Definition
go, so biperiden may not be needed on a regular basis.
Biperiden is classified as an antiparkinsonian agent. It
is sold in the United States under the brand name of
Akineton.
Read more: Biperiden - dose, children, effects,
therapy, drug, person, people, used, medication, brain,
effect, health, Definition, Purpose, Description,
Recommended dosage, Precautions
http://www.minddisorders.com/A-
Br/Biperiden.html#ixzz0fESIxN59
Biperiden is used to treat a group of side effects
(called parkinsonian side effects) that include tremors,
difficulty walking, and slack muscle tone. These side
effects may occur in patients who are taking
antipsychotic medications used to treat mental
disorders such as schizophrenia .
Description
Some medicines, called antipsychotic drugs, that are
used to treat schizophrenia and other mental disorders
can cause side effects that are similar to the symptoms
of Parkinson's disease. The patient does not have
Parkinson's disease, but he or she may experience
shaking in muscles while at rest, difficulty with
voluntary movements, and poor muscle tone. These
symptoms are similar to the symptoms of Parkinson's
disease.
One way to eliminate these undesirable side effects is
to stop taking the antipsychotic medicine.
Unfortunately, the symptoms of the original mental
disorder usually come back, so in most cases simply
stopping the antipsychotic medication is not a
reasonable option. Some drugs such as biperiden that
control the symptoms of Parkinson's disease also
control the parkinsonian side effects of antipsychotic
medicines.
Biperiden works by restoring the chemical balance
between dopamine and acetylcholine, two
neurotransmitter chemicals in the brain . Taking
biperiden along with the antipsychotic medicine helps
to control symptoms of the mental disorder, while
reducing parkinsonian side effects. Biperiden is in the
same family of drugs (commonly known as
anticholinergic drugs) as benztropine , amantadine ,
and trihexyphenidyl .
Recommended dosage
Biperiden is available in 2-mg tablets. For the
treatment of tremor, poor muscle tone, and similar
parkinsonian side effects, the dose of biperiden is 2
mg orally one to three times daily. Parkinson-like side
effects caused by antipsychotic drugs may come and
Biperiden may also be prescribed to prevent these side
effects before they actually occur. This is called as
prophylactic (preventative) therapy.
Precautions
Biperiden should never be used in children under age
three. It should be used cautiously and with close
physician supervision in older children and in the
elderly. Biperiden, like all anticholinergic drugs,
decreases sweating and the body's ability to cool itself.
People who are unaccustomed to being outside in hot
weather should take care to stay as cool as possible
and drink extra fluids. People who are chronically ill,
have a central nervous system disease, or who work
outside during hot weather may need to avoid taking
biperiden.
People who have the following medical problems may
experience increased negative side effects when taking
biperiden. Anyone with these problems should discuss
their condition with their physician before starting the
drug:
• glaucoma, especially closed-angle glaucoma
• intestinal obstruction
• prostate enlargement
• urinary bladder obstruction
Although rare, some patients experience euphoria
while taking biperiden and may abuse it for this
reason. Euphoria can occur at doses only two to four
times the normal daily dose. Patients with a history of
drug abuse should be observed carefully for biperiden
abuse.
Side effects
Although biperiden helps control the side effects of
antipsychotic drugs, it can produce side effects of its
own. A person taking biperiden may have some of the
following side effects, which may vary in intensity:
• dry mouth
• dry skin
• blurred vision
• nausea or vomiting
• constipation
• disorientation
• drowsiness
• irritability
• increased heart rate
• urinary retention
Dry mouth, if severe to the point of causing difficulty INDICATION / USES:
in speaking or swallowing, may be managed by •Organic Psychoses
dosage reduction or temporary discontinuation of the • acute psychotic symptoms
drug. Chewing sugarless gum or sucking on sugarless • Relieve hallucinations, delusions, disorganized
candy may also help to increase the flow of saliva. thinking
Some artificial saliva products may give temporary • severe anxiety
relief. • seizures

Men with prostate enlargement may be especially

prone to urinary retention. Symptoms of this problem COMMON ADVERSE EFFECTS:
include having difficulty starting a urine flow and •CNS: extrapyramidal symptom such as muscle
more difficulty passing urine than usual. This side rigidity or spasm, shuffling gait, posture leaning
effect may be severe and require discontinuation of the forward, drooling, masklike facial appearance,
drug. Urinary retention may require catheterization. dysphagia, akathisia, tardive dyskinesia, headache,
People who think they may be experiencing any side seizures.
effects from this or any other medication should tell •CV: tachycardia, arrhythmias, hypertension,
their physicians. orthostatic hypertension.
•EENT: blurred vision, glaucoma
Patients who take an overdose of biperiden are treated • GI: dry mouth, anorexia, nausea, vomiting,
with forced vomiting, removal of stomach contents constipation, diarrhea, weight gain.
and stomach washing, activated charcoal, and • GU: urinary frequency, urine retention, impotence,
respiratory support if needed. They are also given enuresis, amenorrhea, gynecomastia
physostigmine, an antidote for anticholinergic drug • Hematologic: anemia, leucopenia, agranulocytosis
poisoning. • Skin: rash, dermatitis, phtosensitivity

Interactions
When drugs such as biperiden are taken with
antidepressants such as amitriptyline , imipramine ,
trimipramine , desipramine , nortriptyline ,
protriptyline , amoxapine , and doxepin , as well as
with many antihistamines that also have
anticholinergic properties, the effects of biperiden are
usually intensified.
Drugs such as biperiden decrease the speed with
which food moves through the stomach and intestines.
Because of this, it is possible that the absorption of
some drugs may be enhanced by biperiden. Patients
receiving biperiden should be observed for unusual
responses to other drugs they might be taking.
Generic name:
haloperidol
Brand name:
Haldol
Preparations:
Tablets: 0.5mg, 1mg, 2mg, 5mg, 10mg
CLASSIFICATION: Antipsychotics
ACTION:
• Alters the effects of dopamine in the CNS
• Also has anticholinergic and alpha-adrenergic
blocking activity.
• Diminished signs and symptoms of psychoses
CONTRA-INDICATIONS:
• seizure disorder
• glaucoma
• elderly clients
NURSING CONSIDERATIONS:
• Assess mental status prior to and periodically during
therapy.
• Monitor BP and pulse prior to and frequently during
the period of dosage adjustment. May cause QT
interval changes on ECG.
• Observe patient carefully when administering
medication, to ensure that medication is actually taken
and not hoarded.
•Monitor I&O ratios and daily eight. Assess patient for
signs and symptoms of dehydration.
• Monitor for development of neuroleptic malignant
syndrome (fever, respiratory distress, tachycardia,
seizures, diaphoresis, hypertension or hypotension,
pallor, tiredness, severe muscle stiffness, loss of
bladder control. Report symptoms immediately. May
also cause leukocytosis, elevated liver function tests,
elevated CPK.
• Advise patient to take medication as directed. Take
missed doses as soon as remembered, witih remaining
doses evenly spaced through out the day. May require
several weeks to obtain desired effects. Do not
increase dose or discontinue medication without
consulting health care professional. Abrupt withdrawal
may cause dizziness, nausea, vomiting, GI upset,
trembling, or uncontrolled movements of mouth,
tongue or jaw.
Lithium is commonly used to treat mania and bipolar
depression (manic-depression or bipolar disorder ).
Less commonly, lithium is used to treat certain mood
disorders, such as schizoaffective disorder and
aggressive behavior and emotional instability in adults
and children. Rarely is lithium taken to treat
depression in the absence of mania. When this is the
case, it is usually taken in addition to other
antidepressant medications.
Description
Lithium salts have been used in medical practice for
about 150 years. Lithium salts were first used to treat
gout. It was noted in the 1880s that lithium was
somewhat effective in the treatment of depression, and
in the 1950s lithium was seen to improve the
symptoms of bipolar disease. The way lithium works
in the body is unclear, but its therapeutic benefits are
probably related to its effects on other electrolytes
such as sodium, potassium, magnesium, and calcium.
Lithium is taken either as lithium carbonate tablets or
capsules or as lithium citrate syrup.
The therapeutic effects of lithium may appear slowly.
Maximum benefit is often not evident for at least two
weeks after starting the drug. People taking lithium
should be aware of this and continue taking the drug
as directed even if they do not see immediate changes
in mood.
Lithium is available in 300-mg tablets and capsules,
300-mg and 450-mg sustained-release tablets, and a
syrup containing approximately 300 mg per
teaspoonful.
Recommended dosage
Depending on the patient's medical needs, age, weight,
and kidney function, doses of lithium can range from
600 to 2,400 mg per day, although most patients will
be stabilized on 600 to 1,200 mg per day. Patients who
require large amounts of lithium often benefit from the
addition of another anti-manic drug, which may allow
the dose of lithium to be lowered.
Generally, lithium is taken two or three times daily.
However, the entire dose may be taken at once if the
physician believes that a single daily-dose program
will increase patient compliance . The single dose
schedule is especially helpful for people who are
forgetful and may skip doses on a multiple dose
schedule. Additionally, evidence indicates that once-
daily doses are associated with fewer side effects.
More than with any other drug used in the treatment of
mental disorders, it is essential to maintain lithium
blood levels within a certain narrow range to derive
the maximum therapeutic benefit while minimizing
serious negative side effects. It is important that
people taking lithium have their blood levels of
lithium measured at regular intervals.
Precautions
Because lithium intoxication may be serious and even
life-threatening, blood concentrations of lithium
should be measured weekly during the first four weeks
of therapy and less often after that.
Patients taking lithium should have their thyroid
function monitored and maintain an adequate sodium
(salt) and water balance. Lithium should not be used
or used only with very close physician supervision by
people with kidney impairment, heart disease, and
other conditions that affect sodium balance. Dosage
reduction or complete discontinuation may be
necessary during infection, diarrhea, vomiting, or
prolonged fast. Patients who are pregnant, breast-
feeding, those over age 60, and people taking diuretics
("water pills") should discuss the risks and benefits of
lithium treatment with their doctor before beginning
therapy. Lithium should be discontinued 24 hours
before a major surgery, but may be continued
normally for minor surgical procedures.
Side effects
Tremor is the most common neurological side effect.
Lithium tremor is an irregular, non-rhythmic twitching
of the arms and legs that is variable in both intensity
and frequency. Lithium-induced tremor occurs in
approximately half of persons taking this medication.
The chance of tremor decreases if the dose is reduced.
Acute lithium toxicity (poisoning) can result in
neurological side effects, ranging from confusion and
coordination impairment, to coma, seizures , and
death. Other neurological side effects associated with
lithium therapy include lethargy, memory impairment,
difficulty finding words, and loss of creativity.
About 30 to 35% of patients experience excessive
thirst and urination, usually due to the inability of the
kidneys to retain water and sodium. However, lithium
is not known to cause kidney damage.
Lithium inhibits the synthesis of thyroid hormone.
About 10 to 20% of patients treated with lithium
develop some degree of thyroid insufficiency, but they
usually do not require supplementation with thyroid
hormone tablets.
Gastrointestinal side effects include loss of appetite,
nausea, vomiting, diarrhea, and stomach pain. Weight
gain is another common side effect for patients
receiving long-term treatment. Changes in saliva flow
and enlargement of the salivary glands may occur. An
increase in tooth cavities and the need for dental care
among patients taking lithium has been reported.
Skin reactions to lithium are common but can usually
be managed without discontinuing lithium therapy.
Lithium may worsen folliculitis (inflammation of hair
follicle), psoriasis, and acne. Thinning of the hair may
occur, and, less commonly, hair loss may be
experienced. Swollen feet are an uncommon side
effect that responds to dose reduction.
Electrocardiographic (EKG) abnormalities may occur
with lithium therapy, but significant cardiovascular
effects are uncommon except as the result of
deliberate or accidental overdose.
A mild-to-moderate increase in the number of white
blood cells is a frequent side effect of lithium.
Conversely, lithium may slow the formation of red
blood cells and cause anemia.
Increased risk of fetal cardiovascular disease may be
associated with the use of lithium during pregnancy,
especially during the first trimester (first three
months). For this reason, once a woman becomes
pregnant, lithium should be discontinued until the
second or third trimester and the patient receives
alternative treatments for her mania.
Interactions
People taking lithium should always be concerned that
other medications they are taking may adversely
interact with it; patients should consult their physician
or pharmacists about these interactions. The following
list represents just some of the medications that
lithium may interact with to either (a) increase or
decrease the effectiveness of the lithium or (b)
increase or decrease the effectiveness of the other
drug:
• angiotensin-converting enzyme inhibitors
such as captopril, lisinopril, or enalapril
• non-steroidal anti-inflammatory drugs such
as ibuprofen or naprosyn
• diuretics (water pills) such as
hydrochlorothiazide, furosemide, or
ethacrynic acid
• asthma drugs such as theophylline and
aminophylline
• anticonvulsants such as phenytoin and
carbamazepine
• calcium channel blockers such as verapamil
or diltiazem
• muscle relaxants such as methocarbamol,
carisoprodol, and cyclobenzaprine
• metronidazole, a commonly prescribed
antibiotic, used to treat infections
• antidiabetic therapy
• amiodarone, an anti-arrhythmic drug
• antacids containing sodium bicarbonate
• antidepressants
• http://www.minddisorders.com/Kau-
Nu/Lithium-carbonate.html,
http://www.nursing-nurse.com/drug-study-
haloperidol-haldol-164/
Carbamazepine is an anticonvulsant that is structurally
related to tricyclic antidepressants such as
amitriptyline and imipramine . In the United States,
carbamazepine is sold under the trade names Tegretol
and Carbatrol.
Purpose
Carbamazepine is effective in the treatment of
psychomotor and grand mal seizures and a type of
facial pain called trigeminal neuralgia and, in
combination with other drugs, for psychiatric
disorders such as mania and extreme aggression.
Carbamazepine is also occasionally used to control
pain in persons with cancer.
Description
Carbamazepine was first marketed as an anti-seizure
medication and as a first-line treatment for trigeminal
neuralgia. Because it was later noted to be effective in
patients with certain psychiatric disorders,
psychiatrists began combining it with other drugs such
as lithium and major tranquilizers in severe cases of
bipolar disease and aggressive behavior that could not
be managed with single-drug therapy.
Carbamazepine is available in 100-mg chewable
tablets, 200-mg capsules and a suspension at 100 mg
per 5 ml of liquid.
Recommended dosage
When used to treat seizure disorders or psychiatric
disease, the recommended initial dosage of
carbamazepine is 200 mg two times each day. If
needed, the daily dosage may be increased by 200 mg
once each week. Total daily dosages should not
exceed 1,000 mg in children between the ages of 12
and 15 years. Total daily dosages for adults should not
exceed 1,200 mg. Carbamazepine should be taken
with meals.
Precautions
Carbamazepine should be used with caution in persons
who also experience other types of seizure disorders
such as atypical absence seizures. Among such
individuals, carbamazepine usage has been associated
with an increased risk of initiating, rather than
controlling, generalized convulsions.
Carbamazepine should never be discontinued abruptly
unless another treatment for seizures is initiated at the
same time. If this does not happen, acute withdrawal
of carbamazepine may result in seizures.
Patients should be alert for signs and symptoms of
bone marrow toxicity such as fever, sore throat,
infection, mouth sores, easy bruising, or bleeding
which occurs just under the skin.
Because carbamazepine may affect mental alertness,
especially early in therapy, patients receiving this drug
should not operate dangerous machinery or drive a car
until they understand how the drug will affect them.
Side effects
The most commonly reported adverse reactions to
carbamazepine include dizziness, drowsiness,
unsteadiness, nausea and vomiting. These are more
common when therapy is just beginning.
Carbamazepine has been reported to cause aplastic
anemia. This is a form of anemia that is generally does
not respond to treatment. The bone marrow of persons
with aplastic anemia does not produce adequate
amounts of red blood cells, white blood cells, and
platelets. Blood counts should be monitored for
individuals using this drug. Some people with
previously diagnosed depression of the bone marrow
should not take carbamazepine.
Carbamazepine may cause birth defects and should be
avoided by women who are pregnant. An effective
contraceptive method should be used while taking
carbamazepine. It is important to note that this
medication may decrease the effectiveness of oral
contraceptives.
The drug can cross into breast milk and should be
avoided by women who are breast-feeding.
Carbamazepine may also cause a skin rash or
sensitivity to the sun.
Interactions
Blood levels of carbamazepine may be reduced when
it is used in combination with other drugs such as
phenobarbitol, phenytoin or primidone. This means
that inadequate amounts of carbamazepine are
available to the body, limiting the ability of the drug to
control seizure activity or treat psychiatric disease.
Carbamazepine also causes reductions in the blood
levels of the following drugs when they are used
simultaneously: phenytoin, warfarin, doxycycline,
haloperidol , valproic acid , and theophylline.
The simultaneous administration of carbamazepine
with erythromycin, cimetidine, propoxyohene,
isoniacid, fluoxetine and calcium channel blockers
such as nifedipine or verapamil may increase the
blood level of carbamazepine to a toxic range.
The simultaneous use of carbamazepine and oral
contraceptives may increase the possibility that the
oral contraceptive won't be effective in preventing
pregnancy. Some physicians recommend that a
different method of contraception be used while
carbamazepine is being used.
People taking carbamazepine should not drink
grapefruit juice. Grapefruit juice slows the breakdown
of carbamazepine, increasing the concentration of
carbamazepine in the bloodstream.
Due to the potential of many interactions with other
drugs, individuals should consult with a physician or
pharmacist prior to starting any new medications
either bought over the counter or initiated by another
physician. .http://www.minddisorders.com/Br-
Del/Carbamazepine.html
A multivitamin is a preparation intended to
supplement a human diet with vitamins, dietary
minerals and other nutritional elements. Such
preparations are available in the form of tablets,
capsules, pastilles, powders, liquids and injectable
formulations. Other than injectable formulations,
which are only available and administered under
medical supervision, multivitamins are recognized by
the Codex Alimentarius Commission (the United
Nations' authority on food standards) as a category of
food.[1] Multivitamin supplements are commonly
provided in combination with minerals. A
multivitamin/mineral supplement is defined in the
United States as a supplement containing 3 or more
vitamins and minerals that does not include herbs,
hormones, or drugs, where each vitamin and mineral is
included at a dose below the tolerable upper level, as
determined by the Food and Drug Board, and does not
present a risk of adverse health effects.[2]
The terms multivitamin and multimineral are often
used interchangeably. There is no scientific definition
for either.[3] Linguistically, the terms are compounded
words of which meaning can be derived in that
capacity.
Many multivitamins are formulated and/or labeled to
differentiate consumer sectors e.g. prenatal, children,
mature or 50+, men's, women's, diabetic, stress or
megavitamin. Consumer multivitamin formulas are
available as tablets, capsules, bulk powder, or liquid.
Once and twice per day multivitamin formulas
dominate common usage, although some formulas are
designed for consumption 3–7 times per day or even
allow hourly use.
Compositional variation amongst brands and lines
allows substantial consumer choices. Modern
multivitamin products roughly classify into RDA
centric multivitamins with or without iron, RDA
centric multivitamin/multimineral formulas with or
without iron, higher potency formulas with mostly
above RDA components with or without iron, and
more specialized formulas by condition, such as for
diabetics or by less common components, such as
diversified antioxidants, herbal extracts or premium
vitamin and mineral forms. Legally, the United States
Food and Drug Administration allows a multivitamin
to be called "high potency" if at least two-thirds of its
nutrients have at least 100 percent of the DV. In
practice, "high potency" usually means substantially
increased vitamin C and Bs with some other enhanced
vitamin and mineral levels, but some minerals may
still be much less than DV.
Some components are typically much lower than RDA
amounts, often for cost reasons, e.g. biotin, usually the
most expensive vitamin component, at over $4000 per
active pound, is typically added in at only 5%-30% of
RDA in many one per day formulations. Sometimes
low content composition is for population subgroups,
where the RDA would be inappropriate, such often
occurs with iron, where the original population intake
calculation was ca 12–13 mg iron per day by including
menstruating females but some percentage of HFE
variant gene bearing males with high iron retention,
and others, may only need as little as ~1 mg iron per
day including the normal dietary contribution.
Basic commercial multivitamin supplement products
often contain the following ingredients: vitamin C, B1,
B2, B3, B6, folic acid (B9), B12, B5 (pantothenate), H
(biotin), A, E, D3, K1, potassium iodide, cupric (sulfate
anhydrous, picolinate, sulfate monohydrate, trioxide),
selenomethionine, borate(s), zinc, calcium,
magnesium, chromium, manganese, molybdenum,
betacarotene, and iron. Other formulas may include
additional ingredients such as other carotenes (e.g.
lutein, lycopene), higher than RDA amounts of B, C or
E vitamins including gamma-tocopherol, "near" B
vitamins (inositol, choline, PABA), trimethylglycine
(anhydrous betaine), betaine hydrochloride, vitamin
K2 as menaquinone-7, lecithin, citrus bioflavinoids or
nutrient forms variously described as more easily
absorbable.
Uses
By supplementing the diet with additional vitamins
and minerals, multivitamins can be a valuable tool for
those with dietary imbalances or different nutritional
needs.[6] People with dietary imbalances may include
those on restrictive diets and those who can't or won't
eat a nutritious diet. Pregnant women and elderly
adults have different nutritional needs than other
adults, and a multivitamin may be indicated by their
physicians.
The proponents of orthomolecular medicine
recommend individually optimized vitamin intakes,
usually at higher doses than standard
recommendations (such as the US RDA).[7] They also
recommend more absorbable forms of vitamins and
minerals, in inexpensive but higher potency formulas,
spread across the day.
http://en.wikipedia.org/wiki/Multivitamin
GENERIC NAME: SERTRALINE - ORAL (SER-
truh-leen)
BRAND NAME(S): Zoloft
USES: Sertraline is a selective serotonin reuptake
inhibitor (SSRI) used to treat depression, panic
attacks, obsessive compulsive disorders (OCD), post-
traumatic stress disorder (PTSD), social anxiety
disorder (social phobia), and a severe form of
premenstrual syndrome (premenstrual dysphoric
disorder or PMDD). This medication works by helping
to restore the balance of certain natural chemicals in
the brain.
OTHER USES: This medication has also been used
to treat a type of decreased sexual ability (premature
ejaculation) in men.
HOW TO USE: Take this medication by mouth
usually once daily with or without food; or as directed
by your doctor. It is recommended that you take your
dosage at the same time each day, either in the
morning or in the evening. Use this medication
regularly in order to get the most benefit from it. The
dosage is based on your medical condition and
response to therapy. It is important to continue taking
this medication as prescribed even if you feel well. Do
not stop taking this medication without consulting
your doctor. It may take up to 4 weeks before the full
benefit of this drug takes effect.
SIDE EFFECTS: Nausea, dry mouth, increased
sweating, drowsiness, diarrhea, upset stomach, or
trouble sleeping may occur. If any of these effects
persist or worsen, notify your doctor or pharmacist
promptly. Remember that your doctor has prescribed
this medication because the benefit to you is greater
than the risk of side effects. Many people using this
medication do not have serious side effects. Tell your
doctor immediately if any of these serious side effects
occur: uncontrollable shaking (tremor), loss of
appetite, unusual weight loss. Tell your doctor
immediately if any of these unlikely but serious side
effects occur: black stools, "coffee ground" vomit,
decreased interest in sex, decrease in sexual ability
(ejaculation delay), easy bruising/bleeding. Tell your
doctor immediately if any of these highly unlikely but
very serious side effects occur: unusual or rapid
weight gain, unusual or severe mental/mood changes,
seizures. Males - in the unlikely event you experience
a painful or prolonged erection, seek immediate
medical attention as this is considered a medical
emergency. A very serious allergic reaction to this
drug is unlikely, but seek immediate medical attention
if it occurs. Symptoms of a serious allergic reaction
may include: rash, itching, swelling, severe dizziness,
trouble breathing. If you notice other effects not listed
above, contact your doctor or pharmacist.
GENERIC NAME: SERTRALINE - ORAL (SER-
truh-leen)
BRAND NAME(S): Zoloft
USES: Sertraline is a selective serotonin reuptake
inhibitor (SSRI) used to treat depression, panic
attacks, obsessive compulsive disorders (OCD), post-
traumatic stress disorder (PTSD), social anxiety
disorder (social phobia), and a severe form of
premenstrual syndrome (premenstrual dysphoric
disorder or PMDD). This medication works by helping
to restore the balance of certain natural chemicals in
the brain.
OTHER USES: This medication has also been used
to treat a type of decreased sexual ability (premature
ejaculation) in men.
HOW TO USE: Take this medication by mouth
usually once daily with or without food; or as directed
by your doctor. It is recommended that you take your
dosage at the same time each day, either in the
morning or in the evening. Use this medication
regularly in order to get the most benefit from it. The
dosage is based on your medical condition and
response to therapy. It is important to continue taking
this medication as prescribed even if you feel well. Do
not stop taking this medication without consulting
your doctor. It may take up to 4 weeks before the full
benefit of this drug takes effect.
SIDE EFFECTS: Nausea, dry mouth, increased
sweating, drowsiness, diarrhea, upset stomach, or
trouble sleeping may occur. If any of these effects
persist or worsen, notify your doctor or pharmacist
promptly. Remember that your doctor has prescribed
this medication because the benefit to you is greater
than the risk of side effects. Many people using this
medication do not have serious side effects. Tell your
doctor immediately if any of these serious side effects
occur: uncontrollable shaking (tremor), loss of
appetite, unusual weight loss. Tell your doctor
immediately if any of these unlikely but serious side
effects occur: black stools, "coffee ground" vomit,
decreased interest in sex, decrease in sexual ability
(ejaculation delay), easy bruising/bleeding. Tell your
doctor immediately if any of these highly unlikely but
very serious side effects occur: unusual or rapid
weight gain, unusual or severe mental/mood changes,
seizures. Males - in the unlikely event you experience
a painful or prolonged erection, seek immediate
medical attention as this is considered a medical
emergency. A very serious allergic reaction to this
drug is unlikely, but seek immediate medical attention
if it occurs. Symptoms of a serious allergic reaction
may include: rash, itching, swelling, severe dizziness,
trouble breathing. If you notice other effects not listed
above, contact your doctor or pharmacist.
GENERIC NAME: OFLOXACIN - EAR
SOLUTION (oh-FLOX-uh-sin)
BRAND NAME(S): Floxin
USES: This medication is used to treat external ear
infections (otitis externa) and certain middle ear
infections (otitis media).
HOW TO USE: This drug is generally used once or
twice daily as directed. For accuracy and to avoid
contamination, have another person insert the drops if
possible. Hold container in the hand for a few minutes
in order to warm it. This will minimize dizziness. To
apply ear drops, wash hands first. To avoid
contamination, do not touch the dropper tip or let it
touch your ear or any other surface. Lie on your side
or tilt the affected ear upward. Place the dropper
directly over the ear and administer the prescribed
number of drops. To help the drops roll into the ear
(for adults) hold the earlobe up and back or (for
children) hold the earlobe down and back. Keep the
head tilted for about five minutes or insert a soft
cotton plug if so directed. Learn proper additional
technique if the infection involves the middle ear.
Consult your pharmacist. Do not rinse the dropper.
Replace cap after use. If using the single-use
container, throw away the container after each
application. Do not reuse. For best results, this
medication must be used routinely as directed.
Continue using it for the full time prescribed, then
promptly discontinue use. Stopping this medication
too soon, however, may not clear the infection and
may result in a reinfection. If the infection is not
improved after 1 week, consult your doctor or
pharmacist. Report any ear discharge that occurs after
the treatment period is completed. Not for use in the
eye.
SIDE EFFECTS: Mild irritation or mild discomfort
in the ear may occur with use, as well as dizziness or
change in taste sensation. If these persist or worsen,
notify your doctor promptly. Very unlikely but report
promptly: ringing in the ears, tingling and numbness
sensation. In the unlikely event you have an allergic
reaction to this drug, seek immediate medical
attention. Symptoms of an allergic reaction include:
rash, itching, swelling, trouble breathing. If you notice
other effects not listed above, contact your doctor or
pharmacist.
PRECAUTIONS: Before using ofloxacin, tell your
doctor or pharmacist if you are allergic to it or other
quinolone antibiotics (e.g., ciprofloxacin,
levofloxacin), or if you have any other allergies.
Before using this medication, tell your doctor or
pharmacist your entire medical history, especially of:
other ear problems. Prolonged or repeated use of
antibiotics may result in a secondary infection. Use for
the prescribed period of time only. This medication
should be used only when clearly needed during
pregnancy. Discuss the risks and benefits with your
doctor. When taken in oral form, ofloxacin passes into
breast milk. It is not known if ofloxacin passes into
breast milk after using the ear drop form. Due to
potential risks to the infant, breast-feeding while using
this drug is not recommended. Consult your doctor
before breast-feeding.
DRUG INTERACTIONS: Before using this
medication, tell your doctor or pharmacist of all
prescription and nonprescription/herbal products you
may use, especially of: other ear drops. Do not start or
stop any medicine without doctor or pharmacist
approval.
OVERDOSE: If overdose is suspected, contact your
local poison control center or emergency room
immediately. US residents can call the US national
poison hotline at 1-800-222-1222. Canadian residents
should call their local poison control center directly.
This medicine may be harmful if swallowed.
http://www.medicinenet.com/ofloxacin-
ear_solution/page2.htm.http://www.medicinenet.com/
ofloxacin-ear_solution/page2.htm
GENERIC NAME: LAMOTRIGINE - ORAL (lam-
OH-try-jeen)
BRAND NAME(S): Lamictal
WARNING: Rarely, serious (sometimes fatal) skin
rashes have occurred while using this medication.
These rashes (e.g., Stevens-Johnson syndrome) are
more common in children (less than 16 years old) than
in adults. Therefore, lamotrigine should only be used
in children who have partial seizures or seizures
associated with Lennox-Gastaut syndrome.
Immediately notify your doctor if you develop any
type of rash. If this medication is the cause of the rash,
the drug must be stopped. Even after stopping this
medication, it is still possible for the rash to cause
permanent or life-threatening scarring along with other
problems. The possibility of a rash may be increased
by using too much of this medication when treatment
begins, increasing the dose beyond what your doctor
prescribes during treatment, or taking valproic acid
with lamotrigine. Most life-threatening rashes have
occurred within 2 to 8 weeks of starting this
medication. However, such serious rashes have also
occurred after 6 months of use.
USES: This medication helps control seizure
disorders. Use of lamotrigine in children 2 years of
age and older is restricted to those having certain types
of seizures (partial or Lennox-Gastaut type).
HOW TO USE: Take this medication by mouth
exactly as prescribed. For best effects, take this
medication at evenly spaced times throughout the day
and night. This will ensure a constant level of drug in
your body. Do not take this more often or increase
your dose without consulting your doctor. Do not stop
taking this drug suddenly without your doctor's
approval since seizures may reoccur. Notify your
doctor if seizure control worsens.
SIDE EFFECTS: Headache, fatigue, drowsiness,
dizziness, blurred vision, weakness, clumsiness may
occur the first several days as your body adjusts to the
medication. If any of these effects continue or become
bothersome, inform your doctor. If you develop a rash,
stop using this drug and seek immediate medical
attention. In the unlikely event you have an allergic
reaction to this drug, seek immediate medical
attention. Symptoms of an allergic reaction include:
rash, itching, hives, fever, swollen glands, swelling of
the lips or tongue, painful sores in the mouth or
around the eyes, severe dizziness, trouble breathing. If
you notice other effects not listed above, contact your
doctor or pharmacist.
fluoxetine
BRAND NAME: Prozac, Sarafem
DRUG CLASS AND MECHANISM: Fluoxetine is
an oral drug that is used for treating depression. It is in
a class of drugs called selective serotonin reuptake
inhibitors (SSRIs), a class that also contains
citalopram (Celexa), paroxetine (Paxil) and sertraline
(Zoloft). Fluoxetine affects neurotransmitters, the
chemicals that nerves within the brain use to
communicate with each other. Neurotransmitters are
manufactured and released by nerves and then travel
and attach to nearby nerves. Thus, neurotransmitters
can be thought of as the communication system of the
brain. Serotonin is one neurotransmitter that is
released by nerves in the brain. The serotonin either
travels across the space between nerves and attaches to
receptors on the surface of nearby nerves or it attaches
to receptors on the surface of the nerve that produced
it, to be taken up by the nerve and released again (a
process referred to as re-uptake).
Many experts believe that an imbalance among
neurotransmitters is the cause of depression.
Fluoxetine works by preventing the reuptake of one
neurotransmitter, serotonin, by nerve cells after it has
been released. Since uptake is an important
mechanism for removing released neurotransmitters
and terminating their actions on adjacent nerves, the
reduced uptake caused by fluoxetine increases free
serotonin that stimulates nerve cells in the brain. The
FDA approved Fluoxetine in December 1987.
PRESCRIPTION: Yes
GENERIC AVAILABLE: Yes
PREPARATIONS: Capsules: 10, 20, and 40 mg.
Capsules (delayed release): 90 mg. Tablets: 10, 15,
and 20 mg. Oral suspension: 20mg/5ml
STORAGE: Fluoxetine should be stored at room
temperature 15-30°C (59-86°F).
PRESCRIBED FOR: Fluoxetine is used for treating
depression, bulimia, obsessive-compulsive disorder
(OCD), panic disorder, and premenstrual dysphoric
disorder (PMDD). It also is used in combination with
olanzapine (Zyprexa) for treatment of resistant
depression and treatment of depression associated with
bipolar disorder.
DOSING: Depression in adults is treated with 20-80
mg of fluoxetine daily. The recommended dose for
treating depression in children is 10-20 mg daily.
After 13 weeks of daily administration, once weekly
dosing may be effective in some patients.
Bulimia is treated with 60 mg of fluoxetine daily.
Long-term treatment for up to 52 weeks has been
shown to be beneficial in maintaining remission.
Obsessive-compulsive disorder in adults and children
is treated with 20-60 mg daily and panic disorder is
managed with 10-60 mg daily. The recommended
regimen for PMDD is 20 mg administered every day
of the menstrual cycle or daily for 14 days prior to the
onset of menstruation through the first day of menses.
The recommended treatment for resistant depression is
20-50 mg of fluoxetine and 5-20 mg olanzapine once
daily in the evening while the recommended treatment
for depression associated with bipolar disorder is 20-
50 mg fluoxetine and 5-12.5 mg olanzapine once daily
in the evening
DRUG INTERACTIONS: Fluoxetine should not be
taken with any of the monoamine oxidase inhibitor
(MAOI) class of antidepressants [for example,
isocarboxazid (Marplan), phenelzine (Nardil),
tranylcypromine (Parnate), selegiline (Eldepryl), and
procarbazine (Matulane)] or other drugs that inhibit
monoamine oxidase [for example, linezolid (Zyvox)].
Such combinations may lead to confusion, high blood
pressure, tremor, hyperactivity, coma, and death.
Fluoxetine should not be administered for at least 14
days after stopping MAOIs. Because fluoxetine is
active in the body for several weeks, MAOIs should
not be administered for at least 5 weeks after
fluoxetine has been stopped. Similar reactions occur
when fluoxetine is combined with other drugs, for
example, tryptophan, St. John's wort, meperidine
(Demerol), and tramadol (Ultram) that increase
serotonin in the brain.
Fluoxetine may increase the effect of warfarin
(Coumadin), leading to excessive bleeding. Warfarin
therapy should be monitored more frequently in
patients who are also taking fluoxetine. Combining
SSRIs with aspirin, nonsteroidal anti-inflammatory
drugs or other drugs that affect bleeding may increase
the likelihood of upper gastrointestinal bleeding.
SIDE EFFECTS: Fluoxetine, as with most
antidepressants, can cause nausea, headaches, anxiety,
insomnia, drowsiness, and loss of appetite. Fluoxetine
has been implicated in serious skin rashes and
vasculitis (inflammation of small blood vessels).
Increased blood pressure can occur, and blood
pressure should be monitored. Seizures have been
reported as has sexual dysfunction. Some patients may
experience withdrawal reactions upon stopping
fluoxetine. Symptoms of withdrawal include anxiety,
nausea, nervousness, and insomnia. The dose of
fluoxetine should be gradually reduced when therapy
is discontinued.
Antidepressants increased the risk of suicidal thinking
and behavior in short-term studies in children and
adolescents with depression and other psychiatric
disorders. Anyone considering the use of fluoxetine or
any other antidepressant in a child or adolescent must
balance this risk of suicide with the clinical need.
Patients who are started on therapy should be closely
observed for clinical worsening, suicidal thoughts, or
unusual changes in behavior.
http://www.medicinenet.com/fluoxetine/page2.htm
Prevention and treatment of iron deficiency
anemias
Prevention and treatment of iron deficiency
anemias
Administration of iron for >6 months
should be avoided except in patients
with continued bleeding, menorrhagia, or
repeated pregnancies; avoid in patients
with peptic ulcer, enteritis, or ulcerative
colitis. Anemia in the elderly is often
caused by "anemia of chronic disease" or
associated with inflammation rather than
blood
loss. Iron stores are usually normal or
increased, with a serum ferritin >50 ng/mL
and a decreased total iron binding
capacity. Hence, the "anemia of chronic
disease" is not secondary to iron deficiency
but the inability of the reticuloendothelial
system to reclaim available iron stores.

Contra: Hemochromatosis, hemolytic

anemia; known hypersensitivity to iron
salts

Adverse: >10 %: Gastrointestinal: GI

irritation, epigastric pain, nausea, dark
stool

, vomiting, stomach cramping, constipation

.
1% to 10 %: Gastrointestinal: Heartburn,
diarrhea Genitourinary:Discoloration of
urine Miscellaneous: Liquid preparations
may temporarily stain the teeth.
<1 %: Contact irritation

Overdose: Decreased effect: Absorption

of oral preparation of iron and tetracyclines
are decreased when both of these drugs
are given together;

concurrent administration of antacids may

decrease iron absorption;iron may
decrease absorption of penicillamine when
given at the same time;response to iron
therapy may be delayed in patients
receiving chloramphenicol; milk may
decrease absorption of iron. Increased
effect: Concurrent administration > or
=200 mg vitamin C per 30 mg elemental
Fe increases absorption of oral iron .

May color

stool black, take between meals for

maximum absorption; may take with food
if GI upset occurs, do not take with milk or
antacids; keep out of reach of children.
http://www.medindia.net/education/family
medicine/Pharma-Ferrous-Sulphate.htm