OSCE Guide
SUMMARY
Disease/Symptoms
1. Digestive symptoms
2. Urinary symptoms
3. Type 2 diabetes
4. Ulcer
5. Ischemic heart attack
6. hyperacidity
7. Diarrhea (causes and management)
8. Constipation (check for lifestyle)
9. Acne vulgaris
10. Severe sore throat
11. Dry cough
12. Headache (types of headache)
13. Hypercholesterolemia
14. Nasal symptoms (chronic, recurrent?)
15. URTI
16. Triggers for nasal symptoms
17. osteoporosis
18. Menopausal symptoms
19. Depression
20. Deep vein thrombosis
Drugs/Medications
1. Metformin
2. Plavix (clopidogrel)
3. Hypertensive medication
4. Antibiotics
5. Multivitamins with iron
6. Antihypertensive for pregnant
7. Multiple diuretics
8. Amoxicillin 500mg
9. Classes of laxatives
10. Benzoyl peroxide
11. Carbimazole 20mg
12. Lozenge for sore throat
13. Paracetamol
14. ACE-inhibitor side effects
15. Ramipril
16. HCTZ 20mg/25mg
17. Simvastatin 40mg
18. Non pharmacologic treatment for
constipation
19. Alendronate (how? Side effects)
20. ACE inhibitor side effects
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Stress tabs
Evening primrose
Escitalopram
Morphine (addiction effect)
MX3
Losartan + Amlodipine
Amlodipine
Propranolol
Warfarin (correct dose and frequency
per age, time of day to take warfarin,
missed dose?
Warfarin (emergency advice, target
INR, serious side effects)
Salbutamol inhaler
Seretide diskus inhaler
Turbuhaler
Augmentin oral syringe (check for
allergic rxn
Ear drops Betnesol
Cosopt eye drops
Adult suppository
Faktu supp
Nasonex nasal spray
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OSCE Guide
DISEASE / SYMPTOMS
1. Digestive symptoms
Digestive symptoms
Usual Causes
infection ; inflammation; drug; pregnancy; motion sickness; ate unsterile food
Manifestation of the
Disease / Symptoms
Types of Digestive symptoms:
a. Indigestion: upper abdominal discomfort which may be brought on by excess food, alcohol or medication (aspirin)
Consult doctor if:
● Child
● Age over 45 (if symptoms are 1st time)
● Symptoms more than 5 days
● Blood in vomit/stool
b. Heartburn: acid taste in the mouth; burning discomfort felt in stomach passing upwards; common in px above 55 yrs old
Consult doctor if:
● Child
● Heartburn more than 1 wk
● Took antacids before, but still failed to respond
● Difficulty in swallowing
c. Nausea/vomiting
d. Diarrhea
e. Constipation
f. Dysmenorrhea
Recommended
Treatment / Drugs
a. Indigestion
● Aluminum OH, Mg OH, Simethicone (kremil-S)- OTC
● Sodium alginate NaHCO3+CaCO3 (Gaviscon)- OTC
b. Heartburn
● Aluminum OH, Mg OH, Simethicone (kremil-S)- OTC
● Sodium alginate NaHCO3+CaCO3 (Gaviscon)- OTC
● Famotidine, CaCO3, MgOH (Kremil-S advance)-OTC
c. N/V
● Meclizine (Bonamine)- OTC
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OSCE Guide
d. Diarrhea
● Loperamide (Diatabs)- OTC
e. Constipation
● Bisacodyl (Dulcolax)- OTC
f. Dysmenorrhea
● Hyoscine butylbromide (buscopan)-OTC
● Ibuprofen- OTC
● paracetamol -OTC
Dosage of the Drug
Indigestion
kremil-S Tablet
● adult : Take 1-2 tabs. After meals and at bedtime
Sodium alginate + NaHCO3+CaCO3 (Gaviscon)
● Oral suspension: Take 10-20 mL (2-4 5 mL spoonfuls) BID
● Chewable tablet: Take 2-4 tabs/d. Every 6-12 hrs
Heartburn
kremil-S Tablet
● adult : Take 1-2 tabs. After meals and at bedtime
Sodium alginate + NaHCO3+CaCO3 (Gaviscon)
● Oral suspension: Take 10-20 mL (2-4 5 mL spoonfuls) BID
● Chewable tablet: Take 2-4 tabs/d. Every 6-12 hrs
● kremil-S Advance
● Adults and children 12yrs older: take 1 tab. Prn. Max: 2 tabs/d
Nausea/vomiting
Meclizine (bonamine)
● Adult: 25-50mg every 6-4 hrs.
● Child: 2-6 yrs: 6.25 mg once daily
Diarrhea
Loperamide (imodium)
● Adult & children >12 yr: initially 2 caps.
Constipation
Bisacodyl (Dulcolax)
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OSCE Guide
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Adult: 5-10mg once. Max. 20mg
Child >4-10yrs: 5mg once daily
Direction of Use
May be taken with/ without food
Side Effects
Bronchospasms; constipation; abdominal pain; ulcer if overdose ibuprofen; hepatotoxicity; urinary retention
Contraindication
Antacids reduce the absorption of (tetracyclines, azithromax, ciproflox.,etc)
kremil-S tab: Kidney Dx, constipated; NSAIDs
Ibuprofen: antacids, anticoagulants, alcohol
Important
Counselling Notes
a. Indigestion
● Always ask the symptoms
● Always ask to whom the medication is for and ask the age
● If child; do not dispense
● Advise patient to avoid SMOKING; ALCOHOL; CAFFEINE; CHOCOLATE and FATTY meals because it aggravate
symptoms of stomach discomfort
b. Heartburn
● Always ask the symptoms
● Always ask to whom the medication is for and ask the age
● If child; do not dispense
● If patient is obese, advise weight reduction
● Advise to eat small, frequent meals
● Advise to sit up straight and maintain proper posture
● Advise to avoid tight clothing
c. Nausea/vomiting
d. Diarrhea
● Advise to drink fluids after pooping, to keep the electrolytes
e. Constipation
● Advice to eat more fibre foods (avocados, nuts, potatoes, etc.)
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OSCE Guide
2. Urinary symptoms
Urinary symptoms
Usual Causes
Unhygienic urinary practices, Sexual activity, Age, Sex (Common in Females)
Manifestation of the
Disease / Symptoms
Types of Urinary symptoms
a. UTI
Most common symptoms
● Burning sensation when urinating
● Frequent urination
● Fever and chills
● Pain/ pressure in the back/ lower abdomen
Uncommon symptoms
● Blood in urine
● Pus in urine
● Inflammation of the bladder
Recommended
Treatment / Drugs
a. UTI
Kidney (pyelonephritis)
● Sulfamethoxazole &/ trimethoprim (Bactrim)- RX
● Ciprofloxacin (Cipro)- RX
● levoflox. ( levaquin)- RX
Bladder (Cystitis)
● Phenazopyridine (Pyridium)- RX
Dosage of the Drug
a. UTI
Kidney (pyelonephritis)
Ciprofloxacin (Cipro)
● Adult: Patients with uncomplicated cases: 500mg (IR) BID (7days)
● Patients with complicated cases: 500-750mg BID at least 10-21 days if required
● Child: Patients with complicated cases: 10-20mg/kg. Max: 750mg/dose BID for 10-21 dyas. Max: 750mg/dose
Levofloxacin
● Adult: 500mg once daily (7-10 days)
Bladder (Cystitis)
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OSCE Guide
Phenazopyridine (Pyridium)
● Adult: 190-200mg orally TID
Direction of Use
May be taken with/without food
Side Effects
Stomach pain; hypotension; vertigo; headache; nausea; vomiting
Contraindication
Doxazosin mesylate (alfadil XL); allergy to doxazosin or quinazolines
Important
Counselling Notes
a. UTI
Kidney (pyelonephritis)
Ciprofloxacin (Cipro) and Levofloxacin
● Taken with food to minimize GI discomfort
● Avoid antacids; Fe supplements and dairy products
● Avoid UV exposure
● Store below 25C
● Discard antibiotics after use
Bladder (Cystitis)
Phenazopyridine (Pyridium)
● Take after meal
● Take with a full glass of H2O
3. Type 2 diabetes
Type 2 Diabetes Mellitus
Usual Causes
Being overweight/Obese; Inactivity; Family history; Age; Prediabetes; PCOS; HTN
Manifestation of
the Disease /
Symptoms
Increased urination (polyuria); increased thirst (polydipsia); increased hunger (polyphagia); fatigue; blurred vision; pain/tingling
in hands and feet/ numbness; slow- healing sores; unintended weight loss; areas of darkened skin usually armpits and neck
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OSCE Guide
Recommended
Treatment / Drugs
Dosage of the
Drug
*All are prescription drugs *It also combination/triple drugs depends on the prescriber
Metformin: for initial drug of choice to lower the blood glucose levels and improve body responds to insulin
Sulfonylureas: Oral medications that help your body make more insulin
Meglitinides: Fast-acting, short duration medications that stimulate the pancreas to release more insulin
Thiazolidinediones: make your body more sensitive to insulin
Dipeptidyl peptidase 4 inhibitors: milder medication that help to reduce blood glucose levels
GLP1 receptor agonist: Slow digestion and improve blood glucose levels
SGLT2 inhibitors: help to prevent the kidneys from reabsorbing glucose into blood and sending it out in your urine
Metformin (alone)
● Adult: 500mg BID taken with the morning and evening meals. Maximum: usually not more than 2550mg per day
● Children 10- 16 yrs age: 500mg BID taken with the morning and evening meals. Maximum: usually not more than
2000mg per day
Sulfonylureas
Chlorpropamide:
● Adult: 250mg daily as single dose in morning (5-7 days after treatment initiation). Maintenance: 100-500mg daily
● Elderly: 100-125 mg daily (5-7 days after treatment initiation).
Meglitinides
Repaglinide
● Adult: Combination with metformin, initially 0.5mg. Patient transfer from another hypoglycemic agent, initial 1mg. All doses
taken 30 mins. Before each main meal. Max. 16mg daily
Thiazolidinediones
Pioglitazone
● Adult: 15/ 30mg once daily. Max: 45 mg/day
DDP4 inhib
Vildagliptin
● Adult: 50mg BID
SGLT2
Dapagliflozin
● Adult: monotherapy/combination therap: 10mg once daily/ +metformin 500mg once daily. Heart failure: 10mg once daily
Direction of Use
May be taken with or without food
Side Effects
Hypoglycaemia; weight gain; GIT disturbance; lactic acidosis and fluid retention
Contraindication
T1DM; diabetic ketoacidosis; severe hepatic impairment; severe heart failure; hypersensitivity (Forxiga)
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OSCE Guide
Important
Counselling Notes
Pioglitazone: adequate contraception is recommended in premenopausal anovulatory women that cause resumption of ovulation
Chlorpropamide: adhere strict;y to prescribed diabetic diet
Repaglinide: It caused dizziness due to hypoglycemia
SPECIAL PRECAUTIONS
Metformin: Px w/ risk fac. For lactic acidosis; stable heart failure; renal impairment; pregnancy and lactation
Chlorpropamide: patient w/ condition associated w/ fluid retention. Pregnancy and lactation. Hypersensitivity
Repaglinide: Hepatic and severe renal impairment. Pregnancy and lactation
Pioglitazone: symptomatic and CHF. Pregnancy and lactation
Vildagliptin: Px w/ cardiac failure; hepatic impairment; history acute pancreatitis
Forxiga: severe renal impairments. 2nd and 3rd trimester of pregnancy and lactation
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Ask the patient about the symptoms that he/she experienced (refer to the symptoms above).
Ask how many days already.
Ask if the patient is taking meds for his/her condition.
Ask for past medications and other conditions that may endure by the patient.
Recommend a drug (choose on the drugs above)
Provide information about the drug (see above info)
Recommend the patient to have a healthy lifestyle and if symptoms still persist, suggest to consult the doctor.
4. Ulcer
Ulcer
Types of Ulcers
Most common: Peptic Ulcer
● gastric ulcers, or ulcers that develop in the stomach lining
● esophageal ulcers, or ulcers that develop in the esophagus
● duodenal ulcers, or ulcers that develop in the duodenum (small intestine)
Not common:
● Arterial ulcer (Open sores that primarily develop on the outer side of your ankle, feet, toes, and heels. Develop from damage
to the arteries due to lack of blood flow to tissue)
● Venous ulcer (open wounds often forming on your leg, below your knee and on the inner area of your ankle. They typically
develop from damage to your veins caused by insufficient blood flow back to your heart.)
● Mouth ulcer (small sores or lesions that develop in your mouth or the base of your gums.)
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OSCE Guide
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Usual Causes
Manifestation of
the Disease /
Symptoms
Recommended
Treatment / Drugs
Genital ulcer (sores that develop on genital areas, including the penis, vagina, anus or surrounding areas. Caused by
Sexually transmitted infections)
PEPTIC ULCER
● Heliocobacter pylori (H. pylori)
● Acids from the foods we eat can make the pain and discomfort worse.
● Long-term use of aspirin or anti-inflammatory medicines (ibuprofen)
● Stress and spicy foods
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burning sensation or pain in the middle of your abdomen between your chest and belly button
Nausea
Bloating
Lack of appetite
Heartburn
If H. pylori is found in your digestive tract, the doctor may recommend antibiotics, such as:
● Amoxicillin (Amoxil)
● Clarithromycin (Biaxin)
● Metronidazole (Flagyl)
● Tinidazole (Tindamax)
● Tetracycline
● Levofloxacin
Medications that block acid production and promote healing:
● omeprazole (Prilosec)
● lansoprazole (Prevacid)
● rabeprazole (Aciphex)
● esomeprazole (Nexium)
● pantoprazole (Protonix).
Medications to reduce acid production: H2 BLOCKERS
● famotidine (Pepcid AC)
● cimetidine (Tagamet HB)
● nizatidine (Axid AR)
Medications that neutralize existing stomach acid and can provide rapid pain relief: Antacids
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OSCE Guide
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AlternaGEL,
Amphojel,
Nephrox
Medications that protect the lining of your stomach and small intestine:
● sucralfate (Carafate)
● misoprostol (Cytotec).
Dosage of the Drug
PPI: Omeprazole
Duodenal Ulcer: 20 mg everyday for 4-8 weeks
H. pylori infection:
● PPI: 20 mg PO q12hr for 10 days
● Amoxicillin: 1000 mg PO q12hr
● Clarithromycin: 500 mg PO q12hr for 10-14 days
Gastric Ulcer: 40 mg PO qDay for 4-8 weeks
GERD: 20 mg PO qDay for 4 weeks
Direction of Use
Taken orally. If taken once a day, it should be taken 30 - 60 mins before breakfast. If taken twice a day, it should be taken 30-60 mins
before dinner. Taking the PPI before you eat stops extra acid from being made.
Side Effects
Headache, Diarrhea, Constipation, Flatulence, Nausea, Rash
Contraindication
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Contraindicated in patients who have shown hypersensitivity.
Patients taking medications for HIV
Antifungal medications (ketoconazole) - it can interfere with the absorption and reduce effectiveness
Drugs to treat moods (citalopram, imipramine and clomipramine) - increase the blood levels of citalopram and increase the
risk of certain side effects, including an irregular heart rhythm
Drugs to treat seizures (phenytoin) - may increase phenytoin levels
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OSCE Guide
Important
Counselling Notes
Tell patients that lifestyle changes can help, too. They might need to:
● Quit smoking.
● Drink less alcohol or caffeine.
● Stay away from foods that make your symptoms worse.
Avoid taking together with clopidogrel (omeprazole reduce the effects of clopidogrel by blocking its conversion to its active form)
Omeprazole can reduce the breakdown of drugs (diazepam, warfarin and phenytoin) by the liver and lead to an increase in their
concentration in the blood.
5. Ischemic heart attack
Ischemic Heart Attack
Usual Causes
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Decrease in blood flow through one or more of the blood vessels that carry oxygen to your heart (When blood flow is
reduced, the heart muscle does not receive the amount of oxygen it needs to function properly.)
Occurs more frequently in people with atherosclerosis, blood clots, coronary artery spasm, or severe illnesses that increase
the heart’s need for oxygen.
RISK FACTORS:
● Diabetes
● Family history of heart disease
● High blood cholesterol
● High blood pressure
● High blood triglycerides
● Obesity
● Physical inactivity
● Smoking and other tobacco use
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OSCE Guide
Manifestation of
the Disease /
Symptoms
Recommended
Treatment / Drugs
Dosage of the Drug
Most common: Chest pain, typically on the left side
Other signs & symptoms more commonly experienced by women, older people and people with diabetes:
● Neck or jaw pain
● Shoulder or arm pain
● A fast heartbeat
● Shortness of breath when you are physically active
● Nausea and vomiting
● Sweating
● Fatigue
Silent Ischemia: NO SIGNS & SYMPTOMS
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Angiotensin-converting enzyme (ACE) inhibitors, which relax the blood vessels and lower blood pressure
Angiotensin receptor blockers (ARBs), which lower blood pressure
Anti-ischemic agents such as ranolazine (Ranexa)
Antiplatelet drugs, which prevent the formation of blood clots
Beta-blockers, which lower the heart rate
Calcium channel blockers, which reduce workload on the heart muscle
Nitrates, which dilate the blood vessels
Statins, which lower cholesterol
DRUGS ON THE LIST (OSCE guidelines)
● Plavix: 75 mg PO qDay
● Ramipril: Initial: 2.5 mg PO qDay for 1 week, THEN 5 mg qDay for 3 weeks and then increase as tolerated, to a
maintenance dose of 10 mg once daily.
● Simvastatin 40 mg: 5-40 mg PO qDay in the evening
● Amlodipine: Adult dosage:
Starting dose - 5 mg PO once a day
Maximum dose - 10 mg PO once a day
● Propranolol: 80 mg PO q6-12 hr
● Warfarin: Individualized according to px INR
○ Initial dose: 2-5 mg once daily
○ Maintenance dose: 2-10 mg once daily
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OSCE Guide
Direction of Use
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Taken orally.
Indication determines intensity and duration of therapy
Individualized doses and monitoring of PT/INR are necessary
Dose and medications depend on the individual's condition. Follow your treatment plan for ischemic heart disease precisely
and to take all of the medications as instructed.
Side Effects
Nausea, headache, hypotension, dizziness, severe bleeding, edema, insomnia, swelling
Contraindication
Reversible obstructive lung disease, liver and renal disease, bleeding disorders, pregnancy
Important
Counselling Notes
The same lifestyle habits that can help treat myocardial ischemia can also help prevent it from developing in the first place. Leading
a heart-healthy lifestyle can help keep your arteries strong, elastic and smooth, and allow for maximum blood flow.
In addition to following your treatment plan, you may be able to improve your ischemic heart disease by:
● Carefully managing your diabetes, if applicable
● Getting regular physical activity
● Keeping your cholesterol at a healthy level
● Maintaining normal blood pressure
● Quitting tobacco use
● Reducing cholesterol and fat in your diet
6. Hyperacidity
HYPERACIDITY
Usual Causes
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Poor eating habits
Stress and anxiety
Eating a lot of spicy, fried and junk foods
Excessive consumption of caffeinated beverages, like coffee or tea
Physical inactivity
Going to bed soon after having food
Smoking and alcohol abuse
Continued usage of certain medications
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OSCE Guide
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Other conditions that may cause include pregnancy, obesity, ageing, and fasting
Manifestation of the
Disease / Symptoms
Heartburn, Bitter or sour belching, Nausea and vomiting, Throat irritation, Abdominal distention, Aversion towards food, Mild chest
pain, Flatulence, Poor Appetite, Tiredness
Recommended
Treatment / Drugs
Antacids-OTC
● Kremil-S
● Gaviscon
H2 Receptor Antagonists + Antacid-OTC
● Kremil-S Advance
Dosage of the Drug
Antacids-OTC
● Kremil-S
178mg/233mg/30mg
● Gaviscon
H2 Receptor Antagonists + Antacid-OTC
● Kremil-S Advance
10mg/800/165 mg
Direction of Use
Antacids
● Kremil-S
1-2 tablets to be taken 1 hr after meal and at bedtime, chew the tablet
● Gaviscon (suspension)
10-20 ml to be taken 1 hr after meal and at bedtime
If px is taking other medication, have a 2 hour-gap
H2 Receptor Antagonists + Antacid
● Kremil-S Advance
1 tablet to be taken 1 hr after meal, chew the tablet
Side Effects
Antacids
● Kremil-S: Nausea, vomiting
● Gaviscon: Nausea, vomiting, stomach pain, diarrhea
H2 Receptor Antagonists + Antacid
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OSCE Guide
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Contraindication
Important
Counselling Notes
Kremil-S Advance: Nausea, vomiting, headache, dizziness
Px with hypersensitivity to any ingredient of the product.
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Ask the patient about the symptoms that he/she experienced (refer to the symptoms above).
Ask how many days already.
Ask if the patient is taking meds for his/her condition.
Ask for past medications and other conditions that may endure by the patient.
Recommend a drug (choose on the drugs above)
Provide information about the drug (see above info)
Recommend the patient to have a healthy lifestyle and if symptoms still persist, suggest to consult the doctor.
7. Diarrhea
DIARRHEA
Usual Causes
Manifestation of the
Disease / Symptoms
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Infection by bacteria
Inflammatory Bowel Disease (Crohn’s dx)
Eating foods that upset the digestive system
Allergies and intolerances to certain foods (Celiac disease or lactose intolerance)
Medications
Malabsorption of food (poor absorption)
Loose, watery stools, Abdominal cramps, Abdominal pain, Fever, Blood in the stool, Mucus in the stool, Bloating, Nausea, Urgent
need to have a bowel movement
Recommended
Treatment / Drugs
Anti-diarrheal
● Loperamide (Diatabs)-OTC
Dosage of the Drug
Adult: Initial is 4 mg or 2 capsules followed by 2 mg or 1 tablet every loose stool for 2 days
Child >12 years old: same with adult
Direction of Use
Initial is 4 mg or 2 capsules followed by 2 mg or 1 tablet every loose stool may be taken with or without food for 2 days
Side Effects
Nausea, vomiting, dizziness, constipation
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OSCE Guide
Contraindication
Important Counselling
Notes
Px with hypersensitivity to any ingredient of the product.
Px with Inflammatory Bowel Disease (must consulted to the doctor)
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Ask the patient about the symptoms that he/she experienced (refer to the symptoms above).
Ask how many days already.
Ask if the patient is taking meds for his/her condition.
Ask for past medications and other conditions that may endure by the patient.
Recommend a drug (choose on the drugs above)
Provide information about the drug (see above info)
Caution: It should be used with caution in patients with hepatic dysfunction and in patients with dysentery or if constipation must be
avoided. Pregnancy and lactation.
Recommend the patient to have a healthy lifestyle such as eating well-cooked foods, avoiding caffeine/beverages and if symptoms
still persist or bloody diarrhea occurs, suggest to consult the doctor. Also, tell the px to drink plenty of water to avoid dehydration.
8. Constipation
CONSTIPATION
Usual Causes
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Physical inactivity
Lack of fiber in the diet
Not drinking enough water
Changes in your regular routine, such as traveling or eating or going to bed at different times
Some medications (sedatives, opioid pain medications, some antidepressants or medications to lower blood pressure)
Risk factors (Age and stress)
Manifestation of the
Disease / Symptoms
Difficulty passing stool, straining when passing stool, passing less stool than usual, and lumpy, dry, or hard stool
Recommended
Treatment / Drugs
Bulk laxative-OTC
● Psyllium (C-lium fiber)
Osmotic laxative-OTC
● Polyethylene glycol (Miralax)
Stimulant laxative-OTC
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OSCE Guide
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Dosage of the Drug
Bisacodyl (Dulcolax)
Bulk laxative
● Psyllium (C-lium fiber):
Oral powder: 5 g (1 sachet) dissolved in 1 glass of water
Capsule: 500 mg (1 capsule)
Osmotic laxative
● Polyethylene glycol (Miralax)
Oral powder: 17 g (1 sachet) in 1 glass of water
Stimulant laxative
● Bisacodyl (Dulcolax): 5 mg capsule
Direction of Use
Bulk laxative
● Psyllium (C-lium fiber)
Oral powder: 5 g (1 sachet) dissolved in 1 glass of water, once a day, 1 hr after meal
Capsule: 500 mg (1 capsule), 3 times a day, 1 hr after every meal
Osmotic laxative
● Polyethylene glycol (Miralax)
Oral powder: 17 g (1 sachet) in 1 glass of water, once a day, 1 hr after meal
Stimulant laxative
● Bisacodyl (Dulcolax)
5 mg (1 capsule), once a day at bedtime
Side Effects
Bulk laxative
● Psyllium (C-lium fiber): Nausea, vomiting, stomach pain, flatulence
Osmotic laxative
● Polyethylene glycol (Miralax): Nausea, vomiting, stomach pain, flatulence, bloating
Stimulant laxative-OTC
● Bisacodyl: Nausea, vomiting, stomach pain, excessive diarrhea
Contraindication
Px with hypersensitivity to any ingredient of the product.
Px with appendicitis and inflamed bowel, CVD
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OSCE Guide
Px with high calcium and potassium levels in the body.
Important Counselling
Notes
●
●
●
●
●
●
Ask the patient about the symptoms that he/she experienced (refer to the symptoms above).
Ask how many days already.
Ask if the patient is taking meds for his/her condition.
Ask for past medications and other conditions that may endure by the patient.
Recommend a drug (choose on the drugs above)
Provide information about the drug (see above info)
➔ Start the px with bulk laxative and if symptoms still persist, give osmotic laxative, if still not, give stimulant laxative
➔ If symptoms still persist after taking stimulant laxative, consult the doctor
Recommend the patient to have a healthy lifestyle such as drinking plenty of water, eating foods rich in fiber, exercising regularly, and
avoiding too much stress.
9. Acne vulgaris
ACNE VULGARIS
Usual Causes
a skin condition that occurs when hair follicles are blocked with dead skin cells, bacteria, and oil (sebum). The blocked follicles cause
blemishes on the skin, including pimples, blackheads, whiteheads, and cysts.
Causes:
● Excess oil (sebum) production
● Hair follicles clogged by oil and dead skin cells
● Inflammation
● Bacteria
Manifestation of the
Disease / Symptoms
●
●
●
●
●
●
Whiteheads
Blackheads
Small red, tender bumps
Pimples, which are papules with pus at their tips
Large, solid, painful lumps under the skin
Painful, pus-filled lumps under the skin
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OSCE Guide
Recommended
Treatment / Drugs
Benzoyl Peroxide
Dosage of the Drug
Acne treatment gel
Benzoyl peroxide 2.5%, 5%, 10%
Direction of Use
How to use Benzoyl Peroxide:
1. Wash your face with a fragrance-free cleanser.
2. Apply benzoyl peroxide in the areas where acne can appear.
3. Leave it on for 2 hours
4. Then rinse your face with lukewarm water.
5. Pat gently on your face with a clean towel.
6. Put on a non-oily moisturizer.
Treatments can take up to three months to work.
Side Effects
Tolerable irritation during the first few days of use, skin dryness, peeling
Contraindication
Do not use benzoyl peroxide with any other medicines that may have drying or irritating effects on your skin. These include
alcohol-based skincare products.
Important Counselling Ask the patient about the symptoms that he/she experienced (refer to the symptoms above).
Notes
● Ask how many days already.
● Ask if the patient is taking meds for his/her condition.
● Ask for past medications and other conditions that may endure by the patient.
● Recommend a drug (choose on the drugs above)
● Provide information about the drug (see above info)
Avoid contact with eyes, eyelids, mouth, lips, and other mucous membranes, or broken skin.
Avoid prolonged exposure to sunlight or UV radiation; use sunscreen and wear protective clothing.
May bleach hair and coloured fabrics; avoid contact with hair, clothing, furniture or carpeting.
Recommend the patient to have a healthy lifestyle, wash face twice daily, refrain from harsh scrubbing, refrain from popping or
picking at pimples, avoid eating oily foods and reduce stress. If symptoms still persist, suggest consulting the dermatologist.
10. Severe Sore throat
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OSCE Guide
SEVERE SORE THROAT
Usual Causes
●
Viral infection such as cold and flu
Manifestation of the
Disease / Symptoms
● Pain or a scratchy sensation in the throat
● Pain that worsens with swallowing or talking
● Difficulty swallowing
● Sore, swollen glands in your neck or jaw
● Swollen, red tonsils
● White patches or pus on your tonsils
● A hoarse or muffled voice
Other symptoms: Fever, Cough, Runny nose, Sneezing, Body aches, Headache, Nausea or vomiting
Recommended
Treatment / Drugs
Acetaminophen
Ibuprofen
Flurbiprofen (Strepsil MaxPro)
Hexetidine (Bactidol)
Dosage of the Drug
Acetaminophen (500mg)
Ibuprofen (200 mg)
Flurbiprofen (Strepsil MaxPro)-(8.75mg)
Hexetidine (Bactidol)-0.1% solution-60 ml bottle
Direction of Use
Acetaminophen (500mg)
● 1 tablet (500mg), 6 times a day every 4 hours with food
Ibuprofen (200 mg)
● 1 tablet (200mg), 4 times a day every 6 hours with food
Flurbiprofen (Strepsil MaxPro)-(8.75mg)
● 1 lozenge, 3-4 times a day every 6-8 hours with or without food, allow to dissolve in your mouth
Hexetidine (Bactidol)
● 20 ml should be swished and gargled for 30 seconds, twice a day, morning and evening. Expel the liquid. Do not swallow.
Side Effects
Acetaminophen (500mg): Nausea, stomach pain, headache
Ibuprofen (200 mg): Nausea, vomiting, dizziness, headache, anemia, bleeding
Flurbiprofen (Strepsil MaxPro)-(8.75mg): Rash, stomach pain, oral discomfort
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OSCE Guide
Hexetidine (Bactidol)-0.1% solution: Nausea, vomiting, dizziness, headache
Contraindication
Acetaminophen (500mg)
● hypersensitivity to acetaminophen, severe hepatic impairment, or severe active hepatic disease
Ibuprofen (200 mg)
● hypersensitivity to ibuprofen, aspirin and other NSAIDs
● Px with active gastrointestinal bleeding or peptic ulceration, asthma, CVD
Flurbiprofen (Strepsil MaxPro)-(8.75mg)
● hypersensitivity to any of the ingredients
Hexetidine (Bactidol)-0.1% solution:
● Px with hypersensitivity to any ingredient of the product.
Important Counselling
Notes
Caution:
Acetaminophen
● not take more than one product that contains acetaminophen at a time
● tell your doctor if you have or have ever had liver disease
Ibuprofen
● pregnant women and lactating women
● patients with previous history of gastrointestinal haemorrhage or ulcers; asthma, heart attacks
Strepsils
● pregnant women and lactating women
Hexetidine (Bactidol)
● Supervise children ages 6-12 years when using Bactidol.
● Do not administer to children <6 years unless directed by a doctor.
Ask the patient about the symptoms that he/she experienced (refer to the symptoms above).
Ask how many days already.
Ask if the patient is taking meds for his/her condition.
Ask for past medications and other conditions that may endure by the patient.
Recommend a drug (choose on the drugs above)
Provide information about the drug (see above info)
Recommend the patient to practice good hygiene, get plenty of sleep, reduce stress, and avoid irritants. If symptoms still persist after
3 days, consult the doctor.
11. Dry cough
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OSCE Guide
Dry Cough
Usual Causes
Common colds, bronchospasms from irritationsAllergies, inflammations, trauma, airways obstruction, asthma, smoke, and dusts and
ACEIs
Manifestation of the
Disease / Symptoms
A dry or tickly cough,with no phlegm or mucus, Common Symptoms occur along with dry cough:
● Flu-like symptoms: fatigue, fever, sore throat, headache and pain, Hoarse voice, Nausea, Runny nose (nasal congestion),
Vomiting and Wheezing
In Px with Anti Hypertensive tx: ACEIs
Recommended
Treatment / Drugs
OTC-Dextromethorphan HBr
OTC- Butamirate (Sinecod Forte)
OTC- Strepsils Dry Cough (Dextromethorphan)- Lozenge
OTC- Tuseran Forte
Dosage of the Drug
Dextromethorphan HBr
For cough Suppressant: Non Productive cough
Conventional Preparation: Adult and Children >12 yrs old
● 10-20 mg every 4 hours
● 30 mg every 6-8 hours
Extended release preparation:Adult and Children >12 yrs old
● 60 mg every 12 hours
● Max dose 120 mg daily
Lozenge: Children aged >12 years old, adults and elderly
● 1 lozenge every 2-3 hours or as needed
● MAximum of 12 lozenge daily
Strepsils Dry cough Children aged >12 years old, adults and elderly
● 2 lozenge every 4 hours. Max daily: 12 lozenges in 24 hours
Butamirate Citrate(SInecod Forte)
For cough Suppressant: Non Productive cough
● :Syrup:
○ Children 3 to 6 years old: 1 tsp (5 ml) 3 times daily.(every 8 hours)
■ Max daily dose: 15ml (22.5 mg).
○ Children 6 to 12 years old: 2 tsp (10 ml) 3 times daily. (every 8 hours)
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OSCE Guide
■ Max daily dose:30 ml (45 mg)
Adolescent over 12 years old: 1 tbsp (15 ml) 3 times daily. (every 8 hours)
■ Max daily dose: 45 ml (67.5 mg)
○ Adult: 1 tbsp (15 ml) 4 times daily. (every 6 hours)
■ Max daily dose: 60 ml (90 mg)
Tablet: as 50 mg sustained-released film- coated
○ :Adolescent over 12 years old: 1 tab twice daily. Every 12 hours
■ Max daily dose: 2 tablets (1oo mg)
○ Adult: 1 tab 3 times daily. Every 8 hours
■ Max daily dose: 3 tablets (150 mg)
○
●
Dextromethorphan Hbr, Phenylpropanolamine HCl, Paracetamol (Tuseran Forte)
For dry cough with clogged nose, post nasal drip, fever and pain associated with common cold.
● Capsule :
○ Adult and children >12 yrs old: 1 Cap every 6 hours or as recommended by doctor
Direction of Use
Side Effects
Contraindication
Dextromethorphan
● Maybe taken with or without food.
● In Lozenge: PLace lozenge on mouth, and allow it to dissolve, Do not chew, crush or swallow
Butamirate Citrate: (Sinecod Forte)
● Maybe taken with or without food
● Tabel: To be swallowed whole. Do no crush, or chew
Strepsils Dry cough
● Dissolve 2 lozenges in the mouth one after the other. Do not chew ,or swallow
●
●
Dextromethorphan HBr, Butamirate: Drowsiness and somnolence, dizziness
Tuseran Forte: Sudden, Severe headache.
Dextromethorphan: CI to px with:
● Asthma, History of drug abuse, Children <12 years old, Pregnancy and lactation
Butamirate: CI to px with:
● Children 12 years old and below- it contains alcohol, Concomitant use of expectorant
● Special precaution to px: renal and hepatic impairment, pregnancy and lactation
Tuseran Forte: CI to px with
● High BP and severe heart disease, KIdney and liver disease, pregnancy and Lactation
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OSCE Guide
Important Counselling
Notes
Questions for diagnosing the cause of a dry cough:
● How long have you had the cough?
● Are you coughing up anything (including blood)?
● Are you breathing through your mouth (instead of your nose)?
● Is the cough keeping you up at night?
● Do you have a fever?
●
●
●
●
●
Recommendation to px with dry cough due to ACEIs
○ Ask the physician to have the medication replaced if not comfortable to dry cough.
Do not take for more than 7 days- (dependence) (have the tendency of abuse)
Do not take alcohol:
○ Additive CNS effect when used with alcohol.
This medication can cause drowsiness, if affected do not drive or operate machineries.
Storage:
○ Dextromethorphan: Store between 20-25°C. Protect from light.
○ Butamirate:Store below 30°C. Protect from light.
12. Headache (types of headache)
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OSCE Guide
Headache
Usual Causes
Migraine Headache ● Food triggers:- alcohol, caffeine/caffeine withdrawal. Chocolate, fermented and pickled foods, MSG, nitrates in processed
foods,
● Environmental triggers- glare or flickering lights, high altitude, loud noises, tobacco, weather changes
● Behavioral-Psychological triggers: excess or insufficient sleep, fatigue, menstruation, menopause. Skipped meals, stress
Tension -Type migraine - most common type of headache,
● Two sides of headache- hat band pattern
○ Episodic or chronic
● Episodic tension- mild to moderate pain, Band-like pain (Front, top, sides of the head) and beings usually in the middle of
the day and may last 30 mins to several days. (happening less than 15 days per month)
● Chronic tension headache- pain varies throughout the day, Pain is always present. Pain comes and goes over a long period
of time
Sinus Headache - develop from a sinus infection, common cold, seasonal allergies, nasal polyps and deviated septum
Cluster Headache - triggers- changes in season that may cause allergies or sinusitis, alcohol, and smoking
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OSCE Guide
Temporomandibular Joint Headache (TMJ)- usually caused from teeth grinding, it can also be related to osteoarthritis, joint
hypermobility or osteoporosis.
Neck- cause from stress, poor posture, caffeine withdrawal and hangovers.
Manifestation of the
Disease / Symptoms
MIgraine Headache
● Recurring episodes of throbbing head pain, frequently one sided, usually associated with nausea, vomiting, stiff-neck,
sensitivity to light, sound/or movement
Tension-Type Migraine
● Headache when you wake up, trouble falling asleep and staying asleep, chronic fatigue, mild sensitivity to light or noise and
general muscle aching
Sinus Headaches- steady pain in the area behind the face that gets worse when bending forward
● Presence of nasal congestion, deep and constant pain in the cheekbones, forehead, or bridge of the nose., fever ,stuffy/
runny nose, swollen of puffy face, thick, colored mucus discharge from the nose
Cluster Headache- intense pain on one side of head, (burning, piercing, throbbing or constant pain)
● Pain behind or around the eye and pain last a short time, generally 30 to 90 minutes
TMJ- can also often recur in one or more regions of the head and fae or can feel like tension headaches
● Tight facial or jaw muscles
● Jaw or facial pain
● “Clicking” noise in the jaw
● Restricted movement of the jaw
● Changes in your bite
Neck- Headaches with neck pain, tense muscles in neck, scalp, shoulder and tightened jaw.
Recommended
Treatment / Drugs
MIgraine Headache
● OTC-Ibuprofen (Advil)- 200 mg
● OTC-Sumatriptan- 50 mg
Tension-type Headache
● OTC-Ibuprofen + Paracetamol (Alaxan FR) 500 mg
● OTC- Paracetamol + caffeine (Rexidol Forte) 500 mg
SInus Headache
● OTC-Decolgen 500 mg
● OTC-FLO Baby Saline nasal spray 15 ml
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OSCE Guide
Cluster Headache
● OTC-Sumatriptan- 50 mg
TMJ● OTC-Ibuprofen (Advil)- 200 mg
● OTC- Aspirin
Neck● OTC-Ibuprofen (Advil)- 200 mg
Dosage of the Drug
Migraine Headache
● Aspirin- For fever and mild to moderate pain
○ Oral Tablet: Adult: Initially, 300-900 mg, repeated every 4-6 hours according to clinical needs.
○ Max daily dose: 4 g
● Ibuprofen (Advil)○ Soft Gel Caps- Adults and children aged >12 years old- Take 1-2 soft gel caps every 4-6 hours
○ Max daily dose: 6 Soft gels
Tension Headache
● Alaxan FR○ Capsule: Adult- Take 1 capsule every 6 hours or as prescribed by he physician
○ MAx daily dose: 6 capsules
● Rexidol Forte○ Tablet: Adult and children aged >12 years old: Take 1-2 tablets every 6 hours or as needed.
○ Max daily dose: 8 tablets in 24 hours
Sinus Headache-Helps minimise any impact on the normal function of delicate nasal structures. Helps to thin mucus & stimulates
the natural cleansing action of the nose to clear it away.
● Saline Nasal Spray-FLO Baby Saline nasal spray 15 ml
○ Newborn to 12 month infant: 1 Spray
○ Over 12 months: 1 to 2 sprays
● Decolgen○ Tablet: Adult and children aged >12 years old: Take 1-2 tablets every 6 hours
Sumatriptan
● Oral for migraine○ Adult:>18 years old: 50-100 mg repealed at 2 hour interval if migraine recurs
○ Max daily dose is 300 mg in 24 hours
● Subcutaneous for migraine and Cluster headache:
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OSCE Guide
TMJ●
●
●
Neck●
●
Direction of Use
Side Effects
○
○
Adult:>18 years old:6 mg as a single dose injection, repeated at least 1 hour after the first dose
Max daily dose : 12 mg in 24 hours
Ibuprofen (Advil)○ Soft Gel Caps- Adults and children aged >12 years old- Take 1-2 soft gel caps every 4-6 hours
○ Max daily dose: 6 Soft gels
Aspirin- For fever and mild to moderate pain
○ Oral Tablet: Adult: Initially, 300-900 mg, repeated every 4-6 hours according to clinical needs.
○ Max daily dose: 4 g
Rexidol Forte○ Tablet: Adult and children aged >12 years old: Take 1-2 tablets every 6 hours or as needed.
○ Max daily dose: 8 tablets in 24 hours
Aspirin- For mild to moderate pain
○ Oral Tablet: Adult: Initially, 300-900 mg, repeated every 4-6 hours according to clinical needs.
○ Max daily dose: 4 g
Rexidol Forte○ Tablet: Adult and children aged >12 years old: Take 1-2 tablets every 6 hours or as needed.
○ Max daily dose: 8 tablets in 24 hours
●
●
●
●
Advil Should be taken with food. Take immediately after meals
Alaxan FR Should be taken with food. Take immediately after meal
FLO Baby Saline nasal spray
○ If the baby's nose is blocked or congested, then use it 5-10 minutes before feeding.
○ Before using this product remove the protective cap and prime the pump by depressing the thumb several times
until the first spray is seen.Position FLO Baby Saline underneath the baby's nostril and spray the required dose
into each nostril. Wipe away mucus from the baby’s nose using clean tissue, when finished, clean the tip of the
spray with clean tissue and replace the protective cap.
Aspirin: Taken with food
Rexidol: Maybe taken with or without food. Swallow whole with water. Do not crush, or chew tablet
Sumatriptan: maybe taken with or without food.
Decolgen: maybe taken with or without food.
●
●
●
Advil/Aspirin/Rexidol:Minor abdominal pain, tinnitus,salicylate sensitivity
Sumatriptan: transient hypertension, hypotension,dizziness, drowsiness
Alaxan FR: GI discomfort,fluid retention, palpitations
●
●
●
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OSCE Guide
●
Decolgen: GI discomfort,hypertension or hypotension, dizziness and drowsiness.
Contraindication
CI to px with:
● Advil/Aspirin hypersensitivity to IBuprofen, aspirin or any NSAISs, have history of GI bleeding and ulceration and during
the 3rd trimester of pregnancy, elderly and nursing mothers and children <12 years old., hepatic impairment
● Rexidol:px recovering from alcoholism, with severe damaged,pregnancy and lactation, children <12 years old
● SUmatriptan: history of MI or stroke, severe hepatic impairment, hypersensitivity to sulfonamides, elderly, pregnancy and
lactation
● Alaxan FR:Pregnancy and lactation, px with nasal polyps and bronchospasm precipitated by NSAIDs and analgesics
● Decolgen:Hypersensitivity, High BP, BPH,
Important Counselling
Notes
Non-pharmacological intervention
- for acute migraine headache- Application of ice to the head, periods of rest or sleep ( in dark, quiet environment), identify triggers and avoid.
For sinus headache
- Apply warm compress to painful areas of the face
Advil- In case of missed dose, take missed dose as soon as remembered. If it is almost time for the next dose, skip the missed dose
and continue the regular dosing sched. Do not double dose.
● avoid occurrence of medication overuse as acute treatment
FLO Baby Saline nasal spray
● If taking other medications: patients should allow 20 minutes between the administration of FLO Baby Saline and the other
medication.
● Must be discarded three months from the date of first use.
Sumatriptan; avoid occurrence of medication overuse as acute treatment
Decolgen: if affected by dizziness or drowsiness, do not drive and operate machineries.
In case of a missed dose, take the missed dose as soon as you remember. If it is almost time for the next dose, skip the missed
dose and continue the regular dosing sched. Do not double dose
Alaxan FR: Limit Alcohol intake, Do not use for >10 days for pain,
Storage:
● Advil/Aspirin: Store at a temperature not exceeding 25°C.
● Sumatriptan: Oral and Subcutaneous: Store below 30°C.;
● Decolgen:Store at temperatures not exceeding 30°C.
13. Hypercholesterolemia
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OSCE Guide
Hypercholesterolemia
Usual Causes
●
●
●
●
●
Caused by a gene that's passed down from one or both parents.
Poor diet (eating food rich in saturated fat)
Obesity and lack of exercise
Smoking
Age
Manifestation of the
Disease / Symptoms
● Chest pain
● small bumps on the skin, typically on the hands, elbows, and knees or around the eyes
● xanthomas, which are waxy cholesterol deposits in the skin or tendons
● small, yellow deposits of cholesterol that build up under the eyes or around the eyelids
When a person inherits the mutated genes that cause FH from both parents, they are more likely to develop xanthomas at an early
age and even in infancy
Recommended
Treatment / Drugs
Statins
Statins are usually the first hypercholesterolemia treatment used. Statins help reduce LDL levels by blocking a specific enzyme
that’s necessary to produce cholesterol. Along with lowering LDL cholesterol, statins help prevent hardening of the arteries, which
reduces the chances of a heart attack or stroke. Common statin drugs include Lipitor, Lescol, Pravachol, Crestor, Zocor, and
others.
Dosage of the Drug
Homozygous familial hypercholesterolemia
Atorvastatin (Lipitor)
Starting dose: 10 mg at bedtime
Maximum dose: 80 mg at bedtime. This is because your body makes the most cholesterol at night.
Direction of Use
Side Effects
Contraindication
Swallow the tablet whole. Do not break, crush, or chew it. Take this medicine with or without food. Do not drink large amounts of
alcohol with atorvastatin.
●
●
●
Headaches
Feeling sick (nausea)
diarrhoea and cold-like symptoms
Some products that may interact with this drug include: daptomycin, gemfibrozil. Other medications can affect the removal of
atorvastatin from your body, which may affect how atorvastatin works
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OSCE Guide
●
●
●
Important Counselling
Notes
liver failure, liver problems, decreased kidney function.
a condition with muscle tissue breakdown called rhabdomyolysis.
recent operation.
While taking atorvastatin (Lipitor), avoid high-fat and high-cholesterol foods as part of your overall treatment. You should avoid
large quantities of grapefruit or grapefruit juice, which can increase the risk of serious side effects. Also, avoid excess alcohol use, as
this may cause serious liver problems.
14. Nasal symptoms (chronic, recurrent?)
Nasal Symptoms
Usual Causes
●
●
Infections — such as colds, flu or sinusitis — and allergies are frequent causes of nasal congestion and runny nose.
Non-allergic rhinitis - tobacco smoke and car exhaust
Manifestation of the
Disease / Symptoms
Acute sinusitis usually starts with cold-like symptoms such as a runny, stuffy nose and facial pain. It may start suddenly and
last 2 to 4 weeks.
● Subacute sinusitis usually lasts 4 to 12 weeks.
● Chronic sinusitis symptoms last 12 weeks or longer.
● Recurrent sinusitis happens several times a year.
Nasal Inflammation, thick discolored discharge (runny nose), post nasal drainage, congested or stuffy nose, reduced smell and taste
Recommended
Treatment / Drugs
RX-Antibiotics
● Amoxicillin-clavulanate (Augmentin) as the first-line antibiotic to treat a possible bacterial infection of the sinuses.
● !! Trimethoprim/sulfamethoxazole (Bactrim, Septra) are reasonable alternatives to amoxicillin for treating acute bacterial
rhinosinusitis in patients who are allergic to penicillin.
OTC-Decongestant
● Saline Nasal Spray-FLO Baby Saline nasal spray 15 ml
● Decolgen
● Bioflu Tablet
● Bioflu Suspension
Dosage of the Drug
Antibiotics● Amoxicillin-clavulanate (Augmentin)- 500 mg every eight hours for 10 days OR 875 mg every 12 hours for 10 days
● !!Trimethoprim/sulfamethoxazole (Bactrim, Septra)
●
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OSCE Guide
● Cefdinir (Omnicef)- 800 mg/160 mg twice per day for 10 days
Decongestants:
● Saline Nasal Spray-FLO Baby Saline nasal spray 15 ml
○ Newborn to 12 month infant: 1 Spray
○ Over 12 months: 1 to 2 sprays
● Decolgen
○ Tablet: Adult and children aged >12 years old: Take 1-2 tablets every 6 hours
● Bioflu
○ Tablet: Adult and children aged >12 years old: Take 1-2 tablets every 6 hours
○ Suspension■ Adult and children >12 years old- 15 ml (3 tsp) every 6 hours
■ Children aged 7 to 12 years old- 10 ml (2 tsp) every 6 hours
■ Children aged 2 to 6 years old- 5 ml (1 tsp)
Direction of Use
AUGMENTIN tablets should be taken immediately before or with the first mouthful of food. AUGMENTIN tablets work best when
taken this way. It may also help to prevent stomach upsets.
Trimethoprim/sulfamethoxazole
Take this medication by mouth, , with a full glass of water (8 ounces / 240 milliliters). If stomach upset occurs, take with food or milk
FLO Baby Saline nasal spray
● If the baby's nose is blocked or congested, then use it 5-10 minutes before feeding.
● Before using this product remove the protective cap and prime the pump by depressing the thumb several times until the
first spray is seen.Position FLO Baby Saline underneath the baby's nostril and spray the required dose into each nostril.
Wipe away mucus from the baby’s nose using clean tissue, when finished, clean the tip of the spray with clean tissue and
replace the protective cap.
Decolgen: maybe taken with or without food.
Bioflu Tablet: maybe taken with or without food. May be given w/ food or milk if stomach upset occurs.
Bioflu Suspension: Maybe taken with or without food.
Side Effects
Antibiotic medicines can cause diarrhea, which may be a sign of a new infection.
Decolgen: GI discomfort,hypertension or hypotension, dizziness and drowsiness.
Bioflu:: minor GI discomfort, dizziness, increase BP
Contraindication
Antibiotics: Avoid taking Augmentin together with or just after eating a high-fat meal. This will make it harder for your body to absorb
the medication.
● Acute infective exacerbation of chronic bronchitis
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OSCE Guide
● Otitis media in pediatrics only
● Travelers diarrhea for treatment and prophylaxis
● Urinary tract infections
Decolgen/ Bioflu:Hypersensitivity, High BP, BPH, pregnancy, lactation
Important Counselling
Notes
FLO Baby Saline nasal spray
● If taking other medications: patients should allow 20 minutes between the administration of FLO Baby Saline and the other
medication.
● Must be discarded three months from the date of first use.
Decolgen/ Bioflu Tablet: if affected by dizziness or drowsiness, do not drive and operate machineries.
In case of a missed dose, take the missed dose as soon as you remember. If it is almost time for the next dose, skip the missed dose
and continue the regular dosing sched. Do not double dose
Non-Pharmacological Intervention:
You can treat symptoms at home by resting, taking your medication at the right time and increasing your fluid intake. Make sure you
contact your doctor if symptoms do not improve, and if sinusitis happens often or if you have any symptom that worries you.
15. URTI
Upper Respiratory Tract Infection (URTI)
Usual Causes
The URTI is generally caused by the direct invasion of the inner lining (mucosa or mucous membrane) of the upper airway by the
culprit virus or bacteria.
5 Upper Respiratory Tract Infections:
●
●
Common cold-caused by the rhinovirus, but other culprits include influenza, parainfluenza, and coronavirus.
Pharyngitis- Possible causes include streptococcus bacteria, which causes strep throat, or an infection of your tonsils,
known as tonsillitis. In most cases, pharyngitis is due to a viral infection that attacks the tissue of your throat.
●
Sinusitis- caused by a virus,bacteria, or rarely fungus, other conditions such as allergies, nasal polyps, and tooth infections
can also contribute to sinus pain and symptoms.
Laryngitis- result of a viral infection, but can sometimes occur because of voice overuse.
Rhinitis- inflammation in your nasal passages. Rhinitis is usually defined as either allergic or non-allergic. Allergic rhinitis is
also known as hay fever, and is caused by your body’s immune response to certain allergens. Non-allergic rhinitis has the
same symptoms but does not involve an immune response.
●
●
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Manifestation of the
Disease / Symptoms
●
●
●
●
●
Recommended
Treatment / Drugs
Common Cold- Runny or stuffy nose,Sore throat,Cough,Congestion,Slight body aches or a mild
headache,Sneezing,Low-grade fever and Generally feeling unwell
Pharyngitis- sneezing,runny nose,headache,cough,fatigue,body aches,chills and fever (a low-grade fever with a cold and
higher-grade fever with the flu).
Sinusitis- nasal congestion,thick yellow or green mucus discharge from the nose,sore throat,a cough, usually worse at
night,drainage of mucus in the back of your throat,headache pain, pressure, or tenderness behind your eyes, nose, cheeks,
or forehead and earache.
Laryngitis- Hoarseness,Weak voice or voice loss, Tickling sensation and rawness in your throat,Sore throat,Dry throat and
Dry cough.
Rhinitis- sneezing, itching (of nose, eyes, ears, palate), rhinorrhea, postnasal drip, congestion, anosmia, headache,
earache, tearing, red eyes, eye swelling, fatigue, drowsiness, and malaise.
Common Cold
-OTC- acetaminophen (Tylenol)-For a fever, sore throat and headache in adults.
- OTC- ibuprofen (Advil, Motrin IB)-mild pain relievers in adults.
Pharyngitis
-OTC- acetaminophen or ibuprofen- help reduce pain and fever
Sinusitis
-OTC and Rx- Fluticasone (Flonase Allergy Relief).
-OTC- acetaminophen (Tylenol), ibuprofen (Advil)- help reduce pain.
Laryngitis
- Rx- Prednisone -help reduce vocal cord inflammation.
Rhinitis
- Allergic Rhinitis
-OTC- Diphenhydramine (Benadryl)
-Rx- Rhinocort Aqua(budesonide)- Relieves symptoms of seasonal or perennial allergic rhinitis (nasal congestion, runny
nose, sneezing and itchy nose).
Dosage of the Drug
Common Cold
- Acetaminophen( Tylenol)650 mg- Adult & childn ≥12 yr 1-2 tab 8 hrly. Max: 6 tab/24 hr.
- Ibuprofen ( Advil) 200 mg-
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- Adults: Take 1 to 2 softgel capsules every 4 to 6 hours
Pharyngitis
- Acetaminophen( Tylenol)650 mgAdult & childn ≥12 yr 1-2 tab 8 hrly. Max: 6 tab/24 hr.
- Ibuprofen ( Advil) 200 mg- Adults: Take 1 to 2 softgel capsules every 4 to 6 hours
Sinusitis
- Fluticasone (Flonase Allergy Relief)- Adult: As fluticasone propionate drops: Instill 200 mcg into each nostril 1 or 2 times daily for at least 4-6 weeks.
- Child: ≥16 years Same as adult dose.
- Acetaminophen( Tylenol)650 mgAdult & childn ≥12 yr 1-2 tab 8 hrly. Max: 6 tab/24 hr.
- Ibuprofen ( Advil) 200 mg- Adults: Take 1 to 2 softgel capsules every 4 to 6 hour/
Laryngitis
- Prednisone- Adult: Usual range: Initially, 5-60 mg daily. May consider alternate day therapy for long-term treatment.
- Child:- Initially, 0.05-2 mg/kg daily divided every 6-24 hours. May consider alternate day therapy for long-term
treatment.
Rhinitis
- Diphenhydramine (Benadryl)Adult: 50 mg 3 or 4 times daily.
- Children (>20 lbs): 12.5-25 mg 3 or 4 times daily. Maximum Daily Dose: 300 mg.
Direction of Use
-
Loratadine (Claritin)- Adults and children 6 years of age and over, with a body weight greater than 30kg. Take 1 tablet, once daily.
-
Rhinocort Aqua(budesonide)- Adults and Children 12 years and older: Once daily, use up to 2 sprays in each nostril (256 mcg total daily dose)
while sniffing gently.
- Children 6 years to less than 12 years of age: An adult should supervise use in children under age 12. Once daily,
use 1 spray in each nostril (total dose 128 mcg) while sniffing gently. If symptoms do not improve, dose can be
increased up to 2 sprays per nostril (up to 256 mcg total daily dose).
Common Cold
- Acetaminophen( Tylenol) - May be taken with or without food: Swallow whole, do not chew/crush.
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-
Ibuprofen (Advil) 200 mg- Should be taken with food , and the maximum daily dose should not exceed 1,200 mg or 6 softgel
capsules, unless directed by a doctor.
Pharyngitis
- Acetaminophen( Tylenol) - May be taken with or without food: Swallow whole, do not chew/crush.
- Ibuprofen (Advil) 200 mg- Should be taken with food , and the maximum daily dose should not exceed 1,200 mg or 6 softgel
capsules, unless directed by a doctor.
Sinusitis
- Fluticasone (Flonase Allergy Relief)- Administer through inhalation.
- Acetaminophen( Tylenol) - May be taken with or without food: Swallow whole, do not chew/crush.
- Ibuprofen (Advil) 200 mg- Should be taken with food , and the maximum daily dose should not exceed 1,200 mg or 6 softgel
capsules, unless directed by a doctor.
Laryngitis
- Prednisone- Should be taken with food. Dosage is individualised and adjusted according to the disease being treated and
patient response.
Rhinitis
- Diphenhydramine ( Benadryl) - Should be taken with food.
- Rhinocort Aqua(budesonide)- Nasal Spray
Side Effects
●
●
●
●
●
●
Contraindication
●
●
●
●
●
●
Acetaminophen( Tylenol) -Anaphylactic reaction, hypersensitivity, urticaria, pruritic rash, rash, increased transaminases.
Ibuprofen ( Advil)-Abdominal pain, diarrhea, nausea with or without vomiting,
Fluticasone-Nausea, abdominal pain, diarrhoea, dyspepsia, visual disturbances (e.g. blurred vision, increased intraocular
pressure, glaucoma).
Prednisone- Nausea, vomiting, diarrhoea, constipation, abdominal distension, gastric irritation, ulcerative oesophagitis,
pancreatitis, peptic ulceration with perforation and haemorrhage.
Diphenhydramine (Benadryl) -photosensitivity, excessive perspiration, chills, dryness of mouth, nose and throat.
Headache, palpitations.
Rhinocort Aqua(budesonide)- unpleasant taste/smell,sores or white patches inside or around your nose, or pain, swelling,
burning, itching, or irritation around your nose.
Acetaminophen(Tylenol)- Hypersensitivity to paracetamol or to any of the ingredients. Liver damage
Ibuprofen(Advil)- Hypersensitivity to Aspirin or any nonsteroidal anti-inflammatory drugs (NSAIDs)
Fluticasone- Required intensive measures
Prednisone- Concomitant administration with live or live attenuated vaccines (particularly immunosuppressive doses).
Diphenhydramine (Benadryl)- Hypersensitivity to diphenhydramine HCl and other antihistamines of similar chemical
structure; monoamine oxidase inhibitor therapy.
Use in Lower Respiratory Disease: Antihistamine should not be used to treat lower respiratory tract symptoms including
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●
●
Important Counselling
Notes
asthma.
Contraindicated in breastfeeding mothers
Rhinocort Aqua(budesonide)- Hypersensitivity to budesonide or to any of the ingredients.
Acetaminophen(Tylenol)- Should not be administered to Chronic alcohol users & patients w/ hepatic disease. Serious skin
reactions. Stopped at the 1st sign of skin rash or hypersensitivity.
Ibuprofen(Advil)- Do not use during the last 3 months of pregnancy. If the doctor has told the patient to take the medication
regularly,In case of a missed dose, take the missed dose as soon as you remember. If it is almost time for the next dose, skip the
missed dose and continue the regular dosing sched. Do not double dose
Fluticasone- Store between 15-30°C. Protect from direct heat or sunlight. Do not refrigerate or freeze.
Prednisone- Monitor blood pressure, serum creatinine, serum glucose, Hb, and electrolytes.Metabolism may be inhibited by
liquorice. Increased risk of gastrointestinal ulceration or haemorrhage with alcohol.
Diphenhydramine (Benadryl)- Store at temperatures not exceeding 30°C. Should be used with considerable caution in patients
with narrow-angle glaucoma, stenosing peptic ulcer.
Rhinocort Aqua(budesonide)● Instructions for Use, Handling and Disposal: UNLESS INSTRUCTED OTHERWISE, DO NOT DISPOSE OF UNUSED
MEDICINES BY EMPTYING THEM INTO YOUR SINK, TOILET OR STORM DRAIN.
● Before using Rhinocort Aqua nasal spray for the first time, shake the bottle and then pump several times (5-10 times) into
the air, so that a uniform mist is obtained.
● If not used daily the pump must be loaded again. After the first time it is sufficient to pump just once (1) into the air.
● 1. Blow your nose. Shake the bottle. Remove the protective cap.
● 2. Hold the bottle.
● 3. Insert the tip into your nostril and pump the number of doses prescribed. Administer the spray into the other nostril in the
same way.
● 4. Replace the protective cap. Do not use Rhinocort Aqua nasal spray more often than prescribed.
In Children: Children should only use Rhinocort Aqua nasal spray under supervision by an adult to ensure that the dose is correctly
administered and that the dosage is according to the doctor's prescription.
●
Cleaning: Clean the upper plastic parts regularly. Remove the protective cap and lift off the white nasal applicator. Wash the
plastic parts in warm water. Allow the plastic part to air-dry completely before replacing them.
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●
●
Do not try to clean the nasal applicator by using a pin or sharp object.
Rhinocort Aqua nasal spray does not give immediate relief. Generally it will take a few days to achieve full effect. It is
therefore very important that Rhinocort Aqua is used regularly.
Do not store above 30°C. Do not freeze.
Shelf-Life: 2 years.
16. Triggers for nasal symptoms
TRIGGERS FOR NASAL SYMPTOMS
Usual Causes
●
●
●
●
●
●
●
Allergens
Common cold
Nasal polyps
Influenza
Tobacco smoke
Hormonal changes
Sleep apnea
Manifestation of the
Disease / Symptoms
Runny nose, Sneezing, Itching in the nose and eye, Nasal congestion, Mucus in the throat and Cough.
Recommended
Treatment / Drugs
OTC
Decongestants
● Phenylephrine
Antihistamines
● Diphenhydramine (Benadryl)
Steroid nasal sprays
● Fluticasone Propionate (Nasoflo)
Dosage of the Drug
Decongestants
● Phenylephrine
- Tablet: 5mg, 10mg
Antihistamines
● Diphenhydramine (Benadryl)
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- Tablet: 25mg, 50mg
Steroid nasal sprays
● Fluticasone Propionate (Nasoflo)
- 59 mcg
Direction of Use
Decongestants
● Phenylephrine
- Tablet: 5mg, 10mg
- 10 mg orally every 4 hours when necessary; not to exceed 60 mg in 24 hr
Antihistamines
● Diphenhydramine (Benadryl)
- Adult: 50 mg three to four times a day.
- Children: >20 lb 12.5-25 mg three to four times a day. Max: 300 mg/day. Base on body wt: 5 mg/kg/24 hr
- May be taken with or without food
Steroid nasal sprays
● Fluticasone Propionate (Nasoflo)
Adult & children ≥12 yr
- Usual dose: 2 sprays in each nostril once daily, preferably in the morning, or 1 spray in each nostril twice a day.
Max: 4 sprays in each nostril daily.
- Maintenance: 1 spray in each nostril once daily. Start maintenance dose a few days after (4-7 days) initial therapy.
Children 4-11 yr
- Usual dose: 1 spray in each nostril once daily, preferably in the morning. If necessary, 2 sprays in each nostril once
daily or 1 spray in each nostril twice a day. Then, the patient may shift to the usual dose once adequate control is
achieved. Max: 2 sprays in each nostril daily.
Side Effects
Diphenhydramine: Drowsiness, Dizziness, nausea, vomiting, diarrhea, constipation, palpitations
Fluticasone Propionate: Nasal discharge, bronchitis, sneezing, hoarseness, cough, irritation of the eyes, abdominal pain
Contraindication
Diphenhydramine: Hypersensitivity to diphenhydramine HCl or other similar antihistamines. Asthma attack. Concomitant use w/
MAOIs. Premature & newborn infants. Lactation
Fluticasone Propionate: Hypersensitivity
Important Counselling
Notes
●
●
●
●
Avoid nasal irritants
Practice good hygiene
Drinking fluids
Alcohol, sedatives, and tranquilizers may increase drowsiness
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● May cause drowsiness so be careful when driving a motor vehicle or operating machinery
Fluticasone Propionate
● After inhalation, rinse the mouth with water without swallowing
● should be warned to avoid exposure to chickenpox or measles
17. Osteoporosis
OSTEOPOROSIS
Usual Causes
●
●
●
●
●
●
●
Age
Low calcium intake
Sedentary lifestyle
Hormone Imbalances
Smoking
Excessive alcohol consumption
Thyroid problems
Manifestation of the
Disease / Symptoms
●
●
●
●
Back pain, caused by a fractured or collapsed vertebra
Loss of height over time
A stooped posture
A bone that breaks much more easily than expected
Recommended
Treatment / Drugs
1. Bone-building medications
● Romosozumab (Evenity)
2. Bisphosphonates
● Alendronate (Fosamax)
3. Hormone-related therapy
● Raloxifene (Evista)
4. Monoclonal antibody medications
● Denosumab (Prolia)
Dosage of the Drug
Romosozumab (Evenity)
- 210 mg administered subcutaneously in the abdomen, thigh or upper arm
Alendronate (Fosamax)
● Tablet: available as 5 mg, 10 mg, 35 mg, 40 mg, 70 mg
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● Tablet for solution (effervescent): 70 mg
● Solution, oral: 70 mg/75mL
Raloxifene (Evista)
- 60 mg
Denosumab (Prolia)
- 1 mL of a 60 mg/mL solution in a single-dose prefilled syringe
Direction of Use
Romosozumab (Evenity)
- Administer EVENITY once every month.
- The treatment duration for EVENITY is 12 monthly doses.
- should be adequately supplemented with calcium and vitamin D during treatment with EVENITY
- Steps:
1. Always hold the prefilled syringe by the syringe barrel to remove the syringe from the tray.
2. Select The Injection Site And Prepare The Syringe
3. Pull the gray needle cap straight off and away from your body when you are ready to inject
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4. Insert needle and inject all the liquid subcutaneously. Do not administer into muscle or blood vessels.
5. Immediately dispose of the syringe and needle cap in the nearest sharps container
Alendronate (Fosamax)
Prevention in postmenopausal women
● 5 mg orally once daily or 35 mg orally once weekly
Treatment in postmenopausal women and men
● 10 mg orally once daily or 70 mg orally once weekly
- Take tablet with full glass of water (6-8 oz) at least 30 minutes before first food or drink of day, in upright position only in
morning, not at bedtime or before arising
- Do not lie down for 30 minutes after taking drug; sit or stand upright
Raloxifene (Evista)
- Take one tablet of 60 mg EVISTA (raloxifene hydrochloride tablets) tablet daily, which may be administered any time of day
without regard to meals
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Denosumab (Prolia)
- Steps:
1. Activate the green safety guard (slide over the needle) after the injection
2. Remove Gray Needle Cap
3. Administer Subcutaneous Injection
4. Immediately Slide Green Safety Guard Over Needle
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-
5. Immediately dispose of the syringe and needle cap in the nearest sharps container. DO NOT put the needle cap
back on the used syringe.
Store Prolia in a refrigerator at 2°C to 8°C
Side Effects
Romosozumab (Evenity): headache, joint pain, lightheadedness, muscle spasms or contractions, problems with vision or speech
Alendronate (Fosamax): diarrhea, dizziness, weakness, irritability, trouble sleeping, headache, painful or difficulty urinating,
Raloxifene (Evista): Flu Syndrome, Hot Flashes, Nausea, Diarrhea, Peripheral Edema, Vertigo, Rhinitis
Denosumab (Prolia): severe pain in joints, muscles, or bones, redness, itching, chills, pain, swelling
Contraindication
Romosozumab (Evenity): Hypocalcemia, A history of systemic hypersensitivity to romosozumab or to any component of the
product formulation
Alendronate (Fosamax): Patients at increased risk of aspiration, Hypocalcemia, Hypersensitivity to any component of this product,
Inability to stand or sit upright for at least 30 minutes, Abnormalities of the esophagus which delayed esophageal emptying
Raloxifene (Evista): past history of venous thromboembolism (VTE), pregnancy, in women who may become pregnant, and in
nursing mothers
Denosumab (Prolia): Hypocalcemia, Pregnancy, Hypersensitivity
Important Counselling
Notes
Romosozumab (Evenity)
● should take calcium and vitamin D while you receive EVENITY
● should be thrown away if taken out of the refrigerator and not used within 30 days
Alendronate (Fosamax)
● Take with plain water only, not coffee, juice, or mineral water; sit or stand upright for at least 30 minutes after administration
● ensure adequate calcium and vitamin D intake
● Discontinue therapy in patients who experience severe symptoms of pain
Raloxifene (Evista)
● Being still for a long time (such as sitting still during a long car or airplane trip or being in bed after surgery) can increase
your risk of blood clots
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● Calcium and vitamin D may be taken at the same time as EVISTA.
Denosumab (Prolia):
● Do not take Prolia if you have been told by your doctor that your blood calcium level is too low.
● If you have a weakened immune system or taking medicines that affect the immune system may have an increased risk for
developing serious infections
18. Menopausal symptoms
MENOPAUSAL SYMPTOMS
Usual Causes
●
●
●
Naturally declining reproductive hormones
Surgery that removes the ovaries
Chemotherapy and radiation therapy
Manifestation of the
Disease / Symptoms
●
●
●
●
●
●
●
Irregular periods
Hot flashes
Mood changes
Sleep problems
Weight gain and slowed metabolism
Thinning hair and dry skin
Vaginal dryness
Recommended
Treatment / Drugs
1.
2.
3.
4.
5.
Hormone therapy
Topical hormone therapy
Gabapentin
Clonidine
Vitamin D
Dosage of the Drug
1. Hormone therapy ( available as 0.3 mg, 0.45 mg, 0.625 mg, 0.9 mg, and 1.25 mg)
treatment option for relieving menopausal hot flashes
2. Topical hormone therapy ( available as 0.5g)
- help relieve vaginal dryness, discomfort with intercourse and some urinary symptoms
3. Gabapentin ( available as 100mg, 300mg and 400mg capsules)
- help reduce hot flashes
4. Clonidine ( available as 100 mcg and 150 mcg tablets)
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- used to treat high blood pressure, might provide some relief from hot flashes
5. Vitamin D
- to prevent or treat osteoporosis and help strengthen bones
Direction of Use
Hormone therapy
● Initially, 0.3 mg PO once daily given in a cycle for 3 weeks, followed by 1 week off
Topical hormone therapy ( administered intravaginally once a day in a cyclic regimen (daily for 3 weeks and then off for 1 week)
● Instructions for Use of Gentle Measure Applicator: Remove cap from tube.
● Screw nozzle end of applicator onto tube.
● Gently squeeze the tube from the bottom to force sufficient cream into the barrel to provide the prescribed dose. Use the
marked stopping points on the applicator as a guideline to measure the correct dose.
● Unscrew applicator from tube.
● Lie on your back with knees drawn up. To deliver medication, gently insert the applicator deeply into vagina and press
plunger downward to its original position.
Gabapentin
● The starting dose is 300mg at night. Increase the dose by 300mg every two to three days (add a morning dose then a
midday dose if you have no side effects) until taking 300mg three times a day
● May be taken with or without food: Swallow whole tablet w/ sufficient fluid.
Clonidine
● 25 micrograms (a quarter of a tablet) twice a day. The dose can be increased as tolerated to 50-75micrograms twice a day
over two weeks if necessary
Vitamin D
● 400-1000 IU/day of vitamin D
Side Effects
Hormone therapy: Dizziness, abdominal pain, Breast pain, Insomnia, and changes in libido
Topical hormone therapy: Dizziness, Breast pain, Headache, Vaginal itching and changes in your menstrual periods
Gabapentin: Dizziness, Drowsiness, Dry mouth, Visual disturbance and Forgetfulness, loss of concentration or confusion
Clonidine: Drowsiness, Constipation, Dry mouth and Difficulty in sleeping
Vitamin D: weakness, fatigue, sleepiness, headache, loss of appetite, dry mouth, metallic taste, nausea, vomiting
Contraindication
Hormone therapy and Topical hormone therapy
● Active arterial thromboembolic disease (for example stroke and MI), or a history of these conditions
● Known or suspected pregnancy
● Known liver dysfunction or disease
● Known, suspected, or history of breast cancer
● Undiagnosed abnormal genital bleeding
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Gabapentin
● hypersensitivity to the drug or its ingredients.
Clonidine
● hypersensitivity to clonidine
● Nursing MothDo not drive, operate heavy machinery, or do other dangerous activities
● Pregnancy
Vitamin D
● sarcoidosis
● high amount of phosphate in the blood
● high amount of calcium in the blood
● excessive amount of vitamin D in the body
● kidney stones
● decreased kidney function
Important Counselling
Notes
Hormone therapy and Topical hormone therapy
● If you have any unusual vaginal bleeding
● About all the medicines you take
● About all of your medical problems
Gabapentin
● Do not drink alcohol or take other medicines that make you sleepy or dizzy while taking NEURONTIN
● Do not drive, operate heavy machinery, or do other dangerous activities
Clonidine
● Patients should be cautioned against interruption of clonidine tablets therapy without their physician's advice
● Patients who engage in potentially hazardous activities, such as operating machinery or driving, should be advised of a
possible sedative effect of clonidine. They should also be informed that this sedative effect may be increased by
concomitant use of alcohol, barbiturates, or other sedating drugs.
Vitamin D
● Do not take large amounts daily because it may only harm the bones instead of strengthening it
● Use them with caution if you have diabetes, low blood sugar, low blood pressure, or if you take medications that affect blood
sugar and blood pressure
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19. Depression
DEPRESSION
Usual Causes
●
●
●
●
Genes
Stressful life events
Hormones
Personal factors
Manifestation of the
Disease / Symptoms
●
●
●
●
●
●
Unexplained physical problems, such as back pain or headaches
Anxiety, agitation or restlessness
Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide
Trouble thinking, concentrating, making decisions and remembering things
Sleep disturbances, including insomnia or sleeping too much
Feelings of worthlessness or guilt, fixating on past failures or self-blame
Recommended
Treatment / Drugs
1. Selective serotonin reuptake inhibitors (SSRIs)
● Sertraline
2. Serotonin-norepinephrine reuptake inhibitors (SNRIs)
● Duloxetine
3. Atypical antidepressants
● Mirtazapine
4. Tricyclic antidepressants
● Imipramine
5. Monoamine oxidase inhibitors (MAOIs)
● Selegiline
Dosage of the Drug
Selective serotonin reuptake inhibitors (SSRIs)
● Sertraline (available as 25mg, 50 mg and 100mg)
Serotonin-norepinephrine reuptake inhibitors (SNRIs)
● Duloxetine (available as 20mg, 30mg, DR-60mg)
Atypical antidepressants
● Mirtazapine (available as 7.5mg, 15mg, 30mg and 45mg)
Tricyclic antidepressants
● Imipramine (available as 10mg, 25mg, 75mg, 125mg, 150mg)
Monoamine oxidase inhibitors (MAOIs)
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●
Direction of Use
Side Effects
Selective serotonin reuptake inhibitors (SSRIs)
● Sertraline
➢ Initially 50 mg daily, either daily throughout the menstrual cycle or limited to the luteal phase of the menstrual cycle.
May be increased to 50 mg increments/menstrual cycle up to 150 mg daily or 100 mg daily (during luteal phase)
➢ May be taken with or without food: Take in the morning or evening.
Serotonin-norepinephrine reuptake inhibitors (SNRIs)
● Duloxetine
➢ 60 mg once daily. Max: 120 mg daily in evenly divided doses
➢ May be taken with or without food
Atypical antidepressants
● Mirtazapine
➢ Initially 15-30 mg in the evening. Maintenance: 15-45 mg/day
➢ May be taken with or without food
Tricyclic antidepressants
● Imipramine
➢ Adult: Initially, up to 75 mg daily in divided doses or as a single dose at bedtime
➢ Usual maintenance: 50-150 mg daily, individualised according to patient requirements
➢ Elderly: Initially, 10 mg daily, may gradually increase to 30-50 mg daily
➢ Approximately: 100 mg daily
Monoamine oxidase inhibitors (MAOIs)
● Selegiline
➢ Transdermal:
➢ Adult: Initially, 6 mg daily, may increase in increments of 3 mg/24 hr every 2 weeks. Max: 12 mg/24 hr.
●
●
●
●
●
Contraindication
Selegiline (available as 5mg)
●
Sertraline: yawning, dizziness, agitation, extrapyramidal disorder, decreased/increased weight, euphoric mood
Duloxetine: Palpitations, blurred vision, dizziness, somnolence, anxiety, sleep disorder
Mirtazapine: Increased appetite & weight gain; drowsiness or sedation; jaundice; hyponatremia particularly in elderly.
Extrapyramidal effects, serotonin syndrome
Imipramine: Nausea, vomiting, euphoria, confusion, Hot flushes, blurred vision, hypomanic or manic episodes
Selegiline: Active duodenal or gastric ulcer. Concomitant use w/ serotonin agonists (e.g. sumatriptan, zolmitriptan),
pethidine and other opioids, antidepressants (including TCAs, MAOIs, SSRIs, serotonin norepinephrine reuptake inhibitors),
St John’s wort
Sertraline: Hypersensitivity. Concomitant use w/ MAOIs & pimozide
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●
●
●
●
Important Counselling
Notes
Duloxetine: Hypersensitivity. Concomitant use w/ non selective irreversible MAOIs; fluvoxamine, ciprofloxacin or enoxacine
(ie, potent CYP1A2 inhibitors). Liver disease resulting in hepatic impairment. Severe renal impairment (CrCl <30 mL/min)
Mirtazapine: Hypersensitivity
Imipramine: Recent MI, any degree of heart block or cardiac arrhythmias, narrow-angle glaucoma, urinary retention,
mania, porphyria. Severe hepatic impairment. Children <6 years. Concomitant or within 14 days of MAOI use
Selegiline: Orthostatic hypotension, chest pain, headache, confusion, tremor, dizziness, hallucinations, agitation
● Don’t delay. Seek support early to try to avoid symptoms becoming worse
● Stopping medication should only be done gradually
● Evaluate mental status, suicidal ideation, anxiety, social functioning, panic attacks or unusual changes in behaviour
Non-Pharmacologic Management
● Exercise
● Meditation
● Interpersonal therapy
● Cognitive and behavioral approaches
20. Deep vein thrombosis
DEEP VEIN THROMBOSIS
Usual Causes
●
●
Damage to a vein from surgery or trauma
Inflammation due to infection or injury
Manifestation of the
Disease / Symptoms
●
●
●
●
Swelling in the affected leg. Rarely, there's swelling in both legs.
Pain in your leg. The pain often starts in your calf and can feel like cramping or soreness.
Red or discolored skin on the leg
A feeling of warmth in the affected leg
Recommended
Treatment / Drugs
Pharmacological
1. Anticoagulants
● IV
● Oral
2. Thrombolytics
Enoxaparin (Lovenox)
Rivaroxaban (Xarelto)
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● Alteplase
Non-Pharmacological
1. Compression stockings
2. Filters
Dosage of the Drug
Anticoagulants
● IV
- Enoxaparin (Lovenox)
➢ 1.5 mg/kg every 12 hours administered subcutaneously
●
Oral
-
Rivaroxaban (Xarelto) available as 2.5mg, 10mg, 15mg, 20mg
➢ 15 mg oral every 12hrs. for 21 days, then 20 mg oral everyday
Thrombolytics
● Alteplase
- 0.5-1.0 mg/hr for 12-24 hours
Direction of Use
Anticoagulants
●
IV
-
Enoxaparin (Lovenox)
➢ Remove the needle shield by pulling it straight off the syringe
➢ Inject using standard technique, pushing the plunger to the bottom of the syringe
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➢ Remove the syringe from the injection site keeping your finger on the plunger rod
➢ Orient the needle away from you and others, and activate the safety system by firmly pushing
the plunger rod.
➢ Immediately dispose of the syringe in the nearest sharps container
●
Thrombolytics
●
Side Effects
Oral
-
Rivaroxaban (Xarelto)
➢ Should be taken with food
➢ For patients unable to swallow, tab may be crushed & mixed w/ water or soft foods eg,
applesauce immediately prior to taking.
➢ After administration of a crushed 15 mg or 20 mg tab, the dose should then be immediately
followed by food/enteral feeding.
Alteplase
➢ catheters are introduced into jugular, femoral, popliteal, and/or posterior tibial vein at the ankle so as to
inject alteplase (diluted with normal saline to 0.1mg/ml, throughout the entire length of the clot) once a
day.
Enoxaparin (Lovenox)
● Injection Site Hemorrhage
● Injection Site Pain
● Hematuria
Rivaroxaban (Xarelto)
● Abdominal pain
● Dizziness
● Wound secretion
● Back pain
● Pain in extremity
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● Hematoma
Alteplase
● bleeding
Contraindication
Enoxaparin (Lovenox)
● Known hypersensitivity to enoxaparin sodium
● History of immune-mediated heparin-induced thrombocytopenia (HIT) within the past 100 days or in the presence of
circulating antibodies
● Active major bleeding
Rivaroxaban (Xarelto)
● Patients w/ clinically significant active bleeding (eg, intracranial & GI bleeding)
● hepatic disease associated w/ coagulopathy leading to clinically relevant bleeding risk
● Pregnancy & lactation
● Hypersensitivity
Alteplase
● patients under warfarin therapy
● major surgery or significant trauma in the past 10 days
● Hypersensitivity to alteplase
Important Counselling
Notes
Enoxaparin (Lovenox)
● Inform patients of the instructions for injecting Lovenox
● should report any unusual bleeding, bruising, or signs of thrombocytopenia
● may bruise and/or bleed more easily when they use Lovenox
Rivaroxaban (Xarelto)
● Patients experiencing adverse reactions of syncope and dizziness should not drive or use machines
Alteplase
● Discontinue use if anaphylactoid reactions occur
● Avoid intramuscular injections and trauma to the patient
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MEDICATIONS / DRUGS
1. Metformin
Rx
Glucophage XR
Generic Name /
Device Name
Metformin
Therapeutic Category
Antidiabetic Agents
Indication/Uses
Type 2 DM: Monotherapy/prevention or in combination w/ other oral antidiabetics.
Dosage (children &
adult)
Adult:
●
●
●
Child:
●
Direction of Use
Side effects
●
●
Monotherapy or in combination w/ other oral antidiabetic agents: Initially: 500 mg or 850 mg bid-tid. Max of 3 g daily as
3 divided doses.
Monotherapy in prediabetes: 1,000-1,700 mg/day divided in 2 doses given.
Combination w/ insulin: Initially:500 mg or 850 mg bid or tid, while insulin dosage is adjusted on the basis of blood
glucose measurements.
Children 10 yr &; adolescents: Monotherapy or in combination w/ insulin 500 or 850 mg once daily. Max of 2 g daily
as 2 or 3 divided doses.
Should be taken with food:
XR tab: Swallow whole, do not chew/crush. Must be taken daily w/o interruption w/ evening meal.
GI disorders eg, nausea, vomiting, diarrhea, abdominal pain & loss of appetite; taste disturbance.
Contraindications
●
●
●
Severe renal impairment (eGFR below 30 mL/min/1.73 m2)
Hypersensitivity to metformin.
Acute or chronic metabolic acidosis, including diabetic ketoacidosis, with or without coma.
Interactions
(drug/food)
●
Increased risk of hypoglycaemia with insulin and insulin secretagogues (e.g. sulfonylurea). Increased risk of lactic
acidosis with carbonic anhydrase inhibitors (e.g. acetazolamide, dichlorphenamide), NSAIDs, and antihypertensive
agents (e.g. ACE inhibitors).
Increased risk of lactic acidosis with alcohol.
●
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Special Precautions/
Warnings
●
●
●
●
●
Important counselling
notes
Conditions where renal function may be acutely impaired eg, elderly, when initiating antihypertensive or diuretic therapy &
when starting therapy w/ NSAID.
Risk of lactic acidosis.
Patients should continue following dietary advice.
Avoid consumption of alcoholic beverages.
Possible hypoglycemia when in combination w/ insulin or sulfonylureas. May affect ability to drive or operate machinery on
the onset of hypoglycemia.
Pregnancy and Lactation: Not Recommended
Do not take more or less of it or take it more often than prescribed by your doctor. Swallow metformin extended-release tablets
whole; do not split, chew, or crush them.
2. Plavix (clopidogrel)
Rx
Plavix
Generic Name /
Device Name
Clopidogrel bisulfate
Therapeutic Category
Antiplatelets, Anticoagulant, & Fibrinolytics
Indication/Uses
●
●
Dosage (children &
adult)
Prevent heart attacks and strokes in person with heart disease (recent heart attack), recent stroke, or blood circulation
disease (peripheral vascular disease).
With ASPIRIN: used to treat new/worsening chest pain and prevent blood clot.
Adult: Tablet- 75 mg, 300 mg
Children: NOT RECOMMENDED
Dosage considerations:
● Recent MI & stroke or established peripheral arterial disease 75 mg as a single daily dose.
● Patient w/ non-ST-segment elevation acute coronary syndrome (unstable angina/non-Q-wave MI) Single 300-mg
loading dose, then continued at 75 mg once daily. Should be initiated &amp; continued w/ ASA (75 mg up to 325 mg once
daily).
● Patient w/ ST-segment elevation acute MI 75 mg once daily in combination w/ ASA (w/ or w/o thrombolytics). Atrial
fibrillation 75 mg as a single daily dose. Should be initiated &amp; continued w/ ASA (75-100 mg daily).
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Direction of Use
May be taken w/ or w/o food
Side effects
Dyspepsia, abdominal pain, diarrhea; bleeding, epistaxis, hematuria &amp; hemorrhage; anaphylactoid reactions.
Contraindications
Hypersensitivity. Active pathological bleeding eg, peptic ulcer or intracranial hemorrhage.
Interactions
(drug/food)
Drug:
●
●
●
●
Food:
●
●
Diabetes Drug (Repaglinide) - taken together can increase the amount of repaglinide which results in low blood sugar
level
Stomach Acid Drugs Proton Pump Inhibitors: (ex. Omeprazole), and Opioids - can make clopidogrel less effective (ex.
Morphine)
NSAIDs - may increase the risk of bleeding in the stomach and intestines (ex. ibuprofen, naproxen)
Blood thinners and antidepressants - also increases the risk of bleeding
Grapefruit juice - increase the effects of medicine and make you bleed or bruise easily
Alcohol Interaction - increase risk of bleeding
Special Precautions/
Warnings
Monitor blood cell count; cross reactivity. Patients at risk of increased bleeding from trauma, surgery or other pathological conditions
&amp; those receiving aspirin, heparin, glycoprotein IIb/IIIa inhibitors, NSAIDs, SSRIs or thrombolytics. Renal &amp; hepatic
impairment.
Important counselling
notes
Discontinue use 5-7 days prior to surgery. Should not be used during pregnancy. Lactation. Childn.
3. Hypertensive medication
Types
Uses
Drugs
ACE Inhibitors
Angiotensin is a chemical that causes the arteries to become narrow, especially in the kidneys but also Captopril, Enalapril,
throughout the body. ACE inhibitors help the body produce less angiotensin, which helps the blood vessels Fosinopril
relax and open up, which, in turn, lowers blood pressure.
Angiotensin Receptor
Blockers
Angiotensin needs a receptor- like a chemical "slot" to fit into or bind with- in order to constrict the blood
vessel. ARBs block the receptors so the angiotensin fails to constrict the blood vessel. This means blood
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Losartan,
Olmesartan,
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vessels stay open and blood pressure is reduced.
Valsartan
Alpha-1 Blockers
These drugs reduce the arteries' resistance, relaxing the muscle tone of the vascular walls.
Silodosin,
Tamsulosin
Beta Blockers
Beta-blockers reduce the heart rate, the heart's workload and the heart's output of blood, which lowers blood Atenolol, Bisoprolol
pressure.
Calcium Channel
Blockers
This drug prevents calcium from entering the smooth muscle cells of the heart and arteries. When calcium Diltiazem,
enters these cells, it causes a stronger and harder contraction, so by decreasing the calcium, the hearts' Amlodipine,
contraction is not as forceful. Calcium channel blockers relax and open up narrowed blood vessels, reduce Verapamil
heart rate and lower blood pressure.
Central Sympatholytic
Drugs
Central agonists also help decrease the blood vessels' ability to tense up or contract.
Methyldopa,
Clonidine
Diuretics
Diuretics help the body get rid of excess sodium (salt) and water and help control blood pressure.
Furosemide,
Hydrochlorothiazide
Vasodilators
Blood vessel dilators, or vasodilators, can cause the muscle in the walls of the blood vessels (especially the Hydralazine
arterioles) to relax, allowing the vessel to dilate (widen). This allows blood to flow through better.
(Refer to Product Identification notes for specifics)
Rx
Lifezar Film-Coated tablet
Generic Name /
Device Name
Losartan
Therapeutic Category
Angiotensin Receptor Blocker (Antihypertensive)
Indication/Uses
Treatment of essential hypertension in adults and in children and adolescents 6-18 years of age.
Dosage (children &
adult)
Usual starting & maintenance dose: 50 mg once daily. Max: Antihypertensive effect is attained 3-6 wk after therapy initiation. May
be increased to 100 mg once daily.
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Direction of Use
May be taken with or without food: Swallow w/ glass of water
Side effects
Dizziness; vertigo; hyperkalaemia, hypoglycaemia, increased blood urea, serum creatinine & serum K; asthenia, fatigue; anaemia;
orthostatic hypotension (including dose-related orthostatic effects); renal impairment & failure.
Contraindications
Interactions
(drug/food)
Special Precautions/
Warnings
Important counselling
notes
●
●
●
●
Hypersensitivity.
Concomitant use w/ aliskiren in type 2 diabetes patients.
Severe hepatic impairment.
Pregnancy
Increased incidence of hypotension, hyperkalaemia & changes in renal function w/ angiotensin receptor blocker. May have
increased hypotensive action w/ other antihypertensives. May increase risk of hypotension w/ hypotension-inducing products
(eg, TCAs, antipsychotics, baclofene & amifostine).
●
●
●
History of angioedema.
Patients who are vol- & Na-depleted by vigorous diuretic therapy, dietary salt restriction, diarrhoea or vomiting.
Monitor plasma conc of K & CrCl; renal function.
GENERAL COUNSELING FOR HYPERTENSION:
Px advice from MIMS BOOK: PREVENTION
1. Observe and maintain healthy dietary practices
2. Limit salt intake to less than 5 grams or 1 teaspoon of sodium per day.
3. It is recommended to eat at least 400 grams or five portions of combined fruits and vegetables, for example including
potatoes, cassava and other starchy roots.
4. Alcohol should be limited to less than one drink per day (women) and less than two to drinks per day (men).
5. Drink less caffeine eg: coffee tea color drinking greater than 4 cups of coffee a day may increase blood pressure.
6. Exercise regularly. Physical activity helps maintain a healthy weight and lowers cholesterol and blood pressure levels
7. Avoid smoking, smoking raises blood pressure and increases the risk for heart attack and stroke
8. Reduce stress as much as possible practice muscle relaxation techniques deep breathing or meditation
9. Get enough sleep. Not getting enough sleep on a regular basis increases the risk for heart disease, high blood pressure
and stroke.
MANAGEMENT:
1. Measure blood pressure on a regular basis keeping close tabs on blood pressure shows if medication is working, alerts for
potential complications and keeps a condition in check.
2. Make lifestyle changes blood pressure may be lowered by being physically active and eating a healthy diet
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4. Antibiotics
Rx
Zithromax
Generic Name /
Device Name
Azithromycin Dihydrate
Therapeutic Category
Antibacterial (Belongs to the class of Macrolides)
Indication/Uses
used to treat otitis media (middle ear infection), tonsillitis, laryngitis, bronchitis, pneumonia, and sinusitis caused by susceptible
bacteria
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Dosage
As tab: 500 mg daily for 3 days. Alternatively, 500 mg as a single dose on day 1 followed by 250 mg daily on days 2-5.
Direction of Use
May be taken with or without food: May be taken w/ meals for better absorption & to reduce GI discomfort.
Side effects
loose stools, nausea, abdominal pain, stomach upset, vomiting, constipation, dizziness, tiredness, headache, vaginal itching or
discharge, nervousness
Contraindications
Hypersensitivity to o azithromycin, erythromycin, any macrolide or ketolide antibiotic.
Interactions
(drug/food)
Increased risk of prolonged QT interval with class IA (e.g. quinidine, procainamide) and class III (e.g. dofetilide, amiodarone, sotalol)
antiarrhythmics; pimozide cisapride and terfenadine. Increased serum concentrations of digoxin, colchicine, and ciclosporin.
May potentiate the effects of oral anticoagulants.
Special Precautions/
Warnings
Patients with myasthenia gravis, electrolyte disturbance particularly hypokalaemia and hypomagnesaemia; bradycardia, cardiac
arrhythmia, severe cardiac insufficiency, congenital or documented QT prolongation, history of torsades de pointes
Important counselling
notes
GENERAL COUNSELLING FOR ANTIBIOTICS:
● Counsel patients that antibacterial drugs including Amoxil, should only be used to treat bacterial infections. They do not
treat viral infections.
● Advise patients that diarrhea is a common problem caused by antibacterial drugs and usually resolves when the drug is
discontinued.
● Make sure you take the antibiotics at the correct time and complete the course even if you start feeling better before
completion. Not completing the course might contribute to bacteria becoming “antibiotic resistant” and the antibiotic being
less effective in the future.
● Never take antibiotics that were left over from a previous infection.
● Take the dose as soon as you remember. If it is almost time for the next dose, SKIP missed dose and continue therapy until
course is complete. Do NOT double up on medication unless indicated by the prescriber.
Reconstituted Suspension:
● Shake well before using
● Discard any remaining portion after completion of therapy
● Stability ranges from 10-14 days
Tablets and Capsules:
● Keep at room temperature and away from heat/light/moisture
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5. Multivitamins with iron
OTC
Pro-Iron Capsule
Generic Name /
Device Name
Multivitamins with Iron
Therapeutic Category
Vitamins & Minerals (Pre & Post Natal) / Antianemics
Indication/Uses
Prevention & treatment of anemia due to Fe, folic acid & vit B12 deficiencies, nutritional deficiency, anemia during growth, old age,
prolonged illnesses & convalescence. Pre- & postnatal Fe deficiency, supplement for prenatal care, postpartum & lactation.
Prevention of neural tube defects.
Dosage (children &
adult)
1-2 cap daily.
Direction of Use
Should be taken with food: Take w/ or after meals.
Side effects
GI intolerance.
Contraindications
Hypersensitivity.
Interactions
(drug/food)
Contents: Fe sulfate (equiv to 65 mg elemental Fe) 200 mg, folic acid 400 mcg, niacinamide 20 mg, vit B1 2 mg, vit B12 10 mcg, vit
B2 2 mg, vit B6 2 mg, vit C 100 mg
●
●
Avoid taking an antibiotic medicine within 2 hours before or after you take multivitamins with iron. This is especially
important if you are taking an antibiotic such as ciprofloxacin, levofloxacin norfloxacin, doxycycline, minocycline,
tetracycline, and others.
Do not take multivitamin with iron with milk, other dairy products, calcium supplements, or antacids that contain calcium.
Special Precautions/
Warnings
Store at temperatures not exceeding 30°C, away from direct sunlight.
Important counselling
notes
GENERAL COUNSELLING FOR MULTIVITAMIN WITH IRON:
● Never take more than the recommended dose of a multivitamin.
● Avoid taking any other multivitamin product within 2 hours before or after you take multivitamins with iron.
● Taking similar vitamin products together at the same time can result in a vitamin overdose or serious side effects.
● Missed Dose: Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next
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●
scheduled dose. Do not take extra medicine to make up the missed dose.
It is important to make patients aware of ways in which they can increase their dietary iron intake with foods like red meat
(beef, lamb, pork), leafy vegetables (spinach, broccoli, cabbage), dried fruits, and nuts.
6. Antihypertensive for pregnant
● 1st line: Methyldopa, Labetalol
● 2nd line: Nifedipine
Rx
Apresoline
Generic Name /
Device Name
Hydralazine
Therapeutic Category
Vasodilators
Indication/Uses
For severe hypertension
Dosage (pregnant)
5-10 mg IV/IM initially, then 5-10 mg every 20-30min as needed, or 0.5-10 mg/hr IV infusion
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Direction of Use
Hydralazine should be given as an IV bolus at a dose of 5-10 mg, depending on the severity of hypertension, and may be
administered every 20 minutes up to a maximum dose of 30 mg.
Side effects
Headache, nausea and vomiting
Contraindications
Contraindicated to pregnant women if they are in their third trimester
Interactions
(drug/food)
Monoamine oxidase inhibitors (MAOIs) can increase the effects of hydralazine, MAO inhibitors such as tranylcypromine (Parnate),
phenelzine (Nardil), selegiline (Eldepryl, Zelapar), isocarboxazid (Marplan), and rasagiline (Azilect)
. This raises your risk of side effects, such as very low blood pressure (hypotension).
Special Precautions/
Warnings
Use should be avoided during the first two trimesters of pregnancy; use is not recommended during the third trimester unless the
benefit outweighs the risk to the fetus.
Important counselling
notes
Don't stop taking hydralazine suddenly. Doing so may lead to uncontrolled high blood pressure. It can raise your risk for heart
problems, such as chest pain or heart attack.
Rx
Trandate
Generic Name /
Device Name
Labetalol
Therapeutic Category
Beta-blockers
Indication/Uses
Hypertension
Dosage (pregnantt)
An initial dosage of 100 mg twice daily may be increased, if necessary at weekly intervals by 100 mg twice daily. The total daily
dosage should not exceed 2400 mg.
Direction of Use
Labetalol orally administered in a twice-daily regimen as done in this study is an effective antihypertensive drug in women with
hypertension during late pregnancy. Should be taken with food.
Side effects
●
●
●
Dizziness
Nausea
Tiredness
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Contraindications
Interactions
(drug/food)
Contraindicated during the first trimester of pregnancy
●
●
Combining labetalol with tricyclic antidepressants such as amitriptyline (Elavil, Endep), imipramine (Tofranil), or nortriptyline
(Pamelor) may lead to an increase in tremor which is a side effect of tricyclic antidepressants.
Combined with adrenergic stimulating drugs used for treating asthma, for example, albuterol (Proventil, Ventolin) or
pirbuterol (Maxair), the adrenergic blocking effects of labetalol may counteract the effects of the stimulating drugs and
reduce their effectiveness for treating asthmatic patients.
Special Precautions/
Warnings
●
Before taking labetalol, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product
may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more
details.
Important counselling
notes
●
●
●
Labetalol should only be used during the first trimester
Do not stop taking labetalol suddenly, especially if you have heart disease. This can make your condition worse.
If you forget to take your dose, take it as soon as you remember. If it’s just a few hours until the time for your next dose, wait
and only take one dose at that time.
Rx
Aldomet
Generic Name /
Device Name
Methyldopa
Therapeutic Category
Alpha2 Agonists, Central-acting
Indication/Uses
Prevent the complications caused by hypertension (high blood pressure) in pregnancy
Dosage (pregnant)
250 mg two or three times a day in the first 48 hours. The daily dosage then may be increased or decreased, preferably at intervals
of not less than two days
Direction of Use
May be taken with or without food
Side effects
●
Drowsiness
●
Weakness
●
Headache
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Contraindications
With liver disease (Intrahepatic Cholestasis)
Interactions
(drug/food)
Food: Intake of sodium-containing foods when you are on methyldopa will reduce the blood-pressure lowering effect of methyldopa.
It is better to avoid salty foods while taking this medicine.
Drug: Antidepressant drugs (selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa) and sertraline (Zoloft and
etc. can cause raise in Blood pressure.
Special Precautions/
Warnings
Methyldopa is only recommended for use during pregnancy when benefit outweighs risk. Methyldopa crosses the placenta, and may
cause mild hypotension in neonates of treated mothers.
Important counselling
notes
Methyldopa comes as a tablet and a liquid to take by mouth. It usually is taken two to four times a day. To help you remember to take
methyldopa, take it around the same times every day. Follow the directions on your prescription label carefully, and ask your doctor
or pharmacist to explain any part you do not understand. Take methyldopa exactly as directed. Do not take more or less of it or take
it more often than prescribed by your doctor.
Rx
Adalat
Generic Name /
Device Name
Nifedipine
Therapeutic Category
Calcium-Channel blockers
Indication/Uses
Severe hypertension
Dosage (pregnantt)
Typical dose include 10 mg SL with 20 mg PO, 30 mg PO, or 10 to 20 mg SL or PO every 15 to 20 minutes until contractions stop,
up to a maximum of 30 to 40 mg over 1 hour
Direction of Use
May be taken with or without food, swallow whole , do not chew/crush.
Side effects
Contraindications
●
●
●
●
Flushing
Headaches
Dizziness
Nausea
Nifedipine can cause vascular dilatation in both the uterus and the placenta. The use of nifedipine within the normal dose range does
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not appear to adversely affect fetal outcome and may potentially improve fetal outcome in some disorders of pregnancy.
Interactions
(drug/food)
●
●
Avoid grapefruit juice
Drug: Antidepressant drugs (selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa) and sertraline
(Zoloft and etc. can cause raise in Blood pressure.
Special Precautions/
Warnings
Nifedipine is classified as FDA pregnancy category C. According to the manufacturer, the drug should be used only when its benefits
clearly outweigh the risks to the fetus.
Important counselling
notes
Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue
your regular dosing schedule. Do not take a double dose to make up for a missed one.
7. Multiple diuretics
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Rx
Moduretic
Generic Name /
Device Name
Amiloride and hydrochlorothiazide (5 mg/50 mg)
Therapeutic Category
Diuretic combination
Indication/Uses
For hypertension
Dosage (children &
adult)
Adult: 5/50-10/100 mg (amiloride/HCTZ)/day PO, not advisable for age below 18 years old
Direction of Use
Take hydrochlorothiazide and amiloride with food.
Side effects
Contraindications
Interactions
(drug/food)
●
diarrhea
●
constipation
●
mild stomach pain
●
tired feeling.
You should not use this medication if you are allergic to hydrochlorothiazide or amiloride, or if you have
● kidney disease or are unable to urinate
● high potassium levels (hyperkalemia); or
● if you are taking potassium supplements.
●
●
Special Precautions/
Warnings
Tell your doctor if you regularly use other medicines that make you light-headed (such as cold medicine, a sleeping pill,
narcotic pain medicine, muscle relaxer, or medicine for anxiety, depression, or seizures). They can add to the side effects of
hydrochlorothiazide and amiloride.
Do not eat certain foods which contain a lot of potassium. These foods include milk, bananas, raisins and prunes.
You should not use Moduretic 5-50 if you have kidney disease, urination problems, diabetes, or high levels of potassium in your
blood.
Important counselling If you need surgery or medical tests, tell the doctor ahead of time that you are taking medication that contains hydrochlorothiazide.
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notes
You may need to stop using the medicine for a short time. If you are being treated for high blood pressure, keep using this
medication even if you feel well.
8. Amoxicillin 500mg
Rx
Amoxil
Generic Name /
Device Name
Amoxicillin
Therapeutic Category
Penicillin
Indication/Uses
Treatment of upper &amp; lower resp tract, GIT, GUT, skin &amp; soft tissue, biliary tract, bone &amp; pelvic infections; gonorrhea,
septicemia, endocarditis, meningitis, peritonitis, dental abscess (as an adjunct to surgical management). <em>H. pylori</em>
eradication in PUD. Prophylaxis of endocarditis.
Dosage (children &
adult)
Adults, teenagers, and children weighing 40 kilograms (kg) or more—250 to 500 milligrams (mg) every 8 hours, or 500 to 875 mg
every 12 hours.
Direction of Use
May be taken with or without food: However it is highly recommended to take w/ meals for better absorption &amp; to reduce GI
discomfort.
Side effects
●
●
●
●
●
nausea
vomiting
diarrhea
rash
vaginal yeast infection
Contraindications
Amoxicillin is contraindicated in patients with a known serious hypersensitivity reaction (i.e., anaphylaxis) to other beta-lactams.
Patients with allergies or atopic conditions including asthma, eczema, hives (urticaria), or hay fever may have a greater risk for
hypersensitivity reactions to penicillins.
Interactions
(drug/food)
After taking an antibiotic you may need to wait for up to three hours before eating or drinking any dairy products. Grapefruit juice
and dietary supplements containing minerals like calcium may also work dampen the effect of antibiotics
Do not take these medication when you are taking the following drugs:
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Special Precautions/
Warnings
●
any other antibiotics;
●
allopurinol;
●
probenecid; or
●
a blood thinner--warfarin, Coumadin, Jantoven.
●
Finishing therapy: It’s important to finish the entire course of treatment as prescribed by your doctor. Do not stop taking
this drug or skip doses if you start to feel better. This could cause your infection to last longer. You could also develop a
resistance to the medication. This means that if you get a bacterial infection in the future, you may not be able to treat it with
amoxicillin.
Diarrhea: Amoxicillin may cause diarrhea. Call your doctor if you have bloody or watery diarrhea, with or without stomach
cramps and fever.
●
Important counselling
notes
If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose
and go back to your regular dosing schedule.
9. Classes of laxatives
Class
Uses
Drugs
Bulk Laxatives
Bulk laxatives relieve constipation by forming soft and bulky stools; and by promoting contraction of Methylcellulose, Wheat
intestinal muscles. They are generally considered the safest and are appropriate for patients with small bran, Ispaghula
hard stools.
Stimulant Laxatives
Stimulant laxatives speed up the bowel movement by stimulating the contraction of intestinal muscles.
Bisacodyl, Senna,
Glycerol
Osmotic Laxatives
Osmotic laxatives draw fluid into the bowel, and facilitate bowel movement with bulky and softer stools.
Macrogols, Saline
laxatives (magnesium
hydroxide)
Stool softeners
Stool softeners add moisture to stools, and make them softer and easier to pass out of the body. They
have added value for patients with haemorrhoids or anal fissures.
Docusate
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OTC
Metamucil (BULK LAXATIVE)
Generic Name /
Device Name
Psyllium
Therapeutic Category
Use to treat constipation
Indication/Uses
Laxative
Dosage (children &
adult)
Direction of Use
Side effects
●
Adult: 2.5-7.5 g in 8 oz of water orally, up to 30 g/d divided orally or
●
1 teaspoonful or 1 tablespoon in 8 oz of water orally one to three times daily, depending on product
●
Children under 6 years old: Safety and efficacy not established
●
Children 6-12 years old: 1.25-15 g/day orally in 8 oz of water in divided doses
●
Children over 12 years old: 2.5-7.5 g in 8 oz of water orally, up to 30 g/day in divided doses
Should be taken with food: Drink 6-8 glasses of water a day. Husk: Mix 1 tbsp in &frac12; glass of water or juice. Stir for 10 sec then
drink immediately.
●
●
Bloating
minor change in your bowel habits
Contraindications
Hypersensitivity, GI obstruction, fecal impaction, symptoms of appendicitis or acute surgical abdomen, GI ulceration, dysphagia,
rectal bleeding.
Interactions
(drug/food)
Drugs:
This medication contains psyllium. Do not take Fiberall, Metamucil, or Perdiem Fiber if you are allergic to psyllium or any ingredients
contained in this drug.
Foods:
Special Precautions/
Warnings
Tell your doctor and pharmacist what prescription and nonprescription medications you are taking, including vitamins. Do not take
digoxin (Lanoxin), salicylates (aspirin), or nitrofurantoin (Macrodantin, Furadantin, Macrobid) within 3 hours of taking psyllium.
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Important counselling
notes
●
●
●
Since Metamucil is used when needed, you may not be on a dosing schedule. Skip any missed dose if it's almost time for
your next dose. Do not use two doses at one time.
Avoid breathing in the dust from Metamucil powder when mixing. Inhaling this medicine dust may cause an allergic reaction
Do not take psyllium for longer than 7 days in a row without a doctor's advice.
OTC
Dulcolax (STIMULANT LAXATIVE)
Generic Name /
Device Name
Bisacodyl
Therapeutic Category
Laxative
Indication/Uses
Dulcolax is used to treat constipation or to empty the bowels before surgery, colonoscopy, x-rays, or other intestinal medical
procedure.
Dosage (children &
adult)
Usual Adult Dose for Bowel Preparation:
5 to 15 mg (1 to 3 tablets) orally once a day as needed or
10 mg (1 suppository) rectally once a day as needed or
10 mg rectal liquid once a day as needed.
Usual Adult Dose for Constipation:
5 to 15 mg (1 to 3 tablets) orally once a day as needed or
10 mg (1 suppository) rectally once a day as needed or
10 mg rectal liquid once a day as needed.
Direction of Use
Side effects
Contraindications
Interactions
Should be taken on an empty stomach. Do not take w/in 1 hr of antacids, milk or other dairy products.
●
●
●
stomach pain or discomfort
feeling light-headed; or
rectal burning.
Severe dehydration, ileus, intestinal obstruction, acute abdominal conditions (e.g. appendicitis, acute inflammatory bowel disease,
severe abdominal pain)
●
Avoid using other medications within 2 hours before or 2 hours after using Dulcolax.
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(drug/food)
Special Precautions/
Warnings
Important counselling
notes
●
Avoid drinking milk or taking an antacid within 1 hour before you take Dulcolax by mouth.
Patient with inflammatory bowel disease. Renal impairment. Children. Pregnancy and lactation. Avoid prolonged use (&gt;5 days).
●
●
If this product is used too frequently, it may cause loss of normal bowel function and an inability to have a bowel movement
without using the product (laxative dependence). If you notice symptoms of overuse, such as diarrhea, abdominal pain,
decreased weight, or weakness, contact your doctor promptly.
If this product fails to produce a bowel movement, or if you think you may have a serious medical problem, contact your
doctor promptly.
OTC
Citroma (OSMOTIC LAXATIVE)
Generic Name /
Device Name
Magnesium Citrate
Therapeutic Category
Laxative (osmotic )
Indication/Uses
Magnesium citrate is used for:
● Bowel evacuation (bowel preparation or cleansing)
● Constipation
● Bowel irregularity
● A nutritional supplement and for treating acid indigestion
Dosage (children &
adult)
Nutritional Supplementation
19-30 year old:
● Men – 400 mg/day
●
Women – 310 mg/day
●
Pregnant women younger than 50 years old: 350 mg/day
● Breastfeeding women younger than 50 years old: 320 mg/day
Constipation/Bowel Evacuation:
● Adult dosage:
● 195-300 ml orally in a single daily dose or in divided doses with a full glass of water
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● Alternatively, 2-4 tablets orally at bedtime
Pediatric dosage:
● Children under 2 years old: Safety and efficacy not established
●
Children 2-6 years old: 60-90 ml orally once or in divided doses, not to exceed 90 mg/24 hours
●
Children 6-12 years old: 90-120 ml in a single dose or divided doses with a full glass of water
Children over 12 years old: 195-300 ml orally in a single dose or in divided doses with a full glass of water, alternatively,
may administer 2-4 tablets orally at bedtime
Acid Indigestion:
● 1 tablet twice daily or as directed by healthcare provider
●
Direction of Use
Side effects
Contraindications
Interactions
(drug/food)
Take Citroma on an empty stomach, at least 1 hour before or 2 hours after a meal. Measure liquid medicine with the dosing syringe
provided, or with a special dose-measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your
pharmacist for one. Take this medicine with a full glass of water
●
●
●
●
For this product - Do not use - if you are on a low salt diet - Ask a doctor before use if you have - kidney disease - a magnesium or
sodium-restricted diet - abdominal pain and nausea
●
●
Special Precautions/
Warnings
excessive thirst.
headache.
nausea.
stomach cramps.
Alcohol can decrease the actions of Magnesium supplements by increasing Magnesium elimination from the body. To get
the best results, limit your intake of alcoholic beverages while taking Magnesium supplements
Magnesium can bind with certain medications, preventing their full absorption. If you are taking a tetracycline-type
medication (such as demeclocycline, doxycycline, minocycline, tetracycline), separate the time of the dose from the time of
the magnesium supplement dose by at least 2 to 3 hours.
Avoid use when the following conditions are present:
● renal failure
●
existing electrolyte imbalance
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Important counselling
notes
●
appendicitis or acute surgical abdomen
●
myocardial damage or heart block
●
fecal impaction or rectal fissures
●
intestinal obstruction or perforation
●
dehydration
Avoid taking any other medicines within 2 hours before or 2 hours after you take magnesium citrate. Laxatives can make it harder
for your body to absorb certain other drugs. Do not increase your dose or take it more often than directed on the product package or
by your doctor.
OTC
Colace (STOOL SOFTENERS)
Generic Name /
Device Name
Docusate
Therapeutic Category
Laxative (stool softener)
Indication/Uses
Colace is used to treat or prevent occasional constipation, and to reduce pain or rectal damage caused by hard stools or by straining
during bowel movements.
Dosage (children &
adult)
Adult:
● Docusate sodium: 50-300 mg PO once daily or divided doses
● Docusate calcium: 240 mg PO qDay
Children:
Docusate sodium
●
●
●
<2 years: Safety & efficacy not established
2-12 years: 50-150 mg PO qDay or divided doses
>12 years: 50-300 mg PO once daily or divided doses
Docusate calcium
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●
●
<12 years: Safety & efficacy not established
>12 years: 240 mg PO qDay
Direction of Use
Take this medication by mouth, usually at bedtime with a full glass (8 ounces or 240 milliliters) of water or juice, or as directed by
your doctor. The dosage is based on your medical condition and response to therapy.
Side effects
Stomach pain, diarrhea, or cramping may occur. Irritated throat (with liquid or syrup forms) may also occur.
Contraindications
Intestinal obstruction or undiagnosed abdominal symptoms; presence of abdominal pain, nausea, vomiting. Concomitant use with
liquid paraffin.
Interactions
(drug/food)
Medications known to interact with Colace (docusate)
● lactulose.
● linaclotide.
● mineral oil.
● phenolphthalein.
Special Precautions/
Warnings
Avoid prolonged use. Pregnancy and lactation.
Important counselling
notes
You should not use Colace if you have a blockage in your intestines. Do not use Colace while you are sick with nausea, vomiting, or
severe stomach pain. In general, stool softeners should not be taken within 2 hours of other medications, since they may reduce the
effectiveness of those medications. Talk with your doctor or pharmacist to verify that this is the case with the medications that you
are taking.
10. Benzoyl peroxide
OTC
Benzac
Generic Name /
Device Name
Benzoyl Peroxide
Therapeutic Category
Topical antibiotic
Indication/Uses
This medication is used to treat mild to moderate acne. It may be used in combination with other acne treatments. When applied to
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the skin, benzoyl peroxide works by reducing the amount of acne-causing bacteria and by causing the skin to dry and peel.
Dosage (children &
adult)
Topical/Cutaneous
Acne vulgaris
Adult: 2.5-10% preparations: Apply or use 1-2 times daily or as directed to the affected areas. May initiate treatment with lower
strength preparations. Dos
age recommendations and directions for use may vary among individual products
Child: 12 Same as adult dose. Recommendations for use in children may vary among individual products
Direction of Use
Side effects
Apply in a thin layer once or twice daily or as directed by the dermatologist to the affected areas. Persons with sensitive skin should
be directed to apply it once daily before going to bed. The extent of any drying or peeling may be adjusted by modifying the dosage
schedule
●
●
●
itching or tingly feeling;
skin dryness, peeling, or flaking; or
redness or other irritation
Contraindications
Hypersensitivity
Interactions
(drug/food)
Do not use benzoyl peroxide with any other medicines that may have drying or irritating effects on your skin. These include
alcohol-based skincare products. Always check the ingredients on the label and choose products for sensitive skin.
Special Precautions/
Warnings
Application to the neck and other sensitive areas. Concomitant use with other topical acne therapy. Children. Pregnancy and
lactation.
Important counselling
notes
●
●
Before using this product for the first time, check if you are allergic to it. To check, put a small amount on one or two small
areas of acne for three days. If you have an allergic reaction, stop using this product and get medical help right away (see
the symptoms of an allergic reaction in the Side Effects section). If you don't have an allergic reaction, you can use the
product.
Avoid contact with eyes, eyelids, mouth, lips, and other mucous membranes, or broken skin. Avoid deliberate or prolonged
exposure to sunlight or UV radiation; use sunscreen and wear protective clothing. May bleach hair and coloured fabrics;
avoid contact with hair, clothing, furniture or carpeting.
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11. Carbimazole 20mg
Rx
NeoMercazole 20 mg
Generic Name /
Device Name
Carbimazole
Therapeutic Category
Antithyroid agents
Indication/Uses
Used to treat hyperthyroidism
Dosage (children &
adult)
Adult:
Initial dose: 20 mg (1-3 tabs each day).
Children:
Initially 5 mg/day.
Direction of Use
May be taken with or without food. Swallow whole with a drink of water.
Side effects
Nausea, headache, stomach upset, changes to the taste
Contraindications
Hyperthyroidism due to nodular goitre.
Interactions
(drug/food)
Potentially Fatal: Increased sensitivity to warfarin in hyperthyroidism, antibiotics, beta-blockers
Special Precautions/
Warnings
Liver diseases, Pregnancy, lactation.
Important counselling
notes
The illness usually starts to improve within one to three weeks. However, it usually takes four to eight weeks to have full benefit
from your treatment.
● When the illness is controlled, the doctor will gradually lower your dose to one to three 5 mg tablets each day
● Do not change your dose without talking to your doctor first.
● You may need to keep taking Carbimazole for several months to keep control of your thyroid gland. Your doctor will decide
when treatment can be stopped.
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12. Lozenge for sore throat
OTC
Difflam
Generic Name /
Device Name
Benzydamine Hydrochloride
Therapeutic Category
Preparation for Oral Ulceration & Inflammation
Indication/Uses
Temporary relief of painful conditions of the oral cavity including tonsillitis, sore throat, and other inflammation in the mouth and
throat.
Dosage (children &
adult)
Adult and Children >6 years old: 1 lozenge every 1-2 hours
Max dose: 12 lozenges/day
Max duration: 7 days
Direction of Use
Let it dissolve slowly in the mouth up to three times a day. Should not be swallowed and chewed.
Side effects
Oral numbness, thirst, altered sense of taste
Contraindications
Hypersensitivity to the components of Difflam
Interactions
(drug/food)
No known drug interactions
Special Precautions/
Warnings
A doctor should be consulted immediately if the patient:
● Has history of asthma
● Has glucose intolerance
● If the pain in the mouth gets worse even after taking lozenges for 7 days
Important counselling
notes
Remind the patient that Difflam should not be used for more than 1 week.
Remind the patient to just sip a glass of water if he/she experiences a burning sensation or dryness in the mouth when taking.
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13. Paracetamol
OTC
Biogesic
Generic Name /
Device Name
Paracetamol
Therapeutic Category
Analgesic (Non-Opioid) and Antipyretic
Indication/Uses
used to relieve mild to moderate pain such as headache, backache, menstrual cramps, muscular strain, minor arthritis pain,
toothache, and reduce fevers caused by illnesses such as the common cold and flu.
Dosage (children &
adult)
Adult and children >12 yr: 1-2 500 mg tabs orally every 4-6 hours
Children <12 yr: (oral drop) 100 mg/kg body weight every 4 hours
Direction of Use
May be taken with or without food. Should be swallowed whole. Should not be chewed or crushed.
Side effects
Dizziness, drowsiness, constipation, stomach upset, blurred vision, or dry mouth/nose/throat
Contraindications
Hypersensitivity to paracetamol or to any of its ingredients.
Interactions
(drug/food)
Warfarin or other coumarin derivatives. Other NSAIDs. Alcohol
Special Precautions/
Warnings
best to check with the doctor for advice before taking Paracetamol if the patient has anemia or heart, lung, liver, or kidney problems
Important counselling
notes
Do not give regular paracetamol to an infant younger than one month old unless advised to do so by a doctor. Should the medicine
not relieve your symptoms within an hour, it is also not recommended to take more than the recommended dose. If you miss a dose,
take the next dose if it’s still needed for pain and/or fever and the subsequent 4 to 6 hours thereafter. Do not double the dose.
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14. ACE-inhibitor side effects
ACE INHIBITOR SIDE EFFECTS
Important Counselling
notes
ACE inhibitors are used to treat a number of heart-related conditions, including high blood pressure, heart failure, heart attack, and
preventing kidney damage associated with high blood pressure and diabetes
Examples of ACE Inhibitor drugs: Captopril, Enalapril, Quinapril, Ramipril, Fosinopril, Lisinopril
Side effects:
● Cough.
● Dizziness, lightheadedness or faintness upon rising (may be strongest after the first dose, especially if you have been
taking a diuretic)
● Salty or metallic taste or a decreased ability to taste ( usually goes away as you continue taking the medication).
● Physical symptoms. Sore throat, fever, mouth sores, unusual bruising, fast or irregular heartbeat, chest pain, and swelling
of feet, ankles and lower legs
● Swelling of your neck, face, and tongue (serious side effects)
● High potassium levels. This is a potentially life-threatening complication.
● Kidney failure.
● Severe vomiting or diarrhea.
NOTE: Tell the patient to immediately consult a doctor if she/he experiences serious side effects. The doctor may adjust the dose or
change the medication.
15. Ramipril
Rx
Altace
Generic Name /
Device Name
Ramipril
Therapeutic Category
ACE Inhibitors (Antihypertensives)
Indication/Uses
used to treat high blood pressure (hypertension) or congestive heart failure, and to improve survival after a heart attack
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Dosage (children &
adult)
For HTN:
Adult dosage (ages 18–64 years)
● no diuretic: 2.5–20 mg per day, taken by mouth in 1 or 2 divided doses per day
● With diuretic: 1.25 mg taken once per day
For prevention of heart attack:
Adult dosage (ages 18–64 years): 2.5 mg taken by mouth/day for 1 week. Then 5 mg taken once per day for 3 weeks.
For heart failure:
Adult dosage (ages 18–64 years): 2.5 mg taken by mouth bid (total of 5 mg per day).
If BP drops too low: 1.25 mg bid
Not recommended for children.
If with kidney problems: 1.25 once per day
Direction of Use
May be taken with or without food. Should be swallowed whole.
Side effects
Headache, cough, malaise, dizziness, nausea, vomiting
Contraindications
●
●
●
●
History of angioedema
Hypotensive
Hypersensitivity to ramipril and its components
Pregnancy and lactation
Interactions
(drug/food)
●
●
●
Potassium supplements
Diuretics
NSAIDs
Special Precautions/
Warnings
Important counselling
notes
Warnings for people with the following conditions:
● Kidney disease
● With low WBC
● diabetes
●
●
Remind the patient to monitor his/her BP regularly.
Practice a healthy lifestyle. Avoid alcoholic drinks.
16. HCTZ 20mg/25mg
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Rx
Diuzid
Generic Name /
Device Name
Hydrochlorothiazide
Therapeutic Category
Diuretics
Indication/Uses
Dosage (children &
adult)
●
●
●
●
●
Treatment of edema associated w/ heart failure & renal hepatic disorders.
HTN, either alone or together w/ other antihypertensives e.g., ACE inhibitors & β-blockers.
Treatment of edema accompanying premenstrual syndrome,
prevention of water retention associated w/ corticosteroids & estrogens,
treatment of diabetes insipidus & prevention of renal calculus formation in patients w/ hypercalciuria.
Edema Usual dose: 25-100 mg daily, up to 200 mg daily (for severe cases). Reduced to 25-50 mg daily or intermittently.
Nephrogenic diabetes insipidus Up to 100 mg daily.
HTN Usual dose: 25-50 mg daily.
Childn 1-2 mg/kg daily in 2 divided doses. Infant <6 mth Up to 3 mg/kg daily.
Direction of Use
Should be taken with food.
Side effects
Dry mouth, thirst, weakness, lethargy, drowsiness, restlessness, muscle pain & cramps, seizures, oliguria, hypotension & GI
disturbances. Anorexia, nausea, vomiting, constipation, diarrhea, impotence & yellow vision.
Contraindications
●
●
●
●
Pregnancy & lactation.
Patients w/ severe renal impairment or anuria,
Addison's disease,
preexisting hypercalcemia.
Interactions
(drug/food)
●
●
●
●
●
●
●
Digitalis glycosides,
muscle relaxants.
Corticosteroids,
corticotropin,
salbutamol,
carbenoxolone,
amphotericin B or reboxetine.
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Special Precautions/
Warnings
Important counselling
notes
●
●
●
α-blockers or ACE inhibitors.
Alcohol, barbiturates or opioids.
Lithium, allopurinol & tetracyclines.
●
●
●
●
Patients w/ renal impairment,
existing fluid & electrolyte disturbances.
Elderly.
May precipitate attacks of gout, cause hyperglycemia & aggravate or unmask DM.
No info
17. Simvastatin
Rx
Zocor/Zocor HP
Generic Name /
Device Name
Simvastatin
Therapeutic Category
Dyslipidemic agents
Indication/Uses
Patients at high risk of CHD (w/ or w/o hyperlipidemia) including patients w/ diabetes, history of stroke or other cerebrovascular
disease, peripheral vessel disease, or w/ existing CHD
Dosage (children &
adult)
●
-
5-80 mg/day as a single dose in the evening
Patient at high risk of CHD or w/ existing CHD: Initially 40 mg/day
Hyperlipidemia: Initially 20 mg/day
Direction of Use
May be taken with or without food.
Side effects
Abdominal pain, constipation & flatulence; asthenia & headache.
Contraindications
●
●
●
Hypersensitivity.
Active liver disease
Concomitant administration of potent CYP3A4 inhibitors
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Interactions
(drug/food)
●
●
●
CYP3A4 inhibitors.
grapefruit juice.
coumarin anticoagulants.
Special Precautions/
Warnings
●
●
●
●
●
Risk of myopathy/rhabdomyolysis;
predisposing factors for myopathy include advanced age (≥65 yr),
female gender,
uncontrolled hypothyroidism, &
renal impairment;
Important counselling
notes
●
Take this medication in the evening.
18. Non pharmacologic Treatment for Constipation
Nonpharmacologic treatment for Constipation
Important counselling Diet and lifestyle changes
notes
Your doctor may recommend the following changes to relieve your constipation:
● Increase your fiber intake.
- Adding fiber to your diet increases the weight of your stool and speeds its passage through your intestines.
- Slowly begin to eat more fresh fruits and vegetables each day. Choose whole-grain breads and cereals.
- Your doctor may recommend a specific number of grams of fiber to consume each day. In general, aim for 14
grams of fiber for every 1,000 calories in your daily diet.
- A sudden increase in the amount of fiber you eat can cause bloating and gas, so start slowly and work your way
up to your goal over a few weeks.
● Exercise most days of the week.
- Physical activity increases muscle activity in your intestines. Try to fit in exercise most days of the week. If you do
not already exercise, talk to your doctor about whether you are healthy enough to start an exercise program.
● Don't ignore the urge to have a bowel movement.
- Take your time in the bathroom, allowing yourself enough time to have a bowel movement without distractions and
without feeling rushed.
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19. Alendronate
Rx
Aldren 70
Generic Name /
Device Name
Alendronic acid
Therapeutic Category
Agents affecting Bone Metabolism (Belongs to the class of bisphosphonates.)
Indication/Uses
●
●
Treatment & prevention of osteoporosis in postmenopausal women.
Treatment to increase bone mass in men w/ osteoporosis.
Dosage (children &
adult)
70 mg once weekly.
Direction of Use
Should be taken on an empty stomach: Take at least 30 min before the 1st food/drink/medication of the day w/ a full glass of plain
water & remain in sitting/upright position for at least 30 min. Swallow whole, do not chew/crush.
Side effects
Abdominal pain, nausea, dyspepsia, constipation, diarrhea, flatulence, acid regurgitation, esophageal ulcer, vomiting, dysphagia,
abdominal distension, gastritis, gastric ulcer, melena; musculoskeletal (bone, muscle or joint) pain, muscle cramps; headache,
dizziness; taste perversion.
Contraindications
●
●
●
●
Hypersensitivity.
Abnormalities of the esophagus which delayed esophageal emptying eg, stricture or achalasia.
Inability to stand or sit upright for at least 30 min.
Hypocalcemia.
Interactions
(drug/food)
●
●
●
●
●
Ca supplements,
antacids;
aspirin-containing products;
NSAIDs;
IV ranitidine.
Special Precautions/
Warnings
●
●
●
●
Discontinue use if dysphagia, odynophagia, retrosternal pain or new or worsening heartburn develop.
Patients w/ active upper GI problems.
Correct hypocalcemia & treat other disturbances of mineral metabolism (eg, vit D deficiency) prior to initiating therapy.
Renal insufficiency
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Important counselling
notes
No info
20. ACE inhibitor side effects
Rx
Important counselling
notes
ACE inhibitor side effects
Angiotensin converting enzyme (ACE)are used to treat a number of heart-related conditions, including high blood pressure, heart
failure, heart attack, and preventing kidney damage associated with high blood pressure and diabetes.
Like any drug, an ACE inhibitor is likely to have some side effects. They may include:
● Cough. If this symptom persists or is severe, contact your doctor. Ask your doctor what type of cough medicine you should
use to control the cough. Your doctor may switch you to a different medication that will not cause a cough,
● Red, itchy skin or rash. Contact your doctor; do not treat the rash yourself.
● Dizziness, lightheadedness or faintness upon rising. This side effect may be strongest after the first dose, especially if
you have been taking a diuretic (water pill). Get up more slowly. Contact your doctor if these symptoms persist or are
severe.
● Salty or metallic taste or a decreased ability to taste. This effect usually goes away as you continue taking the
medication.
● Physical symptoms.Sore throat, fever, mouth sores, unusual bruising, fast or irregular heartbeat, chest pain, and
swelling of feet, ankles and lower legs. Contact your doctor if you have any of these symptoms.
● Swelling of your neck, face, and tongue. See a doctor right away if you have any of these symptoms. These represent a
serious emergency.
● High potassium levels. This is a potentially life-threatening complication. Therefore, people on ACE inhibitors should
regularly have blood tests to measure potassium levels. Signs of too much potassium in the body include confusion,
irregular heartbeat, nervousness, numbness or tingling in hands, feet or lips, shortness of breath or difficulty breathing, and
weakness or heaviness in legs. Contact your doctor right away if you have any of these symptoms.
● Kidney failure. Although ACE inhibitors help to protect the kidneys, it can also cause kidney failure in some people.
● Severe vomiting or diarrhea. If you have severe vomiting or diarrhea you may become dehydrated, which can lead to low
blood pressure. Contact your doctor right away.
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21. Stresstabs
OTC
Stesstabs
Generic Name /
Device Name
Multivitamins + Iron
Therapeutic Category
Vitamins &/ or Minerals
Indication/Uses
Prevention & treatment of vit B-complex, vit C & E, Fe deficiencies during periods of stress.
Dosage (children &
adult)
1 tab daily.
Direction of Use
May be taken with or without food: May be taken w/ meals for better absorption.
Side effects
Abdominal discomfort, constipation, diarrhea, nausea, stomach discomfort, hypersensitivity.
Contraindications
Hypersensitivity to its content.
Interactions
(drug/food)
No information available. But from another source: Multivitamin that has also iron, antacids, bisphosphonates, thyroid medications,
antibiotics. Consult a doctor if there is an anti-seizure drug.
Special Precautions/
Warnings
Do not exceed the recommended daily dose. Do not exceed upper tolerable intake Fe levels (45 mg/day). Pregnancy & lactation.
Important counselling
notes
Tell your doctor first if you are pregnant. This medication passes into breast milk. Consult your doctor before breast-feeding.
22. Evening primrose
OTC
Generic Name /
Device Name
Eveprim
Evening primrose oil
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Therapeutic Category
Supplements & Adjuvant therapy
Indication/Uses
Relieve symptoms of premenstrual tension & menopausal discomforts. Also indicated for cervical ripening.
Dosage (children &
adult)
1 softgel cap once-tid.
Direction of Use
Should be taken with food.
Side effects
upset stomach, nausea, diarrhea, and headache
Contraindications
No info
Interactions
(drug/food)
Anticoagulant drugs: Taking evening primrose oil along with medications that also slow clotting might increase the chances of
bruising and bleeding.
Taking evening primrose oil with phenothiazines might increase the risk of having a seizure
Special Precautions/
Warnings
Bleeding disorders: There is a concern that evening primrose might increase the chance of bruising and bleeding. Don't use it if you
have a bleeding disorder.
Surgery: Evening primrose might increase the chance of bleeding during or after surgery. Stop using it at least 2 weeks before a
scheduled surgery.
Important counselling
notes
Possibly safe during pregnancy and breastfeeding, but it's best to check with your healthcare provider first.
23. Escitalopram
Rx
Escitalopram
Brand Name
Lexapro, Conjuopram, Escinal
Therapeutic Category
Antidepressants
Indication/Uses
Depression, Generalised anxiety disorder, Obsessive compulsive disorder, Social anxiety disorder, Panic disorder with or without
agoraphobia
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Dosage (children &
adult)
Depression, Generalised anxiety disorder, Obsessive compulsive disorder
● Adult: 10 mg once daily, may be increased after at least 1 week to Max of 20 mg once daily depending on patient response.
Social anxiety disorder
● Adult: 10 mg once daily, may be decreased to 5 mg or increased to Max of 20 mg once daily after at least 1 week
depending on patient response.
Panic disorder with or without agoraphobia
● Adult: Initially, 5 mg once daily for 1 week then increased to 10 mg once daily. May further increase the dose up to Max of
20 mg daily depending on patient response
Direction of Use
May be taken with or without food.
Side effects
Withdrawal syndrome, anxiety, Decreased or increased appetite, increased weight. Headache, dizziness
Contraindications
Known QT interval prolongation or congenital long QT syndrome, unstable epilepsy. Concomitant use of QT interval prolonging
agents (e.g. pimozide) and MAOIs (or within 14 days of use).
Interactions
(drug/food)
● Increased risk of bleeding tendencies with oral anticoagulants, antiplatelets, antipsychotic and NSAIDs
● Enhanced hypoglycaemic effect of antidiabetic agents
Food Interaction
Increased risk of serotonin syndrome with St. John’s wort.
Special Precautions/
Warnings
Re-evaluate treatment periodically. Monitor for clinical worsening, suicidal behaviour or ideation and unusual changes in behaviour.
Counselling Notes
This drug may impair cognitive or motor performance, if affected, do not drive or operate machinery.
24. Morphine (addiction effect)
Rx
Morphine
Brand Name
Hospira morphine
Therapeutic Category
Analgesic
Indication/Uses
To treat pain
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Dosage (children &
adult)
Oral
Adult: 5-20 mg 4 hourly. As extended-release tab/cap: Recommended initial dose: 1 or 2 (10 mg) tab 12-24 hourly.
Children: 1-5 years 5 mg 4 hourly (Max: 30 mg daily); 6-12 years 5-10 mg 4 hourly (Max: 60 mg daily); ≥13 years Same as adult
dose.
Intravenous
1-10 mg (Max 15 mg) via IV infusion over 4-5 minutes, then 1 mg on demand with 5-10 minutes lockout time.
Parenteral
10-20 mg 4-6 hourly (dose may vary from 5-20 mg) via SC, IM or IV inj.
Direction of Use
May be taken with or without food. May be taken w/ meals to reduce GI discomfort.
Side effects
Constipation, Drowsiness, Vertigo, Nausea, Depression, Increased tolerance, needing more potent doses to feel the same effects.
Addiction Effects:
● Dilated pupils
● Nodding off
● Inattention
● Shallow breath
● Hallucinations
● Euphoria
● False or unusual sense of well-being
● Mental and behavioral symptoms
○ Faking injuries or harming oneself to see a doctor for a prescription
○ Poor hygiene
○ Needle marks from injecting the drug
○ Changes in one’s circle of friends
○ Withdrawal from friends and family
Symptoms of Withdrawal:
● Anxiety
● Chills
● Gastrointestinal problems, such as diarrhea and cramps
● Fast heartbeat and breathing rate
● Insomnia
● Restlessness
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●
●
Overdosage
Sweating
Joint or muscle pain
Management: Ensure adequate airway, ventilation and oxygenation. Administration of opioid antagonists e.g. naloxone may be
given as an antidote.
Management in withdrawal:
Methadone - used to aid in detoxification and maintenance treatment of opioid addiction. Safe in pregnancy.
Contraindications
Interactions
(drug/food)
Special Precautions/
Warnings
Important counselling
notes
Drinking alcohol, taking prescription or nonprescription medications that contain alcohol, or using street drugs during your treatment
with morphine increases the risk that you will experience breathing problems or other serious, life-threatening side effects
●
●
●
●
●
●
Increased depressant effects with other CNS depressants
Reduced analgesic effect with mixed agonist/antagonist opioid analgesics
Decreased therapeutic effect of diuretics.
Increased risk of severe constipation and CNS depression with antidiarrheal agents
Food Interaction
Alcohol enhances the CNS depressant effect of morphine. Increased bioavailability with food (oral).
Morphine may cause serious or life-threatening breathing problems, especially during the first 24 to 72 hours of your treatment and
any time your dose is increased. The risk that you will develop breathing problems may be higher if you are an older adult or are
weakened or malnourished due to disease.
●
●
●
●
Morphine may be habit forming, especially with prolonged use. Take morphine exactly as directed. Do not take more of it,
take it more often, or take it in a different way than directed by your doctor.
Tell your doctor if you are pregnant or plan to become pregnant. If you take morphine regularly during your pregnancy, your
baby may experience life-threatening withdrawal symptoms after birth.
Monitor efficacy of pain control, vital signs, respiratory and mental status. Assess physical and/or psychological
dependence.
Sudden withdrawal from morphine can be extremely uncomfortable and unpleasant; therefore, a medically managed
detoxification is the best way to rid the body of the substance.
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25. MX3
OTC
MX3
Generic Name /
Device Name
Mangosteen xanthone
Therapeutic Category
FOOD SUPPLEMENT
Indication/Uses
used for diarrhea, urinary tract infections (UTIs), gonorrhea, thrush, tuberculosis, menstrual disorders, cancer, osteoarthritis, and an
intestinal infection called dysentery. It is also used for stimulating the immune system and improving mental health
Dosage (children &
adult)
1 tab daily
Direction of Use
May be taken with or without food.
Side effects
There is not enough reliable information to know if mangosteen products are safe for use as medicines.
Contraindications
Avoid use if hypertensive to any constituents of mangosteen.
Interactions
(drug/food)
Mangosteen might slow blood clotting and increase bleeding time. Taking mangosteen along with medications that also slow clotting
might increase the chances of bruising and bleeding.
Special Precautions/
Warnings
Bleeding disorders: Mangosteen might slow blood clotting. Taking mangosteen might increase the risk of bleeding in people with
bleeding disorders.
Important counselling
notes
No info
26. Losartan + Amlodipine
Rx
Brand Name
Losartan + Amlodipine
Amazar, Cozaar XQ
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Therapeutic Category
Angiotensin II Antagonist / Calcium Antagonist
Indication/Uses
To treat hypertension
Dosage (children &
adult)
Adult: Per tablet contains amlodipine 5 mg and losartan potassium 50 mg: Initial: 1 tablet once daily; may increase to 2 tablets daily if
the BP control is inadequate after 1-2 wk.
Direction of Use
May be taken with or without food.
Side effects
Headache, dizziness, back pain, myalgia, resp tract disorders, asthenia/fatigue; first-dose hypotension; rash, cough, angioedema;
neutropaenial GI disturbances; transient elevation of liver enzymes; taste disturbances and hyperkalaemia.
Contraindications
Known hypersensitivity. Avoid concomitant K supplements. Pregnancy.
Interactions
(drug/food)
Amlodipine: Increased metabolism with rifampin. Reduced hypotensive effect with calcium.
Losartan: Concurrent use with NSAIDs may further worsen renal function. Ketoconazole inhibits the conversion of losartan to its
active metabolite. phenobarbital and other enzyme inducers may decrease levels of losartan and its active metabolite.
Special Precautions/
Warnings
Impaired hepatic or renal function, sick-sinus syndrome, severe ventricular dysfunction, hypertrophic cardiomyopathy. Elderly,
children. Lactation. Volume-depleted patients; patients on diuretics and salt restriction; renal artery stenosis. Monitor serum K
concentration.
Important counselling
notes
GENERAL COUNSELING FOR HYPERTENSION:
Px advice from MIMS BOOK: PREVENTION
1. Observe and maintain healthy dietary practices
2. Limit salt intake to less than 5 grams or 1 teaspoon of sodium per day.
3. It is recommended to eat at least 400 grams or five portions of combined fruits and vegetables, for example including
potatoes, cassava and other starchy roots.
4. Alcohol should be limited to less than one drink per day (women) and less than two to drinks per day (men).
5. Drink less caffeine eg: coffee tea color drinking greater than 4 cups of coffee a day may increase blood pressure.
6. Exercise regularly. Physical activity helps maintain a healthy weight and lowers cholesterol and blood pressure levels
7. Avoid smoking, smoking raises blood pressure and increases the risk for heart attack and stroke
8. Reduce stress as much as possible practice muscle relaxation techniques deep breathing or meditation
9. Get enough sleep. Not getting enough sleep on a regular basis increases the risk for heart disease, high blood pressure
and stroke.
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MANAGEMENT:
1. Measure blood pressure on a regular basis keeping close tabs on blood pressure shows if medication is working, alerts for
potential complications and keeps a condition in check.
2. Make lifestyle changes blood pressure may be lowered by being physically active and eating a healthy diet
27. Amlodipine
Rx
Amlodine
Generic Name /
Device Name
Amlodipine
Therapeutic Category
Antihypertensive/Calcium Antagonists
Indication/Uses
Hypertension; prophylaxis for angina
Dosage (children &
adult)
Adult: 5 mg daily, may increase after at least 1-2 weeks. Maximum dose: 10 mg/day
Direction of Use
May be taken w/ or w/o food.
Side effects
Peripheral edema, hypotension, angina/MI
Contraindications
Severe hypotension, cardiogenic shock, left ventricular outflow tract obstruction (eg. high-grade aortic stenosis), heart failure after
acute MI.
Interactions
(drug/food)
Simvastatin CYP3A4 Inhibitors - increased concentration of amlodipine in blood
Grapefruit or grapefruit juice - increased plasma concentration
Special Precautions/
Warnings
Patients with aortic stenosis, congestive heart failure, severe obstructive coronary disease. Hepatic impairment. Pregnant and
lactation.
Drug may cause dizziness, avoid driving or operate a machine.
Important counselling
notes
GENERAL COUNSELING FOR HYPERTENSION:
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Px advice from MIMS BOOK: PREVENTION
1. Observe and maintain healthy dietary practices
2. Limit salt intake to less than 5 grams or 1 teaspoon of sodium per day.
3. It is recommended to eat at least 400 grams or five portions of combined fruits and vegetables, for example including
potatoes, cassava and other starchy roots.
4. Alcohol should be limited to less than one drink per day (women) and less than two to drinks per day (men).
5. Drink less caffeine eg: coffee tea color drinking greater than 4 cups of coffee a day may increase blood pressure.
6. Exercise regularly. Physical activity helps maintain a healthy weight and lowers cholesterol and blood pressure levels
7. Avoid smoking, smoking raises blood pressure and increases the risk for heart attack and stroke
8. Reduce stress as much as possible practice muscle relaxation techniques deep breathing or meditation
9. Get enough sleep. Not getting enough sleep on a regular basis increases the risk for heart disease, high blood pressure
and stroke.
MANAGEMENT:
1. Measure blood pressure on a regular basis keeping close tabs on blood pressure shows if medication is working, alerts for
potential complications and keeps a condition in check.
2. Make lifestyle changes blood pressure may be lowered by being physically active and eating a healthy diet
28. Propranolol
Rx
Indirin
Generic Name /
Device Name
Propranolol
Therapeutic Category
Beta-blockers/Antimigraine Preparations
Indication/Uses
It is used to treat high blood pressure, irregular heartbeat, like atrial fibrillation, prevent heart attacks and strokes, and prevent chest
pain caused by angina.
Dosage (children &
adult)
High Blood Pressure: 80 mg twice a day, and may increase it to a maximum of 160 mg twice a day.
Migraine or Angina (chest pain): 40 mg taken 2 or 3 times a day, may be increased at a maximum of 120 mg to 240 mg a day.
Irregular Heartbeat: 10 to 40 mg 3 or 4 times a day.
Anxiety: 40 mg once a day which can be increased to 40 mg 3 times a day.
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Direction of Use
Tablet: Should be taken with an empty stomach.
Capsule: May be taken w/ or w/o food. Take consistently either always w/ or always w/o meals.
Side effects
Bradycardia, cardiac failure, nausea, vomiting, diarrhea, constipation, lethargy, fatigue.
Contraindications
History of bronchial asthma, bradycardia, cardiogenic shock, hypotension, uncontrolled heart failure.
Interactions
(drug/food)
May have potentiating effects on arterial conduction time and induce additive negative or inotropic effect with propafenone,
amiodarone, quinidine, and calcium channel blockers.
Special Precautions/
Warnings
Patients with Raynaud’s disease or intermittent claudication, 1st degree heart block, diabetes mellitus, myasthenia gravis, psoriasis,
thyroid disease. Avoid abrupt. Hepatic and renal impairment. Elderly. Pregnancy and lactation.
Important counselling
notes
This drug may cause dizziness, if affected, do not drive or operate machinery.
29-30. Warfarin
Rx
Coumadin
Generic Name /
Device Name
Warfarin
Therapeutic Category
Anticoagulant, Antiplatelet & Fibrinolytics (Thrombolytics)
Indication/Uses
Prophylaxis & treatment of venous thrombosis, pulmonary embolism, atrial fibrillation w/ embolization.
Dosage (children &
adult)
Tablet 2.5 mg
Tablet 5 mg
● Dosage is tailored to individual requirements.
● Usual dose: Initially, 5-10 mg daily for 1 or 2 days.
● IV: Maintenance: 2-10 mg daily, depending on the prothrombin time or other appropriate coagulation tests.
● Oral: Maintenance: 3-9 mg daily
Note: The dosage and administration of coumadin must be individualized for each patient according to the particular patient’s
PT/INR response to the drug. The dosage should be adjusted based upon the patient’s PT/INR (International Normalized Ratio: a
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laboratory measurement of how long it takes blood to form a clot.
Direction of Use
Time and Frequency: Take it once a day. Take the dose at the same time each day. Warfarin administration can be at any time
during the day, but recommendations are for administration in the afternoon or evening. Recommended time: 5:00 pm
Missed Dose: If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip
the missed dose and go back to your daily schedule.
May be taken w/ or w/o food.
Target International
Normalized Ratio
(INR) Level
The dose of warfarin should be adjusted to maintain a target INR of 2.5 (INR range, 2.0-3.0)
Monitoring
Monitor INR regularly; haematocrit, prothrombin time. Perform pregnancy test prior to use in women of reproductive potential.
Side effects
Hemorrhage, bleeding, necrosis of skin & other tissues, alopecia, urticaria, dermatitis, nausea.
Contraindications
Hypersensitivity, Alcoholism, Pregnancy: IV/Parenteral/PO: X, D (For high-risk mechanical heart valve)
Interactions
(drug/food)
Macrolides, quinolones, tetracyclines, anticonvulsants, antidepressants, Vitamin K
Special Precautions/
Warnings
Hepatic or renal insufficiency, infectious diseases
Emergency Advice
Call 911 or go to the Emergency Room if you experience any serious conditions: Major bleeding, shortness of breath,chest pain.
Important counselling
notes
●
●
●
●
●
●
Advise patients to avoid eating green leafy vegetables. Foods and vitamin K. Vitamin K is needed for normal blood clotting.
However, large changes in the amount of vitamin K in your diet can change the way warfarin works.
Warfarin should be taken at the same time each day.
Never double up on doses: If a dose is accidentally missed, they should continue with the regimen as prescribed.
Limit the amount of alcohol to a maximum of one or two drinks and advise to never binge drink. If there are major changes
in alcohol consumption then INR can be affected.
Do not make changes in diet, such as eating large amounts of green, leafy vegetables.
Do not use coumadin for a condition for which it was not prescribed. Do not give coumadin to other people, even if they
have the same condition. It may harm them.
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31. Salbutamol Inhaler
Rx
Aero-Vent
Generic Name /
Device Name
Salbutamol Sulfate (Salbutamol Inhaler)
Therapeutic Category
Antiasthmatic & COPD Preparations
Indication/Uses
Manage reversible airway obstruction in asthma & COPD
Direction of Use
To relieve asthma: 1 or 2 puffs.
To prevent asthma: 2 puffs 10-15 minutes before exercise or exposure to a “trigger”.
For regular treatment: 2 puffs up to 4 times a day.
The maximum dose is 8 puffs in a 24 hour period.
Shake the inhaler well.
1. Hold the inhaler upright with your thumb on the base and your finger on the push button. Press the dosing button down
firmly - once only
2. Breathe out as far as is comfortable. Note: do not blow into the device at any time.
3. Place the mouthpiece in your mouth. Close lips firmly around it (do not bite it)
4. Breathe in through your mouth steadily and deeply, to draw the medicine into your lungs.
5. Hold your breath, take the inhaler from your mouth and continue holding your breath for about 5 seconds.
6. For the second puff, keep the inhaler upright and repeat steps 2-5. Replace the mouthpiece cover.
Side effects
Headache, nausea, shaky or tense feeling/tremors
Contraindications
Hypersensitivity
Interactions
Non-selective beta-blocking drugs, such as propranolol.
Special Precautions/
Warnings
Hyperthyroidism, arrhythmia, tachycardia, occlusive vascular disorders.
Important counselling
notes
If you’re using an inhaler make sure that you do not smoke.
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32. Seretide Diskus Inhaler
Rx
Seretide Diskus
Generic Name /
Device Name
Salmeterol + Fluticasone
Therapeutic Category
Antiasthmatic & COPD Preparations
Indication/Uses
For regular treatment of asthma
Dosage (children &
adult)
Adult: 1 inhalation of Seretide 100 or 200 bid
Child: 1 inhalation of Seretide 100 bid
Direction of Use
1. To open your Diskus, hold the outer case in one hand and put the thumb of your other hand on the thumb grip. Push your
thumb away from you as far as it will go. You will hear a click. This will open a small hole in the mouthpiece.
2. Hold your Diskus with the mouthpiece towards you. You can hold it in either your right or left hand. Slide the lever away
from you as far as it will go. You will hear a click. This places a dose of your medicine in the mouthpiece. Every time the
lever is pulled back a blister is opened inside and the powder is made ready for you to inhale. Do not play with the lever as
this opens the blisters and wastes medicine
3. Hold the Diskus away from your mouth, breathe out as far as is comfortable. Do not breathe into your Diskus.
4. Put the mouthpiece to your lips; breathe in steadily and deeply through the Diskus, not through your nose. Remove the
Diskus from your mouth. Hold your breath for about 10 seconds or for as long as is comfortable. Breathe out slowly
5. Afterwards rinse your mouth with water and spit it out, and/or brush your teeth. This may help to stop you getting thrush and
becoming hoarse.
6. To close the Diskus, slide the thumb grip back towards you, as far as it will go. You will hear a click. The lever will return to
its original position and is reset.
Side effects
Headache, mouth and candidiasis, muscle cramps
Contraindications
hypersensitivity . Potential for increased toxicity.
Interactions
(drug/food)
Avoid use w/ non-selective & selective beta-blockers. Increased plasma concentration w/ ritonavir. Increased systemic exposure w/
ketoconazole.
Special Precautions/
Warnings
●
●
Not for relief of acute asthma symptoms.
Treatment with seretide should NOT be stopped abruptly in patients with asthma due to risk of exacerbation.
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Important counselling
notes
Do not switch between brands or types of inhalation devices including spacer devices unless instructed by your doctor. Rinse the
mouth with water after using inhalation devices.
33. Turbuhaler
Rx
Symbicort Turbuhaler
Generic Name /
Device Name
Budesonide/Formoterol
Therapeutic Category
Antiasthmatic & COPD Preparations
Indication/Uses
Treatment of asthma; asthma control including prevention & relief of symptoms & reduced risk of exacerbations; for asthma severity
where the use of inhaled corticosteroids is appropriate.
Dosage (children &
adult)
80 mcg/4.5 mcg turbuhaler
Direction of Use
The recommended maintenance dose is 2 inhalations per day, given either as one inhalation in the morning and evening or as 2
inhalations in either the morning or evening.
To administer one dose, simply follow the instructions as follows.
1. Unscrew and lift off the cover. A rattling sound is heard when unscrewing the cover.
2. Hold the inhaler upright with the red grip downwards. Do not hold the mouthpiece when turning the grip. To load the inhaler
with a dose, turn the grip as far as it will go in one direction, and then back again as far as it will go. It does not matter which
way to turn first. During this procedure the patient will hear a click.
3. Breathe out. Do not breathe out through the mouthpiece.
4. Place the mouthpiece gently between the teeth, close the lips and inhale forcefully and deeply through the mouth. Do not
chew or bite on the mouthpiece.
5. Remove the inhaler from the mouth, before breathing out.
6. If more than one dose has been prescribed, repeat steps 2-5.
7. Replace the cover by screwing it back on tightly.
8. Rinse the mouth with water. Do not swallow.
Side effects
Palpitations, headache, tremor, mild irritation in the throat, coughing.
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Contraindications
Hypersensitivity to budesonide or formoterol, or inhaled lactose.
Interactions
(drug/food)
Budesonide: May increase systemic exposure w/ CYP3A4 inhibitors eg, ketoconazole.
Formoterol: Weakened or inhibited effect w/ beta-adrenergic blockers (including eye drops)
Special Precautions/
Warnings
●
●
●
Avoid spraying your eyes.
It is therefore important that the patient inhales forcefully and deeply through the mouthpiece.
Patients who are receiving symbicort should not use additional formoterol or other LABA for any reason.
Important counselling
notes
●
●
Do not use it to treat severe exacerbations
Rinse your mouth thoroughly after inhalation.
34. Augmentin Oral Syringe
Rx
AUGMENTIN
Generic Name /
Device Name
AMOXICILLIN + CLAVULANIC ACID
Therapeutic Category
amoxicillin and beta-lactamase inhibitor
Indication/Uses
AUGMENTIN is indicated for short-term treatment of bacterial infections at the following sites: Upper respiratory tract infections
(including ENT-Ears,Nose,Throat) e.g. recurrent tonsillitis, sinusitis, otitis media (inflammation or infection located in the middle ear).
Lower respiratory tract infections e.g. acute exacerbation of chronic bronchitis, lobar and bronchopneumonia.
Dosage (children &
adult)
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Direction of Use
To minimise potential gastrointestinal intolerance, administer at the start of a meal. The absorption of AUGMENTIN is optimised
when taken at the start of a meal. Duration of therapy should be appropriate to the indication and should not exceed 14 days without
review.
Instructions for Use/Handling:
Oral suspension:
Glass Bottles: At time of dispensing, the dry powder should be reconstituted to form an oral suspension, as detailed as follows:
-Check cap seal is intact before use.
● Invert and shake the bottle to loosen the powder.
● Add volume of water (indicated as follows). Invert and shake well.
● Alternatively, fill the bottle with water to just below the mark on the bottle label. Invert and shake well, then top up with
water to the mark. Invert and shake again.
● Allow to stand for 5 minutes to ensure full dispersion.
● Shake well before taking each dose.
Side effects
Dark urine, persistent nausea/vomiting, severe stomach/abdominal pain, yellowing eyes/skin, easy bruising/bleeding, new signs of
infection (such as fever, persistent sore throat), unusual tiredness.
ALLERGIC REACTION:
Rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.
Contraindications
Interactions
(drug/food)
AUGMENTIN is contraindicated in patients with a history of hypersensitivity to beta-lactams, e.g. penicillins and cephalosporins.
AUGMENTIN is contraindicated in patients with a previous history of AUGMENTIN-associated jaundice/hepatic dysfunction
●
●
●
Special Precautions/
Warnings
●
●
Probenecid decreases the renal tubular secretion of amoxicillin. Concomitant use with AUGMENTIN may result in
increased and prolonged blood levels of amoxicillin but not of clavulanate.
Concomitant use of allopurinol during treatment with amoxicillin can increase the likelihood of allergic skin reactions.
In common with other antibiotics, AUGMENTIN may affect the gut flora, leading to lower oestrogen reabsorption and
reduced efficacy of combined oral contraceptives.
In patients with reduced urine output, crystalluria has been observed very rarely, predominantly with parenteral therapy.
During the administration of high doses of amoxicillin, it is advisable to maintain adequate fluid intake and urinary output in
order to reduce the possibility of amoxicillin crystalluria (cloudy urine).
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Important counselling
notes
Patient Advice from MIMS Book
1. Avoid or stop smoking. Smoking damages the respiratory tract and weakens the body's natural defenses against
disease-causing pathogens
2. Address indoor air pollution and practice good hygiene to protect oneself from respiratory tract infections
3. Patients who have difficulty swallowing may be given diets with specialized texture to avoid aspiration.
4. Avoid cold dry air. Use an air humidifier or inhale steam from a bowl of hot water to make breathing easier.
5. Wash hands frequently especially after touching respiratory secretion, for example after blowing the nose, sneezing or after
caring for someone who has a cough, cold or sore throat.
6. Promptly dispose soiled paper towels or dirty tissue from runny noses and sneezes to prevent spread of infection.
Oral suspension: The dry powder should be stored in unopened containers in a dry place at below 25°C.
35. Ear drops Betnesol
Rx
BETNESOL
Generic Name /
Device Name
Betamethasone
Therapeutic Category
EAR CORTICOSTEROIDS
Indication/Uses
-Allergic and inflammatory conditions of the ear
-Otitis externa (Condition that causes inflammation (redness and swelling) of the external ear canal)
Dosage (children &
adult)
Adult: For non-infected cases: As 0.1% betamethasone Na phosphate drops:
Initially, instil 2-3 drops into the affected ear(s) 2-3 hourly or 3-4 hourly, then reduce frequency once the condition is under control.
Child: Same as adult dose.
Direction of Use
Use the lowest effective dose for the shortest possible time. Discontinue if there is no clinical response within 7 days of treatment.
●
●
●
●
Wash your hands first. Clean your ear gently with warm water and then pat it dry.
Remove the cap from the bottle.
Lie down, or tilt your head to the side, so that the affected ear is facing upwards.
Gently pull your earlobe downwards to straighten the ear canal.
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●
●
●
●
Hold the bottle upside down near to your ear and apply enough pressure to release two or three drops into your ear.
Keep your ear facing upwards for a few minutes to allow the solution to come into contact with the affected area.
Repeat the process in your other ear if you have been asked to use the drops in both ears.
Replace the cap on the bottle
Side effects
You may get a slight feeling of irritation or burning. This is usually mild and soon passes.
Contraindications
Perforated Tympanic Membrane (ruptured eardrum)- a hole or tear in the thin tissue that separates your ear canal from your
middle ear (eardrum). A ruptured eardrum can result in hearing loss. It can also make your middle ear vulnerable to infections
Interactions (drug/food) May increase the risk of systemic side effects with cobicistat-containing agents.
Special Precautions/
Warnings
●
●
Pregnant or breastfeeding
Avoid abrupt withdrawal (particularly during prolonged therapy).
Important counselling
notes
●
●
●
Store below 25°C.
Do not freeze.
Protect from light
36. Cosopt Eye Drops
Rx
Cosopt (Eye Drop)
Generic Name /
Device Name
DORZOLAMIDE + TIMOLOL
Therapeutic Category
Timolol (Beta Blocker)
Dorzolamide (Carbonic anhydrase inhibitors)
Indication/Uses
Reduces pressure in the eye and is used to treat certain types of glaucoma and other causes of high pressure inside the eye.
Dosage (children & adult)
1 drop two times daily
-When substituting DORZOLAMIDE HCl + TIMOLOL MALEATE (COSOPT) for another ophthalmic antiglaucoma agent(s),
discontinue the other agent(s) after proper dosing on one day, and start DORZOLAMIDE HCl + TIMOLOL MALEATE (COSOPT)
on the next day.
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-If another topical ophthalmic agent is being used, DORZOLAMIDE HCl + TIMOLOL MALEATE (COSOPT) and the other agent
should be administered at least ten minutes apart
Direction of Use
1. Tilt your head back, look upward and pull down the lower eyelid to make a pouch. Hold the dropper directly over your
eye and place one drop in your eye.
2. Look downward and gently close your eyes for 1 to 2 minutes.
3. Place one finger at the corner of your eye (near the nose) and apply gentle pressure.
4. Try not to blink and do not rub your eyes. This will prevent the medication from draining out. Repeat these steps for your
other eye if so directed.
Do not rinse the dropper. Replace the dropper cap after each use.
Side effects
ocular burning and stinging, corneal erosion, conjunctival injection, blurred vision, tearing, and ocular itching
Contraindications
Reactive airway disease, bronchial asthma or a history of bronchial asthma
Interactions (drug/food)
The potential exists for additive effects and production of hypotension and/or marked bradycardia when timolol maleate
ophthalmic solution is administered together with oral calcium channel blockers, catecholamine-depleting drugs, antiarrhythmics,
parasympathomimetics or beta-adrenergic blocking agents.
Special Precautions/
Warnings
●
●
Important
notes
counselling
●
●
●
●
It should not be administered while wearing these lenses. The lenses should be removed before application of the drops
and not be reinserted earlier than 15 minutes after use.
There is an increased potential for developing corneal edema in patients with low endothelial cell count
Store at temperatures not exceeding 25°C
Protect from light.
If you are using another kind of eye medication (e.g., drops or ointments), wait at least 5 minutes before applying other
medications.
Use eye drops before eye ointments to allow the eye drops to enter the eye.
37. Adult suppository
OTC
Dulcolax Suppository
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Generic Name /
Device Name
BISACODYL
Therapeutic Category
Laxative
Indication/Uses
Bisacodyl (Dulcolax) is indicated in patients suffering from constipation and for preparation of diagnostic procedures, in pre- and
post-operative treatment and in conditions which require defecation to be facilitated.
Dosage (children & adult)
1 Suppository (10mg) daily
Direction of Use
1.
2.
3.
4.
5.
Wash your hands thoroughly with soap and water.
Remove all of the foil wrapper from the suppository.
Lie on your side and raise your knee to your chest.
Push the suppository gently and slowly, pointed end first, into the rectum.
Throw away used materials and wash your hands thoroughly.
Dulcolax suppositories generally work in about 20 minutes, but may take up to 45 minutes.
Side effects
abdominal pain and diarrhoea, dehydration, dizziness
Contraindications
It should not be given to patients with ileus, intestinal obstruction, acute abdominal conditions including appendicitis and acute
inflammatory bowel diseases and severe abdominal pain associated with nausea and vomiting which may be indicative of severe
conditions.
Interactions (drug/food)
The concomitant use of diuretic and adreno-corticosteroids may increase the risk of electrolyte imbalance if excessive doses of
Bisacodyl (Dulcolax) are taken.
Special Precautions/
Warnings
Important counselling
notes
●
●
Should not be taken on a continuous daily basis or for extended periods without investigating the cause of constipation.
Prolonged excessive use may lead to fluid and electrolyte imbalance and hypokalaemia.
Store 10 mg suppositories at temperatures not exceeding 25°C
38. Faktu Suppository
Rx
FAKTU SUPPOSITORY
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Generic Name /
Device Name
CINCHOCAINE HYDROCHLORIDE + POLICRESULEN
Therapeutic Category
Anorectal Preparation
Indication/Uses
External and internal hemorrhoids associated with inflammatory symptoms or superficial bleeding, anal fissures and rhagades,
incised or spontaneously perforated perianal thrombosis, anitis, cryptitis, anal eczema, pruritus and postoperative wound treatment
following proctological operations.
Dosage (children & adult)
●
●
Direction of Use
1. Gently squeeze the suppository to check if it is firm enough to insert. If it’s not, let it harden by holding it under cold water
while it is still in the wrapper. You can also place it in the refrigerator for a few minutes.
2. If possible, go to the bathroom and empty your bowels.
3. Wash your hands with soap and water. If soap and water aren’t available, you can use hand sanitizer instead. Dry your
hands with a clean towel or a paper towel.
4. Remove any wrapping from the suppository. If you need to cut the suppository, carefully cut it lengthwise with a clean,
single-edge razor blade.
5. To moisten the tip of the suppository, apply a lubricating jelly such as K-Y Jelly. If you don’t have lubricating jelly, apply a
small amount of water to your rectal area.
6. Insert the suppository into the rectum, narrow end first.
1 suppository 2-3 times daily following evacuation.
After cessation of symptoms, treatment may be maintained with 1 suppository daily or as prescribed by the physician.
Side effects
Mild local discomfort eg, burning sensation or itching, urticaria
Contraindications
Faktu suppositories contain soy lecithin. If the patient is allergic to soya or peanuts, do not use Faktu suppositories.
Use in pregnancy: Like any drug, it is generally not advisable to use Faktu during the 1st trimester of pregnancy.
Interactions (drug/food)
Special Precautions/
Warnings
If you use other drugs or over the counter products at the same time, the effects of Faktu Suppository may change. This may
increase your risk for side-effects or cause your drug not to work properly. Tell your doctor about all the drugs, vitamins, and herbal
supplements you are using, so that your doctor can help you prevent or manage drug interactions.
●
●
●
Consult your doctor if any allergic reaction occurs
Do not use more than directed
For external use only
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Important counselling
notes
●
●
●
Report to doctor if condition worsens or does not improve within 7 days
Should be used in undiluted form
Stop use and ask a doctor if bleeding occurs
●
●
Store at room temperatures not exceeding 25°C
Do not flush medications down the toilet or pour them into drainage unless instructed to do so. Medication discarded in this
manner may contaminate the environment.
39. Nasonex nasal spray
Rx
NASONEX
Generic Name /
Device Name
MOMETASONE
Therapeutic Category
Nasal Decongestant
Indication/Uses
is a steroid used to treat nasal symptoms such as congestion, sneezing, and runny nose caused by seasonal or year-round allergies.
Nasonex Nasal Spray is also used to treat nasal polyps in adults.
Dosage (children &
adult)
*Adjunctive treatment of acute episodes of sinusitis:
Adults (including geriatric patients) and adolescents 12 years of age and older:
The usual recommended dose is two sprays (50 micrograms/spray) in each nostril twice daily (total dose 400 micrograms).
*Nasal Polyposis:
Adults (including geriatric patients) and adolescents 18 years of age and older:
The usual recommended dose for polyposis is two sprays (50 micrograms/spray) in each nostril twice daily (total daily dose of 400
mcg)
*Seasonal allergic or perennial rhinitis:
Adults (including geriatric patients) and adolescents:
The usual recommended dose for prophylaxis and treatment is two sprays (50 micrograms/spray) in each nostril once daily (total
dose 200 micrograms)
Direction of Use
1. Blow nose gently to clear any mucus from inside the nasal passageways
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2.
3.
4.
5.
6.
7.
8.
9.
Remove the cap of the nasal spray and shake the bottle
Stay in an upright position with the head tilted forward slightly.
Hold the nasal spray in your hand with your thumb at the base of the bottle and the index and middle fingers on top.
Insert tip of the spray bottle into one nostril, blocking the other nostril gently with the other hand.
Relax and breathe out slowly.
Squeeze the pump with your index and middle finger and breathe in slowly, just enough to keep the medication in place.
Repeat steps 3 to 5 in the other nostril.
Avoid blowing your nose shortly after taking a dose of the medication.
Side effects
headache, epistaxis (i.e Frank bleeding, blood-tinged mucus, and blood flecks, pharyngitis, nasal burning, nasal irritation, and nasal
ulceration.
Contraindications
Hypersensitivity to any ingredients of Mometasone furoate (NASONEX) Aqueous Nasal Spray.
Interactions (drug/food)
Mometasone furoate (NASONEX) Aqueous Nasal Spray has been administered concomitantly with loratadine with no effect on
plasma concentrations of loratadine or its major metabolite.
Special Precautions/
Warnings
Aqueous Nasal Spray should be used with caution, if at all, in patients with active or quiescent tuberculous infections of the
respiratory tract, or in untreated fungal, bacterial, systemic viral infections or ocular herpes simplex.
Important counselling
notes
Store at temperatures not exceeding 30°C. Do not freeze
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