Displaying 21 - 39 of 39
Therapeutic Code Therapeutic Class Drug Notes
2818 TRANQUILLIZERS
MAJOR TRANQUILLISERS (Neuroleptics) General Indications Used in all forms of psychoses especially schizophrenia. Used in controlling disturbed and parnoid behaviour during the acute phase and for maintenance in low doses. General Side-Effects The following side effects apply generally to all neuroleptics: (a) Central Nervous System effects - extrapyramidal movement disorders, including dystonia and oculogyric crises, parkinsonism, alkathisia and tardive dyskinesia. Patients often complain of sluggishness and weight gain, and at higher doses drowsiness. (b) Autonomic effects - dry mouth, blurred vision, constipation and urinary retention. Tachycardia and postural hypotension are often seen. (c) Endocrine Menstrual irregularities and galactorrhoca (lactation) are seen in a significant percentage. (d) Skin and eye - allergic skin reactions and photo toxicity are uncommon. MINOR TRANQUILLISERS General Indications and Comments For the relief of anxiety and tension in neuroses, as a muscle relaxant and as a hypnotic. Used in the treatment of delirium tremors and status epilepticus in the case of Diazepam. Note Well Nitrazepam, Chlordiazepoxide and Diazepam are all slowly metabolised and accumulate with repeated doses, particulaly in the elderly, who can sometimes lapse into a semi-comatose state on a normal adult dose: Lorazepam has a much shorter half-life (3-8 hours) and is preferable for night sedation. PHENYTOIN NOMOGRAM Given a single reliable serum concentration on a given daily dose of phenytoin, the dose required to achieve a desired serum concentration can be predicted. A line is drawn connecting the observed serum concentration (left‑hand scale) with the dose administered (centre scale) and extended to intersect the right-hand vertical line. From this point of intersection, another line is drawn back to the desired serum level (left-hand scale). The dose required to produce this level can be read off the centre scale. Note: This nomogram will give misleading predictions if the serum concentration measurement is inaccurate, if the patient's compliance is in doubt, or if a change in concurrent treatment has been made since measurement of the serum concentration. (Reproduced with permission from Rambeck et al., 1979).
4028 DIURETICS
Thiazide diuretics are used to relieve the oedema of heart failure as well as to lower blood pressure. They reduce peripheral vascular resistance and for this effect they have a flat dose response curve - i.e. increasing the dose above one or two tablets has little further effect. The potent "loop" diuretics e.g. frusemide are used for quick results in emergencies, e.g. acute pulmonary oedema, and in chronic heart failure resistant to thiazides. They produce much more potassium loss. In hepatic ascites choice of diuretic should be spironolactone first and cautious use of thiazide with potassium later. Loop diuretics can be dangerous as they readily cause hypokalemia and encephalopathy.
4800 RESPIRATORY TRACT AGENTS
4810 RESPIRATORY INFLAMMATORY AGENTS
The non-selective beta agonist isoproterenol has been superseded by the highly specific beta2-agonists salbutamol, fenoterol, orciprenaline and terbutaline in the treatment of bronchospasm. Aerosol inhalers provide more rapid relief and usually cause less side effects than tablets. The dose of drug administered by inhaler is approximately one tenth that of the oral form. Patients must be instructed in the correct use of the inhalers. The very young and the elderly may not be able to master the use of inhalers but the increasing availability of rotahalers, spacers and nebulizers should make inhaled drugs more easily administered. Parenteral preparations are used to treat severe asthmatic attacks. Aminophylline by slow i.v. injection remains the drug of choice but much use is made of beta2-agonists (e.g. Terbutaline) which can be given subcutaneously by the nurse, in preference to the more risky, traditional s.c. adrenaline. There is no useful role for combination tablets containing phenobarbitone and no place for sedatives or tranquilizers in treating attacks.
5200 EAR, EYE , NOSE AND THROAT PREPARATIONS
EAR DROPS There are two types:- (1) Oil or glycerol based; and (2) Antibiotic or Antibiotic/Steroid combination. The former is used entirely as a wax softener. For small wax 3 - 4 drops daily followed by swabbing with cotton buds is recommended. For hard, impacted wax use twice daily for a week followed by syringing. The latter type is used in otitis externa and media if there is no perforation of the ear drum. N.B. Ear drops are contraindicated in traumatic perforation of the ear drum. (It acts as a vehicle for infection to the sterile middle ear cavity via the perforation). EYE DROPS Steroid Eye Drops Care must be taken when using Steroid or Steroid/antibiotic mixture eye drops. Use may cause:- (1) Greatly enhanced Herpes virus (dendritic ulcers) resulting in loss of eye. (2) Steroid induced glaucoma. (3) Steroid induce cataract. Therefore before use it is necessary to perform:- (1) Magnified examination of the cornea. (2) Measurement of the intraocular pressure. In other words steroid eye drops can be dangerous without specialist ophthalmic examination.
5600 GASTROINTESTINAL DRUGS
5608 ANTI-DIARRHOEAL AGENTS
Routine use in the treatment of all diarrhoeal states is not indicated. In most acute diarrhoeas they are unnecessary. They may prolong or worsen the diarrhoea associated with organisms that penetrate the intestinal mucosa i.e. toxigenic e.g. E. Coli, Salmonella, Shigella etc. Barbados is a signatory to the WHO policy on diarrhoeal diseases which encourages the use of Oral Rehydration Salts as the preferred treatment.
5610 ANTIFLATULENTS
5612 CATHARTICS
Many cathartics are available with different mechanisms of action. Saline cathartics e.g. magnesium hydroxide and magnesium sulphate pro-duce a watery evacuation in 1-3 hours. Stimulant cathartics e.g. senna, bisacodyl and agarol produce a soft to semi-fluid stool in 6 - 8 hours. Bulk-formers e.g. Isphagula Husk and Sterculia produce a softening of the stool in 1-3 days. Lubricant cathartics e.g. mineral oil softens the stool in 6-8 hours.
5616 DIGESTANTS
These are drugs that promote the process of digestion in the gastro-intestinal tract in conditions characterized by a lack of one or more of the specified substances that function in the digestion of food.
5640 MISCELLANEOUS G. I. DRUGS
H. Pylori Treatment In the treatment of H. pylori no one regimen can be considered definitive and consideration includes cost, compliance, side-effects, and efficacy. Patients unable to tolerate metronidazole would be better served by the 10-14 days regimen including Ampicillin. Please note that these regimens should be used with proven diagnosis of H. Pylori. 1. 10 - 14 Day Regimen • Proton Pump Inhibitor - twice daily dosing • Ampicillin 1g - twice daily dosing • Clarithromycin 500mg - twice daily dosing 2. 10 Day Regimen (for patients resistant to penicillin) • Proton Pump inhibitor - twice daily dosing • Metronidazole 400mg - twice daily dosing • Clarithromycin 250mg ◦ twice daily dosing • Pepto bismol 2 tbsp four times daily (help to over-come the metronidazole resistance)
6400 HEAVY METAL ANTAGONISTS
The heavy metal antagonists have the property of forming complexes with heavy metals and preventing or reversing the binding of metallic cations to body ligands. These complexes are called chelates. Attention must be paid to the solubility of these complexes and their route of excretion. A list of the antidote and the toxic substance(s) it antagonises is found below: Antidote - Desferrioxamine Toxic Substance - Iron Antidote - Sodium Calciumedetate Toxic Substance - Lead Antidote - Penicillamine Toxic Substance - Copper, Lead
6800 HORMONES AND SYNTHETIC SUBSTITUTES
6820 ANTI-DIABETIC AGENTS
The oral hypoglycaemics are used in insulin independent diabetes mellitus e.g. maturity onset diabetes. Oral sulfonylureas should only be used in combination with insulin under special investigational environments. The routine practice of combining insulin with oral sulfonylureas is not generally encouraged thoughthere may be some clinical circumstances to merit such. They are used to augment caloric and sugar restriction and not to replace it. Metformin is the oral hypoglycaemic of choice in obese, mature onset diabetics, but it is not as well tolerated as the sulphonylureas. Drug Interactions Alcohol: Anti-diabetic agents interact with alcohol to produce excess hypoglycemia and a disulfiram reaction (flushing, sweating, palpitations). Reaction is most pronounced with 1st generation sulphonylureas. Reaction with metformin results in lactic acidosis. Beta Blockers: Hypo/hyperglycemia or hypertension. Propranolol accounts for most interactions and should be avoided. Acarbose: Increased risk of hypoglycemia. Caution patients to carry glucose products rather than sucrose to counteract hypoglycemia. Reaction may be life threatening. MAOI’s: Excessive hypoglycemia, CNS depression, seizures. Monitor blood glucose levels and decrease dose of hypoglycemic agent if necessary.
682008 INSULINS
Insulin is a hormone secreted by the beta cells of the islets of Langerhans located in the pancreas. Insulin preparations are classified as rapid-acting (insulin glulisine, insulin lispro), short-acting (insulin regular human), intermediate -acting (insulin human isophane), or long-acting (insulin insulin glargine). Insulin is used as replacement therapy in the treatment of type 2 diabetes mellitus when the beta cells are not producing any insulin. It is also used in the treatment of diabetic keto-acidosis and hyperos-molar hyperglycemic states. Insulin may also be used as short term treatment in patients with type 2 diabetes who need to undergo major surgery, experience severe trauma, infections, serious renal and hepatic dys-function and those who are pregnant, or in women who develop gestational diabetes. Two major types of insulin are listed as CATEGORY A in the Formulary. These are the short acting, or regular insulin and the intermediate insulin. These are available as the recombinant DNA insulin. Human analogs, insulin glargine and glulisine are available as CATEGORY B for use in patients with type 1 diabetes. Cautions/Side Effects: When prescribing insu-lin,doctors should clearly state the type and dosage of the insulin required. Patients should be given the correct syringes/needles and shown the volume to draw up. Note! Local irritation and lipoatrophy at injection site can be reduced by the routine rotation of the injection site. Additionally, it is recommended that injection sites be rotated within one anatomic region rather than selecting another region to decrease day to day variability in insulin absorp-tion. Patients should inject insulin that is at room temperature to avoid painful injections. Overdose causes hypo-glycaemia. Dose: The dose should be individualized to suit the patient’s condition. It is crucial to check exactly how the patient is measuring the insulin!
682018 SODIUM-GLUCOSE CO-TRANSPORTER INHIBITOR
8000 SERUMS, TOXOIDS AND VACCINES

Immunisation Schedule 2 months - 1st D.P.T.,Hep. B, Hib,Polio, Pneumococcus 4 months - 2ndD.P.T.,Hep. B, Hib,Polio, Pneumococcus 6 months - 3rdD.P.T.,Hep. B, Hib,Polio, Pneumococcus 12 months - 1stM.M.R.& Chicken Pox 18 months - 1st Booster D.P.T & Polio 3-5 years - 2nd M.M.R. 4 ½ years - 2nd Booster D.P.T& Polio 5 - 6 years - B. C. G (at school) 10 – 11+ years - 3rd Booster D.T. & Polio 11+ years HPV (at school) DOSAGE DPT - 0.5ml given intra-muscularly. Polio - 0.2ml orally. Measles or MMR - 0.5ml subcuta-neously in outer aspect of upper arm.

STORAGE OF VACCINE

Diphtheria, Tetanus, and Pertussis vaccine should be stored between 2 C - 8 C. Should not be frozen. Measles or MMR - Best preserved by storing frozen at a temperature of - 10 C to - 30 C or in refrigerator at temperature between +2C and +8C Precautions should be taken to ensure that such temperatures are observed during transportation of vaccine and storage in order to maintain the cold chain.

CONTRAINDICATIONS

  1. Febrile illness.
  2. Diarrhoea. (OPV should be postponed). 
  3. Convulsion within 1-48 hours following pertussis - omit pertussis at next visit.
  4. Rubella should not be given to females when pregnancy is suspected.
  5. Children who have leukaemia or who are on immuno-suppresive therapy e.g. antimetabolites, corticosteroids or in cases of primary immunodeficiency states e.g. hypogamma-globulinemia.

ADVERSE REACTIONS

Diphtheria, Tetanus, and Pertussis -

  1. Mild local reaction consisting of pain, erythema, tenderness and induration at injection site are common and may be associated with systemic reactions including mild to moderate transient fever, chills, malaise and irritability;
  2. more marked reactions such as fever (over 40o C), drowsiness, convulsions, excessive screaming or transient shock-like episodes may occur. Occurence of these features is a CONTRAINDICATION to further injections. Measles Mild fever, rash may occur 5-12 days after vaccine. Omit Measles if child has known allergy to eggs or chicken.
8400 SKIN AND MUCOUS MEMBRANE PREPARATIONS
8800 VITAMINS
Primary vitamin deficiency is due mainly to inadequate intake of nutrients. This is especially so in pregnant and lactating women, pre‑school children and the under-privileged. Most people do not need to take vitamins daily if they eat three balanced meals. Fad diets are often associated with inherent vitamin deficiencies. There is no proven need to take large "mega" doses of vitamins daily especially since the intake of vitamins A, B, and D in large doses may be harmful. There is still no proof that the controversial practice of large daily doses of vitamin C will either prevent or alleviate the symptoms of the "common cold". There is no justification for buying expensive vitamins in the belief that they are better or more potent than less expensive brands. It should be noted that the RDA's (Recommended Dietary Allowances) found on the labels of vitamins are just guides to daily intake and include a surplus to provide for the variation in the requirements of all individuals. Thus the use of multivitamins as a panacea for all conditions, as is the current vogue for vitamin E, or as a substitute for proper eating habits and a balanced diet is not recommended.