MedNotes: Pocket Drug Guide, Third Edition

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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

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.

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BASICS

A–C

D–H

I–M

N–R

S–Z

TOOLS

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™

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: ■ Adrenergic agonists (e.g., epinephrine, isoproterenol, norepinephrine) ■ Cardioplegic solutions ■ Chemotherapeutic agents ■ Chloral hydrate (in pediatric patients) ■ Colchicine injection ■ High concentration dextrose (10% dextrose) ■ Hypoglycemic agents (oral) ■ Hypertonic sodium chloride injection ( 0.9% concentration) ■ Insulin ■ IV adrenergic antagonists (propranolol, esmolol, metoprolol) ■ IV calcium; IV magnesium sulfate ■ IV digoxin ■ IV potassium (phosphate and chloride) ■ Lidocaine/ benzocaine other topical anesthetics ■ Midazolam ■ Neuromuscular blocking agents ■ Opiates (opioids) ■ Thrombolytics, heparin, warfarin

BASICS

BASICS

Safe Medication Administration ■ Carefully read product packaging to note strength of solution, dosage, and/or route of administration. ■ Double-check with a pharmacist about dose range. ■ Have a colleague double-check dosage calculations and infusion pump programming. ■ Use the 5 Rights (right drug, right dose, right patient, right route, right time) as a guide. ■ Clarify any order that is incomplete, contains abbreviations, is confusing or hard to read, or raises a question. ■ 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 ■ All patients need clear written and verbal instruction for all medications. Do not rush. Include family members. ■ Present information in a format the patient can understand. ■ Use an interpreter if provider and patient speak different languages. ■ Have the patient repeat the information you provide. ■ 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

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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) 

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

BASICS

IV Administration Starting an IV ■ Prepare the patient: Explain procedure, answer any questions, and reassure. ■ Gather equipment: IV bag with primed tubing, sharps container, catheter, tape, tourniquet, and antiseptic swabs. ■ Organize supplies: Tear tape, have primed tubing and sharps container within easy reach, and open 22 dressing. ■ Apply tourniquet proximal to intended insertion site, either midforearm or above the elbow. ■ 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. ■ Cleanse site: Using moderate friction, cleanse in a circular motion, moving outward from intended site. ■ Put on gloves while waiting for cleansed area to dry. Avoid touching site once it has been prepared. ■ Apply traction (in the direction opposite the catheter). ■ Position needle, bevel side up, 15–30. NOTE: Hold the needle with the thumb and pointer finger in a way that allows for visualization of the flash chamber. ■ 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. ■ Advance the catheter: Thread catheter into vein while maintaining skin traction. ■ Release the tourniquet, and apply digital pressure just above the end of the catheter tip while gently stabilizing the hub of the catheter. ■ Remove needle, and discard into approved sharps container. ■ Connect IV tubing, open clamp, and observe for free flow of IV fluid. ■ Secure catheter, and apply sterile dressing per hospital policy and procedure. ■ Clean up, and document per hospital policy and procedure.

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5

IV Insertion Guide

BASICS

BASICS

IV Piggyback (IVPB) Setup ■ ■ ■ ■ ■

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.

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7 Flushing IV Catheters Catheter Type

Solution

Strength

Frequency

Peripheral Catheters (Open Ended) Peripheral IV catheter Midline catheter (each lumen if multiple)

Normal saline

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

BASICS

Intramuscular (IM) Injection Sites

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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

Gauge and Angle

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

25 g–26 g, 3/8′′ @ 90 (45 if on a thin patient)

10

Aspirate

Massage Site

No

No

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 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.

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13

Mixing Insulins

BASICS

A–C

ACYCLOVIR (ay-sye-kloe-veer) Avirax, Zovirax Antiviral Pregnancy Category B (PO, IV) C (topical) ■ 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: ■ Inhibition of viral replication, decreased viral shedding, reduced lesion-healing time. ■ 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. ■ 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.

■ 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. ■ CONTRAINDICATIONS: Hypersensitivity to acyclovir or valacyclovir. ■ CAUTIONS: Concurrent use of other nephrotoxic drugs increases the risk of adverse renal effects.

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15 ALBUTEROL (al-byoo-ter-awl) AccuNeb, Proventil, Ventodisk, Ventolin bronchodilator Pregnancy Category C ■ INDICATIONS: Asthma or COPD-induced reversible airway obstruction, acute bronchospasm, prevention of exerciseinduced bronchospasm, long-term control of chronic/persistent bronchospasm. Therapeutic Effects: ■ Bronchodilation. ■ DOSAGE: PO: Adults and Children 12: 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 4 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 4 yr: Via metered-dose inhaler—2 inhalations q 4–6 h. ■ 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. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Nervousness, restlessness, tremor, chest pain, palpitations, angina, arrhythmias, hypertension, hypokalemia. ■ CONTRAINDICATIONS: Hypersensitivity to adrenergic amines or hypersensitivity to fluorocarbons inhaler. ■ 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

A–C

ALENDRONATE (uh-len-dro-nate) Fosamax Bone resorption inhibitor Pregnancy Category C ■ INDICATIONS: Osteoporosis, Paget’s disease of the bone. Therapeutic Effects: ■ Reversal of the progression of osteoporosis with decreased fractures, decreased progression of Paget’s disease. ■ 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. ■ 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. ■ 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. ■ CONTRAINDICATIONS: Renal insufficiency (CCr 35 mL/min), pregnancy, lactation. ■ 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.

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17 ALLOPURINOL (al-oh-pure-i-nawl) Apo-Allopurinol, Lopurin, Zyloprim Anti-gout agent, antihyperuricemic Pregnancy Category C

■ 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: ■ Lowering of serum uric acid levels by inhibiting the production of uric acid. ■ DOSAGE: PO: Adults: 100 to 800 mg/d. Doses 300 mg/d should be given in divided doses. Children 6–10 yr: 300 mg daily. Children 6 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. ■ ADMINISTRATION: May be administered with milk or meals to minimize gastric irritation. May be crushed. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Drowsiness, diarrhea, hepatitis, nausea, vomiting, renal failure, rash, urticaria, bone marrow depression, hypersensitivity reactions. ■ CONTRAINDICATIONS: Hypersensitivity; pregnancy/lactation. ■ 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

A–C

ALPRAZOLAM (al-pra-zoe-lam) Apo-Alpraz, Nu-Alpraz, Xanax antianxiety agent (benzodiazepine) Pregnancy Category D ■ INDICATIONS: Anxiety, panic attacks, premenstrual syndrome (PMS) (unlabeled use). Therapeutic Effects: ■ Relief of anxiety. ■ DOSAGE: PO: Adults: 0.25–0.5 mg 2–3 times daily. ■ ADMINISTRATION: May be administered with food if GI upset occurs. Tablets may be crushed.

■ 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. ■ CONTRAINDICATIONS: Hypersensitivity, narrow-angle glaucoma, cross-sensitivity with other benzodiazepines, preexisting CNS depression, severe, uncontrolled pain, pregnancy and lactation. ■ 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.

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19 AMILORIDE (a-mill-oh-ride) Midamor diuretic (potassiumsparing diuretic) Pregnancy Category B ■ INDICATIONS: Counteract potassium loss caused by other diuretics; used with thiazides to treat edema or hypertension. Therapeutic Effects: ■ Weak diuretic and antihypertensive response when compared with other diuretics, conservation of potassium. ■ DOSAGE: PO: Adults: 5–10 mg/d (up to 20 mg). ■ ADMINISTRATION: PO: Administer in morning to avoid interrupting sleep pattern. Administer with food or milk to minimize gastric irritation and to increase bioavailability. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness, arrhythmias, constipation, GI irritation, impotence, hyperkalemia, hyponatremia, muscle cramps, allergic reactions. ■ CONTRAINDICATIONS: Hypersensitivity, hyperkalemia. ■ 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

A–C

AMIODARONE (a-mee-oh-da-rone) Cordarone, Pacerone antiarrhythmic Pregnancy Category D ■ INDICATIONS: Ventricular arrhythmias. Unlabeled Uses: Supraventricular tachyarrhythmias. Therapeutic Effects: ■ Suppression of arrhythmias. ■ 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. ■ ADMINISTRATION: PO: Administer with meals if GI intolerance occurs. IV: Administer via volumetric pump using an inline filter. ■ 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. ■ CONTRAINDICATIONS: Severe sinus node dysfunction, 2nd and 3rd AV block, bradycardia, pregnancy, and lactation. ■ 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.

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21 AMITRIPTYLINE (a-meh-trip-ti-leen) Elavil, Levate, Novotriptyn antidepressant (tricyclic) Pregnancy Category D ■ INDICATIONS: Depression, chronic pain syndromes (unlabeled use).

Therapeutic Effects: ■ Improved mood. ■ 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.

■ 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.

■ 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.

■ CONTRAINDICATIONS: Narrow-angle glaucoma, pregnancy and lactation.

■ 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

A–C

AMLODIPINE (am-loe-di-peen) Norvasc antihypertensive (calcium channel blocker) Pregnancy Category C ■ INDICATIONS: Management of hypertension, angina pectoris, and vasospastic (Prinzmetal) angina. Therapeutic Effects: ■ Systemic vasodilation and decreased blood pressure. Coronary vasodilation and decreased frequency and severity of angina. ■ DOSAGE: PO: Adults: 5–10 mg daily. ■ ADMINISTRATION: May be administered without regard to meals. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Headache, dizziness, fatigue, peripheral edema, angina, bradycardia, hypotension, palpitations, gingival hyperplasia, nausea, flushing. ■ CONTRAINDICATIONS: Hypersensitivity to amlodipine or blood pressure 90 mm Hg. ■ 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.

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23 AMOXICILLIN/CLAVULANATE (a-mox-i-sill-in klav-yoolan-ate) Augmentin ES, Augmentin XR, Clavulin anti-infective Pregnancy Category B

■ INDICATIONS: Skin and skin structure infections, otitis media, sinusitis, respiratory tract infections, genitourinary tract infections, meningitis, septicemia. Therapeutic Effects: ■ Bactericidal action against susceptible bacteria. ■ DOSAGE: PO: Adults and Children 40 kg: Tablets: 250–500 mg tablet q 8–12 h. Suspension: 500 mg q 12 h. Children 2 yr: 20–40 mg/kg/d in divided doses q 8–12 h. Children 3 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 3 mo: 15 mg/kg q 12 h (125 mg/mL suspension recommended). ■ 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 40 kg due to clavulanate content. ■ ADVERSE REACTIONS AND SIDE EFFECTS: SEIZURES (high doses), PSEUDOMEMBRANOUS COLITIS, diarrhea, hepatic dysfunction, nausea, vomiting, rashes, urticaria, ANAPHYLAXIS and SERUM SICKNESS, superinfection. ■ CONTRAINDICATIONS: Hypersensitivity to penicillins or clavulanate. ■ 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

A–C

AMOXICILLIN (uh-mox-i-sil-in) Amoxil, Novamoxin, Trimox anti-infective, anti-ulcer agent Pharm Class: Aminopenicillins Pregnancy Category B ■ 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: ■ Bactericidal action. ■ DOSAGE: PO: Adults and Children 20 kg: 250–500 mg q 8 h or 500–875 mg q 12 h. Children 3 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 3 mo: up to 30 mg/kg/d in divided doses q 12 h. ■ 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. ■ 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. ■ CONTRAINDICATIONS: Hypersensitivity to penicillins. ■ 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

25 ATENOLOL (a-ten-oh-lole) Apo-Atenolol, Novo-Atenolol, Tenormin antianginal, antihypertensive (selective beta-blocker) Pregnancy Category D ■ INDICATIONS: Hypertension, angina, reduce risk of second MI. Therapeutic Effects: ■ Lower blood pressure and heart rate, decreased frequency of angina. ■ DOSAGE: PO: Adults: 25–100 mg once daily. IV: Adults: Administer 5 mg over 5 min, followed by another 5mg 10 min later. ■ ADMINISTRATION: PO: Take apical pulse before administering drug. If 50 bpm or if arrhythmia occurs, withhold medication and notify physician or other health care professional. IV: Administer each dose over 5 minutes. ■ 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 vasoconstriction, constipation, diarrhea, liver function abnormalities, nausea, vomiting, impotence, decreased libido, urinary frequency. ■ CONTRAINDICATIONS: Uncompensated CHF, pulmonary edema, cardiogenic shock, bradycardia or heart block. ■ 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

A–C

ATORVASTATIN (a-tore-va-sta-tin) Lipitor lipid-lowering agent Pregnancy Category X ■ INDICATIONS: Primary hypercholesterolemia and mixed dyslipidemia. Therapeutic Effects: ■ Lowering of total and LDL cholesterol. ■ DOSAGE: PO: Adults: 10 mg once daily initially; may be increased q 2–4 wk up to 80 mg/d. ■ ADMINISTRATION: Administer with the evening meal. ■ 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. ■ CONTRAINDICATIONS: Hypersensitivity, active liver disease, pregnancy or lactation, concurrent use of gemfibrozil or azole antifungals. ■ 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

27 AZITHROMYCIN (aye-zith-row-my-sin) Zithromax agent for atypical mycobacterium, anti-infectives (macrolide) Pregnancy Category B

■ 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: ■ Bacteriostatic action against susceptible bacteria. ■ 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 500 mg/dose) on 1st day, then 5 mg/kg (not 250 mg/dose.) IV: Adults: 500 mg IV q 24 h.

■ 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.

■ 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.

■ CONTRAINDICATIONS: Hypersensitivity to azithromycin, erythromycin, or other macrolide anti-infectives.

■ 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

A–C

BACLOFEN (bak-loe-fen) Lioresal antispasticity agent, skeletal muscle relaxant Pregnancy Category C ■ INDICATIONS: Reversible spasticity associated with multiple sclerosis or spinal cord lesions. Intrathecal: Severe spasticity originating in the spinal cord. Therapeutic Effects: ■ Decreased spasticity, improvement of bowel and bladder function. ■ 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). ■ 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.

■ ADVERSE REACTIONS AND SIDE EFFECTS: SEIZURES (intrathecal), dizziness, drowsiness, fatigue, weakness, confusion, insomnia, hypotension, nausea, pruritus, ataxia. ■ CONTRAINDICATIONS: Hypersensitivity. ■ 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

29 BECLOMETHASONE (beh-kloe-meth-a-sone) Beclodisk, Becloforte, Beclovent, Vanceril, antiasthmatic, anti-inflammatory (inhalation corticosteroid) Pregnancy Category C ■ INDICATIONS: Asthma. Therapeutic Effects: ■ Decrease frequency and severity of asthma attacks. ■ DOSAGE: Inhalation: Adults and Children 12 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). ■ ADMINISTRATION: Allow at least 1 minute between inhalations of aerosol medication. ■ 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. ■ CONTRAINDICATIONS: Acute attack of asthma/status asthmaticus. ■ 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

A–C

BENAZEPRIL (ben-aye-ze-pril) Lotensin antihypertensive (ACE inhibitors) Pregnancy Category C (first trimester), D (second and third trimesters) ■ INDICATIONS: Hypertension. Therapeutic Effects: ■ Lowering of blood pressure. ■ 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). ■ 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. ■ 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. ■ CONTRAINDICATIONS: Hypersensitivity, pregnancy, angioedema (hereditary or idiopathic). ■ 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

31 BENZTROPINE (benz-troe-peen) Apo-Benztropine, Cogentin antiparkinson agent, anticholinergic Pregnancy Category C ■ INDICATIONS: Parkinson’s disease, including drug-induced extrapyramidal effects and acute dystonic reactions. Therapeutic Effects: ■ Reduces rigidity and tremors.

■ 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. ■ ADMINISTRATION: PO: Administer with food. May be crushed and administered with food if difficulty swallowing. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Depression, hallucinations, blurred vision, dry eyes, mydriasis, arrhythmias, hypotension, palpitations, tachycardia, constipation, dry mouth, ileus, urinary retention, decreased sweating. ■ CONTRAINDICATIONS: Hypersensitivity, children 3 yr, narrow-angle glaucoma, tardive dyskinesia. ■ 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

A–C

BISOPROLOL (bis-oh-proe-lol) Zebeta antihypertensive (betablocker [selective]) Pregnancy Category C ■ INDICATIONS: Hypertension Therapeutic Effects: ■ Decreased blood pressure and heart rate. ■ DOSAGE: PO: Adults: 2.5–20 mg/d. ■ ADMINISTRATION: Administer without regard to meals.

■ 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. ■ CONTRAINDICATIONS: Uncompensated CHF, pulmonary edema, cardiogenic shock, bradycardia or heart block. ■ 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 50 or if arrhythmia occurs withhold medication and notify physician or other health care professional.

32

33 BUDESONIDE (byoo-dess-oh-nide) Pulmicort antiinflammatory (inhalation corticosteroid) Pregnancy Category B ■ INDICATIONS: Asthma Therapeutic Effects: ■ Decrease frequency and severity of asthma attacks. ■ DOSAGE: Inhalation: Adults: 1–2 inhalations once or twice daily or 2–4 inhalations twice daily (maximum 8 inhalations daily). Children 6 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. ■ ADMINISTRATION: Allow at least 1 minute between inhalations of aerosol medication. ■ 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. ■ CONTRAINDICATIONS: Acute attack of asthma/status asthmaticus. ■ 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

A–C

BUMETANIDE (byoo-met-a-nide) Bumex diuretic (loop diuretic) Pregnancy Category C ■ INDICATIONS: Edema secondary to CHF, hepatic or renal disease. Therapeutic Effects: ■ Diuresis and subsequent mobilization of excess fluid. ■ 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). ■ 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.

■ 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. ■ CONTRAINDICATIONS: Hypersensitivity (cross-sensitivity with thiazides and sulfonamides may occur), pre-existing uncorrected electrolyte imbalance, hepatic coma, or anuria. ■ 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

35 BUPROPION (byoo-proe-pee-on) Wellbutrin, Wellbutrin SR, Zyban antidepressant, smoking deterrent Pregnancy Category B ■ INDICATIONS: Depression, smoking cessation (Zyban). Unlabeled Uses: ADHD (adults, SR only), diminished libido in women. Therapeutic Effects: ■ Improved mood, decreased craving for cigarettes. ■ 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. ■ 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. ■ 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. ■ CONTRAINDICATIONS: Hypersensitivity, history of seizures, bulimia, and anorexia nervosa, concurrent MAO inhibitor therapy. ■ 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

A–C

CAPTOPRIL (kap-toe-pril) Capoten angiotensin-converting enzyme (ACE) inhibitor Pregnancy Category C (first trimester), D (second and third trimesters)

■ INDICATIONS: Hypertension, CHF, diabetic nephropathy. Therapeutic Effects: ■ Lowered blood pressure, improvement in symptoms of CHF. ■ 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. ■ ADMINISTRATION: Administer 1 hour before or 2 hours after meals. ■ 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. ■ CONTRAINDICATIONS: Hypersensitivity, cross-sensitivity among ACE inhibitors may occur, pregnancy, angioedema (hereditary or idiopathic). ■ 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

37 CARISOPRODOL (kar-i-sop-roe-dole) Soma, Vanadom skeletal muscle relaxant Pregnancy Category UK ■ INDICATIONS: Adjunct to rest and physical therapy in the treatment of muscle spasm associated with acute painful musculoskeletal conditions.

Therapeutic Effects: ■ Skeletal muscle relaxation. ■ DOSAGE: PO: Adults: 350 mg 4 times daily. Children 5–12 yr: 6.25 mg/kg 4 times daily. ■ ADMINISTRATION: Administer with food to minimize GI irritation. Provide safety measures; supervise ambulation and transfer of patients. ■ 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. ■ CONTRAINDICATIONS: Hypersensitivity to carisoprodol or to meprobamate; porphyria or suspected porphyria. ■ 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

A–C

CARVEDILOL (kar-ve-dil-ole) Coreg antihypertensive (betablocker) Pregnancy Category C ■ INDICATIONS: Hypertension, CHF. Therapeutic Effects: ■ Decreases heart rate and blood pressure, slows the progression of CHF. ■ 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 85 kg or 50 mg twice daily in patients 85 kg). ■ ADMINISTRATION: Administer without regard to food.

■ ADVERSE REACTIONS AND SIDE EFFECTS: Weakness, anxiety, depression, insomnia, blurred vision, bronchospasm, wheezing. BRADYCARDIA, CHF, PULMONARY EDEMA, diarrhea, impotence, hyperglycemia, hypoglycemia. ■ CONTRAINDICATIONS: Uncompensated CHF, pulmonary edema, cardiogenic shock, bradycardia or heart block, hepatic impairment or bronchial asthma/bronchospasm. ■ CAUTIONS: Teach patient to check pulse daily and blood pressure biweekly and to report pulse 50 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 50 bpm or if arrhythmia occurs. Key: underline = most common; CAPS = life-threatening

38

39 CEFEPIME (seff-e-peem) Maxipime anti-infective third generation cephalosporin Pregnancy Category B ■ INDICATIONS: Skin, bone, joint, urinary, gynecologic, respiratory tract, and intra-abdominal infections; septicemia. Therapeutic Effects: ■ Bactericidal action against susceptible bacteria. ■ 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. ■ ADMINISTRATION: IV: Monitor injection site frequently for phlebitis. Rate: Administer over 30 minutes.

■ 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. ■ CONTRAINDICATIONS: Hypersensitivity to cephalosporins or penicillins. ■ 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

A–C

CELECOXIB (sel-e-kox-ib) Celebrex antirheumatic, nonsteroidal anti-inflammatory (COX-2 inhibitor) Pregnancy Category C ■ INDICATIONS: Osteoarthritis, rheumatoid arthritis, familial adenomatous polyposis (FAP). Therapeutic Effects: ■ Decreased arthritic pain and inflammation, decreased number of colorectal polyps. ■ 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. ■ ADMINISTRATION: May be administered without regard to meals.

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

41 CEPHALEXIN (sef-a-lex-in) Apo-Cephalex, Biocef, Keflex, NovoLexin anti-infective (first-generation cephalosporin) Pregnancy Category B ■ INDICATIONS: Skin and skin structure infections, pneumonia, otitis media, urinary tract infections, bone and joint infections, septicemia caused by susceptible organisms. Therapeutic Effects: ■ Bactericidal action against susceptible bacteria. ■ 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. ■ ADMINISTRATION: Administer around the clock on full or empty stomach. Administer with food to minimize GI irritation. Shake oral suspension well before administering. ■ ADVERSE REACTIONS AND SIDE EFFECTS: SEIZURES, PSEUDOMEMBRANOUS COLITIS, diarrhea, nausea, vomiting, cramps, rashes, urticaria, blood dyscrasias, hemolytic anemia, ANAPHYLAXIS and serum sickness, superinfection. ■ CONTRAINDICATIONS: Hypersensitivity to cephalosporins, serious hypersensitivity to penicillins. ■ 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

A–C

CETIRIZINE (se-ti-ra-zeen) Zyrtec allergy, cold and cough remedy, antihistamine Pregnancy Category B ■ INDICATIONS: Relief of allergic symptoms including seasonal and perennial allergic rhinitis, chronic urticaria. Therapeutic Effects: ■ Decreased symptoms of histamine excess (sneezing, rhinorrhea, nasal and ocular pruritus, ocular tearing and redness). ■ DOSAGE: PO: Adults and children 6 yr: 5–10 mg once daily. Children 6–11 yr: 5–10 mg daily. Children 2–5 yr: 2.5–5 mg daily. ■ ADMINISTRATION: Administer once daily without regard to food. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness, drowsiness, fatigue, pharyngitis, dry mouth. ■ CONTRAINDICATIONS: Hypersensitivity, acute attacks of asthma, lactation. ■ 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

43 CHLOROTHIAZIDE (klor-oh-thye-a-zide) Diuril antihypertensive (thiazide diuretic) Pregnancy Category B ■ INDICATIONS: Mild to moderate hypertension, edema.

Therapeutic Effects: ■ Lower blood pressure in hypertensive patients, diuresis with mobilization of edema. ■ DOSAGE: PO: Adults: 250 mg–1 g/d as a single dose or in divided doses. Children 6 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. ■ ADMINISTRATION: Administer in the morning to prevent disruption of sleep cycle. ■ 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. ■ CONTRAINDICATIONS: Hypersensitivity, anuria, lactation. ■ 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

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

■ INDICATIONS: Duodenal, benign and stress-induced gastric ulcers, GERD, heartburn, acid indigestion, Zollinger-Ellison syndrome. Therapeutic Effects: ■ Healing and prevention of ulcers, decreased gastroesophageal reflux, decreased secretion of gastric acid. ■ 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. ■ 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. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Confusion, dizziness, drowsiness, hallucinations, ARRHYTHMIAS, druginduced hepatitis, nausea, AGRANULOCYTOSIS, APLASTIC ANEMIA. ■ CONTRAINDICATIONS: Hypersensitivity. ■ 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.

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45 CIPROFLOXACIN (sip-roe-flox-a-sin) Cipro anti-infective (fluoroquinolone) Pregnancy Category C ■ 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: ■ Resolution of infection. ■ DOSAGE: PO: Adults: 250–750 mg q 12 h. Gonorrhea 250 mg single dose. IV: Adults: 200–400 mg q 12 h. ■ 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. ■ 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. ■ CONTRAINDICATIONS: Hypersensitivity, pregnancy, or children 18 yr. ■ 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

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CITALOPRAM (si-tal-oh-pram) Celexa antidepressant (selective serotonin reuptake inhibitor) Pregnancy Category C ■ INDICATIONS: Depression Therapeutic Effects: ■ Improved mood. ■ DOSAGE: PO: Adults: 20–60 mg/d. Geriatric Patients: 20 mg/d, up to 40 mg/d only in nonresponding patients. ■ ADMINISTRATION: Administer as a single dose in the morning or evening without regard to food. ■ 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. ■ CONTRAINDICATIONS: Hypersensitivity, concurrent MAO inhibitor therapy. ■ 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.

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47 CLINDAMYCIN (klin-da-mye-sin) Cleocin, Dalacin C, antiinfective Pregnancy Category B ■ INDICATIONS: Skin, skin structure, respiratory tract, intraabdominal and gynecologic infections, septicemia, osteomyelitis, endocarditis prophylaxis, severe acne.

Therapeutic Effects: ■ Bactericidal or bacteriostatic to susceptible organisms. ■ 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 1 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 1 mo: 3.75–10 mg/kg q 6 h or 5–13.3 mg/kg q 8 h. Infants 1 mo: 3.75–5 mg/kg q 6 h or 5–6.7 mg/kg q 8 h. ■ ADMINISTRATION: PO: Administer with glass of water; may be given with meals. IM: Do not administer 600 mg in a single IM injection. Intermittent Infusion: Rate: Administer each 300 mg over a minimum of 10 min. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Arrhythmias, hypotension, PSEUDOMEMBRANOUS COLITIS, diarrhea, bitter taste (IV only). ■ CONTRAINDICATIONS: Hypersensitivity, history of pseudomembranous colitis, severe liver impairment, diarrhea. ■ 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

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CLONAZEPAM (kloe-na-ze-pam) Klonopin, Rivotril, SynClonazepam anticonvulsant (benzodiazepine) Schedule IV Pregnancy Category C

■ INDICATIONS: Seizures, panic disorder. Unlabeled Uses: Uncontrolled leg movements during sleep, neuralgias, sedation. Therapeutic Effects: ■ Prevention of seizures, decreased frequency of panic attacks. ■ DOSAGE: PO: Adults: 1.5 mg 3 times daily, not to exceed 20 mg/d. Panic disorder: 0.125 mg twice daily. Children 10 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). ■ ADMINISTRATION: Administer with food to minimize gastric irritation. ■ 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. ■ CONTRAINDICATIONS: Hypersensitivity to clonazepam or other benzodiazepines, severe liver disease. ■ 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.

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49 CLONIDINE (klon-i-deen) Catapres, Catapres-TTS, Duraclon antihypertensive Pregnancy Category C ■ INDICATIONS: Mild to moderate hypertension, management of cancer pain unresponsive to opioids alone, opioid withdrawal (unlabeled use). Therapeutic Effects: ■ Decreased blood pressure, decreased pain. ■ 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. ■ 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. ■ 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. ■ CONTRAINDICATIONS: Hypersensitivity. Epidural: anticoagulant therapy, or bleeding problems. ■ 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

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CLOPIDOGREL (kloh-pid-oh-grel) Plavix antiplatelet agent (platelet aggregation inhibitor) Pregnancy Category B ■ 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: ■ Decreased occurrence of atherosclerotic events in patients at risk. ■ DOSAGE: PO: Adults: 75 mg once daily. ■ ADMINISTRATION: Administer once daily without regard to food. ■ 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. ■ CONTRAINDICATIONS: Hypersensitivity, pathologic bleeding (peptic ulcer, intracranial hemorrhage), lactation. ■ 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.

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51 COLCHICINE (kol-chi-seen) anti-gout agent Pregnancy Category D

■ INDICATIONS: Gouty arthritis. Therapeutic Effects: ■ Decreased pain and inflammation in acute attacks of gout, prevention of attacks. ■ 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. ■ ADMINISTRATION: PO: Administer with food. IV: Avoid extravasation; may cause necrosis. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Diarrhea, nausea, vomiting, abdominal pain, anuria, hematuria, alopecia, AGRANULOCYTOSIS, APLASTIC ANEMIA, leukopenia, thrombocytopenia. ■ CONTRAINDICATIONS: Hypersensitivity, pregnancy, severe renal, hepatic or biliary disease. ■ 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.

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CORTISONE (kor-ti-sone) Cortone, Cortone Acetate, steroidal anti-inflammatory (systemic corticosteroid) Pregnancy Category UK

■ INDICATIONS: Short-acting corticosteroid used to treat adrenocortical insufficiency, and allergic and inflammatory disorders. Therapeutic Effects: ■ Suppression of inflammation; modification of the normal immune response; replacement of deficient adrenal corticoids. ■ 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. ■ ADMINISTRATION: PO: Administer with meals to minimize GI irritation. ■ 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. ■ CONTRAINDICATIONS: Active untreated infections, lactation. ■ 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.

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53 DALTEPARIN (dal-te-pa-rin) Fragmin anticoagulant (low molecular weight heparin [LMWH]) (antithrombotic) Pregnancy Category B ■ 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: ■ Prevention of thrombus formation. ■ 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. ■ ADMINISTRATION: SC: Administer deep into SC tissue. Do not aspirate or massage. Rotate sites frequently. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness, insomnia, edema, urinary retention, ecchymoses, pruritus, rash, urticaria, BLEEDING, anemia, thrombocytopenia, hematoma. ■ CONTRAINDICATIONS: Hypersensitivity, uncontrolled bleeding, thrombocytopenia, regional anesthesia during treatment for unstable angina/non–Q–wave MI. ■ 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

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DEXAMETHASONE (dex-a-meth-a-sone) Decadron, Decaject, Dexameth steroidal anti-inflammatory (systemic corticosteroid) Pregnancy Category UK

■ INDICATIONS: Inflammatory, allergic, hematologic, neoplastic, autoimmune disorders, replacement therapy in adrenal insufficiency, cerebral edema. Diagnostic agent in adrenal disorders. Therapeutic Effects: ■ Suppression of inflammation, modification of the normal immune response. ■ 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. ■ 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. ■ 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. ■ CONTRAINDICATIONS: Active untreated infections, lactation. ■ 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.

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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

■ INDICATIONS: Anxiety, preoperative sedation, conscious sedation, status epilepticus/uncontrolled seizures, skeletal muscle relaxant, alcohol withdrawal. Therapeutic Effects: ■ Relief of anxiety, sedation, skeletal muscle relaxation, decreased seizure activity. ■ DOSAGE: PO: Adults: 2–10 mg 2–4 times daily or 15–30 mg of extended-release form once daily. Children 6 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 5 yr: 1 mg q 2–5 min up to 10 mg. ■ 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. ■ 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)

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DIAZEPAM (Continued) ■ CONTRAINDICATIONS: Hypersensitivity, comatose patients, pre-existing CNS depression, uncontrolled severe pain, narrow-angle glaucoma, pregnancy or lactation. ■ 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.

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57 DIGOXIN (di-jox-in) Digitek, Lanoxicaps, Lanoxin antiarrhythmic, inotropic Pregnancy Category C ■ INDICATIONS: CHF, tachyarrhythmias atrial fibrillation and atrial flutter, paroxysmal atrial tachycardia. Therapeutic Effects: ■ Increased cardiac output and slowing of the heart rate. ■ DOSAGE: PO: Maintenance dose: Adults: 0.125–0.25 mg daily. Geriatrics: 0.0625–0.125 daily or every other day. Children 2 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 2 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 2 yr: 0.025–0.035 mg/kg. Children 1–24 mo: 0.03–0.05 mg/kg.

■ 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. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Fatigue, headache, weakness, blurred vision, yellow vision, ARRHYTHMIAS, bradycardia, ECG changes, anorexia, nausea, vomiting, diarrhea, gynecomastia, thrombocytopenia. ■ CONTRAINDICATIONS: Hypersensitivity, uncontrolled ventricular arrhythmias, AV block, idiopathic hypertrophic subaortic stenosis, constrictive pericarditis. ■ 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 60 bpm in an adult, 70 bpm in a child, or 90 bpm in an infant, or if patient exhibits signs (Continued)

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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 60 or 100. • 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.

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59 DILTIAZEM (dil-tye-a-zem) Apo-Diltiaz, Cardizem, Diltia XT, NuDiltiaz, Tiamate, antianginal, antiarrhythmic, antihypertensive (calcium channel blocker) Pregnancy Category C ■ INDICATIONS: Hypertension, angina, supraventricular tachyarrhythmias, atrial flutter/fibrillation with rapid ventricular rate. Therapeutic Effects: ■ Decreased blood pressure, decreased frequency and severity of angina, suppression of arrhythmias. ■ DOSAGE: PO: Adults: 120–360 mg daily in divided doses. IV: Adults: 5–15 mg/h. ■ ADMINISTRATION: PO: Give with meals if GI irritation is a problem. IV: Rate: Administer bolus over 2 min. ■ 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, palpitations, tachycardia, abnormal liver function studies, erythema multiforme, photosensitivity, pruritus/urticaria, hyperglycemia, blood dyscrasias, STEVENS-JOHNSON SYNDROME, gingival hyperplasia. ■ CONTRAINDICATIONS: Hypersensitivity, sick sinus syndrome, 2nd- or 3rd-degree AV block, blood pressure 90 mm Hg, recent MI or pulmonary congestion. ■ 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 50 bpm. • Caution patient to change positions slowly. Key: underline = most common; CAPS = life-threatening

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DONEPEZIL (doe-nep-i-zill) Aricept anti-Alzheimer’s agent, cholinergic Pregnancy Category C ■ INDICATIONS: Mild to moderate dementia associated with Alzheimer’s disease. Therapeutic Effects: ■ May temporarily lessen some of the dementia associated with Alzheimer’s disease. ■ DOSAGE: PO: Adults: 5 mg once daily; after 4–6 wk may increase to 10 mg once daily. ■ ADMINISTRATION: Administer in the evening just before going to bed. May be taken without regard to food. ■ 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. ■ CONTRAINDICATIONS: Hypersensitivity to donepezil or piperidine derivatives. ■ 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.

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61 DOXAZOSIN (dox-uh-zoe-sin) Cardura antihypertensive (antiadrenergic) Pregnancy Category C ■ INDICATIONS: Hypertension, symptomatic management of benign prostatic hyperplasia (BPH). Therapeutic Effects: ■ Lowers blood pressure. ■ DOSAGE: PO: Adults: Hypertension: 2–16 mg/d; incidence of postural hypotension greatly increased at doses 4 mg/d. BPH: 1 mg once daily, may be gradually increased to 8 mg/d. ■ ADMINISTRATION: Administer daily dose at bedtime. ■ 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. ■ CONTRAINDICATIONS: Hypersensitivity. ■ 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

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ENALAPRIL (e-nal-a-pril) Vasotec ENALAPRILAT (e-nal-a-pril-at) Vasotec IV Pregnancy Category C (first trimester), D (second and third trimesters) ■ INDICATIONS: Hypertension, CHF. Therapeutic Effects: ■ Lowered blood pressure, improvement in CHF symptoms. ■ 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. ■ 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. ■ 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. ■ CONTRAINDICATIONS: Hypersensitivity to enalapril or other ACE inhibitors, pregnancy, history of angioedema. ■ 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.

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63 ENOXAPARIN (e-nox-a-pa-rin) Lovenox anticoagulant (low molecular weight heparin [LMWH]) (antithrombotic) Pregnancy Category B

■ 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: ■ Prevention of thrombus formation. ■ 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. ■ ADMINISTRATION: SC: Administer deep into SC tissue. Do not aspirate or massage. Rotate sites frequently. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness, insomnia, edema, urinary retention, ecchymoses, pruritus, rash, urticaria, BLEEDING, anemia, thrombocytopenia, hematoma. ■ CONTRAINDICATIONS: Hypersensitivity to pork products, uncontrolled bleeding, thrombocytopenia, patients with prosthetic heart valves. ■ 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

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ESTRADIOL (es-tra-dye-ole) Estrace, Gynodiol hormone (estrogen) Pregnancy Category X ■ 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: ■ Restoration of hormonal balance in various deficiency states, treatment of hormone-sensitive tumors. ■ 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. ■ ADMINISTRATION: Administer with or immediately after food to reduce nausea. Estradiol is also available in injectable, transdermal, and vaginal tablet or ring formulations.

■ 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. ■ CONTRAINDICATIONS: Thromboembolic disease, undiagnosed vaginal bleeding, pregnancy, lactation. ■ 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.

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65 FENTANYL (TRANSDERMAL) (fen-ta-nil) Duragesic opioid analgesic, opioid agonist Schedule II Pregnancy Category C ■ INDICATIONS: Chronic pain requiring opioid analgesic therapy. Therapeutic Effects: ■ Decreases severity of chronic pain. ■ 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. ■ ADMINISTRATION: Apply to flat, nonirritated, and nonirradiated site. If skin preparation is necessary, use clear water and clip, do not shave, hair. ■ 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. ■ CONTRAINDICATIONS: Hypersensitivity to fentanyl or adhesives, known intolerance, acute pain. ■ 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 10/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

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FEXOFENADINE (fex-oh-fen-a-deen) Allegra allergy, cold and cough remedy, antihistamine Pregnancy Category C ■ INDICATIONS: Seasonal allergic rhinitis, chronic idiopathic urticaria. Therapeutic Effects: ■ Decreased sneezing, rhinorrhea, itchy eyes, nose, and throat associated with seasonal allergies, decreased urticaria. ■ DOSAGE: PO: Adults and Children 12 yr: 60 mg twice daily, or 180 mg once daily. Children 6–11 yr: 30 mg twice daily. ■ ADMINISTRATION: Administer with food or milk to decrease GI irritation. Capsules and tablets should be taken with water or milk, not juice.

■ ADVERSE REACTIONS AND SIDE EFFECTS: Drowsiness, fatigue, dyspepsia, and dysmenorrhea. ■ CONTRAINDICATIONS: Hypersensitivity. ■ CAUTIONS: Use cautiously in impaired renal function (increased dosing interval recommended), pregnancy, lactation, or children 12 yr. • Magnesium and aluminumcontaining antacids decrease absorption and may decrease effectiveness. • Apple, orange, and grapefruit juice decrease absorption any may decrease effectiveness.

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67 FINASTERIDE (fi-nas-teer-ide) Propecia, Proscar hair regrowth stimulant/androgen inhibitor Pregnancy Category X ■ INDICATIONS: Benign prostatic hyperplasia (BPH), androgenetic alopecia (male pattern baldness) in men only. Therapeutic Effects: ■ Reduces prostate size with associated decrease in urinary symptoms, decreased hair loss, hair regrowth.

■ DOSAGE: PO: Adults: BPH: 5 mg once daily (Proscar); androgenetic alopecia: 1 mg/d (Propecia). ■ ADMINISTRATION: Administer once daily with or without meals. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Decreased libido, decreased volume of ejaculate, impotence. ■ CONTRAINDICATIONS: Hypersensitivity, women. ■ CAUTIONS: • Caution patient that finasteride poses a potential risk to a male fetus. Women who are pregnant or may become pregnant should avoid exposure to semen of a partner taking finasteride and should not handle crushed finasteride because of the potential for absorption. • Clinical effects as noted by urinary tract symptoms and hair regrowth may not be evident for several months and remain for 4 months after discontinuation. • Assess patient for symptoms of prostatic hypertrophy (urinary hesitancy, feeling of incomplete bladder emptying, 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. • Instruct patient to take finasteride as directed, even if symptoms improve or are unchanged. • At least 6–12 months of therapy may be necessary to determine whether or not an individual will respond to finasteride. • Inform patient that the volume of ejaculate may be decreased during therapy but that this will not interfere with normal sexual function. Key: underline = most common; CAPS = life-threatening

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FLUCONAZOLE (floo-kon-a-zole) Diflucan antifungal (systemic) Pregnancy Category C ■ INDICATIONS: Fungal infections, prevention of candidiasis after bone marrow transplantation. Therapeutic Effects: ■ Fungistatic or fungicidal action against susceptible organisms. ■ DOSAGE: PO, IV: Adults: Esophageal or oropharyngeal candidiasis: 200 mg initially, then 100 mg daily for 2–3 weeks. Other candidiasis: 50–400 mg/d. Cryptococcal meningitis: 400 mg once daily until favorable clinical response, then 200–400 mg once daily for at least 10–12 wk after clearing of CSF. Suppressive therapy: 200 mg once daily. Vaginal candidiasis: 150-mg single oral dose. Children 6 mo: 3 mg/kg/d for at least 2–3 wk. Cryptococcal meningitis: 6–12 mg/kg/d for at least 10–12 wk after clearing of CSF. Suppressive therapy: 6 mg/kg/d. ■ ADMINISTRATION: PO: Shake oral suspension well before administration. IV: Open overwrap immediately before infusion. Rate: Infuse at a maximum rate of 200 mg/h. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Headache, HEPATOTOXICITY, abdominal discomfort, diarrhea, nausea, vomiting, exfoliative skin disorders including STEVENSJOHNSON SYNDROME. ■ CONTRAINDICATIONS: Hypersensitivity to fluconazole or other azole antifungals, concurrent use with pimozide. ■ CAUTIONS: Increases the activity of warfarin. • Rifampin, rifabutin, and isoniazid decrease blood levels. • Increases the hypoglycemic effects of tolbutamide, glyburide, or glipizide. • Increases blood levels and risk of toxicity from cyclosporine, rifabutin, tacrolimus, theophylline, zidovudine, alfentanil, and phenytoin. • Increases blood levels and effects of benzodiazepines, zolpidem, buspirone, nisoldipine, tricyclic antidepressants, and losartan.

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69 FLUOROURACIL (flure-oh-yoor-a-sill) Adrucil, Efudex, Fluoroplex, 5-FU antineoplastic antimetabolite Pregnancy Category D ■ INDICATIONS: Colon, breast, rectal, gastric, pancreatic carcinoma. Actinic keratoses and superficial basal cell carcinomas. Therapeutic Effects: ■ Death of malignant cells. ■ DOSAGE: IV: Adults: Carcinoma—Initial dose: 12 mg/kg/d for 4 days, then 1 day of rest, then 6 mg/kg every other day for 4–5 doses. Maintenance: 7–12 mg/kg q 7–10 days or 300–500 mg/m2/d for 4–5 days, repeated monthly (no single daily dose should exceed 800 mg). Topical: Adults: Actinic keratoses: 1% solution or cream 1–2 times daily. Basal cell carcinomas: 5% solution or cream twice daily. ■ ADMINISTRATION: Direct IV: Rate: Administer over 1–2 min. Intermittent Infusion: Rate: Infuse over 2–8 h. Topical: Wear gloves when applying medication. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Diarrhea, nausea, stomatitis, vomiting, alopecia, maculopapular rash, local inflammatory reactions (topical only), melanosis of nails, nail loss, palmar-plantar erythrodysesthesia, phototoxicity, anemia, leukopenia, thrombocytopenia. ■ CONTRAINDICATIONS: Hypersensitivity, pregnancy or lactation. ■ CAUTIONS: HIGH ALERT MED: Chemotherapeutic agents are toxic. Dosing, calculations, and infusion pump settings should be independently checked by two other practitioners. • The number 5 in 5-fluorouracil is part of the drug name and does not refer to the dosage. • Stop infusion if extravasation occurs and restart in another vein. • Instruct patient in correct application of solution or cream; explain that erythema, scaling, and blistering with pruritus and burning sensation are expected. • Review with patient the need for contraception during therapy. Key: underline = most common; CAPS = life-threatening

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FLUOXETINE (floo-ox-uh-teen) Prozac, Prozac Weekly, Sarafem antidepressant (selective serotonin reuptake inhibitor) Pregnancy Category B

■ INDICATIONS: Depression, OCD, bulimia nervosa, premenstrual dysphoric disorder (PMDD). Unlabeled Uses: Anorexia nervosa, ADHD, fibromyalgia, obesity, panic attacks. Therapeutic Effects: ■ Improved mood. ■ DOSAGE: PO: Adults: 20–80mg daily. Geriatric Patients: 10–60 mg daily. ■ ADMINISTRATION: Administer with food as a single dose in the morning. ■ ADVERSE REACTIONS AND SIDE EFFECTS: SEIZURES, anxiety, drowsiness, headache, insomnia, nervousness, tremor, dizziness, fatigue, hypomania, mania, weakness, visual disturbances, cough, chest pain, palpitations, diarrhea, anorexia, dry mouth, nausea, vomiting, weight loss, sexual dysfunction, urinary frequency, excessive sweating, pruritus, erythema nodosum, flushing, arthralgia, myalgia, allergic reactions, hot flashes. ■ CONTRAINDICATIONS: Hypersensitivity, concurrent use or use within 14 days of discontinuing MAO inhibitors (fluoxetine should be discontinued 5 weeks before MAO therapy is initiated). ■ CAUTIONS: Do not confuse Sarafem (fluoxetine) with Serophene (clomiphene). • Discontinue use of MAO inhibitors 14 days before fluoxetine therapy, (increased risk of serotonin syndrome). • Discontinue fluoxetine 5 wk before initiating MAO inhibitor. • Additive CNS depression with alcohol, antihistamines, other antidepressants, opioid analgesics, or sedative/hypnotics. • Increased risk of side effects with other antidepressants, tryptophan, risperidone, or phenothiazines. • May increase risk of toxicity from carbamazepine, clozapine, digoxin, haloperidol, phenytoin, lithium, or warfarin. • Caution patient to avoid driving until response to the drug is known.

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71 FONDAPARINUX (fon-da-par-i-nux) Arixtra anticoagulant Pregnancy Category B ■ INDICATIONS: Prevention of deep vein thrombosis.

Therapeutic Effects: ■ Interruption of the coagulation cascade resulting in inhibition of thrombus formation. ■ DOSAGE: SC: Adults: 2.5 mg once daily, starting 6–8 h after surgery and continuing for 5–9 days (up to 11 days). ■ ADMINISTRATION: Administer SC only into fatty tissue, alternating sites between right and left anterolateral or posterolateral abdominal wall. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Confusion, dizziness, headache, insomnia, edema, hypotension, constipation, diarrhea, dyspepsia, increased serum aminotransferases, nausea, vomiting, urinary retention, bullous eruption, hematoma, purpura, rash, BLEEDING, thrombocytopenia, hypokalemia, fever, increased wound drainage. ■ CONTRAINDICATIONS: Hypersensitivity, severe renal impairment, body weight 50 kg, active major bleeding, bacterial endocarditis, and thrombocytopenia due to fondaparinux antibodies. ■ CAUTIONS: HIGH ALERT MED: Deaths have occurred when two anticoagulant medications inadvertently are given concurrently. Double check medications to ensure that two anticoagulant products are not given simultaneously. • Use with caution in patients with severe uncontrolled hypertension, bleeding disorders, GI pathology, hemorrhagic stroke, recent CNS or ophthalmologic surgery, spinal/epidural anesthesia (increased risk of spinal/epidural hematomas). • Risk of bleeding may be increased by concurrent use of warfarin, aspirin, NSAIDs, dipyridamole, some cephalosporins, valproates, clopidogrel, ticlopidine, abciximab, eptifibatide, tirofiban, and dextran. • Increased risk of bleeding with arnica, chamomile, dong quai, feverfew, garlic, ginger, gingko, Panax ginseng, licorice, and others.

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FOSINOPRIL (foe-sin-oh-pril) Monopril Pregnancy Category C (first trimester), D (second and third trimesters) ■ INDICATIONS: Hypertension, CHF. Therapeutic Effects: ■ Lowered blood pressure, improvement in symptoms of CHF. ■ DOSAGE: PO: Adults: 5–40 mg once daily, maximum 80 mg/d. ■ ADMINISTRATION: Precipitous drop in blood pressure during first 1–3 h following first dose may occur, especially if also taking diuretics. Monitor blood pressure closely. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness, fatigue, headache, cough, hypotension, taste disturbances, anorexia, diarrhea, nausea, proteinuria, impotence, renal failure, rashes, hyperkalemia, AGRANULOCYTOSIS, ANGIOEDEMA. ■ CONTRAINDICATIONS: Hypersensitivity, pregnancy, history of angioedema. ■ CAUTIONS: 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. • Additive hypotension with other antihypertensives, nitrates, phenothiazines, acute ingestion of alcohol, and during surgery or general anesthesia. • Hyperkalemia with 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.

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73 FUROSEMIDE (fur-oh-se-mide) Apo-Furosemide, Furoside, Lasix, Lasix Special diuretic (loop diuretic) Pregnancy Category C ■ INDICATIONS: Edema secondary to CHF, hepatic or renal disease, hypertension. Therapeutic Effects: ■ Diuresis and subsequent mobilization of excess fluid. Lowering of blood pressure. ■ DOSAGE: PO, IM, IV: Adults: Diuretic: 20–80 mg/d initially, may increase by 20–40 mg q 6–8 h (up to 600 mg/d). Antihypertensive: 40–80 mg (up to 200 mg if accompanied by pulmonary edema/acute renal failure). Children: PO: 2 mg/kg as a single dose; may be increased by 1–2 mg/kg q 6–8 h (up to 5–6 mg/kg/d). Children: IM, IV: Diuretic: 1 mg/kg, may increase by 1 mg/kg q 2 h (not to exceed 6 mg/kg). ■ ADMINISTRATION: Direct IV: Rate: Administer slowly over 1–2 min. Intermittent Infusion: Rate: Administer at a rate not to exceed 4 mg/min in adults to prevent ototoxicity. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness, hearing loss, tinnitus, hypotension, constipation, dry mouth, dehydration, hypochloremia, hypokalemia, hypomagnesemia, hyponatremia, hypovolemia, metabolic alkalosis, hyperglycemia, arthralgia, muscle cramps, myalgia, increased BUN. ■ CONTRAINDICATIONS: Hypersensitivity (cross-sensitivity with thiazides and sulfonamides may occur), uncorrected electrolyte imbalance, hepatic coma, anuria. ■ CAUTIONS: Additive hypotension with antihypertensives and 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 effect of warfarin, thrombolytic agents, or anticoagulants.

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

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GABAPENTIN (ga-ba-pen-tin) Neurontin analgesic adjunct, anticonvulsant Pregnancy Category C ■ INDICATIONS: Partial seizures. Unlabeled Uses: Chronic pain, prevention of migraine headache. Therapeutic Effects: ■ Decreased incidence of seizures. ■ DOSAGE: PO: Adults and Children 12 yr: 600–1800 mg/d in 3 divided doses. Doses up to 2400–3600 mg/d have been well tolerated. Children 5–12 yr: 10–35 mg/kg/d in 3 divided doses. Children 3–4 yr: 10–40 mg/kg/d in 3 divided doses. ■ ADMINISTRATION: May be administered without regard to meals. Discontinue gradually over at least 1 week—abrupt discontinuation may increase frequency of seizures. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Drowsiness, anxiety, concentration difficulties (children), dizziness, emotional lability (children), hostility, hyperkinesia (children), malaise, vertigo, weakness, ataxia, altered reflexes, hyperkinesia, paresthesia, abnormal vision, nystagmus, hypertension, anorexia, flatulence, gingivitis, arthralgia, facial edema. ■ CONTRAINDICATIONS: Hypersensitivity. ■ CAUTIONS: Increased risk of CNS depression with other CNS depressants, including alcohol, antihistamines and sedative/ hypnotics. • Kava, valerian, skullcap, chamomile, or hops can increase CNS depression. • Instruct patients on tid dosing not to exceed 12 h between doses. • If a dose is missed, take as soon as possible; if less than 2 h until next dose, take immediately, take next dose 1–2 h later, then resume regular dosing. • Do not double doses. • Do not discontinue abruptly. • Do not to take within 2 h of an antacid.

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75 GEMFIBROZIL (gem-fye-broe-zil) Lopid lipid-lowering agent (fibric acid derivative) Pregnancy Category C ■ INDICATIONS: Management of type II-b hyperlipidemia (decreased HDLs, increased LDLs, increased triglycerides) in patients who do not yet have clinical coronary artery disease and have failed therapy with diet, exercise, weight loss, or other agents (niacin, bile acid sequestrants).

Therapeutic Effects: ■ Decreased plasma triglycerides and increased HDL. ■ DOSAGE: PO: Adults: 600 mg twice daily 30 min before breakfast and dinner. ■ ADMINISTRATION: Administer 30 min before breakfast or dinner. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness, headache, blurred vision, abdominal pain, diarrhea, epigastric pain, gallstones, heartburn, nausea, vomiting, alopecia, rashes, urticaria, anemia, myositis. ■ CONTRAINDICATIONS: Hypersensitivity, primary biliary cirrhosis, concurrent use of HMG-CoA reductase inhibitors. ■ CAUTIONS: May increase the effects of warfarin or sulfonylurea oral hypoglycemic agents. • Concurrent use with HMGCoA reductase inhibitors may increase the risk of rhabdomyolysis. • May decrease the effect of cyclosporine. • Instruct patient to notify health care professional if severe stomach pains with nausea and vomiting, fever, chills, sore throat, rash, diarrhea, muscle cramping, general abdominal discomfort, or persistent flatulence occur. • Advise patient to comply with dietary restrictions, exercise program, and smoking cessation program. • Liver function tests should be assessed before and periodically throughout therapy. • May cause an increase in serum bilirubin, alkaline phosphatase, CK, LDH, AST, and ALT. • If hepatic function tests rise significantly, therapy should be discontinued and not resumed. Key: underline = most common; CAPS = life-threatening

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GLIMEPIRIDE (glye-meh-per-ide) Amaryl antidiabetic (sulfonylureas) Pregnancy Category C ■ INDICATIONS: Type 2 diabetes mellitus. Therapeutic Effects: ■ Control of blood glucose levels. ■ DOSAGE: PO: Adults: 1–2 mg once daily initially; may increase q 1–2 wk up to 8 mg/d (usual range 1–4 mg/d). ■ ADMINISTRATION: Administer with morning meal. If prescribed in 2 divided doses, do not administer after last meal of the day.

■ ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness, drowsiness, headache, weakness, constipation, cramps, diarrhea, drug-induced hepatitis, heartburn, increased appetite, nausea, vomiting, photosensitivity, rashes, hypoglycemia, hyponatremia, APLASTIC ANEMIA, agranulocytosis, leukopenia, pancytopenia, thrombocytopenia. ■ CONTRAINDICATIONS: Hypersensitivity, severe renal, hepatic, thyroid, or other endocrine disease, Type 1 diabetes, diabetic coma or ketoacidosis, uncontrolled infection, serious burns, or trauma. ■ CAUTIONS: Ingestion of alcohol may result in disulfiram-like reaction. • Effectiveness may be decreased by concurrent use of diuretics, corticosteroids, phenothiazines, oral contraceptives, estrogens, thyroid preparations, phenytoin, nicotinic acid, sympathomimetics, and isoniazid. • Concurrent use with warfarin may alter the response to both agents (increased effects of both initially, then decreased activity); close monitoring recommended during any changes in dosage. • Beta-blockers may alter the response to oral hypoglycemic agents (increase or decrease requirements). • Glucosamine may worsen blood glucose control. • Fenugreek, chromium, and coenzyme Q-10 may produce additive hypoglycemic effects.

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77 GLIPIZIDE (glip-i-zide) Glucotrol, Glucotrol XL antidiabetic (sulfonylurea) Pregnancy Category C ■ INDICATIONS: Type 2 diabetes. Therapeutic Effects: ■ Improved blood glucose levels. ■ DOSAGE: PO: Adults: 2.5–40 mg/day; XL dosage form is given once daily. Doses 15 mg/d should be given as 2 divided doses. ■ ADMINISTRATION: Administer with morning meal. If prescribed in 2 divided doses, do not administer after last meal of the day. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness, drowsiness, headache, weakness, constipation, cramps, diarrhea, drug-induced hepatitis, heartburn, increased appetite, nausea, vomiting, photosensitivity, rashes, hypoglycemia, hyponatremia, APLASTIC ANEMIA, agranulocytosis, leukopenia, pancytopenia, thrombocytopenia. ■ CONTRAINDICATIONS: Hypersensitivity, severe renal, hepatic, thyroid, or other endocrine disease, Type 1 diabetes, diabetic coma or ketoacidosis, uncontrolled infection, serious burns, or trauma. ■ CAUTIONS: Ingestion of alcohol may result in disulfiram-like reaction. • Effectiveness may be decreased by concurrent use of diuretics, corticosteroids, phenothiazines, oral contraceptives, estrogens, thyroid preparations, phenytoin, nicotinic acid, sympathomimetics, and isoniazid. • Concurrent use with warfarin may alter the response to both agents (increased effects of both initially, then decreased activity); close monitoring recommended during any changes in dosage. • Beta-blockers may alter the response to oral hypoglycemic agents (increase or decrease requirements). • Glucosamine may worsen blood glucose control. • Fenugreek, chromium, and coenzyme Q-10 may produce additive hypoglycemic effects.

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GLYBURIDE (glye-byoo-ride) DiaBeta, Micronase, Glynase PresTab antidiabetic (sulfonylurea) Pregnancy Category B ■ INDICATIONS: Type 2 diabetes. Therapeutic Effects: ■ Improved blood glucose levels. ■ DOSAGE: PO: Adults: DiaBeta/Micronase (nonmicronized): 1.25–20 mg/d). Glynase PresTab (micronized): 0.75–12 mg/d. ■ ADMINISTRATION: Administer with morning meal. If prescribed in 2 divided doses, do not administer second dose after last meal of the day. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness, drowsiness, headache, weakness, constipation, cramps, diarrhea, drug-induced hepatitis, heartburn, increased appetite, nausea, vomiting, photosensitivity, rashes, hypoglycemia, hyponatremia, APLASTIC ANEMIA, agranulocytosis, leukopenia, pancytopenia, thrombocytopenia. ■ CONTRAINDICATIONS: Hypersensitivity, severe renal, hepatic, thyroid, or other endocrine disease, Type 1diabetes, diabetic coma or ketoacidosis, uncontrolled infection, serious burns, or trauma. ■ CAUTIONS: Ingestion of alcohol may result in disulfiram-like reaction. • Effectiveness may be decreased by concurrent use of diuretics, corticosteroids, phenothiazines, oral contraceptives, estrogens, thyroid preparations, phenytoin, nicotinic acid, sympathomimetics, and isoniazid. • Concurrent use with warfarin may alter the response to both agents (increased effects of both initially, then decreased activity); close monitoring recommended during any changes in dosage. • Beta-blockers may alter the response to oral hypoglycemic agents (increase or decrease requirements). • Glucosamine may worsen blood glucose control. • Fenugreek, chromium, and coenzyme Q-10 may produce additive hypoglycemic effects.

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79 HEPARIN (hep-a-rin) Calcilean, Calciparine, Hepalean anticoagulant (antithrombotic) Pregnancy Category C ■ INDICATIONS: Venous thromboembolism, pulmonary emboli, atrial fibrillation with embolization, acute and chronic coagulopathies, peripheral arterial thromboembolism. Therapeutic Effects: ■ Prevention of thrombus formation, prevention of extension of existing thrombi (full dose). ■ DOSAGE: SC: Adults: Therapeutic Anticoagulation: 5000 units IV, followed by initial SC dose of 10,000–20,000 units, then 8000–10,000 units every 8 hours or 15,000–20,000 units every12 hours. Prophylaxis of Thromboembolism: 5000 units every 8–12 hours (may be started 2 hours prior to surgery). IV: Adults: Therapeutic Anticoagulation: Intermittent bolus: 10,000 units, followed by 5000–10,000 units every 4–6 h. Continuous infusion: 5000 units (35–70 units/kg), followed by 20,000–40,000 units infused over 24 hours (approx. 1000 units/h or 15–18 units/kg/h). Children: Intermittent bolus: 50 units/kg, followed by 50–100 units/kg every 4 h. Continuous infusion: 50 units/kg, followed by 100 units/kg/4 h or 20,000 units/m2/24 h. ■ ADMINISTRATION: SC: Administer deep into SC tissue. Do not aspirate or massage. Rotate sites frequently. Direct IV: Rate: May be given undiluted over at least 1 min. Intermittent/ Continuous Infusion: Dilute in prescribed amount of solution and give as a continuous or intermittent infusion. Ensure adequate mixing of heparin in solution. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Drug-induced hepatitis, alopecia (long-term use), rashes, urticaria, BLEEDING, anemia, thrombocytopenia, pain at injection site, osteoporosis (long-term use), fever, hypersensitivity. ■ CONTRAINDICATIONS: Hypersensitivity, uncontrolled bleeding, severe thrombocytopenia, open wounds (full dose). ■ CAUTIONS: HIGH ALERT MED: Available in various concentrations. Dose and calculation for dilution or direct IV injection should be checked with a second licensed personnel before (Continued)

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HEPARIN (Continued) administration. • 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). Notify physician if these occur. • Use cautiously in severe uncontrolled hypertension, bacterial endocarditis, bleeding disorders, GI bleeding/ulceration/ pathology, hemorrhagic stroke, recent CNS or ophthalmologic surgery, active GI bleeding/ulceration, history of thrombocytopenia related to heparin, severe liver or kidney disease, retinopathy (hypertensive or diabetic), untreated hypertension, ulcer disease, spinal cord or brain injury, history of congenital or acquired bleeding disorder, malignancy, women 60 yr, last trimester of pregnancy, immediate postpartum period. Risk of bleeding may be increased by aspirin, NSAIDs, clopidogrel, dipyridamole, some penicillins, ticlopidine, abciximab, eptifibatide, tirofiban, and dextran. • Risk of bleeding may be increased by concurrent use of drugs that cause hypoprothrombinemia, including quinidine, cefamandole, cefmetazole, cefoperazone, cefotetan, plicamycin, and valproic acid. • Concurrent use of thrombolytic agents increases the risk of bleeding. • Digoxin, tetracycline, nicotine, and antihistamines may decrease the anticoagulant effect of heparin. • Streptokinase may be followed by relative resistance to heparin. Increased risk of bleeding with arnica, anise, chamomile, clove, dong quai, feverfew, garlic, ginger, and Panax ginseng. • Venipunctures and injection sites require application of pressure to prevent bleeding or hematoma formation. • IM injections of other medications should be avoided, because hematomas may develop.

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81 HYDROCHLOROTHIAZIDE (hye-droe-klor-oh-thye-a-zide) Esidrix, HCTZ, Hydro-chlor, HydroDIURIL antihypertensive (thiazide diuretic) Pregnancy Category B ■ INDICATIONS: Mild to moderate hypertension, edema. Therapeutic Effects: ■ Lower blood pressure, diuresis with mobilization of edema. ■ DOSAGE: PO: Adults: Hypertension: 12.5 mg/d initially (range 12.5–100 mg/d in 1–2 doses up to 200 mg/d; not to exceed 50 mg/d for hypertension). Children 6 mo: 1–2 mg/kg (30–60 mg/m2/d) in 1–2 divided doses. Children 6 mo: Up to 3 mg/kg per day. ■ ADMINISTRATION: Administer in the morning to prevent disruption of sleep cycle. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness, lethargy, weakness, hypotension, anorexia, cramping, hepatitis, nausea, photosensitivity, hyperglycemia, hypokalemia, dehydration, hypercalcemia, hypomagnesemia, hyponatremia, hypophosphatemia, hypovolemia, hyperuricemia, elevated lipids, muscle cramps, and pancreatitis. ■ CONTRAINDICATIONS: Hypersensitivity, anuria, lactation. ■ CAUTIONS: • Additive hypotension with other antihypertensives, acute ingestion of alcohol, or nitrates. • Additive hypokalemia with corticosteroids, amphotericin B, mezlocillin, piperacillin, or ticarcillin. • Decreases the excretion of lithium. Cholestyramine or colestipol decreases absorption. • Hypokalemia increases risk of digoxin toxicity. • Assess patient, especially if taking digitalis glycosides, for anorexia, nausea, vomiting, muscle cramps, paresthesia, and confusion. Notify physician or other health care professional if these signs of electrolyte imbalance occur. • Instruct patient to monitor weight biweekly and notify health care professional of significant changes. • Caution patient to change positions slowly to minimize orthostatic hypotension. Key: underline = most common; CAPS = life-threatening

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HYDROCORTISONE (hye-droe-kor-ti-sone) A-hydroCort, Cortef, Hydrocortone, Solu-Cortef steroidal anti-inflammatory (systemic corticosteroid) Pregnancy Category UK ■ INDICATIONS: Adrenocortical insufficiency; allergic and inflammatory disorders. Therapeutic Effects: ■ Suppression of inflammation; modification of the immune response; replacement of deficient adrenal corticoids. ■ DOSAGE: PO: Adults: 20–240 mg/d in divided doses. Children: Adrenocortical insufficiency: 0.56 mg/kg (15–20 mg/m2)/d as a single dose or in divided doses. Other uses: 2–8 mg/kg/d (60–240 mg/m2/d) as a single dose or in divided doses. IM, IV: Adults: Adrenocortical insufficiency: 100–500 mg q 2–6 h. Children: Adrenocortical insufficiency: 0.186–0.28 mg/kg/d (10–12 mg/m2)/d in 3 divided doses. Other uses: 0.666–4 mg/kg (20–120 mg/m2) q 12–24 h. ■ ADMINISTRATION: PO: Administer with meals to minimize GI irritation. Direct IV: Rate: Administer each 100 mg over at least 30 sec. Doses 500 mg and larger should be infused over at least 10 min. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Depression, euphoria, restlessness, hypertension, PEPTIC ULCERATION, anorexia, nausea, acne, decreased wound healing, ecchymoses, hirsutism, petechiae, adrenal suppression, hyperglycemia, hypokalemia, THROMBOEMBOLISM, thrombophlebitis, muscle wasting, osteoporosis, cushingoid appearance, increased susceptibility to infection. ■ CONTRAINDICATIONS: Active untreated infections, lactation. ■ CAUTIONS: Instruct patient to report severe abdominal pain or tarry stools. • May increase need for insulin or oral hypoglycemic agents. • Increased risk of adverse GI effects with NSAIDs. • Instruct patient to report swelling, weight gain, tiredness, bone pain, bruising, nonhealing sores, visual or behavioral changes.

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83 HYDROMORPHONE (hye-droe-mor-fone) Dilaudid, Hydrostat IR opioid analgesic Schedule II Pregnancy Category C ■ INDICATIONS: Moderate to severe pain, persistent dry cough. Therapeutic Effects: ■ Decreased severity of pain, cough suppression. ■ DOSAGE: PO: Adults and children 50 kg: Pain: 1–4 mg q 4–6 h. Antitussive: 1mg q 3–4 h prn. Children 6 months and 50 kg: Pain: 0.03–0.08 mg/kg q 3–4 h. IM, IV, SC: Adults and children 50 kg: 1–4 mg q 3–4 h. Children 6 months and 50 kg: 0.015 mg/kg q 3–4 h. Adults: Continuous infusion: 0.1–0.2 mg q 5–15 min, maximum 4–6 mg q 4 h. ■ ADMINISTRATION: Direct IV: Rate: Give 2 mg over 3–5 min. Rapid administration can lead to respiratory depression and circulatory collapse. Continuous Infusion: Use patientcontrolled analgesia (PCA) pump. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Confusion, sedation, dizziness, RESPIRATORY DEPRESSION, hypotension, constipation, nausea, urinary retention, physical or psychological dependence, tolerance. ■ CONTRAINDICATIONS: Hypersensitivity. ■ CAUTIONS: HIGH ALERT MED: • Do not confuse with morphine; hydromorphone is 5 times stronger and errors have resulted in fatalities. Have a second practitioner independently check infusion pump programming. • Assess level of consciousness, blood pressure, pulse, and respirations. If respiratory rate is 10/min, assess level of sedation. Have naloxone (Narcan) available. • Use with extreme caution in patients receiving MAO inhibitors within 14 days prior (may result in unpredictable, severe reactions—decrease initial dose of morphine to 25% of usual dose). • Use cautiously in head trauma, increased intracranial pressure, severe renal, hepatic, or pulmonary disease, undiagnosed abdominal pain, prostatic hypertrophy, pregnancy or lactation.

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HYDROXYZINE (hye-drox-i-zeen) Apo-Hydroxyzine, Atarax, Hyzine-50, Multipax, Novohydroxyzin, Vistaril antianxiety agent, antihistamine, sedative/hypnotic Pregnancy Category C

■ INDICATIONS: Anxiety, preoperative sedation, nausea and vomiting, and itching. Adjunct to opioids. Therapeutic Effects: ■ Sedation, relief of anxiety, decreased nausea and vomiting, decreased allergic symptoms associated with release of histamine, including itching. ■ DOSAGE: PO: Adults: 25–100 mg 3 to 4 times daily. Children 6–12 yr: 12.5–25 mg 3–4 times daily. Children 6 yr: 12.5 mg 3 to 4 times daily. IM: Adults: 25–100 mg every 4–6 h. Children: 1.1 mg/kg every 4–6 h. ■ ADMINISTRATION: PO: Tablets may be crushed and capsules opened and administered with food or fluids. Shake suspension well before administering. IM: Injection is extremely painful. Administer only IM deep into well-developed muscle, preferably with Z-track technique. Do not use deltoid. If must be administered to children, midlateral muscles of the thigh are preferred. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Drowsiness, agitation, ataxia, dizziness, headache, weakness, wheezing, dry mouth, bitter taste, constipation, nausea, urinary retention, flushing, pain at IM site, abscesses at IM sites, chest tightness. ■ CONTRAINDICATIONS: Hypersensitivity, pregnancy. ■ CAUTIONS: Additive CNS depression with alcohol, antidepressants, antihistamines, opioid analgesics, sedative/hypnotics, kava, valerian, skullcap, chamomile, or hops. • Additive anticholinergic effects with antihistamines, antidepressants, atropine, haloperidol, phenothiazines, quinidine, and disopyramide. • May cause drowsiness or dizziness. • Caution patient to avoid driving and other activities requiring alertness until response to medication is known.

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85 INFLIXIMAB (in-flix-i-mab) Remicade antirheumatic, gastrointestinal anti-inflammatory Pregnancy Category C ■ INDICATIONS: Rheumatoid arthritis, Crohn disease. Therapeutic Effects: ■ Decreased pain, swelling and rate of joint destruction in patients with rheumatoid arthritis. Reduced signs and symptoms of Crohn disease.

■ DOSAGE: IV: Adults: Rheumatoid arthritis: 3 mg/kg followed by 3 mg/kg 2 and 6 wk after initial dose and then every 8 wk. Moderate-to-severe Crohn disease: 5 mg/kg as a single infusion. Fistulizing Crohn disease: 5 mg/kg repeated 2 and 6 wk after initial infusion. ■ ADMINISTRATION: Administer over at least 2 hours through polyethylene-lined administration set with filter. Do not administer with any other agents. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Fatigue, headache, upper respiratory tract infection, dyspnea, chest pain, hypertension, hypotension, tachycardia, worsening of CHF, abdominal pain, nausea, vomiting, constipation, diarrhea, INFECTIONS (including reactivation tuberculosis and invasive fungal infections), fever, infusion reactions. ■ CONTRAINDICATIONS: Hypersensitivity, CHF, and lactation. ■ CAUTIONS: Reactions (fever, chills, urticaria, pruritus) usually seen during and for 2 hours after infusion. Symptoms usually resolve when infusion is discontinued. Frequency of reactions may be reduced with immunosuppressant agents. • Medications (antihistamines, acetaminophen, corticosteroids, epinephrine) and equipment should be readily available in the event of a severe reaction.

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

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INSULIN ASPART (in-su-lin) Novolog antidiabetic (pancreatic hormone) Pregnancy Category B ■ INDICATIONS: Rapid-acting insulin (onset: 10–20 min; peak 1–3 h; duration: 3–5 h) used to treat elevated glucose levels in type 1 and type 2 diabetes (usually in addition to intermediate and long-acting insulins). More rapid absorption and onset than regular insulin, with a shorter duration. Therapeutic Effects: ■ Reduction of blood glucose levels. ■ DOSAGE: SC: Adults: 0.25—0.7 units/kg/d in divided doses injected 5–10 minutes before each meal. ■ ADMINISTRATION: SC: Use only insulin syringes to draw up dose. Do not administer cold insulin: can lead to lipodystrophy. Rotate injection sites.

■ ADVERSE REACTIONS AND SIDE EFFECTS: Urticaria, HYPOGLYCEMIA, rebound hyperglycemia (Somogyi effect), lipodystrophy, itching, lipohypertrophy, redness, swelling, allergic reactions including ANAPHYLAXIS. ■ CONTRAINDICATIONS: Allergy or hypersensitivity. ■ CAUTIONS: HIGH ALERT MED: Do not accept insulin orders that contain the abbreviation “U” for “units.” It can be misread as a zero and has resulted in serious, tenfold overdoses. Clarify any order that contains this abbreviation. • Assess patient for signs and symptoms of hypoglycemia (cool, clammy skin, difficulty concentrating, drowsiness; excessive hunger; headache; irritability; nausea; rapid pulse; shakiness) and hyperglycemia (flushed, dry skin; fruity breath odor; frequent urination; loss of appetite; tiredness; unusual thirst) throughout therapy.

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87 INSULIN GLARGINE (in-su-lin glar-geen) Lantus antidiabetic (pancreatic hormone) Pregnancy Category C ■ INDICATIONS: Type 1 and type 2 diabetes. Long-acting insulin with a constant concentration over 24 hours with no pronounced peak. Provides a continuous level of insulin, similar to the steady secretion of insulin provided by the normal pancreas. Therapeutic Effects: ■ Control of blood glucose levels.

■ DOSAGE: SC: Adults and children: Begin with 10 units at bedtime and titrate according to glucose levels. ■ ADMINISTRATION: SC: Use only insulin syringes to draw up dose. Rotate injection sites. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Urticaria, HYPOGLYCEMIA, rebound hyperglycemia (Somogyi effect), lipodystrophy, itching, lipohypertrophy, redness, swelling, allergic reactions including ANAPHYLAXIS. ■ CONTRAINDICATIONS: Allergy or hypersensitivity. ■ CAUTIONS: HIGH ALERT MED: Lantus insulin cannot be mixed with other insulins; action may be affected in an unpredictable manner. • Do not accept insulin orders that contain the abbreviation “U” for “units.” It can be misread as a zero and has resulted in serious, tenfold overdoses. Clarify any order that contains this abbreviation. • Do not confuse Lantus insulin with Lente insulin. • Assess patient for signs and symptoms of hypoglycemia (cool, clammy skin, difficulty concentrating, drowsiness; excessive hunger; headache; irritability; nausea; rapid pulse; shakiness) and hyperglycemia (flushed, dry skin; fruity breath odor; frequent urination; loss of appetite; tiredness; unusual thirst) throughout therapy.

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

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INSULIN INJECTION CONCENTRATED (in-su-lin) Iletin II Regular (Concentrated) U-500 antidiabetic, hormone Pregnancy Category B ■ INDICATIONS: Short-acting insulin (onset: 1/2–1 h; peak 2–3 h; duration: 5–7 h) used to treat elevated glucose levels only in insulin-resistant patients with type 1 diabetes whose insulin requirements exceed 200 units/d. Therapeutic Effects: ■ Lowered blood glucose levels. ■ DOSAGE: SC: Adults: Individualized dosages 15-30 minutes before meals or based on blood glucose levels. Double check dosages. ■ ADMINISTRATION: Do not administer cold insulin: can lead to lipodystrophy. Rotate injection sites. ■ ADVERSE REACTIONS AND SIDE EFFECTS: HYPOGLYCEMIA, rebound hyperglycemia (Somogyi effect), lipodystrophy, itching, lipohypertrophy, redness, swelling, allergic reactions including ANAPHYLAXIS. ■ CONTRAINDICATIONS: Allergy or hypersensitivity. ■ CAUTIONS: HIGH ALERT MED: Concentrated regular insulin (500 units per mL) is 5 times more concentrated than regular insulin (100 units per mL). Do not confuse with regular insulin. • There are no U-500 syringes and using a U-100 syringe may result in dosage errors. Order should be expressed in units and volume (e.g., 200 units, 0.4 mL) and a tuberculin syringe should be used for administration. • Do not accept insulin orders that contain the abbreviation “U” for “units.” It can be misread as a zero and has resulted in serious, tenfold overdoses. Clarify any order that contains this abbreviation. • Never use concentrated insulin IV because of potential for overdosage. • Assess patient for signs and symptoms of hypoglycemia (cool, clammy skin, difficulty concentrating, drowsiness; excessive hunger; headache; irritability; nausea; rapid pulse; shakiness) and hyperglycemia throughout therapy. ISMP Medication Safety Alert, Jan 23, 2002, WWW.ismp.org/MSArticles/ATQ102action.htm

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89 INSULIN INJECTION (REGULAR) (in-su-lin) Humulin R, Insulin-Toronto, Novolin R, Iletin II Regular, Velosulin BR antidiabetic (pancreatic hormone) Pregnancy Category B

■ INDICATIONS: Short-acting insulin (onset: 1/2–1 h; peak 2–3 h; duration: 5–7 h) used to treat elevated glucose levels in type 1 and type 2 diabetes (usually in addition to intermediate and long-acting insulins); diabetic ketoacidosis/coma, hyperkalemia. Therapeutic Effects: ■ Reduction of blood glucose levels; intracellular shift of potassium.

■ DOSAGE: SC: Adult: 2–10 units 15–30 minutes before meals or in response to blood glucose elevations. Child: 2–4 units 15–30 minutes before meals or in response to blood glucose elevations. IV: Adult: 2–7 units per hour as a continuous infusion. Child: 0.1 unit/kg per hour as a continuous infusion. ■ ADMINISTRATION: Use only insulin syringes to draw up dose. SC: Do not administer cold insulin: can lead to lipodystrophy. Rotate injection sites. IV: Regular insulin is the only insulin that can be administered IV. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Urticaria, HYPOGLYCEMIA, rebound hyperglycemia (Somogyi effect), lipodystrophy, itching, lipohypertrophy, redness, swelling, allergic reactions including ANAPHYLAXIS. ■ CONTRAINDICATIONS: Allergy or hypersensitivity. ■ CAUTIONS: HIGH ALERT MED: • Do not accept insulin orders that contain the abbreviation “U” for “units.” It can be misread as a zero and has resulted in serious, tenfold overdoses. Clarify any order that contains this abbreviation. Do not confuse Humulin R with Humulin N, Humulin U, or Humalog. • Assess patient for signs and symptoms of hypoglycemia (cool, clammy skin, difficulty concentrating, drowsiness; excessive hunger; headache; irritability; nausea; rapid pulse; shakiness) and hyperglycemia throughout therapy. Key: underline = most common; CAPS = life-threatening

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INSULIN, ISOPHANE (NPH) (in-su-lin) Humulin N, NPH Iletin II, Novolin Ge NPH, Novolin N antidiabetic (pancreatic hormone) Pregnancy Category B

■ INDICATIONS: Intermediate-acting insulin (onset: 1–2 h; peak 8–12 h; duration: 18–24 h) used to treat elevated glucose levels in patients with type 1 and type 2 diabetes. Therapeutic Effects: ■ Control of blood glucose levels. ■ DOSAGE: Adults: 7–26 units as a single dose 30-60 minutes before breakfast. A second smaller dose may be given before dinner or at bedtime. Dose may be increased 2-10 units daily or weekly until desired control is achieved. ■ ADMINISTRATION: Use only insulin syringes to draw up dose. SC: Do not administer cold insulin: can lead to lipodystrophy. Rotate vial between palms and invert gently to mix; do not shake. Rotate injection sites. May be mixed with regular insulin. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Urticaria, HYPOGLYCEMIA, rebound hyperglycemia (Somogyi effect), lipodystrophy, itching, lipohypertrophy, redness, swelling, allergic reactions including ANAPHYLAXIS. ■ CONTRAINDICATIONS: Allergy or hypersensitivity. ■ CAUTIONS: HIGH ALERT MED: • Do not accept insulin orders that contain the abbreviation “U” for “units.” It can be misread as a zero and has resulted in serious, tenfold overdoses. Clarify any order that contains this abbreviation. • Do not confuse Humulin N with Humulin R, Humulin U, or Humalog. • Assess patient for signs and symptoms of hypoglycemia (cool, clammy skin, difficulty concentrating, drowsiness; excessive hunger; headache; irritability; nausea; rapid pulse; shakiness) and hyperglycemia throughout therapy. • Advise patient to eat a snack mid-afternoon and bedtime to prevent hypoglycemia during peak hours.

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91 INSULIN LISPRO (in-su-lin) Humalog antidiabetic (pancreatic hormone) Pregnancy Category B ■ INDICATIONS: Rapid-acting insulin used to treat elevated glucose levels in type 1 and type 2 diabetes (usually in addition to intermediate and long-acting insulins, or, with type 2 diabetes, oral hypoglycemic agents). Therapeutic Effects: ■ Reduction of blood glucose levels. ■ DOSAGE: SC: Adults: 5–10 units up to 15 minutes before meals. Use only U-100 insulin syringes to draw up insulin lispro dose. ■ ADMINISTRATION: Use only U-100 insulin syringes to draw up insulin lispro dose. Do not administer cold insulin: can lead to lipodystrophy. Rotate injection sites. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Urticaria, HYPOGLYCEMIA, rebound hyperglycemia (Somogyi effect), lipodystrophy, itching, lipohypertrophy, redness, swelling, allergic reactions including ANAPHYLAXIS. ■ CONTRAINDICATIONS: Allergy or hypersensitivity. ■ CAUTIONS: HIGH ALERT MED: Do not accept insulin orders that contain the abbreviation “U” for “units.” It has been misread as a zero, which resulted in serious, ten-fold overdose. Clarify any order that contains this abbreviation. • Do not confuse Humalog with Humulin. • Hypoglycemia is most likely 2 to 4 hours after administration. Assess patient for signs and symptoms of hypoglycemia (cool, clammy skin, difficulty concentrating, drowsiness; excessive hunger; headache; irritability; nausea; rapid pulse; shakiness) and advise patient to keep a source of concentrated sugar on hand (candy, sugar packets) and identification describing their disease and treatment regimen at all times. • Assess for hyperglycemia throughout therapy. • When mixing insulins, draw insulin lispro into syringe first to avoid contamination of insulin lispro vial. Key: underline = most common; CAPS = life-threatening

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INSULIN ZINC SUSPENSION, EXTENDED (ULTRALENTE) (in-su-lin) Humulin U, Ultralente, Novolin de Ultralente, Novolin U, Ultralente U antidiabetic (pancreatic hormone) Pregnancy Category B

■ INDICATIONS: Long-acting insulin (onset: 4–8 h; peak 16–18 h; duration: 36 h) used to treat elevated glucose levels in patients with type 1 diabetes. Therapeutic Effects: ■ Control of blood glucose levels. ■ DOSAGE: Individualized dose 30 minutes before breakfast. ■ ADMINISTRATION: Use only insulin syringes to draw up dose. SC: Do not administer cold insulin: can lead to lipodystrophy. Rotate vial between palms and invert gently to mix; do not shake. Rotate injection sites. May be mixed with regular insulin. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Urticaria, HYPOGLYCEMIA, rebound hyperglycemia (Somogyi effect), lipodystrophy, itching, lipohypertrophy, redness, swelling, allergic reactions including ANAPHYLAXIS. ■ CONTRAINDICATIONS: Allergy or hypersensitivity. ■ CAUTIONS: HIGH ALERT MED: • Do not accept insulin orders that contain the abbreviation “U” for “units.” It can be misread as a zero and has resulted in serious, tenfold overdoses. Clarify any order that contains this abbreviation. • Do not confuse Humulin U with Humulin R, Humulin N, or Humalog. • Assess patient for signs and symptoms of hypoglycemia (cool, clammy skin, difficulty concentrating, drowsiness; excessive hunger; headache; irritability; nausea; rapid pulse; shakiness) and hyperglycemia (flushed, dry skin; fruity breath odor; frequent urination; loss of appetite; tiredness; unusual thirst) throughout therapy. • Advise patient to eat a snack mid-afternoon and bedtime to prevent hypoglycemia during peak hours.

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93 INSULIN ZINC SUSPENSION (LENTE) (in-su-lin) Humulin L, Lente Iletin II, Novolin Ge Lente, Novolin L antidiabetic (pancreatic hormone) Pregnancy Category B

■ INDICATIONS: Intermediate-acting insulin (onset: 1–2 h; peak 8–12 h; duration: 18–24 h) used to treat elevated glucose levels in patients with type 1 and type 2 diabetes. Therapeutic Effects: ■ Control of blood glucose levels.

■ DOSAGE: Adults: 7–26 units as a single dose 30–60 minutes before breakfast. A second smaller dose may be given before dinner or at bedtime. Dose may be increased 2–10 units daily or weekly until desired control is achieved. ■ ADMINISTRATION: Use only insulin syringes to draw up dose. SC: Do not administer cold insulin: can lead to lipodystrophy. Rotate vial between palms and invert gently to mix; do not shake. Rotate injection sites. May be mixed with regular insulin. ■ ADVERSE REACTIONS AND SIDE EFFECTS: HYPOGLYCEMIA, rebound hyperglycemia (Somogyi effect), lipodystrophy, lipohypertrophy, redness, swelling, allergic reactions including ANAPHYLAXIS. ■ CONTRAINDICATIONS: Allergy or hypersensitivity. ■ CAUTIONS: HIGH ALERT MED: Do not accept insulin orders that contain the abbreviation “U” for “units.” It can be misread as a zero and has resulted in serious, tenfold overdoses. Clarify any order that contains this abbreviation. • Do not confuse Humulin L with Humulin N, Humulin R, Humulin U, or Humalog. Do not confuse Lente insulin with Lantus. • Assess for signs and symptoms of hypoglycemia (fatigue; cool, clammy skin; difficulty concentrating; drowsiness; excessive hunger; headache; irritability; rapid pulse; shakiness. • Advise patient to eat a snack mid afternoon and bedtime to prevent hypoglycemia during peak hours. • Assess patient for signs and symptoms of hyperglycemia throughout therapy. Key: underline = most common; CAPS = life-threatening

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INSULIN, PREMIXED COMBINATIONS (NPH/regular insulin mixtures) Humulin 50/50, Humulin 70/30, Novolin 70/30 ■ INDICATIONS: Combination of short-acting and intermediateacting insulins with short-acting insulin comprising 30% to 50% of the solution and intermediate acting insulin comprising 50% to 70% (onset: 30 min; peak 2–8 h; duration: 24 h). Used to treat elevated glucose levels in patients with type 1 and type 2 diabetes. Therapeutic Effects: ■ Control of blood glucose levels. ■ DOSAGE: SC: Adults: Titrated individually based on multiple factors. Maintenance therapy is usually 0.5–1 unit/kg/d. ■ ADMINISTRATION: Use only insulin syringes to draw up dose. SC: Do not administer cold insulin: can lead to lipodystrophy. Rotate vial between palms and invert gently to mix; do not shake. Rotate injection sites. May be mixed with regular insulin. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Urticaria, HYPOGLYCEMIA, rebound hyperglycemia (Somogyi effect), lipodystrophy, itching, lipohypertrophy, redness, swelling, allergic reactions including ANAPHYLAXIS. ■ CONTRAINDICATIONS: Allergy or hypersensitivity. ■ CAUTIONS: HIGH ALERT MED: • Do not accept insulin orders that contain the abbreviation “U” for “units.” It can be misread as a zero and has resulted in serious, tenfold overdoses. Clarify any order that contains this abbreviation. • Assess patient for signs and symptoms of hypoglycemia (cool, clammy skin, difficulty concentrating, drowsiness; excessive hunger; headache; irritability; nausea; rapid pulse; shakiness) and hyperglycemia throughout therapy. • Advise patient to eat a snack mid afternoon and bedtime to prevent hypoglycemia during peak hours.

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95 IPRATROPIUM (i-pra-troe-pee-um) Atrovent allergy, cold and cough remedy, bronchodilator (anticholinergic) Pregnancy Category B

■ INDICATIONS: Bronchodilation in COPD. Rhinorrhea (intranasal). Unlabeled Use: Adjunctive management of bronchospasm in asthma. Therapeutic Effects: ■ Bronchodilation without systemic anticholinergic effects. Decreased rhinorrhea.

■ DOSAGE: Inhalation: Adults: Metered-dose inhaler: 1–4 inhalations 3–4 times daily (not to exceed 24 inhalations/24 h or more frequently than q 4 h). Via nebulization: 250–500 g 3–4 times daily every 6–8 h as needed (up to 500 g q 4 h). Children 5–12 yr: Metered dose inhaler: 1–2 inhalations every 6–8 h as needed. Via nebulization: 125–250 g 3–4 times daily. Intranasal: Adults and Children 12 yr: Perennial rhinitis: 2 sprays of 0.03% solution 2–3 times daily (21 g/spray); perennial rhinitis: 2 sprays of 0.06% solution 3–4 times daily (42 g/spray) for up to 4 days. ■ ADMINISTRATION: When administering with other inhalation medications, administer adrenergic bronchodilators first, then ipratropium, then corticosteroids. Wait 5 minutes between medications. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness, headache, nervousness, blurred vision, sore throat, bronchospasm, cough, hypotension, palpitations, GI irritation, rash, allergic reactions; nasal only: epistaxis, nasal dryness/irritation. ■ CONTRAINDICATIONS: Hypersensitivity to ipratropium, atropine, belladonna alkaloids, bromide, or fluorocarbons. Avoid use during acute bronchospasm. ■ CAUTIONS: Caution patient not to exceed 12 inhaled doses within 24 hours and to notify health care professional if symptoms do not improve within 30 minutes after administration of medication or if condition worsens.

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ISOSORBIDE DINITRATE (eye-soe-sor-bide dye-nye-trate) Dilatrate-SR, Isorbid, Isordil, Isotrate, Sorbitrate antianginal (nitrate) Pregnancy Category C

■ INDICATIONS: Anginal attacks, management of angina pectoris, CHF. Therapeutic Effects: ■ Relief of anginal attacks increased cardiac output. ■ DOSAGE: PO: Adults: 10–40 mg q 6 h or 40–80 mg q 8–12 h as sustained-release form. SL: Adults: Acute attack of angina pectoris: 2.5–5 mg may be repeated q 5–10 min for 3 doses in 15–30 min. Prophylaxis of angina pectoris: 2.5–10 mg repeated q 2–3 h or 15 min prior to activity. ■ ADMINISTRATION: PO: Administer 1 hour before or 2 hours after meals with a full glass of water for faster absorption. SL: Hold tablet under tongue until dissolved; do not eat, drink, or smoke until dissolved. Replace if inadvertently swallowed. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness, headache, apprehension, weakness, hypotension, tachycardia, paradoxic bradycardia, syncope, abdominal pain, nausea, vomiting, flushing, tolerance. ■ CONTRAINDICATIONS: Hypersensitivity, severe anemia, concurrent use of sildenafil. ■ CAUTIONS: Do not confuse with isosorbide, a diuretic. • Extended-release tablets and capsules should be swallowed whole. • Do not crush, break, or chew. • Concurrent use of sildenafil may result in significant and potentially fatal hypotension. • Additive hypotension with antihypertensives, acute ingestion of alcohol, beta-blockers, calcium channel blockers, and phenothiazines. • Do not discontinue abruptly. • Make position changes slowly to minimize orthostatic hypotension. • Avoid concurrent use of alcohol. • Inform patient that headache is a common side effect that should decrease with continuing therapy. • Do not alter dose to avoid headache.

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97 ISOSORBIDE MONONITRATE (eye-soe-sor-bide mah-noenye-trate) Imdur, Ismo, Monoket antianginal (nitrate) Pregnancy Category C

■ INDICATIONS: Angina pectoris Therapeutic Effects: ■ Prevention of anginal attacks, increased cardiac output.

■ DOSAGE: PO: Adults: Ismo, Monoket: 20 mg twice daily, 7 h apart. Imdur: 30–60 mg once daily may increase to 120 mg once daily (up to 240 mg/d). ■ ADMINISTRATION: Take on an empty stomach with a full glass of water. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness, headache, apprehension, weakness, hypotension, tachycardia, paradoxic bradycardia, syncope, abdominal pain, nausea, vomiting, flushing, tolerance. ■ CONTRAINDICATIONS: Hypersensitivity, severe anemia, concurrent use of sildenafil. ■ CAUTIONS: Concurrent use of sildenafil may result in significant and potentially fatal hypotension. • Do not confuse with isosorbide, a diuretic. • Use cautiously in head trauma or cerebral hemorrhage, geriatric patients, pregnancy (may compromise maternal/fetal circulation), children or lactation. • Additive hypotension with antihypertensives, acute ingestion of alcohol, beta-blockers, calcium channel blockers, and phenothiazines. • Do not discontinue abruptly. • Make position changes slowly to minimize orthostatic hypotension. • Avoid concurrent use of alcohol. • Inform patient that headache is a common side effect that should decrease with continuing therapy. • Do not alter dose to avoid headache.

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

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ITRACONAZOLE (it-tra-kon-a-zole) Sporanox antifungal (systemic) Pregnancy Category C ■ INDICATIONS: Histoplasmosis, blastomycosis, aspergillosis, onychomycosis of the fingernail or toenail, oropharyngeal/esophageal candidiasis, suspected fungal infections in febrile neutropenic patients. Therapeutic Effects: ■ Fungistatic effects against susceptible organisms. ■ DOSAGE: PO, IV: Adults: 100 to 200 mg once or twice daily. ■ ADMINISTRATION: PO: Administer capsules with a full meal. Administer oral solution without food. IV: Rate: Administer 60 mL over 60 min; use an infusion control device. ■ ADVERSE REACTIONS AND SIDE EFFECTS: CHF, edema, hypertension, nausea, abdominal pain, anorexia, diarrhea, drug-induced hepatitis, albuminuria, TOXIC EPIDERMAL NECROLYSIS, adrenal insufficiency, hypokalemia, rhabdomyolysis. ■ CONTRAINDICATIONS: Hypersensitivity, lactation, concurrent quinidine, dofetilide, pimozide, midazolam, triazolam, simvastatin, or lovastatin, severe renal impairment, CHF or other evidence of ventricular dysfunction. ■ CAUTIONS: May increase the risk of potentially fatal arrhythmias with quinidine, dofetilide, or pimozide. • May increase the risk of excessive sedation with midazolam or triazolam. • Increased risk of adverse CNS reactions with pimozide. • Increased risk of myopathy with simvastatin or lovastatin (concurrent use contraindicated). • May increase blood levels and risk of toxicity from warfarin, ritonavir, indinavir, saquinavir, vinca alkaloids, busulfan, diazepam, felodipine, isradipine, nicardipine, nifedipine, nimodipine, cyclosporine, tacrolimus, methylprednisolone, digoxin, and quinidine. • Decreases metabolism and may increase effects of phenytoin and oral hypoglycemic agents.

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99 LAMIVUDINE (lah-mih-vyoo-deen) Epivir, Epivir HBV, 3TC antiretroviral Pregnancy Category C ■ INDICATIONS: HIV infection (AIDS) Chronic hepatitis B infection. Therapeutic Effects: ■ Slows the progression of HIV infection, increases CD4 cell counts and decreases viral load. Protection from liver damage caused by chronic hepatitis B infection. ■ DOSAGE: PO: Adults: Chronic Hepatitis B: 100 mg once daily. Adults and Children 12 yr and 50 kg: HIV infection: 150 mg twice daily. Adults 50 kg: HIV infection: 2 mg/kg twice daily. Children 3 mo–12 yr: HIV infection: 4 mg/kg twice daily (up to 150 mg twice daily). ■ ADMINISTRATION: Administer without regard to food. ■ ADVERSE REACTIONS AND SIDE EFFECTS: SEIZURES, fatigue, headache, insomnia, malaise, cough, HEPATOMEGALY WITH STEATOSIS, PANCREATITIS, anorexia, diarrhea, nausea, vomiting, abnormal liver function studies, musculoskeletal pain, rhabdomyolysis, neuropathy, ANAPHYLAXIS and STEVENS-JOHNSON SYNDROME. ■ CONTRAINDICATIONS: Hypersensitivity, lactation. ■ CAUTIONS: Use extreme caution in pediatric patients with a history of pancreatitis. • Assess patient, especially pediatric patients, for signs of pancreatitis (nausea, vomiting, abdominal pain) periodically throughout therapy. May require discontinuation of therapy. • Monitor serum amylase, lipase, and triglycerides periodically during therapy. Elevated serum levels may indicate pancreatitis and require discontinuation. Monitor liver function. • May cause elevated levels of AST, ALT, CPK, bilirubin, and alkaline phosphatase, which usually resolve after interruption of therapy. • Lactic acidosis may occur with hepatic toxicity causing hepatic steatosis; may be fatal, especially in women. Key: underline = most common; CAPS = life-threatening

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LANSOPRAZOLE (lan-soe-pra-zole) Prevacid antiulcer agent (proton pump inhibitor) Pregnancy Category B ■ INDICATIONS: Erosive esophagitis, duodenal ulcers, active benign gastric ulcer, GERD, Zollinger-Ellison syndrome and other pathologic hypersecretory conditions. Therapeutic Effects: ■ Diminished accumulation of acid in the gastric lumen, with lessened acid reflux, healing of duodenal ulcers and esophagitis. ■ DOSAGE: PO: Adults: 15–30 mg once daily (may be taken twice daily with antibiotics for treatment of H. pylori); pathologic hypersecretory conditions: 60 mg once daily initially, up to 90 mg twice daily (daily dose 120 mg should be given in divided doses). ■ ADMINISTRATION: Administer before meals. Capsules may be opened and sprinkled on 1 tbsp of applesauce, pudding, cottage cheese, or yogurt and swallowed immediately for patients with difficulty swallowing. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness, headache, diarrhea, abdominal pain, nausea, rash. ■ CONTRAINDICATIONS: Hypersensitivity. ■ CAUTIONS: Do not crush or chew capsule contents. Sucralfate decreases absorption of lansoprazole (take 30 minutes before sucralfate). • May decrease absorption of drugs requiring acid pH, including ketoconazole, itraconazole, ampicillin esters, iron salts, and digoxin. • May cause abnormal liver function tests, including increased AST, ALT, alkaline phosphatase, LDH, and bilirubin.

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101 LEVOFLOXACIN (le-voe-flox-a-sin) Levaquin anti-infective (fluoroquinolone) Pregnancy Category C ■ INDICATIONS: Urinary, gynecologic, respiratory, skin and skin structure infections. Therapeutic Effects: ■ Resolution of infection.

■ DOSAGE: PO, IV: Adults: 250–750 mg q 24 h. ■ ADMINISTRATION: PO: Do not give within 2 hours of administration: of antacids, iron, zinc, or sucralfate. IV: Rate: Administer by infusion over at least 60 minutes. Avoid rapid bolus injection. ■ ADVERSE REACTIONS AND SIDE EFFECTS: SEIZURES, dizziness, drowsiness, headache, acute psychoses, lightheadedness, tremors, PSEUDOMEMBRANOUS COLITIS, abdominal pain, diarrhea, nausea, altered taste, photosensitivity, hyperglycemia, hypoglycemia, phlebitis at IV site, tendinitis, tendon rupture, hypersensitivity reactions including ANAPHYLAXIS, STEVENS-JOHNSON SYNDROME. ■ CONTRAINDICATIONS: Hypersensitivity, pregnancy or children 18 yr. ■ 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 occur. • 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

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LEVOTHYROXINE (lee-voe-thye-rox-een) Levo-T, Levothroid, Levoxyl, Synthroid hormone (thyroid preparation) Pregnancy Category A ■ INDICATIONS: Diminished or absent thyroid function. Therapeutic Effects: ■ Restoration of normal hormonal balance. ■ DOSAGE: PO: Adults: 75–125g/d (1.5 g/kg/d). Geriatric Patients: 75 g/d. Children 10 yr: 150–200 g/d (2–3 g/kg/d). Children 6–10 yr: 100–150 g/d (4–5 g/kg/d.) Children 1–5 yr: 75–100 g/d (3–5 g/kg/d). Children 6–12 mo: 50–75 g/d (5–6 g/kg/d). IM, IV: Adults: Hypothyroidism: 50–100 g/d. Myxedema coma/stupor: 200–500 g IV. Children: Hypothyroidism: 75% of the calculated oral dose. ■ ADMINISTRATION: PO: Administer as a single dose, before breakfast. Direct IV: Dilute with 0.9% NaCl without preservatives, for a concentration of 100 g/mL. Rate: 100 g over 1 min. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Insomnia, irritability, nervousness, CARDIOVASCULAR COLLAPSE, arrhythmias, tachycardia, angina pectoris, hypertension, diarrhea, vomiting, hair loss (in children), increased sweating, hyperthyroidism, menstrual irregularities, weight loss, heat intolerance, accelerated bone maturation in children. ■ CONTRAINDICATIONS: Hypersensitivity, recent MI, thyrotoxicosis. ■ CAUTIONS: Bile acid sequestrants decrease absorption of orally administered thyroid preparations. • May alter the effectiveness of warfarin. • May cause an increase in the requirement for insulin or oral hypoglycemic agents in diabetics. • Concurrent estrogen therapy may increase thyroid replacement requirements. • Additive cardiovascular effects with adrenergics (sympathomimetics). • May decrease response to beta-blockers. • Dose should be withheld and health care professional notified if resting pulse 100 bpm.

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103 LISINOPRIL (lye-sin-oh-pril) Prinivil, Zestril antihypertensive (ACE inhibitor) Pregnancy Category D ■ INDICATIONS: Hypertension, CHF. Therapeutic Effects: ■ Lowered blood pressure, improvement in CHF symptoms.

■ DOSAGE: PO: Adults: 5–40 mg/d (maximum 80 mg/d) once daily or in two divided doses. ■ ADMINISTRATION: Precipitous drop in blood pressure during first 1–3 hours following first dose may occur. Monitor blood pressure closely. ■ 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 (CAPTOPRIL ONLY), ANGIOEDEMA, fever. ■ CONTRAINDICATIONS: Hypersensitivity, cross-sensitivity among ACE inhibitors may occur, pregnancy, angioedema (hereditary or idiopathic). ■ CAUTIONS: 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. • Additive hypotension with other antihypertensives, nitrates, phenothiazines, acute ingestion of alcohol, and during surgery or general anesthesia. • Hyperkalemia with 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.

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

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LOPERAMIDE (loe-per-a-mide) Imodium, Kaopectate II Caplets, Pepto Diarrhea Control antidiarrheal Pregnancy Category B ■ INDICATIONS: Acute diarrhea, chronic diarrhea associated with inflammatory bowel disease. Therapeutic Effects: ■ Relieves diarrhea. ■ DOSAGE: PO: Adults: 4 mg initially, then 2 mg after each loose stool. Maintenance doses usually 4–8 mg/d in divided doses. Children 9–11 yr or 30–47 kg: 2 mg initially; then 1 mg after each loose stool (not to exceed 6 mg/24 h). Children 6–8 yr or 24–30 kg: 1 mg initially, then 1 mg after each loose stool (not to exceed 4 mg/24 h). ■ ADMINISTRATION: Administer with clear fluids to help prevent dehydration.

■ ADVERSE REACTIONS AND SIDE EFFECTS: Drowsiness, dizziness, constipation, abdominal pain/distention/discomfort, dry mouth, nausea, allergic reactions. ■ CONTRAINDICATIONS: Hypersensitivity, patients in whom constipation must be avoided, abdominal pain of unknown cause, especially if associated with fever, alcohol intolerance (liquid only). ■ CAUTIONS: Additive CNS depression with other CNS depressants, alcohol, antihistamines, opioid analgesics, and sedative/hypnotics. • Additive anticholinergic properties with other drugs having anticholinergic properties, including antidepressants and antihistamines. • Kava, valerian, skullcap, chamomile, or hops can increase CNS depression. • Assess fluid and electrolyte balance and skin turgor for dehydration. • In acute diarrhea, medication may be ordered after each unformed stool. • Advise patient not to exceed the maximum number of doses. • Advise patient that frequent mouth rinses, good oral hygiene, and sugarless gum or candy may relieve dry mouth. • Caution patient to avoid using alcohol and other CNS depressants concurrently with this medication.

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105 LORATADINE (lor-a-ta-deen) Alavert, Claritin, Claritin RediTabs antihistamine Pregnancy Category B ■ INDICATIONS: Seasonal allergies, chronic idiopathic urticaria, hives. Therapeutic Effects: ■ Decreased symptoms of allergic reactions. ■ DOSAGE: PO: Adults and Children 6 yr: 10 mg once daily. Children 2–5 yr: 5 mg once daily. ■ ADMINISTRATION: Administer once daily. For rapidly disintegrating tablets (Alavert, Claritin RediTabs): Place on tongue. Tablet disintegrates rapidly. May be taken with or without water. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Confusion, drowsiness (rare), paradoxical excitation, blurred vision, dry mouth, GI upset, photosensitivity, rash, and weight gain. ■ CONTRAINDICATIONS: Hypersensitivity, lactation. ■ CAUTIONS: MAO inhibitors may intensify and prolong effects of antihistamines. • Additive CNS depression may occur with other CNS depressants, including alcohol, antidepressants, opioid analgesics, and sedative/hypnotics. • Maintain fluid intake of 1500–2000 mL/d to decrease viscosity of secretions. • Instruct patient to take medication 1 hour before or 2 hours after eating. • Advise patient that good oral hygiene, frequent rinsing of mouth with water, and sugarless gum or candy may minimize dry mouth. • Patient should notify dentist if dry mouth persists more than 2 weeks. • Instruct patient to contact health care professional immediately if dizziness, fainting, or fast or irregular heartbeat occurs.

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

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LORAZEPAM (lor-az-e-pam) Apo-Lorazepam, Ativan, NovoLorazem antianxiety agent, sedative/hypnotic (benzodiazepine) Schedule IV Pregnancy Category D ■ INDICATIONS: Anxiety, insomnia, and preoperative sedation. Unlabeled Use: Antiemetic before chemotherapy, status epilepticus. Therapeutic Effects: ■ Sedation, decreased anxiety, decreased frequency of seizures. ■ DOSAGE: PO: Adults: Anxiety: 1–3 mg 2–3 times daily. Insomnia: 2–4 mg at bedtime. Geriatric or Debilitated Patients: Anxiety: 0.5–2 mg/d in divided doses. Insomnia: 0.25–1 mg. IM: Adults: Preoperative sedation: 50 g (0.05 mg)/kg 2 h before surgery (not to exceed 4 mg). IV: Adults: Preoperative sedation: 44 g/kg (not to exceed 2 mg). Operative amnestic effect: up to 50 g/kg (not to exceed 4 mg). Antiemetic: 2 mg 30 min before chemotherapy; may be repeated q 4 h as needed. Anticonvulsant: 50 g/kg, up to 4 mg; may be repeated after 10–15 min (not to exceed 8 mg/12 h). ■ ADMINISTRATION: IV: Dilute immediately before use with an equal amount of sterile water, D5W, or 0.9% NaCl for injection. Rate: Administer at 2 mg over 1 min. Rapid IV administration may result in apnea, hypotension, bradycardia, or cardiac arrest. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness, drowsiness, lethargy, hangover, respiratory depression, dependence, tolerance. Rapid IV: APNEA, CARDIAC ARREST, bradycardia, hypotension. ■ CONTRAINDICATIONS: Hypersensitivity, pre-existing CNS depression, uncontrolled severe pain, narrow-angle glaucoma, pregnancy and lactation. ■ CAUTIONS: Additive CNS depression with other CNS depressants, kava, valerian, skullcap, chamomile, or hops. • Contact health care professional immediately if pregnancy is planned or suspected.

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107 LOSARTAN (loe-sar-tan) Cozaar: antihypertensive (angiotensin II receptor antagonist) Pregnancy Category C (first trimester), D (second and third trimesters) ■ INDICATIONS: Hypertension. Therapeutic Effects: ■ Lowering of blood pressure.

■ DOSAGE: PO: Adults: 25–100 mg/d as a single daily dose or 2 divided doses. ■ ADMINISTRATION: May be administered without regard to meals. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness, fatigue, headache, hypotension, diarrhea, drug-induced hepatitis, RENAL FAILURE, hyperkalemia. ■ CONTRAINDICATIONS: Hypersensitivity, pregnancy or lactation. ■ CAUTIONS: NSAIDs may decrease antihypertensive effects. Additive antihypertensive effects with other antihypertensives and diuretics. • Risk of hypotension is increased by concurrent diuretic therapy (use lower initial doses). • Concurrent use of potassium-sparing diuretics or potassium supplements may increase the risk of hyperkalemia. • Caution patient to avoid sudden changes in position to decrease orthostatic hypotension. • Use of alcohol, standing for long periods, exercising, and hot weather may increase orthostatic hypotension. • Advise women of childbearing age to use contraception and notify health care professional if pregnancy is suspected or planned. • 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

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METFORMIN (met-for-min) Glucophage, Glucophage XR, NovoMetformin antidiabetic Pregnancy Category B ■ INDICATIONS: Type 2 diabetes mellitus. Therapeutic Effects: ■ Regulation of blood glucose levels. ■ DOSAGE: PO: Adults: 500 mg twice daily; may increase up to 2000 mg/d. If doses 2000 mg/d are required, give in 3 divided doses (not to exceed 2500 mg/d). Extended-release tablets: 500 mg once daily with evening meal, up to 2000 mg. ■ ADMINISTRATION: Administer with meals to minimize GI effects.

■ ADVERSE REACTIONS AND SIDE EFFECTS: Abdominal bloating, diarrhea, nausea, vomiting, unpleasant metallic taste, hypoglycemia, LACTIC ACIDOSIS, decreased vitamin B12 levels. ■ CONTRAINDICATIONS: Hypersensitivity, metabolic acidosis, dehydration, sepsis, hypoxemia, impaired hepatic function, excessive alcohol ingestion, renal dysfunction (serum creatinine 1.5 mg/dL in men or 1.4 mg/dL in women), and radiographic studies requiring IV administration of iodinated contrast media, CHF. ■ CAUTIONS: Report symptoms of lactic acidosis (chills, diarrhea, dizziness, low blood pressure, muscle pain, sleepiness, slow heartbeat or pulse, dyspnea, or weakness) immediately. • Alcohol ingestion or iodinated contrast media increase risk of lactic acidosis. • Nifedipine, cimetidine and furosemide may increase the effects of metformin. • Glucosamine may worsen blood glucose control. • Fenugreek, chromium, and coenzyme Q-10 may produce additive hypoglycemic effects. • Explain risk of lactic acidosis and the potential need for discontinuation of metformin if a severe infection, dehydration, or severe or continuing diarrhea occurs or if medical tests or surgery is required.

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109 METHYLPREDNISOLONE (meth-ill-pred-niss-oh-lone) A-methaPred, Medrol, Solu-Medrol steroidal anti-inflammatory (systemic corticosteroid) Pregnancy Category UK ■ INDICATIONS: Inflammatory, allergic, hematologic, neoplastic, and autoimmune disorders; asthma; replacement therapy in adrenal insufficiency. Therapeutic Effects: ■ Suppression of inflammation, modification of the immune response, replacement therapy in adrenal insufficiency.

■ DOSAGE: PO: Adults: 4–48 mg/d single or divided doses. Children: Adrenocortical insufficiency: 117 g/kg (3.33 mg/m2)/d in 3 doses. Other uses: 0.417 mg/kg–1.67 mg/kg (12.5–50 mg/m2)/d in 3–4 doses. IM, IV: Adults: 10–40 mg. Children: Adrenocortical insufficiency: 117 g/kg (3.33 mg/m2)/d in 3 doses. Other uses: 139–835 g/kg (4.16–25 mg/m2) q 12–24 h. ■ ADMINISTRATION: PO: Administer with meals to minimize GI irritation. Direct IV: Rate: Administer over 1 to several minutes. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Depression, euphoria, psychoses, 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. ■ CONTRAINDICATIONS: Active untreated infections, lactation. ■ 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.

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METOPROLOL (me-toe-proe-lole) Betaloc, Lopressor, Lopressor SR, Toprol-XL antianginal, antihypertensive (betablocker) Pregnancy Category C ■ INDICATIONS: Hypertension, angina, MI, heart failure. Therapeutic Effects: ■ Decreased blood pressure and heart rate, decreased frequency of attacks of angina pectoris. ■ DOSAGE: PO: Adults: 50–450 mg/d as a single dose or 2 divided doses. Geriatric: 25–300 mg/d as a single dose or 2 divided doses. IV: Adults: 5 mg q 2 min for 3 doses. ■ ADMINISTRATION: PO: Withhold medication and notify physician if apical pulse is 50 bpm or irregular. Administer with meals. IV: Inject 5 mg rapidly at 2-min intervals for 3 doses. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Fatigue, weakness, anxiety, depression, dizziness, drowsiness, insomnia, memory loss, blurred vision, stuffy nose, bronchospasm, wheezing, BRADYCARDIA, CHF, PULMONARY EDEMA, hypotension, peripheral vasoconstriction, drug-induced hepatitis, gastric pain, nausea, vomiting, impotence, decreased libido, urinary frequency, rashes, hyperglycemia, hypoglycemia, arthralgia, joint pain, drug-induced lupus syndrome. ■ CONTRAINDICATIONS: Uncompensated CHF, pulmonary edema, cardiogenic shock, bradycardia or heart block. ■ CAUTIONS: Extended-release tablets should be swallowed whole; do not crush, break, or chew. • Additive bradycardia with digoxin. • Additive hypotension with other antihypertensives. • Altered effectiveness of insulins or oral hypoglycemic agents. • Notify health care professional if slow pulse, difficulty breathing, wheezing, cold hands and feet, dizziness, light-headedness, confusion, depression, rash, fever, sore throat, unusual bleeding, or bruising occur. • Change positions slowly to minimize orthostatic hypotension.

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111 METRONIDAZOLE (me-troe-ni-da-zole) Flagyl, Novonidazol, Protostat, anti-infective, antiprotozoal, anti ulcer agent Pregnancy Category B

■ INDICATIONS: Anaerobic infections, septicemia, endocarditis, perioperative prophylactic agent in colorectal surgery, H. pylori, amebic dysentery, amebic liver abscess, trichomoniasis, acne rosacea, bacterial vaginosis. Therapeutic Effects: ■ Bactericidal, trichomonacidal, or amebicidal action. ■ DOSAGE: PO: Adults: Anaerobic infections: 7.5 mg/kg q 6 h (not to exceed 4 g/d). Trichomoniasis: 250 mg q 8 h or single 2-g dose or 1 g bid for 1 day. Amebiasis: 500–750 mg q 8 h. H. pylori: 250 mg 4 times daily or 500 mg twice daily. Bacterial vaginosis: 750 mg once daily. Children: Trichomoniasis: 5 mg/kg q 8 h. Amebiasis: 11.6–16.7 mg/kg q 8 h. IV: Adults: Anaerobic infections: Initial dose 15 mg/kg, then 7.5 mg/kg q 6–8 h or 500 mg q 6–8 h. Perioperative prophylaxis: Initial dose 15 mg/kg 1 h before surgery, then 7.5 mg/kg 6 and 12 h later. Amebiasis: 500–750 mg q 8 h. ■ ADMINISTRATION: PO: Administer with food or milk. IV: Administer IV dose as a slow infusion, single dose over 1 hour. ■ ADVERSE REACTIONS AND SIDE EFFECTS: SEIZURES, dizziness, headache, abdominal pain, anorexia, nausea, diarrhea, dry mouth, furry tongue, unpleasant taste, and urticaria. ■ CONTRAINDICATIONS: Hypersensitivity, first trimester of pregnancy. ■ CAUTIONS: Increases the effects of warfarin. • May cause acute psychosis and confusion with disulfiram. • Avoid alcohol during and for at least 1 day after treatment. • May cause a disulfiram-like reaction (flushing, nausea, vomiting, headache, abdominal cramps). • Inform patient that medication may cause urine to turn dark. Key: underline = most common; CAPS = life-threatening

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MONTELUKAST (mon-te-loo-kast) Singulair bronchodilator (leukotriene antagonist) Pregnancy Category B ■ INDICATIONS: Asthma. Therapeutic Effects: ■ Decreased frequency and severity of acute asthma attacks. ■ DOSAGE: PO: Adults and Children 15 yr: 10 mg once daily. Children 6–14 yr: 5 mg once daily. Children 2–5 yr: 4 mg once daily. ■ ADMINISTRATION: Administer once daily in the evening. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Fatigue, headache, weakness, nasal congestion, otitis (children), sinusitis (children), cough, abdominal pain, diarrhea (children), dyspepsia, nausea (children), increased liver enzymes, rash, eosinophilic conditions (including CHURG-STRAUSS SYNDROME), fever. ■ CONTRAINDICATIONS: Hypersensitivity, lactation. ■ CAUTIONS: Use cautiously in acute attacks of asthma, phenylketonuria (chewable tablets contain aspartame), hepatic impairment, reduction of corticosteroid therapy (may increase the risk of eosinophilic conditions), pregnancy, lactation, or children 6 yr. • Montelukast is not used to treat acute asthma attacks, but may be continued during an acute exacerbation. • Patient should carry rapid-acting therapy for bronchospasm at all times. • Advise patient to notify health care professional if more than the maximum number of shortacting bronchodilator treatments prescribed for a 24-hour period are needed.

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113 MORPHINE (mor-feen) Duramorph, MS Contin, Roxanol, opioid analgesic/agonist Schedule II Pregnancy Category C ■ INDICATIONS: Severe pain, pulmonary edema, pain associated with MI. Therapeutic Effects: ■ Decreased severity of pain.

■ DOSAGE: PO, Rectal: Adults 50 kg: Usual starting dose for moderate to severe pain—30 mg q 3–4 h initially. Adults and Children 50 kg: Usual starting dose for moderate to severe pain: 0.3 mg/kg q 3–4 h initially. IM, IV, SC: Adults 50 kg: Usual starting dose for moderate to severe pain: 4–10 mg q 3–4 h. MI: 8–15 mg. Adults and Children 50 kg: Usual starting dose for moderate to severe pain: 0.1 mg/kg q 3–4 h. IV, SC: Adults: Continuous infusion: 0.8–10 mg/h; may be preceded by a bolus of 15 mg. Epidural: Adults: Intermittent injection: 5 mg/d (initially); if relief is not obtained at 60 min, 1–2 mg increments may be made; (total dose not to exceed 10 mg/d). Continuous infusion: 2–4 mg/24 h; may increase by 1–2 mg/d (up to 30 mg/d). ■ ADMINISTRATION: PO: Administer with food or milk. Extended-release and controlled-release tablets should be swallowed whole; do not crush, break, or chew. Pellets should not be chewed, crushed, or dissolved. IM, SC: Use IM route for repeated doses, because morphine is irritating to SC tissues. Direct IV: Administer 2.5–15 mg over 4–5 min. Rapid administration may lead to increased respiratory depression, hypotension, and circulatory collapse. Continuous Infusion: Administer via infusion pump to control the rate. May be administered via patient-controlled analgesia (PCA) pump. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Confusion, sedation, dizziness, euphoria, miosis, RESPIRATORY DEPRESSION, hypotension, bradycardia, constipation, nausea, urinary retention, flushing, sweating, physical dependence, psychological dependence, tolerance. ■ CONTRAINDICATIONS: Hypersensitivity. (Continued)

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I–M MORPHINE (Continued) ■ CAUTIONS: HIGH ALERT MED: Do not confuse morphine with hydromorphone or meperidine; errors have resulted in fatalities. • When using an infusion pump or PCA (patient controlled analgesia), have a second practitioner independently check dose, concentration and programming. • Assess level of consciousness, blood pressure, pulse, and respirations. If respiratory rate is 10/minutes, assess level of sedation. Subsequent doses may need to be decreased by 25% to 50%. • Instruct family not to administer doses for the patient while he or she is sleeping. • If an opioid antagonist is required, naloxone (Narcan) is the antidote. • Use with extreme caution in patients receiving MAO inhibitors within 14 days prior (may result in unpredictable, severe reactions— decrease initial dose of morphine to 25% of usual dose). • Additive CNS depression with alcohol, sedative/hypnotics, clomipramine, barbiturates, tricyclic antidepressants, and antihistamines. • Administration of partial-antagonist opioid analgesics may precipitate opioid withdrawal in physically dependent patients. • Buprenorphine, dezocine, nalbuphine, butorphanol, or pentazocine may decrease analgesia. • May increase the anticoagulant effect of warfarin. • Patients on a continuous infusion should have additional bolus doses provided every 15–30 min, as needed, for breakthrough pain. • Patients taking sustained-release morphine may require additional short-acting opioid doses for breakthrough pain. • Stimulant laxatives should be administered routinely if opioid use exceeds 2–3 days, unless contraindicated.

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115 MUPIROCIN (myoo-peer-oh-sin) Bactroban, Bactroban Nasal anti-infective Pregnancy Category B ■ INDICATIONS: Topical: Impetigo, skin lesions secondarily infected by Staphylococcus aureus and Streptococcus pyogenes. Intranasal: Nasal colonization with methicillinresistant S. aureus. Therapeutic Effects: ■ Inhibits bacterial growth and reproduction. ■ DOSAGE: Topical: Adults and Children 2 mo: Apply 3 times daily. Intranasal: Adults and Children 12 yr: Apply half of the contents of a single-use nasal ointment tube to each nostril twice daily for 5 days. ■ ADMINISTRATION: Topical: Wash affected area with soap and water and dry thoroughly. Apply a small amount of mupirocin to affected area 3 times daily and rub in gently. Treated area may be covered with gauze if desired. Intranasal: Apply one half of the ointment from the single-use tube to each nostril twice daily (morning and evening) for 5 days. After application, close nostrils by pressing together and releasing sides of the nose repeatedly for 1 minute. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Nasal only: headache, cough, itching, pharyngitis, rhinitis, upper respiratory tract congestion, nausea, altered taste; topical only: burning, itching, pain, stinging. ■ CONTRAINDICATIONS: Hypersensitivity to mupirocin or polyethylene glycol. ■ CAUTIONS: Nasal mupirocin should not be used concurrently with other nasal products. • Advise patient to apply medication exactly as directed for the full course of therapy. • Teach patient and family appropriate hygienic measures to prevent spread of impetigo. • Instruct parents to notify school nurse for screening and prevention of transmission. • Patient should consult health care professional if symptoms have not improved in 3–5 days.

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N–R NAPROXEN (na-prox-en) Aleve, Anaprox, Napron X, Naprosyn, nonopioid analgesic, nonsteroidal anti-inflammatory, antipyretic Pregnancy Category B (first trimester)

■ INDICATIONS: Mild to moderate pain, dysmenorrhea, fever, inflammatory disorders, rheumatoid arthritis, osteoarthritis. Therapeutic Effects: ■ Decreased pain, reduction of fever, suppression of inflammation. ■ DOSAGE: PO: Adults: 250–500 mg bid (up to 1.5 g/d). Children 2 yr: 5 mg/kg/d twice daily as naproxen suspension. ■ ADMINISTRATION: Administer with food or antacids to decrease GI irritation. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness, drowsiness, headache, tinnitus, dyspnea, palpitations, tachycardia, DRUG-INDUCED HEPATITIS, GI BLEEDING, constipation, dyspepsia, nausea, anorexia, diarrhea, vomiting, cystitis, hematuria, renal failure, photosensitivity, rashes, prolonged bleeding time, allergic reactions including ANAPHYLAXIS. ■ CONTRAINDICATIONS: Hypersensitivity, active GI bleeding, ulcer disease. ■ CAUTIONS: Patients with asthma, aspirin-induced allergy, and nasal polyps are at increased risk for hypersensitivity reactions. • Increased risk of bleeding with alcohol, anticoagulants, thrombolytic agents, eptifibatide, tirofiban, cefamandole, cefotetan, cefoperazone, valproic acid, clopidogrel, ticlopidine, plicamycin. arnica, chamomile, dong quai, feverfew, garlic, ginger, ginkgo, Panax ginseng, and licorice. • Additive GI side effects with aspirin, corticosteroids, and other NSAIDs. • May increase risk of hypoglycemia with insulin or oral hypoglycemic agents. • Advise patient to consult health care professional if rash, itching, visual disturbances, tinnitus, weight gain, edema, black stools, persistent headache, or influenza-like syndrome (chills, fever, muscle aches, pain) occurs. Key underline = most common CAPS = life-threatening

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117 NIFEDIPINE (nye-fed-ih-peen) Adalat, Apo-Nifed, Nifedical XL, Procardia antianginal, antihypertensive (calcium channel blocker) Pregnancy Category C

■ INDICATIONS: Hypertension, angina pectoris, Prinzmetal’s angina. Unlabeled use: prevention of migraine. Therapeutic Effects: ■ Systemic and coronary vasodilation. ■ DOSAGE: PO: Adults: 10–30 mg 3 times daily (up to 180 mg/d) or 30–90 mg once daily sustained-release (up to 120 mg/d). ■ ADMINISTRATION: Administer without regard to meals or with meals if GI irritation occurs. Avoid administration with grapefruit juice. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Headache, confusion, dizziness, nervousness, blurred vision, disturbed equilibrium, epistaxis, tinnitus, dyspnea, shortness of breath, ARRHYTHMIAS, CHF, peripheral edema, bradycardia, chest pain, hypotension, palpitations, syncope, tachycardia, abnormal LFTs, anorexia, nausea, vomiting, dysuria, nocturia, flushing, dermatitis, erythema multiforme, hyperglycemia, muscle cramps, paresthesia, tremor, STEVENS-JOHNSON SYNDROME, gingival hyperplasia. ■ CONTRAINDICATIONS: Hypersensitivity, sick sinus syndrome, 2nd- or 3rd-degree AV block (without artificial pacemaker), BP 90 mm Hg. ■ CAUTIONS: Additive hypotension with fentanyl, other antihypertensives, nitrates, alcohol, or quinidine. • May increase risk of toxicity from digoxin. • Concurrent use with betablockers, digoxin, disopyramide, or phenytoin may result in bradycardia, conduction defects, or CHF. • Cimetidine and propranolol may increase risk of toxicity. • May increase the risk of toxicity from cyclosporine, prazosin, quinidine, or carbamazepine. • Grapefruit juice increases serum levels and effect. Instruct patient to contact health care professional if heart rate is 50 bpm.

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NITROFURANTOIN (nye-troe-fyoor-an-toyn) ApoNitrofurantoin, Furadantin, Macrodantin anti-infective Pregnancy Category B ■ INDICATIONS: Urinary tract infections. Therapeutic Effects: ■ Bactericidal or bacteriostatic action against susceptible organisms. ■ DOSAGE: PO: Adults: 50–100 mg q 6–8 h or 100 mg q 12 h extended-release. Chronic suppression: 50–100 mg at bedtime. Children 1 mo: 0.75–1.75 mg/kg q 6 h. Chronic suppression: 1 mg/kg/d at bedtime. ■ ADMINISTRATION: Administer with food or milk to minimize GI irritation. Rinse mouth with water after oral suspension to avoid staining teeth. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness, headache, nystagmus, pneumonitis, chest pain, PSEUDOMEMBRANOUS COLITIS, anorexia, nausea, vomiting, abdominal pain, diarrhea, hepatitis, rust/brown discoloration of urine, photosensitivity, peripheral neuropathy, hypersensitivity reactions. ■ CONTRAINDICATIONS: Hypersensitivity, hypersensitivity to parabens (suspension), oliguria or anuria, G6PD deficiency, infants 1 mo and pregnancy near term. ■ CAUTIONS: 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. • Increased risk of neurotoxicity with neurotoxic drugs. • Increased risk of pneumonitis with drugs that have pulmonary toxicity. • Increased risk of hepatotoxicity with hepatotoxic drugs. • May cause a rust-yellow to brown discoloration of urine, which is not significant. • Notify health care professional if fever, chills, cough, chest pain, dyspnea, skin rash, numbness or tingling of the fingers or toes, intolerable GI upset, or signs of superinfection (milky, foul-smelling urine; perineal irritation; dysuria) occur.

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119 NIZATIDINE (nye-za-ti-deen) Axid, Axid AR antiulcer agent (histamine H2 antagonist) Pregnancy Category B ■ INDICATIONS: Duodenal, benign and stress-induced gastric ulcers, GERD, heartburn, acid indigestion, gastric hypersecretory states (Zollinger-Ellison syndrome).

Therapeutic Effects: ■ Healing and prevention of ulcers, decreased symptoms of gastroesophageal reflux, decreased secretion of gastric acid. ■ DOSAGE: PO: Adults: Short-term treatment of active ulcers: 300 mg once daily at bedtime or 150 mg twice daily. Duodenal ulcer prophylaxis: 150 mg once daily at bedtime. GERD: 150 mg twice daily. OTC use: 75 mg 0–60 min before foods or beverages expected to cause symptoms. ■ ADMINISTRATION: Administer with meals or immediately afterward and at bedtime to prolong effect. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Confusion, dizziness, drowsiness, hallucinations, ARRHYTHMIAS, druginduced hepatitis, nausea, AGRANULOCYTOSIS, APLASTIC ANEMIA. ■ CONTRAINDICATIONS: Hypersensitivity. ■ CAUTIONS: May lead to increased blood levels and toxicity with some (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.

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

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PAROXETINE (par-ox-e-teen) Paxil, Paxil CR antianxiety, antidepressant (SSRI) Pregnancy Category C ■ INDICATIONS: Depression, panic disorder, OCD, social anxiety disorder, generalized anxiety disorder. Therapeutic Effects: ■ Improved mood; decreased frequency of panic attacks, OCD, or anxiety. ■ DOSAGE: PO: Adults: 10–60 mg as a single dose in the morning. Geriatric Patients or Debilitated Patients: 10–40 mg/d. ■ ADMINISTRATION: Administer with food to minimize GI irritation. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Anxiety, dizziness, drowsiness, headache, insomnia, weakness, agitation, mental depression, syncope, blurred vision, yawning, chest pain, edema, hypertension, palpitations, postural hypotension, tachycardia, vasodilation, constipation, diarrhea, dry mouth, nausea, abdominal pain, vomiting, ejaculatory disturbance, decreased libido, sweating, photosensitivity, pruritus, rash, myalgia, myopathy, tremor, myoclonus, paresthesia. ■ CONTRAINDICATIONS: Hypersensitivity, concurrent MAO inhibitor therapy (may result in serious, potentially fatal reactions). ■ CAUTIONS: Serious, potentially fatal reactions (hyperthermia, rigidity, myoclonus, autonomic instability, with fluctuating vital signs and extreme agitation, which may proceed to delirium and coma) may occur with concurrent MAO inhibitor therapy. • MAO inhibitors should be stopped at least 14 days prior to paroxetine therapy. • Paroxetine should be stopped at least 14 days prior to MAO inhibitor therapy. • May decrease the effectiveness of digoxin. • May increase the risk of bleeding with warfarin without altering INR time. • Increased risk of serotinergic side effects including serotonin syndrome with St. John’s wort and SAMe.

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121 PENTOXIFYLLINE (pen-tox-if-i-lin) Trental blood viscosity reducing agent Pregnancy Category C ■ INDICATIONS: Symptomatic peripheral vascular disease (intermittent claudication). Therapeutic Effects: ■ Increased blood flow. ■ DOSAGE: PO: Adults: 400 mg 3 times daily; if GI or CNS side effects occur, decrease dose to 400 mg twice daily. ■ ADMINISTRATION: Administer with meals to minimize GI irritation. Tablets should be swallowed whole; do not crush, break, or chew. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Agitation, dizziness, drowsiness, headache, insomnia, nervousness, blurred vision, dyspnea, angina, arrhythmias, edema, flushing, hypotension, abdominal discomfort, belching, bloating, diarrhea, dyspepsia, flatus, nausea, vomiting, tremor. ■ CONTRAINDICATIONS: Hypersensitivity, intolerance to other xanthine derivatives (caffeine and theophylline). ■ CAUTIONS: Additive hypotension may occur with antihypertensives and nitrates. • May increase the risk of bleeding with warfarin, heparin, aspirin, NSAIDs, cefamandole, cefoperazone, cefotetan, plicamycin, valproic acid, clopidogrel, ticlopidine, eptifibatide, tirofiban, or thrombolytic agents. • May increase the risk of theophylline toxicity. • If GI and CNS side effects occur, decrease dose to twice daily; discontinue if side effects persist. • May cause dizziness and blurred vision; caution patient to avoid driving and other activities requiring alertness until response to medication is known. • Advise patient to avoid smoking, because nicotine constricts blood vessels. Instruct patient to notify health care professional if nausea, vomiting, GI upset, drowsiness, dizziness, or headache persists.

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

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PHENAZOPYRIDINE (fen-az-oh-peer-i-deen) Azo-Standard, Pyridium, Urodine nonopioid analgesic, urinary tract analgesic Pregnancy Category B

■ INDICATIONS: Urinary tract infection and irritation symptoms (pain, itching, burning, urgency, frequency). Therapeutic Effects: ■ Diminished urinary tract discomfort. ■ DOSAGE: PO: Adults: 200 mg 3 times daily for 2 days. Children: 4 mg/kg 3 times daily for 2 days. ■ ADMINISTRATION: Administer medication with or following meals to decrease GI irritation. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Headache, vertigo, hepatotoxicity, nausea, bright-orange urine, renal failure, rash, hemolytic anemia, methemoglobinemia. ■ CONTRAINDICATIONS: Hypersensitivity, glomerulonephritis, severe hepatitis, uremia, or renal failure, renal insufficiency, G6PD deficiency. ■ CAUTIONS: Do not crush, break, or chew tablet. Assess patient for urgency, frequency, and pain on urination. • Interferes with urine tests based on color reactions (glucose, ketones, bilirubin, steroids, protein). • Medication should be discontinued after pain or discomfort is relieved (usually 2 days for treatment of urinary tract infection). • Advise patient that while phenazopyridine administration is stopped once pain or discomfort is relieved, concurrent antibiotic therapy must be continued for full duration of therapy. • Inform patient that drug causes reddish-orange discoloration of urine that may stain clothing or bedding. • Sanitary napkin may be worn to avoid clothing stains. • May also cause staining of soft contact lenses. • Instruct patient to notify health care professional if rash, skin discoloration, or unusual tiredness occurs.

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123 PHENYTOIN (fen-i-toyn) Dilantin, Diphenylan, diphenylhydantoin, DPH anticonvulsant Pregnancy Category C ■ INDICATIONS: Tonic-clonic seizures and complex partial seizures. Therapeutic Effects: ■ Diminished seizure activity. ■ DOSAGE: PO: Adults: 300–400 mg/d in divided doses. Geriatric Patients: 3 mg/kg/d in divided doses. Children: Initially 4–8 mg/kg/d in 2–3 divided doses (not to exceed 300 mg/d). IV: Adults: 15–20 mg/kg. Rate not to exceed 25–50 mg/min, followed by 100 mg q 6–8 h. Children: 15–20 mg/kg (250 mg/m2) at 1–3 mg/kg/min. ■ ADMINISTRATION: PO: Administer with or immediately after meals to minimize GI irritation. Chewable tablets must be crushed or chewed well before swallowing. Direct IV: Administer at a rate not to exceed 50 mg over 1 min (25 mg/min in patients who may develop hypotension, patients who are on sympathomimetic medication, patients with cardiovascular disease, or geriatric patients; 1–3 mg/kg/min in neonates). Rapid administration may result in severe hypotension, cardiovascular collapse, or CNS depression. Intermittent Infusion: Do not mix with dextrose solutions. Mix with no more than 50 mL of 0.9% NaCl for a concentration of 1–10 mg/mL. Administer immediately. Use tubing with a 0.45- to 0.22-micron in-line filter. Rate: Complete infusion within 1 hour at a rate not to exceed 50 mg/min. Monitor cardiac function and blood pressure throughout infusion. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Ataxia, agitation, dizziness, drowsiness, dyskinesia, extrapyramidal syndrome, headache, nervousness, weakness, diplopia, nystagmus, tinnitus, hypotension (increased with IV phenytoin), gingival hyperplasia, nausea, pink, red, reddish-brown discoloration of urine, hypertrichosis, rashes, exfoliative dermatitis, pruritus, hypocalcemia, AGRANULOCYTOSIS, APLASTIC ANEMIA, back pain, osteomalacia, allergic reactions including STEVENS-JOHNSON SYNDROME, fever, lymphadenopathy. (Continued)

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PHENYTOIN (Continued) ■ CONTRAINDICATIONS: Hypersensitivity, sinus bradycardia, sinoatrial block, 2nd- or 3rd-degree heart block, or StokesAdams syndrome. ■ CAUTIONS: Assess patient for phenytoin hypersensitivity syndrome (fever, skin rash, lymphadenopathy). Hypersensitivity syndrome may lead to renal failure, rhabdomyolysis, or hepatic necrosis; may be fatal. • Monitor CBC and platelet count, serum calcium, albumin, urinalysis, and hepatic and thyroid function tests periodically throughout therapy. • Use cautiously in hepatic or renal disease, geriatric patients or those with severe cardiac or respiratory disease, obese patients, pregnancy, lactation. • Barbiturates, carbamazepine, reserpine, chronic ingestion of alcohol, and warfarin may decrease phenytoin blood levels. IV phenytoin and dopamine may cause additive hypotension. Additive CNS depression with other CNS depressants, including alcohol, antihistamines, antidepressants, opioids, and sedative/ hypnotics. • Additive cardiac depression may occur with propranolol or lidocaine. • Concurrent administration of enteral tube feedings may decrease phenytoin absorption. • Instruct patient on importance of maintaining good dental hygiene and seeing dentist frequently. • Advise patient that brands of phenytoin may not be equivalent; check with health care professional if brand or dosage form is changed. • Serum phenytoin levels should be routinely monitored. Therapeutic blood levels are 10–20 g/mL in patients with normal serum albumin and renal function.

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125 PIOGLITAZONE (pi-o-glit-a-zone) Actos antidiabetic Pregnancy Category C ■ INDICATIONS: Type 2 diabetes mellitus.

Therapeutic Effects: ■ Decreased insulin resistance, resulting in glycemic control without hypoglycemia. ■ DOSAGE: PO: Adults: 15–45 mg once daily. ■ ADMINISTRATION: May be administered with or without meals. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Edema, anemia. ■ CONTRAINDICATIONS: Hypersensitivity, diabetic ketoacidosis, active liver disease or increased ALT, pregnancy or lactation, children 18 yr or type 1 diabetes. ■ CAUTIONS: Use cautiously in edema, CHF, hepatic impairment, women with childbearing potential (may restore ovulation and risk of pregnancy). • Ketoconazole may increase the effects of pioglitazone. • Glucosamine may worsen blood glucose control. • Fenugreek, chromium, and coenzyme Q-10 may produce additive hypoglycemic effects. • Review signs of hypoglycemia and hyperglycemia with patient. • If hypoglycemia occurs, advise patient to take a glass of orange juice or 2–3 tsp of sugar, honey, or corn syrup dissolved in water and notify health care professional.

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

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POTASSIUM CHLORIDE, ORAL and POTASSIUM CHLORIDE FOR INJECTION CONCENTRATE (poe-tassee-um) Various trade names electrolyte replacement Pregnancy Category C

■ INDICATIONS: Potassium depletion, arrhythmias secondary to digoxin toxicity. Therapeutic Effects: ■ Restoration or maintenance of electrolyte balance. ■ DOSAGE: PO: Adults: 20–100 mEq/d; single dose should not exceed 20 mEq. Children: 2–3 mEq/kg/d or 20–40 mEq/m2/d in divided doses. IV: Adults: Serum potassium 2.5 mEq/L: up to 200 mEq/d as an infusion (not to exceed 10 mEq/h or a concentration of 40 mEq/L via peripheral line. Serum potassium 2 mEq/L: up to 400 mEq/d as an infusion. Children: Up to 3 mEq/kg/d as an infusion. ■ ADMINISTRATION: PO: Administer with a meal and full glass of water. IV: Rate: 10 mEq/h unless in a monitored setting. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Confusion, restlessness, weakness, ARRHYTHMIAS, ECG changes, abdominal pain, diarrhea, flatulence, nausea, vomiting, irritation at IV site. ■ CONTRAINDICATIONS: Hyperkalemia, severe renal impairment, untreated Addison’s disease, severe tissue trauma, hyperkalemic familial periodic paralysis. ■ CAUTIONS: HIGH ALERT MED: IV potassium concentrate must be diluted before use or else is rapidly fatal. Symptoms of hyperkalemia include bradycardia; fatigue; paresthesia; confusion; dyspnea; ECG changes, notably peaked T waves; and cardiac arrhythmias. Do not administer concentrations 1.5 mEq/mL undiluted. • Do not chew or crush entericcoated or extended-release tablets or capsules. • Use oral potassium dose forms whenever clinically feasible. • Use with potassium-sparing diuretics or ACE inhibitors may lead to hyperkalemia. • Monitor serum potassium before and periodically throughout therapy.

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127 PRAVASTATIN (pra-va-stat-in) Pravachol lipid-lowering agent Pregnancy Category X ■ INDICATIONS: Primary hypercholesterolemia and mixed dyslipidemias. Therapeutic Effects: ■ Lowering of total and LDL cholesterol. ■ DOSAGE: PO: Adults: 10–40 mg once daily. ■ ADMINISTRATION: Administer with the evening meal. ■ 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. ■ CONTRAINDICATIONS: Hypersensitivity, active liver disease, pregnancy or lactation, concurrent use of gemfibrozil or azole antifungals. ■ CAUTIONS: 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. • Use cautiously in history of liver disease, alcoholism, renal impairment, hypotension, major surgery, trauma, uncontrolled seizures, visual disturbances, and myopathy. • 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 also cause elevated alkaline phosphatase and bilirubin levels.

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PREDNISONE (pred-ni-sone) Deltasone, Orasone, Pred-Pak, Prednicot steroidal anti-inflammatory (systemic corticosteroid) Pregnancy Category UK

■ INDICATIONS: Inflammatory, allergic, hematologic, neoplastic, autoimmune disorders, asthma, replacement therapy in adrenal insufficiency. Therapeutic Effects: ■ Suppression of inflammation, modification of the normal immune response, replacement therapy in in adrenal insufficiency. ■ DOSAGE: PO: Adults: 5–60 mg/d single dose or divided doses. Children 10 yr: Nephrosis: 20 mg 4 times daily initially. Children 4–10 yr: Nephrosis: 15 mg 4 times daily initially. Children 18 mo–4 yr: Nephrosis: 7.5–10 mg 4 times daily initially. ■ ADMINISTRATION: Administer with meals to minimize GI irritation. ■ 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. ■ CONTRAINDICATIONS: Active untreated infections, lactation. ■ CAUTIONS: Instruct patient to promptly report severe abdominal pain or tarry stools occur. • Use cautiously in children (chronic use will result in decreased growth), stress (surgery, infections), pregnancy. • 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.

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129 PROMETHAZINE (proe-meth-a-zeen) Anergan, Phenergan, Phenoject antiemetic, antihistamine, sedative/hypnotic Pregnancy Category C

■ INDICATIONS: Allergic conditions, motion sickness, preoperative sedation, nausea and vomiting, adjunct to anesthesia and analgesia. Therapeutic Effects: ■ Relief of symptoms of histamine excess usually seen in allergic conditions. Diminished nausea or vomiting. Sedation. ■ DOSAGE: PO/PR/IM/IV: Adults: 12.5–25 mg up to 4 times per day. Sedation: 25—50 mg preoperatively or at bedtime. Children 2 yr: 5–12.5 mg 3 times daily or 25 mg at bedtime. Sedation: 0.5–1.1 mg/kg or 10–25 mg. Preoperatively or at bedtime. ■ ADMINISTRATION: PO: Administer with food or milk to minimize GI irritation. Direct IV: Do not exceed concentration of 25 mg/mL. Rate: Administer 25 mg over at least 1 min. ■ ADVERSE REACTIONS AND SIDE EFFECTS: NEUROLEPTIC MALIGNANT SYNDROME, confusion, disorientation, sedation, extrapyramidal reactions, fatigue, insomnia, nervousness, blurred vision, diplopia, tinnitus, bradycardia, hypertension, hypotension, tachycardia, drug-induced hepatitis, dry mouth, photosensitivity, rashes. ■ CONTRAINDICATIONS: Hypersensitivity, prostatic hypertrophy, bladder neck obstruction, narrow-angle glaucoma. ■ CAUTIONS: Additive CNS depression with CNS depressants, alcohol, antihistamines, opioid analgesics, and sedative/ hypnotics. • Additive anticholinergic effects with antihistamines, antidepressants, atropine, haloperidol, other phenothiazines, quinidine, and disopyramide. • Monitor for extrapyramidal side effects (akathisia—restlessness; dystonia—muscle spasms and twisting motions; pseudoparkinsonism—mask-like face, rigidity, tremors, drooling, shuffling gait, dysphagia); notify health care professional if they occur.

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PROPRANOLOL (proe-pran-oh-lole) Apo-Propranolol, Betachron E-R, Inderal, Inderal LA, Novopranol, antianginal, antiarrhythmic, antihypertensive, (beta-blocker) Pregnancy Category C ■ INDICATIONS: Hypertension, angina pectoris, arrhythmias, MI, vascular headaches, hypertrophic cardiomyopathy. Therapeutic Effects: ■ Decreased heart rate and blood pressure, suppression of arrhythmias. ■ DOSAGE: PO: Adults: 40–320 mg/d in 2–4 divided doses or once daily as extended/sustained-release capsules. Children: 2–4 mg/kg/d in 2 divided doses. IV: Adults: 1–3 mg; may be repeated after 2 minutes and again in 4 hours. Children: 10–100 g (0.01–0.1 mg)/kg (up to 1 mg/dose); may be repeated q 6–8 h. ■ ADMINISTRATION: PO: Administer with meals or directly after eating to enhance absorption. Take apical pulse prior to administering. If 50 bpm or if arrhythmia occurs, withhold medication and notify physician or other health care professional. IV: Administer undiluted or dilute each 1 mg in 10 mL of D5W for injection. Rate: Administer over at least 1 min. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Fatigue, weakness, anxiety, dizziness, drowsiness, insomnia, memory loss, mental depression, mental status changes, nervousness, nightmares, blurred vision, dry eyes, nasal stuffiness, bronchospasm, wheezing, ARRHYTHMIAS, BRADYCARDIA, CHF, PULMONARY EDEMA, orthostatic hypotension, peripheral vasoconstriction, constipation, diarrhea, nausea, impotence, decreased libido, itching, rashes, hyperglycemia, hypoglycemia (increased in children), arthralgia, back pain, muscle cramps, paresthesia, drug-induced lupus syndrome. ■ CONTRAINDICATIONS: Uncompensated CHF, pulmonary edema, cardiogenic shock, bradycardia or heart block. ■ CAUTIONS: HIGH ALERT MED: The intravenous dose of propranolol is much smaller than the IV dose. Check IV doses carefully. Patients receiving propranolol IV must have continu(Continued)

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131 ous ECG monitoring and may have pulmonary capillary wedge pressure (PCWP) or central venous pressure (CVP) monitoring during and for several hours after administration. • Abrupt withdrawal may precipitate life-threatening arrhythmias, hypertension, or myocardial ischemia. • General anesthesia, IV, phenytoin, and verapamil may cause additive myocardial depression. • Additive bradycardia may occur with digoxin. • Additive hypotension may occur with other antihypertensives, acute ingestion of alcohol, or nitrates. • Concurrent use with amphetamines, cocaine, ephedrine, epinephrine, norepinephrine, phenylephrine, or pseudoephedrine may result in unopposed alpha-adrenergic stimulation (excessive hypertension, bradycardia). • Concurrent thyroid administration may decrease effectiveness. • May alter the effectiveness of insulin or oral hypoglycemic agents (dosage adjustments may be necessary). • May decrease the effectiveness of beta-adrenergic bronchodilators and theophylline. • May decrease the beneficial beta cardiovascular effects of dopamine or dobutamine. • Use cautiously within 14 days of MAO inhibitor therapy (may result in hypertension). • Cimetidine may increase blood levels and toxicity. • Concurrent NSAIDs may decrease antihypertensive action. • Smoking increases metabolism and decreases effects; smoking cessation may increase effects. • Advise patient to make sure enough medication is available for weekends, holidays, and vacations. • A written prescription may be kept in a wallet in case of emergency.

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

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QUINAPRIL (kwin-a-pril) Accupril antihypertensive (ACE inhibitor) Pregnancy Category C (first trimester), D (second and third trimesters)

■ INDICATIONS: Hypertension, CHF. Therapeutic Effects: ■ Lowered blood pressure, improvement in CHF symptoms. ■ DOSAGE: PO: Adults: 10–80 mg/d in single or divided doses. ■ ADMINISTRATION: Precipitous drop in blood pressure during first 1–3 hours following first dose may occur. Monitor blood pressure closely. ■ 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, ANGIOEDEMA, fever. ■ CONTRAINDICATIONS: Hypersensitivity, cross-sensitivity among ACE inhibitors may occur, pregnancy, angioedema (hereditary or idiopathic). ■ CAUTIONS: 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. • Use cautiously in renal or hepatic impairment, hypovolemia, hyponatremia, elderly patients, concurrent diuretic therapy, aortic stenosis/hypertrophic cardiomyopathy, cerebrovascular or cardiac insufficiency, surgery/anesthesia, lactation or children. • Additive hypotension with other antihypertensives, nitrates, phenothiazines, acute ingestion of alcohol, and during surgery or general anesthesia. • Hyperkalemia with 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.

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133 RABEPRAZOLE (ra-bep-ra-zole) Aciphex antiulcer agent (proton pump inhibitor) Pregnancy Category B ■ INDICATIONS: GERD, duodenal ulcer, pathological hypersecretory conditions (Zollinger-Ellison syndrome). Therapeutic Effects: ■ Diminished accumulation of acid in the gastric lumen, with lessened acid reflux, healing of duodenal ulcers and esophagitis, decreased acid secretion in hypersecretory conditions. ■ DOSAGE: PO: Adults: 20 mg once daily. Hypersecretory conditions: 60–100 mg daily. ■ ADMINISTRATION: Administer doses before meals, preferably in the morning.

■ ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness, headache, malaise, abdominal pain, constipation, diarrhea, nausea, photosensitivity, rash, neck pain. allergic reactions, chills, fever. ■ CONTRAINDICATIONS: Hypersensitivity to rabeprazole or related drugs (benzimidazoles). ■ CAUTIONS: Use cautiously in severe hepatic impairment (dosage reduction may be necessary), pregnancy, lactation, or children. • Decreases blood levels of ketoconazole. • Increases blood levels of digoxin.

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

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RALOXIFENE (ra-lox-i-feen) Evista bone resorption inhibitor (selective estrogen receptor modulator) Pregnancy Category X ■ INDICATIONS: Osteoporosis in postmenopausal women. Therapeutic Effects: ■ Prevention of osteoporosis in patients at risk. ■ DOSAGE: PO: Adults: 60 mg once daily. ■ ADMINISTRATION: May be administered without regard to meals. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Leg cramps, hot flashes. ■ CONTRAINDICATIONS: Hypersensitivity; history of thromboembolic events; women with childbearing potential, pregnancy, lactation, or children. ■ CAUTIONS: Use cautiously in potential immobilization (increased risk of thromboembolic events). • Cholestyramine decreases absorption (avoid concurrent use). • May alter effects of warfarin and other highly protein-bound drugs. • Concurrent systemic estrogen therapy is not recommended. • Advise patient to discontinue smoking and alcohol consumption. • Advise patient that raloxifene should be discontinued at least 72 hours before and during prolonged immobilization (recovery from surgery, prolonged bedrest). • Instruct patient to avoid prolonged restrictions of movement during travel because of the increased risk of venous thrombosis. • Advise patient that raloxifene will not reduce hot flashes or flushes associated with estrogen deficiency and may cause hot flashes.

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135 RAMIPRIL (ram-i-pril) Altace antihypertensive (ACE inhibitor) Pregnancy Category C (first trimester), D (second and third trimesters)

■ INDICATIONS: Hypertension, CHF. Therapeutic Effects: ■ Lowered blood pressure, improvement in symptoms of CHF. ■ DOSAGE: PO: Adults: 2.5—5mg once daily, may be increased up to 20 mg/d in 1–2 divided doses. ■ ADMINISTRATION: Precipitous drop in blood pressure during first 1–3 hours following first dose may occur. Monitor blood pressure closely. ■ 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. ■ CONTRAINDICATIONS: Hypersensitivity, cross-sensitivity among ACE inhibitors may occur, pregnancy, history of angioedema. ■ CAUTIONS: 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. • Use cautiously in renal or hepatic impairment, hypovolemia, hyponatremia, elderly patients, concurrent diuretic therapy, aortic stenosis/hypertrophic cardiomyopathy, cerebrovascular or cardiac insufficiency, surgery/anesthesia, lactation or children. • Additive hypotension with other antihypertensives, nitrates, phenothiazines, acute ingestion of alcohol, and during surgery or general anesthesia. • Hyperkalemia with 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.

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REPAGLINIDE (re-pag-gli-nide) Prandin antidiabetic Pregnancy Category C ■ INDICATIONS: Type 2 diabetes mellitus. Therapeutic Effects: ■ Control of blood glucose levels. ■ DOSAGE: PO: Adults: 0.5–4 mg taken before meals (not to exceed 16 mg/d). ■ ADMINISTRATION: Administer up to 30 min before meals.

■ ADVERSE REACTIONS AND SIDE EFFECTS: Angina, chest pain, hypoglycemia, hyperglycemia. ■ CONTRAINDICATIONS: Contraindicated in hypersensitivity, lactation, diabetic ketoacidosis, insulin-dependent diabetes. ■ CAUTIONS: Hypoglycemia may be difficult to recognize in geriatric patients and in patients taking beta-blockers. • Hypoglycemia is more likely to occur with insufficient caloric intake, following intense prolonged exercise, or when alcohol or more than one hypoglycemic agent is used. • Use cautiously in impaired liver function (longer dosing intervals may be necessary), pregnancy and children. • Ketoconazole, miconazole, and erythromycin may decrease metabolism and increase the risk of hypoglycemia. • Increased effects possible with NSAIDs, sulfonamides, chloramphenicol, warfarin, probenecid, MAO inhibitors, and beta-blockers. • Decreased effects possible with corticosteroids, phenothiazines, thyroid preparations, estrogens, hormonal contraceptives, phenytoin, nicotinic acid, sympathomimetics, isoniazid, and calcium channel blockers. • Glucosamine may worsen blood glucose control. • Fenugreek, chromium, and coenzyme Q-10 may produce additive hypoglycemic effects. • Repaglinide therapy should be temporarily discontinued from patients requiring surgery involving restricted intake of food and fluids. • Caution patient to avoid taking other prescription or OTC medications or alcohol during repaglinide therapy without consulting health care professional.

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137 RIFAMPIN (rif-am-pin) Rifadin, Rimactane, Rofact antitubercular Pregnancy Category C ■ INDICATIONS: Active tuberculosis. Therapeutic Effects: ■ Bactericidal action against susceptible organisms. ■ DOSAGE: PO, IV: Adults: 600 mg/d or 10 mg/kg/d. Children: 10–20 mg/kg/d single dose (not to exceed 600 mg/d). ■ ADMINISTRATION: PO: Administer medication on an empty stomach at least 1 hour before or 2 hours after meals with a full glass. Intermittent Infusion: Rate: Administer solutions diluted in 500 mL over 3 hours and solutions diluted in 100 mL over 30 min. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Red discoloration of tears, abdominal pain, diarrhea, flatulence, heartburn, nausea, vomiting, drug-induced hepatitis, red discoloration of saliva, red discoloration of urine, red discoloration of all body fluids. ■ CONTRAINDICATIONS: Hypersensitivity, concurrent indinavir, nelfinavir, or saquinavir. ■ CAUTIONS: Use cautiously in liver disease, concurrent use of other hepatotoxic agents, pregnancy or lactation. • Increased risk of hepatotoxicity with other hepatotoxic agents, including alcohol, isoniazid, pyrazinamide (for pyrazinamide check liver function studies every 2 weeks), and ketoconazole. • Rifampin significantly decreases blood levels of delavirdine, indinavir, nelfinavir, and saquinavir; concurrent use is contraindicated. • Report signs of hepatitis (yellow eyes and skin, nausea, vomiting, anorexia, unusual tiredness, weakness) or of thrombocytopenia (unusual bleeding or bruising) occur.

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

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RISPERIDONE (riss-pear-uh-doan) Risperdal antipsychotic Pregnancy Category C ■ INDICATIONS: Psychotic disorders. Therapeutic Effects: ■ Decreased symptoms of psychoses. ■ DOSAGE: PO: Adults: 4–6 mg/d; not to exceed 16 mg/d. Geriatrics/Renal Impairment/Hepatic Impairment: PO: Adults: 0.5 mg twice daily; increase by 0.5 mg up to 1.5 mg twice daily; then increase at weekly intervals. ■ ADMINISTRATION: Give without regard to food.

■ ADVERSE REACTIONS AND SIDE EFFECTS: NEUROLEPTIC MALIGNANT SYNDROME, aggressive behavior, dizziness, extrapyramidal reactions, headache, increased dreams, increased sleep duration, insomnia, sedation, nervousness, tardive dyskinesia, pharyngitis, rhinitis, visual disturbances, cough, arrhythmias, orthostatic hypotension, tachycardia, constipation, diarrhea, dry mouth, nausea, decreased libido, dysmenorrhea/menorrhagia, itching/skin rash, photosensitivity, weight gain, polydipsia. ■ CONTRAINDICATIONS: Hypersensitivity. ■ CAUTIONS: Monitor for neuroleptic malignant syndrome (fever, respiratory distress, tachycardia, convulsions, diaphoresis, hypertension or hypotension, pallor, tiredness). • Notify health care professional immediately. • Additive CNS depression with CNS depressants, alcohol, antihistamines, sedative/hypnotics, or opioid analgesics. • Monitor for and report extrapyramidal side effects (akathisia—restlessness; dystonia—muscle spasms and twisting motions; or pseudoparkinsonism—mask-like face, rigidity, tremors, drooling, shuffling gait, dysphagia). • Monitor for tardive dyskinesia (involuntary rhythmic movement of mouth, face, and extremities); report immediately—may be irreversible.

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139 ROFECOXIB (roe-fe-kox-ib) Vioxx nonsteroidal antiinflammatory, nonopioid analgesic (COX-2 inhibitor) Pregnancy Category C

■ INDICATIONS: Osteoarthritis, acute pain in adults, primary dysmenorrhea. Therapeutic Effects: ■ Decreased pain and inflammation. ■ DOSAGE: PO: Adults: Osteoarthritis: 12.5–25 mg once daily. Acute pain/primary dysmenorrhea: 50 mg once daily for up to 5 days. ■ ADMINISTRATION: Administer without regard to food. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Fatigue, hypertension, lower extremity edema, GI BLEEDING, nausea, anemia, allergic reactions including ANAPHYLAXIS. ■ CONTRAINDICATIONS: Hypersensitivity; cross-sensitivity may occur with other NSAIDs, including aspirin; history of asthma, urticaria, or allergic-type reactions to aspirin or other NSAIDs; advanced renal disease (may precipitate acute renal failure in patients with renal insufficiency); moderate to severe hepatic impairment; lactation; should not be used in late pregnancy (may cause premature closure of the ductus arteriosus). ■ CAUTIONS: Patients who have asthma, aspirin-induced allergy, and nasal polyps are at increased risk for developing hypersensitivity reactions. • Assess for rhinitis, asthma, and urticaria. • GI toxicity can occur at any time, without warning. • Use cautiously in patients with prior history of ulcer disease or GI bleeding. • May decrease the effectiveness of diuretics or antihypertensives. • Concurrent use of aspirin may increase the risk of GI bleeding. • Increases serum lithium levels. • May increase methotrexate levels and the risk of toxicity. • May increase the effects of warfarin. • Caution patient that use of an NSAID with 3 or more glasses of alcohol per day may increase the risk of GI bleeding. • Advise patient to report abdominal pain or black tarry stools promptly. Key: underline = most common; CAPS = life-threatening

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ROSIGLITAZONE (roe-zi-glit-a-zone) Avandia antidiabetic Pregnancy Category C ■ INDICATIONS: Type 2 diabetes mellitus. Therapeutic Effects: ■ Decreased insulin resistance, resulting in glycemic control without hypoglycemia. ■ DOSAGE: PO: Adults: 4–8 mg as a single daily dose or as two divided doses. ■ ADMINISTRATION: May be administered with or without meals.

■ ADVERSE REACTIONS AND SIDE EFFECTS: Edema, anemia, increased total cholesterol, LDL and HDL, weight gain. ■ CONTRAINDICATIONS: Hypersensitivity; pregnancy or lactation, children 18 yr or type 1 diabetes; diabetic ketoacidosis; active liver disease or increased ALT (2.5 times upper limit of normal). ■ CAUTIONS: Do not confuse Avandia with Coumadin. Use cautiously in edema, CHF (avoid use in moderate to severe CHF unless benefits outweigh risks), hepatic impairment, women with childbearing potential (may restore ovulation and risk of pregnancy). • Glucosamine may worsen blood glucose control. • Fenugreek, chromium, and coenzyme Q-10 may produce additive hypoglycemic effects. • Monitor AST and ALT every 2 months during the first 12 months of therapy and periodically thereafter or if jaundice or symptoms of hepatic dysfunction occur. • May cause irreversible elevations in AST and ALT or hepatic failure (rare). • Review signs of hypoglycemia and hyperglycemia with patient. • If hypoglycemia occurs, advise patient to take a glass of orange juice or 2–3 tsp of sugar, honey, or corn syrup dissolved in water and notify health care professional.

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141 SALMETEROL (sal-meh-ter-all) Serevent bronchodilator (adrenergic) Pregnancy Category C ■ INDICATIONS: Asthma, exercise-induced bronchospasm, prevention of bronchospasm in COPD, chronic bronchitis and emphysema. Therapeutic Effects: ■ Bronchodilation. ■ DOSAGE: Inhalation: Adults and children 12 yr: 50 g (2 inhalations as aerosol or one as dry powder) twice daily (approximately 12 hours apart); exercise-induced bronchospasm: 50 g (2 inhalations as aerosol or one as dry powder) 30–60 min before exercise. Children 4–12 yr: 50 g (as dry powder) twice daily (approximately 12 hours apart); exercise-induced bronchospasm: 50 g (as dry powder) 30–60 min before exercise. ■ ADMINISTRATION: Do not use spacer with powder for inhalation. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Headache, nervousness, palpitations, tachycardia, abdominal pain, diarrhea, nausea, muscle cramps/soreness, trembling, ASTHMARELATED RESPIRATORY EVENTS. ■ CONTRAINDICATIONS: Hypersensitivity, acute asthma attack (onset of action is delayed). ■ CAUTIONS: Use cautiously in cardiovascular disease (including angina and hypertension), diabetes, glaucoma, hyperthyroidism, African-American patients, patients not on inhaled steroids, pheochromocytoma, pregnancy, lactation, or children 4 years (dry powder inhalation may be used in children 4–12 years; aerosol inhalation may be used in children 12 years). • Beta-blockers may decrease the therapeutic effects of salmeterol. • Instruct patient using powder for inhalation never to exhale into discus device and always to hold device in a level horizontal position. • Mouthpiece should be kept dry; never wash. • Caution patient not to use salmeterol to treat acute symptoms. A rapid-acting inhaled beta-adrenergic bronchodilator should be used instead.

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SERTRALINE (ser-tra-leen) Zoloft antidepressant (selective serotonin reuptake inhibitor) Pregnancy Category B ■ INDICATIONS: Depression, panic disorder, OCD, posttraumatic stress disorder (PTSD). Therapeutic Effects: ■ Improved mood, decreased incidence of panic attacks, decreased obsessive and compulsive behavior, decreased feelings of intense fear, helplessness, or horror. ■ DOSAGE: PO: Adults: 50–200 mg once daily. Children 13–17 yr: 50 mg once daily. Children 6–12 yr: 25 mg once daily. ■ ADMINISTRATION: Administer as a single dose in the morning or evening. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness, drowsiness, fatigue, headache, insomnia, agitation, anxiety, confusion, emotional lability, manic reaction, pharyngitis, tinnitus, visual abnormalities, chest pain, palpitations, diarrhea, dry mouth, nausea, abdominal pain, altered taste, anorexia, dyspepsia, sexual dysfunction, menstrual disorders, urinary frequency, increased sweating, myalgia, tremor, hypertonia. ■ CONTRAINDICATIONS: Hypersensitivity, concurrent MAO inhibitor therapy (may result in serious, potentially fatal reactions). ■ CAUTIONS: Serious, potentially fatal reactions (hyperthermia, rigidity, myoclonus, autonomic instability, with fluctuating vital signs and extreme agitation, which may proceed to delirium and coma) may occur with concurrent MAO inhibitors. • MAO inhibitors should be stopped at least 14 days before sertraline therapy. • Sertraline should be stopped at least 14 days before MAO inhibitor therapy. • May increase levels/effects of warfarin and phenytoin. • Increased risk of serotonin syndrome with St. John’s wort and SAMe. • Caution patient to avoid driving and other activities requiring alertness until response to the drug is known.

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143 SIMVASTATIN (sim-va-sta-tin) Zocor lipid-lowering agent Pregnancy Category X ■ INDICATIONS: Primary hypercholesterolemia and mixed dyslipidemia. Therapeutic Effects: ■ Lowering of total and LDL cholesterol. ■ DOSAGE: PO: Adults: 10–40 mg once daily. ■ ADMINISTRATION: Administer with the evening meal. ■ 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. ■ CONTRAINDICATIONS: Hypersensitivity, active liver disease, pregnancy or lactation, concurrent use of gemfibrozil or azole antifungals. ■ CAUTIONS: 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. • Blood levels and the risk of myopathy are increased by concurrent cyclosporine, gemfibrozil, clofibrate, erythromycin, and 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 weeks after initiation of therapy or after dose elevation, and then every 6 months. • If AST levels increase to 3 times normal, HMG-COA reductase inhibitor therapy should be discontinued. • May also cause elevated alkaline phosphatase and bilirubin levels.

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

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SPIRONOLACTONE (speer-oh-no-lak-tone) Aldactone, Novospiroton diuretic (potassium-sparing diuretic) Pregnancy Category B ■ INDICATIONS: Counteract potassium loss caused by other diuretics, used with thiazides to treat edema or hypertension. Therapeutic Effects: ■ Weak diuretic and antihypertensive response when compared with other diuretics, conservation of potassium. ■ DOSAGE: PO: Adults: 25–400 mg/d as a single dose or 2–4 divided doses. CHF: 12.5–25 mg/d (unlabeled use). Children: 1–3 mg/kg/d (30–90 mg/m2/d as a single dose or 2–4 divided doses (not to exceed 3 times initial dose). ■ ADMINISTRATION: Administer in AM to avoid interrupting sleep pattern. Administer with food or milk to minimize gastric irritation and to increase bioavailability. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness, arrhythmias, constipation, GI irritation, impotence, hyperkalemia, hyponatremia, muscle cramps, allergic reactions. ■ CONTRAINDICATIONS: Hypersensitivity, hyperkalemia. ■ CAUTIONS: Use cautiously in hepatic dysfunction, geriatric or debilitated patients or patients with diabetes mellitus (increased risk of hyperkalemia), renal insufficiency (BUN 30 mg/dL or CCr 30 mL/min), pregnancy, lactation, or children. • 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.

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145 SUMATRIPTAN (soo-ma-trip-tan) Imitrex vascular headache suppressant Pregnancy Category C ■ INDICATIONS: Migraine and cluster headaches.

Therapeutic Effects: ■ Relief of acute attacks of migraine. ■ DOSAGE: PO: Adults: 25–50 mg initially; if response is inadequate at 2 hours, may repeat (not to exceed 200 mg in 24 hours). SC: Adults: 6 mg, may repeat after 1 hour (not to exceed 12 mg in 24 hours). Intranasal: Adults: Single dose of 5, 10, or 20 mg in one nostril; may be repeated in 2 hours, not to exceed 40 mg in 24 hours or treatment of 5 episodes/ month. ■ ADMINISTRATION: PO: Tablets are film-coated to because contents have an unpleasant taste. Swallow whole; do not crush, break, or chew. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness, vertigo, anxiety, drowsiness, MI, angina, chest pressure, chest tightness, coronary vasospasm, ECG changes, transient hypertension, tingling, warm sensation, burning sensation, injection site reaction, numbness. ■ CONTRAINDICATIONS: Hypersensitivity, ischemic heart disease, Prinzmetal angina, uncontrolled hypertension, concurrent MAO inhibitor therapy, elderly patients. ■ CAUTIONS: Monitor blood pressure before and for 1 hour after initial SC dose for patients with cardiovascular risk factors. • Use only if cardiovascular status has been evaluated and first dose is administered under supervision. • Increased risk of vasospastic reactions with ergotamine, dihydroergotamine, or methysergide. • Do not use within 2 wk of discontinuing MAO inhibitor. • Increased risk of serotonergic side effects including serotonin syndrome with St. John’s wort and SAMe. • Advise patient to notify health care professional if pain or tightness in the chest occurs. Key: underline = most common; CAPS = life-threatening

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TAMOXIFEN (ta-mox-i-fen) Nolvadex, Tamoxifen, Tamofen antineoplastic, antiestrogen Pregnancy Category D ■ INDICATIONS: Breast cancer; palliative or adjunctive treatment of advanced breast cancer; prevention of breast cancer in high-risk patients; ductal carcinoma in situ following breast surgery and radiation. Therapeutic Effects: ■ Suppresses tumor growth. Reduces incidence of breast cancer in high-risk patients. ■ DOSAGE: PO: Adults: Treatment of breast cancer: 10–20 mg twice daily. Prevention of breast cancer/ductal carcinoma in situ: 20 mg once daily for 5 years. ■ ADMINISTRATION: Administer with food or fluids. Consult physician or other health care professional if patient vomits shortly after administration of medication to determine need for repeat dose. Do not crush, break, chew, or administer an antacid within 1–2 hours of enteric-coated tablet.

■ ADVERSE REACTIONS AND SIDE EFFECTS: Confusion, headache, weakness, blurred vision, edema, nausea, vomiting, endometrial carcinoma, vaginal bleeding, hypercalcemia, leukopenia, thrombocytopenia, hot flashes, bone pain, tumor flare. ■ CONTRAINDICATIONS: Hypersensitivity, concurrent warfarin therapy with history of deep vein thrombosis (patients at high risk for breast cancer only), pregnancy or lactation. ■ CAUTIONS: Blood levels are increased by bromocriptine. May increase the anticoagulant effect of warfarin. • Risk of thromboembolic events is increased by concurrent use of other antineoplastics. • Bone pain may be an indication of the drug’s effectiveness and will resolve over time; analgesics should be ordered to control pain. • May induce ovulation and have teratogenic properties. • Advise patient to use a nonhormonal method of contraception during and for 1 month after the course of therapy.

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147 TAMSULOSIN (tam-soo-loe-sin) Flomax (peripherally acting anti-adrenergic) Pregnancy Category B ■ INDICATIONS: Urinary outflow obstruction associated with prostatic hyperplasia. Therapeutic Effects: ■ Decreased symptoms of prostatic hyperplasia (urinary urgency, hesitancy, nocturia). ■ DOSAGE: PO: Adults: 0.4–0.8 mg once daily after a meal.

■ ADMINISTRATION: Administer daily dose 30 min after the same meal each day. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness, headache, rhinitis, orthostatic hypotension, retrograde/diminished ejaculation. ■ CONTRAINDICATIONS: Hypersensitivity. ■ CAUTIONS: Use cautiously in patients at risk for prostate carcinoma (symptoms may be similar). • Cimetidine may increase blood levels and the risk of toxicity. • Increased risk of hypotension with other peripherally acting anti-adrenergics (doxazosin, prazosin, terazosin); concurrent use should be avoided. • If dose is interrupted for several days at either the 0.4-mg or 0.8-mg dose, restart therapy with the 0.4-mg/d doses. • Assess patient for symptoms of prostatic hyperplasia (urinary hesitancy, feeling of incomplete bladder emptying, interruption of urinary stream, impairment of size and force of urinary stream, terminal urinary dribbling, straining to start flow, dysuria, urgency, bladder distension) before and periodically throughout therapy.

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

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TEMAZEPAM (teh-maz-a-pam) Restoril sedative/hypnotic (benzodiazepine) Schedule IV Pregnancy Category X ■ INDICATIONS: Insomnia. Therapeutic Effects: ■ Relief of insomnia. ■ DOSAGE: PO: Adults: 15–30 mg at bedtime initially if needed; some patients may require only 7.5 mg. Geriatric Patients or Debilitated Patients): 7.5 mg at bedtime. ■ ADMINISTRATION: Administer with food if GI irritation becomes a problem. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Hangover, dizziness, drowsiness, lethargy, paradoxical excitation, blurred vision, constipation, diarrhea, nausea, vomiting, rashes, physical dependence, psychological dependence, tolerance. ■ CONTRAINDICATIONS: Hypersensitivity, pre-existing CNS depression, severe uncontrolled pain, narrow-angle glaucoma, pregnancy or lactation. ■ CAUTIONS: Additive CNS depression with alcohol, antidepressants, antihistamines, opioid analgesics, and other sedative/hypnotics. • May decrease efficacy of levodopa. • Rifampin or smoking increases metabolism and may decrease effectiveness of temazepam. • Probenecid may prolong the effects of temazepam. • Sedative effects may be antagonized by theophylline. • Concomitant use of kava, valerian, skullcap, chamomile, or hops can increase CNS depression. • Prolonged high-dose therapy may lead to psychological or physical dependence; restrict amount of drug available to patient, especially if patient is depressed or suicidal or has a history of addiction. • May cause daytime drowsiness or dizziness; caution patient to avoid driving or other activities requiring alertness until response to medication is known. • Advise patient to avoid the use of alcohol and other CNS depressants and to consult health care professional before using OTC preparations that contain antihistamines or alcohol.

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149 TERAZOSIN (ter-ay-zoe-sin) Hytrin antihypertensive (antiadrenergic) Pregnancy Category C ■ INDICATIONS: Mild to moderate hypertension, urinary obstruction associated with prostatic hyperplasia. Therapeutic Effects: ■ Lowering of blood pressure, decreased symptoms of urinary urgency, hesitancy, nocturia. ■ DOSAGE: PO: Adults: 1 mg initially, then slowly increase up to 5 mg/d (usual range 1–5 mg/d); may be given as single dose. ■ ADMINISTRATION: Administer daily dose at bedtime. If necessary, dosage may be increased to twice daily. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness, headache, weakness, drowsiness, nervousness, nasal congestion, blurred vision, conjunctivitis, sinusitis, dyspnea, firstdose orthostatic hypotension, arrhythmias, chest pain, palpitations, peripheral edema, tachycardia, nausea, abdominal pain, diarrhea, dry mouth, vomiting, impotence, urinary frequency, pruritus, weight gain, arthralgia, back pain, extremity pain, paresthesia. ■ CONTRAINDICATIONS: Hypersensitivity. ■ CAUTIONS: Additive hypotension with other antihypertensives, acute ingestion of alcohol, or nitrates. • NSAIDs, sympathomimetics, or estrogens may decrease the effects of antihypertensive therapy. • Assess patient for first-dose orthostatic reaction and syncope. • May occur 30 minutes to 2 hours after initial dose and occasionally thereafter. • May cause dizziness or drowsiness; advise patient to avoid driving or other activities requiring alertness until response to the medication is known. • Caution patient to avoid sudden changes in position to decrease orthostatic hypotension. • Alcohol, CNS depressants, standing for long periods, hot showers, and exercising in hot weather should be avoided because of enhanced orthostatic effects. Key: underline = most common; CAPS = life-threatening

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TINZAPARIN (tin-za-pa-rin) Innohep anticoagulant (low molecular weight heparin [LMWH]) (antithrombotic) Pregnancy Category B

■ 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: ■ Prevention of thrombus formation. ■ DOSAGE: SC: Adults: Treatment of deep vein thrombosis—175 anti-Xa IU/kg once daily for at least 6 days and until adequate anticoagulation is achieved with warfarin; prophylaxis of deep vein thrombosis: 50–75 anti-Xa units/kg once daily. ■ ADMINISTRATION: Administer deep into SC tissue. Do not aspirate or massage. Rotate sites frequently. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness, insomnia, edema, urinary retention, ecchymoses, pruritus, rash, urticaria, BLEEDING, anemia, thrombocytopenia, hematoma. ■ CONTRAINDICATIONS: Hypersensitivity to pork products, uncontrolled bleeding, thrombocytopenia. ■ 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. • Use cautiously in spinal/epidural anesthesia, bleeding disorders, GI bleeding, hemorrhagic stroke, recent CNS or ophthalmologic surgery, history of thrombocytopenia related to heparin, retinopathy, malignancy. • Risk of bleeding may be increased by warfarin, aspirin, NSAIDs, dipyridamole, some penicillins, clopidogrel, ticlopidine, abciximab, eptifibatide, tirofiban, and dextran.

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151 TOLTERODINE (tol-ter-oh-deen) Detrol, Detrol LA urinary tract antispasmodic, anticholinergic Pregnancy Category C ■ INDICATIONS: Overactive bladder function that results in urinary frequency, urgency, or urge incontinence. Therapeutic Effects: ■ Decreases urinary frequency, urgency, and urge incontinence. ■ DOSAGE: PO: Adults: 2 mg twice daily as tablets; may be lowered depending on response or 2–4 mg once daily as extended-release capsules. ■ ADMINISTRATION: Administer without regard to food. Extended-release capsules should be swallowed whole; do not open or chew. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Headache, dizziness, blurred vision, dry eyes, dry mouth, constipation, dyspepsia. ■ CONTRAINDICATIONS: Urinary retention, gastric retention, uncontrolled narrow-angle glaucoma, lactation. ■ CAUTIONS: Use cautiously in GI obstructive disorders, including pyloric stenosis (increased risk of gastric retention), significant bladder outflow obstruction (increased risk of urinary retention), controlled narrow-angle glaucoma, significant hepatic impairment (lower doses recommended), impaired renal function, pregnancy, children. • Erythromycin, clarithromycin, ketoconazole, itraconazole, and miconazole may inhibit metabolism and increase effects of tolterodine. • Assess patient for urinary urgency, frequency, and urge incontinence periodically throughout therapy. • Instruct patient to take tolterodine exactly as directed. • May cause dizziness and blurred vision—caution patient to avoid driving or other activities requiring alertness until response to medication is known.

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

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TRAMADOL (tray-mah-dol) Ultram analgesic Pregnancy Category C

■ INDICATIONS: Moderate to moderately severe pain. Therapeutic Effects: ■ Decreased pain. ■ DOSAGE: PO: Adults: 50–100 mg every 4–6 h. Geriatrics: 50–100 mg every 4-6 h (not to exceed 300–400 mg per day). Renal Impairment: Adults: CCr 30 mL/min—increase dosing to q 12 h (not to exceed 200 mg/d). Hepatic Impairment: Adults: 50 mg q 12 h. ■ ADMINISTRATION: Administer without regard to meals. ■ ADVERSE REACTIONS AND SIDE EFFECTS: SEIZURES, dizziness, headache, somnolence, anxiety, CNS stimulation, confusion, euphoria, vasodilation, constipation, nausea, diarrhea, dry mouth, sweating, hypertonia, physical and psychological dependence, tolerance. ■ CONTRAINDICATIONS: Hypersensitivity; acute intoxication with alcohol, sedative/hypnotics, centrally acting analgesics, opioid analgesics, or psychotropic agents; physical dependence on opioid analgesics (may precipitate withdrawal), pregnancy or lactation. ■ CAUTIONS: • Increased risk of CNS depression with other CNS depressants, alcohol, antihistamines, sedative/hypnotics, opioid analgesics, anesthetics, or psychotropic agents. Increased risk of seizures with high doses of penicillins or cephalosporins, phenothiazines, opioid analgesics or antidepressants. • Use cautiously in patients who are receiving MAO inhibitors (increased risk of adverse reactions). • Overdose may cause respiratory depression and seizures. Naloxone (Narcan) may reverse some, but not all, of the symptoms of overdose. Treatment should be symptomatic and supportive. • Seizures may be managed with barbiturates or benzodiazepines; naloxone increases risk of seizures.

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153 TRAZODONE (tra-zo-done) Desyrel, Trialodine, Trazon antidepressant Pregnancy Category C ■ INDICATIONS: Major depression, unlabeled uses: insomnia and chronic pain syndromes. Therapeutic Effects: ■ Improved mood. ■ DOSAGE: PO: Adults: Depression: 150 mg daily in 3 divided doses (not to exceed 400 mg/d in outpatients or 600 mg/d in hospitalized patients). Insomnia: 25–100 mg at bedtime. Geriatric Patients: 75 mg daily in divided doses initially. Children 6–18 yr: 1.5–2 mg/kg daily in divided doses. ■ ADMINISTRATION: Administer with or immediately after meals. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Drowsiness, confusion, dizziness, hallucinations, insomnia, slurred speech, blurred vision, tinnitus, hypotension, arrhythmias, chest pain, hypertension, palpitations, tachycardia, dry mouth, constipation, hematuria, impotence, priapism, urinary frequency, rashes, anemia. ■ CONTRAINDICATIONS: Hypersensitivity, recovery period after MI, concurrent electroconvulsive therapy. ■ CAUTIONS: Use cautiously in cardiovascular disease, suicidal behavior. • May increase digoxin or phenytoin serum levels. Additive CNS depression with other CNS depressants, including alcohol, opioid analgesics, and sedative/hypnotics. • Additive hypotension with antihypertensives, acute ingestion of alcohol, or nitrates. • Fluoxetine increases levels and risk of toxicity. • Monitor blood pressure and pulse rate before and during initial therapy. Patients with pre-existing cardiac disease should have ECGs monitored before and periodically during therapy to detect arrhythmias. • Restrict amount of drug available to suicidal patients. • Avoid driving and other activities requiring alertness until response to drug is known. • Change positions slowly to minimize orthostatic hypotension.

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TRIAMCINOLONE (try-am-sin-oh-lone) Azmacort, Azmacort HFA antiasthmatic, anti-inflammatory (inhalation corticosteroid) Pregnancy Category C

■ INDICATIONS: Asthma. Therapeutic Effects: ■ Decrease frequency and severity of asthma attacks. ■ DOSAGE: Inhalation: Adults and Children 12 yr: 2 metered inhalations 3–4 times daily or 4 inhalations twice daily (100 g/metered inhalation; not to exceed 16 metered inhalations/day). Children 6–12 yr: 1–2 metered inhalations 3–4 times daily or 2–4 inhalations twice daily (100 g/metered inhalation; not to exceed 12 metered inhalations/day). ■ ADMINISTRATION: Allow at least 1 minute between inhalations of aerosol medication. ■ 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. ■ CONTRAINDICATIONS: Acute attack of asthma/status asthmaticus. ■ CAUTIONS: Use cautiously in active untreated infections, diabetes or glaucoma, underlying immunosuppression, systemic corticosteroid therapy, pregnancy, lactation, or children 6 years. • 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.

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155 TRIMETHOPRIM/SULFAMETHOXAZOLE (trye-meth-ohprim/sul-fa-meth-ox-a-zole) Bactrim, Septra, TMP/SMZ antiinfective, antiprotozoal Pregnancy Category C ■ INDICATIONS: Bronchitis, Shigella enteritis, otitis media, Pneumocystis carinii pneumonia (PCP), urinary tract infection, traveler’s diarrhea. Therapeutic Effects: ■ Bactericidal action against susceptible bacteria. ■ DOSAGE: (TMP  trimethoprim; SMZ  sulfamethoxazole) PO: Adults and Children 40 kg: Bacterial infections: 160 mg TMP/800 mg SMZ q 12 h. Children 2 mo: Bacterial infections: 4–6 mg/kg TMP/20–30 mg/kg SMZ q 12 h. IV: Adults and Children 2 mo: Bacterial Infections: 2–2.5 mg/kg TMP/10–12.5 mg/kg SMZ q 6 h or 2.7–3.3 mg/kg TMP/13.3–16.7 mg/kg SMZ q 8 h or 4–5 mg/kg TMP/20–25 mg/kg SMZ q 12 h. PCP: 3.75–5 mg/kg TMP/18.75–25 mg SMZ q 6 h or 5–6.7 mg/kg TMP/25–33.3 mg SMZ q 8 h. ■ ADMINISTRATION: PO: Administer around the clock with a full glass of water. IV: Dilute each 5-mL ampule with 100–125 mL of D5W. Rate: Infuse over 60–90 minutes. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Fatigue, headache, insomnia, HEPATIC NECROSIS, nausea, vomiting, diarrhea, stomatitis, TOXIC EPIDERMAL NECROLYSIS, rashes, photosensitivity, AGRANULOCYTOSIS, APLASTIC ANEMIA, hemolytic anemia, leukopenia, megaloblastic anemia, phlebitis at IV site, ERYTHEMA MULTIFORME, STEVENSJOHNSON SYNDROME, fever. ■ CONTRAINDICATIONS: Hypersensitivity, megaloblastic anemia secondary to folate deficiency, severe renal impairment, pregnancy, lactation, or children 2 months. ■ CAUTIONS: May enhance the effects of sulfonylurea oral antidiabetics and warfarin. Increases the risk of thrombocytopenia from thiazide diuretics (increased in geriatric patients). • Decreases efficacy of cyclosporine and increases risk of nephrotoxicity.

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VALACYCLOVIR (val-ay-sye-kloe-veer) Valtrex antiviral Pregnancy Category B ■ INDICATIONS: Herpes zoster, genital herpes. Therapeutic Effects: ■ Inhibited viral replication, decreased viral shedding, and reduced time of healing of lesions. ■ DOSAGE: PO: Adults: Herpes zoster 1g 3 times daily for 7 days. Genital herpes Initial treatment—1 g twice daily for 10 days. Recurrence—500 mg twice daily for 3 days. Suppression of recurrence— 500 mg to 1 g daily. ■ ADMINISTRATION: Administer without regard to meals. For herpes zoster, administer as soon as possible after the onset of signs or symptoms. Most effective if started within 48 hours of the onset of zoster rash. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Headache, dizziness, nausea, anorexia, diarrhea, THROMBOTIC THROMBOCYTOPENIC PURPURA/HEMOLYTIC UREMIC SYNDROME (very high doses in immunosuppressed patients). ■ CONTRAINDICATIONS: Hypersensitivity ■ CAUTIONS: Probenecid and cimetidine increase blood levels; this interaction is only significant in patients with renal impairment. • Monitor patient for signs of thrombotic thrombocytic purpura/hemolytic uremic syndrome (microangiopathic hemolytic anemia, neurological findings, renal dysfunction, fever). Requires prompt treatment; may be fatal. • Herpes zoster: Does not prevent the spread of infection to others. Precautions should be taken around others who have not had chickenpox or varicella vaccine, or are immunosuppressed, until all lesions have crusted. • Genital herpes: Does not prevent the spread of infection to others. Advise patient to avoid contact with lesions and to avoid intercourse while lesions or symptoms are present.

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157 VALPROIC ACID (val-proe-ik as-id) Depakote, Depakote ER, Depakene, Epival, anticonvulsant, vascular headache suppressant Pregnancy Category D

■ INDICATIONS: Seizures, manic episodes associated with bipolar disorder (delayed-release only); migraine headache prevention (delayed and extended release). Therapeutic Effects: ■ Suppression of seizures, decreased manic behavior, and frequency of migraine headaches. ■ DOSAGE: PO, IV: Adults: Anticonvulsant: Single-agent therapy—Initial dose of 5–15 mg/kg daily; increase by 5–10 mg/kg daily q wk. Polytherapy: Initial dose of 10–30 mg/kg daily; increase by 5–10 mg/kg daily q wk. Children: Anticonvulsant: Single-agent therapy: Initial dose of 15–45 mg/kg/d; increase by 5–10 mg/kg daily q wk. Polytherapy: Initial dose of 30–100 mg/kg daily. ■ ADMINISTRATION: PO: Administer with or immediately after meals. IV: Rate: Administer over 60 min (20 mg/min). ■ ADVERSE REACTIONS AND SIDE EFFECTS: Confusion, sedation, HEPATOTOXICITY, nausea, vomiting, diarrhea, prolonged bleeding time. ■ CONTRAINDICATIONS: Hypersensitivity, hepatic impairment, urea cycle disorders. ■ CAUTIONS: Monitor hepatic function (LDH, AST, ALT, and bilirubin) and serum ammonia concentrations, especially during initial 6 months of therapy; fatalities from liver failure have occurred. • Discontinue if hyperammonemia occurs. • Increased risk of bleeding with antiplatelet agents, including aspirin, NSAIDs, tirofiban, eptifibatide, and abciximab, cefamandole, cefoperazone, cefotetan, heparins and thrombolytic agents, or warfarin. • Additive CNS depression with CNS depressants, alcohol, antihistamines, antidepressants, opioid analgesics, MAO inhibitors, and sedative/hypnotics. Key: underline = most common; CAPS = life-threatening

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VALSARTAN (val-sar-tan) Diovan antihypertensive (angiotensin II receptor antagonist) Pregnancy Category C (first trimester), D (second and third trimesters)

■ INDICATIONS: Hypertension. Therapeutic Effects: ■ Lowering of blood pressure. ■ DOSAGE: PO: Adults: 80–320 mg/d. ■ ADMINISTRATION: May be administered without regard to meals. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness, fatigue, headache, hypotension, diarrhea, drug-induced hepatitis, RENAL FAILURE, hyperkalemia. ■ CONTRAINDICATIONS: Hypersensitivity, pregnancy or lactation. ■ CAUTIONS: NSAIDs may decrease antihypertensive effects. Additive antihypertensive effects with other antihypertensives and diuretics. • Risk of hypotension is increased by concurrent diuretic therapy (use lower initial doses). • Telmisartan increases serum digoxin levels. • Concurrent use of potassium-sparing diuretics or potassium supplements may increase the risk of hyperkalemia. • Caution patient to avoid sudden changes in position to decrease orthostatic hypotension. • Use of alcohol, standing for long periods, exercising, and hot weather may increase orthostatic hypotension. • Advise women of childbearing age to use contraception and notify health care professional if pregnancy is suspected or planned. • May cause dizziness. Caution patient to avoid driving, or other activities requiring alertness, until response to medication is known.

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159 VANCOMYCIN (van-koe-mye-sin) Lyphocin, Vancocin, Vancoled anti-infective Pregnancy Category C ■ INDICATIONS: Potentially life-threatening infections when less toxic anti-infectives are contraindicated. Pseudomembranous colitis due to Clostridium difficile. Therapeutic Effects: ■ Bactericidal action against susceptible organisms. ■ DOSAGE: PO: Adults: 125–500 mg q 6 h. Children: 10 mg/kg q 6 h (up to 125 mg/dose; not to exceed 2 g/d). IV: Adults: 500 mg q 6 h or 1 g q 12 h (up to 3–4 g/d). Children 1 mo: 10 mg/kg q 6 h or 20 mg/kg q 12 h. Neonates 1 wk–1 mo: 15 mg/kg initially, then 10 mg/kg q 8 h. Neonates 1 wk: 15 mg/kg initially, then 10 mg/kg q 12 h. Renal Impairment: IV Adults: An initial loading dose of 750 mg–1 g, then if CCr 50–80 mL/min: 1 g q 1–3 days; CCr 10–50 mL/min: 1 g q 3–7 days; CCr 10 mL/min: 1 g q 7–14 days. ■ ADMINISTRATION: Intermittent Infusion: Administer over at least 60 min. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Ototoxicity, hypotension, nausea, vomiting, nephrotoxicity, leukopenia, phlebitis, ANAPHYLAXIS, chills, fever, “red man” syndrome, superinfection. ■ CONTRAINDICATIONS: Hypersensitivity. ■ CAUTIONS: Use cautiously in renal impairment, hearing impairment, intestinal obstruction or inflammation. • May cause additive ototoxicity and nephrotoxicity with other ototoxic and nephrotoxic drugs aspirin, aminoglycosides, cyclosporine, cisplatin, loop diuretics). • May enhance neuromuscular blockade from nondepolarizing neuromuscular blocking agents. • Increased risk of histamine flush when used with general anesthetics in children.

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

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VENLAFAXINE (ven-la-fax-een) Effexor, Effexor XR antidepressant, antianxiety agent Pregnancy Category C ■ INDICATIONS: Major depressive illness or relapse, generalized anxiety disorder (Effexor XR only). Therapeutic Effects: ■ Improved mood, decreased anxiety. ■ DOSAGE: PO: Adults: 75 mg daily in 2–3 divided doses; may increase up to 225 mg/d (not to exceed 375 mg/d in 3 divided doses); extended-release (XR) formulation can be given as a single daily dose. ■ ADMINISTRATION: Administer with food. ■ ADVERSE REACTIONS AND SIDE EFFECTS: SEIZURES, abnormal dreams, anxiety, dizziness, headache, insomnia, nervousness, weakness, agitation, confusion, rhinitis, visual disturbances, tinnitus, chest pain, hypertension, palpitations, abdominal pain, altered taste, anorexia, constipation, diarrhea, dry mouth, dyspepsia, nausea, vomiting, weight loss, sexual dysfunction, urinary retention, ecchymoses, photosensitivity, paresthesia, chills. ■ CONTRAINDICATIONS: Hypersensitivity, concurrent MAO inhibitor therapy. ■ CAUTIONS: Use with MAO inhibitors may result in serious, potentially fatal reactions. • Use cautiously in cardiovascular disease, hepatic impairment, impaired renal function, history of seizures, neurological impairment, mania, or drug abuse, pregnancy, lactation, or children 18 yr. • Alcohol or other CNS depressants, including sedative/hypnotics, antihistamines, and opioid analgesics should be avoided. • Assess suicidal tendencies. • Restrict amount of drug available to patient. • Sustained hypertension may be dose related; decrease or discontinue therapy if this occurs. • Patients taking venlafaxine for 6 weeks should have dose gradually decreased before discontinuation.

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161 VERAPAMIL (ver-ap-a-mil) Calan, Isoptin, Verelan antianginal, antiarrhythmic, antihypertensive, (calcium channel blocker) Pregnancy Category C

■ INDICATIONS: Hypertension, angina pectoris, and/or vasospastic (Prinzmetal) angina, supraventricular arrhythmias and rapid ventricular rates in atrial flutter or fibrillation. Therapeutic Effects: ■ Decreased blood pressure and angina attacks, suppression of ventricular tachyarrhythmias. ■ DOSAGE: PO: Adults: 80–120 mg 3 times daily, increased as needed. Poor ventricular function, hepatic impairment, or geriatric patients: 40 mg 3 times daily. Extended-release preparations: 120–240 mg daily; (up to 240–480 mg/d). Children up to 15 yr: 4–8 mg/kg daily in divided doses. IV: Adults: 5–10 mg. Children 1–15 yr: 2–5 mg (100–300 g/kg). Children 1 yr: 0.75–2 mg (100–200 g/kg). ■ ADMINISTRATION: PO: Administer with meals. IV: Rate: Administer IV undiluted over 2 min. ■ ADVERSE REACTIONS AND SIDE EFFECTS: ARRHYTHMIAS, CHF, bradycardia, chest pain, hypotension, peripheral edema, STEVENS-JOHNSON SYNDROME, gingival hyperplasia. ■ CONTRAINDICATIONS: Hypersensitivity, sick sinus syndrome, 2nd or 3rd AV block, systolic BP 90, CHF, ventricular dysfunction, or cardiogenic shock, unless associated with supraventricular tachyarrhythmias, IV beta-blocker therapy. ■ CAUTIONS: Use cautiously in hepatic impairment, geriatric patients, ventricular arrhythmias, CHF, pregnancy or lactation. • Additive hypotension may occur when used concurrently with fentanyl, other antihypertensives, nitrates, acute ingestion of alcohol, or quinidine. • Serum digoxin levels may be increased. • Concurrent use with beta-blockers, digoxin, disopyramide, or phenytoin may result in bradycardia, conduction defects, or CHF. • Teach patient to take pulse and to contact health care professional if heart rate is 50 bpm. Key: underline = most common; CAPS = life-threatening

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WARFARIN (war-fa-rin) Coumadin, Warfilone anticoagulant Pregnancy Category X ■ INDICATIONS: Venous thrombosis, pulmonary embolism, atrial fibrillation with embolization, MI, prevention of thrombus formation post–prosthetic valve placement. Therapeutic Effects: ■ Prevention of thromboembolic events. ■ DOSAGE: PO: Adults: 2.5–10 mg/d for 2–4 days; then adjust daily dose by results of prothrombin time or international normalized ratio (INR). ■ ADMINISTRATION: PO: Administer at same time daily. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Cramps, nausea, dermal necrosis, BLEEDING, fever. ■ CONTRAINDICATIONS: Uncontrolled bleeding, open wounds, active ulcer disease, recent brain, eye, or spinal cord injury or surgery, severe liver disease, uncontrolled hypertension, pregnancy. ■ CAUTIONS: HIGH ALERT MED: Assess for signs of bleeding and hemorrhage (bleeding gums; nosebleed; bruising; tarry, black stools). • Monitor PT or INR and other clotting factors frequently during therapy. • Androgens, cefotetan, chloral hydrate, chloramphenicol, fluconazole, fluoroquinolones, itraconazole, metronidazole, thrombolytic agents, sulfonamides, quinidine, quinine, NSAIDs, valproates, and aspirin may increase response and risk of bleeding. • Chronic acetaminophen use may increase the risk of bleeding. • Alcohol, barbiturates, and hormonal contraceptives containing estrogen decrease response. • Large quantities of foods high in vitamin K may antagonize the anticoagulant effect. • Antidote is vitamin K (phytonadione, AquaMEPHYTON). • Avoid IM injections and activities leading to injury. Inform all health care personnel about anticoagulant therapy before lab tests, treatment, or surgery. • Increased bleeding risk with arnica, chamomile, clove, dong quai, feverfew, garlic, ginger, ginkgo, Panax ginseng, and other natural products.

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163 ZAFIRLUKAST (za-feer-loo-kast) Accolate antiasthmatic, bronchodilators leukotriene antagonist Pregnancy Category B ■ INDICATIONS: Asthma.

Therapeutic Effects: ■ Decreases frequency and severity of asthma attacks. Decreases airway edema and smooth muscle constriction, resulting in decreased inflammatory process that is part of asthma. ■ DOSAGE: PO: Adults and Children 12 yr: 20 mg twice daily. Children 7–11 yr: 10 mg twice daily. ■ ADMINISTRATION: Administer at regular intervals on an empty stomach, 1 h before or 2 h after meals. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Headache, dizziness, weakness, abdominal pain, diarrhea, drug-induced hepatitis (females), dyspepsia, nausea, vomiting, arthralgia, back pain, myalgia, CHURG-STRAUSS SYNDROME, fever, infection (geriatric patients), pain. ■ CONTRAINDICATIONS: Hypersensitivity, lactation. ■ CAUTIONS: • Advise patient to notify health care professional if symptoms of Churg-Strauss syndrome (generalized flu-like syndrome, fever, muscle aches and pain, weight loss, worsening respiratory symptoms) occur. Occurs rarely but may be life-threatening. More likely to occur when weaning from systemic corticosteroids. • Blood levels are increased by aspirin. • Blood levels are decreased by erythromycin and theophylline. • Increases effects and risk of bleeding with warfarin. • Monitor liver function periodically during therapy. • Instruct patient not to discontinue or reduce other asthma medications without consulting health care professional. • Assess lung sounds and respiratory function prior to and periodically throughout therapy. • Food decreases absorption; take on an empty stomach.

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

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ZIDOVUDINE (zye-doe-vue-deen) Apo-Zidovudine, AZT, NovoAZT, Retrovir antiretroviral, nucleoside reverse transcriptase inhibitor Pregnancy Category C ■ INDICATIONS: HIV infection, prevention of fetal HIV. Therapeutic Effects: ■ Slows progression of HIV infection, decreases risk of transmission of HIV to infants born to HIVinfected mothers. ■ DOSAGE: PO: Adults and Children 13 yr: Management of HIV infection: 100 mg q 4 h while awake or 200 mg 3 times daily or 300 mg twice daily. Prevention of maternal/fetal transmission of HIV infection: Adults 14 wk Pregnant: 100 mg 5 times daily until onset of labor. Children 3 mo–12 yr: Management of HIV infection: 90–180 mg/m2 every 6 h (not to exceed 200 mg q 6 h). Infants: Prevention of maternal/fetal transmission of HIV infection: 2 mg/kg q 6 h, started within 12 h of birth and continued for 6 wk. IV: Adults and Children 12 yr: Management of HIV infection: 1 mg/kg infused over 1 h q 4 h. Prevention of maternal/fetal transmission of HIV infection: Adults During Labor and Delivery: 2 mg/kg over 1 h, then continuous infusion of 1 mg/kg/h until umbilical cord is clamped. Children: Management of HIV infection: 120 mg/m2 q 6 h (not to exceed 160 mg/dose). Prevention of maternal/fetal transmission of HIV Infection: Infants: 1.5 mg/kg q 6 h until able to take PO. ■ ADMINISTRATION: PO: Administer around the clock. Intermittent Infusion: Rate: Infuse at a constant rate over 1 h. ■ ADVERSE REACTIONS AND SIDE EFFECTS: SEIZURES, headache, weakness, anxiety, mental depression, abdominal pain, diarrhea, nausea, anorexia, hepatitis, anemia, granulocytopenia. ■ CONTRAINDICATIONS: Hypersensitivity, lactation. ■ CAUTIONS: Additive bone marrow depression with other agents having bone marrow–depressing properties; additive neurotoxicity with acyclovir.

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165 ZOLPIDEM (zole-pi-dem) Ambien sedative/hypnotic Pregnancy Category B

■ INDICATIONS: Short-term treatment of insomnia. Therapeutic Effects: ■ Sedation and induction of sleep. ■ DOSAGE: PO: Adults: 10 mg at bedtime. Geriatric Patients, Debilitated Patients, or Patients with Hepatic Impairment: 5 mg at bedtime initially; may be increased to 10 mg. ■ ADMINISTRATION: Tablets should be swallowed whole with full glass of water. ■ ADVERSE REACTIONS AND SIDE EFFECTS: Amnesia, daytime drowsiness, dizziness, “drugged” feeling, diarrhea, nausea, vomiting, hypersensitivity reactions, physical dependence, psychological dependence, tolerance. ■ CONTRAINDICATIONS: Hypersensitivity, sleep apnea. ■ CAUTIONS: Use cautiously in history of previous psychiatric illness, suicide attempt, drug or alcohol abuse, geriatric patients and patients with impaired hepatic function, patients with pulmonary disease, pregnancy, lactation, or children. • Additive CNS depression may occur with concurrent use of other sedative/hypnotics, alcohol, phenothiazines, tricyclic antidepressants, opioid analgesics, or antihistamines. • Concomitant use of kava, valerian, skullcap, chamomile, or hops can increase CNS depression. • Protect patient from injury—raise bedside rails or assist with ambulation.

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

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Emergency Drugs (NAME: initial dose [indication]) ADENOSINE: 6 mg rapid IVP; rpt 12 mg
2 [SVT] AMIODARONE: 300 mg IVP [VF, VT, SVT] ATROPINE: 0.5–1 mg q3-5 min up to 2 mg [bradycardia] EPINEPHRINE: 1 mg q3-5 min [cardiac arrest] LASIX: 0.5–1 mg/kg IV [pulmonary edema] LIDOCAINE: 1–1.5 mg/kg IV q5-10 min; maximum 3 mg/kg [VF, VT] MAGNESIUM: (MgSO4) 1–2 g IVP [VT r/t hypo-Mg] MORPHINE: (MSO4) 1–3 mg [CP, pulmonary edema] NARCAN: 0.02–0.2 mg q2-3 min [narcotic-respiratory depression] NITROGLYCERIN: 0.4 mg SL q3-5 min
3 [CP, pulmonary edema] ROMAZICON: 0.2 mg q min up to 1 mg [benzodiazepine OD] SOLU-MEDROL: 1–2 mg/kg [allergic reaction] VASOPRESSIN: 40 units IVP [cardiac arrest]

Drug Suffixes and Meaning Drugs with these endings . . . . . . . . . . .usually belong to this class: -caine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Local anesthetics -cillin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Antibiotics -dine . . . . . . . . . . . . . . . . .Antiulcer agents (histamine H2 blockers) -done . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Opioid analgesics -ide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Oral hypoglycemics -lam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Antianxiety agents -micin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Antibiotics -mide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Diuretics -mycin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Antibiotics -nium . . . . . . . . . . . . . . . . . . . . . . .Neuromuscular blocking agents -olol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Beta blockers -oxacin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Antibiotics -pam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Antianxiety agents -pril . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ACE inhibitors -sone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Steroids -statin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Antihyperlipidemics -vir . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Antivirals -zide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Diuretics

166

167 Common Laboratory Values General Chemistry Laboratory

Conventional

SI Units

Albumin

3.5–5.0 g/100 mL

Aldolase

1.3–8.2 U/L

22–137 nmol · s1/L

Alkaline phosphatase

13–39 U/L, infants and adolescents up to 104 U/L

217–650 nmol · s1/L, up to 1.26 mol/L

Ammonia

12–55 mol/L

12–55 mol/L

Amylase

4–25 units/mL

4–25 arb. unit

Anion gap

8–16 mEq/L

8–16 mmol/L

AST, SGOT

Male: 8–46 U/L

0.14–0.78 kat/L

Bilirubin, direct

35–50 g/L

Female: 7–34 U/L

0.12–0.58 kat/L

Up to 0.4 mg/100 mL

Up to 7 mol/L

Bilirubin, total

Up to 1.0 mg/100 mL

Up to 17 mol/L

BUN

8–25 mg/100 mL

2.9–8.9 mmol/L

Male: 0–14 pg/mL

0–4.1 pmol/L

Female: 0–28 pg/mL

0–8.2 pmol/L

Calcium (Ca)

8.5–10.5 mg/100 mL

2.1–2.6 mmol/L

Carbon dioxide

24–30 mEq/L

24–30 mmol/L

Chloride (Cl–)

100–106 mEq/L

100–106 mmol/L

Cholesterol

200 mg/dL

5.18 mmol/L

Calcitonin

Cortisol Creatine Creatine kinase (CK)

a.m. 5–25 g/100 mL

0.14–0.69 mol/L

p.m. 10 g/100 mL

0–0.28 mol/L

Male: 0.2–0.5 mg/dL

15–40 mol/L

Female: 0.3–0.9 mg/dL

25–70 mol/L

Male: 17–148 U/L

283–2467 nmol · s1/L

Female: 10–79 U/L

167–1317 nmol · s1/L (Continued)

TOOLS

TOOLS General Chemistry Laboratory

Creatinine Ferritin Folate Glucose Ionized calcium Iron (Fe) Iron-binding capacity (IBC) Lactic acid Lactic dehydrogenase (LDH)

Conventional

SI Units

0.6–1.5 mg/100 mL 10–410 ng/dL 2.0–9.0 ng/mL 70–110 mg/100 mL 4.26–5.25 mg/dL 50–150 g/100 mL 250–410 g/100 mL

53–133 mol/L

0.5–1.8 mEq/L 45–90 U/L

0.8–1.8 mmol/L 750–1500 nmol s1/L

4.5–20.4 nmol/L 3.9–5.6 mmol/L 1.1–1.3 mmol/L 9.0–25.9 mol/L 44.8–73.4 mol/L

Lipase 2 units/mL or less Magnesium (Mg) 1.5–2.0 mEq/L

Up to 2 arb. unit 0.8–1.3 mmol/L

Osmolality Phosphorus Potassium (K) Prealbumin Protein, total PSA Pyruvate

280–296 mOsm/kg water 3.0–4.5 mg/100 mL 3.5–5.0 mEq/L 18–32 mg/dL 6.0–8.4 g/100 mL 0.0–4.0 ng/mL 0–0.11 mEq/L

280–296 mmol/kg 1.0–1.5 mmol/L 3.5–5.0 mmol/L

Sodium (Na)

135–145 mEq/L

135–145 mmol/L

T3

75–195 ng/100 mL

1.16–3.00 nmol/L

T4, free

Male: 0.75–2.0 ng/dL Female: 0.75–2.0 ng/dL 4–12 g/100 mL 3–42 /mL 40–150 mg/100 mL 0.5–5.0 U/mL 8–25 mg/100 mL 3.0–7.0 mg/100 mL

52–154 nmol/L 3–42 g/L 0.4–1.5 g/L 0.5–5.0 arb. unit 2.9–8.9 mmol/L 0.18–0.42 mmol/L

T4, total Thyroglobulin Triglycerides TSH Urea nitrogen Uric acid

168

80–84 g/L 0–0.11 mmol/L

169 Hematology (ABC, CBC, Blood Counts) Blood volume

Red blood cell (RBC)

Hemoglobin (Hgb) Hematocrit

8.5–9.0% of body weight in kg

80–85 mL/kg

Male: 4.6–6.2 million/mm3

4.6–6.2
1012/L

Female: 4.2–5.9 million/mm3

4.2–5.9
1012/L

Male: 13–18 g/ 100 mL

8.1–11.2 mmol/L

Female: 12–16 g/ 100 mL

7.4–9.9 mmol/L

Male: 45–52%

0.45–0.52

Female: 37–48%

0.37–0.48

Leukocytes (WBC)

4.300–10.800/ mm3

4.3–10.8
109/L

■ Bands

0–5%

0.03–0.08

■ Basophils

0–1%

0–0.01

■ Eosinophils

1–4%

0.01–0.04

■ Lymphocytes

25–40%

0.25–0.40

10–20%

0.10–0.20

(Hct)

■ B-Lymphocytes ■ T-Lymphocytes

60–80%

0.60–0.80

■ Monocytes

2–8%

0.02–0.08

■ Neutrophils

54–75%

0.54–0.75

Platelets

150,000–350,000/ mm3

150–350
109/L

Erythrocyte sedimentation rate (ESR)

Male: 1–13 mm/h

1–13 mm/h

Female: 1–20 mm/h

1–20 mm/h

TOOLS

TOOLS

Coagulation Laboratory

Conventional

SI Units

ACT

90–130 s

PTT (activated)

21–35 s

21–35 s

Bleeding time

3–7 min

3–7 min

Fibrinogen

160–450 mg/dL

1.6–4.5 g/L

INR (target therapeutic)

2–3

2–3

Plasminogen

62–130%

0.62–1.30

Platelets

150,000–300,000/mm3


106/L

PT (prothrombin time)

10–12 s

10–12 s

PTT (partial thromboplastin time)

30–45 s

30–45 s

Thrombin time

11–15 s

11–15 s

Normal Blood Gases Laboratory

Conventional

SI Units 36–45 mol/L

pH

7.35–7.45

PO2

75–100 mm Hg

10.0–13.3 kPa

PCO2

35–45 mm Hg

4.7–6.0 kPa

HCO3

22–26 mmol/L

22–26 mmol/L

Base excess

(2)–(2) mEq/L

(2)–(2) mmol/L

CO2

19–24 mEq/L

19–24 mmol/L

SaO2

96–100%

0.96–1.00

170

171 IV Potassium Compatibilities Medications Compatible with IV Potassium Chloride acyclovir alatrovafloxacin aldesleukin allopurinol amifostine aminophylline amiodarone ampicillin amrinone atropine aztreonam betamethasone calcium gluconate chlordiazepoxide chlorpromazine cimetidine ciprofloxacin cisatracurium cladribine cyanocobalamin dexamethasone digoxin diltiazem diphenhydramine dobutamine docetaxel dopamine doxorubicin liposome droperidol droperidol/fentanyl

edrophonium enalaprilat epinephrine esmolol conjugated estrogens ethacrynate sodium etoposide famotidine fentanyl filgrastim fludarabine fluorouracil furosemide gatifloxacin gemcitabine granisetron heparin hydralazine idarubicin potassium indomethacin insulin isoproterenol kanamycin labetalol lidocaine linezolid lorazepam magnesium sulfate melphalan menadiol

TOOLS

TOOLS

Medications Compatible with IV Potassium Chloride (Cont’d) propranolol pyridostigmine ranitidine remifentanil sargramostim scopolamine sodium bicarbonate succinylcholine tacrolimus teniposide theophylline thiotepa tirofiban trimethaphan trimethobenzamide vinorelbine warfarin zidovudine

meperidine methoxamine methylergonovine midazolam minocycline morphine neostigmine norepinephrine ondansetron oxacillin oxytocin paclitaxel penicillin G potassium pentazocine phytonadione piperacillin/tazobactam procainamide prochlorperazine edisylate propofol

Medications incompatible with IV potassium ergotamine tartrate

adrenaline HCl amphotericin B cholesteryl sulfate complex atropine sulphate cephalothin sodium chloramphenicol sodium succinate chlorpromazine HCl diazepam

methicillin sodium phenytoin phenytoin sodium sulphadiazine sodium suxamethonium chloride thiopentone sodium

172

173 Formulas & BSA Common Formulas Syringe (Amount to be drawn up)

Desired amount
Total volume  Total amount of drug on hand

mL/h (i.e., 150 mL/h)

Volume
gtt factor  Time (minutes)

mg/min (i.e., 4 mg/min) mg/h (i.e., 20 mg/h)

Desired amount
volume
gtt factor  Amount of drug on hand

Total infusion time in minutes To calculate drops/minute:

To calculate volume/hour: Volume







Volume

gtt factor

(Total in mL) (i.e. 10 gtt/mL)  Time (No. of hours in minutes)

(i.e., 150 mL/hr)

gtt factor (i.e., 10 gtt/mL)

 Time (in minutes)

To figure out the running time (mL/h) on an IV: ➪➪

Drops per minute
60 min  Drip factor

Body Surface Area (BSA) Ht (cm)
Wt (kg)  冪莦莦 3600

Using cm & kg:

Ht (in)
Wt (lbs)  冪莦莦 3131

Using inches & lb:

IV Fluid Rates in Drops per Minute mL/h

50

75

80

100

125

150

175

200

250

10 GTT

8

13

13

17

21

25

29

33

42

15 GTT

12

19

20

25

31

37

44

50

62

60 GTT

50

75

80

100

125

150

175

200

250

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TOOLS

Common Conversions To convert ounces into cc/mL: ( _____ ) oz
30  ( _____ ) cc/mL To convert cc/mL into ounces: ( _____ ) cc/mL/30  ( _____ ) oz 1 oz equals . . . . . . . . . . . . .30 mL 8 oz juice glass . . . . . . . . . .240 mL Small (12-oz) soda . . . . . . .360 mL Medium (16-oz) soda . . . . .480 mL

Large (22-oz) soda . . . . . . .660 mL Coffee or tea mug . . . . . . .200 mL Milk carton . . . . . . . . . . . .120 mL Popsicle . . . . . . . . . . . . . . .90 mL

Conversions Specific to Your Institution

174

175 Common Conversions (Continued) Weight lb 300 275 250 225 210 200 190 180 170 160 150 140 130 120 110 100 90 80 70 60 50 40 30 20 10 5 2.2 2 1

kg 136.4 125.0 113.6 102.3 95.5 90.9 86.4 81.8 77.3 72.7 68.2 63.6 59.1 54.5 50.0 45.5 40.9 36.4 31.8 27.3 22.7 18.2 13.6 9.1 4.5 2.3 1 0.9 0.45

Temperature F

Height

C

cm

in

ft/in

212 108

100 boil 42.2

142 145

56 57

4′8′′ 4′9′′

107 106 105

41.6 41.1 40.6

147 150 152

58 59 60

4′10′′ 4′11′′ 5′0′′

104 103 102

40.0 39.4 38.9

155 157 160

61 62 63

5′1′′ 5′2′′ 5′3′′

101 100 99

38.3 37.8 37.2

163 165 168

64 65 66

5′4′′ 5′5′′ 5′6′′

98.6 98 97

37.0 36.7 36.1

170 173 175

67 68 69

5′7′′ 5′8′′ 5′9′′

96 95 94

35.6 35.0 34.4

178 180 183

70 71 72

5′10′′ 5′11′′ 6′0′′

93 92 91

34.0 33.3 32.8

185 188 191

73 74 75

6′1′′ 6′2′′ 6′3′′

90 32

32.1 0 freeze

193 196

76 77

6′4′′ 6′5′′

lb  kg
2.2 . . . . . . . . . . . . . . . . . . . . . . . . . .kg  lb
0.45 F  ( C
1.8)  32 . . . . . . . . . . . . . . . . . C  ( F – 32)
5/9 inches  cm
0.394 . . . . . . . . . . . . . .cm  inches
2.54

Volume 1 1 1 1 1 1

tsp . . . . . . . . . . . . . . . . . . .5 mL tbsp . . . . . . . . . . . . . . . . .15 mL oz . . . . . . . . . . . . . . . . . . .30 mL cup (8 oz) . . . . . . . . . . . .240 mL pint . . . . . . . . . . . . . . . . .473 mL quart . . . . . . . . . . . . . . . .946 mL

Weight 1 1 1 1 1 1

mg . . . . . . . . . . . . . . . . .1000 g g . . . . . . . . . . . . . . . . . .1000 mg gr . . . . . . . . . . . . . . . . . .60 mg kg . . . . . . . . . . . . . . . . . .2.2 lb L of water . . . . . . . . . . . . .1 kg oz . . . . . . . . . . . . . . . . . . .28 g

TOOLS

TOOLS Wound Care Products Product

Product Characteristics

Indications

Transparent FIlms Tegaderm CarraFilm OpSite BIOCLUSIVE

• Semipermeable • Stage I & II membrane wounds • Waterproof • Work best on • Permeable to superficial oxygen and water wounds, blisvapor. ters and skin • Provide moist healtears. ing environment and prevent bacterial contamination.

Hydrogels Hypergel CarraSorb Nu-gel Curafil

• Water or glycerin • Stage II, III based gels, impregand IV nated gauzes, or wounds sheet dressings. • Provide moist wound environment. Helps clean and debride by supplying liquid to dry, sloughy wounds. • Due to large water content, do not absorb large amounts of exudate. • Occlusive and • Stage II and II adhesive wafer wounds dressings, or • Granulating hydrocolloid and epithelizpowders and ing wounds pastes. with low to • Facilitate rehydramoderate tion and autolytic amounts of débridement of dry, exudate. sloughy, or necrotic wounds.

Hydrocolloid Dressings Tegasorb Comfeel DuoDERM Restore

176

Nursing Considerations • Transparency allows visual inspection of wound. • Can be used as a secondary dressing over alginates or gels. • Dressing change is up to 3 times per week. Do not absorb exudates and need to be changed when fluid collects underneath them. • Reduce pain and promote soothing effect. Easy to apply and remove. • Require secondary dressing. • Change once daily.

• Conformable for easy application and help reduce pain at wound site. • Breakdown of product may produce residue and foul odor, do not confuse with infectious process. • Usually changed up to 3 times per week.

177 Wound Care Products (Cont’d) Product Alginates CURASORB AlgiDERM Sorbsan Algosteril

Foam Dressings Flexzan CURAFOAM Mepilex

Enzymatic Debriding Agents Panafil Santyl Accuzyme

Product Characteristics Indications • Soft non-woven fibers derived from seaweed. • Available in pads, ropes, or ribbons. • Can absorb up to 20 times their weight. • Highly absorbant dressings made from hydrophilic polyurethane foam. • Some have adhesive borders.

• Agents selective in removing necrotic tissues from wound bed.

Nursing Considerations

• Highly absorbant, • Stage III and IV therefore good for wounds with packing exuding moderate to wounds. heavy exudate, but not wounds • Requires secondary dressing. with eschar or dry wound beds. • Usually changed once daily. • Stage III and IV • Highly absorbant wounds foam may allow • Heavily exuding less frequent dresswounds, espeing changes. cially during • Can be left undisinflammatory turbed for 3–4 days. phase following débridement and • Decreases maceration of surrounding sloughing. tissue. • Deep cavity Comfortable and wounds and conformable. weeping ulcers • Usually changed up such as venous to 3 times per week. stasis ulcers. • Stage III and IV • Surgical débrideWounds ment may be • Tunneling avoided in some wounds (may cases with use of remove debris in enzymatic débriding areas that can’t agents. be visualized). • Require prescription.

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TOOLS

MED NOTES* Allergies: Name: Diagnosis and PMH:

Medication/ Dose/Route/ Frequency

Date and Time(s) Given:

Comment/Caution/ Medication Effect (pre and post VS, pain rating, or other measure)

* Not a legal record. Document promptly and thoroughly in the patient record.

178

179

MED NOTES* Allergies: Name: Diagnosis and PMH:

Medication/ Dose/Route/ Frequency

Date and Time(s) Given:

Comment/Caution/ Medication Effect (pre and post VS, pain rating, or other measure)

* Not a legal record. Document promptly and thoroughly in the patient record.

TOOLS

TOOLS

MED NOTES* Allergies: Name: Diagnosis and PMH:

Medication/ Dose/Route/ Frequency

Date and Time(s) Given:

Comment/Caution/ Medication Effect (pre and post VS, pain rating, or other measure)

* Not a legal record. Document promptly and thoroughly in the patient record.

180

181

MED NOTES* Allergies: Name: Diagnosis and PMH:

Medication/ Dose/Route/ Frequency

Date and Time(s) Given:

Comment/Caution/ Medication Effect (pre and post VS, pain rating, or other measure)

* Not a legal record. Document promptly and thoroughly in the patient record.

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TOOLS

INDEX A Abbreviations, 3 Accolate. see Zafirlukast AccuNeb. see Albuterol Accupril. see Quinapril Aciphex. see Rabeprazole Actos. see Pioglitazone Acyclovir, 14 Adalat. see Nifedipine Adenosine, 166 Administration considerations for, 2 intradermal, 11 intramuscular, 8-9, 11 intravenous, 4-7 subcutaneous, 10-11 Adrucil. see Fluorouracil A-hydroCort. see Hydrocortisone Alavert. see Loratadine Albuterol, 15 Aldactone. see Spironolactone Alendronate, 16 Aleve. see Naproxen Alginates, 177 Allegra. see Fexofenadine Allergies, 178-181 Allergy medications fexofenadine, 66 ipratropium, 95 Allopurinol, 17 Alprazolam, 18 Altace. see Ramipril Amaryl. see Glimepiride Ambien. see Zolpidem

A-methaPred. see Methylprednisolone Amiloride, 19 Amiodarone, 20, 166 Amitriptyline, 21 Amlodipine, 22 Amoxicillin, 24 Amoxicillin/clavulanate, 23 Amoxil. see Amoxicillin Analgesics gabapentin, 74 phenazopyridine, 122 rofecoxib, 139 tramadol, 152 Anaprox. see Naproxen Androgen inhibitors, 67 Anergan. see Promethazine Angiotensin-converting enzyme inhibitors benazepril, 30 captopril, 36 Angiotensin II receptor antagonists losartan, 107 valsartan, 158 Anti-Alzheimer’s agents, 60 Antianginals isosorbide dinitrate, 96 isosorbide mononitrate, 97 metoprolol, 110 nifedipine, 117 propranolol, 130-131 verapamil, 161 Antianxiety agents

182

183 alprazolam, 18 diazepam, 55-56 hydroxyzine, 84 lorazepam, 106 paroxetine, 120 venlafaxine, 160 Antiarrhythmics amiodarone, 20, 166 digoxin, 57-58 diltiazem, 59 propranolol, 130-131 verapamil, 161 Antiasthmatics beclomethasone, 29 triamcinolone, 154 zafirlukast, 163 Anticholinergics, 31 Anticoagulants dalteparin, 53 enoxaparin, 63 fondaparinux, 71 heparin, 79-80 tinzaparin, 150 warfarin, 162 Anticonvulsants clonazepam, 48 diazepam, 55-56 gabapentin, 74 phenytoin, 123-124 valproic acid, 157 Antidepressants amitriptyline, 21 bupropion, 35 citalopram, 46 fluoxetine, 70 paroxetine, 120 sertraline, 142

trazodone, 153 venlafaxine, 160 Antidiabetics glimepiride, 76 glipizide, 77 glyburide, 78 insulin. see Insulin metformin, 108 pioglitazone, 125 repaglinide, 136 rosiglitazone, 140 Antidiarrheals, 104 Antiemetics, 129 Antifungals fluconazole, 68 itraconazole, 98 Anti-gout agents allopurinol, 17 colchicine, 51 Antihistamines cetirizine, 42 fexofenadine, 66 hydroxyzine, 84 loratadine, 105 promethazine, 129 Antihypertensives amlodipine, 22 atenolol, 25 benazepril, 30 bisoprolol, 32 carvedilol, 38 chlorothiazide, 43 clonidine, 49 diltiazem, 59 doxazosin, 61 enalapril, 62 fosinopril, 72

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TOOLS

Antihypertensives (Continued) lisinopril, 103 losartan, 107 metoprolol, 110 nifedipine, 117 propranolol, 130-131 terazosin, 149 valsartan, 158 verapamil, 161 Anti-infectives amoxicillin, 24 amoxicillin/clavulanate, 23 azithromycin, 27 cefepime, 39 cephalexin, 41 ciprofloxacin, 45 clindamycin, 47 levofloxacin, 101 metronidazole, 111 mupirocin, 115 nitrofurantoin, 118 trimethoprim/sulfamethoxazole, 155 vancomycin, 159 Anti-inflammatories beclomethasone, 29 budesonide, 33 cortisone, 52 dexamethasone, 54 hydrocortisone, 82 infliximab, 85 methylprednisolone, 109 prednisone, 128 Antineoplastics fluorouracil, 69 tamoxifen, 146

Antiparkinson agents benztropine, 31 Antiplatelet agents, 50 Antiprotozoals metronidazole, 111 trimethoprim/sulfamethoxazole, 155 Antipsychotics, 138 Antiretrovirals lamivudine, 99 zidovudine, 164 Antirheumatics celecoxib, 40 infliximab, 85 Antispasticity agents, 28 Antituberculars, 137 Anti-ulcer agents amoxicillin, 24 cimetidine, 44 lansoprazole, 100 metronidazole, 111 nizatidine, 119 rabeprazole, 133 Antivirals acyclovir, 14 valacyclovir, 156 Apo-Allopurinol. see Allopurinol Apo-Alpraz. see Alprazolam Apo-Atenolol. see Atenolol Apo-Benztropine. see Benztropine Apo-Cephalex. see Cephalexin Apo-Diazepam. see Diazepam Apo-Diltiaz. see Diltiazem Apo-Furosemide. see Furosemide

184

185 Apo-Hydroxyzine. see Hydroxyzine Apo-Lorazepam. see Lorazepam Apo-Nifed. see Nifedipine Apo-Nitrofurantoin. see Nitrofurantoin Apo-Propranolol. see Propranolol Apo-Zidovudine. see Zidovudine Aricept. see Donepezil Arixtra. see Fondaparinux Atarax. see Hydroxyzine Atenolol, 25 Ativan. see Lorazepam Atorvastatin, 26 Atropine, 166 Atrovent. see Ipratropium Augmentin ES. see Amoxicillin/clavulanate Augmentin XR. see Amoxicillin/clavulanate Avandia. see Rosiglitazone Avirax. see Acyclovir Axid. see Nizatidine Axid AR. see Nizatidine Azithromycin, 27 Azmacort. see Triamcinolone Azmacort HFA. see Triamcinolone Azo-Standard. see Phenazopyridine AZT. see Zidovudine B Baclofen, 28

Bactrim. see Trimethoprim/ sulfamethoxazole Bactroban. see Mupirocin Bactroban Nasal. see Mupirocin Beclodisk. see Beclomethasone Becloforte. see Beclomethasone Beclomethasone, 29 Beclovent. see Beclomethasone Benazepril, 30 Benzodiazepines alprazolam, 18 clonazepam, 48 diazepam, 55-56 lorazepam, 106 temazepam, 148 Benztropine, 31 Beta blockers atenolol, 25 bisoprolol, 32 carvedilol, 38 metoprolol, 110 propranolol, 130-131 Betachron E-R. see Propranolol Betaloc. see Metoprolol Biocef. see Cephalexin Bisoprolol, 32 Blood viscosity reducing agent, 121 Body surface area, 173 Bone resorption inhibitors alendronate, 16 raloxifene, 134

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Bronchodilators albuterol, 15 ipratropium, 95 montelukast, 112 salmeterol, 141 zafirlukast, 163 Budesonide, 33 Bumetanide, 34 Bumex. see Bumetanide Bupropion, 35

Cetirizine, 42 Chlorothiazide, 43 Cimetidine, 44 Cipro. see Ciprofloxacin Ciprofloxacin, 45 Citalopram, 46 Claritin. see Loratadine Claritin RediTabs. see Loratadine Clavulin. see Amoxicillin/clavulanate Cleocin. see Clindamycin Clindamycin, 47 Clonazepam, 48 Clonidine, 49 Clopidogrel, 50 Cogentin. see Benztropine Colchicine, 51 Cold and cough remedy fexofenadine, 66 ipratropium, 95 Conversions, 174-175 Cordarone. see Amiodarone Coreg. see Carvedilol Cortef. see Hydrocortisone Cortisone, 52 Cortone. see Cortisone Cortone Acetate. see Cortisone Coumadin. see Warfarin COX-2 inhibitors celecoxib, 40 rofecoxib, 139 Cozaar. see Losartan

C Calan. see Verapamil Calcilean. see Heparin Calciparine. see Heparin Calcium channel blockers amlodipine, 22 diltiazem, 59 nifedipine, 117 verapamil, 161 Capoten. see Captopril Captopril, 36 Cardizem. see Diltiazem Cardura. see Doxazosin Carisoprodol, 37 Carvedilol, 38 Catapres. see Clonidine Catapres-TTS. see Clonidine Catheter flush, 7 Cefepime, 39 Celebrex. see Celecoxib Celecoxib, 40 Celexa. see Citalopram Central venous catheters, 7 Cephalexin, 41 Cephalosporins cefepime, 39 cephalexin, 41

D Dalacin C. see Clindamycin Dalteparin, 53

186

187 Decadron. see Dexamethasone Decaject. see Dexamethasone Deltasone. see Prednisone Depakene. see Valproic acid Depakote. see Valproic acid Depakote ER. see Valproic acid Desyrel. see Trazodone Detrol. see Tolterodine Detrol LA. see Tolterodine Dexameth. see Dexamethasone Dexamethasone, 54 DiaBeta. see Glyburide Diastat. see Diazepam Diazepam, 55-56 Diflucan. see Fluconazole Digitek. see Digoxin Digoxin, 57-58 Dilantin. see Phenytoin Dilatrate-SR. see Isosorbide dinitrate Dilaudid. see Hydromorphone Diltia XT. see Diltiazem Diltiazem, 59 Diovan. see Valsartan Diphenylan. see Phenytoin Diphenylhydantoin. see Phenytoin Diuretics. see also Loop diuretics; Potassiumsparing diuretics; Thiazide diuretics amiloride, 19

bumetanide, 34 chlorothiazide, 43 furosemide, 73 hydrochlorothiazide, 81 spironolactone, 144 Diuril. see Chlorothiazide Dizac. see Diazepam Donepezil, 60 Doxazosin, 61 DPH. see Phenytoin Dressings, 176-177 Drug suffixes, 166 Duracion. see Clonidine Duragesic. see Fentanyl Duramorph. see Morphine D-Val. see Diazepam E Effexor. see Venlafaxine Effexor XR. see Venlafaxine Efudex. see Fluorouracil Elavil. see Amitriptyline Electrolyte replacements, 126, 171-172 Emergency drugs, 166 Enalapril, 62 Enoxaparin, 63 Enzymatic debriding agents, 177 Epinephrine, 166 Epival. see Valproic acid Epivir. see Lamivudine Epivir HBV. see Lamivudine Esidrix. see Hydrochlorothiazide Estrace. see Estradiol Estradiol, 64

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Estrogens, 64 Evista. see Raloxifene

Glyburide, 78 Glynase PreTab. see Glyburide Gynodiol. see Estradiol

F Fentanyl, 65 Fexofenadine, 66 Finasteride, 67 Flagyl. see Metronidazole Flomax. see Tamsulosin Fluconazole, 68 Fluoroplex. see Fluorouracil Fluoroquinolones ciprofloxacin, 45 levofloxacin, 101 Fluorouracil, 69 Fluoxetine, 70 Flushing of catheter, 7 Foam dressings, 177 Fondaparinux, 71 Formulas, 173 Fosamax. see Alendronate Fosinopril, 72 Fragmin. see Dalteparin 5-FU. see Fluorouracil Furadantin. see Nitrofurantoin Furosemide, 73, 166 Furoside. see Furosemide

H Hair regrowth stimulators, 67 HCTZ. see Hydrochlorothiazide Headache suppressants, 145, 157 Hepalean. see Heparin Heparin characteristics of, 79-80 low-molecular-weight. see Low-molecular-weight heparins High alert medications, 1 Histamine blockers, 119 Humalog. see Insulin, Lispro Humulin 50/50. see Insulin, premixed combinations Humulin 70/30. see Insulin, premixed combinations Humulin L. see Insulin, zinc suspension (lente) Humulin N. see Insulin, isophane (NPH) Humulin R. see Insulin injection, regular Humulin U. see Insulin, zinc suspension, extended (ultralente) Hydro-chlor. see Hydrochlorothiazide Hydrochlorothiazide, 81 Hydrocolloid dressings, 176 Hydrocortisone, 82

G Gabapentin, 74 Gemfibrozil, 75 Glimepiride, 76 Glipizide, 77 Glucophage. see Metformin Glucophage XR. see Metformin Glucotrol. see Glipizide Glucotrol XL. see Glipizide

188

189 Hydrocortone. see Hydrocortisone HydroDIURIL. see Hydrochlorothiazide Hydrogels, 176 Hydromorphone, 83 Hydrostat IR. see Hydromorphone Hydroxyzine, 84 Hytrin. see Terazosin Hyzine-50. see Hydroxyzine I Iletin II Regular. see Insulin injection Imdur. see Isosorbide mononitrate Imitrex. see Sumatriptan Implanted port catheters, 7 Inderal. see Propranolol Inderal LA. see Propranolol Infliximab, 85 Injections intramuscular, 8-9, 11 intravenous, 5 subcutaneous, 10 Innohep. see Tinzaparin Insulin isophane (NPH), 90 Lispro, 91 mixing of, 12-13 premixed combinations, 94 types of, 86-94 zinc suspension, extended (ultralente), 92 zinc suspension (lente), 93 Insulin aspart, 86 Insulin glargine, 87

Insulin injection concentrated, 88 regular, 89 Insulin-Toronto. see Insulin injection, regular Intradermal administration, 11 Intramuscular injections, 8-9, 11 Intravenous administration, 4-7, 173 Ipratropium, 95 Ismo. see Isosorbide mononitrate Isoptin. see Verapamil Isorbid. see Isosorbide dinitrate Isordil. see Isosorbide dinitrate Isosorbide dinitrate, 96 Isosorbide mononitrate, 97 Isotrate. see Isosorbide dinitrate Itraconazole, 98 K Kaopectate II Caplets. see Loperamide Keflex. see Cephalexin Klonopin. see Clonazepam L Laboratory values, 167-170 Lamivudine, 99 Lanoxicaps. see Digoxin Lanoxin. see Digoxin Lansoprazole, 100 Lantus. see Insulin glargine Lasix. see Furosemide

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Lente Iletin II. see Insulin, zinc suspension (lente) Leukotriene antagonists, 112 Levaquin. see Levofloxacin Levate. see Amitriptyline Levofloxacin, 101 Levo-T. see Levothyroxine Levothroid. see Levothyroxine Levothyroxine, 102 Levoxyl. see Levothyroxine Lidocaine, 166 Lioresal. see Baclofen Lipid-lowering agents atorvastatin, 26 gemfibrozil, 75 pravastatin, 127 simvastatin, 143 Lipitor. see Atorvastatin Lisinopril, 103 Loop diuretics bumetanide, 34 furosemide, 73 Loperamide, 104 Lopid. see Gemfibrozil Lopressor. see Metoprolol Lopressor SR. see Metoprolol Lopurin. see Allopurinol Loratadine, 105 Lorazepam, 106 Losartan, 107 Lotensin. see Benazepril Lovenox. see Enoxaparin Low-molecular-weight heparins dalteparin, 53

enoxaparin, 63 tinzaparin, 150 Lyphocin. see Vancomycin M Macrodantin. see Nitrofurantoin Magnesium, 166 Maxipime. see Cefepime Medication administration. see Administration Medication errors, 3 Medrol. see Methylprednisolone Metformin, 108 Methylprednisolone, 109 Metoprolol, 110 Metronidazole, 111 Micronase. see Glyburide Midamor. see Amiloride Mixing of insulins, 12-13 Monoket. see Isosorbide mononitrate Monopril. see Fosinopril Montelukast, 112 Morphine, 113-114, 166 MS Contin. see Morphine Multipax. see Hydroxyzine Mupirocin, 115 N Napron X. see Naproxen Naprosyn. see Naproxen Naproxen, 116 Narcan, 166 Neurontin. see Gabapentin Nifedical XL. see Nifedipine Nifedipine, 117

190

191 Nitrofurantoin, 118 Nitroglycerin, 166 Nizatidine, 119 Nolvadex. see Tamoxifen Nonsteroidal anti-inflammatory drugs celecoxib, 40 naproxen, 116 rofecoxib, 139 Norvasc. see Amlodipine Novamoxin. see Amoxicillin Novo-Atenolol. see Atenolol Novo-AZT. see Zidovudine Novocimetine. see Cimetidine Novodipam. see Diazepam Novohydroxyzin. see Hydroxyzine Novo-Lextin. see Cephalexin Novolin 70/30. see Insulin, premixed combinations Novolin de Ultralente. see Insulin, zinc suspension, extended (ultralente) Novolin Ge Lente. see Insulin, zinc suspension (lente) Novolin Ge NPH. see Insulin, isophane (NPH) Novolin L. see Insulin, zinc suspension (lente) Novolin N. see Insulin, isophane (NPH) Novolin R. see Insulin injection, regular

Novolin U. see Insulin, zinc suspension, extended (ultralente) Novolog. see Insulin aspart Novo-Lorazem. see Lorazepam Novo-Metformin. see Metformin Novonidazol. see Metronidazole Novopranol. see Propranolol Novospiroton. see Spironolactone Novotriptyn. see Amitriptyline NPH Iletin II. see Insulin, isophane (NPH) Nu-Alpraz. see Alprazolam Nucleoside reverse transcriptase inhibitors, 164 Nu-Diltiaz. see Diltiazem O Opioid analgesics fentanyl, 65 hydromorphone, 83 morphine, 113-114, 166 Orasone. see Prednisone P Paroxetine, 120 Patient education standards, 2 Paxil. see Paroxetine Paxil CR. see Paroxetine Pentoxifylline, 121 Pepto Diarrhea Control. see Loperamide Peptol. see Cimetidine

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Peripheral catheters, 7 Peripherally acting anti-adrenergics, 147 Phenazopyridine, 122 Phenergan. see Promethazine Phenoject. see Promethazine Phenytoin, 123-124 Piggyback setup, 6 Pioglitazone, 125 Plavix. see Clopidogrel Port catheters, 7 Potassium chloride, 126, 171-172 Potassium-sparing diuretics amiloride, 19 spironolactone, 144 Prandin. see Repaglinide Pravachol. see Pravastatin Pravastatin, 127 Prednicot. see Prednisone Prednisone, 128 Pred-Pak. see Prednisone Prevacid. see Lansoprazole Procardia. see Nifedipine Promethazine, 129 Propecia. see Finasteride Propranolol, 130-131 Proscar. see Finasteride Proton pump inhibitors lansoprazole, 100 rabeprazole, 133 Protostat. see Metronidazole Proventil. see Albuterol Prozac. see Fluoxetine Pulmicort. see Budesonide Pyridium. see Phenazopyridine

Q Quinapril, 132 R Rabeprazole, 133 Raloxifene, 134 Ramipril, 135 Remicade. see Infliximab Repaglinide, 136 Restoril. see Temazepam Retrovir. see Zidovudine Rifadin. see Rifampin Rifampin, 137 Rimactane. see Rifampin Risperdal. see Risperidone Risperidone, 138 Rivotril. see Clonazepam Rofact. see Rifampin Rofecoxib, 139 Romazicon, 166 Rosiglitazone, 140 Roxanol. see Morphine S Salmeterol, 141 Sarafem. see Fluoxetine Sedative/hypnotics promethazine, 129 temazepam, 148 zolpidem, 165 Selective estrogen receptor modulator, 134 Selective serotonin reuptake inhibitors citalopram, 46 fluoxetine, 70

192

193 paroxetine, 120 sertraline, 142 Septa. see Trimethoprim/sulfamethoxazole Serevent. see Salmeterol Sertraline, 142 Simvastatin, 143 Singulair. see Montelukast Skeletal muscle relaxants baclofen, 28 carisoprodol, 37 diazepam, 55-56 Smoking deterrents, 35 Solu-Cortef. see Hydrocortisone Solu-Medrol. see Methylprednisolone Soma. see Carisoprodol Sorbitrate. see Isosorbide dinitrate Spironolactone, 144 Sporanox. see Itraconazole Statins atorvastatin, 26 pravastatin, 127 simvastatin, 143 Subcutaneous injections, 10-11 Sulfonylureas glimepiride, 76 glipizide, 77 glyburide, 78 Sumatriptan, 145 Syn-Clonazepam. see Clonazepam Synthroid. see Levothyroxine

T Tagamet. see Cimetidine Tamofen. see Tamoxifen Tamoxifen, 146 Tamsulosin, 147 3TC. see Lamivudine Temazepam, 148 Tenormin. see Atenolol Terazosin, 149 Thiazide diuretics chlorothiazide, 43 hydrochlorothiazide, 81 Thyroid hormones, 102 Tiamate. see Diltiazem Tinzaparin, 150 TMP/SMZ. see Trimethoprim/ sulfamethoxazole Tolterodine, 151 Toprol-XL. see Metoprolol Tramadol, 152 Transparent films, 176 Trazodone, 153 Trazon. see Trazodone Trental. see Pentoxifylline Trialodine. see Trazodone Triamcinolone, 154 Trimethoprim/sulfamethoxazole, 155 Trimox. see Amoxicillin Tunneled catheters, 7 U Ultralente. see Insulin, zinc suspension, extended (ultralente)

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Vioxx. see Rofecoxib Vistaril. see Hydroxyzine Vivol. see Diazepam

Ultralente U. see Insulin, zinc suspension, extended (ultralente) Ultram. see Tramadol Urinary tract analgesics, 122 Urinary tract antispasmodics, 151 Urodine. see Phenazopyridine

W Warfarin, 162 Warfilone. see Warfarin Wellbutrin. see Bupropion Wellbutrin SR. see Bupropion Wound care products, 176-177

V Valacyclovir, 156 Valium. see Diazepam Valproic acid, 157 Valsartan, 158 Valtrex. see Valacyclovir Vanadom. see Carisoprodol Vanceril. see Beclomethasone Vancocin. see Vancomycin Vancoled. see Vancomycin Vancomycin, 159 Vasopressin, 166 Vasotec. see Enalapril Velosulin BR. see Insulin injection, regular Venlafaxine, 160 Ventodisk. see Albuterol Ventolin. see Albuterol Verapamil, 161 Verelan. see Verapamil

X Xanax. see Alprazolam Z Zafirlukast, 163 Zebeta. see Bisoprolol Zestril. see Lisinopril Zidovudine, 164 Zithromax. see Azithromycin Zocor. see Simvastatin Zoloft. see Sertraline Zolpidem, 165 Zovirax. see Acyclovir Z-track method, 9 Zyban. see Bupropion Zyloprim. see Allopurinol Zyrtec. see Cetirizine

194

195 Illustration Credits Pages 4-13, 166-170, 173-175: From Myers, E: RNotes: Nurse’s Clinical Pocket Guide, FA Davis, Philadelphia, 2003; Page x: From Deglin, J and Vallerand, A: Davis’s Drug Guide for Nurses, 8 ed. FA Davis, Philadelphia, 2003.

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197 Notes

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199 Notes

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