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MED

Notes
Nurse’s Pocket
Pharmacology Guide

Judith Hopfer Deglin
April Hazard Vallerand
Purchase additional copies of th...
F A. Davis Company
.
1915 Arch Street
Philadelphia, PA 19103
www.fadavis.com
Copyright © 2004 by F A. Davis Company
.
All ...
Place 2 78ϫ2 78
/
/

Sticky Notes

here

for a convenient and refillable note pad

Waterproof and Reusable
Wipe-Free Pages...
Look for our other
Davis’s Notes titles
Available Now!

LPN Notes:
Nurse’s Clinical Pocket Guide
Ehren Myers, RN & Tracey ...
1
High Alert Medications
High alert medications are those medications that have a high
risk of causing injury or death whe...
BASICS

Safe Medication Administration
I Carefully read product packaging to note strength of solution,
dosage, and/or rou...
3
Abbreviations and Symbols Associated
with Medication Errors
Abbreviations and symbols are a source of medication errors....
BASICS

IV Administration
Starting an IV
I Prepare the patient: Explain procedure, answer any questions, and reassure.
I G...
5

IV Insertion Guide

BASICS
BASICS

IV Piggyback (IVPB) Setup
I
I
I
I
I

The piggyback bag must be higher than the IV.
To do this, use an extension ho...
7
Flushing IV Catheters
Catheter Type

Solution

Strength

Frequency

Peripheral Catheters (Open Ended)
Peripheral IV cath...
BASICS

Intramuscular (IM) Injection Sites

8
9

Z-Track Method for Giving IM Injections

BASICS
BASICS

Subcutaneous (SC) Injection Sites

Two inches away
from the umbilicus

Subcutaneous (SC) Heparin Injections
Site

...
11

Intradermal (ID), Subcutaneous (SC), and Intramuscular (IM)

BASICS
BASICS

Mixing Insulins
1. Obtain appropriate-size insulin syringe, and draw up enough air
equal to combined volume of bot...
13

Mixing Insulins

BASICS
A–C

ACYCLOVIR (ay-sye-kloe-veer) Avirax, Zovirax Antiviral
Pregnancy Category B (PO, IV) C (topical)
I INDICATIONS: Genit...
15
ALBUTEROL (al-byoo-ter-awl) AccuNeb, Proventil, Ventodisk,
Ventolin bronchodilator Pregnancy Category C
I INDICATIONS: ...
A–C

ALENDRONATE (uh-len-dro-nate) Fosamax Bone resorption
inhibitor Pregnancy Category C
I INDICATIONS: Osteoporosis, Pag...
17
ALLOPURINOL (al-oh-pure-i-nawl) Apo-Allopurinol, Lopurin,
Zyloprim Anti-gout agent, antihyperuricemic Pregnancy Categor...
A–C

ALPRAZOLAM (al-pra-zoe-lam) Apo-Alpraz, Nu-Alpraz, Xanax
antianxiety agent (benzodiazepine) Pregnancy Category D
I IN...
19
AMILORIDE (a-mill-oh-ride) Midamor diuretic (potassiumsparing diuretic) Pregnancy Category B
I INDICATIONS: Counteract ...
A–C

AMIODARONE (a-mee-oh-da-rone) Cordarone, Pacerone antiarrhythmic Pregnancy Category D
I INDICATIONS: Ventricular arrh...
21
AMITRIPTYLINE (a-meh-trip-ti-leen) Elavil, Levate, Novotriptyn
antidepressant (tricyclic) Pregnancy Category D
I INDICA...
A–C

AMLODIPINE (am-loe-di-peen) Norvasc antihypertensive
(calcium channel blocker) Pregnancy Category C
I INDICATIONS: Ma...
23
AMOXICILLIN/CLAVULANATE (a-mox-i-sill-in klav-yoolan-ate) Augmentin ES, Augmentin XR, Clavulin anti-infective
Pregnancy...
A–C

AMOXICILLIN (uh-mox-i-sil-in) Amoxil, Novamoxin, Trimox
anti-infective, anti-ulcer agent Pharm Class: Aminopenicillin...
25
ATENOLOL (a-ten-oh-lole) Apo-Atenolol, Novo-Atenolol,
Tenormin antianginal, antihypertensive (selective beta-blocker)
P...
A–C

ATORVASTATIN (a-tore-va-sta-tin) Lipitor lipid-lowering agent
Pregnancy Category X
I INDICATIONS: Primary hypercholes...
27
AZITHROMYCIN (aye-zith-row-my-sin) Zithromax agent for
atypical mycobacterium, anti-infectives (macrolide) Pregnancy
Ca...
A–C

BACLOFEN (bak-loe-fen) Lioresal antispasticity agent, skeletal
muscle relaxant Pregnancy Category C
I INDICATIONS: Re...
29
BECLOMETHASONE (beh-kloe-meth-a-sone) Beclodisk,
Becloforte, Beclovent, Vanceril, antiasthmatic, anti-inflammatory
(inh...
A–C

BENAZEPRIL (ben-aye-ze-pril) Lotensin antihypertensive (ACE
inhibitors) Pregnancy Category C (first trimester), D (se...
31
BENZTROPINE (benz-troe-peen) Apo-Benztropine, Cogentin
antiparkinson agent, anticholinergic Pregnancy Category C
I INDI...
A–C

BISOPROLOL (bis-oh-proe-lol) Zebeta antihypertensive (betablocker [selective]) Pregnancy Category C
I INDICATIONS: Hy...
33
BUDESONIDE (byoo-dess-oh-nide) Pulmicort antiinflammatory (inhalation corticosteroid) Pregnancy Category B
I INDICATION...
A–C

BUMETANIDE (byoo-met-a-nide) Bumex diuretic (loop diuretic)
Pregnancy Category C
I INDICATIONS: Edema secondary to CH...
35
BUPROPION (byoo-proe-pee-on) Wellbutrin, Wellbutrin SR,
Zyban antidepressant, smoking deterrent Pregnancy Category B
I ...
A–C

CAPTOPRIL (kap-toe-pril) Capoten angiotensin-converting
enzyme (ACE) inhibitor Pregnancy Category C (first trimester)...
37
CARISOPRODOL (kar-i-sop-roe-dole) Soma, Vanadom skeletal
muscle relaxant Pregnancy Category UK
I INDICATIONS: Adjunct t...
A–C

CARVEDILOL (kar-ve-dil-ole) Coreg antihypertensive (betablocker) Pregnancy Category C
I INDICATIONS: Hypertension, CH...
39
CEFEPIME (seff-e-peem) Maxipime anti-infective third generation cephalosporin Pregnancy Category B
I INDICATIONS: Skin,...
A–C

CELECOXIB (sel-e-kox-ib) Celebrex antirheumatic, nonsteroidal
anti-inflammatory (COX-2 inhibitor) Pregnancy Category ...
41
CEPHALEXIN (sef-a-lex-in) Apo-Cephalex, Biocef, Keflex, NovoLexin anti-infective (first-generation cephalosporin) Pregn...
A–C

CETIRIZINE (se-ti-ra-zeen) Zyrtec allergy, cold and cough
remedy, antihistamine Pregnancy Category B
I INDICATIONS: R...
43
CHLOROTHIAZIDE (klor-oh-thye-a-zide) Diuril antihypertensive
(thiazide diuretic) Pregnancy Category B
I INDICATIONS: Mi...
A–C

CIMETIDINE (sye-meh-tih-deen) Novocimetine, Peptol,
Tagamet anti-ulcer agent (histamine h2 antagonist) Pregnancy
Cate...
45
CIPROFLOXACIN (sip-roe-flox-a-sin) Cipro anti-infective (fluoroquinolone) Pregnancy Category C
I INDICATIONS: Urinary t...
A–C

CITALOPRAM (si-tal-oh-pram) Celexa antidepressant (selective
serotonin reuptake inhibitor) Pregnancy Category C
I IND...
47
CLINDAMYCIN (klin-da-mye-sin) Cleocin, Dalacin C, antiinfective Pregnancy Category B
I INDICATIONS: Skin, skin structur...
A–C

CLONAZEPAM (kloe-na-ze-pam) Klonopin, Rivotril, SynClonazepam anticonvulsant (benzodiazepine) Schedule IV
Pregnancy C...
49
CLONIDINE (klon-i-deen) Catapres, Catapres-TTS, Duraclon
antihypertensive Pregnancy Category C
I INDICATIONS: Mild to m...
A–C

CLOPIDOGREL (kloh-pid-oh-grel) Plavix antiplatelet agent
(platelet aggregation inhibitor) Pregnancy Category B
I INDI...
51
COLCHICINE (kol-chi-seen) anti-gout agent Pregnancy
Category D

I INDICATIONS: Gouty arthritis.
Therapeutic Effects: I ...
A–C

CORTISONE (kor-ti-sone) Cortone, Cortone Acetate, steroidal
anti-inflammatory (systemic corticosteroid) Pregnancy Cat...
53
DALTEPARIN (dal-te-pa-rin) Fragmin anticoagulant (low molecular weight heparin [LMWH]) (antithrombotic) Pregnancy
Categ...
D–H

DEXAMETHASONE (dex-a-meth-a-sone) Decadron, Decaject,
Dexameth steroidal anti-inflammatory (systemic corticosteroid)
...
55
DIAZEPAM (dye-az-e-pam) Apo-Diazepam, Diastat, Dizac, DVal, Novodipam, Valium, Vivol antianxiety agent, anticonvulsant,...
D–H

DIAZEPAM (Continued)
I CONTRAINDICATIONS: Hypersensitivity, comatose patients,
pre-existing CNS depression, uncontrol...
57
DIGOXIN (di-jox-in) Digitek, Lanoxicaps, Lanoxin antiarrhythmic, inotropic Pregnancy Category C
I INDICATIONS: CHF tach...
D–H

DIGOXIN (Continued)
or symptoms of toxicity, withhold drug and notify physician or
health care professional immediate...
59
DILTIAZEM (dil-tye-a-zem) Apo-Diltiaz, Cardizem, Diltia XT, NuDiltiaz, Tiamate, antianginal, antiarrhythmic, antihypert...
D–H

DONEPEZIL (doe-nep-i-zill) Aricept anti-Alzheimer’s agent,
cholinergic Pregnancy Category C
I INDICATIONS: Mild to mo...
61
DOXAZOSIN (dox-uh-zoe-sin) Cardura antihypertensive (antiadrenergic) Pregnancy Category C
I INDICATIONS: Hypertension, ...
D–H

ENALAPRIL (e-nal-a-pril) Vasotec ENALAPRILAT (e-nal-a-pril-at)
Vasotec IV Pregnancy Category C (first trimester), D (...
63
ENOXAPARIN (e-nox-a-pa-rin) Lovenox anticoagulant (low
molecular weight heparin [LMWH]) (antithrombotic) Pregnancy
Cate...
D–H

ESTRADIOL (es-tra-dye-ole) Estrace, Gynodiol hormone (estrogen) Pregnancy Category X
I INDICATIONS: Vasomotor symptom...
65
FENTANYL (TRANSDERMAL) (fen-ta-nil) Duragesic opioid
analgesic, opioid agonist Schedule II Pregnancy Category C
I INDIC...
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As new scientific information becomes available through basic and clinical research, recommended treatments and drug therapies undergo changes. The author(s) and publisher have done everything possible to make this book accurate, up to date, and in accord with accepted standards at the time of publication. The author(s), editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of the book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised always to check product information (package inserts) for changes and new information regarding dose and contraindications before administering any drug. Caution is especially urged when using new or infrequently ordered drugs.

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Med notes pocket drug guid

  1. 1. Contacts • Phone/E-Mail Name Ph: e-mail: Name Ph: e-mail: Name Ph: e-mail: Name Ph: e-mail: Name Ph: e-mail: Name Ph: e-mail: Name Ph: e-mail: Name Ph: e-mail: Name Ph: e-mail: Name Ph: e-mail: Name Ph: e-mail: Name Ph: e-mail:
  2. 2. MED Notes Nurse’s Pocket Pharmacology Guide Judith Hopfer Deglin April Hazard Vallerand Purchase additional copies of this book at your health science bookstore or directly from F A. Davis by shopping . online at www.fadavis.com or by calling 800-323-3555 (US) or 800-665-1148 (CAN) A Davis’s Notes Book F. A. Davis Company • Philadelphia
  3. 3. F A. Davis Company . 1915 Arch Street Philadelphia, PA 19103 www.fadavis.com Copyright © 2004 by F A. Davis Company . All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in China by Imago Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1 Publisher, Nursing: Robert G. Martone Design Manager: Louis J. Forgione Cover Designer: Paul Fry As new scientific information becomes available through basic and clinical research, recommended treatments and drug therapies undergo changes. The author(s) and publisher have done everything possible to make this book accurate, up to date, and in accord with accepted standards at the time of publication. The author(s), editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of the book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised always to check product information (package inserts) for changes and new information regarding dose and contraindications before administering any drug. Caution is especially urged when using new or infrequently ordered drugs. Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by F A. Davis Company . for users registered with the Copyright Clearance Center (CCC) Transactional Reporting Service, provided that the fee of $.10 per copy is paid directly to CCC, 222 Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license by CCC, a separate system of payment has been arranged. The fee code for users of the Transactional Reporting Service is: 8036-1109-9/04 0 + $.10.
  4. 4. Place 2 78ϫ2 78 / / Sticky Notes here for a convenient and refillable note pad Waterproof and Reusable Wipe-Free Pages Write directly onto any page of MedNotes with a ballpoint pen. Wipe old entries off with an alcohol pad and reuse. BASICS A–C D–H I–M N–R S–Z TOOLS
  5. 5. Look for our other Davis’s Notes titles Available Now! LPN Notes: Nurse’s Clinical Pocket Guide Ehren Myers, RN & Tracey Hopkins, RN, BSN ISBN: 0-8036-1132-3 RNotes™: Nurse’s Clinical Pocket Guide Ehren Myers, RN ISBN: 0-8036-1060-2 Coming soon! NutriNotes: Nutrition & Diet Therapy Pocket Guide Carroll Lutz, MA, RN & Karen Przytulski, MS, RD ISBN: 0-8036-1114-5 MedSurg Notes: Nurse’s Clinical Pocket Guide Tracey Hopkins, RN, BSN & Ehren Myers, RN ISBN: 0-8036-1115-3 Also by Judith Hopfer Deglin & April Hazard Vallerand Davis’s Drug Guide for Nurses™
  6. 6. 1 High Alert Medications High alert medications are those medications that have a high risk of causing injury or death when improperly handled or administered. Exercise extreme caution when administering these medications: I Adrenergic agonists (e.g., epinephrine, isoproterenol, norepinephrine) I Cardioplegic solutions I Chemotherapeutic agents I Chloral hydrate (in pediatric patients) I Colchicine injection I High concentration dextrose (Ͼ10% dextrose) I Hypoglycemic agents (oral) I Hypertonic sodium chloride injection (Ͼ 0.9% concentration) I Insulin I IV adrenergic antagonists (propranolol, esmolol, metoprolol) I IV calcium; IV magnesium sulfate I IV digoxin I IV potassium (phosphate and chloride) I Lidocaine/ benzocaine other topical anesthetics I Midazolam I Neuromuscular blocking agents I Opiates (opioids) I Thrombolytics, heparin, warfarin BASICS
  7. 7. BASICS Safe Medication Administration I Carefully read product packaging to note strength of solution, dosage, and/or route of administration. I Double-check with a pharmacist about dose range. I Have a colleague double-check dosage calculations and infusion pump programming. I Use the 5 Rights (right drug, right dose, right patient, right route, right time) as a guide. I Clarify any order that is incomplete, contains abbreviations, is confusing or hard to read, or raises a question. I Do not borrow medications from other patients or begin new medications before order has been received in pharmacy: to do so circumvents built-in checks that can detect a prescribing error. Standards for Patient Education I All patients need clear written and verbal instruction for all medications. Do not rush. Include family members. I Present information in a format the patient can understand. I Use an interpreter if provider and patient speak different languages. I Have the patient repeat the information you provide. I Make sure to tell the patient: The brand and generic names of the medication The purpose of the medication The strength and dose of the medication When to take the medication Possible side effects and what to do if they occur How long to take the medication What medications or foods to avoid and why they should be avoided How to store the medication What to do if a dose is missed What activities should be avoided while on the medication Signs and symptoms of adverse drug reactions 2
  8. 8. 3 Abbreviations and Symbols Associated with Medication Errors Abbreviations and symbols are a source of medication errors. Nurses should consult with the prescribing health care provider on any orders that contain the following abbreviations. Abbreviation/ Intended Symbol Meaning AZT CPZ HCl HCT MgSO4 MS MTX Nitro drip Norflox PIT / (slash) ϩ Often Mistaken For Zidovudine Compazine Azathioprine Thorazine (chlorpromazine) Hydrochloric KCl (potassium acid chloride) Hydrocortisone Hydrochlorothiazide Magnesium Morphine sulfate sulfate Morphine Magnesium sulfate sulfate Methotrexate Mitoxantrone Nitroprusside Nitroglycerin Norfloxacin Norflex Pitocin Pitressin “per” “1” (numeral Plus sign “one”) “4” (numeral “four”) 1 mg 10 mg Recommendation Use full drug name Use full drug name Use full drug name Use full drug name Use full drug name Use full drug name Use full drug name Use full drug name Use full drug name Use full drug name Spell out “per” Spell out “and” Zero after a decimal point (e.g., 1.0 mg) No zero .1 mg before a decimal point (e.g., .1 mg) U units 1 mg ALWAYS USE zero before a decimal point 0 (zero), 4 (four) or cc HS Hour of sleep Spell out unit Write out medication strength. Half strength DO NOT USE zero after a decimal point Adapted from the Institute for Safe Medication Practices, 2003 http://www.ismp.org/msaarticles/specialissuetable.html. BASICS
  9. 9. BASICS IV Administration Starting an IV I Prepare the patient: Explain procedure, answer any questions, and reassure. I Gather equipment: IV bag with primed tubing, sharps container, catheter, tape, tourniquet, and antiseptic swabs. I Organize supplies: Tear tape, have primed tubing and sharps container within easy reach, and open 2ϫ2 dressing. I Apply tourniquet proximal to intended insertion site, either midforearm or above the elbow. I Locate vein: Palpate with fingertips. To further enhance dilation, gently tap, apply heat or warm soak, and have patient make a few fists or dangle arm below heart. I Cleanse site: Using moderate friction, cleanse in a circular motion, moving outward from intended site. I Put on gloves while waiting for cleansed area to dry. Avoid touching site once it has been prepared. I Apply traction (in the direction opposite the catheter). I Position needle, bevel side up, 15Њ–30Њ. NOTE: Hold the needle with the thumb and pointer finger in a way that allows for visualization of the flash chamber. I Insert needle, and observe for “flash back” in flash chamber. Lower catheter almost parallel to the skin, and insert the needle 1–2 mm more to ensure that the catheter has also entered the vein. I Advance the catheter: Thread catheter into vein while maintaining skin traction. I Release the tourniquet, and apply digital pressure just above the end of the catheter tip while gently stabilizing the hub of the catheter. I Remove needle, and discard into approved sharps container. I Connect IV tubing, open clamp, and observe for free flow of IV fluid. I Secure catheter, and apply sterile dressing per hospital policy and procedure. I Clean up, and document per hospital policy and procedure. 4
  10. 10. 5 IV Insertion Guide BASICS
  11. 11. BASICS IV Piggyback (IVPB) Setup I I I I I The piggyback bag must be higher than the IV. To do this, use an extension hook. Use the most proximal access port on primary line. Adjust piggyback stopcock to desired rate. After infusion is complete, the primary IV bag will begin to drip again. Ensure primary drip rate. Location of Common Veins Complications of Starting/Maintaining IVs Infiltration Phlebitis Assessment: Classic sign is red line along course of vein; other signs include redness, heat, swelling, and tenderness. Assessment: Swelling; tenderness; decreased or no infusion rate; blanching of skin; site is cool to touch. Interventions: D/C IV, and restart in a new site. Apply warm compress to affected area. Interventions: D/C IV, and restart in a new site. Apply warm compress to affected area. 6
  12. 12. 7 Flushing IV Catheters Catheter Type Solution Strength Frequency Peripheral Catheters (Open Ended) Peripheral IV catheter Normal saline Midline catheter (each lumen if multiple) n/a 3 mL daily and PRN Heparin 10 units/ mL 5 mL daily and PRN Central Venous Catheters (CVC) Valved-tip catheters (Groshong PICC) Normal saline n/a 5 mL per lumen weekly and PRN Open-ended PICC lines Heparin 10 units/ mL 5 mL per lumen daily and PRN Tunneled catheters (Hickman, Broviac) Heparin 100 units/ mL 5 mL per lumen daily and PRN Implanted Port Catheters Groshong Port-a-Cath (when accessed) Heparin 100 units/ mL 5 mL daily and PRN Solution Used to Flush a Catheter Valved-tip catheters require only saline flushes; however, the use of heparin is not contraindicated. All other central lines require heparin flushes to minimize fibrin collection and clot formation. Syringe Selection The smaller the syringe size, the greater the pressure in PSI. Greater PSI pressure increases potential for catheter damage. Therefore, a syringe size of 10 cc or greater is recommended for central-line flushes. Positive-Pressure Flushing of Valved-Tip Catheters Important: To reduce potential for blood backflow into the catheter tip, which promotes clot formation and catheter occlusion, always remove needles or needleless caps slowly while injecting the last 0.5 mL of saline. “SAS” Technique Flush with Saline, Administer Med, Flush with Saline BASICS
  13. 13. BASICS Intramuscular (IM) Injection Sites 8
  14. 14. 9 Z-Track Method for Giving IM Injections BASICS
  15. 15. BASICS Subcutaneous (SC) Injection Sites Two inches away from the umbilicus Subcutaneous (SC) Heparin Injections Site Gauge and Angle Abdomen, posterior upper arm, low back, thigh, and upper back 25 g–26 g, 3/8′′ @ 90Њ (45Њ if on a thin patient) 10 Aspirate Massage Site No No
  16. 16. 11 Intradermal (ID), Subcutaneous (SC), and Intramuscular (IM) BASICS
  17. 17. BASICS Mixing Insulins 1. Obtain appropriate-size insulin syringe, and draw up enough air equal to combined volume of both insulins. 2. Inject the NPH vial with amount of air equal to amount of NPH to be mixed without dipping needle into NPH solution. → This prevents the NPH (which is cloudy) from mixing with the regular insulin (which is clear) and turning it cloudy. 3. Inject remaining air into regular insulin vial, and draw up the regular insulin to be mixed. → Expel any air/bubbles. There should not be any air in the syringe, because the NPH vial has already been pressurized. 4. Mix: Roll (do not shake) NPH vial between hands. → This prevents the formation of air bubbles, which can displace the insulin and alter the dose. 5. Reinsert needle into pressurized NPH and withdraw desired amount. → Remember to triple-check all medication orders, and have another nurse present when you mix the insulin. 12
  18. 18. 13 Mixing Insulins BASICS
  19. 19. A–C ACYCLOVIR (ay-sye-kloe-veer) Avirax, Zovirax Antiviral Pregnancy Category B (PO, IV) C (topical) I INDICATIONS: Genital herpes, localized cutaneous herpes zoster infections, shingles, chickenpox, varicella, herpes simplex encephalitis, limited non–life-threatening herpes simplex infections in immunocompromised patients (topical). Therapeutic Effects: I Inhibition of viral replication, decreased viral shedding, reduced lesion-healing time. I DOSAGE: PO: Adults: 200–800 mg 3 to 5 times daily. Children: 20 mg/kg 4 times daily IV Adults and Children: 5–20 mg/kg q8 h. Topical: Adults and Children: 1/2 inch ribbon for each 4 square inch area 6 times daily. I ADMINISTRATION: PO: Can give with food or on an empty stomach, with a full glass of water. IV: Do not reconstitute with bacteriostatic water with benzyl alcohol or paraben. Administer via infusion pump over at least 1 hour to minimize renal tubular damage. I ADVERSE REACTIONS AND SIDE EFFECTS: SEIZURES, dizziness, headache, diarrhea, nausea, vomiting, pain, phlebitis, RENAL FAILURE, THROMBOTIC THROMBOCYTOPENIC PURPURA/ HEMOLYTIC UREMIC SYNDROME in high doses in immunosuppressed patients. I CONTRAINDICATIONS: Hypersensitivity to acyclovir or valacyclovir. I CAUTIONS: Concurrent use of other nephrotoxic drugs increases the risk of adverse renal effects. 14
  20. 20. 15 ALBUTEROL (al-byoo-ter-awl) AccuNeb, Proventil, Ventodisk, Ventolin bronchodilator Pregnancy Category C I INDICATIONS: Asthma or COPD-induced reversible airway obstruction, acute bronchospasm, prevention of exerciseinduced bronchospasm, long-term control of chronic/persistent bronchospasm. Therapeutic Effects: I Bronchodilation. I DOSAGE: PO: Adults and Children Ն12: 2–4 mg 3–4 times daily; 4–8 mg twice daily for extended-release tablets. Children 6–12 yr: 2 mg 3–4 times daily. Children 2–6 yr: 0.1 mg/kg 3 times daily. Geriatrics: 2 mg 3–4 times daily. Inhalation: Adults and Children 2–12 yr: Via nebulization or IPPB: 1.25–2.5 mg 3–4 times daily. Adults and Children Ն4 yr: Via Rotahaler inhalation device: 200 ␮g as Ventolin Rotacaps q 4–6 h up to 400 ␮g q 4–6 h. Adults and Children Ն4 yr: Via metered-dose inhaler—2 inhalations q 4–6 h. I ADMINISTRATION: PO: Administer oral medication with meals to minimize gastric irritation. Inhalation: Allow at least 1 minute between inhalations of aerosol medication. For nebulization or IPPB, the 0.5–0.83-, 1-, and 2-mg/mL solutions do not require dilution before administration. The 5 mg/mL solution must be diluted with 2.5 mL of 0.9% NaCl for inhalation. I ADVERSE REACTIONS AND SIDE EFFECTS: Nervousness, restlessness, tremor, chest pain, palpitations, angina, arrhythmias, hypertension, hypokalemia. I CONTRAINDICATIONS: Hypersensitivity to adrenergic amines or hypersensitivity to fluorocarbons inhaler. I CAUTIONS: Excessive use may lead to tolerance and paradoxical bronchospasm. • Use with MAO inhibitors may lead to hypertensive crisis. • Beta-blockers may negate therapeutic effect. Key: underline = most common; CAPS = life-threatening A–C
  21. 21. A–C ALENDRONATE (uh-len-dro-nate) Fosamax Bone resorption inhibitor Pregnancy Category C I INDICATIONS: Osteoporosis, Paget’s disease of the bone. Therapeutic Effects: I Reversal of the progression of osteoporosis with decreased fractures, decreased progression of Paget’s disease. I DOSAGE: PO: Adults: Treatment of osteoporosis: 5–10 mg once daily or 70 mg once weekly. Prevention of osteoporosis: 5 mg once daily or 35 mg once weekly. Paget’s disease: 40 mg once daily for 6 mo. I ADMINISTRATION: Remain upright for 30 min following dose to facilitate passage to stomach and minimize risk of esophageal irritation. Do not drink coffee, tea, cola, mineral water, or orange juice within 1/2 hour of taking alendronate. I ADVERSE REACTIONS AND SIDE EFFECTS: Headache, abdominal distention, abdominal pain, acid regurgitation, constipation, diarrhea, dyspepsia, dysphagia, esophageal ulcer, flatulence, gastritis, nausea, altered taste, vomiting, erythema, photosensitivity, rash, musculoskeletal pain. I CONTRAINDICATIONS: Renal insufficiency (CCr Ͻ35 mL/min), pregnancy, lactation. I CAUTIONS: Calcium supplements, antacids, other oral medications and food significantly decrease the absorption of alendronate. Caffeine coffee, tea, cola, mineral water, and orange juice also decrease absorption. Wait 1 hour before consuming. 16
  22. 22. 17 ALLOPURINOL (al-oh-pure-i-nawl) Apo-Allopurinol, Lopurin, Zyloprim Anti-gout agent, antihyperuricemic Pregnancy Category C I INDICATIONS: Prevention of attack of gouty arthritis and nephropathy. Treatment of secondary hyperuricemia that can occur during treatment of tumors or leukemias. Treatment of secondary hyperuricemia. Therapeutic Effects: I Lowering of serum uric acid levels by inhibiting the production of uric acid. I DOSAGE: PO: Adults: 100 to 800 mg/d. Doses Ͼ300 mg/d should be given in divided doses. Children 6–10 yr: 300 mg daily. Children Ͻ6 yr: 150 mg daily. IV: Adults: 200–400 mg/m2/d (up to 600 mg/d) as a single daily dose or in divided doses q 6–12 h. Children: 200 mg/m2 per day as a single daily dose or in divided doses q 6–12 h. I ADMINISTRATION: May be administered with milk or meals to minimize gastric irritation. May be crushed. I ADVERSE REACTIONS AND SIDE EFFECTS: Drowsiness, diarrhea, hepatitis, nausea, vomiting, renal failure, rash, urticaria, bone marrow depression, hypersensitivity reactions. I CONTRAINDICATIONS: Hypersensitivity; pregnancy/lactation. I CAUTIONS: Use with mercaptopurine and azathioprine increases bone marrow depressant properties—dosages of these drugs should be reduced. • Use with ampicillin or amoxicillin increases the risk of rash. • Use with oral hypoglycemic agents and warfarin increases the effects of these drugs. • Use with thiazide diuretics or ACE inhibitors increases the risk of hypersensitivity reactions. • Discontinue allopurinol immediately if rash occurs. • Therapy should be discontinued permanently if reaction is severe. • Therapy may be reinstituted at a lower dose (50 mg/d with very gradual titration) after a mild reaction has subsided. Key: underline = most common; CAPS = life-threatening A–C
  23. 23. A–C ALPRAZOLAM (al-pra-zoe-lam) Apo-Alpraz, Nu-Alpraz, Xanax antianxiety agent (benzodiazepine) Pregnancy Category D I INDICATIONS: Anxiety, panic attacks, premenstrual syndrome (PMS) (unlabeled use). Therapeutic Effects: I Relief of anxiety. I DOSAGE: PO: Adults: 0.25–0.5 mg 2–3 times daily. I ADMINISTRATION: May be administered with food if GI upset occurs. Tablets may be crushed. I ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness, drowsiness, lethargy, confusion, hangover, headache, mental depression, paradoxical excitation, blurred vision, constipation, diarrhea, nausea, vomiting, rashes, physical dependence, psychological dependence, and tolerance. I CONTRAINDICATIONS: Hypersensitivity, narrow-angle glaucoma, cross-sensitivity with other benzodiazepines, preexisting CNS depression, severe, uncontrolled pain, pregnancy and lactation. I CAUTIONS: Alcohol, antidepressants, other benzodiazepines, antihistamines, opioid analgesics, kava, valerian, skullcap, chamomile, or hops can increase CNS depression. • Advise patient to avoid the use of alcohol or other CNS depressants concurrently with alprazolam. • Instruct patient to consult health care professional before taking OTC medications concurrently with this medication. 18
  24. 24. 19 AMILORIDE (a-mill-oh-ride) Midamor diuretic (potassiumsparing diuretic) Pregnancy Category B I INDICATIONS: Counteract potassium loss caused by other diuretics; used with thiazides to treat edema or hypertension. Therapeutic Effects: I Weak diuretic and antihypertensive response when compared with other diuretics, conservation of potassium. I DOSAGE: PO: Adults: 5–10 mg/d (up to 20 mg). I ADMINISTRATION: PO: Administer in morning to avoid interrupting sleep pattern. Administer with food or milk to minimize gastric irritation and to increase bioavailability. I ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness, arrhythmias, constipation, GI irritation, impotence, hyperkalemia, hyponatremia, muscle cramps, allergic reactions. I CONTRAINDICATIONS: Hypersensitivity, hyperkalemia. I CAUTIONS: Additive hypotension with acute ingestion of alcohol, other antihypertensives, or nitrates. • Use with ACE inhibitors, indomethacin, potassium supplements, or cyclosporine increases risk of hyperkalemia. • Decreases lithium excretion. • Effectiveness may be decreased by NSAIDs. • May cause dizziness. • Caution patient to avoid driving or other activities requiring alertness until response to medication is known. Key: underline = most common; CAPS = life-threatening A–C
  25. 25. A–C AMIODARONE (a-mee-oh-da-rone) Cordarone, Pacerone antiarrhythmic Pregnancy Category D I INDICATIONS: Ventricular arrhythmias. Unlabeled Uses: Supraventricular tachyarrhythmias. Therapeutic Effects: I Suppression of arrhythmias. I DOSAGE: PO: Adults: Ventricular Arrhythmias–400–600 mg daily in 1–2 doses. Supraventricular Tachycardia–200–400 mg/d. Children: Ventricular Arrhythmias: 2–5 mg/kg/d. Supraventricular Tachycardia: 2.5 mg/kg/d. IV: Adults: 150 mg over 10 min, followed by 360 mg over the next 6 hours and then 540 mg over the next 18 h. Continue infusion at 0.5 mg/min until oral therapy is initiated. I ADMINISTRATION: PO: Administer with meals if GI intolerance occurs. IV: Administer via volumetric pump using an inline filter. I ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness, fatigue, malaise, corneal microdeposits, ADULT RESPIRATORY DISTRESS SYNDROME (ARDS), PULMONARY FIBROSIS, CHF , WORSENING OF ARRHYTHMIAS, bradycardia, hypotension, LIVER FUNCTION ABNORMALITIES, anorexia, constipation, nausea, vomiting, TOXIC EPIDERMAL NECROLYSIS, photosensitivity, hypothyroidism, ataxia, involuntary movement, paresthesia, peripheral neuropathy, poor coordination, tremor. I CONTRAINDICATIONS: Severe sinus node dysfunction, 2nd and 3rd AV block, bradycardia, pregnancy, and lactation. I CAUTIONS: Increases digoxin levels (decrease digoxin by 50%) and activity of warfarin (decrease warfarin by 33%–50%). • Increases blood levels and may lead to toxicity from quinidine, procainamide, mexiletine, lidocaine, flecainide, cyclosporine, dextromethorphan, methotrexate, phenytoin, and theophylline. • Increased risk of bradyarrhythmias, sinus arrest, or AV heart block with beta-blockers or calcium channel blockers. • Do not confuse amiodarone with amrinone, now called inamrinone. 20
  26. 26. 21 AMITRIPTYLINE (a-meh-trip-ti-leen) Elavil, Levate, Novotriptyn antidepressant (tricyclic) Pregnancy Category D I INDICATIONS: Depression, chronic pain syndromes (unlabeled use). Therapeutic Effects: I Improved mood. I DOSAGE: PO: Adults: 75 to 150 mg/d in divided doses, or 50–100 mg at bedtime; may increase up to 150 mg. Hospitalized patients dose may receive up to 300 mg/d. Geriatric Patients and Adolescents: 10 mg three times daily and 20 mg at bedtime. Up to 100 mg/d in a single bedtime dose or divided doses. IM: Adults: 20–30 mg 4 times daily. I ADMINISTRATION: PO: Administer with a meal to minimize gastric upset. Tablet may be crushed. IM: For short-term IM administration only. Do not administer IV. I ADVERSE REACTIONS AND SIDE EFFECTS: Lethargy, sedation, blurred vision, dry eyes, dry mouth, ARRHYTHMIAS, hypotension, ECG changes, constipation, hepatitis, paralytic ileus, urinary retention, blood dyscrasias, photosensitivity, changes in blood glucose, gynecomastia, increased appetite and weight gain. I CONTRAINDICATIONS: Narrow-angle glaucoma, pregnancy and lactation. I CAUTIONS: May cause hypotension, tachycardia, and potentially fatal reactions when used with MAO inhibitors (discontinue MAO inhibitor 2 weeks before starting amitriptyline). • May cause toxicity when used with SSRI antidepressants (discontinue fluoxetine 5 weeks before starting amitriptyline). • Concurrent use with clonidine may cause hypertensive crisis. • Concurrent use with moxifloxacin or sparfloxacin increases risk of adverse cardiovascular reactions. • Additive CNS depression with other CNS depressants including alcohol, antihistamines, clonidine, opioids, and sedative/hypnotics. • Phenothiazines or oral contraceptives increase levels and may cause toxicity. Key: underline = most common; CAPS = life-threatening A–C
  27. 27. A–C AMLODIPINE (am-loe-di-peen) Norvasc antihypertensive (calcium channel blocker) Pregnancy Category C I INDICATIONS: Management of hypertension, angina pectoris, and vasospastic (Prinzmetal) angina. Therapeutic Effects: I Systemic vasodilation and decreased blood pressure. Coronary vasodilation and decreased frequency and severity of angina. I DOSAGE: PO: Adults: 5–10 mg daily. I ADMINISTRATION: May be administered without regard to meals. I ADVERSE REACTIONS AND SIDE EFFECTS: Headache, dizziness, fatigue, peripheral edema, angina, bradycardia, hypotension, palpitations, gingival hyperplasia, nausea, flushing. I CONTRAINDICATIONS: Hypersensitivity to amlodipine or blood pressure Ͻ90 mm Hg. I CAUTIONS: Additive hypotension may occur when used concurrently with fentanyl, other antihypertensives, nitrates, acute ingestion of alcohol, or quinidine. • Blood levels and effects are increased by concurrent ingestion of grapefruit juice. • Do not confuse amlodipine with amiloride; do not confuse Norvasc with Navane. 22
  28. 28. 23 AMOXICILLIN/CLAVULANATE (a-mox-i-sill-in klav-yoolan-ate) Augmentin ES, Augmentin XR, Clavulin anti-infective Pregnancy Category B I INDICATIONS: Skin and skin structure infections, otitis media, sinusitis, respiratory tract infections, genitourinary tract infections, meningitis, septicemia. Therapeutic Effects: I Bactericidal action against susceptible bacteria. I DOSAGE: PO: Adults and Children Ͼ40 kg: Tablets: 250–500 mg tablet q 8–12 h. Suspension: 500 mg q 12 h. Children Ͻ2 yr: 20–40 mg/kg/d in divided doses q 8–12 h. Children Ͼ3 mo: 200 mg/5 mL or 400 mg/5 mL suspension: 12.5 mg/kg q 12 h or 6.6 mg/kg q 8 h (as 125 mg/5 mL or 250 mg/5 mL suspension). Children Ͻ3 mo: 15 mg/kg q 12 h (125 mg/mL suspension recommended). I ADMINISTRATION: Administer around the clock. May be given with meals to decrease GI side effects. Chewable tablets should be crushed or chewed. Shake oral suspension before administering. Do not administer 250 mg chewable tablets to children Ͻ40 kg due to clavulanate content. I ADVERSE REACTIONS AND SIDE EFFECTS: SEIZURES (high doses), PSEUDOMEMBRANOUS COLITIS, diarrhea, hepatic dysfunction, nausea, vomiting, rashes, urticaria, ANAPHYLAXIS and SERUM SICKNESS, superinfection. I CONTRAINDICATIONS: Hypersensitivity to penicillins or clavulanate. I CAUTIONS: May potentiate the effect of warfarin. • May decrease the effectiveness of hormonal contraceptives. • Instruct patient to notify health care professional immediately if diarrhea, abdominal cramping, fever, or bloody stools occur and not to treat with antidiarrheals without consulting health care professionals. Key: underline = most common; CAPS = life-threatening A–C
  29. 29. A–C AMOXICILLIN (uh-mox-i-sil-in) Amoxil, Novamoxin, Trimox anti-infective, anti-ulcer agent Pharm Class: Aminopenicillins Pregnancy Category B I INDICATIONS: Skin and skin structure infections, otitis media, sinusitis, respiratory infections, genitourinary infections, septicemia, endocarditis prophylaxis, ulcer disease due to Helicobacter pylori. Unlabeled use: Lyme disease. Therapeutic Effects: I Bactericidal action. I DOSAGE: PO: Adults and Children Ͼ20 kg: 250–500 mg q 8 h or 500–875 mg q 12 h. Children Ͼ3 mo: 20–40 mg/kg/d in divided doses q 8 hour or 25–45 mg/kg/d in divided doses q 12 h. Infants Ͻ3 mo: up to 30 mg/kg/d in divided doses q 12 h. I ADMINISTRATION: Administer around the clock. Administer without regard to meals or with meals to decrease GI side effects. Capsule contents may be emptied and swallowed with liquids. Suspension may be given straight or mixed in formula, milk, fruit juice, water, or ginger ale. Administer immediately after mixing. Discard refrigerated reconstituted suspension after 10 days. I ADVERSE REACTIONS AND SIDE EFFECTS: SEIZURES (in high doses), PSEUDOMEMBRANOUS COLITIS, diarrhea, nausea, vomiting, rashes, urticaria, blood dyscrasias, allergic reactions including ANAPHYLAXIS, SERUM SICKNESS, superinfection. I CONTRAINDICATIONS: Hypersensitivity to penicillins. I CAUTIONS: May potentiate the effect of warfarin. • May decrease the effectiveness of oral contraceptives. • Infectious mononucleosis (increased incidence of rash). • Observe for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). • Monitor bowel function for signs or symptoms of pseudomembranous colitis: diarrhea, abdominal cramping, fever, and bloody stools. 24
  30. 30. 25 ATENOLOL (a-ten-oh-lole) Apo-Atenolol, Novo-Atenolol, Tenormin antianginal, antihypertensive (selective beta-blocker) Pregnancy Category D I INDICATIONS: Hypertension, angina, reduce risk of second MI. Therapeutic Effects: I Lower blood pressure and heart rate, decreased frequency of angina. I DOSAGE: PO: Adults: 25–100 mg once daily. IV: Adults: Administer 5 mg over 5 min, followed by another 5mg 10 min later. I ADMINISTRATION: PO: Take apical pulse before administering drug. If Ͻ50 bpm or if arrhythmia occurs, withhold medication and notify physician or other health care professional. IV: Administer each dose over 5 minutes. I ADVERSE REACTIONS AND SIDE EFFECTS: Fatigue, weakness, anxiety, depression, dizziness, insomnia, memory loss, mental status changes, nervousness, nightmares, blurred vision, stuffy nose, bronchospasm, wheezing, BRADYCARDIA, CHF PULMONARY EDEMA, hypotension, peripheral vasocon, striction, constipation, diarrhea, liver function abnormalities, nausea, vomiting, impotence, decreased libido, urinary frequency. I CONTRAINDICATIONS: Uncompensated CHF pulmonary , edema, cardiogenic shock, bradycardia or heart block. I CAUTIONS: Additive bradycardia may occur with digoxin. • Additive hypotension may occur with other antihypertensives, acute ingestion of alcohol, or nitrates. • May alter the effectiveness of insulins or oral hypoglycemic agents (dosage adjustments may be necessary). • May decrease effectiveness of theophylline. • Monitor blood pressure, ECG, and pulse frequently during dosage adjustment period and periodically throughout therapy. Key: underline = most common; CAPS = life-threatening A–C
  31. 31. A–C ATORVASTATIN (a-tore-va-sta-tin) Lipitor lipid-lowering agent Pregnancy Category X I INDICATIONS: Primary hypercholesterolemia and mixed dyslipidemia. Therapeutic Effects: I Lowering of total and LDL cholesterol. I DOSAGE: PO: Adults: 10 mg once daily initially; may be increased q 2–4 wk up to 80 mg/d. I ADMINISTRATION: Administer with the evening meal. I ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness, headache, insomnia, weakness, rhinitis, bronchitis, abdominal cramps, constipation, diarrhea, flatus, heartburn, altered taste, drug-induced hepatitis, dyspepsia, elevated liver enzymes, nausea, pancreatitis, impotence, rashes, pruritus, RHABDOMYOLYSIS, arthralgia, arthritis, myalgia, myositis, hypersensitivity reactions. I CONTRAINDICATIONS: Hypersensitivity, active liver disease, pregnancy or lactation, concurrent use of gemfibrozil or azole antifungals. I CAUTIONS: Blood levels and the risk of myopathy are increased by concurrent cyclosporine and gemfibrozil, clofibrate, erythromycin, large doses of niacin and azole antifungal agents. • Grapefruit juice may cause higher blood levels and increased risk of toxicity. • Liver function tests, including AST, should be monitored before, at 6–12 wk after initiation of therapy or after dose elevation, and then every 6 mo. If AST levels increase to 3 times normal, HMG-COA reductase inhibitor therapy should be discontinued. • May cause elevated alkaline phosphatase and bilirubin levels. • If patient develops muscle tenderness during therapy, CPK levels should be monitored. If CPK levels are markedly increased or myopathy occurs, therapy should be discontinued. 26
  32. 32. 27 AZITHROMYCIN (aye-zith-row-my-sin) Zithromax agent for atypical mycobacterium, anti-infectives (macrolide) Pregnancy Category B I INDICATIONS: Upper and lower respiratory tract infections, bronchitis, pneumonia, skin and skin structure infections, nongonococcal urethritis, cervicitis, gonorrhea, and chancroid, prevention of disseminated Mycobacterium avium complex (MAC) infection in patients with advanced HIV infection. Prevention of bacterial endocarditis (unlabeled use). Therapeutic Effects: I Bacteriostatic action against susceptible bacteria. I DOSAGE: PO: Adults: 500 mg 1st day, then 250 mg/d for duration of therapy. May be given as 1 to 2 g single or weekly dose. Children 2–15 yr: 10–12 mg/kg (not Ͼ500 mg/dose) on 1st day, then 5 mg/kg (not Ͼ250 mg/dose.) IV: Adults: 500 mg IV q 24 h. I ADMINISTRATION: PO: Administer 1 hour before or 2 hours after meals. IV: Administer 1 mg/mL IV solution over 3 hours or 2 mg/mL solution over 1 hour. Do not administer as a bolus. I ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness, drowsiness, fatigue, headache, ANGIOEDEMA, chest pain, palpitations, PSEUDOMEMBRANOUS COLITIS, abdominal pain, diarrhea, nausea, cholestatic jaundice, dyspepsia, flatulence, melena, nephritis, vaginitis, photosensitivity, rashes. I CONTRAINDICATIONS: Hypersensitivity to azithromycin, erythromycin, or other macrolide anti-infectives. I CAUTIONS: Observe for signs and symptoms of anaphylaxis. • Monitor patient for signs and symptoms of pseudomembranous colitis: fever, diarrhea, and stool containing blood, pus, or mucus. • Kaolin, magnesium and aluminum antacids will decrease absorption of azithromycin. Separate dose times by at least 2 hours. • Do not confuse azithromycin with erythromycin. • Do not confuse Zithromax with Zinacef. Key: underline = most common; CAPS = life-threatening A–C
  33. 33. A–C BACLOFEN (bak-loe-fen) Lioresal antispasticity agent, skeletal muscle relaxant Pregnancy Category C I INDICATIONS: Reversible spasticity associated with multiple sclerosis or spinal cord lesions. Intrathecal: Severe spasticity originating in the spinal cord. Therapeutic Effects: I Decreased spasticity, improvement of bowel and bladder function. I DOSAGE: PO: Adults: 5 mg 3 times daily. May increase q 3 days by 5 mg/dose to maximum of up to 80 mg/d. Intrathecal: Adults: 100–800 ␮g/d infusion. Children: 25–1200 ␮g/d infusion (average 275 ␮g/d). I ADMINISTRATION: PO: Administer with milk or food. Intrathecal: Screening phase, dilute for a concentration of 50 ␮g/mL with NaCl for injection. Test dose should be administered over at least 1 minute. If response is inadequate, 2 additional test doses, each 24 hours apart, 75 ␮g/1.5 mL and 100 ␮g/2 mL respectively, may be administered. I ADVERSE REACTIONS AND SIDE EFFECTS: SEIZURES (intrathecal), dizziness, drowsiness, fatigue, weakness, confusion, insomnia, hypotension, nausea, pruritus, ataxia. I CONTRAINDICATIONS: Hypersensitivity. I CAUTIONS: Additive effect with other CNS depressants including alcohol, antihistamines, opioid analgesics, and sedative/hypnotics. • Use with MAO inhibitors may lead to increased CNS depression or hypotension. • Intrathecal: Monitor patient closely during test dose and titration; resuscitative equipment should be immediately available for lifethreatening or intolerable side effects. • Caution patient to avoid abrupt withdrawal of this medication because it may precipitate an acute withdrawal reaction (hallucinations, increased spasticity, seizures, mental changes, restlessness). • Discontinue gradually over 2 weeks or more. 28
  34. 34. 29 BECLOMETHASONE (beh-kloe-meth-a-sone) Beclodisk, Becloforte, Beclovent, Vanceril, antiasthmatic, anti-inflammatory (inhalation corticosteroid) Pregnancy Category C I INDICATIONS: Asthma. Therapeutic Effects: I Decrease frequency and severity of asthma attacks. I DOSAGE: Inhalation: Adults and Children Ͼ12 yr: 42 ␮g/inhalation: 2 inhalations 3–4 times daily or 4 inhalations twice daily. 84 ␮g/inhalation: 2 inhalations twice daily or 4 inhalations twice daily. Children 6–12 yr: 42 ␮g/inhalation: 1–2 inhalations 3–4 times (not to exceed 10 inhalations/day) or 4 inhalations twice daily. 84 ␮g/inhalation: 2 inhalations twice daily (not to exceed 5 inhalations/d). I ADMINISTRATION: Allow at least 1 minute between inhalations of aerosol medication. I ADVERSE REACTIONS AND SIDE EFFECTS: Dysphonia, hoarseness, oropharyngeal fungal infections, cataracts; bronchospasm, cough, wheezing, dry mouth, esophageal candidiasis, adrenal suppression, decreased growth (children), CHURG-STRAUSS SYNDROME. I CONTRAINDICATIONS: Acute attack of asthma/status asthmaticus. I CAUTIONS: Advise patients also using bronchodilator to use bronchodilator first and wait 5 minutes before taking beclomethasone. • Advise patient to use regular peak flow monitoring to determine respiratory status. • Advise patient to notify physician if sore throat or sore mouth occurs. • Instruct patient whose systemic corticosteroids have been recently reduced or withdrawn to carry a warning card indicating the need for supplemental systemic corticosteroids in the event of stress or severe asthma attack unresponsive to bronchodilators. • Caution patient to avoid smoking, known allergens, and other respiratory irritants. Key: underline = most common; CAPS = life-threatening A–C
  35. 35. A–C BENAZEPRIL (ben-aye-ze-pril) Lotensin antihypertensive (ACE inhibitors) Pregnancy Category C (first trimester), D (second and third trimesters) I INDICATIONS: Hypertension. Therapeutic Effects: I Lowering of blood pressure. I DOSAGE: PO: Adults: 5–10 mg once daily, increased gradually to maintenance dose of 20–40 mg/d as single dose or 2 divided doses (begin with 5 mg/d in patients receiving diuretics). I ADMINISTRATION: Precipitous drop in blood pressure during first 1–3 hours following first dose may occur, especially if also taking diuretics. Monitor blood pressure closely. I ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness, fatigue, headache, insomnia, cough, hypotension, angina pectoris, tachycardia, taste disturbances, anorexia, diarrhea, nausea, proteinuria, impotence, renal failure, hyperkalemia, AGRANULOCYTOSIS, ANGIOEDEMA. I CONTRAINDICATIONS: Hypersensitivity, pregnancy, angioedema (hereditary or idiopathic). I CAUTIONS: Additive hypotension with other antihypertensives, nitrates, phenothiazines, acute ingestion of alcohol, and during surgery or general anesthesia. • Hyperkalemia may result from concurrent use of potassium supplements, potassium-sparing diuretics, indomethacin, salt substitutes, or cyclosporine. • May increase the risk of lithium or digoxin toxicity. Instruct patient to notify health care professional if rash; mouth sores; sore throat; fever; swelling of hands or feet; irregular heart beat; chest pain; dry cough; hoarseness; swelling of face, eyes, lips, or tongue; difficulty swallowing or breathing occur. • Persistent dry cough may occur and may not subside until medication is discontinued. 30
  36. 36. 31 BENZTROPINE (benz-troe-peen) Apo-Benztropine, Cogentin antiparkinson agent, anticholinergic Pregnancy Category C I INDICATIONS: Parkinson’s disease, including drug-induced extrapyramidal effects and acute dystonic reactions. Therapeutic Effects: I Reduces rigidity and tremors. I DOSAGE: PO: Adults: Parkinsonism: 1–2 mg/d in 1–2 divided doses. Drug-induced extrapyramidal reactions: 1–4 mg given once or twice daily. IM: Adults: Acute dystonic reactions: 1–2 mg. I ADMINISTRATION: PO: Administer with food. May be crushed and administered with food if difficulty swallowing. I ADVERSE REACTIONS AND SIDE EFFECTS: Depression, hallucinations, blurred vision, dry eyes, mydriasis, arrhythmias, hypotension, palpitations, tachycardia, constipation, dry mouth, ileus, urinary retention, decreased sweating. I CONTRAINDICATIONS: Hypersensitivity, children Ͻ3 yr, narrow-angle glaucoma, tardive dyskinesia. I CAUTIONS: Additive anticholinergic effects with antihistamines, phenothiazines, quinidine, disopyramide, and tricyclic antidepressants. • Antacids and antidiarrheals may decrease absorption. • Teach patient signs of urinary retention and constipation/ileus. • Patients with mental illness are at risk of developing exaggerated symptoms of their disorder during early therapy. • Advise patient to avoid activities that require alertness until response to the drug is known. • Caution patient that this medication decreases perspiration. • Overheating may occur during hot weather; patient should notify health care professional if unable to remain indoors in an air-conditioned environment during hot weather. • IM: Monitor pulse and blood pressure closely and maintain bedrest for 1 hour after administration. Key: underline = most common; CAPS = life-threatening A–C
  37. 37. A–C BISOPROLOL (bis-oh-proe-lol) Zebeta antihypertensive (betablocker [selective]) Pregnancy Category C I INDICATIONS: Hypertension Therapeutic Effects: I Decreased blood pressure and heart rate. I DOSAGE: PO: Adults: 2.5–20 mg/d. I ADMINISTRATION: Administer without regard to meals. I ADVERSE REACTIONS AND SIDE EFFECTS: Fatigue, weakness, anxiety, depression, dizziness, drowsiness, insomnia, memory loss, mental status changes, nightmares, blurred vision, bronchospasm, wheezing, BRADYCARDIA, CHF , PULMONARY EDEMA, hypotension, liver function abnormalities, nausea, impotence, decreased libido, urinary frequency, rashes, hyperglycemia, hypoglycemia, arthralgia, back pain, joint pain, drug-induced lupus syndrome. I CONTRAINDICATIONS: Uncompensated CHF pulmonary , edema, cardiogenic shock, bradycardia or heart block. I CAUTIONS: May alter the effectiveness of insulins or oral hypoglycemic agents. • Additive bradycardia may occur with digoxin. • Additive hypotension may occur with other antihypertensives, acute ingestion of alcohol, or nitrates. • Monitor blood pressure, ECG, and pulse frequently during dosage adjustment period. • Take apical pulse before administering: If Ͻ50 or if arrhythmia occurs withhold medication and notify physician or other health care professional. 32
  38. 38. 33 BUDESONIDE (byoo-dess-oh-nide) Pulmicort antiinflammatory (inhalation corticosteroid) Pregnancy Category B I INDICATIONS: Asthma Therapeutic Effects: I Decrease frequency and severity of asthma attacks. I DOSAGE: Inhalation: Adults: 1–2 inhalations once or twice daily or 2–4 inhalations twice daily (maximum 8 inhalations daily). Children Ն6 yr: 1–2 inhalations twice daily (maximum 4 inhalations daily). Children 12 mo–8 yr: 0.25 to 1 mg/d as a single dose, or twice daily in divided doses. Individual titration is required. I ADMINISTRATION: Allow at least 1 minute between inhalations of aerosol medication. I ADVERSE REACTIONS AND SIDE EFFECTS: Dysphonia, hoarseness, oropharyngeal fungal infections, back pain, headache, dyspepsia, gastroenteritis, cataracts, bronchospasm, cough, wheezing, dry mouth, esophageal candidiasis, adrenal suppression, decreased growth (children), CHURG-STRAUSS SYNDROME. I CONTRAINDICATIONS: Acute attack of asthma/status asthmaticus. I CAUTIONS: Ketoconazole decreases metabolism and increases levels of budesonide • Advise patients also using bronchodilator to use bronchodilator first and wait 5 minutes before taking beclomethasone. • Advise patient to use regular peak flow monitoring to determine respiratory status. • Advise patient to notify physician if sore throat or sore mouth occurs. • Instruct patient whose systemic corticosteroids have been recently reduced or withdrawn to carry a warning card indicating the need for supplemental systemic corticosteroids in the event of stress or severe asthma attack unresponsive to bronchodilators. • Caution patient to avoid smoking, known allergens, and other respiratory irritants. A–C
  39. 39. A–C BUMETANIDE (byoo-met-a-nide) Bumex diuretic (loop diuretic) Pregnancy Category C I INDICATIONS: Edema secondary to CHF hepatic or renal , disease. Therapeutic Effects: I Diuresis and subsequent mobilization of excess fluid. I DOSAGE: PO: Adults: 0.5–2 mg/d as a single dose. Up to 2 additional doses may be given during the day q 4–5 h (up to 10 mg/d). Alternate-day or q 2–3 day regimens may also be used. IM, IV: Adults: 0.5–1 mg, may be repeated q 2–3 h as needed (up to 10 mg/d). I ADMINISTRATION: PO: Administer orally with food or milk to minimize gastric irritation. IV: Direct IV: Rate: Administer slowly over 2 minutes. Intermittent Infusion: Dilute in D5W, 0.9% NaCl, or LR, and administer through Y-tubing or 3-way stopcock. Rate: May be administered over 12 hours for patients with renal impairment. I ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness, headache, insomnia, nervousness, hearing loss, tinnitus, hypotension, constipation, dry mouth, hyperglycemia, dehydration, hypochloremia, hypokalemia, hypomagnesemia, hyponatremia, hypovolemia, metabolic alkalosis, hyperglycemia, arthralgia, muscle cramps, increased BUN. I CONTRAINDICATIONS: Hypersensitivity (cross-sensitivity with thiazides and sulfonamides may occur), pre-existing uncorrected electrolyte imbalance, hepatic coma, or anuria. I CAUTIONS: Additive hypotension with antihypertensives, nitrates. • Additive hypokalemia with other diuretics, mezlocillin, piperacillin, amphotericin B, stimulant laxatives, and corticosteroids. • Hypokalemia may increase digoxin toxicity. • Increased risk of ototoxicity with aminoglycoside. • May increase the effectiveness of warfarin, thrombolytic agents, or anticoagulants. 34
  40. 40. 35 BUPROPION (byoo-proe-pee-on) Wellbutrin, Wellbutrin SR, Zyban antidepressant, smoking deterrent Pregnancy Category B I INDICATIONS: Depression, smoking cessation (Zyban). Unlabeled Uses: ADHD (adults, SR only), diminished libido in women. Therapeutic Effects: I Improved mood, decreased craving for cigarettes. I DOSAGE: PO: Adults: Depression: 100 mg q 12 h; may be increased to 450 mg/d in divided doses (no single dose to exceed 150 mg). Smoking cessation (SR): 150 mg once daily for 3 days, then 150 mg q 12 h for 7–12 wk. I ADMINISTRATION: Administer doses in equally spaced time increments throughout day to minimize the risk of seizures. Sustained-release tablets should be swallowed whole; do not break, crush, or chew. Insomnia may be decreased by avoiding bedtime doses. May be administered with food to lessen GI irritation. I ADVERSE REACTIONS AND SIDE EFFECTS: SEIZURES, agitation, headache, insomnia, mania, psychoses, dry mouth, nausea, vomiting, weight gain, weight loss, photosensitivity, hyperglycemia, hypoglycemia, syndrome of inappropriate ADH secretion, tremor. I CONTRAINDICATIONS: Hypersensitivity, history of seizures, bulimia, and anorexia nervosa, concurrent MAO inhibitor therapy. I CAUTIONS: Increased risk of adverse reactions when used with levodopa or MAO inhibitors. Increased risk of seizures with phenothiazine, antidepressants, theophylline, corticosteroids, OTC stimulants/anorectics, or cessation of alcohol or benzodiazepines. • Bupropion may impair judgment or motor and cognitive skills; caution patient to avoid driving and other activities requiring alertness until response to medication is known. Key: underline = most common; CAPS = life-threatening A–C
  41. 41. A–C CAPTOPRIL (kap-toe-pril) Capoten angiotensin-converting enzyme (ACE) inhibitor Pregnancy Category C (first trimester), D (second and third trimesters) I INDICATIONS: Hypertension, CHF diabetic nephropathy. , Therapeutic Effects: I Lowered blood pressure, improvement in symptoms of CHF . I DOSAGE: PO: Adults: 12.5–25 mg 2–3 times daily, may be increased at 1–2 wk intervals up to 150 mg 3 times daily. I ADMINISTRATION: Administer 1 hour before or 2 hours after meals. I ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness, fatigue, headache, insomnia, weakness, cough, hypotension, angina pectoris, tachycardia, taste disturbances, anorexia, diarrhea, nausea, proteinuria, impotence, renal failure, rashes, hyperkalemia, AGRANULOCYTOSIS, NEUTROPENIA, ANGIOEDEMA, fever. I CONTRAINDICATIONS: Hypersensitivity, cross-sensitivity among ACE inhibitors may occur, pregnancy, angioedema (hereditary or idiopathic). I CAUTIONS: Instruct patient to notify health care professional if rash; mouth sores; sore throat; fever; swelling of hands or feet; irregular heart beat; chest pain; dry cough; hoarseness; swelling of face, eyes, lips, or tongue; difficulty swallowing or breathing occur. • Additive hypotension with other antihypertensives, nitrates, phenothiazines, acute ingestion of alcohol, and during surgery or general anesthesia. • Hyperkalemia may result from concurrent use of potassium supplements, potassium-sparing diuretics, indomethacin, salt substitutes, or cyclosporine. • May increase the risk of lithium or digoxin toxicity. • Persistent dry cough may occur and may not subside until medication is discontinued. 36
  42. 42. 37 CARISOPRODOL (kar-i-sop-roe-dole) Soma, Vanadom skeletal muscle relaxant Pregnancy Category UK I INDICATIONS: Adjunct to rest and physical therapy in the treatment of muscle spasm associated with acute painful musculoskeletal conditions. Therapeutic Effects: I Skeletal muscle relaxation. I DOSAGE: PO: Adults: 350 mg 4 times daily. Children 5–12 yr: 6.25 mg/kg 4 times daily. I ADMINISTRATION: Administer with food to minimize GI irritation. Provide safety measures; supervise ambulation and transfer of patients. I ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness, drowsiness, agitation, ataxia, depression, insomnia, syncope, asthma attacks, hypotension, tachycardia, epigastric distress, hiccups, nausea, vomiting, flushing, rashes, ANAPHYLACTIC SHOCK, fever, psychological dependence, severe idiosyncratic reaction. I CONTRAINDICATIONS: Hypersensitivity to carisoprodol or to meprobamate; porphyria or suspected porphyria. I CAUTIONS: Instruct patient to notify health care professional if signs of allergy (rash, hives, swelling of tongue or lips, dyspnea) or idiosyncratic reaction occur. • Can cause additive CNS depression with other CNS depressants including alcohol, antihistamines, opioid analgesics, and sedative/hypnotics. • Concomitant use of kava, valerian, or chamomile can increase CNS depression. • Observe for idiosyncratic symptoms that may appear within minutes or hours of administration of first dose: extreme weakness, quadriplegia, dizziness, ataxia, dysarthria, visual disturbances, agitation, euphoria, confusion, and disorientation; symptoms usually subside over several hours. • Advise patient to avoid driving or other activities requiring alertness. Instruct patient to change positions slowly to minimize orthostatic hypotension. Key: underline = most common; CAPS = life-threatening A–C
  43. 43. A–C CARVEDILOL (kar-ve-dil-ole) Coreg antihypertensive (betablocker) Pregnancy Category C I INDICATIONS: Hypertension, CHF . Therapeutic Effects: I Decreases heart rate and blood pressure, slows the progression of CHF . I DOSAGE: PO: Adults: Hypertension: 6.25 mg twice daily, up to 25 mg twice daily; CHF: 3.125 mg twice daily; may be increased to 6.25 mg twice daily. Dose may be doubled (not to exceed 25 mg twice daily in patients Ͻ85 kg or 50 mg twice daily in patients Ͼ85 kg). I ADMINISTRATION: Administer without regard to food. I ADVERSE REACTIONS AND SIDE EFFECTS: Weakness, anxiety, depression, insomnia, blurred vision, bronchospasm, wheezing. BRADYCARDIA, CHF PULMONARY EDEMA, diar, rhea, impotence, hyperglycemia, hypoglycemia. I CONTRAINDICATIONS: Uncompensated CHF pulmonary , edema, cardiogenic shock, bradycardia or heart block, hepatic impairment or bronchial asthma/bronchospasm. I CAUTIONS: Teach patient to check pulse daily and blood pressure biweekly and to report pulse Ͻ50 bpm or significant change in blood pressure. • Abrupt withdrawal may precipitate life-threatening arrhythmias, hypertension, or myocardial ischemia. • General anesthetics, IV phenytoin, diltiazem, and verapamil may cause additive myocardial depression. • Additive bradycardia may occur with digoxin. • Additive hypotension may occur with other antihypertensives, or nitrates. • Concurrent use with clonidine increases hypotension and bradycardia. • May alter the effectiveness of insulins or oral hypoglycemic agents. • Use cautiously within 14 days of MAO inhibitor therapy (may result in hypertension). • Withhold medication if pulse is Ͻ50 bpm or if arrhythmia occurs. Key: underline = most common; CAPS = life-threatening 38
  44. 44. 39 CEFEPIME (seff-e-peem) Maxipime anti-infective third generation cephalosporin Pregnancy Category B I INDICATIONS: Skin, bone, joint, urinary, gynecologic, respiratory tract, and intra-abdominal infections; septicemia. Therapeutic Effects: I Bactericidal action against susceptible bacteria. I DOSAGE: IM, IV: Adults: 0.5–1 g q 12 h. Children 2 mo–12 yr and up to 40 kg: 50 mg/kg 12 h. I ADMINISTRATION: IV: Monitor injection site frequently for phlebitis. Rate: Administer over 30 minutes. I ADVERSE REACTIONS AND SIDE EFFECTS: SEIZURES (high doses), PSEUDOMEMBRANOUS COLITIS, diarrhea, nausea, vomiting, rashes, urticaria, bleeding, phlebitis at IV site, allergic reactions including ANAPHYLAXIS and SERUM SICKNESS, superinfection. I CONTRAINDICATIONS: Hypersensitivity to cephalosporins or penicillins. I CAUTIONS: Report fever and diarrhea, especially if stool contains blood, pus, or mucus. • Advise patient not to treat diarrhea without consulting health care professional. • Observe patient for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). • Discontinue drug and report signs and symptoms immediately. • Concurrent use of large doses of cephalosporins and nonsteroidal anti-inflammatory agents (NSAIDs) may increase risk of bleeding. • Concurrent use of loop diuretics or nephrotoxic agents including aminoglycoside may increase the risk of nephrotoxicity. • Determine previous use of and reactions to penicillins or cephalosporins. • Persons with a negative history of penicillin sensitivity may still have an allergic response. • Obtain specimens for culture and sensitivity before initiating therapy. Key: underline = most common; CAPS = life-threatening A–C
  45. 45. A–C CELECOXIB (sel-e-kox-ib) Celebrex antirheumatic, nonsteroidal anti-inflammatory (COX-2 inhibitor) Pregnancy Category C I INDICATIONS: Osteoarthritis, rheumatoid arthritis, familial adenomatous polyposis (FAP). Therapeutic Effects: I Decreased arthritic pain and inflammation, decreased number of colorectal polyps. I DOSAGE: PO: Adults: Osteoarthritis: 200 mg/d as a single dose or 100 mg twice daily. Rheumatoid arthritis: 100–200 mg twice daily. Familial adenomatous polyosis: 400 mg twice daily. I ADMINISTRATION: May be administered without regard to meals. I ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness, headache, insomnia, GI BLEEDING, abdominal pain, diarrhea, dyspepsia, flatulence, nausea, rash. I CONTRAINDICATIONS: Hypersensitivity, allergic reactions to sulfonamides, asthma, urticaria, or allergic reactions to aspirin or other NSAIDs, advanced renal disease, late pregnancy (may cause premature closure of ductus arteriosus). I CAUTIONS: Do not confuse with Celexa (citalopram) or Cerebyx (fosphenytoin). • Advise patient to notify health care professional promptly if signs or symptoms of GI toxicity (abdominal pain, black stools), skin rash, unexplained weight gain, or edema occur. • May decrease effectiveness of ACE inhibitors, thiazide diuretics, and furosemide. • Use with aspirin may increase risk of GI bleeding. • Use with warfarin may increase risk of bleeding. 40
  46. 46. 41 CEPHALEXIN (sef-a-lex-in) Apo-Cephalex, Biocef, Keflex, NovoLexin anti-infective (first-generation cephalosporin) Pregnancy Category B I INDICATIONS: Skin and skin structure infections, pneumonia, otitis media, urinary tract infections, bone and joint infections, septicemia caused by susceptible organisms. Therapeutic Effects: I Bactericidal action against susceptible bacteria. I DOSAGE: PO: Adults: 250–500 mg q 6 h. Cystitis, skin and soft tissue infections, streptococcal pharyngitis: 500 mg q 12 h. Children: 6.25–25 mg/kg q 6 h. Skin and soft-tissue infections, streptococcal pharyngitis: 12.5–50 mg/kg q 12 h. I ADMINISTRATION: Administer around the clock on full or empty stomach. Administer with food to minimize GI irritation. Shake oral suspension well before administering. I ADVERSE REACTIONS AND SIDE EFFECTS: SEIZURES, PSEUDOMEMBRANOUS COLITIS, diarrhea, nausea, vomiting, cramps, rashes, urticaria, blood dyscrasias, hemolytic anemia, ANAPHYLAXIS and serum sickness, superinfection. I CONTRAINDICATIONS: Hypersensitivity to cephalosporins, serious hypersensitivity to penicillins. I CAUTIONS: Instruct patient to notify health care professional if fever and diarrhea develop, especially if diarrhea contains blood, mucus, or pus. Advise patient not to treat diarrhea without consulting health care professional. • Concurrent use of loop diuretics may increase the risk of renal toxicity. • Observe for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). Discontinue drug and notify physician or other health care professional immediately. • Keep epinephrine and resuscitation equipment close by in case of an anaphylactic reaction. Key: underline = most common; CAPS = life-threatening A–C
  47. 47. A–C CETIRIZINE (se-ti-ra-zeen) Zyrtec allergy, cold and cough remedy, antihistamine Pregnancy Category B I INDICATIONS: Relief of allergic symptoms including seasonal and perennial allergic rhinitis, chronic urticaria. Therapeutic Effects: I Decreased symptoms of histamine excess (sneezing, rhinorrhea, nasal and ocular pruritus, ocular tearing and redness). I DOSAGE: PO: Adults and children Ͼ6 yr: 5–10 mg once daily. Children 6–11 yr: 5–10 mg daily. Children 2–5 yr: 2.5–5 mg daily. I ADMINISTRATION: Administer once daily without regard to food. I ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness, drowsiness, fatigue, pharyngitis, dry mouth. I CONTRAINDICATIONS: Hypersensitivity, acute attacks of asthma, lactation. I CAUTIONS: May cause dizziness and drowsiness; caution patient to avoid driving or other activities requiring alertness until response to medication is known. • Advise patient to avoid taking alcohol or other CNS depressants concurrently with this drug. 42
  48. 48. 43 CHLOROTHIAZIDE (klor-oh-thye-a-zide) Diuril antihypertensive (thiazide diuretic) Pregnancy Category B I INDICATIONS: Mild to moderate hypertension, edema. Therapeutic Effects: I Lower blood pressure in hypertensive patients, diuresis with mobilization of edema. I DOSAGE: PO: Adults: 250 mg–1 g/d as a single dose or in divided doses. Children Ն6 mo: 10–20 mg/kg/d as a single dose or in 2 divided doses. IV: Adults: Diuretic: 250 mg q 6–12 h. Antihypertensive: 500 mg–1 g/d as a single dose or 2 divided doses. I ADMINISTRATION: Administer in the morning to prevent disruption of sleep cycle. I ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness, drowsiness, lethargy, weakness, hypotension, anorexia, cramping, hepatitis, nausea, vomiting, photosensitivity, rashes, hyperglycemia, hypokalemia, dehydration, hypercalcemia, hypochloremic alkalosis, hypomagnesemia, hyponatremia, hypophosphatemia, hypovolemia, blood dyscrasias, hyperuricemia, elevated lipids, muscle cramps, pancreatitis. I CONTRAINDICATIONS: Hypersensitivity, anuria, lactation. I CAUTIONS: Additive hypotension with other antihypertensives, acute ingestion of alcohol, or nitrates. • Additive hypokalemia with corticosteroids, amphotericin B, mezlocillin, piperacillin, or ticarcillin. • Hypokalemia increases risk of digoxin toxicity. • Decreases lithium excretion. • Cholestyramine or colestipol decrease absorption. • Assess patient, especially if taking digitalis glycosides, for anorexia, nausea, vomiting, muscle cramps, paresthesia, and confusion; notify health care professional if these signs of electrolyte imbalance occur. • Instruct patient to monitor weight biweekly and report weight gain or loss in excess of 2 pounds. • Caution patient to change positions slowly to minimize orthostatic hypotension. Key: underline = most common; CAPS = life-threatening A–C
  49. 49. A–C CIMETIDINE (sye-meh-tih-deen) Novocimetine, Peptol, Tagamet anti-ulcer agent (histamine h2 antagonist) Pregnancy Category B I INDICATIONS: Duodenal, benign and stress-induced gastric ulcers, GERD, heartburn, acid indigestion, Zollinger-Ellison syndrome. Therapeutic Effects: I Healing and prevention of ulcers, decreased gastroesophageal reflux, decreased secretion of gastric acid. I DOSAGE: PO: Adults: Ulcer treatment or prevention: 600–1200 mg/d in divided doses or 400–800 mg at bedtime. GERD: 800–1600 mg/d in divided doses. Zollinger-Ellison syndrome: 300–600 mg q 6 h (up to 2400 mg/d). Children: Active ulcers: 20–40 mg/kg/d in 4 divided doses. IM, IV: Adults: Active ulcers: 300 mg q 6 h. Continuous IV infusion: 900 mg infused over 24 h (37.5 mg/h). Prevention of upper GI bleeding in critically ill patients: 50 mg/h. Children: Short-term treatment of active ulcers: 5–10 mg/kg q 6–8 h. I ADMINISTRATION: PO: Administer with meals and at bedtime. Direct IV: Rate: Dilute and administer over at least 5 min to prevent hypotension and arrhythmias. Intermittent Infusion: Rate: Dilute and administer over 15–20 min. I ADVERSE REACTIONS AND SIDE EFFECTS: Confusion, dizziness, drowsiness, hallucinations, ARRHYTHMIAS, druginduced hepatitis, nausea, AGRANULOCYTOSIS, APLASTIC ANEMIA. I CONTRAINDICATIONS: Hypersensitivity. I CAUTIONS: May increase blood levels of chlordiazepoxide, diazepam, and midazolam, labetalol, metoprolol, propranolol, caffeine, calcium channel blockers, carbamazepine, chloroquine, lidocaine, metronidazole, moricizine, pentoxifylline, phenytoin, propafenone, quinidine, quinine, metformin, sulfonylureas, tacrine theophylline, triamterene, tricyclic antidepressants, valproic acid, and warfarin. 44
  50. 50. 45 CIPROFLOXACIN (sip-roe-flox-a-sin) Cipro anti-infective (fluoroquinolone) Pregnancy Category C I INDICATIONS: Urinary tract and gynecologic infections, gonorrhea, prostatitis, respiratory tract infections, skin and skin structure infections, bone and joint infections, infectious diarrhea, intra-abdominal infections, febrile neutropenia, postexposure treatment of inhalational anthrax. Therapeutic Effects: I Resolution of infection. I DOSAGE: PO: Adults: 250–750 mg q 12 h. Gonorrhea 250 mg single dose. IV: Adults: 200–400 mg q 12 h. I ADMINISTRATION: PO: Do not give within 2 hours of administration of antacids, iron, zinc, or sucralfate. IV: Rate: Administer over 60 min into a large vein to minimize venous irritation. I ADVERSE REACTIONS AND SIDE EFFECTS: SEIZURES, dizziness, drowsiness, headache, acute psychoses, light-headedness, tremors, PSEUDOMEMBRANOUS COLITIS, abdominal pain, diarrhea, nausea, photosensitivity, hyperglycemia, hypoglycemia, phlebitis at IV site, tendinitis, tendon rupture, hypersensitivity reactions including ANAPHYLAXIS, STEVENS-JOHNSON SYNDROME. I CONTRAINDICATIONS: Hypersensitivity, pregnancy, or children Ͻ18 yr. I CAUTIONS: Instruct patient to notify health care professional if fever and diarrhea develop, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care professional. • Instruct patient to notify health care professional immediately if rash, tendon pain, or inflammation occurs. • May increase the effects of warfarin. Increases serum theophylline levels and may lead to toxicity. • Concurrent use with foscarnet may increase risk of seizures. • Concurrent use with corticosteroids may increase risk of tendon rupture. Key: underline = most common; CAPS = life-threatening A–C
  51. 51. A–C CITALOPRAM (si-tal-oh-pram) Celexa antidepressant (selective serotonin reuptake inhibitor) Pregnancy Category C I INDICATIONS: Depression Therapeutic Effects: I Improved mood. I DOSAGE: PO: Adults: 20–60 mg/d. Geriatric Patients: 20 mg/d, up to 40 mg/d only in nonresponding patients. I ADMINISTRATION: Administer as a single dose in the morning or evening without regard to food. I ADVERSE REACTIONS AND SIDE EFFECTS: Apathy, confusion, drowsiness, insomnia, weakness, tremor, agitation, amnesia, anxiety, decreased libido, dizziness, fatigue, impaired concentration, increased depression, migraine headache, suicide attempt, cough, postural hypotension, tachycardia, abdominal pain, anorexia, diarrhea, dry mouth, dyspepsia, flatulence, increased saliva, nausea, increased appetite, vomiting, amenorrhea, ejaculatory delay, impotence, polyuria, increased sweating, photosensitivity, pruritus, rash, arthralgia, myalgia, paresthesia, fever, yawning. I CONTRAINDICATIONS: Hypersensitivity, concurrent MAO inhibitor therapy. I CAUTIONS: Do not confuse with Celebrex (celecoxib) or Cerebyx (fosphenytoin). • May cause serious, potentially fatal reactions when used with MAO inhibitors; allow at least 14 days between citalopram and MAO inhibitors. • Serotonergic effects may be potentiated by lithium (concurrent use should be carefully monitored). • Concurrent use with 5-HT1 agonists used for migraine headaches may increase the risk of adverse reactions (weakness, hyperreflexia, incoordination). • Increased risk of serotonergic side effects including serotonin syndrome with St. John’s wort and SAMe. 46
  52. 52. 47 CLINDAMYCIN (klin-da-mye-sin) Cleocin, Dalacin C, antiinfective Pregnancy Category B I INDICATIONS: Skin, skin structure, respiratory tract, intraabdominal and gynecologic infections, septicemia, osteomyelitis, endocarditis prophylaxis, severe acne. Therapeutic Effects: I Bactericidal or bacteriostatic to susceptible organisms. I DOSAGE: PO: Adults: Most infections: 150–300 mg q 6 h. P carinii pneumonia: 1200–1800 mg/d in divided doses with . 15–30 mg primaquine/day. CNS toxoplasmosis: 1200–2400 mg/d in divided doses with pyrimethamine 50–100 mg/d. Children Ͼ1 mo: 2–5 mg/kg q 6 h or 2.7–6.7 mg/kg q 8 h. IM, IV: Adults: Most infections: 300–600 mg q 6–8 h or 900 mg q 8 h. P carinii pneumonia: 2400–2700 mg/d in divided doses . with primaquine. Toxoplasmosis: 1200–4800 mg/d in divided doses with pyrimethamine. Children Ͼ1 mo: 3.75–10 mg/kg q 6 h or 5–13.3 mg/kg q 8 h. Infants Ͻ1 mo: 3.75–5 mg/kg q 6 h or 5–6.7 mg/kg q 8 h. I ADMINISTRATION: PO: Administer with glass of water; may be given with meals. IM: Do not administer Ͼ600 mg in a single IM injection. Intermittent Infusion: Rate: Administer each 300 mg over a minimum of 10 min. I ADVERSE REACTIONS AND SIDE EFFECTS: Arrhythmias, hypotension, PSEUDOMEMBRANOUS COLITIS, diarrhea, bitter taste (IV only). I CONTRAINDICATIONS: Hypersensitivity, history of pseudomembranous colitis, severe liver impairment, diarrhea. I CAUTIONS: Monitor GI status, diarrhea, abdominal cramping, fever, and bloody stools may be a sign of pseudomembranous colitis and should be reported immediately. • Pseudomembranous colitis may begin up to several weeks following the cessation of therapy. • Instruct patient to finish the drug completely as directed, even if feeling better. Key: underline = most common; CAPS = life-threatening A–C
  53. 53. A–C CLONAZEPAM (kloe-na-ze-pam) Klonopin, Rivotril, SynClonazepam anticonvulsant (benzodiazepine) Schedule IV Pregnancy Category C I INDICATIONS: Seizures, panic disorder. Unlabeled Uses: Uncontrolled leg movements during sleep, neuralgias, sedation. Therapeutic Effects: I Prevention of seizures, decreased frequency of panic attacks. I DOSAGE: PO: Adults: 1.5 mg 3 times daily, not to exceed 20 mg/d. Panic disorder: 0.125 mg twice daily. Children Ͻ10 yr or 30 kg: Initial daily dose 0.01–0.03 mg/kg/d (not to exceed 0.05 mg/kg/d) given in 2–3 equally divided doses; increase by no more than 0.25–0.5 mg q 3rd day (not to exceed 0.2 mg/kg/d). I ADMINISTRATION: Administer with food to minimize gastric irritation. I ADVERSE REACTIONS AND SIDE EFFECTS: Behavioral changes, drowsiness, diplopia, nystagmus, increased secretions, palpitations, hepatitis, dysuria, nocturia, urinary retention, anemia, ataxia, hypotonia, fever, physical dependence, psychological dependence. I CONTRAINDICATIONS: Hypersensitivity to clonazepam or other benzodiazepines, severe liver disease. I CAUTIONS: Additive CNS depression with alcohol, antidepressants, antihistamines, other benzodiazepines, opioid analgesics, kava, valerian, skullcap, chamomile, or hops. • Cimetidine, hormonal contraceptives, disulfiram, fluoxetine, isoniazid, ketoconazole, metoprolol, propoxyphene, propranolol, or valproic acid may decrease the metabolism of clonazepam, enhancing its actions. • May increase serum phenytoin levels. • Phenytoin may decrease serum clonazepam levels. Instruct patient to notify health care professional of unusual tiredness, bleeding, sore throat, fever, clay-colored stools, yellowing of skin, or behavioral changes. • Do not discontinue abruptly. 48
  54. 54. 49 CLONIDINE (klon-i-deen) Catapres, Catapres-TTS, Duraclon antihypertensive Pregnancy Category C I INDICATIONS: Mild to moderate hypertension, management of cancer pain unresponsive to opioids alone, opioid withdrawal (unlabeled use). Therapeutic Effects: I Decreased blood pressure, decreased pain. I DOSAGE: PO: Adults: 200–600 ␮g (0.2–0.6 mg)/d in 2–3 divided doses (up to 2.4 mg/d). Opioid withdrawal: 300 ␮g (0.3 mg) –1.2 mg/d. Geriatric Patients: 100 ␮g (0.1 mg) at bedtime initially, increased as needed. Children: 50–400 ␮g (0.05–0.4 mg) twice daily. Transdermal: Adults: Hypertension: 100–300 ␮g (0.1–0.3 mg)/24 h every 7 days. Epidural: Adults: 30 ␮g/h. Children: 0.5 ␮g/kg/h. I ADMINISTRATION: PO: Administer last oral dose of the day at bedtime. Transdermal: Absorption of transdermal system is greater when placed on chest or upper arm than when placed on thigh. I ADVERSE REACTIONS AND SIDE EFFECTS: Drowsiness, depression, dizziness, nervousness, nightmares, bradycardia, hypotension, palpitations, dry mouth, constipation, nausea, vomiting, impotence, rash, sweating, sodium retention, weight gain, withdrawal phenomenon. I CONTRAINDICATIONS: Hypersensitivity. Epidural: anticoagulant therapy, or bleeding problems. I CAUTIONS: Additive hypotension with other antihypertensives and nitrates. • Additive bradycardia with myocardial depressants. • Decreased antihypertensive effect with MAO inhibitors, amphetamines, beta-blockers, prazosin, or tricyclic antidepressants. • Withdrawal phenomenon may be increased by discontinuation of beta-blockers. • Increased risk of adverse cardiovascular reactions with verapamil. • All routes of clonidine should be discontinued gradually over 2–4 days to prevent rebound hypertension. Key: underline = most common; CAPS = life-threatening A–C
  55. 55. A–C CLOPIDOGREL (kloh-pid-oh-grel) Plavix antiplatelet agent (platelet aggregation inhibitor) Pregnancy Category B I INDICATIONS: Reduction of atherosclerotic events (MI, stroke, vascular death) in patients at risk for such events (recent MI, stroke, or peripheral vascular disease). Therapeutic Effects: I Decreased occurrence of atherosclerotic events in patients at risk. I DOSAGE: PO: Adults: 75 mg once daily. I ADMINISTRATION: Administer once daily without regard to food. I ADVERSE REACTIONS AND SIDE EFFECTS: Depression, dizziness, fatigue, headache, epistaxis, cough, dyspnea, chest pain, edema, hypertension, GI BLEEDING, abdominal pain, diarrhea, dyspepsia, gastritis, pruritus, purpura, rash, BLEEDING, NEUTROPENIA, THROMBOTIC THROMBOCYTOPENIC PURPURA, hypercholesterolemia, arthralgia, back pain, Hypersensitivity reactions including ANGIOEDEMA, ANAPHYLACTOID REACTIONS, BRONCHOSPASM. I CONTRAINDICATIONS: Hypersensitivity, pathologic bleeding (peptic ulcer, intracranial hemorrhage), lactation. I CAUTIONS: Monitor patient for signs of thrombotic thrombocytic purpura (thrombocytopenia, microangiopathic hemolytic anemia, neurologic findings, renal dysfunction, fever). • Advise patient to notify health care professional promptly if fever, chills, sore throat, or unusual bleeding or bruising occurs. • Concurrent abciximab, eptifibatide, tirofiban, aspirin, NSAIDs, heparin, heparinoids, thrombolytic agents, ticlopidine, or warfarin may increase the risk of bleeding. • May inhibit the metabolism and increase the effects of phenytoin, tolbutamide, tamoxifen, torsemide, fluvastatin, and many NSAIDs. 50
  56. 56. 51 COLCHICINE (kol-chi-seen) anti-gout agent Pregnancy Category D I INDICATIONS: Gouty arthritis. Therapeutic Effects: I Decreased pain and inflammation in acute attacks of gout, prevention of attacks. I DOSAGE: PO: Adults: 0.5–1.2 mg, then 0.5–0.6 mg q 1–2 h until a total cumulative dose of 4 mg is achieved. See following dosage cautions. IV: Adults: 1–2 mg initially, then 0.5 mg q 6 h or 1 mg q 6–12 h until a total cumulative dose of 4 mg is achieved. See following dosage cautions. I ADMINISTRATION: PO: Administer with food. IV: Avoid extravasation; may cause necrosis. I ADVERSE REACTIONS AND SIDE EFFECTS: Diarrhea, nausea, vomiting, abdominal pain, anuria, hematuria, alopecia, AGRANULOCYTOSIS, APLASTIC ANEMIA, leukopenia, thrombocytopenia. I CONTRAINDICATIONS: Hypersensitivity, pregnancy, severe renal, hepatic or biliary disease. I CAUTIONS: HIGH ALERT MED: Therapeutic range is narrow. Overdose can be fatal. Cumulative dose by any route should not exceed 4 mg. Once dosing limit has been reached, (4 mg) no more colchicine by any route should be given for at least 7 days. Limit IV doses to a maximum of 1-2 mg in patients who have recently received oral colchicine. Assess patient for toxicity (weakness, abdominal discomfort, nausea, vomiting, diarrhea, delirium, seizures, sense of suffocation, dilated pupils, difficulty swallowing, ascending paralysis, oliguria), withhold drug and report symptoms immediately. • Cumulative dose should not exceed 2 mg in geriatric and renal patients. After dosing limit has been reached, do not give any additional colchicine by any route for 21 days. Decrease dose by 50% for patients with renal impairment. • Encourage fluids to promote urinary output of at least 2000 mL/d. Instruct patient not to increase doses during an acute attack. A–C
  57. 57. A–C CORTISONE (kor-ti-sone) Cortone, Cortone Acetate, steroidal anti-inflammatory (systemic corticosteroid) Pregnancy Category UK I INDICATIONS: Short-acting corticosteroid used to treat adrenocortical insufficiency, and allergic and inflammatory disorders. Therapeutic Effects: I Suppression of inflammation; modification of the normal immune response; replacement of deficient adrenal corticoids. I DOSAGE: PO: Adults: 25–300 mg/d as a single dose or in divided doses. Children: Adrenocortical insufficiency—0.7 mg/kg (20–25 mg/m2)/d in divided doses. Other uses–2.5–10 mg/kg (75–300 mg/m2)/d as a single dose or in divided doses. IM: Adults: 20–300 mg/d. Children: Adrenocortical insufficiency: 0.7 mg/kg (37.5 mg/m2) q 3 days or 0.23–0.35 mg/kg (12.5 mg/m2)/d. Other uses–0.83–5 mg/kg (25–150 mg/m2) q 12–24 h. I ADMINISTRATION: PO: Administer with meals to minimize GI irritation. I ADVERSE REACTIONS AND SIDE EFFECTS: Depression, euphoria, psychoses, restlessness, cataracts, hypertension, PEPTIC ULCERATION, anorexia, nausea, acne, decreased wound healing, ecchymoses, fragility, hirsutism, petechiae, adrenal suppression, hyperglycemia, hypokalemia, THROMBOEMBOLISM, thrombophlebitis, weight gain, weight loss, muscle wasting, osteoporosis, cushingoid appearance, increased susceptibility to infection. I CONTRAINDICATIONS: Active untreated infections, lactation. I CAUTIONS: Instruct patient to promptly report severe abdominal pain or tarry stools occur. • May increase requirement for insulin or oral hypoglycemic agents. • Increased risk of adverse GI effects with NSAIDs. • Advise patient to carry identification describing medication regimen. • Instruct patient to report swelling, weight gain, tiredness, bone pain, bruising, nonhealing sores, or visual changes. 52
  58. 58. 53 DALTEPARIN (dal-te-pa-rin) Fragmin anticoagulant (low molecular weight heparin [LMWH]) (antithrombotic) Pregnancy Category B I INDICATIONS: Prevention of deep vein thrombosis, pulmonary emboli, ischemic complications in patients with unstable angina/non–Q-wave MI. LMWH has a more predictable anticoagulant response—special monitoring of clotting times is not necessary. Therapeutic Effects: I Prevention of thrombus formation. I DOSAGE: SC: Adults: Presurgical prophylaxis of DVT: 2500 IU 1–2 h before surgery, then 2500–5000 IU once daily; angina/non–Q-wave MI: 120 IU/kg every 12 h. I ADMINISTRATION: SC: Administer deep into SC tissue. Do not aspirate or massage. Rotate sites frequently. I ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness, insomnia, edema, urinary retention, ecchymoses, pruritus, rash, urticaria, BLEEDING, anemia, thrombocytopenia, hematoma. I CONTRAINDICATIONS: Hypersensitivity, uncontrolled bleeding, thrombocytopenia, regional anesthesia during treatment for unstable angina/non–Q–wave MI. I CAUTIONS: HIGH ALERT MED: Assess patient for signs of bleeding and hemorrhage (bleeding gums; nosebleed; unusual bruising; black, tarry stools; hematuria; fall in hematocrit or blood pressure; guaiac-positive stools); bleeding from surgical site. Notify physician if these occur. • Risk of bleeding may be increased by warfarin, aspirin, NSAIDs, dipyridamole, some penicillins, clopidogrel, ticlopidine, abciximab, eptifibatide, tirofiban, and dextran. • Increased bleeding risk with anise, arnica, chamomile, clove, feverfew, garlic, ginger, ginkgo, Panax ginseng, and others. Key: underline = most common; CAPS = life-threatening D–H
  59. 59. D–H DEXAMETHASONE (dex-a-meth-a-sone) Decadron, Decaject, Dexameth steroidal anti-inflammatory (systemic corticosteroid) Pregnancy Category UK I INDICATIONS: Inflammatory, allergic, hematologic, neoplastic, autoimmune disorders, replacement therapy in adrenal insufficiency, cerebral edema. Diagnostic agent in adrenal disorders. Therapeutic Effects: I Suppression of inflammation, modification of the normal immune response. I DOSAGE: PO: Adults: 0.5–9 mg daily in single or divided doses. IM, IV: Adults: Dexamethasone acetate (IM): 8–16 mg q 1–3 wk. Dexamethasone phosphate (IV): 0.5–24 mg/d. Cerebral edema: Dexamethasone phosphate: 10 mg initially IV, 4 mg q 6 h, may be decreased to 2 mg q 8–12 h. I ADMINISTRATION: PO: Administer with meals to minimize GI irritation. Direct IV: May be given undiluted. Do not administer suspension IV. Rate: Administer over 1 min. I ADVERSE REACTIONS AND SIDE EFFECTS: Depression, euphoria, psychoses, restlessness, cataracts, hypertension, PEPTIC ULCERATION, anorexia, nausea, acne, decreased wound healing, ecchymoses, fragility, hirsutism, petechiae, adrenal suppression, hyperglycemia, hypokalemia, THROMBOEMBOLISM, thrombophlebitis, weight gain, muscle wasting, osteoporosis, cushingoid appearance, increased susceptibility to infection. I CONTRAINDICATIONS: Active untreated infections, lactation. I CAUTIONS: Instruct patient to promptly report severe abdominal pain or tarry stools occur. • May increase requirement for insulin or oral hypoglycemic agents. • Increased risk of adverse GI effects with NSAIDs. • Advise patient to carry identification describing medication regimen. Instruct patient to report swelling, weight gain, tiredness, bone pain, bruising, nonhealing sores, visual or behavioral changes. 54
  60. 60. 55 DIAZEPAM (dye-az-e-pam) Apo-Diazepam, Diastat, Dizac, DVal, Novodipam, Valium, Vivol antianxiety agent, anticonvulsant, sedative/hypnotic, skeletal muscle relaxant (benzodiazepine) Schedule IV Pregnancy Category D I INDICATIONS: Anxiety, preoperative sedation, conscious sedation, status epilepticus/uncontrolled seizures, skeletal muscle relaxant, alcohol withdrawal. Therapeutic Effects: I Relief of anxiety, sedation, skeletal muscle relaxation, decreased seizure activity. I DOSAGE: PO: Adults: 2–10 mg 2–4 times daily or 15–30 mg of extended-release form once daily. Children Ͼ6 mo: 1–2.5 mg 3–4 times daily may be increased. Geriatric or Debilitated Patients: 2–2.5 mg 1–2 times daily initially. IV, IM: Adults: 5–10 mg every 10 to 15 min up to 30 mg, if needed. Children 1 mo–5 yr: 0.2–0.5 mg q 2–5 min to maximum of 5 mg. Children Ն5 yr: 1 mg q 2–5 min up to 10 mg. I ADMINISTRATION: PO: Tablets may be crushed. Do not crush, break, or chew sustained-release capsules. IM: IM injections are painful and erratically absorbed; inject deeply into deltoid muscle for maximum absorption. IV: Do not dilute or mix IV diazepam with any other drug. Administer into Y-site as close to insertion site as possible—can precipitate in IV fluids and be absorbed into infusion bags and tubing. Injection may cause burning and venous irritation; avoid small veins. Rate: Administer slowly at a rate of 5 mg over at least 1 min. Infants and children should receive total dose over a minimum of 3–5 min. Rectal: Do not repeat Diastat rectal dose more than 5 times/mo or 1 episode every 5 days. Round dose up to next available dose unit. I ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness, drowsiness, lethargy, depression, hangover, headache, paradoxical excitation, blurred vision, respiratory depression, hypotension (IV only), constipation, diarrhea, nausea, vomiting, rashes, pain (IM), phlebitis (IV), venous thrombosis, physical dependence, psychological dependence, tolerance. (Continued) D–H
  61. 61. D–H DIAZEPAM (Continued) I CONTRAINDICATIONS: Hypersensitivity, comatose patients, pre-existing CNS depression, uncontrolled severe pain, narrow-angle glaucoma, pregnancy or lactation. I CAUTIONS: Have resuscitation equipment available when administering IV; rapid injection may cause apnea, hypotension, bradycardia, or cardiac arrest. • Use cautiously in hepatic dysfunction, severe renal impairment, history of suicide attempt or drug dependence, geriatric or debilitated patients and children. • Concurrent use alcohol, antidepressants, antihistamines, and opioid analgesics results in additive CNS depression. • Cimetidine, hormonal contraceptives, disulfiram, fluoxetine, isoniazid, ketoconazole, metoprolol, propoxyphene, propranolol, or valproic acid may decrease the metabolism of diazepam, enhancing its actions. • May decrease the efficacy of levodopa. • Rifampin or barbiturates may increase the metabolism and decrease effectiveness of diazepam. • Sedative effects may be decreased by theophylline. • Concomitant use of kava, valerian, skullcap, chamomile, or hops can increase CNS depression. • Medication may cause drowsiness, clumsiness, or unsteadiness; advise patient to avoid driving or other activities requiring alertness until response to medication is known. • Caution patient to avoid taking alcohol or other CNS depressants concurrently with this medication. 56
  62. 62. 57 DIGOXIN (di-jox-in) Digitek, Lanoxicaps, Lanoxin antiarrhythmic, inotropic Pregnancy Category C I INDICATIONS: CHF tachyarrhythmias atrial fibrillation and , atrial flutter, paroxysmal atrial tachycardia. Therapeutic Effects: I Increased cardiac output and slowing of the heart rate. I DOSAGE: PO: Maintenance dose: Adults: 0.125–0.25 mg daily. Geriatrics: 0.0625–0.125 daily or every other day. Children Ͼ2 yr: 0.012 mg/kg, divided, q 12 h. Children 1–24 mo: 0.01–0.02 mg/kg, divided, q 12 hr. Loading dose: Adults: 0.5–1mg in divided doses over 24 h. Children Ͼ2 yr: 0.02–0.04mg/kg, divided, q 8 h over 24 h. Children 1–24 mo: 0.035–0.06 mg/kg, divided, q 8 h over 24 h. IV: Loading dose: Adults: 0.5–1 mg. Children Ͼ2 yr: 0.025–0.035 mg/kg. Children 1–24 mo: 0.03–0.05 mg/kg. I ADMINISTRATION: PO: Administer without regard to meals. Tablets can be crushed. IV: IV doses may be given undiluted or each 1 mL may be diluted in 4 mL of sterile water, 0.9% NaCl, D5W, or LR for injection. Less diluent will cause precipitation. Use diluted solution immediately. Rate: Administer over a minimum of 5 min. I ADVERSE REACTIONS AND SIDE EFFECTS: Fatigue, headache, weakness, blurred vision, yellow vision, ARRHYTHMIAS, bradycardia, ECG changes, anorexia, nausea, vomiting, diarrhea, gynecomastia, thrombocytopenia. I CONTRAINDICATIONS: Hypersensitivity, uncontrolled ventricular arrhythmias, AV block, idiopathic hypertrophic subaortic stenosis, constrictive pericarditis. I CAUTIONS: HIGH ALERT MED: Narrow therapeutic range (normal serum level: 0.5–2 ng/mL). Monitor digoxin levels and assess for signs and symptoms of toxicity: abdominal pain, anorexia, nausea, vomiting, visual disturbances, bradycardia, and other arrhythmias. • Assess apical pulse for 1 min before administering. If pulse rate is Ͻ60 bpm in an adult, Ͻ70 bpm in a child, or Ͻ90 bpm in an infant, or if patient exhibits signs (Continued) D–H
  63. 63. D–H DIGOXIN (Continued) or symptoms of toxicity, withhold drug and notify physician or health care professional immediately. • Monitor ECG throughout IV administration. • Treatment of life-threatening arrhythmias from digitalis toxicity may include administration of digoxin immune Fab (Digibind), which binds to the digitalis glycoside molecule in the blood and is excreted by the kidneys. Temporary ventricular pacing may be useful in advanced heart block. • Teach patient to take pulse and to contact health care professional before taking medication if pulse rate is Ͻ60 or Ͼ100. • Review signs and symptoms of digitalis toxicity with patient and family. Advise patient to notify health care professional immediately if these or symptoms of CHF occur. Inform patient that these symptoms may be mistaken for those of colds or flu. • Use cautiously in electrolyte abnormalities (may predispose to toxicity), geriatric patients (very sensitive to toxic effects), MI, renal impairment, obese patients (dose should be based on ideal body weight), pregnancy and lactation. • Thiazide and loop diuretics, mezlocillin, piperacillin, ticarcillin, amphotericin B, and corticosteroids, which cause hypokalemia, may increase the risk of toxicity. • Quinidine, quinine, cyclosporine, amiodarone, verapamil, diltiazem, propafenone, and diclofenac increase serum levels and may lead to toxicity. • Spironolactone increases half-life. • Additive bradycardia may occur with beta-blockers and other antiarrhythmics (quinidine, disopyramide). • St. John’s wort may decrease digoxin levels and effect. 58
  64. 64. 59 DILTIAZEM (dil-tye-a-zem) Apo-Diltiaz, Cardizem, Diltia XT, NuDiltiaz, Tiamate, antianginal, antiarrhythmic, antihypertensive (calcium channel blocker) Pregnancy Category C I INDICATIONS: Hypertension, angina, supraventricular tachyarrhythmias, atrial flutter/fibrillation with rapid ventricular rate. Therapeutic Effects: I Decreased blood pressure, decreased frequency and severity of angina, suppression of arrhythmias. I DOSAGE: PO: Adults: 120–360 mg daily in divided doses. IV: Adults: 5–15 mg/h. I ADMINISTRATION: PO: Give with meals if GI irritation is a problem. IV: Rate: Administer bolus over 2 min. I ADVERSE REACTIONS AND SIDE EFFECTS: Anxiety, confusion, weakness, blurred vision, paresthesia, tremor, disturbed equilibrium, epistaxis, tinnitus, cough, dyspnea, ARRHYTHMIAS, CHF peripheral edema, bradycardia, chest pain, palpita, tions, tachycardia, abnormal liver function studies, erythema multiforme, photosensitivity, pruritus/urticaria, hyperglycemia, blood dyscrasias, STEVENS-JOHNSON SYNDROME, gingival hyperplasia. I CONTRAINDICATIONS: Hypersensitivity, sick sinus syndrome, 2nd- or 3rd-degree AV block, blood pressure Ͻ90 mm Hg, recent MI or pulmonary congestion. I CAUTIONS: Monitor ECG during IV administration: Have emergency equipment available. • Additive hypotension with fentanyl, antihypertensives, nitrates, or quinidine. • Digoxin levels may be increased. • Concurrent use with beta-blockers, digoxin, disopyramide, or phenytoin may result in bradycardia, conduction defects, or CHF • Cimetidine, ranitidine . and grapefruit juice increase blood levels. • Instruct patient to monitor pulse and contact health care professional if Ͻ50 bpm. • Caution patient to change positions slowly. Key: underline = most common; CAPS = life-threatening D–H
  65. 65. D–H DONEPEZIL (doe-nep-i-zill) Aricept anti-Alzheimer’s agent, cholinergic Pregnancy Category C I INDICATIONS: Mild to moderate dementia associated with Alzheimer’s disease. Therapeutic Effects: I May temporarily lessen some of the dementia associated with Alzheimer’s disease. I DOSAGE: PO: Adults: 5 mg once daily; after 4–6 wk may increase to 10 mg once daily. I ADMINISTRATION: Administer in the evening just before going to bed. May be taken without regard to food. I ADVERSE REACTIONS AND SIDE EFFECTS: Headache, abnormal dreams, depression, dizziness, drowsiness, fatigue, insomnia, syncope, atrial fibrillation, hypertension, hypotension, vasodilation, diarrhea, nausea, anorexia, vomiting, frequent urination, ecchymoses, hot flashes, weight loss, arthritis, muscle cramps. I CONTRAINDICATIONS: Hypersensitivity to donepezil or piperidine derivatives. I CAUTIONS: Exaggerates muscle relaxation from succinylcholine. • Interferes with the action of anticholinergics. Increases the cholinergic effects of bethanechol. • May increase the risk of GI bleeding from NSAIDs. Quinidine and ketoconazole decrease the metabolism. Rifampin, carbamazepine, dexamethasone, phenobarbital, and phenytoin induce the enzymes that metabolize donepezil and may decrease its effects. • Monitor heart rate during therapy; may cause bradycardia. • Caution patient and caregiver that donepezil may cause dizziness. • Advise patient and caregiver to notify health care professional if nausea, vomiting, diarrhea, or changes in color of stool occur or if new symptoms occur, or previously noted symptoms increase in severity. • Advise patient and caregiver to notify health care professional of medication regimen before treatment or surgery. 60
  66. 66. 61 DOXAZOSIN (dox-uh-zoe-sin) Cardura antihypertensive (antiadrenergic) Pregnancy Category C I INDICATIONS: Hypertension, symptomatic management of benign prostatic hyperplasia (BPH). Therapeutic Effects: I Lowers blood pressure. I DOSAGE: PO: Adults: Hypertension: 2–16 mg/d; incidence of postural hypotension greatly increased at doses Ͼ4 mg/d. BPH: 1 mg once daily, may be gradually increased to 8 mg/d. I ADMINISTRATION: Administer daily dose at bedtime. I ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness, headache, depression, drowsiness, fatigue, nervousness, weakness, abnormal vision, blurred vision, conjunctivitis, epistaxis, dyspnea, first-dose orthostatic hypotension, arrhythmias, chest pain, edema, palpitations, abdominal discomfort, constipation, diarrhea, dry mouth, flatulence, nausea, vomiting, decreased libido, sexual dysfunction, flushing, rash, arthralgia, arthritis, gout, myalgia. I CONTRAINDICATIONS: Hypersensitivity. I CAUTIONS: Additive hypotension with acute ingestion of alcohol, other antihypertensives, or nitrates. • May decrease antihypertensive effect of clonidine. • Monitor blood pressure and pulse 2–6 h after first dose, with each increase in dose, and periodically throughout course of therapy. • BPH: Assess patient for symptoms of prostatic hyperplasia (urinary hesitancy, feeling of incomplete bladder emptying, bladder distention, interruption of urinary stream, impairment of size and force of urinary stream, terminal urinary dribbling, straining to start flow, dysuria, urgency) before and periodically throughout therapy. • Hypertension: May be administered concurrently with a diuretic or other antihypertensive. • Advise patient to check blood pressure at least weekly and report significant changes. Key: underline = most common; CAPS = life-threatening D–H
  67. 67. D–H ENALAPRIL (e-nal-a-pril) Vasotec ENALAPRILAT (e-nal-a-pril-at) Vasotec IV Pregnancy Category C (first trimester), D (second and third trimesters) I INDICATIONS: Hypertension, CHF . Therapeutic Effects: I Lowered blood pressure, improvement in CHF symptoms. I DOSAGE: PO (Enalapril): Adults: 5–40 mg/d in 1–2 divided doses; initiate therapy at 2.5 mg/d in patients receiving diuretics. IV (Enalaprilat): Adults: 0.625–1.25 mg (0.625 mg if receiving diuretics) q 6 h. I ADMINISTRATION: PO: Precipitous drop in blood pressure during first 1–3 h following first dose may occur. Monitor blood pressure closely. IV: Rate: Administer undiluted over at least 5 min. May be given as intermittent infusion. I ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness, fatigue, headache, insomnia, cough, hypotension, angina pectoris, tachycardia, taste disturbances, diarrhea, nausea, proteinuria, renal failure, rashes, and hyperkalemia, AGRANULOCYTOSIS, ANGIOEDEMA. I CONTRAINDICATIONS: Hypersensitivity to enalapril or other ACE inhibitors, pregnancy, history of angioedema. I CAUTIONS: Additive hypotension with other antihypertensives, nitrates, phenothiazines, and general anesthesia. • Hyperkalemia with concurrent use of potassium supplements, potassium-sparing diuretics, indomethacin, salt substitutes, or cyclosporine. • May increase risk of lithium or digoxin toxicity. Instruct patient to report rash; mouth sores; sore throat; fever; swelling of hands or feet; irregular heart beat; chest pain; dry cough; hoarseness; swelling of face, eyes, lips, or tongue; difficulty swallowing or breathing occur. • Persistent dry cough may occur and may not subside until medication is discontinued. 62
  68. 68. 63 ENOXAPARIN (e-nox-a-pa-rin) Lovenox anticoagulant (low molecular weight heparin [LMWH]) (antithrombotic) Pregnancy Category B I INDICATIONS: Prevention of deep vein thrombosis, pulmonary emboli, ischemic complications in patients with unstable angina/non–Q-wave MI. LMWH has a more predictable anticoagulant response than unfractionated heparin—special monitoring of clotting times is not necessary. Therapeutic Effects: I Prevention of thrombus formation. I DOSAGE: SC: Adults: Knee/hip surgery: 40 mg once daily starting 9–15 h before hip surgery; abdominal surgery: 40 mg once daily starting within 24 h postop; treatment of DVT/PE: 1 mg/kg q 12 h or 1.5 mg/kg q 24 h; angina/non–Q-wave MI: 1 mg/kg q 12 h. I ADMINISTRATION: SC: Administer deep into SC tissue. Do not aspirate or massage. Rotate sites frequently. I ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness, insomnia, edema, urinary retention, ecchymoses, pruritus, rash, urticaria, BLEEDING, anemia, thrombocytopenia, hematoma. I CONTRAINDICATIONS: Hypersensitivity to pork products, uncontrolled bleeding, thrombocytopenia, patients with prosthetic heart valves. I CAUTIONS: HIGH ALERT MED: Assess patient for signs of bleeding and hemorrhage (bleeding gums, nosebleed; unusual bruising; black, tarry stools, hematuria; fall in hematocrit or blood pressure; guaiac-positive stools), bleeding from surgical site. Notify physician if these occur. • Risk of bleeding may be increased by warfarin, aspirin, NSAIDs, dipyridamole, some penicillins, clopidogrel, ticlopidine, abciximab, eptifibatide, tirofiban, and dextran. Increased bleeding risk with arnica, chamomile, feverfew, garlic, ginger, ginkgo, Panax ginseng, and others. Key: underline = most common; CAPS = life-threatening D–H
  69. 69. D–H ESTRADIOL (es-tra-dye-ole) Estrace, Gynodiol hormone (estrogen) Pregnancy Category X I INDICATIONS: Vasomotor symptoms of menopause and of various estrogen deficiency states, treatment and prevention of postmenopausal osteoporosis, inoperable metastatic postmenopausal breast or prostate carcinoma. Therapeutic Effects: I Restoration of hormonal balance in various deficiency states, treatment of hormone-sensitive tumors. I DOSAGE: PO: Adults: 0.5–2 mg daily or in a cycle. Postmenopausal breast carcinoma: 10 mg 3 times daily. Prostate carcinoma: 1–2 mg 3 times daily. I ADMINISTRATION: Administer with or immediately after food to reduce nausea. Estradiol is also available in injectable, transdermal, and vaginal tablet or ring formulations. I ADVERSE REACTIONS AND SIDE EFFECTS: Headache, dizziness, lethargy, intolerance to contact lenses, MI, THROMBOEMBOLISM, edema, hypertension, nausea, weight changes, jaundice, oily skin, acne, pigmentation, urticaria, gynecomastia (men), hyperglycemia, hypercalcemia, sodium and water retention, leg cramps, breast tenderness, women—amenorrhea, dysmenorrhea, breakthrough bleeding, cervical erosions, loss of libido, vaginal candidiasis, men—impotence, testicular atrophy. I CONTRAINDICATIONS: Thromboembolic disease, undiagnosed vaginal bleeding, pregnancy, lactation. I CAUTIONS: May alter requirement for warfarin, oral hypoglycemic agents, or insulins. • Barbiturates or rifampin may decrease effectiveness. • Smoking increases the risk of adverse CV reactions. 64
  70. 70. 65 FENTANYL (TRANSDERMAL) (fen-ta-nil) Duragesic opioid analgesic, opioid agonist Schedule II Pregnancy Category C I INDICATIONS: Chronic pain requiring opioid analgesic therapy. Therapeutic Effects: I Decreases severity of chronic pain. I DOSAGE: Transdermal: Adults: 25 ␮g/h is the initial dose; patients who have not been receiving opioids should receive not more that 25 ␮g/h. See package insert for determining equianalgesic dosages in patients already receiving opioid analgesics. Transdermal patch lasts 72 hours in most patients. Some patients require a new patch every 48 hours. I ADMINISTRATION: Apply to flat, nonirritated, and nonirradiated site. If skin preparation is necessary, use clear water and clip, do not shave, hair. I ADVERSE REACTIONS AND SIDE EFFECTS: Confusion, sedation, APNEA, bronchoconstriction, laryngospasm, respiratory depression, bradycardia, anorexia, constipation, dry mouth, nausea, vomiting, sweating, erythema, application site reactions, skeletal and thoracic muscle rigidity. I CONTRAINDICATIONS: Hypersensitivity to fentanyl or adhesives, known intolerance, acute pain. I CAUTIONS: HIGH ALERT MED: Do not use in patients who have received MAO inhibitors within the previous 14 days (may cause unpredictable, potentially fatal reactions). Additive CNS and respiratory depression with other CNS depressants, alcohol, antihistamines, antidepressants, sedative/hypnotics, and other opioids. • If respiratory rate is Ͻ10/min, assess level of sedation. Dose may need to be decreased by 25% to 50%. • Naloxone (Narcan) is the antidote to reverse respiratory depression or coma. Key: underline = most common; CAPS = life-threatening D–H

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