Cims drug book 2018 pdf download

Adverse Drug Vomiting, bleeding from puncture sites, gingival tissues and Reactions urinary tract. Potentially Fatal: Haemorrhage esp with previous trauma or unsuspected underlying cause of bleeding, intracerebral bleeding. Drug Interactions Heparin reduces risk of coronary reocclusion.

Prostacyclin and nitrates increase plasma alteplase clearance. Increased risk of hemorrhage with warfarin. Lab Interference May interfere with estimation of plasma fibrinogen and other coagulation tests.

Reconstituted solution: Use within 8 hr. Mechanism of Alteplase initiates local fibrinolysis and dissolution of clots by Action binding to fibrin in a thrombus and the fibrin-bound plasminogen is converted to plasmin. Alteplase initiates local fibrinolysis and dissolution of clots by binding to fibrin in a thrombus and the fibrin-bound plasminogen is converted to plasmin. Excretion: Cleared rapidly from the plasma mainly by hepatic metabolism.

Half-life: minutes initial ; about 40 minutes terminal. S01XA13 - alteplase; Belongs to the class of other agents used as ophthalmologicals. Oral Hyperphosphataemia in patients with chronic renal failure Adult: Dose is adjusted to the individual patient's requirement. Max Dosage: 10 g daily in divided doses.

Contraindications Hypersensitivity to aluminium salts. Adverse Drug Constipation; intestinal obstruction with large doses ; phosphate Reactions depletion may occur with prolonged admin or large doses. Drug Interactions Enhanced absorption with citrates or ascorbic acid. Decreases absorption of allopurinol, tetracyclines, quinolones, cephalosporins, biphosphonate derivatives, corticosteroids, cyclosporin, delavirdine, Fe salts, imidazole antifungals, isoniazid, mycophenolate, penicillamine,phosphate supplements, phenytoin, phenothiazines, trientine.

Food Interaction Food decreases gastric emptying time. Mechanism of Alumunium hydroxide acts on the HCl in the stomach by Action neutralization, forming aluminium chloride salt and water. Absorption: Alumunium hydroxide reacts with hydrochloric acid in the stomach to form soluble aluminium chloride, which is absorbed from the GI tract. Excretion: Absorbed aluminium is excreted via the urine. Insoluble aluminium salts formed in the intestines, eg, hydroxides, carbonates, phosphates and fatty acid derivatives, are excreted in the faeces.

Used for the treatment of acid-related disorders. Oral Prophylaxis of influenza A Adult: mg daily for up to 6 wk; when used with influenza vaccination: only up to 3 wk after vaccination. Child: yr: mg daily. Oral Herpes zoster in immunocompromised patients Adult: mg bid for 14 days, continued for another 14 days if pain persists.

Overdosage Cardiac arrest may occur. Epilepsy or other seizure disorders, severe renal impairment and gastric ulceration. Special Patients with CV or liver disease, impaired renal function, Precautions recurrent eczema. Withdrawal of the drug should be gradual. Adverse Drug Seizures, psychosis, hallucinations, confusion, ataxia, heart Reactions failure, depression, orthostatic hypotension, blood dyscrasias, urinary retention, irritability, GI disturbances, anorexia, livedo reticularis, ankle oedema.

Potentially Fatal: Congestive heart failure, convulsions. Drug Interactions Enhances the adverse effects of antimuscarinics and levodopa. CNS stimulants, drugs that raise urinary pH. Mechanism of Amantadine is a weak dopamine agonist possessing Action antimuscarinic properties. It alters dopamine release and re-uptake. It also noncompetitively antagonises N-methyl-D-aspartate. As an antiviral drug, it inhibits replication of influenza type A virus. Absorption: Readily absorbed from the GIT oral ; peak concentrations after 4 hrs.

Distribution: Crosses the placenta and the blood-brain barrier; enters breast milk. Excretion: Mainly via urine by glomerular filtration and tubular secretion as unchanged and small amounts of an acetylated metabolite ; hrs elimination half-life , significantly prolonged in the elderly and renal impairment; may be increased by acidification of the urine. Used in the management of parkinson's disease. Adverse Drug Mild GI effects and allergic reactions. Reactions Mechanism of Ambroxol is a metabolite of bromhexine and is used Action similarly as a mucolytic.

Used in the treatment of wet cough. Reconstitution: Each single-use vial contains mg of anhydrous amifostine. Reconstitute with 9. Visual inspection for particulate matter and discoloration prior to admin is recommended. Do not use if cloudiness or precipitate is observed. Incompatibility: Y-site incompatibility: Acyclovir, amphotericin B, chlorpromazine, cisplatin, ganciclovir, hydroxyzine HCl, prochlorperazine edisylate. Overdosage May cause hypotension which can be managed by supportive care and normal saline infusion.

Patients should be well-hydrated Precautions and kept supine during infusion. Prolonged infusion causes greater side effects: Stop antihypertensive drugs 24 hr before infusion. Monitor BP regularly, at least before and immediately after infusion. Admin antiemetics before infusion especially when emetogenic drugs are used. Adverse Drug Hypotension during infusion. Systolic fall is greater.

Reactions Transient and reversible loss of consciousness rarely. Nausea, vomiting, flushing, feeling of warmth, chills, dizziness, sneezing, cough and drowsiness, mild skin rashes. Potentially Fatal: Severe skin reactions, including Stevens-Johnson syndrome. Drug Interactions Concurrent use with antihypertensives may cause severe hypotension.

Mechanism of Amifostine is a prodrug that is converted to a Action pharmacologically active metabolite free thiol , which selectively protects non-cancer cells from the toxic effects of antineoplastics eg, cisplatin and radiation. Distribution: Volume of distribution: 3. Metabolism: Dephosphorylated by alkaline phosphatase to an active metabolite, a free thiol compound. P - Contraindicated in pregnancy L - Caution when used during lactation.

Max Dosage: Renal impairment: Dosage adjustments may be made by a normal doses at increased dosing intervals or b reduced doses at the usual intervals. For b , initiate at normal dose. Maintenance doses can be calculated by dividing the normal dose by the patient's serum creatinine.

Max: Up to mg every 8 hr in life-threatening infections. Max cumulative dose: 15 g. Renal impairment: Dosage adjustments may be made by a normal doses at increased dosing intervals or b reduced doses at the usual intervals.

Overdosage Peritoneal dialysis or haemodialysis may be used in case of overdosage. Contraindications Pregnancy, perforated ear drum, myasthenia gravis, hypersensitivity. Special Renal impairment; vertigo, tinnitus. Discontinue if signs of Precautions ototoxicity, neurotoxicity or hypersensitivity occurs; lactation. Monitor renal function before and during treatment.

Adverse Drug Tinnitus, vertigo; ataxia and overt deafness. Reactions Potentially Fatal: Ototoxicity, nephrotoxicity, neuromuscular blockade. Drug Interactions Amphotericin B may lead to increased nephrotoxicity and reduced clearance of amikacin when used together.

Potentially Fatal: Increased ototoxic or nephrotoxic effects with other nephrotoxic or ototoxic drugs. Enhanced neuromuscular blockade with neuromuscular blocking drugs.

Increased risk of ototoxicity with potent diuretics. Mechanism of Amikacin binds to 30S ribosomal subunits of susceptible Action bacteria, thus inhibiting its protein synthesis. Distribution: Detected in body tissues and fluids after inj; crosses the placenta but does not readily penetrate the CSF.

Significant amounts penetrate the blood-brain barrier in children with meningitis. Excretion: Via the urine by glomerular filtration within 24 hr ; hr elimination half-life. J01GB06 - amikacin; Belongs to the class of other aminoglycosides.

Used in the treatment of systemic infections. S01AA21 - amikacin; Belongs to the class of antibiotics. Contraindications Hyperkalemia, renal impairment, hypersensitivity, pregnancy, lactation Special Oliguria, elderly, neonatal jaundice, oliguria, renal disease, Precautions hepatic disease, diabetic nephropathy, systemic lupus erythematosus, acute pancreatitis, hyponatremia, hypercalcemia, gout, hypercholesterolemia, IDDM, NIDDM sympathectomy, acidosis, hyponatremia.

Adverse Drug Electrolyte imbalance, hyperkalemia, hypochloremic alkalosis, Reactions hypokalemia, hyponatremia, anorexia, constipation, diarrhea, dizziness, GI irritation, headache, muscle cramps, orthostatic hypotension, photosensitivity, sexual function impairment, agranulocytosis, allergic dermatitis, allergic reaction, anaphylaxis, cholecystitis, gout, hepatic function impairment, hives, hyperuricemia, itching, jaundice, pancreatitis, shortness of breath, skin rash, thrombocytopenia.

Drug Interactions Concomitant use of amiloride with ACE inhibitors may increase the risk of hyperkalemia. Thiazide diuretics co-administered with alcohol, barbiturates, or narcotics can potentiate orthostatic hypotension. Hydrochlorothiazide can reduce the effect of antidiabetic drugs.

Co -administration of thiazide with other antihypertensive drugs provides an additive effect or potentiation. Cholestyramine and colestipol resins reduce the absorption of hydrochlorothiazide. Mechanism of Amiloride HCl is a potassium-conserving drug that possesses Action weak compared with thiazide diuretics natriuretic, diuretic and antihypertensive activity.

These effects have been partially additive to the effects of thiazide diuretics. Amiloride HCl exerts its potassium-sparing effect through the inhibition of Na reabsorption at the distal convoluted tubule, cortical collecting tubule and collecting duct; this decreases the net -ve potential of the tubular lumen and reduces both K and hydrogen secretion and their subsequent excretion.

Hydrochlorothiazide is a diuretic and antihypertensive. It affects the distal renal tubular mechanism of electrolyte reabsorption. Hydrochlorothiazide increases excretion of Na and chloride in approx equiv amounts. Natriuresis may be accompanied by some loss of K and bicarbonate. Used to promote excretion of urine. C03DB01 - amiloride; Belongs to the class of other potassium-sparing agents. Used as diuretics. Adverse Drug Skin reactions, contact and photocontact allergic dermatitis.

Reactions Drug Interactions Combination with benzophenones gives added protection against photosensitive disorders. Immersion in water causes serious loss of protection. Mechanism of Aminobenzoic acid is used topically as a sunscreen. It is Action used to prevent sunburn, but unlikely to prevent drug-related or other photosensitivity reactions associated with UVA light.

Max: 24 g in 24 hr. Renal impairment: Dosage reduction may be required. Oral Patients with haemophilia undergoing dental extraction Adult: Initially, 6 g immediately after the procedure, followed by 6 g every 6 hr for up to 10 days. Overdosage Symptoms may range from no reaction to transient hypotension or severe acute renal failure resulting in death. Contraindications Bleeding due to disseminated intravascular coagulation.

Rapid IV administration. Special Renal or cardiac disorders. Urinary tract bleeding, Precautions haematuria of upper urinary tract origin; veno-occlusive hepatic disease, skeletal myopathy, neonates.

Monitor creatinine phosphokinase. Avoid admin with factor IX complex concentrates. Potentially Fatal: Cardiac and hepatic damage.

Drug Interactions Increased risk of hypercoagulability with OC and oestrogens. Mechanism of Aminocaproic acid inhibits the action of plasminogen Action activators and, to a lesser extent, it also has some antiplasmin activity. Absorption: Absorbed readily from the GI tract oral ; peak plasma concentrations after 2 hr. Distribution: Distributed widely. Excretion: Via urine as unchanged ; 2 hr elimination half-life.

Used in the treatment of hemorrhage. Elderly: Dose reduction may be ncessary. Hepatic impairment: Dose reduction may be ncessary. Maintenance infusion dose: 0.

Child: Loading dose: same as adult dose. Special Populations: Reduce maintenance dose in patients with cor pulmonale or heart failure. Increase maintenance dose for smokers. Incompatibility: Incompatible with metals.

Take on an empty stomach at least 1 hr before or 2 hr after meals. Treatment is usually supportive and withdrawal of the drug. Restoration of fluid and electrolyte balance is necessary. Adverse Drug Nausea, vomiting, abdominal pain, diarrhoea, headache, Reactions insomnia, dizziness, anxiety, restlessness; tremor, palpitations.

Potentially Fatal: Convulsions, cardiac arrhythmias, hypotension and sudden death after too rapid IV injection. Drug Interactions Other xanthines. Clearance reduced by allopurinol, some antiarrhythmics, cimetidine, disulfiram, fluvoxamine, interferon-a, macrolide antibiotics, quinolones, oral contraceptives, thiabendazole and viloxazine. Clearance increased by phenytoin, anticonvulsants, ritonavir,rifampicin, sulfinpyrazone, cigarette smoking. Potentially Fatal: Increased risk of cardiac arrhythmias with sympathomimetics and halothane.

Tachycardia with pancuronium. Increased risk of convulsion with quinolones, ketamine. Food Interaction Rate of absorption reduced but not extent. Mechanism of Aminophylline is a combination of theophylline and Action ethylenediamine. Ethylenediamine is inactive; it increases the solubility of theophylline in water.

Theophylline relaxes bronchial smooth muscle. Suggested mechanisms are an increase in intracellular cAMP through inhibition of phosphodiesterase; adenosine receptor antagonism, prostaglandin antagonism and effects on intracellular calcium.

Absorption: Rate of absorption delayed by food. Distribution: Crosses the placenta and enters breast milk. Metabolism: Undergoes hepatic metabolism. Excretion: Via urine. Daily doses may be divided. Close monitoring of the patient is recommended. Use the minimum effective dose. Hepatic impairment: Dosage reduction may be necessary.

Intravenous Life-threatening ventricular arrhythmias Adult: Recommended starting dose: About 1 g over 1st 24 hr. Dose is given in a 3-phase sequence. After the 1st 24 hr, maintain infusion rate at 0.

Maintenance infusion at up to 0. Concentrate for inj should be diluted prior to admin. Conversion to oral therapy will depend on the administered dose of the IV therapy and the bioavailability of the oral drug. Max: 2. Incompatibility: Y-site incompatibility: Cefamandole, sodium bicarbonate, heparin, aminophylline. Syringe incompatibility: Heparin. Overdosage Symptoms include hypotension, cardiogenic shock, bradycardia, AV block and hepatotoxicity.

Hypotension and cardiogenic shock should be treated by slowing the infusion rate or with vasopressor drugs, positive inotropic agents and volume expansion. Bradycardia and AV block may require temporary pacing. Monitor hepatic enzyme concentrations. Amiodarone is not dialyzable. Contraindications Hypersensitivity to amiodarone or iodine. Severe sinus node dysfunction, 2nd and 3rd degree heart block except in patients with a functioning artificial pacemaker , cardiogenic shock, pregnancy. Special Close monitoring is recommended as amiodarone may Precautions worsen arrhythmia especially when used concurrently with other anti-arrhythmic drugs or drugs that prolong QT interval.

May cause hypotension and bradycardia. May increase risk of liver toxicity. May cause lung damage; monitor for pulmonary toxicity e.

Monitor liver functions regularly. May affect defibrillation or pacing thresholds of cardiac devices. Correct electrolyte imbalance before starting treatment. Caution when used in patients undergoing surgery. Avoid excessive sunlight exposure due to increased risk of photosensitivity.

Hepatic impairment, thyroid disease, elderly. Adverse Drug Blue-grey discolouration of skin, photosensitivity, peripheral Reactions neuropathy, paraesthesia, myopathy, ataxia, tremor, nausea, vomiting, metallic taste, hypothyroidism, hyperthyroidism, alopoecia, sleep disturbances, corneal microdeposits, hot flushes, sweating.

Heart block, bradycardia, sinus arrest, hepatotoxicity, heart failure. Potentially Fatal: Pulmonary toxicity including pulmonary fibrosis and interstitial pneumonitis, hepatotoxicity, thyrotoxicity.

Ventricular arrhythmias, pulmonary alveolitis, exacerbation of arrhythmias and rare serious liver injury. Generally in patients with high doses and having preexisting abnormalities of diffusion capacity.

Drug Interactions Potentiation of antiarrhythmic drugs. Possible increased risk of adverse effects when used with anaesthetic agents. Monitor plasma levels of amiodarone when used with HIV protease inhibitors. Cimetidine may increase serum levels of amiodarone. Concurrent use may increase serum levels of ciclosporin. Rifampin may reduce the serum levels of amiodarone. Potentially Fatal: Potentiates the effect of warfarin and other anticoagulants hence dose of warfarin generally needs to be reduced approx half.

Raised plasma concentrations of digoxin, phenytoin and quinidine. Additive effect with beta-blockers and calcium-channel blockers e. Food Interaction St John's wort may reduce serum levels of amiodarone. Grapefruit juice may increase serum levels of amiodarone. Mechanism of Amiodarone is a class III antiarrhythmic agent which inhibits Action stimulation, prolongs action potential and refractory period in myocardial tissues.

It also decreases AV conduction and sinus node function. Amiodarone can cause marked sinus bradycardia or sinus arrest and heart block. In acute IV doses, amiodarone may exert a mild negative inotropic effect.

Onset: IV: minutes. Duration: IV: hr. Distribution: Extensively distributed to body tissues; accumulates in muscles and fats. Crosses the placenta and enters breast milk. Excretion: Mainly in the faeces via bile; via urine small amounts of amiodarone and its metabolites. Terminal elimination half-life: About 50 days; may range from days due to extensive tissue distribution.

Max: 1. For patients with predominantly negative symptoms: mg daily. Intramuscular Acute psychosis Adult: mg daily. Preferably taken before meals.

Overdosage Symptoms include generalised convulsions, coma, motor restlessness, tachycardia and slight prolongation of the QT interval. Contraindications Pregnancy and lactation, pheochromocytoma, prolactin-dependent tumors. May affect performance of skilled tasks. GI disorders and dry mouth. CNS effects. Hyperprolactinaemia with galactorrhoea, amenorrhoea, gynecomastia, breast pain, sexual dysfunction. Drug Interactions Guanethidine and other adrenergic neuron blockers, antiarrhythmics, antihistamines, antimalarials and cisapride, diuretics, general anaesthetics, hypnotics, anxiolytics and opioids.

Metoclopramide may increase the risk of antipsychotic-induced extrapyramidal effects. Mechanism of Amisulpride is a substituted benzamide atypical antipsychotic Action with general properties similar to those of sulpiride and is reported to have a high affinity for dopamine D 2 and D3 receptors.

Metabolism: Limited metabolism. Excretion: Terminal half-life: 12 hr. Mainly excreted unchanged in urine. Used in the management of psychosis. May increase dose gradually to mg daily, if needed. Up to mg daily may be used in severe cases. Elderly: mg daily or in divided doses, preferably at bedtime. Oral Neuropathic pain Adult: Initially, mg daily at night, may increase to 75 mg daily if needed.

Higher doses require specialist attention. Oral Prophylaxis of migraine Adult: Initially, 10 mg at night. Maintenance: 50—75 mg at night. Overdosage Symptoms: Excitement and restlessness with marked antimuscarinic effects, including dryness of the mouth, hot dry skin, dilated pupils, tachycardia, urinary retention and intestinal stasis. Severe symptoms include unconsciousness, convulsions and myoclonus, hyperreflexia, hypothermia, hypotension, metabolic acidosis, and respiratory and cardiac depression, with life-threatening cardiac arrhythmias that may recur some days after apparent recovery.

Concurrent usage with cisapride. Special Bipolar illness, pregnancy, lactation elderly, CVS disease, Precautions renal or liver impairment, epilepsy, thyroid dysfunction, DM.

Avoid abrupt withdrawal; urinary retention, prostatic hyperplasia; chronic constipation; angle-closure glaucoma; phaeochromocytoma. Monitor for signs of clinical worsening, suicidality or behavioural changes.

May increase risks associated with electro-convulsive therapy. Adverse Drug Postural hypotension, tachycardia, conduction disturbances. Reactions Dry mouth, wt gain, sour or metallic taste, stomatitis, constipation; blurring of vision, urinary retention, fatigue, dizziness, weakness, tremors, headache, confusion and delirium in elderly, sexual disturbances; peripheral neuropathy; urticaria, angioedema, sweating.

Potentially Fatal: Cardiac arrhythmias. Drug Interactions Reduced effect of antihypertensives. Potentiates hypertensive effects of sympathomimetics.

Concurrent use with altretamine may cause orthostatic hypotension. May increase adverse CV effects when used with amphetamines. May increase serum levels of carbamazepine.

Absorption may be reduced when used with cholestyramine, colestipol or sucralfate. Additive sedative effects when used with CNS depressants. Concurrent use with CYP2D6 inhibtors e. May increase antidiabetic effect of tolazamide,chlorpropamide or insulin. May reduce absorption of levodopa. Increased risk of neurotoxicity when used with lithium. Increased risk of seizures when used with tramadol. May increase anticoagulant effect of warfarin. May cause QT prolongation and fatal arrhythmias when used with drugs that prolong QT interval.

Potentially Fatal: Increased risk of QT prolongation and arrhythmias when used with cisapride. Serious adverse effects e. Food Interaction Alcohol may enhance adverse effects. Absorption: Readily absorbed from the GI tract oral. Distribution: Widely distributed; crosses the placenta; enters breast milk. Protein-binding: Extensive. Metabolism: Extensively 1st-pass effect; demethylated hepatically to nortriptyline active metabolite.

Excretion: Urine as metabolites in free or conjugated form ; hr elimination half-life. Used in the management of depression. Elderly: Initial dose: 2. Hepatic impairment: Initial dose: 2. Overdosage Overdosage may cause marked peripheral vasodilation and hypotension. Contraindications Known hypersensitivity to dihydropyridines. Special Impaired liver or renal function, CHF, sick-sinus syndrome, Precautions severe ventricular dysfunction, hypertrophic cardiomyopathy, severe aortic stenosis.

Caution when used in patients with idiopathic hypertrophic subaortic stenosis. Elderly, children. Adverse Drug Headache, peripheral oedema, fatigue, somnolence, nausea, Reactions abdominal pain, flushing, dyspepsia, palpitations, dizziness. Rarely pruritus, rash, dyspnoea, asthenia, muscle cramps. Drug Interactions Increased metabolism with rifampin. Reduced hypotensive effect with calcium. Potentiates effects of thiazide diuretics and ACE inhibitors. May increase serum levels of CYP1A2 substrates e.

CYP3A4 inhibitors e. Additive BP-lowering effects when used with sildenafil, tadalafil or vardenafil. Mechanism of Amlodipine relaxes peripheral and coronary vascular smooth Action muscle.

It produces coronary vasodilation by inhibiting the entry of Ca ions into the voltage-sensitive channels of the vascular smooth muscle and myocardium during depolarisation. It also increases myocardial O2 delivery in patients with vasospastic angina. Distribution: Protein-binding: Metabolism: Hepatic: Extensive. Used in the treatment of cardiovascular diseases.

Elderly: Per tablet contains atenolol 25 mg and amlodipine besylate 5 mg: Initiate with 1 tablet daily. Renal impairment: Per tablet contains atenolol 25 mg and amlodipine besylate 5 mg: Initiate with 1 tablet daily. Overdosage Overdosage may cause hypotension and less commonly, congestive cardiac failure.

Unabsorbed drug may be removed by gastric lavage or use of activated charcoal. Symptomatic treatment may be administered. Special Excessive fall of BP may occur in elderly patients. Caution in diabetic patients as beta-blockers may mask tachycardia occurring with hypoglycaemia. Withdrawal should be gradual.

Safety and efficacy have not been established in children. Not to be used in untreated phaeochromocytoma. Adverse Drug Headache, hypotension, dizziness, breathlessness, fatigue, Reactions muscle cramps, bradycardia, palpitations, flushing, oedema, dyspnoea, dyspepsia, cold extremities.

Hypersensitivity reactions. If used with clonidine, clonidine withdrawal should occur a few days after withdrawal of the beta-blocker to prevent rebound hypertension; if replacing clonidine by beta-blocker, beta-blocker should be introduced only after clonidine administration has stopped for several days. Concurrent use with prostaglandin synthase inhibiting drugs e.

Mechanism of Atenolol is a cardioselective beta blocker. Amlodipine is a Action dihydropyridine calcium-channel blocker that blocks the transmembrane influx of calcium ions into vascular smooth muscle and cardiac muscle. Combination of the two drugs results in additive antihypertensive action.

Atenolol: Little or no hepatic metabolism. C08CA01 - amlodipine; Belongs to the class of selective dihydropyridine derivative calcium-channel blockers with mainly vascular effects. Max: 10 mg once daily. Titrate dose over 7 to 14 days. Atorvastatin component for hyperlipidemias: Initially mg daily, Range: mg daily. Atorvastatin component for prevention of cardiovascular disease: 10 mg once daily. Elderly: In patients with hyperlipidemia or for prevention of cardiovascular disease: As tab containing amlodipine and atorvastatin 2.

Elderly patients are more prone to myopathy, a side effect of atorvastatin. Hepatic impairment: In patients with hyperlipidemia or for prevention of cardiovascular disease: As tab containing amlodipine and atorvastatin 2. Oral Angina pectoris Adult: In patients with hyperlipidemia or for prevention of cardiovascular disease: As tab containing amlodipine and atorvastatin 2. Elderly: Lower amlodipine dose suggested in the elderly.

Amlodipine compoenent for angina: 5 mg once daily. Hepatic impairment: Amlodipine: Lower dose suggested in the hepatic impairment. Atorvastatin: Do not use in acute liver disease. Decrease dosage in severe disease. Active liver disease or unexplained persistent elevated serum tranminases. Adverse Drug Amlodipine: Headache, dizziness, somnolence, peripheral Reactions edema, pulmonary edema, hot flushes, palpitations, nausea and jaundice.

Atorvastatin: Headache, constipation, dyspepsia, flatulance, and abdominal pain, diarrhoea, arthritis, chest pain, peripheral edema, nausea, bronchitis, pruritis, rhinitis, UTI, increased transaminases and myalgia.

Drug Interactions Interactions involving both amlodipine and atorvastatin: Rifamycins increase the metabolism of both amlodipine and atorvastatin. Atorvastatin: There is an increase riskof rhabdomyolysis with use with azoles eg itraconazole and ketoconazole and gemfibrozil.

Potentially Fatal: Manufacturer of posaconazole and tipranavir contraindictates use with atorvastatin as there may be a risk of rhabdomylosis. Use of a macrolide, telithromycin is contraindicated with atorvastatin as atorvastatin is metabolised by CYP3A4. Food Interaction The metabolism of both amlodipine and atorvastatin may be reduced by graepfruit juice.

Mechanism of Amlodipine relaxes peripheral vascular smooth muscle. Action Vasodilation is produced via inhibiting the entry of Ca ions into the voltage-sensitive channels of the vascular smooth muscle during depolarisation.

It reduces peripheral vascular resistance and hence resulting in a reduction in blood pressure. Plus this is the best selling book as well on amazon and offline.

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It is one of the best for this subject. This is the list of best pharmacology ebooks that i believe to be best ones for medical students. After that you would be in a position to decide which one you should follow. Any variation in the information available in different sources can promote irrational drug use. In this study, we assessed this variation in a sample of commonly used drugs. A subset analysis was done for 24 such drugs which were mentioned in all the four sources and it was found that NFI had listed the maximum number of indications per drug 3.

We also observed some gross qualitative variation regarding drug information given in different sources. Variation exists in the quantity and quality of information available on indications about drugs available in various sources. Necessary steps need to be taken to harmonize drug information available across various sources so as to provide reliable and uniform drug information thereby promoting rational drug use.

Irrational and inappropriate use of drugs can lead to suboptimal clinical benefit and possible adverse drug reactions ADRs. There are various sources of information which are utilized by treating physicians for accessing relevant drug information such as their indications, ADRs, contraindications, and special precautions.

Drug information is usually sourced from National Formularies e. It has been observed that there is variation in the quantity and quality of information mentioned in different drug information sources and a single credible benchmark is lacking. Such variation not only deprives the medical fraternity from accessing reliable drug information but can also promote off-label and irrational drug use leading to increased incidence of adverse reactions and possible treatment failure.

We identified 50 commonly used drugs belonging to different groups e. These drugs were chosen on the basis of prescription pattern in the hospital. Two senior residents D. Clinical Pharmacology students and one PhD student collected and analyzed the PIs of the selected drugs. The following parameters were assessed. The number of drugs out of the selected 50, whose indication information was missing in different sources. In the next step, we compared only those drugs whose indications were mentioned in all the four sources.

We also looked upon gross qualitative differences existing across various sources of drug information used in this study. To find the difference between different sources, data were statistically analyzed by applying Friedman Test using Graph Pad Instat trial version software.

PIs of all the 50 selected drugs were collected, and they had information about indications which was included in the analysis for comparison. Only MIMS contained information about all the 50 drugs. The number of indications per drug was variable in all these four sources. The details of this information are given in Table 1. NFI was excluded from this analysis as this source had information of only about 24 of these 40 drugs.

In respect of these 40 drugs, the PI had listed maximum number of indications 2. To include NFI as well, a subset analysis was done in respect of those 24 drugs information about which were available in all the four sources including NFI.

We found that NFI had listed maximum number of indications 3. After the quantitative comparison, we identified any gross qualitative mismatch in information across these four sources. Following gross discrepancies are observed:. Of the 40 drugs mentioned in CDSCO, only broad single indication is mentioned in respect of some drugs e. It is apparent that such abridged information only reflects the broad use of the drug without providing more specific and relevant information to the prescribing physicians.

Labetalol is one of the preferred drugs for treatment of pregnancy induced hypertension, and its oral administration is considered as safe and effective as methyldopa. Surprisingly, NFI lists out the maximum indications for fluoxetine which includes premenstrual disorder, anorexia nervosa, and Parkinson's disease as well over and above the indications given in other three sources.

For tablet topiramate, the CDSCO site mentions it only as an antiepileptic, whereas other sources go on to describe the type of epileptic disorders for which it is indicated. In addition, PI mentions prophylaxis of migraine as one of its indication. Besides above variations, some minor typographical errors were also noticed in information provided in CDSCO, e. In India, Drugs Controller General of India is the drug regulatory authority who is responsible for granting approval and marketing permission of drugs in our country.

The drugs are approved by drug regulator of any country for specific indications in specified dosage, which is known as the labeling information of that particular drug. However, the actual use of the drug in clinical practice may vary and may not be according to its labeling information at times.

For example, metformin is used for the treatment of polycystic ovarian disease which is not its approved indication. Here we have listed different units wise downloadable links of Computer Aided Design and Manufacturing pdf Notes where you can click to download respectively.

ISBN Choosing the right journal is an important factor in the publication process and is one that will maximize the chances of publication of the scientific research. Clinical trials are an important part of medical research and these investigations help determine how new treatments will work in human patients and also in collecting valuable data about the effects of new drugs, medical approaches, and procedures. This ebook gives an overview of the clinical The black box of orthodontic research is considered as a reference for orthodontic professionals who look for validation and optimization of their basic knowledge, experience and updated research concerning the orthodontic field.

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