Diphenoxylate + Atropine + Furazolidone Pharmacology
Diphenoxylate + Atropine + Furazolidone
Diphenoxylate
2.Headache
3.Dizziness
4.Respiratory depression
5.Pruritis
6.Rash
7.Restlessness
2.Acute diarrhea
3.Obstructive jaundice
2.Narcotic dependence
3.Ulcerative colitis
4.Stop immediately if abdominal distension occurs
Below 2 years:Contraindicated
Children:
2 - 5 years: 6 mg / day in 3 divided doses
5 - 8 years: 6 mg / day in 4 divided doses
8 - 12 years: 10mg / day in 5 divided doses
Atropine
Atropine inhibits the muscarinic actions of acetylcholine on structures innervated by postganglionic cholinergic nerves, and on smooth muscles, which respond to endogenous acetylcholine.
Atropine reduces secretions in the mouth and respiratory passages, relieves the constriction and spasm of the respiratory passages, and reduces the paralysis of respiration. Atropine-induced parasympathetic inhibition may be preceded by a transient phase of stimulation, especially on the heart where small doses first slow the rate before characteristic tachycardia develops due to paralysis of vagal control. Although mild vagal excitation occurs, the increased respiratory rate and occasionally increased depth of respiration produced by atropine are more probably the result of bronchiolar dilatation. Accordingly, atropine is an unreliable respiratory stimulant and large or repeated doses may depress respiration.
Adequate doses of atropine abolish various types of reflex vagal cardiac slowing or asystole. The drug also prevents or abolishes Bradycardia or asystole produced by injection of choline esters, anticholinesterase agents or other parasympathomimetic drugs, and cardiac arrest produced by stimulation of the vagus. Atropine may also lessen the degree of partial heart block when vagal activity is an etiologic factor. In some individuals with complete heart block, the idioventricular rate may be accelerated by atropine; in others, the rate is stabilized. Occasionally, a large dose may cause atrio ventricular (A-V) block and nodal rhythm.
Atropine in clinical doses counteracts the peripheral dilatation and abrupt decrease in blood pressure produced by choline esters. However, when given by itself, atropine does not exert a striking or uniform effect on blood vessels or blood pressure. Systemic doses slightly raise systolic and lower diastolic pressures and can produce significant postural hypotension. Such doses also slightly increase cardiac output and decrease central venous
pressure. Occasionally, therapeutic doses dilate cutaneous blood vessels, particularly in the "blush" area (atropine flush), and may case atropine "fever" due to suppression of sweat gland activity especially in infants and small
General anaesthesia: Once muscle paralysis is no longer desired, acetyl cholinesterase inhibitors are combined with a muscarinic receptor antagonist such as Glycopyrrolate or Hyoscine or Atropine to offset the muscarinic activation resulting from esterase inhibition
2.Constipation
3.Difficulty in swallowing
4.Tachycardia
5.Headache
6.Restlessness
7.Insomnia
8.Dizziness
9.Nausea
10.Vomiting
11.Decreased secretions
12.Irritation at the site of injection site
13.Fever
14.Retention of urine
2.Tachycardia
3.Obstructive disease of gastrointestinal tract
4.Obstructive uropathy
5.Unstable cardiovascular status in acute haemorrhage
7.Paralytic ileus
8.Toxic megacolon
9.Intestinal atony
10.Asthma
11.Myasthenia gravis
12.Thyrotoxicosis
2. Symptomatic Bradycardia
3.To block the adverse muscarinic effect of anticholinesterase agents
4.Antidote for anticholinesterase insecticide poisoning
5.Bronchospasm
6.Cycloplegic refractions
7.Acute iritis
8.Lessen the degree of AV block
Adult:
Pre anaesthetic medication: (IM) or (SC) 300-600mcg is given 30-60 minutes before surgery.
Bradycardia (IV ): 0.3 - 1 mg dose can be repeated every 3 - 5 minutes 0.03 mg / kg in patient with mild Bradycardia and 0.4 mg / kg with severe Bradycardia,
To block the adverse muscarinic effect of anticholinesterase agents: 0.6 - 1.2 mg for each 0.5 - 2.5 mg of Neostigmine administered intravenously a few minutes before anticholinesterase agents.
Antidote for anticholinesterase insecticidal poisoning: (IM or IV): Initial dose: 1 - 2mg is given and dose can be increased up to 6 mg in severe cases and repeat the dose every 5 - 60 minutes until muscarinic symptoms disappears.
Prevention of Bronchospasm: 0.025 mg / kg is administered with the help of a nebulisers 3 - 4 times daily up to 2.5 mg
Children
Premedication: (IM) or (SC): 20mcg/kg.
Bradycardia (IV): 10 - 20 mcg/kg doses can be repeated up to 1 mg
Antidote for anticholinesterase insecticidal poisoning: (IM or IV): Initial dose: 0.05 mg / kg is given and repeat the dose every 10 -30 minutes until muscarinic symptoms disappears
Furazolidone
Excretion: It is excreted in urine
2. Headache
3. Nausea
4. Vomiting
5. Decreased B.P
6. Deafness with tinnitus
7. Urticaria
8. Fever
9. Arthralgia
10. Disulfiram like reactions with alcohol.
2. Along with alcohol
2. Urine colour turns orange which has no clinical significance
Neonates : Contraindicated
2. Protozoal diarrhoea
3. Enteritis
4. Giardiasis
5. Trichomoniasis
6. Food poisoning
7. Infections caused by salmonella shigella etc.
8. Bacterial and monilial vaginitis
Anorexiants: Increased pressor response of anorexiants due to MAO inhibition.
Levodopa: Both efficacy and adverse effects of levodopa increased especially hypertensive crisis. Effect lasts for several weeks after stopping furazolidone.
Sympathomimetics (indirect & mixed): Increased pressor sensitivity to these agents due to MAO inhibition.
TCAs: Hypertension, hyperpyrexia, seizures, tachycardia, acute psychosis.
Hypnotics & Sedatives: Dose of hypnotics and sedatives should be reduced.
Hypoglycaemics: Potentiates them.
Food: Hypertensive crisis with tyramine containing foods.
Children: 1.25 mg 6 hourly for 2 to 5 days & up to 10days for Giardiasis
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