CIMS MEDICAL BOOK PDF

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bestthing.info - Free ebook download as PDF File .pdf), Text File .txt) or a drugs part 1 - Dr John CIMS India Drugs Reference. Also visit my Other Post Indian Drugs Brand Names Free Android Mobile Application -edT (E Drug Today). This the most expected mobile. For over 50 years, MIMS has provided trusted and relevant clinical information for over two million healthcare professionals in Asia. Designed for busy.


Cims Medical Book Pdf

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Outcomes. Care Institute of Medical Sciences. A premier multi-super specialty hospital. GREEN. C I M S. Green Hospital. Here is a link to CIMS India Drug Information eBook in pdb format.:) version (28th August ) CIMS India eBook by Dr bestthing.info PDF(doxylamine + pyridoxine): Learn about PDF's Dosage, Side Effects and indications.

Helped out me a lot. Such things on net is keeping good things alive. AKZ management. Post a Comment. Join My Facebook Page. Suggest your favorite medical site to help others. Download books from shared sites. The eBook of CIMS India contains details about medical drugs - indications and usual dosage, adverse reactions side effects , precautions , whether to take before, with or after food, drugs interactons with other medicines and with alcohol or certain foodstuff.

USE isilo reade r on your mobilephone to read this book You can also use Alternate mediafire link to download the cims book. Posted by Unknown. Visit http: Newer Post Older Post Home. Intermittent treatment is needed for continued efficacy.

Oral Preoperative management of angle-closure glaucoma Adult: Oral Adjunct in open-angle glaucoma Adult: Oral Epilepsy Adult: Either alone or with other antiepileptics: Neonates and up to 12 yr: Initially, 2. Oral Prophylaxis of high-altitude disorders Adult: Prompt descent is still advised if severe symptoms such as cerebral or pulmonary oedema occur.

Intravenous Chronic open-angle glaucoma Adult: As an adjunct, 0. Adjust dose according to symptomatology and ocular tension. Intravenous Acute closed angle glaucoma Adult: Intravenous Epilepsy Adult: Optimum dose: When used with other anticonvulsants, initiate at mg once daily in addition to existing medications and adjust accordingly.

Admixture incompatibility: Overdosage Symptoms may include electrolyte imbalance, acidotic state and central nervous effects. Monitor serum electrolyte levels particularly potassium and blood pH levels. Supportive measures are required to restore electrolyte and pH balance. Acidotic state can usually be corrected by the admin of bicarbonate. Contraindications Hypersensitivity to sulphonamides; sodium or potassium depletion, hepatic insufficiency; hepatic cirrhosis; hyperchloraemic acidosis; severe renal impairment; severe pulmonary obstruction; chronic noncongestive angle-closure glaucoma; adrenocortical insufficiency.

Special Potassium supplements may be required. Impaired hepatic Precautions or renal function; diabetes. Monitor plasma electrolytes and blood count regularly.

IM route is not recommended. Adverse Drug Drowsiness, paraesthesia, ataxia, dizziness, thirst, anorexia, Reactions headache; confusion, malaise, depression; GI distress, metabolic acidosis, polyuria, hyperuricaemia, renal calculi, nephrotoxicity, hepatic dysfunction.

Rarely, skin reactions or blood dyscrasias. Drug Interactions Aids penetration of weakly acidic substances like sulphonamides across blood and CSF barrier. May inhibit renal excretion of basic drugs e. May increase salicylate toxicity acidosis.

Hypokalaemia with corticosteroids and potassium-wasting diuretics. May increase excretion of lithium and primidone. May cause osteomalacia with anticonvulsants. May potentiate effect of folic acid antagonists, oral hypoglycaemic agents, oral anticoagulants and severe reactions to sulphonamides. Lab Interference May cause false positive results for urinary protein. Interferes with HPLC theophylline assay and serum uric acid levels. Either studies in animals have revealed adverse effects on the foetus teratogenic or embryocidal or other and there are no controlled studies in women or studies in women and animals are not available.

Storage Intravenous: Mechanism of Acetazolamide specifically inhibits the enzyme carbonic Action anhydrase which catalyses the reversible reaction involving the hydration of CO2 and dehydration of carbonic acid. Carbonic anhydrase is also inhibited in the CNS to retard abnormal and excessive discharge from neurons. Moderately rapid absorption from the GI tract; peak plasma concentrations after 2 hr oral. Concentrates in the red blood cells and renal cortex; enters the breast milk.

Urine as unchanged drug ; hr elimination half-life. Note that there are some more drugs interacting with acetazolamide acetazolamide acetazolamide brands available in India Always prescribe with Generic Name: P - Caution when used during pregnancy L - Caution when used during lactation.

Oral Paracetamol poisoning Adult: Repeat dose if the patient vomits within 1 hr of admin. Continue therapy until paracetamol levels are not detectable and there is no evidence of hepatotoxicity.

Intravenous Paracetamol poisoning Adult: Doses as per adult dose but adjust volume of based on child age and wt to avoid fluid overload. Inhalation Mucolytic Adult: Endotracheal Mucolytic Adult: Ophthalmic Dry eye associated with abnormal mucus production Adult: Incompatible with metals e. A change in colour of solution to light purple may be observed and does not indicate significant change in safety or efficacy.

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Special Asthmatic patients, history of bronchospasm, peptic ulceration. Precautions Pregnancy, lactation. Adverse Drug Flushing, fever, stomatitis, nausea, vomiting, rhinorrhoea, Reactions bronchospasm, anaphylactoid reactions, rashes. Rarely, blurred vision, bradycardia, syncope, thrombocytopenia, convulsions. Rarely, respiratory or cardiac arrest. Either animal-reproduction studies have not demonstrated a foetal risk but there are no controlled studies in pregnant women or animal-reproduction studies have shown an adverse effect other than a decrease in fertility that was not confirmed in controlled studies in women in the 1st trimester and there is no evidence of a risk in later trimesters.

Storage Endotracheal: Undiluted solution may be kept refrigerated for 96 hr. Diluted solution to be used within 1 hr. Mechanism of Acetylcysteine may decrease the viscosity of secretions by Action splitting of disulphide bonds in mucoproteins.

It also promotes the detoxification of an intermediate paracetamol metabolite which is used in the management of paracetamol overdosage. Rapidly absorbed from the GI tract oral ; peak plasma concentrations after 0. Extensively hepatic. Urine; elimination half-life: Classification Used in the treatment of wet cough.

S01XA08 - acetylcysteine; Belongs to the class of other agents used as ophthalmologicals. V03AB23 - acetylcysteine; Belongs to the class of antidotes. Used to neutralize paracetamol overdose.

Note that there are some more drugs interacting with acetylcysteine acetylcysteine acetylcysteine brands available in India Always prescribe with Generic Name: Oral Suppression of recurrent herpes simplex Adult: May reduce to mg daily if necessary.

Reassess the condition every mth. For mild or infrequent recurrences: Episodic treatment may be used: Oral Prophylaxis of herpes simplex in immunocompromised patients Adult: Oral Herpes zoster shingles Adult: Intravenous Mucocutaneous herpes simplex in immunocompromised patients Adult: Dose to be given as IV infusion over 1 hr. Peritoneal dialysis: Half the usual dose once daily. Half the usual dose every 24 hr and an additional half-dose after haemodialysis.

Intravenous Herpes simplex encephalitis Adult: Intravenous Genital herpes Adult: Intravenous Neonatal herpes simplex virus infections Child: Birth - 3 mth: Intravenous Herpes zoster in immunocompromised patients Adult: Ophthalmic Herpes simplex keratitis Adult: Remove the calculated dose and add it to any appropriate IV solution at a volume selected for admin during each 1-hr infusion. Recommended infusion concentrations: Higher concentrations e. Standard, commercially available electrolyte and glucose solutions are suitable for IV admin; biologic or colloidal fluids e.

Y-site incompatibility: Syringe incompatibility: Pantoprazole, caffeine citrate. Dobutamine, dopamine. Special Renal impairment. Neurological Precautions abnormalities with significant hypoxia, serious hepatic or electrolyte abnormalities.

Maintain adequate hydration. Adverse Drug Nausea, vomiting, headache, diarrhoea, rash, haematological Reactions changes occasional , increase in liver enzymes, burning, itching or erythema topical use.

Eye application may produce stinging, superficial punctate keratopathy, blepharitis or conjunctivitis. IV administration: Local reaction, pain, inflammation, phlebitis, extravasation leads to ulceration.

Rarely, renal failure. Occasionally neurotoxicity after IV use: Lethargy, confusion, agitation, tremors, seizures, coma.

Drug Interactions Probenecid decreases urinary excretion and increases half-life. Risk of renal impairment increased by other nephrotoxic drugs.

Either animal-reproduction studies have not demonstrated a foetal risk but there are no controlled studies in pregnant women or animal-reproduction studies have shown an adverse effect other than a decrease in fertility that was not confirmed in controlled studies in women in the 1 st trimester and there is no evidence of a risk in later trimesters.

Once diluted for admininstration, solution should be used within 24 hr. J05AB01 - aciclovir; Belongs to the class of nucleosides and nucleotides excluding reverse transcriptase inhibitors. S01AD03 - aciclovir; Belongs to the class of antiinfectives, antivirals. Used in the treatment of eye infections. Note that there are some more drugs interacting with aciclovir aciclovir further details are available in official CIMS India aciclovir aciclovir brands available in India Always prescribe with Generic Name: Initially, 10 mg daily for wk.

Other books: CIMS DRUG INDEX PDF

Max dose: Oral Congenital icthyosis Adult: Initially, mg daily for wk before dose adjustments are done. Usual range: Oral Severe lichen planus Adult: Oral Severe psoriasis Adult: Overdosage Symptoms are identical to acute hypervitaminosis A, ie, headache and vertigo. Hepatic and renal impairment. Special Female patients to avoid alcohol during and 2 mth after Precautions treatment.

Avoid blood donation during therapy or at least yr after stopping therapy. Radiographic treatment for prolonged therapy. Monitor plasma lipid and glucose levels especially diabetics regularly. Monitor LFTs. Adverse Drug Dryness of mucous membranes and skin; conjunctivitis, dry Reactions sore mouth; ophth disturbances; raised lipid level, pancreatitis; sticky skin, dermatitis.

Severe headache; GI disturbances; dermatologic reactions, oedema, paronychia, granulomatous lesions, bullous eruptions; reversible hair thinning and alopoecia; CNS disturbances; sweating; taste disturbance, gingivitis; benign intracranial hypertension; photosensitivity; skeletal hyperostosis; extraosseous calcification; premature epiphyseal closure in child.

Phototoxicity, jaundice, hepatitis and hepatotoxity. Drug Interactions Concomitant use with keratolytics or high dose vitamin A. Reduces anticoagulant effect of coumarins e. Concomitant use of microdised progestin oral contraceptives.

Concomitant use of methotrexate can potentiate hepatotoxicty. Concomitant use with tetracycline.

Food Interaction Co-administration with food may increase oral bioavailability. Lab Interference Elevation of liver enzymes, lipids, triglycerides and cholesterol level in blood. Studies in animals or human beings have demonstrated foetal abnormalities or there is evidence of foetal risk based on human experience or both, and the risk of the use of the drug in pregnant women clearly outweighs any possible benefit.

The drug is contraindicated in women who are or may become pregnant. Mechanism of Acitretin is an active metabolite of etretinate but its Action mechanism of action is unknown.

Note that there are some more drugs interacting with acitretin acitretin acitretin brands available in India Always prescribe with Generic Name: Contraindications Pregnancy, lactation; CV disease. Special Myocardial irradiation and use of radiotherapy. Hepatic or Precautions renal impairment. Adverse Drug Nausea, vomiting, mucositis, irritant to tissue, sore mouth, Reactions bone-marrow suppression, hyperuricaemia.

Alopoecia rare. Cardiotoxicity rare , myelosuppression in patients who received mitomycin or a nitrosourea, leucopenia.

Drug Interactions Other cardiotoxic drugs e. Lab Interference Elevated bilirubin level. Mechanism of Aclarubicin is an anthracycline, a cytotoxic antibiotic, and Action inhibits RNA synthesis through intercalation. Rapidly distributed into tissues after IV admin. Extensively metabolised. Triphasic clearance. Terminal elimination half-life: About 3 hr.

Excreted in urine mainly as metabolites. Used in the treatment of cancer. Apply thinly onto affected areas once daily at night after cleansing.

Special Patients with sunburn, eczema. Avoid Precautions excessive exposure to sunlight or UV irradiation. Keep away from the eyes, lips, nostrils and mucous membranes. Do not apply to cuts, abrasions, scaly or flaky skin, or patches of sunburned skin. Use with caution with preparations containing sulfur, resorcinol, or salicylic acid. Adverse Drug Mild skin irritation, scaling, erythema, cutaneous dryness, Reactions sensations of stinging and burning, pruritus.

Drug Interactions Increased irritation may occur with medicated or abrasive soaps, products with a pronounced drying effect and those containing alcohol or astringents.

Mechanism of Adapalene binds to specific retinoic acid nuclear receptors Action which normalises the differentiation of follicular epithelial cells resulting in decreased microcomedone formation. Adapalene binds to specific retinoic acid nuclear receptors which normalises the differentiation of follicular epithelial cells resulting in decreased microcomedone formation.

Minimal topical. Haemodialysis patients: Overdosage Monitor for signs of toxicity, apply supportive treatment when necessary. Contraindications Lactation. Special Pregnancy; elderly; child; renal or hepatic impairment. HIV Precautions antibody testing to be performed before initiation due to possible resistance development in untreated HIV infection. Increased risk of hepatotoxicity in females, obese patients and with prolonged treatment. Monitor renal function every 3 mth; hepatitis B biochemical, viral and serological markers every 6 mth and LFTs.

Discontinue therapy if liver function worsens, severe hepatomegaly, steatosis or unexplained metabolic or lactic acidosis. Monitor hepatic function for several mth in patients whose antihepatitis therapy is discontinued as acute exacerbations of hepatitis may occur.

Adverse Drug Nausea, dyspepsia, abdominal pain, flatulence, diarrhoea, Reactions asthenia, headache. Pruritus, skin rashes, and respiratory effects e. Lactic acidosis, severe hepatomegaly with steatosis, hepatotoxicity, nephrotoxicity.

Drug Interactions Increased risk of nephrotoxicity with nephrotoxic drugs e. Ibuprofenincreases bioavailability of adefovir. Food Interaction Increased risk of hepatotoxicty with alcohol in hepatitis B infection. Mechanism of Adefovir dipivoxil is an acyclic nucleoside reverse transciptase Action inhibitor. The diester function is hydrolyzed and subsequently phosphorylated to the active adefovir diphosphate.

It can be used in patients with lamivudine-resistant hepatitis B. Rapidly converted to adefovir after oral admin. Plasma concentration peaks after 0. Widely distributed to body tissues.

Protein binding: Note that there are some more drugs interacting with adefovir dipivoxil adefovir dipivoxil adefovir dipivoxil brands available in India Always prescribe with Generic Name: Initially, 3 mg by rapid IV inj into a central or large peripheral vein over 2 sec with cardiac monitoring; 6 mg may be given after minutes if necessary, then 12 mg after a further minutes.

Avoid increments if high level AV block occurs at any particular dose. Max Dosage: Intravenous Paroxysmal supraventricular tachycardia Adult: Intravenous Myocardial imaging Adult: Inject radionuclide 3 minute after infusion.

Contraindications 2nd or 3rd degree AV block and sick sinus syndrome unless pacemaker fitted , asthma, hypersensitivity. Special Pregnancy; heart transplant patients; patients on Precautions dipyridamole lower initial dose of adenosine 0. Adverse Drug Facial flushing, palpitations, chest pain, bradycardia, Reactions sweating, hypotension, dyspnoea, choking sensation, headache, lightheadedness, tingling, numbness, neck and back pain, nausea, metallic taste.

ECG changes suggestive of rhythm disturbances. Drug Interactions Adenosine effects antagonised by methylxanthines like caffeine, theophylline, etc. Concomitant carbamazepine may increase the risk of heart block. Adenosine effects are potentiated by dipyridamole. Mechanism of Adenosine acts rapidly to slow down conduction through the Action AV node via the A1 receptors. It also mediates peripheral and coronary vasodilatation by stimulating the A2 receptors.

Rapidly taken up into the erythrocytes and vascular endothelial cells. Metabolised to adenosine monophosphate and inosine. Plasma half-life: Note that there are some more drugs interacting with adenosine adenosine adenosine brands available in India Always prescribe with Generic Name: For cystic echinococcosis, up to 3 treatment cycles of 28 days each may be given with 14 treatment-free days in between cycles.

For alveolar echinococcosis, treatment cycles of 28 days each with 14 treatment-free days in between. Treatment cycles may need to be continued for mth or yr until complete eradication of parasites. Oral Neurocysticercosis Adult: Oral Ascariasis Adult: Oral Hookworm infections Adult: Oral Enterobiasis Adult: Enterobiasis Adult: Oral Strongyloidiasis Adult: Oral Giardiasis Adult: Overdosage Symptomatic and supportive measures are advised.

Contraindications Pregnancy and lactation. Hypersensitivity, liver impairment. Special Monitor blood counts and liver function.

Administer within 7 Precautions days of start of normal menstruation in women of childbearing age. Adequate nonhormonal contraceptive measures must be taken during and for 1 mth after therapy.

Perform liver function tests and blood counts before and every 2 wk during high dose therapy of hydatid disease. Adverse Drug GI discomfort, headache, nausea, dizziness, allergic Reactions reactions, pruritus, raised liver enzymes, alopecia and dry mouth.

Bone marrow depression. Drug Interactions Cimetidine increases albendazole metabolism. Serum levels are increased if taken with dexamethasone and praziquantel agent.

Mechanism of Albendazole exhibits a broad-spectrum anthelmintic activity Action showing vermicidal, ovicidal and larvicidal actions. It inhibits tubulin polymerization in the parasite and blocks glucose uptake; energy levels are reduced resulting to death of the parasite. Susceptible parasites include hookworm, roundworm, threadworm, whipworm, tapeworm, strongyloides, opisthorchis and hydatid disease Echinococcus.

Poorly absorbed from the GI tract oral. Widely distributed; bile, CSF. Extensive hepatic first-pass metabolism; converted to albendazole sulfoxide. Via bile; via urine small amounts. Note that there are some more drugs interacting with albendazole albendazole further details are available in official CIMS India albendazole albendazole brands available in India Always prescribe with Generic Name: Oral Paget's disease of bone Adult: Oral Prophylaxis of postmenopausal osteoporosis Adult: Oral Corticosteroid-induced osteoporosis Adult: Treatment and prevention: Administration Should be taken on an empty stomach.

Overdosage Symptoms may include hypocalcaemia, hypophosphataemia and upper GI adverse events, such as upset stomach, heartburn, esophagitis, gastritis or ulcer.

Milk or antacids should be given to bind alendronate. Should not induce vomiting due to the risk of oesophageal irritation. Patient should remain fully upright. Dialysis would not be beneficial.

Correct vitamin D and calcium deficiency before starting therapy. To be taken half an hr before breakfast and remain upright for at least 30 minutes after admin. Adverse Drug Oesophagitis, oesophageal ulcers and erosions, dysphagia, Reactions heartburn, retrosternal pain, abdominal pain, distension, diarrhoea, constipation, flatulence, headache, rash, erythema, musculoskeletal pain, transient decreases in serum phosphate.

Drug Interactions Concomitant iron, calcium supplements and antacids hinder alendronate absorption. Food Interaction Food, mineral water, coffee, tea and juice interfere with absorption of alendronate.

Mechanism of Alendronic acid reduces bone resorption by inhibiting the Action action of osteoclasts. Poorly absorbed from the GIT oral ; reduced by food. Used in the treatment of bone diseases. Initially, 1 mcg daily. Premature infants and neonates: Overdosage Symptoms may include anorexia, lassitude, nausea and vomiting, constipation or diarrhoea, polyuria, nocturia, sweating, headache, thirst, somnolence and vertigo and hypercalcaemia.

Stop admin of alfacalcidol. Treatment is symptomatic and supportive. Ensure patient is well hydrated by i. Monitor electrolytes, calcium levels, renal function, ECG especially in patients on digitalis. Consider treatment with glucocorticosteroids, loop diuretics, bisphosphonates, calcitonin and haemodialysis with low calcium content.

Contraindications Hypercalcaemia, metastatic calcification, hyperphosphataemia except when occurring with hypoparathyroidism , hypermagnesaemia. Special Pregnancy, lactation, renal impairment, infants, elderly. Monitor Precautions serum levels of calcium in patients with renal failure.

Caution in hypercalciuria esp in those with history of renal calculi. Avoid in patients with hypersensitivity to inj. Adverse Drug Anorexia, nausea, vomiting, diarrhoea, lassitude, polyuria, Reactions sweating, headache, thirst, vertigo, pruritus, rash, urticaria. Hypercalcaemia, hypercalciuria and ectopic calcification. In case of renal impairment, hyperphosphataemia. In hypercalcaemic dialysis patients, possibility of calcium influx from the dialysate should be considered.

Drug Interactions Thiazides may increase the risk of hypercalcaemia. Some antiepileptics e. Rifampicin, isoniazid and corticosteroids may reduce the efficacy of vitamin D. Mechanism of Alfacalcidol is a precursor of the active calcitriol. It does not Action require renal hydroxylation but requires hydroxylation in the liver for conversion to calcitriol. Adequately absorbed from the GI tract oral.

Adipose and muscle tissue; enters breast milk. Specific to a-globulin. Hepatic; rapidly converted to calcitriol. Faeces and urine small amounts. Used as dietary supplements. Note that there are some more drugs interacting with alfacalcidol alfacalcidol alfacalcidol brands available in India Always prescribe with Generic Name: Initiate with 2. Adjust dose according to response.

Mild-moderate impairment: Modified-release preparations are not recommended. Overdosage May lead to hypotension. Maintain patient in supine position to restore BP. Monitor renal function.

Contraindications Severe hepatic impairment; history of postural hypotension and micturition syncope; intestinal occlusion; severe renal insufficiency; lactation. Special Elderly; hypertension; coronary insufficiency; angina Precautions discontinue ; renal or hepatic impairment.

Monitor BP regularly. May affect ability to drive or operate machinery. Adverse Drug Drowsiness, postural hypotension, syncope, asthenia, Reactions depression, headache, dry mouth, GI disturbances, edema, blurred vision, rhinitis, erectile disorders, tachycardia, palpitation, hypersensitivity reactions; flushes; chest pain; dizziness; lack of energy. Reduced serum levels when used with CYP3A4 inducers e. Concurrent use with potent CYP3A4 inhibitors e.

Mechanism of Alfuzosin is a quinazoline-derivative which exhibits selectivity Action for a1 -adrenergic receptors in the lower urinary tract. Blockade of these adrenoreceptors causes relaxation of smooth muscle in the bladder neck and prostate, resulting in improvement in urine flow and a reduction in symptoms of benign prostatic hyperplasia.

Readily absorbed after oral admin. Extensively metabolised in the liver, mainly by the cytochrome P isoenzyme CYP3A4, to inactive metabolites. Metabolites are mainly excreted in faeces via bile. Used in the treatment of benign prostatic hypertrophy. Note that there are some more drugs interacting with alfuzosin alfuzosin further details are available in official CIMS India alfuzosin alfuzosin brands available in India Always prescribe with Generic Name: Up to mg may be taken as a single dose; larger doses should be taken in divided doses to minimise gastric irritation.

Max initial dose: Severe impairment: Dose reduction may be needed. Monitor liver function regularly. Oral Gout Adult: Oral Prophylaxis of uric acid nephropathy associated with cancer therapy Adult: Ensure adequate fluid intake. Maintenance for patients with hyperuricaemia secondary to cancer or cancer therapy: Dose is titrated based on response. Oral Recurrent calcium oxalate stones Adult: Dose is adjusted based on subsequent hr urinary urateexcretion.

Intravenous Cancer therapy-induced hyperuricaemia Adult: Therapy should be started hr before initiating the treatment. Ensure sufficient fluid intake to produce a daily urinary output of at least 2 L and maintenance of a neutral, or slightly alkaline urine. Dose can be given as a single dose or equally divided doses at 6-, 8- or hr intervals; infuse over minutes. Therapy should be started hr before initiating the chemotherapy treatment.

Amikacin sulfate, amphotericin B, carmustine, cefotaxime sodium, chlormethine hydrochloride, chlorpromazine hydrochloride, cimetidine hydrochloride, clindamycin phosphate, cytarabine, dacarbazine, daunorubicin hydrochloride, diphenhydramine hydrochloride, doxorubicin hydrochloride, doxycycline hyclate, droperidol, floxuridine, gentamicin sulfate, haloperidol lactate, hydroxyzine hydrochloride, idarubicin hydrochloride, imipenem with cilastatin sodium, methylprednisolone sodium succinate, metoclopramide hydrochloride, minocycline hydrochloride, nalbuphine hydrochloride, netilmicin sulfate, ondansetron hydrochloride, pethidine hydrochloride, prochlorperazine edisilate, promethazine hydrochloride, sodium bicarbonate, streptozocin, tobramycin sulfate and vinorelbine tartrate.

Take immediately after meals. Contraindications Hypersensitivity; acute attack of gout. Students usually select P-drugs properly and are able to answer most questions during the viva but there are often problems in defining the therapeutic objective, understanding the concept that a P-drug is a drug ready for action and verifying the suitability of the selected P-drug.

The exercise in other medical schools in Nepal The faculty members originally present with the author at MCOMS have now dispersed and are at different institutions in Nepal, India and Netherlands Antilles. The PG students are also working at different institutions in Nepal. Subish is in the process of starting the exercise at the College of Medical Sciences CMS , Bharatpur and another colleague is interested in starting the process in India.

ACKNOWLEDGEMENTS

The exercise of P-drug selection is not thought to be performed in other medical schools in Nepal. Also there are certain areas of confusion especially regarding giving scores to drug groups and individual drugs with regard to efficacy and cost.

There have been no workshops at a national or a regional level about how to carry the exercise of P-drug selection forward and how spread it to different medical and pharmacy schools in the country.

It is unclear whether pharmacy schools in Nepal are conducting the exercise of P-drug selection as part of their undergraduate and postgraduate pharmacy programmes.

Information about the exercise in nursing and healthcare professional schools is also lacking. The exercise has the potential to teach healthcare students as future professionals to select medicines on the basis of objective and well-defined criteria and should be strongly encouraged and expanded. Suggestions for replicating the exercise in other developing countries The exercise on P-drug selection can be replicated in health profession schools in other developing countries.

We found medicine and pharmacology textbooks and books detailing the cost of medicines, such as CIMS and institution drug lists, to be useful. The numerical method of P-drug selection described by Joshi and colleagues has been useful. Teaching P-drug selection is best carried out in small groups using easily available resources.

Flip charts can be an excellent method to present findings to the larger group of students and obtain suggestions. The support of the head of the department is required and the departmental faculty should be trained in facilitating small group sessions. Assessment of the exercise requires time during the practical examination but can be easily carried out. Closer interaction between faculty members conducting Pdrug selection exercises in different institutions will be helpful.

He thanks the World Health Organization for their support in terms of books and other resources.

Seven years’ experience of P-drug selection

Footnotes Not commissioned. Externally peer reviewed. A problem-orientated pharmacotherapy package for undergraduate medical students. Med Teach. Shankar PR. Training postgraduate pharmacology students in a medical college in western Nepal.

The Clinical Researcher. Personal drug selection: Problem based learning in Pharmacology: Experiences from a medical school in Nepal. PLoS One. Teaching pharmacology at a Nepalese medical school: The student perspective. Australasian Medical Journal.Lab Interference May interfere with estimation of plasma fibrinogen and other coagulation tests.

Overdosage Symptoms include generalised convulsions, coma, motor restlessness, tachycardia and slight prolongation of the QT interval. Oral Herpes zoster in immunocompromised patients Adult: Dialysis would not be beneficial.

First 10 mg as bolus, followed by infusion of the remainder dose over 2 hr.

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Mechanism of Allopurinol is an inhibitor of the enzyme xanthine oxidase Action which converts hypoxanthine to xanthine then uric acid. Immersion in water causes serious loss of protection. Initially, mg daily in divided doses or as a single dose at night.

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