Syllabus • Drugs used in deaddiction
• Drugs used in CPR & emergency
• Vitamins and minerals
• Vaccines and Sera
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
•300mg as a single dose on the 1st
day of treatment, reduce dose by
200 mg daily, maintenance 100
– 200 mg daily.
•Precautional use in case of pregnancy or breast
•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
Instruction to use Disulfiram
•Disulfiram may be taken with or without food.
•It may be swallowed whole, chewed or crushed and mixed
•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.
Important safety information
•It may cause drowsiness, do not drive or
•Avoid all alcohol including found in
sauces, vinegar, mouth wash, liquid
medicines, lotion after shave or back rub
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
• 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.
• Start IV (Intravenous) lines for administration of resuscitation
• Catheterization should be maintain.
Medications used in CPR (commonly)
• Epinephrine (Adrenaline)
Action: It increase systemic vascular resistance and blood pressure.
Action: It blocks parasympathetic action, increases SA node
automaticity and AV condition.
• Sodium Bicarbonate:
Action: Corrects metabolic acidosis.
Action: Increase inotropic action (contraction ) of heart.
•Dose: 0.5 ml to
slowly or I.V.
I.M or I.V.
•Dose: 0.2 to
25. Inj. Soda-
meq. 7.4% soln.
27. Inj. Vit. K.
time in liver
disease, To stop
28. Inj. Dextrose
• Route: IV.
• Dose: 5 pints a
day. But depend
on age group and
29. Inj. Normal
loss of sodium and
• Route: SC/IV.
• Dose: 5 pints a day.
But depend on age
group and condition.
30. Inj. Ringer
specially due to
loss of blood and
• Route: IV
• Dose: 5 pints a
day. But depend on
age group and
shock due to
blood or plasm
•Dose: Depend on
age group and
•Dose: 100cc or
Depend on age
•Vitamins: Folic Acid (Vit. B9)
•Clinical Applications: Blood cell regeneration in
pernicious anemia but not controls of its
•Requirements: 400mg, 800mg, in pregnancy.
•Food Sources: Liver, Green leafy vegetables,
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,
•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
•Food Sources: Green leafy vegetables, fruit, egg yolk,
butter, red cabbage.
•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
•Vitamins: Vitamin E (Tocopherol)
•Clinical Applications: Hemolysis of RBC,
Anemia, Possible protection of unsaturated fatty
•Requirements: Adult 8-10mg, Pregnancy and
Lactation: 10-11mg, children: 3-10 mg
•Food Sources: Vegetable oils.
• 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
Summary of Major Minerals
•Mineral: Calcium (Ca)
•Clinical Applications: Tetany – Decreased in ionized
serum calcium, Rickets, Renal Calculi,
•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.
• 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,
• Requirements: Adults half times calcium intake pregnancy
& Lactation: 1to2 gm, Infants 240-400 mg, Children 0.8 to
• Food Sources: Milk cheese, meat, whole grains, egg yolk,
•Mineral: Magnesium (Mg)
•Clinical Applications: Tremors, spasm, low
serum level following gastrointestinal loses.
•Requirements: 300-350mg deficiency in human
•Food Sources: whole grains, nuts, meat, milk,
•Mineral: Sodium (Na)
•Clinical Applications: Fluid shift and control
buffer system, losses in G.I. disorders.
•Requirements: About 0.5 gm diet usually has
•Food Sources: Table salt (Na cl), milk, meat,
egg. Baking soda, baking powder, carrots, beet,
•Mineral: Chlorine (Cl)
•Clinical Applications: Hyperchloremic
alkalosis in prolonged vomiting, diarrhea.
•Requirements: About 0.5 gm usually has
•Food Sources: Table salt.
•Minerals: Sulphur (S)
•Clinical Applications: Cystine, renal calculi,
•Requirements: Diet adequate in protein contains
•Food Sources: Meat, Egg, Cheese, nuts,
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.
•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-
•Food Sources: Cereals, whole grains, soybean,
legumes, nut, tea, coffee, vegetable, fruits supplied by
preformed vitamin B12
•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,
•Food Sources: widely distributed in liver, sea
food especially oyster, eggs, milk, whole grains.
• Trace Mineral: Molybdenum (Mo)
• Clinical Applications: Growth: children, Pregnant & Lactating
• Requirements: 2 micrograms (μg) of molybdenum per day was
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.
•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
•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.
• Trace Minerals: Iron (Fe)
• Clinical Applications: Growth (Anemia, pregnancy
demands, iron deficiency, Hemosiderosis,
• 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
•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.
Mechanism of action
• Their action are different according to their four categories:
1. Azathioprine suppresses cell-mediated immunity and alters
2. Cyclosporin inhibit proliferation and function of T –
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.
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.
Indication / uses
•Treatment of autoimmune disorders such as
psoriasis, rheumatoid arthritis, crohn’s disease,
multiple sclerosis, alopecia areata (Pathy hair
•Used to prevent rejection of organ
•Prednisolone is used for its anti-inflammatory or
Contraindications / precautions.
•Bone marrow depression.
•Impaired liver or kidney functions (Cautiously
•Contraindicated in patient with a hypersensitivity
to polysorbate – 80.
•Use all immunosuppressive cautiously in
pregnant and breast feeding women.
•Concurrent use of cyclosporine with other
nephrotoxic drugs causes additive
•Ketoconazole and cimetidine increase the
risk of toxicity from cyclosporine.
•Allopurinol increases the risk of toxicity.
• 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
• Nurse should the patient about the importance of life long
compliance with immunosuppressive therapy to prevent organ
• Assess the for sign and symptoms of infection, such as fever,
tachycardia, malaise redness and inflammation.
•A Drug that counteracts
the effects of a poison or
overdosage by another
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.
S. No. Poisoning Antidotes
9 Lead Calcium – di – sodium
10 Iron Dimercaprol
11 Arsenic Dimercaprol
12 Copper D – Penicillamine
13 Mushroom poisoning Atropine
15 Iodine Sodium thiosulphate
16 Magnesium Sulphate Inj. Calcium gluconate 10% IV.
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
• 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,
10. Yellow fever
•Dose: 0.5 ml.
After 10 yr. of
•Vaccination given during childhood are
generally safe, some potential side effects
2. Pain around injective site.
3. Muscle aches.
•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.
•Sera contain immunoglobulins
(Antibodies) against some
particular infection or disease.
They are used to produce passive
immunity against some specific
disease / infection.
Drug examples and doses
S. No. Drugs Doses
1 Diphtheria Antitoxin (Anti
10,000 IU or IV
2 Tetanus antitoxin 500 IU, IM
3 Anti-rabies Serum (ARS) 1,000 IU by injection.
4 Hepatitis B
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.
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-
• Hepatitis B indicated in persons acutely exposed to
HBs Ag positive blood or blood products.
• Nurse should be done sensitivity test before
• Adrenaline may be infected SC concurrently to reduce
• Antihistamine and corticosteroids may also be given
• Sera should be kept in a refrigerator at 2-8⁰ C,
otherwise they may become inactive.
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.