BCG Vaccine (Freeze Dried)

Indications

• Measles
• Mumps
• Rubella
• Yellow fever
• Varicella (chickenpox)
• Rotavirus

Dosage

Children: Refer to specific vaccine guidelines for paediatric dosing.

Adults: Refer to specific vaccine guidelines for adult dosing.

Mechanism of action

Attenuated vaccines work by mimicking a natural infection. The weakened pathogen replicates in the body, stimulating the immune system to produce a response against it, which includes the activation of T-cells and the production of antibodies. This prepares the immune system to recognize and fight off the pathogen if exposed in the future.

Pharmacodynamics

The pharmacodynamics of attenuated vaccines involve the interaction of the attenuated pathogen with the host's immune system. Upon administration, the vaccine induces both humoral (antibody-mediated) and cell-mediated immunity. This leads to the development of memory cells that ensure a faster and more effective response upon subsequent exposure to the actual pathogen.

Pharmacokinetics

Attenuated vaccines are generally administered via subcutaneous or intramuscular injection. The pharmacokinetics are characterized by the distribution of the vaccine components within the body, with the attenuated organisms replicating locally and inducing an immune response. The onset of immunity typically occurs within weeks, and the duration of immunity can vary depending on the specific vaccine.

Contra-indications

• Severe immunodeficiency
• Pregnant women (specific live attenuated vaccines)
• Severe allergic reactions to vaccine components

Adverse effects

• Injection site reactions (pain, swelling, redness)
• Low-grade fever
• Malaise
• Rash
• Rare neurological complications (e.g., Guillain-Barré syndrome)

Interactions

• Immunosuppressive agents (may reduce vaccine efficacy)
• Blood products (may interfere with immune response to vaccine)
• Other live vaccines (timing may affect immune response)

Precautions

• History of allergic reactions to previous vaccinations
• Presence of active infections
• Chronic illnesses that may affect immune response

Pregnancy

Live attenuated vaccines are generally contraindicated during pregnancy due to potential risks to the fetus.

Breast-feeding

Most live attenuated vaccines are considered safe during breastfeeding, but caution and consultation with a healthcare provider are advised.

Storage

Store in a refrigerator at 2-8°C. Do not freeze. Protect from light.

Formulations

• Injectable suspension
• Oral suspension
• Lyophilized powder for reconstitution

Indications

• Schizophrenia
• Bipolar disorder
• Major depressive disorder (as an adjunct)
• Severe anxiety disorders

Dosage

Children: Refer to the BNF for Children for guidance on dosing in paediatric patients, as dosage should be determined based on age, weight, and clinical condition.

Adults: Refer to the specific guidelines in the BNF for appropriate dosing recommendations for adults, as dosage may vary based on the condition being treated and patient response.

Mechanism of action

Between acts primarily as an antagonist at dopamine D2 receptors and serotonin 5-HT2A receptors. By blocking these receptors, it reduces the effects of excessive dopamine activity, which is often implicated in psychotic symptoms, while also balancing serotonin levels, contributing to mood stabilization.

Pharmacodynamics

The pharmacodynamics of Between involve its ability to alter the balance of neurotransmitters in the brain, primarily dopamine and serotonin. This modulation leads to a reduction in psychotic symptoms such as hallucinations and delusions, and has mood-stabilizing effects in bipolar disorder. The onset of action may take several weeks to observe in some patients.

Pharmacokinetics

Between is typically absorbed well after oral administration, with peak plasma concentrations occurring within a few hours. The drug undergoes extensive hepatic metabolism, primarily via cytochrome P450 enzymes, leading to active metabolites. Its elimination half-life can vary, but it is generally eliminated through renal pathways. The pharmacokinetics may be influenced by factors such as age, liver function, and concurrent medications.

Pregnancy

Safety during pregnancy has not been established. Use only if clearly needed and the benefits outweigh risks.

Breast-feeding

Caution is advised as the effects on breastfeeding infants are not well studied. Use only if clearly needed.

Storage

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

Indications

• Diabetes mellitus (for bovine insulin)
• Hormonal deficiencies
• Certain metabolic disorders
• Growth hormone deficiencies

Dosage

Children: Refer to BNF for Children or specific product guidelines for pediatric dosing information.

Adults: Refer to specific product guidelines or clinical protocols, as dosing can vary widely among different bovine-derived products.

Mechanism of action

The mechanism of action for bovine-derived products can vary significantly depending on the specific component involved. For example, bovine insulin acts by facilitating glucose uptake in tissues, thereby lowering blood glucose levels. Other bovine-derived compounds may exert effects through different pathways, such as modulating immune responses or influencing metabolic processes.

Pharmacodynamics

Pharmacodynamics of bovine products largely depend on the active ingredients present. For instance, bovine insulin’s primary effect is to stimulate glucose uptake and inhibit hepatic glucose production. Other bovine-derived hormones may impact various physiological processes, such as growth, metabolism, and immune function.

Pharmacokinetics

The pharmacokinetics of bovine-derived medications can vary widely. Generally, proteins and peptides derived from bovine sources are subject to enzymatic degradation in the gastrointestinal tract, which may limit oral bioavailability. However, when administered via injection (as with insulin), the pharmacokinetics can be more predictable, with onset of action, peak times, and duration of effect influenced by formulation and route of administration.

Pregnancy

There is limited information on the safety of bovis during pregnancy. It is advised to use caution and consult healthcare professionals before use.

Breast-feeding

Due to insufficient data, it is recommended to consult a healthcare professional before using bovis while breastfeeding.

Storage

Store at room temperature, away from direct light and moisture. Keep out of reach of children.

Indications

• Cognitive enhancement
• Neuroprotective strategies in neurodegenerative diseases
• Potential roles in mood disorders

Dosage

Children: Refer to BNF for Children for specific dosing information.

Adults: Refer to BNF for specific dosing information.

Mechanism of action

Glutamate activates both ionotropic (AMPA, kainate, and NMDA receptors) and metabotropic glutamate receptors. It is primarily involved in neuronal signaling and synaptic transmission. Due to its inability to cross the blood-brain barrier, it is converted into L-glutamine for utilization in the brain.

Pharmacodynamics

As an excitatory neurotransmitter, glutamate is essential for normal brain function. It is a key player in neurotransmission and synaptic plasticity, influencing learning and memory. Moreover, it acts as a precursor for GABA synthesis in GABAergic neurons.

Pharmacokinetics

Glutamate is not freely available in significant quantities in the brain due to the blood-brain barrier. Instead, it is synthesized from glucose and other precursors. Its metabolism involves conversion into L-glutamine, which is then utilized in the brain. The transient nature of glutamate makes it challenging to study pharmacokinetically.

Pregnancy

Glutamate is generally regarded as safe during pregnancy when consumed in normal dietary amounts, but excessive intake, particularly in supplement form, should be approached with caution.

Breast-feeding

Glutamate is considered safe during breastfeeding as it is naturally present in various foods and is not expected to pose a risk to nursing infants.

Storage

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

Indications

• Measles
• Mumps
• Rubella
• Varicella (chickenpox)
• Yellow fever
• Rotavirus
• Intranasal influenza

Dosage

Children: Refer to the BNF for Children for specific dosing information based on age and vaccine type.

Adults: Refer to specific product guidelines for dosing information, as it can vary by vaccine type and brand.

Mechanism of action

Live vaccines work by introducing a weakened or attenuated form of a pathogen into the body. This stimulates the immune system to recognize and respond to the pathogen, leading to the production of antibodies and memory cells that provide long-term protection against future infections by the same pathogen.

Pharmacodynamics

The pharmacodynamics of live vaccines involve the activation of both humoral and cellular immunity. Following vaccination, the immune system generates a robust response, including the production of specific antibodies and the activation of T cells that can recognize and eliminate infected cells. This dual action helps establish long-term immunity.

Pharmacokinetics

The pharmacokinetics of live vaccines vary depending on the specific vaccine. Generally, the vaccine is administered via injection, allowing the live attenuated organisms to enter the bloodstream. The immune response typically begins within days and can last for years, depending on the vaccine. Live vaccines are usually stored under refrigeration to maintain their viability, and they should be administered within their expiration dates.

Interactions

• livevaccines + abrocitinib: Severe (increases risk of generalised infection (possibly life-threatening))
• livevaccines + baricitinib: Severe (increases risk of generalised infection (possibly life-threatening))
• livevaccines + filgotinib: Severe (increases risk of generalised infection (possibly life-threatening))
• livevaccines + dexrazoxane: Severe (increases risk of generalised infection (possibly life-threatening))
• livevaccines + iron chelators: Severe (increases risk of generalised infection (possibly life-threatening))
• livevaccines + ozanimod: Severe (increases risk of generalised infection (possibly life-threatening))
• livevaccines + ponesimod: Severe (increases risk of generalised infection (possibly life-threatening))
• livevaccines + siponimod: Severe (increases risk of generalised infection (possibly life-threatening))
• livevaccines + upadacitinib: Severe (increases risk of generalised infection (possibly life-threatening))
• livevaccines + diroximelfumarate: Moderate (increases risk of generalised infection (possibly life-threatening))

Indications

• Cancer (various types)
• Rheumatoid arthritis
• Multiple sclerosis
• Inflammatory bowel disease
• Psoriasis
• Hypercholesterolemia
• Infectious diseases (e.g., COVID-19)

Dosage

Children: Refer to the BNF for Children for paediatric dosing information, as it varies based on the specific monoclonal antibody and the condition being treated.

Adults: Refer to the specific monoclonal antibody product information for adult dosage, as it varies based on indication and specific agent used.

Mechanism of action

Monoclonal antibodies work by binding to specific proteins on the surface of cells. This binding can block the activity of certain proteins, mark cells for destruction by the immune system, or deliver cytotoxic agents directly to target cells. The mechanism of action varies depending on the specific monoclonal antibody but often involves modulation of immune response, inhibition of cell proliferation, and induction of apoptotic pathways.

Pharmacodynamics

The pharmacodynamics of monoclonal antibodies is primarily characterized by their specificity and affinity for targeted antigens. This leads to a variety of effects, including neutralization of pathogens, blockade of receptor-ligand interactions, and antibody-dependent cellular cytotoxicity. The clinical effects depend on the disease being treated and the specific antibody's action, such as inducing tumor regression in cancer or reducing inflammation in autoimmune diseases.

Pharmacokinetics

Monoclonal antibodies typically have a long half-life, allowing for less frequent dosing. They are generally administered intravenously or subcutaneously, with absorption and distribution influenced by the antibody's size and charge. The elimination occurs primarily through proteolytic degradation and intracellular recycling. Factors such as patient-specific variables, including immunogenicity and the presence of antibodies against the monoclonal antibody, can impact pharmacokinetics.

Interactions

• abatacept+monoclonalantibodies: Severe (increases risk of generalised infection (possibly life-threatening))
• anakinra+monoclonalantibodies: Severe (increases risk of generalised infection (possibly life-threatening))
• anthracyclines+monoclonalantibodies: Severe (increases risk of cardiotoxicity)
• filgotinib+monoclonalantibodies: Severe (increases risk of immunosuppression)
• monoclonalantibodies+fingolimod: Severe (increases risk of generalised infection (possibly life-threatening))
• normal immunoglobulin+monoclonalantibodies: Severe (affects effects)
• monoclonalantibodies+ozanimod: Severe (increases risk of generalised infection (possibly life-threatening))
• monoclonalantibodies+siponimod: Severe (increases risk of generalised infection (possibly life-threatening))
• monoclonalantibodies+vemurafenib: Severe (increases risk of hepatotoxicity)
• monoclonalantibodies+aminophylline: Moderate (decreases exposure)

Indications

• Hyponatremia
• Electrolyte imbalance
• Fluid replacement therapy
• Management of certain types of metabolic alkalosis

Dosage

Children: Dosage should be determined based on the clinical condition and should follow the guidelines provided in the BNF for Children.

Adults: Dosage varies depending on the condition being treated. Refer to specific guidelines for the appropriate dosage in individual cases.

Mechanism of action

Monosodium acts as an electrolyte, helping to maintain fluid balance and osmotic pressure in the body. It dissociates in solution to release sodium ions, which are critical for the proper functioning of cells, including nerve and muscle cells. Sodium ions play a crucial role in generating action potentials in neurons and muscle fibers.

Pharmacodynamics

Sodium is vital for maintaining homeostasis and is involved in various physiological processes. It contributes to the regulation of blood pressure, volume, and pH balance. The body regulates sodium levels through hormonal control, primarily via aldosterone, which promotes sodium reabsorption in the kidneys.

Pharmacokinetics

Sodium is absorbed in the gastrointestinal tract and is distributed throughout the body's extracellular fluid. The kidneys are primarily responsible for sodium excretion, and they adjust sodium reabsorption according to the body's needs. The half-life of sodium is not typically defined as it is continuously regulated by the body’s homeostatic mechanisms.

Indications

• Tuberculosis (TB)
• Leprosy
• Mycobacterial infections
• Nontuberculous mycobacterial infections

Dosage

Adults: Refer to specific treatment guidelines for dosing and duration of therapy, as it varies based on the drug and the severity

Mechanism of action

Mycobacterium species possess a unique cell wall structure rich in mycolic acids, which is crucial for their virulence. Antibiotics that target Mycobacterium, such as isoniazid and rifampicin, work by inhibiting cell wall synthesis or interfering with RNA synthesis, respectively. Isoniazid is a prodrug that becomes activated by the bacterial catalase-peroxidase enzyme, leading to the inhibition of mycolic acid synthesis. Rifampicin inhibits bacterial DNA-dependent RNA polymerase, preventing RNA transcription and bacterial replication.

Pharmacodynamics

The pharmacodynamics of Mycobacterium-targeting drugs relate to their ability to penetrate the bacterial cell wall and exert their effects. The efficacy of these drugs often depends on the growth phase of the bacteria, as some agents are more effective against actively dividing bacteria while others can target dormant forms. The immune response also plays a significant role in controlling mycobacterial infections, with the host's cellular immunity being crucial for clearing the infection.

Pharmacokinetics

Pharmacokinetics varies among different drugs used to treat Mycobacterium infections. For instance, isoniazid is readily absorbed from the gastrointestinal tract, with peak plasma concentrations occurring within 1 to 2 hours. It is metabolized in the liver through acetylation, and its half-life can vary significantly among individuals. Rifampicin also shows good oral bioavailability and is extensively metabolized in the liver, with a half-life of approximately 2 to 5 hours. Both drugs can penetrate well into tissues, including lung tissue, making them effective in treating pulmonary tuberculosis.

Adverse effects

• Hypersensitivity reactions
• Gastrointestinal disturbances
• Hepatotoxicity
• Peripheral neuropathy
• Rash
• Fever

Interactions

• Anticonvulsants may reduce efficacy
• Rifampicin may decrease serum concentrations of other drugs

Precautions

• Monitor liver function tests regularly
• Assess for signs of peripheral neuropathy
• Use with caution in patients with a history of liver disease

Pregnancy

Use in pregnancy only if the benefit justifies the potential risk to the fetus. Some agents may be teratogenic.

Breast-feeding

Excreted in breast milk. Use with caution and consider the risk-benefit ratio.

Storage

Store in a cool, dry place away from light. Specific storage conditions depend on the formulation.

Formulations

• Tablets
• Injectable solutions
• Suspensions

Dosage

Children: Refer to established pediatric dosing guidelines specific to Product, ensuring adherence to age and weight-based dosing recommendations.

Adults: Refer to the specific dosing guidelines for Product based on clinical indications. Standard adult dosing should be followed as per established pharmacological references.

Mechanism of action

The mechanism of action for Product typically involves modulation of specific receptors or pathways in the body, leading to a desired therapeutic effect. For instance, it may act on neurotransmitter systems, inhibit enzymes, or alter ion channel activity, depending on its primary use.

Pharmacodynamics

Product exhibits pharmacodynamic properties that are influenced by its concentration in the body, the interaction with target receptors, and the subsequent physiological response. The drug's effect can vary based on individual patient factors such as age, weight, and overall health.

Pharmacokinetics

The pharmacokinetics of Product includes absorption, distribution, metabolism, and excretion. It is typically absorbed through the gastrointestinal tract, with peak plasma concentrations occurring within a certain timeframe post-administration. The drug may be extensively metabolized in the liver, and its elimination half-life can vary, influencing dosing frequency.

Pregnancy

Safety during pregnancy has not been established. Use only if clearly needed and the benefits outweigh the risks.

Breast-feeding

Caution is advised. Evaluate the risk versus the benefit.

Storage

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

Indications

• Bacterial infections
• Viral infections
• Fungal infections
• Vaccination
• Rehydration therapy

Dosage

Children: Refer to the BNF for Children for appropriate dosing information based on the specific reconstituted medication and the child's age, weight, and clinical condition.

Adults: Refer to the specific product's prescribing information for detailed dosing guidelines. Doses vary depending on the drug being reconstituted and the condition being treated.

Mechanism of action

The mechanism of action for reconstituted drugs depends on the specific medication being reconstituted. For example, reconstituted antibiotics may work by inhibiting bacterial cell wall synthesis, disrupting protein synthesis, or interfering with nucleic acid metabolism. Each active ingredient will have its unique pathway that facilitates its therapeutic effect.

Pharmacodynamics

Pharmacodynamics refers to the study of the effects of drugs on biological systems. Reconstituted medications exhibit pharmacodynamic properties that are primarily dictated by their active ingredients. For antibiotics, this may involve bactericidal or bacteriostatic actions, determined by the drug's concentration and the susceptibility of the target bacteria. The onset of action, peak effect, and duration of action also vary based on the drug's formulation and the route of administration.

Pharmacokinetics

Pharmacokinetics involves the absorption, distribution, metabolism, and excretion of drugs. Reconstituted medications are typically administered parenterally, which allows for rapid absorption into the bloodstream. The pharmacokinetics of the drug will depend on its specific formulation and the characteristics of the diluent used. Factors such as volume of reconstitution and the solubility of the active ingredient can influence the drug's bioavailability and clearance rates. Generally, reconstituted drugs follow first-order kinetics, where the rate of elimination is proportional to the drug concentration in the plasma.

Pregnancy

Consult relevant guidelines, as safety varies with specific drugs being reconstituted.

Breast-feeding

Consult relevant guidelines, as safety may vary based on the drug.

Storage

Store reconstituted solutions as per specific drug guidelines, typically in a cool, dry place, protected from light.

Indications

• Muscle strain
• Tendon strain
• Acute pain management
• Inflammation control

Dosage

Children: Refer to specific medication guidelines as dosing varies by drug used for pain management.

Adults: Refer to specific medication guidelines as dosing varies by drug used for pain management.

Mechanism of action

The mechanism of injury in strains involves the disruption of muscle fibers or tendons due to excessive tension or force. This can lead to inflammation, pain, and impaired function. Inflammatory mediators are released at the site of injury, resulting in local vasodilation, increased permeability of blood vessels, and recruitment of immune cells which contribute to the healing process.

Pharmacodynamics

The pharmacodynamics of treating strains often involve the use of analgesics and anti-inflammatory medications, which work by inhibiting cyclooxygenase (COX) enzymes, leading to decreased production of prostaglandins. This reduces pain and inflammation associated with muscle or tendon injury. Physical therapy may also play a significant role in enhancing recovery and restoring function.

Pharmacokinetics

The pharmacokinetics of medications used for strains, such as NSAIDs, vary depending on the specific drug. Generally, these agents are absorbed rapidly from the gastrointestinal tract, peak in plasma concentration within a few hours, and have a half-life that varies widely. Metabolism typically occurs in the liver, and excretion is primarily via the kidneys. Individual responses can vary based on age, weight, and overall health.

Pregnancy

Consult healthcare provider before use.

Breast-feeding

Consult healthcare provider before use.

Storage

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

Mechanism of action

Glutamate activates both ionotropic and metabotropic glutamate receptors. The ionotropic ones being non-NMDA (AMPA and kainate) and NMDA receptors. Free glutamic acid cannot cross the blood-brain barrier in appreciable quantities; instead it is converted into L-glutamine, which the brain uses for fuel and protein synthesis. It is conjectured that glutamate is involved in cognitive functions like learning and memory in the brain, though excessive amounts may cause neuronal damage associated in diseases like amyotrophic lateral sclerosis, lathyrism, and Alzheimer's disease. Also, the drug phencyclidine (more commonly known as PCP) antagonizes glutamate at the NMDA receptor, causing behavior reminiscent of schizophrenia. Glutamate in action is extremely difficult to study due to its transient nature.

Pharmacodynamics

In addition to being one of the building blocks in protein synthesis, it is the most widespread neurotransmitter in brain function, as an excitatory neurotransmitter and as a precursor for the synthesis of GABA in GABAergic neurons.