Bacillus Calmette–Guérin (BCG) vaccine 

BCG vaccine and tuberculosis

The bacille Calmette-Guerin (BCG) vaccine is used mainly against tuberculosis (TB) diseases. TB is caused by the bacterium Mycobacterium tuberculosis which primarily affects the lungs although it may sometimes affect other organs such as kidney, spine, and brain. TB is a potentially fatal disease; however, not everyone with TB will get sick. Individuals infected with Mycobacterium tuberculosis can be classified into being afflicted with latent TB infection (LTBI) or TB disease.

TB is spread from one person to another through the air. TB bacteria is released into the air when a person infected speaks or coughs. Individuals that end up breathing in the released bacteria may become infected. The infection starts when the bacteria breathed in reaches the lungs and start to grow. From the lungs, it may migrate to other organs such as spine or kidneys; however, on the TB disease in the respiratory tract is infectious.

Individuals infected with TB may show symptoms of persistent coughing, chest pain and expelling blood or mucus when coughing. Other symptoms include fatigue, fever, poor appetite and chills. Individuals with latent TB infection do not show symptoms nor are they infectious.

People with weakened immune system (HIV, diabetes mellitus, organ transplant recipient) or close contact with recently infected individuals (health care providers, relatives of infected, immigrated from areas with prevalent TB infection) are at  a higher risk of becoming infected with TB themselves.

The BCG vaccine is used for preventing TB disease. It is currently not regularly given in Canada and US but is commonly given to infant and children in other countries where TB is much more prevalent. The vaccine is recommended to be given intradermally at the deltoid.

Actaminophen 50mg injection

Acetaminophen is an antipyretic and analgesic used for reduction of fever and treatment of mild to moderate pain. It has low risk of adverse effects hence it is frequently used as a first line agent. It is commonly used as an analgesic for osteoarthritis, muscle injuries, sprains and headaches. Due to its tolerability and safety, it is u  sed often in vulnerable patients groups such children, pregnant/breastfeeding women, high bleeding risk patient, renal problems. It should be avoided in patient with hepatic diseases or used very cautiously.

Cisplatin 50mg injection

Cisplatin is a chemotherapeutic agent used to treat tumours such as ovarian, testicular, cervical, lung and bladder cancer. It works by disrupting DNA transcription and replication which results in cytotoxicity. It also induces apoptosis in tumour cells through activation of signal transduction pathways. Secondary to its cytotoxic and apoptotic potential, it can cause side effects such as bone marrow suppression, ototoxicity, nephrotoxicity and neurotoxicity.

Octreotide 20mg injection

Octreotide is a synthetic somatostatin analogue that has a longer pharmacological effect then its natural counterpart. Octreotide has many suggested mechanisms of action such as inhibition of exocrine secretions in the digestive system, inhibition of endocrine secretion in the body (ie. growth hormone, insulin, glucagon), modulate GI motility and apoptosis induction. Octreotide is primarily used for acromegaly, carcinoid tumours, VIPomas and gastro-entero pancreatic tumours. Other uses are chemotherapy-induced diarrhea, malignant intestinal obstruction, pancreatic cancer and thymoma. It has the potential to cause hypertension and cardiovascular arrhythmias. Due to this, it should be used cautiously in patients with heart failure or taking medications that alters heart rate or rhythm. Other common side effects include diarrhea, nausea, gallstones and hyperglycemia.

Levofloxacin 500mg tablets

Levofloxacin is an fluoroquinolone antibiotic that inhibits bacterial DNA synthesis by targeting the type II and IV topoisomerases which results in its bactericidal effect. It can be used to treat infections including sinusitis, acute exacerbation of chronic bronchitis, pneumonia, prostatitis, urinary tract infection and soft tissue infection. It may also be used for tuberculosis, meningitis and pelvic inflammatory disease. Common side effects include nausea and diarrhea. Although uncommon, it can cause serious side effects such as tendon inflammation, tendon rupture, seizures, psychosis and peripheral nerve damage.

Voriconazole 200mg tablets

Voriconazole is a triazole antifungal agent with fungicidal activity against Aspergillus spp. and other filamentous fungi. Its primary mechanism of action is inhibition of the fungal CYP450-mediated 14α-sterol methylation which disrupts ergosterol synthesis. Voriconazole is indicated for treatment of invasive aspergillosis, candidemia in non-neutropenic patients and candida infections in the abdomen, kidney, bladder and wounds. The most frequently reported adverse effects are visual disturbances, fever, rash, abdominal pain, nausea, vomiting, diarrhea and peripheral edema.

Capecitabine 500mg tablets

Capecitabine is an anti-metabolite drug used in chemotherapy. As a pre-prodrug to 5-fluorouracil, it is rapidly converted into 5-fluorouracil in tumour tissues to inhibit thymidylate synthase. Inhibition of thymidylate synthase results in the scarcity of pyrimidine thymidine which is a nucleoside needed for DNA replication. Capecitabine has become a popular option in place of 5-fluorouracil and is indicated for the treatment of breast cancer, colorectal cancer and pancreatic cancer. Some side effects reported are anemia, lymphopenia, neutropenia, thrombocytopenia, fatigue, fever, edema, hand-foot skin reaction, diarrhea, nausea, stomatitis and vomiting.

Imatinib 100mg tablets

Imatinib is a tyrosine kinase inhibitor that competitively inhibits by binding to the enzyme’s ATP-binding site. This disrupts the BCR-ABL signal transduction leading to subsequent growth inhibition or apoptosis in cells that express the BCR-ABL oncogene. Indications for imatinib includes chronic myeloid leukemia and gastrointestinal stromal sacroma. Some side effects reported are anemia, neutropenia, thrombocytopenia, edema, nausea, vomiting, diarrhea and elevated liver enzymes. It should be used cautiously in patients with poor renal function or carriers of hepatitis B virus due to its potential to cause progressive renal function decline and reactivation of hepatitis B virus, respectively.

Sunitinib 50mg tablets

Sunitinib inhibits multiple receptor tyrosine kinases. These include the platelet-derived growth factor receptors, vascular endothelial growth factor receptors, colony stimulating factor receptor and stem cell growth factor receptor. By inhibiting these receptor tyrosine kinases, sunitinib may inhibit tumour growth, inhibit angiogenesis and induce tumour regression. It is second-line option for patients with gastrointestinal stromal tumour that is resistant to imatinib. Clinically important side effects include hypertension, left ventricular dysfunction, neutropenia, thrombocytopenia, fatigue, hair discolouration, hand-foot skin reaction, skin discolouration, diarrhea, nausea and hypothyroidism.

Temozolamide 100mg tablets

Temozolamide is converted to the active compound monomethyl triazeno imidazole carboxamide at physiologic pH. This compound produces its cytotoxic effect by methylating DNA at O-6 position of guanine. This methylation damages DNA resulting in the death of tumour cells. Temozolamide is used to treat astrocytoma, glioblastoma, brain metastases from solid tumours and melanoma. Side effects include neutropenia, thrombocytopenia, hepatic failure and nausea.