THERAPEUTIC INDEX Generic Brand MOA Indication Metronidazole Bactericidal Infections in the intra-abdominal, skin & skin structure,

bone & joint, gyne, bacterial septicaemia, CNS, lower RTI, endocarditis Lactation Convulsive seizures; peripheral neuropathy; GI upsets; rash, pruritus 500mg TIV q8 Generic Brand MOA Indication CI AE Dose Cefalexin acts by inhibiting the synthesis of bacterial cell wall GUT, skin & soft tissue infection, Cellulitis, SC abscess, Staph & Strep infection hypersensitivity to cephalosporins nausea, vomiting, anorexia, diarrhea, colitis 500mg/cap q6 x 7 day

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Ceftriaxone Xtenda Inhibit cell wall synthesis by preventing cross-linking LRTI, UTI, intra-abdominal infections Hypersensitivity to penicillins Pain, tenderness, phlebitis after IV administration, rash, GI reactions 1gm TIV OD

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Mefenamic Acid inhibit both COX and phospholipase A2 mild to moderate severe somatic & neuritic, headache, migraine GI ulcerations or inflammation. Kidney or liver impairment GI disturbances, GI hemorrhages 500mg, TID PRN for pain

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Magnesium Sulfate Reduces striated muscle contractions by a depressant effect on the central nervous system and by reducing the release of acetylcholine at the myoneuronal junction Convulsions associated with pre-eclampsia and eclampsia of pregnancy, hypomagnesaemia, uterine tetany and premature labour as a myometrial relaxant Heart block, renal failure (Creatinine clearances < 20 ml/min.) and intolerance to magnesium sulfate Flushing, hypotension, hypothermia, hypotonia, reduced heart rate and reduced respiratory rate I.V. loading dose of 4 g is administered over up to 20 minutes,followed by either I.V. infusion of 1 g/hour or deeply I.M. of 5 g into each buttock then 5 g I.M. on alternate buttocks every 4 hours as needed

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Hydralazine Interferes with the action of the second messenger IP3, limiting calcium release from the sarcoplasmic reticulum of smooth muscle. This results in an arterial and arteriolar relaxation Hypertension Severe tachycardia, dissecting aortic aneurysm, heart failure with high cardiac output, cor pulmonale, myocardial insufficiency due to mechanical obstruction, coronary artery disease, idiopathic SLE. Patients with recent MI Tachycardia; palpitations; angina pectoris; haemolytic anaemia; paralytic ileus; severe headache; GI disturbances; flushing, 40-50 mg/day in divided doses. Max: 200 mg/day

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Tramadol TDL Centrally acting analgesic, binds to mu-opioid receptors & inhibits reuptake of norepinephrine & serotonin moderate to severe acute & chronic pain, painful diagnostic procedures & surgery acute intoxication with alcohol, hypnotics, analgesics or other CNS acting drugs 50mg IV q6 RTC X 24 hours

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Nifedipine a specific and potent calcium antagonist that relaxes arterial smooth muscle, both in the coronary and peripheral circulation Prophylaxis of chronic stable angina pectoris; treatment of Raynaud's phenomenon & HTN Cardiogenic shock, aortic stenosis, unstable angina, during or w/in 1 mth of MI Headache, vasodilatation, palpitations, nausea, dizziness, lethargy, asthenia 10mg 1tab TID

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Hyoscine-N-butylbromide Buscopan acts by interfering with the transmission of nerve impulses by acetylcholine in the parasympathetic nervous system (specifically the vomiting center) acute GI, biliary, & GU spasm myasthenia gravis, megacolon, hypersensitivity tachycardia, urinary retention 1 amp IV, IM q1

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Doxycycline inhibits protein synthesis by binding to the ribosomal 30S subunit of susceptible bacteria RTI, ENT, skin & soft tissues, GIT, GUT, obstetric & gynecologic infections porphyria, pregnancy, children <12 y/o GI upsets, photosensitivity 100mg/tab, BID

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Amoxicillin Acts by inhibiting the synthesis of bacterial cell wall RTI, UTI, dental, venereal, pelvic, severe systemic, skin, & soft tissue infections. Renal or hepatic impairment nausea, vomiting, irritability, volatile mood swings, disorientation, aggressiveness and easy fatigue, Loose bowel movements (diarrhea) 500mg, TID x 7 days Methylergometrine maleate Methergin stimulates uterine and vascular smooth muscle, causing contractions, decreased bleeding uterine atony/hemorrhage Pregnancy Abdominal pain, HPN TID x 9 doses Ampicillin Interferes with cell wall synthesis of susceptible organisms, preventing bacterial multiplication Prophylaxis for abdominal operation Hypersensitivity to penicillins, infectious mononucleosis Anaphylaxis, GI disturbances 1gram IV loading dose Ketorolac Toradol Inhibits prostaglandin synthesis by inhibition of COX enzyme Short term management of moderate to severe acute postoperative pain Hypersensitivity to ASA and other NSAIDS Nausea, dyspepsia, GI pain, drowsiness 30mg IV, q6 Nalbuphine Nubain Binds with opiate receptors in the CNS Relief of moderate to severe pain, pre-op analgesia Hypersensitivity Sedation, drowsiness, sweating, nausea 5mg IV q4 PRN for pain Bisacodyl Dulcolax Constipation, relief of evacuation in haemorrhoids Acute surgical abdomen Abdominal discomfort, soreness in the anal region 1amp IV, supp at bedtime Dexamethasone Synthetic glucocorticoid with marked anti-inflammatory effect because of its ability to inhibit prostaglandin synthesis Infections of the skin caused by fungi and/or bacteria Syphilis, skin TB, Varicella Skin irritation, acne telangectasis 12mg IV q12 x 2doses Naloxone

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Reversal of respiratory depression induced by opiods Nausea, vomiting, hypotension 4mg/ml Cefuroxime Inhibits bacterial cell wall synthesis RTI, UTI, dental, vereneal, pelvic, severe systemic, skin & soft tissue infections Sensitivity to Cefuroxime axetil Nausea, vomiting, irritability, volatile mood swings, disorientation, aggressiveness and easy fatigue, diarrhea 500mg BID x 7days Co-amoxiclav Natravox Acts by inhibiting the synthesis of bacterial cell wall RTI, UTI, dental, venereal, pelvic, severe systemic, skin & soft tissue infections Allergy to penicillins Transient hepatitis, cholestatic jaundice 625mg/tab TID x 7days Ferrous Sulfate Provides/replaces elemental iron, an essential component in formation of haemoglobin in RBC development Iron deficiency anemia & co-existing B complex deficiency

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1cap BID Ranitidine Inhibits histamine at H2 receptor site in the gastric parietal cells, which inhibits gastric acid secretion Duodenal ulcer, benign gastric ulcer History of acute porphyria, hypersensitivity to Ranitidine GI disturbances, headache, dizziness 150mg/tab BID Oxytocin Syntocinon Acts directly in myofibrils, producing uterine contractions; stimulates milk ejection by the breast Induction/enhancement of labor Hypersensitivity Nausea, vomiting, cardiac arrhythmias 1amp 10 IU/ml Etoricoxib Arcoxia Inhibits prostaglandin synthesis by decreasing enzyme needed for biosynthesis, analgesic, anti-inflammatory Hypersensitivity, active peptic ulceration, or active GI bleeding 60mg BID Captopril Capoten Heart failure, HPN Hypersensitivity, pregnancy

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Rash, dysgeusia, taste alteration, neutropenia, cough 25mg/tab SL PRN for BP 160/100mmHg Ipratropium Bromide Berodual Inhibits interaction of acetylcholine at receptor sites on the bronchial smooth muscle, resulting in decreased cyclic guanosine monophosphate and bronchodilation Acute prevention & treatment of symptoms of COPD with reversible bronchospasm Hypertrophic obstructive cardiomyopathy, tachyarrythmia Tremor, restlessness, palpitation, tachycardia q30 x 3doses Nitroglycerin Deponit

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Symptomatic hypotension; dehydration, hemoconcentration, hypokalemia, hyponatremia, metabolic acidosis 40mg IV Hydrocortisone Sodium Succinate Solucortef increases the rate and force of the heartbeat, increasing blood supply to essential areas, such as the heart, brain and muscles, and increasing the bodys supply of energy by raising blood sugar levels Hypoadrenalism (includes Addison's disease), Asthma, Arthritis, Severe Allergic Reaction, Crohn's disease, Systemic lupus erythematosus Systemic fungal infections, hypersensitivity to hydrocortisione, administration of live or live attenuated vaccines an extreme allergic reaction (anaphylaxis), fluid retention, muscle weakness and wasting, increased blood pressure (hypertension), inflammation of the pancreas (pancreatitis), headache, balance problems 200mg IV then 100g IV x 3doses Ipratropium bromide + Salbutamol Combivent Inhibits interaction of Acetylcholin at receptor sites on the bronchial smooth muscle, resulting in decreased cGMP and bronchodilation Management of reversible bronchospasm associated with obstructive airway disease in patients who require more than a single bronchodilator Hypertropic obstructive cardiomyopathy or tachyarrythmia; hypersensitivity to atropine or its derivatives Headache, dizziness, nervousness, tachycardia, fine tremor of skeletal muscles & palpitations Nebulization q4 Paracetamol Antipyretic, analgesic Pyrexia, prevention of febrile convulsions Nephropathy Skin eruption, hematological toxicity 360mg IV Perindopril arginine, amlodipine besilate Coveram Perindopril is an ACE (angiotensin-converting enzyme) inhibitor. Amlodipine is a calcium antagonist (which belongs to a class of medicines called dihydropyridines). Together, these 2 drugs work to widen and relax the blood vessels so that blood passes through them more easily and makes it easier for the heart to maintain a good blood flow Treatment of HTN &/or stable coronary artery disease Hypersensitivity to other ACE inhibitors or dihydropyridines. Patients w/ cardiogenic shock, aortic stenosis, unstable angina, severe hypotension, heart failure during the first 28 days after MI. Women who might become pregnant. Last 6 mth of pregnancy, lactation. Angioedema (stop treatment if) w/ symptoms eg swelling of the face, lips, mouth, tongue or throat, difficulty in breathing, severe dizziness or fainting, unusual fast or irregular heart beat. 1 tab OD Salbutamol Ventolin acts on the 2-adrenoceptors of bronchial and uterine

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AE Long-term treatment of CHD, treatment of CHF Acute circulatory shock, severe hypotension, acute MI Headache, reflex tachycardia, postural hypotesion, nausea, dizziness 2.5mg patch OACW hold for SBP 90 Cefoxitin Monowel Peritonitis and other intra-abdominal & intrapelvic infections, gynaecological infections, UTI, RTI Hypersensitivity to cephalosporins Phlebitis at the site of injection, GI reactions 2grams IV, q6 Tranexamic Acid Antifibrinolytic agent used mainly in the treatment and prophylaxis of hemorrhage associated with excessive fibrinolytic. Tx & prophylaxis of hemorrhage associated with excessive fibinolysis; prophylaxis of hereditary angioedema Pxs with active intravascular clotting; predisposition to thrombosis, hemorrhage due to DIC Dose-related GI disturbances; Hypotension; thrombolytic complications 1amp IV then 500mg TIV q8 Calcium gluconate Enhances contractility through regulation of action potential Hypocalcemic tetany or hyperkalemia & parathyroid tetany; Mg intoxication to counteract respiratory paralysis Hypercalcemia, ventricular fibrillation Overdose may produce serious cardiac effects 1amp SIVP Furosemide Lasix inhibits primarily the absorption of sodium and chloride not only in the proximal and distal tubules but also in the loop of Henle Edema due to cardiac, hepatic or renal disorders, or burna; mild to moderate hypertension, hypertensive crisis, acute heart failure; acute & chronic renal failure, nephrotic syndrome Anuria, hepatic coma & precoma; severe hypokalemia &/or hyponatremia, hypovolemia

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muscle with little or no action on the 1-adrenoceptors at cardiac muscle. It provides a short-acting (4-6 hrs) bronchodilation with a fast onset Relief of mild, moderate or severe asthma & bronchospasm inchronic bronchitis, emphysema. Nebules Routine management of chronic bronchospasm unresponsive to conventional therapy & treatment of acute severe asthma Threatened abortion (for obstetric use only) Hypersensitivity, hypokalemia, tremors, headache, acute angle-closure glaucoma 0.15-0.30mkdose q8 Losartan Competitive antagonist of the thromboxane A2 receptor and attenuates platelet aggregation Hypertension, renal protection for DM2 pxs with proteinuria Hypersensitivity Dizziness, rash, angioedema, hepatitis, liver function abnormalities 50mg/tab OD Aspirin Relieves pain and reduces inflammation by inhibition of peripheral prostaglandin synthesis; decreases platelet aggregation by preventing formation of thromboxane A Ischaemic stroke, transient ischemic attack, acute myocardial infarction, prevention of recurrent MI, unstable angina, chronic stable angina Hypersensitivity, asthma, rhinitis & nasal polyps; history of active peptic ulcer Dyspepsia, GI bleeding, ulceration & perforation, Reyes syndrome 80mg/tab ODAL; 300mg/tab Clopidogrel Inhibition of platelet aggregation Reduction of atherosclerotic events in patients with atherosclerosis documented by recent stroke, myocardial infarction; Acute coronary syndrome Hypersensitivity, severe liver impairment, active pathological bleeding GI bleeding, purpura, hematoma, epistaxis, hematuria, intracranial bleeding 75mg/tab Pantoprazole inhibition of the gastric H+,K+-ATPase (proton pump) Duodenal & gastric ulcer, moderate & severe reflux esophagitis, eradication of H. pylori, Zollinger-Ellison syndrome Hypersensitivity; moderate to severe liver or renal dysfunction Headache, diarrhea, edema, onset of depression, blurred vision 40mg/tab OD Atenolol Competitively and selectively blocks stimulation of Beta1adrenergic receptors within vascular smooth muscle to produce negative chronotropic and positive inotropic activity; decreases RAAS at high doses and inhibits Beta2receptors in bronchial system at higher doses

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Hypertension, long term management of angina, acute MI Sinus bradycardia, heart block greater than 1st degree, cardiogenic shock & overt cardiac failure Headache, fatigue, dizziness, weakness or lethargy, nausea, bradycardia, edema, depression, impotence, anxiety 50mg/tab OD Methimazole inhibits the addition of iodine to thyroglobulin by the enzyme thyroperoxidase, a necessary step in the synthesis of triiodothyronine (T3) and thyroxine (T4) Mild to severe hyperthyroidism, treatment of Grave disease, prep of hyperthyroid patients for thyroidectomy & use as an adjunct to radioactive iodine therapy Hypersensitivity to thiamazole & carbimazole; agranulocytosis during earlier treatment with thiamazole, carbimazole or PTU Fever, arthralgia, arthritis, rashes, leukopenia, agranulocytosis, hepatotoxicity, vasculitis, LE syndrome, aplastic aneami

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Dose Generic Brand MOA Digoxin Lanoxin Inhibits Na+-K+ activated ATPase, thereby allowing influx of calcium into the intracellular space, more available calcium promotes increased force of myocardial contraction (+ inotropic effect) resulting to increased cardiac output; decreases cardiac rate by vagal stimulation Cardiac failure accompanied by atrial fibrillation; management of chronic cardiac failure where systolic dysfunction or ventricular dilatation is dominant; management of certain supraventricular arrhythmias, particularly atrial flutter & fibrillation Intermittent complete heart block or 2nd degree AV block esp. if there is a history of Stokes-Adams attacks; arrhythmia caused by cardiac glycoside intoxication, supraventricular arrhythmia caused by Wolff-Parkinson-White syndrome; ventricular tachycardia or fibrillation; hypertrophic obstructive cardiomyopathy; hypersensitivity to other digitalis glycosides Nausea, vomiting, anorexia, diarrhea, gynecomastia, headache, weakness, apathy, malaise, fatigue, depression, psychosis, visual disturbance, intestinal ischemia, skin rashes & thrombocytopenia

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Dose Generic Brand MOA Lactulose Causes an influx of fluid in the intestinal tract by increasing the osmotic pressure within the intestinal lumen; lowers intestinal absorption of ammonia presumably due to increased utilization of ammonia by intestinal bacteria Constipation; portal systemic encephalopathy; salmonellosis Low galactose diet Flatulence, meteorism; diarrhea 30cc ODHS Atorvastatin Selectively inhibits HMG-CoA reductase, which converts HMG-CoA to mevalonate, a precursor of sterols. Lowers cholesterol and lipoprotein levels Reduction of elevated total cholesterol & LDL, apolipoprotein B & triglycerides in patients with primary hypercholesterolemia, mixed hyperlipidemia, heterozygous & homozygous familial hypercholesterolemia Active liver disease or elevated serum transaminases >3x

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the upper limit of normal; pregnancy & lactation GI disturbances, headache, myalgia, asthenia, insomnia, angioneurotic edema, muscle cramps, myositis, myopathy, cholestatic jaundice

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Trimetazidine Valsartan MR Long term treatment for coronary insufficiency, angina pectoris Allergy, pregnancy, lactation Rare cases of GI disorders 1 tab in the morning and evening at meal times Clarithromycin Inhibits or interferes with bacterial protein synthesis by binding to the 50S ribosomal sub-units of bacterial chromosome Treatment of RTI and in skin and soft tissue infections. Also for the treatment of leprosy and for prophylaxis and treatment of opportunistic mycobacterial infections Impaired renal or hepatic function, pregnancy Taste disturbances, stomatitis, glossitis and tooth discoloration. Transient elevations of liver enzyme values, cholestatic jaundice and hepatitis. 250 mg BID Ethambutol + Rifampicin + INH + Pyrazinamide Myrin P-forte Tuberculostatic, it suppresses the growth of tubercle bacilli however the specific mechanism of action is unknown Initial phase of pulmonary & extra-pulmonary TB Hypersensitivity; jaundice Optic neuritis, GI disturbances, insomnia, headache, toxic psychoses, paresthesias 3tabs OD BB (275mg/150mg/75mg/400mg) Insulin Humulin N (NPH); Humulin R (Regular) Lowers the concentration of glucose in blood by inhibiting hepatic glucose production and by stimulating the uptake & metabolism of glucose by muscle and adipose tissue. Insulin-dependent diabetes mellitus (IDDM) Hypoglycemia, IV admi, hyperglycaemic coma Lipodystrophy, insulin resistance. Local & generalized allergic reactions

Dose Generic Brand MOA Enoxaparin Accelerates formation of anti-thrombin IIIB-thrombin complex and deactivates thrombin, preventing conversion of fibrinogen to fibrin Prophylaxis of venous thrombosis; patients with high risk of thromboembolism, DVT w/ or w/o pulmonary embolism; unstable angina & non-Q-wave MI Conditions with a high risk of uncontrollable hemorrhage including major bleeding disorders and focal lesions Hemorrhage, thrombocytopenia; local reactions such as pain, hematoma & mild irritation following SC inj.; asymptomatic & reversible increase in platelet counts & liver enzyme

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Dose Dose Generic Brand MOA Simvastatin Inhibits HMG-COA reducatase enzyme which reduces cholesterol synthesis; this enzyme is needed for cholesterol production Reduces LDL-cholesterol, apolipoprotein B,and triglycerides. Increases HDL-cholesterol in the treatment of hyperlipidemias Hypersensitivity, acute liver disease or unexplained persistently raised serum-aminotransferase concentrations, pregnancy GI disturbance, headache, skin rashes, dizziness, blurred vision, insomnia and dysgeusia Tab 10mg, 20mg, 40mg, 80mg Amlodipine Inhibits influx of calcium across cell membranes to produce relaxation of coronary vascular smooth muscle Treatment of hypertension and prophylaxis of angina Hypersensitivity to dihydropyridines Dizziness, flushing, headache, hypotension, peripheral edema Tab 5 mg, 10 mg Citicoline Indication CI AE Dose Generic Brand MOA Indication For the treatment of CVD, including ischemic stroke and head injury Hypersensitivity Hypersensitivity reaction, insomnia, headache, dizziness, convulsion Sol. For injection: 250 mg/2ml x 5 ampules Metoclopromide Plasil Disturbance of GI motility. Nausea and vomiting of central and peripheral origin associated with surgery, metabolic diseases, infectious and drug-induced diseases GI hemorrhage, mechanical obstruction or perforation Extrapyramidal reactions, drowsiness, fatigue and lassitude, anxiety. Generic Brand MOA Indication CI AE Dose Generic Brand MOA

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Acetylcysteine Fluimucil Decreases viscosity of respiratory tract secretions and promote their removal by breaking disulfide bonds Treatment of respiratory infections characterized by thich & viscous hypersecretions: acute & chronic bronchitis & its exacerbations, pulmonary emphysema, mucoviscidosis & bronchiectasis Hypersensitivity, phenylketonuria (contains aspartame) Pyrosis, nausea, vomiting; rarely, urticaria & bronchospasm 600mg/tab in 20cc water OD

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