nifedipine or any components of the formulation.
39
Contraindication Description
Contraindicated in patients with severe hypotension (<90 mmHg

Severe Hypotension systolic).
Cardiogenic Shock Contraindicated in patients with cardiogenic shock.
Acute Myocardial Contraindicated in patients with acute myocardial infarction and

Infarction pulmonary congestion.
10. Special Considerations:
Special Consideration Description
Use with caution in patients with hepatic impairment; dosage

Liver Impairment adjustment may be necessary.
Use with caution in patients with renal impairment; dosage adjustment

Renal Impairment may be necessary.
Caution is advised in elderly patients, who may be more susceptible to

Elderly adverse effects.
Pregnancy and Use during pregnancy or lactation only if benefits outweigh risks;
Lactation consult a healthcare provider.
11. Dosage Forms:
Dosage Form Description
Extended-Release Available for once-daily dosing in various strengths (e.g., 30 mg, 60 mg,
Tablets 90 mg).
Immediate-Release Less common, used for specific indications or in hypertensive

Capsules emergencies.
Some formulations may be available as oral solutions for specific patient

Oral Solution populations or situations.
Generally not recommended due to the risk of serious adverse effects;

Intravenous reserved for specific clinical scenarios under close medical supervision.
40
Drug # 20: NSAIDS
Nonsteroidal anti-inflammatory drugs (NSAIDs) are a class of medications widely
used to relieve pain, reduce inflammation, and lower fever. They work by inhibiting the
activity of cyclooxygenase enzymes (COX-1 and COX-2), which are involved in the
production of prostaglandins, substances that contribute to pain and inflammation.
NSAIDs are commonly used to manage various conditions such as arthritis, menstrual
cramps, headaches, and musculoskeletal injuries.
1. Brand and Generic Names:
Generic Brand
Ibuprofen Advil, Motrin
Naproxen Aleve, Naprosyn
Aspirin Bayer, Bufferin
 COX Inhibition: NSAIDs block cyclooxygenase (COX) enzymes, particularly
COX-1 and COX-2.
 Prostaglandin Reduction: By inhibiting COX enzymes, NSAIDs decrease
prostaglandin synthesis, which mediates inflammation, pain, and fever.
 Analgesia: NSAIDs alleviate pain by reducing prostaglandin levels, thereby
diminishing pain perception.
 Anti-inflammatory: NSAIDs curb inflammation by lowering prostaglandin
production, mitigating swelling and discomfort.
 Antipyretic: NSAIDs lower fever by inhibiting prostaglandins in the
hypothalamus, regulating body temperature.
 Oral administration is the most common route for NSAIDs, with many available
in tablet, capsule, or liquid form for ease of ingestion.
 Some NSAIDs may also be available in topical formulations for localized pain
relief, applied directly to the skin over the affected area.
41
4. Indications:
 NSAIDs are primarily indicated for the management of pain, inflammation, and
fever associated with various conditions such as arthritis, musculoskeletal injuries,
and headaches.
 They are often used as first-line agents in the treatment of mild to moderate pain,
including acute and chronic pain syndromes.
 Caution should be exercised in patients with a history of gastrointestinal ulcers or
bleeding, as NSAIDs can increase the risk of gastrointestinal adverse effects.
 Patients with renal impairment or heart failure require careful monitoring when
using NSAIDs, as these medications can affect renal function and fluid balance.
 Long-term use of NSAIDs, especially at high doses, should be approached
cautiously due to the potential for cardiovascular events and renal toxicity.
 NSAIDs are contraindicated in patients with a history of hypersensitivity reactions
to these medications or other components of the formulation.
 They should be avoided in individuals with a history of gastrointestinal bleeding,
peptic ulcer disease, or inflammatory bowel disease.
 Use of NSAIDs is contraindicated in the setting of perioperative coronary artery
bypass graft (CABG) surgery due to the increased risk of cardiovascular events.
7. Pharmacokinetics and Dynamics:
 Tmax (Time to Peak Plasma Concentration): Tmax varies among different
NSAIDs and formulations, typically ranging from 1 to 4 hours after oral
administration.
 Cmax (Peak Plasma Concentration): Cmax also varies depending on the
specific NSAID and dosage form but generally occurs within a few hours after
administration.
 Volume of Distribution (Vd): Vd represents the theoretical volume in which the
total amount of drug would need to be uniformly distributed to produce the
observed plasma concentration. It varies widely among NSAIDs due to differences
in their physicochemical properties.
 Area Under the Curve (AUC): AUC reflects the total systemic exposure to the
drug over time and is influenced by factors such as absorption, distribution,
metabolism, and elimination.
 Half-Life: The half-life of NSAIDs varies widely, ranging from a few hours to
several days, depending on factors such as drug potency, metabolism, and renal
clearance.
42
8. Dosage form:
Drug # 21: Oral rehydration solution (ORS)

1. Name (Generic+trade):
Generic: Oral rehydration solution (ORS)
Trade: Various commercial brands exist globally, with names like Pedialyte, Rehidrat,
Dioralyte, etc.
2. Class:
Electrolyte and carbohydrate replacement therapy
3. MOA:
Replaces fluids and electrolytes lost through diarrhea, vomiting, or other illnesses.
Sugar promotes water absorption through the intestines.
Electrolytes maintain fluid balance and essential mineral levels.
4-Indications:
 Treatment of dehydration caused by diarrhea, vomiting, or other illnesses leading
to fluid loss.
 Prevention of dehydration in high-risk groups, especially children under 5.
5. PK (ADME):
Absorption: Rapidly absorbed from the intestines into the bloodstream.
Distribution: Distributed throughout body fluids.
Metabolism: Electrolytes and carbohydrates are used by the body for various functions.
Elimination: Excess fluids and electrolytes are excreted through urine and feces.
Oral administration, given in small, frequent sips.
7. ADR
Generally well-tolerated in most individuals.
Potential for electrolyte imbalance with improper dilution or use.
Mild gastrointestinal discomfort in some cases (e.g., bloating, nausea).
8. Contra indications:
 Severe dehydration requiring intravenous fluids.
 Known intestinal blockage or perforation.
 Severe intolerance to any ingredient in ORS.
9. Dosage form/ Dosage:
 Pre-mixed solutions sold in packets, sachets, or bottles.
43
 Homemade versions can be prepared using specific recipes and precise
measurements.
 Dosage varies depending on age, severity of dehydration, and individual needs.
 Follow precise instructions for preparation and administration, especially for
homemade solutions.
 Store pre-mixed solutions according to product recommendations.
 Seek medical attention if severe dehydration, persistent symptoms, or concerns
arise.
 Do not use as a substitute for breastfeeding or formula in infants.
Drug # 22: Penicillin

1. Generic name of Penicillin
Penicillin g benzathine
Penicillin v
2. Trade name of Penicillin

Amoxicillin and penicillin are both available as generic drugs
3. Mechanism of action.
Penicillin kills bacteria through binding of the beta-lactam ring to DD-transpeptidase,
inhibiting its cross-linking activity and preventing new cell wall formation
4. Indication
44
Penicillin V potassium is used to treat certain infections caused by bacteria such as
pneumonia and other respiratory tract infections, scarlet fever, and ear, skin, gum, mouth,
and throat infections.
Descriptions. Penicillin G benzathine injection is used to treat bacterial infections (eg,
mild to moderate infections of the upper respiratory tract, syphilis, yaws, bejel, pinta). It
is also used to prevent rheumatic fever, chorea, rheumatic heart disease, or acute
glomerulonephritis. This medicine is an antibiotic.
5. Pharmacokinetic profile:
6. ADR’s
 Hypersensitivity Reactions: The commonly encountered adverse drug reaction
with penicillin is hypersensitivity of immediate onset or delayed onset.
 Immediate onset: This kind of reaction occurs within 20 minutes post-
administration. It is characterized by urticaria, pruritis, edema, laryngospasm,
bronchospasm, hypotension, vascular collapse, and death.
 Delayed onset: This reaction occurs within 1 to 2 weeks of treatment. It is rare
and is characterized by fever, malaise, urticaria, myalgia, arthralgia, abdominal
pain, and skin rashes.
 Gastrointestinal System: GI symptoms were the most common and were
reported in over 1% of patients, including nausea, vomiting, stomatitis, which are
commonly observed with oral administration. Pseudomembranous colitis is also
observed during or after the treatment.
 Hematologic Reactions: If the dose is exceeded 10 million units/day and if a
patient has received a higher dose previously, then those patients can precipitate
Coombs positive hemolytic anemia and neutropenia, which is resolved when
therapy is stopped.
 Metabolic Reactions: The salt form of penicillin G may cause electrolyte
imbalances, i.e., hyperkalemia when given IV in a large dose.
 Nervous System: Neurological manifestations include hyperreflexia, myoclonic
twitches, seizures, and coma after IV doses and are more likely in patients with
impaired renal function.
 Urogenital System: Urological manifestations with large IV doses include renal
tubular damage. The penicillins can also cause acute interstitial nephritis, a disease
characterized by inflammation of the tubules and interstitium of the kidneys.[15]
Acute interstitial nephritis can also present with hematuria, fever, and rash. The
recommendation is to withdraw the drug as the disease could lead to renal failure
in this situation.
 Other: Jarisch- Herxheimer reaction is precipitated when penicillin is administered
in patients with syphilis.
 Drug-Drug Interactions
 Concurrent sulfonamides, erythromycin, chloramphenicol should be avoided due
to antagonistic effects.
 Tubular secretion of penicillin G can be blocked by probenecid- higher and longer
plasma concentrations are achieved. Probenecid also decreases the volume of
distribution of penicillin.
45
 Drugs like aspirin, phenylbutazone, sulfonamides, indomethacin, thiazide,
furosemide, and ethacrynic acid increase the half-life of penicillin by competing
with tubular secretion
7. Route of adminstration.
Penicillin G administration can be either intravenously or intramuscularly. Penicillin G

potassium for injection USP vial is available in 1 million units, 5 million units, and 20
million units per vial. Penicillin G degrades more easily by stomach acid and has less than
30% bioavailability; therefore, it is a parenterally administered drug. Because of the short
half-life, penicillin G is usually administered in divided doses 4 to 6 hours apart via the
intravenous or intramuscular route. Penicillin G benzathine administration ensures a
continuous low dose of penicillin G over 2 to 4 weeks.
Penicillin V and penicillin VK (potassium salt of penicillin V) is available in orally
administered forms as a solution for reconstitution (125 mg/5 mL, 250 mg/5 mL) and
tablets (250 mg and 500 mg). Penicillin V has a bioavailability of around 65% after
passing stomach acid. Penicillin V is best administered to a fasting patient as it degrades
in stomach acid. The normal dose ranges from 125 mg to 500 mg every 6 to 8 hours based
on the clinical indication and patient weight.
Contraindications of penicillin include a previous history of severe allergic reactions or
penicillin and its derivatives. Penicillin is also contraindicated in patients who have had
Stevens-Johnson syndrome after administering penicillin or a penicillin derivative.
Penicillin has an antagonistic effect with tetracycline and reportedly can lead to 2.6 times
greater risk for mortality when treating pneumococcal meningitis than using penicillin
alone.
Nearly all antibacterial agents have been linked to Clostridium difficile associated
diarrhea (CDAD), including penicillin, with severity ranging from mild diarrhea to fatal
colitis. This strain produces toxins A and B that contribute to the development of CDAD.
During infections caused by hyper toxin-producing strains of C. Difficile, the rate of
morbidity and mortality can be increased since these infections are often resistant to
antimicrobial treatments and may require colectomy.
9. Dosage form and dosage

Injectable suspension
600,000 units/1mL syringe
1.2 million units/2mL syringe
Pneumonia
Indicated for moderately severe uncomplicated pneumococcal pneumonia
600,000-1,000,000 units IM qDay
Streptococcal Infections (Group A)
Indicated for moderately severe-to-severe tonsillitis, erysipelas, scarlet fever, upper
respiratory tract, skin and soft tissue infections
600,000-1,000,000 units IM qDay for at least 10 days
Staphylococcal Infections
600,000-1,000,000 units IM qDay
Bacterial Endocarditis
Indicated only for treatment of extremely sensitive infections; not indicated for
prophylaxis
600,000 -1,000,000 units IM qDay
Syphilis
Primary, secondary, and latent: 600,000 units IM qDay for 8 days
Late (tertiary and latent syphilis with positive spinal fluid): 600,000 units IM qDay for
10-15 days (total 6-9 million units)
Neurosyphilis: 2.4 million units IM qDay x10-14 days; administer with probenecid 500
mg PO QID (penicillin G aqueous preferred)
Anthrax
46
Cutaneous: 600,000-1,000,000 units IM qDay
Inhaled (post-exposure): 1.2 million units IM q12hr for up to 2 weeks, THEN switch to
PO treatment (total treatment 60 days)
Diphtheria
Adjunct with antitoxin: 300,000-600,000 units IM qDay
Carrier state: 300,000 units IM qDay
Vincent’s Infection (fusospirochetosis)
600,000-1,000,000 units IM qDay
Erysipeloid
600,000-1,000,000 units IM qDay
Rat-Bite Fever
Indicated for Streptobacillus moniliformis and Spirillum minus (rat-bite fever)
600,000-1,000,000 units IM qDay
Whipple’s disease
1.2 million units IM qDay for 10-14 days; coadminister with streptomycin, THEN
Trimethoprim/sulfamethoxazole or doxycycline PO for 1 yr
10. Special instructions

Proper Use. Penicillins (except bacampicillin tablets, amoxicillin, penicillin V,
pivampicillin, and pivmecillinam) are best taken with a full glass (8 ounces) of water on
an empty stomach (either 1 hour before or 2 hours after meals) unless otherwise directed
by your doctor.
 Binds to receptors: Prednisolone enters cells and binds to glucocorticoid

receptors.
 Changes gene expression: The prednisolone-receptor complex travels to the cell
nucleus and interacts with DNA, altering gene expression.
 Reduces inflammation: Prednisolone suppresses genes that promote
inflammation and activates genes with anti-inflammatory effects.
 Immunosuppression (high doses): At high doses, prednisolone also suppresses
the immune system, which can be helpful for autoimmune diseases but also
increases infection risk.
47
 Intravenous (IV): For rapid systemic effect, often used in severe cases or
emergencies.
 Intramuscular (IM): For long-acting effect, especially when oral administration
is not feasible.
 Topical: For localized inflammation, such as in skin conditions or eye problems.
 Inhalation: For respiratory conditions like asthma.
 Increased appetite and weight gain

 Fluid retention and edema
 Mood swings, irritability, or insomnia
 Increased susceptibility to infections
 Weakened bones (osteoporosis)

 Increased blood sugar levels (hyperglycemia)
 Increased blood pressure (hypertension)
 Cataracts and glaucoma
 Skin thinning and bruising
 Hypersensitivity: If you have a known allergy to prednisolone or any of its

components, it's strictly contraindicated.
 Systemic fungal infections: Prednisolone can worsen fungal infections, so it's
contraindicated in such cases.
 Live vaccines: Due to its immunosuppressive effects, prednisolone is
contraindicated during live vaccinations to avoid serious infections.
 Uncontrolled infections: It's generally contraindicated in uncontrolled infections
unless the benefits outweigh the risks and appropriate antimicrobial therapy is
given concurrently.
 Tablets: Strengths range from 1 mg to 50 mg.

 Liquids: Solutions typically come in concentrations of 1 mg/mL or 5 mg/mL.
48
 Syrups: Available in concentrations like 1 mg/mL or 5 mg/mL.
 Injectable solutions: Usually in concentrations of 1 mg/mL or 5 mg/mL.
 Injectable suspensions: Available in strengths like 25 mg/mL or 50 mg/mL.
 Creams: Strengths may vary depending on the specific condition being treated.
 Ointments: Similar to creams, strengths vary based on the intended use.
 Eye drops: Typically come in concentrations of 0.1% or 1%.
 Inhalers: Metered-dose inhalers deliver specific amounts of medication per puff.
 Metered-dose inhalers: Delivering 50 mcg or 100 mcg per puff.
 Individualized approach: The dose is tailored to the specific condition, its

severity, and the patient's characteristics like age, weight, and medical history.
 Lowest effective dose: The goal is to use the lowest dose possible that achieves
the desired therapeutic effect while minimizing side effects.
 Duration matters: The risk of side effects generally increases with longer
treatment duration. Prednisolone is often tapered gradually to reduce side effects
and prevent adrenal suppression.
 Route of administration: The chosen route (oral, injection, inhalation, etc.)
influences dose and potential side effects.
 Monitoring: Regular monitoring for side effects like weight gain, blood sugar
levels, and blood pressure is crucial.
Drug # 24: Salbutamol

1. Generic Name: Salbutamol
2. Trade name: Bronchilate
3. Class of drug: Salbutamol belongs to the class of drugs called
beta-2 adrenergic agents.
49
The mechanism of action Salbutamol, or albuterol, primarily works by
binding to and activating beta-2 adrenergic receptors in the smooth muscle cells of the
lungs. This activation leads to the relaxation of these muscles, resulting in bronchodilation
and improved airflow. Additionally, salbutamol can inhibit the release of inflammatory
mediators and increase the clearance of mucus from the airways.
5. Indications:
Salbutamol, also known as albuterol, is commonly prescribed for the treatments:
 Asthma
 Chronic obstructive pulmonary disease (COPD)
 Respiratory conditions
 It's used to relieve symptoms such as wheezing
 Shortness of breath
 Chest tightness
 Coughing
6. Pharmacokinetics of salbutamol :
The pharmacokinetics of salbutamol involve rapid absorption after inhalation, with peak
plasma concentrations reached within 1 to 2 hours. It has a relatively short duration of
action, typically around 4 to 6 hours. Salbutamol undergoes extensive metabolism in the
liver, primarily via sulfation and glucuronidation, and is excreted mainly in the urine as
inactive metabolites.
7. Adverse Drug reactions :
Common adverse drug reactions (ADRs) associated with salbutamol include:
 Tremor: Especially in the hands.
 Palpitations: Increased heart rate or awareness of heartbeat.
 Headache: Mild to moderate headaches may occur.
 Tachycardia: Rapid heart rate.
 Nervousness: Feelings of anxiety or restlessness.
8. Route of administration: Salbutamol can be administered:
 Inhalar
 Orally : Tablets and syrups
 Parenterally : IV , IM injections
 Hypersensitive
 Cardiovascular conditions
 Hyperthyroidism
 Severe hypertension
 Diabetes
 Pregnancy and breastfeeding
10. Dosage:
Adult dose
Metered-Dose Inhaler (MDI):
 For acute asthma symptoms: 2 inhalations (100-200 mcg per inhalation) every 4-
6 hours as needed. The maximum dose should not exceed 8 inhalations in 24 hours.
50
 For prevention of exercise-induced bronchospasm: 2 inhalations 15-30 minutes
before exercise.
Nebulizer Solution:
 The usual dose is 2.5 mg to 5 mg (0.083% or 0.5% solution) administered via
nebulization every 4-6 hours as needed. The maximum dose should not exceed 20
mg in 24 hours.
Extended-Release Tablets:
 The typical dosage is 4 mg orally every 12 hours. However, dosing may vary based
on individual response and physician recommendations.
Neonatal dose :
 Intravenous: 4 micrograms/kg IV over 10 minutes.
 Nebulized endotracheal: 400 microgram 2 hrly, maximum 12 doses.
11. Dosage form:
12. Special considerations :

Salbutamol is commonly used to treat asthma and chronic obstructive pulmonary disease
(COPD). Nursing Considerations: Monitor respiratory rate, oxygen saturation, and lungs
sounds before and after administration. If more than one inhalation is ordered, wait at least
2 minutes between inhalations.
Drug # 25: Vancomycin

1. Brand Name: Vancomycin
51
2. Trade Name: Vancocin
3. Class of drugs: Glycopeptides antibiotics.
When it reaches the cell wall of an actively dividing susceptible gram-positive bacterium,
vancomycin binds to the acyl-D-ala-D-ala portion of the growing cell wall. After binding,
it prevents the cell wall from forming the cross-linking necessary to keep it strong.
5. Indications:
Vancomycin is indicated in adult and pediatric patients for the treatment of septicemia,
infective endocarditis, skin and skin structure infections, bone infections, and lower
respiratory tract infections.
6. Pharmacokinetics:
Absorption:
Oral vancomycin has a bioavailability of less than 10%.
Onset of action:
Vancomycin has a rapid onset of action with a serum peak concentration immediately
following the completion of the intravenous infusion. The onset of action of oral
vancomycin is currently unknown.
Distribution:
large volume of distribution (0.4 L/kg to 1.0 L/kg) in body tissues and fluids, excluding
cerebrospinal fluid (CSF) with non-inflamed meninges
Protein Binding:
approximately 55%
Metabolism: No evident metabolism (excreted unchanged)
Clearance: 0.71 mL/minute/kg to 1.31 mL/minute/kg in adults with normal renal

function
Half-life: Vancomycin has a bi-phasic elimination half-life, with its initial half-life being
relatively quick and a terminal half-life of 4 to 6 hours in healthy adults with normal renal
function. The elimination half-life is significantly prolonged in patients with renal
dysfunction. Close monitoring is necessary for these patients.
Excretion: Intravenous vancomycin injection is primarily eliminated by glomerular

filtration in the kidney (75% via urine). Oral vancomycin predominantly gets excreted in
feces.

The main adverse reactions of vancomycin include hypersensitivity reactions,
nephrotoxicity, ototoxicity, and so on. The most common manifestation of
hypersensitivity reactions is hypersensitivity macular cutaneous rashes and anaphylaxis.
8. Side effect:
 Nausea or stomach upset may occur
 Dizziness
 Hearing problems
 Easy bruising/bleeding
 signs of kidney problems (such as changes in the amount of urine).
52
Intravenous, oral, rectal administration, since vancomycin hydrochloride is irritating to
tissue and causes drug fever, pain and possibly necrosis it should never be injected
intramuscularly.
vancomycin hydrochloride is contraindicated in patients with known hypersensitivity to
vancomycin, or any other excipients or in patients with previous anaphylaxis or major
allergy with other glycopeptides.
Patients are at a higher risk for developing AKI if they have underlying renal function
impairment.
11. Dosage Form and Dosage:
Dosage Form Dosage
Capsule (Vancocin) - 125mg
- 250mg
Injection, lyophilized powder for reconstitution - 500mg
- 750mg
- 1g
- 5g
- 10g
Powder for oral solution - 3.75g
- 7.5g
- 10.5g
- 15g
Injection, single-dose flexible bag (generic) - 500mg/100mL
- 750mg/150mL
- 1g/200mL
- 1.25g/250mL
- 1.5g/300mL
- 1.75g/350mL
- 2g/400mL

 Hearing Loss Risk: Hearing loss may occur while receiving this medication.
 Diarrhea Risk: This medication may cause diarrhea.
53
3 Standard Clinical cases
1) Hypertension
Mr. JS is a 55-year-old male who presents to the clinic with a chief complaint of frequent
headaches and occasional dizziness. He reports that these symptoms have been bothering
him for the past few months. He describes the headaches as throbbing in nature, primarily
occurring in the mornings and sometimes accompanied-by nausea. He also mentions a
family history of hypertension-and-heart disease.
Medical History
➢ Hypertension: Diagnosed 5 years ago.
➢ Medications: Losartan 50 mg daily.
➢ Allergies: None reported.
➢ Lifestyle: Sedentary, BMI 30, occasional alcohol consumption, non-smoker.
➢ Vital Signs:
➢ Blood Pressure: 160/95 mm Hg
➢ Heart Rate: 80 bpm
➢ Respiratory Rate: 16 bpm
➢ Temperature: 36.8°C (98.2°F)
➢ Physical Examination:
➢ Obese appearance
➢ Fundoscopy: No signs of hypertensive retinopathy
➢ Cardiac examination: Regular rate and rhythm, no murmurs. Lungs: Clear on

auscultation
➢ Abdomen: Soft, non-tender
➢ Extremities: No edema
➢ Laboratory Findings:
➢ Fasting Blood Glucose: 110 mg/dL Total Cholesterol: 220 mg/d.
➢ HDL Cholesterol: 40 mg/dL
➢ LDL Cholesterol: 150 mg/dL Serum Creatinine: 1.0 mg/dL
➢ Urinalysis: Normal
Questions:
1.What is the most likely diagnosis based on John Smith's presenting symptoms and
54
medical history?
Considering John Smith's symptoms and medical history, the likely diagnosis is
uncontrolled
hypertension accompanied by symptoms like headaches and occasional dizziness.
2 .What is the significance of John's family history of hypertension and heart disease
John's family history of hypertension and heart disease indicates a genetic
predisposition to cardiovascular conditions, underscoring the importance of
effective management strategies.
3.Evaluate John's current blood pressure reading. Is it within the recommended
target.
range for hypertensive patients, and how would you classify his hypertension
according to guidelines?
John's blood pressure reading of 160/95 mm Hg exceeds the recommended target range
for
hypertensive patients, classifying his hypertension as Stage 2 according to guidelines.
4. Review John's current antihypertensive medication, Losartan 50 mg daily. Is this
an appropriate initial treatment, and should any changes be considered?
Initiation of Losartan 50 mg daily is appropriate, but considering his elevated blood
pressure, dosage adjustment or additional medication may be necessary for better control.
5. What lifestyle modifications would you recommend to John for managing his
hypertension?
Lifestyle modifications for John should include weight loss through regular exercise and
a low sodium diet, reduction of alcohol consumption, and stress management techniques
like meditation or yoga to help lower blood pressure and improve overall cardiovascular
health.
6.Interpret John's laboratory findings, including fasting blood glucose, cholesterol
levels, and serum creatinine. How do these values contribute to his overall
cardiovascular risk?
John's laboratory results show slightly elevated fasting blood glucose, high cholesterol
levels, and normal serum creatinine, indicating increased cardiovascular risk due to
potential metabolic syndrome and dyslipidemia.
7. What additional diagnostic tests or assessments, If any, would you recommend for
Johns' hypertension evaluation?
Additional diagnostic tests such as ambulatory blood pressure monitoring,
echocardiogram, and renal function tests may be warranted to assess for target organ
damage and secondary causes of hypertension.
8. Discuss the potential reasons for John's morning headaches and occasional
dizziness. Could they be related to his hypertension?
These symptoms could be related to John's hypertension, possibly due to increased
intracranial pressure from elevated blood pressure levels exacerbated by poor lifestyle
habits.
9. What are the primary goals of treatment for John's hypertension, and how would
you monitor his progress in achieving these goals?
55
The primary goals of treatment involve lowering John's blood pressure to target levels,
reducing cardiovascular risk, and preventing target organ damage. Monitoring progress
includes regular, blood pressure checks, assessing medication adherence, lifestyle
modifications, and evaluating for any adverse effects.
2) Asthma
HT, a 32-year-old woman, 155 cm, 81 kg; presented to hospital casualty with a history of
increased breathlessness and wheezing, over the last 5days. She is known to have had
asthma for 20 years and has smoked 10 cigarettes per day since the age of 15. Her last
hospital admission was one month ago. She works in a small ‘do-it-yourself’ shop, as a
counter assistant. HT lives in a tenth-floor council flat; she is single. On medical
examination, the following is found:
❖ Audible wheeze throughout the chest, using accessory muscles
❖ Not able to speak in sentences – stops for breath after Two words
❖ Tachycardia – pulse 130 beats per minute
❖ tachypneic – respiratory rate 25 breaths per minute
❖ peak expiratory flow rate 150 L/min.
❖ 450-550 L/min in adult males and it is 320-470 L/min in adult females

Questions
1: Explain why this patient is tachycardia and tachypneic.
Tachycardia (fast heart rate) and tachypnea (rapid breathing) in asthma happen because
the body tries hard to get enough oxygen and get rid of excess carbon dioxide when
oxygen levels drop and carbon dioxide levels rise.
2. Describe what peak expiratory flow measures and how this value is interpreted in
this Woman.
Peak expiratory flow (PEF) measures how fast air comes out of the lungs when you
breathe out forcefully. In this woman, a PEF value of 150 L/min means her asthma is
severe and not well controlled.
3. Describe what other tests would be of importance to this patient at the time of
admission.
When admitted, it's crucial to do tests like checking oxygen levels in the blood, doing a
chest Xray to look for lung problems, and doing spirometry to see how well the lungs
are working.
4. Explain how the severity of acute asthma is estimated and how often investigations
should be done.
Asthma severity is judged by symptoms, PEF rate, and oxygen levels. Tests should be
done regularly, usually every 1-2 hours at first, to monitor how well the treatment is
working.
5. List the medicines available for the acute treatment of asthma and describe the
method of administration.
56
Medicines like inhalers with short-acting beta-agonists (like salbutamol) are used for
quick relief. Corticosteroids (like prednisolone) are taken by mouth, and ipratropium
bromide is used as an inhaler.
6. Describe the role of the pharmacist in the care of this patient.
Pharmacists help by teaching patients how to use inhalers correctly, making sure they
take their medicines as prescribed, and giving advice on managing asthma triggers.
7. What are the aims of asthma treatment for the patient and the professional?
Patients want relief from symptoms, fewer flare-ups, and a better quality of life.
Professionals aim to help patients control their asthma well by giving personalized
treatment plans and educating them about managing their condition.
8. Explain the social issues this patient will face on discharge.
After leaving the hospital, the patient might face challenges like finding suitable housing,
getting help to quit smoking, and dealing with asthma triggers at work.
9. Critically review the non-pharmacological therapies that are available for people
with asthma. Would these be of benefit to this patient?
Non-medical treatments like avoiding triggers, staying away from smoke, and managing
stress can help some people with asthma. These might be helpful for this patient too.
10. Discuss the role of an asthma management plan for this patient.
An asthma management plan is like a roadmap for patients, showing them how to watch
for symptoms, what medicines to take, and what to do if their asthma gets worse. It helps
patients take charge of their asthma and stay healthy.
57
3) Ulcerative colitis
Mrs. D has recently been admitted with an episode of acute severe ulcerative colitis. This
is her third flare this year. This time she has a 5-day history of bloody diarrhea with
abdominal pain. Onaverage, she passed her bowels seven times a day. She is currently
taking mesalazine 800 mg three times daily and prednisolone 20 mg daily. Mrs. also has
an elevated temperature of 38°C and a pulse rate of 92 bpm. She is due to have an
abdominal X-ray and a stool culture.
Biochemistry Findings
➢ Na+ 143 mmol/L (range 133 to 145 mmol/L)
➢ K+ 3.2mmol/L (range 3.3 to 5.1 mmol/L) 81 micromol/L
➢ Creatinine (range 44 to 80 micromoliL) ·
➢ Urea 7.2 mmol/L (range 1.7 to 8.3 mmol/L)
➢ Albumin 28 g/L (range 34 to 48 g/L) 。
➢ Hb10.4g/dL (range 11 to 16 g/L) 。
➢ WCC 14x10/L (range 3.5 to 11x10°/L)
➢ ESR38mm/h (range 0 to 9mm/h)
➢ CRP 95mg/L (range less than 5 mg/L)

Questions
1.Why is she taking mesalazine?
Mesalazine is prescribed to manage inflammatory bowel diseases like ulcerative colitis
by calming down inflammation in the colon.
2.What adverse effects should Mrs. D be particularly aware of ?
Mrs. D should watch out for side effects like nausea, diarrhea, headaches, and, although
rare, kidney or liver issues while taking mesalazine.
3. What signs and symptoms indicate that she needs to be admitted?
Mrs. D's acute severe ulcerative colitis is indicated by bloody diarrhea, abdominal pain,
elevated temperature (38°C), and tachycardia (pulse rate of 92 bpm). These symptoms,
along with her history of multiple flares and abnormal biochemistry findings, warrant
admission for urgent management and further evaluation.
4. Why does she have a low potassium and a low albumin?
Low potassium and albumin levels can occur during a flare of ulcerative colitis due to
increased bowel movements and reduced intake of nutrients.
5. Why is she having an abdominal X-ray and stool cultures done?
These tests help assess inflammation severity and rule out infections in ulcerative colitis.
6. How should this flare be managed? Several days later you see Mrs. D, who is
distressed as she is not responding to treatment and she desperately wants to avoid
surgery. The consultant has suggested that ciclosporin may be an option, and she
asks to talk to you
about it.
58
Flare management may involve adjusting medication doses, using steroids, and
monitoring for complications.
7. Why is surgery likely?
Surgery becomes likely if medical treatments fail or if complications like perforation or
severe bleeding occur.
8. What is the evidence for the use of ciclosporin.
Studies show that ciclosporin can be effective in severe cases of ulcerative colitis,
particularly when surgery is a concern.
9. What should you discuss with her about the use of ciclosporin?
Mrs. D should discuss potential side effects like kidney problems, high blood pressure,
and increased infection risk with her doctor before starting ciclosporin.
10. What dose of ciclosporin should she receive and how should it be given?
Mrs. D's doctor will determine the appropriate dose and how to administer ciclosporin
based on her individual situation.
11. What drugs would you expect her to be discharged on?
After discharge, Mrs. D may receive mesalazine, immunosuppressant like azathioprine,
and possibly a gradual reduction in prednisolone dosage.
12. What monitoring would you do?
Ongoing monitoring will involve checking inflammatory markers, kidney function, and
electrolyte levels to ensure treatment effectiveness and safety.
13. What counselling should she be given?
Mrs. D should be educated about the importance of sticking to her medication regimen,
recognizing signs of worsening symptoms, and understanding potential side effects.
14. What future treatment is she likely to receive?
Future treatment will likely involve long-term maintenance medications and regular
follow-up appointments to manage her condition effectively.
15. Do antibacterial have a role in ulcerative colitis?
Antibiotics are generally not used as the primary treatment for ulcerative colitis since it's
considered an inflammatory condition rather than an infectious one
Summary
59
I started my clinical clerkship at Rehman Medical Institute(RMI) on 4th December which
comes to end on 22nd of January During Clinical Clerkship at RMI hospital has
highlighted the critical role pharmacists play in patient care. I have learned how to collect
cases from patients and different Medical departments. Moreover, I've learned about
medication management, including reconciliation and safety protocols, as well as
different drug distribution systems like unit dose and automated dispensing. Clinical
pharmacy services, such as therapy management and antimicrobial stewardship,
underscored the pharmacist's role in optimizing therapy. Pharmaceutical care planning
involves assessing patient needs and developing tailored care plans. Overall, hospital
pharmacy studies have equipped me with essential skills to provide safe and effective
pharmaceutical care in both inpatient and outpatient settings. During Hospital visits I
learned about Professional dealing with patients and other Health Care Professionals.
We have studied 7 modules during clinical Pharmacy sessions. By Applying these

modules, we have come to know how we will relate clinical knowledge to patient
condition.
• Management of disease state
• Patient monitoring
• Chart review / data review
• Laboratory findings
• Patient history
• Drug information
• Discharge medications and patient counseling
These key modules ensure effective patient care. The first manages disease states by
recording history, conducting lab tests, and diagnosing conditions. The second module
monitors patients daily for reactions and treatment effectiveness, considering interactions.
Module three reviews charts and data for therapy planning. Module four analyzes lab
findings to tailor therapy plans. Module five gathers detailed patient histories. The sixth
module uses drug information to address queries on drug use and toxicity. Lastly, module
seven focuses on discharge medications and counseling for personalized instructions,
ensuring comprehensive care and optimal outcomes.
During these sessions we have studied 3 standard cases;
60
1) Hypertension 2) Asthma 3) Ulcerative Colitis
Three cases were studied, each presenting unique challenges in healthcare management.
Hypertension was addressed with pharmacological and non-pharmacological
interventions based on NICE guidelines, focusing on ARBs and lifestyle modifications.
Asthma management involved quick-relief medications and essential tests for assessing
lung function, highlighting the pharmacist's role in patient education. Ulcerative colitis
posed difficulties despite initial treatment, leading to consideration of ciclosporin therapy,
emphasizing the importance of longterm monitoring and patient counseling for effective
disease management.
During classes, students presented topics. e.g. In-patient Flow, De range values and Drug
Dose Calculations. I have come to know that Inpatient pharmacy flow ensures efficient
medication management from admission to discharge, involving settlement, verification,
dispensing, counseling, and monitoring. Clinical assessment relies on reference ranges for
interpreting lab results and identifying health issues, crucial for accurate diagnosis and
treatment monitoring. These Values can be easily related to patent condition for disease
or infection identification, moreover before and after lab values must be keep in
consideration to know about either medication is working or not. Drug dose calculations
is important part of Intensive Care Unit (ICU). Different tasks must be performed in ICU
to ensure patient safety Dose Optimization, Dilutions, Fluid selection, Narcotic drugs,
anesthetic drugs and Sepsis management. I have learned about basic formulas needed for
calculations of High alert medications like Aminophyline, Amiodarone, Dopamine,
Epinephrine, Esmolol, and Bretylium.
61

Drug # 1: Adrenaline: 1. Generic & Trade Name

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Drug # 1: Adrenaline: 1. Generic & Trade Name

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Drug # 1: ADRENALINE

1. Generic & Trade Name :

2. Different brands classification:

 Adrenaline is the first-line treatment for severe allergic reactions

 Adrenaline may be used in the treatment of severe

5. Adverse Drug Reactions

 It is contraindicated with patients who are already cardiovascularly compromised.

 Adrenaline is contraindicated in individuals with

7. Route of Administration, Dosage & Dosage Form

 Adrenaline is administered through the Intramuscular route (IM)

 Adrenaline is rapidly absorbed following IM or SC injection, with

Aminoglycosides have a broad spectrum of activity covering aerobic organisms, including

Absorption: Poor oral absorption, usually administered parenterally.

Metabolism: Minimal metabolism.

Elimination: Excreted unchanged in the urine.

Typically administered by intramuscular or intravenous injection.

11. Special instruction

Reconstitution of the Drug:

Drug # 3: Anti Epileptic Drug

2. Trade name: Epival ( Abbott Laboratories).

Off-label uses include:

o Maintenance therapy for bipolar disorder.

• They are well absorbed after oral administration.

 Hypersensitivity reactions (rash, fever, eosinophilia)

 Hypersensitivity to valproic acid or any components of the formulation.

11. Special instructions/ Consideration:

2. Trade name: Nydrazid,rifater etc

8. Adverse drug reaction(ADRs)

10. Dosage form

Available as tablet ,capsule ,syrups and parentral form.

11. Special consideration.

3. Mechanism of Action: Atropine works as a competitive antagonist of acetylcholine at

 Absorption: Atropine is well-absorbed after oral administration.

7. Adverse Drug Reactions (ADRs):

10. Dosage and Dosage Form:

11. Special Instructions/Considerations:

6. Adverse drug reactions:

7. Dosage form and dosage:

10. Special instructions:

2. Drug Brand Name: Velosef (GSK), Vericef (Indus pharma), Velora(Platinum)

3. Class: Cephradine belongs to the class of antibiotics known as first-generation

7. Adverse Drug Reactions:

9. Dosage form and dosage

Cephradine is available in various dosage forms, including:

Cephradine is contraindicated in individuals with a known hypersensitivity to cephalosporin

11. Special considerations:

Special considerations for while using cephradine :

 Allergy: Assess patient history for hypersensitivity to cephalosporins or penicillins, as

7. ADRs (adverse drug reaction)

10. Special consideration

4. Mechanism of Action: The H2-receptor antagonist cimetidine competitively blocks

A. Duodenal ulcers, non-malignant gastric ulcers

B. gastroesophageal reflux disease

C. pathological hyper secretion associated with Zollinger-Ellison Syndrome

E. multiple endocrine adenomas

F. It is indicated for prophylaxis of recurrent gastric or duodenal ulcers G. Adjunctive therapy

6. Adverse Drug reactions :

7. Route of administration: cimetidine can be administered:

Orally : Tablets and suspension

8. Contraindications: Cimetidine is contraindicated for patients known to have

10. Dosage Form :

Drug # 10: DIGOXIN

11. Special contraindication of Digoxin:

 Tendon Disorders: Exercise caution in individuals with a history of tendon

 Pregnancy and Lactation: Moxifloxacin is generally not recommended during

 Hypersensitivity: Patients with a known hypersensitivity or allergic reaction to