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MED
Notes Nurses Pocket
Pharmacology Guide

Judith Hopfer Deglin

April Hazard Vallerand
Purchase additional copies of this book
at your health science bookstore or
directly from F. A. Davis by shopping
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A Daviss Notes Book

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F. A. Davis Company
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[Link]

Copyright 2004 by F. A. Davis Company

All rights reserved. This book is protected by copyright. No part of it may

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Publisher, Nursing: Robert G. Martone

Design Manager: Louis J. Forgione
Cover Designer: Paul Fry

As new scientific information becomes available through basic and clinical

research, recommended treatments and drug therapies undergo changes.
The author(s) and publisher have done everything possible to make this
book accurate, up to date, and in accord with accepted standards at the
time of publication. The author(s), editors, and publisher are not responsi-
ble for errors or omissions or for consequences from application of the
book, and make no warranty, expressed or implied, in regard to the
contents of the book. Any practice described in this book should be applied
by the reader in accordance with professional standards of care used in
regard to the unique circumstances that may apply in each situation. The
reader is advised always to check product information (package inserts) for
changes and new information regarding dose and contraindications before
administering any drug. Caution is especially urged when using new or
infrequently ordered drugs.

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BASICS AC DH IM NR SZ TOOLS
 Look for our other
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Also by Judith Hopfer Deglin

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Daviss Drug Guide for Nurses
 1
High Alert Medications
High alert medications are those medications that have a high
risk of causing injury or death when improperly handled or
administered. Exercise extreme caution when administering
these medications:
Adrenergic agonists (e.g., epinephrine, isoproterenol, norepi-
nephrine)
Cardioplegic solutions
Chemotherapeutic agents
Chloral hydrate (in pediatric patients)
Colchicine injection
High concentration dextrose (10% dextrose)
Hypoglycemic agents (oral)
Hypertonic sodium chloride injection ( 0.9% concentration)
Insulin
IV adrenergic antagonists (propranolol, esmolol, metoprolol)
IV calcium; IV magnesium sulfate
IV digoxin
IV potassium (phosphate and chloride)
Lidocaine/ benzocaine other topical anesthetics
Midazolam
Neuromuscular blocking agents
Opiates (opioids)
Thrombolytics, heparin, warfarin

BASICS
 BASICS

Safe Medication Administration

Carefully read product packaging to note strength of solution,
dosage, and/or route of administration.
Double-check with a pharmacist about dose range.
Have a colleague double-check dosage calculations and infu-
sion pump programming.
Use the 5 Rights (right drug, right dose, right patient, right
route, right time) as a guide.
Clarify any order that is incomplete, contains abbreviations, is
confusing or hard to read, or raises a question.
Do not borrow medications from other patients or begin new
medications before order has been received in pharmacy: to
do so circumvents built-in checks that can detect a prescribing
error.

Standards for Patient Education

All patients need clear written and verbal instruction for all
medications. Do not rush. Include family members.
Present information in a format the patient can understand.
Use an interpreter if provider and patient speak different
languages.
Have the patient repeat the information you provide.
Make sure to tell the patient:
The brand and generic names of the medication
The purpose of the medication
The strength and dose of the medication
When to take the medication
Possible side effects and what to do if they occur
How long to take the medication
What medications or foods to avoid and why they should be
avoided
How to store the medication
What to do if a dose is missed
What activities should be avoided while on the medication
Signs and symptoms of adverse drug reactions

2
 3
Abbreviations and Symbols Associated
with Medication Errors
Abbreviations and symbols are a source of medication errors.
Nurses should consult with the prescribing health care provider
on any orders that contain the following abbreviations.

Abbreviation/ Intended Often

Symbol Meaning Mistaken For Recommendation
AZT Zidovudine Azathioprine Use full drug name
CPZ Compazine Thorazine Use full drug name
(chlorpromazine)
HCl Hydrochloric KCl (potassium Use full drug name
acid chloride)
HCT Hydrocortisone Hydrochlorothiazide Use full drug name
MgSO4 Magnesium Morphine sulfate Use full drug name
sulfate
MS Morphine Magnesium sulfate Use full drug name
sulfate
MTX Methotrexate Mitoxantrone Use full drug name
Nitro drip Nitroprusside Nitroglycerin Use full drug name
Norflox Norfloxacin Norflex Use full drug name
PIT Pitocin Pitressin Use full drug name
/ (slash) per 1 (numeral Spell out per
 Plus sign one) Spell out and
4 (numeral
four)
Zero after 1 mg 10 mg DO NOT USE zero
a decimal after a decimal
point point
(e.g., 1.0 mg)
No zero .1 mg 1 mg ALWAYS USE zero
before a before a decimal
decimal point point
(e.g., .1 mg)
U units 0 (zero), 4 (four) or Spell out unit
cc Write out
medication
HS Half strength Hour of sleep strength.

Adapted from the Institute for Safe Medication Practices, 2003

[Link]

BASICS
 BASICS

IV Administration
Starting an IV
Prepare the patient: Explain procedure, answer any ques-
tions, and reassure.
Gather equipment: IV bag with primed tubing, sharps
container, catheter, tape, tourniquet, and antiseptic swabs.
Organize supplies: Tear tape, have primed tubing and
sharps container within easy reach, and open 22 dressing.
Apply tourniquet proximal to intended insertion site, either
midforearm or above the elbow.
Locate vein: Palpate with fingertips. To further enhance dila-
tion, gently tap, apply heat or warm soak, and have patient
make a few fists or dangle arm below heart.
Cleanse site: Using moderate friction, cleanse in a circular
motion, moving outward from intended site.
Put on gloves while waiting for cleansed area to dry. Avoid
touching site once it has been prepared.
Apply traction (in the direction opposite the catheter).
Position needle, bevel side up, 1530. NOTE: Hold the
needle with the thumb and pointer finger in a way that allows
for visualization of the flash chamber.
Insert needle, and observe for flash back in flash chamber.
Lower catheter almost parallel to the skin, and insert the
needle 12 mm more to ensure that the catheter has also
entered the vein.
Advance the catheter: Thread catheter into vein while
maintaining skin traction.
Release the tourniquet, and apply digital pressure just
above the end of the catheter tip while gently stabilizing the
hub of the catheter.
Remove needle, and discard into approved sharps container.
Connect IV tubing, open clamp, and observe for free flow
of IV fluid.
Secure catheter, and apply sterile dressing per hospital
policy and procedure.
Clean up, and document per hospital policy and procedure.

4
 IV Insertion Guide
5

BASICS
 BASICS

IV Piggyback (IVPB) Setup

The piggyback bag must be higher than the IV.
To do this, use an extension hook.
Use the most proximal access port on primary line.
Adjust piggyback stopcock to desired rate.
After infusion is complete, the primary IV bag will
begin to drip again. Ensure primary drip rate.

Location of Common Veins

Complications of Starting/Maintaining IVs

Infiltration Phlebitis
Assessment: Swelling; Assessment: Classic sign is red
tenderness; decreased or no line along course of vein; other
infusion rate; blanching of skin; signs include redness, heat,
site is cool to touch. swelling, and tenderness.
Interventions: D/C IV, and restart Interventions: D/C IV, and restart
in a new site. Apply warm in a new site. Apply warm
compress to affected area. compress to affected area.

6
 7
Flushing IV Catheters
Catheter Type Solution Strength Frequency

Peripheral Catheters (Open Ended)

Peripheral IV catheter Normal n/a 3 mL daily
saline and PRN
Midline catheter Heparin 10 units/ 5 mL daily
(each lumen if multiple) mL and PRN
Central Venous Catheters (CVC)
Valved-tip catheters Normal n/a 5 mL per
(Groshong PICC) saline lumen weekly
and PRN
Open-ended Heparin 10 units/ 5 mL per
PICC lines mL lumen daily
and PRN
Tunneled catheters Heparin 100 units/ 5 mL per
(Hickman, Broviac) mL lumen daily
and PRN
Implanted Port Catheters
Groshong Port-a-Cath Heparin 100 units/ 5 mL daily
(when accessed) mL and PRN
Solution Used to Flush a Catheter
Valved-tip catheters require only saline flushes; however, the use of heparin is
not contraindicated. All other central lines require heparin flushes to minimize
fibrin collection and clot formation.
Syringe Selection
The smaller the syringe size, the greater the pressure in PSI. Greater PSI
pressure increases potential for catheter damage. Therefore, a syringe size of
10 cc or greater is recommended for central-line flushes.
Positive-Pressure Flushing of Valved-Tip Catheters
Important: To reduce potential for blood backflow into the catheter tip, which
promotes clot formation and catheter occlusion, always remove needles or
needleless caps slowly while injecting the last 0.5 mL of saline.

SAS Technique Flush with Saline,

Administer Med, Flush with Saline

BASICS
BASICS

Intramuscular (IM) Injection Sites

8
 Z-Track Method for Giving IM Injections
9

BASICS
BASICS

Subcutaneous (SC) Injection Sites

Two inches away

from the umbilicus

Subcutaneous (SC) Heparin Injections

Gauge Massage
Site and Angle Aspirate Site
Abdomen, posterior 25 g26 g, 3/8 No No
upper arm, low back, @ 90 (45 if on
thigh, and upper back a thin patient)

10
 Intradermal (ID), Subcutaneous (SC), and Intramuscular (IM)
11

BASICS
 BASICS

Mixing Insulins

1. Obtain appropriate-size insulin syringe, and draw up enough air

equal to combined volume of both insulins.
2. Inject the NPH vial with amount of air equal to amount of NPH
to be mixed without dipping needle into NPH solution.
This prevents the NPH (which is cloudy) from mixing with the
regular insulin (which is clear) and turning it cloudy.
3. Inject remaining air into regular insulin vial, and draw up the
regular insulin to be mixed.
Expel any air/bubbles. There should not be any air in the
syringe, because the NPH vial has already been pressurized.
4. Mix: Roll (do not shake) NPH vial between hands.
This prevents the formation of air bubbles, which can displace
the insulin and alter the dose.
5. Reinsert needle into pressurized NPH and withdraw desired
amount.
Remember to triple-check all medication orders, and have another nurse
present when you mix the insulin.

12
 Mixing Insulins
13

BASICS
 AC

ACYCLOVIR (ay-sye-kloe-veer) Avirax, Zovirax Antiviral

Pregnancy Category B (PO, IV) C (topical)
INDICATIONS: Genital herpes, localized cutaneous herpes
zoster infections, shingles, chickenpox, varicella, herpes
simplex encephalitis, limited nonlife-threatening herpes
simplex infections in immunocompromised patients (topical).
Therapeutic Effects: Inhibition of viral replication,
decreased viral shedding, reduced lesion-healing time.
DOSAGE: PO: Adults: 200800 mg 3 to 5 times daily. Children:
20 mg/kg 4 times daily IV Adults and Children: 520 mg/kg
q8 h. Topical: Adults and Children: 1/2 inch ribbon for each 4
square inch area 6 times daily.
ADMINISTRATION: PO: Can give with food or on an empty
stomach, with a full glass of water. IV: Do not reconstitute
with bacteriostatic water with benzyl alcohol or paraben.
Administer via infusion pump over at least 1 hour to minimize
renal tubular damage.
ADVERSE REACTIONS AND SIDE EFFECTS: SEIZURES,
dizziness, headache, diarrhea, nausea, vomiting, pain,
phlebitis, RENAL FAILURE, THROMBOTIC THROMBOCY-
TOPENIC PURPURA/ HEMOLYTIC UREMIC SYNDROME in high
doses in immunosuppressed patients.
CONTRAINDICATIONS: Hypersensitivity to acyclovir or valacy-
clovir.
CAUTIONS: Concurrent use of other nephrotoxic drugs
increases the risk of adverse renal effects.

14
 15
ALBUTEROL (al-byoo-ter-awl) AccuNeb, Proventil, Ventodisk,
Ventolin bronchodilator Pregnancy Category C
INDICATIONS: Asthma or COPD-induced reversible airway
obstruction, acute bronchospasm, prevention of exercise-
induced bronchospasm, long-term control of chronic/persist-
ent bronchospasm.
Therapeutic Effects: Bronchodilation.
DOSAGE: PO: Adults and Children 12: 24 mg 34 times
daily; 48 mg twice daily for extended-release tablets.
Children 612 yr: 2 mg 34 times daily. Children 26 yr: 0.1
mg/kg 3 times daily. Geriatrics: 2 mg 34 times daily.
Inhalation: Adults and Children 212 yr: Via nebulization or
IPPB: 1.252.5 mg 34 times daily. Adults and Children 4 yr:
Via Rotahaler inhalation device: 200 g as Ventolin Rotacaps q
46 h up to 400 g q 46 h. Adults and Children 4 yr: Via
metered-dose inhaler2 inhalations q 46 h.
ADMINISTRATION: PO: Administer oral medication with meals
to minimize gastric irritation. Inhalation: Allow at least 1
minute between inhalations of aerosol medication. For nebu-
lization or IPPB, the 0.50.83-, 1-, and 2-mg/mL solutions do
not require dilution before administration. The 5 mg/mL solu-
tion must be diluted with 2.5 mL of 0.9% NaCl for inhalation.
ADVERSE REACTIONS AND SIDE EFFECTS: Nervousness,
restlessness, tremor, chest pain, palpitations, angina, arrhyth-
mias, hypertension, hypokalemia.
CONTRAINDICATIONS: Hypersensitivity to adrenergic amines
or hypersensitivity to fluorocarbons inhaler.
CAUTIONS: Excessive use may lead to tolerance and para-
doxical bronchospasm. Use with MAO inhibitors may lead
to hypertensive crisis. Beta-blockers may negate therapeutic
effect.

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

AC
 AC

ALENDRONATE (uh-len-dro-nate) Fosamax Bone resorption

inhibitor Pregnancy Category C
INDICATIONS: Osteoporosis, Pagets disease of the bone.
Therapeutic Effects: Reversal of the progression of
osteoporosis with decreased fractures, decreased progression
of Pagets disease.
DOSAGE: PO: Adults: Treatment of osteoporosis: 510 mg
once daily or 70 mg once weekly. Prevention of osteoporosis:
5 mg once daily or 35 mg once weekly. Pagets disease: 40 mg
once daily for 6 mo.
ADMINISTRATION: Remain upright for 30 min following dose
to facilitate passage to stomach and minimize risk of
esophageal irritation. Do not drink coffee, tea, cola, mineral
water, or orange juice within 1/2 hour of taking alendronate.
ADVERSE REACTIONS AND SIDE EFFECTS: Headache,
abdominal distention, abdominal pain, acid regurgitation,
constipation, diarrhea, dyspepsia, dysphagia, esophageal
ulcer, flatulence, gastritis, nausea, altered taste, vomiting,
erythema, photosensitivity, rash, musculoskeletal pain.
CONTRAINDICATIONS: Renal insufficiency (CCr 35 mL/min),
pregnancy, lactation.
CAUTIONS: Calcium supplements, antacids, other oral
medications and food significantly decrease the absorption of
alendronate. Caffeine coffee, tea, cola, mineral water, and
orange juice also decrease absorption. Wait 1 hour before
consuming.

16
 17
ALLOPURINOL (al-oh-pure-i-nawl) Apo-Allopurinol, Lopurin,
Zyloprim Anti-gout agent, antihyperuricemic Pregnancy Category
C
INDICATIONS: Prevention of attack of gouty arthritis and
nephropathy. Treatment of secondary hyperuricemia that can
occur during treatment of tumors or leukemias. Treatment of
secondary hyperuricemia.
Therapeutic Effects: Lowering of serum uric acid levels
by inhibiting the production of uric acid.
DOSAGE: PO: Adults: 100 to 800 mg/d. Doses 300 mg/d
should be given in divided doses. Children 610 yr: 300 mg
daily. Children 6 yr: 150 mg daily. IV: Adults: 200400
mg/m2/d (up to 600 mg/d) as a single daily dose or in divided
doses q 612 h. Children: 200 mg/m2 per day as a single daily
dose or in divided doses q 612 h.
ADMINISTRATION: May be administered with milk or meals to
minimize gastric irritation. May be crushed.
ADVERSE REACTIONS AND SIDE EFFECTS: Drowsiness,
diarrhea, hepatitis, nausea, vomiting, renal failure, rash,
urticaria, bone marrow depression, hypersensitivity reactions.
CONTRAINDICATIONS: Hypersensitivity; pregnancy/lactation.
CAUTIONS: Use with mercaptopurine and azathioprine
increases bone marrow depressant propertiesdosages of these
drugs should be reduced. Use with ampicillin or amoxicillin
increases the risk of rash. Use with oral hypoglycemic agents
and warfarin increases the effects of these drugs. Use with
thiazide diuretics or ACE inhibitors increases the risk of hyper-
sensitivity reactions. Discontinue allopurinol immediately if
rash occurs. Therapy should be discontinued permanently if
reaction is severe. Therapy may be reinstituted at a lower
dose (50 mg/d with very gradual titration) after a mild reaction
has subsided.

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

AC
 AC

ALPRAZOLAM (al-pra-zoe-lam) Apo-Alpraz, Nu-Alpraz, Xanax

antianxiety agent (benzodiazepine) Pregnancy Category D
INDICATIONS: Anxiety, panic attacks, premenstrual syndrome
(PMS) (unlabeled use).
Therapeutic Effects: Relief of anxiety.
DOSAGE: PO: Adults: 0.250.5 mg 23 times daily.
ADMINISTRATION: May be administered with food if GI upset
occurs. Tablets may be crushed.
ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,
drowsiness, lethargy, confusion, hangover, headache, mental
depression, paradoxical excitation, blurred vision, constipa-
tion, diarrhea, nausea, vomiting, rashes, physical dependence,
psychological dependence, and tolerance.
CONTRAINDICATIONS: Hypersensitivity, narrow-angle glau-
coma, cross-sensitivity with other benzodiazepines, pre-
existing CNS depression, severe, uncontrolled pain, preg-
nancy and lactation.
CAUTIONS: Alcohol, antidepressants, other
benzodiazepines, antihistamines, opioid analgesics, kava,
valerian, skullcap, chamomile, or hops can increase CNS
depression. Advise patient to avoid the use of alcohol or
other CNS depressants concurrently with alprazolam.
Instruct patient to consult health care professional before
taking OTC medications concurrently with this medication.

18
 19
AMILORIDE (a-mill-oh-ride) Midamor diuretic (potassium-
sparing diuretic) Pregnancy Category B
INDICATIONS: Counteract potassium loss caused by other
diuretics; used with thiazides to treat edema or hypertension.
Therapeutic Effects: Weak diuretic and antihypertensive
response when compared with other diuretics, conservation of
potassium.
DOSAGE: PO: Adults: 510 mg/d (up to 20 mg).
ADMINISTRATION: PO: Administer in morning to avoid inter-
rupting sleep pattern. Administer with food or milk to mini-
mize gastric irritation and to increase bioavailability.
ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,
arrhythmias, constipation, GI irritation, impotence, hyper-
kalemia, hyponatremia, muscle cramps, allergic reactions.
CONTRAINDICATIONS: Hypersensitivity, hyperkalemia.
CAUTIONS: Additive hypotension with acute ingestion of
alcohol, other antihypertensives, or nitrates. Use with ACE
inhibitors, indomethacin, potassium supplements, or
cyclosporine increases risk of hyperkalemia. Decreases
lithium excretion. Effectiveness may be decreased by
NSAIDs. May cause dizziness. Caution patient to avoid
driving or other activities requiring alertness until response to
medication is known.

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

AC
 AC

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

rhythmic Pregnancy Category D
INDICATIONS: Ventricular arrhythmias. Unlabeled Uses:
Supraventricular tachyarrhythmias.
Therapeutic Effects: Suppression of arrhythmias.
DOSAGE: PO: Adults: Ventricular Arrhythmias400600 mg
daily in 12 doses. Supraventricular Tachycardia200400
mg/d. Children: Ventricular Arrhythmias: 25 mg/kg/d.
Supraventricular Tachycardia: 2.5 mg/kg/d. IV: Adults: 150 mg
over 10 min, followed by 360 mg over the next 6 hours and
then 540 mg over the next 18 h. Continue infusion at 0.5
mg/min until oral therapy is initiated.
ADMINISTRATION: PO: Administer with meals if GI intoler-
ance occurs. IV: Administer via volumetric pump using an in-
line filter.
ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,
fatigue, malaise, corneal microdeposits, ADULT RESPIRATORY
DISTRESS SYNDROME (ARDS), PULMONARY FIBROSIS, CHF,
WORSENING OF ARRHYTHMIAS, bradycardia, hypotension,
LIVER FUNCTION ABNORMALITIES, anorexia, constipation,
nausea, vomiting, TOXIC EPIDERMAL NECROLYSIS, photosen-
sitivity, hypothyroidism, ataxia, involuntary movement, pares-
thesia, peripheral neuropathy, poor coordination, tremor.
CONTRAINDICATIONS: Severe sinus node dysfunction, 2nd
and 3rd AV block, bradycardia, pregnancy, and lactation.
CAUTIONS: Increases digoxin levels (decrease digoxin by
50%) and activity of warfarin (decrease warfarin by 33%50%).
Increases blood levels and may lead to toxicity from quini-
dine, procainamide, mexiletine, lidocaine, flecainide, cyclo-
sporine, dextromethorphan, methotrexate, phenytoin, and
theophylline. Increased risk of bradyarrhythmias, sinus
arrest, or AV heart block with beta-blockers or calcium channel
blockers. Do not confuse amiodarone with amrinone, now
called inamrinone.

20
 21
AMITRIPTYLINE (a-meh-trip-ti-leen) Elavil, Levate, Novotriptyn
antidepressant (tricyclic) Pregnancy Category D
INDICATIONS: Depression, chronic pain syndromes (unlabeled
use).
Therapeutic Effects: Improved mood.
DOSAGE: PO: Adults: 75 to 150 mg/d in divided doses, or 50100
mg at bedtime; may increase up to 150 mg. Hospitalized patients
dose may receive up to 300 mg/d. Geriatric Patients and
Adolescents: 10 mg three times daily and 20 mg at bedtime. Up
to 100 mg/d in a single bedtime dose or divided doses. IM:
Adults: 2030 mg 4 times daily.
ADMINISTRATION: PO: Administer with a meal to minimize
gastric upset. Tablet may be crushed. IM: For short-term IM
administration only. Do not administer IV.
ADVERSE REACTIONS AND SIDE EFFECTS: Lethargy,
sedation, blurred vision, dry eyes, dry mouth, ARRHYTHMIAS,
hypotension, ECG changes, constipation, hepatitis, paralytic
ileus, urinary retention, blood dyscrasias, photosensitivity,
changes in blood glucose, gynecomastia, increased appetite and
weight gain.
CONTRAINDICATIONS: Narrow-angle glaucoma, pregnancy and
lactation.
CAUTIONS: May cause hypotension, tachycardia, and poten-
tially fatal reactions when used with MAO inhibitors (dis-
continue MAO inhibitor 2 weeks before starting amitriptyline).
May cause toxicity when used with SSRI antidepressants
(discontinue fluoxetine 5 weeks before starting amitriptyline).
Concurrent use with clonidine may cause hypertensive crisis.
Concurrent use with moxifloxacin or sparfloxacin increases risk
of adverse cardiovascular reactions. Additive CNS depression
with other CNS depressants including alcohol, antihistamines,
clonidine, opioids, and sedative/hypnotics. Phenothiazines or
oral contraceptives increase levels and may cause toxicity.

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

AC
 AC

AMLODIPINE (am-loe-di-peen) Norvasc antihypertensive

(calcium channel blocker) Pregnancy Category C
INDICATIONS: Management of hypertension, angina pectoris,
and vasospastic (Prinzmetal) angina.
Therapeutic Effects: Systemic vasodilation and
decreased blood pressure. Coronary vasodilation and decreased
frequency and severity of angina.
DOSAGE: PO: Adults: 510 mg daily.
ADMINISTRATION: May be administered without regard to
meals.
ADVERSE REACTIONS AND SIDE EFFECTS: Headache, dizzi-
ness, fatigue, peripheral edema, angina, bradycardia,
hypotension, palpitations, gingival hyperplasia, nausea,
flushing.
CONTRAINDICATIONS: Hypersensitivity to amlodipine or
blood pressure 90 mm Hg.
CAUTIONS: Additive hypotension may occur when used
concurrently with fentanyl, other antihypertensives, nitrates,
acute ingestion of alcohol, or quinidine. Blood levels and
effects are increased by concurrent ingestion of grapefruit
juice. Do not confuse amlodipine with amiloride; do not
confuse Norvasc with Navane.

22
 23
AMOXICILLIN/CLAVULANATE (a-mox-i-sill-in klav-yoo-
lan-ate) Augmentin ES, Augmentin XR, Clavulin anti-infective
Pregnancy Category B
INDICATIONS: Skin and skin structure infections, otitis media,
sinusitis, respiratory tract infections, genitourinary tract infec-
tions, meningitis, septicemia.
Therapeutic Effects: Bactericidal action against susceptible
bacteria.
DOSAGE: PO: Adults and Children 40 kg: Tablets: 250500
mg tablet q 812 h. Suspension: 500 mg q 12 h. Children
2 yr: 2040 mg/kg/d in divided doses q 812 h. Children
3 mo: 200 mg/5 mL or 400 mg/5 mL suspension: 12.5 mg/kg
q 12 h or 6.6 mg/kg q 8 h (as 125 mg/5 mL or 250 mg/5 mL
suspension). Children 3 mo: 15 mg/kg q 12 h (125 mg/mL
suspension recommended).
ADMINISTRATION: Administer around the clock. May be given
with meals to decrease GI side effects. Chewable tablets
should be crushed or chewed. Shake oral suspension before
administering. Do not administer 250 mg chewable tablets to
children 40 kg due to clavulanate content.
ADVERSE REACTIONS AND SIDE EFFECTS: SEIZURES (high
doses), PSEUDOMEMBRANOUS COLITIS, diarrhea, hepatic
dysfunction, nausea, vomiting, rashes, urticaria, ANAPHY-
LAXIS and SERUM SICKNESS, superinfection.
CONTRAINDICATIONS: Hypersensitivity to penicillins or clavu-
lanate.
CAUTIONS: May potentiate the effect of warfarin. May
decrease the effectiveness of hormonal contraceptives.
Instruct patient to notify health care professional immedi-
ately if diarrhea, abdominal cramping, fever, or bloody stools
occur and not to treat with antidiarrheals without consulting
health care professionals.

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

AC
 AC

AMOXICILLIN (uh-mox-i-sil-in) Amoxil, Novamoxin, Trimox

anti-infective, anti-ulcer agent Pharm Class: Aminopenicillins
Pregnancy Category B
INDICATIONS: Skin and skin structure infections, otitis media,
sinusitis, respiratory infections, genitourinary infections,
septicemia, endocarditis prophylaxis, ulcer disease due to
Helicobacter pylori. Unlabeled use: Lyme disease.
Therapeutic Effects: Bactericidal action.
DOSAGE: PO: Adults and Children 20 kg: 250500 mg q 8 h
or 500875 mg q 12 h. Children 3 mo: 2040 mg/kg/d in
divided doses q 8 hour or 2545 mg/kg/d in divided doses q
12 h. Infants 3 mo: up to 30 mg/kg/d in divided doses q 12 h.
ADMINISTRATION: Administer around the clock. Administer
without regard to meals or with meals to decrease GI side
effects. Capsule contents may be emptied and swallowed with
liquids. Suspension may be given straight or mixed in
formula, milk, fruit juice, water, or ginger ale. Administer
immediately after mixing. Discard refrigerated reconstituted
suspension after 10 days.
ADVERSE REACTIONS AND SIDE EFFECTS: SEIZURES (in
high doses), PSEUDOMEMBRANOUS COLITIS, diarrhea,
nausea, vomiting, rashes, urticaria, blood dyscrasias, allergic
reactions including ANAPHYLAXIS, SERUM SICKNESS, super-
infection.
CONTRAINDICATIONS: Hypersensitivity to penicillins.
CAUTIONS: May potentiate the effect of warfarin. May
decrease the effectiveness of oral contraceptives. Infectious
mononucleosis (increased incidence of rash). Observe for
signs and symptoms of anaphylaxis (rash, pruritus, laryngeal
edema, wheezing). Monitor bowel function for signs or
symptoms of pseudomembranous colitis: diarrhea, abdominal
cramping, fever, and bloody stools.

24
 25
ATENOLOL (a-ten-oh-lole) Apo-Atenolol, Novo-Atenolol,
Tenormin antianginal, antihypertensive (selective beta-blocker)
Pregnancy Category D
INDICATIONS: Hypertension, angina, reduce risk of second MI.
Therapeutic Effects: Lower blood pressure and heart
rate, decreased frequency of angina.
DOSAGE: PO: Adults: 25100 mg once daily. IV: Adults:
Administer 5 mg over 5 min, followed by another 5mg 10 min
later.
ADMINISTRATION: PO: Take apical pulse before administering
drug. If 50 bpm or if arrhythmia occurs, withhold medication
and notify physician or other health care professional.
IV: Administer each dose over 5 minutes.
ADVERSE REACTIONS AND SIDE EFFECTS: Fatigue, weak-
ness, anxiety, depression, dizziness, insomnia, memory loss,
mental status changes, nervousness, nightmares, blurred
vision, stuffy nose, bronchospasm, wheezing, BRADYCARDIA,
CHF, PULMONARY EDEMA, hypotension, peripheral vasocon-
striction, constipation, diarrhea, liver function abnormalities,
nausea, vomiting, impotence, decreased libido, urinary
frequency.
CONTRAINDICATIONS: Uncompensated CHF, pulmonary
edema, cardiogenic shock, bradycardia or heart block.
CAUTIONS: Additive bradycardia may occur with digoxin.
Additive hypotension may occur with other antihyperten-
sives, acute ingestion of alcohol, or nitrates. May alter the
effectiveness of insulins or oral hypoglycemic agents (dosage
adjustments may be necessary). May decrease effectiveness
of theophylline. Monitor blood pressure, ECG, and pulse
frequently during dosage adjustment period and periodically
throughout therapy.

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

AC
 AC

ATORVASTATIN (a-tore-va-sta-tin) Lipitor lipid-lowering agent

Pregnancy Category X
INDICATIONS: Primary hypercholesterolemia and mixed
dyslipidemia.
Therapeutic Effects: Lowering of total and LDL
cholesterol.
DOSAGE: PO: Adults: 10 mg once daily initially; may be
increased q 24 wk up to 80 mg/d.
ADMINISTRATION: Administer with the evening meal.
ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,
headache, insomnia, weakness, rhinitis, bronchitis, abdominal
cramps, constipation, diarrhea, flatus, heartburn, altered taste,
drug-induced hepatitis, dyspepsia, elevated liver enzymes,
nausea, pancreatitis, impotence, rashes, pruritus, RHAB-
DOMYOLYSIS, arthralgia, arthritis, myalgia, myositis, hyper-
sensitivity reactions.
CONTRAINDICATIONS: Hypersensitivity, active liver disease,
pregnancy or lactation, concurrent use of gemfibrozil or azole
antifungals.
CAUTIONS: Blood levels and the risk of myopathy are
increased by concurrent cyclosporine and gemfibrozil, clofi-
brate, erythromycin, large doses of niacin and azole antifun-
gal agents. Grapefruit juice may cause higher blood levels
and increased risk of toxicity. Liver function tests, including
AST, should be monitored before, at 612 wk after initiation of
therapy or after dose elevation, and then every 6 mo. If AST
levels increase to 3 times normal, HMG-COA reductase
inhibitor therapy should be discontinued. May cause
elevated alkaline phosphatase and bilirubin levels. If patient
develops muscle tenderness during therapy, CPK levels
should be monitored. If CPK levels are markedly increased or
myopathy occurs, therapy should be discontinued.

26
 27
AZITHROMYCIN (aye-zith-row-my-sin) Zithromax agent for
atypical mycobacterium, anti-infectives (macrolide) Pregnancy
Category B
INDICATIONS: Upper and lower respiratory tract infections, bron-
chitis, pneumonia, skin and skin structure infections, nongono-
coccal urethritis, cervicitis, gonorrhea, and chancroid, prevention
of disseminated Mycobacterium avium complex (MAC) infection
in patients with advanced HIV infection. Prevention of bacterial
endocarditis (unlabeled use).
Therapeutic Effects: Bacteriostatic action against
susceptible bacteria.
DOSAGE: PO: Adults: 500 mg 1st day, then 250 mg/d for duration
of therapy. May be given as 1 to 2 g single or weekly dose.
Children 215 yr: 1012 mg/kg (not 500 mg/dose) on 1st day,
then 5 mg/kg (not 250 mg/dose.) IV: Adults: 500 mg IV q 24 h.
ADMINISTRATION: PO: Administer 1 hour before or 2 hours after
meals. IV: Administer 1 mg/mL IV solution over 3 hours or 2
mg/mL solution over 1 hour. Do not administer as a bolus.
ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,
drowsiness, fatigue, headache, ANGIOEDEMA, chest pain, palpi-
tations, PSEUDOMEMBRANOUS COLITIS, abdominal pain, diar-
rhea, nausea, cholestatic jaundice, dyspepsia, flatulence, melena,
nephritis, vaginitis, photosensitivity, rashes.
CONTRAINDICATIONS: Hypersensitivity to azithromycin, erythro-
mycin, or other macrolide anti-infectives.
CAUTIONS: Observe for signs and symptoms of anaphylaxis.
Monitor patient for signs and symptoms of pseudomembra-
nous colitis: fever, diarrhea, and stool containing blood, pus, or
mucus. Kaolin, magnesium and aluminum antacids will
decrease absorption of azithromycin. Separate dose times by at
least 2 hours. Do not confuse azithromycin with erythromycin.
Do not confuse Zithromax with Zinacef.

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

AC
 AC

BACLOFEN (bak-loe-fen) Lioresal antispasticity agent, skeletal

muscle relaxant Pregnancy Category C
INDICATIONS: Reversible spasticity associated with multiple
sclerosis or spinal cord lesions. Intrathecal: Severe spasticity
originating in the spinal cord.
Therapeutic Effects: Decreased spasticity, improvement
of bowel and bladder function.
DOSAGE: PO: Adults: 5 mg 3 times daily. May increase q 3
days by 5 mg/dose to maximum of up to 80 mg/d. Intrathecal:
Adults: 100800 g/d infusion. Children: 251200 g/d infusion
(average 275 g/d).
ADMINISTRATION: PO: Administer with milk or food.
Intrathecal: Screening phase, dilute for a concentration of 50
g/mL with NaCl for injection. Test dose should be adminis-
tered over at least 1 minute. If response is inadequate, 2 addi-
tional test doses, each 24 hours apart, 75 g/1.5 mL and 100
g/2 mL respectively, may be administered.
ADVERSE REACTIONS AND SIDE EFFECTS: SEIZURES
(intrathecal), dizziness, drowsiness, fatigue, weakness, confu-
sion, insomnia, hypotension, nausea, pruritus, ataxia.
CONTRAINDICATIONS: Hypersensitivity.
CAUTIONS: Additive effect with other CNS depressants
including alcohol, antihistamines, opioid analgesics, and
sedative/hypnotics. Use with MAO inhibitors may lead to
increased CNS depression or hypotension. Intrathecal:
Monitor patient closely during test dose and titration; resusci-
tative equipment should be immediately available for life-
threatening or intolerable side effects. Caution patient to
avoid abrupt withdrawal of this medication because it may
precipitate an acute withdrawal reaction (hallucinations,
increased spasticity, seizures, mental changes, restlessness).
Discontinue gradually over 2 weeks or more.

28
 29
BECLOMETHASONE (beh-kloe-meth-a-sone) Beclodisk,
Becloforte, Beclovent, Vanceril, antiasthmatic, anti-inflammatory
(inhalation corticosteroid) Pregnancy Category C
INDICATIONS: Asthma.
Therapeutic Effects: Decrease frequency and severity of
asthma attacks.
DOSAGE: Inhalation: Adults and Children 12 yr: 42
g/inhalation: 2 inhalations 34 times daily or 4 inhalations
twice daily. 84 g/inhalation: 2 inhalations twice daily or 4
inhalations twice daily. Children 612 yr: 42 g/inhalation: 12
inhalations 34 times (not to exceed 10 inhalations/day) or 4
inhalations twice daily. 84 g/inhalation: 2 inhalations twice
daily (not to exceed 5 inhalations/d).
ADMINISTRATION: Allow at least 1 minute between inhala-
tions of aerosol medication.
ADVERSE REACTIONS AND SIDE EFFECTS: Dysphonia,
hoarseness, oropharyngeal fungal infections, cataracts; bron-
chospasm, cough, wheezing, dry mouth, esophageal candidia-
sis, adrenal suppression, decreased growth (children),
CHURG-STRAUSS SYNDROME.
CONTRAINDICATIONS: Acute attack of asthma/status asth-
maticus.
CAUTIONS: Advise patients also using bronchodilator to use
bronchodilator first and wait 5 minutes before taking beclo-
methasone. Advise patient to use regular peak flow monitor-
ing to determine respiratory status. Advise patient to notify
physician if sore throat or sore mouth occurs. Instruct patient
whose systemic corticosteroids have been recently reduced or
withdrawn to carry a warning card indicating the need for
supplemental systemic corticosteroids in the event of stress or
severe asthma attack unresponsive to bronchodilators. Caution
patient to avoid smoking, known allergens, and other respiratory
irritants.

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

AC
 AC

BENAZEPRIL (ben-aye-ze-pril) Lotensin antihypertensive (ACE

inhibitors) Pregnancy Category C (first trimester), D (second and
third trimesters)
INDICATIONS: Hypertension.
Therapeutic Effects: Lowering of blood pressure.
DOSAGE: PO: Adults: 510 mg once daily, increased gradually
to maintenance dose of 2040 mg/d as single dose or 2
divided doses (begin with 5 mg/d in patients receiving diuret-
ics).
ADMINISTRATION: Precipitous drop in blood pressure during
first 13 hours following first dose may occur, especially if
also taking diuretics. Monitor blood pressure closely.
ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,
fatigue, headache, insomnia, cough, hypotension, angina
pectoris, tachycardia, taste disturbances, anorexia, diarrhea,
nausea, proteinuria, impotence, renal failure, hyperkalemia,
AGRANULOCYTOSIS, ANGIOEDEMA.
CONTRAINDICATIONS: Hypersensitivity, pregnancy,
angioedema (hereditary or idiopathic).
CAUTIONS: Additive hypotension with other antihyperten-
sives, nitrates, phenothiazines, acute ingestion of alcohol, and
during surgery or general anesthesia. Hyperkalemia may
result from concurrent use of potassium supplements, potas-
sium-sparing diuretics, indomethacin, salt substitutes, or
cyclosporine. May increase the risk of lithium or digoxin
toxicity. Instruct patient to notify health care professional if
rash; mouth sores; sore throat; fever; swelling of hands or
feet; irregular heart beat; chest pain; dry cough; hoarseness;
swelling of face, eyes, lips, or tongue; difficulty swallowing or
breathing occur. Persistent dry cough may occur and may
not subside until medication is discontinued.

30
 31
BENZTROPINE (benz-troe-peen) Apo-Benztropine, Cogentin
antiparkinson agent, anticholinergic Pregnancy Category C
INDICATIONS: Parkinsons disease, including drug-induced
extrapyramidal effects and acute dystonic reactions.
Therapeutic Effects: Reduces rigidity and tremors.
DOSAGE: PO: Adults: Parkinsonism: 12 mg/d in 12 divided
doses. Drug-induced extrapyramidal reactions: 14 mg given
once or twice daily. IM: Adults: Acute dystonic reactions:
12 mg.
ADMINISTRATION: PO: Administer with food. May be crushed
and administered with food if difficulty swallowing.
ADVERSE REACTIONS AND SIDE EFFECTS: Depression,
hallucinations, blurred vision, dry eyes, mydriasis, arrhyth-
mias, hypotension, palpitations, tachycardia, constipation, dry
mouth, ileus, urinary retention, decreased sweating.
CONTRAINDICATIONS: Hypersensitivity, children 3 yr,
narrow-angle glaucoma, tardive dyskinesia.
CAUTIONS: Additive anticholinergic effects with antihista-
mines, phenothiazines, quinidine, disopyramide, and tricyclic
antidepressants. Antacids and antidiarrheals may decrease
absorption. Teach patient signs of urinary retention and
constipation/ileus. Patients with mental illness are at risk of
developing exaggerated symptoms of their disorder during
early therapy. Advise patient to avoid activities that require
alertness until response to the drug is known. Caution
patient that this medication decreases perspiration.
Overheating may occur during hot weather; patient should
notify health care professional if unable to remain indoors in
an air-conditioned environment during hot weather.
IM: Monitor pulse and blood pressure closely and maintain
bedrest for 1 hour after administration.

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

AC
 AC

BISOPROLOL (bis-oh-proe-lol) Zebeta antihypertensive (beta-

blocker [selective]) Pregnancy Category C
INDICATIONS: Hypertension
Therapeutic Effects: Decreased blood pressure and
heart rate.
DOSAGE: PO: Adults: 2.520 mg/d.
ADMINISTRATION: Administer without regard to meals.
ADVERSE REACTIONS AND SIDE EFFECTS: Fatigue, weak-
ness, anxiety, depression, dizziness, drowsiness, insomnia,
memory loss, mental status changes, nightmares, blurred
vision, bronchospasm, wheezing, BRADYCARDIA, CHF,
PULMONARY EDEMA, hypotension, liver function abnormali-
ties, nausea, impotence, decreased libido, urinary frequency,
rashes, hyperglycemia, hypoglycemia, arthralgia, back pain,
joint pain, drug-induced lupus syndrome.
CONTRAINDICATIONS: Uncompensated CHF, pulmonary
edema, cardiogenic shock, bradycardia or heart block.
CAUTIONS: May alter the effectiveness of insulins or oral
hypoglycemic agents. Additive bradycardia may occur with
digoxin. Additive hypotension may occur with other antihy-
pertensives, acute ingestion of alcohol, or nitrates. Monitor
blood pressure, ECG, and pulse frequently during dosage
adjustment period. Take apical pulse before administering:
If 50 or if arrhythmia occurs withhold medication and notify
physician or other health care professional.

32
 33
BUDESONIDE (byoo-dess-oh-nide) Pulmicort anti-
inflammatory (inhalation corticosteroid) Pregnancy Category B
INDICATIONS: Asthma
Therapeutic Effects: Decrease frequency and severity of
asthma attacks.
DOSAGE: Inhalation: Adults: 12 inhalations once or twice
daily or 24 inhalations twice daily (maximum 8 inhalations
daily). Children 6 yr: 12 inhalations twice daily (maximum
4 inhalations daily). Children 12 mo8 yr: 0.25 to 1 mg/d as a
single dose, or twice daily in divided doses. Individual titra-
tion is required.
ADMINISTRATION: Allow at least 1 minute between inhala-
tions of aerosol medication.
ADVERSE REACTIONS AND SIDE EFFECTS: Dysphonia,
hoarseness, oropharyngeal fungal infections, back pain,
headache, dyspepsia, gastroenteritis, cataracts, bron-
chospasm, cough, wheezing, dry mouth, esophageal candidia-
sis, adrenal suppression, decreased growth (children),
CHURG-STRAUSS SYNDROME.
CONTRAINDICATIONS: Acute attack of asthma/status asth-
maticus.
CAUTIONS: Ketoconazole decreases metabolism and
increases levels of budesonide Advise patients also using
bronchodilator to use bronchodilator first and wait 5 minutes
before taking beclomethasone. Advise patient to use regu-
lar peak flow monitoring to determine respiratory status.
Advise patient to notify physician if sore throat or sore
mouth occurs. Instruct patient whose systemic cortico-
steroids have been recently reduced or withdrawn to carry a
warning card indicating the need for supplemental systemic
corticosteroids in the event of stress or severe asthma attack
unresponsive to bronchodilators. Caution patient to avoid
smoking, known allergens, and other respiratory irritants.

AC
 AC

BUMETANIDE (byoo-met-a-nide) Bumex diuretic (loop diuretic)

Pregnancy Category C
INDICATIONS: Edema secondary to CHF, hepatic or renal
disease.
Therapeutic Effects: Diuresis and subsequent mobiliza-
tion of excess fluid.
DOSAGE: PO: Adults: 0.52 mg/d as a single dose. Up to 2
additional doses may be given during the day q 45 h (up to
10 mg/d). Alternate-day or q 23 day regimens may also be
used. IM, IV: Adults: 0.51 mg, may be repeated q 23 h as
needed (up to 10 mg/d).
ADMINISTRATION: PO: Administer orally with food or milk to
minimize gastric irritation. IV: Direct IV: Rate: Administer
slowly over 2 minutes. Intermittent Infusion: Dilute in D5W,
0.9% NaCl, or LR, and administer through Y-tubing or 3-way
stopcock. Rate: May be administered over 12 hours for
patients with renal impairment.
ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,
headache, insomnia, nervousness, hearing loss, tinnitus,
hypotension, constipation, dry mouth, hyperglycemia, dehy-
dration, hypochloremia, hypokalemia, hypomagnesemia,
hyponatremia, hypovolemia, metabolic alkalosis, hyper-
glycemia, arthralgia, muscle cramps, increased BUN.
CONTRAINDICATIONS: Hypersensitivity (cross-sensitivity with
thiazides and sulfonamides may occur), pre-existing uncor-
rected electrolyte imbalance, hepatic coma, or anuria.
CAUTIONS: Additive hypotension with antihypertensives,
nitrates. Additive hypokalemia with other diuretics,
mezlocillin, piperacillin, amphotericin B, stimulant laxatives,
and corticosteroids. Hypokalemia may increase digoxin
toxicity. Increased risk of ototoxicity with aminoglycoside.
May increase the effectiveness of warfarin, thrombolytic
agents, or anticoagulants.

34
 35
BUPROPION (byoo-proe-pee-on) Wellbutrin, Wellbutrin SR,
Zyban antidepressant, smoking deterrent Pregnancy Category B
INDICATIONS: Depression, smoking cessation (Zyban).
Unlabeled Uses: ADHD (adults, SR only), diminished libido in
women.
Therapeutic Effects: Improved mood, decreased craving
for cigarettes.
DOSAGE: PO: Adults: Depression: 100 mg q 12 h; may be
increased to 450 mg/d in divided doses (no single dose to
exceed 150 mg). Smoking cessation (SR): 150 mg once daily
for 3 days, then 150 mg q 12 h for 712 wk.
ADMINISTRATION: Administer doses in equally spaced time
increments throughout day to minimize the risk of seizures.
Sustained-release tablets should be swallowed whole; do not
break, crush, or chew. Insomnia may be decreased by avoid-
ing bedtime doses. May be administered with food to lessen
GI irritation.
ADVERSE REACTIONS AND SIDE EFFECTS: SEIZURES,
agitation, headache, insomnia, mania, psychoses, dry mouth,
nausea, vomiting, weight gain, weight loss, photosensitivity,
hyperglycemia, hypoglycemia, syndrome of inappropriate
ADH secretion, tremor.
CONTRAINDICATIONS: Hypersensitivity, history of seizures,
bulimia, and anorexia nervosa, concurrent MAO inhibitor
therapy.
CAUTIONS: Increased risk of adverse reactions when used with
levodopa or MAO inhibitors. Increased risk of seizures with
phenothiazine, antidepressants, theophylline, corticosteroids,
OTC stimulants/anorectics, or cessation of alcohol or benzodi-
azepines. Bupropion may impair judgment or motor and
cognitive skills; caution patient to avoid driving and other activi-
ties requiring alertness until response to medication is known.

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

AC
 AC

CAPTOPRIL (kap-toe-pril) Capoten angiotensin-converting

enzyme (ACE) inhibitor Pregnancy Category C (first trimester),
D (second and third trimesters)
INDICATIONS: Hypertension, CHF, diabetic nephropathy.
Therapeutic Effects: Lowered blood pressure, improve-
ment in symptoms of CHF.
DOSAGE: PO: Adults: 12.525 mg 23 times daily, may be
increased at 12 wk intervals up to 150 mg 3 times daily.
ADMINISTRATION: Administer 1 hour before or 2 hours after
meals.
ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,
fatigue, headache, insomnia, weakness, cough, hypotension,
angina pectoris, tachycardia, taste disturbances, anorexia,
diarrhea, nausea, proteinuria, impotence, renal failure, rashes,
hyperkalemia, AGRANULOCYTOSIS, NEUTROPENIA,
ANGIOEDEMA, fever.
CONTRAINDICATIONS: Hypersensitivity, cross-sensitivity
among ACE inhibitors may occur, pregnancy, angioedema
(hereditary or idiopathic).
CAUTIONS: Instruct patient to notify health care professional
if rash; mouth sores; sore throat; fever; swelling of hands or
feet; irregular heart beat; chest pain; dry cough; hoarseness;
swelling of face, eyes, lips, or tongue; difficulty swallowing or
breathing occur. Additive hypotension with other antihyper-
tensives, nitrates, phenothiazines, acute ingestion of alcohol,
and during surgery or general anesthesia. Hyperkalemia
may result from concurrent use of potassium supplements,
potassium-sparing diuretics, indomethacin, salt substitutes,
or cyclosporine. May increase the risk of lithium or digoxin
toxicity. Persistent dry cough may occur and may not
subside until medication is discontinued.

36
 37
CARISOPRODOL (kar-i-sop-roe-dole) Soma, Vanadom skeletal
muscle relaxant Pregnancy Category UK
INDICATIONS: Adjunct to rest and physical therapy in the
treatment of muscle spasm associated with acute painful
musculoskeletal conditions.
Therapeutic Effects: Skeletal muscle relaxation.
DOSAGE: PO: Adults: 350 mg 4 times daily. Children 512 yr:
6.25 mg/kg 4 times daily.
ADMINISTRATION: Administer with food to minimize GI irrita-
tion. Provide safety measures; supervise ambulation and
transfer of patients.
ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,
drowsiness, agitation, ataxia, depression, insomnia, syncope,
asthma attacks, hypotension, tachycardia, epigastric distress,
hiccups, nausea, vomiting, flushing, rashes, ANAPHYLACTIC
SHOCK, fever, psychological dependence, severe idiosyncratic
reaction.
CONTRAINDICATIONS: Hypersensitivity to carisoprodol or to
meprobamate; porphyria or suspected porphyria.
CAUTIONS: Instruct patient to notify health care professional
if signs of allergy (rash, hives, swelling of tongue or lips,
dyspnea) or idiosyncratic reaction occur. Can cause additive
CNS depression with other CNS depressants including
alcohol, antihistamines, opioid analgesics, and
sedative/hypnotics. Concomitant use of kava, valerian, or
chamomile can increase CNS depression. Observe for idio-
syncratic symptoms that may appear within minutes or hours
of administration of first dose: extreme weakness, quadriple-
gia, dizziness, ataxia, dysarthria, visual disturbances, agitation,
euphoria, confusion, and disorientation; symptoms usually
subside over several hours. Advise patient to avoid driving
or other activities requiring alertness. Instruct patient to
change positions slowly to minimize orthostatic hypotension.
Key:
underline = most common;
CAPS = life-threatening

AC
 AC

CARVEDILOL (kar-ve-dil-ole) Coreg antihypertensive (beta-

blocker) Pregnancy Category C
INDICATIONS: Hypertension, CHF.
Therapeutic Effects: Decreases heart rate and blood
pressure, slows the progression of CHF.
DOSAGE: PO: Adults: Hypertension: 6.25 mg twice daily, up to
25 mg twice daily; CHF: 3.125 mg twice daily; may be
increased to 6.25 mg twice daily. Dose may be doubled (not to
exceed 25 mg twice daily in patients 85 kg or 50 mg twice
daily in patients 85 kg).
ADMINISTRATION: Administer without regard to food.
ADVERSE REACTIONS AND SIDE EFFECTS: Weakness, anxi-
ety, depression, insomnia, blurred vision, bronchospasm,
wheezing. BRADYCARDIA, CHF, PULMONARY EDEMA, diar-
rhea, impotence, hyperglycemia, hypoglycemia.
CONTRAINDICATIONS: Uncompensated CHF, pulmonary
edema, cardiogenic shock, bradycardia or heart block, hepatic
impairment or bronchial asthma/bronchospasm.
CAUTIONS: Teach patient to check pulse daily and blood
pressure biweekly and to report pulse 50 bpm or significant
change in blood pressure. Abrupt withdrawal may precipi-
tate life-threatening arrhythmias, hypertension, or myocardial
ischemia. General anesthetics, IV phenytoin, diltiazem, and
verapamil may cause additive myocardial depression.
Additive bradycardia may occur with digoxin. Additive
hypotension may occur with other antihypertensives, or
nitrates. Concurrent use with clonidine increases hypoten-
sion and bradycardia. May alter the effectiveness of insulins
or oral hypoglycemic agents. Use cautiously within 14 days
of MAO inhibitor therapy (may result in hypertension).
Withhold medication if pulse is 50 bpm or if arrhythmia
occurs.

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

38
 39
CEFEPIME (seff-e-peem) Maxipime anti-infective third genera-
tion cephalosporin Pregnancy Category B
INDICATIONS: Skin, bone, joint, urinary, gynecologic, respira-
tory tract, and intra-abdominal infections; septicemia.
Therapeutic Effects: Bactericidal action against suscepti-
ble bacteria.
DOSAGE: IM, IV: Adults: 0.51 g q 12 h. Children 2 mo12 yr
and up to 40 kg: 50 mg/kg 12 h.
ADMINISTRATION: IV: Monitor injection site frequently for
phlebitis. Rate: Administer over 30 minutes.
ADVERSE REACTIONS AND SIDE EFFECTS: SEIZURES (high
doses), PSEUDOMEMBRANOUS COLITIS, diarrhea, nausea,
vomiting, rashes, urticaria, bleeding, phlebitis at IV site, aller-
gic reactions including ANAPHYLAXIS and SERUM SICK-
NESS, superinfection.
CONTRAINDICATIONS: Hypersensitivity to cephalosporins or
penicillins.
CAUTIONS: Report fever and diarrhea, especially if stool
contains blood, pus, or mucus. Advise patient not to treat
diarrhea without consulting health care professional.
Observe patient for signs and symptoms of anaphylaxis
(rash, pruritus, laryngeal edema, wheezing). Discontinue
drug and report signs and symptoms immediately.
Concurrent use of large doses of cephalosporins and non-
steroidal anti-inflammatory agents (NSAIDs) may increase risk
of bleeding. Concurrent use of loop diuretics or nephrotoxic
agents including aminoglycoside may increase the risk of
nephrotoxicity. Determine previous use of and reactions to
penicillins or cephalosporins. Persons with a negative
history of penicillin sensitivity may still have an allergic
response. Obtain specimens for culture and sensitivity
before initiating therapy.

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

AC
 AC

CELECOXIB (sel-e-kox-ib) Celebrex antirheumatic, nonsteroidal

anti-inflammatory (COX-2 inhibitor) Pregnancy Category C
INDICATIONS: Osteoarthritis, rheumatoid arthritis, familial
adenomatous polyposis (FAP).
Therapeutic Effects: Decreased arthritic pain and
inflammation, decreased number of colorectal polyps.
DOSAGE: PO: Adults: Osteoarthritis: 200 mg/d as a single
dose or 100 mg twice daily. Rheumatoid arthritis: 100200 mg
twice daily. Familial adenomatous polyosis: 400 mg twice
daily.
ADMINISTRATION: May be administered without regard to
meals.
ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,
headache, insomnia, GI BLEEDING, abdominal pain, diarrhea,
dyspepsia, flatulence, nausea, rash.
CONTRAINDICATIONS: Hypersensitivity, allergic reactions to
sulfonamides, asthma, urticaria, or allergic reactions to aspirin
or other NSAIDs, advanced renal disease, late pregnancy (may
cause premature closure of ductus arteriosus).
CAUTIONS: Do not confuse with Celexa (citalopram) or
Cerebyx (fosphenytoin). Advise patient to notify health care
professional promptly if signs or symptoms of GI toxicity
(abdominal pain, black stools), skin rash, unexplained weight
gain, or edema occur. May decrease effectiveness of ACE
inhibitors, thiazide diuretics, and furosemide. Use with
aspirin may increase risk of GI bleeding. Use with warfarin
may increase risk of bleeding.

40
 41
CEPHALEXIN (sef-a-lex-in) Apo-Cephalex, Biocef, Keflex, Novo-
Lexin anti-infective (first-generation cephalosporin) Pregnancy
Category B
INDICATIONS: Skin and skin structure infections, pneumonia,
otitis media, urinary tract infections, bone and joint infections,
septicemia caused by susceptible organisms.
Therapeutic Effects: Bactericidal action against suscepti-
ble bacteria.
DOSAGE: PO: Adults: 250500 mg q 6 h. Cystitis, skin and soft
tissue infections, streptococcal pharyngitis: 500 mg q 12 h.
Children: 6.2525 mg/kg q 6 h. Skin and soft-tissue infections,
streptococcal pharyngitis: 12.550 mg/kg q 12 h.
ADMINISTRATION: Administer around the clock on full or
empty stomach. Administer with food to minimize GI irritation.
Shake oral suspension well before administering.
ADVERSE REACTIONS AND SIDE EFFECTS: SEIZURES,
PSEUDOMEMBRANOUS COLITIS, diarrhea, nausea, vomiting,
cramps, rashes, urticaria, blood dyscrasias, hemolytic anemia,
ANAPHYLAXIS and serum sickness, superinfection.
CONTRAINDICATIONS: Hypersensitivity to cephalosporins,
serious hypersensitivity to penicillins.
CAUTIONS: Instruct patient to notify health care professional
if fever and diarrhea develop, especially if diarrhea contains
blood, mucus, or pus. Advise patient not to treat diarrhea
without consulting health care professional. Concurrent use
of loop diuretics may increase the risk of renal toxicity.
Observe for signs and symptoms of anaphylaxis (rash, pruri-
tus, laryngeal edema, wheezing). Discontinue drug and notify
physician or other health care professional immediately.
Keep epinephrine and resuscitation equipment close by in
case of an anaphylactic reaction.

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

AC
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CETIRIZINE (se-ti-ra-zeen) Zyrtec allergy, cold and cough

remedy, antihistamine Pregnancy Category B
INDICATIONS: Relief of allergic symptoms including seasonal
and perennial allergic rhinitis, chronic urticaria.
Therapeutic Effects: Decreased symptoms of histamine
excess (sneezing, rhinorrhea, nasal and ocular pruritus, ocular
tearing and redness).
DOSAGE: PO: Adults and children 6 yr: 510 mg once daily.
Children 611 yr: 510 mg daily. Children 25 yr: 2.55 mg
daily.
ADMINISTRATION: Administer once daily without regard to
food.
ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness, drowsi-
ness, fatigue, pharyngitis, dry mouth.
CONTRAINDICATIONS: Hypersensitivity, acute attacks of
asthma, lactation.
CAUTIONS: May cause dizziness and drowsiness; caution
patient to avoid driving or other activities requiring alertness
until response to medication is known. Advise patient to
avoid taking alcohol or other CNS depressants concurrently
with this drug.

42
 43
CHLOROTHIAZIDE (klor-oh-thye-a-zide) Diuril antihypertensive
(thiazide diuretic) Pregnancy Category B
INDICATIONS: Mild to moderate hypertension, edema.
Therapeutic Effects: Lower blood pressure in hyperten-
sive patients, diuresis with mobilization of edema.
DOSAGE: PO: Adults: 250 mg1 g/d as a single dose or in
divided doses. Children 6 mo: 1020 mg/kg/d as a single
dose or in 2 divided doses. IV: Adults: Diuretic: 250 mg q 612
h. Antihypertensive: 500 mg1 g/d as a single dose or 2
divided doses.
ADMINISTRATION: Administer in the morning to prevent
disruption of sleep cycle.
ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,
drowsiness, lethargy, weakness, hypotension, anorexia,
cramping, hepatitis, nausea, vomiting, photosensitivity,
rashes, hyperglycemia, hypokalemia, dehydration, hypercal-
cemia, hypochloremic alkalosis, hypomagnesemia, hypona-
tremia, hypophosphatemia, hypovolemia, blood dyscrasias,
hyperuricemia, elevated lipids, muscle cramps, pancreatitis.
CONTRAINDICATIONS: Hypersensitivity, anuria, lactation.
CAUTIONS: Additive hypotension with other antihyperten-
sives, acute ingestion of alcohol, or nitrates. Additive
hypokalemia with corticosteroids, amphotericin B,
mezlocillin, piperacillin, or ticarcillin. Hypokalemia increases
risk of digoxin toxicity. Decreases lithium excretion.
Cholestyramine or colestipol decrease absorption. Assess
patient, especially if taking digitalis glycosides, for anorexia,
nausea, vomiting, muscle cramps, paresthesia, and confusion;
notify health care professional if these signs of electrolyte
imbalance occur. Instruct patient to monitor weight
biweekly and report weight gain or loss in excess of 2 pounds.
Caution patient to change positions slowly to minimize
orthostatic hypotension.
Key:
underline = most common;
CAPS = life-threatening

AC
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CIMETIDINE (sye-meh-tih-deen) Novocimetine, Peptol,

Tagamet anti-ulcer agent (histamine h2 antagonist) Pregnancy
Category B
INDICATIONS: Duodenal, benign and stress-induced gastric
ulcers, GERD, heartburn, acid indigestion, Zollinger-Ellison
syndrome.
Therapeutic Effects: Healing and prevention of ulcers,
decreased gastroesophageal reflux, decreased secretion of
gastric acid.
DOSAGE: PO: Adults: Ulcer treatment or prevention: 6001200
mg/d in divided doses or 400800 mg at bedtime. GERD:
8001600 mg/d in divided doses. Zollinger-Ellison syndrome:
300600 mg q 6 h (up to 2400 mg/d). Children: Active ulcers:
2040 mg/kg/d in 4 divided doses. IM, IV: Adults: Active ulcers:
300 mg q 6 h. Continuous IV infusion: 900 mg infused over 24
h (37.5 mg/h). Prevention of upper GI bleeding in critically ill
patients: 50 mg/h. Children: Short-term treatment of active
ulcers: 510 mg/kg q 68 h.
ADMINISTRATION: PO: Administer with meals and at bedtime.
Direct IV: Rate: Dilute and administer over at least 5 min to
prevent hypotension and arrhythmias. Intermittent Infusion:
Rate: Dilute and administer over 1520 min.
ADVERSE REACTIONS AND SIDE EFFECTS: Confusion, dizzi-
ness, drowsiness, hallucinations, ARRHYTHMIAS, drug-
induced hepatitis, nausea, AGRANULOCYTOSIS, APLASTIC
ANEMIA.
CONTRAINDICATIONS: Hypersensitivity.
CAUTIONS: May increase blood levels of chlordiazepoxide,
diazepam, and midazolam, labetalol, metoprolol, propranolol,
caffeine, calcium channel blockers, carbamazepine, chloro-
quine, lidocaine, metronidazole, moricizine, pentoxifylline,
phenytoin, propafenone, quinidine, quinine, metformin,
sulfonylureas, tacrine theophylline, triamterene, tricyclic anti-
depressants, valproic acid, and warfarin.

44
 45
CIPROFLOXACIN (sip-roe-flox-a-sin) Cipro anti-infective (fluo-
roquinolone) Pregnancy Category C
INDICATIONS: Urinary tract and gynecologic infections,
gonorrhea, prostatitis, respiratory tract infections, skin and
skin structure infections, bone and joint infections, infectious
diarrhea, intra-abdominal infections, febrile neutropenia, post-
exposure treatment of inhalational anthrax.
Therapeutic Effects: Resolution of infection.
DOSAGE: PO: Adults: 250750 mg q 12 h. Gonorrhea 250 mg
single dose. IV: Adults: 200400 mg q 12 h.
ADMINISTRATION: PO: Do not give within 2 hours of adminis-
tration of antacids, iron, zinc, or sucralfate. IV: Rate:
Administer over 60 min into a large vein to minimize venous
irritation.
ADVERSE REACTIONS AND SIDE EFFECTS: SEIZURES,
dizziness, drowsiness, headache, acute psychoses, light-head-
edness, tremors, PSEUDOMEMBRANOUS COLITIS, abdomi-
nal pain, diarrhea, nausea, photosensitivity, hyperglycemia,
hypoglycemia, phlebitis at IV site, tendinitis, tendon rupture,
hypersensitivity reactions including ANAPHYLAXIS,
STEVENS-JOHNSON SYNDROME.
CONTRAINDICATIONS: Hypersensitivity, pregnancy, or chil-
dren 18 yr.
CAUTIONS: Instruct patient to notify health care professional
if fever and diarrhea develop, especially if stool contains
blood, pus, or mucus. Advise patient not to treat diarrhea
without consulting health care professional. Instruct patient
to notify health care professional immediately if rash, tendon
pain, or inflammation occurs. May increase the effects of
warfarin. Increases serum theophylline levels and may lead to
toxicity. Concurrent use with foscarnet may increase risk of
seizures. Concurrent use with corticosteroids may increase
risk of tendon rupture.
Key:
underline = most common;
CAPS = life-threatening

AC
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CITALOPRAM (si-tal-oh-pram) Celexa antidepressant (selective

serotonin reuptake inhibitor) Pregnancy Category C
INDICATIONS: Depression
Therapeutic Effects: Improved mood.
DOSAGE: PO: Adults: 2060 mg/d. Geriatric Patients: 20 mg/d,
up to 40 mg/d only in nonresponding patients.
ADMINISTRATION: Administer as a single dose in the morn-
ing or evening without regard to food.
ADVERSE REACTIONS AND SIDE EFFECTS: Apathy, confu-
sion, drowsiness, insomnia, weakness, tremor, agitation,
amnesia, anxiety, decreased libido, dizziness, fatigue,
impaired concentration, increased depression, migraine
headache, suicide attempt, cough, postural hypotension,
tachycardia, abdominal pain, anorexia, diarrhea, dry mouth,
dyspepsia, flatulence, increased saliva, nausea, increased
appetite, vomiting, amenorrhea, ejaculatory delay, impotence,
polyuria, increased sweating, photosensitivity, pruritus, rash,
arthralgia, myalgia, paresthesia, fever, yawning.
CONTRAINDICATIONS: Hypersensitivity, concurrent MAO
inhibitor therapy.
CAUTIONS: Do not confuse with Celebrex (celecoxib) or
Cerebyx (fosphenytoin). May cause serious, potentially fatal
reactions when used with MAO inhibitors; allow at least 14
days between citalopram and MAO inhibitors. Serotonergic
effects may be potentiated by lithium (concurrent use should
be carefully monitored). Concurrent use with 5-HT1 agonists
used for migraine headaches may increase the risk of adverse
reactions (weakness, hyperreflexia, incoordination).
Increased risk of serotonergic side effects including sero-
tonin syndrome with St. Johns wort and SAMe.

46
 47
CLINDAMYCIN (klin-da-mye-sin) Cleocin, Dalacin C, anti-
infective Pregnancy Category B
INDICATIONS: Skin, skin structure, respiratory tract, intra-
abdominal and gynecologic infections, septicemia,
osteomyelitis, endocarditis prophylaxis, severe acne.
Therapeutic Effects: Bactericidal or bacteriostatic to
susceptible organisms.
DOSAGE: PO: Adults: Most infections: 150300 mg q 6 h.
P. carinii pneumonia: 12001800 mg/d in divided doses with
1530 mg primaquine/day. CNS toxoplasmosis: 12002400
mg/d in divided doses with pyrimethamine 50100 mg/d.
Children 1 mo: 25 mg/kg q 6 h or 2.76.7 mg/kg q 8 h.
IM, IV: Adults: Most infections: 300600 mg q 68 h or 900 mg
q 8 h. P. carinii pneumonia: 24002700 mg/d in divided doses
with primaquine. Toxoplasmosis: 12004800 mg/d in divided
doses with pyrimethamine. Children 1 mo: 3.7510 mg/kg q
6 h or 513.3 mg/kg q 8 h. Infants 1 mo: 3.755 mg/kg q 6 h
or 56.7 mg/kg q 8 h.
ADMINISTRATION: PO: Administer with glass of water; may
be given with meals. IM: Do not administer 600 mg in a
single IM injection. Intermittent Infusion: Rate: Administer
each 300 mg over a minimum of 10 min.
ADVERSE REACTIONS AND SIDE EFFECTS: Arrhythmias,
hypotension, PSEUDOMEMBRANOUS COLITIS, diarrhea,
bitter taste (IV only).
CONTRAINDICATIONS: Hypersensitivity, history of
pseudomembranous colitis, severe liver impairment, diarrhea.
CAUTIONS: Monitor GI status, diarrhea, abdominal cramp-
ing, fever, and bloody stools may be a sign of pseudomem-
branous colitis and should be reported immediately.
Pseudomembranous colitis may begin up to several weeks
following the cessation of therapy. Instruct patient to finish
the drug completely as directed, even if feeling better.
Key:
underline = most common;
CAPS = life-threatening

AC
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CLONAZEPAM (kloe-na-ze-pam) Klonopin, Rivotril, Syn-

Clonazepam anticonvulsant (benzodiazepine) Schedule IV
Pregnancy Category C
INDICATIONS: Seizures, panic disorder. Unlabeled Uses:
Uncontrolled leg movements during sleep, neuralgias, seda-
tion.
Therapeutic Effects: Prevention of seizures, decreased
frequency of panic attacks.
DOSAGE: PO: Adults: 1.5 mg 3 times daily, not to exceed 20
mg/d. Panic disorder: 0.125 mg twice daily. Children 10 yr or
30 kg: Initial daily dose 0.010.03 mg/kg/d (not to exceed 0.05
mg/kg/d) given in 23 equally divided doses; increase by no
more than 0.250.5 mg q 3rd day (not to exceed 0.2 mg/kg/d).
ADMINISTRATION: Administer with food to minimize gastric
irritation.
ADVERSE REACTIONS AND SIDE EFFECTS: Behavioral
changes, drowsiness, diplopia, nystagmus, increased secre-
tions, palpitations, hepatitis, dysuria, nocturia, urinary reten-
tion, anemia, ataxia, hypotonia, fever, physical dependence,
psychological dependence.
CONTRAINDICATIONS: Hypersensitivity to clonazepam or
other benzodiazepines, severe liver disease.
CAUTIONS: Additive CNS depression with alcohol, antide-
pressants, antihistamines, other benzodiazepines, opioid
analgesics, kava, valerian, skullcap, chamomile, or hops.
Cimetidine, hormonal contraceptives, disulfiram, fluoxetine,
isoniazid, ketoconazole, metoprolol, propoxyphene, propra-
nolol, or valproic acid may decrease the metabolism of clo-
nazepam, enhancing its actions. May increase serum
phenytoin levels. Phenytoin may decrease serum clon-
azepam levels. Instruct patient to notify health care profes-
sional of unusual tiredness, bleeding, sore throat, fever,
clay-colored stools, yellowing of skin, or behavioral changes.
Do not discontinue abruptly.

48
 49
CLONIDINE (klon-i-deen) Catapres, Catapres-TTS, Duraclon
antihypertensive Pregnancy Category C
INDICATIONS: Mild to moderate hypertension, management
of cancer pain unresponsive to opioids alone, opioid with-
drawal (unlabeled use).
Therapeutic Effects: Decreased blood pressure, decreased
pain.
DOSAGE: PO: Adults: 200600 g (0.20.6 mg)/d in 23
divided doses (up to 2.4 mg/d). Opioid withdrawal: 300 g (0.3
mg) 1.2 mg/d. Geriatric Patients: 100 g (0.1 mg) at bedtime
initially, increased as needed. Children: 50400 g (0.050.4
mg) twice daily. Transdermal: Adults: Hypertension: 100300
g (0.10.3 mg)/24 h every 7 days. Epidural: Adults: 30 g/h.
Children: 0.5 g/kg/h.
ADMINISTRATION: PO: Administer last oral dose of the day at
bedtime. Transdermal: Absorption of transdermal system is
greater when placed on chest or upper arm than when placed
on thigh.
ADVERSE REACTIONS AND SIDE EFFECTS: Drowsiness,
depression, dizziness, nervousness, nightmares, bradycardia,
hypotension, palpitations, dry mouth, constipation, nausea,
vomiting, impotence, rash, sweating, sodium retention,
weight gain, withdrawal phenomenon.
CONTRAINDICATIONS: Hypersensitivity. Epidural: anticoagu-
lant therapy, or bleeding problems.
CAUTIONS: Additive hypotension with other antihyperten-
sives and nitrates. Additive bradycardia with myocardial
depressants. Decreased antihypertensive effect with MAO
inhibitors, amphetamines, beta-blockers, prazosin, or tricyclic
antidepressants. Withdrawal phenomenon may be
increased by discontinuation of beta-blockers. Increased risk
of adverse cardiovascular reactions with verapamil. All
routes of clonidine should be discontinued gradually over 24
days to prevent rebound hypertension.
Key:
underline = most common; CAPS = life-threatening

AC
 AC

CLOPIDOGREL (kloh-pid-oh-grel) Plavix antiplatelet agent

(platelet aggregation inhibitor) Pregnancy Category B
INDICATIONS: Reduction of atherosclerotic events (MI, stroke,
vascular death) in patients at risk for such events (recent MI,
stroke, or peripheral vascular disease).
Therapeutic Effects: Decreased occurrence of athero-
sclerotic events in patients at risk.
DOSAGE: PO: Adults: 75 mg once daily.
ADMINISTRATION: Administer once daily without regard to
food.
ADVERSE REACTIONS AND SIDE EFFECTS: Depression,
dizziness, fatigue, headache, epistaxis, cough, dyspnea, chest
pain, edema, hypertension, GI BLEEDING, abdominal pain,
diarrhea, dyspepsia, gastritis, pruritus, purpura, rash, BLEED-
ING, NEUTROPENIA, THROMBOTIC THROMBOCYTOPENIC
PURPURA, hypercholesterolemia, arthralgia, back pain,
Hypersensitivity reactions including ANGIOEDEMA, ANAPHY-
LACTOID REACTIONS, BRONCHOSPASM.
CONTRAINDICATIONS: Hypersensitivity, pathologic bleeding
(peptic ulcer, intracranial hemorrhage), lactation.
CAUTIONS: Monitor patient for signs of thrombotic throm-
bocytic purpura (thrombocytopenia, microangiopathic
hemolytic anemia, neurologic findings, renal dysfunction,
fever). Advise patient to notify health care professional
promptly if fever, chills, sore throat, or unusual bleeding or
bruising occurs. Concurrent abciximab, eptifibatide,
tirofiban, aspirin, NSAIDs, heparin, heparinoids, thrombolytic
agents, ticlopidine, or warfarin may increase the risk of bleed-
ing. May inhibit the metabolism and increase the effects of
phenytoin, tolbutamide, tamoxifen, torsemide, fluvastatin,
and many NSAIDs.

50
 51
COLCHICINE (kol-chi-seen) anti-gout agent Pregnancy
Category D
INDICATIONS: Gouty arthritis.
Therapeutic Effects: Decreased pain and inflammation
in acute attacks of gout, prevention of attacks.
DOSAGE: PO: Adults: 0.51.2 mg, then 0.50.6 mg q 12 h until
a total cumulative dose of 4 mg is achieved. See following
dosage cautions. IV: Adults: 12 mg initially, then 0.5 mg q 6 h
or 1 mg q 612 h until a total cumulative dose of 4 mg is
achieved. See following dosage cautions.
ADMINISTRATION: PO: Administer with food. IV: Avoid
extravasation; may cause necrosis.
ADVERSE REACTIONS AND SIDE EFFECTS: Diarrhea,
nausea, vomiting, abdominal pain, anuria, hematuria, alope-
cia, AGRANULOCYTOSIS, APLASTIC ANEMIA, leukopenia,
thrombocytopenia.
CONTRAINDICATIONS: Hypersensitivity, pregnancy, severe
renal, hepatic or biliary disease.
CAUTIONS: HIGH ALERT MED: Therapeutic range is
narrow. Overdose can be fatal. Cumulative dose by any route
should not exceed 4 mg. Once dosing limit has been reached,
(4 mg) no more colchicine by any route should be given for at
least 7 days. Limit IV doses to a maximum of 1-2 mg in
patients who have recently received oral colchicine. Assess
patient for toxicity (weakness, abdominal discomfort, nausea,
vomiting, diarrhea, delirium, seizures, sense of suffocation,
dilated pupils, difficulty swallowing, ascending paralysis,
oliguria), withhold drug and report symptoms immediately.
Cumulative dose should not exceed 2 mg in geriatric and
renal patients. After dosing limit has been reached, do not
give any additional colchicine by any route for 21 days.
Decrease dose by 50% for patients with renal impairment.
Encourage fluids to promote urinary output of at least
2000 mL/d. Instruct patient not to increase doses during
an acute attack.

AC
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CORTISONE (kor-ti-sone) Cortone, Cortone Acetate, steroidal

anti-inflammatory (systemic corticosteroid) Pregnancy Category
UK
INDICATIONS: Short-acting corticosteroid used to treat
adrenocortical insufficiency, and allergic and inflammatory
disorders.
Therapeutic Effects: Suppression of inflammation;
modification of the normal immune response; replacement of
deficient adrenal corticoids.
DOSAGE: PO: Adults: 25300 mg/d as a single dose or in
divided doses. Children: Adrenocortical insufficiency0.7
mg/kg (2025 mg/m2)/d in divided doses. Other uses2.510
mg/kg (75300 mg/m2)/d as a single dose or in divided doses.
IM: Adults: 20300 mg/d. Children: Adrenocortical insuffi-
ciency: 0.7 mg/kg (37.5 mg/m2) q 3 days or 0.230.35 mg/kg
(12.5 mg/m2)/d. Other uses0.835 mg/kg (25150 mg/m2) q
1224 h.
ADMINISTRATION: PO: Administer with meals to minimize GI
irritation.
ADVERSE REACTIONS AND SIDE EFFECTS: Depression,
euphoria, psychoses, restlessness, cataracts, hypertension,
PEPTIC ULCERATION, anorexia, nausea, acne, decreased
wound healing, ecchymoses, fragility, hirsutism, petechiae,
adrenal suppression, hyperglycemia, hypokalemia, THROM-
BOEMBOLISM, thrombophlebitis, weight gain, weight loss,
muscle wasting, osteoporosis, cushingoid appearance,
increased susceptibility to infection.
CONTRAINDICATIONS: Active untreated infections, lactation.
CAUTIONS: Instruct patient to promptly report severe
abdominal pain or tarry stools occur. May increase require-
ment for insulin or oral hypoglycemic agents. Increased risk
of adverse GI effects with NSAIDs. Advise patient to carry
identification describing medication regimen. Instruct
patient to report swelling, weight gain, tiredness, bone pain,
bruising, nonhealing sores, or visual changes.

52
 53
DALTEPARIN (dal-te-pa-rin) Fragmin anticoagulant (low molec-
ular weight heparin [LMWH]) (antithrombotic) Pregnancy
Category B
INDICATIONS: Prevention of deep vein thrombosis, pulmonary
emboli, ischemic complications in patients with unstable
angina/nonQ-wave MI. LMWH has a more predictable antico-
agulant responsespecial monitoring of clotting times is not
necessary.
Therapeutic Effects: Prevention of thrombus formation.
DOSAGE: SC: Adults: Presurgical prophylaxis of DVT: 2500 IU
12 h before surgery, then 25005000 IU once daily;
angina/nonQ-wave MI: 120 IU/kg every 12 h.
ADMINISTRATION: SC: Administer deep into SC tissue. Do
not aspirate or massage. Rotate sites frequently.
ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,
insomnia, edema, urinary retention, ecchymoses, pruritus,
rash, urticaria, BLEEDING, anemia, thrombocytopenia,
hematoma.
CONTRAINDICATIONS: Hypersensitivity, uncontrolled bleed-
ing, thrombocytopenia, regional anesthesia during treatment
for unstable angina/nonQwave MI.
CAUTIONS: HIGH ALERT MED: Assess patient for signs of
bleeding and hemorrhage (bleeding gums; nosebleed;
unusual bruising; black, tarry stools; hematuria; fall in hemat-
ocrit or blood pressure; guaiac-positive stools); bleeding from
surgical site. Notify physician if these occur. Risk of bleed-
ing may be increased by warfarin, aspirin, NSAIDs, dipyri-
damole, some penicillins, clopidogrel, ticlopidine, abciximab,
eptifibatide, tirofiban, and dextran. Increased bleeding risk
with anise, arnica, chamomile, clove, feverfew, garlic, ginger,
ginkgo, Panax ginseng, and others.

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

DH
 DH

DEXAMETHASONE (dex-a-meth-a-sone) Decadron, Decaject,

Dexameth steroidal anti-inflammatory (systemic corticosteroid)
Pregnancy Category UK
INDICATIONS: Inflammatory, allergic, hematologic, neoplastic,
autoimmune disorders, replacement therapy in adrenal insuf-
ficiency, cerebral edema. Diagnostic agent in adrenal disor-
ders.
Therapeutic Effects: Suppression of inflammation, modifica-
tion of the normal immune response.
DOSAGE: PO: Adults: 0.59 mg daily in single or divided
doses. IM, IV: Adults: Dexamethasone acetate (IM): 816 mg q
13 wk. Dexamethasone phosphate (IV): 0.524 mg/d. Cerebral
edema: Dexamethasone phosphate: 10 mg initially IV, 4 mg q
6 h, may be decreased to 2 mg q 812 h.
ADMINISTRATION: PO: Administer with meals to minimize GI
irritation. Direct IV: May be given undiluted. Do not administer
suspension IV. Rate: Administer over 1 min.
ADVERSE REACTIONS AND SIDE EFFECTS: Depression,
euphoria, psychoses, restlessness, cataracts, hypertension,
PEPTIC ULCERATION, anorexia, nausea, acne, decreased
wound healing, ecchymoses, fragility, hirsutism, petechiae,
adrenal suppression, hyperglycemia, hypokalemia, THROM-
BOEMBOLISM, thrombophlebitis, weight gain, muscle wast-
ing, osteoporosis, cushingoid appearance, increased
susceptibility to infection.
CONTRAINDICATIONS: Active untreated infections, lactation.
CAUTIONS: Instruct patient to promptly report severe
abdominal pain or tarry stools occur. May increase require-
ment for insulin or oral hypoglycemic agents. Increased risk
of adverse GI effects with NSAIDs. Advise patient to carry
identification describing medication regimen. Instruct patient
to report swelling, weight gain, tiredness, bone pain, bruising,
nonhealing sores, visual or behavioral changes.

54
 55
DIAZEPAM (dye-az-e-pam) Apo-Diazepam, Diastat, Dizac, D-
Val, Novodipam, Valium, Vivol antianxiety agent, anticonvulsant,
sedative/hypnotic, skeletal muscle relaxant (benzodiazepine)
Schedule IV Pregnancy Category D
INDICATIONS: Anxiety, preoperative sedation, conscious seda-
tion, status epilepticus/uncontrolled seizures, skeletal muscle
relaxant, alcohol withdrawal.
Therapeutic Effects: Relief of anxiety, sedation, skeletal
muscle relaxation, decreased seizure activity.
DOSAGE: PO: Adults: 210 mg 24 times daily or 1530 mg of
extended-release form once daily. Children 6 mo: 12.5 mg
34 times daily may be increased. Geriatric or Debilitated
Patients: 22.5 mg 12 times daily initially. IV, IM: Adults: 510
mg every 10 to 15 min up to 30 mg, if needed. Children 1
mo5 yr: 0.20.5 mg q 25 min to maximum of 5 mg. Children
5 yr: 1 mg q 25 min up to 10 mg.
ADMINISTRATION: PO: Tablets may be crushed. Do not crush,
break, or chew sustained-release capsules. IM: IM injections
are painful and erratically absorbed; inject deeply into deltoid
muscle for maximum absorption. IV: Do not dilute or mix IV
diazepam with any other drug. Administer into Y-site as close
to insertion site as possiblecan precipitate in IV fluids and
be absorbed into infusion bags and tubing. Injection may
cause burning and venous irritation; avoid small veins. Rate:
Administer slowly at a rate of 5 mg over at least 1 min. Infants
and children should receive total dose over a minimum of 35
min. Rectal: Do not repeat Diastat rectal dose more than
5 times/mo or 1 episode every 5 days. Round dose up to next
available dose unit.
ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,
drowsiness, lethargy, depression, hangover, headache, para-
doxical excitation, blurred vision, respiratory depression,
hypotension (IV only), constipation, diarrhea, nausea, vomit-
ing, rashes, pain (IM), phlebitis (IV), venous thrombosis, physi-
cal dependence, psychological dependence, tolerance.

(Continued)

DH
 DH

DIAZEPAM (Continued)
CONTRAINDICATIONS: Hypersensitivity, comatose patients,
pre-existing CNS depression, uncontrolled severe pain,
narrow-angle glaucoma, pregnancy or lactation.
CAUTIONS: Have resuscitation equipment available when
administering IV; rapid injection may cause apnea, hypoten-
sion, bradycardia, or cardiac arrest. Use cautiously in
hepatic dysfunction, severe renal impairment, history of
suicide attempt or drug dependence, geriatric or debilitated
patients and children. Concurrent use alcohol, antidepres-
sants, antihistamines, and opioid analgesics results in addi-
tive CNS depression. Cimetidine, hormonal contraceptives,
disulfiram, fluoxetine, isoniazid, ketoconazole, metoprolol,
propoxyphene, propranolol, or valproic acid may decrease the
metabolism of diazepam, enhancing its actions. May
decrease the efficacy of levodopa. Rifampin or barbiturates
may increase the metabolism and decrease effectiveness of
diazepam. Sedative effects may be decreased by theo-
phylline. Concomitant use of kava, valerian, skullcap,
chamomile, or hops can increase CNS depression.
Medication may cause drowsiness, clumsiness, or unsteadi-
ness; advise patient to avoid driving or other activities requir-
ing alertness until response to medication is known.
Caution patient to avoid taking alcohol or other CNS
depressants concurrently with this medication.

56
 57
DIGOXIN (di-jox-in) Digitek, Lanoxicaps, Lanoxin antiarrhyth-
mic, inotropic Pregnancy Category C
INDICATIONS: CHF, tachyarrhythmias atrial fibrillation and
atrial flutter, paroxysmal atrial tachycardia.
Therapeutic Effects: Increased cardiac output and slowing
of the heart rate.
DOSAGE: PO: Maintenance dose: Adults: 0.1250.25 mg daily.
Geriatrics: 0.06250.125 daily or every other day. Children 2
yr: 0.012 mg/kg, divided, q 12 h. Children 124 mo: 0.010.02
mg/kg, divided, q 12 hr. Loading dose: Adults: 0.51mg in
divided doses over 24 h. Children 2 yr: 0.020.04mg/kg,
divided, q 8 h over 24 h. Children 124 mo: 0.0350.06 mg/kg,
divided, q 8 h over 24 h. IV: Loading dose: Adults: 0.51 mg.
Children 2 yr: 0.0250.035 mg/kg. Children 124 mo:
0.030.05 mg/kg.
ADMINISTRATION: PO: Administer without regard to meals.
Tablets can be crushed. IV: IV doses may be given undiluted
or each 1 mL may be diluted in 4 mL of sterile water, 0.9%
NaCl, D5W, or LR for injection. Less diluent will cause precipi-
tation. Use diluted solution immediately. Rate: Administer
over a minimum of 5 min.
ADVERSE REACTIONS AND SIDE EFFECTS: Fatigue,
headache, weakness, blurred vision, yellow vision, ARRHYTH-
MIAS, bradycardia, ECG changes, anorexia, nausea, vomiting,
diarrhea, gynecomastia, thrombocytopenia.
CONTRAINDICATIONS: Hypersensitivity, uncontrolled ventric-
ular arrhythmias, AV block, idiopathic hypertrophic subaortic
stenosis, constrictive pericarditis.
CAUTIONS: HIGH ALERT MED: Narrow therapeutic range
(normal serum level: 0.52 ng/mL). Monitor digoxin levels and
assess for signs and symptoms of toxicity: abdominal pain,
anorexia, nausea, vomiting, visual disturbances, bradycardia,
and other arrhythmias. Assess apical pulse for 1 min before
administering. If pulse rate is 60 bpm in an adult, 70 bpm
in a child, or 90 bpm in an infant, or if patient exhibits signs
(Continued)

DH
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DIGOXIN (Continued)
or symptoms of toxicity, withhold drug and notify physician or
health care professional immediately. Monitor ECG through-
out IV administration. Treatment of life-threatening arrhyth-
mias from digitalis toxicity may include administration of
digoxin immune Fab (Digibind), which binds to the digitalis
glycoside molecule in the blood and is excreted by the
kidneys. Temporary ventricular pacing may be useful in
advanced heart block. Teach patient to take pulse and to
contact health care professional before taking medication if
pulse rate is 60 or 100. Review signs and symptoms of
digitalis toxicity with patient and family. Advise patient to
notify health care professional immediately if these or symp-
toms of CHF occur. Inform patient that these symptoms may
be mistaken for those of colds or flu. Use cautiously in elec-
trolyte abnormalities (may predispose to toxicity), geriatric
patients (very sensitive to toxic effects), MI, renal impairment,
obese patients (dose should be based on ideal body weight),
pregnancy and lactation. Thiazide and loop diuretics,
mezlocillin, piperacillin, ticarcillin, amphotericin B, and corti-
costeroids, which cause hypokalemia, may increase the risk of
toxicity. Quinidine, quinine, cyclosporine, amiodarone, vera-
pamil, diltiazem, propafenone, and diclofenac increase serum
levels and may lead to toxicity. Spironolactone increases
half-life. Additive bradycardia may occur with beta-blockers
and other antiarrhythmics (quinidine, disopyramide).
St. Johns wort may decrease digoxin levels and effect.

58
 59
DILTIAZEM (dil-tye-a-zem) Apo-Diltiaz, Cardizem, Diltia XT, Nu-
Diltiaz, Tiamate, antianginal, antiarrhythmic, antihypertensive
(calcium channel blocker) Pregnancy Category C
INDICATIONS: Hypertension, angina, supraventricular tachy-
arrhythmias, atrial flutter/fibrillation with rapid ventricular
rate.
Therapeutic Effects: Decreased blood pressure, decreased
frequency and severity of angina, suppression of arrhythmias.
DOSAGE: PO: Adults: 120360 mg daily in divided doses.
IV: Adults: 515 mg/h.
ADMINISTRATION: PO: Give with meals if GI irritation is a
problem. IV: Rate: Administer bolus over 2 min.
ADVERSE REACTIONS AND SIDE EFFECTS: Anxiety, confu-
sion, weakness, blurred vision, paresthesia, tremor, disturbed
equilibrium, epistaxis, tinnitus, cough, dyspnea, ARRHYTH-
MIAS, CHF, peripheral edema, bradycardia, chest pain, palpita-
tions, tachycardia, abnormal liver function studies, erythema
multiforme, photosensitivity, pruritus/urticaria, hyperglycemia,
blood dyscrasias, STEVENS-JOHNSON SYNDROME, gingival
hyperplasia.
CONTRAINDICATIONS: Hypersensitivity, sick sinus syndrome,
2nd- or 3rd-degree AV block, blood pressure 90 mm Hg,
recent MI or pulmonary congestion.
CAUTIONS: Monitor ECG during IV administration: Have
emergency equipment available. Additive hypotension with
fentanyl, antihypertensives, nitrates, or quinidine. Digoxin
levels may be increased. Concurrent use with beta-blockers,
digoxin, disopyramide, or phenytoin may result in brady-
cardia, conduction defects, or CHF. Cimetidine, ranitidine
and grapefruit juice increase blood levels. Instruct patient
to monitor pulse and contact health care professional if
50 bpm. Caution patient to change positions slowly.

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

DH
 DH

DONEPEZIL (doe-nep-i-zill) Aricept anti-Alzheimers agent,

cholinergic Pregnancy Category C
INDICATIONS: Mild to moderate dementia associated with
Alzheimers disease.
Therapeutic Effects: May temporarily lessen some of the
dementia associated with Alzheimers disease.
DOSAGE: PO: Adults: 5 mg once daily; after 46 wk may
increase to 10 mg once daily.
ADMINISTRATION: Administer in the evening just before
going to bed. May be taken without regard to food.
ADVERSE REACTIONS AND SIDE EFFECTS: Headache,
abnormal dreams, depression, dizziness, drowsiness, fatigue,
insomnia, syncope, atrial fibrillation, hypertension, hypoten-
sion, vasodilation, diarrhea, nausea, anorexia, vomiting,
frequent urination, ecchymoses, hot flashes, weight loss,
arthritis, muscle cramps.
CONTRAINDICATIONS: Hypersensitivity to donepezil or piperi-
dine derivatives.
CAUTIONS: Exaggerates muscle relaxation from succinyl-
choline. Interferes with the action of anticholinergics.
Increases the cholinergic effects of bethanechol. May
increase the risk of GI bleeding from NSAIDs. Quinidine and
ketoconazole decrease the metabolism. Rifampin, carba-
mazepine, dexamethasone, phenobarbital, and phenytoin
induce the enzymes that metabolize donepezil and may
decrease its effects. Monitor heart rate during therapy; may
cause bradycardia. Caution patient and caregiver that
donepezil may cause dizziness. Advise patient and caregiver
to notify health care professional if nausea, vomiting, diar-
rhea, or changes in color of stool occur or if new symptoms
occur, or previously noted symptoms increase in severity.
Advise patient and caregiver to notify health care profes-
sional of medication regimen before treatment or surgery.

60
 61
DOXAZOSIN (dox-uh-zoe-sin) Cardura antihypertensive (antia-
drenergic) Pregnancy Category C
INDICATIONS: Hypertension, symptomatic management of
benign prostatic hyperplasia (BPH).
Therapeutic Effects: Lowers blood pressure.
DOSAGE: PO: Adults: Hypertension: 216 mg/d; incidence of
postural hypotension greatly increased at doses 4 mg/d.
BPH: 1 mg once daily, may be gradually increased to 8 mg/d.
ADMINISTRATION: Administer daily dose at bedtime.
ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,
headache, depression, drowsiness, fatigue, nervousness,
weakness, abnormal vision, blurred vision, conjunctivitis,
epistaxis, dyspnea, first-dose orthostatic hypotension, arrhyth-
mias, chest pain, edema, palpitations, abdominal discomfort,
constipation, diarrhea, dry mouth, flatulence, nausea, vomit-
ing, decreased libido, sexual dysfunction, flushing, rash,
arthralgia, arthritis, gout, myalgia.
CONTRAINDICATIONS: Hypersensitivity.
CAUTIONS: Additive hypotension with acute ingestion of
alcohol, other antihypertensives, or nitrates. May decrease
antihypertensive effect of clonidine. Monitor blood pressure
and pulse 26 h after first dose, with each increase in dose,
and periodically throughout course of therapy. BPH: Assess
patient for symptoms of prostatic hyperplasia (urinary hesi-
tancy, feeling of incomplete bladder emptying, bladder disten-
tion, interruption of urinary stream, impairment of size and
force of urinary stream, terminal urinary dribbling, straining to
start flow, dysuria, urgency) before and periodically through-
out therapy. Hypertension: May be administered concur-
rently with a diuretic or other antihypertensive. Advise
patient to check blood pressure at least weekly and report
significant changes.

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

DH
 DH

ENALAPRIL (e-nal-a-pril) Vasotec ENALAPRILAT (e-nal-a-pril-at)

Vasotec IV Pregnancy Category C (first trimester), D (second and
third trimesters)
INDICATIONS: Hypertension, CHF.
Therapeutic Effects: Lowered blood pressure, improvement
in CHF symptoms.
DOSAGE: PO (Enalapril): Adults: 540 mg/d in 12 divided
doses; initiate therapy at 2.5 mg/d in patients receiving diuret-
ics. IV (Enalaprilat): Adults: 0.6251.25 mg (0.625 mg if receiv-
ing diuretics) q 6 h.
ADMINISTRATION: PO: Precipitous drop in blood pressure
during first 13 h following first dose may occur. Monitor
blood pressure closely. IV: Rate: Administer undiluted over at
least 5 min. May be given as intermittent infusion.
ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,
fatigue, headache, insomnia, cough, hypotension, angina
pectoris, tachycardia, taste disturbances, diarrhea, nausea,
proteinuria, renal failure, rashes, and hyperkalemia, AGRANU-
LOCYTOSIS, ANGIOEDEMA.
CONTRAINDICATIONS: Hypersensitivity to enalapril or other
ACE inhibitors, pregnancy, history of angioedema.
CAUTIONS: Additive hypotension with other antihyperten-
sives, nitrates, phenothiazines, and general anesthesia.
Hyperkalemia with concurrent use of potassium supple-
ments, potassium-sparing diuretics, indomethacin, salt
substitutes, or cyclosporine. May increase risk of lithium
or digoxin toxicity. Instruct patient to report rash; mouth
sores; sore throat; fever; swelling of hands or feet; irregular
heart beat; chest pain; dry cough; hoarseness; swelling of
face, eyes, lips, or tongue; difficulty swallowing or breathing
occur. Persistent dry cough may occur and may not subside
until medication is discontinued.

62
 63
ENOXAPARIN (e-nox-a-pa-rin) Lovenox anticoagulant (low
molecular weight heparin [LMWH]) (antithrombotic) Pregnancy
Category B
INDICATIONS: Prevention of deep vein thrombosis, pulmonary
emboli, ischemic complications in patients with unstable
angina/nonQ-wave MI. LMWH has a more predictable antico-
agulant response than unfractionated heparinspecial moni-
toring of clotting times is not necessary.
Therapeutic Effects: Prevention of thrombus formation.
DOSAGE: SC: Adults: Knee/hip surgery: 40 mg once daily
starting 915 h before hip surgery; abdominal surgery: 40 mg
once daily starting within 24 h postop; treatment of DVT/PE:
1 mg/kg q 12 h or 1.5 mg/kg q 24 h; angina/nonQ-wave MI:
1 mg/kg q 12 h.
ADMINISTRATION: SC: Administer deep into SC tissue. Do not
aspirate or massage. Rotate sites frequently.
ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,
insomnia, edema, urinary retention, ecchymoses, pruritus,
rash, urticaria, BLEEDING, anemia, thrombocytopenia,
hematoma.
CONTRAINDICATIONS: Hypersensitivity to pork products,
uncontrolled bleeding, thrombocytopenia, patients with pros-
thetic heart valves.
CAUTIONS: HIGH ALERT MED: Assess patient for signs of
bleeding and hemorrhage (bleeding gums, nosebleed;
unusual bruising; black, tarry stools, hematuria; fall in hemat-
ocrit or blood pressure; guaiac-positive stools), bleeding from
surgical site. Notify physician if these occur. Risk of bleed-
ing may be increased by warfarin, aspirin, NSAIDs, dipyri-
damole, some penicillins, clopidogrel, ticlopidine, abciximab,
eptifibatide, tirofiban, and dextran. Increased bleeding risk
with arnica, chamomile, feverfew, garlic, ginger, ginkgo, Panax
ginseng, and others.
Key:
underline = most common;
CAPS = life-threatening

DH
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ESTRADIOL (es-tra-dye-ole) Estrace, Gynodiol hormone (estro-

gen) Pregnancy Category X
INDICATIONS: Vasomotor symptoms of menopause and of
various estrogen deficiency states, treatment and prevention
of postmenopausal osteoporosis, inoperable metastatic post-
menopausal breast or prostate carcinoma.
Therapeutic Effects: Restoration of hormonal balance in
various deficiency states, treatment of hormone-sensitive
tumors.
DOSAGE: PO: Adults: 0.52 mg daily or in a cycle.
Postmenopausal breast carcinoma: 10 mg 3 times daily.
Prostate carcinoma: 12 mg 3 times daily.
ADMINISTRATION: Administer with or immediately after food
to reduce nausea. Estradiol is also available in injectable,
transdermal, and vaginal tablet or ring formulations.
ADVERSE REACTIONS AND SIDE EFFECTS: Headache, dizzi-
ness, lethargy, intolerance to contact lenses, MI, THROM-
BOEMBOLISM, edema, hypertension, nausea, weight changes,
jaundice, oily skin, acne, pigmentation, urticaria, gynecomas-
tia (men), hyperglycemia, hypercalcemia, sodium and water
retention, leg cramps, breast tenderness, womenamenor-
rhea, dysmenorrhea, breakthrough bleeding, cervical
erosions, loss of libido, vaginal candidiasis, menimpotence,
testicular atrophy.
CONTRAINDICATIONS: Thromboembolic disease, undiag-
nosed vaginal bleeding, pregnancy, lactation.
CAUTIONS: May alter requirement for warfarin, oral hypo-
glycemic agents, or insulins. Barbiturates or rifampin may
decrease effectiveness. Smoking increases the risk of
adverse CV reactions.

64
 65
FENTANYL (TRANSDERMAL) (fen-ta-nil) Duragesic opioid
analgesic, opioid agonist Schedule II Pregnancy Category C
INDICATIONS: Chronic pain requiring opioid analgesic ther-
apy.
Therapeutic Effects: Decreases severity of chronic pain.
DOSAGE: Transdermal: Adults: 25 g/h is the initial dose;
patients who have not been receiving opioids should receive
not more that 25 g/h. See package insert for determining
equianalgesic dosages in patients already receiving opioid
analgesics. Transdermal patch lasts 72 hours in most patients.
Some patients require a new patch every 48 hours.
ADMINISTRATION: Apply to flat, nonirritated, and nonirradi-
ated site. If skin preparation is necessary, use clear water and
clip, do not shave, hair.
ADVERSE REACTIONS AND SIDE EFFECTS: Confusion, seda-
tion, APNEA, bronchoconstriction, laryngospasm, respiratory
depression, bradycardia, anorexia, constipation, dry mouth,
nausea, vomiting, sweating, erythema, application site reac-
tions, skeletal and thoracic muscle rigidity.
CONTRAINDICATIONS: Hypersensitivity to fentanyl or adhe-
sives, known intolerance, acute pain.
CAUTIONS: HIGH ALERT MED: Do not use in patients who
have received MAO inhibitors within the previous 14 days
(may cause unpredictable, potentially fatal reactions). Additive
CNS and respiratory depression with other CNS depressants,
alcohol, antihistamines, antidepressants, sedative/hypnotics,
and other opioids. If respiratory rate is 10/min, assess
level of sedation. Dose may need to be decreased by 25% to
50%. Naloxone (Narcan) is the antidote to reverse respira-
tory depression or coma.

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

DH
 DH

FEXOFENADINE (fex-oh-fen-a-deen) Allegra allergy, cold and

cough remedy, antihistamine Pregnancy Category C
INDICATIONS: Seasonal allergic rhinitis, chronic idiopathic
urticaria.
Therapeutic Effects: Decreased sneezing, rhinorrhea, itchy
eyes, nose, and throat associated with seasonal allergies,
decreased urticaria.
DOSAGE: PO: Adults and Children 12 yr: 60 mg twice daily,
or 180 mg once daily. Children 611 yr: 30 mg twice daily.
ADMINISTRATION: Administer with food or milk to decrease
GI irritation. Capsules and tablets should be taken with water
or milk, not juice.
ADVERSE REACTIONS AND SIDE EFFECTS: Drowsiness,
fatigue, dyspepsia, and dysmenorrhea.
CONTRAINDICATIONS: Hypersensitivity.
CAUTIONS: Use cautiously in impaired renal function
(increased dosing interval recommended), pregnancy, lacta-
tion, or children 12 yr. Magnesium and aluminum-
containing antacids decrease absorption and may decrease
effectiveness. Apple, orange, and grapefruit juice decrease
absorption any may decrease effectiveness.

66
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FINASTERIDE (fi-nas-teer-ide) Propecia, Proscar hair regrowth
stimulant/androgen inhibitor Pregnancy Category X
INDICATIONS: Benign prostatic hyperplasia (BPH), androge-
netic alopecia (male pattern baldness) in men only.
Therapeutic Effects: Reduces prostate size with associated
decrease in urinary symptoms, decreased hair loss, hair
regrowth.
DOSAGE: PO: Adults: BPH: 5 mg once daily (Proscar); andro-
genetic alopecia: 1 mg/d (Propecia).
ADMINISTRATION: Administer once daily with or without
meals.
ADVERSE REACTIONS AND SIDE EFFECTS: Decreased
libido, decreased volume of ejaculate, impotence.
CONTRAINDICATIONS: Hypersensitivity, women.
CAUTIONS: Caution patient that finasteride poses a poten-
tial risk to a male fetus. Women who are pregnant or may
become pregnant should avoid exposure to semen of a part-
ner taking finasteride and should not handle crushed finas-
teride because of the potential for absorption. Clinical
effects as noted by urinary tract symptoms and hair regrowth
may not be evident for several months and remain for 4
months after discontinuation. Assess patient for symptoms
of prostatic hypertrophy (urinary hesitancy, feeling of incom-
plete bladder emptying, interruption of urinary stream, impair-
ment of size and force of urinary stream, terminal urinary
dribbling, straining to start flow, dysuria, urgency) before and
periodically throughout therapy. Instruct patient to take
finasteride as directed, even if symptoms improve or are
unchanged. At least 612 months of therapy may be neces-
sary to determine whether or not an individual will respond to
finasteride. Inform patient that the volume of ejaculate may
be decreased during therapy but that this will not interfere
with normal sexual function.
Key:
underline = most common;
CAPS = life-threatening

DH
 DH

FLUCONAZOLE (floo-kon-a-zole) Diflucan antifungal (systemic)

Pregnancy Category C
INDICATIONS: Fungal infections, prevention of candidiasis
after bone marrow transplantation.
Therapeutic Effects: Fungistatic or fungicidal action against
susceptible organisms.
DOSAGE: PO, IV: Adults: Esophageal or oropharyngeal
candidiasis: 200 mg initially, then 100 mg daily for 23 weeks.
Other candidiasis: 50400 mg/d. Cryptococcal meningitis: 400
mg once daily until favorable clinical response, then 200400
mg once daily for at least 1012 wk after clearing of CSF.
Suppressive therapy: 200 mg once daily. Vaginal candidiasis:
150-mg single oral dose. Children 6 mo: 3 mg/kg/d for at
least 23 wk. Cryptococcal meningitis: 612 mg/kg/d for at
least 1012 wk after clearing of CSF. Suppressive therapy:
6 mg/kg/d.
ADMINISTRATION: PO: Shake oral suspension well before
administration. IV: Open overwrap immediately before infu-
sion. Rate: Infuse at a maximum rate of 200 mg/h.
ADVERSE REACTIONS AND SIDE EFFECTS: Headache,
HEPATOTOXICITY, abdominal discomfort, diarrhea, nausea,
vomiting, exfoliative skin disorders including STEVENS-
JOHNSON SYNDROME.
CONTRAINDICATIONS: Hypersensitivity to fluconazole or
other azole antifungals, concurrent use with pimozide.
CAUTIONS: Increases the activity of warfarin. Rifampin,
rifabutin, and isoniazid decrease blood levels. Increases the
hypoglycemic effects of tolbutamide, glyburide, or glipizide.
Increases blood levels and risk of toxicity from cyclosporine,
rifabutin, tacrolimus, theophylline, zidovudine, alfentanil, and
phenytoin. Increases blood levels and effects of benzodi-
azepines, zolpidem, buspirone, nisoldipine, tricyclic antide-
pressants, and losartan.

68
 69
FLUOROURACIL (flure-oh-yoor-a-sill) Adrucil, Efudex,
Fluoroplex, 5-FU antineoplastic antimetabolite Pregnancy
Category D
INDICATIONS: Colon, breast, rectal, gastric, pancreatic carci-
noma. Actinic keratoses and superficial basal cell carcinomas.
Therapeutic Effects: Death of malignant cells.
DOSAGE: IV: Adults: CarcinomaInitial dose: 12 mg/kg/d for
4 days, then 1 day of rest, then 6 mg/kg every other day for
45 doses. Maintenance: 712 mg/kg q 710 days or 300500
mg/m2/d for 45 days, repeated monthly (no single daily dose
should exceed 800 mg). Topical: Adults: Actinic keratoses: 1%
solution or cream 12 times daily. Basal cell carcinomas: 5%
solution or cream twice daily.
ADMINISTRATION: Direct IV: Rate: Administer over 12 min.
Intermittent Infusion: Rate: Infuse over 28 h. Topical: Wear
gloves when applying medication.
ADVERSE REACTIONS AND SIDE EFFECTS: Diarrhea,
nausea, stomatitis, vomiting, alopecia, maculopapular rash,
local inflammatory reactions (topical only), melanosis of nails,
nail loss, palmar-plantar erythrodysesthesia, phototoxicity,
anemia, leukopenia, thrombocytopenia.
CONTRAINDICATIONS: Hypersensitivity, pregnancy or lacta-
tion.
CAUTIONS: HIGH ALERT MED: Chemotherapeutic agents are
toxic. Dosing, calculations, and infusion pump settings should
be independently checked by two other practitioners. The
number 5 in 5-fluorouracil is part of the drug name and does
not refer to the dosage. Stop infusion if extravasation
occurs and restart in another vein. Instruct patient in correct
application of solution or cream; explain that erythema, scal-
ing, and blistering with pruritus and burning sensation are
expected. Review with patient the need for contraception
during therapy.
Key:
underline = most common;
CAPS = life-threatening

DH
 DH

FLUOXETINE (floo-ox-uh-teen) Prozac, Prozac Weekly, Sarafem

antidepressant (selective serotonin reuptake inhibitor) Pregnancy
Category B
INDICATIONS: Depression, OCD, bulimia nervosa, premen-
strual dysphoric disorder (PMDD). Unlabeled Uses: Anorexia
nervosa, ADHD, fibromyalgia, obesity, panic attacks.
Therapeutic Effects: Improved mood.
DOSAGE: PO: Adults: 2080mg daily. Geriatric Patients: 1060
mg daily.
ADMINISTRATION: Administer with food as a single dose in
the morning.
ADVERSE REACTIONS AND SIDE EFFECTS: SEIZURES, anxi-
ety, drowsiness, headache, insomnia, nervousness, tremor,
dizziness, fatigue, hypomania, mania, weakness, visual distur-
bances, cough, chest pain, palpitations, diarrhea, anorexia, dry
mouth, nausea, vomiting, weight loss, sexual dysfunction,
urinary frequency, excessive sweating, pruritus, erythema
nodosum, flushing, arthralgia, myalgia, allergic reactions, hot
flashes.
CONTRAINDICATIONS: Hypersensitivity, concurrent use or
use within 14 days of discontinuing MAO inhibitors (fluoxetine
should be discontinued 5 weeks before MAO therapy is initi-
ated).
CAUTIONS: Do not confuse Sarafem (fluoxetine) with
Serophene (clomiphene). Discontinue use of MAO inhibitors
14 days before fluoxetine therapy, (increased risk of serotonin
syndrome). Discontinue fluoxetine 5 wk before initiating
MAO inhibitor. Additive CNS depression with alcohol, anti-
histamines, other antidepressants, opioid analgesics, or seda-
tive/hypnotics. Increased risk of side effects with other
antidepressants, tryptophan, risperidone, or phenothiazines.
May increase risk of toxicity from carbamazepine, clozapine,
digoxin, haloperidol, phenytoin, lithium, or warfarin.
Caution patient to avoid driving until response to the drug
is known.

70
 71
FONDAPARINUX (fon-da-par-i-nux) Arixtra anticoagulant
Pregnancy Category B
INDICATIONS: Prevention of deep vein thrombosis.
Therapeutic Effects: Interruption of the coagulation cascade
resulting in inhibition of thrombus formation.
DOSAGE: SC: Adults: 2.5 mg once daily, starting 68 h after
surgery and continuing for 59 days (up to 11 days).
ADMINISTRATION: Administer SC only into fatty tissue, alter-
nating sites between right and left anterolateral or posterolat-
eral abdominal wall.
ADVERSE REACTIONS AND SIDE EFFECTS: Confusion, dizzi-
ness, headache, insomnia, edema, hypotension, constipation,
diarrhea, dyspepsia, increased serum aminotransferases,
nausea, vomiting, urinary retention, bullous eruption,
hematoma, purpura, rash, BLEEDING, thrombocytopenia,
hypokalemia, fever, increased wound drainage.
CONTRAINDICATIONS: Hypersensitivity, severe renal impair-
ment, body weight 50 kg, active major bleeding, bacterial
endocarditis, and thrombocytopenia due to fondaparinux anti-
bodies.
CAUTIONS: HIGH ALERT MED: Deaths have occurred when
two anticoagulant medications inadvertently are given concur-
rently. Double check medications to ensure that two anticoag-
ulant products are not given simultaneously. Use with
caution in patients with severe uncontrolled hypertension,
bleeding disorders, GI pathology, hemorrhagic stroke, recent
CNS or ophthalmologic surgery, spinal/epidural anesthesia
(increased risk of spinal/epidural hematomas). Risk of bleed-
ing may be increased by concurrent use of warfarin, aspirin,
NSAIDs, dipyridamole, some cephalosporins, valproates,
clopidogrel, ticlopidine, abciximab, eptifibatide, tirofiban, and
dextran. Increased risk of bleeding with arnica, chamomile,
dong quai, feverfew, garlic, ginger, gingko, Panax ginseng,
licorice, and others.

DH
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FOSINOPRIL (foe-sin-oh-pril) Monopril Pregnancy Category C

(first trimester), D (second and third trimesters)
INDICATIONS: Hypertension, CHF.
Therapeutic Effects: Lowered blood pressure, improvement
in symptoms of CHF.
DOSAGE: PO: Adults: 540 mg once daily, maximum 80 mg/d.
ADMINISTRATION: Precipitous drop in blood pressure during
first 13 h following first dose may occur, especially if also
taking diuretics. Monitor blood pressure closely.
ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,
fatigue, headache, cough, hypotension, taste disturbances,
anorexia, diarrhea, nausea, proteinuria, impotence, renal fail-
ure, rashes, hyperkalemia, AGRANULOCYTOSIS,
ANGIOEDEMA.
CONTRAINDICATIONS: Hypersensitivity, pregnancy, history of
angioedema.
CAUTIONS: Instruct patient to report rash; mouth sores; sore
throat; fever; swelling of hands or feet; irregular heart beat;
chest pain; dry cough; hoarseness; swelling of face, eyes, lips,
or tongue; difficulty swallowing or breathing occur. Additive
hypotension with other antihypertensives, nitrates, pheno-
thiazines, acute ingestion of alcohol, and during surgery or
general anesthesia. Hyperkalemia with potassium supple-
ments, potassium-sparing diuretics, indomethacin, salt
substitutes, or cyclosporine. May increase the risk of
lithium or digoxin toxicity. Persistent dry cough may occur
and may not subside until medication is discontinued.

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FUROSEMIDE (fur-oh-se-mide) Apo-Furosemide, Furoside,
Lasix, Lasix Special diuretic (loop diuretic) Pregnancy Category C
INDICATIONS: Edema secondary to CHF, hepatic or renal
disease, hypertension.
Therapeutic Effects: Diuresis and subsequent mobilization
of excess fluid. Lowering of blood pressure.
DOSAGE: PO, IM, IV: Adults: Diuretic: 2080 mg/d initially,
may increase by 2040 mg q 68 h (up to 600 mg/d).
Antihypertensive: 4080 mg (up to 200 mg if accompanied by
pulmonary edema/acute renal failure). Children: PO: 2 mg/kg
as a single dose; may be increased by 12 mg/kg q 68 h (up
to 56 mg/kg/d). Children: IM, IV: Diuretic: 1 mg/kg, may
increase by 1 mg/kg q 2 h (not to exceed 6 mg/kg).
ADMINISTRATION: Direct IV: Rate: Administer slowly over 12
min. Intermittent Infusion: Rate: Administer at a rate not to
exceed 4 mg/min in adults to prevent ototoxicity.
ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness, hear-
ing loss, tinnitus, hypotension, constipation, dry mouth, dehy-
dration, hypochloremia, hypokalemia, hypomagnesemia,
hyponatremia, hypovolemia, metabolic alkalosis, hyper-
glycemia, arthralgia, muscle cramps, myalgia, increased BUN.
CONTRAINDICATIONS: Hypersensitivity (cross-sensitivity with
thiazides and sulfonamides may occur), uncorrected elec-
trolyte imbalance, hepatic coma, anuria.
CAUTIONS: Additive hypotension with antihypertensives and
nitrates. Additive hypokalemia with other diuretics,
mezlocillin, piperacillin, amphotericin B, stimulant laxatives,
and corticosteroids. Hypokalemia may increase digoxin
toxicity. Increased risk of ototoxicity with aminoglycoside.
May increase the effect of warfarin, thrombolytic agents, or
anticoagulants.

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

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GABAPENTIN (ga-ba-pen-tin) Neurontin analgesic adjunct,

anticonvulsant Pregnancy Category C
INDICATIONS: Partial seizures. Unlabeled Uses: Chronic pain,
prevention of migraine headache.
Therapeutic Effects: Decreased incidence of seizures.
DOSAGE: PO: Adults and Children 12 yr: 6001800 mg/d in
3 divided doses. Doses up to 24003600 mg/d have been well
tolerated. Children 512 yr: 1035 mg/kg/d in 3 divided
doses. Children 34 yr: 1040 mg/kg/d in 3 divided doses.
ADMINISTRATION: May be administered without regard to
meals. Discontinue gradually over at least 1 weekabrupt
discontinuation may increase frequency of seizures.
ADVERSE REACTIONS AND SIDE EFFECTS: Drowsiness,
anxiety, concentration difficulties (children), dizziness,
emotional lability (children), hostility, hyperkinesia (children),
malaise, vertigo, weakness, ataxia, altered reflexes, hyperkine-
sia, paresthesia, abnormal vision, nystagmus, hypertension,
anorexia, flatulence, gingivitis, arthralgia, facial edema.
CONTRAINDICATIONS: Hypersensitivity.
CAUTIONS: Increased risk of CNS depression with other CNS
depressants, including alcohol, antihistamines and sedative/
hypnotics. Kava, valerian, skullcap, chamomile, or hops can
increase CNS depression. Instruct patients on tid dosing not
to exceed 12 h between doses. If a dose is missed, take as
soon as possible; if less than 2 h until next dose, take immedi-
ately, take next dose 12 h later, then resume regular dosing.
Do not double doses. Do not discontinue abruptly. Do
not to take within 2 h of an antacid.

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GEMFIBROZIL (gem-fye-broe-zil) Lopid lipid-lowering agent
(fibric acid derivative) Pregnancy Category C
INDICATIONS: Management of type II-b hyperlipidemia
(decreased HDLs, increased LDLs, increased triglycerides) in
patients who do not yet have clinical coronary artery disease
and have failed therapy with diet, exercise, weight loss, or
other agents (niacin, bile acid sequestrants).
Therapeutic Effects: Decreased plasma triglycerides and
increased HDL.
DOSAGE: PO: Adults: 600 mg twice daily 30 min before break-
fast and dinner.
ADMINISTRATION: Administer 30 min before breakfast or
dinner.
ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,
headache, blurred vision, abdominal pain, diarrhea, epigastric
pain, gallstones, heartburn, nausea, vomiting, alopecia,
rashes, urticaria, anemia, myositis.
CONTRAINDICATIONS: Hypersensitivity, primary biliary
cirrhosis, concurrent use of HMG-CoA reductase inhibitors.
CAUTIONS: May increase the effects of warfarin or sulfony-
lurea oral hypoglycemic agents. Concurrent use with HMG-
CoA reductase inhibitors may increase the risk of
rhabdomyolysis. May decrease the effect of cyclosporine.
Instruct patient to notify health care professional if severe
stomach pains with nausea and vomiting, fever, chills, sore
throat, rash, diarrhea, muscle cramping, general abdominal
discomfort, or persistent flatulence occur. Advise patient to
comply with dietary restrictions, exercise program, and smok-
ing cessation program. Liver function tests should be
assessed before and periodically throughout therapy. May
cause an increase in serum bilirubin, alkaline phosphatase,
CK, LDH, AST, and ALT. If hepatic function tests rise signifi-
cantly, therapy should be discontinued and not resumed.
Key:
underline = most common;
CAPS = life-threatening

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GLIMEPIRIDE (glye-meh-per-ide) Amaryl antidiabetic (sulfony-

lureas) Pregnancy Category C
INDICATIONS: Type 2 diabetes mellitus.
Therapeutic Effects: Control of blood glucose levels.
DOSAGE: PO: Adults: 12 mg once daily initially; may
increase q 12 wk up to 8 mg/d (usual range 14 mg/d).
ADMINISTRATION: Administer with morning meal. If
prescribed in 2 divided doses, do not administer after last
meal of the day.
ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,
drowsiness, headache, weakness, constipation, cramps, diar-
rhea, drug-induced hepatitis, heartburn, increased appetite,
nausea, vomiting, photosensitivity, rashes, hypoglycemia,
hyponatremia, APLASTIC ANEMIA, agranulocytosis, leukope-
nia, pancytopenia, thrombocytopenia.
CONTRAINDICATIONS: Hypersensitivity, severe renal, hepatic,
thyroid, or other endocrine disease, Type 1 diabetes, diabetic
coma or ketoacidosis, uncontrolled infection, serious burns, or
trauma.
CAUTIONS: Ingestion of alcohol may result in disulfiram-like
reaction. Effectiveness may be decreased by concurrent use
of diuretics, corticosteroids, phenothiazines, oral contracep-
tives, estrogens, thyroid preparations, phenytoin, nicotinic
acid, sympathomimetics, and isoniazid. Concurrent use
with warfarin may alter the response to both agents
(increased effects of both initially, then decreased activity);
close monitoring recommended during any changes in
dosage. Beta-blockers may alter the response to oral hypo-
glycemic agents (increase or decrease requirements).
Glucosamine may worsen blood glucose control.
Fenugreek, chromium, and coenzyme Q-10 may produce
additive hypoglycemic effects.

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GLIPIZIDE (glip-i-zide) Glucotrol, Glucotrol XL antidiabetic
(sulfonylurea) Pregnancy Category C
INDICATIONS: Type 2 diabetes.
Therapeutic Effects: Improved blood glucose levels.
DOSAGE: PO: Adults: 2.540 mg/day; XL dosage form is given
once daily. Doses 15 mg/d should be given as 2 divided
doses.
ADMINISTRATION: Administer with morning meal. If
prescribed in 2 divided doses, do not administer after last
meal of the day.
ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,
drowsiness, headache, weakness, constipation, cramps, diar-
rhea, drug-induced hepatitis, heartburn, increased appetite,
nausea, vomiting, photosensitivity, rashes, hypoglycemia,
hyponatremia, APLASTIC ANEMIA, agranulocytosis, leukope-
nia, pancytopenia, thrombocytopenia.
CONTRAINDICATIONS: Hypersensitivity, severe renal, hepatic,
thyroid, or other endocrine disease, Type 1 diabetes, diabetic
coma or ketoacidosis, uncontrolled infection, serious burns, or
trauma.
CAUTIONS: Ingestion of alcohol may result in disulfiram-like
reaction. Effectiveness may be decreased by concurrent use
of diuretics, corticosteroids, phenothiazines, oral contracep-
tives, estrogens, thyroid preparations, phenytoin, nicotinic
acid, sympathomimetics, and isoniazid. Concurrent use
with warfarin may alter the response to both agents
(increased effects of both initially, then decreased activity);
close monitoring recommended during any changes in
dosage. Beta-blockers may alter the response to oral
hypoglycemic agents (increase or decrease requirements).
Glucosamine may worsen blood glucose control.
Fenugreek, chromium, and coenzyme Q-10 may produce
additive hypoglycemic effects.

DH
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GLYBURIDE (glye-byoo-ride) DiaBeta, Micronase, Glynase

PresTab antidiabetic (sulfonylurea) Pregnancy Category B
INDICATIONS: Type 2 diabetes.
Therapeutic Effects: Improved blood glucose levels.
DOSAGE: PO: Adults: DiaBeta/Micronase (nonmicronized):
1.2520 mg/d). Glynase PresTab (micronized): 0.7512 mg/d.
ADMINISTRATION: Administer with morning meal. If
prescribed in 2 divided doses, do not administer second dose
after last meal of the day.
ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,
drowsiness, headache, weakness, constipation, cramps, diar-
rhea, drug-induced hepatitis, heartburn, increased appetite,
nausea, vomiting, photosensitivity, rashes, hypoglycemia,
hyponatremia, APLASTIC ANEMIA, agranulocytosis, leukope-
nia, pancytopenia, thrombocytopenia.
CONTRAINDICATIONS: Hypersensitivity, severe renal, hepatic,
thyroid, or other endocrine disease, Type 1diabetes, diabetic
coma or ketoacidosis, uncontrolled infection, serious burns, or
trauma.
CAUTIONS: Ingestion of alcohol may result in disulfiram-like
reaction. Effectiveness may be decreased by concurrent use
of diuretics, corticosteroids, phenothiazines, oral contracep-
tives, estrogens, thyroid preparations, phenytoin, nicotinic
acid, sympathomimetics, and isoniazid. Concurrent use
with warfarin may alter the response to both agents
(increased effects of both initially, then decreased activity);
close monitoring recommended during any changes in
dosage. Beta-blockers may alter the response to oral
hypoglycemic agents (increase or decrease requirements).
Glucosamine may worsen blood glucose control.
Fenugreek, chromium, and coenzyme Q-10 may produce
additive hypoglycemic effects.

78
 79
HEPARIN (hep-a-rin) Calcilean, Calciparine, Hepalean anticoag-
ulant (antithrombotic) Pregnancy Category C
INDICATIONS: Venous thromboembolism, pulmonary emboli,
atrial fibrillation with embolization, acute and chronic coagu-
lopathies, peripheral arterial thromboembolism.
Therapeutic Effects: Prevention of thrombus formation,
prevention of extension of existing thrombi (full dose).
DOSAGE: SC: Adults: Therapeutic Anticoagulation: 5000 units
IV, followed by initial SC dose of 10,00020,000 units, then
800010,000 units every 8 hours or 15,00020,000 units
every12 hours. Prophylaxis of Thromboembolism: 5000 units
every 812 hours (may be started 2 hours prior to surgery). IV:
Adults: Therapeutic Anticoagulation: Intermittent bolus: 10,000
units, followed by 500010,000 units every 46 h. Continuous
infusion: 5000 units (3570 units/kg), followed by
20,00040,000 units infused over 24 hours (approx. 1000
units/h or 1518 units/kg/h). Children: Intermittent bolus: 50
units/kg, followed by 50100 units/kg every 4 h. Continuous
infusion: 50 units/kg, followed by 100 units/kg/4 h or 20,000
units/m2/24 h.
ADMINISTRATION: SC: Administer deep into SC tissue. Do not
aspirate or massage. Rotate sites frequently. Direct IV: Rate:
May be given undiluted over at least 1 min. Intermittent/
Continuous Infusion: Dilute in prescribed amount of solution
and give as a continuous or intermittent infusion. Ensure
adequate mixing of heparin in solution.
ADVERSE REACTIONS AND SIDE EFFECTS: Drug-induced
hepatitis, alopecia (long-term use), rashes, urticaria, BLEED-
ING, anemia, thrombocytopenia, pain at injection site, osteo-
porosis (long-term use), fever, hypersensitivity.
CONTRAINDICATIONS: Hypersensitivity, uncontrolled bleed-
ing, severe thrombocytopenia, open wounds (full dose).
CAUTIONS: HIGH ALERT MED: Available in various concen-
trations. Dose and calculation for dilution or direct IV injection
should be checked with a second licensed personnel before
(Continued)

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

80
 81
HYDROCHLOROTHIAZIDE (hye-droe-klor-oh-thye-a-zide)
Esidrix, HCTZ, Hydro-chlor, HydroDIURIL antihypertensive
(thiazide diuretic) Pregnancy Category B
INDICATIONS: Mild to moderate hypertension, edema.
Therapeutic Effects: Lower blood pressure, diuresis with
mobilization of edema.
DOSAGE: PO: Adults: Hypertension: 12.5 mg/d initially (range
12.5100 mg/d in 12 doses up to 200 mg/d; not to exceed 50
mg/d for hypertension). Children 6 mo: 12 mg/kg (3060
mg/m2/d) in 12 divided doses. Children 6 mo: Up to
3 mg/kg per day.
ADMINISTRATION: Administer in the morning to prevent
disruption of sleep cycle.
ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,
lethargy, weakness, hypotension, anorexia, cramping, hepati-
tis, nausea, photosensitivity, hyperglycemia, hypokalemia,
dehydration, hypercalcemia, hypomagnesemia, hyponatremia,
hypophosphatemia, hypovolemia, hyperuricemia, elevated
lipids, muscle cramps, and pancreatitis.
CONTRAINDICATIONS: Hypersensitivity, anuria, lactation.
CAUTIONS: Additive hypotension with other antihyperten-
sives, acute ingestion of alcohol, or nitrates. Additive
hypokalemia with corticosteroids, amphotericin B, mezlocillin,
piperacillin, or ticarcillin. Decreases the excretion of lithium.
Cholestyramine or colestipol decreases absorption.
Hypokalemia increases risk of digoxin toxicity. Assess
patient, especially if taking digitalis glycosides, for anorexia,
nausea, vomiting, muscle cramps, paresthesia, and confusion.
Notify physician or other health care professional if these
signs of electrolyte imbalance occur. Instruct patient to
monitor weight biweekly and notify health care professional
of significant changes. Caution patient to change positions
slowly to minimize orthostatic hypotension.
Key:
underline = most common;
CAPS = life-threatening

DH
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HYDROCORTISONE (hye-droe-kor-ti-sone) A-hydroCort, Cortef,

Hydrocortone, Solu-Cortef steroidal anti-inflammatory (systemic
corticosteroid) Pregnancy Category UK
INDICATIONS: Adrenocortical insufficiency; allergic and
inflammatory disorders.
Therapeutic Effects: Suppression of inflammation; modifi-
cation of the immune response; replacement of deficient adrenal
corticoids.
DOSAGE: PO: Adults: 20240 mg/d in divided doses. Children:
Adrenocortical insufficiency: 0.56 mg/kg (1520 mg/m2)/d as a
single dose or in divided doses. Other uses: 28 mg/kg/d
(60240 mg/m2/d) as a single dose or in divided doses. IM, IV:
Adults: Adrenocortical insufficiency: 100500 mg q 26 h.
Children: Adrenocortical insufficiency: 0.1860.28 mg/kg/d
(1012 mg/m2)/d in 3 divided doses. Other uses: 0.6664
mg/kg (20120 mg/m2) q 1224 h.
ADMINISTRATION: PO: Administer with meals to minimize GI
irritation. Direct IV: Rate: Administer each 100 mg over at least
30 sec. Doses 500 mg and larger should be infused over at
least 10 min.
ADVERSE REACTIONS AND SIDE EFFECTS: Depression,
euphoria, restlessness, hypertension, PEPTIC ULCERATION,
anorexia, nausea, acne, decreased wound healing, ecchy-
moses, hirsutism, petechiae, adrenal suppression, hyper-
glycemia, hypokalemia, THROMBOEMBOLISM,
thrombophlebitis, muscle wasting, osteoporosis, cushingoid
appearance, increased susceptibility to infection.
CONTRAINDICATIONS: Active untreated infections, lactation.
CAUTIONS: Instruct patient to report severe abdominal pain
or tarry stools. May increase need for insulin or oral hypo-
glycemic agents. Increased risk of adverse GI effects with
NSAIDs. Instruct patient to report swelling, weight gain,
tiredness, bone pain, bruising, nonhealing sores, visual or
behavioral changes.

82
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HYDROMORPHONE (hye-droe-mor-fone) Dilaudid, Hydrostat
IR opioid analgesic Schedule II Pregnancy Category C
INDICATIONS: Moderate to severe pain, persistent dry cough.
Therapeutic Effects: Decreased severity of pain, cough
suppression.
DOSAGE: PO: Adults and children 50 kg: Pain: 14 mg q 46
h. Antitussive: 1mg q 34 h prn. Children 6 months and 50
kg: Pain: 0.030.08 mg/kg q 34 h. IM, IV, SC: Adults and chil-
dren 50 kg: 14 mg q 34 h. Children 6 months and 50
kg: 0.015 mg/kg q 34 h. Adults: Continuous infusion: 0.10.2
mg q 515 min, maximum 46 mg q 4 h.
ADMINISTRATION: Direct IV: Rate: Give 2 mg over 35 min.
Rapid administration can lead to respiratory depression and
circulatory collapse. Continuous Infusion: Use patient-
controlled analgesia (PCA) pump.
ADVERSE REACTIONS AND SIDE EFFECTS: Confusion, seda-
tion, dizziness, RESPIRATORY DEPRESSION, hypotension,
constipation, nausea, urinary retention, physical or psycholog-
ical dependence, tolerance.
CONTRAINDICATIONS: Hypersensitivity.
CAUTIONS: HIGH ALERT MED: Do not confuse with
morphine; hydromorphone is 5 times stronger and errors
have resulted in fatalities. Have a second practitioner inde-
pendently check infusion pump programming. Assess level
of consciousness, blood pressure, pulse, and respirations. If
respiratory rate is 10/min, assess level of sedation. Have
naloxone (Narcan) available. Use with extreme caution in
patients receiving MAO inhibitors within 14 days prior (may
result in unpredictable, severe reactionsdecrease initial dose
of morphine to 25% of usual dose). Use cautiously in head
trauma, increased intracranial pressure, severe renal, hepatic,
or pulmonary disease, undiagnosed abdominal pain, prostatic
hypertrophy, pregnancy or lactation.

DH
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HYDROXYZINE (hye-drox-i-zeen) Apo-Hydroxyzine, Atarax,

Hyzine-50, Multipax, Novohydroxyzin, Vistaril antianxiety agent,
antihistamine, sedative/hypnotic Pregnancy Category C
INDICATIONS: Anxiety, preoperative sedation, nausea and
vomiting, and itching. Adjunct to opioids.
Therapeutic Effects: Sedation, relief of anxiety, decreased
nausea and vomiting, decreased allergic symptoms associated
with release of histamine, including itching.
DOSAGE: PO: Adults: 25100 mg 3 to 4 times daily. Children
612 yr: 12.525 mg 34 times daily. Children 6 yr: 12.5 mg 3
to 4 times daily. IM: Adults: 25100 mg every 46 h. Children:
1.1 mg/kg every 46 h.
ADMINISTRATION: PO: Tablets may be crushed and capsules
opened and administered with food or fluids. Shake suspen-
sion well before administering. IM: Injection is extremely
painful. Administer only IM deep into well-developed muscle,
preferably with Z-track technique. Do not use deltoid. If must
be administered to children, midlateral muscles of the thigh
are preferred.
ADVERSE REACTIONS AND SIDE EFFECTS: Drowsiness,
agitation, ataxia, dizziness, headache, weakness, wheezing,
dry mouth, bitter taste, constipation, nausea, urinary reten-
tion, flushing, pain at IM site, abscesses at IM sites, chest
tightness.
CONTRAINDICATIONS: Hypersensitivity, pregnancy.
CAUTIONS: Additive CNS depression with alcohol, antide-
pressants, antihistamines, opioid analgesics,
sedative/hypnotics, kava, valerian, skullcap, chamomile, or
hops. Additive anticholinergic effects with antihistamines,
antidepressants, atropine, haloperidol, phenothiazines, quini-
dine, and disopyramide. May cause drowsiness or dizziness.
Caution patient to avoid driving and other activities requir-
ing alertness until response to medication is known.

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 85
INFLIXIMAB (in-flix-i-mab) Remicade antirheumatic, gastroin-
testinal anti-inflammatory Pregnancy Category C
INDICATIONS: Rheumatoid arthritis, Crohn disease.
Therapeutic Effects: Decreased pain, swelling and rate of
joint destruction in patients with rheumatoid arthritis. Reduced
signs and symptoms of Crohn disease.
DOSAGE: IV: Adults: Rheumatoid arthritis: 3 mg/kg followed
by 3 mg/kg 2 and 6 wk after initial dose and then every 8 wk.
Moderate-to-severe Crohn disease: 5 mg/kg as a single infu-
sion. Fistulizing Crohn disease: 5 mg/kg repeated 2 and 6 wk
after initial infusion.
ADMINISTRATION: Administer over at least 2 hours through
polyethylene-lined administration set with filter. Do not
administer with any other agents.
ADVERSE REACTIONS AND SIDE EFFECTS: Fatigue,
headache, upper respiratory tract infection, dyspnea, chest
pain, hypertension, hypotension, tachycardia, worsening of
CHF, abdominal pain, nausea, vomiting, constipation, diarrhea,
INFECTIONS (including reactivation tuberculosis and invasive
fungal infections), fever, infusion reactions.
CONTRAINDICATIONS: Hypersensitivity, CHF, and lactation.
CAUTIONS: Reactions (fever, chills, urticaria, pruritus) usually
seen during and for 2 hours after infusion. Symptoms usually
resolve when infusion is discontinued. Frequency of reactions
may be reduced with immunosuppressant agents.
Medications (antihistamines, acetaminophen, cortico-
steroids, epinephrine) and equipment should be readily avail-
able in the event of a severe reaction.

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

IM
 IM

INSULIN ASPART (in-su-lin) Novolog antidiabetic (pancreatic

hormone) Pregnancy Category B
INDICATIONS: Rapid-acting insulin (onset: 1020 min; peak
13 h; duration: 35 h) used to treat elevated glucose levels in
type 1 and type 2 diabetes (usually in addition to intermediate
and long-acting insulins). More rapid absorption and onset
than regular insulin, with a shorter duration.
Therapeutic Effects: Reduction of blood glucose levels.
DOSAGE: SC: Adults: 0.250.7 units/kg/d in divided doses
injected 510 minutes before each meal.
ADMINISTRATION: SC: Use only insulin syringes to draw up
dose. Do not administer cold insulin: can lead to lipodystro-
phy. Rotate injection sites.
ADVERSE REACTIONS AND SIDE EFFECTS: Urticaria, HYPO-
GLYCEMIA, rebound hyperglycemia (Somogyi effect), lipodys-
trophy, itching, lipohypertrophy, redness, swelling, allergic
reactions including ANAPHYLAXIS.
CONTRAINDICATIONS: Allergy or hypersensitivity.
CAUTIONS: HIGH ALERT MED: Do not accept insulin orders
that contain the abbreviation U for units. It can be misread
as a zero and has resulted in serious, tenfold overdoses.
Clarify any order that contains this abbreviation. Assess
patient for signs and symptoms of hypoglycemia (cool,
clammy skin, difficulty concentrating, drowsiness; excessive
hunger; headache; irritability; nausea; rapid pulse; shakiness)
and hyperglycemia (flushed, dry skin; fruity breath odor;
frequent urination; loss of appetite; tiredness; unusual thirst)
throughout therapy.

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INSULIN GLARGINE (in-su-lin glar-geen) Lantus antidiabetic
(pancreatic hormone) Pregnancy Category C
INDICATIONS: Type 1 and type 2 diabetes. Long-acting insulin
with a constant concentration over 24 hours with no
pronounced peak. Provides a continuous level of insulin, simi-
lar to the steady secretion of insulin provided by the normal
pancreas.
Therapeutic Effects: Control of blood glucose levels.
DOSAGE: SC: Adults and children: Begin with 10 units at
bedtime and titrate according to glucose levels.
ADMINISTRATION: SC: Use only insulin syringes to draw up
dose. Rotate injection sites.
ADVERSE REACTIONS AND SIDE EFFECTS: Urticaria, HYPO-
GLYCEMIA, rebound hyperglycemia (Somogyi effect), lipodys-
trophy, itching, lipohypertrophy, redness, swelling, allergic
reactions including ANAPHYLAXIS.
CONTRAINDICATIONS: Allergy or hypersensitivity.
CAUTIONS: HIGH ALERT MED: Lantus insulin cannot be
mixed with other insulins; action may be affected in an unpre-
dictable manner. Do not accept insulin orders that contain
the abbreviation U for units. It can be misread as a zero
and has resulted in serious, tenfold overdoses. Clarify any
order that contains this abbreviation. Do not confuse Lantus
insulin with Lente insulin. Assess patient for signs and
symptoms of hypoglycemia (cool, clammy skin, difficulty
concentrating, drowsiness; excessive hunger; headache; irri-
tability; nausea; rapid pulse; shakiness) and hyperglycemia
(flushed, dry skin; fruity breath odor; frequent urination; loss
of appetite; tiredness; unusual thirst) throughout therapy.

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

IM
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INSULIN INJECTION CONCENTRATED (in-su-lin) Iletin II

Regular (Concentrated) U-500 antidiabetic, hormone
Pregnancy Category B
INDICATIONS: Short-acting insulin (onset: 1/21 h; peak 23 h;
duration: 57 h) used to treat elevated glucose levels only in
insulin-resistant patients with type 1 diabetes whose insulin
requirements exceed 200 units/d.
Therapeutic Effects: Lowered blood glucose levels.
DOSAGE: SC: Adults: Individualized dosages 15-30 minutes
before meals or based on blood glucose levels. Double check
dosages.
ADMINISTRATION: Do not administer cold insulin: can lead to
lipodystrophy. Rotate injection sites.
ADVERSE REACTIONS AND SIDE EFFECTS: HYPO-
GLYCEMIA, rebound hyperglycemia (Somogyi effect), lipodys-
trophy, itching, lipohypertrophy, redness, swelling, allergic
reactions including ANAPHYLAXIS.
CONTRAINDICATIONS: Allergy or hypersensitivity.
CAUTIONS: HIGH ALERT MED: Concentrated regular insulin
(500 units per mL) is 5 times more concentrated than regular
insulin (100 units per mL). Do not confuse with regular insulin.
There are no U-500 syringes and using a U-100 syringe may
result in dosage errors. Order should be expressed in units
and volume (e.g., 200 units, 0.4 mL) and a tuberculin syringe
should be used for administration. Do not accept insulin
orders that contain the abbreviation U for units. It can be
misread as a zero and has resulted in serious, tenfold over-
doses. Clarify any order that contains this abbreviation.
Never use concentrated insulin IV because of potential for
overdosage. Assess patient for signs and symptoms of hypo-
glycemia (cool, clammy skin, difficulty concentrating, drowsi-
ness; excessive hunger; headache; irritability; nausea; rapid
pulse; shakiness) and hyperglycemia throughout therapy.
ISMP Medication Safety Alert, Jan 23, 2002,
[Link]/MSArticles/[Link]

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INSULIN INJECTION (REGULAR) (in-su-lin) Humulin R,
Insulin-Toronto, Novolin R, Iletin II Regular, Velosulin BR antidia-
betic (pancreatic hormone) Pregnancy Category B
INDICATIONS: Short-acting insulin (onset: 1/21 h; peak 23 h;
duration: 57 h) used to treat elevated glucose levels in type 1
and type 2 diabetes (usually in addition to intermediate and
long-acting insulins); diabetic ketoacidosis/coma, hyper-
kalemia.
Therapeutic Effects: Reduction of blood glucose levels;
intracellular shift of potassium.
DOSAGE: SC: Adult: 210 units 1530 minutes before meals or
in response to blood glucose elevations. Child: 24 units
1530 minutes before meals or in response to blood glucose
elevations. IV: Adult: 27 units per hour as a continuous infu-
sion. Child: 0.1 unit/kg per hour as a continuous infusion.
ADMINISTRATION: Use only insulin syringes to draw up dose.
SC: Do not administer cold insulin: can lead to lipodystrophy.
Rotate injection sites. IV: Regular insulin is the only insulin
that can be administered IV.
ADVERSE REACTIONS AND SIDE EFFECTS: Urticaria, HYPO-
GLYCEMIA, rebound hyperglycemia (Somogyi effect), lipodys-
trophy, itching, lipohypertrophy, redness, swelling, allergic
reactions including ANAPHYLAXIS.
CONTRAINDICATIONS: Allergy or hypersensitivity.
CAUTIONS: HIGH ALERT MED: Do not accept insulin
orders that contain the abbreviation U for units. It can be
misread as a zero and has resulted in serious, tenfold over-
doses. Clarify any order that contains this abbreviation. Do
not confuse Humulin R with Humulin N, Humulin U, or
Humalog. Assess patient for signs and symptoms of hypo-
glycemia (cool, clammy skin, difficulty concentrating, drowsi-
ness; excessive hunger; headache; irritability; nausea; rapid
pulse; shakiness) and hyperglycemia throughout therapy.
Key:
underline = most common;
CAPS = life-threatening

IM
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INSULIN, ISOPHANE (NPH) (in-su-lin) Humulin N, NPH Iletin

II, Novolin Ge NPH, Novolin N antidiabetic (pancreatic hormone)
Pregnancy Category B
INDICATIONS: Intermediate-acting insulin (onset: 12 h; peak
812 h; duration: 1824 h) used to treat elevated glucose
levels in patients with type 1 and type 2 diabetes.
Therapeutic Effects: Control of blood glucose levels.
DOSAGE: Adults: 726 units as a single dose 30-60 minutes
before breakfast. A second smaller dose may be given before
dinner or at bedtime. Dose may be increased 2-10 units daily
or weekly until desired control is achieved.
ADMINISTRATION: Use only insulin syringes to draw up dose.
SC: Do not administer cold insulin: can lead to lipodystrophy.
Rotate vial between palms and invert gently to mix; do not
shake. Rotate injection sites. May be mixed with regular
insulin.
ADVERSE REACTIONS AND SIDE EFFECTS: Urticaria, HYPO-
GLYCEMIA, rebound hyperglycemia (Somogyi effect), lipodys-
trophy, itching, lipohypertrophy, redness, swelling, allergic
reactions including ANAPHYLAXIS.
CONTRAINDICATIONS: Allergy or hypersensitivity.
CAUTIONS: HIGH ALERT MED: Do not accept insulin
orders that contain the abbreviation U for units. It can be
misread as a zero and has resulted in serious, tenfold over-
doses. Clarify any order that contains this abbreviation. Do
not confuse Humulin N with Humulin R, Humulin U, or
Humalog. Assess patient for signs and symptoms of hypo-
glycemia (cool, clammy skin, difficulty concentrating, drowsi-
ness; excessive hunger; headache; irritability; nausea; rapid
pulse; shakiness) and hyperglycemia throughout therapy.
Advise patient to eat a snack mid-afternoon and bedtime
to prevent hypoglycemia during peak hours.

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INSULIN LISPRO (in-su-lin) Humalog antidiabetic (pancreatic
hormone) Pregnancy Category B
INDICATIONS: Rapid-acting insulin used to treat elevated
glucose levels in type 1 and type 2 diabetes (usually in addi-
tion to intermediate and long-acting insulins, or, with type 2
diabetes, oral hypoglycemic agents).
Therapeutic Effects: Reduction of blood glucose levels.
DOSAGE: SC: Adults: 510 units up to 15 minutes before
meals. Use only U-100 insulin syringes to draw up insulin
lispro dose.
ADMINISTRATION: Use only U-100 insulin syringes to draw
up insulin lispro dose. Do not administer cold insulin: can lead
to lipodystrophy. Rotate injection sites.
ADVERSE REACTIONS AND SIDE EFFECTS: Urticaria, HYPO-
GLYCEMIA, rebound hyperglycemia (Somogyi effect), lipodys-
trophy, itching, lipohypertrophy, redness, swelling, allergic
reactions including ANAPHYLAXIS.
CONTRAINDICATIONS: Allergy or hypersensitivity.
CAUTIONS: HIGH ALERT MED: Do not accept insulin orders
that contain the abbreviation U for units. It has been
misread as a zero, which resulted in serious, ten-fold over-
dose. Clarify any order that contains this abbreviation. Do
not confuse Humalog with Humulin. Hypoglycemia is most
likely 2 to 4 hours after administration. Assess patient for
signs and symptoms of hypoglycemia (cool, clammy skin,
difficulty concentrating, drowsiness; excessive hunger;
headache; irritability; nausea; rapid pulse; shakiness) and
advise patient to keep a source of concentrated sugar on hand
(candy, sugar packets) and identification describing their
disease and treatment regimen at all times. Assess for
hyperglycemia throughout therapy. When mixing insulins,
draw insulin lispro into syringe first to avoid contamination of
insulin lispro vial.
Key:
underline = most common;
CAPS = life-threatening

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INSULIN ZINC SUSPENSION, EXTENDED (ULTRALENTE)

(in-su-lin) Humulin U, Ultralente, Novolin de Ultralente, Novolin
U, Ultralente U antidiabetic (pancreatic hormone) Pregnancy
Category B
INDICATIONS: Long-acting insulin (onset: 48 h; peak 1618 h;
duration: 36 h) used to treat elevated glucose levels in
patients with type 1 diabetes.
Therapeutic Effects: Control of blood glucose levels.
DOSAGE: Individualized dose 30 minutes before breakfast.
ADMINISTRATION: Use only insulin syringes to draw up dose.
SC: Do not administer cold insulin: can lead to lipodystrophy.
Rotate vial between palms and invert gently to mix; do not
shake. Rotate injection sites. May be mixed with regular
insulin.
ADVERSE REACTIONS AND SIDE EFFECTS: Urticaria, HYPO-
GLYCEMIA, rebound hyperglycemia (Somogyi effect), lipodys-
trophy, itching, lipohypertrophy, redness, swelling, allergic
reactions including ANAPHYLAXIS.
CONTRAINDICATIONS: Allergy or hypersensitivity.
CAUTIONS: HIGH ALERT MED: Do not accept insulin
orders that contain the abbreviation U for units. It can be
misread as a zero and has resulted in serious, tenfold over-
doses. Clarify any order that contains this abbreviation. Do
not confuse Humulin U with Humulin R, Humulin N, or
Humalog. Assess patient for signs and symptoms of hypo-
glycemia (cool, clammy skin, difficulty concentrating, drowsi-
ness; excessive hunger; headache; irritability; nausea; rapid
pulse; shakiness) and hyperglycemia (flushed, dry skin; fruity
breath odor; frequent urination; loss of appetite; tiredness;
unusual thirst) throughout therapy. Advise patient to eat a
snack mid-afternoon and bedtime to prevent hypoglycemia
during peak hours.

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INSULIN ZINC SUSPENSION (LENTE) (in-su-lin) Humulin L,
Lente Iletin II, Novolin Ge Lente, Novolin L antidiabetic (pancre-
atic hormone) Pregnancy Category B
INDICATIONS: Intermediate-acting insulin (onset: 12 h; peak
812 h; duration: 1824 h) used to treat elevated glucose
levels in patients with type 1 and type 2 diabetes.
Therapeutic Effects: Control of blood glucose levels.
DOSAGE: Adults: 726 units as a single dose 3060 minutes
before breakfast. A second smaller dose may be given before
dinner or at bedtime. Dose may be increased 210 units daily
or weekly until desired control is achieved.
ADMINISTRATION: Use only insulin syringes to draw up dose.
SC: Do not administer cold insulin: can lead to lipodystrophy.
Rotate vial between palms and invert gently to mix; do not
shake. Rotate injection sites. May be mixed with regular
insulin.
ADVERSE REACTIONS AND SIDE EFFECTS: HYPO-
GLYCEMIA, rebound hyperglycemia (Somogyi effect), lipodys-
trophy, lipohypertrophy, redness, swelling, allergic reactions
including ANAPHYLAXIS.
CONTRAINDICATIONS: Allergy or hypersensitivity.
CAUTIONS: HIGH ALERT MED: Do not accept insulin orders
that contain the abbreviation U for units. It can be misread
as a zero and has resulted in serious, tenfold overdoses.
Clarify any order that contains this abbreviation. Do not
confuse Humulin L with Humulin N, Humulin R, Humulin U,
or Humalog. Do not confuse Lente insulin with Lantus.
Assess for signs and symptoms of hypoglycemia (fatigue;
cool, clammy skin; difficulty concentrating; drowsiness; exces-
sive hunger; headache; irritability; rapid pulse; shakiness.
Advise patient to eat a snack mid afternoon and bedtime to
prevent hypoglycemia during peak hours. Assess patient for
signs and symptoms of hyperglycemia throughout therapy.
Key:
underline = most common;
CAPS = life-threatening

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INSULIN, PREMIXED COMBINATIONS (NPH/regular insulin

mixtures) Humulin 50/50, Humulin 70/30, Novolin 70/30
INDICATIONS: Combination of short-acting and intermediate-
acting insulins with short-acting insulin comprising 30% to
50% of the solution and intermediate acting insulin compris-
ing 50% to 70% (onset: 30 min; peak 28 h; duration: 24 h).
Used to treat elevated glucose levels in patients with type 1
and type 2 diabetes.
Therapeutic Effects: Control of blood glucose levels.
DOSAGE: SC: Adults: Titrated individually based on multiple
factors. Maintenance therapy is usually 0.51 unit/kg/d.
ADMINISTRATION: Use only insulin syringes to draw up dose.
SC: Do not administer cold insulin: can lead to lipodystrophy.
Rotate vial between palms and invert gently to mix; do not
shake. Rotate injection sites. May be mixed with regular
insulin.
ADVERSE REACTIONS AND SIDE EFFECTS: Urticaria, HYPO-
GLYCEMIA, rebound hyperglycemia (Somogyi effect), lipodys-
trophy, itching, lipohypertrophy, redness, swelling, allergic
reactions including ANAPHYLAXIS.
CONTRAINDICATIONS: Allergy or hypersensitivity.
CAUTIONS: HIGH ALERT MED: Do not accept insulin
orders that contain the abbreviation U for units. It can be
misread as a zero and has resulted in serious, tenfold over-
doses. Clarify any order that contains this abbreviation.
Assess patient for signs and symptoms of hypoglycemia
(cool, clammy skin, difficulty concentrating, drowsiness;
excessive hunger; headache; irritability; nausea; rapid pulse;
shakiness) and hyperglycemia throughout therapy. Advise
patient to eat a snack mid afternoon and bedtime to prevent
hypoglycemia during peak hours.

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IPRATROPIUM (i-pra-troe-pee-um) Atrovent allergy, cold and
cough remedy, bronchodilator (anticholinergic) Pregnancy
Category B
INDICATIONS: Bronchodilation in COPD. Rhinorrhea
(intranasal). Unlabeled Use: Adjunctive management of bron-
chospasm in asthma.
Therapeutic Effects: Bronchodilation without systemic anti-
cholinergic effects. Decreased rhinorrhea.
DOSAGE: Inhalation: Adults: Metered-dose inhaler: 14 inhala-
tions 34 times daily (not to exceed 24 inhalations/24 h or
more frequently than q 4 h). Via nebulization: 250500 g 34
times daily every 68 h as needed (up to 500 g q 4 h).
Children 512 yr: Metered dose inhaler: 12 inhalations every
68 h as needed. Via nebulization: 125250 g 34 times daily.
Intranasal: Adults and Children 12 yr: Perennial rhinitis: 2
sprays of 0.03% solution 23 times daily (21 g/spray); peren-
nial rhinitis: 2 sprays of 0.06% solution 34 times daily (42
g/spray) for up to 4 days.
ADMINISTRATION: When administering with other inhalation
medications, administer adrenergic bronchodilators first, then
ipratropium, then corticosteroids. Wait 5 minutes between
medications.
ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,
headache, nervousness, blurred vision, sore throat, bron-
chospasm, cough, hypotension, palpitations, GI irritation,
rash, allergic reactions; nasal only: epistaxis, nasal
dryness/irritation.
CONTRAINDICATIONS: Hypersensitivity to ipratropium,
atropine, belladonna alkaloids, bromide, or fluorocarbons.
Avoid use during acute bronchospasm.
CAUTIONS: Caution patient not to exceed 12 inhaled doses
within 24 hours and to notify health care professional if symp-
toms do not improve within 30 minutes after administration of
medication or if condition worsens.

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ISOSORBIDE DINITRATE (eye-soe-sor-bide dye-nye-trate)

Dilatrate-SR, Isorbid, Isordil, Isotrate, Sorbitrate antianginal
(nitrate) Pregnancy Category C
INDICATIONS: Anginal attacks, management of angina
pectoris, CHF.
Therapeutic Effects: Relief of anginal attacks increased
cardiac output.
DOSAGE: PO: Adults: 1040 mg q 6 h or 4080 mg q 812 h as
sustained-release form. SL: Adults: Acute attack of angina
pectoris: 2.55 mg may be repeated q 510 min for 3 doses in
1530 min. Prophylaxis of angina pectoris: 2.510 mg repeated
q 23 h or 15 min prior to activity.
ADMINISTRATION: PO: Administer 1 hour before or 2 hours
after meals with a full glass of water for faster absorption. SL:
Hold tablet under tongue until dissolved; do not eat, drink, or
smoke until dissolved. Replace if inadvertently swallowed.
ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,
headache, apprehension, weakness, hypotension, tachycardia,
paradoxic bradycardia, syncope, abdominal pain, nausea,
vomiting, flushing, tolerance.
CONTRAINDICATIONS: Hypersensitivity, severe anemia,
concurrent use of sildenafil.
CAUTIONS: Do not confuse with isosorbide, a diuretic.
Extended-release tablets and capsules should be swallowed
whole. Do not crush, break, or chew. Concurrent use of
sildenafil may result in significant and potentially fatal hypo-
tension. Additive hypotension with antihypertensives, acute
ingestion of alcohol, beta-blockers, calcium channel blockers,
and phenothiazines. Do not discontinue abruptly. Make
position changes slowly to minimize orthostatic hypotension.
Avoid concurrent use of alcohol. Inform patient that
headache is a common side effect that should decrease with
continuing therapy. Do not alter dose to avoid headache.

96
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ISOSORBIDE MONONITRATE (eye-soe-sor-bide mah-noe-
nye-trate) Imdur, Ismo, Monoket antianginal (nitrate) Pregnancy
Category C
INDICATIONS: Angina pectoris
Therapeutic Effects: Prevention of anginal attacks,
increased cardiac output.
DOSAGE: PO: Adults: Ismo, Monoket: 20 mg twice daily, 7 h
apart. Imdur: 3060 mg once daily may increase to 120 mg
once daily (up to 240 mg/d).
ADMINISTRATION: Take on an empty stomach with a full glass
of water.
ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,
headache, apprehension, weakness, hypotension, tachycardia,
paradoxic bradycardia, syncope, abdominal pain, nausea,
vomiting, flushing, tolerance.
CONTRAINDICATIONS: Hypersensitivity, severe anemia,
concurrent use of sildenafil.
CAUTIONS: Concurrent use of sildenafil may result in signifi-
cant and potentially fatal hypotension. Do not confuse with
isosorbide, a diuretic. Use cautiously in head trauma or
cerebral hemorrhage, geriatric patients, pregnancy (may
compromise maternal/fetal circulation), children or lactation.
Additive hypotension with antihypertensives, acute inges-
tion of alcohol, beta-blockers, calcium channel blockers, and
phenothiazines. Do not discontinue abruptly. Make posi-
tion changes slowly to minimize orthostatic hypotension.
Avoid concurrent use of alcohol. Inform patient that
headache is a common side effect that should decrease with
continuing therapy. Do not alter dose to avoid headache.

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

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ITRACONAZOLE (it-tra-kon-a-zole) Sporanox antifungal

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

98
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LAMIVUDINE (lah-mih-vyoo-deen) Epivir, Epivir HBV, 3TC anti-
retroviral Pregnancy Category C
INDICATIONS: HIV infection (AIDS) Chronic hepatitis B infec-
tion.
Therapeutic Effects: Slows the progression of HIV infec-
tion, increases CD4 cell counts and decreases viral load.
Protection from liver damage caused by chronic hepatitis B
infection.
DOSAGE: PO: Adults: Chronic Hepatitis B: 100 mg once daily.
Adults and Children 12 yr and 50 kg: HIV infection: 150 mg
twice daily. Adults 50 kg: HIV infection: 2 mg/kg twice daily.
Children 3 mo12 yr: HIV infection: 4 mg/kg twice daily (up to
150 mg twice daily).
ADMINISTRATION: Administer without regard to food.
ADVERSE REACTIONS AND SIDE EFFECTS: SEIZURES,
fatigue, headache, insomnia, malaise, cough, HEPATOMEGALY
WITH STEATOSIS, PANCREATITIS, anorexia, diarrhea, nausea,
vomiting, abnormal liver function studies, musculoskeletal
pain, rhabdomyolysis, neuropathy, ANAPHYLAXIS and
STEVENS-JOHNSON SYNDROME.
CONTRAINDICATIONS: Hypersensitivity, lactation.
CAUTIONS: Use extreme caution in pediatric patients with a
history of pancreatitis. Assess patient, especially pediatric
patients, for signs of pancreatitis (nausea, vomiting, abdomi-
nal pain) periodically throughout therapy. May require discon-
tinuation of therapy. Monitor serum amylase, lipase, and
triglycerides periodically during therapy. Elevated serum
levels may indicate pancreatitis and require discontinuation.
Monitor liver function. May cause elevated levels of AST,
ALT, CPK, bilirubin, and alkaline phosphatase, which usually
resolve after interruption of therapy. Lactic acidosis may
occur with hepatic toxicity causing hepatic steatosis; may be
fatal, especially in women.
Key:
underline = most common;
CAPS = life-threatening

IM
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LANSOPRAZOLE (lan-soe-pra-zole) Prevacid antiulcer agent

(proton pump inhibitor) Pregnancy Category B
INDICATIONS: Erosive esophagitis, duodenal ulcers, active
benign gastric ulcer, GERD, Zollinger-Ellison syndrome and
other pathologic hypersecretory conditions.
Therapeutic Effects: Diminished accumulation of acid in
the gastric lumen, with lessened acid reflux, healing of duodenal
ulcers and esophagitis.
DOSAGE: PO: Adults: 1530 mg once daily (may be taken
twice daily with antibiotics for treatment of H. pylori); patho-
logic hypersecretory conditions: 60 mg once daily initially, up
to 90 mg twice daily (daily dose 120 mg should be given in
divided doses).
ADMINISTRATION: Administer before meals. Capsules may be
opened and sprinkled on 1 tbsp of applesauce, pudding,
cottage cheese, or yogurt and swallowed immediately for
patients with difficulty swallowing.
ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,
headache, diarrhea, abdominal pain, nausea, rash.
CONTRAINDICATIONS: Hypersensitivity.
CAUTIONS: Do not crush or chew capsule contents.
Sucralfate decreases absorption of lansoprazole (take 30
minutes before sucralfate). May decrease absorption of
drugs requiring acid pH, including ketoconazole, itraconazole,
ampicillin esters, iron salts, and digoxin. May cause abnor-
mal liver function tests, including increased AST, ALT, alkaline
phosphatase, LDH, and bilirubin.

100
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LEVOFLOXACIN (le-voe-flox-a-sin) Levaquin anti-infective (fluo-
roquinolone) Pregnancy Category C
INDICATIONS: Urinary, gynecologic, respiratory, skin and skin
structure infections.
Therapeutic Effects: Resolution of infection.
DOSAGE: PO, IV: Adults: 250750 mg q 24 h.
ADMINISTRATION: PO: Do not give within 2 hours of adminis-
tration: of antacids, iron, zinc, or sucralfate. IV: Rate:
Administer by infusion over at least 60 minutes. Avoid rapid
bolus injection.
ADVERSE REACTIONS AND SIDE EFFECTS: SEIZURES,
dizziness, drowsiness, headache, acute psychoses, light-
headedness, tremors, PSEUDOMEMBRANOUS COLITIS,
abdominal pain, diarrhea, nausea, altered taste, photosensi-
tivity, hyperglycemia, hypoglycemia, phlebitis at IV site,
tendinitis, tendon rupture, hypersensitivity reactions including
ANAPHYLAXIS, STEVENS-JOHNSON SYNDROME.
CONTRAINDICATIONS: Hypersensitivity, pregnancy or chil-
dren 18 yr.
CAUTIONS: Instruct patient to notify health care professional
if fever and diarrhea develop, especially if stool contains
blood, pus, or mucus. Advise patient not to treat diarrhea
without consulting health care professional. Instruct patient
to notify health care professional immediately if rash, tendon
pain or inflammation occur. May increase the effects of
warfarin. Increases serum theophylline levels and may lead
to toxicity. Concurrent use with foscarnet may increase risk
of seizures. Concurrent use with corticosteroids may
increase risk of tendon rupture.

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

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LEVOTHYROXINE (lee-voe-thye-rox-een) Levo-T, Levothroid,

Levoxyl, Synthroid hormone (thyroid preparation) Pregnancy
Category A
INDICATIONS: Diminished or absent thyroid function.
Therapeutic Effects: Restoration of normal hormonal
balance.
DOSAGE: PO: Adults: 75125g/d (1.5 g/kg/d). Geriatric
Patients: 75 g/d. Children 10 yr: 150200 g/d (23 g/kg/d).
Children 610 yr: 100150 g/d (45 g/kg/d.) Children 15 yr:
75100 g/d (35 g/kg/d). Children 612 mo: 5075 g/d (56
g/kg/d). IM, IV: Adults: Hypothyroidism: 50100 g/d.
Myxedema coma/stupor: 200500 g IV. Children:
Hypothyroidism: 75% of the calculated oral dose.
ADMINISTRATION: PO: Administer as a single dose, before
breakfast. Direct IV: Dilute with 0.9% NaCl without preserva-
tives, for a concentration of 100 g/mL. Rate: 100 g over
1 min.
ADVERSE REACTIONS AND SIDE EFFECTS: Insomnia, irri-
tability, nervousness, CARDIOVASCULAR COLLAPSE, arrhyth-
mias, tachycardia, angina pectoris, hypertension, diarrhea,
vomiting, hair loss (in children), increased sweating, hyperthy-
roidism, menstrual irregularities, weight loss, heat intolerance,
accelerated bone maturation in children.
CONTRAINDICATIONS: Hypersensitivity, recent MI, thyrotoxi-
cosis.
CAUTIONS: Bile acid sequestrants decrease absorption of
orally administered thyroid preparations. May alter the
effectiveness of warfarin. May cause an increase in the
requirement for insulin or oral hypoglycemic agents in dia-
betics. Concurrent estrogen therapy may increase thyroid
replacement requirements. Additive cardiovascular effects
with adrenergics (sympathomimetics). May decrease
response to beta-blockers. Dose should be withheld and
health care professional notified if resting pulse 100 bpm.

102
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LISINOPRIL (lye-sin-oh-pril) Prinivil, Zestril antihypertensive
(ACE inhibitor) Pregnancy Category D
INDICATIONS: Hypertension, CHF.
Therapeutic Effects: Lowered blood pressure, improve-
ment in CHF symptoms.
DOSAGE: PO: Adults: 540 mg/d (maximum 80 mg/d) once
daily or in two divided doses.
ADMINISTRATION: Precipitous drop in blood pressure during
first 13 hours following first dose may occur. Monitor blood
pressure closely.
ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,
fatigue, headache, insomnia, weakness, cough, hypotension,
angina pectoris, tachycardia, taste disturbances, anorexia,
diarrhea, nausea, proteinuria, impotence, renal failure, rashes,
hyperkalemia, AGRANULOCYTOSIS, NEUTROPENIA (CAPTO-
PRIL ONLY), ANGIOEDEMA, fever.
CONTRAINDICATIONS: Hypersensitivity, cross-sensitivity
among ACE inhibitors may occur, pregnancy, angioedema
(hereditary or idiopathic).
CAUTIONS: Instruct patient to report rash; mouth sores; sore
throat; fever; swelling of hands or feet; irregular heart beat;
chest pain; dry cough; hoarseness; swelling of face, eyes, lips,
or tongue; difficulty swallowing or breathing occur. Additive
hypotension with other antihypertensives, nitrates, pheno-
thiazines, acute ingestion of alcohol, and during surgery or
general anesthesia. Hyperkalemia with potassium supple-
ments, potassium-sparing diuretics, indomethacin, salt
substitutes, or cyclosporine. May increase the risk of
lithium or digoxin toxicity. Persistent dry cough may occur
and may not subside until medication is discontinued.

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

IM
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LOPERAMIDE (loe-per-a-mide) Imodium, Kaopectate II Caplets,

Pepto Diarrhea Control antidiarrheal Pregnancy Category B
INDICATIONS: Acute diarrhea, chronic diarrhea associated
with inflammatory bowel disease.
Therapeutic Effects: Relieves diarrhea.
DOSAGE: PO: Adults: 4 mg initially, then 2 mg after each loose
stool. Maintenance doses usually 48 mg/d in divided doses.
Children 911 yr or 3047 kg: 2 mg initially; then 1 mg after
each loose stool (not to exceed 6 mg/24 h). Children 68 yr or
2430 kg: 1 mg initially, then 1 mg after each loose stool (not
to exceed 4 mg/24 h).
ADMINISTRATION: Administer with clear fluids to help
prevent dehydration.
ADVERSE REACTIONS AND SIDE EFFECTS: Drowsiness,
dizziness, constipation, abdominal pain/distention/discomfort,
dry mouth, nausea, allergic reactions.
CONTRAINDICATIONS: Hypersensitivity, patients in whom
constipation must be avoided, abdominal pain of unknown
cause, especially if associated with fever, alcohol intolerance
(liquid only).
CAUTIONS: Additive CNS depression with other CNS depres-
sants, alcohol, antihistamines, opioid analgesics, and seda-
tive/hypnotics. Additive anticholinergic properties with
other drugs having anticholinergic properties, including anti-
depressants and antihistamines. Kava, valerian, skullcap,
chamomile, or hops can increase CNS depression. Assess
fluid and electrolyte balance and skin turgor for dehydration.
In acute diarrhea, medication may be ordered after each
unformed stool. Advise patient not to exceed the maximum
number of doses. Advise patient that frequent mouth
rinses, good oral hygiene, and sugarless gum or candy may
relieve dry mouth. Caution patient to avoid using alcohol
and other CNS depressants concurrently with this medication.

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LORATADINE (lor-a-ta-deen) Alavert, Claritin, Claritin RediTabs
antihistamine Pregnancy Category B
INDICATIONS: Seasonal allergies, chronic idiopathic urticaria,
hives.
Therapeutic Effects: Decreased symptoms of allergic
reactions.
DOSAGE: PO: Adults and Children 6 yr: 10 mg once daily.
Children 25 yr: 5 mg once daily.
ADMINISTRATION: Administer once daily. For rapidly disinte-
grating tablets (Alavert, Claritin RediTabs): Place on tongue.
Tablet disintegrates rapidly. May be taken with or without
water.
ADVERSE REACTIONS AND SIDE EFFECTS: Confusion,
drowsiness (rare), paradoxical excitation, blurred vision, dry
mouth, GI upset, photosensitivity, rash, and weight gain.
CONTRAINDICATIONS: Hypersensitivity, lactation.
CAUTIONS: MAO inhibitors may intensify and prolong
effects of antihistamines. Additive CNS depression may
occur with other CNS depressants, including alcohol, anti-
depressants, opioid analgesics, and sedative/hypnotics.
Maintain fluid intake of 15002000 mL/d to decrease viscos-
ity of secretions. Instruct patient to take medication 1 hour
before or 2 hours after eating. Advise patient that good oral
hygiene, frequent rinsing of mouth with water, and sugarless
gum or candy may minimize dry mouth. Patient should
notify dentist if dry mouth persists more than 2 weeks.
Instruct patient to contact health care professional immedi-
ately if dizziness, fainting, or fast or irregular heartbeat occurs.

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

IM
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LORAZEPAM (lor-az-e-pam) Apo-Lorazepam, Ativan, Novo-

Lorazem antianxiety agent, sedative/hypnotic (benzodiazepine)
Schedule IV Pregnancy Category D
INDICATIONS: Anxiety, insomnia, and preoperative sedation.
Unlabeled Use: Antiemetic before chemotherapy, status
epilepticus.
Therapeutic Effects: Sedation, decreased anxiety,
decreased frequency of seizures.
DOSAGE: PO: Adults: Anxiety: 13 mg 23 times daily.
Insomnia: 24 mg at bedtime. Geriatric or Debilitated Patients:
Anxiety: 0.52 mg/d in divided doses. Insomnia: 0.251 mg.
IM: Adults: Preoperative sedation: 50 g (0.05 mg)/kg 2 h
before surgery (not to exceed 4 mg). IV: Adults: Preoperative
sedation: 44 g/kg (not to exceed 2 mg). Operative amnestic
effect: up to 50 g/kg (not to exceed 4 mg). Antiemetic: 2 mg
30 min before chemotherapy; may be repeated q 4 h as
needed. Anticonvulsant: 50 g/kg, up to 4 mg; may be
repeated after 1015 min (not to exceed 8 mg/12 h).
ADMINISTRATION: IV: Dilute immediately before use with an
equal amount of sterile water, D5W, or 0.9% NaCl for injection.
Rate: Administer at 2 mg over 1 min. Rapid IV administration
may result in apnea, hypotension, bradycardia, or cardiac
arrest.
ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,
drowsiness, lethargy, hangover, respiratory depression,
dependence, tolerance. Rapid IV: APNEA, CARDIAC ARREST,
bradycardia, hypotension.
CONTRAINDICATIONS: Hypersensitivity, pre-existing CNS
depression, uncontrolled severe pain, narrow-angle glaucoma,
pregnancy and lactation.
CAUTIONS: Additive CNS depression with other CNS depres-
sants, kava, valerian, skullcap, chamomile, or hops. Contact
health care professional immediately if pregnancy is planned
or suspected.

106
 107
LOSARTAN (loe-sar-tan) Cozaar: antihypertensive (angiotensin
II receptor antagonist) Pregnancy Category C (first trimester), D
(second and third trimesters)
INDICATIONS: Hypertension.
Therapeutic Effects: Lowering of blood pressure.
DOSAGE: PO: Adults: 25100 mg/d as a single daily dose or
2 divided doses.
ADMINISTRATION: May be administered without regard to
meals.
ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,
fatigue, headache, hypotension, diarrhea, drug-induced hepa-
titis, RENAL FAILURE, hyperkalemia.
CONTRAINDICATIONS: Hypersensitivity, pregnancy or lacta-
tion.
CAUTIONS: NSAIDs may decrease antihypertensive effects.
Additive antihypertensive effects with other antihypertensives
and diuretics. Risk of hypotension is increased by concur-
rent diuretic therapy (use lower initial doses). Concurrent
use of potassium-sparing diuretics or potassium supplements
may increase the risk of hyperkalemia. Caution patient to
avoid sudden changes in position to decrease orthostatic
hypotension. Use of alcohol, standing for long periods,
exercising, and hot weather may increase orthostatic hypoten-
sion. Advise women of childbearing age to use contracep-
tion and notify health care professional if pregnancy is
suspected or planned. May cause dizziness; caution patient
to avoid driving or other activities requiring alertness until
response to medication is known.

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

IM
 IM

METFORMIN (met-for-min) Glucophage, Glucophage XR, Novo-

Metformin antidiabetic Pregnancy Category B
INDICATIONS: Type 2 diabetes mellitus.
Therapeutic Effects: Regulation of blood glucose levels.
DOSAGE: PO: Adults: 500 mg twice daily; may increase up to
2000 mg/d. If doses 2000 mg/d are required, give in 3
divided doses (not to exceed 2500 mg/d). Extended-release
tablets: 500 mg once daily with evening meal, up to 2000 mg.
ADMINISTRATION: Administer with meals to minimize GI
effects.
ADVERSE REACTIONS AND SIDE EFFECTS: Abdominal
bloating, diarrhea, nausea, vomiting, unpleasant metallic
taste, hypoglycemia, LACTIC ACIDOSIS, decreased vitamin
B12 levels.
CONTRAINDICATIONS: Hypersensitivity, metabolic acidosis,
dehydration, sepsis, hypoxemia, impaired hepatic function,
excessive alcohol ingestion, renal dysfunction (serum creati-
nine 1.5 mg/dL in men or 1.4 mg/dL in women), and radi-
ographic studies requiring IV administration of iodinated
contrast media, CHF.
CAUTIONS: Report symptoms of lactic acidosis (chills, diar-
rhea, dizziness, low blood pressure, muscle pain, sleepiness,
slow heartbeat or pulse, dyspnea, or weakness) immediately.
Alcohol ingestion or iodinated contrast media increase risk
of lactic acidosis. Nifedipine, cimetidine and furosemide
may increase the effects of metformin. Glucosamine may
worsen blood glucose control. Fenugreek, chromium, and
coenzyme Q-10 may produce additive hypoglycemic effects.
Explain risk of lactic acidosis and the potential need for
discontinuation of metformin if a severe infection, dehydra-
tion, or severe or continuing diarrhea occurs or if medical
tests or surgery is required.

108
 109
METHYLPREDNISOLONE (meth-ill-pred-niss-oh-lone)
A-methaPred, Medrol, Solu-Medrol steroidal anti-inflammatory
(systemic corticosteroid) Pregnancy Category UK
INDICATIONS: Inflammatory, allergic, hematologic, neoplastic,
and autoimmune disorders; asthma; replacement therapy in
adrenal insufficiency.
Therapeutic Effects: Suppression of inflammation, modifi-
cation of the immune response, replacement therapy in adrenal
insufficiency.
DOSAGE: PO: Adults: 448 mg/d single or divided doses.
Children: Adrenocortical insufficiency: 117 g/kg (3.33
mg/m2)/d in 3 doses. Other uses: 0.417 mg/kg1.67 mg/kg
(12.550 mg/m2)/d in 34 doses. IM, IV: Adults: 1040 mg.
Children: Adrenocortical insufficiency: 117 g/kg (3.33
mg/m2)/d in 3 doses. Other uses: 139835 g/kg (4.1625
mg/m2) q 1224 h.
ADMINISTRATION: PO: Administer with meals to minimize GI
irritation. Direct IV: Rate: Administer over 1 to several
minutes.
ADVERSE REACTIONS AND SIDE EFFECTS: Depression,
euphoria, psychoses, hypertension, PEPTIC ULCERATION,
anorexia, nausea, acne, decreased wound healing, ecchy-
moses, fragility, hirsutism, petechiae, adrenal suppression,
hyperglycemia, hypokalemia, THROMBOEMBOLISM, throm-
bophlebitis, weight gain, muscle wasting, osteoporosis,
cushingoid appearance, increased susceptibility to infection.
CONTRAINDICATIONS: Active untreated infections, lactation.
CAUTIONS: Instruct patient to promptly report severe
abdominal pain or tarry stools occur. May increase require-
ment for insulin or oral hypoglycemic agents. Increased risk of
adverse GI effects with NSAIDs. Advise patient to carry
identification describing medication regimen. Instruct
patient to report swelling, weight gain, tiredness, bone pain,
bruising, nonhealing sores, visual or behavioral changes.

IM
 IM

METOPROLOL (me-toe-proe-lole) Betaloc, Lopressor,

Lopressor SR, Toprol-XL antianginal, antihypertensive (beta-
blocker) Pregnancy Category C
INDICATIONS: Hypertension, angina, MI, heart failure.
Therapeutic Effects: Decreased blood pressure and heart
rate, decreased frequency of attacks of angina pectoris.
DOSAGE: PO: Adults: 50450 mg/d as a single dose or 2
divided doses. Geriatric: 25300 mg/d as a single dose or 2
divided doses. IV: Adults: 5 mg q 2 min for 3 doses.
ADMINISTRATION: PO: Withhold medication and notify physi-
cian if apical pulse is 50 bpm or irregular. Administer with
meals. IV: Inject 5 mg rapidly at 2-min intervals for 3 doses.
ADVERSE REACTIONS AND SIDE EFFECTS: Fatigue, weak-
ness, anxiety, depression, dizziness, drowsiness, insomnia,
memory loss, blurred vision, stuffy nose, bronchospasm,
wheezing, BRADYCARDIA, CHF, PULMONARY EDEMA,
hypotension, peripheral vasoconstriction, drug-induced hepa-
titis, gastric pain, nausea, vomiting, impotence, decreased
libido, urinary frequency, rashes, hyperglycemia, hypo-
glycemia, arthralgia, joint pain, drug-induced lupus syndrome.
CONTRAINDICATIONS: Uncompensated CHF, pulmonary
edema, cardiogenic shock, bradycardia or heart block.
CAUTIONS: Extended-release tablets should be swallowed
whole; do not crush, break, or chew. Additive bradycardia
with digoxin. Additive hypotension with other antihyperten-
sives. Altered effectiveness of insulins or oral hypoglycemic
agents. Notify health care professional if slow pulse, diffi-
culty breathing, wheezing, cold hands and feet, dizziness,
light-headedness, confusion, depression, rash, fever, sore
throat, unusual bleeding, or bruising occur. Change posi-
tions slowly to minimize orthostatic hypotension.

110
 111
METRONIDAZOLE (me-troe-ni-da-zole) Flagyl, Novonidazol,
Protostat, anti-infective, antiprotozoal, anti ulcer agent
Pregnancy Category B
INDICATIONS: Anaerobic infections, septicemia, endocarditis,
perioperative prophylactic agent in colorectal surgery, H.
pylori, amebic dysentery, amebic liver abscess, trichomonia-
sis, acne rosacea, bacterial vaginosis.
Therapeutic Effects: Bactericidal, trichomonacidal, or
amebicidal action.
DOSAGE: PO: Adults: Anaerobic infections: 7.5 mg/kg q 6 h
(not to exceed 4 g/d). Trichomoniasis: 250 mg q 8 h or single
2-g dose or 1 g bid for 1 day. Amebiasis: 500750 mg q 8 h. H.
pylori: 250 mg 4 times daily or 500 mg twice daily. Bacterial
vaginosis: 750 mg once daily. Children: Trichomoniasis: 5
mg/kg q 8 h. Amebiasis: 11.616.7 mg/kg q 8 h. IV: Adults:
Anaerobic infections: Initial dose 15 mg/kg, then 7.5 mg/kg q
68 h or 500 mg q 68 h. Perioperative prophylaxis: Initial
dose 15 mg/kg 1 h before surgery, then 7.5 mg/kg 6 and 12 h
later. Amebiasis: 500750 mg q 8 h.
ADMINISTRATION: PO: Administer with food or milk. IV:
Administer IV dose as a slow infusion, single dose over
1 hour.
ADVERSE REACTIONS AND SIDE EFFECTS: SEIZURES,
dizziness, headache, abdominal pain, anorexia, nausea, diar-
rhea, dry mouth, furry tongue, unpleasant taste, and urticaria.
CONTRAINDICATIONS: Hypersensitivity, first trimester of
pregnancy.
CAUTIONS: Increases the effects of warfarin. May cause
acute psychosis and confusion with disulfiram. Avoid alco-
hol during and for at least 1 day after treatment. May cause
a disulfiram-like reaction (flushing, nausea, vomiting,
headache, abdominal cramps). Inform patient that medica-
tion may cause urine to turn dark.
Key:
underline = most common;
CAPS = life-threatening

IM
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MONTELUKAST (mon-te-loo-kast) Singulair bronchodilator

(leukotriene antagonist) Pregnancy Category B
INDICATIONS: Asthma.
Therapeutic Effects: Decreased frequency and severity of
acute asthma attacks.
DOSAGE: PO: Adults and Children 15 yr: 10 mg once daily.
Children 614 yr: 5 mg once daily. Children 25 yr: 4 mg once
daily.
ADMINISTRATION: Administer once daily in the evening.
ADVERSE REACTIONS AND SIDE EFFECTS: Fatigue,
headache, weakness, nasal congestion, otitis (children), sinusi-
tis (children), cough, abdominal pain, diarrhea (children),
dyspepsia, nausea (children), increased liver enzymes, rash,
eosinophilic conditions (including CHURG-STRAUSS
SYNDROME), fever.
CONTRAINDICATIONS: Hypersensitivity, lactation.
CAUTIONS: Use cautiously in acute attacks of asthma,
phenylketonuria (chewable tablets contain aspartame), hepatic
impairment, reduction of corticosteroid therapy (may increase
the risk of eosinophilic conditions), pregnancy, lactation, or
children 6 yr. Montelukast is not used to treat acute
asthma attacks, but may be continued during an acute exacer-
bation. Patient should carry rapid-acting therapy for bron-
chospasm at all times. Advise patient to notify health care
professional if more than the maximum number of short-
acting bronchodilator treatments prescribed for a 24-hour
period are needed.

112
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MORPHINE (mor-feen) Duramorph, MS Contin, Roxanol, opioid
analgesic/agonist Schedule II Pregnancy Category C
INDICATIONS: Severe pain, pulmonary edema, pain associ-
ated with MI.
Therapeutic Effects: Decreased severity of pain.
DOSAGE: PO, Rectal: Adults 50 kg: Usual starting dose for
moderate to severe pain30 mg q 34 h initially. Adults and
Children 50 kg: Usual starting dose for moderate to severe
pain: 0.3 mg/kg q 34 h initially. IM, IV, SC: Adults 50 kg:
Usual starting dose for moderate to severe pain: 410 mg q
34 h. MI: 815 mg. Adults and Children 50 kg: Usual start-
ing dose for moderate to severe pain: 0.1 mg/kg q 34 h. IV,
SC: Adults: Continuous infusion: 0.810 mg/h; may be
preceded by a bolus of 15 mg. Epidural: Adults: Intermittent
injection: 5 mg/d (initially); if relief is not obtained at 60 min,
12 mg increments may be made; (total dose not to exceed
10 mg/d). Continuous infusion: 24 mg/24 h; may increase by
12 mg/d (up to 30 mg/d).
ADMINISTRATION: PO: Administer with food or milk.
Extended-release and controlled-release tablets should be
swallowed whole; do not crush, break, or chew. Pellets should
not be chewed, crushed, or dissolved. IM, SC: Use IM route
for repeated doses, because morphine is irritating to SC
tissues. Direct IV: Administer 2.515 mg over 45 min. Rapid
administration may lead to increased respiratory depression,
hypotension, and circulatory collapse. Continuous Infusion:
Administer via infusion pump to control the rate. May be
administered via patient-controlled analgesia (PCA) pump.
ADVERSE REACTIONS AND SIDE EFFECTS: Confusion,
sedation, dizziness, euphoria, miosis, RESPIRATORY DEPRES-
SION, hypotension, bradycardia, constipation, nausea, urinary
retention, flushing, sweating, physical dependence, psycho-
logical dependence, tolerance.
CONTRAINDICATIONS: Hypersensitivity.

(Continued)

IM
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MORPHINE (Continued)
CAUTIONS: HIGH ALERT MED: Do not confuse morphine
with hydromorphone or meperidine; errors have resulted in
fatalities. When using an infusion pump or PCA (patient
controlled analgesia), have a second practitioner indepen-
dently check dose, concentration and programming. Assess
level of consciousness, blood pressure, pulse, and respira-
tions. If respiratory rate is 10/minutes, assess level of seda-
tion. Subsequent doses may need to be decreased by 25% to
50%. Instruct family not to administer doses for the patient
while he or she is sleeping. If an opioid antagonist is
required, naloxone (Narcan) is the antidote. Use with
extreme caution in patients receiving MAO inhibitors within
14 days prior (may result in unpredictable, severe reactions
decrease initial dose of morphine to 25% of usual dose).
Additive CNS depression with alcohol, sedative/hypnotics,
clomipramine, barbiturates, tricyclic antidepressants, and
antihistamines. Administration of partial-antagonist opioid
analgesics may precipitate opioid withdrawal in physically
dependent patients. Buprenorphine, dezocine, nalbuphine,
butorphanol, or pentazocine may decrease analgesia. May
increase the anticoagulant effect of warfarin. Patients on a
continuous infusion should have additional bolus doses
provided every 1530 min, as needed, for breakthrough pain.
Patients taking sustained-release morphine may require
additional short-acting opioid doses for breakthrough pain.
Stimulant laxatives should be administered routinely if
opioid use exceeds 23 days, unless contraindicated.

114
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MUPIROCIN (myoo-peer-oh-sin) Bactroban, Bactroban Nasal
anti-infective Pregnancy Category B
INDICATIONS: Topical: Impetigo, skin lesions secondarily
infected by Staphylococcus aureus and Streptococcus
pyogenes. Intranasal: Nasal colonization with methicillin-
resistant S. aureus.
Therapeutic Effects: Inhibits bacterial growth and repro-
duction.
DOSAGE: Topical: Adults and Children 2 mo: Apply 3 times
daily. Intranasal: Adults and Children 12 yr: Apply half of the
contents of a single-use nasal ointment tube to each nostril
twice daily for 5 days.
ADMINISTRATION: Topical: Wash affected area with soap and
water and dry thoroughly. Apply a small amount of mupirocin
to affected area 3 times daily and rub in gently. Treated area
may be covered with gauze if desired. Intranasal: Apply one
half of the ointment from the single-use tube to each nostril
twice daily (morning and evening) for 5 days. After applica-
tion, close nostrils by pressing together and releasing sides
of the nose repeatedly for 1 minute.
ADVERSE REACTIONS AND SIDE EFFECTS: Nasal only:
headache, cough, itching, pharyngitis, rhinitis, upper respira-
tory tract congestion, nausea, altered taste; topical only: burn-
ing, itching, pain, stinging.
CONTRAINDICATIONS: Hypersensitivity to mupirocin or poly-
ethylene glycol.
CAUTIONS: Nasal mupirocin should not be used concur-
rently with other nasal products. Advise patient to apply
medication exactly as directed for the full course of therapy.
Teach patient and family appropriate hygienic measures to
prevent spread of impetigo. Instruct parents to notify school
nurse for screening and prevention of transmission. Patient
should consult health care professional if symptoms have not
improved in 35 days.

IM
 NR

NAPROXEN (na-prox-en) Aleve, Anaprox, Napron X, Naprosyn,

nonopioid analgesic, nonsteroidal anti-inflammatory, antipyretic
Pregnancy Category B (first trimester)
INDICATIONS: Mild to moderate pain, dysmenorrhea, fever,
inflammatory disorders, rheumatoid arthritis, osteoarthritis.
Therapeutic Effects: Decreased pain, reduction of fever,
suppression of inflammation.
DOSAGE: PO: Adults: 250500 mg bid (up to 1.5 g/d). Children
2 yr: 5 mg/kg/d twice daily as naproxen suspension.
ADMINISTRATION: Administer with food or antacids to
decrease GI irritation.
ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,
drowsiness, headache, tinnitus, dyspnea, palpitations, tachy-
cardia, DRUG-INDUCED HEPATITIS, GI BLEEDING, constipa-
tion, dyspepsia, nausea, anorexia, diarrhea, vomiting, cystitis,
hematuria, renal failure, photosensitivity, rashes, prolonged
bleeding time, allergic reactions including ANAPHYLAXIS.
CONTRAINDICATIONS: Hypersensitivity, active GI bleeding,
ulcer disease.
CAUTIONS: Patients with asthma, aspirin-induced allergy,
and nasal polyps are at increased risk for hypersensitivity
reactions. Increased risk of bleeding with alcohol, anticoag-
ulants, thrombolytic agents, eptifibatide, tirofiban, cefaman-
dole, cefotetan, cefoperazone, valproic acid, clopidogrel,
ticlopidine, plicamycin. arnica, chamomile, dong quai, fever-
few, garlic, ginger, ginkgo, Panax ginseng, and licorice.
Additive GI side effects with aspirin, corticosteroids, and
other NSAIDs. May increase risk of hypoglycemia with
insulin or oral hypoglycemic agents. Advise patient to
consult health care professional if rash, itching, visual distur-
bances, tinnitus, weight gain, edema, black stools, persistent
headache, or influenza-like syndrome (chills, fever, muscle
aches, pain) occurs.
Key
underline = most common
CAPS = life-threatening

116
 117
NIFEDIPINE (nye-fed-ih-peen) Adalat, Apo-Nifed, Nifedical XL,
Procardia antianginal, antihypertensive (calcium channel blocker)
Pregnancy Category C
INDICATIONS: Hypertension, angina pectoris, Prinzmetals
angina. Unlabeled use: prevention of migraine.
Therapeutic Effects: Systemic and coronary vasodilation.
DOSAGE: PO: Adults: 1030 mg 3 times daily (up to 180 mg/d)
or 3090 mg once daily sustained-release (up to 120 mg/d).
ADMINISTRATION: Administer without regard to meals or
with meals if GI irritation occurs. Avoid administration with
grapefruit juice.
ADVERSE REACTIONS AND SIDE EFFECTS: Headache,
confusion, dizziness, nervousness, blurred vision, disturbed
equilibrium, epistaxis, tinnitus, dyspnea, shortness of breath,
ARRHYTHMIAS, CHF, peripheral edema, bradycardia, chest
pain, hypotension, palpitations, syncope, tachycardia, abnor-
mal LFTs, anorexia, nausea, vomiting, dysuria, nocturia, flush-
ing, dermatitis, erythema multiforme, hyperglycemia, muscle
cramps, paresthesia, tremor, STEVENS-JOHNSON
SYNDROME, gingival hyperplasia.
CONTRAINDICATIONS: Hypersensitivity, sick sinus syndrome,
2nd- or 3rd-degree AV block (without artificial pacemaker), BP
90 mm Hg.
CAUTIONS: Additive hypotension with fentanyl, other antihy-
pertensives, nitrates, alcohol, or quinidine. May increase
risk of toxicity from digoxin. Concurrent use with beta-
blockers, digoxin, disopyramide, or phenytoin may result in
bradycardia, conduction defects, or CHF. Cimetidine and
propranolol may increase risk of toxicity. May increase the
risk of toxicity from cyclosporine, prazosin, quinidine, or
carbamazepine. Grapefruit juice increases serum levels and
effect. Instruct patient to contact health care professional if
heart rate is 50 bpm.

NR
 NR

NITROFURANTOIN (nye-troe-fyoor-an-toyn) Apo-

Nitrofurantoin, Furadantin, Macrodantin anti-infective
Pregnancy Category B
INDICATIONS: Urinary tract infections.
Therapeutic Effects: Bactericidal or bacteriostatic action
against susceptible organisms.
DOSAGE: PO: Adults: 50100 mg q 68 h or 100 mg q 12 h
extended-release. Chronic suppression: 50100 mg at
bedtime. Children 1 mo: 0.751.75 mg/kg q 6 h. Chronic
suppression: 1 mg/kg/d at bedtime.
ADMINISTRATION: Administer with food or milk to minimize
GI irritation. Rinse mouth with water after oral suspension to
avoid staining teeth.
ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,
headache, nystagmus, pneumonitis, chest pain,
PSEUDOMEMBRANOUS COLITIS, anorexia, nausea, vomiting,
abdominal pain, diarrhea, hepatitis, rust/brown discoloration
of urine, photosensitivity, peripheral neuropathy, hypersensi-
tivity reactions.
CONTRAINDICATIONS: Hypersensitivity, hypersensitivity to
parabens (suspension), oliguria or anuria, G6PD deficiency,
infants 1 mo and pregnancy near term.
CAUTIONS: Notify health care professional if fever and diar-
rhea develop, especially if stool contains blood, pus, or
mucus; advise patient not to treat diarrhea without consulting
health care professional. Increased risk of neurotoxicity with
neurotoxic drugs. Increased risk of pneumonitis with drugs
that have pulmonary toxicity. Increased risk of hepatotoxic-
ity with hepatotoxic drugs. May cause a rust-yellow to
brown discoloration of urine, which is not significant. Notify
health care professional if fever, chills, cough, chest pain,
dyspnea, skin rash, numbness or tingling of the fingers or
toes, intolerable GI upset, or signs of superinfection (milky,
foul-smelling urine; perineal irritation; dysuria) occur.

118
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NIZATIDINE (nye-za-ti-deen) Axid, Axid AR antiulcer agent
(histamine H2 antagonist) Pregnancy Category B
INDICATIONS: Duodenal, benign and stress-induced gastric
ulcers, GERD, heartburn, acid indigestion, gastric hypersecre-
tory states (Zollinger-Ellison syndrome).
Therapeutic Effects: Healing and prevention of ulcers,
decreased symptoms of gastroesophageal reflux, decreased
secretion of gastric acid.
DOSAGE: PO: Adults: Short-term treatment of active ulcers:
300 mg once daily at bedtime or 150 mg twice daily. Duodenal
ulcer prophylaxis: 150 mg once daily at bedtime. GERD: 150
mg twice daily. OTC use: 75 mg 060 min before foods or
beverages expected to cause symptoms.
ADMINISTRATION: Administer with meals or immediately
afterward and at bedtime to prolong effect.
ADVERSE REACTIONS AND SIDE EFFECTS: Confusion, dizzi-
ness, drowsiness, hallucinations, ARRHYTHMIAS, drug-
induced hepatitis, nausea, AGRANULOCYTOSIS, APLASTIC
ANEMIA.
CONTRAINDICATIONS: Hypersensitivity.
CAUTIONS: May lead to increased blood levels and toxicity
with some (chlordiazepoxide, diazepam, and midazolam,
labetalol, metoprolol, propranolol), caffeine, calcium channel
blockers, carbamazepine, chloroquine, lidocaine, metronida-
zole, moricizine, pentoxifylline, phenytoin, propafenone, quini-
dine, quinine, metformin, sulfonylureas, tacrine theophylline,
triamterene, tricyclic antidepressants, valproic acid, and
warfarin.

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

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PAROXETINE (par-ox-e-teen) Paxil, Paxil CR antianxiety, antide-

pressant (SSRI) Pregnancy Category C
INDICATIONS: Depression, panic disorder, OCD, social anxiety
disorder, generalized anxiety disorder.
Therapeutic Effects: Improved mood; decreased frequency
of panic attacks, OCD, or anxiety.
DOSAGE: PO: Adults: 1060 mg as a single dose in the morn-
ing. Geriatric Patients or Debilitated Patients: 1040 mg/d.
ADMINISTRATION: Administer with food to minimize GI irrita-
tion.
ADVERSE REACTIONS AND SIDE EFFECTS: Anxiety, dizzi-
ness, drowsiness, headache, insomnia, weakness, agitation,
mental depression, syncope, blurred vision, yawning, chest
pain, edema, hypertension, palpitations, postural hypotension,
tachycardia, vasodilation, constipation, diarrhea, dry mouth,
nausea, abdominal pain, vomiting, ejaculatory disturbance,
decreased libido, sweating, photosensitivity, pruritus, rash,
myalgia, myopathy, tremor, myoclonus, paresthesia.
CONTRAINDICATIONS: Hypersensitivity, concurrent MAO
inhibitor therapy (may result in serious, potentially fatal reac-
tions).
CAUTIONS: Serious, potentially fatal reactions (hyperther-
mia, rigidity, myoclonus, autonomic instability, with fluctuat-
ing vital signs and extreme agitation, which may proceed to
delirium and coma) may occur with concurrent MAO inhibitor
therapy. MAO inhibitors should be stopped at least 14 days
prior to paroxetine therapy. Paroxetine should be stopped at
least 14 days prior to MAO inhibitor therapy. May decrease
the effectiveness of digoxin. May increase the risk of bleed-
ing with warfarin without altering INR time. Increased risk of
serotinergic side effects including serotonin syndrome with
St. Johns wort and SAMe.

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

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

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PHENAZOPYRIDINE (fen-az-oh-peer-i-deen) Azo-Standard,

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

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PHENYTOIN (fen-i-toyn) Dilantin, Diphenylan, diphenylhydan-
toin, DPH anticonvulsant Pregnancy Category C
INDICATIONS: Tonic-clonic seizures and complex partial
seizures.
Therapeutic Effects: Diminished seizure activity.
DOSAGE: PO: Adults: 300400 mg/d in divided doses.
Geriatric Patients: 3 mg/kg/d in divided doses. Children:
Initially 48 mg/kg/d in 23 divided doses (not to exceed
300 mg/d). IV: Adults: 1520 mg/kg. Rate not to exceed 2550
mg/min, followed by 100 mg q 68 h. Children: 1520 mg/kg
(250 mg/m2) at 13 mg/kg/min.
ADMINISTRATION: PO: Administer with or immediately after
meals to minimize GI irritation. Chewable tablets must be
crushed or chewed well before swallowing. Direct IV:
Administer at a rate not to exceed 50 mg over 1 min (25
mg/min in patients who may develop hypotension, patients
who are on sympathomimetic medication, patients with
cardiovascular disease, or geriatric patients; 13 mg/kg/min in
neonates). Rapid administration may result in severe hypoten-
sion, cardiovascular collapse, or CNS depression. Intermittent
Infusion: Do not mix with dextrose solutions. Mix with no
more than 50 mL of 0.9% NaCl for a concentration of 110
mg/mL. Administer immediately. Use tubing with a 0.45- to
0.22-micron in-line filter. Rate: Complete infusion within
1 hour at a rate not to exceed 50 mg/min. Monitor cardiac
function and blood pressure throughout infusion.
ADVERSE REACTIONS AND SIDE EFFECTS: Ataxia, agita-
tion, dizziness, drowsiness, dyskinesia, extrapyramidal
syndrome, headache, nervousness, weakness, diplopia,
nystagmus, tinnitus, hypotension (increased with IV pheny-
toin), gingival hyperplasia, nausea, pink, red, reddish-brown
discoloration of urine, hypertrichosis, rashes, exfoliative
dermatitis, pruritus, hypocalcemia, AGRANULOCYTOSIS,
APLASTIC ANEMIA, back pain, osteomalacia, allergic reactions
including STEVENS-JOHNSON SYNDROME, fever,
lymphadenopathy.
(Continued)

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PHENYTOIN (Continued)
CONTRAINDICATIONS: Hypersensitivity, sinus bradycardia,
sinoatrial block, 2nd- or 3rd-degree heart block, or Stokes-
Adams syndrome.
CAUTIONS: Assess patient for phenytoin hypersensitivity
syndrome (fever, skin rash, lymphadenopathy).
Hypersensitivity syndrome may lead to renal failure, rhab-
domyolysis, or hepatic necrosis; may be fatal. Monitor CBC
and platelet count, serum calcium, albumin, urinalysis, and
hepatic and thyroid function tests periodically throughout
therapy. Use cautiously in hepatic or renal disease, geriatric
patients or those with severe cardiac or respiratory disease,
obese patients, pregnancy, lactation. Barbiturates, carba-
mazepine, reserpine, chronic ingestion of alcohol, and
warfarin may decrease phenytoin blood levels. IV phenytoin
and dopamine may cause additive hypotension. Additive CNS
depression with other CNS depressants, including alcohol,
antihistamines, antidepressants, opioids, and sedative/
hypnotics. Additive cardiac depression may occur with pro-
pranolol or lidocaine. Concurrent administration of enteral
tube feedings may decrease phenytoin absorption. Instruct
patient on importance of maintaining good dental hygiene
and seeing dentist frequently. Advise patient that brands of
phenytoin may not be equivalent; check with health care
professional if brand or dosage form is changed. Serum
phenytoin levels should be routinely monitored. Therapeutic
blood levels are 1020 g/mL in patients with normal serum
albumin and renal function.

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PIOGLITAZONE (pi-o-glit-a-zone) Actos antidiabetic Pregnancy
Category C
INDICATIONS: Type 2 diabetes mellitus.
Therapeutic Effects: Decreased insulin resistance, resulting
in glycemic control without hypoglycemia.
DOSAGE: PO: Adults: 1545 mg once daily.
ADMINISTRATION: May be administered with or without
meals.
ADVERSE REACTIONS AND SIDE EFFECTS: Edema, anemia.
CONTRAINDICATIONS: Hypersensitivity, diabetic ketoacidosis,
active liver disease or increased ALT, pregnancy or lactation,
children 18 yr or type 1 diabetes.
CAUTIONS: Use cautiously in edema, CHF, hepatic impair-
ment, women with childbearing potential (may restore ovula-
tion and risk of pregnancy). Ketoconazole may increase the
effects of pioglitazone. Glucosamine may worsen blood
glucose control. Fenugreek, chromium, and coenzyme Q-10
may produce additive hypoglycemic effects. Review signs of
hypoglycemia and hyperglycemia with patient. If hypo-
glycemia occurs, advise patient to take a glass of orange juice
or 23 tsp of sugar, honey, or corn syrup dissolved in water
and notify health care professional.

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

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POTASSIUM CHLORIDE, ORAL and POTASSIUM

CHLORIDE FOR INJECTION CONCENTRATE (poe-tass-
ee-um) Various trade names electrolyte replacement Pregnancy
Category C
INDICATIONS: Potassium depletion, arrhythmias secondary to
digoxin toxicity.
Therapeutic Effects: Restoration or maintenance of elec-
trolyte balance.
DOSAGE: PO: Adults: 20100 mEq/d; single dose should not
exceed 20 mEq. Children: 23 mEq/kg/d or 2040 mEq/m2/d in
divided doses. IV: Adults: Serum potassium 2.5 mEq/L: up to
200 mEq/d as an infusion (not to exceed 10 mEq/h or a
concentration of 40 mEq/L via peripheral line. Serum potas-
sium 2 mEq/L: up to 400 mEq/d as an infusion. Children: Up
to 3 mEq/kg/d as an infusion.
ADMINISTRATION: PO: Administer with a meal and full glass
of water. IV: Rate: 10 mEq/h unless in a monitored setting.
ADVERSE REACTIONS AND SIDE EFFECTS: Confusion, rest-
lessness, weakness, ARRHYTHMIAS, ECG changes, abdominal
pain, diarrhea, flatulence, nausea, vomiting, irritation at IV
site.
CONTRAINDICATIONS: Hyperkalemia, severe renal impair-
ment, untreated Addisons disease, severe tissue trauma,
hyperkalemic familial periodic paralysis.
CAUTIONS: HIGH ALERT MED: IV potassium concentrate
must be diluted before use or else is rapidly fatal. Symptoms
of hyperkalemia include bradycardia; fatigue; paresthesia;
confusion; dyspnea; ECG changes, notably peaked T waves;
and cardiac arrhythmias. Do not administer concentrations
1.5 mEq/mL undiluted. Do not chew or crush enteric-
coated or extended-release tablets or capsules. Use oral
potassium dose forms whenever clinically feasible. Use
with potassium-sparing diuretics or ACE inhibitors may lead
to hyperkalemia. Monitor serum potassium before and peri-
odically throughout therapy.

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PRAVASTATIN (pra-va-stat-in) Pravachol lipid-lowering agent
Pregnancy Category X
INDICATIONS: Primary hypercholesterolemia and mixed
dyslipidemias.
Therapeutic Effects: Lowering of total and LDL cholesterol.
DOSAGE: PO: Adults: 1040 mg once daily.
ADMINISTRATION: Administer with the evening meal.
ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,
headache, insomnia, weakness, rhinitis, bronchitis, abdominal
cramps, constipation, diarrhea, flatus, heartburn, altered taste,
drug-induced hepatitis, dyspepsia, elevated liver enzymes,
nausea, pancreatitis, impotence, rashes, pruritus, RHAB-
DOMYOLYSIS, arthralgia, arthritis, myalgia, myositis, hyper-
sensitivity reactions.
CONTRAINDICATIONS: Hypersensitivity, active liver disease,
pregnancy or lactation, concurrent use of gemfibrozil or azole
antifungals.
CAUTIONS: If patient develops muscle tenderness during
therapy, CPK levels should be monitored. If CPK levels are
markedly increased or myopathy occurs, therapy should be
discontinued. Use cautiously in history of liver disease,
alcoholism, renal impairment, hypotension, major surgery,
trauma, uncontrolled seizures, visual disturbances, and
myopathy. Blood levels and the risk of myopathy are
increased by concurrent cyclosporine and gemfibrozil, clofi-
brate, erythromycin, large doses of niacin and azole antifun-
gal agents. Grapefruit juice may cause higher blood levels
and increased risk of toxicity. Liver function tests, including
AST, should be monitored before, at 612 wk after initiation of
therapy or after dose elevation, and then every 6 mo. If AST
levels increase to 3 times normal, HMG-CoA reductase
inhibitor therapy should be discontinued. May also cause
elevated alkaline phosphatase and bilirubin levels.

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PREDNISONE (pred-ni-sone) Deltasone, Orasone, Pred-Pak,

Prednicot steroidal anti-inflammatory (systemic corticosteroid)
Pregnancy Category UK
INDICATIONS: Inflammatory, allergic, hematologic, neoplastic,
autoimmune disorders, asthma, replacement therapy in adre-
nal insufficiency.
Therapeutic Effects: Suppression of inflammation, modifi-
cation of the normal immune response, replacement therapy in
in adrenal insufficiency.
DOSAGE: PO: Adults: 560 mg/d single dose or divided doses.
Children 10 yr: Nephrosis: 20 mg 4 times daily initially.
Children 410 yr: Nephrosis: 15 mg 4 times daily initially.
Children 18 mo4 yr: Nephrosis: 7.510 mg 4 times daily
initially.
ADMINISTRATION: Administer with meals to minimize GI irri-
tation.
ADVERSE REACTIONS AND SIDE EFFECTS: Depression,
euphoria, psychoses, restlessness, cataracts, hypertension,
PEPTIC ULCERATION, anorexia, nausea, acne, decreased
wound healing, ecchymoses, fragility, hirsutism, petechiae,
adrenal suppression, hyperglycemia, hypokalemia, THROM-
BOEMBOLISM, thrombophlebitis, weight gain, muscle wast-
ing, osteoporosis, cushingoid appearance, increased
susceptibility to infection.
CONTRAINDICATIONS: Active untreated infections, lactation.
CAUTIONS: Instruct patient to promptly report severe
abdominal pain or tarry stools occur. Use cautiously in chil-
dren (chronic use will result in decreased growth), stress
(surgery, infections), pregnancy. May increase requirement
for insulin or oral hypoglycemic agents. Increased risk of
adverse GI effects with NSAIDs. Advise patient to carry
identification describing medication regimen. Instruct
patient to report swelling, weight gain, tiredness, bone pain,
bruising, nonhealing sores, visual or behavioral changes.

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PROMETHAZINE (proe-meth-a-zeen) Anergan, Phenergan,
Phenoject antiemetic, antihistamine, sedative/hypnotic
Pregnancy Category C
INDICATIONS: Allergic conditions, motion sickness, preopera-
tive sedation, nausea and vomiting, adjunct to anesthesia and
analgesia.
Therapeutic Effects: Relief of symptoms of histamine excess
usually seen in allergic conditions. Diminished nausea or
vomiting. Sedation.
DOSAGE: PO/PR/IM/IV: Adults: 12.525 mg up to 4 times per
day. Sedation: 2550 mg preoperatively or at bedtime.
Children 2 yr: 512.5 mg 3 times daily or 25 mg at bedtime.
Sedation: 0.51.1 mg/kg or 1025 mg. Preoperatively or at
bedtime.
ADMINISTRATION: PO: Administer with food or milk to mini-
mize GI irritation. Direct IV: Do not exceed concentration of
25 mg/mL. Rate: Administer 25 mg over at least 1 min.
ADVERSE REACTIONS AND SIDE EFFECTS: NEUROLEPTIC
MALIGNANT SYNDROME, confusion, disorientation, sedation,
extrapyramidal reactions, fatigue, insomnia, nervousness,
blurred vision, diplopia, tinnitus, bradycardia, hypertension,
hypotension, tachycardia, drug-induced hepatitis, dry mouth,
photosensitivity, rashes.
CONTRAINDICATIONS: Hypersensitivity, prostatic hypertro-
phy, bladder neck obstruction, narrow-angle glaucoma.
CAUTIONS: Additive CNS depression with CNS depressants,
alcohol, antihistamines, opioid analgesics, and sedative/
hypnotics. Additive anticholinergic effects with antihis-
tamines, antidepressants, atropine, haloperidol, other
phenothiazines, quinidine, and disopyramide. Monitor
for extrapyramidal side effects (akathisiarestlessness; dysto-
niamuscle spasms and twisting motions; pseudoparkinson-
ismmask-like face, rigidity, tremors, drooling, shuffling gait,
dysphagia); notify health care professional if they occur.

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PROPRANOLOL (proe-pran-oh-lole) Apo-Propranolol,

Betachron E-R, Inderal, Inderal LA, Novopranol, antianginal,
antiarrhythmic, antihypertensive, (beta-blocker) Pregnancy
Category C
INDICATIONS: Hypertension, angina pectoris, arrhythmias,
MI, vascular headaches, hypertrophic cardiomyopathy.
Therapeutic Effects: Decreased heart rate and blood
pressure, suppression of arrhythmias.
DOSAGE: PO: Adults: 40320 mg/d in 24 divided doses or
once daily as extended/sustained-release capsules. Children:
24 mg/kg/d in 2 divided doses. IV: Adults: 13 mg; may be
repeated after 2 minutes and again in 4 hours. Children:
10100 g (0.010.1 mg)/kg (up to 1 mg/dose); may be
repeated q 68 h.
ADMINISTRATION: PO: Administer with meals or directly after
eating to enhance absorption. Take apical pulse prior to
administering. If 50 bpm or if arrhythmia occurs, withhold
medication and notify physician or other health care profes-
sional. IV: Administer undiluted or dilute each 1 mg in 10 mL
of D5W for injection. Rate: Administer over at least 1 min.
ADVERSE REACTIONS AND SIDE EFFECTS: Fatigue, weak-
ness, anxiety, dizziness, drowsiness, insomnia, memory loss,
mental depression, mental status changes, nervousness,
nightmares, blurred vision, dry eyes, nasal stuffiness, bron-
chospasm, wheezing, ARRHYTHMIAS, BRADYCARDIA, CHF,
PULMONARY EDEMA, orthostatic hypotension, peripheral
vasoconstriction, constipation, diarrhea, nausea, impotence,
decreased libido, itching, rashes, hyperglycemia, hypo-
glycemia (increased in children), arthralgia, back pain, muscle
cramps, paresthesia, drug-induced lupus syndrome.
CONTRAINDICATIONS: Uncompensated CHF, pulmonary
edema, cardiogenic shock, bradycardia or heart block.
CAUTIONS: HIGH ALERT MED: The intravenous dose of
propranolol is much smaller than the IV dose. Check IV doses
carefully. Patients receiving propranolol IV must have continu-
(Continued)
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 131
ous ECG monitoring and may have pulmonary capillary
wedge pressure (PCWP) or central venous pressure (CVP)
monitoring during and for several hours after administration.
Abrupt withdrawal may precipitate life-threatening arrhyth-
mias, hypertension, or myocardial ischemia. General anes-
thesia, IV, phenytoin, and verapamil may cause additive
myocardial depression. Additive bradycardia may occur
with digoxin. Additive hypotension may occur with other
antihypertensives, acute ingestion of alcohol, or nitrates.
Concurrent use with amphetamines, cocaine, ephedrine,
epinephrine, norepinephrine, phenylephrine, or pseu-
doephedrine may result in unopposed alpha-adrenergic stimu-
lation (excessive hypertension, bradycardia). Concurrent
thyroid administration may decrease effectiveness. May
alter the effectiveness of insulin or oral hypoglycemic agents
(dosage adjustments may be necessary). May decrease the
effectiveness of beta-adrenergic bronchodilators and theo-
phylline. May decrease the beneficial beta cardiovascular
effects of dopamine or dobutamine. Use cautiously within
14 days of MAO inhibitor therapy (may result in hyperten-
sion). Cimetidine may increase blood levels and toxicity.
Concurrent NSAIDs may decrease antihypertensive action.
Smoking increases metabolism and decreases effects;
smoking cessation may increase effects. Advise patient to
make sure enough medication is available for weekends,
holidays, and vacations. A written prescription may be
kept in a wallet in case of emergency.

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

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QUINAPRIL (kwin-a-pril) Accupril antihypertensive (ACE

inhibitor) Pregnancy Category C (first trimester), D (second and
third trimesters)
INDICATIONS: Hypertension, CHF.
Therapeutic Effects: Lowered blood pressure, improvement
in CHF symptoms.
DOSAGE: PO: Adults: 1080 mg/d in single or divided doses.
ADMINISTRATION: Precipitous drop in blood pressure during
first 13 hours following first dose may occur. Monitor blood
pressure closely.
ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,
fatigue, headache, insomnia, weakness, cough, hypotension,
angina pectoris, tachycardia, taste disturbances, anorexia,
diarrhea, nausea, proteinuria, impotence, renal failure, rashes,
hyperkalemia, AGRANULOCYTOSIS, ANGIOEDEMA, fever.
CONTRAINDICATIONS: Hypersensitivity, cross-sensitivity
among ACE inhibitors may occur, pregnancy, angioedema
(hereditary or idiopathic).
CAUTIONS: Instruct patient to report rash; mouth sores; sore
throat; fever; swelling of hands or feet; irregular heart beat;
chest pain; dry cough; hoarseness; swelling of face, eyes, lips,
or tongue; difficulty swallowing or breathing occur. Use
cautiously in renal or hepatic impairment, hypovolemia,
hyponatremia, elderly patients, concurrent diuretic therapy,
aortic stenosis/hypertrophic cardiomyopathy, cerebrovascular
or cardiac insufficiency, surgery/anesthesia, lactation or chil-
dren. Additive hypotension with other antihypertensives,
nitrates, phenothiazines, acute ingestion of alcohol, and
during surgery or general anesthesia. Hyperkalemia with
potassium supplements, potassium-sparing diuretics,
indomethacin, salt substitutes, or cyclosporine. May
increase the risk of lithium or digoxin toxicity. Persistent dry
cough may occur and may not subside until medication is
discontinued.

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RABEPRAZOLE (ra-bep-ra-zole) Aciphex antiulcer agent
(proton pump inhibitor) Pregnancy Category B
INDICATIONS: GERD, duodenal ulcer, pathological hypersecre-
tory conditions (Zollinger-Ellison syndrome).
Therapeutic Effects: Diminished accumulation of acid in the
gastric lumen, with lessened acid reflux, healing of duodenal
ulcers and esophagitis, decreased acid secretion in hypersecre-
tory conditions.
DOSAGE: PO: Adults: 20 mg once daily. Hypersecretory condi-
tions: 60100 mg daily.
ADMINISTRATION: Administer doses before meals, preferably
in the morning.
ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,
headache, malaise, abdominal pain, constipation, diarrhea,
nausea, photosensitivity, rash, neck pain. allergic reactions,
chills, fever.
CONTRAINDICATIONS: Hypersensitivity to rabeprazole or
related drugs (benzimidazoles).
CAUTIONS: Use cautiously in severe hepatic impairment
(dosage reduction may be necessary), pregnancy, lactation,
or children. Decreases blood levels of ketoconazole.
Increases blood levels of digoxin.

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

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RALOXIFENE (ra-lox-i-feen) Evista bone resorption inhibitor

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

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RAMIPRIL (ram-i-pril) Altace antihypertensive (ACE inhibitor)
Pregnancy Category C (first trimester), D (second and third
trimesters)
INDICATIONS: Hypertension, CHF.
Therapeutic Effects: Lowered blood pressure, improvement
in symptoms of CHF.
DOSAGE: PO: Adults: 2.55mg once daily, may be increased
up to 20 mg/d in 12 divided doses.
ADMINISTRATION: Precipitous drop in blood pressure during
first 13 hours following first dose may occur. Monitor blood
pressure closely.
ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,
fatigue, headache, insomnia, weakness, cough, hypotension,
angina pectoris, tachycardia, taste disturbances, anorexia,
diarrhea, nausea, proteinuria, impotence, renal failure, rashes,
hyperkalemia, AGRANULOCYTOSIS, NEUTROPENIA,
ANGIOEDEMA, fever.
CONTRAINDICATIONS: Hypersensitivity, cross-sensitivity
among ACE inhibitors may occur, pregnancy, history of
angioedema.
CAUTIONS: Instruct patient to report rash; mouth sores; sore
throat; fever; swelling of hands or feet; irregular heart beat;
chest pain; dry cough; hoarseness; swelling of face, eyes, lips,
or tongue; difficulty swallowing or breathing occur. Use
cautiously in renal or hepatic impairment, hypovolemia,
hyponatremia, elderly patients, concurrent diuretic therapy,
aortic stenosis/hypertrophic cardiomyopathy, cerebrovascular
or cardiac insufficiency, surgery/anesthesia, lactation or chil-
dren. Additive hypotension with other antihypertensives,
nitrates, phenothiazines, acute ingestion of alcohol, and
during surgery or general anesthesia. Hyperkalemia with
potassium supplements, potassium-sparing diuretics,
indomethacin, salt substitutes, or cyclosporine. May
increase the risk of lithium or digoxin toxicity. Persistent dry
cough may occur and may not subside until medication is
discontinued.

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REPAGLINIDE (re-pag-gli-nide) Prandin antidiabetic Pregnancy

Category C
INDICATIONS: Type 2 diabetes mellitus.
Therapeutic Effects: Control of blood glucose levels.
DOSAGE: PO: Adults: 0.54 mg taken before meals (not to
exceed 16 mg/d).
ADMINISTRATION: Administer up to 30 min before meals.
ADVERSE REACTIONS AND SIDE EFFECTS: Angina, chest
pain, hypoglycemia, hyperglycemia.
CONTRAINDICATIONS: Contraindicated in hypersensitivity,
lactation, diabetic ketoacidosis, insulin-dependent diabetes.
CAUTIONS: Hypoglycemia may be difficult to recognize
in geriatric patients and in patients taking beta-blockers.
Hypoglycemia is more likely to occur with insufficient caloric
intake, following intense prolonged exercise, or when alcohol
or more than one hypoglycemic agent is used. Use
cautiously in impaired liver function (longer dosing intervals
may be necessary), pregnancy and children. Ketoconazole,
miconazole, and erythromycin may decrease metabolism and
increase the risk of hypoglycemia. Increased effects possible
with NSAIDs, sulfonamides, chloramphenicol, warfarin,
probenecid, MAO inhibitors, and beta-blockers. Decreased
effects possible with corticosteroids, phenothiazines, thyroid
preparations, estrogens, hormonal contraceptives, phenytoin,
nicotinic acid, sympathomimetics, isoniazid, and calcium
channel blockers. Glucosamine may worsen blood glucose
control. Fenugreek, chromium, and coenzyme Q-10 may
produce additive hypoglycemic effects. Repaglinide therapy
should be temporarily discontinued from patients requiring
surgery involving restricted intake of food and fluids.
Caution patient to avoid taking other prescription or OTC
medications or alcohol during repaglinide therapy without
consulting health care professional.

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RIFAMPIN (rif-am-pin) Rifadin, Rimactane, Rofact antitubercular
Pregnancy Category C
INDICATIONS: Active tuberculosis.
Therapeutic Effects: Bactericidal action against susceptible
organisms.
DOSAGE: PO, IV: Adults: 600 mg/d or 10 mg/kg/d. Children:
1020 mg/kg/d single dose (not to exceed 600 mg/d).
ADMINISTRATION: PO: Administer medication on an empty
stomach at least 1 hour before or 2 hours after meals with a
full glass. Intermittent Infusion: Rate: Administer solutions
diluted in 500 mL over 3 hours and solutions diluted in
100 mL over 30 min.
ADVERSE REACTIONS AND SIDE EFFECTS: Red discol-
oration of tears, abdominal pain, diarrhea, flatulence, heart-
burn, nausea, vomiting, drug-induced hepatitis, red
discoloration of saliva, red discoloration of urine, red discol-
oration of all body fluids.
CONTRAINDICATIONS: Hypersensitivity, concurrent indinavir,
nelfinavir, or saquinavir.
CAUTIONS: Use cautiously in liver disease, concurrent use
of other hepatotoxic agents, pregnancy or lactation.
Increased risk of hepatotoxicity with other hepatotoxic
agents, including alcohol, isoniazid, pyrazinamide (for pyra-
zinamide check liver function studies every 2 weeks), and
ketoconazole. Rifampin significantly decreases blood levels
of delavirdine, indinavir, nelfinavir, and saquinavir; concurrent
use is contraindicated. Report signs of hepatitis (yellow
eyes and skin, nausea, vomiting, anorexia, unusual tiredness,
weakness) or of thrombocytopenia (unusual bleeding or bruis-
ing) occur.

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

NR
 NR

RISPERIDONE (riss-pear-uh-doan) Risperdal antipsychotic

Pregnancy Category C
INDICATIONS: Psychotic disorders.
Therapeutic Effects: Decreased symptoms of psychoses.
DOSAGE: PO: Adults: 46 mg/d; not to exceed 16 mg/d.
Geriatrics/Renal Impairment/Hepatic Impairment: PO: Adults:
0.5 mg twice daily; increase by 0.5 mg up to 1.5 mg twice
daily; then increase at weekly intervals.
ADMINISTRATION: Give without regard to food.
ADVERSE REACTIONS AND SIDE EFFECTS: NEUROLEPTIC
MALIGNANT SYNDROME, aggressive behavior, dizziness,
extrapyramidal reactions, headache, increased dreams,
increased sleep duration, insomnia, sedation, nervousness,
tardive dyskinesia, pharyngitis, rhinitis, visual disturbances,
cough, arrhythmias, orthostatic hypotension, tachycardia,
constipation, diarrhea, dry mouth, nausea, decreased libido,
dysmenorrhea/menorrhagia, itching/skin rash, photosensitiv-
ity, weight gain, polydipsia.
CONTRAINDICATIONS: Hypersensitivity.
CAUTIONS: Monitor for neuroleptic malignant syndrome
(fever, respiratory distress, tachycardia, convulsions, diaphore-
sis, hypertension or hypotension, pallor, tiredness). Notify
health care professional immediately. Additive CNS depres-
sion with CNS depressants, alcohol, antihistamines, seda-
tive/hypnotics, or opioid analgesics. Monitor for and report
extrapyramidal side effects (akathisiarestlessness;
dystoniamuscle spasms and twisting motions; or
pseudoparkinsonismmask-like face, rigidity, tremors, drool-
ing, shuffling gait, dysphagia). Monitor for tardive dyskine-
sia (involuntary rhythmic movement of mouth, face, and
extremities); report immediatelymay be irreversible.

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ROFECOXIB (roe-fe-kox-ib) Vioxx nonsteroidal anti-
inflammatory, nonopioid analgesic (COX-2 inhibitor)
Pregnancy Category C
INDICATIONS: Osteoarthritis, acute pain in adults, primary
dysmenorrhea.
Therapeutic Effects: Decreased pain and inflammation.
DOSAGE: PO: Adults: Osteoarthritis: 12.525 mg once daily.
Acute pain/primary dysmenorrhea: 50 mg once daily for up
to 5 days.
ADMINISTRATION: Administer without regard to food.
ADVERSE REACTIONS AND SIDE EFFECTS: Fatigue, hyper-
tension, lower extremity edema, GI BLEEDING, nausea,
anemia, allergic reactions including ANAPHYLAXIS.
CONTRAINDICATIONS: Hypersensitivity; cross-sensitivity may
occur with other NSAIDs, including aspirin; history of asthma,
urticaria, or allergic-type reactions to aspirin or other NSAIDs;
advanced renal disease (may precipitate acute renal failure in
patients with renal insufficiency); moderate to severe hepatic
impairment; lactation; should not be used in late pregnancy
(may cause premature closure of the ductus arteriosus).
CAUTIONS: Patients who have asthma, aspirin-induced
allergy, and nasal polyps are at increased risk for developing
hypersensitivity reactions. Assess for rhinitis, asthma, and
urticaria. GI toxicity can occur at any time, without warning.
Use cautiously in patients with prior history of ulcer disease
or GI bleeding. May decrease the effectiveness of diuretics
or antihypertensives. Concurrent use of aspirin may
increase the risk of GI bleeding. Increases serum lithium
levels. May increase methotrexate levels and the risk of
toxicity. May increase the effects of warfarin. Caution
patient that use of an NSAID with 3 or more glasses of alcohol
per day may increase the risk of GI bleeding. Advise patient
to report abdominal pain or black tarry stools promptly.
Key:
underline = most common;
CAPS = life-threatening

NR
 NR

ROSIGLITAZONE (roe-zi-glit-a-zone) Avandia antidiabetic

Pregnancy Category C
INDICATIONS: Type 2 diabetes mellitus.
Therapeutic Effects: Decreased insulin resistance, resulting
in glycemic control without hypoglycemia.
DOSAGE: PO: Adults: 48 mg as a single daily dose or as two
divided doses.
ADMINISTRATION: May be administered with or without
meals.
ADVERSE REACTIONS AND SIDE EFFECTS: Edema, anemia,
increased total cholesterol, LDL and HDL, weight gain.
CONTRAINDICATIONS: Hypersensitivity; pregnancy or lacta-
tion, children 18 yr or type 1 diabetes; diabetic ketoacidosis;
active liver disease or increased ALT (2.5 times upper limit
of normal).
CAUTIONS: Do not confuse Avandia with Coumadin. Use
cautiously in edema, CHF (avoid use in moderate to severe
CHF unless benefits outweigh risks), hepatic impairment,
women with childbearing potential (may restore ovulation and
risk of pregnancy). Glucosamine may worsen blood glucose
control. Fenugreek, chromium, and coenzyme Q-10 may
produce additive hypoglycemic effects. Monitor AST and
ALT every 2 months during the first 12 months of therapy and
periodically thereafter or if jaundice or symptoms of hepatic
dysfunction occur. May cause irreversible elevations in AST
and ALT or hepatic failure (rare). Review signs of hypo-
glycemia and hyperglycemia with patient. If hypoglycemia
occurs, advise patient to take a glass of orange juice or 23
tsp of sugar, honey, or corn syrup dissolved in water and
notify health care professional.

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SALMETEROL (sal-meh-ter-all) Serevent bronchodilator (adren-
ergic) Pregnancy Category C
INDICATIONS: Asthma, exercise-induced bronchospasm,
prevention of bronchospasm in COPD, chronic bronchitis and
emphysema.
Therapeutic Effects: Bronchodilation.
DOSAGE: Inhalation: Adults and children 12 yr: 50 g (2
inhalations as aerosol or one as dry powder) twice daily
(approximately 12 hours apart); exercise-induced bron-
chospasm: 50 g (2 inhalations as aerosol or one as dry
powder) 3060 min before exercise. Children 412 yr: 50 g
(as dry powder) twice daily (approximately 12 hours apart);
exercise-induced bronchospasm: 50 g (as dry powder) 3060
min before exercise.
ADMINISTRATION: Do not use spacer with powder for inhala-
tion.
ADVERSE REACTIONS AND SIDE EFFECTS: Headache, nerv-
ousness, palpitations, tachycardia, abdominal pain, diarrhea,
nausea, muscle cramps/soreness, trembling, ASTHMA-
RELATED RESPIRATORY EVENTS.
CONTRAINDICATIONS: Hypersensitivity, acute asthma attack
(onset of action is delayed).
CAUTIONS: Use cautiously in cardiovascular disease (includ-
ing angina and hypertension), diabetes, glaucoma, hyperthy-
roidism, African-American patients, patients not on inhaled
steroids, pheochromocytoma, pregnancy, lactation, or children
4 years (dry powder inhalation may be used in children 412
years; aerosol inhalation may be used in children 12 years).
Beta-blockers may decrease the therapeutic effects of salme-
terol. Instruct patient using powder for inhalation never to
exhale into discus device and always to hold device in a level
horizontal position. Mouthpiece should be kept dry; never
wash. Caution patient not to use salmeterol to treat acute
symptoms. A rapid-acting inhaled beta-adrenergic bron-
chodilator should be used instead.

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SERTRALINE (ser-tra-leen) Zoloft antidepressant (selective

serotonin reuptake inhibitor) Pregnancy Category B
INDICATIONS: Depression, panic disorder, OCD, post-
traumatic stress disorder (PTSD).
Therapeutic Effects: Improved mood, decreased incidence
of panic attacks, decreased obsessive and compulsive behavior,
decreased feelings of intense fear, helplessness, or horror.
DOSAGE: PO: Adults: 50200 mg once daily. Children 1317
yr: 50 mg once daily. Children 612 yr: 25 mg once daily.
ADMINISTRATION: Administer as a single dose in the morn-
ing or evening.
ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,
drowsiness, fatigue, headache, insomnia, agitation, anxiety,
confusion, emotional lability, manic reaction, pharyngitis,
tinnitus, visual abnormalities, chest pain, palpitations,
diarrhea, dry mouth, nausea, abdominal pain, altered taste,
anorexia, dyspepsia, sexual dysfunction, menstrual disorders,
urinary frequency, increased sweating, myalgia, tremor,
hypertonia.
CONTRAINDICATIONS: Hypersensitivity, concurrent MAO
inhibitor therapy (may result in serious, potentially fatal reac-
tions).
CAUTIONS: Serious, potentially fatal reactions (hyperther-
mia, rigidity, myoclonus, autonomic instability, with fluctuat-
ing vital signs and extreme agitation, which may proceed to
delirium and coma) may occur with concurrent MAO
inhibitors. MAO inhibitors should be stopped at least 14
days before sertraline therapy. Sertraline should be stopped
at least 14 days before MAO inhibitor therapy. May increase
levels/effects of warfarin and phenytoin. Increased risk of
serotonin syndrome with St. Johns wort and SAMe.
Caution patient to avoid driving and other activities requir-
ing alertness until response to the drug is known.

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SIMVASTATIN (sim-va-sta-tin) Zocor lipid-lowering agent
Pregnancy Category X
INDICATIONS: Primary hypercholesterolemia and mixed
dyslipidemia.
Therapeutic Effects: Lowering of total and LDL cholesterol.
DOSAGE: PO: Adults: 1040 mg once daily.
ADMINISTRATION: Administer with the evening meal.
ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,
headache, insomnia, weakness, rhinitis, bronchitis, abdominal
cramps, constipation, diarrhea, flatus, heartburn, altered taste,
drug-induced hepatitis, dyspepsia, elevated liver enzymes,
nausea, pancreatitis, impotence, rashes, pruritus, RHAB-
DOMYOLYSIS, arthralgia, arthritis, myalgia, myositis, hyper-
sensitivity reactions.
CONTRAINDICATIONS: Hypersensitivity, active liver disease,
pregnancy or lactation, concurrent use of gemfibrozil or azole
antifungals.
CAUTIONS: If patient develops muscle tenderness during
therapy, CPK levels should be monitored. If CPK levels are
markedly increased or myopathy occurs, therapy should be
discontinued. Blood levels and the risk of myopathy are
increased by concurrent cyclosporine, gemfibrozil, clofibrate,
erythromycin, and large doses of niacin and azole antifungal
agents. Grapefruit juice may cause higher blood levels and
increased risk of toxicity. Liver function tests, including AST,
should be monitored before, at 612 weeks after initiation of
therapy or after dose elevation, and then every 6 months. If
AST levels increase to 3 times normal, HMG-COA reductase
inhibitor therapy should be discontinued. May also cause
elevated alkaline phosphatase and bilirubin levels.

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

SZ
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SPIRONOLACTONE (speer-oh-no-lak-tone) Aldactone,

Novospiroton diuretic (potassium-sparing diuretic) Pregnancy
Category B
INDICATIONS: Counteract potassium loss caused by other
diuretics, used with thiazides to treat edema or hypertension.
Therapeutic Effects: Weak diuretic and antihypertensive
response when compared with other diuretics, conservation of
potassium.
DOSAGE: PO: Adults: 25400 mg/d as a single dose or 24
divided doses. CHF: 12.525 mg/d (unlabeled use). Children:
13 mg/kg/d (3090 mg/m2/d as a single dose or 24 divided
doses (not to exceed 3 times initial dose).
ADMINISTRATION: Administer in AM to avoid interrupting
sleep pattern. Administer with food or milk to minimize gastric
irritation and to increase bioavailability.
ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,
arrhythmias, constipation, GI irritation, impotence, hyper-
kalemia, hyponatremia, muscle cramps, allergic reactions.
CONTRAINDICATIONS: Hypersensitivity, hyperkalemia.
CAUTIONS: Use cautiously in hepatic dysfunction, geriatric
or debilitated patients or patients with diabetes mellitus
(increased risk of hyperkalemia), renal insufficiency (BUN 30
mg/dL or CCr 30 mL/min), pregnancy, lactation, or children.
Additive hypotension with acute ingestion of alcohol, other
antihypertensives, or nitrates. Use with ACE inhibitors,
indomethacin, potassium supplements, or cyclosporine
increases risk of hyperkalemia. Decreases lithium excretion.
Effectiveness may be decreased by NSAIDs. May cause
dizzinesscaution patient to avoid driving or other activities
requiring alertness until response to medication is known.

144
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SUMATRIPTAN (soo-ma-trip-tan) Imitrex vascular headache
suppressant Pregnancy Category C
INDICATIONS: Migraine and cluster headaches.
Therapeutic Effects: Relief of acute attacks of migraine.
DOSAGE: PO: Adults: 2550 mg initially; if response is inade-
quate at 2 hours, may repeat (not to exceed 200 mg in 24
hours). SC: Adults: 6 mg, may repeat after 1 hour (not to
exceed 12 mg in 24 hours). Intranasal: Adults: Single dose of
5, 10, or 20 mg in one nostril; may be repeated in 2 hours, not
to exceed 40 mg in 24 hours or treatment of 5 episodes/
month.
ADMINISTRATION: PO: Tablets are film-coated to because
contents have an unpleasant taste. Swallow whole; do not
crush, break, or chew.
ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,
vertigo, anxiety, drowsiness, MI, angina, chest pressure, chest
tightness, coronary vasospasm, ECG changes, transient hyper-
tension, tingling, warm sensation, burning sensation, injection
site reaction, numbness.
CONTRAINDICATIONS: Hypersensitivity, ischemic heart
disease, Prinzmetal angina, uncontrolled hypertension,
concurrent MAO inhibitor therapy, elderly patients.
CAUTIONS: Monitor blood pressure before and for 1 hour
after initial SC dose for patients with cardiovascular risk
factors. Use only if cardiovascular status has been evalu-
ated and first dose is administered under supervision.
Increased risk of vasospastic reactions with ergotamine,
dihydroergotamine, or methysergide. Do not use within
2 wk of discontinuing MAO inhibitor. Increased risk of
serotonergic side effects including serotonin syndrome with
St. Johns wort and SAMe. Advise patient to notify health
care professional if pain or tightness in the chest occurs.

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

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TAMOXIFEN (ta-mox-i-fen) Nolvadex, Tamoxifen, Tamofen anti-

neoplastic, antiestrogen Pregnancy Category D
INDICATIONS: Breast cancer; palliative or adjunctive treat-
ment of advanced breast cancer; prevention of breast cancer
in high-risk patients; ductal carcinoma in situ following breast
surgery and radiation.
Therapeutic Effects: Suppresses tumor growth. Reduces
incidence of breast cancer in high-risk patients.
DOSAGE: PO: Adults: Treatment of breast cancer: 1020 mg
twice daily. Prevention of breast cancer/ductal carcinoma in
situ: 20 mg once daily for 5 years.
ADMINISTRATION: Administer with food or fluids. Consult
physician or other health care professional if patient vomits
shortly after administration of medication to determine need
for repeat dose. Do not crush, break, chew, or administer an
antacid within 12 hours of enteric-coated tablet.
ADVERSE REACTIONS AND SIDE EFFECTS: Confusion,
headache, weakness, blurred vision, edema, nausea, vomiting,
endometrial carcinoma, vaginal bleeding, hypercalcemia,
leukopenia, thrombocytopenia, hot flashes, bone pain, tumor
flare.
CONTRAINDICATIONS: Hypersensitivity, concurrent warfarin
therapy with history of deep vein thrombosis (patients at high
risk for breast cancer only), pregnancy or lactation.
CAUTIONS: Blood levels are increased by bromocriptine.
May increase the anticoagulant effect of warfarin. Risk of
thromboembolic events is increased by concurrent use of
other antineoplastics. Bone pain may be an indication of
the drugs effectiveness and will resolve over time; analgesics
should be ordered to control pain. May induce ovulation
and have teratogenic properties. Advise patient to use a
nonhormonal method of contraception during and for 1
month after the course of therapy.

146
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TAMSULOSIN (tam-soo-loe-sin) Flomax (peripherally acting
anti-adrenergic) Pregnancy Category B
INDICATIONS: Urinary outflow obstruction associated with
prostatic hyperplasia.
Therapeutic Effects: Decreased symptoms of prostatic
hyperplasia (urinary urgency, hesitancy, nocturia).
DOSAGE: PO: Adults: 0.40.8 mg once daily after a meal.
ADMINISTRATION: Administer daily dose 30 min after the
same meal each day.
ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,
headache, rhinitis, orthostatic hypotension, retrograde/dimin-
ished ejaculation.
CONTRAINDICATIONS: Hypersensitivity.
CAUTIONS: Use cautiously in patients at risk for prostate
carcinoma (symptoms may be similar). Cimetidine may
increase blood levels and the risk of toxicity. Increased risk
of hypotension with other peripherally acting anti-adrenergics
(doxazosin, prazosin, terazosin); concurrent use should be
avoided. If dose is interrupted for several days at either the
0.4-mg or 0.8-mg dose, restart therapy with the 0.4-mg/d
doses. Assess patient for symptoms of prostatic hyperplasia
(urinary hesitancy, feeling of incomplete bladder emptying,
interruption of urinary stream, impairment of size and force of
urinary stream, terminal urinary dribbling, straining to start
flow, dysuria, urgency, bladder distension) before and periodi-
cally throughout therapy.

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

SZ
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TEMAZEPAM (teh-maz-a-pam) Restoril sedative/hypnotic

(benzodiazepine) Schedule IV Pregnancy Category X
INDICATIONS: Insomnia.
Therapeutic Effects: Relief of insomnia.
DOSAGE: PO: Adults: 1530 mg at bedtime initially if needed;
some patients may require only 7.5 mg. Geriatric Patients or
Debilitated Patients): 7.5 mg at bedtime.
ADMINISTRATION: Administer with food if GI irritation
becomes a problem.
ADVERSE REACTIONS AND SIDE EFFECTS: Hangover, dizzi-
ness, drowsiness, lethargy, paradoxical excitation, blurred
vision, constipation, diarrhea, nausea, vomiting, rashes, physi-
cal dependence, psychological dependence, tolerance.
CONTRAINDICATIONS: Hypersensitivity, pre-existing CNS
depression, severe uncontrolled pain, narrow-angle glaucoma,
pregnancy or lactation.
CAUTIONS: Additive CNS depression with alcohol, antide-
pressants, antihistamines, opioid analgesics, and other
sedative/hypnotics. May decrease efficacy of levodopa.
Rifampin or smoking increases metabolism and may
decrease effectiveness of temazepam. Probenecid may
prolong the effects of temazepam. Sedative effects may be
antagonized by theophylline. Concomitant use of kava,
valerian, skullcap, chamomile, or hops can increase CNS
depression. Prolonged high-dose therapy may lead to
psychological or physical dependence; restrict amount of drug
available to patient, especially if patient is depressed or suici-
dal or has a history of addiction. May cause daytime
drowsiness or dizziness; caution patient to avoid driving or
other activities requiring alertness until response to medica-
tion is known. Advise patient to avoid the use of alcohol
and other CNS depressants and to consult health care profes-
sional before using OTC preparations that contain antihista-
mines or alcohol.

148
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TERAZOSIN (ter-ay-zoe-sin) Hytrin antihypertensive (anti-
adrenergic) Pregnancy Category C
INDICATIONS: Mild to moderate hypertension, urinary
obstruction associated with prostatic hyperplasia.
Therapeutic Effects: Lowering of blood pressure,
decreased symptoms of urinary urgency, hesitancy, nocturia.
DOSAGE: PO: Adults: 1 mg initially, then slowly increase up to
5 mg/d (usual range 15 mg/d); may be given as single dose.
ADMINISTRATION: Administer daily dose at bedtime. If neces-
sary, dosage may be increased to twice daily.
ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,
headache, weakness, drowsiness, nervousness, nasal conges-
tion, blurred vision, conjunctivitis, sinusitis, dyspnea, first-
dose orthostatic hypotension, arrhythmias, chest pain,
palpitations, peripheral edema, tachycardia, nausea, abdomi-
nal pain, diarrhea, dry mouth, vomiting, impotence, urinary
frequency, pruritus, weight gain, arthralgia, back pain, extrem-
ity pain, paresthesia.
CONTRAINDICATIONS: Hypersensitivity.
CAUTIONS: Additive hypotension with other antihyperten-
sives, acute ingestion of alcohol, or nitrates. NSAIDs,
sympathomimetics, or estrogens may decrease the effects of
antihypertensive therapy. Assess patient for first-dose
orthostatic reaction and syncope. May occur 30 minutes to
2 hours after initial dose and occasionally thereafter. May
cause dizziness or drowsiness; advise patient to avoid driving
or other activities requiring alertness until response to the
medication is known. Caution patient to avoid sudden
changes in position to decrease orthostatic hypotension.
Alcohol, CNS depressants, standing for long periods, hot
showers, and exercising in hot weather should be avoided
because of enhanced orthostatic effects.

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

SZ
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TINZAPARIN (tin-za-pa-rin) Innohep anticoagulant (low mole-

cular weight heparin [LMWH]) (antithrombotic) Pregnancy
Category B
INDICATIONS: Prevention of deep vein thrombosis, pulmonary
emboli, ischemic complications in patients with unstable
angina/nonQ-wave MI. LMWH has a more predictable antico-
agulant response than unfractionated heparinspecial moni-
toring of clotting times is not necessary.
Therapeutic Effects: Prevention of thrombus formation.
DOSAGE: SC: Adults: Treatment of deep vein thrombosis175
anti-Xa IU/kg once daily for at least 6 days and until adequate
anticoagulation is achieved with warfarin; prophylaxis of deep
vein thrombosis: 5075 anti-Xa units/kg once daily.
ADMINISTRATION: Administer deep into SC tissue. Do not
aspirate or massage. Rotate sites frequently.
ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,
insomnia, edema, urinary retention, ecchymoses, pruritus,
rash, urticaria, BLEEDING, anemia, thrombocytopenia,
hematoma.
CONTRAINDICATIONS: Hypersensitivity to pork products,
uncontrolled bleeding, thrombocytopenia.
CAUTIONS: HIGH ALERT MED: Assess patient for signs of
bleeding and hemorrhage (bleeding gums; nosebleed;
unusual bruising; black, tarry stools; hematuria; fall in hemat-
ocrit or blood pressure; guaiac-positive stools); bleeding from
surgical site. Notify physician if these occur. Use cautiously
in spinal/epidural anesthesia, bleeding disorders, GI bleeding,
hemorrhagic stroke, recent CNS or ophthalmologic surgery,
history of thrombocytopenia related to heparin, retinopathy,
malignancy. Risk of bleeding may be increased by warfarin,
aspirin, NSAIDs, dipyridamole, some penicillins, clopidogrel,
ticlopidine, abciximab, eptifibatide, tirofiban, and dextran.

150
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TOLTERODINE (tol-ter-oh-deen) Detrol, Detrol LA urinary tract
antispasmodic, anticholinergic Pregnancy Category C
INDICATIONS: Overactive bladder function that results in
urinary frequency, urgency, or urge incontinence.
Therapeutic Effects: Decreases urinary frequency, urgency,
and urge incontinence.
DOSAGE: PO: Adults: 2 mg twice daily as tablets; may be
lowered depending on response or 24 mg once daily as
extended-release capsules.
ADMINISTRATION: Administer without regard to food.
Extended-release capsules should be swallowed whole; do
not open or chew.
ADVERSE REACTIONS AND SIDE EFFECTS: Headache, dizzi-
ness, blurred vision, dry eyes, dry mouth, constipation,
dyspepsia.
CONTRAINDICATIONS: Urinary retention, gastric retention,
uncontrolled narrow-angle glaucoma, lactation.
CAUTIONS: Use cautiously in GI obstructive disorders,
including pyloric stenosis (increased risk of gastric retention),
significant bladder outflow obstruction (increased risk of
urinary retention), controlled narrow-angle glaucoma, signifi-
cant hepatic impairment (lower doses recommended),
impaired renal function, pregnancy, children. Erythromycin,
clarithromycin, ketoconazole, itraconazole, and miconazole
may inhibit metabolism and increase effects of tolterodine.
Assess patient for urinary urgency, frequency, and urge
incontinence periodically throughout therapy. Instruct
patient to take tolterodine exactly as directed. May cause
dizziness and blurred visioncaution patient to avoid driving
or other activities requiring alertness until response to
medication is known.

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

SZ
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TRAMADOL (tray-mah-dol) Ultram analgesic Pregnancy

Category C
INDICATIONS: Moderate to moderately severe pain.
Therapeutic Effects: Decreased pain.
DOSAGE: PO: Adults: 50100 mg every 46 h. Geriatrics:
50100 mg every 4-6 h (not to exceed 300400 mg per day).
Renal Impairment: Adults: CCr 30 mL/minincrease dosing
to q 12 h (not to exceed 200 mg/d). Hepatic Impairment:
Adults: 50 mg q 12 h.
ADMINISTRATION: Administer without regard to meals.
ADVERSE REACTIONS AND SIDE EFFECTS: SEIZURES,
dizziness, headache, somnolence, anxiety, CNS stimulation,
confusion, euphoria, vasodilation, constipation, nausea, diar-
rhea, dry mouth, sweating, hypertonia, physical and psycho-
logical dependence, tolerance.
CONTRAINDICATIONS: Hypersensitivity; acute intoxication
with alcohol, sedative/hypnotics, centrally acting analgesics,
opioid analgesics, or psychotropic agents; physical depen-
dence on opioid analgesics (may precipitate withdrawal),
pregnancy or lactation.
CAUTIONS: Increased risk of CNS depression with other
CNS depressants, alcohol, antihistamines, sedative/hypnotics,
opioid analgesics, anesthetics, or psychotropic agents.
Increased risk of seizures with high doses of penicillins or
cephalosporins, phenothiazines, opioid analgesics or antide-
pressants. Use cautiously in patients who are receiving
MAO inhibitors (increased risk of adverse reactions).
Overdose may cause respiratory depression and seizures.
Naloxone (Narcan) may reverse some, but not all, of the
symptoms of overdose. Treatment should be symptomatic and
supportive. Seizures may be managed with barbiturates or
benzodiazepines; naloxone increases risk of seizures.

152
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TRAZODONE (tra-zo-done) Desyrel, Trialodine, Trazon antide-
pressant Pregnancy Category C
INDICATIONS: Major depression, unlabeled uses: insomnia
and chronic pain syndromes.
Therapeutic Effects: Improved mood.
DOSAGE: PO: Adults: Depression: 150 mg daily in 3 divided
doses (not to exceed 400 mg/d in outpatients or 600 mg/d in
hospitalized patients). Insomnia: 25100 mg at bedtime.
Geriatric Patients: 75 mg daily in divided doses initially.
Children 618 yr: 1.52 mg/kg daily in divided doses.
ADMINISTRATION: Administer with or immediately after
meals.
ADVERSE REACTIONS AND SIDE EFFECTS: Drowsiness,
confusion, dizziness, hallucinations, insomnia, slurred speech,
blurred vision, tinnitus, hypotension, arrhythmias, chest pain,
hypertension, palpitations, tachycardia, dry mouth, constipa-
tion, hematuria, impotence, priapism, urinary frequency,
rashes, anemia.
CONTRAINDICATIONS: Hypersensitivity, recovery period after
MI, concurrent electroconvulsive therapy.
CAUTIONS: Use cautiously in cardiovascular disease, suici-
dal behavior. May increase digoxin or phenytoin serum
levels. Additive CNS depression with other CNS depressants,
including alcohol, opioid analgesics, and sedative/hypnotics.
Additive hypotension with antihypertensives, acute inges-
tion of alcohol, or nitrates. Fluoxetine increases levels and
risk of toxicity. Monitor blood pressure and pulse rate
before and during initial therapy. Patients with pre-existing
cardiac disease should have ECGs monitored before and peri-
odically during therapy to detect arrhythmias. Restrict
amount of drug available to suicidal patients. Avoid driving
and other activities requiring alertness until response to drug
is known. Change positions slowly to minimize orthostatic
hypotension.

SZ
 SZ

TRIAMCINOLONE (try-am-sin-oh-lone) Azmacort, Azmacort

HFA antiasthmatic, anti-inflammatory (inhalation corticosteroid)
Pregnancy Category C
INDICATIONS: Asthma.
Therapeutic Effects: Decrease frequency and severity of
asthma attacks.
DOSAGE: Inhalation: Adults and Children 12 yr: 2 metered
inhalations 34 times daily or 4 inhalations twice daily (100
g/metered inhalation; not to exceed 16 metered
inhalations/day). Children 612 yr: 12 metered inhalations 34
times daily or 24 inhalations twice daily (100 g/metered
inhalation; not to exceed 12 metered inhalations/day).
ADMINISTRATION: Allow at least 1 minute between inhala-
tions of aerosol medication.
ADVERSE REACTIONS AND SIDE EFFECTS: Dysphonia,
hoarseness, oropharyngeal fungal infections, cataracts; bron-
chospasm, cough, wheezing, dry mouth, esophageal candidia-
sis, adrenal suppression, decreased growth (children),
CHURG-STRAUSS SYNDROME.
CONTRAINDICATIONS: Acute attack of asthma/status asth-
maticus.
CAUTIONS: Use cautiously in active untreated infections,
diabetes or glaucoma, underlying immunosuppression,
systemic corticosteroid therapy, pregnancy, lactation, or chil-
dren 6 years. Advise patients also using bronchodilator to
use bronchodilator first and wait 5 minutes before taking
beclomethasone. Advise patient to use regular peak flow
monitoring to determine respiratory status. Advise patient
to notify physician if sore throat or sore mouth occurs.
Instruct patient whose systemic corticosteroids have been
recently reduced or withdrawn to carry a warning card indicat-
ing the need for supplemental systemic corticosteroids in the
event of stress or severe asthma attack unresponsive to bron-
chodilators. Caution patient to avoid smoking, known aller-
gens, and other respiratory irritants.

154
 155
TRIMETHOPRIM/SULFAMETHOXAZOLE (trye-meth-oh-
prim/sul-fa-meth-ox-a-zole) Bactrim, Septra, TMP/SMZ anti-
infective, antiprotozoal Pregnancy Category C
INDICATIONS: Bronchitis, Shigella enteritis, otitis media,
Pneumocystis carinii pneumonia (PCP), urinary tract infection,
travelers diarrhea.
Therapeutic Effects: Bactericidal action against susceptible
bacteria.
DOSAGE: (TMP  trimethoprim; SMZ  sulfamethoxazole)
PO: Adults and Children 40 kg: Bacterial infections: 160 mg
TMP/800 mg SMZ q 12 h. Children 2 mo: Bacterial infec-
tions: 46 mg/kg TMP/2030 mg/kg SMZ q 12 h. IV: Adults and
Children 2 mo: Bacterial Infections: 22.5 mg/kg TMP/1012.5
mg/kg SMZ q 6 h or 2.73.3 mg/kg TMP/13.316.7 mg/kg SMZ
q 8 h or 45 mg/kg TMP/2025 mg/kg SMZ q 12 h. PCP: 3.755
mg/kg TMP/18.7525 mg SMZ q 6 h or 56.7 mg/kg
TMP/2533.3 mg SMZ q 8 h.
ADMINISTRATION: PO: Administer around the clock with a full
glass of water. IV: Dilute each 5-mL ampule with 100125 mL
of D5W. Rate: Infuse over 6090 minutes.
ADVERSE REACTIONS AND SIDE EFFECTS: Fatigue,
headache, insomnia, HEPATIC NECROSIS, nausea, vomiting,
diarrhea, stomatitis, TOXIC EPIDERMAL NECROLYSIS, rashes,
photosensitivity, AGRANULOCYTOSIS, APLASTIC ANEMIA,
hemolytic anemia, leukopenia, megaloblastic anemia,
phlebitis at IV site, ERYTHEMA MULTIFORME, STEVENS-
JOHNSON SYNDROME, fever.
CONTRAINDICATIONS: Hypersensitivity, megaloblastic
anemia secondary to folate deficiency, severe renal impair-
ment, pregnancy, lactation, or children 2 months.
CAUTIONS: May enhance the effects of sulfonylurea oral
antidiabetics and warfarin. Increases the risk of thrombocy-
topenia from thiazide diuretics (increased in geriatric
patients). Decreases efficacy of cyclosporine and increases
risk of nephrotoxicity.

SZ
 SZ

VALACYCLOVIR (val-ay-sye-kloe-veer) Valtrex antiviral

Pregnancy Category B
INDICATIONS: Herpes zoster, genital herpes.
Therapeutic Effects: Inhibited viral replication, decreased
viral shedding, and reduced time of healing of lesions.
DOSAGE: PO: Adults: Herpes zoster 1g 3 times daily for 7
days. Genital herpes Initial treatment1 g twice daily for 10
days. Recurrence500 mg twice daily for 3 days. Suppression
of recurrence 500 mg to 1 g daily.
ADMINISTRATION: Administer without regard to meals. For
herpes zoster, administer as soon as possible after the onset
of signs or symptoms. Most effective if started within
48 hours of the onset of zoster rash.
ADVERSE REACTIONS AND SIDE EFFECTS: Headache, dizzi-
ness, nausea, anorexia, diarrhea, THROMBOTIC THROMBOCY-
TOPENIC PURPURA/HEMOLYTIC UREMIC SYNDROME (very
high doses in immunosuppressed patients).
CONTRAINDICATIONS: Hypersensitivity
CAUTIONS: Probenecid and cimetidine increase blood levels;
this interaction is only significant in patients with renal impair-
ment. Monitor patient for signs of thrombotic thrombocytic
purpura/hemolytic uremic syndrome (microangiopathic
hemolytic anemia, neurological findings, renal dysfunction,
fever). Requires prompt treatment; may be fatal. Herpes
zoster: Does not prevent the spread of infection to others.
Precautions should be taken around others who have not had
chickenpox or varicella vaccine, or are immunosuppressed,
until all lesions have crusted. Genital herpes: Does not
prevent the spread of infection to others. Advise patient to
avoid contact with lesions and to avoid intercourse while
lesions or symptoms are present.

156
 157
VALPROIC ACID (val-proe-ik as-id) Depakote, Depakote ER,
Depakene, Epival, anticonvulsant, vascular headache suppres-
sant Pregnancy Category D
INDICATIONS: Seizures, manic episodes associated with bipo-
lar disorder (delayed-release only); migraine headache
prevention (delayed and extended release).
Therapeutic Effects: Suppression of seizures, decreased
manic behavior, and frequency of migraine headaches.
DOSAGE: PO, IV: Adults: Anticonvulsant: Single-agent
therapyInitial dose of 515 mg/kg daily; increase by 510
mg/kg daily q wk. Polytherapy: Initial dose of 1030 mg/kg
daily; increase by 510 mg/kg daily q wk. Children:
Anticonvulsant: Single-agent therapy: Initial dose of 1545
mg/kg/d; increase by 510 mg/kg daily q wk. Polytherapy:
Initial dose of 30100 mg/kg daily.
ADMINISTRATION: PO: Administer with or immediately after
meals. IV: Rate: Administer over 60 min (20 mg/min).
ADVERSE REACTIONS AND SIDE EFFECTS: Confusion,
sedation, HEPATOTOXICITY, nausea, vomiting, diarrhea,
prolonged bleeding time.
CONTRAINDICATIONS: Hypersensitivity, hepatic impairment,
urea cycle disorders.
CAUTIONS: Monitor hepatic function (LDH, AST, ALT, and
bilirubin) and serum ammonia concentrations, especially
during initial 6 months of therapy; fatalities from liver failure
have occurred. Discontinue if hyperammonemia occurs.
Increased risk of bleeding with antiplatelet agents, including
aspirin, NSAIDs, tirofiban, eptifibatide, and abciximab,
cefamandole, cefoperazone, cefotetan, heparins and throm-
bolytic agents, or warfarin. Additive CNS depression with
CNS depressants, alcohol, antihistamines, antidepressants,
opioid analgesics, MAO inhibitors, and sedative/hypnotics.

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

SZ
 SZ

VALSARTAN (val-sar-tan) Diovan antihypertensive (angiotensin

II receptor antagonist) Pregnancy Category C (first trimester),
D (second and third trimesters)
INDICATIONS: Hypertension.
Therapeutic Effects: Lowering of blood pressure.
DOSAGE: PO: Adults: 80320 mg/d.
ADMINISTRATION: May be administered without regard to
meals.
ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,
fatigue, headache, hypotension, diarrhea, drug-induced hepa-
titis, RENAL FAILURE, hyperkalemia.
CONTRAINDICATIONS: Hypersensitivity, pregnancy or lacta-
tion.
CAUTIONS: NSAIDs may decrease antihypertensive effects.
Additive antihypertensive effects with other antihyper-
tensives and diuretics. Risk of hypotension is increased by
concurrent diuretic therapy (use lower initial doses).
Telmisartan increases serum digoxin levels. Concurrent
use of potassium-sparing diuretics or potassium supplements
may increase the risk of hyperkalemia. Caution patient to
avoid sudden changes in position to decrease orthostatic
hypotension. Use of alcohol, standing for long periods,
exercising, and hot weather may increase orthostatic hypo-
tension. Advise women of childbearing age to use contra-
ception and notify health care professional if pregnancy is
suspected or planned. May cause dizziness. Caution patient
to avoid driving, or other activities requiring alertness, until
response to medication is known.

158
 159
VANCOMYCIN (van-koe-mye-sin) Lyphocin, Vancocin, Vancoled
anti-infective Pregnancy Category C
INDICATIONS: Potentially life-threatening infections when less
toxic anti-infectives are contraindicated. Pseudomembranous
colitis due to Clostridium difficile.
Therapeutic Effects: Bactericidal action against susceptible
organisms.
DOSAGE: PO: Adults: 125500 mg q 6 h. Children: 10 mg/kg q
6 h (up to 125 mg/dose; not to exceed 2 g/d). IV: Adults: 500
mg q 6 h or 1 g q 12 h (up to 34 g/d). Children 1 mo: 10
mg/kg q 6 h or 20 mg/kg q 12 h. Neonates 1 wk1 mo: 15
mg/kg initially, then 10 mg/kg q 8 h. Neonates 1 wk: 15
mg/kg initially, then 10 mg/kg q 12 h. Renal Impairment: IV
Adults: An initial loading dose of 750 mg1 g, then if CCr
5080 mL/min: 1 g q 13 days; CCr 1050 mL/min: 1 g q 37
days; CCr 10 mL/min: 1 g q 714 days.
ADMINISTRATION: Intermittent Infusion: Administer over at
least 60 min.
ADVERSE REACTIONS AND SIDE EFFECTS: Ototoxicity,
hypotension, nausea, vomiting, nephrotoxicity, leukopenia,
phlebitis, ANAPHYLAXIS, chills, fever, red man syndrome,
superinfection.
CONTRAINDICATIONS: Hypersensitivity.
CAUTIONS: Use cautiously in renal impairment, hearing
impairment, intestinal obstruction or inflammation. May
cause additive ototoxicity and nephrotoxicity with other
ototoxic and nephrotoxic drugs aspirin, aminoglycosides,
cyclosporine, cisplatin, loop diuretics). May enhance neuro-
muscular blockade from nondepolarizing neuromuscular
blocking agents. Increased risk of histamine flush when
used with general anesthetics in children.

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

SZ
 SZ

VENLAFAXINE (ven-la-fax-een) Effexor, Effexor XR antidepres-

sant, antianxiety agent Pregnancy Category C
INDICATIONS: Major depressive illness or relapse, generalized
anxiety disorder (Effexor XR only).
Therapeutic Effects: Improved mood, decreased anxiety.
DOSAGE: PO: Adults: 75 mg daily in 23 divided doses; may
increase up to 225 mg/d (not to exceed 375 mg/d in 3 divided
doses); extended-release (XR) formulation can be given as a
single daily dose.
ADMINISTRATION: Administer with food.
ADVERSE REACTIONS AND SIDE EFFECTS: SEIZURES,
abnormal dreams, anxiety, dizziness, headache, insomnia,
nervousness, weakness, agitation, confusion, rhinitis, visual
disturbances, tinnitus, chest pain, hypertension, palpitations,
abdominal pain, altered taste, anorexia, constipation, diarrhea,
dry mouth, dyspepsia, nausea, vomiting, weight loss, sexual
dysfunction, urinary retention, ecchymoses, photosensitivity,
paresthesia, chills.
CONTRAINDICATIONS: Hypersensitivity, concurrent MAO
inhibitor therapy.
CAUTIONS: Use with MAO inhibitors may result in serious,
potentially fatal reactions. Use cautiously in cardiovascular
disease, hepatic impairment, impaired renal function, history
of seizures, neurological impairment, mania, or drug abuse,
pregnancy, lactation, or children 18 yr. Alcohol or other
CNS depressants, including sedative/hypnotics, antihista-
mines, and opioid analgesics should be avoided. Assess
suicidal tendencies. Restrict amount of drug available to
patient. Sustained hypertension may be dose related;
decrease or discontinue therapy if this occurs. Patients
taking venlafaxine for 6 weeks should have dose gradually
decreased before discontinuation.

160
 161
VERAPAMIL (ver-ap-a-mil) Calan, Isoptin, Verelan antianginal,
antiarrhythmic, antihypertensive, (calcium channel blocker)
Pregnancy Category C
INDICATIONS: Hypertension, angina pectoris, and/or
vasospastic (Prinzmetal) angina, supraventricular arrhythmias
and rapid ventricular rates in atrial flutter or fibrillation.
Therapeutic Effects: Decreased blood pressure and angina
attacks, suppression of ventricular tachyarrhythmias.
DOSAGE: PO: Adults: 80120 mg 3 times daily, increased as
needed. Poor ventricular function, hepatic impairment, or geri-
atric patients: 40 mg 3 times daily. Extended-release prepara-
tions: 120240 mg daily; (up to 240480 mg/d). Children up to
15 yr: 48 mg/kg daily in divided doses. IV: Adults: 510 mg.
Children 115 yr: 25 mg (100300 g/kg). Children 1 yr:
0.752 mg (100200 g/kg).
ADMINISTRATION: PO: Administer with meals. IV: Rate:
Administer IV undiluted over 2 min.
ADVERSE REACTIONS AND SIDE EFFECTS: ARRHYTHMIAS,
CHF, bradycardia, chest pain, hypotension, peripheral edema,
STEVENS-JOHNSON SYNDROME, gingival hyperplasia.
CONTRAINDICATIONS: Hypersensitivity, sick sinus syndrome,
2nd or 3rd AV block, systolic BP 90, CHF, ventricular dysfunc-
tion, or cardiogenic shock, unless associated with supraven-
tricular tachyarrhythmias, IV beta-blocker therapy.
CAUTIONS: Use cautiously in hepatic impairment, geriatric
patients, ventricular arrhythmias, CHF, pregnancy or lactation.
Additive hypotension may occur when used concurrently
with fentanyl, other antihypertensives, nitrates, acute inges-
tion of alcohol, or quinidine. Serum digoxin levels may be
increased. Concurrent use with beta-blockers, digoxin,
disopyramide, or phenytoin may result in bradycardia,
conduction defects, or CHF. Teach patient to take pulse and
to contact health care professional if heart rate is 50 bpm.
Key:
underline = most common;
CAPS = life-threatening

SZ
 SZ

WARFARIN (war-fa-rin) Coumadin, Warfilone anticoagulant

Pregnancy Category X
INDICATIONS: Venous thrombosis, pulmonary embolism,
atrial fibrillation with embolization, MI, prevention of throm-
bus formation postprosthetic valve placement.
Therapeutic Effects: Prevention of thromboembolic events.
DOSAGE: PO: Adults: 2.510 mg/d for 24 days; then adjust
daily dose by results of prothrombin time or international
normalized ratio (INR).
ADMINISTRATION: PO: Administer at same time daily.
ADVERSE REACTIONS AND SIDE EFFECTS: Cramps, nausea,
dermal necrosis, BLEEDING, fever.
CONTRAINDICATIONS: Uncontrolled bleeding, open wounds,
active ulcer disease, recent brain, eye, or spinal cord injury or
surgery, severe liver disease, uncontrolled hypertension, preg-
nancy.
CAUTIONS: HIGH ALERT MED: Assess for signs of bleeding
and hemorrhage (bleeding gums; nosebleed; bruising; tarry,
black stools). Monitor PT or INR and other clotting factors
frequently during therapy. Androgens, cefotetan, chloral
hydrate, chloramphenicol, fluconazole, fluoroquinolones, itra-
conazole, metronidazole, thrombolytic agents, sulfonamides,
quinidine, quinine, NSAIDs, valproates, and aspirin may
increase response and risk of bleeding. Chronic acetamino-
phen use may increase the risk of bleeding. Alcohol, barbi-
turates, and hormonal contraceptives containing estrogen
decrease response. Large quantities of foods high in vita-
min K may antagonize the anticoagulant effect. Antidote is
vitamin K (phytonadione, AquaMEPHYTON). Avoid IM injec-
tions and activities leading to injury. Inform all health care
personnel about anticoagulant therapy before lab tests, treat-
ment, or surgery. Increased bleeding risk with arnica,
chamomile, clove, dong quai, feverfew, garlic, ginger, ginkgo,
Panax ginseng, and other natural products.

162
 163
ZAFIRLUKAST (za-feer-loo-kast) Accolate antiasthmatic, bron-
chodilators leukotriene antagonist Pregnancy Category B
INDICATIONS: Asthma.
Therapeutic Effects: Decreases frequency and severity of
asthma attacks. Decreases airway edema and smooth muscle
constriction, resulting in decreased inflammatory process that is
part of asthma.
DOSAGE: PO: Adults and Children 12 yr: 20 mg twice daily.
Children 711 yr: 10 mg twice daily.
ADMINISTRATION: Administer at regular intervals on an
empty stomach, 1 h before or 2 h after meals.
ADVERSE REACTIONS AND SIDE EFFECTS: Headache, dizzi-
ness, weakness, abdominal pain, diarrhea, drug-induced hepa-
titis (females), dyspepsia, nausea, vomiting, arthralgia, back
pain, myalgia, CHURG-STRAUSS SYNDROME, fever, infection
(geriatric patients), pain.
CONTRAINDICATIONS: Hypersensitivity, lactation.
CAUTIONS: Advise patient to notify health care profes-
sional if symptoms of Churg-Strauss syndrome (generalized
flu-like syndrome, fever, muscle aches and pain, weight loss,
worsening respiratory symptoms) occur. Occurs rarely but
may be life-threatening. More likely to occur when weaning
from systemic corticosteroids. Blood levels are increased by
aspirin. Blood levels are decreased by erythromycin and
theophylline. Increases effects and risk of bleeding with
warfarin. Monitor liver function periodically during therapy.
Instruct patient not to discontinue or reduce other asthma
medications without consulting health care professional.
Assess lung sounds and respiratory function prior to and
periodically throughout therapy. Food decreases absorption;
take on an empty stomach.

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

SZ
 SZ

ZIDOVUDINE (zye-doe-vue-deen) Apo-Zidovudine, AZT, Novo-

AZT, Retrovir antiretroviral, nucleoside reverse transcriptase
inhibitor Pregnancy Category C
INDICATIONS: HIV infection, prevention of fetal HIV.
Therapeutic Effects: Slows progression of HIV infection,
decreases risk of transmission of HIV to infants born to HIV-
infected mothers.
DOSAGE: PO: Adults and Children 13 yr: Management of HIV
infection: 100 mg q 4 h while awake or 200 mg 3 times daily
or 300 mg twice daily. Prevention of maternal/fetal transmis-
sion of HIV infection: Adults 14 wk Pregnant: 100 mg 5
times daily until onset of labor. Children 3 mo12 yr:
Management of HIV infection: 90180 mg/m2 every 6 h (not to
exceed 200 mg q 6 h). Infants: Prevention of maternal/fetal
transmission of HIV infection: 2 mg/kg q 6 h, started within 12
h of birth and continued for 6 wk. IV: Adults and Children 12
yr: Management of HIV infection: 1 mg/kg infused over 1 h q 4
h. Prevention of maternal/fetal transmission of HIV infection:
Adults During Labor and Delivery: 2 mg/kg over 1 h, then
continuous infusion of 1 mg/kg/h until umbilical cord is
clamped. Children: Management of HIV infection: 120 mg/m2 q
6 h (not to exceed 160 mg/dose). Prevention of maternal/fetal
transmission of HIV Infection: Infants: 1.5 mg/kg q 6 h until
able to take PO.
ADMINISTRATION: PO: Administer around the clock.
Intermittent Infusion: Rate: Infuse at a constant rate over 1 h.
ADVERSE REACTIONS AND SIDE EFFECTS: SEIZURES,
headache, weakness, anxiety, mental depression, abdominal
pain, diarrhea, nausea, anorexia, hepatitis, anemia, granulocy-
topenia.
CONTRAINDICATIONS: Hypersensitivity, lactation.
CAUTIONS: Additive bone marrow depression with other
agents having bone marrowdepressing properties; additive
neurotoxicity with acyclovir.

164
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ZOLPIDEM (zole-pi-dem) Ambien sedative/hypnotic Pregnancy
Category B
INDICATIONS: Short-term treatment of insomnia.
Therapeutic Effects: Sedation and induction of sleep.
DOSAGE: PO: Adults: 10 mg at bedtime. Geriatric Patients,
Debilitated Patients, or Patients with Hepatic Impairment:
5 mg at bedtime initially; may be increased to 10 mg.
ADMINISTRATION: Tablets should be swallowed whole with
full glass of water.
ADVERSE REACTIONS AND SIDE EFFECTS: Amnesia,
daytime drowsiness, dizziness, drugged feeling, diarrhea,
nausea, vomiting, hypersensitivity reactions, physical depen-
dence, psychological dependence, tolerance.
CONTRAINDICATIONS: Hypersensitivity, sleep apnea.
CAUTIONS: Use cautiously in history of previous psychiatric
illness, suicide attempt, drug or alcohol abuse, geriatric
patients and patients with impaired hepatic function, patients
with pulmonary disease, pregnancy, lactation, or children.
Additive CNS depression may occur with concurrent use of
other sedative/hypnotics, alcohol, phenothiazines, tricyclic
antidepressants, opioid analgesics, or antihistamines.
Concomitant use of kava, valerian, skullcap, chamomile, or
hops can increase CNS depression. Protect patient from
injuryraise bedside rails or assist with ambulation.

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

SZ
 TOOLS

Emergency Drugs
(NAME: initial dose [indication])
ADENOSINE: 6 mg rapid IVP; rpt 12 mg
2 [SVT]
AMIODARONE: 300 mg IVP [VF, VT, SVT]
ATROPINE: 0.51 mg q3-5 min up to 2 mg [bradycardia]
EPINEPHRINE: 1 mg q3-5 min [cardiac arrest]
LASIX: 0.51 mg/kg IV [pulmonary edema]
LIDOCAINE: 11.5 mg/kg IV q5-10 min; maximum 3 mg/kg [VF, VT]
MAGNESIUM: (MgSO4) 12 g IVP [VT r/t hypo-Mg]
MORPHINE: (MSO4) 13 mg [CP, pulmonary edema]
NARCAN: 0.020.2 mg q2-3 min [narcotic-respiratory depression]
NITROGLYCERIN: 0.4 mg SL q3-5 min
3 [CP, pulmonary edema]
ROMAZICON: 0.2 mg q min up to 1 mg [benzodiazepine OD]
SOLU-MEDROL: 12 mg/kg [allergic reaction]
VASOPRESSIN: 40 units IVP [cardiac arrest]

Drug Suffixes and Meaning

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

166
 167
Common Laboratory Values
General Chemistry
Laboratory Conventional SI Units
Albumin 3.55.0 g/100 mL 3550 g/L
Aldolase 1.38.2 U/L 22137 nmol s1/L
Alkaline 1339 U/L, infants and 217650 nmol s1/L,
phosphatase adolescents up to up to 1.26 mol/L
104 U/L
Ammonia 1255 mol/L 1255 mol/L
Amylase 425 units/mL 425 arb. unit
Anion gap 816 mEq/L 816 mmol/L
AST, SGOT Male: 846 U/L 0.140.78 kat/L
Female: 734 U/L 0.120.58 kat/L
Bilirubin, direct Up to 0.4 mg/100 mL Up to 7 mol/L
Bilirubin, total Up to 1.0 mg/100 mL Up to 17 mol/L
BUN 825 mg/100 mL 2.98.9 mmol/L
Male: 014 pg/mL 04.1 pmol/L
Calcitonin
Female: 028 pg/mL 08.2 pmol/L
Calcium (Ca) 8.510.5 mg/100 mL 2.12.6 mmol/L
Carbon dioxide 2430 mEq/L 2430 mmol/L
Chloride (Cl) 100106 mEq/L 100106 mmol/L
Cholesterol 200 mg/dL 5.18 mmol/L
a.m. 525 g/100 mL 0.140.69 mol/L
Cortisol
p.m. 10 g/100 mL 00.28 mol/L
Male: 0.20.5 mg/dL 1540 mol/L
Creatine
Female: 0.30.9 mg/dL 2570 mol/L
Creatine Male: 17148 U/L 2832467 nmol s1/L
kinase (CK) Female: 1079 U/L 1671317 nmol s1/L
(Continued)

TOOLS
 TOOLS

General Chemistry
Laboratory Conventional SI Units
Creatinine 0.61.5 mg/100 mL 53133 mol/L
Ferritin 10410 ng/dL
Folate 2.09.0 ng/mL 4.520.4 nmol/L
Glucose 70110 mg/100 mL 3.95.6 mmol/L
Ionized calcium 4.265.25 mg/dL 1.11.3 mmol/L
Iron (Fe) 50150 g/100 mL 9.025.9 mol/L
Iron-binding 250410 g/100 mL 44.873.4 mol/L
capacity (IBC)
Lactic acid 0.51.8 mEq/L 0.81.8 mmol/L
Lactic dehydro- 4590 U/L 7501500 nmol
genase (LDH) s1/L
Lipase 2 units/mL or less Up to 2 arb. unit
Magnesium (Mg) 1.52.0 mEq/L 0.81.3 mmol/L
Osmolality 280296 mOsm/kg water 280296 mmol/kg
Phosphorus 3.04.5 mg/100 mL 1.01.5 mmol/L
Potassium (K) 3.55.0 mEq/L 3.55.0 mmol/L
Prealbumin 1832 mg/dL
Protein, total 6.08.4 g/100 mL 8084 g/L
PSA 0.04.0 ng/mL
Pyruvate 00.11 mEq/L 00.11 mmol/L
Sodium (Na) 135145 mEq/L 135145 mmol/L
T3 75195 ng/100 mL 1.163.00 nmol/L
T4, free Male: 0.752.0 ng/dL
Female: 0.752.0 ng/dL
T4, total 412 g/100 mL 52154 nmol/L
Thyroglobulin 342 /mL 342 g/L
Triglycerides 40150 mg/100 mL 0.41.5 g/L
TSH 0.55.0 U/mL 0.55.0 arb. unit
Urea nitrogen 825 mg/100 mL 2.98.9 mmol/L
Uric acid 3.07.0 mg/100 mL 0.180.42 mmol/L

168
 169
Hematology (ABC, CBC, Blood Counts)

Blood volume 8.59.0% of body 8085 mL/kg

weight in kg
Male: 4.66.2 4.66.2

Red blood cell million/mm3 1012/L
(RBC) Female: 4.25.9 4.25.9

million/mm3 1012/L
Male: 1318 g/ 8.111.2
Hemoglobin 100 mL mmol/L
(Hgb) Female: 1216 g/ 7.49.9 mmol/L
100 mL
Hematocrit Male: 4552% 0.450.52
(Hct) Female: 3748% 0.370.48
Leukocytes (WBC) 4.30010.800/ 4.310.8

mm3 109/L
Bands 05% 0.030.08
Basophils 01% 00.01
Eosinophils 14% 0.010.04
Lymphocytes 2540% 0.250.40
B-Lymphocytes 1020% 0.100.20
T-Lymphocytes 6080% 0.600.80
Monocytes 28% 0.020.08
Neutrophils 5475% 0.540.75
Platelets 150,000350,000/ 150350

mm3 109/L
Erythrocyte
sedimentation Male: 113 mm/h 113 mm/h
rate (ESR) Female: 120 mm/h 120 mm/h

TOOLS
 TOOLS

Coagulation
Laboratory Conventional SI Units
ACT 90130 s
PTT (activated) 2135 s 2135 s
Bleeding time 37 min 37 min
Fibrinogen 160450 mg/dL 1.64.5 g/L
INR (target therapeutic) 23 23
Plasminogen 62130% 0.621.30
Platelets 150,000300,000/mm3
106/L
PT (prothrombin time) 1012 s 1012 s
PTT (partial 3045 s 3045 s
thromboplastin time)
Thrombin time 1115 s 1115 s

Normal Blood Gases

Laboratory Conventional SI Units

pH 7.357.45 3645 mol/L

PO2 75100 mm Hg 10.013.3 kPa
PCO2 3545 mm Hg 4.76.0 kPa
HCO3 2226 mmol/L 2226 mmol/L
Base excess (2)(2) mEq/L (2)(2) mmol/L
CO2 1924 mEq/L 1924 mmol/L
SaO2 96100% 0.961.00

170
 171
IV Potassium Compatibilities
Medications Compatible with IV Potassium Chloride
acyclovir edrophonium
alatrovafloxacin enalaprilat
aldesleukin epinephrine
allopurinol esmolol
amifostine conjugated estrogens
aminophylline ethacrynate sodium
amiodarone etoposide
ampicillin famotidine
amrinone fentanyl
atropine filgrastim
aztreonam fludarabine
betamethasone fluorouracil
calcium gluconate furosemide
chlordiazepoxide gatifloxacin
chlorpromazine gemcitabine
cimetidine granisetron
ciprofloxacin heparin
cisatracurium hydralazine
cladribine idarubicin potassium
cyanocobalamin indomethacin
dexamethasone insulin
digoxin isoproterenol
diltiazem kanamycin
diphenhydramine labetalol
dobutamine lidocaine
docetaxel linezolid
dopamine lorazepam
doxorubicin liposome magnesium sulfate
droperidol melphalan
droperidol/fentanyl menadiol

TOOLS
 TOOLS

Medications Compatible with IV Potassium Chloride (Contd)

meperidine propranolol
methoxamine pyridostigmine
methylergonovine ranitidine
midazolam remifentanil
minocycline sargramostim
morphine scopolamine
neostigmine sodium bicarbonate
norepinephrine succinylcholine
ondansetron tacrolimus
oxacillin teniposide
oxytocin theophylline
paclitaxel thiotepa
penicillin G potassium tirofiban
pentazocine trimethaphan
phytonadione trimethobenzamide
piperacillin/tazobactam vinorelbine
procainamide warfarin
prochlorperazine edisylate zidovudine
propofol

Medications incompatible with IV potassium

adrenaline HCl ergotamine tartrate

amphotericin B cholesteryl methicillin sodium
sulfate complex phenytoin
atropine sulphate
phenytoin sodium
cephalothin sodium
sulphadiazine sodium
chloramphenicol sodium
succinate suxamethonium chloride
chlorpromazine HCl thiopentone sodium
diazepam

172
 173
Formulas & BSA
Common Formulas

Syringe Desired amount
Total volume


(Amount to be drawn up) Total amount of drug on hand

mL/h (i.e., 150 mL/h) Volume
gtt factor


Time (minutes)
mg/min (i.e., 4 mg/min)
Desired amount
volume
gtt factor
mg/h (i.e., 20 mg/h) 
Amount of drug on hand
Total infusion time in minutes

To calculate volume/hour: To calculate drops/minute:

Volume
gtt factor Volume
gtt factor
(Total in mL) (i.e. 10 gtt/mL) (i.e., 150 mL/hr) (i.e., 10 gtt/mL)
 
Time (No. of hours in minutes) Time (in minutes)

To figure out the running time

Drops per minute
60 min
(mL/h) on an IV: 
Drip factor

Body Surface Area (BSA)

Using cm
& kg:
Ht (cm)
Wt (kg)

3600
Using inches
& lb:
Ht (in)
Wt (lbs)

3131

IV Fluid Rates in Drops per Minute

mL/h 50 75 80 100 125 150 175 200 250
10 GTT 8 13 13 17 21 25 29 33 42

15 GTT 12 19 20 25 31 37 44 50 62

60 GTT 50 75 80 100 125 150 175 200 250

TOOLS
 TOOLS

Common Conversions
To convert ounces into cc/mL: ( _____ ) oz
30  ( _____ ) cc/mL
To convert cc/mL into ounces: ( _____ ) cc/mL/30  ( _____ ) oz
1 oz equals . . . . . . . . . . . . .30 mL Large (22-oz) soda . . . . . . .660 mL
8 oz juice glass . . . . . . . . . .240 mL Coffee or tea mug . . . . . . .200 mL
Small (12-oz) soda . . . . . . .360 mL Milk carton . . . . . . . . . . . .120 mL
Medium (16-oz) soda . . . . .480 mL Popsicle . . . . . . . . . . . . . . .90 mL

Conversions Specific to Your Institution

174
 175
Common Conversions (Continued)
Weight Temperature Height
lb kg F C cm in ft/in
300 136.4 212 100 boil 142 56 48
275 125.0 108 42.2 145 57 49
250 113.6
225 102.3 107 41.6 147 58 410
210 95.5 106 41.1 150 59 411
200 90.9 105 40.6 152 60 50
190 86.4
180 81.8 104 40.0 155 61 51
170 77.3 103 39.4 157 62 52
160 72.7 102 38.9 160 63 53
150 68.2
140 63.6 101 38.3 163 64 54
130 59.1 100 37.8 165 65 55
120 54.5 99 37.2 168 66 56
110 50.0
100 45.5 98.6 37.0 170 67 57
90 40.9 98 36.7 173 68 58
80 36.4 97 36.1 175 69 59
70 31.8
60 27.3 96 35.6 178 70 510
50 22.7 95 35.0 180 71 511
40 18.2 94 34.4 183 72 60
30 13.6
20 9.1 93 34.0 185 73 61
10 4.5 92 33.3 188 74 62
5 2.3 91 32.8 191 75 63
2.2 1
2 0.9 90 32.1 193 76 64
1 0.45 32 0 freeze 196 77 65

lb  kg
2.2 . . . . . . . . . . . . . . . . . . . . . . . . . .kg  lb
0.45

F  ( C
1.8)  32 . . . . . . . . . . . . . . . . . C  ( F 32)
5/9

inches  cm
0.394 . . . . . . . . . . . . . .cm  inches
2.54

Volume Weight
1 tsp . . . . . . . . . . . . . . . . . . .5 mL 1 mg . . . . . . . . . . . . . . . . .1000 g
1 tbsp . . . . . . . . . . . . . . . . .15 mL 1 g . . . . . . . . . . . . . . . . . .1000 mg
1 oz . . . . . . . . . . . . . . . . . . .30 mL 1 gr . . . . . . . . . . . . . . . . . .60 mg
1 cup (8 oz) . . . . . . . . . . . .240 mL 1 kg . . . . . . . . . . . . . . . . . .2.2 lb
1 pint . . . . . . . . . . . . . . . . .473 mL 1 L of water . . . . . . . . . . . . .1 kg
1 quart . . . . . . . . . . . . . . . .946 mL 1 oz . . . . . . . . . . . . . . . . . . .28 g

TOOLS
 TOOLS

Wound Care Products

Product Nursing
Product Characteristics Indications Considerations
Transparent Semipermeable Stage I & II Transparency allows
FIlms membrane wounds visual inspection of
Tegaderm Waterproof Work best on wound.
CarraFilm Permeable to superficial Can be used as a
OpSite oxygen and water wounds, blis- secondary dressing
BIOCLUSIVE vapor. ters and skin over alginates or
Provide moist heal- tears. gels.
ing environment Dressing change is
and prevent bacter- up to 3 times per
ial contamination. week. Do not
absorb exudates
and need to be
changed when fluid
collects underneath
them.
Hydrogels Water or glycerin Stage II, III Reduce pain and
Hypergel based gels, impreg- and IV promote soothing
CarraSorb nated gauzes, or wounds effect. Easy to apply
Nu-gel sheet dressings. and remove.
Curafil Provide moist Require secondary
wound environ- dressing.
ment. Helps clean Change once daily.
and debride by
supplying liquid to
dry, sloughy
wounds.
Due to large water
content, do not
absorb large
amounts of
exudate.
Hydrocolloid Occlusive and Stage II and II Conformable for
Dressings adhesive wafer wounds easy application
Tegasorb dressings, or Granulating and help reduce
Comfeel hydrocolloid and epitheliz- pain at wound site.
DuoDERM powders and ing wounds Breakdown of prod-
Restore pastes. with low to uct may produce
Facilitate rehydra- moderate residue and foul
tion and autolytic amounts of odor, do not
dbridement of dry, exudate. confuse with infec-
sloughy, or necrotic tious process.
wounds. Usually changed up
to 3 times per week.

176
 177
Wound Care Products (Contd)
Product Nursing
Product Characteristics Indications Considerations
Alginates Soft non-woven Stage III and IV Highly absorbant,
CURASORB fibers derived wounds with therefore good for
AlgiDERM from seaweed. moderate to packing exuding
Sorbsan Available in heavy exudate, wounds.
Algosteril pads, ropes, or but not wounds Requires secondary
ribbons. with eschar or dressing.
Can absorb up to dry wound beds. Usually changed
20 times their once daily.
weight. Stage III and IV
Foam Highly absorbant wounds Highly absorbant
Dressings dressings made Heavily exuding foam may allow
Flexzan from hydrophilic wounds, espe- less frequent dress-
CURAFOAM polyurethane cially during ing changes.
Mepilex foam. inflammatory Can be left undis-
Some have phase following turbed for 34 days.
adhesive dbridement and Decreases macera-
borders. sloughing. tion of surrounding
Deep cavity tissue.
wounds and Comfortable and
weeping ulcers conformable.
such as venous Usually changed up
stasis ulcers. to 3 times per week.
Stage III and IV
Enzymatic Agents selective Wounds Surgical dbride-
Debriding in removing Tunneling ment may be
Agents necrotic tissues wounds (may avoided in some
Panafil from wound remove debris in cases with use of
Santyl bed. areas that cant enzymatic dbriding
Accuzyme be visualized). agents.
Require prescrip-
tion.

TOOLS
 MED NOTES* Allergies:
TOOLS

Name:
Diagnosis and PMH:
Medication/ Date and Comment/Caution/
Dose/Route/ Time(s) Medication Effect (pre
Frequency Given: and post VS, pain rating,
or other measure)

178
* Not a legal record. Document promptly and thoroughly in the patient record.
 MED NOTES* Allergies:

TOOLS
Name:
Diagnosis and PMH:
Medication/ Date and Comment/Caution/
Dose/Route/ Time(s) Medication Effect (pre
Frequency Given: and post VS, pain rating,
or other measure)
179
* Not a legal record. Document promptly and thoroughly in the patient record.
 MED NOTES* Allergies:
TOOLS

Name:
Diagnosis and PMH:
Medication/ Date and Comment/Caution/
Dose/Route/ Time(s) Medication Effect (pre
Frequency Given: and post VS, pain rating,
or other measure)

180
* Not a legal record. Document promptly and thoroughly in the patient record.
 MED NOTES* Allergies:

TOOLS
Name:
Diagnosis and PMH:
Medication/ Date and Comment/Caution/
Dose/Route/ Time(s) Medication Effect (pre
Frequency Given: and post VS, pain rating,
or other measure)
181
* Not a legal record. Document promptly and thoroughly in the patient record.
 TOOLS

INDEX

A A-methaPred. see
Abbreviations, 3 Methylprednisolone
Accolate. see Zafirlukast Amiloride, 19
AccuNeb. see Albuterol Amiodarone, 20, 166
Accupril. see Quinapril Amitriptyline, 21
Aciphex. see Rabeprazole Amlodipine, 22
Actos. see Pioglitazone Amoxicillin, 24
Acyclovir, 14 Amoxicillin/clavulanate, 23
Adalat. see Nifedipine Amoxil. see Amoxicillin
Adenosine, 166 Analgesics
Administration gabapentin, 74
considerations for, 2 phenazopyridine, 122
intradermal, 11 rofecoxib, 139
intramuscular, 8-9, 11 tramadol, 152
intravenous, 4-7 Anaprox. see Naproxen
subcutaneous, 10-11 Androgen inhibitors, 67
Adrucil. see Fluorouracil Anergan. see Promethazine
A-hydroCort. see Angiotensin-converting
Hydrocortisone enzyme inhibitors
Alavert. see Loratadine benazepril, 30
Albuterol, 15 captopril, 36
Aldactone. see Spironolactone Angiotensin II receptor
Alendronate, 16 antagonists
Aleve. see Naproxen losartan, 107
Alginates, 177 valsartan, 158
Allegra. see Fexofenadine Anti-Alzheimers agents, 60
Allergies, 178-181 Antianginals
Allergy medications isosorbide dinitrate, 96
fexofenadine, 66 isosorbide mononitrate,
ipratropium, 95 97
Allopurinol, 17 metoprolol, 110
Alprazolam, 18 nifedipine, 117
Altace. see Ramipril propranolol, 130-131
Amaryl. see Glimepiride verapamil, 161
Ambien. see Zolpidem Antianxiety agents

182
 183
alprazolam, 18 trazodone, 153
diazepam, 55-56 venlafaxine, 160
hydroxyzine, 84 Antidiabetics
lorazepam, 106 glimepiride, 76
paroxetine, 120 glipizide, 77
venlafaxine, 160 glyburide, 78
Antiarrhythmics insulin. see Insulin
amiodarone, 20, 166 metformin, 108
digoxin, 57-58 pioglitazone, 125
diltiazem, 59 repaglinide, 136
propranolol, 130-131 rosiglitazone, 140
verapamil, 161 Antidiarrheals, 104
Antiasthmatics Antiemetics, 129
beclomethasone, 29 Antifungals
triamcinolone, 154 fluconazole, 68
zafirlukast, 163 itraconazole, 98
Anticholinergics, 31 Anti-gout agents
Anticoagulants allopurinol, 17
dalteparin, 53 colchicine, 51
enoxaparin, 63 Antihistamines
fondaparinux, 71 cetirizine, 42
heparin, 79-80 fexofenadine, 66
tinzaparin, 150 hydroxyzine, 84
warfarin, 162 loratadine, 105
Anticonvulsants promethazine, 129
clonazepam, 48 Antihypertensives
diazepam, 55-56 amlodipine, 22
gabapentin, 74 atenolol, 25
phenytoin, 123-124 benazepril, 30
valproic acid, 157 bisoprolol, 32
Antidepressants carvedilol, 38
amitriptyline, 21 chlorothiazide, 43
bupropion, 35 clonidine, 49
citalopram, 46 diltiazem, 59
fluoxetine, 70 doxazosin, 61
paroxetine, 120 enalapril, 62
sertraline, 142 fosinopril, 72

TOOLS
 TOOLS

Antihypertensives (Continued) Antiparkinson agents

lisinopril, 103 benztropine, 31
losartan, 107 Antiplatelet agents, 50
metoprolol, 110 Antiprotozoals
nifedipine, 117 metronidazole, 111
propranolol, 130-131 trimethoprim/sulfamethoxa-
terazosin, 149 zole, 155
valsartan, 158 Antipsychotics, 138
verapamil, 161 Antiretrovirals
Anti-infectives lamivudine, 99
amoxicillin, 24 zidovudine, 164
amoxicillin/clavulanate, Antirheumatics
23 celecoxib, 40
azithromycin, 27 infliximab, 85
cefepime, 39 Antispasticity agents, 28
cephalexin, 41 Antituberculars, 137
ciprofloxacin, 45 Anti-ulcer agents
clindamycin, 47 amoxicillin, 24
levofloxacin, 101 cimetidine, 44
metronidazole, 111 lansoprazole, 100
mupirocin, 115 metronidazole, 111
nitrofurantoin, 118 nizatidine, 119
trimethoprim/sulfamethoxa- rabeprazole, 133
zole, 155 Antivirals
vancomycin, 159 acyclovir, 14
Anti-inflammatories valacyclovir, 156
beclomethasone, 29 Apo-Allopurinol. see
budesonide, 33 Allopurinol
cortisone, 52 Apo-Alpraz. see Alprazolam
dexamethasone, 54 Apo-Atenolol. see Atenolol
hydrocortisone, 82 Apo-Benztropine. see
infliximab, 85 Benztropine
methylprednisolone, 109 Apo-Cephalex. see Cephalexin
prednisone, 128 Apo-Diazepam. see Diazepam
Antineoplastics Apo-Diltiaz. see Diltiazem
fluorouracil, 69 Apo-Furosemide. see
tamoxifen, 146 Furosemide

184
 185
Apo-Hydroxyzine. see Bactrim. see Trimethoprim/
Hydroxyzine sulfamethoxazole
Apo-Lorazepam. see Bactroban. see Mupirocin
Lorazepam Bactroban Nasal. see
Apo-Nifed. see Nifedipine Mupirocin
Apo-Nitrofurantoin. see Beclodisk. see
Nitrofurantoin Beclomethasone
Apo-Propranolol. see Becloforte. see
Propranolol Beclomethasone
Apo-Zidovudine. see Beclomethasone, 29
Zidovudine Beclovent. see
Aricept. see Donepezil Beclomethasone
Arixtra. see Fondaparinux Benazepril, 30
Atarax. see Hydroxyzine Benzodiazepines
Atenolol, 25 alprazolam, 18
Ativan. see Lorazepam clonazepam, 48
Atorvastatin, 26 diazepam, 55-56
Atropine, 166 lorazepam, 106
Atrovent. see Ipratropium temazepam, 148
Augmentin ES. see Benztropine, 31
Amoxicillin/clavulanate Beta blockers
Augmentin XR. see atenolol, 25
Amoxicillin/clavulanate bisoprolol, 32
Avandia. see Rosiglitazone carvedilol, 38
Avirax. see Acyclovir metoprolol, 110
Axid. see Nizatidine propranolol, 130-131
Axid AR. see Nizatidine Betachron E-R. see
Azithromycin, 27 Propranolol
Azmacort. see Triamcinolone Betaloc. see Metoprolol
Azmacort HFA. see Biocef. see Cephalexin
Triamcinolone Bisoprolol, 32
Azo-Standard. see Blood viscosity reducing
Phenazopyridine agent, 121
AZT. see Zidovudine Body surface area, 173
Bone resorption inhibitors
B alendronate, 16
Baclofen, 28 raloxifene, 134

TOOLS
 TOOLS

Bronchodilators Cetirizine, 42
albuterol, 15 Chlorothiazide, 43
ipratropium, 95 Cimetidine, 44
montelukast, 112 Cipro. see Ciprofloxacin
salmeterol, 141 Ciprofloxacin, 45
zafirlukast, 163 Citalopram, 46
Budesonide, 33 Claritin. see Loratadine
Bumetanide, 34 Claritin RediTabs. see
Bumex. see Bumetanide Loratadine
Bupropion, 35 Clavulin. see
Amoxicillin/clavulanate
C Cleocin. see Clindamycin
Calan. see Verapamil Clindamycin, 47
Calcilean. see Heparin Clonazepam, 48
Calciparine. see Heparin Clonidine, 49
Calcium channel blockers Clopidogrel, 50
amlodipine, 22 Cogentin. see Benztropine
diltiazem, 59 Colchicine, 51
nifedipine, 117 Cold and cough remedy
verapamil, 161 fexofenadine, 66
Capoten. see Captopril ipratropium, 95
Captopril, 36 Conversions, 174-175
Cardizem. see Diltiazem Cordarone. see Amiodarone
Cardura. see Doxazosin Coreg. see Carvedilol
Carisoprodol, 37 Cortef. see Hydrocortisone
Carvedilol, 38 Cortisone, 52
Catapres. see Clonidine Cortone. see Cortisone
Catapres-TTS. see Clonidine Cortone Acetate. see
Catheter flush, 7 Cortisone
Cefepime, 39 Coumadin. see Warfarin
Celebrex. see Celecoxib COX-2 inhibitors
Celecoxib, 40 celecoxib, 40
Celexa. see Citalopram rofecoxib, 139
Central venous catheters, 7 Cozaar. see Losartan
Cephalexin, 41
Cephalosporins D
cefepime, 39 Dalacin C. see Clindamycin
cephalexin, 41 Dalteparin, 53

186
 187
Decadron. see bumetanide, 34
Dexamethasone chlorothiazide, 43
Decaject. see Dexamethasone furosemide, 73
Deltasone. see Prednisone hydrochlorothiazide, 81
Depakene. see Valproic spironolactone, 144
acid Diuril. see Chlorothiazide
Depakote. see Valproic Dizac. see Diazepam
acid Donepezil, 60
Depakote ER. see Valproic Doxazosin, 61
acid DPH. see Phenytoin
Desyrel. see Trazodone Dressings, 176-177
Detrol. see Tolterodine Drug suffixes, 166
Detrol LA. see Tolterodine Duracion. see Clonidine
Dexameth. see Duragesic. see Fentanyl
Dexamethasone Duramorph. see Morphine
Dexamethasone, 54 D-Val. see Diazepam
DiaBeta. see Glyburide
Diastat. see Diazepam E
Diazepam, 55-56 Effexor. see Venlafaxine
Diflucan. see Fluconazole Effexor XR. see Venlafaxine
Digitek. see Digoxin Efudex. see Fluorouracil
Digoxin, 57-58 Elavil. see Amitriptyline
Dilantin. see Phenytoin Electrolyte replacements,
Dilatrate-SR. see Isosorbide 126, 171-172
dinitrate Emergency drugs, 166
Dilaudid. see Hydromorphone Enalapril, 62
Diltia XT. see Diltiazem Enoxaparin, 63
Diltiazem, 59 Enzymatic debriding agents,
Diovan. see Valsartan 177
Diphenylan. see Phenytoin Epinephrine, 166
Diphenylhydantoin. see Epival. see Valproic acid
Phenytoin Epivir. see Lamivudine
Diuretics. see also Loop Epivir HBV. see Lamivudine
diuretics; Potassium- Esidrix. see
sparing diuretics; Thiazide Hydrochlorothiazide
diuretics Estrace. see Estradiol
amiloride, 19 Estradiol, 64

TOOLS
 TOOLS

Estrogens, 64 Glyburide, 78
Evista. see Raloxifene Glynase PreTab. see Glyburide
Gynodiol. see Estradiol
F
Fentanyl, 65 H
Fexofenadine, 66 Hair regrowth stimulators, 67
Finasteride, 67 HCTZ. see
Flagyl. see Metronidazole Hydrochlorothiazide
Flomax. see Tamsulosin Headache suppressants, 145,
Fluconazole, 68 157
Fluoroplex. see Fluorouracil Hepalean. see Heparin
Fluoroquinolones Heparin
ciprofloxacin, 45 characteristics of, 79-80
levofloxacin, 101 low-molecular-weight. see
Fluorouracil, 69 Low-molecular-weight
Fluoxetine, 70 heparins
Flushing of catheter, 7 High alert medications, 1
Foam dressings, 177 Histamine blockers, 119
Fondaparinux, 71 Humalog. see Insulin, Lispro
Formulas, 173 Humulin 50/50. see Insulin,
Fosamax. see Alendronate premixed combinations
Fosinopril, 72 Humulin 70/30. see Insulin,
Fragmin. see Dalteparin premixed combinations
5-FU. see Fluorouracil Humulin L. see Insulin, zinc
Furadantin. see Nitrofurantoin suspension (lente)
Furosemide, 73, 166 Humulin N. see Insulin,
Furoside. see Furosemide isophane (NPH)
Humulin R. see Insulin injec-
G tion, regular
Gabapentin, 74 Humulin U. see Insulin, zinc
Gemfibrozil, 75 suspension, extended (ultra-
Glimepiride, 76 lente)
Glipizide, 77 Hydro-chlor. see
Glucophage. see Metformin Hydrochlorothiazide
Glucophage XR. see Hydrochlorothiazide, 81
Metformin Hydrocolloid dressings,
Glucotrol. see Glipizide 176
Glucotrol XL. see Glipizide Hydrocortisone, 82

188
 189
Hydrocortone. see Insulin injection
Hydrocortisone concentrated, 88
HydroDIURIL. see regular, 89
Hydrochlorothiazide Insulin-Toronto. see Insulin
Hydrogels, 176 injection, regular
Hydromorphone, 83 Intradermal administration, 11
Hydrostat IR. see Intramuscular injections,
Hydromorphone 8-9, 11
Hydroxyzine, 84 Intravenous administration,
Hytrin. see Terazosin 4-7, 173
Hyzine-50. see Hydroxyzine Ipratropium, 95
Ismo. see Isosorbide
I mononitrate
Iletin II Regular. see Insulin Isoptin. see Verapamil
injection Isorbid. see Isosorbide
Imdur. see Isosorbide mononi- dinitrate
trate Isordil. see Isosorbide
Imitrex. see Sumatriptan dinitrate
Implanted port catheters, 7 Isosorbide dinitrate, 96
Inderal. see Propranolol Isosorbide mononitrate, 97
Inderal LA. see Propranolol Isotrate. see Isosorbide
Infliximab, 85 dinitrate
Injections Itraconazole, 98
intramuscular, 8-9, 11
intravenous, 5 K
subcutaneous, 10 Kaopectate II Caplets. see
Innohep. see Tinzaparin Loperamide
Insulin Keflex. see Cephalexin
isophane (NPH), 90 Klonopin. see Clonazepam
Lispro, 91
mixing of, 12-13 L
premixed combinations, 94 Laboratory values, 167-170
types of, 86-94 Lamivudine, 99
zinc suspension, extended Lanoxicaps. see Digoxin
(ultralente), 92 Lanoxin. see Digoxin
zinc suspension (lente), 93 Lansoprazole, 100
Insulin aspart, 86 Lantus. see Insulin glargine
Insulin glargine, 87 Lasix. see Furosemide

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Lente Iletin II. see Insulin, zinc enoxaparin, 63

suspension (lente) tinzaparin, 150
Leukotriene antagonists, Lyphocin. see Vancomycin
112
Levaquin. see Levofloxacin M
Levate. see Amitriptyline Macrodantin. see
Levofloxacin, 101 Nitrofurantoin
Levo-T. see Levothyroxine Magnesium, 166
Levothroid. see Levothyroxine Maxipime. see Cefepime
Levothyroxine, 102 Medication administration.
Levoxyl. see Levothyroxine see Administration
Lidocaine, 166 Medication errors, 3
Lioresal. see Baclofen Medrol. see
Lipid-lowering agents Methylprednisolone
atorvastatin, 26 Metformin, 108
gemfibrozil, 75 Methylprednisolone, 109
pravastatin, 127 Metoprolol, 110
simvastatin, 143 Metronidazole, 111
Lipitor. see Atorvastatin Micronase. see Glyburide
Lisinopril, 103 Midamor. see Amiloride
Loop diuretics Mixing of insulins, 12-13
bumetanide, 34 Monoket. see Isosorbide
furosemide, 73 mononitrate
Loperamide, 104 Monopril. see Fosinopril
Lopid. see Gemfibrozil Montelukast, 112
Lopressor. see Morphine, 113-114, 166
Metoprolol MS Contin. see Morphine
Lopressor SR. see Multipax. see Hydroxyzine
Metoprolol Mupirocin, 115
Lopurin. see Allopurinol
N
Loratadine, 105
Napron X. see Naproxen
Lorazepam, 106
Naprosyn. see Naproxen
Losartan, 107
Naproxen, 116
Lotensin. see Benazepril
Narcan, 166
Lovenox. see Enoxaparin
Neurontin. see Gabapentin
Low-molecular-weight
Nifedical XL. see Nifedipine
heparins
Nifedipine, 117
dalteparin, 53
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Nitrofurantoin, 118 Novolin U. see Insulin, zinc
Nitroglycerin, 166 suspension, extended
Nizatidine, 119 (ultralente)
Nolvadex. see Tamoxifen Novolog. see Insulin aspart
Nonsteroidal anti-inflamma- Novo-Lorazem. see
tory drugs Lorazepam
celecoxib, 40 Novo-Metformin. see
naproxen, 116 Metformin
rofecoxib, 139 Novonidazol. see
Norvasc. see Amlodipine Metronidazole
Novamoxin. see Novopranol. see Propranolol
Amoxicillin Novospiroton. see
Novo-Atenolol. see Spironolactone
Atenolol Novotriptyn. see Amitriptyline
Novo-AZT. see Zidovudine NPH Iletin II. see Insulin,
Novocimetine. see isophane (NPH)
Cimetidine Nu-Alpraz. see Alprazolam
Novodipam. see Diazepam Nucleoside reverse transcrip-
Novohydroxyzin. see tase inhibitors, 164
Hydroxyzine Nu-Diltiaz. see Diltiazem
Novo-Lextin. see Cephalexin
Novolin 70/30. see Insulin, O
premixed combinations Opioid analgesics
Novolin de Ultralente. see fentanyl, 65
Insulin, zinc suspension, hydromorphone, 83
extended (ultralente) morphine, 113-114, 166
Novolin Ge Lente. see Orasone. see Prednisone
Insulin, zinc suspension
(lente) P
Novolin Ge NPH. see Paroxetine, 120
Insulin, isophane (NPH) Patient education standards, 2
Novolin L. see Insulin, zinc Paxil. see Paroxetine
suspension (lente) Paxil CR. see Paroxetine
Novolin N. see Insulin, Pentoxifylline, 121
isophane (NPH) Pepto Diarrhea Control. see
Novolin R. see Insulin Loperamide
injection, regular Peptol. see Cimetidine

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Peripheral catheters, 7 Q
Peripherally acting anti-adren- Quinapril, 132
ergics, 147
Phenazopyridine, 122 R
Phenergan. see Promethazine Rabeprazole, 133
Phenoject. see Promethazine Raloxifene, 134
Phenytoin, 123-124 Ramipril, 135
Piggyback setup, 6 Remicade. see Infliximab
Pioglitazone, 125 Repaglinide, 136
Plavix. see Clopidogrel Restoril. see Temazepam
Port catheters, 7 Retrovir. see Zidovudine
Potassium chloride, 126, Rifadin. see Rifampin
171-172 Rifampin, 137
Potassium-sparing diuretics Rimactane. see Rifampin
amiloride, 19 Risperdal. see
spironolactone, 144 Risperidone
Prandin. see Repaglinide Risperidone, 138
Pravachol. see Pravastatin Rivotril. see Clonazepam
Pravastatin, 127 Rofact. see Rifampin
Prednicot. see Prednisone Rofecoxib, 139
Prednisone, 128 Romazicon, 166
Pred-Pak. see Prednisone Rosiglitazone, 140
Prevacid. see Lansoprazole Roxanol. see Morphine
Procardia. see Nifedipine
Promethazine, 129 S
Propecia. see Finasteride Salmeterol, 141
Propranolol, 130-131 Sarafem. see Fluoxetine
Proscar. see Finasteride Sedative/hypnotics
Proton pump inhibitors promethazine, 129
lansoprazole, 100 temazepam, 148
rabeprazole, 133 zolpidem, 165
Protostat. see Metronidazole Selective estrogen receptor
Proventil. see Albuterol modulator, 134
Prozac. see Fluoxetine Selective serotonin reuptake
Pulmicort. see Budesonide inhibitors
Pyridium. see citalopram, 46
Phenazopyridine fluoxetine, 70

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paroxetine, 120 T
sertraline, 142 Tagamet. see Cimetidine
Septa. see Tamofen. see Tamoxifen
Trimethoprim/sulfamethoxa- Tamoxifen, 146
zole Tamsulosin, 147
Serevent. see Salmeterol 3TC. see Lamivudine
Sertraline, 142 Temazepam, 148
Simvastatin, 143 Tenormin. see Atenolol
Singulair. see Montelukast Terazosin, 149
Skeletal muscle relaxants Thiazide diuretics
baclofen, 28 chlorothiazide, 43
carisoprodol, 37 hydrochlorothiazide,
diazepam, 55-56 81
Smoking deterrents, 35 Thyroid hormones, 102
Solu-Cortef. see Tiamate. see Diltiazem
Hydrocortisone Tinzaparin, 150
Solu-Medrol. see TMP/SMZ. see Trimethoprim/
Methylprednisolone sulfamethoxazole
Soma. see Carisoprodol Tolterodine, 151
Sorbitrate. see Isosorbide Toprol-XL. see
dinitrate Metoprolol
Spironolactone, 144 Tramadol, 152
Sporanox. see Itraconazole Transparent films, 176
Statins Trazodone, 153
atorvastatin, 26 Trazon. see Trazodone
pravastatin, 127 Trental. see Pentoxifylline
simvastatin, 143 Trialodine. see Trazodone
Subcutaneous injections, Triamcinolone, 154
10-11 Trimethoprim/sulfamethoxa-
Sulfonylureas zole, 155
glimepiride, 76 Trimox. see Amoxicillin
glipizide, 77 Tunneled catheters, 7
glyburide, 78
Sumatriptan, 145 U
Syn-Clonazepam. see Ultralente. see Insulin,
Clonazepam zinc suspension, extended
Synthroid. see Levothyroxine (ultralente)

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Ultralente U. see Insulin, Vioxx. see Rofecoxib

zinc suspension, extended Vistaril. see Hydroxyzine
(ultralente) Vivol. see Diazepam
Ultram. see Tramadol
Urinary tract analgesics, W
122 Warfarin, 162
Urinary tract antispasmodics, Warfilone. see Warfarin
151 Wellbutrin. see Bupropion
Urodine. see Phenazopyridine Wellbutrin SR. see
Bupropion
V Wound care products,
Valacyclovir, 156 176-177
Valium. see Diazepam X
Valproic acid, 157 Xanax. see Alprazolam
Valsartan, 158
Valtrex. see Valacyclovir Z
Vanadom. see Carisoprodol Zafirlukast, 163
Vanceril. see Beclomethasone Zebeta. see Bisoprolol
Vancocin. see Vancomycin Zestril. see Lisinopril
Vancoled. see Vancomycin Zidovudine, 164
Vancomycin, 159 Zithromax. see
Vasopressin, 166 Azithromycin
Vasotec. see Enalapril Zocor. see Simvastatin
Velosulin BR. see Insulin injec- Zoloft. see Sertraline
tion, regular Zolpidem, 165
Venlafaxine, 160 Zovirax. see Acyclovir
Ventodisk. see Albuterol Z-track method, 9
Ventolin. see Albuterol Zyban. see Bupropion
Verapamil, 161 Zyloprim. see Allopurinol
Verelan. see Verapamil Zyrtec. see Cetirizine

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

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