CRITICAL CARE INJECTABLES
PRESENTEDBY
SUDIPTO HALDAR
WHY CRITICAL CARE
Problems with the heart and blood vessels - such as very high blood pressure, very low blood pressure (called shock), abnormal heart beats, or a heart attack.
Problems with the lungs - such as asthma, severe pneumonia, or pulmonary embolism (blood clots in the lung).
Problems with salts, chemicals, or minerals in the bloodstream -The body's cells require a number of substances that must be present in the correct balance for the body to work properly.
WHY CRITICAL CARE
Brain injuries - Severe brain injuries including bleeding, stroke and head trauma, may cause loss of consciousness, also called coma.
Severe trauma - such as auto accidents, gunshot wounds and burns.
Major surgery - Patients undergoing major surgery, who need special monitoring or who are at high risk of having problems after the operation.
CLASSIFICATION OF CRITICAL CARE
Neonatal Intensive Care Unit (NICU)
Pediatric Intensive Care Unit (PICU)
Psychiatric Intensive Care Unit (PICU)
Coronary Care Unit (CCU)
Post Anesthesia Care Unit (PACU)
High Dependency Unit (HDU) or Post-Operative Critical Care Unit (POCCU)
High Dependency Unit (HDU)
SVU Ward
PSDU Ward
INSIGHT FOR CRITICAL CARE INJECTABLES IN RTIICS/DEVI SHETTY MUKUNDAPUR
Preferred CC Molecule In RTIICS
BRAND NAME COMPANY MOLECULE CLASS INDICATIONS
RANTAC 50mg / 2ml
J.B.Chemicals
Ranitidine H2 Antagonist(Reduction Of gastric Acid Secretion)
Critical condition & acid aspiration syndrome
ZIN TAC Injection 50 mg/2ml
GSK Zantac H2 Antagonist(Reduction Of gastric Acid Secretion)
Duodenal ulcer, benign gastric ulcer, post -operative ulcer, reflux oesophagitis, Zollinger -Ellison Syndrome
TAZACTpiperacillin 4 g, tazobactam sodium 500 mg, piperacillin2 g, tazobactam 250 mg, piperacillin 1 g, tazobactam 125 mg.
CIPLA Piperacillin+Tazobactum
Extended Spectrum Penicillins(Ureidopenicillins)+ β- lactameInhibitors
Noscomial pneumonia, various infections for antibacterial agent, diabetes related foot infections, peritonitis,, febrile neutropenia
Preferred CC Molecule In RTIICS
BRAND NAME
COMPANY MOLECULE CLASS INDICATIONS
PANTAC Pantoprazole Proton Pump Inhibitors
Gastroesophagealreflux disease (GERD), ulcers, Zollinger-Ellison Syndrome, and erosive esophagitis
STECORT (100mg IV, IM)
RANBAXY Hydrocortisone Corticosteroids relative corticosteroid insufficiency in patients with severe septic shock,adrenal insufficiency,steroid responsive inflammatory conditions
LASIX (10mg/ml)
SANOFI-AVENTIS
Furosemide Diuretics For Adult& paedEdema associate with CHF, Renal failure, acute pulmonary edema
Preferred CC Molecule In RTIICS
BRAND NAME COMPANY MOLECULE CLASS INDICATIONS
ARIXTRA GSK (fondaparinuxNa)
Anticoagulant (factor XAinhibitor)
Prophylaxix of DVT, acute pulmonary embolism, Knee replacement, abdominal surgery
NITROCIN inj(proprietary)
NA 10 mg Nitroglycerin in 10 ml sterile isotonic sol, 50 mg in 50 ml
Unresponsive systolic Leftventricular failure
ONDET2mgx1mlx10ml, 2mgx 1mlx2ml,2mgx 1mlx4ml
Intas Ondansteron Antiemetic Nausea & vomiting
BEPARIN BIO E Heparin Anticoagulant Atrial fibrillation with embolization
LOX Neon Labs Lignocaine Antiarrhythmic Itching, burning,skin inflammation
Maximum Number of CC Molecule consumption in RTIICS (in a Week)
0
10
20
30
40
50
60
53
40
25
1518
Weekly Consumption (Vial)Analysis:
Maximum No. of consumption:
Hydrocortisonemol. In RTIICS
Total Vial Consumption: 600-800 approx.
INSIGHT FOR CRITICAL CARE INJECTABLES IN APOLLO HOSPITAL
Preferred CC Molecule In APOLLO,KOLKATA
Brand Name Company Molecule Class Indication
Metrogyl Inj J.B. Chemicals Metronidazole500mg/100ml
Nitroimidazole In prophylaxis & treatment of Anaerobic infections
Augmentin
IV 0,6IV 1,2
GSK AmoxicillinNa+Clavulanic acid 500 mg of Amoxicillin & 100 mg Cl. Acid Or 1000 mg/200mg
Upperrespiratory tract infection: sinustis, otitismedia, tonsilitis.Lower respiratory tract Infection: Bronchitis,Urinary Tract Infections: Cystitis, Urethritis
Preferred CC Molecule In APOLLO,KOLKATA
Brand Name
Company Molecule Class Indication
Zobactin, Tazact
GSK, CIPLA Piperacillin+Tazobactum
ExtendedSpectrum Penicillins(Ureidopenicillins)+ β-lactameInhibitors
Same(mentioned in RTIICS)
AMIKIN Health& Bio Amikacin Aminoglycosideantibiotic
In serious kidney problem treat bacterial infection
ESBLANEM,MERONEM
GSK, Astrazeneca Meropenam Febrile neutropenia, hematological malignacies, Bone marrow suppression
Preferred CC Molecule In APOLLO,KOLKATA
Brand Name Company Molecule Class Indication
DORIBAX JanseenPharmaceuticals
DoripenemMonohydrate
Carbapenemantibiotics
Complicated intra abdominal infections, Complicated urinary tract infections
Total Consumption: Approximately 3000 vial in a week
Maximum No.Of CC Molecule consumption in Apollo,Kolkata
0
20
40
60
80
100
120
140
160
180
200
Metronidazole Piperacillin+ Tazobactum
Amoxicillin Na+ Clavunate
Doripenem Acyclovir
200
110
200
40 30
Weekly consumption(Vial)
Analysis: Nitroimidazole
& Antibiotic consumption is
more.
MARKET SURVEY ON CRITICAL CARE INJECTABLES IN AMRI(SALTLAKE)
MARKET SURVEY OF AMRI(SALTLAKE)
No. of General wards: 10-12 (no. of beds 1oo & above)
ICU: 1 (no. of beds 10-12)
NICU:1 (no. of beds 15-20)
PICU: 1 (no. of beds 10-12)
Target Patients for Critical Care
On basis of the survey of AMRI:
NICU Patients(age group): 3-9 months
PICU Patients (age group): 1-10 years
ICU Patients(age group): 15-80 years
Molecule Preferred Most In AMRI,SALTLAKE
BRAND NAME COMPANY MOLECULE
MERONEM ASTRAZENECA Meropenam
NA NA Itraconazole, Fluconazole, LiposomalAMP B
NA NA Capsofungin
Total Vial Consumption: 1000 approx.
Insight for CRITICAL CARE BELLE VUE CLINIC
PREFERRED MOLECULE IN BELLE VUE CLINIC
BRAND NAME COMPANY MOLECULE
3 CEF NOVO 1.5, 3 CEF NOVO 375
ALKEM Cefoperazone Na, Sulbactam
Pigewest NA Pigecycline(tetracycline-antibacterial
Tazact CIPLA Piperacillin +Tazobactum
Cancidas Merck & CO Capsofangin(antifungal)
Total Consumption: 1500-2000 vial in weekly basis(approx)
Most Common Critical Care Diseases according to Doctor’s feedback
Asthma
Renal Failure
Diabetic Coma
Cerebrovascular Hameorrhage
Acute Coronary syndrome
Maximum Number of Critical Care Disease
30
40
10
20
Percentage of Disease(%)
Acute Coronary Syndrome 35-50 yrs
Brain stroke 50 & above yrs
Pregnancy 20-30 yrs
Others 10-80 yrs
Analysis: Elderlypatients suffer much more in critical care
condition
Present Trend in Molecule Level
According to survey in antibiotic the present trend is moving to the Uripenam/ Indipenam
80% cases antibiotic is preferred molecule.
Hydrocortisone is also useful for critical care treatment.
Adrenaline, Morphine widely used in Critical care for Govt. Hospital as well as Non Govt. Hospitals, Nursing homes.