By V. Jose. Moravian College.

Levocetrizine Pregnancy Category-B Schedule H Indicatons Allergic rhinits cheap fluconazole 200 mg with amex, chronic urtcaria generic 50mg fluconazole mastercard. Dose Oral Rhinits, chronic urtcaria: Adult & children (>12 years) - 5 mg once daily in the evening. Contraindicatons Hypersensitvity, end-stage renal disease with creatnine clearance < 10 ml/min. Adverse Efects Somnolence, fatgue, dry mouth, nasopharyngits have been reported in adults. Storage Store protected from heat, light and moisture at a temperature not exceeding 30⁰C. Noradrenaline Pregnancy Category-C Indicatons Acute hypotension, adjunct in cardiac arrest, upper gastrointestnal haemorrhage. Reconsttuton Dilute with 5% glucose injecton, with or without sodium chloride; diluton with sodium chloride injecton alone is not recommended. Contraindicatons Hypertension, pregnancy (Appendix 7c), patents with peripheral or mesenteric vascular thrombosis unless necessary as a life-saving procedure. Adverse Efects Elevaton of blood pressure, bradycardia, peripheral ischemia, arrhythmias, anxiety, transient headache, respiratory difculty, extravasaton necrosis at injecton site. Pheniramine* Pregnancy Category-C Schedule H Indicatons Symptomatc relief of allergy; allergic rhinits; urtcaria. Contraindicatons Epilepsy; pregnancy (Appendix 7c); acute asthma; acute porphyria; symptomatc prostatc hypertrophy; neonates and premature infants. Precautons Glaucoma; driving or operatng machinery; asthma or severe cardiovascular disease, pregnancy (Appendix 7c), lactaton. Dose Oral Adult and Child- Initally up to 10 to 20 mg daily in divided doses (severe diseases up to 60 mg), preferably afer breakfast. Contraindicatons Untreated systemic infecton; administraton of live virus vaccines; hypersensitvity. Adverse Efects Nausea, dyspepsia, malaise, hiccups; hyper- sensitvity reactons including anaphylaxis; supraclavicular lump, fragile skin. The disease mainly afects the older populaton and is the most common cause of dementa (early stage). As the disease advances behavioural changes such as confusion, irritability and aggression, mood swings, language break- down, long term loss of memory etc. The biochemical mechanisms involved in its pathogenesis are suggested to be the accumulaton of abnormally folded amyloid β and τ proteins in the brain, involvement of infammatory cytokines, alteraton in distributon of diferent neurotrophic factors and expression of their receptors etc. Alzheimer’s Associaton has pointed out 10 warning symp- toms for this disease which are as under: 1. Loss of initatve There is no cure for this disease, drug therapy is mainly symp- tomatc and palliatve in nature. Contraindicatons Hypersensitvity, severe hepatc and renal impairment, pregnancy (Appendix 7c), lactaton, not recommended for children. Adverse Efects Nausea, vomitng, diarrhoea, fatgue, insomnia, muscle cramps, bradycardia, convulsions, gastrointestnal, haemorrhage, hepatts, urinary incontnence, infuenza, pruritus, increased liver transaminases. Galantamine Pregnancy Category-B Schedule H Indicatons To treat the symptoms of mild to moderate Alzheimer’s disease, Dementa syndrome. Contraindicatons Hypersensitvity to galantamine, severe kidney and liver problems, pregnancy (Appendix 7c), lactatng mothers, children. Precautons Patents with asthma or lung disease, epilepsy, stomach ulcer, take plenty of fuids during treatment. Adverse Efects Diarrhoea, nausea, anorexia and weight loss, chest pain or shortness of breath. Memantne Pregnancy Category-B Indicatons Treatment of moderate to severe dementa of Alzheimer’s disease. Precautons Seizure, rise in urine pH results in increased plasma levels, pregnancy (Appendix 7c), lactaton, children. Adverse Efects Fatgue, pain, hypertension, dizziness, headache, constpaton, vomitng, back pain, confusion, somnolence, hallucinaton, coughing, dyspnea, insomnia, urinary tract infectons, anxiety, peripheral oedema, arthralgia. Rivastgmine Pregnancy Category-B Schedule H Indicatons Moderate to severe dementa. Contraindicatons Hypersensitvity to carbamate derivatves and severe hepatc impairment, children, lactaton. Tacrine Pregnancy Category-C Schedule H Indicatons Mild to moderate Alzheimer’s type dementa. Contraindicatons Hepatc impairment, hyperbilirubinaemia, bradycardia, bronchial asthma, seizures and gastro intestnal obstructon. Close supervision is then needed to ensure that treatment regimens are tolerated and that appropriate changes are made to the regimen as the disease progresses. The most efectve form of therapy is a combinaton of levodopa and a peripheral dopa-decarboxylase inhibitor, such as carbi- dopa. The response to levodopa with carbidopa is a compromise between increased mobility and adverse efects. Dyskinesias may be dose limitng and increasingly frequent with increased duraton of treatment.

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Detoxification A controlled process of providing symptomatic relief to assist patients to complete withdrawal from a Drug fluconazole 200 mg, while minimising the associated adverse effects order 50 mg fluconazole with amex. In the context of Illicit drug use, the aim of detoxification is to reverse or reduce Dependence on and Tolerance to a Psychoactive drug. Diversion From a medical perspective, diversion is the inappropriate use of a Drug by those for whom it has been prescribed, or use by a person for whom the medication was not prescribed. The term may be used to describe diversion of a shipment of drugs out of legal channels at wholesale level or, for example, to describe the sale of prescription methadone to, and use by, an individual for whom it was not prescribed. The term diversion is also used in a criminal justice context to refer to measures that take an arrestee out of the criminal justice system and into education, medical management or another type of intervention. In medicine, it refers to any substance with the potential to prevent or cure disease or enhance physical or mental welfare, and in pharmacology it refers to any chemical agent that alters the biochemical or physiological processes of tissues or organisms. In common usage, the term often refers specifically to Psychoactive drugs, and often, even more specifically, to Illicit drugs, of which there is non-medical use in addition to any medical use. Professional formulations (eg ‘alcohol and other drugs’) often seek to make the point that caffeine, tobacco, alcohol and other substances in common non-medical use are also drugs in the sense of being taken, at least in part, for their psychoactive effects. In other contexts, abuse has referred to non-medical or unsanctioned patterns of use, irrespective of consequences. Drug control The regulation, by a system of laws and agencies, of the production, distribution, sale and use of specific Psychoactive drugs (Controlled substances) locally, nationally or internationally. Drug misuse Use of a substance for a purpose that is not consistent with legal or medical guidelines, as in the non-medical use of prescription medications. This term is often preferred to Drug abuse, as it is perceived to be less judgemental. Drug poisoning A state of major disturbance of consciousness level, vital functions, and behaviour following the administration in excessive dosage (deliberately or accidentally) of a Psychoactive substance. In the field of toxicology, the term poisoning is used more broadly to denote a state resulting from the administration of excessive amounts of any pharmacological agent, psychoactive or not. In the context of Illicit drug use, poisoning may occur as a result of adulterants in the drug. Drug policy In the context of Psychoactive drugs, the aggregate of policies designed to affect the supply and/or demand for Illicit drugs, locally or nationally, including education, treatment, control and other programmes and polices to reduce the harms related to illicit drug use. In this context, ‘drug policy’ often does not include pharmaceutical policy (except with regard to diversion to non-medical use), or tobacco or alcohol policy. Drug-related problem Any of the range of adverse accompaniments of Drug use, particularly Illicit drug use. The term was coined by analogy with alcohol-related problems but is less used, since it is Drug use itself, rather than the consequence, that tends to be defined as the problem. This term has been used throughout this book rather than Drug abuse or Drug misuse, as it is non-judgemental. Gateway drug An Illicit or Licit drug, use of which is regarded as opening the way to the use of another drug, usually one that is viewed as more problematic. Harmful use A pattern of Psychoactive Substance use that is causing damage to health. The damage may be physical (eg hepatitis following injection of drugs) or mental (eg depressive episodes secondary to heroin use). Harmful use commonly, but not invariably, has adverse social consequences but social consequences are not necessary to justify a diagnosis of harmful use. Harm reduction In the context of alcohol or other drugs, harm reduction describes policies or programmes that focus directly on reducing the harm resulting from the use of alcohol or other drugs. The term is used particularly of policies or programmes that aim to reduce the harm without necessarily affecting the underlying Drug use; examples include Maintenance treatment in Opioid Dependence and needle/syringe exchanges to counteract needle sharing among heroin users. Harm reduction can be used either to refer to goals (focusing on the harm rather than on use per se) or to means (eg needle exchanges, Opioid Substitution Therapy etc); in the latter sense, it is often contrasted to the dichotomy of supply reduction and demand reduction. Hazardous use A pattern of substance use that increases the risk of harmful consequences for the user. Some would limit the consequences to physical and mental health (as in Harmful use); some would also include social consequences. In contrast to Harmful use, hazardous use refers to patterns of use that are of public health significance, despite the absence of any current disorder in the individual user. It is also commonly used for Licit drugs, such as alcohol, which allows comparison between the pattern of use of these drugs and the harm related to their use. These substances cause dopamine to be released rapidly and in huge quantities when compared to usual brain levels, which leads to the intense feelings of pleasure. Illicit drug A Psychoactive substance, the possession, production, sale or use of which is prohibited. Strictly speaking, it is not the Drug that is illicit, but its possession, production, sale or use in particular circumstances in a given jurisdiction. Illicit drug market, a more exact term, refers to the production, distribution, and sale of any drug outside legally sanctioned channels. Complications may include trauma, inhalation of vomitus, delirium, coma, and convulsions, depending on the substance and method of administration.

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Long-term Management Acetylsalicylic acid should be given to all patents in a dose of 75-150 mg daily by mouth purchase fluconazole 200 mg mastercard, unless it is contraindicated purchase 50mg fluconazole otc. Treatment with beta-blockers should be contnued for at least 1 year and possibly for up to 3 years. Stroke: Stroke (cerebrovascular accident) may be ischaemic or haem- orrhagic; precise diagnosis is essental, as management for the two types of stroke is quite diferent. Primary preventon of both types of stroke includes reducton of high blood pressure, stopping smoking, weight reducton and cholesterol reducton. Atrial fbrillaton, acute myocardial infarcton and valvular disease may produce embolism and ischaemic stroke. Prophylaxis in patents at risk of ischaemic stroke includes oral antcoagulants such as warfarin and antplatelet drugs such as acetylsalicylic acid. Treatment of acute ischaemic stroke includes use of acetylsalicylic acid, antcoagulants such as heparin and of thrombolytcs, such as streptokinase. Long-term therapy with acetyl- salicylic acid reduces the risk of having another stroke. Antplatelet and thrombolytc drugs are not used in the management of haemorrhagic stroke, as they may exacerbate bleeding. Acetylsalicylic acid is normally given for at least one year afer coronary artery bypass surgery. It is also given to patents with prosthetc heart valves who have had cerebral embolism despite warfarin treatment. Contraindicatons Surgery within 10 days, including organ biopsy, puncture of noncompressible vessels, serious trauma, cardiopulmonary resuscitaton, actve bleeding, serious gastrointestnal bleeding within 3 months, previous cerebrovascular accident or actve intracranial process, thrombocytopenia, severe uncontrolled hypertension, aortc dissecton, acute pericardits. Precautons Monitor platelet count for thrombocytopenia; interactions (Appendix 6c); pregnancy (Appendix 7c). Dose Oral Adult-Prophylaxis of cerebrovascular disease or myocardial infarcton: 75 to 100 mg daily. Adverse Efects Bronchospasm;gastrointestnalhaemorrhage (rarely, major); also other haemorrhage (for example subconjunctval); urtcaria; hepatomegaly. Alteplase Pregnancy Category-C Schedule H Indicatons Acute myocardial infarcton, acute massive pulmonary embolism, acute ischaemic stroke. Dose Intravenous Acute myocardial infarcton Adult: The recommended total dose is 100 mg. Heparin therapy to be insttuted or reinsttuted near the end of or immediately following the alteplase infusion when the partal thromboplastn tme returns to twice normal or less. Acute ischemic stroke Adult: Use recommended within frst 3 h of onset of the symptoms. Caution in recent surgery or invasive procedures, diabetic hemorrhagic retinopathy, severe hepatic and renal impairment, pregnancy (Appendix 7c), lactation, children, elderly, interactions (Appendix 6c). Adverse Efects Hemorrhage including intracranial, gastrointestnal or genitourinary bleeding, transient hypotension, reperfusion dysrythmias, cerebral edema, seizures, allergic-type reactons, nausea, vomitng. Storage Store protected from heat, light and moisture at room temperature (<30°C) or under refrigeraton. Clopidogrel* Pregnancy Category-B Schedule H Indicatons Prophylaxis in thromboembolic disorders including myocardial infarcton, peripheral arterial disease and stroke, acute coronary syndrome. Contraindicatons Hypersensitvity, actve pathological bleed- ing such as peptc ulcer or intracranial hem- orrhage, coagulaton disorders, lactaton. Precautons Patient with increased risk of bleeding from trauma, surgery or other pathological conditions, ulcers, renal impairment, hepatic impairment, history of bleeding or haemostatic disorder, pregnancy (Appendix 7c); interactions (Appendix 6c). Adult- Thrombosis: 2,50,000 units over 30 min, followed by 1,00,000 units every h for 12 to 72 h according to conditon with monitoring of clotng parameters. Contraindicatons Recent haemorrhage; surgery (including dental); parturiton; trauma; heavy vaginal bleeding; haemorrhagic stroke; history of cerebrovascular disease (especially recent or if residual disability); coma; severe hypertension; coagulaton defects; bleeding diatheses; aortc dissecton; risk of gastrointestnal bleeding such as recent history of peptc ulcer; oesophageal varices; ulceratve colits; acute pancreatts; severe liver disease; acute pulmonary disease with cavitaton; previous allergic reactons; pregnancy (Appendix 7c). Precautons Risk of bleeding from any invasive procedure; including injecton; external chest compres- sion; abdominal aneurysm or where throm- bolysis may give rise to embolic complica- tons such as enlarged lef atrium with atrial fbrillaton (risk of dissoluton of clot and sub- sequent embolizaton); diabetc retnopathy (small risk of retnal haemorrhage); recent or concurrent antcoagulant treatment; platelet count; fbrinogen level; thrombin and pro- thrombin tme. Storage Store in a sealed container protected from light in refrigerator (2 to 8⁰C). Urokinase* Pregnancy Category-C Schedule H Indicatons Acute myocardial infarcton; pulmonary embolism; deep vein thrombosis; peripheral vascular thrombosis; peripheral arterial thromboembolism; arterial thrombosis. Dose Intravenous infusion Deep vein thrombosis: 4,400 units/kg body weight in 15 ml Sodium Chloride (0. Contraindicatons In recent haemorrhage; trauma; or surgery (including dental extracton); coagulaton defects; bleeding diatheses; aortc dissecton; coma; history of cerebrovascular disease especially recent events or with any residual disability; recent symptoms of possible peptc ulceraton; heavy vaginal bleeding; severe hypertension; actve pulmonary disease with cavitaton; acute pancreatts; pericardits; bacterial endocardits; severe liver disease and oesophageal varices. They should also be used with cauton in external chest compression; pregnancy (Appendix 7c); elderly; hypertension; abdominal aneurysm or other conditons in which thrombolysis might give rise to embolic complicatons such as enlarged lef atrium with atrial fbrillaton (risk of dissoluton of clot and subsequent embolisaton); diabetc retnopathy (very small risk of retnal bleeding) and recent or concurrent use of drugs that increase the risk of bleeding; hematocrit platelet count; thrombin and prothrombin tme. Bleeding is usually limited to the site of injecton; but intracerebral haemorrhage or bleeding from other sites can occur.

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