c
 (c


) is a medication used to treat several medical conditions. It is a direct-acting Į2
adrenergic agonist and an imidazoline.

MECHANISM

Clonidine treats high blood pressure by stimulating Į2 receptors in the brain, which decreases cardiac
output and peripheral vascular resistance, lowering blood pressure. It has specificity towards the
presynaptic Į2 receptors in the vasomotor center in the brainstem. This binding decreases presynaptic
calcium levels, and inhibits the release of norepinephrine . The net effect is a decrease in sympathetic
tone.

Is has also been hypothesised that the antihypertensive effect of clonidine is in fact due to agonism on
the imidazoline receptor which mediates the sympatho-inhibitory actions of imidazolines to lower blood
pressure.

ADVERSE EFFECT

This drug may cause lightheadedness, dry mouth, dizziness, or constipation. Clonidine may also cause
hypotension

Clonidine also has peripheral alpha agonist effects, which can lead to hypertension. These effects are
seen during an overdose in children, where after taking clonidine their blood pressure increases. As the
clonidine is eliminated by the body the peripheral effects wear off and the central hypotensive effects
become visible. Both the hypertensive and hypotensive effects can be harmful



  is an angiotensin II receptor antagonist drug used mainly to treat high blood pressure
(hypertension). Losartan was the first angiotensin II receptor antagonist to be marketed. It is currently
marketed by Merck & Co. under the trade name c
 . As of 2010 Losartan is now available in generic
form.

MECHANISM

Losartan is a selective, competitive Angiotensin II receptor type 1 (AT1) receptor antagonist, reducing the
end organ responses to angiotensin II. Losartan administration results in a decrease in total peripheral
resistance (afterload) and cardiac venous return (preload) All of the physiological effects of angiotensin II,
including stimulation of release of aldosterone, are antagonized in the presence of losartan. Reduction in
blood pressure occurs independently of the status of the renin-angiotensin system. As a result of losartan
dosing, plasma renin activity increases due to removal of the angiotensin II feedback.

 first marketed as   by Hoffmann-La Roche, is a benzodiazepine derivative drug. It is

commonly used for treating anxiety, insomnia, seizures including status epilepticus, muscle spasms,
restless legs syndrome, alcohol withdrawal, benzodiazepine withdrawal and Ménière's disease. It may
also be used before certain medical procedures (such as endoscopies) to reduce tension and anxiety,
and in some surgical procedures to induce amnesia. It possesses anxiolytic, anticonvulsant, hypnotic,
sedative, skeletal muscle relaxant, and amnestic propertiesThe pharmacological action of diazepam
enhances the effect of the neurotransmitter GABA by binding to the benzodiazepine site on the GABAA
receptor leading to central nervous system depressionDiazepam has also been used as a recreational
drug.

Adverse effects of diazepam include anterograde amnesia (especially at higher doses) and sedation as
well as paradoxical effects such as excitement, rage or worsening of seizures in epileptics.
Benzodiazepines also can cause or worsen depression. Long-term effects of benzodiazepines such as
diazepam include tolerance, benzodiazepine dependence as well as a benzodiazepine withdrawal
syndrome upon dose reduction; additionally after cessation of benzodiazepines cognitive deficits may
persist for at least 6 months and may not fully return to normal, however it was suggested that longer than
6 months may be needed for recovery from some deficits Diazepam also has abuse potential and can
cause serious problems of addiction. Urgent action by National Governments to improve prescribing
practices has been recommended.

CONTRAINDICATIONS:

[45]
Use of diazepam should be avoided, when possible, in individuals with the following conditions:

r Ataxia
r Severe hypoventilation
r Acute narrow-angle glaucoma
r Severe hepatic deficiencies (hepatitis and liver cirrhosis decrease elimination by a factor of 2)
r Severe renal deficiencies (e.g. patients on dialysis)
r Liver disorders
r Severe respiratory disorders
r Severe sleep apnea
r Severe depression, particularly when accompanied by suicidal tendencies
r Psychosis
r Pregnancy or breast feeding
r Caution required in elderly or debilitated patients
r Coma or shock
r Abrupt discontinuation of therapy
r Acute intoxication with alcohol, narcotics, or other psychoactive substances (with the exception of
some hallucinogens, where it is occasionally used as a treatment for overdose)
r History of alcohol or drug dependence
r Myasthenia gravis, or MG, an autoimmune disorder causing marked fatiguability.
r Hypersensitivity or allergy to any drug in the benzodiazepine class

SIDE EFFECT Diazepam has a range of side-effects that are common to most benzodiazepines. Most
common side-effects include:

r Suppression of REM sleep

r Impaired motor function
 Impaired coordination
 Impaired balance
 Dizziness and nausea
r Depression[54]
r Reflex tachycardia

Less commonly paradoxical side-effects can occur and include nervousness, irritability, Diazepam may
impair the ability to drive vehicles or operate machinery. The impairment is worsened by consumption of
alcohol, because both act as central nervous system depressants

During the course of therapy, tolerance to the sedative effects usually develops, but not to the anxiolytic
and myorelaxant effects

MOA
Diazepam is a benzodiazepine that binds to a specific subunit on the GABAA receptor at a site that is
distinct from the binding site of the endogenous GABA molecule. The GABAA receptor is an inhibitory
channel which, when activated, decreases neuronal activity. Benzodiazepines do not supplement for the
neurotransmitter GABA, rather benzodiazepines such as diazepam bind to a different location on the
GABAA receptor with the result that the effects of GABA are enhanced. Benzodiazepines cause an
increased opening of the chloride ion channel when GABA binds to its site on the GABAA receptor leading
to more chloride ions entering the neuron which in turn leads to enhanced central nervous system
depressant effects. The muscle relaxant properties of diazepam are produced via inhibition of
polysynaptic pathways in the spinal cord.

 
is a proton pump inhibitor (brand names 
 , 
 , , ,

  ; 
 in Italy,  in Belgium and South Africa) developed and marketed by
AstraZeneca which is used in the treatment of dyspepsia, peptic ulcer disease (PUD),
gastroesophageal reflux disease (GORD/GERD) and Zollinger-Ellison syndrome. Esomeprazole
is the ˜-enantiomer of omeprazole (marketed as Losec/Prilosec), and AstraZeneca claims
improved efficacy of this single enantiomer product over the racemic mixture of omeprazole.
However, this greater efficacy has been disputed, with some claiming it offers no benefit from its
older form.

SIDE EFFECT

Common side effects include headache, diarrhea, nausea, gas, decreased appetite,
constipation, dry mouth, and abdominal pain. More severe side effects are severe allergic
reactions, chest pain, dark urine, fast heartbeat, fever, paresthesia, persistent sore throat,
severe stomach pain, unusual bruising or bleeding, unusual tiredness, and yellowing of the eyes
or skin

Proton pump inhibitors may be associated with a greater risk of hip fracturesand clostridium
difficile-associated diarrhea Patients are frequently administered the drugs in intensive care as a
protective measure against ulcers, but this use is also associated with a 30% increase in
occurrence of pneumonia.

—

is a nitroimidazole antibiotic medication used particularly for anaerobic bacteria
and protozoa. Metronidazole is an antibiotic, amebicide, and antiprotozoal.[1] It is the drug of
choice for first episodes of mild-to-moderate c
 

  infection.[2] It is marketed by
Pfizer under the trade name þ  in the US, by Sanofi-Aventis globally under the same
tradename þ  , in Pakistan it is also available with the brand name of  manufactured
and marketed by Star Laboratories. In Thailand it is marketed as — by Thai Nakhorn
Patana. They are also marketed in UK by Milpharm Limited.

MOA

Metronidazole, taken up by diffusion, is selectively absorbed by anaerobic bacteria and

sensitive protozoa. Once taken up by anaerobes, it is non-enzymatically reduced by reacting
with reduced ferredoxin, which is generated by pyruvate oxido-reductase. This reduction causes
the production of toxic products to anaerobic cells, and allows for selective accumulation in
anaerobes.
The metronidazole metabolites are taken up into bacterial DNA, and form unstable molecules.
This function only occurs when metronidazole is partially reduced, and because this reduction
usually happens only in anaerobic cells, it has relatively little effect upon human cells or aerobic
bacteria.





Common adverse drug reactions associated with systemic metronidazole therapy include:
nausea, diarrhea, and/or metallic taste in the mouth. Intravenous administration is commonly
associated with thrombophlebitis. Infrequent adverse effects include: hypersensitivity reactions
(rash, itch, flushing, fever), headache, dizziness, vomiting, glossitis, stomatitis, dark urine,
and/or paraesthesia.

High doses and/or long-term systemic treatment with metronidazole is associated with the
development of leukopenia, neutropenia, increased risk of peripheral neuropathy and/or CNS
toxicity.

BUSCOPAN

Drug: Hyoscine butylbromide

Use: Smooth muscle anti-spasmodic

Buscopan is an antimuscarinic medicine that is indicated for the symptomatic relief of gastro-
intestinal spasms (stomach and bowel cramps) associated with irritable bowel syndrome. It
works by exerting an antispasmodic effect on the smooth muscle of the bowel.

It may also be given to relieve genetio-urinary muscle spasms.

Dose:

Typical dose is 10mg 3 times daily.

Adult dose may be increased if required up to to 20mg 4 times daily (max 80mg/day).

Cautions:

- oesophageal reflux
- diarrhoea
- ulcerative colitis
- high blood pressure
- fever
- pregnancy and breastfeeding (safety not yet been established).

Contra-indications:

- glaucoma
- myasthenia gravis
- paralytic ileus
- pyloric stenosis
- prostatic enlargement
- porphyria

Side effects:

Side effects include constipation, dry mouth, photophobia, flushing, skin rash. Busopan may
also cause urinary urgency and urinary retention.

Less common side effects include confusion, nausea, vomiting and dizziness.