Polymyxin B + Neomycin + Hydrocortisone Pharmacology

Polymyxin B + Neomycin + Hydrocortisone

About Polymyxin B + Neomycin + Hydrocortisone
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Mechanism of Action of Polymyxin B + Neomycin + Hydrocortisone
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Pharmacokinets of Polymyxin B + Neomycin + Hydrocortisone
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Onset of Action for Polymyxin B + Neomycin + Hydrocortisone
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Duration of Action for Polymyxin B + Neomycin + Hydrocortisone
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Half Life of Polymyxin B + Neomycin + Hydrocortisone
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Side Effects of Polymyxin B + Neomycin + Hydrocortisone
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Contra-indications of Polymyxin B + Neomycin + Hydrocortisone
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Special Precautions while taking Polymyxin B + Neomycin + Hydrocortisone
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Pregnancy Related Information
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Old Age Related Information
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Breast Feeding Related Information
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Children Related Information
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Indications for Polymyxin B + Neomycin + Hydrocortisone
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Interactions for Polymyxin B + Neomycin + Hydrocortisone
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Typical Dosage for Polymyxin B + Neomycin + Hydrocortisone
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Schedule of Polymyxin B + Neomycin + Hydrocortisone
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Storage Requirements for Polymyxin B + Neomycin + Hydrocortisone
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Effects of Missed Dosage of Polymyxin B + Neomycin + Hydrocortisone
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Effects of Overdose of Polymyxin B + Neomycin + Hydrocortisone
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Polymyxin B

About Polymyxin B
Basic polypeptide(Polymyxin)antibiotic, Antibiotic.
Mechanism of Action of Polymyxin B
Polymixin B is a member of poly peptide antibiotic. Being poly peptide they exert a detergent like effect. They have high affinity for phospholipids. Peptide molecules orient between these phospholipids and cause cell membrane distortion and amino acids and ions come out with in the cell.Polymixin B is useful against gram negative bacteria only.
Pharmacokinets of Polymyxin B
Absorption: It is well absorbed after parenteral administration.Distribution: It is very widely distributed in the body.Metabolism: It does not undergo significant metabolism.Excretion: It is excreted mainly through urine.
Onset of Action for Polymyxin B
N/A
Duration of Action for Polymyxin B
N/A
Half Life of Polymyxin B
6 hours.
Side Effects of Polymyxin B
1.Pain at the site of injection
2.Nystagmus
3.Flushing
4.Nausea
5.vomiting
6.Diarrhoea
7.Rash
8.Partial deafness
9. Pruritis
10.Ataxia
11.Vertigo
12.Nephrotoxicity
13.Disturbances of vision
Contra-indications of Polymyxin B
1. Hypersensitive to Polymixin B and other polypeptide antibiotic
Special Precautions while taking Polymyxin B
1.Myasthenia gravis
2.Renal dysfunction
Pregnancy Related Information
Contraindicated
Old Age Related Information
Use with caution
Breast Feeding Related Information
Contraindicated
Children Related Information
Use with caution
Indications for Polymyxin B
1.Skin infection
2.Urinary tract infection
3.Burns
4.Enteric infection
Interactions for Polymyxin B
Aminoglycosides: Concurrent use may increase risk of respiratory paralysis and renal dysfunction.
Non-depolarising muscle relaxants: Neuromuscular blockade may be enhanced.
Typical Dosage for Polymyxin B
Adult :( IV) DOSE: 15000 - 25000 units /kg body weight/day in divided dose for 1 - 2 week
Children (IV) dose: 20000 - 40000 units/kg body weight/day in divided dose.
Schedule of Polymyxin B
H
Storage Requirements for Polymyxin B
Store the drug at 10 - 30 degree Celsius
Effects of Missed Dosage of Polymyxin B
Take the missed dose as soon as noticed and if it is the time for next dose then skip the missed dose.Continue the regular schedule.Do not double the dose.
Effects of Overdose of Polymyxin B
Give supportive measures and sumptomatic treatment.

Neomycin

About Neomycin
An aminoglycoside, Antibiotic, Ammonium Detoxicant.
Mechanism of Action of Neomycin
This aminoglycoside cause protein synthesis inhibition by "irreversibly" bind to specific 30S-subunit proteins and 16S rRNA. Specifically Neomycin binds to four nucleotides of 16S rRNA and a single amino acid of protein S12. This interferes with decoding site in the vicinity of nucleotide 1400 in 16S rRNA of 30S subunit. This region interacts with the wobble base in the anticodon of tRNA. This leads to interference with the initiation complex, misreading of mRNA so incorrect amino acids are inserted into the polypeptide leading to nonfunctional or toxic peptides and the breakup of polysomes into nonfunctional monosomes.
Pharmacokinets of Neomycin
Absorption- Poorly absorbed after oral administration
Distribution- Rapidly distributed in the body after oral administration. 30% bound to the plasma proteins. It crosses the placenta
Metabolism- Not metabolized
Excretion- Excreted through urine and feces (primarily as unchanged form). It also excreted through breast milk
Onset of Action for Neomycin
1 to 4 hr after oral administration
Duration of Action for Neomycin
8hrs after oral administration
Half Life of Neomycin
Its plasma half life is 2 to 3 hrs
Side Effects of Neomycin
1. Rash
2. Diarrhoea
3. Inflammation of the large intestine (colitis)
4. Nausea
5. Vomiting
6. Ototoxicity
7. Damage to the kidneys
8. Damage to vestibular function within the ear
Contra-indications of Neomycin
1. Hypersensitivity to the drug or any ingredients of it
2. Hypersensitivity to other amino glycosides
3. Intestinal obstruction
Special Precautions while taking Neomycin
1. Impaired renal function
2. Neuromuscular disorder
3. Ulcerative bowel lesions
4. Extensive dermatologic conditions
5. Any other eye infection or condition
6. Glaucoma
7. Cataract surgery
8. Blockage of the bowel
9. Eighth-cranial-nerve disease (loss of hearing and/or balance)
10. Kidney disease
11. Myasthenia gravis
12. Parkinson`s disease
13. Ulcers of the bowel
Pregnancy Related Information
Contraindicated
Old Age Related Information
Use with caution
Breast Feeding Related Information
Contraindicated
Children Related Information
Use with caution
Indications for Neomycin
1. Coma due to liver disease
2. Preventing infection following surgery
3. Topical infections
4. Systemic infections
Interactions for Neomycin
N/A
Typical Dosage for Neomycin
Ophthalmic suspension:
Adults-
1 or 2 drops every three or four hours- For eye infection
Oral (solution, tablets):
Adults and teenagers-
1 to 3 grams every six hours for five or six days- coma from liver disease
Adults and teenagers-
1 gram every hour for four hours, then 1 gram every four hours for the rest of a twenty-four hour period; or 1 gram nineteen hours before surgery, 1 gram eighteen hours before surgery, and 1 gram nine hours before surgery- cleaning the bowel before surgery.
Children-
14.7 milligrams mg/kg or 6.7 mg/ pound every four hours for three days
Ear preparation:
Adults and children-
2 to 5 drops into ear canal 3 to 4 times daily for 7 to 10 days- External ear canal infection
Schedule of Neomycin
C
Storage Requirements for Neomycin
Eye preparations store in the refrigerator protected from strong light. Do not freeze. Others are stored at <250C. Keep out of reach of children.
Effects of Missed Dosage of Neomycin
Take the missed dose as soon as noticed and if it is the time for next dose then skip the missed dose. Continue the regular schedule. Do not double the dose.
Effects of Overdose of Neomycin
Give symptomatic and supportive treatment. Provide haemodialysis or peritoneal dialysis to remove the drug. Treated with calcium salts or anticholinesterase to reverses neuromuscular blockade. Administer activated charcoal to prevent the further absorption of drug

Hydrocortisone

About Hydrocortisone
Systemic synthetic glucocorticoid, anti-inflammatory
Mechanism of Action of Hydrocortisone
The drug exerts it`s pharmacological action by penetrating and binding to cytoplasmic receptor protein and causes a structural change in steroid receptor complex. This structural change allows it`s migration in to the nucleus and then binding to specific sites on the DNA which leads to transcription of specific m-RNA and which ultimately regulates protein synthesis. It exerts both glucocorticoid and mineralocorticoid actions.
The drug exerts anti-inflammatory and immunosuppressant actions as follows: - 1) Induce lipocortins in macrophages, endothelium, and fibroblasts which inhibits phospholipase A2 and thus decreases the production of Prostaglandins, leukotriens (LT), and platelet activating factor, 2) Causes negative regulation of genes for cytokines in macrophages, endothelial cells and lymphocytes and thus decreases the production of interleukins (IL-1, IL-2, IL-3, IL-6), TNF-alpha, GM-CSF (granulocyte macrophage colony stimulating factor), Gama interferon and suppresses fibroblast proliferation and T-lymphocyte functions and interferes chemo taxis. 3) Decreases the production of acute phase reactants from macrophages and endothelial cells and interferes complement function. 4) Decreases the production of ELAM-1(Endothelial leukocyte adhesion molecule-1) and ICAM-1(intracellular adhesion molecule-1) in endothelial cells. 5) Inhibit IgE mediated histamine and LT-C4 release from basophiles and the effects of antigen-antibody reaction is not mediated 6) Reduces the production of collagenase and stromolysin and thus prevents tissue destruction.

Pharmacokinets of Hydrocortisone
Absorption: Absorption ranges from 1% to 36% after topical application. Absorption after injection varies depending up on the site of injection and blood supply to particular area.
Distribution: After topical application distributed throughout the local skin layers. Any drug absorbed in to circulation is rapidly removed from blood and distributed in to muscle, liver, kidney, skin, and intestine. Metabolism: Metabolized primarily in skin after topical application and a small amount absorbed in to circulation is metabolized in liver. Excretion: Metabolites are excreted mainly through urine and a small amount is excreted through faeces.
Onset of Action for Hydrocortisone
N/A
Duration of Action for Hydrocortisone
N/A
Half Life of Hydrocortisone
N/A
Side Effects of Hydrocortisone
1. Burning
2. Irritation
3. Pruritus
4. Dryness
5. Erythema
6. Folliculitis
7. Hypertrichosis
8. Acneiform eruptions
9. Allergic contact dermatitis
10. Secondary infections
11. Atrophy
12. Striae
13. Suppression of adrenocorticotropic hormone
14. Cushing`s syndrome
15. Glucosuria
16. Hyperglycaemia
17. Fluid retention
18. Sodium retention
19. Hypokalaemia
20. Oedema
21. Weakness
22. Muscle wasting
23. Gastrointestinal discomfort
24. Peptic ulcer
25. Haemorrhage
26. Joint damage
27. Fibrosis
28. Headache
29. Convulsions
30. Vertigo
31. Increased intracranial pressure
32. Depression
33. Local hypopigmentation

Contra-indications of Hydrocortisone
1. Hypersensitivity to the drug
2. Not to be given I.V. or I.M.
3. Local or systemic infections
4. Fungal or herpetic keratitis
5. Cataract
6. Tubercular or syphilitic lesions.

Special Precautions while taking Hydrocortisone
1. Occlusive dressings (Topical preparation)
2. Use of potent preparations should be short term or intermittent
3. Milder drugs should be used in acute lesions and stronger ones are for chronic lesions
4. Avoid sudden discontinuation of the drug
5. Hypothyroidism
6. Cirrhosis
7. Stress
8. Sepsis
9. Ocular herpes simplex
10. Peptic ulcer
11. Hypertension
12. Osteoporosis
13. Myasthenia gravis
14. Renal impairment
15. Ulcerative colitis
16. Diverticulitis
Pregnancy Related Information
Use with caution
Old Age Related Information
Use with caution
Breast Feeding Related Information
Use with caution
Children Related Information
Use with caution
NEONATES : Contraindicated

Indications for Hydrocortisone
Intra-articular injection :
1. Rheumatoid arthritis
2. Gouty arthritis
3. Osteoarthritis
4. Joint sequelae of fractures and dislocations
5. Other inflammatory conditions of joints.
Periarticular or soft tissue injections:
1. Bursitis
2. Synovitis
3. Tendinitis
4. Taenosinovitis
5. Cystic tumors of tendon or aponeurosis
6. Epicondylitis
7. Scapulo-humeral periarthritis
8. Periarthritis of hip
9. Tarsalgias
10. Meta-tarsalgias
11. Dupuytren`s contracture
12. Peyronie`s disease.

Intra-lesional injections:
1. Tubal stenosis in gynaecology
2. Dermatological lesions
3. Keloids
4. Hypertrophic scars
5. Localized hypertrophies
6. Inflammatory lesions of lichen
7. Lichen simplex chronicus
8. Granuloma annulare
9. Alopecia areata
10. Necrobiosis lipoidica diabeticorum
11. Discoid lupus erythematosus
12. Psoriatic plaques
Intra-thecal or epidural injections:
1. Lumbago
2. Cervico-brachial neuralgia
3. Sciatica
4. Other painful radiculopathies
5. Multiple sclerosis
6. Tuberculous meningitis.
Interactions for Hydrocortisone
N/A
Typical Dosage for Hydrocortisone
Cream:
Apply 0.5% to 2.5% 1 to 4 times daily as required.
Ointment:
0.5% to 2.5% Apply 1 to 4 times as required.
Lotion:
0.5% to 2.5% Apply 1 to 4 times as required.
Intra-articular, Intra-dermal, Intra-pleural injection:
5 to 50mg depending up on the size of the joint and severity of the condition.

Schedule of Hydrocortisone
H
Storage Requirements for Hydrocortisone
Store at room temperature at a range of 15 to 300C. Protect from light and moisture. Keep out of reach of children.
Effects of Missed Dosage of Hydrocortisone
Take the missed dose as soon as noticed and if it is the time for next dose then skip the missed dose. Continue the regular schedule. Do not double the dose.
Effects of Overdose of Hydrocortisone
Provide symptomatic treatment and supportive measures.

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