UNIT 5 Miscellaneous
Deaddiction therapy involves pharmacological and psychological interventions to help individuals recover from substance use disorders (SUDs). Various drugs are used to reduce cravings, prevent withdrawal symptoms, and block the effects of addictive substances.
1️⃣ Disulfiram (Antabuse)
2️⃣ Naltrexone
3️⃣ Acamprosate
1️⃣ Methadone
2️⃣ Buprenorphine
3️⃣ Naltrexone
4️⃣ Naloxone (For Opioid Overdose Reversal)
1️⃣ Nicotine Replacement Therapy (NRT)
2️⃣ Bupropion (Zyban)
3️⃣ Varenicline (Chantix)
1️⃣ Modafinil
2️⃣ Topiramate
1️⃣ N-Acetylcysteine (NAC)
2️⃣ Gabapentin
❌ Liver Disease: Naltrexone, Disulfiram (Hepatotoxicity)
❌ Cardiac Disease: Disulfiram (Risk of arrhythmia, hypertension)
❌ Severe Psychiatric Disorders: Varenicline, Bupropion (Suicidal ideation risk)
❌ Respiratory Depression: Methadone, Buprenorphine (Can worsen breathing issues)
👩⚕️ Pre-Treatment Assessment
✔ Assess substance use history (Duration, Type, Frequency)
✔ Evaluate withdrawal symptoms (COWS for Opioids, CIWA for Alcohol)
✔ Monitor for comorbid psychiatric illnesses (Depression, Anxiety, Psychosis)
✔ Obtain LFTs, RFTs, ECG (Before starting drugs like Disulfiram, Methadone, Naltrexone)
💉 Administration Guidelines
✔ Naltrexone IM injection should only be given if the patient is opioid-free for 7-10 days.
✔ Disulfiram must be given under supervision, and alcohol avoidance must be ensured.
✔ Methadone & Buprenorphine should be started under close monitoring (Risk of overdose).
🩺 Monitoring During Treatment
✔ Observe for signs of overdose or withdrawal (Respiratory depression, Seizures, Anxiety, Hallucinations).
✔ Monitor liver function (AST, ALT) in patients on Disulfiram, Naltrexone, Acamprosate.
✔ Check BP and ECG in Methadone therapy to avoid cardiac toxicity.
📢 Patient Education
✔ Educate about lifestyle modifications and behavioral therapies (Cognitive Behavioral Therapy – CBT, Motivational Enhancement Therapy – MET).
✔ Inform about support groups (Alcoholics Anonymous, Narcotics Anonymous).
✔ Advise family involvement for better outcomes.
Cardiopulmonary Resuscitation (CPR) and emergency management involve the use of critical life-saving drugs to support circulation, respiration, and stabilize cardiac function during medical emergencies.
🔹 Key Conditions Requiring Emergency Drugs in CPR:
✔ Cardiac Arrest (VF, VT, Asystole, PEA)
✔ Anaphylaxis (Severe Allergic Reaction)
✔ Bradycardia & Hypotension
✔ Shock (Cardiogenic, Septic, Hypovolemic)
✔ Severe Asthma or Respiratory Distress
🚨 First-line Drug in CPR, Anaphylaxis, and Severe Shock
✅ Alpha-1 Receptor Activation → Vasoconstriction (↑ BP, ↑ Coronary & Cerebral Perfusion)
✅ Beta-1 Receptor Activation → Increased Heart Rate & Cardiac Output
✅ Beta-2 Receptor Activation → Bronchodilation (For Asthma, Anaphylaxis)
| Indication | Dose | Route |
|---|---|---|
| Cardiac Arrest (VF, VT, Asystole, PEA) | 1 mg every 3-5 minutes | IV/IO (1:10,000 dilution) |
| Anaphylaxis | 0.3-0.5 mg every 5-15 minutes | IM (1:1000 dilution) |
| Severe Bradycardia/Hypotension | 2-10 mcg/min | IV infusion |
| Severe Asthma Attack | 0.3-0.5 mg | SC/IM (1:1000 dilution) |
🔹 Note: Endotracheal (ET) Route (if no IV access): 2-2.5 mg diluted in 10 mL NS
✔ Cardiac Arrest (VF, Pulseless VT, PEA, Asystole)
✔ Severe Anaphylaxis (Life-threatening allergic reaction)
✔ Severe Hypotension (Shock, Cardiac arrest, Sepsis)
✔ Severe Bronchospasm (Acute Asthma attack, Anaphylaxis)
❌ Uncontrolled Hypertension
❌ Arrhythmias (SVT, AF, VT with pulse in stable patient)
❌ Narrow-Angle Glaucoma (Increased IOP)
❌ Peripheral Vascular Disease (Risk of tissue necrosis)
⚠ Cardiac Effects: Tachycardia, Palpitations, Hypertension
⚠ Neurological Effects: Anxiety, Tremors, Headache
⚠ Local Effects: Tissue necrosis (If extravasated)
🚨 Signs of Adrenaline Overdose:
| Drug | Class | Indications | Dosage & Route |
|---|---|---|---|
| Amiodarone | Antiarrhythmic | Refractory VT, VF (After defibrillation, Epinephrine) | 300 mg IV bolus (repeat 150 mg if needed) |
| Lidocaine | Antiarrhythmic | VT, VF (Alternative to Amiodarone) | 1-1.5 mg/kg IV bolus, then infusion |
| Atropine | Anticholinergic | Bradycardia (<50 bpm, symptomatic) | 0.5 mg IV every 3-5 min (Max 3 mg) |
| Dopamine | Vasopressor | Bradycardia, Hypotension (Alternative to Adrenaline in Shock) | 2-20 mcg/kg/min IV infusion |
| Dobutamine | Inotropic Agent | Cardiogenic Shock, Heart Failure | 2-20 mcg/kg/min IV infusion |
| Sodium Bicarbonate | Alkalizing Agent | Metabolic Acidosis, Hyperkalemia | 1 mEq/kg IV bolus |
| Calcium Gluconate | Electrolyte | Hyperkalemia, Calcium Channel Blocker Overdose | 1 g IV over 10 minutes |
| Magnesium Sulfate | Electrolyte | Torsades de Pointes, Eclampsia | 1-2 g IV over 10-15 minutes |
| Naloxone | Opioid Antagonist | Opioid Overdose (Respiratory Depression) | 0.4-2 mg IV every 2-3 min (Max 10 mg) |
| Glucose (Dextrose 50%) | Hyperglycemic Agent | Hypoglycemia (Emergency) | 25-50 mL IV push |
👩⚕️ Pre-Administration Check
✔ Ensure correct dilution & route before administering IV drugs.
✔ Monitor ECG, BP, HR, O₂ Saturation before and during drug administration.
✔ Secure IV access (Central line preferred for high-risk drugs).
💉 During Administration
✔ Give Adrenaline IV every 3-5 minutes in CPR (Flush with 20 mL NS).
✔ Monitor BP and HR continuously for Dopamine, Dobutamine, and Vasopressors.
✔ Use an IV pump for continuous infusion drugs (Amiodarone, Dopamine).
✔ Atropine must be given rapidly (Slow administration may cause paradoxical bradycardia).
🩺 Post-Administration Monitoring
✔ Check for Return of Spontaneous Circulation (ROSC) after Adrenaline use.
✔ Observe for arrhythmias (Common after CPR medications).
✔ Monitor blood gases (ABG) and electrolytes.
✔ Check for signs of extravasation (Tissue necrosis risk with Vasopressors).
📢 Patient Education (For Survived Patients)
✔ Explain post-CPR care, cardiac rehabilitation, and lifestyle changes.
✔ Educate about medication side effects (e.g., Adrenaline tachycardia, Amiodarone thyroid toxicity).
✔ Teach CPR techniques to family members.
✅ H₁ Receptor Blockade:
✅ CNS Depressant Action:
✅ Anticholinergic Effect:
✅ Mild Local Anesthetic Effect:
| Indication | Dose (Adults) | Dose (Children) | Route |
|---|---|---|---|
| Allergic Rhinitis, Urticaria | 4 mg every 6 hrs (Max: 24 mg/day) | 2 mg every 6-8 hrs | Oral |
| Anaphylaxis (With Adrenaline) | 10-20 mg IV/IM | 0.2 mg/kg IV/IM | IV, IM |
| Common Cold | 4 mg every 6-8 hrs | 2 mg every 6-8 hrs | Oral |
| Motion Sickness | 4 mg 30 minutes before travel | 2 mg before travel | Oral |
| Pruritus, Insect Bites | Apply as needed | Apply as needed | Topical |
🔹 Note: Elderly patients should receive lower doses due to sedation risk.
✔ Allergic Conditions: Allergic rhinitis, Urticaria, Hay fever, Drug reactions
✔ Cold & Flu: Relieves sneezing, nasal congestion (often in combination with other drugs)
✔ Anaphylaxis (Adjunct to Adrenaline): Used after epinephrine to prevent recurrence of symptoms
✔ Motion Sickness & Nausea: Prevents nausea and dizziness
✔ Itching & Skin Allergies: Used in insect bites, contact dermatitis
❌ Severe Asthma (May cause thickened mucus, worsening symptoms)
❌ Glaucoma (Increases intraocular pressure)
❌ Prostate Enlargement (BPH) (May worsen urinary retention)
❌ Severe Liver Disease (Metabolism may be impaired)
❌ Neonates (Risk of CNS depression, respiratory failure)
🚫 With CNS Depressants (Alcohol, Benzodiazepines, Opioids):
🚫 With Monoamine Oxidase Inhibitors (MAOIs – e.g., Selegiline):
🚫 With Anticholinergic Drugs (Atropine, Oxybutynin):
🚫 With Sedatives (Diazepam, Lorazepam):
⚠ Common Side Effects:
⚠ Rare Side Effects:
🚨 Severe Drowsiness & Coma (Overdose)
🚨 Respiratory Depression
🚨 Severe Hypotension
🚨 Seizures & Hallucinations
🚨 Signs of Overdose:
🔹 Management:
1️⃣ Stop the drug immediately
2️⃣ Activated Charcoal (If recent ingestion)
3️⃣ Supportive care (Oxygen, IV fluids, BP monitoring)
4️⃣ Physostigmine IV (For severe anticholinergic toxicity)
5️⃣ Benzodiazepines (For seizures)
👩⚕️ Before Administration:
✔ Assess for history of allergies, asthma, glaucoma, BPH.
✔ Check baseline BP, HR, and mental status.
💉 Administration Guidelines:
✔ Give with food to prevent nausea.
✔ If IV, give slowly to avoid hypotension.
✔ Advise patient to avoid alcohol & sedatives.
🩺 Monitoring:
✔ Monitor for excessive sedation (Especially in elderly & children).
✔ Check for dry mouth, urinary retention, and constipation.
✔ Observe for signs of anaphylaxis (If used in severe allergies).
📢 Patient Education:
✔ Avoid driving or operating machinery (Risk of drowsiness).
✔ Increase fluid intake to prevent dry mouth & constipation.
✔ Do not take with alcohol or sleeping pills.
✅ Glucocorticoid Action:
✅ Mineralocorticoid Action (Mild):
✅ Inhibits Cytokine Release:
| Indication | Dose (Adults) | Route |
|---|---|---|
| Acute Adrenal Insufficiency (Addisonian Crisis) | 100 mg IV bolus, then 50 mg every 6 hrs | IV |
| Severe Allergic Reactions/Anaphylaxis | 100-200 mg IV every 4-6 hrs | IV |
| Septic Shock (Adjuvant Therapy) | 50 mg IV every 6 hrs | IV |
| Chronic Adrenal Insufficiency | 15-25 mg/day | Oral |
| Asthma & COPD Exacerbations | 100 mg IV every 6 hrs | IV |
| Topical Use (Skin Inflammation, Eczema) | Apply thin layer 2-3 times/day | Topical |
🔹 Note: IV route is preferred in emergencies.
✔ Endocrine Disorders: Adrenal Insufficiency (Addison’s Disease, Congenital Adrenal Hyperplasia)
✔ Severe Allergic Reactions (Anaphylaxis, Drug Reactions, Angioedema)
✔ Inflammatory Conditions (Asthma, Rheumatoid Arthritis, Lupus, Crohn’s Disease, Ulcerative Colitis)
✔ Shock & Sepsis (Reduces inflammation in septic shock)
✔ Skin Conditions (Eczema, Psoriasis, Contact Dermatitis)
❌ Systemic Fungal Infections (May worsen)
❌ Active Tuberculosis (Suppresses immune response, worsens infection)
❌ Uncontrolled Diabetes (Increases blood sugar)
❌ Peptic Ulcer Disease (Increases gastric acid, may cause bleeding)
❌ Severe Hypertension & Heart Failure (Fluid retention risk)
🚫 With NSAIDs (Ibuprofen, Aspirin):
🚫 With Diuretics (Furosemide, Hydrochlorothiazide):
🚫 With Insulin & Oral Hypoglycemics:
🚫 With Live Vaccines:
⚠ Short-Term Use:
⚠ Long-Term Use:
🚨 Adrenal Suppression & Crisis (If Stopped Suddenly)
🚨 Severe Hyperglycemia (Diabetic Ketoacidosis in Diabetes Patients)
🚨 Peptic Ulcer & GI Bleeding (If Used with NSAIDs)
🚨 Severe Infections (Due to Immunosuppression)
🚨 Signs of Hydrocortisone Overdose:
🔹 Management:
1️⃣ Taper dose gradually (Do NOT stop abruptly!)
2️⃣ Control blood sugar & BP
3️⃣ Calcium & Vitamin D supplements (To prevent osteoporosis)
👩⚕️ Before Administration:
✔ Check BP, Blood Sugar, Electrolytes.
✔ Monitor signs of infection (Fever, Weakness).
✔ Avoid live vaccines during therapy.
💉 During Administration:
✔ Give IV slowly over 1-2 minutes (Avoid rapid infusion).
✔ Monitor blood pressure & blood sugar regularly.
📢 Patient Education:
✔ DO NOT stop suddenly (Risk of adrenal crisis).
✔ Monitor for weight gain, swelling, high BP.
✔ Avoid crowded places (Risk of infections).
✅ Anti-Inflammatory & Immunosuppressive Action:
✅ Prevents Cerebral Edema (Brain Swelling):
✅ Long-Acting Glucocorticoid:
| Indication | Dose | Route |
|---|---|---|
| Cerebral Edema (Brain Swelling) | 4-8 mg IV every 6 hrs | IV |
| Severe Asthma, COPD Exacerbation | 4-8 mg IV every 6-12 hrs | IV, IM |
| COVID-19 (Severe Cases) | 6 mg IV/Oral daily for 10 days | IV, Oral |
| Chemotherapy-Induced Nausea (Anti-Emetic Use) | 8 mg IV before chemotherapy | IV |
🔹 Note: IV route is preferred in emergencies.
✔ Cerebral Edema (Brain Swelling, Head Injury, Meningitis, Stroke)
✔ Severe Allergic Reactions & Anaphylaxis
✔ Severe COVID-19 (Reduces lung inflammation)
✔ Cancer Chemotherapy (Prevents nausea & vomiting)
✔ Autoimmune Diseases (Lupus, Rheumatoid Arthritis, Multiple Sclerosis)
⚠ Similar to Hydrocortisone but More Potent & Long-Lasting
🚨 Severe Adverse Effects:
Intravenous (IV) fluids are essential for fluid resuscitation, electrolyte balance, and drug administration in various medical conditions.
1️⃣ Crystalloids (Mainly Used for Volume Replacement & Hydration)
2️⃣ Colloids (Used in Shock & Severe Fluid Loss)
3️⃣ Electrolyte Replacements (Used for Specific Deficiencies)
✔ Contain water and dissolved salts (electrolytes)
✔ Used for fluid replacement, hydration, and electrolyte balance
✔ Composition: Sodium Chloride (NaCl: 154 mEq/L)
✔ Osmolarity: Isotonic (308 mOsm/L)
✅ Uses:
🚨 Contraindications:
💉 Dosage: 500-1000 mL IV over 1-2 hrs (Adjust as per need)
⚠ Side Effects: Fluid overload, Hypernatremia, Edema
✔ Composition: Sodium (130 mEq/L), Potassium (4 mEq/L), Calcium (3 mEq/L), Lactate (28 mEq/L)
✔ Osmolarity: Isotonic (273 mOsm/L)
✅ Uses:
🚨 Contraindications:
💉 Dosage: 500-1000 mL IV as needed
⚠ Side Effects: Hyperkalemia, Metabolic alkalosis
✔ Types:
✅ Uses:
🚨 Contraindications:
💉 Dosage: 500-1000 mL IV over 2-4 hrs
⚠ Side Effects: Hyperglycemia, Fluid overload
✔ Composition: Sodium Chloride (77 mEq/L Na+ and Cl−)
✔ Osmolarity: Hypotonic (154 mOsm/L)
✅ Uses:
🚨 Contraindications:
💉 Dosage: 500-1000 mL IV as per need
⚠ Side Effects: Hyponatremia, Confusion
✔ Contain large molecules (proteins or starches)
✔ Used for volume expansion in severe fluid loss
✔ Composition: Human albumin protein
✔ Osmolarity: Isotonic (5%) or Hypertonic (25%)
✅ Uses:
🚨 Contraindications:
💉 Dosage: 5% Albumin: 500 mL IV over 1-2 hrs
⚠ Side Effects: Allergic reactions, Pulmonary edema
✔ Synthetic plasma volume expander
✔ Used in hypovolemia (Alternative to albumin)
✅ Uses:
🚨 Contraindications:
💉 Dosage: 500-1000 mL IV over 4-6 hrs
⚠ Side Effects: Coagulopathy, Kidney damage
✔ Used to correct imbalances in sodium, potassium, calcium, and magnesium
✔ Use: Metabolic Acidosis, Hyperkalemia
✔ Dose: 1 mEq/kg IV over 10-15 min
✔ Side Effects: Metabolic alkalosis, Hypernatremia
✔ Use: Hypokalemia (Low potassium levels)
✔ Dose: 10-20 mEq IV over 1-2 hrs (NEVER rapid IV push)
✔ Side Effects: Cardiac arrhythmias, Phlebitis
🚨 High Alert: Rapid infusion can cause cardiac arrest
✔ Use: Hypocalcemia, Hyperkalemia, Calcium Channel Blocker Toxicity
✔ Dose: 1 g IV over 10 min
✔ Side Effects: Arrhythmias, IV irritation
✔ Use: Hypomagnesemia, Eclampsia, Torsades de Pointes
✔ Dose: 1-2 g IV over 10-15 min
✔ Side Effects: Respiratory depression, Bradycardia
👩⚕️ Pre-Administration Check:
✔ Assess fluid status, BP, electrolytes, and kidney function.
✔ Check IV site patency & infusion rate.
✔ Monitor for signs of overload (Edema, High BP, Crackles in lungs).
💉 During Administration:
✔ Use IV infusion pump for potassium & hypertonic fluids.
✔ NEVER give potassium IV push (Risk of cardiac arrest).
✔ Monitor urine output (Should be >30 mL/hr in fluid therapy).
🩺 Monitoring:
✔ Check for IV site phlebitis, extravasation, or infections.
✔ Watch for electrolyte imbalances (Arrhythmias, Confusion, Weakness).
✔ Observe for fluid overload symptoms (Dyspnea, Edema, Crackles on auscultation).
📢 Patient Education:
✔ Encourage oral fluids if possible (For mild dehydration).
✔ Avoid excessive sodium intake in hypertensive patients.
✔ Report symptoms of numbness, tingling, or weakness (Sign of electrolyte imbalance).
Poisoning occurs when a toxic substance enters the body through ingestion, inhalation, injection, or skin contact. Immediate medical intervention is critical to prevent life-threatening complications.
🔹 Types of Poisons:
✔ Household Chemicals (Pesticides, Detergents, Acids, Alkalis)
✔ Pharmaceutical Overdose (Sedatives, Opioids, NSAIDs, Paracetamol)
✔ Heavy Metals (Lead, Arsenic, Mercury)
✔ Alcohol & Drugs (Methanol, Ethanol, Cocaine, Amphetamines)
✔ Plant & Animal Toxins (Snake Venom, Mushroom Poisoning, Food Toxins)
1️⃣ Stabilization:
2️⃣ Decontamination:
3️⃣ Antidotes:
4️⃣ Supportive Therapy:
| Poison | Symptoms | Antidote / Treatment |
|---|---|---|
| Paracetamol Overdose | Nausea, Liver Damage | N-Acetylcysteine (NAC) IV |
| Opioids (Morphine, Heroin) | Respiratory Depression, Coma | Naloxone IV |
| Benzodiazepines (Diazepam, Lorazepam) | Drowsiness, Respiratory Depression | Flumazenil IV |
| Organophosphates (Pesticides) | Salivation, Sweating, Seizures | Atropine IV + Pralidoxime |
| Methanol & Ethylene Glycol | Blindness, Metabolic Acidosis | Fomepizole, Ethanol IV |
| Cyanide Poisoning | Hypoxia, Seizures | Sodium Thiosulfate, Hydroxocobalamin |
| Iron Poisoning | Vomiting, Bloody Diarrhea | Deferoxamine IV |
| Snake Bite (Neurotoxic) | Paralysis, Respiratory Arrest | Anti-Snake Venom (ASV) |
| Carbon Monoxide Poisoning | Cherry-red Skin, Hypoxia | 100% Oxygen, Hyperbaric Therapy |
| Lead Poisoning | Anemia, CNS Symptoms | EDTA, Dimercaprol (BAL), DMSA |
🔹 Note: Activated Charcoal is effective for many oral poisonings if given early.
🚨 First-line treatment for many ingested poisons
| Age Group | Dose | Route |
|---|---|---|
| Adults | 50-100 g (Single Dose) | Oral / NG Tube |
| Children (1-12 yrs) | 25-50 g | Oral / NG Tube |
| Infants (<1 yr) | 1 g/kg | Oral |
🔹 Multiple-Dose Activated Charcoal (MDAC):
✔ Drug Overdose (Aspirin, Paracetamol, Tricyclic Antidepressants, Theophylline, Barbiturates, NSAIDs, Digoxin, Beta-blockers)
✔ Toxic Plant or Food Ingestion
✔ Heavy Metals (In combination with other chelating agents)
🚨 Not Effective For:
❌ Unprotected Airway (Risk of Aspiration, Unconscious Patient)
❌ Caustic Poisoning (Burns Esophagus, Worsens Injury)
❌ Intestinal Obstruction (Can cause blockage)
❌ Gastrointestinal Bleeding or Perforation
⚠ Common Side Effects:
🚨 Serious Risks:
👩⚕️ Initial Assessment:
✔ Identify the Poison (History, Symptoms, Timing, Dose)
✔ Check Vital Signs (BP, HR, RR, Oxygen Saturation, Consciousness Level)
✔ Order Lab Tests (Serum Drug Levels, ABG, Electrolytes, Liver/Kidney Function Tests)
💉 Administration of Activated Charcoal:
✔ Ensure Airway Patency (Intubate if needed before giving charcoal)
✔ Shake the suspension well before administration
✔ Give via Oral or NG tube (If unconscious, use NG tube)
✔ Monitor for Vomiting (Risk of Aspiration in unconscious patients)
🩺 Monitoring & Supportive Care:
✔ Watch for Seizures (If neurotoxic poison is suspected)
✔ Monitor for Arrhythmias (With Cardiotoxic Drugs like Digoxin, Beta-Blockers, Tricyclic Antidepressants)
✔ Check Urine Output (For nephrotoxic poisons like Ethylene Glycol, Heavy Metals)
📢 Patient Education & Prevention:
✔ Educate on Safe Storage of Household Chemicals & Medications
✔ Advise Against Self-Medication (Especially Painkillers & Sedatives)
✔ Inform about Poison Control Helplines
🚨 Ipecac syrup was traditionally used for inducing vomiting in poisoning cases but is now rarely recommended due to the risk of aspiration and delayed treatment effectiveness.
✅ Emetic Action:
✅ Central Action:
| Age Group | Dose | Route |
|---|---|---|
| Adults | 15-30 mL (1-2 tbsp), followed by 1-2 glasses of water | Oral |
| Children (1-12 years) | 15 mL (1 tbsp), followed by water | Oral |
| Infants (6-12 months) | 5-10 mL | Oral |
🔹 Vomiting usually occurs within 20-30 minutes. If no vomiting, a second dose may be given after 20 minutes (max 2 doses).
✔ Oral Poisoning Cases (ONLY if immediate hospital care is unavailable)
✔ Drug Overdose (Certain cases where activated charcoal is not available)
✔ Accidental poisoning in remote settings (with medical advice)
🚨 Rarely Used Today!
🔹 Now replaced by activated charcoal and gastric lavage as the preferred methods.
🚫 NEVER use in corrosive poisoning (Acids, Alkalis, Bleach, Phenols) – Risk of esophageal burns & perforation
🚫 Petroleum & Hydrocarbon Poisoning (Kerosene, Gasoline, Paint Thinners) – Risk of aspiration pneumonitis
🚫 Altered Consciousness (Unconscious, Drowsy, Seizures) – Risk of aspiration
🚫 Poisoning with Rapid CNS Depressants (Opioids, Benzodiazepines, Alcohol, Barbiturates) – Vomiting can worsen airway obstruction
🚫 Ingested Poisons More than 1 Hour Ago – Most toxins are already absorbed, making ipecac ineffective
🚫 With Activated Charcoal:
🚫 With CNS Depressants (Opioids, Benzodiazepines, Alcohol):
🚫 With Cardiotoxic Drugs (Digoxin, Beta-blockers, Calcium Channel Blockers):
⚠ Common Side Effects:
🚨 Serious Side Effects:
🚨 Severe Toxicity (If Ipecac is overused or absorbed systemically):
🔹 Management of Ipecac Overdose:
1️⃣ Stop Ipecac Immediately!
2️⃣ Provide IV Fluids & Electrolyte Replacement
3️⃣ Administer Activated Charcoal (If Ipecac was ingested recently)
4️⃣ Treat Arrhythmias (If Emetine toxicity occurs, give Beta-blockers)
5️⃣ Oxygen & Ventilatory Support (If Aspiration occurs)
👩⚕️ Pre-Administration Check:
✔ Confirm time of poisoning (If >1 hour, Ipecac is NOT effective).
✔ Assess patient’s consciousness level (Do NOT give if unconscious).
✔ Identify type of poison (Ipecac is contraindicated in corrosives & hydrocarbons).
💉 Administration Guidelines:
✔ Give Ipecac on an empty stomach (For best emetic effect).
✔ Follow with 1-2 glasses of water to improve absorption.
✔ DO NOT give with activated charcoal (Reduces effectiveness).
🩺 Monitoring:
✔ Observe for onset of vomiting within 30 minutes.
✔ Monitor for aspiration symptoms (Coughing, Difficulty breathing, Cyanosis).
✔ Check hydration & electrolyte balance in repeated vomiting cases.
📢 Patient Education:
✔ Do NOT use Ipecac at home without medical advice.
✔ Activated charcoal is safer for poisoning treatment.
✔ Seek medical help IMMEDIATELY in case of poisoning.
An antidote is a substance that counteracts the effects of poisoning or overdose. Antidotes can work by neutralizing toxins, preventing absorption, enhancing elimination, or blocking toxic effects.
🔹 Types of Antidotes Based on Mechanism:
✔ Chemical Antidotes – Neutralize the poison (e.g., Sodium thiosulfate for Cyanide poisoning)
✔ Physiological Antidotes – Oppose the toxic effect (e.g., Atropine for Organophosphates)
✔ Pharmacological Antidotes – Compete at receptor sites (e.g., Naloxone for Opioids)
| Poison / Toxin | Symptoms | Antidote & Mechanism | Dosage & Route |
|---|---|---|---|
| Paracetamol (Acetaminophen) | Liver failure, Jaundice | N-Acetylcysteine (NAC) – Restores glutathione | IV: 150 mg/kg over 1 hr, then 50 mg/kg over 4 hrs, then 100 mg/kg over 16 hrs |
| Opioids (Morphine, Heroin, Fentanyl) | Respiratory depression, Pinpoint pupils, Coma | Naloxone – Opioid receptor antagonist | IV: 0.4-2 mg every 2-3 min (Max: 10 mg) |
| Benzodiazepines (Diazepam, Lorazepam, Alprazolam) | Drowsiness, Respiratory depression | Flumazenil – Benzodiazepine receptor antagonist | IV: 0.2 mg over 15 sec, repeat every 1 min (Max: 3 mg) |
| Organophosphates (Pesticides, Nerve Gas) | Salivation, Sweating, Seizures | Atropine & Pralidoxime (2-PAM) – Blocks muscarinic effects & reactivates acetylcholinesterase | Atropine IV: 1-2 mg every 5 min, Pralidoxime IV: 30 mg/kg over 30 min |
| Methanol & Ethylene Glycol (Antifreeze, Industrial Solvents) | Blindness, Metabolic acidosis | Fomepizole / Ethanol – Inhibits alcohol dehydrogenase | Fomepizole IV: 15 mg/kg, then 10 mg/kg every 12 hrs |
| Cyanide (Smoke inhalation, Industrial exposure) | Confusion, Seizures, Coma | Sodium Thiosulfate & Hydroxocobalamin | IV: 50 mL of 25% solution over 10 min |
| Carbon Monoxide (CO) | Cherry-red skin, Hypoxia | 100% Oxygen, Hyperbaric Therapy | Oxygen via non-rebreather mask or Hyperbaric chamber |
| Heavy Metals (Lead, Arsenic, Mercury, Iron) | Anemia, Neuropathy, Kidney failure | Dimercaprol (BAL), EDTA, Deferoxamine (For Iron) | Deferoxamine IV: 15 mg/kg/hr (Max: 6 g/day) |
| Snake Bite (Neurotoxic & Hemotoxic) | Paralysis, Bleeding, Shock | Anti-Snake Venom (ASV) | IV: 10 vials initially, repeat as needed |
| Beta-Blockers (Propranolol, Metoprolol, Atenolol) | Bradycardia, Hypotension | Glucagon – Increases heart rate & BP | IV: 5 mg over 5 min, then infusion 2-5 mg/hr |
| Calcium Channel Blockers (Amlodipine, Verapamil, Diltiazem) | Hypotension, AV Block | Calcium Gluconate, Insulin-Glucose | IV: 1-2 g Calcium Gluconate over 10 min |
| Warfarin & Rodenticides (Rat Poison) | Bleeding, Bruising | Vitamin K1 (Phytonadione) – Restores clotting factors | Oral/IV: 5-10 mg based on INR level |
| Heparin Overdose | Excessive bleeding | Protamine Sulfate | IV: 1 mg per 100 units of heparin (Max: 50 mg) |
| Digoxin Overdose | Nausea, Arrhythmias, Hyperkalemia | Digoxin-Specific Antibody (Digibind) | IV: Based on digoxin level |
| TCA Overdose (Tricyclic Antidepressants – Amitriptyline, Imipramine) | Seizures, Wide QRS, Arrhythmias | Sodium Bicarbonate – Alkalinizes blood to reduce toxicity | IV: 1 mEq/kg bolus, repeat as needed |
👩⚕️ Pre-Administration Assessment
✔ Identify poison type, route of exposure, time of ingestion
✔ Assess vital signs (BP, HR, RR, Oxygen saturation, Consciousness level)
✔ Check ECG, Electrolytes, Renal & Liver Function Tests
💉 During Administration
✔ Ensure correct antidote & dose based on patient weight & poison severity
✔ Give IV antidotes slowly (e.g., Calcium Gluconate, NAC, Atropine)
✔ Use infusion pump for controlled delivery (e.g., Naloxone, Fomepizole, Digibind)
🩺 Monitoring
✔ Observe for allergic reactions, infusion site reactions
✔ Monitor BP, ECG, Neurological status (Especially for CNS depressants & cardiac toxins)
✔ Check lab parameters (e.g., INR for Warfarin, Blood pH for Methanol poisoning, K+ for Digoxin toxicity)
📢 Patient Education
✔ Inform about safe storage of drugs & chemicals
✔ Explain the importance of medical follow-up after poisoning treatment
✔ Advise against self-medication in case of suspected overdose
Anti-Snake Venom (ASV) is the only specific treatment for snakebite envenomation. It is prepared using antibodies derived from hyperimmunized horses and neutralizes the toxic effects of snake venom.
🔹 Types of Snake Venom:
✔ Neurotoxic – Causes paralysis, respiratory failure (e.g., Cobra, Krait, Coral Snake)
✔ Hemotoxic – Causes bleeding, clotting disorders (e.g., Viper, Russell’s Viper)
✔ Cytotoxic – Causes tissue necrosis, gangrene (e.g., Pit Viper, Hump-Nosed Viper)
✔ Myotoxic – Causes muscle destruction, kidney failure (e.g., Sea Snake, Some Vipers)
🔹 Types of ASV:
1️⃣ Monovalent ASV – Neutralizes venom of a single species of snake
2️⃣ Polyvalent ASV – Neutralizes venom of multiple species of snakes (Common in India & other tropical countries)
| Snake Type | Dose (Adults & Children) | Route |
|---|---|---|
| Cobra, Krait, Russell’s Viper, Saw-Scaled Viper, Pit Viper | 10 vials (100 mL) | IV Infusion |
| Severe Envenomation (Neurotoxic or Bleeding Symptoms) | 20 vials or more | IV Infusion |
| Refractory Cases (Persistent Symptoms) | Additional 10 vials every 6 hours as needed | IV Infusion |
🔹 Route of Administration:
✔ IV Infusion (Diluted in 500 mL Normal Saline/Dextrose over 1-2 hours)
✔ NEVER given IM (Slow absorption, risk of delayed action)
🔹 Repeat Dosing:
✔ Monitor for improvement – If symptoms persist, give additional doses every 6 hours
✔ Confirmed Snakebite with Signs of Envenomation
✔ Neurotoxic Symptoms (Paralysis, Ptosis, Respiratory Depression)
✔ Hemotoxic Symptoms (Bleeding, Hematuria, Shock)
✔ Severe Local Reactions (Rapid Swelling, Gangrene Risk)
✔ Acute Kidney Injury (Myotoxic Venom Effects)
🚫 NOT Required If:
❌ No envenomation signs (Dry bite – when the snake does not inject venom)
❌ Unknown Snakebite with no systemic symptoms
❌ Allergy to Horse Serum (Risk of anaphylaxis)
❌ Previous Severe Serum Sickness
❌ Hypersensitivity to Equine Proteins
❌ Mild Snakebites Without Symptoms
🚫 With Corticosteroids (Hydrocortisone, Dexamethasone):
🚫 With NSAIDs (Ibuprofen, Aspirin):
🚫 With Anticoagulants (Warfarin, Heparin):
⚠ Mild Side Effects:
🚨 Severe Side Effects (Allergic Reactions):
🔹 Prevention: Pre-medication with Antihistamines (Chlorpheniramine) & Hydrocortisone may be given before ASV to reduce reactions.
🚨 Anaphylactic Shock (Severe Allergy to ASV)
🚨 Serum Sickness (Delayed Immune Reaction, 5-14 Days Later)
👩⚕️ Before ASV Administration:
✔ Confirm Envenomation Symptoms (Ptosis, Bleeding, Shock, Respiratory Distress, Local Tissue Necrosis)
✔ Check History of Allergies (Horse Serum Sensitivity)
✔ Set Up IV Line, Monitor Vitals (BP, HR, RR, Oxygen Saturation, Urine Output)
💉 During ASV Infusion:
✔ Give Slowly via IV Infusion (Diluted in 500 mL NS/Dextrose over 1-2 hrs)
✔ Observe for Anaphylaxis (Monitor BP, HR, Respiratory Rate Every 15 Minutes)
✔ Keep Adrenaline, Hydrocortisone, Antihistamines Ready
🩺 Post-ASV Care:
✔ Monitor for Signs of Serum Sickness (Delayed Allergic Reactions After 5-14 Days)
✔ Ensure Urine Output >30 mL/hr (To Monitor for Kidney Damage in Myotoxic Venoms)
✔ Educate Patient on Follow-Up (May Need More ASV If Symptoms Persist)
📢 Patient Education:
✔ Avoid Massaging or Cutting the Bite Area (Increases Venom Spread)
✔ Do NOT Apply Ice or Tourniquet (Can Worsen Tissue Necrosis)
✔ Seek Immediate Medical Care for ANY Snakebite
Vitamins and minerals are essential micronutrients required for growth, metabolism, immunity, and overall health.
🔹 Classification of Vitamins:
✔ Fat-Soluble Vitamins – Stored in the body (Vitamins A, D, E, K)
✔ Water-Soluble Vitamins – Not stored, must be replenished daily (Vitamins B-complex, C)
🔹 Classification of Minerals:
✔ Macrominerals – Needed in larger amounts (Calcium, Magnesium, Potassium, Sodium, Phosphorus)
✔ Trace Elements – Needed in small amounts (Iron, Zinc, Copper, Iodine, Selenium)
| Vitamin | Sources | Function | Deficiency Diseases | Toxicity Symptoms |
|---|---|---|---|---|
| Vitamin A | Carrots, Eggs, Liver, Milk | Vision, Growth, Immunity | Night Blindness, Xerophthalmia | Liver Damage, Birth Defects |
| Vitamin D | Sunlight, Fish, Egg Yolk | Calcium Absorption, Bone Health | Rickets (Children), Osteomalacia (Adults) | Hypercalcemia, Kidney Damage |
| Vitamin E | Nuts, Green Leafy Veg | Antioxidant, Skin Protection | Neuropathy, Muscle Weakness | Bleeding, GI Disturbances |
| Vitamin K | Green Leafy Veg, Liver | Blood Clotting | Hemorrhagic Disease (Newborns) | Blood Clots |
| Vitamin B1 (Thiamine) | Whole Grains, Meat | Nerve Function, Energy | Beriberi, Wernicke’s Encephalopathy | Rare |
| Vitamin B2 (Riboflavin) | Dairy, Meat, Eggs | Skin Health, Energy | Angular Cheilitis, Glossitis | Rare |
| Vitamin B3 (Niacin) | Meat, Peanuts | DNA Repair, Cholesterol | Pellagra (Diarrhea, Dementia, Dermatitis) | Flushing, Liver Damage |
| Vitamin B6 (Pyridoxine) | Banana, Poultry | Brain Function, Hemoglobin | Neuropathy, Seizures | Nerve Damage |
| Vitamin B9 (Folic Acid) | Green Veg, Beans | DNA Synthesis, Fetal Development | Neural Tube Defects, Anemia | Masks B12 Deficiency |
| Vitamin B12 (Cobalamin) | Meat, Dairy, Eggs | Nerve Function, RBC Formation | Pernicious Anemia, Neuropathy | Rare |
| Vitamin C (Ascorbic Acid) | Citrus Fruits, Tomatoes | Wound Healing, Immunity | Scurvy (Bleeding Gums, Weakness) | Kidney Stones |
| Mineral | Sources | Function | Deficiency Symptoms | Toxicity Symptoms |
|---|---|---|---|---|
| Calcium | Milk, Cheese, Green Leafy Veg | Bone Health, Muscle Contraction | Osteoporosis, Tetany | Kidney Stones |
| Iron | Red Meat, Beans, Spinach | Hemoglobin Formation | Anemia, Fatigue | Hemochromatosis, Liver Damage |
| Zinc | Nuts, Meat, Shellfish | Wound Healing, Growth | Poor Immunity, Slow Healing | Nausea, GI Upset |
| Iodine | Iodized Salt, Seafood | Thyroid Hormones | Goiter, Cretinism | Thyroid Dysfunction |
| Magnesium | Nuts, Seeds, Dark Chocolate | Muscle Function, Enzymes | Muscle Cramps, Arrhythmias | Diarrhea, Weakness |
| Sodium | Salt, Processed Food | Fluid Balance, Nerve Function | Hyponatremia (Weakness, Confusion) | Hypertension, Edema |
| Potassium | Bananas, Beans, Citrus | Nerve Impulse, Heart Function | Hypokalemia (Weakness, Arrhythmia) | Hyperkalemia (Cardiac Arrest) |
| Vitamin/Mineral | Daily Requirement (Adults) | Pregnancy/Lactation |
|---|---|---|
| Vitamin A | 700-900 mcg | 770-1300 mcg |
| Vitamin D | 600-800 IU | 600-800 IU |
| Vitamin E | 15 mg | 15 mg |
| Vitamin K | 90-120 mcg | 90-120 mcg |
| Vitamin C | 75-90 mg | 85-120 mg |
| Calcium | 1000-1200 mg | 1000-1300 mg |
| Iron | 8-18 mg | 27 mg |
| Folic Acid (B9) | 400 mcg | 600 mcg |
| Vitamin B12 | 2.4 mcg | 2.6-2.8 mcg |
✔ Pregnancy & Lactation – Folic Acid, Iron, Calcium, Vitamin D
✔ Malnutrition & Poor Diet – Multivitamins, Zinc, Iron
✔ Chronic Diseases (CKD, Liver Disease, GI Malabsorption) – Vitamin D, B12, Iron, Calcium
✔ Elderly Patients – Vitamin D, Calcium, B12, Zinc
✔ Vegetarians & Vegans – Vitamin B12, Iron, Zinc, Omega-3
✔ Children & Adolescents – Vitamin D, Calcium, Iron (For Growth)
🚫 Excessive Fat-Soluble Vitamins (A, D, E, K) Can Be Toxic
🚫 Iron Overload (Hemochromatosis, Sickle Cell Disease)
🚫 Kidney Disease (Excess Potassium, Magnesium Can Be Dangerous)
🚫 Hypervitaminosis A or D (Can Cause Organ Damage)
⚠ Common Side Effects:
🚨 Severe Toxicity:
👩⚕️ Pre-Supplementation Assessment:
✔ Check Nutritional Status, Deficiency Symptoms
✔ Monitor Blood Levels (Iron, Vitamin B12, Calcium, Vitamin D if needed)
✔ Assess Pregnancy, Chronic Illness, Medication Interactions
💉 During Administration:
✔ Give Iron Supplements with Vitamin C for Better Absorption
✔ Avoid Giving Calcium with Iron (Interferes with Absorption)
✔ Administer Vitamin B12 IM in Pernicious Anemia
🩺 Monitoring & Follow-Up:
✔ Check for Signs of Overdose (Vitamin A, D, Iron)
✔ Monitor for Allergic Reactions (Rare but possible with IV or IM supplementation)
✔ Educate Patients on Diet & Natural Sources of Vitamins
📢 Patient Education:
✔ Eat a Balanced Diet (Whole Foods Are Better Than Supplements)
✔ Do Not Self-Medicate with High-Dose Vitamins Without Medical Advice
✔ Pregnant Women Should Take Folic Acid Before & During Pregnancy
🔹 Vaccines are biological preparations that stimulate the immune system to develop protection against specific infectious diseases.
🔹 Sera (Antisera) contain pre-formed antibodies and provide passive immunity (e.g., Tetanus Antitoxin, Rabies Immunoglobulin).
🔹 Types of Immunity:
✔ Active Immunity – Induced by vaccines, long-lasting protection (e.g., Polio, DTP, MMR).
✔ Passive Immunity – Provided by immune sera or maternal antibodies, temporary protection (e.g., Rabies Immunoglobulin, Tetanus Antitoxin).
🔹 Types of Vaccines:
✔ Live Attenuated Vaccines – Weakened form of the virus/bacteria (e.g., BCG, OPV, MMR).
✔ Inactivated Vaccines – Killed microorganisms (e.g., IPV, Hepatitis A).
✔ Toxoid Vaccines – Inactivated toxins (e.g., Tetanus, Diphtheria).
✔ Subunit, Recombinant, Conjugate Vaccines – Contain specific parts of pathogens (e.g., Hepatitis B, HPV, Pneumococcal).
🚨 Launched in 1985, covers 12 major vaccine-preventable diseases under Mission Indradhanush.
🔹 Vaccines under UIP:
✔ At Birth – BCG, OPV-0, Hepatitis B (Birth dose)
✔ 6 Weeks – Pentavalent-1 (DPT + Hep B + Hib), IPV-1, OPV-1, Rotavirus-1, PCV-1
✔ 10 Weeks – Pentavalent-2, IPV-2, OPV-2, Rotavirus-2, PCV-2
✔ 14 Weeks – Pentavalent-3, OPV-3, IPV Booster, Rotavirus-3, PCV Booster
✔ 9-12 Months – Measles-Rubella-1 (MR-1), JE-1 (Selected Areas)
✔ 16-24 Months – DPT Booster-1, OPV Booster, MR-2, JE-2 (Selected Areas)
✔ 5-6 Years – DPT Booster-2
✔ 10-16 Years – Td Vaccine
| Age | Vaccines | Route |
|---|---|---|
| At Birth | BCG, OPV-0, Hepatitis B (Birth dose) | BCG: Intradermal, Others: IM/Oral |
| 6 Weeks | Pentavalent-1 (DPT+Hep B+Hib), IPV-1, OPV-1, Rotavirus-1, PCV-1 | IM, Oral |
| 10 Weeks | Pentavalent-2, IPV-2, OPV-2, Rotavirus-2, PCV-2 | IM, Oral |
| 14 Weeks | Pentavalent-3, OPV-3, IPV Booster, Rotavirus-3, PCV Booster | IM, Oral |
| 9-12 Months | MR-1, JE-1 (High-risk areas) | SC, IM |
| 16-24 Months | DPT Booster-1, OPV Booster, MR-2, JE-2 | IM, Oral |
| 5-6 Years | DPT Booster-2 | IM |
| 10-16 Years | Td Vaccine | IM |
🔹 New Additions Under UIP:
✔ PCV (Pneumococcal Conjugate Vaccine) for pneumonia prevention
✔ Rotavirus Vaccine to prevent severe diarrhea
✔ JE Vaccine in endemic areas
✔ Tetanus & Diphtheria (Td) – Every 10 years
✔ Hepatitis B – 3 doses (0, 1, 6 months)
✔ Influenza Vaccine – Annually for elderly, pregnant women, healthcare workers
✔ COVID-19 Vaccine – As per government guidelines
✔ HPV Vaccine – For cervical cancer prevention in females (9-26 years)
🚨 Provides passive immunity by giving pre-formed antibodies
🚨 Used for emergency protection in high-risk exposures
| Sera/Immunoglobulin | Indication |
|---|---|
| Tetanus Antitoxin (TAT) | Tetanus prevention in non-immunized individuals |
| Tetanus Immunoglobulin (TIG) | Severe tetanus-prone wounds |
| Rabies Immunoglobulin (RIG) | Category III rabies exposure (Animal bites) |
| Diphtheria Antitoxin | Diphtheria treatment |
| Snake Antivenom (ASV) | Snakebite treatment |
✔ Intramuscular (IM): Pentavalent, Hepatitis B, DPT, PCV, Td
✔ Subcutaneous (SC): MR, MMR, JE
✔ Oral (PO): OPV, Rotavirus
✔ Intradermal (ID): BCG
❌ Severe Allergic Reaction (Anaphylaxis) to a Previous Dose
❌ Live Vaccines (BCG, OPV, MR, MMR, JE) in Immunocompromised Patients
❌ Pregnancy (Avoid Live Vaccines Like MR, MMR, BCG)
❌ Severe Acute Illness (High Fever, Uncontrolled Epilepsy)
⚠ Common Side Effects (Mild & Self-Limiting):
✔ Fever, Redness, Swelling at Injection Site
✔ Mild Rash (After MR/MMR Vaccine)
✔ Temporary Irritability in Infants
🚨 Serious Reactions (Rare):
✔ Anaphylaxis (Severe allergic reaction) – Needs Adrenaline & Oxygen
✔ Severe Hypotonia (DPT Side Effect in Rare Cases)
✔ Convulsions (Rare with MMR, DTP)
👩⚕️ Before Vaccination:
✔ Verify Vaccination Schedule (Age, Doses Completed)
✔ Assess for Contraindications (Allergy, Immunosuppression)
✔ Explain Vaccine Benefits & Possible Side Effects to Parents
💉 During Administration:
✔ Use Correct Vaccine, Dose, and Route
✔ Use Separate Syringe for Different Vaccines
✔ Follow Proper Cold Chain Maintenance (2-8°C for Most Vaccines)
🩺 After Vaccination:
✔ Monitor for Any Immediate Allergic Reactions (Stay 30 min in OPD)
✔ Provide Paracetamol for Fever Management (If Needed)
✔ Document the Vaccination (Date, Batch Number, Site of Injection)
📢 Parent/Patient Education:
✔ Explain Next Dose Due Date
✔ Reassure that Mild Fever/Redness is Normal
✔ Advise to Seek Medical Help if High Fever or Seizures Occur
🚨 Chemotherapeutic drugs are used to treat cancer by killing or stopping the growth of malignant cells.
🔹 Action: Targets rapidly dividing cells, including cancer cells and some normal cells (bone marrow, hair follicles, GI tract).
🔹 Types: Cytotoxic chemotherapy, Targeted therapy, Hormonal therapy, Immunotherapy
🔹 General Side Effects:
✔ Bone marrow suppression (Anemia, Leukopenia, Thrombocytopenia)
✔ Nausea, Vomiting, Diarrhea
✔ Hair Loss (Alopecia)
✔ Fatigue, Weakness
| Class | Examples | Mechanism of Action | Common Uses |
|---|---|---|---|
| Alkylating Agents | Cyclophosphamide, Ifosfamide, Cisplatin, Carboplatin | DNA cross-linking → Inhibits replication | Breast cancer, Ovarian cancer, Lymphomas |
| Antimetabolites | Methotrexate, 5-Fluorouracil (5-FU), Capecitabine, Cytarabine | Interfere with DNA/RNA synthesis | Leukemia, GI cancers, Breast cancer |
| Antitumor Antibiotics | Doxorubicin, Bleomycin, Mitomycin C | Intercalates DNA, inhibits topoisomerase | Breast cancer, Hodgkin’s lymphoma, Sarcoma |
| Topoisomerase Inhibitors | Irinotecan, Etoposide, Topotecan | Prevents DNA unwinding | Lung cancer, Colon cancer |
| Mitotic Inhibitors | Paclitaxel, Docetaxel, Vincristine, Vinblastine | Blocks mitotic spindle formation | Breast cancer, Ovarian cancer, Lymphoma |
| Hormonal Therapy | Tamoxifen, Letrozole, Anastrozole, Flutamide | Blocks hormone-dependent cancer growth | Breast cancer (Tamoxifen), Prostate cancer (Flutamide) |
| Targeted Therapy | Trastuzumab (Herceptin), Imatinib, Rituximab | Targets specific cancer molecules | HER2+ Breast Cancer (Trastuzumab), CML (Imatinib) |
| Immunotherapy | Pembrolizumab, Nivolumab, Ipilimumab | Boosts immune system to fight cancer | Melanoma, Lung cancer |
✔ Cyclophosphamide – Breast cancer, Lymphomas, Ovarian cancer
✔ Cisplatin & Carboplatin – Lung cancer, Bladder cancer, Ovarian cancer
✔ Ifosfamide – Sarcoma, Testicular cancer
💉 Side Effects:
🚨 Bone marrow suppression, Hemorrhagic cystitis (Cyclophosphamide), Nephrotoxicity & Ototoxicity (Cisplatin)
✔ Methotrexate – Leukemia, Breast cancer, Rheumatoid Arthritis
✔ 5-Fluorouracil (5-FU) – GI cancers, Breast cancer
✔ Capecitabine – Colorectal cancer, Breast cancer
💉 Side Effects:
🚨 Mucositis, GI toxicity, Myelosuppression, Hepatotoxicity
✔ Doxorubicin (Adriamycin) – Breast cancer, Lymphomas
✔ Bleomycin – Testicular cancer, Hodgkin’s lymphoma
💉 Side Effects:
🚨 Cardiotoxicity (Doxorubicin), Pulmonary fibrosis (Bleomycin)
✔ Paclitaxel & Docetaxel – Breast cancer, Ovarian cancer
✔ Vincristine & Vinblastine – Lymphoma, Leukemia
💉 Side Effects:
🚨 Neurotoxicity (Vincristine), Peripheral Neuropathy, Hypersensitivity Reactions
✔ Irinotecan, Topotecan – Colon cancer, Lung cancer
✔ Etoposide – Testicular cancer, Lung cancer
💉 Side Effects:
🚨 Severe Diarrhea (Irinotecan), Bone Marrow Suppression
✔ Tamoxifen (Selective Estrogen Receptor Modulator – SERM) – Breast cancer
✔ Aromatase Inhibitors (Letrozole, Anastrozole) – Breast cancer
✔ Flutamide (Anti-Androgen Therapy) – Prostate cancer
💉 Side Effects:
🚨 Hot Flashes, Osteoporosis, Increased Risk of Blood Clots (Tamoxifen)
✔ Trastuzumab (Herceptin) – HER2+ Breast Cancer
✔ Imatinib (Gleevec) – Chronic Myeloid Leukemia (CML)
✔ Rituximab – Non-Hodgkin’s Lymphoma
💉 Side Effects:
🚨 Infusion Reactions, Cardiotoxicity (Trastuzumab), Hepatotoxicity (Imatinib)
✔ Pembrolizumab, Nivolumab (PD-1 Inhibitors) – Lung cancer, Melanoma
✔ Ipilimumab (CTLA-4 Inhibitor) – Melanoma
💉 Side Effects:
🚨 Autoimmune Reactions (Pneumonitis, Hepatitis, Colitis), Fatigue
✔ Intravenous (IV) – Most Common Route (Doxorubicin, Cisplatin, Paclitaxel)
✔ Oral (PO) – Some Antimetabolites & Hormonal Drugs (Methotrexate, Capecitabine, Tamoxifen)
✔ Intrathecal (IT) – For CNS Cancers (Methotrexate)
👩⚕️ Pre-Chemotherapy Care:
✔ Check Complete Blood Count (CBC) – Avoid if WBC < 3000 or Platelets < 100,000
✔ Assess Kidney & Liver Function (LFTs, RFTs)
✔ Pre-Medication (Antiemetics, Hydration for Cisplatin to Prevent Nephrotoxicity)
✔ Verify Correct Dosage & IV Line Patency
💉 During Chemotherapy Administration:
✔ Monitor for Allergic Reactions (Especially with Paclitaxel, Rituximab)
✔ Administer Slowly via Infusion Pump
✔ Check for Signs of Extravasation (Doxorubicin, Vincristine – Vesicants)
🩺 Post-Chemotherapy Care:
✔ Monitor for Bone Marrow Suppression (Check WBC, RBC, Platelets Regularly)
✔ Assess for Neurotoxicity (Vincristine, Cisplatin)
✔ Provide Hydration (Prevent Nephrotoxicity with Cisplatin, Methotrexate)
✔ Educate Patients on Infection Control & Managing Side Effects (Avoid Crowds, Maintain Oral Hygiene, Eat High-Protein Diet)
🔹 Immunosuppressants reduce immune system activity and are used for organ transplantation, autoimmune diseases, and inflammatory disorders.
🔹 Immunostimulants enhance the immune response and are used for infections, cancer, and immunodeficiency conditions.
🔹 Why Are These Drugs Important?
✔ Immunosuppressants – Prevent organ rejection, control autoimmune diseases.
✔ Immunostimulants – Boost immunity in cancer, chronic infections, and immunodeficiency disorders.
🚨 Used to suppress immune response in organ transplants and autoimmune diseases.
🔹 Mechanism: Inhibit T-cell activation, cytokine release, and antibody formation.
| Class | Examples | Mechanism of Action | Uses |
|---|---|---|---|
| Calcineurin Inhibitors | Cyclosporine, Tacrolimus | Inhibit T-cell activation by blocking IL-2 production | Organ transplantation, Psoriasis, Rheumatoid Arthritis |
| mTOR Inhibitors | Sirolimus, Everolimus | Inhibit T-cell proliferation | Kidney transplantation |
| Cytotoxic Drugs | Azathioprine, Cyclophosphamide, Mycophenolate mofetil | Inhibit DNA synthesis, block immune cell replication | Lupus, Rheumatoid Arthritis, Kidney Transplant |
| Corticosteroids | Prednisolone, Dexamethasone | Reduce inflammation & immune response | Transplant rejection, Autoimmune diseases |
| Monoclonal Antibodies | Basiliximab, Rituximab | Block T-cell activation | Organ Transplant, Lymphomas, Autoimmune Diseases |
✔ Cyclosporine & Tacrolimus – Kidney, Liver, Heart Transplants
✔ Azathioprine & Mycophenolate Mofetil – Autoimmune diseases (Lupus, Rheumatoid Arthritis)
✔ Sirolimus & Everolimus – Kidney Transplant (Alternative to Calcineurin Inhibitors)
✔ Prednisolone & Dexamethasone – Short-term inflammation control in organ transplants, severe autoimmune flare-ups
💉 Side Effects of Immunosuppressants:
🚨 Increased Risk of Infections (Due to immune suppression)
🚨 Nephrotoxicity (Cyclosporine, Tacrolimus)
🚨 Hypertension, Hyperlipidemia (Sirolimus, Everolimus)
🚨 Bone Marrow Suppression (Azathioprine, Cyclophosphamide)
🚨 Cushing’s Syndrome, Hyperglycemia (Corticosteroids)
👩⚕️ Pre-Administration:
✔ Assess for signs of infections (Fever, Cough, Wounds, WBC Count)
✔ Monitor Renal & Liver Function Tests (Creatinine, ALT/AST, Electrolytes)
✔ Check CBC for Bone Marrow Suppression (Low WBC, Platelets, Anemia)
💉 During Administration:
✔ Give Oral Cyclosporine on an Empty Stomach (Better Absorption)
✔ Monitor BP (Hypertension is Common with Cyclosporine, Tacrolimus)
✔ Check for Allergic Reactions with Monoclonal Antibodies (Basiliximab, Rituximab)
🩺 Post-Administration:
✔ Monitor for Infections (Strict Aseptic Techniques Required)
✔ Educate Patient on Lifelong Immunosuppression (For Transplant Patients)
✔ Advise Regular Blood Tests for Kidney & Liver Function Monitoring
📢 Patient Education:
✔ Avoid Crowded Places (High Risk of Infections)
✔ Report Unusual Bruising or Bleeding (Bone Marrow Suppression Risk)
✔ Regular Blood Pressure & Blood Sugar Monitoring (Steroid Side Effects)
🚨 Used to boost immune response in infections, cancer, and immune deficiency disorders.
🔹 Mechanism: Increase T-cell activity, cytokine release, and antibody production.
| Class | Examples | Mechanism of Action | Uses |
|---|---|---|---|
| Colony-Stimulating Factors (CSFs) | Filgrastim (G-CSF), Sargramostim (GM-CSF) | Stimulate bone marrow to produce WBCs | Neutropenia (Chemotherapy, HIV) |
| Interferons (IFNs) | IFN-α, IFN-β, IFN-γ | Activate immune cells to fight cancer & viral infections | Hepatitis B & C, Multiple Sclerosis, Cancer |
| Interleukins (ILs) | Aldesleukin (IL-2) | Stimulate T-cell proliferation | Renal Cell Cancer, Melanoma |
| Vaccines (Active Immunity) | BCG Vaccine, HPV Vaccine | Stimulate antigen-specific immunity | Tuberculosis, Cervical Cancer Prevention |
| Immune Checkpoint Inhibitors | Nivolumab, Pembrolizumab | Block immune system suppression | Cancer (Lung, Melanoma) |
✔ Filgrastim (G-CSF) & Sargramostim (GM-CSF) – Boost WBC production in chemotherapy-induced neutropenia
✔ Interferon-α (IFN-α) – Hepatitis B & C, Leukemia
✔ Aldesleukin (IL-2) – Stimulates T-cell response in kidney cancer
✔ Checkpoint Inhibitors (Nivolumab, Pembrolizumab) – Cancer immunotherapy
💉 Side Effects of Immunostimulants:
🚨 Flu-like Symptoms (Fever, Fatigue, Chills – Common with Interferons, IL-2)
🚨 Bone Pain (Common with CSFs like Filgrastim, Sargramostim)
🚨 Autoimmune Reactions (Seen in Checkpoint Inhibitors, Can Cause Colitis, Thyroiditis, Hepatitis)
🚨 Neurotoxicity (Confusion, Mood Changes – Seen with IL-2 Therapy)
👩⚕️ Pre-Administration:
✔ Check CBC for Baseline WBC & Platelet Counts
✔ Assess for Autoimmune Disorders (Risk of Exacerbation with Immunostimulants)
✔ Monitor Renal & Liver Function Tests Before Interferon Therapy
💉 During Administration:
✔ Give Filgrastim as SC Injection (Do NOT Shake Vial)
✔ Interferon Should Be Given at Bedtime (Reduces Flu-like Symptoms)
✔ Monitor for Hypersensitivity Reactions (Especially with IL-2 Therapy)
🩺 Post-Administration:
✔ Monitor for Severe Fatigue, Flu-like Symptoms (Common with Interferons, IL-2)
✔ Assess for Mood Changes & Depression (Side Effect of Long-Term Interferon Use)
✔ Educate Patients on Injection Site Reactions (Common with CSFs, Interferons)
📢 Patient Education:
✔ Drink Plenty of Water to Reduce Side Effects of Interleukins
✔ Rest if Fatigue is Severe (Seen in Interferon Therapy)
✔ Avoid Immunosuppressants While on Immunostimulants