Dexamethasone + Ketorolac (Eye prepn.) Pharmacology
Dexamethasone + Ketorolac (Eye prepn.)
Dexamethasone
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-a, 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.
Dexamethasone has antiemetic properties, particularly against acute and delayed vomiting induced by cancer chemotherapy. It may be used alone for prevention of acute symptoms associated with moderately-emetogenic treatment and is combined with a 5-HT3 antagonist for highly-emetogenic treatment. Dexamethasone is also effective for the prevention of postoperative nausea and vomiting, and may be used to manage nausea and vomiting in palliative care.
2.Peptic ulcer
3.Haemorrhage
4.Glycosuria
5.Hyperglycaemia
6.Osteoporosis
7.Atrophy of adrenal cortex(on prolonged therapy)
8.Suppression of adrenocorticotropic hormone
9.Cushing`s syndrome
10.Inhibition of growth in children
11.Amenorrhoea
12.Behavioral disturbances
13.Thromoembolic disorders
14.Myopahy
15.Weaknss
16.Lymphocytopenia
17.Muscle wasting
18.Gastrointestinal discomfort
19.Increased appetite
20.Delayed wound healing
21.Headache
22.Euphoria
23.Insomnia
24.Seizures
25.Heart failure
26.Arrhythmias
27.Posterior sub capsular cataract
28.Glaucoma
29.Hirsutism
30.Increased intracranial pressure
Eye preparation:
1.Burning
2.Redness
3.Stinging in the eye
4.Blurred vision
2.Psychosis
3.Tuberculosis
4.Untreated infections
5.Systemic fungal infections
6.Osteoporosis
7.Congestive heart failure
8.Renal impairment
2.Use lower dosages as much as possible
3.Ocular herpes simplex
4.Primary glaucoma
5.Peptic ulcer
6.Epilepsy
7.Recent myocardial infarction
8.Heart failure
9.Diabetes mellitus
10.Hypothyroidism
11.Cirrhosis
12.Stress
13.Sepsis
14.Hypertension
15.Myasthenia gravis
16.Hepatic impairment
17.Non specific Ulcerative colitis
18.Diverticulitis
19.Recent intestinal anastomosis
20.Thromboembolic disorders
Eye preparation:
1.Cataracts
2.Contact lens wearer
3.Diabetes
4.Glaucoma
Neonates: Contraindicated
2.Allergic reactions
3.Shock
4.Anaphylaxis
5.Intra-articular and soft tissue inflammation
6.Asthma
7.Rheumatoid arthritis
8.Adrenal insufficiency
9.Tuberculous meningitis
10.Respiratory diseases
11.Malignancies
12.Cerebral oedema.
13.Acute gout
14.Nausea and vomiting induced by cancer chemotherapy
15. Pemphigus
Carbamazepine, Primidone: Decreases efficacy.
Oral contraceptives: Increases efficacy of dexamethasone.
Ephedrine: Decrease efficacy of dexamethasone.
Oestrogens: Decrease efficacy of dexamethasone
Hydantoins: Decrease efficacy of dexamethasone
Ketoconazole: Increase efficacy of dexamethasone
Rifampicin: Decreases efficacy.
Dexamethasone effects the actions of the following:
Anticholinesterases: Efficacy antagonised in myasthenia gravis.
Oral anticoagulants: Altered response.
Cyclosporine: Increased cyclosporine efficacy leading to enhanced toxicity.
Digitalis glycosides: Increased toxicity associated with hypokalaemia.
Isoniazid: Decreased serum levels of isoniazid.
Salicylates: Decreased serum levels of salicylates.
Diuretics: Increase efficacy may cause increased hypokalaemia and increased hyperglycemia.
Non-depolarising muscle relaxants: Altered response.
Theophyllines: Altered response of either agent.
IUCDs: contraceptive failure.
Lab. Tests: a) Increases serum cholesterol levels.
Increases urine glucose levels.
Decreases Thyroid I131 uptake. Decreases T3 serum levels. Decreases serum potassium.
Brain Scan: Dexamethasone alters result of brain scan due to decreased uptake of radioactive material.
I.M. or I.V.: 0.5 to 20mg/day I.M. or as slow I.V. injection depending up on the severity of the condition; repeated as required up to 80mg/day.
Antiemetic: 4 to 8 mg by mouth immediately before moderately-emetogenic chemotherapy and 20 mg by intravenous injection for more severely emetogenic chemotherapy.
Children: 100mcg to 500mcg/kg/day
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