OSPITAL NG MAYNILA MEDICAL CENTER DEPARTMENT OF INTERNAL MEDICINE
Name: FERNANDEZ, SHIRLEY Address: Baseco, Port Area Manila Date of Admission: March 31, 2008 Admitting Diagnosis: Community Acquired Pneumonia, Moderate Risk Abnormal Uterine Bleeding r/o EM Pathology Residents-in-charge: Drs. Gutierrez/Dimaandal/Areja Clerks-in-charge: Liwag/Lopez
Hospital #:1817790 Age/Sex: 42/F
DRUG INDEX Drug Cefuroxime MOA Active against βlactamaseproducing H. influenzae or K. pneumoniae and penicillinresistant pneumococci Inhibition of protein synthesis by binding to 50s ribosomal subunit Indication Infections of the respiratory tract, ENT, soft tissues and bones. Also for O and G infections, wound infections, erysipelas and peritonitis. Dosage Adult: 750mg IM or IV Children: 30100mg/kg/day in 3-4 divided doses. CI Hypersensitivity to cephalosporins DI Concomitant therapy with aminoglycosides may cause renal impairment. ADR Hypersensitivity reactions, GI disturbances, transient pain at IM injection site Preparation 250mg vial 750mg vial
clarithromycin
LRTI, URTI, skin and soft tissue infections, mycobacterial infections due to mycobacterium avium or M. intracellulare. Localized infections due to M. chelonei, M. fortuitum, or M. kansasii, Prevention of M. avium complex in HIV patients w/CD4 lyphocyte count equal to or less than 100/mm3. Eradication of H. pylori in the presence of acid suppression, acute otitis media Treatment of infection of the respiratory ad urinary tract; sepsis, meningitis, infections of the bones, joints and soft tissues; intraabdominal infections, genital infections, infections in immunocompromised patients, perioperative prophylaxis
250 mg or 500 mg BID for 6-14 days
Concomitant use w/ cisapride, pimozide, & terfenadine
Ceftriaxone
Inhibits bacterial cell wall synthesis
Paracetamol
A weak prostaglandin inhibitor in peripheral tissues with significant anti-
Pyrexia of unknown origin. Fever and pain with common childhood disorders, tonsillitis, upper respiratory tract infections, post-
Adult and child > 12 years, 1-2g once daily. Severe infections: 4g daily. Child> 50kg, use adult dose. Infants > 15 days and child < 12 yrs, 20-80mg/kg body weight once daily. IV doses > 50mg/kg body weight should be given over 30 minutes. Adult and children > 10 yrs: 2-3mL; <10 yrs: 1-2 mL. Depending on the severity of
Hypersensitivity to cephalosporins
Decreased metabolism of cisaspride; possible ventricular arrhythmia; decreased cyclosporine metabolism; reduced renal excretion of digoxin; decreased statin metabolism; decreased pimozide metabolism; decreased theophylline metabolism; Aminoglycosides
GI disturbances, headache, taste perversion, transient elevation of liver enzymes
Tab 250 mg, 500 mg
Renal and hepatic failure
Coumarin anticoagulants
GI disorders, pruritus, urticaria, allergic dermatitis, edema, exanthema, erythema multiforme, eosinophilia, hematoma or bleeding, thrombocytopenia, leucopenia, granulocytopenia, hemolytic anemia, headache, dizziness, anaphylactic reaction, pain at injection site and phlebitis. Hemtological, skin and other allergic reactions
Vial 1g x 1’s
150mg/mL x 2mL amp
inflammatory effects.
Aspirin
Nonselective inhibitor of both COX isoforms
immunizaton reactions, after tonsillectomy and other conditions. Prevention of febrile convulsions, headache, cold, sinusitis, musclepain, arthritis and toothache. Secondary prevention of cerebrovascular events in patients with transient ischemic attack and minor stroke, reinfarction in patients with previous MI, restenosis of coronary bypass graft, thrombosis of arteriovenous shunts in patients undergoing hemodialysis.
the case, dose may be repeated 4 hourly. In sever cases, dose may be administered via IV very slowly. 1 tab OB Severe anemia, blood coagulation defects, renal insufficiency Activated charcoal, urinary acidifiers, antacids, urinary alkalizers, carbonic anhydrase inhibitor, corticosteroid may affect absorption, excretion or pharmacologic effects of ASA Nausea, dyspepsia, epigastric discomfort, anorexia, GI bleeding. May worsen peptic ulcer. Hypersensitivity, prolonged bleeding time, leucopenia, thrombocytopenia, purpura, decreased plasma Fe conc, shortened erythrocyte survival time Rash, dysgeusia, taste alteration, neutropenia, cough Tab 80 mg
captopril
ACE inhibitor
Hypertension, Heart failure, MI, Diabetic nephropathy
25 mg BID or TID. May inc to 50 mg BID or TID
Hypersensitivity, pregnancy
Furosemide
Selectively inhibit NaCl reabsorption in the thick ascending limb of t he loop of Henle
Edema, hypertension
½ to 1 tab per dose. Frequency as prescribed by physician
Hepatic coma, electrolyte depletion, tinnitus
Patients on prior diuretics, nitrated, Ksparing diuretics, NSAID’s, Indomethacin, lithium Aminoglycosides, salicylic acid, lithium
Tab 25 mg, 50 mg
Dehydration, circulatory collapse, possible vascular thrombosis
Tab 40 mg
Digoxin
Cardiac failure accompanied by atrial fibrillation, management of chronic cardiac failure were systolic dysfunction or ventricular dilatation is dominant; management of certain supraventricular arrhythmias particularly atrial flutter and fibrillation.
Rapid oral loading dose 750-1500 mcg as a single dose. Slow oral loading dose 250-750 mcg daily for one week followed by an appropriate maintenance dose. Maintenance dose: 125750 mcg/day or ≤ 62.5 mcg/day may suffice
Intermittent complete heart block or 2nd degree AV block esp if there is history of StokesAdams attacks; arrhythmia caused by cardiac glycoside intoxication, supraventricular arrhythmia caused by WolffParkinson-White syndrome; ventricular tachycardia or fibrillation; hypertrophic obstructive cardiomyopathy. Hypersensitivity to other digitalis glycosides.
Sensitivity is increased with agents causing hypokalemia eg diuretics, lithium, carbenoxolone, corticosteroids. Digoxin levels increased by: Amiodarone, flecainide, prazosin, propafenone, quinidine, spirinolactone, erythromycin, tetracycline, gentamicin, itraconazole, quinine, trimethoprim, alprazolam, diphenoxylate with atropine, indomethacin, propantheline, verapamil, tilapamil, felodipine. Digoxin levels reduced by:Antacids, some bulk laxatives, kaolin-
Nausea, vomiting, anorexia, diarrhea, gynecomastia, headache, weakness, apathy, malaise, fatigue, depression, psychosis, visual disturbance. Ventricular premature contractions, atrial or ventricular arrhythmias and conduction effects. Intestinal ischemia. Rarely, skin rashes and thrombocytopenia.
Tab 0.25 mg, Amp 0.25 mg/ml
ISDN
Denitration of the drug, with release of free nitrite iion, relaxes cardiac smooth muscle cels.
CHD, angina pectoris, MI, CHF, chronic right ventricular failure, chronic cor pulmonale, acute left ventricular failure
Angina attack: 1 tab SL 2-3 hourly
Very low BP, acute MI w/ low filling pressure except in ICU, shoch w/ vascular collapse
pectin, neomycin, peinicillamine, rifampicin, some cytostatics, metoclopramide, sulphasalazine, adrenaline, salbutamol, cholestyramine, phenytoin, St. John's wort (Hypercium perforatum) Alcohol, antihypertensives, Beta blockers, phenothiazines
Cutaneous vasodilatation w/ nausea, vomiting
Tab 5 mg, 10 mg; SL tab 5 mg
Simvastatin
Type IIa & IIb hyperlipoproteinemias in conjunction with lifestyle modification. Prophylaxis in ischemic heart disease as an adjunct to diet
5-10 mg at night. May be adjusted at intervals at intervals of not < 4 wk up to a max of 40 mg once daily at night
Active liver disease or unexplained persistent elevation of serum transaminases. Porphyria. Pregnancy & lactation.
Use with caution with coumarin anticoagulants, HIV protease inhibitors, fibric acid derivatives or niacin, cyclosporine, erythromycin, verapamil, diltiazem, grapefruit juice.
Constipation, dyspepsia, flatulence, rarely rhabdomyolysis.
FeSO4
Replaces iron in anemia
Treatment or prevention of nutritional iron deficiency or iron deficiency anemia
Prevention 0.3-0.6 ml; therapy 0.6mL/dose
Anemia not due to iron deficiency, intolerance to iron, inability to absorb iron, or where ulcerative colitis, regional enteritis, colostomy, ileostomy, or hemochromatosis is present
DROPS 75 MG/0.6Ml X 15 ML