Angiotensin-Converting Enzyme Inhibitors

Angiotensin-Converting Enzyme Inhibitors

The class of drugs called angiotensin converting enzyme (ACE) inhibitors, as the class name suggests, reduces the activity of angiotensin converting enzyme. ACE converts angiotensin I produced by the body to angiotensin II in the blood. Angiotensin II is a very potent chemical that causes the muscles surrounding blood vessels to contract and narrow the blood vessels. Narrowing of blood vessels increases the pressure within the blood vessels and may lead to high blood pressure (hypertension). By reducing the activity of ACE, ACE inhibitors decrease the formation of angiotensin II which leads to widening (dilation) of blood vessels, and thereby reduces blood pressure. By lowering blood pressure against which the heart must pump, the amount of work that the heart must do is reduced. ACE inhibitors also reduce blood pressure in the kidneys, slowing the progression of kidney disease due to high blood pressure or diabetes. ACE inhibitors are effective for control of blood pressure, congestive heart failure, and prevention of stroke and hypertension, or diabetes-related kidney damage. ACE

inhibitors are especially important because they have been shown to prevent early death resulting from hypertension, heart failure or heart attacks; in studies of patients with hypertension, heart failure, or prior heart attacks, patients who received an ACE inhibitor survived longer than patients who did not receive an ACE inhibitor. ACE inhibitors may be combined with other drugs to achieve optimal blood pressure control. ACE inhibitors are very similar, and all are effective for treating hypertension. Some are eliminated primarily by the kidneys while others are also eliminated in bile and feces. This difference in elimination may be important in choosing among ACE inhibitors in patients with reduced kidney or liver function, who may accumulate drugs that are excreted via the kidneys or liver. Except for captopril and lisinopril, ACE inhibitors are inactive until they are converted to an active form in the body. Common side effects are: dizziness, headache, drowsiness, diarrhea, low blood pressure, weakness, cough, and rash. An abnormal taste (metallic or salty), elevated blood potassium levels, and sexual dysfunction may also occur. A nonproductive and persistent cough may occur in 5%-25% of individuals. It may take up to 2 weeks or longer for coughing to subside after the ACE inhibitor is discontinued. If one ACE inhibitor causes cough, it is likely that the others will also. ACE inhibitors may cause birth defects and, therefore, should not be used during pregnancy.

CAPTOPRIL:

Indications: mild to moderate essential hypertension alone or with thiazide therapy and severe hypertension resistant to other treatment; congestive heart failure with left ventricular dysfunction); following myocardial infarction, see dose; diabetic nephropathy (microalbuminuria greater than 30 mg/day) in insulin-dependent diabetes.

Contraindications: Contraindicated in patients with hypersensitivity to ACE inhibitors (including angioedema). ACE inhibitors should not be used in pregnancy.

Dose and Administration: Hypertension, used alone, initially 12.5 mg twice daily; if used in addition to diuretic, or in elderly, initially 6.25 mg twice daily (first dose at bedtime); usual maintenance dose 25 mg twice daily; max. 50 mg twice daily (rarely 3 times daily in severe hypertension). Heart failure (adjunct), initially 6.25–12.5 mg under close medical supervision, increased gradually at intervals of at least 2 weeks up to max. 150 mg daily in divided doses if tolerated. Prophylaxis after infarction in clinically stable patients with asymptomatic or symptomatic left ventricular dysfunction (radionuclide ventriculography or echocardiography undertaken before initiation), initially 6.25 mg, starting as early as 3 days after infarction, then increased over several weeks to 150 mg daily (if tolerated) in divided doses. Diabetic nephropathy, 75–100 mg daily in divided doses; if further blood pressure reduction required, other antihypertensives may be used in conjunction with captopril; in severe renal impairment, initially 12.5 mg twice daily.

ENALAPRIL:

Indications: Treatment of hypertension alone or in combination with other antihypertensive agents, especially thiazide-type diuretics. indicated for the treatment of symptomatic congestive heart failure, usually in combination with diuretics and digitalis.

Contraindications: contraindicated in patients who are hypersensitive to this product and in patients with a history of angioedema related to previous treatment with an angiotensin converting enzyme inhibitor and in patients with hereditary or idiopathic angioedema.

Dose and Administration: The recommended initial dose in patients not on diuretics is 5 mg once a day. Dosage should be adjusted according to blood pressure response. The usual dosage range is 10 to 40 mg per day administered in a single dose or two divided doses. If the diuretic cannot be discontinued an initial dose of 2.5 mg should be used under medical supervision for at least two hours and until blood pressure has stabilized for at least an additional hour. Heart Failure: The recommended dosing range is 2.5 to 20 mg given twice a day.

Enalapril-Hydrochlorothiazide:

Indications: indicated for the treatment of hypertension, this fixed dose combination is not indicated for initial treatment.

Contraindications: see under enalapril.

Dose and Administration: The usual dosage of enalapril is 20 mg per day administered in a single dose; hydrochlorothiazide is effective in doses of 12.5 mg daily.

LISINOPRIL:

Indications: hypertension; symptomatic heart failure; short-term treatment following myocardial infarction in haemodynamically stable patients; renal complications of diabetes mellitus.

Contraindications: see under enalapril.

Dose and Administration: Hypertension, initially 10 mg once daily; if used in addition to diuretic or in cardiac decompensation or in volume depletion, initially 2.5–5 mg once daily; usual maintenance dose 20 mg once daily; max. 80 mg once daily. Heart failure (adjunct), initially 2.5 mg once daily under close medical supervision; increased in steps no greater than 10 mg at intervals of at least 2 weeks up to max. 35 mg once daily if tolerated. Prophylaxis after myocardial infarction, systolic blood pressure over 120 mmHg, 5 mg within 24 hours, followed by further 5 mg 24 hours later, then 10 mg after a further 24 hours, and continuing with 10 mg once daily for 6 weeks (or continued if heart failure); systolic blood pressure 100–120 mmHg, initially 2.5 mg once daily, increased to maintenance dose of 5 mg once daily.

PERINDOPRIL:

Indications: hypertension; symptomatic heart failure; prophylaxis of cardiac events following myocardial infarction or revascularisation in stable coronary artery disease.

Contraindications:  see under enalapril.

Dose and Administration:

Hypertension, initially 5 mg once daily in the morning adjusted according to response; if used in addition to diuretic, in elderly or in renal impairment, initially 2.5 mg once daily; max. 10 mg daily

Heart failure (adjunct), initially 2 mg once daily in the morning under close medical supervision, increased after at least 2 weeks to max. 4 mg once daily if toleratedFollowing myocardial infarction or revascularisation, initially 5 mg once daily in the morning increased after 2 weeks to 10 mg once daily if tolerated; elderly 2 mg once daily for 1 week, then 4 mg once daily for 1 week, thereafter increased to 10 mg once daily if tolerated.

Perindopril-Indapamide:

Indications: treatment of essential hypertension.

Contraindications: previous history of quincke`s oedema, severe renal failure,

pregnancy and lactation.

Dose and Administration: the normal dose one tablet daily.

Sympathomimetics

Sympathomimetics

My formulary,Sympathomimetics,Dobutamine,Inotropic ,Indications,Contraindications,Administration,Dose ,Dopamine,ISOPRENALINE,pheochromocytoma ,Vasoconstrictor ,Ephedrine,Noradrenaline,Cardiopulmonary ,Resuscitaction,Adrenaline,Epinephrine

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Nitrates, Calcium Channel Blockers and Other Antianginal Drugs

Nitrates, Calcium Channel Blockers and  Other Antianginal Drugs

My formulary,Nitrates,Calcium Channel,Blockers,Antianginal,Drugs,Glyceryl Trinitrate,Nitrates,Isosorbide Dinitrate:,Indications,Contraindications,Administration,Dose ,Isosorbide ,Mononitrate,Nifedipine,Amlodipine,Diltiazem,Nimodipine,Verapamil,Amlodipine ,Valsartan,Trimetazidine,Ivabradine,Pentoxifylline,Diosmin,Rutosides

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Alpha-Adrenoceptor Blocking Drugs

Alpha-Adrenoceptor Blocking Drugs

Terazosin:

Indications: indicated for the treatment of symptomatic benign prostatic hyperplasia (BPH). also indicated for the treatment of hypertension alone or in combination with other antihypertensive agents such as diuretics or beta­adrenergic blocking agents.

Contraindications: contraindicated in patient’s known to be hypersensitive to terazosin hydrochloride.

Dose and Administration: Benign Prostatic Hyperplasia: 1 mg at bedtime is the starting dose The dose should be increased in a stepwise fashion to 2 mg, 5 mg, or 10 mg once daily to achieve the desired improvement of symptoms and/or flow rates. Hypertension: The usual recommended dose range is 1 mg to 5 mg administered once a day; however, some patients may benefit from doses as high as 20 mg per day.

Doxazosin:

Indications: treatment of both the urinary outflow obstruction and obstructive and irritative symptoms associated with BPH. also indicated for the treatment of hypertension alone or in combination with diuretics, beta-adrenergic blocking agents, calcium channel blockers or angiotensin-converting enzyme inhibitors.

Contraindications: contraindicated in patients with a known sensitivity to quinazolines.

Dose and Administration: Benign Prostatic Hyperplasia 1–8 mg once daily. Hypertension 1–16 mg once daily.

Alfuzosin:

Indications: indicated for the treatment of signs and symptoms of benign prostatic hyperplasia. It is not indicated for the treatment of hypertension. Contraindications: contraindicated for use in patients with moderate or severe hepatic impairment, contraindicated for use with potent CYP3A4 inhibitors such as ketoconazole, itraconazole, and ritonavir.

Dose and Administration: The recommended dosage is one 10 mg once daily.

Angiotensin-II Receptor Antagonist

Angiotensin-II Receptor Antagonist

The class of drugs called angiotensin receptor blockers (ARBs), as the class name suggests, are drugs that block the action of angiotensin. Specifically, ARBs prevent angiotensin II from binding to the angiotensin II receptor on blood vessels and other tissues. Angiotensin II is a very potent chemical that causes the muscles surrounding blood vessels to contract, thereby narrowing the blood vessels. Narrowing of blood vessels increases the pressure within the blood vessels and may lead to high blood pressure (hypertension). Reducing the binding and activity of angiotensin II leads to widening (dilation) of blood vessels and reduces blood pressure. ARBs are used alone or in combination with other drugs for controlling high blood pressure. They also are used for treating congestive heart failure, preventing diabetes or high blood pressure-related kidney failure, and reducing the risk of stroke in patients with hypertension and an enlarged heart. ARBs also may prevent the recurrence of atrial fibrillation. Since ARBs have effects that are similar to those of ACE inhibitors, they are often used when ACE inhibitors are not tolerated by patients because of side effects. ARBs are similar in action and side effects. They differ in how they are eliminated from the body and the extent to which they are distributed throughout the body. Some ARBs are converted to an active form in the body before they can exert their effects.Some ARBs are slightly better at reducing blood pressure than others; in some studies, irbesartan and candesartan were slightly more effective in reducing blood pressure than losartan.All ARBs usually are administered once daily for treatment of hypertension. Some patients may benefit from twice daily dosing of losartan if blood pressure is not controlled with once daily dosing. Common side effects include dizziness, headache, drowsiness, nausea, vomiting, diarrhea, cough, elevated potassium levels, low blood pressure, muscle or bone pain, and rash.ARBs cause cough less frequently than ACE inhibitors. Therefore, they are often substituted for ACE inhibitors when patients complain of cough with ACE inhibitors. Like other antihypertensives, ARBs are associated with sexual dysfunction.

CANDESARTAN:

Indications: hypertension; heart failure with impaired left ventricular systolic function in conjunction with an ACE inhibitor, or when ACE inhibitors are not tolerated.

Contraindications: Angiotensin-II receptor antagonists should be avoided in pregnancy.

Dose and Administration:

Hypertension, initially 8 mg (hepatic impairment 2 mg, renal impairment or intravascular volume depletion 4 mg) once daily, increased if necessary at intervals of 4 weeks to max. 32 mg once daily; usual maintenance dose 8 mg once daily

Heart failure, initially 4 mg once daily, increased at intervals of at least 2 weeks to ‘target’ dose of 32 mg once daily or to max. tolerated dose.

IRBESARTAN:

Indications: treatment of hypertension and treatment of diabetic nephropathy with an elevated serum creatinine and proteinuria (> 300 mg/day) in patients with type 2 diabetes and hypertension.

Contraindications: Angiotensin-II receptor antagonists should be avoided in pregnancy.

Dose and Administration:

Hypertension, initially 150 mg once daily, increased if necessary to 300 mg once daily (in haemodialysis or in elderly over 75 years, initial dose of 75 mg once daily may be used); child not recommended

Renal disease in hypertensive type 2 diabetes mellitus, initially 150 mg once daily, increased to 300 mg once daily if tolerated (in haemodialysis or in elderly over 75 years, consider initial dose of 75 mg once daily); child not recommended.

EPROSARTAN:

Indications: treatment of hypertension. It may be used alone or in combination with other anti hypertensives such as diuretics and calcium channel blockers.

Contraindications: Angiotensin-II receptor antagonists should be avoided in pregnancy.

Dose and Administration: 600 mg once daily (elderly over 75 years, mild to moderate hepatic impairment, renal impairment, initially 300 mg once daily); if necessary increased after 2–3 weeks to 800 mg once daily.

LOSARTAN:

Indications: hypertension (including reduction of stroke risk in hypertension with left ventricular hypertrophy); diabetic nephropathy in type 2 diabetes mellitus.

Contraindications: Angiotensin-II receptor antagonists should be avoided in pregnancy.

Dose and Administration: Usually 50 mg once daily (intravascular volume depletion, initially 25 mg once daily); if necessary increased after several weeks to 100 mg once daily; elderly over 75 years initially 25 mg daily. Pediatric Hypertensive Patients ≥ 6 years of age: The usual recommended starting dose is 0.7 mg/kg once daily (up to 50 mg total) administered as a tablet or a suspension Dosage should be adjusted according to blood pressure response. Doses above 1.4 mg/kg (or in excess of 100 mg) daily have not been studied in pediatric patients.

VALSARTAN:

Indications: hypertension; myocardial infarction with left ventricular failure or left ventricular systolic dysfunction.

Contraindications: Angiotensin-II receptor antagonists should be avoided in pregnancy.

Dose and Administration: Hypertension, usually 80 mg once daily (initially 40 mg once daily in intravascular volume depletion); if necessary increased at intervals of 4 weeks up to max. 320 mg daily; elderly over 75 years, initially 40 mg once daily. Myocardial infarction, initially 20 mg twice daily increased over several weeks to 160 mg twice daily if tolerated.

OLMESARTAN:

Indications: treatment of hypertension. It may be used alone or in combination with other antihypertensive agents.

Contraindications: Angiotensin-II receptor antagonists should be avoided in pregnancy.

Dose and Administration: Dosage must be individualized. The usual recommended starting dose of Benicar is 20 mg once daily when used as monotherapy in patients who are not volume-contracted. For patients requiring further reduction in blood pressure after 2 weeks of therapy, the dose of Benicar may be increased to 40 mg.

TELMISARTAN:

Indications: treatment of hypertension. It may be used alone or in combination with other antihypertensive agents.

Contraindications: Angiotensin-II receptor antagonists should be avoided in pregnancy.

Dose and Administration: Usually 40 mg once daily (but 20 mg may be sufficient), increased if necessary after at least 4 weeks, to max. 80 mg once daily.

Candesartan-Hydrochlorothiazide:

Indications: indicated for the treatment of hypertension. This fixed dose combination is not indicated for initial therapy.

Contraindications: Angiotensin-II receptor antagonists should be avoided in pregnancy and in patients with anuria or hypersensitivity to other sulfonamide-derived drugs.

Dose and Administration: The usual recommended starting dose of candesartan cilexetil is 16 mg once daily; Hydrochlorothiazide is effective in doses of 12.5mg once daily.

Irbesartan-Hydrochlorothiazide:

Indications: treatment of hypertension. may be used in patients whose blood pressure is not adequately controlled on monotherapy. also be used as initial therapy in patients who are likely to need multiple drugs to achieve their blood pressure goals.

Contraindications: Angiotensin-II receptor antagonists should be avoided in pregnancy and in patients with anuria or hypersensitivity to other sulfonamide-derived drugs.

Dose and Administration: In patients not controlled on monotherapy with irbesartan the recommended doses, in order of increasing mean effect, are (irbesartan-hydrochlorothiazide) 150/12.5 mg, 300/12.5 mg, and 300/25 mg. The largest incremental effect will likely be in the transition from monotherapy to 150/12.5 mg

Eprosartan-Hydrochlorothiazide:

Indications: treatment of hypertension. It may be used alone or in combination with other anti hypertensives such as calcium channel blockers.

Contraindications: Angiotensin-II receptor antagonists should be avoided in pregnancy and in patients with anuria or hypersensitivity to other sulfonamide-derived drugs.

Dose and Administration: The usual recommended dose is 600 mg/12.5 mg once daily when used as combination therapy in patients who are not volume-depleted

Losartan-Hydrochlorothiazide:

Indications: treatment of hypertension. This fixed dose combination is not indicated for initial therapy of hypertension also indicated to reduce the risk of stroke in patients with hypertension and left ventricular hypertrophy.

Contraindications: Angiotensin-II receptor antagonists should be avoided in pregnancy and in patients with anuria or hypersensitivity to other sulfonamide-derived drugs.

Dose and Administration: A patient, whose blood pressure is not adequately controlled with losartan monotherapy, may be switched to losartan 50 mg/hydrochlorothiazide 12.5 mg once daily. If blood pressure remains uncontrolled after about 3 weeks of therapy, the dose may be increased to one tablet of losartan 100 mg/hydrochlorothiazide 25 mg once daily.

Valsartan-Hydrochlorothiazide:

Indications: indicated for the treatment of hypertension in patients whose blood pressure is not adequately controlled on monotherapy. It may be used as initial therapy in patients who are likely to need multiple drugs to achieve blood pressure goals.

Contraindications: Angiotensin-II receptor antagonists should be avoided in pregnancy and in patients with anuria or hypersensitivity to other sulfonamide-derived drugs.

Dose and Administration: Dose once daily. Maximum antihypertensive effects are attained within 2 to 4 weeks after a change in dose.

Olmesartan-Hydrochlorothiazide:

Indications: indicated for the treatment of hypertension. This fixed dose combination is not indicated for initial therapy.

Contraindications: Angiotensin-II receptor antagonists should be avoided in pregnancy and in patients with anuria or hypersensitivity to other sulfonamide-derived drugs.

Dose and Administration: Dosing should be individualized. Depending on the blood pressure response, the dose may be titrated at intervals of 2-4 weeks.

Telmisartan-Hydrochlorothiazide:

Indications: indicated for the treatment of hypertension. This fixed dose combination is not indicated for initial therapy.

Contraindications: Angiotensin-II receptor antagonists should be avoided in pregnancy and in patients with anuria or hypersensitivity to other sulfonamide-derived drugs.

Dose and Administration: A patient whose blood pressure is not adequately controlled with telmisartan monotherapy 80 mg may be switched to telmisartan 80 mg/hydrochlorothiazide 12.5 mg once daily.

Centrally Acting Antihypertensive Drugs

Centrally Acting Antihypertensive Drugs

Methyldopa:

Indications: hypertension

Contraindications: contraindicated in patients with active hepatic disease, such as acute hepatitis and active cirrhosis, with liver disorders previously associated with methyldopa therapy. on therapy with monoamine oxidase (MAO) inhibitors. Dose and Administration: Initially 250 mg 2–3 times daily, increased gradually at intervals of at least 2 days, max. 3 g daily; elderly initially 125 mg twice daily, increased gradually, max. 2 g daily.

CLONIDINE:

Indications: in the treatment of hypertension.

Contraindications: not be used in patients with known hypersensitivity to

clonidine.

Dose and Administration: By slow intravenous injection, 150–00 micrograms;

max. 750 micrograms in 24 hours.

MOXONIDINE:

Indications: mild to moderate essential hypertension.

Contraindications: history of angioedema; conduction disorders (sick sinus syndrome, sino-atrial block, second- or third-degree AV block); bradycardia; life-threatening arrhythmia; severe heart failure; severe coronary artery disease, unstable angina; severe liver disease or severe renal impairment; also on theoretical grounds: Raynaud’s syndrome, intermittent claudication, epilepsy, depression, Parkinson’s disease; pregnancy and breast-feeding.

Dose and Administration: 200 micrograms once daily in the morning, increased if necessary after 3 weeks to 400 micrograms daily in 1–2 divided doses; max. 600 micrograms daily in 2 divided doses (max. single dose 400 micrograms)

Rilmenidine:

Indications: mild to moderate hypertension.

Contraindications: severe depression and severe renal failure.

Dose and Administration: 1mg daily as a single dose which can be increased if necessary after 1 month to 2mg daily in divided doses.

Chronic Bowel Disorders

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Aminosalicylates:

MESALAZINE:

Indications: is an anti-inflammatory drug used to treat inflammation of the digestive tract ulcerative colitis and mild to moderate Crohn’s disease. Contraindications: severe hepatic impairment.

Dose and Administration: for ulcerative colitis 1-2 tablet 3 times daily before meals in acute attacks, for long treatment of ulcerative colitis 500mg 3 times daily. For Crohn’s disease 1-3 tablets 3 times daily. For enema use the content (4gm/60ml) per day.

 

SULPHASALAZINE:

Indications: treatment of mild to moderate and sever ulcerative colitis and maintenance of remission active Crohn’s disease also for rheumatoid arthritis. Contraindications: child under 2 years of age, asthmatic patients, and intestinal and urinary obstruction.

Dose and Administration: adults acute attack 1-2 gm 4 times daily until remission occurs, reducing to maintenance dose of 500mg 4 times daily. Children over 2 years acute attack 40-60mg/kg daily. Maintenance doses 20-30mg/kg daily.

Cortecosteroids:

BUDESONIDE:

Indications: ulcerative colitis involving rectal and recto-sigmoid disease. Contraindications: use of enemas and rectal forms in obstruction, bowel perforation, and extensive fistulas; untreated infection.

Dose and Administration: 1 enema at bedtime for 4 weeks.

 

Cytokine Inhibitors:  INFLIXIMAB:

Indications: inflammatory bowel disease, ankylosing spondylitis, and rheumatoid arthritis.

Contraindications: pregnancy, breast-feeding and sever infection.

Dose and Administration: adults over 18 years initially 5mg/kg if responding within 2 weeks of initial dose, then 5mg/kg 2 weeks and 6 weeks after initial dose.

Antiemetics

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Antiemetics are a diverse group of drugs used to treat or prevent nausea and vomiting, including that associated with cancer therapy, anaesthesia and surgery, and motion sickness. Antiemetics described here include: the dopamine antagonists’ metoclopramide and chlorpromazine hydrochloride; antihistamines such as Dimenhydrinate, Meclizine Hydrochloride & Promethazine Hydrochloride. The choice of drug depends partly on the cause of nausea and vomiting. For example, hyoscine or antihistamines are used in motion sickness where as dopamine antagonists, who act selectively on the chemoreceptor trigger zone, are in effective for the treatment of motion sickness. Conversely, nausea and vomiting associated with cancer chemotherapy is often hard to control and special regimens have been devised including the use of metoclopramide in high doses and more recently 5 HT3 antagonist and ondanesetron.

Metoclopramide Hydrochloride

Indications: nausea and vomiting in gastrointestinal disorders and treatment with cytotoxics or radiotherapy; gastro-oesophageal reflux, gastroparesis؛ pre­medication and postoperatively, aid to gastro-intestinal intubation, nausea and vomiting in migraine; see also notes above.

Contraindication: epilepsy; gastrointestinal hemorrhage, mechanical obstruction or perforation; pheochromocytoma.

Dose and Administration: Nausea and vomiting, gastro-oesophageal reflux, gastroparesis: – Adult؛ Orally, or IM, or slow IV injection10 mg 3 times daily; young، adult 15 – 19 years (under 60 Kg) 5 mg 3 times daily; Children؛ Orally, or IM, or slow IV injection, up to 1 year (up to 10 Kg) ١ mg twice daily, 1 – 3 years (10-14 Kg) 1 mg 2 – 3 times daily, 3 – 5 years (15 – 19 Kg) 2 mg 2 – 3 times daily, 5 – 9 years (20-28 Kg.) 2.5 mg I times daily, 9 – 14 years (30 Kg and over) 5 mg 3 times daily. (Usual maximum 500 micrograms/Kg daily, particularly for children and young adults). Pre-medication: – Adults, by slow I.V.، 10 mg as a single dose. Aid to gastrointestinal intubation, Orally, or IM or by slow intravenous injection, Adult 10 – 20 mg as a single dose 5 – 10 minutes before examination؛ Young Adult (15 – 19 years) 10mg; child under 3 years 1 mg، 3 – 5 years 2 mg, 5 – 9 years 2.5 mg, 9 – 14 years 5 mg.

 

Meclizine-Pyridoxine Hydrochloride

Indications: for the prevention and treatment of nausea, vomiting and/or vertigo associated with motion sickness; see also notes above. Contraindications: Bladder Outflow Obstruction, Chronic Idiopathic Constipation, Narrow Angle Glaucoma, Pyloroduodenal Obstruction, And Urinary Retention.

Dose and Administration: Adults & Children (>12 years of age): – Motion sickness (prophylaxis & treatment) – Oral, 25 to 50 mg one hours before travel. Dose may be repeated every twenty-four ours as needed. Vertigo (prophylaxis and treatment)- Oral, 25 to 100 mg a day as needed; in divided doses.

Dimenhydrinate:

Indications: Motion Sickness, Nausea, Nausea and Vomiting, Prevention of Motion Sickness, Prevention of Nausea and Vomiting, Vertigo, Vomiting.

Dose and Administration: Adults: Oral، 50 to 100 mg every four to six hours. Children: Oral, 6-12 Years of age, 25 to 50 mg every six to eight hours as needed، not to exceed 150 mg per day; 2-6 years of age, 12.5 to 25 mg every six to eight hours as needed, not to exceed 75 mg per day. Note: Oral dosage forms used for motion sickness should be taken 30 minutes before motion. Contraindications: Acute Asthma Attack, Lactating Mothe, Benign Prostatic Hypertrophy, Bladder Outflow Obstruction, Chronic Idiopathic Constipation, Glaucoma, Stenosing Peptic Ulcer, And Urinary Retention.

Promethazine Hydrochloride

Indications: – control of nausea, vomiting, and vertigo of various cause, as a sedative and hypnotic, and as a common ingredient of cough and cold preparations؛ also see notes above.

Contraindications: – patients who have exhibited hypersensitivity to the drug؛ also in those who have received large doses of CNS depressants and/or in those who are comatose, in epileptic seizures.

Dose and Administration: Note: For motion sickness, the initial 25 mg dose should be taken one half to one hour before travel, and the dose repeated 8 – 12 hours later, if necessary. Adult, 25 mg initially, then 10 to 25 mg every 4 – 6 hours as needed. Children (>2 years of age); 0.25 to 0.5 mg per Kg of body weight every 4 to 6 hours or 10 to 25 mg every four to six hours as needed. IM or IV, Adults, 12.5 to 25 mg every 4 hours as needed. Children (> 2 years of age); 0.25 to 0.5 mg per Kg of body weight every 4 to 6 hours as needed. Antivertigo agent Oral, Adult, 25mg 2 times a day as needed. Children (> 2 years of age), ٠.5 mg to 1mg per kg of body weight or 10 to 25mg 2 times a day as needed.

 

Chlorpromazine Hydrochloride

Indications: – For the prevention and control of severe nausea and vomiting. Contraindications: – severe central nervous system depression, or severe cardiovascular diseases and hypotension.

Dose and Administration: Adults: Oral, 12.5 –25mg every 4 – 6 hours, as necessary. Slow، deep I.M.، 25 mg as a single dose, the dosage being increased to 25 – 50mg every 3 – 4 hours until vomiting stops; it is then given orally if necessary. Children (6 month and over): Oral or slow, deep I.M.، 0.55mg/kg every 6–٨ hour as necessary.

Note: Patients should remain lying down for at least 30 minutes after injection.

Ondansetron:

Indications: moderately emetogenic chemotherapy or radiotherapy; prevention of postoperative nausea and vomiting.

Contraindications: pregnancy and breast-feeding, moderate or sever hepatic impairment.

Dose and Administration: – The recommended adult oral dosage of ZOFRAN is 24 mg given as three 8-mg tablets administered 30 minutes before the start of single-day highly emetogenic chemotherapy, including cisplatin ≥ 50 mg/m2. Multiday, single-dose administration of a 24 mg dosage has not been studied. For the injection The first dose is injected 30 minutes before chemotherapy is begun. After chemo is completed, use as directed by your doctor, usually for 1 or 2 days after chemo is done.

Domperidone:

Indications: upper gastrointestinal motility (GI) modifier, nausea and vomiting. Contraindications: – renal impairment, pregnancy and breast-feeding, gastrointestinal hemorrhage.

Dose and Administration: upper GI disorders adult: 10mg 3-4 times a day. Nausea and vomiting, 20mg 3-4 times a day. Child 2.5mg/10kg body weight 3 times daily before meals.

Vasodilator Antihypertensive Drugs

Vasodilator Antihypertensive Drugs

Hydralazine:

Indications: moderate to severe hypertension (adjunct); heart failure (with long-acting nitrate), hypertensive crisis (including during pregnancy)

Contraindications: Hypersensitivity to hydralazine; coronary artery disease; mitral valvular rheumatic heart disease.

Dose and Administration: By slow intravenous injection, hypertension with renal complications and hypertensive crisis, 5–10 mg diluted with 10 mL sodium chloride 0.9%; may be repeated after 20–30 minutes. By intravenous infusion, hypertension with renal complications and hypertensive crisis, initially 200– 300 micrograms/minute; maintenance usually 50–150 micrograms/minute

Sodium Nitroprusside:

Indications: Sodium nitroprusside is indicated for the immediate reduction of blood pressure of patients in hypertensive crises. Concomitant longer-acting antihypertensive medication should be administered so that the duration of treatment with sodium nitroprusside can be minimized. also indicated for producing controlled hypotension in order to reduce bleeding during surgery. also indicated for the treatment of acute congestive heart failure.

Contraindications: Sodium nitroprusside should not be used in the treatment of compensatory hypertension, where the primary hemodynamic lesion is aortic coarctation or arteriovenous shunting. should not be used to produce hypotension during surgery in patients with known inadequate cerebral circulation. should not be used for the treatment of acute congestive heart failure associated with reduced peripheral vascular resistance such as high-output heart failure that may be seen in endotoxic sepsis.

Dose and Administration:  Hypertensive crisis, by intravenous infusion, initially 0.5–1.5 micrograms/kg/minute, then increased in steps of 500 nanograms/kg/minute every 5 minutes within      range   0.5–8 micrograms/kg/minute (lower doses if already receiving other antihypertensives); stop if response unsatisfactory with max. dose in 10 minutes.

Drugs For Hepatic Disorders

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SILYMARIN:

Indications: acute hepatitis, cirrhosis, fatty degeneration, prophylaxis and treatment of toxin drug induced liver disorders.

Dose and Administration: 3-6 tablets daily on divided doses (210mg-420mg)

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