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MEDNotesMEDNotes

Judith Hopfer Deglin

April Hazard Vallerand

Nurses PocketPharmacology Guide

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 calling800-323-3555 (US) or 800-665-1148 (CAN)

A Daviss Notes Book

F. A. Davis Company Philadelphia


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F. A. Davis Company

1915 Arch StreetPhiladelphia, PA 19103www.fadavis.com

Copyright 2004 by F. A. Davis Company

All rights reserved. This book is protected by copyright. No part of it maybe reproduced, stored in a retrieval system, or transmitted in any form orby any means, electronic, mechanical, photocopying, recording, or other-wise, 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. MartoneDesign Manager: Louis J. Forgione

Cover Designer:Paul Fry

As new scientific information becomes available through basic and clinicalresearch, recommended treatments and drug therapies undergo changes.The author(s) and publisher have done everything possible to make thisbook accurate, up to date, and in accord with accepted standards at thetime of publication. The author(s), editors, and publisher are not responsi-ble for errors or omissions or for consequences from application of thebook, and make no warranty, expressed or implied, in regard to the

contents of the book. Any practice described in this book should be appliedby the reader in accordance with professional standards of care used inregard to the unique circumstances that may apply in each situation. Thereader is advised always to check product information (package inserts) forchanges and new information regarding dose and contraindications beforeadministering any drug. Caution is especially urged when using new orinfrequently ordered drugs.

Authorization to photocopy items for internal or personal use, or the inter-nal or personal use of specific clients, is granted by F. A. Davis Companyfor users registered with the Copyright Clearance Center (CCC)Transactional Reporting Service, provided that the fee of $.10 per copy ispaid directly to CCC, 222 Rosewood Drive, Danvers, MA 01923. For thoseorganizations that have been granted a photocopy license by CCC, a sepa-rate system of payment has been arranged. The fee code for users of theTransactional Reporting Service is: 8036-1109-9/04 0 + $.10.


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BASICS AC DH IM NR SZ TOOLS

Waterproof and Reusable

Wipe-Free Pages

Write directly onto any page of MedNoteswith

a ballpoint pen. Wipe old entries off with an

alcohol pad and reuse.


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Look for our other

Daviss Notes titles

Available Now!

LPN Notes:

Nurses Clinical Pocket Guide

Ehren Myers, RN & Tracey Hopkins, RN, BSNISBN: 0-8036-1132-3

RNotes:

Nurses Clinical Pocket GuideEhren Myers, RN

ISBN: 0-8036-1060-2

Coming soon!

NutriNotes:Nutrition & Diet Therapy Pocket Guide

Carroll Lutz, MA, RN & Karen Przytulski, MS, RDISBN: 0-8036-1114-5

MedSurg Notes:

Nurses Clinical Pocket Guide

Tracey Hopkins, RN, BSN & Ehren Myers, RNISBN: 0-8036-1115-3

Also by Judith Hopfer Deglin

& April Hazard Vallerand

Daviss Drug Guide for Nurses


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High Alert MedicationsHigh alert medications are those medications that have a highrisk of causing injury or death when improperly handled oradministered. Exercise extreme caution when administeringthese medications:

I Adrenergic agonists (e.g., epinephrine, isoproterenol, norepi-nephrine)

I Cardioplegic solutions

I Chemotherapeutic agents

I Chloral hydrate (in pediatric patients)

I Colchicine injection

I High concentration dextrose (10% dextrose)

I Hypoglycemic agents (oral)

I Hypertonic sodium chloride injection ( 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

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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 infu-sion pump programming.

I Use the 5 Rights (right drug, right dose, right patient, rightroute, right time) as a guide.

I Clarify any order that is incomplete, contains abbreviations, isconfusing or hard to read, or raises a question.

I Do not borrow medications from other patients or begin newmedications before order has been received in pharmacy: todo so circumvents built-in checks that can detect a prescribingerror.

Standards for Patient Education

I All patients need clear written and verbal instruction for allmedications. 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 differentlanguages.

I Have the patient repeat the information you provide.

I Make sure to tell the patient:

The brand and generic names of the medicationThe purpose of the medicationThe strength and dose of the medicationWhen to take the medicationPossible side effects and what to do if they occur

How long to take the medicationWhat medications or foods to avoid and why they should be

avoidedHow to store the medicationWhat to do if a dose is missedWhat activities should be avoided while on the medicationSigns and symptoms of adverse drug reactions

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Abbreviations and Symbols Associated

with Medication ErrorsAbbreviations and symbols are a source of medication errors.Nurses should consult with the prescribing health care provideron any orders that contain the following abbreviations.

Abbreviation/ Intended OftenSymbol Meaning Mistaken For Recommendation

AZTCPZ

HCl

HCTMgSO4

MS

MTXNitro dripNorfloxPIT/ (slash)

Zero aftera decimalpoint(e.g., 1.0 mg)

No zerobefore adecimal point(e.g., .1 mg)

U

HS

Adapted from the Institute for Safe Medication Practices, 2003http://www.ismp.org/msaarticles/specialissuetable.html.

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ZidovudineCompazine

Hydrochloricacid

HydrocortisoneMagnesium

sulfateMorphine

sulfateMethotrexateNitroprussideNorfloxacinPitocinperPlus sign

1 mg

.1 mg

units

Half strength

AzathioprineThorazine

(chlorpromazine)KCl (potassium

chloride)HydrochlorothiazideMorphine sulfate

Magnesium sulfate

MitoxantroneNitroglycerinNorflexPitressin1 (numeral

one)4 (numeral

four)10 mg

1 mg

0 (zero), 4 (four) orcc

Hour of sleep

Use full drug nameUse full drug name

Use full drug name

Use full drug nameUse full drug name

Use full drug name

Use full drug nameUse full drug nameUse full drug nameUse full drug nameSpell out perSpell out and

DO NOT USE zeroafter a decimalpoint

ALWAYS USE zerobefore a decimalpoint

Spell out unitWrite out

medicationstrength.


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4

BASICS

IV Administration

Starting an IVI Prepare the patient: Explain procedure, answer any ques-

tions, 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 22 dressing.

I Apply tourniquet proximal to intended insertion site, eithermidforearm or above the elbow.

I Locate vein: Palpate with fingertips. To further enhance dila-tion, 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. Avoidtouching site once it has been prepared.

I Apply traction (in the direction opposite the catheter).I Position needle, bevel side up, 1530. 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 theneedle 12 mm more to ensure that the catheter has also

entered the vein.

I Advance the catheter:Thread catheter into vein whilemaintaining skin traction.

I Release the tourniquet, and apply digital pressure justabove 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.


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IV

InsertionGu

ide

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IV Piggyback (IVPB) Setup

I The piggyback bag must be higher than the IV.I To do this, use an extension hook.I Use the most proximal access port on primary line.I Adjust piggyback stopcock to desired rate.I 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: Swelling;tenderness; decreased or noinfusion rate; blanching of skin;site is cool to touch.

Interventions: D/C IV, and restartin a new site. Apply warmcompress to affected area.

Assessment: Classic sign is redline along course of vein; othersigns include redness, heat,swelling, and tenderness.

Interventions: D/C IV, and restartin a new site. Apply warmcompress to affected area.

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Flushing IV Catheters

Catheter Type Solution Strength Frequency

Peripheral Catheters (Open Ended)

Peripheral IV catheter Normal n/a 3 mL dailysaline and PRN

Midline catheter Heparin 10 units/ 5 mL daily

(each lumen if multiple) mL and PRN

Central Venous Catheters (CVC)

Valved-tip catheters Normal n/a 5 mL per

(Groshong PICC) saline lumen weeklyand PRN

Open-ended Heparin 10 units/ 5 mL per

PICC lines mL lumen dailyand PRN

Tunneled catheters Heparin 100 units/ 5 mL per(Hickman, Broviac) mL lumen daily

and PRN

Implanted Port Catheters

Groshong Port-a-Cath Heparin 100 units/ 5 mL daily

(when accessed) mL and PRN

Solution Used to Flush a Catheter

Valved-tip catheters require only saline flushes; however, the use of heparin isnot contraindicated. All other central lines require heparin flushes to minimizefibrin 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 of10 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, whichpromotes clot formation and catheter occlusion, always remove needles or

needleless caps slowly while injecting the last 0.5 mL of saline.

SAS Te chnique Flush with Saline,

Administer Med, Flush with Saline

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Intramuscular (IM) Injection Sites

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Subcutaneous (SC) Injection Sites

Subcutaneous (SC) Heparin Injections

Gauge MassageSite and Angle Aspirate Site

Abdomen, posteriorupper arm, low back,thigh, and upper back

25 g26 g, 3/8@ 90 (45 if ona thin patient)

No No

Two inches away

from the umbilicus

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Intraderm

al(ID),Subcu

taneous(SC)

,andIntramu

scular(IM)

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Mixing Insulins

1. Obtain appropriate-size insulin syringe, and draw up enough airequal to combined volume of both insulins.

2. Inject the NPH vial with amount of air equal to amount of NPHto be mixed without dipping needle into NPH solution.This prevents the NPH (which is cloudy) from mixing with theregular insulin (which is clear) and turning it cloudy.

3. Inject remaining air into regular insulin vial, and draw up theregular insulin to be mixed.

Expel any air/bubbles. There should not be any air in thesyringe, 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 displacethe insulin and alter the dose.

5. Reinsert needle into pressurized NPH and withdraw desiredamount.

Remember to triple-check all medication orders, and have another nurse

present when you mix the insulin.

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MixingInsulin

s

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I CAUTIONS:

ACYCLOVIR (ay-sye-kloe-veer) Avirax, Zovirax AntiviralPregnancy Category B (PO, IV) C (topical)

I INDICATIONS: Genital herpes, localized cutaneous herpeszoster infections, shingles, chickenpox, varicella, herpessimplex encephalitis, limited nonlife-threatening herpessimplex infections in immunocompromised patients (topical).

Therapeutic Effects: I Inhibition of viral replication,decreased viral shedding, reduced lesion-healing time.

I DOSAGE: PO: Adults: 200800 mg 3 to 5 times daily. Children:20 mg/kg 4 times daily IV Adults and Children: 520 mg/kgq8 h. Topical: Adults and Children: 1/2 inch ribbon for each 4square inch area 6 times daily.

I ADMINISTRATION: PO: Can give with food or on an emptystomach, with a full glass of water. IV: Do not reconstitutewith bacteriostatic water with benzyl alcohol or paraben.

Administer via infusion pump over at least 1 hour to minimizerenal tubular damage.

I ADVERSE REACTIONS AND SIDE EFFECTS: SEIZURES,dizziness, headache, diarrhea, nausea, vomiting, pain,phlebitis, RENAL FAILURE, THROMBOTIC THROMBOCY-TOPENIC PURPURA/ HEMOLYTIC UREMIC SYNDROME in highdoses in immunosuppressed patients.

I CONTRAINDICATIONS: Hypersensitivity to acyclovir or valacy-clovir.

I CAUTIONS:Concurrent use of other nephrotoxic drugsincreases the risk of adverse renal effects.

AC


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I CAUTIONS:

ALBUTEROL (al-byoo-ter-awl) AccuNeb, Proventil, Ventodisk,

Ventolin bronchodilatorPregnancy Category C

I INDICATIONS: Asthma or COPD-induced reversible airwayobstruction, acute bronchospasm, prevention of exercise-induced bronchospasm, long-term control of chronic/persist-ent bronchospasm.

Therapeutic Effects: I Bronchodilation.

I DOSAGE: PO: Adults and Children 12: 24 mg 34 timesdaily; 48 mg twice daily for extended-release tablets.Children 612 yr: 2 mg 34 times daily. Children 26 yr: 0.1mg/kg 3 times daily. Geriatrics: 2 mg 34 times daily.Inhalation: Adults and Children 212 yr: Via nebulization orIPPB:1.252.5 mg 34 times daily. Adults and Children 4 yr:Via Rotahaler inhalation device: 200 g as Ventolin Rotacaps q46 h up to 400 g q 46 h. Adults and Children 4 yr: Viametered-dose inhaler2 inhalations q 46 h.

I ADMINISTRATION: PO: Administer oral medication with mealsto minimize gastric irritation. Inhalation: Allow at least 1minute between inhalations of aerosol medication. For nebu-lization or IPPB, the 0.50.83-, 1-, and 2-mg/mL solutions donot require dilution before administration. The 5 mg/mL solu-tion 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, arrhyth-mias, hypertension, hypokalemia.

I CONTRAINDICATIONS: Hypersensitivity to adrenergic aminesor hypersensitivity to fluorocarbons inhaler.

I CAUTIONS:Excessive use may lead to tolerance and para-

doxical bronchospasm. Use with MAO inhibitors may leadto hypertensive crisis. Beta-blockers may negate therapeuticeffect.

Key:underline = most common;

CAPS = life-threatening


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I CAUTIONS:

ALENDRONATE (uh-len-dro-nate) Fosamax Bone resorptioninhibitorPregnancy Category C

I INDICATIONS: Osteoporosis, Pagets disease of the bone.

Therapeutic Effects: I Reversal of the progression ofosteoporosis with decreased fractures, decreased progressionof Pagets disease.

I DOSAGE: PO: Adults: Treatment of osteoporosis: 510 mgonce daily or 70 mg once weekly. Prevention of osteoporosis:

5 mg once daily or 35 mg once weekly. Pagets disease:40 mgonce daily for 6 mo.

I ADMINISTRATION: Remain upright for 30 min following doseto facilitate passage to stomach and minimize risk ofesophageal irritation. Do not drink coffee, tea, cola, mineralwater, 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, esophagealulcer, flatulence, gastritis, nausea, altered taste, vomiting,erythema, photosensitivity, rash, musculoskeletal pain.

I CONTRAINDICATIONS: Renal insufficiency (CCr 35 mL/min),pregnancy, lactation.

I CAUTIONS:Calcium supplements, antacids, other oralmedications and food significantly decrease the absorption ofalendronate. Caffeine coffee, tea, cola, mineral water, andorange juice also decrease absorption. Wait 1 hour beforeconsuming.


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I CAUTIONS:

ALLOPURINOL (al-oh-pure-i-nawl) Apo-Allopurinol, Lopurin,

Zyloprim Anti-gout agent, antihyperuricemicPregnancy CategoryC

I INDICATIONS: Prevention of attack of gouty arthritis andnephropathy. Treatment of secondary hyperuricemia that canoccur during treatment of tumors or leukemias. Treatment ofsecondary hyperuricemia.

Therapeutic Effects:I

Lowering of serum uric acid levelsby inhibiting the production of uric acid.

I DOSAGE: PO: Adults: 100 to 800 mg/d. Doses 300 mg/dshould be given in divided doses. Children 610 yr: 300 mgdaily. Children 6 yr: 150 mg daily. IV: Adults: 200400mg/m2/d (up to 600 mg/d) as a single daily dose or in divideddoses q 612 h. Children: 200 mg/m2 per day as a single dailydose or in divided doses q 612 h.

I ADMINISTRATION: May be administered with milk or meals tominimize 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 azathioprineincreases bone marrow depressant propertiesdosages of thesedrugs should be reduced. Use with ampicillin or amoxicillinincreases the risk of rash. Use with oral hypoglycemic agentsand warfarin increases the effects of these drugs. Use withthiazide diuretics or ACE inhibitors increases the risk of hyper-sensitivity reactions. Discontinue allopurinol immediately if

rash occurs. Therapy should be discontinued permanently ifreaction is severe. Therapy may be reinstituted at a lowerdose (50 mg/d with very gradual titration) after a mild reactionhas subsided.




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I CAUTIONS:

ALPRAZOLAM (al-pra-zoe-lam) Apo-Alpraz, Nu-Alpraz, Xanaxantianxiety 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: 0.250.5 mg 23 times daily.

I ADMINISTRATION: May be administered with food if GI upsetoccurs. Tablets may be crushed.

I ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,drowsiness, lethargy, confusion, hangover, headache, mentaldepression, paradoxical excitation, blurred vision, constipa-tion, diarrhea, nausea, vomiting, rashes, physical dependence,psychological dependence, and tolerance.

I CONTRAINDICATIONS: Hypersensitivity, narrow-angle glau-coma, cross-sensitivity with other benzodiazepines, pre-existing CNS depression, severe, uncontrolled pain, preg-nancy and lactation.

I CAUTIONS:Alcohol, antidepressants, otherbenzodiazepines, antihistamines, opioid analgesics, kava,valerian, skullcap, chamomile, or hops can increase CNSdepression. Advise patient to avoid the use of alcohol orother CNS depressants concurrently with alprazolam. Instruct patient to consult health care professional beforetaking OTC medications concurrently with this medication.


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I CAUTIONS:

AMILORIDE (a-mill-oh-ride) Midamor diuretic (potassium-

sparing diuretic)Pregnancy Category B

I INDICATIONS: Counteract potassium loss caused by otherdiuretics; used with thiazides to treat edema or hypertension.

Therapeutic Effects: I Weak diuretic and antihypertensiveresponse when compared with other diuretics, conservation ofpotassium.

I DOSAGE: PO: Adults: 510 mg/d (up to 20 mg).I ADMINISTRATION: PO: Administer in morning to avoid inter-

rupting sleep pattern. Administer with food or milk to mini-mize gastric irritation and to increase bioavailability.

I ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,arrhythmias, constipation, GI irritation, impotence, hyper-kalemia, hyponatremia, muscle cramps, allergic reactions.

I CONTRAINDICATIONS: Hypersensitivity, hyperkalemia.

I CAUTIONS:Additive hypotension with acute ingestion ofalcohol, other antihypertensives, or nitrates. Use with ACEinhibitors, indomethacin, potassium supplements, orcyclosporine increases risk of hyperkalemia. Decreaseslithium excretion. Effectiveness may be decreased byNSAIDs. May cause dizziness. Caution patient to avoiddriving or other activities requiring alertness until response tomedication is known.




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I CAUTIONS:

AMIODARONE (a-mee-oh-da-rone) Cordarone, Pacerone antiar-rhythmicPregnancy Category D

I INDICATIONS: Ventricular arrhythmias. Unlabeled Uses:Supraventricular tachyarrhythmias.

Therapeutic Effects: I Suppression of arrhythmias.

I DOSAGE: PO: Adults: Ventricular Arrhythmias400600 mgdaily in 12 doses. Supraventricular Tachycardia200400mg/d. Children: Ventricular Arrhythmias:25 mg/kg/d.

Supraventricular Tachycardia:2.5 mg/kg/d. IV: Adults: 150 mgover 10 min, followed by 360 mg over the next 6 hours andthen 540 mg over the next 18 h. Continue infusion at 0.5mg/min until oral therapy is initiated.

I ADMINISTRATION: PO: Administer with meals if GI intoler-ance occurs. IV: Administer via volumetric pump using an in-line filter.

I ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,fatigue, malaise, corneal microdeposits, ADULT RESPIRATORYDISTRESS SYNDROME (ARDS), PULMONARY FIBROSIS, CHF,WORSENING OF ARRHYTHMIAS, bradycardia, hypotension,LIVER FUNCTION ABNORMALITIES, anorexia, constipation,nausea, vomiting, TOXIC EPIDERMAL NECROLYSIS, photosen-sitivity, hypothyroidism, ataxia, involuntary movement, pares-

thesia, 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 by50%) and activity of warfarin (decrease warfarin by 33%50%). Increases blood levels and may lead to toxicity from quini-dine, procainamide, mexiletine, lidocaine, flecainide, cyclo-

sporine, dextromethorphan, methotrexate, phenytoin, andtheophylline. Increased risk of bradyarrhythmias, sinusarrest, or AV heart block with beta-blockers or calcium channelblockers. Do not confuse amiodarone with amrinone, nowcalled inamrinone.


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I CAUTIONS:

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 50100

mg at bedtime; may increase up to 150 mg. Hospitalized patients

dose may receive up to 300 mg/d. Geriatric Patients andAdolescents: 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: 2030 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, paralyticileus, urinary retention, blood dyscrasias, photosensitivity,changes in blood glucose, gynecomastia, increased appetite andweight gain.

I CONTRAINDICATIONS: Narrow-angle glaucoma, pregnancy and

lactation.I CAUTIONS:May cause hypotension, tachycardia, and poten-

tially fatal reactions when used with MAO inhibitors (dis-

continue 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 riskof 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


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I CAUTIONS:

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 anddecreased blood pressure. Coronary vasodilation and decreasedfrequency and severity of angina.

I DOSAGE: PO: Adults: 510 mg daily.

I ADMINISTRATION: May be administered without regard tomeals.

I ADVERSE REACTIONS AND SIDE EFFECTS: Headache, dizzi-ness, fatigue, peripheral edema, angina, bradycardia,hypotension, palpitations, gingival hyperplasia, nausea,flushing.

I CONTRAINDICATIONS: Hypersensitivity to amlodipine orblood pressure 90 mm Hg.

I CAUTIONS:Additive hypotension may occur when usedconcurrently with fentanyl, other antihypertensives, nitrates,acute ingestion of alcohol, or quinidine. Blood levels andeffects are increased by concurrent ingestion of grapefruit

juice. Do not confuse amlodipine with amiloride; do notconfuse Norvasc with Navane.


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I CAUTIONS:

AMOXICILLIN/CLAVULANATE (a-mox-i-sill-in klav-yoo-

lan-ate) Augmentin ES, Augmentin XR, Clavulin anti-infectivePregnancy Category B

I INDICATIONS: Skin and skin structure infections, otitis media,sinusitis, respiratory tract infections, genitourinary tract infec-tions, meningitis, septicemia.

Therapeutic Effects: I Bactericidal action against susceptible

bacteria.I DOSAGE: PO: Adults and Children 40 kg:Tablets: 250500

mg tablet q 812 h. Suspension: 500 mg q 12 h. Children2 yr: 2040 mg/kg/d in divided doses q 812 h. Children3 mo: 200 mg/5 mL or 400 mg/5 mL suspension:12.5 mg/kgq 12 h or6.6 mg/kg q 8 h (as 125 mg/5 mL or 250 mg/5 mLsuspension). Children 3 mo: 15 mg/kg q 12 h (125 mg/mLsuspension recommended).

I ADMINISTRATION: Administer around the clock. May be givenwith meals to decrease GI side effects. Chewable tabletsshould be crushed or chewed. Shake oral suspension beforeadministering. Do not administer 250 mg chewable tablets tochildren 40 kg due to clavulanate content.

I ADVERSE REACTIONS AND SIDE EFFECTS: SEIZURES (high

doses), PSEUDOMEMBRANOUS COLITIS, diarrhea, hepaticdysfunction, nausea, vomiting, rashes, urticaria, ANAPHY-LAXIS and SERUM SICKNESS, superinfection.

I CONTRAINDICATIONS: Hypersensitivity to penicillins or clavu-lanate.

I CAUTIONS:May potentiate the effect of warfarin. Maydecrease the effectiveness of hormonal contraceptives.

Instruct patient to notify health care professional immedi-ately if diarrhea, abdominal cramping, fever, or bloody stoolsoccur and not to treat with antidiarrheals without consultinghealth care professionals.




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I CAUTIONS:

AMOXICILLIN (uh-mox-i-sil-in) Amoxil, Novamoxin, Trimoxanti-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 toHelicobacter pylori. Unlabeled use: Lyme disease.

Therapeutic Effects: I Bactericidal action.

I DOSAGE: PO: Adults and Children 20 kg: 250500 mg q 8 hor500875 mg q 12 h. Children 3 mo: 2040 mg/kg/d individed doses q 8 hour or2545 mg/kg/d in divided doses q12 h. Infants 3 mo: up to 30 mg/kg/d in divided doses q 12 h.

I ADMINISTRATION: Administer around the clock. Administerwithout regard to meals or with meals to decrease GI sideeffects. Capsule contents may be emptied and swallowed with

liquids. Suspension may be given straight or mixed informula, milk, fruit juice, water, or ginger ale. Administerimmediately after mixing. Discard refrigerated reconstitutedsuspension after 10 days.

I ADVERSE REACTIONS AND SIDE EFFECTS: SEIZURES (inhigh doses), PSEUDOMEMBRANOUS COLITIS, diarrhea,nausea, vomiting, rashes, urticaria, blood dyscrasias, allergic

reactions including ANAPHYLAXIS, SERUM SICKNESS, super-infection.

I CONTRAINDICATIONS: Hypersensitivity to penicillins.

I CAUTIONS:May potentiate the effect of warfarin. Maydecrease the effectiveness of oral contraceptives. Infectiousmononucleosis (increased incidence of rash). Observe forsigns and symptoms of anaphylaxis (rash, pruritus, laryngeal

edema, wheezing). Monitor bowel function for signs orsymptoms of pseudomembranous colitis: diarrhea, abdominalcramping, fever, and bloody stools.


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I CAUTIONS:

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 heartrate, decreased frequency of angina.

I DOSAGE: PO: Adults: 25100 mg once daily. IV: Adults:

Administer 5 mg over 5 min, followed by another 5mg 10 minlater.

I ADMINISTRATION: PO:Take apical pulse before administeringdrug. If 50 bpm or if arrhythmia occurs, withhold medicationand notify physician or other health care professional.IV: Administer each dose over 5 minutes.

I ADVERSE REACTIONS AND SIDE EFFECTS: Fatigue, weak-

ness, anxiety, depression, dizziness, insomnia, memory loss,mental status changes, nervousness, nightmares, blurredvision, stuffy nose, bronchospasm, wheezing, BRADYCARDIA,CHF, PULMONARY EDEMA, hypotension, peripheral vasocon-striction, constipation, diarrhea, liver function abnormalities,nausea, vomiting, impotence, decreased libido, urinaryfrequency.

I CONTRAINDICATIONS: Uncompensated CHF, pulmonaryedema, cardiogenic shock, bradycardia or heart block.

I CAUTIONS:Additive bradycardia may occur with digoxin. Additive hypotension may occur with other antihyperten-sives, acute ingestion of alcohol, or nitrates. May alter theeffectiveness of insulins or oral hypoglycemic agents (dosageadjustments may be necessary). May decrease effectiveness

of theophylline. Monitor blood pressure, ECG, and pulsefrequently during dosage adjustment period and periodicallythroughout therapy.




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I CAUTIONS:

ATORVASTATIN (a-tore-va-sta-tin) Lipitor lipid-lowering agentPregnancy Category X

I INDICATIONS: Primary hypercholesterolemia and mixeddyslipidemia.

Therapeutic Effects: I Lowering of total and LDLcholesterol.

I DOSAGE: PO: Adults: 10 mg once daily initially; may beincreased q 24 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, abdominalcramps, constipation, diarrhea, flatus, heartburn, altered taste,drug-induced hepatitis, dyspepsia, elevated liver enzymes,nausea, pancreatitis, impotence, rashes, pruritus, RHAB-DOMYOLYSIS, arthralgia, arthritis, myalgia, myositis, hyper-

sensitivity reactions.

I CONTRAINDICATIONS: Hypersensitivity, active liver disease,pregnancy or lactation, concurrent use of gemfibrozil or azoleantifungals.

I CAUTIONS:Blood levels and the risk of myopathy areincreased by concurrent cyclosporine and gemfibrozil, clofi-brate, erythromycin, large doses of niacin and azole antifun-gal agents. Grapefruit juice may cause higher blood levelsand increased risk of toxicity. Liver function tests, includingAST, should be monitored before, at 612 wk after initiation oftherapy or after dose elevation, and then every 6 mo. If ASTlevels increase to 3 times normal, HMG-COA reductaseinhibitor therapy should be discontinued. May causeelevated alkaline phosphatase and bilirubin levels. If patient

develops muscle tenderness during therapy, CPK levelsshould be monitored. If CPK levels are markedly increased ormyopathy occurs, therapy should be discontinued.


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I CAUTIONS:

AZITHROMYCIN (aye-zith-row-my-sin) Zithromax agent for

atypical mycobacterium, anti-infectives (macrolide)PregnancyCategory B

I INDICATIONS: Upper and lower respiratory tract infections, bron-chitis, pneumonia, skin and skin structure infections, nongono-coccal urethritis, cervicitis, gonorrhea, and chancroid, preventionof disseminated Mycobacterium avium complex (MAC) infectionin patients with advanced HIV infection. Prevention of bacterial

endocarditis (unlabeled use).

Therapeutic Effects: I Bacteriostatic action againstsusceptible bacteria.

I DOSAGE: PO: Adults: 500 mg 1st day, then 250 mg/d for durationof therapy. May be given as 1 to 2 g single or weekly dose.Children 215 yr: 1012 mg/kg (not 500 mg/dose) on 1st day,then 5 mg/kg (not 250 mg/dose.) IV: Adults: 500 mg IV q 24 h.

I ADMINISTRATION: PO: Administer 1 hour before or 2 hours aftermeals. IV: Administer 1 mg/mL IV solution over 3 hours or 2mg/mL solution over 1 hour. Do not administer as a bolus.

I ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,drowsiness, fatigue, headache, ANGIOEDEMA, chest pain, palpi-tations, PSEUDOMEMBRANOUS COLITIS, abdominal pain, diar-rhea, nausea, cholestatic jaundice, dyspepsia, flatulence, melena,

nephritis, vaginitis, photosensitivity, rashes.

I CONTRAINDICATIONS: Hypersensitivity to azithromycin, erythro-mycin, or other macrolide anti-infectives.

I CAUTIONS:Observe for signs and symptoms of anaphylaxis. Monitor patient for signs and symptoms of pseudomembra-nous colitis: fever, diarrhea, and stool containing blood, pus, ormucus. Kaolin, magnesium and aluminum antacids will

decrease absorption of azithromycin. Separate dose times by atleast 2 hours. Do not confuse azithromycin with erythromycin. Do not confuse Zithromax with Zinacef.




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I CAUTIONS:

BACLOFEN (bak-loe-fen) Lioresal antispasticity agent, skeletalmuscle relaxantPregnancy Category C

I INDICATIONS: Reversible spasticity associated with multiplesclerosis or spinal cord lesions. Intrathecal: Severe spasticityoriginating in the spinal cord.

Therapeutic Effects: I Decreased spasticity, improvementof 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: 100800 g/d infusion. Children: 251200 g/d infusion(average 275 g/d).

I ADMINISTRATION: PO: Administer with milk or food.Intrathecal: Screening phase, dilute for a concentration of 50g/mL with NaCl for injection. Test dose should be adminis-tered over at least 1 minute. If response is inadequate, 2 addi-

tional test doses, each 24 hours apart, 75 g/1.5 mL and 100g/2 mL respectively, may be administered.

I ADVERSE REACTIONS AND SIDE EFFECTS: SEIZURES(intrathecal), dizziness, drowsiness, fatigue, weakness, confu-sion, insomnia, hypotension, nausea, pruritus, ataxia.

I CONTRAINDICATIONS: Hypersensitivity.

I CAUTIONS:Additive effect with other CNS depressantsincluding alcohol, antihistamines, opioid analgesics, andsedative/hypnotics. Use with MAO inhibitors may lead toincreased CNS depression or hypotension. Intrathecal:Monitor patient closely during test dose and titration; resusci-tative equipment should be immediately available for life-threatening or intolerable side effects. Caution patient toavoid 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.


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I CAUTIONS:

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 ofasthma attacks.

I DOSAGE: Inhalation: Adults and Children 12 yr: 42

g/inhalation:2 inhalations 34 times daily or 4 inhalationstwice daily. 84g/inhalation:2 inhalations twice daily or 4inhalations twice daily. Children 612 yr: 42g/inhalation:12inhalations 34 times (not to exceed 10 inhalations/day) or 4inhalations twice daily. 84g/inhalation:2 inhalations twicedaily (not to exceed 5 inhalations/d).

I ADMINISTRATION: Allow at least 1 minute between inhala-

tions of aerosol medication.I ADVERSE REACTIONS AND SIDE EFFECTS: Dysphonia,

hoarseness, oropharyngeal fungal infections, cataracts; bron-chospasm, cough, wheezing, dry mouth, esophageal candidia-sis, adrenal suppression, decreased growth (children),CHURG-STRAUSS SYNDROME.

I CONTRAINDICATIONS: Acute attack of asthma/status asth-

maticus.

I CAUTIONS:Advise patients also using bronchodilator to usebronchodilator first and wait 5 minutes before taking beclo-methasone. Advise patient to use regular peak flow monitor-ing to determine respiratory status. Advise patient to notifyphysician if sore throat or sore mouth occurs. Instruct patientwhose systemic corticosteroids have been recently reduced or

withdrawn to carry a warning card indicating the need forsupplemental systemic corticosteroids in the event of stress orsevere asthma attack unresponsive to bronchodilators. Cautionpatient to avoid smoking, known allergens, and other respiratoryirritants.




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I CAUTIONS:

BENAZEPRIL (ben-aye-ze-pril) Lotensin antihypertensive (ACEinhibitors)Pregnancy Category C (first trimester), D (second and

third trimesters)

I INDICATIONS: Hypertension.

Therapeutic Effects: I Lowering of blood pressure.

I DOSAGE: PO: Adults: 510 mg once daily, increased graduallyto maintenance dose of 2040 mg/d as single dose or 2divided doses (begin with 5 mg/d in patients receiving diuret-

ics).I ADMINISTRATION: Precipitous drop in blood pressure during

first 13 hours following first dose may occur, especially ifalso taking diuretics. Monitor blood pressure closely.

I ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,fatigue, headache, insomnia, cough, hypotension, anginapectoris, 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 antihyperten-sives, nitrates, phenothiazines, acute ingestion of alcohol, andduring surgery or general anesthesia. Hyperkalemia mayresult from concurrent use of potassium supplements, potas-sium-sparing diuretics, indomethacin, salt substitutes, orcyclosporine. May increase the risk of lithium or digoxintoxicity. Instruct patient to notify health care professional ifrash; mouth sores; sore throat; fever; swelling of hands orfeet; 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 maynot subside until medication is discontinued.


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I CAUTIONS:

BENZTROPINE (benz-troe-peen) Apo-Benztropine, Cogentin

antiparkinson agent, anticholinergicPregnancy Category C

I INDICATIONS: Parkinsons disease, including drug-inducedextrapyramidal effects and acute dystonic reactions.

Therapeutic Effects: I Reduces rigidity and tremors.

I DOSAGE: PO: Adults: Parkinsonism:12 mg/d in 12 divideddoses. Drug-induced extrapyramidal reactions:14 mg given

once or twice daily. IM: Adults: Acute dystonic reactions:12 mg.

I ADMINISTRATION: PO: Administer with food. May be crushedand administered with food if difficulty swallowing.

I ADVERSE REACTIONS AND SIDE EFFECTS: Depression,hallucinations, blurred vision, dry eyes, mydriasis, arrhyth-mias, hypotension, palpitations, tachycardia, constipation, dry

mouth, ileus, urinary retention, decreased sweating.

I CONTRAINDICATIONS: Hypersensitivity, children 3 yr,narrow-angle glaucoma, tardive dyskinesia.

I CAUTIONS:Additive anticholinergic effects with antihista-mines, phenothiazines, quinidine, disopyramide, and tricyclicantidepressants. Antacids and antidiarrheals may decreaseabsorption. Teach patient signs of urinary retention andconstipation/ileus. Patients with mental illness are at risk ofdeveloping exaggerated symptoms of their disorder duringearly therapy. Advise patient to avoid activities that requirealertness until response to the drug is known. Cautionpatient that this medication decreases perspiration. Overheating may occur during hot weather; patient shouldnotify health care professional if unable to remain indoors in

an air-conditioned environment during hot weather. IM: Monitor pulse and blood pressure closely and maintainbedrest for 1 hour after administration.




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I CAUTIONS:

BISOPROLOL (bis-oh-proe-lol) Zebeta antihypertensive (beta-blocker [selective])Pregnancy Category C

I INDICATIONS: Hypertension

Therapeutic Effects: I Decreased blood pressure andheart rate.

I DOSAGE: PO: Adults: 2.520 mg/d.

I ADMINISTRATION: Administer without regard to meals.

I

ADVERSE REACTIONS AND SIDE EFFECTS: Fatigue, weak-ness, anxiety, depression, dizziness, drowsiness, insomnia,memory loss, mental status changes, nightmares, blurredvision, bronchospasm, wheezing, BRADYCARDIA, CHF,PULMONARY EDEMA, hypotension, liver function abnormali-ties, nausea, impotence, decreased libido, urinary frequency,rashes, hyperglycemia, hypoglycemia, arthralgia, back pain,joint pain, drug-induced lupus syndrome.

I CONTRAINDICATIONS: Uncompensated CHF, pulmonaryedema, cardiogenic shock, bradycardia or heart block.

I CAUTIONS:May alter the effectiveness of insulins or oralhypoglycemic agents. Additive bradycardia may occur withdigoxin. Additive hypotension may occur with other antihy-pertensives, acute ingestion of alcohol, or nitrates. Monitorblood pressure, ECG, and pulse frequently during dosageadjustment period. Take apical pulse before administering:If 50 or if arrhythmia occurs withhold medication and notifyphysician or other health care professional.


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I CAUTIONS:

BUDESONIDE (byoo-dess-oh-nide) Pulmicort anti-

inflammatory (inhalation corticosteroid)Pregnancy Category B

I INDICATIONS: Asthma

Therapeutic Effects: I Decrease frequency and severity ofasthma attacks.

I DOSAGE: Inhalation: Adults: 12 inhalations once or twicedaily or 24 inhalations twice daily (maximum 8 inhalations

daily). Children 6 yr: 12 inhalations twice daily (maximum4 inhalations daily). Children 12 mo8 yr: 0.25 to 1 mg/d as asingle dose, or twice daily in divided doses. Individual titra-tion is required.

I ADMINISTRATION: Allow at least 1 minute between inhala-tions of aerosol medication.

I ADVERSE REACTIONS AND SIDE EFFECTS: Dysphonia,

hoarseness, oropharyngeal fungal infections, back pain,headache, dyspepsia, gastroenteritis, cataracts, bron-chospasm, cough, wheezing, dry mouth, esophageal candidia-sis, adrenal suppression, decreased growth (children),CHURG-STRAUSS SYNDROME.

I CONTRAINDICATIONS: Acute attack of asthma/status asth-maticus.

I CAUTIONS:Ketoconazole decreases metabolism andincreases levels of budesonide Advise patients also usingbronchodilator to use bronchodilator first and wait 5 minutesbefore taking beclomethasone. Advise patient to use regu-lar peak flow monitoring to determine respiratory status. Advise patient to notify physician if sore throat or soremouth occurs. Instruct patient whose systemic cortico-

steroids have been recently reduced or withdrawn to carry awarning card indicating the need for supplemental systemiccorticosteroids in the event of stress or severe asthma attackunresponsive to bronchodilators. Caution patient to avoidsmoking, known allergens, and other respiratory irritants.


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I CAUTIONS:

BUMETANIDE (byoo-met-a-nide) Bumex diuretic (loop diuretic)Pregnancy Category C

I INDICATIONS: Edema secondary to CHF, hepatic or renaldisease.

Therapeutic Effects: I Diuresis and subsequent mobiliza-tion of excess fluid.

I DOSAGE: PO: Adults: 0.52 mg/d as a single dose. Up to 2additional doses may be given during the day q 45 h (up to

10 mg/d). Alternate-day or q 23 day regimens may also beused. IM, IV: Adults: 0.51 mg, may be repeated q 23 h asneeded (up to 10 mg/d).

I ADMINISTRATION: PO: Administer orally with food or milk tominimize gastric irritation. IV: Direct IV:Rate:Administerslowly 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 forpatients with renal impairment.

I ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,headache, insomnia, nervousness, hearing loss, tinnitus,hypotension, constipation, dry mouth, hyperglycemia, dehy-dration, hypochloremia, hypokalemia, hypomagnesemia,hyponatremia, hypovolemia, metabolic alkalosis, hyper-

glycemia, arthralgia, muscle cramps, increased BUN.I CONTRAINDICATIONS: Hypersensitivity (cross-sensitivity with

thiazides and sulfonamides may occur), pre-existing uncor-rected 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 digoxintoxicity. Increased risk of ototoxicity with aminoglycoside. May increase the effectiveness of warfarin, thrombolyticagents, or anticoagulants.


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I CAUTIONS:

BUPROPION (byoo-proe-pee-on) Wellbutrin, Wellbutrin SR,

Zyban antidepressant, smoking deterrentPregnancy Category B

I INDICATIONS: Depression, smoking cessation (Zyban).Unlabeled Uses: ADHD (adults, SR only), diminished libido inwomen.

Therapeutic Effects: I Improved mood, decreased cravingfor cigarettes.

I DOSAGE: PO: Adults: Depression:100 mg q 12 h; may beincreased to 450 mg/d in divided doses (no single dose toexceed 150 mg). Smoking cessation (SR):150 mg once dailyfor 3 days, then 150 mg q 12 h for 712 wk.

I ADMINISTRATION: Administer doses in equally spaced timeincrements 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 avoid-ing bedtime doses. May be administered with food to lessenGI 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 inhibitortherapy.

I CAUTIONS:Increased risk of adverse reactions when used withlevodopa or MAO inhibitors. Increased risk of seizures withphenothiazine, antidepressants, theophylline, corticosteroids,

OTC stimulants/anorectics, or cessation of alcohol or benzodi-azepines. Bupropion may impair judgment or motor andcognitive skills; caution patient to avoid driving and other activi-ties requiring alertness until response to medication is known.




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I CAUTIONS:

CAPTOPRIL (kap-toe-pril) Capoten angiotensin-convertingenzyme (ACE) inhibitorPregnancy Category C (first trimester),

D (second and third trimesters)

I INDICATIONS: Hypertension, CHF, diabetic nephropathy.

Therapeutic Effects: I Lowered blood pressure, improve-ment in symptoms of CHF.

I DOSAGE: PO: Adults: 12.525 mg 23 times daily, may beincreased at 12 wk intervals up to 150 mg 3 times daily.

I ADMINISTRATION: Administer 1 hour before or 2 hours aftermeals.

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-sensitivityamong ACE inhibitors may occur, pregnancy, angioedema(hereditary or idiopathic).

I CAUTIONS:Instruct patient to notify health care professionalif rash; mouth sores; sore throat; fever; swelling of hands orfeet; irregular heart beat; chest pain; dry cough; hoarseness;swelling of face, eyes, lips, or tongue; difficulty swallowing orbreathing occur. Additive hypotension with other antihyper-tensives, nitrates, phenothiazines, acute ingestion of alcohol,and during surgery or general anesthesia. Hyperkalemiamay 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 notsubside until medication is discontinued.


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I CAUTIONS:

CARISOPRODOL (kar-i-sop-roe-dole) Soma, Vanadom skeletal

muscle relaxantPregnancy Category UK

I INDICATIONS: Adjunct to rest and physical therapy in thetreatment of muscle spasm associated with acute painfulmusculoskeletal conditions.

Therapeutic Effects: I Skeletal muscle relaxation.

I DOSAGE: PO: Adults: 350 mg 4 times daily. Children 512 yr:

6.25 mg/kg 4 times daily.I ADMINISTRATION: Administer with food to minimize GI irrita-

tion. Provide safety measures; supervise ambulation andtransfer 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, ANAPHYLACTICSHOCK, fever, psychological dependence, severe idiosyncraticreaction.

I CONTRAINDICATIONS: Hypersensitivity to carisoprodol or tomeprobamate; porphyria or suspected porphyria.

I CAUTIONS:Instruct patient to notify health care professionalif signs of allergy (rash, hives, swelling of tongue or lips,dyspnea) or idiosyncratic reaction occur. Can cause additiveCNS depression with other CNS depressants includingalcohol, antihistamines, opioid analgesics, andsedative/hypnotics. Concomitant use of kava, valerian, orchamomile can increase CNS depression. Observe for idio-syncratic symptoms that may appear within minutes or hoursof administration of first dose: extreme weakness, quadriple-

gia, dizziness, ataxia, dysarthria, visual disturbances, agitation,euphoria, confusion, and disorientation; symptoms usuallysubside over several hours. Advise patient to avoid drivingor other activities requiring alertness. Instruct patient tochange positions slowly to minimize orthostatic hypotension.




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I CAUTIONS:

CARVEDILOL (kar-ve-dil-ole) Coreg antihypertensive (beta-blocker)Pregnancy Category C

I INDICATIONS: Hypertension, CHF.

Therapeutic Effects: I Decreases heart rate and bloodpressure, slows the progression of CHF.

I DOSAGE: PO: Adults: Hypertension:6.25 mg twice daily, up to25 mg twice daily; CHF:3.125 mg twice daily; may beincreased to 6.25 mg twice daily. Dose may be doubled (not to

exceed 25 mg twice daily in patients 85 kg or 50 mg twicedaily in patients 85 kg).

I ADMINISTRATION: Administer without regard to food.

I ADVERSE REACTIONS AND SIDE EFFECTS: Weakness, anxi-ety, depression, insomnia, blurred vision, bronchospasm,wheezing. BRADYCARDIA, CHF, PULMONARY EDEMA, diar-rhea, impotence, hyperglycemia, hypoglycemia.

I CONTRAINDICATIONS: Uncompensated CHF, pulmonaryedema, cardiogenic shock, bradycardia or heart block, hepaticimpairment or bronchial asthma/bronchospasm.

I CAUTIONS:Teach patient to check pulse daily and bloodpressure biweekly and to report pulse 50 bpm or significantchange in blood pressure. Abrupt withdrawal may precipi-tate life-threatening arrhythmias, hypertension, or myocardialischemia. General anesthetics, IV phenytoin, diltiazem, andverapamil may cause additive myocardial depression. Additive bradycardia may occur with digoxin. Additivehypotension may occur with other antihypertensives, ornitrates. Concurrent use with clonidine increases hypoten-sion and bradycardia. May alter the effectiveness of insulinsor oral hypoglycemic agents. Use cautiously within 14 days

of MAO inhibitor therapy (may result in hypertension). Withhold medication if pulse is 50 bpm or if arrhythmiaoccurs.

Key:underline = most common;CAPS = life-threatening


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I CAUTIONS:

CEFEPIME (seff-e-peem) Maxipime anti-infective third genera-

tion cephalosporin Pregnancy Category B

I INDICATIONS: Skin, bone, joint, urinary, gynecologic, respira-tory tract, and intra-abdominal infections; septicemia.

Therapeutic Effects: I Bactericidal action against suscepti-ble bacteria.

I DOSAGE: IM, IV: Adults: 0.51 g q 12 h. Children 2 mo12 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 (highdoses), PSEUDOMEMBRANOUS COLITIS, diarrhea, nausea,vomiting, rashes, urticaria, bleeding, phlebitis at IV site, aller-gic reactions including ANAPHYLAXIS and SERUM SICK-

NESS, superinfection.

I CONTRAINDICATIONS: Hypersensitivity to cephalosporins orpenicillins.

I CAUTIONS:Report fever and diarrhea, especially if stoolcontains blood, pus, or mucus. Advise patient not to treatdiarrhea without consulting health care professional. Observe patient for signs and symptoms of anaphylaxis(rash, pruritus, laryngeal edema, wheezing). Discontinuedrug and report signs and symptoms immediately. Concurrent use of large doses of cephalosporins and non-steroidal anti-inflammatory agents (NSAIDs) may increase riskof bleeding. Concurrent use of loop diuretics or nephrotoxicagents including aminoglycoside may increase the risk ofnephrotoxicity. Determine previous use of and reactions to

penicillins or cephalosporins. Persons with a negativehistory of penicillin sensitivity may still have an allergicresponse. Obtain specimens for culture and sensitivitybefore initiating therapy.




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I CAUTIONS:

CELECOXIB (sel-e-kox-ib) Celebrex antirheumatic, nonsteroidalanti-inflammatory (COX-2 inhibitor)Pregnancy Category C

I INDICATIONS: Osteoarthritis, rheumatoid arthritis, familialadenomatous polyposis (FAP).

Therapeutic Effects: I Decreased arthritic pain andinflammation, decreased number of colorectal polyps.

I DOSAGE: PO: Adults: Osteoarthritis:200 mg/d as a singledose or100 mg twice daily. Rheumatoid arthritis:100200 mg

twice daily. Familial adenomatous polyosis:400 mg twicedaily.

I ADMINISTRATION: May be administered without regard tomeals.

I ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,headache, insomnia, GI BLEEDING, abdominal pain, diarrhea,dyspepsia, flatulence, nausea, rash.

I CONTRAINDICATIONS: Hypersensitivity, allergic reactions tosulfonamides, asthma, urticaria, or allergic reactions to aspirinor other NSAIDs, advanced renal disease, late pregnancy (maycause premature closure of ductus arteriosus).

I CAUTIONS:Do not confuse with Celexa (citalopram) orCerebyx (fosphenytoin). Advise patient to notify health careprofessional promptly if signs or symptoms of GI toxicity(abdominal pain, black stools), skin rash, unexplained weightgain, or edema occur. May decrease effectiveness of ACEinhibitors, thiazide diuretics, and furosemide. Use withaspirin may increase risk of GI bleeding. Use with warfarinmay increase risk of bleeding.


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I CAUTIONS:

CEPHALEXIN (sef-a-lex-in) Apo-Cephalex, Biocef, Keflex, Novo-

Lexin anti-infective (first-generation cephalosporin)PregnancyCategory 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 suscepti-

ble bacteria.I DOSAGE: PO: Adults: 250500 mg q 6 h. Cystitis, skin and soft

tissue infections, streptococcal pharyngitis:500 mg q 12 h.Children: 6.2525 mg/kg q 6 h. Skin and soft-tissue infections,streptococcal pharyngitis:12.550 mg/kg q 12 h.

I ADMINISTRATION: Administer around the clock on full orempty 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 professionalif fever and diarrhea develop, especially if diarrhea containsblood, mucus, or pus. Advise patient not to treat diarrheawithout consulting health care professional. Concurrent useof loop diuretics may increase the risk of renal toxicity. Observe for signs and symptoms of anaphylaxis (rash, pruri-tus, laryngeal edema, wheezing). Discontinue drug and notify

physician or other health care professional immediately. Keep epinephrine and resuscitation equipment close by incase of an anaphylactic reaction.




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I CAUTIONS:

CETIRIZINE (se-ti-ra-zeen) Zyrtec allergy, cold and coughremedy, antihistaminePregnancy Category B

I INDICATIONS: Relief of allergic symptoms including seasonaland perennial allergic rhinitis, chronic urticaria.

Therapeutic Effects: I Decreased symptoms of histamineexcess (sneezing, rhinorrhea, nasal and ocular pruritus, oculartearing and redness).

I DOSAGE: PO: Adults and children 6 yr: 510 mg once daily.

Children 611 yr: 510 mg daily. Children 25 yr: 2.55 mgdaily.

I ADMINISTRATION: Administer once daily without regard tofood.

I ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness, drowsi-ness, fatigue, pharyngitis, dry mouth.

I CONTRAINDICATIONS: Hypersensitivity, acute attacks ofasthma, lactation.

I CAUTIONS:May cause dizziness and drowsiness; cautionpatient to avoid driving or other activities requiring alertnessuntil response to medication is known. Advise patient toavoid taking alcohol or other CNS depressants concurrentlywith this drug.


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I CAUTIONS:

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 hyperten-sive patients, diuresis with mobilization of edema.

I DOSAGE: PO: Adults: 250 mg1 g/d as a single dose or individed doses. Children 6 mo: 1020 mg/kg/d as a single

dose or in 2 divided doses. IV: Adults: Diuretic:250 mg q 612h. Antihypertensive:500 mg1 g/d as a single dose or 2divided doses.

I ADMINISTRATION: Administer in the morning to preventdisruption of sleep cycle.

I ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,drowsiness, lethargy, weakness, hypotension, anorexia,

cramping, hepatitis, nausea, vomiting, photosensitivity,rashes, hyperglycemia, hypokalemia, dehydration, hypercal-cemia, hypochloremic alkalosis, hypomagnesemia, hypona-tremia, hypophosphatemia, hypovolemia, blood dyscrasias,hyperuricemia, elevated lipids, muscle cramps, pancreatitis.

I CONTRAINDICATIONS: Hypersensitivity, anuria, lactation.

I CAUTIONS:Additive hypotension with other antihyperten-sives, acute ingestion of alcohol, or nitrates. Additivehypokalemia with corticosteroids, amphotericin B,mezlocillin, piperacillin, or ticarcillin. Hypokalemia increasesrisk of digoxin toxicity. Decreases lithium excretion. Cholestyramine or colestipol decrease absorption. Assesspatient, especially if taking digitalis glycosides, for anorexia,nausea, vomiting, muscle cramps, paresthesia, and confusion;

notify health care professional if these signs of electrolyteimbalance occur. Instruct patient to monitor weightbiweekly and report weight gain or loss in excess of 2 pounds. Caution patient to change positions slowly to minimizeorthostatic hypotension.




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I CAUTIONS:

CIMETIDINE (sye-meh-tih-deen) Novocimetine, Peptol,Tagamet anti-ulcer agent (histamine h2 antagonist)Pregnancy

Category B

I INDICATIONS: Duodenal, benign and stress-induced gastriculcers, GERD, heartburn, acid indigestion, Zollinger-Ellisonsyndrome.

Therapeutic Effects: I Healing and prevention of ulcers,decreased gastroesophageal reflux, decreased secretion of

gastric acid.I DOSAGE: PO: Adults: Ulcer treatment or prevention:6001200

mg/d in divided doses or400800 mg at bedtime. GERD:8001600 mg/d in divided doses. Zollinger-Ellison syndrome:300600 mg q 6 h (up to 2400 mg/d). Children: Active ulcers:2040 mg/kg/d in 4 divided doses. IM, IV: Adults: Active ulcers:300 mg q 6 h. Continuous IV infusion:900 mg infused over 24h (37.5 mg/h). Prevention of upper GI bleeding in critically illpatients:50 mg/h. Children: Short-term treatment of activeulcers:510 mg/kg q 68 h.

I ADMINISTRATION: PO: Administer with meals and at bedtime.Direct IV: Rate:Dilute and administer over at least 5 min toprevent hypotension and arrhythmias. Intermittent Infusion:Rate:Dilute and administer over 1520 min.

I ADVERSE REACTIONS AND SIDE EFFECTS: Confusion, dizzi-ness, drowsiness, hallucinations, ARRHYTHMIAS, drug-induced hepatitis, nausea, AGRANULOCYTOSIS, APLASTICANEMIA.

I CONTRAINDICATIONS: Hypersensitivity.

I CAUTIONS:May increase blood levels of chlordiazepoxide,diazepam, and midazolam, labetalol, metoprolol, propranolol,

caffeine, calcium channel blockers, carbamazepine, chloro-quine, lidocaine, metronidazole, moricizine, pentoxifylline,phenytoin, propafenone, quinidine, quinine, metformin,sulfonylureas, tacrine theophylline, triamterene, tricyclic anti-depressants, valproic acid, and warfarin.


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I CAUTIONS:

CIPROFLOXACIN (sip-roe-flox-a-sin) Cipro anti-infective (fluo-

roquinolone)Pregnancy Category C

I INDICATIONS: Urinary tract and gynecologic infections,gonorrhea, prostatitis, respiratory tract infections, skin andskin structure infections, bone and joint infections, infectiousdiarrhea, intra-abdominal infections, febrile neutropenia, post-exposure treatment of inhalational anthrax.

Therapeutic Effects: I Resolution of infection.

I DOSAGE: PO: Adults: 250750 mg q 12 h. Gonorrhea250 mgsingle dose. IV: Adults: 200400 mg q 12 h.

I ADMINISTRATION: PO: Do not give within 2 hours of adminis-tration of antacids, iron, zinc, or sucralfate. IV: Rate:Administer over 60 min into a large vein to minimize venousirritation.

I ADVERSE REACTIONS AND SIDE EFFECTS: SEIZURES,dizziness, drowsiness, headache, acute psychoses, light-head-edness, tremors, PSEUDOMEMBRANOUS COLITIS, abdomi-nal 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 chil-dren 18 yr.

I CAUTIONS:Instruct patient to notify health care professionalif fever and diarrhea develop, especially if stool containsblood, pus, or mucus. Advise patient not to treat diarrheawithout consulting health care professional. Instruct patientto notify health care professional immediately if rash, tendon

pain, or inflammation occurs. May increase the effects ofwarfarin. Increases serum theophylline levels and may lead totoxicity. Concurrent use with foscarnet may increase risk ofseizures. Concurrent use with corticosteroids may increaserisk of tendon rupture.




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I CAUTIONS:

CITALOPRAM (si-tal-oh-pram) Celexa antidepressant (selectiveserotonin reuptake inhibitor)Pregnancy Category C

I INDICATIONS: Depression

Therapeutic Effects: I Improved mood.

I DOSAGE: PO: Adults: 2060 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 morn-ing or evening without regard to food.

I ADVERSE REACTIONS AND SIDE EFFECTS: Apathy, confu-sion, drowsiness, insomnia, weakness, tremor, agitation,amnesia, anxiety, decreased libido, dizziness, fatigue,impaired concentration, increased depression, migraineheadache, 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 MAOinhibitor therapy.

I CAUTIONS:Do not confuse with Celebrex (celecoxib) orCerebyx (fosphenytoin). May cause serious, potentially fatalreactions when used with MAO inhibitors; allow at least 14days between citalopram and MAO inhibitors. Serotonergiceffects may be potentiated by lithium (concurrent use shouldbe carefully monitored). Concurrent use with 5-HT1 agonistsused for migraine headaches may increase the risk of adversereactions (weakness, hyperreflexia, incoordination). Increased risk of serotonergic side effects including sero-

tonin syndrome with St. Johns wort and SAMe.


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I CAUTIONS:

CLINDAMYCIN (klin-da-mye-sin) Cleocin, Dalacin C, anti-

infectivePregnancy Category B

I INDICATIONS: Skin, skin structure, respiratory tract, intra-abdominal and gynecologic infections, septicemia,osteomyelitis, endocarditis prophylaxis, severe acne.

Therapeutic Effects: I Bactericidal or bacteriostatic tosusceptible organisms.

I DOSAGE: PO: Adults: Most infections:150300 mg q 6 h.P. carinii pneumonia:12001800 mg/d in divided doses with1530 mg primaquine/day. CNS toxoplasmosis:12002400mg/d in divided doses with pyrimethamine 50100 mg/d.Children 1 mo: 25 mg/kg q 6 h or2.76.7 mg/kg q 8 h.IM, IV: Adults: Most infections:300600 mg q 68 h or900 mgq 8 h. P. carinii pneumonia:24002700 mg/d in divided doseswith primaquine. Toxoplasmosis:12004800 mg/d in divideddoses with pyrimethamine. Children 1 mo: 3.7510 mg/kg q6 h or513.3 mg/kg q 8 h. Infants 1 mo: 3.755 mg/kg q 6 hor56.7 mg/kg q 8 h.

I ADMINISTRATION: PO: Administer with glass of water; maybe given with meals. IM: Do not administer 600 mg in asingle IM injection. Intermittent Infusion: Rate:Administereach 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 ofpseudomembranous colitis, severe liver impairment, diarrhea.

I CAUTIONS:Monitor GI status, diarrhea, abdominal cramp-

ing, fever, and bloody stools may be a sign of pseudomem-branous colitis and should be reported immediately. Pseudomembranous colitis may begin up to several weeksfollowing the cessation of therapy. Instruct patient to finishthe drug completely as directed, even if feeling better.




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I CAUTIONS:

CLONAZEPAM (kloe-na-ze-pam) Klonopin, Rivotril, Syn-Clonazepam anticonvulsant (benzodiazepine)Schedule IV

Pregnancy Category C

I INDICATIONS: Seizures, panic disorder. Unlabeled Uses:Uncontrolled leg movements during sleep, neuralgias, seda-tion.

Therapeutic Effects: I Prevention of seizures, decreasedfrequency of panic attacks.

I DOSAGE: PO: Adults: 1.5 mg 3 times daily, not to exceed 20mg/d. Panic disorder:0.125 mg twice daily. Children 10 yr or30 kg: Initial daily dose 0.010.03 mg/kg/d (not to exceed 0.05mg/kg/d) given in 23 equally divided doses; increase by nomore than 0.250.5 mg q 3rd day (not to exceed 0.2 mg/kg/d).

I ADMINISTRATION: Administer with food to minimize gastricirritation.

I ADVERSE REACTIONS AND SIDE EFFECTS: Behavioralchanges, drowsiness, diplopia, nystagmus, increased secre-tions, palpitations, hepatitis, dysuria, nocturia, urinary reten-tion, anemia, ataxia, hypotonia, fever, physical dependence,psychological dependence.

I CONTRAINDICATIONS: Hypersensitivity to clonazepam orother benzodiazepines, severe liver disease.

I CAUTIONS:Additive CNS depression with alcohol, antide-pressants, antihistamines, other benzodiazepines, opioidanalgesics, kava, valerian, skullcap, chamomile, or hops. Cimetidine, hormonal contraceptives, disulfiram, fluoxetine,isoniazid, ketoconazole, metoprolol, propoxyphene, propra-nolol, or valproic acid may decrease the metabolism of clo-nazepam, enhancing its actions. May increase serum

phenytoin levels. Phenytoin may decrease serum clon-azepam levels. Instruct patient to notify health care profes-sional of unusual tiredness, bleeding, sore throat, fever,clay-colored stools, yellowing of skin, or behavioral changes. Do not discontinue abruptly.


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I CAUTIONS:

CLONIDINE (klon-i-deen) Catapres, Catapres-TTS, Duraclon

antihypertensivePregnancy Category C

I INDICATIONS: Mild to moderate hypertension, managementof cancer pain unresponsive to opioids alone, opioid with-drawal (unlabeled use).

Therapeutic Effects: I Decreased blood pressure, decreasedpain.

I DOSAGE: PO: Adults: 200600 g (0.20.6 mg)/d in 23divided doses (up to 2.4 mg/d). Opioid withdrawal:300 g (0.3mg) 1.2 mg/d. Geriatric Patients: 100 g (0.1 mg) at bedtimeinitially, increased as needed. Children: 50400 g (0.050.4mg) twice daily. Transdermal: Adults: Hypertension:100300g (0.10.3 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 atbedtime. Transdermal: Absorption of transdermal system isgreater when placed on chest or upper arm than when placedon 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:anticoagu-lant therapy, or bleeding problems.

I CAUTIONS:Additive hypotension with other antihyperten-sives and nitrates. Additive bradycardia with myocardialdepressants. Decreased antihypertensive effect with MAO

inhibitors, amphetamines, beta-blockers, prazosin, or tricyclicantidepressants. Withdrawal phenomenon may beincreased by discontinuation of beta-blockers. Increased riskof adverse cardiovascular reactions with verapamil. Allroutes of clonidine should be discontinued gradually over 24days to prevent rebound hypertension.

Key:

underline = most common; CAPS = life-threatening


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I CAUTIONS:

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 athero-sclerotic events in patients at risk.

I DOSAGE: PO: Adults: 75 mg once daily.

I ADMINISTRATION: Administer once daily without regard tofood.

I ADVERSE REACTIONS AND SIDE EFFECTS: Depression,dizziness, fatigue, headache, epistaxis, cough, dyspnea, chestpain, edema, hypertension, GI BLEEDING, abdominal pain,diarrhea, dyspepsia, gastritis, pruritus, purpura, rash, BLEED-ING, NEUTROPENIA, THROMBOTIC THROMBOCYTOPENIC

PURPURA, hypercholesterolemia, arthralgia, back pain,Hypersensitivity reactions includingANGIOEDEMA, ANAPHY-LACTOID REACTIONS, BRONCHOSPASM.

I CONTRAINDICATIONS: Hypersensitivity, pathologic bleeding(peptic ulcer, intracranial hemorrhage), lactation.

I CAUTIONS:Monitor patient for signs of thrombotic throm-bocytic purpura (thrombocytopenia, microangiopathichemolytic anemia, neurologic findings, renal dysfunction,fever). Advise patient to notify health care professionalpromptly if fever, chills, sore throat, or unusual bleeding orbruising occurs. Concurrent abciximab, eptifibatide,tirofiban, aspirin, NSAIDs, heparin, heparinoids, thrombolyticagents, ticlopidine, or warfarin may increase the risk of bleed-ing. May inhibit the metabolism and increase the effects of

phenytoin, tolbutamide, tamoxifen, torsemide, fluvastatin,and many NSAIDs.


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I CAUTIONS:

COLCHICINE (kol-chi-seen) anti-gout agentPregnancy

Category D

I INDICATIONS: Gouty arthritis.

Therapeutic Effects: I Decreased pain and inflammationin acute attacks of gout, prevention of attacks.

I DOSAGE: PO: Adults: 0.51.2 mg, then 0.50.6 mg q 12 h untila total cumulative dose of 4 mg is achieved. See following

dosage cautions. IV: Adults: 12 mg initially, then 0.5 mg q 6 hor1 mg q 612 h until a total cumulative dose of 4 mg isachieved. See following dosage cautions.

I ADMINISTRATION: PO: Administer with food. IV: Avoidextravasation; may cause necrosis.

I ADVERSE REACTIONS AND SIDE EFFECTS: Diarrhea,nausea, vomiting, abdominal pain, anuria, hematuria, alope-

cia, AGRANULOCYTOSIS, APLASTIC ANEMIA, leukopenia,thrombocytopenia.

I CONTRAINDICATIONS: Hypersensitivity, pregnancy, severerenal, hepatic or biliary disease.

I CAUTIONS:HIGH ALERT MED:Therapeutic range isnarrow. Overdose can be fatal. Cumulative dose by any routeshould not exceed 4 mg. Once dosing limit has been reached,(4 mg) no more colchicine by any route should be given for atleast 7 days. Limit IV doses to a maximum of 1-2 mg inpatients who have recently received oral colchicine. Assesspatient 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 andrenal patients. After dosing limit has been reached, do notgive 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 least2000 mL/d. Instruct patient not to increase doses duringan acute attack.


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CORTISONE (kor-ti-sone) Cortone, Cortone Acetate, steroidalanti-inflammatory (systemic corticosteroid)Pregnancy Category

UK

I INDICATIONS: Short-acting corticosteroid used to treatadrenocortical insufficiency, and allergic and inflammatorydisorders.

Therapeutic Effects: I Suppression of inflammation;modification of the normal immune response; replacement of

deficient adrenal corticoids.I DOSAGE: PO: Adults: 25300 mg/d as a single dose or in

divided doses. Children: Adrenocortical insufficiency0.7mg/kg (2025 mg/m2)/d in divided doses. Other uses2.510mg/kg (75300 mg/m2)/d as a single dose or in divided doses.IM: Adults: 20300 mg/d. Children: Adrenocortical insuffi-ciency:0.7 mg/kg (37.5 mg/m2) q 3 days or0.230.35 mg/kg(12.5 mg/m2)/d. Other uses0.835 mg/kg (25150 mg/m2) q1224 h.

I ADMINISTRATION: PO: Administer with meals to minimize GIirritation.

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, THROM-BOEMBOLISM, 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 require-ment for insulin or oral hypoglycemic agents. Increased riskof adverse GI effects with NSAIDs. Advise patient to carryidentification describing medication regimen. Instructpatient to report swelling, weight gain, tiredness, bone pain,bruising, nonhealing sores, or visual changes.


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I CAUTIONS:

DALTEPARIN (dal-te-pa-rin) Fragmin anticoagulant(low molec-

ular weight heparin [LMWH]) (antithrombotic)PregnancyCategory B

I INDICATIONS: Prevention of deep vein thrombosis, pulmonaryemboli, ischemic complications in patients with unstableangina/nonQ-wave MI. LMWH has a more predictable antico-agulant responsespecial monitoring of clotting times is notnecessary.

Therapeutic Effects: I Prevention of thrombus formation.

I DOSAGE: SC: Adults: Presurgical prophylaxis of DVT:2500 IU12 h before surgery, then 25005000 IU once daily;angina/nonQ-wave MI:120 IU/kg every 12 h.

I ADMINISTRATION: SC: Administer deep into SC tissue. Donot 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 bleed-ing, thrombocytopenia, regional anesthesia during treatmentfor unstable angina/nonQwave MI.

I CAUTIONS:HIGH ALERT MED: Assess patient for signs ofbleeding and hemorrhage (bleeding gums; nosebleed;unusual bruising; black, tarry stools; hematuria; fall in hemat-ocrit or blood pressure; guaiac-positive stools); bleeding fromsurgical site. Notify physician if these occur. Risk of bleed-ing may be increased by warfarin, aspirin, NSAIDs, dipyri-damole, some penicillins, clopidogrel, ticlopidine, abciximab,

eptifibatide, tirofiban, and dextran. Increased bleeding riskwith anise, arnica, chamomile, clove, feverfew, garlic, ginger,ginkgo, Panax ginseng, and others.




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I CAUTIONS:

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 insuf-ficiency, cerebral edema. Diagnostic agent in adrenal disor-ders.

Therapeutic Effects: I Suppression of inflammation, modifica-

tion of the normal immune response.I DOSAGE: PO: Adults: 0.59 mg daily in single or divided

doses. IM, IV: Adults: Dexamethasone acetate(IM): 816 mg q13 wk. Dexamethasone phosphate(IV): 0.524 mg/d. Cerebraledema: Dexamethasone phosphate:10 mg initially IV, 4 mg q6 h, may be decreased to 2 mg q 812 h.

I ADMINISTRATION: PO: Administer with meals to minimize GI

irritation. Direct IV: May be given undiluted. Do not administersuspension IV. Rate:Administer over 1 min.

I ADVERSE REACTIONS AND SIDE EFFECTS: Depression,euphoria, psychoses, restlessness, cataracts, hypertension,PEPTIC ULCERATION, anorexia, nausea, acne, decreasedwound healing, ecchymoses, fragility, hirsutism, petechiae,adrenal suppression, hyperglycemia, hypokalemia, THROM-

BOEMBOLISM, thrombophlebitis, weight gain, muscle wast-ing, osteoporosis, cushingoid appearance, increasedsusceptibility to infection.

I CONTRAINDICATIONS: Active untreated infections, lactation.

I CAUTIONS: Instruct patient to promptly report severeabdominal pain or tarry stools occur. May increase require-ment for insulin or oral hypoglycemic agents. Increased risk

of adverse GI effects with NSAIDs. Advise patient to carryidentification describing medication regimen. Instruct patientto report swelling, weight gain, tiredness, bone pain, bruising,nonhealing sores, visual or behavioral changes.


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Val, Novodipam, Valium, Vivol antianxiety agent, anticonvulsant,sedative/hypnotic, skeletal muscle relaxant (benzodiazepine)

Schedule IV Pregnancy Category D

I INDICATIONS: Anxiety, preoperative sedation, conscious seda-tion, status epilepticus/uncontrolled seizures, skeletal musclerelaxant, alcohol withdrawal.

Therapeutic Effects: I Relief of anxiety, sedation, skeletalmuscle relaxation, decreased seizure activity.

I DOSAGE: PO: Adults: 210 mg 24 times daily or1530 mg ofextended-release form once daily. Children 6 mo: 12.5 mg34 times daily may be increased. Geriatric or DebilitatedPatients: 22.5 mg 12 times daily initially. IV, IM: Adults: 510mg every 10 to 15 min up to 30 mg, if needed. Children 1

mo5 yr: 0.20.5 mg q 25 min to maximum of 5 mg. Children5 yr: 1 mg q 25 min up to 10 mg.

I ADMINISTRATION: PO:Tablets may be crushed. Do not crush,break, or chew sustained-release capsules. IM: IM injectionsare painful and erratically absorbed; inject deeply into deltoidmuscle for maximum absorption. IV: Do not dilute or mix IVdiazepam with any other drug. Administer into Y-site as closeto insertion site as possiblecan precipitate in IV fluids andbe absorbed into infusion bags and tubing. Injection maycause burning and venous irritation; avoid small veins. Rate:Administer slowly at a rate of 5 mg over at least 1 min. Infantsand children should receive total dose over a minimum of 35min. Rectal: Do not repeat Diastatrectal dose more than5 times/mo or 1 episode every 5 days. Round dose up to nextavailable dose unit.

I ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,drowsiness, lethargy, depression, h

med notes. pocket drug guide

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