GPO Pharmacist team . . . Cough Cold

GPO Pharmacist team . .   .   Cough Cold

GPO Pharmacist team . . . Cough Cold Remedies

1. (conventional antihistamine) conventional antihistamine) Chlorpheniramine, Brompheniramine, Tripolidine, Hydroxyzine 2. (conventional antihistamine) non-sedating antihistamine) Loratadine, Cetirizine, Fexofenadine, Desloratadine, Levocetirizine 3.

Histamine receptor Block Acetylcholine paradoxical stimulation

(conventional antihistamine) ) - Onset 15-30 - Cmax 1-2 .

Duration 3-5 . 24 . (conventional antihistamine) ) Dose Chlorpheniramine : Child - 0.35 mg/kg/day divided TID : Adult 4 mg TID Brompheniramine : Child 0.125 mg/kg/ dose TID

: Adult 4 mg TID Hydroxyzine : Child 2 mg/kg/day divided TQID : Adult 50-100 mg/ day divided TQID (conventional antihistamine) ) Dose Diphenhydramine : Child (conventional antihistamine) 6-11 yr.) 12.525 mg TID : Adult 25-50 mg TID Dimenhydrinate : Child (conventional antihistamine) 6-11 yr.) 25-50

mg TID : Adult 50 mg TID (conventional antihistamine) ) ADR Diphenhydramine Contraindication

- anticholinergic - Duration 12-24 .

24 . (conventional antihistamine) ) Dose Cetirizine : Child - 5-10 mg QD : Adult 10 mg QD Loratadine : Child 5-10 mg QD : Adult 10 mg QD Fexofenadine : Child 30 mg BID

: Adult 60 mg BID or 180 mg QD (conventional antihistamine) ) Dose Desloratadine : Child 2.5 mg QD : Adult 5 mg QD Levocetirizine : Child 2.5 mg QD : Adult 5 mg QD

(conventional antihistamine) ) ADR (conventional antihistamine) ) Precaution

Ketotifen - H1 Receptor - Stabilized Mast cell mediator - - Cmax 24 . - 48 . (conventional antihistamine) )

Ketotifen dose - Child 0.05 mg/kg/day divided BID - Adult 1-2 mg/day divided BID - ADR - Corticosteroids nasal spray Mechanism

inflammation mediator, inh. PG - Rhinocort (conventional antihistamine) Budesonide) Nasacort(conventional antihistamine) Triamcinolone) Beclonase (conventional antihistamine) Beclomethasone) Flixonase (conventional antihistamine) Fluticasone) Nasonex (conventional antihistamine) Mometasone) Avamys (conventional antihistamine) Fluticasone)

Corticosteroids nasal spray (conventional antihistamine) ) Dose : 1-2 puff QD or BID ADR : : Dextromethorphan medulla

threshold child : 5-10 mg q 4 hr; max 60 mg/day adult : 10-20 mg q 4 hr; max 120 mg/day Drug abuse : more than 360 mg >> hallucinate, delusion Toxicity : N/V

ADR : Acetylcysteine : disulfide bond : child 100 mg TID : adult 100-200 mg TQID ADR : N/V, asthma exacerbation (conventional antihistamine) maybe)

Carbocysteine : disulfide bond : child 8 mg/kg/dose TID : adult 375-750 mg TQID ADR : N/V

s - Carbocysteine Lysine : disulfide bond : child 5 ml BID : adult 30 ml OD or 15 ml BID ADR : N/V Bromhexine :

celia mucopolysaccharide : child 0.6-0.8 mg/kg/day divided TID : adult 8 mg TQID ADR : GI irritation(conventional antihistamine) mild) Ambroxol

: : child 1.5 mg/kg/day divided TID : adult 30 mg TQID ADR : GI irritation (conventional antihistamine) mild) Guaifenesin

: celia : child 100-200 mg q 4 hr max 1200 mg/day adult 200-400 mg q 4 hr max 2400 mg/day ADR : GI irritation (conventional antihistamine) mild) Bronchodilator

beta adrenergic agonist - - - - Salbutamol : onset inhaler 30 min, oral 2-3 hr

: duration inhaler 3-4 hr, oral 4-6 hr : elimination hepatic first-pass metab. : 50% inactive Dose Child-0.1-0.2 mg/kg/dose TID Max 12 mg/day Adult- 2-4 mg TID Max 32 mg/day Salbutamol (conventional antihistamine) ) ADR : , : , :

: (conventional antihistamine) rare) Terbutaline : onset oral 30-45 hr : duration inhaler 3-4 hr, oral 4-6 hr : metab. inactive sulfate conjugates : Dose Child-0.15 mg/kg/dose TID Max 5

mg/day Adult- 2.5-5 mg TID Max 15 mg/day Terbutaline (conventional antihistamine) ) ADR : , : , , , : : :

(conventional antihistamine) rare) Theophylline : metab. demethylation oxidation : : therapeutic window : Allopurinol, Cimetidine, INH, Macrolide, Quinolone theophylline : Beta-blocker, CBZ, Phenytoin,

Protease inh, thyroid product theophylline Theophylline (conventional antihistamine) ) ADR : N / V , , , , , Theophylline Toxicity : , , , , , , : ,

, , , allergy allergic rhinitis viral infection (respiratory tract) Antibacterial agent Bacteriostatic vs

Bactericidal Bacteriostatic Macrolide, Tetracycline, Chloramphenicol, Sulfonamide Bactericidal

Penicillin, Cephalosporin, Aminoglycoside, Fluoroquinolone, Metronidazole Bacteriostatic vs Bactericidal Drug inhibiting cell wall synthesis cell wall peptidoglycan beta-lactamase

enz. outer membrane lipid beta-lactamase periplasmic space betalactam beta-lactam Penicillin group Penicillin group Classification

1. Natural Penicillin : Pen V, Pen G (conventional antihistamine) only Inj.) 2. Beta-lactamase resistance penicillin : Cloxacillin Dicloxacillin 3. Broad spectrum penicillin : Ampicillin, Amoxicillin beta-lactamase 4. Extended spectrum penicillin or antipseudomonas penicillin : pseudomonas Piperacillin, Carbepenicillin

Penicillin group MOA : Penicillin Binding Protein (conventional antihistamine) PBPs) 1. beta-lactamase 2. PBPs Penicillin group

Penicillin V (conventional antihistamine) Abs. Abs. ) Child : 25-50 mg/kg/day divided every 6-8 hr. Max 3g./day Adult : 500 mg. TQID 10 day Amoxicillin (conventional antihistamine) Abs. ) Child : EENT 20-50 mg/kg/day divided every 812 hr. : Acute otitis media 80-90 divided every 8-12 hr. Adult : EENT mild to moderate 500 q 12 hr., severe 500 mg. q 8 hr.

Penicillin group Amoxicillin (conventional antihistamine) Abs. )+ Clavulanic acid Dose up to amoxicillin Cloxacillin (conventional antihistamine) Abs. Abs. ) staphylococcus Child : 25-50 mg/kg/day divided every 6hr. Adult : 500 mg. TQID 10 day max 6 g./day Dicloxacillin(conventional antihistamine) Abs. Abs. ) staphylococcus

Child : 12.5-50 mg/kg/day divided every 6hr. Not more than 250 mg/dose Adult : 125-1000 mg. TQID 10 day max 6 g./day Penicillin group ADR (conventional antihistamine) maculopapular rash) dermatitis, Erythema SJS, Erythema multiform,

multifor Anaphylatic shock m SJS Maculopa Penicillin group Anaphylaxis 0.04-0.2 %

penicillin cross Beta-lactam cephalosporin ADR - N/V/D (conventional antihistamine) pseudomembranous colitis) - Clavulanic Acid oxapenam Streptomyces clavuligerus

beta-lactamase amoxicillin Staphylococcus beta-lactamase : H. Influenzae, Gonococci, E. coli Cephalosporin Cephalosporin Classification - 1st generation

: inh g (conventional antihistamine) +) bact. Enterococci, MRSA, S. epidermidis : g (conventional antihistamine) -) bact M. catarrhalis, E. coli, P. mirabilis : Cephalexin, Cefadroxil, Cefazolin - 2nd generation : g (conventional antihistamine) -) bact. : beta-lactamase : Cefaclor, Cefuroxime, Cefprozil, Cefoxitin Cephalosporin

Classification - 3rd generation : inh g (conventional antihistamine) +) bact. : g (conventional antihistamine) -) bact Enterobacteriaceae beta-lactamase : Cefdinir, Cefixime, Ceftibuten, Cefditoren pivoxil, Cefotaxime, Ceftriaxone, Cefoperazole, Ceftazidime - 4th generation : 3rd Gen. :

: Cefpirome, Cefepime Cephalosporin 1st Gen 3rd Gen 4th Gen beta-latamase + +++ ++++

Gram + +++ ++ +++ Gram + +++ +++ Anaerobe ++ ++ P. Aeruginosa ++

++ 2nd Gen + ++ ++ - Cephalosporin MOA : Penicillin

Binding Protein (conventional antihistamine) PBPs) 1. 2. PBPs PBP 3. beta-lactam lactam ring Cephalosporin

1st Generation Cephalosporin : g (conventional antihistamine) +) Enterococci, Staphylococci : g (conventional antihistamine) ) E. coli : Cephalexin (conventional antihistamine) ) Child : 25-100 mg/kg/Day divided every 6-8 hr. Max 4 g./day otitis media : 75-100 mg/kg/Day divided every 6-8 hr. Pharyngitis, skin : 25-50 mg/kg/Day divided every 6-8 hr. Adult : 250-1000 mg every 6 hr. cellulitis : 500 mg every 6 hr. streptococcal Pharyngitis, skin in infection :

500 mg every 6 hr. uncomplicated cystitis : 500 mg every 12 hr (conventional antihistamine) 7-14 Day) Cephalosporin 2nd Generation Cephalosporin : spectrum 1st gen. + H. influenzae : Cefaclor Child : 20-40 mg/kg/Day divided every 812 hr. Max 1 g./day Otitis media : 40 mg/kg/Day divided every 12 hr. Pharyngitis : 20 mg/kg/Day

divided every 12hr. Adult : 250-500 mg every 12 hr. Cephalosporin 3rd Generation Cephalosporin : g (conventional antihistamine) ) Enterobacteriaceae : P. Aeruginosa Staphylococcus spp. : beta-lactamse : Cefixime >> Child : 8 mg/kg/Day divided every 12 hr.

Max 400 mg./day Adult : 400 mg divided every 12 hr. Tx gonorrhoeae : 400 mg. single dose Cephalosporin : 3rd Generation Cephalosporin : Ceftibuten >> Child : 9 mg/kg/Day Max 400 mg./day Adult : 400 mg OD : Cefdinir

Child : skin infection 7 mg/kg/Dose BID Otitis media, pharyngitis, tonsilitis 14 mg. once daily Max 600 g./day for 10 day. Adult : 300 mg BID or 600 mg. OD Cephalosporin : 3rd Generation Cephalosporin

: Cefditoren Child : 200-400 mg/kg BID Adult : Chronic bronchitis, Dental infection 400 mg BID ADR : penicillin Macrolide Macrolide Spectrum : g (conventional antihistamine) +) Streptococcus, Corynebacterium

diptheria, Clostridium perfringen, Actinomyces israelii, Mycobacterium - g (conventional antihistamine) -) N. meningitidis, N. gonorrhoeae, Bordetella pertussin H. influenzae - g (conventional antihistamine) -) g (conventional antihistamine) -) - Mycoplasma pneumoniae MOA : inh. Protein synthesis 70 S 50 S Ribosome translocation tRNA

Macrolide Erythromycin : acid labile estolate salt, ethylsuccinate salt, sterate salt Child : 30-50 mg/kg/day devided 2-4 times Max 2 g/day Adult : 250-500 q 6-12 hr. Max 4 g/day ADR : N/V/D, abdominal discomfort, pseudomembranous colitis D/I : theophylline, CBZ, Warfarin

digoxin Macrolide Roxithromycin : , EENT, , : Child : 2.5-5 mg/kg BID Adult : 150 mg BID ADR : N/V/D, abdominal discomfort, pseudomembranous colitis

Macrolide Clarithromycin : H. influenzae, Mycobacterium avium complex, H. pylori, Toxoplasma gondii, M. catarrhalis, S. aureus : Child : 7.5 mg/kg BID Max 500 mg/day Adult : 150 mg BID : ADR : N/V/D, abdominal discomfort, pseudomembranous colitis

Macrolide Azithromycin : clarithromycin : S. aureus (conventional antihistamine) beta-lactamase), S. epidermidis, Streptococci group N. gonorrhoeae macrolide : Child : 5-12 mg/kg OD for 3 days Max 500 mg/day

Sinusitis, Otitis media : 10 mg/kg OD Pharyngitis, Tonsilitis : 12 mg/kg OD Macrolide Adult : 250 - 500 mg OD for 3 days URI, Otitis media, soft tissue infect : 500 mg OD for 3 days C. trachomatis : 1 g single dose N. gonorrhoeae : 2 g

single dose Fluoroquinolone Fluoroquinolone MOA : inh enzyme 2 DNA gyrase (conventional antihistamine) topoisomerase II) DNA g (conventional antihistamine) -) Topoisomerase IV Daugther DNA g (conventional antihistamine) +) Spectrum :

g (conventional antihistamine) -) Enterobacteriaceae g(conventional antihistamine) -) bacilli E. coli, K. Pneumoniae, Enterobactor, Proteus, H. influenzae, M. cattarrhalis, N. gonorrhoeae P. aeruginosa g(conventional antihistamine) +) Fluoroquinolone Spectrum (conventional antihistamine) ) : g (conventional antihistamine) +) ; Staphylococcus aureus, Streptococcus

spp. g(conventional antihistamine) -) : norfloxacin : : Fluoroquinolone Norfloxacin : :

: Dose : 400 mg BID max 800 mg/day Dysenteric Enterocolitis (conventional antihistamine) shigellosis) : 5 days Travelers Diarrhea : 3 days UTI : uncomplicate 3 days, complicate 7-21 days ADR : GI irritation Ciprofloxacin : Pseudomonas aeruginosa Fluoroquinolone

Ofloxacin Dose : 200-400 mg BID Gonococcal : 400 mg single dose Bronchitis, Skin infection: 400 mg BID 10 days UTI : uncomplicate 200 mg BID 3 days complicate 200 mg BID 7-21 days Traveller diarrhea : 300 mg BID for 3 days Fluoroquinolone

Levofloxacin : g (conventional antihistamine) +) Dose : Skin infection : 500 mg OD Sinusitis : 500 mg OD 10-14 days Bronchitis: 500 mg OD 7 days UTI : uncomplicate 250 mg OD 3 days complicate 250 mg BID 10 days Precaution : (conventional antihistamine) antacid) 60-95% D/I : theophylline ADR : N/V/D, anorexia, , ,

Tetracycline Tetracycline - g (conventional antihistamine) +), g (conventional antihistamine) -), Anaerobe, Rickettsia, Chlamydia, Mycoplasma, Spirochete Protozoa - Doxycycline Tetracycline - URI

- N. gonorrhoeae (conventional antihistamine) 3rd Gen. Cephalosporin ) - H. influenza, Vibrio spp. Tetracycline MOA : Ribosome S 30 : 1.

2. ribosome protection protein ribosome 3. enzyme Tetracycline Tetracycline : P. acne : Child

tooth discoloration, Tissue pigmentation Adult : 250-500 q 6 hr. Tetracycline Doxycycline : - Child : 100-200 mg/Day divided BID Chlamydia infection : 100 mg BID for 7 days - Adult : Bronchitis 100 mg BID for 7 days Gonococcal infection 100 mg BID

for 14 days Urethritis 100 mg BID for 7 days Acne 100 mg BID - D/I : CBZ, Phenyltoin, Barbiturate metabolism Doxycycline Tetracycline ADR : - Anorexia - N/V/D - BUN increase (conventional antihistamine) dose related)

Sulfamethoxazole/ trimetoprim Sulfamethoxazole/ Trimetoprim MOA : competitive inhibitor dihydroptheroate syntase dihydropteric acid intermediate folic acid MOA : inh. Dihydrofolate reductase dihydrofolate tetrahydrofolate

2 bactericidal Sulfamethoxazole = bacteriostatic Sulfamethoxazole + Trimetoprim = bactericidal Pteridine + dihydropter PABA oic acid glutam Dihydropteroa ate

te Dihydrofolic synthase acidNADPH Inh. By Dihydrofolat SULFONA MIDE NADPe reductas Inh. By Tetrahydrof

e TRIMETOP olic acid RIM purine Nucleic acid synthesi s Sulfamethoxazole/ Trimetoprim

: g (conventional antihistamine) +) g (conventional antihistamine) -) S. pyogenes, S. pneumoniae, H. influenza, H. ducreyi, Actinomyces, C. trachomatis E. coli : dose Child Otitis media : TMP 8 mg/kg devided q 12 hr. for 10 days Shigellosis : TMP 8 mg/kg devided q 12 hr. for 5 days UTI : TMP 6-12 mg/kg devided q 12 hr. for 7-14 days

Adult Bronchitis, Skin/Soft tiss. Infect : 800/160 mg q 12 hr 10-14 days Shigellosis, Traveller diarrhea : 800/160 mg q 12 hr 5 days UTI : 800/160 mg q 12 hr complicate 7-10 days uncomplicated 3-5 day Sulfamethoxazole/ Trimetoprim ADR : N/V : hemolytic anemia : SJS

: hepatotoxic, anorexia Clindamycin Clindamycin MOA : inh. Protein synthesis Ribosome 50s : anaerobe : Streptococci group A, S. aureus, S. pneumoniae, B. fragilis, C. perfringens :

: : dose - Child : 8-20 mg/kg divided TQID Adult : 150-450 mg q 6 hr Max 1.8 g/ day : ADR abdominal pain, diarrhea, esophagitis, pseudomembranous colitis, liver function test abnormal Respiratory tract infection viral infection pharyngitis

tonsilitis sinusitis otitis media Viral Infection Viral Infection - - -

- : Pharyngitis Pharyngitis : inflammation caused by an upper respiratory tract infection : Cause - viral : adenovirus, rhinovirus, coronavirus etc.

- bacterial : Strep gr.A, M. catarrhalis, H. influenzae - fungal (conventional antihistamine) rare) : Candida albicans - GERD : Symptoms - fever, chill (conventional antihistamine) maybe) - fatique - cough, sneezing, sore throat - enlarge lymph node in neck Pharyngitis Treatment

- Antihistamine (conventional antihistamine) non sedative vs sedative) - Anticough, mucolytic - Paracetamol or Ibuprofen - Bronchodilator (conventional antihistamine) if hard cough) - Gargle several times per day - Antibiotic in case of Bacterial infection Tonsilitis : inflammation of the tonsils : Cause

- viral : adenovirus, rhinovirus, coronavirus etc. - bacterial : Strep gr.A, M. catarrhalis, H. influenzae : Symptoms - red and swallen tonsils (conventional antihistamine) white or yellow patch on the tonsils) - fever, chill - sore throat, body ache, earache, nasal congestion - swollen lymph node

Tonsilitis : Treatment - Antihistamine (conventional antihistamine) non sedative vs sedative) - Anticough, mucolytic - Paracetamol or Ibuprofen - Bronchodilator (conventional antihistamine) if hard cough) - Gargle several times per day - Antibiotic in case of Bracterial infection - Tonsillectomy (conventional antihistamine) pt. who have infected five or more time per year)

Sinusitis : inflammation of the sinus that occurs with a viral, bacterial or fungi. Sinusitis : Cause - viral : adenovirus, rhinovirus, coronavirus etc. - bacterial : Strep gr.A, M. catarrhalis, H. influenzae

Sinusitis can occur from one of these condition - Cilia in the sinuses dont work properly. - Colds and allergy may cause too much mucus to be block the opening of sinuses - A deviated nasal septum ot nasal polyps may block the opening of sinuses Sinusitis Classification - acute : symptoms last up to 4 weeks - sub-acute : symptoms last 4-12

weeks - chronic : symptoms last 3 months or longer Risk factor allergic rhinitis, cystic fibrosis, day care, change in altitude, smoking, tooth infection, weakended immune system from HIV or chemotherapy Sinusitis Symptoms - Bad breath or loss of smell

- Cough - Fatigue, fever, headache, facial pain, - Nasal congestion and discharge - Sore throat and post nasal drip Sinusitis Treat - Antihistamine (conventional antihistamine) non sedative) - Anticough, mucolytic - Paracetamol or Ibuprofen - Bronchodilator (conventional antihistamine) if hard cough)

- Nasal irrigation - Nasal steroid spray - Antibiotic in case of Bacterial infection Otitis media : inflammation in middle ear or infection. Between tympanic mb. and inner ear (conventional antihistamine) include Eustachian tube) : most often in 16-18 month. : Cause

Eustachian tube are blocked by - respiratory infection - allergy - smoking Otitis media Symptoms : pain : fever : difficult in hearing : dizziness, vertigo

Otitis media Risk factor - Age children 6-36 month Secondhand smoke - Day care - History of allergy Treatment - Antihistamine (conventional antihistamine) non sedative vs sedative) - Anticough, mucolytic - Paracetamol or Ibuprofen - Bronchodilator (conventional antihistamine) if hard cough) - Antibiotic in case of Bacterial infection

G-6-PD G-6-PD : Glucose 6 Phosphate Dyhydrogenase Deficiency acute renal failure 1.

2. 3. Diabetic acidosis 4. NSAIDs, Quinolone, Sulfa, Chloramphenicol

Recently Viewed Presentations

  • Pathway Introduction: Information Technology

    Pathway Introduction: Information Technology

    Asymptotic Analysis : focus on behavior for large values. BigO Limitations. BigO focuses on categories at scale. Results may not hold for small problem sizes. BigO Limitations. BigO focuses on categories at scale. Other terms and constants may matter for...
  • The Second Teacher: Putting Classroom Walls to Work for You

    The Second Teacher: Putting Classroom Walls to Work for You

    www.onevoiceone.wikispaces.com. To access documents - double click on document. ... Posters or classroom displays may not be copied and moved to an alternative testing location which creates an artificial environment and may lead students to believe that they should use...
  • Search: Games & Adversarial Search

    Search: Games & Adversarial Search

    Search: Games & Adversarial Search Artificial Intelligence CMSC 25000 January 28, 2003
  • Liens arien-souterrain S. Barot IRD, UMR 137 http://millsonia.free.fr/

    Liens arien-souterrain S. Barot IRD, UMR 137 http://millsonia.free.fr/

    (bactérie) Effet de l'augmentation de la production végétale Difficile d'interpréter les changements de la nématofaune ESOL, Aérien-souterrain, Barot Critique de l'expérience Pas de vrai répétition Pseudoréplication Manipulation simultanée de nombreux facteurs Ressource Habitat Tous le réseaux d'interaction Difficulté d ...
  • Nuclear Proliferation - The Hay

    Nuclear Proliferation - The Hay

    The bombs codenamed "fat man" and " little boy." Arms Race This would start the nuclear arms race as, Russia would detonate a bomb in 1949 and U.K. in 1952, France in 1960 and China in 1964. Other players such...
  • Sun, Earth and Moon

    Sun, Earth and Moon

    Topography of the Moon. Lab Tomorrow! Set up Today! Read the Impact Crater Procedure. You need to read the front and back so that you know what you and your lab group are doing tomorrow! If you don't pre-read, you...
  • Understanding political disenchantment in contemporary democracies Gerry Stoker,

    Understanding political disenchantment in contemporary democracies Gerry Stoker,

    Political leaders are drawn from an increasingly small pool, often lack a broader life experience. The declining social base of political elites in turn rests on the weak and declining membership and active capacity of political parties. Politics offered more...
  • Cards 104-107 II PETER FORETELLS OF S R

    Cards 104-107 II PETER FORETELLS OF S R

    Cards 104-107. II PETER FORETELLS OF. FALSE TEACHERS. END OF WORLD. II Peter is a very important book for the twenty first century because it deals with the very issues confronting the modern church; laxity of lifestyle based on false...