Today is our topic of discussion Commonly Used Intravenous Drugs.
Commonly Used Intravenous Drugs
COMMONLY USED INTRAVENOUS DRUGS
Antibiotics (Ampicillin, Crystalline Penicillin) Indication: Treat mainly gram positive infection (e otitis media), meningitis, endocarditis, pneumonia Act by interfering with bacteria cell wall synthesis-well distributed. Poor penetrator to CSF (except in inflamed one). Ineffective against penicillin’s producer
Side effect, contraindication (C/I): Serious allergic reactions rarely encephalopathy with high dose or normal dose in renal impairment patients. Never to be given intrathecally. Encephalopathy could be fatal. Accumulation of Na or K for electrolyte restricted patient.
Flucloxacillin: Of narrow spectrum but effective against pencillinase producer bacteria of good effect against MSSA (Methicillin Sensitive Staph aureus), Piperacillin known as anti-pseudomonal penicillin. Its activity is extended to cover gram negative bacteria.
Indicated when serious infection by P. aeruginosa is suspected. Drug Interaction of Penicillin With probenecid, reduced excretion of penicillin Synergistic effect with aminoglycoside against gram negative bacteria Reduces excretion of methotrexate, increases
MTC toxicity Cephalosporins: Are classified into first, second and third generation and this is determined by the activity against gram negative .They are of broad spectrum (positive, and gram negative) act by the same way as penicillin does .Rockin (Ceftriaxone) of longer half-life is given once bacteria and stability against betalactamase enzyme. Daily in preoperatively prophylaxis Fortum (Ceftazadine) of good pseudomonal effect.
Side effect and contraindication: Allergic reaction.
Amikacin Gentamicin: Bactericidal acts against gram negative bacteria including Pauerigenosa.
Side Effects: Damage the 8th cranial nerve leads to deafness.
Ototoxicity Nephrotoxicity: Excreted via kidneys in renal impairment, accumulation may occur (1) never exceed 7-10 days treatment with Amikacin-Gentamicin. (ii) Never to be given more than TDS/daily. Given in combination with and hemolytic
Streptococci pneumococci: Contraindicated in pregnancy. Plasma level monitoring is required for peaks and troughs
Drug interactions: With cyclosporin increase the risk of nephrotoxicity With cisplatin increase the risk of nephrotoxicity and ototoxicity
Erythromycin Injection: Indication: Alternative to penicillin for penicillin hypersensitive patients, good for upper respiratory tract infection, campylobacter enteritis, atypical pneumonia, legionnella. Contraindicated, in liver disease (porphyria).Side effects; If given for more than 14 days-cholestatic jaundice. Avoid concurrent administration of hisminal or teldane.
Drug interactions: Erythromycin inhibits hepatic microsomal enzyme leads to increase plasma concentration of antiarrhythmic, carbamazepine, terfenadine, and cyclosporin.
Vancomycin: Drug of choice in treatment of pseudo membranous colitis. MRSA, prophylaxis for endocarditis Side effects/Caution: Avoid rapid infusion (anaphylactic shock. Rotate the infusion site, Renal toxicity. History of deafness. Blood disorder should be considered seriously with vancomycin.
Vitamin K
Indication: Vitamin K deficiency bleeding. Good antidote for bleeding due to overdose of oral anticoagulant.
Prophylaxis, in newborn, vitamin K deficiency (bleeding). Patients with fat malabsorption (obstructive biliary) are advised to take water soluble forms.
Aminophylline
Indication: Indicated alone or in addition to beta 2 agonist to relieve bronchospasm. The drug is metabolized by liver cirrhosis, viral infection-cimetidine, erythromycin. Aminophylline half-life decreased with rifampicin, smoking, phenytoin and carbamazepine.
The significance of half-life is important as the therapeutic toxic margin of aminophylline is narrow. When initiating IV therapy with aminophylline we should make sure that the patient was not taking from oral of aminophylline.
Side effects: Arrhythmia due to hypokalemia, convulsion, GIT disturbance. Aminophylline toxicity is treated by correcting the hypokalemia with KCI (60 mmol/1 hour), tachycardia is treated with IV propranolol.
Dopamine/Dobutamine
- They are inotropic drugs, cardiac stimulant, exerting their action through beta 1 receptor at the heart. Indicated in case of cardiogenic shock
- Side effects: Tachycardia
- Half-life: It is only 1-2 minutes as they are destructed by MAO. This is why it should be given in continuous infusion.
- Hypovolemia should be corrected first.
Intrathecal Injections
Definition and purpose: Medicine injected in the sub- arachnoids space of the spinal canal drugs such as anti- infectious or anti-neoplastic used for treating meningeal leukemia are injected by this route as they do not travel in the bloodstream. It is also given for anesthesia such as lidocaine hydrochloride (for regional anesthesia).
Complications:
- Inflammation at the puncture site
- Septicemia
- Spinal deformities especially while giving anesthesia.
Note: Care must be taken when preparing this kind of injections to ensure that they do not have any bacterial substance.
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