ESSENTIAL MEDICINES

ESSENTIAL MEDICINES
TAHIR, ALBASHIR (BSc. Pharm.)
albashirtahir@gmail.com
+2348068440615
APRIL, 2023.
1

GOALS
This course is designed to equip students with the knowledge and skills
to enable them manage essential medicines and drug revolving fund
(DRF)
OBJECTIVES
At the end of this course, students should be able to achieve the
following;
Describe the management of Essential Medicines and supply system
Explain the methods used in quantification of medicines
Discuss the concept and management of DRF
Describe the pharmacology of medicines in the Essential Drug List
Discuss the control and monitoring of quality of medicines
2

• According to World Health Organisation (WHO), essential drugs
are those drugs that satisfy the health care needs of the majority
of the population, they should therefore be available at all times
in adequate amounts and in appropriate dosage forms, at a price
the community can afford.
• The Essential Drug Programme of the Federal Republic of Nigeria
came on stream in 1988 and received legal backing in 1989 when
Decree 43 was promulgated.
• That same year, the first Essential Drug List was published.
4

Objectives of the National Essential Drug Programme (NEDP)
• To continuously ensure that drugs that are needed to the entire
population are available
• To reduce the cost of drugs by purchasing drugs with generic names
instead of brand names
• To impact management skills to health workers
• To prevent production, distribution and use of fake and sub-standard
drugs at all levels
• To encourage the use of only safe and effective drugs at all levels.
5

Criteria for the Selection of Essential Drugs
• The drug should meet the health care needs of the majority of the people
• Evidence on safety and efficacy
• Disease prevalence
• Stability in various conditions
• Single drug formulations are mostly preferable
• Genetic and environmental factors
• Demographic factors with respect to that community
• Should be in dosage forms, acceptable to the people and should have a reliable
shelf life
6

• It is economical in terms of cost
• It is affordable and accessible since majority of the population can
afford to buy
• It enables agencies related to drug control perform effectively
• Drug usage in health facilities can easily be managed
• It makes prescription easy since the drugs are available
• The reduction in the number of drugs used in the healthcare system
makes purchasing, storage and distribution easier
7
Advantages of Essential Drugs

Steps for the Management of Essential Drugs and
Supply
• Selecting from the essential drugs list those drugs needed
• Ordering the drugs
• Receiving and storing the drugs
• Issuing and using the drugs
8

QUANTIFICATION OF
ESSENTIAL DRUGS
9

Quantification of selected essential drugs can be defined as the process
for determining the quantity of drugs given for a certified health
problem and is expected to prevent or cure the health problem.
This ensures that adequate supplies are available to treat the cases of
patients presenting to the health facility.
The aim of quantification is to procure the right amount of drugs the
patients need in a cost effective manner.
10

QUANTIFICATION…
Under stocking of drugs in the health facility leads to frustration
and the people will eventually abandon the health centre.
On the other hand, over stocking will not only tie down fund,
unduly, but leads to wastage arising from the expiration of drugs,
increased risk of pilferage and difficulty in providing adequate
storage spaces and facilities.
11

Quantification of selected essential drugs can be done both scientifically or by the old but conservative
means, however, the scientific method is often employed in most parts of the world today, hence the
under stated advantages;
• Prevents over stocking with its associated wastage
• Prevents under stocking with its attendant frustrations
• It provides strategies for judicious use of resources especially when they are scarce as in many
developing nations
• Encourages rational use of drugs as in appropriate demands and wasteful prescription practices are not
provided for
• Can be used as management tool to convince and justify budget for drugs.
12
Advantages of Scientific Quantification

Methods of Quantification
Various methods are used in the quantification of selected essential
drugs, but the most commonly used, includes the followings:
• Morbidity/Standard treatment method
• Consumption patterns
• Epidemiology/Population base
• Estimate
• Define daily dose
13

Morbidity/Standard Treatment Method
• This is based on adequate statistics on health services utilization
• The major focus here is the number of people treated for various
diseases over a given period of time in the facility
• The quantity of drugs to treat an illness must be known either
from standing orders or worked out
14

Steps in Quantification using morbidity
data
• Collect information on number of treatment episodes requiring drugs
• Identify major health problems seen in the facility
• Get standard treatment schedule for each drug formulation
• Calculate the quality of drug formulation required for each disease using the formula below;
𝑁𝑜_ 𝑜𝑓 𝑒𝑥𝑝𝑒𝑐𝑡𝑒𝑑 𝑝𝑎𝑡𝑖𝑒𝑛𝑡𝑠 × 𝐷𝑟𝑢𝑔𝑠 𝑐𝑜𝑛𝑠𝑢𝑚𝑒𝑑 𝑎𝑐𝑐𝑜𝑟𝑑𝑖𝑛𝑔 𝑡𝑜 𝑠𝑡𝑑 𝑡𝑟𝑒𝑎𝑡𝑚𝑒𝑛𝑡 𝑝𝑟𝑜𝑡𝑜𝑐𝑜𝑙
• Adjust quantity above upward to allow for damages, loss etc.
• Where a drug is used for more than one condition, repeat steps 1 – 5 for each condition and
then add up for the total quantity of drugs required by the facility.
15

Consumption Method
• This approach depends on the information on the quantity of drugs
previously used over time in determining future needs
• Consumption method does not require much data as in morbidity data
use as all the data needed are in the pharmacy unit
• It is, therefore, faster, easier and has been found useful where special
drugs are required in hospitals.
16

Consumption Method…
Consumption method suffers from some serious deficiencies like;
• Wastage due to expiration of drugs, pilferage, breakages are assumed to have been
consumed
• Encourages irrational drug prescription and use as the focus is the quantity of drugs
consumed and not how it was arrived at
• Does not provide for programme expansion either through planned activities or
disease out breaks.
17

Epidemiology/Population base Method
• A survey of the disease pattern and care seeking behaviour in the
area may be conducted
• From the result, the quantity of drugs required to treat each
condition for a certain period may be extrapolated.
18

Steps involved in Quantification
For a meaningful and more reliable quantification, a combination of morbidity and
consumption pattern methods are recommended as both are based on data concerning the
actual or projected use of health services;
• Data collection.
• Data harmonization.
• Identification of health problems.
• Identify common diseases and develop standard treatment schedules
• Actual quantification exercise resulting in actual quantity needed for a period of time,
dosage forms and packs.
19

Procurement is the actual process of acquiring needed drugs and
medical supplies after due processes of selection, quantification, and
costing of drugs
The efforts and gains made in earlier stages of drug management can
easily be wiped off, if drugs are sourced from questionable suppliers
with the attendant risk of fake and substandard and products
Effective procurement strategies, therefore, aims at obtaining high
quality drugs at the lowest possible cost and delivered timely
21

Steps in Procurement of Essential Drugs
Procurement of essential drugs previously selected and quantified can be put
in place by following the understated steps;
• Determining how often to order drugs
• Listing the drugs needed
• Completing the requisition forms
• Calculating the cost of drugs ordered
• Forwarding money for drugs ordered together with requisition materials.
22

Sources/Suppliers of Essential Drugs
Suppliers of medicines and medical supplies must be reputable.
On the basis of how the drugs are sourced, suppliers may be
grouped into three;
Primary suppliers
• These are the manufacturers themselves
• Irrespective of the supplier, it is important for the essential drugs
programme to know the drug manufacturers since they play a
major role in determining drug quality
• No amount of proper storage and careful handling will turn
around an unwholesome product.
23

Secondary suppliers
• These are groups that procure directly from the manufacturers
and supply to others
• They may be local wholesale distributors or international supply
group like UNICEF.
Tertiary suppliers
• These are procurement agents commissioned by essential drugs
programmes to procure drugs and medical supplies on their
behalf
• The tertiary suppliers may buy from secondary sources to meet
their commitment to their clients.
24

• Storage can be defined as the housing of the drugs in a safe place
to safeguard the quality and potency of the drug pending
dispensing or distribution to users
• Drug storage aims at ensuring that the quality and potency of the
preparations are maintained for as long as is practicable
• Adequate storage also shields the drugs from theft
• Housing, conditions, space and ventilation must be favourable
26

• When drugs deteriorate, there may be change in colour, consistency and
odour
• Often times, there may be no physical change except that the expiry date has
passed
• Some of the factors that affect the quality of drugs in storage are as follows:
Temperature
Sunlight
Humidity
Burglar
Proofing
Pests
27

• Good inventory of drugs is necessary to avoid embarrassing the
drug supply system
• Stock control ensures that essential drugs are available, prevents
overstocking and makes early detection of missing drugs possible
• It also provides data that may be used in estimating drugs for re-
ordering.
29

Stock Cards and Stock Control Book
• Each stock and form of any drug is expected to be assigned a card called stock or bin card
• It is on this card that vital information is entered as soon as there is any transaction or development in
respect of the preparation
• This includes the quantity of drugs received or issued, stock balanced, date and signature of the person
making the entry
• Besides this, the stock control book is also called the ledger
• At regular intervals, e.g. every month, the information on the stock cards is transferred into the ledger
• The information in the ledger is organised to show the quantity of each preparation used since last
entry and the quantity to order if necessary
30

Stock Taking
• Each month, the information on the bin card is matched with what is
actually on ground
• The following are noted:
Quantity of the preparations on the shoves, in case of discrepancies are detected, the
quantity in the bin card is adjusted to reflect the actual balance. Investigation then
follows while the ledger is also updated.
The expiry dates of the drugs. Items that will expire or were manufactured first are put in
front of the shelf to be used first, in line with FIFO (first in, first out principle)
 The condition of the containers to see if the seals or any part of the container has been
broken or tampered with
31

• DRF is a system whereby the revenue generated from the sale of drugs
to patient is used to purchase new drugs and ensure availability,
effective and efficient system
• It is a special fund set aside to ensure the steady availability of essential
drugs in the health unit by recovering the cost of drugs, ploughing it
back for the purchase of more drugs for continuity of the system
33

Steps for Setting up A DRF
• Sensitize the development committees on the need for DRF
• Make a list of the required essential drugs in the facility
• Advice the committee to appoint the staffs and treasurer for DRF
• Calculate the amount of drugs needed for about 3-6 months according to level
• Cost the drugs according to the LGA central medical store price
• Raise the initial capital (seed capital) through contribution, donation, etc.
• Order the seed stock
• Explain to the DRF staff and community what cost recovery means
• Open a ledger with a page for each drug
• Advice on a DRF account and signatories to the account
• Obtain and review monthly statement of the account
34

Advantages of DRF
• It is self-accounting
• Encourages community involvement and participation
• Promotes accountability in drug management
• Encourages rational use of drugs
• The community value their drug unlike when it is free of charge
35

Reasons Why DRF Fail
• Poor management
• Under budgeting (low seed capital)
• Purchasing of drugs at exorbitant prices
• Ineffective cost recovery (selling prices below replacement cost)
• Delays in cash flow for subsequent purchase
• Rapid program expansion for which additional capital funds are not available
• Loss through pilfering, deterioration or expiring
• Price increase, i.e. unexpected inflation
• Lack of business orientation of DRF
• Diversion of drug money into other ventures
• Difficulty in raising initial capital
36

• According to a research released by the World Health
Organization (WHO) in November 2017, an estimated 1 in 10
medical products circulating in low and middle-income countries,
are either falsified or substandard
• The bogus-drug trade is not only a nation’s problem but a danger
to the whole of mankind
38

Risks Related to Fake/Substandard Medicines
The risks related to fake medicines can cause several health consequences as;
• Treatment failure
• Prolonged sickness
• It may contain toxic ingredients
• Increased healthcare cost
• Drug tolerance/resistance
• The quantity of the active ingredients in fake medicines may not be accurate
• It may contain totally different active ingredients that may cause serious side effects
• Increased risk of mortality
39

How to Identify Fake Medicines
• Detecting substandard drugs is not an easy task. Some are entirely fake
while some are potentially dead (does not produce a desired result or
ineffective)
• Consumers do not have testing equipment at home, but there are ways
by which counterfeit medicines can be identified and avoided
• Checking a medicine for genuineness is not an easy task but can be
done by following these tricks;
40

Check the Packaging
• This is the simplest and the easiest method to check the authenticity of
medicines
• Check the packaging for details like unusual fonts, print colour, and
spelling errors
• Analyse whether it appears the same or different from the one you have
used before
No Breakage in the Seal
• The security seal (especially in bottled medicines) should not be
damaged. Look for a crack or breaks in the sealing tape
Check the Tablets/Dosage Form
• Look for dissimilarities in physical appearance of the drug like its
colour, size, uniformity, consistency, shape, etc.
41

Physical Attributes of Tablets
• As stated by World Health Organization, the common physical
attributes that need to be looked out in medicine tablets are:
Small pieces of tablets or excessive powder at the bottom of the medicine
container
Cracks in the tablets
The appearance of crystal on the container walls or on the medicine tablets
Softening or hardening of the medicines
Swelling, spots or discoloration of the tablets.
42

Allergies / Unexpected Side Effects
• Most of the medicines have mild side effects as such it is
important to consult your doctor before the usage to keep a check
on allergies arising from it
• Certain unexpected or harmful side effects from any medication
should be reported immediately.
Price
• If the price of the medicine is suddenly far cheaper than the usual
rate, double check the product as there may be a chance that the
fake companies wanted to lure customers by providing medicines
at much cheaper rates.
43

Verify Medicines by Online or SMS
• Unique Identification Code along with a barcode is printed on
medicine packages or strips
• Consumers can send the unique “Authentication code” by SMS to
receive an authentication message from the pharmaceutical
manufacturer to confirm the authenticity of the drug being
purchased
• The Authentication code may not be available on all medicines,
except for some expensive medicines.
44

Vendors
• The pharmaceutical industry is flooded with a plethora of
medicine brands
• Purchasing medicines from a reputable pharmacy or good
medicine brands will greatly reduce your chances of buying fake
drugs
• Stop buying from unqualified and illiterate street Vendors.
Details on the Drug
• Match whether the Expiry date, Batch number and the address of
the Manufacturer on the secondary package are same as that on
the primary package.
45

Verify Manufacturer’s Address
• To verify the manufacturer’s origin is simple and easy only when it
comes from a reputable, international company that has a well-
tracking system in place
• That’s often not the scenario as fake companies can’t get their exact
address printed on the medicines
• In that case, check if the manufacturer’s address is traceable, i.e.
whether it contains the exact location of the company and not just the
country’s name.
46

• Pharmacovigilance has been defined by WHO as: The science and
activities relating to the detection, assessment, understanding and
prevention of adverse effects or any other drug-related problem
• Good pharmacovigilance will identify the risks in the shortest possible
time after the medicine has been marketed and will help to establish
and/or identify risk factors
• When communicated effectively, this information allows for
intelligent, evidence-based prescribing with potential for preventing
many adverse reactions and will ultimately help each patient to receive
optimum therapy at a lower cost to the health system
48

Types of Pharmacovigilance
Passive pharmacovigilance
• Also referred to as “spontaneous” or “voluntary” reporting, this is the
most common form of pharmacovigilance
• No active measures are taken to look for adverse effects other than the
encouragement of health professionals and others to report safety
concerns
• Reporting is entirely dependent on the initiative and motivation of the
potential reporters.
49

Active pharmacovigilance
• Active (or proactive) safety surveillance means that active
measures are taken to detect adverse events
• This is managed by active follow-up after treatment and the
events may be detected by asking patients directly or screening
patient records
• Active pharmacovigilance is sometimes very descriptively referred
to as hot pursuit. The most comprehensive method is cohort
event monitoring (CEM). CEM is an adaptable and powerful
method of getting good comprehensive data.
50

ANAESTHETICS
General Anaesthetics and Oxygen
General Anaesthetics are drugs that produce reversible loss of all sensation
and consciousness.
Inhalational
1. Halothane
2. Isoflurane
3. Nitrous oxide
4. Oxygen
5. Sevoflurane
Injectable
1. Ketamine
2. Propofol
52

Ketamine
Indications
 Induction and maintenance of anaesthesia
 Anaesthesia for short-term diagnostic and surgical procedures
Adverse effects
 Raised intracranial pressure
 Postoperative nausea, vomiting and salivation
 Hallucinationsa
Contra-indications
 Increased intracranial pressure
 Psychiatric disturbance
 Hypertension
 Thyrotoxicosisb
53

Local Anaesthetics
Local anaesthetics are drugs which upon topical
application or local injection cause reversible loss of
sensory perception, especially of pain, in a restricted area
of the body.
1. Bupivacaine
2. Lidocaine
3. Lidocaine + Epinephrine (Adrenaline)
54

Lidocaine
Indications
 Nerve block anaesthesia
 Infiltration anaesthesia
 Epidural anaesthesia
 Spinal anaesthesia
Adverse effects
 Drowsiness
 Dysphoria
 Altered taste
 Tinnitus
 Blurred vision
 Light-headedness
Contra-indications
 Adjacent skin infection
 Inflamed skin
 Concomitant anticoagulant
therapy
55

Bupivacaine
Indications
 Infiltration anaesthesia
 Peripheral and sympathetic nerve
block
 Spinal anaesthesia
 Postoperative pain relief
Adverse effects
 Light-headedness
 Blurred vision
 Hypotension
 Restlessness
Contra-indications
 Adjacent skin infection
 Inflamed skin
 Concomitant anticoagulant
therapy
 Severe anaemia or heart
disease
56

MEDICINES FOR PAIN AND PALLIATIVE
CARE
Narcotic Analgesics
1. Dihydrocodeine
2. Fentanyl
3. Morphine
4. Pentazocine
5. Pethidine
6. Tramadol
Non-narcotic Analgesics and
Antipyretics
1. Acetylsalicylic acid
2. Paracetamol
NSAIDs, Gout and Rheumatoid
Medicines
1. Allopurinol
2. Colchicine
3. Diclofenac
4. Febuxostat
5. Ibuprofen
6. Ketoprofen
7. Naproxen
57

Pentazocine
Indications
 Moderate to severe pain
Adverse effects
 Sedation
 Dizziness
 Occasional euphoria
 Nausea and vomiting
 Light headedness
 Constipation
 Respiratory disturbances
 Visual disturbances
Contra-indications
 Respiratory depression
 Renal or hepatic impairment
 Pregnancy
 Myocardial infarction
58

Acetylsalicylic Acid
Indications
 Dysmenorrhea
 Headache
 Pyrexia
 Acute migraine attack
 Antiplatelet
Adverse effects
 Nausea
 Ulceration with occult bleeding
 Tinnitus
 Vertigo
 Confusion
 Increase bleeding time
Contra-indications
 Hypersensitivity
 Reye syndrome
 Previous or active peptic ulceration
 Haemophilia
59

Paracetamol
Indications
 Headache
 Dysmenorrhea
 Pyrexia
 Pain relief in osteoarthritis and soft tissue lesions
Adverse effects
 Hepatic damage
 Renal damage (rare)
Contra-indications
 Severe hepatic disease
60

Diclofenac
Indications
 Inflammation and degenerative
forms of rheumatism
 Post-traumatic inflammation
 Dysmenorrhea
 Adjuvant in severe painful
inflammatory infections of the
ENT
Adverse effects
 GI upset
 Upper abdominal pain
 Nausea
 Diarrhoea
 Hypersensitivity reactions such as
skin rash and pruritus
Contra-indications
 Peptic ulcers
 Pregnancy
 Lactation
 Severe disorders of liver function
61

Ibuprofen
Indications
 Mild to moderate pain and inflammation
 Headache
 Dysmenorrhea
 Pyrexia
Adverse effects
 GI disturbance including nausea, diarrhoea
 GI ulceration and haemorrhage
 Vertigo
 Tinnitus
 Hepatic damage (rare)
Contra-indications
 Hypersensitivity including asthma, urticarial, rhinitis
 Active peptic ulceration
62

Allopurinol
Indications
 Pr0phylaxis of gout
 Prophylaxis of hyperuricaemia associated with cancer chemotherapy
Adverse effects
 Rash
 Fever
 Hepatitis
 Renal impairment
Contra-indications
63

ANTI-ALLERGICS AND MEDICINES USED IN
ANAPHYLAXIS
Allergy is a reaction to foreign substances by the immune system- the
body system of defence against foreign invaders, particularly pathogens.
Anti-anaphylactics
1. Dexamethasone
2. Epinephrine (Adrenaline)
3. Hydrocortisone
Antihistamines
1. Chlorpheniramine (Chlorphenamine)
2. Loratadine
3. Predisolone
4. Promethazine
64

Chlorpheniramine
Indications
 Nasal allergies
 Allergic dermatoses
 Management of severe allergic or hypersensitivity reactions
Adverse effects
 Drowsiness
 Drowsiness
 Arrythmias
 Constipation
 Dry mouth
Contra-indications
 Lactation
 Children <4 years
65

Promethazine
Indications
 Prevention and treatment of N and V especially motion sickness
 Premedication prior to surgery
 Anaphylactic reactions
 Symptomatic treatment of allergic conditions of the respiratory track and skin
Adverse effects
 Sedation
 Headache
 Nightmares
 Psychomotor impairment
 Photosensitivity reactions
 Dry mouth, blurred vision, urinary retention
Contra-indications
 Narrow-angle glaucoma
 Children <2 years due to the potential for fatal respiratory depression
 Porphyria
66

Loratadine
Indications
 Relief of symptoms of seasonal allergies
 Management of chronic idiopathic urticaria
 Management of hives
Adverse effects
 Confusion
 Drowsiness (rare)
 Blurred vision
 Dry mouth
Contra-indications
67

ANTIDOTES
Non-specific (General) Antidotes
1. Charcoal (activated)
Specific Antidotes
1. Acetylcysteine
2. Atropine
3. Calcium gluconate
4. Methionine
5. Methylammonium chloride
(methylene blue)
6. Naloxone
7. Phytomenadione (vit. K1)
8. Potassium ferric
hexacyanoferrate (II) (Prussian
blue)
9. Protamine sulphate
Complementary List
1. Deferoxamine
2. Dimercaprol
3. Fomepizole
4. Sodium calcium edetate
5. Pralidoxime
68

Atropine
Indication
1. To inhibit salivary secretions
2. To inhibit arrhythmias resulting from excessive vagal stimulation
3. To block the parasympathomimetic effects of anticholinestrases and carbamate
poisoning
Adverse effects
1. Dry mouth
2. Blurred vision
3. Photophobia
4. Difficulty in micturition
5. Flushing
Contra-indication
1. Angle-closure glaucoma
2. Myasthenia gravis
69

POISONING ANTIDOTE
Organophosphates, nerve gases Atropine
Heparin Protamine sulphate
Naloxone Opiates
Heparin Protamine sulphate
Warfarin Phytonadione
Iron Deferoxamine
Paracetamol Acetylcysteine, Methionine
70

ANTIMIGRAINE DRUGS
Migraine is a periodic attack of headache on one or both sides of
the head. These may be accompanied by nausea, vomiting,
increased sensitivity of the eyes to light (photophobia), increased
sensitivity to sound (phonophobia), dizziness, blurred vision,
cognitive disturbances, and other symptoms.
1. Ergotamine
2. Ibuprofen
3. Paracetamol
4. Sumatriptan
71

ANTISEPTICS AND DISINFECTANTS
1. Benzoin
2. Cetrimide + Chlorhexidine
3. Chlorhexidine
4. Coal tar
5. Dichloroxylenol +
Chlorophenol
6. Formaldehyde
7. Glutaraldehyde
8. Iodine
9. Methylated spirit
10. Povidone-iodine
11. Potassium permanganate
12. Sodium hypochloride
13. Trichlorophenol
72

CARDIOVASCULAR DRUGS
Anti-anginal Medicines
1. Bisoprolol
2. Diltiazem
3. Glyceryl trinitrate
4. Isosorbide dinitrate
Anti-arrhythmic Drugs
1. Amiodarone
2. Bisoprolol
3. Lidocaine
4. Procainamide
5. Propranolol
6. Verapamil
Medicines Used in Heart Failure
1. Captopril
2. Carvedilol
3. Digoxin
4. Dobutamine
5. Dopamine
6. Enalapril
7. Furosemide
8. Metoprolol
9. Spironolactone
10. Torsemide
73

CARDIOVASCULAR DRUGS…
Antihypertensive Drugs
1. Amiloride +
Hydrochlorothiazide
2. Amlodipine
3. Atenolol
4. Bendrofuazide
5. Captopril
6. Enalapril
7. Hydrochlorothiazide
8. Hydralazine
9. Indapamide
10. Labetalol
11. Lisinopril
12. Lorsatan
13. Methyldopa
14. Nifedipine
15. Nimodipine
16. Propranolol
17. Telmisartan
Lipid-lowering Agents
1. Artovastatin
2. Simvastatin
74

Amlodipine
Indications
 Hypertension
 Angina
Adverse effects
 Abdominal pain
 Nausea
 Headache
 Dizziness
 Sleep disturbances
 Fatigue
Contra-indications
 Severe hepatic impairment
(dosage reduction recommended)
75

Propranolol
Indication
 Angina pectoris
 Cardiac arrhythmias
 Hypertension
 Prophylaxis of migraine
Adverse effects
 Bradycardia
 Hypotension
 Heart failure
 Fatigue
 Bronchospasm
Contra-indications
 Asthma or history of obstructive
airways disease
 Marked bradycardia
 Hypotension
76

DIURETICS
1. Amiloride + Hydrochlorothiazide
2. Furosemide
3. Hydrochlorothiazide
4. Mannitol
5. Spironolactone
6. Torsemide
77

Furosemide
Indication
 Oedema
 Oliguria due to renal failure
 Hypertension
Adverse effects
 Blurred vision
 Dizziness
 Vertigo
 Headache
 Itching or rash
Contra-indications
 Pregnancy
 Lactation
 Infants and children less than 4
years
78

ORAL ANTIDIABETIC MEDICINES
1. Glibenclamide
2. Gliclazide
3. Glimeperide
4. Metformin
5. Vidagliptin
6. Sitagliptin
79

Metformin
Indications
 Type 2 diabetes mellitus
Adverse effects
 Anorexia
 Nausea
 Vomiting
 Abdominal pain
 Pruritus (itching)
 Urticaria (hives)
Contra-indications
 Renal impairment
80

MEDICINES ACTING ON THE
RESPIRATORY TRACT
Anti-asthmatic Medicines
1. Budesonide
2. Epinephrine (Adrenaline)
3. Ipratropium bromide
4. Salbutamol
5. Salmeterol + Fluticasone
81

Salbutamol
Indications
 Prophylaxis and treatment of asthma
Adverse effects
 Arrythmias
 Tachycardia
 Headache
 Insomnia
 Fine tremor
Contra-indications
 Use cautiously in: Cardiac disease, Hypertension, Diabetes
82

GASTRO-INTESTINAL DRUGS
Anti-emetic Medicines
1. Dexamethasone
2. Metoclopramide
3. Ondansetron
4. Promethazine
Antacids
1. Aluminium hydroxide +
Magnesium trisilicate
2. Magnesium trisilicate
Anti-ulcer Medicines
1. Omeprazole
2. Rabeprazole
3. Ranitidine
Laxatives
1. Bisacodyl
2. Lactulose
3. Liquid Paraffin
4. Senna
Medicines Used in Diarrhoea
1. Loperamide
2. Diphenoxylate + Atropine
83

Metoclopramide
Indication
 Nausea and vomiting associated with migraine
 Nausea and vomiting in GI disorders and cytotoxic therapy
Adverse effects
 Extrapyramidal effects (especially in children and young adults)
 Drowsiness
 restlessness
Contra-indications
 GI obstruction
 Haemorrhage or perforation
 Within 3-4 days of GI surgery
84

Omeprazole
Indication
 Treatment of pyrosis (heartburns)
 Gastroesophageal reflux disease (GERD)
 Stress ulceration
 Gastric and duodenal ulcers
 Prophylaxis in long-term NSAID therapy
Adverse effects
 Nausea
 Headache
 Diarrhoea
 Constipation
Contra-indications
 Pregnancy and lactation
85

Bisacodyl
Indication
 Treatment of constipation
 Bowel clearance before surgery,
labour or radiological
examination
Adverse effects
 Mild abdominal cramps
 Rectal burning
 Vertigo
Contra-indications
 Abdominal pain
 Nausea, vomiting
 Rectal fissures
 Ulcerated haemorrhoids
 Intestinal obstruction
86

Loperamide
Indication
 Symptomatic control of acute and chronic diarrhoea
Adverse effects
 Hypersensitivity reactions (skin rash)
 Abdominal pain, distention or discomfort
 Constipation
 Tiredness
Contra-indications
 Child < 2 yrs due to risk of respiratory depression
 Abdominal pain in the absence of diarrhoea
87

ANTICONVULSANTS (ANTI-EPILEPTICS)
1. Carbamazepine
2. Clonazepam
3. Diazepam
4. Ethosuximide
5. Magnesium sulphate
6. Midazolam
7. Phenobarbital
8. Phenytoin sodium
9. Pregabalin
10. Sodium valproate (Valproic acid)
11. Topiramate
88

Diazepam
Indications
 Drug of choice in the emergency control of convulsions
 Pre-operative sedation
 Skeletal muscle relaxant
Adverse effects
 Drowsiness
 Amnesia
 Dependence
 Hypotension
Contra-indications
 Respiratory depression
 Acute pulmonary insufficiency
 Sleep apnea
 Severe hepatic impairment
 Myasthenia gravis
89

Carbamazepine
Indication
 Prophylaxis of bipolar disorder
 Diabetic neuropathy
Adverse effects
 Dizziness
 Headache
 Ataxia
 Blurred vision
 GI intolerance
Contra-indications
 History of bone marrow depression
 Porphyria 90

OXYTOCIC
1. Ergometrine
2. Misoprostol
3. Oxytocin
91

Misoprostol
Indication
1. Duodenal and gastric ulcer
2. Prophylaxis of NSAID-induced
ulcers
3. Induction of labour
Adverse effects
1. Diarrhoea
2. Abdominal pain
3. Headache
4. Nausea
5. Flatulence
6. Dysmenorrhoea
7. Foetal distress
Contra-indication
1. Pregnancy
2. Hypersensitivity to
prostaglandin medications
92

Oxytocin
Indication
1. Induction of labour for medical reasons
2. Prevention and treatment of postpartum uterine atony and haemorrhage
Adverse effects
1. Uterine spasm
2. Foetal distress, asphyxia and death (excessive doses)
3. Nausea
4. Vomiting
5. Arrhythmias
Contra-indication
1. Mechanical obstruction of labour
2. Foetal distress
3. Any condition where spontaneous labour or vaginal delivery is inadvisable
93

ANTI-INFECTIVE DRUGS
Anti-amoebic and Antigiardiasis
Medicines
1. Metronidazole
2. Tinidazole
Anthelminthics
 Antifilarials
1. Albendazole
2. Diethylcarbamazine
3. Ivermectin
 Antischistosomal and Other
Antitrematode Medicines
1. Praziquantel
Intestinal Anthelminthics
1. Albendazole
2. Mebendazole
3. Pyrantel pamoate
4. Praziquantel
94

ANTI-INFECTIVE DRUGS…
Antibacterial Drugs
1. Ampicillin
2. Amoxicillin
3. Amoxicillin + clavulanic acid
4. Benzathine benzylpenicillin
5. Benzylpenicillin
6. Cefixime
7. Ceftriaxone
8. Cefuroxime
9. Cefpodoxime
10. Chloramphenicol
11. Ciprofloxacin
12. Clarithromycin
13. Clindamycin
14. Cloxacillin
15. Doxycycline
16. Erythromycin
17. Flucloxacillin
18. Gentamicin
19. Levofloxacin
20. Metronidazole
21. Ofloxacin
22. Nitrofurantoin
23. Phenoxymethyl penicillin
24. Piperallin + Tazobactam
25. Sulfamethoxazole +
Trimethoprim (C0-trimaxazole)
26. Tetracycline
95

Antifungal Medicines (Systemic)
1. Amphotericin B
2. Clotrimazole
3. Fluconazole
4. Miconazole
5. Nystatin
Antileprosy Drugs
1. Clofazimine
2. Dapsone
3. Rifampicin
Antimalarial Medicines
 For treatment
1. Artemeter
2. Artemeter + Lumefantrine
3. Artesunate
4. Artesunate + Amodiaquine
5. Artesunate + Pyronaridine +
tetraphosphate
6. Dihydroartemisinin + Piperaquine
phosphate
7. Doxycycline
8. Quinine
 Prophylaxis
1. Atovaquone + Proguanil
2. Proguanil
3. Mefloquine
4. Sulfadoxine + Pyrimethamine
96

Antituberculosis Drugs
1. Ethambutol
2. Ethambutol + Isoniazid
3. Isoniazid
4. Isoniazid + Pyrazinamide +
Rifampicin
5. Isoniazid + Rifampicin
6. Isoniazid + Rifampicin +
Ethambutol + Pyrazinamide
7. Pyrazinamide
8. Rifampicin
Antiretroviral (ARV) Drugs
 Non-nucleoside Reverse
Transcriptase Inhibitors
1. Nevirapine
2. Efavirenz
 Nucleoside Reverse Transcriptase
Inhibitors
1. Abacavir
2. Didanosine
3. Lamivudine
4. Zidovudine
 Protease Inhibitors
1. Indinavir
2. Lopinavir + Ritonavir
97

Antihepatitis Medines
 Medicines for Hepatitis B
1. Entecavir
2. Lamivudine
3. Tenofovir
 Medicines for Hepatitis C
1. Daclatasvir
2. Sofosbuvir
98

Metronidazole
Indications
 Tetanus
 Septicaemia
 Skin and soft tissue infections
 Helicobacter pylori eradication
 Amoebic dysentery
 Bacterial vaginosis
Adverse effects
 Nausea
 Vomiting
 Unpleasant metallic taste
 Furred tongue
 Anorexia
Contra-indications
 Chronic alcohol dependence
 First trimester of pregnancy

Ampicillin
Indications
 Gynaecological infections
 Septicaemia
 Meningitis
 Osteomyelitis
Adverse effects
 Nausea
 Vomiting
 Diarrhoea
 Hypersensitivity reactions (urticarial, rashes)
Contra-indications
 Hypersensitivity to penicillins

Ciprofoxacin
Indications
 Typhoid fever
 Gastroenteritis
 Gonorrhoea
 Meningitis
 RTIs
 Skin infections
Adverse effects
 Nausea
 Vomiting
 Abdominal pain
 Hyperglycaemia
Contra-indications
 History of myasthenia gravis (may
worsen muscle weakness and
breathing)
 History of tendon disorders
related to quinolone use

Tetracycline
Indications
 ENT infections
 Respiratory tract infections
 GI tract infections
 Liver infections
 Genitourinary infections
Adverse effects
 GI disturbances
 Photosensitivity
 Dermatological reactions
Contra-indications
 Hypersensitivity to tetracyclines
 Pregnancy
 Lactation
 Children < 12 yrs (permanent
teeth stain)
 Kidney disease

Isoniazid
Indications
 Treatment of tuberculosis (in combination with other drugs)
 Prophylaxis of tuberculosis
Adverse effects
 GI disorders (N, V, D pain, constipation, dry mouth)
 Hypersensitivity (fever, rashes, joint pain, usually during 1st week of tx)
 Blood disorders
 Hepatitis (>35 yrs and regular alcoholism)
Contra-indications
 Acute liver disease
 Drug-induced hepatic disease

Artemeter
Indications
 Management of severe malaria (injection)
 In combination with other drugs in the treatment of uncomplicated malaria
caused by P. falciparum (oral).
Adverse effects
 N, V, D
 Headache
 Tinnitus
 Elevated liver enzyme values
 ECG abnormalities
Contra-indications
 First trimester of pregnancy

Quinine
Indications
 Multi-drug resistant P. falciparum malaria
 Orally in the treatment of uncomplicated P. falciparum malaria in first trimester
of pregnancy in combination with Clindamycin
Adverse effects
 Cinchonism
 Hypersensitivity reactions
Contra-indications
 Haemoglobinuria
 Optic neuritis
 Tinnitus

Lamivudine
Indications
 Treatment of chronic HBV in
adult and children > 16 yrs
 HIV infection in combination
with at least two other ARV drugs
 Prevention of mother-to-child
transmission of HIV
Adverse effects
 N, V, D
 Abdominal pain
 Cough
 Headache
 Fatigue
 Insomnia
 Malaise
 Fever
 Rash
 Alopecia
Contra-indications
 Paediatric patients with a history
of or sig. risk factors for
pancreatitis (use only if no
alternative)

ANTINEOPLASTIC, IMMUNOSUPPRESSIVE
MEDICINES AND ADJUVANTS
1. Actinomycin-D
2. Azathioprine
3. Bleomycin
4. Busulphan
5. Chlorambucil
6. Cisplastin
7. Cyclophosphamide
8. Cytarabine
9. Dexamethasone
10. Doxorubicin
11. Fluorouracil
12. Mercaptopurine
13. Methotrexate
14. Prednisolone
15. Procarbazine
16. Stilboesterol
17. Tamoxifem
18. Vincristine
107

Dexamethasone
Indications
 Adjunct in the emergency
treatment of anaphylaxis
 Suppression of inflammatory and
allergic disorders
 Shock
 Skin diseases
 Cerebral oedema
Adverse effects
 Nausea
 Vomiting
 Stomach upset
 Heartburn
 Headache
 Endocrine effects including
adrenal suppression, menstrual
irregularities and amenorrhea,
hirsutism, increased appetite
Contra-indications
 Systemic infection
 Avoid chronic use in lactating
mothers
108

Methotrexate
Indications
 Rheumatoid arthritis
 Carcinoma of the breast, head
and neck, and lung
 Non-Hodgkin lymphomas
Adverse effects
 Liver damage
 Pulmonary toxicity
 Renal failure
 Skin reactions
 Alopecia
 Osteoporosis
Contra-indications
 Pregnancy and lactation
 Immunodeficiency syndromes
109

MEDICINES FOR PARKINSONISM AND
OTHER NEUROLOGICAL DISORDERS
Antiparkinsonism drugs
1. Benzhexol
2. Biperiden
3. Levodopa + Carbidopa
Drugs for Myasthenia gravis
1. Neostigmine
2. Pyridostigmine
110

Benzhexol
Indications
 Adjunctive treatment of Parkinson’s disease
 Extrapyramidal syndrome induced by phenothiazines and reserpine
Adverse effects
 Constipation
 Dry mouth
 Decreased sweating
 Dry mouth, throat and skin
 Difficult urination
Contra-indications
 Narrow-angle glaucoma

Neostigmine
Indications
 Postoperative urinary retention
Adverse effects
 Increased salivation
 Nausea, vomiting, diarrhoea
 Abdominal cramps
Contra-indications
 Recent intestinal or bladder surgery
 Mechanical intestinal or urinary tract obstruction
 Pneumonia

MEDICINES AFFECTING THE BLOOD
Anti-anaemic Medicines (Haematinics)
1. Ferrous salt
2. Folic acid
3. Hydroxocobalamin (Vitamin B12)
Medicines Affecting Coagulation
1. Desmopressin
2. Phytomenadione (Vitamin K1)
3. Heparin sodium
4. Warfarin
113

Folic acid
Indications
 Treatment of folate-deficiency megaloblastic anemia
 Prevention of neural tube defect in pregnancy
Adverse effects
 Folate dependent malignant disease
 Rash
 Irritability
 Difficulty sleeping
 Malaise
Contra-indications
 Used cautiously in undiagnosed anemias

Desmopressin
Indications
 Treatment of diabetes insipidus
 Controlling of bleeding in mild to moderate haemophilia
 Nocturnal enuresis
Adverse effects
 Nausea
 Abdominal cramps
 Headache
 Dizziness
 Increase in BP
 Pain at injection site
Contra-indications
 Cardiac insufficiency

Warfarin
Indications
 Prophylaxis of embolization in rheumatic heart disease and atrial fibrillation
 Prophylaxis and treatment of venous thrombosis and pulmonary embolism
 Transient ischemic attack
Adverse effects
 Hypersensitivity (rash)
 Haemorrhage
 Alopecia
 N, V
 Pancreatitis
Contra-indications
 Pregnancy
 Peptic ulcer
 Severe hypertension

ESSENTIAL MEDICINES

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