PHARCARE CASES COMPILATIONCase No. 1(Prescribed with Amoxicillin 500 mg PO Q8 for 7 days and Mefenamic Acid 500 mg PO Q6 as needed for pain) Indication Amoxicillin - for treatment of bacterial infection. Mefenamic acid - to relieve pain

Dose Amoxicillin - 500mg every 8 hourls for 7 days Mefenamic acid Geriatric, Adult, & Children (greater than 14) 500 mg first dose then 250 mg every 6 hours, not more than 7 days, as needed. DO NOT USE ON CHILDREN LESS THAN 14 [if for dysmenorrhea same dosage]

Proper Technique of Administration Amoxicillin taken with meals and drink with water Mefenamic acid taken immediately after meals with water usually 8-12 oz

Special Features Amoxicillin - stomach pains, dark stools and bloody or dark yellow urine, blistering of skin, bloated, bloody nose, cough, diarrhea, difficulty In breathing, fast heartbeat Mefenamic acid - bloody urine and stool, heartburn, increase bleeding time, indigestion, pruritis, nausea, swelling, tired, vomit, weight gain and lose

Schedule Amoxicillin - every8 hours Mefenamic acid - as needed for pain

Drug-Drug or Food Interaction No interaction with each other. Amoxicillin - there are drugs that increase the effects of antibiotics ex. Methotrexate, probenacid Mefenamic acid - do not take: ACE inhibitors Alcohol Anticoagulant Diuretics Hydantoins Lithium Salicylates Sulphonamides

Adverse Effects Amoxicillin Nausea Appetite loss Diarrhea Dry mouth Pruritus Mefenamic acid GI discomfort Nausea Diarrhea Anorexia Dizziness Insomnia Blurred vision

Contraindications Amoxicillin - not to be used on patients that are: sensitive to penicillin liver problems kidney problems blockage of normal bile flow colitis Mefenamic acid - patients present with: peptic ulcer or with renal disease asthma, urticarial those that underwent coronary artery bypass graft surgery

Contraindicated Allergies Amoxicillin - skin rash, hives, itching, fever, swelling, shortness of breath, wheezing, watery eyes, anaphylaxis Mefenamic acid - rash, hives, shortness of breath, dizziness, colds

Special Precautions Amoxicillin - impaired renal function, sensitive to cephalosporins, elderly Mefenamic acid - elderly, allergy, pregnant, peptic ulcer, blurred vision, eye irritation, rash, swelling, irregular heartbeat, GI effects, liver disease

What to do in case of manifestation of adverse effects CONTACT DOCTOR AND STOP MEDICATION Amoxicillin more fluid intake and diuresis Mefenamic acid no specific antidote, emesis, activated charcoal, osmotic cathartic for large overdose within 4 hours of overdose

Storage Conditions (BOTH): Store in room temperature, away from moisture, heat and lightCase No. 2Paracetamol 250mg/5mL, 5mL every Q6 as needed for fever and Vitamin C (Proteen-C) 1 tsp OD every am

PARACETAMOL 250mg/5mLIndication

For the treatment of mild to moderate pain, including headache, migraine, neuralgia, toothache, sore throat, period pains, aches and pains.

For the reduction of fever and to be used as an adjunctive treatment to relieve symptoms of cold and flu.

Dose / Proper Technique of Administration / Schedule / For oral administration only It is important toshake the bottlefor at least 10 seconds before use. Do not overfill the spoon Do not give anything else containing paracetamol while giving this medicine For short term use only

Child's AgeHow MuchHow often (in 24 hours)

6 8 yearsOne 5 mL spoonful (large end)4 times

8 10 yearsOne 5.0 mL spoonful (large end) and one 2.5 mL spoonful (small end)4 times

10 12 yearsTwo 5 mL spoonfuls (large end)4 times

Do not give more than 4 doses in any 24 hour period Leave at least 4 hours between doses Do not give this medicine to your child for more than 3 days without speaking to your doctor or pharmacist Do not give to children under the age of 6 years.

Children aged 12-16 years: Two - three 5mL spoonfuls (large end) up to 4 times a day Adults and children over 16 years: Two - four 5mL spoonfuls (large end) up to 4 times a day.

Special FeaturesDrug-Drug or Food InteractionThe hepatotoxicity of Paracetamol, particularly after overdosage, may be increased by drugs which induce liver microsomal enzymes such as barbiturates, tricyclic antidepressants and alcohol.The speed of absorption of paracetamol may be increased by metoclopramide or domperidone and absorption reduced by colestyramine.

The anticoagulant effect of warfarin and other coumarins may be enhanced by prolonged regular use of paracetamol with increased risk of bleeding; occasional doses have no significant effect.

Antivirals: Regular use of Paracetamol possibly reduces metabolism of Zidovudine (increased risk of neutropenia).

The use of drugs that induce hepatic microsomal enzymes such as anticonvulsants and oral contraceptives may increase the extent of metabolism of paracetamol resulting in reduced plasma concentrations of the drug and a faster elimination rate.

Adverse EffectsAdverse effects of paracetamol are rare but hypersensitivity including skin rash may occur. There have been reports of blood dyscrasias including thrombocytopenia and agranulocytosis, but these were not necessarily causality related to paracetamol.

Very rare cases of serious skin reactions have been reported.

Cases of acute pancreatitis have been reported. Paracetamol has been widely used and reports of adverse reactions are rare, and are generally associated with overdosage.

Allergic reactions occur occasionally.

Chronic hepatic necrosis has been reported in a patient who took daily therapeutic doses of paracetamol for about a year and liver damage has been reported after daily ingestion of excessive amounts for shorter periods. A review of a group of patients with chronic active hepatitis failed to reveal differences in the abnormalities of liver function in those who were long-term users of paracetamol nor was the control of the disease improved after paracetamol withdrawal.

Side Effects allergic reactions including swelling of the face, tongue or throat, difficulty swallowing, unexplained wheezing, shortness of breath which may be accompanied by skin rash or hives. becoming unusually tired, unexpected bruising or bleeding and getting more infections (such as colds) than usual.

ContraindicationsHypersensitivity to paracetamol and/or other constituents.Patients with severe hepatic dysfunction.

Special PrecautionsCare is advised in the administration of paracetamol to patients with severe renal or severe hepatic impairment. The hazards of overdose are greater in those with non-cirrhotic alcoholic liver disease. Contains paracetamol. Do not give with any other paracetamol-containing products. For oral use only. Never give more medicine than shown in the table. Always use the spoon supplied with the pack. Do not overfill the spoon. Do not give more than 4 doses in any 24 hour period. Leave at least 4 hours between doses. Do not give this medicine to your child for more than 3 days without speaking to your doctor or pharmacist. As with all medicines, if your child is currently taking any medicine consult your doctor or pharmacist before taking this product. Do not store above 25C. Protect from light. Store in the original package. Immediate medical advice should be sought in the event of an overdose, even if the child seems well, because of the risk of delayed serious liver damage. If symptoms persist consult your doctor. Keep out of the reach and sight of children.

What to do in case of manifestation of adverse effects/OverdosageLiver damage is possible in adults who have taken 10g or more of paracetamol. Ingestion of 5g or more of paracetamol may lead to liver damage if the patient has risk factors (see below).

Risk factorsIf the patienta) Is on long term treatment with carbamazepine, phenobarbital, phenytoin, primidone, rifampicin, St. John's Wort or other drugs that induce liver enzymes.

b) Regularly consumes ethanol in excess of recommended amounts.

c) Is likely to be glutathione depleted e.g. eating disorders, cystic fibrosis, HIV infection, starvation, cachexia.

Symptoms Symptoms of paracetamol overdosage in the first 24 hours are pallor, nausea, vomiting, anorexia and abdominal pain. Liver damage may become apparent 12 to 48 hours after ingestion. Abnormalities of glucose metabolism and metabolic acidosis may occur. In severe poisoning, hepatic failure may progress to encephalopathy, haemorrhage, hypoglycaemia, cerebral oedema, and death. Acute renal failure with acute tubular necrosis, strongly suggested by loin pain, haematuria and proteinuria may develop even in the absence of severe liver damage. Cardiac arrhythmias and pancreatitis have been reported.

Management

Immediate treatment is essential in the management of paracetamol overdose. Despite a lack of significant early symptoms, patients should be referred to hospital urgently for immediate medical attention. Symptoms may be limited to nausea or vomiting and may not reflect the severity of overdose or the risk of organ damage. Management should be in accordance with established treatment guidelines, see BNF overdose section. Treatment with activated charcoal should be considered if the overdose has been taken within 1 hour. Plasma paracetamol concentration should be measured at 4 hours or later after ingestion (earlier concentrations are unreliable). Treatment with N-acetylcysteine may be used up to 24 hours after ingestion of paracetamol, however, the maximum protective effect is obtained up to 8 hours post-ingestion. The effectiveness of the antidote declines sharply after this time. If required, the patient should be given intravenous N-acetylcysteine in line with the established dosage schedule. If vomiting is not a problem, oral methionine may be a suitable alternative for remote areas, outside hospital. Management of patients who present with serious hepatic dysfunction beyond 24h from ingestion should be discussed with the NPIS or a liver unit.

Storage ConditionsStore below 25C. Protect from light. Store in the original package.

Vitamin C (Proteen-C)Indication Vitamin C deficiency. Taking vitamin C by mouth or injecting as a shot prevents and treats vitamin C deficiency, including scurvy. Also, taking vitamin C can reverse problems associated with scurvy.

Dose For scurvy: 100-250 mg once or twice daily for several days. For treating the common cold: 1-3 grams daily. For preventing kidney damage related to contrast media used during diagnostic tests: vitamin C 3 grams is given before coronary angiography and then 2 grams is given after the procedure in the evening and again the following morning. For slowing progression of hardening of the arteries: slow-release vitamin C 250 mg in combination with 91 mg (136 IU) of vitamin E twice daily for up to 6 years. For tyrosinemia in premature infants on high protein diets: 100 mg of vitamin C. For reducing protein in the urine of patients with type 2 diabetes: vitamin C 1250 mg with vitamin E 680 IU daily for 4 weeks. For preventing complex regional pain syndrome in patients with wrist fractures, vitamin C 500 mg daily for 50 days.The daily recommended dietary allowances (RDAs) are: Infants 0 to 12 months, human milk content (older recommendations specified 30-35 mg) Children 1 to 3 years, 15 mg; Children 4 to 8 years, 25 mg Children 9 to 13 years, 45 mg Adolescents 14 to 18 years, 75 mg for boys and 65 mg for girls Adults age 19 and greater, 90 mg for men and 75 mg for women Pregnancy and Lactation: age 18 or younger, 115 mg; ages 19 to 50 years 120 mg People who use tobacco should take an additional 35 mg per day.

Do not take more than the following amounts of vitamin C: 400 mg per day for children ages 1 to 3 years 650 mg per day for children 4 to 8 years 1200 mg per day for children 9 to 13 years 1800 mg per day for adolescents and pregnant and breast-feeding women 14 to 18 years 2000 mg per day for adults and pregnant and lactating women.Proper Technique of Administration / ScheduleTake this vitamin by mouth with or without food, usually 1 to 2 times daily. Follow all directions on the product package, or take as directed by your doctor.Special Precautions and WarningsPregnancy and breast-feeding: Vitamin C isLIKELY SAFEfor pregnant or breast-feeding women when taken by mouth in amounts no greater than 2000 mg daily for women over 19 years-old, and 1800 mg daily for women 14 to 18 years-old, or when given intravenously (by IV) or intramuscularly and appropriately. Taking too much vitamin C during pregnancy can cause problems for the newborn baby. Vitamin C isPOSSIBLY UNSAFEwhen taken by mouth in excessive amounts.

Infants and children: Vitamin C isLIKELY SAFEwhen taken by mouth appropriately. Vitamin C isPOSSIBLY UNSAFEwhen taken by mouth in amounts higher than 400 mg daily for children 1 to 3 years, 650 mg daily for children 4 to 8 years, 1200 mg daily for children 9 to 13 years, and 1800 mg daily for adolescents 14 to 18 years.

Angioplasty, a heart procedure: Avoid taking supplements containing vitamin C or other antioxidant vitamins (beta-carotene, vitamin E) immediately before and following angioplasty without the supervision of a health care professional. These vitamins seem to interfere with proper healing.

Cancer: Cancerous cells collect high concentrations of vitamin C. Until more is known, only use high doses of vitamin C under the direction of your oncologist.

Diabetes: Vitamin C might raise blood sugar. In older women with diabetes, vitamin C in amounts greater than 300 mg per day increases the risk of death from heart disease. Do not take vitamin C in doses greater than those found in basic multivitamins.

Blood-iron disorders, including conditions called thalassemia and hemochromatosis: Vitamin C can increase iron absorption, which might make these conditions worse. Avoid large amounts of vitamin C.

Kidney stones, or a history of kidney stones: Large amounts of vitamin C can increase the chance of getting kidney stones. Do not take vitamin C in amounts greater than those found in basic multivitamins.

Heart attack: Vitamin C levels are reduced during a heart attack. However, low vitamin C has not been linked to an increased risk for heart attack.

A metabolic deficiency called glucose-6-phosphate dehydrogenase (G6PD) deficiency: Large amounts of vitamin C can cause red blood cells to break in people with this condition. Avoid excessive amounts of vitamin C.

Smoking and chewing tobacco: Smoking and chewing tobacco lowers vitamin C levels. Vitamin C intake in the diet should be increased in people who smoke or chew tobacco.

Sickle cell disease: Vitamin C might make this condition worse. Avoid using large amounts of vitamin C.Drug-Drug or Food InteractionAmygdalinRisk of life-threatening cyanide toxicity to amygdalin may be increased. Although the FDA has banned the use of the synthetic form of amygdalin, laetrile, for cancer treatment, amygdalin has been used as alternative medicine by some patients. Avoid concurrent use.DisulfiramOn occasion, ascorbic acid has been used as a specific antidote for symptoms resulting from the interaction between ethanol and disulfiram; it may be expected that the coadministration of ascorbic acid will interfere with the effectiveness of disulfiram given to patients to encourage abstention from alcohol.Drugs affected by urinary acidification (eg, amphetamine, mexiletine)Acidification of the urine by ascorbic acid may cause precipitation of cysteine, urate, or oxalate stones and will alter the excretion of certain other drugs administered concurrently. Elimination of certain drugs may be enhanced by urinary acidification. Monitor the clinical response of the patient. If an interaction is suspected, it may be necessary to discontinue ascorbic acid or adjust the dose of the drug altered by urinary acidification.WarfarinLarge ascorbic acid doses interfere with the anticoagulant effect of warfarin. Monitor coagulation parameters in patients receiving ascorbic acid 5 g or more daily and adjust the warfarin dose as needed.

Adverse Effects Large doses of ascorbic acid are reported to cause diarrhoea and other gastrointestinal disturbances and are associated with renal calcium oxalate calculi. Ascorbic acid should be given with care to patients with hyperoxaluria There is a report of an allergic reaction to ascorbic acid in 3 patients presenting as eczema, uticaria or asthma.ContraindicationsThis vitamin may interfere with certain laboratory tests (including certain urine glucose tests), possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug.

Special PrecautionsBefore taking ascorbic acid, tell your doctor or pharmacist if you have any allergies. This product may contain inactive ingredients (such as peanut/soy), which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this vitamin, tell your doctor or pharmacist your medical history, especially of: kidney disease (such as kidney stones), a certain enzyme deficiency (G6PD deficiency).During pregnancy, this vitamin has been found to be safe when used in recommended doses. Higher doses should be used during pregnancy only if clearly needed. Discuss the risks and benefits with your doctor.This vitamin passes into breast milk and is considered to be safe during breast-feeding when used in recommended doses. Consult your doctor for more information.

What to do in case of manifestation of adverse effects/Missed DoseIf 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. Do not double doses.If you miss taking a vitamin for one or more days there is no cause for concern, since it takes some time for your body to become seriously low in vitamins.

Storage ConditionsStore injection in refrigerator at 36 to 46F. Do not allow to stand at room temperature before use. Store oral products at room temperature.

Case No. 3Amlodipine 5 mg PO OD and Furosemide 20 mg PO OD ( Hypertensive drugs)AmlodipineIndicationHypertensionChronic stable angina pectoris. Vasospastic (Prinzmetal's) angina Amlodipine belongs to a group of medicines called calcium antagonists. In patients with high blood pressure, your medicine works by relaxing blood vessels, so that blood passes through them more easily. In patients with angina, Amlodipine tablets works by improving blood supply to the heart muscle, which then receives more oxygen, and as a result chest pain is prevented.Amlodipine is used alone or in combination with other medications to treat high blood pressure and chest pain (angina). Amlodipine is in a class of medications called calcium channel blockers. It lowers blood pressure by relaxing the blood vessels so the heart does not have to pump as hard. It controls chest pain by increasing the supply of blood to the heart. If taken regularly, amlodipine controls chest pain, but it does not stop chest pain once it starts. Your doctor may prescribe a different medication to take when you have chest pain.High blood pressure is a common condition and when not treated, can cause damage to the brain, heart, blood vessels, kidneys and other parts of the body. Damage to these organs may cause heart disease, a heart attack, heart failure, stroke, kidney failure, loss of vision, and other problems. In addition to taking medication, making lifestyle changes will also help to control your blood pressure. These changes include eating a diet that is low in fat and salt, maintaining a healthy weight, exercising at least 30 minutes most days, not smoking, and using alcohol in moderation.

Dose GeriartricAmlodipine used at similar doses in elderly or younger patients is equally well tolerated. Normal dosage regimens are recommended in the elderly, but increase of the dosage should take place with care.AdultFor both hypertension and angina the usual initial dose is 5 mg Amlodipine once daily which may be increased to a maximum dose of 10 mg depending on the individual patient's response. In hypertensive patients, Amlodipine has been used in combination with a thiazide diuretic, alpha blocker, beta blocker, or an angiotensin converting enzyme inhibitor. For angina, Amlodipine may be used as monotherapy or in combination with other antianginal medicinal products in patients with angina that is refractory to nitrates and/or to adequate doses of beta blockers.ChildrenThe recommended antihypertensive oral dose in paediatric patients ages 6-17 years is 2.5 mg once daily as a starting dose, up-titrated to 5 mg once daily if blood pressure goal is not achieved after 4 weeks. Doses in excess of 5 mg daily have not been studied in paediatric patients (see sections 5.1 and 5.2).

Proper Technique of AdministrationAmlodipine comes as a tablet to take by mouth. It is usually taken once a day. To help you remember to take amlodipine, take it around the same time 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 amlodipine exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.Your doctor will probably start you on a low dose of amlodipine and gradually increase your dose.Amlodipine controls high blood pressure and chest pain (angina) but does not cure them. Continue to take amlodipine even if you feel well. Do not stop taking amlodipine without talking to your doctor.

Special FeaturesTablets are formulated as white tablets equivalent to 2.5, 5, and 10 mg of amlodipine for oral administration. In addition to the active ingredient, amlodipine besylate, each tablet contains the following inactive ingredients: microcrystalline cellulose, dibasic calcium phosphate anhydrous, sodium starch glycolate, and magnesium stearate.Schedule ng Pag-inomTypically used once a day in the morning, with or without food.

Drug-Drug or Food InteractionEffects of other medicinal products on amlodipine CYP3A4 inhibitors: Concomitant use of amlodipine with strong or moderate CYP3A4 inhibitors (protease inhibitors, azole antifungals, macrolides like erythromycin or clarithromycin, verapamil or diltiazem) may give rise to significant increase in amlodipine exposure. The clinical translation of these PK variations may be more pronounced in the elderly. Clinical monitoring and dose adjustment may thus be required.CYP3A4 inducers: There is no data available regarding the effect of CYP3A4 inducers on amlodipine. The concomitant use of CYP3A4 inducers (e.g. rifampicin, hypericum perforatum) may give a lower plasma concentration of amlodipine. Amlodipine should be used with caution together with CYP3A4 inducers.Administration of amlodipine with grapefruit or grapefruit juice is not recommended as bioavailability may be increased in some patients resulting in increased blood pressure lowering effects. Dantrolene (infusion): In animals, lethal ventricular fibrillation and cardiovascular collapse are observed in association with hyperkalemia after administration of verapamil and intravenous dantrolene. Due to risk of hyperkalemia, it is recommended that the co-administration of calcium channel blockers such as amlodipine be avoided in patients susceptible to malignant hyperthermia and in the management of malignant hyperthermia.Effects of amlodipine on other medicinal products The blood pressure lowering effects of amlodipine adds to the blood pressure-lowering effects of other medicinal products with antihypertensive properties.In clinical interaction studies, amlodipine did not affect the pharmacokinetics of atorvastatin, digoxin, warfarin or cyclosporin.Simvastatin: Co-administration of multiple doses of 10 mg of amlodipine with 80 mg simvastatin resulted in a 77% increase in exposure to simvastatin compared to simvastatin alone. Limit the dose of simvastatin in patients on amlodipine to 20 mg daily.

Adverse EffectsThe most commonly reported adverse reactions during treatment are somnolence, dizziness, headache, palpitations, flushing, abdominal pain, nausea, ankle swelling, oedema and fatigueAmlodipine can have minor or moderate influence on the ability to drive and use machines. If patients taking amlodipine suffer from dizziness, headache, fatigue or nausea the ability to react may be impaired. Caution is recommended especially at the start of treatment. swelling of the hands, feet, ankles, or lower legs headache upset stomach stomach pain dizziness or lightheadedness drowsiness excessive tiredness flushing more frequent or more severe chest pain rapid, pounding, or irregular heartbeat fainting

ContraindicationsAmlodipine is contraindicated in patients with: - severe hypotension- shock (including cardiogenic shock)- obstruction of the outflow tract of the left ventricle (e.g. high grade aortic stenosis)- haemodynamically unstable heart failure after acute myocardial infarction

Contraindicated AllergiesHypersensitivity to dihydropyridine derivatives, amlodipine or any of the excipientsSpecial PrecautionsPatients with cardiac failure:Patients with heart failure should be treated with caution. In a long-term, placebo controlled study in patients with severe heart failure (NYHA class III and IV) the reported incidence of pulmonary oedema was higher in the amlodipine treated group than in the placebo group. Calcium channel blockers, including amlodipine, should be used with caution in patients with congestive heart failure, as they may increase the risk of future cardiovascular events and mortality. Use in patients with impaired hepatic function:The half life of amlodipine is prolonged and AUC values are higher in patients with impaired liver function; dosage recommendations have not been established. Amlodipine should therefore be initiated at the lower end of the dosing range and caution should be used, both on initial treatment and when increasing the dose. Slow dose titration and careful monitoring may be required in patients with severe hepatic impairment..

What to do in case of manifestation of adverse effectsSymptoms: Available data suggest that gross overdosage could result in excessive peripheral vasodilatation and possibly reflex tachycardia. Marked and probably prolonged systemic hypotension up to and including shock with fatal outcome have been reported.Treatment: Clinically significant hypotension due to amlodipine overdosage calls for active cardiovascular support including frequent monitoring of cardiac and respiratory function, elevation of extremities and attention to circulating fluid volume and urine output.A vasoconstrictor may be helpful in restoring vascular tone and blood pressure, provided that there is no contraindication to its use. Intravenous calcium gluconate may be beneficial in reversing the effects of calcium channel blockade. Gastric lavage may be worthwhile in some cases. In healthy volunteers the use of charcoal up to 2 hours after administration of amlodipine 10 mg has been shown to reduce the absorption rate of amlodipine. Since amlodipine is highly protein-bound, dialysis is not likely to be of benefit.

Storage ConditionsKeep Amlodipine tablets out of the sight and reach of children.Do not store the tablets above 30C.

Sources: https://www.medicines.org.uk/emc/medicine/24888http://xpil.medicines.org.uk/ViewPil.aspx?DocID=18031http://www.nlm.nih.gov/medlineplus/druginfo/meds/a692044.html

FurosemideIndicationFurosemide tablets is one of a group of medicines called diuretics (water tablets).

Furosemide tablets are used to treat a condition called oedema where there is too much water in your body. This could be due to problems with your heart, kidneys, liver, blood vessels or high blood pressure. Furosemide helps your kidneys to get rid of the extra water that is not needed in your body.

Dose GeriartricMay be reduced in this age group.AdultAdults and children over 12 years: Water retention: the usual starting dose is 40mg in the morning, then 20mg a day or 40mg on alternate days. Up to 80mg a day may be given.ChildrenChildren under 12 years: 1-3mg per kg of bodyweight. A more suitable dosage form e.g. oral solution, may be appropriate.Proper Technique of AdministrationTake this medication by mouth as directed by your doctor, with or without food, usually once or twice daily.Special FeaturesFurosemide tablets are white, uncoated tablets.

Schedule ng Pag-inomIt is best to avoid taking this medication within 4 hours of your bedtime to prevent having to get up to urinate. Take a dose as soon as you remember. If it is almost time for your next dose, wait until then and take a regular dose.

Drug-Drug or Food Interaction cisplatin (Platinol); cyclosporine (Neoral, Gengraf, Sandimmune); ethacrynic acid (Edecrin); lithium (Eskalith, Lithobid); methotrexate (Rheumatrex, Trexall); phenytoin (Dilantin); an antibiotic such as amikacin (Amikin), cefdinir (Omnicef), cefprozil (Cefzil), cefuroxime (Ceftin), cephalexin (Keflex), gentamicin (Garamycin), kanamycin (Kantrex), neomycin (Mycifradin, Neo Fradin, Neo Tab), streptomycin, tobramycin (Nebcin, Tobi); heart or blood pressure medication such as amiodarone (Cordarone, Pacerone), benazepril (Lotensin), candesartan (Atacand), eprosartan (Teveten), enalapril (Vasotec), irbesartan (Avapro, Avalide), lisinopril (Prinivil, Zestril), losartan (Cozaar, Hyzaar), olmesartan (Benicar), quinapril (Accupril), ramipril (Altace), telmisartan (Micardis), valsartan (Diovan), and others; a laxative (Metamucil, Milk of Magnesia, Colace, Dulcolax, Epsom salts, senna, and others) salicylates such as aspirin, Disalcid, Doan's Pills, Dolobid, Salflex, Tricosal, and others; or steroids (prednisone and others). If you also takesucralfate, allow at least 2 hours between the time you takefurosemideand the time you take sucralfate.

Adverse EffectsDizziness, lightheadedness, headache, or blurred vision may occur as your body adjusts to the medication. This medication may cause a serious loss of body water (dehydration) and salt/minerals. Tell your doctor right away if you have any of these unlikely but serious side effects: muscle cramps, weakness, unusual tiredness, confusion, severe dizziness, fainting, drowsiness, unusual dry mouth/thirst, nausea, vomiting, fast/irregular heartbeat, unusual decrease in the amount of urine.This medicine may cause the following problems: Hypokalemia (low potassium in yourblood) Changes inblood sugarlevels Hearing problems Allergic reaction: Itching orhives, swelling in your face or hands, swelling or tingling in yourmouthorthroat,chesttightness, trouble breathing Blistering, peeling, redskinrash Chestpain, shortness of breath Confusion, weakness, muscle twitching Drymouth, increased thirst,muscle cramps,nauseaorvomiting, uneven heartbeat Sudden and severestomachpain,nausea,vomiting,fever, lightheadedness Hearing loss, ringing in the ears Lightheadedness, dizziness, fainting Severediarrhea Unusualbleedingor bruising Yellowskinor eyes

Contraindicationskidney disease, enlarged prostate, urination problems, cirrhosis or other liver disease, an electrolyte imbalance, high cholesterol, gout, lupus, diabetes, are dehydrated , have low blood pressure, take potassium supplements or potassium sparing diuretics for high blood pressure (e.g. amiloride or spironolactone), have Addisons disease (low levels of corticosteroid hormones secreted) and have digitalis poisoning (feeling or being sick, high levels of potassium in the blood, slow, fast or irregular heart beats). Tell your doctor if you have recently had an MRI (magnetic resonance imaging) or any type of scan using a radioactive dye that is injected into your veins.Contraindicated AllergiesAllergic (hypersensitive) to furosemide, other sulphonamide related drugs or any of the other ingredients in Furosemide tablets.

Special PrecautionsFurosemide can pass into breast milk and may harm a nursing baby. This medication may also slow breast milk production. What to do in case of manifestation of adverse effectsStop using furosemide and call your doctor at once if you have a serious side effect such as: ringing in your ears, hearing loss; itching, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes); severe pain in your upper stomach spreading to your back, nausea and vomiting; weight loss, body aches, numbness; swelling, rapid weight gain, urinating less than usual or not at all; chest pain, new or worsening cough with fever, trouble breathing; pale skin, bruising, unusual bleeding, feeling light-headed, rapid heart rate, trouble concentrating; low potassium (confusion, uneven heart rate, leg discomfort, muscle weakness or limp feeling); low calcium (tingly feeling around your mouth, muscle tightness or contraction, overactive reflexes); headache, feeling unsteady, weak or shallow breathing; or severe skin reaction -- fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.

Storage ConditionsKeep out of the reach and sight of children.Store below 25C in a dry place. Protect from lightSources: http://www.emedicinehealth.com/drug-furosemide/article_em.htm#sideeffectshttp://www.rxlist.com/lasix-drug/indications-dosage.htm#Dhttp://xpil.medicines.org.uk/ViewPil.aspx?DocID=18200http://www.webmd.com/drugs/2/drug-5512-8043/furosemide-oral/furosemide-oral/details#Case No. 4Ciprofloxacin 500 mg PO Q12 for 7 daysIndicationSusceptible infections, including lower respiratory tract, skin and skin structures, bone and joint, acute sinusitis, complicated intraabdominal (w. metronidazole), UTIs, chronic bacterial prostatitis, acute uncomplicated cystitis in females. Postexposure prophylaxis and treatment of anthrax. Infectious diarrhea, typhoid fever, uncomplicated cervical and urethral gonorrheaDose GeriartricElderly patients should receive a dose selected according to the severity of the infection and the patient's creatinine clearance.AdultInfectiONADULT DOSAGE GUIDELINES

SEVERITYDOSEFREQUENCYUSUAL DURATIONS

Urinary TractAcute Uncomplicated250 mgq 12 h3 days

Mild/Moderate250 mgq 12 h7 to 14 days

Severe/ Complicated500 mgq 12 h7 to 14 days

Chronic Bacterial ProstatitisMild/ Moderate500 mgq 12 h28 days

Lower Respiratory TractMild/ Moderate500 mgq 12 h7 to 14 days

Severe/ Complicated750 mgq 12 h7 to 14 days

Acute SinusitisMild/ Moderate500 mgq 12 h10 days

Skin andMild/ Moderate500 mgq 12 h7 to 14 days

Skin StructureSevere/ Complicated750 mgq 12 h7 to 14 days

Bone and JointMild/ Moderate500 mgq 12 h 4 to 6 weeks

Severe/ Complicated750 mgq 12 h 4 to 6 weeks

Intra-Abdominal*Complicated500 mgq 12 h7 to 14 days

Infectious DiarrheaMild/ Moderate/ Severe500 mgq 12 h5 to 7 days

Typhoid FeverMild/ Moderate500 mgq 12 h10 days

Urethral and Cervical Gonococcal InfectionsUncomplicated250 mgsingle dosesingle dose

Ihnalational anthrax (post-exposure)500 mgq h 1260 days

* Used in conjunction with metronidazole Generally ciprofloxacin should be continued for at least 2 days after the signs and symptoms of infection have disappeared, except for inhalational anthrax (post-exposure).** Drug administration should begin as soon as possible after suspected or confirmed exposure.

Children10 mg/kg to 20 mg/kg (maximum 750 mg per dose; not to be exceeded even in patients weighing > 51 kg)Proper Technique of AdministrationTake this medicine with a full glass of water (8 ounces). Drink several extraglassesof fluid each day while you are taking this medicine. Ciprofloxacin may be taken with or withoutfood, but take it at the same time each day.Do not take ciprofloxacin with dairy products such as milk or yogurt, or with calcium-fortified juice. You may eat or drink these products as part of a regular meal, but do not use them alone when taking ciprofloxacin. They could make the medication less effective.Special FeaturesCiprofloxacin is used to treat different types of bacterial infections. It is also used to treat people who have been exposed to anthrax.

Schedule ng Pag-inomCiprofloxacin is usually taken every 12 hours. Follow all directions on yourprescriptionlabel. Do not take this medicine in larger or smaller amounts or for longer than recommended.Drug-Drug or Food InteractionAvoid taking the following medicines within 6 hours before or 2 hours after you take ciprofloxacin. These other medicines can make ciprofloxacin much less effective when taken at the same time: antacids that contain magnesium or aluminum (such as Maalox, Mylanta, or Rolaids), or the ulcer medicine sucralfate (Carafate); didanosine (Videx) powder or chewable tablets; vitamin or mineral supplements that contain calcium, iron, or zinc.Avoid caffeine while you are taking ciprofloxacin, because the medication can make the effects of caffeine stronger.Adverse EffectsCiprofloxacin may cause swelling or tearing of (rupture) a tendon. It can also have serious effects on your nerves, and may cause permanent nerve damage.Stop taking this medicine and call your doctor at once if you have: signs of tendon rupture--sudden pain, swelling, bruising, tenderness, stiffness, movement problems, or a snapping or popping sound in any of your joints (rest the joint until you receive medical care or instructions); or nerve symptoms--numbness, tingling, burning pain, or being more sensitive to temperature, light touch, or the sense of your body position.Stop using ciprofloxacin and call your doctor at once if you have: headache with chest pain and severe dizziness, fainting, fast or pounding heartbeats; nausea, upper stomach pain, itching, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes); muscle weakness or trouble breathing; diarrhea that is watery or bloody; sudden weakness or ill feeling, fever, chills, sore throat, mouth sores, easy bruising or bleeding; depression, confusion, hallucinations, paranoia, tremors, feeling restless or anxious, unusual thoughts or behavior, insomnia, nightmares; seizure (convulsions); or increased pressure inside the skull-- severe headaches, ringing in your ears, dizziness, nausea, vision problems, pain behind your eyes.

ContraindicationsCiprofloxacin is contraindicated in persons with a history of hypersensitivity to ciprofloxacin, any member of the quinolone class of antimicrobial agents, or any of the product componentsContraindicated AllergiesSigns of an allergic reaction to ciprofloxacin: hives, or the first sign of a skin rash; fast heartbeat, difficult breathing; swelling of your face, lips, tongue, or throat.Special PrecautionsCiprofloxacin, may also cause central nervous system (CNS) events, including: nervousness, agitation, insomnia, anxiety, nightmares or paranoia. Alteration of the dosage regimen is necessary for patients with impairment of renal function

What to do in case of manifestation of adverse effectsIn the event of acute overdosage, reversible renal toxicity has been reported in some cases. The stomach should be emptied by inducing vomiting or by gastric lavage. The patient should be carefully observed and given supportive treatment, including monitoring of renal function, urinary pH and acidify, if required, to prevent crystalluria and administration of magnesium, aluminum, or calcium containing antacids, which can reduce the absorption of ciprofloxacin. Adequate hydration must be maintained. Only a small amount of ciprofloxacin ( < 10%) is removed from the body after hemodialysis or peritoneal dialysis.Storage ConditionsStore at room temperature away from moisture and heat.Case No. 5(Simvastatin 20 mg PO ODHS, Metoprolol 50 mg PO BID, Aspirin 80 mg PO OD) Indication SIMVASTATIN This is used in the reduction of total LDL-cholesterol, apolipoprotein B & triglycerides in the treatment of hyperlipidemia including hypercholesterolemia, adjunct therapy for homozygous familial hypercholesterolemia & ischemic heart disease. METOPROLOL Hypertension: As monotherapy or in combination with other antihypertensive agents. Pediatric hypertension. Angina Pectoris: Long-term prophylaxis. Cardiac Arrhythmias Myocardial Infarction: Maintenance treatment after MI. Functional heart disorders with palpitations. Hyperthyroidism. Prophylaxis of migraine headache.

ASPIRIN Relief of mild to moderate pain An antithrombotic in the initial treatment of CV disorders Prevention of MI & stroke. Prevention of Cardiovascular Disease Primary Prevention of Thromboembolic Disorders and Cardiovascular Events:Ischemic stroke; transient ischemic attack (TIA); prevention of recurrent myocardial infarction (MI); unstable angina pectoris; chronic stable angina pectoris. Secondary Prevention of Cardiovascular Disease in Persons with Diabetes Mellitus Especially in the Following Subgroups:History of MI, vascular bypass procedure, stroke or transient ischemic attack and angina. Persons with additional risk factors: Hypertension, smoking, dyslipidemia and family history of cardiovascular disease. Revascularization Procedures:Patients who have undergone revascularization procedures eg, coronary artery bypass graft (CABG), percutaneous transluminal coronary angioplasty (PTCA) and carotid endarterectomy when there is a preexisting condition for which aspirin is already indicated. Pregnancy-Induced Hypertension

Dose

Geriartric SIMVASTATIN same with adult but with caution/close monitoring METOPROLOL - Use lower dosage (with adult) in management of hypertension ASPIRIN - Older age is also a strong risk factor for bleeding from aspirin use. Even low-dose aspirin can increase the risk of bleeding in the gut. CAUTION OR CLOSE MONITORING IS ADVICED Adult SIMVASTATIN Hypercholesterolemia Usual dosage range: 5-40 mg PO qDay Initial: 10-20 mg PO qDay in the evening Patients at high CHD risk: Start 40 mg/day Homozygous Familial Hypercholesterolemia Recommended dose: 40 mg PO qDay in the evening METOPROLOL Acute Myocardial InfarctionEarly treatment Metoprolol tartrate 5 mg rapid IV q2min, up to 3 doses; then, 15 minutes after last IV, 50 mg PO q6hr for 48 hours; then 50-100 mg PO q12hr Congestive Heart Failure Metoprolol succinate 25 mg PO qDay initially; increased every 2 weeks PRN; target dosage, 200 mg/day New York Heart Association (NYHA) class II: Reduce dosage 12.5 mg/day Hypertension Metoprolol tartrate 100 mg/day PO initially in single dose or divided q12hr; may be increased at intervals of 1 week or longer; not to exceed 450 mg/day Metoprolol succinate 25-100 mg PO qDay initially; may be increased at intervals of 1 week or longer; usual range, 50-100 mg/day; not to exceed 400 mg/day Angina Metoprolol tartrate 100 mg/day PO initially divided q12hr; may be increased at intervals of 1 week or longer; not to exceed 400 mg/day Metoprolol succinate 100 mg/day PO initially; may be increased at intervals of 1 week or longer; not to exceed 400 mg/day Hyperthyroidism 25-50 mg PO q6hr*Hepatic impairment: Consider initiating extended release tablet at doses lower than those recommended; gradually increase dosage to optimize therapy, while monitoring closely for adverse events ASPIRIN Pain & Fever 325-650 mg PO/PR q4-6hr PRN Controlled/extended/delayed-release products (enteric-coated): 650-1300 mg PO q8hr; not to exceed 3.9 g/day Acute Coronary Syndrome For use as adjunctive antithrombotic effects for ACS (ST-segment elevation myocardial infarction [STEMI], unstable angina [UA]/non-ST-segment elevation myocardial infarction [NSTEMI]) Acute symptoms 160-325 mg PO; chew nonenteric-coated tablet upon presentation (within minutes of symptoms) If unable to take PO, may give 300-600 mg suppository PR Maintenance (secondary prevention) 75-81 mg PO qDay indefinitely (preferred dose); may give 81-325 mg/day Regimen may depend on coadministered drugs or comorbid conditions Coadministered with ticagrelor: 81 mg PO qDay Percutaneous transluminal coronary angioplasty Adjunctive aspirin therapy to support reperfusion with primary PCI (with or without fibrinolytic therapy) Preoperative dose: 162-325 mg PO before procedure Maintenance: 81 mg PO qDay indefinitely (preferred dose) may give 81-325 mg/day Regimen may depend on coadministered drugs or comorbid conditions Coadministered with ticagrelor: 81 mg PO qDay Ischemic Stroke & Transient Ischemic Attack 50-325 mg/day PO within 48 hours of stroke or TIA, then 75-100 mg/day PO Osteoarthritis Up to 3 g/day PO in divided doses Rheumatoid Arthritis 3 g/day PO in divided doses; increased PRN for anti-inflammatory efficacy (target plasma salicylate, 150-300 mcg/mL) Spondyloarthropathy 3.6-5.4 g/day PO in divided doses; monitor serum concentrations

Children SIMVASTATIN Hypercholesterolemia