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Top 300 Capstone > top 300 drugs by class > Flashcards

top 300 drugs by class Flashcards

1
Q

Acetaminophen 300mg / Codeine 30mg

A

Tylenol #3

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2
Q

Acetaminophen 300mg / Codeine 30mg (tylenol#3) class

A

Analgesic/opioid

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3
Q

Acetaminophen 300mg / Codeine 30mg (tylenol#3) dose

A

1-2 tab q4-6h (max 4g APAP/day)

limit use for 5 days for acute pain

3 days for fever

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4
Q

Acetaminophen 300mg / Codeine 30mg (tylenol#3) contraindications

A

children undergoing tonsillectomy/ adenoidectomy

caution G6PD deficiency

causes hepatotoxicity

[BBW] Acetaminophen–> acute liver failure, at times resulting in liver transplant and death

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5
Q

Acetaminophen 300mg / Codeine 30mg (tylenol#3) dose adjustment

A

Hepatic (APAP)

renal (codeine)

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6
Q

Acetaminophen (APAP) oral

A

Tylenol

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7
Q

Acetaminophen (tylenol, Ofirmev) class

A

analgesic

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8
Q

Acetaminophen PO (tylenol) dose

A

650mg q 4-6h (max 4g/day APAP)

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9
Q

Acetaminophen (APAP) IV

A

Ofirmev

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10
Q

Acetaminophen IV (ofirmev) dose

A

<50 kg: 12.5 mg/kg q4h

or 15 mg/kg q6 hrs; (max single dose: 15 mg/kg/dose) ; (max daily dose: 75 mg/kg/day)

≥50 kg: 650 mg q 4h

or 1,000 mg q6 h; (max single dose: 1,000 mg/dose); (max daily dose: 4 g/day)

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11
Q

Acetaminophen Contraindications

A

caution with G6PD deficiency

causes hepatotoxicity

[BBW] Acetaminophen –> acute liver failure, at times resulting in liver transplant and death

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12
Q

acetaminophen dose adjustment

A

hepatic

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13
Q

Aspirin

A

Aspirin

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14
Q

Aspirin class

A

analgesic, Salicylate, anti-platelet

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15
Q

Aspirin Acute coronary syndrome dose

A

initial: 162-325mg
maintenance: 81-325mg qd

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16
Q

Aspirin Analgesic and antipyretic dose

A

IR: 325-650mg prn q4h (max 4g/day) (((higher dose)))

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17
Q

Aspirin contraindications

A

Patients with:

  • asthma
  • rhinitis
  • nasal polyps

Do not use in children or teenagers for viral infections with or without fever –> Reye Syndrome

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18
Q

Aspirin dose adjustment

A

renal

hepatic

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19
Q

Celecoxib

A

Celebrex

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20
Q

Celecoxib (Celebrex) class

A

analgesic, COX 2 selective, NSAID

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21
Q

Celecoxib (Celebrex) dose

A

100mg BID

or 200mg QD

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22
Q

Celecoxib (Celebrex) contraindication

A
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23
Q

Celecoxib (Celebrex) dose adjustment

A

renal

hepatic

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24
Q

Diclofenac PO

A

Cambia

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25
Q

Diclofenac Patch

A

Flector

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26
Q

Diclofenac Gel

A

Voltaren

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27
Q

Diclofenac (Cambia, Flector, Voltaren) class

A

analgesic, NSAID

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28
Q

Diclofenac PO (Cambia) dose

A

PO: 50mg 2-3x/d

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29
Q

Diclofenac patch (Flector) dose

A

Patch: apply 1 patch BID to most painful area

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30
Q

Diclofenac Gel (Voltaren) dose

A

Gel: apply 2-4g of 1% gel to affected areas 4x/d

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31
Q

Diclofenac (Cambia, Flector, Voltaren) contraindications

A
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32
Q

Diclofenac (Cambia, Flector, Voltaren) dose adjustment

A

renal

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33
Q

Fentanyl

A

Abstral, Duragesic, Fentora

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34
Q

Fentanyl (Abstral, Duragesic, Fentora) class

A

analgesic, opioid

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35
Q

Fentanyl (Abstral, Duragesic, Fentora) IV dose

A

IV: 50-100mcg LD with 25-50mcg/h titrated to pt need

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36
Q

Fentanyl (Abstral, Duragesic, Fentora) Transdermal dose

A

Transdermal: 25-100mcg/h

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37
Q

Fentanyl (Abstral, Duragesic, Fentora) contraindications

A

Life-threatening respiratory depression

Addiction, abuse, and misuse

Risk of concomitant use with benzodiazepines or other CNS depressants

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38
Q

Fentanyl (Abstral, Duragesic, Fentora) dose adjustment

A

renal

hepatic

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39
Q

Hydrocodone/ Acetaminophen

A

Norco, Vicodin, Lorcet

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40
Q

Hydrocodone/ Acetaminophen (Norco, Vicodin, Lorcet) class

A

analgesic, opioid

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41
Q

Hydrocodone/ Acetaminophen (Norco, Vicodin, Lorcet) dose

A

PO: Hydrocodone 2.5-10 mg Q 4-6h.

Max APAP <4g/day

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42
Q

Hydrocodone/ Acetaminophen (Norco, Vicodin, Lorcet) contraindications

A

Severe CNS depression

Severe respiratory depression

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43
Q

Hydrocodone/ Acetaminophen (Norco, Vicodin, Lorcet) dose adjustment

A

renal

hepatic

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44
Q

Hydromorphone

A

Diladud

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45
Q

Hydromorphone (Diladud) class

A

analgesic, opioid

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46
Q

Hydromorphone (Diladud) tablet dose

A

PO: Initial: 2-4 mg Q 4-6h prn (tablets)

parenteral doses are NOT equivalent; parenteral doses are up to 5 times more potent.

Opiate naïve (lower doses to start)

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47
Q

Hydromorphone (Diladud) contraindications

A
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48
Q

Hydromorphone (Diladud) dose adjustment

A

hepatic

renal

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49
Q

Hydromorphone (Diladud) oral solution dose

A

2.5 mg- 10 mg Q 3-6h prn (oral solution).

parenteral doses are NOT equivalent; parenteral doses are up to 5 times more potent.

Opiate naïve (lower doses to start)

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50
Q

Hydromorphone (Diladud) IV dose

A

IV: 0.2-1mg Q2-3h PRN

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51
Q

Ibuprofen

A

Motrin, Advil

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52
Q

Ibuprofen (Motrin, Advil) class

A

Analgesic, NSAID

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53
Q

Ibuprofen (Motrin, Advil) RX dose

A

400-800mg 3-4x/d (max 3200mg/d)

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54
Q

Ibuprofen (Motrin, Advil) contraindications

A

Concurrent use with ketorolac (NSAID) or pentoxifylline

Treatment of perioperative pain with CABG

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55
Q

Ibuprofen (Motrin, Advil) dose adjustment

A

renal

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56
Q

Ibuprofen (Motrin, Advil) OTC dose

A

200-400 mg Q 4-6h (max 1200mg/d)

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57
Q

Indomethacin

A

Indocin; Tivorbex

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58
Q

Indomethacin (Indocin; Tivorbex) class

A

analgesic, NSAID

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59
Q

Indomethacin (Tivorbex) acute pain dose

A

PO: 20mg TID

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60
Q

Indomethacin (Indocin; Tivorbex) ER dose

A

PO: ER 75mg QD-BID

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61
Q

Indomethacin (Indocin; Tivorbex) contraindications

A

IV administration with neonates

CABG surgery

History of asthma, urticarial

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62
Q

Indomethacin (Indocin; Tivorbex) dose adjustment

A

none

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63
Q

Ketoralac

A

Toradol

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64
Q

Ketoralac (Toradol) class

A

Analgesic, NSAID

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65
Q

Ketoralac (Toradol) dose

A

IV: 30mg single dose

or 30mg Q6h (120mg)

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66
Q

Ketoralac (Toradol) contraindications

A

NSAID –» High risk of bleeding, Active or history of peptic ulcer disease, Recent or history of GI bleeding or perforation, Concurrent ASA or other NSAID use

Patients with advanced renal disease or risk of renal failure

Prophylaxis before major surgery

Suspected or confirmed cerebrovascular bleeding

Hemorrhagic diathesis

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67
Q

Ketoralac (Toradol) dose adjustment

A

hepatic

renal

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68
Q

Lidocaine

A

Lidoderm, Xylocaine

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69
Q

Lidocaine (Lidoderm, Xylocaine) class

A

anesthetic analgesic, local antiarrhythmic class IB

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70
Q

Lidocaine (Lidoderm, Xylocaine) dose

A

Apply 4.5 mg/kg/day divided in four doses

Apply 5% patch to painful area for 12h QD

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71
Q

Lidocaine (Lidoderm, Xylocaine) contraindications

A

Use with caution in patients with known drug sensitivities

Accumulation of metabolites may be increased in renal dysfunction

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72
Q

Lidocaine (Lidoderm, Xylocaine) dose adjustment

A

hepatic

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73
Q

Meloxicam tablet

A

Mobic

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74
Q

Meloxicam caps

A

Vivlodex

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75
Q

Meloxicam ODT

A

Omiiz

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76
Q

Meloxicam (Mobic, Vivlodex, Qmiiz) class

A

Analgesic, COX2 Selective NSAID

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77
Q

Meloxicam (Mobic, Vivlodex, Qmiiz) dose

A

5-15mg daily (max 15 mg/day)

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78
Q

Meloxicam (Mobic, Vivlodex, Qmiiz) contraindications

A

Renal damage can occur (avoid use with severe impairment)

Increase in blood pressure (monitor)

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79
Q

Meloxicam (Mobic, Vivlodex, Qmiiz) dose adjustment

A

None

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80
Q

Methadone

A

Dolophine

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81
Q

Methadone (Dolophine) class

A

analgesic opioid

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82
Q

Methadone (Dolophine) pain management

PO dose
IV dose
detoxification dose

A

PO: 2.5mg Q8h
titrated increase to achieve stable dose

IV: 2.5-10mg Q 8-12h

detoxification: PO: titrate to about 40mg/d in divided doses to achieve stabilization

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83
Q

Methadone (Dolophine) contraindications

A
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84
Q

Methadone (Dolophine) dose adjustment

A

renal

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85
Q

Morphine

A

Duramorph, MS Contin

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86
Q

Morphine (Duramorph, MS Contin) class

A

analgesic opioid

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87
Q

Morphine (Duramorph, MS Contin) opioid-naive dose

A

IV: 2.5-5mg Q3-4h

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88
Q

Morphine (Duramorph, MS Contin) Epidural lumbar region dose

A

30-100mcg/kg as a single dose

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89
Q

Morphine (Duramorph, MS Contin) contraindications

A

Caution in both renal and liver impairment—monitor patients

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90
Q

Morphine (Duramorph, MS Contin) dose adjustment

A

none

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91
Q

Naproxen

A

Naprosyn, Aleve

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92
Q

Naproxen (Naprosyn, Aleve) class

A

analgesic, NSAID

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93
Q

Naproxen (Naprosyn, Aleve) dose

A

250-750mg BID (max1500mg/kg)

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94
Q

Naproxen (Naprosyn, Aleve) contraindications

A

Renal damage can occur (avoid use with severe impairment)

Increase in blood pressure (monitor)

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95
Q

Naproxen (Naprosyn, Aleve) dose adjustment

A

renal

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96
Q

oxycodone

A

OxyContin

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97
Q

oxycodone (OxyContin) class

A

analgesic opioid

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98
Q

oxycodone (OxyContin) IR initial dose

A

IR: 5-15mg Q4-6h prn (range 5-20mg/dose)

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99
Q

oxycodone (OxyContin) opioid-naive dose
ER tab
ER caps

A

ER tab: 10mg Q12h

ER caps: 9mg Q12h

ER caps not equivalent to ER tab

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100
Q

oxycodone (OxyContin) contraindications

A

Severe CNS depression

Severe respiratory depression

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101
Q

oxycodone (OxyContin) dose adjustment

A

renal

hepatic

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102
Q

Oxycodone/ Acetaminophen

A

Endocet, Percocet

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103
Q

Oxycodone/ Acetaminophen (Endocet, Percocet) class

A

analgesic/ opioid comb

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104
Q

Oxycodone/ Acetaminophen (Endocet, Percocet) dose

IR
ER

A

IR: 5mg moderate pain
10 mg severe pain

ER: 2 tab Q12h the second initial dose may be administered as early as 8 hours after the first initial dose if needed

(Do not exceed 4 g/day of acetaminophen)

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105
Q

Oxycodone/ Acetaminophen (Endocet, Percocet) contraindications

A

Swallow oxycodone/acetaminophen ER whole; crushing, chewing, or dissolving ER can cause rapid release and absorption of a potentially fatal dose of oxycodone

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106
Q

Oxycodone/ Acetaminophen (Endocet, Percocet) dose adjustment

A

hepatic

renal

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107
Q

Phenazopyridine

A

Azo, Pyridium

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108
Q

Phenazopyridine (Azo, Pyridium) class

A

urinary analgesic

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109
Q

Phenazopyridine (Azo, Pyridium) RX dose

A

200mg TID after meals for 2 days

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110
Q

Phenazopyridine (Azo, Pyridium) OTC dose

A

190mg TID with or after meals up to 2 days

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111
Q

Phenazopyridine (Azo, Pyridium) contraindications

A

Reddish-orange discoloration of the urine occurs.

Drug should be discontinued if skin or sclera develop a yellow color (may indicate drug accumulation due to impaired renal excretion).

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112
Q

Phenazopyridine (Azo, Pyridium) dose adjustment

A

renal

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113
Q

promethazine/ codeine

A

Phenergan with Codeine

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114
Q

promethazine/ codeine (Phenergan with Codeine) class

A

analgesic, opioid, antitussive, H1 antagonist 1st generation

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115
Q

promethazine/ codeine (Phenergan with Codeine) dose

A

PO: 5ml (Promethazine 6.25/10 mg codeine) Q4-6h (max 30ml/d)

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116
Q

promethazine/ codeine (Phenergan with Codeine) contraindications

A

Coma or CNS depressants

Altered cardiac conduction

Anticholinergic side effects

Extrapyramidal symptoms

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117
Q

promethazine/ codeine (Phenergan with Codeine) dose adjustment

A

renal

hepatic

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118
Q

Tramadol

A

Ultram

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119
Q

Tramadol (Ultram) class

A

analgesic

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120
Q

Tramadol (Ultram) dose

A

25-100mg Q4-6h prn (400mg/d)

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121
Q

Tramadol (Ultram) contraindications

A

Paralytic ileus

Severe respiratory depression

Drug abuse and dependence

Increase risk of seizures

Serotonin syndrome

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122
Q

Tramadol (Ultram) dose adjustment

A

hepatic

renal

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123
Q

Bubprenorphine/ naloxone

A

Suboxone, Bunavail, Zubsoly

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124
Q

Buprenorphine/ naloxone (Suboxone, Bunavail, Zubsoly) class

A

opioid partial agonist/antagonist

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125
Q

Buprenorphine/ naloxone (Suboxone) dose

A

initial: sublingual: Buprenorphine 2mg/ naloxone 0.5mg
or
Buprenorphine 4mg/ naloxone 1 mg

may titrate dose

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126
Q

Buprenorphine/ naloxone (Suboxone, Bunavail, Zubsoly) contraindications

A

CNS and respiratory depression (opioid)

Avoid for severe hepatic dysfunction

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127
Q

Buprenorphine/ naloxone (Suboxone, Bunavail, Zubsoly) dose adjustment

A

hepatic

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128
Q

Naloxone

A

Eyzio, Narcan

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129
Q

Naloxone (Eyzio, Narcan) class

A

opioid antagonist

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130
Q

Naloxone (Eyzio, Narcan) dose

opioid overdose IV, IM, SQ

Intranasal

A

IV, IM, SubQ: Initial 0.4 -2 mg Q 2 -3 minutes up to 10 mg total

Intranasal: 4 mg (1 spray) as single dose in one nostril. May repeat in 3-5 min if respiratory depression persists

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131
Q

Naloxone (Eyzio, Narcan) dose adjustment

A

none

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132
Q

Acyclovir

A

zovirax

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133
Q

Acyclovir (zovirax) class

A

antiviral

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134
Q

Acyclovir (zovirax) dose

PO
IV

A

Shingles

800mg 5 x/day for 7-10 days.

Initiate at earliest sign or symptom; most effective when initiated ≤72 hours after rash onset

IV: 10-15 mg/kg/dose q8h for 10-14 days

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135
Q

Acyclovir (zovirax) contraindications

A

neurotoxicity esp with renal failure

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136
Q

Acyclovir (zovirax) dose adjustment

A

renal

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137
Q

Oseltamivir

A

Tamiflu

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138
Q

Oseltamivir (Tamiflu) class

A

antiviral

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139
Q

Oseltamivir (Tamiflu) dose

A

Prophylaxis: 75 mg QD

Treatment: 75 mg BID

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140
Q

Oseltamivir (Tamiflu) dose adjustment

A

renal

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141
Q

Valacyclovir

A

Valterx

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142
Q

Valacyclovir (Valterx) class

A

antiviral

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143
Q

Valacyclovir (Valterx) dose

A

Treatment, initial episode:
PO: 1 g BID for 7-10 days

Treatment, recurrent episode: PO: 500 mg BID for 3 days
or 1 g QD for 5 days.

Suppressive therapy (eg, for severe and/or frequent recurrences): PO: 500 mg 
or 1 g QD
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144
Q

Valacyclovir (Valterx) contraindications

A

CNS AEs

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145
Q

Valacyclovir (Valterx) dose adjustment

A

renal

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146
Q

Alendronate

A

Fosamax, Binosto

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147
Q

Alendronate (Fosamax, Binosto) class

A

Bisphosphonate

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148
Q

Alendronate (Fosamax, Binosto) dose

A

Prophylaxis: 5mg qd or 35mg q wk

treatment: 10mg qd or 70mg q wk

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149
Q

Alendronate (Fosamax, Binosto) contraindications

A

Esophageal abnormalities or high risk for adverse esophageal effects

Hypocalcemia

Inability to sit or stand upright for at least 30 minutes

Atypical femur fractures

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150
Q

Alendronate (Fosamax, Binosto) dose adjustment

A

renal

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151
Q

Ibandronate

A

Boniva

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152
Q

Ibandronate (Boniva) class

A

Bisphosphonate

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153
Q

Ibandronate (Boniva) dose
PO
IV

A

PO: 150mg Q month
IV: 3mg Q 3 months

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154
Q

Ibandronate (Boniva) contraindications

A

Esophageal abnormalities or high risk for adverse esophageal effects

Hypocalcemia

Inability to sit or stand upright for at least 30 minutes

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155
Q

Ibandronate (Boniva) dose adjustment

A

renal

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156
Q

Risedronate

A

Actonel

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157
Q

Risedronate (Actonel) class

A

Bisphosphonate

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158
Q

Risedronate (Actonel) dose
IR
DR

A

IR: Prevention and treatment: 5 mg QD or 35 mg Q wk or 150 mg Q month

DR: 35 mg Q wk

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159
Q

Risedronate (Actonel) contraindications

A

Esophageal abnormalities which delay esophageal emptying

Hypocalcemia

Inability to sit or stand for 30 minutes

Atypical femur fractures

Osteonecrosis of the jaw

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160
Q

Risedronate (Actonel) dose adjustments

A

renal

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161
Q

Alprazolam

A

Xanax

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162
Q

Alprazolam (Xanax) class

A

BDZ

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163
Q

Alprazolam (Xanax) dose
IR
ER

A

IR: 0.25-0.5 mg 3x/d (max 4mg/day)

ER: 0.5 -1 mg QD; titrate dose every 3 to 4 days in increments ≤1 mg/day (range: 3 to 6 mg/day)

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164
Q

Alprazolam (Xanax) contraindications

A

Benzodiazepines have been associated with anterograde amnesia

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165
Q

Alprazolam (Xanax) dose adjustment

A

hepatic

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166
Q

Clonazepam

A

Klonopin

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167
Q

Clonazepam (Klonopin) class

A

BDZ

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168
Q

Clonazepam (Klonopin) dose

A

0.25-2mg BID (max 4mg/day)

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169
Q

Clonazepam (Klonopin) contraindications

A

Anterograde amnesia

CNS depression

Potential for abuse

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170
Q

Clonazepam (Klonopin) dose adjustment

A

none

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171
Q

Diazepam

A

Valium, Diastat (rectal)

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172
Q

Diazepam (Valium, Diastat (rectal)) class

A

BZD

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173
Q

Diazepam (Valium, Diastat (rectal)) dose
PO, IM,IV
rectal

A

Anxiety
PO, IM, IV: 2-10 mg 2-4x/ day PRN
(note: IM has erratic absorption and is not recommended)

Rectal: 0.2-0.5 mg/kg (max 20 mg)

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174
Q

Diazepam (Valium, Diastat (rectal)) contraindications

A

Anterograde amnesia

Drug abuse potential

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175
Q

Diazepam (Valium, Diastat (rectal)) dose adjustments

A

hepatic

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176
Q

Lorazepam

A

Ativan

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177
Q

Lorazepam (Ativan) class

A

BDZ

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178
Q

Lorazepam (Ativan) dose
PO
IV

A

Anxiety
PO: 2-6mg in divided doses (10 mg/day)
Agitation
IV: 0.02-0.06 mg/kg every 2-6 hours

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179
Q

Lorazepam (Ativan) contraindications

A

Severe respiratory depression

Abuse potential

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180
Q

Lorazepam (Ativan) dose adjustment

A

hepatic

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181
Q

Midazolam

A

Nayzilam (nasal)

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182
Q

Midazolam (Nayzilam) class

A

BDZ

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183
Q

Midazolam (Nayzilam) dose
Pre-op sedation
seizures

A

Pre-op sedation
IV: 0.1 to 0.35 mg/kg over 20 to 30 seconds

Seizures (nasal): 5 mg (one spray) as a single dose in one nostril; may repeat dose in 10 minutes in alternate nostril based on response and tolerability

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184
Q

Midazolam (Nayzilam) contraindications

A

Anterograde amnesia

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185
Q

Midazolam (Nayzilam) dose adjustments

A

none

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186
Q

Temazepam

A

Restoril

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187
Q

Temazepam (Restoril) class

A

BDZ

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188
Q

Temazepam (Restoril) dose

A

7.5-30mg at bedtime

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189
Q

Temazepam (Restoril) contraindications

A

Pregnancy

Benzodiazepines have been associated with anterograde amnesia

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190
Q

Temazepam (Restoril) dose adjustment

A

none

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191
Q

Trazodone

A

Deseryl

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192
Q

Trazodone (Deseryl) class

A

antidepressant, SSRI

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193
Q

Trazodone (Deseryl) dose

A

Insomnia

25mg-200mg at bedtime

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194
Q

Trazodone (Deseryl) contraindications

A

Serotonin syndrome

Prolongs the QT/QTc interval

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195
Q

Trazodone (Deseryl) dose adjustment

A

none

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196
Q

Vilazodone

A

Viibryd

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197
Q

Vilazodone (Viibryd) class

A

antidepressant SSRI

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198
Q

Vilazodone (Viibryd) dose

A

10mg QD for 7days

then increase to 20 then 40 QD

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199
Q

Vilazodone (Viibryd) contraindications

A

Serotonin syndrome

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200
Q

Vilazodone (Viibryd) dose adjustment

A

none

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201
Q

Escitalopram

A

Lexapro

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202
Q

Escitalopram (Lexapro) class

A

antidepressant, SSRI

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203
Q

Escitalopram (Lexapro) dose

A

10-20mg QD (max 20mg/day)

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204
Q

Escitalopram (Lexapro) contraindications

A

[BBW]Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults

Potentially life-threatening serotonin syndrome has occurred with serotonergic agents

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205
Q

Escitalopram (Lexapro) dose adjustment

A

renal

hepatic

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206
Q

Fluoxetine

A

Prozac, Sarafem

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207
Q

Fluoxetine (Prozac, Sarafem) class

A

antidepressant, SSRI

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208
Q

Fluoxetine (Prozac, Sarafem) dose

A

5-20 mg QD (max 80mg/day)

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209
Q

Fluoxetine (Prozac, Sarafem) contraindications

A

Potentially life-threatening serotonin syndrome (SS) has occurred with serotonergic agents

When discontinuing antidepressant treatment that has lasted for >3 weeks, gradually taper the dose

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210
Q

Fluoxetine (Prozac, Sarafem) dose adjustment

A

hepatic

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211
Q

Paroxetine

A

Paxil

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212
Q

Paroxetine (Paxil) class

A

antidepressant, SSRI

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213
Q

Paroxetine (Paxil) dose
IR
CR

A

Depression
IR: 20 mg QD; may increase dose based on response and tolerability in increments of 10 to 20 mg/day at intervals ≥1 week to a maximum of 50 mg/day

CR: 25 mg QD; may increase based on response and tolerability in increments of 12.5 mg/day at intervals ≥1 week to a maximum of 62.5 mg/day

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214
Q

Paroxetine (Paxil) contraindications

A

Potentially life-threatening serotonin syndrome (SS) has occurred with serotonergic agents

When discontinuing antidepressant treatment that has lasted for >3 weeks, gradually taper the dose

Discontinuing paroxetine or switching to another antidepressant unless the benefits of therapy justify continuing treatment during pregnancy

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215
Q

Paroxetine (Paxil) dose adjustment

A

renal

hepatic

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216
Q

Sertraline

A

Zoloft

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217
Q

Sertraline (Zoloft) class

A

antidepressant, SSRI

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218
Q

Sertraline (Zoloft) dose

A

Depression

50-100mg/day (max 200mg/day)

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219
Q

Sertraline (Zoloft) contraindications

A

Potentially life-threatening serotonin syndrome (SS) has occurred with serotonergic agents

When discontinuing antidepressant treatment that has lasted for >3 weeks, gradually taper the dose

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220
Q

Sertraline (Zoloft) dose adjustment

A

hepatic

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221
Q

Citalopram

A

Celexa

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222
Q

Citalopram (Celexa) class

A

antidepressant, SSRI

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223
Q

Citalopram (Celexa) dose

A

Depression:
10-40 mg daily

Due to the risk of QT prolongation, the maximum recommended daily dose for all indications is 40 mg. A lower maximum daily dose of 20 mg is recommended in patients >60 years of age, those with significant hepatic impairment, and patients who are concurrently receiving medications that significantly increase citalopram levels (eg, cimetidine, omeprazole) or known poor metabolizers of CYP2C19 substrates

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224
Q

Citalopram (Celexa) contraindications

A

Potentially life-threatening serotonin syndrome (SS) has occurred with serotonergic agents

Avoid use in CYP2C19 poor metabolizers

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225
Q

Citalopram (Celexa) dose adjustment

A

hepatic

renal

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226
Q

Desvenlafaxine

A

Pristiq, Khedezla

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227
Q

Desvenlafaxine (Pristiq, Khedezla) class

A

SNRI

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228
Q

Desvenlafaxine (Pristiq, Khedezla) dose

A

25-50 mg daily (some studies support titration up to 400 mg daily)

When discontinuing antidepressants that has lasted for >3 weeks, gradually taper the dose (eg, over 2 to 4 weeks) to minimize withdrawal symptoms

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229
Q

Desvenlafaxine (Pristiq, Khedezla) contraindications

A

Serotonin syndrome

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230
Q

Desvenlafaxine (Pristiq, Khedezla) dose adjustment

A

renal

hepatic

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231
Q

Venlafaxine

A

Effexor

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232
Q

Venlafaxine (Effexor ) class

A

SNRI

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233
Q

Venlafaxine (Effexor )dose

A

Depression

37.5-75mg QD (225mg/day)

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234
Q

Venlafaxine (Effexor ) contraindications

A

Serotonin syndrome

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235
Q

Venlafaxine (Effexor ) dose adjustment

A

hepatic

renal

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236
Q

Duloxetine

A

Cymbalta

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237
Q

Duloxetine (Cymbalta) class

A

antidepressant, SNRI

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238
Q

Duloxetine (Cymbalta) dose

A

30-60mg QD (max 120mg/day)

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239
Q

Duloxetine (Cymbalta) contraindications

A

Concurrent use of MAOI, TCA, or linezolid

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240
Q

Duloxetine (Cymbalta) dose adjustment

A

hepatic

renal

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241
Q

Amitriptyline

A

Amitriptyline

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242
Q

Amitriptyline class

A

Antidepressant, TCA

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243
Q

Amitriptyline dose

A

Depression:
25-50 mg QD at bedtime or in divided doses,

can gradually increase to 100-300 mg daily

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244
Q

Amitriptyline contraindications

A

Abrupt discontinuation or interruption of antidepressant therapy has been associated with a discontinuation syndrome

Use with caution in patients with a history of cardiovascular disease; the risk of conduction abnormalities with this agent is high relative to other antidepressants

Use with caution in patients at risk of seizures, including those with a history of seizures, head trauma, brain damage, alcoholism, or concurrent therapy with medications which may lower seizure threshold

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245
Q

Amitriptyline dose adjustment

A

none

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246
Q

Nortriptyline

A

Pamelor

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247
Q

Nortriptyline (Pamelor) class

A

antidepressant, TCA

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248
Q

Nortriptyline (Pamelor) dose

A

Depression
25mg 3-4x/day
(150mg/day)

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249
Q

Nortriptyline (Pamelor) contraindications

A

Abrupt discontinuation or interruption of antidepressant therapy has been associated with a discontinuation syndrome

Use with caution in patients with a history of cardiovascular disease; the risk of conduction abnormalities with this agent is high relative to other antidepressants

Use with caution in patients at risk of seizures, including those with a history of seizures, head trauma, brain damage, alcoholism, or concurrent therapy with medications which may lower seizure threshold

Nortriptyline is metabolized hepatically; use with caution

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250
Q

Nortriptyline (Pamelor) dose adjustment

A

none

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251
Q

Bupropion

A

Wellbutrin, Frofivo, Aplenzin (hydrobromide salt)

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252
Q

Bupropion (Wellbutrin, Frofivo, Aplenzin (hydrobromide salt)) class

A

antidepressant, dopamine reuptake inhibitor

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253
Q

Bupropion (Wellbutrin, Frofivo, Aplenzin (hydrobromide salt)) dose

A

150mg daily (max 450mg/day) for HCl salt

conversions available for hydrobromide salt

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254
Q

Bupropion (Wellbutrin, Frofivo, Aplenzin (hydrobromide salt)) contraindications

A

May cause a dose-related risk of seizures. Use is contraindicated in patients with a history of seizures or certain conditions with high seizure risk

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255
Q

Bupropion (Wellbutrin, Frofivo, Aplenzin (hydrobromide salt)) dose adjustment

A

hepatic

renal

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256
Q

Mirtazapine

A

Remeron

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257
Q

Mirtazapine (Remeron) class

A

Antidepressant, alpha 2 antagonist

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258
Q

Mirtazapine (Remeron) dose

A

MDD:
15mg QD at bedtime
increase dose in 15mg increments at intervals no less than Q 1-2wks (45mg/day)

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259
Q

Mirtazapine (Remeron) contraindications

A
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260
Q

Mirtazapine (Remeron) dose adjustment

A

none

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261
Q

Buspirone

A

Buspirone

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262
Q

Buspirone class

A

Anti anxiety agent

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263
Q

Buspirone dose

A

10-15mg/day in 2-3 divided doses

max 60mg/day

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264
Q

Buspirone contraindications

A

Potentially life-threatening serotonin syndrome has occurred with serotonergic agents, including buspirone, particularly when used in combination with other serotonergic agents (eg, triptans, TCAs, fentanyl, lithium, tramadol, buspirone, St John’s wort, tryptophan) or agents that impair metabolism of serotonin (eg, MAOIs intended to treat psychiatric disorders, other MAOIs [ie, linezolid and IV methylene blue])

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265
Q

Buspirone dose adjustment

A

renal

hepatic

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266
Q

Amiodarone PO

A

Pacerone

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267
Q

Amiodarone IV

A

Nexterone

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268
Q

Amiodarone PO (Pacerone, Nexterone) class

A

antiarrhythmic class III

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269
Q

Amiodarone PO (Pacerone) dose

A

PO: 200-1600 mg/day in 1-2 divided doses

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270
Q

Amiodarone IV (Nexterone) dose

A

IV: 150-300mg infused over 10 min

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271
Q

Amiodarone PO (Pacerone, Nexterone) contraindications

A

Hypersensitivity to iodine

BBW:
Hepatotoxicity (may be fatal). Obtain baseline and periodic liver transaminases and discontinue or reduce dose if the increase exceeds 3 times normal or doubles in a patient with an elevated baseline

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272
Q

Amiodarone PO (Pacerone, Nexterone) dose adjustment

A

hepatic

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273
Q

Digoxin

A

Lanoxin, Digitek

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274
Q

Digoxin (Lanoxin, Digitek) class

A

cardiac glycoside, antiarrhythmic class IV

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275
Q

Digoxin (Lanoxin, Digitek) dose

A

PO:0125-0.25mg QD

Total digitalizing dose: Initial: IV: 0.25 to 0.5 mg over several minutes, with repeat doses of 0.25 mg every 6 hours to a maximum of 1.5 mg over 24 hours

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276
Q

Digoxin (Lanoxin, Digitek) contraindications

A

Correct electrolyte disturbances, especially hypokalemia or hypomagnesemia, prior to use and throughout therapy

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277
Q

Digoxin (Lanoxin, Digitek) dose adjustment

A

renal

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278
Q

Verapamil

A

Calan SR, Verelan, Verelan PM

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279
Q

Verapamil (Calan SR, Verelan, Verelan PM) class

A 
antihypertensive, CCB
antiarrhythmic, class IV
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280
Q

Verapamil (Calan SR, Verelan, Verelan PM) dose

IR
SR
IV

A

PO: IR: 80-160mg 3x/day

SR: 180-480mg QD

IV: 2.5-10mg over 2 min, repeat if necessary

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281
Q

Verapamil (Calan SR, Verelan, Verelan PM) contraindications

A

Due to its negative inotropic and chronotropic effects, use is generally avoided in patients:
1- taking a BB
2- HFrEF
3- sinus node dysfunction, or 2nd or 3rd degree AV block unless a functioning pacemaker has been placed

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282
Q

Verapamil (Calan SR, Verelan, Verelan PM) dose adjustment

283
Q

Amlodipine

284
Q

Amlodipine (Norvasc) class

A

antihypertensive, CCB

285
Q

Amlodipine (Norvasc) dose

A

PO:2.5-10mg QD

286
Q

Amlodipine (Norvasc) contraindications

A

The most common side effect is peripheral edema; occurs within 2 to 3 weeks of starting therapy

287
Q

Amlodipine (Norvasc) dose adjustment

288
Q

Diltiazem

A

Cardizem, Cartia, Dilt-CD

289
Q

Diltiazem (Cardizem, Cartia, Dilt-CD) class

A

antihypertensive, CCB

290
Q

Diltiazem (Cardizem, Cartia, Dilt-CD) dose
PO
IV

A

PO:60-360mg QD or BID depending on dosage form
(480 mg/day)

IV continuous infusion: 5-10 mg/hr; may increase up to 15 mg/hr PRN

291
Q

Diltiazem (Cardizem, Cartia, Dilt-CD) contraindications

A

Due to its negative inotropic and chronotropic effects, use is generally avoided in patients:
1- taking a BB
2- HfrEF
3- sinus node dysfunction or 2nd or 3rd degree AV block UNLESS a functioning pacemaker has been placed

292
Q

Diltiazem (Cardizem, Cartia, Dilt-CD) dose adjustment

293
Q

Nifedipine

A

Procardia, Adalet

294
Q

Nifedipine (Procardia, Adalet) class

A

antihypertensive, CCB

295
Q

Nifedipine (Procardia, Adalet) dose

A

ER: 30-60mg daily (120-180 mg/day)

296
Q

Nifedipine (Procardia, Adalet) contraindications

A

Concurrent use with strong CYP3A4 inducers
Cardiogenic shock

ST-elevation MI
Avoid use with cirrhosis

297
Q

Nifedipine (Procardia, Adalet) dose adjustment

298
Q

Olmesartan

299
Q

Olmesartan (Benicar) class

A

antihypertensive/ CHF, ARB

300
Q

Olmesartan (Benicar) dose

301
Q

Olmesartan (Benicar) contraindications

A

pregnancy
History of angioedema
concurrent use of aliskiren

302
Q

Olmesartan (Benicar) dose adjustment

303
Q

Valsartan

304
Q

Valsartan (Diovan) class

A

antihypertensive/CHF, ARB

305
Q

Valsartan (Diovan) dose

A

40-160mg QD or BID (320mg/day)

306
Q

Valsartan (Diovan) contraindications

A

pregnancy
History of angioedema
concurrent use of aliskiren

307
Q

Valsartan (Diovan) dose adjustment

308
Q

Irbesartan

309
Q

Irbesartan (Avapro) class

A

Antihypertensive/CHF, ARB

310
Q

Irbesartan (Avapro) dose

A

PO:150-330 QD

311
Q

Irbesartan (Avapro) contraindications

A

pregnancy

concurrent use of aliskiren

312
Q

Irbesartan (Avapro) dose adjustment

313
Q

Losartan

314
Q

Losartan (Cozaar) class

A

antihypertensive/CHF, ARB

315
Q

Losartan (Cozaar) dose

A

PO: 50mg QD (100mg/day)

316
Q

Losartan (Cozaar) contraindications

A

pregnancy
History of angioedema
concurrent use of aliskiren

317
Q

Losartan (Cozaar) dose adjustment

318
Q

Sacubitril/valsartan

319
Q

Sacubitril/valsartan (Entresto) class

320
Q

Sacubitril/valsartan (Entresto) dose

A

PO:24/26mg, 49/52mg, 97/103mg BID

321
Q

Sacubitril/valsartan (Entresto) contraindications

A

Concomitant use of (ACE) inhibitor is contraindicated; allow a 36-hour washout period when switching from or to an ACE inhibitor

concomitant use of aliskiren

angioedema

hyperkalemia

322
Q

Sacubitril/valsartan (Entresto) dose adjustment

A

renal

hepatic

323
Q

Benazepril

324
Q

Benazepril (Lotensin) class

A

Antihypertensive, CHF, ACE-I

325
Q

Benazepril (Lotensin) dose

A

5-40mg in 1 or 2 daily doses

326
Q

Benazepril (Lotensin) contrainidcations

A

History of angioedema

Contraindicated in pregnancy

327
Q

Benazepril (Lotensin) dose adjustment

328
Q

Enalapril

Enalaprilat IV

A

Vasotec, Epand (oral solution)

329
Q

Enalapril (Vasotec, Epand (oral solution))
Enalaprilat IV
class

A

antihypertensive, CHF, ACE-I

330
Q

Enalapril (Vasotec, Epand (oral solution))
Enalaprilat IV
doses

A

PO: 2.5-40mg QD

IV: 1.25mg/ dose over 5 min Q6h up to 5mg/dose

331
Q

Enalapril (Vasotec, Epand (oral solution))

Enalaprilat IV contraindications

A

History of angioedema

Contraindicated in pregnancy

332
Q

Enalapril (Vasotec, Epand (oral solution))

Enalaprilat IV dose adjustment

333
Q

Lisinopril

A

Zestril, Prinivil

334
Q

Lisinopril (Zestril, Prinivil) class

A

antihypertensive, CHF, ACE-I

335
Q

Lisinopril (Zestril, Prinivil) dose
HTN
CHF

A

HTN: PO: 10-40mg QD

CHF: PO: 20-40mg QD

336
Q

Lisinopril (Zestril, Prinivil) contraindications

A

History of angioedema

Contraindicated in pregnancy

concurrent use of aliskiren

337
Q

Lisinopril (Zestril, Prinivil) dose adjustment

338
Q

Ramipril

339
Q

Ramipril (Altace) class

A

Antihypertensive, CHF, ACE-I

340
Q

Ramipril (Altace) dose

A

1.5-5mg QD (20mg/day)

341
Q

Ramipril (Altace) contraindications

A

History of angioedema

Contraindicated in pregnancy

concurrent use of aliskiren

342
Q

Ramipril (Altace) dose adjustment

343
Q

Carvedilol

344
Q

Carvedilol (Coreg) class

A

antihypertensive, CHF, BB

345
Q

Carvedilol (Coreg) dose
IR
ER

A

CHF
IR: 3.125-50mg BID

ER: 10-80mg QD

346
Q

Carvedilol (Coreg) contraindications

A

BB therapy should not be withdrawn abruptly (particularly in patients with CAD), but gradually tapered to avoid acute tachycardia, hypertension, and/or ischemia

347
Q

Carvedilol (Coreg) dose adjustment

348
Q

Labetalol

A

Labetalol, formerly Trandate, Normodyne

349
Q

Labetalol ( formerly Trandate, Normodyne) class

A

antyhypertensive, BB

350
Q

Labetalol ( formerly Trandate, Normodyne) dose
PO
IV

A

PO: 100mg BID up to 200-800mg BID

IV: 10-20mg IV push over 2 min at 10 min intervals until target SBP. 80mg/daily

351
Q

Labetalol ( formerly Trandate, Normodyne) contraindications

A

Severe Bradycardia

Heart Block greater than first degree
Cardiogenic Shock

Bronchial asthma

Uncompensated cardiac failure

Beta-blocker therapy should not be withdrawn abruptly

352
Q

Labetalol ( formerly Trandate, Normodyne) dose adjustment

353
Q

Nebivolol

354
Q

Nebivolol (Bystolic) class

A

antihypertensive, BB

355
Q

Nebivolol (Bystolic) dose

A

5 QD (40mg)

356
Q

Nebivolol (Bystolic) contraindications

A

Severe bradycardia
2nd or 3rd AV block

Decompensated heart failure

Severe hepatic impairment

357
Q

Nebivolol (Bystolic) dose adjustment

A

hepatic

renal

358
Q

Propranolol

359
Q

Propranolol (Inderal) class

A

antihypertensive, BB

360
Q

Propranolol (Indral) dose
PO
IV

A

PO: IR: 40-320mg/day
IV: 1-3mg bolus (640mg/day)

361
Q

Propranolol (Indral) contraindications

A

Severe sinus bradycardia

Uncompensated CHF

Beta-blocker therapy should not be withdrawn abruptly

362
Q

Propranolol (Indral) dose adjustment

363
Q

Bisoprolol

A

Bisoprolol

364
Q

Bisoprolol class

A

Antihypertensive, CHF, BB, B1 selective

365
Q

Bisoprolol dose

A

PO: initial 2.5-5mg (max 20mg/day)

366
Q

Bisoprolol contraindications

A

Cardiogenic shock, cardiac failure, or first degree heart block, sinus bradycardia

Beta-blocker therapy should not be withdrawn abruptly

367
Q

Bisoprolol dose adjustment

A

renal

hepatic

368
Q

Metoprolol succinate

369
Q

Metoprolol succinate (Toprol) class

A

antihypertensive, CHF, BB, B1 selective

370
Q

Metoprolol succinate (Toprol) dose

A

PO:50-100mg QD (400mg/day)

371
Q

Metoprolol succinate (Toprol) contraindications

A

Severe bradycardia 2nd or 3rd degree AV block

Decompensated heart failure

372
Q

Metoprolol succinate (Toprol) dose adjustment

373
Q

Metoprolol Tartrate

374
Q

Metoprolol Tartrate (Lopressor) class

A

antihypertensive, BB, B1 selective

375
Q

Metoprolol Tartrate (Lopressor) dose
PO
IV

A

PO: 25-100mg BID
(200mg/day)

IV: 1.25-5 mg Q 6-12 hours
(450 mg/day)

376
Q

Metoprolol Tartrate (Lopressor) contraindications

A

Severe bradycardia 2nd or 3rd degree AV block

Decompensated heart failure

377
Q

Metoprolol Tartrate (Lopressor) dose adjustment

378
Q

Atenolol

379
Q

Atenolol (Tenormin) class

A

antihypertensive, BB, selective

380
Q

Atenolol (Tenormin) dose

A

25-100mg QD

381
Q

Atenolol (Tenormin) contraindications

A

Severe sinus bradycardia

Uncompensated CHF

Beta-blocker therapy should not be withdrawn abruptly

382
Q

Atenolol (Tenormin) dose adjustment

383
Q

Clonidine

A

Catapres, Duraclon “Epidural”, Kapvay

384
Q

Clonidine (Catapres, Duraclon “Epidural”, Kapvay) class

A

antihypertensive, alpha 2 adrenergic agonist

385
Q

Clonidine (Catapres, Duraclon “Epidural”, Kapvay) dose

A

PO: 0.1-0.2 mg BID (max 2.4mg/day)

Transdermal patch: 0.1-0.3mg once weekly

386
Q

Clonidine (Catapres, Duraclon “Epidural”, Kapvay) contraindication

A

Do not discontinue therapy abruptly. When discontinuing, taper gradually to decrease risk of rebound hypertension

387
Q

Clonidine (Catapres, Duraclon “Epidural”, Kapvay) dose adjustment

388
Q

Dxazosin

389
Q

Dxazosin (Cardura) class

A

antihypertensive, alpha 1 blocker

390
Q

Dxazosin (Cardura) dose

A

IR: 1 mg daily titrated up to 8 mg/day

ER: 4 mg daily titrated up to 8 mg/day

391
Q

Dxazosin (Cardura) contraindication

A

Do not use in severe hepatic impairment (Child-Pugh class C)

May cause orthostatic hypotension and syncope within a few hours after dosing, but may occur later; anticipate a similar effect if therapy is interrupted for a few days, if dosage is increased, or if another antihypertensive drug, PDE-5 inhibitor, or nitrates are introduced. Use with caution in patients with symptomatic orthostatic hypotension

392
Q

Dxazosin (Cardura) dose adjustment

393
Q

Trazosin

A

Formerly known as Hytrin

394
Q

Trazosin (Formerly known as Hytrin) class

A

antihypertensive, alpha1 antagonist

395
Q

Trazosin (Formerly known as Hytrin) dose

A

1mg daily at bedtime (20mg/day)

396
Q

Trazosin (Formerly known as Hytrin) contraindication

A

Floppy iris syndrome

Hypotension/syncope

397
Q

Trazosin (Formerly known as Hytrin) dose adjustment

398
Q

Tamsulosin

399
Q

Tamsulosin (Flomax) class

A

Alpha-1 antagonist

400
Q

Tamsulosin (Flomax) dose

A

0.4 mg daily ½ hour after the same meal each day

Max 0.8mg daily

401
Q

Tamsulosin (Flomax) contraindications

A

Angina

Floppy iris syndrome

Orthostatic hypotension/syncope

402
Q

Tamsulosin (Flomax) dose adjustment

403
Q

Hydralazine

A

Apresoline

404
Q

Hydaralazine (Apresoline) class

A

Antihypertensive, vaodilator

405
Q

Hydaralazine (Apresoline) dose

A

CHF: initial 25-50mg 3-4x/day in combination with isosorbide dinitrate 3 or 4 times daily (300 mg/day)

406
Q

Hydaralazine (Apresoline) contraindications

A

Coronary Artery disease

May cause a drug-induced lupus-like syndrome

407
Q

Hydaralazine (Apresoline) dose adjustment

408
Q

Amoxicillin

A

Amoxicillin

409
Q

Amoxicillin class

A

antibiotic, PCN

410
Q

Amoxicillin dose

A

PO: 500mg-1g Q8-12h

411
Q

Amoxicillin contraindications

A

A high percentage of patients with infectious mononucleosis develop an erythematous rash during amoxicillin therapy; avoid use in these patients

412
Q

Amoxicillin dose adjustment

413
Q

Amoxicillin/potassium clavulanate

414
Q

Amoxicillin/potassium clavulanate (Augmentin) class

A

antibiotic, PCN

415
Q

Amoxicillin/potassium clavulanate (Augmentin) dose
IR
ER

A

PO:
IR: 500mg Q8h
or 875mg Q12h

ER:2g Q12h

416
Q

Amoxicillin/potassium clavulanate (Augmentin) contraindications

A

differing content of clavulanic acid, not all formulations are interchangeable;
use of an inappropriate product –>
diarrhea
or subtherapeutic clavulanic acid concentrations
–> decreased clinical efficacy.

Some products contain
Phenylalanine

417
Q

Amoxicillin/potassium clavulanate (Augmentin) dose adjustment

A

hepatic

renal

418
Q

Ampicillin/ Sulbactam

419
Q

Ampicillin/ Sulbactam (Unasyn) class

A

antibiotic, PCN

420
Q

Ampicillin/ Sulbactam (Unasyn) dose

A

2:1 ratio.
Dosage recommendations are expressed as total grams of ampicillin/sulbactam
IM, IV: 1-2 g ampicillin as 1.5-3 g Unasyn® q6h

421
Q

Ampicillin/ Sulbactam (Unasyn) contraindications

A

Hepatotoxicity has been reported. Monitor hepatic function at regular intervals

422
Q

Ampicillin/ Sulbactam (Unasyn) dose adjustment

423
Q

Penicillin V potassium

A

formerly Pen VK

424
Q

Penicillin V potassium (formerly Pen VK) class

A

antibiotic, PCN

425
Q

Penicillin V potassium (formerly Pen VK) dose

A

PO:125-500mg Q6-8h

426
Q

Penicillin V potassium (formerly Pen VK) contraindications

A

Prolonged use may result in fungal or bacterial superinfection

427
Q

Penicillin V potassium (formerly Pen VK) dose adjustment

428
Q

Piperacillin/ tazobactam

429
Q

Piperacillin/ tazobactam (Zosyn) class

A

antibiotic, PCN

430
Q

Piperacillin/ tazobactam (Zosyn) dose

A

Adult doses are expressed as the combined amount of piperacillin and tazobactam.

IV: 3.375 gm q6h or 4.5gm q6-8h (max 18 gm/day)

431
Q

Piperacillin/ tazobactam (Zosyn) contraindications

A

Sodium content (2.84 mEq per gram of piperacillin) should be considered in patients requiring sodium restriction

Risk of nephrotoxicity is increased when piperacillin and tazobactam is given in combination with vancomycin

432
Q

Piperacillin/ tazobactam (Zosyn) dose adjustment

433
Q

Rifaximin

434
Q

Rifaximin (Xifaxan) class

A

anitbiotic, Rifamycin

435
Q

Rifaximin (Xifaxan) dose

A

Hepatic encephalopathy: 550 mg BID

IBS–diarrhea:
550 mg TID for 14 days

Traveler’s Diarrhea:
200 mg TID for 3 days

436
Q

Rifaximin (Xifaxan) contraindications

A

Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy.

437
Q

Rifaximin (Xifaxan) dose adjustment

438
Q

sulfamethoxazole 800mg/ trimethoprim 160 PO

439
Q

sulfamethoxazole 800mg/ trimethoprim 160 IV

440
Q

sulfamethoxazole 800mg/ trimethoprim 160 (Bactrim, Sulfatrim) class

A

antibiotic, sulfonamide

441
Q

sulfamethoxazole 800mg/ trimethoprim 160 PO (Bactrim) dose

A

PO: 1-2 double strength tab Q12-24h

442
Q

sulfamethoxazole 800mg/ trimethoprim 160 IV (Sulfatrim) dose

A

IV: 8-20mg/kg/day (TMP component) divided Q6-12h

443
Q

sulfamethoxazole 800mg/ trimethoprim 160 (Bactrim, Sulfatrim) contrindications

A

megaloblastic anemia due to folate deficiency;

infants <2 months (manufacturer’s labeling), infants <4 weeks (CDC 2009); marked hepatic damage or severe renal disease (if patient not monitored);

concomitant administration with dofetilide

444
Q

sulfamethoxazole 800mg/ trimethoprim 160 (Bactrim, Sulfatrim) dose adjustment

445
Q

Tobramycin

A

Tobramycin, formerly Tobradex

446
Q

Tobramycin (formerly Tobradex) class

A

antibiotic, aminoglycoside

447
Q

Tobramycin (formerly Tobradex) dose

A

Conventional: 1 - 2.5 mg/kg/dose Q8 -12 h;

to ensure adequate peak concentrations early in therapy: 4-7 mg/kg/dose QD

448
Q

Tobramycin (formerly Tobradex) contraindications

A

May cause neuromuscular blockade and respiratory paralysis; especially when given soon after anesthesia or neuromuscular blockers.

Ototoxicity is proportional to the amount of drug given and the duration of treatment. Tinnitus or vertigo may be indications of vestibular injury and impending bilateral irreversible damage. Discontinue treatment if signs of ototoxicity occur.

449
Q

Tobramycin (formerly Tobradex) dose adjustment

450
Q

Gentamicin

A

formerly Garamycin

451
Q

Gentamicin (formerly Garamycin) class

A

antibiotic, aminoglycoside

452
Q

Gentamicin (formerly Garamycin) dose

A

Depends on condition

Conventional: IM, IV: 3-5 mg/kg/day in divided doses Q 8h

extended-interval dosing: IV: 5-7 mg/kg/day QD

453
Q

Gentamicin (formerly Garamycin) contraindications

A

May cause neuromuscular blockade and respiratory paralysis; especially when given soon after anesthesia or neuromuscular blockers.

Ototoxicity is proportional to the amount of drug given and the duration of treatment. Tinnitus or vertigo may be indications of vestibular injury and impending bilateral irreversible damage. Discontinue treatment if signs of ototoxicity occur.

454
Q

Gentamicin (formerly Garamycin) dose adjustment

455
Q

Levofloxacin

A

Formerly Levaquin

456
Q

Levofloxacin (Levaquin) class

A

antibiotic, FQ

457
Q

Levofloxacin (Levaquin) dose

A

PO,IV: 250-750mg daily

458
Q

Levofloxacin (Levaquin) contraindications

A 
[BBW]: Fluoroquinolones are associated with disabling and potentially irreversible serious adverse reactions that may occur together, including:
 tendinitis
tendon rupture
peripheral neuropathy
and CNS effects.

Discontinue levofloxacin immediately and avoid use of fluoroquinolones in patients who experience any of these serious adverse reactions

459
Q

Levofloxacin (Levaquin) dose adjustment

460
Q

Moxifloxacin

A

Moxifloxacin, Avelox (IV)

461
Q

Moxifloxacin (Moxifloxacin, Avelox (IV)) class

A

antibiotic, FQ

462
Q

Moxifloxacin (Moxifloxacin, Avelox (IV)) dose

A

PO, IV: 400mg QD

463
Q

Moxifloxacin (Moxifloxacin, Avelox (IV)) contraindications

A 
[BBW]: Fluoroquinolones are associated with disabling and potentially irreversible serious adverse reactions that may occur together, including:
 tendinitis
tendon rupture
peripheral neuropathy
and CNS effects.

Discontinue moxifloxacin immediately and avoid use of fluoroquinolones in patients who experience any of these serious adverse reactions

464
Q

Moxifloxacin (Moxifloxacin, Avelox (IV)) dose adjustment

465
Q

ciprofloxacin

466
Q

ciprofloxacin (cipro) class

A

antibiotic, FQ

467
Q

ciprofloxacin (cipro) dose
PO
IV

A

PO: 250-750mg Q12h

IV: 400mg Q12h

468
Q

ciprofloxacin (cipro) contraindications

A 
[BBW]: Fluoroquinolones are associated with disabling and potentially irreversible serious adverse reactions that may occur together, including:
 tendinitis
tendon rupture
peripheral neuropathy
and CNS effects.

Discontinue ciprofloxacin immediately and avoid use of fluoroquinolones in patients who experience any of these serious adverse reactions

469
Q

ciprofloxacin (cipro) dose adjustment

470
Q

Clarithromycin

A

formerly Biaxin

471
Q

Clarithromycin (formerly Biaxin ) class

A

antibiotic, macrolide

472
Q

Clarithromycin (formerly Biaxin ) dose

A 
PO: 250-500mg Q12h
or 1000mg (two 500mg ER) QD
473
Q

Clarithromycin (formerly Biaxin ) contraindications

A

Potentially significant interactions may exist with CYP3A4 metabolism including some statins

History of QT prolongation or ventricular arrhythmia

474
Q

Clarithromycin (formerly Biaxin ) dose adjustment

A

renal

hepatic

475
Q

Fidaxomicin

476
Q

Fidaxomicin (Dificid) class

A

antibiotic, macrolide

477
Q

Fidaxomicin (Dificid) dose

A

C. diff: 200mg BID for 10 days

478
Q

Fidaxomicin (Dificid) contraindications

A

Do not use for systemic infections; fidaxomicin systemic absorption is negligible.

479
Q

Fidaxomicin (Dificid) dose adjustment

480
Q

Azithromycin

481
Q

Azithromycin (Zithromax) class

A

antibiotic, macrolide

482
Q

Azithromycin (Zithromax) dose

A

IV: CAP
500mg QD for at least 3 days, then 500mg PO QD to complete 7-10 days tx

PO: 500mg on day 1 followed by 250mg QD x 4days

483
Q

Azithromycin (Zithromax) contraindications

A

Altered cardiac conduction with potential QT prolongation

Conflicting data on increased cardiovascular mortality

484
Q

Azithromycin (Zithromax) dose adjustment

485
Q

Clindamycin

486
Q

Clindamycin (Cleocin) class

A

antibiotic, lincosamide

487
Q

Clindamycin (Cleocin) dose

A

PO: 600-800 mg/day in 2 to 4 divided doses; up to 2400 mg/day in 4 divided doses may be given for severe infections

IM, IV: 600-2700 mg/day in 2 to 4 divided doses, up to 4,800 mg/day IV (in divided doses) has been used in life-threatening infections
maximum: 600 mg/dose IM

488
Q

Clindamycin (Cleocin) dose adjustment

489
Q

Clindamycin (Cleocin) dose adjustment

490
Q

Doxycycline

A

Vibramycin

491
Q

Doxycycline (Vibramycin)class

A

antibiotic, tetracycline

492
Q

Doxycycline (Vibramycin) dose

A

Doxycycline is available as hyclate, monohydrate, and calcium salts. All doses are expressed as doxycycline base.

Oral: 100 to 200 mg/day in 1 to 2 divided doses.
IV: 100 mg every 12 hours

493
Q

Doxycycline (Vibramycin) contraindications

A

May cause tissue hyperpigmentation, tooth enamel hypoplasia, or permanent tooth discoloration (more common with long-term use, but observed with repeated, short courses) when used during tooth development (last half of pregnancy, infancy, and childhood ≤8 years of age

IV form may cause phlebitis.

494
Q

Doxycycline (Vibramycin) dose adjustment

495
Q

Minocycline

A

CoreMino, Minocin, Minolirra, Solodyn, Ximino

Minocin (IV)

496
Q

Minocycline (CoreMino, Minocin, Minolirra, Solodyn, Ximino, Minocin (IV)) class

A

antibiotic, tetracycline derivative

497
Q

Minocycline (CoreMino, Minocin, Minolirra, Solodyn, Ximino, Minocin (IV)) dose

A

IV: 200 mg for 1 dose, then 100 mg q12h, max 400mg/day

PO: Initial: 200 mg for 1 dose; Maintenance: 100 mg every 12 hours; more frequent dosing intervals may be used (50 mg 4 times daily)

Acne
PO: 50 to 100 mg twice daily

498
Q

Minocycline (CoreMino, Minocin, Minolirra, Solodyn, Ximino, Minocin (IV)) contraindications

A

Hyperpigmentation may occur in nails, bone, skin (including scar and injury sites), eyes, sclerae, thyroid, oral cavity, visceral tissue, and heart valves; skin and oral hyperpigmentation are independent of dose or administration duration.

Do not use during pregnancy.

499
Q

Minocycline (CoreMino, Minocin, Minolirra, Solodyn, Ximino, Minocin (IV)) dose adjustment

500
Q

Mupirocin

A

Bactroban, Centany

501
Q

Mupirocin (Bactroban, Centany ) class

A

antiobiotic, topical

502
Q

Mupirocin (Bactroban, Centany ) dose

A

Apply to affected area three times per day

Elimination of MRSA colonization: Intranasal: Approximately one-half of the ointment from the single-use tube should be applied into one nostril and the other half into the other nostril twice daily (morning and evening) for 5 days

503
Q

Mupirocin (Bactroban, Centany ) contraindications

A

some dosage forms may contain propylene glycol

504
Q

Mupirocin (Bactroban, Centany ) dose adjustment

505
Q

Chlorhexidine

A

Paroex, Peridex, Periogard

506
Q

Chlorhexidine (Paroex, Peridex, Periogard) class

A

antibiotic, oral rinse

507
Q

Chlorhexidine (Paroex, Peridex, Periogard) dose

A

Swish and spit for 30 seconds with 15 ml twice daily after brushing teeth

508
Q

Chlorhexidine (Paroex, Peridex, Periogard) contraindications

A

Staining of oral surfaces

509
Q

Chlorhexidine (Paroex, Peridex, Periogard) dose adjustment

510
Q

Nitrofurantoin

A

Macodantin, Macrobid, Furadantin

511
Q

Nitrofurantoin (Macodantin, Macrobid, Furadantin) class

A

antibiotic, Miscellaneous

512
Q

Nitrofurantoin (Macodantin, Macrobid, Furadantin) dose

A

Nitrofurantoin is chemically available as nitrofurantoin macrocrystals and nitrofurantoin monohydrate. Two different preparations are available in the US: A combination of nitrofurantoin monohydrate and nitrofurantoin macrocrystals (Macrobid), which is typically dosed twice daily for the treatment of acute infections and a preparation that consists solely of nitrofurantoin macrocrystals (Furadantin, Macrodantin), which is typically dosed 4 times daily for the treatment of acute infections. Regardless of the formulation used, advise patients to administer with food to improve absorption.

Different dosing for prophylaxis versus active treatment

Macrodantin: 50-100mg once daily to 4 times per day (max 400 mg/day)

Macrobid: 100mg 1-2 times daily

513
Q

Nitrofurantoin (Macodantin, Macrobid, Furadantin) contraindications

A

Due to the possibility of hemolytic anemia caused by immature erythrocyte enzyme systems (glutathione instability), the drug is contraindicated in pregnant patients at term (38 to 42 weeks gestation), during labor and delivery, or when the onset of labor is imminent; also contraindicated in neonates younger than 1 month of age.

Contraindicated in patients with a previous history of cholestatic jaundice or hepatic dysfunction associated with nitrofurantoin.

514
Q

Nitrofurantoin (Macodantin, Macrobid, Furadantin) dose adjustment

515
Q

Metronidazole

516
Q

Metronidazole (Flagyl) class

A

antibiotic, Miscellaneous amebicide

517
Q

Metronidazole (Flagyl) dose

A

Anaerobic infections;
PO: 250-750 mg every 8-12 hours

IV: 500-750 mg every 6-8 hours

518
Q

Metronidazole (Flagyl) contraindications

A

Concomitant alcohol consumption (disulfiram-like reactions); avoid alcoholic beverages or products containing propylene glycol during oral or injectable therapy and for at least 3 days after therapy.

Avoid in pregnancy (1st trimester)

519
Q

Metronidazole (Flagyl) dose ajustment

520
Q

Vancomycin

A

Vancocin, Firvanq

521
Q

Vancomycin (Vancocin, Firvanq) class

A

antibiotic, glycopeptide

522
Q

Vancomycin (Vancocin, Firvanq) dose

A

IV: 15 to 20 mg/kg/dose (rounded to the nearest 250 mg; usual maximum: 2 g/dose initially) every 8 to 12 hours

PO: 125 to 500 mg 4 times daily

523
Q

Vancomycin (Vancocin, Firvanq) contraindications

A

Oral is ineffective for treating systemic infections due to lack of absorption

524
Q

Vancomycin (Vancocin, Firvanq) dose adjustment

525
Q

Cefazolin

A

formerly Ancef

526
Q

Cefazolin (formerly Ancef) class

A

antibiotic, 1st generation cephalosporin

527
Q

Cefazolin (formerly Ancef) dose

A

IV: 250mg-2g Q6-12h

528
Q

Cefazolin (formerly Ancef) contraindications

A

Caution in patients with a history of seizure disorder; high levels, particularly in renal impairment, may increase risk of seizures

529
Q

Cefazolin (formerly Ancef) dose adjustment

530
Q

Cephalexin

531
Q

Cephalexin (Keflex) class

A

antibiotic, 1st generation cephalosporin

532
Q

Cephalexin (Keflex) dose

A

250 to 1,000 mg every 6 hours or 500 mg every 12 hours (maximum: 4 g/day)

533
Q

Cephalexin (Keflex) contrainidcations

A

Positive direct Coombs tests and acute intravascular hemolysis have been reported. If anemia develops, discontinue use and work up for drug-induced hemolytic anemia

534
Q

Cephalexin (Keflex) dose adjustment

535
Q

Cefoxitin

A

formerly Mefoxin

536
Q

Cefoxitin (formerly Mefoxin ) class

A

antibiotic, 2nd generation cephalosporin

537
Q

Cefoxitin (formerly Mefoxin ) dose

A

IM, IV: 1-2g Q6-8h

538
Q

Cefoxitin (formerly Mefoxin ) contrainidcations

A

Pediatric ≥3 months of age, higher doses have been associated with an increased incidence of eosinophilia and elevated AST

539
Q

Cefoxitin (formerly Mefoxin ) dose adjustment

540
Q

Cefuroxime

A

formerly Zinacef or Ceftin

541
Q

Cefuroxime (formerly Zinacef or Ceftin ) class

A

antibiotic, 2nd generation cephalosporin

542
Q

Cefuroxime (formerly Zinacef or Ceftin ) dose

A

PO: 250-500 BID

IV: 750-1.5g Q8h

543
Q

Cefuroxime (formerly Zinacef or Ceftin ) contraindications

A

Tablets and oral suspension are not bioequivalent; do not substitute on a mg-per-mg basis

544
Q

Cefuroxime (formerly Zinacef or Ceftin ) dose adjustment

545
Q

Cefdinir

546
Q

Cefdinir (Omnicef) class

A

antibiotic, cephalosporin, 3rd generation

547
Q

Cefdinir (Omnicef) dose

A

PO: 300mg BID or

600mg QD for 5-7days

548
Q

Cefdinir (Omnicef) contraindications

A

Cases of reddish stools have been reported with cefdinir with iron-containing products due to the formation of a nonabsorbable complex in the GI tract

549
Q

Cefdinir (Omnicef) dose adjustment

550
Q

Ceftriaxone

A

Formerly Rocephin

551
Q

Ceftriaxone (Formerly Rocephin ) class

A

antibiotic, 3rd generation cephalosporin

552
Q

Ceftriaxone (Formerly Rocephin ) dose

A

IM, IV: 1-2g Q12-24h

553
Q

Ceftriaxone (Formerly Rocephin )contraindications

A

Hyperbilirubinemic neonates

Concurrent use with IV calcium containing solutions in neonates

554
Q

Ceftriaxone (Formerly Rocephin ) dose adjustment

555
Q

Cefepime

556
Q

Cefepime (Maxipime) class

A

antibiotic, 4th generation cephalosporin

557
Q

Cefepime (Maxipime) dose

A

IV: 1-2g Q8-12h

558
Q

Cefepime (Maxipime) contraindications

A

Neurotoxicity: Severe neurological reactions reported, including seizures and nonconvulsive status epilepticus. Risk may be increased with renal impairment; ensure dose adjusted for renal function and discontinue therapy if neurotoxicity develops

559
Q

Cefepime (Maxipime) dose adjustment

560
Q

Linezolid

561
Q

Linezolid (Zyvox ) class

A

antibiotic, oxazolidinone

562
Q

Linezolid (Zyvox ) dose

A

PO: 400-600mg Q12h

IV: 600mg Q12h

563
Q

Linezolid (Zyvox ) contraindications

A

Serotonin syndrome: Symptoms of agitation, confusion, hallucinations, hyperreflexia, myoclonus, shivering, and tachycardia may occur with concomitant proserotonergic drugs (ex. SSRI, SNRI, tramadol) agents which reduce linezolid’s metabolism, or in patients with carcinoid syndrome. Avoid use in such patients unless clinically appropriate and under close monitoring

564
Q

Linezolid (Zyvox ) dose adjustment

565
Q

Meropenem

566
Q

Meropenem (Merrem) class

A

antibiotic, carbapenem

567
Q

Meropenem (Merrem) dose

A

IV:500mg Q6h

or 1-2g Q8h

568
Q

Meropenem (Merrem) contraindications

A

Use with caution in patients with renal impairment; dosage adjustment required with CrCl ≤50 mL/min. Increased seizure risk and thrombocytopenia have been reported in patients with renal impairment.

569
Q

Meropenem (Merrem) dose adjustment

570
Q

Apixaban

571
Q

Apixaban (Eliquis) class

A

anticoagulant, factor Xa inhibitor

572
Q

Apixaban (Eliquis) dose

A

Nonvalvular atrial fibrillation: PO: 5 mg BID unless patient has any 2 of the following: Age ≥80 years
wt ≤60 kg
SCr ≥1.5 mg/dL

then reduce dose to 2.5 mg BID

573
Q

Apixaban (Eliquis) contraindications

574
Q

Apixaban (Eliquis) dose adjustment

A

renal

hepatic

575
Q

Edoxaban

576
Q

Edoxaban (Savaysa) class

A

anticoagulant, factor Xa inhibitors

577
Q

Edoxaban (Savaysa) dose

A

PO: 60mg QD

578
Q

Edoxaban (Savaysa) contraindications

A

If CrCl >95ml/min do not use

579
Q

Edoxaban (Savaysa) dose adjustment

580
Q

Rivaroxaban

581
Q

Rivaroxaban (Xarelto ) class

A

anticoagulant, factor Xa inhibitor

582
Q

Rivaroxaban (Xarelto ) dose

A

2.5-20mg QD-BID with food (max 20mg QD)

583
Q

Rivaroxaban (Xarelto ) contraindications

A

Avoid use with CrCl < 30ml/min or in severe hepatic failure

Bleeding

584
Q

Rivaroxaban (Xarelto ) sdose adjusmtnet

A

renal and hepatic

585
Q

Warfarin

586
Q

Warfarin (Coumadin) class

A

anticoagulant, vitamin K antagonist

587
Q

Warfarin (Coumadin) dose

588
Q

Warfarin (Coumadin) contraindications

A

Hemorrhagic tendencies

Recent or potential surgery

Severe uncontrolled HTN

Pregnancy

589
Q

Warfarin (Coumadin) dose adjustment

590
Q

Dabigatran

591
Q

Dabigatran (Pradaxa) class

A

anticoagulant, direct thrombin inhibitor

592
Q

Dabigatran (Pradaxa) dose

593
Q

Dabigatran (Pradaxa) contraindications

594
Q

Dabigatran (Pradaxa) dose adjustment

595
Q

Enoxaparin

596
Q

Enoxaparin (Lovenox) class

A

anticoagulant, LMWH

597
Q

Enoxaparin (Lovenox) dose

A

px: 30mg BID or 40mg QD SQ
tx: 1mg/kg BID or 1.5mg/kg QD SQ

598
Q

Enoxaparin (Lovenox) contraindications

A

Thrombocytopenia with positive test for antiplatelet antibodies with enoxaparin use

Hypersensitivity to pork products

Active major bleeding,

599
Q

Enoxaparin (Lovenox)dose adjustment

600
Q

Heparin

601
Q

Heparin class

A

anticoagulant

602
Q

Heparin dose

A

Thromboembolism prophylaxis
5000 units every 8-12 hours subcutaneously

Treatment of thromboembolism
80 units/kg IV push followed by continuous infusion of 18 units/kg/hour

603
Q

Heparin contraindications

A

Severe thrombocytopenia

Uncontrolled active bleeding

604
Q

Heparin dose adjustment

605
Q

Prochlorperazine

A

Compro (rectal)

Oral formerly known as Compazine

606
Q

Prochlorperazine (Compro (rectal), PO formerly Compazine)

class

A

antipsychotic, 1st generation, antiemetic

607
Q

Prochlorperazine (Compro (rectal), PO formerly Compazine)

dose

A

Nausea and Vomiting
PO: 5-10 mg three to four times per day
(max 40 mg/day)

IV: 2.5-10 mg three to four times per day

Rectal: 25 mg bid

608
Q

Prochlorperazine (Compro (rectal), PO formerly Compazine)

contraindications

A

Coma or CNS depressants

Altered cardiac conduction

Anticholinergic side effects

Extrapyramidal symptoms

609
Q

Prochlorperazine (Compro (rectal), PO formerly Compazine)

dose adjustment

610
Q

Haloperidol

611
Q

Haloperidol (Haldol) class

A

antipsychotic, 1st generation

612
Q

Haloperidol (Haldol) dose

A

Psychosis: 0.5 to 5 mg in divided doses

Schizophrenia: IM: 2 to 5 mg in divided doses (20 mg/day)

613
Q

Haloperidol (Haldol) coontraindications

A

May cause extrapyramidal symptoms (EPS), including pseudoparkinsonism, acute dystonic reactions, akathisia, and tardive dyskinesia

614
Q

Haloperidol (Haldol) dose adjustment

615
Q

Lurasidone

616
Q

Lurasidone (Latuda) class

A

antipsychotic, atypical 2nd generation

617
Q

Lurasidone (Latuda) dose

A

Bipolar Depression
Initial 20 mg at bedtime, titrated up to 120 mg/day

Schizophrenia
Initial: 40 mg daily increased to 160 mg/day

618
Q

Lurasidone (Latuda) contraindications

A

Increased mortality in elderly patients with dementia related psychosis

Use with caution in patients at risk of seizures

Guidelines recommend gradually tapering antipsychotics to avoid physical withdrawal symptoms

619
Q

Lurasidone (Latuda) dose adjustment

A

renal

hepatic

620
Q

Olanzapine

A

Zyprexa, Zyprexa Relprevv

621
Q

Olanzapine (Zyprexa, Zyprexa Relprevv) class

A

Antipsychotic, atypical 2nd generation

622
Q

Olanzapine (Zyprexa, Zyprexa Relprevv) dose

A

Short-acting injection: IM: Initial dose: 10 mg

PO: Initial: 5 mg in the evening; adjust as tolerated to usual range of 5 to 20mg daily (30mg/day)

Extended-release injection: IM: Note: Establish tolerance to oral olanzapine prior to changing to extended-release injection. Maximum dose: 300 mg every 2 weeks or 405 mg every 4 weeks

623
Q

Olanzapine (Zyprexa, Zyprexa Relprevv) contraindications

624
Q

Olanzapine (Zyprexa, Zyprexa Relprevv) dose adjustment

625
Q

Risperidone

A

(Risperdal, Risperdal Consta “IM”, Perseris “SQ”)

626
Q

Risperidone (Risperdal, Risperdal Consta “IM”, Perseris “SQ”) class

A

Antipsychotic, atypical 2nd generation

627
Q

Risperidone (Risperdal, Risperdal Consta “IM”, Perseris “SQ”) dose

A

Oral: 0.25-3 mg daily (16mg/day)

IM: Initial: 25 mg every 2 weeks (50mg)

SQ: Usual dose: 90 or 120 mg once monthly

628
Q

Risperidone (Risperdal, Risperdal Consta “IM”, Perseris “SQ”) contraindications

A

Increased risk of hyperglycemia and metabolic changes

629
Q

Risperidone (Risperdal, Risperdal Consta “IM”, Perseris “SQ”) dose adjustment

A

hepatic

renal

630
Q

Ziprasidone

631
Q

Ziprasidone (Geodon) class

A

Antipsychotic, atypical 2nd generation

632
Q

Ziprasidone (Geodon) dose

A

Oral: 20-40mg twice daily with food. (80-100mg twice daily depending on indication

IM: 10 mg to 20 mg administered as required up to a maximum dose of 40 mg per day

633
Q

Ziprasidone (Geodon)contraindications

A

Should be avoided in combination with other drugs that are known to prolong the QTc interval

Severe cutaneous adverse reactions

634
Q

Ziprasidone (Geodon) dose adjustment

635
Q

Aripiprazole

A

Abilify, Abilify Maintena IM

636
Q

Aripiprazole (Abilify, Abilify Maintena IM) class

A

Antipsychotic, Atypical, 2nd generation

637
Q

Aripiprazole (Abilify, Abilify Maintena IM) dose

A

PO: 10-15mg daily (30mg/day)

IM, ER: 400mg once monthly (doses should be separated by ≥26 days)

638
Q

Aripiprazole (Abilify, Abilify Maintena IM) contraindications

639
Q

Aripiprazole (Abilify, Abilify Maintena IM) dose adjustment

640
Q

Clozapine

A

Clozaril, FazaClo, Versacloz

641
Q

Clozapine (Clozaril, FazaClo, Versacloz) class

A

Antipsychotic, Atypical, 2nd generation

642
Q

Clozapine (Clozaril, FazaClo, Versacloz)dose

A

12.5mg daily or twice daily increased to 300-450 mg/day (max dose 900mg.day)

643
Q

Clozapine (Clozaril, FazaClo, Versacloz) contraindications

A

BBW Fatalities due to myocarditis and cardiomyopathy have been reported

Severe, life-threatening and sometimes fatal hepatotoxicity

BBW Seizures have been associated with clozapine use in a dose-dependent manner

644
Q

Clozapine (Clozaril, FazaClo, Versacloz) dose adjustment

645
Q

lithium

646
Q

Lithium (Lithobid) class

A

antimanic Agent

647
Q

Lithium (lithobid) dose

A

Monitor serum concentrations and clinical response (efficacy and toxicity) to determine proper dose

Bipolar Disorder
600-900 mg BID-TID initially then titrated to 900 to 1800 mg/day

648
Q

Lithium (lithobid) contraindications

A

Severe cardiovascular or renal disease

Concurrent use with diuretics

Caution with sodium intake or high sodium excretion

Concurrent use with ACE-Inhibitors or (ARBs)

Use with caution in patients with thyroid disease; hypothyroidism may occur with treatment

649
Q

Lithium (lithobid) dose adjustment

650
Q

Meclizine

A

Bonine, Feormerly Antivert

651
Q

Meclizine (Bonine, Feormerly Antivert) class

A

Antihistamine/antiemetic, Histamine 1 antagonist, first generation

652
Q

Meclizine (Bonine, Formerly Antivert) dose

A

Vertigo: 25-100mg/day in divided doses

Motion Sickness: 25 to 50 mg 1 hour before travel, repeat dose every 24 hours if needed

653
Q

Meclizine (Bonine, Feormerly Antivert) contraindications

A

CNS depression

Caution in patients with glaucoma

654
Q

Meclizine (Bonine, Feormerly Antivert) dose adjustment

655
Q

Promethazine

656
Q

Promethazine (Phenergan) class

A

Antihistamine/antiemetic, Histamine 1 antagonist, first generation

657
Q

Promethazine (Phenergan) dose

A

Oral or Rectal: 25 mg at bedtime or 12.5 mg before meals and at bedtime

IV, IM: 25 mg, may repeat in 2 hours when necessary; switch to oral route as soon as feasible

658
Q

Promethazine (Phenergan) CI

A

Coma or CNS depressants

Altered cardiac conduction

Anticholinergic side effects

Extrapyramidal symptoms

659
Q

Promethazine (Phenergan) dose adjustments

660
Q

Cetirizine

661
Q

Cetirizine (Zyrec) class

A

Antihistamine, Second generation H1 Histamine Antagonist

662
Q

Cetirizine (Zyrtec) dose

A

10mg daily

Up to 40mg daily depending on condition and response

663
Q

Cetirizine (Zyrtec) CI

A

May cause CNS depression, which may impair physical or mental abilities

664
Q

Cetirizine (Zyrec) dose adjustment

665
Q

Fexofenadine

666
Q

Fexofenadine (Allegra) class

A

Antihistamine, H1 antagonist

Antihistamine/ Antiemetic, Histamine H1 Antagonist

667
Q

Fexofenadine (Allegra) dose

A

60mg twice daily or 180mg daily
Antiemetic; IM: 25 to 100 mg/dose
Anxiety; PO 50-100 mg four times daily

668
Q

Fexofenadine (Allegra) CI

A

Use caution in patients with severe renal dysfunction based on published studies and not manufacturer data.
Precaution in renal failure patients, manufacturer does not provide recommendation but some studies indicate a lower dose is necessary

Caution in patients with glaucoma

QT prolongation/torsades de pointes

669
Q

Fexofenadine (Allegra) dose adjustment

670
Q

Levocetirizine

671
Q

Levocetirizine (Xyzal) class

A

Antihistamine, Histamine H1 Antagonist

672
Q

Levocetirizine (Xyzal) dose

A

PO: 5mg QD

673
Q

Levocetirizine (Xyzal) CI

A

May cause CNS depression, which may impair physical or mental abilities

Rebound pruritus may occur within several days after stopping cetirizine

674
Q

Levocetirizine (Xyzal) dose adjustment

675
Q

Metoclopramide

676
Q

Metoclopramide (Reglan)class

A

Gastrointestinal, Prokinetic, antiemetic

677
Q

Metoclopramide (Reglan) dose

A

PO: 10-20 mg 4 times per day

IV: 10-20mg over 1-2 minutes

678
Q

Metoclopramide (Reglan) CI

A

Extrapyramidal symptoms (EPS)

Hyperprolactinemia

Neuroleptic malignant syndrome

679
Q

Metoclopramide (Reglan) dose adjustment

680
Q

Ondansetron

681
Q

Ondansetron (Zofran) class

A

Antiemetic, Selective 5-HT3 Receptor Antagonist

682
Q

Ondansetron (Zofran) dose

A

IV: 8-16 mg/day

683
Q

Ondansetron (Zofran) CI

A

QT prolongation (increase risk > 16mg at one dose)

Serotonin syndrome

684
Q

Ondansetron (Zofran) dose adjustment

685
Q

Sumatriptan

686
Q

Sumatriptan (Imitrex) class

A

Antimigraine, serotonin 5-HT receptor agonists

687
Q

Sumatriptan (Imitrex) dose

A

Oral: 25-100mg as a single dose. May repeat dose in 2 hours. (200mg/day)

SQ: 6 mg (0.5 mL) subcutaneously (SC) with autoinjector; may repeat in 1 hour or more (12mg/24 hours)

688
Q

Sumatriptan (Imitrex) CI

A

Cerebrovascular syndromes/stroke

Hemiplegic or basilar migraine

Ischemic heart disease

Uncontrolled hypertension

Severe hepatic impairment

Use within 24 hours of ergotamine derivatives or another 5HT1 agonist

Concurrent use with MAOI

689
Q

Sumatriptan (Imitrex) dose adjustment

690
Q

Baclofen

A

Gablofen, Lioresal

691
Q

Baclofen (Gablofen, Lioresal) class

A

skeletal muscle relaxant

692
Q

Baclofen (Gablofen, Lioresal) dose

A

Oral: 5 mg three times daily, then 10 mg three times daily until optimal response. Range 40-80 mg daily

Intrathecal: 50 mcg for 1 dose every 4-8 hours. Do not exceed 100 mcg/24 hours

693
Q

Baclofen (Gablofen, Lioresal) contraindication

A

[BBW] Abrupt withdrawal of intrathecal baclofen, has resulted in sequelae, multiple organ-system failure, and death. Prevention of abrupt discontinuation requires careful attention to programming and monitoring of infusion system, refill scheduling and procedures, and pump alarms

694
Q

Baclofen (Gablofen, Lioresal) dose adjustment

695
Q

Carisoprodol

696
Q

Carisoprodol (Soma) class

A

skeletal muscle relaxant

697
Q

Carisoprodol (Soma) dose

A

250-350 mg three times daily and at bedtime

698
Q

Carisoprodol (Soma) CI

A

Use with caution in patients with a history of drug abuse or acute alcoholism; potential for drug dependency exists. Tolerance, psychological and physical dependence to carisoprodol (and its metabolite, meprobamate) may occur with prolonged use

Limit use to 2 to 3 weeks

699
Q

Carisoprodol (Soma) dose adjustment

700
Q

Cyclobenzaprine

A

Amrix, Fexmid

701
Q

Cyclobenzaprine (Amrix, Fexmid) class

A

skeletal muscle relaxant

702
Q

Cyclobenzaprine (Amrix, Fexmid) dose

A

ER: 15 mg once daily; some patients may require up to 30 mg once daily
IR: 5 mg three times daily; may increase up to 10 mg 3 times daily if needed

703
Q

Cyclobenzaprine (Amrix, Fexmid) CI

A 
Concurrent use of MAOI
CHF
Heart block
Arrythmias
Acute recovery after MI
Hyperthyroidism
704
Q

Cyclobenzaprine (Amrix, Fexmid) dose adjustment

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