AntiDiarrheals Drug Actions Adverse Reactions and Contraindication

Mode Of Actions
Antidiarrheals decrease intestinal peristalsis, which is usually increased when the patient has diarrhea.Examples of these drugs include difenoxin with atropine (Motofen),diphenoxylate with atropine (Lomotil), and loperamide (Imodium).

Indication to Uses
Antidiarrheals are used in the treatment of diarrhea

Adverse Reactions
Diphenoxylate use may result in anorexia, nausea,vomiting, constipation, rash, dizziness, drowsiness,sedation, euphoria, and headache. This drug is a narcotic-related drug that has no analgesic activity but has sedative and euphoric effects and drug dependence potential. To discourage abuse, it is combined with atropine (an anticholinergic or cholinergic blocking drug), which causes dry mouth and other mild adverse minimal adverse reactions are associated with its use.Occasionally, abdominal discomfort, pain, and distention have been seen, but these symptoms also occur with severe diarrhea and are difficult to distinguish
from an adverse drug reaction

CONTRAINDICATIONS, PRECAUTIONS,AND INTERACTIONS
These drugs are contraindicated in patients whose diarrhea is associated with organisms that can harm the intestinal mucosa (Escherichia coli, Salmonella, Shigella) and in patients with pseudomembranous colitis, abdominal pain of unknown origin, and obstructive jaundice.The antidiarrheal drugs are contraindicated in children younger than 2 years.The antidiarrheal drugs are used cautiously in patients with severe hepatic impairment or inflammatory bowel disease. Antidiarrheals are classified as Pregnancy Category B drugs and should be used cautiously during pregnancy and lactation.
The antidiarrheal drugs cause an additive CNS depression when administered with alcohol, antihistamines, narcotics, and sedatives or hypnotics. There are additive cholinergic effects when administered with other drugs having anticholinergic activity, such as antidepressants or antihistamines. Concurrent use of the antidiarrheals with a monoamine oxidase inhibitor increases the risk of a hypertensive crisis.

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Unknown Antianxiety Drugs, AntiDiarrheals, Contraindicated, Intrerations

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

calcium channel blockers Adverse reactions and Contraindicated

The agents commonly called the  calcium channel blockers comprise an increasing number of agents, including the prototypical verapamil (Calan, Isoptin), nifedipine (Adalat, Procardia), and diltiazem (Cardizem). These agents are a chemically and pharmacologically heterogeneous group of synthetic drugs, but they possess the common property of selectively antagonizing Ca++movements that underlie the process of excitation contraction coupling in the cardiovascular system. The primary use of these agents is in the treatment of angina, selected cardiac arrhythmias, and hypertension.

Although the Ca++ channel blockers are potent vasodilating drugs, they lack the fluidaccumulating properties of other vasodilators and the persistent activation

of the sympathetic and renin–angiotensin–aldosterone axes. Furthermore, the broad potential range of activities, both within and without the cardiovascular system,

suggests that they may be clinically useful in disorders from vertigo to failure of gastrointestinal smooth muscle to relax .

A number of second-generation analogues are known, particularly in the nifedipine (1,4-dihydropyridine) series, including nimodipine (Nimotop), nicardipine (Cardene), felodipine (Plendil), nisoldipine (Sular), and amlodipine (Norvasc). These agents differ from nifedipine principally in their potency, pharmacokinetic characteristics, and selectivity of action.Nimodipine has selectivity for the cerebral vasculature; amlodipine exhibits very slow kinetics of onset and offset of blockade;and felodipine and nisoldipine are vascular-selective 1,4-dihydropyridines.

 Adverse reactions

Adverse reactions to the calcium channel blocking drugs usually are not serious and rarely require discontinuation of the drug therapy. The more common adverse reactions include dizziness, light-headedness, nausea,diarrhea, constipation, peripheral edema, headache,

bradycardia, flushing, dermatitis, skin rash, and nervousness. Antianginal

Drugs for a more specific listing of the adverse reactions

of the calcium channel blockers. 

 Contraindicated 

Calcium channel blockers are contraindicated in patients who are hypersensitive to the drugs and those with sick sinus syndrome, second- or third-degree AV block (except with a functioning pacemaker), hypotension (systolic less than 90 mm Hg), ventricular dysfunction,

or cardiogenic shock. The calcium channel blockers are used cautiously during pregnancy (Pregnancy Category C) and lactation and in patients with congestive heart

failure (CHF), hypotension, or renal or hepatic impairment.

The effects of the calcium channel blockers are increased when administered with cimetidine or ranitidine. A decrease in effectiveness of the calcium channel blockers may occur when the agents are administered with phenobarbital or phenytoin. The calcium channel blockers have an antiplatelet effect (inhibition of platelet function) when administered with aspirin, causing easy bruising, petechiae (pin point purplish red spot caused by intradermal hemorrhage), and bleeding. There is an additive depressive effect on the myocardium when the calcium channel

blockers are administered with the  -adrenergic blocking drugs. When the calcium channel blockers are administered with digoxin, there is an increased

risk for digitalis toxicity.

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Unknown Adverse Reactions, calcium channel blockers, Contraindicated

Narcotic Antagonists Contraindicated Actions and Adverse Reactions

An antagonist is a substance that counteracts the action of something else. A drug that is an antagonist has an affinity for a cell receptor, and by binding to it, prevents the cell from responding. Thus, a narcotic antago-nist reverses the actions of a narcotic. Specific antagonists have been developed to reverse the respiratory depression associated with the opiates. The two narcotic antagonists in use today are naloxone (Narcan) and naltrexone Naloxone is capable of restoring respiratory function within 1 to 2 minutes after administration.
Naltrexone is used primarily for the treatment of narcotic dependence to block the effects of the opiates, especially the euphoric effects experienced in opiate dependence.


NALOXONE


ACTIONS

Administration of naloxone prevents or reverses the effects of the opiates. The exact mechanism of action is
not fully understood, but it is believed that naloxone reverses opioid effects by competing for opiate receptor site If the individual has taken or180 received an opiate, the effects of the opiate are reversed.If the individual has not taken or received an opiate,naloxone has no drug activity.

USES
This drug is used for complete or partial reversal of narcotic depression, including respiratory depression Narcotic depression may be due to intentional or acci dental overdose (self-administration by an individual)
accidental overdose by medical personnel, and drug idiosyncrasy. Naloxone also may be used for diagnosis of a suspected acute opioid overdosage.

ADVERSE REACTIONS

Although not a true adverse reaction, abrupt reversal of narcotic depression may result in nausea, vomiting, sweat-ing, tachycardia, increased blood pressure, and tremors.

CONTRAINDICATIONS, PRECAUTIONS,
AND INTERACTIONS
Naloxone is contraindicated in those with a hypersensi-tivity to the narcotic antagonists. Naloxone is used cautiously in those with a narcotic addiction. Naloxone is used cautiously in patients with cardiovascular dis-
ease; those who are pregnant (Pregnancy Category B);
and in infants of opioid-dependent mothers. These drugs may produce withdrawal symptoms in those physically dependent on the narcotics. The patient must not have taken any opiate for the last 7 to
10 days. Naloxone may prevent the action of opioid antidiarrheals, antitussives, and analgesics. This drug is used cautiously during lactation.

NALTREXONE

ACTIONS

Naltrexone completely blocks the effects of IV opiates,as well as drugs with agonist-antagonist actions
(butorphanol, nalbuphine, and pentazocine). The mechanism of action appears to be the same as that for
naloxone.

USES

Naltrexone is used to treat persons dependent on opioids. Patients receiving naltrexone have been detoxified and are enrolled in a program for treatment of narcotic addiction. Naltrexone, along with other methods of
treatment (counseling, psychotherapy), is used to maintain an opioid-free state. Patients taking naltrexone on a scheduled basis will not experience any narcotic effects if they use an opioid.

ADVERSE REACTIONS

Administration of naltrexone may result in anxiety, dif-ficulty sleeping, abdominal cramps, nasal congestion,joint and muscle pain, nausea, vomiting, dizziness, irritability, depression, fatigue, and drowsiness.

CONTRAINDICATIONS, PRECAUTIONS,
AND INTERACTIONS

Naltrexone is contraindicated in those with a hyper- sensitivity to the narcotic antagonists. Naltrexone is contraindicated during pregnancy (Category C).
Naltrexone is used cautiously in those with a narcotic addiction; in patients with cardiovascular disease, acute hepatitis, liver failure, or depression; and in patients who are suicidal. Naltrexone is used cau-tiously during lactation.Naltrexone may produce withdrawal symptoms in those physically dependent on narcotics. The patient must not have taken any opiate for the last 7 to 10 days.Concurrent use of naltrexone with thioridazine may cause increased drowsiness and lethargy. Naltrexone may prevent the action of opioid antidiarrheals, antitussives, and analgesics .

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Unknown Actions, Adverse Reactions, Contraindicated, Narcotic Antagonists