INORGANIC DRUGS.pptx

INORGANIC DRUGS
Occurrence, preparation, physical characteristics,
chemical properties, incompatibilities and
pharmaceutical uses of inorganic drugs
1
Pharmaceutical Chemistry by Dr. Asma
Ahmed

1.Aluminum Hydroxide (Al(OH)3)
Aluminum trihydrate
• Occurrence AND Physical characteristics:
– ODOURLESS
– Color: WHITE SOLID IN VARIOUS FORMS (amorphous powder; balls or
granules; Bulky, amorphous powder)
– Melting Point: 300°C
– Solubility: Insoluble in water; soluble in alkaline solutions, acid solutions;
Practically insoluble in water, but soluble in alkaline aqueous solutions or in
HCl, H2SO4 and other strong acids in the presence of some water; Readily
soluble in both acids and strong bases
– Density: 2.42 g/cu cm
– Vapour pressure: Pa at 20°C
– Stability
• Forms gels on prolonged contact with water
• Absorbs acids, carbon dioxide
• Less sensitive than trialkylaminums to oxidation upon exposure to air
– Dissociation Constants: Aluminum hydroxide is capable of reacting as either
an acid or a base
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• Pharmaceutical uses:
– Adjuvants
– Immunologic
– Antacids
– Inhalation of aluminum hydroxide is used as preventive and curative
agent for silicosis
– Treatment of peptic ulcer
– Used to treat renal calculi and to control hyperphosphatemia
encountered early in course of chronic renal failure
– Neutralize acids in hyperchlorhydria and protectant in gastroenteritis
and diarrheas.
– Mild intestinal antiseptic and astringent capable of adsorbing bacteria
and toxins.
– Decreases acidic phosphate ion absorption, thus reducing or preventing
acidosis and formation of phosphate calculi in urinary tract
– Aluminum hydroxide is sometimes used as an antidiarrheal agent,
especially when diarrhea is thought to be caused by bile acids;
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• Incompatibilities:
– Almost all antacid gels (aluminum hydroxide ) contain enough sodium to
preclude their unrestricted use in patients requiring low-sodium diet.
Knowledge of exact amount of sodium is required when these antacids are
prescribed for these patients
– Proteins, peptides, amino acids and certain dietary organic acids greatly
impair neutralizing capacity of aluminum hydroxide
– On the basis of these studies, it would seem wise to space the administration
of oral phenothiazines and antacids so that mixing in the gastrointestinal tract
will be minimized
– One should be alert for reduced effect of digoxin in patients who are
receiving concomitant antacid therapy. Spacing the doses in order to
minimize mixing in the gastrointestinal tract may reduce the inhibitory effect
of antacids on digoxin absorption. The use of digoxin capsules instead of
tablets may minimize the interaction
– Tetracyclines should not be administered within hour or two of the
administration of antacids containing Al, Mg, or Ca.
– Decrease in plasma parathyroid hormone levels following aluminum
hydroxide therapy in patients with chronic renal failure appears to be indirect
effect of Al intoxication. Binding of Al with plasma inorganic P increases
plasma Ca level with proportionate fall in parathyroid hormone
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• Adverse effect of Al antacids
– Cause nausea, vomiting, and constipation; Decreased bowel motility, dehydration, or
fluid restriction may predispose patients to intestinal obstruction
– Hemorrhoids and fissures, or fecal impaction may occur
– long-term administration of Al antacids In patients with renal failure or chronic renal
failure may result in hyperaluminemia since small amounts of Al are absorbed from the
GI tract and excretion of Al is decreased in patients with renal failure. Al may then
accumulate in bones, lungs, and nerve tissue.
– Al accumulation in the CNS may be the cause of dialysis encephalopathy.
– Dialysis dementia also may occur in patients with renal failure receiving long-
term Al antacid therapy for hyperphosphatemia.
– Al intoxication with severe osteomalacia and extensive Al deposition at the junction
between calcified and non- calcified bone has been reported in several young children
who were receiving large dosages of aluminum hydroxide for the management of
hyperphosphatemia associated with azotemia
– Children don't undergo hemodialysis during aluminum hydroxide therapy/ Al antacids.
– Excessive doses/ even normal doses in patients with low-phosphate diets, may lead
to phosphate depletion accompanied by increased resorption and urinary excretion
of Ca with the risk of renal rickets in the young or osteomalacia in older patients.
– Al salts may cause P depletion which is generally negligible. However, with prolonged
administration or large doses, hypophosphatemia may occur, especially in patients with
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inadequate dietary intake of P; hypercalciuria secondary to bone resporption and increased
intestinal absorption of Ca results.
• Preparation
– So-called Al (OH)3 is actually a mixture of aluminum hydroxide and aluminum oxide
hydrates and it usually contains some fixed carbon dioxide (ie, carbonate).
– Al (OH)3 gel is white, viscous suspension ... contains equiv of 3.6-4.4% aluminum
oxide in form of aluminum hydroxide and hydrated oxide. May contain /flavoring
and sweetening agents
– Al (OH)3, Mg (OH)3 and simethicone tablets differ from USP preparation by addition
of antifoam agent simethicone.
– Al (OH)3 and magnesium trisilicate oral suspension, and Al (OH)3 gel and
magnesium trisilicate tablets ... are available
– Preparations vary in neutralizing potency.
• Chemical properties
– Al hydroxide is a common compound of aluminum, hydrogen, and oxygen which
can be considered either a base with the formula Al(OH)3, or an acid with the
formula H3AlO3. In addition, the compound is frequently treated as a hydrate—a
water-bonded compound—of aluminum oxide and designated variously as hydrated
alumina, or aluminum hydrate or trihydrate, hydrated aluminum, or hydrated
aluminum oxide; Al2O3(H20)x.
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2. Aluminum Chloride
• Chemical Properties
– It is a powerful Lewis acid, capable of forming stable Lewis acid-base adducts
with even weak Lewis bases such as benzophenone or mesitylene. It forms
AlCl4
− in the presence of chloride ion.
– In water, partial hydrolysis forms HCl gas or H3O+. Aqueous solutions
behave similarly to other aluminum salts containing hydrated Al3+ions - for
example giving a gelatinous precipitate of aluminum hydroxide upon
reaction with the correct quantity of aqueous sodium hydroxide;
AlCl3( aq) + 3NaOH ( aq) → Al(OH)3( s) + 3 NaCl( aq)
– Hemostatic and antiperspirant agent.
– Used to help control excessive sweating.
– Do not get the medication in your eyes or apply it to broken, irritated,
or recently shaved skin. If you do get the medication on those areas,
flush with plenty of water.
– Apply a thin layer of this medication to the affected area, usually
once daily.
• Preparations
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FORM ROUTE STRENGTH
Liquid Topical 15 g/100mL OR 20 % OR 0.12 mg/1.0mL OR 12 mg/1mL OR 12
mL/100mL OR 150 mg/1mL OR 15 mg/1mL
Liquid Dental 25 %
Gel Topical 150 mg/1mL
Solution Dental; Oral; Topical 8.75 g/35g
Liquid Dental 100 mg OR 250 mg
Packing Dental; Topical 1 mg
Solution Dental; Oral; Periodontal 3.75 g/15mL
Gel Topical 200 mg OR 15 g/100mL
Solution Topical 15 g/100mL OR 250 mg/1g
Cream OR Lotion Topical
Solution Dental 7500 mg/30mL
Aerosol, spray Topical 150 mg/1mL
Liquid Dental
Solution Topical 140 mg/1mL
Solution Dental 250 mg/1g
Liquid Topical 0.0625 g/1g
Spray Epidural 4.4375 g/35.5mL OR 5.325 g/35.5mL
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Occurrence
White or pale yellow solid; hygroscopic.
Physical properties
Boiling Point 180°C
Crystal Structure Monoclinic
Density 2.48 g/cm3
Melting Point 192.4 °C
Molar Mass 133.34 g/mol
Molecular Formula AlCl3
Molecular Shape Trigonal planar
Synonyms
Aluminium Trichloride;Trichloroalumane;
Trichloridoaluminium
Solubility
soluble in hydrogen chloride, ethanol,
chloroform, carbon tetrachloride
slightly soluble in benzene
Solubility in Water
439 g/l (0 °C); 449 g/l (10 °C); 458 g/l (20 °C)
466 g/l (30 °C); 473 g/l (40 °C); 481 g/l (60 °C);
486 g/l (80 °C); 490 g/l (100 °C)
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– This medicine may be harmful if swallowed. If someone has
overdosed and has serious symptoms such as passing out or trouble
breathing
– During pregnancy, this medication should be used only when clearly
needed. Discuss the risks and benefits with your doctor.
– It is not known whether this medication passes into breast milk.
Consult your doctor before breast-feeding.
• Adverse effect
– Tingling, mild itching, or irritation may occur when the medication is
first applied.
– Many people using this medication do not have serious side effects.
– A very serious allergic reaction to this drug is rare. However, seek
immediate medical attention if you notice any symptoms of a
serious allergic reaction, including: rash, itching/swelling (especially
of the face/tongue/throat), severe dizziness, trouble breathing.
– Avoid bringing anhydrous AlCl3 in contact with water or bases, or an
explosive reaction may result.
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3. Sodium Carbonate
– Na2CO3 is the disodium salt of carbonic acid, also known as sal soda,
washing soda, soda ash and soda crystals.
– It exists as a white powder
– Absorbs moisture from the air, and forms a strong alkaline aqueous solution
– Used topically for dermatitides
– Mouthwash
– Vaginal douche
– Veterinary use as emergency emetic.
– Occasionally, for dermatitides topically as a lotion.
– Medication (Vet): In solution to cleanse skin, in eczema, to soften scabs of
ringworm.
• Adverse effect
– Skin and Eye Irritation
– Reproductive Effects
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– Acids
• Preparation
– Concrobium (Siamons International, Inc.): Active ingredient: sodium
carbonate 0.95%.
– Liquid Intravenous
– Powder Topical
– Solution Irrigation
– Liquid Irrigation
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4. Sodium Chloride
– Molar mass: 58.44 g/mol; Formula: NaCl; Melting point: 801 °C;
IUPAC ID: Sodium chloride; Boiling point: 1,465 °C; odorless, white,
cubic crystals with salty taste. Salt is hygroscopic in nature.
– used to treat or prevent sodium loss caused by dehydration,
excessive sweating, or other causes
– Can reduce some types of bacteria in certain body secretions, such as saliva.
– Sodium chloride inhalation is used to produce sputum (mucus, or phlegm)
from the mouth to help improve lung function in people with cystic fibrosis,
or to collect sputum for medical testing.
– This medication may also be used to dilute other medications inhaled
through a nebulizer.
– Caution must be exercised in the administration of NaCl Injection, USP to
patients receiving corticosteroids or corticotropin.
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– Studies have not been conducted to evaluate additional drug/drug or
drug/food interactions with Sodium Chloride (sodium chloride (sodium
chloride injection) injection) Injection, USP.
– in patients with congestive heart failure, severe renal insufficiency, and in
clinical states in which there exists edema with sodium retention.
– Sodium Chloride (sodium chloride (sodium chloride injection) injection)
Injection, USP should be given to a pregnant woman only if clearly
needed, during labor and delivery, to a nursing woman
• Adverse effect
– Hives
– Difficult breathing
– Swelling of your face, lips, tongue, or throat
– chest pain, trouble breathing;
– A light-headed feeling, like you might pass out;
– Swelling in your hands or feet;
– Tiredness, muscle twitching;
– Confusion, uneven heart rate, extreme thirst, increased or decreased
urination, leg discomfort, muscle weakness or limp feeling.
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• Preparation
– 0.45% Sodium Chloride Injection, USP contains 4.5 g/L Sodium Chloride
(sodium chloride (sodium chloride injection) injection) , USP (NaCl) with
an osmolarity of 154 mOsmol/L (calc). It contains 77 mEq/L sodium and
77 mEq/L chloride.
– 0.9% Sodium Chloride Injection, USP contains 9 g/L Sodium Chloride
(sodium chloride (sodium chloride injection) injection) , USP (NaCl) with
an osmolarity of 308 mOsmol/L (calc). It contains 154 mEq/L sodium and
154 mEq/L chloride.
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5. Sodium thiosulphate (Na₂S₂O₃. 5H₂O)
– White or colorless pentahydrate
– Efflorescent crystalline substance
– Molar mass: 158.11 g/mol (anhydrous) & 248.18 g/mol (pentahydrate)
– Odor: Odorless
– Density: 1.667 g/cm3
– Melting point: 48.3 °C (118.9 °F; 321.4 K) (pentahydrate)
– Boiling point: 100 °C (212 °F; 373 K) (pentahydrate, - 5H2O
decomposition)
– Solubility in water: 70.1 g/100 mL (20 °C) & 231 g/100 mL (100 °C)
– Solubility: negligible in alcohol
– Crystal structure: monoclinic
– Sodium thiosulfate is a component of the Cyanide Antidote Package. Also
contained in the kit are: amyl nitrite inhalants (0.3 mL) and sodium nitrite
injection, (300 mg per 10 mL).
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– Sodium nitrite and sodium thiosulfate is a combination medicine that is used
as an antidote to cyanide poisoning.
– Antineoplastic adjunct
– Edematous sodium-retaining conditions such as:
• Cirrhosis of liver
• Congestive heart failure
• Renal function impairment
• Toxemia of pregnancy
• Hypertension (may be exacerbated)
• Adverse effect
– Symptoms of thiocyanate toxicity: Arthralgias (pain in the joints); blurred
vision ; hyperreflexia ; muscle cramps ; nausea and vomiting ; psychotic
behavior (agitation; delusions; hallucinations); tinnitus (ringing in the ears
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– Signs of an allergic reaction: hives; chest tightness, difficulty
breathing; swelling of your face, lips, tongue, or throat.
– serious side effect such as: feeling like you might pass out; headache;
tired feeling; blue-colored skin; feeling short of breath; fast or irregular
heart rate; or pounding heartbeats or fluttering in your chest.
– Less serious side effects may include: mild dizziness; blurred vision;
confusion; anxiety; sweating; nausea; vomiting; stomach pain; salty
taste in your mouth; feeling of warmth; tingly feeling where the
injection was given
• Preparation
– Stability: Sodium thiosulfate contains no preservative; therefore,
unused portions should be discarded.
– SODIUM THIOSULFATE INJECTION USP, Intravenous
– Serum thiocyanate concentrations below 10 mg per 100 mL (1.72
mmol/L).
– Usual adult, adolescent and pediatric dose
• Varies according to the type of toxicity and additional drug used
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6. Sodium tetraborate : B4Na2O7
(Borax/ Sodium borate anhydrous)
– Molecular Weight: 201.219339 g/mol
– Density: 2.367 g/mL at 25 C
– Melting point: 741 C.
– Colorless glassy solid; hygroscopic; Light grey, vitreous granules; White to gray
powder; becomes opaque on exposure to air
– Odorless
– Boiling Point: 1,575 deg C (decomposes)
– pH = 9.3 at 20 deg C (3% solution)
– Solubilities:
Water solubility: 3.1% at 25 deg C; 2.5% at 20 deg C; Solubility at 25 deg C: 16.7%
in methanol; 30% in ethylene glycol; 40.6 g/L in formamide
– Hygroscopic (Becomes/ opaque on exposure to air. /Anhydrous)
– Pharmaceutic aid (alkalizing)
– Antiseptic agent (Ophthalmic agent)
– Otitis Externa
– Diaper Rash 19
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– Insect Bites and Stings
– Sunburn
– Exhibits minimal bacteriostatic and antifungal activities at high concentrations
over prolonged exposures (treat recurrent vulvovaginal candidiasis)
– Borates are used in medicated powders, lotions, soaps, mouthwash, toothpaste,
astringents, eyewashes, and cosmetics.
– Mixed with sugar, boric acid has been used as a cockroach killer.
– An intravenous dose of 14-20 g of sodium borate , administered for the
purposes of neutron capture therapy to patients, experienced immediate nausea,
vomiting, defecation, and occasionally seizures and respiratory depression.
– Effects on the central nervous system, kidneys and gastrointestinal tract by
ingestion at high dose or through damaged skin.
• Adverse effect
– Symptoms of poisoning: Nausea, diarrhea, rashes, CNS depression, coma,
Inhalation: Cough, shortness of breath, sore throat, nose bleed.
– Repeated or prolonged contact with skin may cause dermatitis. .
• Preparation
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INGREDIENTS DOSAGE ROUTE
Sodium borate (1.89 mg) + Boric acid (11.1 mg) Liquid Ophthalmic
Sodium borate (0.18 %) + Boric acid (1.11 %) Liquid Ophthalmic
Sodium borate (20 mg) + Sodium benzoate (20 mg) Liquid Topical
Sodium borate decahydrate (0.2 g/10g) + Amber (0.1
g/10g) + Borneol (0.2 g/10g)+ Bos taurus gallstone (0.1
g/10g) + Moschus berezovskii musk sac resin (0.15
g/10g) + Pearl (hyriopsis cumingii) (0.25 g/10g) + Zinc
carbonate (0.65 g/10g)
Ointment Topical
Sodium borate decahydrate (0.1 mg/1mL) + Glycerin (0.4
mg/1mL)
Solution Topical
Sodium borate (1.9 mg) + Boric acid (11.16
mg) + Phenylephrine hydrochloride (.2 mg)
Solution /
drops
Ophthalmic
Sodium borate (1.896 mg) + Boric acid(11.1
mg) + Phenylephrine hydrochloride(.01 mg)
Lotion Ophthalmic
Sodium borate (40 mg) + Sodium carbonate (960 mg) Powder Topical
Sodium borate (1.9 mg) + Boric acid (11.16 mg) Solution /
drops
Ophthalmic
Sodium borate (0.7 %) + Boric acid (1.0
%) + Oxyquinoline sulfate (0.025 %)
Jelly Vaginal
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7. Magnesium Carbonate MgCO3 (Magnesite)
• Occurrence AND Physical characteristics: white, yellowish, grayish-white or brown
crystalline solid or crystalline powder. Density: 3-3.1 g cm-3. An important ore
for magnesium. Used in the manufacture of materials capable of withstanding very high
temperatures.
• Chemical Properties: All forms of magnesium carbonate react in acids
– Alginic acid/aluminum hydroxide/magnesium carbonate systemic & Aluminum
hydroxide/magnesium carbonate systemic: Antacids (Used to treat GERD & Indigestion)
– Calcium acetate/magnesium carbonate systemic: Phosphate binders (Used to treat
Hyperphosphatemia of Renal Failure)
– Calcium carbonate/magnesium carbonate systemic: Antacids (Used to treat GERD;
Hyperphosphatemia of Renal Failure; Indigestion; Peptic Ulcer).
– Citric acid/glucono-delta-lactone/magnesium carbonate topical: Sterile irrigating solutions
– Magnesium carbonate/sodium bicarbonate systemic: Antacids (Used to treat GERD & Indigestion)
• Adverse effect
– Stomach upset
– Diarrhea
– A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you
notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the
face/tongue/throat), severe dizziness, trouble breathing
• Preparation
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Pharmaceutical Chemistry by Dr. Asma Ahmed

DOSAGE STRENGTH ROUTE
Tablet 100 mg Oral
Suspension 50 mg/1mL Oral
Magnesium carbonate (358 mg/15mL) + Aluminum hydroxide (95
mg/15mL)
Liquid Oral
Magnesium carbonate (105 mg/1) + Aluminum hydroxide (160 mg/1) Tablet, chewable Oral
Magnesium carbonate (172.2 mg) + Calcium Carbonate (327.8 mg) Tablet Oral
Magnesium carbonate (52.3 mg) + Acetylsalicylic acid (500 mg) + Calcium
Carbonate (246.2 mg) + Magnesium oxide (96.9 mg)
Tablet Oral
Magnesium carbonate (52.32 mg) + Acetylsalicylic acid (500 mg) + Calcium
Carbonate (246.22 mg) + Magnesium oxide (96.95 mg)
Tablet Oral
Magnesium carbonate (34 mg) + Acetylsalicylic acid (325 mg) + Calcium
Carbonate (160 mg) + Magnesium oxide (63 mg)
Tablet Oral
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Tablet Dosages Route
Magnesium carbonate (80 mg) + Calcium Carbonate (160 mg) Tablet Oral
Magnesium carbonate (0.59 g/3.5g)+ Aluminum hydroxide (0.18 g/3.5g)+ Bismuth subcarbonate (0.21 g/3.5g) + Calcium
Carbonate (0.25 g/3.5g) + Sodium bicarbonate (2.27 g/3.5g)
Powder Oral
Magnesium carbonate (237.5 mg/5mL) + Aluminum hydroxide (254 mg/5mL) Suspension Oral
Magnesium carbonate (100 mg) + Copper gluconate (.1 mg) + Cyanocobalamin (100 mcg) + Potassium gluconate (50
mg) + Pyridoxine hydrochloride (50 mg) + Vitamin A (1000 unit)
Tablet Oral
Magnesium carbonate (358 mg/15mL) + Aluminum hydroxide (95 mg/15mL) Suspension Oral
Magnesium carbonate (358 mg/15mL) + Aluminum hydroxide (95 mg/15mL) Liquid Oral
Magnesium carbonate (237.5 mg/5mL) + Aluminum hydroxide (254 mg/5mL) Liquid Oral
Magnesium carbonate (100 mg) + Sodium alginate (250 mg) Liquid Oral
Magnesium carbonate (40 mg) + Alginic acid (200 mg) Tablet Oral
Magnesium carbonate (400 mg/1.92g) + Aluminum hydroxide(400 mg/1.92g) + Sodium bicarbonate (700 mg/1.92g) Granule Oral
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Magnesium carbonate (105 mg/1) + Aluminum hydroxide (160 mg/1) Tablet,
chewable
Oral
Magnesium carbonate (232 mg) + Calcium Carbonate (311 mg) Tablet Oral
Magnesium carbonate (125 mg) + Sodium alginate (275 mg) + Calcium Carbonate (300 mg) Suspension Oral
Magnesium carbonate (100 unit) + Calcium (125.00 mg) + Magnesium(125.00 mg) Capsule Oral
Magnesium carbonate (32 mg) + Magnesium oxide (136 mg) Tablet Oral
Magnesium carbonate (3.268 g/100mL) + Citric Acid (6.602 g/100mL) + Gluconolactone (0.198 g/100mL) Solution Irrigation
Magnesium carbonate (3.376 g/100mL) + Citric Acid (6.6 g/100mL)+ Gluconolactone (0.198 g/100mL) Solution Irrigation
Magnesium carbonate (358 mg/15mL) + Aluminum hydroxide (95 mg/15mL) Liquid Oral
chewable
Oral
chewable
Oral
Magnesium carbonate (58 mg/1g) + Sodium bicarbonate (809 mg/1g) Capsule Oral
Magnesium carbonate (58 mg/1g) + Sodium bicarbonate (809 mg/1g) Powder Oral
chewable
Oral
Magnesium carbonate (120 mg) + Acetylsalicylic acid (325 mg) + Calcium Carbonate (90 mg) + Magnesium (15 mg) Tablet Oral
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8. Potassium chloride
• Pharmaceutical uses: This medication is a mineral supplement used to treat or
prevent low amounts of potassium in the blood. (Hypokalemia)
– You should tell your doctor about all prescription, non-prescription, illegal,
and recreational drugs; herbal remedies; nutritional or dietary supplements
you're taking, especially:
• Angiotensin-converting enzyme (ACE) inhibitors, such
as captopril (Capoten), enalapril (Vasotec), and lisinopril(Prinivil, Zestri)
• Angiotensin-receptor blockers (ARB), such
as losartan(Cozaar), diovan (Valsartan), or irbesartan (Avapro)
• Diuretic drugs (often called "water pills")
• Vitamins
• Salt substitutes, such as "Mrs. Dash"
– You should not take potassium if you are taking the following:
• Amiloride (Midamor)
• Spironolactone (Aldactone)
• Triamterene (Dyrenium)
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• Adverse effect
– Hyperkalemia. Potassium chloride can lead to dangerously high levels of potassium, which could
cause the heart to stop beating. Tell your doctor if you have a history of heart or kidney disease.
– Digestive tract injury. Potassium chloride can remain in the digestive system for too long, leading to
injuries in the digestive tract (stomach, intestines). Tell your healthcare provider right away if you
have some or all of the following symptoms of digestive tract injury:
• stomach pain
• swollen stomach
• dark or black stools
– Metabolic acidosis (too much acid in the body). Patients should be treated with a particular
potassium salt such as potassium bicarbonate, potassium citrate, potassium acetate, or potassium
gluconate. Use with potassium chloride is not recommended.
– Mental confusion
– Tingling, prickling, burning, tight, or pulling sensation of arms, hands, legs, or feet
– Stomach pain
– Lethargy
– Heaviness or weakness of legs
– Cold, pale, or gray skin
– Unusual stomach bulging
– Black stools
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• Preparation
– This medication comes in tablet and capsule forms and may be taken multiple times a day with
food and water.
– Swallow capsules and tablets whole. Do not chew or crush contents of either the tablet or capsule.
– This medication is also available in an inject able form to be given directly into a vein by a
healthcare professional.
• The liquid for injection form is to be used by your hospital physician.
• For patients who have difficulty swallowing tablets whole, the tablet may be broken in half.
• For patients who have difficulty swallowing capsules whole, its contents may be sprinkled
into soft food followed by a glass of water or other liquid.
• If one cannot swallow a tablet, a capsule, or half a tablet, try the following alternate methods of
administration:
– Prepare an aqueous (water) suspension as follows:
• Place the whole tablet or pour the capsule's contents in approximately one-half glass of
water (4 fluid ounces).
• Allow approximately 2 minutes for the contents to dissolve.
• Stir for about half a minute after the contents have dissolved.
• Swirl the suspension and consume the entire suspension immediately by drinking or by the
use of a straw.
• Add another one fluid ounce of water, swirl, and consume immediately.
• Then, add an additional one fluid ounce of water, swirl, and consume immediately.
– If not taken immediately, it should be discarded. The use of other liquids besides water for
dissolving tablets or capsule contents is not recommended.
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9. Lithium carbonate (Li2CO3)
• Occurrence:
• Molar mass: 73.891 g/mol; Melting point: 723 °C; Density: 2.11 g/cm³;
Soluble in: Water
• Properties
• Take this medication by mouth as directed by your doctor, usually 2-3 times
daily.
• Take lithium with or immediately after meals to lessen stomach upset. Do not
crush or chew this medication. Doing so can release all of the drug at once,
increasing the risk of side effects.
• Also, do not split the tablets unless they have a score line and your doctor or
pharmacist tells you to do so.
• Swallow the whole or split tablet without crushing or chewing.
• Drink 8 to 12 glasses (8 ounces or 240 milliliters each) of water or other fluid
each day, and eat a healthy diet with normal amounts of salt (sodium) as
directed by your doctor or dietician while taking this medication.
• Large changes in the amount of salt in diet may change your
lithium blood levels. Do not change the amount of salt in diet unless doctor tells
to do so.
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• This medication is used to treat manic-depressive disorder (bipolar
disorder).
• It works to stabilize the mood and reduce extremes in behavior by restoring
the balance of certain natural substances (neurotransmitters) in the brain.
• Some of the benefits of continued use of this medication include decreasing
how often manic episodes occur and decreasing the symptoms of manic
episodes such as exaggerated feelings of well-being, feelings that others
wish to harm you, irritability, anxiousness, rapid/loud speech, and
aggressive/hostile behaviors.
• Other medications can affect the removal of lithium from your body, which
may affect how lithium works e.g. ACE inhibitors, ARBs, NSAIDs, water
pills (diuretics), other drugs for mental/mood conditions. Doctor may need
to adjust your dose of lithium if someone is on these medications.
• Lithium is an FDA Pregnancy Category D drug, which means it could harm
an unborn baby.
• Lithium can also pass into breast milk and may harm a breastfeeding baby.
• It's important to limit the amount of caffeine you consume while taking
lithium.

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• Common Side Effects of Lithium
•Restlessness
•Loss of appetite
•Weight gain or weight loss
•Stomach pain, gas, constipation, or indigestion
•Mild thirst
•Dry mouth
•Excessive saliva in mouth
•Change in the ability to taste food
•Swollen lips
•Acne
•Hair loss
•Extreme discomfort in cold temperatures
•Depression
•Muscle or joint pain
•Itching or rash
•Thin, brittle fingernails or hair
•Hand movements that are difficult to control

– Serious side effects
• Excessive thirst or sweating
• Excessive urination
• Fever
• Unusual fatigue or weakness
• Slow, jerky movements or movements
that are difficult to control
• Frequent urination
• Blackouts or fainting
• Seizures
• Dizziness or lightheadedness
• Shortness of breath
• Fast, slow, irregular, or pounding
heartbeat
• Chest tightness
• Confusion or hallucinations
• Crossed eyes
• Headache
• Pounding inside of head
• Swelling of the feet, ankles, or lower legs
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•Painful, cold, or discolored fingers and toes
•Drowsiness
•Diarrhea or vomiting
•Slurred speech
•Shaking of a party of the body that you can't
control
•Muscle weakness, stiffness, twitching, or
tightness
•Ringing in the ears
•Blurred vision
•Giddiness
•Loss of coordination
•This medication may increase serotonin and
rarely cause a very serious condition
called serotonin syndrome/toxicity. The risk
increases if you are also taking other drugs that
increase serotonin.
•A very serious allergic reaction to this drug is
rare.

• Preparation
– Tablets
– Oral suspension
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10. Sodium Nitrite (NaNO2)
– It is used together with sodium thiosulfate
– Antidotes and is used to treat Cyanide Poisoning.
– Vasodilator
– Sodium nitrite is known for its role in inhibiting the growth of Clostridium
botulinum spores in refrigerated meats BUT it can be toxic in high amounts for
animals and humans. Sodium nitrite's LD50 in rats is 180 mg/kg and its human LDLo
is 71 mg/kg, meaning a 65 kg person would likely have to consume at least 4.6 g to
result in death..
– This medicine may cause low blood pressure and a red blood cell problem called
methemoglobinemia. These may be life-threatening.
– This medicine is only for use when cyanide poisoning is life-threatening. This
medicine must be used with care if it is not known if cyanide poisoning has
happened.
– Tell doctor if inhaled a lot of smoke or if have any of these health problems like
Anemia, heart problems, lack of a certain enzyme called congenital methemoglobin
reductase deficiency, or lung problems.
34
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Occurrence AND Physical characteristics:
Molar mass 68.9953 g/mol
Appearance white or slightly yellowish solid
Density 2.168 g/cm
3
Melting point 271 °C (520 °F; 544 K) (decomposes at 320 °C)
Solubility in water Is very soluble in water and is hygroscopic.
71.4 g/100 mL (0 °C)
84.8 g/100 mL (25 °C)
160 g/100 mL (100 °C)
Solubility soluble in methanol (4.4 g/100 mL) ethanol
slightly soluble in diethyl ether (0.3 g/100 mL)
very soluble in ammonia
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Preparation
•Inject able Solution
•Topical Solution

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36
• Adverse effect
•Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered,
or peeling skin with or without fever; wheezing; tightness in the chest or throat;
trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the
mouth, face, lips, tongue, or throat.
•Signs of methemoglobinemia like a blue or gray color of the lips, nails, or skin; a
heartbeat that does not feel normal; seizures; very bad dizziness or passing out;
very bad headache; feeling very sleepy; feeling tired or weak; or shortness of
breath. This effect is rare but may be deadly if it happens.
•Signs of too much acid in the blood (acidosis) like confusion; fast breathing; fast
heartbeat; a heartbeat that does not feel normal; very bad stomach pain, upset
stomach, or throwing up; feeling very sleepy; shortness of breath; or feeling very
tired or weak.
•Very bad dizziness or passing out.
•A fast heartbeat.
•A heartbeat that does not feel normal.
•Feeling confused.
•Blurred eyesight.
•Seizures.
•Numbness and tingling.
•Fast breathing.
•Shortness of breath.
•Dizziness.
•Flushing.
•Headache.
•Upset stomach or throwing up.
•Belly pain.
•Bad taste in your mouth.
•Anxiety.
•Sweating a lot.
•Feeling tired or weak.

11.Calcium gluconate (C12H22CaO14)
Molar mass: 430.373 g/mol; Melting point: 120 °C; Soluble in: Water
• Pharmaceutical uses and Preparations:
• Calcium salt of gluconic acid, an intravenous medication used to treat conditions
arising from calcium deficiencies such as hypocalcemic tetany, hypocalcemia related to
hypoparathyrodism, and hypocalcemia due to rapid growth or pregnancy.
• 10% calcium gluconate solution (given intravenously) is the form of calcium most
widely used in the treatment of low blood calcium.
• Calcium gluconate is used as a cardioprotective agent in people with high blood
potassium levels, with one alternative being the use of calcium chloride.
• It is also used to counteract an overdose of Epsom salts magnesium sulfate, which is
often administered to pregnant women in order to prophylactically prevent seizures (as
in a patient experiencing preeclampsia)
• Gel preparations of calcium gluconate are used to treat hydrofluoric acid burns.
• Calcium gluconate was used as an antidote for black widow spider envenomation,
often in conjunction with muscle relaxants. This therapy, however, has since been
shown to be ineffective.
• Preparations
• Injectable solution: 100mg/mL (10%)
• Tablet: 50mg or 500mg or 650mg
• Capsule (adult only): 500mg 37
Ahmed

• Adverse effect
• Nausea
• Constipation, and upset stomach
• Rapid intravenous injections of calcium gluconate may cause hypercalcaemia, which
can result in vasodilation, cardiac arrhythmias, decreased blood pressure,
and bradycardia.
• Extravasation of calcium gluconate can lead to cellulitis. Intramuscular injections may
lead to local necrosis and abscess formation.
• It is also reported that this form of calcium increases renal plasma flow, diuresis,
natriuresis, glomerular filtration rate, and prostaglandin E2 and F1-alpha levels.
• Hypersensitivity
• Intramuscular/subcutaneous (IM/SC) administration
• Ventricular fibrillation during CPR
• High blood calcium (hypercalcemia)
• Digoxin poisonings
• Sarcoidosis
• Hepatic or renal impairment
• Cardiovascular disease
• Acidosis
38
Ahmed

Ahmed
39
• History of renal calculi
• Constipation, bloating, and gas may occur with oral administration.
• Use caution in patients with severe hyperphosphatemia.
• Rapid intravenous (IV) infusion associated with low blood pressure
(hypotension), slow heart rate (bradycardia), fainting (syncope), cardiac arrest,
cardiac arrhythmias, sense of oppression or heat waves,
tingling sensation, vasodilatation.
• Use calcium gluconate with caution during pregnancy if benefits outweigh risks.
• Calcium gluconate enters human milk; use with caution if breastfeeding.

12. Calcium carbonate (CaCO3)
– This medication is used to prevent or treat low blood calcium levels in
people who do not get enough calcium from their diets.
– It may be used to treat conditions caused by low calcium levels such
as bone loss (osteoporosis), weak bones (osteomalacia/rickets),
decreased activity of the parathyroid gland (hypoparathyroidism), and a
certain muscle disease (latent tetany).
– It may also be used in certain patients to make sure they are getting
enough calcium (e.g., women who are pregnant, nursing, or
postmenopausal, people taking certain medications such as
phenytoin, phenobarbital, or prednisone).
– Calcium plays a very important role in the body. It is necessary for
normal functioning of nerves, cells, muscle, and bone. If there is not
enough calcium in the blood, then the body will take calcium from
bones, thereby weakening bones.
– Having the right amount of calcium is important for building and
keeping strong bones.
40
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– This medication is taken by mouth with food.
– If product contains calcium citrate, then it may be taken with or without food.
– For best absorption, if daily dose is more than 600 milligrams, then divide dose and
space it throughout the day.
– If using the chewable product, chew it well before swallowing.
– If using the effervescent tablet, allow the tablet to fully dissolve in a glass of water
before drinking it. Do not chew or swallow the tablet whole.
– Before taking calcium, tell doctor or pharmacist if have any allergies. This product
may contain inactive ingredients, which can cause allergic reactions or other
problems.
– Harmful in high calcium levels (hypercalcemia).
– Consult doctor or pharmacist before using this product in kidney disease, kidney
stones, little or no stomach acid (achlorhydria), heart disease, disease of
the pancreas, a certain lung disease (sarcoidosis), difficulty absorbing nutrition from
food (malabsorption syndrome).
– Some sugar-free formulations of calcium may contain aspartame. If person have
phenylketonuria (PKU) or any other condition that requires to restrict intake of
aspartame (or phenylalanine), consult doctor or pharmacist about using this drug.
41
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• Adverse effect
– Constipation and upset stomach may occur
– serious side effects occur: nausea/vomiting, loss of appetite, unusual weight
loss, mental/mood changes, bone/muscle pain, headache, increased
thirst/urination, weakness, unusual tiredness.
– A very serious allergic reaction to this drug is rare. However, seek immediate
medical attention if you notice any symptoms of a serious allergic reaction,
including: rash, itching/swelling (especially of the face/tongue/throat),
severe dizziness, trouble breathing.
• Preparation
– Usual Adult Dose for Dyspepsia
Chewable Tablets:
-Recommended dose: 1000 to 3531 mg orally up to 4 times a day as needed
-Maximum dose: 6750 to 7500 mg/day
-Gum:
Recommended dose: 500 mg (1 piece) orally every 2 to 4 hours as needed
Maximum dose: 6000 mg/day (12 pieces/day)
-Liquid:
Recommended dose: 1250 mg orally as needed for symptoms
Maximum dose: 7500 mg/day 42
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• Powder Packets:
Recommended dose: 1000 mg (1 packet) orally as needed for symptoms
Maximum dose: 8000 mg/day (8 packets/day)
– Usual Pediatric Dose for Dyspepsia
Chewable Tablets:
2 to 5 years OR 24 to 47 pounds:
-Recommended dose: 400 mg orally up to 3 times a day as needed
-Maximum dose: 1200 mg/day
2 years and older:
-Recommended dose: 1000 to 2000 mg orally up to 3 times a day as needed
Granule Formulations:
-Recommended dose :750 mg orally once a day as needed
Gum:
12 years and older:
-Recommended dose: 500 mg (1 piece) orally every 2 to 4 hours as needed
-Maximum dose: 6000 mg/day (12 pieces/day) 43
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13. Calcium chloride (CaCl2)
– Calcium Chloride has moderate interactions with at least 48 different drugs.
– Calcium Chloride has mild interactions with at least 52 different drugs.
– Antidotes, Other; Calcium Salts
– It is a mineral indicated in the immediate treatment of hypocalcemic tetany
(abnormally low levels of calcium in the body that cause muscle spasm).
– Its injection is also used in cardiac resuscitation,
arrhythmias, hypermagnesemia, calcium channel blocker overdose, and beta-
blocker overdose.
– Severe interactions of Calcium Chloride include:
• ceftriaxone
– Serious interactions of Calcium Chloride include:
• demeclocycline
• dolutegravir 44
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• doxycycline
• eltrombopag
• lymecycline
• minocycline
• oxytetracycline
• tetracycline
– Contraindications
• VFib during CPR, hypercalcemia, risk for digitalis toxicity,
hypophosphatemia, renal calculi
• Intramuscular (IM) or subcutaneous (SC) administration
• Pulseless ventricular tachycardia
– Hepatic impairment, sarcoidosis, cardiovascular
disease, renal disease, acidosis, cor pulmonale, or digitalized patients.
– Not recommended in treatment of asystole and electromechanical dissociation.
– PALS no longer recommends Ca for pediatric cardiac arrest.
– Life-threatening cardiac arrhythmias may occur in severe hypokalemia.
– Use calcium chloride with caution during pregnancy
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– As a component of human milk calcium enters milk. Use caution
if breastfeeding.
• Adverse effect
– Redness
– Low blood magnesium (hypomagnesemia)
– Low blood phosphates (hypophosphatemia)
– Low blood pressure (hypotension)
– High blood calcium (hypercalcemia)
– Nausea
– Tissue necrosis at injection site
– Vasodilation
– Weakness
– Kidney stones
– Hot flashes
– Serum amylase increased
– Tingling sensations
– Injection site reactions (tingling, burning sensation, inflammation of the veins
[phlebitis])
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– Fainting
– Side effects of calcium chloride rapid administration include:
• Irregular heartbeat (arrhythmia)
– Slow heart rate
– Calcium taste
– Sense of heat waves
– Ventricular fibrillation
• Preparation
– Injection, USP10% (100 mg/mL(13.6 mEq Calcium/10 mL)
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14. Calcium lactate
• Adverse effect
• Preparation
48
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15. Ferrous fumarate
• Adverse effect
• Preparation
49
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16. Ferrous sulfate
• Adverse effect
• Preparation
50
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17. Ferrous gluconate
• Adverse effect
• Preparation
51
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18. Iron polysaccharide
• Adverse effect
• Preparation
52
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19. Silver nitrate
• Adverse effect
• Preparation
53
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20. Antimony gluconate
• Chemical formula and common name
• Adverse effect
• Preparation
• Used in drugs which are available in market
54
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21. Iodine Hydrogen per oxide
• Adverse effect
• Preparation
55
Ahmed

22. Boric acid
• Adverse effect
• Preparation
56
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23. Zinc oxide
• Adverse effect
• Preparation
57
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