Nursing Spectrum Drug Handbook 2010, Fifth Edition

Common abbreviations The abbreviations below are commonly used by nurses. Not all of them, however, are acceptable. Tho...

Author: Patricia Schull

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Common abbreviations The abbreviations below are commonly used by nurses. Not all of them, however, are acceptable. Those in red marked with a Clinical Alert logo 2were identified as contributing to medication errors in the National Patient Safety Goals of the Joint Commission and by the Institute for Safe Medication Practices. To avoid mistakes and to ensure Joint Commission compliancy, spell out the entire term.

ABG a.c. ACE ACLS ACTH 2AD ADH ADLs AICD AIDS ALP ALT APTT 2AS AST 2AU AV B1 B2 BCLS b.i.d. BP BSA 2B.T. BUN cC cAMP CBC 2cc CI

arterial blood gas before meals angiotensin-converting enzyme advanced cardiac life support adrenocorticotropic hormone right ear antidiuretic hormone activities of daily living automatic implantable cardiac defibrillator acquired immunodeficiency syndrome alkaline phosphatase alanine aminotransferase activated partial thromboplastin time left ear aspartate aminotransferase each ear atrioventricular beta1 beta2 basic cardiac life support twice daily blood pressure body surface area bedtime blood urea nitrogen with Celsius cyclic 3’, 5’ adenosine monophosphate complete blood count cubic centimeter cardiac index

2Clinical alert. Do not use.

CK cm CMV CNS COPD CR CV CVA CYP D5W DIC 2D/C dl DNA ECG EEG EENT F FDA g G GABA GFR GGT GI GnRH gr gtt G6PD GU H1 H2 HCL

creatine kinase centimeter cytomegalovirus central nervous system chronic obstructive pulmonary disease controlled release cardiovascular cerebrovascular accident cytochrome dextrose 5% in water disseminated intravascular coagulation discharge, discontinue deciliter deoxyribonucleic acid electrocardiogram electroencephalogram eyes, ears, nose, and throat Fahrenheit Food and Drug Administration gram gauge gamma-aminobutyric acid glomerular filtration rate gamma-glutamyltransferase gastrointestinal gonadotropin-releasing hormone grain drops glucose-6-phosphate dehydrogenase genitourinary histamine1 histamine2 hydrochloride

HCT HDL Hg Hgb HIV

hematocrit high-density lipoprotein mercury hemoglobin human immunodeficiency virus HMG-CoA 3-hydroxy-3-methylglutaryl coenzyme A HR heart rate 2h.s. at bedtime 2H.S. half-strength 2I.J. injection I.M. intramuscular 2I.N. intranasal INR International Normalized Ratio IPPB intermittent positivepressure breathing 2IU international unit I.V. intravenous K potassium kg kilogram KVO keep vein open L liter lb pound LD lactate dehydrogenase LDL low-density lipoprotein m meter m2 square meters 2µg microgram MAO monoamine oxidase mcg microgram MDI metered-dose inhaler mEq milliequivalent mg milligram 2MgSO4 magnesium sulfate ml milliliter mm millimeter mm3 cubic millimeters mm Hg millimeters of mercury mmol millimole 2MS morphine sulfate 2MSO4 morphine sulfate Na sodium NA not applicable NaCl sodium chloride ng nanogram NG nasogastric N.P.O. nothing by mouth 2Clinical alert. Do not use.

NSAID

nonsteroidal anti-inflammatory drug 2O.D. right eye 2O.S. left eye OTC over the counter 2O.U. each eye oz ounce p.c. after meals PCA patient-controlled analgesia per through, by P.O. by mouth P.R. by rectum p.r.n. as needed PT prothrombin time PTT partial thromboplastin time PVC premature ventricular contraction q every 2Q.D. every day 2q.h.s. at bedtime q.i.d. four times daily 2Q.O.D. every other day RBC red blood cell RDA recommended dietary allowance RNA ribonucleic acid RSV respiratory syncytial virus SA sinoatrial 2S.C. subcutaneous SI International System of Units SIADH syndrome of inappropriate antidiuretic hormone secretion S.L. sublingual 2S.Q. subcutaneous SSRI selective serotonin reuptake inhibitor T3 triiodothyronine T4 thyroxine TCA tricyclic antidepressant t.i.d. three times daily 2T.I.W. three times a week tRNA transfer ribonucleic acid tsp teaspoon 2U unit USP United States Pharmacopeia VMA vanillylmandelic acid WBC white blood cell

2010 Nursing Spectrum

DRUG Handbook

Notice Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy are required. The authors and the publisher of this work have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical sciences, neither the authors nor the publisher nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they disclaim all responsibility for any errors or omissions or for the results obtained from use of the information contained in this work. Readers are encouraged to confirm the information contained herein with other sources. For example and in particular, readers are advised to check the product information sheet included in the package of each drug they plan to administer to be certain that the information contained in this work is accurate and that changes have not been made in the recommended dose or in the contraindications for administration. This recommendation is of particular importance in connection with new or infrequently used drugs.

2010 Nursing Spectrum

DRUG Handbook Patricia Dwyer Schull, MSN, RN

New York Chicago San Francisco Lisbon London Madrid Mexico City Milan New Delhi San Juan Seoul Singapore Sydney Toronto

Copyright © 2010 by The McGraw-Hill Companies, Inc. All rights reserved. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publiser. ISBN: 978-0-07-170009-2 MHID: 0-07-170009-9 The material in this eBook also appears in the print version of this title: ISBN: 978-0-07-162278-3, MHID: 0-07-162278-0. All trademarks are trademarks of their respective owners. Rather than put a trademark symbol after every occurrence of a trademarked name, we use names in an editorial fashion only, and to the benefit of the trademark owner, with no intention of infringement of the trademark. Where such designations appear in this book, they have been printed with initial caps. McGraw-Hill eBooks are available at special quantity discounts to use as premiums and sales promotions, or for use in corporate training programs. To contact a representative please e-mail us at [email protected]. Photographs on pages P1-P16 are licensed and used with permission from SFIMedical Publishing.However,copyright ofthe photographs remains with theharmaceutical company that produces and owns each drug. TERMS OF USE This is a copyrighted work and The McGraw-Hill Companies, Inc. (“McGraw-Hill”) and its licensors reserve all rights in and to the work. Use of this work is subject to these terms. Except as permitted under the Copyright Act of 1976 and the right to store and retrieve one copy of the work, you may not decompile, disassemble, reverse engineer, reproduce, modify, create derivative works based upon, transmit, distribute, disseminate, sell, publish or sublicense the work or any part of it without McGraw-Hill’s prior consent. You may use the work for your own noncommercial and personal use; any other use of the work is strictly prohibited. Your right to use the work may be terminated if you fail to comply with these terms. THE WORK IS PROVIDED “AS IS.” McGRAW-HILL AND ITS LICENSORS MAKE NO GUARANTEES OR WARRANTIES AS TO THE ACCURACY, ADEQUACY OR COMPLETENESS OF OR RESULTS TO BE OBTAINED FROM USING THE WORK, INCLUDING ANY INFORMATION THAT CAN BE ACCESSED THROUGH THE WORK VIA HYPERLINK OR OTHERWISE, AND EXPRESSLY DISCLAIM ANY WARRANTY, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. McGraw-Hill and its licensors do not warrant or guarantee that the functions contained in the work will meet your requirements or that its operation will be uninterrupted or error free. Neither McGraw-Hill nor its licensors shall be liable to you or anyone else for any inaccuracy, error or omission, regardless of cause, in the work or for any damages resulting therefrom. McGraw-Hill has no responsibility for the content of any information accessed through the work. Under no circumstances shall McGraw-Hill and/or its licensors be liable for any indirect, incidental, special, punitive, consequential or similar damages that result from the use of or inability to use the work, even if any of them has been advised of the possibility of such damages. This limitation of liability shall apply to any claim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise.

Contents Common abbreviations Foreword Advisors Contributors and reviewers Preface and user’s guide

Inside front cover vii viii ix xii

Part 1 Drug monographs A to Z Safe drug administration Drug compatibilities Conversions and calculations Drug names that look or sound alike Tall Man Letters Tablets and capsules not to crush Preventing and treating extravasation Identifying injection sites Monitoring blood levels Effects of dialysis on drug therapy Anaphylaxis: Treatment guidelines Adult cardiac arrest: Treatment guidelines Pediatric cardiac arrest: Treatment guidelines Acute coronary syndrome: Treatment guidelines Stroke: Treatment guidelines Guidelines for handling, preparing, and administering hazardous drugs Managing poisoning and overdoses

Photogallery of common tablets and capsules

3 S2 S6 S7 S10 S11 S13 S14 S16 S18 S21 S22 S23 S24 S26 S27 S30

P1-P16

Part 2 Drug classes Vitamins and minerals Herbs and supplements

1255 1303 1314

v

vi

Contents

Part 3 Appendices Common anesthetic drugs Common combination drug products Adult immunization schedule by age group Childhood immunization schedule by age group Adolescent immunization schedule by age group Normal laboratory values for blood tests Drug infusion rates Identifying life-threatening adverse reactions Potentially inappropriate drugs for elderly patients Hazardous drugs Most commonly used drugs in nursing specialties Top 200 most commonly prescribed drugs

Selected references Index

1330 1342 1346 1347 1348 1349 1352 1357 1364 1367 1369 1371

1374 1376

Foreword

A

s recent studies have shown, medication administration and poor communication about medications can lead to errors that result in patient harm. In the 2009 Comprehensive Accreditation Manual for Hospitals, the Joint Commission devotes a chapter to medication management, emphasizing the potential harm that drugs can cause despite their crucial role in the palliative, symptomatic, and curative treatment of disease. Improving the safety of medication use is also one of the Joint Commission’s National Patient Safety Goals. For the nurse, a critical step in improving safety is to ensure the “five rights”—right patient, right drug, right dosage, right time, and right route—before administering each dose. To these critical steps, I would add a sixth—the right drug reference, which you’re holding in your hands. Nursing Spectrum Drug Handbook guides you through the often-complex maze of drug actions and potential interactions. This invaluable resource goes beyond just the basics, explaining how to adjust dosages for patients with certain illnesses and of certain ages. It presents FDA boxed warnings, elaborates on key administration steps and explains each drug’s pharmacologic actions, specifies indications and dosages, spells out contraindications and precautions, elaborates on key administration steps, lists adverse reactions, and explains how to monitor and teach patients who are receiving the drug. According to the Institute for Healthcare Improvement and the Institute for Safe Medication Practices, poor communication of patients’ drug information accounts for up to half of all medication errors and up to 20% of adverse drug events in hospitals. Consequently, many patient safety initiatives—including another Joint Commission National Patient Safety Goal—focus on medication reconciliation, which hinges on communicating accurate information about the patient’s medications to other healthcare providers. The continuum of medication administration—from prescribing and dispensing through administration—encompasses dozens of steps involving multiple care providers. Mistakes can happen anywhere along the line. Any nurse, whether novice or seasoned, can make a mistake. New nurse graduates and nurses who’ve recently returned to clinical care will find this handbook a “must have.” And all nurses will appreciate how quickly it helps them get up to speed on the drugs, dosages, and drug forms that have recently entered the market. Giving drugs safely requires nurses to absorb a tremendous amount of information. This brings me to another reason why I highly recommend Nursing Spectrum Drug Handbook: the special 32-page section on “Safe drug administration.” To find it quickly, look for the colored-edge pages near the front. The first time you use it, you’ll quickly realize how valuable and timely this insert is. It covers such topics as drug compatibilities; look-alike, sound-alike drug names; drugs that shouldn’t be crushed; blood drug level monitoring; hazardous drug preparation and administration; and drug administration guidelines for life-threatening emergencies. Nursing Spectrum Drug Handbook is tailored specifically to meet the needs of all nurses. The writers and editors have collected reams of drug data, selected the essential nuggets, organized drug monographs for optimal accessibility, customized the content and wording, and polished the copy. The result is a densely packed yet eminently friendly reference—the perfect all-in-one package offering everything a nurse needs to know to administer drugs in a safe, proficient manner. Terris E. Kennedy, PhD, RN Chief Nursing Officer, Vice President for Patient Care Services Shore Memorial Hospital Nassawadox, Virginia vii

Advisors Vicki L. Buchda, RN, MS, CNAA Vice-Chair Division of Nursing Services Mayo Clinic Phoenix, Ariz.

David Hawkins, PharmD Professor and Dean California Northstate College of Pharmacy Sacramento, Calif.

Pamela R. Dellinger, RN, PhD, CHCR Recruitment Specialist Carolinas Medical Center-Lincoln Lincolnton, N.C.

Joyce E. Johnson, RN, PhD, CNAA, FAAN Senior Vice President of Operations/ Chief Nursing Officer Georgetown University Hospital Washington, D.C.

Gloria F. Donnelly, RN, PhD, FAAN Dean and Professor College of Nursing and Health Professions Drexel University Philadelphia, Pa. Maureen Duff, RGN, SCM, Dip HV, MSc, FFNMRCSI Teaching Fellow Department of Nursing and Midwifery University of Stirling Scotland, UK Harriet R. Feldman, RN, PhD, FAAN Dean and Professor Lienhard School of Nursing Interim Dean, School of Education Pace University Pleasantville and New York, N.Y. Ella Ferris, RN, MBA Executive Vice President and Chief Nursing Executive Saint Michael’s Hospital Toronto, Ontario Linda Groah, RN, MS, CNOR, CNAA, FAAN Director of Hospital Operations Kaiser Permanente Medical Center San Francisco, Calif.

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Peggy Kalowes, RN, PhD, CNS Director Center for Women’s Cardiac Health and Research Heart and Vascular Institute Long Beach Memorial Hospital Long Beach, Calif. Terris E. Kennedy, RN, PhD Chief Nursing Officer Vice President for Patient Care Services Shore Memorial Hospital Nassawadox, Va. James A. Koestner, BS, PharmD Critical Care Pharmacist Vanderbilt University Medical Center Nashville, Tenn. Claire M. Young, RN, MBA Chief Nursing Officer Chair, Division of Nursing The Cleveland Clinic Foundation Cleveland, Ohio

Contributors and reviewers Sue Apple, RN, DNSc Assistant Professor School of Nursing and Health Studies Georgetown University Washington, D.C.

Jason Buckway, RN, BSN, MBA Director CV/Medical/GI Services McKay-Dee Hospital Intermountain Health Care Ogden, Utah

Nancy Balkon, RN, PhD, ANP-C, APRN-CS Clinical Associate Professor Stony Brook University School of Nursing Stony Brook, N.Y.

Joseph T. Catalano, RN, PhD Professor and Chairman Department of Nursing East Central University Ada, Okla.

Cathy L. Bartels, PharmD, FAAIM Associate Professor Creighton University Medical Center Omaha, Neb. Barbara Barzoloski-O’Connor, RN, MSN, CIC Infection Control Manager Howard County General Hospital Columbia, Md. Melanie Boock, RN, BSN Emergency Room Charge Nurse Vail Valley Medical Center Vail, Colo. Vicky Borders-Hemphill, PharmD Drug Utilization Data Analyst Food and Drug Administration Silver Spring, Md. Terry M. Bottomley, RN Charge Nurse Emergency Department Wooster Community Hospital Wooster, Ohio Cheryl Bozman, BSN, RRT, RN-BC Information Systems Coordinator Nursing Education Department Henry Ford Wyandotte Hospital Wyandotte, Mich.

Linda Carman Copel, PhD, APRN, BC, NCC, DAPA Associate Professor College of Nursing Villanova University Villanova, Pa. Teresa Dowdell, PharmD Associate Professor College of Nursing University of South Florida Tampa Julie M. Gerhart, MS, RPh Pharmacy Affairs Manager Merck & Co., Inc. West Point, Pa. Cheryl A. Grandinetti, PharmD Senior Clinical Research Pharmacist Pharmaceutical Management Branch Cancer Therapy Evaluation Program Division of Cancer Treatment and Diagnosis National Cancer Institute Rockville, Md. Franklin R. Grollman, PharmD, BCOP Clinical Pharmacist National Naval Medical Center Bethesda, Md.

ix

x

Contributors and reviewers

Delilah S. Hall, RN, MSN, CNS, CMSRN, CRRN Clinical Nurse Specialist Center for Rehabilitation The Cleveland Clinic Foundation Cleveland, Ohio Helena M. Hardin, RN Clinical Manager Cardiac and Medical Intensive Care Unit Oakwood Hospital and Medical Center Dearborn, Mich. Nancy Hargis, RN, BSN Nurse Manager Emergency Department Shore Memorial Hospital Nassawadox, Va. Kathleen E. Jones, RN, CPN Freelance Author Westerville, Ohio Sandy Keefe, RN, MSN Freelance Nurse Writer El Dorado Hills, Calif. Frank J. Krivanek, PharmD Clinical Coordinator Director of Pharmacy Practice Residency Program Mount Carmel West Columbus, Ohio Nancy Laplante, RN, PhD Assistant Professor Division of Nursing and Health Sciences Neumann College Aston, Pa. Mary Jo Lombardo, RN, MSN, CEN Clinical Education Program Manager Howard County General Hospital Columbia, Md.

Mary Jane McDevitt, RN, BS, CDE Nurse Manager Center for Diabetes Springfield Hospital Springfield, Pa. Keith M. Olsen, PharmD, FCCP, FCCM Professor and Chair Department of Pharmacy Practice University of Nebraska Medical Center Omaha Lois A. Piano, RN, MSN, EdD Senior Research Associate Curtis Analytic Partners Philadelphia, Pa. Martha Polovich, RN, MN, AOCN Associate Director, Clinical Practice Duke Oncology Network Durham, N.C. Christine Price, PharmD Clinical Coordinator and PGY1 Residency Director Morton Plant Mease Health Care Clearwater, Fla. Barbara Putrycus, RN, MSN, CCRN Director Infection Control, Quality & Regulatory Compliance for Surgical Services Oakwood Hospital & Medical Center Dearborn, Mich. Michele Riccardi, PharmD Pharmacy Clinical Coordinator Midstate Medical Center Meriden, Conn. Minnie Bowen Rose, RN, BSN, MEd Clinical Consultant Atlantic City, N.J. Cynthia Saver, RN, MS President CLS Development, Inc. Columbia, Md.

Contributors and reviewers

Melinda K. Schott, RPh, PharmD Clinical Pharmacist Coram Healthcare Wallingford, Conn. AnnMarie Smith, RN, BSN, MA Clinical Instructor The Cleveland Clinic Foundation Cleveland, Ohio Mary E. Stassi, RN, C Health Occupations Coordinator St. Charles Community College St. Peters, Mo. Barbara Tassone, RN, CNP Nurse Practitioner Greater Baltimore Medical Center Baltimore, Md.

Vera Usinowicz, RN, MS, CCRN, CCNS Advanced Practice Nurse Critical Care The Valley Hospital Ridgewood, N.J. Jeannette Yeznach Wick, RPh, MBA, FASCP Senior Clinical Research Pharmacist National Cancer Institute Bethesda, Md.

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Preface and user’s guide Like all nurses, you’re no doubt aware that medication errors are a huge problem whose causes are multifold and complex. A wide range of systemic, organizational, environmental, and individual factors—or a combination—can set the stage for a mistake with a patient’s drug regimen. If adverse drug events (ADEs) brought on by such errors were classified as a disease, they would rank as the fifth leading cause of death in the United States. Elderly patients alone experience 1.8 million ADEs every year. Of course, nurses are front and center in the ADE spotlight. Up to 62% of medication errors occur during the drug administration phase, which is usually performed by nurses. Traditionally, medication errors have been blamed on individuals rather than systems, with individual nurses shouldering much of the blame (often without justification). Yet a significant number of errors stem from failures at the system level. Accordingly, over the last decade, the focus of efforts to reduce medication errors has shifted from the individual to the healthcare organization as a whole. To make drug administration safer, organizations must redesign their processes, systems, culture, and work environment to rectify the problems that cause or contribute to ADEs—excessive patient loads, worker fatigue, staffing shortages, illegible prescriber handwriting, flawed drug-dispensing systems, and misleading drug labels, to name a few. While being at the front and center means you’re more likely to be blamed when a problem happens, it also gives you the opportunity to detect and intercept errors that occurred during the xii

prescribing, transcribing, and dispensing stages. Serving as an early detection system for medication errors puts you in the best position to avert or minimize negative patient outcomes. But this task isn’t easy in a fastpaced environment full of distractions, interruptions, and multiple stressors. In fact, the challenge can seem daunting. What’s more, even if your facility has made system changes aimed at reducing drug errors, you’re not off the hook. You’re still legally responsible for administering drugs safely. Nurses have an ongoing need to obtain more knowledge about current and newly approved medications, as well as a duty to use evidence-based best practices when giving drugs. One study found that deficits in provider knowledge accounted for two-thirds of ADEs that led to patient deaths. To meet this challenge, you need a reliable, practical source of drug information written especially for nurses. Nursing Spectrum Drug Handbook 2010 fits the bill precisely. From its first edition, this book has focused primarily on safe medication use. With each subsequent edition, we’ve added new safety-centered components and features to address newly introduced drugs, new uses for existing drugs, new drug concerns, and new evidence about the best medication administration practices. Over the past few years, as studies have shed more light on the causes of medication errors, as new drugs have been introduced, and as postmarketing ADE reports have been collected and analyzed, Nursing Spectrum Drug Handbook has been refined, updated, and augmented. In short, this book has grown—and so must you.

Preface and user’s guide

Targeting excellence The quality, relevance, and success of any book for nurses hinge on whether it meets its audience’s needs. To help us refine and update the book for this fifth edition, we took the same approach as with past editions, asking more than 60 practicing nurses, student nurses, nursing school deans, nursing executives, and pharmacists to review the previous edition. We also took to heart the valuable comments submitted by nurses who purchased the book. Most importantly, we’ve continually monitored the literature for pharmacotherapeutic research advances and innovations and emerging safety concerns.

Outstanding features Nursing Spectrum Drug Handbook 2010 continues to offer the outstanding features of previous editions while introducing new features reflecting recent research, readers’ and reviewers’ feedback, and the Joint Commission’s patient safety goals and other mandates. You’ll find alphabetically arranged drug monographs for approximately 1,000 generic drugs and 3,000 trade drugs. The information in these monographs has been reviewed and updated by dozens of practicing nurses and pharmacists, and then edited by our team of clinical and editorial experts. Features of this edition include: ● new monographs for newly approved drugs and certain other medications ● new indications, dosages, off-label uses, and safety warnings for preexisting drugs ● generic and trade-name drugs available in Canada (marked by a maple leaf) and the United Kingdom (UK), which are marked with a special icon ( ) ● red “Clinical Alert” logos (2), which call attention to critical administration and safety considerations (especially for high-alert drugs) ● a scored tablet icon 1 to instantly guide your eye to the “Indications and dosages” section

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Food and Drug Administration (FDA) boxed warnings in the monographs of all drugs that have such warnings ● special icons in the monographs of every hazardous drug ( ) or highalert drug ( ) ● detailed administration guidelines for each drug, with specific instructions on oral, I.M., I.V., subcutaneous, and other routes when applicable ● life-threatening adverse reactions shown in boldface ● interactions with other drugs, diagnostic tests, foods, herbs and nutritional supplements, and behaviors ● patient monitoring guidelines, including ongoing assessment, follow-up laboratory test results that indicate adverse reactions, and warning signs of an untoward event ● crucial information to consider when giving the drug to elderly or pediatric patients ● drug-altering laboratory values ● an enhanced version of our popular full-color “Safe drug administration” insert, which includes the FDA’s list of recommended “tall man” names to distinguish drugs with look-alike or sound-alike names, along with guidelines for managing, preparing, and administering hazardous drugs ● several new appendices, including one on the Beers criteria for potentially inappropriate medications for elderly adults ● a photogallery of common tablets and capsules ● guidelines for preparing and administering hazardous drugs ● a comprehensive index so you can look up a drug by its generic name, trade name, or indications. ●

Drug administration guidelines From the time a prescriber orders a drug to the time the patient receives it, the process of drug administration may involve anywhere from 80 to 200

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individual steps. Missteps can happen at any point in this process—but you can help prevent some of these errors long before the dose is prepared.

Evidence-based best practices of drug administration Best practices for preventing and detecting medication errors always starts with patient assessment at the time of admission and should be performed whenever the patient’s symptoms change or a new symptom develops. During the initial patient evaluation, review the patient’s current drug regimen, obtain drug allergy information, measure height and weight, and check the diagnosis and other baseline data to help determine the patient’s risk of an adverse reaction. Also, make sure you’re familiar with the drug’s action, expected benefits, adverse reactions, and interaction potential in light of such patient factors as diagnosis and medical condition. To further gauge your patient’s risk of an ADE, ask yourself these questions: ● Is the patient elderly? Advanced age increases the risk of an ADE. ● Is the drug you’re administering a high-alert or hazardous one? If so, find out what precautions you can take to reduce the chance of an ADE. ● Is the drug appropriate for the patient’s diagnosis? Is it the drug of choice for this diagnosis—or just the prescriber’s preference for reasons other than evidence, contraindications to alternative drugs, or a positive outcome? ● Is the patient receiving multiple drugs? Polypharmacy is extremely common, especially among older patients. The addition of each new drug increases the chance of an ADE by 10%. The more daily drugs, daily doses, and different prescribers and pharmacies involved in a patient’s regimen, the greater the risk of ADEs. ● Is the patient especially vulnerable to a harmful interaction, such as a

drug-drug, drug-food, drug-herb, drugalcohol, or drug-behavior interaction? ● Has the drug been prescribed based on an altered laboratory value caused by another drug? ● Is the patient a child? Pediatric patients are at increased risk for ADEs. Drug formulations and labeling generally are geared to adults; to administer a drug to a child, you may need to calculate the pediatric dosage or mix the drug in a certain way, which increases the risk of error. Also, a child’s body isn’t completely developed and thus less able to overcome the effects of an overdose or interaction.

The “five rights” of drug administration Nurses are legally responsible for applying and ensuring the “five rights” of drug administration. To help achieve these goals, use the following strategies: ● Right patient. Always confirm the patient’s identity before administering a drug. Check his ID bracelet and ask him to state his name; then confirm his name, age, and allergies. The Joint Commission requires the use of two identifiers, such as the patient number, his telephone number, or his Social Security number. Ideally, match the ordered treatment to the patient using his name bracelet and ID number, comparing it to the drug order transcribed in the medication administration record (MAR). Be especially cautious if your patient is confused, because he may answer to the wrong name. ● Right drug. Giving the wrong drug is the most common type of medication error. It typically results from such factors as look-alike and sound-alike drug names, similar drug labels and packaging, and poor communication. Never try to decipher an illegible drug order, and never give a drug if you’re not sure why it was prescribed. To make sure you give the right drug, match the drug label against the order


in the MAR three times—once when you remove the container from the patient’s drug drawer, again before you remove the dose from the container and, finally, before you return the container to the drawer or discard it. Never give a drug from a container that is unlabeled or has an unreadable label, and never borrow a drug from another patient. In an effort to reduce “wrong-drug” and other medication errors, many hospitals have adopted newer technologies, such as bar-code point-ofcare drug administration systems. When using such a system, keep in mind that it must be monitored regularly for problems and that staff members must receive adequate training in its use. ● Right dosage. Check the dosage against the order in the MAR. Determine if it’s appropriate based on the patient’s age, size, vital signs, and condition. If the dose needs to be measured, use appropriate equipment—for instance, an oral syringe rather than a parenteral syringe to measure an oral liquid drug. Be on the lookout for misinterpretation of orders, incorrect calculation of volumes and infusion rates, misreading of decimal points, and labeling errors. When administering a drug that can cause serious harm if given incorrectly (such as I.V. insulin or heparin) or when giving an infusion to a pediatric patient, always double-check the dosage and pump settings; then verify these with a colleague. ● Right time. Incorrect timing of drug administration accounted for 43% of medication errors reported in a 2002 study in the Archives of Internal Medicine. Although most medications are not time-sensitive, dose timing can be critical if the patient must maintain a specific blood drug level or to ensure accurate laboratory test values or avoid interactions with other drugs.

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Usually, a dose should be given within 30 minutes before or after the time specified in the order, in accordance with your facility’s established protocols. Always administer a dose as it’s prepared. To maximize the drug’s therapeutic efficacy, check whether it should be given with or without food and whether it could interact with or impede the absorption of concurrently administered drugs. ● Right route. Many drugs can be given by multiple routes. The prescriber chooses the route based on such factors as the patient’s condition and the desired onset of action. In turn, the prescribed dosage is based on the administration route. Generally, oral dosages of a given drug are greater than injected dosages, so a serious overdose may occur if a dose intended for oral administration is given by injection instead. Also, keep in mind that most serious error outcomes occur when the I.V. route is used. (Only a few high-risk drugs, such as warfarin, some chemotherapy drugs, and a few sedatives, are given orally.) Finally, be aware that some drugs or drug forms (for instance, sustained-release tablets or capsules) should never be crushed. Crushing can alter the dosage delivered, causing the patient to receive a bolus of a drug that’s meant to be released slowly over several hours.

Additional nursing responsibilities Of course, nursing responsibilities don’t stop with these five rights. Documentation, monitoring, and patient teaching are also crucial. After giving the drug, always document that it was administered. Document the dose as soon as it is given— never before. When documenting, use only accepted abbreviations and avoid those that are used rarely or that could be misread or misinterpreted.

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Avoiding dangerous abbreviations To help reduce medication errors, all healthcare team members must use abbreviations correctly. The Joint Commission mandates that healthcare organizations standardize a list of abbreviations, acronyms, and symbols that should not be used. Organizations must approve a minimum required list of prohibited abbreviations, which includes the first five items shown below. The Joint Commission also advises organizations to consider adding the remaining items to their "Do not use" list.

Abbreviation

Potential problem

Solution

U (for "unit")

Mistaken as "0," "4," or "cc"

Write "unit."

IU (for "international unit") Mistaken as "IV" ("intravenous") or 10 ("ten")

Write "international unit."

Q.D., Q.O.D. (for "once daily," "every other day")

Mistaken for each other. Period after "Q" may be mistaken for "I"; "O" may be mistaken for "I."

Write "daily" or "every other day."

Trailing zero (X.0 mg) (prohibited only for drugrelated notations); lack of leading zero (.X mg)

Decimal point is missed.

Never write a zero by itself after decimal point (X mg); always use a zero before decimal point (0.X mg).

MS MSO4 MgSO4

Confused for one another. May mean "morphine sulfate" or "magnesium sulfate."

Write "morphine sulfate" or "magnesium sulfate."

µg (for "microgram")

Mistaken for "mg" (milligrams), resulting in 1,000-fold overdose

Write "mcg."

H.S. (for "half-strength" or Mistaken for "half-strength" "at bedtime") or "hour of sleep" ("at bedtime")

Write "half-strength"or "at bedtime."

q.H.S. (for "at bedtime")

Mistaken for "every hour"

Write "at bedtime."

T.I.W. (for "3 times a week")

Mistaken for "3 times a day" or "twice weekly"

Write "3 times weekly" or "three times weekly."

S.C. or S.Q. (for "subcutaneous")

Mistaken for "S.L." (sublingual) or "5 every"

Write "Sub-Q," "subQ," or "subcutaneously."

D/C (for "discharge")

Misinterpreted as "discontinue"

Write "discharge."

cc (for "cubic centimeters") Mistaken for "U" (units) if poorly written

Write "ml" for milliliters.

AS, AD, AU (for "left ear," "right ear," "both ears")

Write "left ear," "right ear," or "both ears."

Mistaken for OS, OD, or OU


Understanding pregnancy risk categories Whenever possible, pregnant women should avoid drug therapy. The risks of taking drugs during pregnancy range from relatively minor fetal defects (such as ear tags or extra digits) to fetal death. When drug therapy is considered, the drug’s benefits to the mother must be weighed against the risk to the fetus. Ideally, the drug should provide clear benefits to the mother without harming the fetus. To help prescribers and pregnant patients assess a drug’s risk-to-benefit ratio, the Food and Drug Administration assigns one of five pregnancy risk categories to each drug. In addition, certain drugs are not rated. Category A: No evidence of risk exists. Adequate, well-controlled studies in pregnant women don’t show an increased risk of fetal abnormalities during any trimester. Category B: The risk of fetal harm is possible but remote. Animal studies show no fetal risk; however, controlled studies haven’t been done in humans. Or animal studies do show a risk to the fetus, but adequate studies in pregnant women haven’t shown such a risk. Category C: Fetal risk can’t be ruled out. Although animal studies show risks, adequate, well-controlled human studies are lacking. Despite the potential fetal risks, use of the drug may be acceptable because of benefits to the mother. Category D: Positive evidence of fetal risk exists. Nevertheless, potential benefits from the drug may outweigh the risk. For example, the drug may be acceptable in a life-threatening situation or serious disease if safer drugs can’t be used or are ineffective. Category X: Contraindicated during pregnancy. Studies in animals or humans or reports of adverse reactions show evidence of fetal risk that clearly outweighs any possible benefit to the patient. Category NR: Not rated.

xvii

(See Avoiding dangerous abbreviations, page xvi, and the inside front cover, Common abbreviations.) If the patient refuses a medication, report this to the prescriber immediately. Then record his refusal on both the MAR and the patient’s record; include your initials, full name, and credentials on both records. During the course of drug therapy, monitor the patient to determine drug efficacy and detect signs and symptoms of an adverse reaction or interaction. Teach the patient the name of the prescribed drug, its dosage, administration route, dosing frequency and times, and duration of therapy. Make sure he knows how to recognize the drug’s therapeutic effects, adverse reactions, and interactions with other drugs, foods, herbs, and behaviors. Be aware that the Joint Commission’s 2009 National Patient Safety Goals mandate that healthcare facilities (and by extension, nurses) implement applicable practices that will improve or bring about the following: ● better communication among caregivers ● creation of a standardized list of abbreviations, symbols, and dose designations not to be used ● improved safety of drug use ● verification of all labels both verbally and visually by two qualified individuals, if the person preparing the drug is not the same person who will administer it ● accurate and complete medication reconciliation across the continuum of care ● reduction of the risk of patient harm stemming from falls caused by medications ● active involvement of patients in their own care (including teaching them about their drugs).

xviii


User’s guide to Nursing Spectrum Drug Handbook 2010 This book is organized in three main parts.

Part 1: A to Z drug monographs Part 1 presents individual drug monographs in alphabetical order by generic name. Where applicable, the top banner of the monograph includes an icon or logo denoting that the drug is a highalert drug ( ) or a hazardous drug ( ). As defined by the Institute of Safe Medication Practices, high-alert drugs are those that can cause an increased risk of significant patient harm when used in error, and deserve special attention, caution, and safeguards. Drugs designated as hazardous by the National Institute for Occupational Safety and Health, American Society of Health-System Pharmacists, and the Centers for Disease Control and Prevention include cancer chemotherapy agents, some antivirals, certain hormones, some bioengineered drugs, and selected miscellaneous drugs. These agents meet one or more of the following criteria: carcinogenicity, teratogenicity or other developmental toxicity, reproductive toxicity, organ toxicity at low doses, genotoxicity, or structure and toxicity profiles that mimic existing drugs determined to be hazardous by the above criteria. These drugs must be handled within an established safety program (see “Guidelines for preparing, handling, and administering hazardous drugs,” in the “Safe drug administration” insert). Below the banner, each monograph is presented in the following order: Generic name. A drug’s generic name is the nonproprietary name, typically assigned by the manufacturer. When more than one therapeutic form of the drug is available, generic names of these forms are listed alphabetically.

Schedules of controlled substances The Controlled Substances Act of 1970 regulates the production and distribution of stimulants, narcotics, depressants, hallucinogens, and anabolic steroids. Drugs regulated by this law fall into five categories, or schedules, based on their abuse potential, medicinal value, and harmfulness. Schedule I drugs are the most hazardous; schedule V drugs, the least hazardous. Schedule I: High potential for abuse; no currently accepted medical use in the United States. Using the drug even under medical supervision is thought to be unsafe. Schedule II: High potential for abuse; currently accepted medical use in the United States (or currently accepted medical use with severe restrictions). Abuse may lead to severe psychological or physical dependence. Emergency telephone orders for limited quantities may be authorized, but the prescriber must provide a written, signed prescription order. Schedule III: Lower abuse potential than schedule I and II drugs; currently accepted medical use in the United States. Abuse may lead to a moderate or low degree of physical dependence or high psychological dependence. Telephone orders are permitted. Schedule IV: Lower abuse potential than schedule I, II, or III drugs; currently accepted medical use in the United States. Abuse may lead to limited physical dependence or psychological dependence. Telephone orders are permitted. Schedule V: Low abuse potential compared to drugs in other schedules; currently accepted medical use in the United States. Abuse may lead to limited physical dependence or to psychological dependence. Some schedule V drugs may be available in limited quantities without a prescription (if state law permits).


xix

High-alert drugs Certain drugs expose patients to an increased risk of significant harm when used in error. In 2007, the Institute for Safe Medication Practices (ISMP) updated its list of high-alert drugs based on voluntary medication error reports, harmful medication errors described in the literature, practitioner feedback, and expert reviews. The ISMP has identified both high-alert drug classes (or categories) and specific high-alert drugs.

High-alert drug classes and categories ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ●

adrenergic agonists, I.V. adrenergic antagonists, I.V. anesthetic agents, general, inhaled and I.V. antiarrhythmics, I.V. anticoagulants cardioplegic solutions chemotherapeutic agents dextrose (20% or greater) dialysis solutions epidural and intrathecal drugs glycoprotein IIb/IIIa inhibitors hypoglycemics, oral inotropic drugs, I.V. liposomal drug forms moderate sedation agents, I.V. (or oral agents for children) narcotics and opioids neuromuscular blocking agents radiocontrast agents, I.V. thrombolytics and fibrinolytics, I.V. total parenteral nutrition solutions

Trade names. A drug’s common trade, or brand, name is the proprietary, trademarked name under which it’s marketed. Trade-name and generic drugs are therapeutically equivalent in strength, quality, performance, and use; when interchanged, they have the same effects and no differences. However, they may vary in preservatives, color, shape, labeling and, possibly, scoring. In the monographs, tradename drugs available in Canada are marked with a maple leaf, and those available in the UK are marked with a for easy identification. Pharmacologic and therapeutic classes. This section specifies the drug’s

Specific high-alert drugs ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ●

●

amiodarone, I.V. colchicine, injection epoprostenol heparin, low molecular weight heparin, unfractionated, I.V. insulin, subcutaneous and I.V. lidocaine, I.V. magnesium sulfate injection methotrexate, oral nononcologic use oxytocin potassium chloride for injection potassium phosphates injection promethazine, I.V. sodium chloride injection sodium nitroprusside for injection sterile water for injection, inhalation, and irrigation in containers of 100 ml or more warfarin

pharmacologic class (based on its pharmacologic properties and action—for example, sulfonamide or corticosteroid) and therapeutic class (based on approved therapeutic uses of the drug—for instance, antineoplastic or antihypertensive). Many drugs fall into multiple therapeutic classes. Pregnancy risk category. This section lists the category assigned by the FDA to indicate the drug’s potential danger to the fetus when taken during pregnancy. (See Understanding pregnancy risk categories, page xvii.) Controlled substance schedule. Narcotics, stimulants, and certain other drugs fall under the Controlled

xx


Substances Act. The Drug Enforcement Agency assigns each of these drugs a category, or schedule, based on its abuse potential and other factors. (See Schedules of controlled substances, page xviii.) When applicable, this section lists the drug’s assigned schedule. FDA boxed warning. The FDA assigns a boxed warning if: ● the drug may cause an adverse reaction so serious (relative to the drug’s potential benefit) that prescribers must carefully weigh risk against benefit ● a serious adverse reaction can be prevented or reduced through careful patient selection, rigorous monitoring, avoiding certain concomitant therapy, adding another drug, managing the patient in a specific way, or avoiding use in a specific clinical situation ● the FDA approved the drug with restrictions to assure its safe use because it concluded that the drug can be used safely only if its distribution or use is restricted. In this book, boxed warnings have been condensed and edited for space reasons. Be sure to review the complete package insert before administering the drug in question. Action. This section summarizes how the drug achieves its therapeutic effect—the action that takes place when it reaches its target site and combines with cellular drug receptors to cause certain physiologic responses. When a drug’s action isn’t known or when researchers have proposed theories for the action but haven’t clarified it definitively, we state this fact. Availability. This section lists the physical forms in which the drug is produced and dispensed, plus available strengths (the amount of active ingredient present) for each form. Indications and dosages. Marked with a red scored tablet icon 1 for quick identification, this section details the drug’s FDA-approved indications for adults, children, infants, and neonates

(when appropriate), along with recommended dosages, administration routes, and dosing frequency for each indication. The indications and dosages shown reflect current clinical trends, not unequivocal standards, and must be considered in light of the patient’s condition and diagnosis. (Although we’ve made every effort to ensure the accuracy of all dosages, we urge you to become familiar with the official package insert for each drug you administer.) Dosage adjustment. This section tells which patient groups (such as children or elderly patients), diseases, or disorders (such as renal or hepatic dysfunction) may necessitate dosage adjustment. Off-label uses. Here you’ll find a list of off-label (unlabeled or unapproved) uses of the drug, when applicable. Offlabel drug use has become increasingly common as clinical research moves ahead of the FDA’s approval process. In some cases, off-label use has become the standard of care. Contraindications. This section lists conditions that contraindicate use of the drug, such as preexisting diseases. As a rule, never give a drug to a patient who has a history of hypersensitivity to that drug. Drugs commonly implicated in hypersensitivity reactions include antibiotics, histamines, iodides, phenothiazines, tranquilizers, anesthetics, diagnostic agents (such as iodinated contrast media), and biologic agents (such as insulin, vaccines, and antitoxins). Precautions. For some patients, a specific drug may pose an increased risk of untoward effects—yet the physician prescribes it because, in his judgment, the potential benefits outweigh the risks. For instance, many drugs can be dangerous for elderly patients, pregnant or breastfeeding women, young children, and patients with renal or hepatic dysfunction. This section tells you which patients to whom you must


administer the drug cautiously. Precautions can be especially important if you’re administering a high-alert drug. (See High-alert drugs, page xix.) Administration. Here you’ll find information to help you prepare the drug and administer it correctly and safely, regardless of the route—including whether to give it with or without food, how to mix it for I.V. or I.M. use, and what flow rate to use. Route, onset, peak, and duration. Presented in table form, this section provides a pharmacokinetic profile— onset of action, peak blood level, and duration of action—for each route by which the drug is administered. Adverse reactions. Occurring in roughly 30% of hospital patients, reactions can range from mild to lifethreatening. They may arise immediately and suddenly, or take weeks or even months to develop. Adverse reactions can be especially dangerous if a medication error occurs in a patient who’s receiving a high-alert drug. The sickest patients—those in intensive care—typically receive anywhere from 20 to 40 different drugs. These patients are the most vulnerable to adverse reactions, drug interactions, and life-threatening consequences of a medication error. In this section, we list the most commonly reported adverse reactions by body system. Lifethreatening reactions appear in boldface. Interactions. With Americans taking more prescription and nonprescription drugs than ever, you’re likely to encounter patients experiencing the effects of drug interactions. Many people also take herbs and nutritional supplements that can interact with drugs to cause dangerous effects or to impede a drug’s intended effect. This section presents documented and clinically significant interactions that may occur if the drug is used concurrently with other drugs, specific foods, and certain herbs or supplements, or if it’s combined

xxi

with certain behaviors (for instance, smoking or alcohol use). It also describes the drug’s effects on diagnostic test results, which can be especially important for hospital patients. Patient monitoring. Close patient monitoring is essential during drug therapy (and in some cases, even after therapy ends) to help gauge whether the drug is effective and to detect untoward reactions or interactions. Early detection of troublesome side effects or drug inefficacy allows timely adjustments in therapy and may prevent patient injury or avoid a treatment delay. To monitor your patient effectively, you must be familiar with the drug you’re administering and its intended outcome. You must also determine whether this drug might interact with other drugs that your patient is receiving, and determine whether his medical condition, vital signs, or recent laboratory findings make him more vulnerable to interactions or adverse effects. This section discusses important nursing assessments and interventions to perform, such as monitoring blood drug levels to help determine the correct dosage and to prevent toxicity. Patient teaching. The nurse’s responsibility for teaching patients about their care has never been greater. What’s more, patients are now demanding more information about their treatment. This section describes key teaching points you should cover with a patient who’s receiving the drug, including essential information needed to create a patient teaching plan and protect your patient even after discharge.

Part 2: Drug classes, vitamins and minerals, herbs and supplements Part 2 presents collective monographs on therapeutic drug classes and abbreviated monographs on vitamins, minerals, herbs, and nutritional supplements. Monographs on therapeutic drug classes familiarize you with the

xxii


overall attributes of an entire drug class. These monographs also tell you which drugs the prescriber may order if a particular drug in the same class is unsuitable for your patient. The use of herbal remedies and supplements is soaring—yet many users and healthcare practitioners are in the dark about these products’ adverse effects and potential interactions with prescription and over-the-counter drugs. This section gives basic information that may help your patients use herbs more safely.

Part 3: Appendices, references, and index Appendices serve as handy references on important drug topics and related issues—everything from normal laboratory values for monitoring and detecting drug levels to the top 200 most commonly prescribed drugs.

Website, PDA download, and other bonuses Our website, www.nursesdrughandbook.com, gives you 24-hour access to hundreds of drug monographs, online versions of the book’s safe drug administration insert, drug news (including new approvals and indications), and patient teaching aids on common drugs (which you can customize and give to patients). Also, this website will provide access to the full text of the Nursing Spectrum Drug Handbook 2010, which you can download free to your personal digital assistant. I’m certain Nursing Spectrum Drug Handbook 2010 will continue to enhance your practice and help you continue to make drug therapy safer and more effective for your patients.

Acknowledgments A project of this scope and intensity demands incredible effort, hard work, and the expertise of a dedicated team. I’m indeed fortunate to work with such a group, the MedVantage Publishing

team. I want to thank them all; in particular, Minnie Rose, our clinical manager, whose patience, knowledge, and attention to detail add so much to the success of this project; also Kathy Goldberg, editorial manager; Karen Comerford, copyedit supervisor; Stephanie Peters, design manager; and Julia Knipe, administrator extraordinaire. The entire McGraw-Hill team deserve a heartfelt thank you, especially John Williams, Phil Galea, Arushi Chawla, and Joseph Morita. Their continued support is, as always, much appreciated. I also wish to thank our advisors, contributors, and reviewers for continuing to share their expertise—and their valuable time. A project like this wouldn’t be possible without them. And a most-important thank you to all you wonderful nurses who give unselfishly of yourselves to ensure the best care and protection of your patients. I’m especially grateful to those of you who’ve written or e-mailed me with kind words for Nursing Spectrum Drug Handbook. I appreciate your enthusiastic support and will continue to work hard to bring you the tools you need to safeguard your patients. Patricia Dwyer Schull, MSN, RN About the author: Patricia Dwyer Schull, President of MedVantage Publishing, has more than 20 years’ experience in medical and nursing publishing. Before establishing MedVantage Publishing, she held executive management positions with the top medical publishers in the world. She is the editor and author of many popular medical and nursing publications. Before entering the publishing industry, she practiced for many years as a professional nurse and held various nursing positions in hospital management, direct patient care, and staff education. She has a Master of Science degree in Nursing, a Bachelor of Science degree and a Registered Nurse Diploma.

Pa r t 1 Drug monographs A to Z Safe drug administration Photogallery of common tablets and capsules

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abacavir sulfate

a

3

Children ages 3 months to 16 years: 8 mg/kg P.O. b.i.d., to a maximum dosage of 300 mg b.i.d.

Contraindications ●

abacavir sulfate Ziagen Pharmacologic class: Carbocyclic nucleoside reverse transcriptase Therapeutic class: Antiretroviral Pregnancy risk category C

FDA BOXED WARNING Drug may cause serious and potentially fatal hypersensitivity reactions, including multi-organ syndrome marked by fever, rash, GI distress, malaise, fatigue, achiness, dyspnea, cough, and pharyngitis. Discontinue immediately if you suspect such a reaction. If hypersensitivity can’t be ruled out, discontinue permanently, even if other diagnoses are possible. ● After hypersensitivity reaction, never restart drug or other agents containing it, because more severe symptoms (including severe hypotension and death) may arise within hours. ●

Action Converts via intracellular enzymes to active metabolite carbovir triphosphate, which inhibits activity of human immunodeficiency virus-1 (HIV-1) reverse transcriptase. Inhibits viral reproduction by interfering with DNA and RNA synthesis.

Availability Oral solution: 20 mg/ml Tablets: 300 mg

1Indications and dosages

➣ HIV-1 infection Adults: 300 mg P.O. b.i.d.

Reactions in bold are life-threatening.

● ● ●

Hypersensitivity to drug Hepatic disease, lactic acidosis Breastfeeding Children younger than age 3 months

Precautions Use cautiously in: ● impaired renal function, bone marrow suppression ● risk factors for hepatic disease ● elderly patients ● pregnant patients.

Administration Always give in combination with other antiretrovirals. 2Be aware that drug may cause fatal hypersensitivity reactions. ● Give with food if GI upset occurs. ●

Route P.O.

Onset Unknown

Peak 0.5-1.7 hr

Duration Unknown

Adverse reactions CNS: headache, weakness, insomnia GI: nausea, vomiting, diarrhea, poor appetite, pancreatitis Hematologic: neutropenia, severe anemia Hepatic: hepatic failure Metabolic: mild hyperglycemia, lactic acidosis Skin: rash, erythema multiforme, toxic epidermal necrolysis Other: body fat redistribution, StevensJohnson syndrome, fatal hypersensitivity reaction

Interactions Drug-drug. Methadone: Increased oral methadone clearance Drug-diagnostic tests. Alanine aminotransferase, aspartate aminotransferase, creatine phosphokinase, gammaglutamyltransferase, glucose, triglycerides: increased levels 2Clinical alert

a

Safe drug administration

The following guidelines on preparing, administering, and monitoring drug therapy will help you ensure patient safety and drug effectiveness.

S2


Use the table below to determine if you can safely mix two drugs together in the same syringe or administer them together through the same I.V. line. KEY C: compatible I: incompatible ✳: conflicting data exist Blank space: no data available

acyclovir sodium amikacin amiodarone amphotericin B aztreonam calcium chloride calcium gluconate cefazolin cefepime ceftazidime clindamycin cyclosporine dexamethasone digoxin diltiazem diphenhydramine dobutamine dopamine enalaprilat epinephrine

acyclovir sodium amikacin amiodarone amphotericin B aztreonam calcium chloride calcium gluconate cefazolin cefepime ceftazidime clindamycin cyclosporine dexamethasone digoxin diltiazem diphenhydramine dobutamine dopamine enalaprilat

Drug compatibilities

I I I C I C C C C C I C C C C C C C CC C C I I C I C C I C I C✳ I I C I C C C C C C C C C C C C ✳C C C C I I C C✳ C C I C I ✳C C C C C C I I C C C C C C C I ✳ C CC C C C C ✳ C C C C ✳ I I I C C C C C CC C ✳C C ✳ I C C ✳✳ I C C C I C I C C ✳ C CC C I C C C C C C C

esmolol famotidine

C C

✳✳

C C

C

C

C

C

C C

C C

C

C

fluconazole

C

furosemide

✳✳

C C C

C

C C C

C C

C C C C

C C C I I I

S3

epinephrine esmolol famotidine fluconazole furosemide heparin hydrocortisone hydromorphone hydrochloride imipenem and cilastatin sodium insulin labetalol levofloxacin lorazepam magnesium methylprednisolone metoclopramide hydrochloride metoprolol metronidazole midazolam milrinone morphine nitroglycerin nitroprusside norepinephrine ondansetron phenylephrine potassium chloride sodium bicarbonate tobramycin vancomycin vecuronium


C C✳ I C

C C

C C C C✳ C ✳C

I C C

I

I

C C

✳C

C C

C C

C C

✳C C C

C ✳

C

C

C C

C C

C

C I I C ✳

C C C

C

C

✳✳ C

I ✳

C C C

I ✳

I C C✳ I C C I C C

C

C

C

C C C C

C ✳

C C C

C✳

I C C

C C

C C

C

I

✳C C C C C

I

C C

✳C C C C C C C

C I

C

C C

C

C

C

C C

C

C C

C C C

C C

I I C

C C C

C✳ I

C C C C

✳

C C✳

C

✳

C C

I C

C I ✳✳

C

I

C C

C✳C

C

C

✳C C

C C

✳ ✳C C

C

I

C C

C CCC C I C C C CC ✳ C C C C C I ✳ C C

I C

C

C✳

C C

C

C

C

C C C

C C

C C I C C C

C

C

C C ✳

C C

C

C C C C C✳

✳C C C

C C C

C C C C

C✳C

I I C C

✳

C C C C C C

I

C

C C

C

C

C

C C C

C

C C C

C C C C C C C C

I I I C C

C I

I C✳

C

S4


KEY C: compatible I: incompatible ✳: conflicting data exist Blank space: no data available

acyclovir sodium amikacin amiodarone amphotericin B aztreonam calcium chloride calcium gluconate cefazolin cefepime ceftazidime clindamycin cyclosporine dexamethasone digoxin diltiazem diphenhydramine dobutamine dopamine enalaprilat

Drug compatibilities (continued)

C✳C✳C

heparin

I

I C

hydrocortisone

C

I C C C

C

C C ✳✳✳ C C ✳C

C

C C

hydromorphone hydrochloride imipenem and cilastatin sodium

I

C

insulin

C

C

labetalol

C C

levofloxacin

C

C C C

C C

magnesium

C ✳✳ C I ✳ C

I

C C C C

C C

C

C C C

✳ I

C C C

lorazepam methylprednisolone

I ✳

C

C I ✳

I C

C

✳ I

C

metoclopramide hydrochloride

C C C

C

metoprolol metronidazole

C C

midazolam

C C

milrinone

C C

morphine

C C

nitroglycerin

C

nitroprusside

✳

norepinephrine ondansetron phenylephrine

✳C C C C

I

✳C

C C

I C

✳C

C C C

C C

C C C

C C

C C

C C

C

C C C C C C

C

C C

C

C C C

C C

✳C

C I C

C

C

C C ✳✳

C

potassium chloride

C C

C

sodium bicarbonate

C I

C I I

C C C

C

C C

C C C C

C C ✳

I

tobramycin

C

C

C C I ✳✳ C

vancomycin

C C

✳

C✳C✳

vecuronium

C

C

✳✳ C I I

C I

C

C C

C C C

S5

metoprolol metronidazole midazolam milrinone morphine nitroglycerin nitroprusside norepinephrine ondansetron phenylephrine potassium chloride sodium bicarbonate tobramycin vancomycin vecuronium

metoclopramide hydrochloride

epinephrine esmolol famotidine fluconazole furosemide heparin hydrocortisone hydromorphone hydrochloride imipenem and cilastatin sodium insulin labetalol levofloxacin lorazepam magnesium methylprednisolone


✳ C I ✳ I C C ✳ C C C I ✳ C C C C C I ✳ C C C C C C✳ C C I C C C C C C I C C I I C C I C C I C C I I C C C C C C I C✳C C C C I ✳ I C C C C C C C C✳C C C I I I C C I I C C C C C C C C I C C C ✳ C C C C C C✳ C C C C C C C C I C C C ✳ ✳ I C✳CC I C C C I C C C C C C C C C C C C C C C I C I C I C C ✳ C CC C C C C C C I C C C C I C I C C C C C CC C C C C C C C C C C C I I C C C C C C C C C C C C C C C I C C C C C C✳ C C I C C C C C C C C C C C I C C C C CC C C C I C C C C C C I C C C C ✳ ✳ C C CI C C C C C C C C C I C C C C C C C C C C C CC C C C I ✳✳ C I I C I I C I C ✳ I C C C I C C C C I C C ✳ I C C C C C C C C C C I C C C C C C C C C C C C C C C C C C C

C✳

S6


Conversions and calculations Accurate conversions and calculations are crucial to ensuring safe drug administration. Use the tables below when you need to convert one unit to another, find equivalent measures, convert temperatures between Celsius and Fahrenheit, or calculate dosages or administration rates.

Metric measures Solids 1 milligram (mg) = 1,000 micrograms (mcg) 1 gram (g) = 1,000 mg 1 kilogram (kg) = 1,000 g Liquids 1 milliliter (ml) = 1 cubic centimeter (cc) 1 ml = 1,000 microliters (mcl) 1 cc = 1,000 mcl 1 liter (L) = 1,000 ml 1 L = 1,000 cc

Household to metric equivalents 1 teaspoon (tsp) = 5 ml 1 tablespoon (tbs) = 15 ml 1 ounce (oz) = 30 ml 2 tbs = 30 ml 1 oz = 30 g 1 pound (lb) = 454 g 2.2 lb = 1 kg 1 inch = 2.54 centimeters (cm)

Temperature conversions To convert Celsius (°C) to Fahrenheit (°F) Use the following equation: (°C × 9/5) + 32 = °F Example: 38 °C times 9/5 is 68.4; 68.4 plus 32 equals 100.4 °F. To convert °F to °C (°F– 32) × 5/9 = °C Example: 98.6 °F minus 32 is 66.8.; 66.8 times 5/9 equals 37 °C.

Calculating dosages and administration rates Concentration of solution in mg/ml = Infusion rate in mg/minute =

mg of drug ml of solution

mg of drug × flow rate (ml/hour) ÷ 60 minutes ml of solution

Concentration of solution in mcg/ml =

mg of drug × 1,000 ml of solution

Infusion rate in mcg/minute = mg of drug × 1,000 × flow rate (ml/hour) ÷ 60 minutes ml of solution Infusion rate in mcg/kg/minute = mg of drug × 1,000 × flow rate (ml/hour) ÷ 60 minutes ÷ weight in kg ml of solution Infusion rate in ml/hour = ml of solution ÷ 60 minutes Infusion rate in gtt/minutes =

ml of solution × drip factor (gtt/ml) time in minutes


S7

Drug names that look or sound alike The drug names below can easily be confused, either verbally or in writing, because they either sound alike or have similar spellings. Generic names of these drugs appear in regular type; trade names are capitalized and in boldface. Accupril, Accutane Accutane, Anturane acetazolamide, acetohexamide acetylcholine, acetylcysteine Aciphex, Aricept Adderall, Inderal albuterol, atenolol Aldactazide, Aldactone Aldomet, Aldoril Aldoril, Elavil alfentanil, fentanyl, Sufenta, sufentanil Allegra, Viagra alprazolam, diazepam, lorazepam, midazolam Altace, alteplase Alupent, Atrovent amantadine, rimantadine Ambien, Amen Amicar, Amikin amiloride, amiodarone, amlodipine amitriptyline, nortriptyline amoxicillin, Augmentin Anafranil, enalapril Apresazide, Apresoline ASA, 5-ASA Asacol, Os-Cal Asacol, Os-Cal, Oxytrol Atarax, Ativan atenolol, timolol Avandia, Avandryl Avinza, Invanz azithromycin, erythromycin baclofen, Bactroban Benadryl, Bentyl, Benylin, Betalin bepridil, Prepidil Betagan, BetaGen Bumex, Buprenex bupivacaine, ropivacaine bupropion, buspirone

Calan, Colace calcifediol, calcitriol Capitrol, captopril carboplatin, cisplatin Cardene, Cardizem Cardene, codeine cefazolin, cefprozil cefotaxime, ceftizoxime cefuroximine, deferoxamine Cefzil, Kefzol Celexa, Cerebyx chlorpromazine, chlorpropamide, promethazine ciprofloxacin, ofloxacin Clinoril, Clozaril clofazimine, clonidine, clozapine clomiphene, clomipramine clonazepam, clorazepate clonidine, quinidine clotrimazole, co-trimoxazole codeine, Lodine Coreg, Zomig Cozaar, Zocor cyclobenzaprine, cyproheptadine cycloserine, cyclosporine dacarbazine, procarbazine dactinomycin, daunorubicin danazol, Dantrium Darvon, Diovan daunorubicin, idarubicin Decadron, Percodan desipramine, imipramine Desogen, desonide desoximetasone, dexamethasone Desoxyn, digitoxin, digoxin Diabeta, Zebeta diazepam, Ditropan (continued)

S8


Drug names that look or sound alike (continued) diazoxide, Dyazide dimenhydrinate, diphenhydramine Diprivan, Ditropan dipyridamole, disopyramide dobutamine, dopamine doxapram, doxazosin, doxepin, doxycycline Doxil, Paxil, Plavix dronabinol, droperidol dyclonine, dicyclomine Dynacin, DynaCirc Echogen, Epogen Elavil, Equanil, Mellaril Eldepryl, enalapril Elmiron, Imuran eloxatin, Exelon enalapril, ramipril Entex, Tenex, Xanax ephedrine, epinephrine esmolol, Osmitrol Estraderm, Estratab, Estratest Estraderm, Testoderm ethosuximide, methsuximide etidronate, etretinate Eurax, Urex Evista, E-vista Femara, FemHRT fenoprofen, flurbiprofen fentanyl, sulfentanil Fioricet, Fiorinal Flaxedil, Flexeril Flomax, Fosamax flunisolide, fluocinonide fluoxetine, fluvastatin, fluvoxamine, paroxetine flurazepam, temazepam folic acid, folinic acid Foradil, Toradol fosinopril, lisinopril, Risperdal fosphenytoin, phenytoin furosemide, torsemide glimepiride, glipizide, glyburide Granulex, Regranex guaifenesin, guanfacine Haldol, Stadol

heparin, Hepsera, Hespan Hycodan, Vicodin hydralazine, hydroxyzine hydromorphone, morphine Hyperstat, Nitrostat imipenem, Omnipen imipramine, Norpramin Inderal, Inderide, Isordil Intropin, Isoptin Keflex, Ketek Klonopin, Clonidine Lamasil, Lomotil Lamictal, Lamisil lamivudine, lamotrigine Lanoxin, Lasix, Lonox Levatol, Lipitor Levbid, Lithobid Levitra, Raptiva Librax, Librium Loniten, Lotensin, lovastatin Lorabid, Slo-bid losartan, valsartan Mandol, nadolol Maxidex, Maxzide Mazicon, Mevacor, Mivacron mebendazole, methimazole meclizine, memantine melphalan, Mephyton meperidine, meprobamate Mesantoin, Mestinon metaproterenol, metoprolol methicillin, mezlocillin methotrexate, metolazone metoprolol, misoprostol minoxidil, Monopril mithramycin, mitomycin nadolol, nevivolol naloxone, naltrexone Naprelan, Naprosyn Navane, Nubain nelfinavir, nevirapine Neurontin, Noroxin niacinamide, nicardipine nicardipine, nifedipine, nimodipine Norpace, Norpramin


Ocufen, Ocuflox olanzapine, olsalazine Orinase, Ornade oxaprozin, oxazepam oxycodone, OxyContin paclitaxel, paclitaxel protein-bound particles paclitaxel, paroxetine Panadol, pindolol, Plendil pancuronium, pipecuronium Parlodel, pindolol paroxetine, pralidoxime, pyridoxine pentobarbital, phenobarbital pentosan, pentostatin Percocet, Percodan, Procet Phenaphen, Phenergan phenelzine, Phenylzin phentermine, phentolamine pioglitazone, rosiglitazone Pitocin, Pitressin Pravachol, Prevacid Pravachol, propranolol prednisolone, prednisone, primidone Premarin, Primaxin Prilosec, Prinivil, Proventil Prilosec, Prozac ProAmatine, protamine probenecid, Procanbid promazine, promethazine Proscar, Provera, Prozac protamine, Protopam, Protropin Quarzan, Questran quinidine, quinine ranitidine, rimantadine Relpax, Revex, Revia Reminyl, Robinul reserpine, Risperdal Restoril, Vistaril Retrovir, ritonavir ribavirin, riboflavin rifabutin, rifampin Rifadin, Rifamate, Rifater Rifadin, Ritalin, ritodrine Roxanol, Roxicet Salbutamol, salmeterol saquinavir, Sinequan selegiline, Stelazine

Serentil, Serevent Seroquel, Serzone Solu-Cortef, Solu-Medrol somatropin, sumatriptan Spiriva, Stalevo Sufenta, Survanta sulfasalazine, sulfisoxazole sumatriptan, zolmitriptan Tambocor, tamoxifen Tequin, Ticlid terbinafine, terbutaline, terfenadine terbutaline, tolbutamide terconazole, tioconazole testolactone, testosterone thiamine, Thorazine tiagabine, tizanidine Timoptic, Viroptic Tobradex, Tobrex tolazamide, tolbutamide tolnaftate, Tornalate tramadol, trazodone Trandate, Tridate Trendar, Trental tretinoin, trientine triamcinolone, Triaminicin, Triaminicol triaminic, Triaminicin triamterene, trimipramine trifluoperazine, triflupromazine Ultracef, Ultracet Urised, Urispas valacyclovir, valganciclovir Vancenase, Vanceril Vanceril, Vansil VePesid, Versed verapamil, Verelan Verelan, Virilon vinblastine, vincristine, vindesine, vinorelbine Wellbutrin, Wellcovorin, Wellferon Xanax, Zantac Zantac, Zyrtec Zestril, Zostrix Zocor, Zoloft Zofran, Zosyn Zymar, Zyprexa, Zyrtec

S9

S10


Tall Man letters In 2001, the Office of Generic Drugs requested manufacturers of some look-alike name pairs to voluntarily revise the appearance of their established names in order to minimize medication errors resulting from look-alike confusion. Manufacturers were encouraged to supplement their applications with revised labels and labeling that visually differentiated their established names with the use of "Tall Man" letters. The following is a list of the established names involved and the recommended revisions that highlight dissimilar letters by using upper and lower case for drugs that have similar letters.

Established name

Recommended name

acetazolamide acetohexamide bupropion buspirone chlorpromazine chlorpropamide clomiphene clomipramine cycloserine cyclosporine daunorubicin doxorubicin dimenhydrinate diphenhydramine dobutamine dopamine glipizide glyburide hydralazine hydroxyzine medroxyprogesterone methylprednisolone methyltestosterone mitoxantrone nicardipine nifedipine prednisolone prednisone sulfadiazine sulfisoxazole tolazamide tolbutamide vinblastine vincristine

acetaZOLAMIDE acetaHEXAMIDE buPROPion busPIRone chlorproMAZINE chlorproPAMIDE clomiPHENE clomiPRAMINE cycloSERINE cycloSPORINE DAUNOrubicin DOXOrubicin dimenhyDRINATE diphenhydrAMINE DOBUTamine DOPamine glipiZIDE glyBURIDE hydrALAZINE hydrOXYzine medroxyPROGESTERone methylPREDNISolone methylTESTOSTERone mitoXANTRONE NiCARdipine NIFEdipine prednisoLONE predniSONE sulfADIAZINE sulfiSOXAZOLE TOLAZamide TOLBUTamide vinBLAStine vinCRIStine


S11

Tablets and capsules not to crush Crushing extended-release or other long-acting oral drug forms can cause the ingredients to be released all at once instead of gradually. Similarly, crushing can break the coating of enteric-coated drugs, leading to GI irritation. Other drugs may taste bad or have carcinogenic or teratogenic potential when crushed. Never crush the trade-name drugs listed below. Accutane Aciphex Adalat CC Aggrenox Allegra D Arthrotec Asacol Bayer EC Bellergal-S Biaxin XL Boniva Calan SR Carbatrol Carbiset-TR Cardene SR Cardizem CD, LA, SR Carter’s Little Pills Cartia XT Carvedilol Ceclor CD CellCept Choledyl SA Claritin-D Colace Colestid Compazine Spansules Concerta Cotazym-S Covera-HS Creon Cymbalta Cytovene Deconamine SR Depakene Depakote Desoxyn Gradumets Dexedrine Spansule Diamox Sequels Dilacor XR Dilatrate-SR

Disobrom Ditropan XL Donnatal Extentabs Donnazyme Drixoral Dulcolax DynaCirc CR Easprin Ecotrin Effexor XR Entex LA Erythromycin Base Eskalith CR Factive Fentora Feocyte Feosol Feratab Ferro-Sequel Flomax Glucotrol XL Guaifed Ilotycin Imdur Inderal LA Inderide LA Indocin SR Isoptin SR Isordil Sublingual, Tembids Isosorbide Dinitrate Sublingual Kadian Kaon-Cl K-Dur Klor-Con Klotrix K-Tab Levbid Lexxel Lithobid Lodine XL (continued)

S12


Lodrane LD Macrobid Mestinon Timespans Methylin ER Micro-K Extencaps Monafed MS Contin Naldecon Naprelan Nexium Nia-Bid Niaspan Nicotinic Acid Nitroglyn Nitrong Nitrostat Norflex Norpace CR Novafed A Oramorph SR OxyContin Pancrease MT PCE Pentasa Perdiem Phazyme Phyllocontin Plendil Pneumomist Prelu-2 Prevacid Prilosec Pristiq Pro-Banthine Procardia Proscar Protonix Proventil Repetabs Prozac Quibron-T/SR Quinaglute Dura-Tabs Quinidex Extentabs Respaire SR Respbid Revlimid Reyataz Ritalin-SR Roxanol SR Ru-Tuss Sinemet CR

Slo-bid Gyrocaps Slo-Niacin Slo-Phyllin GG, Gyrocaps Slow FE Slow-K Slow-Mag Sorbitrate SA Sprycel Striant Sudafed 12 Hour Sular Sustaire Tasigna Tavist-D Tegretol-XR Teldrin Ten-K Tenuate Dospan Tessalon Perles Theobid Duracaps Theochron Theoclear LA Theo-Dur Theolair-SR Theo-Sav Theospan-SR Theo-24 Theovent Theo-X Thorazine Spansules Tiazac Toprol XL T-Phyl Tranxene-SD Trental Triaminic Trilafon Repetabs Trinalin Repetabs Tuss-Ornade Spansules Tylenol Extended Relief Ultrase MT Uniphyl Verelan Volmax Voltaren, XR Wellbutrin SR, XL Xanax-XR ZORprin Zyban Zymase


S13

Preventing and treating extravasation Extravasation—escape of a vesicant drug into surrounding tissues—can result from a damaged vein or from leakage around a venipuncture site. Vesicant drugs (such as daunorubicin and vincristine) can cause severe tissue damage if extravasation occurs. To help prevent extravasation, make sure the existing I.V. line is patent before you administer a drug by the I.V. route. Check patency by: ● inspecting the site for edema or pain ● flushing the I.V. line with 0.9% sodium chloride solution ● gently aspirating blood from the catheter. Alternatively, you may insert a new I.V. catheter to ensure correct catheter placement. For vesicant drugs, consider using a central venous catheter. If extravasation occurs, stop the infusion at once. Notify the physician to obtain treatment orders. Administer the antidote as ordered. Aspirate the remaining drug from the catheter before removing the I.V. line (unless you need the catheter to administer an antidote). If the extravasated drug was daunorubicin or doxorubicin, apply a cold compress to the area for 24 to 48 hours; if it was vinblastine or vincristine, apply a warm compress. Then elevate the affected extremity. Administering antidotes Antidotes for extravasation typically are either given through the existing I.V. line or injected subcutaneously around the infiltrated site using a 1-ml tuberculin syringe. Be sure to use a new needle for each antidote injection.

Extravasated drug

Antidote and dosage

aminophylline ● calcium solutions ● contrast media ● dextrose solutions (concentrations of 10% or more) ● etoposide ● nafcillin ● potassium solutions ● teniposide ● total parenteral nutrition solutions ● vinblastine ● vincristine ● vindesine

hyaluronidase: 15 units/ml, as 0.2 ml subcutaneous injection near extravasation site

●

●

dactinomycin

ascorbic acid injection: 50 mg

●

daunorubicin ● doxorubicin

hydrocortisone sodium succinate: 100 mg/ml: 50 to 200 mg

dopamine epinephrine ● metaraminol ● norepinephrine

phentolamine: 5 to 10 mg diluted in 10 to 15 ml of normal saline solution, administered within 12 hours of extravasation

● ●

●

mechlorethamine

sodium thiosulfate 10%: 10 ml

S14


Identifying injection sites Injection sites vary with administration route. The instructions below describe proper identification sites for I.M., subcutaneous, and I.V. drugs. To begin, wash your hands, put on gloves, and locate the appropriate site. Clean the site with an alcohol pad, and administer the injection as described here.

I.M. injections You can administer an I.M. injection into the muscles shown below. In these illustrations, specific injection sites are shaded. Deltoid site ● Locate the lower edge of the acromial process. ● Insert the needle 1" to 2" below the acromial process at a 90-degree angle. Deltoid Acromial process Deltoid muscle Scapula Deep brachial artery Radial nerve Humerus

Ventrogluteal site ● With the palm of your hand, locate the greater trochanter of the femur. ● Spread your index and middle fingers posteriorly from the anterior superior iliac spine to the furthest area possible. This is the correct injection site. ● Remove your fingers and insert the needle at a 90-degree angle. Ventrogluteal Iliac crest Anterior superior iliac spine Gluteus medius

Dorsogluteal site ● Draw an imaginary line from the posterior superior iliac spine to the greater trochanter. ● Insert the needle at a 90-degree angle above and outside the drawn line. ● You can administer a Z-track injection through this site. After drawing up the drug, change the needle, displace the skin lateral to the injection site, withdraw the needle, and then release the skin. Dorsogluteal Posterior superior iliac spine Gluteus medius

Greater trochanter of femur

Vastus lateralis and rectus femoris sites ● Find the lateral quadriceps muscle for the vastus lateralis, or the anterior thigh for the rectus femoris. ● Insert the needle at a 90-degree angle into the middle third of the muscle, parallel to the skin surface. Vastus lateralis and rectus femoris

Gluteus maximus

Greater trochanter of femur Rectus femoris

Greater trochanter of femur Sciatic nerve

Vastus lateralis Quadriceps muscle


S15

Subcutaneous injections Subcutaneous drugs can be injected into the fat pads on the abdomen, buttocks, upper back, and lateral upper arms and thighs (shaded in the illustrations below). If your patient requires frequent subcutaneous injections, make sure to rotate injection sites. ● Gently gather and elevate or spread subcutaneous tissue. ● Insert the needle at a 45- or 90-degree angle, depending on the drug or the amount of subcutaneous tissue at the site. Subcutaneous injection sites

I.V. injections I.V. drugs can be injected into the veins of the arms and hands. The illustration on the right shows commonly used sites. ● Locate the vein using a tourniquet. ● Insert the catheter at a slight angle (about 10 degrees). ● Release the tourniquet when blood appears in the syringe or tubing. ● Slowly inject the drug into the vein.

Illustrator: Kevin A. Somerville

I.V. injection sites

Median cubital vein Basilic vein Cephalic vein

Radial vein

S16


Monitoring blood levels The table below shows therapeutic and toxic blood levels for selected drugs. Keep in mind that such levels may vary slightly among laboratories.

Drug

Therapeutic blood level

Toxic blood level

acetaminophen alprazolam amikacin

10 to 20 mcg/ml 0.025 to 0.102 mcg/ml Peak: 25 to 35 mcg/ml Trough: 5 to 10 mcg/ml 10 to 20 mcg/ml 1 to 2.5 mcg/ml 120 to 250 ng/ml 1 to 5 mcg/ml 0.2 to 0.7 mcg/ml 1 to 2 ng/ml 9 to 10.5 mg/dl 4 to 14 mcg/ml 10 to 80 ng/ml 0.6 to 1.2 mg/dl 50 to 300 ng/ml 115 to 300 ng/ml 0.5 to 2 mcg/ml 0.8 to 2 ng/ml Trough (> 12 hours after dose): Heart failure: 0.8 to 1.5 ng/ml Arrhythmias: 1.5 to 2 ng/ml 0.05 to .40 mcg/ml 10 to 20 mcg/ml 2 to 8 mcg/ml 40 to 100 mcg/ml 0.2 to 1 mcg/ml 5 to 15 mcg/ml 0.09 to 0.40 mcg/ml Peak: 4 to 12 mcg/ml Trough: 1 to 2 mcg/ml 70 to 110 mg/dl 2 to 6 mcg/ml 5 to 20 ng/ml 0.008 to 0.049 mcg/ml

> 150 mcg/ml Not defined > 35 mcg/ml > 10 mcg/ml > 20 mcg/ml > 2.5 mcg/ml > 500 ng/ml > 10 mcg/ml 35 mcg/ml > 2 ng/ml > 12 mg/dl > 15 mcg/ml > 100 ng/ml > 4 mg/dl > 400 ng/ml > 400 ng/ml > 3 mcg/ml Adults: > 2.5 ng/ml Children: > 3 ng/ml

aminophylline amiodarone amitriptyline amobarbital atenolol bepridil calcium carbamazepine clonazepam creatinine cyclosporine desipramine diazepam digoxin

diltiazem diphenylhydantoin disopyramide ethosuximide flecainide fluconazole fluoxetine gentamicin glucose glutethimide haloperidol hydromorphone

3.7 to 6.1 mcg/ml 20 to 50 mcg/ml > 8 mcg/ml > 100 mcg/ml > 1 mcg/ml Not defined Not defined > 12 mcg/ml > 2 mcg/ml > 300 mg/dl > 5 mcg/ml > 20 ng/ml Not defined


S17

Drug

Therapeutic blood level

Toxic blood level

imipramine lidocaine lithium lorazepam magnesium meperidine meprobamate methotrexate methsuximide methylphenidate metoprolol mezlocillin milrinone nifedipine nortriptyline oxazepam paroxetine phenobarbital phenytoin potassium primidone procainamide propranolol quinidine salicylates sertraline sodium streptomycin tacrolimus theophylline tobramycin

225 to 300 ng/ml 1.5 to 6 mcg/ml 0.6 to 1.2 mEq/L 50 to 240 ng/ml 12 to 32 mcg/ml 100 to 550 ng/ml 6 to 12 mcg/ml > 0.01 mcmol 10 to 40 mcg/ml 0.01 to 0.06 mcg/ml 0.03 to 0.27 mcg/ml 35 to 45 mcg/ml 150 to 250 ng/ml 0.025 to 0.1 mcg/ml 50 to 140 ng/ml 0.2 to 1.4 mcg/ml 0.031 to 0.062 mcg/ml 10 to 40 mcg/ml 10 to 20 mcg/ml 3.5 to 5.0 mEq/L 4 to 12 mcg/ml 4 to 8 mcg/ml 50 to 200 ng/ml 2 to 5 mcg/ml 100 to 300 mcg/ml 0.055 to 0.25 mcg/ml 135 to 145 mEq/L 25 mcg/ml 0.005 to 0.02 mcg/ml 10 to 20 mcg/ml Peak: 4 to 12 mcg/ml Trough: 1 to 2 mcg/ml 4 to 10 mcg/ml 50 to 100 mcg/ml Peak: 20 to 40 mcg/ml Trough: 5 to 15 mcg/ml 0.08 to 0.3 mcg/ml 0.003 to 0.018 mcg/ml

> 500 ng/ml > 6 mcg/ml > 1.5 mEq/L 300 to 600 ng/ml 80 to 120 mcg/ml > 1,000 ng/ml > 60 mcg/ml > 10 mcmol/24 hr > 44 mcg/ml 0.8 mcg/ml Not defined > 45 mcg/ml > 250 ng/ml > 0.1 mcg/ml > 300 ng/ml > 2 mcg/ml Not defined > 40 mcg/ml > 20 mcg/ml > 6 mEq/L > 12 mcg/ml > 10 mcg/ml > 200 ng/ml > 5 mcg/ml > 300 mcg/ml Not defined > 160 mEq/L > 25 mcg/ml > 0.03 mcg/ml > 20 mcg/ml > 12 mcg/ml > 2 mcg/ml Not defined > 100 mcg/ml > 40 mcg/ml > 15 mcg/ml Not defined Not defined

tocainide valproic acid vancomycin verapamil zolpidem

S18


Effects of dialysis on drug therapy A patient receiving a drug that’s removed by hemodialysis (HD) or peritoneal dialysis (PD) will need supplemental doses of that drug. The chart below shows which drugs are removed by dialysis and therefore will necessitate supplemental dosing during or after dialysis. Drugs listed as “unlikely” haven’t been studied; however, because of their chemical properties, dialysis is unlikely to remove them. Generic drug acetaminophen acyclovir adenosine albumin alendronate allopurinol alprazolam amikacin amiodarone amitriptyline amlodipine amoxicillin amphotericin B ampicillin ascorbic acid aspirin atenolol atorvastatin aztreonam bleomycin bumetanide bupropion buspirone candesartan captopril carbamazepine carbenicillin carboplatin carisoprodol carmustine cefaclor cefadroxil cefazolin cefepime cefmetazole cefonicid

Removed by HD Yes Yes Unlikely Unlikely No Yes No Yes No No No Yes No Yes Yes Yes Yes No Yes No No No No No Yes No Yes Yes Yes No Yes Yes Yes Yes Yes No

Removed by PD No No Unlikely Unlikely No data No data Unlikely Yes No No No No No No Yes Yes No Unlikely No No Unlikely No No data No data No No No No data Yes No data Yes No No Yes No No

Generic drug cefoperazone cefotaxime cefotetan cefoxitin cefpodoxime ceftazidime ceftriaxone cefuroxime cephalexin chloramphenicol chlorpheniramine cimetidine ciprofloxacin citalopram clindamycin clofibrate clonazepam clonidine codeine colchicine cyclophosphamide cyclosporine dapsone desipramine dexamethasone diazepam diazoxide dicloxacillin digoxin diltiazem diphenhydramine divalproex dobutamine dopamine doxazosin

Removed by HD No Yes Yes Yes Yes Yes No Yes Yes Yes Yes No No No No No No No No No Yes

Removed by PD No No Yes No No Yes No No No No No No No Unlikely No No Unlikely No Unlikely No No data

No Yes No No No Yes No No No Unlikely No No No No

No No data No No Unlikely Yes No No No Unlikely No No Unlikely No


Generic drug doxepin doxycycline drotrecogin alfa edetate calcium enalapril epinephrine epoetin alfa ertapenem erythromycin esmolol estradiol ethacrynic acid etoposide exoxaparin famciclovir famotidine felodipine fenofibrate filgrastim flecainide fluconazole flucytosine fluoxetine folic acid foscarnet furosemide gabapentin ganciclovir gemfibrozil gentamicin glyburide haloperidol heparin hydralazine hydrochlorothiazide hydrocodone hydromorphone hydroxyzine ibuprofen ibutilide imipenem imipramine indomethacin insulin irbesartan

Removed by HD No No Unlikely Yes Yes No data No Yes No Yes No No No No Yes No No No No No Yes Yes No Yes Yes No Yes Yes No Yes No No No No No

Removed by PD No No Unlikely Yes Yes No data No No data No Yes No data Unlikely No Unlikely No data No Unlikely Unlikely Unlikely Unlikely Yes Yes No No data No data Unlikely No data No data No Yes Unlikely No No No Unlikely

No data No data No No No data Yes No No No No

No data No data No Unlikely No data Yes No Unlikely No No data

Generic drug isoniazid isosorbide dinitrate isosorbide mononitrate isradipine itraconazole ketoconazole ketoprofen labetalol lansoprazole levetiracetam levofloxacin lidocaine linezolid lisinopril lithium loracarbef loratadine lorazepam losartan lovastatin loxapine mannitol maprotiline melphalan meperidine mercaptopurine meropenem mesalamine mesna metformin methadone methicillin methotrexate methyldopa methylprednisolone metoclopramide metoprolol metronidazole mexiletine miconazole midazolam minoxidil morphine

S19

Removed by HD No No Yes

Removed by PD No No No

No No No Unlikely No No Yes Unlikely No Yes Yes Yes Yes No No No Unlikely No data Yes No No No Yes Yes Yes No data Yes No No Yes Yes Yes

No Unlikely No Unlikely No Unlikely No data Unlikely Unlikely No data No data Yes No data No Unlikely No Unlikely No data Yes Unlikely No data Unlikely No data No data Unlikely No data No data No No No Yes No data

No Yes Yes Yes No No Yes No data

No No data No No No Unlikely Yes No (continued)

S20


Generic drug nadolol nafcillin nalbuphine naloxone naltrexone naproxen neomycin nicardipine nifedipine nilutamide nimodipine nitrofurantoin nitroglycerin nitroprusside nortriptyline octreotide ofloxacin olanzapine omeprazole ondansetron oxazepam oxycodone paclitaxel pancuronium pantoprazole paricalcitol paroxetine penicillin phenobarbital phenytoin piperacillin pravastatin prazosin prednisone primidone procainamide promethazine propafenone propoxyphene propranolol propylthiouracil pseudoephedrine quinapril quinidine

Removed Removed by HD by PD Yes No data No No No data No data No data No data No data No data No Unlikely Yes yes No Unlikely No No No data No data No No Yes No data No No Yes Yes No No Yes No data Yes No No No Unlikely Unlikely Unlikely Unlikely No Unlikely No data No data No Unlikely No data No data No No data Yes Yes No Unlikely Yes No Yes Yes No No Yes No No No data No No No No Yes No data Yes No No No data No No No No No No No No data No Unlikely No No No; removed No

quinine

No

by hemoperfusion

No

Generic drug ramipril ranitidine reserpine reteplase rifampin risperidone ritodrine ritonavir rosiglitazone rosuvastatin salsalate sertraline simvastatin sotalol stavudine streptomycin sulfamethoxazole sulfisoxazole tamoxifen temazepam terazosin tetracycline theophylline thiamine ticarcillin timolol tirofiban tobramycin torsemide tramadol trimethoprim valacyclovir valproic acid valsartan vancomycin venlafaxine verapamil vinblastine vincristine voriconazole warfarin zalcitabine ziprasidone zolpidem

Removed by HD No No No No data No No data Yes Unlikely No No Yes No Unlikely Yes Yes Yes Yes Yes No data No No No Yes No Yes No Yes Yes No No Yes Yes No No No No No Unlikely Unlikely Yes No No data No No

Removed by PD No data No No No data No No data Yes No Unlikely No data No Unlikely Unlikely No data No data Yes No Yes No data Unlikely No No No Unlikely No No No data Yes Unlikely No data No No No Unlikely No Unlikely No Unlikely Unlikely Unlikely No No data Unlikely Unlikely


S21

Anaphylaxis: Treatment guidelines A hypersensitivity reaction may occur when a patient comes in contact with a certain agent, such as a drug, food, or other foreign protein. In some patients, this reaction progresses to life-threatening anaphylaxis, marked by sudden development of urticaria and respiratory distress. If this reaction continues, it may precipitate vascular collapse, leading to shock and, occasionally, death. Hypersensitivity reaction Adults: Epinephrine 0.2 to 0.5 ml of 1:1,000 solution subcutaneously or intramuscularly; repeat q 10 to 15 minutes to maximum dosage of 1 mg. Children: Epinephrine 10 mcg/kg of 1:1,000 solution subcutaneously or intramuscularly, to maximum of 500 mcg/dose; may repeat q 15 minutes for 2 doses, then q 4 hours p.r.n.

Adults or children: Diphenhydramine 1 to 2 mg/kg I.V.or I.M. Adults: Hydrocortisone 100 mg I.V. initially; then administer as indicated. Children: Hydrocortisone 0.16 to 1 mg/kg I.V. given once or twice daily If poor response, use anaphylaxis algorithm. KEY: CPR: cardiopulmonary resuscitation

Anaphylaxis

Administer CPR if patient loses circulation or breathing; follow Advanced Cardiac Life Support guidelines. If hypotension occurs, give vasopressors (such as dopamine, norepinephrine, or neosynephrine). Provide fluid resuscitation with large volumes of normal saline or lactated Ringer’s solution. Adults and children: If bronchospasm occurs, give 1 to 2 nebulized treatments of inhaled bronchodilator and consider loading dose of 6 mg/kg theophylline I.V., followed by maintenance dose as indicated. Adults: Epinephrine 0.2 to 0.5 ml of 1:1,000 solution subcutaneously or intramuscularly; repeat q 10 to 15 minutes to maximum dosage of 1 mg. Children: Epinephrine 10 mcg/kg of 1:1,000 solution subcutaneously or intramuscularly; to maximum of 500 mcg/dose; may repeat dose q 15 minutes for 2 doses, then q 4 hours as needed If patient doesn’t respond, dilute epinephrine to yield 1:10,000 solution. For adults, infuse at 1 mcg/minute; may titrate to 2 to 10 mcg/minute. For children, infuse at 0.1 mcg/kg/minute.

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Adult cardiac arrest: Treatment guidelines If you suspect your patient is in cardiac arrest, take appropriate steps, as described below. Assess responsiveness. Unresponsive Begin primary survey. Activate emergency response system. Call for defibrillator. Assess breathing (open airway; look, listen, and feel for breathing).

Not breathing Give two breaths. Assess pulse, if pulseless, start chest compressions. Continue CPR for 2 minutes (5 cycles of 30 compressions to 2 breaths). Assess pulse and cardiac rhythm. Attach monitor or defibrillator.

No pulse Initiate CPR (5 cycles of 30 compressions to 2 breaths) for 2 minutes. Assess cardiac rhythm.

VF or VT on monitor Administer CPR until defibrillator charged: give 1 shock (360j for monophasic defibrillator; 200j for biphasic defibrillator). Immediately restart CPR for 2 minutes. After 2 minutes, check cardiac rhythm and pulse; if VF or VT, give 1 shock (360j for monophasic defribrillator or 200 to 300j for biphasic defibrillator). Start CPR immediately after the shock is delivered. Continue CPR for 2 minutes. Assess pulse and cardiac rhythm.

Asystole or PEA on monitor

Administer CPR for 2 minutes. After 2 minutes of CPR, check cardiac rhythm and pulse, then immediately restart CPR if PEA and asystole persist. Always verify asystole in 2 leads.

Conduct secondary ABCD survey Airway: Attempt to insert airway device. Once an advanced airway is in place, give 8 to 10 breaths/minute and continuous chest compressions at 100 per minutes. Breathing: Confirm and secure airway device; provide ventilation and oxygenation. Circulation: Obtain I.V. or I.O. access, administer adrenergic drug; consider antiarrhythmics, buffer agents, and pacing. For asystole or PEA, give epinephrine 1 mg I.V.; repeat every 3 to 5 minutes. Give vasopressin 40 units to replace the first or second dose of epinephrine. For PEA with a rate less than 60/minute, consider atropine 1 mg every 3 to 5 minutes for a total dose of 3 mg. For VF/VT, give epinephrine 1 mg I.V or I.O.; repeat every 3 to 5 minutes. May use vasopressin 40 units to replace the first or second dose of epinephrine. Differential diagnosis: Search for and treat reversible causes. KEY ABCD: airway, breathing, circulation, CPR: cardiopulmonary resuscitation VF: ventricular fibrillation VT: ventricular tachycardia differential diagnosis I.O.: intraosseous PEA: pulseless electrical activity


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Pediatric cardiac arrest: Treatment guidelines For a pediatric patient in suspected cardiac arrest, take the following steps.

Assess responsiveness.

Unresponsive Begin primary survey. Activate emergency response system. Attach monitor/defibrillator as soon as available. Assess breathing (open airway; look, listen, and feel for breathing).

Not breathing Give two breaths that make the chest rise. Assess pulse. Start chest compressions (5 cycles of 30 compressions to 2 breaths) if patient is pulseless.

No pulse Continue CPR. Assess heart rhythm.

VF or VT on monitor Attempt defibrillation Deliver 1 shock at 2 J/kg. Resume CPR immediately for 2 minutes. After 2 minutes, if VF or pulseless VT continues, deliver 1 shock at 4 J/kg. Give epinephrine I.V. or I.O. at 0.01 mg/kg. Resume CPR immediately for 2 minutes. After 2 minutes, if VF or pulseless VT continues. Deliver 1 shock at 4 J/kg.

Asystole or PEA on monitor Give epinephrine 0.01 mg/kg I.V. or I.O. Continue CPR for 2 minutes then reassess; pulse and cardiac rythm. Always verify asystole in 2 leads.

Conduct secondary ABCD survey Airway: Attempt to insert airway device. Breathing: Confirm and secure airway device; ventilate and oxygenate. Circulation: Obtain I.V. access; defibrillate and give drugs as appropriate. *For VF/VT, give epinephrine 0.01 mg/kg (0.1 ml/kg of 1:10,000 solution) I.V. or I.O.; repeat q 3 to 5 minutes; then consider amiodarone or lidocaine. For asystole, give epinephrine 0.01 mg/kg (0.1 ml/kg of 1:10,000 solution) I.V. or I.O.; repeat q 3 to 5 minutes. Differential diagnosis: Search for and treat reversible causes, including hypoxemia, hypovolemia, metabolic disorders, and thromboembolism.

KEY ABDC: airway, breathing, circulation, differential diagnosis CPR: cardiopulmonary resuscitation

I.O.: intraosseus J: joules PEA: pulseless electrical activity

VF: ventricular fibrillation VT: ventricular tachycardia

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Acute coronary syndrome: Treatment guidelines Chest pain suggestive of ischemia Immediate assessment (within 10 minutes): ● Measure vital signs and oxygen saturation. ● Obtain I.V. access, 12-lead ECG, and initial serum cardiac marker levels. ● Perform brief history and physical exam; review/complete fibrinolytic eligibility and contraindications. ● Obtain initial electrolyte and coagulation studies and cardiac marker levels. ● Request and review portable chest x-ray within 30 minutes. Assess initial 12-lead ECG. ST elevation or new LBBB (strongly suggests injury) ● ST-elevation AMI

●

Start adjunctive treatments (as indicated; do not delay reperfusion therapy) ● Beta-adrenergic blockers I.V. ● Nitroglycerin I.V., heparin I.V. ● Clopidogrel, GPIIb/IIIa inhibitors, heparin (UFH or LMWH) Time from symptom onset?

> 12 hours

< 12 hours Choose reperfusion strategy based on local resources. ● Angiography ● PCI (angioplasty +/- stent)

Fibrinolytic therapy chosen: ● alteplase or ● reteplase or ● tenecteplase Goal: Door-to-drug within 30 minutes KEY ACE: angiotensin-converting enzyme AMI: acute myocardial infarction

If signs of cardiogenic shock, PCI is treatment of choice. ● If PCI not available, use fibrinolytics (if no contraindications). ●

Primary PCI chosen: ● Door-to-balloon inflation within 90 minutes ● Experienced operators ● High-volume medical center ● Cardiac surgical capability APSAC: anisoylated plasminogen streptokinase activator complex LBBB: left bundle-branch block PCI: percutaneous coronary intervention


Immediate general treatment: Oxygen at 4 L/minute ● Aspirin 160 to 325 mg (may be given by EMS). ● Nitroglycerin S.L. or by spray or I.V. ● Morphine I.V. (if nitroglycerin does not relieve pain). Use MONA as memory aid: Morphine, Oxygen, Nitroglycerin, Aspirin. ●

ST depression or dynamic T-wave inversion (strongly suggests ischemia) ● High-risk unstable angina/non-STelevation AMI ●

Start adjunctive treatments (as indicated, no contraindications): ● Heparin (UFH or LMWH) ● Clopidogrel ● Glycoprotein IIb/IIIa inhibitors ● Nitroglycerin I.V. ● Beta-adrenergic receptor blockers

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EMS personnel can perform immediate assessment and treatment, including 12-lead ECG and review for fibrinolytic eligibility and administering aspirin, nitroglycerin and morphine.

● Non-diagnostic ECG: no ST segment or T-wave changes ● Intermediate- or low-risk unstable angina

Meets criteria for unstable or new-onset angina? Or troponin positive?

Yes

No

Assess clinical status. High-risk patient, defined by: ● persistent symptoms ● recurrent ischemia ● depressed left ventricular function ● widespread ECG changes ● previous AMI, PCI, or CABG. Perform cardiac catheterization. Anatomy suitable for revascularization? Yes Revascularization: ● PCI ● CABG

Admit to monitored bed. ● Obtain serial serum markers (including troponin). ● Repeat ECG/continuous ST monitoring . ● Consider imaging study.

Clinically stable? No

Yes

Admit to critical care unit. ● Continue or start treatment. ● Obtain serial cardiac markers and ECG. ● Consider imaging study.

Evidence of ischemia or infarction? No Discharge acceptable ● Arrange follow-up

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Stroke: Treatment guidelines This algorithm for the treatment of cerebrovascular accident (stroke) or suspected stroke is based on the one created by the American Heart Association. Suspected stroke Within 10 minutes of ED arrival, conduct immediate general assessment and stabilization: ● Assess ABCs and vital signs. ● Give oxygen if hypoxemic. ● Obtain I.V. access; draw blood. ● Check blood glucose level; treat accordingly. ● Obtain 12-lead ECG. ● Perform neurocheck. ● Alert stroke team. ● Obtain emergency non-contrast CT of the head.

Within 25 minutes of ED arrival, conduct immediate neurological assessment by stroke team or designee: ● Review patient history. ● Establish symptom onset. ● Perform neurological examination (NIH Stroke Scale or Canadian Neurological Scale).

Within 45 minutes of ED arrival, review/read/evaluate CT—Does CT show evidence of hemorrhage? Yes

No Probable ischemic stroke; consider fibrinolytic therapy ● CT scan exclusions? ● Improving neurologic deficits? ● Fibrinolytic exclusions? ● Symptom onset < 3 hours? No to above

Patient is candidate for fibrinolytic therapy?

Consult neurosurgery. Consider transfer if neurosurgery not available. Treat for acute hemorrhage per neurosurgery protocols or plan of care ● Reverse anticoagulants and bleeding disorder. ● Monitor neurologic status. ● Treat hypertension if patient is conscious.

No

Yes Within 60 minutes of ED arrival: ● Obtain informed consent and review risks and benefits with patient and family ● Begin fibrinolytic therapy. ● Monitor neurologic status; obtain CT scan if condition deteriorates. ● Monitor BP; treat as indicated. ● Admit to CCU or stroke unit. ● Withhold anticoagulants and antiplatelet drugs for 24 hours.

Initiate stroke care per facility protocols

Blood on LP If high suspicion of SAH despite negative CT, perform LP. No blood on LP

Initiate ongoing therapies. ABCs: airway, breathing, and circulation BP: blood pressure CCU: critical care unit CT: computed tomography

ECG: electrocardiogram ED: emergency department LP: lumbar puncture SAH: subarachnoid hemorrhage


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Guidelines for handling, preparing, and administering hazardous drugs Healthcare professionals who work with or near hazardous drugs may be exposed to these agents in the air; on work surfaces, clothing, or medical equipment; or through contact with patient urine or feces. Hazardous drugs include many cancer chemotherapy agents, antivirals, hormones, and certain miscellaneous drugs. (Follow these hazardous drug guidelines for handling, preparation, and administration of all drugs with the special “hazardous drug” icon [ ] at the top of the monograph.) The safety of healthcare workers who handle hazardous drugs is an ongoing concern. More than 5 million healthcare workers, including nurses, pharmacists, and physicians, are thought to be at risk. The greatest exposure occurs during preparation, administration, and disposal of these agents. In 2004, the National Institute for Occupational Safety and Health (NIOSH) issued an alert to inform workers of the possible risks of hazardous drugs. The alert included the following: Warning! Working with or near hazardous drugs in healthcare settings may cause skin rashes, infertility, miscarriage, birth defects, and possibly leukemia or other cancers. In 2006, the American Society of Health-System Pharmacists (ASHP) published revised guidelines on handling hazardous drugs. The following guidelines reflect the latest recommendations of ASHP, NIOSH, and the Centers for Disease Control and Prevention.

General preparation Read all material safety data sheets for each hazardous drug you handle. ● Prepare hazardous drugs in a controlled area designated for that purpose alone and restricted to authorized ●

personnel. Identify these areas clearly with warning signs. ● Prepare hazardous drugs inside a ventilated cabinet with negative air pressure, to avoid spread of airborne drug contaminants and protect drugs that require sterile handling. ● Always work below eye level, within easy reach of a spill kit and a hazardous drug waste container. ● Wash hands with soap and water immediately before and after preparation. ● Use stringent sterile technique during any procedure in which sterile dosage forms are manipulated with needles and syringes. ● Whenever possible, use luer-lock syringes, I.V. administration sets, and connections, as these are less likely to separate during preparation. ● When supplemental protection is needed, use closed-system drugtransfer devices, glove bags, and needleless systems inside the ventilated cabinet. ● Know that hazardous drugs must be clearly labeled. Preparation and cleaning areas also need to be identified with warning signs or labels that are clear to non-English readers.

Personal protective equipment Always wear personal protective equipment (PPE) during any activity involving hazardous drugs, including:

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reconstituting or admixing these drugs handling vials or finished products ● opening drug packaging ● assembling the delivery system ● administering these drugs ● labeling hazardous containers ● disposing of drug-related waste ● handling excretions from patients who have received hazardous drugs. ● ●

Gloves ● Wear two pairs of powder-free gloves. Make sure the inner pair is beneath the cuff of your gown and the outer pair covers the outside cuff. ● Before donning gloves, inspect them for defects. ● Remove the outer gloves after wiping down the final drug preparation but before labeling or removing it from the designated area. Place these gloves in a containment bag. ● Use clean gloves (the inner pair) to wipe the surface of the container, put the label on the final preparation, and place the drug container into the passthrough. ● Don fresh gloves to complete the final check and place the container for transport. ● Change gloves every 30 minutes during compounding, or immediately if damaged or contaminated. Gown Wear a disposable, nonabsorbent gown made of polypropylene material with a closed front, long sleeves, and elastic cuffs. Face and eye shield Wear a face or eye shield (as appropriate) if splashes, sprays, or aerosolizations to the eyes, nose, or mouth are possible during drug handling or administration. Proper sequence for donning PPE After washing your hands, don the first pair of gloves, then the gown and face shield (as appropriate), and then the second pair of gloves (which should extend beyond the cuff of your gown).

Dose reconstitution Avoid pressurizing vial contents, as this may cause the drug to spray out around or through the needle. To avoid pressurization, draw air into the syringe to create negative pressure in the vial. ● Transfer small amounts of diluent slowly as equal volumes of air are removed. ● Keeping the needle in the vial, swirl contents slowly until they dissolve. ● Make sure the syringe is no more than three-quarters full when it holds the final drug dosage. ●

Dose withdrawal and transfer Keeping the vial inverted, withdraw only the proper amount of drug solution. ● Remove the needle with the vial upright, making sure the needle hub is clear. ● To withdraw a dose from an ampule, gently tap the neck of the ampule. Then wipe the neck with alcohol and attach a 5-micron filter needle to a syringe. Draw the solution through the needle, clearing it from the needle and hub. ● If the drug will be dispensed in the syringe, draw back the plunger to clear fluid from the needle and hub. Replace the needle with a locking cap, and then wipe and lock the syringe. ● When using a needleless system, use gauze pads at connection points to contain leaks. ● If the drug will be transferred to an I.V. bag or bottle, prime the I.V. set before adding the drug. Puncture only the septum of the injection port. After injecting the drug solution into the bag, wipe the port, container, and I.V. set (if attached). ● Once drug preparation is complete, seal the final product in a plastic bag or other sealable container for transport (continued) ●


before taking it out of the ventilated cabinet; then label it with a unique identifier. Seal and wipe all waste containers inside the ventilated cabinet before removal. Finally, remove your outer gloves and sleeve covers (if used) and bag them while still inside the ventilated cabinet.

Administration Wash your hands and don gloves and gown. If spraying, splashing, or aerosolization is anticipated, wear a face shield or goggles. ● Visually examine the drug dose while it’s still in the transport bag. If it appears intact, remove it from the bag. ● Place an absorbent pad on the work or administration area to contain spills or contamination. ●

Oral (noninjectable or nonparenteral) administration ● Oral hazardous drugs should be dispensed in the final dosage and form whenever possible. ● Avoid crushing tablets or opening capsules; instead, use liquid forms whenever possible. ● Never crush or compound an oral drug in an unprotected environment. ● Be aware that liquid hazardous drugs should be dispensed and maintained in sealable plastic bags. I.M. or subcutaneous administration ● Remove the syringe cap and connect the appropriate safety needle. ● Don’t expel air from the syringe or prime the safety needle. ● After administering the dose, discard the syringe (with safety needle attached) directly into an appropriate waste container. I.V. administration ● If priming is necessary at the administration site, prime the I.V. tubing with an I.V. solution that doesn’t contain a hazardous drug, or by using the backflow method.

S29

Place gauze pads under the connections at injection ports to catch leaks during administration. ● Use the transport bag as a containment bag for contaminated materials. Discard hazardous drug bags and bottles with their administration sets attached. ●

Disposal and clean-up Handle hazardous wastes and contaminated materials separately from other trash. ● Wash surfaces contaminated with hazardous drugs with detergent, hypochlorite solution, and neutralizer, as appropriate. ● Clean and decontaminate work areas before and after each hazardous drughandling activity and at the end of each shift. Clean up small spills immediately. ● Dispose of drug-contaminated syringes and needles in puncture-proof containers labeled “Chemotherapy waste” or “Hazardous waste.” ● Never push or force materials contaminated with hazardous drugs into waste containers. ●

After exposure to a hazardous drug In case of skin contact with a cytotoxic drug, immediately remove contaminated clothing and wash the affected area with soap and water. Don’t scrub, because this will abrade the skin. Rinse the area thoroughly, and consult a physician for further treatment and monitoring. ● In case of eye contact, flush the affected eye with water or normal saline solution continuously for 15 minutes. Consult a physician for further treatment and monitoring. ● Document the exposure incident in your employee record and your facility’s medical surveillance log. ●

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Managing poisonings and overdoses This chart serves as a quick reference for managing poisonings and drug overdoses. For more detailed instructions, consult your local poison control center. To find your local center, call the American Association of Poison Control Centers at 1-800-222-1222 or visit http://www.aapcc.org/findyour.htm.

Poison or drug

Antidote and dosage

acetaminophen

acetylcysteine (Acetadote, Mucomyst) Give P.O. as 5% solution by diluting with carbonated beverage or fruit juice. Loading dose: 140 mg/kg followed by 17 additional doses of 70 mg/kg q 4 hours. Repeat dose if patient vomits within 1 hour of administration. I.V. dose: 150 mg/kg over 15 minutes. Maintenance dose: 50 mg/kg infused over 4 hours, followed by 100 mg/kg infused over 16 hours.

anticholinergic agents antihistamines atropine

physostigmine (Antilirium) Adults: 0.5 to 2 mg slow I.V. injection (not to exceed 1 mg/minute). May repeat q 20 minutes until response or adverse effects occur. If initial dose is effective, additional doses of 1 to 4 mg may be given q 30 to 60 minutes as life-threatening signs (arrythmias, seizures, deep coma) recur. Children: 0.02 mg/kg I.M. or slow I.V. injection (not to exceed 0.5 mg/minute). May repeat q 5 to 10 minutes until therapeutic response occurs or maximum dosage of 2 mg is given.

arsenic trioxide

dimercaprol (BAL) Adults: 3 mg/kg I.M. q 4 hours until immediate life-threatening toxicity has subsided. Thereafter, give penicillamine 250 mg P.O. up to maximum frequency of four times daily (maximum: 1 g/day).

benzodiazepines

flumazenil (Romazicon) Adults: Initially, 0.2 mg I.V. injected over 30 seconds; follow with 0.3 mg if desired level of consciousness isn’t reached. May give further doses of 0.5 mg at 60-second intervals until therapeutic response occurs or cumulative dosage of 3 mg is given. If partial response is achieved at 3 mg, patients may rarely need additional doses up to a total of 5 mg. If sedation recurs, repeat dose at 20-minute intervals. Maximum dosage is 3 mg/hour. Children: Initially 0.01 mg/kg (maximum dosage 0.2 mg) with repeat doses of 0.01 mg/kg (maximum dosage 0.2 mg) given q minute to maximum cumulative dosage of 1 mg.

calcium channel blockers

activated charcoal Consider prehospital administration of activated charcoal as a slurry in patient with potentially toxic ingestion who is awake and able to protect airway. Use minimum of 240 ml water/30 g charcoal. Adults and adolescents: Usual dosage, 25 to 100 g P.O. Children ages 1 to 12: 25 to 50 g P.O. (or 0.5 to 1 g/kg) Children < age 1: 0.5 to 1 g/kg P.O.


Poison or drug

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Antidote and dosage calcium chloride Adults: If massive overdose occurs with hypotension remaining unresponsive to supportive measures, administer vasopressors (such as phenylephrine) as prescribed. Calcium gluconate 2 g/hour I.V titrated to maintain blood pressure has been used successfully.

cholinergic agonists

activated charcoal Administer charcoal as a slurry (240 ml water/30 g charcoal). Adults and adolescents: Usual dosage, 25 to 100 g P.O. Children ages 1 to 12: 25 to 50 g P.O. Children < age 1: 1 g/kg P.O. atropine sulfate Atropine is the drug of choice for significant muscarinic symptoms. Adults: 2 to 4 mg I.V., repeated q 3 to 60 minutes as needed to control symptoms, then p.r.n. for 24 to 48 hours Children: 0.04 to 0.08 mg/kg I.V. (up to 4 mg), repeated q 5 to 60 minutes as needed epinephrine Epinephrine may help overcome severe cardiovascular or bronchoconstrictor responses. Adults: 0.1 to 1 mg subcutaneously

digoxin

digoxin immune Fab (Digibind, DigiFab) Calculate dosage as number of 38-mg vials, using this formula: Digoxin level (in ng) × patient’s weight (in kg) divided by 100. Usual dosage range is four to six vials. If ingested amount of digoxin is unknown, give 10 to 20 vials (380 to 800 mg) I.V. over 30 minutes through a 0.22-micron filter. May give bolus dose if cardiac arrest is imminent.

ethylene glycol

fomepizole (Antizol) Loading dose: 15 mg/kg I.V. over 30 minutes, followed by 10 mg/kg I.V. over 30 minutes q 12 hours for four doses Maintenance dose: 15 mg/kg I.V. over 30 minutes q 12 hours until ethylene glycol level falls below 20 mg/dl

heparin

protamine sulfate Dosage is based on partial thromboplastin time; usually, 1 mg for each 100 units of heparin. Give I.V. over 10 minutes (maximum rate of 5 mg/minute) in doses not exceeding 50 mg. Patients allergic to fish, vasectomized or infertile men, and patients taking protamine-insulin products are at increased risk for protamine hypersensitivity.

hypercalcemic emergency

edetate disodium (Endrate) Adults: 50 mg/kg/day by slow I.V. infusion over at least 3 hours, up to a maximum of 3 g/day. Children: 40 mg/kg/day by slow I.V. infusion over at least 3 hours, up to a maximum of 70 mg/kg/day. Dilute with normal saline solution or dextrose 5% in water; don’t infuse rapidly. Keep patient in bed for 15 minutes after infusion to avoid orthostatic hypotension. Keep I.V. calcium readily available, because drug may cause profound hypocalcemia, leading to tetany, seizures, arrhythmias, and respiratory arrest. Alternate I.V. sites daily to decrease risk of thrombophlebitis. Alert: Do not confuse drug with edetate calcium disodium, used as lead poisoning antidote. (continued)

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Managing poisonings and overdoses (continued) Poison or drug

Antidote and dosage

iron

deferoxamine (Desferal) Acute iron intoxication: Initially, 1 g I.M., followed by 500 mg q 4 hours for two doses depending on clinical response, and then 500 mg q 4 to 12 hours, up to 6 g/day. May give I.V. infusion of 10 to 15 mg/kg/hour for first 1 g. Subsequent doses shouldn’t exceed 125 mg/hour. Maximum dosage is 6 g in 24 hours. Chronic iron intoxication: In adults, 1 to 2 g/day subcutaneously. In children, maximum dosage of 2 g/day subcutaneously.

opioid overdose and dependence

naloxone hydrochloride (Narcan) Opioid overdose Adults: 0.4 to 2 mg I.V., I.M., or subcutaneously; repeat q 2 to 3 minutes, p.r.n., up to 10 mg If ordered, give initial adult dose of 0.1 mg I.V. to assess patient’s response. Give subsequent doses of 0.4 mg or less (undiluted) by direct injection over 15 seconds, or titrate based on response. As needed, give continuous I.V. infusion, diluting 2 mg of naloxone with 500 ml of normal saline solution or dextrose 5% in water for a final concentration of 4 mcg/ml; titrate based on patient’s response. Children > age 5 or * 20 kg: 2 mg/dose; repeat q 2 to 3 minutes. Children < age 5 or < 20 kg: 0.1 mg/kg; repeat q 2 to 3 minutes. Postoperative opioid-induced respiratory depression Adults: 0.1 to 0.2 mg I.V. q 2 to 3 minutes, p.r.n. Children: 0.005 to 0.01 mg/kg q 2 to 3 minutes. Opioid dependence naltrexone (Depade, ReVia) Adults: Initially, 25 mg P.O.; give an additional dose of 25 mg if no withdrawal symptoms occur within 1 hour. When patient is receiving 50 mg q 24 hours, a maintenance schedule of 50 to 150 mg/day P.O. may be used. Don’t initiate therapy until patient has been opiate-free for 7 to 10 days; do not begin for opioid dependence until a naloxone challenge test has been given. Alert: Do not confuse naltrexone with naloxone.

organophosphate insecticides

pralidoxime (Protopam) Adults: 1 to 2 g I.V. in 100 ml of normal saline solution infused over 15 to 30 minutes. If pulmonary edema occurs, may give as 5% solution I.V. over 5 minutes. May repeat dose in 1 hour if muscle weakness persists; may give additional doses at 10- to 12-hour intervals cautiously if muscle weakness continues. Children: 20 to 50 mg/kg (up to 1 g) in 250 ml normal saline solution I.V. over 30 minutes

warfarin

phytonadione (Vitamin K) Adults: 2.5 to 10 mg subcutaneously. based on prothrombin time/ International Normalized Ratio; may repeat in 6 to 8 hours as needed. In emergency, 2.5 to 25 mg slow I.V. (no faster than 1 mg/minute); may repeat 6 to 8 hours after first dose.

miscellaneous drug overdose

activated charcoal Adults: 1 to 2 g/kg with at least a 10:1 ratio of activated charcoal to intoxicant (usual dose is 25 to 100 g charcoal in water or sorbitol) and administered P.O. or by nasogastric tube. Do not give doses greater than 100 g. Children: 1 to 2 g/kg or 25 to 50 g charcoal. The use of repeated oral charcoal with sorbitol doses is not recommended.

2010 Nursing Spectrum Drug Handbook Photogallery of common tablets and capsules This special section helps you identify unlabeled drugs that patients bring from home. It can also serve as a visual aid for patients who can’t recall the names of the drugs they’re taking. (Note: For more help in identifying medications, see the drug imprint codes at www.nursesdrughandbook.com.) Drugs are shown alphabetically by generic name; corresponding trade names also appear. Dosage forms appear in increasing order of strength. alendronate sodium

Fosamax 5 mg

alprazolam

Xanax 0.25 mg

10 mg

35 mg

70 mg

0.5 mg

1 mg

5 mg

10 mg

5 mg/10 mg

5 mg/20 mg

10 mg/20 mg

10 mg/40 mg

250 mg

500 mg

2 mg

amlodipine besylate

Norvasc 2.5 mg

amlodipine besylate and benazepril hydrochloride

Lotrel 2.5 mg/10 mg

5 mg/40 mg

amoxicillin trihydrate

Amoxil 125 mg

875 mg

P1

P2


amoxicillin trihydrate

Amoxil (continued) 250 mg

500 mg

amoxicillin and clavulanate potassium

Augmentin 200 mg/28.5 mg

400 mg/57 mg

250 mg/125 mg

875/125 mg

1,000 mg/62.5 mg

7.5 mg

10 mg

15 mg

20 mg

Adderall XR 5 mg

10 mg

15 mg

20 mg

25 mg

500 mg/125 mg

amphetamine sulfate combination

Adderall 5 mg

12.5 mg

amphetamine sulfate combination

aripiprazole

Abilify 2 mg

5 mg

10 mg

15 mg

20 mg

30 mg


atomoxetine hydrochloride

atorvastatin calcium

Strattera 10 mg

18 mg

40 mg

60 mg

Lipitor 10 mg

20 mg

25 mg

40 mg

80 mg

azithromycin

Zithromax 250 mg

500 mg

benazepril hydrochloride

Lotensin 5 mg

bupropion hydrochloride

Wellbutrin 75 mg

100 mg

bupropion hydrochloride

Wellbutrin SR 100 mg

150 mg

carvedilol

Coreg 3.125 mg

10 mg

6.25 mg

20 mg

40 mg

200 mg

12.5 mg

25 mg

P3

P4


cefprozil

Cefzil 250 mg

500 mg

celecoxib

Celebrex 100 mg

200 mg

cephalexin monohydrate

Keflex 250 mg

500 mg

ciprofloxacin hydrochloride

Cipro 100 mg

250 mg

400 mg

500 mg

750 mg

citalopram hydrobromide

Celexa 10 mg

20 mg

clarithromycin

Biaxin 250 mg

500 mg

clarithromycin

Biaxin XL 500 mg

clopidogrel bisulfate

Plavix 75 mg

40 mg


codeine/ acetaminophen

Acetaminophen with Codeine 325 mg/15 mg 325 mg/30 mg

desloratadine

Clarinex 5 mg

digoxin

Lanoxin 0.125 mg

0.25 mg

Tiazac 120 mg

180 mg

240 mg

300 mg

360 mg

420 mg

Depakote 125 mg

250 mg

500 mg

diltiazem hydrochloride

divalproex sodium

325 mg/60 mg

125 mg

divalproex sodium

escitalopram oxalate

Depakote ER 250 mg

500 mg

Lexapro 5 mg

10 mg

20 mg

P5

P6


esomeprazole magnesium

Nexium 20 mg

40 mg

estrogens, conjugated

Premarin 0.3 mg

0.45 mg

0.9 mg

1.25 mg

ezetimibe

0.625 mg

Zetia 10 mg

fenofibrate

Tricor 48 mg

145 mg

fexofenadine hydrochloride

Allegra 30 mg

60 mg

180 mg

fexofenadine hydrochloride and pseudoephedrine hydrochloride

Allegra-D

fluconazole

Diflucan 50 mg

100 mg

150 mg

200 mg


fluoxetine hydrochloride

Prozac 10 mg

20 mg

40 mg

20 mg

40 mg

20 mg

40 mg

80 mg

Neurontin 100 mg

300 mg

400 mg

600 mg

800 mg

90 mg

fosinopril sodium

furosemide

gabapentin

glimepiride

glipizide

glipizide

Monopril 10 mg

Lasix

Amaryl 1 mg

2 mg

Glucotrol 5 mg

10 mg

Glucotrol XL 2.5 mg

5 mg

4 mg

10 mg

P7

P8


glyburide and metformin hydrochloride

Glucovance 1.25 mg/250 mg

2.5 mg/500 mg

5 mg/500 mg

hydrocodone bitartrate and acetaminophen

Lortab 2.5 mg/500 mg

5 mg/500 mg

7.5 mg/500 mg

Motrin 400 mg

600 mg

800 mg

Avapro 75 mg

150 mg

300 mg

Prevacid 15 mg

30 mg

Levaquin 250 mg

500 mg

750 mg

Levoxyl 25 mcg

50 mcg

75 mcg

88 mcg

100 mcg

112 mcg

125 mcg

137 mcg

150 mcg

175 mcg

200 mcg

10 mg/500 mg

ibuprofen

irbesartan

lansoprazole

levofloxacin

levothyroxine sodium


Synthroid 25 mcg

50 mcg

75 mcg

88 mcg

100 mcg

112 mcg

125 mcg

137 mcg

150 mcg

175 mcg

200 mcg

300 mcg

Prinivil 2.5 mg

5 mg

10 mg

20 mg

40 mg

Zestril 2.5 mg

5 mg

10 mg

20 mg

30 mg

40 mg

20 mg/12.5 mg

20 mg/25 mg

Ativan 0.5 mg

1 mg

2 mg

losartan potassium Cozaar 25 mg

50 mg

100 mg

levothyroxine sodium

lisinopril

lisinopril

lisinopril and Zestoretic hydrochlorothiazide 10 mg/12.5 mg

lorazepam

P9

P10


losartan potassium Hyzaar and 50 mg/12.5 mg hydrochlorothiazide

100 mg/25 mg

memantine hydrochloride

Namenda 5 mg

10 mg

metformin hydrochloride

Glucophage 500 mg

850 mg

metformin hydrochloride

Glucophage XR 500 mg

750 mg

methylphenidate hydrochloride

Concerta 18 mg

27 mg

36 mg

50 mg

100 mg

5 mg

10 mg

1,000 mg

54 mg

metoprolol succinate

Toprol-XL 25 mg

200 mg

montelukast sodium

Singulair 4 mg


nitrofurantoin macrocrystals

Macrodantin 25 mg

nitrofurantoin monohydrate

Macrobid 100 mg

olanzapine

50 mg

100 mg

Zyprexa 2.5 mg

5 mg

7.5 mg

10 mg

15 mg

20 mg

olmesartan medoxomil

Benicar 5 mg

20 mg

40 mg

omeprazole

Prilosec 10 mg

20 mg

40 mg

Trileptal 150 mg

300 mg

600 mg

Ditropan XL 5 mg

10 mg

15 mg

oxcarbazepine

oxybutynin chloride

oxycodone hydrochloride pantoprazole sodium

OxyContin 10 mg

Protonix 40 mg

20 mg

40 mg

80 mg

P11

P12


paroxetine hydrochloride

Paxil 10 mg

paroxetine hydrochloride

Paxil CR 12.5 mg

25 mg

penicillin V potassium

Penicillin 250 mg

500 mg

phenytoin sodium (extended)

Dilantin 30 mg

100 mg

pioglitazone hydrochloride

Actos 15 mg

30 mg

45 mg

pravastatin sodium

Pravachol 10 mg

20 mg

40 mg

20 mg

30 mg

40 mg

37.5 mg

80 mg

propoxyphene napsylate and acetaminophen

Darvocet-N 50 50 mg

Darvocet-N 100 100 mg

quetiapine fumarate

Seroquel 25 mg

50 mg

100 mg

200 mg

300 mg

400 mg


quinapril hydrochloride

Accupril 5 mg

10 mg

20 mg

2.5 mg

5 mg

40 mg

rabeprazole sodium

Aciphex 20 mg

raloxifene hydrochloride

Evista

ramipril

Altace 1.25 mg

60 mg

10 mg

risedronate sodium

Actonel 5 mg

30 mg

35 mg

risperidone

Risperdal 0.25 mg

0.5 mg

1 mg

2 mg

3 mg

4 mg

Avandia 2 mg

4 mg

8 mg

rosiglitazone maleate

P13

P14


rosuvastatin calcium

Crestor 5 mg

10 mg

20 mg

25 mg

50 mg

100 mg

25 mg

50 mg

100 mg

5 mg

10 mg

20 mg

40 mg

80 mg

sumatriptan succinate

Imitrex 25 mg

50 mg

100 mg

tadalafil

Cialis 10 mg

20 mg

40 mg

sertraline hydrochloride

Zoloft

sildenafil citrate

Viagra

simvastatin

Zocor

5 mg

tamsulosin hydrochloride

Flomax 0.4 mg


tolterodine

tolterodine

topiramate

topiramate

P15

Detrol 1 mg

2 mg

Detrol LA 2 mg

4 mg

Topamax 25 mg

Topamax Sprinkle 15 mg

tramadol hydrochloride

Ultram 50 mg

tramadol hydrochloride

Ultram (ER) 100 mg

tramadol hydrochloride and acetaminophen

Ultracet 37.5 mg/325 mg

valacyclovir hydrochloride

Valtrex 500 mg

50 mg

100 mg

200 mg

25 mg

200 mg

1,000 mg

300 mg

P16


valsartan

Diovan 80 mg

valsartan and Diovan HCT hydrochlorothiazide 80 mg/12.5 mg

320 mg/12.5 mg

160 mg

320 mg

160 mg/12.5 mg

160 mg/25 mg

320 mg/25 mg

vardenafil hydrochloride

Levitra 2.5 mg

venlafaxine hydrochloride

Effexor 25 mg

37.5 mg

75 mg

100 mg

5 mg

10 mg

20 mg

50 mg

venlafaxine hydrochloride

Effexor XR 37.5 mg

75 mg

150 mg

warfarin sodium

Coumadin 1 mg

2 mg

2.5 mg

3 mg

4 mg

5 mg

6 mg

7.5 mg

10 mg

©2009, SFI Medical Publishing

4

abacavir sulfate and lamivudine

Drug-herbs. St. John’s wort: decreased drug blood level and reduced drug effect Drug-behaviors. Alcohol use: increased drug half-life and concentration

Patient monitoring

2Assess for severe lactic acidosis, especially in women and obese patients. 2Evaluate closely for signs and symptoms of hypersensitivity reaction, which can be fatal. These include fever, rash, fatigue, nausea, vomiting, diarrhea, abdominal pain, dyspnea, cough, and pharyngitis. 2Never restart therapy if patient has experienced a previous hypersensitivity reaction to this drug. ● Check for liver enlargement. ● Monitor CBC, serum electrolytes, and liver and kidney function test results.

Patient teaching Advise patient to take drug with food to minimize GI upset. ● Instruct patient to refrigerate drug but not to freeze it. 2Teach patient how to recognize hypersensitivity reaction. Instruct him to stop taking drug and contact prescriber immediately if signs or symptoms of such a reaction occur. 2Tell patient to contact prescriber if he develops a rash (possible sign of Stevens-Johnson syndrome). ● Inform patient that drug doesn’t cure HIV but lowers viral count. ● Instruct patient to obtain medication guide and warning card with each refill. ● Tell patient he’ll undergo frequent blood and urine testing during therapy. ● Advise patient to consult prescriber before drinking alcohol or using herbs. ● As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, herbs, and behaviors mentioned above. ●

Canada

UK

abacavir sulfate and lamivudine Epzicom, Kavexa Pharmacologic class: Nucleoside analogue Therapeutic class: Antiretroviral agent Pregnancy risk category C

FDA BOXED WARNING Give only to patients whose regimens would otherwise include both abacavir sulfate and lamivudine. ● Abacavir component may cause serious and potentially fatal hypersensitivity reactions, including multi-organ syndrome marked by fever, rash, GI distress, malaise, fatigue, achiness, dyspnea, cough, and pharyngitis. Discontinue immediately if you suspect such a reaction. If hypersensitivity can’t be ruled out, discontinue permanently, even if other diagnoses are possible. ● After hypersensitivity reaction, never restart drug or other agents containing it, because more severe symptoms (including severe hypotension and death) may arise within hours. ● Lactic acidosis and severe hepatomegaly with steatosis (including fatal cases) have occurred in patients receiving one or both components. ● Severe acute hepatitis B exacerbations have occurred in patients coinfected with hepatitis B virus and human immunodeficiency virus (HIV) after they discontinued lamivudine. ●

Action Abacavir converts to its active metabolite (carbovir triphosphate), and lamivudine is phosphorylated to its active metabolite (lamivudine triphosphate) by intracellular enzymes. Hazardous drug

High alert drug

abacavir sulfate and lamivudine

These metabolites inhibit activity of HIV-1 reverse transcriptase. Drug interferes with DNA and RNA synthesis, thereby inhibiting viral reproduction.

Availability Tablets: 600 mg abacavir/300 mg lamivudine


➣ HIV-1 infection Adults: 1 tablet P.O. daily Contraindications

Hypersensitivity to abacavir, lamivudine, or other product components ● Hepatic impairment ●

Precautions Use cautiously in: ● treatment-experienced patients (cross-resistance may occur) ● concurrent hepatitis B infection ● renal impairment ● elderly patients ● pregnant or breastfeeding patients ● children (safety and efficacy not established).

Administration

2Before administering, ask patient if he’s allergic to abacavir or lamivudine. ● Always give in combination with other antiretrovirals. ● Administer with plenty of water, with or without food. ● Know that drug isn’t recommended for patients who would require dosage adjustment, because tablet shouldn’t be broken. Route P.O.

Onset Unknown

Peak Unknown

Duration Unknown

Adverse reactions CNS: paresthesia, peripheral neuropathy, insomnia, depression or depressed Reactions in bold are life-threatening.

5

mood, migraine, fatigue, malaise, weakness, dizziness, vertigo, anxiety, abnormal dreams, seizures GI: nausea, diarrhea, abdominal pain, gastritis, stomatitis, pancreatitis Hematologic: lymphadenopathy, splenomegaly, anemia (including pure red-cell aplasia and severe anemias progressing with therapy), aplastic anemia Hepatic: posttreatment exacerbation of hepatitis B, hepatic steatosis Metabolic: hyperglycemia, lactic acidosis Musculoskeletal: muscle weakness, rhabdomyolysis Respiratory: abnormal breath sounds, wheezing Skin: alopecia, toxic epidermal necrolysis, erythema multiforme, StevensJohnson syndrome Other: body fat redistribution, fever, allergic reactions including urticaria and anaphylaxis

Interactions Drug-drug. Nelfinavir, sulfamethoxazole/ trimethoprim: increased lamivudine blood level Drug-diagnostic tests. Amylase, bilirubin, creatine kinase, glucose, lipase, triglycerides: elevated levels Liver function tests: abnormal results Platelet count: decreased Drug-behaviors. Alcohol use: increased abacavir blood level

Patient monitoring Monitor patients (especially women and overweight patients) for signs and symptoms of lactic acidosis. ● Monitor hepatic function closely during therapy and for at least several months afterward. ●

Patient teaching

2Advise patient not to use drug if he is allergic to abacavir or lamivudine. ● Tell patient to take drug with plenty of water, with or without food. 2Clinical alert

a

6

abatacept

2Instruct patient to stop taking drug and get immediate medical attention if he experiences such allergic symptoms as fatigue, general ill feeling, achiness, rash, fever, difficulty breathing, cough, throat inflammation, or severe nausea, vomiting, diarrhea, or abdominal pain. 2Caution patient never to take drug again if he experiences an allergic reaction. ● Tell patient to make sure he receives medication guide and warning card issued with each prescription and refill. Teach him to carry card at all times. 2Advise patient to contact prescriber right away if he develops symptoms of liver impairment (unusual tiredness, weakness, nausea, itching, yellowing of eyes or skin, tenderness on upper right side of abdomen, or flulike symptoms). 2Tell patient not to stop taking drug without consulting prescriber. If he stops taking it for any reason other than allergic reaction, he must consult prescriber before restarting, because serious or life-threatening reactions may occur. ● Tell HIV-infected women not to breastfeed infants, to avoid risk of transmitting HIV infection. ● Inform patient that he’ll have regular blood tests during drug therapy. ● As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and behaviors mentioned above.

Action Inhibits T-cell activation by binding to CD80 and CD86, blocking interaction with CD28. (This interaction triggers costimulatory signal necessary for full activation of T cells, which are implicated in rheumatoid arthritis pathogenesis.)

Availability Powder for infusion (lyophilized): 250 mg/15 ml in single-use vial


➣ To reduce signs and symptoms, slow progression of structural damage, and improve physical function in patients with moderately to severely active rheumatoid arthritis who’ve responded inadequately to one or more disease-modifying antirheumatic drugs or tumor necrosis factor (TNF) antagonists (such as adalimumab, etanercept, or infliximab) Adults weighing less than 60 kg (132 lb): 500 mg I.V. given over 30 minutes at weeks 0, 2, and 4; thereafter, give every 4 weeks Adults weighing 60 to 100 kg (132 to 220 lb): 750 mg I.V. given over 30 minutes at weeks 0, 2, and 4; thereafter, give every 4 weeks Adults weighing more than 100 kg: 1g I.V. given over 30 minutes at weeks 0, 2, and 4; thereafter, give every 4 weeks Contraindications Hypersensitivity to drug or its components

●

Precautions

abatacept Orencia Pharmacologic class: Selective costimulation modulator Therapeutic class: Antirheumatic Pregnancy risk category C

Canada

UK

Use cautiously in: ● increased risk of infection or history of recurrent infections, immunocompromised state, chronic obstructive pulmonary disease (COPD) ● concurrent use of concomitant TNF antagonists ● patients older than age 65 ● pregnant or breastfeeding patients Hazardous drug

High alert drug

abciximab

children (safety and efficacy not established).

●

Administration

2Reconstitute each vial with 10 ml sterile water for injection, using only silicone-free disposable syringe included with product. 2During reconstitution, rotate vial by swirling gently. Avoid prolonged or vigorous agitation. Don’t shake. ● Further dilute reconstituted solution to volume of 100 ml with normal saline solution. ● Use silicone-free syringe to add drug to infusion bag or bottle, and mix gently. Resulting drug concentration should be 5 mg/ml for two vials, 7.5 mg/ml for three vials, or 10 mg/ml for four vials, respectively. ● Administer infusion over 30 minutes using infusion set and nonpyrogenic, low protein-binding filter. ● Complete infusion within 24 hours of vial reconstitution. ● Don’t infuse other drugs concurrently through same I.V. line. ● Watch for infusion-related reactions (hypotension or hypertension, dyspnea, nausea, dizziness, headache, flushing, urticaria, pruritus, rash, cough, or wheezing), which usually occur within 1 hour of administration. Be prepared to intervene appropriately. Route I.V.

Onset Unknown

Peak Unknown

Duration Unknown

Adverse reactions CNS: headache, dizziness CV: hypertension, hypotension EENT: nasopharyngitis GI: nausea, dyspepsia, diverticulitis GU: urinary tract infection, acute pyelonephritis Musculoskeletal: back pain, extremity pain Respiratory: cough, upper respiratory tract infection (including herpes zoster Reactions in bold are life-threatening.

7

infection), pneumonia, wheezing, bronchitis, dyspnea Skin: rash, flushing, urticaria, pruritus Other: malignancies, infusion-related reactions, hypersensitivity reaction

Interactions Drug-drug. Immunizations: possible decrease in immunization efficacy

Patient monitoring Continue to monitor patient for infusion-related events. ● Assess patient’s overall health at each visit to evaluate infection status. ● Closely monitor COPD patient because of increased likelihood of adverse events. ●

Patient teaching Instruct patient to report signs and symptoms of infection. ● Caution patient to avoid immunizations during or within 3 months of stopping drug. ● Tell female with childbearing potential that pregnancy and breastfeeding aren’t recommended during therapy. ● As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs mentioned above. ●

abciximab ReoPro Pharmacologic class: Platelet aggregation inhibitor Therapeutic class: Antithrombotic, antiplatelet drug Pregnancy risk category C

Action Inhibits fibrinogen binding and plateletplatelet interaction by impeding 2Clinical alert

a

8

abciximab

fibrinogen binding to platelet receptor sites, thereby prolonging bleeding time

Availability Injection: 2 mg/ml (5-ml vials containing 10 mg)


➣ Adjunct to aspirin and heparin to prevent acute cardiac ischemic complications in patients undergoing percutaneous coronary intervention (PCI) Adults: 0.25 mg/kg I.V. bolus given 10 to 60 minutes before start of PCI, followed by infusion of 0.125 mcg/kg/ minute for 12 hours. Maximum dosage is 10 mcg/minute. ➣ Adjunct to aspirin and heparin in patients with unstable angina who haven’t responded to conventional medical therapy and will undergo PCI within 24 hours Adults: 0.25 mg/kg I.V. bolus, followed by 18- to 24-hour infusion of 10 mcg/ minute, ending 1 hour after PCI Contraindications Hypersensitivity to drug or murine proteins ● Active internal bleeding ● Bleeding diathesis ● Severe, uncontrolled hypertension ● Thrombocytopenia (< 100,000 cells/mm3) ● Neutropenia ● Aneurysm ● Arteriovenous malformation ● History of cerebrovascular accident ● Oral anticoagulant therapy within past 7 days (unless prothrombin time is < 1.2 times control) ●

Precautions Use cautiously in: ● patients receiving drugs that affect hemostasis (such as thrombolytics, anticoagulants, or antiplatelet drugs) ● pregnant or breastfeeding patients. Canada

UK

Administration I.V. bolus dose may be given undiluted. For I.V. infusion, further dilute the desired dose with normal saline or D5W. ● Give through separate I.V. line with no other drugs. ● Avoid noncompressible I.V. sites, such as subclavian or jugular vein. 2Stop continuous infusion after failed PCI. ● Restrict patient to bed rest for 6 to 8 hours after drug withdrawal or 4 hours after heparin withdrawal (whichever occurs first). ● After catheter removal, apply pressure to femoral artery for at least 30 minutes. ●

Route I.V.

Onset Rapid

Peak 30 min

Duration 48 hr

Adverse reactions CNS: dizziness, anxiety, agitation, abnormal thinking, hypoesthesia, difficulty speaking, confusion, weakness, cerebral ischemia, coma CV: pseudoaneurysm, palpitations, vascular disorders, arteriovenous fistula, hypotension, peripheral edema, weak pulse, intermittent claudication, bradycardia, ventricular or supraventricular tachycardia, atrial fibrillation or flutter, atrioventricular block, nodal arrhythmias, pericardial effusion, embolism, thrombophlebitis EENT: abnormal or double vision GI: nausea, vomiting, diarrhea, constipation, dyspepsia, ileus, gastroesophageal reflux, enlarged abdomen, dry mouth GU: urinary tract infection, urine retention or urinary incontinence, painful or frequent urination, abnormal renal function, cystalgia, prostatitis Hematologic: anemia, leukocytosis, thrombocytopenia, bleeding Metabolic: diabetes mellitus, hyperkalemia Hazardous drug

High alert drug

acamprosate calcium

Musculoskeletal: myopathy, myalgia, increased muscle tension, reduced muscle stretching ability Respiratory: pneumonia, crackles, rhonchi, bronchitis, pleurisy, pleural effusion, bronchospasm, pulmonary edema, pulmonary embolism Skin: pallor, cellulitis, petechiae, pruritus, bullous eruptions, diaphoresis Other: abscess, peripheral coldness, development of human antichimeric antibodies

Interactions Drug-drug. Drugs that affect hemostasis (such as aspirin, dextran, dipyridamole, heparin, nonsteroidal antiinflammatory drugs, oral anticoagulants, thrombolytics, and ticlopidine): increased bleeding risk Drug-diagnostic tests. Activated partial thromboplastin time (APTT), clotting time, prothrombin time (PT): increased values Platelets: decreased count

9

2Instruct patient to immediately report unusual bleeding or bruising. ● Caution patient to avoid activities that may cause injury. Advise him to use soft toothbrush and electric razor to avoid gum and skin injury. ● Inform patient that he’ll undergo regular blood testing during therapy. ● As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.

acamprosate calcium Campral Pharmacologic class: Gammaaminobutyric acid (GABA) analogue Therapeutic class: Detoxification agent Pregnancy risk category C

Patient monitoring Assess platelet count before, during, and after therapy. 2Monitor catheter insertion site frequently for bleeding. 2During catheter insertion and for 6 hours after catheter removal, frequently monitor digital pulse in leg where catheter was inserted. ● Monitor CBC, PT, APTT, and International Normalized Ratio. ● Minimize arterial or venous punctures, automatic blood pressure cuff use, I.M. injections, nasotracheal or nasogastric intubation, and urinary catheterization. ● Use indwelling venipuncture device, such as heparin lock, to draw blood.

➣ To maintain abstinence from alcohol in patients with alcohol dependence who are abstinent when treatment begins Adults: 2 tablets P.O. t.i.d.

Patient teaching

Dosage adjustment

●

Tell patient what to expect during and after drug administration. ● Advise patient to minimize GI upset by eating small, frequent servings of food and drinking plenty of fluids. ●


Action Unclear. May interact with glutamate and GABA neurotransmitter systems centrally, restoring balance between neuronal excitation and inhibition (which is altered by chronic alcoholism).

Availability Tablets (enteric-coated): 333 mg


●

Moderate renal impairment

Contraindications ● ●

Hypersensitivity to drug Severe renal impairment 2Clinical alert

a

10

acamprosate calcium

Precautions Use cautiously in: ● mild to moderate renal impairment ● suicidal ideation or behavior ● elderly patients ● breastfeeding patients ● children.

Administration Give without regard to meals. Don’t crush or break enteric-coated tablet. ● Know that drug helps maintain alcohol abstinence only when used as part of treatment program that includes counseling and support. ● ●

Route P.O.

Onset Unknown

Peak 3-8 hr

Duration Unknown

Hematologic: anemia, ecchymosis, eosinophilia, lymphocytosis, thrombocytopenia Hepatic: hepatic cirrhosis Metabolic: hyperglycemia, diabetes mellitus, hyperuricemia, gout, avitaminosis Musculoskeletal: joint, muscle, neck, or back pain Respiratory: cough, dyspnea, bronchitis, epistaxis, pneumonia, asthma Skin: pruritus, sweating Other: abnormal taste, increased thirst, increased appetite, weight gain or loss, pain, infection, flulike symptoms, chills, abscess, hernia, allergic reaction, accidental or intentional injury, intentional overdose

Interactions Adverse reactions CNS: apathy, confusion, agitation, neurosis, malaise, somnolence, abnormal thinking, vertigo, asthenia, anxiety, depression, dizziness, insomnia, paresthesia, tremor, withdrawal syndrome headache, migraine, abnormal dreams, hallucinations, seizures, suicidal ideation or suicide attempt CV: chest pain, palpitations, syncope, hypotension, angina pectoris, varicose veins, phlebitis, peripheral edema, orthostatic hypotension, vasodilation, tachycardia, hypertension, myocardial infarction EENT: abnormal vision, amblyopia, hearing loss, tinnitus, rhinitis, pharyngitis GI: nausea, vomiting, diarrhea, constipation, abdominal pain, dyspepsia, flatulence, belching, gastroenteritis, gastritis, esophagitis, hematemesis, dry mouth, anorexia, pancreatitis, rectal hemorrhage, GI hemorrhage GU: urinary frequency, urinary tract infection, urinary incontinence, erectile dysfunction, increased or decreased libido, metrorrhagia, vaginitis Canada

UK

Drug-drug. Naltrexone: increased acamprosate blood level Drug-diagnostic tests. Bilirubin, eosinophils, lymphocytes: increased levels Liver function tests: abnormal results Red blood cells: decreased count

Patient monitoring

2Monitor patient for depression or expressed suicidal ideation. ● Monitor creatinine clearance during therapy.

Patient teaching Instruct patient to swallow tablet whole, with or without food. ● Advise patient to keep taking drug exactly as prescribed, even if he has a relapse. Encourage him to discuss any renewed alcohol consumption with prescriber. 2Instruct patient to contact prescriber immediately if he experiences seizure, chest pain, suicidal thoughts, or symptoms of liver problems (such as unusual tiredness or yellowing of skin or eyes). ● Caution patient to move slowly to a sitting or standing position, to avoid ●

Hazardous drug

High alert drug

acarbose

dizziness or light-headedness from a sudden blood pressure decrease. ● Advise patient to avoid driving and other hazardous activities until he knows how drug affects concentration, alertness, vision, coordination, and physical dexterity. ● Instruct female patient to notify prescriber if she becomes or intends to become pregnant or to breastfeed during therapy. ● Inform patient that drug helps maintain abstinence from alcohol only when used as part of treatment program that includes counseling and support. ● Emphasize that drug doesn’t eliminate or diminish alcohol withdrawal symptoms. ● As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.

11

Adults: Initially, 25 mg P.O. t.i.d. Increase q 4 to 8 weeks as needed until maintenance dosage is reached. Maximum dosage is 100 mg P.O. t.i.d. for adults weighing more than 60 kg (132 lb); 50 mg P.O. t.i.d. for adults weighing 60 kg or less.

Contraindications Hypersensitivity to drug Renal dysfunction ● Type 1 diabetes mellitus, diabetic ketoacidosis ● GI disease ● Cirrhosis ● Colonic ulcers ● Inflammatory bowel disease ● Intestinal obstruction ● Pregnancy or breastfeeding ● ●

Precautions Use cautiously in: ● patients receiving concurrent hypoglycemic drugs ● children.

Administration Give with first bite of patient’s three main meals. ● Know that drug prevents breakdown of table sugar (sucrose). Thus, mild hypoglycemia must be corrected with oral glucose (such as D-glucose or dextrose), and severe hypoglycemia may warrant I.V. glucose or glucagon injection. ● Be aware that drug may be used alone or in combination with insulin, metformin, or sulfonylureas (such as glipizide, glyburide, or glimepiride). ●

acarbose Glucobay , Prandase, Precose Pharmacologic class: Alphaglucosidase inhibitor Therapeutic class: Hypoglycemic Pregnancy risk category B

Action Improves blood glucose control by slowing carbohydrate digestion in intestine and prolonging conversion of carbohydrates to glucose

Availability Tablets: 25 mg, 50 mg, 100 mg


➣ Treatment of type 2 (non-insulindependent) diabetes mellitus when diet alone doesn’t control blood glucose Reactions in bold are life-threatening.

Route P.O.

Onset Rapid

Peak 1 hr

Duration Unknown

Adverse reactions GI: diarrhea, abdominal pain, flatulence Metabolic: hypoglycemia (when used with insulin or sulfonylureas) Other: edema, hypersensitivity reaction (rash) 2Clinical alert

a

12

acebutolol hydrochloride

Interactions

Urge patient to keep oral glucose on hand to correct mild hypoglycemia; inform him that sugar in candy won’t correct hypoglycemia. ● Inform patient that GI symptoms such as flatulence may result from delayed carbohydrate digestion in intestine. ● Advise patient to obtain medical alert identification and to carry or wear it at all times. ● As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above. ●

Drug-drug. Activated charcoal, calcium channel blockers, corticosteroids, digestive enzymes, diuretics, estrogen, hormonal contraceptives, isoniazid, nicotinic acid, phenothiazines, phenytoin, sympathomimetics, thyroid products: decreased therapeutic effect of acarbose Digoxin: decreased digoxin blood level and reduced therapeutic effect Insulin, sulfonylureas: hypoglycemia Drug-diagnostic tests. Alanine aminotransferase, aspartate aminotransferase: increased levels Calcium, vitamin B6: decreased levels Hematocrit: decreased

Patient monitoring Monitor patient for hypoglycemia if he’s taking drug concurrently with insulin or sulfonylureas. ● Stay alert for hyperglycemia during periods of increased stress. ● Assess GI signs and symptoms to differentiate drug effects from those caused by paralytic ileus. ● Check 1-hour postprandial glucose level to gauge drug’s efficacy. ● Monitor liver function test results. Report abnormalities so that dosage adjustments may be made as needed. ●

Patient teaching Inform patient that drug may cause serious interactions with many common medications, so he should tell all prescribers he’s taking it. ● Teach patient about other ways to control blood glucose level, such as recommendations regarding diet, exercise, weight reduction, and stress management. ● Stress importance of testing urine and blood glucose regularly. ● Teach patient about signs and symptoms of hypoglycemia. Tell him that although this drug doesn’t cause hypoglycemia when used alone, hypoglycemic symptoms may arise if he takes it with other hypoglycemics. ●

Canada

UK

acebutolol hydrochloride Monitan, Rhotral, Sectral Pharmacologic class: Beta-adrenergic blocker (selective) Therapeutic class: Antihypertensive, antiarrhythmic (class II) Pregnancy risk category B

Action At low doses, selectively inhibits response to adrenergic stimulation by blocking cardiac beta1-adrenergic receptors (with little effect on beta2adrenergic receptors of bronchial and vascular smooth muscle). At high doses, inhibits both beta1- and beta2-adrenergic receptors, causing airway resistance.

Availability Capsules: 200 mg, 400 mg Tablets: 100 mg, 200 mg, 400 mg


➣ Hypertension Adults: Initially, 400 mg P.O. daily or 200 mg b.i.d.; optimal response usually occurs at 400 to 800 mg daily. For severe hypertension, increase dosage gradually to a maximum of 1,200 mg daily in two divided doses. Hazardous drug

High alert drug

acebutolol hydrochloride

➣ Premature ventricular arrhythmias Adults: Initially, 200 mg P.O. b.i.d. Increase dosage gradually until optimum response occurs, usually at 600 to 1,200 mg daily. Dosage adjustment ● ●

Renal impairment Elderly patients

Off-label uses Acute phase of myocardial infarction (MI) ● Stable angina ●

Contraindications ● ● ● ● ● ●

Hypersensitivity to drug Heart failure or cardiogenic shock Second- or third-degree heart block Severe bradycardia Obstructive airway disease Breastfeeding

Precautions Use cautiously in: ● renal or hepatic impairment, inadequate cardiac function, peripheral or mesenteric vascular disease, hyperthyroidism, diabetes mellitus ● elderly patients ● pregnant patients ● children.

Administration

2Withhold drug and notify prescriber if patient’s apical pulse is below 60 beats/minute. ● Before surgery, notify anesthesiologist that patient is receiving drug. ● Avoid dosages above 800 mg daily in elderly patients. Route Onset Peak P.O. (blood 1-1.5 hr 2-8 hr pressure effect)

Duration 12-24 hr

P.O. (antiar1 hr rhythmic effect)

Up to 10 hr

4-6 hr

Adverse reactions CNS: fatigue, lethargy, insomnia, dizziness, depression, short-term memory Reactions in bold are life-threatening.

13

loss, emotional lability, anxiety, confusion, headache, partial sensation loss, hemiparesis CV: hypotension, chest pain, palpitations, peripheral vascular insufficiency, peripheral vasodilation, worsening arterial insufficiency, claudication, bradycardia, heart failure, intensified atrioventricular nodal block EENT: dry burning eyes, abnormal or blurred vision, eye irritation and pain, conjunctivitis, tinnitus, pharyngitis GI: nausea, vomiting, diarrhea, constipation, dyspepsia, abdominal pain, dry mouth, anorexia, mesenteric arterial thrombosis, ischemic colitis GU: frequent or difficult urination, nocturia, diminished libido, impotence, Peyronie’s disease Hematologic: agranulocytosis, nonthrombocytopenic purpura Metabolic: type 2 diabetes mellitus, hypoglycemia in nondiabetic patients, increased hypoglycemic response to insulin Musculoskeletal: joint, back, or muscle pain Respiratory: dyspnea, wheezing, cough, shortness of breath, bronchospasm, bronchoconstriction Skin: rash, pruritus, diaphoresis Other: fever, thirst, edema, pneumonitis, pleurisy, lupus erythematosus–like illness, hypersensitivity reaction, pulmonary granuloma, pleuropulmonary fibrosis

Interactions Drug-drug. Alpha agonists (such as nasal decongestants and other betaadrenergic blockers): increased risk of severe hypertension Aluminum or calcium salts, barbiturates, cholestyramine, colestipol, indomethacin, nonsteroidal anti-inflammatory drugs, penicillin, rifampin, salicylates, sulfinpyrazone: decreased antihypertensive effect Anticholinergics, hydralazine, methyldopa, prazosin: increased risk of bradycardia and hypotension 2Clinical alert

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acetaminophen

Beta2-agonists (such as theophylline): decreased beta2-agonist effect, possibly leading to bronchoconstriction Calcium channel blockers (nondihydropyridine): synergistic effects Cardiac glycosides: additive negative effect on sinoatrial (SA) or atrioventricular node conduction, slowing or completely suppressing SA node activity Catecholamine-depleting drugs: marked bradycardia, hypertension, vertigo, syncope, and orthostatic blood pressure changes Diuretics: increased hypotensive effect Epinephrine: increased risk of blocked sympathomimetic effects Ergot alkaloids: increased risk of peripheral ischemia and gangrene Glyburide in patients with type 2 diabetes: decreased hypoglycemic effect Lidocaine: increased lidocaine blood level and possible toxicity Drug-diagnostic tests. Alkaline phosphatase, antinuclear antibody titers, bilirubin, blood urea nitrogen, lactate dehydrogenase, low-density lipoproteins, transaminases: increased levels Glucose tolerance test: altered tolerance Drug-herbs. Aloe, buckthorn bark or berry, cascara bark, rhubarb root, senna leaf or fruit: increased acebutolol effect Ephedra (ma huang): arrhythmias

Patient monitoring Carefully monitor blood pressure during initial dosage titration. Notify prescriber of significant or abrupt blood pressure decrease. ● Observe for orthostatic hypotension, especially when giving drug with other antihypertensives. ● Watch closely for marked bradycardia or hypotension if giving drug with reserpine or other catecholaminedepleting agents. ● Be aware that drug may mask signs and symptoms of hypoglycemia in patients with diabetes mellitus or hyperthyroidism. ●

Canada

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2Taper dosage gradually over 2 weeks when discontinuing. Abrupt withdrawal may exacerbate angina or trigger MI, especially in patients with coronary artery disease.

Patient teaching Teach patient how to take his pulse. Tell him to notify prescriber if pulse rate is below 60 beats/minute. ● Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration, alertness, and vision. ● Tell patient to watch for and report hypoglycemia signs and symptoms. ● Instruct patient with bronchospastic disease to keep bronchodilator on hand at all times. ● Instruct patient to store drug in tight container at room temperature, protected from light. ● As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and herbs mentioned above. ●

acetaminophen Abenol, Acephen, Anadin Paracetamol ,Apo-Acetaminophen, Aspirin Free Anacin,Atasol, Calpol , Cetaphen, Children’s Tylenol Soft Chews, Disprol , Feverall, Galpamol , Genapap, Genebs, Little Fevers, Mandanol , Mapap, Nortemp, Nortemp Children's, Novo-Gesic, Pain Eze, Panadol , Pediatrix, Silapap,Tempra,Tycolene,Tylenol 8 Hour,Tylenol,Tylenol Arthritis,Valorin Pharmacologic class: Synthetic nonopioid p-aminophenol derivative Therapeutic class: Analgesic, antipyretic Pregnancy risk category B Hazardous drug

High alert drug

acetaminophen

Action

Oral use (continued)

Unclear. Pain relief may result from inhibition of prostaglandin synthesis in CNS, with subsequent blockage of pain impulses. Fever reduction may result from vasodilation and increased peripheral blood flow in hypothalamus, which dissipates heat and lowers body temperature.

Age

Availability Caplets, capsules: 160 mg, 500 mg, 650 mg (extended-release) Drops: 100 mg/ml Elixir: 80 mg/2.5 ml, 80 mg/5 ml, 120 mg/5 ml, 160 mg/5 ml Gelcaps: 500 mg Liquid: 160 mg/5 ml, 500 mg/15 ml Solution: 80 mg/1.66 ml, 100 mg/1 ml, 120 mg/2.5 ml, 160 mg/5 ml, 167 mg/5 ml Suppositories: 80 mg, 120 mg, 125 mg, 300 mg, 325 mg, 650 mg Suspension: 32 mg/ml, 160 mg/5 ml Syrup: 160 mg/5 ml Tablets (chewable): 80 mg, 160 mg Tablets (extended-release): 160 mg, 325 mg, 500 mg, 650 mg Tablets (film-coated): 160 mg, 325 mg, 500 mg


➣ Mild to moderate pain caused by

headache, muscle ache, backache, minor arthritis, common cold, toothache, or menstrual cramps or fever Adults: 325 to 650 mg P.O. q 4 to 6 hours, or 1,000 mg three or four times daily. Or two extended-release caplets or tablets P.O. q 8 hours, to a maximum dosage of 4,000 mg/day. Or 650 mg P.R. q 4 to 6 hours, to a maximum dosage of 4,000 mg/day. Children: 10 to 15 mg/kg, or as indicated below: Oral use Age

Usual dosage 11-12 years 480 mg q 4 hr

Maximum dosage 5 doses in 24 hr

9-10 years

5 doses in 24 hr

400 mg q 4 hr

15

6-8 years

Usual dosage 320 mg q 4 hr

Maximum dosage 5 doses in 24 hr

4-5 years

240 mg q 4 hr

5 doses in 24 hr

2-3 years

160 mg q 4 hr

5 doses in 24 hr

1 year

120 mg q 4 hr

5 doses in 24 hr

4-11 months 80 mg q 4 hr

5 doses in 24 hr


5 doses in 24 hr

Rectal use Age

Usual dosage 325-650 mg q 4 hr

Maximum dosage 4,000 mg/day

11-12 years 320-480 mg q 4 hr

2,880 mg/day

12 years and older

6-11 years

325 mg q 4 hr

2,600 mg/day

3-6 years

120-125 mg q 6 hr

720 mg/day

1-3 years

80 mg q 4 hr


Dosage adjustment ●

Renal or hepatic impairment


Hypersensitivity to drug

Precautions Use cautiously in: ● anemia, hepatic or renal disease ● elderly patients ● pregnant or breastfeeding patients ● children younger than age 2.

Administration Be aware that although most patients tolerate drug well, toxicity can occur with a single dose. ● Know that acetylcysteine may be ordered to treat acetaminophen toxicity, depending on patient’s blood drug level. Activated charcoal is used to treat acute, recent acetaminophen overdose (within 1 hour of ingestion). ●

(continued)


2Clinical alert

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acetazolamide

Determine overdose severity by measuring acetaminophen blood level no sooner than 4 hours after overdose ingestion (to ensure that peak concentration has been reached).

●

Route P.O.

Onset 0.5-1 hr

Peak 10-60 min

Duration 3-8 hr (dose dependent)

P.R.

0.5-1 hr

10-60 min

3-4 hr

Adverse reactions Hematologic: thrombocytopenia, hemolytic anemia, neutropenia, leukopenia, pancytopenia Hepatic: jaundice, hepatotoxicity Metabolic: hypoglycemic coma Skin: rash, urticaria Other: hypersensitivity reactions (such as fever)

Interactions Drug-drug. Activated charcoal, cholestyramine, colestipol: decreased acetaminophen absorption Barbiturates, carbamazepine, diflunisal, hydantoins, isoniazid, rifabutin, rifampin, sulfinpyrazone: increased risk of hepatotoxicity Hormonal contraceptives: decreased acetaminophen efficacy Oral anticoagulants: increased anticoagulant effect Phenothiazines (such as chlorpromazine, fluphenazine, thioridazine): severe hypothermia Zidovudine: increased risk of granulocytopenia Drug-diagnostic tests. Home glucose measurement systems: altered results Urine 5-hydroxyindole acetic acid: falsepositive result Drug-behaviors. Alcohol use: increased risk of hepatotoxicity

Patient monitoring

2Observe for acute toxicity and overdose. Signs and symptoms of acute toxicity are as follows—Phase 1: Nausea, Canada

UK

vomiting, anorexia, malaise, diaphoresis. Phase 2: Right upper quadrant pain or tenderness, liver enlargement, elevated bilirubin and hepatic enzyme levels, prolonged prothrombin time, oliguria (occasional). Phase 3: Recurrent anorexia, nausea, vomiting, and malaise; jaundice; hypoglycemia; coagulopathy; encephalopathy; possible renal failure and cardiomyopathy. Phase 4: Either recovery or progression to fatal complete hepatic failure.

Patient teaching Caution parents or other caregivers not to give acetaminophen to children younger than age 2 without consulting prescriber first. ● Tell patient, parents, or other caregivers not to use drug concurrently with other acetaminophen-containing products. ● Advise patient, parents, or other caregivers to contact prescriber if fever or other symptoms persist despite taking recommended amount of drug. ● Inform patients with chronic alcoholism that drug may increase risk of severe liver damage. ● As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and behaviors mentioned above. ●

acetazolamide Acetazolam, AK-Zol, Apo-Acetazolamide, Diamox, Diamox Sequels Pharmacologic class: Carbonic anhydrase inhibitor Therapeutic class: Diuretic, antiglaucoma drug, anticonvulsant, altitude agent, urinary alkalinizer Pregnancy risk category C Hazardous drug

High alert drug

acetazolamide 17

Inhibits carbonic anhydrase in kidney, decreasing water reabsorption and increasing excretion of sodium, potassium, and bicarbonate. Lowers intraocular pressure by decreasing aqueous humor production. May raise seizure threshold by reducing carbonic anhydrase in CNS, thereby decreasing neuronal conduction.

➣ Acute high-altitude (mountain) sickness Adults: 500 mg to 1 g P.O. daily in divided doses, or sustained-release capsule q 12 to 24 hours. Dosing should begin 24 to 48 hours before ascent and continue during ascent and for 48 hours after reaching desired altitude. For rapid ascent, 1-g P.O. dose is recommended.

Availability

Dosage adjustment

Capsules (sustained-release): 500 mg Injection: 500 mg/vial Tablets: 125 mg, 250 mg

●

Action


➣ Open-angle (chronic simple) glaucoma (given with miotics) Adults: 250 mg P.O. one to four times daily, or 500-mg sustained-release capsule P.O. once or twice daily. Don’t exceed total daily dosage of 1 g. ➣ Preoperative treatment of closedangle (secondary) glaucoma Adults: 250 mg P.O. q 4 hours or 250 mg P.O. b.i.d.; in acute cases only, 500 mg P.O. followed by 125 to 250 mg P.O. q 4 hours. For rapid relief of increased intraocular pressure, 500 mg I.V., repeated in 2 to 4 hours; then 125 to 250 mg P.O. q 4 to 6 hours. Children: 10 to 15 mg/kg/day P.O. in divided doses q 6 to 8 hours, or 5 to 10 mg/kg I.V. q 6 hours ➣ Seizure disorder (given with other anticonvulsants) Adults and children: 250 mg P.O. daily when given with another anticonvulsant, or 8 to 30 mg/kg daily P.O. in one to four divided doses. Usual dosage range is 375 mg to 1 g daily. ➣ Drug-induced edema or edema secondary to heart failure Adults: Initially, 250 to 375 mg P.O. daily. If diuresis fails, give dose on alternate days, or give for 2 days alternating with day of rest. Children: 5 mg/kg P.O. daily, or 150 mg/ m2 P.O. or I.V. once daily in morning Reactions in bold are life-threatening.

Mild renal failure

Off-label uses ● ● ● ● ● ● ● ●

Acute pancreatitis Alkalosis after open-heart surgery Hereditary ataxia Peptic ulcer Periodic paralysis Renal calculi Phenobarbital or lithium overdose Hydrocephalus in infants

Contraindications Hypersensitivity to drug or sulfonamides ● Adrenocortical insufficiency ● Closed-angle glaucoma ● Severe pulmonary obstruction ● Severe renal disease, hypokalemia, hyponatremia ● Hepatic disease ●

Precautions Use cautiously in: ● respiratory, renal, or hepatic disease; diabetes mellitus, hypercalcemia, gout, adrenocortical insufficiency ● pregnant or breastfeeding patients.

Administration

2Before giving, ask if patient is pregnant. Drug may cause fetal toxicity. ● Direct I.V. administration is preferred. When giving by direct I.V. route, reconstitute 500-mg vial with more than 5 ml of sterile water for injection; administer over 1 minute. 2Clinical alert

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acetazolamide

When giving drug intermittently by I.V. infusion, further dilute with normal saline solution or dextrose solution and infuse over 4 to 8 hours. ● Be aware that I.M. administration is painful because solution is alkaline. ● If necessary, crush tablets and mix in nonsweet, nonalcoholic syrup or nonglycerin solution. ●

Route P.O.

Onset 1 hr

Peak 2-4 hr

Duration 8-12 hr

P.O. 2 hr (sustained)

8-12 hr

18-24 hr

I.V., I.M.

15-18 min 4-5 hr

1-2 min

Adverse reactions CNS: weakness, nervousness, irritability, drowsiness, confusion, dizziness, depression, tremor, headache, paresthesia, flaccid paralysis, seizures EENT: transient myopia, tinnitus, hearing dysfunction, sensation of lump in throat GI: nausea, vomiting, diarrhea, constipation, melena, abdominal distention, dry mouth, anorexia GU: dysuria, hematuria, glycosuria, polyuria, crystalluria, renal colic, renal calculi, uremia, sulfonamide-like renal lesions, renal failure Hematologic: thrombocytopenia, leukopenia, agranulocytosis, hemolytic anemia, thrombocytopenic purpura, pancytopenia, bone marrow depression with aplastic anemia Hepatic: hepatic insufficiency Metabolic: hypokalemia, hyperglycemia and glycosuria, hyperuricemia and gout, metabolic acidosis, hyperchloremic acidosis Respiratory: hyperpnea Skin: rash, pruritus, urticaria, photosensitivity, hirsutism, cyanosis Other: altered taste and smell, weight loss, fever, excessive thirst, pain at I.M. injection site, hypersensitivity reaction, Stevens-Johnson syndrome

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Interactions Drug-drug. Amphetamines, procainamide, quinidine, tricyclic antidepressants: decreased excretion and enhanced or prolonged effect of these drugs, leading to toxicity Amphotericin B, corticosteroids, corticotrophin, other diuretics: increased risk of hypokalemia Lithium, phenobarbital, salicylates: increased excretion of these drugs, possibly reducing their efficacy Methenamine compounds: inactivation of these drugs Phenytoin, primidone: severe osteomalacia Salicylates: increased risk of salicylate toxicity Drug-diagnostic tests. Ammonia, bilirubin, calcium, chloride, glucose, uric acid: increased levels Thyroid iodine uptake: decreased in patients with hyperthyroidism or normal thyroid function Urinary protein (with some reagents): false-positive result Drug-behaviors. Sun exposure: increased risk of photosensitivity

Patient monitoring

2Evaluate for signs and symptoms of sulfonamide sensitivity; drug can cause fatal hypersensitivity. 2Monitor laboratory test results for hematologic changes; blood glucose, potassium, bicarbonate, and chloride levels; and liver and kidney function changes. ● Observe for signs and symptoms of bleeding tendency. ● Monitor fluid intake and output.

Patient teaching Advise patient to take drug with food if GI upset occurs. ● Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness. ●

Hazardous drug

High alert drug

acetylcysteine 19

Tell patient to eat potassium-rich foods (such as seafood, bananas, and oranges) if taking drug long term or receiving other potassium-depleting drugs. ● Advise patient to avoid activities that can cause injury. Advise him to use soft toothbrush and electric razor to avoid gum and skin injury. ● Tell patient to report significant numbness or tingling. ● Inform patient that he’ll undergo regular blood testing during therapy. ● As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and behaviors mentioned above. ●

acetylcysteine (N-acetylcysteine) Acetadote, Mucomyst, Mucomyst 10, Mucosil-10, Mucosil-20, Parovelex Pharmacologic class: N-acetyl derivative of naturally occurring amino acid (L-cysteine) Therapeutic class: Mucolytic, acetaminophen antidote Pregnancy risk category B

Action Decreases viscosity of secretions, promoting secretion removal through coughing, postural drainage, and mechanical means. In acetaminophen overdose, maintains and restores hepatic glutathione, needed to inactivate toxic metabolites.

Availability Injection: 200 mg/ml Solution: 10%, 20%



➣ Mucolytic agent in adjunctive

treatment of acute and chronic bronchopulmonary disease (bronchitis, bronchiectasis, chronic asthmatic bronchitis, emphysema, pneumonia, primary amyloidism of lungs, tuberculosis, tracheobronchitis), pulmonary complications of cystic fibrosis, atelectasis, or pulmonary complications related to surgery, posttraumatic chest conditions, tracheostomy care, or use during anesthesia Adults and children: Nebulization (face mask, mouthpiece, tracheostomy)— 6 to 10 ml of 10% solution or 3 to 5 ml of 20% solution three or four times daily. Dosage range is 2 to 20 ml of 10% solution or 1 to 10 ml of 20% solution q 2 to 6 hours. Nebulization (tent or croupette)—Volume of 10% or 20% solution that will maintain heavy mist for desired period Instillation (direct)—1 to 2 ml of 10% to 20% solution q 1 hour p.r.n. Instillation via syringe attached to percutaneous intratracheal catheter—2 to 4 ml of 10% solution or 1 to 2 ml of 20% solution q 1 to 4 hours ➣ Diagnostic bronchial studies Adults and children: Two to three doses of 2 to 4 ml of 10% solution or 1 to 2 ml of 20% solution by nebulization or intratracheal instillation before procedure ➣ Acetaminophen overdose Adults, elderly patients, children: Give immediately if 24 hours or less have elapsed since acetaminophen ingestion. Use the following protocol: empty stomach by lavage or emesis induction, and then have patient drink copious amounts of water. If activated charcoal has been given, perform lavage before giving acetylcysteine. Draw blood for acetaminophen plasma assay and baseline aspartate aminotransferase (AST), alanine aminotransferase (ALT), prothrombin time, bilirubin, blood glucose, blood urea 2Clinical alert

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acetylcysteine

nitrogen, electrolyte, and creatinine clearance levels. If ingested acetaminophen dose is in toxic range, give acetylcysteine 140 mg/kg P.O. as loading dose from 20% solution. Administer 17 maintenance doses of 70 mg/kg P.O. q 4 hours, starting 4 hours after loading dose. Repeat procedure until acetaminophen blood level is safe. If patient vomits loading dose or any maintenance dose within 1 hour of administration, repeat that dose.

Off-label uses ●

Unstable angina

Contraindications Hypersensitivity to drug (except with antidotal use) ● Status asthmaticus (except with antidotal use) ●

Precautions Use cautiously in: ● renal or hepatic disease, Addison’s disease, alcoholism, brain tumor, bronchial asthma, seizure disorder, hypothyroidism, respiratory insufficiency, psychosis ● elderly patients ● pregnant or breastfeeding patients.

Administration Separate administration times of this drug and antibiotics. ● Use plastic, glass, or stainless steel container when giving by nebulizer, because solution discolors on contact with rubber and some metals. ● Once solution is exposed to air, use within 96 hours. ● Dilute solution before administering for acetaminophen overdose, to reduce risk of vomiting, drug’s unpleasant odor, and irritating or sclerosing properties. ● Chill solution and have patient sip through straw, or, if necessary, give by nasogastric tube when administering for acetaminophen overdose. ●

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UK

Route P.O.

Onset Peak 30-60 min 1-2 hr

Instillation, 1 min inhalation

Duration Unknown

5-10 min 2-3 hr

Adverse reactions CNS: dizziness, drowsiness, headache CV: hypotension, hypertension, tachycardia EENT: severe rhinorrhea GI: nausea, vomiting, stomatitis, constipation, anorexia Hepatic: hepatotoxicity Respiratory: hemoptysis, tracheal and bronchial irritation, increased secretions, wheezing, chest tightness, bronchospasm Skin: urticaria, rash, clamminess, angioedema Other: tooth damage, chills, fever, hypersensitivity including anaphylaxis

Interactions Drug-drug. Activated charcoal: increased absorption and decreased efficacy of acetylcysteine Nitroglycerin: increased nitroglycerin effects, causing hypotension and headache Drug-diagnostic tests. Liver function tests: abnormal results

Patient monitoring Monitor respirations, cough, and character of secretions.

●

Patient teaching Instruct patient to report worsening cough and other respiratory symptoms. ● Advise patient to mix oral form with juice or cola to mask bad taste and odor. ● As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above. ●

Hazardous drug

High alert drug

acetylsalicylic acid

21


➣ Mild pain or fever

acetylsalicylic acid (aspirin) Alka , Angettes , Apo-Asa, Apo–ASEN, Arthrinol, Arthrisin, Artria S.R., ASA, Aspercin, Aspergum, Aspir-Low, Aspirtab, Astrin, Bayer, Caprin , Coryphen, Dispirin , Easprin, Ecotrin, Enpirin , Entrophen, Halfprin, Headache Tablet, Micoprin , Novasen, Nu-Seals , PMS-ASA, PostMI , Sal-Adult, Sal-Infant, St. Joseph, Supasa, ZORprin Pharmacologic class: Nonsteroidal anti-inflammatory drug (NSAID) Therapeutic class: Nonopioid analgesic, antipyretic, antiplatelet drug Pregnancy risk category C (with full dose in third trimester: D)

Action Reduces pain and inflammation by inhibiting prostaglandin production. Fever reduction mechanism unknown; may be linked to decrease in endogenous pyrogens in hypothalamus resulting from prostaglandin inhibition. Exerts antiplatelet effect by inhibiting synthesis of prostacyclin and thromboxane A2.

Availability Gum (chewable): 227 mg Suppositories: 60 mg, 120 mg, 200 mg, 300 mg, 325 mg, 600 mg, 650 mg Tablets: 81 mg, 325 mg, 500 mg Tablets (chewable): 81 mg Tablets (enteric-coated, delayed-release): 81 mg, 162 mg, 325 mg, 500 mg, 650 mg, 975 mg Tablets (extended-release): 650 mg, 800 mg Tablets (film-coated): 325 mg, 500 mg Reactions in bold are life-threatening.

Adults: 325 to 500 mg P.O. q 3 hours, or 325 to 650 mg P.O. q 4 hours, or 650 to 1,000 mg P.O. q 6 hours, to a maximum dosage of 4,000 mg/day. Extended-release tablets—650 mg to 1,300 mg q 8 hours, not to exceed 3,900 mg/day; or 800 mg q 12 hours. Children: 10 to 15 mg/kg P.O. or P.R. q 4 hours, not to exceed total daily dosage of 3.6 g, or up to 60 to 80 mg/kg/ day. See chart below. Age (years) 12-14

Dosage (q 4 hr) 648 mg

11-12

486 mg

9-10

405 mg

6-8

324 mg

4-5

243 mg

2-3

162 mg

➣ Mild to moderate pain caused by inflammation (as in rheumatoid arthritis or osteoarthritis) Adults: Initially, 2,400 to 3,600 mg P.O. daily in divided doses. Dosage may be increased by 325 to 1,200 mg daily at intervals of at least 1 week. Usual maintenance dosage is 3.6 to 5.4 g/day P.O. in divided doses, to a maximum dosage of 6 g/day. ➣ Juvenile rheumatoid arthritis Children: 60 to 130 mg/kg/day P.O. in children weighing 25 kg (55 lb) or less, or 2,400 to 3,600 mg P.O. daily in children weighing more than 25 kg P.O.; give in divided doses q 6 to 8 hours. ➣ Acute rheumatic fever Adults: 5 to 8 g/day P.O. in divided doses Children: Initially, 100 mg/kg/day P.O. in individual doses for first 2 weeks; then maintenance dosage of 75 mg/kg/day P.O. in divided doses for next 4 to 6 weeks ➣ To reduce the risk of transient ischemic attacks (TIAs) or cerebrovascular 2Clinical alert

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accident in men with a history of TIAs caused by emboli Adults: 650 mg P.O. b.i.d or 325 mg P.O. q.i.d. ➣ To reduce the risk of myocardial infarction (MI) in patients with a history of MI or unstable angina Adults: 75 to 325 mg/day P.O. ➣ Kawasaki disease Children: Initially during acute febrile period, 80 to 180 mg/kg/day P.O. in four divided doses. Maintenance dosage is 3 to 10 mg/kg/day given as a single dose for up to 8 weeks or until platelet count and erythrocyte sedimentation rate return to normal. ➣ Thromboembolic disorders Adults: 325 to 650 mg P.O. once or twice daily

Contraindications Hypersensitivity to salicylates, other NSAIDs, or tartrazine ● Renal impairment ● Severe hepatic impairment ● Hemorrhagic states or blood coagulation defects ● Vitamin K deficiency caused by dehydration ● Concurrent anticoagulant use ● Pregnancy (third trimester) or breastfeeding ●

Precautions Use with extreme caution, if at all, in: ● hepatic disorders, anemia, asthma, gastritis, Hodgkin’s disease ● heart failure or other conditions in which high sodium content is harmful (buffered aspirin) ● patients receiving other salicylates or NSAIDs concurrently ● elderly patients ● children and adolescents.

Administration

2Never administer to child or adolescent who has signs or symptoms of chickenpox or flulike illness. Canada

UK

2Don’t give within 6 weeks after administration of live varicella virus vaccine, because of risk of Reye’s syndrome. ● Give with food or large amounts of water or milk to minimize GI irritation. ● Know that extended-release and enteric-coated forms are best for longterm therapy. ● Be aware that aspirin should be discontinued at least 1 week before surgery because it may inhibit platelet aggregation. Route P.O. (tablets)

Onset Peak 15-30 min 1-2 hr

P.O. (chewable) Rapid P.O. (entericcoated)

Duration 4-6 hr

Unknown 1-4 hr

5-30 min 2-4 hr

8-12 hr

P.O. (extended) 5-30 min 1-4 hr

3-6 hr

P.R.

1-4 hr

5-30 min 3-4 hr

Adverse reactions EENT: hearing loss, tinnitus, ototoxicity GI: nausea, vomiting, abdominal pain, dyspepsia, epigastric distress, heartburn, anorexia, GI bleeding Hematologic: thrombocytopenia, hemolytic anemia, leukopenia, agranulocytosis, shortened red blood cell life span Hepatic: hepatotoxicity Metabolic: hyponatremia, hypokalemia, hypoglycemia Respiratory: wheezing, hyperpnea, pulmonary edema with toxicity Skin: rash, urticaria, bruising, angioedema Other: hypersensitivity reactions, salicylism or acute toxicity

Interactions Drug-drug. Acidifying drugs (such as ammonium chloride): increased salicylate blood level Activated charcoal: decreased salicylate absorption Hazardous drug

High alert drug


Alkalinizing drugs (such as antacids): decreased salicylate blood level Angiotensin-converting enzyme (ACE) inhibitors: decreased antihypertensive effect Anticoagulants, NSAIDs, thrombolytics: increased bleeding risk Carbonic anhydrase inhibitors (such as acetazolamide): salicylism Corticosteroids: increased salicylate excretion and decreased blood level Furosemide: increased diuretic effect Live varicella virus vaccine: increased risk of Reye’s syndrome Methotrexate: decreased methotrexate excretion and increased blood level, causing greater risk of toxicity Nizatidine: increased salicylate blood level Spironolactone: decreased spironolactone effect Sulfonylureas (such as chlorpropamide, tolbutamide): enhanced sulfonylurea effects Tetracycline (oral): decreased absorption of tetracycline (with buffered aspirin) Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, amylase, aspartate aminotransferase, coagulation studies, PaCO2, uric acid: increased values Cholesterol, glucose, potassium, proteinbound iodine, sodium, thyroxine, triiodothyronine: decreased levels Pregnancy test, protirelin-induced thyroid stimulating hormone, radionuclide thyroid imaging, serum theophylline (Schack and Waxler method), urine catecholamines, urine glucose, urine hydroxyindoleacetic acid, urine ketones (ferric chloride method), urine vanillylmandelic acid: test interference Tests using phenosulfonphthalein as diagnostic agent: decreased urinary excretion of phenosulfonphthalein Urine protein: increased level Drug-food. Urine-acidifying foods: increased salicylate blood level


23

Drug-herbs. Anise, arnica, cayenne, chamomile, clove, fenugreek, feverfew, garlic, ginger, ginkgo biloba, ginseng, horse chestnut, kelpware, licorice: increased bleeding risk Drug-behaviors. Alcohol use: increased bleeding risk

Patient monitoring

2Watch for signs and symptoms of hypersensitivity and other adverse reactions, especially bleeding tendency. ● Stay alert for signs and symptoms of acute toxicity, such as diplopia, ECG abnormalities, generalized seizures, hallucinations, hyperthermia, oliguria, acute renal failure, incoherent speech, irritability, restlessness, tremor, vertigo, confusion, disorientation, mania, lethargy, laryngeal edema, anaphylaxis, and coma. ● Monitor elderly patients carefully because they’re at greater risk for salicylate toxicity. ● With prolonged therapy, frequently assess hemoglobin, hematocrit, International Normalized Ratio, and kidney function test results. ● Check salicylate blood levels frequently. ● Evaluate patient for signs and symptoms of ototoxicity (hearing loss, tinnitus, ataxia, and vertigo).

Patient teaching Tell patient to report ototoxicity symptoms, unusual bleeding, and bruising. ● Caution patient to avoid activities that may cause injury. Advise him to use soft toothbrush and electric razor to avoid gum and skin injury. ● Instruct patient to tell all prescribers he’s taking the drug, because it may cause serious interactions with many common medications. ● Tell patient not to take other overthe-counter preparations containing aspirin. ●

2Clinical alert

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acitretin

Inform patient that he may need to undergo regular blood testing during therapy. ● As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, herbs, and behaviors mentioned above. ●

Action Unclear. Promotes normal growth cycle of skin cells, possibly by targeting retinoid receptors in these cells and adjusting factors that affect epidermal proliferation and synthesis of RNA and DNA.

Availability Capsules: 10 mg, 25 mg


acitretin Neotigason , Soriatane Pharmacologic class: Secondgeneration retinoid Therapeutic class: Antipsoriatic Pregnancy risk category X

➣ Severe psoriasis, including erythrodermic and generalized pustule types Adults and elderly patients: Initially, 25 to 50 mg/day P.O. as a single dose with main meal. If initial response is satisfactory, give maintenance dosage of 25 to 50 mg/day P.O. Off-label uses

Drug may harm fetus and must not be used by pregnant patients, those who intend to become pregnant, or those who may not use reliable contraception during therapy and for at least 3 years afterward. ● Patient must commit to using two effective contraceptive forms simultaneously. At least one form must be primary, unless patient chooses absolute abstinence, has had a hysterectomy, or is postmenopausal. ● Drug should be prescribed only by clinicians with special competence in diagnosing and treating severe psoriasis, experience using systemic retinoids, and understanding of teratogenicity risk. ● Consider drug only for women with severe psoriasis unresponsive to other therapies or whose clinical condition contraindicates other therapies. ● Instruct patient not to donate blood during therapy and for at least 3 years afterward. ●

Canada

Darier’s disease (keratosis follicularis) ● Lamellar ichthyosis (in children) ● Lichen planus ● Nonbullous and bullous ichthyosiform erythroderma ● Palmoplantar pustulosis ● Sjögren-Larsson syndrome ●

FDA BOXED WARNING

UK

Contraindications Hypersensitivity to drug or paraben (used as preservative in gelatin capsule) ● Pregnancy or anticipated pregnancy within 3 years after drug discontinuation (drug has teratogenic and embryotoxic effects) ● Women of childbearing age who may not use reliable contraception during therapy and for at least 3 years after drug discontinuation ● Breastfeeding ●

Precautions Use cautiously in: ● hepatic or renal impairment, diabetes mellitus, obesity ● elevated cholesterol or triglyceride levels ● elderly patients. Hazardous drug

High alert drug

acitretin

Administration

2Verify that patient isn’t pregnant before giving drug. ● Give as a single dose with main meal. Route P.O.

Onset Unknown

Peak Unknown

Duration Unknown

Adverse reactions CNS: headache, depression, insomnia, drowsiness, fatigue, migraine, rigors, abnormal gait, nerve inflammation, hyperesthesia, paresthesia, pseudotumor cerebri EENT: abnormal or blurred vision, dry eyes, eye irritation, eyebrow and eyelash loss, eyelid inflammation, cataract, conjunctivitis, corneal epithelial abnormality, reduced night vision, photophobia, recurrent styes, earache, tinnitus, hearing loss, epistaxis, rhinitis, sinusitis, papilledema GI: nausea, vomiting, diarrhea, constipation, abdominal pain, gastritis, stomatitis, esophagitis, melena, painful straining at stool, pancreatitis, lip inflammation and cracking, dry mouth, anorexia GU: abnormal urine, dysuria, atrophic vaginitis, leukorrhea Hepatic: abnormal hepatic function, jaundice, hepatitis Metabolic: poor blood glucose control Musculoskeletal: joint, muscle, back, and bone pain; arthritis; bone disorders; spinal bone overgrowth; increased muscle tone or rigidity; tendinitis Respiratory: coughing, increased sputum, laryngitis Skin: dry skin, pruritus, skin atrophy, skin peeling, abnormal skin odor, sticky skin, seborrhea, dermatitis, diaphoresis, cold clammy skin, skin infection, rash, pyrogenic granuloma, skin ulcers, skin fissures, sunburn, flushing, purpura, nail disorder, inflammation of tissue surrounding nails, abnormal hair texture, alopecia


25

Other: abnormal taste, glossitis, tongue ulcers, gingival bleeding, gingivitis, edema, thirst, hot flashes

Interactions Drug-drug. Glyburide: increased blood glucose clearance Methotrexate: increased risk of hepatotoxicity Oral contraceptives (“minipill”): decreased contraceptive efficacy Drug-diagnostic tests. Alanine aminotransferase, aspartate aminotransferase, triglycerides: increased levels Low-density lipoproteins: decreased level Drug-behaviors. Alcohol use: interference with acitretin elimination, possible drug toxicity

Patient monitoring Monitor patient who has early signs or symptoms of pseudotumor cerebri, such as headache, nausea, vomiting, and visual disturbances. Discontinue drug immediately if papilledema occurs. ● Check blood lipid levels before therapy begins and every 1 to 2 weeks during therapy. ● Monitor blood glucose levels and kidney and liver function test results. ● If drug causes open skin lesions resulting from dermatitis or blisters, watch for signs and symptoms of infection. ● Assess for pain, stinging, and itching. Apply cool compresses as needed for relief. 2Be aware that women taking this drug must avoid alcohol-containing foods, beverages, medications, and over-the-counter products during therapy and for 2 months afterward. ●

Patient teaching Instruct patient to take drug with main meal to minimize GI upset. ● Tell patient to avoid driving and other hazardous activities until he knows ●

2Clinical alert

a

26

activated charcoal

how drug affects concentration, alertness, and vision. ● Caution patient not to drink alcohol during therapy. 2Advise females to use effective contraception for at least 1 month before starting drug, throughout entire course of therapy, and for 3 years after discontinuing drug. ● Explain that disease may seem to worsen at start of therapy. ● Tell contact lens wearers that lens intolerance may develop. ● As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and behaviors mentioned above.

Oral suspension: 12.5 g/60 ml, 15 g/ 75 ml, 25 g/120 ml, 30 g/120 ml, 50 g/ 240 ml Powder: 15, 30, 40, 130, 240 g/container


➣ Poisoning Adults: 25 to 100 g P.O. (or 1 g/kg, or about 10 times the amount of poison ingested) as a suspension in 120 to 240 ml (4 to 8 oz) of water Children: Initially, 1 to 2 g/kg P.O. (or 10 times the amount of poison ingested) as a suspension in 120 to 240 ml (4 to 8 oz) of water ➣ Flatulence Adults: 600 mg to 5 g P.O. as a single dose, or 975 mg to 3.9 g in divided doses Off-label uses ●

activated charcoal Actidose, Actidose-Aqua, Bragg’s Medicinal Charcoal , Carbomix , Charcadote, Char-Caps, Charco Caps, EZ-Char Pharmacologic class: Carbon residue Therapeutic class: Antiflatulent, antidote Pregnancy risk category C

Action Binds to poisons, toxins, irritants, and drugs, forming a barrier between particulate material and GI mucosa that inhibits absorption of this material in GI tract. As an antiflatulent, reduces intestinal gas volume and relieves related discomfort.

Availability Capsules: 260 mg Granules: 15 g/120 ml Liquid: 15 g/120 ml, 50 g/240 ml, 208 mg/1 ml Canada

UK

● ●

Diarrhea GI distress Hypercholesterolemia

Contraindications None

Precautions Use cautiously in: ● patients who have aspirated corrosives or hydrocarbons and are vomiting.

Administration

2Don’t try to give activated charcoal to semiconscious patient. 2If signs of aspiration occur, stop giving drug immediately to avoid fatal airway obstruction or infection. ● Administer by large-bore nasogastric tube after gastric lavage, as needed. ● Give within 30 minutes of poison ingestion when possible. ● Mix powder with tap water to form thick syrup. Add fruit juice or flavoring to improve taste. ● Be aware that drug inactivates ipecac syrup. ● Know that drug is ineffective in poisoning from ethanol, methanol, and iron salts. Hazardous drug

High alert drug

acyclovir

Don’t give children more than one dose of drug product containing sorbitol (sweetener). ● When used for indications other than as antidote, give drug at least 2 hours before or 1 hour after other drugs.

27

●

a acyclovir acyclovir sodium Zovirax

Route P.O.

Onset Immediate

Peak Duration Unknown Unknown

Adverse reactions GI: nausea, vomiting, diarrhea, constipation, black stools, intestinal obstruction

Interactions Drug-drug. Acetaminophen, barbiturates, carbamazepine, digitoxin, digoxin, furosemide, glutethimide, hydantoins, methotrexate, nizatidine, phenothiazines, phenylbutazones, propoxyphene, salicylates, sulfonamides, sulfonylurea, tetracycline, theophyllines, tricyclic antidepressants, valproic acid: decreased absorption of these drugs Ipecac syrup: ipecac absorption and inactivation Drug-food. Milk, ice cream, sherbet: decreased absorptive activity of drug

Patient monitoring Monitor patient for constipation. If patient vomits soon after receiving dose, ask prescriber if dose should be repeated.

● ●

Patient teaching Instruct patient to drink six to eight glasses of fluid daily to prevent constipation. ● Tell patient that stools will be black as charcoal is excreted from body. ● As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and foods mentioned above. ●


Pharmacologic class: Acyclic purine nucleoside analogue Therapeutic class: Antiviral Pregnancy risk category B

Action Inhibits viral DNA polymerase, thereby inhibiting replication of viral DNA. Specific for herpes simplex types 1 (HSV-1) and 2 (HSV-2), varicellazoster virus, Epstein-Barr virus, and cytomegalovirus (CMV).

Availability Capsules: 200 mg Cream: 5% in 2-g tube Injection: 50 mg/ml Ointment: 5% in 15-g tube Powder for injection: 500 mg/vial, 1,000 mg/vial Suspension: 200 mg/5 ml Tablets: 400 mg, 800 mg


➣ Acute treatment of herpes zoster (shingles) Adults: 800 mg P.O. q 4 hours while awake (five times/day) for 7 to 10 days ➣ Initial episode of genital herpes Adults: 200 mg P.O. q 4 hours while awake (1,000 mg/day) for 10 days ➣ Chronic suppressive therapy for recurrent genital herpes episodes Adults: 400 mg P.O. b.i.d., or 200 mg P.O. three to five times daily for up to 12 months ➣ Intermittent therapy for recurrent genital herpes episodes Adults: 200 mg P.O. q 4 hours while awake (five times/day) for 5 days, initiated at first sign or symptom of recurrence 2Clinical alert

28

acyclovir

➣ Management of initial episodes of genital herpes and limited, non-lifethreatening mucocutaneous herpes simplex virus infections in immunocompromised patients Adults: Apply approximately 1⁄2" ribbon of ointment per 4 square inches of surface area to sufficiently cover all lesions q 3 hours, six times daily for 7 days. ➣ Treatment of recurrent herpes labialis (cold sores) Adults and adolescents ages 12 and older: Apply cream to infected area five times daily for 4 days. ➣ Varicella (chickenpox) Adults and children weighing more than 40 kg (88 lb): 800 mg P.O. q.i.d. for 5 days Children older than age 2: 20 mg/kg P.O. q.i.d. for 5 days ➣ Mucosal and cutaneous HSV-1 and HSV-2 in immunocompromised patients Adults and children older than age 12: 5 mg/kg I.V. infusion over 1 hour given q 8 hours for 7 days Children younger than age 12: 10 mg/ kg I.V. infusion over 1 hour given q 8 hours for 7 days ➣ Herpes simplex encephalitis Adults and children older than age 12: 10 mg/kg I.V. over 1 hour given q 8 hours for 10 days Children ages 3 months to 12 years: 20 mg/kg I.V. over 1 hour given q 8 hours for 10 days Children from birth to 3 months: 10 mg/kg I.V. over 1 hour given q 8 hours for 10 days ➣ Varicella zoster infections in immunocompromised patients Adults and adolescents older than age 12: 10 mg/kg I.V. over 1 hour given q 8 hours for 7 days Children younger than age 12: 20 mg/ kg I.V. over 1 hour given q 8 hours for 7 days Dosage adjustment ●

Renal impairment

Canada

UK

Obesity (adult dosage based on ideal weight) ● Elderly patients ●

Off-label uses Herpes zoster encephalitis CMV and HSV infection after bone marrow or kidney transplantation ● Infectious mononucleosis ● Varicella pneumonia ● ●

Contraindications Hypersensitivity to drug or valacyclovir

●

Precautions Use cautiously in: ● preexisting serious neurologic, hepatic, pulmonary, or fluid or electrolyte abnormalities ● renal impairment ● obesity ● pregnant or breastfeeding patients.

Administration Make sure patient is adequately hydrated before starting therapy. ● Give single I.V. dose by infusion over at least 1 hour to minimize renal damage. ● Don’t give by I.V. bolus or by I.M. or subcutaneous route. ● Be aware that absorption of topical acyclovir is minimal. ●

Route P.O.

Onset Variable

Peak 1.5-2 hr

Duration 4 hr

I.V.

Immediate

1 hr

8 hr

Topical

Unknown

Unknown Unknown

Adverse reactions CNS: aggressive behavior, dizziness, malaise, weakness, paresthesia, headache; with I.V. use—encephalopathic changes (lethargy, tremors, obtundation, confusion, hallucinations, agitation, seizures, coma) CV: peripheral edema EENT: vision abnormalities GI: nausea, vomiting, diarrhea Hazardous drug

High alert drug

adalimumab

GU: proteinuria, hematuria, crystalluria, vaginitis, candidiasis, changes in menses, vulvitis, oliguria, renal pain, renal failure, glomerulonephritis Hematologic: anemia, lymphadenopathy, thrombocytopenia, thrombotic thrombocytopenic purpura/hemolytic uremic syndrome (in immunocompromised patients), disseminated intravascular coagulation, hemolysis, leukopenia, leukoclastic vasculitis Hepatic: jaundice, hepatitis Musculoskeletal: myalgia Skin: photosensitivity rash, pruritus, angioedema, alopecia, urticaria, severe local inflammatory reactions (with I.V. extravasation), toxic epidermal necrolysis, erythema multiforme Other: gingival hyperplasia, fever, excessive thirst, pain at injection site, anaphylaxis, Stevens-Johnson syndrome

Interactions Drug-drug. Interferon: additive effect Nephrotoxic drugs: increased risk of nephrotoxicity Probenecid: increased acyclovir blood level Zidovudine: increased CNS effects, especially drowsiness Drug-diagnostic tests. Alanine aminotransferase, aspartate aminotransferase, bilirubin, blood urea nitrogen: increased levels

Patient monitoring Monitor fluid intake and output. Assess for signs and symptoms of encephalopathy. ● Evaluate patient frequently for adverse reactions, especially bleeding tendency. ● Monitor CBC with white cell differential and kidney function test results. ● ●

Patient teaching Instruct patient to keep taking drug exactly as prescribed, even after symptoms improve.

●


29

Advise patient to drink enough fluids to ensure adequate urinary output. ● Tell patient to monitor urine output and report significant changes. 2Instruct patient to immediately report unusual bleeding or bruising. ● Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness. ● Advise patient to minimize GI upset by eating small, frequent servings of food and drinking plenty of fluids. ● Tell patient to use soft toothbrush and electric razor to avoid injury to gums and skin. ● Advise patient to avoid sexual intercourse when visible herpes lesions are present. ● Inform patient that he may need to undergo regular blood testing during therapy. ● As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above. ●

adalimumab Humira Pharmacologic class: Biological modifier Therapeutic class: Antirheumatic (disease-modifying), immunomodulator Pregnancy risk category B

FDA BOXED WARNING Tuberculosis (TB), invasive fungal infections, and other opportunistic infections (some fatal) have occurred in patients receiving drug. Treatment of latent TB infection reduces reactivation risk; however, active TB has developed

●

2Clinical alert

a

30

adalimumab

in patients who tested negative for latent TB. ● Before and during therapy, evaluate patients for TB risk factors and test them for latent TB infection. Begin treatment of latent TB before starting drug. During therapy, monitor patients for signs and symptoms of active TB, even if they tested negative for latent TB.

●

Action

Administration

Human immunoglobulin (Ig) G1 monoclonal antibody that binds to human tumor necrosis factor (TNF), which plays a role in inflammation and immune responses. Also modulates biological responses induced or modulated by TNF.

Availability Injection (preservative-free): 40 mg/ 0.8 ml


➣ To reduce signs and symptoms,

slow disease progression, and improve physical function of moderately to severely active rheumatoid arthritis and to reduce signs and symptoms of psoriatic arthritis Adults: 40 mg subcutaneously every other week alone or in combination with methotrexate or other disease modifying antirheumatic drugs ➣ To reduce signs and symptoms of ankylosing spondylitis Adults: 40 mg subcutaneously every other week ➣ Crohn’s disease Adults: Initially, 160 mg subcutaneously at week 0; 80 mg at week 2; then a maintenance dose of 40 mg every other week beginning at week 4. Initial dose may be given as four injections on 1 day or divided over 2 days.


Active infection, including chronic or localized infection

Precautions Use cautiously in: ● preexisting or recent onset of demyelinating disorders, immunosuppression, or lymphoma ● elderly patients ● pregnant or breastfeeding patients ● children. Give subcutaneously; rotate injection sites. ● Be aware that patients not receiving methotrexate concurrently may benefit from dosage increase to 40 mg weekly. ● Store in refrigerator and protect from light. ●

Route Subcut.

Onset Slow

Peak 75-187 hr

Duration Unknown

Adverse reactions CNS: headache, demyelinating disease CV: hypertension, arrhythmias EENT: sinusitis GI: nausea, vomiting, abdominal pain GU: urinary tract infection, hematuria Metabolic: hyperlipidemia, hypercholesterolemia Musculoskeletal: back pain Respiratory: upper respiratory tract infection Skin: rash Other: accidental injury, pain and swelling at injection site, flulike symptoms, lupuslike syndrome, fungal infection, allergic reactions, tuberculosis reactivation, malignancies

Interactions Drug-drug. Immunosuppressants (including corticosteroids): serious infection Live-virus vaccines: serious illness Drug-diagnostic tests. Alkaline phosphatase: elevated level


Canada

UK

Hazardous drug

High alert drug

adefovir dipivoxil

Patient monitoring

2Monitor for signs and symptoms of infection if patient is receiving concurrent corticosteroids or other immunosuppressants (because of risk that infection may progress). ● Monitor CBC.

Patient teaching Teach patient how to recognize and report signs and symptoms of allergic response and other adverse reactions. ● Inform patient that drug lowers resistance to infection. Instruct him to immediately report fever, cough, breathing problems, and other infection symptoms. ● Instruct patient to minimize GI upset by eating small, frequent servings of healthy food and drinking plenty of fluids. ● As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above. ●

adefovir dipivoxil Hepsera Pharmacologic class: Nucleotide reverse transcriptase inhibitor Therapeutic class: Antiviral Pregnancy risk category C

FDA BOXED WARNING Severe acute hepatitis exacerbations have occurred after drug withdrawal. Monitor hepatic function closely for at least several months in patients who discontinue drug or other anti– hepatitis B therapy; if appropriate, resume such therapy. ● Long-term therapy may cause nephrotoxicity in patients with or at ●


31

risk for underlying renal dysfunction. Monitor renal function closely and adjust dosage as needed. ● Human immunodeficiency virus (HIV) resistance may occur during therapy in patients with chronic hepatitis B infection who have unrecognized or untreated HIV infection. ● Lactic acidosis and severe hepatomegaly with steatosis (including fatal cases) may occur with use of drug alone or combined with other antiretrovirals.

Action Inhibits hepatitis B virus (HBV) DNA polymerase and suppresses HBV replication

Availability Tablets: 10 mg


➣ Chronic HBV with active viral replication plus persistent elevations in alanine aminotransferase (ALT) or aspartate aminotransferase (AST) or histologically active disease Adults: 10 mg P.O. daily Dosage adjustment ●

Renal impairment



Precautions Use cautiously in: ● lactic acidosis, renal or hepatic impairment ● elderly patients ● pregnant or breastfeeding patients ● children.

Administration Offer HIV testing before starting therapy. (Drug may increase resistance to antiretrovirals in HIV patients.) ● Give with or without food. ●

2Clinical alert

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32

adenosine

Route P.O.

Onset Rapid

Peak 0.6-4 hr

Duration Unknown

Adverse reactions CNS: headache GI: nausea, vomiting, diarrhea, abdominal pain, flatulence, dyspepsia, anorexia, pancreatitis GU: renal dysfunction Hepatic: severe hepatomegaly with steatosis, hepatitis exacerbation (if therapy is withdrawn) Metabolic: lactic acidosis Respiratory: pneumonia Other: fever, infection, pain, antiretroviral resistance in patients with unrecognized HIV

Instruct patient to drink plenty of fluids to ensure adequate urine output. ● Advise patient to monitor urine output and color and to report significant changes. ● Tell patient that drug may cause weakness. Discuss appropriate lifestyle adjustments. ● Caution patient not to take over-thecounter analgesics without prescriber’s approval. ● Inform patient that he’ll undergo regular blood testing during therapy. ● As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above. ●

Interactions Drug-drug. Acetaminophen, aspirin, indomethacin: granulocytopenia Acyclovir, adriamycin, amphotericin B, benzodiazepines, cimetidine, dapsone, doxorubicin, experimental nucleotide analogue, fluconazole, flucytosine, ganciclovir, indomethacin, interferon, morphine, phenytoin, probenecid, sulfonamide, trimethoprim, vinblastine, vincristine: increased risk of nephrotoxicity Drug-diagnostic tests. Amylase, blood glucose, blood urea nitrogen, creatine kinase, hepatic enzymes, lipase: elevated levels

Patient monitoring Monitor fluid intake and output. Watch for hematuria. ● Assess for signs and symptoms of lactic acidosis, especially in women and overweight patients. ● Check for liver enlargement. ● Monitor liver and kidney function test results. ● After therapy ends, monitor patient for evidence of serious hepatitis exacerbation. ● ●

Patient teaching Advise patient to take drug with or without food.

●

Canada

UK

adenosine Adenacor , Adenocard, Adenoscan Pharmacologic class: Endogenous nucleoside Therapeutic class: Antiarrhythmic Pregnancy risk category C

Action Converts paroxysmal supraventricular tachycardia (PSVT) to normal sinus rhythm by slowing conduction through atrioventricular (AV) node and interrupting reentry pathway. Also used as a diagnostic agent in thallium scanning.

Availability Injection: 3 mg/ml


Adenocard— ➣ PSVT, including that associated with Wolff-Parkinson-White syndrome (after attempting vagal maneuvers, when appropriate) Adults and children weighing more than 50 kg (110 lb): Initially, 6 mg by Hazardous drug

High alert drug

adenosine

rapid I.V. bolus over 1 to 2 seconds. If desired effect isn’t achieved within 1 to 2 minutes, give 12 mg by rapid I.V. bolus; may repeat 12-mg I.V. bolus dose as needed. Maximum single dosage is 12 mg. Children weighing less than 50 kg (110 lb): 0.05 to 0.1 mg/kg by rapid I.V. bolus. If this dosage proves ineffective, increase in 1 to 2 minutes by 0.05 mg/kg q 2 minutes, to a maximum single dosage of 0.3 mg/kg. Maximum single dosage is 12 mg. Adenoscan— ➣ Diagnosis of coronary artery disease in conjunction with thallium-201 myocardial perfusion scintigraphy in patients unable to exercise adequately during testing Adults: 140 mcg/kg/minute by I.V. infusion over 6 minutes, for a total dosage of 0.84 mg/kg. Required dose of thallium-201 is injected at midpoint (after first 3 minutes) of Adenoscan infusion.

Off-label uses Diagnosis of supraventricular arrhythmias ● Pulmonary hypertension ●

Contraindications ● ● ● ●

Hypersensitivity to drug Second- or third-degree AV block Sinus node disease Bronchoconstrictive lung disease

Precautions Use cautiously in: ● asthma, angina ● elderly patients ● pregnant patients ● children.

Administration Don’t administer through central line (may cause asystole). ● Don’t give more than 12 mg Adenocard as a single dose. ● Don’t dilute Adenocard. Administer Adenocard by I.V. injection as a rapid ●


33

bolus directly into vein whenever possible during cardiac monitoring. ● After administering Adenocard, flush I.V. line immediately and rapidly with normal saline solution to drive drug into bloodstream. ● Dilute a single dose of Adenoscan in sufficient normal saline solution to be given by continuous infusion over 6 minutes. Route I.V.

Onset Immediate

Peak 10 sec

Duration 20-30 sec

Adverse reactions CNS: light-headedness, dizziness, apprehension, headache, tingling in arms, numbness CV: chest pain, palpitations, hypotension, ST-segment depression, first- or second-degree AV block, atrial tachyarrhythmias, other arrhythmias EENT: blurred vision, tightness in throat GI: nausea, pressure in groin Musculoskeletal: discomfort in neck, jaw, and arms Respiratory: chest pressure, dyspnea and urge to breathe deeply, hyperventilation Skin: burning sensation, facial flushing, sweating Other: metallic taste

Interactions Drug-drug. Carbamazepine: worsening of progressive heart block Digoxin, verapamil: increased risk of ventricular fibrillation Dipyridamole: increased adenosine effect Theophylline: decreased adenosine effect Drug-food. Caffeine: decreased adenosine effect Drug-herbs. Aloe, buckthorn bark or berry, cascara sagrada, rhubarb root, senna leaf or fruits: increased adenosine effect Guarana: decreased adenosine effect 2Clinical alert

a

34

agalsidase beta

Drug-behaviors. Smoking: increased risk of tachycardia

Patient monitoring

Action Provides exogenous source of alphagalactosidase A (which is deficient in Fabry disease) and reduces deposits of globotriaosylceramide in kidney and other body tissues

Monitor heart rhythm for new arrhythmias after administering dose. ● Check vital signs. Assess for chest pain or pressure, dyspnea, and sweating. 2Watch for bronchoconstriction in patients with asthma, emphysema, or bronchitis. ● Ask patient if he has recently used aloe, buckthorn, cascara sagrada, guarana, rhubarb root, or senna. If response is positive, notify prescriber.

➣ Fabry disease Adults: 1 mg/kg I.V. q 2 weeks. Infuse no faster than 0.25 mg/minute; if tolerated, increase rate by 0.05 to 0.08 mg/ minute in subsequent infusions.

Patient teaching

Contraindications

Advise patient to report problems at infusion site. ● Tell patient he may experience 1 to 2 minutes of flushing, chest pain and pressure, and breathing difficulty during administration. Assure him that these effects will subside quickly. ● Advise patient to minimize GI upset by eating small, frequent servings of healthy food and drinking plenty of fluids. ● As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, foods, herbs, and behaviors mentioned above.

None

●

●

Availability Powder for reconstitution: 37 mg (5 mg/ ml)


Precautions Use cautiously in: ● cardiac dysfunction ● pregnant or breastfeeding patients ● children.

Administration Premedicate with antipyretics, as prescribed. ● To reconstitute, slowly inject 7.2 ml of sterile water for injection into vial; then roll and tilt vial gently to mix drug. ● Don’t shake drug, and don’t use filter needles. ● Dilute reconstituted solution with normal saline injection to a final volume of 500 ml. ● Infuse through separate I.V. line; don’t mix with other drugs. ●

agalsidase beta Fabrazyme, Fibrazyme

Route I.V.

Pharmacologic class: Homodimeric glycoprotein Therapeutic class: Recombinant human alpha-galactosidase enzyme Pregnancy risk category B

Adverse reactions

Canada

UK

Onset End of infusion

Peak 90 min

Duration Up to 5 hr

CNS: anxiety, depression, dizziness, paresthesias CV: dependent edema, chest pain, cardiomegaly Hazardous drug

High alert drug

albuterol

EENT: rhinitis, sinusitis, laryngitis, pharyngitis GI: nausea, dyspepsia GU: testicular pain Musculoskeletal: arthrosis, bone pain Respiratory: bronchitis, bronchospasm Skin: pallor Other: pain, allergic reactions, infusion reactions (hypertension, chest tightness, dyspnea, fever, rigors, hypotension, abdominal pain, pruritus, myalgia, headache, urticaria)

Interactions Drug-drug. Amiodarone, chloroquine, gentamicin, monobenzone: inhibition of intracellular agalsidase activity

35

a albuterol (salbutamol) Proventil

albuterol sulfate (salbutamol sulfate)

AccuNeb, Gen-Salbutamol, Nu-Salbutamol, Proventil HFA, Ventolin HFA, Vospire-ER Pharmacologic class: Sympathomimetic (beta2-adrenergic agonist) Therapeutic class: Bronchodilator, antiasthmatic Pregnancy risk category C

Patient monitoring Watch closely for signs and symptoms of allergic or infusion reaction. ● Monitor vital signs and fluid intake and output. Stay alert for dependent edema, blood pressure changes, and chest pain. ● Measure temperature. Watch for signs and symptoms of infection (particularly EENT and respiratory infections). ● Evaluate patient’s mood. Report significant anxiety or depression. ●

Patient teaching

2Teach patient to recognize and immediately report signs and symptoms of allergic or infusion reaction. ● Caution patient to avoid driving and other hazardous activities until he knows how drug affects mood, balance, and blood pressure. ● Advise patient to report signs and symptoms of infection (particularly EENT and respiratory infections). ● Inform patient that drug can cause depression and anxiety. Instruct him to notify prescriber if these effects occur. ● As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs mentioned above. Reactions in bold are life-threatening.

Action Relaxes smooth muscles by stimulating beta2-receptors, thereby causing bronchodilation and vasodilation

Availability Aerosol: 90 mcg/actuation Oral solution: 2 mg/5 ml Solution for inhalation: 0.083% (3 ml), 0.5% (0.5 and 20 ml), 0.63 mg/3 ml, 1.25 mg/3 ml Syrup: 2 mg/5 ml Tablets: 2 mg, 4 mg Tablets (extended-release): 4 mg, 8 mg


➣ To prevent and relieve bronchospasm in patients with reversible obstructive airway disease Adults and children ages 12 and older: Tablets—2 to 4 mg P.O. three or four times daily, not to exceed 32 mg daily. Extended-release tablets—4 to 8 mg P.O. q 12 hours, not to exceed 32 mg daily in divided doses. Syrup—2 to 4 mg (1 to 2 tsp or 5 to 10 ml) three or four times daily, not to exceed 8 mg q.i.d. Aerosol—one to two inhalations q 4 to 6 hours to relieve bronchospasm; two inhalations q.i.d. to prevent bronchospasm. Solution for 2Clinical alert

36

albuterol

inhalation—2.5 mg three to four times daily by nebulization, delivered over 5 to 15 minutes. Children ages 6 to 12: Tablets—2 mg P.O. three or four times daily; maximum daily dosage is 24 mg, given in divided doses. Extended-release tablets—4 mg q 12 hours; maximum daily dosage is 24 mg/kg given in divided doses. Syrup—2 mg (1 tsp or 5 ml) three or four times daily, not to exceed 24 mg. Children ages 2 to 12 weighing more than 15 kg (33 lb): Solution for inhalation—2.5 mg three to four times/day by nebulization Children ages 2 to 6: Syrup—Initially, 0.1 mg/kg P.O. t.i.d., not to exceed 2 mg (1 tsp) t.i.d. Maximum dosage is 4 mg (2 tsp) t.i.d. ➣ To prevent exercise-induced bronchospasm Adults and children older than age 4 (older than age 12 with Proventil): Two inhalations 15 minutes before exercise

Dosage adjustment Sensitivity to beta-adrenergic stimulants ● Elderly patients ●

Off-label uses Chronic obstructive pulmonary disease ● Hyperkalemia with renal failure ● Preterm labor management ●



Precautions Use cautiously in: ● cardiac disease, hypertension, diabetes mellitus, glaucoma, seizure disorder, hyperthyroidism, exercise-induced bronchospasm, prostatic hypertrophy ● elderly patients ● pregnant or breastfeeding patients ● children. Canada

UK

Administration Give extended-release tablets whole; don’t crush or mix with food. ● Administer solution for inhalation by nebulization over 5 to 15 minutes, after diluting 0.5 ml of 0.5% solution with 2.5 ml of sterile normal saline solution. ● Know that children weighing less than 15 kg (33 lb) who require less than 2.5 mg/dose should receive 0.5% inhalation solution. ●

Route P.O.

Onset 15-30 min

P.O. 30 min (extended)

Peak 2-3 hr

Duration 6-12 hr

2-3 hr

12 hr

Adverse reactions CNS: dizziness, excitement, headache, hyperactivity, insomnia CV: hypertension, palpitations, tachycardia, chest pain EENT: conjunctivitis, dry and irritated throat, pharyngitis GI: nausea, vomiting, anorexia, heartburn, GI distress, dry mouth Metabolic: hypokalemia Musculoskeletal: muscle cramps Respiratory: cough, dyspnea, wheezing, paradoxical bronchospasm Skin: pallor, urticaria, rash, angioedema, flushing, sweating Other: tooth discoloration, increased appetite, hypersensitivity reaction

Interactions Drug-drug. Beta-adrenergic blockers: inhibited albuterol action, possibly causing severe bronchospasm in asthmatic patients Digoxin: decreased digoxin blood level MAO inhibitors: increased cardiovascular adverse effects Oxytoxics: severe hypotension Potassium-wasting diuretics: ECG changes, hypokalemia Theophylline: increased risk of theophylline toxicity

Hazardous drug

High alert drug

aldesleukin

Drug-food. Caffeine-containing foods and beverages (such as coffee, tea, chocolate): increased stimulant effect Drug-herbs. Cola nut, ephedra (ma huang), guarana, yerba maté: increased stimulant effect

37

a aldesleukin (interleukin-2, IL-2) Proleukin

Patient monitoring

Pharmacologic class: Interleukin-2 (IL-2), human recombinant (cytokine) Therapeutic class: Antineoplastic (miscellaneous) Pregnancy risk category C

Patient teaching

FDA BOXED WARNING

2Stay alert for hypersensitivity reactions and paradoxical bronchospasm. Stop drug immediately if these occur. ● Monitor serum electrolyte levels. Tell patient to swallow extendedrelease tablets whole and not to mix them with food. 2Teach patient signs and symptoms of hypersensitivity reaction and paradoxical bronchospasm. Tell him to stop taking drug immediately and contact prescriber if these occur. 2Instruct patient to notify prescriber immediately if prescribed dosage fails to provide usual relief, because this may indicate seriously worsening asthma. ● Advise patient to limit intake of caffeine-containing foods and beverages and to avoid herbs unless prescriber approves. ● Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness. ● Advise patient to establish effective bedtime routine and to take drug well before bedtime to minimize insomnia. ● As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, foods, and herbs mentioned above. ●


Give only to patients with normal cardiac and pulmonary function, as shown by thallium stress testing and pulmonary function testing. Use extreme caution when giving to patients with normal thallium stress test and normal pulmonary function tests who have a history of cardiac or pulmonary disease. ● Give under supervision of physician experienced in cancer chemotherapy, in setting where intensive care facilities and cardiopulmonary or intensive care specialists are available. ● Drug is linked to capillary leak syndrome, which causes hypotension and reduced organ perfusion (possibly severe and resulting in death). ● Before starting drug, preexisting bacterial infections must be treated, because drug may impair neutrophil function and increase disseminated infection risk. Patients with indwelling central lines are at special risk for infection with gram-positive microorganisms. Prophylactic antibiotics can help prevent staphylococcal infections. ● Withhold drug in patients who develop moderate to severe lethargy or somnolence; continued administration may cause coma. ●

2Clinical alert

38

aldesleukin

Action Activates cellular immunity and inhibits tumor growth by increasing lymphocytes and cytokines, which lyse tumor cells

Availability Injection: 22 million international units/vial


➣ Metastatic renal cell carcinoma and metastatic melanoma Adults older than age 18: 600,000 international units/kg I.V. given over 15 minutes q 8 hours for a maximum of 14 doses, followed by 9 days of rest. Repeat for another 14 doses, for a maximum of 28 doses per course. Off-label uses ● ● ●

Colorectal cancer Kaposi’s sarcoma Non-Hodgkin’s lymphoma

Contraindications Hypersensitivity to drug Arrhythmias, cardiac tamponade, seizures, severe GI bleeding, coma or toxic psychosis lasting more than 48 hours ● Organ allograft ● Abnormal thallium stress test or pulmonary function test results ● ●

Precautions Use cautiously in: ● anemia, bacterial infections, heart disease, CNS metastases, hepatic disease, pulmonary disease, renal disease, thrombocytopenia ● pregnant or breastfeeding patients ● children.

Administration Make sure patient’s thallium stress test and pulmonary function test results are normal before giving.

●

Canada

UK

2Don’t give if patient is drowsy or severely lethargic; contact prescriber immediately. ● Reconstitute drug according to label directions with 1.2 ml of sterile water for injection by injecting diluent against side of vial (to prevent excessive foaming). ● Further dilute reconstituted dose with 50 ml of 5% dextrose injection. ● Administer I.V. infusion over 15 minutes. ● Don’t use in-line filter. Route I.V.

Onset 5 min

Peak 13 min

Duration 3-4 hr

Adverse reactions CNS: dizziness, mental status changes, syncope, sensory or motor dysfunction, headache, fatigue, rigors, weakness, malaise, poor memory, depression, sleep disturbances, hallucinations CV: bradycardia, sinus tachycardia, premature atrial complexes, premature ventricular contractions, arrhythmias, myocardial ischemia, cardiac arrest, capillary leak syndrome and severe hypotension, myocardial infarction EENT: reversible vision changes, conjunctivitis GI: nausea, vomiting, diarrhea, constipation, dyspepsia, abdominal pain, stomatitis, anorexia, intestinal perforation, ileus, GI bleeding GU: hematuria, proteinuria, dysuria, renal failure, oliguria or anuria Hematologic: anemia, purpura, eosinophilia, thrombocytopenia, coagulation disorders, leukopenia, leukocytosis Hepatic: jaundice, ascites Metabolic: hyperglycemia, hypoglycemia, acidosis, alkalosis Musculoskeletal: joint and back pain, myalgia Respiratory: cough, chest pain, tachypnea, wheezing, dyspnea, pulmonary congestion, pulmonary

Hazardous drug

High alert drug

alemtuzumab

edema, respiratory failure, apnea, pleural effusion Skin: erythema, pruritus, rash, dry skin, petechiae, urticaria, exfoliative dermatitis Other: weight gain or loss, fever, chills, edema, infection, pain or reaction at injection site, hypersensitivity reaction

Interactions Drug-drug. Aminoglycosides, asparaginase, cytotoxic chemotherapy agents, doxorubicin, indomethacin, methotrexate: increased toxicity Antihypertensives: increased hypotensive effect Glucocorticoids: reduced antitumor effects Drug-diagnostic tests. Alkaline phosphatase, bilirubin, glucose, blood urea nitrogen, creatinine, potassium, transaminases: increased levels Calcium, glucose, magnesium, phosphorus, potassium, protein sodium, uric acid: decreased levels

39

Instruct patient to minimize GI upset by eating small, frequent servings of food and drinking plenty of fluids. ● Provide dietary counseling. Refer patient to dietitian if adverse GI effects significantly limit food intake. ● Notify patient that he’ll undergo blood testing and have chest X-rays taken during therapy. ● As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above. ●

alemtuzumab Campath, MabCampath Pharmacologic class: Monoclonal antibody Therapeutic class: Antineoplastic Pregnancy risk category C

Patient monitoring Monitor heart rate and rhythm, vital signs, and fluid intake and output. ● Assess for signs and symptoms of hypersensitivity reaction and infection. ● Monitor for adverse CNS effects. Report these immediately. ● Evaluate chest X-rays. ● Monitor CBC, electrolyte levels, and liver and kidney function test results. ●

Patient teaching

2Tell patient that drug lowers resistance to infections. Advise him to immediately report fever, cough, breathing problems, and other signs or symptoms of infection. 2Advise patient to immediately report chest pain, irregular or fast heart beats, easy bruising or bleeding, or abdominal pain.


FDA BOXED WARNING Give under supervision of physician experienced in cancer chemotherapy. ● Drug may cause hematologic toxicity. Serious, and rarely fatal, cases of pancytopenia, thrombocytopenia, and autoimmune hemolytic anemia have occurred. Don’t give single doses exceeding 30 mg or cumulative doses exceeding 90 mg/week, because these increase pancytopenia risk. ● Drug may cause serious infusion reactions. Monitor patient carefully during infusion; if indicated, discontinue. Escalate dosage gradually to recommended maintenance dose when initiating therapy and if therapy is interrupted for 7 or more days. ● Serious and sometimes fatal bacterial, viral, fungal, and protozoan infections have occurred. Prophylaxis against Pneumocystis carinii pneumonia and ●

2Clinical alert

a

40

alemtuzumab

herpesvirus infections has decreased but not eliminated such infections.

Action Binds to CD52 antigen on surface of B- and T-lymphocytes, monocytes, macrophages, “natural killer” cells, and granulocytes. Lyses leukemic cells and reduces tumor size.

Availability Solution for injection: 30 mg/3 ml


➣ Chronic lymphocytic (B-cell) leukemia when fludarabine therapy fails Adults: Initially, 3 mg/day I.V. given over 2 hours; if tolerated, increase to 10 mg/day, to a maximum single dose of 30 mg/day. Then give a maintenance dose of 30 mg three times weekly on nonconsecutive days (such as Monday, Wednesday, Friday) for up to 12 weeks. Dosage adjustment ●

Hematologic toxicity

Contraindications Type I hypersensitivity or anaphylactic reaction to drug or its components ● Active systemic infection ● Immunodeficiency (as in human immunodeficiency virus infection) ●

Route I.V.

Onset Unknown

Peak Unknown

Duration Unknown

Adverse reactions CNS: tremor, malaise, dizziness, depression, insomnia, drowsiness, weakness, headache, abnormal sensations, fatigue CV: peripheral edema, chest pain, hypotension, hypertension, tachycardia, supraventricular tachycardia EENT: rhinitis, pharyngitis, epistaxis GI: nausea, vomiting, constipation, diarrhea, dyspepsia, abdominal pain, stomatitis, anorexia Hematologic: anemia, thrombocytopenia, pancytopenia, bone marrow hypoplasia, neutropenia, bone marrow depression Metabolic: hypokalemia, hypomagnesemia Musculoskeletal: myalgia, bone or back pain Respiratory: cough, bronchitis, dyspnea, pneumonitis, bronchospasm Skin: herpes simplex infection, urticaria, pruritus, diaphoresis Other: edema, fever, candidiasis, infection, infusion-related reactions, sepsis

Interactions

Precautions Use cautiously in: ● pregnant or breastfeeding patients ● children.

Administration

2Withhold drug and contact prescriber if patient has signs or symptoms of systemic infection at time of scheduled infusion. 2Don’t give by I.V. push or bolus. ● Withdraw dose from ampule and filter with sterile, low-protein-binding, 5-micron filter. Canada

Dilute with 100 ml of normal saline solution or dextrose 5% in water. ● Infuse over 2 hours. ● Protect I.V. solution from light. ●

UK

Drug-drug. Live-virus vaccines: decreased drug efficacy and increased adverse effects Drug-diagnostic tests. CD4+ T lymphocytes, hematocrit, hemoglobin, lymphocytes, neutrophils, platelets, red blood cells, white blood cells: decreased values

Patient monitoring Assess for hypotension during infusion. Monitor vital signs frequently throughout entire course of therapy. ● Monitor CBC, CD4+ level, electrolyte levels, and platelet count. ● ●

Hazardous drug

High alert drug

alendronate sodium

Patient teaching

2Inform patient that drug lowers resistance to infection. Instruct him to immediately report fever, cough, breathing problems, sore throat, and other signs or symptoms. 2Tell patient to immediately report irregular or fast heart beats or easy bruising or bleeding. ● Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness. ● Advise patient to minimize GI upset by eating small, frequent servings of food and drinking plenty of fluids. ● Instruct patient to follow regular bedtime routine and avoid bedtime stimulants. ● Encourage patient to discuss activity recommendations and pain management with prescriber. ● Inform patient that he’ll undergo regular blood testing during therapy. ● As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.

41

blocking dissolution of hydroxyapatite crystal of bone

Availability Oral solution: 70 mg/75 ml in singledose bottles Tablets: 5 mg, 10 mg, 35 mg, 40 mg, 70 mg


➣ Paget’s disease of bone (men and women) Adults: 40 mg P.O. daily for 6 months ➣ Prevention of osteoporosis in postmenopausal women Adults: 5 mg P.O. daily or 35 mg P.O. once weekly for up to 7 years ➣ Glucocorticoid-induced osteoporosis in men and women Adults: 5 mg P.O. daily. For postmenopausal women not receiving estrogen, recommended dosage is 10 mg P.O. once daily. ➣ Treatment of osteoporosis in postmenopausal women; treatment to increase bone mass in men with osteoporosis Adults: 70-mg tablet or 70 mg oral solution P.O. weekly or 10-mg tablet P.O. daily Contraindications Hypersensitivity to drug or its components ● Hypocalcemia ● Esophageal abnormalities such as stricture or achalasia, that delay esophageal emptying ● Inability to stand or sit upright for 30 minutes ● Increased risk of aspiration (oral solution) ●

alendronate sodium Apo-Alendronate, Co Alendronate, Dom-Alendronate Fosamax, Gen-Alendronate, RatioAlendronate, Sandoz Alendronate Pharmacologic class: Bisphosphonate Therapeutic class: Bone-resorption inhibitor Pregnancy risk category C

Action Impedes bone resorption by inhibiting osteoclast activity, absorbing calcium phosphate crystal in bone, and directly Reactions in bold are life-threatening.

Precautions Use cautiously in: ● Severe renal insufficiency (creatinine clearance less than 35 ml/minute), esophageal disease, GI ulcers, gastritis, osteonecrosis of jaw ● pregnant or breastfeeding patients ● children. 2Clinical alert

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42

alfuzosin

Administration Give with 6 to 8 oz of water 30 minutes before first food, beverage, or medication of day. ● Don’t give at bedtime or before patient arises for the day. ● Don’t give food, other beverages, or oral drugs for at least 30 minutes after giving tablets. ● Keep patient upright for at least 30 minutes after giving dose to avoid serious esophageal irritation. ● Follow oral solution with at least 60 ml (2 oz) of water to facilitate gastric emptying. ● Be aware that patients should receive supplemental calcium and vitamin D if dietary intake is inadequate. ● Be aware that aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) may worsen GI upset. Discuss alternative analgesics with prescriber. ●

Route P.O.

Onset 1 mo

Peak 3-6 mo

Duration 3 wk-7 mo

Adverse reactions CNS: headache CV: hypertension GI: nausea, vomiting, diarrhea, constipation, abdominal pain, acid regurgitation, esophageal ulcer, flatulence, dyspepsia, abdominal distention, dysphagia GU: urinary tract infection Hematologic: anemia Metabolic: hypomagnesemia, hypophosphatemia, hypokalemia, fluid overload Musculoskeletal: bone or muscle pain Skin: rash, redness, photosensitivity Other: abnormal taste

Interactions Drug-drug. Antacids, calcium supplements: decreased alendronate absorption NSAIDs, salicylates: increased risk of GI upset Ranitidine: increased alendronate effect Canada

UK

Drug-diagnostic tests. Calcium, phosphate: decreased levels Drug-food. Any food, caffeine (as in coffee, tea, cocoa), mineral water, orange juice: decreased drug absorption

Patient monitoring Monitor for signs and symptoms of GI irritation, including ulcers. ● Monitor blood pressure. ● Evaluate blood calcium and phosphate levels. ●

Patient teaching

2Tell patient to immediately report serious vomiting, severe chest or abdominal pain, difficulty swallowing, or abdominal swelling. ● Instruct patient to take tablets first thing in the morning on an empty stomach, with 6 to 8 oz of water only. ● Instruct patient to follow oral solution with at least 60 ml (2 oz) of water. ● Tell patient not to lie down, eat, drink, or take other oral medications for 30 minutes after taking dose. ● Advise patient to take only those pain relievers suggested by prescriber. Inform him that some over-the-counter pain medications (such as aspirin and NSAIDs) may worsen drug’s adverse effects. ● As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and foods mentioned above.

alfuzosin Besavar , Uroxatral, Xatral Pharmacologic class: Alpha1-adrenergic receptor blocker Therapeutic class: Benign prostatic hyperplasia agent Pregnancy risk category B Hazardous drug

High alert drug

aliskiren

Action Selectively inhibits alpha1-adrenergic receptors in lower urinary tract, relaxing smooth muscle in bladder neck and prostate

Availability Tablets (extended-release): 10 mg


➣ Signs and symptoms of benign prostatic hyperplasia Adults: 10 mg P.O. once daily with food, given at same meal each day Contraindications

Hypersensitivity to drug or its components ● Moderate or severe hepatic impairment ● Concomitant use of potent CYP4503A4 inhibitors (such as itraconazole, ketoconazole, or ritonavir) ●

Precautions Use cautiously until prostate cancer is ruled out. Also use cautiously in: ● coronary, hepatic, or renal insufficiency ● congenital or acquired QT prolongation.

Administration ● ●

Administer with food. Don’t crush or break tablet.

Route P.O.

Onset Unknown

Peak 8 hr

Duration Unknown

Adverse reactions CNS: dizziness, headache, fatigue EENT: sinusitis, pharyngitis GI: nausea, constipation, abdominal pain, dyspepsia Respiratory: upper respiratory tract infection, bronchitis Other: pain

Interactions Drug-drug. Atenolol, cimetidine, diltiazem, itraconazole, ketoconazole, ritonavir: increased alfuzosin blood level Reactions in bold are life-threatening.

43

Drug-food. Any food: increased alfuzosin absorption

Patient monitoring Monitor patient for adverse reactions, such as dizziness.

●

Patient teaching Instruct patient to take drug with food at same time each day. ● Tell patient not to break, chew, or crush tablet. ● Caution patient to avoid driving and other hazardous activities until he knows if drug makes him dizzy. ● As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs and foods mentioned above. ●

aliskiren Tekturna Pharmacologic class: Direct renin inhibitor Therapeutic class: Antihypertensive Pregnancy risk category C (first trimester), D (second and third trimesters)

FDA BOXED WARNING When used during second or third trimester of pregnancy, drug may cause fetal injury and death. Discontinue as soon as possible when pregnancy is detected. ●

Action Decreases plasma renin activity and inhibits conversion of angiotensinogen to angiotensin

Availability Tablets: 150 mg, 300 mg 2Clinical alert

a

44

alitretinoin

Indications and dosages

None

Irbesartan: reduced aliskiren C and AUC up to 50% after multiple doses Drug-diagnostic tests. BUN, creatine kinase, potassium, serum creatinine, serum uric acid: increased values Hematocrit, hemoglobin: decreased values Drug-food. High-fat meals: decreased drug absorption

Precautions

Patient monitoring

Use cautiously in: ● patients with severe renal dysfunction, nephrotic syndrome, renovascular hypertension, or history of dialysis ● diabetic patients (when combined with ACE inhibitors) because of hyperkalemia risk ● angioedema (laryngeal edema) ● females of childbearing age ● pregnant or breastfeeding patients ● children (safety and efficacy not established).

●

➣ Hypertension (alone or in combi-

nation with other antihypertensives) Adults: Initially, 150 mg P.O. once daily; may increase to 300 mg if blood pressure isn’t adequately controlled

Contraindications

Administration Give consistently with or without food, but not with high-fat foods.

●

Route P.O.

Onset Unknown

Peak 1-3 hr

Duration Unknown

Monitor routinely for hyperkalemia in patients with diabetes mellitus receiving concurrent ACE inhibitors. ● Stay alert for signs and symptoms of renal dysfunction. ● Monitor patient for angioedema; discontinue drug if signs and symptoms occur.

Patient teaching Instruct patient to take drug consistently with or without food, but not with high-fat foods. ● Advise female to tell prescriber if she’s pregnant or breastfeeding before taking drug. ● As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs, tests, and foods mentioned above. ●

Adverse reactions CNS: headache, fatigue CV: dizziness, hypotension EENT: nasopharyngitis GI: diarrhea, gastroesophageal reflux Musculoskeletal: back pain Respiratory: upper respiratory tract infection, cough Skin: rash Other: edema, angioedema

Interactions Drug-drug. Atorvastatin: increased aliskiren C and area under the curve (AUC) after multiple doses Furosemide: diminished furosemide efficacy Ketoconazole: increased aliskiren blood level Canada

UK

alitretinoin Panretin Pharmacologic class: Secondgeneration retinoid Therapeutic class: Topical antineoplastic Pregnancy risk category D

Action Binds to and activates intracellular retinoid receptor subtypes, regulating expression of genes that control cellular differentiation and proliferation Hazardous drug

High alert drug

allopurinol

Availability

Patient monitoring

Topical gel: 0.1%

●


➣ Treatment of cutaneous lesions in patients with AIDS-related Kaposi’s sarcoma Adults: Apply to lesions b.i.d., gradually increasing to t.i.d. or q.i.d. according to individual lesion tolerance Contraindications Hypersensitivity to retinoids or other drug components

●

Precautions Use cautiously in: ● photosensitivity ● concomitant use of insecticides containing diethyltoluamide (DEET) ● elderly patients ● pregnant or breastfeeding patients ● children.

Administration Apply generous amount of gel to affected area. Let it dry for 3 to 5 minutes before covering with clothing.

●

Route Topical

Onset Unknown

Peak Unknown

Duration Unknown

45

Monitor patient for serious adverse effects, especially burns caused by exposure to sunlight or sun lamps.

Patient teaching Instruct patient to apply generous amount of gel to affected skin area and let dry for 3 to 5 minutes before covering area with clothing. ● Caution patient to avoid applying gel to mucous membranes or to normal skin surrounding lesions. 2Inform patient that drug increases sensitivity to sunlight and that exposure to sunlight or sun lamps (even through window glass or on a cloudy day) may cause serious burn of treated areas. Caution him to avoid such exposure. ● Tell patient to avoid insect repellents containing DEET during therapy. ● Emphasize importance of keeping all medical appointments so prescriber can check progress and monitor for unwanted drug effects. ● Advise females of child-bearing potential to avoid becoming pregnant while using this drug. ● As appropriate, review all other significant adverse reactions and interactions, especially those related to the behaviors mentioned above. ●

Adverse reactions CNS: paresthesia Skin: rash, pruritus, exfoliative dermatitis, skin disorder at application site (such as abrasion, burning, blisters, excoriation, scab, cracking, crusting, drainage, eschar, fissure, oozing, peeling, redness, or swelling), edema Other: pain, increased sensitivity to sunlight or sun lamps

Interactions Drug-behaviors. DEET-containing insect repellents: increased adverse reactions to DEET


allopurinol Apo-Allopurinol, Caplenol , Cosuric , Nu-purol, Rimapurinol , Zyloprim, Zyloprim

allopurinol sodium Aloprim Pharmacologic class: Xanthine oxidase inhibitor Therapeutic class: Antigout drug Pregnancy risk category C 2Clinical alert

a

46

allopurinol

Action

Precautions

Inhibits conversion of xanthine to uric acid and increases reutilization of hypoxanthine and xanthine for nucleic acid synthesis, thereby decreasing uric acid levels in both serum and urine

Use cautiously in: ● acute gout attack, renal insufficiency, dehydration ● pregnant or breastfeeding patients.

Administration Availability


➣ Gout in patients with frequent disabling attacks; gout resulting from hyperuricemia, acute or chronic leukemia, psoriasis, or multiple myeloma Adults: 200 to 300 mg P.O. daily in mild cases or 400 to 600 mg P.O. daily in severe cases, to a maximum dosage of 800 mg/day; or 200 to 400 mg/m2/ day I.V. as a single infusion or in equally divided doses q 6, 8, or 12 hours to a maximum dosage of 600 mg/day Children ages 6 to 10: 300 mg P.O. daily Children younger than age 6: 150 mg P.O. daily ➣ To prevent acute gout attacks Adults: 100 mg P.O. daily; increase by 100 mg at weekly intervals without exceeding maximum dosage of 800 mg, until uric acid level falls to 6 mg/dl or less ➣ Recurrent calcium oxalate calculi Adults: 200 to 300 mg P.O. daily in single dose or divided doses ➣ To prevent uric acid nephropathy during cancer chemotherapy Adults: 600 to 800 mg P.O. daily for 2 to 3 days, accompanied by high fluid intake Dosage adjustment ●

Renal impairment

Off-label uses Hematemesis caused by gastritis induced by nonsteroidal anti-inflammatory drugs ● Pain from acute pancreatitis ● Seizures refractory to standard therapy ●



Canada

Reconstitute single-dose vial with 25 ml sterile water for injection. Further dilute with normal saline solution or D5W to a concentration of 6 mg/ml or less. ● Infuse over 30 to 60 minutes. ● Don’t mix I.V. form with other drugs or give through same I.V. port as drugs that may be incompatible. ● Divide oral doses larger than 300 mg. ● Give oral form with or right after meals. ● Don’t give oral form with mineral water, orange juice, or caffeinated beverages. ●

Powder for injection: 500-mg vial Tablets: 100 mg, 300 mg

UK

Route P.O.

Onset 2-3 days

Peak 0.5-2 hr

Duration 1-2 wk

I.V.

Unknown

0.5 hr

Unknown

Adverse reactions CNS: drowsiness, dizziness, headache, peripheral neuropathy, neuritis, paresthesia CV: hypersensitivity vasculitis, necrotizing vasculitis EENT: retinopathy, cataract, epistaxis GI: nausea, vomiting, diarrhea, abdominal pain, dyspepsia, gastritis GU: exacerbation of gout and renal calculi, uremia, renal failure Hematologic: eosinophilia, anemia, thrombocytopenia, bone marrow depression, agranulocytosis, leukocytosis, aplastic anemia, leukopenia Hepatic: cholestatic jaundice, hepatomegaly, hepatitis, hepatic necrosis Musculoskeletal: myopathy, joint pain Skin: rash; alopecia; maculopapular, urticarial, or purpuric lesions; severe furunculosis of nose; ichthyosis; bruising; scaly or exfoliative erythema multiforme; toxic epidermal necrolysis Hazardous drug

High alert drug

almotriptan malate

Other: abnormal taste, loss of taste, fever, chills

Interactions Drug-drug. Amoxicillin, ampicillin, bacampicillin: increased risk of rash Anticoagulants (except warfarin): increased anticoagulant effect Antineoplastics: increased risk of myelosuppression Azathioprine, mercaptopurine: inhibition of allopurinol metabolism Chlorpropamide: increased hypoglycemic effects Diazoxide, diuretics, mecamylamine, pyrazinamide: increased uric acid levels Ethacrynic acid, thiazide diuretics: increased risk of allopurinol toxicity Uricosurics: increased uric acid excretion Urine-acidifying drugs (ammonium chloride, ascorbic acid, potassium or sodium phosphate): increased risk of renal calculi Xanthines: increased theophylline levels Drug-diagnostic tests. Alanine aminotransferase, alanine phosphatase, aspartate aminotransferase, bilirubin, eosinophils: increased levels Granulocytes, hemoglobin, platelets, white blood cells: decreased levels Drug-food. Caffeine-containing beverages and foods, mineral water, orange juice: decreased drug absorption, increased uric acid level Drug-behaviors. Alcohol use: increased uric acid level

Patient monitoring Assess fluid intake and output. Intake should be sufficient to yield daily output of at least 2 L of slightly alkaline urine. ● Monitor uric acid level to help evaluate drug efficacy.

47

Tell patient to take drug with food or milk, exactly as prescribed. ● Explain that gout attacks may not ease significantly until 2 to 6 weeks of therapy. ● Caution patient to avoid driving and other hazardous tasks until he knows how drug affects concentration and alertness. ● Advise patient to avoid alcohol, caffeine-containing beverages and foods, mineral water, and orange juice during therapy. ● As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, and behaviors mentioned above. ●

almotriptan malate Axert Pharmacologic class: Serotonin (5-hydroxytryptamine [5-HT]) receptor agonist Therapeutic class: Vascular headache suppressant, antimigraine drug Pregnancy risk category C

Action Promotes vascular constriction and relieves migraine by stimulating specific 5-HT receptors in intracranial blood vessels and sensory trigeminal nerves

●

Patient teaching

2Instruct patient to promptly report painful urination, bloody urine, rash, eye irritation, or swelling of lips and mouth. Reactions in bold are life-threatening.

Availability Tablets: 6.25 mg, 12.5 mg


➣ Acute migraine Adults: Single dose of 6.25 to 12.5 mg P.O. at first sign or symptom of migraine; may be repeated after 2 hours. Don’t exceed two doses in a 24-hour period. 2Clinical alert

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48

almotriptan malate


Severe renal or hepatic impairment

Contraindications Hypersensitivity to drug Ischemic heart disease, history of myocardial infarction (MI), documented silent ischemia, symptoms or findings consistent with ischemic heart disease, cerebrovascular accident, uncontrolled hypertension, coronary artery vasospasm ● Ischemic bowel disease ● Basilar or hemiplegic migraine ● MAO inhibitor use in past 14 days ● Use of other 5-HT agonists or ergotamine-containing or ergot-type drugs within past 24 hours ● ●

Precautions Use cautiously in: ● impaired renal or hepatic function ● cardiovascular risk factors ● pregnant or breastfeeding patients ● children younger than age 18 (use not recommended).

Administration Give with or without food. Wait at least 2 hours after initial dose before giving repeat dose. ● Don’t exceed two doses in 24 hours. 2Don’t give within 14 days of MAO inhibitors or within 24 hours of other 5-HT agonists or ergotamine-containing or ergot-type drugs.

EENT: vision changes; nasal, throat, and mouth discomfort GI: nausea, abdominal distress, dysphagia, dry mouth Musculoskeletal: weakness, stiff neck, muscle pain Respiratory: chest tightness or pressure Skin: sweating, flushing

Interactions Drug-drug. CYP2D6 inhibitors (erythromycin, itraconazole, ritonavir): increased almotriptan effect Ergot derivatives, other 5-HT agonists: prolonged vasoactive action Ketoconazole and other CYP3A inhibitors: increased almotriptan blood level, leading to toxicity MAO inhibitors: decreased almotriptan absorption Selective serotonin reuptake inhibitors: weakness, hyperreflexia, poor coordination

Patient monitoring Assess patient’s cardiovascular status, noting chest tightness or pressure. ● Monitor vital signs. ●

● ●

Route P.O.

Onset Variable

Peak 1-3 hr

Duration Unknown

Adverse reactions CNS: headache, anxiety, dizziness, fatigue, malaise, weakness, cold or hot sensations, sedation, numbness, burning or tingling sensations CV: blood pressure changes, palpitations, tachycardia, coronary artery vasospasm, MI, ventricular fibrillation, ventricular tachycardia Canada

UK

Patient teaching

2Tell patient to immediately report chest tightness or pressure. ● Inform patient that he may take drug with or without food. ● If second dose is needed, tell patient to take it at least 2 hours after first. ● Caution patient not to take more than two doses in 24 hours. ● Instruct patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness. ● As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs mentioned above.

Hazardous drug

High alert drug

alosetron hydrochloride

alosetron hydrochloride Lotronex Pharmacologic class: Serotonin receptor antagonist Therapeutic class: Agent for irritable bowel syndrome Pregnancy risk category B

49

abnormalities and who are unresponsive to conventional therapy Adult women: Initially, 0.5 mg P.O. b.i.d. If after 4 weeks dose is well tolerated but doesn’t adequately control IBS, may increase to 1 mg P.O. b.i.d.; therapy should be discontinued in patients not responding to 1 mg P.O. b.i.d. after 4 weeks.

Contraindications Concurrent use of fluvoxamine Severe hepatic impairment ● Current constipation or history of chronic or severe constipation ● History of complications related to constipation ● History of intestinal obstruction, stricture, toxic megacolon, GI perforation, or adhesion ● History of ischemic colitis, impaired intestinal circulation, thrombophlebitis, or hypercoagulable state ● Current Crohn’s disease or ulcerative colitis, active diverticulitis, or history of these disorders ● Inability to understand or comply with patient-physician agreement for drug ● ●

FDA BOXED WARNING Infrequent but serious GI problems have occurred, resulting in hospitalization and, rarely, blood transfusions, surgery, and death. ● Only physicians enrolled in GlaxoSmithKline’s Prescribing Program for Lotronex should prescribe Lotronex. ● Drug is indicated only for women with severe, diarrhea-predominant irritable bowel syndrome who don’t respond adequately to conventional therapy. Patient must read and sign agreement before receiving initial prescription. ● Discontinue immediately if patient develops constipation or ischemic colitis symptoms. Don’t resume therapy in patients who developed ischemic colitis. Patients with resolved constipation should resume only on advice of physician. ●

Action Inhibits activation of nonselective cation channels, resulting in modulation of enteric nervous system

Availability Tablets: 0.5 mg, 1 mg


➣ Women with severe, diarrheapredominant irritable bowel syndrome (IBS) who have chronic symptoms not caused by anatomic or biochemical Reactions in bold are life-threatening.

Precautions Use cautiously in: ● hepatic insufficiency ● moderate CYP/A2 inhibitors, such as quinolone antibiotics and cimetidine (avoid use) ● elderly patients ● pregnant or breastfeeding patients ● children.

Administration

2Before administering, know that drug is approved with the following marketing restrictions: Ensure that patient understands that drug has serious risks, patient reads and signs patient-physician agreement, and patient follows directions in accompanying medication guide.

2Clinical alert

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50

alprazolam

Know that anatomical and biochemical abnormalities of GI tract should be ruled out before drug therapy starts. ● Give with or without food. 2Don’t administer drug if patient is constipated. 2Stop therapy immediately if patient develops constipation or signs or symptoms of ischemic colitis. ●

Route P.O.

Onset Rapid

Peak 1 hr

Duration Unknown

Adverse reactions CNS: anxiety, malaise CV: increased blood pressure, extrasystoles, tachyarrhythmias, arrhythmias GI: nausea; constipation; GI pain, discomfort, or spasms; abdominal distention; regurgitation or gastroesophageal reflux; hemorrhoids; decreased salivation; dyspepsia; ischemic colitis; GI perforation; small-bowel mesenteric ischemia GU: urinary frequency Hematologic: hemorrhage Respiratory: breathing disorders Skin: sweating, urticaria Other: fatigue, cramps, disturbed temperature regulation

Interactions

patient-physician agreement, and that she follows directions in accompanying medication guide. ● Tell patient to take drug exactly as prescribed, with or without food. 2Instruct patient to contact prescriber immediately if she develops constipation or symptoms of insufficient blood flow to bowel (such as new or worsening pain in bowels or bloody bowel movements). ● As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.

alprazolam Apo-Alpraz, Niravam, NovoAlprazol, Nu-Alpraz, Xanax, Xanax TS, Xanax XR Pharmacologic class: Benzodiazepine Therapeutic class: Anxiolytic Controlled substance schedule IV Pregnancy risk category D

Drug-drug. CYP450 inducers or inhibitors: altered alosetron clearance Fluvoxamine: increased alosetron concentration and half-life Drug-diagnostic tests. Blood glucose, calcium, phosphate: increased or decreased level

Action

Patient monitoring

Solution: 1 mg/ml Tablets (extended-release): 0.5 mg, 1 mg, 2 mg, 3 mg Tablets (immediate-release): 0.25 mg, 0.5 mg, 1 mg, 2 mg Tablets (orally disintegrating): 0.25 mg, 0.5 mg, 1 mg, 2 mg

2Monitor patient closely for adverse reactions, especially such GI reactions as constipation and signs or symptoms of ischemic colitis.

Patient teaching

2Make sure patient knows about drug’s marketing restrictions, which stipulate that she understands drug has serious risks, that she reads and signs Canada

UK

Unclear. Thought to act at limbic, thalamic, and hypothalamic levels of CNS to produce sedative, anxiolytic, skeletal muscle relaxant, and anticonvulsant effects.

Availability


➣ Anxiety disorders Hazardous drug

High alert drug

alprazolam

Adults: Initially, 0.25 to 0.5 mg P.O. t.i.d. Maximum dosage is 4 mg daily in divided doses. Elderly patients: Initially, 0.25 mg P.O. two or three times daily. Maximum dosage is 4 mg daily in divided doses. ➣ Panic disorders Adults: Immediate-release or orally disintegrating tablets—Initially, 0.5 mg P.O. t.i.d. Extended-release tablets—Initially, 0.5 to 1 mg P.O. daily. Usual dosage is 3 to 6 mg daily, with a maximum dosage of 10 mg daily. For all dosage forms, increase by a maximum of 1 mg daily at intervals of 3 to 4 days, with a maximum of 10 mg daily in divided doses.


Hepatic impairment

Off-label uses ● ● ●

Agoraphobia Depression Premenstrual syndrome

Contraindications ● ● ● ●

Hypersensitivity to benzodiazepines Narrow-angle glaucoma Labor and delivery Pregnancy or breastfeeding

Precautions Use cautiously in: ● hepatic dysfunction ● history of attempted suicide or drug dependence ● elderly patients.

Administration Don’t give with grapefruit juice. Make sure patient swallows extended-release tablets whole without chewing or crushing. ● Mix oral solution with liquids or semisolid foods and instruct patient to consume entire amount immediately. ● Administer orally disintegrating tablets by placing tablet on patient’s tongue. If only one-half of scored tablet is used, discard unused portion immediately.

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2Don’t withdraw drug suddenly. Seizures and other withdrawal symptoms may occur unless dosage is tapered carefully. Route P.O.

Onset 30 min

Peak 1-2 hr

Duration 4-6 hr

Adverse reactions CNS: dizziness, drowsiness, depression, fatigue, light-headedness, disorientation, anger, hostility, euphoria, hypomanic episodes, restlessness, confusion, crying, delirium, headache, stupor, rigidity, tremor, paresthesia, vivid dreams, extrapyramidal symptoms CV: bradycardia, tachycardia, hypertension, hypotension, palpitations, CV collapse EENT: blurred or double vision, nystagmus, nasal congestion GI: gastric disorders, dysphagia, anorexia, increased salivation, dry mouth GU: menstrual irregularities, urinary retention, urinary incontinence, libido changes, gynecomastia Hematologic: blood dyscrasias such as eosinophilia, agranulocytosis, leukopenia, and thrombocytopenia Hepatic: hepatic dysfunction (including hepatitis) Musculoskeletal: muscle rigidity, joint pain Skin: dermatitis, rash, pruritus, urticaria, increased sweating Other: weight loss or gain, hiccups, fever, edema, psychological drug dependence, drug tolerance

● ●


Interactions Drug-drug. Antidepressants, antihistamines, opioids, other benzodiazepines: increased CNS depression Barbiturates, rifampin: increased metabolism and decreased efficacy of alprazolam Cimetidine, disulfiram, erythromycin, fluoxetine, hormonal contraceptives, isoniazid, ketoconazole, metoprolol, propoxyphene, propranolol, valproic 2Clinical alert

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alteplase

acid: decreased metabolism and increased action of alprazolam Digoxin: increased risk of digoxin toxicity Levodopa: decreased antiparkinsonian effect Theophylline: increased sedative effect Tricyclic antidepressants (TCAs): increased TCA blood levels Drug-diagnostic tests. Itraconazole, ketoconazole: increased alprazolam plasma level Drug-food. Grapefruit juice: decreased drug metabolism and increased blood level Drug-herbs. Chamomile, hops, kava, skullcap, valerian: increased CNS depression Drug-behaviors. Alcohol use: increased CNS depression Smoking: decreased alprazolam efficacy

Patient monitoring Watch for excessive CNS depression if patient is concurrently taking antidepressants, other benzodiazepines, antihistamines, or opioids. ● If patient is taking TCAs concurrently, watch for increase in adverse TCA effects. ● Monitor CBC and liver and kidney function test results. ● Monitor vital signs and weight. ● Report signs of drug abuse, including frequent requests for early refills. ●

alteplase (tissue plasminogen activator, recombinant) Actilyse , Activase, Activase rt-PA, Cathflo Activase Pharmacologic class: Plasminogen activator Therapeutic class: Thrombolytic Pregnancy risk category C

Action Converts plasminogen to plasmin, which in turn breaks down fibrin and fibrinogen, thereby dissolving thrombus

Availability

Patient teaching Instruct patient to swallow extendedrelease tablets whole without crushing or chewing. 2Tell patient that drug may make him more depressed, angry, or hostile. Urge him to contact prescriber immediately if he thinks he’s dangerous to himself or others. ● Inform patient that drug may cause tremors, muscle rigidity, and other movement problems. Advise him to report these effects to prescriber. ●

Canada

2Caution patient not to stop taking drug suddenly. Withdrawal symptoms, including seizures, may occur unless drug is tapered carefully. ● Advise patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness. ● As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, herbs, and behaviors mentioned above.

UK

Injection: 2-mg single-patient vials; 50-mg, 100-mg vials


➣ Lysis of thrombi obstructing coronary arteries in acute myocardial infarction (MI) 3-hour infusion— Adults: 100 mg I.V. over 3 hours as follows: 60 mg over first hour (give 6 to 10 mg as bolus over first 1 to 2 minutes), then 20 mg I.V. over second hour, then 20 mg I.V. over third hour Hazardous drug

High alert drug

alteplase

Adults weighing less than 65 kg (143 lb): 1.25 mg/kg I.V. in divided doses over 3 hours, not to exceed 100 mg Accelerated infusion— Adults weighing more than 67 kg (147 lb): Give total dosage of 100 mg as follows: 15 mg I.V. bolus over 1 to 2 minutes, then 50 mg I.V. over next 30 minutes, then 35 mg I.V. over next 60 minutes. Adults weighing 67 kg (147 lb) or less: 15 mg I.V. bolus over 1 to 2 minutes, followed by 0.75 mg/kg I.V. over next 30 minutes (not to exceed 50 mg), followed by 0.5 mg/kg I.V. over next hour, not to exceed 35 mg ➣ Acute ischemic cerebrovascular accident (CVA) Adults: 0.9 mg/kg I.V. over 1 hour, to a maximum dosage of 90 mg, with 10% of total dosage given as I.V. bolus within first minute ➣ Acute massive pulmonary embolism Adults: 100 mg I.V. over 2 hours, followed by heparin ➣ Restoration of function of central venous access device Adults weighing 30 kg (66 lb) or more: Cathflo Activase—2 mg/2-ml concentration instilled in dysfunctional catheter. If catheter function isn’t restored in 120 minutes after first dose, may give second dose. Adults weighing 10 kg (22 lb) to less than 30 kg: Cathflo Activase—Use 110% of catheter lumen volume not to exceed 2 mg/2-ml concentration instilled in dysfunctional catheter. If catheter function isn’t restored in 120 minutes after first dose, may give second dose.

Off-label uses Small-vessel occlusion by microthrombi ● Peripheral arterial thromboembolism ●


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Contraindications Hypersensitivity to drug or its components (Cathflo Activase) ● Seizures, stroke, aneurysm, intracranial neoplasm, bleeding diathesis ●

Precautions Use cautiously in: ● hypersensitivity to anistreplase or streptokinase ● GI or genitourinary bleeding, ophthalmic hemorrhage, organ biopsy, severe hepatic or renal disease ● elderly patients ● pregnant or breastfeeding patients ● children.

Administration

2Be aware that intracranial hemorrhage must be ruled out before therapy begins. 2To treat acute ischemic CVA, give within 3 hours of initial signs or symptoms. 2If uncontrolled bleeding occurs, stop infusion and notify prescriber immediately. ● Give I.V. only, using controlledinfusion pump. ● Reconstitute with unpreserved sterile water for injection. May be further diluted with normal saline solution or D5W. Route I.V.

Onset Unknown


Adverse reactions CNS: cerebral hemorrhage, cerebral edema, CVA (with accelerated infusion) CV: hypotension, bradycardia, recurrent ischemia, pericardial effusion, pericarditis, mitral regurgitation, electromechanical dissociation, arrhythmias, cardiogenic shock, heart failure, cardiac arrest, cardiac tamponade, myocardial rupture, embolization, venous thrombosis GI: nausea, vomiting, GI bleeding 2Clinical alert

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aluminum hydroxide

GU: GU tract bleeding Hematologic: spontaneous bleeding, bone marrow depression Musculoskeletal: musculoskeletal pain Respiratory: pulmonary edema Skin: bruising, flushing Other: fever, edema, phlebitis or bleeding at I.V. site, hypersensitivity reaction (including rash, anaphylactic reaction, laryngeal edema), sepsis

elevates gastric pH, inhibiting the action of pepsin (an effect important in peptic ulcer disease).

Interactions

➣ Hyperacidity Adults: 500 to 1,500 mg (tablet or capsule) P.O. 1 hour after meals and at bedtime; or 5 to 30 ml (oral suspension) between meals and at bedtime, as needed or directed

Drug-drug. Aspirin, drugs affecting platelet activity (such as abciximab, heparin, dipyridamole, oral anticoagulants, vitamin K antagonists): increased risk of bleeding Drug-diagnostic tests. Blood urea nitrogen: elevated level

Patient monitoring Monitor vital signs, ECG, and neurologic status. ● Maintain strict bed rest. ● Watch for signs and symptoms of bleeding tendency and hemorrhage. ● Monitor patient on Cathflo Activase for GI bleeding, venous thrombosis, and sepsis. ● Evaluate results of clotting studies. ●

Patient teaching As appropriate, explain therapy and monitoring to patient and family.

●

Availability Capsules: 400 mg, 475 mg, 500 mg Oral suspension: 320 mg/5 ml, 450 mg/ 5 ml, 600 mg/5 ml, 675 mg/5 ml Tablets: 300 mg, 500 mg, 600 mg


Off-label uses ● ●

Bleeding from stress ulcers Gastroesophageal reflux disease

Contraindications Signs or symptoms of appendicitis or inflamed bowel

●

Precautions Use cautiously in: ● gastric outlet obstruction, hypercalcemia, hypophosphatemia, massive upper GI hemorrhage ● patients using other aluminum products concurrently ● patients on dialysis ● pregnant or breastfeeding patients.

Administration Administer with water or fruit juice. Give 1 hour after meals and at bedtime. ● In reflux esophagitis, administer 20 to 40 minutes after meals and at bedtime. ● Don’t give within 1 to 2 hours of antibiotics, histamine2 (H2) blockers, iron preparations, corticosteroids, or enteric-coated drugs. ● Provide care as appropriate if patient becomes constipated. ●

aluminum hydroxide AlternaGEL,Alu-Cap,Alu-Tab Pharmacologic class: Inorganic salt Therapeutic class: Antacid Pregnancy risk category NR

Action Dissolves in acidic gastric secretions, releasing anions that partially neutralize gastric hydrochloric acid. Also Canada

UK

●

Hazardous drug

High alert drug

amantadine hydrochloride Route P.O.

Onset 15-30 min

Peak 30 min

Duration 30 min-3 hr

Adverse reactions CNS: malaise (with prolonged use), neurotoxicity, encephalopathy GI: constipation, anorexia (with prolonged use), intestinal obstruction Metabolic: hypophosphatemia (with prolonged use) Musculoskeletal: osteomalacia and chronic phosphate deficiency with bone pain, malaise, muscle weakness (with prolonged use) Other: aluminum toxicity

Interactions Drug-drug. Allopurinol, anti-infectives (including quinolones, tetracyclines), corticosteroids, diflunisal, digoxin, ethambutol, H2 blockers, hydantoins, iron salts, isoniazid, penicillamine, phenothiazines, salicylates, thyroid hormone, ticlopidine: decreased effects of these drugs Enteric-coated drugs: premature release of these drugs in stomach Drug-diagnostic tests. Gastrin: increased level Phosphate: decreased level Some imaging studies: test interference Drug-food. Milk, other foods high in vitamin D: milk-alkali syndrome (nausea, vomiting, distaste for food, headache, confusion, hypercalcemia, hypercalciuria)

Patient monitoring Monitor long-term use of high doses if patient is on sodium-restricted diet. (Drug contains sodium.) ● Assess for GI bleeding. ● Watch for constipation. ● With long-term use, monitor blood phosphate level and assess for signs and symptoms of hypophosphatemia (anorexia, malaise, muscle weakness). Also monitor bone density. ●


55

Patient teaching Tell patient to take drug 1 hour after meals and at bedtime. ● Caution patient not to take drug within 1 to 2 hours of anti-infectives, H2 blockers, iron, corticosteroids, or enteric-coated drugs. ● Advise patient to take drug with water or fruit juice. ● Instruct patient to report signs and symptoms of GI bleeding and hypophosphatemia (appetite loss, malaise, muscle weakness). ● Recommend increased fiber and fluid intake and regular physical activity to help ease constipation. ● Inform patient that drug contains sodium, so he should discuss drug therapy with health care providers if he’s later told to consume a low-sodium diet. ● Advise patient that he’ll need to undergo periodic blood testing and bone mineral density tests if he’s receiving long-term therapy. ● As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and foods mentioned above. ●

amantadine hydrochloride Dom-Amantadine, GenAmantadine, Lysovir , PMS-Amantadine, Symmetrel, Pharmacologic class: Anticholinergiclike agent Therapeutic class: Antiviral, antiparkinsonian Pregnancy risk category C

Action Antiviral action unclear; may prevent penetration of influenza A virus into host cell. Antiparkinsonian action unknown; may ease parkinsonian 2Clinical alert

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amantadine hydrochloride

symptoms by increasing dopamine release, preventing dopamine reuptake into presynaptic neurons, stimulating dopamine receptors, or enhancing dopamine sensitivity.

untreated closed-angle glaucoma (use not recommended) ● elderly patients ● pregnant or breastfeeding patients. ●

Administration Availability


➣ Symptomatic treatment or prophylaxis of influenza type A virus in patients with respiratory conditions Adults older than age 65 with normal renal function: 100 mg P.O. once daily Adults to age 64 with normal renal function: 200 mg (tablets) or 4 tsp of syrup P.O. daily in a single dose, or 100 mg tablet or 2 tsp of syrup P.O. b.i.d. Children ages 9 to 12: 100 mg P.O. q 12 hours Children ages 1 to 9 or weighing less than 45 kg (99 lb): 4.4 to 8.8 mg/kg/ day of syrup P.O. q 12 hours, not to exceed 150 mg daily ➣ Parkinson’s disease Adults: Initially, 100 mg P.O. daily, increased to 100 mg b.i.d. if needed. If patient doesn’t respond adequately, give 200 mg b.i.d., up to 400 mg/day. ➣ Drug-induced extrapyramidal reactions Adults: 100 mg P.O. b.i.d.; may increase dosage to maximum of 300 mg daily in divided doses Dosage adjustment ●

Renal impairment



Precautions Use cautiously in: ● cardiac disease, hepatic disease, renal impairment, seizure disorder, psychiatric problems Canada

For antiviral use, start therapy within 24 to 48 hours of symptom onset and continue for 24 to 48 hours after symptoms resolve. ● When giving as prophylactic antiviral, start therapy as soon as possible and continue for at least 10 days after exposure to virus. ● When giving with influenza vaccine, continue drug for 2 to 3 weeks while patient develops antibody response to vaccine. ●

Capsules (liquid-filled): 100 mg Syrup: 50 mg/5 ml Tablets: 100 mg

UK

Route P.O.

Onset 48 hr

Peak 2 wk

Duration Unknown

Adverse reactions CNS: depression, dizziness, drowsiness, insomnia, light-headedness, anxiety, irritability, hallucinations, confusion, ataxia, headache, nervousness, abnormal dreams, agitation, fatigue, delusions, aggressive behavior, manic reaction, psychosis, slurred speech, euphoria, abnormal thinking, amnesia, increased or decreased motor activity, paresthesia, tremor, abnormal gait, delirium, stupor, coma CV: orthostatic hypotension, tachycardia, peripheral edema, heart failure, cardiac arrest, arrhythmias EENT: blurred vision, mydriasis, keratitis, photosensitivity, optic nerve palsy, nasal congestion GI: nausea, vomiting, diarrhea, constipation, dry mouth, dysphagia, anorexia GU: urine retention, decreased libido Hematologic: leukocytosis Musculoskeletal: involuntary muscle contractions Respiratory: tachypnea, acute respiratory failure, pulmonary edema Skin: purplish skin discoloration, rash, pruritus, diaphoresis Hazardous drug

High alert drug

amifostine

Other: edema, fever, allergic reactions including anaphylaxis

Interactions Drug-drug. Anticholinergics, antihistamines, phenothiazines, quinidine, tricyclic antidepressants: increased atropine-like adverse effects CNS stimulants: increased CNS stimulation Hydrochlorothiazide, triamterene: increased amantadine effects Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, bilirubin, blood urea nitrogen, creatine kinase, creatinine, gamma-glutamyltransferase, lactate dehydrogenase: increased levels Drug-herbs. Angel’s trumpet, jimsonweed, scopolia: increased cardiac and anticholinergic-like effects Drug-behaviors. Alcohol use: increased CNS adverse reactions

Patient monitoring

2Monitor patient for depression and suicidal ideation. ● Watch for mental status changes, especially in elderly patients. ● Stay alert for worsening of psychiatric problems if patient has a history of such problems or substance abuse. ● Monitor for orthostatic hypotension. ● Evaluate for signs and symptoms of fluid overload. ● Monitor kidney and liver function test results.

Patient teaching

2Caution patient that taking more than prescribed dosage may lead to serious adverse reactions or even death. ● Advise patient to establish effective bedtime routine and to take drug several hours before bedtime to minimize insomnia. ● Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness. Reactions in bold are life-threatening.

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Advise patient to minimize GI upset by eating small, frequent servings of foods and drinking plenty of fluids. ● Instruct patient to contact prescriber if he develops signs or symptoms of depression. ● As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, herbs, and behaviors mentioned above. ●

amifostine Ethyol Pharmacologic class: Organic thiophosphate cytoprotective drug Therapeutic class: Cytoprotectant Pregnancy risk category C

Action Undergoes conversion to free thiol, an active metabolite that reduces toxic effects of cisplatin on renal tissue

Availability Powder for injection: 500-mg anhydrous base and 500 mg mannitol in 10-ml vials


➣ To reduce cumulative renal toxicity of cisplatin therapy in patients with ovarian cancer or non-small-cell lung cancer Adults: 910 mg/m2 I.V. daily as a 15-minute infusion, starting 30 minutes before chemotherapy ➣ To reduce moderate to severe xerostomia in patients undergoing postoperative radiation treatment for head or neck cancer Adults: 200 mg/m2 I.V. daily as a 3-minute infusion, starting 15 to 2Clinical alert

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amifostine

30 minutes before standard fraction radiation therapy

2Keep patient supine during administration.

Off-label uses

Route I.V.

Protection against cisplatin- and paclitaxel-induced neurotoxicity

●

●

Hypersensitivity to drug Hypotension

Precautions Use cautiously in: ● arrhythmias, heart failure, ischemic heart disease, renal impairment, hearing impairment, hypocalcemia, myasthenia gravis, nausea, vomiting, hypotension, obesity ● history of cerebrovascular accident or transient ischemic attacks ● concurrent antihypertensive therapy that can’t be discontinued for 24 hours before amifostine therapy (not recommended) ● definitive radiotherapy (not recommended) ● elderly patients ● pregnant patients (safety and efficacy not established) ● breastfeeding patients ● children (safety and efficacy not established).

CNS: dizziness, drowsiness, rigors CV: hypotension GI: nausea, vomiting Metabolic: hypocalcemia Respiratory: dyspnea, sneezing Skin: flushing, rash, urticaria, erythema multiforme Other: chills, warm sensation, hiccups, allergic reactions

Interactions Drug-drug. Antihypertensives: increased risk of hypotension Drug-diagnostic tests. Calcium: decreased level

Patient monitoring Monitor blood pressure every 5 minutes during infusion and immediately after infusion as clinically indicated. ● Assess for severe nausea and vomiting. ● Monitor fluid intake and output. ● Monitor blood calcium level. Give calcium supplements as ordered. ●

Patient teaching

Administration Ensure that patient is adequately hydrated before starting drug. ● Give antiemetics before and during therapy. ● Reconstitute single-dose vial with 9.7 ml of sterile normal saline injection. May be further diluted with normal saline solution up to a concentration of 40 mg/ml. ● Don’t mix with other drugs or solutions. ● Know that drug also can be prepared in polyvinyl chloride bags. ● Don’t infuse longer than 15 minutes; doing so increases risk of adverse reactions. ●

Canada


Adverse reactions


Onset 5-8 min

UK

Emphasize importance of remaining supine during drug administration to prevent hypotension. ● Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness. ● Advise patient to minimize GI upset by eating small, frequent servings of food and drinking plenty of fluids. ● Provide dietary counseling. Refer patient to dietitian if adverse GI effects significantly limit food intake. ● Inform patient that sneezing is a normal effect of drug. ●

Hazardous drug

High alert drug

amikacin sulfate

As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.

●

59

Action Interferes with protein synthesis in bacterial cells by binding to 30S ribosomal subunit, leading to bacterial cell death

Availability Injection: 50 mg/ml, 250 mg/ml

amikacin sulfate Amikin Pharmacologic class: Aminoglycoside Therapeutic class: Anti-infective Pregnancy risk category D

FDA BOXED WARNING Observe patient closely because of potential ototoxicity and nephrotoxicity. Safety isn’t established for treatment exceeding 14 days. ● Neuromuscular blockade and respiratory paralysis have occurred after parenteral injection, topical use (as in orthopedic and abdominal irrigation), and oral use. ● Monitor renal function and eighthnerve function closely, especially in patients with known or suspected renal impairment at onset of therapy, as well as those with initially normal renal function who develop signs of renal dysfunction during therapy. ● Avoid concurrent use with potent diuretics (such as furosemide and ethacrynic acid) because diuretics may cause ototoxicity. Also, I.V. diuretics may increase aminoglycoside toxicity by altering antibiotic serum and tissue levels. ● Avoid concurrent and sequential systemic, oral, or topical use of other neurotoxic or nephrotoxic products and other aminoglycosides. Advanced age and dehydration also may increase toxicity risk. ●



➣ Severe systemic infections caused by sensitive strains of Pseudomonas aeruginosa, Escherichia coli, or Proteus, Klebsiella, Serratia, Enterobacter, Actinobacter, Providencia, Citrobacter, or Staphylococcus species Adults, children, and older infants: 15 mg/kg/day I.V. or I.M. in two to three divided doses q 8 to 12 hours in 100 to 200 ml of dextrose 5% in water (D5W) over 30 to 60 minutes. Maximum dosage is 1.5 g/day. Neonates: Initially, 10 mg/kg I.M., then 7.5 mg/kg I.M. q 12 hours ➣ Uncomplicated urinary tract infections caused by susceptible organisms Adults, children, and older infants: 250 mg I.M. or I.V. twice daily Dosage adjustment ● ●

Renal impairment (adults) Patients undergoing hemodialysis

Off-label uses Mycobacterium avium-intracellulare infection

●

Contraindications ● ●

Hypersensitivity to aminoglycosides Breastfeeding

Precautions Use cautiously in: ● decreased renal function, neuromuscular disorders ● parkinsonism, myasthenia gravis ● concurrent or serial use of other nephrotoxic and ototoxic drugs ● elderly patients ● pregnant patients. 2Clinical alert

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amikacin sulfate

Administration

Interactions

Don’t physically mix amikacin with other drugs. Administer separately. ● For I.V. use, dilute in 100 to 200 ml of normal saline solution or D5W and give over 30 to 60 minutes. ● Ensure adequate fluid intake to avoid dehydration. ● Draw peak blood level 1 hour after I.M. infusion or 30 to 60 minutes after I.V. infusion. ● Draw trough blood level just before next dose.

Drug-drug. Acyclovir, amphotericin B, cephalosporin, cisplatin, diuretics, vancomycin: increased risk of ototoxicity and nephrotoxicity Depolarizing and nondepolarizing neuromuscular junction blockers, general anesthetics: increased amikacin effect, possibly leading to respiratory depression Dimenhydrinate: masking of ototoxicity signs and symptoms Indomethacin: increased trough and peak amikacin levels Parenteral penicillin: amikacin inactivation Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, bilirubin, blood urea nitrogen, creatinine, lactate dehydrogenase, nonprotein nitrogen, nitrogen compounds (such as urea): increased levels Calcium, potassium, magnesium, sodium: decreased levels Reticulocytes: increased or decreased count

●

Route I.V.

Onset Immediate

Peak 30 min

Duration 8-12 hr

I.M.

Variable

1 hr

8-12 hr

Adverse reactions CNS: dizziness, vertigo, tremor, numbness, depression, confusion, lethargy, headache, paresthesia, ataxia, neuromuscular blockade, seizures, neurotoxicity CV: hypotension, hypertension, palpitations EENT: nystagmus and other visual disturbances, ototoxicity, hearing loss, tinnitus GI: nausea, vomiting, splenomegaly, stomatitis, increased salivation, anorexia GU: azotemia, increased urinary excretion of casts, polyuria, painful urination, impotence, nephrotoxicity Hematologic: purpura, eosinophilia, leukemoid reaction, aplastic anemia, neutropenia, agranulocytosis, leukopenia, thrombocytopenia, pancytopenia, hemolytic anemia Hepatic: hepatomegaly, hepatic necrosis, hepatotoxicity Musculoskeletal: joint pain, muscle twitching Respiratory: apnea Skin: rash, alopecia, urticaria, itching, exfoliative dermatitis Other: weight loss, superinfection, pain and irritation at I.M. site Canada

UK

Patient monitoring Monitor kidney function test results and urine cultures, output, protein, and specific gravity. ● Monitor results of peak and trough drug blood levels. ● Evaluate for signs and symptoms of ototoxicity (hearing loss, tinnitus, ataxia, and vertigo). ● Assess for secondary superinfections, particularly upper respiratory tract infections. ●

Patient teaching

2Inform patient that drug may cause hearing loss, seizures, and other neurologic problems. Tell him to report these symptoms immediately. ● Instruct patient to immediately report fever, cough, breathing problems, sore throat, and other signs and symptoms of infection.

Hazardous drug

High alert drug

aminocaproic acid

Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness. ● Instruct patient to notify prescriber if he’s urinating much more or much less than normal. ● Advise patient to minimize GI upset by eating small, frequent servings of food and drinking plenty of fluids. ● Inform patient that he’ll undergo regular blood and urine testing during therapy. ● As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above. ●

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over 1 hour, followed by continuous infusion of 1 g/hour in 50 ml of diluent. Continue for 8 hours or until bleeding stops. Maximum daily dosage is 30 g.


Dental extractions Hemorrhage

Contraindications Hypersensitivity to drug Disseminated intravascular coagulation ● Neonates (injectable form) ● ●

Precautions Use cautiously in: ● heart, hepatic, or renal failure ● upper urinary tract bleeding.

Administration Dilute I.V. form in normal saline solution, dextrose 5% in water, or Ringer’s solution for injection. Give at prescribed rate. ● Know that oral and I.V. doses are the same. ●

aminocaproic acid Amicar Pharmacologic class: Carboxylic acid derivative Therapeutic class: Antihemorrhagic, antifibrinolytic Pregnancy risk category C

Action Interferes with plasminogen activator substances and blocks action of fibrinolysin (plasmin)

Availability Injection: 250 mg/ml Syrup: 250 mg/ml Tablets: 500 mg, 1,000 mg


➣ Excessive bleeding caused by fibrinolysis Adults: 5 g P.O. during first hour; then 1 to 1.25 g/hour until drug blood level of 0.13 mg/ml is reached and sustained and bleeding is controlled. Or 4 to 5 g in 250 ml of compatible diluent I.V. Reactions in bold are life-threatening.

Route P.O.

Onset 1 hr

Peak 2 hr

Duration Unknown

I.V.

1 hr

Unknown 3 hr

Adverse reactions CNS: dizziness, malaise, headache, delirium, hallucinations, weakness, seizures CV: hypotension, ischemia, thrombophlebitis, cardiomyopathy, bradycardia, arrhythmias EENT: conjunctival suffusion, tinnitus, nasal congestion GI: nausea, vomiting, diarrhea, abdominal pain, dyspepsia GU: intrarenal obstruction, renal failure Hematologic: bleeding tendency, generalized thrombosis, agranulocytosis, leukopenia, thrombocytopenia

2Clinical alert

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aminophylline

Musculoskeletal: myopathy, rhabdomyolysis Respiratory: dyspnea, pulmonary embolism Skin: rash, pruritus

Interactions Drug-drug. Estrogens, hormonal contraceptives: increased risk of hypercoagulation Activated prothrombin, prothrombin complex concentrates: increased signs of active intravascular clotting Drug-diagnostic tests. Alanine aminotransferase, aldolase, aspartate aminotransferase, blood urea nitrogen, creatinine, creatine kinase, potassium: increased levels Drug-herbs. Alfalfa, anise, arnica, astragalus, bilberry, black currant seed oil, capsaicin, cat’s claw, celery, chaparral, clove oil, dandelion, dong quai, evening primrose oil, feverfew, garlic, ginger, ginkgo, papaya extract, rhubarb, safflower oil, skullcap: increased anticoagulant effect Coenzyme Q10, St. John’s wort: reduced anticoagulant effect

Patient monitoring Monitor vital signs, fluid intake and output, and ECG. 2Assess for signs and symptoms of thrombophlebitis and pulmonary embolism. 2Monitor neurologic status, especially for signs of impending seizure. ● Monitor kidney and liver function test results, serum electrolyte levels, and CBC with white cell differential. ● Evaluate for blood dyscrasias, particularly bleeding tendencies. ●

Patient teaching Tell patient that drug may significantly affect many body systems. Assure him that he’ll be monitored closely. 2Instruct patient to immediately report signs and symptoms of thrombophlebitis, pulmonary embolism, or unusual bleeding. ●

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Tell patient he’ll undergo frequent blood testing during therapy. ● As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and herbs mentioned above. ●

aminophylline (theophylline, ethylenediamine) Amnivent , Phyllocontin Pharmacologic class: Xanthine Therapeutic class: Bronchodilator Pregnancy risk category C

Action Unclear. Thought to directly relax smooth muscle of bronchial airways and increase pulmonary blood flow by inhibiting phosphodiesterase.

Availability Injection: 250 mg/10 ml Oral liquid: 105 mg/5 ml Suppositories: 250 mg, 500 mg Tablets: 100 mg, 200 mg


➣ Symptomatic relief of bronchospasm in patients with acute symptoms who require rapid theophyllinization Adults (nonsmokers): 0.7 mg/kg/hour I.V. for first 12 hours. Maintenance dosage is 0.5 mg/kg/hour I.V. Children ages 9 to 16: 1 mg/kg/hour I.V. for first 12 hours. Maintenance dosage is 0.8 mg/kg/hour I.V. Children ages 6 months to 9 years: 1.2 mg/kg/hour I.V. for first 12 hours. Maintenance dosage is 1 mg/kg/hour I.V. ➣ Chronic bronchial asthma Hazardous drug

High alert drug

aminophylline 63

Adults and children: Dosage is highly individualized. Common initial dosage is 16 mg/kg/24 hours I.V. or 400 mg/24 hours I.V. in divided doses at 6- or 8hour intervals. If needed, dosage may be increased 25% at 3-day intervals.

Dosage adjustment ● ● ● ●

Heart failure Hepatic disease Elderly patients Smokers

Off-label uses Dyspnea in patients with chronic obstructive pulmonary disease (COPD)

●

Contraindications Hypersensitivity to xanthine compounds or ethylenediamine ● Seizure disorders ●

Precautions Use cautiously in: ● COPD, diabetes mellitus, glaucoma, renal or hepatic disease, heart failure or other cardiac or circulatory impairment, hypertension, hyperthyroidism, peptic ulcer, severe hypoxemia ● active peptic ulcer disease ● elderly patients ● neonates, infants, and young children.

Administration For I.V. use, dilute according to label directions and infuse at a rate no faster than 25 mg/minute. ● Don’t give in I.V. solutions containing invert sugar, fructose, or fat emulsions. ● Give oral form at meals with 8 oz of water. ●

Route Onset P.O. Variable (extended)

Peak Variable

Duration Variable

P.O. (liquid)

15-60 min 1-7 hr

I.V.

Immediate Immediate 6-8 hr

P.R.

Unknown

Unknown

Variable

Adverse reactions CNS: irritability, dizziness, nervousness, restlessness, headache, insomnia, stammering speech, abnormal behavior, mutism, unresponsiveness alternating with hyperactivity, seizures CV: palpitations, sinus tachycardia, extrasystoles, marked hypotension, arrhythmias, circulatory failure GI: nausea, vomiting, diarrhea, epigastric pain, hematemesis, gastroesophageal reflux, anorexia GU: urine retention (in men with enlarged prostate), diuresis, increased excretion of renal tubular cells and red blood cells, proteinuria Metabolic: hyperglycemia Musculoskeletal: muscle twitching Respiratory: tachypnea, respiratory arrest Skin: flushing Other: fever, hypersensitivity reactions (including exfoliative dermatitis and urticaria)

Interactions Drug-drug. Adenosine: decreased antiarrhythmic effect of adenosine Barbiturates, nicotine, phenytoin, rifampin: decreased aminophylline blood level Beta-adrenergic blockers: antagonism of aminophylline effects Calcium channel blockers, cimetidine, ciprofloxacin, disulfiram, erythromycin, hormonal contraceptives, influenza vaccine, interferon, methotrexate: elevated aminophylline blood level Carbamazepine, isoniazid, loop diuretics (such as furosemide): increased or decreased aminophylline blood level Ephedrine, other sympathomimetics: toxicity, arrhythmias Lithium: increased lithium excretion Drug-diagnostic tests. Aspartate aminotransferase, glucose: increased levels

Unknown


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amiodarone hydrochloride

Drug-herbs. Cayenne: increased risk of aminophylline toxicity Drug-behaviors. Smoking: increased aminophylline elimination


Patient monitoring

Amyben , Cordarone, Cordarone X , Pacerone

2Monitor aminophylline blood level. Adjust dosage if patient has signs or symptoms of toxicity (tachycardia, headache, anorexia, nausea, vomiting, diarrhea, restlessness, and irritability). ● Assess for arrhythmias, especially after giving loading dose. ● Check vital signs and fluid intake and output. ● Monitor patient’s response to drug, and assess pulmonary function test results.

Patient teaching Advise patient to take oral doses at meals with 8 oz of water. ● Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness. ● Tell patient to minimize GI upset by eating small, frequent servings of food and drinking plenty of fluids. ● Advise patient to establish effective bedtime routine to minimize insomnia. ● Caution patient not to change aminophylline brands. ● If patient smokes, tell him to notify prescriber if he stops smoking; dosage may need to be adjusted. ● As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, herbs, and behaviors mentioned above. ●

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Pharmacologic class: Benzofuran derivative Therapeutic class: Antiarrhythmic (class III) Pregnancy risk category D

FDA BOXED WARNING Because of substantial toxicity, drug is indicated only in patients with lifethreatening arrhythmias. ● Drug may cause potentially fatal pulmonary toxicities, including hypersensitivity pneumonitis and interstitial/ alveolar pneumonitis. Pulmonary toxicity is fatal about 10% of time. ● Hepatic injury is common but usually mild, manifesting only as abnormal liver enzyme levels. However, overt hepatic disease can occur and, in rare cases, is fatal. ● Drug may exacerbate arrhythmias by reducing tolerance for them or making them harder to reverse. Arrhythmias and significant heart block or sinus bradycardia occur in 2% to 5% of patients. ● Even in patients at high risk for arrhythmic death in whom toxicity is an acceptable risk, drug poses major management problems. Therefore, other agents should be tried first whenever possible. ● Difficulty of using drug effectively and safely poses significant risk. Patients with indicated arrhythmias must be hospitalized to receive loading dose; response generally takes at least 1 week, but usually 2 or more. ●

Hazardous drug

High alert drug


Action

●

Prolongs duration and refractory period of action potential. Slows electrical conduction, electrical impulse generation from sinoatrial node, and conduction through accessory pathways. Also dilates blood vessels.

●

Availability Injection: 50 mg/ml in 3-ml ampules Tablets: 100 mg, 200 mg, 400 mg


➣ Life-threatening ventricular arrhythmias Adults: 150 mg in 100 ml of dextrose 5% in water (D5W) by rapid I.V. infusion over 10 minutes; then dilute 900 mg in 500 ml of D5W and administer 360 mg by slow I.V. infusion over next 6 hours; then 540-mg I.V. maintenance infusion over next 18 hours. Or 800 to 1,600 mg P.O. daily in one to two doses for 1 to 3 weeks; then 600 to 800 mg P.O. daily in one to two doses for 1 month; then 400-mg P.O. daily as maintenance dosage. All dosages are titrated to individual patient’s clinical needs. Off-label uses Atrioventricular (AV) nodal reentry tachycardia (with parenteral use) ● Conversion of atrial fibrillation to normal sinus rhythm ●

Contraindications Hypersensitivity to drug or its components, including iodine ● Cardiogenic shock ● Second- or third-degree AV block ● Marked sinus bradycardia ● Breastfeeding ● Neonates ●

Precautions Use cautiously in: ● electrolyte imbalances, severe pulmonary or hepatic disease, thyroid disorders Reactions in bold are life-threatening.

● ●

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history of heart failure elderly patients pregnant patients children.

a

Administration

2Know that I.V. amiodarone is a high-alert drug. 2Give loading dose only in hospital setting with continuous ECG monitoring. ● Administer oral loading dose in two equal doses with meals. Give maintenance dose daily or in two divided doses to minimize GI upset. ● Don’t give I.V. unless patient is on continuous ECG monitoring. ● Dilute I.V. drug with dextrose 5% in water and use in-line filter. Drug isn’t compatible with normal saline solution. ● Use central venous catheter when giving repeated doses. If possible, use dedicated catheter for drug. Route P.O.

Onset Variable

Peak 3-7 hr

Duration Wks-mos

I.V.

Hrs

Unknown

Variable

Adverse reactions CNS: dizziness, fatigue, headache, insomnia, paresthesia, peripheral neuropathy, poor coordination, involuntary movements, tremor, sleep disturbances CV: hypotension, heart failure, worsening arrhythmia, AV block, sinoatrial node dysfunction, bradycardia, asystole, cardiac arrest, cardiogenic shock, electromechanical dissociation, ventricular tachycardia EENT: corneal microdeposits, corneal or macular degeneration, visual disturbances, dry eyes, eye discomfort, optic neuritis or neuropathy, scotoma, lens opacities, photophobia, visual halos, papilledema GI: nausea, vomiting, constipation, abdominal pain, abnormal salivation, anorexia GU: decreased libido 2Clinical alert

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Hematologic: coagulation abnormalities, thrombocytopenia Hepatic: nonspecific hepatic disorders, hepatic dysfunction Metabolic: hypothyroidism, hyperthyroidism Respiratory: cough, adult respiratory distress syndrome, pulmonary inflammation or fibrosis, pulmonary edema Skin: flushing, photosensitivity, toxic epidermal necrolysis Other: abnormal taste and smell, edema, fever, Stevens-Johnson syndrome

Interactions Drug-drug. Anticoagulants: increased prothrombin time (PT) Azole antifungals, fluoroquinolones, loratadine, macrolide antibiotics, trazodone: increased risk of life-threatening arrhythmias Beta-adrenergic blockers: increased risk of bradycardia and hypotension Calcium channel blockers: increased risk of AV block (with verapamil, diltiazem) or hypotension (with any calcium channel blocker) Cholestyramine: decreased amiodarone blood level Cimetidine, ritonavir: increased amiodarone blood level Class I antiarrhythmics (disopyramide, flecainide, lidocaine, mexiletine, procainamide, quinidine): increased blood levels of these drugs, leading to toxicity Cyclosporine: elevated cyclosporine and creatinine blood levels Dextromethorphan: impaired dextromethorphan metabolism (with amiodarone therapy of 2 weeks or longer) Digoxin: increased digoxin blood level, leading to toxicity Fentanyl: increased bradycardia, hypotension Methotrexate: impaired methotrexate metabolism, possibly causing toxicity (with amiodarone use longer than 2 weeks) Phenytoin: decreased amiodarone blood level or increased phenytoin Canada

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blood level (with amiodarone use longer than 2 weeks) Protease inhibitors (atazanavir, indinavir, nelfinavir): possible increased amiodarone concentration Rifampin: decreased amiodarone concentration Theophylline: increased theophylline blood level (with amiodarone use longer than 1 week) Drug-diagnostic tests. Kidney function tests: abnormal results Drug-food. Grapefruit juice: increased drug concentration Drug-herb. St. John’s wort: decreased drug blood level

Patient monitoring

2Monitor patient closely. Drug may cause serious or life-threatening adverse reactions. 2Watch for slow onset of lifethreatening arrhythmias, especially after giving loading dose. 2Monitor ECG continuously during loading dose and when dosage is changed. ● Check patient’s blood pressure, pulse, and heart rhythm regularly. ● Assess for signs and symptoms of lung inflammation. ● Monitor baseline and subsequent chest X-rays, as well as pulmonary, liver, and thyroid function test results. ● Closely monitor patient who’s receiving other drugs concurrently because amiodarone can interact with many drugs. Check digoxin blood level if patient is receiving digoxin; monitor PT or International Normalized Ratio if patient is receiving anticoagulants.

Patient teaching

2Inform patient that drug may cause serious adverse reactions. Instruct him to report these immediately. ● Tell patient to take oral doses with meals. Advise him to divide daily dose into two doses if drug causes GI upset.

Hazardous drug

High alert drug

amitriptyline hydrochloride

Tell patient that adverse reactions are most common with high doses and may become more frequent after 6 months of therapy. ● Inform patient that he’ll undergo regular blood testing, eye examinations, chest X-rays, and pulmonary function tests during therapy. ● As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above. ●

amitriptyline hydrochloride Apo-Amitriptyline, Levate, Novotriptyn Pharmacologic class: Tricyclic compound Therapeutic class: Antidepressant Pregnancy risk category D

neurotransmitters in brain. Also has sedative, anticholinergic, and mild peripheral vasodilating effects.

Availability Injection: 10 mg/ml Syrup: 10 mg/5 ml Tablets: 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, 150 mg


➣ Depression Adults: 75 mg P.O. daily in divided doses; may increase gradually to 150 mg/day. Or start with 50 to 100 mg P.O. at bedtime and increase by 25 to 50 mg as needed, to a total dosage of 150 mg. Hospitalized patients initially may receive 100 mg P.O. daily, with gradual increases as needed to a total dosage of 300 mg P.O. With I.M. use, give 20 to 30 mg q.i.d. Dosage adjustment ● ● ●

FDA BOXED WARNING Drug may increase risk of suicidal thinking and behavior in children and adolescents with major depressive disorder and other psychiatric disorders. Risk is greater during first few months of treatment, and must be balanced with clinical need, as depression itself increases suicide risk. With patient of any age, observe closely for clinical worsening, suicidality, and unusual behavior changes when therapy begins. Advise family to observe patient closely and communicate with prescriber as needed. ● Drug isn’t approved for use in pediatric patients. ●

Action Unclear. Inhibits norepinephrine and serotonin reuptake at presynaptic neuron, increasing levels of these Reactions in bold are life-threatening.

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Elderly patients Adolescents Outpatients

Off-label uses Analgesic adjunct for phantom limb pain or chronic pain

●

Contraindications Hypersensitivity to drug or other tricyclic antidepressants (TCAs) ● Acute recovery phase after myocardial infarction ● MAO inhibitor use within past 14 days ● Children younger than age 12 ●

Precautions Use cautiously in: ● seizures, cardiovascular disease, renal or hepatic impairment, urinary retention, hyperthyroidism, increased intraocular pressure, closed-angle glaucoma, prostatic hypertrophy, bipolar disorder, schizophrenia, paranoia ● elderly patients ● pregnant or breastfeeding patients. 2Clinical alert

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amitriptyline hydrochloride

Administration Administer full dose at bedtime to minimize orthostatic hypotension. ● Give injectable form by I.M. route only. ● Don’t withdraw drug suddenly. Instead, taper dosage gradually. ● If patient is scheduled for surgery, discuss dosage tapering with prescriber. ● Be aware that drug is often used in conjunction with psychotherapy. ●

Route P.O.

Onset 2-4 wk

Peak 2-6 wk

Duration Unknown

I.M.

2-3 wk

2-6 wk

Unknown

Adverse reactions CNS: headache, fatigue, agitation, numbness, paresthesia, peripheral neuropathy, weakness, restlessness, panic, anxiety, dizziness, drowsiness, difficulty speaking, excitement, hypomania, psychosis exacerbation, extrapyramidal effects, poor coordination, hallucinations, insomnia, nightmares, seizures, coma, suicidal behavior or ideation (especially in children and adolescents) CV: ECG changes, tachycardia, hypertension, orthostatic hypotension, arrhythmias, heart block, myocardial infarction EENT: blurred vision, dry eyes, mydriasis, abnormal visual accommodation, increased intraocular pressure, tinnitus GI: nausea, vomiting, constipation, dry mouth, epigastric pain, anorexia, paralytic ileus GU: urinary retention, delayed voiding, urinary tract dilation, gynecomastia Hematologic: agranulocytosis, thrombocytopenia, thrombocytopenic purpura, leukopenia Metabolic: changes in blood glucose level Skin: photosensitivity rash, urticaria, flushing, diaphoresis

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Other: increased appetite, weight gain, high fever, edema, hypersensitivity reaction

Interactions Drug-drug. Activated charcoal: decreased amitriptyline absorption Adrenergics, anticholinergics, anticholinergic-like drugs: increased anticholinergic effects Amiodarone, cimetidine, quinidine, ritonavir: increased amitriptyline effects Barbiturates: decreased amitriptyline blood level, increased CNS and respiratory effects Clonidine: hypertensive crisis CNS depressants (including antihistamines, opioids, sedative-hypnotics): increased CNS depression Drugs metabolized by CYP-4502D6 (such as other antidepressants, phenothiazines, carbamazepine, class 1C antiarrhythmics): decreased amitriptyline clearance, possibly causing toxicity Guanethidine: antagonism of antihypertensive action Levodopa: delayed or decreased levodopa absorption, hypertension MAO inhibitors: hypotension, tachycardia, potentially fatal reactions Rifabutin, rifampin, rifapentine: decreased amitriptyline blood level and effects Selective serotonin reuptake inhibitors: increased risk of toxicity Sympathomimetics: increased pressor effect of direct-acting sympathomimetics (epinephrine, norepinephrine), possibly causing arrhythmias; decreased pressor effect of indirect-acting sympathomimetics (ephedrine, metaraminol) Drug-diagnostic tests. Eosinophils, liver function tests: increased values Glucose, granulocytes, platelets, white blood cells: increased or decreased levels Drug-herbs. Angel’s trumpet, jimsonweed, scopolia: increased anticholinergic effects

Hazardous drug

High alert drug

amlodipine besylate

Chamomile, hops, kava, skullcap, valerian: increased CNS depression St. John’s wort: decreased drug blood level and reduced efficacy Drug-behaviors. Alcohol use: increased CNS sedation Smoking: increased drug metabolism and altered effects Sun exposure: increased risk of photosensitivity reaction

Patient monitoring Evaluate for signs and symptoms of psychosis. If present, discuss possible dosage change with prescriber. ● Assess for changes in patient’s mood or mental status. 2Monitor for signs and symptoms of depression and assess for suicidal ideation (especially in child or adolescent). ● Check blood pressure for orthostatic hypertension. ● Monitor CBC with white cell differential, glucose levels, and liver function test results. ●

Patient teaching

2Instruct patient, parent, or caregiver to contact prescriber if severe mood changes or suicidal thoughts occur (especially if patient is child or adolescent). ● Tell patient that drug may cause temporary blood pressure decrease if he stands up suddenly. Advise him to rise slowly and carefully. ● Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness. ● Advise patient to minimize GI upset by eating small, frequent servings of food and drinking plenty of fluids. ● Inform patient that he’ll undergo frequent blood testing during therapy. ● As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, herbs, and behaviors mentioned above. Reactions in bold are life-threatening.

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a amlodipine besylate Norvasc Pharmacologic class: Calcium channel blocker Therapeutic class: Antihypertensive Pregnancy risk category C

Action Inhibits influx of extracellular calcium ions, thereby decreasing myocardial contractility, relaxing coronary and vascular muscles, and decreasing peripheral resistance

Availability Tablets: 2.5 mg, 5 mg, 10 mg


➣ Essential hypertension, chronic stable angina pectoris, and vasospastic angina (Prinzmetal’s angina) Adults: 5 to 10 mg P.O. once daily Dosage adjustment ● ●

Hepatic impairment Elderly patients


Pulmonary hypertension Raynaud’s disease



Precautions Use cautiously in: ● aortic stenosis, severe hepatic impairment, heart failure ● elderly patients ● pregnant or breastfeeding patients. ● children.

2Clinical alert

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amlodipine besylate and atorvastatin calcium

Administration Be aware that this drug may be given alone or with other drugs to relieve hypertension or angina.

●

Route P.O.

Onset Unknown

Peak 6-9 hr

Duration 24 hr

knows how drug affects concentration and alertness. ● As appropriate, review all other significant adverse reactions, especially those related to the drugs and behaviors mentioned above.

Adverse reactions CNS: headache, dizziness, drowsiness, light-headedness, fatigue, weakness, lethargy CV: peripheral edema, angina, bradycardia, hypotension, palpitations GI: nausea, abdominal discomfort Musculoskeletal: muscle cramps, muscle pain or inflammation Respiratory: shortness of breath, dyspnea, wheezing Skin: rash, pruritus, urticaria, flushing

Interactions Drug-drug. Beta-adrenergic blockers: increased risk of adverse effects Fentanyl, nitrates, other antihypertensives, quinidine: additive hypotension Drug-behaviors. Acute alcohol ingestion: additive hypotension

Patient monitoring

2Monitor patient for worsening angina. ● Monitor heart rate and rhythm and blood pressure, especially at start of therapy. 2Assess for heart failure; report signs and symptoms (peripheral edema, dyspnea) to prescriber promptly. 2Give sublingual nitroglycerin, as prescribed, if patient has signs or symptoms of acute myocardial infarction (especially when dosage is increased).

Patient teaching If patient also uses sublingual nitroglycerin, tell him he can take nitroglycerin as needed for acute angina. ● Caution patient to avoid driving and other hazardous activities until he ●

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amlodipine besylate and atorvastatin calcium Caduet Pharmacologic class: Calcium channel blocker, HMG-CoA reductase inhibitor Therapeutic class: Antihypertensive, antianginal, lipid-lowering agent Pregnancy risk category X

Action Amlodipine inhibits influx of extracellular calcium ions, thereby decreasing myocardial contractility, relaxing coronary and vascular muscles, and reducing peripheral resistance. Atorvastatin inhibits HMG-CoA reductase, which catalyzes first step in cholesterol synthesis; this action reduces serum cholesterol and low-density lipoprotein (LDL) levels; atorvastatin also moderately increases concentration of highdensity lipoproteins (HDLs).

Availability Tablets: (amlodipine besylate/atorvastatin calcium) 2.5/10 mg, 2.5/20 mg, 2.5/40 mg, 5/10 mg, 5/20 mg, 5/40 mg, 5/80 mg, 10/10 mg, 10/20 mg, 10/40 mg, 10/80 mg


➣ Patients for whom treatment with both amlodipine and atorvastatin is appropriate, such as those with hypertension (used alone or combined with other antihypertensives), coronary artery disease, cardiovascular disease Hazardous drug

High alert drug


prevention, heterozygous familial or nonfamilial hypercholesterolemia, homozygous familial hypercholesterolemia, elevated serum triglycerides, or dysbetalipoproteinemia Adults: Dosage individualized based on efficacy of and tolerance for each component. Maximum amlodipine dosage: 10 mg P.O. daily; maximum atorvastatin dosage: 80 mg P.O. daily.

Dosage adjustment Alanine aminotransferase (ALT) or aspartate aminotransferase (AST) more than three times upper limit of normal ● Small, frail, or elderly patients ●

Contraindications Hypersensitivity to drug or its components ● Active hepatic disease or unexplained persistent serum transaminase elevations ● Pregnant or breastfeeding patients ●

Precautions Use cautiously in: ● hepatic or renal impairment; aortic stenosis; heart failure; hypotension; uncontrolled seizures; myopathy; severe metabolic, endocrine, or electrolyte disorders ● alcohol abuse ● concurrent use of fibric acid derivatives (such as gemfibrozil) or drugs that may decrease endogenous steroids (such as cimetidine, ketoconazole, spironolactone) ● elderly patients ● females of childbearing potential ● children (safety and efficacy not established).

Administration Before starting therapy, patient should attempt to control hypercholesterolemia with appropriate diet, exercise, and weight reduction (if obese)

●


71

and should receive treatment for other underlying medical problems. ● Administer with or without food. ● Don’t give with grapefruit juice or antacids. ● Titrate dosage over 7 to 14 days. (Titration may be more rapid if warranted and if patient is assessed frequently.) ● Dosage of amlodipine, atorvastatin, or both may be increased, if appropriate, for additional antianginal, hypotensive, or lipid-lowering effect. Route P.O.

Onset Unknown

Peak Unknown

Duration Unknown

Adverse reactions Amlodipine component CNS: dizziness, headache, fatigue, somnolence CV: palpitations, chest pain, arrhythmias EENT: abnormal vision, conjunctivitis, diplopia, eye pain, tinnitus GI: nausea, abdominal pain, dry mouth GU: frequent urination, urination disorder, nocturia Hematologic: purpura, leukopenia, thrombocytopenia Metabolic: hyperglycemia Skin: flushing, erythema multiforme Other: edema, increased sweating, thirst Atorvastatin component CNS: headache, migraine, asthenia, insomnia, dizziness, malaise, depression, peripheral neuropathy, somnolence, amnesia, abnormal dreams, emotional lability, facial paralysis, incoordination, hyperkinesia, paresthesia, hypoesthesia, hypertonia CV: chest pain, palpitations, vasodilation, syncope, hypertension, orthostatic hypotension, phlebitis, angina pectoris, arrhythmias EENT: amblyopia, refraction disorder, eye hemorrhage, glaucoma, dry eyes,

2Clinical alert

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hearing loss, tinnitus, parosmia, epistaxis, rhinitis, sinusitis, pharyngitis GI: nausea, vomiting, diarrhea, constipation, abdominal pain, dyspepsia, flatulence, enteritis, gastroenteritis, colitis, gastritis, esophagitis, eructation, biliary pain, duodenal ulcer, gastric ulcer, pancreatitis, cholestatic jaundice, tenesmus, melena, dysphagia, cheilitis, glossitis, stomatitis, dry mouth, ulcerative stomatitis, rectal and gum hemorrhage GU: decreased libido, sexual dysfunction, fibrocystic breasts, breast enlargement, metrorrhagia, epididymitis, abnormal ejaculation, urinary tract infection, hematuria, albuminuria, urinary frequency, urinary incontinence, urinary retention, urinary urgency, nocturia, cystitis, dysuria, renal calculus, nephritis, vaginal and uterine hemorrhage Hematologic: anemia, thrombocytopenia Hepatic: abnormal liver function tests, hepatitis Metabolic: gout Musculoskeletal: back pain, arthralgia, myalgia, myositis, myasthenia, arthritis, neck rigidity, leg cramps, bursitis, tenosynovitis, tendon contracture Respiratory: bronchitis, pneumonia, dyspnea, asthma Skin: rash, pruritus, contact dermatitis, alopecia, dry skin, acne, urticaria, eczema, seborrhea, skin ulcer, ecchymosis, petechiae, photosensitivity Other: taste loss or alteration; appetite changes; weight gain; infection; lymphadenopathy; accidental injury; flulike syndrome; peripheral, facial, or generalized edema; allergic reaction

Interactions Drug-drug. Antacids, colestipol: decreased atorvastatin level Azole antifungals, cyclosporine, erythromycin, fibric acid derivatives, niacin, other HMG-CoA inhibitors: increased myopathy risk Canada

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Beta-adrenergic blockers: increased risk of adverse effects (amlodipine component) Cimetidine, ketoconazole, spironolactone: decreased levels or activity of endogenous steroids (atorvastatin component) Digoxin: increased digoxin level, increased risk of digoxin toxicity Fentanyl, nitrates, other antihypertensives, quinidine: additive hypotension (amlodipine component) Hormonal contraceptives: increased estrogen level Drug-diagnostic tests. ALT, AST, creatinine kinase: increased (atorvastatin component) Blood glucose: increased or decreased CBCs, platelets: decreased Drug-food. Grapefruit juice: increased drug level, greater risk of adverse effects Drug-herb. Red yeast rice: increased risk of adverse herbal effects Drug-behaviors. Acute alcohol ingestion: additive hypotension (amlodipine component)

Patient monitoring Monitor heart rate and rhythm and blood pressure, especially at start of therapy. ● Monitor liver function tests before therapy starts, at 12 weeks, and after dosage increase; thereafter, monitor periodically. ● Watch for signs and symptoms of allergic response. 2Monitor patient for worsening angina. 2Assess for heart failure; promptly report signs and symptoms (peripheral edema, dyspnea). ● Monitor patients who develop transaminase elevations until these resolve. 2Evaluate for muscle weakness (a symptom of myositis and possibly rhabdomyolysis). ● Measure blood glucose level regularly. ●

Hazardous drug

High alert drug

amoxapine

Patient teaching Tell patient drug may be taken with or without food. ● Advise patient to minimize GI upset by eating small, frequent servings of food and drinking plenty of fluids. ● Instruct patient to avoid grapefruit juice during therapy. 2Urge patient to immediately report unexplained muscle pain, tenderness, or weakness—especially if accompanied by malaise or fever. 2Instruct patient to immediately report signs and symptoms of liver damage, such as nausea, fatigue, anorexia, jaundice, dark urine, light-colored stools, intense itching, or tender abdomen. 2Tell patient to promptly report chest pain, swelling, or difficulty breathing. ● Caution patient to avoid driving and other hazardous activities until drug effects are known. ● Instruct patient to avoid alcohol use during therapy. ● Advise female with childbearing potential to avoid pregnancy and breastfeeding during therapy. ● As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, herbs, and behaviors mentioned above. ●

amoxapine Pharmacologic class: Tricyclic compound Therapeutic class: Antidepressant Pregnancy risk category C

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disorder and other psychiatric disorders. Risk must be balanced with clinical need, as depression itself increases suicide risk. With patient of any age, observe closely for clinical worsening, suicidality, and unusual behavior changes when therapy begins. Advise family to observe patient closely and communicate with prescriber as needed. ● Drug isn’t approved for use in pediatric patients.

Action Unclear. Inhibits reuptake of norepinephrine or serotonin at presynaptic neuron, thereby increasing levels of these neurotransmitters in brain. Also has sedative, anticholinergic, and mild peripheral vasodilatory properties.

Availability Tablets: 25 mg, 50 mg, 100 mg, 150 mg


➣ Depression accompanied by anxiety or agitation, depression in patients with neurotic or reactive depressive disorders, endogenous and psychotic depression Adults: Initially, 50 mg P.O. two or three times daily, increased to 100 mg two or three times daily by end of first week. If starting dosage (up to 300 mg/ day) is tolerated but ineffective for at least 2 weeks, dosage may be increased. For outpatients, maximum suggested dosage is 400 mg/day; for hospitalized patients, 600 mg/day. Dosage adjustment ●

Elderly patients

Off-label uses FDA BOXED WARNING Drug may increase risk of suicidal thinking and behavior in children and adolescents with major depressive

●


Analgesic adjunct for phantom limb pain or chronic pain

●

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amoxapine

Contraindications Hypersensitivity to drug or other tricyclic antidepressants (TCAs) ● Acute recovery phase after myocardial infarction ● MAO inhibitor use within past 14 days ●

Precautions Use cautiously in: ● renal or hepatic impairment, prostatic hypertrophy, hyperthyroidism, angle-closure glaucoma, bipolar disorder, schizophrenia ● elderly patients ● pregnant or breastfeeding patients ● children younger than age 16 (safety and efficacy not established).

Administration

2Don’t give drug if patient has taken MAO inhibitors within past 14 days. ● If desired, give daily dose up to 300 mg at bedtime. ● If patient is scheduled for surgery, discuss need for dosage tapering with prescriber. Route P.O.

Onset Unknown

Peak 2-4 hr

Duration 2-4 wk

Adverse reactions CNS: agitation, restlessness, fatigue, panic, anxiety, dizziness, drowsiness, difficulty articulating words, excitement, hypomania, psychosis exacerbation, extrapyramidal effects, tardive dyskinesia, poor coordination, hallucinations, headache, insomnia, nightmares, numbness, paresthesia, peripheral neuropathy, weakness, neuroleptic malignant syndrome, seizures, coma, suicidal behavior or ideation (especially in children and adolescents) CV: ECG changes, hypertension, orthostatic hypotension, arrhythmias, heart block, myocardial infarction, tachycardia EENT: blurred vision, dry eyes, mydriasis, abnormal visual accommodation, increased intraocular pressure, tinnitus Canada

UK

GI: nausea, vomiting, constipation, anorexia, epigastric pain, dry mouth, paralytic ileus GU: urine retention, delayed voiding, urinary tract dilation, gynecomastia Hematologic: agranulocytosis, thrombocytopenia, thrombocytopenic purpura, leukopenia Metabolic: changes in blood glucose level Skin: photosensitivity rash, urticaria, flushing, diaphoresis Other: increased appetite, weight gain, high fever, edema, hypersensitivity reactions

Interactions Drug-drug. Adrenergics, anticholinergics, anticholinergic-like drugs: increased anticholinergic effects Amiodarone, cimetidine, quinidine, ritonavir: increased amoxapine effects Barbiturates: reduced amoxapine blood level, increased CNS and respiratory effects Clonidine: hypertensive crisis CNS depressants (including antihistamines, opioids, sedative-hypnotics): increased CNS depression Drugs metabolized by CYP450 2D6 (such as other antidepressants, carbamazepine, class IC antiarrhythmics, phenothiazines): decreased amoxapine clearance, possible toxicity Guanethidine: antagonism of antihypertensive action Levodopa: delayed or decreased levodopa absorption, hypertension MAO inhibitors: hypotension, tachycardia, extreme excitation, fever, hyperpyrexia, seizures Rifabutin, rifampin, rifapentine: decreased amoxapine blood level and effects Selective serotonin reuptake inhibitors: increased toxicity Sympathomimetics: increased pressor effects of direct-acting sympathomimetics (epinephrine, norepinephrine), possibly causing arrhythmias; Hazardous drug

High alert drug

amoxicillin

decreased pressor effects of indirectacting sympathomimetics (ephedrine, metaraminol) Valproic acid: increased valproic acid blood level, greater risk of adverse reactions Drug-diagnostic tests. Eosinophils, liver function tests: increased values Glucose, granulocytes, platelets, white blood cells: increased or decreased values Drug-herbs. Evening primrose: lower seizure threshold, increased risk of seizures Drug-behaviors. Alcohol use: increased CNS sedation Smoking: increased metabolism and altered drug effects Sun exposure: increased risk of photosensitivity reactions

Patient monitoring

2Watch for signs and symptoms of neuroleptic malignant syndrome (high fever, rapid pulse and breathing, profuse sweating). ● Monitor patient for signs and symptoms of psychosis. If these occur, consult prescriber. ● Evaluate patient for development of tardive dyskinesia (involuntary movements of face, arms, legs, and trunk). ● Assess for changes in mood and mental status. ● Check blood pressure for orthostatic hypertension. 2Watch for signs and symptoms of depression, and assess for suicidal ideation. ● Monitor CBC with white cell differential, glucose level, and kidney and liver function test results.

Patient teaching

2Tell patient to contact prescriber immediately if he develops high fever, rapid pulse and breathing, profuse sweating, changes in mental status, or involuntary movements.


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2Instruct patient to promptly report severe mood changes or suicidal thoughts. ● Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness. ● Tell patient that stopping drug suddenly can cause withdrawal symptoms. ● Advise patient to rise slowly and carefully to avoid dizziness. ● Caution patient that drug may cause serious interactions with many common drugs. Instruct him to tell all prescribers that he’s taking this drug. ● Advise patient to minimize GI upset by eating small, frequent servings of food and drinking plenty of fluids. ● Tell patient he’ll undergo frequent blood testing during therapy. ● As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, herbs, and behaviors mentioned above.

amoxicillin amoxicillin trihydrate Amix , Amox, Amoxident , Amoxil, Apo-Amoxil, Moxatag, Novamoxin, Nu-Amoxil, Trimox Pharmacologic class: Aminopenicillin Therapeutic class: Anti-infective Pregnancy risk category B

Action Inhibits cell-wall synthesis during bacterial multiplication, leading to cell death. Shows enhanced activity toward gram-negative bacteria compared to natural and penicillinase-resistant penicillins.

2Clinical alert

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amoxicillin

Availability Capsules: 250 mg, 500 mg Powder for oral suspension: 50 mg/ml and 125 mg/5 ml (pediatric), 200 mg/ 5 ml, 250 mg/5 ml, 400 mg/5 ml Tablets: 500 mg, 875 mg Tablets for oral suspension: 200 mg, 400 mg Tablets (chewable): 125 mg, 200 mg, 250 mg, 400 mg


➣ Uncomplicated gonorrhea Adults and children weighing at least 40 kg (88 lb): 3 g P.O. as a single dose Children ages 2 and older weighing less than 40 kg (88 lb): 50 mg/kg P.O. given with probenecid 25 mg/kg P.O. as a single dose ➣ Bacterial endocarditis prophylaxis for dental, GI, and GU procedures Adults: 2 g P.O. 1 hour before procedure Children: 50 mg/kg P.O. 1 hour before procedure ➣ Lower respiratory tract infections caused by streptococci, pneumococci, non-penicillinase-producing staphylococci, and Haemophilus influenzae Adults and children weighing more than 20 kg (44 lb): 875 mg P.O. q 12 hours or 500 mg P.O. q 8 hours Children weighing less than 20 kg (44 lb): 45 mg/kg/day P.O. in divided doses q 12 hours or 40 mg/kg/day P.O. in divided doses q 8 hours ➣ Ear, nose, and throat infections caused by streptococci, pneumococci, non-penicillinase-producing staphylococci, and H. influenzae; GU infections caused by Escherichia coli, Proteus mirabilis, and Streptococcus faecalis Adults and children weighing more than 20 kg (44 lb): 500 mg P.O. q 12 hours or 250 mg P.O. q 8 hours Children weighing less than 20 kg (44 lb): 45 mg/kg/day P.O. in divided doses q 12 hours or 20 to 40 mg/kg P.O. in divided doses q 8 hours Canada

UK

➣ Eradication of Helicobacter pylori to reduce risk of duodenal ulcer recurrence Adults: 1 g P.O. q 12 hours for 14 days in combination with clarithromycin and lansoprazole, or in combination with lansoprazole alone as 1 g t.i.d. for 14 days ➣ Postexposure anthrax prophylaxis Adults: 500 mg P.O. t.i.d. for 60 days Children: 80 mg/kg/day P.O. t.i.d. for 60 days ➣ Skin and skin-structure infections caused by streptococci (alpha- and beta-hemolytic strains), staphylococci, and E. coli Adults: 500 mg P.O. q 12 hours to 250 mg P.O. q 8 hours. For severe infections, 875 mg P.O. q 12 hours or 500 mg P.O. q 8 hours. Children older than age 3 months: 25 mg/kg/day P.O. in divided doses q 12 hours or 20 mg/kg/day P.O. in divided doses every 8 hours. For severe infections, 45 mg/kg/day P.O. in divided doses q 12 hours or 40 mg/kg/day P.O. in divided doses every 8 hours. Dosage adjustment ● ● ●

Renal impairment Hemodialysis Infants ages 3 months and younger

Off-label uses ● Chlamydia trachomatis infection in pregnant patients

Contraindications Hypersensitivity to drug or any penicillin

●

Precautions Use cautiously in: ● severe renal insufficiency, infectious mononucleosis, hepatic dysfunction ● pregnant patients.

Administration

2Ask about history of penicillin allergy before giving. Hazardous drug

High alert drug

amoxicillin

Give with or without food. Store liquid form in refrigerator when possible. ● Know that maximum dosage for infants ages 3 months and younger is 30 mg/kg/day divided q 12 hours. ● ●

Route P.O.

Onset 30 min

Peak 1-2 hr

Duration 8-12 hr

Adverse reactions CNS: lethargy, hallucinations, anxiety, confusion, agitation, depression, dizziness, fatigue, hyperactivity, insomnia, behavioral changes, seizures (with high doses) GI: nausea, vomiting, diarrhea, bloody diarrhea, abdominal pain, gastritis, stomatitis, glossitis, black “hairy” tongue, furry tongue, enterocolitis, pseudomembranous colitis GU: vaginitis, nephropathy, interstitial nephritis Hematologic: eosinophilia, anemia, thrombocytopenia, thrombocytopenic purpura, leukopenia, hemolytic anemia, agranulocytosis, bone marrow depression Hepatic: cholestatic jaundice, hepatic cholestasis, cholestatic hepatitis, nonspecific hepatitis Respiratory: wheezing Skin: rash Other: superinfections (oral and rectal candidiasis), fever, anaphylaxis

Interactions Drug-drug. Allopurinol: increased risk of rash Chloramphenicol, macrolides, sulfonamides, tetracycline: decreased amoxicillin efficacy Hormonal contraceptives: decreased contraceptive efficacy Probenecid: decreased renal excretion Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, eosinophils, lactate dehydrogenase: increased levels


77

Granulocytes, hemoglobin, platelets, white blood cells: decreased values Direct Coombs’ test, urine glucose, urine protein: false-positive results Drug-food. Any food: delayed or reduced drug absorption Drug-herbs. Khat: decreased antimicrobial efficacy

Patient monitoring Monitor for signs and symptoms of hypersensitivity reaction. 2Evaluate for seizures when giving high doses. ● Monitor patient’s temperature and watch for other signs and symptoms of superinfection (especially oral or rectal candidiasis). ●

Patient teaching

2Instruct patient to immediately report signs and symptoms of hypersensitivity reactions, such as rash, fever, or chills. ● Tell patient he may take drug with or without food. ● Tell patient not to chew or swallow tablets for suspension, because they’re not meant to be dissolved in mouth. ● Advise patient to minimize GI upset by eating small, frequent servings of food and drinking plenty of fluids. ● Tell patient taking hormonal contraceptives that drug may reduce contraceptive efficacy. Suggest she use alternative birth control method. ● Inform patient that drug lowers resistance to other types of infections. Instruct him to report new signs and symptoms of infection, especially in mouth or rectum. ● Tell parents they may give liquid form of drug directly to child or may mix it with foods or beverages. ● As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, and herbs mentioned above. 2Clinical alert

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amoxicillin and clavulanate potassium Apo-Amoxi-Clav, Augmentin, Augmentin-Duo , Augmentin ES-600, Augmentin XR, Clavulin, Novo-Clavamoxin Pharmacologic class: Aminopenicillin Therapeutic class: Anti-infective Pregnancy risk category B

Action Amoxicillin inhibits transpeptidase, preventing cross-linking of bacterial cell wall and leading to cell death. Addition of clavulanate (a beta-lactam) increases drug’s resistance to beta-lactamase (an enzyme produced by bacteria that may inactivate amoxicillin).

Availability Oral suspension: 125 mg amoxicillin with 31.25 mg clavulanic acid/5 ml, 200 mg amoxicillin with 28.5 mg clavulanic acid/5 ml, 250 mg amoxicillin with 62.5 mg clavulanic acid/ 5 ml, 400 mg amoxicillin with 57 mg clavulanic acid/5 ml, 600 mg amoxicillin with 42.9 mg clavulanic acid/5 ml Tablets (chewable): 125 mg amoxicillin with 31.25 mg clavulanate, 200 mg amoxicillin with 28.5 mg clavulanate, 250 mg amoxicillin with 62.5 mg clavulanate, 400 mg amoxicillin with 57 mg clavulanate Tablets (extended-release): 1,000 mg amoxicillin with 62.5 mg clavulanate Tablets (film-coated): 250 mg amoxicillin with 125 mg clavulanate, 500 mg amoxicillin with 125 mg clavulanate, 875 mg amoxicillin with 125 mg clavulanate


➣ Lower respiratory tract infections, otitis media, sinusitis, skin and Canada

UK

skin-structure infections, and urinary tract infections (UTIs) caused by susceptible strains of gram-negative and gram-positive organisms Adults and children weighing more than 40 kg (88 lb): 500 mg q 12 hours or 250 mg P.O. q 8 hours (based on amoxicillin component). For severe infections, 875 mg P.O. q 12 hours or 500 mg P.O. q 8 hours. ➣ Serious infections and communityacquired pneumonia Adults and children weighing more than 40 kg (88 lb): 875 mg P.O. q 12 hours or 500 mg P.O. q 8 hours Infants and children ages 3 months and older weighing less than 40 kg (88 lb): 20 to 45 mg/kg/day P.O. in divided doses q 12 hours or 20 or 25 to 40 mg/kg/day in divided doses q 8 hours, based on severity of infection and amoxicillin component (125 mg/5 ml or 250 mg/5 ml suspension) Infants younger than 3 months: 30 mg/ kg/day P.O. (based on amoxicillin component) divided q 12 hours. (125 mg/ 5 ml oral suspension is recommended.) ➣ Recurrent or persistent acute otitis media caused by Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis in children ages 2 and younger and in children who have received antibiotic therapy within last 3 months Children ages 3 months to 12 years: 90 mg/kg/day of Augmentin ES-600 P.O. q 12 hours for 10 days

Dosage adjustment ● ● ●

Severe renal impairment Hemodialysis Infants ages 3 months and younger

Contraindications Hypersensitivity to drug or any penicillin ● Phenylketonuria (some products) ● History of cholestatic jaundice or hepatic dysfunction associated with this drug ●

Hazardous drug

High alert drug


Precautions Use cautiously in: ● severe renal insufficiency, infectious mononucleosis ● pregnant patients.

Administration

2Ask about history of penicillin allergy before giving. ● Give with or without food. ● Know that maximum dosage for infants ages 3 months and younger is 30 mg/kg/day divided q 12 hours. ● Be aware that 12-hour dosing is recommended to reduce diarrhea. Route P.O.

Onset Unknown

P.O. Unknown (extended)

Peak Duration 1-2.5 hr 6-8 hr 1-4 hr

Unknown

Adverse reactions CNS: lethargy, hallucinations, anxiety, confusion, agitation, depression, dizziness, fatigue, hyperactivity, insomnia, behavioral changes, seizures (with high doses) GI: nausea, vomiting, diarrhea, abdominal pain, stomatitis, glossitis, gastritis, black “hairy” tongue, furry tongue, enterocolitis, pseudomembranous colitis GU: vaginitis, nephropathy, interstitial nephritis Hematologic: anemia, thrombocytopenia, thrombocytopenic purpura, leukopenia, hemolytic anemia, agranulocytosis, bone narrow depression, eosinophilia Hepatic: cholestatic hepatitis Respiratory: wheezing Skin: rash Other: superinfections (oral and rectal candidiasis), fever, anaphylaxis

Interactions Drug-drug. Any food: enhanced clavulanate absorption


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Chloramphenicol, macrolides, sulfonamides, tetracycline: decreased amoxicillin efficacy Hormonal contraceptives: decreased contraceptive efficacy Probenecid: decreased renal excretion and increased blood level of amoxicillin Drug-food. Any food: enhanced clavulanate absorption Drug-herbs. Khat: decreased antimicrobial effect

Patient monitoring Monitor patient carefully for signs and symptoms of hypersensitivity reaction. 2Monitor for seizures when giving high doses. ● Check patient’s temperature and watch for other signs and symptoms of superinfection, especially oral or rectal candidiasis. ●

Patient teaching

2Instruct patient to immediately report signs or symptoms of hypersensitivity reaction, such as rash, fever, or chills. ● Tell patient he may take drug with or without food. ● Inform patient that drug lowers resistance to some types of infections. Instruct him to report new signs or symptoms of infection (especially of mouth or rectum). ● Advise patient to minimize GI upset by eating small, frequent servings of food and drinking plenty of fluids. ● Tell patient taking hormonal contraceptives that drug may reduce contraceptive efficacy. Suggest she use alternative birth control method. ● Inform parents that they may give liquid form of drug directly to child or may mix it with foods or beverages. ● As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, foods, and herbs mentioned above. 2Clinical alert

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amphotericin B

amphotericin B cholesteryl sulfate Amphocil , Amphotec

amphotericin B desoxycholate


Fungilin , Fungizone Intravenous

amphotericin B lipid complex Abelcet

amphotericin B liposome AmBisome Pharmacologic class: Systemic polyene antifungal Therapeutic class: Antifungal Pregnancy risk category B

FDA BOXED WARNING Amphotericin B desoxycholate should be used mainly to treat progressive and potentially life-threatening fungal infections. It shouldn’t be used to treat noninvasive forms of fungal disease (such as oral thrush, vaginal candidiasis, or esophageal candidiasis) in patients with normal neutrophil counts. ●

Action Binds to sterols in fungal cell membrane, increasing permeability. This allows potassium to exit the cell, causing fungal impairment or death.

Availability Amphotericin B cholesteryl sulfate— Injection: 50 mg, 100 mg Amphotericin B desoxycholate— Injection: 50-mg vial Canada

Oral suspension: 100 mg/ml in 24-ml bottles Amphotericin B lipid complex— Suspension for injection: 100 mg/20-ml vials Amphotericin B liposome— Injection: 50 mg

UK

➣ Invasive aspergillosis Adults: Amphotericin B desoxycholate—For patients with good cardiorenal function who tolerate test dose, give 0.25 to 0.3 mg/kg daily by slow I.V. infusion (0.1 mg/ml over 2 to 6 hours). Gradually increase to 0.5 to 0.6 mg/kg daily. Patients with neutropenia or rapidly progressing, potentially fatal infections may require higher dosages (1 to 1.5 mg/kg daily). Adults and children ages 1 month and older: Amphotericin B liposome—3 to 5 mg/kg I.V. daily ➣ Invasive aspergillosis in patients with renal impairment or unacceptable toxicity who can’t tolerate or don’t respond to amphotericin B desoxycholate in effective doses Adults and children: Amphotericin B cholesteryl sulfate—3 to 4 mg/kg daily reconstituted in sterile water for injection and diluted in dextrose 5% in water (D5W) and give by continuous infusion at 1 mg/kg/hour. Amphotericin B lipid complex—5 mg/kg daily I.V. prepared as 1-mg/ml infusion and delivered at a rate of 2.5 mg/kg/hour. ➣ Systemic histoplasmosis Adults: Amphotericin B desoxycholate—If patient tolerates test dose, gradually increase from initial recommended dosage of 0.25 to 0.3 mg/kg daily by slow I.V. infusion (0.1 mg/ml over 2 to 6 hours) to usual dosage of 0.5 to 0.6 mg/kg daily I.V. for 4 to 8 weeks; higher dosages (0.7 to 1 mg) may be necessary for rapidly progressing, potentially fatal infections. ➣ Systemic coccidioidomycosis and blastomycosis Hazardous drug

High alert drug

amphotericin B

Adults: Amphotericin B desoxycholate— If patient tolerates test dose, gradually increase from initial recommended dosage of 0.25 to 0.3 mg/kg daily by slow I.V. infusion (0.1 mg/ml over 2 to 6 hours) to usual dosage of 0.5 to 1 mg/kg daily I.V. for 4 to 12 weeks. ➣ Systemic cryptococcosis Adults: Amphotericin B desoxycholate—If patient tolerates test dose, gradually increase from initial recommended dosage of 0.25 to 0.3 mg/kg daily by slow I.V. infusion (0.1 mg/ml over 2 to 6 hours) to usual dosage of 0.3 to 1 mg/kg daily I.V. (with or without flucytosine) for 2 weeks to several months. For patients with human immunodeficiency virus (HIV) infection, usual dosage is 0.7 mg/kg daily I.V. for 4 weeks, followed by 0.7 mg/kg I.V. given on alternate days for 4 additional weeks. If patient can’t tolerate or doesn’t respond to amphotericin B desoxycholate, give amphotericin B cholesteryl sulfate at a dosage of 3 to 6 mg/kg daily I.V. Adults and children ages 1 month and older: Amphotericin B liposome—3 to 5 mg/kg daily I.V. ➣ Cryptococcal meningitis in HIVinfected patients Adults: Amphotericin B desoxycholate—If patient tolerates test dose, gradually increase from initial recommended dosage of 0.25 to 0.3 mg/kg daily by slow I.V. infusion (0.1 mg/ml over 2 to 6 hours) to usual dosage of 0.3 to 1 mg/kg daily I.V. (with or without flucytosine) for 2 weeks to several months. Amphotericin B lipid complex—5 mg/kg I.V. infusion daily for 6 weeks, followed by 12 weeks of oral fluconazole therapy. Amphotericin B liposome—6 mg/kg I.V. infusion daily. ➣ Disseminated candidiasis Adults: Amphotericin B desoxycholate—If patient tolerates test dose, gradually increase from initial recommended dosage of 0.25 to 0.3 mg/kg daily by slow I.V. infusion (0.1 mg/ml Reactions in bold are life-threatening.

81

over 2 to 6 hours) to usual dosage of 0.4 to 0.6 mg/kg daily by slow I.V. infusion for 7 to 14 days (low-risk patients) or for 6 weeks (high-risk patients). For hepatosplenic candidiasis, 1 mg/kg daily I.V. given with oral flucytosine; for severe or refractory esophageal candidiasis in HIV-infected patients, 0.3 mg/kg daily I.V. for at least 5 to 7 days; for candiduria, 0.3 mg/kg daily I.V. for 3 to 5 days. Adults and children ages 1 month and older: Amphotericin B liposome—3 to 5 mg/kg/day I.V. for 5 to 7 days ➣ Systemic zygomycosis, including mucormycosis Adults: Amphotericin B desoxycholate—If patient tolerates test dose, gradually increase from initial recommended dosage of 0.25 to 0.3 mg/kg daily by slow I.V. infusion (0.1 mg/ml over 2 to 6 hours) to usual dosage of 1 to 1.5 mg/kg daily I.V. for 2 to 3 months. For rhinocerebral phycomycosis form, total dosage is 3 g I.V. ➣ Systemic disseminated sporotrichosis Adults: Amphotericin B desoxycholate—If patient tolerates test dose, gradually increase from initial recommended dosage of 0.25 to 0.3 mg/kg daily by slow I.V. infusion (0.1 mg/ml over 2 to 6 hours) to usual dosage of 0.4 to 0.5 mg/kg daily I.V. for 2 to 3 months. ➣ Cutaneous leishmaniasis Adults and children: Amphotericin B desoxycholate—If patient tolerates test dose, gradually increase from initial recommended dosage of 0.25 to 0.5 mg/kg/day given by slow I.V. infusion (0.1 mg/ml over 2 to 6 hours) until 0.5 to 1 mg/kg/day is reached; then give every other day. Usual duration is 3 to 12 weeks. ➣ Visceral leishmaniasis in immunocompetent patients Adults and children ages 1 month and older: Amphotericin B liposome— 3 mg/ kg given I.V. over 2 hours on 2Clinical alert

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amphotericin B

days 1 through 5, 14, and 21. Repeat course if initial treatment fails to clear parasites. ➣ Visceral leishmaniasis in immunocompromised patients Adults and children ages 1 month and older: Amphotericin B liposome—4 mg/ kg given I.V. over 2 hours on days 1 through 5, 10, 17, 24, 31, and 38 ➣ Empiric therapy for presumed fungal infection in febrile, neutropenic patients Adults: Amphotericin B desoxycholate—If patient tolerates test dose, gradually increase from initial recommended dosage of 0.25 to 0.3 mg/kg daily by slow I.V. infusion (0.1 mg/ml over 2 to 6 hours) to usual dosage of 0.25 to 1 mg/kg daily I.V. Amphotericin B liposome—3 mg/kg daily given I.V. over 120 minutes for 2 weeks

Off-label uses Chemoprophylaxis in immunocompromised patients ● Coccidioidal arthritis ● Prophylaxis of fungal infections in bone-marrow transplant recipients, patients with primary amoebic meningoencephalitis caused by Naegleria fowleri, and patients with ocular aspergillosis ●

Contraindications Hypersensitivity to drug and its components ● Severe respiratory distress ●

Precautions Use cautiously in: ● renal impairment, electrolyte abnormalities ● pregnant or breastfeeding patients ● children.

Administration Know that amphotericin B should be given only by health care professionals thoroughly familiar with drug, its administration, and adverse reactions.

●

Canada

UK

2Before giving first dose of conventional amphotericin B (desoxycholate form), test dose may be ordered (due to widely varying tolerance and clinical status) as follows: 1 mg in 20 ml of D5W over 20 to 30 minutes; monitor vital signs every 30 minutes for next 2 hours. ● Know that if desoxycholate form is discontinued for 1 week or longer, drug should be restarted at 0.25 mg/kg daily, with dosage then increased gradually. ● Pretreat with antihistamines, antipyretics, or corticosteroids, as prescribed. ● Give through separate I.V. line, using infusion pump and in-line filter with pores larger than 1 micron. ● Choose distal vein for I.V. site. Alternate sites regularly. ● Mix with sterile water to reconstitute. Don’t mix with sodium chloride, other electrolytes, or bacteriostatic products. ● Flush I.V. line with 5% dextrose injection before and after infusion. ● Keep dry form of drug away from light. Once mixed with fluid, solution can be kept in light for up to 8 hours. 2Know that total daily dosage of amphotericin B desoxycholate form should never exceed 1.5 mg/kg. Route P.O.

Onset Peak Unknown Unknown

Duration Unknown

I.V.

Rapid

24 hr

End of infusion

Adverse reactions CNS: anxiety, confusion, headache, insomnia, weakness, depression, dizziness, drowsiness, hallucinations, speech difficulty, ataxia, vertigo, stupor, psychosis, seizures CV: hypotension, hypertension, tachycardia, phlebitis, chest pain, orthostatic hypotension, vasodilation, asystole, atrial fibrillation, bradycardia,

Hazardous drug

High alert drug

amphotericin B

cardiac arrest, shock, supraventricular tachycardia EENT: double or blurred vision, amblyopia, eye hemorrhage, hearing loss, tinnitus, epistaxis, rhinitis, sinusitis, pharyngitis GI: nausea, vomiting, diarrhea, melena, abdominal pain, abdominal distention, dry mouth, oral inflammation, oral candidiasis, anorexia, GI hemorrhage GU: painful urination, hematuria, albuminuria, glycosuria, excessive urea buildup, urine of low specific gravity, nephrocalcinosis, renal failure, renal tubular acidosis, oliguria, anuria Hematologic: eosinophilia; normochromic, normocytic, or hypochromic anemia; leukocytosis; thrombocytopenia; leukopenia; agranulocytosis; coagulation disorders Hepatic: jaundice, acute hepatic failure, hepatitis Metabolic: hypomagnesemia, hypokalemia, hypocalcemia, hypernatremia, hyperglycemia, dehydration, hypoproteinemia, hypervolemia, hyperlipidemia, acidosis Musculoskeletal: muscle, joint, neck, or back pain Respiratory: increased cough, hypoxia, lung disorders, hyperventilation, wheezing, dyspnea, hemoptysis, tachypnea, asthma, bronchospasm, respiratory failure, pulmonary edema, pleural effusion Skin: discoloration, bruising, flushing, pruritus, urticaria, acne, rash, sweating, nodules, skin ulcers, alopecia, maculopapular rash Other: gingivitis, fever, infection, peripheral or facial edema, weight changes, pain or reaction at injection site, tissue damage with extravasation, hypersensitivity reactions including anaphylaxis

Interactions Drug-drug. Antineoplastics (such as mechlorethamine): renal toxicity, bronchospasm, hypotension Reactions in bold are life-threatening.

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Cardiac glycosides: increased risk of digitalis toxicity (in potassiumdepleted patients) Corticosteroids: increased potassium depletion Cyclosporine, tacrolimus: increased creatinine levels Flucytosine: increased flucytosine toxicity Imidazoles (clotrimazole, fluconazole, ketoconazole, miconazole): antagonism of amphotericin B effects Leukocyte transfusion: pulmonary reactions Nephrotoxic drugs (such as antibiotics, pentamidine): increased risk of renal toxicity Thiazides: increased electrolyte depletion Skeletal muscle relaxants: increased skeletal muscle relaxation Zidovudine: increased myelotoxicity and nephrotoxicity Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, bilirubin, blood urea nitrogen, creatinine, gammaglutamyltransferase, lactate dehydrogenase, nitrogenous compounds (urea), uric acid: increased levels Calcium, hemoglobin, magnesium, platelets, potassium, protein: decreased levels Eosinophils, glucose, white blood cells: increased or decreased levels Liver function tests: abnormal results Prothrombin time: prolonged Drug-herbs. Gossypol: increased risk of renal toxicity

Patient monitoring

2Monitor for infusion-related reactions (fever, chills, hypotension, GI symptoms, breathing difficulties, and headache). Stop infusion and notify prescriber immediately if reaction occurs. 2After giving test dose, monitor vital signs and temperature every 30 minutes for 2 to 4 hours, as ordered. ● Assess fluid intake and output. 2Clinical alert

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ampicillin sodium

Monitor kidney and liver function test results and serum electrolyte levels. ● Assess for signs and symptoms of ototoxicity (hearing loss, tinnitus, ataxia, and vertigo). ●

Patient teaching

2Advise patient to contact prescriber immediately if he has fever, chills, headache, vomiting, diarrhea, cough, or breathing problems. ● Instruct patient to report hearing loss, dizziness, or unsteady gait. ● Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration, alertness, and vision. ● Instruct patient to drink plenty of fluids. ● Tell patient to monitor urine output and report significant changes. ● Advise patient to minimize GI upset by eating small, frequent servings of food and drinking plenty of fluids. ● As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and herbs mentioned above.

ampicillin sodium Apo-Ampi, Novo-Ampicillin, Nu-Ampi, Penbritin , Rimacillin Pharmacologic class: Aminopenicillin Therapeutic class: Anti-infective Pregnancy risk category B

Action Destroys bacteria by inhibiting bacterial cell-wall synthesis during microbial multiplication

Availability Capsules: 250 mg, 500 mg Canada

UK

Oral suspension: 125 mg/5 ml, 250 mg/ 5 ml Powder for injection: 125 mg, 250 mg, 500 mg, 1 g, 2 g, 10 g


➣ Respiratory tract, skin, and softtissue infections caused by Haemophilus influenzae, staphylococci, and streptococci Adults and children weighing 40 kg (88 lb) or more: 250 to 500 mg I.V. or I.M. q 6 hours Adults and children weighing less than 40 kg (88 lb): 25 to 50 mg/kg/day I.M. or I.V. in divided doses q 6 to 8 hours Adults and children weighing more than 20 kg (44 lb): 250 mg P.O. q 6 hours Children weighing 20 kg (44 lb) or less: 50 mg/kg/day P.O. in divided doses q 6 to 8 hours ➣ Bacterial meningitis caused by Neisseria meningitidis, Escherichia coli, group B streptococci, or Listeria monocytogenes; septicemia caused by Streptococcus species, penicillin G–susceptible staphylococci, enterococci, E. coli, Proteus mirabilis, or Salmonella species Adults: 150 to 200 mg/kg/day by continuous I.V. infusion or I.M. injection in equally divided doses q 3 to 4 hours, to a maximum dosage of 14 g Children: 100 to 200 mg/kg/day I.V. in divided doses q 3 to 4 hours ➣ GI or urinary tract infections, including Neisseria gonorrhoeae infection in women Adults and children weighing more than 40 kg (88 lb): 500 mg I.M. or I.V. q 6 hours Adults and children weighing 40 kg (88 lb) or less: 50 to 100 mg/kg/day I.M. or I.V. in equally divided doses q 6 to 8 hours ➣ Endocarditis prophylaxis for dental, oral, or upper respiratory tract procedures Hazardous drug

High alert drug

ampicillin sodium

Adults: 2 g I.M. or I.V. within 30 minutes before procedure Children: 50 mg/kg I.V. or I.M. within 30 minutes before procedure ➣ Prevention of bacterial endocarditis before GI or GU surgery or instrumentation High-risk adults: 2 g I.M. or I.V. with gentamicin 1.5 mg/kg I.M. or I.V. within 30 minutes before procedure. Six hours later, give ampicillin 1 g I.M. or I.V., or amoxicillin 1 g P.O. High-risk children: 50 mg/kg I.M. or I.V. with 1.5 mg/kg of gentamicin I.M. or I.V. within 30 minutes before procedure; 6 hours later, give ampicillin 25 mg/kg I.M. or I.V. or ampicillin 25 mg/ kg P.O. Moderate-risk adults: 2 g I.M. or I.V. within 30 minutes before procedure Moderate-risk children: 50 mg/kg I.M. or I.V. within 30 minutes before procedure ➣ Prophylaxis for neonatal group B streptococcal disease Adult women: During labor, loading dose of 2 g I.V.; then 1 g I.V. q 4 hours until delivery ➣ N. gonorrhoeae infections Adults: Single dose of 3.5 g P.O. given with l g probenecid Children weighing 40 kg (88 lb) or more: 500 mg I.M. or I.V. q 6 hours Children weighing less than 40 kg (88 lb): 50 mg/kg/day in divided doses q 6 to 8 hours ➣ Urethritis caused by N. gonorrhoeae (in males) Adults and children weighing 40 kg (88 lb) or more: 500 mg I.V. or I.M., repeated 8 to 12 hours later ➣ Prophylaxis against sexually transmitted diseases in adult rape victims Adults: 3.5 g P.O. with l g probenecid as a single dose


Renal impairment


85

Contraindications Hypersensitivity to penicillins, cephalosporins, imipenem, or other beta-lactamase inhibitors

●

Precautions Use cautiously in: ● severe renal insufficiency, infectious mononucleosis ● pregnant or breastfeeding patients.

Administration Ask patient about history of penicillin allergy before giving. ● For I.V. use, mix powder with bacteriostatic water for injection in amount listed on label. ● For direct I.V. injection, give over 10 to 15 minutes. Don’t exceed 100 mg/ minute. ● For intermittent I.V. infusion, mix with 50 to 100 ml of normal saline solution and give over 15 to 30 minutes. ● Change I.V. site every 48 hours. ● Give oral doses 1 hour before or 2 hours after meals. ●

Route P.O.

Onset 30 min

Peak 2 hr

Duration 6-8 hr

I.V.

Immediate

5 min

6-8 hr

I.M.

15 min

1 hr

6-8 hr

Adverse reactions CNS: lethargy, hallucinations, anxiety, confusion, agitation, depression, fatigue, dizziness, seizures CV: vein irritation, thrombophlebitis, heart failure EENT: blurred vision, itchy eyes GI: nausea, vomiting, diarrhea, abdominal pain, enterocolitis, gastritis, stomatitis, glossitis, black “hairy” tongue, furry tongue, oral or rectal candidiasis, pseudomembranous colitis GU: vaginitis, nephropathy, interstitial nephritis Hematologic: anemia, eosinophilia, agranulocytosis, hemolytic anemia, 2Clinical alert

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86

ampicillin sodium and sulbactam sodium

leukopenia, thrombocytopenic purpura, thrombocytopenia, neutropenia Hepatic: nonspecific hepatitis Musculoskeletal: arthritis exacerbation Respiratory: wheezing, dyspnea, hypoxia, apnea Skin: rash, urticaria, fever, diaphoresis Other: pain at injection site, superinfections, hyperthermia, hypersensitivity reaction, anaphylaxis, serum sickness

Interactions Drug-drug. Allopurinol: increased risk of rash Chloramphenicol: synergistic or antagonistic effects Hormonal contraceptives: decreased contraceptive effect, increased risk of breakthrough bleeding Probenecid: decreased renal excretion of ampicillin, increased ampicillin blood level Tetracyclines: reduced bactericidal effect Drug-diagnostic tests. Conjugated estrone, estradiol, estriol-glucuronide, total conjugated estriols: increased levels in pregnant patients Granulocytes, hemoglobin, platelets, white blood cells: decreased levels Coombs’ test, urine glucose: falsepositive results Eosinophils: increased count Drug-food. Any food: reduced ampicillin efficacy

Patient monitoring Watch for signs and symptoms of hypersensitivity reaction. 2Monitor for seizures when giving high doses. ● Frequently measure patient’s temperature and check for signs and symptoms of superinfection, especially oral or rectal candidiasis. ● Monitor for bleeding tendency or hemorrhage. ●

Canada

UK

Patient teaching Tell patient to take oral dose with 8 oz of water 1 hour before or 2 hours after a meal. 2Instruct patient to immediately report signs and symptoms of hypersensitivity reaction, such as rash, fever, or chills. ● Inform patient that drug lowers resistance to certain other infections. Tell him to report new signs or symptoms of infection, especially in mouth or rectum. ● Advise patient to minimize GI upset by eating small, frequent servings of food and drinking plenty of fluids. 2Instruct patient to promptly report unusual bleeding or bruising. ● Tell patient to avoid activities that can cause injury. Advise him to use soft toothbrush and electric razor to avoid gum and skin injury. ● Inform patient taking hormonal contraceptives that drug may reduce contraceptive efficacy. Advise her to use alternative birth control method. ● As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and foods mentioned above. ●

ampicillin sodium and sulbactam sodium Unasyn Pharmacologic class: Aminopenicillin/ beta-lactamase inhibitor Therapeutic class: Anti-infective Pregnancy risk category B

Action Destroys bacteria by inhibiting bacterial cell-wall synthesis during microbial multiplication. Addition of Hazardous drug

High alert drug

ampicillin sodium and sulbactam sodium

sulbactam enhances drug’s resistance to beta-lactamase, an enzyme that can inactivate ampicillin.

Availability Injection: Vials; piggyback vials containing 1.5 g (l g ampicillin sodium and 0.5 g sulbactam sodium), 3 g (2 g ampicillin sodium and l g sulbactam sodium), and 15 g (10 g ampicillin sodium and 5 g sulbactam sodium)


➣ Intra-abdominal, gynecologic, and skin-structure infections caused by susceptible beta-lactamase-producing strains Adults and children weighing 40 kg (88 lb) or more: 1.5 to 3 g (l g ampicillin and 0.5 g sulbactam to 2 g ampicillin and l g sulbactam) I.M. or I.V. q 6 hours. Maximum dosage is 4 g sulbactam daily. Children ages 1 year and older: 300 mg/ kg/day (200 mg ampicillin/100 mg sulbactam) by I.V. infusion q 6 hours in equally divided doses Dosage adjustment ●

Renal impairment

Contraindications Hypersensitivity to penicillins, cephalosporins, imipenem, or other beta-lactamase inhibitors

●

Precautions Use cautiously in: ● severe renal insufficiency, infectious mononucleosis ● pregnant or breastfeeding patients.

Administration Ask patient about history of penicillin allergy before giving. ● Let vial stand several minutes until foam has evaporated before administering drug. ● Don’t mix I.V. form with other I.V. drugs.

87

Give direct I.V. dose over 10 to 15 minutes. ● Give intermittent infusion in 50 to 100 ml of compatible solution over 15 to 30 minutes. ● Change I.V. site every 48 hours. ● Don’t give I.M. to children. ●

Route I.V.

Onset Immediate

Peak End of infusion

Duration 6-8 hr

I.M.

Rapid

1 hr

6-8 hr

Adverse reactions CNS: lethargy, hallucinations, anxiety, confusion, agitation, depression, fatigue, dizziness, seizures CV: vein irritation, thrombophlebitis, heart failure EENT: blurred vision, itchy eyes GI: nausea, vomiting, diarrhea, abdominal pain, enterocolitis, gastritis, stomatitis, glossitis, black “hairy” tongue, furry tongue, oral and rectal candidiasis, pseudomembranous colitis GU: hematuria, hyaline casts in urine, vaginitis, nephropathy, interstitial nephritis Hematologic: anemia, eosinophilia, agranulocytosis, hemolytic anemia, leukopenia, thrombocytopenic purpura, thrombocytopenia, neutropenia Hepatic: nonspecific hepatitis Musculoskeletal: arthritis exacerbation Respiratory: wheezing, dyspnea, hypoxia, apnea Skin: rash, urticaria, diaphoresis Other: pain at injection site, fever, hyperthermia, superinfections, hypersensitivity reactions, anaphylaxis, serum sickness

●


Interactions Drug-drug. Allopurinol: increased risk of rash Chloramphenicol: synergistic or antagonistic effects

2Clinical alert

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88

amyl nitrite

Hormonal contraceptives: decreased contraceptive efficacy, increased risk of breakthrough bleeding Probenecid: decreased renal excretion and increased blood level of ampicillin Tetracyclines: reduced bactericidal effect Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, bilirubin, blood urea nitrogen, creatine kinase, creatinine, gamma-glutamyltransferase, eosinophils, lactate dehydrogenase: increased levels Estradiol, estriol-glucuronide, granulocytes, hemoglobin, lymphocytes, neutrophils, platelets, white blood cells: decreased levels Coombs’ test: false-positive result Urinalysis: red blood cells, hyaline casts

Patient monitoring Monitor for signs and symptoms of hypersensitivity reaction. ● Check for signs and symptoms of infection at injection site. 2Monitor for seizures when giving high doses. ● Watch for bleeding tendency and hemorrhage. ● Check patient’s temperature and watch for other signs and symptoms of superinfection, especially oral or rectal candidiasis. ● Monitor CBC and liver function test results.

to report new signs or symptoms of infection, especially in mouth or rectum. 2Tell patient to promptly report unusual bleeding or bruising. ● Inform patient taking hormonal contraceptives that drug may reduce contraceptive efficacy. Advise her to use alternative birth control method. ● Instruct patient to avoid activities that can cause injury. Advise him to use soft toothbrush and electric razor to avoid gum and skin injury. ● Inform patient that he may need to undergo regular blood testing during therapy. ● As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.

●

Patient teaching

2Instruct patient to immediately report signs and symptoms of hypersensitivity reaction, such as rash, fever, or chills. ● Tell patient to report signs and symptoms of infection or other problems at injection site. ● Advise patient to minimize GI upset by eating small, frequent servings of food and drinking plenty of fluids. ● Inform patient that drug lowers resistance to certain infections. Instruct him Canada

UK

amyl nitrite Amyl Nitrite Pharmacologic class: Coronary vasodilator Therapeutic class: Antianginal Pregnancy risk category C

Action Relaxes vascular smooth muscle, thereby dilating large coronary vessels, decreasing systemic vascular resistance, reducing afterload, decreasing cardiac output, and relieving angina

Availability Ampules: 0.3 ml

1 Indications and dosages

➣ Acute angina attack Adults: 0.18 to 0.3 ml by inhalation, repeated in 3 to 5 minutes if needed ➣ Antidote for cyanide poisoning Hazardous drug

High alert drug

anagrelide hydrochloride

Adults and children: 0.3 ml by inhalation for 15 to 30 seconds q 5 minutes until sodium nitrite infusion is available



Precautions Use cautiously in: ● glaucoma, hypotension, hyperthyroidism, severe anemia, early myocardial infarction ● elderly patients ● pregnant or breastfeeding patients.

Administration Crush ampule and wave under patient’s nose one to six times. If needed, repeat in 3 to 5 minutes.

●

Route Onset Inhalation 30 sec

Peak Unknown

Duration 3-5 min

Adverse reactions CNS: headache, dizziness, weakness, syncope, restlessness CV: orthostatic hypotension, flushing, palpitations, tachycardia EENT: increased intraocular pressure GI: nausea, vomiting, fecal incontinence GU: urinary incontinence Hematologic: hemolytic anemia, methemoglobinemia Skin: cutaneous vasodilation, rash, pallor, facial and neck flushing

Interactions Drug-drug. Aspirin: increased amyl nitrite blood level and action Calcium channel blockers: increased risk of symptomatic orthostatic hypotension Sildenafil: increased risk of hypotension Sympathomimetics: decreased antianginal effects, hypotension, tachycardia Drug-behaviors. Alcohol use: severe hypotension, cardiovascular collapse


89

Patient monitoring Monitor vital signs. Stay alert for tachycardia and orthostatic hypotension. ● Assess for bowel and bladder incontinence. ● Monitor neurologic response. Watch closely for dizziness and syncope. ● Assess level of headache pain. ● In long-term therapy, monitor CBC. ●

Patient teaching Teach patient to crush capsule and wave it under his nose until angina is relieved (usually after one to six inhalations). ● Tell patient that drug often causes dizziness, orthostatic hypotension, and syncope. Advise him to sit or lie down until these effects subside. ● Inform patient that drug often causes headache. Instruct him to follow prescriber’s recommendations for pain relief. ● Tell patient that drug may cause fecal or urinary incontinence. Encourage him to use bathroom frequently to avoid accidents. ● As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and behaviors mentioned above. ●

anagrelide hydrochloride Agrylin, Xagrid Pharmacologic class: Hematologic drug Therapeutic class: Antiplatelet drug Pregnancy risk category C

Action Unclear. May reduce platelet production by decreasing megakaryocytic hypermaturation, thereby decreasing 2Clinical alert

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90

anagrelide hydrochloride

platelet count and inhibiting platelet aggregation (at higher doses).

Availability Capsules: 0.5 mg, 1 mg


➣ Essential thrombocythemia Adults: 0.5 mg P.O. q.i.d. or 1 mg P.O. b.i.d. for 1 week. Adjust as needed to lowest effective dosage that maintains platelet count below 600,000/mm3. Maximum dosage is 10 mg daily or 2.5 mg as a single dose. Dosage adjustment ●

Hepatic or renal disease

Contraindications Prolonged exposure to sunlight Women who are or may become pregnant

● ●

EENT: amblyopia, abnormal or double vision, visual field abnormalities, tinnitus, epistaxis, rhinitis, sinusitis GI: nausea, vomiting, diarrhea, constipation, abdominal pain, melena, gastric or duodenal ulcers, dyspepsia, aphthous stomatitis, anorexia, flatulence, gastritis, pancreatitis, GI hemorrhage GU: painful urination, hematuria Hematologic: lymphadenoma, bleeding tendency, anemia, thrombocytopenia Metabolic: dehydration Musculoskeletal: leg cramps; joint, back, muscle, neck pain Respiratory: bronchitis, dyspnea, pneumonia, respiratory disease, asthma, pulmonary infiltrates, pulmonary fibrosis, pulmonary hypertension Skin: bruising, pruritus, rash, alopecia, urticaria, skin disease, photosensitivity reaction Other: chills, fever, flulike symptoms, edema

Precautions Use cautiously in: ● renal, hepatic, or cardiac dysfunction ● pregnant or breastfeeding patients ● children younger than age 16.

Administration Give 1 hour before or 2 hours after meals.

●

Route P.O.

Onset Immediate

Peak 1 hr

Duration 48 hr

Adverse reactions CNS: amnesia, confusion, depression, dizziness, drowsiness, weakness, headache, syncope, insomnia, migraine, nervousness, pain, paresthesia, malaise, seizures, cerebrovascular accident CV: angina, chest pain, hypertension, palpitations, orthostatic hypotension, peripheral edema, vasodilation, arrhythmias, tachycardia, heart failure, hemorrhage, myocardial infarction, cardiomyopathy, cardiomegaly, atrial fibrillation, complete heart block, pericarditis Canada

UK

Interactions Drug-drug. Sucralfate: interference with anagrelide absorption Drug-diagnostic tests. Hemoglobin, platelets: decreased values Hepatic enzymes: elevated values Drug-food. Any food: decreased drug bioavailability Drug-herbs. Evening primrose oil, feverfew, garlic, ginger, ginkgo biloba, ginseng, grapeseed: increased antiplatelet effect

Patient monitoring

2Watch for signs and symptoms of vasodilation, heart failure, and arrhythmias in patients with cardiovascular disease. ● For first 2 weeks, monitor CBC and liver and kidney function test results. ● Monitor platelet count regularly until maintenance dosage is established. ● Check regularly for adverse reactions, especially bleeding tendency. ● Monitor blood pressure for orthostatic hypertension. Hazardous drug

High alert drug

anakinra

91

Patient teaching

Action

Instruct patient to take drug 1 hour before or 2 hours after meals. ● Tell patient that drug may cause a temporary blood pressure decrease if he sits or stands up suddenly. Tell him to rise slowly and carefully. 2Instruct patient to report unusual bleeding or bruising or difficulty breathing. 2Tell patient to avoid prolonged exposure to sunlight. ● Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration, alertness, and vision. ● Inform patient using hormonal contraceptives that drug may interfere with contraceptive efficacy. Advise her to use alternative birth control method. ● Tell patient to avoid activities that may cause injury. Tell him to use soft toothbrush and electric razor to avoid gum and skin injury. ● Advise patient to minimize GI upset by eating small, frequent servings of food and drinking plenty of fluids. ● Notify patient that he’ll undergo regular blood testing during therapy. ● As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, and herbs mentioned above.

Inhibits binding of IL-1 with IL type I receptors, thereby mediating immunologic, inflammatory, and other physiologic responses

●

anakinra Kineret Pharmacologic class: Interleukin-1 (IL-1) blocker Therapeutic class: Immunomodulator, antirheumatic Pregnancy risk category B


Availability Prefilled glass syringes: 100 mg/0.67 ml


➣ Moderately to severely active rheumatoid arthritis in patients ages 18 and older who don’t respond to disease-modifying antirheumatics alone Adults: 100 mg/day subcutaneously, given at same time each day Contraindications Hypersensitivity to drug or Escherichia coli–derived protein ● Serious infections ●

Precautions Use cautiously in: ● immunosuppression, active infection, chronic illness, renal impairment ● elderly patients ● pregnant or breastfeeding patients ● children.

Administration

2Withhold drug and notify prescriber if patient shows signs or symptoms of active infection. 2Use extreme caution if patient is concurrently receiving drugs that block tumor necrosis factor (TNF), because of increased risk of serious infection. ● Give entire dose from prefilled syringe. ● Don’t freeze or shake syringe. Route Subcut.

Onset Slow

Peak 3-7 hr

Duration Unknown

2Clinical alert

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92

anastrozole

Adverse reactions CNS: headache EENT: sinusitis GI: nausea, diarrhea, abdominal pain Hematologic: thrombocytopenia, neutropenia Respiratory: upper respiratory tract infection Skin: rash, pruritus, injection site reaction or bruising, rash, erythema, inflammation Other: flulike symptoms, infections

Interactions Drug-drug. Etanercept, infliximab, other drugs that block TNF: increased risk of serious infection Live-virus vaccines: vaccine inefficacy Drug-diagnostic tests. Neutrophils: decreased count

Patient monitoring Monitor CBC with white cell differential. ● Assess injection site for reactions. ●

Patient teaching

2Tell patient to immediately report signs or symptoms of infection. ● Advise patient to report signs and symptoms of allergic response. ● Instruct patient to take drug at same time each day for best response. ● Teach patient about proper drug disposal (in puncture-resistant container). Also caution him against reusing needles, syringes, and drug product. ● Tell patient not to freeze or shake drug. ● As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.

anastrozole Arimidex Pharmacologic class: Nonsteroidal aromatase inhibitor Therapeutic class: Antineoplastic Pregnancy risk category D

Action Reduces serum estradiol levels with no significant effect on adrenocorticoid or aldosterone level; decreases stimulating effect of estrogen on tumor growth

Availability Tablets: 1 mg


➣ Postmenopausal women with hormone receptor-unknown or hormone receptor-positive advanced breast cancer or with advanced breast cancer after tamoxifen therapy; adjuvant treatment for hormone receptor-positive breast cancer Adults: 1 mg P.O. daily Contraindications ● ●

Pregnancy Children

Precautions Use cautiously in: ● women of childbearing age ● breastfeeding patients.

Administration Verify that patient isn’t pregnant before giving drug.

●

Route P.O.

Onset >24 hr

Peak Duration Unknown 25 U/ml CA 19-9 (Siemens Chemiluminescent Method) < 37 U/ml CA 125 (Siemens Chemiluminescent Method) < 21 U/ml Carcinoembryonic antigen < 3 ng/ml, individualized and variable (nonsmokers) < 5 ng/ml, individualized and variable (smokers) Prostate-specific antigen ≤ 4 ng/ml Prostatic acid phosphatase < 0 to 2.7 ng/ml

Cardiac studies Cardiac troponin I < 1.0 µg/ml Creatine kinase (CK) Total CK— Men: 54 to 186 IU/L Women: 41 to 117 IU/L Isoenzymes— CK-MM: 96% to 100% of total CK-MB: 0% to 4% of total CK-BB: 0% of total High sensitivity C-reactive protein Low cardiovascular risk: < 1.0 mg/L Average cardiovascular risk: 1.0 to 3.0 mg/L

Lymphocyte surface markers CD3 Absolute: 840 to 3,060 cells/µL Percentage: 57% to 85% CD4 Absolute: 490 to 1,740 cells/µL Percentage: 30% to 61% CD8 Absolute: 180 to 1,170 cells/µL Percentage: 12% to 42% Helper: suppressor (CD4: CD8) ratio 0.86 to 5

Appendix F: Normal laboratory values for blood tests

Iron studies

Hormone studies (continued)

Serum iron 40 to 180 mcg/dl Ferritin Men: 18 to 270 µg/ml Women: 18 to 160 µg/ml Iron-binding capacity 200 to 450 mcg/dl Transferrin 88 to 341 mg/dl Transferrin saturation 12% to 57%

17-Hydroxyprogesterone Men: 0.06 to 3.0 mg/L Women (follicular phase): 0.2 to 1.0 mg/L Parathyroid hormone, intact Ages 2 to 20 years: 9 to 52 pg/ml Older than age 20: 8 to 97 pg/ml Radioactive iodine uptake 10% to 30% Testosterone Males > age 18: 241 to 827 ng/dl Females > age 18: 14 to 76 ng/dl Triiodothyronine (T3) 60 to 181 ng/dl Thyroxine (T4) 4.5 to 12.5 mcg/dl Thyroid hormone binding ratio 0.9 to 1.1 Thyroid-stimulating hormone 0.5 to 4.70 microIU/ml

Hormone studies Cortisol, free 8:00 to 10:00 A.M. 0.07 to 0.93 mcg/dl 4:00 to 6:00 P.M. 0.04 to 0.45 mcg/dl 10:00 to 10:00 P.M. 0.04 to 0.35 mcg/dl Cortisol, total 8:00 to 10:00 A.M. 4.6 to 20.6 mcg/dl 4:00 to 6:00 P.M. 1.8 to 13.6 mcg/dl Estradiol Men: < 50 pg/ml Women: Menstruating (day of cycle relative to LH peak) — Follicular (-12): 19 to 83 pg/ml Follicular (-4): 64 to 183 pg/ml Midcycle (-1): 150 to 528 pg/ml Luteal (+2): 58 to 157 pg/ml Luteal (+6): 60 to 211 pg/ml Luteal (+12): 55 to 150 pg/ml Postmenopausal (no treatment): 0 to 31 pg/ml Free thyroxine 0.7 to 1.9 ng/dl Free thyroxine fraction 0.03% to 0.005% Growth hormone Age 1 day: 5 to 53 ng/ml Age 1 week: 5 to 27 ng/ml Age 1 to 12 months: 2 to 10 ng/ml Age 1 year and older: < 5 ng/ml

1351

1352 Appendix G: Drug infusion rates

Drug infusion rates The tables below show infusion rates for common drug infusions. Before using these tables as your administration guide, make sure the concentration of the prescribed infusion matches the concentration shown in the table.

Adenosine (Adenoscan) infusion rates Using this table, you can determine that the appropriate infusion rate is corrected for total body weight. Patient’s weight kg

lb

Infusion rate (ml/minute)

45 50 55 60 65 70 75 80 85 90

99 110 121 132 143 154 165 176 187 198

2.1 2.3 2.6 2.8 3 3.3 3.5 3.8 4.0 4.2

Aminophylline infusion rates Although aminophylline infusion rates are highly individualized, this table can help you determine the infusion rate for an infusion containing aminophylline 500 mg ( = 400 mg theophylline) in 500 ml D5W that must be controlled by an automated infusion control device. Dosage (mg/hour)

Dosage (mg/hour)

Aminophylline 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80

Theophylline 8 12 16 20 24 28 32 36 40 44 48 52 56 60 64

Rate (ml/hour) 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80

Appendix G: Drug infusion rates

1353

Argatroban infusion rates Using this table, you can determine the infusion rate for argatroban (for a 2-mcg/kg/minute dose) that has been diluted in normal saline solution, D5W, or lactated Ringer’s solution to a concentration of 1 mg/ml. Patient’s weight (kg)

Dosage (mcg/minute)

Infusion rate (ml/hour)

50 60 70 80 90 100 110 120 130 140

100 120 140 160 180 200 220 240 260 280

6 7 8 10 11 12 13 14 16 17

Clindamycin phosphate infusion rates Using this table, you can determine dilution and infusion rates after diluting I.V. solution to a concentration of not more than 18 mg/ml using normal saline solution, D5W, or lactated Ringer’s solution. Dilution and infusion rates Dosage (mg)

Diluent (ml)

Infusion rate (minutes)

300 600 900 1,200

50 50 50 to 100 100

10 20 30 40

Dobutamine infusion rates Using this table, you can determine the infusion rate for an infusion containing dobutamine 250 mg mixed in 250 ml of dextrose 5% in water (1,000 mcg/ml). Dosage Patient’s weight (kg) (mcg/kg/ 40 45 50 55 60 65 70 75 minute) Infusion rate (ml/hour) 0.5 1 1 2 2 2 2 2 2 1.5 4 4 5 5 5 6 6 7 2.5 6 7 8 8 9 10 11 11 5.0 12 14 15 17 18 20 21 23 7.5 18 20 23 25 27 29 32 34 10.0 24 27 30 33 36 39 42 45 12.5 30 34 38 41 45 49 53 56 15.0 36 41 45 50 54 59 63 68 20.0 48 54 60 66 72 78 84 90 25.0 60 68 75 83 90 98 105 113 30.0 72 81 90 99 108 117 126 135 35.0 84 95 105 116 126 137 147 158 40.0 96 108 120 132 144 156 168 180

80

85

90

2 7 12 24 36 48 60 72 96 120 144 168 192

3 8 13 26 38 51 64 77 102 128 153 179 204

3 8 14 27 41 54 68 81 108 135 162 189 216

95 100 105 110 3 9 14 29 43 57 71 86 114 143 171 200 228

3 9 15 30 45 60 75 90 120 150 180 210 240

3 9 16 32 47 63 79 95 126 158 189 221 252

3 10 17 33 50 66 83 99 132 165 198 231 264

(continued)


Drug infusion rates (continued) Dopamine infusion rates Using this table, you can determine the infusion rate for an infusion containing dopamine 400 mg in 250 ml of dextrose 5% in water (1,600 mcg/ml). Dosage Patient’s weight (kg) (mcg/kg/ 40 45 50 55 60 65 70 75 80 85 minute) Infusion rate (ml/hour) 0.5 1 1 1 1 1 1 1 1 2 2 1.5 2 3 3 3 3 4 4 4 5 5 2.5 4 4 5 5 6 6 7 7 8 8 5.0 8 8 9 10 11 12 13 14 15 16 7.5 11 13 14 15 17 18 20 21 23 24 10.0 15 17 19 21 23 24 26 28 30 32 12.5 19 21 23 26 28 30 33 35 38 40 15.0 23 25 28 31 34 37 39 42 45 48 20.0 30 34 38 41 45 49 53 56 60 64 25.0 38 42 47 52 56 61 66 70 75 80 30.0 45 51 56 62 67 73 79 84 90 96 35.0 53 59 66 72 79 85 92 98 105 112 40.0 60 68 75 83 90 98 105 113 120 128 45.0 68 76 84 93 101 110 118 127 135 143 50.0 75 84 94 103 113 122 131 141 150 159

Epinephrine infusion rates Use this table to determine the rate at which to infuse epinephrine 1 mg in 250 ml of dextrose 5% in water (4 mcg/ml). Dosage (mcg/minute) 1 2 3 4 5 6 7 8 9 10 15

Infusion rate (ml/hour) 15 30 45 60 75 90 105 120 135 150 225

90 2 5 8 17 25 34 42 51 68 84 101 118 135 152 169

95 100 105 2 6 9 18 27 36 45 53 71 89 107 125 143 160 178

2 6 9 19 28 38 47 56 75 94 113 131 150 169 188

2 6 10 20 30 39 49 59 79 98 118 138 158 177 197

Appendix G: Drug infusion rates

1355

Nitroglycerin infusion rates When infusing nitroglycerin, first find the prescribed concentration and then determine the infusion rate in ml/hour. Dosage (mcg/minute)

Nitroglycerin

Nitroglycerin

25 mg/250 ml D5W (100 mcg/ml) Infusion rate (ml/hour)

50 mg/250 ml D5W (200 mcg/ml) Infusion rate (ml/hour)

5 10 15 20 25 30 40 50 60 70 80 90 100

3 6 9 12 15 18 24 30 36 42 48 54 60

2 3 5 6 8 9 12 15 18 21 24 27 30

KEY D5W: dextrose 5% in water

Nitroprusside infusion rates Using this table, you can determine the infusion rate for an infusion containing nitroprusside 50 mg in 250 ml of dextrose 5% in water (200 mcg/ml). Dosage Patient’s weight (kg) (mcg/kg/ 40 45 50 55 60 minute) Infusion rate (ml/hour) 0.3 4 4 5 5 5 0.5 6 7 8 8 9 1.0 12 14 15 17 18 1.5 18 20 23 25 27 2.0 24 27 30 33 36 3.0 36 41 45 50 54 4.0 48 54 60 66 72 5.0 60 68 75 83 90 6.0 72 81 90 99 108 7.0 84 95 105 116 126 8.0 96 108 120 132 144 9.0 108 122 135 149 162 10.0 120 135 150 165 180

65 70 6 10 20 29 39 59 78 98 117 137 156 176 195

6 11 21 32 42 63 84 105 126 147 168 189 210

75

80

7 11 23 34 45 68 90 113 135 158 180 203 225

7 12 24 36 48 72 96 120 144 168 192 216 240

85 90 8 13 26 38 51 77 102 128 153 179 204 230 255

8 14 27 41 54 81 108 135 162 189 216 243 270

95 100 105 110 9 14 29 43 57 86 114 143 171 200 228 257 285

9 15 30 45 60 90 120 150 180 210 240 270 300

9 16 32 47 63 95 126 158 189 221 252 284 315

10 17 33 50 66 99 132 165 198 231 264 297 330

(continued)


Drug infusion rates (continued) Phenylephrine infusion rates Using this table, you can determine the infusion rate for an infusion containing phenylephrine 20 mg in 250 ml of dextrose 5% in water or normal saline solution (80 mcg/ml). Dosage (mcg/minute) 9 11 12 13 15 16 17 19 20 21 23 24

Rate (ml/hour) 7 8 9 10 11 12 13 14 15 16 17 18

Dosage (mcg/minute) 25 27 29 32 35 37 40 43 45 48 51 53

Rate (ml/hour) 19 20 22 24 26 28 30 32 34 36 38 40

Appendix H: Identifying life-threatening adverse reactions

1357

Identifying life-threatening adverse reactions Early recognition of a life-threatening adverse drug reaction is a crucial aspect of patient care and safety. This appendix helps you identify life-threatening adverse reactions that are relatively rare or cause symptoms you may not be readily familiar with. Some reactions are potentially lethal from the onset; others can become lethal if they progress. Acute pancreatitis Inflammation of the pancreas Signs and symptoms: sudden onset of epigastric pain, nausea, and vomiting Acute respiratory distress syndrome (ARDS) Respiratory insufficiency in which abnormal permeability of the alveolarcapillary membrane causes fluid to fill the alveoli, disrupting gas exchange Signs and symptoms: dyspnea, tachypnea, and progressive hypoxemia despite oxygen therapy; pulmonary edema Adrenal suppression Condition marked by inhibition of one or more of the enzymes essential to adrenocortical hormone production Signs and symptoms: weakness, fatigue, abdominal pain, appetite and weight loss, dizziness, orthostatic hypotension, increased skin pigmentation Adynamic ileus Intestinal obstruction caused by a reduction in intestinal motility Signs and symptoms: nausea, vomiting, decreased or absent bowel sounds, abdominal distention Agranulocytopenia Acute condition caused by deficiencies of neutrophils, basophils, and eosinophils in the blood Signs and symptoms: chills, fever, headache, malaise, weakness, fatigue

Alkalosis Increase in blood alkalinity caused by buildup of alkalis or reduction of acids Signs and symptoms: in metabolic alkalosis—apathy, confusion, stupor (when severe); in respiratory alkalosis—air hunger, muscle twitching, numbness or tingling of extremities or circumoral area Amyloidosis Metabolic disorder caused by deposition of protein-containing fibrils in tissues, which may attack the heart and blood vessels, brain, kidneys, liver, spleen, intestines, or endocrine glands Signs and symptoms: vary with area of invasion Anaphylactoid shock Hypersensitivity reaction marked by acute airway obstruction and vascular collapse within minutes of exposure to an antigen Signs and symptoms: edema, rash, tachycardia, hypotension, respiratory distress, seizures, unconsciousness Anaphylaxis Hypersensitivity reaction to an antigen to which the patient has been previously sensitized, causing sudden release of immunologic mediators either locally or throughout the body Signs and symptoms: urticaria, angioedema, flushing, wheezing, dyspnea, increased mucus production, nausea, vomiting

(continued)

1358 Appendix H: Identifying life-threatening adverse reactions

Identifying life-threatening adverse reactions (continued) Angioedema Vascular reaction involving deep dermal, submucosal, or subcutaneous tissues in which capillaries become dilated and more permeable; also called angioneurotic edema Signs and symptoms: edema of skin, mucous membranes, and internal organs; urticaria; giant wheals; respiratory distress Autoimmune phenomena Immunologic responses, such as serum sickness, lupus, vasculitis, and hepatitis, associated with development of antibodies (as to a particular drug) Signs and symptoms: possibly none; or signs and symptoms specific to the particular autoimmune condition Bone marrow depression Disruption of healthy blood cell development in the bone marrow (including red and white blood cells and platelets), which impairs or weakens the body’s defense against pathogenic organisms, toxins, and irritants Signs and symptoms: increased susceptibility to infection, fever, weakness Cardiac tamponade Condition marked by increased cardiac pressure, which inhibits filling of the heart chambers during diastole Signs and symptoms: chest pain, weak peripheral pulses, distended neck veins, dyspnea, orthopnea, diaphoresis, anxiety, restlessness, pallor Cardiomyopathy Any disease or disorder of the heart that impairs normal cardiac performance Signs and symptoms: shortness of breath, orthopnea, fatigue, chest pain, syncope Cardiotoxicity The quality of being poisonous or harmful to the heart (as with certain drugs) Signs and symptoms: variable cardiacrelated symptoms

Cardiovascular collapse Sudden loss of effective blood flow to body tissues Signs and symptoms: hypotension, vasovagal syncope, cardiogenic shock, cardiac arrest Cerebral ischemia Temporary lack of arterial or circulatory blood flow to the brain, possibly causing localized tissue death Signs and symptoms: persistent focal neurologic deficit in the area of distribution of the involved cerebral artery Chemical arachnoiditis Inflammation of the arachnoid (middle) layer of the meninges of the brain and spinal cord in response to exposure to a toxic substance Signs and symptoms: mild nausea or vomiting, headache, fever, neck or back pain and stiffness Cholesterol embolism Sudden obstruction of a blood vessel by cholesterol-containing plaques Signs and symptoms: hypotension, sudden shortness of breath, weak pulse, cyanosis, chest pain, decreased level of consciousness Clostridium difficile–associated diarrhea Antibiotic-associated diarrhea caused by Clostridium difficile, a spore-forming, gram-positive, anaerobic bacillus that produces two exotoxins: toxin A and toxin B Signs and symptoms: watery diarrhea, fever, loss of appetite, nausea, abdominal pain, abdominal tenderness, colon perforation, sepsis, and death (rarely)


Disseminated intravascular coagulation Disorder marked by abnormal activation of coagulation factors in the blood, causing hemostasis, thrombosis, and possibly, organ damage Signs and symptoms: bleeding (possibly from multiple sites), hematomas, thrombosis, petechiae, ecchymosis, cutaneous oozing Disulfiram-like reaction Acute, unpleasant reaction to alcohol ingestion in a patient taking disulfiram (Antabuse) for alcohol aversion therapy Signs and symptoms: flushing, dyspnea, headache, nausea, copious vomiting, blood pressure fluctuations Encephalopathy Generalized dysfunction of the brain Signs and symptoms: impaired speech, orientation, or cognition; sluggish reaction to stimuli Eosinophilic pneumonitis Infiltration of pulmonary alveoli by large numbers of eosinophils and mononuclear cells, causing inflammation Signs and symptoms: dyspnea, cough, fever, night sweats, pulmonary edema, weight loss Epileptiform seizures Sudden, uncontrolled electrical discharge from the cerebral cortex caused by epilepsy Signs and symptoms: variable; may include a cry, a fall, unconsciousness, overt seizure, amnesia, or incontinence Erythema multiforme Hypersensitivity reaction of the skin and mucous membranes; may take a severe multisystemic form Signs and symptoms: rash, macules, papules, or blisters on the face, palms, and extremities

1359

Fanconi syndrome Congenital form of anemia caused by excessive amino acids in the blood secondary to renal tubular failure Signs and symptoms: polyuria; growth impairment; soft, flexible, brittle bones Granulocytopenia Abnormal reduction in the number of granulocytes in the blood Signs and symptoms: increased susceptibility to infection Heart block Interference with the normal electrical impulses of the heart, classified by the level of impairment that results (first-, second-, or-third-degree block) Signs and symptoms: prolonged PR interval, widened QRS interval, and delayed or dropped beats on ECG; other symptoms vary with the degree of heart block and may include dizziness, syncope, shortness of breath, fatigue, and orthostatic hypotension Hepatomegaly Liver enlargement Signs and symptoms: possibly none; or abdominal distention, abdominal pain, and constipation Hepatotoxicity Liver inflammation caused by exposure to a toxin or a toxic amount of a substance in the body Signs and symptoms: jaundice, fatigue, weakness, altered mental status Hyperkalemia A condition marked by an excessive amount of potassium in the blood Signs and symptoms: possibly none; with severe hyperkalemia—muscle weakness, arrhythmias

(continued)


Identifying life-threatening adverse reactions (continued) Hypertensive crisis Severe blood pressure elevation, usually defined as diastolic pressure higher than 130 mmHg Signs and symptoms: severe headache, dizziness, light-headedness Hypertonia Excessive tension or pressure within a muscle or an artery Signs and symptoms: muscle pain and spasms Hypervolemia Abnormal increase in volume of circulating body fluid Signs and symptoms: weight gain, peripheral edema, ascites, dyspnea, pulmonary edema, paroxysmal nocturnal dypsnea Immune reconstitution syndrome Enhanced immunologic response, especially during the initial phase of combination antiretroviral treatment, when patients whose immune systems respond may develop an inflammatory response to indolent or residual opportunistic infections (such as Mycobacterium avium infection, cytomegalovirus, Pneumocystis jirovecii pneumonia, or tuberculosis). Signs and symptoms: possibly nonspecific, including new or worsening fever, persistent or cyclic fever, new pleural effusions, new or worsening lymphadenopathy, fatigue, weakness, night sweats, anorexia, weight loss, chronic diarrhea, abdominal pain, and vulnerability to infection Impaired myocardial contractility Decreased contractile ability of the middle layer of the heart muscle wall Signs and symptoms: shortness of breath, chest pain, edema

Increased intracranial pressure Increased pressure within the brain, as from increased cerebrospinal fluid pressure or a brain lesion or swelling; also called intracranial hypertension Signs and symptoms: in infants— bulging fontanel, separated sutures, lethargy, vomiting; in older children and adults—lethargy, vomiting, headache, behavior changes, seizures, neurologic deficits, progressive decrease in level of consciousness Interstitial pneumonia Chronic, noninfectious inflammation of the pulmonary alveolar walls Signs and symptoms: shortness of breath, either with activity or at rest Ischemic colitis Inflammation of the colon caused by lack of blood supply to mesenteric arteries of the small intestine Signs and symptoms: abdominal pain, weight loss Lactic acidosis Accumulation of lactic acid in the blood caused by reduced oxygenation and perfusion to tissues, muscles, and major organs Signs and symptoms: muscle pain, fatigue, hyperventilation, nausea, vomiting, dizziness, light-headedness Leukocytosis Abnormal increase in the number of white blood cells (leukocytes) in the blood Signs and symptoms: fever, hemorrhage Leukopenia Abnormal reduction (below 5,000 cells/mm3) in circulating white blood cells, as from drug-induced impairment of blood cell production Signs and symptoms: infection, fever, stomatitis, sinusitis


1361

Lupuslike syndrome A syndrome similar to systemic lupus erythematosus that occurs in response to drug therapy and resolves when the drug is withdrawn Signs and symptoms: fever; red, scaly, macular skin rash; joint inflammation

Nephrotoxicity The quality of causing damage to the kidney (as from a drug); usually leads to increased permeability to proteins, which results in edema and hypoalbuminemia Signs and symptoms: proteinuria, hematuria, fluid retention

Lupus nephritis Kidney inflammation associated with systemic lupus erythematosus (SLE), marked by deposition of antigenantibody complexes in the mesangium and basement membrane Signs and symptoms: hypertension, peripheral edema, proteinuria, renal failure, cardiac decompensation, other symptoms of active SLE (such as fatigue, fever, rash, arthritis, CNS disease)

Neuroleptic malignant syndrome Reaction to a drug that alters the brain’s dopamine level or to withdrawal of a drug that increases the dopamine level Signs and symptoms: sweating, altered mental status, seizures, renal failure

Megaloblastic anemia Anemia marked by production and proliferation of megaloblasts (large immature red blood cells) in the bone marrow or circulation Signs and symptoms: weakness, fatigue, light-headedness, headache, rapid pulse, breathlessness Metabolic acidosis Increase in blood acidity caused by buildup of acids or loss of bicarbonate Signs and symptoms: lethargy, drowsiness, headache, diminished muscle tone and reflexes, hyperventilation, arrhythmias, nausea, vomiting, diarrhea, abdominal pain Methemoglobinemia Condition in which a portion of the iron component of hemoglobin has been oxidized to the ferric state, making it incapable of transporting oxygen Signs and symptoms: cyanosis, dizziness, drowsiness, headache Neoplasm Abnormal growth of new tissue, such as a tumor Signs and symptoms: vary with tumor site

Neutropenia Abnormal decrease in the level of neutrophils in the blood (usually below 1,500 per µL) Signs and symptoms: infection, fever, mouth and throat sores Osmotic nephrosis Disruption of osmotic pressure in the kidney’s renal tubule Signs and symptoms: fluid retention, edema Pancytopenia Deficiency of all cellular elements of the blood, including red blood cells, white blood cells, and platelets Signs and symptoms: bleeding from the nose and gums, easy bruising, fatigue, shortness of breath Papilledema Swelling and inflammation of the optic nerve Signs and symptoms: severe headache, visual disturbances, blindness Pericardial effusion Escape of fluid from blood vessels into the pericardium Signs and symptoms: hypotension, tachycardia, muffled heart sounds, decreased breath sounds, distended jugular vein, pulsus paradoxus, widened pulse pressure, weak peripheral pulses, pericardial friction rub, tachypnea, edema, cyanosis (continued)


Identifying life-threatening adverse reactions (continued) Pseudomembranous colitis Condition in which an inflammatory exudate forms on epithelial tissues of the colon Signs and symptoms: diarrhea with blood and mucus, abdominal cramps Pseudotumor cerebri Benign intracranial hypertension without evidence of a brain tumor Signs and symptoms: headache, papilledema, elevated cerebrospinal fluid pressure Pulmonary toxicity The quality of causing damage to the lungs and alveoli (as from certain drugs) Signs and symptoms: any respiratory sign or symptom Renal acidosis Acidosis caused by accumulation of phosphoric and sulfuric acids in the body, which the kidneys fail to excrete Signs and symptoms: appetite loss, altered level of consciousness, altered respiratory rate or effort Renal failure Condition marked by a serum creatinine increase of 25% or more, which impairs the kidney’s ability to excrete wastes, concentrate urine, and conserve electrolytes Signs and symptoms: dehydration, fluid overload, altered neurologic status, appetite loss, weight gain, bleeding Respiratory acidosis Acidosis resulting from accumulation and retention of carbon dioxide in the lungs Signs and symptoms: dyspnea, diaphoresis, tremors, decreased reflexes, decreased level of consciousness Rhabdomyolysis Acute disorder in which byproducts of skeletal muscle destruction accumulate in the renal tubules, causing renal failure Signs and symptoms: See “Hyperkalemia” and “Metabolic acidosis.”

Salicylate toxicity Toxic condition caused by overdose of a salicylate, such as aspirin or an aspirin derivative Signs and symptoms: rapid breathing, irritability, headache, vomiting, and (if extreme) seizures and respiratory failure Sarcoidosis Multisystemic disease that causes granulomatous lesions of organs or tissues throughout the body Signs and symptoms: fatigue, weight loss, shortness of breath, anorexia, skin lesions, cough, skeletal changes (in later stages) Sepsis Systemic inflammatory response caused by pathogenic microorganisms or their toxins Signs and symptoms: tachycardia, fever, rapid breathing, hypothermia, evidence of reduced blood flow to major organs Serum sickness Hypersensitivity reaction to administration of a nonprotein drug Signs and symptoms: fever, rash, joint pain, edema, lymphadenopathy Steatosis Fatty liver degeneration Signs and symptoms: possibly none; or right upper abdominal quadrant pain, abdominal discomfort, fatigue, malaise Stevens-Johnson syndrome Severe allergic reaction marked by severe skin and mucous membrane lesions, most often in response to a drug Signs and symptoms: respiratory tract infection, fever, sore throat, chills, headache, malaise, vomiting, diarrhea, tachycardia, hypotension, corneal ulcers, conjunctivitis, epistaxis, dysuria, erosive vulvovaginitis, balanitis, seizures, altered level of consciousness, coma


Syndrome of inappropriate antidiuretic hormone secretion Metabolic disturbance marked by an increase in antidiuretic hormone, which causes a decrease in serum sodium concentration Signs and symptoms: weakness, fatigue, malaise, headache, altered mental status, lethargy, irritability, delirium, psychosis, personality changes, anorexia, nausea, vomiting, thirst, abdominal and muscle cramps Tardive dyskinesia Disorder marked by slow, rhythmic involuntary movements of the face, limbs, and torso in patients who have received longterm dopaminergic antagonist therapy Signs and symptoms: involuntary, repetitive facial grimacing and twisting; tongue protrusion; lip puckering and smacking; chewing or sucking motions; involuntary, snakelike writhing movements (such as wiggling or twisting); excessive blinking; involuntary flexion and extension movements of the fingers and hands Tetany Hyperexcitability of nerves and muscles caused by a decrease in extracellular calcium Signs and symptoms: muscle twitching, cramps, sharp flexion of wrist and ankle joints, seizures Thrombocytopenia Abnormal decrease in the number of platelets caused by destruction of erythroid tissue in the bone marrow Signs and symptoms: purpura, ecchymosis, petechiae, internal hemorrhage, hematuria, abdominal distention, melena Torsade de pointes Rapid form of ventricular tachycardia that appears as twisting or shifting QRS complexes on the ECG Signs and symptoms: pallor, diaphoresis, rapid pulse, low or normal blood pressure, transient or prolonged loss of consciousness

1363

Toxic epidermal necrolysis Exfoliative skin condition that represents a severe cutaneous reaction (as to a drug, infection, or chemical exposure) Signs and symptoms: scalded appearance of the skin, skin erosion and redness Tumor lysis syndrome Complication that usually follows chemotherapy treatment of myelolymphoproliferative diseases in which a metabolic derangement produced by rapid tumor breakdown is a consequence of therapy Signs and symptoms: possibly no symptoms in early stages, but progression of the syndrome may lead to cardiac arrhythmias, shortness of breath, hyperkalemia, hyperuricemia, hyperphosphatemia, hypocalcemia, impaired mental ability, and renal failure Withdrawal phenomena Physiologic changes caused by discontinuation of a drug or alcohol after prolonged use Signs and symptoms: vary with type of substance used. In opioid withdrawal— rapid pulse and breathing, runny nose, yawning, restlessness, insomnia, fatigue, pupil dilation, nausea, vomiting, diarrhea, abdominal cramps, weakness, muscle aches, joint pain, hot and cold flushes. In benzodiazepine withdrawal—headache; aches and pains; anxiety; sleep disturbances; feelings of unreality; impaired memory; palpitations; hypersensitivity to noise, light, and touch.

1364 Appendix I: Potentially inappropriate drugs for elderly patients

Potentially inappropriate drugs for elderly patients Drug-drug interactions can have potentially life-threatening consequences in older adults, who often take several drugs at once for multiple diseases. Elderly patients are more susceptible to drug interactions than younger patients because of the physiologic changes associated with aging and the sheer number of drugs older patients are taking. Beers criteria, originally published in the Archives of Internal Medicine in 1991, with updated articles in 1997 and again in 2003, identified several drugs that adults ages 65 and older should avoid. This list is based on those criteria.

Generic drug or class

Brand names

alprazolam

Niravam, Xanax (> 2 mg), Xanax X


Cordarone, Pacerone

amitriptyline hydrochloride amphetamines (excluding methylphenidate and anorexics)

Adderall, Adderall XR, Desoxyn, Dexedrine, DextroStat, Liquadd

anorexics

Adipex-P, Bontril, Bontril PDM, Didrex, Meridia, Pro-Fast HS, Pro-Fast SA

barbiturates (except phenobarbital for seizure control)

Butisol Sodium, Mebaral, Seconal Sodium

belladonna alkaloids

Donnatal

carisoprodol

Soma

chlordiazepoxide hydrochloride

Librium

chlordiazepoxide and amtriptyline chlordiazepoxide hydrochloride and clidinium bromide

Limbitrol, Limbitrol DS Librax

chlorpheniramine maleate

Ahist, Aller-Chlor, Chlorphen, Chlor-Trimeton, CPM-12, Diabetic Tussin Allergy Relief, QDALL AR, Teldrin HBP

chlorpropamide

Diabenese

chlorzoxazone

Parafon Forte DSC

cimetidine

Tagamet, Tagamet HB 200

clonidine hydrochloride

Catapres, Catapres-TTS, Duraclon

clorazepate

Tranxene

cyclobenzaprine hydrochloride

Amrix, Fexmid, Flexeril

cyproheptadine hydrochloride dexchlorpheniramine

Appendix I: Potentially inappropriate drugs for elderly patients

diazepam

Valium

dicyclomine

Bentyl

digoxin

Digitek, Lanoxin (> 0.125 mg/day except when treating atrial arrhythmias)

diphenhydramine hydrochloride

Aler-Cap, Aler-Dryl, Aler-Tab, AllerMax, Altaryl, Banophen, Benadryl, Compoz, Diphen, Diphenhist, Genahist, Hydramine, Nytol, Siladryl, Silphen, Simply Sleep, Sleep-ettes D, Sleepinal, Sominex, Twilite, Unisom

dipyridamole

Persantine

disopyramide

Norpace, Norpace CR

doxazosin mesylate

Cardura, Cardura XR

1365

doxepin hydrochloride ergot mesyloids estrogens (in older women)

Cenestin, Enjuvia, Premarin

ethacrynic acid

Edecrin

ferrous sulfate (> 325 mg/day)

Feosol, Feratab, Fer-Gen-Sol, Fer-In-Sol, Fer-Iron, Slow FE

fluoxetine hydrochloride (daily)

Prozac, Sarafem, Selfemra

flurazepam hydrochloride

Dalmane

hydroxyzine

Atarax, Vistaril

hyoscyamine sulfate

Levsin

indomethacin

Indocin, Indocin SR

isoxsuprine ketorolac tromethamine lorazepam

Ativan (> 3 mg)

meperidine hydrochloride

Demerol

meprobamate metaxalone

Skelaxin

methocarbamol

Robaxin

methyldopa methyldopa and hydrochlorothiazide methyltestosterone

Android, Methitest, Testred, Virilon

mineral oil nifidepine (short-acting)

Procardia

(continued)

1366 Appendix I: Potentially inappropriate drugs for elderly patients

Potentially inappropriate drugs for elderly patients (continued) nitrofurantion

Furadantin, Macrobid, Macrodantin

non–COX-selective NSAIDs (long-term use of full dose): naproxen oxaprozin piroxicam

Aleve, Anaprox, Naprosyn Daypro Feldene

orphenadrine

Norflex

oxazepram

Serax (> 60 mg)

oxybutynin chloride

Ditropan, Ditropan XL

pentazocine

Talwin

perphenazine and amitriptyline promethazine hydrochloride

Phenadoz, Phenergan, Promethagan

propantheline bromide

Pro-Banthine

propoxyphene and combination products

Darvocet-N, Darvon, Darvon-N

quazepam

Doral

reserpine (dosages > 0.25 mg) stimulant laxatives (except when used for chronic pain requiring opioid analgesics): bisacodyl

Dulcolax

temazepam

Restoril (> 15 mg)

Thioridazine thyroid, dessicated

Armour Thyroid, Nature-Throid, Westhroid

ticlopidine hydrochloride

Ticlid

Triazolam

Halcion (> 0.25 mg)

trimethobenzamide hydrochloride

Tigan

Appendix J: Hazardous drugs

1367

Hazardous drugs The drugs listed below have been designated as hazardous by the National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, and/or the American Society of Health-System Pharmacists. The list doesn’t include all hazardous drugs. The agents listed here meet one or more of the following criteria: carcinogenicity, teratogenicity or other developmental toxicity, reproductive toxicity, organ toxicity at low doses, genotoxicity, or structure and toxicity profiles that mimic existing drugs determined to be hazardous by the above criteria. All healthcare workers handling these drugs must follow appropriate precautions along with recommendations included in the manufacturer's complete package insert. Aldesleukin Alemtuzumab Alitretinoin Altretamine Amifostine Aminoglutethimide Amsacrine Anastrozole Arsenic trioxide Asparaginase Azacitidine Azathioprine Bacillus Calmette-Guerin vaccine Bendamustine hydrochloride Bexarotene Bicalutamide Bleomycin Bortezomib Busulfan Capecitabine Carboplatin Carmustine Cetrorelix acetate Chlorambucil Chloramphenicol Chlorotrianisene Chlorozotocin Choriogonadotropin alfa Cidofovir Cisplatin Cladribine Clofarabine Colchicine Cyclophosphamide Cyclosporine

Cytrabine Dacarbazine Dactinomycin Dasatinib Daunorubicin HCl Denileukin Dienestrol Diethylstilbestrol Dinoprostone Docetaxel Doxorubicin Dutasteride Epirubicin Ergonovine/methylergonovine Estradiol Estramustine phosphate sodium Estrogen-progestin combinations Estrogens, conjugated Estrogens, esterified Estrone Estropipate Ethinyl estradiol Etoposide Exemestane Finasteride Floxuridine Fludarabine Fluorouracil Fluoxymesterone Flutamide Fulvestrant Ganciclovir Ganirelix acetate Gemcitabine Gemtuzumab ozogamicin (continued)

1368 Appendix J: Hazardous drugs

Hazardous drugs (continued) Gonadotropin, chorionic Goserelin Hydroxyurea Ibritumomab tiuxetan Idarubicin Ifosfamide Imatinib mesylate Interferon alfa-2a Interferon alfa-2b Interferon alfa-n1 Interferon alfa-n3 Irinotecan HCl Isotretinoin Leflunomide Lenalidomide Letrozole Leuprolide acetate Levamisole Lomustine Mechlorethamine Medroxyprogesterone Megestrol Melphalan Menotropins Mercaptopurine Methotrexate Methyltestosterone Mifepristone Mitomycin Mitotane Mitoxantrone HCl Mycophenolate mofetil Nafarelin Nilotinib Nilutamide Oxaliplatin Oxytocin Paclitaxel Pegaspargase Pentamidine isethionate

Pentostatin Perphosphamide Pipobroman Piritrexim isethionate Plicamycin Podofilox Podophyllum resin Prednimustine Procarbazine Progesterone Progestins Raloxifene Raltitrexed Ribavirin Streptozocin Tacrolimus Tamoxifen Temozolomide Teniposide Testolactone Testosterone Thalidomide Thioguanine Thiotepa Topotecan Toremifene citrate Tositumomab Tretinoin Trifluridine Trimetrexate glucuronate Triptorelin Uracil mustard Valganciclovir Valrubicin Vidarabine Vinblastine sulfate Vincristine sulfate Vindesine Vinorelbine tartrate Zidovudine

Appendix K: Most commonly used drugs in nursing specialties

1369

Most commonly used drugs in nursing specialties Nurses are often required to float to units in which they’re not accustomed to working, where they might have to administer unfamiliar drugs. If you know ahead of time which drugs are most commonly used in the various nursing specialties, you’ll be able to increase your confidence—and reduce the chance of making a drug error. The table below shows the 10 most commonly used drugs in nine nursing specialties.

Specialty

Top 10 drugs

Critical care nursing

amiodarone hydrochloride diltiazem hydrochloride dopamine hydrochloride epinephrine hydrochloride furosemide insulin lorazepam morphine sulfate nitroglycerin propofol

Emergency care nursing

acetaminophen aspirin diltiazem hydrochloride diphtheria and tetanus toxoids famotidine ibuprofen ketorolac levofloxacin metoclopramide nitroglycerin

Home care nursing

acetaminophen acetaminophen/oxycodone acetaminophen/propoxyphene napsylate digoxin diltiazem hydrochloride docusate sodium furosemide metformin hydrochloride potassium chloride warfarin

Long-term care nursing

carbidopa/levodopa digoxin docusate sodium donepezil hydrochloride enalapril maleate furosemide metoprolol tartrate mirtazapine pantoprazole sodium potassium chloride

Medical-surgical nursing

acetaminophen diltiazem hydrochloride

(continued)

1370 Appendix K: Most commonly used drugs in nursing specialties

Most commonly used drugs in nursing specialties (continued) Specialty

Top 10 drugs

Medical-surgical nursing (continued)

enalapril maleate furosemide heparin sodium insulin levofloxacin metoprolol tartrate morphine sulfate potassium chloride

Obstetric nursing

acetaminophen/codeine acetaminophen/oxycodone dinoprostone ibuprofen magnesium sulfate nalbuphine hydrochloride oxytocin penicillin promethazine hydrochloride terbutaline sulfate

Pediatric nursing

albuterol amoxicillin/clavulanate potassium amoxicillin trihydrate cetirizine hydrochloride co-trimoxazole fluticasone propionate gentamicin sulfate hydrocortisone (topical) methylphenidate hydrochloride montelukast sodium

Post-anesthesia care nursing

bupivacaine hydrochloride fentanyl citrate hydromorphone hydrochloride lidocaine hydrochloride lorazepam meperidine hydrochloride metoclopramide hydrochloride midazolam hydrochloride morphine sulfate ondansetron hydrochloride

Psychiatric nursing

carbamazepine clonazepam divalproex sodium escitalopram oxalate lithium carbonate olanzapine paroxetine hydrochloride risperidone sertraline hydrochloride venlafaxine hydrochloride

Appendix L: Top 200 most commonly prescribed drugs

1371

Top 200 most commonly prescribed drugs The table below lists the top 200 drugs ranked by the number of prescriptions sold in the United States in 2007. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36.

Lipitor Nexium Advair Diskus Prevacid Plavix Singulair Seroquel Effexor XR Lexapro Actos Protonix Vytorin Topamax Risperdal Abilify Cymbalta Lamictal Zyprexa Levaquin Celebrex Zetia Valtrex Crestor Fosamax Zyrtec Lantus Adderall XR Diovan Avandia Tricor Aciphex Diovan HCT OxyContin Concerta Coreg Flomax

37. 38. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48. 49. 50. 51. 52. 53. 54. 55. 56. 57. 58. 59. 60. 61. 62. 63. 64. 65. 66. 67. 68. 69. 70. 71. 72.

Lyrica Wellbutrin XL Aricept Imitrex Oral Ambien Lotrel Nasonex Toprol XL Ambien CR Enbrel Spiriva Viagra Lidoderm Actonel Chantix Norvasc Lovenox Provigil Lunesta Altace Keppra Geodon Oral Cozaar Detrol LA Atripla Truvada CellCept Pulmicort Respules Humalog Depakote ER Depakote Premarin Tabs Synthroid Niaspan Byetta Budeprion XL (continued)

1372 Appendix L: Top 200 most commonly prescribed drugs

Top 200 most commonly prescribed drugs (continued) 73. 74. 75. 76. 77. 78. 79. 80. 81. 82. 83. 84. 85. 86. 87. 88. 89. 90. 91. 92. 93. 94. 95. 96. 97. 98. 99. 100. 101. 102. 103. 104. 105. 106. 107. 108. 109. 110.

Strattera Combivent Trileptal Yasmin 28 Flovent HFA Skelaxin Prograf Arimidex Evista Hyzaar Namenda Januvia Humira Cialis Reyataz Xalatan Omnicef Avelox ProAir HFA Asacol Benicar HCT Fentanyl Oral Citra Requip Boniva Caduet Avapro Gleevec Kaletra Ortho Tri-Cyclen Lo Benicar AndroGel Xopenex Procrit Lamisil Oral Avalide Nasacort AQ Combivir Allegra-D 12 Hour

111. 112. 113. 114. 115. 116. 117. 118. 119. 120. 121. 122. 123. 124. 125. 126. 127. 128. 129. 130. 131. 132. 133. 134. 135. 136. 137. 138. 139. 140. 141. 142. 143. 144. 145. 146. 147. 148.

Duragesic Copaxone RenaGel Femara Enbrel Sureclick NovoLog Mix 70/30 Clarinex Aldara Forteo Suboxone Avodart Paxil CR Norvir Avandamet Restasis Avonex Sensipar Tarceva Patanol Yaz .254 Lovaza Mirapex Focalin XR Cosopt Zyvox Epzicom NuvaRing Actiq Fosamax Plus D Actoplus Met Lumigan Rhinocort Aqua Solodyn Thalomid Fuzeon Astelin BenzaClin Relpax

(continued)

Appendix L: Top 200 most commonly prescribed drugs

149. 150. 151. 152. 153. 154. 155. 156. 157. 158. 159. 160. 161. 162. 163. 164. 165. 166. 167. 168. 169. 170. 171. 172. 173. 174.

Viread Casodex Vigamox Vesicare Humalog Mix 75/25 Trizivir Budeprion SR Xeloda Sustiva Levitra Endocet Risperdal Consta Aggrenox Humira Pen Kadian Differin Catapres-TTS Alphagan P Tussionex Zyrtec Syrup Maxalt Zoloft Prilosec Ciprodex Otic Temodar Tobradex

Source: Verispan, VONA

175. 176. 177. 178. 179. 180. 181. 182. 183. 184. 185. 186. 187. 188. 189. 190. 191. 192. 193. 194. 195. 196. 197. 198. 199. 200.

Zyrtec-D Welchol Maxalt MLT Asmanex Atacand Coumadin Tabs Dovonex Klor-Con Pegasys Ultram ER Betaseron Zovirax Topical Trinessa Pulmozyme Neupogen Humulin N Micardis HCT Ortho Evra Allegra-D 24 Hour Fentora Enablex Famvir Avinza Prempro Coreg CR Marinol

1373

1374

Selected references

Selected references Publications AHFS Drug Information 2009. Bethesda, Md.: American Society of HealthSystem Pharmacists, 2009. American Heart Association. Advanced Cardiovascular Life Support Provider Manual. Dallas, Tex.: American Heart Association, 2007. American Society of Health-System Pharmacists. “ASHP guidelines on handling hazardous drugs 2005,” Am J Health-Syst Pharm. 2006;63:1172-1193. Blumenthal, M., Brinckmann, J., and Wollschlaeger, B., eds. The ABC Clinical Guide to Herbs. New York, N.Y.: Thieme Medical Publishers, 2003. Blumenthal, M., et al. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Newton, Mass.: Integrative Medicine Communication, 1998. Blumenthal, M., et al., eds. Herbal Medicine: Expanded Commission E Monographs. Newton, Mass.: Integrative Medicine Communication, 2000. Brunton, L., Lazo, J., and Parker, K. Goodman & Gilman's The Pharmacological Basis of Therapeutics, 11th ed. New York, N.Y.: McGraw-Hill Professional, 2005. Drug Facts and Comparisons 2009. Philadelphia, Pa.: Lippincott Williams & Wilkins, 2008. Drug Information for the Health Care Professional (USP DI Vol 1: Drug Information for the Health Care Professional), 27th ed. Greenwood Village, Colo.: Micromedex Thomson Healthcare, 2007. The Elsevier Guide to Oncology Drugs & Regimens. Huntington, N.Y.: Elsevier Oncology, 2006. Glynn-Tucker, E.M., McDiarmid, M., Newton, S.A., et al., eds. Safe Handling of Hazardous Drugs. Pittsburgh, Pa.: Oncology Nursing Society, 2003. Hansten, P.D., and Horn, J.R. Drug Interactions Analysis and Management 2009. Philadelphia, Pa.: Lippincott Williams & Wilkins, 2009. Hansten, P.D., and Horn, J.R. Top 100 Drug Interactions 2009: A Guide to Patient Management. Edmonds, Wash.: H&H Publications, 2008. Hazinski, M.F., Field, J., and Gilmore, D., eds. Handbook of Emergency Cardiovascular Care 2008: For Healthcare Providers. Dallas, Tex.: American Heart Association, 2008. Institute of Medicine of the National Academies. Preventing Medication Errors. Washington, D.C.: Institute of Medicine, 2006. The Joint Commission. 2008 National Patient Safety Goals. www.jointcommission.org/PatientSafety/NationalPatientSafetyGoals. King Guide to Parenteral Admixtures, 35th ed. Napa, Calif.: King Guide Publications, Inc., 2006. Kohn, L.T., Corrigan, J.M., and Donaldson, M.S., eds. To Err is Human: Building a Safer Health System. Washington, D.C.: National Academy Press, 2000. Moore, T.J., Cohen, M.R., and Furberg, C.D. “Serious adverse drug events reported to the Food and Drug Administration, 1998-2005,” Arch Intern Med. 2007;167:1752-1759.

Selected references

1375

Mosby's Drug Consult 2007, 17th ed. St. Louis, Mo.: Mosby, 2006. National Institute for Occupational Safety and Health. Preventing occupational exposure to antineoplastic and other hazardous drugs in health care settings. www.cdc.gov/niosh/docs/2004-165. PDR for Herbal Medicines, 4th ed. Montvale, N.J.: Thomson Healthcare, 2007. Physicians' Desk Reference 2009, 63nd ed. Montvale, N.J.: Thomson Healthcare, 2008. Pickar, G.D. Dosage Calculations, 8th ed. Clifton Park, N.Y.: Thomson Delmar Learning, 2007. Ralston, M., Hazinski, M.F., Zaritsky, A., et al., eds. Pediatric Advanced Life Support: Provider Manual. Dallas, Tex.: American Heart Association, 2007. Shargel, L., Wu-Pong, S., and Yu, A.B. Applied Biopharmaceutics & Pharmacokinetics, 5th ed. New York, N.Y.: McGraw-Hill Medical, 2004. Sweetman, S.C., et al., eds. Martindale: The Complete Drug Reference, 36th ed. London: Pharmaceutical Press, 2009. Tatro, D.S. 2009 Drug Interaction Facts. Philadelphia, Pa.: Lippincott Williams & Wilkins, 2008. 2008 Dialysis of Drugs. Madison, Wis.: CKD Insights, 2008. Websites American Heart Association: www.americanheart.org Center for Drug Evaluation and Research (drug safety): http://www.fda.gov/CDER/Drug/MedErrors/nameDiff.htm Centers for Disease Control and Prevention (hepatitis C information): www.cdc.gov/mmwr/preview/mmwrhtml/rr5203a1.htm Centers for Disease Control and Prevention (immunization schedules): www.cdc.gov/vaccines/recs/schedules; www.cdc.gov/mmwR/PDF/wk/mm5451-Immunization.pdf Daily Med (drug information): http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=2412 Drugs.com (drug information): www.drugs.com Drugs@FDA (catalog of FDA-approved drugs): www.accessdata.fda.gov/scripts/cder/drugsatfda Druginfonet.com (drug information): www.druginfonet.com/index.php?pageID=official.htm Health Canada (Canadian drug product database): www.hc-sc.gc.ca/hpb/drugs-dpd Institute for Safe Medication Practices: www.ismp.org MedlinePlus (drug information): www.nlm.nih.gov/medlineplus/ druginformation.html MedWatch (drug safety): http://www.fda.gov/medwatch/safety/2008/aug08.htm National Institute for Occupational Safety and Health (hazardous drug information): http://www.cdc.gov/niosh/docs/2004-165 RxList (drug information): www.rxlist.com U.S. Pharmacopeia: www.usp.org

Index A abacavir sulfate, 3–4 abacavir sulfate and lamivudine, 4–6 abatacept, 6–7 Abbreviations, dangerous, xvi abciximab, 7–9 Abdominal cramping, bismuth for, 143 Abdominal distention, neostigmine for, 813 Abdominal infection. See Intra-abdominal infection. Abelcet, 80 Abenol, 14 Abilify, 102, P2 Abortion dinoprostone for, 355 mifepristone for, 762 oxytocin for, 878 acamprosate calcium, 9–11 acarbose, 11–12 Accolate, 1240 AccuNeb, 35 Accupril, 1009, P13 Accupro, 1009 Accuretic, 1342 Acea, 752 acebutolol hydrochloride, 12–14 Aceon, 919 Acephen, 14 Acepril, 177 Acetadote, 19, S30 acetaminophen, 14–16 therapeutic and toxic blood levels for, S16 Acetaminophen overdose, acetylcysteine for, 19, S30 Acetaminophen with Codeine, P5 Acetazolam, 16 acetazolamide, 16–19 acetylcysteine, 19–20, S30 acetylsalicylic acid, 21–24 t: table

Acid indigestion. See also Heartburn. bismuth for, 143 cimetidine for, 252 famotidine for, 458 magnesium for, 694 sodium bicarbonate for, 1083 Acid Reducer, 1024 AcipHex, 1017, P13 acitretin, 24–26 Aclasta, 1247 Acne clindamycin for, 264 erythromycin for, 424 minocycline for, 765 sulfacetamide for, 1105 tetracycline for, 1142, 1143 tretinoin for, 1193 Acova, 100 Acquired immunodeficiency syndrome. See Human immunodeficiency virus infection. Acromegaly bromocriptine for, 154 octreotide for, 848 pegvisomant for, 901 Actidose, 26 Actidose-Aqua, 26 Actifed, 1342 Actilyse, 52 Actimmune, 604 Actinic keratoses, fluorouracil for, 479 Actinomycosis, penicillin G potassium for, 906 Actiprofen Caplets, 566 Actiq, 464, 1332t–1333t Activase, 52 Activase rt-PA, 52 activated charcoal, 26–27 for calcium channel blockers overdose, S30 for miscellaneous drug overdose, S31 Activella Tablets, 1342

Actonel, 1043, P13 Actonel with Calcium, 1342 Actoplus Met, 1342 Actos, 941, P12 Acular, 625 Acular LS, 625 Acute coronary syndrome clopidogrel for, 273, 274 eptifibatide for, 418 tirofiban for, 1169 treatment guidelines for, S24–S25 Acute intermittent porphyria, chlorpromazine for, 241 Acute lymphoblastic leukemia clofarabine for, 265 imatinib for, 573 mercaptopurine for, 714 methotrexate for, 732 nelarabine for, 808 pegaspargase for, 894 Acute lymphocytic leukemia asparaginase for, 106 daunorubicin for, 318 mercaptopurine for, 714 Acute myelogenous leukemia sargramostim for, 1065 Acute myeloid leukemia, idarubicin for, 570 Acute nonlymphocytic leukemia cytarabine for, 298 daunorubicin for, 318 mitoxantrone for, 774 Acute promyelocytic leukemia arsenic trioxide for, 105 tretinoin for, 1193 Acute pyelonephritis, levofloxacin for, 654 Acute respiratory distress syndrome, 1357 Acute rheumatic carditis, triamcinolone for, 1196 acyclovir, 27–29 acyclovir sodium, 27–29 Boldface: Color section

Alora

Adalat CC, 822 Adalat LA, 822 Adalat PA, 822 Adalat Retard, 822 Adalat XL, 822 adalimumab, 29–31 Adartrel, 1054 Adcal, 170 Adcortyl, 1195 Adderall, 1342, P2 Adderall XR, P2 Addison’s disease. See Adrenocortical insufficiency. adefovir dipivoxil, 31–32 Adenacor, 32 Adenocard, 32 Adenoscan, 32 Adenoscan infusion rates, 1352t adenosine, 32–34 Adenosine infusion rates, 1352t Adipine, 822 Adizem, 351 Administration rates, calculating, S6 Adoxa, 383 Adrenal insufficiency, cortisone for, 286 Adrenal suppression, 1357 Adrenalin Chloride, 409 Adrenocortical insufficiency hydrocortisone for, 552 triamcinolone for, 1196 Adrenocorticoid overdose potassium acetate for, 954 potassium chloride for, 957 Adriamycin PFS, 378 Adriamycin RDF, 378 Adrucil, 479 Adult Dry Cough, 336 Advagraf, 1118 Advair Diskus, 1342 Advate, 94 Adverse reactions, lifethreatening, identifying, 1357–1363 Advicor, 1342 Advil, 566 Advil Extra Strength, 566 t: table

Advil Migraine, 566 Advil Pediatric Drops, 566 Adynamic ileus, 1357 Aerius, 326, 683 AeroBec, 129 Afeditab CR, 822 Aflaxen, 800 Afrin Children’s Pump Mist, 930 agalsidase beta, 34–35 Aggrastat, 1168 Aggrenox, 1342 Aggression, risperidone for, 1045 Agitation, amoxapine for, 73 Agranulocytopenia, 1357 Agrylin, 89 AH-Chew D, 930 AHF, 94 A-hydroCort, 551 AIDS wasting, somatropin, recombinant for, 1092 AK-Sulf, 1105 AK-Zol, 16 Akne-Mycin, 423 Aknemin, 765 Aktob, 1171 Ala-Cort, 551 Ala-Scalp, 551 Alavert, 683 albuterol, 35–37 albuterol sulfate, 35–37 Alcohol dependence acamprosate for, 9 hydroxyzine for, 559 Alcohol withdrawal chlordiazepoxide for, 234 clorazepate for, 275 diazepam for, 340 oxazepam for, 868 Alcomicin, 523 Aldactazide, 1342 Aldactone, 1097 aldesleukin, 37–39 Aldomet, 736 Aldoril, 1342 alemtuzumab, 39–41 alendronate sodium, 41–42, P1 Aler-Cap, 356 Aler-Dryl, 356 Alertec, 776

1377

Aleve, 800 Alferon N, 597 alfuzosin, 42–43 Alimta, 902 Alinia, 829 aliskiren, 43–44 alitretinoin, 44–45 Alka, 21 Alka-Mints, 170 Alkalosis, 1357 Alkeran, 707 Alkylating agents, 1272–1274 Allegra, 468, P6 Allegra ODT, 468 Allegra-D, 1342 Allegron, 844 Aller-Relief, 226 Allercalm, 239 Allerdryl, 356 Allergic dermatoses, diphenhydramine for, 356 Allergies betamethasone for, 135 brompheniramine for, 155 cetirizine for, 226 chlorpheniramine for, 239 cortisone for, 286 cromolyn for, 288 cyproheptadine for, 296 dexamethasone for, 331 diphenhydramine for, 356 loratadine for, 683 methylprednisolone for, 744 montelukast for, 779 prednisolone for, 969 Allergy Relief, 226 Allerief, 239 AllerMax, 356 Allertin, 683 Alli, 860 allopurinol, 45–47 allopurinol sodium, 45–47 almotriptan malate, 47–48 Alodox, 383 aloe, 1314 Alopecia areata, minoxidil for, 768 Alophen, 141 Aloprim, 45 Alora, 429 Boldface: Color section

1378

alosetron hydrochloride

alosetron hydrochloride, 49–50 Aloxi, 885 5-Alpha reductase inhibitors, 1297–1298 alpha tocopherols, 1312 Alpha1-adrenergic agents, 1255–1256 Alphanate, 94 AlphaNine SD, 455 alprazolam, 50–52, P1 therapeutic and toxic blood levels for, S16 ALS. See Amyotrophic lateral sclerosis Altace, 1021, P13 alteplase, 52–54 AlternaGEL, 54 Alti-Clonazepam, 270 Alti-Ipratropium, 605 Altoprev, 687 Alu-Cap, 54 Alu-Tab, 54 aluminum hydroxide, 54–55 Alupent, 720 Alzheimer’s dementia donepezil for, 368 galantamine for, 512 memantine for, 709 rivastigmine for, 1052 tacrine for, 1117 amantadine hydrochloride, 55–57 Amaryl, 527, P7 Amatine, 760 Ambien, 1250 Ambien CR, 1250 AmBisome, 80 Amebiasis chloroquine for, 236 erythromycin for, 423 metronidazole for, 753 tinidazole for, 1162 Amebic liver abscess metronidazole for, 753 tinidazole for, 1162 Amenorrhea medroxyprogesterone for, 700 norethindrone for, 841 progesterone for, 987 Amerge, 802 A-Methapred, 744 t: table

amethopterin, 731–735 Amias, 175 Amicar, 61 Amidate, 1330t–1331t amifostine, 57–59 amikacin therapeutic and toxic blood levels for, S16 amikacin sulfate, 59–61 Amikin, 59 aminocaproic acid, 61–62 Aminoglycosides, 1269–1270 aminophylline, 62–64 therapeutic and toxic blood levels for, S16 Aminophylline infusion rates, 1352t 5-aminosalicylic acid, 717–718 amiodarone hydrochloride, 64–67 therapeutic and toxic blood levels for, S16 Amitiza, 690 amitriptyline hydrochloride, 67–69 therapeutic and toxic blood levels for, S16 Amix, 75 amlodipine besylate, 69–70, P1 amlodipine besylate and atorvastatin calcium, 70–73 amlodipine besylate and benazepril hydrochloride, P1 Amnesia lorazepam for, 684 midazolam for, 758, 759 Amnivent, 62 amobarbital, therapeutic and toxic blood levels for, S16 Amox, 75 amoxapine, 73–75 amoxicillin, 75–77 amoxicillin and clavulanate potassium, 78–79, P2

amoxicillin trihydrate, 75–77, P1, P22 Amoxident, 75 Amoxil, 75, P1, P2 amphetamine sulfate combination, P2 Amphocil, 80 Amphotec, 80 amphotericin B cholesteryl sulfate, 80–84 amphotericin B desoxycholate, 80–84 amphotericin B lipid complex, 80–84 amphotericin B liposome, 80–84 ampicillin sodium, 84–86 ampicillin sodium and sulbactam sodium, 86–88 Amrix, 289 Amyben, 64 Amyl Nitrite, 88 amyl nitrite, 88–89 Amyloidosis, 1357 acetylcysteine for, 19 Amyotrophic lateral sclerosis, riluzole for, 1041 Anabact, 752 Anadin Ibuprofen, 566 Anadin Paracetamol, 14 Anadin Ultra, 566 Anafranil, 268 Anafranil SR, 268 anagrelide hydrochloride, 89–91 anakinra, 91–92 Analgesia. See also Labor pain; Pain. diclofenac for, 343 fentanyl for, 466, 1332t–1333t levorphanol for, 658 promethazine for, 989 remifentanil for, 1336t–1337t sufentanil for, 1340t–1341t Analgesics nonopioid, 1293–1294 opioid, 1294 Anandron, 826 Anapen, 409 Boldface: Color section

Anticonvulsants

Anaphylactic reactions, cyproheptadine as adjunct to, 296 Anaphylactoid shock, 1357 Anaphylaxis, 1357 chlorpheniramine for, 239 diphenhydramine for, 356 epinephrine for, 410 treatment guidelines for, S21 Anaplastic astrocytoma, temozolomide for, 1129 Anaprox, 800 Anaprox DS, 800 Anaspaz, 560 anastrozole, 92–93 Ancef, 201 Ancobon, 476 Ancotil, 476 Ancylostoma duodenale infection, mebendazole for, 698 Androderm, 1139 AndroGel, 1139 Androgens, 1297–1298 Andropatch, 1139 Anectine, 1338t–1339t Anemia azacitidine for, 117 darbepoetin alfa for, 309 epoetin alfa for, 415, 416 folic acid for, 1306 iron dextran for, 610 iron sucrose for, 612 lenalidomide for, 642 leucovorin calcium for, 646 leuprolide for, 648 lymphocyte immune globulin for, 692 triamcinolone for, 1197 Anesthesia acetylcysteine for, 19 butorphanol for, 168 epinephrine for prolonging, 410 etomidate for, 1330t–1331t fentanyl for, 466, 1332t–1333t lidocaine for, 663, 664 meperidine for, 712 t: table

Anesthesia (continued) midazolam for, 758, 1334t–1335t nalbuphine for, 799, 1334t–1335t pancuronium for, 1334t–1335t pentazocine for, 913, 1334t–1335t phenylephrine for, 931 procaine for, 1336t–1337t remifentanil for, 1336t–1337t rocuronium for, 1338t–1339t succinylcholine for, 1338t–1339t sufentanil for, 1340t–1341t thiopental for, 1340t–1341t vecuronium for, 1340t–1341t Anesthetic drugs, common, 1330t–1334t Anesticaine, 662 Anesticon, 662 Anexsia, 549 Angettes, 21 Angeze, 618 Angina abciximab for, 8 acetylsalicylic acid for, 22 amlodipine for, 69 amyl nitrite for, 88 atenolol for, 109 bivalirudin for, 145 clopidogrel for, 274 dalteparin for, 303 diltiazem for, 351 enoxaparin for, 405 eptifibatide for, 418 isosorbide for, 619 metoprolol for, 750 nadolol for, 795 nicardipine for, 818 nifedipine for, 822 nitroglycerin for, 832 propranolol for, 996 ranolazine for, 1026 verapamil for, 1228 Angioedema, 1358 cyproheptadine for, 296 Angiomax, 145

1379

Angiopine, 822 Angiotensin II receptor antagonists, 1295–1296 Angiotensin-converting enzyme inhibitors, 1295–1296 Angiox, 145 Angitak, 618 Angitil, 351 anidulafungin, 93–94 Ankylosing spondylitis adalimumab for, 30 celecoxib for, 223 diclofenac for, 343 etanercept for, 438 indomethacin for, 586 naproxen for, 800 Anorexia, megestrol for, 704 Antacids, 1256 Antara, 460 Antepsin, 1104 Anthrax amoxicillin for, 76 ciprofloxacin for, 255 doxycycline for, 384 levofloxacin for, 654 penicillin G potassium for, 906 penicillin G procaine for, 908 anti-Alzheimer’s agents, 1256–1257 Anti-infectives, 1269–1270 Antiarrhythmics, 1257–1259 Anticholinergic overdose, managing, S30 Anticholinergics, 1259–1260, 1264–1265, 1274 Anticholinesterase insecticide poisoning, atropine for, 114 Anticoagulant overdose, factor IX for, 455 Anticoagulants, 1260–1261 Anticoagulation argatroban for, 101 heparin for, 544 Anticonvulsants, 1261–1262 Boldface: Color section

1380 Antidepressants

Antidepressants, 1262–1263 Antidiabetic drugs, 1263–1264 Antidopaminergics, 1264–1265 Antiemetics, 1264–1265 Antifungals, 1265 Antigout agents, 1266 antihemophilic factor, 94–96 Antihistamine overdose, managing, S30 Antihistamines, 1266–1267 Antihyperlipidemics, 1267–1268 Antihyperuricemia agents, 1266 Antilirium, S30 Antimalarials, 1270–1271 Antimetabolites, 1272–1274 Antimigraine drugs, 1271–1272 Antimitotics, 1272–1274 Antineoplastics, 1272–1274 Antiparkinsonian drugs, 1274 Antiplatelet drugs, 1275 Antipressan, 108 Antipsychotics, 1276 Antiretrovirals, 1279–1280 Antirheumatic drugs, 1276–1277 antithrombin III, human, 96–97 antithymocyte globulin equine, 691–693 Antituberculars, 1277–1278 Antiulcer drugs, 1278–1279 Antivert, 699 Antivirals and antiretrovirals, 1274, 1279–1280 Antizol, S31 Anxiety. See also Generalized anxiety disorder. alprazolam for, 50 amoxapine for, 73 buspirone for, 164 t: table

Anxiety (continued) chlordiazepoxide for, 234 clorazepate for, 275 diazepam for, 339 doxepin for, 376 duloxetine for, 390 hydroxyzine for, 559 lorazepam for, 684 midazolam for, 758, 759 oxazepam for, 868 prochlorperazine for, 985 trifluoperazine for, 1202 Anxiolytics, 1280–1281 Anzemet, 367 Apidra, 590 Aplastic anemia, lymphocyte immune globulin for, 692 APO Sulfasalazine, 1109 Apo-Acetaminophen, 14 Apo-Acetazolamide, 16 Apo-Alendronate, 41 Apo-Allopurinol, 45 Apo-Alpraz, 50 Apo-Amitriptyline, 67 Apo-Amoxi-Clav, 78 Apo-Amoxil, 75 Apo-Ampi, 84 Apo-Asa, 21 Apo-ASEN, 21 Apo-Azathioprine, 118 Apo-Baclofen, 124 Apo-Beclomethasone, 129 Apo-Benazepril, 130 Apo-Benztropine, 134 Apo-Bicalutamide, 140 Apo-Bisacodyl, 141 Apo-Bisoprolol, 144 Apo-Bromocriptine, 154 APO-Butorphanol, 167 APO-Calcitonin, 169 Apo-Capto, 177 Apo-Carbamazepine, 180 Apo-Carvedilol, 194 Apo-Cefaclor, 198 Apo-Cefprozil, 214 Apo-Cefuroxime, 221 Apo-Cephalex, 224 Apo-Chlordiazepoxide, 234 Apo-Chlorpromazine, 241 Apo-Chlorpropamide, 243 Apo-Chlorthalidone, 245

Apo-Cimetidine, 252 Apo-Clindamycin, 263 Apo-Clomipramine, 268 Apo-Clonazepam, 270 Apo-Clonidine, 272 Apo-Clorazepate, 275 Apo-Clozapine, 276 Apo-Cromolyn, 287 Apo-Cyclobenzaprine, 289 Apo-Cyclosporine, 293 Apo-Desipramine, 324 Apo-Desmopressin, 327 Apo-Dexamethasone, 331 Apo-Diazepam, 339 Apo-Diclo, 343 Apo-Digoxin, 348 Apo-Diltiaz, 351 Apo-Diltiazem, 351 Apo-Dimenhydrinate, 353 Apo-Dipyridamole FC, 359 Apo-Dipyridamole SC, 359 Apo-Divalproex, 1216 Apo-Docusate Calcium, 366 Apo-Docusate Sodium, 366 Apo-Doxepin, 376 Apo-Doxy, 383 Apo-Enalpril, 401 Apo-Erythro, 423 Apo-Erythro-EC, 423 Apo-Erythro-ES, 423 Apo-Etodolac, 442 Apo-Famciclovir, 456 Apo-Famotidine, 457 Apo-Fenofibrate, 460 Apo-Flecainide, 472 Apo-Flucanazole, 474 APO-Flunisolide, 478 Apo-Fluphenazine, 483 Apo-Flurazepam, 486 APO-Flutamide, 487 Apo-Fluvoxamine, 493 APO-Fosinopril, 501 Apo-Furosemide, 507 Apo-Gabapentin, 510 Apo-Gain, 767 Apo-Gemfibrozil, 520 Apo-Glimepiride, 527 Apo-Glyburide, 532 APO-go, 97 Apo-Haloperidol, 541 Apo-Hydralazine, 546 Apo-Hydro, 547 Apo-Hydroxychloroquine, 556 Boldface: Color section

Arrhythmias

Apo-Hydroxyzine, 559 Apo-Ibuprofen, 566 Apo-Imipramine, 576 Apo-Indapamide, 583 Apo-Indomethacin, 586 Apo-ISDN, 618 Apo-K, 957 Apo-Ketoconazole, 623 Apo-Ketorolac, 625 Apo-Lactulose, 630 Apo-Lamotrigine, 633 Apo-Leflunomide, 640 Apo-Levetiracetam, 651 Apo-Levocarb, 182 Apo-Lisinopril, 675 Apo-Lithium Camcolit, 677 Apo-Lithium Carbonate, 677 Apo-Loperamide, 681 Apo-Lorazepam, 684 Apo-Lovastatin, 687 Apo-Loxapine, 689 Apo-Medroxy, 700 Apo-Mefloquine, 702 Apo-Megestrol, 704 Apo-Meloxicam, 705 Apo-Metformin, 723 Apo-Methimazole, 728 Apo-Methotrexate, 731 Apo-Methyldopa, 736 Apo-Methylphenidate, 740 Apo-Metoclop, 746 Apo-Metoprolol, 750 Apo-Metronidazole, 752 Apo-Midazolam, 758, 1334t–1335t Apo-Midodrine, 760 Apo-Milrinone, 764 Apo-Mirtazapine, 769 Apo-Misoprostol, 771 Apo-Mofafinil, 776 Apo-Nadolol, 794 Apo-Napro-Na, 800 Apo-Napro-Na DS, 800 Apo-Naproxen, 800 Apo-Nifed, 822 Apo-Nitrofurantoin, 830 Apo-Nizatidine, 836 Apo-Nortriptyline, 844 Apo-Ondansetron, 858 Apo-Orciprenaline, 720 Apo-Oxaprozin, 866 Apo-Oxazepam, 868 Apo-Oxcarbazepine, 869 Apo-Oxybutinin, 871 t: table

Apo-Paclitaxel, 879 Apo-Pantoprazole, 888 Apo-Paroxetine, 890 Apo-Pen VK, 909 Apo-Pentoxyphylline, 918 Apo-Perindopril, 919 Apo-Perphenazine, 921 Apo-Pimozide, 938 Apo-Pindol, 939 Apo-Pioglitazone, 941 Apo-Piroxicam, 947 Apo-Pramipexole, 963 Apo-Pravastatin, 966 Apo-Prazo, 967 Apo-Prednisone, 972 Apo-Primidone, 978 Apo-Procainamide, 980 Apo-Propafenone, 990 Apo-Propranolol, 995 Apo-Quin-G, 1011 Apo-Quinidine, 1011 Apo-Quinine, 1014 Apo-Ramipril, 1021 Apo-Ranitidine, 1024 Apo-Selegiline, 1070 Apo-Sertraline, 1073 Apo-Simvastatin, 1078 Apo-Sotalol, 1095 Apo-Sucralfate, 1104 Apo-Sulfatrim, 1106 Apo-Sulfatrim DS, 1106 Apo-Sumatriptan, 1113 Apo-Temazepam, 1128 Apo-Terazosin, 1134 Apo-Tetra, 1142 Apo-Theo LA, 1146 Apo-Ticlopidine, 1156 Apo-Timol, 1159 Apo-Tizanidine, 1170 Apo-Tobramycin, 1171 Apo-Tomax, 1122 Apo-Topiramate, 1177 Apo-Trazodone, 1189 Apo-Triazo, 1200 Apo-Trifluoperazine, 1202 Apo-Trihex, 1204 Apo-Trimip, 1206 Apo-Valacyclovir, 1213 Apo-Valproic Syrup, 1216 Apo-Verap, 1228 Apo-Verap SR, 1228 Apo-Warfarin, 1238 Apo-Zidovudine, 1243 Apokyn, 97

1381

apomorphine hydrochloride, 97–99 Appendix, ruptured, piperacillin and tazobactam for, 944 Appetite stimulant, dronabinol as, 386 aprepitant, 99–100 Apresoline, 546 Apri, 1342 Aprovel, 607 Aptivus, 1166 Aquachloral, 230 AquaMEPHYTON, 1308 Aquasol A, 1310 Aquavit E, 1312 Arachnoiditis, chemical, 1358 Aranesp, 308 Arava, 640 Arbil, 180 Aredia, 887 argatroban, 100–102 Argatroban infusion rates, 1353t Argoral, 1072 Aricept, 368 Arimidex, 92 aripiprazole, 102–104, P2 Aristospan Intra-Articular, 1195 Aristospan Intralesional, 1195 Arixtra, 495 Arlevert, 353 Arm & Hammer Baking Soda, 1083 Armour Thyroid, 1151 Aromasin, 449 Arranon, 808 Arret, 681 Arrhythmias acebutolol for, 13 adenosine for, 32 amiodarone for, 65 atropine for, 114 digoxin for, 348 diltiazem for, 351 disopyramide for, 360 esmolol for, 427 flecainide for, 473 ibutilide for, 569 isoproterenol for, 617 lidocaine for, 663 Boldface: Color section

1382 Arrhythmias

Arrhythmias (continued) mexiletine for, 755 phenylephrine for, 931 potassium acetate for, 954 potassium chloride for, 957 procainamide for, 981 propafenone for, 991 propranolol for, 996 quinidine for, 1011 sotalol for, 1095 verapamil for, 1228 warfarin for, 1238 arsenic trioxide, 104–106 Arsenic trioxide overdose, managing, S30 Arterial thrombosis, streptokinase for, 1100 Arthrinol, 21 Arthrisin, 21 Arthritis. See also Gouty arthritis; Psoriatic arthritis; Rheumatoid arthritis. acetaminophen for, 15 hydrocortisone for, 552 piroxicam for, 947 Arthrofen, 566 Arthrotec, 1342 Arthroxen, 800 Artria S.R., 21 Arythmol, 990 ASA, 21 5-ASA, 717–718 Asacol, 717 Ascariasis mebendazole for, 698 pyrantel for, 1002 ascorbic acid, 1303 Asmabec, 129 asparaginase, 106–108 Aspercin, 21 Aspergillosis amphotericin B for, 80 caspofungin for, 196 itraconazole for, 621 posaconazole for, 952 voriconazole for, 1236 Aspergum, 21 Aspir-Low, 21 aspirin, 21 Aspirin Free Anacin, 14 t: table

Aspirtab, 21 Assisted reproduction technology menotropins for, 710 progesterone for, 987 Asthma aminophylline for, 62 beclomethasone for, 129 budesonide for, 157 cortisone for, 286 cromolyn for, 288 epinephrine for, 410 fluticasone for, 489 formoterol for, 497 ipratropium for, 605 metaproterenol for, 720 montelukast for, 779 omalizumab for, 856 prednisolone for, 969 salmeterol for, 1060 triamcinolone for, 1196 zafirlukast for, 1240 Astramorph PF, 780 Astrin, 21 AT-III, 96–97 Atacand, 175 Atacand HCT, 1342 Atarax, 559 Atasol, 14 Atelectasis, acetylcysteine for, 19 Atenix, 108 atenolol, 108–110 therapeutic and toxic blood levels for, S16 ATG, 691–693 ATG equine, 691–693 Atgam, 691 Atherectomy, tirofiban for, 1169 Athetosis, diazepam for, 339 Atimos Modulite, 497 Ativan, 684, P9 atomoxetine hydrochloride, 110–112, P3 Atopic dermatitis pimecrolimus for, 937 tacrolimus for, 1119 atorvastatin calcium, 112–114, P3 atracurium besylate, 1330t–1331t Atralin, 1192 Atriance, 808

Atripla, 1342 AtroPen, 114 Atrophic vaginitis estradiol for, 430 estrogens, conjugated for, 432 estrogens, esterified for, 434 atropine sulfate, 114–116 for cholinergic overdose, S31 atropine sulfate ophthalmic, 114–116 Atropine sulfate overdose, managing, S30 Atrovent HFA, 605 A/T/S, 423 Attention deficit hyperactivity disorder atomoxetine for, 111 dexmethylphenidate for, 333 dextroamphetamine for, 335 imipramine for, 577 lisdexamfetamine for, 673 methylphenidate for, 741 Augmentin, 78, 1342, P2 Augmentin ES-600, 78 Augmentin XR, 78 Augmentin-Duo, 78 Autistic disorder, risperidone for, 1046 Autoimmune disorders betamethasone for, 135 cortisone for, 286 hydrocortisone for, 552 Autoimmune hemolytic anemia, triamcinolone for, 1197 Autoimmune phenomena, 1358 Avalide, 1342 Avamys, 488 Avandaryl, 1342 Avandia, 1056, P13 Avapro, 607, P8 Avastin, 138 Avelox, 783 Aventyl, 844 Avinza, 780 Avita, 1192 Avodart, 393 Boldface: Color section

Bipolar disorder 1383

Avomine, 988 Avonex, 602 Axert, 47 Axid, 836 Axid AR, 836 Ayercillin, 908 Aygestin, 841 Aymmetrel, 55 azacitidine, 116–118 Azactam, 122 Azasan, 118 azathioprine, 118–120 Azilect, 1027 azithromycin, 120–122, P3 azithromycin dihydrate, 120–122 Azmacort Inhalation Aerosol, 1195 AZO-Gesic, 923 Azo-Standard, 923 Azor, 1342 aztreonam, 122–124 Azulfidine, 1109 Azulfidine EN-tabs, 1109

B Backache, acetaminophen for, 15 Baclofen, 124 baclofen, 124–126 Bacteremia, chloramphenicol for, 233 Bacterial vaginosis tinidazole for, 1162 Bacterial vaginosis, metronidazole for, 753 Bactrim, 1106, 1343 Bactrim DS, 1106 Bactroban, 785 Bactroban Nasal 2%, 785 Balminil DM, 336 Balminil Expectorant, 539 balsalazide disodium, 126–127 Banophen, 356 Baraclude, 408 Barbiturates, 1296–1297 Baridium, 923 Basal cell carcinoma, fluorouracil for, 479 basiliximab, 127–128 Baxan, 200 Bayer, 21 Bazetham, 1123 t: table

BD Glucose, 337 Bebulin VH, 455 Beclodisk, 129 Becloforte, 129 beclomethasone dipropionate, 129–130 Beconase AQ Nasal Spray, 129 Bedol, 429 Bedranol SR, 995 Beesix, 1309 Bejel penicillin G benzathine for, 904 penicillin G procaine for, 908 Bell/ans, 1083 Benadryl, 356 Benadryl Allergy, 356 Benadryl Allergy Oral Solution, 226 Benadryl Child Chesty Cough, 356 Benadryl Dye-Free Allergy, 356 Benadryl One a Day, 226 benazepril hydrochloride, 130–132, P3 bendamustine hydrochloride, 132–133 BeneFix, 455 Benicar, 853, P11 Benign prostatic hyperplasia alfuzosin for, 42 doxazosin for, 375 dutasteride for, 393 finasteride for, 471 tamsulosin for, 1124 terazosin for, 1134 Benilyn Childrens Chesty Coughs, 539 Bentyl, 345 Bentylol, 345 Benuryl, 979 Benylin-E, 539 Benzodiazepine overdose, managing, S30 Benzodiazepines, 1280–1281 benztropine mesylate, 134–135 bepridil, therapeutic and toxic blood levels for, S16

Beriberi, thiamine for, 1311 Besavar, 42 Beta-adrenergic blockers, 1281–1282 Beta-Cardone, 1095 Beta-Prograne, 995 Betachron E-R, 995 Betaferon, 602 Betaloc, 750 Betaloc Durules, 750 betamethasone, 135–137 betamethasone acetate and sodium phosphate, 135–137 Betapace, 1095 Betapace AF, 1095 Betaseron, 602 bethanechol chloride, 137–138 Betim, 1159 Betimol, 1159 Betnelan, 135 bevacizumab, 138–140 Biamine, 1311 Biaxin, P4 Biaxin Filmtab, 261 Biaxin Granules, 261 Biaxin XL, P4 Biaxin XL Filmtab, 261 bicalutamide, 140–141 Bicillin L-A, 904 BiCNU, 190 Big Shot B-12, 1305 bilberry, 1314–1315 Bile acid suppressants, 1267–1268 Biliary tract infection, cefazolin for, 202 Bio-Carbamazepine, 180 Bio-Diazepam, 339 Bio-Flurazepam, 486 Bio-Furosemide, 507 Bio-Oxazepam, 868 Bio-Statin, 846 Biocef, 224 Biolax, 141 Biological response modifiers, 1276–1277 Biphentin, 740 Bipolar disorder. See also Mania. aripiprazole for, 102 Boldface: Color section

1384

Bipolar disorder

Bipolar disorder (continued) divalproex sodium for, 1217 lamotrigine for, 635 lithium for, 677 olanzapine for, 852 quetiapine for, 1007 risperidone for, 1045 Bisac-Evac, 141 bisacodyl, 141–142 Bismatrol, 142 Bismatrol Maximum Strength, 142 bismuth subsalicylate, 142–144 Bisoprolol, 144 bisoprolol fumarate, 144–145 Bisphosphonates, 1282–1283 bivalirudin, 145–147 black cohosh, 1315 Black Draught, 1072 Bladder atony, neostigmine for, 813 Bladder cancer cisplatin, 258 doxorubicin for, 379 vinblastine for, 1231 Bladder, overactive. See Overactive bladder. Blanching test, phenylephrine for, 931 Blastomycosis amphotericin B for, 80 itraconazole for, 621 ketoconazole for, 624 Bleeding, excessive, aminocaproic acid for, 61 Blenoxane, 147 bleomycin sulfate, 147–149 Bleph-10, 1105 Blepharospasm, botulinum toxin for, 152 Blood cell transplantation, sargramostim for, 1065 Blood clotting, heparin for prevention of, 544 Blood tests, normal values for, 1349–1351 t: table

Blood transfusions epoetin alfa to reduce need for, 416 sodium chloride for, 1084 Bonamine, 699 Bone and joint infection cefazolin for, 202 cefoxitin for, 211 ceftazidime for, 216 ceftriaxone for, 219 cefuroxime for, 221 cephalexin for, 225 ciprofloxacin for, 256 imipenem and cilastatin for, 575 Bone marrow depression, 1358 Bone marrow transplantation immune globulin for, 580 sargramostim for, 1065 Bone metastases, zoledronic acid for, 1247 Bone pain, oxandrolone for, 865 Bonine, 699 Boniva Injection, 562 Bonviva, 562 Boots Threadworm, 698 Borrelia recurrentis infection, tetracycline for, 1142 bortezomib, 149–150 bosentan, 150–152 Botox, 152 Botox Cosmetic, 152 botulinum toxin type A, 151–153 botulinum toxin type B, 151–153 Bowel preparation bisacodyl for, 141 senna for, 1072 sodium phosphates for, 1088 Bragg’s Medicinal Charcoal, 26 Brain surgery, carmustine as adjunct to, 190 Brain tumor carmustine for, 190 lomustine for, 680 Breast cancer anastrozole for, 92 capecitabine for, 176

Breast cancer (continued) cyclophosphamide for, 291 docetaxel for, 364 doxorubicin for, 379 epirubicin for, 412 estradiol for, 430 estrogens, conjugated for, 432 estrogens, esterified for, 434 exemestane for, 449 fluorouracil for, 479 fulvestrant for, 506 gemcitabine for, 519 goserelin for, 536 letrozole for, 644 megestrol for, 704 paclitaxel for, 880 pamidronate for, 887 raloxifene for, 1018 tamoxifen for, 1122 testosterone for, 1140 trastuzumab for, 1188 vinblastine for, 1231 Brevibloc, 427 Brexidol, 947 Bricanyl, 1137 Broflex, 1204 Bromfenac, 155 bromocriptine mesylate, 154–155 brompheniramine, 155–157 Bronchial studies, acetylcysteine for, 19 Bronchiectasis, acetylcysteine for, 19 Bronchitis acetylcysteine for, 19 cefaclor for, 199 cefdinir for, 204 cefixime for, 207 cefpodoxime for, 212 cefprozil for, 214 ceftibuten for, 217 clarithromycin for, 261, 262 gemifloxacin for, 522 levofloxacin for, 654 moxifloxacin for, 784 ofloxacin for, 849 Boldface: Color section

Candidiasis

Bronchitis (continued) sulfamethoxazoletrimethoprim for, 1106 Broncho-Grippol-DM, 336 Bronchoconstriction, montelukast for, 779 Bronchodilation, epinephrine for, 410 Bronchodilators, 1283 Bronchopulmonary disease, acetylcysteine for, 19 Bronchospasm albuterol for, 35, 36 aminophylline for, 62 cromolyn for, 288 formoterol for, 497 ipratropium for, 605 isoproterenol for, 617 levalbuterol for, 649 metaproterenol for, 720 salmeterol for, 1060 terbutaline for, 1137 theophylline for, 1147 tiotropium for, 1165 Bronitin Mist, 409 Brove X, 155 Brucellosis streptomycin for, 1102 tetracycline for, 1142 Brufen, 566 Buccastem, 984 Budenofalk, 157 Budeprion SR, 162 Budeprion XL, 162 budesonide, 157–159 Bulimia nervosa, fluoxetine for, 482 bumetanide, 159–161 Bumetanide Injection, 159 Bumex, 159 Buprenex, 161 buprenorphine hydrochloride, 161–162 bupropion hydrochloride, 162–164, P3 Burinex, 161 Burkitt’s lymphoma, methotrexate for, 732 t: table

Burns gentamicin for, 524 potassium acetate for, 954 potassium chloride for, 957 Bursitis betamethasone for, 135 indomethacin for, 586 methylprednisolone for, 744 naproxen for, 800 Buscopan, 1067 Busilvex, 165 BuSpar, 164 buspirone hydrochloride, 164–165 busulfan, 165–167 Busulfex, 165 butorphanol tartrate, 167–169 Byetta, 450 Bystolic, 804

C Cachexia megestrol for, 704 somatropin, recombinant for, 1092 Cacit, 170 Caduet, 70, 1343 Caelyx, 381 Cal-Citrate-225, 170 Cal-Lac, 171 Calan, 1228 Calan SR, 1228 Calax, 366 Calcarb 600, 170 Calchan, 822 Calci-Chew, 170 Calci-Mix, 170 Calcicard, 351 Calciject, 170 Calcimar, 169 Calcionate, 171 Calciparine, 543 Calciquid, 171 calcitonin (salmon), 169–170 calcium acetate, 170–172 calcium carbonate, 170–172 Calcium channel blockers, 1284

1385

Calcium channel blockers overdose, managing, S30 calcium chloride, 170–172, S31 calcium citrate, 170–172 Calcium Folinate, 645 calcium glubionate, 171–172 calcium gluceptate, 171–172 calcium gluconate, 171–172 calcium lactate, 171–172 Calcium oxalate calculi, allopurinol for, 46 calcium polycarbophil, 173–174 calcium, therapeutic and toxic blood levels for, S16 Calculi, calcium oxalate, allopurinol for, 46 calfactant, 174 Calimol, 239 Calmylin #1, 336 Calmylin Expectorant, 539 Calorie replacement, dextrose for, 338 Calpol, 14 Calprofen, 566 Caltine, 169 Caltrate 600, 170 Campath, 39 Campral, 9 Campto, 608 Camptosar, 608 Camptylobacter infection, tetracycline for, 1142 Canasa, 717 Cancer. See also specific type. fluorouracil for, 479 pegfilgrastim for, 895 Cancidas, 196 candesartan cilexetil, 175–176 Candidemia anidulafungin for, 93 caspofungin for, 196 micafungin for, 756 Candidiasis amphotericin B for, 81 anidulafungin for, 93 Boldface: Color section

1386

Candidiasis

Candidiasis (continued) caspofungin for, 197 fluconazole for, 474, 475 itraconazole for, 621 ketoconazole for, 624 micafungin for, 756, 757 nystatin for, 846 posaconazole for, 952 voriconazole for, 1236 Candiduria, ketoconazole for, 624 Candistatin, 846 Canesten Oral, 474 Canusal, 543 capecitabine, 176–177 Caplenol, 45 Capoten, 177 Capozide, 1343 Caprin, 21 Capsules not to crush, S11–S12 captopril, 177–179 Carace, 675 Carafate, 1104 Carbagen, 180 Carbamaz, 180 carbamazepine, 180–182 therapeutic and toxic blood levels for, S16 Carbapenems, 1269–1270 Carbatrol, 180 carbidopa-levodopa, 182–184 carbidopa-levodopaentacapone, 185–186 Carbolith, 677 Carbomix, 26 Carbonic anhydrase inhibitors, 1287–1288 carboplatin, 187–188 Cardene, 818 Cardene IV, 818 Cardene SR, 818 Cardiac arrest calcium for, 171 epinephrine for, 410 treatment guidelines for, S22, S23 tromethamine for, 1210 Cardiac bypass surgery, tromethamine for, 1210 t: table

Cardiac decompensation, dobutamine for, 362 Cardiac surgery, dobutamine for, 362 Cardiac tamponade, 1358 Cardiac vagal reflex blockade atropine for, 115 glycopyrrolate for, 534 Cardiac valve placement, warfarin for, 1238 Cardicor, 144 Cardilate MR, 822 Cardiomyopathy, 1358 Cardioplen, 459 Cardiospasm, scopolamine for, 1067 Cardiotoxicity, 1358 Cardiovascular collapse, 1358 Cardiovascular disease, amlodipine and atorvastatin for prevention of, 70 Cardiovascular events, pravastatin for prevention of, 966 Cardiovascular surgery, heparin for, 544 Cardioversion, diazepam as preparation for, 339 Cardizem, 351 Cardizem CD, 351 Cardizem LA, 351 Cardozin XL, 375 Cardura, 375 Cardura XL, 375 Carimune NF, 579 carisoprodol, 188–189 carmustine, 190–191 carteolol hydrochloride, 191–193 Carter’s Little Pills, 141 Cartia XT, 351 carvedilol, 194–196, P3 carvedilol phosphate, 194–196 Casodex, 140 caspofungin acetate, 196–198 cat’s claw, 1315–1316 Cataflam, 343 Catapres, 272 Catapres-TTS, 272

Cathflo Activase, 52 Cecon, 1303 Cedax, 217 Cedocard, 618 Cedocard-SR, 618 CeeNU, 679 cefaclor, 198–200 cefadroxil, 200–201 cefazolin sodium, 201–203 cefdinir, 203–205 cefepime hydrochloride, 205–207 cefixime, 207–208 cefotaxime sodium, 208–210 cefoxitin sodium, 210–212 cefpodoxime proxetil, 212–214 cefprozil, 214–215, P4 ceftazidime, 215–217 ceftibuten, 217–219 Ceftin, 221 ceftriaxone sodium, 219–221 cefuroxime axetil, 221–223 cefuroxime sodium, 221–223 Cefzil, 214, P4 Celebrex, 223, P4 celecoxib, 223–224, P4 Celestone, 135 Celestone Soluspan, 135 Celevac, 735 Celexa, 259, P4 CellCept, 788 CellCept Intravenous, 788 Central nervous system depression, doxapram for, 373 Central nervous system stimulants, 1285–1286 Central venous access device, restoration, alteplase for, 53 cephalexin, 224–226, P4 Cephalosporin blood level, probenecid to increase, 979 Cephalosporins, 1269–1270 Cerebral ischemia, 1358 Cerebral palsy dantrolene for, 307 diazepam for, 339 Boldface: Color section

Ciprodex

Cerebrovascular accident acetylsalicylic acid for, 21 alteplase for, 53 atorvastatin for, 112 clopidogrel for, 273 losartan for, 686 ramipril for, 1022 ticlopidine for, 1156 treatment guidelines for, S26 Cerebyx, 503 Cerubidine, 318 Cervical cancer, bleomycin for, 147 Cervical ripening, dinoprostone for, 355 Cervicitis azithromycin for, 121 cefotaxime for, 209 ofloxacin for, 849 Cervidil Vaginal Insert, 354 C.E.S., 432 Cesamet, 791 Cesarean delivery cefotaxime for, 209 ropivacaine for, 1338t–1339t Ceta-Plus, 549 Cetacort, 551 Cetaphen, 14 cetirizine hydrochloride, 226–227 cetuximab, 227–229 Cevi-Bid, 1303 chamomile, 1316 Champix, 1224 Chancroid azithromycin for, 121 tetracycline for, 1142 Chantix, 1224 Char-Caps, 26 Charcadote, 26 Charco Caps, 26 Chemydur, 618 Chibroxin, 842 Chickenpox. See Varicella. Children’s Advil, 566 Children’s Allergy Fastmelt, 356 Children’s Motrin, 566 Children’s Pepto Chooz, 170 Children’s Tylenol Soft Chews, 14 t: table

Chlamydial infection, ofloxacin for, 849 Chlor-Trimeton, 239 Chlor-Trimeton Allergy 12 Hour, 239 Chlor-Trimeton Allergy 4 Hour, 239 Chlor-Trimeton Allergy 8 Hour, 239 Chlor-Tripolon, 239 chloral hydrate, 230–231 chlorambucil, 231–232 chloramphenicol, 232–234 chlordiazepoxide hydrochloride, 234–235 Chloromycetin Ophthalmic, 232 chloroquine phosphate, 235–237 chlorothiazide, 237–239 Chlorphen, 239 chlorpheniramine maleate, 239–240 chlorpromazine hydrochloride, 241–243 chlorpropamide, 243–245 chlorthalidone, 245–247 chlorzoxazone, 247–248 cholecalciferol, 1303–1304 Cholera, tetracycline for, 1142 Cholestagel, 283 Cholesterol embolism, 1358 cholestyramine, 248–249 cholinergic agonists overdose, managing, S31 Cholinergic effects, glycopyrrolate for blocking, 534 Cholinergics, 1284–1284 chondroitin, 1316 Chorea, penicillin V potassium for, 910 Choriocarcinoma methotrexate for, 732 vinblastine for, 1231 Christmas disease, factor IX for, 455 Chroma-Pak, 1304 chromic chloride, 1304 chromium, 1304

1387

Chromomycosis, ketoconazole for, 624 Chronic granulomatous disease, interferon gamma-1b for, 604 Chronic lymphocytic leukemia alemtuzumab for, 40 bendamustine for, 132 chlorambucil for, 231 immune globulin for, 580 Chronic myelocytic leukemia dasatinib for, 314 imatinib for, 573 Chronic myelogenous leukemia busulfan for, 166 hydroxyurea for, 558 chronic myelogenous leukemia nilotinib for, 824 Chronic myelomonocytic leukemia, azacitidine for, 117 Chronic obstructive pulmonary disease. See also Asthma; Bronchitis; Bronchospasm azithromycin for, 121 formoterol for, 497 ipratropium for, 605 salmeterol for, 1060 tiotropium for, 1165 Chronic renal failure, torsemide for, 1181 Cialis, 1120, P14 Cibral, 618 Cibral XL, 618 cidofovir, 249–251 Cidomycin, 523 cilostazol, 251–252 Ciloxam, 255 cimetidine, 252–253 cinacalcet hydrochloride, 253–255 Cipralex, 425 Cipro, 255, P4 Cipro I.V., 255 Cipro XR, 255 Ciprodex, 1343 Boldface: Color section

1388

ciprofloxacin hydrochloride

ciprofloxacin hydrochloride, 255–258, P4 Ciproxin, 255 Cirrhosis chlorothiazide for, 237 chlorthalidone for, 245 hydrochlorothiazide for, 547 spironolactone for, 1097 torsemide for, 1181 cisplatin, 258–259 Cisplatin therapy complications, amifostine for, 57 citalopram hydrobromide, 259–261, P4 Citracal, 170 Citracal Liquitabs, 170 Citramag, 693 Citro-Mag, 693 Citrocarbonate, 1083 Citroma, 693 citrovorum factor, 645–647 Citrucel, 735 Citrus Calcium, 170 Claforan, 208 Clarinex, 326, P5 Clarinex Reditabs, 326 Clarinex-D 12 Hour, 1343 clarithromycin, 261–263, P4 Claritin, 683 Claritin RediTabs, 683 Claritin-D, 1343 Clarityn, 683 Clarosip, 261 Clavulin, 78 Clear Nicoderm CQ, 819 Cleocin, 263 Cleocin Pediatric, 263 Cleocin Phosphate, 263 Cleocin T, 263 Clexane, 405 Climanor, 700 Climara, 429 Climaval, 430 Clindagel, 263 ClindaMax, 263 clindamycin hydrochloride, 263–265 Clindamycin infusion rates, 1353t clindamycin palmitate hydrochloride, 263–265 t: table

clindamycin phosphate, 263–265 Clindets, 263 clofarabine, 265–267 Clolar, 265 Clomid, 267 clomifene, 267–268 clomiphene citrate, 267–268 clomipramine hydrochloride, 268–270 Clonapam, 270 clonazepam, 270–271 therapeutic and toxic blood levels for, S16 clonidine, 272–273 clonidine hydrochloride, 272–273 clopidogrel bisulfate, 273–275, P4 clorazepate dipotassium, 275–276 Clostridial infection, penicillin G potassium for, 906 Clostridium difficile, 1358 clozapine, 276–278 Clozaril, 276 Co Alendronate, 41 Co Clomipramine, 268 Co Clonazepam, 270 CO Enalpril, 401 Co Fluconazole, 474 Co Fluvoxamine, 493 Co Gabapentin, 510 CO Glimepiride, 527 Co Levetiracetam, 651 Co Lovastatin, 687 Co Meloxicam, 705 Co Metformin, 723 Co Pantoprazole, 888 Co Paroxetine, 890 Co Pioglitazone, 941 CO Pravastatin, 966 Co Ramipril, 1021 Co Ranitidine, 1024 Co Sertraline, 1073 Co Simvastatin, 1078 Co Sotalol, 1095 Co Sumatriptan, 1113 Co Temazepam, 1128 Co Venlafaxine, 1226 Co Venlafaxine XR, 1226 Co-carledopa, 182

Co-Gesic, 549 Co-Lisinopril, 675 co-phenotrope, 357–359 Co-Topiramate, 1177 co-trimoxazole, 1106–1109 coagulation factor VIIa (recombinant), 278–279 Coccidioidomycosis amphotericin B for, 80 ketoconazole for, 624 codeine phosphate, 280–281 codeine sulfate, 280–281 codeine/acetaminophen, P5 coenzyme Q10, 1316–1317 Cogentin, 134 Cognex, 1117 Colace, 366 Colazal, 126 Colazide, 126 colchicine, 281–283 Cold sores, acyclovir for, 28 colesevelam hydrochloride, 283–284 Colestid, 284 colestipol hydrochloride, 284–285 Colitis, ischemic, 1360 Collagen disorders hydrocortisone for, 552 methylprednisolone for, 744 Colocort, 551 Colon cancer. See Colorectal cancer. Colonoscopy, sodium phosphates for, 1088 Colony-stimulating factors, 1289–1290 Colorectal cancer bevacizumab for, 139 capecitabine for, 176 cetuximab for, 227 fluorouracil for, 479 irinotecan for, 609 leucovorin calcium for, 646 oxaliplatin for, 863 Colorectal polyps, celecoxib for, 223 Combantrin, 1001 Combination drug products, 1342–1345 Boldface: Color section

Cushing’s syndrome

CombiPatch, 1343 Combivent, 1343 Combivir, 1343 Combunox, 1343 Commit, 819 Common cold acetaminophen for, 15 ipratropium for, 605 Compazine, 984 Compoz Nighttime Sleep Aid, 356 Compro, 984 Comtan, 407 Comtess, 407 Concerta, 740, P10 Concerta XL, 740 Condylomata acuminata. See Genital warts. Congenital hypoplastic anemia, triamcinolone for, 1197 Congest, 432 Conjunctivitis ciprofloxacin for, 256 cromolyn for, 288 erythromycin for, 424 gatifloxacin for, 516 levofloxacin for, 654 moxifloxacin for, 784 norfloxacin for, 842 ofloxacin for, 849 sulfacetamide for, 1105 Constipation bisacodyl for, 141 calcium polycarbophil for, 173 lactulose for, 630 lubiprostone for, 690 magnesium for, 694 methylcellulose for, 735 methylnaltrexone for, 738 psyllium for, 1001 senna for, 1072 sodium phosphates for, 1088 Constulose, 630 Contac Non Drowsy, 999 Contiflo XL, 1123 Contraception etonogestrel and ethinyl estradiol vaginal ring, 444 levonorgestrel for, 656 t: table

Contraception (continued) medroxyprogesterone for, 701 norelgestromin/ethinyl estradiol for, 837 Controlled substance schedules, xviii Convulex, 1216 Convulsive therapy, succinylcholine for, 1338t–1339t Copaxone, 526 Copegus, 1033 copper, 1304–1305 Coracten, 822 Cordarone, 64 Cordarone X, 64 Cordilox MR, 1228 Coreg, 194, P3 Coreg CR, 194 Corgard, 794 Coricidin, 930 Corlopam, 462 Corneal ulcers ciprofloxacin for, 256 levofloxacin for, 654 ofloxacin for, 849 Coronary artery disease adenosine for diagnosis of, 33 amlodipine and atorvastatin for, 70 perindopril for, 920 simvastatin for, 1078 Coronary heart disease atorvastatin for, 112 fluvastatin for, 491 Coronary stents, ticlopidine for, 1156 Corpus luteum insufficiency, progesterone for, 987 Correctol, 141 Correctol Stool Softener, 366 Cortef, 551 Cortenema, 551 Corticosteroid therapy chlorothiazide as adjunct to, 237 chlorthalidone as adjunct to, 245 hydrochlorothiazide as adjunct to, 547 Corticosteroids, 1286–1287

1389

Corticotropin overdose potassium acetate for, 954 potassium chloride for, 957 Cortifoam, 551 cortisone acetate, 285–287 Cortisyl, 285 Corvert, 568 Coryphen, 21 Corzide, 1343 Cosmofer, 610 Cosopt, 1343 Cosuric, 45 Cough codeine for, 280 dextromethorphan for, 337 diphenhydramine for, 356 guaifenesin for, 539 hydrocodone for, 550 Coumadin, 1238, P16 Covera-HS, 1228 Coversyl, 919 Cozaar, 685, P9 creatinine, therapeutic and toxic blood levels for, S16 Creo-Terpin, 336 Creomulsion, 336 Crestor, 1057, P14 Crinone, 986 Critical care nursing, most commonly used drugs in, 1369–1370 Crixivan, 584 Crohn’s disease adalimumab for, 30 budesonide for, 157 infliximab for, 588 Crolom, 287 cromolyn sodium, 287–289 Cryptococcal infection amphotericin B for, 81 fluconazole for, 475 flucytosine for, 476 Crysticillin-AS, 908 Cupric Sulfate, 1304–1305 Cuprofen, 566 Curosurf, 950 Cushing’s syndrome, dexamethasone for diagnosis of, 331 Boldface: Color section

1390

Cutivate

Cutivate, 488 Cyanide poisoning, amyl nitrite as antidote for, 88 cyanocobalamin, 1305 Cyanoject, 1305 cyclobenzaprine hydrochloride, 289–291 Cyclomen, 304 cyclophosphamide, 291–293 Cycloplegia, atropine for, 115 cyclosporine, 293–296 therapeutic and toxic blood levels for, S16 cyclosporine ophthalmic emulsion, 293–296 Cymbalta, 390 Cymevene, 513 cyproheptadine hydrochloride, 296–297 Cystic fibrosis acetylcysteine for, 19 tobramycin for, 1172 Cystitis hyoscyamine for, 561 ofloxacin for, 849 Cystospaz, 560 Cystrin, 871 cytarabine, 297–299 Cytomegalovirus prophylaxis ganciclovir for, 513 valganciclovir for, 1215 Cytomegalovirus retinitis cidofovir for, 249 ganciclovir for, 513 valganciclovir for, 1215 Cytomel, 669 Cytoprotective agents, 1272–1274 Cytosar, 297 Cytosar-U, 297 Cytotec, 771 Cytovene, 513

D dacarbazine, 299–300 daclizumab, 300–302 Dactarin Gold, 623 Dalacin C, 263 t: table

Dalacin C Flavored Granules, 263 Dalacin C Phosphate, 263 Dalacin T, 263 Dalmane, 486 dalteparin sodium, 302–304 danazol, 304–306 Dandrazol, 623 Dandruff scaling, ketoconazole for, 624 Danol, 304 Dantrium, 306 Dantrium Intravenous, 306 dantrolene sodium, 306–308 Daonil, 532 d’Apha E, 1312 Daraprim, 1005 darbepoetin alfa, 308–310 darifenacin hydrobromide, 310–311 darunavir ethanolate, 311–313 Darvocet N-100, 1343, P12 Darvocet-N 50, P12 Darvon, 993 Darvon-N, 993 dasatinib, 313–316 daunorubicin citrate liposome, 316–317 daunorubicin hydrochloride, 318–319 DaunoXome, 316 Daypro, 866 Daytrana, 740 DC Softgels, 366 DDAVP, 327 ddl, 346–348 1-deamino-8-D-arginine vasopressin, 327–329 Decapeptyl SR, 1208 Decongestant, phenylephrine for, 931 Deep vein thrombosis dalteparin for, 302 enoxaparin for, 405, 406 fondaparinux for, 495 streptokinase for, 1100 tinzaparin for, 1163 deferasirox, 319–321 deferoxamine, S32

Defix, 455 Delacortril, 969 Delatestryl, 1139 delavirdine mesylate, 321–323 Delestrogen, 430 Delsym, 336 Delta-D, 1303 Deltastab, 969 Demadex, 1181 Dementia. See also Alzheimer’s dementia. galantamine for, 512 tacrine for, 1117 Demerol, 712 Denazapine, 276 denileukin diftitox, 323–324 Dentinox Colic Drops, 1077 Dentomycin, 765 Depacon, 1216 Depade, S32 Depakene, 1216 Depakote, 1216, P5 Depakote ER, 1216, P5 Depakote Sprinkle, 1216 Depo-Estradiol, 429 Depo-Medrol, 744 Depo-Medrone, 744 Depo-Provera, 700 Depo-SUBQ-Provera 104, 700 Depo-Testosterone, 1139 DepoCyt, 297 DepoCyte, 297 Depression. See also Major depressive disorder. amitriptyline for, 67 amoxapine for, 73 bupropion for, 163 citalopram for, 260 desipramine for, 325 desvenlafaxine for, 329 doxepin for, 376 duloxetine for, 390 escitalopram for, 425 fluoxetine for, 481 imipramine for, 577 isocarboxazid for, 613 mirtazapine for, 769 nefazodone for, 807 nortriptyline for, 844 phenelzine for, 925 quetiapine for, 1007 Boldface: Color section

Dilatrate-SR

Depression (continued) sertraline for, 1073 tranylcypromine for, 1186 trazodone for, 1190 trimipramine for, 1207 venlafaxine for, 1226 Dermatofibrosarcoma protuberans, imatinib for, 574 Dermatologic disorders hydrocortisone for, 552 prednisolone for, 969 triamcinolone for, 1196 Dermatoses, corticosteroidresponsive fluticasone for, 489 triamcinolone for, 1196 Dermographism, cyproheptadine for, 296 Desenex Max, 1135 Desferal, S32 desipramine hydrochloride, 324–326 therapeutic and toxic blood levels for, S16 desloratadine, 326–327, P5 DesmoMelt, 327 desmopressin acetate, 327–329 Desmospray, 327 desvenlafaxine, 329–331 Detrol, 1176, P15 Detrol LA, 1176, P15 Detrusitol, 1176 Detrusitol XL, 1176 DexAlone, 336 dexamethasone, 331–333 dexamethasone sodium phosphate, 331–333 Dexasone, 331 Dexedrine Spansule, 334 DexFerrum, 610 dexmethylphenidate hydrochloride, 333–334 dextroamphetamine sulfate, 334–336 dextromethorphan hydrobromide, 336–337 dextrose, 337–339 DextroStat, 334 d4T, 1098–1100 t: table

d-glucose, 337–339 DHPG, 513–515 DiaBeta, 532 Diabetes insipidus, desmopressin for, 328 Diabetes mellitus acarbose for, 11 chlorpropamide for, 244 colesevelam for, 283 exenatide for, 451 glimepiride for, 527 glipizide for, 529 glyburide for, 532 insulin aspart for, 593 insulin for, 590 insulin glargine for, 595 losartan for, 686 metformin for, 724 miglitol for, 763 nateglinide for, 804 pioglitazone for, 941 pramlintide for, 964 repaglinide for, 1030 rosiglitazone for, 1056 sitagliptin for, 1082 Diabetic acidosis potassium acetate for, 954 potassium chloride for, 957 Diabetic gastroparesis, metoclopramide for, 747 Diabetic ketoacidosis, insulin for, 590 Diabetic nephropathy, captopril for, 178 Diabetic peripheral neuropathy, pregabalin for, 975 Diabetic Tussin Allergy Relief, 239 Diabetic Tussin EX, 539 Diabinese, 243 Diah-Limit, 681 Dialar, 339 Dialysis, effects of, on drug therapy, S18–S20 Diamode, 681 Diamox, 16 Diamox Sequels, 16 Diaquitte, 681 Diareze, 681 Diarr-Eze, 681

1391

Diarrhea. See also Traveler’s diarrhea. bismuth for, 143 calcium polycarbophil for, 173 ciprofloxacin for, 255 Clostridium difficile, 1358 diphenoxylate and atropine for, 358 loperamide for, 681, 682 nitazoxanide for, 829 octreotide for, 847 rifiximin for, 1040 vancomycin for, 1222 Diarrhea Relief, 681 Diastat, 339 Diazemuls, 339 diazepam, 339–341 therapeutic and toxic blood levels for, S16 Diazepam Intensol, 339 diazoxide, 341–343 diclofenac potassium, 343–345 diclofenac sodium, 343–345 Diclofex, 343 Diclophen, 345 dicyclomine, 345–346 dicycloverine, 345–346 didanosine, 346–348 2,3-dideoxyinosine, 346–348 Didronel, 441 Didronel PMO, 441 Dietary supplement calcium as, 172 zinc as, 1312 Diflucan, 474, P6 Digibind, S31 DigiFab, S31 Digitek, 348 digoxin, 348–351, P5 therapeutic and toxic blood levels for, S16 digoxin immune Fab, S31 Digoxin overdose, managing, S31 Dilacor-XR, 351 Dilantin, P12 Dilantin Infatabs, 934 Dilantin Kapseals, 934 Dilantin-125, 934 Dilatrate-SR, 618 Boldface: Color section

1392

Dilaudid

Dilaudid, 554 Dilaudid-5, 554 Dilaudid-HP, 554 Dilcardia, 351 Dilt-CD, 351 Dilt-XR, 351 Diltia XT, 351 diltiazem hydrochloride, 351–353, P5 therapeutic and toxic blood levels for, S16 Dilution, body water, sodium chloride for, 1085 Dilution, drug, sodium chloride for, 1084 Dilzem, 351 dimenhydrinate, 353–354 dimercaprol (BAL), S30 Dimetane, 155 Dimetapp Allergy, 155 dinoprostone, 354–355 Diocalm Ultra, 681 Diocaps, 681 Diocto, 366 Dioctyl, 366 Diogent, 523 Diomycin, 423 Diopred, 969 Diosulf, 1105 Diotame, 142 Diovan, 1219, P16 Diovan HCT, P16 Dipentum, 855 Diphen AF, 356 Diphenhist, 356 diphenhydramine hydrochloride, 356–357 diphenoxylate hydrochloride and atropine sulfate, 357–359 Diphenylan, 934 diphenylhydantoin, 934–936 diphenylhydantoin sodium, 934–936 diphenylhydantoin, therapeutic and toxic blood levels for, S16 Diphtheria penicillin G potassium for, 906 penicillin G procaine for, 908 t: table

Diphtheria, tetanus, pertussis immunization schedule, 1346t, 1347t, 1348t dipyridamole, 359–360 Disease-modifying agents, 1276–1277 Disogram, 351 disopyramide, 360–362 therapeutic and toxic blood levels for, S16 disopyramide phosphate, 360–362 Dispirin, 21 Disprol, 14 Disseminated intravascular coagulation, 1359 Distaclor, 198 Disulfiram-like reaction, 1359 Ditropan, 871 Ditropan XL, 871, P11 Diuchlor H, 547 Diuresis, mannitol for, 697 Diuretics, 1287–1288 Diuril, 237 divalproex sodium, 1216–1219, P5 Diverticulitis scopolamine for, 1067 simethicone for, 1077 Dixarit, 272 Dizziness, dimenhydrinate for, 353 DNA topoisomerase inhibitors, 1272–1274 dobutamine hydrochloride, 362–363 Dobutamine infusion rates, 1353t docetaxel, 363–365 docusate calcium, 366–367 docusate sodium, 366–367 Docusol, 366 dolasetron mesylate, 367–368 Dolophine, 725 Dom-Alendronate, 41 Dom-Amantadine, 55 Dom-Bicalutamide, 140 Dom-Bromocriptine, 154 Dom-Captopril, 177 Dom-Carbamazepine, 180

Dom-Carvedilol, 194 Dom-Cephalexin, 224 Dom-Clomipramine, 268 Dom-Clonazepam, 270 Dom-Clonidine, 272 Dom-Cyclobenzaprine, 289 Dom-Desipramine, 324 Dom-Diclofenac, 343 Dom-Divalproex, 1216 Dom-Docusate Sodium, 366 Dom-Fluconazole, 474 Dom-Fluvoxamine, 493 Dom-Furosemide, 507 Dom-Gabapentin, 510 Dom-Gemfibrozil, 520 Dom-Glyburide, 532 Dom-Indapamide, 583 Dom-Ipratropium, 605 Dom-Isoniazid, 615 Dom-Levetiracetam, 651 Dom-Levo-Carbidopa, 182 Dom-Lisinopril, 675 Dom-Loperamide, 681 Dom-Lorazepam, 684 Dom-Lovastatin, 687 Dom-Loxapine, 689 Dom-Medroxyprogesterone, 700 Dom-Meloxicam, 705 Dom-Metformin, 723 Dom-Metoprolol, 750 Dom-Minocycline, 765 Dom-Mirtazapine, 769 Dom-Nizatidine, 836 Dom-Nortriptyline, 844 Dom-Nystatin, 846 Dom-Ondansetron, 858 Dom-Oxybutinin, 871 Dom-Paroxetine, 890 Dom-Pindolol, 939 Dom-Piroxicam, 947 Dom-Pravastatin, 966 Dom-Propranolol, 995 Dom-Selegiline, 1070 Dom-Sertraline, 1073 Dom-Simvastatin, 1078 Dom-Sotalol, 1095 Dom-Sucralfate, 1104 Dom-Sumatriptan, 1113 Dom-Temazepam, 1128 Dom-Terazosin, 1134 Dom-Ticlopidine, 1156 Dom-Timolol, 1159 Dom-Topiramate, 1177 Boldface: Color section

EC-Naprosyn

Dom-Trazodone, 1189 Dom-Valproic Acid, 1216 Dom-Verapamil SR, 1228 donepezil hydrochloride, 368–369 dong quai, 1317 dopamine hydrochloride, 369–371 Dopamine infusion rates, 1354t Dopaminergics, 1274 Dopram, 373 Doribax, 371 doripenem monohydrate, 371–372 dornase alpha, 372–373 Doryx, 383 D.O.S. Softgels, 366 Dosages, calculating, S6 Doxadura, 375 doxapram hydrochloride, 373–375 doxazosin mesylate, 375–376 doxepin hydrochloride, 376–378 doxercalciferol, 1306 Doxidan, 141 Doxil, 381 Doxine, 1309 doxorubicin hydrochloride, 378–381 doxorubicin hydrochloride, liposomal, 381–383 Doxy 100, 383 doxycycline, 383–385 doxycycline calcium, 383–385 doxycycline hyclate, 383–385 doxycycline monohydrate, 383–385 Doxytab, 383 Dozic, 541 Dramamine, 353 Dramamine Less Drowsy Formula, 699 Dramanate, 353 Drixoral Nasal Decongestant, 999 Drixoral Non-Drowsy Formula, 999 Drogenil, 487 Dromadol SR, 1182 t: table

Dromadol XL, 1182 dronabinol, 386–387 droperidol, 387–389 drotrecogin alfa (activated), 389–390 Droxia, 557 Drug administration five rights of, xiv general guidelines for, xiii–xv safe, S1–S32 Drug classes, 1255–1302 Drug compatibilities, S2–S5 Drug conversion and calculations, S6 Drug desensitization, asparaginase for, 107 Drug names that look or sound alike, S7–S9 Drug therapy, effects of dialysis on, S18–S20 Drugs 200 most commonly prescribed, 1371–1373 hazardous, guidelines for handling, preparing, and administering, S27–S299 high-alert, xix D-S-S, 366 DTIC, 299 DTIC-Dome, 299 Duetact, 1343 DulcoEase, 366 Dulcolax, 141 Dulcolax Milk of Magnesia, 693 Dull-C, 1303 duloxetine hydrochloride, 390–393 Duodenal ulcer amoxicillin for, 76 cimetidine for, 252 esomeprazole for, 428 famotidine for, 458 lansoprazole for, 637 nizatidine for, 836 omeprazole for, 857 rabeprazole for, 1017

1393

Duodenal ulcer (continued) ranitidine for, 1024 sucralfate for, 1104 Duodenography, hyoscyamine for, 561 Duphalac, 630 Duraclon, 272 Duragesic, 464 Duralith, 677 Duramorph, 780 Durogesic, 464 dutasteride, 393–394 Duvoid, 137 Dyazide, 1343 Dymotil, 357 Dynacin, 765 DynaCirc CR, 620 Dynamin, 618 Dynamin XL, 618 Dyrenium, 1199 Dysbetalipoproteinemia amlodipine and atorvastatin for, 71 atorvastatin for, 112 pravastatin for, 966 Dysentery, scopolamine for, 1067 Dyskinesia, diphenhydramine for, 356 Dyslipidemia, mixed atorvastatin for, 112 fenofibrate for, 461 pravastatin for, 966 rosuvastatin for, 1058 Dysmenorrhea celecoxib for, 223 diclofenac for, 343 ibuprofen for, 567 naproxen for, 800, 801 Dyspamet, 252 Dyspepsia, simethicone for, 1077 Dystonic reactions, benztropine for, 134 Dytac, 1199

E Ear infection, amoxicillin for, 76 Easprin, 21 Easyhaler Budesonide, 157 Ebixa, 709 EC-Naprosyn, 800 Boldface: Color section

1394

Eccoxolac

Eccoxolac, 442 echinacea, 1317–1318 Ecotrin, 21 Edema acetazolamide for, 17 bumetanide for, 159 chlorothiazide for, 237 chlorthalidone for, 245 dexamethasone for, 331 furosemide for, 508 hydrochlorothiazide for, 547 indapamide for, 583 methylprednisolone for, 744 metolazone for, 748 spironolactone for, 1097 triamterene for, 1199 edetate disodium, S31 E.E.S., 423 efavirenz, 394–395 Efexor, 1226 Effexor, 1226, P16 Effexor XR, 1226, P16 Efudex, 479 E-Glades, 423 Elantan, 618 Elantan LA, 618 Eldepryl, 1070 Elderly potentially inappropriate drugs for, 1364–1366 Electrolyte replacement, sodium chloride for, 1085 Elestrin, 429 eletriptan hydrobromide, 396–397 Elidel, 936 Eligard, 647 Elitek, 1029 ElixiSure Cough, 336 Elixophyllin, 1146 Ellence, 412 Elleste, 429 Elleste-Solo, 429 Eloxitan, 862 Elspar, 106 Eltroxin, 660 Elyzol, 752 Embolus, cholesterol, 1358 Emcor, 144 Emcor LS, 144 Emend, 99 t: table

Emergency care nursing, most commonly used drugs in, 1369 EMLA Cream, 1343 Emphysema, acetylcysteine for, 19 Emsam, 1070 Emselex, 310 emtricitabine, 397–399 emtricitabine and tenofovir disoproxil fumarate, 399–401 Emtriva, 397 Enablex, 310 enalapril maleate, 401–403 enalaprilat, 401–403 Enbrel, 437 Encephalitis, acyclovir for, 28 Encephalopathy, 1359 Endocarditis cefazolin for, 202 flucytosine for, 476 imipenem and cilastatin for, 575 penicillin G potassium for, 906 penicillin G procaine for, 908 Endocarditis prophylaxis amoxicillin for, 76 ampicillin for, 84, 85 gentamicin for, 524 vancomycin for, 1221 Endocervical infection, tetracycline for, 1142 Endocet, 1343 Endocrine disorders methylprednisolone for, 744 prednisolone for, 969 Endometrial cancer medroxyprogesterone for, 701 megestrol for, 704 Endometrial changes, medroxyprogesterone to prevent, 701 Endometrial hyperplasia, progesterone to prevent, 987 Endometrin, 986

Endometriosis danazol for, 305 goserelin for, 536 leuprolide for, 648 medroxyprogesterone for, 701 nafarelin for, 796 norethindrone for, 841 Endoscopy diazepam for, 339 hyoscyamine for, 561 Endotracheal intubation atracurium for, 1330t–1331t pancuronium for, 1334t–1335t rocuronium for, 1338t–1339t succinylcholine for, 1338t–1339t vecuronium for, 1340t–1341t Endoxana, 291 Endrate, S31 enfuvirtide, 403–405 enoxaparin sodium, 405–407 Enpirin, 21 entacapone, 407–408 entecavir, 408–409 Enterobiasis mebendazole for, 698 pyrantel for, 1002 Enterocolitis, vancomycin for, 1222 Enthanate, 1139 Entocalm, 681 Entocort CR, 157 Entocort EC, 157 Entocort Enema, 157 Entrocel, 735 Entrophen, 21 Enulose, 630 Enuresis imipramine for, 577 Eosinophilic pneumonitis, 1359 Epanutin, 934 Epi-E-Z Pen, 409 Epilem, 1216 Epilem Chrono, 1216 Epilepsy. See Seizures. Epileptiform seizures, 1359 Epimaz, 180 Boldface: Color section

Evoltra

epinephrine, 409–411 for cholinergic overdose, S31 epinephrine bitartrate, 409–411 epinephrine hydrochloride, 409–411 Epinephrine infusion rates, 1354t EpiPen, 409 EpiPen Jr., 409 Epipodophyllotoxins, 1272–1274 epirubicin hydrochloride, 412–413 Episenta, 1216 Epitol, 180 Epival CR, 1216 Epival ECT, 1216 Epivir, 631 Epivir-HBV, 631 eplerenone, 414–415 epoetin alfa, 415–417 Epogen, 415 Eposin, 446 Eprex, 415 eprosartan mesylate, 417–418 Epsom Salts, 694 eptadone, 725–728 eptifibatide, 418–419 Epzicom, 4, 1343 Equalactin, 173 Equalizer Gas Relief, 1077 Equasym, 740 Equasym XL, 740 Equetro, 180 Eraxis, 93 Erbitux, 227 Erectile dysfunction sildenafil for, 1075 tadalafil for, 1120 vardenafil for, 1223 Erectile dysfunction agents, 1288–1289 Ergotamine derivatives, 1271–1272 erlotinib, 419–421 Erosive esophagitis esomeprazole for, 428 lansoprazole for, 637 nizatidine for, 836 omeprazole for, 857 pantoprazole for, 888 ranitidine for, 1024 t: table

ertapenem, 421–422 Ery-Tab, 423 Erybid, 423 Erycette, 423 Eryderm, 423 Erygel, 423 Erymax, 423 EryPed, 423 Erysipeloid infection penicillin G potassium for, 906 penicillin G procaine for, 908 penicillin V potassium for, 910 Erythema multiforme, 1359 Erythema nodosum leprosum, thalidomide for, 1145 Erythroblastopenia, triamcinolone for, 1197 Erythrocin, 423 Erythrocin Stearate, 423 Erythromid, 423 erythromycin, 423–425 erythromycin (topical), 423–425 erythromycin ethylsuccinate, 423–425 erythromycin lactobionate, 423–425 erythromycin stearate, 423–425 escitalopram oxalate, 425–426, P5 esmolol hydrochloride, 427–428 E-Solve 2, 423 esomeprazole magnesium, 428–429, P6 Esophagitis, nizatidine for, 836. See also Erosive esophagitis. Essential tremor, propranolol for, 996 Estrace, 429 Estraderm, 429 estradiol, 429–431 estradiol acetate, 429–431 estradiol cypionate, 429–431 estradiol hemihydrate, 429–431 estradiol transdermal system, 429–431

1395

estradiol valerate, 430–431 Estradot, 429 Estrasorb, 429 Estring, 429 Estrogel, 429 Estrogen therapy chlorothiazide as adjunct to, 237 chlorthalidone as adjunct to, 245 hydrochlorothiazide as adjunct to, 547 Estrogens, 1297–1298 estrogens, conjugated, 432–434, P6 estrogens, esterified, 434–436 eszopiclone, 436–437 etanercept, 437–439 ETH-Oxydose, 872 ethambutol hydrochloride, 439–440 ethosuximide, therapeutic and toxic blood levels for, S16 ethylene glycol overdose, managing, S31 ethylenediamine, 62–64 Ethyol, 57 Etibi, 439 etidronate disodium, 441–442 etodolac, 442–444 etomidate, 1330t–1331t etonogestrel and ethinyl estradiol vaginal ring, 444–445 Etopophos, 446 etoposide, 446–447 etoposide phosphate, 446–447 etravirine, 447–449 Eucardic, 194 Eudemine, 341 Euflex, 487 Euglucon, 532 Euro-Lac, 630 Euro-Lithium, 677 Eustachian tube congestion, pseudoephedrine for, 999 Euthyrox, 660 evening primrose, 1318 Evista, 1018, P13 Evoltra, 265 Boldface: Color section

1396

Evorel

Evorel, 429 Evotrox, 660 Evra, 837 Ex-Lax Gentle, 1072 Exelon, 1052 exemestane, 449–450 exenatide acetate, 450–452 Exforge, 1343 Exjade, 319 Exocin, 849 Expectorant, potassium iodide as, 961 Extina, 623 Extra Strength Motrin IB, 566 Extrapyramidal reactions amantadine for, 56 benztropine for, 134 trihexyphenidyl for, 1204 Extravasation, preventing and treating, S13 Eye disorders, methylprednisolone for, 744 Eye inflammation, prednisolone for, 969 Eye irritation, phenylephrine for, 931 EZ-Char, 26 ezetimibe, 452–453, P6 ezetimibe/simvastatin, 453–454 Ezetrol, 452

F Fabrazyme, 34 Fabry disease, agalsidase beta for, 34 Facial skin roughness, tretinoin for, 1193 Factive, 521 factor IX (human), 455–456 factor IX (recombinant), 455–456 factor IX complex, 455–456 Factor IX deficiency, factor IX for, 455 Factor VIII, 94 Factor VIII deficiency, antihemophilic factor for, 95 famciclovir, 456–457 t: table

famotidine, 457–459 Famvir, 456 Fanconi syndrome, 1359 Fansidar, 1343 Fasigyn, 1161 Faslodex, 506 Fasturtek, 1029 Faverin, 493 Fazaclo ODT, 276 Febrile neutropenia cefepime for, 205 ciprofloxacin for, 255 Fectrim, 1106 Feldene, 947 felodipine, 459–460 Felotens, 459 Femara, 644 Fematrix, 429 Femhrt, 1343 Femilax, 141 Femogex, 430 Femring, 429 Femseven, 429 Femtrace, 429 Fenactol, 343 fenofibrate, 460–462, P6 Fenogal, 460 fenoldopam mesylate, 462–463 Fenox, 930 fentanyl citrate, 464–468, 1332t–1333t Fentanyl Oralet, 464, 1332t–1333t fentanyl transdermal system, 464–468 fentanyl transmucosal, 464–468, 1332t–1333t Fentazin, 921 Fentora, 464 Fever acetaminophen for, 15 acetylsalicylic acid for, 21 ibuprofen for, 567 tetracycline for, 1142 Feverall, 14 feverfew, 1318–1319 fexofenadine hydrochloride, 468–469, P6 fexofenadine hydrochloride and pseudoephedrine hydrochloride, P6

Fiber-Lax, 173 Fiberall, 1000 FiberCon, 173 Fibrazyme, 34 Fibrelief, 1000 Fibric acid derivatives, 1267–1268 Fibro-Lax, 1000 Fibro-XL, 1000 Fibrocystic breast disease, danazol for, 305 Fibromyalgia pregabalin for, 975 Fibromyalgia, duloxetine for, 390 Filair, 129 filgrastim, 470–471 Filnarine, 780 Filnarine SR, 780 finasteride, 471–472 Fioricet, 1343 Fiorinal, 1343 fish oils, 1319 Five rights of drug administration, xiv Flagyl, 752 Flagyl ER, 752 Flagyl IV, 752 Flagystatin, 752 Flatulence, activated charcoal for, 26 flaxseed oil, 1319–1320 Flebogamma, 579 flecainide acetate, 472–474 therapeutic and toxic blood levels for, S16 Fleet Enema, 1087 Fleet Pediatric Enema, 1087 Fleet Phospho-Soda, 1087 Fleet Stimulant Laxative, 141 Fletcher’s, 1072 Flexeril, 289 Flexin, 586 Flixonase, 488 Flixotide, 488 Flomax, 1123, P14 Flomax CR, 1123 Flomaxtra, 1123 Flonase, 488 Florazole ER, 752 Florical, 170 Boldface: Color section

Gastrointestinal bleeding

Flovent, 488 Flovent HFA, 488 Floxin, 849 fluconazole, 474–476, P6 therapeutic and toxic blood levels for, S16 flucytosine, 476–477 Fluid and electrolyte replacement, sodium chloride for, 1084, 1085 Flumadine, 1042 flumazenil, S30 flunisolide, 478–479 Fluoroplex, 479 Fluoroquinolones, 1269–1270 fluorouracil, 479–481 5-fluorouracil, 479–481 fluoxetine hydrochloride, 481–483, P7 therapeutic and toxic blood levels for, S16 fluphenazine decanoate, 483–485 fluphenazine hydrochloride, 483–485 Fluphenazine Omega, 483 flurazepam hydrochloride, 486–487 Flushing, octreotide for, 847 flutamide, 487–488 fluticasone furoate, 488–491 fluticasone propionate, 488–491 fluvastatin sodium, 491–493 fluvoxamine maleate, 493–495 Focalin, 333 Focalin XR, 333 folic acid, 1306–1307 Folic acid antagonist overdose, leucovorin calcium for, 646 Folic acid deficiency, folic acid for, 1306 folinic acid, 645–647 Folvite, 1306 fomepizole, S31 t: table

fondaparinux sodium, 495–496 Foradil, 497 Foradil Aerolizer, 497 formoterol fumarate, 497–498 Formulex, 345 Forsteo, 1138 Fortamet, 723 Fortaz, 215 Forteo, 1138 Fortical, 169 Fortipine, 822 Fortral, 913 Fortum, 215 Fosamax, 41, P1 Fosamax Plus D, 1343 fosamprenavir calcium, 498–501 fosinopril sodium, 501–503, P7 fosphenytoin sodium, 503–505 Fosrenol, 639 Fragmin, 302 Frova, 505 frovatriptan succinate, 505–506 Frusol, 507 5-FU, 479–481 fulvestrant, 506–507 Fungal infection amphotericin B for, 82 caspofungin for, 197 flucytosine for, 476 voriconazole for, 1236 Fungilin, 80 Fungizone Intravenous, 80 Furadantin, 830 furosemide, 507–510, P7 Fusospirochetal infection penicillin G potassium for, 906 penicillin G procaine for, 908 penicillin V potassium for, 910 Fuzeon, 403 Fybogel, 1000

G gabapentin, 510–511, P7 Gabarone, 510 Gabitril Filmtabs, 1153

1397

galantamine hydrobromide, 512–513 Galenmet, 252 Galpamol, 14 Galsud, 999 Gamimune N 5% S/D, 579 Gammagard S/D 0.5 g, 579 Gammar-P IV, 579 GammaSTAN S/D, 579 Gamunex, 579 ganciclovir, 513–515 ganirelix acetate, 515–516 Gantrisin Pediatric Suspension, 1111 Garamycin, 523 garlic, 1320 Gas, excessive, simethicone for, 1077 Gas-X, 1077 Gas-X Extra Strength, 1077 GasAid, 1077 Gastric cancer docetaxel for, 364 doxorubicin for, 379 fluorouracil for, 479 mitomycin for, 772 Gastric ulcer cimetidine for, 252 esomeprazole for, 428 famotidine for, 458 lansoprazole for, 637 misoprostol for, 771 nizatidine for, 836 omeprazole for, 857 ranitidine for, 1024 Gastrobid, 746 Gastrocrom, 287 Gastroesophageal reflux disease cimetidine for, 252 esomeprazole for, 428 famotidine for, 458 lansoprazole for, 637 metoclopramide for, 747 nizatidine for, 836 omeprazole for, 857 pantoprazole for, 888 rabeprazole for, 1017 ranitidine for, 1024 Gastrointestinal bleeding, cimetidine for prevention of, 252 Boldface: Color section

1398

Gastrointestinal disorders

Gastrointestinal disorders hyoscyamine for, 561 methylprednisolone for, 744 prednisolone for, 969 Gastrointestinal infection ampicillin for, 84 nystatin for, 846 Gastrointestinal stromal tumor imatinib for, 574 sunitinib for, 1115 Gastromax, 746 gatifloxacin, 516–517 Gavilast, 1024 gefitinib, 517–518 gemcitabine hydrochloride, 518–520 gemfibrozil, 520–521 gemifloxacin mesylate, 521–523 Gemzar, 518 Gen Naproxen, 800 Gen-Alendronate, 41 Gen-Amantadine, 55 Gen-Azathioprine, 118 Gen-Baclofen, 124 Gen-Bicalutamide, 140 Gen-Captopril, 177 Gen-Carbamazepine, 180 Gen-Clomipramine, 268 Gen-Clonazepam, 270 Gen-Clozapine, 276 Gen-Diltiazem, 351 Gen-Divalproex, 1216 Gen-Enalpril, 401 Gen-Etodolac, 442 Gen-Famotidine, 457 Gen-Fluconazole, 474 Gen-Fosinopril, 501 Gen-Gabapentin, 510 Gen-Gemfibrozil, 520 Gen-Glybe, 532 Gen-Hydroxychloroquine, 556 Gen-Indapamide, 583 Gen-Ipratropium, 605 Gen-Lac, 630 Gen-Lamotrigine, 633 Gen-Lisinopril, 675 Gen-Lovastatin, 687 Gen-Medroxy, 700 Gen-Meloxicam, 705 Gen-Metformin, 723 Gen-Metoprolol, 750 t: table

Gen-Minocycline, 765 Gen-Minoxidil, 767 Gen-Mirtazapine, 769 Gen-Nabumetone, 793 Gen-Naproxen EC, 800 Gen-Nifedical, 822 Gen-Nizatidine, 836 Gen-Nortriptyline, 844 Gen-Ondansetron, 858 Gen-Oxybutinin, 871 Gen-Pantoprazole, 888 Gen-Paroxetine, 890 Gen-Pindolol, 939 Gen-Pioglitazone, 941 Gen-Piroxicam, 947 Gen-Pravastatin, 966 Gen-Propafenone, 990 Gen-Salbutamol, 35 Gen-Selegiline, 1070 Gen-Sertraline, 1073 Gen-Simvastatin, 1078 Gen-Sotalol, 1095 Gen-Sumatriptan, 1113 Gen-Tamoxifen, 1122 Gen-Temazepam, 1128 Gen-Ticlopidine, 1156 Gen-Timolol, 1159 Gen-Tizanidine, 1170 Gen-Topiramate, 1177 Gen-Trazodone, 1189 Gen-Triazolam, 1200 Gen-Valproic-Cap, 1216 Gen-Venlafaxine XR, 1226 Gen-Verapamil, 1228 Gen-Verapamil SR, 1228 Gen-Warfarin, 1238 Genahist, 356 Genapap, 14 Genaphed, 999 Genasoft Softgels, 366 Genasyme, 1077 Genatuss, 539 Genebs, 14 Generalized anxiety disorder escitalopram for, 426 paroxetine for, 891 venlafaxine for, 1226 Generlac, 630 Genfiber, 1000 Gengraf, 293 Genital herpes acyclovir for, 27, 28 famciclovir for, 456 valacyclovir for, 1214

Genital infection, cefazolin for, 202 Genital ulcer, azithromycin for, 121 Genital warts interferon alfa-2b for, 599 interferon alfa-n3 for, 597 Genitourinary infection amoxicillin for, 76 cephalexin for, 225 ertapenem for, 421 Genotropin, 1091 Gentacidin, 523 Gentak, 523 gentamicin sulfate, 523–525 therapeutic and toxic blood levels for, S16 Genticin, 523 Gentlax, 141 Geodon, 1245 Giardiasis, tinidazole for, 1162 ginger, 1320–1321 ginkgo, 1321 ginseng, 1321–1322 Glabellar lines, botulinum toxin for, 152 glatiramer acetate, 526–527 Glaucoma acetazolamide for, 17 carteolol for, 192 epinephrine for, 410 phenylephrine for, 931 timolol for, 1160 Gleevec, 573 Gliadel Wafer, 190 glibenclamide, 532–533 Glibenese, 529 glimepiride, 527–528, P7 glipizide, 529–530, P7 Glivec, 573 Glomerulonephritis, penicillin G benzathine as prophylaxis for, 904 GlucaGen, 530 glucagon, 530–531 Glucobay, 11 Gluconorm, 1030 Glucophage, 723, P10 Boldface: Color section

Heart failure

Glucophage XR, 723, P10 glucosamine, 1322 glucose, therapeutic and toxic blood levels for, S16 Glucotrol, 529, P7 Glucotrol XL, 529, P7 Glucovance, 1343, P8 Glumetza, 723 glutethimide, therapeutic and toxic blood levels for, S16 Glutose, 337 glyburide, 532–533 glyburide and metformin hydrochloride, P8 glyceryl guaiacolate, 539–540 Glycon, 723 glycopyrrolate, 534–535 glycopyrronium, 534–535 Glynase PresTab, 532 Glyset, 763 GM-CSF, 1065–1067 Goiter levothyroxine for, 660 liothyronine for, 669 goldenseal, 1322 Gonapeptyl Depot, 1208 Gonococcal infection ampicillin for, 84 cefpodoxime for, 212 penicillin G potassium for, 906 Gonorrhea amoxicillin for, 76 cefixime for, 207 cefotaxime for, 209 cefpodoxime for, 212 ceftazidime for, 216 ceftriaxone for, 219 cefuroxime for, 221 ciprofloxacin for, 255 doxycycline for, 384 minocycline for, 765 norfloxacin for, 842 ofloxacin for, 849 penicillin G procaine for, 908 piperacillin for, 942 probenecid for, 979 tetracycline for, 1142 Goptin, 1184 goserelin acetate, 535–537 t: table

Gout allopurinol for, 45, 46 naproxen for, 801 Gouty arthritis colchicine for, 282 indomethacin for, 586 GPI-Lactulose, 630 Graft-versus-host disease, immune globulin for, 580 granisetron hydrochloride, 537–538 Granisol, 537 Granulocytopenia, 1359 Granuloma inguinale, tetracycline for, 1142 grapeseed, 1323 Gravol, 353 green tea, 1323 Growth failure, somatropin, recombinant for, 1091, 1092 Growth hormone deficiency, somatropin, recombinant for, 1091, 1092 guaifenesin, 539–540 guanfacine, 540–541 Gummas, penicillin G benzathine for, 904 Gynecologic infection ampicillin and sulbactam for, 87 cefoxitin for, 211 ceftazidime for, 216 cefuroxime for, 221 imipenem and cilastatin for, 575 ticarcillin and clavulanate for, 1154 Gynodiol, 429

H Haemophilus influenza type B immunization schedule, 1347t Hair loss finasteride for, 472 minoxidil for, 767 Hair transplantation, minoxidil as adjunct to, 767

1399

Hairy cell leukemia interferon alfa-2b for, 598 pentostatin for, 917 Halcion, 1200 Haldol, 541 Haldol Decanoate 50, 541 Haldol LA Omega, 541 Half Beta-Prograne, 995 Half Inderal LA, 995 Half Securon, 1228 Half Sinemet, 182 Halfprin, 21 haloperidol, 541–543 therapeutic and toxic blood levels for, S16 haloperidol decanoate, 541–543 haloperidol lactate, 541–543 Haverhill fever, penicillin G potassium for, 906 hawthorn, 1323–1324 Hayfever Relief, 129 Hazardous drugs, 1367–1368 guidelines for handling, preparing, and administering, S27–S29 Head and neck cancer amifostine for, 57 bleomycin for, 147 cetuximab for, 228 docetaxel for, 364 hydroxyurea for, 558 Headache. See also Migraine. acetaminophen for, 15 propranolol for, 996 timolol for, 1160 Headache Tablet, 21 Heart block, 1359 hyoscyamine for, 561 isoproterenol for, 617 Heart failure acetazolamide for, 17 captopril for, 178 carvedilol for, 194 chlorothiazide for, 237 chlorthalidone for, 245 digoxin for, 348 dobutamine for, 362 dopamine for, 370 enalapril for, 402 Boldface: Color section

1400

Heart failure

Heart failure (continued) eplerenone for, 414 fosinopril for, 502 hydrochlorothiazide for, 547 inamrinone for, 582 indapamide for, 583 lisinopril for, 675 metolazone for, 748 metoprolol for, 751 milrinone for, 764 nesiritide for, 815 nitroglycerin for, 832 quinapril for, 1009 ramipril for, 1022 spironolactone for, 1097 torsemide for, 1181 trandolapril for, 1184 valsartan for, 1220 Heart transplant rejection, preventing cyclosporine for, 293 muromonab-CD3 for, 787 mycophenolate for, 789 tacrolimus for, 1119 Heart transplantation, valganciclovir for, 1215 Heartburn. See also Acid indigestion. bismuth for, 143 cimetidine for, 252 famotidine for, 458 omeprazole for, 857 Heartburn Relief, 857 Heat cramps, sodium chloride for, 1085 Hectorol, 1306 Hedex, 566 Helicobacter pylori infection clarithromycin for, 262 rabeprazole for, 1017 tetracycline for, 1142 Helidac, 1343 Hematologic disorders betamethasone for, 135 cortisone for, 286 hydrocortisone for, 552 methylprednisolone for, 744 prednisolone for, 969 Hematopoietic agents, 1289–1290 t: table

Hemodialysis, sodium chloride for, 1084 Hemodynamic imbalance, dopamine for, 370 Hemofil M, 94 Hemophilia antihemophilic factor for, 95 coagulation factor VIIa (recombinant) for, 279 desmopressin for, 328 factor IX for, 455 Hemorrhage, antihemophilic factor for, 95 Hemorrhagic cystitis, mesna for, 719 Hemorrhagic disease of newborn, phytonadione for, 1309 Hep-Lock, 543 Hep-Lock U/P, 543 Hepalean, 543 heparin cofactor 1, 96–97 Heparin Leo, 543 Heparin overdose, managing, S31 heparin sodium, 543–546 Hepatic encephalopathy, neomycin for, 812 Hepatitis A immunization schedule, 1346t, 1347t, 1348t Hepatitis A virus infection, immune globulin for, 579 Hepatitis B immunization schedule, 1346t, 1347t, 1348t Hepatitis B virus infection adefovir for, 31 entecavir for, 408 interferon alfa-2b for, 598 lamivudine for, 632 Hepatitis C virus infection interferon alfa-2b for, 598 interferon alfacon-1 for, 601 peginterferon alfa-2a for, 897 peginterferon alfa-2b for, 899 ribavirin for, 1033

Hepatocellular carcinoma, sorafenib for, 1093 Hepatomegaly, 1359 Hepatotoxicity, 1359 Hepsal, 543 Hepsera, 31 Heptovir, 631 Herbs and supplements, 1314–1328 Herceptin, 1187 Hereditary angioedema, danazol for, 305 Herpes labialis acyclovir for, 28 famciclovir for, 456 valacyclovir for, 1214 Herpes simplex virus infection acyclovir for, 28 famciclovir for, 456 Herpes zoster immunization schedule, 1346t Herpes zoster infection acyclovir for, 27 famciclovir for, 456 valacyclovir for, 1214 Hexit Lotion, 665 Hexit Shampoo 1, 665 Hi-Cor, 551 Hiccups, chlorpromazine for, 241 High-alert drugs, xix High-altitude sickness, acetazolamide for, 17 Hipfix, 455 Histac, 1024 Histamine-receptor antagonists, 1278–1279 Histantil, 988 Histergan, 356 Histiocytosis X, vinblastine for, 1231 Histoplasmosis amphotericin B for, 80 itraconazole for, 621 ketoconazole for, 624 Hives, desloratadine for, 326 HMG-CoA reductase inhibitors, 1267–1268 Hodgkin’s disease bleomycin for, 147 carmustine for, 190 Boldface: Color section

Hypercalciuria

Hodgkin’s disease (continued) chlorambucil for, 231 cyclophosphamide for, 291 dacarbazine for, 299 doxorubicin for, 379 lomustine for, 680 procarbazine for, 982 vinblastine for, 1231 Hold DM, 336 Home care nursing, most commonly used drugs in, 1369 Hookworm infestation, mebendazole for, 698 5-HT3 receptor antagonists, 1264–1265 Humalog, 589 Humalog Mix 50/50, 590 Humalog Mix 75/25 Z, 590 Humalog Pen, 589 Human erythropoietins, 1289–1290 Human immunodeficiency virus infection abacavir and lamivudine for, 5 abacavir for, 3 cidofovir for, 249 darunavir for, 311 delavirdine for, 321 didanosine for, 347 efavirenz for, 394 emtricitabine and tenofovir for, 399 emtricitabine for, 397 enfuvirtide for, 403 etravirine for, 447 fosamprenavir for, 498 ganciclovir for, 513 immune globulin for, 581 indinavir for, 584 lamivudine for, 632 nelfinavir for, 810 nevirapine for, 816 raltegravir for, 1019 rifabutin for, 1035 ritonavir for, 1048 saquinavir for, 1063 stavudine for, 1099 tenofovir for, 1132 t: table

Human immunodeficiency virus infection (continued) tipranavir for, 1167 zidovudine for, 1244 Human papillomavirus immunization schedule, 1346t, 1348t Humatrope, 1091 Humira, 29 Humulin 50/50, 590 Humulin 50/50 (50% isophane insulin and 50% insulin injection), 590 Humulin 70/30, 590, 1343 Humulin 70/30 PenFill, 590 Humulin N, 590 Humulin R, 589 Humulin-R Regular U-500 (concentrate), 589 Hycamtin, 1179 Hycodan, 549, 1344 Hycort, 551 Hydatidiform mole, methotrexate for, 732 hydralazine hydrochloride, 546–547 Hydramine, 356 Hydration, sodium chloride for, 1085 Hydrea, 557 Hydro-Crysti-12, 1305 Hydro-Par, 547 Hydrocet, 549, 1344 hydrochlorothiazide, 547–549 Hydrocil Instant, 1000 hydrocodone bitartrate and acetaminophen, 549–551, P8 hydrocodone bitartrate and aspirin, 549–551 hydrocodone bitartrate and homatropine methylbromide, 549–551 hydrocodone bitartrate and ibuprofen, 549–551 hydrocortisone, 551–554 hydrocortisone acetate, 551–554

1401

hydrocortisone butyrate, 551–554 hydrocortisone sodium succinate, 551–554 hydrocortisone valerate, 551–554 Hydrocotisab, 551 Hydromorph Contin, 554 Hydromorph-IR, 554 hydromorphone hydrochloride, 554–556 therapeutic and toxic blood levels for, S16 hydroxocobalamin crystalline, 1305 hydroxychloroquine sulfate, 556–557 hydroxyurea, 557–559 hydroxyzine hydrochloride, 559–560 hydroxyzine pamoate, 559–560 Hygroton, 245 hyoscine, 1067–1068 hyoscine hydrobromide, 1067–1068 hyoscyamine, 560–562 hyoscyamine sulfate, 560–562 Hyospaz, 560 Hyperacidity, aluminum hydroxide for, 54 Hyperactivity, haloperidol for, 542 Hyperadrenocorticism potassium acetate for, 954 potassium chloride for, 957 Hypercalcemia calcitonin for, 169 cinacalcet for, 254 etidronate for, 441 hydrocortisone for, 552 pamidronate for, 887 plicamycin for, 949 zoledronic acid for, 1247 Hypercalcemic emergency, managing, S31 Hypercalciuria, plicamycin for, 949 Boldface: Color section

1402

Hypercholesterolemia

Hypercholesterolemia amlodipine and atorvastatin for, 71 atorvastatin for, 112 cholestyramine for, 248 colesevelam for, 283 colestipol for, 284 ezetimibe for, 452 ezetimibe/simvastatin for, 453 fenofibrate for, 461 fluvastatin for, 491 lovastatin for, 687 pravastatin for, 966 rosuvastatin for, 1058 simvastatin for, 1078 Hypereosinophilic syndrome/chronic eosinophilic leukemia, imatinib for, 573 Hyperkalemia, 1359 sodium polystyrene sulfonate for, 1089 Hyperlipidemia cholestyramine for, 248 ezetimibe/simvastatin for, 453 gemfibrozil for, 520 niacin for, 1307 simvastatin for, 1078 Hyperosmolar diabetes, sodium chloride for, 1085 Hyperparathyroidism cinacalcet for, 254 doxercalciferol for, 1306 paricalcitol for, 1308 Hyperphosphatemia, calcium for, 171 Hyperpigmentation, tretinoin for, 1193 Hyperprolactinemia, bromocriptine for, 154 Hypersecretory conditions atropine for, 115 cimetidine for, 252 esomeprazole for, 428 famotidine for, 458 hyoscyamine for, 561 lansoprazole for, 637 omeprazole for, 857 pantoprazole for, 888 t: table

Hypersecretory conditions (continued) rabeprazole for, 1017 ranitidine for, 1024 Hypersensitivity reaction brompheniramine for, 156 epinephrine for, 410 promethazine for, 988 Hyperstat IV, 341 Hypertension acebutolol for, 12 aliskiren for, 43 amlodipine and atorvastatin for, 70 amlodipine for, 69 atenolol for, 108 benazepril for, 130 bisoprolol for, 144 bosentan for, 151 candesartan for, 175 captopril for, 178 carteolol for, 192 carvedilol for, 194 chlorothiazide for, 238 chlorthalidone for, 245 clonidine for, 272 diltiazem for, 351 doxazosin for, 375 enalapril for, 401 eplerenone for, 414 eprosartan for, 417 esmolol for, 427 felodipine for, 459 fenoldopam for, 462 fosinopril for, 502 furosemide for, 508 guanfacine for, 540 hydralazine for, 546 hydrochlorothiazide for, 547 irbesartan for, 607 isradipine for, 620 labetalol for, 628 lisinopril for, 675 losartan for, 686 methyldopa for, 736 metolazone for, 748 metoprolol for, 750 minoxidil for, 767 moexipril for, 777 nadolol for, 795 nebivolol for, 805 nicardipine for, 818 nifedipine for, 822

Hypertension (continued) nisoldipine for, 828 nitroglycerin for, 832 olmesartan for, 854 perindopril for, 920 phentolamine, 929 pindolol for, 939 prazosin for, 968 propranolol for, 996 quinapril for, 1009 ramipril for, 1022 spironolactone for, 1097 telmisartan for, 1127 terazosin for, 1134 timolol for, 1160 torsemide for, 1181 trandolapril for, 1184 valsartan for, 1220 verapamil for, 1228 Hypertensive crisis, 1360 diazoxide for, 341 labetalol for, 628 nitroprusside for, 835 Hyperthyroidism methimazole for, 728 propylthiouracil for, 998 sodium iodide 131I for, 1086 Hypertonia, 1360 Hypertriglyceridemia amlodipine and atorvastatin for, 71 fenofibrate for, 461 lovastatin for, 687 pravastatin for, 966 rosuvastatin for, 1058 Hypertrophic subaortic stenosis, propranolol for, 996 Hyperuricemia probenecid for, 979 rasburicase for, 1029 Hypervolemia, 1360 Hypnotic effect, phenobarbital for, 927 Hypnovel, 758 Hypocalcemic emergency, calcium for, 171 Hypocalcemic tetany, calcium for, 171 Hypochloremia, sodium chloride for, 1085 Hypogammaglobulinemia, immune globulin for, 580 Boldface: Color section

Infection

Hypoglycemia dextrose for, 338 diazoxide for, 342 glucagon for, 531 Hypoglycemics, 1263–1264 Hypogonadism estradiol for, 430 estrogens, conjugated for, 432 estrogens, esterified for, 434 testosterone for, 1139 Hypokalemia, spironolactone for, 1097 Hypolar Retard, 822 Hypomagnesemia, magnesium for, 694 Hyponatremia, sodium chloride for, 1085 Hypoprothrombinemia, phytonadione for, 1308 Hypotension dopamine for, 370 nitroprusside for, 835 norepinephrine for, 839 phenylephrine for, 931 Hypotensive emergency, phenylephrine for, 931 Hypothyroidism levothyroxine for, 660 liothyronine for, 669 liotrix for, 671 thyroid, desiccated for, 1152 Hypovase, 967 Hytone, 551 Hytrin, 1134 Hyzaar, 1344, P10

I ibandronate sodium, 562–564 ibandronic acid, 562–564 ibritumomab tiuexetan, 564–566 Ibugel, 566 Ibuleve, 566 Ibumousse, 566 Ibuprofen, 566 ibuprofen, 566–568, P8 Ibuspray, 566 t: table

ibutilide fumarate, 568–570 Idamycin PFS, 570 idarubicin hydrochloride, 570–571 Idiopathic thrombocytopenic purpura, immune globulin for, 580 Ifex, 571 ifosfamide, 571–573 IGIM, 579–581 IGIV, 579–581 IL-2, 37–39 imatinib mesylate, 573–575 Imazin XL, 618 Imdur, 618 Imigran, 1113 imipenem and cilastatin sodium, 575–576 imipramine hydrochloride, 576–578 therapeutic and toxic blood levels for, S17 imipramine pamoate, 576–578 Imitrex, 1113, P14 Immukin, 604 immune globulin for I.M. use, 579–581 immune globulin for I.V. use, human, 579–581 Immune reconstitution syndrome, 1360 Immune VH, 455 Immunization schedules, 1346t, 1347t, 1348t Immunodeficiency, immune globulin for, 579 Immunoglobulin deficiency, immune globulin for, 579 Immunoprin, 118 Immunosuppressants, 1290–1291 Immunosuppression prednisolone for, 969 prednisone for, 972 triamcinolone for, 1196 Imo LA, 618 Imodium, 681 Imodium A-D, 681

1403

Impetigo, mupirocin for, 786 Impril, 576 Imuran, 118 inamrinone lactate, 582–583 Inapsine, 387 Indameth, 586 indapamide, 583–584 Inderal, 995 Inderal LA, 995 Inderide, 1344 Indigestion. See Acid indigestion; Heartburn. indinavir sulfate, 584–586 Indocid, 586 Indocid PDA, 586 Indocid-R, 586 Indocin SR, 586 Indolar SR, 586 Indomax SR, 586 indometacin, 586–587 indomethacin, 586–587 Indotec, 586 Inegy, 453 Infacol, 1077 Infantaire Gas, 1077 Infasurf, 174 Infection. See also specific type. amikacin for, 59 amoxicillin and clavulanate for, 78 aztreonam for, 122 cefotaxime for, 209 ceftriaxone for, 219 chloramphenicol for, 233 clarithromycin for, 262 clindamycin for, 263 doxycycline for, 383 filgrastim for, 470 gentamicin for, 524 imipenem and cilastatin for, 575 immune globulin for, 580, 581 linezolid for, 667 mebendazole for, 698 metronidazole for, 753 minocycline for, 765 nafcillin for, 797 neomycin for, 812 pegfilgrastim for, 895 Boldface: Color section

1404

Infection

Infection (continued) penicillin G potassium for, 906 penicillin G procaine for, 908 penicillin V potassium for, 910 piperacillin for, 942 quinupristin and dalfopristin for, 1016 streptomycin for, 1102 sulfisoxazole for, 1111 tetracycline for, 1142 ticarcillin and clavulanate for, 1155 tobramycin for, 1172 vancomycin for, 1221 InFeD, 610 Infergen, 600 Inflamase Mild Ophthalmic, 969 Inflammation acetylsalicylic acid for, 21 betamethasone for, 135 cortisone for, 286 dexamethasone for, 331 hydrocortisone for, 552 methylprednisolone for, 744 piroxicam for, 947 prednisolone for, 969 prednisone for, 972 triamcinolone for, 1196 infliximab, 587–589 Influenza amantadine for, 56 oseltamivir for, 862 rimantadine for, 1042 zanamivir for, 1243 Influenza immunization schedule, 1346t, 1347t, 1348t Infumorph, 780 Infusion rates, 1352t–1356t INH, 615–617 Injection sites, identifying, S14–S15 Innofem, 429 Innohep, 1163 Innopran XL, 995 Innovace, 401 Inotropics, 1291–1292 t: table

Insecticide poisoning, atropine for, 114 Insomnia eszopiclone for, 436 flurazepam for, 486 lorazepam for, 684 ramelteon for, 1020 secobarbital for, 1069 temazepam for, 1128 triazolam for, 1200 zaleplon for, 1241 zolpidem for, 1250 Inspra, 414 Insta-Glucose, 337 insulin (lispro), 589–592 insulin aspart (rDNA origin), 592–594 insulin aspart and insulin aspart protamine, 592–594 insulin glargine (rDNA origin), 595–596 insulin glulisine, recombinant, 590–592 insulin injection, 589–592 insulin lispro protamine, human, 590–592 insulin, regular, 589–592 Insulin-Toronto, 589 Intal, 287 Integrilin, 418 Intelence, 447 interferon alfa-2b, recombinant, 598–600 interferon alfa-n3, 597–598 interferon alfacon-1, 600–602 interferon beta-1a, 602–604 interferon beta-1b, 602–604 interferon gamma-1b, 604–605 interleukin-2, 37–39 Intermittent claudication cilostazol for, 251 pentoxifylline for, 918 Interstitial pneumonia, 1360 Intestinal antisepsis, preoperative, neomycin for, 812

Intra-abdominal abscess, anidulafungin for, 93 Intra-abdominal infection ampicillin and sulbactam for, 87 cefepime for, 205 ceftazidime for, 216 ciprofloxacin for, 255 doripenem for, 371 ertapenem for, 421 imipenem and cilastatin for, 575 meropenem for, 715 tigecycline for, 1158 Intracranial pressure, increased, 1360 mannitol for, 696 thiopental for, 1340t–1341t urea for, 1212 Intramuscular injections, sites for, S14 Intraocular pressure, increased. See Ocular hypertension. Intravenous injections, sites for, S15 Intron A, 598 Intropin, 369 Invanz, 421 Invega, 882 Invirase, 1063 Iodotope, 1086 Ionsys, 464 Iostat, 961 Ipocol, 717 ipratropium bromide, 605–607 Iquix, 653 irbesartan, 607–608, P8 Iressa, 517 irinotecan hydrochloride, 608–610 iron dextran, 610–611 Iron overdose, managing, S32 Iron overload, deferasirox for, 320 Iron replacement, iron dextran for, 611 Boldface: Color section

labetalol hydrochloride

iron sucrose, 611–613 Iron-deficiency anemia iron dextran for, 610 iron sucrose for, 612 Irritability, risperidone for, 1045 Irritable bowel syndrome alosetron for, 49 calcium polycarbophil for, 173 dicyclomine for, 345 lubiprostone for, 690 psyllium for, 1001 scopolamine for, 1067 Isentress, 1019 Isib, 618 ISMO, 618 isocarboxazid, 613–615 Isochron, 618 Isodur, 618 Isogel, 1000 Isoket, 618 isoniazid, 615–617 isophane insulin suspension, 590–592 isophane insulin suspension and insulin injection, 590–592 isoproterenol hydrochloride, 617–618 Isoptin, 1228 Isoptin SR, 1228 Isopto Atropine, 114 Isordil Titradose, 618 isosorbide dinitrate, 618–620 isosorbide mononitrate, 618–620 Ispagel, 1000 isradipine, 620–621 Istalol, 1159 Isuprel, 617 itraconazole, 621–623 I.V. catheter, sodium chloride for, 1084 Iveegam EN, 579 I.V. flush, heparin for, 544

J Jantoven, 1238 Janumet, 1344 Januvia, 1081 Joint infection. See Bone and joint infection. Junior Strength Advil, 566 t: table

Junior Strength Motrin, 566 Juvenile rheumatoid arthritis acetylsalicylic acid for, 21 etanercept for, 438 ibuprofen for, 567 meloxicam for, 706 sulfasalazine for, 1109

K K10, 957 Kadian, 780 Kaletra, 1344 Kao-Tin, 142 Kaon, 957 Kaopectate, 142 Kaopectate Extra Strength, 142 Kapectolin, 142 Kaposi’s sarcoma alitretinoin for, 44 daunorubicin citrate liposome for, 316 doxorubicin hydrochloride, liposomal for, 381 interferon alfa-2b for, 598 paclitaxel for, 880 vinblastine for, 1231 KaracilW, 1000 kava, 1324 Kavexa, 4 Kawasaki disease acetylsalicylic acid for, 22 immune globulin for, 580 Kay-Cee-L, 957 Kayexalate, 1089 K-Dur, 957 K-Effervescent, 955 Keflex, 224, P4 Keloc, 459 Kemicetine, 232 Kemstro, 124 Kenalog, 1195 Kenalog-10, 1195 Kenalog-40, 1195 Kentera, 871 Kepivance, 881 Keppra, 651 Keppra XR, 651 Keratitis, cromolyn for, 288

1405

Keratoconjunctivitis, cromolyn for, 288 ketamine, 1332t–1333t Ketanodur, 618 Ketek, 1124 ketoconazole, 623–625 ketorolac tromethamine, 625–628 K-Exit Poudre, 1089 Kidkare Decongestant, 999 Kidney transplant rejection, preventing azathioprine for, 119 basiliximab for, 127 cyclosporine for, 293 daclizumab for, 301 lymphocyte immune globulin for, 692 muromonab-CD3 for, 787 mycophenolate for, 789 sirolimus for, 1079 tacrolimus for, 1118 Kidney transplantation, valganciclovir for, 1215 Kidrolase, 106 Kineret, 91 Kionex, 1089 Klaricid, 261 Klaron, 1105 K-Lor, 957 Klonopin, 270 Klonopin Wafer, 270 Klor-Con, 957 Klotrix, 957 K-Lyte, 957 K-Med, 957 Koate-DVI, 94 Koffex Expectorant, 539 Koffex-DM, 336 Kogenate FS, 94 Konsyl, 173, 1000 K-Pek II, 681 Kristalose, 630 Kryoxolr, 623 K-Tab, 957 K-Vescent, 955 Kwells, 1067 Kytril, 537

L LA-12, 1305 labetalol hydrochloride, 628–630 Boldface: Color section

1406

Labor induction

Labor induction, oxytocin for, 878 Labor pain butorphanol for, 168 meperidine for, 712 oxymorphone for, 875 pentazocine for, 913 ropivacaine for, 1338t–1339t sufentanil for, 1340t–1341t Laboratory values, normal, 1349–1351 Lactic acidosis, 1360 lactoflavin, 1310 Lactugal, 630 Lactulax, 630 lactulose, 630–631 Lamictal, 633 Lamictal Chewable Dispersible, 633 Lamisil, 1135 Lamisil AT, 1135 lamivudine, 631–633 lamotrigine, 633–636 Lanoxin, 348, P5 lansoprazole, 637–639, P8 lanthanum carbonate, 639 Lantus, 595 Larapam SR, 1182 Lariam, 702 Laryng-O-Jet, 662 Lasix, 507, P7 Lasix Special, 507 Laxatives, 1292 Laxoberal, 141 Lederfolin, 645 leflunomide, 640–641 Left ventricular dysfunction captopril for, 178 carvedilol for, 194 enalapril for, 402 trandolapril for, 1184 valsartan for, 1220 Left ventricular failure, valsartan for, 1220 Legionnaires’ disease, erythromycin for, 423 Leiomyomas, uterine, leuprolide for, 648 Leishmaniasis, amphotericin B for, 81, 82 Lemlax, 630 lenalidomide, 641–643 t: table

Lennox-Gastaut syndrome clonazepam for, 270 lamotrigine for, 633, 634 topiramate for, 1177 lepirudin, 643–644 Leptospirosis, tetracycline for, 1142 Lescol, 491 Lescol XL, 491 letrozole, 644–645 leucovorin calcium, 645–647 Leucovorin rescue, leucovorin calcium for, 646 Leukemia alemtuzumab for, 40 arsenic trioxide for, 105 asparaginase for, 106, 107 azacitidine for, 117 bendamustine for, 132 busulfan for, 166 chlorambucil for, 231 clofarabine for, 265 cyclophosphamide for, 291 cytarabine for, 298 dasatinib for, 314 daunorubicin for, 318 doxorubicin for, 379 hydroxyurea for, 558 idarubicin for, 570 imatinib for, 573 immune globulin for, 580 interferon alfa-2b for, 598 mercaptopurine for, 714 methotrexate for, 732 mitoxantrone for, 774 nelarabine for, 808 nilotinib for, 824 pegaspargase for, 894 pentostatin for, 917 sargramostim for, 1065 tretinoin for, 1193 triamcinolone for, 1197 vincristine for, 1232 Leukeran, 231 Leukine, 1065 Leukocytosis, 1360 Leukopenia, 1360 leuprolide acetate, 647–649

leuprorelin, 647–649 levalbuterol hydrochloride, 649–650 Levaquin, 653, P8 Levate, 67 levetiracetam, 651–652 Levitra, 1223, P16 Levo-Dromoran, 658 Levo-T, 660 levocetirizine, 652–653 levocetirizine dihydrochloride, 652–653 levofloxacin, 653–656, P8 Levolet, 660 Levonelle, 656 levonorgestrel, 656–658 Levophed, 839 levorphanol tartrate, 658–660 Levothroid, 660 levothyroxine sodium, 660–662, P8, P9 Levoxyl, 660, P8 Levsin, 560 Levsin/SL, 560 Lexapro, 425, P5 Lexiva, 498 Lialda, 717 Librax, 1344 Librium, 234 Lice, lindane for, 666 licorice, 1324 lidocaine hydrochloride, 662–665 therapeutic and toxic blood levels for, S17 Lidodan, 662 Lidoderm, 662 Lidomax, 662 LidoPen Auto-Injector, 662 LIG, 691–693 Lin-Fosinopril, 501 Lincosamides, 1269–1270 lindane, 665–667 linezolid, 667–669 Lioresal, 124 Lioresal Intrathecal, 124 Liotec, 124 liothyronine sodium, 669–671 liotrix, 671–673 Lipantil, 460 Lipitor, 112, P3 Lipofen, 460 Boldface: Color section

magnesium

Lipostat, 966 lisdexamfetamine dimesylate, 673–675 lisinopril, 675–677, P9 lisinopril and hydrochlorothiazide, P9 Liskonum, 677 Listeria infection, penicillin G potassium for, 906 Lithane, 677 lithium carbonate, 677–679 therapeutic and toxic blood levels for, S17 lithium citrate, 677–679 Lithobid, 677 Lithonate, 677 Little Fevers, 14 Liver transplant rejection, preventing cyclosporine for, 293 muromonab-CD3 for, 787 mycophenolate for, 789 tacrolimus for, 1118 LoCHOLEST, 248 LoCHOLEST Light, 248 Locoid, 551 Loestrin 24 FE, 1344 Lofibra, 460 Lomine, 345 Lomotil, 357, 1344 lomustine, 679–681 Long-term care nursing, most commonly used drugs in, 1369 Loniten, 767 Lonox, 357 Lopace, 1021 Loperacap, 681 loperamide hydrochloride, 681–683 Lopid, 520 Lopresor, 750 Lopresor SR, 750 Lopressor, 750 Lopressor HCT, 1344 loratadine, 683–684 t: table

lorazepam, 684–685, P9 therapeutic and toxic blood levels for, S17 Lortab, 549, 1344, P8 losartan potassium, 685–687, P9 losartan potassium and hydrochlorothiazide, P10 Losec, 857 Lotensin, 130, P3 Lotensin HCT, 1344 Lotrel, 1344, P1 Lotronex, 49 lovastatin, 687–689 Lovenox 3, 405 Loxapac, 689 loxapine succinate, 689–690 Lozide, 583 Lozol, 583 L-PAM, 707–709 L-phenylalanine mustard, 707–709 L-sarcolysin, 707–709 L-thyroxine, 660–662 LTA Pediatric, 662 lubiprostone, 690–691 Lumbar epidural block, ropivacaine for, 1338t–1339t Luminal Sodium, 926 Lunesta, 436 Lung cancer bevacizumab for, 138 docetaxel for, 364 doxorubicin for, 379 erlotinib for, 420 etoposide for, 446 gefitinib for, 517 gemcitabine for, 519 paclitaxel for, 880 pemetrexed for, 902 topotecan for, 1179 vinblastine for, 1231 vinorelbine for, 1234 Lupron, 647 Lupron Depot, 647 Lupron Depot-3 Month, 647 Lupron Depot-4 Month, 647 Lupron Depot-Ped, 647

1407

Lupron-3 Month SR Depot, 647 Lupus nephritis, 1361 Lupuslike syndrome, 1361 Lurocaine, 662 Lustral, 1073 lutein, 1325 Luvox CR, 493 Lyflex, 124 Lyme disease, doxycycline for, 384 lymphocyte immune globulin, 691–693 Lymphoma. See also Non-Hodgkin’s lymphoma. bortezomib for, 149 carmustine for, 190 chlorambucil for, 231 cyclophosphamide for, 291 denileukin for, 323 doxorubicin for, 379 triamcinolone for, 1197 vinblastine for, 1231 Lymphosarcoma, methotrexate for, 733 Lyrica, 975 Lyrinel XL, 871 Lysovir, 55

M Maalox H2 Acid Controller, 457 Maalox Regular Chewable, 170 Maalox Total Stomach Relief, 142 MabCampath, 39 Mabron, 1182 MabThera, 1050 Macrobid, 830, P11 Macrodantin, 830, P11 Macrolides, 1269–1270 Macugen, 892 Macular degeneration, pegaptanib sodium injection for, 893 Mag G, 693 Mag-ox, 693 magnesium, therapeutic and toxic blood levels for, S17 Boldface: Color section

1408

magnesium chloride

magnesium chloride, 693–696 magnesium citrate, 693–696 magnesium gluconate, 693–696 magnesium hydroxide, 693–696 Magnesium intoxication, calcium for, 171 magnesium oxide, 693–696 magnesium sulfate, 694–696 Magonate, 693 Major depressive disorder aripiprazole for, 103 desvenlafaxine for, 329 duloxetine for, 390 paroxetine for, 890 selegiline for, 1070 Malaria chloroquine for, 236 doxycycline for, 384 hydroxychloroquine for, 556 mefloquine for, 702 primaquine for, 977 pyrimethamine for, 1005 quinidine for, 1012 quinine for, 1014 Male-pattern baldness. See Hair loss. Malignant hyperthermia, dantrolene for, 307 Malignant melanoma aldesleukin for, 38 dacarbazine for, 300 hydroxyurea for, 558 interferon allfa-2b for, 598 vinblastine for, 1231 Malignant pleural mesothelioma, pemetrexed for, 902 Mandalyn Paedetriac, 356 Mandanol, 14 manganese chloride, 1307 manganese, chelated, 1307 Mania. See also Bipolar disorder. chlorpromazine for, 241 divalproex sodium for, 1217 olanzapine for, 851 t: table

Mania (continued) quetiapine for, 1007 risperidone for, 1045 mannitol, 696–698 Mapap, 14 Marevan, 1238 Marinol, 386 Marplan, 613 Mastocytosis cromolyn for, 288 imatinib for, 573 Matrifen, 464 Matulane, 982 Mavik, 1184 Maxair Autohaler, 945 Maxalt, 1053 Maxalt RPD, 1053 Maxalt-MLT, 1053 Maxeran, 746 Maximum Relief Ex-Lax, 1072 Maximum Strength Mylanta Gas, 1077 Maxipime, 205 Maxolon, 746 Maxolon SR, 746 Maxtrex, 731 Maxzide, 1344 Mazepine, 180 Measles, immune globulin for, 579 Measles, mumps, rubella immunization schedule, 1346t, 1347t, 1348t mebendazole, 698–699 Mechanical ventilation rocuronium for, 1338t–1339t succinylcholine for, 1338t–1339t thiopental for, 1340t–1341t vecuronium for, 1340t–1341t meclizine hydrochloride, 699–700 meclozine, 699–700 Med Metformin, 723 Med Sotalol, 1095 Med Verapamil SR, 1228 Med-Captopril, 177 Med-Clomipramine, 268 Med-Diltiazem, 351

Medical-surgical nursing, most commonly used drugs in, 1369 Medikinet, 740 Medikinet XL, 740 Medrol, 744 Medrone, 744 medroxyprogesterone acetate, 700–702 mefloquine hydrochloride, 702–704 Megace, 704 Megace ES, 704 Megace-OS, 704 Megaloblastic anemia, 1361 folic acid for, 1306 megestrol acetate, 704–705 melatonin, 1325 meloxicam, 705–707 melphalan, 707–709 melphalan hydrochloride, 707–709 Meltus Decongestant, 999 memantine, 709–710, P10 Menest, 434 Meningeal leukemia cytarabine for, 298 methotrexate for, 732 Meningitis amphotericin B for, 81 ampicillin for, 84 ceftriaxone for, 219 cefuroxime for, 221 chloramphenicol for, 233 cytarabine for, 298 fluconazole for, 475 flucytosine for, 476 meropenem for, 715 methylprednisolone for, 744 penicillin G potassium for, 906 triamcinolone for, 1197 Meningococcal immunization schedule, 1346t, 1347t, 1348t Meningococcal meningitis, penicillin G potassium for, 906 Menopausal symptoms estradiol for, 430 Boldface: Color section

Migraine

Menopausal symptoms (continued) estrogens, conjugated for, 432 Menopur, 710 Menostar, 429 menotropins, 710–712 Menses induction, medroxyprogesterone for, 701 Menstrual cramps, acetaminophen for, 15 meperidine hydrochloride, 712–714 therapeutic and toxic blood levels for, S17 Meperitab, 712 Mephyton, 1308 Mepradec, 857 meprobamate, therapeutic and toxic blood levels for, S17 Merbentyl, 345 mercaptopurine, 714–715 6-mercaptopurine, 714–715 Meronem, 715 meropenem, 715–717 Merrem I.V., 715 mesalamine, 717–718 mesalazine, 717–718 Mesasal, 717 mesna, 719–720 Mesnex, 719 Mesothelioma, malignant pleural, pemetrexed for, 902 Mesren, 717 Mestinon, 1003 Mestinon Timespan, 1003 Mestinon-SR, 1003 Metabolic acidosis, 1361 sodium bicarbonate for, 1083 tromethamine for, 1210 Metabolic alkalosis potassium acetate for, 954 potassium chloride for, 957 sodium chloride for, 1084 Metadate CD, 740 Metadate ER, 740 t: table

Metadol, 725 Metalyse, 1130 Metamucil, 1000 Metamucil Orange Flavor, 1000 Metamucil Sugar Free, 1000 metaproterenol sulfate, 720–722 metaxalone, 722–723 Metenix, 748 metformin hydrochloride, 723–725, P10 Methadone HCl Intensol, 725 methadone hydrochloride, 725–728 Methadose, 725 Methemoglobinemia, 1361 Methergine, 739 methimazole, 728–729 methocarbamol, 730–731 methotrexate, 731–735 therapeutic and toxic blood levels for, S17 methotrexate sodium, 731–735 methsuximide, therapeutic and toxic blood levels for, S17 methylcellulose, 735–736 methyldopa, 736–738 methylergonovine maleate, 739–740 Methylin, 740 Methylin ER, 740 methylnaltrexone bromide, 738–739 methylphenidate therapeutic and toxic blood levels for, S17 methylphenidate hydrochloride, 740–744, P10 methylprednisolone, 744–746 methylprednisolone acetate, 744–746 methylprednisolone sodium succinate, 744–746 metoclopramide hydrochloride, 746–748

1409

Metoject, 731 metolazone, 748–750 metoprolol succinate, 750–752, P10 metoprolol tartrate, 750–752 therapeutic and toxic blood levels for, S17 Metric measures, S6 MetroCream, 752 MetroGel, 752 MetroGel-Vaginal, 752 MetroLotion, 752 Metrolyl, 752 metronidazole, 752–754 metronidazole hydrochloride, 752–754 Metrosa, 752 Metrotop, 752 Metrozol, 752 Metsol, 723 Mevacor, 687 mexiletine hydrochloride, 754–756 Mezavant, 717 mezlocillin, therapeutic and toxic blood levels for, S17 Miacalcic, 169 Miacalcin, 169 Miacalcin Nasal Spray, 169 micafungin sodium, 756–758 Micardis, 1127 Micoprin, 21 Micro-K, 957 Micronase, 532 Microzide, 547 midazolam hydrochloride, 758–760, 1334t–1335t midodrine hydrochloride, 760–761 Mifegyne, 761 Mifeprex, 761 mifepristone, 761–763 Migard, 505 miglitol, 763–764 Migraine almotriptan for, 47 divalproex sodium for, 1217 eletriptan for, 396 frovatriptan for, 505 Boldface: Color section

1410

Migraine

Migraine (continued) naratriptan for, 802 propranolol for, 996 rizatriptan for, 1053 sumatriptan for, 1113 topiramate for, 1177 zolmitriptan for, 1249 milk thistle, 1325–1326 Milophene, 267 milrinone lactate, 764–765 therapeutic and toxic blood levels for, S17 Mimpara, 253 Minims Phenylephrine, 930 Minims Sodium Chloride, 1084 Minipress, 967 Minirin, 327 Minitran, 832 Minizide, 1344 Minocin, 765 minocycline hydrochloride, 765–767 Minodiab, 529 Minox, 767 minoxidil, 767–769 Mirapex, 963 Mirapexin, 963 Mirena, 656 mirtazapine, 769–770 misoprostol, 771–772 Mithracin, 949 mithramycin, 949–950 mitomycin, 772–773 Mitoxana, 571 mitoxantrone hydrochloride, 773–775 Mobic, 705 Mobicox, 705 modafinil, 776–777 Modane Bulk, 1000 Modecate, 483 Modisal, 618 Moditen, 483 Moduretic, 1344 moexipril hydrochloride, 777–778 Molipaxin, 1189 Monarc-M, 94 Monigen, 618 Monigen XL, 618 Monit, 618 Monit LS, 618 Monitan, 12 t: table

Monobactams, 1269–1270 Monoclate-P, 94 Monocor, 144 Monodox, 383 Monoket, 618 Monomax, 618 Monomax SR, 618 Monomax XL, 618 Monomil, 618 Mononine, 455 Monoparin, 543 Monopril, 501, P7 Monosorb, 618 Monovent, 1137 montelukast sodium, 778–780, P10 Morcap SR, 780 morphine hydrochloride, 780–783 morphine sulfate, 780–783 morphine sulphate, 780–783 Morphitec, 780 Morphogesic, 780 Morphogesic SR, 780 Motion sickness meclizine for, 699 promethazine for, 989 scopolamine for, 1067 Motor neuron disorders, dantrolene for, 307 Motrin, 566, P8 Motrin IB, 566 Motrin Infant, 566 Mountain sickness, acetazolamide for, 17 Moxatag, 75 moxifloxacin hydrochloride, 783–785 6-MP, 714–715 MS Contin, 780 MST Continus, 780 MTX, 731–735 Mucinex, 539 Mucolytic agent, acetylcysteine as, 19 Mucomyst, 19, S30 Mucomyst 10, 19 Mucormycosis, amphotericin B for, 81 Mucosil-10, 19 Mucosil-20, 19 Multiparin, 543

Multiple myeloma bortezomib for, 149 carmustine for, 190 cyclophosphamide for, 291 doxorubicin for, 379 lenalidomide for, 642 melphalan for, 707 pamidronate for, 887 zoledronic acid for, 1247 Multiple sclerosis baclofen for, 124 dantrolene for, 307 glatiramer for, 526 hydrocortisone for, 552 interferon beta-1a for, 602 interferon beta-1b for, 602 methylprednisolone for, 744–726 mitoxantrone for, 774 prednisolone for, 969 prednisone for, 972 Mumps immunization schedule, 1346t, 1347t, 1348t mupirocin, 785–787 muromonab-CD3, 787–788 Muscarinic toxicity, hyoscyamine for, 561 Muscle ache, acetaminophen for, 15 Muscle spasm baclofen for, 124 carisoprodol for, 189 chlorzoxazone for, 247 cyclobenzaprine for, 289 dantrolene for, 307 diazepam for, 339 methocarbamol for, 730 tizanidine for, 1170 Muscle tone, increased, tizanidine for, 1170 Musculoskeletal conditions carisoprodol for, 189 chlorzoxazone for, 247 cyclobenzaprine for, 289 metaxalone for, 722 methocarbamol for, 730 Mushroom toxicity, muscarinic-induced, atropine for, 115 Mutamycin, 772 Boldface: Color section

Necator americanus infection

MXL, 780 Myambutol, 439 Myasthenia gravis neostigmine for, 813 pyridostigmine for, 1003 Mycamine, 756 Mycobacterial infection azithromycin for, 121 clarithromycin for, 262 ethambutol for, 439 rifabutin for, 1035 streptomycin for, 1102 Mycobutin, 1035 mycophenolate mofetil, 788–791 mycophenolate mofetil hydrochloride, 788–791 mycophenolate sodium, 788–791 Mycoplasmal infection, tetracycline for, 1142 Mycosis fungoides cyclophosphamide for, 291 methotrexate for, 732 vinblastine for, 1231 Mycostatin, 846 Mydfrin, 930 Mydriasis, atropine for, 115 Myelodysplastic syndromes, azacitidine for, 117 Myeloid reconstitution, sargramostim for, 1065 Myfortic, 788 Mylanta AR, 457 Mylanta Children’s, 170 Mylanta Gas, 1077 Myleran, 165 Mylicon, 1077 Mylicon Infant Drops, 1077 Myobloc, 152 Myocardial contractility, impaired, 1360 Myocardial infarction acetylsalicylic acid for, 22 alteplase for, 52 atenolol for, 109 atorvastatin for, 112 captopril for, 178 carvedilol for, 194 t: table

Myocardial infarction (continued) clopidogrel for, 273 dalteparin for, 303 enoxaparin for, 405 eplerenone for, 414 eptifibatide for, 418 lisinopril for, 675 metoprolol for, 750 nitroglycerin for, 832 propranolol for, 996 ramipril for, 1022 reteplase for, 1032 streptokinase for, 1100 tenecteplase for, 1131 timolol for, 1160 trandolapril for, 1184 valsartan for, 1220 warfarin for, 1238 Myocet, 381 Myotonachol, 137 Myotonine, 137 Mysoline, 978 Myxedema coma levothyroxine for, 661 liothyronine for, 669 Myxedema, liothyronine for, 669

N nabilone, 791–793 nabumetone, 793–794 N-acetylcysteine, 19–20 nadolol, 794–796 Nadostine, 846 nafarelin acetate, 796–797 nafcillin sodium, 797–798 nalbuphine hydrochloride, 798–800, 1334t–1335t Nalcrom, 287 naloxone hydrochloride, S32 naltrexone, S32 Namenda, 709, P10 Napratec, 800 Naprelan, 800 Naprosyn, 800 Naprosyn SR, 800 Naprosyn-E, 800 Naprosyn-EC, 800 naproxen, 800–802 naproxen sodium, 800–802 Naramig, 802 naratriptan hydrochloride, 802–803

1411

Narcan, S32 Narcolepsy dextroamphetamine for, 335 methylphenidate for, 742 modafinil for, 776 Nardil, 924 Naropin, 1338t–1339t Nasacort AQ, 1195 Nasahist B, 155 Nasal congestion phenylephrine for, 931 pseudoephedrine for, 999 Nasalcrom, 287 Nasarel, 478 Nasobec, 129 nateglinide, 803–804 Natrecor, 815 Natrilix, 583 Natural Fiber Therapy, 1000 Naturalyte, 1083 Nature Throid, 1151 Nausea and vomiting aprepitant for, 99 bismuth for, 143 chlorpromazine for, 241 dimenhydrinate for, 353 diphenhydramine for, 356 dolasetron for, 367 dronabinol for, 386 droperidol for, 387 granisetron for, 537 hydroxyzine for, 559 metoclopramide for, 747 nabilone for, 791 ondansetron for, 859 palonosetron for, 886 perphenazine for, 922 prochlorperazine for, 984 promethazine for, 989 scopolamine for, 1067 trimethobenzamide for, 1205 Navelbine, 1234 ND-Stat, 155 nebivolol, 804–806 NebuPent, 911 Necator americanus infection, mebendazole for, 698 Boldface: Color section

1412

Neck cancer

Neck cancer. See Head and neck cancer. Neck pain, botulinum toxin for, 152 Necrosis, dermal, phentolamine for, 929 nefazodone hydrochloride, 806–808 Neisseria meningitidis carriers, rifampin for, 1037 nelarabine, 808–810 nelfinavir mesylate, 810–811 Nembutal Sodium, 915 Neo-Codema, 547 Neo-DM, 336 Neo-Fradin, 812 Neo-Synephrine, 930 Neoclarityn, 326 Neofel, 459 neomycin sulfate, 812–813 Neonatal group B streptococcal disease, ampicillin as prophylaxis for, 85 Neoplasm, 1361 Neoplastic disorders betamethasone for, 135 cortisone for, 286 methylprednisolone for, 744 prednisolone for, 969 NeoProfen, 566 Neoral, 293 neostigmine bromide, 813–814 neostigmine methylsulfate, 813–814 Neotigason, 24 Neotren, 918 Neozipine XL, 822 Nephritis, acute, magnesium for, 695 Nephro-Calci, 170 Nephrotic syndrome cyclophosphamide for, 291 hydrocortisone for, 552 prednisolone for, 969 spironolactone for, 1097 triamcinolone for, 1197 Nephrotoxicity, 1361 t: table

Nerve block lidocaine for, 663 procaine for, 1336t–1337t Nervous system disorders, prednisolone for, 969 nesiritide, 815–816 Nestrex, 1309 Neulasta, 895 Neupogen, 470 Neuroblastoma cyclophosphamide for, 291 doxorubicin for, 379 NeuroBloc, 152 Neuroleptic malignant syndrome, 1361 bromocriptine for, 154 Neuromuscular blockade, reversing neostigmine for, 814 pyridostigmine for, 1003 Neuromuscular blockers, 1292–1293 Neurontin, 510, P7 Neurosyphilis penicillin G benzathine for, 904 penicillin G potassium for, 906 Neutratop, 752 Neutropenia, 1361 filgrastim for, 470 Neutrophil recovery, sargramostim for, 1065 nevirapine, 816–817 Nexavar, 1093 Nexium, 428, P6 niacin, 1307–1308 Niacin deficiency, niacin for, 1307 niacinamide, 1307–1308 nicardipine, 818–819 Nicoderm CQ, 819 Nicopatch, 819 Nicorette, 819 Nicorette Patch, 819 nicotinamide, 1307–1308 nicotine, 819–822 nicotine inhaler, 819–822 nicotine nasal spray, 819–822

nicotine polacrilex, 819–822 nicotine transdermal system, 819–822 Nicotine withdrawal, nicotine for, 820 Nicotinell, 819 nicotinic acid, 1307–1308 Nicotrol Inhaler, 819 Nicotrol NS, 819 Nidagel, 752 Nifediac CC, 822 Nifedical XL, 822 nifedipine, 822–823 therapeutic and toxic blood levels for, S17 Nifedipress MR, 822 Nifopress MR, 822 Nightcalm, 356 Nilandron, 826 nilotinib, 823–824 Nilstat, 846 nilutamide, 826–827 nimodipine, 827–828 Nimotop, 827 Nindaxa, 583 Nipent, 916 Nipride, 834 NiQuitin, 819 Niravam, 50 nisoldipine, 828–829 nitazoxanide, 829–830 Nitrek, 832 Nitro-Dur, 832 nitrofurantoin, 830–832, P11 nitrofurantoin macrocrystals, 830–832, P11 nitroglycerin, 832–834 Nitroglycerin infusion rates, 1355t Nitroject, 832 Nitrolingual, 832 Nitromist, 832 Nitronal, 832 Nitropress, 834 Nitroprusside infusion rates, 1355t nitroprusside sodium, 834–836 Nitroquick, 832 Nitrostat, 832 Nivemycin, 812 nizatidine, 836–837 Boldface: Color section

Novo-Tamoxifen

Nizoral, 623 Nizoral A-D, 623 Nobligan Retard, 1182 Nocturia bumetanide for, 159 oxybutynin for, 871 Nolvadex, 1122 Nolvadex-D, 1122 Non-Drowsy Sudafed Decongestant, 999 Non-Hodgkin’s lymphoma bleomycin for, 147 ibritumomab for, 565 interferon alfa-2b for, 599 rituximab for, 1050 Nonpsychotic behavior disorder, haloperidol for, 542 Noradrenaline, 839 Norco, 549 Norcuron, 1340t–1341t Norditropin, 1091 norelgestromin/ethinyl estradiol, 837–839 norepinephrine bitartrate, 839–840 Norepinephrine extravasation, phentolamine for, 929 norethindrone acetate, 841–842 norfloxacin, 842–844 Norgalax, 366 Norimode, 681 Noritate, 752 Normaloe, 681 Noroxin, 842 Norpace, 360 Norpace CR, 360 Norpramin, 324 Nortemp, 14 Nortemp Children’s, 14 nortriptyline hydrochloride, 844–846 therapeutic and toxic blood levels for, S17 Norvasc, 69, P1 Norventyl, 844 Norvir, 1047 Nose infection amoxicillin for, 76 mupirocin for, 786 Novamoxin, 75 Novantrone, 773 t: table

Novasen, 21 Novo Docusate, 366 Novo-5-ASA-Ect, 717 Novo-Alprazol, 50 Novo-Ampicillin, 84 Novo-Atenol, 108 Novo-Azathioprine, 118 Novo-AZT, 1243 Novo-Bicalutamide, 140 Novo-Bisoprolol, 144 Novo-Carbamazepine, 180 Novo-Carvedilol, 194 Novo-Cefadroxil, 200 Novo-Chlorpromazine, 241 Novo-Cholamine, 248 Novo-Cholamine Light, 248 Novo-Cimetine, 252 Novo-Clavamoxin, 78 Novo-Clonazepam, 270 Novo-Clonidine, 272 Novo-Clopamine, 268 Novo-Clopate, 275 Novo-Cycloprine, 289 Novo-Desipramine, 324 Novo-Difenac, 343 Novo-Difenac-K, 343 Novo-Difenac-SR, 343 Novo-Diltazem, 351 Novo-Dipam, 339 Novo-Divalproex, 1216 Novo-Docusate Calcium, 366 Novo-Doxepin, 376 Novo-Doxylin, 383 Novo-Enalpril, 401 Novo-Famotidine, 457 Novo-Flucanazole, 474 Novo-Flupam, 486 Novo-Flutamide, 487 Novo-Fluvoxamine, 493 Novo-Fosinopril, 501 Novo-Furantoin, 830 Novo-Gabapentin, 510 Novo-Gemfibrozil, 520 Novo-Gesic, 14 Novo-Glimepiride, 527 Novo-Glyburide, 532 Novo-Hydrazide, 547 Novo-Hydroxyzin, 559 Novo-Hylazin, 546 Novo-Indapamide, 583 Novo-Ipramide, 605 Novo-Ketoconazole, 623 Novo-Lamotrigine, 633 Novo-Leflunomide, 640

1413

Novo-Levocarbidopa, 182 Novo-Levofloxacin, 653 Novo-Lexin, 224 Novo-Lisinopril, 675 Novo-Loperamide, 681 Novo-Lorazem, 684 Novo-Lovastatin, 687 Novo-Medrone, 700 Novo-Meloxicam, 705 Novo-Metformin, 723 Novo-Methacin, 586 Novo-Metoprol, 750 Novo-Mexiletine, 754 Novo-Minocycline, 765 Novo-Mirtazapine, 769 Novo-Misoprostol, 771 Novo-Morphine, 780 Novo-Nabumetone, 793 Novo-Nadolol, 794 Novo-Naprox, 800 Novo-Naprox Sodium, 800 Novo-Naprox Sodium DS, 800 Novo-Nidazol, 752 Novo-Nifedin, 822 Novo-Nizatidine, 836 Novo-Nortriptyline, 844 Novo-Ondansetron, 858 Novo-Oxybutinin, 871 Novo-Pantoprazole, 888 Novo-Paroxetine, 890 Novo-Pen-VK, 909 Novo-Peridol, 541 Novo-Pheniram, 239 Novo-Pindol, 939 Novo-Pioglitazone, 941 Novo-Pirocam, 947 Novo-Pramipexole, 963 Novo-Pravastatin, 966 Novo-Prazin, 967 Novo-Profen, 566 Novo-Propamide, 243 Novo-Quinine, 1014 Novo-Rabeprazole, 1017 Novo-Ramipril, 1021 Novo-Risperidone, 1045 Novo-Selegiline, 1070 Novo-Sertraline, 1073 Novo-Simvastatin, 1078 Novo-Sorbide, 618 Novo-Sotalol, 1095 Novo-Spiroton, 1097 Novo-Sucralfate, 1104 Novo-Sumatriptan, 1113 Novo-Tamoxifen, 1122 Boldface: Color section

1414

Novo-Tamsulosin

Novo-Tamsulosin, 1123 Novo-Temazepam, 1128 Novo-Terazosin, 1134 Novo-Thalidone, 245 Novo-Theophyl SR, 1146 Novo-Ticlopidine, 1156 Novo-Timol, 1159 Novo-Topiramate, 1177 Novo-Trazodone, 1189 Novo-Trifluzine, 1202 Novo-Trimel, 1106 Novo-Trimel DS, 1106 Novo-Tripramine, 1206 Novo-Valproic ECC, 1216 Novo-Venlafaxine XR, 1226 Novo-Veramil, 1228 Novo-Warfarin, 1238 Novocain, 1336t–1337t Novochlorocap, 232 Novolin 70/30, 590 Novolin 70/30 PenFill, 590 Novolin N, 590 Novolizer Budesonide, 157 NovoLog, 592 NovoLog Mix 70/30, 592, 1344 Novomedopa, 736 NovoNorm, 1030 Novopramine, 576 Novopranol, 995 Novosemide, 507 NovoSeven, 278 NovoSeven RT, 278 Novotetra, 1142 Novotriptyn, 67 Novoxapam, 868 Noxafil, 951 NPH insulin, 590–592 Nu-Alpraz, 50 Nu-Amoxil, 75 Nu-Ampi, 84 Nu-Baclo, 124 Nu-Cal, 170 Nu-Carbamazepine, 180 Nu-Cephalex, 224 Nu-Cimet, 252 Nu-Clonidine, 272 Nu-Cotrimox, 1106 Nu-Cotrimox DS, 1106 Nu-Cromolyn, 287 Nu-Desipramine, 324 Nu-Diclo, 343 Nu-Diltiaz, 351 Nu-Divalproex, 1216 Nu-Famotidine, 457 t: table

Nu-Fenofibrate, 460 Nu-Flovoxamine, 493 Nu-Furosemide, 507 Nu-Gemfibrozil, 520 Nu-Glyburide, 532 Nu-Hydral, 546 Nu-Hydroxyzine, 559 Nu-Ibuprofen, 566 Nu-Indapamide, 583 Nu-Indo, 586 NU-Ipratropium, 605 Nu-Ketocon, 623 Nu-Ketoconazole, 623 Nu-Lax, 1072 Nu-Levocarb, 182 Nu-Loraz, 684 Nu-Lovastatin, 687 Nu-Loxapine, 689 Nu-Medopa, 736 Nu-Megestrol, 704 Nu-Metformin, 723 Nu-Metoclopramide, 746 Nu-Metop, 750 Nu-Naprox, 800 Nu-Nifed, 822 Nu-Nortriptyline, 844 Nu-Oxybutinin, 871 Nu-Pindol, 939 Nu-Pirox, 947 Nu-Pravastatin, 966 Nu-Prazo, 967 Nu-Propranolol, 995 Nu-purol, 45 Nu-Salbutamol, 35 Nu-Seals, 21 Nu-Selegiline, 1070 Nu-Sertraline, 1073 Nu-Simvastatin, 1078 Nu-Sotalol, 1095 Nu-Sucralfate, 1104 Nu-Temazepam, 1128 Nu-Terazosin, 1134 Nu-Tetra, 1142 Nu-Thyro, 660 NU-Ticlopidine, 1156 NU-Timolol, 1159 Nu-Trazodone, 1189 Nu-Trimipramine, 1206 Nu-Valproic, 1216 Nu-Verap, 1228 Nu-Verap SR, 1228 Nubain, 798, 1334t–1335t Nuelin SA, 1146 NuLYTELY, 1344

Nurofen, 566 Nursing specialties, most commonly used drugs in, 1369–1370 Nutr-E-Sol, 1312 Nutropin AQ, 1091 Nutropin AQ Pen, 1091 Nutropin Depot, 1091 NuvaRing, 444 Nyaderm, 846 Nycopren, 800 Nystan, 846 nystatin, 846–847 Nystop, 846 Nytol, 356

O Obesity, orlistat for, 860 Obsessive-compulsive disorder clomipramine for, 268 fluoxetine for, 481 fluvoxamine for, 493 paroxetine for, 890 sertraline for, 1073 Obstetric amnesia, scopolamine for, 1067 Obstetric nursing, most commonly used drugs in, 1370 Obstructive airway disease, reversible albuterol for, 35 pirbuterol for, 946 Octagam, 579 Octaplex, 455 octreotide acetate, 847–849 Ocu-Sul 10, 1105 Ocu-Sul 15, 1105 Ocu-Sul 30, 1105 Ocuflox, 849 Ocular hypertension carteolol for, 192 mannitol for, 696 timolol for, 1160 urea for, 1212 Ocular infection chloramphenicol for, 233 gentamicin for, 524 sulfacetamide for, 1105 tobramycin for, 1172 Ocular inflammation, ketorolac for, 626 Boldface: Color section

Otitis media

Ocular itching, ketorolac for, 626 Ocular pain, ketorolac for, 626 Ocupress, 191 Oestrogel, 429 ofloxacin, 849–851 Oftaquix, 653 olanzapine, 851–853, P11 Oliguria, mannitol as test dose for, 696 olmesartan medoxomil, 853–855, P11 Olmetec, 853 olsalazine sodium, 855 omalizumab, 856 omeprazole, 857–858, P11 Omnic MR, 1123 Omnicef, 203 Omnipred, 969 Omnitrope, 1091 Oncaspar, 894 ondansetron hydrochloride, 858–860 Ondemet, 858 Onkotrone, 773 Ontak, 323 Onxol, 879 Onychomycosis itraconazole for, 622 terbinafine for, 1135 Opana, 874 Opana ER, 874 Ophthalmia neonatorum, erythromycin as prophylaxis for, 423 Ophthalmic disorders, prednisolone for, 969 Ophthalmic inflammatory diseases, triamcinolone for, 1197 Opioid detoxification, methadone for, 726 Opioid overdose and dependence buprenorphine for, 161 managing, S32 Optil, 351 Oracea, 383 Oral cavity disorders, lidocaine for, 664 Oral mucositis, palifermin for, 882 t: table

Oral thrush, ketoconazole for, 624 Oramorph SR, 780 Orap, 938 Orapred, 969 Orapred ODT, 969 Oraxyl, 383 orciprenaline, 720–722 Orelox, 212 Orencia, 6 Orgalutran, 515 Organ transplant rejection, preventing azathioprine for, 119 basiliximab for, 127 betamethasone for, 135 cortisone for, 286 cyclosporine for, 293 daclizumab for, 301 lymphocyte immune globulin for, 692 muromonab-CD3 for, 787 mycophenolate for, 789 sirolimus for, 1079 tacrolimus for, 1118, 1119 Organ transplantation, ganciclovir for, 513 Organidin NR, 539 Organophosphate insecticide overdose, managing, S32 Orlept, 1216 orlistat, 860–861 Ortho Evra, 837 Ortho-Cyclen, 1344 Orthoclone OKT3, 787 Orthostatic hypotension, midodrine for, 760 Orvaten, 760 Os-Cal, 170 Os-Cal 500, 170 oseltamivir phosphate, 861–862 Osmitrol, 696 Osmotic nephrosis, 1361 Ossification, heterotopic, etidronate for, 441 Osteitis deformans. See Paget’s disease of bone. Osteoarthritis acetylsalicylic acid for, 21

1415

Osteoarthritis (continued) betamethasone for, 135 celecoxib for, 223 diclofenac for, 343 etodolac for, 442 ibuprofen for, 567 indomethacin for, 586 meloxicam for, 706 methylprednisolone for, 744 nabumetone for, 793 naproxen for, 800 oxaprozin for, 866 salsalate for, 1061 Osteolytic lesions, pamidronate for, 887 Osteopetrosis, interferon gamma-1b for, 604 Osteoporosis alendronate for, 41 calcitonin for, 169 estradiol for, 430 estrogens, conjugated for, 432 estrogens, esterified for, 434 ibandronate for, 562 oxandrolone for, 865 raloxifene for, 1018 risedronate for, 1043 teriparatide for, 1138 zoledronic acid for, 1247 Osteosarcoma, methotrexate for, 732 Otitis externa, ofloxacin for, 850 Otitis media amoxicillin and clavulanate for, 78 azithromycin for, 121 cefaclor for, 199 cefdinir for, 204 cefixime for, 207 cefpodoxime for, 212 cefprozil for, 214 ceftibuten for, 218 ceftriaxone for, 219 cefuroxime for, 221 cephalexin for, 225 clarithromycin for, 262 erythromycin for, 423 ofloxacin for, 850 penicillin V potassium for, 910 Boldface: Color section

1416

Otitis media

Otitis media (continued) sulfamethoxazoletrimethoprim for, 1107 Ovace, 1105 Ovace Wash, 1105 Ovarian cancer amifostine for, 57 carboplatin for, 187 cisplatin for, 258 cyclophosphamide for, 291 doxorubicin hydrochloride, liposomal for, 381 gemcitabine for, 519 hydroxyurea for, 558 melphalan for, 707 paclitaxel for, 880 topotecan for, 1179 Ovarian failure clomiphene for, 267 estradiol for, 430 estrogens, conjugated for, 432 Ovarian hyperstimulation, ganirelix for, 515 Ovarian stimulation, menotropins for, 710 Ovariectomy, estrogens, conjugated for, 432 Overactive bladder darifenacin for, 310 oxybutynin for, 871 solifenacin for, 1090 tolterodine for, 1176 trospium for, 1211 Overdoses, managing, S30–S32 Ovex, 698 Ovol, 1077 oxaliplatin, 862–864 Oxandrin, 864 oxandrolone, 864–866 oxaprozin, 866–868 oxaprozin potassium, 866–868 oxazepam, 868–869 therapeutic and toxic blood levels for, S17 oxcarbazepine, 869–871, P11 Oxeze, 497 Oxis, 497 t: table

Oxy-IR, 872 oxybutynin, 871–872 oxybutynin chloride, 871–872, P11 oxycodone hydrochloride, 872–874, P11 OxyContin, 872, P11 OxyFast, 872 oxymorphone hydrochloride, 874–877 Oxynorm, 872, 874 oxytocin, 877–879 Oxytrol, 871 Oysco, 170 Oyst-Cal 500, 170 Oystercal 500, 170

P Pacerone, 64 paclitaxel, 879–881 Paget’s disease of bone alendronate for, 41 calcitonin for, 169 etidronate for, 441 pamidronate for, 887 risedronate for, 1043 zoledronic acid for, 1247 Pain. See also Analgesia. acetaminophen for, 15 acetylsalicylic acid for, 21 buprenorphine for, 161 butorphanol for, 168 celecoxib for, 223 clonidine for, 272 codeine for, 280 duloxetine for, 390 etodolac for, 442 fentanyl for, 465 hydrocodone for, 550 hydromorphone for, 555 hyoscyamine for, 561 ibuprofen for, 567 ketorolac for, 626 levorphanol for, 658 lidocaine for, 664 meperidine for, 712 methadone for, 726 mitoxantrone for, 774 morphine for, 781 nalbuphine for, 799 naproxen for, 800, 801 oxycodone for, 873 oxymorphone for, 875, 876 pentazocine for, 913

Pain (continued) phenazopyridine for, 924 propoxyphene for, 994 tramadol for, 1182 Pain Eze, 14 palifermin, 881–882 paliperidone, 882–884 palivizumab, 884–885 Palladone, 554 Palladone SR, 554 Palmitate-A 5000, 1310 palonosetron hydrochloride, 885–886 Pamelor, 844 pamidronate disodium, 887–888 Panadol, 14 Pancreas transplantation, valganciclovir for, 1215 Pancreatic cancer erlotinib for, 420 fluorouracil for, 479 gemcitabine for, 518 mitomycin for, 772 Pancreatitis, acute, 1357 hyoscyamine for, 561 pancuronium bromide, 1334t–1335t Pancytopenia, 1361 Panic disorder alprazolam for, 51 fluoxetine for, 482 paroxetine for, 890 sertraline for, 1073 venlafaxine for, 1226 Panixine DisperDose, 224 Panretin, 44 Pantoloc, 888 pantoprazole sodium, 888–889, P11 Papilledema, 1361 Paracoccidioidomycosis, ketoconazole for, 624 Parafon Forte DSC, 247 Paralysis attack potassium acetate for, 954 potassium chloride for, 957 Paramax, 746 Pardelprin, 586 Boldface: Color section

Peripheral blood progenitor cell transplantation

paricalcitol, 1308 Pariet, 1017 Parkinsonism atropine for, 115 benztropine for, 134 carbidopa-levodopa for, 182 trihexyphenidyl for, 1204 Parkinson’s disease amantadine for, 56 apomorphine for, 98 bromocriptine for, 154 carbidopa-levodopa for, 183 carbidopalevodopaentacapone for, 185 diphenhydramine for, 356 entacapone for, 407 hyoscyamine for, 561 pramipexole for, 963 rasagiline for, 1027 ropinirole for, 1055 selegiline for, 1070 tolcapone for, 1175 Parlodel, 154 Parnate, 1185 Parovelex, 19 paroxetine hydrochloride, 890–892, P12 paroxetine mesylate, 890–892 therapeutic and toxic blood levels for, S17 Pasteurella infection, penicillin G potassium for, 906 Pavulon, 1334t–1335t Paxene, 879 Paxil, 890, P12 Paxil CR, 890, P12 PCE, 423 Pedi-Dri, 846 PediaCare Fever, 566 PediaCare Infants LongActing Cough, 336 Pediapred, 969 Pediatric nursing, most commonly used drugs in, 1370 Pediatrix, 14 t: table

Pediazole, 1344 Pediculosis infestation, lindane for, 666 PEG-Intron, 898 PEG-L-asparaginase, 894–895 pegaptanib sodium injection, 892–893 pegaspargase, 894–895 Pegasys, 896 pegfilgrastim, 895–896 peginterferon alfa-2a, 896–898 peginterferon alfa-2b, 898–900 PegIntron, 898 pegvisomant, 900–901 Pellagra, niacin for, 1307 Pelvic infection, ertapenem for, 421 Pelvic inflammatory disease azithromycin for, 121 clindamycin for, 264 erythromycin for, 423 ofloxacin for, 849 piperacillin and tazobactam for, 944 pemetrexed, 902–904 Pen-Vee, 909 Penbritin, 84 Penicillin blood level, probenecid to increase, 979 penicillin G benzathine, 904–905 penicillin G potassium, 905–908 penicillin G procaine, 908–909 penicillin V potassium, 909–911, P12 Penicillins, 1269–1270, P12 Penile cancer, bleomycin for, 147 Pentacarinat, 911 Pentam 300, 911 pentamidine isethionate, 911–913 Pentamycetin, 232 Pentasa, 717 pentazocine hydrochloride and acetaminophen, 913–914

1417

pentazocine hydrochloride and naloxone hydrochloride, 913–914 pentazocine lactate, 913–914, 1334t–1335t pentobarbital sodium, 915–916 pentostatin, 916–918 Pentothal, 1340t–1341t pentoxifylline, 918–919 Pentoxil, 918 Pentoxyphylline, 918 Pentoxyphylline SR, 918 Pepcid, 457 Pepcid AC, 457 Peptic ulcer atropine for, 115 glycopyrrolate for, 534 propantheline for, 992 simethicone for, 1077 Pepto-Bismol, 142 Pepto-Bismol Bismuth Maximum Strength, 142 Percocet, 1344 Percodan, 1344 Percutaneous coronary intervention abciximab for, 8 argatroban for, 101 bivalirudin for, 146 eptifibatide for, 418 fluvastatin for, 491 Percutaneous transluminal coronary angioplasty, tirofiban for, 1169 Perdix, 777 Perforomist, 497 Periactin, 296 Pericardial effusion, 1361 Peridol, 541 perindopril erbumine, 919–921 Periodontitis, doxycycline for, 384 Periostat, 383 Peripheral arterial disease, clopidogrel for, 273 Peripheral blood progenitor cell transplantation, sargramostim for, 1065 Boldface: Color section

1418

Peritonitis

Peritonitis anidulafungin for, 93 flucanozole for, 475 micafungin for, 756 piperacillin and tazobactam for, 944 Permapen, 904 Pernicious anemia, cyanocobalamin for, 1305 perphenazine, 921–923 Persantin, 359 Persantine, 359 Pertussis erythromycin for, 424 immunization schedule for, 1347t, 1348t pethidine hydrochloride, 712–714 Pexeva, 890 Pfizerpen, 905 PGE2, 354–355 Phanacin XPECT, 539 Pharmorubicin PMS, 412 Pharyngeal disorders, lidocaine for, 664 Pharyngitis azithromycin for, 121 cefaclor for, 199 cefadroxil for, 200 cefdinir for, 204 cefixime for, 207 cefpodoxime for, 212 cefprozil for, 214 ceftibuten for, 217 cefuroxime for, 221 clarithromycin for, 261 Phazyme, 1077 Phenazo, 923 phenazopyridine hydrochloride, 923–924 phenelzine sulfate, 924–926 Phenergan, 988 phenobarbital, 926–929 therapeutic and toxic blood levels for, S17 phenobarbital sodium, 926–929 phentolamine mesylate, 929–930 phenylephrine hydrochloride, 930–933 t: table

Phenylephrine infusion rates, 1356t Phenytek, 934 phenytoin, 934–936 therapeutic and toxic blood levels for, S17 phenytoin sodium, 934–936, P12 Pheochromocytectomy, phentolamine for hypertensive control during, 929 Pheochromocytoma phentolamine for diagnosis of, 929 propranolol for, 996 Phillips Milk of Magnesia, 693 Phillips Milk of Magnesia Concentrate, 693 PHL-Bicalutamide, 140 PHL-Carbamazepine, 180 PHL-Carvedilol, 194 PHL-Clomipramine, 268 PHL-Clonazepam, 270 PHL-Cyclobenzaprine, 289 PHL-Desipramine, 324 PHL-Divalproex, 1216 PHL-Docusate Sodium, 366 PHL-Fluconazole, 474 PHL-Fluvoxamine, 493 PHL-Gabapentin, 510 PHL-Hydromorphone, 554 PHL-Indapamide, 583 PHL-Ipratropium, 605 PHL-Levetiracetam, 651 PHL-Lisinopril, 675 PHL-Lithium Carbonate, 677 PHL-Loperamide, 681 PHL-Lorazepam, 684 PHL-Lovastatin, 687 PHL-Loxapine, 689 PHL-Meloxicam, 705 PHL-Metformin, 723 PHL-Methylphenidate, 740 PHL-Metoprolol, 750 PHL-Mirtazapine, 769 PHL-Nizatidine, 836 PHL-Ondansetron, 858 PHL-Oxybutinin, 871 PHL-Paroxetine, 890 PHL-Pravastatin, 966 PHL-Risperidone, 1045 PHL-Sertraline, 1073

PHL-Simvastatin, 1078 PHL-Sodium Polystyrene Sulfonate, 1089 PHL-Sotalol, 1095 PHL-Sumatriptan, 1113 PHL-Temazepam, 1128 PHL-Terazosin, 1134 PHL-Topiramate, 1177 PHL-Trazodone, 1189 PHL-Valproic Acid, 1216 PHL-Verapamil SR, 1228 Phos-Ex, 170 PhosLo, 170 PhosLo Gelcap, 170 Phosphodiesterase type 5 inhibitors, 1288–1289 Phyllocontin, 62 Physeptone, 725 physostigmine, S30 phytonadione, 1308–1309, S32 Pima, 961 pimecrolimus, 936–937 pimozide, 938–939 Pin-X, 1001 pindolol, 939–941 Pink Bismuth, 142 Pinta penicillin G benzathine for, 904 penicillin G procaine for, 908 Pinworm infestation mebendazole for, 698 pyrantel for, 1002 pioglitazone hydrochloride, 941–942, P12 piperacillin sodium, 942–944 piperacillin sodium and tazobactam sodium, 944–945 pirbuterol acetate, 945–947 Piriteze, 226 Piriton, 239 piroxicam, 947–949 Pitocin, 877 Pituitary tumors, bromocriptine for, 154 Plague streptomycin for, 1102 tetracycline for, 1142 Boldface: Color section

Pneumonia

Plan B, 656 Plaquenil, 556 Plasma expanders, 1294–1295 Plasmodia transmission, pyrimethamine to control, 1005 Platinex, 258 Platinol, 258 Plavix, 273, P4 Plendil, 459 Pletal, 251 Pleural effusion, bleomycin for, 147 plicamycin, 949–950 PMS Benztropine, 134 PMS Digoxin, 348 PMS Haloperidol, 541 PMS Morphine Sulfate SR, 780 PMS Propranolol, 995 PMS Pyrazinamide, 1002 PMS-Amantadine, 55 PMS-ASA, 21 PMS-Baclofen, 124 PMS-Bethanecol Chloride, 137 PMS-Bicalutamide, 140 PMS-Bisoprolol, 144 PMS-Bromocriptine, 154 PMS-Butorphanol, 167 PMS-Carbamazepine, 180 PMS-Carvedilol, 194 PMS-Cefaclor, 198 PMS-Cephalexin, 224 PMS-Chloral Hydrate, 230 PMS-Clomipramine, 268 PMS-Clonazepam, 270 PMS-Clozapine, 276 PMS-Cyclobenzaprine, 289 PMS-Cyproheptadine, 296 PMS-Desipramine, 324 PMS-Diazepam, 339 PMS-Diclofenac, 343 PMS-Dimenhydrinate, 353 PMS-Diphenhydramine, 356 PMS-Divalproex, 1216 PMS-Docusate Calcium, 366 PMS-Docusate Sodium, 366 PMS-Enalpril, 401 PMS-Famciclovir, 456 PMS-Fluconazole, 474 t: table

PMS-Flunisolide, 478 PMS-Fluphenazine, 483 PMS-Flurazepam, 486 PMS-Flutamide, 487 PMS-Fluvoxamine, 493 PMS-Fosinopril, 501 PMS-Furosemide, 507 PMS-Gabapentin, 510 PMS-Gemfibrozil, 520 PMS-Gentamicin, 523 PMS-Glimepiride, 527 PMS-Glyburide, 532 PMS-Hydrochlorothiazide, 547 PMS-Hydromorphone, 554 PMS-Hydroxyzine, 559 PMS-Ibuprofen, 566 PMS-Imipramine, 576 PMS-Indapamide, 583 PMS-Ipratropium, 605 PMS-Isosorbide, 618 PMS-Lactulose, 630 PMS-Lamotrigine, 633 PMS-Leflunomide, 640 PMS-Levetiracetam, 651 PMS-Lindane LOT1, 665 PMS-Lindane SHP1, 665 PMS-Lithium Carbonate, 677 PMS-Lithium Citrate, 677 PMS-Loperamine, 681 PMS-Lorazepam, 684 PMS-Lovastatin, 687 PMS-Loxapine, 689 PMS-Medroxyprogesterone, 700 PMS-Metformin, 723 PMS-Methocarbamol, 730 PMS-Methylphenidate, 740 PMS-Metoclopramide, 746 PMS-Metoprolol-L, 750 PMS-Metronidazole, 752 PMS-Minocycline, 765 PMS-Mirtazapine, 769 PMS-Misoprostol, 771 PMS-Naproxen EC, 800 PMS-Neostigmine Methylsulfate, 813 PMS-Nizatidine, 836 PMS-Nortriptyline, 844 PMS-Nystatin, 846 PMS-Ondansetron, 858 PMS-Oxazepam, 868 PMS-Oxybutinin, 871 PMS-Pantoprazole, 888

1419

PMS-Paroxetine, 890 PMS-Phenobarbital, 926 PMS-Pimozide, 938 PMS-Pindolol, 939 PMS-Pioglitazone, 941 PMS-Piroxicam, 947 PMS-Potassium Gluconate, 959 PMS-Pramipexole, 963 PMS-Pravastatin, 966 PMS-Promethazine, 988 PMS-Propafenone, 990 PMS-Rabeprazole, 1017 PMS-Risperidone, 1045 PMS-Selegiline, 1070 PMS-Sertraline, 1073 PMS-Simvastatin, 1078 PMS-Sodium Polystyrene Sulfonate, 1089 PMS-Sotalol, 1095 PMS-Sucralfate, 1104 PMS-Sulfacetamide, 1105 PMS-Sulfasalazine, 1109 PMS-Sulfasalazine-E.C., 1109 PMS-Sumatriptan, 1113 PMS-Tamoxifen, 1122 PMS-Temazepam, 1128 PMS-Terazosin, 1134 PMS-Testosterone, 1139 PMS-Theophylline, 1146 PMS-Ticlopidine, 1156 PMS-Timolol, 1159 PMS-Tobramycin, 1171 PMS-Topiramate, 1177 PMS-Trazodone, 1189 PMS-Trifluoperazine, 1202 PMS-Trihexyphenidyl, 1204 PMS-Valproic Acid, 1216 PMS-Vancomycin, 1221 PMS-Venlafaxine XR, 1226 PMS-Verapamil SR, 1228 Pneumococcal immunization schedule, 1346t, 1347t, 1348t Pneumomist, 539 Pneumonia acetylcysteine for, 19 amoxicillin and clavulanate for, 78 azithromycin for, 120 cefazolin for, 202 cefdinir for, 204 Boldface: Color section

1420

Pneumonia

Pneumonia (continued) cefepime for, 206 cefpodoxime for, 212 ciprofloxacin for, 256 clarithromycin for, 262 ertapenem for, 421 erythromycin for, 424 gemifloxacin for, 522 hydrocortisone for, 552 immune globulin for, 580 levofloxacin for, 654 linezolid for, 667 moxifloxacin for, 784 ofloxacin for, 849 penicillin G procaine for, 908 pentamidine for, 911 piperacillin and tazobactam for, 944 piperacillin for, 942 prednisone for, 972 sulfamethoxazoletrimethoprim for, 1106, 1107 telithromycin for, 1125 Poisoning, activated charcoal for, 26 Poisonings and overdoses, managing, S30–S32 Poliovirus immunization schedule, 1347t, 1348t Pollenase Nasal, 129 Pollenshield Hayfever, 226 Polyarthritis, salsalate for, 1061 Polyfusor, 696 Polygam S/D, 579 poractant alfa, 950–951 Portal-system encephalopathy, lactulose for, 630 posaconazole, 951–954 Posanol, 951 Post-anesthesia care nursing, most commonly used drugs in, 1370 Postherpetic neuralgia gabapentin for, 510 pregabalin for, 975 PostMI, 21 t: table

Postpartum bleeding methylergonovine for, 739 oxytocin for, 878 Posttraumatic stress disorder paroxetine for, 890 sertraline for, 1073 Posture, 171 potassium acetate, 954–955 potassium bicarbonate, 955–957 potassium chloride, 957–959 Potassium depletion potassium acetate for, 954 potassium bicarbonate for, 956 potassium chloride for, 957 potassium gluconate for, 959 potassium gluconate, 959–960 potassium iodide, 961–963 potassium, therapeutic and toxic blood levels for, S17 Prader-Willi syndrome, somatropin, recombinant for, 1092 pralidoxime, S32 pramipexole dihydrochloride, 963–964 pramlintide acetate, 964–965 Prandase, 11 Prandin, 1030 Pravachol, 966, P12 pravastatin sodium, 966–967, P12 prazosin hydrochloride, 967–968 Precortisyl, 969 Precose, 11 Pred Forte Ophthalmic, 969 Pred Mild Ophthalmic, 969 prednisolone, 969–972 prednisolone acetate, 969–972 prednisolone sodium phosphate, 969–972 prednisone, 972–974

Predsol, 969 Preferin, 930 pregabalin capsules CV, 975–976 Pregnancy preventing (See Contraception.) terminating (See Abortion) Pregnancy risk categories, xvii Prelone, 969 Premarin, 432, P6 Premarin Intravenous, 432 Premenstrual dysphoric disorder fluoxetine for, 482 paroxetine for, 891 sertraline for, 1073 Premphase, 1344 Prepidil Endocervical Gel, 354 Prescal, 620 Prevacid, 637, P8 Prevacid SoluTab, 637 Prevalite, 248 Prezista, 311 Priadel, 677 Priftin, 1038 Prilosec, 857, P11 Prilosec OTC, 857 primaquine phosphate, 976–977 Primary aldosteronism potassium acetate for, 954 potassium chloride for, 957 Primary hyperaldosteronism, spironolactone for, 1097 Primatene Mist, 409 Primaxin, 575, 1344 primidone, 978–979 therapeutic and toxic blood levels for, S17 Prinivil, 675, P9 Pripsen, 698 Pristiq, 329 Privigen, 579 Pro-Banthine, 992 Pro-Epanutin, 503 Pro-Indo, 586 Pro-Lorazepam, 684 PRO-Piroxicam, 947 Boldface: Color section

Pulmonary artery hypertension

ProAmatine, 760 probenecid, 979–980 procainamide hydrochloride, 980–982 therapeutic and toxic blood levels for, S17 procaine hydrochloride, 1336t–1337t Procan SR, 980 procarbazine hydrochloride, 982–984 Procardia, 822 Procardia XL, 822 prochlorperazine, 984–986 prochlorperazine edisylate, 984–986 prochlorperazine maleate, 984–986 Procrit, 415 Proctitis hydrocortisone for, 552 mesalamine for, 717 Proctosigmoiditis, mesalamine for, 717 Procytox, 291 Prodiem PlainW, 1000 Prodium, 923 Profilnine SD, 455 progesterone, 986–988 Progestins, 1297–1298 Proglycem, 341 Prograf, 1118 Progynova, 429 Proleukin, 37 promethazine hydrochloride, 988–990 Promethegan, 988 Prometrium, 986 Pronestyl, 980 propafenone hydrochloride, 990–992 propantheline bromide, 992–993 Propecia, 471 Proplex T (heat-treated), 455 propoxyphene hydrochloride, 993–995 propoxyphene napsylate, 993–995 propoxyphene napsylate and acetaminophen, P12 t: table

propranolol hydrochloride, 995–998 therapeutic and toxic blood levels for, S17 Propress, 354 Propyl-Thyracil, 998 propylthiouracil, 998–999 Proscar, 471 prostaglandin E2, 354–355 Prostap, 647 Prostate cancer bicalutamide for, 140 docetaxel for, 364 estradiol for, 430 estrogens, conjugated for, 432 estrogens, esterified for, 434 flutamide for, 487 goserelin for, 535, 536 leuprolide for, 648 mitoxantrone for, 774 nilutamide for, 826 triptorelin for, 1209 Prostate, transurethral resection of, mannitol for, 697 Prostatitis ciprofloxacin for, 255 levofloxacin for, 654 norfloxacin for, 842 ofloxacin for, 849 Prostep, 819 Prostigmin, 813 Prostin E2 Vaginal Suppository, 354 protamine sulfate, S31 Protium, 888 Proton pump inhibitors, 1278–1279 Protonix, 888, P11 Protonix IV, 888 Protopam, S32 Protopic, 1118 Protrin, 1106 Protrin DS, 1106 Protylol, 345 Proventil, 35 Proventil HFA, 35 Provera, 700 Provigil, 776 Prozac, 481, P7 Prozac Weekly, 481 Proziere, 984

1421

Prozit, 481 Prudoxin, 376 Pruritus cholestyramine for, 248 desloratadine for, 326 doxepin for, 376 hydrocortisone for, 552 hydroxyzine for, 559 pseudoephedrine hydrochloride, 999–1000 pseudoephedrine sulfate, 999–1000 Pseudomembranous colitis, 1362 Pseudomonas aeruginosa infection, tobramycin for, 1172 pseudomonic acid, 785–787 pseudomonic acid A, 785–787 Pseudotumor cerebri, 1362 Psoriasis acitretin for, 24 cyclosporine for, 293 etanercept for, 438 methotrexate for, 733 triamcinolone for, 1196 Psoriatic arthritis adalimumab for, 30 etanercept for, 438 Psychiatric emergencies, hydroxyzine for, 559 Psychiatric nursing, most commonly used drugs in, 1370 Psychotic disorders fluphenazine for, 484 haloperidol for, 541, 542 olanzapine for, 851 psyllium, 1000–1001 PTU, 998–999 Puberty delayed, testosterone for, 1139 precocious leuprolide for, 648 nafarelin for, 796 Pulmicort Flexhaler, 157 Pulmicort Respules, 157 Pulmonary artery hypertension, treprostinil for, 1191 Boldface: Color section

1422

Pulmonary complications

Pulmonary complications, surgical, acetylcysteine for, 19 Pulmonary disease, doxapram for, 373 Pulmonary edema, furosemide for, 508 Pulmonary embolism alteplase for, 53 dalteparin for, 302 enoxaparin for, 405 fondaparinux for, 495 streptokinase for, 1100 warfarin for, 1238 Pulmonary function, dornase alfa for improving, 372 Pulmonary infection, flucytosine for, 476 Pulmonary toxicity, 1362 Pulmophyllin ELX, 1146 Pulmozyme, 372 Pupil dilation atropine for, 115 phenylephrine for, 931 Puri-Nethol, 714 Purinethol, 714 Pyelonephritis, ciprofloxacin for, 256 Pylorospasm, scopolamine for, 1067 pyrantel pamoate, 1001–1002 pyrazinamide, 1002–1003 Pyridium, 923 pyridostigmine bromide, 1003–1005 Pyridoxine deficiency, pyridoxine for, 1309 pyridoxine hydrochloride, 1309 pyrimethamine, 1005–1006

Q QDall AR, 239 Quelicin, 1338t–1339t Questran, 248 Questran Light, 248 quetiapine fumarate, 1007–1009, P12 quinapril hydrochloride, 1009–1011, P13 t: table

quinidine gluconate, 1011–1014 therapeutic and toxic blood levels for, S17 quinidine sulfate, 1011–1014 Quinil, 1009 quinine sulfate, 1014–1015 quinupristin and dalfopristin, 1015–1017 Quixin, 653 QVAR, 129

R rabeprazole sodium, 1017–1018, P13 Raciran, 1024 Radiation protectant, potassium iodide as, 961 Radiologic examination glucagon for, 531 metoclopramide for, 747 Ralivia, 1182 raloxifene, 1018–1019, P13 raltegravir, 1019–1020 ramelteon, 1020–1021 ramipril, 1021–1024, P13 Ran-Cefprozil, 214 Ran-Fentanyl, 464 Ran-Fosinopril, 501 Ran-Lovastatin, 687 Ran-Metformin, 723 Ran-Pantoprazole, 888 Ran-Pravastatin, 966 Ran-Rabeprazole, 1017 Ran-Risperidone, 1045 Ran-Tamsulosin, 1123 Ranexa, 1026 Raniclor, 198 ranitidine hydrochloride, 1024–1026 Ranitil, 1024 ranolazine, 1026–1027 Rantek, 1024 Ranzolont, 1078 Rap-eze, 170 Rapamune, 1079 Rape victims, ampicillin for, 85 Rapilysin, 1032 Rapranol SR, 995

rasagiline, 1027–1029 rasburicase, 1029–1030 Rat bite fever penicillin G potassium for, 906 penicillin G procaine for, 908 Ratio Clomipramine, 268 Ratio Clonazepam, 270 Ratio-Alendronate, 41 Ratio-Bicalutamide, 140 Ratio-Cefuroxime, 221 Ratio-Cyclobenzaprine, 289 Ratio-Desipramine, 324 Ratio-Diltiazem, 351 Ratio-Docusate Calcium, 366 Ratio-Docusate Sodium, 366 Ratio-Enalpril, 401 Ratio-Fentanyl, 464 Ratio-Flunisolide, 478 Ratio-Fluvoxamine, 493 Ratio-Fosinopril, 501 Ratio-Gabapentin, 510 Ratio-Gentamicin, 523 Ratio-Glimepiride, 527 Ratio-Glyburide, 532 Ratio-Indomethacin, 586 Ratio-Ipratropium, 605 Ratio-Ketoconazole, 623 Ratio-Lactulose, 630 Ratio-Lamotrigine, 633 Ratio-Lisinopril, 675 Ratio-Lovastatin, 687 Ratio-Meloxicam, 705 Ratio-Metformin, 723 Ratio-Methotrexate Sodium, 731 Ratio-Methylphenidate, 740 Ratio-Minocycline, 765 Ratio-Mirtazapine, 769 Ratio-Morphine Sulfate SR, 780 Ratio-MPA, 700 Ratio-Nortriptyline, 844 Ratio-Nystatin, 846 Ratio-Omeprazole, 857 Ratio-Ondansetron, 858 Ratio-Pantoprazole, 888 Ratio-Pioglitazone, 941 Ratio-Pravastatin, 966 Ratio-Ramipril, 1021 Ratio-Risperidone, 1045 Boldface: Color section

Restless leg syndrome

Ratio-Sertraline, 1073 Ratio-Simvastatin, 1078 Ratio-Sotalol, 1095 Ratio-Sumatriptan, 1113 Ratio-Tamsulosin, 1123 Ratio-Temazepam, 1128 Ratio-Terazosin, 1134 Ratio-Theo-Bronc, 1146 Ratio-Topiramate, 1177 Ratio-Trazodone, 1189 Ratio-Valproic, 1216 Ratio-Valproic ECC, 1216 Ratio-Venlafaxine XR, 1226 Razadyne, 512 Razadyne ER, 512 Reactine, 226 ReAzo, 923 Rebetol, 1033 Rebif, 602 Reclast, 1247 Recombinate, 94 Recommended dietary allowance for ascorbic acid, 1303 for cholecalciferol, 1303 for cyanocobalamin, 1305 for folic acid, 1306 for manganese, 1307 for niacin, 1307 for pyridoxine, 1309 for retinol, 1310 for riboflavin, 1310 for selenium, 1311 for thiamine, 1311 for tocopherols, 1312 for zinc, 1312 Rectal cancer. See Colorectal cancer Rectal infection, tetracycline for, 1142 red yeast rice, 1326 ReFacto, 94 Refludan, 643 Refolinon, 645 Refraction, phenylephrine for, 931 Regaine, 767 Reglan, 746 Regonol, 1003 Regulan, 1000 Reguloid, 1000 t: table

Reguloid Sugar Free, 1000 Regulose, 630 Regurin, 1211 Relenza, 1242 Relifex, 793 Relistor, 738 Relpax, 396 Remegel, 170 Remeron, 769 Remeron RD, 769 Remeron Soltab, 769 Remicade, 587 remifentanil hydrochloride, 1336t–1337t Reminyl, 512 Reminyl XL, 512 Remodulin, 1191 Renal acidosis, 1362 Renal cancer medroxyprogesterone for, 701 vinblastine for, 1231 Renal cell carcinoma aldesleukin for, 38 sorafenib for, 1093 sunitinib for, 1115 Renal colic, hyoscyamine for, 561 Renal disorders chlorothiazide for, 237 chlorthalidone for, 245 lanthanum for, 639 metolazone for, 748 Renal dysfunction, hydrochlorothiazide for, 547 Renal failure, 1362 mannitol for, 696 Renal function, inadequate, mannitol as test dose for, 696 Renal tubular necrosis, sodium bicarbonate for, 1083 Renedil, 459 Renin-angiotensin system antagonists, 1295–1296 Rennie Soft Chews, 170 Renova, 1192 ReoPro, 7 repaglinide, 1030–1032 Replenine, 455

1423

Reproductive technologies, assisted menotropins for, 710 progesterone for, 987 Repronex, 710 Requip, 1054 Requip XL, 1054 Rescriptor, 321 Resectisol, 696 Resonium A, 1089 Respiratory acidosis, 1362 Respiratory depression, doxapram for, 373 Respiratory disorders betamethasone for, 135 methylprednisolone for, 744 palivizumab for, 884 prednisolone for, 969 triamcinolone for, 1197 Respiratory distress syndrome calfactant for, 174 poractant alfa for, 951 Respiratory syncytial virus infection palivizumab for, 884 ribavirin for, 1034 Respiratory tract infection amoxicillin and clavulanate for, 78 amoxicillin for, 76 ampicillin for, 84 cefaclor for, 199 cefazolin for, 202 cefoxitin for, 211 ceftazidime for, 216 ceftriaxone for, 219 cefuroxime for, 221 cephalexin for, 225 ciprofloxacin for, 256 dornase alfa for, 372 erythromycin for, 423 flucytosine for, 476 guaifenesin for, 539 imipenem and cilastatin for, 575 penicillin G benzathine for, 904 penicillin V potassium for, 910 ribavirin for, 1034 Respontin, 605 Restasis, 293 Restless leg syndrome Boldface: Color section

1424

Restless leg syndrome

Restless leg syndrome (continued) pramipexole for, 963 ropinirole for, 1055 Restoril, 1128 Resyl, 539 Retavase, 1032 reteplase, recombinant, 1032–1033 Retin-A, 1192 Retin-A Micro, 1192 retinol, 1310 Retinoscopy, phenylephrine for, 931 Retrovir, 1243 Revatio, 1075 ReVia, S32 Revlimid, 641 Rhabdomyolysis, 1362 Rheumacin, 586 Rheumatic disorders methylprednisolone for, 744 prednisolone for, 969 triamcinolone for, 1196 Rheumatic fever acetylsalicylic acid for, 21 penicillin G benzathine as prophylaxis for, 904 penicillin V potassium for, 910 Rheumatism, salsalate for, 1061 Rheumatoid arthritis. See also Juvenile rheumatoid arthritis. abatacept for, 6 acetylsalicylic acid for, 21 adalimumab for, 30 anakinra for, 91 azathioprine for, 119 betamethasone for, 135 celecoxib for, 223 cyclosporine for, 293 diclofenac for, 343 etanercept for, 438 etodolac for, 442 hydroxychloroquine for, 557 ibuprofen for, 567 indomethacin for, 586 infliximab for, 588 t: table

Rheumatoid arthritis (continued) leflunomide for, 640 meloxicam for, 706 methotrexate for, 733 nabumetone for, 793 oxaprozin for, 866 rituximab for, 1050 salsalate for, 1061 sulfasalazine for, 1109 Rhinalar Nasal Mist, 478 Rhinall, 930 Rhinitis beclomethasone for, 129 budesonide for, 157 cromolyn for, 288 cyproheptadine for, 296 desloratadine for, 326 diphenhydramine for, 356 fexofenadine for, 468 flunisolide for, 478 fluticasone for, 489 hyoscyamine for, 561 ipratropium for, 605 levocetirizine for, 653 montelukast for, 779 triamcinolone for, 1196 Rhinocort Aqua, 157 Rhodacine, 586 Rhotard, 780 Rhotral, 12 Rhoxal-Metformin, 723 Rhoxal-Oxaprozin, 866 Rhoxal-Sotalol, 1095 Rhoxal-Timolol, 1159 Rhythmodan, 360 Rhythmodan-LA, 360 Ribasphere, 1033 ribavirin, 1033–1035 riboflavin, 1310 Riboflavin deficiency, riboflavin for, 1310 Rickettsial infection, tetracycline for, 1142 rifabutin, 1035–1036 Rifadin, 1036 Rifamate, 1345 rifampicin, 1036–1038 rifampin, 1036–1038 rifapentine, 1038–1040 Rifater, 615, 1345 Rifinah, 615 rifiximin, 1040–1041 Rilutek, 1041

riluzole, 1041–1042 Rimacid, 586 Rimacillin, 84 Rimactazid, 615 rimantadine hydrochloride, 1042–1043 Rimapurinol, 45 Rinatec, 605 Riomet, 723 risedronate sodium, 1043–1045, P13 Risperdal, 1045, P13 Risperdal Consta, 1045 Risperdal M-Tab, 1045 risperidone, 1045–1047, P13 Ritalin, 740 Ritalin LA, 740 Ritalin-SR, 740 ritonavir, 1047–1049 Rituxan, 1050 rituximab, 1050–1052 Riva K 20 SR, 957 Riva Oxazepam, 868 Riva-Cyclobenzaprine, 289 Riva-Enalpril, 401 Riva-Fluconazole, 474 Riva-Fluvoxamine, 493 Riva-Fosinopril, 501 Riva-Gabapentin, 510 Riva-Gemfibrozil, 520 Riva-Glyburide, 532 Riva-Hydroxyzine, 559 Riva-Indapamide, 583 Riva-Lisinopril, 675 Riva-Loperamine, 681 Riva-Metformin, 723 Riva-Minocycline, 765 Riva-Mirtazapine, 769 Riva-Naproxen, 800 Riva-Naproxen Sodium, 800 Riva-Paroxetine, 890 Riva-Pravastatin, 966 Riva-Risperidone, 1045 Riva-Sertraline, 1073 Riva-Simvastatin, 1078 Riva-Sumatriptan, 1113 Riva-Venlafaxine XR, 1226 Riva-Verapamil SR, 1228 Rivanese, 129 rivastigmine tartrate, 1052–1053 Rivotril, 270 rizatriptan benzoate, 1053–1054 Boldface: Color section

Schizophrenia

Robaxin, 730 Robidrine, 999 Robinul, 534 Robinul Forte, 534 Robitussin, 539 Robitussin Chesty Cough, 539 Robitussin CoughGels, 336 Robitussin for Dry Coughs, 336 Robitussin Maximum Strength Cough Suppressant, 336 Robitussin Pediatric Cough, 336 Rocephin, 219 rocuronium bromide, 1338t–1339t Rodex, 1309 Rofact, 1036 Rogaine, 767 Rogaine Extra Strength, 767 Rogitine, 929 Rolaids Calcium Rich, 170 Romazicon, S30 Rommix, 423 ropinirole hydrochloride, 1054–1056 ropivacaine hydrochloride, 1338t–1339t Rosacea, metronidazole for, 753 Rosasol, 752 rosiglitazone maleate, 1056–1057, P13 rosuvastatin calcium, 1057–1059, P14 Rotavirus immunization schedule, 1347t Roundworm infestation mebendazole for, 698 pyrantel for, 1002 Rowasa, 717 Roxicet, 1345 Roxicodone, 872 Rozerem, 1020 Rozex, 752 RU-486, 761–763 Rubella exposure, immune globulin for, 579 Rubella immunization schedule, 1346t, 1347t, 1348t Rubex, 378 t: table

Rubramin, 1305 Rylosol, 1095 Rythmol, 990

S S-adenosylmethionine, 1326–1327 Safe drug administration, S1–S32 Saizen, 1091 Sal-Adult, 21 Sal-Infant, 21 Salazopyrin, 1109 Salazopyrin EN-Tabs, 1109 salbutamol, 35–37 salbutamol sulfate, 35–37 Salicylate toxicity, 1362 salicylates, therapeutic and toxic blood levels for, S17 salmeterol xinafoate, 1060–1061 Salofalk, 717 salsalate, 1061–1063 SAM-e, 1326–1327 Sanctura, 1211 Sanctura XR, 1211 Sancuso, 537 Sandimmune, 293 Sandoglobulin, 579 Sandostatin, 847 Sandostatin LAR, 847 Sandoz Alendronate, 41 Sandoz Bicalutamide, 140 Sandoz Bisoprolol, 144 Sandoz Calcitonin, 169 Sandoz Carbamazepine, 180 Sandoz Cefprozil, 214 Sandoz Cyclosporine, 293 Sandoz Diltiazem, 351 Sandoz Famciclovir, 456 Sandoz Fluvoxamine, 493 Sandoz Glimepiride, 527 Sandoz Glyburide, 532 Sandoz Indomethacin, 586 Sandoz Leflunomide, 640 Sandoz Loperamide, 681 Sandoz Lovastatin, 687 Sandoz Metformin, 723 Sandoz Metoprolol, 750 Sandoz Minocycline, 765 Sandoz Mirtazapine, 769 Sandoz Nabumetone, 793 Sandoz Omeprazole, 857

1425

Sandoz Ondansetron, 858 Sandoz Pantoprazole, 888 Sandoz Paroxetine, 890 Sandoz Pioglitazone, 941 Sandoz Pravastatin, 966 Sandoz Ramipril, 1021 Sandoz Risperidone, 1045 Sandoz Sertraline, 1073 Sandoz Simvastatin, 1078 Sandoz Sotalol, 1095 Sandoz Sumatriptan, 1113 Sandoz Tamsulosin, 1123 Sandoz Ticlopidine, 1156 Sandoz Timolol, 1159 Sandoz Valproic, 1216 Sandoz Venlafaxine XR, 1226 Sandoz-Enalpril, 401 Sandoz-Pindolol, 939 Sandoz-Topiramate, 1177 Sandrena, 429 Sans-Acne, 423 saquinavir mesylate, 1063–1065 Sarafem, 481 Sarcoidosis, 1362 sargramostim, 1065–1067 SAS Tab, 1109 saw palmetto, 1327 Scabies, lindane for, 666 Scalds potassium acetate for, 954 potassium chloride for, 957 Scaling, ketoconazole for, 624 Scarlet fever, penicillin V potassium for, 910 Schizophrenia aripiprazole for, 102 chlorpromazine for, 241 clozapine for, 277 haloperidol for, 541 loxapine for, 689 olanzapine for, 851 paliperidone for, 883 perphenazine for, 921 prochlorperazine for, 985 quetiapine for, 1007 risperidone for, 1045 thioridazine for, 1149 trifluoperazine for, 1202 ziprasidone for, 1245 Boldface: Color section

1426

Scopace

Scopace, 1067 Scopoderm TTS, 1067 scopolamine, 1067–1068 scopolamine hydrobromide, 1067–1068 Scot-tussin Expectorant, 539 Scurvy, ascorbic acid for, 1303 Sea-Legs, 699 SeapCal, 170 Seasonale, 1345 Sebomin, 765 Seborrheic dermatitis, ketoconazole for, 624 Sebren, 765 secobarbital, 1069–1070 Seconal, 1069 Secretions, diminishing atropine for, 115 glycopyrrolate for, 534 hyoscyamine for, 561 Sectral, 12 Securon SR, 1228 Sedation chloral hydrate for, 230 chlorpromazine for, 241 diphenhydramine for, 356 hydroxyzine for, 559 lorazepam for, 684 meperidine for, 712 midazolam for, 758, 1334t–1335t pentazocine for, 913 pentobarbital for, 915 phenobarbital for, 927 promethazine for, 989 scopolamine for, 1067 secobarbital for, 1069 Sedative-hypnotics, 1296–1297 Sedatuss, 336 Seizures. See also Status epilepticus. acetazolamide for, 17 carbamazepine for, 180 clonazepam for, 270 clorazepate for, 275 diazepam for, 339 divalproex sodium for, 1217 fosphenytoin for, 503 gabapentin for, 510 lamotrigine for, 633, 634, 635 t: table

Seizures (continued) levetiracetam for, 651 magnesium for, 695 oxcarbazepine for, 870 pentobarbital for, 915 phenobarbital for, 927 phenytoin for, 934 pregabalin for, 975 primidone for, 978 thiopental for, 1340t–1341t tiagabine for, 1153 topiramate for, 1177 valproate for, 1217 valproic acid for, 1217 zonisamide for, 1251 Selax, 366 Sele-Pak, 1311 Selective aldosterone receptor antagonists, 1295–1296 Selective estrogen receptor modulators, 1297–1298 selegiline hydrochloride, 1070–1072 selenium, 1311 Selenium deficiency, selenium for, 1311 Selepen, 1311 Self-injury, risperidone for, 1045 Semi-Daonil, 532 Senexon, 1072 senna, 1072–1073 Senna-Gen, 1072 Sennatural, 1072 sennosides, 1072–1073 Senokot, 1072 Senokot Granules, 1072 SenokotXTRA, 1072 Senolax, 1072 Sensipar, 253 Sepsis, 1362 Septicemia ampicillin for, 84 cefazolin for, 202 cefotaxime for, 209 cefoxitin for, 211 ceftazidime for, 216 ceftriaxone for, 219 drotrecogin alfa for, 389 flucytosine for, 476 immune globulin for, 580

Septra, 1106, 1345 Septra DS, 1106 Septrin, 1106 Serenace, 541 Serevent, 1060 Serevent Diskus, 1060 Serophene, 267 Seroquel, 1007, P12 Seroquel XR, 1007 Serostim, 1091 Serotonin receptor agonists, 1271–1272 Seroxat, 890 sertraline hydrochloride, 1073–1075, P14 therapeutic and toxic blood levels for, S17 Serum sickness, 1362 Setlers, 170 Sevredol, 780 Sex hormones, 1297–1298 Sexually transmitted disease, ampicillin as prophylaxis for, 85 Shadow test, phenylephrine for, 931 shark cartilage, 1327 Shigellosis, sulfamethoxazoletrimethoprim for, 1106 Shingles. See Herpes zoster infection. Shock dopamine for, 370 isoproterenol for, 617 phenylephrine for, 931 Short bowel syndrome, somatropin, recombinant for, 1092 Short stature, somatropin, recombinant for, 1092 Sickle cell anemia, hydroxyurea for, 558 Silace, 366 Siladryl, 356 Silapap, 14 sildenafil citrate, 1075–1077, P14 Silfedrine Children’s, 999 Siltussin SA, 539 Boldface: Color section

Soma

simethicone, 1077 simeticone, 1077 Simply Sleep, 356 Simulect, 127 Simvador, 1078 simvastatin, 1078–1079, P14 Sinemet, 182, 1345 Sinemet CR, 182 Sinepin, 376 Singulair, 778, P10 Sinus congestion, pseudoephedrine for, 999 Sinusitis amoxicillin and clavulanate for, 78 azithromycin for, 121 cefdinir for, 204 cefprozil for, 214 ciprofloxacin for, 255 clarithromycin for, 261 levofloxacin for, 654 moxifloxacin for, 784 sirolimus, 1079–1081 sitagliptin phosphate, 1081–1083 Sitosterolemia, ezetimibe for, 452 Skelaxin, 722 Skeletal muscle relaxants, 1298–1299 Skeletal muscle relaxation atracurium for, 1330t–1331t botulinum toxin for, 152 pancuronium for, 1334t–1335t rocuronium for, 1338t–1339t succinylcholine for, 1338t–1339t vecuronium for, 1340t–1341t Skin and skin-structure infection amoxicillin and clavulanate for, 78 amoxicillin for, 76 ampicillin and sulbactam for, 87 ampicillin for, 84 azithromycin for, 121 cefaclor for, 199 cefadroxil for, 200 t: table

Skin and skin-structure infection (continued) cefazolin for, 202 cefdinir for, 204 cefepime for, 205 cefoxitin for, 211 cefpodoxime for, 212 cefprozil for, 214 ceftazidime for, 216 ceftriaxone for, 219 cefuroxime for, 221 cephalexin for, 225 ciprofloxacin for, 256 clarithromycin for, 262 ertapenem for, 421 erythromycin for, 423 imipenem and cilastatin for, 575 levofloxacin for, 654 linezolid for, 667 moxifloxacin for, 784 ofloxacin for, 849 penicillin V potassium for, 910 piperacillin and tazobactam for, 944 quinupristin and dalfopristin for, 1016 tigecycline for, 1158 Skin cancer, bleomycin for, 147 Skin disorders, methylprednisolone for, 744 Skin lesions, mupirocin for, 786 Sleepeaze, 356 Slo-Indo, 586 Slo-Niacin, 1307 Slo-Phyllin, 1146 Slo-Pro, 995 Slo-Salt, 1084 Slofedipine, 822 Slow Sodium, 1084 Slow-K, 957 Slow-Pot, 957 Slozem, 351 Small-bowel intubation, metoclopramide for, 747 Small-for-gestational-age infants, somatropin, recombinant for, 1092

1427

Smoking cessation bupropion for, 163 nicotine for, 820 varenicline for, 1224 Social anxiety disorder fluvoxamine for, 493 sertraline for, 1073 venlafaxine for, 1226 sodium bicarbonate, 1083–1084 sodium chloride, 1084–1085 therapeutic and toxic blood levels for, S17 Sodium chloride replacement, sodium chloride for, 1084 Sodium depletion, sodium chloride for, 1085 sodium iodide 131I, 1086–1087 Sodium Iodide 131I Therapeutic, 1086 sodium phosphates, 1087–1088 sodium polystyrene sulfonate, 1089–1090 Soflax C, 366 Soft-tissue infection amoxicillin for, 76 ampicillin for, 84 cefdinir for, 204 cefpodoxime for, 212 linezolid for, 667 penicillin V potassium for, 910 Solage, 1345 Solar keratoses, fluorouracil for, 479 Solfoton, 926 solifenacin succinate, 1090–1091 Solodyn, 765 Soloxine, 660 Soltamox, 1122 Solu-Cortef, 551 Solu-Crom, 287 Solu-Medrol, 744 Solu-Medrone, 744 Som Pam, 486 Soma, 188 Boldface: Color section

1428

somatropin, recombinant

somatropin, recombinant, 1091–1093 Somavert, 900 Sominex, 356, 988 Somnol, 486 Somnote, 230 Sonata, 1241 Soni-Slo SR, 618 sorafenib, 1093–1095 Sorbid, 618 Soriatane, 24 Sorine, 1095 Sotacor, 1095 sotalol hydrochloride, 1095–1097 Sour stomach, famotidine for, 458 soy, 1327–1328 Spasticity. See Muscle spasm. Spinal cord injury, dantrolene for, 307 Spinal cord lesions, baclofen for, 124 Spiriva HandiHaler, 1165 spironolactone, 1097–1098 Sporanox, 621 Sporotrichosis, amphotericin B for, 81 Spriva, 1165 Sprycel, 313 SPS Sodium Polystyrene Sulfonate, 1089 SSKI, 961 St. John’s wort, 1328 St. Joseph, 21 Stadol, 167 Stagesic, 549 Stalevo, 185, 1345 Staril, 501 Starlix, 803 Statex, 780 Status epilepticus diazepam for, 339 fosphenytoin for, 503 lorazepam for, 684 phenobarbital for, 927 phenytoin for, 934 stavudine, 1098–1100 Steatosis, 1362 Stem cell transplantation busulfan for, 166 filgrastim for, 470 micafungin for, 757 t: table

Stemetil, 984 Stesolid, 339 Stevens-Johnson syndrome, 1362 Stie-Cort, 551 Stiemycin, 423 Stiff-man syndrome, diazepam for, 339 Stilnoct, 1250 Stimate, 327 Stomach cancer. See Gastric cancer. Stool Softener DC, 366 Stool softener, docusate as, 366 Strabismus, botulinum toxin for, 152 Strattera, 110, P3 Streptase, 1100 Streptogramins, 1269–1270 streptokinase, 1100–1102 streptomycin sulfate, 1102–1104 therapeutic and toxic blood levels for, S17 Striant, 1139 Strifon Forte, 247 Stroke. See Cerebrovascular accident. Stronazon, 1123 Subarachnoid hemorrhage, nimodipine for, 827 Subcutaneous injections, sites for, S15 Sublimaze, 464, 1332t–1333t Subutex, 161 succinylcholine chloride, 1338t–1339t sucralfate, 1104–1105 Sudafed, 999 Sudafed 12 Hour, 999 Sudafed Children’s Nasal Decongestant, 999 Sudafed PE, 930 Sudo-Tab, 999 Sudodrin, 999 SudoGest, 999 Sufenta, 1340t–1341t sufentanil, 1340t–1341t Sular, 828 Sulazine, 1109 Sulcrate, 1104

sulfacetamide sodium, 1105–1106 sulfamethoxazoletrimethoprim, 1106–1109 sulfasalazine, 1109–1111 Sulfate SR, 780 Sulfatrim, 1106 Sulfazine, 1109 Sulfazine EC, 1109 sulfisoxazole acetyl, 1111–1113 Sulfonamides, 1269–1270 sumatriptan succinate, 1113–1115, P14 sunitinib malate, 1115–1117 Supasa, 21 Supeudol, 872 Supralip, 460 Suprax, 207 Sure-Lax, 1072 Surfak Liquigels, 366 Surgical complications, acetylcysteine for, 19 Surgical prophylaxis cefazolin for, 202 cefotaxime for, 209 cefoxitin for, 211 ceftriaxone for, 219 ertapenem for, 421 gentamicin for, 524 metronidazole for, 753 neomycin for, 812 Surmontil, 1206 Sustiva, 394 Sutent, 1115 Symax, 560 Symax-SL, 560 Symax-SR, 560 Symbyax, 1345 Symlin, 964 Symmetrel, 55 Sympathetic ophthalmia, triamcinolone for, 1197 Synacort, 551 Synagis, 884 Synarel, 796 Synastone, 725 Syndrome of inappropriate diuretic hormone secretion, 1363 Synercid, 1015 Boldface: Color section

Thalitone

Synflex, 800 Synthroid, 660, P9 Syntocinon, 877 Syntometrine, 877 Syphilis erythromycin for, 423 minocycline for, 765 penicillin G benzathine for, 904 penicillin G procaine for, 908 tetracycline for, 1142 Syprol, 995 Syscor, 828 Systemic infection, ticarcillin and clavulanate for, 1154 Systemic lupus erythematosus hydroxychloroquine for, 557 triamcinolone for, 1196

T T3, 669–671 T3 suppression test, liothyronine for, 669 T4, 660–662 Tablets and capsules not to crush, S11–S12 Tabphyn, 1123 Taclonex, 1345 tacrine hydrochloride, 1117–1118 tacrolimus, 1118–1120 therapeutic and toxic blood levels for, S17 tadalafil, 1120–1122, P14 Tagamet HB, 252 Talacen, 913 Tall Man letters, S10 Talwin, 913 Talwin Lactate, 1334t–1335t Talwin Nx, 913 Tambocor, 472 Tambocor XL, 472 Tamiflu, 861 Tamofen, 1122 tamoxifen citrate, 1122–1123 tamsulosin hydrochloride, 1123–1124, P14 t: table

Tanta Orciprenaline, 720 Tapazole, 728 Tarceva, 419 Tardive dyskinesia, 1363 Tarivid, 849 Tarka, 1345 Taro-Enalpril, 401 Taro-Mupirocin, 785 Taro-Ultradol, 442 Taro-Warfarin, 1238 Tasigna, 823 Tasmar, 1174 Tavanic, 653 Taxol, 879 Taxotere, 363 Tazicef, 215 Tazocin, 944 Taztia XT, 351 3TC, 631 Tear production, increasing, cyclosporine for, 294 Tebrazid, 1002 Tegretol, 180 Tegretol-XR, 180 Tekturna, 43 Teldrin, 239 Telfast, 468 telithromycin, 1124–1127 telmisartan, 1127–1128 Telzir, 498 temazepam, 1128–1129 Temgesic, 161 Temodal, 1129 Temodar, 1129 temozolomide, 1129–1130 Temper tantrums, risperidone for, 1046 Temperature conversions, S6 Tempra, 14 Tendinitis betamethasone for, 135 indomethacin for, 586 naproxen for, 800 tenecteplase, 1130–1132 Tenex, 540 tenofovir disoproxil fumarate, 1132–1134 Tenoretic, 1345 Tenormin, 108 Tenosynovitis, betamethasone for, 135 Tenosynovitis. See also Tendintis

1429

Tensipine, 822 Tensium, 339 Teoptic, 191 terazosin hydrochloride, 1134–1135 terbinafine hydrochloride, 1135–1136 terbutaline sulfate, 1137–1138 Terfluzine, 1202 teriparatide (recombinant), 1138–1139 Tertroxin, 669 Testicular cancer bleomycin for, 147 cisplatin for, 258 etoposide for, 446 ifosfamide for, 572 plicamycin for, 949 vinblastine for, 1231 Testim, 1139 Testogel, 1139 Testopel Pellets, 1139 Testos, 1139 testosterone, 1139–1141 testosterone cypionate, 1139–1141 testosterone enanthate, 1139–1141 Testosterone overdose potassium acetate for, 954 potassium chloride for, 957 Tetanus chlorpromazine for, 242 diazepam for, 339 Tetanus, diphtheria immunization schedule, 1346t Tetanus, diphtheria, pertussis immunization schedule, 1347t, 1348t Tetany, 1363 calcium for, 171 tetracycline hydrochloride, 1142–1144 Tetracyclines, 1269–1270 Tev-Tropin, 1091 Teveten, 417 thalidomide, 1144–1146 Thalitone, 245 Boldface: Color section

1430 Thallium myocardial perfusion imaging

Thallium myocardial perfusion imaging, dipyridamole for, 359 Thalomid, 1144 Tham, 1210 The-24, 1146 Theo-Time, 1146 Theochron, 1146 Theolair, 1146 Theophyl SR, 1146 theophylline, 62–64, 1146–1149 therapeutic and toxic blood levels for, S17 Thiamilate, 1311 thiamine, 1311 Thiamine deficiency, thiamine for, 1311 Thiamine Hydrochloride, 1311 thiopental sodium, 1340t–1341t thioridazine hydrochloride, 1149–1151 Throat infection, amoxicillin for, 76 Thrombate III, 96 Thrombocythemia, anagrelide for, 90 Thrombocytopenia, 1363 argatroban for, 100, 101 bivalirudin for, 146 lepirudin for, 643 triamcinolone for, 1197 Thromboembolism acetylsalicylic acid for, 22 antithrombin III, human, for, 96 dalteparin for, 303 dipyridamole for, 359 heparin for, 544 Thrombolytics, 1299 Thrombosis. See also Deep vein thrombosis. argatroban for, 100 eptifibatide for, 418 streptokinase for, 1100 ticlopidine for, 1156 Thrombus lysis alteplase for, 52 Thyroid cancer doxorubicin for, 379 levothyroxine for, 661 t: table

Thyroid cancer (continued) sodium iodide 131I for, 1086 Thyroid hormone antagonists, 1300–1301 Thyroid hormones, 1300 Thyroid nodules, levothyroxine for, 661 thyroid, desiccated, 1151–1153 Thyroid-stimulating hormone suppression, levothyroxine for, 661 Thyroidectomy preparation, potassium iodide for, 961 Thyrolar, 671 Thyrosafe, 961 ThyroShield, 961 Thyrotoxic crisis potassium iodide for, 961 propylthiouracil for, 998 tiagabine hydrochloride, 1153–1154 Tiazac, 351, P5 ticarcillin disodium and clavulanate potassium, 1154–1156 Ticlid, 1156 ticlopidine hydrochloride, 1156–1157 Tics, pimozide for, 938 Tigan, 1205 tigecycline, 1158–1159 Tildiem, 351 Tilolec, 182 Tiloryth, 423 Timentin, 1154 timolol maleate, 1159–1161 Timoptic, 1159 Timoptix-XE, 1159 Tindamax, 1161 Tinea infection itraconazole for, 622 ketoconazole for, 624 terbinafine for, 1135 tinidazole, 1161–1163 tinzaparin sodium, 1163–1165 tiotropium, 1165–1166 tipranavir, 1166–1168

tirofiban hydrochloride, 1168–1170 tissue plasminogen activator, recombinant, 52–54 Tixylix Chesty Cough, 539 tizanidine hydrochloride, 1170–1171 TNKase, 1130 TOBI, 1171 tobramycin, 1171–1174 therapeutic and toxic blood levels for, S17 tobramycin sulfate, 1171–1174 Tobrex, 1171 tocainide, therapeutic and toxic blood levels for, S17 tocopherols, 1312 Tofranil, 576 Tofranil-PM, 576 tolcapone, 1174–1176 tolterodine, 1176–1177, P15 Tonsillitis azithromycin for, 121 cefaclor for, 199 cefadroxil for, 200 cefdinir for, 204 cefixime for, 207 cefpodoxime for, 212 cefprozil for, 214 ceftibuten for, 217 cefuroxime for, 221 clarithromycin for, 261 Toothache, acetaminophen for, 15 Topamax, 1177, P15 Topamax Sprinkle, P15 Topicycline, 1142 topiramate, 1177–1179, P15 Toposar, 446 topotecan hydrochloride, 1179–1180 Toprol-XL, 750, P10 torasemide, 1181–1182 Torem, 1181 Torsades de pointes, 1363 torsemide, 1181–1182 Total parenteral nutrition chromium as supplement in, 1304 copper as supplement in, 1304 Boldface: Color section

Tygacil

Total parenteral nutrition (continued) magnesium as supplement in, 694 manganese as supplement in, 1307 selenium as supplement in, 1311 zinc as supplement in, 1312 Tourette syndrome haloperidol for, 541, 542 pimozide for, 938 Toxic epidermal necrolysis, 1363 Toxoplasmosis, pyrimethamine for, 1005 Tracheobronchitis, acetylcysteine for, 19 Tracheostomy care, acetylcysteine for, 19 Trachoma, sulfacetamide for, 1105 Tracleer, 150 Tracrium, 1330t–1331t Tradorec XL, 1182 tramadol hydrochloride, 1182–1184, P15 tramadol hydrochloride and acetaminophen, P15 Tramake, 1182 Trandate, 628 trandolapril, 1184–1185 Trangina, 618 Trangina XL, 618 Tranquilyn, 740 Transderm-Scop, 1067 Transderm-V, 1067 Transfusion reactions, chlorpheniramine for, 239 Transfusions, exchange, calcium for, 171 Transient ischemic attack, acetylsalicylic acid for, 21 Transtec, 161 Tranxene, 275 Tranxene-SD, 275 Tranxene-SD Half Strength, 275 Tranxene-T, 275 t: table

tranylcypromine sulfate, 1185–1187 trastuzumab, 1187–1189 Travamine, 353 Traveleeze, 699 Traveler’s diarrhea rifiximin for, 1040 sulfamethoxazoletrimethoprim for, 1107 trazodone hydrochloride, 1189–1191 Trazorel, 1189 Treanda, 132 Trelstar Depot, 1208 Trelstar LA, 1208 Trental, 918 treprostinil sodium, 1191–1192 tretinoin, 1192–1195 Trexall, 731 Triaderm, 1195 triamcinolone, 1195–1199 triamcinolone acetonide, 1195–1199 triamcinolone hexacetonide, 1195–1199 triamterene, 1199–1200 triazolam, 1200–1201 tricalcium phosphate, 171–172 Trichinosis hydrocortisone for, 552 methylprednisolone for, 744 Trichomoniasis metronidazole for, 753 tinidazole for, 1162 Trichuris trichiura infection, mebendazole for, 698 Tricor, 460, P6 Tridural, 1182 trifluoperazine hydrochloride, 1202–1203 Trigeminal neuralgia, carbamazepine for, 180 Triglide, 460 trihexyphenidyl hydrochloride, 1204–1205

1431

Trileptal, 869, P11 trimethobenzamide hydrochloride, 1205–1206 trimipramine maleate, 1206–1208 Trimox, 75 Triostat, 669 triptorelin pamoate, 1208–1210 Trisenox, 104 Trisulfa, 1106 Trisulfa DS, 1106 Trisulfa S Suspension, 1106 Tritace, 1021 Trizivir, 1345 tromethamine, 1210–1211 Trophoblastic tumors, methotrexate for, 732 trospium chloride, 1211–1212 Truvada, 399, 1345 Tuberculosis acetylcysteine for, 19 ethambutol for, 439 isoniazid for, 615 pyrazinamide for, 1002 rifampin for, 1037 rifapentine for, 1039 streptomycin for, 1102 Tuberculous meningitis methylprednisolone for, 744 triamcinolone for, 1197 Tularemia streptomycin for, 1102 tetracycline for, 1142 Tumor lysis syndrome, 1363 Tumors, solid, doxorubicin for, 379 Tums, 170 Tums E-X, 170 Tums Ultra, 170 Turner’s syndrome, somatropin, recombinant for, 1092 Tussionex, 1345 Twilite, 356 Twinject, 409 Tycolene, 14 Tygacil, 1158 Boldface: Color section

1432 Tylenol

Tylenol, 14 Tylenol 8 Hour, 14 Tylenol Arthritis, 14 Tylox, 1345 Typhoid fever, ciprofloxacin for, 256

U Ucerax, 559 Ulcerative colitis balsalazide for, 126 hydrocortisone for, 552 infliximab for, 588 mesalamine for, 717 olsalazine for, 855 psyllium for, 1001 sulfasalazine for, 1109 Ulcer disease, bismuth for, 143 Ulcers. See specific type. Ulcidine, 457 Ultiva, 1336t–1337t Ultra Heartburn Relief, 457 Ultracet, 1345, P15 Ultradol, 442 Ultram, 1182, P15 Ultram ER, 1182, P15 Ultrase, 1345 Unasyn, 86, 1345 Uni-Senna, 1072 Unimed, 744 Uniphyl, 1146 Uniphyllin Continus, 1146 Unisom Maximum Strength SleepGels, 356 Unithroid, 660 Unitron Peg, 898 Univasc, 777 Univer, 1228 urea, 1212–1213 Urecholine, 137 Urethritis ampicillin for, 85 azithromycin for, 121 cefotaxime for, 209 minocycline for, 765 ofloxacin for, 849 tetracycline for, 1142 Uric acid nephropathy, allopurinol for prevention of, 46 Uridon, 245 t: table

Urinary alkalization, sodium bicarbonate for, 1083 Urinary frequency darifenacin for, 310 oxybutynin for, 871 solifenacin for, 1090 trospium for, 1211 Urinary incontinence darifenacin for, 310 oxybutynin for, 871 solifenacin for, 1090 trospium for, 1211 Urinary tract infection amikacin, 59 amoxicillin and clavulanate for, 78 ampicillin for, 84 cefaclor for, 199 cefadroxil for, 200 cefazolin for, 202 cefepime for, 205 cefixime for, 207 cefoxitin for, 211 cefpodoxime for, 212 ceftazidime for, 216 cefuroxime for, 221 ciprofloxacin for, 256 doripenem for, 371 fluconazole for, 475 flucytosine for, 476 imipenem and cilastatin for, 575 levofloxacin for, 654 nitrofurantoin for, 830 norfloxacin for, 842 ofloxacin for, 849 piperacillin for, 942 sulfamethoxazoletrimethoprim for, 1106 sulfisoxazole for, 1111 ticarcillin and clavulanate for, 1154 Urinary tract irritation, phenazopyridine for, 924 Urinary urgency oxybutynin for, 871 solifenacin for, 1090 trospium for, 1211 Urine retention, bethanechol for, 137

Uro-Mag, 693 Uromax, 871 Uromitexan, 719 Uroxatral, 42 Urozide, 547 Urticaria cyproheptadine for, 296 desloratadine for, 326 fexofenadine for, 468 levocetirizine for, 653 loratadine for, 683 Uterine bleeding estrogens, conjugated for, 432 goserelin for, 536 medroxyprogesterone for, 701 norethindrone for, 841 progesterone for, 987 UTI Relief, 923 Utinor, 842 Uveitis atropine for, 115 phenylephrine for, 931

V Vagifem, 429 valaciclovir, 1213–1215 valacyclovir hydrochloride, 1213–1215, P15 Valclair, 339 Valcyte, 513, 1215 valerian, 1328 valganciclovir hydrochloride, 1215–1216 Valium, 339 Valni Retard, 822 Valni XL, 822 Valorin, 14 valproate sodium, 1216–1219 valproic acid, 1216–1219 therapeutic and toxic blood levels for, S17 valsartan, 1219–1221, P16 valsartan and hydrochlorothiazide, P16 Valtrex, 1213, P15 Vancocin, 1221 vancomycin hydrochloride, 1221–1223 therapeutic and toxic blood levels for, S17 Boldface: Color section

Wellbutrin SR

Vantin, 212 vardenafil hydrochloride, 1223–1224, P16 varenicline, 1224–1226 Varicella acyclovir for, 28 immune globulin for, 579 Varicella immunization schedule, 1346t, 1347t, 1348t Varicella zoster infection, acyclovir for, 28 Vascalpha, 459 Vaseretic, 1345 Vasoconstriction, phenylephrine for, 931 Vasodilators, 1301–1302 Vasomotor symptoms, estrogens, esterified for, 434 Vasotec, 401 Vasotec IV, 401 VCR, 1232–1234 vecuronium bromide, 1340t–1341t Velcade, 149 Venereal warts, interferon alfa-2b for, 599 venlafaxine hydrochloride, 1226–1227, P16 Venofer, 611 Venoglobulin-I, 579 Venoglobulin-S, 579 Venos for Kids, 539 Venous thrombosis, warfarin for, 1238 Ventolin HFA, 35 VePesid, 446 Vera-Til SR, 1228 Veramyst, 488 verapamil hydrochloride, 1228–1230 therapeutic and toxic blood levels for, S17 Verapress, 1228 Verelan, 1228 Verelan PM, 1228 Vermox, 698 Versed, 1334t–1335t Vertab SR, 1228 t: table

Vertigo dimenhydrinate for, 353 diphenhydramine for, 356 meclizine for, 699 Vesanoid, 1192 VESIcare, 1090 Vesicare, 1090 Vfend, 1235 Viadur, 647 Viagra, 1075, P14 Viazem, 351 Vibra-Tabs, 383 Vibramycin, 383 Vibramycin Calcium, 383 Vibramycin Hyclate, 383 Vibramycin-D, 383 Vicks 44 Cough Relief, 336 Vicks Sinex Ultra Fine Mist, 930 Vicks Vaposyrup for Chesty Coughs, 539 Vicks Vaposyrup for Dry Cough, 336 Vicodin, 549, 1345 Vicodin ES, 549 Vicodin HP, 549 Vicoprofen, 549 Vidaza, 116 Videx, 346 Videx EC, 346 Vigamox, 783 vinblastine sulfate, 1230–1232 Vincent’s infection, penicillin V potassium for, 910 vincristine sulfate, 1232–1234 vinorelbine tartrate, 1234–1235 Viracept, 810 Viraferon, 598 ViraferonPeg, 898 Viramune, 816 Virazole, 1033 Viread, 1132 Visicol, 1087 Visken, 939 Vistaril, 559 Vistide, 249 Vita-C, 1303 Vita-Plus E, 1312 vitamin A, 1310

1433

Vitamin A defciency, retinol for, 1310 vitamin B1, 1311 vitamin B12, 1305 Vitamin B12 deficiency, cyanocobalamin for, 1305 vitamin B2, 1310 vitamin B3, 1307–1308 vitamin B6, 1309 vitamin C, 1303 vitamin D3, 1303–1304 vitamin E, 1312 Vitamin E deficiency, tocopherols for, 1312 vitamin K, 1308–1309, S32 Vitamins and minerals, 1303–1313 Vitrasert, 513 Vivaglobulin, 579 Vivelle, 429 Vivol, 339 VLB, 1230–1232 Voltaren, 343 Voltaren XR, 343 Voltarol, 343 Vomiting. See Nausea and vomiting. von Willebrand’s disease, desmopressin for, 328 voriconazole, 1235–1238 Vospire-ER, 35 VP-16-213, 446–447 Vulva cancer, bleomycin for, 147 Vusion, 1345 Vytorin, 453, 1345 Vyvanse, 673

W Warfarin overdose, managing, S32 warfarin sodium, 1238–1240, P16 Water replacement, sodium chloride for, 1084 Weight gain, promoting megestrol for, 704 oxandrolone for, 865 Weight loss, orlistat for, 860 Welchol, 283 Wellbutrin, 162, P3 Wellbutrin SR, 162, P3 Boldface: Color section

1434 Wellbutrin XL

Wellbutrin XL, 162 Wernicke’s encephalopathy, thiamine for, 1311 Westcort, 551 Westhroid, 1151 Whipworm infestation, mebendazole for, 698 Wilms’ tumor, doxorubicin for, 379 Wind-Eze, 1077 Winpred, 972 Withdrawal phenomena, 1363 Wolff-Parkinson-White syndrome, adenosine for, 32 Wrinkles, tretinoin for, 1193

X Xagrid, 89 Xanax, 50, P1 Xanax TS, 50 Xanax XR, 50 Xatral, 42 Xeloda, 176 Xenical, 860 Xepin, 376 Xifaxan, 1040 Xigris, 389 Xismox, 618 Xodol, 549 Xolair, 856 Xolegel, 623 Xopenex HFA, 649 Xylocaine, 662 Xylocaine-MPF, 662 Xylocard, 662 Xyzal, 652

Y Yaws penicillin G benzathine for, 904 penicillin G procaine for, 908 tetracycline for, 1142 Yentreve, 390

Z zafirlukast, 1240–1241 zaleplon, 1241–1242

t: table

Zamadol, 1182 Zanaflex, 1170 zanamivir, 1242–1243 Zanprol, 857 Zantac, 1024 Zantac 75, 1024 Zantac EFFERdose, 1024 Zaponex, 276 Zaroxolyn, 748 Zavedos, 570 Zebeta, 144 Zeffix, 631 Zegerid, 857 Zelapar, 1070 Zeldox, 1245 Zemon, 618 Zemon XL, 618 Zemplar, 1308 Zemtard, 351 Zemuron (P/F), 1338t–1339t Zenapax, 300 Zerit, 1098 Zestoretic, 1345, P9 Zestril, 675, P9 Zetia, 452, P6 Zevalin, 564 Ziac, 1345 Ziagen, 3 Ziana Gel, 1345 Zidoval, 752 zidovudine, 1243–1245 Zinacef, 221 zinc chloride, 1312–1313 zinc gluconate, 1312–1313 zinc sulfate, 1312–1313 Zinca-Pak, 1312 Zindaclin, 263 Zinga, 836 Zinnat, 221 ziprasidone hydrochloride, 1245–1247 Zirtec, 226 Zispin, 769 Zithromax, 120, P3 Ziz, 988 Zmax, 120 Zocor, 1078, P14 Zofran, 858 Zofran ODT, 858 Zofran Preservative Free, 858

Zoladex, 535 Zoladex 3-Month, 535 Zoladex LA, 535 zoldipem, therapeutic and toxic blood levels for, S17 zoledronic acid, 1247–1248 Zollinger-Ellison syndrome cimetidine for, 252 esomeprazole for, 428 famotidine for, 458 lansoprazole for, 637 omeprazole for, 857 rabeprazole for, 1017 ranitidine for, 1024 zolmitriptan, 1248–1250 Zoloft, 1073, P14 zolpidem tartrate, 1250–1251 Zolvera, 1228 Zomacton, 1091 Zometa, 1247 Zomig Rapimelt, 1248 Zomig-ZMT, 1248 Zomorph, 780 Zonalon, 376 Zonegran, 1251 zonisamide, 1251–1252 Zorbtive, 1091 ZORprin, 21 Zosyn, 944 Zoton, 637 Zovirax, 27 Zumenon, 429 Zyban, 162 Zydis, 851 Zydol, 1182 Zydone, 549 Zygomycosis, amphotericin B for, 81 Zyloprim, 45 Zymar, 516 Zyomet, 752 Zyprexa, 851, P11 Zyprexa IntraMuscular, 851 Zyrtec, 226 Zyrtec-D, 1345 Zytram XL, 1182 Zyvox, 667 Zyvoxam, 667

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