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Generic name: cefadroxil Brand name: Drozid Dossage: 500 mg capsule 125 mg/5mL Powder for syrup Category:

antibacterial Formulaton: each capsule contains: Cefadroxil (monohydrate) 500mg Each 1 teaspoonful (5 mL) contains: Cefadroxil (monohydrate) 125 mg Indication: Respiratory tract infections: Tonsillitis, pharyngitis, pneumonia, bronchitis, bronchieactasis, lung abscesses, emphysema, pleuritis, sinusitis, laryngitis, otitis media. Urinary tract infections: Pyelonephritis, cystitis, adnexitis, endometritis Skin and soft tissues infections: Lymphangitis, abscesses, cellulitis, decubitus ulcers, mastitis, furunculosis, erysipelas Dosage and administration: Adults: -For treatment of uncomplicated urinary tract infections like cystitis 1-2 g daily, given as single dose or in 2 equally divided doses. For other urinary tract infections: 2 g daily or 2 equally divided doses. -Skin structure infections: 1 g daily given as a single dose or in 2 equally divided doses. -For the treatment of group A beta-hemolytic streptococcal pharyngitis and tonsillitis, the ususal dosage is 1 g daily, as a single dose or in 2 equally divided doses for at least 10 days. -For respiratory infections: usual dosge is 1 g/day in 2 divided doses (500 mg 2 times a day). For moderate to severe infections: the recommended dosage is 1-2 g daily in 2 divided doses (500mg -1000mg every 12 hours) Children: -urinary tract infections and skin infections: 30 mg/kg per day in divided doses every 12 hours -pharyngitis and tonsillitis: Chidlren dosage 30 mg/kg of body weight per day in single dose or in 2 divided doses. -the infection treatment caused by group A beta-hemolytic streptococcus is given at least for 10 days. For dry syrup: Prepare suspension at time of dispensing by adding 37 mL of water. Shake well before use. Contraindications: Patients with known hypersensitivity to cephalosporins. Side effects:

-Gastrointestinal: Nausea, vomiting and diarrhea -Hypersensitivity: Rash, urticaria, and angioedema -Other reactions: Pyrosis, anorexia, dyspepsia, abdominal pain, headache, dizziness, moniliasis, vaginitis, and pseudomembraneous colitis. Warnings and Precautions: -In penicillin-allergic patients due to the possibility of cross-allergy. If a hypersensitivity reaction occurs, the drug should be discontinued and the patient should be treated with usual agents (epinephrine or other pressor amines, antihistamines or corticosteroids). -Should be used with caution in the presence of impaired renal function (creatinine clearance rate <50 mL/min/1.73m2) and patients with colitis. -Reproduction study in mice and rats with doses up to 11 times the human dose have revealed no evidence of impaired fertility or harm the fetus due to Cefadroxil. However, there are no adequate and well controlled studies in pregnant women. -Positive use of Cefadroxil may result in overgrowth of nonsusceptible organisms. -Positive Benedit, Fehling or Clinitest tablets test in glycosuria reported during treatment with Cefadroxil. But not if using enzymatic reaction like Clinistix. Usage during pregnancy and lactation: -Although there have been no reports of adverse effects to the fetus to date, safe use of cephalosporins during pregnancy has not been definitely established. -The drugs should be used during pregnancy only when clearly needed. -Cephalosporins are secreted into the milk, so the drugs should be used with caution in nursing women. Pharmacology: Cefadroxil is rapidly and almost completely absorbed from the gastrointestinal trct. The rate of absorption is unaffected by food. Peak serum concentration +16 and 28 mg/mL are attained within 1-2 hours after single 500 mg and 1000 mg oral dose. The serum shelf-life of Cefadroxil is 1-2 hours in adults with normal renal function and prolonged patients with impaired renal function. Cefadroxil is excreted unchanged about 70-90% within 24 hours. Renal elimination of Cefadroxil is substantially reduced in patients with impaired renal function. In vitro test demonstrates that the cephalosporins are bactericidal because of their inhibition of cell wall synthesis. Sensitive gram-negative organisms are: E. coli, Klebsiella, pneumonia and some strains of P. mirabilis, Haemophylus influenza, Salmonella spp. and Shigella spp. Drug interactions: -Concomitant administration of oral probenecid competitively inhibits tubular secretion resulting in higher and more prolonged serum concentrations of most cephalosporins. -Concurrent use of nephrotoxic agents such as aminoglycosides, colistin, polymyxin beta, or vancomycin may increase the risk of nephrotoxicity with some cephalosporins and probably should be avoided, if possible.

-In vitro studies indicate that the antibacterial activity of cephalosporin may be additive or synergistic with aminoglycosides or penicillins against some organisms. Availability: Cefadroxil 500 mg Capsule, box contains 10 strips of 6 capsules Cefadroxil 125mg/5mL Powder for Syrup, bottle of 60 mL Storage: Store in a dry place, below 30 degrees Celsius Protect from light. Caution: foods, drugs, devices and cosmetics act prohibits dispensing without prescription.

Generice Name: Mefenamic Acid Brand Name:Ponstan, Ponstel Classifications:central nervous system agent;analgesic; nsaid; antipyretic Pregnancy Category:C Availability 250 mg tablets Actions Anthranilic acid derivative. Like ibuprofen inhibits prostaglandin synthesis and affects platelet function. No evidence that it is superior to aspirin. Therapeutic effects Analgesic, antiinflammatory, and antipyretic actions similar to those of ibuprofen. Uses Short-term relief of mild to moderate pain including primary dysmenorrhea.

Contraindications Hypersensitivity to drug;GI inflammation,or ulceration.Safety in children <14 y, during pregnancy (category C), or lactation is not established. Cautious use History of kidney or liver disease;blood dyscrasias;asthma;diabetes mellitus;hypersensitivity to aspirin. Long term use increases risk of serious adverse events. Route & Dosage Mild to Moderate Pain adult: PO Loading Dose 500 mg PO Maintenance Dose 250 mg q6h prn Administration Oral

Give with meals, food, or milk to minimize GI adverse effects. Do not use drug for a period exceeding 1 wk (manufacturers warning).

Adverse effects CNS:Drowsiness, insomnia, dizziness, nervousness, confusion, headache. GI:Severe diarrhea, ulceration, and bleeding; nausea, vomiting, abdominal cramps, flatus, constipation, hepatic toxicity. Hematologic:Prolonged prothrombin time, severe autoimmune hemolytic anemia (long-term use), leukopenia, eosinophilia, agranulocytosis, thrombocytopenic purpura, megaloblastic anemia, pancytopenia, bone marrow hypoplasia. Urogenital:Nephrotoxicity, dysuria, albuminuria, hematuria, elevation of BUN. Skin:Urticaria, rash, facial edema. SpecSenses:Eye irritation, loss of color vision (reversible), blurred vision, ear pain. BodyWhole:Perspiration. CV:Palpitation. Respiratory:Dyspnea; acute exacerbation of asthma; bronchoconstriction (in patients sensitive to aspirin). Nursing implications Assessment & Drug Effects

Assess patients who develop severe diarrhea and vomiting for dehydration and electrolyte imbalance. Lab tests: With long-term therapy (not recommended) obtain periodic complete blood counts, Hct and Hgb, and kidney function tests.

Patient & Family Education

Discontinue drug promptly if diarrhea, dark stools, hematemesis, ecchymoses, epistaxis, or rash occur and do not use again. Contact physician. Notify physician if persistent GI discomfort, sore throat, fever, or malaise occur. Do not drive or engage in potentially hazardous activities until response to drug is known. It may cause dizziness and drowsiness. Monitor blood glucose for loss of glycemic control if diabetic. Do not breast feed while taking this drug without consulting physician.

Cefuroxime Axetil and Cefuroxime Sodium by SHIN DAVID on MARCH 8, 2011 Generic Name: Cefuroxime Axetil Cefuroxime Sodium Brand Name: Cefuroxime Axetil (Ceftin [P.O.]) Cefuroxime Sodium (Zinacef [Parenteral]) Available Forms: Cefuroxime Axetil

Suspension: 125 mg / 5 ml, 250 mg / 5 ml Tablets: 125 mg, 250 mg, 500 mg Cefuroxime Sodium Infusion: 750 mg, 1.5 g premixed, frozen solution Injection: 750 mg, 1.5 g Indications: * Pharyngitis, tonsillitis, infections of the urinary and lower respiratory tracts, and skin and skin-structure infections caused by Streptococcus pneumoniae and S. pyogenes, Haemophillus influenzae, Staphylococcus aureus, Escherichia coli, Moraxella catarrhalis (including betalactamase-producing strains), Neisseria gonorrheae, and Klebsiella and Enterobacter species. * Serious lower respiratory tract infections, UTIs, skin and skin-structure infections, bone and joint infections, septicemia, meningitis, and gonorrhea * Uncomplicated UTIs * Otitis Media * Pharyngitis and Tonsillitis * Perioperative Prevention * Early Lyme Disease (erythema migrans) caused by Borrelia burgdorferi * Secondary bacterial infection of acute bronchitis * Uncomplicated gonorrhea * Acute bacterial maxillary sinusitis caused by Streptococcus pneumoniae or Haemophilus influenza (only strains that dont produce beta-lactamase) Mechanism of Action: Second-generation cephalosporin that inhibits cell-wall synthesis, promoting osmotic instability; usually bactericidal. Adverse Reactions: CV: phlebitis, thrombophlebitis GI: pseudomembranous colitis, nausea, anorexia, vomiting, diarrhea Hematologic: transient neutropenia, eosinophilia, hemolytic anemia, thrombocytopenia Skin: maculopapular and erythematous rashes, urticaria, pain, induration, sterile abscesses, temperature elevation, tissue sloughing at intramuscular injection site Other: hypersensitivity reactions, serum sickness, anaphylaxis. Effects on Lab Test Results: * May increase ALT, AST, alkaline phosphatase, bilirubin, and LDH levels. May decrease hemoglobin and hematocrit level.

* May increase PT and INR and eosinophil count. May decrease neutrophil and platelet counts. * May falsely increase serum or urine creatinine level in tests using Jaffe reaction. May cause false-positive results of Coombs test and urine glucose tests using cupric sulfate (Benedicts reagent or Clinitest). Contraindications and Cautions: * Contraindicated in patients hypersensitive to drug. * Use cautiously in patients hypersensitive to penicillin because of possibility of cross-sensitivity with other beta-lactam antibiotics. * Use with caution in breast-feeding women and in patients with history of colitis or renal sufficiency. Responsibilities: * Before administering, make sure patient is not allergic to penicillins or cephalosporins. * Absorption of cefuroxime axetil is enhanced by food. * Cefuroxime axetil tablets may be crushed if swallowing is a difficulty. Cefuroxime axetil tablets may be dissolved in small amounts of apple, orange or grape juice, even chocolate milk. However, drugs bitter taste is difficult to mask even with food. * High-fat meals increased drug bioavailability. * ALERT! Cefuroxime axetil film-coated tablet and oral suspension are not bioequivalent. * If large doses are given, therapy is prolonged, or patient is at high risk, monitor patient for signs and symptoms of superinfection. * Unlike other second generation cephalosporins, cefuroxime can cross the blood-brain-barrier. * ALERT! Do not confuse with other cephalosporins that sound alike. * Take medication as prescribed, even after feeling better. * Take oral form with food. * If suspension is being used, shake the container well before measuring dose. * Notify prescriber about rashes or superinfections. * Notify prescriber about loose stools or diarrhea.

GENERIC NAME: Ketorolac BRAND NAME: Toradol CLASSIFICATION: Nonsteroidal anti-inflammatory agents, nonopioid analagesics DOSAGE: 30mg/amp1 amp IM MECHANISM OF ACTION: - Inhibits prostaglandin synthesis, producing peripherally mediated analgesia - Also has antipyretic and anti-inflammatory properties. - Therapeutic effect:Decreased pain INDICATION: Short term management of pain (not to exceed 5 days total for all routes combined) CONTRAINDICATIONS: - Hypersensitivity - Cross-sensitivity with other NSAIDs may existPre- or perioperative use - Known alcohol intoleranceUse cautiously in: 1) History of GI bleeding 2) Renal impair-ment (dosage reduction may be required) 3) Cardiovascular disease SIDE EFFECTS/ ADVERSE EFFECTS: - CNS: 1) drowsiness 2) abnormal thinking 3) dizziness 4) euphoria 5) headache- RESP: 1) asthma 2) dyspnea - CV: 1) edema 2) pallor 3) vasodilation - GI: 1) GI Bleeding 2) abnormal taste 3) diarrhea

4) dry mouth 5) dyspepsia 6) GI pain 7) nausea - GU: 1) oliguria 2) renal toxicity 3) urinary frequency - DERM: 1) pruritis 2) purpura 3) sweating 4) urticaria - HEMAT: 1) prolonged bleeding time - LOCAL: 1) injection site pain - NEURO: 1) paresthesia - MISC: 1) allergic reaction, anaphylaxis NURSING IMPLICATIONS/RESPONSIBILITIES: - Patients who have asthma, aspirin-induced allergy, and nasal polyps are at increased risk for developing hypersensitivity reactions. Assess for rhinitis, asthma, and urticaria. - Assess pain (note type, location, and intensity) prior to and 1-2 hr following administration. - Ketorolac therapy should always be given initially by the IM or IV route. Oral therapy should be used only as a continuation of parenteral therapy. - Caution patient to avoid concurrent use of alcohol, aspirin, NSAIDs, acetaminophen, or other OTC medications without consulting health care professional. - Advise patient to consult if rash, itching, visual disturbances, tinnitus, weight gain, edema, black stools, persistent headche, or influenza-like syndromes (chills,fever,muscles aches, pain) occur. - Effectiveness of therapy can be demonstrated by decrease in severity of pain. Patients who do not respond to one NSAIDs may respond to another.

GENERIC NAME: Ranitidine BRAND NAME: Zantac CLASSIFICATION Therapeutic: Anti-ulcer agents Pharmacologic: Histamine H2 antagonists DOSAGE 20 mg IV q8h MECHANISM OF ACTION Inhibits the action of histamine at the H2 receptor site located primarily in gastric parietal cells, resulting in inhibition of gastric acid secretion. In addition, ranitidine bismuth citrate has some antibacterial action against H. pylori. INDICATION Treatment and prevention of heartburn, acid indigestion, and sour stomach. CONTRA INDICATIONS Contraindicated in: Hypersensitivity, Cross-sensitivity may occur; some oral liquids contain alcohol and should be avoided in patients with known intolerance. Use Cautiously in: Renal impair- ment Geriatric patients (more susceptible to adverse CNS reactions) Pregnancy or Lactation SIDE EFFECTS/ ADVERSE EFFECTS CNS: Confusion, dizziness, drowsiness, hallucinations, headache CV: Arrhythmias GI: Altered taste, black tongue, constipation, dark stools, diarrhea, drug-induced hepatitis, nausea GU: Decreased sperm count, impotence

ENDO: Gynecomastia HEMAT: Agranulocytosis, Aplastic Anemia, neutropenia, thrombocytopenia LOCAL: Pain at IM site MISC: Hypersensitivity reactions, vasculitis NURSING IMPLICATIONS/RESPONSIBILITIES Assess patient for epigastric or abdominal pain and frank or occult blood in the stool, emesis, or gastric aspirate. Nurse should know that it may cause false-positive results for urine protein; test with sulfosalicylic acid. Inform patient that it may cause drowsiness or dizziness. Inform patient that increased fluid and fiber intake may minimize constipation. Advise patient to report onset of black, tarry stools; fever, sore throat; diarrhea; dizziness; rash; confusion; or hallucinations to health car professional promptly. Inform patient that medication may temporarily cause stools and tongue to appear gray black.

tramadol + paracetamol

Indications Dosage

Moderate to severe pain. PO 12 yr: Per tab contains tramadol HCl 37.5 mg and paracetamol 325 mg: 2 tab 6 hrly. Max: 8 tab/day. Click to view tramadol + paracetamol Dosage by Indications For action to be taken in the event of accidental overdose ... click to view tramadol + paracetamol Hypersensitivity to tramadol, paracetamol or opioids. Situations where opioid use may be contra-indicated (e.g. acute intoxication with alcohol, hypnotic drugs, centrally-acting analgesics, opioids or psychotropic drugs). Severe hepatic impairment, uncontrolled epilepsy. Concurrent use or within 2 wk of discontinuation from MAOIs. Not recommended in severe renal impairment (CrCl <10 ml/min), severe respiratory insufficiency, liver disease or opioid dependent patients. Increased intracranial pressure or head injury, patients at risk of seizures or on drugs that may lower the seizure threshold (e.g. SSRI, TCA, antipsychotics, centrally acting analgesics or local anaesthesia), biliary tract

Overdosage Contraindications

Special Precautions

disorders, in a state of shock or unconsciousness. May impair ability to drive or operate machinery. Avoid abrupt withdrawal. May cause withdrawal symptoms, dependence and abuse. Elderly. Pregnancy, lactation. Adverse Drug Reactions Nausea, vomiting, constipation, diarrhoea, abdominal pain, dry mouth, dyspepsia, flatulence, dizziness, somnolence, headache, confusion, mood changes, nightmares, amnesia, sweating, pruritus. Potentially Fatal: Severe anaphylactic reactions. Increased risk serotonin syndrome with SSRI and triptans. Increased risk of seizures of SSRI, TCA, antipsychotics, centrally acting analgesics or local anaesthesia. Decreased tramadol levels with carbamazepine. Decreased analgesic efficacy of tramadol with ondansetron. Increased INR with warfarin. Potentially Fatal: Increased risk of serotonin syndrome with MAOIs, avoid concurrent use or within 2 wk of discontinuation from MAOIs. Increased risk of CNS and respiratory depression with CNS depressants (e.g.alcohol, opioids, anaesthetic agents, narcotics, phenothiazines, tranquilizers or sedative hypnotics). Click to view more tramadol + paracetamol Drug Interactions For details of the mechanism of action, pharmacology and pharmacokinetics and toxicology ... click to view tramadol + paracetamol Analgesics (Opioid) N02AX02 - Tramadol ; Belongs to the class of other opioids. Used to relieve pain. N02BE01 - Paracetamol ; Belongs to the class of anilide preparations. Used to relieve pain and fever.

Drug Interactions

Mechanism of Action MIMS Class ATC Classification

GENERIC NAME: ranitidine


DRUG CLASS AND MECHANISM: Ranitidine is an oral drug that blocks the production of acid by acid-producing cells in the stomach. It belongs to a class of drugs called H2 (histamine-2) blockers that also includes cimetidine(Tagamet), nizatidine (Axid), and famotidine (Pepcid). Histamine is a naturally-occurring chemical that stimulates cells in the stomach (parietal cells) to produce acid. H2blockers inhibit the action of histamine on the cells, thus reducing the production of acid by the stomach. Since excessive stomach acid can damage the esophagus, stomach, and duodenum and lead to inflammation and ulceration, reducing stomach acid prevents and heals acid-induced inflammation and ulcers. The FDA approved ranitidine in October 1984. PRESCRIPTION: yes; OTC (Zantac 75 and 150 mg) GENERIC AVAILABLE: yes PREPARATIONS: Tablets or Capsules: 25, 75, 150 and 300 mg; Syrup: 15 mg/ml; Injection: 1 mg/ml or 25 mg/ml. STORAGE: Tablets should be stored at room temperature between 1530 C (59-86 F) in a tightly closed container. Syrup and injection should be stored between 4 and 25 C (39 and 77 F).

PRESCRIBED FOR: Ranitidine is useful in promoting the healing of ulcers in the stomach and duodenum, and in reducing ulcer pain. Ranitidine has been effective in preventing ulcer recurrence when given in low doses for prolonged periods of time. It also is used as needed for the treatment of occasional heartburn to reflux of acid into the esophagus. In doses higher than that used for the treatment of ulcers, ranitidine has been helpful in treating heartburn and in healing ulcers and inflammation of the esophagus resulting from acid reflux (erosive esophagitis). It is also used for treating Zollinger Ellison syndrome, a syndrome caused by tumors that stimulate the stomach to produce large amounts of acid. DOSING: Ranitidine may be taken with or without food. Usual oral doses for treating ulcers and GERD are 150 mg twice daily or 300 mg at bedtime. The maintenance dose is 150 mg daily.

Erosive esophagitis is treated with 150 mg 4 times daily. Zollinger Ellison syndrome may be treated with as much as 6 g daily. Heartburn is treated with 75 mg or 150 mg once or twice daily 30-60 minutes before consuming meals or beverages that cause heartburn.

Self-medication should not last longer than 2 weeks unless advised by a physician. DRUG INTERACTIONS: Ranitidine, like other drugs that reduce stomach acid, may interfere with the absorption of drugs that require acid for adequate absorption. Examples include iron salts (for example iron sulphate), itraconazole (Sporanox), and ketoconazole (Nizoral, Extina, Xolegel, Kuric). PREGNANCY: There are no adequate studies of ranitidine in pregnant women. Available evidence suggests that there is little risk when used during pregnancy. NURSING MOTHERS: Ranitidine is secreted into human breast milk and may pose a potential risk to the infant. SIDE EFFECTS: Minor side effects include constipation, diarrhea, fatigue,headache, insomnia, muscle pain, nausea, and vomiting. Major side effects are rare; they include: agitation, anemia, confusion, depression, easy bruising or bleeding, hallucinations, hair loss, irregular heartbeat, rash, visual changes, and yellowing of the skin or eyes.