NUTRIFLEX OMEGA PERI EMULSION FOR INFUSION (Each 1000mls contains Gluc. H2O / NaH2 phos. dehydrate / Zn acet. dehydrate/ Medium-chain tg/ Soya-bean oil / Omega-3 tg / Egg phos. for inj. / Glyc. / Na cit. / Alph-toco. / AAS / NaCl / NaOH / Na acet 3H2O / K acet/ Mg acet 4H2O 176g/2.34g/ 0.0182g/100g/ 80g/20g/ 12g/25g/0.3g/ 9.2g/82.12/2.162g/ 1.6g/ 1.088g/5.886g/1.288g)

Indications

• Glaucoma
• Epilepsy
• Altitude sickness
• Metabolic alkalosis
• Congestive heart failure
• Idiopathic intracranial hypertension

Dosage

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

Adults: Refer to the BNF for specific dosing information.

Mechanism of action

Acetazolamide inhibits the enzyme carbonic anhydrase, which catalyzes the reversible hydration of carbon dioxide to bicarbonate and protons. This inhibition leads to decreased bicarbonate reabsorption in the kidneys, resulting in increased bicarbonate and water excretion, and consequently, a mild diuretic effect. The reduction in bicarbonate levels also affects acid-base balance, which can be useful in treating metabolic alkalosis.

Pharmacodynamics

By inhibiting carbonic anhydrase, acetazolamide affects the bicarbonate buffering system, leading to metabolic acidosis, which can increase respiratory drive and improve gas exchange. This mechanism is particularly useful in conditions like altitude sickness where hypoxia is prevalent. Acetazolamide also reduces intraocular pressure, making it effective in glaucoma management.

Pharmacokinetics

Acetazolamide is well absorbed from the gastrointestinal tract, with peak plasma concentrations occurring within 1-3 hours after oral administration. It has a volume of distribution of 0.5-1 L/kg and is primarily eliminated through the kidneys. The half-life of acetazolamide is approximately 10 hours, but this can vary based on renal function. It is important to monitor renal function in patients taking this medication due to its renal clearance pathway.

Interactions

• acetazolamide+methenamine: Severe (decreases efficacy)
• acetazolamide+antiepileptics: Unknown (increases risk of overheating and dehydration)
• acetazolamide+zonisamide: Unknown (increases risk of overheating and dehydration)
• acetazolamide+lithium: Unknown (affects concentration)

Indications

• Vitamin E deficiency
• Antioxidant supplementation
• Skin health improvement
• Support for immune function

Dosage

Children: Refer to the BNF for Children for appropriate dosing information.

Adults: Refer to clinical guidelines for specific dosing; typical supplementation ranges from 15 mg to 1000 mg daily depending on the indication.

Mechanism of action

Alpha-tocopherol exerts its antioxidant effects by donating electrons to free radicals, thereby stabilizing them and preventing cellular damage. It is incorporated into cell membranes, where it helps to maintain membrane integrity and fluidity by preventing lipid peroxidation. Additionally, it may enhance the immune response and influence gene expression.

Pharmacodynamics

Alpha-tocopherol has been shown to have various pharmacological effects, including anti-inflammatory properties, modulation of cell signaling pathways, and potential roles in preventing chronic diseases such as cardiovascular disease and certain cancers. Its antioxidant capacity is primarily responsible for its protective effects against oxidative stress.

Pharmacokinetics

Alpha-tocopherol is absorbed in the intestines and is dependent on dietary fat for optimal absorption. Once absorbed, it is transported in the bloodstream via lipoproteins. The liver plays a significant role in the metabolism of alpha-tocopherol, which is then distributed to various tissues. The elimination half-life is variable but generally ranges from 48 to 72 hours, with excretion primarily occurring through bile.

Pregnancy

There is limited data on the use of alphtoco in pregnancy. It is advisable to consult with a healthcare provider before use.

Breast-feeding

It is unknown if alphtoco is excreted in human breast milk. Caution is recommended when administering to breastfeeding women.

Storage

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

Indications

• Mild to moderate dehydration
• Severe dehydration
• Diarrhea-related dehydration
• Vomiting-related dehydration
• Heat-related illnesses
• Post-operative fluid replacement

Dosage

Children: In children, the oral rehydration solution is typically administered at a rate of 75

Adults: The specific dosage for rehydration will vary based on the severity of dehydration. In mild cases, oral rehydration solutions can be administered at a rate of 50-100 mL/kg over 2-4 hours. For moderate to severe dehydration, intravenous fluids may be indicated, and specific protocols should be followed based on clinical guidelines.

Mechanism of action

Dehydration itself does not have a mechanism of action as it is a physiological state rather than a pharmacological agent. However, the treatment for dehydration typically involves the administration of fluids and electrolytes, either orally or intravenously, to restore hydration status. The rehydration process helps to restore normal blood volume and electrolyte balance, facilitating cellular functions and overall metabolic processes.

Pharmacodynamics

The pharmacodynamics of rehydration solutions involve the restoration of body fluid levels and the correction of electrolyte imbalances. Oral rehydration solutions (ORS) contain a balanced ratio of salts and sugars, which enhance the absorption of water in the intestines. This process helps to re-establish osmotic balance, improve hydration, and support physiological functions. In severe cases, intravenous fluids may be required to rapidly replenish lost fluids and electrolytes.

Pharmacokinetics

The pharmacokinetics of rehydration fluids depend on the type of fluid administered. Oral rehydration solutions are absorbed primarily in the small intestine, with the absorption rate influenced by the osmolarity and composition of the solution. Intravenous fluids are distributed directly into the bloodstream, with effects seen almost immediately. The elimination of excess fluids occurs through renal excretion, which helps maintain homeostasis.

Contra-indications

• Hypersensitivity to the active substance or any of the excipients
• Severe dehydration
• Acute kidney injury

Adverse effects

• Electrolyte imbalance
• Hypotension
• Dizziness
• Dry mouth
• Thirst
• Skin rash
• Nausea
• Vomiting

Interactions

• Caution with concomitant use of diuretics
• May interact with other medications affecting electrolyte levels
• Potential interaction with medications that affect kidney function

Precautions

• Use with caution in patients with renal impairment
• Monitor electrolyte levels during therapy
• Ensure adequate hydration during treatment

Pregnancy

Use only if clearly needed and prescribed by a healthcare professional. Risk-benefit should be considered.

Breast-feeding

Consult healthcare provider before use. Monitor infant for any adverse effects.

Storage

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

Formulations

• Oral solution
• Oral powder
• Intravenous solution

Indications

• Cough associated with the common cold
• Acute bronchitis
• Chronic bronchitis
• Respiratory tract infections

Dosage

Children: Refer to the BNF for Children for specific dosing recommendations.

Adults: Refer to the BNF for specific dosing recommendations.

Mechanism of action

Guaifenesin enhances the output of phlegm and bronchial secretions by decreasing the viscosity and adhesiveness of such material. It may also act as an irritant to gastric vagal receptors, leading to increased glandular exocytosis of less viscous mucus. This action is thought to facilitate the cough reflex, helping to clear obstructed airways. Additionally, guaifenesin has been suggested to exhibit anticonvulsant and muscle relaxant properties, possibly through NMDA receptor antagonism.

Pharmacodynamics

Guaifenesin is categorized as an expectorant, promoting increased flow and decreased viscosity of respiratory secretions. By enhancing mucociliary clearance, guaifenesin aids in transforming dry, unproductive coughs into more effective coughs that help to clear accumulated mucus from the airways. Its effects are aimed at improving respiratory function during conditions that involve thickened secretions.

Pharmacokinetics

Guaifenesin is well absorbed from the gastrointestinal tract and is rapidly distributed throughout the body. It is metabolized in the liver and excreted primarily in the urine. The onset of action typically occurs within 30 minutes to 1 hour after administration, with a duration of effect lasting for several hours. The pharmacokinetics of guaifenesin can be influenced by factors such as renal function and concurrent medications.

Interactions

• clozapine+glycopyrronium: Unknown (additive effect)
• antipsychotics, second generation+glycopyrronium: Unknown (additive effect)

Pregnancy

There is insufficient data on the use of guaifenesin during pregnancy. It should only be used if the potential benefit justifies the potential risk to the fetus.

Breast-feeding

Guaifenesin is excreted in breast milk. Caution should be exercised when administering guaifenesin to nursing mothers.

Storage

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

Formulations

• Oral solution
• Tablets
• Syrup

Indications

• Hypovolemia
• Dehydration
• Electrolyte imbalances
• Uterine contractions for abortion (in specific contexts)
• Intravenous fluid replacement

Dosage

Children: Refer to BNF for Children for specific dosing guidelines and formulations.

Adults: Refer to BNF for specific dosing guidelines and formulations.

Mechanism of action

Sodium and chloride work together as major electrolytes to regulate extracellular volume and blood pressure. Changes in sodium concentrations in the extracellular fluid can lead to disorders of water balance. Hypertonic sodium chloride solutions can induce uterine contractions, which may lead to abortion by releasing prostaglandins from damaged decidual cells.

Pharmacodynamics

Sodium, as the principal cation in extracellular fluid, plays a crucial role in controlling water distribution, fluid balance, and osmotic pressure. It is also involved in acid-base equilibrium alongside chloride and bicarbonate, while chloride concentrations reflect the body's acid-base status.

Pharmacokinetics

Sodium chloride is readily absorbed and distributed throughout the extracellular fluid. The excretion of sodium primarily occurs through the kidneys, with regulation influenced by various hormones, including aldosterone. Chloride follows sodium in its movements and metabolism.

Pregnancy

Intra-amniotic instillation of sodium chloride can induce abortion and fetal death, and should be used with caution in pregnant women.

Breast-feeding

No specific information available; consult a healthcare professional for advice.

Storage

Store at room temperature, protect from light, and keep container tightly closed.

Formulations

• 20% sodium chloride injection

Dosage

Children: Sodium hydroxide is not indicated for pediatric use due to its high causticity and potential for severe tissue damage.

Adults: Sodium hydroxide is not used for therapeutic dosing in adults due to its corrosive nature. It is primarily used in industrial applications.

Mechanism of action

Sodium hydroxide in aqueous solution causes bond breakage in proteins, particularly disulfide bridges, due to its high alkalinity. This leads to the dissolution of hair and fingernails after prolonged contact. The caustic properties result in severe tissue damage and necrosis at the application site, with the extent of injury dependent on the concentration and duration of exposure.

Pharmacodynamics

Sodium hydroxide forms a strongly alkaline and caustic solution. As a caustic agent, it destroys organic tissue through chemical action, leading to significant cellular damage and necrosis.

Pharmacokinetics

Sodium hydroxide does not undergo significant metabolism and does not have a typical pharmacokinetic profile like other drugs. Its effects are localized to the site of exposure, where it acts rapidly upon contact with tissue.

Adverse effects

• Severe skin burns
• Corrosive injury to eyes
• Respiratory distress if inhaled
• Gastrointestinal burns if ingested

Precautions

• Handle with care to avoid skin and eye contact
• Use appropriate personal protective equipment
• Avoid inhalation of vapors

Pregnancy

Sodium hydroxide should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus, as it is a caustic agent.

Breast-feeding

Caution is advised when using sodium hydroxide while breastfeeding due to its corrosive nature.

Storage

Store in a cool, dry place, away from incompatible materials, in a tightly closed container.

Formulations

• Sodium hydroxide solution (various concentrations)

Mechanism of action

Although the exact mechanism of action of guaifenesin may not yet be formally or totally elucidated, it is believed that expectorants like guaifenesin function by increasing mucus secretion. Moreover, it is also further proposed that such expectorants may also act as an irritant to gastric vagal receptors, and recruit efferent parasympathetic reflexes that can elicit glandular exocytosis that is comprised of a less viscous mucus mixture. Subsequently, these actions may provoke coughing that can ultimately flush difficult to access, congealed mucopurulent material from obstructed small airways to facilitate a temporary improvement for the individual. Consequently, while it is generally proposed that guaifenesin functions as an expectorant by helping to loosen phlegm (mucus) and thin bronchial secretions to rid the bronchial passageways of bothersome mucus and make coughs more productive, there has also been research to suggest that guaifenesin possesses and is capable of demonstrating anticonvulsant and muscle relaxant effects to some degree possibly by acting as an NMDA receptor antagonist. Guaifenesin is thought to act as an expectorant by increasing the volume and reducing the viscosity of secretions in the trachea and bronchi. Thus it may increase the efficiency of the cough reflex and facilitate removal of the secretions; however, objective evidence for this is limited and conflicting. By increasing respiratory tract fluid, guaifenesin reduces the viscosity of tenacious secretions and acts as an expectorant. Guaifenesin, a commonly used agent for the treatment of cough, is termed an expectorant since it is believed to alleviate cough discomfort by increasing sputum volume and decreasing its viscosity, thereby promoting effective cough. Despite its common usage, relatively few studies, yielding contrasting results, have been performed to investigate the action and efficacy of guaifenesin. To evaluate the effect of guaifenesin on cough reflex sensitivity. Randomized, double-blind, placebo-controlled trial. Fourteen subjects with acute viral upper respiratory tract infection (URI) and 14 healthy volunteers. On 2 separate days, subjects underwent capsaicin cough challenge 1 to 2 hr after receiving a single, 400-mg dose (capsules) of guaifenesin or matched placebo. Measurements and results: The concentration of capsaicin inducing five or more coughs (C(5)) was determined. Among subjects with URI, mean (+/- SEM) log C(5) after guaifenesin and placebo were 0.92 +/- 0.17 and 0.66 +/- 0.14, respectively (p = 0.028). No effect on cough sensitivity was observed in healthy volunteers. /The/ results demonstrate that guaifenesin inhibits cough reflex sensitivity in subjects with URI, whose cough receptors are transiently hypersensitive, but not in healthy volunteers. Possible mechanisms include a central antitussive effect, or a peripheral effect by increased sputum volume serving as a barrier shielding cough receptors within the respiratory epithelium from the tussive stimulus.

Pharmacodynamics

Guaifenesin is categorized as an expectorant that acts by enhancing the output of phlegm (sputum) and bronchial secretions via decreasing the adhesiveness and surface tension of such material. Furthermore, guaifenesin elicits an increased flow of less viscous gastric secretions that subsequently promote ciliary action - all actions that ultimately change dry, unproductive coughing to coughs that are more productive and less frequent. Essentially, by decreasing the viscosity and adhesiveness of such secretions, guaifenesin enhances the efficacy of mucociliary activity in removing accumulated secretions from the upper and lower airway.

Mechanism of action

Sodium and chloride - major electrolytes of the fluid compartment outside of cells (i.e., extracellular) - work together to control extracellular volume and blood pressure. Disturbances in sodium concentrations in the extracellular fluid are associated with disorders of water balance. Intra-amniotic instillation of 20% sodium chloride injection induces abortion and fetal death. Although the mechanism has not been conclusively determined, some studies indicate that the drug's abortifacient activity may be mediated by prostaglandins released from decidual cells damaged by hypertonic solutions of sodium chloride. Hypertonic sodium chloride-induced uterine contractions are usually sufficient to cause evacuation of both the fetus and placenta; however, abortion may be incomplete in 25-40% of patients. /20% injection/

Pharmacodynamics

Sodium, the major cation of the extracellular fluid, functions primarily in the control of water distribution, fluid balance, and osmotic pressure of body fluids. Sodium is also associated with chloride and bicarbonate in the regulation of the acid-base equilibrium of body fluid. Chloride, the major extracellular anion, closely follows the metabolism of sodium, and changes in the acid-base balance of the body are reflected by changes in the chloride concentration.

Mechanism of action

Because of its high-level alkalinity, sodium hydroxide in aqueous solution directly causes bond breakage in proteins (especially disulfide bridges). Hair and fingernails are found to be dissolved after 20 hours of direct contact with sodium hydroxide at pH values higher than 9.2. Sodium hydroxide has depilatory effects which have been described after accidental contact with solutions in the workplace. The breakage of bonds in proteins may lead to severe necrosis to the application site. The level of corrosion depends on the period of contact with the tissue, and on the concentration of sodium hydroxide.

Pharmacodynamics

Sodium Hydroxide 10% forms a strongly alkaline and caustic solution. As a caustic agent, it is used to destroy organic tissue by chemical action.