THE RESPIRATORY

SYSTEM
DR EZEKIEL EFEOBHOKHAN
 COURSE CONTENTS

• ANTI-TUSSIVE AGENTS
• BRONCHODILATORS
• EXPECTORANTS
• ANTIBIOTICS AND ANTI-NFECTIVES
• SYMPATHOMIMETICS
• ANTI-TUBERCULOSIS DRUGS
ANTI-TUSSIVE AGENTS
 INTRODUCTION

• These constitutes a heterogeneous class of compounds

that inhibit cough through either a central or a peripheral
mechanism, or a mixture of the two.

• They can be grouped into the centrally acting and

peripherally acting agents.

• The centrally acting includes; dextromethorphan, codeine

and hydrocodone.

• The peripherally acting are camphor, menthol, eucalyptus

oil, benzonatate, levodropropizine.
 MECHANISM OF ACTION

• Antitussive are cough suppresants. There are two ways in

which cough can be inhibited and they are centrally and
peripherally.

• COUGH
•This is produced due to the stimulation of sensory receptors
of the glassopharyngeal and vagus nerves, innervating the
mucous membranes of the lower pharynx, larynx, trachea,
and smaller airways of the respiratory system.
•This receptors transmit the signal to the cough centre of
the brain, which triggers a reflex motor response that
results in the contraction of the muscles to close the vocal
cords and to contract the muscles responsible for expiration.
 DEXTROMETHORPHAN

• This results in a sudden increase in intrathoracic

pressure, followed by relaxation of the vocal cords
resulting in rapid expulsion of air.

• Dextromethorphan for example is an N-methyl-d-

aspartate (NMDA)antagonist, although it is not known
what contribution this has to its antitussive effects.

• Dextromethorphan acts by suppresses a cough centre

in the medulla oblongata or the cough receptors in
the throat, or lung, effectively elevating the cough
threshold.
 INDICATION

• Used in managing dry cough, hacking, non-

productive cough that interferes with rest and
sleep.
ADVERSE EFFECTS:
1. Nausea
2. Drowsiness
3. Rash
4. Difficulty in breathing
5. Hallucinations at high doses.

CONTRA-INDICATION:
Hypersensitivity to drug or its excipients; liver
disease; patients on SSRIs; under 6 years.
 NURSING ACTION

1. Not safe for children under the age of 6 years.

2. Educate patients that they should avoid irritants
that stimulate their cough.
3. Patients should avoid alcohol and other CNS
depressants while taking this medication.
4. May cause drowsiness, patient should avoid
machines and heavy duty work.
5. Should be administered undiluted.
Dosage:
Adult and child >12years; 30mg every 6-8 hours.
Maximum of 120mg/day.
Child 6-12 years; 5-10mg every 1-4 hours; maximum
of 60mg/day.

PHARMACOKINETICS:
1. Onset of action 1hour and lasts for about 4 hours.
2. Excreted unchanged.
3. Undergoes extensive first-pass metabolism
4. Well absorbed from the GIT.
BRONCHODILATORS
 INTRODUCTION

• These are medications that make breathing

easier by relaxing the muscles in the lungs and
widens the airways (bronchi).
• They dilate the bronchi and bronchioles,
decreasing resistance in the respiratory airway
and increasing airflow to the lungs.
• They are used in the long and short-term
treatment of conditions such as;
1. Asthma
2. Chronic obstructive pulmonary disease (COPD).
• They can be grouped into either; Short-acting or
long-acting bronchodilators.

SHORT-ACTING BRONCHODILATOR:
Used as a short-term relief of sudden and
unexpected attack of breathlessness. It

LONG-ACTING BRONCHODILATOR:
These are used in the daily control of the
symptoms of asthma and COPD.
 TYPES OF BRONCHODILATORS

• There are three types and may be grouped into;

• Beta-2 adrenergic agonists

• Anticholinergic
• Xanthines

BETA-2 ADRENERGIC AGONISTS; are a class of

drugs that act on the Beta-2 adrenergic receptor.
They cause smooth muscle relaxation.
They are primarily used in the treatment of asthma
and other pulmonary disorders, such as COPD.
• They can be divided into short-acting and long
acting beta adrenergic receptor agonists.

• Examples of short-acting beta-2 agonists are

Fenoterol, salbutamol, terbutaline etc.

• Examples of long-acting beta-2 agonists are

formoterol, salmoterol, clenbuterol etc.
 MECHANISM OF ACTION

• Activation of beta adrenergic receptors leads to

relaxation of smooth muscle in the lungs, and dilation
and opening of the airways.

• Beta adrenergic receptors are coupled to a

stimulatory G-protein of adenylyl cyclase. Thus
producing a cAMP.
•
• In the lungs cAMP decreases calcium concentrations
within the cells and activates protein kinase A. These
results in the inactivation of myosin light chain kinase
and activates myosin light chain phosphatase.
 SALBUTAMOL

• It is a short acting beta-2 adrenergic receptor agonists which

acts by causing relaxation of airway smooth muscle.

• Used in the treatment of Asthma and COPD,

• Used as an inhaler, nebulizer, tablet form, liquid and intravenous

solution.

DOSAGE:
By mouth in an Adult ad child >12years; 2-4mg 3 or 4 times daily.
In some patients 8mg 3-4 times daily.
By aerosol; 1-00-200ug(1-2puffs).

Child by mouth 100ug/kg repeated up to 4 times daily.

MECHANISM OF ACTION:
Activation of beta adrenergic receptors leads to relaxation of
smooth muscle in the lungs, and dilation and opening of the
airways.

PHARMACOKINETICS:
1. Metabolized by the liver.
2. Onset of action is <15 minutes when inhaled and <30
minutes when taken orally.
3. Elimination half life is 3.8-6 hours.
4. Duration of action is 2-6 hours.
5. It is excreted by the kidney.
ADVERSE EFFECTS:
1. Shakiness
2. Headache
3. Fast heart rate
4. Dizziness
5. Anxiety
6. Irregular heartbeat
7. Hypokalaemia.

CONTRA-INDICATION:
Hypersensitivity to salbutamol or to any of its ingredients.
NURSING ACTION:
1. Before using, the inhaler must be shaken well.
2. Relieve dry mouth with sips of water or gum.
3. Do not exceed the prescribed dose.
4. Observe patient for wheezing after
administration; if this occurs call the physician.
5. Teach patient how to use metered dose inhaler.
 ANTICHOLINERGICS

• Examples include Tiotropium and Ipratropium bromide.

• Tiotropium is a long lasting, 24-hour anticholinergic

bronchodilator used in the management of Chronic
Obstructive Pulmonary Disease (COPD).

• Has shown use in the treatment of Asthma.

• Ipratropium bromide is a short-acting antichonergic

which acts by improving lungs function and reducing the
risk of exacerbation in people with symptomatic asthma.
 IPRATROPIUM BROMIDE

• A short-acting anticholinergic which is usually not used alone,

it is most time paired with a short-acting beta-2 agonists.

• PHARMACOKINETICS:
1. Administered via inhalation.
2. Has a protein binding of 0-9% in vitro.
3. It is metabolized in the liver.
4. The elimination half life is 3 hours.

DOSAGE:
By aerosol inhalation; Adult 20-40 ug 3-4 times daily.
Child up to 6 years, 20ug 3 times daily, 6-12 years, 20-40ug 3
times daily.
MECHANIS,M OF ACTION:
Exhibits its broncholytic action by reducing
cholinergic influence on the bronchial musculature.

It blocks muscarinic acetylcholine receptors,

without specificity for subtypes and therefore
promotes the degradation of cGMP. Leading to a
decreased intracellular concentration of cGMP thus
reduced intracellular calcium and in return reduced
smooth muscle contractility.
CONTRA-INDICATION:
Hypersensitivity to Atropine, Ipratropium bromide
or any of the components.

ADVERSE EFFECTS:
1. Dry mouth
2. Urinary retention
3. Constipation
4. Tachycardia
5. Atrial fibrillation.
NURSING ACTION:
1. Inform and educate patient that the onset of
action is slower than that of salbutamol.
2. When giving via a nebulizer monitor patient
closely.
3. Ensure that the powder doesn’t touch or enter
the patients eyes.
 XANTHINES

These are a group of alkaloids.

• There are several stimulants derived from the

Xanthine and they include; Caffeine, Theophylline
and Theobromine.

• Xanthine is a pure product on the pathway of purine

degradation.

• Those that have found usefulness as

bronchodilators are Aminophylline and Theophylline.
 AMINOPHYLLINE

PHARMACOKINETICS:
1. Can be given via the oral, and I.V route.
2. Has a protein binding of 60%
3. Elimination half life is 7-9 hours.

MECHANISM OF ACTION:
Acts as a competitive non-selective
phosphodiesteraase inhibitor which raises
intracellular AMP, activates PKA, inhibits TNF-alpha
and Leukotriene synthesis, and reduces
inflammation and innate immunity.
CONTRA-INDICATION:
Hypersensitivity to the Xanthine or any component;
uncontrolled arrhythmia; hyperthyroidism; peptic ulcers;
uncontrolled seizures.

ADVERSE EFFECTS:
1. GI irritation
2. Visual disorders
3. Hypotension
4. Hyperthermia
5. Convulsion and
6. Headache.
DOSAGE:
Adult by mouth; 100-300mg 3-4 times daily after food.
By slow IV injection over 20 minutes; 200-500mg in 10-20ml of
water.

NURSING ACTION:
1. Give per oral with a full glass of water after meals to decrease
GI upset.
2. Dilute IV dose in D5W to prevent the burning effect.
3. Avoid IM injection; may cause pain and tissue damage.
4. Encourage patient to drink adequate fluid to decrease mucous
viscosity.
5. Advise patient to avoid hazardous activities because dizziness
may occur.
EXPECTORANTS
 INTRODUCTION

• These are mucoactive agents which are a class of

chemical substances that aid in the clearance of
mucous or sputum from the upper and lower
airways. Including the lungs, bronchi and trachea.

• An expectorant increases the bronchial secretions

and reduces the thickness or viscosity of bronchial
secretions thus increasing the mucus flow that
can be removed more easily by coughing.

• Examples include Guaifesin, Bromhexine etc.

 GUAIFENESIN

• Also known as Glyceryl guaicolate, is an

expectorant which aids in the elimination of
sputum from the respiratory tract.

• PHARMACOKINETICS:
1. Administered via the mouth
2. Readily absorbed from the GIT.
3. Metabolized in the kidneys
4. Has an elimination half life of 1-5 hours.
5. Excreted via the urine.
DOSAGE:
By mouth Adult; 200-400mg every 4 hours as
needed. Not to exceed 2400mg daily.
Child; 2-6years, 50-100mg every 4 hours as
needed; not to exceed 600mg per day.

MECHANISM OF ACTION:
Acts by increasing the volume and reducing the
viscosity of secretions from the trachea and
bronchi. T
CONTRA-INDICATION:
Hypersensitivity to guaifenesin and bisulphites.

ADVERSE EFFECT:
1. GI discomfort
2. Nausea
3. Vomiting
4. Diarrhoea
5. Drowsiness
6. Stomach pain
NURSING ACTION:
1. To help loosen mucus in the lungs, patient
should drink a glass of water after each dose.
2. Dosage for children under 2 years of age must
be individualized.
3. Nausea and vomiting effect can be reduced by
taking with meals.
4. If any severe effect as rash and swelling of the
gums occur, please report to the prescribing
physician
ANTITUBERCULOSIS
 INTRODUCTION

• Tuberculosis is a chronic infectious disease

caused primarily by Mycobacterium tuberculosis
or sometimes M. bovis.

• Generally affects the lungs, but it can also affects

other parts of the body.

• It is usually Latent or Active Tuberculosis. The

latent tuberculosis does not show any symptom.
• Typical symptoms of Active TB include; chronic
cough with blood-containing mucus, fever, night
sweats and weight loss.

• Risk factors is smoking and HIV/AIDS.

• It is spread from one person to another through

the air when people who have active TB in their
lungs cough, spit, speak or sneeze.
 PREVENTION

• Vaccines:
the use of Bacillus Calmette-Guerin (BCG) in
children decreases the risk of getting infected by
20% and the risk of an infection becoming active
by 60%.

The immunity it induces decreases after 10 years.

• Screening those at high risk

• Treatment of those infected.

 ANTITUBERCULOSIS

• The treatment of tuberculosis includes the use of

antibiotics although the bacterial cell wall hardly
allows for the entry of the drugs but treatment is
usually progressive.

• The treatment of tuberculosis is usually a long-term

course, ranging from 3 -9 months or even 12
months in some cases.

• And it involves the combination of two or more

drugs due to the issue of resistance and treatment
failure.
• The modern short course therapy is usually in 2-phases.
The initial phase (2 months) involving the concurrent
use of at least 3 drugs to reduce the bacterial
population rapidly and prevent the emergence of drug
resistant bacterial.

• The second phase (4-6 months) involves fewer drugs

and is used to eliminate any bacteria remaining and
preventing recurrence.

• There are five antituberculosis drugs currently and they

include Ethambutol, Rifampicin, Pyrazinamide, Isoniazid
and Streptomycin.
 RIFAMPICIIN

• It is an antibiotic and antituberculous agent.

MECHANISM OF ACTION:

Inhibits bacterial DNA- dependent RNA synthesis by inhibiting

bacterial DNA-dependent RNA Polymerase.

PHARMACOKINETICS:
1. Has a bioavailability of 90-95% by mouth.
2. Has a protein binding of 80%.
3. Metabolized actively by the liver.
4. Has an elimination half life of 3-4 hours.
5. Excreted in the urine and faeces.
DOSAGE:
By mouth, Adult and Child; 10mg/kg daily or 3 times weekly.
Maximum daily dose is 600mg.

CONTRA-INDICATION:
Hypersensitivity to Rifamycin; Jaundice.

ADVERSE EFFECTS:
1. Severe GI disturbances
2. Headache
3. Drowsiness
4. Fever
5. Rashes
NURSING ACTION:
1. Give on an empty stomach 1 or 2 hours before
meal.
2. Advise against use with alcohol as it may
increase risk of hepatotoxicity.
3. Monitor hepatic function and serum uric acid
regularly.
4. New born of rifampicin-treated mothers may
suffer haemorrhage.
5. Warn patients of possible discolouration of
urine, tears, sweat and other bodily fluids.
 ISONIAZID
• Used in the treatment and prevention of Tuberculosis.

• Used as a preventive in high risk HIV/AIDS patients, taken during the first 6-
12 months of beginning therapy.

MECHANISM OF ACTION:
Acts by inhibiting the formation of the mycobacterial cell wall.
It gets activated by KatG, which catalysis the formation of isonicotinic acyl
radical, which is spontaneously coupled with NADH to form Nicotinoyl-NAD
adduct. This process inhibits the synthesis of mycolic acids, components of
the cell wall.

PHARMACOKINETICS:
1. Very low protein binding effect.
2. Metabolized by the liver
3. Has an elimination half life of 0.5-1.6 hours for fast acetylators and 2-5
hours for slow acetylators.
4. Excreted primarily in the urine.
DOSAGE:
For treatment, Adult and Child; By mouth 5mg/kg daily or 10mg/kg 3
times weekly. For 6-8 months

For prevention, adult and child 5mg/kg daily for 6 months.

CONTRA-INDICATION:
Drug induced hepatic disease.

ADVERSE EFFECTS:
1. GI disturbances such s Nausea, vomiting, constipation etc.
2. Haemolytic anaemia
3. Pellagra
4. Hepatitis
5. Peripheral neuropathy
NURSING ACTION:
1. Advise patient o take with food if GI
disturbances occur.
2. Advise against use with alcohol.
3. Pyridoxine may be co-administered to prevent
peripheral neuropathy.
4. Emphasize the need to comply with dosage and
appointments to prevent relapse.
5. Monitor hepatic function and notify doctor if the
need arises.
SYMPATHOMIMETICS
 INTRODUCTION

• Also known as adrenergic drugs and adrenergic amines.

• They are stimulant compounds that mimic the effects of

endogenous agonists of the sympathetic nervous system.

• Example of that which act in the respiratory system is

Epinephrine.

• They act by several mechanisms, such as directly

activating postsynaptic receptors, blocking breakdown and
reuptake of certain neurotransmitters, or stimulating the
production and release of catecholamine.
 EPINEPHRINE

Also known as Adrenaline.

MECHANISM OF ACTION:
Acts by directly activating postsynaptic receptors, blocking
breakdown and reuptake of certain neurotransmitters, or
stimulating the production and release of catecholamine.

PHARMACOKINETICS:
1. Protein binding of 15-20%
2. Metabolized by adrenergic synapse to metanephrine.
3. Has a rapid onset of action
4. Elimination half life is 2 minutes.
5. Excreted via the urine.
DOSAGE:
Anaphylaxis; by IM or SC injection of 1:1000 epinephrine injection.

CONTRA-INDICATION:
Hypersensitivity to epinephrine; shock; organ damage;
Narrow angle glaucoma.

ADVERSE EFFECTS:
1. Tachycardia
2. Hypertension
3. Tremor
4. Anxiety
5. Sweating
6. Nausea and vomiting
7. Hyperglycaemia
NURSING ACTION:
1. Read drug label to ensure you are using correct
concentrations, route and dosage.
2. Shake before using
3. Rotate IM/SC sites
4. Massage after injection
5. Monitor injection site for tissue damage
6. Warn patients to avoid use of the OTC.
ANTIBIOTICS AND ANTI-
INFECTIVES
 INTRODUCTION

• These are types of antimicrobial agents or

substances active against bacteria.

• They are used in the prevention and treatment of

bacterial infections.

• They may kill or inhibit the growth of bacteria.

• They are not effective against viruses such as

common cold or influenza.
 CLASSIFICATION

• They are commonly classified based on the

mechanism of action, chemical structure, or
spectrum of activity.

• Those that target the bacterial cell wall

(Penicillins and cephalosporin) or the cell
membrane (polymyxins) or interfere with
essential bacterial enzymes (rifamycins,
quinolones and sulphonamides). All of these
exhibit bacterial killing effects.
• Protein synthesis Inhibitors (macrolides,
lincosamides and tetracycline) are usually
bacteriostatic that is they inhibit the growth of
bacteria.

• Antibiotics can also be further divided based on

their target specificity. ‘Narrow-spectrum’
antibiotics target specific types of bacteria, such
as gram-negative and gram-positive, whereas
broad-spectrum will have effect on a wide range
of antibiotics.
 B-LACTAM ANTIBIOTICS

• These include the Penicillins, Cephalosporins and

carbapenems.

• They all share a common chemical structure with

the beta lactam rung infused.

• They are bactericidal in nature,

• They act by inhibiting peptidoglycan, a

mucopeptide in bacterial cell walls.
 PENICILLIN

• These are a group of B-lactam antibiotics

originally obtained from Penicillium moulds.

• A number of them are obtained naturally such as

Penicillin G and V. Some others can be gotten
synthetically.

• They were the first medications to be effective

against many bacterial infections caused by
Staphylococci and Streptococci.
 PENICILLIN DISCOVERY

• Penicillin was discovered in 1928 by Scottish scientist

Alexander Fleming as a crude extract of P.rubens.

• Fleming’s student was the first to successfully use

penicillin to treat eye infection in 1930.

• The purified compound, Penicillin F was isolated by a

team led by Howard Florey and Ernst Boris Chain in
1940 at the university of Oxford.

• Fleming first used the purified penicillin to treat

streptococcal meningitis in 1942.
 TYPES

• Penicillin can be further divided into Naturally

occurring and Semi-synthetic Penicillins.

• Natural Penicillin (Penicillin G) was first produced

from a penicillium fungus that occurs in nature.

• A strain used today in manufacturing Penicillin G

was created by genetic engineering.

• The semi-synthetic penicilliin includes Penicillin V

and others.
• The others in the group of semi-synthetic penicillins can
be classified into; Antistaphylococcal antibiotics, broad-
spectrum antibiotics and antipseudomonal antibiotics.

• Examples of antistaphylococcal antibiotics are Cloxacillin,

Flucloxacillin, Methicillin, Nafcillin and Oxacillin.

• Examples of broad-spectrum antibiotics are ampicillin and

amoxicillin.

• Examples of antipseudomonal antibiotics are

carboxypenicillins (carbenicillin, Ticarcillin) and
ureidopenicillins (piperacillin, azlocillin).
 AMOXICILLIN

• This is an extended or broad-spectrum antibiotic

which has a bactericidal effect.

• Used in numerous indications as UTIs, URTIs,

Bronchitis, Pneumonia, Otitis media etc.

MECHANISM OF ACTION:
Acts by inhibiting the cross-linkage between the
linear peptidoglycan polymer chains that make up
a major component of the bacterial cell wall.
DOSAGE:
Adult and Child above 10 years; 250 mg every 8
hours, doubled in severe infections.

PHARMACOKINETICS:
1. 95% bioavailability when taken via the oral route.
2. Metabolized by the liver
3. Excreted into the urine.
4. Has an onset of action of 30 minutes
5. Has a half-life of 3.7 hours in neonates and 1.4
hours in adults.
CONTRA-INDICATIONS:
Hypersensitivity to penicillins.

ADVERSE EFFECTS:
1. Nausea and vomiting
2. Diarrhoea
3. Hypersensitivity reactions like rash, urticaria,
anaphylaxis etc.
4. Haemolytic anaemia
5. Antibiotic associated colitis.
NURSING ACTION:
1. Obtain specimens for culture and sensitivity
before the first dose.
2. Give with food to avoid GI disturbances.
3. Monitor closely for signs of super infection
especially with large doses and prolonged
therapy.
4. Advise patient to report immediately if rash,
fever or chills occur.
5. Advise patient to report diarrhoea.
 CEPHALOSPORINS

• are a class of B-lactam antibiotics originally

derived from the fungus Acremonium.

• They are bactericidal in nature.

• As a B-lactam ring holder they act by inhibiting

the peptidoglycan in the bacterial cell wall.

• The peptidoglycan layer is important for the cell

wall structural integrity.
 CLASSIFICATION

• Can be grouped into generations by their

antimicrobial properties.

1. FIRST GENERATION: Examples include Cefalotin,

Cefazolin, Cefalexin, Cefradine etc.
2. SECOND GENERATION: Examples include
Cefoxitin, cefuroxime, cefaclor, cefoxitin etc
3. THIRD GENERATION: Examples include
ceftazidime, ceftriaxone amd cefotaxime.
4. FOURTH GENERATION: Examples include Cefipime
and cefpirome.
 CEFUROXIME

A second-generation cephalosporin that its found

its use in the treatment and prevention of a
number of bacterial infections.

MECHANISM OF ACTION:
As a B-lactam ring holder they act by inhibiting the
peptidoglycan in the bacterial cell wall.
DOSAGE:
By mouth; 250mg twice daily for Adult. And
doubled dose for severe infections.

PHARMACOKINETICS:
1. 37% on an empty stomach, up to 52% if taken
after food.
2. Elimination half life is 80 minutes.
3. Urine 66-100% unchanged.
4. Administered via the oral, intramuscular and
intravenous route.
CONTRA-INDICATION:
Hypersensitivity to cephalosporin antibiotics.

ADVERSE EFFECT:
1. Hypersensitivity reactions
2. GI disturbances
3. Candidiasis
4. Pain at injection site
5. Headache
NURSING ACTION:
1. Obtain specimen for C and S tests prior to the
first dose; administer around the clock.
2. The tablet may be crushed to aid swallowing but
it has a bitter taste.
3. Give deep IM into a large muscle mass, such as
gluteus or lateral aspect of thigh.
4. Total daily dosage is the same for IM or IV
administration and depends on susceptibility
results.
 CARBAPENEM

• Used mostly to treat severe infections and

suspected multidrug- resistant (MDR) bacterial
infections.

• They are a member of the beta-lactam

antibiotics.

• Examples include Imipenem, Meropenem,

Ertopenem etc.
 MEROPENEM

• It is stable to mammalian dehydropeptidase and

does not require co-administration of cilastin as
should be in imipenem.

• It is somewhat less potent than imipenem against

gram-positive and more potent against gram-
negative.

• It is bactericidal except against Listeria

monocytogenes, where it is bacteriostatic. It inhibits
bacterial cell wall synthesis by inhibiting the
formation of the peptidoglycan.
DOSAGE:
Adult; by IV 1g every 8hours.
Child ( >3 months-12years) 10-20mg/kg every 8 hours.

PHARMACOKINETICS:
1. Bioavailability of 100%
2. Administered via the intravenous route
3. Protein binding of 2%.
4. Elimination of 1 hour
5. Excreted via the urine.

CONTRA-INDICATION:
Hypersensitivity to meropenem or other beta-lactams.
ADVERSE EFFECT:
1. Thrombocythaemia
2. Headache
3. Nausea and vomiting
4. Abdominal pain
5. Rash, pruritus and urticaria

NURSING ACTION:
6. Give as an IV bolus injection over 5minutes or by IV infusion
over 15-30 minutes.
7. Ensure reconstituted solutions are clear and colourless or
pale yellow.
8. Reduce dose in patients with CrCl <51 ml/min .
 OTHERS

• These include the Fluoroquinolones, Macrolides,

Tetracycline etc.

• They also have found use in the management of

respiratory infections (upper and lower).

• Examples of the Fluoroquinolones include

Ciprofloxacin, Levofloxacin, Ofloxacin, Norfloxacin etc.

• Examples of the Macrolides include Erythromycin,

Azithromycin etc.