04-Drug-Nomenclature-Dosage-Forms-and-Drug-Interaction_.docx.pdf

PHARMACOLOGY SEM 01 | CYC 01 LECTURE AUF-CON NCM 0106 MODULE 04 – DRUG NOMENCLATURE, D...

PHARMACOLOGY SEM 01 | CYC 01 LECTURE AUF-CON NCM 0106 MODULE 04 – DRUG NOMENCLATURE, DOSAGE FORMS, AND DRUG INTERACTIONS Describes the common name of the drug OUTLINE Signifies a chemical derivation denoting the I Drug Nomenclature non-proprietary name (walang may-ari sa kanila) A Chemical Name of a compound used medicinally B Generic Name Tinitingnan mo ‘yung active ingredient present in C Trade Name i Disadvantages the medication D Generics Act of 1988 Same generic name = same effect II Common Drug Classifications ○ Usually, excipients lang ‘yung difference nila III Dosage Forms Ex. Aspirin, Prednisone, Paracetamol 📌NOTE: Palagi itong kasama sa prescription A Oral Dosage Forms i Tablet, Capsule, Lozenges/Troches, Powders, Suppositories, Solutions, Suspension, Emulsion, Confection, Decoction B Topical Dosage Forms C Injectable Drugs 3. TRADE NAME IV Drug Interaction Trademarks, Brand Name, Proprietary Name, Commercial Name DRUG NOMENCLATURE Used to identify the drugs manufactured by various drug companies A system of naming drugs based on its chemical Ex. Ventolin (trade name) component and molecular entities by the official ○ Salbutamol: non-proprietary name (generic governing bodies name) ○ Glaxo Smith Kline: company 1. CHEMICAL NAME A trade name frequently appears with the sign ® at Indicates the anatomic and molecular structure, its upper right corner which indicates that the name given as chemical formula or accompanied by a is registered and its production is restricted to that diagram pharmaceutical company as sole owner This name is not suitable for routine use by ○ Trade name refers to a particular company medical professionals or common people. There is great debate about the use of ○ Hindi naman name-memorize lahat non-proprietary vs trade names in the prescription. ○ However, this is very helpful for the discovery However, drugs sold under non-proprietary names of new compounds for therapeutic purposes are usually cheaper than those sold under trade Ex. Acetylsalicylic acid (aspirin), Ascorbic acid names (Vitamin C) Hindi na pwede i-manufacture ng ibang company ‘yung Biogesic kasi pagmamay-ari na siya ng 2. GENERIC NAME UniLab. However, pwede pa sila gumawa ng Paracetamol. Scientific, officially approved name ○ Will have the same name all throughout the DISADVANTAGES OF USING BRAND NAMES world as long as their particular active ingredient is also the same A single drug can have several brand names NCM 0106| Banaag, Cato, Diala, Mallari, Malonzo, Navarro, Paras|1  MODULE 04 — DRUG NOMENCLATURE, DOSAGE FORMS, AND DRUG INTERACTIONS OTCs may have the same brand name but become more aware and cognisant of the different active ingredients (different purpose) therapeutic awareness Mahihirapan ka maghanap ng gamot if you only To promote drug safety by minimizing duplication know the brand name. in medications and/or use of drugs with potentially ○ Travelling: hindi naman lahat ng countries adverse drug interactions mayroong Biogesic ○ Importance of knowing the generic name PROVISIONS All Government Agencies and their personnel as BRAND GENERIC NAME GENERIC NAME NAME [USA] [EUROPE] well as other government agencies shall use Flomax Tamsulosin Morniflumate generic terminology or generic names in all Naqua Trichlormethiazide Furosemide transactions related to purchasing, prescribing, Norpramin Desipramine Omeprazole dispensing and administering of all drugs and Sominex Diphenhydramine Promethazine medicines Trexan Naltrexone Methotrexate ○ We are trying to eliminate bias in Ethinyl estradiol, medications. Vivelle Estradiol norgestimate All medical, dental, and veterinary practitioners, including private practitioners, shall write prescriptions using generic names. The brand name may be included if so desired. ○ Emphasize that the brand is optional; they GENERICS ACT OF 1988 can purchase any medication as long as the PURPOSES generic name is the same. Any organization or company involved in the To promote, encourage and require the use of manufacture, importation, repacking, marketing, generic terminology in the importation, and/or distribution of drugs and medicine shall manufacture, distribution, marketing, advertising indicate prominently the generic name of the and promotion, prescription and dispensing of product labels as well as in advertising and other drugs; promotional materials. To ensure the adequate supply of drugs with ○ Ex: Paracetamol (Biogesic and Tempra) generic names at the lowest possible cost and Drug outlets, including drugstores, hospital and endeavor to make them available free for indigent non-hospital pharmacies and non-traditional patients; outlets such as supermarkets and stores shall To encourage the extensive use of drugs with inform any buyer about all other drugs products generic names through a national system of having the same generic name, together with their procurement and distribution corresponding prices so that the buyer may ○ Gives the patients the capability to choose adequately exercise their options. the most cost-effective medication for them ○ As long as same naman ‘yung therapeutic COMMON DRUG CLASSIFICATION effect, dosage, and primary ingredient, no need naman to purchase ‘yung branded BODY SYSTEM To emphasize the scientific basis for the use of ○ Drugs affecting different body systems (e.g. drugs, in order that health professionals may central, cardiovascular, gastrointestinal system are grouped together) NCM 0106 | Banaag, Cato, Diala, Mallari, Malonzo, Navarro, Paras|2  MODULE 04 — DRUG NOMENCLATURE, DOSAGE FORMS, AND DRUG INTERACTIONS THERAPEUTIC USE Scored ○ Clinical indications: antacids, ○ Facilitates division into halves or even antihypertensives, antibiotics and quarters (may mga hati) antipyretics ○ Enables us to accurately, if necessary, create PHYSIOLOGIC OR CHEMICAL ACTION partitions in medications ○ Beta-lactam drugs (made of beta-lactam ○ 100 mg ‘yung gamot pero 50 mg lang need ring) mo → tama ‘yung dami ng gamot na ○ Depende sa kung anong reaction or changes makukuha mo ‘yung ine-elicit niya sa katawan PRESCRIPTION ○ Medication cannot be purchased without a prescription from a physician ○ E.g.: Antibiotics Layered Self-medicating using antibiotics may ○ Has different or several drugs separated lead to resistance ○ No therapeutic bearing; for aesthetics only NON-PRESCRIPTION ○ Ex: Neozep ○ Readily accessible even without medical ○ 📌NOTE: Only scored and layered tablets can prescriptions be cut into smaller pieces ○ Over-the-counter; non-regulated ○ E.g.: Paracetamol, supplements, multivitamins, ascorbic acids ILLEGAL ○ Used for recreational purposes DOSAGE FORMS ORAL DOSAGE FORMS Enteric-coated ○ Coated with a substance that resists the TABLET action of gastric juices, thus it does not Preparations of powdered drugs, which are dissolve in the stomach but in the small composed or molded into a small disk with precise intestine shape and sizes. ○ 📌NOTE: DO NOT crush/cut these as this will Cornstarch expose the purposefully-coated medications ○ Disintegrating agent, which swells when it destroying its intended purpose comes in contact with fluid in the stomach causing the tablet to break into smaller CAPSULE particles, which dissolves rapidly and A small globular or cylindrical shell or container releases the active drug. made of some digestible or soluble material as gelatin ○ Pabalot/shell lang ‘yung nakikita; naka-enclose ‘yung medication para madaling ma-administer TYPES OF TABLET Hard NCM 0106 | Banaag, Cato, Diala, Mallari, Malonzo, Navarro, Paras|3  MODULE 04 — DRUG NOMENCLATURE, DOSAGE FORMS, AND DRUG INTERACTIONS ○ Two parts slide together that can be opened inflammation and to decrease to mix content with food or liquid or to be microorganisms present in the area used/administered with tube feeding ○ NOT advised to swallow as it does not have ○ Powdered drug is inside to reach the GIT to have a therapeutic effect ○ Hindi need i-crush ang capsule kasi p’wede Advice the patient to just keep it in the namang buksan pero i-dissolve muna sa mouth and let it be dissolved naturally solvent by the saliva Used for patients who cannot tolerate E.g.: Strepsils, Robitussin oral medications Soft POWDERS ○ Encapsulated medicinal liquid that is completely sealed A preparation in the form of the fine particles either ○ Liquid drug is inside = faster rate limiting of a single drug or of several drugs in combination Absorbed faster than hard capsule as Usually dispensed wrapped in a paper they do not undergo Seldomly used; mas efficient ‘yung tablets liquefaction/dissolution (already done by manufacturer) SUPPOSITORIES Time-Sustained Capsule Dosage form that is shaped suitable for insertion ○ Specifically devised where particular amount into external orifice of the body like the vagina, of drug is to be released in a continuous and urethra or rectum sustained manner (little by little) Once inserted, it either dissolves slowly in the body ○ Timely release of the medication ○ 📌NOTE: DO NOT open/crush/cut these as fluids or melts at body temperature to release the medicinal content this will destroy its intended purpose; NURSING RESPONSIBILITIES: magiging available kaagad ‘yung gamot kasi ○ Drape the client to provide privacy inalis mo ‘yung coating niya Na-e-expose ‘yung private area ng client when inserting suppositories As it can be uncomfortable for the patient, make them feel as comfortable as they can ○ You may use lubricants as inserting suppositories may be physically and emotionally uncomfortable Cocoa Butter: vehicle or base ○ Waxy, solid at room or refrigerator LOZENGES/TROCHES temperature but melts at body temperature Flat, round or rectangular preparation held in the mouth until dissolved to release medication with SOLUTIONS either antiseptic or anesthetic effect on tissues of the oral cavity or throat Clear, liquid preparation, which contains one or ○ Site of action is on the posterior more solvent water and one or more dissolved oropharyngeal area, to decrease components or solutes NCM 0106 | Banaag, Cato, Diala, Mallari, Malonzo, Navarro, Paras|4  MODULE 04 — DRUG NOMENCLATURE, DOSAGE FORMS, AND DRUG INTERACTIONS ○ Wala dapat solid particles na nagse-settle EMULSION ○ Even if you stock them for quite some time, they will not have sediments Dispersion of fine droplets of oil in water or water in Presence of solid particles may indicate oil spoilage or lack of potency Ex: Propofol (sedative used for surgeries) Orally taken, this is usually colored and flavored Advantages: Easy to administer and doses can vary. TYPES OF SOLUTION Syrups — SUGAR ○ Solutions that contain high concentration of dissolved sugar to mask unpleasant (bitter) taste of the drug ○ Common among medicines for children CONFECTION Elixir — WATER + ALCOHOL ○ Solutions that contain a solvent mixture of Paste-like preparation made by boiling a alcohol and water as well as other vegetable or medicinal plant with water and then components straining the fluid ○ Usually employed as a vehicle in dissolving substances (using small amount of alcohol), DECOCTION which do not dissolve in water alone An aqueous preparation made by boiling a Tincture — ALCOHOL + WATER vegetable or medicinal plant with water and ○ Solutions that contain alcohol as the primary straining the fluid solvent but which may contain water as well ○ Mas mataas ‘yung alcohol content TOPICAL DOSAGE FORMS Spirit — ALCOHOL ○ Alcoholic solution and volatile drugs Applied to skin surfaces to treat dermatological ○ Also called essence disorder ○ NURSING RESPONSIBILITY: These are highly volatile (evaporate easily). Always keep them TYPES OF TOPICAL DRUGS secured and close the cap prior to storing. Ointments SUSPENSION ○ Semi-solid preparations of medicinal substances in petrolatum Liquid dosage forms that contain solid drug ○ Vaseline or lanolin base, greasy and not particles that are suspended in a suitable liquid water removable medium ○ Mas mahal kasi mas matagal nags-stay sa NURSING RESPONSIBILITY: These should be shaken balat and has petroleum (water resistant - thoroughly prior to administration oil based) ○ Kasi may nagse-settle sa baba; shake para Cream mag-spread ‘yung active ingredient ○ Usually white, not generally greasy, semi-solid and can be removed with water NCM 0106 | Banaag, Cato, Diala, Mallari, Malonzo, Navarro, Paras|5  MODULE 04 — DRUG NOMENCLATURE, DOSAGE FORMS, AND DRUG INTERACTIONS (water based), employed on areas which are ○ Applied through an atomizer and deposits moist and/or when absorbing secretions from thin liquid to powder film on area of skin lesions application Paste ○ Useful when applied to large areas or when ○ Same as ointment but contains high powder manual application would be painful content (more starch substance) (example: burns) ○ Stiff in consistency with a good protective Powder quality ○ Can be shaken or blown onto the affected ○ May be used in absorbing secretions from area skin lesions ○ Promotes drying and with lubricant Lotion properties ○ Liquid having varying viscosities ○ Useful on moist areas and/or when friction is ○ May be a clear solution, suspension or to be reduced emulsion Oil ○ Best used for protection, astringent, cleansing ○ Liquid and not-water soluble or anti-pruritic, especially on large areas with ○ There are also oils in liquid capsules like fish hairy portions oils which are not water soluble ○ More appropriate for their feature of easy ○ E.g.: Omega painkillers penetration on skin Tape ○ Lotions are considered as drugs since they ○ Drug uniformly released from tape have moisturizing capabilities that alters the ○ May have splitting action on area of natural state of the skin application Gel/Jelly ○ Useful when small, straight areas require drug ○ Usually clear or translucent; semi-solid but application and when occlusion is desirable. liquefies upon application to skin ○ E.g.: Salonpas, analgesic tapes ○ Easily removed, with a good lubricating effect ○ Liquid increases surface tension (reduces CATEGORIES OF DRUG ORDERS surface friction) making it easy for the CATEGORY DESCRIPTION EXAMPLE suppository to enter May be an Amoxicillin 500 Aerosol Foam ongoing order mg, IV q 6h ○ Spreads drug over a wide area May be given for Atorvastatin 40 ○ Usually applied into the body like vagina or Standing a specific mg/tab ODHS rectum or onto hairy areas of the body Order number of days (once daily before Because of their minute presentation, or doses hours of sleep) they can pass through hairy areas and reach their desired anatomical site of May include PRN Ampicillin 750 concern orders mg/IV q 8h ○ Presence of atomizer which liquify areas and Ongoing orders but only given spread in a larger scope Paracetamol 325 when necessary PRN Orders mg Tab, 1 tab q4h Pro Re Nata for temp= 38 or All PRN orders are higher Aerosol Spray considered as standing orders NCM 0106 | Banaag, Cato, Diala, Mallari, Malonzo, Navarro, Paras|6  MODULE 04 — DRUG NOMENCLATURE, DOSAGE FORMS, AND DRUG INTERACTIONS Number of doses Ferrous sulfate 1 and the duration Self tab OD x 30 days of medication Terminating/ therapy have Limiting Clindamycin 750 already been q12h IV for 3 days specified Methergine 100 mg IM after Given once and One-Time or Placental delivery usually at Single-Dose specific time Dulcolax 1 tab at 10 PM Given once, immediately Diazepam 5 All STAT orders mg/IM at deltoid are considered STAT NEEDLE COMPONENTS PARTS STAT Orders as single-dose Gauge orders but not all D 50-50 1 vial IV (diameter of the single-dose STAT Catapres 75 needle, size of the Bevel orders are mcg SL now actual opening of (pointed opening part; considered as needle; as you go slanted) STAT orders higher, 21g to 23g = mas lalo lumiliit ang FOR INJECTABLE DRUGS opening) Length Shaft Syringe (usually expressed in (actual body of the ○ The smaller the gauge, the larger the size of inches; specific to site needle; long part) lumen of injection) Plunger/Pistol Hub Decreased circumference = increased (what you move when (actual opening that pressure administering; usually comes in contact with the have flat end) body of the syringe) Barrel (actual body of syringe; Collar calibrated to determine (enables ease when how much medication handling syringe) there is and how much have been administered) Luer Slip Luer Lock (simple slip; for removing (screw type lock; the needle by simply secure the needle pulling out the rest of the more) syringe) TYPES General Purpose ○ Plastic/Glass NCM 0106 | Banaag, Cato, Diala, Mallari, Malonzo, Navarro, Paras|7  MODULE 04 — DRUG NOMENCLATURE, DOSAGE FORMS, AND DRUG INTERACTIONS Plastics are preferred to maintain ○ The response elicited by combined drugs is sterility; para hindi nare-reuse ‘yung EQUAL TO the combined response of the syringe individual drugs Tuberculin Synergism — (1+1 = 3) ○ 1 mL slender syringe (will have fractions - 0.1, ○ The response is elicited by combined drugs is 0.2) GREATER THAN the combined responses of Insulin Syringe the individual drugs ○ 1 mL capacity measured in units Potentiation — (0+1 = 2) ○ Used for administration of insulin as this is ○ A drug that has no effect enhances the effect measured in units and not mL of a second drug Antagonism — (1+1 = 0) ○ A drug inhibits the effect of another drug Incompatibility ○ Occurs when two drugs mixed together in a syringe produce a chemical reaction, so they cannot be given. ○ Nursing Responsibilities for Drug incompatibilities Under NO circumstances should such a mixture be administered to the patient until the safety of the mixture can be Pre-Filled Cartridges and Syringe assured ○ Needles are permanently attached ○ Consult a pharmacist first for ○ No need to aspirate since it is already confirmation pre-filled Before combining two drugs/solutions, ○ There is a desired air/bubble to push the every attempt must be made to medication ascertain the stability and safety of the ‘wag i-expel, Ibaligtad mo ‘yung mixture with the pharmacist/drug syringe para mapunta sa baba ‘yung info/package insert air This will help you administer the medication properly; walang matitira B. DRUG INTERACTION AND PHARMACOKINETICS DRUG INTERACTION Altered Absorption ○ Drugs may inhibit absorption of other drugs Altered or modified action or effect of a drug as a across biological membranes by: result of interaction with one or more drugs. Change in the gastric emptying time When one drug administered in combination with Change in the gastric pH or shortly after another drug alters the effect of one Altered Distribution or both drugs ○ Administration of two or more drugs that are highly protein bound. A. TYPES OF DRUG INTERACTION Altered Metabolism ○ Induction or competition for metabolizing Addition — (1+1 = 2) enzymes. NCM 0106 | Banaag, Cato, Diala, Mallari, Malonzo, Navarro, Paras|8  MODULE 04 — DRUG NOMENCLATURE, DOSAGE FORMS, AND DRUG INTERACTIONS Altered Excretion adults whose body water is relatively decreased in ○ Drugs may act on the kidneys to reduce relation to TBW excretion of specific agents. Decreased plasma CHON [protein] binding sites (longer half-life) C. DRUG AND FOOD INTERACTION ○ Bawasan ‘yung highly protein-bound medications kasi kaunti lang ‘yung protein Food also interacts with drugs by increasing or ○ Increased risk for toxicity decreasing drug absorption. Blood-brain barrier is relatively developed Food also interacts with drugs to dangerous ○ Selectively-permeable layer that only allow adverse effects. certain medications to pass through the neural system D. DRUG AND SERUM ELECTROLYTE INTERACTIONS 3. METABOLISM Plasma levels of some electrolytes may affect the Immature liver, decreased activity of liver enzymes, capacity of some drugs to reach toxic levels half-life may be prolonged (first pass system is less producing toxic effects effective) ○ Mas kaunti ‘yung activity ng liver = hindi PEDIATRIC AND GERIATRIC CONSIDERATIONS IN kaagad name-metabolize PHARMACOLOGY I. PEDIATRIC PHARMACOLOGY 4. EXCRETION A. PHARMACOKINETICS Immature kidneys, until after the first year of life ○ Binababa ‘yung dosage 1. ABSORPTION Decreased blood flow to kidneys ○ GFR is 30-40% of adults rate (longer half-life Decreased gastric acid production and possible toxicity) ○ Alkaline in nature ‘yung stomach Slow gastric emptying time (enhanced absorption) B. PHARMACODYNAMICS ○ Mas matagal ‘yung stasis = mas mataas ‘yung na-a-absorb = bawasan ‘yung dosage Immature organs affect drug action and drug if necessary dosage frequently needs to be adjusted Skin is thin and drugs pass rapidly/readily, hence Rapidly developing tissues of infants and small kids absorption of topical drugs is enhanced can be more sensitive to certain drugs ○ E.g.: tetracycline can cause permanent 2. DISTRIBUTION discoloration of the teeth if given during the last trimester and early childhood Decreased BP affects blood flow to tissues, liver and Corticosteroid therapy can result in suppression of brain and kidneys = slower distribution growth ○ Mahina pa ‘yung pagtibok ng puso and kaunti pa lang ‘yung resistance II. GERIATRIC PHARMACOLOGY 65 to 75% of total body weight (TBW) is comprised of water hence, a relatively “larger” dose is needed SYSTEM PHYSIOLOGIC CHANGE to achieve the intended drug effect compared to NCM 0106 | Banaag, Cato, Diala, Mallari, Malonzo, Navarro, Paras|9  MODULE 04 — DRUG NOMENCLATURE, DOSAGE FORMS, AND DRUG INTERACTIONS Increased gastric pH (alkalinic in Decreased enzyme production nature) Decreased total liver function GIT Hepatic Decreased peristalsis and gastric ○ Results in decreased emptying time metabolism Decreased cardiac contractility = Decreased functioning nephron decreased output/ blood flow Renal Decreased GFR (glomerular (whole pharmacokinetic phase is filtration rate) altered) Increase portion of fat Cardiac or Decreased protein binding Decrease muscle mass Circulatory Tissue Level ○ Hypoalbuminemia ○ Has a decreased relationship ○ Mas madaling magkaroon ng with dosage toxicity (increased free drugs) REFERENCES Synchronous Lecture: 06 Sept 22 (CI: Sir Jonas Solis) Module: NCM 0106 - Module 04 ABBREVIATIONS COMMONLY FOUND IN DRUG ORDERS DRUG MEASUREMENTS AND DRUG FORMS ABBREVIATION MEANING ABBREVIATION MEANING cap capsule min Minim cc cubic centimeter oz Ounce dr Dram pt Pint elix Elixir qt Quart fl dr Fluid dram SR Sustained release fl oz Fluid ounce ss One-half G, gm, G, GM gram supp Suppository gr Grain susp Suspension gtt drops T.O. Telephone order kg Kilogram T, tbsp Tablespoon L, l Liter U Units m2 Square meter V.O. Verbal order NCM 0106 | Banaag, Cato, Diala, Mallari, Malonzo, Navarro, Paras|10  MODULE 04 — DRUG NOMENCLATURE, DOSAGE FORMS, AND DRUG INTERACTIONS mcg microgram > Greater than mEq Milliequivalent < Less Than mg Milligram mL, ml millimeter ROUTES OF DRUG ADMINISTRATION ABBREVIATION MEANING ABBREVIATION MEANING A.D., a.d. Right ear O.D., od Right eye A.S., a.s. Left ear O.S., o.s. Left eye A.U., a.u. Both ears O.U., o.u. Both eyes ID Intradermal PO, po, os By mouth IM Intramuscular R Right IV Intravenous SC, subc,sc, SQ Subcutaneous IVPB Intravenous SL, sl, subl Sublingual piggyback KVO Keep vein open TKO To keep open L Left Vag vaginal NGT Nasogastric tube TIMES OF ADMINISTRATION ABBREVIATION MEANING ABBREVIATION MEANING AC, ac Before meals QAM Every morning ad lib As desired qd, od Every day, once a day B.i.d., b.i.d. Twice a day qh Every hour C With Q.i.d., q.i.d. Four times a day Hs Hours of sleep q.o.d. Every other day NCM 0106 | Banaag, Cato, Diala, Mallari, Malonzo, Navarro, Paras|11  MODULE 04 — DRUG NOMENCLATURE, DOSAGE FORMS, AND DRUG INTERACTIONS Noct At night s Without NPO Nothing per orem SOS Once if necessary, if (mouth) there is a need PC, pc After meals Stat Immediately PRN, p.r.n. Whenever necessary, T.i.d., t.i.d. Three times a day as needed Q Every ABBREVIATIONS OF SOLUTIONS INTRAVENOUS SOLUTION ABBREVIATION 5% Dextrose in Water D5W, 5% D/W 10% Dextrose in Water D10W, 10% D/W 0.9 Sodium Chloride 0.9 NaCl Normal Saline Solution NSS 0.45% Sodium Chloride, 1⁄2 NSS 0.45 NaCl, 1⁄2 NSS 5% Dextrose in 0.95 sodium chloride D5NSS, 5% D/NSS 5% Dextrose in Lactated Ringer's Solution D5LRS Balance Multiple Replacement Solution with 5% D5NM Dextrose or Eurosol-R in D5 Water Balance Multiple Maintenance Solution with 5% D5IMB Dextrose or Eurosol-M in D5 Water Balance Multiple Replacement Solution with 5% D5NR Dextrose or Normosol-R in D5 Water Lactated Ringers Solution Plain LRS, PLRS Balance Multiple Maintenance Solution with 5% Dextrose or Eurosol-MK in D5 Water with Light D5MK Potassium NCM 0106 | Banaag, Cato, Diala, Mallari, Malonzo, Navarro, Paras|12