AWE HAND SANITIZER

Indications

• Constipation
• Bowel cleansing

Dosage

Children: Child 1–11 months: 1 g as required, Child 1–11 years: 2 g as required, Child 12–17 years: 4 g as required.

Adults: 4 g as required, usually administered rectally.

Mechanism of action

When administered rectally, glycerol exerts a hygroscopic and/or local irritant action, drawing water from the tissues into the feces and reflexively stimulating evacuation. It decreases intraocular pressure by creating an osmotic gradient between the blood and intraocular fluid, causing fluid to move from the aqueous and vitreous humors into the bloodstream. Glycerol is classified as a hyperosmotic laxative and may also have lubricating and fecal softening effects.

Pharmacodynamics

Glycerol is commonly classified as an osmotic laxative, acting through its local irritant effects and possibly having lubricating and fecal softening actions. Glycerol suppositories usually produce effects within 15 to 30 minutes, providing quick relief from constipation.

Pharmacokinetics

Glycerol is rapidly absorbed through the gastrointestinal tract. It is metabolized in the liver and other tissues, with a half-life that varies depending on the route of administration. Following rectal administration, glycerol is primarily excreted in urine. The pharmacokinetics may vary based on dosage forms and individual patient factors.

Contra-indications

• Acute abdominal conditions
• Acute inflammatory bowel disease
• Intestinal obstruction
• Severe dehydration

Adverse effects

• Abdominal cramps
• Asthenia
• Gastrointestinal disorders
• Hypermagnesaemia
• Skin reactions
• Urine discolouration

Precautions

• Avoid prolonged contact with skin, especially in incontinent patients or infants wearing nappies due to the risk of irritation and excoriation.
• Excessive use may cause diarrhea and related effects such as hypokalaemia.

Pregnancy

Manufacturers advise avoidance due to limited information available.

Breast-feeding

Manufacturers advise avoidance as there is no information available.

Storage

Store at room temperature, away from direct sunlight.

Formulations

• Glycerol 1g suppositories
• Glycerol 2g suppositories
• Glycerol 4g suppositories
• Glycerol oral suspension

Indications

• Skin disinfection
• Preparation of skin before injections
• Cleansing minor wounds

Dosage

Children: Apply to the skin as required; consult product literature for specific guidance.

Adults: Apply to the skin as required for disinfection.

Mechanism of action

Alcohol exerts its antiseptic effect by denaturing proteins, disrupting cell membranes, and dehydrating microbial cells, leading to cell lysis and death.

Pharmacodynamics

Alcohol has broad-spectrum antimicrobial activity, effective against bacteria, fungi, and viruses. Its efficacy is influenced by concentration, with higher concentrations generally being more effective.

Pharmacokinetics

Alcohol is rapidly absorbed through the skin and mucous membranes. It is metabolized primarily in the liver, with a half-life that varies based on the individual's metabolic rate and the amount consumed.

Contra-indications

• Concomitant use with lithium
• Regular use in neonates
• Patients with severe burns when diathermy has been preceded by application of alcoholic skin disinfectants

Adverse effects

• Eye erythema
• Punctate keratitis
• Cytotoxicity
• Eye discolouration

Interactions

• Increases risk of visual disturbances with antiepileptics
• Increases concentration with methylphenidate
• Increases risk of facial flushing and skin irritation with topical pimecrolimus
• Increases concentration with retinoids
• Increases concentration with acitretin
• Increases risk of facial flushing and skin irritation with topical tacrolimus
• Decreases antidiuretic effect with vasopressin

Precautions

• Avoid regular application to inflamed or broken skin or mucosa
• Avoid broken skin
• Flammable

Pregnancy

Sufficient iodine may be absorbed to affect the fetal thyroid in the second and third trimester.

Breast-feeding

Avoid regular or excessive use.

Storage

Store in a cool, dry place away from heat and direct sunlight.

Formulations

• Betadine 2.5% dry powder spray
• Industrial methylated spirit
• Povidone-Iodine 25 mg per 1 gram

Indications

• Topical drug formulations
• Ophthalmic solutions
• Cosmetic products
• Transdermal drug delivery systems

Dosage

Children: Refer to specific product guidelines as carbomer is used as a formulation agent and does not have standard dosing.

Adults: Refer to specific product guidelines as carbomer is used as a formulation agent and does not have standard dosing.

Mechanism of action

Carbomer works by absorbing water and swelling to form a gel, which increases the viscosity of the formulation. This property is utilized in topical preparations to improve the delivery and stability of active ingredients, allowing for a more controlled release of the drug.

Pharmacodynamics

The pharmacodynamics of carbomer are primarily related to its physical properties as a gelling agent. It enhances the stability and viscosity of formulations, which can improve the bioavailability of drugs when used in topical applications. Carbomer itself has no systemic pharmacological effects since it is not absorbed into the bloodstream when applied topically.

Pharmacokinetics

Carbomer is not significantly absorbed through the skin or gastrointestinal tract, which means it does not have a traditional pharmacokinetic profile characterized by absorption, distribution, metabolism, and excretion. It primarily acts locally at the site of application.

Adverse effects

• Local irritation
• Allergic reactions
• Redness
• Swelling

Precautions

• Avoid contact with eyes
• Use caution in individuals with known allergies to carbomers
• If irritation occurs, discontinue use

Pregnancy

Carbomer is generally considered safe for use during pregnancy, but it is always advisable to consult a healthcare provider before use.

Breast-feeding

Carbomer is not known to be absorbed systemically, making it likely safe for use while breastfeeding, but consulting a healthcare provider is recommended.

Storage

Store in a cool, dry place, away from direct sunlight. Keep out of reach of children.

Formulations

• Gel
• Cream
• Ointment
• Powder

Dosage

Children: Refer to specific product guidelines or BNF for Children for accurate dosing information based on the formulation and indication.

Adults: Refer to specific product guidelines or BNF for accurate dosing information based on the formulation and indication.

Mechanism of action

The mechanism of action of compounds varies depending on their specific components. Generally, compounds can work through synergistic effects where the combined action of the ingredients leads to enhanced therapeutic outcomes. This may involve interactions at specific receptor sites, modulation of enzyme activity, or alteration of physiological pathways.

Pharmacodynamics

Pharmacodynamics of compounds is dependent on the individual pharmacological properties of each active ingredient within the formulation. This can include effects on receptor binding, ion channel modulation, and influence on neurotransmitter levels, leading to a range of therapeutic effects such as analgesia, anti-inflammatory action, or antimicrobial activity.

Pharmacokinetics

Pharmacokinetics of a compound involves the absorption, distribution, metabolism, and excretion of the active ingredients. Depending on their chemical nature, some compounds may exhibit rapid absorption, while others may have prolonged release characteristics. The bioavailability and half-life of each component can differ significantly, affecting overall efficacy and safety profiles.

Pregnancy

Use only if clearly needed, as safety in pregnancy is not established.

Breast-feeding

Caution is advised, as it is not known if the drug is excreted in human milk.

Storage

Store in a cool, dry place away from light. Keep out of reach of children.

Indications

• Disinfectant
• Preservative
• Sterilization of medical instruments
• Formalin for histology and pathology specimens

Dosage

Children: Refer to local guidelines and recommendations, as doses may vary based on the specific clinical situation and formulation used.

Adults: Refer to local guidelines and recommendations, as doses may vary based on the specific clinical situation and formulation used.

Mechanism of action

Formaldehyde acts primarily as a cross-linking agent, covalently binding to proteins and nucleic acids. This mechanism is responsible for its effectiveness as a preservative and disinfectant, as it disrupts cellular metabolism and integrity in microorganisms, leading to cell death.

Pharmacodynamics

The pharmacodynamics of formaldehyde involves its ability to inactivate proteins and DNA through cross-linking, which interferes with cellular functions. This action results in its antimicrobial and preservative effects, although it also contributes to toxicity. The compound can elicit inflammatory responses in tissues and has been associated with respiratory irritations and carcinogenic effects upon prolonged exposure.

Pharmacokinetics

Formaldehyde is rapidly absorbed via inhalation and dermal routes, and it is metabolized mainly by the enzyme formaldehyde dehydrogenase to formic acid, which is then converted to carbon dioxide and water. The elimination half-life in the body is relatively short due to its rapid metabolism. Formaldehyde is distributed widely in body tissues, but due to its reactivity, it does not accumulate significantly.

Pregnancy

Safety in pregnancy has not been established.

Breast-feeding

It is unknown whether this drug is excreted in human milk.

Storage

Store at room temperature, away from moisture and heat.

Dosage

Children: As with adults, dosing for children is highly variable and specific to the product used. It is advisable to refer to product guidelines and consult a healthcare professional.

Adults: Dosing varies widely based on the specific product and its intended use, with no standardized dosage for fragrance as it is generally applied topically or used in the environment.

Mechanism of action

Fragrances primarily act by stimulating the olfactory receptors in the nasal cavity, which send signals to the brain's olfactory bulb. This process is responsible for the perception of smell and can evoke emotional responses, enhance mood, and even influence behavior. The specific compounds in fragrances can interact with various biochemical pathways, but their exact mechanisms can vary widely depending on the individual components and their concentrations.

Pharmacodynamics

The pharmacodynamics of fragrance compounds can involve modulation of neurotransmitter activity in the brain, particularly those associated with mood and emotional responses. Certain fragrance compounds may have calming effects, potentially influencing the levels of stress hormones and promoting relaxation. However, responses can be highly subjective and vary from person to person.

Pharmacokinetics

The pharmacokinetics of fragrance components depend on their chemical nature. Many volatile aromatic compounds can be rapidly absorbed through the skin or inhaled, leading to quick onset of effects. Metabolism may occur in the liver, and elimination can happen through urine or exhalation. The half-lives of these compounds can vary significantly based on their structure and the route of exposure.

Adverse effects

• Allergic reactions
• Skin irritation
• Respiratory issues
• Headaches
• Nausea

Precautions

• Use with caution in individuals with known allergies
• Avoid use in those with respiratory conditions like asthma
• Patch testing recommended prior to widespread use on skin

Pregnancy

Fragrance use during pregnancy should be limited, as some ingredients may pose risks to fetal development.

Breast-feeding

Generally considered safe, but caution is advised due to potential for skin absorption and transfer to infant.

Storage

Store in a cool, dry place away from direct sunlight, tightly sealed to prevent evaporation.

Formulations

• Perfumes
• Colognes
• Body sprays
• Scented lotions
• Candles
• Essential oils

Indications

• Antiseptic for skin disinfection
• Solvent in pharmaceutical formulations
• Cleaning agent in laboratories and healthcare settings

Dosage

Children: For pediatric use, consult specific guidelines in the BNF for Children, as dosing may vary based on age, weight, and clinical circumstances.

Adults: For skin antisepsis, apply isopropyl alcohol topically in a concentration of 70% to the affected area. Dosage may vary based on clinical indication and setting.

Mechanism of action

Isopropyl alcohol works primarily as an antiseptic by denaturing proteins and disrupting cell membranes of bacteria, viruses, and fungi, leading to cell lysis and death. Its efficacy is enhanced by the presence of water, which facilitates the penetration of the alcohol into microbial cells.

Pharmacodynamics

Isopropyl alcohol exhibits a rapid onset of action against a variety of pathogens, including gram-positive and gram-negative bacteria, fungi, and some viruses. Its antimicrobial activity is concentration-dependent, with higher concentrations generally providing a broader spectrum of activity. It is commonly used in concentrations ranging from 60% to 90%, with 70% being optimal for disinfection due to its ability to penetrate the cell wall effectively.

Pharmacokinetics

Isopropyl alcohol is readily absorbed through the skin and mucous membranes. After absorption, it is metabolized primarily in the liver to acetone, which is then further metabolized and excreted, mostly via urine. The elimination half-life of isopropyl alcohol varies but is typically around 2 to 3 hours. Its effects can be influenced by factors such as dosage, route of exposure, and individual metabolic differences.

Pregnancy

Isopropyl alcohol should be used with caution during pregnancy. It is a category C drug, indicating that risk cannot be ruled out.

Breast-feeding

Caution is advised when using isopropyl alcohol during breastfeeding, as it is not known if it is excreted in human milk.

Storage

Isopropyl alcohol should be stored at room temperature, away from heat and flame. Keep the container tightly closed and in a well-ventilated area.

Formulations

• Isopropyl alcohol 70% solution
• Isopropyl alcohol 99% solution

Indications

• Anti-inflammatory
• Antioxidant
• Antimicrobial
• Wound healing
• Pain relief
• Nutritional support

Dosage

Children: Paediatric dosing for tree-derived substances is highly variable and should be determined by a healthcare professional. Specific recommendations depend on the tree species and the health condition being addressed.

Adults: Dosage for tree-derived substances varies widely based on the specific product and its intended use. It is important to refer to the manufacturer's guidelines or consult with a healthcare professional for appropriate dosing.

Mechanism of action

The mechanism of action for tree-derived compounds varies widely depending on the specific chemical constituents present in the parts used. Many tree extracts contain flavonoids, terpenoids, alkaloids, and tannins, which can exhibit anti-inflammatory, antioxidant, antimicrobial, and anti-cancer properties through various biochemical pathways. These compounds may modulate the immune response, inhibit oxidative stress, or interfere with cellular signaling pathways.

Pharmacodynamics

Pharmacodynamics of tree-derived compounds can include effects such as modulation of inflammation, enhancement of immune function, and reduction of oxidative stress. Certain compounds can also influence neurotransmitter systems, providing potential benefits in mood disorders. The efficacy and safety profiles are highly dependent on the species and part of the tree used, as well as the preparation method.

Pharmacokinetics

The pharmacokinetics of tree-derived substances vary greatly. Factors such as solubility, absorption, distribution, metabolism, and excretion can be influenced by the specific compounds and their formulations. Generally, tree extracts may demonstrate variable bioavailability due to differences in extraction methods and the presence of other active constituents that can enhance or inhibit absorption.

Pregnancy

Not well-studied; consult with a healthcare professional.

Breast-feeding

Not well-studied; consult with a healthcare professional.

Storage

Store in a cool, dry place away from direct sunlight.

Mechanism of action

Ethanol affects the brain’s neurons in several ways. It alters their membranes as well as their ion channels, enzymes, and receptors. Alcohol also binds directly to the receptors for acetylcholine, serotonin, GABA, and the NMDA receptors for glutamate. The sedative effects of ethanol are mediated through binding to GABA receptors and glycine receptors (alpha 1 and alpha 2 subunits). It also inhibits NMDA receptor functioning. In its role as an anti-infective, ethanol acts as an osmolyte or dehydrating agent that disrupts the osmotic balance across cell membranes. ... Ethanol is known to affect a large number of membrane proteins that participate in signaling pathways such as neurotransmitter receptors, enzymes, and ion channels, and there is extensive evidence that ethanol interacts with a variety of neurotransmitters. The major actions of ethanol involve enhancing the inhibitory effects of gamma-aminobutyric acid (GABA) at GABAa receptors and blockade of the N-methyl-D-aspartate (NMDA) subtype of glutamate, an excitatory amine acid (EAA) receptor. Animal studies indicate that the acute effects of ethanol result from competitive inhibition of glycine binding to NMDA receptor and disruption of glutamatergic neurotransmission by inhibiting the response of the NMDA receptor. Persistent glycine antagonism and attenuation of glutamatergic neurotransmission by chronic ethanol exposure results in tolerance to ethanol by enhancing EAA neurotransmission and NMDA receptor upregulation. The latter appears to involve selective increases in NMDA R2B subunit concentrations and other molecular changes in specific brain loci. The abrupt withdrawal of ethanol thus produces a hyperexcitable state that leads to the ethanol withdrawal syndrome and excitotoxic neuronal death. GABA-mediated inhibition, which normally acts to limit excitation, is eliminated during ethanol withdrawal syndrome and further intensifies this excitation. In addition, NMDA receptors function to inhibit the release of dopamine in the nucleus accumbens and mesolimbic structures, which modulate the reinforcing action of addictive xenobiotics such as ethanol. By inhibiting NMDA receptor activity, ethanol could increase dopamine release from the nucleus accumbens and ventral tegmental area and could thus create dependence. Chronic ethanol administration also results in tolerance, dependence, and an ethanol withdrawal syndrome, mediated, in part, by desensitization and or downregulation of GABAa receptors. The development of alcoholic ketoacidosis (AKA) requires that a combination of physical and physiologic events occur. The normal response to starvation and depletion of hepatic glycogen stores is for amino acids to be converted to pyruvate. Pyruvate can serve as a substrate for gluconeogenesis, be converted to acetyl-CoA, which can enter the Krebs cycle or can be utilized in various biosynthetic pathways (eg, fatty acid, ketone bodies, cholesterol, and acetylcholine) ... Ethanol metabolism generates NADH, resulting in an excess of reducing potential. This high redox state favors the conversion of pyruvate to lactate, diverting pyruvate from being a substrate for gluconeogenesis. To compensate for the lack of normal metabolic substrates, the body mobilizes fat from adipose tissue and increased fatty acid metabolism as an alternative source of energy. This response is mediated by a decrease in insulin and an increased secretion of glucagon, catecholamines, growth hormone, and cortisol. Fatty acid metabolism results in the formation of acetyl-CoA and it combines with the excess acetate that is generated from ethanol metabolism to form acetoacetate. Most of the acetoacetate is reduced to beta-hydroxybutyrate due to the excess reducing potential or high redox state of the cell. Volume depletion interferes with the renal elimination of acetoacetate and beta-hydroxybutyrate, and contributes to the acidosis. An elevated lactate concentration may result from shunting from pyruvate or

Pharmacodynamics

Alcohol produces injury to cells by dehydration and precipitation of the cytoplasm or protoplasm. This accounts for its bacteriocidal and antifungal action. When alcohol is injected in close proximity to nerve tissues, it produces neuritis and nerve degeneration (neurolysis). Ninety to 98% of ethanol that enters the body is completely oxidized. Ethanol is also used as a cosolvent to dissolve many insoluble drugs and to serve as a mild sedative in some medicinal formulations. Ethanol also binds to GABA, glycine, NMDA receptors and modulates their effects. Ethanol is also metabolised by the hepatic enzyme alcohol dehydrogenase.

Mechanism of action

When administered rectally, glycerin exerts a hygroscopic and/or local irritant action, drawing water from the tissues into the feces and reflexively stimulating evacuation. Glycerin decreases intraocular pressure by creating an osmotic gradient between the blood and intraocular fluid, causing fluid to move out of the aqueous and vitreous humors into the bloodstream. Glycerin (glycerol) and sorbitol are hyperosmotic laxatives. When administered rectally, glycerin and sorbitol exert a hygroscopic and/or local irritant action, drawing water from the tissues into the feces and reflexly stimulating evacuation. The extent to which the simple physical distention of the rectum and the hygroscopic and/or local irritant actions are responsible for the laxative effects of some of these drugs is not known. Only extremely high oral doses of sorbitol (25 g daily) or glycerin exert laxative action. /Glycerin/ decreases intraocular pressure by creating an osmotic gradient between the blood and intraocular fluid, causing fluid to move out of the aqueous and vitreous humors into the bloodstream. The physicochemical effects of a series of alkanols, alkanediols and glycerol on erythrocyte shape and hemolysis at 4 and 20 degrees C were examined. We calculated the dielectric constant of the incubation medium, Ds, and the dielectric constant of the erythrocyte membrane Dm in the presence of organic solutes. The ratio Ds/Dm = -38.48 at 20 degrees C defines the normal biconcave shape in a medium without hemolytic agents. A decrease in Ds/Dm favors externalization or internalization with consequent hemolysis. Alkanols and alkanediols convert biconcave erythrocytes into echinocytes, which is accompanied by an increase in the projected surface area. Glycerol converts biconcave erythrocytes into stomatocytes, which was accompanied by a marginal decrease in the projected surface area. Progressive externalization in alkanols and alkanediols or internalization in glycerol resulted in a decrease in the projected surface area and the formation of smooth spheres. The degree of shape change induced was related to the degree of hemolysis and the ratio Ds/Dm. A decrease in temperature reduced both the degree of shape change and hemolysis. .../Thus/ physicochemical toxicity may be a result of a temperature dependent hydrophobic interaction between the organic solutes and the membrane and is best interpreted by the ability of the solutes to change Ds and Dm.

Pharmacodynamics

Glycerin is commonly classified as an osmotic laxative but may act additionally or alternatively through its local irritant effects; it may also have lubricating and fecal softening actions. Glycerin suppositories usually work within 15 to 30 minutes.