Baclofen(Lioresal) Mechanism of Action Clinical Uses and Adverse Effects

Baclofen (Lioresal) is the parachlorophenol analogue of the naturally occurring neurotransmitter y-aminobutyric acid (GABA).

Mechanism of Action
Baclofen appears to affect the neuromuscular axis by acting directly on sensory afferents, y-motor neurons,and collateral neurons in the spinal cord to inhibit both monosynaptic and polysynaptic reflexes. The principal effect is to reduce the release of excitatory neurotrans mitters by activation of presynaptic GABAB receptors.This seems to involve a G protein and second-messenger link that either increases K+ conductance or decreases Ca++ conductance.

Absorption, Metabolism, and Excretion
 Baclofen is rapidly and effectively absorbed after oral administration. It is lipophilic and able to penetrate the blood-brain barrier.Approximately 35% of the drug is excreted unchanged in the urine and feces.

Clinical Uses
Baclofen is an agent of choice for treating spinal spasticity and spasticity associated with multiple sclerosis. It is not useful for treating spasticity of supraspinal origin. Doses should be increased gradually to a maximum of 100 to 150 mg per day, divided into four doses.

Adverse Effects
Side effects are not a major problem, and they can be minimized by graduated dosage increases.They include lassitude, slight nausea, and mental disturbances (in cluding confusion, euphoria, and depression). The drowsiness is less pronounced than that produced by diazepam—an important therapeutic advantage. Hypotension has been noted, particularly following overdose.Elderly patients and patients with multiple sclerosis may require lower doses and may display increased sensitivity to the central side effects.Baclofen may increase the frequency of seizures in epileptics.

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Unknown Actions, Adverse Effects, Baclofen, clinical uses

Propranolol Indication Doses Contra Indication And Adverse Effects

Indications:
A non-cardio selective betablocker indicated in the treatment of hypertension, angina pectoris, cardiac arrhythmias, anxiety, hyperthyroidism, hypertrophic obstructive cardiomyopathy and prevention of re-infarction after acute myocardial infarctions.
 
Doses & Administrations:
Oral: Adult: Hypertension: The usual dose is 80mg twice daily with maintenance range of 160-320mg daily. Angina Pectoris: 40mg 2-3 times daily. maintenance dose is 120 to 240mg daily. Anxiety: Tremor and migraine, initially 40mg 2-3 times a day, maintenance 160 to 240mg daily. Prophylaxis after infarction, 40mg four times daily for 2 to 3 days then 80mg twice daily, beginning 5-21 days after infarction. Pediatric: Arrhythmias-0.5-1mg/kg/day in a divided doses to a maximum of 60mg/day. Hypertension-0.5-1mg/kg/day up to 2mg/kg daily. Thyrotoxicosis-2mg/kg/day every 6 hours-interval. Parenteral: (Arrythmias) Adult: 1mg over 1 minute, if necessary repeat at 2 minutes interval. Maximum: 10mg (5mg in anesthesia). Pediatric: 0.01-0.1mg/kg/ dose over 3 to 5 minutes up to maximum of 1mg/day.
 
Contra Indications: 
Bronchial asthma, sinus bradycardia, second or third degree heart block, cardiogenic shock.
 
Precautions:
Late pregnancy, impaired renal or hepatic functions, lactation, diabetics, mellitus, myasthenia gravis, cardiac failure.
 
Pregnancy Status:
Category "C"
 
Renal Failure Doses:
Dosage adjustment is not necessary in patients with renal failure.
 
Lactation Status:
Controversial
 
Interactions:
Avoid concomitant use with amiodarone, benzodiazepine, chlorpromazine, anti-diabetics, cimetidine, oral contraceptive, succinyl choline, epinephrine, theophylline and lidocaine. Decrease carbohydrate tolerance and increase in BUN.
 
Adverse Effects: 
Bronchospasm, bradycardia, heart failure, peripheral vasconstrictions, fatigue, sleep disturbance, rash (rare).
 
Nursing Considerations: 
- HISTORY:ALLERGY TO BETA BLOCKRS, SINUS BRADYCARDIA, CARDIOGENIC SHOCK, BRONCHIAL ASTHMA, DIABETES, THYROTOXICOSIS, PREGNANCY. - ENSURE THAT ALPHA ADRENERGIC BLOCKERS HAS BEEN GIVEN BEFORE GI VING PROPANOLOL WHEN TREATING PATIENT WITH PHEOCHROMOCYTOMA, - PROVIDE CONTINUOUS CARDIAC MONITORING AND REGULAR MONITORING OF BP WITH IV FORM. IV DILUTION: 1 mg/ 50 ml 10-15 MIN. 15 mg/ 250ml TITRATE RATE DILUTE IN NS / D5W

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Unknown Adverse Effects, dosese, indication, propranolol

DIAZEPAM(VALIUM) Indications Doses Precautions and Adverse Effects

Indications:

Anxiety, epilepsy, muscle relaxation (tetanus), and acute alcohol with drawal.

Doses & Administrations:
Oral: Adult: Anxiety: 2mg three times daily. maximum 30mg/daily. Acute alcohol with drawl: 5-20mg, repeated 2 to 4 hours if required. Muscle Spasm : 2-15mg daily in divided doses. Muscle Spasm (Tetanus) : 3-10mg/kg/day. Pediatric: 0.1-0.8mg/kg/day every 6 to 8 hours. Parenteral: Adult: Severe Anxiety : 2-10mg I/V or I/M repeated after 4 hours if required. Muscle Spasm : 5-10mg I/V or I/M repeated after 4 hours if needed. Tetanus : 0.1-0.3mg/kg I/V repeated at intervals of 1 to 4 hours or by 1.v infusion of 3- 10mg/kg/day. Status Epilepticus: 10-20mg I/V or I/M repeated 30-60 minutes if necessary. Pediatric: 0.1 to 0.3mg/kg repeated in 2 to 4 hours as required.
Contra Indications:
Hypersensitivity to benzodiazepines, respiratory depression, and chronic psychosis.

Precautions:
Avoid prolong use and abrupt withdrawal, respiratory depression, late pregnancy, lactation, hepatic and renal impairment.

Pregnancy Status:
Category "D"

Renal Failure Doses:
No specific dosage adjustment is necessary in renal insufficiency.

Lactation Status:
Contraversial.

Interactions:
Neuroleptics, tranquilizers, antidepressants, analgesics and anaesthetic.

Adverse Effects:
Drowsiness, sedation, ataxia, hypotension, apnoea, G.I, upset skin, rashes, visual disturbance, changes in libido and urinary retention.

Nursing Considerations:
Concentration available are 5mg/ml in 2ml ampoule. The product should be protected from light and retain potency for 3 months at room temperature. For IM administration it should be given deeply in the muscle. Do not use small veins (dorsum of hand or wrist) for IV injection. Reduce dose of narcotic analgesics with IV diazepam. Carefully monitor PULSE, BP, and RESPIRATION during IV administration. Maintain patients receiving parenteral diazepam in bed for 3 hrs. Monitor liver and kidney function, CBC during long term therapy. Report severe dizziness, weakness, drowsiness that persists, rash or skin lesions, palpitations, swelling of the ankles, visual or hearing disturbances, difficulty voiding.

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Unknown Adverse Effects, DIAZEPAM, doses, indication, Precautions

OCTREOTIDE ACETATE(SANDOSTATIN) Adverse Effects Indications and Precautions

Indications:

Octreotide inhibits growth hormone secretions and glucagon, secretion,useful in the treatment of acromegaly,Zollinger-ellison syndrome,secretory diarrhea,carcinoid syndrome and GI endocrine tumors.

Doses & Administrations:
Adult: subcutaneous Acromegaly: 50 - 100 mcg SC 2 - 3 times daily. Gastrinoma: 200 mcg SC 2 times daily. Pancreatic Tumors: 100 - 600 mcg/ day SC in 2 - 4 divided doses. Small bowl fistula: 225 - 300 mcg/day in 3 divided doses. Intravenous; Zollinger- ellison syndrome as continuous infusion 25 mcg/hour. Maintenance : 100 mcg SC Twice daily.

Contra Indications:
Hypersensitivity to the drug.

Precautions:
Diabetic patient,repeated injection should be avoided, pregnancy,lactation,renal impairement and gall bladder abnormalities.

Pregnancy Status:
Category "B"

Renal Failure Doses:
Dose adjustment may be necessary in patients with severe renal failure requiring dialysis since half life of drug can be increased. Ref:Micromeix

Lactation Status:
Unknown.

Interactions:
Cyclosporin.

Adverse Effects:
Diarrhea, loose stools,nausea,abdominal discomfort, headache,dizziness,fatigue,weakness,sinus bradycardia, arrythmias,pneumonia,cold symptoms,injection site pain, hyperglycemia,hypoglycemia and galactorrhea.

Nursing Considerations:
IV DILUTION-----0 to 200 mcg/ 50 ml (@ 15-30 min) 600 mcg/ 250 ml (@ 25 mcg/hr) 1250 mcg/ 250 ml (@ 50 mcg/hr) Usually 25 to 50 mcg/ hr. Dilute in NS preferably, but acn also dilute in D5W *(Ref:Vancouver Hospital Health Sciences Center, Parenteral Drug Therapy Manual)

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Unknown Adverse Effects, indication, OCTREOTIDE ACETATE, Precautions

DINOPROSTONE Doses Contra Indications Interactions and Adverse Effects

Indications:

Induction of labor especially in patients with favorable induction feature or maternal contraindications.

Doses & Administrations:
Parenteral: Abortion (intraamniotic) 40 mg transabdominally into the intact amniotic to induce mid trimester abortion (after 15 weeks). Abortion (Extraamniotic): By I/V infusion: 1 mg/hr or 5 mg bolus every 2 to 3 hrs to a total dose of 15 mg. Labor Induction (I/V): By I/V infusion: 5 mcg/minute. Intravaginal: 3mg to be inserted high into the posterior fornix, a second tablet may be inserted after six to eight hours if labor is not established. (Maximum dose 6mg).

Contra Indications:
Hypersensitivity to prostaglandin, acute pelvic inflammatory disease or active cardiac, pulmonary, renal or hepatic disease, patients with history of caesarean section or major uterine surgery.

Precautions:
Glaucoma or raised intraocular pressure, asthma or history of asthma, infected endocervical lesions, acute vaginitis, epilepsy, diabetes mellitus, anemia, jaundice.

Pregnancy Status:
Category "C".

Renal Failure Doses:
Dose adjustment is not required.

Lactation Status:
Unknown.

Interactions:
Prostaglandin inhibiter (aspirin, indomethacin, NSAIDS) oxytocin and ethanol.

Adverse Effects:
Nausea, vomiting, headache, chills, shivering, backache, weakness and muscle cramps.

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Unknown Adverse Effects, Contraindications, DINOPROSTONE, Intrerations

Celecoxib Indications Doses Contra Indications and Adverse Effects

Indications:
Celecoxib is indicated for the treatment of osteoarthritis, rheumatoid arthritis, acute pain including primary dysmenorrhea, and is also indicated for reducing the number of colon and rectal polyps in familial adenomatous polyposis (FAP). This treatment has NOT been shown to reduce the risk of gastrointestinal cancer or the need for FAP-associated surgeries and routine endoscopic surveillance. Celecoxib is a nonsteroidal anti-inflammatory drug, which selectively inhibits the enzyme, cyclo-oxygenase-2 (COX-2).
 
Doses & Administrations: Osteoarthritis : 200 mg daily qd or bid Rheumatoid Arthritis : 100-200 mg bid Familial Adenomatous Polyposis: 400 mg bid
 
Contra Indications: 
Hypersensitivity to celecoxib Hypersensitivity to sulfonamides Allergic-type reactions, including asthma and urticaria, to aspirin or nonsteroidal antiinflammatory agents
 
Pregnancy Status: CATEGORY C

Lactation Status:
UNKNOWN
 
Interactions:
aspirin fluconazole loop diuretics warfarin
 
Adverse Effects:  Common adverse effects include dyspepsia, diarrhea, and abdominal pain. Although the risk for ulcers and other serious gastrointestinal adverse effects is lower than for other NSAIDs, product labeling still includes warnings about the risk of ulceration, bleeding and perforation.
 
Nursing Considerations: 
Celecoxib taken with a high-fat meal resulted in one to two hour delay in the peak plasma level with an increase in the total absorption of 10% to 20%. Administer with foods

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Unknown Adverse Effects, Celecoxib, indication, Intrerations

Gabapentin Indications Doses Precautions Interactions and Adverse Effects

Indications:

Gabapentin has been effective as add-on therapy in patients with drug-resistant partial seizures in patients over 3 years of age; limited studies also suggest efficacy of the drug in generalized seizures; comparisons of gabapentin with standard antiepileptic agents are required to determine its ultimate place in therapy.

Doses & Administrations:
DOSE: ADULT: Initially a dose of 300mg TID should be used, this should be titrated to acheive response and a usual dose of 400mg TID, dose may be titrated according to the response to a maximum dose of 2400-3600mg/day PEDIATRIC: FOR 01 MONTH - 05 YEARS: 40MG/KG/DAY in three divided doses FOR 5 YEARS TO 12 YEARS: 30MG/KG/DAY in three divided doses FOR OVER 12 YEARS: 300MG TID

Contra Indications:
Hypersensitivity to GABAPENTIN Pancreatitis

Precautions:
Renal insufficiency Abrupt discontinuation may precipitate status epilepticus.

Pregnancy Status:
CATEGORY: 'C' (contraversial)

Renal Failure Doses:
IF creatinine clearance is 30 to 60 milliliters/minute, the recommended GABAPENTIN dose is 300 milligrams twice a day. creatinine clearance 15 to 30 milliliters/minute, the GABAPENTIN dose is 300 milligrams daily. For creatinine clearance less than 15 ml/minutes, the recommended dose is 300 milligrams every other day

Lactation Status:
BREASTFEEDING: Unknown.

Interactions:
ANTACID-GABAPENTIN: ANTACID MAY DECREASE THE BIOAVAILABILITY OF GABAPENTIN TO 20%, THEREFORE, GABAPENTIN SHOULD BE AVOIDED WITH ANTACIDS PHENYTOIN-GABAPENTIN: GABAPENTIN MAY INCREASES THE PHENYTOIN LEVELS IN SERUM, THEREFORE, CARE SHOULD BE TAKEN WHEN BOTH ARE USED SIMULTANEOUSLY OR WHEN ONE OF THEM IS ADDED OR REMOVE FROM THE REGIMEN.

Adverse Effects:
The most frequent adverse effects of gabapentin in studies to date have been somnolence, fatigue, dizziness, blood pressure changes, ataxia, and nystagmus; other adverse effects include abnormal coordination, weight gain, edema, skin rash, purpura, nausea, vomiting, blurred vision, diplopia, mood changes, headache, seizures, tremor, and slurred speech.

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Unknown Adverse Effects, Gabapentin, Interactions, Intrerations, Precautions

Levofloxacin Indications Doses Contra Indications Precautions and Adverse Effects

Indications:

Levofloxacin is the active stereisomere of ofloxacin. Levofloxacin is approved for the treatment of COMMUNITY ACQUIRED PNEUMONIA,and other repiratory tract infections.

Doses & Administrations:
ADULTS: RTI: 500 mg ONCE DAILY TB : 500 mg bid or 750 mg qd May take with or with out meals. Take at least 2 hours apart from antacids, zinc and iron containing preps. PEDIATRIC (IV+PO) : Limited data for dose available. 5-10mg/kg/day, maximum : 500 mg/day

Contra Indications:
Hypersensitivity to levofloxacin,other fluoroquinolones, or to any of its components.

Precautions:
CNS disorders (epilepsy) Renal insufficiency (dose reduction) Liver disease (transamine elevations have occured) Risk factors for tendinitis include pt.>60 years of age,renal failure, dialysis,concomitant therapy,and dyslipidemia. Pregnant and nursing women.

Pregnancy Status:
Category "C"

Renal Failure Doses:
Cr.clear(ml/min) Loading Dose Subsequent dose =======20-49 500 mg 250 mg/24 hr. 10-19 500 mg 250 mg/48 hr. Hemodialysis 500 mg 250 mg/48 hr. (<10ml/min) NOTE: No need to give loading dose if pt. is already on Levofloxacin.

Lactation Status:
Unknown,levofloxacin has not been measured in human milk, however, based upon data from ofloxacin,it can be presumed that it will be excreted.

Interactions:
Minor and moderate interactions with drugs like antacids,calcium , cimetidine are reported with levofloxacin. DRUG FOOD INTERACTIONS: *Take atleast 02hrs before or after antacids,dairy products,sucralfate,iron supplements,calcium,magnesium,aluminium,zinc,minerals & multivitamins. * Limit fat & caffeine intake REF: http://www.mdanderson.org/departments/nutrition/index.cfm

Adverse Effects:
The most common adverse effects are nausea,diarrhea,headache,and constipation. Levofloxacin should be avoided in prepubertal children since animal studies have demonstrated erosion of the cartilage and weight-bearing joints.

Nursing Considerations:
THE VIAL IS FOR SINGLE USE ONLY. The diluted solution in compatible fluids is stable for 14 days in refrigerator and 72 hours at room temperature at the concentration of 5mg/ml in plastic IV containers.

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Unknown Adverse Effects, Contraindicated, doses, indication, Levofloxacin, Precautions