Tag Archives forIndications

Immunoglobulins

 

 

Normal immunoglobulin

 

HUMAN NORMAL IMMUNOGLOBULIN:

Indications: Replacement therapy in: Primary immunodeficiency syndromes such as: congenital agammaglobulinaemia and hypogammaglobulinaemia. common variable immunodeficiency. severe combined immunodeficiency. Wiskott Aldrich syndrome. Myeloma or chronic lymphatic leukaemia with severe secondary hypogammaglobulinaemia and recurrent infections. Children with congenital AIDS and recurrent infections. Immunomodulation. Idiopathic thrombocytopenic purpura (ITP) in children or adults at high risk of bleeding or prior to surgery to correct the platelet count. Guillain Barré syndrome. Kawasaki disease Allogeneic bone marrow transplantation.

Contraindications: Hypersensitivity to the active substance or to any of the excipients. Hypersensitivity to homologous immunoglobulins, especially in the very rare cases of IgA deficiency when the patient has antibodies against IgA.

Dose and Administration: The dose and dosage regimen is dependent on the indication. In replacement therapy the dosage may need to be individualised for each patient dependent on the pharmacokinetic and clinical response. The dosage regimen should achieve a trough level of IgG (measured before the next infusion) of at least 4 – 6 g/l. Three to six months are required after the initiation of therapy for equilibration to occur. The recommended starting dose is 0.4 – 0.8 g/kg, followed by at least 0.2 g/kg every three weeks. The dose required to achieve a trough level of 6 g/l is of the order of 0.2 – 0.8 g/kg/month. The dosage interval when steady state has been reached, varies from 2 to 4 weeks. Trough levels should be measured in order to adjust the dose and dosage interval. Guillain Barré syndrome: 0.4 g/kg/day for 3 to 7 days.

 

Specific Immunoglobulin

 

HEPATITIS B IMMUNOGLOBULIN:

Indications: indicated for post-exposure prophylaxis following either parenteral exposure (e.g. accidental “needle-stick”), direct mucous membrane contact, or oral ingestion of HBsAg-positive materials, such as blood, plasma or serum. Also indicated for the temporary protection of infants born to HBsAg-positive mothers (especially those who are HBeAg-positive), since these infants are at risk of acquiring hepatitis B infection. Infants born to HBsAg-positive mothers should receive hepatitis B immunoglobulin and the first dose of hepatitis B vaccine at the same time.

Contraindications: Intramuscular injections are not advocated for patients with bleeding disorders. The risk-benefit ratio in patients with a history of immunoglobulin A (IgA) deficiency or severe anaphylactic reactions to plasma

products should be considered. Is not appropriate for the treatment of any type of hepatitis B infection.

Dose and Administration: By intramuscular injection (as soon as possible after exposure; ideally within 12 hours, but no later than 7 days after exposure), adult and child over 10 years 500 units; child under 5 years 200 units, 5–9 years 300 units; neonate 200 units as soon as possible after birth

 

ANTI-D (RH0) IMMUNOGLOBULIN:

Indications: Rh (D) incompatibility.

Contraindications: Thrombocytopenia, coagulation disorders preventing intramuscular injection.

Dose and Administration: By intramuscular injection, to rhesus-negative woman for prevention of Rh0 (D) sensitisation: Following birth of rhesus-positive infant, 1000–1650 units immediately or within 72 hours; for large transplacental blood loss, 50–125 units per mL of fetal red cells. Antenatal prophylaxis, 1000– 1650 units given at weeks 28 and 34 of pregnancy; if infant rhesus-positive, further dose is needed immediately or within 72 hours of delivery.

 

 

 

Radiology Preparations

Radiology Preparations

IOHEXOL:

Indications: It is an X-ray contrast medium for use in adults and children for cardioangiography, arteriography, urography, phlebography and CT-enhancement. Lumbar, thoracic, cervical myelography and computed tomography of the basal cisterns, following subarachnoid injection. It is also indicated for arthrography, endoscopic retrograde pancreatography (ERP), endoscopic retrograde cholangiopancreatography (ERCP), herniography, hysterosalpingography.

Contraindications: Manifest thyrotoxicosis. History of serious reaction to Iohexol.

Dose and Administration: The dosage varies depending on the type of examination, age, weight, cardiac output and general condition of the patient and the technique used. Usually the same iodine concentration and volume is used as with other iodinated X-ray contrast media in current use. Adequate hydration should be assured before and after administration as for other contrast media.

IOBITRIDOL:

Indications: intravenous urography, computed tomography, intravenous digital subtraction angiography, arteriography, and angiocardiography.

Contraindications: Manifest thyrotoxicosis. History of serious reaction to Iohexol.

Dose and Administration: The doses must be adapted to the examination and the regions to be opacified, as well as to the body weight and renal function.

GADODIAMIDE:

Indications: It is a contrast medium for cranial and spinal magnetic resonance imaging (MRI). It is also indicated for whole body MRI including head and neck region, thoracic space including the heart, extremities, abdomen and pelvis (prostate and bladder), female breast, abdomen (pancreas and liver), retroperitoneal space (kidney), musculosceletal system and vessels (angiography) by intravenous administration. Omniscan facilitates visualisation of abnormal structures or lesions and helps in the differentiation between healthy and pathological tissue.

Contraindications: Hypersensitivity to the active substance gadodiamide or to any of the excipients. Gadodiamide is contraindicated in patients with severe renal impairment (GFR <30 ml/min/1.73m2), and those who have had or are undergoing liver transplantation.

Dose and Administration: The recommended dosage to adults and children is 0.2-ml/kg body weight (b.w.) (0.1 mmol/kg b.w.) up to 100 kg. Above 100 kg body weight 20 ml is usually sufficient. When brain metastases are suspected, a dosage of 0.6 ml/kg b.w. (0.3 mmol/kg b.w.) can be administered to adults up to 100 kg. Above 100 kg bodyweight a total of 60 ml is usually sufficient. The dose of 0.6 ml/kg can be administered as a single injection. Alternatively a second bolus injection of 0.4 ml/kg b.w. (0.2 mmol/kg b.w.) may be administered within 20 minutes of the first injection of 0.2 ml/kg b.w. (0.1mmol/kg b.w.).

GADOTERIC ACID:

Indications: Magnetic Resonance Imaging for: cerebral and spinal disease; diseases of the vertebral column; other whole-body pathologies (including angiography).

Contraindications: Hypersensitivity to the active substance or to any of the excipients.

Dose and Administration: The recommended dose is 0.1 mmol/kg, i.e. 0.2 mL/kg in adults, children and infants.
In angiography, depending on the results of the examination being performed, a second injection may be administered during the same session if necessary. In some exceptional cases, as in the confirmation of isolated metastasis or the detection of leptomeningeal tumours, a second injection of 0.2 mmol/kg can be administered.

The product must be administered by strict intravenous injection.

 

 

General anaesthesia

General anaesthesia

Several different types of drug are given together during general anaesthesia. Anaesthesia is induced with either a volatile drug given by inhalation or with an intravenously administered drug; anaesthesia is maintained with an intravenous or inhalational anaesthetic. Analgesics, usually short-acting opioids, are also used. The use of neuromuscular blocking drugs necessitates intermittent positive-pressure ventilation. Following surgery, anticholinesterases can be given to reverse the effects of neuromuscular blocking drugs; specific antagonists can be used to reverse central and respiratory depression caused by some drugs used in surgery. A local anaesthetic can be used to reduce pain at the injection site. The required dose of induction agent may be less if the patient has been premedicated with a sedative agent or an opioid analgesic has been used.

 

Intravenous anaesthetics

Intravenous anaesthetics may be used either to induce anaesthesia or for maintenance of anaesthesia throughout surgery. Intravenous anaesthetics nearly all produce their effect in one arm-brain circulation time and can cause apnoea and hypotension, and so adequate resuscitative facilities must be available. They are contra-indicated if the anaesthetist is not confident of being able to maintain the airway (e.g. in the presence of a tumour in the pharynx or larynx). Extreme care is required in surgery of the mouth, pharynx, or larynx and in patients with acute circulatory failure (shock) or fixed cardiac output.

 

Barbiturates

 

THIOPENTAL SODIUM:

Indications: induction of general anaesthesia; anaesthesia of short duration; reduction of raised intracranial pressure if ventilation controlled; status epilepticus.

Contraindications: Respiratory obstruction, acute asthma, severe shock and dystrophia myotonica. Porphyria. Patients with hypersensitivity reactions to barbiturates. Breastfeeding should be temporarily suspended or breast milk expressed before induction of anaesthesia.

Dose and Administration: Induction of general anaesthesia, by slow intravenous injection usually as a 2.5% (25 mg/mL) solution, adult over 18 years, fit and premedicated, initially 100–150 mg (reduced in elderly or debilitated) over 10–15 seconds (longer in elderly or debilitated), followed by further quantity if necessary according to response after 30–60 seconds; or up to 4 mg/kg (max. 500 mg); child 1 month–18 years, initially up to 4 mg/kg, then 1 mg/kg repeated as necessary (max. total dose 7 mg/kg). Raised intracranial pressure, by slow intravenous injection, 1.5–3 mg/kg, repeated as required. Status epilepticus, by slow intravenous injection as a 2.5% (25 mg/mL) solution, adult over 18 years, 75–125 mg as a single dose; child 1 month–18 years,

initially up to 4 mg/kg by slow intravenous injection, then up to 8 mg/kg/hour by continuous intravenous infusion, adjusted according to

response.

 

Other intravenous anaesthetics

 

KETAMINE:

Indications: As an anaesthetic agent for diagnostic and surgical procedures. When used by intravenous or intramuscular injection, Ketamine is best suited for short procedures. For the induction of anaesthesia prior to the administration of other general anaesthetic agents.

Contraindications: persons in whom an elevation of blood pressure would constitute a serious hazard and in those who have shown hypersensitivity to the drug. Ketalar should not be used in patients with eclampsia or pre-eclampsia, severe coronary or myocardial disease, cerebrovascular accident or cerebral trauma.

Dose and Administration: By intramuscular injection, short procedures, initially 6.5–13 mg/kg, adjusted according to response (10 mg/kg usually produces 12–25 minutes of surgical anaesthesia). Diagnostic manoeuvres and procedures not involving intense pain, initially 4 mg/kg. By intravenous injection over at least 60 seconds, short procedures, initially 1–4.5 mg/kg, adjusted according to response (2 mg/kg usually produces 5–10 minutes of surgical anaesthesia). By intravenous infusion of a solution containing 1 mg/mL, longer procedures, induction, total dose of 0.5–2 mg/kg; maintenance, 10– 45 micrograms/kg/minute, rate adjusted according to response.

 

PROPOFOL:

Indications: For induction and maintenance of general anaesthesia. For sedation of artificially ventilated patients in the intensive care unit.

Contraindications: Hypersensitivity to propofol or to one of the excipients. Pregnancy (except in cases of abortion). Should not be used for general anaesthesia in children under the age of three years and for sedation of children under the age of 16 in the intensive care unit. Should not be used during lactation.

Dose and Administration: Induction of anaesthesia, by intravenous injection or infusion, 1.5–2.5 mg/kg (1–1.5 mg in those over 55 years) at a rate of 20– 40 mg every 10 seconds until response; child over 1 month, administer slowly until response (usual dose in child over 8 years 2.5 mg/kg, may need more in younger child e.g. 2.5–4 mg/kg). Maintenance of anaesthesia, by intravenous infusion, 4–12 mg/kg/hour or by intravenous injection, 25–50 mg repeated according to response; child over 3 years, by intravenous infusion, 9– 15 mg/kg/hour.

 

Inhalational anaesthetics

Inhalational anaesthetics may be gases or volatile liquids. They can be used both for induction and maintenance of anaesthesia and can also be used following induction with an intravenous anaesthetic. Volatile liquid anaesthetics are administered using calibrated vaporisers, using air, oxygen, or nitrous oxide– oxygen mixtures as the carrier gas; all can trigger malignant hyperthermia and are contra-indicated in those susceptible to malignant hyperthermia. To prevent hypoxia inhalational anaesthetics must be given with concentrations of oxygen greater than 21%.

 

ISOFLURANE:

Indications: Isoflurane may be used for induction and maintenance of general anesthesia. Adequate data have not been developed to establish its application in obstetrical anesthesia.

Contraindications: Known sensitivity to Isoflurane, USP or to other halogenated agents. Known or suspected genetic susceptibility to malignant hyperthermia.

Dose and Administration: Induction of anaesthesia, using specifically calibrated vaporiser, in oxygen or nitrous oxide–oxygen, increased gradually from 0.5% to 3%. Maintenance of anaesthesia, using specifically calibrated vaporiser, 1–2.5% in nitrous oxide–oxygen; an additional 0.5–1% may be required when given with oxygen alone; caesarean section, 0.5–0.75% in nitrous oxide–oxygen.

 

SEVOFLURANE:

Indications: Sevoflurane is indicated for induction and maintenance of general anesthesia in adult and pediatric patients.

Contraindications: Sevoflurane can cause malignant hyperthermia. It should not be used in patients with known sensitivity to sevoflurane or to other halogenated agents nor in patients with known or suspected susceptibility to malignant hyperthermia.

Dose and Administration: Induction of anaesthesia, using a specifically calibrated vaporiser, in oxygen or nitrous oxide–oxygen, adjusted according to response, adult up to 5%; child 1 month–18 years up to 8%. Maintenance of anaesthesia, using a specifically calibrated vaporiser, in oxygen or nitrous oxide– oxygen, adjusted according to response, adult and child over 1 month 0.5–3%.

 

Antimuscarinic drugs

Antimuscarinic drugs are used as premedicants to dry bronchial and salivary secretions which are increased by intubation, by surgery to the upper airways, and by some inhalational anaesthetics. They are also used before or with neostigmine to prevent bradycardia, excessive salivation, and other muscarinic actions of neostigmine. They also prevent bradycardia and hypotension associated with drugs such as propofol and suxamethonium.

Atropine sulphate: used for premedication but still has an emergency role in the treatment of vagotonic side-effects. For its role in acute arrhythmias after myocardial infarction,

Hyoscine hydrobromide reduces secretions and also provides a degree of amnesia, sedation and anti-emesis. Unlike atropine it may produce bradycardia rather than tachycardia. In some patients, especially the elderly, hyoscine may cause the central anticholinergic syndrome (excitement, ataxia, hallucinations, behavioural abnormalities, and drowsiness)

 

GLYCOPYRRONIUM BROMIDE (Glycopyrrolate):

Indications: indicated for use as a preoperative antimuscarinic to reduce salivary, tracheobronchial, and pharyngeal secretions; to reduce the volume and free acidity of gastric secretions; and to block cardiac vagal inhibitory reflexes during induction of anesthesia and intubation. may be used intraoperatively to counteract surgically or drug- induced or vagal reflexes associated arrhythmias. Glycopyrrolate protects against the peripheral muscarinic effects (e.g., bradycardia and excessive secretions) of cholinergic agents such as neostigmine and pyridostigmine given to reverse the neuromuscular blockade due to non-depolarizing muscle relaxants.

Contraindications: Known hypersensitivity to glycopyrrolate or any of its inactive ingredients.

Dose and Administration: Premedication, by intramuscular or intravenous injection, 200–400 micrograms or 4–5 micrograms/kg (max. 400 micrograms); child by intramuscular or by intravenous injection, 4–8 micrograms/kg (max. 200 micrograms). Intra-operative use, by intravenous injection, 200– 400 micrograms or 4–5 micrograms/kg (max. 400 micrograms), repeated if necessary; child under 18 years 4–8 micrograms/kg (max. 200 micrograms), repeated if necessary. Control of muscarinic side-effects of neostigmine in reversal of non-depolarising neuromuscular block, by intravenous injection, 200 micrograms per 1 mg of neostigmine, or 10–15 micrograms/kg; child 10 micrograms/kg.

 

Sedative and analgesic peri-operative drugs

These drugs are given to allay fear and anxiety in the pre-operative period (including the night before an operation), to relieve pain and discomfort when present, and to augment the action of subsequent anaesthetic agents. A number of the drugs used also provide some degree of pre-operative amnesia. The choice will vary with the individual patient, the nature of the operative procedure, the anaesthetic to be used, and other prevailing circumstances such as outpatients, obstetrics, and recovery facilities. The choice also varies between elective and emergency operations.

 

Anxiolytics and neuroleptics

Benzodiazepines possess useful properties for premedication including relief of anxiety, sedation, and amnesia; short-acting benzodiazepines taken by mouth are the most common premedicants. They have no analgesic effect so an opioid analgesic may sometimes be required for pain.

Benzodiazepines can alleviate anxiety at doses that do not necessarily cause excessive sedation and they are of particular value during short procedures or during operations under local anaesthesia (including dentistry). Amnesia reduces the likelihood of any unpleasant memories of the procedure (although benzodiazepines, particularly when used for more profound sedation, can sometimes induce sexual fantasies). Benzodiazepines are also used in intensive care units for sedation, particularly in those receiving assisted ventilation

 

Opioid analgesics

Opioid analgesics given in small doses before or with induction reduce the dose requirement of some drugs used during anaesthesia. Alfentanil, fentanyl, and remifentanil are particularly useful because they act within 1–2 minutes and have short durations of action. The initial doses of alfentanil or fentanyl are followed either by successive intravenous injections or by an intravenous infusion; prolonged infusions increase the duration of effect. Repeated intra-operative doses of alfentanil or fentanyl should be given with care since the resulting respiratory depression can persist postoperatively and occasionally it may become apparent for the first time postoperatively when monitoring of the patient might be less intensive. Alfentanil, fentanyl, and remifentanil can cause muscle rigidity, particularly of the chest wall or jaw; this can be managed by the use of neuromuscular blocking drugs

 

Neuromuscular blocking drugs

Neuromuscular blocking drugs used in anaesthesia are also known as muscle relaxants. By specific blockade of the neuromuscular junction they enable light levels of anaesthesia to be employed with adequate relaxation of the muscles of the abdomen and diaphragm. They also relax the vocal cords and allow the passage of a tracheal tube. Their action differs from the muscle relaxants acting on the spinal cord or brain which are used in musculoskeletal disorders. Patients

who have received a neuromuscular blocking drug should always have their respiration assisted or controlled until the drug has been inactivated or antagonised. They should also receive sufficient concomitant inhalational or intravenous anaesthetic, or sedative drugs to prevent awareness.

 

Non-depolarising neuromuscular blocking drugs

Non-depolarising neuromuscular blocking drugs (also known as competitive muscle relaxants) compete with acetylcholine for receptor sites at the neuromuscular junction and their action may be reversed with anticholinesterases such as neostigmine. Non-depolarising neuromuscular blocking drugs have a slower onset of action than suxamethonium. These drugs can be classified by their duration of action as short-acting (15–30 minutes), intermediate-acting (30–40 minutes) and long-acting (60–120 minutes), although duration of action is dose-dependent. Drugs with a shorter or intermediate duration of action, such as atracurium and vecuronium, are more widely employed than those with a longer duration of action such as pancuronium.

 

ATRACURIUM BESILATE (Atracurium besylate):

Indications: highly selective, competitive or non-depolarising neuromuscular blocking agent (short to intermediate duration). It is used as an adjunct to general anaesthesia or sedation in the intensive care unit (ICU), to relax skeletal muscles, and to facilitate tracheal intubation and mechanical ventilation.

Contraindications: Atracurium is contraindicated in patients’ known to be hypersensitive to atracurium, cisatracurium or benzenesulfonic acid.

Dose and Administration: Surgery or intubation, adult and child over 1 month, by intravenous injection, initially 300–600 micrograms/kg; maintenance, by intravenous injection, 100–200 micrograms/kg as required or by intravenous infusion, 5–10 micrograms/kg/minute (300–600 micrograms/kg/hour). Intensive care, adult and child over 1 month, by intravenous injection, initially 300–

600 micrograms/kg      (optional)    then       by     intravenous           infusion 4.5–
29.5 micrograms/kg/minute (usual dose 11–13 micrograms/kg/minute).

 

CISATRACURIUM:

Indications: indicated for use during surgical and other procedures and in intensive care. It can be used as an adjunct to general anaesthesia, or sedation in the Intensive Care Unit (ICU) to relax skeletal muscles, and to facilitate tracheal intubation and mechanical ventilation (intermediate duration).

Contraindications: Cisatracurium is contraindicated in patients’ known to be hypersensitive to atracurium, cisatracurium or benzenesulfonic acid.

Dose and Administration: Intubation, by intravenous injection, adult and child over 1 month, initially 150 micrograms/kg; maintenance, by intravenous injection, 30 micrograms/kg approx. every 20 minutes; child 2–12 years, 20 micrograms/kg approx. every 9 minutes; or maintenance, by intravenous

infusion, adult and child over 2 years, initially, 3 micrograms/kg/minute, then after stabilisation, 1–2 micrograms/kg/minute; dose reduced by up to 40% if used with isoflurane. Intensive care, by intravenous infusion, adult 0.5– 10.2 micrograms/kg/minute (usual dose 3 micrograms/kg/minute).

 

MIVACURIUM:

Indications: Mivacurium is a highly selective, short-acting, non-depolarising neuromuscular blocking agent with a fast recovery profile. Mivacurium is used as an adjunct to general anaesthesia to relax skeletal muscles and to facilitate tracheal intubation and mechanical ventilation.

Contraindications: Mivacurium is contraindicated in patients’ known to be hypersensitive. Also contraindicated in pregnancy since there is no information on the use of Mivacron in pregnant women and in patients known or suspected of being homozygous for the atypical plasma cholinesterase gene.

Dose and Administration: By intravenous injection, 70–250 micrograms/kg; maintenance 100 micrograms/kg every 15 minutes; child 2–6 months initially 150 micrograms/kg, 7 months–12 years initially 200 micrograms/kg; maintenance (child 2 months–12 years) 100 micrograms/kg every 6–9 minutes. Doses up to 150 micrograms/kg may be given over 5–15 seconds, higher doses should be given over 30 seconds. In patients with asthma, cardiovascular disease or those who are sensitive to falls in arterial blood pressure give over 60 seconds. By intravenous infusion, maintenance of block, 8–10 micrograms/kg/minute, adjusted if necessary every 3 minutes by 1 microgram/kg/minute to usual dose of 6–7 micrograms/kg/minute; child 2 months–12 years, usual dose 11– 14 micrograms/kg/minute.

 

ROCURONIUM BROMIDE:

Indications: Rocuronium is indicated as an adjunct to general anaesthesia to facilitate tracheal intubation during routine and rapid sequence induction, and to provide skeletal muscle relaxation (intermediate duration) during surgery. Rocuronium is also indicated as an adjunct in the intensive care unit (ICU) to facilitate intubation and mechanical ventilation.

Contraindications: Hypersensitivity to rocuronium or to the bromide ion or to any of the excipients.

Dose and Administration: Intubation, adult and child over 1 month, by intravenous injection, initially 600 micrograms/kg; maintenance by intravenous injection, 150 micrograms/kg (elderly 75–100 micrograms/kg) or maintenance by

intravenous      infusion,      300–600 micrograms/kg/hour      (elderly      up      to
400 micrograms/kg/hour). Intensive care, by intravenous injection, adult initially

600 micrograms/kg;      maintenance        by       intravenous      infusion,        300–

600 micrograms/kg/hour for first hour, then adjusted according to response.

 

Depolarising neuromuscular blocking drugs

 

SUXAMETHONIUM CHLORIDE (Succinylcholine chloride):

Indications: Depolarising muscle relaxant of short duration. neuromuscular blockade (rapid onset, short duration)

Contraindications: family history of malignant hyperthermia, hyperkalaemia; major trauma, severe burns, neurological disease involving acute wasting of major muscle, prolonged immobilisation—risk of hyperkalaemia, personal or family history of congenital myotonic disease, Duchenne muscular dystrophy, low plasma-cholinesterase activity (including severe liver disease)

Dose and Administration: By intravenous injection, initially 1 mg/kg; maintenance, usually 0.5–1 mg/kg at 5–10 minute intervals; max. 500 mg/hour; neonate and infant under 1 year, 2 mg/kg; child over 1 year, 1 mg/kg. By intravenous infusion of a solution containing 1–2 mg/mL (0.1–0.2%), 2.5– 4 mg/minute; max. 500 mg/hour; child reduce infusion rate according to body-weight. By intramuscular injection, infant under 1 year, up to 4–5 mg/kg; child over 1 year, up to 4 mg/kg; max. 150 mg.

 

Anticholinesterases used in anaesthesia

Anticholinesterases reverse the effects of the non-depolarising (competitive) neuromuscular blocking drugs such as pancuronium but they prolong the action of the depolarising neuromuscular blocking drug suxamethonium.

Neostigmine: has a long duration of action. It is the specific drug for reversal of non-depolarising (competitive) blockade. It acts within one minute of intravenous injection and its effects last for 20 to 30 minutes; a second dose may then be necessary. Glycopyrronium or alternatively atropine, given before or with neostigmine, prevent bradycardia, excessive salivation, and other muscarinic effects of neostigmine

 

Antagonists for central and respiratory depression

Respiratory depression is a major concern with opioid analgesics and it may be treated by artificial ventilation or be reversed by Naloxone. Naloxone will immediately reverse opioid-induced respiratory depression but the dose may have to be repeated because of the short duration of action of naloxone; however, naloxone will also antagonise the analgesic effect.

 

NALOXONE HYDROCHLORIDE:

Indications: reversal of opioid-induced respiratory depression; reversal of neonatal respiratory depression resulting from opioid administration to mother during labour; overdosage with opioids.

Contraindications: contraindicated in patients with hypersensitivity to naloxone hydrochloride or to any of the excipients of this medicinal product.

Dose and Administration: By intravenous injection, 100–200 micrograms (1.5–3 micrograms/kg); if response inadequate, increments of 100 micrograms every 2 minutes; further doses by intramuscular injection after 1–2 hours if required; child by intravenous injection, 10 micrograms/kg; subsequent dose of 100 micrograms/kg if no response; if intravenous route not possible, may be given in divided doses by intramuscular or subcutaneous injection. neonate, reversal of respiratory and CNS depression resulting from opioid administration to mother during labour, by subcutaneous, intramuscular, or intravenous injection, 10 micrograms/kg, repeated every 2–3 minutes; alternatively by intramuscular injection, 200 micrograms (60 micrograms/kg) as a single dose at birth.

 

FLUMAZENIL:

Indications: indicated for the complete or partial reversal of the central sedative effects of benzodiazepines. It may therefore be used in anaesthesia and intensive care in the following situations: Termination of general anaesthesia induced and/or maintained with benzodiazepines. Reversal of benzodiazepine sedation in short diagnostic and therapeutic procedures. For the specific reversal of the central effects of benzodiazepines, to allow return to spontaneous respiration and consciousness, in patients in intensive care.

Contraindications: life-threatening condition (e.g. raised intracranial pressure, status epilepticus) controlled by benzodiazepines.

Dose and Administration: By intravenous injection, 200 micrograms over 15 seconds, then 100 micrograms at 60-second intervals if required; usual dose range, 300–600 micrograms; max. total dose 1 mg (2 mg in intensive care); question aetiology if no response to repeated doses. By intravenous infusion, if drowsiness recurs after injection, 100–400 micrograms/hour, adjusted according

to level of arousal.

 

Drugs for malignant hyperthermia

Malignant hyperthermia is a rare but potentially lethal complication of anaesthesia. It is characterised by a rapid rise in temperature, increased muscle rigidity, tachycardia, and acidosis. The most common triggers of malignant hyperthermia are the volatile anaesthetics. Suxamethonium has also been

implicated, but malignant hyperthermia is more likely if it is given following a volatile anaesthetic. Volatile anaesthetics and suxamethonium should be avoided during anaesthesia in patients at high risk of malignant hyperthermia. Dantrolene is used in the treatment of malignant hyperthermia. It acts on skeletal muscle cells by interfering with calcium efflux, thereby stopping the contractile process

 

 

 

 

Local anaesthesia

Local anaesthesia

Local anaesthetic drugs act by causing a reversible block to conduction along nerve fibres. The drugs used vary widely in their potency, toxicity, duration of action, stability, solubility in water, and ability to penetrate mucous membranes. These variations determine their suitability for use by various routes, e.g. topical (surface), infiltration, peripheral nerve block, intravenous regional anaesthesia (Bier’s block), plexus, epidural (extradural) or spinal block. Local anaesthetics may also be used for postoperative pain relief, thereby reducing the need for analgesics such as opioids.

 

LIDOCAINE HYDROCHLORIDE (Lignocaine hydrochloride):

Indications: Lignocaine is used as a local anaesthetic in infiltration field block, nerve block and spinal anaesthesia. As a local anaesthetic it has an action of intermediate duration, which can be increased by adding adrenaline.

Contraindications: Contra-indicated in patients that are hypersensitive to local anaesthetics. Lignocaine hydrochloride should not be given to patients with hypovolaemia, heartblock or other conduction disturbances, bradycardia, cardiac decompensation or hypotension unrelated to treatable tachyarrhythmias, myasthenia gravis.

Dose and Administration: Infiltration anaesthesia, by injection, according to patient’s weight and nature of procedure, max. 200 mg. Surface anaesthesia, usual strengths 2–4%.

 

Lidocaine hydrochloride 5% Ointment:

Dose: Dental practice, rub gently into dry gum, Sore nipples from breast-feeding, apply using gauze and wash off immediately before feed. Pain relief (in anal fissures, haemorrhoids, pruritus ani, pruritus vulvae, herpes zoster, or herpes labialis), 1–2 mL applied when necessary; avoid long-term use.

 

Lidocaine hydrochloride 10% Spray:

Dose: Dental practice, 1–5 doses. Maxillary sinus puncture, 3 doses. During delivery in obstetrics, up to 20 doses. Bronchoscopy, laryngoscopy, oesophagoscopy, endotracheal intubation, up to 20 doses; child up to 3 mg/kg.

 

LIDOCAINE-PRILOCAINE:

Indications: indicated for local anaesthesia – on intact skin prior to minor dermatological procedures (e.g. needle insertion and surgical treatment of localised lesions) and prior to dermal procedures on larger areas e.g. split skin grafting. – on genital mucosa prior to surgical treatment of localised lesions. In term newborn infants and children under the age of 18 years, it is indicated for local anaesthesia on intact skin prior to minor dermatological procedures.

Contraindications: Known hypersensitivity to anaesthetics of the amide type or to any other component of the product.

Dose and Administration: Anaesthesia before minor skin procedures including venepuncture, apply thick layer under occlusive dressing 1–5 hours before procedure (2–5 hours before procedures on large areas e.g. split skin grafting); infant 1–12 months single application on intact skin under specialist supervision, under 1 month not recommended. Anaesthesia before removal of warts from genital mucosa in adults, apply up to 10 g 5–10 minutes before removal.

 

BUPIVACAINE HYDROCHLORIDE:

Indications: Intrathecal (subarachnoid) spinal anaesthesia for surgery (urological and lower limb surgery lasting 2–3 hours, abdominal surgery lasting 45–60 minutes). Bupivacaine is a long-acting anaesthetic agent of the amide type. Marcain Heavy has a rapid onset of action and long duration. The duration of analgesia in the T10–T12 segments is 2–3 hours.

Marcain Heavy produces a moderate muscular relaxation of the lower extremities lasting 2–2.5 hours. The motor blockade of the abdominal muscles makes the solution suitable for performance of abdominal surgery lasting 45–60 minutes. The duration of the motor blockade does not exceed the duration of analgesia. The cardiovascular effects of Marcain Heavy are similar or less than those seen with other spinal agents.

Contraindications: Hypersensitivity to local anaesthetics of the amide type or to any of the excipients. Intrathecal anaesthesia, regardless of the local anaesthetic used, has its own contraindications, which include: Active disease of the central nervous system such as meningitis, poliomyelitis, intracranial haemorrhage, sub-acute combined degeneration of the cord due to pernicious anaemia and cerebral and spinal tumours. Coagulation disorders or ongoing anticoagulation treatment.

Dose and Administration: Local infiltration, max. 60 mL, using a 2.5 mg/mL (0.25%) solution. Peripheral nerve block, max. 60 mL, using a 2.5 mg/mL (0.25%) solution; max. 30 mL, using a 5 mg/mL (0.5%) solution. Epidural block Surgery, lumbar, max. 20 mL, using a 5 mg/mL (0.5%) solution, Surgery, caudal, max. 30 mL, using a 5 mg/mL (0.5%) solution; child (up to 10 years) using a 2.5 mg/mL (0.25%) solution, up to lower-thoracic (T10) 0.3–0.4 mL/kg, up to mid-thoracic (T6) 0.4–0.8 mL/kg, Labour, lumbar, max. 12 mL using a

2.5 mg/mL (0.25%) or 5 mg/mL (0.5%) solution; caudal max. 20 mL using a 2.5 mg/mL (0.25%) or 5 mg/mL (0.5%) solution. Sympathetic block, max. 50 mL, using a 2.5 mg/mL (0.25%) solution. Marcain Heavy: Dose Intrathecal anaesthesia for surgery, 2–4 mL (dose may need to be reduced in elderly and in late pregnancy).

 

ROPIVACAINE HYDROCHLORIDE:

Indications: Surgical anaesthesia Epidural blocks for surgery, including Caesarean section. Major nerve blocks. Field blocks. Acute pain management Continuous epidural infusion or intermittent bolus administration during postoperative or labour pain. Field blocks.

Contraindications: Hypersensitivity to ropivacaine or to other local anaesthetics of the amide type. General contraindications related to epidural anaesthesia, regardless of the local anaesthetic used, should be taken into account. Obstetric paracervical anaesthesia. Hypovolaemia.

Dose and Administration: Surgical anaesthesia: lumbar epidural, adult and child over 12 years, 15–20 mL of 10 mg/mL solution or 15–25 mL of 7.5 mg/mL solution (max. total dose 200 mg); caesarean section, 15–20 mL of 7.5 mg/mL solution in incremental doses (max. total dose 150 mg). thoracic epidural (to establish block for postoperative pain), adult and child over 12 years, 5–15 mL of 7.5 mg/mL solution. major nerve block (brachial plexus block), adult and child over 12 years, 30–40 mL of 7.5 mg/mL solution. field block, adult and child over 12 years, 1–30 mL of 7.5 mg/mL solution.

 

MEPIVACAINE HYDROCHLORIDE:

Indications: For the production of local anaesthesia for conservative and surgical interventions in the oral region (especially for dental work).

Contraindications: in patients with a known hypersensitivity to the amide type of local anaesthetic.

Dose and Administration: The dose varies and depends on the area to be anaesthetized, vascularity of the tissues, number of neuronal segments to be blocked, individual tolerances and the technique of anaesthesia. The lowest dose needed to provide effective anaesthesia should be administered. The average dose of one dental cartridge will usually suffice. This dose may be doubled if necessary to effect anaesthesia. The maximum adult dose should not exceed 400 mg mepivacaine hydrochloride, (approximately 7 mg/kg) at any one time and the total dose should not exceed 1 g in any twenty-four hour period.

 

 

 

 

Emergency treatment of poisoning

Emergency treatment of poisoning

 

Prevention of absorption

Given by mouth, activated charcoal can bind many poisons in the gastro­intestinal system, thereby reducing their absorption. The sooner it is given the more effective it is, but it may still be effective up to 1 hour after ingestion of the poison—longer in the case of modified-release preparations or of drugs with antimuscarinic (anticholinergic) properties. It is relatively safe and is particularly useful for the prevention of absorption of poisons that are toxic in small amounts, e.g. antidepressants.

 

CHARCOAL, ACTIVATED:

Indications: adsorption of poisons in the gastro-intestinal system.

Contraindications: drowsy or comatose patient (risk of aspiration); reduced gastro-intestinal motility (risk of obstruction); not for poisoning with petroleum distillates, corrosive substances, alcohols, clofenotane (dicophane, DDT), Malathion, and metal salts including iron and lithium salts.

Dose and Administration: Reduction of absorption, adult and child over 12 years, 50 g; child under 12 years, 1 g/kg (max. 50 g).

 

IPICAC:

Indications: To induce vomiting after ingesting something poisonous.

Contraindications: Do not administer ipecac when a patient has a decreased level of consciousness or has ingested either a corrosive substance or hydrocarbon with a high aspiration potential.

Dose and Administration: Ipecac syrup, which contains total alkaloids123 to 157 mg per 100 mL, has been used to induce vomiting. The usual dose range for the syrup is 10 to 30 mL, yielding a dose of alkaloids of 12 to 48 mg. Do not confuse the syrup with the fluid extract of ipecac, which is 14 times stronger. Cumulative toxicity requires administration of emetine for amebic dysentery in low doses for a short time with intervals of several weeks before further treatment.

 

Specific drugs

 

ACETYLCYSTEINE:

Indications: Indicated For the treatment of paracetamol overdosage.

Contraindications: Hypersensitivity to any ingredient in the preparation.

Dose and Administration: By intravenous infusion, adult and child, initially 150 mg/kg (max. 16.5 g) over 15 minutes, then 50 mg/kg (max. 5.5 g) over 4 hours then 100 mg/kg (max. 11 g) over 16 hours.

 

NALOXONE HYDROCHLORIDE:

Indications: Opioid-induced toxicity especially respiratory depression. Post­operative opioid depression. Neonatal respiratory depression secondary to the administration of opioids to the mother.

Contraindications: Known sensitivity to naloxone hydrochloride. Safety in pregnancy has not been established.

Dose and Administration: Doses used in acute opioid overdosage may not be appropriate for the management of opioid-induced respiratory depression and sedation in those receiving palliative care and in chronic opioid use. Opioid toxicity in Adults: 0,4 to 2 mg intravenously repeated if necessary at two to three

minute                              intervals                              as                              needed.
If no response has been observed after a total dose of 10 mg, then the diagnosis of overdosage with agents other than opioids should be considered. Children – Opioid toxicity: 0,01 mg/kg body mass intravenously followed, if necessary, by a larger dose of 0,1 mg/kg body mass.

 

DESFERRIOXAMINE MESILATE:

Indications: Treatment for chronic iron overload, e.g. transfusional haemosiderosis in patients receiving regular transfusions (e.g. thalassaemia major). primary and secondary haemochromatosis in patients in whom concomitant disorders (e.g. severe anaemia, hypoproteinaemia, renal or cardiac failure) preclude phlebotomy. Treatment for acute iron poisoning. For the diagnosis of iron storage disease and certain anaemias. Aluminium overload – In patients on maintenance dialysis for end stage renal failure where preventative measures (e.g. reverse osmosis) have failed and with proven aluminium-related bone disease and/or anaemia, dialysis encephalopathy; and for diagnosis of aluminium overload.

Contraindications: Hypersensitivity to desferrioxamine mesilate unless the patients can be desensitised.

Dose and Administration: By continuous intravenous infusion, adult and child up to 15 mg/kg/hour, reduced after 4–6 hours; max. 80 mg/kg in 24 hours.

 

PENICILLAMINE:

Indications: lead poisoning.

Contraindications: Hypersensitivity to penicillamine or any of the ingredients. Agranulocytosis or severe thrombocytopenia due to penicillamine. Lupus erythematosus. Moderate or severe renal impairment.

Dose and Administration: 1–2 g daily in 3 divided doses before food until urinary lead is stabilised at less than 500 micrograms/day; child 20 mg/kg daily in 3 divided doses before food.

 

FLUMAZENIL:

Indicated for the complete or partial reversal of the central sedative effects of benzodiazepines. It may therefore be used in anaesthesia and intensive care in the following situations: Termination of general anaesthesia induced and/or maintained with benzodiazepines. Reversal of benzodiazepine sedation in short diagnostic and therapeutic procedures. For the specific reversal of the central effects of benzodiazepines, to allow return to spontaneous respiration and consciousness, in patients in intensive care see under (15.1.7).

 

PROTAMINE SULPHATE:

Indications: Neutralisation of the anticoagulant effect of heparin therapy and the treatment of heparin overdose.

Contraindications: Previous life threatening reaction to protamine.

Dose and Administration: Adults: Protamine Sulphate Injection should be administered by slow intravenous injection (max rate 5 mg/min) over a period of 10 minutes. The dose is dependent on the amount of heparin to be neutralised. One mg of Protamine Sulphate will usually neutralise at least 100 IU of mucous heparin or 80 IU of lung heparin if given within 15 minutes of heparin administration. If more than 15 minutes has elapsed since heparin administration then less Protamine is required due to the rapid excretion of heparin. Not more than 50 milligrams of Protamine Sulphate should be administered in a ten minute period. To antagonise heparin infusion: 25-50mg after stopping infusion. To antagonise heparin subcutaneous injection: 1-1.5 mg/ 100 IU heparin. 25-50 mg can be given by slow IV injection and the remainder by slow IV infusion over 8- 16 hours (or the expected duration of absorption of heparin), or 2 hourly divided doses.

 

METHYLENE BLUE (Methylthioninium chloride):

Indications: Methemoglobinemia. large doses of methylene blue are sometimes used as an antidote to potassium cyanide poisoning.

Contraindications: Deficiency of Glucose-6-Phosphate Dehydrogenase, Hemolytic Anemia from Pyruvate Kinase and G6PD Deficiencies, Severe Renal Disease.

Dose and Administration: Adult Min/Max Dose: 1.0mg/kg/4.0mg/kg Pediatric Min/Max Dose: 1.0mg/kg/4.0mg/kg.

 

DIGOXIN-SPECIFIC ANTIBODY:

Indications: indicated for the treatment of known or strongly suspected digoxin or digitoxin toxicity, where measures beyond the withdrawal of the digitalis glycoside and correction of any serum electrolyte abnormality are felt to be necessary.

Contraindications: Allergy to ovine protein.

Dose and Administration: Acute ingestion of unknown amount of glycoside: Adults and children over 20 kg: If a patient presents with potentially life-threatening digitalis toxicity after acute ingestion of an unknown amount of digoxin or digitoxin, and neither a serum digoxin concentration nor an estimate of the ingested amount of glycoside is available, 20 vials of Digibind can be administered. This amount will be adequate to treat most life-threatening ingestions in adults and large children. Infants and children 20 kg: In infants and small children 20 kg) with potentially life- threatening digitalis toxicity after acute ingestion of an unknown amount of digoxin or digitoxin, when neither a serum concentration nor an estimate of the ingested amount is available, clinical judgement must be exercised to estimate an appropriate number of vials of Digibind to administer.

 

 

 

 

Skin Cleansers and Antiseptics

 

 

CHLORHEXIDINE:

chlorhexidine gluconate 0.05% For cleansing and disinfecting wounds and burns and swabbing in obstetrics.

STERETS UNISEPT 0.05%

chlorhexidine gluconate 4% for the Use instead of soap for pre-operative hand and skin preparation and for general hand and skin disinfection.

SCRUB-STAT & HISCRUB 4%

chlorhexidine gluconate 0.5% in an alcoholic solution For pre-operative skin disinfection.

ULTRASEPT & HISOL HAND RUBB.

 

POVIDONE–IODINE:

Indications: Disinfection of wounds, lacerations, abrasions and burns. Prophylaxis against infection in hospital and surgery procedures. Preparation of skin and mucous membranes prior to surgery. Post- operative application to protect against infection. Treatment of infected skin conditions.

Contraindications: preterm neonate gestational age under 32 weeks; avoid regular use in patients with thyroid disorders or those receiving lithium therapy.

Dose and Administration: Apply full strength, as paint, or soak or spray as often as needed.

 

 

 

Sunscreens and camouflagers

Sunscreens and camouflagers

HYDROQUINONE:

Indications: indicated for the gradual bleaching of hyperpigmented skin such as chloasma, melasma, freckles and other unwanted areas of melanin hyperpigmentation.

Contraindications: history of sensitivity or allergic reaction to any of the ingredients.

Dose and Administration: a thin application should be applied to the affected area twice daily.

HYDROQUINONE-SUNBLOCK:

Indications: indicated for the gradual bleaching of hyperpigmented skin such as chloasma, melasma, freckles and other unwanted areas of melanin hyperpigmentation.

Contraindications: history of sensitivity or allergic reaction to any of the ingredients.

Dose and Administration: a thin application should be applied to the affected area twice daily.

 

camouflagers,Sunscreens ,HYDROQUINONE,HYDROQUINONE,SUNBLOCK,Indications,Contraindications,Dose ,Administration,hyperpigmentation,hyperpigmented ,melasma,freckles

Shampoos and other preparations for  scalp and hair conditions

Shampoos and other preparations for  scalp and hair conditions

Dandruff is considered to be a mild form of seborrhoeic dermatitis. Shampoos containing antimicrobial agents may have beneficial effects. Shampoos containing tar extracts may be useful and they are also used in psoriasis. Ketoconazole shampoo should be considered for more persistent or severe dandruff or for seborrhoeic dermatitis of the scalp.

 

Dandruff shampoos

 

KETOCONAZOLE:

Indications: used for the prevention and treatment of dandruff caused by fungal infections of the scalp, as well as for the relief of associated symptoms such as flaking, scaling and itching.

Contraindications: Known hypersensitivity to ketoconazole or any of the other ingredients, which may be recognised by severe itching and redskin after application of the shampoo.

Dose and Administration: Wet hair. Apply sufficient shampoo to produce a generous lather. Gently massage over the entire scalp. Allow the shampoo to

Soak in for 3 to 5 minutes before rinsing.
Use regularly, at least twice a week for 8 weeks to treat the infection. To prevent the infection reappearing, use once a week or once every two weeks.

 

CICLOPIROX:

Indications: Treatment of dandruff, seborrhoeic dermatitis & pruritus associated w/ these conditions.

Contraindications: Pregnancy & lactation. Known hypersensitivity to Ciclopirox or any of the other ingredients.

Dose and Administration: Use as shampoo for the hair & scalp 2-3 times/week.

 

Male-pattern baldness

Topical application of minoxidil may stimulate limited hair growth in a small proportion of adults but only for as long as it is used.

 

MINOXIDIL:

Indications: treatment of alopecia androgenetica in men aged between 18 and 65. Onset and degree of hair regrowth may be variable among users. Although trends in the data suggest that those users who are younger, who have been balding for a shorter period of time or who have a smaller area of baldness on

the vertex are more likely to respond to Regaine for Men Gel, individual responses cannot be predicted.

Contraindications: in users with a history of sensitivity to minoxidil, ethanol, propylene glycol, carbomer and diisopropanolamine, in users with treated or untreated hypertension, in users with any scalp abnormality (including psoriasis and sunburn).

Dose and Administration: Apply 1 mL twice daily to dry hair and scalp (discontinue if no improvement after 1 year); 5% strength for use in men only.

 

 

 

Vaccines, Antisera & Diagnostic agents

Vaccines, Antisera & Diagnostic agents

 

VACCINES & Antisera

 

BCG VACCINE (intradermal):

Indications: Active immunisation against tuberculosis.

Contraindications: Febrile illness, impaired immunity, widespread malignancy, tuberculin positive patients.

Dose and Administration: Adult Dosage: BCG Vaccine (intradermal): 0.1 mL strictly by intradermal injection. Child Dosage: BCG Vaccine (percutaneous): Neonates and young children only, by percutaneous vaccination using multiple puncture technique. BCG Vaccine (intradermal): Under 3 months, 0.05 mL; over 3 months, 0.1 mL. Both strictly by intradermal injection.

 

DTP VACCINE:

Indications: Active immunisation against diphtheria, tetanus and pertussis.

Contraindications: Acute febrile illness. History of convulsions, cerebral irritation or damage in the neonatal period. Severe local or general reaction to a preceding dose. History of familial epilepsy. Neurological familial epilepsy. Neurological disease, developmental neurological defect.

Dose and Administration: Adult Dosage: Not recommended. Child Dosage: Over 2 months, primary immunisation: 3 doses of 0 .5 mL by deep subcutaneous or intramuscular injection at minimum of four week intervals. Reinforcing dose of DIP/TET at 3 years: 0.5 mL by subcutaneous or intramuscular injection. Over 10 years, not recommended.

 

DTP-HAEMOPHILUS B CONJUGATED VACCINE:

Indications: Primary vaccination of infants, at or above the age of two months and as a booster in children up to 7th birthday against diphtheria, tetanus, pertussis and invasive haemophilus influenza type b infection.

Contraindications: Acute febrile illness. History of convulsions, cerebral irritation or damage in the neonatal period. Severe local or general reaction to a preceding dose. History of familial epilepsy. Neurological familial epilepsy. Neurological disease, developmental neurological defect. History of severe allergy.

Dose and Administration: Adult Dosage: Not recommended. Child Dosage: Over 2 months, primary immunisation: 3 doses of 0 .5 mL by deep subcutaneous or intramuscular injection. Over 7 years, not recommended.

 

DTP-HEPATITIS B VACCINE:

Indications: Active immunisation against diphtheria, tetanus, pertussis & hepatitis B in infants from 6 wk onwards.

Contraindications: Acute severe febrile illness. Encephalopathy of unknown aetiology, occurring w/in 7 days following previous vaccination w/ pertussis­containing vaccine.

Dose and Administration: Primary vaccination 3 doses of 0.5 mL each w/in the 1st 6 mth of life. Administer each dose at intervals of at least 4 wk. A booster dose can be administered in the 2nd yr of life.

 

DTP-HEPATITIS B-HAEMOPHILUS B VACCINE:

Indications: Active immunisation against diphtheria, tetanus, pertussis, hepatitis B & diseases caused by H. Influenza type B in infants from 6 wk onwards and up to 7 years of age.

Contraindications: Acute severe febrile illness. Encephalopathy of unknown aetiology, occurring w/in 7 days following previous vaccination w/ pertussis­containing vaccine.

Dose and Administration: Primary vaccination 3 doses of 0.5 mL each w/in the 1st 6 mth of life. Administer each dose at intervals of at least 4 wk. A booster dose can be administered in the 2nd yr of life.

 

HEPATITIS A:

Indications: indicated for active immunisation against HAV infection. The vaccine is particularly indicated for those at increased risk of infection or transmission. It is also indicated for use during outbreaks of hepatitis A infection. Contraindications: Hypersensitivity to any component of the vaccine. Acute severe febrile illness.

Dose and Administration: AVAXIM: 0.5 mL as a single dose; booster dose 0.5 mL 6–12 months after initial dose; child under 16 years, not recommended. HAVRIX: 1 mL as a single dose; booster dose, 1 mL 6–12 months after initial dose; child 1–15 years 0.5 mL; booster dose, 0.5 mL 6–12 months after initial dose.

 

HEPATITIS B:

Indications: indicated for active immunisation against hepatitis B virus infection (HBV) caused by all known subtypes in non-immune subjects.

Contraindications: should not be administered to subjects with known hypersensitivity to any component of the vaccine, or to subjects having shown

signs of hypersensitivity after previous administration. As with other vaccines, the administration of the vaccine should be postponed in subjects suffering from acute severe febrile illness. The presence of a minor infection, however, is not a contra-indication for immunisation.

Dose and  Administration: Adult dosage: The 20 μg dose vaccine in 1.0 ml suspension is intended for use in subjects 16 years of age and above. A 0, 1, 6 months schedule which gives optimal protection at month 7 and produces high antibody titres. Child dosage: 12 years and under: 0 .5 mL by intramuscular injection into the antero-lateral aspect of thigh (infants) or deltoid, repeated 1 month and 6 months later. Rapid immunisation, 0 .5 mL by intramuscular injection, repeated 1 month, 2 months and 12 months later.

 

HUMAN PAPILLOMA VIRUS VACCINE:

Indications: for the prevention of premalignant genital lesions (cervical, vulvar and vaginal), cervical cancer and external genital warts (condyloma acuminata) causally related to Human Papillomavirus (HPV) types 6, 11, 16 and 18.

Contraindications: Hypersensitivity to the active substances or to any of the excipients. Individuals who develop symptoms indicative of hypersensitivity after receiving a dose of the vaccine should not receive further doses of the vaccine. Administration of the vaccine should be postponed in subjects suffering from an acute severe febrile illness. However, the presence of a minor infection, such as a mild upper respiratory tract infection or low-grade fever, is not a contraindication for immunisation.

Dose and Administration: The primary vaccination series consists of 3 separate 0.5 ml doses administered according to the following schedule: 0, 2, 6 months. If an alternate vaccination schedule is necessary, the second dose should be administered at least one month after the first dose and the third dose should be administered at least 3 months after the second dose. All three doses should be given within a 1-year period. Cervarix is not recommended for use in girls below 10 years of age due to lack of data on safety and immunogenicity in this age-group. Gardasil is not recommended for use in children below 9 years of age due to insufficient data on immunogenicity, safety and efficacy.

 

INFLUENZA VACCINE:

Indications: Prophylaxis of influenza, especially in those who run an increased risk of associated complications. The use of Enzira should be based on official recommendations.

Contraindications: Hypersensitivity to the active substances, to any of the excipients, to eggs and/or chicken proteins. Immunisation shall be postponed in patients with febrile illness or acute infection.

Dose and Administration: Adults and children from 36 months: 0.5 ml. Children from 6 months to 35 months: Clinical data are limited. Dosages of 0.25 ml or 0.5 ml have been used. For children who have not previously been vaccinated, a second dose should be given after an interval of at least 4 weeks.

 

MEASLES VACCINE:

Indications: indicated for vaccination against measles in persons 9 months of age or older.

Contraindications: Hypersensitivity to any component of the vaccine. Do not give Measles vaccine to pregnant females; the possible effects of the vaccine on fetal development are unknown at this time. If vaccination of postpubertal females is undertaken, pregnancy should be avoided for 3 months following vaccination.

Dose and Administration: The dose for any age is 0.5 mL administered subcutaneously, preferably into the outer aspect of the upper arm. The recommended age for primary vaccination is 9 to 15 months.

 

MEASLES, MUMPS AND RUBELLA (MMR) VACCINE:

Indications: indicated for active immunisation against measles, mumps and rubella.

Contraindications: contraindicated in subjects with known systemic hypersensitivity to any component of the vaccine or to neomycin a history of contact dermatitis to neomycin is not a contraindication. MMR vaccine must not be administered to pregnant women. Furthermore, pregnancy must be avoided for one month after vaccination.

Dose and Administration: 0.5 ml of the reconstituted vaccine constitutes one dose. MMR Vaccine may be used for both primary immunisation and revaccination of children over 9 months of age, adolescents and adults. For infants in their first year of life. The vaccine should be given according to the recommended schedule.

 

MENINGOCOCCAL ACWY VACCINE:

Indications: active immunization against invasive meningococcal disease caused by these serogroups.5 Meningococcal Polysaccharide Vaccine, Groups A, C, Y and W-135 Combined may be used to prevent and control outbreaks of serogroup C meningococcal disease.

Contraindications: contraindicated in subjects with known systemic hypersensitivity to any component of the vaccine.

Dose and Administration: For both adults and children, vaccine is administered subcutaneously as a single 0.5 mL dose. Protective antibody levels may be achieved within 7 to 10 days after vaccination.5 Revaccination of a single 0.5 mL dose administered subcutaneously may be indicated for individuals at high-risk of infection, particularly children who were first vaccinated when they were less than 4 years of age; such children should be considered for revaccination after 2 or 3 years if they remain at high-risk.

 

PNEUMOCOCCAL POLYSACCHARIDE VACCINE:

Indications: active immunisation against disease caused by the pneumococcal serotypes included in the vaccine. The vaccine is recommended for individuals 2 years of age or older in whom there is an increased risk of morbidity and mortality from pneumococcal disease.

Contraindications: Hypersensitivity to the active substance(s) or to any of the excipients.

Dose and Administration: Adults and children of 2 years of age or older- one single dose of 0.5 millilitres by intramuscular or subcutaneous injection. The vaccine is not recommended for use in children below 2 years of age as the safety and efficacy of the vaccine have not been established and the antibody response may be poor.

 

PNEUMOCOCCAL POLYSACCHARIDE CONJUGATED VACCINE: 

Indications: Active immunisation against invasive disease (including sepsis, meningitis, bacteraemic pneumonia, bacteraemia) caused by Streptococcus pneumoniae serotypes 4, 6B, 9V, 14, 18C, 19F and 23F in: – infants and young children from 2 months of age to 2 years of age – previously unvaccinated children aged 2 years to 5 years. For the number of doses to be administered in the different age groups.

Contraindications: Hypersensitivity to the active substances or to any of the excipients, or to diphtheria toxoid.

Dose and Administration: The immunisation schedules for Prevenar should be based on official recommendations. Infants aged 2 – 6 months: The primary infant series consists of three doses, each of 0.5 ml, the first dose usually given at 2 months of age and with an interval of at least 1 month between doses. A fourth dose is recommended in the second year of life. The first dose may be given from the age of 2 months with a second dose at least 2 months later and a third (booster) dose at 11-15 months of age.

 

POLIOMYELITIS VACCINE, LIVE ORAL (OPV):

Indications: Active immunisation against poliomyelitis.

Contraindications: Acute febrile illness or intercurrent infection, persistent diarrhoea, or vomiting or other gastrointestinal disturbance. Impaired immune reponse, including leukaemia, lymphoma, generalised malignancy or treatment with corticosteroids, cytotoxic drugs or irradiation. Known systemic hypersensitivity to any constituents of the vaccine.

Dose and Administration: Three drops of vaccine from the monodose or ten-dose tube constitute one dose, which may be given with syrup or on a lump of sugar to mask the bitter salty taste of the magnesium chloride.

 

DTP-IPV-HAEMOPHILUS B CONJUGATED VACCINE:

Indications: indicated for the active immunisation of infants against diphtheria, tetanus, pertussis, poliomyelitis and invasive infections caused by Haemophilus influenzae type b. the vaccine may also be administered as a single dose to children who have previously completed a primary immunisation series with diphtheria, tetanus, pertussis, polio and Hib antigens, in accordance with the applicable official recommendations.

Contraindications: should not be given to children who: Are known to be hypersensitive to any component of the vaccine (including neomycin, streptomycin and polymyxin B which may be present in trace amounts). Have had a previous severe local or general reaction to this vaccine or to any other vaccine that contains one or more of the antigenic components. Have a fever or acute severe systemic illness. In this case vaccination should be postponed until the child has recovered. Minor infections without fever or systemic upset are not reasons to postpone vaccination.

Dose and Administration: The primary immunisation series in infancy may be commenced from two months of age according to applicable official recommendations. A single 0.5 millilitre dose should be given on three separate occasions with at least one month between doses. Child dosage: Primary Immunisation Series in Infancy The primary immunisation series in infancy may be commenced from two months of age according to applicable official recommendations. A single 0.5 millilitre dose should be given on three separate occasions with at least one month between doses.

 

DTP-IPV-HEPATITIS B- HAEMOPHILUS B VACCINE:

Indications: indicated for the active immunisation of infants against diphtheria, tetanus, pertussis, poliomyelitis, hepatitis B and invasive infections caused by Haemophilus influenzae type b. the vaccine may also be administered as a single dose to children who have previously completed a primary immunisation series

with diphtheria, tetanus, pertussis, polio and Hib antigens, in accordance with the applicable official recommendations.

Contraindications: should not be given to children who: Are known to be hypersensitive to any component of the vaccine (including neomycin, streptomycin and polymyxin B which may be present in trace amounts). Have had a previous severe local or general reaction to this vaccine or to any other vaccine that contains one or more of the antigenic components. Have a fever or acute severe systemic illness.

Dose and Administration: The primary immunisation series in infancy may be commenced from two months of age according to applicable official recommendations. A single 0.5 millilitre dose should be given on three separate occasions with at least one month between doses. Child dosage: Primary Immunisation Series in Infancy The primary immunisation series in infancy may be commenced from two months of age according to applicable official recommendations. A single 0.5 millilitre dose should be given on three separate occasions with at least one month between doses.

 

RABIES VACCINE:

Indications: For prophylactic immunisation against rabies. Treatment of patients following suspected rabies contact.

Contraindications: Pre Exposure, Known systemic hypersensitivity reaction to any component of Rabies Vaccine BP or after previous administration of the vaccine or a vaccine containing the same components as Rabies Vaccine BP.

Dose and Administration: Three injections each of 1 millilitre given on days 0, 7 and 28. A single reinforcing dose should be given at two or three year intervals to those at continued risk.

 

ROTAVIRUS VACCINE:

Indications: immunisation of infants over 6 weeks of age for protection against gastro-enteritis caused by rotavirus infection.

Contraindications: in individuals with immunodeficiency and in those predisposed to, or with a history of, intussusception. The administration of rotavirus vaccine should be postponed in infants with diarrhoea or vomiting.

Dose and Administration: By mouth infant over 6 weeks, 2 doses of 1 mL separated by an interval of at least 4 weeks; course should be completed before 24 weeks of age (preferably before 16 weeks)

 

TETANUS VACCINE:

Indications: Active immunisation against tetanus. Reinforcement of immunity to tetanus.

Contraindications: Acute infectious disease except in tetanus prone wounds.

Dose and Administration: Primary immunisation: 3 doses of 0.5 mL at minimum 4-week intervals. Normally, use triple vaccine in children. Reinforcing doses: 0 .5 ml 10 years after primary immunisation with a further 0.5 mL 10 years later. Injuries: 0 .5 mL unless a booster has been given in the preceding year. All by deep subcutaneous or intramuscular injection. intramuscular injection.

 

TYPHOID VACCINE: 

Indications: indicated for active immunisation against typhoid fever for both adults and children two years of age and older.

Contraindications: should not be administered to subjects with known hypersensitivity to any component of the vaccine or to subjects having shown signs of hypersensitivity after previous administration. As with other vaccines, the administration of Typhoid vaccine should be postponed in subjects suffering from acute febrile illness. The presence of a minor infection, however, is not a contraindication for vaccination.

Dose and Administration: A single dose of 0.5 ml is recommended for both adults and children two years of age and older.

 

VARICELLA-ZOSTER VACCINE:

Indications: Varicella vaccine is used to prevent infection by the varicella-zoster virus, which causes chickenpox.

Contraindications: Varicella vaccine should not be used by anyone who: is sensitive or allergic to any of the components of the vaccine (including gelatin). Is pregnant or planning to become pregnant within 3 months of receiving the vaccine.is receiving mmunosuppressive therapy (e.g., some medications used for the treatment of cancer or for transplant recipients).

Dose and Administration: Adults and adolescents 13 years of age and older receive a dose of 0.5 mL followed by a second 0.5 mL dose 4 to 8 weeks later. Children 12 months of age receive a single dose of 0.5 mL and 2nd dose at the school age.

 

POLYVALENT SNAKE ANTIVENOM: 

Indications: For the treatment of snakebite.

Contraindications: Significant allergic disease, or a history of an adverse reaction to the injection of serum.

Dose and Administration: For fast effect, the Anti Snkae Venom Serum should be injected intravenously as soon as possible after the bite. As a first dose, at least 20 ml. of the reconstituted serum should be injected intravenously very gradually (for every 1 ml per minute). The second dose should be repeated two hours after the first dose or even earlier.

SCORPION ANTIVENOM:

Indications: Used for treatment of the sting of the parabuthus scorpion.

Contraindications: Should be used with great caution if patient is subject to allergic diseases such as asthma or infantile eczema, or was allergic to any previous antiserum injection.

Dose and Administration: Local symptoms may be relieved by the subcutaneous injection of serum around the site of the sting. For serious parabuthus stings, inject 5 mL intravenously or intramuscularly, and repeat injection after 1 to 2 hours if improvement has not occurred.

 

Diagnostic Agents

 

TUBERCULIN PURIFIED PROTEIN DERIVATIVE (PPD):

Indications: The intradermal (Mantoux) skin test employing PPD RT/23 is used as an aid in the diagnosis of tuberculosis infection. Reactivity to the test may be depressed or suppressed if the individual is suffering from advanced tuberculosis disease, acute viral infection (including immunisation with live viral vaccine during past 14 days), or overwhelming bacterial infection. Patients receiving corticosteroids or other immunosuppressive agents, or who are suffering from malignant conditions, may also react poorly to the tuberculin test.

Contraindications: Known hypersensitivity to the test, such as may occur in individuals who are known tuberculin reactors and who have been repeatedly tested with tuberculin, or in persons who have previously suffered from tuberculosis.

Dose and Administration: By intradermal injection, for Mantoux test, 2 units (0.1 mL of 20 units/mL strength) for routine Mantoux test; if first test is negative and a further test is considered appropriate 10 units (0.1 mL of 100 units/mL strength)

 

Anti-infective skin preparations

 

Antibacterial preparations

Although there are a great many antibacterial drugs presented in topical preparations some are potentially hazardous and frequently their use is not necessary if adequate hygienic measures can be taken. Moreover, not all skin conditions that are oozing, crusted, or characterised by pustules are actually infected. Topical antibacterials should be avoided on leg ulcers unless used in short courses for defined infections; treatment of bacterial colonisation is generally inappropriate. To minimise the development of resistant organisms it is advisable to limit the choice of antibacterials applied topically to those not used systemically.

 

MUPIROCIN:

Indications: indicated for the topical treatment of secondarily infected traumatic lesions such as small lacerations, sutured wounds or abrasions (up to 10cm in length or 100cm2 in area), due to susceptible strains of Staphylococcus aureus and Streptococcus pyogenes.

Contraindications: History of hypersensitivity to mupirocin or any of the excipients.

Dose and Administration: Three times a day for up to 10 days, depending on the response.

 

SILVER SULFADIAZINE:

Indications: prophylaxis and treatment of infection in burn wounds; as an adjunct to short-term treatment of infection in leg ulcers and pressure sores; as an adjunct to prophylaxis of infection in skin graft donor sites and extensive abrasions; for conservative management of finger-tip injuries

Contraindications: pregnancy and breast-feeding; sensitivity to sulphonamides; not recommended for neonates

Dose and Administration: Burns, apply daily or more frequently if very exudative; leg ulcers or pressure sores, apply daily or on alternate days (not recommended if ulcer very exudative); finger-tip injuries, apply every 2–3 days.

 

ARGENIN ACID COLLOIDAL POLYMER:

Indications: superficial burns and grazes, postoperative wounds, pressure sores and ulcers.

Contraindications: History of hypersensitivity to mupirocin or any of the excipients.

Dose and Administration: apply a thick layer (5mm) onto the wound for 1-3 days depending on the nature of the wound.

 

FUSIDIC ACID:

Indications: Indicated either alone or in combination with systemic therapy, in the treatment of primary and secondary skin infections caused by sensitive strains of Staphylococcus aureus, streptococcus spp and Corynebacterium minutissimum. Primary skin infections that may be expected to respond to treatment with fusidic acid applied topically include: impetigo contagiosa, superficial folliculitis, sycosis barbae, paronychia and erythrasma; also such secondary skin infections as infected eczematoid dermatitis, infected contact dermatitis and infected cuts /abrasions.

Contraindications: Infection caused by non-susceptible organisms, in particular, Pseudomonas aeruginosa. contra-indicated in patients with hypersensitivity to fusidic acid and its salts.

Dose and Administration: Adults and Children: Uncovered lesions – apply gently, three or four times daily. Covered lesions – less frequent applications may be adequate.

 

GENTAMYCIN:

Indications: Bacterial Skin and Skin Structure Infection, Folliculitis, Furunculosis, Paronychia.

Contraindications: contra-indicated in patients with hypersensitivity to Gentamycin and its salts.

Dose and Administration: apply a small amount to the affected area by topical route 3 times per day.

 

Antifungal preparations

Most localised fungal infections are treated with topical preparations. To prevent relapse, local antifungal treatment should be continued for 1–2 weeks after the disappearance of all signs of infection. Systemic therapy is necessary for nail or scalp infection or if the skin infection is widespread, disseminated, or intractable. Skin scrapings should be examined if systemic therapy is being considered or where there is doubt about the diagnosis.

 

AMOROLFINE:

Indications: Dermatomycoses caused by dermatophytes: tinea pedis (athlete’s foot), tinea cruris, tinea inguinalis, tinea corporis, and tinea manuum. Pityriasis versicolor.

Contraindications: must not be reused by patients who have shown hypersensitivity to the treatment. No experience exists of use during pregnancy and nursing, therefore, the use of Loceryl should be avoided during pregnancy and lactation.

Dose and Administration: To be applied to affected skin areas once daily following cleansing (in the evening). The treatment should be continued without interruption until clinical cure, and for 3 – 5 days thereafter. The required duration of treatment depends on the species of fungi and on the localisation of the infection. In general, treatment should be continued for at least two to three weeks. With foot mycoses, up to six weeks of therapy may be necessary.

 

CLOTRIMAZOLE:

Indications: Fungal and Gram-positive bacterial skin and nail infections.

Contraindications: Possible hypersensitivity to clotrimazole.

Dose and Administration: Apply sparingly two or three times daily until two

weeks after clinical cure.

 

KETOCONAZOLE:

Indications: topical application in the treatment of dermatophyte infections of the skin such as tinea corporis, tinea cruris, tinea manus and tinea pedis infections due to Trichophyton spp, Microsporon spp and Epidermophyton spp. also indicated for the treatment of cutaneous candidosis (including vulvitis), tinea (pityriasis) versicolor and seborrhoeic dermatitis caused by Malassezia (previously called Pityrosporum) spp. P For the treatment of the following mycotic infections of the skin: tinea pedis, tinea cruris and candidal intertrigo.

Contraindications: Ketoconazole cream is contra-indicated in patients with a known hypersensitivity to any of the ingredients or to ketoconazole itself.

Dose and Administration: Tinea pedis apply twice daily; other fungal infections, apply 1–2 times daily.

 

MICONAZOLE NITRATE:

Indications: For the treatment of the following mycotic infections of the skin: tinea pedis, tinea cruris and candidal intertrigo.

Contraindications: contra-indicated in patients with a known hypersensitivity to any of the ingredients or to ketoconazole itself.

Dose and Administration: Apply twice daily continuing for 10 days after lesions have healed; nail infections, apply 1–2 times daily.

 

TERBINAFINE:

Indications: Fungal infections of the skin and nails caused by Trichophyton (eg. T. rubrum, T.mentagrophytes, T. verrucosum, T. violaceum), Microsporum canis and Epidermophyton floccosum. 1. Oral Lamisil is indicated in the treatment of ringworm (tinea corporis, tinea cruris and tinea pedis) where oral therapy is considered appropriate due to the site, severity or extent of the infection. 2. Oral Lamisil is indicated in the treatment of onychomycosis.

Contraindications: Hypersensitivity to Terbinafine. pregnancy, breast-feeding; avoid contact with eyes.

Dose and Administration: Apply thinly 1–2 times daily for up to 1 week in tinea pedis, 1–2 weeks in tinea corporis and tinea cruris, 2 weeks in cutaneous candidiasis and pityriasis versicolor; review after 2 weeks.

 

Combined Anti-infective and anti-inflammatory topical preparations

 

CLOTRIMAZOLE-BETAMETHASONE DIPROPIONATE:

Indications: Short-term topical treatment of tinea infections due to Trichophyton rubrum; T.mentagrophytes; Epidermophyton floccusum and Microsporum canis; candidiasis due to Candida albicans.

Contraindications: contraindicated in those patients with a history of sensitivity to any of its components or to other corticosteroids or imidazoles. Also contraindicated in facial rosacea, acne vulgaris, perioral dermatitis, napkin eruptions and bacterial or viral infections.

Dose and Administration: Adults and children over the age of 12 years: Topical administration twice daily for two weeks (tinea cruris, tinea corporis and candidiasis) or for four weeks (tinea pedis).

 

FUSIDIC ACID-BETAMETHASONE VALERATE:

Indications: indicated for the treatment of eczematous dermatoses including atopic eczema, infantile eczema, discoid eczema, stasis eczema, contact eczema and seborrhoeic eczema when secondary bacterial infection is confirmed or suspected.

Contraindications: Acne rosacea and perioral dermatitis. Skin lesions of viral, fungal or bacterial origin. Hypersensitivity to the preparation.

Dose and Administration: A small quantity should be applied to the affected area twice daily until a satisfactory response is obtained. A single treatment course should not normally exceed 2 weeks.

 

FUSIDIC ACID-HYDROCORTESONE:

Indications: indicated in eczema and dermatitis with secondary bacterial infections, including atopic eczema, primary irritant dermatitis and allergic and seborrhoeic dermatitis where the organisms responsible are known to be or believed to be sensitive to fusidic acid.

Contraindications: Hypersensitivity to fusidic acid and its salts. As with other topical corticosteroid preparations, It is contraindicated in primary bacterial, viral and fungal skin infections, skin manifestations in relation to tuberculosis or syphilis, perioral dermatitis and rosacea.

Dose and Administration: Adults and Children: Uncovered lesions – a small quantity should be applied to the affected area twice daily until a satisfactory response is obtained. A single treatment course should not normally exceed 2 weeks. Covered lesions – less frequent applications may be adequate.

 

MICONAZOLE NITRATE-HYDROCORTESONE:

Indications: For the topical treatment of inflamed dermatoses where infection by susceptible organisms and inflammation co-exist, eg intertrigo and infected eczema. Moist or dry eczema or dermatitis including atopic eczema, primary irritant or contact allergic eczema or seborrhoeic eczema including that associated with acne.

Contraindications: True hypersensitivity to any of the ingredients. Tubercular or viral infections of the skin or those caused by Gram-negative bacteria.

Dose and Administration: Apply the cream two or three times a day to the affected area, rubbing in gently until the cream has been absorbed by the skin.

 

NEOMYCIN-NATAMYCIN-HYDROCORTESONE:

Indications: to relieve the itching and discomfort of many skin problems where these also have an added bacterial and/or candidal (fungal) infection.

Contraindications: hypersensitivity to any of the ingredients.

Dose and Administration: applied sparingly to the affected area 2-4 times daily. Treatment should not be continued for longer than 14 days.

 

GENTAMYCIN-BETAMETHASONE:

Indications: Secondarily infected steroid-responsive dermatoses.

Contraindications: contra-indicated in patients with hypersensitivity to Gentamycin and betamethasone or its salts.

Dose and Administration: applied sparingly to the affected area 2-4 times daily. Treatment should not be continued for longer than 14 days.

 

MICONAZOLE NITRATE-BETAMETHASONE: 

Indications: infection of skin with fungi along with inflammation.

Contraindications: hypersensitivity to any of ingredients.

Dose and Administration: topical use once or twice daily.

 

MICONAZOLE NITRATE-GENTAMYCIN-BETAMETHASONE:

Indications: mixed infection of skin with fungi and bacteria along with

inflammation.

Contraindications: hypersensitivity to any of ingredients.

Dose and Administration: topical use once or twice daily.

 

MICONAZOLE NITRATE-MOMETASONE FUROATE:

Indications: for infections of skin by candida spp. Or dermatophytes in which

inflammatory and pruritic manifestations are prominent.

Contraindications: contraindicated in patients who are hypersensitive to

mometasone, miconazole or to any ingredient of the preparation.

Dose and Administration: apply a thin film to the affected skin areas once or

twice daily.

 

MICONAZOLE-GENTAMYCIN-MOMETASONE FUROATE:

Indications: mixed infection of skin with fungi and bacteria. These include atopic eczema, contact eczema, follicular eczema, infantile eczema, otitis externa, post traumatic infective eczema, neurodermatitis and psoriasis.

Contraindications: contraindicated in patients who are hypersensitive to any ingredient of the preparation.

Dose and Administration: apply a thin film to the affected skin areas once or twice daily.

 

Antiviral preparations

 

ACICLOVIR (Acyclovir):

Indications: indicated for the treatment of Herpes Simplex virus infections of the skin including initial and recurrent genital herpes and herpes labialis. Route of administration: topical. Do not use in eyes.

Contraindications: contraindicated in patients known to be hypersensitive to aciclovir, valaciclovir, propylene glycol or any of the excipients.

Dose and Administration: Adults and Children: Aciclovir Cream should be applied five times daily at approximately four hourly intervals, omitting the night time application. The cream should be applied to the lesions or impending lesions as soon as possible, preferably during the early stages (prodrome or erythema). Treatment can also be started during the later (papule or blister) stages. Treatment should be continued for at least 4 days for herpes labialis and for 5 days for genital herpes. If healing has not occurred then treatment may be continued for up to an additional 5 days.

 

Preparations for minor skin infections

 

ZINC OXIDE:

Indications: Napkin and urinary rash. Eczematous conditions.

Contraindications: hypersensitive to any of the ingredients.

Dose and Administration: Apply frequently even after improvement observed.

 

DEXAPANTHENOL:

Indications: gentle and soothing antiseptic cream, which can treat a variety of skin irritations.

Contraindications: hypersensitive to any of the ingredients.

Dose and Administration: Baby care- Apply Dexapanthen at each nappy change.

 

BETA-SITOSTEROL:

Indications: treatment of burns, wounds and skin ulcers.

Contraindications: hypersensitive to any of the ingredients.

Dose and Administration: a thin layer of the ointment should cover the whole

burn or wound bed and renewed 3-4 times daily if the area is left exposed or

twice daily if covered.

 

PURPLE CONEFLOWER JUICE:

Indications: treatment of surface wounds with a tendency to poor healing.

Contraindications: hypersensitive to any of the ingredients.

Dose and Administration: a thin layer of the ointment should cover the whole burn or wound bed and renewed 3-4 times daily if the area is left exposed or twice daily if covered.

 

 

 

 

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