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By Y. Vatras. University of Dayton.

Atorvastatin and macrolide anti- biotics may attenuate the effects of clopidogrel generic combivent 100 mcg visa medications post mi, and additional monitoring is required 100mcg combivent amex medicine tour. Poisoning Information Treatment of clopidogrel overdose is supportive and symptomatic. Dipyridamole Indication In the United States, dipyridamole has been used in myocardial imaging and for prophylaxis of prosthetic cardiac valve thrombosis and prosthetic cardiac valve-related embolism. Anticoagulants, Antithrombotics, and Antiplatelets 263 of patency after surgical grafting procedures, including coronary artery bypass and prevention of thromboembolic disorders. Dipyridamole has been used in addition to aspirin therapy for the prevention and treatment of coronary thrombosis in patients with Kawasaki’s Disease. Monitoring Parameters Blood pressure, heart rate, electrocardiogram, and vital signs during I. Contraindications Hypersensitivity to dipyridamole products is a contraindication to use. Precautions/Warning Use caution in administering dipyridamole to patients with hypotension; patients on antiplatelet agents or anticoagulation; or patients with severe coronary artery disease or abnormal cardiac rhythm. Adverse Effects Potential adverse effects of dipyridamole are headache (dose-related), vasodi- lation, hypotension, flushing, weakness, dizziness, syncope, rash, pruritus, abdominal distress, and diarrhea. Based on limited experience, signs, and symptoms of oxidose include hypoten- sion, dizziness, headache, weakness, facial flushing, and fainting. Enoxaparin Indication Enoxaparin is indicated for prophylaxis and treatment of thromboembolic disorders. Anticoagulants, Antithrombotics, and Antiplatelets 265 Dosing Children: Initial S. Repeat anti-Factor Xa level before next dose and then 4 hours after the dose is administered If the anti-Factor Xa level is greater than 2Units/mL, then hold the dose until the anti-Factor Xa level has come down to 0. Repeat anti-Factor Xa level before the next dose until the level has come down to 0. Enoxaparin does not cross the placental barrier and does not bind to most heparin-binding proteins. Enoxaparin is renally excreted, 40% as active and inactive fragments and 10% as unchanged drug. Contraindications Contraindications to enoxaparin use are hypersensitivity to enoxaparin, heparin, pork products, or benzyl alcohol; patients with active major bleeding; and patients with thrombocytopenia. Use enox- aparin with caution in patients with any increased risk of hemorrhage, uncon- trolled hypertension, or renal impairment. Adverse Effects Potential adverse effects of enoxaparin use are edema, diarrhea, nausea, hematoma, normocytic hypochromic anemia, confusion, pain, dyspnea, fever, 11. Anticoagulants, Antithrombotics, and Antiplatelets 267 local irritation, atrial fibrillation, heart failure, eczema, skin necrosis, hemorrhage, thrombocytopenia, increased liver function tests, anaphylactoid reaction, hematoma, pneumonia, and pulmonary edema. Poisoning Information Therapeutic reference ranges for anti-Factor Xa levels are between 0. Protamine may be used at dosage of 1 mg of protamine for each milligram of enoxaparin admin- istered. Heparin Indication Heparin is indicated for prophylaxis and treatment of thromboembolic disorders. Inter- estingly, infants also have a decreased production of thrombin and have similar levels when compared with heparinized adults. Loading dose can be modified based on preexisting condition Systemic heparin adjustment: General guidelines: target range and dose will need to be adjusted based on clinical conditions. It is eliminated renally in small amounts as unchanged drug, with a half-life of 90 minutes and a range of 1 to 2 hours. Factors that can prolong the half-life include obesity, renal dysfunction, hepatic dysfunction, malignancy, infection, and the presence of pulmonary embolism. Contraindications Contraindications for heparin use are hypersensitivity to heparin or any com- ponent; uncontrollable active bleeding (unless secondary to disseminated 11. Anticoagulants, Antithrombotics, and Antiplatelets 269 intravascular coagulation); severe thrombocytopenia; and suspected or confirmed intracranial hemorrhage; shock, severe hypotension.

Contraindicatons Galactosemia cheap 100 mcg combivent with visa treatment mononucleosis, intestnal obstructon generic combivent 100 mcg otc medicine zanaflex, patents on low galactose diet. Adverse efects Diarrhoea (dose related), nausea, vomitng, hypokalaemia; dehydraton; hypernatremia; bloatng and abdominal cramps. Dose Oral Adult- 2 to 4 tablets, usually at night; inital dose should be low, then gradually increased. Precautons Avoid prolonged use unless indicated for preventon of faecal impacton; pregnancy (Appendix 7c), lactaton (Appendix 7b); hypersensitvity, undiagnosed abdominal pain, intestnal blockage. Adverse Efects Abdominal discomfort; atonic non- functoning colon and hypokalaemia (with prolonged use or overdosage); red or yellow brown urine, diarrhoea, nausea, vomitng, bloatng. Severely dehydrated patents must be treated initally with intravenous fuids untl they are able to take fuids by mouth. For oral rehydraton it is important to administer the soluton in small amounts at regular intervals as indicated below. Plan A: No dehydraton: Nutritonal advice and increased fuid intake are sufcient (soup, rice, water and yoghurt, or even water). For infants aged under 6 months who have not yet started taking solids, oral rehydraton soluton must be presented before ofering milk. In the case of mixed breast-milk/formula feeding, the contributon of lactaton must be increased. Plan B: Moderate dehydraton: Whatever the child’s age, a 4-h treatment plan is applied to avoid short-term problems. It is recom- mended that parents are shown how to give approximately 75 ml/kg of oral rehydraton soluton with a spoon over a 4-h period and it is suggested that parents should be watched to see how they cope at the beginning of the treatment. A larger amount of soluton can be given if the child contnues to have frequent stools. In case of vomitng, rehydraton must be discontnued for 10 min and then resumed at a slower rate (about one teaspoonful every 2 min). The child’s status must be re-assessed afer 4 h to decide on the most appropriate subsequent treatment. Oral rehydraton soluton should contnue to be ofered once dehydraton has been controlled, for as long as the child contnues to have diarrhoea. Plan C: Severe dehydraton: Hospitalizaton is necessary, but the most urgent priority is to start rehydraton. In hospital (or elsewhere), if the child can drink, oral rehydraton soluton must be given pending, and even during intravenous infusion (20 ml/kg every h by mouth before infusion, then 5 ml/kg every h by mouth during intravenous rehydraton). For intra- venous supplementaton, it is recommended that compound soluton of sodium lactate (see chapter 28. If the intravenous route is unavailable, a nasogastric tube is also suitable for administering oral rehydraton soluton, at a rate of 20 ml/kg every h. If the child vomits, the rate of administra- ton of the oral soluton should be reduced. Note: The soluton may be prepared either from prepackaged sugar/salt mixtures or from bulk substances and water. Solutons must be freshly prepared, preferably with recently boiled and cooled water. Accurate weighing and thorough mixing and dissoluton of ingredients in the correct volume of clean water is important. Adult- Fluid and electrolyte loss in acute diarrhoea; 200 to 400 ml soluton afer every loose moton. Adverse Efects Vomitng- may indicate too rapid administraton; hypernatraemia and hyperkalaemia may result from overdose in renal impairment or administraton of too concentrated a soluton. Antdotes and Substances Used in Poisoning These notes are only guidelines and it is strongly recom- mended that poisons informaton centres (Appendix 5) be consulted in cases where there is doubt about the degree of risk or about appropriate management. Patents who have taken poisons with delayed actons should also be admited, even if they appear well; delayed-acton poisons include acetylsalicylic acid, iron, lithium, paracetamol, paraquat, tricyclic antdepressants and warfarin. However, it is ofen impossible to establish with certainty the identty of the poison and the size of the dose but informaton on the type and tming of poisoning may be useful for symptomatc management. Cardiac conducton defects and arrhythmias ofen respond to correcton of underlying hypoxia, acidosis, or other biochemical abnormalites. Hypothermia which may develop in patents who have been unconscious for some hour is best treated by wrapping the patent in blankets to conserve body heat.

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I (4–1–10 Edition) the acid-reacting substances acid burette into the air keep the dis- monocalcium phosphate and sodium placement solution in the leveling bulb aluminum phosphate 100 mcg combivent free shipping medications bad for liver. When it is tested by the at a lower level than that in the gas- method prescribed in paragraph (b) of measuring tube purchase 100 mcg combivent otc medications 2 times a day. The acid- for 3 minutes to mix the contents inti- reacting substance is added in suffi- mately. Allow to stand for 10 minutes cient quantity to neutralize the sodium to bring to equilibrium. The combined weight of pressure in the measuring tube by such acid-reacting substance and so- means of the leveling bulb and read the dium bicarbonate is not more than 4. Determine this quantity leveling bulk E bring the displacement by multiplying weight of carbon diox- solution to the 25 cc. Close the stopcock, parent percent of carbon dioxide in of- lower the leveling bulb somewhat to re- ficial sample to obtain percent of car- duce the pressure within the apparatus, bon dioxide evolved from the official and slowly run into the decomposition sample. Association of Official Analytical Yellow corn meal conforms to the Chemists," 13th Ed. Standard Series)," under except that cleaned yellow corn is used the heading "Definitions of Terms and instead of cleaned white corn. For corn is used instead of cleaned white information on the availability of this corn. At- degerminated white corn meal except tach cover and hold the assembly in a that cleaned yellow corn is used in- slightly inclined position with one stead of cleaned white corn. Turn the sieves forms to the definition and standard of about one-sixth of a revolution, each identity prescribed by §137. It is freed from bran coat, that: or bran coat and germ, to such extent (1) It contains in each pound not less that the percent of ash therein, cal- than 2. I (4–1–10 Edition) (2) Vitamin D may be added in such the statement "Enzyme treated for quantity that each pound of the fin- quicker cooking". It is content complies with the require- freed from bran coat, or bran coat and ments of this section allowance is germ, to such extent that the percent made for ash resulting from any added of ash therein, calculated to a mois- iron or salts of iron or calcium, or from ture-free basis, is not more than 0. Each of the added so that each pound of the rice ingredients used in the food shall be de- contains: clared on the label as required by the (1) Not less than 2. Cal- tains not less than 85 percent of the cium carbonate derived from the use of minimum quantity specified for the this substance in milling rice, when substance or substances used. The vitamins re- graph (c) of this section is as follows: ferred to in paragraphs (a) (1) and (2) of Mix the contents of one or more con- this section may be combined with tainers and transfer 1⁄2 pound thereof to harmless substances to render them in- a 4-liter flask containing 2 liters of dis- soluble in water, if the water-insoluble tilled water at room temperature (but products are assimilable. Stopper the flask and (4) In the case of enriched parboiled swirl it moderately for 1⁄2 minute so rice, butylated hydroxytoluene may be that the rice is in motion and in uni- added as an optional ingredient in an form suspension. To the contents of the flask, section may be added in a harmless add 1,600 milliliters of distilled water carrier. Such carrier is used only in the and 20 milliliters of 10 N hydrochloric quantity necessary to effect an inti- acid. Agitate vigorously and wash mate and uniform mixture of such sub- down the sides of the flask with 150 stances with the rice. In (c) Unless the label of the food bears order to avoid excess foaming during the statement "To retain vitamins do the extraction, heat the mixture slowly not rinse before or drain after cooking" to about 100 °C, agitate if necessary, immediately preceding or following the and maintain at this temperature until name of the food and in letters not less air is expelled. Again wash down the than one-fourth the point size of type sides of the flask with 150 milliliters of used for printing the name of the food 0. Heat the mix- (but in no case less than 8-point type) ture in an autoclave at 120 °C to 123 °C and the label bears no cooking direc- for 30 minutes, remove and cool to tions calling for washing or draining or room temperature. Dilute the mixture unless the food is precooked and it is with distilled water so that the total packaged in consumer packages which volume is 2,500 milliliters. Swirl the are conspicuously and prominently la- flask, and while the solids are in uni- beled with directions for preparation form suspension pour off about 250 mil- which, if followed, will avoid washing liliters of the mixture for later deter- away or draining off enriching ingredi- mination of iron (and calcium, if this is ents, the substances named in para- to be determined). With filter paper graphs (a) (1), (2), and (3) of this section that has been shown not to adsorb thi- shall be present in such quantity or in amine, riboflavin, or niacin, filter such form that when the enriched rice enough of the remaining mixture for is washed as prescribed in paragraph (e) determination of thiamine, riboflavin, of this section, the washed rice con- and niacin.

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All changes should be accom- bility and the stability of the drug products should be panied by the standard stability commitment to conduct confirmed in all diluents and containers and closures as or complete long-term stability studies on the first one or well as in the presence of all other drug products indicated three batches of the drug substance or drug product and for admixture in the labeling purchase combivent 100 mcg without a prescription symptoms zoloft overdose. Compatibility studies annual batches thereafter cheap combivent 100mcg visa medicine news, in accordance with the approved should be conducted on at least the lowest and highest stability protocol. The accumulated stability data should concentrations of the drug product in each diluent as be submitted in the subsequent annual reports. The stability and compatibility otherwise noted, if the data give no reason to believe that studies should be performed on at least three batches of the proposed change will alter the stability of the drug the drug product. Compatibility studies should be product, the previously approved expiration dating period repeated if the drug product or any of the recommended can be used. Ordinarily, the approved expiration A change in the manufacturing process of the drug sub- dating period for the drug product may be retained if the stance at the approved manufacturing site should be sup- drug substance is shown to be of comparable quality (e. If the drug sub- stability of the drug substance and the resulting drug prod- stance is not of comparable quality, then more extensive uct. Because chemical stability of a substance is an intrinsic stability data on the drug product manufactured from the property, changes made in the preparation of that substance drug substance will be needed. Special con- will be addressed in a separate forthcoming guidance on cerns for biological products may exist if changes are made postapproval changes for the drug substance. Site Change for the Drug Product Specific submission and stability issues will be addressed in detail in a separate forthcoming guidance For a move of the manufacturing site within an existing dealing with postapproval changes for drug substances. Site changes consist of changes in the location of the site For a move to a different campus using similar equip- of manufacture, packaging operations, or analytical test- ment and manufacturing processes, stability data on the ing laboratory both of company-owned as well as contract drug product in the new facility should be submitted in manufacturing facilities. Three months of accelerated filing mechanisms indicated below apply to site changes and available long-term stability data on one to three only. If other changes occur concurrently, the most exten- batches of drug product manufactured in the new site is sive data package associated with the individual changes recommended, depending on the complexity of the dos- should be submitted. A commitment should be made to conduct long- ing site for any portion of the manufacturing process of a term stability studies on the first or first three production drug substance or drug product is made, sufficient data to batch or batches of the drug product, depending on the show that such a change does not alter the characteristics dosage form and the existence of a significant body of or compromise the quality, purity, or stability of the drug information, manufactured at the new site in accordance substance or drug product may be necessary. If the stability data should include a side-by-side comparison of all attributes are satisfactory, the existing expiration dating period may to demonstrate comparability and equivalency of the drug be used. Site Change for the Drug Substance A stand-alone packaging operation site change for solid For a change limited to an alternate manufacturing site for oral dosage–form drug products using containers and clo- the drug substance using similar equipment and manufac- sures in the approved application should be submitted as turing process, stability data on the drug substance may a Changes Being Effected Supplement. No up-front sta- not always be necessary because, for essentially pure drug bility data are necessary. The facility should have a current substances, stability is an intrinsic property of the material. The standard annual batches thereafter on long-term stability studies stability commitment should be made to conduct long-term using the approved protocol in the application and to sub- stability studies in accordance with the approved stability mit the resulting data in annual reports. Stability Testing of Drug Substances and Drug Products 63 A packaging site change for other than solid oral dos- G. The stability data packages for changes in container and closure of a drug product vary. Change in Testing Laboratory determining the stability data package recommendation is whether the protective properties of the container and clo- An analytical testing laboratory site change may be sub- sure system are affected by the proposed change. Protective mitted as a Changes Being Effected Supplement under properties of the container and closure system include, but certain circumstances. Changes that may affect these properties should be supported by a greater amount D. A solid dosage form will A change limited to the manufacturing process of the drug generally be less affected by a container change than a product, such as a change in the type of equipment used, liquid dosage form. Because considerably more informa- can be supported by the submission of sufficient data to tion will be needed to document a container and closure show that such a change does not alter the characteristics change than just stability data, applicants are encouraged or compromise the stability of the drug product. Such a modification to the approved stability protocol nature of the reprocessing procedure and any specific should be submitted as a Prior Approval Supplement. The effect it might have on the existing stability profile of the justification may include a demonstrated history of satis- drug. The expiration dating period for a reprocessed batch factory product stability, which may in turn include, but should not exceed that of the parent batch, and the expi- not be limited to, full long-term stability data from at least ration date should be calculated from the original date of three production batches. For example, drug products with an expiration procedure, which can range from repackaging a batch when dating period of less than 18 months should be tested at packing equipment malfunctions to regrinding and recom- quarterly intervals, products with an expiration dating pressing tablets.

Contraindications: Hypersensitivity to fluoroquinolone antibi- otics or quinolone antibiotics generic combivent 100mcg with mastercard symptoms 14 dpo, eg trusted combivent 100 mcg symptoms anemia, cinoxacin, nalidixic acid. Editorial comments • Ofloxacin offers no advantages over ciprofloxacin, but is less active against Pseudomonas aeruginosa. This enzyme promotes transport of hydrogen ions across the parietel cell membrane into the gastric lumen. Onset of Action Peak Effect Duration 1 h 2 h 50% maximum effect remains at 24 h Food: Should be taken 30 minutes before meal. Contraindications: Prior hypersensitivity reaction to omepra- zole, maintenance therapy for duodenal ulcer. Warnings/precautions: Relief of symptoms by omeprazole does not preclude a gastric malignancy. Clinically important drug interactions • Omeprazole increases effects/toxicity of warfarin, phenytoin, benzodiazepines, cyclosporine, carbamazepine, digoxin. This combination should be avoided in pregnant women (clarithromycin is category D). Onset of Action Peak Effect Duration Rapid 15–30 min 4 h Food: Take without regard to meals. Adverse reactions • Common: headache, diarrhea, fatigue, dizziness, constipation, musculoskeletal pain. Clinically important drug interactions • Drugs that increase effects/toxicity of ondansetron: cimetidine, allopurinol, disulfiram. Alternatively, administration of diphenhydramine and ben- ztropine may be indicated. Editorial comments • Ondansetron is useful as an alternative to metoclopramide in patients likely to develop extrapyramidal reactions from meto- clopramide. Advice to patient: Take fat-soluble vitamin supplements (vitamins A, D, E, and K) at least 2 hours before or after taking orlistat. Clinically important drug interactions: Orlistat reduces absorp- tion of fat-soluble vitamins. Parameters to monitor: Weight of patient to determine whether drug is losing effectiveness. Editorial comments • The benign side effect profile of this drug makes it a safe antiobesity agent. There are no data concerning the safety or efficacy of combining this drug with other anti-obesity drugs such as phentermine. Editorial comments • This drug is not listed in the Physicians’Desk Reference, 54th edition, 2000. Mechanism of action: Inhibits cyclooxygenase, resulting in inhi- bition of synthesis of prostaglandins and other inflammatory mediators. American Academy of Pediatrics expresses concern about breast- feeding while taking benzodiazepines. Editorial comments • This drug is listed without details in the Physician’s Desk Reference, 54th edition, 2000. Mechanism of action: Blocks acetylcholine effects at muscarinic receptors throughout the body. Mechanism of action: Binds to opiate receptors and blocks asce- nding pain pathways. Contraindications: Hypersensitivity to oxycodone or other nar- cotics of the same chemical class, respiratory depression, severe bronchial asthma, paralytic ileus. Warnings/precautions • Use with caution in patients with: head injury with increased intracranial pressure, serious alcoholism, prostatic hypertro- phy, chronic pulmonary disease, severe liver or kidney disease, disorders of biliary tract, supraventricular tachycardia, history of convulsion disorder, postoperative patients with pulmonary disease. If nausea and vomiting persist, it may be necessary to administer an antiemetic, eg, droperidol or prochlorperazine. Mechanism of action: Binds to opiate receptors and blocks ascending pain pathways. Contraindications: Hypersensitivity to narcotics of the same chemical class, paralytic ileus, acute asthmatic attack, severe respiratory depression, upper urinary tract obstruc- tion, pulmonary edema secondary to chemical respiratory irritant. If nausea and vomiting persist, it may be necessary to administer an antiemetic, eg, droperidol or prochlorperazine. Mechanism of action: Oxytocic action: stimulates contractions of uterine smooth muscle. Contraindications: Hypersensitivity to oxytocin, fetal distress, severe toxemia, total placenta previa, anticipated nonvaginal delivery (invasive cervical cancer), prolapse, active herpes genitalis, unfavorable fetal position, hyperactive uterus, contraindicated vagi- nal delivery, women with four or more previous deliveries.

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As shown in Figure 12- 2 cheap combivent 100 mcg line treatment yeast infection men, because the peak concentration occurs at the end of the 1-hour infusion discount combivent 100 mcg overnight delivery medicine nobel prize 2016, t′ in this equation is always (dosing interval) minus t (duration of infusion). Remember that we actually picked a desired Ctrough of 1 mg/L, but we also shortened the desired dosing interval from 13. If, based on clinical judgment, a lower Ctrough is desired, the dose can be recalculated with a longer dosing interval, such as 16 hours. Therefore, we would need to reexamine the rounding of our dosing interval and would probably round it up from 13. Calculate an appropriate loading dose to approximate a plasma concentration of 6 mg/L There are several methods to calculate a loading dose, and two are presented. Because one method requires estimation of the maintenance dose first, the loading dose is determined after the maintenance dose and dosing interval are calculated. In clinical practice, the loading and maintenance doses would be calculated at the same time. Like all drugs given at the same maintenance dose via intermittent administration, aminoglycosides will not reach the desired steady-state therapeutic concentration for three (87. Therefore, subtherapeutic concentrations may exist for 1-2 days of therapy in patients with renal dysfunction. Figure 12-3 a shows a plasma drug concentration versus time simulation for an aminoglycoside given at the same dose six times. We saw in Lesson 4 that it takes three to five drug half-lives to reach steady-state concentrations. Thus, time to reach steady state is dependent on the elimination rate constant (K) for a given patient. However, a loading dose infusion can produce a plasma drug concentration approximately equal to the eventual steady-state concentration (see Figure 12-3 b). In addition, any time the dose or dosing interval is changed it will take another three to five half-lives to reach a new steady-state concentration. After changing a dosing regimen, remember to allow enough time to reach a new steady-state concentration before repeating plasma drug concentrations. Because aminoglycosides are infused over 30 minutes to an hour, the equation below must be used to calculate a loading dose to account -Kt for the amount of drug eliminated over the infusion period. The term (1 - e ) represents the fraction remaining after (t), the time of infusion. By this method, the loading dose infusion can be determined before the maintenance dose is calculated, but only with a complicated equation. Another, easier loading dose formula that requires calculation of the maintenance dose first is shown below: 12-5 where: K0 = estimated maintenance dose, -Kτ 1/(1 - e ) = accumulation factor at steady state (see Equation 4-2), and τ = dosing interval at which estimated maintenance dose is given. With this loading dose formula, you are, in essence, multiplying the desired maintenance dose by a factor (the accumulation factor) representing the sum of the "fraction of doses" that have accumulated at steady state. This factor describes how much the concentration will be increased at steady state. Begin with our general formula and rearrange it to solve for K0: The first numerator/denominator combination in the above equation is also found in the equation for the loading dose: Therefore, the right-hand term of this loading dose equation can be substituted into the general equation for K0 (Step 1 below) and then rearranged (Step 2 below) to then yield our other loading dose formula: Step 1. However, some prefer the loading dose equation that requires the maintenance dose to be calculated first because it is simple. Based on the estimated parameters, steady state should be attained in three to five half-lives (3 × 4. In this example, the trough level was taken just before the fourth dose was given, and the peak level was obtained just after the fourth dose was given. This procedure is normal and appropriate if the concentrations are at steady state. Figure 12-4 illustrates that, at steady state, Ctrough from a "trough and peak" is equal to the Ctrough from a "peak and trough" because all Ctrough and all Cpeak values are the same. We know that if we measured a Ctrough after the Cpeak, it would equal the Ctrough before the Cpeak. In this case, therefore, when a "peak and trough" is ordered, the literal interpretation would be: 1.

Vaginal tab (3 mg) 3 mg inserted into posterior fornix combivent 100mcg generic medicine 100 years ago, followed by another 3 mg if labour does not start within 6 hour discount combivent 100 mcg mastercard treatment rosacea. Nonsteroidal Antiinfammatory Drugs/ Antipyretic-Analgesics 23 24 Autacoids and Related Drugs Preparations 1. Aspirin: Antiinfammatory dose 3–5 g/day (75–100 mg/kg/day); analgesic-antipyretic dose 0. Aminophylline (Theophylline-ethylenediamine; 85% theophylline): water soluble, can be injected i. Hydroxyethyl theophylline (Etophylline, 80% theophylline): water soluble; can be injected i. Selective Estrogen Receptor Down Regulator/Pure Estrogen Antagonist Fulvestrant: 250 mg i. Ulipristal (selective progesterone receptor modulator) 30 mg single dose as soon as possible, before 120 hours of intercourse. Note: For preparations of prostaglandins and uterine relaxants, see Index 5 Drugs Acting on Peripheral (somatic) Nervous System Skeletal Muscle Relaxants 61 Preparations (Note: Doses of neuromuscular blocking agents given below are initial paralysing doses for nitrous oxide-oxygen/opioid anaesthesia. These doses are to be reduced to 1/3–1/2 in patients anaesthetised with ether/halothane/isofurane etc. Fortified procaine penicillin G inj: contains 3 lac U procaine penicillin and 1 lac U sod. Aminoglycoside Antibiotics Systemic aminoglycosides Topical aminoglycosides Streptomycin Gentamicin Kanamycin Neomycin Framycetin Tobramycin Amikacin Sisomicin Netilmicin Paromomycin Preparations 1. Chloramphenicol: 250–500 mg 6 hourly oral (max 28 g total in a course), children 25–50 mg/kg/day; 0. Note: See Index for preparations of ciprofoxacin, ofoxacin, levofoxacin and moxifoxacin. Fluconazole: For tinea infections, cutaneous and vaginal candidiasis 150 mg oral weekly; for systemic mycosis 200–400 mg daily oral/i. Antiviral Drugs (Non-retroviral) 153 154 Antifungal, Antiviral, Antiprotozoal and Anthelmintic Drugs Antiviral Drugs (Non-retroviral) 155 Preparations Antiviral Drugs (Non-retroviral) 1. Acyclovir: 200 mg 5 times a day oral (15 mg/kg/day), 5–10 mg/kg 8 hourly by slow i. Chloroquine: For clinical cure: 600 mg (base) followed by 300 mg after 8 hours and 300 mg daily for 2 days (total 1500 mg); total dose (in 3 days) for infants 150 mg, children 1–4 years 200–400 mg, 5–10 years 600–1000 mg. Quinine: For complicated (Cerebral) malaria: 20 mg/kg diluted in 5% glucose and infused i. For Anaerobic infections: prophylactic—2 g single dose before colorectal surgery; therapeutic—2 g followed by 0. Secnidazole: 2 g single dose (children 30 mg/kg) for intestinal amoebiasis, giardiasis, trichomonas vaginitis and nonspecifc bacterial vaginosis; 1. Piperazine: For roundworm infestation 4 g once a day for 2 consecutive days; children 0. Melphalan: 10 mg daily for 7 days or 6 mg/day for 2–3 weeks—4 weeks gap—2 to 4 mg daily for maintenance orally. Note: See Index for preparations of hormones and hormone antagonists 176 14 Miscellaneous Drugs Immunosuppressant Drugs 177 Preparations 1. Cyclosporine: 10–15 mg/kg/day with milk or fruit juice till 1–2 weeks after transplantation, gradually reduced to maintenance dose of 2–6 mg/kg/day. Azathioprine: Initially 3–5 mg/kg/day oral, followed by 1–2 mg/kg/day for maintenance. Glycyrrhiza: as glycyrrhiza dry extract 1–2 g or liquid extract 2–4 ml, in lozenges and mixtures. Dermal protectives: Magnesium stearate, Zinc stearate, Talc, Calamine, Zinc oxide, Bentonite, Starch, Boric acid, Aloe-vera gel. Vegetable astringents Tannic acid: as glycerine of tannic acid 25% Tannins: as tincture catechu, tea leaf infusion 2. Mineral astringents Alum, Aluminium hydroxychloride, Zinc oxide, Zirconyl hydroxychloride E. Keratolytics and Caustics Salicylic acid, Resorcinol, Podophyllum resin, Silver nitrate, Phenol, Trichloracetic acid, Glacial acetic acid. Antiseborrheics Selenium sulfide, Zinc pyrithione, Sulfur, Resorcinol, Coal tar, Ketoconazole, Clotrimazole, Topical corticosteroids. Phenol derivatives: Phenol, Cresol, Hexylresorcinol, Chloroxylenol, Hexachlorophene.