Drugs study

Isoxilan brand, Isoxsuprine generic –

Indications/Uses

Uterine hypermotility disorders eg, threatened abortion & uncomplicated premature

labor. Adjunct therapy in the treatment of peripheral vascular disease eg,
arteriosclerosis obliterans, thromboangiitis obliterans (Buerger's disease) & Raynaud's
disease. Relief of symptoms associated w/ cerebrovascular insufficiency.

Dosage/Direction for Use

Uterine hypermotility Oral 20 mg tid-qid when uterine contractions have ceased for at

least 12 hr w/ parenteral isoxsuprine. IV Infusion Initially, 100 mg in 500 mL infusion
fluid w/ starting infusion rate of 0.5 mL/min (10 drops/min). Increase infusion rate in
increments of 10 drops/min at 10 min interval. IM inj 10 mg every 3 hr for 24 hr then 4-6
hr for 48 hr. Circulatory disturbances Oral 20 mg tid-qid. Inj 5-10 mg IM tid.

Administration
May be taken with or without food: May be taken w/ meals, milk or antacids to minimise
GI discomfort.

Special Precautions
Discontinue if rash develops. To avoid pulmonary edema in women treated for
premature labor, monitor for state of hydration, cardiac & resp function. Keep fluid
infusions vol to the min. For infusion, hypotonic dextrose is preferred over isotonic
saline soln. If signs of pulmonary edema develop, discontinue immediately & institute
diuretic therapy. Childn.

Contraindications
Following recent arterial hemorrhage, known heart disease & severe anemia.
Hypotension, tachycardia, premature detachment of the placenta, immediately
postpartum & premature labor if there is infection.

Use In Pregnancy & Lactation

Ileus and respiratory distress syndrome has been found to be more common in the
offspring of pregnant women who received isoxsuprine. Incidence of respiratory distress
syndrome increases as the isoxsuprine concentration in cord blood exceeds 10 ng/mL.
The incidence of hypocalcemia and hypotension rises progressively with increasing
isoxsuprine concentration in the cord blood.
Use isoxsuprine in pregnant women only when the potential benefit outweighs the
potential risk to mother and infant.
There are no reports of problems with isoxsuprine in breastfeeding babies.

Drug Interactions
May cause severe hypotension w/ other vasodilators & antihypertensives.

Decamethasone
Brand names: Decadron, Dexamethasone Intensol, Decadron Phosphate, Injectable,
Dexasone. Drug class(es): glucocorticoids. Dexamethasone systemic is used in the
treatment of: Addison's Disease.

Indications and Dosage

Intra-articular
Inflammatory joint diseases
Adult: 333 mcg to 5 mg depending on the degree of inflammation and the size and
location of the joint. For soft tissues: 2-6 mg. All doses are repeated once every 3-5
days for bursae to once every 2-3 weeks for joints.  Refer to detailed product guideline.
Child: 167-333 mcg/kg daily.

Intravenous
Shock
Adult: 1.67-5 mg/kg slowly over several minutes, may be repeated within 2-6 hours
until condition is stable and usually for up to 72 hours. Alternatively, initial dose may be
followed by continuous infusion of 2.5 mg/kg per 24 hours.
Child: 167-333 mcg/kg daily.

Ophthalmic
Inflammatory eye disorders
Adult: As 0.1% solution: Instill 1 drop 4-6 times daily. Severe conditions: Instill 1 drop
hourly,  then reduced to 1 drop 4 hourly as the inflammation subsides.

Oral
Anti-inflammatory or immunosuppressive
Adult: Initially, 0.5-9 mg daily in divided doses. Max: 1.5 mg daily. Dosage is
individualised and adjusted depending on the disease being treated and patient
response. Refer to detailed product guideline.
Child: Initially, 0.02-0.3 mg/kg daily in 3-4 divided doses. Dose depends on disease
severity and patient response. Refer to detailed product guideline.
Administration
Should be taken with food.

Contraindications
Systemic fungal infections; systemic infection unless being treated with specific anti-
infectives. Perforation of drum membrane (otic). Administration of live virus vaccine.

Special Precautions
Patient with hypertension, acute MI,  heart failure, diabetes mellitus, gastrointestinal
diseases (e.g. diverticulitis intestinal anastomoses, active or latent peptic ulcer
ulcerative colitis); ocular diseases (e.g. cataracts, glaucoma, history of ocular herpes
simplex); osteoporosis, history of seizure disorder, thyroid disease. Renal and hepatic
impairment. Elderly. Children. Pregnancy and lactation. Avoid abrupt withdrawal or rapid
dose reduction.

Adverse Reactions
Significant: Adrenal suppression (e.g. hypercortisolism, suppression of hypothalamic-
pituitary-adrenal [HPA] axis); Kaposi sarcoma; myopathy; perineal irritation, psychiatric
disturbance, immunosuppression (e.g. secondary infections, activation of latent
infections, mask acute infection); increased intra-ocular pressure, open-angle glaucoma
and cataracts. Rarely, anaphylactoid reactions
Endocrine disorders: Growth retardation in children.
Eye disorders: Bacterial keratitis, eye irritation and pruritus, burning sensation, ocular
discomfort.
General disorders and admin site conditions: Impaired wound healing.
Investigations: Weight gain.
Metabolism and nutrition disorders: Cushing’s syndrome, obesity.
Musculoskeletal and connective tissue disorders: Osteoporosis.
Nervous system disorders: Headache, muscle atrophy.
Psychiatric disorders: Euphoria, depression, suicidal tendencies.
Skin and subcutaneous tissue disorders: Skin fragility.

Patient Counseling Information

Ophth: This drug may cause blurring of vision, if affected, do not  drive or reinsert
operate machinery. Remove contact lenses prior to ophthalmic administration and after
15 minutes.

Overdosage
Symptoms: Anaphylactic and hypersensitivity reactions. Management: Supportive
treatment. May administer adrenaline, aminophylline; provide  positive pressure
ventilation.
Action
Description: Dexamethasone is a highly potent and long-acting glucocorticoid which
acts as an anti-inflammatory agent by suppressing neutrophil migration, decreasing
production of inflammatory mediators, reversing increased capillary permeability, and
suppressing immune response. It lacks mineralocorticoid properties and has minimal
Na-retaining properties which makes it suitable for treating conditions where water
retention is a disadvantage.
Pharmacokinetics:
Absorption: Readily absorbed from the gastrointestinal tract. Time to peak plasma
concentration: 1-2 hours (oral); approx 30-120 minutes (IM); 5-10 minutes (IV).
Distribution: Crosses placenta and enters breast milk. Plasma protein binding: Approx
77%, mainly to albumins.
Metabolism: Metabolised in the liver by CYP3A4 enzyme.
Excretion: Via urine (up to 65%). Elimination half-life: 4±0.9 hours (oral); approx 1-5
hours (IV).

Nubain

Generic Name : Nalbuphine

Indications/Uses
Relief of moderate to severe pain. Pre-op analgesia, as a supplement to balanced or
surgical anesth, for obstet analgesia during labor & relief of pain following MI. Post-op
somatic & visceral pain.

Dosage/Direction for Use

SC/IM/IV Adult 0.15-0.2 mg/kg. Dose may be repeated every 3-6 hr or as
needed. Childn 0.1-0.2 mg/kg up to a total single dose of 10 mg. Dose may be
repeated every 3-6 hr or as needed.

Contraindications
Hypersensitivity.

Special Precautions
Emotionally unstable patients or those w/ history of narcotic abuse. Abrupt w/drawal
during chronic use. Presence of head injury, intracranial lesions or preexisting increase
in intracranial pressure. Concomitant use w/ narcotic analgesic, general anesth,
phenothiazines or other tranquilizers, sedatives, hypnotics or other CNS depressants
(including alcohol). Impaired respiration; renal or hepatic function. May impair ability to
drive or operate machinery. Pregnancy & lactation.

Adverse Reactions
Sedation, drowsiness, sweating, nausea, dry mouth & dizziness.

Use In Pregnancy & Lactation

Caution should be exercised when administered to pregnant and nursing patients.
Nalbuphine should only be administered when in the judgment of the physician, the
potential benefits outweigh the possible hazards.
Use in pregnancy: Safe use of Nubain in pregnancy (other than labor) has not been
established. It should only be administered to pregnant women (other than in labor)
when, in the judgment of the physician, the potential benefits outweigh the possible
hazards. Potent analgesics should be used with caution in women delivering premature
infants. In full-term labor, 10-15 mg of nalbuphine has provided analgesia equivalent to
that of 75-113 mg of meperidine with fewer maternal side effects.
Use During Labor and Delivery: The placental transfer of nalbuphine is high, rapid and
variable with a maternal-to-fetal ratio ranging from 1:0.37 to 1:1.6. Fetal and neonatal
adverse effects that have been reported following the administration of nalbuphine to
the mother during labor include fetal tachycardia, respiratory depression at birth, apnea
and cyanosis. Maternal administration of naloxone during labor has normalized these
effects in some cases. Severe and prolonged fetal bradycardia has been reported.
Permanent neurological damage attributed to fetal bradycardia has occurred. A
sinusoidal fetal heart rate pattern associated with the use of nalbuphine has also been
reported.
Nubain should be used with caution in women during labor and delivery and newborns
should be monitored for respiratory depression, apnea, bradycardia and arrhythmias if
Nubain has been used.

Drug Interactions
Additive effect w/ narcotic analgesic, general anesth, phenothiazines or other
tranquilizers, sedatives, hypnotics or other CNS depressants (including alcohol).

Action
Pharmacology: Pharmacokinetics: Nalbuphine HCl is a potent analgesic, 10 mg of
which is comparable in analgesic potency to 8-10 mg of morphine sulfate, whether
administered IV, SC or IM.
The onset of action occurs within 2-3 min after IV administration of nalbuphine HCl and
in <10 min following SC or IM injection.
Clinical experience suggests that in some patients, analgesia may be longer lasting
than from comparable doses of morphine, effects having been observed in acute and
chronic pain for 3-8 hrs. The half-life (t½) of nalbuphine is 5 hrs.
Nubain has the effect of lowering the cardiac work load and can be used immediately in
myocardial infarction (use with caution where emesis is involved). Hemodynamic
studies in patients with severe arteriosclerotic heart changes reveal that nalbuphine HCl
has circulatory effects similar to those of morphine ie, a minimal decrease in oxygen
consumption, cardiac index, left ventricular end diastolic pressure and cardiac work.
Nubain antagonist activity is ¼ as potent as nalorphine and approximately 1/40 that of
naloxone.

Benadryl AH

Generic Name : Diphenhydramine.

Indications and Dosage

Oral
Allergic conditions, Motion sickness
Adult: 25-50 mg 3 or 4 times daily. Max: 300 mg daily. For prevention of motion
sickness, administer 30 minutes before exposure to motion.
Child: 2-6 years 6.25 mg 4-6 hourly; 6-12 years 12.5-25 mg 4-6 hourly; >12
years Same as adult dose. For prevention of motion sickness, administer 30 minutes
before exposure to motion.

Oral
Short-term management of insomnia
Adult: 50 mg given 30 minutes before bedtime as needed.

Parenteral
Allergic conditions, Motion sickness
Adult: 10-50 mg up to 100 mg if needed via IV inj at a rate of 25 mg/min or deep IM inj.
Max: 400 mg daily. For prevention of motion sickness, administer 30 minutes before
exposure to motion.
Child: 5 mg/kg via IV inj at a rate of 25 mg/min or deep IM inj in 4 divided doses. Max:
300 mg daily. For prevention of motion sickness, administer 30 minutes before
exposure to motion.

Administration
May be taken with or without food.

Incompatibility
IV/IM: Incompatible with amphotericin B, cefmetazole, cefalotin, hydrocortisone Na
succinate, soluble barbiturates, contrast media, and strong acids or alkali solutions.

Contraindications
Stenosing peptic ulcer or pyloroduodenal obstruction. Premature infants and neonates.
Lactation. Concomitant use with other antihistamine-containing medicines (including
topical antihistamines).
Adverse Reactions
Significant: Drug tolerance (continuous use). Rarely, eczematous reactions (topical).
Blood and lymphatic system disorders: Haemolytic anaemia, thrombocytopenia,
agranulocytosis.
Cardiac disorders: Palpitations, tachycardia, extrasystoles.
Gastrointestinal disorders: Dry mouth, epigastric distress, nausea, vomiting, diarrhoea,
constipation.
General disorders and admin site conditions: Fatigue.
Metabolism and nutrition disorders: Anorexia.
Nervous system disorders: Sedation, drowsiness, restlessness, dizziness, excitability
(children), headache.
Psychiatric disorders: Disturbance in attention, confusion, nervousness.
Renal and urinary disorders: Urinary frequency, urinary retention, difficulty in micturition.
Respiratory, thoracic and mediastinal disorders: Thickening of bronchial secretions.
Skin and subcutaneous tissue disorders: Sensitisation reaction, photosensitivity.
Vascular disorders: Hypotension.

Special Precautions
Patient with narrow-angle glaucoma, prostatic hypertrophy or genitourinary obstruction,
urinary retention, asthma, bronchitis, COPD, CV disease (e.g. hypertension, ischaemic
heart disease), thyroid disorder, myasthenia gravis, seizure disorders (e.g. epilepsy).
Moderate to severe renal and hepatic impairment. Elderly. Pregnancy.

MonitoringParameters
Monitor mental alertness.

Food Interaction
May potentiate sedative effects of alcohol.

Action
Description: Diphenhydramine, a monoethanolamine derivative, is an antihistamine
with sedative and antimuscarinic properties. It competes with histamine for H 1 receptor
sites on effector cells in the blood vessels, gastrointestinal tract, and respiratory tract.
Duration: Histamine-induced wheal suppression: ≤10 hours; histamine-induced flare
suppression: ≤12 hours.
Pharmacokinetics:
Absorption: Well absorbed from the gastrointestinal tract. Bioavailability: 42-62%. Time
to peak plasma concentration: Approx: 1-4 hours.
Distribution: Widely distributed throughout the body including the CNS. Crosses the
placenta, enters breastmilk. Volume of distribution: 17 L/kg. Plasma protein binding:
98.5%.
Metabolism: Extensively metabolised in the liver by CYP2D6 isoenzyme via N-
demethylation and minor demethylation by CYP1A2, 2C9, 2C19; smaller degrees in
pulmonary and renal systems; undergoes significant first-pass effect.
Excretion: Mainly via urine (as metabolites and unchanged drug). Elimination half-life:
2.4-9.3 hours.

Ketorolac generic name

Toradol brand name

Indications and Dosage

Nasal
Moderate to severe pain
Adult: 1 spray (15.75 mg) in each nostril every 6-8 hours. Max: 126 mg daily. <50 kg: 1
spray (15.75 mg) in only 1 nostril every 6-8 hours. Max: 63 mg daily.
Elderly: 1 spray (15.75 mg) in only 1 nostril every 6-8 hours. Max: 63 mg daily.

Ophthalmic
Prophylaxis and reduction of postoperative ocular inflammation
Adult: As 0.5% solution: Instill 1 drop into the affected eye(s) 4 times daily starting 24
hours after ocular surgery, continue for 2 weeks of the postoperative period. As 0.45%
solution: Instill 1 drop into the affected eye(s) bid starting 24 hours prior to ocular
surgery until the day of surgery, continue for 2 weeks of postoperative period. As 0.4%
solution: Instill 1 drop into the affected eye(s) 4 times daily as necessary for up to 4
days after surgery.

Oral
Postoperative pain
Adult: Moderate to severe: As a continuation therapy from parenteral (IM/IV) dosing:
Initially, 20 mg followed by 10 mg every 4-6 hours as needed. <50 kg: Initially, 10 mg
followed by 10 mg every 4-6 hours as needed. Max: 40 mg daily. Max duration: 5 days
(combined oral and parenteral).
Elderly: Moderate to severe: As a continuation therapy from parenteral (IM/IV) dosing:
Initially, 10 mg followed by 10 mg every 4-6 hours as needed. Max: 40 mg daily.

Incompatibility
Syringe: Morphine, meperidine, promethazine, hydroxyzine.

Contraindications
Hypersensitivity to ketorolac, aspirin or other NSAIDs. History of bronchospasm,
asthma, rhinitis, urticaria or other allergic-type reactions associated with aspirin or
NSAID therapy. active or history of peptic ulceration, gastrointestinal bleeding or
perforation, confirmed or suspected cerebrovascular bleeding, haemorrhagic diathesis,
incomplete haemostasis, high risk of bleeding; severe heart failure, risk of renal failure
due to volume depletion or dehydration, treatment of pain in the setting of CABG, or
prophylactic analgesic prior to any major surgery, labour and delivery. Moderate to
severe renal and severe hepatic impairment. Pregnancy (3rd trimester). Concomitant
use with aspirin or NSAIDs, probenecid, pentoxifylline.
Adverse Reactions
Significant: Renal papillary necrosis, acute renal failure, interstitial nephritis, nephrotic
syndrome, hypertension, fluid retention, hyperkalaemia. Rarely, blood dyscrasias (e.g.
agranulocytosis, thrombocytopenia, aplastic anaemia). Ophthalmic: Keratitis, corneal
thinning, erosion, ulceration or perforation.
Ear and labyrinth disorders: Tinnitus.

MonitoringParameters
Monitor blood pressure, CBC, chemistry profile, LFT, renal function (e.g. serum
creatinine, BUN, urine output), signs and symptoms of bleeding or gastrointestinal
effects (e.g. bleeding, abdominal pain).

Drug Interactions
Increased risk of bleeding with other NSAIDs, corticosteroids, SSRIs, anticoagulants,
antiplatelet agents (e.g. aspirin), and pentoxifylline. Increased plasma concentration
with probenecid, lithium, cardiac glycosides (e.g. digoxin) and methotrexate. May
enhance nephrotoxicity with ACE inhibitors, angiotensin II antagonists, ciclosporin, and
diuretics. Increased risk of seizure with antiepileptic drugs (e.g. phenytoin,
carbamazepine). Hallucination may occur when used with psychoactive drugs (e.g.
fluoxetine, thiothixene, alprazolam). May enhance adverse effect (e.g. apnoea) of
nondepolarizing muscle relaxants.

Food Interaction
Decreased peak concentrations and delayed time to peak concentrations with high-fat
food.

Action
Description: Ketorolac, a pyrrolizine carboxylic acid derivative, is an NSAID that
reversibly inhibits cyclooxygenase-1 and -2 (COX-1 and -2) enzymes, resulting in
decreased formation of prostaglandin precursors. It has antipyretic, anti-inflammatory
and analgesic properties.
Onset: Analgesic: 30-60 minutes (oral); approx 30 minutes (IV/IM); within 20 minutes
(nasal).
Duration: Analgesic: 4-6 hours.
Pharmacokinetics:
Absorption: Well absorbed from the gastrointestinal tract after oral administration;
rapidly and completely absorbed following IM administration. Bioavailability: 100% (Oral,
IM); approx. 60% (nasal). Time to peak plasma concentration: Approx 45 minutes (oral);
1-3 minutes (IV); 30-60 minutes (IM).
Distribution: Poor penetration into the cerebrospinal fluid, crosses placenta and
present in breastmilk (small amounts). Volume of distribution: Approx 13 L. Plasma
protein binding: 99%.
Metabolism: Metabolised in the liver via glucuronic acid conjugation and hydroxylation.
Excretion: Via urine (approx 92%; approx. 60% as unchanged drug), faeces (approx
6%). Elimination half-life: Approx 5 hours (S-enantiomer: approx 2.5 hours, R-
enantiomer: 5 hours).

Mefenanic acid generic name

Brand Name: Ponstel

Indications and Dosage

Oral
Dental pain, Headache, Menorrhagia, Mild to moderate pain, Osteoarthritis, Pain
and inflammation associated with musculoskeletal and joint disorders,
Postoperative pain, Primary dysmenorrhoea, Rheumatoid arthritis
Adult: 500 mg tid.
Child: ≥14 years Same as adult dose.
Elderly: Initiate at a lower dose and shortest possible duration.

Renal Impairment
Severe: Contraindicated.

Hepatic Impairment
Severe: Contraindicated.

Administration
Should be taken with food.

Contraindications
Hypersensitivity. Patients with active or history of recurrent peptic ulcer/haemorrhage,
history of gastrointestinal bleeding or perforation (related to previous NSAID therapy),
inflammatory bowel disease, severe heart failure, history of asthma, bronchospasm,
rhinitis, angioedema, urticaria, or allergic-type reactions after taking aspirin or other
NSAIDs.

Adverse Reactions
Significant: Anaphylactoid reactions, fluid retention, anaemia, hyperkalaemia.
Blood and lymphatic system disorders: Eosinophilia, leukopenia, thrombocytopenia,
purpura, agranulocytosis.
Cardiac disorders: Dyspnoea.
Action
Description: Mefenamic acid, an anthranilic acid derivative, is an NSAID. It reversibly
inhibits cyclooxygenase-1 and -2 (COX-1 and -2), thus resulting in reduced rate of
prostaglandin synthesis. It exhibits analgesic, anti-inflammatory and antipyretic
properties.
Pharmacokinetics:
Absorption: Rapidly absorbed from the gastrointestinal tract. Time to peak plasma
concentration: 2-4 hours.
Distribution: Present in breast milk. Volume of distribution: 1.06 L/kg. Plasma protein
binding: >90% to albumin.
Metabolism: Metabolised in the liver by CYP2C9 isoenzyme to 3-hydroxymethyl
mefenamic acid, which may then be oxidised to 3-carboxymefenamic acid.
Excretion: Via urine (approx 52%; 6% as glucuronides, 25% as 3-hydroxymefenamic
acid, 21% as 3-carboxymefenamic acid), faeces (up to 20%, mainly as unconjugated 3-
carboxymefenamic acid). Elimination half-life: Approx 2 hours.

Clomitene: brand name

Generic Name : Metoclopramide

Indications and Dosage

Intravenous
Prophylaxis of chemotherapy-induced nausea and vomiting
Adult: Loading dose: 2-4 mg/kg via continuous infusion over 15-20 minutes.
Maintenance: 3-5 mg/kg infused over 8-12 hours. Alternatively, initial dose of up to 2
mg/kg via intermittent infusion over at least 15 minutes, may be given before cancer
therapy and repeated at 2-hourly intervals. Max total: 10 mg/kg in 24 hours.
Child: As 2nd line option: Usual dose: 1-18 years 0.1-0.15 mg/kg up to tid. 1-<3
years 10-14 kg: 1 mg; 3-<5 years 15-19 kg: 2 mg; 5-<9 years 20-29 kg: 2.5 mg; 9-18
years 30 kg-60 kg: 5 mg; 15-18 years >60 kg: Same as adult dose. All doses to be
given up to tid. Max: 0.5 mg/kg in 24 hours. Max duration: 5 days.
Elderly: Dosage reduction may be needed.

Intravenous
Nausea and vomiting, Prophylaxis of nausea and vomiting associated with
radiation therapy
Adult: 10 mg up to tid. Max: 30 mg or 0.5mg/kg daily.
Child: As 2nd line option: Usual dose: 1-18 years 0.1-0.15 mg/kg up to tid. 1-<3
years 10-14 kg: 1 mg; 3-<5 years 15-19 kg: 2 mg; 5-<9 years 20-29 kg: 2.5 mg; 9-18
years 30 kg-60 kg: 5 mg; 15-18 years >60 kg: Same as adult dose. All doses to be
given up to tid. Max: 0.5 mg/kg in 24 hours. Max duration: 5 days.
Elderly: Dosage reduction may be needed.
Oral
Nausea and vomiting, Prophylaxis of nausea and vomiting associated with
radiation therapy
Adult: 10 mg up to tid. Max: 30 mg or 0.5 mg/kg daily. Recommended Max treatment
duration: 5 days.
Elderly: Dosage reduction may be needed.

Dosage/Direction for Use

10 mg tid by IM or slow IV inj, max 0.5 mg/kg body wt. Before cancer therapy Loading
dose: 2-4 mg/kg body wt by continuous IV infusion over 15-30 min. Maintenance: 3-5
mg/kg by continuous IV infusion over 8-12 hr. Or initial: 2 mg/kg by IV infusion over at
least 15 min & repeated every 2 or 3 hr for 5 doses. Max: 10 mg/kg in 24 hr.

Special Precautions
Pheochromocytoma. Renal & hepatic impairment. Childn & elderly.

Adverse Reactions
Extrapyramidal symptoms. Occasionally, parkinsonism & tardive dyskinesia during
prolonged treatment in elderly. Restlessness, drowsiness, dizziness, headache & bowel
upsets. Hypotension, HTN & depression. Blood disorders, hypersensitivity reactions,
neuroleptic malignant syndrome & urinary incontinence. Galactorrhea or related
disorders.

Administration
Should be taken on an empty stomach. Take 30 min before meals.

Contraindications
Patient with gastrointestinal perforation, haemorrhage or mechanical obstruction,
suspected or known pheochromocytoma or other catecholamine-releasing
paragangliomas, history of neuroleptic or drug-induced tardive dyskinesia, seizure
disorder (e.g. epilepsy), Parkinson’s disease, known history of methaemoglobinaemia
with metoclopramide or nicotinamide adenine dinucleotide-cytochrome b5 reductase
(NADH-Cyb5R) deficiency. Concomitant use with drugs which may cause
extrapyramidal reactions (e.g. antipsychotics, levodopa). Children <1 year.

Adverse Reactions
Significant: Dystonic reactions, akathisia, parkinsonian symptoms, tardive dyskinesia,
methaemoglobinaemia, circulatory collapse, severe bradycardia, cardiac arrest, QT
prolongation, sinus arrest, torsades de pointes. depression, suicidal ideation;
gynaecomastia, galactorrhoea, amenorrhoea and impotence secondary to
hyperprolactinaemia,
Blood and lymphatic system disorders: Rarely, agranulocytosis, leucopenia,
neutropenia, sulfhaemoglobinaemia.
Action
Description: Metoclopramide is a substituted benzamide with prokinetic and antiemetic
properties. It stimulates the motility of the upper gastrointestinal tract and accelerates
gastric peristalsis without stimulating gastric, biliary or pancreatic secretions, leading to
increased gastric emptying and intestinal transit time. It blocks dopamine receptors and
serotonin receptors (at higher doses) in chemoreceptor trigger zone of the CNS.
Onset: 30-60 minutes (oral); 1-3 minutes (IV); 10-15 minutes (IM).
Duration: 1-2 hours.
Pharmacokinetics:
Absorption: Rapidly and almost completely from the gastrointestinal tract after oral
administration. Absolute bioavailability: 80±15.5%. Time to peak plasma concentration:
Approx 1-2 hours (oral).
Distribution: Extensively distributed to body tissues. Crosses the blood-brain barrier
and placenta and enters breast milk at low level. Volume of distribution: Approx 3.5
L/kg. Plasma protein binding: Approx 30%.
Metabolism: Metabolised in the liver by CYP2D6 via oxidation and glucuronide and
sulfate conjugation to major metabolite, monodeethylmetoclopramide. Undergoes
hepatic first-pass metabolism.
Excretion: Via urine (approx 85%, with approx 50% as free or conjugated
metoclopramide); faeces (approx 5%). Elimination half-life: 2.5-6 hours.

Cefavex: brand name

Generic Name : Cefazolin

Indications and Dosage

Parenteral
Susceptible infections
Adult: Mild: 0.25-0.5 g 8 hrly. Moderate to severe: 0.5-1 g 6-8 hrly. Severe, life-
threatening: 1-1.5 g 6 hrly. Max: 12 g daily. All doses to be given by deep IM inj, slow IV
inj over 3-5 min, or intermittent or continuous IV infusion.
Child: >1 yr 25-50 mg/kg daily in 3 or 4 divided doses to be given by deep IM inj, slow
IV inj over 3-5 min, or intermittent or continuous IV infusion. Max: 100 mg/kg daily in
divided doses for severe infections.

Parenteral
Acute uncomplicated urinary tract infections
Adult: 1 g 12 hrly to be given by deep IM inj, slow IV inj over 3-5 min, or intermittent or
continuous IV infusion. Max: 12 g daily.
Child: >1 yr 25-50 mg/kg daily in 3 or 4 divided doses to be given by deep IM inj, slow
IV inj over 3-5 min, or intermittent or continuous IV infusion. Max: 100 mg/kg daily in
divided doses for severe infections.
Incompatibility
Aminoglycosides. Y-site: Amphotericin B cholesteryl sulfate complex, caspofungin,
idarubicin, pemetrexed, pentamidine, vinorelbine. Variable: Amiodarone, anakinra,
cisatracurium, doxapram, hetastarch in NS, hydromorphone, pantoprazole,
promethazine, vancomycin.

Contraindications
Hypersensitivity to cephalosporins.

Special Precautions
Patient w/ history of hypersensitivity to penicillins, GI disease particularly colitis, seizure
disorder. Renal impairment. Pregnancy and lactation.

Adverse Reactions
Diarrhoea, oral candidiasis, vomiting, nausea, stomach cramps, anorexia; eosinophilia,
itching, drug fever, skin rash, Stevens-Johnson syndrome; neutropenia, leucopenia,
thrombocytopenia, thrombocythemia; transient elevation in SGOT, SGPT and alkaline
phosphatase levels; hepatitis; increased BUN and creatinine levels, renal failure;
phlebitis, induration; genital and anal pruritus (e.g. vulvar pruritus, genital moniliasis,
vaginitis).
Potentially Fatal: Anaphylaxis, pseudomembranous colitis.

Drug Interactions
May enhance the anticoagulant effect of vit K antagonists (e.g. warfarin). May diminish
the therapeutic effect of Na picosulfate, BCG and typhoid vaccine. May decrease the
protein binding of fosphenytoin and phenytoin. Probenecid may decrease renal tubular
secretion of cefazolin, resulting in increased and prolonged blood levels. May increase
the nephrotoxic effects of aminoglycosides.

Food Interaction
Disulfiram-like reaction w/ alcohol.

Action
Description: Cefazolin binds to 1 or more of the penicillin-binding proteins (PBPs)
which inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell
wall, thus inhibiting biosynthesis and arresting cell wall assembly resulting in bacterial
cell death.
Pharmacokinetics:
Absorption: Poorly absorbed from GI tract. Time to peak plasma concentration: 1 hr
(IM).
Distribution: Diffuses into bone, ascitic, pleural and synovial fluids; CSF (small
amount). Crosses the placenta and enters breast milk. Plasma protein-binding: Approx
85%.
Metabolism: Minimally hepatic.
Excretion: Via urine (80-100% as unchanged drug). Plasma half-life: Approx 1.8 hr.
Actimed Cefuroxime: brand name

Generic Name : Cefuroxime

Indications and Dosage

Intramuscular
Gonorrhoea
Adult: As cefuroxime Na: 1.5 g as a single dose divided between 2 inj sites. May be
given w/ oral probenecid 1 g.

Intravenous
Meningitis
Adult: As cefuroxime Na: 3 g 8 hrly.
Child: ≤3 wk 30-100 mg/kg daily by IV inj given as 2 or 3 divided doses; >3 wk <40 kg:
30-100 mg/kg daily by IV inj given as 3 or 4 divided doses; 60 mg/kg daily to most
infections.

Oral
Susceptible infections
Adult: As cefuroxime axetil: 250 or 500 mg 12 hourly for 7-10 days.
Child: >3 months weighing <40 kg: 15 mg/kg 12 hourly for 7-10 days. Max: 250 mg 12
hourly.

Administration
Oral Susp: Should be taken with food.
Tab: May be taken with or without food.

Incompatibility
Aminoglycosides. Y-site: Azithromycin, filgrastim, fluconazole, midazolam,
pantoprazole, vinorelbine.

Contraindications
Hypersensitivity to cefuroxime or to other cephalosporins.

Special Precautions
History of hypersensitivity to penicillin, and GI disease (particularly colitis). Renal
impairment. Pregnancy and lactation.
Adverse Reactions
Rash, fever, pruritus, erythema, urticaria, Stevens-Johnson syndrome, erythema
multiforme, toxic epidermal necrolysis, serum sickness-like reactions, angioedema; mild
to moderate hearing loss (childn); nausea, vomiting, gagging, epigastric burning, GI
bleeding and infection, abdominal pain, flatulence,

Action
Description: Cefuroxime inhibits bacterial cell wall synthesis by binding to one 1 or
more of the penicillin-binding proteins (PBPs) which in turn inhibit the final
transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting
cell wall biosynthesis and arresting cell wall assembly resulting in bacterial cell death.
Pharmacokinetics:
Absorption: Absorbed from the GI tract. Enhanced by the presence of food. Time to
peak plasma concentration: Approx 2-3 hr (oral); 45 min (IM).
Distribution: Widely distributed into the body (including pleural fluid, synovial fluid,
aqueous humour, sputum, bone), CSF even on inflamed meninges. Crosses the
placenta and enters breast milk. Plasma protein binding: Up to 50%.
Excretion: Via urine (66-100% as unchanged drug); bile (small amounts). Plasma half-
life: Approx 70 min.

Discharge planning

1. General activities
• I'll tell/teach the patient to do some mild physical activities like walking. The
more she is up and out of bed, the faster her recovery will be.
•I'll tell/teach the patient to avoid heavy lifting, strenuous exercise and excessive
stair climbing. A good rule to follow is that she should not lift anything heavier
than her baby in the car seat.
• I'll tell/teach the patient to elevate her feet when sitting or lying down and make
sure the she drink a lot of fluids to help her body get rid of the excess fluid. She
should call her health care provider if one leg is much more swollen than the
other, if she have pain in her leg when walking or if there is a red hot area in one
leg.
• I'll tell/teach the patient to try to get as much rest as she can. Plan to get at
least one nap a day as she will be up frequently during the night with the baby. A
good time to nap is when the baby sleeps. Lack of sleep can affect her mood and
can increase anxiety.
• Allow friends and relatives to help with housework, cooking and other chores.
• I'll tell/teach the patient shower as often as she like, but avoid tub baths or
swimming until after her postpartum checkup. There should be nothing placed in
the vagina until after her postpartum checkup. This means no tampons, douching
or intercourse (sex).
2. Nutrition
• continue to take prenatal vitamins. Eat a well-balanced diet that is high in
protein (meat, fish, legumes), fiber (fruits, vegetables, whole grains), calcium
(milk, yogurt, cheese, green leafy vegetables) and fluids.
3. Uterine changes/bleeding/perineal care
• I'll teach the patient that there is a temporary contractions especially in the early
weeks, breastfeeding mothers may experience more cramping during after
feeding. I'll teach the patient to do a relaxation/breathing techniques and to take
the pain medications that is prescribed by the doctor.
• I'll teach/tell the patient to continue to use peri-bottle to clean her perineum,
rinsing front to back with warm water until the bleeding stops. Use sitz-bath as
directed; this will help dissolve any stitches and aid in healing the perineum.