By U. Silas. Gallaudet University.
Contraindications: Hypersensitivity to adrenergic compounds trusted risperdal 3mg, tachycardia (idiopathic or from digitalis) 4mg risperdal otc. Editorial comments: Seizures, liver enzyme elevations, and hyper- sensitivity reactions have rarely been reported with terbutaline use. Mechanism of action: Stimulates receptors in androgen-respon- sive organs, thereby promoting growth and development of male sex organs. Drug should be administered only by physician who is aware of possible adverse effects of drug on bone maturation. Contraindications: Hypersensitivity, males with carcinoma of the breast, known or suspected carcinoma of the prostate, seri- ous cardiac, renal or hepatic decompensation. This drug is listed without detail in Physician’s Desk Reference, 54th edition, 2000. Mechanism of action: Stimulates receptors in androgen-respon-sive organs, thereby promoting growth and development of male sex organs. Adjustment of dosage • Kidney disease: No experience with use in renal insufficiency. Contraindications: Hypersensitivity to testosterone, males with carcinoma of the breast, known or suspected carcinoma of the prostate, serious cardiac, renal or hepatic decompensation. Editorial comments • If desired results are not achieved in 6–8 weeks, another form of testosterone replacement should be considered. Mechanism of action: Reversibly inhibits initiation and conduc- tion of nerve impulses near site of injection. Contraindications: Hypersensitivity for ester-type local anes- thetic (eg, procaine). Warnings/precautions: Use with caution in patients with severe liver disease, spinal deformities, existing neurologic disease, severe uncontrolled hypotension, septicemia, infection at site of injection, abnormal or reduced levels of serum cholinest- erase. Editorial comments: If an oxytocic drug has been administered along with tetracaine, extreme care must be used when a vaso- pressor agent is used to treat the hypotension that frequently accompanies spinal anesthesia. Mechanism of action: Inhibits bacterial protein synthesis after specific ribosomal binding. Susceptible organisms in vivo: Borrelia burgdorferi, Borrelia recurrentis, Brucella sp, Calymmatobacterium granulomatis, Chlamydia pneumoniae, Chlamydia psittaci, Chlamydia tra- chomatis, Ehrlichia sp, Helicobacter pylori, Rickettsia (Q fever), Rickettsia sp, Vibrio sp. Thereafter, continue tetra- cycline orally to complete at least 14 days of therapy. Contraindications: Hypersensitivity to any tetracycline, patients with esophageal obstruction, children ≤8 years. Warnings/precautions • Use with caution in patients with impaired kidney function. Clinically important drug interactions • Drugs that decrease effects/toxicity of tetracyclines: aluminum antacids, iron preparations, calcium salts, magnesium salts, sodium bicarbonate, zinc salts, bismuth salts, cimetidine. Editorial comments • Uses for tetracyclines include treatment of early Lyme disease, Vibrio infections such as cholera, and rickettsial infections including typhus, Q fever, and Rocky Mountain spotted fever. They are also used to treat genital infections (granuloma ing- uinale, nongonococcal urethritis, pelvic inflammatory disease, and other infections caused by C. Theophylline Brand names: Aerolate, Aminophyllin, Marax, Respbid, Slo- Phyllin, Theo-Dur, Theolair (also many other name brands). Increase dose to 400 mg/d after 3 days and again up to 600 mg/d after 3 more days. Food: Patient should take limited amounts of xanthine-containing foods or beverages (caffeine-containing coffees, colas, choco- lates, teas). Contraindications: Hypersensitivity to xanthine compounds (caffeine, theobromine), uncontrolled seizures, uncontrolled arrh- ythmias. Clinically important drug interactions • Drugs that increase effects/toxicity of theophylline: sympa- thomimetic drugs, erythromycin and other macrolide antibiotics, cimetidine, glucocorticoids, interferon, oral contraceptives, β blockers, tetracycline, mexiletine, ciprofloxacin and other quinolones, allopurinol, thyroid hormone, halothane, trolean- domycin, calcium channel blockers, disulfiram, thiabendazole. Editorial comments • Status asthmaticus is not rapidly responsive to usual doses of conventional bronchodilators. An oral pre- paration of theophylline is not used for treating status asth- maticus. Contraindications: Hypersensitivity to thiabendazole, use for pinworm infestation. Warnings/precautions: Use with caution in patients with kidney or liver disease, anemia, severe malnutrition, vomiting. Advice to patient • Avoid driving and other activities requiring mental alertness or that are potentially dangerous until response to drug is known. Adverse reactions • Common: drowsiness, headache, hypotension, anorexia, nausea, vomiting, rash. Clinically important drug interactions: Thiabendazole increases effects/toxicity of aminophylline, theophylline. Editorial comments: This drug is not to be used as a prophylac- tic therapy for pinworm infestation. Editorial comments • This drug is not listed in the Physicians’Desk Reference, 54th edition, 2000. Contraindications: Hypersensitivity, severe bone marrow depres- sion, liver disease (relative contraindicated), kidney disease (relat- ive contraindicated).
Cameroon 2001 Chloroquine order 4 mg risperdal free shipping, Colorimetric Private Convenience 284 112/284 (39%) Not tested 49/284 (18%) (2004) quinine discount risperdal 2 mg free shipping, test, thin layer pharmacies sampling sulfadoxine- chromatography only from various pyrimethamine vendors Amin et al. Cameroon 2001 Chloroquine, Colorimetric Private Convenience 284 112/284 (39%) Not tested 49/284 (18%) (2004) quinine, test, thin layer pharmacies sampling sulfadoxine- chromatography only from various pyrimethamine vendors Amin et al. Burkina Faso 2006 Artesunate, Packaging Private Convenience 77 32/77 (42%); 28/77 (38%) 29/77 (38%) (2008) artemether analysis, and public 1/32 (3%)† lumefantrine, disintegration pharmacies or quinine, analysis, outlets chloroquine, colorimetric sulfadoxine- tests, thin layer pyrimethamine, chromatography, amodiaquine ultraviolet-visible spectroscopy U. Burkina Faso 2006 Artesunate, Packaging Private Convenience 77 32/77 (42%); 28/77 (38%) 29/77 (38%) (2008) artemether analysis, and public 1/32 (3%)† lumefantrine, disintegration pharmacies or quinine, analysis, outlets chloroquine, colorimetric sulfadoxine- tests, thin layer pyrimethamine, chromatography, amodiaquine ultraviolet-visible spectroscopy U. Congo choroquine, Pharmacopeia private 1/16 (6%)† (2007) sulfadoxine- standards, pharmacies pyrimethamine, uniformity of mass, and outlets mefoquine disintegration analysis Aina et al. Congo choroquine, Pharmacopeia private 1/16 (6%)† (2007) sulfadoxine- standards, pharmacies pyrimethamine, uniformity of mass, and outlets mefoquine disintegration analysis Aina et al. Congo, Ghana, dihydroartemisinin- pollen analysis, private Kenya, Nigeria, piperaquine X-ray difraction, and public Rwanda, Senegal artemether- packaging analysis pharmacies lumefantrine, artemether- amodiaquine, amodiaquine, halofantrine ‡ 115 samples from Laos were randomly selected. The quality of sulphadoxine- pyrimethamine and amodiaquine products in the Kenyan retail sector. Anti-infective medicine quality: Analysis of basic product quality by approval status and country of manufacture. Medicine registration and medicine quality: A pre- liminary analysis of key cities in emerging markets. The global threat of counterfeit drugs: Why industry and governments must communicate the dan- gers. Quality of anti-malarials collected in the private and informal sectors in Guyana and Suriname. Interpol launches global campaign against fake medicines with powerful Af- rican voices. Ensuring safe foods and medical products through stronger regulatory systems abroad. A nationwide survey of the quality of antimalarials in retail outlets in Tanzania. Counterfeit or substandard antimicrobial drugs: A review of the scientifc evidence. Transactions of the Royal Society of Tropical Medicine and Hygiene 100(11):1019-1024. Quality of anti-malarial drugs provided by public and private healthcare providers in south-east Nigeria. Presentation to the committee on understanding the global public health implications of substandard, falsifed, and counterfeit medical products: Meeting 1, March 13. Poor-quality medi- cal products: Time to address substandards, not only counterfeits. The need for better data about counterfeit drugs in developing countries: A proposed standard research methodology tested in Chennai, India. Uterotonic drug quality: An assessment of the potency of injectable uterotonic drugs purchased by simulated clients in three districts in Ghana. Survey of the quality of selected antimalarial medicines circulating in six countries of sub-Saharan Africa. New global mechanism to combat substandard/spurious/falsely-labelled/ falsifed/counterfeit medical products. Counterfeit and substandard drugs in Myanmar and Viet Nam: Report of a study carried out in cooperation with the governments of Myanmar and Viet Nam. Countering the Problem of Falsified and Substandard Drugs 4 Causes of Falsifed and Substandard Drugs The committee recognizes that the factors that encourage the prolifera- tion of substandard and falsifed medicines are different but overlapping. In general, neglect of good manufacturing practices, both accidental and deliberate, drives the circulation of substandard drugs, while falsifcation of medicines has its roots in crime and corruption. Both types of products circulate because of the erratic supply and constant demand for medicines and weaknesses in the regulatory system. An inaccurate or inadequate understanding of the problem among health workers and the public con- tributes to the problem. Substandard medicines may, for example, be made in such a way that they do not dissolve properly; they may be of incorrect hardness or osmolarity; they may contain im- proper doses of the active ingredients; or be made from impure or unstable ingredients. Uneven Manufacturing Quality Any company can make mistakes, but adherence to good manufactur- ing practices makes mistakes less likely and easier to correct. There are many exemplary manufacturers in de- veloping countries that observe international best practices. There are also many that do not, but they operate anyway, either because the regulatory authority is unaware of the problem, or because regulators are under pres- sure to ignore it in the name of promoting industry. Quality control is a part of good manufacturing practices sometimes neglected in developing countries. The majority of the pharmaceutical industry in the poorest countries only formulates and re- Copyright © National Academy of Sciences.
Surgical prophylaxis: 1g for inducton risperdal 3mg without prescription, repeated every three h generic risperdal 2 mg mastercard, supplemented in high risk surgery by doses of 500 mg for 8 to 16 h. Adverse Efects Nausea, vomitng, diarrhoea; antbiotc- associated colits; taste disturbances; tooth or tongue discolouraton, hearing loss; blood disorders, (decreased haematocrit, increased prothrombin tme) positve Coombs’ test; allergic reactons including rash, pruritus, urtcaria, erythema multforme (Steven’s-Johnson syndrome), fever, anaphylactc reactons, rarely, toxic epidermal necrolysis, exfoliatve dermatts; myoclonic actvity, convulsions, confusion and mental disturbances; slight increase in liver enzymes and bilirubin, rarely, hepatts; increase in serum creatnine and blood urea; red coloraton of urine in children; erythema, pain and induraton and thrombophlebits at injecton sites; bone marrow depression. Meropenem Pregnancy Category-B Schedule H Indicatons Nosocomial infecton like septcemia, febrile neutropenia, intraabdominal and pelvic infecton etc caused by cephalosporins resistant bacteria, meningits, cystc fbrosis. GiardiasisL: 200 mg three tmes a day for 7 to 10 days or intravenous injecton 500 mg 8 hly for 7 days. Precautons Disulfram-like reacton with alcohol; hepatc impairment and hepatc encephalopathy (Appendix 7a); lactaton (Appendix 7b); clinical and laboratory monitoring in courses lastng longer than 10 days; interactons (Appendix 6a, 6c, 6d); pregnancy (Appendix 7c); phenobarbitone, history of blood dyscrasias. Nalidixic Acid Pregnancy Category-C Schedule H Indicatons Urinary-tract infectons; shigellosis. Child- Over 3 months: max 50 mg/kg body weight in divided doses, in prolonged therapy, reduced to 30 mg/kg body weight daily. Contraindicatons Hypersensitvity; children <3 years age, porphyria; convulsive disorder. Nitrofurantoin* Pregnancy Category-B Schedule H Indicatons Urinary-tract infectons; cystts. Severe chronic recurrent infectons: 100 mg every 6 h with food for 7 days, discontnue or reduce dosage in case of nausea. Adverse Efects Dose-related gastrointestnal disorders, nausea; hypersensitvity reactons including urtcaria, rash, sialadenits, pruritus, angioedema; anaphylaxis reported; rarely, cholestatc jaundice, hepatts, exfoliatve dermatts; erythema multforme, pancreatts, arthralgia; blood disorders; pulmonary reactons (pulmonary fbrosis; possible associaton with lupus erythematosus-like syndrome); peripheral neuropathy; benign intracranial hypertension; transient alopecia; dyspepsia, dizziness, nystagmus. Dose Oral Urinary tract infecton and upper respiratory tract infectons: 200 to 400 mg daily preferably in the morning. Uncomplicated genital chlamydia infectons, non-gonococcal urethrits: 400 mg daily in single dose for 7 days or divided doses for 7 days. Exposure to excessive sunlight should be avoided (discontnue if photosensitvity occurs). Adverse Efects Nausea, vomitng, dyspepsia, abdominal pain, diarrhoea (rarely, antbiotc-associat- ed colits), headache, dizziness, sleep dis- orders; rash (rarely, Stevens-Johnson syn- drome and toxic epidermal necrolysis) and pruritus. Less frequent side-efects include anorexia, increase in blood urea and cre- atnine; drowsiness, restlessness, asthenia, depression, confusion, hallucinatons, convulsions, tremor, paraesthesia, hypo- aesthesia; photosensitvity, hypersensitvity reactons including fever, urtcaria, angioedema, arthralgia, myalgia and ana- phylaxis; blood disorders (including eosi- nophilia, leucopenia, thrombocytopenia); disturbances in vision, taste, hearing and smell. The drug should be discontnued if psychiatric, neurological or hypersensitv- ity reactons (including severe rash) occur; rash, heart burn, abdominal cramps, irrita- bility. Ofoxacin* Pregnancy Category-C Schedule H Indicatons Acute uncomplicated cystts, community acquired pneumonia, acute exacerbaton of chronic bronchits. Precautons Patents with epilepsy, kidney disease, tendon problem, nervous system problem, liver disease (Appendix 7a), limit alcohol intake, pregnancy (Appendix 7c); lactaton (Appendix 7b). Adverse efects Sinus tachycardia, hallucinaton, Steven’s Johnson syndrome, seizure; dizziness, headache, nausea, vomitng, diarrhoea; insomnia, pruritus, photosensitvity. Phenoxymethyl Penicillin (Penicillin V) Pregnancy Category-B Schedule H Indicatons Streptococcal pharyngits; otts media; erysipelas; mouth infectons; secondary prophylaxis of rheumatc fever; post- splenectomy prophylaxis. Contraindicatons Hypersensitvity to penicillins (see notes above); serious infectons (see notes above). Adverse Efects Hypersensitvity reactons including urtcaria, serum sickness reacton; joint pain, rash, angioedema, anaphylaxis (see notes above); nausea and diarrhoea; epigastric distress, skin eruptons; haemolytc anaemia. Piperacillin + Tazobactam Pregnancy Category-B Schedule H Indicatons Nosocomial pneumonia, infectons following burns, urinary tract infectons. Precautons Pregnancy (Appendix 7c), lactaton; prolonged treatment may increase super infectons, interactons (Appendix 6c). Adverse Efects Hypersensitvity reactons like rash, fever, bronchospasm, vasculits, serum sickness, exfoliatve dermatts, Steven’s-Johnson syndrome, and anaphylaxis. Procaine Benzyl Penicillin (Procaine Penicillin G) Pregnancy Category-B Schedule H Indicatons Syphilis; anthrax; childhood pneumonia; diphtheria carrier state; cellulits; mouth infectons; bites. Dose Intramuscular and intravenous injecton or infusion Adult- Streptococcal infecton and pyroderma: single dose 12 lac units. Precautons History of allergy (see notes above); renal failure; pregnancy (Appendix 7c). Adverse Efects Hypersensitvity reactons including urtcaria, fever, joint pains, rashes, angioedema, anaphylaxis, serum sickness-like reacton, haemolytc anaemia, intersttal nephrits (see also notes above); neutropenia, thrombocytopenia, coagulaton disorders and central nervous system toxicity (associated with high doses and severe renal failure); Jarisch-Herxheimer reacton (during treatment for syphilis and other spirochaete infectons, probably due to release of endotoxins); rarely, non-allergic (embolic- toxic) reactons; pain and infammaton at injecton site. Storage The consttuted soluton should be used immidiately afer preparaton but in any case within the period recommended by the manufacturer. Roxithromycin Pregnancy Category-B Schedule H Indicatons Susceptble infectons; pneumonia, acute bronchits, sinusits, pharyngits, tonsillits, genital infecton. Precautons Hepatc dysfuncton; paediatrics (reduce dose); interactons (Appendix 6d); pregnancy (Appendix 7c). Adverse Efects Diarrhoea; vomitng; nausea; transient rise in liver transaminase; skin rash; gastralgia. Contraindicatons Hypersensitvity to sulfonamides; porphyria; severe renal hepatc impairment, blood dyscrasias, elderly.