Dosage and Frequency
Determination of dose and repetition thereof are the most difficult facets of any prescription which generally is dependent upon following factors, viz.
(a) Stage and status of the disease
(b) Type of infection and resultant disease.
(c) Duration of ailment-whether acute or chronic
(d) Age & Sex of the patient
(e) Allergy or intolerance to certain ingredients.
(f) Patient acceptability and compliance.
Cautions in use of Medicines
Following types of patients need continuous monitoring of dose and frequency
(a) Pregnant ladies
(b) Infants & Children
(c) Persons suffering from asthma, boncho-pneumonia, Diphtheria, any heart problem,Renal failure, anuria, malignant tumors, tuberculosis etc.
(d) Acute diarrhoea, dysentery
(e) Diabetic patient,especially whose blood sugar level suddenly rises and falls
(f) children on insulin therapy
(g) Highly emaciated elderly people.
(h) Bleeding from any orifice (opening) of the body
(i) Pre and Post operative patients
(j) Obese persons on dietary control etc.
Pharmaceutical companies generally indicate dosage for all age groups but, even then, the recommended doses may have to be adjusted due to drug-interaction, contra-indication, drug reactions and other cautionary advice must be closely studied, but each case should be individualized in view of a patient’s condition, symptoms and health status. A number of useful books provide enough and requisite information about following points viz
(i) Brand /Trade name of the medicine and its manufacturing company.
(ii) Presentation and potency, including General symptoms which necessitate use of the medicine
(iii) Actual ingredient and concentration/proportion in a drug.
(iv) Available in which form (Tablet, capsule or liquid)
(v) Agewise dosage and probable duration of use
(vi) Whether recommended for infants, children, pregnant ladies and the elderly .
(vii) Contra-indications
(viii) Special precautions
(ix) Drug interactions (i.e. with which medicines a specific drug should he taken so as not to enhance or reduce the effect’s.
(xi) Additional drug reactions
Some enterprises publish a directory on drugs on monthdly, quarterly, or annual basis. For instance, ‘Drug Today’, ‘MIMS India’ publish booklets, containing the said information on quarterly and monthly basis but the details given serve the purpose of qualified and experienced doctors only, though some glaring exceptions cannot be ruled out. More inquisitive readers can gather more information also from various sources .
It is believed that a person who has basic knowledge of human body and its functions, diseases, drugs and drug- combinations can benefit a lot from such and many other identical publications. Diagnostic methods and drug prescriptions is a continuous process, hence no information is a final word and every practitioner is expected to keep himself abreast of all the latest developments so that one is armed with an upto -date knowledge.
Cautions on use of medicines, dose, and potency of medicine should neither be enhanced or decreased abuptly nor its frequency altered, without giving it sufficient time to act and show results. Always start with minimum dose and potency. No identical cases should be ever compared nor medicine, dosage, potency and frequency be equated, for the simple reason that even identical medicines may show variable results even when the symptions synchronize. In case of any unusual development, never hesitate to consult a doctor for proper guidance.
Some enterprises publish a directory on drugs on monthdly, quarterly, or annual basis. For instance, ‘Drug Today’, ‘MIMS India’ publish booklets, containing the said information on quarterly and monthly basis but the details given serve the purpose of qualified and experienced doctors only, though some glaring exceptions cannot be ruled out. More inquisitive readers can gather more information also from various sources .
It is believed that a person who has basic knowledge of human body and its functions, diseases, drugs and drug- combinations can benefit a lot from such and many other identical publications. Diagnostic methods and drug prescriptions is a continuous process, hence no information is a final word and every practitioner is expected to keep himself abreast of all the latest developments so that one is armed with an upto -date knowledge.
Cautions on use of medicines, dose, and potency of medicine should neither be enhanced or decreased abuptly nor its frequency altered, without giving it sufficient time to act and show results. Always start with minimum dose and potency. No identical cases should be ever compared nor medicine, dosage, potency and frequency be equated, for the simple reason that even identical medicines may show variable results even when the symptions synchronize. In case of any unusual development, never hesitate to consult a doctor for proper guidance.
Avoidance of Drugs
Following categories of persons (rather patients) should not be given medicines, indicated against each category.
Pregnant ladies
Carbimazole, Barbiturates (Lumenal), Aspirin (dispirin) Busulphane, B-coumarin, chloremphenical, chloroquine, chlorcyclazine, clomiphene, dexamethasone, diazepam, dexamphatamine , cortesone, Diazoxid, Estrogens cylophosphamide, Ethisterone, Ethinamide Glibenclamide, Furosomide, Dicoumarol, Hydralazine, Hydroprogestorone, Indomethacin, Diclofenac sodium, Lithium Carbonate, Menaphtone, Melphalan, Mercapturine, Methyldopa Methodone, Morphine Norethisterone, Nitroiiirantion, Norethynodral oral Contraceptives, opium, phenformim, Pethidine etc.
Infants and Children
1 Anlagin, 2 Chloromphenical, 3 Betamethasone, 4, Dexamethasone 5, Diphenoxylate, 6, Ethylestrenol, 7, Methandesterone, 8, Prednisolon, 9, Nandrolone, 10, Stanozolol 11, Triamcinolone, 12, Tetracyclines etc
Side-effects
Most of the above mentioned drugs cause bone marrow depression, inhibition of bone growth, some produce long lasting effects, tetracyclines get deposited in the bones and teeth and also cause yellow colour to the teeth and urine.
The Elderly
Generally most of the important organs such as kidneys, heart, brain, lungs, digestive organs, bone joints etc lose much of their functional capacity and capability after the age of 45 (which is not a decisive dividing line). In this respect following points may be noted.
(i) Reduction in heart function – 80% at the age of 50, 70% at 60, and 65% at the age of 80.
(ii) Kidney functions’ decline – Redical renal function to 80 % at the age of 60. 70% at the age of 80
(iii) Breathing capacity:- It comes down to 85% at the age of 50, 60% at 60 and 40% about the age of 80.
Further, the elderly people have a reduced (lean) body mass (as evidenced by percentage of body weight, reduction in body water and tendency to an increased body fat). Needless to say, all such changes, aided by progressive decline in vital capacities, often permeate in the form of and altered and defective handing of the drugs by the aging body in respect of absorption, distribution, metabolism and excretion of waste and harmful products, Lessened and changed absorption invariably point to ‘Bioavailability’ of the drugs which means delayed absorption of drugs by the bodies of the elderly.
Avoid using the following drugs in the elderly. Viz CNS drugs like Cardinal, Diazepam, Melleril, Valium, Depsonil, lithocarb, Amiline etc, and CVS drugs and diuretics like (Digoxin) Lanoxin, Aldatone Hythalton. Also avoid using antibiotics like cry-4, PPF, Doxy-1, Alberciline, Zocef Genticyn, Kancin, Furadantin. Cepheradine etc (only trade names mentioned and not ingredients.
The elderly are less responsive to the action of Asthalin (used in Asthma), Atenolol and propanalol (used in hypertension), their trade names being Inderal and Betacard respectively. Also they are more sensitive to the effects of valium, Emdopa, Arkamin, Largactil, Gardinal, Prazpress etc. Drugs which lower body’s temperature are not generally tolerated by the elderly, as their body temperature and general vitality are already under decline, hence such drugs (that reduce body temperature) must not be used in the elderly.
If used discreetly and prudently with proper safeguards, certain drugs can help the elderly people to enjoy a protonged and greatly improved life. Element of error can surface due to wrong prescription of a physician or when patient’s compliance is found wanting. It may also be noted that all drugs have beneficial and harmful effects which factors must not be overlooked when prescribing for the elderly. Any drug, which tends to decrease the already depleted defence mechanism and general resistance of the elderly, must be avoided. Moreover, Constant monitoring of dosage, frequency and change in drug (if, at all, necessary) should not be lost sight of.