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.