Kinz injection

Generic:

Nalbuphine HCL

Available dosage form:

IV 10mg/20mg

Therapeutic class:

Morphinian derivative opioid analgesic.

Pharmacological class:

KAPPA acquired receptor agonist.

MU acquired receptor antagonist.

Mechanism of action:

Nalbuphine is a phenanthrine derivative with mixed opioid agonist and antagonist activity (agonist at kappa opiate receptors and partial antagonist at mu receptors in the CNS.

It inhibits the ascending pain pathways and alters the perception of and response to the pain. Additionally, it causes generalized CNS depression.

Manufacturer:

SAMI pharmaceuticals (Pvt) Ltd.

Storage:

15-30 degree celsius.

Prescription drug?

Yes

Indications and dosages:

Adult

• Pain:

  a) Non-opioid tolerant patient:

  10-20 mg/70Kg IV/IM/SC q3-2hrs PRN; individual do not exceed 20 mg.

  
  

  b)Opioid dependant patient:

  1/4th dose, and observe for withdrawal signs. Not exceeding 160mg/day.

  
  

• Anaesthesia supplement:

  0.3-3 mg/Kg IV over 10-15 min, then 0.25-0.5 mg/kg PRN.

  
  

• Opioid-induced pruritis (Off-label)

Paeds:

• Pain:

<1yr= safety and efficacy not established

>1yr= 0.1+0.2+mg/kg IV/IM/SC every 3-2 hrs PRN; individual dose doesn't exceed 20 mg; not to exceed 160 mg/day

Side effects:

• Pulmonary edema

• Agitation

• Reactions at the injection site such as vein swelling, burning, and hot sensations

• If >10%, sedation occurs, 1-10%, clamminess occurs.

• Nausea and vomiting

• Dizziness

• Xerostomia

• Headache

• <1%= asthma, bradycardia, burning, dyspnea, hypertension,

• pulmonary edema

• Hypoglycaemia (post-marketing complaint)

  
  

  Interactions (serious):

• Alvimopan

• Olanzapine/semidorphan

• Alfentanil

• Benzhydrocodon/acetaminophen

• Buprenorphine

• Cimetidine

• Clonidine

• Butrophenol

• Codeine

• Desvenlafaxine

• Hydrocodone

• Isocarboxazid

• Linezolid

• Loratadine

• Benzodiazepine

• Alprazolam

• Albuterol

• Amphetamine

• Amitriptyline

• Clonazepam

• Clomipramine

• Desloratadine

• Dopamine

• Ephedrine

• Haloperidol

• Lorazepam

• Melatonin

• Metazolam

• Morphine

• Phenobarbital

• Topiramate

Pregnancy/lactation

Not accepted

Cautions:

Do not administer, if the ampoule has cloudiness/ un-dissolved particles/ leaking.

Vitamin D capsule (SG indrop D)

Generic:

Cholecalciferol (Vitamin D3)

Manufacturer:

Neutropharma pvt limited

Therapeutic class:

Nutritional supplement

Pharmacological class:

Bone resorption inhibitor and vitamin D3 agonist

Storage:

Store below 25 degrees Celsius

Prescription drug?

OTC/prescription

Avaiable dosage forms for sg indrop D capsule:

Sg indrop D capsule 5,000 IU, comes in a box of 30 softgel capsules.

Sg indrop D capsule 2,00,000 IU, comes in a box of one softgel capsule.

Pharmacology (Mechanism of action):

• Stimulates calcium resorption at renal tubule.

• Stimulates calcium and phosphate absorption from the small intestine.

• Stimulates secretion of calcium into blood from bones.

Pregnancy/lactation:

Accepted but only for the recommended dose, a higher dose than recommended is not accepted.

Indications and dosages

Adults

• Osteoporosis

Prophylaxis and treatment:

For >50 yrs: 800-1000 IV PO OD with calcium supplements.

• Hypothyroidism:

50,000-2,00,000 IU OD PO with calcium supplemets.

• Vitamin D resistant rickets:

  12,000-5,00,000 IU PO OD

• Familial hypophosphatemia

  10,000-50,000 PO OD

RDA for adults:

19-70 yrs: 600 IU PO OD.

Pregnancy/lactation: 600 IU PO OD.

Paeds

• Vitamin D resistant rickets:

  12,000-5,00,000 IU PO OD

• Familial hypophosphatemia:

  4,00,000-80,000 PO OD with phosphate supplement.

  
  

• RDA for paeds:

  0-12yrs: 400 IU OD IV

  1-18yr: 600 IU OD PO

Geriatrics:

RDA:

>70yrs: 800 IU PO OD.

<70yrs: 600 IU PO OD.

Interactions:

Serious:

• Pexidartinib

• Pretomanib

• Aluminium hydroxide

• calcium acetate

• calcium gluconate

• calcium carbonate

• digoxin

• indapamide

• magnesium citrate

• phenobarbital

• phenytoin

• sucralfate

• primidone

Adverse Effects:

• Asthma

• confusion

• headache

• constipation

• dry mouth

• hyperglycemia

• lethargy

• metallic taste

• muscle/bone pain

• nausea/vomiting

• sluggishness

  
  

  Counselling points:

• Don't give vitamin/mineral supplements and antacids with sg indrop D.

• Monitor your calcium level while using this medicine.

  
  

  Contra-indications:

• Allergy to cholecalciferol/any component of the medicine.

• High calcium level

• Hyperparathyroidism

• kidney disorder

• Histoplasmosis

• Granulomatous disorder

• Lymphomas

• Congenital disorder

• Dysregulated vitamin D3 metabolism

  
  

  

  
  

Onset

Brand name:

Onset

Generic name:

Ondansetron HCL

Available dosage forms and their doses.

Tablets: 4mg/8mg

Injections: 4mg/8mg transparent glass ampoule.

Therapeutic class:

Anti-emetic

Pharmacologocal class:

Serotonin 5HT3 receptor antagonist

Manufacturer:

Pharmacy Laboratories (Pvt limited)

Storage:

Injection: store between 2-30 degree Celsius

Tablets: Room temperature.(15-25 degree Celsius)

Prescription drug?

Yes

Clinical pharmacology (Mechanism of action):

Ondansetron selectivity blocks the serotonin receptor sub-type 5HT3 located on vagal afferents. These receptors are usually stimulated by the 5HT serotonin hormone secreted from enterochromaffin cells of the small intestine.

Indications and dosages:

• Chemotherapy-induced nausea and vomiting:

  
  

Adults:

8mg I.V. infused over 15 min; 30 min before chemo.

 Max dose: 32 mg / 24 hrs

 After 24hrs of chemo, 8 mg orally every 8 hrs for up to 5 days.

Children:

4-12 yrs of age; 3-5mg/m2 over 15min immediately before chemo. After chemo, 4 mg tab every 8 hrs for up to 5 days.

Geriatrics:

It's the same dose as for adults.

• Radiotherapy-induced nausea and vomiting:

  
  

Adults :

 8mg tab 1-2 hrs before therapy.

Geriatrics:

It's the same dose as for adults.

• Post-operative nausea and vomiting:

Adults:

16 mg orally 1 hr before anesthesia.

Side Effects:

Common:

• Headache

• Tiredness

• Constipation/diarrhea

Serious

•  Severe allergic reactions

• QT prolongation

• Torsade de pointes

• Myocardial infarction

• Serotonin syndrome

Interactions:

• With drugs that cause QT prolongation

• With SSRIs

• With SNRIs

• With sumatriptan (anti-migraine drug)

• With apomorphine (anti-parkinsonian drug)

• Tramadol (opioid analgesic)

  
  

Pregnancy:

Not acceptable but if treatment is necessary and outweighs the risk, then it can be given to pregnant women.

Lactating mothers:

Not acceptable.

Precautions:

• Ondansetron is not for motion-sickness-induced vomiting.

• Patients with hepatic impairment/jaundice should avoid this medicine.

Counselling point

Onset can be taken with or without food but greater effect is seen when taken on an empty stomach or 1 hr before taking food or 2 hrs after taking food.