GPO Pharmacist team

.

.

.
Cough Cold
Remedies


1.

(conventional antihistamine)
Chlorpheniramine,
Brompheniramine, Tripolidine,
Hydroxyzine
2.

(non-sedating

Histamine receptor Block







Acetylcholine





( )



- Onset 15-30



- Cmax 1-2 .
- Duration 3-5 .

-


-
24 .
 ()

Dose
Chlorpheniramine : Child - 0.35
mg/kg/day divided TID
:
Adult 4 mg TID
Brompheniramine : Child 0.125
mg/kg/dose TID
:
Adult 4 mg TID
Hydroxyzine : Child 2
 ()

Dose
Diphenhydramine : Child (6-11 yr.)
12.5-25 mg TID
:
Adult 25-50 mg TID
Dimenhydrinate : Child (6-11
yr.) 25-50 mg TID
:
Adult 50 mg TID
 ()

ADR




Diphenhydramine



-



anticholinergic

-


-




Dose
()
Cetirizine : Child - 5-10 mg QD
: Adult 10 mg QD
Loratadine : Child 5-10 mg QD
: Adult 10 mg
QD
Fexofenadine : Child 30 mg BID
: Adult 60
mg BID or 180 mg QD


Dose
()
Desloratadine : Child 2.5 mg QD
: Adult 5
mg QD
Levocetirizine : Child 2.5 mg QD
: Adult 5
mg QD


()
ADR
()





Precaution


Ketotifen

-
H1 Receptor
- Stabilized Mast cell
mediator

-




()
Ketotifen dose
- Child 0.05 mg/kg/day divided BID
- Adult 1-2 mg/day divided BID
-





ADR
-
 Corticosteroids nasal
spray
Mechanism inflammation
mediator, inh. PG



-


Corticosteroids nasal spray ()

Dose : 1-2 puff QD or BID

ADR :


 :
Dextromethorphan


medulla
threshold

child : 5-10 mg q 4 hr;

max 60 mg/day
adult : 10-20 mg q 4
hr; max 120 mg/day
Drug abuse : more than 360 mg >>

Acetylcysteine

:
disulfide bond

: child 100 mg TID
: adult 100-200 mg
TQID
ADR : N/V, asthma exacerbation

Carbocysteine

:
disulfide bond

: child 8 mg/kg/dose
TID
: adult 375-750 mg
TQID

s - Carbocysteine Lysine

:
disulfide bond

: child 5 ml BID
: adult 30 ml OD or
15 ml BID
ADR : N/V

Bromhexine


:




celia

mucopolysaccharide

: child 0.6-0.8

Ambroxol
:






: child 1.5 mg/kg/day
divided TID
: adult 30 mg TQID

Guaifenesin
:



celia
: child 100-200 mg q 4
hr max 1200 mg/day
adult 200-400 mg q
4 hr max 2400 mg/day
Bronchodilator

beta
adrenergic agonist

-


-
-

Salbutamol
: onset inhaler 30 min, oral 2-3
hr
: duration inhaler 3-4 hr, oral 4-6
hr
: elimination hepatic first-pass
metab.
: 50%
inactive

Salbutamol ()

,
ADR :

: ,

:

:

Terbutaline
: onset oral 30-45 hr
: duration inhaler 3-4 hr, oral 4-6
hr
: metab. inactive sulfate


conjugates

:
Dose Child-0.15 mg/kg/dose TID Max 5
mg/day

Terbutaline ()

ADR : ,
: ,
,
,

:



Theophylline
: metab. demethylation
oxidation

:
: therapeutic window

: Allopurinol,

Cimetidine, INH, Macrolide,

Theophylline ()
, ,

ADR : N / V ,
,
,

Theophylline Toxicity
:
, , ,
, ,

allergy
allergic rhinitis
viral infection (respiratory tract)
Antibacterial agent
 Bacteriostatic vs
Bactericidal
Bacteriostatic











Macrolide, Tetracycline,
Chloramphenicol, Sulfonamide
Bactericidal

Bacteriostatic vs
Bactericidal
 Drug inhibiting cell wall
synthesis
cell wall
peptidoglycan
beta-lactamase
enz.

outer membrane
lipid beta-lactamase
periplasmic space
Penicillin group
 Penicillin group
Classification
1. Natural Penicillin : Pen V, Pen G
(only Inj.)
2. Beta-lactamase resistance penicillin
: Cloxacillin Dicloxacillin
3. Broad spectrum penicillin :
Ampicillin, Amoxicillin



beta-

lactamase
 Penicillin group
MOA :


Penicillin Binding Protein (PBPs)

 Penicillin group
Penicillin V (Abs.

Abs.

)

Child : 25-50 mg/kg/day divided every
6-8 hr. Max 3g./day
Adult : 500 mg. TQID 10 day
Amoxicillin (
Abs. )
Child : EENT 20-50 mg/kg/day divided
 Penicillin group
Amoxicillin (

Abs. )+ Clavulanic acid
Dose up to amoxicillin
Cloxacillin (Abs.

Abs.

)



staphylococcus
Child : 25-50 mg/kg/day divided every
6hr.
 Penicillin group
ADR


(maculopapular rash)

Erythema
multiform
dermatitis, SJS, Erythema multiform,
Anaphylatic shock
SJS

Maculopapul
 Penicillin group
Anaphylaxis 0.04-0.2 %




penicillin cross

Beta-

lactam cephalosporin
 Clavulanic Acid
oxapenam
Streptomyces clavuligerus
beta-lactamase

amoxicillin


Staphylococcus
beta-lactamase : H. Influenzae,
Gonococci, E. coli
Cephalosporin
 Cephalosporin
Classification
- 1st generation
: inh g (+) bact. Enterococci,
MRSA, S. epidermidis
: g (-) bact
M.
catarrhalis, E. coli, P. mirabilis
: Cephalexin, Cefadroxil, Cefazolin
- 2nd generation
: g (-) bact.

 Cephalosporin
Classification
- 3rd generation
: inh g (+) bact.
:
g (-) bact
Enterobacteriaceae

beta-lactamase

: Cefdinir, Cefixime, Ceftibuten, Cefditoren
pivoxil, Cefotaxime,
Ceftriaxone, Cefoperazole, Ceftazidime
 Cephalosporin
1st Gen
2nd Gen 3rd Gen
4th Gen
beta-latamase +
+ +++
++++

Gram + +++
++ ++
+++
 Cephalosporin

MOA :

Penicillin Binding Protein (PBPs)

 Cephalosporin
1st Generation Cephalosporin
: g (+) Enterococci,
Staphylococci
:
g () E. coli

: Cephalexin (
)
Child : 25-100 mg/kg/Day divided every 6-8
hr. Max 4 g./day
otitis media : 75-100
mg/kg/Day divided every 6-8 hr.
 Cephalosporin
2nd Generation Cephalosporin

: spectrum 1st
gen. + H. influenzae
: Cefaclor
Child : 20-40 mg/kg/Day divided every
8-12 hr. Max 1 g./day
Otitis media : 40 mg/kg/Day
divided every 12 hr.
Pharyngitis : 20 mg/kg/Day divided
every 12hr.
Adult : 250-500 mg every 12 hr.
 Cephalosporin
3rd Generation Cephalosporin
: g ()
Enterobacteriaceae
: P. Aeruginosa
Staphylococcus spp.
: beta-lactamse
: Cefixime >>

 Cephalosporin : 3rd Generation
Cephalosporin
: Ceftibuten >>

Child : 9 mg/kg/Day Max 400 mg./day
Adult : 400 mg OD

: Cefdinir
Child : skin infection 7 mg/kg/Dose
BID
Otitis media, pharyngitis,
tonsilitis 14 mg. once daily
Max 600 g./day
 Cephalosporin : 3rd Generation
Cephalosporin
: Cefditoren
Child : 200-400 mg/kg BID
Adult : Chronic bronchitis, Dental
infection 400 mg BID

ADR : penicillin
Macrolide
 Macrolide
Spectrum
: g (+)
Streptococcus,
Corynebacterium diptheria,
Clostridium perfringen, Actinomyces
israelii, Mycobacterium
- g (-)
N. meningitidis, N.
gonorrhoeae, Bordetella pertussin
H. influenzae

 Macrolide
Erythromycin : acid labile
estolate salt,
ethylsuccinate
salt,sterate salt
Child: 30-50 mg/kg/day devided 2-4
timesMax 2 g/day
Adult: 250-500 q 6-12 hr. Max 4
g/day
ADR : N/V/D, abdominal discomfort,
pseudomembranous
 Macrolide

Roxithromycin :


, EENT, ,

:
Child : 2.5-5 mg/kg BID
Adult : 150 mg BID
ADR : N/V/D, abdominal discomfort,
pseudomembranous
 Macrolide
Clarithromycin
:

H.
influenzae, Mycobacterium avium
complex, H. pylori, Toxoplasma
gondii, M. catarrhalis, S. aureus

:

Child : 7.5 mg/kg BID Max 500 mg/day
Adult : 150 mg BID
: ADR : N/V/D, abdominal discomfort,
pseudomembranous
 Macrolide
Azithromycin
:


clarithromycin
:
S. aureus (beta-lactamase),
S. epidermidis, Streptococci group
N. gonorrhoeae

macrolide
:
 Macrolide
Adult : 250 - 500 mg OD for 3 days
URI, Otitis media, soft
tissue infect : 500 mg OD for 3 days
C. trachomatis : 1 g single
dose
N. gonorrhoeae : 2 g single
dose
Fluoroquinolone
 Fluoroquinolone
MOA : inh enzyme 2
DNA gyrase (topoisomerase II)



DNA g (-)
Topoisomerase IV


Daugther DNA g (+)

Spectrum :

 Fluoroquinolone
Spectrum ()

:

g (+) ; Staphylococcus

aureus, Streptococcus spp.
g(-)

:
norfloxacin
 Fluoroquinolone
Norfloxacin :

:

:

Dose : 400 mg BID max 800 mg/day
Dysenteric Enterocolitis (shigellosis) :
5 days
 Fluoroquinolone
Ofloxacin
Dose : 200-400 mg BID
Gonococcal : 400 mg single dose
Bronchitis, Skin infection: 400 mg BID
10 days
UTI : uncomplicate 200 mg BID 3 days
complicate 200 mg BID 7-21
days
Traveller diarrhea : 300 mg BID for 3
days
 Fluoroquinolone

Levofloxacin :
g (+)
Dose : Skin infection : 500 mg OD
Sinusitis : 500 mg OD 10-14 days
Bronchitis: 500 mg OD 7 days
UTI : uncomplicate 250 mg OD 3 days
complicate 250 mg BID 10
days
Precaution :
Tetracycline
 Tetracycline
-
g (+), g (-
), Anaerobe, Rickettsia, Chlamydia,
Mycoplasma, Spirochete Protozoa
- Doxycycline



Tetracycline
- URI



 Tetracycline
MOA :



Ribosome S 30

: 1.


2. ribosome protection
 Tetracycline
Tetracycline :


P. acne

: Child
tooth
discoloration,
 Tetracycline
Doxycycline :
- Child : 100-200 mg/Day divided BID
Chlamydia infection : 100 mg BID for 7
days
- Adult : Bronchitis 100 mg BID for 7
days
Gonococcal infection 100
mg BID for 14 days
Urethritis 100 mg BID for
7 days
 Tetracycline
ADR :
- Anorexia
- N/V/D
- BUN increase (dose related)
Sulfamethoxazole/
trimetoprim
Sulfamethoxazole/Trimetopr
im
MOA : competitive inhibitor

dihydroptheroate syntase

dihydropteric acid

intermediate
folic acid
MOA : inh. Dihydrofolate reductase


dihydrofolate
tetrahydrofolate
Pteridine + dihydropteroic
PABA acid
Dihydropteroate glutamat
synthase e
Dihydrofolic
Inh. By acid NADPH
SULFONAMIDE Dihydrofolate
reductase
NADP
Inh. By Tetrahydrofoli
TRIMETOPRIM c acid

purine

Nucleic acid
synthesis
Sulfamethoxazole/Trimetopr
im
:
g (+) g (-)
S. pyogenes, S. pneumoniae, H.
influenza, H. ducreyi, Actinomyces,
C. trachomatis E. coli
: dose
Child Otitis media : TMP 8 mg/kg
devided q 12 hr. for 10 days
Shigellosis : TMP 8 mg/kg
devided q 12 hr. for 5 days
UTI : TMP 6-12 mg/kg
Sulfamethoxazole/Trimetopr
im
ADR : N/V
: hemolytic anemia
: SJS
: hepatotoxic, anorexia
Clindamycin
 Clindamycin
MOA : inh. Protein synthesis
Ribosome 50s
: anaerobe

: Streptococci group A, S.
aureus, S. pneumoniae, B. fragilis,
C. perfringens
:


:
 Respiratory tract infection
viral infection
pharyngitis
tonsilitis
sinusitis
otitis media
Viral Infection
 Viral Infection

-


-
-

-
Pharyngitis
 Pharyngitis
: inflammation caused by an upper respiratory
tract infection
: Cause
- viral : adenovirus, rhinovirus,
coronavirus etc.
- bacterial : Strep gr.A, M. catarrhalis,
H. influenzae
- fungal (rare) : Candida albicans
- GERD
: Symptoms
- fever, chill (maybe)
- fatique
- cough, sneezing, sore throat
 Pharyngitis
Treatment
- Antihistamine (non sedative vs
sedative)
- Anticough, mucolytic
- Paracetamol or Ibuprofen
- Bronchodilator (if hard cough)
- Gargle several times per day
- Antibiotic in case of Bacterial
infection
 Tonsilitis
: inflammation of the tonsils
: Cause
- viral : adenovirus, rhinovirus,
coronavirus etc.
- bacterial : Strep gr.A, M.
catarrhalis, H. influenzae
: Symptoms
- red and swallen tonsils
(white or yellow patch on the
tonsils)
- fever, chill
 Tonsilitis
: Treatment
- Antihistamine (non sedative vs
sedative)
- Anticough, mucolytic
- Paracetamol or Ibuprofen
- Bronchodilator (if hard cough)
- Gargle several times per day
- Antibiotic in case of Bracterial
infection
- Tonsillectomy (pt. who have infected
five or more time per year)
 Sinusitis

: inflammation of the sinus that occurs

with a viral, bacterial or fungi.
 Sinusitis
: Cause
- viral : adenovirus, rhinovirus,
coronavirus etc.
- bacterial : Strep gr.A, M.
catarrhalis, H. influenzae
Sinusitis can occur from one of these
condition
- Cilia in the sinuses dont work
properly.
- Colds and allergy may cause too much
mucus to be block the opening of
sinuses
 Sinusitis
Classification
- acute : symptoms last up to 4 weeks
- sub-acute : symptoms last 4-12
weeks
- chronic : symptoms last 3 months or
longer

Risk factor
allergic rhinitis, cystic fibrosis,
day care, change in altitude,
smoking, tooth infection, weakended
immune system from HIV or
 Sinusitis
Symptoms
- Bad breath or loss of smell
- Cough
- Fatigue, fever, headache, facial
pain,
- Nasal congestion and discharge
- Sore throat and post nasal drip
 Sinusitis
Treat
- Antihistamine (non sedative)
- Anticough, mucolytic
- Paracetamol or Ibuprofen
- Bronchodilator (if hard cough)
- Nasal irrigation
- Nasal steroid spray
- Antibiotic in case of Bacterial
infection
 Otitis media
: inflammation in middle ear or
infection. Between tympanic mb. and
inner ear (include Eustachian tube)
: most often in 16-18 month.
: Cause
Eustachian tube are blocked by
- respiratory infection
- allergy
- smoking
 Otitis media
Symptoms
: pain
: fever
: difficult in hearing
: dizziness, vertigo
 Otitis media
Risk factor
- Age children 6-36 month -
Secondhand smoke
- Day care - History of
allergy
Treatment
- Antihistamine (non sedative vs
sedative)
- Anticough, mucolytic
- Paracetamol or Ibuprofen
- Bronchodilator (if hard cough)
 G-6-PD
G-6-PD
: Glucose 6
Phosphate Dyhydrogenase Deficiency








acute
renal failure