Manzoor (Pharm-D)

Antidotes for Warfarin are those agents which reverse the effects of toxicity of warfarin. Warfarin is an oral anticoagulant that is commonly used to treat and prevent blood clots. Warfarin has more clinical applications approved by the FDA and off label. Warfarin uses It can be used for the prophylaxis and treatment of Venous thrombosis and pulmonary embolism. Thromboembolic complications due to atrial fibrillation or valvular cardiac replacement. Heart attack Reduction of the risk of death. Stroke, systemic embolization after myocardial infarction. Side effects The possible side effects are: Unusual bruises Nosebleeds Bleeding from the gums Bleeding from cuts that take a long time to stop. Menstrual bleeding or vaginal bleeding more intense than normal Urine pink or brown Red or black stools Blood coughed Vomit blood. While Serious side effects include Death of skin tissue. Purple cornea syndrome Mechanism Warfarin works by preventing your body from forming blood clots. This is done by blocking the formation of coagulation factors necessary for coagulation. Warfarin inhibits vitamin KO reductase and, therefore, limits the availability of vitamin K in the cyclic response. This reduces the blood’s clotting activity by reducing the production of vitamin K-dependent factors. The effect of warfarin can be overestimated by the administration of vitamin K1 (phytonadione) as a medication or through diet. Therefore, vitamin KH2 is available for carboxylation without the need for vitamin KO reductase. It can also be stored in the liver when it is administered in large amounts that confer warfarin resistance to the patient for several periods of time. Warfarin also prevents the carboxylation of other proteins produced in the bone, which explains its teratogenic effects in the formation of fetal bone when used in pregnancy. However, this does not appear to affect normal bone metabolism after birth. Warfarin competitively inhibits Vitamin K 1 epoxide reductase complex (VKORC1), an enzyme essential for activating the vitamin k available in the body. Through this mechanism, warfarin can deplete the functional stores of vitamin K and, therefore, reduce the synthesis of active coagulation factors. In people who require a rapid reversal of warfarin due to severe bleeding or emergency surgery, the effect of warfarin on vitamin K, prothrombin complex concentrate (PCC) or fresh frozen plasma (PFF) may reverse. Antidotes for warfarin 1. Vitamin K1 To reverse the effects of warfarin, vitamin K1 can be given. This is one of the best antidote for warfarin. Vitamin K1 is available as an oral tablet or as an ampoule for intravenous (IV) or oral administration. Ampoules are not recommended for intramuscular or subcutaneous use. Intramuscular vitamin K1 Antidotes for warfarin is not recommended as it has sedimentation properties that may interfere with the reuptake of anticoagulant therapy. In addition, intramuscular injection poses a significant risk of hematoma formation in patients with anticoagulant therapy (especially if anticoagulant). Studies have also shown that the response to intramuscular or subcutaneous vitamin K1 is unpredictable and sometimes delayed. Ideally, unless the patient is bleeding actively, vitamin K1 is administered at a dose that rapidly reduces INR to a safe area, but not to a therapeutic area without causing resistance when warfarin is restored. Oral vitamin K1 is the treatment of choice Antidotes for warfarin unless a very rapid reversal of anticoagulation is required. For most patients, 1.0 to 2.0 mg oral vitamin K1 is sufficient. If INR is particularly high, 5 mg may be required orally. Although the injectable vitamin K1 formulation (Konakion MM, Roche Products Pty Ltd) is not approved for oral use of government agencies in Australia and New Zealand, it is favored for elimination of anticoagulation due to its flexible dose. Although the IV injection causes a faster response, it may be associated with anaphylactic reactions. There is no evidence that this rare but serious complication can be avoided using low doses. Antidotes for warfarin Dose (Vitamin K) The optimal intravenous dose of vitamin K1 for partial relief of excessive anticoagulation with warfarin is 0.5 to 1.0 mg. If an INR correction is desired (instead of just returning to the usual therapeutic area), higher doses of vitamin K1 are required. In general, INR can be normalized within 24 hours with an intravenous dose of 5 to 10 mg vitamin K1. Large doses of vitamin K1 can lead to some resistance to warfarin reanticoagulation. This can be avoided by administering lower doses. Larger doses are appropriate when a clinical decision is taken to complete treatment with additional warfarin. 2. Prothrombin concentrate and fresh frozen plasma. Full effect of vitamin K1 by reducing INR lasting up to 24 hours, even when administered in larger doses to achieve complete reversal. For immediate reversal of clinically significant bleeding, the combination of Prothrombin Complex Concentrate (PCC) and Fresh Frozen Plasma (FFP) period is covered before vitamin K1 has reached full effect. Vitamin K1 is important in maintaining the reversal achieved by PCC and FFP. Prothrombinx-HT is the only PCC approved for reversal of warfarin in Australia and New Zealand. It is a concentrate of three factors that contain Factors II, IX and X, but only small amounts of Factor VII. Therefore, additional use of the FFP should be considered as the source of factor VII. 3. Kcentra In 2013, FDA approves Prothrombin Complex Concentrate (Kcentra, CSL Behring). It is one of the first CCPs of four unactivated factors indicated for the acute reversal of vitamin K antagonist anticoagulation (warfarin) in patients with acute, severe bleeding.

Zalcitabine is an antiretroviral. Antiretrovirals are medications which suppress the activity or replication of retroviruses like HIV. It is a member of some type of medications known as reverse transcriptase inhibitors. This particular antiviral is categorized as a nucleoside reverse transcriptase inhibitor, which means it blocks the enzyme that’s important for the retrovirus to multiply. It is suggested in combination with antiretroviral agents for treating HIV disease. It’s utilized as part of a combination program with antiretroviral agents. Nevertheless, it was stopped by Roche Pharmaceuticals on December 31, 2006 because of the availability of newer HIV drugs. Zalcitabine was approved by the FDA in June 1992. Mechanism zalcitabine is converted to its active metabolite, dideoxycytidine 5′-triphosphate (ddCTP), by the sequential action of cellular enzymes. DdCTP interferes with viral RNA-directed DNA polymerase (reverse transcriptase) by competing for use of the organic substrate deoxycytidine 5′-triphosphate (dCTP), in addition to incorpating into viral DNA. Because of it’s absence of a 3′-OH group, the creation of a 5′ to 3′ phosphodiester linkage that’s crucial for DNA chain elongation is inhibited, thus resulting in the blocking of viral DNA development. The triphosphate form of this drug inhibits HIV reverse transcriptase by competing for incorporation into viral DNA in addition to chain conclusion of this viral DNA as a result of deficiency of a 3′-OH group. Don’t Use if: You’ve lactic acidosis (a metabolic disease ) or particular liver problems (eg, enlarged liver, liver steatosis, abnormal liver function tests) You’re allergic to any component in zalcitabine You’re taking lamivudine or didanosine Speak to your health care provider or healthcare provider straight away if any of them apply to you. Zalcitabine warnings It may rarely cause severe side effects, which might be fatal. It can cause acute neurological problems (peripheral neuropathy), and must be used with extreme care in those who suffer from this disease. Tell your doctor promptly if nausea, stomach/abdominal pain, or persistent nausea happen, as zalcitabine might want to be ceased until you may be checked. Paradoxically, deadly liver failure has happened in people with hepatitis B disease whilst using zalcitabine. Zalcitabine ought to be used with care when you’ve got a hepatitis B disease. Tell your doctor immediately if tingling/numbness of their feet and hands, dark urine, yellowing of eyes/skin, quick breathing, muscular aches, or abnormal drowsiness occurs. zalcitabine Side effects Frequent side effects include Gastrointestinal problems, Allergic reactions, Anemia and Neutropenia. Some dose limiting toxicities are Painful sensorimotor peripheral neuropathy, mainly at the lower extremities. Other side effects include Unusual cases of hepatitis, Heart failure, Sugar abnormalities and pancreatitis. Pregnancy And Breast feeding It is a Category C drug. Human studies insufficient. While Zalcitabine has been demonstrated to be teratogenic in rats at concentrations 1365 and 2730 days over the maximum recommended human dose. HIV-infected mothers shouldn’t breastfeed due to the possible danger of transmitting HIV to an infant that’s not infected. Zalcitabine Dose The suggested dose for adults is 0.75 mg daily.

Bacitracin is an anti-bacterial drug. Anti-bacterial are medications that kill or inhibit the growth of bacteria and are, therefore, helpful in treating minor infections. Uses This medicine can be used to prevent minor skin infections brought on by little cuts, scratches, or burns. It belongs to a category of medication called antibiotics. This antibiotic prevents bacterial diseases. It won’t do the job for viruses or even fungus infections. Don’t use it for severe skin ailments. Consult your Physician first before applying this product for severe skin injuries (like heavy or puncture wounds, animal bites, and severe burns). A different treatment could be necessary for these kinds of conditions. Precautions Tell every one of your healthcare providers about all of your medical conditions, allergies, and all medications you use. Bacitracin shouldn’t be utilized in patients who have known hypersensitivity responses to bacitracin. Bacitracin treatment may cause respiratory paralysis because of neuromuscular blockade, and concurrent management with neuromuscular blockers during operation ought to be avoided. Bacitracin topical ointment is for topical use on the skin and isn’t for use in ears or eyes; it prevents ocular vulnerability of the topical ointment. Because of the risks of nephrotoxicity, use bacitracin IM with care in infants and children. Side effects This medicine generally has no side effects. If You have any unusual symptoms, contact your physician physician or pharmacist immediately. Severe allergic response to this drug is infrequent. But, seek prompt medical attention if you see any signs of a severe allergic reaction, such as: Rash, itching/swelling (particularly of this face/tongue/throat), Acute nausea, Difficulty breathing. This is a partial list of potential side effects. Bacitracin in Pregnancy & Breastfeeding It’s not known whether bacitracin enters into breastfeeding or if it might harm a nursing baby. Ask a physician or pharmacist if it’s safe for you to use this medication if you’re pregnant or breastfeeding. Dosage Don’t use in smaller or larger quantities or for longer than advised. You can apply bacitracin into the affected area 1 to 3 times every day. Apply only enough to pay for the area you are treating. Don’t use this medication over large regions of skin. Please don’t use it for more than seven days in a row. Call your Physician if your symptoms don’t improve after seven days of therapy or when you build a skin rash.  

Colchicine belongs to a class of drugs known as anti-gout drugs. Colchicine is used to prevent or treat attacks of gout (also called gouty arthritis). Gout is characterized by sudden, intense pain at the joints, and this is due to elevated levels of uric acid from blood vessels. An attack of gout occurs when uric acid causes inflammation (pain, swelling, redness, and heat) at a joint. Colchicine doesn’t cure gout, but it is going to help prevent gout attacks. Colchicine isn’t an ordinary pain reliever and won’t alleviate many types of pain. It can also be utilized to treat a rare disease known as familial Mediterranean fever (FMF) in adults and children older than four decades old. Colchicine Uses It can be utilized to handle conditions Aside from gout, for example: Dermatitis herpetiformis Amyloidosis Biliary and hepatic cirrhosis Familial Mediterranean fever Paget’s disease Behcet’s disease Pericarditis Pseudogout Mechanism of Action While colchicine has powerful anti-inflammatory properties, its effectiveness in treating pain aside from gout is constrained. Colchicine isn’t considered an analgesic (pain relieving) and does nothing to change elevated uric acid amounts related to gout. Colchicine works by binding to a sort of white blood cell referred to as a neutrophil. By doing this, the cells cannot migrate to regions where uric acid crystals have collected. This tempers the inflammatory reaction and, with it, a lot of the pain. Colchicine in Pregnancy and Breastfeeding Colchicine is an FDA Pregnancy Category C drug, which means injury to an unborn baby can not be ruled out. You need to tell your doctor if you’re pregnant or intend to become pregnant while taking this medication. It is also not known if this drug enters breastfeeding or if it may damage a breastfeeding infant. Side effects The most Frequent side effects of colchicine are dose-related and comprise: Nausea, Vomiting, stomach and abdominal pain, and Infection. fever, chills, body aches, flu Colchicine can also trigger baldness, weakness, and pale or gray lips, tongue, or hands Nerve irritation. Serious side effects may include: Rhabdomyolysis (muscle damage) Warnings Before taking colchicine, you should tell your doctor if you’ve had or have ever had: Crohn’s disease Any severe gastrointestinal problem Heart disease A blood disorder Liver disease Ulcer in the stomach Kidney disease Ulcerative colitis Intestinal bleeding Interactions Some medications can cause undesirable or harmful effects when combined with colchicine, particularly in the event that you have kidney or liver disease. Your Physician Might Need to change your treatment program if you use some of the following medications: Nefazodone; Tipranavir; Clarithromycin or telithromycin; Cyclosporine; Itraconazole or ketoconazole; or Atazanavir, Darunavir, Fosamprenavir, Indinavir, Lopinavir, Nelfinavir, Ritonavir, or saquinavir. To Be Sure this drug is secure for you, tell your Physician if you have: Kidney disease Liver disorder If you take digoxin or cholesterol-lowering drugs. Dose The suggested dose for acute gout is: 1.2 mg at the first sign of symptoms, accompanied by 0.6 mg an hour after. The maximum dose of more than a 1-hour interval is 1.8 mg. In clinical trials, 1.8 milligrams of colchicine administered over 1 hour has been as influential as 4.8 mg administered for more than six months, and patients experienced fewer side effects. The suggested dose for preventing the consequences of gout in people older than 16 decades old is 0.6 mg twice or once per day. Total daily doses could be administered in 2 divided doses. Doses should be increased by 0.3 mg per day as tolerated until symptoms have been controlled or the highest daily doses have been attained. Doses must be decreased by 0.3 mg per day should side effects occur. More Medicine