Miscellaneous drugs

1. Unit VII Miscellaneous
Drugs.
Mr. Abhay Rajpoot

2. Syllabus • Drugs used in de-addiction
• Drugs used in CPR & emergency
• Vitamins and minerals
• Immunosuppressants
• Antidotes
• Antivenom
• Vaccines and Sera

3. Drug used in de-addiction – Disulfiram
•Introduction: Disulfiram (DSM) is an
alcohol abuse drug. It works by blocking the
breakdown of alcohol, causing unpleasant
side effects (eg. Vomiting upset stomach)
when even a small amount of alcohol is
consumed.

4. Dose
•300mg as a single dose on the 1st
day of treatment, reduce dose by
200 mg daily, maintenance 100
– 200 mg daily.

5. Contraindication/precautions
•Precautional use in case of pregnancy or breast
feeding.
•Precautional used if taking any prescription or
non prescription medicine.
•If patient is taking alcohol containing medicines
(eg. HIV protease inhibitors amprenal, cough
syrup, metronidazole) disulfiram may be
contraindicated.

6. Instruction to use Disulfiram
•Disulfiram may be taken with or without food.
•It may be swallowed whole, chewed or crushed and mixed
with food.
•Do not take the first dose of disulfiram for at least 12hrs.
After drinking alcohol.
•If patient miss a dose of disulfiram take it as soon as
possible if it is almost time for next dose, skip the missed
dose and go back to regular dosing schedule. Do not take
two doses at once.

7. Important safety information
•It may cause drowsiness, do not drive or
operate machinery.
•Avoid all alcohol including found in
sauces, vinegar, mouth wash, liquid
medicines, lotion after shave or back rub
products.

8. Adverse effects
• Chest pain.
• Fast breathing.
• Fast heart beat.
• Headache.
• Nausea.
• Abdominal pain.
• Vomiting.
• Fainting.
• Drowsiness.
• Flushing.
• Thirst
• Severe allergic
reactions.

9. Drugs used in CPR & Emergency
•CPR (Cardiopulmonary resuscitation) is
only emergency management for these cases.
External cardiac massage it is used in cases
of cardiac arrest or apparent sudden death
resulting from electric shock, drowning
respiratory arrest.

10. Nursing Care
• Apply cardiac monitor.
• Record elctrocardiac events.
• Immediately administer defibrillation.
• Quickly attend to the clients airway and oxygen.
• Insert an oral (artificial) airway to maintain the tongue in forward
position. Administer 100% oxygen.
• Suctioning.
• Start IV (Intravenous) lines for administration of resuscitation
medication.
• Catheterization should be maintain.

11. Medications used in CPR (commonly)
• Epinephrine (Adrenaline)
Action: It increase systemic vascular resistance and blood pressure.
• Atropine:
Action: It blocks parasympathetic action, increases SAnode
automaticity and AVcondition.
• Sodium Bicarbonate:
Action: Corrects metabolic acidosis.
• Vasopressin:
Action: Increase inotropic action (contraction ) of heart.

12. 1. Inj.
Adrenaline.
•Indications:
Anaphylactic
Shock, Cardiac
Arrest, Status
asthmaticus
(Asthma)
•Route: S/C
•Dose: 0.5 ml to
1ml.
2. Inj.
Aminophylline.
•Indications:
Bronchial
Asthma.
•Route: I.V.
slowly or I.V.
drip.
•Dose: 250-
500mg
3. Inj.
Atropine.
•Indications:
Bradycardia,
Organophosph
orus,
Poisoning.
•Route: S/C,
I.M or I.V.
•Dose: 0.2 to
2mg.

13. 4. Inj. Avil.
•Indications:
Allergic
reaction.
•Route: I.M.
•Dose: 25 mg.
5. Inj.Analgin.
•Indications:
Pain reliever,
Anti-pyrutic.
•Route: I.M/I.V.
•Dose: 2.5 cc
(100-250mg)
6. Inj. Betnesol
(Betamethasone).
•Indications:
Anaphylactic
shock, Bronchial
asthma,
Hypotension.
•Route: I.M or
I.V.
•Dose: 2-5 c.c

14. 7. Inj. Cal.
Gluconate 10%.
•Indications:
Allergic
reaction, Cardiac
stimulation,
Rigor.
•Route: IV
slowly.
•Dose: 10-20
C.C.
8. Inj. Baralgan.
•Indications:
Spasm of smooth
muscle,
abdominal colic,
renal colic.
•Route: IM or IV
•Dose: 2-5cc
9. Inj. Calmpose.
•Indications:
Relieve anxiety,
In high doses 20-
30 mg, induce
sleep.
•Route: IV / IM
•Dose: 5-40 mg

15. 10. Inj. Digoxin.
•Indications:
Heart failure,
Fibrillation.
•Route: IV
Slowly.
•Dose: 0.5 mg
stat. followed by
0.25 mg 6hrly on
1st day: 0.25 to
0.75mg per day.
11. Inj.
Deriphyllin.
•Indications:
Bronchial
Asthma.
•Route: IM/IV
•Dose: 1
ampoule.
12. Inj. Fortwin
(Pentazocine).
•Indications:
Myocardial
infarction,
analgesic
hypnotic.
•Route: IM/IV
•Dose: 30-60 mg

16. 13. Inj.
Furosemide
(Lasix).
•Indications: As
Diuretic,
Pulmonary
edema, Cerebral
edema.
•Route: IM/IV
•Dose: 40 – 160
mg.
14. Inj.
Phenobarbitone
(Gardinol).
•Indications:
Epilepsy, To
induce sleep.
•Route: IM/IV
•Dose: 100 – 200
mg.
15. Inj.
Hydrocortisone
Hemisuccinate
(Efcorlin).
• Indications:
Immediate action
on Hypotension,
Anaphylactic
shock, Bronchial
asthma.
• Route: IV.
• Dose: 100 – 300
mg.

17. 16. Inj.
Lignocaine.
•Indications:
Ventricular
Arrhythmias,
•Route: IV drip.
•Dose: 1-2 mg
/kg
17. Inj.
Methergine.
•Indications: To
stop vaginal
bleeding.
•Route: IV or IM.
•Dose: 1Ampoule
18. Inj.
Mephentin.
•Indications:
Hypotension.
•Route: IM/IV or
IV drip.
•Dose: 20 – 80
mg.

18. 19. Inj.
Metaclopramide
(Mexeron,
Raglan).
•Indications:
Vomiting.
•Route: IM.
•Dose: 10-30 mg
20. Inj.
Morphine.
•Indications:
Myocardial
infarction,
Analgesic
Hypnotic.
•Route: IM/IV
•Dose: 10-20 mg.
21. Inj.
Oxytocin
(Syntocinon).
•Indications:
Post partum
hemorrhage.
•Route: SC/IM
•Dose: 2-5 unit
in post partum.

19. 22. Inj. Pot.
chloride.
•Indications:
Hypokalemia.
•Route: IV drip.
•Dose: 20 mg or
as per needed.
23. Inj.
Phenergan.
•Indications:
Sedation,
psychiatric
patients, labor
pain 1st stage,
Rigor.
•Route: IM/IV
•Dose: 20 – 50
mg.
24. Inj. Pethidine.
•Indications:
Narcotic
Analgesic,
Myocardial
infarction, severe
pain, labor pain.
•Route: SC/IM/IV.
•Dose: 20-100
mg.

20. 25. Inj. Soda-
bicarb.
•Indications:
Metabolic
Acidosis,
•Route: IV
•Dose: 50-200
meq. 7.4% soln.
26. Inj.
Streptobion.
•Indications: To
stop bleeding.
•Route: IM/IV
•Dose: 1
Ampoule
27. Inj. Vit. K.
•Indications: To
increase
prothrombin
time in liver
disease, To stop
bleeding
•Route: IM
•Dose: one
Ampoule.

21. 28. Inj. Dextrose
5%.
• Indications:
Dehydration and
providing energy
• Route: IV.
• Dose: 5 pints a
day. But depend
on age group and
condition.
29. Inj. Normal
saline.
• Indications:
Dehydration with
electrolyte
imbalance specially
loss of sodium and
chloride (Diarrhea
& Vomiting)
• Route: SC/IV.
• Dose: 5 pints a day.
But depend on age
group and condition.
30. Inj. Ringer
lactate.
• Indications:
Dehydration with
electrolyte
imbalance
specially due to
loss of blood and
in burn
• Route: IV
• Dose: 5 pints a
day. But depend on
age group and
condition.

22. 31. Inj.
Lomodex.
•Indications:
Hypovolemic
shock due to
blood or plasm
loss.
•Route: IV
•Dose: Depend on
age group and
condition
32. Inj.
Mannitol.
•Indications:
Cerebral edema,
Renal failure.
•Route: IV
•Dose: 100cc or
Depend on age
group and
condition.

23. Vitamins & Minerals

24. Summary of B – Complex Vitamins
•Vitamins: Thiamin (Vit. B1)
•Clinical Applications: Beri-beri (Deficiency), GI –
Anorexia, Gastric atony, indigestion, deficient,
Hydrochloric acid. CNS – Fatigue, Apathy, Neuritis,
Paralysis. CV – Cardiac failure, peripheral
vasodilation and edema of extremities.
•Requirements: 0.5mg/1000 calories.
•Food Sources: Pork, Beef, Liver, Whole or enriched
grains, legumes.

25. •Vitamins: Riboflavin (Vitamin B2)
•Clinical Applications: Woundaggravation,
cheilosis, Glossitis, eye irritation,
photophobia, Seborrheic dermatitis.
•Requirements: 0.6 mg/1000 calories.
•Food Sources: Milk, Liver, Enriched
calories.

26. •Vitamins: Niacin (Nicotinic acid) (Precursor
Tryptophan)
•Clinical Applications: Pellagra (Deficiency)
weakness, lassitude anorexia, skin – scaly
dermatitis, CNS – Neuritis, confusion.
•Requirements: 14 – 20 mg
•Food Sources: Meat, peanuts, enriched grains.

27. •Vitamins: Pantothenic acid (Vit B5)
•Clinical Applications: Contribute to
Lipogenesis, amino acid activation, formation of
cholesterol, formation of steroid hormone,
formation of hem, excretion of drugs.
•Requirements: Liver, egg, skimmed milk.
•Food Sources: Cauliflower, mushrooms, cheese,
lean pork, sweet potato.

28. •Vitamins: Pyridoxine (Vit B6 )
•Clinical Applications: Anemia, CNS –
Hyperirritability, convulsions, neuritis, isoniazid
is an antagonist for pyridoxine, pregnancy,
anemia.
•Requirements: 2mg
•Food Sources: wheat, corn, meat, liver.

29. •Vitamins: Biotin (Vit. H)
•ClinicalApplications:
Undetermined.
•Requirements: 30μg /per day.
•Food Sources: Egg yolk, Liver.

30. •Vitamins: Folic Acid (Vit. B9)
•Clinical Applications: Blood cell regeneration in
pernicious anemia but not controls of its
neurological problem.
•Requirements: 400mg, 800mg, in pregnancy.
•Food Sources: Liver, Green leafy vegetables,
asparagus.

31. Summary of Fat Soluble Vitamins
•Vitamins: Vit. A(Retinol)
•Clinical Applications: Xerophthalmia.
•Requirements: Adult male 10mg (5000 IU),
Adult female 800mg (4000 IU)
•Food Sources: Liver, Cream, Butter, whole milk,
green vegetables.

32. •Vitamins: Provitamin A(Carotene).
•Clinical Applications: Night blindness, keratinization
of epithelium, follicular hyperkeratosis, skin and
mucous membrane infections, Faulty tooth formation.
•Requirements: Adult female: 800mg (4000IU),
Pregnancy 100mg (5000IU), Lactation 1200mg
(6000IU), Children 400mg (2000 IU) to 800mg
(4000IU).
•Food Sources: Green leafy vegetables, fruit, egg yolk,
butter, red cabbage.

33. •Vitamins: Vit D (Calciferol)
•Clinical Applications: Rickets, Faulty bone
growth, osteomalacia in adults.
•Requirements: Adult 5-10 mg calciferol, (200-
400 IU), Pregnancy and lactation 10-12.5 mg,
children 3-10 mg.
•Food Sources: Fish oil, fortified or irradiated
milk.

34. •Vitamins: Vitamin E (Tocopherol)
•Clinical Applications: Hemolysis of RBC,
Anemia, Possible protection of unsaturated fatty
acid, sterility.
•Requirements: Adult 8-10mg, Pregnancy and
Lactation: 10-11mg, children: 3-10 mg
•Food Sources: Vegetable oils.

35. •Vitamins: Vit. K
•Clinical Applications: Hemorrhagic disease of the
new born, Bleeding tendencies, in biliary disease or
surgical procedure deficiency in intestinal
malabsorption (Sprue, celiac disease, colitis)
prolonged antibiotic therapy, anticoagulant therapy
( Dicoumarol counteracts).
•Requirements: Unknown.
•Food Sources: Green leafy vegetables, cheese Egg
yolk, liver.

36. Summary of Vitamin C (Ascorbic Acid)
•Vitamins: Vitamin C (AscorbicAcid)
•Clinical Applications: Scurvy (Deficiency),
Megaloblastic Anemia, Wound healing, tissue
formation, fevers, infections, stress reaction, Growth
rates.
•Requirements: 60mg daily (Adults)
•Food Sources: Citrus fruits, tomato’s, cabbage,
potato's, strawberry’s, melon, chili papers.

37. Summary of Major Minerals
•Mineral: Calcium (Ca)
•Clinical Applications: Tetany – Decreased in ionized
serum calcium, Rickets, Renal Calculi,
Hyperparathyroidism, Hypoparathyroidism.
•Requirements: 0.8gm Pregnancy & Lactation 1.2gm,
Infants 360-540mg, Children 0.8-1.2gm.
•Food Sources: Milk cheese, green leafy vegetables, whole
grains, egg yolk, legumes, nuts.

38. • Minerals: Phosphorus (P)
• Clinical Applications: Growth, Hypophosphatemia,
Recovery state of diabetic acidosis sprue, celiac disease,
(Malabsorption), Bone disease (Calcium and phosphorus in
balance) Hyperphosphatemia, Renal insufficiency,
Hypoparathyroidism, Tetany.
• Requirements: Adults half times calcium intake pregnancy
& Lactation: 1to2 gm, Infants 240-400 mg, Children 0.8 to
1.2 gm
• Food Sources: Milk cheese, meat, whole grains, egg yolk,
legumes, nuts.

39. •Mineral: Magnesium (Mg)
•Clinical Applications: Tremors, spasm, low
serum level following gastrointestinal loses.
•Requirements: 300-350mg deficiency in human
unlikely.
•Food Sources: whole grains, nuts, meat, milk,
legumes.

40. •Mineral: Sodium (Na)
•Clinical Applications: Fluid shift and control
buffer system, losses in G.I. disorders.
•Requirements: About 0.5 gm diet usually has
more: 2-6gm
•Food Sources: Table salt (Na cl), milk, meat,
egg. Baking soda, baking powder, carrots, beet,
spinach, celery.

41. •Mineral: Chlorine (Cl)
•Clinical Applications: Hyperchloremic
alkalosis in prolonged vomiting, diarrhea.
•Requirements: About 0.5 gm usually has
more 2-6gm.
•Food Sources: Table salt.

42. •Minerals: Sulphur (S)
•Clinical Applications: Cystine, renal calculi,
Cystinuria.
•Requirements: Diet adequate in protein contains
adequate Sulphur.
•Food Sources: Meat, Egg, Cheese, nuts,
legumes.

43. Summary of Trace Minerals
• Trace Minerals: Copper (Cu)
• Clinical Applications: Hypocupremia, Nephrosis, Malabsorption, Wilson’sdisease,
excess copper storage.
• Requirements: The RDAs for copper are: 200 μg of copper for 0–6-month-old males and
females, and 220 μg of copper for 7–12-month-old males and females.
1. 340 μg of copper for 1–3-year-old males,
2. 440 μg of copper for 4–8-year-old males,
3. 700 μg of copper for 9–13-year-old males,
4. 890 μg of copper for 14–18-year-old males, and 900 μg of copper for males that are 19
years old and older.
5. The RDAs for copper are: 340 μg of copper for 1–3-year-old females, 440 μg of copper
for 4–8-year-old females,
6. 700 μg of copper for 9–13-year-old females, 890 μg of copper for 14–18-year-old
females, and 900 μg of copper for females that are 19 years old and older.
7. The RDAs for copper are: 1,000 μg of copper for 14–50-year-old pregnant females;
furthermore, 1,300 μg of copper for 14–50-year-old lactating females.
• Food Sources: Liver, meat, sea food, whole grain, legumes, nuts, cocoa, raisins food,
cooked in copper utensils.

44. •Trace Mineral: Manganese (Mine)
•Clinical Applications: No clinical deficiency observed
in humans. Inhalation toxicity in minors. Role found in
Neurological disorders, Childhood developmental
disorders, Neurodegenerative diseases.
•Requirements: 2.5 to 7mg estimated. Diet provides 3-
9 mg.
•Food Sources: Cereals, whole grains, soybean,
legumes, nut, tea, coffee, vegetable, fruits supplied by
preformed vitamin B12

45. •Trace Mineral: Zinc (Zn)
•Clinical Applications: Possible relation to liver
disease, wound healing, taste and smell acuity,
retard sexual, and physical development
•Requirements: Adults 15mg, children 10mg,
infants 3-5mg.
•Food Sources: widely distributed in liver, sea
food especially oyster, eggs, milk, whole grains.

46. • Trace Mineral: Molybdenum (Mo)
• Clinical Applications: Growth: children, Pregnant & Lactating
women’s.
• Requirements: 2 micrograms (μg) of molybdenum per day was
established for:
1. Infants up to 6 months of age, and 3 μg/day from 7 to 12 months of
age, both for males and females.
2. For older children and adults, the following daily RDAs have been
established for molybdenum: 17 μg from 1 to 3 years of age, 22 μg
from 4 to 8 years, 34 μg from 9 to 13 years, 43 μg from 14 to 18
years, and 45 μg for persons 19 years old and older.
3. Pregnant or lactating females from 14 to 50 years of age have a
higher daily RDA of 50 μg of molybdenum
• Food Sources: Milk. Organ meats, whole grain, leafy vegetables.

47. •Trace Minerals : Fluorine (Fl)
•Clinical Applications: Small amount
prevents dental caries, Excess causes
endemic dental fluorosis.
•Requirements: 1-3 mg (estimated)
•Food Sources: Water.

48. •Trace Minerals : Selenium (Se)
•Clinical Applications: Constituent of
factor III, which act with vitamin E to
prevent fatty liver.
•Requirements: Under 10mg (estimated).
•Food Sources: Sea foods, meat, whole
grains.

49. •Trace Minerals: Chromium (Cr)
•Clinical Applications: Infants unable to
metabolize sugar and adult diabetes shows
definite improvement when small amounts of
chromium added to diet possible link with
cardiovascular disorder and diabetes.
•Requirements: 20-50mg (estimated)
•Food Sources: Animal proteins, especially meat,
except fish, whole grains.

50. •Trace Minerals: Iron (Fe)
•Clinical Applications: Growth (Anemia, pregnancy
demands, iron deficiency, Hemosiderosis,
Hemochromatosis.)
•Requirements: Man: 10mg, Women 18+mg, Lactation
18mg, Children 10-18mg.
•Food Sources: Liver, meats, Egg yolk, grains,
enriched bread, dark green vegetables, legume, nuts
and cereals.

51. Immunosuppressants

52. Introduction
•These drugs suppress or reduce the strength
of body’s immune system.
•They are also called as Anti-rejection drugs.
•One of the primary uses of
immunosuppressant drug is to lower the
body’s ability to reject a transplanted organ
such as liver, heart, kidney.

53. Mechanism of action
• Their action are different according to their four categories:
1. Azathioprine suppresses cell-mediated immunity and alters
antibody formation.
2. Cyclosporin inhibit proliferation and function of T –
Lymphocytes.
3. Monoclonal antibodies which includes Basiliximab, and
Muromonab blocks T cell functions.
4. Corticosteroids (Prednisolone) inhibits macrophage
formation and hinders migration of macrophage and
leukocytes to inflamed areas.

54. Drug Examples and Doses
S. No Drugs Doses
1 Azathioprine 1mg/kg (50-100mg) PO IV per day in divided doses
max. dose 2.5mg/kg PO /IV per day.
2 Cyclosporine 10-15 mg/kg/day with milk
3 Daclizumab 0.1 mg/kg
4 Muromonab 5mg ID OD
5 Basiliximab 10-20mg
6 Prednisolone 5-60 mg per day in divided doses 1-4 times/day.

55. Indication / uses
•Treatment of autoimmune disorders such as
psoriasis, rheumatoid arthritis, crohn’s disease,
multiple sclerosis, alopecia areata (Pathy hair
loss).
•Used to prevent rejection of organ
transplantation.
•Prednisolone is used for its anti-inflammatory or
immunosuppressive actions.

56. Contraindications / precautions.
•Bone marrow depression.
•Infections, Cancer.
•Impaired liver or kidney functions (Cautiously
used).
•Contraindicated in patient with a hypersensitivity
to polysorbate – 80.
•Use all immunosuppressive cautiously in
pregnant and breast feeding women.

57. Adverse Effect
• Peptic ulcer.
• Increased Sr. glucose level.
• Nausea / vomiting.
• Anorexia.
• Hepatotoxicity.
• Fever & Chills.
• Electrolyte change.
• Tremors.
• Weight gains.
• Edema.
• Mood swings.
• Diarrhea.
• Leukopenia.
• Thrombocytopenia.
• GI Disorders.
• Nephrotoxicity.
• Dyspnea.
• Flu like symptoms.

58. Drug Interactions
•Concurrent use of cyclosporine with other
nephrotoxic drugs causes additive
nephrotoxicity.
•Ketoconazole and cimetidine increase the
risk of toxicity from cyclosporine.
•Allopurinol increases the risk of toxicity.
From azathioprine.

59. Nursing Responsibilities
• Nurse should monitor for adverse effect, toxicity and signs,
symptoms of injection.
• Nurse should monitor and maintain intake and output chart.
• Should instruct patient to report unusual bleeding or signs &
symptoms of infection or transplant rejection.
• Nurse should inform the patient about potential teratogenic effect of
these drugs during pregnancy and urge the patient to use
contraception.
• Nurse should the patient about the importance of life long
compliance with immunosuppressive therapy to prevent organ
transplant rejection.
• Assess the for sign and symptoms of infection, such as fever,
tachycardia, malaise redness and inflammation.

60. Antidotes
•A Drug that counteracts
the effects of a poison or
overdosage by another
drug.

61. Specific Poisoning & Antidote
S. No. Poisoning Antidotes
1 Paracetamol N-Acetylcyteine
2 Morphine Naloxone
3 Heparin Protamine sulphate
4 Warfarin Vit. K + Fresh blood
5 Insulin Oral glucose / Fruit juice
6 Aspirin (Salicylate) Vit. K+NaHco3+Furosemide
7 Neostigmine bromide Atropine sulphate
8 Atropine Neostigmine / physostigmine.

62. S. No. Poisoning Antidotes
9 Lead Calcium – di – sodium
10 Iron Dimercaprol
11 Arsenic Dimercaprol
12 Copper D – Penicillamine
13 Mushroom poisoning Atropine
14 Organophosphorus
poisoning
Atropine sulphate
15 Iodine Sodium thiosulphate
16 Magnesium Sulphate Inj. Calcium gluconate 10% IV.

63. Antivenom
•Separately discussed

64. Vaccines & Sera
•A vaccine is a biological preparation which
provides active acquired immunity to a
particular disease. Vaccine contain an
antigen that stimulates the immune
mechanism of the body to produces
antibodies against some specific disease or
infection.

65. Types
• These are several types of vaccine:
1. Inactivated (Killed): Vaccine contain inactivated but
previously virulent. Eg. Cholera, Influenza plague, polio,
hepatitis Aetc.
2. Attenuated: Vaccines contain live attenuate micro-organism,
some are active viruses that have been cultivated under
condition that liable their virulent nature, or that use closely
related but less dangerous organism to produce a broad immune
response EG. Yellow fever, measles, mumps, typhoid.
3. Toxoid: These are made from inactivated toxic compounds that
causes illness rather than microorganism, Eg. Tetanus,
Diphtheria.

66. 1. Tetanus Vaccine.
• Type: Toxoid
• Dose: 0.5 ml.
• Route: I.M.
• Immunization:
Three dose at 6
weeks interval.
• Booster Dose: At
5yrs. interval.
2. Cholera
Vaccine.
• Type: Killed
inactivated
• Dose: 0.5 ml..
• Route: I.M./SC.
• Immunization:
2doses, 2nd dose
1ml @ 1-2 week
intervals.
• Booster Dose: 6
monthly.
3. DPT Vaccine.
• Type: Mixed
toxoid + killed
• Dose: 0.5 ml.
• Route: I.M.
• Immunization:
2doses @ 4-8
weeks interval
between 3-9
months of age.
• Booster Dose:
1dose @
18months old.

67. 4. Poliomyelitis
Vaccine.
• Type: Inactivated
• Dose: 1ml.
• Route:
Subcutaneous.
• Immunization:
3doses @ 4-6
weeks intervals.
• Booster Dose:
Every 5 Yr..
5. Plague
Vaccine.
•Type: Killed
•Dose: 1ml.
•Route: I.M.
•Immunization:
2doses @ 2-4
weeks intervals.
•Booster Dose:
Nil.
6. BCG (Bacillus,
Calmette, Guerin)
Vaccine.
• Type: Live
attenuated
• Dose: 0.5ml to
1ml.
• Route: I.D.
• Immunization:
Single dose at
birth.
• Booster Dose:
Nil.

68. 7. Typhoid,
Paratyphoid
Vaccine.
• Type: Killed
inactivated
• Dose: 0.5ml.
• Route: SC.
• Immunization:
3doses @ 2-4
weeks interval.
• Booster Dose:
Every 1-2 yrs.
8. Influenza
Vaccine.
•Type:
Inactivated
•Dose: 0.5ml.
•Route: I.M.
•Immunization:
2doses @ 1-2
months interval.
•Booster Dose:
Nil.
9. MMR
Vaccine.
•Type: Live
attenuated
•Dose: 0.5,ml.
•Route: SC/I.M.
•Immunization:
Single dose in 1-
5 yr. child.
•Booster Dose:
Nil.

69. 10. Yellow fever
Vaccine.
•Type: Live
attenuated
•Dose: 0.5 ml.
•Route: SC.
•Immunization:
Single dose.
•Booster Dose:
After 10 yr. of
age.

70. Adverse Effects
•Vaccination given during childhood are
generally safe, some potential side effects
are:
1. Fever.
2. Pain around injective site.
3. Muscle aches.

71. Nursing Responsibilities
•Vaccine should be kept in refrigerator at 2-8⁰ C. otherwise
they may become inactive.
•Immunization is contraindicated in acute illness.
•Live vaccine should not be given to those who have
reduced immunity due to prolonged usage of corticosteroids
or cytotoxic drugs.
•Immunization is also contraindicated in pregnancy, unless
and until it is very necessary.

72. Sera
•Sera contain immunoglobulins
(Antibodies) against some
particular infection or disease.
They are used to produce passive
immunity against some specific
disease / infection.

73. Drug examples and doses
S. No. Drugs Doses
1 Diphtheria Antitoxin (Anti
diphtheric ADS)
10,000 IU or IV
2 Tetanus antitoxin 500 IU, IM
3 Anti-rabies Serum (ARS) 1,000 IU by injection.
4 Hepatitis B
Immunoglobulin
1,000-2,000 IU.
5 Anti-snake venom 0.6 mg of standard cobra.
0.6 mg of standard russel’s viper.
0.45 mg of standard Sawscalded viper.
0.45 mg of standard krait.
20ml IV (1ml/min. inj. Repeated at 1-6 hrly
intervals till symptoms disappear.

74. Indication & Uses
•ADS used therapeutically in clinical diphtheria
without waiting for bacteriological report.
•Tetanus Antitoxin used for prophylaxis in non
immunized person’s receiving a contaminated wound
who are high risk of developing tetanus.
•ARS is indicated after suspected exposure and non-
immunized person.
•Hepatitis B indicated in persons acutely exposed to
HBs Ag positive blood or blood products.

75. Adverse Effects
•Allergic Reactions.
•Anaphylactic shock.

76. Nursing Responsibilities
•Nurse should be done sensitivity test before
administration serum.
•Adrenaline may be infected SC concurrently to reduce
allergic reactions.
•Antihistamine and corticosteroids may also be given
prophylactically.
•Sera should be kept in a refrigerator at 2-8⁰ C,
otherwise they may become inactive.

77. References
1. Dr. P.K. Panwar, Essentials of pharmacology for nurses,AITBS pub. 2017,
India, Pg no. 71 – 84.
2. Dr. Suresh k sharma, Textbook of pharmacology, pathology & genetics for
nurses, Jaypee pub. 2016 India Pg no 227 – 250.
3. Tara v. Shanbhag, Smita shenoy, Pharmacology preparation manual for
undergraduate, Elsevier pub. 2014. Pg no. 482, 488, 492 – 495.
4. Marilyn Herbert – Ashton, Nancy Clarkson, Pharmacology, Jones & Barlet
pub 2010 India, Pg no 619-625.
5. Govind s. mittal, Pharmacology at a glance, Paras medical book pub. 2009
India 57 – 59.
6. Madhuri Inamdar, Pharmacology in nursing, Vora medical pub. 2006 India
1st edition, Pg no 210 – 216.

78. Thanks