Commonly Prescribed Drugs in the OPD

For Pain &/or Fever

1. Mefenamic Acid 2. Ibuprofen3. Paracetamol

For Pain &/or Fever

• Mefenamic Acid– Analgesic, anti-inflammatory, anti-pyretic – MOA: binds COX-1 and COX-2 receptors, inhibiting

the action of prostaglandin synthetase– AE: GI & visual disturbances, drowsiness, dizziness

& nervousness. Skin & other allergic reactions– Prep: 250mg/cap, 500mg/cap, 50mg/5ml

suspension– D: 1cap TID, susp 4 to 6.5 mg/kg per dose (max

daily of 25mkd)

For Pain &/or Fever

• Ibuprofen– Anagesic, antipyretic– MOA: The exact MOA is unknown. Its pharmacological

effects are believed to be due to inhibition COX-2. Inhibition of COX-1 is thought to cause some of the side effects of ibuprofen including GI ulceration.

– AE: Abdominal pain, diarrhea, nausea w/ or w/o vomiting, GI bleeding & ulceration.

– Prep: 200mg/gel cap, 500mg/cap, 100mg/5ml suspension– D: 1cap 4-6h, susp in 5-10mkd every 6-8h (max daily dose

of 40)

For Pain &/or Fever

• Paracetamol– Analgesic, anti-pyretic– MOA: Inhibits the synthesis of prostaglandins in the CNS

and peripherally blocks pain impulse generation; produces antipyresis from inhibition of hypothalamic heat-regulating center.

– AE: Hematological, skin & other allergic reactions.– Prep: 100mg/ml drops, 120mg/5ml susp, 250mg/5ml

susp, 500mg– D: 1-2tabs q4-6 hrs prn, drops/susp 10-15mkdose q4-

6hrs

Antibiotics

1. Amoxicillin 2. Cloxacillin 3. Clindamycin 4. Co-Amoxiclav 5. Cefuroxime 6. Ciprofloxacin

Antibiotics

• Amoxicillin– MOA: inhibits the final transpeptidation step of

peptidoglycan synthesis in bacterial cell wall by binding to one or more of the PBPs, thus inhibiting cell wall biosynthesis resulting in cell wall lysis.

– AE: Hyperactivity, agitation, insomnia, dizziness; skin & hematological reactions; diarrhea, nausea, vomiting; Potentially Fatal: Neuromuscular hypersensitivity; pseudomembranous colitis.

– Prep: 250 or 500mg/cap, 100mg/ml drops, 125mg/5ml susp, 250mg/5ml susp

Antibiotics

• Amoxicillin– Dose: • Children > 3 months of age up to 40 kg: 20-40

mg/kg/day in divided doses every 8 hours OR 25-45 mg/kg/day in divided doses every 12 hours• Children > 40 kg & adults: 250-500 mg every 8 hours OR

500-875 mg every 12 hours

Antibiotics

• Cloxacillin– MOA: binding to specific PBPs of the bacterial cell wall,

inhibiting the third and last stage of cell wall synthesis. Resistant to degradation by penicillinases. It is particularly useful against penicillinase-producing staphylococci. Highly active against S aureus, S pyogenes, S viridans and S pneumoniae.

– AE: Neutropenia, agranulocytosis; GI upsets; rash. Sore mouth or tongue. Black hairy tongue. Potentially Fatal: Neuromuscular hypersensitivity; pseudomembranous colitis; anaphylaxis.

– Prep: 250 or 500mg/cap, 125mg/5ml susp – D: 1 cap q6h, susp 50-100 mkd q6h

Antibiotics

• Clindamycin– MOA: inhibits protein synthesis by reversibly binding to the

50S subunit of the ribosomal thus blocking the transpeptidation or translocation reactions of susceptible organisms resulting to stunted cell growth.

– AE: Diarrhoea, nausea, vomiting, abdominal pain; erythema multiforme, contact dermatitis, exfoliative and vesiculous dermatitis, urticaria; eosinophilia; local irritation, thrombophloebitis. Potentially Fatal: Gasping syndrome (neonates); pseudomembranous colitis.

– Prep: 150 or 300mg/cap, palmitate HCl granules 75mg/5ml

Antibiotics

• Clindamycin– Dose: • Children: 8-20 mg/kg/day in 3-4 divided doses as

hydrochloride OR 8-25 mg/kg/day in 3-4 divided doses as palmitate• Adults: 150-450 mg every 6 hours (maximum 1.8g/day)

Antibiotics

• Co-amoxiclav– MOA: Amoxicillin: cell wall lysis; Clavulanic acid

competitively and irreversibly inhibits a wide variety of beta-lactamases. By inactivating beta-lactamase, the accompanying penicillin/cephalosporin drugs may be made more potent as well.

– AE: Diarrhea, nausea & vomiting, skin rash & urticaria, vaginitis. Rarely, pseudomembranous enterocolitis, stomatitis & candidiasis, erythema multiforme & other skin effects. Hepatic, renal, hematologic or CNS effects.

Antibiotics

• Co-amoxiclav– Prep: 156.25mg/5ml or 228.5mg/5ml or

312.5mg/5ml or 457mg/5ml susp, 1g or 375mg or 625mg tab

– Dose: • Children > 3 months of age up to 40 kg: 25-45 mg/kg/day

in doses divided every 12 hours (Prescribe suspension or chewabletablet due to clavulanic acid component)

• Children > 40 kg & adults: 500-875 mg every 12 hours (Prescribe tablet)

Antibiotics

• Cefuroxime– MOA: binds to one or more of the PBPs which inhibits the

final transpeptidation step of peptidoglycan synthesis in bacterial cell wall, thus inhibiting biosynthesis and arresting cell wall assembly resulting in bacterial cell death.

– AE: Large doses can cause cerebral irritation and convulsions; nausea, vomiting, diarrhoea, GI disturbances; erythema multiforme, Stevens-Johnson syndrome, epidermal necrolysis. Potentially Fatal: Anaphylaxis, nephrotoxicity, pseudomembranous colitis.

– Prep: 250 or 500 mg/tab, 125mg/5ml or 250mg/5ml susp

Antibiotics

• Cefuroxime– Dose:– 3 months to 12 years:• Suspension: 10 to 15 mg/kg orally twice a day

(maximum dose 1000 mg/day)• Tablets: 250 mg orally twice a day

– 13 years or older: • 250 to 500 mg BID for 7-10 days

Antibiotics

• Ciprofloxacin– MOA: Promotes breakage of double-stranded DNA

in susceptible organisms and inhibits DNA gyrase, which is essential in reproduction of bacterial DNA.

– AE: Hypersensitivity & skin reactions. Anaphylaxis, serum sickness, toxic epidermal necrolysis.

– Prep: 250 or 500mg/tab– D: 1-2 tabs BID

For Cough

1. Carbocisteine 2. Ambroxol3. Bromhexine4. Nafarin A

For Cough & Colds

• Carbocistein– MOA: mucolytic – AE: Nausea, gastric discomfort, GI bleeding, skin

rash– Prep: 500mg/cap, 50mg/ml drops, 100mg/5ml

syrup

For Cough & Colds

• Carbocistein– Dose: – Drops- 50mg/ml- 3to 4times a day

• Infants- 9-12months -1.0ml• 6-8months -0.75ml• 3-5months-0.5ml• below 2months- 0.25ml

– Syrup- 100mg/5ml- every 6hours• 2-5 years old- 1 teaspoonful (5ml)• 6-12 years old- 2 teaspoonful(10ml)• Adults- 1-11/12 tablespoonfuls( 15-22.5ml)

– Capsules- Adult; 1 cap TID-QID

For Cough & Colds

• Ambroxol– MOA: mucolytic – AE: Mild GI effects and allergic reactions.– Prep: 75mg/cap, 30mg/tab, 30mg/5ml syrup, 7.5mg/ml

drops– Dose:– Adult & child: 1cap daily, 1tab TID – Adult: 60-120 mg daily, in 2-3 divided doses– Child: <2 yr: 7.5 mg bid 2-5 yr: 7.5 mg bid/tid 6-12 yr: 15 mg bid/tid

For Cough & Colds

• Bromhexine– MOA: Mucolytic. – AE: GI side effects; headache, dizziness, sweating, skin

rashes. Inhalation: Cough or bronchospasm– Prep: 4mg/5ml syr, 8mg/tab– Dose: Tab Adult & childn >12 yr 1 tab tid, 7-12 yr ½ tab tid, 2-6 yr ½ tab bid. Adult syr Adult & childn >12 yr 5 mL tid Ped syr Childn >12 yr 10 mL tid, 7-12 yr 5 mL tid, 2-6 yr 2.5 mL tid, <2 yr 1.25 mL tid

For Cough & Colds

• Nafarin A (reformulated)– Combination of a nasal decongestant

(phenylpropanolamine), an antihistamine (chlorphenamine) and an analgesic-antipyretic (paracetamol)

– Per tab Phenylpropanolamine HCl 20 mg, chlorphenamine maleate 1 mg, paracetamol 325 mg.

– Per 5 mL syr Phenylpropanolamine HCl 6.25 mg, chlorphenamine 500 mcg, paracetamol 125 mg

– Dose: Tab Adult 1 tab. Syr Adult 3 tsp, 7-12 yr 2 tsp, 2-6 yr 1 tsp, <2 yr As prescribed. To be given 6 hrly.

For Throat pain

1. Hexetidine2. Benzydamine

For Throat pain

• Hexetidine Gargle (Bactidol) – Gargle with 30 mL 3 times a day after meals for 7 days– Minor sore throat; halitosis; general oral hygiene;

improves appearance of mouth tissues; protects tooth surfaces against formation of decay acids.

– AE: Transient numbness & alteration in taste may occur

For Throat pain

1. Benzydamine lozenges (Difflam) – Dissolve one lozenge on tongue every 3 to 4 hours as needed for throat pain

2. Benzydamine gargle (Difflam) – Gargle with 30 mL every 4 hours as needed for throat pain

3. Benzydamine spray (Difflam) – Spray 2 times to throat every 4 hours as needed for throat pain– For Mouth/Throat Pain or irritation of the mouth and

throat – AE: Numbness or stinging sensation of oral mucosa

For Allergy

1. Loratidine 2. Levocetirizine 3. Hydroxyzine

For Allergy

• Loratidine – MOA: a non-sedating antihistamine. It works by

selectively binding to peripheral histamine H1 -receptors on effector cells.

– AE: Fatigue, giddiness, dizziness, dry mouth, headache, nausea, somnolence.

– Prep: 10mg/tab, 5mg/5ml syr– D: Adult: 10 mg OD Child: 2-5 yr: 5 mg OD. 6-12 yr: 10 mg OD

For Allergy

• Levocetirizine – MOA: an active isomer of cetirizine, selectively

inhibits histamine H1-receptors.– AE: Fatigue, somnolence, dry mouth,

nasopharyngitis, pyrexia, cough, epistaxis– Prep: 5mg/tab– D: Adult: 2.5-5 mg ODHS Child: 6-11 yr: 2.5 mg ODHS ≥12 yr: 2.5-5 mg ODHS

For Allergy

• Hydroxyzine– MOA: blocks histamine H1-receptors on effector cells of the

GI tract, blood vessels and respiratory tract; significant sedative properties. It also possesses skeletal muscle relaxing, bronchodilator, antiemetic and analgesic properties.

– AE: CNS depression, paradoxical CNS stimulation, dry mouth, thickened respiratory secretions, constipation, blurring of vision, tachycardia, GI disturbances, headache, hypotension, tinnitus.

– Prep: 2mg/ml syr, 10-25 mg/tab– D: Adult: Initially, 25 mg ODHS to TID-QID Child: 6 mth-6 yr: 5-15 mg ODHS (max 50 mg/day) >6 yr: 15-25 mg/day (max 50-100 mg/day)

For Deworming

1. Mebendazole2. Oxantel pamoate

For Deworming

• Mebendazole– MOA: acts by destroying the cytoplasmic microtubules in

the worm's intestinal cells. This blocks the uptake of glucose and other nutrients resulting in death of the helminth.

– AE: Transient diarrhea, abdominal pain, nausea, vomiting, headache, tinnitus, numbness, fever and dizziness. Potentially Fatal: Myelosuppression (high doses).

– Prep: • Antiox: 100 or 500mg/tab; 20 or 50mg/ml susp• Combantrin 125mg; 250mg/tab, 125mg/5mL susp

For Deworming

• Mebendazole– Dose: • 1-dose treatment

– 500 mg to be taken as a single dose

• 3-day treatment – 100 mg or 5 mL bid given for 3 consecutive days – 20 mg/mL susp 5 mL bid for 3 consecutive days. – 50 mg/mL susp 10 mL in a single dose.

For Deworming

• Oxantel pamoate– MOA: a depolarizing neuromuscular blocking

agent, which results in spastic paralysis of the worms.

– AE: Headache, abdominal pain, diarrhoea– Prep: Tablet or Susp– D: 10-20mkdose as single dose