MISCELLANEOUS DRUGS (BSc. NURSING)

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MISCELLANEOUS DRUGS

PREPARED BY MR. ABHIJIT DAS


DRUGS USED FOR DEADDICTION

DRUGS USED FOR ALCOHOL DEADDICTION:

DISULFIRAM

MOA:

Disulfiram works by inhibiting the enzyme acetaldehyde dehydrogenase, which is responsible for metabolizing acetaldehyde, a byproduct of alcohol metabolism. When acetaldehyde dehydrogenase is inhibited, acetaldehyde accumulates in the blood, leading to unpleasant physiological reactions when alcohol is consumed. These reactions include flushing, nausea, vomiting, severe abdominal pain, headache, and palpitations, which discourage the patient from consuming alcohol.


DOSE AND ROUTE:

  • Initial Dose: 500 mg orally once daily for 1-2 weeks.
  • Maintenance Dose: 250 mg orally once daily (range: 125-500 mg/day).
  • Route: Oral, taken as a tablet.

CONTRAINDICATIONS:

  • Severe cardiovascular disease.
  • Psychosis.
  • Severe liver disease.
  • Hypersensitivity to disulfiram or any of its components.

ROLE OF NURSE:

1.     Assessment: Evaluate the patient's health and liver function before starting treatment.

2.     Education: Explain how disulfiram works, the risks of consuming alcohol while on the medication.

3.     Monitoring: Regularly check for side effects and liver function, and ensure the patient is following the treatment plan.

DRUGS USED FOR NICOTINE DEADDICTION:

BUPROPION

  • Mechanism: Bupropion is an atypical antidepressant that acts as a norepinephrine and dopamine reuptake inhibitor, reducing the urge to smoke.
  • Adverse Effects: Dry mouth, insomnia, headache, weight loss, and, in rare cases, seizures.
  • Dose and Route: Typically, 150 mg once daily for 3 days, then 150 mg twice daily for 7-12 weeks. Taken orally.

VARENICILIN

·        Mechanism: Varenicline is a partial agonist at the nicotinic acetylcholine receptors (specifically the α4β2 subtype). By binding to the nicotinic receptors, varenicline blocks nicotine from attaching to these receptors. This prevents nicotine from exerting its full effects, thereby reducing the pleasure derived from smoking.

  • Adverse Effects: Nausea, insomnia, abnormal dreams, headache, and, in rare cases, mood changes or suicidal thoughts.
  • Dose and Route: Typically, 0.5 mg once daily for 3 days, then 0.5 mg twice daily for 4 days, followed by 1 mg twice daily for 11-12 weeks. Taken orally.


DRUGS USED IN CPR AND EMERGENCY

ADRENALINE

MECHANISM OF ACTION (MOA):

  • Vasoconstriction: Adrenaline stimulates alpha-1 adrenergic receptors, leading to vasoconstriction, which increases peripheral resistance and raises blood pressure.
  • Bronchodilation: Adrenaline stimulates beta-2 adrenergic receptors in the lungs, resulting in bronchodilation and relief of bronchospasm.

ADVERSE EFFECTS:

  • Tachycardia
  • Hypertension
  • Arrhythmias
  • Anxiety
  • Tremors
  • Headache

USES:

  • Cardiopulmonary resuscitation (CPR)
  • Anaphylaxis (severe allergic reaction)
  • Cardiac arrest

DOSE AND ROUTE:

Anaphylaxis (Severe Allergic Reaction)

  • Dose: 0.3-0.5 mg (0.3-0.5 mL of 1:1000 solution)
  • Route: Intramuscular (IM), preferably into the mid-outer thigh
  • Frequency: May repeat every 5-15 minutes if necessary

Cardiac Arrest

·        Dose: 1 mg

·        Route: Intravenous (IV)

·        Frequency: Every 3-5 minutes during resuscitation efforts

 

CHLORPHENIRAMINE

MECHANISM OF ACTION (MOA):

  • Antihistamine: Blocks H1 receptors, inhibiting the action of histamine.

ADVERSE EFFECTS:

  • Drowsiness
  • Dry mouth
  • Dizziness
  • Blurred vision
  • Urinary retention
  • Constipation

USES:

  • Allergic rhinitis [Rhinitis is an inflammation of the mucous membranes in the nose]
  • Common cold symptoms

DOSE AND ROUTE:

  • Adults:
    • Dose: 4 mg
    • Route: Oral (PO)
    • Frequency: Every 4-6 hours as needed, maximum 24 mg per day
  • Children (2-6 years):
    • Dose: 1 mg
    • Route: Oral (PO)
    • Frequency: Every 4-6 hours as needed, maximum 6 mg per day

 

HYDROCORTISONE

MOA:

Anti-inflammatory: Hydrocortisone binds to glucocorticoid receptors, inhibiting inflammatory response by reducing the production of inflammatory mediators (e.g., prostaglandins, leukotrienes).

ADVERSE EFFECTS:

  • Hyperglycemia
  • Hypertension
  • Increased risk of infection
  • Osteoporosis

USES:

  • Inflammatory and autoimmune conditions
  • Allergic reactions

DOSE AND ROUTE:

  • Inflammatory and Autoimmune Conditions:
    • Dose: Varies widely, typically 20-240 mg
    • Route: Oral (PO), Intravenous (IV), or Intramuscular (IM)
  • Allergic Reactions:
    • Dose: 100-500 mg
    • Route: Intravenous (IV) or Intramuscular (IM)

 

DEXAMETHASONE

MOA:

Dexamethasone works by reducing the production of inflammatory substances like interleukins and leukotrienes. It also prevents white blood cells from moving to inflamed areas, reducing inflammation.

ADVERSEC EFFECTS:

·        Insomnia

·        Increased appetite

·        Weight gain

·        Increased risk of infections

·        Hypertension

USES:

  • Management of inflammatory conditions
  • Treatment of allergic reactions

DOSE AND ROUTE:

  • Adults:
    • Dose: 0.5 to 6 mg orally once daily
    • Route: Oral (PO)
  • Children:
    • Dose: 0.02 to 0.4 mg/kg orally once daily
    • Route: Oral (PO)


IV FLUIDS AND ELECTROLYTES REPLACEMENT

COMMON TYPES OF IV FLUIDS

1.     Normal Saline (0.9% NaCl in 100 mL of water):

·         Composed of sodium chloride dissolved in sterile water.

·         Use:

1.     Rehydration for patients with fluid deficits.

2.     Blood transfusions as it does not cause hemolysis.

2.     Lactated Ringer's Solution:

·         Contains sodium chloride, sodium lactate, potassium chloride, and calcium chloride.

·         Use:

1.     Fluid resuscitation in trauma patients.

2.     Perioperative fluid management. [Perioperative fluid management involves the administration of IV fluids before, during, and after surgery to maintain adequate hydration]

3.     Dextrose Solution:

·         Common concentrations include D5W (5% dextrose in water).

·         Use:

1.     Provides a source of calories in patients unable to eat.

2.     Treats hypoglycemia.

 

COMMON ELECTROLYTE REPLACEMENT AS PART OF IV FLUID THERAPY

1.     Sodium (Na+):

·         Sodium chloride (NaCl)

2.     Potassium (K+):

·         Potassium chloride (KCl)

3.     Calcium (Ca2+):

·         Calcium gluconate

·         Calcium chloride

4.     Magnesium (Mg2+):

·         Magnesium sulfate

5.     Phosphate (PO4³-):

·         Sodium phosphate

·         Potassium phosphate


COMMON POISONS, DRUGS USED FOR TREATMENT OF POISONING

COMMON POISONS

HOUSEHOLD CHEMICALS:

  • Bleach
  • Ammonia
  • Pesticides

MEDICATIONS:

  • Overdose of medicines
  • Misuse of medicines
  • Abuse of medicines

HEAVY METALS:

  • Lead
  • Mercury
  • Arsenic

SNAKE AND INSECT BITES:

  • Rattlesnake venom
  • Black widow spider venom
  • Scorpion venom

DRUGS USED FOR TREATMENT OF POISONING:

ACTIVATED CHARCOAL:

Activated charcoal has a large surface area due to its porous structure. When ingested, it adsorbs a wide variety of drugs and toxins onto its surface, reducing their absorption in the stomach and intestines.

IPECAC:

1.    Emetic Effect: Ipecac contains alkaloids, primarily emetine and cephaeline, which irritate the gastric mucosa and stimulate the chemoreceptor trigger zone (CTZ) in the brain.

2.    Induction of Vomiting: This dual action causes the vomiting reflex, leading to the expulsion of stomach contents, including the ingested poison.

ANTIDOTES:

Paracetamol (Acetaminophen) Overdose:

  • Antidote: N-acetylcysteine (NAC)

Opioid Overdose:

  • Antidote: Naloxone

Benzodiazepine Overdose:

  • Antidote: Flumazenil

Iron Overdose:

  • Antidote: Deferoxamine

Heavy Metal Poisoning:

  • Chelating Agent:
    • Lead Poisoning: EDTA (Ethylenediaminetetraacetic acid) or Dimercaprol (British Anti-Lewisite, BAL)
    • Mercury Poisoning: Dimercaprol (BAL) or Succimer (DMSA)
    • Arsenic Poisoning: Dimercaprol (BAL) or Succimer (DMSA)

Examples of Chelating Agents:

  • Dimercaprol (BAL)
  • EDTA (Ethylenediaminetetraacetic acid)
  • Succimer (DMSA)

ANTI-SNAKE VENOM(ASV):

Mechanism of Action (MOA) of Antivenom:

1.    Neutralization of Venom Toxins: Antivenom contains antibodies that specifically bind to the venom components. These antibodies are derived from the serum of animals (usually horses or sheep) that have been immunized with small, non-lethal doses of the venom.

2.    Inhibition of Toxic Effects: By binding to the venom toxins, the antibodies prevent these toxins from interacting with their biological targets in the human body. This action stops the progression of symptoms caused by the venom, such as neurotoxicity, coagulopathy, and cytotoxicity.

3.    Facilitation of Clearance: The immune complexes formed between the antivenom antibodies and venom toxins are then cleared from the body

Examples of Antivenom for Indian Snakes:

1.    Polyvalent Snake Antivenom:

·        Effective against Russell's Viper, Indian Cobra, Common Krait, Saw-scaled Viper.

2.    Russell's Viper Antivenom:

·        Specifically for Russell's Viper.

3.    Cobra Antivenom:

·        Specifically for Indian Cobra.


VITAMINS AND MINERALS

VITAMINS

Types of Vitamins:

1.    Fat-Soluble Vitamins:

·        Vitamin A

·        Vitamin D

·        Vitamin E

·        Vitamin K

2.    Water-Soluble Vitamins:

·        Vitamin B1 (Thiamine)

·        Vitamin B2 (Riboflavin)

·        Vitamin B3 (Niacin)

·        Vitamin B5 (Pantothenic Acid)

·        Vitamin B6 (Pyridoxine)

·        Vitamin B7 (Biotin)

·        Vitamin B9 (Folate or Folic Acid)

·        Vitamin B12 (Cobalamin)

·        Vitamin C (Ascorbic Acid)

Supplementation:

  • Reasons for Supplementation:
    • Addressing deficiencies due to inadequate dietary intake.
    • Managing specific health conditions.
    • Supporting overall health and well-being.
  • How to Take:
    • Vitamins are available in various forms such as tablets, capsules, liquids, and powders.

MINERALS

Minerals and Daily Doses:

1.    Calcium:

·        Daily Dose:

·        Adults under 50: 1000 mg

·        Adults over 50: 1200 mg

2.    Iron:

·        Daily Dose:

·        Men: 8 mg

·        Women (18-50 years): 18 mg

·        Women (over 50 years): 8 mg

3.    Magnesium:

·        Daily Dose:

·        Men (19-30 years): 400 mg

·        Women (19-30 years): 310 mg

·        Men (over 30 years): 420 mg

·        Women (over 30 years): 320 mg

4.    Zinc:

·        Daily Dose:

·        Men: 11 mg

·        Women: 8 mg

5.    Potassium:

·        Daily Dose:

·        Adults: 4700 mg

6.    Sodium:

·        Daily Dose:

·        Adults: 1500 mg (minimum requirement)

7.    Phosphorus:

·        Daily Dose:

·        Adults: 700 mg

8.    Selenium:

·        Daily Dose:

·        Adults: 55 mcg

9.    Iodine:

·        Daily Dose:

·        Adults: 150 mcg

10. Copper:

·        Daily Dose:

·        Adults: 900 mcg

11. Manganese:

·        Daily Dose:

·        Men: 2.3 mg

·        Women: 1.8 mg


VACCINES AND SERA

VACCINES

·        Vaccines are biological preparations that stimulate the immune system to produce an immune response against specific pathogens, such as viruses or bacteria.

·        They typically contain weakened or inactivated forms of the pathogen, or specific antigens derived from the pathogen, to trigger an immune response without causing the disease itself. This immune response helps the body to recognize and fight the pathogen if it is encountered in the future, providing immunity against the disease.

·        Vaccines are administered via injection or oral administration, and they are a crucial tool in preventing infectious diseases on an individual and population level through immunization programs.

SERA:

·        Sera refers to blood plasma that has been depleted of clotting factors, resulting in a fluid containing antibodies and other proteins.

·        They are derived from the blood of individuals or animals that have been previously exposed to or vaccinated against a particular pathogen.

·        Immune sera can provide immediate protection against certain diseases by transferring pre-formed antibodies to individuals at risk. They are typically administered via injection and are used for post-exposure prophylaxis or treatment of diseases such as rabies, tetanus, and snake envenomation.

UNIVERSAL IMMUNIZATION PROGRAM SCHEDULE

1.    At Birth:

·        BCG (Bacillus Calmette-Guérin) Vaccine: Protection against tuberculosis.

·        Oral Polio Vaccine (OPV) - 0 dose: Protection against polio.

2.    6 Weeks:

·        Oral Polio Vaccine (OPV) - 1st dose

·        Pentavalent Vaccine (DTP-HepB-Hib) - 1st dose: Protection against diphtheria, tetanus, pertussis (whooping cough), Hepatitis B, and Haemophilus influenzae type b.

·        Rotavirus Vaccine (RV) - 1st dose: Protection against rotavirus infection, a common cause of severe diarrhea in infants.

3.    10 Weeks:

·        Oral Polio Vaccine (OPV) - 2nd dose

·        Pentavalent Vaccine (DTP-HepB-Hib) - 2nd dose

·        Rotavirus Vaccine (RV) - 2nd dose

4.    14 Weeks:

·        Oral Polio Vaccine (OPV) - 3rd dose

·        Pentavalent Vaccine (DTP-HepB-Hib) - 3rd dose

·        Rotavirus Vaccine (RV) - 3rd dose

5.    9 Months:

·        Measles Vaccine: Protection against measles.

6.    12-18 Months:

·        1st Booster Dose of Pentavalent Vaccine (DTP-HepB-Hib)

7.    16-24 Months:

·        2nd Booster Dose of Pentavalent Vaccine (DTP-HepB-Hib)

·        1st Booster Dose of Oral Polio Vaccine (OPV)

8.    5 Years:

·        2nd Booster Dose of Oral Polio Vaccine (OPV)

·        DPT (Diphtheria, Tetanus, Pertussis) Vaccine: Booster dose against diphtheria, tetanus, and pertussis.

9.    10 Years:

·        Tetanus Toxoid (TT) Vaccine: Booster dose against tetanus.

10. 14 Years:

·        Tetanus Toxoid (TT) Vaccine: Booster dose against tetanus.


ANTICANCER DRUGS

CLASSIFICATION

1.    Alkylating Agents

·        Cyclophosphamide

·        Ifosfamide

·        Mechlorethamine

·        Thiotepa

·        Busulfam

·        Dacarbazine

2.    Antimetabolites

·        Folate Antagonist

·        Methotrexate

·        Pemetrexed

·        Purine Antagonists

·        6-Mercaptopurine

·        6-Thioguanine

·        Azathioprine

·        fludarabine

·        Pyrimidine Antagonists

·        5-Fluorouracil

·        Cytarabine

3.    Vinca Alkaloids

·        Vincristine

·        Vinblastine

·        Vinorelbine

4.    Taxanes

·        Paclitaxel

·        Docetaxel

·        Cabazitaxel

5.    Epipodophyllotoxins

·        Etoposide

·        Teniposide

ALKYLATING AGENTS

MOA:

Alkylating agents work by adding alkyl groups to DNA, leading to DNA cross-linking and strand breakage. This prevents DNA replication and RNA transcription, ultimately leading to cell death.

ADVERSE EFFECTS:

  • Myelosuppression: Decreased production of blood cells, leading to anemia, leukopenia, and thrombocytopenia.
  • Gastrointestinal: Nausea, vomiting, and diarrhea.
  • Alopecia: Hair loss.
  • Cardiotoxicity: Heart damage, especially with high doses.
  • Immunosuppression: Increased susceptibility to infections.

USES:

  • Cancer Treatment:
    • Leukemias (acute lymphocytic leukemia, chronic lymphocytic leukemia)
    • Breast cancer
    • Ovarian cancer
  • Non-Cancer Conditions:
    • Autoimmune diseases (e.g., rheumatoid arthritis)

DOSE AND ROUTE:

Cyclophosphamide

1.    Breast Cancer:

·        Dose: 600 mg/m² IV on day 1 of each 21-day cycle, often in combination with other chemotherapeutic agents such as doxorubicin and fluorouracil.

·        Route: Intravenous (IV)

2.    Ovarian Cancer:

·        Dose: 600 mg/m² IV on day 1 of each 21-day cycle, typically combined with other chemotherapeutic agents.

·        Route: Intravenous (IV)

ANTIMETABOLITES

FOLATE ANTAGONIST:

METHOTREXATE

MOA:

Methotrexate is an antifolate agent. It inhibits dihydrofolate reductase (DHFR), an enzyme involved in the conversion of dihydrofolate to tetrahydrofolate. Tetrahydrofolate is essential for the synthesis of purines and thymidylate, which are necessary for DNA and RNA synthesis. By blocking this pathway, methotrexate interferes with the replication and function of rapidly dividing cells, including cancer cells.

ADVERSE EFFECTS:

  • Myelosuppression: Anemia, leukopenia, thrombocytopenia
  • Gastrointestinal: Nausea, vomiting, diarrhea, stomatitis, mucositis
  • Hepatotoxicity: Elevated liver enzymes, liver fibrosis, cirrhosis
  • Nephrotoxicity: Renal dysfunction, elevated serum creatinine
  • Pulmonary Toxicity: Pneumonitis, pulmonary fibrosis
  • Neurotoxicity: Headaches, dizziness, seizures (high doses)

[NOTE: Fibrosis is a medical condition characterized by the formation of excess fibrous connective tissue in an organ or tissue in response to injury, damage, or inflammation. This process results in the thickening and scarring of the tissue, which can impair the normal function of the affected organ.]

USES:

  • Acute lymphoblastic leukemia (ALL) [A rapidly progressing cancer of the bone marrow characterized by the overproduction of immature lymphocytes.]
  • Non-Hodgkin’s lymphoma [a cancer that originates in the lymphatic system, characterized by the proliferation of abnormal lymphocytes, which are a type of white blood cell, leading to the formation of tumors in lymph nodes and other lymphoid tissues]
  • Breast cancer
  • Osteosarcoma [Bone Cancer]
  • Head and neck cancers

 

CONTRAINDICATIONS:

  • Pregnancy: Methotrexate is teratogenic and contraindicated in pregnancy.
  • Liver Disease: Significant hepatic impairment or chronic liver disease.
  • Renal Disease: Severe renal impairment or failure.
  • Bone Marrow Suppression: Pre-existing severe bone marrow suppression or blood dyscrasias.

DOSE AND ROUTE:

Acute Lymphoblastic Leukemia (ALL)

  • Dose: 20-40 mg/m² IV or IM once weekly

Non-Hodgkin’s Lymphoma

  • Dose: 200-500 mg/m² IV once weekly

Osteosarcoma

  • Dose: 12 g/m² IV every 1-3 weeks, with leucovorin rescue

Breast Cancer

  • Dose: 40 mg/m² IV or IM once weekly

Head and Neck Cancers

  • Dose: 40-60 mg/m² IV or IM once weekly

 

PURINE ANTAGONISTS:

6-MERCAPTOPURINE

MECHANISM OF ACTION (MOA):

6-Mercaptopurine (6-MP) is a purine analog that inhibits the synthesis of purine nucleotides. It interferes with DNA and RNA synthesis by being incorporated into the nucleic acids, leading to the inhibition of the proliferation of rapidly dividing cells, such as cancer cells and white blood cells.

ADVERSE EFFECTS:

1.    Bone marrow suppression

2.    Hepatotoxicity

3.    Nausea and vomiting

USES:

1.    Acute lymphoblastic leukemia (ALL)

2.    Inflammatory bowel disease (IBD)

CONTRAINDICATIONS:

1.    Hypersensitivity to 6-mercaptopurine

2.    Patients with severe liver impairment

DOSE AND ROUTE:

  • Dose: Typically 1.5 to 2.5 mg/kg/day
  • Route: Oral administration (tablet form)

6-THIOGUANINE

Mechanism of Action (MOA): 6-Thioguanine is a guanine analog that is incorporated into DNA and RNA, disrupting their synthesis and function, which inhibits the growth of rapidly dividing cells.

Adverse Effects:

1.    Bone marrow suppression

2.    Hepatotoxicity

3.    Nausea and vomiting

Uses:

1.    Acute myeloid leukemia (AML)

2.    Chronic myeloid leukemia (CML)

[NOTE:
Myeloid leukemia (AML): A type of cancer where the bone marrow produces abnormal myeloblasts, red blood cells, or platelets.

Myeloblast: An immature white blood cell found in the bone marrow that can develop into a type of white blood cell called a granulocyte.]

CONTRAINDICATIONS:

1.    Pregnancy

2.    Breastfeeding

DOSE AND ROUTE:

  • Dose: Typically 2 to 3 mg once daily
  • Route: Oral administration

PYRIMIDINE ANTAGONISTS:

5-FLUOROURACIL

MECHANISM OF ACTION (MOA):

5-Fluorouracil is an uracil analog that interferes with the synthesis of DNA and RNA, ultimately leading to cell death.

ADVERSE EFFECTS:

1.    Myelosuppression

2.    Gastrointestinal toxicity

3.    Hand-foot syndrome

USES:

1.    Colorectal cancer

2.    Breast cancer

CONTRAINDICATIONS:

1.    Known severe hypersensitivity to 5-fluorouracil.

2.    Severe bone marrow suppression.

DOSE AND ROUTE:

  • Dose: Typically 12 to 15 mg/kg/day for 4 to 5 days, repeated every 3 to 4 weeks.
  • Route: Intravenous administration.

CYTARABINE

MECHANISM OF ACTION (MOA):

Cytarabine, a cytidine analog, interferes with DNA synthesis, ultimately leading to cell death.

ADVERSE EFFECTS:

1.    Myelosuppression

2.    Nausea and vomiting

USES:

1.    Acute myeloid leukemia (AML)

2.    Non-Hodgkin lymphoma

CONTRAINDICATIONS:

1.    Severe bone marrow suppression

2.    Hypersensitivity to cytarabine

DOSE AND ROUTE:

  • Dose: Typically administered at 100 to 200 mg/m² daily for 5 to 7 days, based on body surface area.
  • Route: Intravenous (IV) administration.

VINCA ALKALOIDS

VINCRISTINE

MECHANISM OF ACTION (MOA):

Inhibits microtubule formation, disrupting mitosis and cell division.

ADVERSE EFFECTS:

1.    Peripheral neuropathy

2.    Constipation

USES:

1.    Various cancers, including leukemia and lymphoma

2.    Pediatric tumors, such as neuroblastoma

VINBLASTINE

MECHANISM OF ACTION (MOA):

Inhibits microtubule formation, disrupting mitosis and cell division.

ADVERSE EFFECTS:

1.    Bone marrow suppression

2.    Hair loss

USES:

1.    Hodgkin's lymphoma

2.    Testicular cancer


IMMUNO-SUPPRESSANTS AND IMMUNOSTIMULANTS

IMMUNO-SUPPRESSANTS:

CALCINEURIN INHIBITORS

MOA:

Calcineurin inhibitors, such as cyclosporine and tacrolimus, inhibit calcineurin inside T cells. This prevents the activation of key transcription factors needed for interleukin-2 (IL-2) production. As a result, T cell activation is blocked, reducing the immune response.

ADVERSE EFFECTS:

1.    Nephrotoxicity: Kidney damage or dysfunction.

2.    Hypertension: Elevated blood pressure.

3.    Neurotoxicity: Tremors, headaches, and other neurological symptoms.

4.    Increased Risk of Infections: Due to suppression of the immune system.

5.    Hepatotoxicity: Liver damage.

USES:

1.    Organ Transplantation: Preventing rejection of transplanted organs (e.g., kidney, liver, heart).

2.    Autoimmune Diseases: Treating conditions like rheumatoid arthritis and inflammatory bowel disease.

CONTRAINDICATIONS:

Cyclosporine:

1.    Hypersensitivity: Known hypersensitivity to cyclosporine or any of its components.

2.    Uncontrolled Hypertension: Patients with severe, uncontrolled high blood pressure.

3.    Renal Dysfunction: Severe renal impairment or failure.

 

Tacrolimus:

1.    Hypersensitivity: Known hypersensitivity to tacrolimus or any of its components.

2.    Allergic Reactions to Macrolides: Patients with a known allergy to macrolide antibiotics.

3.    Uncontrolled Hypertension: Patients with severe, uncontrolled high blood pressure.

4.    Renal Dysfunction: Severe renal impairment or failure.

5.    Liver Dysfunction: Severe hepatic impairment.

DOSE AND ROUTE:

CYCLOSPORINE

Dose:

For Organ Transplantation (Prophylaxis):

·        Initial dose: 8-15 mg/kg/day, divided into two doses, starting 12 hours before transplantation.

·        Maintenance dose: Typically, 3-10 mg/kg/day, adjusted based on blood levels and clinical response.

Route:

  • Oral: Capsules or oral solution.
  • Intravenous: For patients who cannot take oral medication (1/3 of the oral dose, diluted and administered over 2-6 hours).

 

TACROLIMUS

Dose:

For Organ Transplantation (Prophylaxis):

·        Initial dose (oral): 0.1-0.2 mg/kg/day, divided into two doses, starting 6-12 hours after transplantation.

·        Maintenance dose: Adjusted based on blood levels and clinical response, typically 0.1-0.3 mg/kg/day.

Route:

  • Oral: Capsules.
  • Intravenous: For patients who cannot take oral medication (1/5 of the oral dose, administered over 24 hours via continuous infusion).

IMMUNOSTIMULANTS:

COLONY RTIMULATING FACTORS:

SARGRAMOSTIM AND MOLGRAMOSTIM

MECHANISM OF ACTION (MOA):

  • Both sargramostim and molgramostim are granulocyte-macrophage colony-stimulating factors (GM-CSFs).
  • They stimulate the production, maturation, and activation of white blood cells, particularly neutrophils, macrophages, and dendritic cells.

Adverse Effects:

  • Fever
  • Bone pain
  • Fatigue
  • Headache
  • Edema

USES:

Sargramostim:

1.    Helping recover white blood cells after chemotherapy.

2.    Speeding up recovery after bone marrow transplants.

Molgramostim:

1.    Boosting white blood cell production during chemotherapy.

CONTRAINDICATIONS:

Sargramostim:

1.    Hypersensitivity to sargramostim or any component of the formulation.

2.    Concurrent use with chemotherapy or radiotherapy within 24 hours before or after administration.

Molgramostim:

1.    Hypersensitivity to molgramostim or any component of the formulation.

2.    Concurrent use with chemotherapy or radiotherapy within 24 hours before or after administration.

INTERLEUKINS AS IMMUNOSTIMULANTS

Mechanism of Action (MOA):

  • Interleukins enhance the cytotoxic activity of natural killer (NK) cells and other immune cells.
  • This increased activity helps the immune system target and destroy cancer cells.

Uses:

  • Cancer Treatment: Interleukins, such as interleukin-2 (IL-2), are used to boost the immune response against certain types of cancers, including metastatic renal cell carcinoma.

INTERFERONS AS IMMUNOSTIMULANTS

Mechanism of Action (MOA):

  • Interferons are proteins that enhance the immune response by stimulating the activity of immune cells.
  • They increase the production of antiviral proteins that inhibit viral replication within host cells.

Uses:

1.    Antiviral Therapy:

·        Treating viral infections such as hepatitis B and hepatitis C.

2.    Cancer Treatment:

·        Managing certain types of cancer, such as melanoma and chronic myeloid leukemia.

Adverse Effects:

  • Flu-like symptoms (fever, chills, headache, muscle aches)
  • Fatigue
  • Depression

Contraindications:

  • Hypersensitivity to interferons or any component of the formulation
  • Severe liver disease
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