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

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

Dexamethasone Indications Doses Contra Indications and Interactions

Indications:Primary or secondary adrenocortical insufficiency; allergy and anaphylaxis, shock, crohn's disease, ulcerative colitis, rheumatic arthritis, skin disorders and cerebral edema.

Doses & Administrations:
Oral: Adult: 0.5-9mg daily individed doses depending on the disease and response of the patient. Maximum: 15 mg daily. Pediatric: 0.03 - 0.15 mg/kg/day every 6 to 12 hours or 1.5mg/m2 every 6 to 12 hours. Parenteral (I/M or I/V): Adult : 0.5 - 9mg daily in divided dose depending an disease being treated. day by constant I/V infusion after bolus dose of 20 mg. by constant I/V infusion after bolus dose of 20mg. I/M every 6 hours as required for 2-10 days. Pediatric: Neonates : 0.2 - 0.5 mg/kg followed by 0.1 mg/kg po or I/V every 6 to 8 hours. Cerebral edema: 1.5 mg/kg/day every 4 to 6 hours for 5 days. Maximum : 6 mg/kg/day.

Contra Indications: Hypersensitivity to Dexamethasone or other component of the preparation dendritic keratitis, varicella and tuberculosis of the eye.

Precautions:Use cautiously in patients with renal insufficiency, diabetes mellitus, hypertension, osteoporosis, glaucoma, active or latent peptic ulcer, viral infection, tuberculosis; avoid abrupt withdrawal, monitor growth in infants and children who are on iron therapy.

Pregnancy Status:Category "C".

Renal Failure Doses:No dosage adjustment is required.

Lactation Status:Unsafe.

Interactions:Phenytoin, ephedrine, rifampicin, barbiturate may decreased blood level of cortico steroids, avoid use of live virus vaccine. Decrease absorption of calcium and phosphorus, urinary excretion of ascorbic acid, calcium, potassium, zinc, nitrogen. Increase blood glucose, triglycerides, cholesterol. Increase need for B6, Ascorbic acid, folate and vitamin D.

Adverse Effects:
Glucoma cataract formation secondary ocular infection and thinning of the cornea.

Nursing Considerations:
- Monitor baseline body weight, temperature, pulse and respiratory rate. - Monitor fluid balance. - Taper systemic steroid carefully. prolonged sore throat and unusual weight gain. - Monitor Baseline body weight, temperature, Pulse and Respiratory. - Monitor fluid balance. - Taper systemic steroids carefully. - Teach patient to report if stool black/Tarry, Muscle weakness, Prolonged sore throat and unusal weight gain. ---------------------------------------------------------------- IV DILUTION: 0 to 50 mg/ 50 ml...OVER 30 MIN. 51 to 100 mg/ 100 ml IN D5W / NS CAN BE GIVEN BY IV PUSH: Over 1 minute to several min. if dose is < 10 mg.

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Unknown Contraindications, Dexamethasone, doses, Intrerations

Antifungal Drugs Contraindications Precautions And Intrerations

Fungal infections range from superficial skin infections to life-threatening systemic infections. Systemic fungal infections are serious infections that occur when fungi gain entrance into the interior of the body.
A fungus is a colorless plant that lacks chlorophyll.
Fungi that cause disease in humans may be yeastlike or moldlike; the resulting infections are called mycotic
infections or fungal infections.Mycotic (fungal) infections may be one of two types:
1. Superficial mycotic infections
2. Deep (systemic) mycotic infections
The superficial mycotic infections occur on the surface of, or just below, the skin or nails. Superficial infections include tinea pedis (athlete’s foot), tinea cruris (jock itch), tinea corporis (ringworm), onychomycosis (nailfungus), and yeast infections, such as those caused by Candida albicans.
Yeast infections or those caused by C. albicans affect women in the vulvovaginal area and can be difficult
to control. Women who are at increased risk for vulvovaginal yeast infections arethose who have diabetes, are pregnant, or are taking oral contraceptives, antibiotics, or corticosteroids. Deep mycotic infections develop inside the body, such as in the lungs. Treatment for deep mycotic infections is often difficult and prolonged.
ACTIONS
Antifungal drugs may be fungicidal (able to destroy fungi) or fungistatic (able to slow or retard the multiplication of fungi). Amphotericin B (Fungizone IV),miconazole (Monistat), nystatin (Mycostatin), and ketoconazole (Nizoral) are thought to have an effect on the cell membrane of the fungus, resulting in a fungicidal or fungistatic effect. The fungicidal or fungistatic effect of these drugs appears to be related to their concentration in body tissues. Fluconazole (Diflucan) has fungistatic activity that appears to result from the depletion of sterols (a group of substances related to fats) in the fungus cells. Griseofulvin (Grisactin) exerts its effect by being deposited in keratin precursor cells, which are then gradually lost (due to the constant shedding of top skin cells), and replaced by new , noninfected cells.The mode of action of flucytosine (Ancobon) is not clearly understood. Clotrimazole (Lotrimin, Mycelex) binds with phospholipids in the fungal cell membrane,increasing permeability of the cell and resulting in loss of intracellular components.

USES
Antifungal drugs are used to treat superficial and deep fun-gal infections. The antifungal drugs specifically discussed in this chapter are: amphotericin B (Fungizone), flucona-zole (Diflucan), flucytosine (Ancobon), griseofulvin (Grisactin), ketoconazole (Nizoral), and miconazole (Monistat).
Miconazole is an antifungal drug used to treat vulvo-vaginal “yeast” infections and is representative of all of the vaginal antifungal agents.Fungal infections of the skin or mucous membranes may be treated with topical or vaginal preparations.

ADVERSE REACTIONS
When topical antifungal drugs, such as clotrimazole, are applied to the skin or mucous mem-branes, few adverse reactions are seen. On occasion, a local reaction, such as irritation or burning, may occur with topical use. The vulvovaginal antifungal drugs may cause local irritation, redness, stinging, or abdominal
pain. Few adverse reactions are seen with the use of the vulvovaginal antifungal drugs.

Amphotericin B
Amphotericin B is the most effective drug available forthe treatment of most systemic fungal infections.Administration often results in serious reactions,including fever, shaking, chills, headache, malaise, anorexia, joint and muscle pain, abnormal renal func-tion, nausea, vomiting, and anemia. This drug is given
parenterally, usually for a period of several months.Its use is reserved for serious and potentially life-threatening fungal infections. Some of these adverse reactions may be lessened by use of aspirin, antihistamines, or antiemetics.

Fluconazole
Administration may result in nausea, vomiting,headache, diarrhea, abdominal pain, and skin rash.Abnormal liver function tests may be seen and may require follow-up tests to determine if liver function has been affected.
Flucytosine
Administration may result in nausea, vomiting, diar-rhea, rash, anemia, leukopenia, and thrombocytopenia.Signs of renal impairment include elevated blood urea nitrogen (BUN) and
serum creatinine levels. Periodic renal function tests are usually performed during therapy.

Griseofulvin
Administration may result in a hypersensitivity-type reaction that includes rash and urticaria. Nausea, vomit-ing, oral thrush, diarrhea, and headache also may be seen.
Itraconazole
The most common adverse reactions are nausea, vomit-ing, and diarrhea. On occasion, severe hypokalemia (low potassium level) has occurred in patients receiving 600 mg or more of the drug on a daily basis. Hepatotoxicity is a possibility with itraconazole administration.

Ketoconazole
This drug is usually well tolerated, but nausea, vomit-ing, headache, dizziness, abdominal pain, and pruritus may be seen. Most adverse reactions are mild and transient. On rare occasions, hepatic toxicity may be seen,and use of the drug must be discontinued immediately.Periodic hepatic function tests are recommended to monitor for hepatic toxicity.
Miconazole
Administration of miconazole for a vulvovaginal fungal infection may cause irritation, sensitization, or vulvo- vaginal burning. Skin irritation may result in redness, itching, burning, or skin fissures. Other adverse reac-tions with miconazole include cramping, nausea, and headache. Adverse reactions associated with topical use are usually not severe.

CONTRAINDICATIONS, PRECAUTIONS,
AND INTERACTIONS

Amphotericin B

Amphotericin B is contraindicated in patients with a his-tory of allergy to the drug and during lactation. It is used cautiously in patients with renal dysfunction, electrolyte imbalances, and in combination with antineoplastic drugs (because it can cause severe bone marrow sup-pression). This drug is a Pregnancy Category B drug and is used during pregnancy only when the situation is life threatening. When given with the corticosteroids, severe hypokalemia may occur. There may be an increased risk of digitalis toxicity if digoxin is administered con-currently with amphotericin B. Administration with nephrotoxic drugs (eg,aminoglycosides or cyclosporine)may increase the risk of nephrotoxicity in patients also taking amphotericin B. Amphotericin B decreases the effects of miconazole. Amphotericin B is given only under close supervision in the hospital setting.
Fluconazole

Fluconazole is contraindicated in patients with known hypersensitivity to the drug. The drug is used cautiously in patients with renal impairment and during pregnancy (Category C) and lactation. The drug is given during pregnancy only if the benefit of the drug clearly outweighs any possible risk to the infant. When fluconazole is administered with oral hypoglycemics, there is an increased effect of the oral hypoglycemics.Fluconazole may decrease the metabolism of phenytoin and warfarin.

Flucytosine

Flucytosine is contraindicated in patients with known hypersensitivity to the drug. Flucytosine is used autiously in patients with bone marrow depression and with extreme caution in those with renal impairment.
The drug is also used cautiously during pregnancy (Category C) and lactation. When flucytosine and
amphotericin B are administered concurrently, the risk of flucytosine toxicity is increased.

Griseofulvin

Griseofulvin is contraindicated in patients with known hypersensitivity to the drug and in those with severe liver disease. This drug is used cautiously during pregnancy (Category C) and lactation. It is impor-tant to use caution when administering concurrently with penicillin because there is a possibility of crosssensitivity. When griseofulvin is administered with warfarin, the anticoagulant effect may be decreased.When administered with the barbiturates the effect of griseofulvin may be decreased. A decrease in the effects of oral contraceptives may occur with griseo-fulvin therapy, causing breakthrough bleeding, preg-nancy, or amenorrhea. Blood salicylate concentrations may be decreased when the salicylates are adminis tered with griseofulvin.


Itraconazole

Itraconazole is contraindicated in patients with a known hypersensitivity to the drug. The drug is used cautiously in patients with hepatitis, those with human immunodeficiency virus, impaired liver function, and in pregnant women (Pregnancy Category C). In patients with hypochlorhydria, the absorption of itraconazole
is decreased. Multiple drug interactions occur with itraconazole. Itraconazole elevates blood concentrations of digoxin and cyclosporine. Phenytoin decreases blood levels of itraconazole and alters the metabolism of phenytoin. Histamine antagonists, isoniazid, and rifampin decrease plasma levels of itraconazole. There is
an increased anticoagulant effect when warfarin is administered concurrently with itraconazole.

Ketoconazole
Ketoconazole is contraindicated in patients with known hypersensitivity to the drug. Ketoconazole is used cau-tiously in patients with hepatic impairment, those who are pregnant (Category C), and during lactation. The absorption of ketoconazole is impaired when the drug is taken with histamine antagonists and antacids.
Ketoconazole enhances the anticoagulant effect of warfarin and causes an additive hepatotoxicity when given with other hepatotoxic drugs and alcohol.
Administration of ketoconazole with rifampin or isoni-azid may decrease the blood levels of ketoconazole.

Miconazole
Miconazole is contraindicated in patients with known hypersensitivity to the drug. The drug is given cau-tiously in cases of chronic or recurrent candidiasis.With recurrent or chronic candidiasis the patient may have underlying diabetes. Recurrent or chronic candidi-asis requires an evaluation for diabetes. The drug is
used cautiously during pregnancy (Category C). If used during pregnancy, a vaginal applicator may be con-traindicated. Manual insertion of the vaginal tablets may be preferred. Because small amounts of these drugs may be absorbed from the vagina, the drug is used dur-ing the first trimester only when essential.

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Unknown Antifungal Drugs, Contraindications, Intrerations, Precautions