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Anesthetic: Local anaesthesia (lignocaine)

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Class: Stimulant Laxative

Indications: Constipation, bowel prep for procedures, surgery.

Pharmacodynamics (PD) Molecular Target

Acts on the smooth muscle (bowel wall) of the colon, stimulating peristalsis and fluid secretion.

PD Physiological Effect

Increases bowel movement and water secretion, softening stool.

Key Pharmacokinetics

Absorption: Minimal.

Distribution: Does not significantly distribute systemically due to minimal absorption.

Metabolism: Prodrug = Converted to active form in the colon.

Excretion: Mostly in feces.

Contraindications

Acute abdominal conditions (e.g., appendicitis, obstruction), Hypersensitivity, Severe dehydration

Cautions

Electrolyte imbalances, chronic use risks.

Use cautiously in pregnancy and lactation.

Not to be used by children under 6

Drug-Drug Interactions

Risk of electrolyte imbalances with diuretics and corticosteroids.

Antacids can increase bisacodyl absorption.

Adverse Effects

Common: Abdominal cramps, diarrhea, bloating.

Serious: Electrolyte imbalances, colonic dependence, rectal bleeding (though rare)

Monitoring

Electrolytes (mainly potassium), hydration status, bowel function.

Dosing Regimen

Oral: 5-10 mg daily.

Suppository: 10 mg daily.

Clinical Practice Considerations

Short-term use only, educate on hydration and lifestyle changes to avoid dependence.

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Group 3                                             Antiemetic-Metoclopramide           

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Group 3                                             Antiemetic-Metoclopramide           

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Group 12: Analgesia Non-opioid analgesics (paracetamol)

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Group 12: Analgesia Non-opioid analgesics (paracetamol)

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Group 13-Analgesia: NSAIDs (diclofenac, naproxen, ibuprofen)

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Group 13-Analgesia: NSAIDs (diclofenac, naproxen, ibuprofen)

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Group 1 (Blessy Abraham, Jyoti Mishra, Francesca Molnar):-

Gastric acid suppression: Proton pump inhibitors (omeprazole)

Drug Classification & Name

Class: Proton Pump Inhibitor (PPI)

Drug Name: Omeprazole

Indications:

Gastroesophageal reflux disease (GERD)

Peptic ulcer disease (PUD)

Helicobacter pylori eradication (part of triple therapy)

Zollinger-Ellison syndrome (excess stomach acid)

Prevention of NSAID-induced ulcers

Pharmacodynamics (PD): Molecular Target

Target: Hydrogen/Potassium ATPase (proton pump) in gastric parietal cells

Pharmacodynamics (PD): Physiological Effect

Irreversibly blocks acid production, reducing stomach acidity and promoting ulcer healing

Key Pharmacokinetics

Absorption: Well absorbed in the small intestine

Metabolism: Liver (CYP2C19, CYP3A4 enzymes)

Half-life: 1–2 hours, but effects last 24+ hours

Excretion: Mostly in urine and feces

Contraindications

Allergy to omeprazole or other PPIs

Severe liver disease

Concomitant use with rilpivirine (HIV drug)

Cautions

Long-term use may cause vitamin B12 deficiency

Risk of osteoporosis and fractures

May increase risk of gut infections (C. difficile)

Caution in kidney disease

Drug-Drug Interactions

Reduces absorption of drugs needing stomach acid (e.g., ketoconazole, calcium carbonate, iron supplements)

Increases blood levels of warfarin, diazepam, and phenytoin (CYP2C19 inhibition)

May reduce the effect of clopidogrel (antiplatelet drug)

Adverse Effects

Common: Headache, nausea, diarrhea, constipation, flatulence

Serious but rare: Kidney disease, low magnesium, fractures, gut infections

Monitoring

Check vitamin B12 levels in long-term users

Bone health monitoring in older adults

Magnesium levels in long-term therapy

Kidney function tests for prolonged use

Dosing Regimen

GERD & ulcers: 20–40 mg once daily

H. pylori eradication: 20 mg twice daily (with antibiotics)

Zollinger-Ellison syndrome: 60 mg once daily, adjust as needed

Important Clinical Practice Considerations

Use lowest effective dose for the shortest time

Taper gradually if stopping after long-term use to prevent acid rebound

Advise calcium & vitamin D supplementation for long-term users

Assess for drug interactions in patients on multiple medications

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4. Antiemetic: 5HT3 Antagonist (Ondansetron)

Class & Indications:

5HT3 receptor antagonists - Used for nausea/vomiting due to chemotherapy, radiotherapy, or surgery.

PD Molecular Target:

Blocks 5HT3 receptors in the chemoreceptor trigger zone and gastrointestinal tract.

PD Physiological Effect:

Reduces nausea and vomiting by inhibiting serotonin's effect.

Key Pharmacokinetics:

Absorption: Rapid, taken orally or IV.

Metabolism: Hepatic (CYP3A4).

Half-life: 3-4 hours.

Contraindications:

Hypersensitivity to ondansetron.

Cautions:

Risk of QT prolongation, especially with other QT-prolonging drugs.

Drug-drug Interactions:

Apomorphine (serious hypotension), other QT-prolonging agents (e.g., amiodarone).

Adverse Effects:

Headache, constipation, dizziness, QT prolongation.

Monitoring:

Monitor for QT prolongation in high-risk patients.

Dosing Regimen:

4-8 mg every 8 hours, can be increased for chemotherapy-induced nausea.

Important Clinical Practice Considerations:

Effective for acute nausea but not for long-term management.

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Class & indications:

Naloxone: Opioid antagonist; used for opioid overdose reversal.

Acetylcysteine: Mucolytic and antidote for acetaminophen overdose.

PD Molecular target:

Naloxone: μ-opioid receptor antagonist.

Acetylcysteine: Restores hepatic glutathione levels via its sulfhydryl group.

PD physiological effect:

Naloxone: Competitive inhibition of opioid effects, reversing respiratory depression, sedation, and analgesia.

Acetylcysteine: Reduces hepatotoxicity by detoxifying N-acetyl-p-benzoquinone imine (NAPQI), a toxic acetaminophen metabolite.

Key pharmacokinetics:

Naloxone: Rapid onset (2-5 minutes IV), short half-life (30-80 minutes), requiring repeated dosing in long-acting opioid toxicity.

Acetylcysteine: Administered IV or orally; metabolized in the liver with ~6-hour half-life. Best efficacy when given within 8-10 hours post-overdose.

Contraindications:

Naloxone: None in emergency situations.

Acetylcysteine: Hypersensitivity to acetylcysteine.

Cautions:

Naloxone: Precipitation of acute opioid withdrawal in dependent individuals.

Acetylcysteine: Anaphylactoid reactions when administered intravenously (rare).

Drug-drug interactions:

Naloxone: No significant drug interactions but may diminish opioid analgesia.

Acetylcysteine: No significant drug interactions reported.

Adverse effects:

Naloxone: Nausea, vomiting, tachycardia, agitation, withdrawal symptoms.

Acetylcysteine: Nausea, vomiting, rash, flushing, or anaphylactoid reactions.

Monitoring:

Naloxone: Reassess respiratory rate, oxygen saturation, and level of consciousness frequently.

Acetylcysteine: Monitor serum acetaminophen levels, liver function tests (ALT, AST, bilirubin). Watch for hypersensitivity reactions.

Important clinical practice considerations:

Naloxone: Ensure adequate airway management; anticipate prolonged care for long-acting opioids.

Acetylcysteine: Effective when given early. Include close observation for signs of overdose progression and hepatic failure.