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Miscellaneous drugs

Slides are prepared as per INC Syllabus Unit VII Miscellaneous drugs and it is most benefited for B sc Nursing students and faculty of the subject.

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Miscellaneous drugs

  1. 1. Unit VII Miscellaneous Drugs. Mr. Dipti Sorte
  2. 2. Syllabus • Drugs used in deaddiction • Drugs used in CPR & emergency • Vitamins and minerals • Immunosuppressants • Antidotes • Antivenom • Vaccines and Sera
  3. 3. Drug used in deaddiction – Disulfiram •Introduction: Disulfiram (DSM) is an alcohol abuse drug. It works by blocking the breakdown of alcohol, causing unpleasant side effects (eg. Vomiting upset stomach) when even a small amount of alcohol is consumed.
  4. 4. Dose •300mg as a single dose on the 1st day of treatment, reduce dose by 200 mg daily, maintenance 100 – 200 mg daily.
  5. 5. Contraindication/precautions •Precautional use in case of pregnancy or breast feeding. •Precautional used if taking any prescription or non prescription medicine. •If patient is taking alcohol containing medicines (eg. HIV protease inhibitors amprenal, cough syrup, metronidazole) disulfiram may be contraindicated.
  6. 6. Instruction to use Disulfiram •Disulfiram may be taken with or without food. •It may be swallowed whole, chewed or crushed and mixed with food. •Do not take the first dose of disulfiram for at least 12hrs. After drinking alcohol. •If patient miss a dose of disulfiram take it as soon as possible if it is almost time for next dose, skip the missed dose and go back to regular dosing schedule. Do not take two doses at once.
  7. 7. Important safety information •It may cause drowsiness, do not drive or operate machinery. •Avoid all alcohol including found in sauces, vinegar, mouth wash, liquid medicines, lotion after shave or back rub products.
  8. 8. Adverse effects • Chest pain. • Fast breathing. • Fast heart beat. • Headache. • Nausea. • Abdominal pain. • Vomiting. • Fainting. • Drowsiness. • Flushing. • Thirst • Severe allergic reactions.
  9. 9. Drugs used in CPR & Emergency •CPR (Cardiopulmonary resuscitation) is only emergency management for these cases. External cardiac massage it is used in cases of cardiac arrest or apparent sudden death resulting from electric shock, drowning respiratory arrest.
  10. 10. Nursing Care • Apply cardiac monitor. • Record elctrocardiac events. • Immediately administer defibrillation. • Quickly attend to the clients airway and oxygen. • Insert an oral (artificial) airway to maintain the tongue in forward position. Administer 100% oxygen. • Suctioning. • Start IV (Intravenous) lines for administration of resuscitation medication. • Catheterization should be maintain.
  11. 11. Medications used in CPR (commonly) • Epinephrine (Adrenaline) Action: It increase systemic vascular resistance and blood pressure. • Atropine: Action: It blocks parasympathetic action, increases SA node automaticity and AV condition. • Sodium Bicarbonate: Action: Corrects metabolic acidosis. • Vasopressin: Action: Increase inotropic action (contraction ) of heart.
  12. 12. 1. Inj. Adrenaline. •Indications: Anaphylactic Shock, Cardiac Arrest, Status asthmaticus (Asthma) •Route: S/C •Dose: 0.5 ml to 1ml. 2. Inj. Aminophylline. •Indications: Bronchial Asthma. •Route: I.V. slowly or I.V. drip. •Dose: 250- 500mg 3. Inj. Atropine. •Indications: Bradycardia, Organophosph orus, Poisoning. •Route: S/C, I.M or I.V. •Dose: 0.2 to 2mg.
  13. 13. 4. Inj. Avil. •Indications: Allergic reaction. •Route: I.M. •Dose: 25 mg. 5. Inj. Analgin. •Indications: Pain reliever, Anti-pyrutic. •Route: I.M/I.V. •Dose: 2.5 cc (100-250mg) 6. Inj. Betnesol (Betamethasone). •Indications: Anaphylactic shock, Bronchial asthma, Hypotension. •Route: I.M or I.V. •Dose: 2-5 c.c
  14. 14. 7. Inj. Cal. Gluconate 10%. •Indications: Allergic reaction, Cardiac stimulation, Rigor. •Route: IV slowly. •Dose: 10-20 C.C. 8. Inj. Baralgan. •Indications: Spasm of smooth muscle, abdominal colic, renal colic. •Route: IM or IV •Dose: 2-5cc 9. Inj. Calmpose. •Indications: Relieve anxiety, In high doses 20- 30 mg, induce sleep. •Route: IV / IM •Dose: 5-40 mg
  15. 15. 10. Inj. Digoxin. •Indications: Heart failure, Fibrillation. •Route: IV Slowly. •Dose: 0.5 mg stat. followed by 0.25 mg 6hrly on 1st day: 0.25 to 0.75mg per day. 11. Inj. Deriphyllin. •Indications: Bronchial Asthma. •Route: IM/IV •Dose: 1 ampoule. 12. Inj. Fortwin (Pentazocine). •Indications: Myocardial infarction, analgesic hypnotic. •Route: IM/IV •Dose: 30-60 mg
  16. 16. 13. Inj. Furosemide (Lasix). •Indications: As Diuretic, Pulmonary edema, Cerebral edema. •Route: IM/IV •Dose: 40 – 160 mg. 14. Inj. Phenobarbitone (Gardinol). •Indications: Epilepsy, To induce sleep. •Route: IM/IV •Dose: 100 – 200 mg. 15. Inj. Hydrocortisone Hemisuccinate (Efcorlin). • Indications: Immediate action on Hypotension, Anaphylactic shock, Bronchial asthma. • Route: IV. • Dose: 100 – 300 mg.
  17. 17. 16. Inj. Lignocaine. •Indications: Ventricular Arrhythmias, •Route: IV drip. •Dose: 1-2 mg /kg 17. Inj. Methergine. •Indications: To stop vaginal bleeding. •Route: IV or IM. •Dose: 1Ampoule 18. Inj. Mephentin. •Indications: Hypotension. •Route: IM/IV or IV drip. •Dose: 20 – 80 mg.
  18. 18. 19. Inj. Metaclopramide (Mexeron, Raglan). •Indications: Vomiting. •Route: IM. •Dose: 10-30 mg 20. Inj. Morphine. •Indications: Myocardial infarction, Analgesic Hypnotic. •Route: IM/IV •Dose: 10-20 mg. 21. Inj. Oxytocin (Syntocinon). •Indications: Post partum hemorrhage. •Route: SC/IM •Dose: 2-5 unit in post partum.
  19. 19. 22. Inj. Pot. chloride. •Indications: Hypokalemia. •Route: IV drip. •Dose: 20 mg or as per needed. 23. Inj. Phenergan. •Indications: Sedation, psychiatric patients, labor pain 1st stage, Rigor. •Route: IM/IV •Dose: 20 – 50 mg. 24. Inj. Pethidine. •Indications: Narcotic Analgesic, Myocardial infarction, severe pain, labor pain. •Route: SC/IM/IV. •Dose: 20-100 mg.
  20. 20. 25. Inj. Soda- bicarb. •Indications: Metabolic Acidosis, •Route: IV •Dose: 50-200 meq. 7.4% soln. 26. Inj. Streptobion. •Indications: To stop bleeding. •Route: IM/IV •Dose: 1 Ampoule 27. Inj. Vit. K. •Indications: To increase prothrombin time in liver disease, To stop bleeding •Route: IM •Dose: one Ampoule.
  21. 21. 28. Inj. Dextrose 5%. • Indications: Dehydration and providing energy • Route: IV. • Dose: 5 pints a day. But depend on age group and condition. 29. Inj. Normal saline. • Indications: Dehydration with electrolyte imbalance specially loss of sodium and chloride (Diarrhea & Vomiting) • Route: SC/IV. • Dose: 5 pints a day. But depend on age group and condition. 30. Inj. Ringer lactate. • Indications: Dehydration with electrolyte imbalance specially due to loss of blood and in burn • Route: IV • Dose: 5 pints a day. But depend on age group and condition.
  22. 22. 31. Inj. Lomodex. •Indications: Hypovolemic shock due to blood or plasm loss. •Route: IV •Dose: Depend on age group and condition 32. Inj. Mannitol. •Indications: Cerebral edema, Renal failure. •Route: IV •Dose: 100cc or Depend on age group and condition.
  23. 23. Vitamins & Minerals
  24. 24. Summary of B – Complex Vitamins • Vitamins: Thiamin (Vit. B1) • Clinical Applications: Beri-beri (Deficiency), GI – Anorexia, Gastric atony, indigestion, deficient, Hydrochloric acid. CNS – Fatigue, Apathy, Neuritis, Paralysis. CV – Cardiac failure, peripheral vasodilation and edema of extremities. • Requirements: 0.5mg/1000 calories. • Food Sources: Pork, Beef, Liver, Whole or enriched grains, legumes.
  25. 25. •Vitamins: Riboflavin (Vitamin B2) •Clinical Applications: Wound aggravation, cheilosis, Glossitis, eye irritation, photophobia, Seborrheic dermatitis. •Requirements: 0.6 mg/1000 calories. •Food Sources: Milk, Liver, Enriched calories.
  26. 26. •Vitamins: Niacin (Nicotinic acid) (Precursor Tryptophan) •Clinical Applications: Pellagra (Deficiency) weakness, lassitude anorexia, skin – scaly dermatitis, CNS – Neuritis, confusion. •Requirements: 14 – 20 mg •Food Sources: Meat, peanuts, enriched grains.
  27. 27. •Vitamins: Pantothenic acid (Vit B5) •Clinical Applications: Contribute to Lipogenesis, amino acid activation, formation of cholesterol, formation of steroid hormone, formation of hem, excretion of drugs. •Requirements: Liver, egg, skimmed milk. •Food Sources: Cauliflower, mushrooms, cheese, lean pork, sweet potato.
  28. 28. •Vitamins: Pyridoxine (Vit B6 ) •Clinical Applications: Anemia, CNS – Hyperirritability, convulsions, neuritis, isoniazid is an antagonist for pyridoxine, pregnancy, anemia. •Requirements: 2mg •Food Sources: wheat, corn, meat, liver.
  29. 29. •Vitamins: Biotin (Vit. H) •Clinical Applications: Undetermined. •Requirements: 30μg /per day. •Food Sources: Egg yolk, Liver.
  30. 30. •Vitamins: Folic Acid (Vit. B9) •Clinical Applications: Blood cell regeneration in pernicious anemia but not controls of its neurological problem. •Requirements: 400mg, 800mg, in pregnancy. •Food Sources: Liver, Green leafy vegetables, asparagus.
  31. 31. Summary of Fat Soluble Vitamins •Vitamins: Vit. A (Retinol) •Clinical Applications: Xerophthalmia. •Requirements: Adult male 10mg (5000 IU), Adult female 800mg (4000 IU) •Food Sources: Liver, Cream, Butter, whole milk, green vegetables.
  32. 32. •Vitamins: Provitamin A (Carotene). •Clinical Applications: Night blindness, keratinization of epithelium, follicular hyperkeratosis, skin and mucous membrane infections, Faulty tooth formation. •Requirements: Adult female: 800mg (4000IU), Pregnancy 100mg (5000IU), Lactation 1200mg (6000IU), Children 400mg (2000 IU) to 800mg (4000IU). •Food Sources: Green leafy vegetables, fruit, egg yolk, butter, red cabbage.
  33. 33. •Vitamins: Vit D (Calciferol) •Clinical Applications: Rickets, Faulty bone growth, osteomalacia in adults. •Requirements: Adult 5-10 mg calciferol, (200- 400 IU), Pregnancy and lactation 10-12.5 mg, children 3-10 mg. •Food Sources: Fish oil, fortified or irradiated milk.
  34. 34. •Vitamins: Vitamin E (Tocopherol) •Clinical Applications: Hemolysis of RBC, Anemia, Possible protection of unsaturated fatty acid, sterility. •Requirements: Adult 8-10mg, Pregnancy and Lactation: 10-11mg, children: 3-10 mg •Food Sources: Vegetable oils.
  35. 35. • Vitamins: Vit. K • Clinical Applications: Hemorrhagic disease of the new born, Bleeding tendencies, in biliary disease or surgical procedure deficiency in intestinal malabsorption (Sprue, celiac disease, colitis) prolonged antibiotic therapy, anticoagulant therapy ( Dicoumarol counteracts). • Requirements: Unknown. • Food Sources: Green leafy vegetables, cheese Egg yolk, liver.
  36. 36. Summary of Vitamin C (Ascorbic Acid) • Vitamins: Vitamin C (Ascorbic Acid) • Clinical Applications: Scurvy (Deficiency), Megaloblastic Anemia, Wound healing, tissue formation, fevers, infections, stress reaction, Growth rates. • Requirements: 60mg daily (Adults) • Food Sources: Citrus fruits, tomato’s, cabbage, potato's, strawberry’s, melon, chili papers.
  37. 37. Summary of Major Minerals •Mineral: Calcium (Ca) •Clinical Applications: Tetany – Decreased in ionized serum calcium, Rickets, Renal Calculi, Hyperparathyroidism, Hypoparathyroidism. •Requirements: 0.8gm Pregnancy & Lactation 1.2gm, Infants 360-540mg, Children 0.8-1.2gm. •Food Sources: Milk cheese, green leafy vegetables, whole grains, egg yolk, legumes, nuts.
  38. 38. • Minerals: Phosphorus (P) • Clinical Applications: Growth, Hypophosphatemia, Recovery state of diabetic acidosis sprue, celiac disease, (Malabsorption), Bone disease (Calcium and phosphorus in balance) Hyperphosphatemia, Renal insufficiency, Hypoparathyroidism, Tetany. • Requirements: Adults half times calcium intake pregnancy & Lactation: 1to2 gm, Infants 240-400 mg, Children 0.8 to 1.2 gm • Food Sources: Milk cheese, meat, whole grains, egg yolk, legumes, nuts.
  39. 39. •Mineral: Magnesium (Mg) •Clinical Applications: Tremors, spasm, low serum level following gastrointestinal loses. •Requirements: 300-350mg deficiency in human unlikely. •Food Sources: whole grains, nuts, meat, milk, legumes.
  40. 40. •Mineral: Sodium (Na) •Clinical Applications: Fluid shift and control buffer system, losses in G.I. disorders. •Requirements: About 0.5 gm diet usually has more: 2-6gm •Food Sources: Table salt (Na cl), milk, meat, egg. Baking soda, baking powder, carrots, beet, spinach, celery.
  41. 41. •Mineral: Chlorine (Cl) •Clinical Applications: Hyperchloremic alkalosis in prolonged vomiting, diarrhea. •Requirements: About 0.5 gm usually has more 2-6gm. •Food Sources: Table salt.
  42. 42. •Minerals: Sulphur (S) •Clinical Applications: Cystine, renal calculi, Cystinuria. •Requirements: Diet adequate in protein contains adequate Sulphur. •Food Sources: Meat, Egg, Cheese, nuts, legumes.
  43. 43. Summary of Trace Minerals • Trace Minerals: Copper (Cu) • Clinical Applications: Hypocupremia, Nephrosis, Malabsorption, Wilson’s disease, excess copper storage. • Requirements: The RDAs for copper are: 200 μg of copper for 0–6-month-old males and females, and 220 μg of copper for 7–12-month-old males and females. 1. 340 μg of copper for 1–3-year-old males, 2. 440 μg of copper for 4–8-year-old males, 3. 700 μg of copper for 9–13-year-old males, 4. 890 μg of copper for 14–18-year-old males, and 900 μg of copper for males that are 19 years old and older. 5. The RDAs for copper are: 340 μg of copper for 1–3-year-old females, 440 μg of copper for 4–8-year-old females, 6. 700 μg of copper for 9–13-year-old females, 890 μg of copper for 14–18-year-old females, and 900 μg of copper for females that are 19 years old and older. 7. The RDAs for copper are: 1,000 μg of copper for 14–50-year-old pregnant females; furthermore, 1,300 μg of copper for 14–50-year-old lactating females. • Food Sources: Liver, meat, sea food, whole grain, legumes, nuts, cocoa, raisins food, cooked in copper utensils.
  44. 44. •Trace Mineral: Manganese (Mine) •Clinical Applications: No clinical deficiency observed in humans. Inhalation toxicity in minors. Role found in Neurological disorders, Childhood developmental disorders, Neurodegenerative diseases. •Requirements: 2.5 to 7mg estimated. Diet provides 3- 9 mg. •Food Sources: Cereals, whole grains, soybean, legumes, nut, tea, coffee, vegetable, fruits supplied by preformed vitamin B12
  45. 45. •Trace Mineral: Zinc (Zn) •Clinical Applications: Possible relation to liver disease, wound healing, taste and smell acuity, retard sexual, and physical development •Requirements: Adults 15mg, children 10mg, infants 3-5mg. •Food Sources: widely distributed in liver, sea food especially oyster, eggs, milk, whole grains.
  46. 46. • Trace Mineral: Molybdenum (Mo) • Clinical Applications: Growth: children, Pregnant & Lactating women’s. • Requirements: 2 micrograms (μg) of molybdenum per day was established for: 1. Infants up to 6 months of age, and 3 μg/day from 7 to 12 months of age, both for males and females. 2. For older children and adults, the following daily RDAs have been established for molybdenum: 17 μg from 1 to 3 years of age, 22 μg from 4 to 8 years, 34 μg from 9 to 13 years, 43 μg from 14 to 18 years, and 45 μg for persons 19 years old and older. 3. Pregnant or lactating females from 14 to 50 years of age have a higher daily RDA of 50 μg of molybdenum • Food Sources: Milk. Organ meats, whole grain, leafy vegetables.
  47. 47. •Trace Minerals : Fluorine (Fl) •Clinical Applications: Small amount prevents dental caries, Excess causes endemic dental fluorosis. •Requirements: 1-3 mg (estimated) •Food Sources: Water.
  48. 48. •Trace Minerals : Selenium (Se) •Clinical Applications: Constituent of factor III, which act with vitamin E to prevent fatty liver. •Requirements: Under 10mg (estimated). •Food Sources: Sea foods, meat, whole grains.
  49. 49. •Trace Minerals: Chromium (Cr) •Clinical Applications: Infants unable to metabolize sugar and adult diabetes shows definite improvement when small amounts of chromium added to diet possible link with cardiovascular disorder and diabetes. •Requirements: 20-50mg (estimated) •Food Sources: Animal proteins, especially meat, except fish, whole grains.
  50. 50. • Trace Minerals: Iron (Fe) • Clinical Applications: Growth (Anemia, pregnancy demands, iron deficiency, Hemosiderosis, Hemochromatosis.) • Requirements: Man: 10mg, Women 18+mg, Lactation 18mg, Children 10-18mg. • Food Sources: Liver, meats, Egg yolk, grains, enriched bread, dark green vegetables, legume, nuts and cereals.
  51. 51. Immunosuppressants Mr. Dipti Sorte
  52. 52. Introduction •These drugs suppress or reduce the strength of body’s immune system. •They are also called as Anti-rejection drugs. •One of the primary uses of immunosuppressant drug is to lower the body’s ability to reject a transplanted organ such as liver, heart, kidney.
  53. 53. Mechanism of action • Their action are different according to their four categories: 1. Azathioprine suppresses cell-mediated immunity and alters antibody formation. 2. Cyclosporin inhibit proliferation and function of T – Lymphocytes. 3. Monoclonal antibodies which includes Basiliximab, and Muromonab blocks T cell functions. 4. Corticosteroids (Prednisolone) inhibits macrophage formation and hinders migration of macrophage and leukocytes to inflamed areas.
  54. 54. Drug Examples and Doses S. No Drugs Doses 1 Azathioprine 1mg/kg (50-100mg) PO IV per day in divided doses max. dose 2.5mg/kg PO /IV per day. 2 Cyclosporine 10-15 mg/kg/day with milk 3 Daclizumab 0.1 mg/kg 4 Muromonab 5mg ID OD 5 Basiliximab 10-20mg 6 Prednisolone 5-60 mg per day in divided doses 1-4 times/day.
  55. 55. Indication / uses •Treatment of autoimmune disorders such as psoriasis, rheumatoid arthritis, crohn’s disease, multiple sclerosis, alopecia areata (Pathy hair loss). •Used to prevent rejection of organ transplantation. •Prednisolone is used for its anti-inflammatory or immunosuppressive actions.
  56. 56. Contraindications / precautions. •Bone marrow depression. •Infections, Cancer. •Impaired liver or kidney functions (Cautiously used). •Contraindicated in patient with a hypersensitivity to polysorbate – 80. •Use all immunosuppressive cautiously in pregnant and breast feeding women.
  57. 57. Adverse Effect • Peptic ulcer. • Increased Sr. glucose level. • Nausea / vomiting. • Anorexia. • Hepatotoxicity. • Fever & Chills. • Electrolyte change. • Tremors. • Weight gains. • Edema. • Mood swings. • Diarrhea. • Leukopenia. • Thrombocytopenia. • GI Disorders. • Nephrotoxicity. • Dyspnea. • Flu like symptoms.
  58. 58. Drug Interactions •Concurrent use of cyclosporine with other nephrotoxic drugs causes additive nephrotoxicity. •Ketoconazole and cimetidine increase the risk of toxicity from cyclosporine. •Allopurinol increases the risk of toxicity. From azathioprine.
  59. 59. Nursing Responsibilities • Nurse should monitor for adverse effect, toxicity and signs, symptoms of injection. • Nurse should monitor and maintain intake and output chart. • Should instruct patient to report unusual bleeding or signs & symptoms of infection or transplant rejection. • Nurse should inform the patient about potential teratogenic effect of these drugs during pregnancy and urge the patient to use contraception. • Nurse should the patient about the importance of life long compliance with immunosuppressive therapy to prevent organ transplant rejection. • Assess the for sign and symptoms of infection, such as fever, tachycardia, malaise redness and inflammation.
  60. 60. Antidotes •A Drug that counteracts the effects of a poison or overdosage by another drug.
  61. 61. Specific Poisoning & Antidote S. No. Poisoning Antidotes 1 Paracetamol N-Acetylcyteine 2 Morphine Naloxone 3 Heparin Protamine sulphate 4 Warfarin Vit. K + Fresh blood 5 Insulin Oral glucose / Fruit juice 6 Aspirin (Salicylate) Vit. K+NaHco3+Furosemide 7 Neostigmine bromide Atropine sulphate 8 Atropine Neostigmine / physostigmine.
  62. 62. S. No. Poisoning Antidotes 9 Lead Calcium – di – sodium 10 Iron Dimercaprol 11 Arsenic Dimercaprol 12 Copper D – Penicillamine 13 Mushroom poisoning Atropine 14 Organophosphorus poisoning Atropine sulphate 15 Iodine Sodium thiosulphate 16 Magnesium Sulphate Inj. Calcium gluconate 10% IV.
  63. 63. Antivenom •Separately discussed
  64. 64. Vaccines & Sera •A vaccine is a biological preparation which provides active acquired immunity to a particular disease. Vaccine contain an antigen that stimulates the immune mechanism of the body to produces antibodies against some specific disease or infection.
  65. 65. Types • These are several types of vaccine: 1. Inactivated (Killed): Vaccine contain inactivated but previously virulent. Eg. Cholera, Influenza plague, polio, hepatitis A etc. 2. Attenuated: Vaccines contain live attenuate micro-organism, some are active viruses that have been cultivated under condition that liable their virulent nature, or that use closely related but less dangerous organism to produce a broad immune response EG. Yellow fever, measles, mumps, typhoid. 3. Toxoid: These are made from inactivated toxic compounds that causes illness rather than microorganism, Eg. Tetanus, Diphtheria.
  66. 66. 1. Tetanus Vaccine. • Type: Toxoid • Dose: 0.5 ml. • Route: I.M. • Immunization: Three dose at 6 weeks interval. • Booster Dose: At 5yrs. interval. 2. Cholera Vaccine. • Type: Killed inactivated • Dose: 0.5 ml.. • Route: I.M./SC. • Immunization: 2doses, 2nd dose 1ml @ 1-2 week intervals. • Booster Dose: 6 monthly. 3. DPT Vaccine. • Type: Mixed toxoid + killed • Dose: 0.5 ml. • Route: I.M. • Immunization: 2doses @ 4-8 weeks interval between 3-9 months of age. • Booster Dose: 1dose @ 18months old.
  67. 67. 4. Poliomyelitis Vaccine. • Type: Inactivated • Dose: 1ml. • Route: Subcutaneous. • Immunization: 3doses @ 4-6 weeks intervals. • Booster Dose: Every 5 Yr.. 5. Plague Vaccine. •Type: Killed •Dose: 1ml. •Route: I.M. •Immunization: 2doses @ 2-4 weeks intervals. •Booster Dose: Nil. 6. BCG (Bacillus, Calmette, Guerin) Vaccine. • Type: Live attenuated • Dose: 0.5ml to 1ml. • Route: I.D. • Immunization: Single dose at birth. • Booster Dose: Nil.
  68. 68. 7. Typhoid, Paratyphoid Vaccine. • Type: Killed inactivated • Dose: 0.5ml. • Route: SC. • Immunization: 3doses @ 2-4 weeks interval. • Booster Dose: Every 1-2 yrs. 8. Influenza Vaccine. •Type: Inactivated •Dose: 0.5ml. •Route: I.M. •Immunization: 2doses @ 1-2 months interval. •Booster Dose: Nil. 9. MMR Vaccine. •Type: Live attenuated •Dose: 0.5,ml. •Route: SC/I.M. •Immunization: Single dose in 1- 5 yr. child. •Booster Dose: Nil.
  69. 69. 10. Yellow fever Vaccine. •Type: Live attenuated •Dose: 0.5 ml. •Route: SC. •Immunization: Single dose. •Booster Dose: After 10 yr. of age.
  70. 70. Adverse Effects •Vaccination given during childhood are generally safe, some potential side effects are: 1. Fever. 2. Pain around injective site. 3. Muscle aches.
  71. 71. Nursing Responsibilities •Vaccine should be kept in refrigerator at 2-8⁰ C. otherwise they may become inactive. •Immunization is contraindicated in acute illness. •Live vaccine should not be given to those who have reduced immunity due to prolonged usage of corticosteroids or cytotoxic drugs. •Immunization is also contraindicated in pregnancy, unless and until it is very necessary.
  72. 72. Sera •Sera contain immunoglobulins (Antibodies) against some particular infection or disease. They are used to produce passive immunity against some specific disease / infection.
  73. 73. Drug examples and doses S. No. Drugs Doses 1 Diphtheria Antitoxin (Anti diphtheric ADS) 10,000 IU or IV 2 Tetanus antitoxin 500 IU, IM 3 Anti-rabies Serum (ARS) 1,000 IU by injection. 4 Hepatitis B Immunoglobulin 1,000-2,000 IU. 5 Anti-snake venom 0.6 mg of standard cobra. 0.6 mg of standard russel’s viper. 0.45 mg of standard Sawscalded viper. 0.45 mg of standard krait. 20ml IV (1ml/min. inj. Repeated at 1-6 hrly intervals till symptoms disappear.
  74. 74. Indication & Uses • ADS used therapeutically in clinical diphtheria without waiting for bacteriological report. • Tetanus Antitoxin used for prophylaxis in non immunized person’s receiving a contaminated wound who are high risk of developing tetanus. • ARS is indicated after suspected exposure and non- immunized person. • Hepatitis B indicated in persons acutely exposed to HBs Ag positive blood or blood products.
  75. 75. Adverse Effects •Allergic Reactions. •Anaphylactic shock.
  76. 76. Nursing Responsibilities • Nurse should be done sensitivity test before administration serum. • Adrenaline may be infected SC concurrently to reduce allergic reactions. • Antihistamine and corticosteroids may also be given prophylactically. • Sera should be kept in a refrigerator at 2-8⁰ C, otherwise they may become inactive.
  77. 77. References 1. Dr. P.K. Panwar, Essentials of pharmacology for nurses, AITBS pub. 2017, India, Pg no. 71 – 84. 2. Dr. Suresh k sharma, Textbook of pharmacology, pathology & genetics for nurses, Jaypee pub. 2016 India Pg no 227 – 250. 3. Tara v. Shanbhag, Smita shenoy, Pharmacology preparation manual for undergraduate, Elsevier pub. 2014. Pg no. 482, 488, 492 – 495. 4. Marilyn Herbert – Ashton, Nancy Clarkson, Pharmacology, Jones & Barlet pub 2010 India, Pg no 619-625. 5. Govind s. mittal, Pharmacology at a glance, Paras medical book pub. 2009 India 57 – 59. 6. Madhuri Inamdar, Pharmacology in nursing, Vora medical pub. 2006 India 1st edition, Pg no 210 – 216.
  78. 78. Thanks