Med Notes, Pocket Drug Guide

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3rd Edition
Med
Notes Pocket Drug Guide
Judith Hopfer Deglin, PharmD

April Hazard Vallerand, PhD, RN, FAAN
Purchase additional copies of this book at your

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A Davis’s Notes Book

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BASICS A–C D–H I–M N–R S–Z INDEX
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High Alert Medications

High alert medications are those medications that have a high risk of
causing injury or death when handled or administered improperly.
Exercise extreme caution when administering these medications:
Classes/Categories of Medications Specific Medications

• Adrenergic agonists, IV • Amiodarone, IV
(e.g., epinephrine) • Colchicine injection
• Adrenergic antagonists, IV • Heparin, low molecular weight,
(e.g., propranolol) injection
• Anesthetic agents, general, • Heparin, unfractionated, IV
inhaled and IV (e.g., propofol)
• Insulin, subcutaneous and IV
• Cardioplegic solutions
• Lidocaine, IV
• Chemotherapeutic agents,
• Magnesium sulfate injection
parenteral and oral
• Methotrexate, oral,
• Dextrose, hypertonic, 20% or
non-oncological use
greater
• Nesiritide
• Dialysis solutions, peritoneal
and hemodialysis • Nitroprusside sodium for injection
• Epidural or intrathecal • Potassium chloride for injection
medications concentrate
• Glycoprotein IIb/IIIa inhibitors • Potassium phosphates injection
(e.g., eptifibatide) • Sodium chloride injection,
• Hypoglycemics, oral hypertonic (more than 0.9%
concentration)
• Inotropic medications, IV (e.g.,
digoxin, milrinone) • Warfarin
• Liposomal forms of drugs (e.g.,
liposomal amphotericin B)
• Moderate sedation agents, IV
(e.g., midazolam)
• Moderate sedation agents, oral,
for children (e.g., Chloral hydrate)
• Narcotics/opiates, IV and oral
(including liquid concentrates)
Continued
BASICS
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BASICS
Classes/Categories of Medications Specific Medications

• Immediate- and sustained-release
formulations
• Neuromuscular blocking agents
(e.g., succinylcholine)
• Radiocontrast agents, IV
• Thrombolytics/fibrinolytics, IV
(e.g., tenecteplase)
• Total parenteral nutrition
solutions
Safe Medication Administration

■ Carefully read product packaging to note strength of solution,
dosage, and route(s) of administration.
■ Double-check with a pharmacist about dose range.
■ Have a colleague double-check dosage calculations and infusion
pump programming.
■ Use the five 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 as patient allows
being mindful of privacy laws (HIPAA).
■ Present information in a format the patient can understand.
■ Use an interpreter if provider and patient speak different language.
■ Have the patient repeat the information you provide and provide
return demonstrations where appropriate.
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■ 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.
■ Minor side effects and what to do if they occur.
■ Serious 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.
BASICS
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BASICS
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)
DPT Demerol- Diphtheria- Use complete drug
Phenergan- pertussis-tetanus name
Thorazine (vaccine)
HCl Hydrochloric KCl (potassium Use full drug name
acid chloride)
HCT Hydrocortisone Hydrochlorothia- Use full drug name
zide
MgSO4 Magnesium Morphine Use full drug name
sulfate sulfate
MS Morphine Magnesium Use full drug name
sulfate sulfate
MTX Methotrexate Mitoxantrone Use full drug name
Nitro drip Nitroprusside Nitroglycerin Use full drug name
Norflox Norfloxacin Norflex Use full drug name
OD or o.d. Once daily “Right eye” (OD- Use “daily”
oculus dexter)
PCA Procainamide Patient Controlled Use complete drug
Analgesia name
PIT/(slash) Pitocin “per” Pitressin Use full drug name
QD or q.d. Every day QID when the Use “daily”
period after the
“q” or the tail of
the “q” is mis-
taken for an “i”
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5
Abbreviation/ Intended Often
Symbol Meaning Mistaken For Recommendation
SSRI Sliding scale Selective- Spell out “sliding
regular insulin seratonin reup- scale (insulin)”
take inhibitor
T3 Tylenol with Liothyronine Use complete drug
codeine No. 3 name
+ Plus sign “1” (numeral Spell out “per”
“one”) Spell out “and”
“4” (numeral
“four”)
Zero after a 1 mg 10 mg DO NOT USE zero
decimal point after a decimal
(e.g., 1.0 mg) point
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), Spell out “unit”
4 (four), cc
HS Half strength Hour of sleep Write out medica-
tion strength
Adapted from the Institute for Safe Medication Practices, 2007.

http://www.ismp.org/Tools/errorproneabbreviations.pdf
BASICS
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BASICS
IV Administration
Starting an IV
■ Prepare the patient: Explain procedure, answer any questions, and
give reassurance.
■ Gather equipment: IV bag with primed tubing, sharps container,
catheter, tape, dressing, tourniquet, antiseptic swabs, gloves, IV
catheter of appropriate size.
■ Organize supplies: Tear tape, hang IV solution with primed tubing
close by, sharps container within easy reach, 2⫻2 or other dressing.
■ Apply tourniquet: Proximal to intended insertion site, either mid-
forearm or above the elbow; don gloves.
■ Locate vein: Palpate with fingertips. To further enhance dilation,
gently tap, apply heat/warm soak, have patient make a fist, or dangle
arm below heart.
■ Remove tourniquet after vein is located, reapply after cleansing site.
■ 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 touch-
ing site once it has been prepared.
■ Apply traction: Opposite the direction of the catheter.
■ Position needle: Bevel side up, 15°–30°. Note: Hold the needle with
the thumb and pointer finger in a way that allows for visualization of
the flash chamber.
■ Insert needle: Perform venipuncture and observe for “flash back” in
flash chamber. Once flash back occurs, lower catheter almost parallel
to the skin, and insert the needle 1–2 additional mm. This is done to
ensure that the catheter has entered the vein.
■ Advance the catheter: Thread catheter into vein while maintaining
skin traction and pulling back on needle.
■ Release the tourniquet: After releasing tourniquet, apply digital
pressure just above the end of the catheter tip while gently stabilizing
the hub of the catheter.
■ Remove needle: Remove and discard into approved sharps container.
■ Connect IV tubing: Open clamp, and observe for free flow of IV fluid.
■ Secure catheter: Apply tape and sterile dressing per policy.
■ Clean up: Discard soiled equipment per hospital policy.
■ Document: Per hospital policy and guidelines.
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IV Insertion Guide
BASICS
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BASICS
IV Solutions: Crystalloids and Colloids

IV solutions can be divided into two basic categories: crystalloids and colloids
(volume expanders). Crystalloids contain water, dextrose, and/or elec-
trolytes and are commonly used to treat different fluid and electrolyte imbal-
ances. Colloids (also referred to as plasma expanders or volume expanders)
have an increased osmotic pressure in comparison with crystalloids; they
remain in the intravascular space longer and are used for volume expansion.
Type of Solution Components Indications

Saline solutions Na and Cl • Alkalosis
NS, 0.9% NaCl, • Fluid loss
sodium chloride, • Sodium depletion
saline, 3% and
5% saline
Dextrose solutions Dextrose in water • Replace calories as
D5W, D10W carbohydrates
• Prevent dehydration
• Maintain water
balance
• Promote sodium
diuresis
Dextrose and Dextrose in saline • Promote diuresis
saline mixtures • Correct moderate fluid
D5NS, D5 1/2NS, loss
D10NS • Prevent alkalosis
• Provide calories and
sodium chloride
Multi-electrolyte Combination of Na, Cl, • Replace fluid lost
solutions K, Ca, and lactate due to vomiting or GI
Lactated Ringer’s, suctioning
Ringer’s lactate • Treat dehydration
• Restore normal fluid
balance
Volume expanders include colloids, dextran, and hetastarch. Colloids are
protein solutions such as albumin, plasma, and commercial plasmas
(e.g., Plasmanate). Dextran is a complex, synthetic sugar. Because Dextran
is slowly metabolized, it does not stay in the vascular space as long as a
colloid. Hetastarch is a synthetic colloid that works similarly to Dextran.
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Volume Expanders (Colloids)
Type of Solution Components Indications

Albumin Human plasma protein 5%: Rapid volume
5% and 25% expansion and mobilize
interstitial edema
25%: Hypoproteinemia
Plasma Plasmanate Contains human To increase serum
Plasma protein plasma proteins in NS colloid osmotic
fraction pressure
Dextran Synthetic colloid Volume expansion
40% and 70% made of glucose Mobilize interstitial
polysaccharides edema
Hetastarch: Hespan Synthetic colloid made Volume expansion
from corn Mobilize interstitial edema
Blood and Blood Products

Blood products: any of the components found in whole blood.
Blood Product Components Indications

Whole blood Contains all blood Rarely used; may be
products given to an exsan-
guinating patient
Packed red blood No clotting factors or Acute and chronic
cells (PRBCs) platelets, 80% plasma anemia; blood loss
removed
Platelets Usually given in pools Low platelet counts;
of 6–10 units coagulopathies; 1 unit
may increase platelet
count by 6000 units
Continued
BASICS
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BASICS
Blood Product Components Indications

Fresh frozen plasma Plasma and clotting To replace clotting
(FFP) factors factors after multiple
transfusions (>6 units
PRBCs); Coumadin
intoxication; replace
clotting factors
Cryoprecipitate Clotting factors Hemophilia, fibrinogen
deficiency, DIC
Flushing IV Catheters
Catheter Type Solution Strength Frequency

Peripheral Vascular Access Devices (VAD)
• Peripheral IV line NS N/A 3 mL daily and PRN
• Midline catheter Heparin 10 units/mL 5 mL daily and PRN
Peripherally Inserted Central Catheters (PICC)
• Groshong PICC NS N/A 5 mL per lumen
every 7 days and
after each use
• Per-Q-Cath Heparin 10 units/mL 2.5 mL (child) or
(Pediatric VAD) 0.5 mL (infant) q 8 h
and after each use
Central Venous Catheters
• Valved-tip NS N/A 5 mL per lumen
(no clamps) weekly and PRN
• Open-ended (clamps) Heparin 10 units/mL 5 mL daily and PRN
Implanted Port Catheters
• Groshong Heparin 100 units/mL 5 mL daily and PRN
Port-A-Cath
10
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Intramuscular (IM) Injection Sites
BASICS
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BASICS
Adults: The dorsogluteal site is associated with sciatic nerve injury and
should not be used. The ventrogluteal is the preferred site for adults for
a single injection of greater than 1 mL. When giving multiple injections,
the vastus lateralis site should be used. The deltoid site is used for injec-
tions of 1 mL or smaller (usually vaccines).
The vastus lateralis site is preferred for children under 2 years of age.
Z-Track Method for Giving IM Injections
Injections: Intradermal (ID), Subcutaneous (SC),

and Intramuscular (IM)
ID SC IM
Site Inner forearm, Upper posterior Gluteus, thigh, and
chest, and back arm, upper back, deltoid muscles
low back, anterior
lateral thigh, and
abdomen
Gauge 27–30 g 25–28 g 21–23 g
Length 1/4–3/8” 3/8–5/8” 1–1 1/2”
Angle 10°–15° 90° or 45° for very 90°
thin patients
Volume 0.1–0.2 mL 0.5–1 mL Up to 3 mL; small
muscles (deltoid)
no more than 1 mL
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Angle of Injection
SC Injection Sites
Two inches
away from
the umbilicus
BASICS
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BASICS
Mixing Insulin
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15
Notes
BASICS
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A–C
ACYCLOVIR (ay-sye-kloe-veer) Avirax, Zovirax Antiviral Pregnancy

Category B (PO, IV) C (Topical)
■ INDICATIONS: Genital herpes, localized cutaneous herpes zoster infec-
tions, shingles, chickenpox, varicella, herpes simplex encephalitis,
limited non–life-threatening herpes simplex infections in immuno-
compromised patients (topical).
■ THERAPEUTIC EFFECTS: Inhibition of viral replication, decreased viral
shedding, reduced lesion-healing time.
■ DOSAGE: PO Adults: 200–800 mg 3 to 5 times daily. Children: 20 mg/kg
4 times daily. IV: Adults and Children: 5–20 mg/kg q 8 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: Reconstitute with sterile water. Do not
reconstitute with bacteriostatic water, benzyl alcohol, or paraben.
Administer via infusion pump over at least 1 h to minimize renal
tubular damage.
■ ADVERSE REACTIONS AND SIDE EFFECTS: SEIZURES, dizziness,
headache, diarrhea, nausea, vomiting, pain, phlebitis, RENAL FAIL-
URE, THROMBOTIC THROMBOCYTOPENIC PURPURA/HEMOLYTIC
UREMIC SYNDROME in high doses in immunosuppressed patients.
■ CONTRAINDICATIONS: Hypersensitivity to acyclovir or valacyclovir.
Use cautiously in patients with preexisting serious neurological,
hepatic, pulmonary, or fluid and electrolyte abnormalities.
■ CAUTIONS: Concurrent use of other nephrotoxic drugs increases the
risk of adverse renal effects.
ALBUTEROL (al-byoo-ter-awl) Airet, Proventil, Ventodisk, Ventolin
Bronchodilator Pregnancy Category C
■ INDICATIONS: Control and prevent reversible airway obstruction
caused by asthma and COPD, acute bronchospasm, prevention of
exercise-induced bronchospasm, long-term control of chronic/
persistent bronchospasm.
■ THERAPEUTIC EFFECTS: Bronchodilation.
■ DOSAGE: PO: Adults and Children ≥12: 2–4 mg 3–4 times daily;
4–8 mg twice daily for extended-release tablets. Children 6–12 yr:
2 mg 3–4 times daily. Children 2–6 yr: 0.1 mg/kg 3 times daily.
Geriatrics: 2 mg 3–4 times daily. Inhalation: Adults and
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Children 2–12 yr: Via nebulization or IPPB: 1.25–2.5 mg 3–4 times daily.
Adults and Children ≥4 yr: Via Rotahaler inhalation device: 200 mcg as
Ventolin Rotacaps q 4–6 h up to 400 mcg q 4–6 h. Adults and Children
≥4 yr: Via metered-dose inhaler—2 inhalations q 4–6 h.
■ ADMINISTRATION: PO: Administer oral medication with meals to
minimize gastric irritation. Inhalation: Allow at least 1 min between
inhalations of aerosol medication. For nebulization or IPPB, the
0.5–0.83, 1, and 2 mg/mL solutions do not require dilution before
administration. The 5 mg/mL solution must be diluted with 2.5 mL of
0.9% NaCl for inhalation.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Nervousness, restless-
ness, tremor, chest pain, palpitations, angina, arrhythmias, hyperten-
sion, hypokalemia. hypoglycemia.
■ CONTRAINDICATIONS: Hypersensitivity to adrenergic amines or
hypersensitivity to fluorocarbon inhaler. Use cautiously in patients
with cardiac disease, hypertension, hyperthyroidism, diabetes, glau-
coma, seizure disorders.
■ CAUTIONS: Excessive use may lead to tolerance and paradoxical
bronchospasm. • Use with MAO inhibitors may lead to hypertensive
crisis. • Beta blockers may negate therapeutic effect.
ALENDRONATE (uh-len- drone-ate) Fosamax Bone resorption inhibitor
Pregnancy Category C
■ INDICATIONS: Osteoporosis, Paget’s disease of the bone.
■ THERAPEUTIC EFFECTS: Reversal of the progression of osteoporosis
with decreased fractures, decreased progression of Paget’s disease.
■ DOSAGE: PO: Adults: Treatment of osteoporosis: 10 mg once daily or
70 mg once weekly. Prevention of osteoporosis: 5 mg once daily or
35 mg once weekly. Paget’s disease: 40 mg once daily for 6 mo.
■ ADMINISTRATION: Remain upright for 30 min following dose to
facilitate passage to stomach and minimize risk of esophageal irrita-
tion. Do not drink coffee, tea, cola, mineral water, or orange juice
within 1 h of taking alendronate.
Key: underline = most common CAPS = life-threatening
A–C
2139_Tab02_016-052 7/8/09 11:33 AM Page 18
A–C
■ 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, muscu-
loskeletal pain.
■ CONTRAINDICATIONS: Renal insufficiency (CCr <35 mL/min), preg-
nancy, lactation. Use cautiously in patients with active GI pathology
(dysphasia, esophageal disease, gastritis, duodenitis, ulcers).
■ 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 h before consuming.
ALISKIREN (a-lis-ki-ren) Tekturna Antihypertensive Pregnancy Category C
■ INDICATIONS: Treatment of hypertension (alone or with other
agents).
■ THERAPEUTIC EFFECTS: Blocks angiotension II (a powerful vasocon-
strictor) leading to lowered blood pressure.
■ DOSAGE: PO: Adults: 150 mg/day initially; may be increased to
300 mg/day.
■ ADMINISTRATION: Administer at the same time each day without
regard to meals.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Cough, abdominal pain,
diarrhea ↑ (in females and elderly), dyspepsia, reflux, ANGIOEDEMA.
■ CONTRAINDICATIONS: Hypersensitivity; pregnancy/lactation. Use
cautiously in patients with severe renal impairment, salt or volume
depletion (correct before use).
■ CAUTIONS: Correct salt or volume depletion before use. Use
cautiously with severe renal impairment. Blood levels are ↓ by
irbesartan. Blood levels are ↑ by atorvastatin, ketoconazole, and
cyclosporine (concurrent use with cyclosporine not recommended). ↓
blood levels and may ↓ effects of furosemide. Antihypertensive effects
may be ↑ by other antihypertensives, diuretics, and nitrates. ↑ risk of
hyperkalemia with concurrent use of ACE inhibitors, angiotensin II
receptor antagonists, potassium supplements, potassium-sparing
diuretics, or potassium-containing salt substitutes. High-fat meals
significantly ↓ absorption.
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19
ALLOPURINOL (al-oh-pure-i- nole) Apo-Allopurinol, Lopurin, Zyloprim
Anti-gout agent, antihyperuricemic Pregnancy Category C
■ INDICATIONS: Prevention of attack of gouty arthritis and nephropa-
thy. 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: 100–800 mg/d. Doses >300 mg/d should be
given in divided doses. Children 6–10 yr: 300 mg daily. Children <6 yr:
150 mg daily. IV: Adults: 200–400 mg/m2/d (up to 600 mg/d) as a
single daily dose or in divided doses q 6–12 h. Children: 200 mg/m2/d
as a single daily dose or in divided doses q 6–12 h.
■ ADMINISTRATION: May be administered with milk or meals to mini-
mize gastric irritation. May be crushed.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Drowsiness, diarrhea,
hepatitis, nausea, vomiting, renal failure, rash (discontinue drug at
first sign of rash), urticaria, bone marrow depression, hypersensitivity
reactions.
■ CONTRAINDICATIONS: Hypersensitivity; pregnancy/lactation. Use
cautiously in patients with acute attack of gout, renal insufficiency,
dehydration.
■ CAUTIONS: Use with mercaptopurine and azathioprine increases
bone marrow–depressant properties—dosages of these drugs should
be reduced. • Use with ampicillin or amoxicillin increases the risk of
rash. • Use with oral hypoglycemic agents and warfarin increases the
effects of these drugs. • Use with thiazide diuretics or ACE inhibitors
increases the risk of hypersensitivity reactions. • Discontinue allopuri-
nol immediately if rash occurs. • Therapy should be discontinued per-
manently 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.
A–C
2139_Tab02_016-052 7/8/09 11:33 AM Page 20
A–C
ALPRAZOLAM (al-pray-zoe-lam) Apo-Alpraz, Nu-Alpraz, Xanax Anti-

anxiety agent (benzodiazepine) Pregnancy Category D
■ INDICATIONS: Anxiety, panic attacks, premenstrual syndrome
(unlabeled use).·
■ THERAPEUTIC EFFECTS: Relief of anxiety.
■ DOSAGE: PO: Adults: 0.25–0.5 mg 2–3 times daily.
■ ADMINISTRATION: May be administered with food if GI upset occurs.
Tablets may be crushed.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness, drowsiness,
lethargy, confusion, hangover, headache, mental depression, para-
doxical excitation, blurred vision, constipation, diarrhea, nausea,
vomiting, rashes, physical dependence, psychological dependence,
and tolerance.
■ CONTRAINDICATIONS: Hypersensitivity, narrow-angle glaucoma,
cross-sensitivity with other benzodiazepines, preexisting CNS depres-
sion; severe, uncontrolled pain; pregnancy, and lactation. Use cau-
tiously in patients with renal impairment, hepatic dysfunction, history
of suicide attempt, or alcohol/drug dependence.
■ CAUTIONS: Alcohol, antidepressants, other benzodiazepines, antihis-
tamines, 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.
ALTEPLASE (al-te-plase) Activase, Activase rt-PA, Cathflo Activase,
tissue plasminogen activator, t-PA Thrombolytics Pregnancy Category C
■ INDICATIONS: Acute myocardial infarction, acute ischemic stroke,
pulmonary embolism, occluded central venous access devices.
Unlabeled Uses: Deep venous thrombosis; acute peripheral arterial
thrombosis.
■ THERAPEUTIC EFFECTS: Lysis of thrombi in coronary arteries,
pulmonary and intracranial vasculature. Restoration of cannula or
catheter function.
■ DOSAGE: Myocardial Infarction (Accelerated Regimen) IV:
(Adults): 15 mg bolus, then 0.75 mg/kg (up to 50 mg) over 30 min,
then 0.5 mg/kg (up to 35 mg) over next 60 min; usually accompanied
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by heparin therapy. Myocardial Infarction (Standard Regimen) IV:
(Adults >65 kg): 60 mg over 1st h (6–10 mg given as a bolus over 1st
1–2 min), 20 mg over the 2nd h, and 20 mg over the 3rd h for a total
dose of 100 mg. IV: (Adults <65 kg): 0.75 mg/kg over 1st h
(0.075–0.125 mg/kg given as a bolus over 1st 1–2 min), 0.25 mg/kg
over the 2nd h, and 0.25 mg/kg over the 3rd h for a total dose of
1.25 mg/kg (not to exceed 100 mg total). Acute Ischemic Stroke IV:
(Adults): 0.9 mg/kg (not to exceed 90 mg), given as an infusion over
1 h, with 10% of the dose given as a bolus over the 1st min.
Pulmonary Embolism: IV: (Adults): 100 mg over 2 h; follow with
heparin. Occluded Venous Access Devices IV: (Adults and Children
>30 kg): 2 mg/2 mL instilled into occluded catheter; if unsuccessful,
may repeat once after 2 h. IV: (Children <30 kg): 110% of the lumen
volume (not to exceed 2 mg in 2 mL) instilled into occluded catheter;
if unsuccessful, may repeat once after 2 h.
■ ADMINISTRATION: IV: Use preservative-free sterile water; reconsti-
tute 20-mg vials with 20-mL and 50-mg vials with 50 mL. Use an
18-gauge needle. Swirl invert gently to mix. Administer as reconsti-
tuted (1 mg/mL) or dilute further immediately before use in an equal
amount of 0.9% NaCl or D5W. Rate: • Flush line with 20–30 mL
(adults) of saline at completion of infusion to ensure entire dose is
received. • Cathflo Activase: Reconstitute with 2.2 mL of sterile water.
Mix by gently swirling; allow 3 minutes for complete dissolution. Do
not shake. Withdraw 2.0 mL of reconstituted solution and instill into
occluded catheter. After 30 min, attempt to aspirate blood. If catheter
still occluded, wait another hour and a half. Instill second dose if nec-
essary. If catheter function is restored, aspirate 4–5 mL of blood to
remove Cathflo Activase and residual clot, then gently irrigate
catheter with 0.9% NaCl.
■ ADVERSE REACTIONS AND SIDE EFFECTS: INTRACRANIAL HEMOR-
RHAGE, epistaxis, gingival bleeding. bronchospasm, hemoptysis.
reperfusion arrhythmias, hypotension, RECURRENT ISCHEMIA or
THROMBOEMBOLISM. GI BLEEDING, nausea, RETROPERITONEAL
BLEEDING, vomiting, GU TRACT BLEEDING, ecchymoses, flushing,
urticaria, hemorrhage at injection site, phlebitis at injection site, aller-
gic reactions including ANAPHYLAXIS, fever.
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■ CONTRAINDICATIONS: Active internal bleeding; history of CVA;

recent (within 2 months) intracranial or intraspinal injury or trauma;
brain tumor, AV malformation or aneurysm, uncontrolled hyperten-
sion, known bleeding tendencies, hypersensitivity. Use cautiously in
recent (within 10 days) major surgery, trauma, GI or GU bleeding;
severe hepatic or renal disease. Patients >75 yr have increased risk of
intracranial bleeding.
■ CAUTIONS: HIGH ALERT MED: Overdosage and underdosage of
thrombolytic medications have resulted in patient harm or death.
Have second practitioner independently check original order, dosage
calculations, and infusion pump settings. Do not confuse abbreviation
t-PA for alteplase (Activase) with the abbreviations TNK t-PA for
tenecteplase (TNKase) and r-PA for reteplase (Retavase). Clarify
orders that contain any of these abbreviations. Aspirin, other NSAIDs,
warfarin, heparin and heparin-like agents, abciximab, eptifibatide,
tirofiban, clopidogrel, ticlopidine, or dipyridamole ↑ risk of bleeding,
although they are frequently used together or in sequence.
AMIODARONE (am-ee-oh-da-rone) Cordarone, Pacerone Antiar-
rhythmic Pregnancy Category D
■ INDICATIONS: Life-threatening ventricular arrhythmias. Unlabeled
Uses: Supraventricular tachyarrhythmias.
■ THERAPEUTIC EFFECTS: Suppression of arrhythmias.
■ DOSAGE: PO: Adults: Ventricular Arrhythmias: 800–1600 mg/d in
1–2 doses for 1–3 wk; then 600–800 mg/d in 1–2 doses for 1 month,
then 400 mg/d maintenance. Supraventricular Tachycardia:
600–800 mg/d for 1 wk or until desired response then decrease to
400 mg/d for 3 wk, then maintenance dose of 200–400 mg/d.
Children: Ventricular Arrhythmias and Supraventricular Tachycardia:
10 mg/kg/d for 10 days or until desired response, then 5 mg/kg/d for
several weeks, then decrease to 2.5 mg/kg/d for maintenance dose.
IV: Adults: 150 mg over 10 min, followed by 360 mg over the next 6 h
and then 540 mg over the next 18 h. Continue infusion at 0.5 mg/min
until oral therapy is initiated.
■ ADMINISTRATION: PO: Administer with meals if GI intolerance
occurs. IV: Administer via volumetric pump using an in-line filter.
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■ ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness, fatigue,
malaise, corneal microdeposits, ADULT RESPIRATORY DISTRESS
SYNDROME, PULMONARY FIBROSIS, CHF, WORSENING OF
ARRHYTHMIAS, bradycardia, hypotension, LIVER FUNCTION
ABNORMALITIES, anorexia, constipation, nausea, vomiting, TOXIC
EPIDERMAL NECROLYSIS, photosensitivity, hypothyroidism, ataxia,
involuntary movement, paresthesia, peripheral neuropathy, poor
coordination, tremor.
■ CONTRAINDICATIONS: Cardiogenic shock, severe sinus node
dysfunction, 2nd and 3rd AV block, bradycardia, pregnancy, and
lactation.
■ CAUTIONS: Increases digoxin levels (decreases digoxin by 50%) and
activity of warfarin (decreases warfarin by 33%–50%). • Increases
blood levels and may lead to toxicity from quinidine, procainamide,
mexiletine, lidocaine, flecainide, cyclosporine, dextromethorphan,
methotrexate, phenytoin, and theophylline. • Increased risk of brady-
arrhythmias, sinus arrest, or AV heart block with beta blockers or cal-
cium channel blockers. • Do not confuse amiodarone with amrinone,
now called inamrinone.
AMITRIPTYLINE (a-mee-trip-ti-leen) Elavil, Levate, Novotriptyn Anti-
depressant (tricyclic) Pregnancy Category C
■ INDICATIONS: Depression. Unlabeled Uses: Chronic pain syndromes,
anxiety, insomnia.
■ THERAPEUTIC EFFECTS: Improved mood.
■ DOSAGE: PO: Adults: 75 to 150 mg/d in divided doses, or 50–100 mg
at bedtime; may increase up to 150 mg. Geriatric Patients and
Adolescents: 10 mg 3 times daily and 20 mg at bedtime. Up to
100 mg/d in a single bedtime dose or divided doses.
■ ADMINISTRATION: PO: Administer with a meal to minimize
gastric upset. Tablet may be crushed. May increase risk of suicide
attempt/ideation especially during dose early treatment and adjustment.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Lethargy, sedation,
blurred vision, dry eyes, dry mouth, ARRHYTHMIAS, hypotension,
ECG changes, constipation, hepatitis, paralytic ileus, urinary reten-
tion, blood dyscrasias, photosensitivity, changes in blood glucose,
gynecomastia, increased appetite and weight gain.
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■ CONTRAINDICATIONS: Narrow-angle glaucoma, pregnancy, and lac-

tation; know history of QTc prolongation, recent MI, heart failure.
■ CAUTIONS: May cause hypotension, tachycardia, and potentially fatal
reactions when used with MAO inhibitors (discontinue MAO inhibitor
2 weeks before starting amitriptyline). • May cause toxicity when
used with SSRI antidepressants (discontinue fluoxetine 5 weeks
before starting amitriptyline). • Concurrent use with clonidine may
cause hypertensive crisis. • Concurrent use with moxifloxacin or
sparfloxacin increases risk of adverse cardiovascular reactions.
• Additive CNS depression with other CNS depressants including
alcohol, antihistamines, clonidine, opioids, and sedative/hypnotics.
• Phenothiazines or oral contraceptives increase levels and may
cause toxicity.
AMLODIPINE (am-loe-di-peen) Norvasc Antihypertensive (calcium
channel blocker) Pregnancy Category C
■ INDICATIONS: Management of hypertension, angina pectoris, and
vasospastic (Prinzmetal) angina.
■ THERAPEUTIC EFFECTS: Systemic vasodilation and decreased
blood pressure. Coronary vasodilation and decreased frequency and
severity of angina.
■ DOSAGE: PO: Adults: 5–10 mg daily.
■ ADMINISTRATION: May be administered without regard to meals.
Avoid large amounts (6–8 glasses) of grapefruit juice during therapy.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Headache, dizziness,
fatigue, peripheral edema, angina, bradycardia, hypotension, palpita-
tions, gingival hyperplasia, nausea, flushing.
■ CONTRAINDICATIONS: Hypersensitivity to amlodipine, blood pres-
sure <90 mm Hg. Use cautiously in patients with severe hepatic
impairment, aortic stenosis, CHF.
■ 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 con-
current ingestion of grapefruit juice. • Do not confuse amlodipine
with amiloride; do not confuse Norvasc with Navane.
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AMOXICILLIN/CLAVULANATE (a-mox-i-sill-in/ klav-yoo-lan-ate) Aug-
mentin, Augmentin ES, Augmentin XR, Clavulin Anti-infective Pregnancy
Category B
■ INDICATIONS: Skin and skin structure infections, otitis media, sinusi-
tis, respiratory tract infections, GU tract infections.
■ THERAPEUTIC EFFECTS: Bactericidal action against susceptible
bacteria.
■ DOSAGE: PO: Adults and Children >40 kg: Tablets: 250–500 mg tablet
q 8–12 h. Children >3 mo: 200 mg/5 mL or 400 mg/5 mL suspension:
25mg/kg q 12 h or 20mg/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 suspen-
sion recommended).
■ ADMINISTRATION: Administer around the clock. Administer at the
start of a meal to increase absorption and to decrease GI side effects.
Chewable tablets should be crushed or chewed. Shake oral suspen-
sion 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, nau-
sea, vomiting, rashes, urticaria, ANAPHYLAXIS and SERUM SICK-
NESS, superinfection.
■ CONTRAINDICATIONS: Hypersensitivity to penicillins or clavulanate.
Use cautiously in patients with severe renal insufficiency, hepatic
impairment, monitor liver function.
■ CAUTIONS: May potentiate the effect of warfarin. • May decrease the
effectiveness of hormonal contraceptives. • Instruct patient to notify
health-care professional immediately if diarrhea, abdominal cramp-
ing, fever, or bloody stools occur and not to treat with antidiarrheals
without consulting health-care professionals.
AMOXICILLIN (a-mox-i-sil-in) Amoxil, Novamoxin, Trimox Anti-infective,
antiulcer agent Pharm Class: Aminopenicillins Pregnancy Category B
■ INDICATIONS: Skin and skin structure infections, otitis media, sinus-
itis, respiratory infections, GU infections, endocarditis prophylaxis,
ulcer disease due to Helicobacter pylori. Unlabeled Use: Lyme
disease.
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■ THERAPEUTIC EFFECTS: Bactericidal action. Spectrum is broader

than penicillins.
■ DOSAGE: PO: Adults : 250–500 mg q 8 h or 500–875 mg q 12 h.
Children >3 mo: 25–50 mg/kg/d in divided doses q 8 h or
25–50 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 d.
■ ADVERSE REACTIONS AND SIDE EFFECTS: SEIZURES (in high
doses), PSEUDOMEMBRANOUS COLITIS, diarrhea, nausea, vomiting,
rashes, urticaria, blood dyscrasias, allergic reactions including ANA-
PHYLAXIS, SERUM SICKNESS, superinfection.
■ CONTRAINDICATIONS: Hypersensitivity to penicillins. Use cautiously
in patients with several renal insufficiency, OB, lactation.
■ 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.
ATENOLOL (a-ten-oh-lole) Apo-Atenolol, Novo-Atenolol, Tenormin
Antianginal, antihypertensive (selective beta blocker) Pregnancy Category D
■ INDICATIONS: Hypertension, angina, prevention of MI.
■ THERAPEUTIC EFFECTS: Lower blood pressure and heart rate,
decreased frequency of angina.
■ DOSAGE: PO: Adults: 25–100 mg once daily. IV: Adults: Administer
5 mg over 5 min, followed by another 5 mg 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 min (1 mg/min).
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■ ADVERSE REACTIONS AND SIDE EFFECTS: Fatigue, weakness, anxi-
ety, depression, dizziness, insomnia, memory loss, mental status
changes, nervousness, nightmares, blurred vision, stuffy nose, bron-
chospasm, wheezing, BRADYCARDIA, CHF, PULMONARY EDEMA,
hypotension, peripheral vasoconstriction, constipation, diarrhea, liver
function abnormalities, nausea, vomiting, erectile dysfunction,
decreased libido, urinary frequency.
■ CONTRAINDICATIONS: Uncompensated CHF, pulmonary edema, car-
diogenic shock, bradycardia or heart block. Use cautiously in patients
with renal impairment, hepatic impairment, pulmonary disease, dia-
betes, thyrotoxicosis, OB, lactation.
■ CAUTIONS: Additive bradycardia may occur with digoxin. • Additive
hypotension may occur with other antihypertensives, acute ingestion
of alcohol, or nitrates. • May alter the effectiveness of insulins or oral
hypoglycemic agents (dosage adjustments may be necessary). • May
decrease effectiveness of theophylline. • Monitor blood pressure,
ECG, and pulse frequently during dosage adjustment period and peri-
odically throughout therapy.
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 and
triglycerides.
■ DOSAGE: PO: Adults: 10–20 mg once daily initially; may be increased
q 2–4 wk up to 80 mg/d.
■ ADMINISTRATION: Administer with the evening meal.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness, headache,
insomnia, weakness, rhinitis, bronchitis, abdominal cramps, constipa-
tion, diarrhea, flatus, heartburn, altered taste, drug-induced hepatitis,
dyspepsia, elevated liver enzymes, nausea, pancreatitis, impotence,
rashes, pruritus, RHABDOMYOLYSIS, arthralgia, arthritis, myalgia,
myositis, hypersensitivity reactions.
■ CONTRAINDICATIONS: Hypersensitivity, active liver disease, pregnancy
or lactation, concurrent use of gemfibrozil or azole antifungals.
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■ CAUTIONS: Blood levels and the risk of myopathy are increased by

concurrent cyclosporine and gemfibrozil, clofibrate, erythromycin,
large doses of niacin and azole antifungal agents. • Grapefruit juice
may cause higher blood levels and increased risk of toxicity. • Liver
function tests, including AST, should be monitored before, at 6–12 wk
after initiation of therapy or after dose elevation, and then every
6 mo. If AST levels increase to 3 times normal, HMG-COA reductase
inhibitor therapy should be discontinued. • May cause elevated alka-
line 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.
AZITHROMYCIN (aye-zith-row-my-sin) Zithromax, Zmax Agent for atypi-
cal Mycobacterium, anti-infectives (macrolide) Pregnancy Category B
■ INDICATIONS: Upper and lower respiratory tract infections, bronchi-
tis, pneumonia, skin and skin structure infections, nongonococcal
urethritis, cervicitis, gonorrhea, and chancroid. Prevention of dissemi-
nated Mycobacterium avium complex (MAC) infection in patients
with advanced HIV infection. Unlabeled Use: Prevention of bacterial
endocarditis.
■ 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 1–2 g single or weekly dose.
Children >6 months: 10 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 h before or 2 h after meals.
IV: Administer 1 mg/mL IV solution over 3 h or 2 mg/mL solution over
1 h. Do not administer as a bolus.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness, seizures,
drowsiness, fatigue, headache, ANGIOEDEMA, chest pain, palpita-
tions, hypotension, PSEUDOMEMBRANOUS COLITIS, abdominal
pain, diarrhea, nausea, cholestatic jaundice, dyspepsia, flatulence,
melena, nephritis, vaginitis, photosensitivity, rashes.
■ CONTRAINDICATIONS: Hypersensitivity to azithromycin, erythromy-
cin, or other macrolide anti-infectives. Use cautiously in severe liver
impairment, OB, lactation, children under the age of 5 yr.
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■ CAUTIONS: Observe for signs and symptoms of anaphylaxis.
• Monitor patient for signs and symptoms of pseudomembranous
colitis: fever, diarrhea, and stool containing blood, pus, or mucus.
• Magnesium and aluminum antacids will decrease absorption of
azithromycin. Separate dose times by at least 2 h. • Do not confuse
azithromycin with erythromycin. • Do not confuse Zithromax with
Zinacef.
BACLOFEN (bak-loe-fen) Lioresal, Kemstro 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 d by
5 mg/dose to maximum of up to 80 mg/d. Intrathecal: Adults:
100–800 mcg/d infusion. Children: 25–1200 mcg/d infusion
(average 275 mcg/d).
■ ADMINISTRATION: PO: Administer with milk or food. Intrathecal:
Screening phase, dilute for a concentration of 50 mcg/mL with NaCl
for injection. Test dose should be administered over at least 1 min.
If response is inadequate, 2 additional test doses, each 24 h apart,
75 mcg/1.5 mL and 100 mcg/2 mL respectively, may be administered.
■ ADVERSE REACTIONS AND SIDE EFFECTS: SEIZURES (intrathecal),
dizziness, drowsiness, fatigue, weakness, confusion, insomnia,
hypotension, nausea, pruritus, ataxia.
■ CONTRAINDICATIONS: Hypersensitivity. Use cautiously in patients
whose spasticity maintains posture and balance, epilepsy, renal
impairment, OB, lactation.
■ CAUTIONS: Additive effect with other CNS depressants including
alcohol, antihistamines, opioid analgesics, and sedative/hypnotics.
• Use with MAO inhibitors may lead to increased CNS depression or
hypotension. • Intrathecal: Monitor patient closely during test dose
and titration; resuscitative equipment should be immediately avail-
able for life-threatening or intolerable side effects. • Caution patient to
avoid abrupt withdrawal of this medication because it may precipitate
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an acute withdrawal reaction (hallucinations, increased spasticity,

seizures, mental changes, restlessness). • Discontinue gradually over
2 wk or more.
BECLOMETHASONE (beh-kloe-meth-a-sone) QVAR, Antiasthmatic,
Corticosteroid (inhalation) Pregnancy Category C
■ INDICATIONS: Maintenance treatment of asthma.
■ THERAPEUTIC EFFECTS: Decrease frequency and severity of asthma
attacks.
■ DOSAGE: Inhalation: Adults and Children >12 yr: 40–80 mcg twice
daily (not to exceed 320 mcg daily). Children 5–11yr: 40 mcg twice
daily (not to exceed 80 mcg twice daily).
■ ADMINISTRATION: Allow at least 1 min between inhalations of
aerosol medication.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Dysphonia, hoarseness,
oropharyngeal fungal infections, bronchospasm, cough, wheezing,
dry mouth, esophageal candidiasis, adrenal suppression, decreased
growth (children), CHURG-STRAUSS SYNDROME. Headache, agita-
tion, depression, dizziness, fatigue, insomnia, restlessness.
■ CONTRAINDICATIONS: Acute attack of asthma/status asthmaticus.
Use cautiously in patients with active untreated infections, diabetes,
glaucoma, hepatic dysfunction.
■ CAUTIONS: Advise patients also using bronchodilator to use
bronchodilator first and wait 5 min before taking beclomethasone.
• Advise patient to use regular peak flow monitoring to determine
respiratory status. • Advise patient to notify physician if sore throat or
sore mouth occurs. • Instruct patient whose systemic corticosteroids
have been recently reduced or withdrawn to carry a warning card
indicating the need for supplemental systemic corticosteroids in the
event of stress or severe asthma attack unresponsive to bronchodila-
tors. • Caution patient to avoid smoking, known allergens, and other
respiratory irritants.
BENAZEPRIL (ben-aye-ze-pril) Lotensin Antihypertensive (ACE inhibi-
tors) Pregnancy Category C (first trimester), D (second and third trimesters)
■ INDICATIONS: Hypertension.
■ THERAPEUTIC EFFECTS: Lowering of blood pressure.
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■ DOSAGE: PO: Adults: 10 mg once daily, increased gradually to main-
tenance dose of 20–40 mg/d as single dose or 2 divided doses (begin
with 5 mg/d in patients receiving diuretics).
■ ADMINISTRATION: Precipitous drop in blood pressure during first
1–3 h following first dose may occur, especially if also taking diuret-
ics. Monitor blood pressure closely.
headache, insomnia, cough, hypotension, angina pectoris, tachycardia,
taste disturbances, anorexia, diarrhea, nausea, proteinuria, impotence,
renal failure, hyperkalemia, AGRANULOCYTOSIS, ANGIOEDEMA.
■ CONTRAINDICATIONS: Hypersensitivity, angioedema (hereditary or
idiopathic). OB: Can cause injury or death to the fetus. Use cautiously
in patients with renal impairment, hepatic impairment, hypovolemia,
concurrent diuretic therapy.
■ CAUTIONS: Additive hypotension with other antihypertensives,
nitrates, phenothiazines, acute ingestion of alcohol, and during
surgery or general anesthesia. • Hyperkalemia may result from con-
current use of potassium supplements, potassium-sparing diuretics,
indomethacin, salt substitutes, or cyclosporine. • May increase the
risk of lithium or digoxin toxicity. Instruct patient to notify health-care
professional if rash; mouth sores; sore throat; fever; swelling of
hands or feet; irregular heartbeat; chest pain; dry cough; hoarseness;
swelling of face, eyes, lips, or tongue; difficulty swallowing or breath-
ing occurs. • Persistent dry cough may occur and may not subside
until medication is discontinued.
BENZTROPINE (benz-troe-peen) Apo-Benztropine, Cogentin Antiparkin-
son agent, anticholinergic Pregnancy Category C
■ INDICATIONS: Parkinson’s disease, including drug-induced extrapyra-
midal effects and acute dystonic reactions.
■ THERAPEUTIC EFFECTS: Reduces rigidity and tremors.
■ DOSAGE: PO: Adults: Parkinsonism: 1–2 mg/d in 1–2 divided doses.
Drug-induced extrapyramidal reactions: 1–4 mg given once or twice
daily. IM: Adults: Acute dystonic reactions: 1–2 mg.
■ ADMINISTRATION: PO: Administer with food. May be crushed and
administered with food if difficulty swallowing.
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■ ADVERSE REACTIONS AND SIDE EFFECTS: Depression, hallucina-

tions, blurred vision, dry eyes, mydriasis, arrhythmias, hypotension,
palpitations, tachycardia, constipation, dry mouth, ileus, urinary
retention, decreased sweating.
■ CONTRAINDICATIONS: Hypersensitivity, children <3 yr, narrow-angle
glaucoma, tardive dyskinesia. Use cautiously in patients with prostatic
hypotension, seizure disorder, cardiac dysfunction.
■ CAUTIONS: Additive anticholinergic effects with antihistamines, phe-
nothiazines, 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 activi-
ties 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 h after
administration.
BISOPROLOL (bis-oh-proe-lol) Monocor, Zebeta Antihypertensive (beta
blocker [selective]) Pregnancy Category C
■ THERAPEUTIC EFFECTS: Decreased blood pressure and heart rate.
■ DOSAGE: PO: Adults: 5 mg once daily, may be increased to 10 mg
once daily.
■ ADMINISTRATION: Administer without regard to meals.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Fatigue, weakness,
anxiety, depression, dizziness, drowsiness, insomnia, memory loss,
mental status changes, nightmares, blurred vision, bronchospasm,
wheezing, BRADYCARDIA, CHF, PULMONARY EDEMA, hypotension,
liver function abnormalities, nausea, impotence, decreased libido,
urinary frequency, rashes, hyperglycemia, hypoglycemia, arthralgia,
back pain, joint pain, drug-induced lupus syndrome.
diogenic shock, bradycardia, or heart block. Use cautiously in renal
failure; hepatic impairment, pulmonary disease.
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■ CAUTIONS: May alter the effectiveness of insulins or oral hypo-
glycemic agents. • Additive bradycardia may occur with digoxin.
• Additive hypotension may occur with other antihypertensives, acute
ingestion of alcohol, or nitrates. • Monitor blood pressure, ECG, and
pulse frequently during dosage adjustment period. • Take apical pulse
before administering: if <50 or if arrhythmia occurs withhold medica-
tion and notify physician or other health-care professional.
BUDESONIDE (byoo-dess-oh-nide) Pulmicort Corticosteroids (inhala-
tion) Pregnancy Category B
■ INDICATIONS: Maintenance treatment of asthma.
attacks.
■ DOSAGE: Inhalation: Adults: 180–360 mcg twice daily (not to exceed
720 mcg twice daily). Children 6–17 yr: 180–360 mcg twice daily (not
to exceed 360 mcg twice daily). Nebulization: Children 12 mo–8 yr:
0.25–1 mg/d as a single dose, or twice daily in divided doses.
Individual titration is required.
aerosol medication.
oropharyngeal fungal infections, back pain, headache, dyspepsia,
gastroenteritis, cataracts, bronchospasm, cough, wheezing, dry
mouth, esophageal candidiasis, adrenal suppression, decreased
growth (children), CHURG-STRAUSS SYNDROME.
Use cautiously in patients with active untreated infections, diabetes,
glaucoma.
■ CAUTIONS: Ketoconazole decreases metabolism and increases levels
of budesonide. • Advise patients also using bronchodilator to use
bronchodilator first and wait 5 min before taking beclomethasone.
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
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bronchodilators. • Caution patient to avoid smoking, known allergens,

and other respiratory irritants.
BUMETANIDE (byoo-met-a-nide) Bumex Diuretic (loop diuretic)
■ INDICATIONS: Edema secondary to CHF, hepatic or renal disease.
■ THERAPEUTIC EFFECTS: Diuresis and subsequent mobilization of
excess fluid.
■ DOSAGE: PO: Adults: 0.5–2 mg/d as a single dose or twice daily
(maximum dose 10 mg/d). IM, IV: Adults: 0.5–1 mg, may be repeated
q 2–3 h as needed (up to 10 mg/d).
■ ADMINISTRATION: PO: Administer orally with food or milk to mini-
mize gastric irritation. IV: Direct IV: Rate: Administer slowly over
2 min. Intermittent Infusion: Dilute in D5W, 0.9% NaCl and administer
through Y-tubing or 3-way stopcock. Rate: May be administered over
12 h for patients with renal impairment.
hearing loss, tinnitus, hypotension, diarrhea, dry mouth, hyper-
glycemia, dehydration, hypochloremia, hypokalemia, hypomagne-
semia, hyponatremia, hypovolemia, metabolic alkalosis, hyper-
glycemia, arthralgia, muscle cramps, increased BUN.
■ CONTRAINDICATIONS: Hypersensitivity (cross-sensitivity with
thiazides and sulfonamides may occur), preexisting uncorrected elec-
trolyte imbalance, hepatic coma, or anuria. Use cautiously in severe
liver disease, diabetes.
■ 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.
BUPROPION (byoo-proe-pee-on) Wellbutrin, Wellbutrin SR, Zyban
Antidepressant Pregnancy Category B
■ INDICATIONS: Depression, smoking cessation (Zyban). Unlabeled
Uses: ADHD (adults, SR only), increased libido in women.
■ THERAPEUTIC EFFECTS: Improved mood, decreased craving for
cigarettes.
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■ 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 d, then 150 mg q
12 h for 7–12 wk.
■ ADMINISTRATION: Administer doses in equally spaced time incre-
ments throughout day to minimize the risk of seizures. Sustained-
release tablets should be swallowed whole; do not break, crush, or
chew. Insomnia may be decreased by avoiding bedtime doses. May
be administered with food to lessen GI irritation.
■ ADVERSE REACTIONS AND SIDE EFFECTS: SEIZURES, agitation,
headache, insomnia, mania, psychoses, dry mouth, nausea, vomiting,
weight gain, weight loss, photosensitivity, hyperglycemia, hypo-
glycemia, syndrome of inappropriate ADH secretion, tremor.
■ CONTRAINDICATIONS: Hypersensitivity, history of seizures, bulimia,
and anorexia nervosa, concurrent MAO inhibitor therapy. Use cau-
tiously in patients with renal/hepatic impairment, recent MI, history of
suicide attempt, unstable cardiovascular status.
■ 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 activities requiring
alertness until response to medication is known.
BUSPIRONE (byoo-spye-rone) BuSpar Antianxiety agents Pregnancy
Category B
■ INDICATIONS: Management of anxiety.
■ THERAPEUTIC EFFECTS: Relief of anxiety.
■ DOSAGE: PO: (Adults): 7.5 mg twice daily; increase by 5 mg/day q
2–4 d as needed (not to exceed 60 mg/d). Usual dose is 20–30 mg/d.
■ Administration: May be administered with food to minimize gastric
irritation.
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excitement, fatigue, headache, insomnia, nervousness, weakness,
incoordination, numbness, paresthesia, tremor, personality changes,
blurred vision, hyperventilation, chest pain, palpitations, tachycardia,
hypertension, hypotension, syncope, nausea, abdominal pain, consti-
pation, dry mouth, changes in libido, rashes, alopecia.
■ CONTRAINDICATIONS: Hypersensitivity, severe hepatic or renal
impairment, concurrent use of MAO inhibitors.
■ CAUTIONS: Grapefruit juice ↑ serum levels and effect; ingestion of
large amounts of grapefruit juice is not recommended. Use with MAO
inhibitors may result in hypertension and is not recommended.
Erythromycin, nefazodone, ketoconazole, itraconazole, ritonavir, and
other inhibitors of CYP 3A4 ↑ blood levels and effects of buspirone;
dose reduction is recommended.
CAPTOPRIL (kap-toe-pril) Capoten Antihypertensive Angiotensin-
converting enzyme (ACE) inhibitor Pregnancy Category C (first trimester),
D (second and third trimesters)
■ INDICATIONS: Hypertension, CHF, diabetic nephropathy.
■ THERAPEUTIC EFFECTS: Lowered blood pressure, improvement in
symptoms of CHF. Decrease progression of diabetes neropathy
■ DOSAGE: PO: Adults: 12.5–25 mg 2–3 times daily, may be increased
at 1–2 wk intervals up to 150 mg 3 times daily.
■ ADMINISTRATION: Administer 1 h before or 2 h after meals.
headache, insomnia, weakness, cough, hypotension, angina pectoris,
tachycardia, taste disturbances, anorexia, diarrhea, nausea, protein-
uria, impotence, renal failure, rashes, hyperkalemia, AGRANULOCY-
TOSIS, NEUTROPENIA, ANGIOEDEMA, fever.
■ CONTRAINDICATIONS: Hypersensitivity, cross-sensitivity among ACE
inhibitors may occur, angioedema (hereditary or idiopathic). OB:
Increased risk of congenital malformation when taken during first
trimester. Use cautiously in renal impairment, hepatic impairment,
hypovolemia, hyponatremia, concurrent diuretic therapy.
■ 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
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tongue; difficulty swallowing or breathing occur. • Additive hypotension
with other antihypertensives, nitrates, phenothiazines, acute ingestion
of alcohol, and during surgery or general anesthesia. • Hyperkalemia
may result from concurrent use of potassium supplements, potassium-
sparing diuretics, indomethacin, salt substitutes, or cyclosporine. • May
increase the risk of lithium or digoxin toxicity. • Persistent dry cough
may occur and may not subside until medication is discontinued.
CARBAMAZEPINE (kar-ba-maz-e-peen) Tegretol, Tegretol CR Anti-
convulsant Pregnancy Category D
■ INDICATIONS: Prophylaxis of tonic-clonic, mixed, and complex-partial
seizures. Management of pain in trigeminal neuralgia or diabetic
neuropathy.
■ THERAPEUTIC EFFECTS: Prevention of seizures. Relief of pain in
trigeminal neuralgia.
■ DOSAGE: PO: Adults: Anticonvulsant—200 mg twice daily (tablets) or
100 mg 4 times daily (suspension); increase by 200 mg/d q 7 d until
therapeutic levels are achieved (range is 600–1200 mg/d in divided
doses q 6–8 h). Not to exceed 1 g/d in 12–15-yr-olds. Extended-release
products are given twice daily (XR, CR). Neuropathic pain relief—
100 mg twice daily or 50 mg 4 times daily (suspension); increase by up
to 200 mg/day until pain is relieved, then maintenance dose of
200–1200 mg/day in divided doses (usual range, 400–800 mg/d).
Children 6–12 yr: 100 mg twice daily (tablets) or 50 mg 4 times daily
(suspension) increased by 100 mg weekly until therapeutic levels are
obtained (usual range 400–800 mg/d; not to exceed 1 g/d). Extended-
release products (XR, CR) are given twice. Children <6 yr: 10–20 mg/kg/d
in 2–3 divided doses; may be increased at weekly intervals. Usual main-
tenance dose is 250–350 mg/d (not to exceed 350 mg/kg/day).
■ ADMINISTRATION: May be administered with food to minimize gas-
tric irritation. Do not crush or chew extended-release tablets.
■ ADVERSE REACTIONS AND SIDE EFFECTS: ataxia, drowsiness,
fatigue, hypertension, hypotension, syncope, hepatitis, hesitancy,
urinary retention, photosensitivity, rashes, urticaria. AGRANULOCY-
TOSIS, APLASTIC ANEMIA, THROMBOCYTOPENIA, eosinophilia,
leukopenia.
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■ CONTRAINDICATIONS: Hypersensitivity, bone marrow depression.

Use cautiously in cardiac or hepatic disease.
■ CAUTIONS: OB: Use during pregnancy only if potential benefits out-
weigh risks to the fetus. Geri: Cautious use in older men with prostat-
ic hypertrophy. May ↓ effectiveness of corticosteroids, doxycycline,
felbamate, quinidine, warfarin, estrogen-containing contraceptives,
barbiturates, cyclosporine, benzodiazepines, theophylline, lamotri-
gine, valproic acid, bupropion, and haloperidol. Concurrent use (with-
in 2 wk) of MAO inhibitors may result in hyperpyrexia, hypertension,
seizures, and death. Verapamil, diltiazem, propoxyphene, erythromy-
cin, clarithromycin, SSRIs, antidepressants, or cimetidine ↑ levels
and may cause toxicity. Grapefruit juice ↑ serum levels and effect.
Instruct patients that fever, sore throat, mouth ulcers, easy bruising,
petechiae, unusual bleeding, abdominal pain, chills, rash, pale stools,
dark urine, or jaundice should be reported to health-care professional
immediately.
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 >16 yr: 250–350 mg 4 times daily for
no > 2–3 wk.
■ ADMINISTRATION: Administer with food to minimize GI irritation.
Give dose at bedtime. Provide safety measures; supervise ambulation
and transfer of patients.
agitation, ataxia, depression, insomnia, syncope, asthma attacks,
hypotension, tachycardia, epigastric distress, hiccups, nausea, vomit-
ing, flushing, rashes, ANAPHYLACTIC SHOCK, fever, psychological
dependence, severe idiosyncratic reaction.
■ CONTRAINDICATIONS: Hypersensitivity to carisoprodol or to
meprobamate; porphyria or suspected porphyria. Use cautiously in
severe liver and kidney disease, OB, lactation, children <16 years old.
■ CAUTIONS: Instruct patient to notify health-care professional if
signs of allergy (rash, hives, swelling of tongue or lips, dyspnea) or
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idiosyncratic reaction occur. • Can cause additive CNS depression
with other CNS depressants including alcohol, antihistamines, opioid
analgesics, and sedative/hypnotics. • Concomitant use of kava, valer-
ian, 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, quadriplegia, dizzi-
ness, ataxia, dysarthria, visual disturbances, agitation, euphoria, con-
fusion, 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.
CARVEDILOL (kar-ve-dil-ole) Coreg Antihypertensive (beta blocker)
■ 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 q 2 wk as tolerated (not to exceed
25 mg twice daily in patients <85 kg or 50 mg twice daily in patients
>85 kg).
■ ADMINISTRATION: Administer with food to minimize orthostatic
hypotension.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Weakness, dizziness anxi-
ety, depression, insomnia, blurred vision, bronchospasm, wheezing,
BRADYCARDIA, CHF, PULMONARY EDEMA, diarrhea, impotence,
hyperglycemia, hypoglycemia.
diogenic shock, bradycardia or heart block, hepatic impairment or
bronchial asthma/bronchospasm. Use cautiously in renal impairment,
hepatic impairment, diabetes.
■ CAUTIONS: Teach patient to check pulse daily and blood pressure
biweekly and to report pulse <50 bpm or significant change in blood
pressure. • Abrupt withdrawal may precipitate life-threatening
arrhythmias, hypertension, or myocardial ischemia. • General anes-
thetics, IV phenytoin, diltiazem, and verapamil may cause additive
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myocardial depression. • Additive bradycardia may occur with

digoxin. • Additive hypotension may occur with other antihyperten-
sives or nitrates. • 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.
CEFEPIME (seff-e-peem) Maxipime Anti-infective fourth generation
cephalosporin Pregnancy Category B
■ INDICATIONS: Skin, bone, joint, urinary, gynecological, respiratory
tract, and intra-abdominal infections; septicemia.
bacteria.
■ DOSAGE: IM, IV: Adults: 0.5–1 g q 12 h. Children 2 mo–16 yr:
50 mg/kg q 12 h (not to exceed 2 g/dose).
■ ADMINISTRATION: IV: Monitor injection site frequently for phlebitis.
Rate: Administer over 30 min.
■ ADVERSE REACTIONS AND SIDE EFFECTS: SEIZURES (high doses),
PSEUDOMEMBRANOUS COLITIS, diarrhea, nausea, vomiting, rashes,
urticaria, bleeding, phlebitis at IV site, allergic reactions including
ANAPHYLAXIS and SERUM SICKNESS, superinfection.
■ CONTRAINDICATIONS: Hypersensitivity to cephalosporins or peni-
cillins. Use cautiously in renal impairment, colitis, hepatic dysfunc-
tion, poor nutritional status.
■ 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, wheez-
ing). • Discontinue drug and report signs and symptoms immediately.
• Concurrent use of large doses of cephalosporins and 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.
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CELECOXIB (sel-e-kox-ib) Celebrex Antirheumatic, nonsteroidal anti-
inflammatory (COX-2 inhibitor) Pregnancy Category C
■ INDICATIONS: Osteoarthritis, rheumatoid arthritis, familial adenoma-
tous polyposis.
■ THERAPEUTIC EFFECTS: Decreased arthritic pain and inflammation,
decreased number of colorectal polyps.
■ DOSAGE: PO: Adults: Osteoarthritis: 200 mg/d as a single dose or
100 mg twice daily. Rheumatoid arthritis: 100–200 mg twice daily.
Familial adenomatous poliosis: 400 mg twice daily.
Capsules may be opened and sprinkled on applesauce and ingested
immediately with water.
insomnia, GI BLEEDING, abdominal pain, diarrhea, dyspepsia, flatu-
lence, nausea, rash.
■ CONTRAINDICATIONS: Hypersensitivity, allergic reactions to sulfon-
amides, asthma, urticaria, or allergic reactions to aspirin or other
NSAIDs, advanced renal disease, late pregnancy (may cause prema-
ture closure of ductus arteriosus). Use cautiously in preexisting renal
disease heart failure, liver dysfunction, concurrent diuretic or ACE
inhibitor therapy.
■ 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.
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.
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bacteria.
■ DOSAGE: PO: Adults: 250–500 mg q 6 h. Cystitis, skin, and
soft-tissue infections, streptococcal pharyngitis: 500 mg q 12 h.
Children: 25–50 mg/kg/day n divided q 6–8 h. (Can be administered
q 12 h for skin and soft-tissue infections, streptococcal pharyngitis.)
Otitis media: 18.75–25 mg/kg q 6 h (maximum = 4 g/day).
■ 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, ANA-
PHYLAXIS and serum sickness, superinfection.
■ CONTRAINDICATIONS: Hypersensitivity to cephalosporins, serious
hypersensitivity to penicillins. Use cautiously in renal impairment,
colitis, OB, lactation.
■ 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 and aminoglyco-
sides may increase risk of renal toxicity. • Observe for signs and
symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheez-
ing). Discontinue drug and notify physician or other health-care
professional immediately. • Keep epinephrine and resuscitation
equipment close by in case of an anaphylactic reaction.
CERTOLIZUMAB PEGOL (ser-toe-liz-u-mab) Cimzia Gastroinestinal anti-
inflammatories; tumor necrosis factor blockers Pregnancy Category B
■ INDICATIONS: Moderately-to-severely active Crohn’s disease when
response to conventional therapy has been inadequate.
■ THERAPEUTIC EFFECTS: Decreased signs/symptoms of Crohn’s
disease.
■ DOSAGE: Subcut: Adults: 400 mg initially, repeat 2 and 4 wk later;
may be followed by maintenance dose of 400 mg every 4 wk.
■ ADMINISTRATION: Reconstitute with 1 mL of sterile water for
injection for each vial (2 vials = one dose) for a concentration of
200 mg/mL. Gently swirl; do not shake. May take as long as 30 min
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to fully reconstitute. Refrigerated after 2 h and for up to 24 h prior to
injection. Use 2 syringes to administer, each with a 23-gauge needle.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Arthralgia. ALLERGIC
REACTIONS INCLUDING ANAPHYALXIS, INFECTIONS, lupus-like
syndrome.
■ CONTRAINDICATIONS: Active untreated infection; hepatitis B
reactivation.
■ CAUTIONS: History of recurrent infections, concurrent immuno-
supressants, medical conditions associated with increased risk of
infection, current residence in areas where tuberculosis or histoplas-
mosis are endemic, history of hepatitis B infection (may reactivate),
history of demyelinating disorders (may exacerbate), history of heart
failure. OB: Use only if clearly needed. Lactation: Avoid. Pedi: Safe
use in children not established. Geri: May increase risk of infections.
CETIRIZINE (se-ti-ra-zeen) Zyrtec Allergy, cold and cough remedy, anti-
histamine Pregnancy Category B
■ INDICATIONS: Relief of allergic symptoms including seasonal and
perennial allergic rhinitis, chronic urticaria.
■ THERAPEUTIC EFFECTS: Decreased symptoms of histamine excess
(sneezing, rhinorrhea, nasal and ocular pruritus, ocular tearing and
redness).
■ DOSAGE: PO: Adults and Children >6 yr: 5–10 mg once daily.
Children 2–5 yr: 2.5–5 mg daily. Children 1–2 yr: 2.5 mg once daily,
may be increased to 2.5 mg twice daily. Children 6–12 mo: 2.5 mg
once daily
■ ADMINISTRATION: Administer once daily without regard to food.
fatigue, pharyngitis, dry mouth.
■ CONTRAINDICATIONS: Hypersensitivity, acute attacks of asthma,
lactation. Use cautiously in hepatic or renal impairment.
■ 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.
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CIMETIDINE (sye-meh-tih-deen) Novocimetine, Tagamet Antiulcer agent

(histamine h2 antagonist) Pregnancy Category B
■ INDICATIONS: Duodenal and benign gastric ulcers, GERD, heartburn,
acid indigestion, Zollinger-Ellison syndrome.
■ THERAPEUTIC EFFECTS: Healing and prevention of ulcers, decreased
gastroesophageal reflux, decreased secretion of gastric acid.
■ DOSAGE: PO: Adults: Ulcer treatment or prevention: 600–1200 mg/d
in divided doses or 400–800 mg at bedtime. GERD: 800–1600 mg/d in
divided doses. Zollinger-Ellison syndrome: 300–600 mg q 6 h (up to
2400 mg/d). Children: Active ulcers: 5–10 mg/kg 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 bleed-
ing in critically ill patients: 50 mg/h. Children: Short-term treatment of
active ulcers: 5–10 mg/kg q 6 h.
■ ADMINISTRATION: PO: Administer with meals and at bedtime. Direct
IV: Rate: Dilute and administer over at least 5 min to prevent hypoten-
sion and arrhythmias. Intermittent Infusion: Rate: Dilute and adminis-
ter over 15–30 min.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Confusion, dizziness,
drowsiness, hallucinations, ARRHYTHMIAS, drug-induced hepatitis,
nausea, AGRANULOCYTOSIS, APLASTIC ANEMIA.
■ CONTRAINDICATIONS: Hypersensitivity. Use cautiously in renal
impairment, OB, lactation, geriatric patients more susceptible to CNS
reaction.
■ CAUTIONS: May increase blood levels of chlordiazepoxide, diazepam,
and midazolam, labetalol, metoprolol, propranolol, caffeine, calcium
channel blockers, carbamazepine, chloroquine, lidocaine, metronida-
zole, moricizine, pentoxifylline, phenytoin, propafenone, quinidine,
quinine, metformin, sulfonylureas, tacrine theophylline, triamterene,
tricyclic antidepressants, valproic acid, and warfarin.
CIPROFLOXACIN (sip-roe-flox-a-sin) Cipro Anti-infective (fluoroquino-
lone) Pregnancy Category C
■ INDICATIONS: Urinary tract and gynecological infections, gonorrhea,
prostatitis, respiratory tract infections, skin and skin structure infec-
tions, bone and joint infections, infectious diarrhea, intra-abdominal
infections, febrile neutropenia, postexposure treatment of inhalational
anthrax.
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■ THERAPEUTIC EFFECTS: Death of susceptible bacteria.
■ DOSAGE: PO: Adults: 500–750 mg q 12 h. Gonorrhea: 250-mg single
dose. IV: Adults: 200–400 mg q 12 h.
■ ADMINISTRATION: PO: Do not give within 2 h of administration of
antacids, iron, zinc, or sucralfate. IV: Rate: Administer over 60 min
into a large vein to minimize venous irritation.
drowsiness, headache, acute psychoses, light-headedness, tremors,
PSEUDOMEMBRANOUS COLITIS, abdominal pain, diarrhea, nausea,
photosensitivity, hyperglycemia, hypoglycemia, phlebitis at IV site,
tendinitis, tendon rupture, hypersensitivity reactions including ANA-
PHYLAXIS, STEVENS-JOHNSON SYNDROME.
■ CONTRAINDICATIONS: Hypersensitivity, pregnancy. Use cautiously in
CNS disorders, renal impairment, cirrhosis, Pedi: treatment of anthrax
and complicated UTIs in children 1–17 yr.
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.
CITALOPRAM (si-tal-oh-pram) Celexa Antidepressant (selective sero-
tonin reuptake inhibitor) Pregnancy Category C
■ INDICATIONS: Depression.
■ DOSAGE: PO: Adults: 20–60 mg/d (usual dose is 40mg/day). Geriatric
Patients: 20 mg/d, up to 40 mg/d only in nonresponding patients.
■ ADMINISTRATION: Administer as a single dose in the morning or
evening without regard to food.
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■ ADVERSE REACTIONS AND SIDE EFFECTS: Apathy, confusion,

drowsiness, insomnia, weakness, tremor, agitation, amnesia, anxiety,
decreased libido, dizziness, fatigue, impaired concentration, increased
depression, migraine headache, suicide attempt, cough, postural
hypotension, tachycardia, abdominal pain, anorexia, diarrhea, dry
mouth, dyspepsia, flatulence, increased saliva, nausea, increased
appetite, vomiting, amenorrhea, ejaculatory delay, impotence,
polyuria, increased sweating, photosensitivity, pruritus, rash,
arthralgia, myalgia, paresthesia, fever, yawning.
■ CONTRAINDICATIONS: Hypersensitivity, concurrent MAO inhibitor
therapy. Use cautiously in mania, suicide attempt/ideation, seizure
disorder, severe renal and hepatic impairment.
■ 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 d between citalopram and
MAO inhibitors. • Serotonergic effects may be potentiated by lithium
(concurrent use should be carefully monitored). • Concurrent use with
5-HT1 agonists used for migraine headaches may increase the risk
of adverse reactions (weakness, hyperreflexia, incoordination).
• Increased risk of serotonergic side effects including serotonin
syndrome with St. John’s wort and SAMe.
CLINDAMYCIN (klin-da-mye-sin) Cleocin, Dalacin C Anti-infective
Pregnancy Category B
■ INDICATIONS: Skin, skin structure, respiratory tract, intra-abdominal
and gynecological infections, septicemia, osteomyelitis, endocarditis
prophylaxis, severe acne.
■ THERAPEUTIC EFFECTS: Bactericidal or bacteriostatic to susceptible
organisms.
■ DOSAGE: PO: Adults: Most infections: 150–450 mg q 6 h. P. carinii
pneumonia: 1200–1800 mg/d in divided doses with 15–30 mg
primaquine/d. CNS toxoplasmosis: 1200–2400 mg/d in divided doses
with pyrimethamine 50–100 mg/d. Children >1 mo: 2–5 mg/kg q 6 h or
2.7–6.7 mg/kg q 8 h. IM, IV: Adults: Most infections: 300–600 mg q 6–8 h
or 900 mg q 8 h. P. carinii pneumonia: 2400–2700 mg/d in divided doses
with primaquine. Toxoplasmosis: 1200–4800 mg/d in divided doses with
pyrimethamine. Children >1 mo: 10–30 mg/kg/day divided in q 6–8 h,
maximum dose 1.8g/day. Infants <1 mo: 5 mg/kg q 8–12 h.
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■ 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 (30 mg/min).
■ ADVERSE REACTIONS AND SIDE EFFECTS: Arrhythmias, hypoten-
sion, PSEUDOMEMBRANOUS COLITIS, diarrhea, bitter taste (IV only),
nausea, vomiting, rash.
■ CONTRAINDICATIONS: Hypersensitivity, history of pseudomembra-
nous colitis, severe liver impairment, diarrhea. Use cautiously in OB
and lactation.
■ CAUTIONS: Monitor GI status, diarrhea, abdominal cramping, fever,
and bloody stools may be a sign of pseudomembranous colitis and
should be reported immediately. • Pseudomembranous colitis may
begin up to several weeks following the cessation of therapy.
• Instruct patient to finish the drug completely as directed, even
if feeling better.
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, sedation.
■ THERAPEUTIC EFFECTS: Prevention of seizures, decreased frequency
of panic attacks.
■ DOSAGE: PO: Adults: 0.5 mg 3 times daily, not to exceed 20 mg/d.
Panic disorder: 0.125 mg twice daily. Children <10 yr or 30 kg: Initial
daily dose 0.01–0.03 mg/kg/d (not to exceed 0.05 mg/kg/d) given in
2–3 equally divided doses; increase by no more than 0.25–0.5 mg q
3rd day (not to exceed 0.2 mg/kg/d).
■ ADMINISTRATION: Administer with food to minimize gastric irritation.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Behavioral changes,
drowsiness, diplopia, nystagmus, increased secretions, palpitations,
hepatitis, dysuria, nocturia, urinary retention, anemia, ataxia, hypoto-
nia, fever, physical dependence, psychological dependence.
■ CONTRAINDICATIONS: Hypersensitivity to clonazepam or other
benzodiazepines, severe liver disease. Use cautiously in glaucoma,
sleep apnea, chronic respiratory disease, OB, lactation, pediatrics,
geriatrics.
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■ CAUTIONS: Additive CNS depression with alcohol, antidepressants,

antihistamines, other benzodiazepines, opioid analgesics, kava,
valerian, skullcap, chamomile, or hops. • Cimetidine, hormonal con-
traceptives, disulfiram, fluoxetine, isoniazid, ketoconazole, metopro-
lol, propoxyphene, propranolol, or valproic acid may decrease the
metabolism of clonazepam, enhancing its actions. • May increase
serum phenytoin levels. • Phenytoin may decrease serum clonazepam
levels. Instruct patient to notify health-care professional of unusual
tiredness, bleeding, sore throat, fever, clay-colored stools, yellowing
of skin, or behavioral changes. • Do not discontinue abruptly.
CLONIDINE (klon-i-deen) Catapres, Catapres-TTS, Duraclon Anti-
hypertensive Pregnancy Category C
■ INDICATIONS: Mild-to-moderate hypertension; epidural: management
of cancer pain unresponsive to opioids alone (unlabeled use); opioid
withdrawal (unlabeled use).
■ THERAPEUTIC EFFECTS: Decreased blood pressure, decreased pain.
■ DOSAGE: PO: Adults: 200–600 mcg (0.2–0.6 mg)/d in 2–3 divided
doses (up to 2.4 mg/d). Opioid withdrawal: 300 mcg (0.3 mg)–
1.2 mg/d. Geriatric Patients: 100 mcg (0.1 mg) at bedtime initially,
increased as needed. Children: 50–400 mcg (0.05–0.4 mg) twice daily.
Transdermal: Adults: Hypertension: 100–300 mcg (0.1–0.3 mg)/24 h
every 7 days. Epidural: Adults: 30 mcg/h. Children: 50–400 mcg
(0.05–0.4 mg) twice daily.
■ ADMINISTRATION: PO: Administer last oral dose of the day at bed-
time. 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, palpi-
tations, dry mouth, constipation, nausea, vomiting, impotence, rash,
sweating, sodium retention, weight gain, withdrawal phenomenon.
■ CONTRAINDICATIONS: Hypersensitivity. Epidural: anticoagulant ther-
apy, or bleeding problems. Use cautiously in cardiac or cerebrovascu-
lar disease, renal failure.
■ CAUTIONS: Additive hypotension with other antihypertensives
and nitrates. • Additive bradycardia with myocardial depressants.
• Decreased antihypertensive effect with MAO inhibitors,
amphetamines, beta blockers, prazosin, or tricyclic antidepressants.
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• Withdrawal phenomenon may be increased by discontinuation of
beta blockers. • Increased risk of adverse cardiovascular reactions with
verapamil. • All routes of clonidine should be discontinued gradually
over 2–4 d to prevent rebound hypertension.
CLOPIDOGREL (kloh-pid-oh-grel) Plavix Antiplatelet agent (platelet
aggregation inhibitor) Pregnancy Category B
■ INDICATIONS: Reduction of atherosclerotic events (MI, stroke, vascu-
lar death) in patients at risk for such events (recent MI, stroke, or
peripheral vascular disease).
■ THERAPEUTIC EFFECTS: Decreased occurrence of atherosclerotic
events in patients at risk.
■ DOSAGE: PO: Adults: 300 mg initially then 75 mg once daily; aspirin
75–325 mg once daily should be given concurrently.
■ ADMINISTRATION: Administer once daily without regard to food.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Depression, dizziness,
fatigue, headache, epistaxis, cough, dyspnea, chest pain, edema,
hypertension, GI BLEEDING, abdominal pain, diarrhea, dyspepsia,
gastritis, pruritus, purpura, rash, BLEEDING, NEUTROPENIA, THROM-
BOTIC THROMBOCYTOPENIC PURPURA, hypercholesterolemia, arthral-
gia, back pain. Hypersensitivity reactions including ANGIOEDEMA,
ANAPHYLACTOID REACTIONS, BRONCHOSPASM.
■ CONTRAINDICATIONS: Hypersensitivity, pathological bleeding (peptic
ulcer, intracranial hemorrhage). Lactation: May pass into breast milk
and expose nursing infant to pharmacological effects.
■ CAUTIONS: Monitor patient for signs of thrombotic thrombocytic pur-
pura (thrombocytopenia, microangiopathic hemolytic anemia, neuro-
logical 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, eptifi-
batide, tirofiban, aspirin, NSAIDs, heparin, heparinoids, thrombolytic
agents, ticlopidine, or warfarin may increase the risk of bleeding.
• May inhibit the metabolism and increase the effects of phenytoin,
tolbutamide, tamoxifen, torsemide, fluvastatin, and many NSAIDs.
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CLOZAPINE (kloe-za-peen) Clozaril, FazaClo Antipsychotics Pregnancy

Category B
■ INDICATIONS: Schizophrenia unresponsive to or intolerant of stan-
dard therapy with other antipsychotics. To reduce recurrent suicidal
behavior in schizophrenic patients.
■ THERAPEUTIC EFFECTS: Diminished schizophrenic or suicidal
behavior.
■ DOSAGE: PO: Adults: 25 mg 1–2 times daily initially; increase by
25–50 mg/d over a period of 2 wk up to target dose of 300–450 mg/d.
May increase by up to 100 mg/d once or twice further (not to exceed
900 mg/d). Treatment should be continued for at least 2 yr in patients
with suicidal behavior.
■ ADMINISTRATION: PO: Administer capsules with food or milk to
decrease gastric irritation. Leave oral disintegrating tablet in blister
until ready to use, then peel foil and gently remove tablet.
Immediately place tablet in mouth and allow to disintegrate.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Extrapyramidal reactions,
NEUROLEPTIC MALIGNANT SYNDROME, SEIZURES, dizziness, seda-
tion, visual disturbances, MYOCARDITIS, hypotension, tachycardia,
hypertension, constipation, dry mouth, increased salivation, nausea,
vomiting, hyperglycemia, AGRANULOCYTOSIS, LEUKOPENIA.
■ CONTRAINDICATIONS: Hypersensitivity, bone marrow depression,
severe CNS depression/coma. Lactation: Do not use if breastfeeding.
■ CAUTIONS: Cautious use in prostatic enlargement, narrow-angle
glaucoma, diabetes, seizures or patients with cardiovascular, hepatic,
or renal disease. Increased anticholinergic effects with other agents
having anticholinergic properties, including antihistamines,
quinidine, disopyramide, and antidepressants. Concurrent use with
SSRI antidepressants ↑ blood levels and risk of toxicity (especially
fluvoxamine). ↑ CNS depression with alcohol, antidepressants, anti-
histamines, opioid analgesics, or sedative/hypnotics. ↑ hypotension
with nitrates, acute ingestion of alcohol, or antihypertensives. ↑ risk
of bone marrow suppression with antihypertensives or radiation
therapy. Use with lithium ↑ risk of adverse CNS reactions, including
seizures. Pedi: Safety not established for children <16 yr. Geri: ↑ risk
of death in elderly patients with dementia-related psychosis.
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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: 0.6–1.2 mg, then 0.6 mg q 1–2 h until a total
cumulative dose of 8 mg is achieved. See following dosage cautions.
IV: Adults: 2 mg initially, then 0.5 mg q 6 h or 1 mg q 6–12 h until a total
cumulative dose of 4 mg is achieved. See following dosage cautions.
■ ADMINISTRATION: PO: Administer with food. IV: Avoid extravasation;
may cause necrosis.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Diarrhea, nausea, vomit-
ing, abdominal pain, anuria, hematuria, alopecia, AGRANULOCYTO-
SIS, APLASTIC ANEMIA, leukopenia, thrombocytopenia.
■ CONTRAINDICATIONS: Hypersensitivity; pregnancy; severe renal,
hepatic or biliary disease. Use cautiously in elderly, debilitated
patients; renal impairment; lactation; children.
■ CAUTIONS: HIGH ALERT MED: Therapeutic range is narrow.
Overdose can be fatal. In an acute exacerbation, 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 d. 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 d. 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.
CYCLOBENZAPRINE (sye-kloe-ben-za-preen) Flexeril Skeletal muscle
relaxants Pregnancy Category B
■ INDICATIONS: Management of acute painful musculoskeletal condi-
tions associated with muscle spasm. Unlabeled Uses: Management of
fibromyalgia.
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■ THERAPEUTIC EFFECTS: Reduction in muscle spasm and hyper-

activity without loss of function.
■ DOSAGE: PO: Adults: Acute painful musculoskeletal conditions:
10 mg 3 times daily (range 20–40 mg/d in 2–4 divided doses; not to
exceed 60 mg/d). Fibromyalgia: 5–40 mg at bedtime (unlabeled).
■ ADMINISTRATION: May be administered with meals to minimize
gastric irritation.
confusion, fatigue, headache, nervousness, dry mouth, blurred vision,
arrhythmias, constipation, dyspepsia, nausea, unpleasant taste,
urinary retention.
■ CONTRAINDICATIONS: Should not be used within 14 days of MAO
inhibitor therapy. Hypersensitivity, immediate period after MI, severe
or symptomatic cardiovascular disease, cardiac conduction distur-
bances, hyperthyroidism.
■ CAUTIONS: Cardiovascular disease, additive CNS depression with
other CNS depressants, including alcohol, antihistamines, opioid
analgesics, and sedative/hypnotics. Additive anticholinergic effects
with drugs possessing anticholinergic properties, including antihista-
mines, antidepressants, atropine, disopyramide, haloperidol, and
phenothiazines. Avoid use within 14 d of MAO inhibitors (hyper-
pyretic crisis, seizures, and death may occur). May blunt the response
to guanadrel. Do not confuse cyclobenzaprine with cyproheptadine.
OB/Lactation/Pedi: Safety not established for pregnant or lactating
women, or children <15 yr. Geri: Appears on Beers list. Poorly
tolerated by geriatric patients due to anticholinergic effects.
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DALTEPARIN (dal-te-pa-rin) Fragmin Anticoagulant (low molecular
weight heparin [LMWH]) (antithrombotic) Pregnancy Category B
■ INDICATIONS: Prevention of deep vein thrombosis, pulmonary
emboli, ischemic complications in patients with unstable
angina/non–Q-wave MI. LMWH has a more predictable anticoagulant
response—special monitoring of clotting times is not necessary.
■ THERAPEUTIC EFFECTS: Prevention of thrombus formation.
■ DOSAGE: SC: Adults: Presurgical prophylaxis of DVT: 2500 IU 1–2 h
before surgery, then once daily for 5–10 days; angina/non–Q-wave
MI: 120 IU/kg every 12 h (not to exceed 10,000 IU).
■ ADMINISTRATION: SC: Administer deep into SC tissue. Do not aspi-
rate or massage. Rotate sites frequently.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness, insomnia,
edema, urinary retention, ecchymoses, pruritus, rash, urticaria,
BLEEDING, anemia, thrombocytopenia, hematoma.
■ CONTRAINDICATIONS: Hypersensitivity, uncontrolled bleeding,
thrombocytopenia, regional anesthesia during treatment for unstable
angina/non–Q-wave MI.
■ CAUTIONS: HIGH ALERT MED: Assess patient for signs of bleeding
and hemorrhage (bleeding gums; nosebleed; unusual bruising; black,
tarry stools; hematuria; fall in hematocrit or blood pressure; guaiac-
positive stools); bleeding from surgical site. Notify physician if these
occur. • Risk of bleeding may be increased by warfarin, aspirin,
NSAIDs, dipyridamole, some penicillins, clopidogrel, ticlopidine,
abciximab, eptifibatide, tirofiban, and dextran. • Increased bleeding
risk with anise, arnica, chamomile, clove, feverfew, garlic, ginger,
ginkgo, Panax ginseng, and others.
DARUNAVIR (da-runa-veer) Prezista Antiretroviral, protease inhibitor
■ INDICATIONS: HIV infection (must be used with ritonavir and with
other antiretrovirals).
■ THERAPEUTIC EFFECTS: Increased CD4 cell counts and decreased
viral load with subsequent slowed progression of HIV infection and
its sequelae.
■ DOSAGE: PO: Adults: 600 mg with ritonavir 100 mg twice daily.
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■ ADMINISTRATION: Must be administered with a meal or light snack

along with ritonavir 100 mg to be effective. Do not chew.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Constipation, diarrhea,
nausea, vomiting. Hyperglycemia, body fat redistribution, rash.
■ CONTRAINDICATIONS: Concurrent dihydroergotamine, ergonovine,
ergotamine, methylergonovine, midazolam, pimozide, triazolam,
lovastatin, simvastatin, rifampin, or St. John’s wort; Lactation: HIV
may be transmitted in human milk; Pedi: Safety not established.
■ CAUTIONS: Darunavir and ritonavir are both inhibitors of CYP3A and
are metabolized by CYP3A. Multiple drug-drug interactions can be
expected with drugs that share, inhibit, or induce these pathways.
Consult product information for more specific details. ↑ metabolism
and may ↓ antiretroviral effectiveness, concurrent use is contraindi-
cated. ↓ metabolism of and may ↑ risk of myopathy with lovastatin
and simvastatin; concurrent use is contraindicated. ↑ levels and risk
of cardiotoxicity with pimozide; concurrent use is contraindicated. ↑
levels and risk of excess CNS depression with midazolam or triazo-
lam; concurrent use is contraindicated. ↑ levels and risk of myopathy
from atorvastatin, rosuvastatin, or pravastatin (use lowest dose of
these agents or consider fluvastatin). Concurrent use with efavirenz
results in ↓ darunavir levels and ↑ efavirenz levels; use combination
cautiously. Lopivavir/ritonavir may ↓ levels; although concurrent use
is not recommended, additional ritonavir may be required. Saquinavir
may ↓ levels; concurrent use is not recommended. ↑ levels of lido-
caine, quinidine, propafenone, flecainide, and amiodarone; use cau-
tiously and with available blood level monitoring. ↓ levels of
warfarin; monitor INR. ↑ levels of trazodone and desipramine; use
cautiously and ↓ dose if necessary. ↑ levels of clarithromycin; ↓ dose
of clarithromycin if CCr ≤60 mL/min. Ketoconazole and itraconazole
may ↑ levels . ↑ levels of ketoconazole and itraconazole; daily dose
of itraconazole or ketoconazole should not be >200 mg. ↓ levels of
voriconazole; concurrent use not recommended. Concurrent use with
rifabutin ↑ rifabutin levels and ↓ darunavir levels; (may be due to
ritonavir); ↓ rifabutin dose to 150 mg every other day. ↑ levels of
felodipine, nifedipine, or nicardipine; monitor clinical response care-
fully. Dexamethasone ↓ levels. May ↑ levels of inhaled fluticasone;
choose alternative inhaled corticosteroid. ↑ levels of cyclosporine,
tacrolimus, or sirolimus; blood level monitoring recommended.
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↓ levels of methadone. ↓ levels of sertraline and paroxetine; adjust
dose by clinical response. St. John’s wort ↑ metabolism and may ↓
antiretroviral effectiveness; concurrent use is contraindicated.
DEXAMETHASONE (dex-a-meth-a-sone) DexPak Steroidal anti-
inflammatory (systemic corticosteroid) Pregnancy Category C
■ INDICATIONS: Inflammatory, allergic, hematological, neoplastic,
autoimmune disorders; replacement therapy in adrenal insufficiency,
cerebral edema. Diagnostic agent in adrenal disorders.
■ THERAPEUTIC EFFECTS: Suppression of inflammation, modification
of the normal immune response.
■ DOSAGE: PO, IM, IV: Adults: 0.5–9 mg daily in divided doses q 6–12 h.
Cerebral edema: 10 mg initially IV, 4 mg q 6 h, until maximum response
achieved, then switch to PO regimen and taper over 5–7 days.
■ ADMINISTRATION: PO: Administer with meals to minimize GI irrita-
tion. Direct IV: May be given undiluted. Do not administer suspension
IV. Rate: Administer over 1–4 min if dose is <10 mg.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Depression, euphoria,
psychoses, restlessness, cataracts, hypertension, PEPTIC ULCERA-
TION, anorexia, nausea, acne, decreased wound healing,
ecchymoses, 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. Use
cautiously in hypothyroidism, cirrhosis, pediatrics, OB.
■ CAUTIONS: Instruct patient to promptly report severe abdominal pain
or tarry stools. • May increase requirement for insulin or oral hypo-
glycemic 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.
DIAZEPAM (dye-az-e-pam) Apo-Diazepam, Diastat, Novodipam, Valium,
Vivol Antianxiety agent, anticonvulsant, sedative/hypnotic, skeletal muscle
relaxant (benzodiazepine) Schedule IV Pregnancy Category D
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■ INDICATIONS: Anxiety, preoperative sedation, conscious sedation,

status epilepticus/uncontrolled seizures, skeletal muscle relaxant,
alcohol withdrawal.
■ THERAPEUTIC EFFECTS: Relief of anxiety, sedation, skeletal muscle
relaxation, decreased seizure activity, amnesia.
■ DOSAGE: PO: Adults: 2–10 mg 2–4 times daily. Children >1 mo:
0.12–0.8 mg/kg/d 3–4 times daily. IV, IM: Adults: 2–10 mg may repeat
in 3–4 h as needed. Children >1 mo: 0.04–0.3 mg/kg/d q 2–4 h to a
maximum of 0.6 mg/kg within an 8-h period
■ ADMINISTRATION: PO: Tablets may be crushed. Do not crush, break,
or chew sustained-release capsules. IM: IM injections are painful and
erratically absorbed; inject deeply into deltoid muscle for maximum
absorption. IV: Do not dilute or mix IV diazepam with any other drug.
Administer into Y site as close to insertion site as possible—can pre-
cipitate 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 1–2 mg/min. Rectal: Do not repeat Diastat
rectal dose more than 5 times/mo or 1 episode every 5 d. Round up
dose to next available dose unit.
lethargy, depression, hangover, headache, paradoxical excitation,
blurred vision, respiratory depression, hypotension (IV only), consti-
pation, diarrhea, nausea, vomiting, rashes, pain (IM), phlebitis (IV),
venous thrombosis, physical dependence, psychological dependence,
tolerance.
■ CONTRAINDICATIONS: Hypersensitivity, comatose patients, preexisting
CNS depression, uncontrolled severe pain, narrow-angle glaucoma,
pregnancy, or lactation.
■ CAUTIONS: Have resuscitation equipment available when adminis-
tering IV; rapid injection may cause apnea, hypotension, bradycardia,
or cardiac arrest. • Use cautiously in hepatic dysfunction, severe renal
impairment, history of suicide attempt or drug dependence, geriatric
or debilitated patients, and children. • Concurrent use of alcohol, anti-
depressants, antihistamines, and opioid analgesics results in additive
CNS depression. • Cimetidine, hormonal contraceptives, disulfiram,
fluoxetine, isoniazid, ketoconazole, metoprolol, propoxyphene, pro-
pranolol, or valproic acid may decrease the metabolism of diazepam,
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enhancing its actions. • May decrease the efficacy of levodopa.
• Rifampin or barbiturates may increase the metabolism and
decrease effectiveness of diazepam. • Sedative effects may be
decreased by theophylline. • Concomitant use of kava, valerian, skull-
cap, chamomile, or hops can increase CNS depression. • Medication
may cause drowsiness, clumsiness, or unsteadiness; advise patient to
medication is known. • Caution patient to avoid taking alcohol or
other CNS depressants concurrently with this medication.
DICLOFENAC (topical patch) (dye-kloe-fen-ak) Flector Nonsteroidal anti-
inflammatory agent, analgesic Pregnancy Category B
■ INDICATIONS: Topical treatment of acute pain due to arthritis and
minor strains, sprains, or contusions.
■ THERAPEUTIC EFFECTS: Decreased pain.
■ DOSAGE: Transdermal: One patch applied to most painful area twice
daily.
■ ADMINISTRATION: Apply patch to the most painful area twice a
day. Do not apply to nonintact or damaged skin resulting from any
etiology (exudative dermatitis, eczema, infected lesion, burns,
wounds). Avoid contact with eyes; wash hands after applying,
handling, or removing patch.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Edema, hypertension, GI
BLEEDING, ↑ liver enzymes, renal toxicity, STEVENS-JOHNSON SYN-
DROME, TOXIC EPIDERMAL NECROLYSIS, local reactions at treat-
ment site, rash, ALLERGIC REACTIONS INCLUDING ANAPHYLACTOID
REACTIONS.
■ CONTRAINDICATIONS: Hypersensitivity; cross-sensitivity with other
NSAIDs may exist; history of aspirin triad (nasal polyps, asthma, bron-
chospasm following aspirin); treatment of perioperative pain following
coronary artery bypass graft (CABG) surgery; advanced renal disease;
application to nonintact or damaged skin. OB: Late pregnancy (may
cause premature closure of the ductus arteriosus) or lactation.
■ CAUTIONS: Concurrent use with aspirin or warfarin may ↑ risk of
adverse GI reactions. • May ↓ antihypertensive response to thiazide
diuretics, ACE inhibitors, or loop diuretics. • May ↑ blood levels and
risk of toxicity from lithium or methotrexate; careful monitoring
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required. • Use cautiously in patients with history of cardiovascular

disease or risk factors (increased risk of serious cardiovascular
effects); history of hypertension or edema (may exacerbate condi-
tion); history of impaired renal or hepatic function, heart failure, con-
current ACE inhibitor or diuretic therapy (increased risk of renal toxic-
ity); chronic corticosteroid therapy (slow tapering of corticosteroids
required); bleeding abnormalities or platelet dysfunction. • Exercise
extreme caution in patients with history of ulcer disease or GI bleed-
ing, preexisting asthma. • Pedi: Safe use not established. • Geri:
Increased risk of adverse effects; consider age-related decrease in
metabolic pathways, concurrent disease states, and drug therapy.
DIGOXIN (di-jox-in) Digitek, Lanoxicaps, Lanoxin Antiarrhythmic,
inotropic Pregnancy Category C
■ INDICATIONS: CHF, tachyarrhythmias atrial fibrillation and atrial flutter,
paroxysmal atrial tachycardia.
■ THERAPEUTIC EFFECTS: Increased cardiac output and slowing of the
heart rate.
■ DOSAGE: PO: Maintenance dose: Adults: 0.125–0.5 mg daily. Geriatric
Patients: Daily dosage should not exceed 0.125 mg except when
treating atrial fibrillation. Children >10 yr: 2.5–5 mcg/kg, daily as a
single dose. Children 5–10 yr: 5–10 mcg/kg given daily in 2 divided
doses. Children 2–5 yr: 7.5–10 mcg/kg given daily in 2 divided doses.
Children 1–24 mo: 10–15 mcg/kg given daily in 2 divided doses.
Loading dose IV: Adults: 0.5–1 mg given as 50% of the dose initially
and one quarter of the initial dose in each of 2 subsequent doses at
6–12 h intervals. Children >10 yr: 8–12 mcg/kg given as 50% of the
dose initially and one quarter of the initial dose in each of 2 subse-
quent doses at 6–12 h intervals. Children 5–10 yr: 15–30 mcg/kg given
as 50% of the dose initially and one quarter of the initial dose in each
of 2 subsequent doses at 6–12 h intervals. Children 2–5 yr: 25–35 mcg/kg
given as 50% of the dose initially and one quarter of the initial dose
in each of 2 subsequent doses at 6–12 h intervals. Children 1–24
mo: 30–50 mcg/kg given as 50% of the dose initially and one quarter
of the initial dose in each of 2 subsequent doses at 6–12 h intervals.
■ ADMINISTRATION: PO: Administer without regard to meals. Tablets
can be crushed. IV: IV doses may be given undiluted or each mL may
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be diluted in 4 mL of sterile water, 0.9% NaCl, D5W, or LR for injec-
tion. Less diluent will cause precipitation. Use diluted solution imme-
diately. Rate: Administer over a minimum of 5 min.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Fatigue, headache, weak-
ness, blurred vision, yellow vision, ARRHYTHMIAS, bradycardia, ECG
changes, anorexia, nausea, vomiting, diarrhea, gynecomastia, throm-
bocytopenia.
■ CONTRAINDICATIONS: Hypersensitivity, uncontrolled ventricular
arrhythmias, AV block, idiopathic hypertrophic subaortic stenosis,
constrictive pericarditis.
■ CAUTIONS: HIGH ALERT MED: Narrow therapeutic range (normal
serum level: 0.5–2 ng/mL). Monitor digoxin levels and assess for
signs and symptoms of toxicity: abdominal pain, anorexia, nausea,
vomiting, visual disturbances, bradycardia, and other arrhythmias.
• Assess apical pulse for 1 min before administering. If pulse rate is
<60 bpm in an adult, <70 bpm in a child, or <90 bpm in an infant, or if
patient exhibits signs or symptoms of toxicity, withhold drug and
notify physician or health-care professional immediately. • Monitor
ECG throughout IV administration. • Treatment of life-threatening
arrhythmias from digitalis toxicity may include administration of
digoxin immune Fab (Digibind), which binds to the digitalis glycoside
molecule in the blood and is excreted by the kidneys. Temporary ven-
tricular pacing may be useful in advanced heart block. • Teach patient
to take pulse and to contact health-care professional before taking
medication if pulse rate is <60 or >100. • Review signs and symptoms
of digitalis toxicity with patient and family. Advise patient to notify
health-care professional immediately if these or symptoms of CHF
occur. Inform patient that these symptoms may be mistaken for those
of colds or flu. • Use cautiously in electrolyte abnormalities (may pre-
dispose 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 cortico-
steroids, which cause hypokalemia, may increase the risk of toxicity.
• Quinidine, quinine, cyclosporine, amiodarone, verapamil, diltiazem,
propafenone, and diclofenac increase serum levels and may lead to
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toxicity. • Spironolactone increases half-life. • Additive bradycardia

may occur with beta blockers and other antiarrhythmics (quinidine,
disopyramide). • St. John’s wort may decrease digoxin levels and
effect.
DILTIAZEM (dil-tye-a-zem) Apo-Diltiaz, Cardizem, Diltia XT, Nu-Diltiaz,
Antianginal, antiarrhythmic, antihypertensive (calcium channel blocker)
■ INDICATIONS: Hypertension, angina, supraventricular tachyarrhyth-
mias, atrial flutter/fibrillation with rapid ventricular rate.
■ THERAPEUTIC EFFECTS: Decreased blood pressure, decreased
frequency and severity of angina, suppression of arrhythmias.
■ DOSAGE: PO: Adults: 30–120 mg 3–4 times daily or 60–120 mg daily
as SR capsule or 240 mg daily as CD, XR, or LA. IV: Adults: 0.25 mg/kg;
may repeat in 15 minutes with a dose of 0.35 mg/kg. May follow with
infusion at 10 mg/h
■ ADMINISTRATION: PO: Give with meals if GI irritation is a problem.
IV: Rate: Administer bolus over 2 min (5 mg/m).
■ ADVERSE REACTIONS AND SIDE EFFECTS: Anxiety, confusion, weak-
ness, blurred vision, paresthesia, tremor, disturbed equilibrium, epis-
taxis, tinnitus, cough, dyspnea, ARRHYTHMIAS, CHF, peripheral
edema, bradycardia, chest pain, palpitations, tachycardia, abnormal
liver function studies, erythema multiforme, photosensitivity,
pruritus/urticaria, hyperglycemia, blood dyscrasias, STEVENS-
JOHNSON SYNDROME, gingival hyperplasia.
■ CONTRAINDICATIONS: Hypersensitivity, sick sinus syndrome, 2nd- or
3rd-degree AV block, blood pressure <90 mm Hg, recent MI, or pul-
monary congestion. Use cautiously in severe renal or hepatic impair-
ment, serious ventricular arrhythmias, CHF.
■ CAUTIONS: Monitor ECG during IV administration: Have emergency
equipment available. • Additive hypotension with fentanyl, antihyper-
tensives, nitrates, or quinidine. • Digoxin levels may be increased.
• Concurrent use with beta blockers, digoxin, disopyramide, or
phenytoin may result in bradycardia, conduction defects, or CHF.
• Cimetidine, ranitidine, and grapefruit juice increase blood levels.
• Instruct patient to monitor pulse and contact health-care
professional if <50 bpm. • Caution patient to change positions
slowly.
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DONEPEZIL (doe-nep-i-zill) Aricept Anti-Alzheimer’s agent, cholinergic
■ INDICATIONS: Mild-to-moderate dementia associated with Alzheimer’s
disease.
■ THERAPEUTIC EFFECTS: May temporarily lessen some of the dementia
associated with Alzheimer’s disease.
■ DOSAGE: PO: Adults: 5 mg once daily; after 4–6 wk may increase to
10 mg once daily (dose should not exceed 5 mg/d in frail, elderly
females).
■ 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, syn-
cope, atrial fibrillation, hypertension, hypotension, vasodilation,
diarrhea, nausea, anorexia, vomiting, frequent urination,
ecchymoses, hot flashes, weight loss, arthritis, muscle cramps.
■ CONTRAINDICATIONS: Hypersensitivity to donepezil or piperidino
derivatives. Use cautiously in patients with underlying cardiac dis-
ease, sick sinus syndrome, supraventricular conduction defect.
■ CAUTIONS: Exaggerates muscle relaxation from succinylcholine.
• Interferes with the action of anticholinergics. Increases the choliner-
gic effects of bethanechol. • May increase the risk of GI bleeding from
NSAIDs. Quinidine and ketoconazole decrease the metabolism.
Rifampin, carbamazepine, dexamethasone, phenobarbital, and
phenytoin induce the enzymes that metabolize donepezil and may
decrease its effects. • Monitor heart rate during therapy; may cause
bradycardia. • Caution patient and caregiver that donepezil may
cause dizziness. • Advise patient and caregiver to notify health-care
professional if nausea, vomiting, diarrhea, or changes in color of
stool occur, if new symptoms occur, or previously noted symptoms
increase in severity. • Advise patient and caregiver to notify health-
care professional of medication regimen before treatment or surgery.
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DOXAZOSIN (dox-ay-zoe-sin) Cardura Antihypertensive (antiadrenergic)

■ INDICATIONS: Hypertension, symptomatic management of benign
prostatic hyperplasia (BPH).
■ THERAPEUTIC EFFECTS: Lowers blood pressure.
■ DOSAGE: PO: Adults: Hypertension: 2–16 mg/d; incidence of postural
hypotension greatly increased at doses >4 mg/d. BPH: 1 mg once
daily, may be gradually increased to 8 mg/d.
■ ADMINISTRATION: Administer daily dose at bedtime.
depression, drowsiness, fatigue, nervousness, weakness, abnormal
vision, blurred vision, conjunctivitis, epistaxis, dyspnea, first-dose
orthostatic hypotension, arrhythmias, chest pain, edema, palpitations,
abdominal discomfort, constipation, diarrhea, dry mouth, flatulence,
nausea, vomiting, decreased libido, sexual dysfunction, flushing,
rash, arthralgia, arthritis, gout, myalgia.
■ CONTRAINDICATIONS: Hypersensitivity. Use cautiously in hepatic
and renal dysfunction.
■ CAUTIONS: Additive hypotension with acute ingestion of alcohol,
other antihypertensives, or nitrates. • May decrease antihypertensive
effect of clonidine. • Monitor blood pressure and pulse 2–6 h after
first dose, with each increase in dose, and periodically throughout
course of therapy. • BPH: Assess patient for symptoms of prostatic
hyperplasia (urinary hesitancy, feeling of incomplete bladder empty-
ing, bladder distention, interruption of urinary stream, impairment of
size and force of urinary stream, terminal urinary dribbling, straining
to start flow, dysuria, urgency) before and periodically throughout
therapy. • Hypertension: May be administered concurrently with a
diuretic or other antihypertensive. • Advise patient to check blood
pressure at least weekly and report significant changes.
DOXYCYCLINE (dox-i-sye-kleen) Apo-Doxy, Doryx, Doxy, Doxy Caps,
Doxycin, Monodox, Novodoxylin, Periostat, Vibramycin, Vibra-Tabs
Antiinfectives Pregnancy Category D
■ INDICATIONS: Treatment of various infections caused by unusual
organisms, including: Mycoplasma, Chlamydia, Rickettsia, Borrelia
burgdorferi; treatment of inhalational anthrax (postexposure) and
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cutaneous anthrax; treatment of gonorrhea and syphilis in penicillin-
allergic patients; prevention of exacerbations of chronic bronchitis;
treatment of acne.
■ THERAPEUTIC EFFECTS: Bacteriostatic action against susceptible
bacteria.
■ Dosage: PO: Adults and Children >8 yr and >45 kg: Most infections—
100 mg q 12 h on the 1st day, then 100–200 mg once daily or 50–100 mg
q 12 h; Gonorrhea—100 mg q 12 h for 7 d or 300 mg followed 1 h later
by another 300-mg dose; Malaria prophylaxis—100 mg once daily;
Lyme disease—100 mg twice daily; Periodontitis—20 mg twice daily.
Inhalational anthrax: 100 mg twice daily for 60 days. Children >8 yr and
<45 kg: Most infections—2–5 mg/kg/d in 1–2 divided doses (not to
exceed 200 mg/d). IV: Adults and children >8 yr and >45 kg: 200 mg
once daily or 100 mg q 12 h on first day; then 100–200 mg once daily
or 50–100 mg q 12 h. Anthrax: 100 mg twice daily change to oral when
clinically appropriate for a total of 60 d. IV: Children >8 yr <45 kg or
<8yrs: 4.4 mg/kg once daily or 2.2 mg/kg q 12 h on first day then
2.2–4.4 mg/kg/d given once daily or 1.1–2.2 mg/kg twice daily.
Anthrax: 2.2 mg/kg q 12 h. change to oral when clinically appropriate
for a total of 60 d.
■ ADMINISTRATION: PO: Administer around the clock, at least 1 h
before or 2 h after meals. May be taken with food or milk if GI irrita-
tion occurs. Administer with a full glass of liquid and at least 1 h
before going to bed to avoid esophageal ulceration. Use calibrated
measuring device for liquid preparations. Shake liquid preparations
well. Do not administer within 1–3 h of other medications. Avoid
administration of calcium, antacids, magnesium-containing medica-
tions, sodium bicarbonate, or iron supplements within 1–3 h of oral
doxycycline. Intermittent Infusion: Dilute each 100 mg with 10 mL of
sterile water or 0.9% NaCl for injection. Dilute further in 100–1000 mL
of 0.9% NaCl, D5W, D5/LR, Ringer’s solution, or lactated Ringer’s solu-
tion. Solution is stable for 12 h at room temperature and 72 h if refrig-
erated. If diluted with D5/LR or lactated Ringer’s solution, administer
within 6 h. Protect solution from direct sunlight. Concentrations of less
than 1 mcg/mL or greater than 1 mg/mL are not recommended. Rate:
Administer over a minimum of 1–4 h. Avoid rapid administration.
Avoid extravasation.
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■ ADVERSE REACTIONS AND SIDE EFFECTS: Benign intracranial

hypertension (higher in children), diarrhea, nausea, vomiting,
esophagitis, hepatotoxicity, pancreatitis, photosensitivity, rashes,
phlebitis at IV site, hypersensitivity reactions, superinfection.
■ CONTRAINDICATIONS: Hypersensitivity. Some products contain
alcohol or bisulfites and should be avoided in patients with known
hypersensitivity or intolerance.
■ CAUTIONS: Use cautiously in debilitated patients, patients with renal
disease or hepatic impairment. OB, Lactation, Pedi: Use during last
half of pregnancy, breastfeeding, or in children <8 yr results in per-
manent staining of teeth. May ↑ effect of warfarin. May ↓ effective-
ness of estrogen-containing oral contraceptives. Cholestyramine or
colestipol ↓ absorption. Adsorbent antidiarrheals may ↓ absorption.
Barbiturates, carbamazepine, or phenytoin may decrease activity. Do
not confuse doxycycline with doxepin.
ENALAPRIL (e-nal-a-pril) Vasotec ENALAPRILAT (e-nal-a-pril-at) Vasotec
IV Pregnancy Category C (first trimester), D (second and third trimesters)
CHF symptoms.
■ DOSAGE: PO: (Enalapril): Adults: 2.5–40 mg/d in 1–2 divided doses;
initiate therapy at 2.5 mg/d in patients receiving diuretics. IV
(Enalaprilat): Adults: 0.625–1.25 mg (0.625 mg if receiving diuretics)
q 6 h can be titrated up to 5 mg q 6 h.
■ ADMINISTRATION: PO: Precipitous drop in blood pressure during first
1–3 h following first dose may occur. Monitor blood pressure closely.
IV: Rate: Administer undiluted over at least 5 min. May be given as
intermittent infusion.
headache, insomnia, cough, hypotension, angina pectoris, tachycar-
dia, taste disturbances, diarrhea, nausea, proteinuria, renal failure,
rashes, hyperkalemia, AGRANULOCYTOSIS, ANGIOEDEMA.
■ CONTRAINDICATIONS: Hypersensitivity to enalapril or other ACE
inhibitors, pregnancy, history of angioedema. Use cautiously in renal
impairment, hepatic impairment, hypovolemia.
■ CAUTIONS: Additive hypotension with other antihypertensives,
nitrates, phenothiazines, and general anesthesia.
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• Hyperkalemia with concurrent use of potassium supplements,
potassium-sparing diuretics, indomethacin, salt substitutes, or
cyclosporine. • May increase risk of lithium or digoxin toxicity.
Instruct patient to report rash; mouth sores; sore throat; fever;
swelling of hands or feet; irregular heartbeat; chest pain; dry cough;
hoarseness; swelling of face, eyes, lips, or tongue; difficulty swallow-
ing or breathing. • Persistent dry cough may occur and may not sub-
side until medication is discontinued.
ENOXAPARIN (e-nox-a-pa-rin) Lovenox Anticoagulant (low molecular
response than unfractionated heparin—special monitoring of clotting
times is not necessary.
■ DOSAGE: SC: Adults: Knee/hip surgery: 30 mg q 12 h starting 12–24 h
post-op for 7–10 days; abdominal surgery: 40 mg once daily starting
2 h before surgery then continuing for 7–10 days postop; treatment of
DVT/PE: 1 mg/kg q 12 h or 1.5 mg/kg q 24 h; angina/non–Q-wave MI:
1 mg/kg q 12 h for 2–8 days (with aspirin).
rate or massage. Rotate sites frequently. To enhance absorption,
inject into abdomin.
■ CONTRAINDICATIONS: Hypersensitivity to pork products, uncon-
trolled bleeding, thrombocytopenia, patients with prosthetic heart
valves. Use cautiously in severe renal or hepatic disease.
and hemorrhage (bleeding gums; nosebleed; unusual bruising; black,
tarry stools; hematuria; fall in hematocrit or blood pressure levels;
guaiac-positive stools), bleeding from surgical site. Notify physician if
these occur. • Risk of bleeding may be increased by warfarin, aspirin,
NSAIDs, dipyridamole, some penicillins, clopidogrel, ticlopidine,
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abciximab, eptifibatide, tirofiban, and dextran. Increased bleeding

risk with arnica, chamomile, feverfew, garlic, ginger, ginkgo, Panax
ginseng, and others.
EPLERENONE (e-ple-re-none) Inspra Antihypertensives Pregnancy
Category B
■ INDICATIONS: Hypertension (alone, or with other agents).
■ THERAPEUTIC EFFECTS: Lowers blood pressure.
■ DOSAGE: PO: (Adults): 50 mg once daily initially; may be increased to
50 mg twice daily; patients receiving concurrent weak CYP3A4
inhibitors (erythromycin, saquinavir, verapamil, fluconazole)—25 mg
once daily initially.
■ ADMINISTRATION: PO: Administer once daily. May be increased to
twice daily if response is inadequate.
abnormal liver function tests, abdominal pain, diarrhea, albuminuria,
abnormal vaginal bleeding, gynecomastia, HYPERKALEMIA, hyper-
cholesterolemia, hypertriglyceridemia.
■ CONTRAINDICATIONS: Serum potassium >5.5 mEq/L; type 2 diabetes
with microalbuminuria (increased risk of hyperkalemia); serum creati-
nine >2.0 mg/dL in males or >1.8 mg/dL in females; CCr <50 mL/min;
concurrent use of potassium-sparing diuretics; concurrent use of
strong inhibitors of the CYP3A4 enzyme system (ketoconazole, itra-
conazole). Lactation: Should not be used by breastfeeding women.
■ CAUTIONS: Use cautiously with ACE inhibitors or angiotensin II
receptor antagonists due to increased risk of hyperkalemia. OB/Pedi:
Use during pregnancy only if clearly needed. Safety not established
in children. Concurrent use of strong inhibitors of the CYP3A4
enzyme system (ketoconazole, itraconazole) significantly ↑ effects of
eplenerone and should be avoided. Concurrent use of weak inhibitors
of the CYP3A4 enzyme system (erythromycin, saquinavir,
fluconazole, verapamil) may ↑ effects of eplerenone; initial dose of
eplerenone should be ↓ by 50%. NSAIDs may ↓ antihypertensive
effects. Concurrent use of ACE inhibitors or angiotensin II receptor
blockers may ↑ risk of hyperkalemia.
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ESTRADIOL (es-tra-dye-ole) Estrace, Gynodiol Hormone (estrogen)
Pregnancy Category X
■ INDICATIONS: Vasomotor symptoms of menopause and of various
estrogen deficiency states, treatment and prevention of post-
menopausal osteoporosis, inoperable metastatic postmenopausal
breast or prostate carcinoma.
■ THERAPEUTIC EFFECTS: Restoration of hormonal balance in various
deficiency states, treatment of hormone-sensitive tumors.
■ DOSAGE: PO: Adults: 0.45–2 mg daily or in a cycle. IM: Adults: 1–5 mg
monthly or 10–20 mg monthly.
■ ADMINISTRATION: Administer with or immediately after food to
reduce nausea. Estradiol is also available in injectable, transdermal,
and vaginal tablet or ring formulations.
lethargy, intolerance to contact lenses, MI, THROMBOEMBOLISM,
edema, hypertension, nausea, weight changes, jaundice, oily skin,
acne, pigmentation, urticaria, gynecomastia (men), hyperglycemia,
hypercalcemia, sodium and water retention, leg cramps, breast
tenderness, women—amenorrhea, dysmenorrhea, breakthrough
bleeding, cervical erosions, loss of libido, vaginal candidiasis,
men—impotence, testicular atrophy.
■ CONTRAINDICATIONS: Thromboembolic disease, undiagnosed vagi-
nal bleeding, pregnancy, lactation. Use cautiously in cardiovascular
disease, hepatic and renal dysfunction.
■ CAUTIONS: May alter requirement for warfarin, oral hypoglycemic
agents, or insulins. • Barbiturates or rifampin may decrease effective-
ness. • Smoking increases the risk of adverse CV reactions.
ETRAVIRINE (e-tra-veer-een) Intelence Antiretroviral, non-nucleoside
reverse transcriptase inhibitor Pregnancy Category B
■ INDICATIONS: HIV infection (with other antiretrovirals).
■ THERAPEUTIC EFFECTS: Evidence of decreased viral replication and
reduced viral load with slowed progression of HIV and its sequelae.
■ DOSAGE: PO: Adults: 200 mg twice daily.
■ ADMINISTRATION: Administer with or immediately after food to
reduce nausea. Estradiol is also available in injectable, transdermal,
and vaginal tablet or ring formulations.
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■ ADVERSE REACTIONS AND SIDE EFFECTS: SEIZURES, anxiety, con-

fusion, fatigue, headache, insomnia, sleep disorders, blurred vision,
vertigo, MYOCARDIAL INFARCTION, angina pectoris, atrial fibrillation,
hypertension, nausea, abdominal pain, anorexia, dry mouth, hepati-
tis, stomatitis, vomiting, renal failure, gynecomastia, hyperglycemia,
hyperlipidemia, anemia, hemolytic anemia, rash, fat redistribution,
peripheral neuropathy, hemarthrosis, allergic reactions including
STEVENS-JOHNSON SYNDROME, IMMUNE RECONSTITUTION
SYNDROME.
■ CONTRAINDICATIONS: Concurrent use with other non-nucleoside
reverse transcriptase inhibitors (NNRTIs), rifampin, rifapentine,
St. John’s wort.
■ CAUTIONS: Etravirine is a substrate of the CYP3A4, CYP2C9, and
CYP2C19 enzyme systems; other medications that induce or inhibit
these systems may be expected to alter the response to etravirine.
Etravirine is an inducer of CYP3A4 and an inhibitor of CYP2C9 and
CYP2C19. The effects of medications that are substrates of these
enzyme systems may be altered by concurrent use. Concurrent use
with other NNRTIs including efavirenz, nevirapine, and delavirdine
may lead to ↓ effectiveness and should be avoided. Concurrent use
with protease inhibitors (PIs) including atazanavir, fosamprenavir,
nelfinavir, and indinavir may lead to altered plasma levels and should
be undertaken with concurrent low-dose ritonavir. Concurrent
use with higher dose ritonavir, combination tipranavir/ritonavir,
fosamprenavir/ritonavir, atazanavir/ritonavir alter levels and effec-
tiveness of etravirine and should be avoided. Concurrent use of the
combination saquinavir/ritonavir should be undertaken cautiously.
↓ blood levels and effectiveness of antiarrhythmics including amio-
darone, bepridil, disopyramide, flecainide, lidocaine, mexiletine,
quinidine, propafenone, and quinidine; blood level monitoring recom-
mended. Blood levels and effects may be ↓ by anticonvulsants includ-
ing carbamazepine, phenobarbital, and phenytoin. May alter levels
and response to clarithromycin; other agents should be considered.
Rifampin and rifapentine ↓ blood levels and effectiveness and should
be avoided; rifabutin should only be used without a protease
inhibitor/ritonavir combination. Levels and effectiveness may be ↓ by
dexamethasone; use cautiously and consider alternatives. St. John’s
wort may ↓ blood levels and effectiveness; avoid concurrent use. Use
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with caution in patients on antiarrhythmics, anticonvulsants, antifun-
gals, clarithromycin, rifabutin, diazepam, dexamethasone, HMG-CoA
reductase inhibitors (statins), immunosuppressants. Geri: Consider
age-related decrease in organ function and body mass, concurrent
disease states, and medications; OB/Lactation/Pedi: Safety not estab-
lished, breastfeeding not recommended in HIV-infected women.
FENTANYL (BUCCAL) (fen-ta-nil) Fentora Opioid analgesic, opioid ago-
nist Schedule II Pregnancy Category C
■ INDICATIONS: Management of breakthrough pain in patients receiving
around-the-clock opioid analgesic therapy.
■ THERAPEUTIC EFFECTS: Decreases severity of breakthrough pain.
■ DOSAGE: Buccal-Adults: 100 mcg, then titrated to dose that provides
adequate analgesia with tolerable side effects.
■ ADMINISTRATION: For patients not previously using transmucosal
fentanyl, initial dose should be 100 mcg. Titrate to provide adequate
relief while minimizing side effects. For patients switching from oral
transmucosal fentanyl to fentanyl buccal, if transmucosal dose
is 200–400 mcg, switch to 100 mcg buccal; if transmucosal dose is
600–800 mcg, switch to 200 mcg buccal; if transmucosal dose is
1200–1600 mcg, switch to 400 mcg buccal fentanyl. Once a successful
dose has been established, if more than 4 breakthrough pain
episodes/day occur, reevaluate opioid dose for persistent pain.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness, drownsiness,
headache, confusion, depression, fatigue, insomnia, RESPIRATORY
DEPRESSION, cough, dyspnea, anorexia, constipation, dry
mouth, nausea, vomiting, sweating, erythema, application site
reactions, dehydration, edema, physical dependence, psychological
dependence.
■ CONTRAINDICATIONS: Hypersensitivity to fentanyl, known intoler-
ance, acute/postoperative pain. Opioid naïve patients. OB/Pedi: Labor
and delivery or lactation. Use cautiously in chronic pulmonary dis-
ease, history of substance abuse, severe renal/hepatic impairment,
head injuries/increased intracranial pressure.
■ 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
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depression with other CNS depressants, alcohol, antihistamines, anti-

depressants, sedative/hypnotics, and other opioids. • If respiratory rate
is <10/min, assess level of sedation. Dose may need to be decreased by
25% to 50%. • Naloxone (Narcan) is the antidote to reverse respiratory
depression or coma. Pedi: Children <18 yr (safety not established).
DOSE CAN BE LETHAL TO A CHILD. Geri: May be more sensitive to
effects and may have an ↑ risk of adverse reactions; titrate dosage
carefully.
FENTANYL (TRANSDERMAL) (fen-ta-nil) Duragesic Opioid analgesic,
opioid agonist Schedule II Pregnancy Category C
■ INDICATIONS: Chronic pain requiring opioid analgesic therapy.
■ THERAPEUTIC EFFECTS: Decreases severity of chronic pain.
■ DOSAGE: Transdermal: Adults: 25 mcg/h is the initial dose; patients
who have not been receiving opioids should receive not more than
25 mcg/h. See package insert for determining equianalgesic dosages
in patients already receiving opioid analgesics. Transdermal patch
lasts 72 hours in most patients. Some patients require a new patch
every 48 hours.
■ ADMINISTRATION: Apply to flat, nonirritated, and nonirradiated site.
If skin preparation is necessary, use clear water and clip, do not
shave hair.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Confusion, sedation,
APNEA, bronchoconstriction, laryngospasm, respiratory depression,
bradycardia, anorexia, constipation, dry mouth, nausea, vomiting,
sweating, erythema, application site reactions, skeletal and thoracic
muscle rigidity.
■ CONTRAINDICATIONS: Hypersensitivity to fentanyl or adhesives,
known intolerance, acute pain. Use cautiously in patients >60 yr,
cachectic or debilitated, severe pulmonary or hepatic disease, CNS
tumors; head trauma/increased intracranial pressure, cardiac disease.
■ 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, antihist-
amines, antidepressants, sedative/hypnotics, and other opioids. • If
respiratory rate is <10/min, assess level of sedation. Dose may need
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to be decreased by 25% to 50%. • Naloxone (Narcan) is the antidote
to reverse respiratory depression or coma.
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 2–11 yr: 30 mg twice daily. Children
6 mo–2yr: 15 mg twice daily.
■ ADMINISTRATION: Administer with food or milk to decrease GI
irritation. Capsules and tablets should be taken with water or milk,
not juice.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Drowsiness, fatigue,
dyspepsia, and dysmenorrhea.
■ CONTRAINDICATIONS: Hypersensitivity.
■ CAUTIONS: Use cautiously in impaired renal function (increased
dosing interval recommended), pregnancy, lactation. • Magnesium-
and aluminum-containing antacids decrease absorption and may
decrease effectiveness. • Apple, orange, and grapefruit juice
decrease absorption and may decrease effectiveness.
FINASTERIDE (fi-nas-teer-ide) Propecia, Proscar Hair regrowth stimulant/
androgen inhibitor Pregnancy Category X
■ INDICATIONS: Benign prostatic hyperplasia (BPH), androgenetic
alopecia (male pattern baldness) in men only.
■ THERAPEUTIC EFFECTS: Reduces prostate size with associated
decrease in urinary symptoms; decreased hair loss; hair regrowth.
■ DOSAGE: PO: Adults: BPH: 5 mg once daily (Proscar); androgenetic
alopecia: 1 mg/d (Propecia).
■ ADMINISTRATION: Administer once daily with or without meals.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Decreased libido,
decreased volume of ejaculate, impotence.
■ CONTRAINDICATIONS: Hypersensitivity, women. Use cautiously in
hepatic dysfunction or obstruction uropathy.
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■ CAUTIONS: • Caution patient that finasteride poses a potential risk to

a male fetus. Women who are pregnant or may become pregnant
should avoid exposure to semen of a partner taking finasteride and
should not handle crushed finasteride because of the potential for
absorption. • Clinical effects as noted by hair regrowth may not be
evident for 3 months or longer • Assess patient for symptoms of
prostatic hypertrophy (urinary hesitancy, feeling of incomplete blad-
der emptying, interruption of urinary stream, impairment of size and
force of urinary stream, terminal urinary dribbling, straining to start
flow, dysuria, urgency) before and periodically throughout therapy.
• Instruct patient to take finasteride as directed, even if symptoms
improve or are unchanged. • At least 6–12 months of therapy may be
necessary to determine whether or not an individual will respond to
finasteride. • Inform patient that the volume of ejaculate may be
decreased during therapy but that this will not interfere with normal
sexual function.
FLUCONAZOLE (floo-kon-a-zole) Diflucan Antifungal (systemic)
■ INDICATIONS: Fungal infections, prevention of candidiasis after bone
marrow transplantation.
■ THERAPEUTIC EFFECTS: Fungistatic or fungicidal action against sus-
ceptible organisms.
■ DOSAGE: PO, IV: Adults: Esophageal or oropharyngeal candidiasis:
200 mg initially, then 100 mg daily for at least 2 weeks. Other candidia-
sis: 400 mg/d initially, then 200–800 mg/d for 28 days. Cryptococcal
meningitis: 400 mg once daily until favorable clinical response, then
200–800 mg once daily for at least 10–12 wk after clearing of CSF.
Suppressive therapy: 400 mg once daily beginning several days before
procedure. Vaginal candidiasis: 150-mg single dose (prevention);
150 mg/d for 3 days then weekly for 6 mo. Children >14 days:
6–12 mg/kg/d for 28 days. Cryptococcal meningitis: 12 mg/kg/d
initially then 6–12 mg/kg/d for at least 10–12 wk after clearing of
CSF. Suppressive therapy: 200 mg once daily.
■ ADMINISTRATION: PO: Shake oral suspension well before adminis-
tration. IV: Open overwrap immediately before infusion. Rate: Infuse
at a maximum rate of 200 mg/h. For children receiving >6 mg/kg/d,
give over 2 h.
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■ ADVERSE REACTIONS AND SIDE EFFECTS: Headache, HEPATOTOX-
ICITY, abdominal discomfort, diarrhea, nausea, vomiting, exfoliative
skin disorders including STEVENS-JOHNSON SYNDROME,
hypokalemia, allergic reactions including ANAPHYLAXIS.
■ CONTRAINDICATIONS: Hypersensitivity to fluconazole or other azole
antifungals, concurrent use with pimozide. Use cautiously in renal
impairment.
■ 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, theophyl-
line, zidovudine, alfentanil, and phenytoin. • Increases blood
levels and effects of benzodiazepines, zolpidem, buspirone,
nisoldipine, tricyclic antidepressants, and losartan.
FLUOROURACIL (flure-oh-yoor-a-sill) Adrucil, Efudex, Fluoroplex, 5-FU
Antineoplastic antimetabolite Pregnancy Category D
■ INDICATIONS: Colon, breast, rectal, gastric, pancreatic carcinoma.
Actinic keratoses and superficial basal cell carcinomas.
■ THERAPEUTIC EFFECTS: Death of malignant cells.
■ DOSAGE: IV: Adults: Carcinoma—Initial dose: 12 mg/kg/d for 4 d, then
1 day of rest, then 6 mg/kg every other day for 4–5 doses.
Maintenance: 7–12 mg/kg q 7–10 d or 300–500 mg/m2/d for 4–5 d,
repeated monthly (no single daily dose should exceed 800 mg).
Topical: Adults: Actinic keratoses: 1% solution or cream 1–2 times
daily. Basal cell carcinomas: 5% solution or cream twice daily for
3–6 wk (up to 12 wk).
■ ADMINISTRATION: Direct IV: Rate: Administer over 1–2 min
(50 mg/mL). Intermittent Infusion: Rate: Infuse over 2–8 h.
Topical: Wear gloves when applying medication.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Diarrhea, nausea,
stomatitis, vomiting, alopecia, maculopapular rash, local inflammatory
reactions (topical only), melanosis of nails, nail loss, palmar-plantar ery-
throdysesthesia, phototoxicity, anemia, leukopenia, thrombocytopenia.
■ CONTRAINDICATIONS: Hypersensitivity, pregnancy, or lactation. Use
cautiously in infections, depressed bone marrow reserve, other
chronic debilitating illnesses.
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■ CAUTIONS: HIGH ALERT MED: Chemotherapeutic agents are toxic.

Dosing, calculations, and infusion pump settings should be indepen-
dently checked by two other practitioners. • The number 5 in
5-fluorouracil is part of the drug name and does not refer to the dosage.
• Stop infusion if extravasation occurs and restart in another vein.
• Instruct patient in correct application of solution or cream; explain that
erythema, scaling, and blistering with pruritus and burning sensation are
expected. • Review with patient the need for contraception during therapy.
FLUOXETINE (floo-ox-uh-teen) Prozac, Prozac Weekly, Sarafem Anti-
depressant (selective serotonin reuptake inhibitor) Pregnancy Category B
■ INDICATIONS: Depression, OCD, bulimia nervosa, panic disorders,
premenstrual dysphoric disorder (PMDD). Unlabeled Uses: Anorexia
nervosa, ADHD, fibromyalgia, obesity.
■ DOSAGE: PO: Adults: 20–80 mg daily. Geriatric Patients: 10–60 mg
daily. Children 7–17 yr: 10–60 mg/d.
■ ADMINISTRATION: Administer with food as a single dose in the
morning. Some patients may require increased amounts, in divided
doses, with a 2nd dose at noon.
■ ADVERSE REACTIONS AND SIDE EFFECTS: SEIZURES, anxiety,
drowsiness, headache, insomnia, nervousness, tremor, dizziness,
fatigue, hypomania, mania, weakness, visual disturbances, cough,
chest pain, palpitations, diarrhea, anorexia, dry mouth, nausea, vom-
iting, 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 discon-
tinued 5 weeks before MAO therapy is initiated). Use cautiously in
severe renal or hepatic impairment, seizure disorder, diabetes, con-
current chronic illnesses.
■ CAUTIONS: Do not confuse Sarafem (fluoxetine) with Serophene
(clomiphene). • Additive CNS depression with alcohol, antihistamines,
other antidepressants, opioid analgesics, or sedative/hypnotics.
• Increased risk of side effects with other antidepressants, tryptophan,
risperidone, or phenothiazines. • May increase risk of toxicity from
carbamazepine, clozapine, digoxin, haloperidol, phenytoin, lithium,
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or warfarin. • Caution patient to avoid driving until response to the
drug is known.
FLUTICASONE (floo-ti-ka-sone) Flovent HFA, Flovent Anti-inflammatories
■ INDICATIONS: Maintenance and prophylactic treatment of asthma.
■ Therapeutic Effects: Decreases frequency and severity of asthma attacks.
■ DOSAGE: Aerosol: Inhaln: (Adults and Children ≥12 yr): 88–440 mcg
twice daily initially, may be increased up to 440 mcg twice daily. Powder:
Inhaln: (Adults and Children ≥12 yr): 100 mcg twice daily initially, may be
increased up to 500 mcg twice daily. Inhaln: (Children 4–11 yr): 88 mcg
twice daily initially, (may not exceed 88 mcg twice daily) Powder:
Children 4–11 yr: 50 mcg twice daily initially, may be increased to
100 mcg twice daily.
■ ADMINISTRATION: Aerosol Inhalation: Allow at least 1 min between
inhalations of aerosol medication. Powder for Inhalation: Do not use
with a spacer.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Headache, dizziness, dys-
phonia, hoarseness, oropharyngeal fungal infections, nasal stuffiness,
rhinorrhea, sinusitis, bronchospasm, cough, wheezing, diarrhea,
decreased growth in children, Cushing’s syndrome. CHURG-
STRAUSS SYNDROME.
■ CONTRAINDICATIONS: Hypersensitivity to propellants; acute asthma
attack.
■ CAUTIONS: Active untreated infections, diabetes, glaucoma,
immunosuppression (due to disease or concurrent therapy); hepatic
dysfunction; severe milk protein allergy (powder for oral inhalation
contains lactose). OB/Lactation/Pedi: Safety not established for preg-
nant or breastfeeding women, children <4 yr. Prolonged or high-dose
therapy may lead to complications.
FONDAPARINUX (fon-da-par-i-nux) Arixtra Anticoagulant Pregnancy
Category B
■ INDICATIONS: Prevention and treatment of deep vein thrombosis.
■ THERAPEUTIC EFFECTS: Interruption of the coagulation cascade
resulting in inhibition of thrombus formation.
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■ DOSAGE: SC: Adults: Prevention: 2.5 mg once daily, starting 6–8 h

after surgery and continuing for 5–9 d (up to 11 d). Treatment: 5 mg
once daily for at least 5 d until therapeutic anticoagulation with war-
farin is achieved (INR >2).
■ ADMINISTRATION: Administer SC only into fatty tissue, alternating
sites between right and left anterolateral or posterolateral
abdominal wall.
headache, insomnia, edema, hypotension, constipation, diarrhea,
dyspepsia, increased serum aminotransferases, nausea, vomiting,
urinary retention, bullous eruption, hematoma, purpura, rash, BLEED-
ING, thrombocytopenia, hypokalemia, fever, increased wound
drainage.
■ CONTRAINDICATIONS: Hypersensitivity, severe renal impairment,
body weight <50 kg, active major bleeding, bacterial endocarditis,
and thrombocytopenia due to fondaparinux antibodies.
■ CAUTIONS: HIGH ALERT MED: Deaths have occurred when two anti-
coagulant medications inadvertently are given concurrently. Double-
check medications to ensure that two anticoagulant products are not
given simultaneously. • Use with caution in patients with severe
uncontrolled hypertension, bleeding disorders, GI pathology, hemor-
rhagic stroke, recent CNS or ophthalmological surgery, spinal/
epidural anesthesia (increased risk of spinal/epidural hematomas).
• Risk of bleeding may be increased by concurrent use of warfarin,
aspirin, NSAIDs, dipyridamole, some cephalosporins, valproates,
clopidogrel, ticlopidine, abciximab, eptifibatide, tirofiban, and dex-
tran. • Increased risk of bleeding with arnica, chamomile, dong quai,
feverfew, garlic, ginger, gingko, Panax ginseng, licorice, and others.
FOSINOPRIL (foe-sin-oh-pril) Monopril Pregnancy Category C (first
trimester), D (second and third trimesters)
symptoms of CHF.
■ DOSAGE: PO: Adults: Hypertension: 10 mg once daily, may increase
as required to 80 mg/d. CHF: 10 mg once daily (5 mg once daily in
patients who have been vigorously diuresed. Children >6 yr and
> 50 kg: Hypertension: 5–10 mg once daily.
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1–3 h following first dose may occur, especially if also taking
diuretics. Monitor blood pressure closely.
headache, cough, hypotension, taste disturbances, anorexia, diarrhea,
nausea, proteinuria, impotence, renal failure, rashes, hyperkalemia,
AGRANULOCYTOSIS, ANGIOEDEMA.
■ CONTRAINDICATIONS: Hypersensitivity, pregnancy, history of
angioedema. Use cautiously in renal or hepatic impairment, hypo-
volemia, hyponatremia, concurrent diuretic therapy.
■ CAUTIONS: Instruct patient to report rash; mouth sores; sore throat;
fever; swelling of hands or feet; irregular heartbeat; chest pain; dry
cough; hoarseness; swelling of face, eyes, lips, or tongue; difficulty
swallowing or breathing. • Additive hypotension with other antihy-
pertensives, nitrates, phenothiazines, acute ingestion of alcohol, and
during surgery or general anesthesia. • Hyperkalemia with potassium
supplements, potassium-sparing diuretics, indomethacin, salt substi-
tutes, or cyclosporine. • May increase the risk of lithium or digoxin
toxicity. • Persistent dry cough may occur and may not subside until
medication is discontinued.
FUROSEMIDE (fur-oh-se-mide) Apo-Furosemide, Lasix, Lasix Special
Diuretic (loop diuretic) Pregnancy Category C
■ INDICATIONS: Edema secondary to CHF, hepatic or renal disease,
hypertension.
■ THERAPEUTIC EFFECTS: Diuresis and subsequent mobilization of
excess fluid; lowering of blood pressure.
■ DOSAGE: PO, IM, IV: Adults: Diuretic: 20–80 mg/d initially, may
increase by 20–40 mg q 6–8 h (up to 600 mg/d). Antihypertensive:
40 mg twice daily initially; adjust further dosing based on response.
Children: IM, IV: Diuretic: 1–2 mg/kg q 6–12 h, Neonates: 1–2 mg/kg/dose
q 12–24 h.
■ ADMINISTRATION: PO: May be taken with food or milk to minimize
gastric irritation. Direct IV: Rate: Administer at rate of 20 mg/min.
Intermittent Infusion: Rate: Administer at a rate not to exceed
4 mg/min in adults to prevent ototoxicity.
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■ ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness, hearing loss,

tinnitus, hypotension, constipation, dry mouth, dehydration,
hypochloremia, hypokalemia, hypomagnesemia, hyponatremia,
hypovolemia, metabolic alkalosis, hyperglycemia, arthralgia, muscle
cramps, myalgia, increased BUN.
■ CONTRAINDICATIONS: Hypersensitivity (cross-sensitivity with thi-
azides and sulfonamides may occur), uncorrected electrolyte imbal-
ance, hepatic coma, anuria. Use cautiously in severe liver disease,
diabetes, azotemia.
■ 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.
GABAPENTIN (ga-ba-pen-tin) Neurontin Analgesic adjunct, anticonvul-
sant Pregnancy Category C
■ INDICATIONS: Partial seizures. Unlabeled Uses: Chronic pain,
prevention of migraine headache.
■ THERAPEUTIC EFFECTS: Decreased incidence of seizures.
■ DOSAGE: PO: Adults and Children >12 yr: 600–1800 mg/d in 3 divided
doses. Doses up to 2400–3600 mg/d have been well tolerated.
Children ≥5–12 yr: 10–35 mg/kg/d in 3 divided doses. Children 3–4 yr:
10–40 mg/kg/d in 3 divided doses.
Discontinue gradually over at least 1 wk—abrupt discontinuation may
increase frequency of seizures.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Drowsiness, anxiety,
concentration difficulties (children), dizziness, emotional lability
(children), hostility, hyperkinesia (children), malaise, vertigo, weak-
ness, ataxia, altered reflexes, hyperkinesia, paresthesia, abnormal
vision, nystagmus, hypertension, anorexia, flatulence, gingivitis,
arthralgia, facial edema.
■ CONTRAINDICATIONS: Hypersensitivity. Use cautiously in renal insuf-
ficiency, OB, lactation, pediatrics < 3 yr.
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■ CAUTIONS: Increased risk of CNS depression with other CNS
depressants, including alcohol, antihistamines, and sedative/
hypnotics. • Kava, valerian, skullcap, chamomile, or hops can
increase CNS depression. • Instruct patients on tid dosing not to
exceed 12 h between doses. • If a dose is missed, take as soon as
possible; if less than 2 h until next dose, take immediately; take next
dose 1–2 h later, then resume regular dosing. • Do not take double
doses. • Do not discontinue abruptly. • Do not to take within 2 h of an
antacid.
GEMFIBROZIL (gem-fye-broe-zil) Lopid Lipid-lowering agent (fibric acid
derivative) Pregnancy Category C
■ INDICATIONS: Management of type II-b hyperlipidemia (decreased
HDLs, increased LDLs, increased triglycerides) in patients who do
not yet have clinical coronary artery disease and have failed therapy
with diet, exercise, weight loss, or other agents (niacin, bile acid
sequestrants).
■ THERAPEUTIC EFFECTS: Decreased plasma triglycerides and
increased HDL.
■ DOSAGE: PO: Adults: 600 mg twice daily 30 min before breakfast and
dinner.
■ ADMINISTRATION: Administer 30 min before breakfast or dinner.
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. Use cautiously in
gallbladder disease, liver disease, severe renal impairment, OB, lacta-
tion, or children.
■ CAUTIONS: May increase the effects of warfarin or sulfonylurea 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 profes-
sional if severe stomach pains with nausea and vomiting, fever, chills,
sore throat, rash, diarrhea, muscle cramping, general abdominal
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discomfort, or persistent flatulence occur. • Advise patient to comply

with dietary restrictions, exercise program, and smoking cessation pro-
gram. • Liver function tests should be assessed before and periodically
throughout therapy. • May cause an increase in serum bilirubin, alka-
line phosphatase, CK, LDH, AST, and ALT. • If hepatic function tests rise
significantly, therapy should be discontinued and not resumed.
GLIMEPIRIDE (glye-meh-per-ide) Amaryl Antidiabetic (sulfonylureas)
■ INDICATIONS: Type 2 diabetes mellitus (requires some pancreatic
action).
■ THERAPEUTIC EFFECTS: Lower blood glucose levels.
■ DOSAGE: PO: Adults: 1–2 mg once daily initially; may increase q 1–2 wk
up to 8 mg/d (usual range 1–4 mg/d). Geriatrics: 1 mg/d initially.
■ ADMINISTRATION: Administer with morning meal. If prescribed in
2 divided doses, do not administer after last meal of the day.
headache, weakness, constipation, cramps, diarrhea, drug-induced
hepatitis, heartburn, increased appetite, nausea, vomiting, photosen-
sitivity, rashes, hypoglycemia, hyponatremia, APLASTIC ANEMIA,
agranulocytosis, leukopenia, pancytopenia, thrombocytopenia.
■ CONTRAINDICATIONS: Hypersensitivity; severe renal, hepatic, thy-
roid, or other endocrine disease; type 1 diabetes; diabetic coma or
ketoacidosis; uncontrolled infection; serious burns; or trauma. Use
cautiously in renal/hepatic dysfunction, impaired adrenal or pituitary
function, debilitated, malnutrition, OB, lactation, pediatrics.
■ CAUTIONS: Ingestion of alcohol may result in disulfiram-like reaction.
• Effectiveness may be decreased by concurrent use of diuretics,
corticosteroids, phenothiazines, oral contraceptives, estrogens, thy-
roid 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 acti-
vity); close monitoring recommended during any changes in dosage.
• Beta blockers may alter the response to oral hypoglycemic agents
(increase or decrease requirements). • Glucosamine may worsen
blood glucose control. • Fenugreek, chromium, and coenzyme Q-10
may produce additive hypoglycemic effects.
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GLIPIZIDE (glip-i-zide) Glucotrol, Glucotrol XL Antidiabetic (sulfonyl-
urea) Pregnancy Category C
■ INDICATIONS: Type 2 diabetes (requires some pancreatic action).
■ DOSAGE: PO: Adults: 5 mg/d initially, increase by 2.5–5 mg/d at
weekly intervals as needed; maximum dose 40 mg/d; XL dosage form
is given once daily 20mg/d . 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.
• Effectiveness may be decreased by concurrent use of diuretics, cor-
ticosteroids, phenothiazines, oral contraceptives, estrogens, thyroid
preparations, phenytoin, nicotinic acid, sympathomimetics, and iso-
niazid. • 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.
GLYBURIDE (glye-byoo-ride) DiaBeta, Micronase, Glynase PresTab Anti-
diabetic (sulfonylurea) Pregnancy Category B
■ INDICATIONS: Type 2 diabetes (requires some pancreatic action).
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■ DOSAGE: PO: Adults: DiaBeta/Micronase (nonmicronized): 2.5–5 mg

once daily initially; may increase by 2.5–5 mg/d at weekly intervals
(range 1.25–20 mg/d). Glynase PresTab (micronized): 1.5–3 mg/d
initially; may be increased by 1.5 mg/d at weekly intervals (range
0.75–12 mg/d).
■ ADMINISTRATION: Administer with morning meal. If prescribed
in 2 divided doses, do not administer second dose after last meal of
the day.
• Effectiveness may be decreased by concurrent use of diuretics, cor-
ticosteroids, phenothiazines, oral contraceptives, estrogens, thyroid
preparations, phenytoin, nicotinic acid, sympathomimetics, and iso-
niazid. • 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.
HALOPERIDOL (ha-loe-per-i-dole) Apo-Haloperidol, Haldol, Haldol
Decanoate Antipsychotics Pregnancy Category C
■ INDICATIONS: Schizophrenia, manic states, drug-induced psychoses,
agitation. Tourette’s syndrome.
■ THERAPEUTIC EFFECTS: Diminished signs and symptoms of psy-
choses, diminshed tics and utterances in patients with Tourette’s
syndrome.
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■ DOSAGE: Haloperidol: PO: Adults: 0.5–5 mg 2–3 times daily. Patients
with severe symptoms may require up to 100 mg/d. PO: Children 3–12 yr
or 15–40 kg: 50 mcg/kg/d in 2–3 divided doses; IM: (Adults): 2–5 mg q
1–8 h (not to exceed 100 mg/d). Haloperidol Decanoate: IM (Adults):
10–15 times the previous daily oral dose; not to exceed 100 mg initially.
Given monthly (not to exceed 300 mg/month).
■ ADMINISTRATION: PO: Administer with food or full glass of water or
milk to minimize GI irritation. • Use calibrated measuring device for
accurate dosage. IM: Inject slowly, using 2-in. 21-gauge needle into
well-developed muscle via Z-track technique. Do not exceed 3 mL per
injection site. Keep patient recumbent for at least 30 min following
injection to minimize hypotensive effects.
■ ADVERSE REACTIONS AND SIDE EFFECTS: SEIZURES, extrapyrami-
dal reactions, confusion, drowsiness, restlessness, tardive dyskinesia,
blurred vision, dry eyes, respiratory depression, hypotension, tachy-
cardia, constipation, dry mouth, anorexia, drug-induced hepatitis,
ileus, urinary retention, photosensitivity, rashes, NEUROLEPTIC
MALIGNANT SYNDROME, hypersensitivity reactions.
■ CONTRAINDICATIONS: Hypersensitivity; narrow-angle glaucoma;
bone marrow depression; CNS depression; severe liver or cardiovas-
cular disease; some products contain tartrazine, sesame oil, or benzyl
alcohol and should be avoided in patients with known intolerance or
hypersensitivity.
■ CAUTIONS: Use cautiously with cardiac disease, diabetes, respiratory
insufficiency, prostatic hypertrophy, intestinal obstruction, and
seizures. Geri: Geriatric patients are more susceptible to anticholiner-
gic side effects; dosage reduction required. OB/Lactation: Safety not
established for pregnant or breastfeeding women. Inform patient of
possibility of extrapyramidal symptoms and tardive dyskinesia and to
report symptoms immediately. Advise patient to change positions
slowly to minimize orthostatic hypotension. ↑ hypotension with anti-
hypertensives, nitrates, or acute ingestion of alcohol. ↑
Anticholinergic effects with drugs having anticholinergic properties,
including antihistamines, antidepressants, atropine, phenothiazines,
quinidine, and disopyramide. ↑ CNS depression with other CNS
depressants, including alcohol, antihistamines, opioid analgesics,
and sedative/hypnotics. Concurrent use with epinephrine may result
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in severe hypotension and tachycardia. May ↓ therapeutic effects of

levodopa or pergolide. Acute encephalopathic syndrome may occur
when used with lithium. Dementia may occur with methyldopa.
HEPARIN (hep-a-rin) Calcilean, Calciparine, Hepalean Anticoagulant
(antithrombotic) Pregnancy Category C
■ INDICATIONS: Venous thromboembolism, pulmonary emboli, atrial
fibrillation with embolization, acute and chronic coagulopathies,
peripheral arterial thromboembolism.
■ THERAPEUTIC EFFECTS: Prevention of thrombus formation, preven-
tion of extension of existing thrombi (full dose).
■ DOSAGE: SC: Adults: Therapeutic Anticoagulation: 5000 units IV,
followed by initial SC dose of 10,000–20,000 units, then 8000–10,000
units every 8 h or 15,000–20,000 units every 12 h. Prophylaxis of
Thromboembolism: 5000 units every 8–12 h (may be started 2 h prior
to surgery). IV: Adults: Therapeutic Anticoagulation: Intermittent
bolus: 10,000 units, followed by 5000–10,000 units every 4–6 h.
Continuous infusion: 5000 units (35–70 units/kg), followed by
20,000–40,000 units infused over 24 h (approx. 1000 units/h or
15–18 units/kg/h). Children: Intermittent bolus: 50 units/kg, followed
by 50–100 units/kg every 4 h. Continuous infusion: 50 units/kg,
followed by 100 units/kg/4 h or 20,000 units/m2/24 h.
rate or massage. Rotate sites frequently. Direct IV: Rate: May be given
undiluted over at least 1 min. Intermittent/Continuous Infusion:
Dilute in prescribed amount of solution and give as a continuous or
intermittent infusion. Ensure adequate mixing of heparin in solution.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Drug-induced hepatitis,
alopecia (long-term use), rashes, urticaria, BLEEDING, anemia, throm-
bocytopenia, pain at injection site, osteoporosis (long-term use),
fever, hypersensitivity.
■ CONTRAINDICATIONS: Hypersensitivity, uncontrolled bleeding,
severe thrombocytopenia, open wounds (full dose).
■ CAUTIONS: HIGH ALERT MED: Available in various concentrations.
Dose and calculation for dilution or direct IV injection should be
checked with a second licensed practitioner before administration.
• Assess patient for signs of bleeding and hemorrhage (bleeding
gums; nosebleed; unusual bruising; black, tarry stools; hematuria; fall
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in hematocrit or blood pressure levels; notify physician if these occur.
• Use cautiously in severe uncontrolled hypertension, bacterial endo-
carditis, bleeding disorders, GI bleeding/ulceration/pathology, hemor-
rhagic stroke, recent CNS or ophthalmological surgery, active GI
bleeding/ulceration, history of thrombocytopenia related to heparin,
severe liver or kidney disease, retinopathy (hypertensive or diabetic),
untreated hypertension, ulcer disease, spinal cord or brain injury, his-
tory of congenital or acquired bleeding disorder, malignancy; women
>60 yr, last trimester of pregnancy, immediate postpartum period.
Risk of bleeding may be increased by aspirin, NSAIDs, clopidogrel,
dipyridamole, some penicillins, ticlopidine, abciximab, eptifibatide,
tirofiban, and dextran. • Risk of bleeding may be increased by con-
current use of drugs that cause hypoprothrombinemia, including
quinidine, cefamandole, cefmetazole, cefoperazone, cefotetan, pli-
camycin, 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.
HYDROCHLOROTHIAZIDE (hye-droe-klor-oh-thye-a-zide) Apo-hydro,
Oretic, Esidrix, HCTZ, Antihypertensive (thiazide diuretic) Pregnancy
Category B
■ INDICATIONS: Mild-to-moderate hypertension, edema associated
with CHF, renal dysfunction, cirrhosis.
■ THERAPEUTIC EFFECTS: Lower blood pressure, diuresis with mobi-
lization of edema.
■ DOSAGE: PO: Adults: 12.5 mg/d initially (range 12.5–100 mg/d in
1–2 doses up to 200 mg/d; not to exceed 50 mg/d for hypertension).
Children >6 mo: 1–3 mg/kg/d 1–2 divided doses (not to exceed
37.5 mg/d). Children <6 mo: 1–3 mg/kg per day in 2 divided doses.
■ ADMINISTRATION: May give with food or milk to minimize gastric
irritation. Administer in the morning to prevent disruption of
sleep cycle.
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■ ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness, lethargy, weak-

ness, hypotension, anorexia, cramping, hepatitis, nausea, photosensi-
tivity, hyperglycemia, hypokalemia, dehydration, hypercalcemia,
hypomagnesemia, hyponatremia, hypophosphatemia, hypovolemia,
hyperuricemia, elevated lipids, muscle cramps, and pancreatitis.
■ CONTRAINDICATIONS: Hypersensitivity, anuria, lactation. Use cau-
tiously in renal or hepatic impairment, OB.
■ CAUTIONS: • Additive hypotension with other antihypertensives,
acute ingestion of alcohol or nitrates. • Additive hypokalemia with
corticosteroids, amphotericin B, mezlocillin, piperacillin, or ticarcillin.
• Decreases the excretion of lithium. Cholestyramine or colestipol
decreases absorption. • Hypokalemia increases risk of digoxin
toxicity. • Assess patient, especially if taking digitalis glycosides, for
anorexia, nausea, vomiting, muscle cramps, paresthesia, and confu-
sion. 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.
HYDROCORTISONE (hye-droe-kor-ti-sone) A-hydroCort, Cortef, Solu-
Cortef Steroidal anti-inflammatory (systemic corticosteroid) Pregnancy
Category C
■ INDICATIONS: Adrenocortical insufficiency; allergic and inflammatory
disorders.
■ THERAPEUTIC EFFECTS: Suppression of inflammation; modification
of the immune response; replacement of deficient adrenal corticoids.
■ DOSAGE: PO: Adults: 20–240 mg/d in divided doses. Children:
Adrenocortical insufficiency: 0.56 mg/kg (15–20 mg/m2)/d as a single
dose or in divided doses. Other uses: 2–8 mg/kg/d (60–240 mg/m2/d)
as a single dose or in divided doses. IM, IV: Adults: 100–500 mg
q 2–6 h (range 100–80000 mg/d). Children: Adrenocortical insuffi-
ciency: 0.186–0.28 mg/kg/d (10–12 mg/m2)/d in 3 divided doses.
Other uses: 0.666–4 mg/kg (20–120 mg/m2) q 12–24 h.
tion. Direct IV: Rate: May be given undiluted. 4–10 mg/mL. Administer
over 1–4 min if dose is <10 mg.
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restlessness, hypertension, PEPTIC ULCERATION, anorexia, nausea,
acne, decreased wound healing, ecchymoses, hirsutism, petechiae,
adrenal suppression, hyperglycemia, hypokalemia, THROMBOEM-
BOLISM, thrombophlebitis, muscle wasting, osteoporosis, cushingoid
appearance, increased susceptibility to infection.
■ CONTRAINDICATIONS: Active untreated infections, lactation. Use
cautiously in chronic treatment, hypothyroidism, cirrhosis, OB.
■ CAUTIONS: Instruct patient to report severe abdominal pain or tarry
stools. • May increase need for insulin or oral hypoglycemic agents.
• Increased risk of adverse GI effects with NSAIDs. • Instruct patient
to report swelling, weight gain, tiredness, bone pain, bruising, non-
healing sores, visual changes, or behavioral changes.
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 suppres-
sion.
■ DOSAGE: PO: Adults and Children >50 kg: 4–8 mg q 3–4 h initially.
(some patients may respond to doses as small as 2 mg). Adults and
Children <50 kg: 0.06 mg/kg q 3–4 h initially, younger children may
require smaller doses of 0.03 mg/kg. Maximum dose 5 mg. IM, IV,
SC: Adults and Children >50 kg:1.5 mg q 3–4 h as needed initially;
may be increased. Adults and Children <50 kg: 0.015 mg/kg q 3–4 h.
Adults: Continuous infusion: 0.2–30 mg/h depending on previous
opioid use.
■ ADMINISTRATION: PO: may be administered with food or milk to
minimize GI irritation. Direct IV: Rate: Dilute with at least 5 mL sterile
water or NS. Give 2 mg over 3–5 min. Rapid administration can lead
to respiratory depression and circulatory collapse.
dizziness, RESPIRATORY DEPRESSION, hypotension, constipation,
nausea, urinary retention, physical or psychological dependence,
tolerance.
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■ CAUTIONS: HIGH ALERT MED: • Do not confuse with morphine;

hydromorphone is five times stronger and errors have resulted in
fatalities. Have a second practitioner independently check infusion
pump programming. • Assess level of consciousness, blood pressure,
pulse, and respirations. If respiratory rate is <10/min, assess level of
sedation. Have naloxone (Narcan) available. • Use with extreme cau-
tion in patients receiving MAO inhibitors within 14 days prior (may
result in unpredictable, severe reactions—decrease initial dose of
morphine to 25% of usual dose). • Use cautiously in head trauma,
increased intracranial pressure, severe renal, hepatic, or pulmonary
disease, undiagnosed abdominal pain, prostatic hypertrophy, preg-
nancy or lactation.
HYDROXYZINE (hye-drox-i-zeen) Apo-Hydroxyzine, Atarax, Hyzine-50,
Multipax, Novohydroxyzin, Vistaril Antianxiety agent, antihistamine,
sedative/hypnotic Pregnancy Category C
■ INDICATIONS: Anxiety, preoperative sedation, nausea and vomiting,
and itching. Adjunct to opioids.
■ THERAPEUTIC EFFECTS: Sedation, relief of anxiety, decreased nausea
and vomiting, decreased allergic symptoms associated with release
of histamine, including itching.
■ DOSAGE: PO: Adults: 25–100 mg 3–4 times daily. Children: 2 mg/kg/d
divided q 6–8 h. IM: Adults: 25–100 mg every 4–6 h. Children: 0.5–1 mg/kg
every 4–6 h.
■ ADMINISTRATION: PO: Tablets may be crushed and capsules opened
and administered with food or fluids. Shake suspension well before
administering. IM: Injection is extremely painful. Administer only IM
deep into well-developed muscle, preferably with Z-track technique.
Do not use deltoid. If must be administered to children, midlateral
muscles of the thigh are preferred.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Drowsiness, agitation,
ataxia, dizziness, headache, weakness, wheezing, dry mouth, bitter
taste, constipation, nausea, urinary retention, flushing, pain at IM site,
abscesses at IM sites, chest tightness.
■ CONTRAINDICATIONS: Hypersensitivity, pregnancy. Use cautiously in
severe hepatic dysfunction.
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antihistamines, opioid analgesics, sedative/hypnotics, kava, valerian,
skullcap, chamomile, or hops. • Additive anticholinergic effects with
antihistamines, antidepressants, atropine, haloperidol, phenothia-
zines, quinidine, and disopyramide. • May cause drowsiness or
dizziness. • Caution patient to avoid driving and other activities
requiring alertness until response to medication is known.
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INFLIXIMAB (in-flix-i-mab) Remicade Antirheumatic, gastrointestinal anti-

inflammatory Pregnancy Category C
■ INDICATIONS: Rheumatoid arthritis, Crohn’s 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’s disease: 5 mg/kg as a single infusion. Fistulizing
Crohn’s disease: 5 mg/kg repeated 2 and 6 wk after initial infusion.
■ ADMINISTRATION: Administer over at least 2 h 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 h after infusion. Symptoms usually resolve when
infusion is discontinued. Frequency of reactions may be reduced with
immunosuppressant agents. • Medications (antihistamines, acetamin-
ophen, corticosteroids, epinephrine) and equipment should be readily
available in the event of a severe reaction.
INSULIN ASPART (in-su-lin) Novolog Antidiabetic (pancreatic hormone)
■ INDICATIONS: Rapid-acting insulin (onset: 10–20 min; peak 1–3 h;
duration: 3–5 h) used to treat elevated glucose levels in type 1 and
type 2 diabetes (usually in addition to intermediate and long-acting
insulins). More rapid absorption and onset than regular insulin, with
a shorter duration.
■ THERAPEUTIC EFFECTS: Reduction of blood glucose levels.
■ DOSAGE: SC: Adults: 0.25–0.7 units/kg/d in divided doses injected
5–10 minutes before each meal.
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■ ADMINISTRATION: SC: Use only insulin syringes to draw up dose. Do
not administer cold insulin: can lead to lipodystrophy. Rotate injection
sites.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Urticaria, HYPO-
GLYCEMIA, rebound hyperglycemia (Somogyi effect), lipodystrophy,
itching, lipohypertrophy, redness, swelling, allergic reactions includ-
ing ANAPHYLAXIS.
■ CONTRAINDICATIONS: Allergy or hypersensitivity.
■ CAUTIONS: HIGH ALERT MED: Do not accept insulin orders that con-
tain the abbreviation “U” for “units.” It can be misread as a zero and
has resulted in serious, tenfold overdoses. Clarify any order that con-
tains this abbreviation. • Assess patient for signs and symptoms of
hypoglycemia (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) through-
out therapy.
INSULIN DETEMIR (in-su-lin de-te-mir) Levemir Antidiabetic (pancreatic
hormone) Pregnancy Category C
■ INDICATIONS: Long-acting basal insulin (onset: 2 h; peak: 3–14 h;
duration: 24 h) used to treat diabetes mellitus.
■ THERAPEUTIC EFFECTS: Control of blood glucose in diabetic
patients.
■ DOSAGE: For new diabetics, detemir should be started at 0.1–0.2 units/kg/d
or 10 units twice daily. For patients already on basal insulin (e.g., NPH or
glargine), detemir may be given on a unit-to-unit basis.
■ ADMINISTRATION: Administer subcutaneously using only an insulin
syringe.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Urticaria. HYPO-
GLYCEMIA, rebound hyperglycemia (Somogyi effect), lipodystrophy
(lipoatrophy, lipohypertrophy), itching, redness, swelling. allergic
reactions including ANAPHYLAXIS.
■ CONTRAINDICATIONS:. Hypoglycemia.
■ CAUTIONS: HIGH ALERT MED: Insulin-related medication errors have
resulted in patient harm and death. Do not accept orders using the
abbreviation “u” for units (can be misread as a zero; has resulted in
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tenfold overdoses). Clarify ambiguous orders and have another

licensed staff member read original order. Do not interchange
insulins. Insulin detemir is clear, which can be confusing. Do not mix
insulin detemir (Levemir) with any other insulin or solution, or use
syringes containing any other medicinal product or residue. If giving
with a short-acting insulin, use separate syringes and different injec-
tion sites. Use cautiously in pregnancy, stress, and infection, which
can alter insulin requirements. Assess patient for signs and symp-
toms of hypoglycemia (anxiety; restlessness; mood changes; tingling
in hands, feet, lips, or tongue; chills; cold sweats; confusion; cool,
pale skin; drowsiness; excessive hunger; headache; rapid pulse; shak-
iness) throughout therapy.
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 h with no pronounced peak. Provides
a continuous level of insulin, similar to the steady secretion of insulin
provided by the normal pancreas.
■ THERAPEUTIC EFFECTS: Control of blood glucose levels.
■ DOSAGE: SC: Adults and Children: Begin with 10 units at bedtime
and titrate according to glucose levels.
■ ADMINISTRATION: SC: Use only insulin syringes to draw up dose.
Rotate injection sites.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Urticaria, HYPOGLYCEMIA,
rebound hyperglycemia (Somogyi effect), lipodystrophy, itching,
lipohypertrophy, redness, swelling, allergic reactions including
ANAPHYLAXIS.
■ CAUTIONS: HIGH ALERT MED: Lantus insulin cannot be mixed with
other insulins; action may be affected in an unpredictable manner.
• Do not accept insulin orders that contain the abbreviation “U” for
“units.” It can be misread as a zero and has resulted in serious, ten-
fold overdoses. Clarify any order that contains this abbreviation. • Do
not confuse Lantus insulin with Lente insulin. • Assess patient for
signs and symptoms of hypoglycemia (cool, clammy skin, difficulty
concentrating; drowsiness; excessive hunger; headache; irritability;
nausea; rapid pulse; shakiness) and hyperglycemia (flushed, dry skin;
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fruity breath odor; frequent urination; loss of appetite; tiredness;
unusual thirst) throughout therapy.
INSULIN INJECTION CONCENTRATED (in-su-lin) Iletin II Regular
(Concentrated) U-500 Antidiabetic, hormone Pregnancy Category B
■ INDICATIONS: Short-acting insulin (onset: 1/2–1 h; peak 2–3 h; dura-
tion: 5–7 h) used to treat elevated glucose levels only in insulin-
resistant patients with type 1 diabetes whose insulin requirements
exceed 200 units/d.
■ THERAPEUTIC EFFECTS: Lowered blood glucose levels.
■ DOSAGE: SC: Adults: Individualized dosages 15–30 min before meals
or based on blood glucose levels. Double-check dosages.
■ ADMINISTRATION: Do not administer cold insulin: can lead to lipo-
dystrophy. Rotate injection sites.
■ ADVERSE REACTIONS AND SIDE EFFECTS: HYPOGLYCEMIA,
ANAPHYLAXIS.
■ CAUTIONS: HIGH ALERT MED: Concentrated regular insulin (500
units per mL) is five 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 adminis-
tration. • Do not accept insulin orders that contain the abbreviation
“U” for “units.” It can be misread as a zero and has resulted in seri-
ous, tenfold overdoses. Clarify any order that contains this abbrevia-
tion. • Never use concentrated insulin IV because of potential for
overdosage. • Assess patient for signs and symptoms of hypo-
glycemia (cool, clammy skin; difficulty concentrating; drowsiness;
excessive hunger; headache; irritability; nausea; rapid pulse; shaki-
ness) and hyperglycemia throughout therapy.
INSULIN INJECTION (REGULAR) (in-su-lin) Humulin R, Insulin-Toronto,
Novolin R, Iletin II Regular, Velosulin BR Antidiabetic (pancreatic hor-
mone) Pregnancy Category B
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■ INDICATIONS: Short-acting insulin (onset: 1/2–1 h; peak 2–3 h; dura-

tion: 5–7 h) used to treat elevated glucose levels in type 1 and type 2
diabetes (usually in addition to intermediate- and long-acting
insulins); diabetic ketoacidosis/coma, hyperkalemia.
■ THERAPEUTIC EFFECTS: Reduction of blood glucose levels; intracel-
lular shift of potassium.
■ DOSAGE: SC: Adults: 2–10 units 15–30 min before meals or in
response to blood glucose elevations. Children: 2–4 units 15–30 min
before meals or in response to blood glucose elevations. IV: Adults:
2–7 units per hour as a continuous infusion. Children: 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), lipodystrophy,
itching, lipohypertrophy, redness, swelling, allergic reactions includ-
ing ANAPHYLAXIS.
■ CAUTIONS: HIGH ALERT MED: • Do not accept insulin orders that
contain the abbreviation “U” for “units.” It can be misread as a zero
and has resulted in serious, tenfold overdoses. Clarify any order that
contains this abbreviation. Do not confuse Humulin R with Humulin
N, Humulin U, or Humalog. • Assess patient for signs and symptoms
of hypoglycemia (cool, clammy skin; difficulty concentrating; drowsi-
shakiness) and hyperglycemia throughout therapy.
INSULIN, ISOPHANE (NPH) (in-su-lin) Humulin N, NPH Iletin II, Novolin
Ge NPH, Novolin N Antidiabetic (pancreatic hormone) Pregnancy
Category B
■ INDICATIONS: Intermediate-acting insulin (onset: 1–2 h; peak 8–12 h;
duration: 18–24 h) used to treat elevated glucose levels in patients
with type 1 and type 2 diabetes.
■ DOSAGE: Adults: 7–26 units as a single dose 30–60 minutes before
breakfast. A second smaller dose may be given before dinner or at
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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 injec-
tion sites. May be mixed with regular insulin.
ANAPHYLAXIS.
contains this abbreviation. • Do not confuse Humulin N with Humulin
R, Humulin U, or Humalog. • Assess patient for signs and symptoms
shakiness) and hyperglycemia throughout therapy. • Advise patient to
eat a snack mid-afternoon and at bedtime to prevent hypoglycemia
during peak hours.
INSULIN LISPRO (in-su-lin) Humalog Antidiabetic (pancreatic hormone)
■ INDICATIONS: Rapid-acting insulin used to treat elevated glucose lev-
els in type 1 and type 2 diabetes (usually in addition to intermediate
and long-acting insulins, or with type 2 diabetes, oral hypoglycemic
agents).
■ THERAPEUTIC EFFECTS: Reduction of blood glucose levels.
■ DOSAGE: SC: Adults: 5–10 units up to 15 min before meals.
■ ADMINISTRATION: Use only U-100 insulin syringes to draw up
insulin lispro dose. Do not administer cold insulin: can lead to lipo-
dystrophy. Rotate injection sites.
ANAPHYLAXIS.
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■ CAUTIONS: HIGH ALERT MED: Do not accept insulin orders that con-
tain the abbreviation “U” for “units.” It can be misread as a zero and
has resulted in serious, tenfold overdoses. Clarify any order that con-
tains this abbreviation. • Do not confuse Humalog with Humulin.
• Hypoglycemia is most likely 2 to 4 h 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 at all times describing disease and treatment regimen.
• Assess for hyperglycemia throughout therapy. • When mixing
insulins, draw insulin lispro into syringe first to avoid contamination
of insulin lispro vial.
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%–50% of the solution
and intermediate-acting insulin comprising 50%–70% (onset: 30 min;
peak: 2–8 h; duration: 24 h). Used to treat elevated glucose levels in
patients with type 1 and type 2 diabetes.
■ DOSAGE: SC: Adults: Titrated individually based on multiple factors.
Maintenance therapy is usually 0.5–1 unit/kg/d.
■ ADMINISTRATION: Use only insulin syringes to draw up dose. SC: Do
not administer cold insulin: can lead to lipodystrophy. Rotate vial
between palms and invert gently to mix; do not shake. Rotate injec-
tion sites. May be mixed with regular insulin.
ANAPHYLAXIS.
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contains this abbreviation. • Assess patient for signs and symptoms
shakiness) and hyperglycemia throughout therapy. • Advise patient to
eat a snack mid-afternoon and at bedtime to prevent hypoglycemia
during peak hours.
IPRATROPIUM (i-pra-troe-pee-um) Atrovent Allergy, cold and cough
remedy, bronchodilator (anticholinergic) Pregnancy Category B
■ INDICATIONS: Bronchodilation in COPD. Rhinorrhea (intranasal).
Unlabeled use: Adjunctive management of bronchospasm in asthma.
■ THERAPEUTIC EFFECTS: Bronchodilation without systemic anticholin-
ergic effects. Decreased rhinorrhea.
■ DOSAGE: Inhalation: Adults: Metered-dose inhaler: 1–4 inhalations
3–4 times daily (not to exceed 24 inhalations/24 h or more frequently
than q 4 h). Via nebulization: 250–500 mcg 3–4 times daily every 6–8 h
as needed (up to 500 mcg q 4 h). Children 5–12 yr: Metered-dose
inhaler: 1–2 inhalations every 6–8 h as needed. Via nebulization:
125–250 mcg 3–4 times daily. Intranasal: Adults and Children ≥12 yr:
Perennial rhinitis: 2 sprays of 0.03% solution 2–3 times daily
(21 mcg/spray); perennial rhinitis: 2 sprays of 0.06% solution
3–4 times daily (42 mcg/spray) for up to 4 d.
■ ADMINISTRATION: When administering with other inhalation medica-
tions, administer adrenergic bronchodilators first, then ipratropium,
then corticosteroids. Wait 5 minutes between medications.
nervousness, blurred vision, sore throat, bronchospasm, cough,
hypotension, palpitations, GI irritation, rash, allergic reactions; nasal
only: epistaxis, nasal dryness/irritation.
■ CONTRAINDICATIONS: Hypersensitivity to ipratropium, atropine, bel-
ladonna alkaloids, bromide, or fluorocarbons. Avoid use during acute
bronchospasm.
■ CAUTIONS: Caution patient not to exceed 12 inhaled doses within
24 hours and to notify health-care professional if symptoms do not
improve within 30 minutes after administration of medication or if
condition worsens.
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ISOSORBIDE DINITRATE (eye-soe-sor-bide dye-nye-trate) Dilatrate-SR,

Isorbid, Isordil, Isotrate, Sorbitrate Antianginal (nitrate) Pregnancy
Category C
■ INDICATIONS: Anginal attacks, management of angina pectoris, CHF.
■ THERAPEUTIC EFFECTS: Relief of anginal attacks, increased cardiac
output.
■ DOSAGE: PO: Adults: 10–40 mg q 6 h or 40–80 mg q 8–12 h as sus-
tained-release form. SL: Adults: Acute attack of angina pectoris:
2.5–5 mg may be repeated q 5–10 min for 3 doses in 15–30 min.
Prophylaxis of angina pectoris: 2.5–10 mg repeated q 2–3 h or
15 min prior to activity.
■ ADMINISTRATION: PO: Administer 1 h before or 2 h 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.
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 sig-
nificant and potentially fatal hypotension. • Additive hypotension with
antihypertensives, acute ingestion of alcohol, beta blockers, calcium
channel blockers, and phenothiazines. • Do not discontinue abruptly.
• Make position changes slowly to minimize orthostatic hypotension.
• Avoid concurrent use of alcohol. • Inform patient that headache is a
common side effect that should decrease with continuing therapy.
• Do not alter dose to avoid headache.
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.
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■ DOSAGE: PO: Adults: Ismo, Monoket: 20 mg twice daily, 7 h apart.
Imdur: 30–60 mg once daily; may increase to 120 mg once daily (up
to 240 mg/d).
■ ADMINISTRATION: Take on an empty stomach with a full glass of
water.
apprehension, weakness, hypotension, tachycardia, paradoxic
bradycardia, syncope, abdominal pain, nausea, vomiting, flushing,
tolerance.
■ CONTRAINDICATIONS: Hypersensitivity, severe anemia, concurrent
use of sildenafil.
■ CAUTIONS: Concurrent use of sildenafil may result in significant and
potentially fatal hypotension. • Do not confuse with isosorbide, a
diuretic. • Use cautiously in head trauma or cerebral hemorrhage,
geriatric patients, pregnancy (may compromise maternal/fetal circula-
tion), children, or lactation. • Additive hypotension with antihyperten-
sives, 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 com-
mon side effect that should decrease with continuing therapy. • Do
not alter dose to avoid headache.
ITRACONAZOLE (it-tra-kon-a-zole) Sporanox Antifungal (systemic)
■ INDICATIONS: Histoplasmosis, blastomycosis, aspergillosis, ony-
chomycosis 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: 100–200 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.
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■ ADVERSE REACTIONS AND SIDE EFFECTS: CHF, edema, hyperten-

sion, nausea, abdominal pain, anorexia, diarrhea, drug-induced
hepatitis, albuminuria, TOXIC EPIDERMAL NECROLYSIS, adrenal
insufficiency, hypokalemia, rhabdomyolysis.
■ CONTRAINDICATIONS: Hypersensitivity; lactation; concurrent quini-
dine, dofetilide, pimozide, midazolam, triazolam, simvastatin, or
lovastatin; severe renal impairment, CHF, or other evidence of ven-
tricular dysfunction.
■ CAUTIONS: May increase the risk of potentially fatal arrhythmias with
quinidine, dofetilide, or pimozide. • May increase the risk of excessive
sedation with midazolam or triazolam. • Increased risk of adverse
CNS reactions with pimozide. • Increased risk of myopathy with
simvastatin or lovastatin (concurrent use contraindicated). • May
increase blood levels and risk of toxicity from warfarin, ritonavir,
indinavir, saquinavir, vinca alkaloids, busulfan, diazepam, felodipine,
isradipine, nicardipine, nifedipine, nimodipine, cyclosporine,
tacrolimus, methylprednisolone, digoxin, and quinidine. • Decreases
metabolism and may increase effects of phenytoin and oral hypo-
glycemic agents.
KETOROLAC (kee-toe-role-ak) Toradol NSAID Pregnancy Category C
■ INDICATIONS: Short-term management of pain (not to exceed 5 days
total for all routes combined).
■ THERAPEUTIC EFFECTS: Decreased pain. Also has antipyretic and
anti-inflammatory properties.
■ DOSAGE: Oral therapy is indicated only as a continuation of parenter-
al therapy; parenteral therapy should not exceed 20 doses/5 d. Total
duration of therapy by all routes should not exceed 5 d. PO: Adults
<65 yr: 20 mg initially, followed by 10 mg q 4–6 h as needed (not to
exceed 40 mg/d). PO: Adults ≥ 65 yr, <50 kg, or with renal impair-
ment: 10 mg q 4–6 hr as needed (not to exceed 40 mg/d). IM: Adults
<65 yr: Single dose: 60 mg. Multiple dosing: 30 mg q 6 hr (not to
exceed 120 mg/d). IM: Adults ≥65 yr, <50 kg, or with renal impair-
ment: Single dose: 30 mg. Multiple dosing: 15 mg q 6 hr (not to
exceed 60 mg/d). IV: Adults <65 yr: Single dose: 30 mg. Multiple dos-
ing: 30 mg q 6 hr (not to exceed 120 mg/d). IV: Adults ≥65 yr, <50 kg,
or with renal impairment: Single dose: 15 mg. Multiple dosing: 15 mg
q 6 hr (not to exceed 60 mg/d).
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■ ADMINISTRATION: PO: Oral therapy is only a continuation of par-
enteral therapy. Direct IV: Administer undiluted. Rate: Administer
over at least 15 sec.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Drowsiness, abnormal
thinking, dizziness, euphoria, headache, asthma, dyspnea, edema,
pallor, GI BLEEDING, abnormal taste, diarrhea, dry mouth, dyspepsia,
GI pain, nausea, oliguria, renal toxicity, urinary frequency, EXFOLIA-
TIVE DERMATITIS, STEVENS-JOHNSON SYNDROME, TOXIC EPIDER-
MAL NECROLYSIS, pruritus, purpura, sweating, urticaria, allergic
reactions including, anaphylaxis.
■ CONTRAINDICATIONS: Hypersensitivity; cross-sensitivity with other
NSAIDs may exist, perioperative use. Known alcohol intolerance
(injection only); perioperative pain from coronary artery bypass graft
surgery. OB/Lactation: Not recommended for use during labor, deliv-
ery, or breastfeeding
■ CAUTIONS: Do not confuse Toradol (ketorolac) with Torecan (thi-
ethylperazine) or tramadol (Ultram). Use cautiously with cardiovascu-
lar disease—may increase risk of serious thrombotic events, myocar-
dial infarction, and stroke, especially with prolonged use; history of
GI bleeding; renal impairment (dosage reduction required).
Concurrent use with aspirin may decrease effectiveness. Increased
adverse GI effects with aspirin, other NSAIDs, potassium supple-
ments, corticosteroids, or alcohol. May decrease effectiveness of
diuretics or antihypertensives. May increase serum lithium levels and
increase risk of toxicity. Increased risk of bleeding with cefotetan, cef-
operazone, valproic acid, clopidogrel, ticlopidine, tirofiban, eptifi-
batide, thrombolytic agents, or anticoagulants. Probenecid increases
ketorolac blood levels and the risk of adverse reactions (concurrent
use should be avoided). OB/Pedi: Use not recommended during 2nd
half of pregnancy or for children. Geri: Appears on Beers list.
Geriatric patients have increased risk of GI bleeding.
LAMIVUDINE (lah-mih-vyoo-deen) Epivir, Epivir HBV, 3TC Antiretroviral
■ INDICATIONS: HIV infection (AIDS) Chronic hepatitis B infection.
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■ THERAPEUTIC EFFECTS: Slows the progression of HIV infection,

increases CD4 cell counts and decreases viral load. Protection from
liver damage caused by chronic hepatitis B infection.
■ DOSAGE: PO: Adults: Chronic hepatitis B: 100 mg once daily. Adults
and Children >12 yr and ≥ 50 kg: HIV infection: 150 mg twice daily.
Adults <50 kg: HIV infection: 2 mg/kg twice daily. Children 3 mo–12 yr:
HIV infection: 4 mg/kg twice daily (up to 150 mg twice daily).
■ ADMINISTRATION: Administer without regard to food.
■ ADVERSE REACTIONS AND SIDE EFFECTS: SEIZURES, fatigue,
headache, insomnia, malaise, cough, HEPATOMEGALY WITH
STEATOSIS, PANCREATITIS, anorexia, diarrhea, nausea, vomiting,
abnormal liver function studies, musculoskeletal pain, rhabdomyoly-
sis, neuropathy, ANAPHYLAXIS, and STEVENS-JOHNSON
SYNDROME.
■ CONTRAINDICATIONS: Hypersensitivity, lactation.
■ CAUTIONS: Assess patient, especially pediatric patients, for signs of
pancreatitis (nausea, vomiting, abdominal pain) periodically through-
out therapy. May require discontinuation of therapy. • Monitor serum
amylase, lipase, and triglycerides periodically during therapy.
Elevated serum levels may indicate pancreatitis and require discon-
tinuation. 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.
• Pedi: Use extreme caution in pediatric patients with a history of
pancreatitis.
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 pathologi-
cal hypersecretory conditions.
■ THERAPEUTIC EFFECTS: Diminished accumulation of acid in the gas-
tric lumen, with lessened acid reflux, healing of duodenal ulcers and
esophagitis.
■ DOSAGE: PO: Adults: 15–30 mg once daily (may be taken twice daily
with antibiotics for treatment of H. pylori); pathological hypersecretory
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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 diffi-
culty swallowing.
diarrhea, abdominal pain, nausea, rash, increased risk of hip fracture
in elderly.
■ CAUTIONS: Do not crush or chew capsule contents. Sucralfate
decreases absorption of lansoprazole (take 30 minutes before sucral-
fate). • May decrease absorption of drugs requiring acid pH, including
ketoconazole, itraconazole, ampicillin esters, iron salts, and digoxin.
• May cause abnormal liver function tests, including increased AST,
ALT, alkaline phosphatase, LDH, and bilirubin.
LAPATINIB (la-pat-i-nib) Tykerb Antineoplastic, enzyme inhibitor
Pregnancy Category D
■ INDICATIONS: Advanced metastatic breast cancer with tumor overex-
pression of the Human Epidermal Receptor Type 2 (HER2) and past
therapy with an anthracycline, ataxane and trastuzumab; used in
combination with capecitabine (Xeloda).
■ THERAPEUTIC EFFECTS: Decreased/slowed spread of metastatic
breast cancer.
■ DOSAGE: PO: Adults: 1250 mg (5 tablets) once daily for 21 days.
Hepatic Impairment: Severe hepatic impairment: 750 mg/day.
■ ADMINISTRATION: Administer 5 tablets once daily at least 1 h before
or 1 hr after a meal for 21 days. Administer capecitabine with food or
30 min after meals twice daily.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Fatigue, insomnia,
dyspnea, interstitial lung disease, pneumonitis, decreased left ventricu-
lar ejection fraction, HEPATOTOXICITY, diarrhea, nausea, vomiting,
dyspepsia, increased liver enzymes, stomatitis, palmar-plantar ery-
throdysesthesia, rash, dry skin, neutropenia, back pain, extremity pain.
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■ CONTRAINDICATIONS: Decreased left ventricular ejection fraction

(Grade 2 or greater); OB:/Lactation: Can cause fetal harm. Contact
health-care provider if pregnancy occurs during treatment. Use an
effective form of birth control.
■ CAUTIONS: Concurrent use of CYP3A4 inhibitors including ketocona-
zole, itraconazole, clarithromycin, atazanavir, indinavir, nefazodone,
nelfinavir, ritoanvir, saquinavir, telithromycin, and voriconazole
should be avoided (if necessary, dosage reduction of lapatinib is
required); concurrent use of CYP3A4 inducers including dexametha-
sone, phenytoin, carbamazepine, rifampin, rifabutin, rifapentin and
phenobarbital may decrease levels and effectiveness and should be
avoided (if necessary, dosage of lapatinib may be titrated upward to
4500 mg/day as tolerated); Severe hepatic impairment (dosage
reduction recommended for Child-Pugh Class C); known QTc prolon-
gation or co-existing risk factors of QTc prolongation including
hypokalemia, hypomagnesemia, concurrent antiarrhythmics or med-
ications that are known to prolong QTc; Pedi: Safety in children has
not been established. Geri: Elderly patients may be more sensitive
to effects.
LEVOFLOXACIN (le-voe-flox-a-sin) Levaquin Anti-infective (fluoro-
quinolone) Pregnancy Category C
■ INDICATIONS: Urinary, gynecological, respiratory, skin and skin struc-
ture infections.
■ THERAPEUTIC EFFECTS: Resolution of infection.
■ DOSAGE: PO, IV: Adults: 250–750 mg q 24 h.
■ ADMINISTRATION: PO: Do not give within 2 h of administration of
antacids, iron, zinc, or sucralfate. IV: Rate: Administer by infusion
over at least 60 minutes. Avoid rapid bolus injection.
drowsiness, headache, acute psychoses, lightheadedness, tremors,
PSEUDOMEMBRANOUS COLITIS, abdominal pain, diarrhea, nausea,
altered taste, photosensitivity, hyperglycemia, hypoglycemia,
phlebitis at IV site, tendinitis, tendon rupture, hypersensitivity reac-
tions including ANAPHYLAXIS, STEVENS-JOHNSON SYNDROME.
■ CONTRAINDICATIONS: Hypersensitivity. OB/Pedi: Potential for fetal
harm. Safety not established in children <18 yr.
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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.
LEVOTHYROXINE (lee-voe-thye-rox-een) Levo-T, Levothroid, Levoxyl,
Synthroid Hormone (thyroid preparation) Pregnancy Category A
■ INDICATIONS: Diminished or absent thyroid function.
■ THERAPEUTIC EFFECTS: Restoration of normal hormonal balance.
■ DOSAGE: PO: Adults: 75–125 mcg/d (1.5 mcg/kg/d). Geriatric
Patients: 75 mcg/d. Children >10 yr: 150–200 mcg/d (2–3 mcg/kg/d).
Children 6–10 yr: 100–150 mcg/d (4–5 mcg/kg/d). Children 1–5 yr:
75–100 mcg/d (3–5 mcg/kg/d). Children 6–12 mo: 50–75 mcg/d
(5–6 mcg/kg/d). IM, IV: Adults: Hypothyroidism: 50–100 mcg/d.
Myxedema coma/stupor: 200–500 mcg IV. Children: Hypothyroidism:
75% of the calculated oral dose.
■ ADMINISTRATION: PO: Administer as a single dose, before breakfast.
Direct IV: Dilute with 0.9% NaCl without preservatives, for a concen-
tration of 100 mcg/mL. Rate: 100 mcg over 1 min.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Insomnia, irritability, ner-
vousness, CARDIOVASCULAR COLLAPSE, arrhythmias, tachycardia,
angina pectoris, hypertension, diarrhea, vomiting, hair loss (in chil-
dren), increased sweating, hyperthyroidism, menstrual irregularities,
weight loss, heat intolerance, accelerated bone maturation in children.
■ CONTRAINDICATIONS: Hypersensitivity, recent MI, thyrotoxicosis.
■ CAUTIONS: Bile acid sequestrants decrease absorption of orally
administered thyroid preparations. • May alter the effectiveness of
warfarin. • May cause an increase in the requirement for insulin or
oral hypoglycemic agents in diabetics. • Concurrent estrogen therapy
may increase thyroid replacement requirements. • Additive cardiovas-
cular effects with adrenergics (sympathomimetics). • May decrease
response to beta blockers. • Dose should be withheld and health-care
professional notified if resting pulse >100 bpm.
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LISINOPRIL (lye-sin-oh-pril) Prinivil, Zestril Antihypertensive (ACE

inhibitor) Pregnancy Category D
CHF symptoms.
■ DOSAGE: PO: Adults: 5–40 mg/d (maximum 80 mg/d) once daily or in
2 divided doses.
■ ADMINISTRATION: Precipitous drop in blood pressure during
first 1–3 h following first dose may occur. Monitor blood pressure
closely.
TOSIS, NEUTROPENIA (CAPTOPRIL ONLY), ANGIOEDEMA, fever.
Potential for congenital malformation if taken during first trimester.
swallowing or breathing. • Additive hypotension with other antihy-
pertensives, nitrates, phenothiazines, acute ingestion of alcohol, and
during surgery or general anesthesia. • Hyperkalemia with potassium
supplements, potassium-sparing diuretics, indomethacin, salt substi-
tutes, or cyclosporine. • May increase the risk of lithium or digoxin
toxicity. • Persistent dry cough may occur and may not subside until
medication is discontinued.
LITHIUM (lith-ee-um) Carbolith, Duralith, Eskalith, Eskalith-CR, Lithobid,
Lithonate Antimanic Pregnancy Category D
■ INDICATIONS: Bipolar affective disorders.
■ THERAPEUTIC EFFECTS: Prevents/decreases incidence of acute manic
episodes.
■ DOSAGE: Precise dosing is based on serum lithium levels. 300 mg
lithium carbonate contains 8–12 mEq lithium. PO: (Adults and children
≥12 yr): Tablets/capsules: 300–600 mg three times daily initially.
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Slow-release capsules: 200–300 mg three times daily initially;
increased up to 1800 mg/d in divided doses. Extended-release tablets:
450–900 mg twice daily or 300–600 mg three times daily initially. PO:
Children <12 yr: 15–20 mg (0.4–0.5 mEq)/kg/d in 2–3 divided doses.
■ ADMINISTRATION: PO: Administer with food or milk to minimize GI
irritation.
■ ADVERSE REACTIONS AND SIDE EFFECTS: SEIZURES, fatigue,
headache, impaired memory, muscle weakness, tremors, hyperirri-
tability, rigidity, ataxia, confusion, dizziness, drowsiness, stupor,
blurred vision, ARRHYTHMIAS, ECG changes, abdominal pain,
anorexia, bloating, diarrhea, nausea, dry mouth, polyuria, glycosuria,
renal toxicity, acne, folliculitis, pruritus, hypothyroidism, hyper-
glycemia, hyponatremia, leukocytosis, weight gain.
■ CONTRAINDICATIONS: Hypersensitivity; severe cardiovascular or
renal disease; dehydrated or debilitated patients; should be used only
where therapy, including blood levels, may be closely monitored;
OB/Lactation: High risk for fetal harm; do not use during pregnancy
or lactation.
■ CAUTIONS: Use cautiously in patients with cardiac, renal, or thyroid
disease and diabetes mellitus; increased risk of neurological toxicity
with haloperidol or molindone. Diuretics, methyldopa, probenecid,
fluoxetine, and NSAIDs. Blood levels may be increased by ACE
inhibitors. Chlorpromazine may mask early signs of lithium toxicity.
Psyllium and caffeine can decrease lithium levels. Monitor serum
lithium levels; therapeutic level is 0.5 to 1.5 mEq/L. Assess for signs
and symptoms of lithium toxicity: vomiting, diarrhea, slurred speech,
decreased coordination, drowsiness, muscle weakness, or twitching.
Report immediately. Pedi: Safety not established. Geri: Initial dosage
reduction recommended.
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.
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■ DOSAGE: PO: Adults: 4 mg initially, then 2 mg after each loose

stool. Maintenance doses usually 4–8 mg/d in divided doses.
Children 9–11 yr or 30–47 kg: 2 mg initially; then 1 mg after each
loose stool (not to exceed 6 mg/24 h). Children 6–8 yr or 24–30 kg:
1 mg initially, then 1 mg after each loose stool (not to exceed
4 mg/24 h).
■ ADMINISTRATION: Administer with clear fluids to help prevent
dehydration.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Drowsiness, dizziness,
constipation, abdominal pain/distention/discomfort, dry mouth,
nausea, allergic reactions.
■ CONTRAINDICATIONS: Hypersensitivity; patients in whom constipa-
tion must be avoided; abdominal pain of unknown cause, especially if
associated with fever; alcohol intolerance (liquid only).
■ CAUTIONS: Additive CNS depression with other CNS depressants,
alcohol, antihistamines, opioid analgesics, and sedative/hypnotics.
• Additive anticholinergic properties with other drugs having anti-
cholinergic properties, including antidepressants and antihistamines.
• Kava, valerian, skullcap, chamomile, or hops can increase CNS
depression. • Assess fluid and electrolyte balance and skin turgor for
dehydration. • In acute diarrhea, medication may be ordered after
each unformed stool. • Advise patient not to exceed the maximum
number of doses. • Advise patient that frequent mouth rinses, good
oral hygiene, and sugarless gum or candy may relieve dry mouth.
• Caution patient to avoid using alcohol and other CNS depressants
concurrently with this medication.
LORATADINE (lor-a-ta-deen) Alavert, Claritin, Claritin RediTabs Anti-
histamine Pregnancy Category B
■ INDICATIONS: Seasonal allergies, chronic idiopathic urticaria, hives.
■ THERAPEUTIC EFFECTS: Decreased symptoms of allergic reactions.
■ DOSAGE: PO: Adults and Children ≥6 yr: 10 mg once daily. Children
≥2–5 yr: 5 mg once daily.
■ ADMINISTRATION: Administer once daily. For rapidly disintegrating
tablets (Alavert, Claritin RediTabs): Place on tongue. Tablet disinte-
grates rapidly. May be taken with or without water.
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■ ADVERSE REACTIONS AND SIDE EFFECTS: Confusion, drowsiness
(rare), paradoxical excitation, blurred vision, dry mouth, GI upset,
photosensitivity, rash, and weight gain.
■ CAUTIONS: MAO inhibitors may intensify and prolong effects of anti-
histamines. • Additive CNS depression may occur with other CNS
depressants, including alcohol, antidepressants, opioid analgesics,
and sedative/hypnotics. • Maintain fluid intake of 1500–2000 mL/d to
decrease viscosity of secretions. • Instruct patient to take medication
1 hour before or 2 h 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 wk. • Instruct patient to contact health-
care professional immediately if dizziness, fainting, or fast or irregular
heartbeat occurs.
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 fre-
quency of seizures.
■ DOSAGE: PO: Adults: Anxiety: 1–3 mg two to three times daily.
Insomnia: 2–4 mg at bedtime. Geriatric or Debilitated Patients:
Anxiety: 0.5–2 mg/d in divided doses. Insomnia: 0.25–1 mg.
IM: Adults: Preoperative sedation: 50 mcg (0.05 mg)/kg 2 h before
surgery (not to exceed 4 mg). IV: Adults: Preoperative sedation:
44 mcg/kg (not to exceed 2 mg). Operative amnestic effect: up to
50 mcg/kg (not to exceed 4 mg). Antiemetic: 2 mg 30 min before
chemotherapy; may be repeated q 4 h as needed. Anticonvulsant:
50 mcg/kg, up to 4 mg; may be repeated after 10–15 min (not to
exceed 8 mg/12 h).
■ ADMINISTRATION: IV: Dilute immediately before use with an equal
amount of sterile water, D5W, or 0.9% NaCl for injection. Rate:
Administer at 2 mg over 1 min. Rapid IV administration may result
in apnea, hypotension, bradycardia, or cardiac arrest.
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lethargy, hangover, respiratory depression, dependence, tolerance.
Rapid IV: APNEA, CARDIAC ARREST, bradycardia, hypotension.
■ CONTRAINDICATIONS: Hypersensitivity, preexisting CNS depression,
uncontrolled severe pain, narrow-angle glaucoma, pregnancy and
lactation.
■ CAUTIONS: Additive CNS depression with other CNS depressants,
kava, valerian, skullcap, chamomile, or hops. • Contact health-care
professional immediately if pregnancy is planned or suspected.
LOSARTAN (loe-sar-tan) Cozaar: Antihypertensive (angiotensin II recep-
tor antagonist) Pregnancy Category C (first trimester), D (second and
third trimesters)
■ DOSAGE: PO: Adults: 25–100 mg/d as a single daily dose or 2 divided
doses.
headache, hypotension, diarrhea, drug-induced hepatitis, RENAL
FAILURE, hyperkalemia.
■ CONTRAINDICATIONS: Hypersensitivity, pregnancy, or lactation.
■ CAUTIONS: NSAIDs may decrease antihypertensive effects. Additive
antihypertensive effects with other antihypertensives and diuretics.
• Risk of hypotension is increased by concurrent diuretic therapy (use
lower initial doses). • Concurrent use of potassium-sparing diuretics
or potassium supplements may increase the risk of hyperkalemia.
• Caution patient to avoid sudden changes in position to decrease
orthostatic hypotension. • Use of alcohol, standing for long periods,
exercising, and hot weather may increase orthostatic hypotension.
• May cause dizziness; caution patient to avoid driving or other activi-
ties requiring alertness until response to medication is known. • OB:
Advise women of childbearing age to use contraception and notify
health-care professional if pregnancy is suspected or planned.
METFORMIN (met-for-min) Glucophage, Glucophage XR, Novo-
Metformin Antidiabetic Pregnancy Category B
■ INDICATIONS: Type 2 diabetes mellitus.
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■ 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, dehydra-
tion, sepsis, hypoxemia, impaired hepatic function, excessive alcohol
ingestion, renal dysfunction (serum creatinine > 1.5 mg/dL in men or
>1.4 mg/dL in women), and radiographic studies requiring IV admin-
istration of iodinated contrast media, CHF.
■ CAUTIONS: Report symptoms of lactic acidosis (chills, diarrhea, dizzi-
ness, low blood pressure, muscle pain, sleepiness, slow heartbeat or
pulse, dyspnea, or weakness) immediately. • Alcohol ingestion or
iodinated contrast media increase risk of lactic acidosis. • Nifedipine,
cimetidine, and furosemide may increase the effects of metformin.
• Glucosamine may worsen blood glucose control. • Fenugreek,
chromium, and coenzyme Q-10 may produce additive hypoglycemic
effects. • Explain risk of lactic acidosis and the potential need for
discontinuation of metformin if a severe infection, dehydration, or
severe or continuing diarrhea occurs or if medical tests or surgery
is required.
METHOXYPOLYETHYLENE GLYCOL-EPOETIN BETA (meh-thok-see-
pah-lee-eh-thih-leen gly-kol ee-poh-eh-tin bay-ta) Mircera Antianemics,
hormones Pregnancy Category C
■ INDICATIONS: Anemia due to chronic renal failure.
■ THERAPEUTIC EFFECTS: Maintains and may elevate RBCs, decreas-
ing the need for transfusions.
■ DOSAGE: Subcut, IV: Adults: 0.6 mcg/kg once every 2 wk, dosing
based on hemoglobin values. After every-2-wk dose is determined,
may be given monthly at twice the every-2-wk dose.
■ ADMINISTRATION: Subcut: May be administered in outer area of
upper arms, front of middle thighs, or abdomen, except for 2-inch
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area around navel. Do not inject in tender, red, bruised, or hard areas,
or areas that have scars or stretch marks. Pinch skin and inject at a
45° or 90° angle. IV/Subcut: If using a prefilled syringe, plunger must
be fully depressed and full dose given during injection in order for
the needle guard to activate. Following administration, remove nee-
dle from injection site and release plunger to allow the needle guard
to move up until entire needle is covered.
■ ADVERSE REACTIONS AND SIDE EFFECTS: SEIZURES, headaches, CAR-
DIOVASCULAR AND THROMBOTIC EVENTS, hypertension, hypotension,
diarrhea, constipation, vomiting, PURE RED APLASIA, ALLERGIC REAC-
TIONS INCLUDING ANAPHYLAXIS, fistula complications.
■ CONTRAINDICATIONS: Hypersensitivity, uncontrolled hypertension,
treatment of anemia due to cancer chemotherapy.
■ CAUTIONS: Monitor blood pressure closely before and during thera-
py, especially in patients with history of CV disease or hypertension.
If blood pressure cannot be controlled, dose should be reduced or
medication held. Monitor for signs of allergic reactions (tachycardia,
pruritus, rash, wheezing, dyspnea, dizziness, fainting, swelling around
mouth or eyes, sweating). If signs occur, discontinue therapy and pro-
vide supportive care. May cause seizure. Assess neurological status
periodically during therapy, especially if hemoglobin increases
>1 g/dL in any 2–wk period. The dose of Mircera should be reduced
as the hemoglobin approaches 12 g/dL or increases by more than
1 g/dL in any 2-wk period. During therapy, hematological parameters
should be monitored regularly. Individualize dosing to achieve and
maintain hemoglobin levels within the range of 10 to 12 g/dL. Use
cautiously in patients with hypertension or cardiovascular disease
(monitor closely); dialysis patients (IV route recommended to
decrease immunogenicity); predialysis patients (may require lower
doses). OB/Lactation: Use during pregnancy only if maternal benefit
outweighs fetal risk; Pedi: Safe use not established. Geri: Use lower
doses, consider age-related decrease in metabolic function, concur-
rent disease states, and medications.
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METHYLPREDNISOLONE (meth-ill-pred-niss-oh-lone) A-methaPred,
Medrol, Solu-Medrol steroidal anti-inflammatory (systemic cortico-
steroid) Pregnancy Category UK
■ INDICATIONS: Inflammatory, allergic, hematological, neoplastic, and
autoimmune disorders; asthma; replacement therapy in adrenal
insufficiency.
■ THERAPEUTIC EFFECTS: Suppression of inflammation, modification of
the immune response, replacement therapy in adrenal insufficiency.
■ DOSAGE: PO: Adults: 4–48 mg/d single or divided doses. Children:
Adrenocortical insufficiency: 117 mcg/kg (3.33 mg/m2)/d in 3 doses.
Other uses: 0.417 mg/kg–1.67 mg/kg (12.5–50 mg/m2)/d in 3–4 doses.
IM, IV: Adults: 10–40 mg. Children: Adrenocortical insufficiency:
117 mcg/kg (3.33 mg/m2)/d in 3 doses. Other uses: 139–835 mcg/kg
(4.16–25 mg/m2) q 12–24 h.
tion. Direct IV: Rate: Administer over one to several minutes.
psychoses, hypertension, PEPTIC ULCER, anorexia, nausea, acne,
decreased wound healing, ecchymoses, fragility, hirsutism, petechiae,
adrenal suppression, hyperglycemia, hypokalemia, THROMBOEM-
BOLISM, thrombophlebitis, weight gain, muscle wasting, osteoporo-
sis, cushingoid appearance, increased susceptibility to infection.
■ CONTRAINDICATIONS: Active untreated infections, lactation.
■ CAUTIONS: Instruct patient to promptly report severe abdominal pain
or tarry stools. • May increase requirement for insulin or oral hypo-
glycemic 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.
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.
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■ DOSAGE: PO: Adults: 50–450 mg/d as a single dose or 2 divided

doses. Geriatric: 25–300 mg/d as a single dose or 2 divided doses.
IV: Adults: 5 mg q 2 min for 3 doses.
■ ADMINISTRATION: PO: Withhold medication and notify physician if
apical pulse is <50 bpm or irregular. Administer with meals. IV: Inject
5 mg rapidly at 2-min intervals for 3 doses.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Fatigue, weakness,
anxiety, depression, dizziness, drowsiness, insomnia, memory loss,
blurred vision, stuffy nose, bronchospasm, wheezing, BRADYCARDIA,
CHF, PULMONARY EDEMA, hypotension, peripheral vasoconstriction,
drug-induced hepatitis, gastric pain, nausea, vomiting, impotence,
decreased libido, urinary frequency, rashes, hyperglycemia, hypo-
glycemia, arthralgia, joint pain, drug-induced lupus syndrome.
diogenic shock, bradycardia, or heart block.
■ CAUTIONS: Extended-release tablets should be swallowed whole;
do not crush, break, or chew. • Additive bradycardia with digoxin.
• Additive hypotension with other antihypertensives. • Altered effec-
tiveness of insulins or oral hypoglycemic agents. • Notify health-care
professional if slow pulse, difficulty breathing, wheezing, cold hands
and feet, dizziness, lightheadedness, confusion, depression, rash,
fever, sore throat, unusual bleeding, or bruising occur. • Change posi-
tions slowly to minimize orthostatic hypotension.
METRONIDAZOLE (me-troe-ni-da-zole) Flagyl, Novonidazol, Protostat,
Anti-infective, antiprotozoal, anti-ulcer agent Pregnancy Category B
■ INDICATIONS: Anaerobic infections, septicemia, endocarditis, periop-
erative prophylactic agent in colorectal surgery, H. pylori, amebic
dysentery, amebic liver abscess, trichomoniasis, acne rosacea, bacter-
ial 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 d. Amebiasis: 500–750 mg q 8 h. H. pylori: 250 mg 4 times
daily or 500 mg twice daily. Bacterial vaginosis: 750 mg once daily.
Children: Trichomoniasis: 5 mg/kg q 8 h. Amebiasis: 11.6–16.7 mg/kg
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q 8 h. IV: Adults: Anaerobic infections: Initial dose 15 mg/kg, then
7.5 mg/kg q 6–8 h or 500 mg q 6–8 h. Perioperative prophylaxis: Initial
dose 15 mg/kg 1 h before surgery, then 7.5 mg/kg 6 and 12 h later.
Amebiasis: 500–750 mg q 8 h.
■ ADMINISTRATION: PO: Administer with food or milk. IV: Administer
IV dose as a slow infusion, single dose over 1 h.
headache, abdominal pain, anorexia, nausea, diarrhea, dry mouth,
furry tongue, unpleasant taste, and urticaria.
■ CONTRAINDICATIONS: Hypersensitivity, first trimester of pregnancy.
■ CAUTIONS: Increases the effects of warfarin. • May cause acute psy-
chosis and confusion with disulfiram. • Avoid alcohol during and for
at least 1 d after treatment. • May cause a disulfiram-like reaction
(flushing, nausea, vomiting, headache, abdominal cramps). • Inform
patient that medication may cause urine to turn dark.
MONTELUKAST (mon-te-loo-kast) Singulair Bronchodilator (leukotriene
antagonist) Pregnancy Category B
■ INDICATIONS: Asthma.
■ THERAPEUTIC EFFECTS: Decreased frequency and severity of acute
asthma attacks.
■ DOSAGE: PO: Adults and Children ≥15 yr: 10 mg once daily. Children
6–14 yr: 5 mg once daily. Children 2–5 yr: 4 mg once daily.
■ ADMINISTRATION: Administer once daily in the evening.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Fatigue, headache, weak-
ness, nasal congestion, otitis (children), sinusitis (children), cough,
abdominal pain, diarrhea (children), dyspepsia, nausea (children),
increased liver enzymes, rash, eosinophilic conditions (including
CHURG-STRAUSS SYNDROME), fever.
■ CONTRAINDICATIONS: Hypersensitivity. Lactation: May pass into
breast milk and expose nursing infant to pharmacological effects.
■ CAUTIONS: Use cautiously in acute attacks of asthma, phenylke-
tonuria (chewable tablets contain aspartame), hepatic impairment,
reduction of corticosteroid therapy (may increase the risk of
eosinophilic conditions). • Montelukast is not used to treat acute
asthma attacks but may be continued during an acute exacerbation.
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• Patient should carry rapid-acting therapy for bronchospasm at all

times. • Advise patient to notify health-care professional if more than
the maximum number of short-acting bronchodilator treatments pre-
scribed for a 24-h period are needed. • OB/Pedi: Use cautiously in
pregnancy and children <6 yr.
MORPHINE (mor-feen) Duramorph, MS Contin, Roxanol, Opioid
analgesic/agonist Schedule II Pregnancy Category C
■ INDICATIONS: Severe pain, pulmonary edema, pain associated
with MI.
■ THERAPEUTIC EFFECTS: Decreased severity of pain.
■ DOSAGE: PO, Rectal: Adults ≥50 kg: Usual starting dose for moderate
to severe pain—30 mg q 3–4 h initially. Adults and Children <50 kg:
Usual starting dose for moderate to severe pain: 0.3 mg/kg q 3–4 h
initially. IM, IV, SC: Adults ≥50 kg: Usual starting dose for moderate
to severe pain: 4–10 mg q 3–4 h. MI: 8–15 mg. Adults and Children
<50 kg: Usual starting dose for moderate-to-severe pain: 0.1 mg/kg q
3–4 h. IV, SC: Adults: Continuous infusion: 0.8–10 mg/h; may be pre-
ceded by a bolus of 15 mg. Epidural: Adults: Intermittent injection:
5 mg/d (initially); if relief is not obtained at 60 min, 1–2 mg incre-
ments may be made (total dose not to exceed 10 mg/d). Continuous
infusion: 2–4 mg/24 h; may increase by 1–2 mg/d (up to 30 mg/d).
■ ADMINISTRATION: PO: Administer with food or milk. Extended-
release and controlled-release tablets should be swallowed whole; do
not crush, break, or chew. Pellets should not be chewed, crushed, or
dissolved. IM, SC: Use IM route for repeated doses, because mor-
phine is irritating to SC tissues. Direct IV: Administer 2.5–15 mg over
4–5 min. Rapid administration may lead to increased respiratory
depression, hypotension, and circulatory collapse. Continuous
Infusion: Administer via infusion pump to control the rate. May be
administered via patient-controlled analgesia (PCA) pump.
dizziness, euphoria, miosis, RESPIRATORY DEPRESSION, hypoten-
sion, bradycardia, constipation, nausea, urinary retention, flushing,
sweating, physical dependence, psychological dependence, tolerance.
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■ CAUTIONS: HIGH ALERT MED: Do not confuse morphine with hydro-
morphone or meperidine; errors have resulted in fatalities. • When
using an infusion pump or PCA, have a second practitioner independ-
ently check dose, concentration, and programming. • Assess level of
consciousness, blood pressure, pulse, and respirations. If respiratory
rate is <10/min, assess level of sedation. Subsequent doses may need
to be decreased by 25%–50%. • Instruct family not to administer
doses for the patient while patient is sleeping. • If an opioid antago-
nist is required, naloxone (Narcan) is the antidote. • Use with extreme
caution in patients receiving MAO inhibitors within 14 days prior
(may result in unpredictable, severe reactions—decrease initial dose
of morphine to 25% of usual dose). • Additive CNS depression with
alcohol, sedative/hypnotics, clomipramine, barbiturates, tricyclic
antidepressants, and antihistamines. • Administration of partial-
antagonist opioid analgesics may precipitate opioid withdrawal in
physically dependent patients. • Buprenorphine, dezocine,
nalbuphine, butorphanol, or pentazocine may decrease analgesia.
• May increase the anticoagulant effect of warfarin. • Patients on a
continuous infusion should have additional bolus doses provided
every 15–30 min, as needed, for breakthrough pain. • Patients taking
sustained-release morphine may require additional short-acting opi-
oid doses for breakthrough pain. • Stimulant laxatives should be
administered routinely if opioid use exceeds 2–3 d, unless
contraindicated.
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 reproduction.
■ DOSAGE: Topical: Adults and Children ≥2 mo: Apply three times
daily. Intranasal: Adults and Children ≥12 yr: Apply half of the con-
tents 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
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area three times daily and rub in gently. Treated area may be covered
with gauze if desired. Intranasal: Apply one half of the ointment from
the single-use tube to each nostril twice daily (morning and evening)
for 5 days. After application, close nostrils by pressing together and
releasing sides of the nose repeatedly for 1 minute.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Nasal only: headache,
cough, itching, pharyngitis, rhinitis, upper respiratory tract conges-
tion, nausea, altered taste; Topical only: burning, itching, pain,
stinging.
■ CONTRAINDICATIONS: Hypersensitivity to mupirocin or polyethylene
glycol.
■ CAUTIONS: Nasal mupirocin should not be used concurrently with
other nasal products. • Advise patient to apply medication exactly
as directed for the full course of therapy. • Teach patient and family
appropriate hygienic measures to prevent spread of impetigo.
• Instruct parents to notify school nurse for screening and prevention
of transmission. • Patient should consult health-care professional if
symptoms have not improved in 3–5 d.
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NAPROXEN (na-prox-en) Aleve, Anaprox, Napron X, Naprosyn, Non-
opioid analgesic, nonsteroidal anti-inflammatory, antipyretic Pregnancy
Category B (first trimester)
■ INDICATIONS: Mild-to-moderate pain, dysmenorrhea, fever, inflam-
matory disorders, rheumatoid arthritis, osteoarthritis.
■ THERAPEUTIC EFFECTS: Decreased pain, reduction of fever, suppres-
sion of inflammation.
■ DOSAGE: PO: Adults: 250–500 mg bid (up to 1.5 g/d). Children ≥2 yr:
5 mg/kg/d twice daily as naproxen suspension.
■ ADMINISTRATION: Administer with food or antacids to decrease GI
irritation.
headache, tinnitus, dyspnea, palpitations, tachycardia, DRUG-
INDUCED HEPATITIS, GI BLEEDING, constipation, dyspepsia, nausea,
anorexia, diarrhea, vomiting, cystitis, hematuria, renal failure, photo-
sensitivity, rashes, prolonged bleeding time, allergic reactions includ-
ing ANAPHYLAXIS.
■ CONTRAINDICATIONS: Hypersensitivity, active GI bleeding, ulcer
disease.
■ CAUTIONS: Patients with asthma, aspirin-induced allergy, and nasal
polyps are at increased risk for hypersensitivity reactions. Increased
risk of bleeding with alcohol, anticoagulants, thrombolytic agents,
eptifibatide, tirofiban, cefamandole, cefotetan, cefoperazone, valproic
acid, clopidogrel, ticlopidine, plicamycin. arnica, chamomile, dong
quai, feverfew, garlic, ginger, ginkgo, Panax ginseng, and licorice.
• Additive GI side effects with aspirin, corticosteroids, and other
NSAIDs. • May increase risk of hypoglycemia with insulin or oral
hypoglycemic agents. • Advise patient to consult health-care profes-
sional if rash, itching, visual disturbances, tinnitus, weight gain,
edema, black stools, persistent headache, or influenza-like syndrome
(chills, fever, muscle aches, pain) occurs.
NEBIVOLOL (ne-bi-vi-lole) Bystolic Antihypertensive beta blocker
(selective) Pregnancy Category C
■ THERAPEUTIC EFFECTS: Lowered blood pressure.
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■ DOSAGE: PO: Adults: 5 mg once daily initially, may increase at

2-wk intervals up to 40 mg/d.
■ ADMINISTRATION: PO: May be administered without regard to food.
When discontinuation is planned, observe patient carefully and
advise to minimize physical activity. Taper over 1–2 wk when possi-
ble. If angina worsens or acute coronary insufficiency develops, rein-
stitute nebivolol promptly, at least temporarily.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Headache, nausea,
bradycardia fatigue, weakness, dizziness. Nebivolol has fewer side
effects than other beta receptor blocking agents.
■ CONTRAINDICATIONS: Hypersensitivity. Severe bradycardia, heart
block greater than first degree. Cardiogenic shock, decompensated
heart failure or sick sinus syndrome (without pacemaker); severe
hepatic impairment; bronchospastic disease; lactation.
■ CAUTIONS: Drugs that affect the CYP2D6 enzyme system are expected
to alter levels and possibly effects of nebivolol; dose alterations may be
required. Fluoxetine, a known inhibitor of CYP2D6, ↑ levels and effects;
similar effects may be expected from quinidine, propafenone, and
paroxetine. Blood levels are also ↑ by cimetine. Anesthetic agents
including ether, trichloroethylene, and cyclopropane as well as other
myocardial depressants or inhibitors of AV conduction such as
diltiazem and verapamil may ↑ risk of myocardial depression and
bradycardia. Avoid concurrent use with beta blockers. Concurrent use
with reserpine or guanethidine may excessively reduce sympathetic
activity. If used concurrently with clonidine, nebivolol should be tapered
and discontinued several days prior to gradual withdrawal of clonidine.
Coronary artery disease (abrupt discontinuation of nebivolol should be
avoided); compensated congestive heart failure; diabetes mellitus (may
mask signs of hypoglycemia); thyrotoxicosis (may mask symptoms);
moderate hepatic impairment (↓ metabolism); severe renal impairment
(↓ initial dose if CCr <30 mL/min); OB: use in pregnancy only if maternal
benefit outweighs fetal risk. Pedi: Safe use in children <18 yr not estab-
lished. Geri: Consider increased sensitivity, concurrent chronic diseases,
medications and presence of age-related decrease in clearance.
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NIFEDIPINE (nye-fed-ih-peen) Adalat, Apo-Nifed, Nifedical XL, Procardia
Antianginal, antihypertensive (calcium channel blocker) Pregnancy
Category C
■ INDICATIONS: Hypertension, angina pectoris, Prinzmetal’s angina.
Unlabeled Use: Prevention of migraine.
■ THERAPEUTIC EFFECTS: Systemic and coronary vasodilation.
■ DOSAGE: PO: Adults: 10–30 mg 3 times daily (up to 180 mg/d) or
30–90 mg once daily sustained-release (up to 120 mg/d).
■ ADMINISTRATION: Administer without regard to meals or with meals
if GI irritation occurs. Avoid administration with grapefruit juice.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Headache, confusion,
dizziness, nervousness, blurred vision, disturbed equilibrium, epi-
staxis, tinnitus, dyspnea, shortness of breath, ARRHYTHMIAS, CHF,
peripheral edema, bradycardia, chest pain, hypotension, palpitations,
syncope, tachycardia, abnormal LFTs, anorexia, nausea, vomiting,
dysuria, nocturia, flushing, dermatitis, erythema multiforme, hyper-
glycemia, 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 antihyperten-
sives, nitrates, alcohol, or quinidine. • May increase risk of toxicity
from digoxin. • Concurrent use with beta blockers, digoxin, disopyra-
mide, 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.
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.
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■ DOSAGE: PO: Adults: 50–100 mg q 6–8 h or 100 mg q 12 h

extended-release. Chronic suppression: 50–100 mg at bedtime.
Children >1 mo: 0.75–1.75 mg/kg q 6 h. Chronic suppression:
1 mg/kg/d at bedtime.
■ ADMINISTRATION: Administer with food or milk to minimize GI irrita-
tion. Rinse mouth with water after oral suspension to avoid staining
teeth.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness, headache, nys-
tagmus, pneumonitis, chest pain, PSEUDOMEMBRANOUS COLITIS,
anorexia, nausea, vomiting, abdominal pain, diarrhea, hepatitis,
rust/brown discoloration of urine, photosensitivity, peripheral neu-
ropathy, hypersensitivity reactions.
■ CONTRAINDICATIONS: Hypersensitivity, hypersensitivity to parabens
(suspension), oliguria or anuria, G6PD deficiency, OB/Pedi: Potential
for fetal/neonatal harm; not for use in infants <1 mo or pregnancy
near term.
■ CAUTIONS: Notify health-care professional if fever and diarrhea
develop, especially if stool contains blood, pus, or mucus; advise
patient not to treat diarrhea without consulting health-care profes-
sional. • Increased risk of neurotoxicity with neurotoxic drugs.
• Increased risk of pneumonitis with drugs that have pulmonary toxi-
city. • Increased risk of hepatotoxicity with hepatotoxic drugs. • May
cause a rust-yellow to brown discoloration of urine, which is not sig-
nificant. • 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.
OLANZAPINE (oh-lan-za-peen) Zyprexa, Zyprexa Zydis Antipsychotics
■ INDICATIONS: Bipolar disorder, schizophrenia. Unlabeled Uses:
Anorexia nervosa, nausea/vomiting due to chemotherapy.
■ THERAPEUTIC EFFECTS: Improved control of psychiatric disorder;
prevention of chemotherapy-induced nausea (off-label).
■ DOSAGE: PO: Adults: Schizophrenia: 5–10 mg/d initially; may
increase at weekly intervals by 5 mg/d (not to exceed 20 mg/d).
Bipolar mania: 10–15 mg/d initially; may increase every 24 h by
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5 mg/d (not to exceed 20 mg/d). IM: Adults: Acute agitation: 5–10 mg,
may repeat in 2 h, then 4 h later.
■ ADMINISTRATION: PO: May be administered without regard to
meals. For orally disintegrating tablets, peel back foil on blister, do
not push tablet through foil. Using dry hands, remove from foil and
place entire tablet in mouth. Tablet will disintegrate with or without
liquid. IM: Reconstitute with 2.1 mL of sterile water for injection for a
concentration of 5 mg/mL. Solution should be clear and yellow; do
not administer solutions that are discolored or that contain particulate
matter. Inject slowly, deep into muscle. Do not administer IV or sub-
cutaneously. Administer within 1 h of reconstitution. Discard unused
solution.
■ ADVERSE REACTIONS AND SIDE EFFECTS: NEUROLEPTIC MALIG-
NANT SYNDROME, SEIZURES, agitation, tremor, dizziness, headache,
restlessness, sedation, weakness, insomnia, mood changes, tardive
dyskinesia, orthostatic hypotension, tachycardia, constipation, dry
mouth, weight gain.
■ CONTRAINDICATIONS: Hypersensitivity, lactation, orally
disintegrating tablets contain aspartame—contraindicated for
phenylketonurics.
■ CAUTIONS: Do not confuse Zyprexa (olanzapine) with Celexa (citalo-
pram) or Zyrtec (cetrizine). Cautious use in patients with hepatic
impairment; cardiovascular or cerebrovascular disease; seizures;
history of attempted suicide; hyperglycemia, prostatic hypertrophy,
narrow-angle glaucoma, history of paralytic ileus. Effects may be ↓ by
concurrent carbamazepine, omeprazole, or rifampin. ↑ hypotension
with antihypertensives. ↑ CNS depression with concurrent use of alco-
hol or other CNS depressants. May antagonize the effects of levodopa
or other dopamine agonists. OB/Peds: Safety not established. Geri:
Geriatric patients may require ↓ doses; do not use for dementia—is
associated with ↑ mortality.
OMEPRAZOLE (o-mep-ra-zole) Losec, Prilosec, Prilosec OTC, Zegerid
Antiulcer agents Pregnancy Category C
■ INDICATIONS: GERD, duodenal ulcer, Zollinger-Ellison syndrome, ↓
risk of GI bleeding.
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tric lumen with lessened gastroesophageal reflux. Healing of duode-
nal ulcers.
■ DOSAGE: PO: (Adults): GERD/erosive esophagitis: 20 mg once daily.
Duodenal ulcers: 40 mg daily for 2 wk, then 20 mg daily for
2 wk. Gastric ulcer: 40 mg once daily for 4–6 wk. Reducing risk of GI
bleeding: 40 mg initially, then 40 mg 6–8 h later, followed by 40 mg
once daily for up to 14 d. Zollinger-Ellison syndrome: 60 mg once
daily; may be increased up to 120 mg 3 times daily. PO: (Children
>2 yr and <20 kg): 10 mg once daily. PO: (Children >2 yr and ≥20 kg):
20 mg once daily.
■ ADMINISTRATION: PO: Administer before meals. Swallow capsules
whole; do not crush or chew. Capsules may be opened and sprinkled
on cool applesauce. Use immediately. Powder for oral suspension:
Administer on empty stomach, 1 h before meal. With tube feedings:
stop feeding 3 h before and 1 h after administration. Mix with
1–2 tablespoons of water; do not use other liquids. For NG
tubes: use 20 mL of water.
headache, chest pain, abdominal pain, acid regurgitation,
itching, rash, allergic reactions.
■ CAUTIONS: Use cautiously in liver disease. OB/Lactation/Pedi (under
2 yr): Safety not established. Metabolized by CYP450 enzyme system;
may compete with other drugs metabolized by this system. May ↓
metabolism and ↑ effects of diazepam, flurazepam, triazolam,
cyclosporine, disulfiram, phenytoin, and warfarin. May interfere with
absorption of drugs requiring acidic gastric pH, including ampicillin,
iron, digoxin, cyanocobalamine, and ketoconazole. May ↑ risk of
bleeding with warfarin. Do not confuse Prilosec (omeprazole) with
Prinivil (lisinopril).
ONDANSETRON (on-dan-se-tron) Zofran Antiemetics Pregnancy
Category B
■ INDICATIONS: Prevention of nausea and vomiting associated with
chemotherapy or radiation therapy. IM, IV: Prevention and treatment
of postoperative nausea and vomiting.
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■ THERAPEUTIC EFFECTS: Decreased incidence and severity of nausea
and vomiting.
■ DOSAGE: PO: Adults and Children ≥12 yr: Chemotherapy-induced
nausea/vomiting: 8 mg 30 min prior to chemotherapy and repeated
8 h later; 8 mg q 12 h may be given for 1–2 d following chemotherapy.
Radiation-induced nausea/vomiting: 8 mg 1–2 h prior to radiation.
Postoperative nausea/vomiting: 16 mg 1 h before induction of anes-
thesia. PO: Children 4–11 yr: Chemotherapy-induced nausea/vomiting:
4 mg 30 min prior to chemotherapy and repeated 4 and 8 h later;
4 mg q 8 h may be given for 1–2 d following chemotherapy. IV: Adults:
Chemotherapy-induced nausea/vomiting: 0.15 mg/kg 15–30 min prior
to chemotherapy, repeated 4 and 8 h later, or 32-mg single dose
30 min prior to chemotherapy. IM/IV: Postoperative nausea/vomiting:
4 mg before induction of anesthesia or postoperatively. IV: Children
4–18 yr: Chemotherapy-induced nausea/vomiting: 0.15 mg/kg 1
5–30 min prior to chemotherapy, repeated 4 and 8 h later. IV: Children
2–12 yr and ≥40 kg: Postoperative nausea/vomiting: 0.15 mg/kg.
IV: Children >40 kg: Postoperative nausea/vomiting 4 mg. Hepatic
Impairment: PO, IM, IV: Adults: Not to exceed 8 mg/d.
■ ADMINISTRATION: PO: For orally disintegrating tablets, peel off
backing and place on tongue. Direct IV: Administer undiluted over
2–5 min. Intermittent Infusion: Dilute in 50 mL of D5W, 0.9% NaCl, or
combinations of both and administer over 15 min.
fatigue, diarrhea, constipation, abdominal pain, dry mouth, increased
liver enzymes, extrapyramidal reactions.
■ CAUTIONS: Do not confuse Zofran (ondansetron) with Zosyn
(piperacillin/tazobactam). Use cautiously in liver impairment (dose
not to exceed 8 mg/d), abdominal surgery (may mask ileus). Pedi:
Safety not established in under children <3 yr.
PALIPERIDONE (pa-li-per-i-done) Invega antipsychotics benzisoxazoles
■ INDICATIONS: Schizophrenia.
■ THERAPEUTIC EFFECTS: Decreased manifestations of schizophrenia.
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■ DOSAGE: PO: Adults: 6 mg/d; may be titrated as needed

(range 3–12 mg/d).
Renal Impairment: CCr 50–80 mL/min—dose should not exceed
6 mg/d; CCr 10–<50 mL/min—dose should not exceed 3 mg/d.
■ ADMINISTRATION: Administer once daily in the morning without
regard to food. Tablets should be swallowed whole; do not crush,
break, or chew.
NANT SYNDROME, drowsiness, headache, anxiety, confusion, dizzi-
ness, extrapyramidal disorders (dose related), fatigue, parkinsonism
(dose related), tardive dyskinesia, weakness, blurry vision, dyspnea,
cough, palpitations, tachycardia (dose related), bradycardia, orthosta-
tic hypotension, ↑ QTc interval, abdominal pain, dry mouth, dyspep-
sia, nausea, swollen tongue, hyperglycemia, back pain, dystonia
(dose related), akithisia, dyskinesia, tremor (dose related).
■ CONTRAINDICATIONS: Hypersensitivity to paliperidone or risperi-
done; concurrent use of drugs known to cause QTc prolongation
(including quinidine, procainamide, sotalol, amiodarone, chlorpro-
mazine, thioridazine, moxofloxacin); history of congenital QTc prolon-
gation or other cardiac arrhythmias; bradycardia, hypokalemia, hypo-
magnesemia (increased risk of QTc prolongation); preexisting severe
GI narrowing (due to nature of tablet formulation). Lactation:
Discontinue drug or bottle feed.
■ CAUTIONS: Use caution in patients with history of suicide attempt;
patients at risk for aspiration pneumonia; history of seizures; conditions
that may increase body temperature (strenuous exercise, exposure to
extreme heat, concurrent anticholinergics or risk of dehydration). ↑ risk
of CNS depression with other CNS depressants including alcohol, anti-
histamines, sedative/hypnotics, or opioid analgesics. May antagonize
the effects of levodopa or other dopamine agonists. ↑ risk of orthostat-
ic hypotension with antihypertensives, nitrates, or other agents that
lower blood pressure. Carbamazepine may ↓ levels/effects. OB: Safety
not established; use only if maternal benefit outweighs fetal risk. Pedi:
Safety not established. Geri: ↑ risk of mortality in elderly patients treat-
ed for dementia-related psychosis; consider age-related decrease in
renal function.
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PANTOPRAZOLE (pan-toe-pra-zole) Protonix, Protonix IV Antiulcer
agents Pregnancy Category B
■ INDICATIONS: Erosive esophagitis associated with GERD.
Pathological gastric hypersecretory conditions.
■ THERAPEUTIC EFFECTS: Diminished accumulation of acid in
the gastric lumen, with decreased acid reflux. Healing of duodenal
ulcers and esophagitis. Decreased acid secretion in hypersecretory
conditions.
■ DOSAGE: PO: Adults: GERD: 40 mg once daily. Gastric hypersecretory
conditions: 40 mg twice daily, up to 120 mg twice daily. IV: Adults:
GERD: 40 mg once daily for 7–10 d. Gastric hypersecretory condi-
tions: 80 mg q 12 h (up to 240 mg/d).
■ ADMINISTRATION: PO: May be administered with or without food.
Do not break, crush, or chew tablets. IV: Reconstitute each vial with
10 mL of 0.9% NaCl for a concentration of 4 mg/mL (40 mg total).
Direct IV: Administer 4 mg/mL solution undiluted over at least 2 min.
Intermittent Infusion: Add reconstituted medication to 100 mL of D5W,
0.9% NaCl, or LR for a concentration of 0.4 mg/mL. Diluted solution is
stable for 24 h at room temperature. Rate: Administer over 15 min at a
rate of <3 mg/min.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Headache, abdominal
pain, diarrhea, eructation, flatulence, hyperglycemia.
■ CONTRAINDICATIONS: Hypersensitivity; lactation.
■ CAUTIONS: May alter the bioavailability and effects of drugs for
which absorption is pH-dependent. May ↑ risk of bleeding with war-
farin (monitor INR/PT). OB/Pedi: Safety not established.
PAROXETINE (par-ox-e-teen) Paxil, Paxil CR Antianxiety, antidepressant
(SSRI) Pregnancy Category C
■ INDICATIONS: Depression, panic disorder, OCD, social anxiety disor-
der, generalized anxiety disorder.
■ THERAPEUTIC EFFECTS: Improved mood; decreased frequency of
panic attacks, OCD, or anxiety.
■ DOSAGE: PO: Adults: 10–60 mg as a single dose in the morning.
Geriatric Patients or Debilitated Patients: 10–40 mg/d.
■ ADMINISTRATION: Administer with food to minimize GI irritation.
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■ ADVERSE REACTIONS AND SIDE EFFECTS: Anxiety, dizziness,

drowsiness, headache, insomnia, weakness, agitation, mental depres-
sion, syncope, blurred vision, yawning, chest pain, edema, hyperten-
sion, 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.
therapy (may result in serious, potentially fatal reactions).
■ CAUTIONS: Serious, potentially fatal reactions (hyperthermia, rigidity,
myoclonus, autonomic instability, with fluctuating vital signs and
extreme agitation, which may proceed to delirium and coma) may occur
with concurrent MAO inhibitor therapy. • MAO inhibitors should be
stopped at least 14 d prior to paroxetine therapy. • Paroxetine should be
stopped at least 14 d prior to MAO inhibitor therapy. • May decrease the
effectiveness of digoxin. • May increase the risk of bleeding with war-
farin without altering INR time. • Increased risk of serotinergic side
effects including serotonin syndrome with St. John’s wort and SAMe.
PENTOXIFYLLINE (pen-tox-if-i-lin) Trental Blood viscosity reducing
agent Pregnancy Category C
■ INDICATIONS: Symptomatic peripheral vascular disease (intermittent
claudication).
■ THERAPEUTIC EFFECTS: Increased blood flow.
■ DOSAGE: PO: Adults: 400 mg 3 times daily; if GI or CNS side effects
occur, decrease dose to 400 mg twice daily.
■ ADMINISTRATION: Administer with meals to minimize GI irritation.
Tablets should be swallowed whole; do not crush, break, or chew.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Agitation, dizziness,
drowsiness, headache, insomnia, nervousness, blurred vision, dysp-
nea, angina, arrhythmias, edema, flushing, hypotension, abdominal
discomfort, belching, bloating, diarrhea, dyspepsia, flatus, nausea,
vomiting, tremor.
■ CONTRAINDICATIONS: Hypersensitivity, intolerance to other xanthine
derivatives (caffeine and theophylline).
■ CAUTIONS: Additive hypotension may occur with antihypertensives
and nitrates. • May increase the risk of bleeding with warfarin,
heparin, aspirin, NSAIDs, cefamandole, cefoperazone, cefotetan,
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plicamycin, valproic acid, clopidogrel, ticlopidine, eptifibatide,
tirofiban, or thrombolytic agents. • May increase the risk of theo-
phylline 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 activi-
ties 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.
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 d. Children:
4 mg/kg 3 times daily for 2 d.
■ ADMINISTRATION: Administer medication with or following meals to
decrease GI irritation.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Headache, vertigo, hepa-
totoxicity, nausea, bright orange urine, renal failure, rash, hemolytic
anemia, methemoglobinemia.
■ CONTRAINDICATIONS: Hypersensitivity, glomerulonephritis, severe
hepatitis, uremia, or renal failure, renal insufficiency, G6PD deficiency.
■ CAUTIONS: Do not crush, break, or chew tablet. Assess patient for
urgency, frequency, and pain on urination. • Interferes with urine tests
based on color reactions (glucose, ketones, bilirubin, steroids, pro-
tein). • Medication should be discontinued after pain or discomfort is
relieved (usually 2 d 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
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or bedding. • Sanitary napkin may be worn to avoid clothing stains.

• May also cause staining of soft contact lenses. • Instruct patient to
notify health-care professional if rash, skin discoloration, or unusual
tiredness occurs.
PHENYTOIN (fen-i-toyn) Dilantin, Diphenylan, diphenylhydantoin, DPH
Anticonvulsant Pregnancy Category D
■ INDICATIONS: Tonic-clonic seizures and complex partial seizures.
■ THERAPEUTIC EFFECTS: Diminished seizure activity.
■ DOSAGE: PO: Adults: 200–1200 mg/d in divided doses. Geriatric
Patients: 3 mg/kg/d in divided doses. Children: Initially 5–10 mg/kg/d
in 2–3 divided doses. IV: Adults: 15–20 mg/kg. Rate not to exceed
25–50 mg/min. Children: 15–20 mg/kg at 1–3 mg/kg/min.
■ ADMINISTRATION: PO: Administer with or immediately after meals to
minimize GI irritation. Chewable tablets must be crushed or chewed
well before swallowing. Direct IV: Administer at a rate not to exceed
50 mg over 1 min (25 mg/min in patients who may develop hypoten-
sion, patients who are on sympathomimetic medication, patients with
cardiovascular disease, or geriatric patients; 1–3 mg/kg/min in
neonates). Rapid administration may result in severe hypotension,
cardiovascular collapse, or CNS depression. Intermittent Infusion: Do
not mix with dextrose solutions. Mix with no more than 50 mL of
0.9% NaCl for a concentration of 1–10 mg/mL. Administer immediate-
ly. Use tubing with a 0.45- to 0.22-micron in-line filter. Rate: Complete
infusion within 1 h at a rate not to exceed 50 mg/min. Monitor cardiac
function and blood pressure throughout infusion.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Ataxia, agitation, dizzi-
ness, drowsiness, dyskinesia, extrapyramidal syndrome, headache,
nervousness, weakness, diplopia, nystagmus, tinnitus, hypotension
(increased with IV phenytoin), gingival hyperplasia, nausea; pink, red,
reddish-brown discoloration of urine; hypertrichosis, rashes, exfolia-
tive dermatitis, pruritus, hypocalcemia, AGRANULOCYTOSIS, APLAS-
TIC ANEMIA, back pain, osteomalacia, allergic reactions including
STEVENS-JOHNSON SYNDROME, fever, lymphadenopathy.
■ CONTRAINDICATIONS: Hypersensitivity, sinus bradycardia,
sinoatrial block, 2nd- or 3rd-degree heart block, or Stokes-Adams
syndrome.
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■ CAUTIONS: Assess patient for phenytoin hypersensitivity syndrome
(fever, skin rash, lymphadenopathy). Hypersensitivity syndrome may
lead to renal failure, rhabdomyolysis, or hepatic necrosis; may be
fatal. • Monitor CBC and platelet count, serum calcium, albumin, uri-
nalysis, and hepatic and thyroid function tests periodically through-
out therapy. • Barbiturates, carbamazepine, reserpine, chronic inges-
tion of alcohol, and warfarin may decrease phenytoin blood levels. IV
phenytoin and dopamine may cause additive hypotension. Additive
CNS depression with other CNS depressants, including alcohol,
antihistamines, antidepressants, opioids, and sedative/hypnotics.
• Additive cardiac depression may occur with propranolol or
lidocaine. • Concurrent administration of enteral tube feedings may
decrease phenytoin absorption. • Instruct patient on importance of
maintaining good dental hygiene and seeing dentist frequently.
• Advise patient that brands of phenytoin may not be equivalent;
check with health-care professional if brand or dosage form is
changed. • Serum phenytoin levels should be routinely monitored.
Therapeutic blood levels are 10–20 mcg/mL in patients with normal
serum albumin and renal function.
PIOGLITAZONE (pi-o-glit-a-zone) Actos Antidiabetic Pregnancy
Category C
■ THERAPEUTIC EFFECTS: Decreased insulin resistance, resulting in
glycemic control without hypoglycemia.
■ DOSAGE: PO: Adults: 15–45 mg once daily.
■ ADMINISTRATION: May be administered with or without meals.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Edema, anemia.
■ CONTRAINDICATIONS: Hypersensitivity, type 1 diabetes, diabetic
ketoacidosis, active liver disease or increased ALT. OB/Lactation/Pedi:
Potential for fetal harm; may pass into breast milk and cause hypo-
glycemia in the infant. Safety not established for children <18 yr.
■ CAUTIONS: Use cautiously in edema, CHF, hepatic impairment,
women with childbearing potential (may restore ovulation and risk of
pregnancy). • Ketoconazole may increase the effects of pioglitazone.
• Glucosamine may worsen blood glucose control. • Fenugreek,
chromium, and coenzyme Q-10 may produce additive hypoglycemic
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effects. • Review signs of hypoglycemia and hyperglycemia with

patient. • If hypoglycemia occurs, advise patient to take a glass of
orange juice or 2–3 teaspoons of sugar, honey, or corn syrup dis-
solved in water and notify health-care professional.
POSACONAZOLE (po-sa-kon-a-zole) Noxafil Antifungals, triazoles
■ INDICATIONS: Prevention of invasive Aspergillus and Candida
infections in severely immunocompromised patients. Treatment of
oropharyngeal candidiasis (including candidiasis unresponsive to
itraconazole or fluconazole).
■ THERAPEUTIC EFFECTS: Fungistatic/fungicidal action against
susceptible fungi.
■ DOSAGE: PO: Adults: Oropharyngeal candidiasis: 100 mg twice daily
for 1 d, then 100 mg daily for 13 d. Refractory oropharyngeal candidi-
asis: 400 mg twice daily. PO: Adults and Children≥13 yr: Prophylaxis
of invasive fungal infections: 200 mg three times daily.
■ ADMINISTRATION: Shake suspension well before use. Administer
200 mg (5-mL dose) with a full meal or liquid nutritional supplement
to enhance absorption. Rinse spoon for administration with water
after each use. Alternative therapy or close monitoring for break-
through fungal infections should be considered for patients unable
to eat a full meal or tolerate a nutritional supplement.
■ ADVERSE REACTIONS AND SIDE EFFECTS: HEPATOCELLULAR DAM-
AGE, diarrhea, nausea, vomiting, adrenal insufficiency.
■ CONTRAINDICATIONS: Hypersensitivity; concurrent use of pimozide
or quinidine (↑ risk of serious arrhythmias); concurrent use of ergot
alkaloids (↑ risk of ergotism); concurrent use of sirolimus (↑ risk of
sirolimus toxicity).
■ CAUTIONS: History of/predisposition to QTc prolongation including
congenital QTc prolongation, concurrent medications that prolong QTc,
high cumulative anthracycline; history or electrolyte abnormalities
(hypokalemia, hypomagnesemia); correct preexisting abnormalities
prior to administration; hypersensitivity to other azole antifungals;
hepatic impairment; severe diarrhea, vomiting, or renal impairment
(monitor for breakthrough fungal infections). Posaconazole inhibits the
CYP3A4 enzyme systems and should be expected to interact with other
drugs affected by this system. Rifabutin, phenytoin, cimetidine, and
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efavirenz ↓ levels and may ↓ antifungal effectiveness; avoid concurrent
use. ↑ cyclosporine, sirolimus, and tacrolimus levels and risk of toxici-
ty; use with sirolimus contraindicated; for cyclosporine and tacrolimus,
↓ dose initially and monitor levels frequently. ↑ rifabutin levels; avoid
concurrent use. ↑ phenytoin, midazolam, ritonavir, and atazanavir lev-
els; monitor for excess clinical effect. ↑ levels and risk of neurotoxicity
of vinca alkaloids, including vincristine and vinblastine; consider dose
adjustment. ↑ levels and risk of toxicity of HMG-CoA reductase
inhibitors (statins); consider ↓ statin dose. OB/Lactation: Use only if
maternal benefit outweighs risk to child. May pass into breast milk
and pose a risk to the nursing infant. Pedi: Safety not established in
children <13 yr.
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 electrolyte
balance.
■ DOSAGE: PO: Adults: 20–100 mEq/d; single dose should not exceed
20 mEq. Children: 2–3 mEq/kg/d or 20–40 mEq/m2/d in divided doses.
IV: Adults: Serum potassium >2.5 mEq/L: up to 200 mEq/d as an
infusion (not to exceed 10 mEq/h or a concentration of 40 mEq/L via
peripheral line. Serum potassium <2 mEq/L: up to 400 mEq/d as an
infusion. Children: Up to 3 mEq/kg/d as an infusion.
■ ADMINISTRATION: PO: Administer with a meal and full glass of
water. IV: Rate: 10 mEq/h unless in a monitored setting.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Confusion, restlessness,
weakness, ARRHYTHMIAS, ECG changes, abdominal pain,
diarrhea, flatulence, nausea, vomiting, irritation at IV site.
■ CONTRAINDICATIONS: Hyperkalemia, severe renal impairment,
untreated Addison’s disease, severe tissue trauma, hyperkalemic
familial periodic paralysis.
■ CAUTIONS: HIGH ALERT MED: IV potassium concentrate must be
diluted before use or else is rapidly fatal. Symptoms of hyperkalemia
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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 hyper-
kalemia. • Monitor serum potassium before and periodically through-
out therapy.
PRAVASTATIN (pra-va-stat-in) Pravachol Lipid-lowering agent Pregnancy
Category X
dyslipidemias.
■ THERAPEUTIC EFFECTS: Lowering of total and LDL cholesterol.
■ DOSAGE: PO: Adults: 10–40 mg once daily.
■ 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 dis-
turbances, and myopathy. • Blood levels and the risk of myopathy are
increased by concurrent cyclosporine and gemfibrozil, clofibrate,
erythromycin, large doses of niacin and azole antifungal agents.
• Grapefruit juice may cause higher blood levels and increased risk
of toxicity. • Liver function tests, including AST, should be monitored
before, at 6–12 wk after initiation of therapy or after dose elevation,
and then every 6 mo. • If AST levels increase to 3 times normal,
HMG-CoA reductase inhibitor therapy should be discontinued. • May
also cause elevated alkaline phosphatase and bilirubin levels.
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PREDNISONE (pred-ni-sone) Deltasone, Orasone, Pred-Pak, Prednicot
Steroidal anti-inflammatory (systemic corticosteroid) Pregnancy Category UK
■ INDICATIONS: Inflammatory, allergic, hematological, neoplastic,
autoimmune disorders; asthma, replacement therapy in adrenal
insufficiency.
■ THERAPEUTIC EFFECTS: Suppression of inflammation, modification
of the normal immune response, replacement therapy in adrenal
insufficiency.
■ DOSAGE: PO: Adults: 5–60 mg/d single dose or divided doses.
Children ≥10 yr: Nephrosis: 20 mg 4 times daily initially. Children
4–10 yr: Nephrosis: 15 mg 4 times daily initially. Children 18 mo–4 yr:
Nephrosis: 7.5–10 mg 4 times daily initially.
■ ADMINISTRATION: Administer with meals to minimize GI irritation.
psychoses, restlessness, cataracts, hypertension, PEPTIC ULCER,
anorexia, nausea, acne, decreased wound healing, ecchymoses,
fragility, hirsutism, petechiae, adrenal suppression, hyperglycemia,
hypokalemia, THROMBOEMBOLISM, thrombophlebitis, weight gain,
muscle wasting, osteoporosis, cushingoid appearance, increased sus-
ceptibility to infection.
■ CONTRAINDICATIONS: Active untreated infections. Lactation: May
pass into breast milk and expose nursing infant to adverse reaction
and side effects.
■ CAUTIONS: Use cautiously in stress (surgery, infections). Instruct
patient to promptly report severe abdominal pain or tarry stools.
• 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, non-
healing sores, visual or behavioral changes. • OB/Pedi: Potential for
fetal harm. Use cautiously in children (chronic use will result in
decreased growth).
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PROMETHAZINE (proe-meth-a-zeen) Anergan, Phenergan, Phenoject

Antiemetic, antihistamine, sedative/hypnotic Pregnancy Category C
■ INDICATIONS: Allergic conditions, motion sickness, preoperative
sedation, nausea and vomiting, adjunct to anesthesia and analgesia.
■ THERAPEUTIC EFFECTS: Relief of symptoms of histamine excess
usually seen in allergic conditions. Diminished nausea or vomiting.
Sedation.
■ DOSAGE: PO/PR/IM/IV: Adults: 12.5–25 mg up to 4 times per day.
Sedation: 25–50 mg preoperatively or at bedtime. Children ≥2 yr:
5–12.5 mg 3 times daily or 25 mg at bedtime. Sedation: 0.5–1.1 mg/kg
or 10–25 mg. Preoperatively or at bedtime.
■ ADMINISTRATION: PO: Administer with food or milk to minimize GI
irritation. Direct IV: Do not exceed concentration of 25 mg/mL. Rate:
Administer 25 mg over at least 1 min.
NANT SYNDROME, confusion, disorientation, sedation, extrapyrami-
dal reactions, fatigue, insomnia, nervousness, blurred vision, diplopia,
tinnitus, bradycardia, hypertension, hypotension, tachycardia, drug-
induced hepatitis, dry mouth, photosensitivity, rashes.
■ CONTRAINDICATIONS: Hypersensitivity, prostatic hypertrophy, blad-
der neck obstruction, narrow-angle glaucoma.
■ CAUTIONS: Additive CNS depression with CNS depressants, alcohol,
antihistamines, opioid analgesics, and sedative/hypnotics. • Additive
anticholinergic effects with antihistamines, antidepressants, atropine,
haloperidol, other phenothiazines, quinidine, and disopyramide.
• Monitor for extrapyramidal side effects (akathisia—restlessness;
dystonia—muscle spasms and twisting motions; pseudoparkinsonism—
mask-like face, rigidity, tremors, drooling, shuffling gait, dysphagia);
notify health-care professional if they occur.
PROPRANOLOL (proe-pran-oh-lole) Apo-Propranolol, Betachron E-R,
Inderal, Inderal LA, Novopranol, Antianginal, antiarrhythmic, antihyper-
tensive, (beta blocker) Pregnancy Category C
■ INDICATIONS: Hypertension, angina pectoris, arrhythmias, MI, vascu-
lar headaches, hypertrophic cardiomyopathy.
■ THERAPEUTIC EFFECTS: Decreased heart rate and blood pressure,
suppression of arrhythmias.
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■ DOSAGE: PO: Adults: 40–320 mg/d in 2–4 divided doses or once daily
as extended/sustained-release capsules. Children: 2–4 mg/kg/d in 2
divided doses. IV: Adults: 1–3 mg; may be repeated after 2 min and
again in 4 h. Children: 10–100 mcg (0.01–0.1 mg)/kg (up to 1
mg/dose); may be repeated q 6–8 h.
■ ADMINISTRATION: PO: Administer with meals or directly after eating
to enhance absorption. Take apical pulse prior to administering. If
<50 bpm or if arrhythmia occurs, withhold medication and notify
physician or other health-care professional. IV: Administer undiluted
or dilute each 1 mg in 10 mL of D5W for injection. Rate: Administer
over at least 1 min.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Fatigue, weakness, anxi-
ety, dizziness, drowsiness, insomnia, memory loss, mental depres-
sion, mental status changes, nervousness, nightmares, blurred vision,
dry eyes, nasal stuffiness, bronchospasm, wheezing, ARRHYTHMIAS,
BRADYCARDIA, CHF, PULMONARY EDEMA, orthostatic hypotension,
peripheral vasoconstriction, constipation, diarrhea, nausea, impo-
tence, decreased libido, itching, rashes, hyperglycemia, hypoglycemia
(increased in children), arthralgia, back pain, muscle cramps, pares-
thesia, drug-induced lupus syndrome.
diogenic shock, bradycardia, or heart block.
■ CAUTIONS: HIGH ALERT MED: The intravenous dose of propranolol
is much smaller than the oral dose. Check IV doses carefully. Patients
receiving propranolol IV must have continuous ECG monitoring and
may have pulmonary capillary wedge pressure (PCWP) or central
venous pressure (CVP) monitoring during and for several hours after
administration. • Abrupt withdrawal may precipitate life-threatening
arrhythmias, hypertension, or myocardial ischemia. • General 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 stimulation
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(excessive hypertension, bradycardia). • Concurrent thyroid adminis-

tration 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 bron-
chodilators and theophylline. • May decrease the beneficial beta car-
diovascular effects of dopamine or dobutamine. • Use cautiously
within 14 d of MAO inhibitor therapy (may result in hypertension).
• Cimetidine may increase blood levels and toxicity. • Concurrent
NSAIDs may decrease antihypertensive action. • Smoking increases
metabolism and decreases effects; smoking cessation may increase
effects. • Advise patient to make sure enough medication is available
for weekends, holidays, and vacations. • A written prescription may
be kept in a wallet in case of emergency.
QUETIAPINE (kwet-eye-a-peen) Seroquel antipsychotics Pregnancy
Category C
■ INDICATIONS: Schizophrenia. Bipolar mania.
■ THERAPEUTIC EFFECTS: Decreased manifestations of psychoses or
acute mania.
■ DOSAGE: PO: Adults: Schizophrenia: 25 mg twice daily initially,
increased by 25–50 mg 2–3 times daily over 3 d, up to 300–400 mg/d
in 2–3 divided doses by the 4th day (not to exceed 800 mg/d). Bipolar
mania: 100 mg/d in 2 divided doses on day 1, increase dose by
100 mg/d up to 400 mg/d by day 4, then may increase in increments
of 200 mg/d up to 800 mg/d on day 6 if required.
■ ADMINISTRATION: May be administered without regard to food.
NANT SYNDROME, SEIZURES, dizziness, cognitive impairment,
extrapyramidal symptoms, sedation, tardive dyskinesia, dyspnea pal-
pitations, peripheral edema, postural hypotension, anorexia, consti-
pation, dry mouth, sweating, leukopenia, weight gain.
■ CONTRAINDICATIONS: Hypersensitivity. Lactation: May pass into
breast milk and expose nursing infant to adverse effects.
■ CAUTIONS: Use cautiously in cardiovascular disease, cerebrovascular
disease, dehydration or hypovolemia (increased risk of hypotension);
hepatic impairment (dosage reduction may be necessary); hypothy-
roidism (may be exacerbated); history of suicide attempt. ↑ CNS
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depression with alcohol, antihistamines, opioid analgesics, and
sedative/hypnotics. ↑ risk of hypotension with acute ingestion of
alcohol or antihypertensives. Phenytoin carbamazepine, barbiturates
and thioridazine ↓ effectiveness of quetiapine (dose change may be
necessary). Effects may be ↑ by ketoconazole, itraconazole, flucona-
zole, or erythromycin. Do not confuse Seroquel (quetiapine) with
Serzone (nefazodone). OB/Pedi: Safety not established. Geri: Geriatric
patients (age ≥65 yr) may require ↓ doses. Use cautiously in seizures
or Alzheimer’s dementia (use with dementia associated with ↑
mortality).
QUINAPRIL (kwin-a-pril) Accupril Antihypertensive (ACE inhibitor)
Pregnancy Category C (first trimester), D (second and third trimesters)
CHF symptoms.
■ DOSAGE: PO: Adults: 10–80 mg/d in single or divided doses.
TOSIS, ANGIOEDEMA, fever.
Potential for fetal harm or congenital malformation if taken in first
trimester. Lactation: May pass into breast milk and expose infant to
side effects and adverse reactions.
swallowing or breathing. • Use cautiously in renal or hepatic impair-
ment, hypovolemia, hyponatremia, elderly patients, concurrent
diuretic therapy, aortic stenosis/hypertrophic cardiomyopathy, cere-
brovascular or cardiac insufficiency, surgery/anesthesia, lactation or
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children. • Additive hypotension with other antihypertensives,

nitrates, phenothiazines, acute ingestion of alcohol, and during sur-
gery 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 medica-
tion is discontinued. Pedi: Safety not established. Geri: Consider
comorbidities, renal and hepatic function, and potential for electrolyte
imbalance.
RABEPRAZOLE (ra-bep-ra-zole) Aciphex Antiulcer agent (proton pump
inhibitor) Pregnancy Category B
■ INDICATIONS: GERD, duodenal ulcer, pathological hypersecretory
conditions (Zollinger-Ellison syndrome).
tric lumen, with lessened acid reflux, healing of duodenal ulcers and
esophagitis, decreased acid secretion in hypersecretory conditions.
■ DOSAGE: PO: Adults: 20 mg once daily. Hypersecretory conditions:
60–100 mg daily.
■ ADMINISTRATION: Administer doses before meals, preferably in the
morning.
malaise, abdominal pain, constipation, diarrhea, nausea, photosensi-
tivity, rash, neck pain. allergic reactions, chills, fever, increase risk of
hip fracture in geriatric patients.
■ CONTRAINDICATIONS: Hypersensitivity to rabeprazole or related
drugs (benzimidazoles).
■ CAUTIONS: Use cautiously in severe hepatic impairment (dosage
reduction may be necessary). • Decreases blood levels of ketocona-
zole. • Increases blood levels of digoxin. OB/Lactation/Pedi: Use with
caution.
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.
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■ ADVERSE REACTIONS AND SIDE EFFECTS: Leg cramps, hot flashes.
■ CONTRAINDICATIONS: Hypersensitivity, history of thromboembolic
events, women with childbearing potential. OB/Lactation/Pedi:
Potential for fetal harm; may pass into breast milk and expose infant
to side effects and adverse reactions. Not for use in 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 dis-
continued at least 72 h before and during prolonged immobilization
(recovery from surgery, prolonged bedrest). • Instruct patient to avoid
prolonged restrictions of movement during travel because of the
increased risk of venous thrombosis. • Advise patient that raloxifene
will not reduce hot flashes or flushes associated with estrogen defi-
ciency and may cause hot flashes.
RALTEGRAVIR (ral-teg-ra-veer) Isentress Antiretroviral, integrase strand
transfer inhibitor (INSTI) Pregnancy Category C
■ INDICATIONS: HIV infection (with other antiretrovirals) in patients
who are failing other treatments as evidenced by continued viral
replication and resistance to other agents.
■ THERAPEUTIC EFFECTS: Evidence of decreased viral replication and
reduced viral load with slowed progression of HIV and its sequelae.
■ DOSAGE: PO: Adults: 400 mg twice daily.
fatigue, weakness, myocardial infarction, diarrhea, abdominal pain,
gastritis, hepatitis, vomiting, renal failure/impairment, anemia, neu-
tropenia, lipodystrophy, hypersensitivity reactions, immune reconsti-
tution syndrome, fever.
■ CONTRAINDICATIONS: OB: Lactation (breastfeeding not recommended
in HIV-infected patients).
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■ CAUTIONS: Concurrent use with strong inducers of the UGT A1A

enzyme system including rifampin may ↓ blood levels and effective-
ness. Concurrent use with strong inhibitors of the UGT A1A enzyme
system may ↑ blood levels. ↑ risk of rhabdomyolysis/myopathy
HMG-CoA reductase inhibitors. Use cautiously in patients taking med-
ications associated with rhabdomyolysis/myopathy (may increase risk)
concurrently. OB: Use in pregnancy only if maternal benefit outweighs
fetal risk. Pedi: Safe use in children <16 yr not established. Geri:
Choose dose carefully, considering concurrent disease states, drug
therapy and age-related decrease in hepatic and renal function.
RAMIPRIL (ram-i-pril) Altace Antihypertensive (ACE inhibitor) Pregnancy
Category C (first trimester), D (second and third trimesters)
symptoms of CHF.
■ DOSAGE: PO: Adults: 2.5–5mg once daily, may be increased up to
20 mg/d in 1–2 divided doses.
TOSIS, NEUTROPENIA, ANGIOEDEMA, fever.
inhibitors may occur, history of angioedema. OB: Potential for con-
genital malformation if taken in first trimester.
swallowing or breathing. • Use cautiously in renal or hepatic impair-
ment, hypovolemia, hyponatremia, concurrent diuretic therapy, aortic
stenosis/hypertrophic cardiomyopathy, cerebrovascular or cardiac
insufficiency, or surgery/anesthesia. • Additive hypotension with
other antihypertensives, nitrates, phenothiazines, acute ingestion of
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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. Lactation/
Pedi/Geri: Use with caution.
RANITIDINE (ra-ni-ti-deen) Apo-Ranitidine, Zantac, Zantac-C, Zantac 75
Antiulcer agents Pregnancy Category B
■ INDICATIONS: Short-term treatment of active duodenal ulcers and
benign gastric ulcers. Maintentance therapy for duodenal and gastric
ulcers after healing of active ulcer(s). Management of gastric hyper-
secretory states (Zollinger-Ellison syndrome). Treatment of and
maintenace therapy for erosive esophagitis. Treatment of gastro-
esophageal reflux disease (GERD). Heartburn, acid indigestion, and
sour stomach (OTC use). IV: Prevention and treatment of stress-
induced upper GI bleeding in critically ill patients.
■ 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: 150 mg
twice daily or 300 mg once daily at bedtime. Duodenal ulcer prophy-
laxis: 150 mg once daily at bedtime. GERD: 150 mg twice daily.
Erosive esophagitis: 150 mg 4 times daily initially, then 150 mg twice
daily as maintenance. Gastric hypersecretory conditions: 150 mg
twice daily initially; up to 6 g/d have been used. OTC use: 75 mg
when symptoms occur (up to twice daily). PO: Children 1 mo–16 yr:
Treatment of active ulcers: 2–4 mg/kg/d divided twice daily, maxi-
mum 300 mg/d. GERD and erosive esophagitis: 4–10 mg/kg/d divided
twice daily, maximum 300 mg/d for GERD, 600 mg/d for erosive
esophagitis. PO: Neonates: 2 mg/kg/d divided q 12 h. IV, IM: Adults:
50 mg q 6–8 h (not to exceed 400 mg/d). Continuous IV infusion:
6.25 mg/h. Gastric hypersecretory conditions: 1 mg/kg/h; may be
increased by 0.5 mg/kg/h (not to exceed 2.5 mg/kg/h). IV, IM:
Children 1 mo–16 yr: Treatment of active ulcers: 2–4 mg/kg/d divided
q 6–8 h, maximum 200 mg/d.Continuous infusion: 1 mg/kg/dose
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followed by 0.08–0.17 mg/kg/h. IV: Neonates: 1.5 mg/kg/dose load,

then in 12 h start maintenance of 1.5–2 mg/kg/d divided q 12 h.
Continuous IV infusion: 1.5 mg/kg/dose load followed by
0.04–0.08 mg/kg/h infusion.
Renal Impairment: PO: Adults: CCr 10–50 mL/min: reduce dose to
50% of dose recommended for indication; CCr, 10 mL/min: reduce
dose to 25% of dose recommended for indication; further reductions
may be necessary if there is coexistent hepatic impairment.
■ ADMINISTRATION: Avoid administration of antacids within 1 h of ran-
itidine; sucralfate may decrease the absorption of ranitidine—take 2 h
after ranitidine. PO: Remove foil from effervescent tablets or granules
and dissolve in 6–8 oz water. Direct IV: Dilute each 50 mg in 20 mL of
0.9% NaCl or D5W for injection. Rate: Administer over at least 5 min
at a maximum of 10 mg/min. Rapid administration may cause
hypotension and arrhythmias. Intermittent Infusion: Dilute each
50 mg in 100 mL of 0.9% NaCl or D5W. Diluted solution is stable for
48 h at room temperature. Rate: Administer over 15–20 min.
Continuous Infusion: Add ranitidine to D5W for a concentration of
150 mg/250 mL (no greater than 2.5 mg/mL for Zollinger-Ellison
patients). Rate: Administer at a rate of 6.25 mg/h. In patients with
Zollinger-Ellison syndrome, start infusion at 1 mg/kg/h. If gastric acid
output is >10 mEq/h, adjust dose by 0.5 mg/kg/h increments and
remeasure gastric output.
drowsiness, hallucinations, headache, ARRHYTHMIAS, constipation,
diarrhea, nausea, impotence, AGRANULOCYTOSIS, APLASTIC ANE-
MIA, anemia, neutropenia, thrombocytopenia, hypersensivity reac-
tions, vasculitis.
■ CAUTIONS: Do not confuse Zantac (ranitidine) with Xanax (alprazo-
lam) or Zyrtec (cetrizine). Use cautiously in patients with renal or
hepatic impairment or acute porphyria. Effervescent tablets and gran-
ules contain phenylalanine. OB: Cautious use in pregnancy. Lactation:
Passes into breast milk and can cause decreased stomach acid in the
infant. Geri: Geriatric patients are more susceptible to adverse CNS
reactions including dizziness and confusion; dosage reduction
recommended.
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RANOLAZINE (ra-nole-a-zeen) Ranexa Antianginals Pregnancy Category C
■ INDICATIONS: Chronic angina pectoris not adequately controlled by
conventional antianginals (amlodipine, beta blockers, nitrates).
■ THERAPEUTIC EFFECTS: Decreased frequency of angina
■ DOSAGE: PO: Adults: 500 mg twice daily initially, may be increased
to 1000 mg twice daily.
Tablets should be swallowed whole; do not crush, break, or chew.
■ ADVERSE REACTIONS AND SIDE EFFECTS: dizziness, headache, tin-
nitus, palpitations, QTc prolongation, abdominal pain, constipation,
dry mouth, nausea, vomiting.
■ CONTRAINDICATIONS: Hypersensitivity, preexisting QTc prolongation
or concurrent use of other medications causing QTc prolongation,
potent inhibitors of CYP3A (ketoconazole, verapamil, diltiazem),
hepatic impairment. Lactation: May pass into breast milk and expose
nursing infant to adverse reactions and side effects.
■ CAUTIONS: Increases blood levels of simvastatin and its active
metabolite. Partially inhibits CYP2D6 enzyme system; may ↓ metabo-
lism and increase effects of tricyclic antidepressants and antipsy-
chotics, dosage adjustments may be necessary. Inhibits P-glycoprotein
(P-gp), which may lead to ↑ digoxin levels; dosage adjustment may be
required. Use with caution in patients with severe renal impairment
(may ↑ blood pressure). OB: Use only when use outweighs risk to
fetus. Pedi: Safety not established. Geri: Patients >75 yr have ↑ risk
of adverse reactions.
RASAGILINE (raza-ji-leen) Azilect Antiparkinson agents, monoamine
oxidase type B inhibitors Pregnancy Category C
■ INDICATIONS: Parkinson’s disease
■ THERAPEUTIC EFFECTS: Improvement in symptoms of Parkinson’s
disease, allowing increase in function.
■ DOSAGE: PO: Adults: Monotherapy: 1 mg daily. Adjunct therapy:
0.5 mg daily, may be increased to 1 mg daily. Concurrent
ciprofloxacin or other CYP1A2 inhibitor: 0.5 mg daily. Hepatic
Impairment: PO: Adults: Mild hepatic impairment: 1 mg daily.
Adjunct therapy: 0.5 mg daily, may be increased to 1 mg daily.
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■ ADMINISTRATION: Administer once daily.

■ ADVERSE REACTIONS AND SIDE EFFECTS: Depression, dizziness,
hallucinations, malaise, asthma, chest pain, postural hypotension
(may ↑ levodopa-induced hypotension), syncope, anorexia, vomiting,
albuminuria, ↓ libido, ↑ melanoma risk, rash, weight loss, leukopenia,
dyskinesia (may ↑ levodopa-induced dyskinesia), paresthesia, allergic
reactions, flu-like syndrome, ↑ fall risk, fever.
■ CONTRAINDICATIONS: Hypersensitivity, preexisting QTc prolongation
or concurrent use of other medications causing QTc prolongation,
potent inhibitors of CYP3A (ketoconazole, verapamil, diltiazem),
hepatic impairment. Lactation: May inhibit lactation and may pass
into breast milk and expose nursing infant to adverse reactions and
side effects.
■ CAUTIONS: Ciprofloxacin and other inhibitors of the CYP1A2 enzyme
↑ rasagiline levels; dose adjustment is recommended. Meperidine has
resulted in life-threatening reactions when used with MAO inhibitors;
wait at least 14 d after discontinuation of rasagiline to initiate meperi-
dine. Similar reactions may occur with tramadol, methadone,
propoxyphene; concurrent use should be avoided. Concurrent use
with dextromethorphan may result in psychosis/bizarre behavior and
should be avoided. Risk of adverse reactions in ↑ with mirtazapine
and cyclobenzapine. Hypertensive crisis may occur with sympatho-
mimetic amines including amphetamines, cold products, and some
weight loss products containing vasoconstrictors such as pseu-
doephedrine, phenylephrine, or ephedrine. Risk of CNS toxicity is ↑
with tricyclic antidepressants, SSRI antidepressants, NSRI antide-
pressants, and other MAO inhibitors; rasagiline should be discontin-
ued at least 14 d prior to initiation of antidepressants (fluoxetine
should be discontinued at least 5 weeks prior to rasagiline therapy).
Hypertensive crisis may also occur when rasagiline is used with other
MAO inhibitors; allow at least 14 d between usage. Ingestion of
tyramine-rich foods or beverages may result in life-threatening
hypertensive crisis. Use cautiously in hepatic impairment (↑ blood
levels). OB: Use only if maternal benefit outweighs fetal risk.
Pedi: Safety in children has not been established.
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REPAGLINIDE (re-pag-li-nide) Prandin Antidiabetic Pregnancy Category C
■ DOSAGE: PO: Adults: 0.5–4 mg taken before meals (not to exceed
16 mg/d).
■ ADMINISTRATION: Administer up to 30 min before meals.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Angina, chest pain, hypo-
glycemia, hyperglycemia.
■ CONTRAINDICATIONS: Contraindicated in hypersensitivity, diabetic
ketoacidosis, insulin-dependent diabetes. Lactation: May pass into
breast milk and expose nursing infant to adverse reactions.
■ 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 pro-
longed exercise or when alcohol or more than one hypoglycemic
agent is used. • Use cautiously in impaired liver function (longer dos-
ing intervals may be necessary). • Ketoconazole, miconazole, and
erythromycin may decrease metabolism and increase the risk of
hypoglycemia. • Increased effects possible with NSAIDs, sulfon-
amides, chloramphenicol, warfarin, probenecid, MAO inhibitors, and
beta blockers. • Decreased effects possible with corticosteroids, phe-
nothiazines, thyroid preparations, estrogens, hormonal contracep-
tives, 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 tem-
porarily discontinued for patients requiring surgery involving restrict-
ed intake of food and fluids. • Caution patient to avoid taking other
prescription or OTC medications or alcohol during repaglinide thera-
py without consulting health-care professional. OB/Pedi: Use with
caution.
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RIFAMPIN (rif-am-pin) Rifadin, Rimactane, Rofact Antitubercular

■ INDICATIONS: Active tuberculosis.
organisms.
■ DOSAGE: PO, IV: Adults: 600 mg/d or 10 mg/kg/d. Children:
10–20 mg/kg/d single dose (not to exceed 600 mg/d).
■ ADMINISTRATION: PO: Administer medication on an empty stomach
at least 1 h before or 2 h after meals with a full glass. Intermittent
Infusion: Rate: Administer solutions diluted in 500 mL over 3 h and
solutions diluted in 100 mL over 30 min.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Red discoloration of
tears, abdominal pain, diarrhea, flatulence, heartburn, nausea, vomit-
ing, drug-induced hepatitis, red discoloration of saliva, red discol-
oration of urine, red discoloration of all body fluids.
■ CONTRAINDICATIONS: Hypersensitivity, concurrent indinavir, nelfi-
navir, or saquinavir.
■ CAUTIONS: Use cautiously in liver disease, concurrent use of other
hepatotoxic agents. • Increased risk of hepatotoxicity with other hepa-
totoxic agents, including alcohol, isoniazid, pyrazinamide (for pyrazi-
namide check liver function studies every 2 wk), and ketoconazole.
• Rifampin significantly decreases blood levels of delavirdine, indi-
navir, nelfinavir, and saquinavir; concurrent use is contraindicated.
• Report signs of hepatitis (yellow eyes and skin, nausea, vomiting,
anorexia, unusual tiredness, weakness) or of thrombocytopenia
(unusual bleeding or bruising) occur. OB/Pedi: Use with caution.
RISPERIDONE (riss-pear-uh-doan) Risperdal Antipsychotic Pregnancy
Category C
■ INDICATIONS: Psychotic disorders.
■ THERAPEUTIC EFFECTS: Decreased symptoms of psychoses.
■ DOSAGE: PO: Adults: 4–6 mg/d; not to exceed 16 mg/d.
Geriatrics/Renal Impairment/Hepatic Impairment: PO: Adults: 0.5 mg
twice daily; increase by 0.5 mg up to 1.5 mg twice daily; then increase
at weekly intervals.
■ ADMINISTRATION: Give without regard to food.
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NANT SYNDROME, aggressive behavior, dizziness, extrapyramidal
reactions, headache, increased dreams, increased sleep duration,
insomnia, sedation, nervousness, tardive dyskinesia, pharyngitis,
rhinitis, visual disturbances, cough, arrhythmias, orthostatic hypoten-
sion, tachycardia, constipation, diarrhea, dry mouth, nausea,
decreased libido, dysmenorrhea/menorrhagia, itching/skin rash, pho-
tosensitivity, weight gain, polydipsia.
■ CAUTIONS: Monitor for neuroleptic malignant syndrome (fever, respi-
ratory distress, tachycardia, convulsions, diaphoresis, hypertension or
hypotension, pallor, tiredness). • Notify health-care professional
immediately. • Additive CNS depression with CNS depressants,
alcohol, antihistamines, sedative/hypnotics, or opioid analgesics.
• Monitor for and report extrapyramidal side effects (akathisia—
restlessness; dystonia—muscle spasms and twisting motions; or
pseudoparkinsonism—mask-like face, rigidity, tremors, drooling,
shuffling gait, dysphagia). • Monitor for tardive dyskinesia (involun-
tary rhythmic movement of mouth, face, and extremities); report
immediately—may be irreversible.
ROSIGLITAZONE (roe-zi-glit-a-zone) Avandia Antidiabetic Pregnancy
Category C
■ THERAPEUTIC EFFECTS: Decreased insulin resistance, resulting in
glycemic control without hypoglycemia.
■ DOSAGE: PO: Adults: 4–8 mg as a single daily dose or as 2 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. Increased risk
of fractures of the arm, hand, and foot in female patients.
■ CONTRAINDICATIONS: Hypersensitivity, type 1 diabetes, diabetic
ketoacidosis, active liver disease, or increased ALT (>2.5 times upper
limit of normal). OB/Lactation/Pedi: May cause fetal harm; may pass
into breast milk and expose nursing infant to adverse reactions.
Safety not established in children <18 yr.
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■ 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 poten-
tial (may restore ovulation and risk of pregnancy). • Glucosamine
may worsen blood glucose control. • Fenugreek, chromium, and
coenzyme Q-10 may produce additive hypoglycemic effects.
• Monitor AST and ALT every 2 months during the first 12 months
of therapy and periodically thereafter or if jaundice or symptoms of
hepatic dysfunction occur. • May cause irreversible elevations in AST
and ALT or hepatic failure (rare). • Review signs of hypoglycemia and
hyperglycemia with patient. • If hypoglycemia occurs, advise patient
to take a glass of orange juice or 2–3 teaspoons of sugar, honey, or
corn syrup dissolved in water and notify health-care professional.
ROSUVASTATIN (roe-soo-va-sta-tin) Crestor Lipid-lowering agents
Pregnancy Category X
■ INDICATIONS: Primary hypercholesterolemia and mixed dyslipi-
demias.
■ THERAPEUTIC EFFECTS: Lowers cholesterol and triglycerides.
■ DOSAGE: PO: Adults: 10 mg once daily initially (range 5–20 mg ini-
tially); doses of 40 mg/d are associated with ↑ risk of rhabdomyolysis.
Renal Impairment: PO: Adults: CCr, <30 mL/min—5 mg once daily
intially, may be increased to but not exceed 10 mg/d.
■ ADMINISTRATION: PO: Administer once daily without regard to food.
Do not administer with antacid; wait at least 2 h after rosuvastatin.
Avoid grapefruit and grapefruit juice.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Weakness, abdominal
pain, constipation, nausea, rash, RHABDOMYOLYSIS, myalgia.
■ CONTRAINDICATIONS: Hypersensitivity, active liver disease, or unex-
plained persistent elevations in AST and ALT. OB/Lactation: Not rec-
ommended for pregnant or breastfeeding women.
■ CAUTIONS: History of liver disease, alcoholism, renal impairment,
patients with Asian ancestry (may have ↑ risk of rhabdomyolysis).
Careful observation with concurrent use of gemfibrozil, azole anti-
fungals, protease inhibitors, niacin, cyclosporine, amiodarone, or
verapamil—increases risk of myopathy/rhabdomyolysis. Antacids ↓
absorption (administer 2 h after rosuvastatin). Cyclosporine ↑ levels
and risk of toxicity (dosage adjustment required). ↑ levels of
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norgestrel and ethinyl estradiol. Concurrent use of fibrates or niacin
(↑ risk of rhabdomyolysis; avoid gemfibrozil if possible). May ↑ risk of
bleeding with warfarin (monitor INR). Grapefruit juice ↑ blood levels
and the risk of rhabdomyolysis. If patient develops muscle tenderness
during therapy, CPK levels should be monitored. If CPK levels are
markedly ↑ or myopathy occurs, therapy should be discontinued.
OB: Cautious use in women of childbearing age. Pedi: Safety not
established.
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SALMETEROL (sal-meh-ter-all) Serevent Bronchodilator (adrenergic)

■ 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 mcg (two inhala-
tions as aerosol or one as dry powder) twice daily (approximately
12 h apart); exercise-induced bronchospasm: 50 mcg (two inhalations
as aerosol or one as dry powder) 30–60 min before exercise. Children
4–12 yr: 50 mcg (as dry powder) twice daily (approximately 12 h
apart); exercise-induced bronchospasm: 50 mcg (as dry powder)
30–60 min before exercise.
■ ADMINISTRATION: Do not use spacer with powder for inhalation.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Headache, nervousness,
palpitations, tachycardia, abdominal pain, diarrhea, nausea, muscle
cramps/soreness, trembling, ASTHMA-RELATED RESPIRATORY
EVENTS.
■ CONTRAINDICATIONS: Hypersensitivity, acute asthma attack (onset
of action is delayed).
■ CAUTIONS: Use cautiously in cardiovascular disease (including angina
and hypertension), diabetes, glaucoma, hyperthyroidism, African
American patients, patients not on inhaled steroids, pheochromocy-
toma, aerosol inhalation may be used in children >12 yr. • Beta block-
ers may decrease the therapeutic effects of salmeterol. • Instruct
patient using powder for inhalation never to exhale into discus device
and to always hold device in a level horizontal position. • Mouthpiece
should be kept dry; never wash. • Caution patient not to use salme-
terol to treat acute symptoms. A rapid-acting inhaled beta-adrenergic
bronchodilator should be used instead. OB/Lactation/Pedi: Pregnancy,
lactation, or children <4 yr (dry powder inhalation may be used in
children 4–12 yr).
SELEGILINE TRANSDERMAL (se-le-ji-leen) Emsam Antidepressant,
monoamine oxidase type B inhibitor Pregnancy Category C
■ INDICATIONS: Major depressive disorder.
■ THERAPEUTIC EFFECTS: Decreased symptoms of depression.
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■ DOSAGE: Transdermal: Adults: 6 mg/24 h, if necessary , may be
increased at 2-wk intervals in increments of 3 mg, up to 12 mg/24 h.
■ ADMINISTRATION: Transdermal: Apply system once every 24 h at the
same time each day to dry, intact skin on the upper torso such as
chest, back, upper thigh, or outer surface of the upper arm. Avoid
hairy, oily, irritated, broken, or scarred areas. Wash area with soap
and warm water, rinse thoroughly. Allow skin to dry completely.
Apply system immediately after removing from package. Do not cut
the system. Remove liner from adhesive layer and press firmly in
place with palm of hand for 30 sec, especially around the edges.
Remove used system and fold so that adhesive edges are together.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Insomnia, abnormal
thinking, agitation, amnesia, worsening of mania/hypomania, ↑
cough, HYPERTENSIVE CRISIS, chest pain, orthostatic hypotension,
peripheral edema, diarrhea, altered taste, anorexia, constipation, flat-
ulence, gastroenteritis, application site reactions , pruritus, sweating.
■ CONTRAINDICATIONS: Hypersensitivity; pheochromocytoma; concur-
rent selective serotonin re-uptake inhibitors (fluoxetine, paroxetine
citalopram, escitalopram and others), non-selective serotonin re-
uptake inhibitors (venlafaxine, duloxetine), tricyclic antidepressants
(amitriptyline, imipramine and others), carbamazepine, oxcar-
bazepine, amphetamines, vasoconstrictors (ephedrine, pseu-
doephedrine), bupropion, meperidine, tramadol, methadone,
propoxyphene, dextromethorphan, mirtazapine cyclobenzaprine,
other MAO inhibitors (isocarboxazid, phenelzine, tranylcypromine)
oral selegiline, sympathomimetic amines, amphetamines, cocaine or
local anesthetics with vasoconstrictors; St. John’s wort; alcohol.
■ CAUTIONS: May ↑ risk of suicide attempt/ideation especially during
early treatment or dose adjustment; risk may be greater in children or
adolescents (safe use in children <12 yr not established). History of
mania; dosing at 9 mg/24 h or 12 mg/24 h requires dietary modifica-
tion (avoid foods containing large amounts of tyramine). Concurrent
use of selective serotonin re-uptake inhibitors (fluoxetine,
paroxetine, citalopram, escitalopram and others), nonselective sero-
tonin reuptake inhibitors (venlafaxine, duloxetine), tricyclic antide-
pressants (amitriptyline, imipramine, and others), carbamazepine,
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oxcarbazepine, amphetamines, vasoconstrictors (ephedrine, pseu-

doephedrine, phenylpropanolamine), bupropion, meperidine, tra-
madol, methadone, propoxyphene, dextromethorphan, mirtazapine,
cyclobenzaprine, other MAO inhibitors (isocarboxazid, phenelzine,
tranylcypromine) oral selegiline, sympathomimetic amines, ampheta-
mines, cocaine, or local anesthetics with vasoconstrictors may ↑ risk
of hypertensive crisis. (Fluoxetine should not be used within 2 wk of
initiating therapy). OB: Use only if benefit outweighs risk to the fetus.
Lactation: Safety not established. Pedi: Safe use in children and ado-
lescents not established. Geri: May be more susceptible to orthostatic
hypotension.
SERTRALINE (ser-tra-leen) Zoloft antidepressant (Selective serotonin
reuptake inhibitor) Pregnancy Category B
■ INDICATIONS: Depression, panic disorder, OCD, post-traumatic stress
disorder (PTSD), social anxiety disorder (social phobia), premenstrual
dysphoric disorder (PMDD).
■ THERAPEUTIC EFFECTS: Improved mood, decreased incidence of
panic attacks, decreased obsessive and compulsive behavior,
decreased feelings of intense fear, helplessness, or horror.
■ DOSAGE: PO: Adults: 50–200 mg once daily. Children 13–17 yr:
50 mg once daily. Children 6–12 yr: 25 mg once daily.
■ ADMINISTRATION: Administer as a single dose in the morning or
evening.
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.
therapy (may result in serious, potentially fatal reactions).
■ CAUTIONS: Serious, potentially fatal reactions (hyperthermia, rigidity,
myoclonus, autonomic instability, with fluctuating vital signs and
extreme agitation, which may proceed to delirium and coma) may
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occur with concurrent MAO inhibitors. • MAO inhibitors should be
stopped at least 14 d before sertraline therapy. • Sertraline should be
stopped at least 14 d before MAO inhibitor therapy. • May increase
levels/effects of warfarin and phenytoin. • Increased risk of serotonin
syndrome with St. John’s wort and SAMe. • Caution patient to avoid
driving and other activities requiring alertness until response to the
drug is known.
SIMVASTATIN (sim-va-sta-tin) Zocor Lipid-lowering agent Pregnancy
Category X
dyslipidemia.
■ THERAPEUTIC EFFECTS: Lowering of total and LDL cholesterol.
■ DOSAGE: PO: Adults: 5–80 mg once daily in the evening.
■ CAUTIONS: If patient develops muscle tenderness during therapy,
CPK levels should be monitored. • If CPK levels are markedly
increased or myopathy occurs, therapy should be discontinued.
• Blood levels and the risk of myopathy are increased by concurrent
cyclosporine, gemfibrozil, clofibrate, erythromycin, and large doses
of niacin and azole antifungal agents. • Grapefruit juice may cause
higher blood levels and increased risk of toxicity. • Liver function
tests, including AST, should be monitored before, at 6–12 wk after ini-
tiation of therapy or after dose elevation, and then every 6 mo. • If
AST levels increase to three times normal, HMG-CoA reductase
inhibitor therapy should be discontinued. • May also cause elevated
alkaline phosphatase and bilirubin levels.
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SITAGLIPTIN (sit-a-glip-tin) Januvia Antidiabetic, enzyme inhibitor

■ INDICATIONS: Adjunct to diet and exercise to improve glycemic con-
trol in patients with type 2 diabetes mellitus; may be used as
monotherapy or combination therapy with metformin and a thiazo-
lidinedione and/or a sulfonylurea.
■ THERAPEUTIC EFFECTS: Improved control of blood glucose.
■ DOSAGE: PO: Adults: 100 mg once daily. Renal Impairment: CCr
30–<50mL/min: 50 mg once daily; CCr <30 mL/min: 25 mg once daily.
Tablets should be swallowed whole with full glass of water.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Headache, nausea, diar-
rhea, upper respiratory tract infection, nasopharyngitis, hypersensitiv-
ity reactions including anaphylaxis, angioedema, and exfoliative skin
conditions (Stevens-Johnson syndrome), rash, urticaria.
■ CONTRAINDICATIONS: Type 1 diabetes mellitus, diabetic ketoacido-
sis, hypersensitivity.
■ CAUTIONS: Use cautiously in history of renal impairment (dose
reduction required for CCr <50 mL/min; OB/Lactation: Use in preg-
nancy only if clearly needed; use cautiously in lactation. Pedi: Safe
use in children not established. Geri: Consider age-related decrease in
renal function when determining dose.
SPIRONOLACTONE (speer-oh-no-lak-tone) Aldactone, Novospiroton
Diuretic (potassium-sparing diuretic) Pregnancy Category B
■ INDICATIONS: Counteract potassium loss caused by other diuretics,
used with thiazides to treat edema or hypertension.
■ THERAPEUTIC EFFECTS: Weak diuretic and antihypertensive
response when compared with other diuretics, conservation of
potassium.
■ DOSAGE: PO: Adults: 25–400 mg/d as a single dose or 2–4 divided
doses. CHF: 12.5–25 mg/d (unlabeled use). Children: 1–3 mg/kg/d
(30–90 mg/m2/d as a single dose or 2–4 divided doses (not to exceed
three times initial dose).
■ ADMINISTRATION: Administer in a.m. to avoid interrupting sleep pat-
tern. Administer with food or milk to minimize gastric irritation and to
increase bioavailability.
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■ ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness, arrhythmias,
constipation, GI irritation, impotence, hyperkalemia, hyponatremia,
muscle cramps, allergic reactions.
■ CONTRAINDICATIONS: Hypersensitivity, hyperkalemia.
■ CAUTIONS: Use cautiously in hepatic dysfunction, geriatric or debili-
tated patients, or patients with diabetes mellitus (increased risk
of hyperkalemia), renal insufficiency (BUN >30 mg/dL or CCr
<30 mL/min), pregnancy, lactation, or children. • Additive hypotension
with acute ingestion of alcohol, other antihypertensives, or nitrates.
• Use with ACE inhibitors, indomethacin, potassium supplements, or
cyclosporine increases risk of hyperkalemia. • Decreases lithium
excretion. Effectiveness may be decreased by NSAIDs. • May cause
dizziness—caution patient to avoid driving or other activities requir-
ing alertness until response to medication is known.
SUMATRIPTAN (soo-ma-trip-tan) Imitrex Vascular headache suppres-
sant Pregnancy Category C
■ INDICATIONS: Migraine and cluster headaches.
■ THERAPEUTIC EFFECTS: Relief of acute attacks of migraine.
■ DOSAGE: PO: Adults: 25–50 mg initially; if response is inadequate at
2 h, may repeat (not to exceed 200 mg in 24 h). SC: Adults: 6 mg;
may repeat after 1 h (not to exceed 12 mg in 24 h). Intranasal: Adults:
Single dose of 5, 10, or 20 mg in one nostril; may be repeated in 2 h,
not to exceed 40 mg in 24 h or treatment of >5 episodes/month.
■ ADMINISTRATION: PO: Tablets are film-coated because contents have
an unpleasant taste. Swallow whole; do not crush, break, or chew.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness, vertigo, anxi-
ety, drowsiness, MI, angina, chest pressure, chest tightness, coronary
vasospasm, ECG changes, transient hypertension, tingling, warm sen-
sation, burning sensation, injection site reaction, numbness.
■ CONTRAINDICATIONS: Hypersensitivity, ischemic heart disease,
Prinzmetal’s angina, uncontrolled hypertension, concurrent MAO
inhibitor therapy, elderly patients.
■ CAUTIONS: Monitor blood pressure before and for 1 h after initial SC
dose for patients with cardiovascular risk factors. • Use only if cardio-
vascular status has been evaluated and first dose is administered
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under supervision. • Increased risk of vasospastic reactions with

ergotamine, dihydroergotamine, or methysergide. • Do not use
within 2 wk of discontinuing MAO inhibitor. • Increased risk of
serotonergic side effects including serotonin syndrome with
St. John’s wort and SAMe. • Advise patient to notify health-care
professional if pain or tightness in the chest occurs.
SUNITINIB (su-ni-ti-nib) Sutent Antineoplastic Pregnancy Category D
■ INDICATIONS: Gastrointestinal stromal tumor that has progressed on
or intolerance to imatinib. Advanced renal cell carcinoma.
■ THERAPEUTIC EFFECTS: Decreased tumor spread.
■ DOSAGE: PO: Adults: 50 mg once daily for 4 wk, followed by 2-wk
rest, alteration of dose is based on safety/tolerability and is made in
12.5 mg increments/decrements.
■ ADMINISTRATION: PO: Administer once daily with or without food
for 4 wk, then 2 wk off therapy.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Fatigue, dizziness,
headache, CHF, hypertension, peripheral edema, thromboembolic
events, diarrhea, dyspepsia, nausea, stomatitis, vomiting, altered
taste, anorexia, constipation, ↑ lipase/amylase, ↑ liver enzymes, oral
pain, alopecia, hand-foot syndrome, hair color change, rash, skin
discoloration, adrenal insufficiency, hypothyroidism, dehydration,
hypophosphatemia, HEMORRHAGE, anemia, lymphopenia, neutrope-
nia, thrombocytopenia, hyperuricemia, arthralgia, back pain, limb
pain, myalgia, fever.
■ CONTRAINDICATIONS: Hypersensitivity; Pregnancy; lactation;
Concurrent use of ketoconazole or St. John’s wort.
■ CAUTIONS: Use cautiously in patients with hepatic/renal impairment.
Patients with child-bearing potential. Pedi: Safety not established.
Ketoconazole and other inhibitors of the CYP3A4 enzyme system
may ↑ levels and the risk of toxicity; dosage may need to be
decreased (avoid ketoconazole). Rifampin and other inducers of the
CYP3A4 enzyme system may ↓ levels and effectiveness; dose may
need to be increased. St. John’s wort may ↓ levels and effectiveness;
avoid concurrent use.
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TAMOXIFEN (ta-mox-i-fen) Nolvadex, Tamoxifen, Tamofen Anti-
neoplastic, antiestrogen Pregnancy Category D
■ INDICATIONS: Breast cancer, palliative or adjunctive treatment of
advanced breast cancer, prevention of breast cancer in high-risk
patients, ductal carcinoma in situ following breast surgery and
radiation.
■ THERAPEUTIC EFFECTS: Suppresses tumor growth. Reduces inci-
dence of breast cancer in high-risk patients.
■ DOSAGE: PO: Adults: Treatment of breast cancer: 10–20 mg twice
daily. Prevention of breast cancer/ductal carcinoma in situ: 20 mg
once daily for 5 years.
■ ADMINISTRATION: Administer with food or fluids. Consult physician
or other health-care professional if patient vomits shortly after admin-
istration of medication to determine need for repeat dose. Do not
crush, break, chew, or administer an antacid within 1–2 h of enteric-
coated tablet.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Confusion, headache,
weakness, blurred vision, edema, nausea, vomiting, endometrial car-
cinoma, vaginal bleeding, hypercalcemia, leukopenia, thrombocy-
topenia, 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 thromboembol-
ic events is increased by concurrent use of other antineoplastics.
• Bone pain may be an indication of the drug’s effectiveness and will
resolve over time; analgesics should be ordered to control pain.
• May induce ovulation and have teratogenic properties. • Advise
patient to use a nonhormonal method of contraception during and for
1 mo after the course of therapy.
TAMSULOSIN (tam-soo-loe-sin) Flomax (Peripherally acting antiadren-
ergic) Pregnancy Category B
■ INDICATIONS: Urinary outflow obstruction associated with prostatic
hyperplasia.
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■ THERAPEUTIC EFFECTS: Decreased symptoms of prostatic hyperpla-

sia (urinary urgency, hesitancy, nocturia).
■ DOSAGE: PO: Adults: 0.4–0.8 mg once daily after a meal.
■ ADMINISTRATION: Administer daily dose 30 min after the same meal
each day.
rhinitis, orthostatic hypotension, retrograde/diminished ejaculation.
■ 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 antiadrenergics (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
0.4-mg/d dose. • Assess patient for symptoms of prostatic hyper-
plasia (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 distention) before and periodically throughout
therapy.
TEMAZEPAM (teh-maz-a-pam) Restoril Sedative/hypnotic (benzodi-
azepine) Schedule IV Pregnancy Category X
■ INDICATIONS: Short-term management of insomnia (<4 weeks).
■ THERAPEUTIC EFFECTS: Relief of insomnia.
■ DOSAGE: PO: Adults: 15–30 mg at bedtime initially if needed; some
patients may require only 7.5 mg. Geriatric Patients or Debilitated
Patients: 7.5 mg at bedtime.
■ ADMINISTRATION: Administer with food if GI irritation becomes a
problem.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Hangover, dizziness,
drowsiness, lethargy, paradoxical excitation, blurred vision, constipa-
tion, diarrhea, nausea, vomiting, rashes, physical dependence, psy-
chological dependence, tolerance, sleep-related behaviors including
sleep-driving and sleep-cooking, ANAPHYLAXIS.
■ CONTRAINDICATIONS: Hypersensitivity, preeexisting CNS depres-
sion, severe uncontrolled pain, narrow-angle glaucoma, pregnancy,
or lactation.
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antihistamines, opioid analgesics, and other sedative/hypnotics.
• May decrease efficacy of levodopa. • Rifampin or smoking
increases metabolism and may decrease effectiveness of temazepam.
• Probenecid may prolong the effects of temazepam. • Sedative
effects may be antagonized by theophylline. • Concomitant use of
kava, valerian, skullcap, chamomile, or hops can increase CNS
depression. • Prolonged high-dose therapy may lead to psychological
or physical dependence; restrict amount of drug available to patient,
especially if patient is depressed or suicidal or has a history of addic-
tion. • May cause daytime drowsiness or dizziness; caution patient to
medication is known. • Advise patient to avoid the use of alcohol and
other CNS depressants and to consult health-care professional before
using OTC preparations that contain antihistamines or alcohol.
TERAZOSIN (ter-ay-zoe-sin) Hytrin Antihypertensive (antiadrenergic)
■ INDICATIONS: Mild-to-moderate hypertension, urinary obstruction
associated with prostatic hyperplasia.
■ THERAPEUTIC EFFECTS: Lowering of blood pressure; decreased
symptoms of urinary urgency, hesitancy, nocturia.
■ DOSAGE: PO: Adults: 1 mg initially, then slowly increase up to 5
mg/d (usual range 1–5 mg/d); may be given as single dose or in 2
divided doses (not to exceed 20 mg/d).
■ ADMINISTRATION: Administer daily dose at bedtime. If necessary,
dosage may be increased to twice daily.
weakness, drowsiness, nervousness, nasal congestion, blurred vision,
conjunctivitis, sinusitis, dyspnea, first-dose orthostatic hypotension,
arrhythmias, chest pain, palpitations, peripheral edema, tachycardia,
nausea, abdominal pain, diarrhea, dry mouth, vomiting, impotence,
urinary frequency, pruritus, weight gain, arthralgia, back pain,
extremity pain, paresthesia.
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■ CAUTIONS: Additive hypotension with other antihypertensives, acute

ingestion of alcohol, or nitrates. • NSAIDs, sympathomimetics, or
estrogens may decrease the effects of antihypertensive therapy.
• Assess patient for first-dose orthostatic reaction and syncope.
• May occur 30 min to 2 h after initial dose and occasionally there-
after. • 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 depres-
sants, standing for long periods, hot showers, and exercising in hot
weather should be avoided because of enhanced orthostatic effects.
TINZAPARIN (tin-za-pa-rin) Innohep Anticoagulant (low molecular
response than unfractionated heparin—special monitoring of clotting
times is not necessary.
■ DOSAGE: SC: Adults: Treatment of deep vein thrombosis: 175 anti-Xa
IU/kg once daily for at least 6 d and until adequate anticoagulation is
achieved with warfarin; prophylaxis of deep vein thrombosis: 50–75
anti-Xa units/kg once daily.
■ ADMINISTRATION: Administer deep into SC tissue. Do not aspirate or
massage. Rotate sites frequently.
■ CONTRAINDICATIONS: Hypersensitivity to pork products, uncon-
trolled bleeding, thrombocytopenia.
and hemorrhage (bleeding gums, nosebleed; unusual bruising; black,
tarry stools; hematuria; fall in hematocrit or blood pressure levels;
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 ophthal-
mological surgery, history of thrombocytopenia related to heparin,
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retinopathy, malignancy. • Risk of bleeding may be increased by war-
farin, aspirin, NSAIDs, dipyridamole, some penicillins, clopidogrel,
ticlopidine, abciximab, eptifibatide, tirofiban, and dextran.
TOLTERODINE (tol-ter-oh-deen) Detrol, Detrol LA Urinary tract antispas-
modic, anticholinergic Pregnancy Category C
■ INDICATIONS: Overactive bladder function that results in urinary
frequency, urgency, or urge incontinence.
■ THERAPEUTIC EFFECTS: Decreases urinary frequency, urgency, and
urge incontinence.
■ DOSAGE: PO: Adults: 2 mg twice daily as tablets; may be lowered
depending on response or 2–4 mg once daily as extended-release
capsules.
■ ADMINISTRATION: Administer without regard to food. Extended-
release capsules should be swallowed whole; do not open or chew.
blurred vision, dry eyes, dry mouth, constipation, dyspepsia.
■ CONTRAINDICATIONS: Urinary retention, gastric retention, uncon-
trolled narrow-angle glaucoma, lactation.
■ CAUTIONS: Use cautiously in GI obstructive disorders, including
pyloric stenosis (increased risk of gastric retention), significant blad-
der outflow obstruction (increased risk of urinary retention), con-
trolled narrow-angle glaucoma, significant hepatic impairment (lower
doses recommended), impaired renal function, pregnancy, children.
• Erythromycin, clarithromycin, ketoconazole, itraconazole, and
miconazole may inhibit metabolism and increase effects of toltero-
dine. • Assess patient for urinary urgency, frequency, and urge incon-
tinence periodically throughout therapy. • Instruct patient to take
tolterodine exactly as directed. • May cause dizziness and blurred
vision—caution patient to avoid driving or other activities requiring
alertness until response to medication is known.
TRAMADOL (tray-mah-dol) Ultram Analgesic Pregnancy Category C
■ INDICATIONS: Moderate to moderately severe pain.
■ THERAPEUTIC EFFECTS: Decreased pain.
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■ DOSAGE: PO: Adults: 50–100 mg every 4–6 h (not to exceed 400 mg/d).
Geriatrics: 50–100 mg every 4–6 h (not to exceed 300–400 mg/d). Renal
Impairment: Adults: CCr <30 mL/min: increase dosing to q 12 h (not to
exceed 200 mg/d). Hepatic Impairment: Adults: 50 mg q 12 h.
■ ADMINISTRATION: Administer without regard to meals.
headache, somnolence, anxiety, CNS stimulation, confusion, eupho-
ria, vasodilation, constipation, nausea, diarrhea, dry mouth, sweating,
hypertonia, physical and psychological dependence, tolerance.
■ CONTRAINDICATIONS: Hypersensitivity; acute intoxication with alco-
hol, sedative/hypnotics, centrally acting analgesics, opioid analgesics,
or psychotropic agents; physical dependence on opioid analgesics
(may precipitate withdrawal). OB/Lactation: Potential for harm to
fetus or nursing infant.
■ 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, pheno-
thiazines, opioid analgesics, or antidepressants. • Use cautiously in
patients who are receiving MAO inhibitors (increased risk of adverse
reactions). • Overdose may cause respiratory depression and
seizures. Naloxone (Narcan) may reverse some, but not all, of the
symptoms of overdose. Treatment should be symptomatic and
supportive. • Seizures may be managed with barbiturates or benzodi-
azepines; naloxone increases risk of seizures.
TRAZODONE (tra-zo-done) Desyrel, Trialodine, Trazon Antidepressant
■ INDICATIONS: Major depression. Unlabeled Uses: Insomnia and
chronic pain syndromes.
■ DOSAGE: PO: Adults: Depression: 150 mg daily in 3 divided doses
(not to exceed 400 mg/d in outpatients or 600 mg/d in hospitalized
patients). Insomnia: 25–100 mg at bedtime. Geriatric Patients: 75 mg
daily in divided doses initially. Children 6–18 yr: 1.5–2 mg/kg daily in
divided doses.
■ ADMINISTRATION: Administer with or immediately after meals.
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■ ADVERSE REACTIONS AND SIDE EFFECTS: Drowsiness, confusion,
dizziness, hallucinations, insomnia, slurred speech, blurred vision, tin-
nitus, hypotension, arrhythmias, chest pain, hypertension, palpita-
tions, tachycardia, dry mouth, constipation, hematuria, impotence,
priapism, urinary frequency, rashes, anemia.
■ CONTRAINDICATIONS: Hypersensitivity, recovery period after MI,
concurrent electroconvulsive therapy.
■ CAUTIONS: Use cautiously in cardiovascular disease, suicidal behav-
ior. • May increase digoxin or phenytoin serum levels. Additive CNS
depression with other CNS depressants, including alcohol, opioid
analgesics, and sedative/hypnotics. • Additive hypotension with anti-
hypertensives, acute ingestion of alcohol, or nitrates. • Fluoxetine
increases levels and risk of toxicity. • Monitor blood pressure and
pulse rate before and during initial therapy. Patients with preexisting
cardiac disease should have ECGs monitored before and periodically
during therapy to detect arrhythmias. • Restrict amount of drug avail-
able to suicidal patients. • Avoid driving and other activities requiring
alertness until response to drug is known. • Change positions slowly
to minimize orthostatic hypotension.
TRIAMCINOLONE (try-am-sin-oh-lone) Azmacort Antiasthmatic, anti-
inflammatory (inhalation corticosteroid) Pregnancy Category C
attacks.
■ DOSAGE: Inhalation: Adults and Children >12 yr: 2 metered inhala-
tions 3–4 times daily or 4 inhalations twice daily (100 mcg/metered
inhalation; not to exceed 16 metered inhalations/d). Children 6–12 yr:
1–2 metered inhalations 3–4 times daily or 2–4 inhalations twice
daily (100 mcg/metered inhalation; not to exceed 12 metered
inhalations/d).
aerosol medication.
oropharyngeal fungal infections, cataracts; bronchospasm, cough,
wheezing, dry mouth, esophageal candidiasis, adrenal suppression,
decreased growth (children), CHURG-STRAUSS SYNDROME.
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■ CAUTIONS: Use cautiously in active untreated infections, diabetes or
glaucoma, underlying immunosuppression, systemic corticosteroid
therapy. • Advise patients also using bronchodilator to use bron-
chodilator first and wait 5 min before taking beclomethasone.
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 bron-
chodilators. • Caution patient to avoid smoking, known allergens, and
other respiratory irritants. OB/Lactation/Pedi: Exercise caution when
using during pregnancy or lactation, or for children <6 yr.
TRIMETHOPRIM/SULFAMETHOXAZOLE (trye-meth-oh-prim/sul-fa-
meth-ox-a-zole) Bactrim, Septra, TMP/SMZ Anti-infective, antiprotozoal
■ INDICATIONS: Bronchitis, Shigella enteritis, otitis media,
Pneumocystis carinii pneumonia (PCP), urinary tract infection,
traveler’s diarrhea.
bacteria.
■ DOSAGE: (TMP = trimethoprim; SMZ = sulfamethoxazole) PO: Adults and
Children ≥40 kg: Bacterial infections: 160 mg TMP/800 mg SMZ q 12 h.
Children >2 mo: Bacterial infections: 4–6 mg/kg TMP/20–30 mg/kg
SMZ q 12 h. IV: Adults and Children >2 mo: Bacterial Infections:
2–2.5 mg/kg TMP/10–12.5 mg/kg SMZ q 6 h or 2.7–3.3 mg/kg
TMP/13.3–16.7 mg/kg SMZ q 8 h or 4–5 mg/kg TMP/20–25 mg/kg
SMZ q 12 h. PCP: 3.75–5 mg/kg TMP/18.75–25 mg SMZ q 6 h or
5–6.7 mg/kg TMP/25–33.3 mg SMZ q 8 h.
■ ADMINISTRATION: PO: Administer around the clock with a full glass
of water. IV: Dilute each 5-mL ampule with 100–125 mL of D5W. Rate:
Infuse over 60–90 minutes.
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■ ADVERSE REACTIONS AND SIDE EFFECTS: Fatigue, headache,
insomnia, HEPATIC NECROSIS, nausea, vomiting, diarrhea, stomatitis,
TOXIC EPIDERMAL NECROLYSIS, rashes, photosensitivity, AGRANU-
LOCYTOSIS, APLASTIC ANEMIA, hemolytic anemia, leukopenia,
megaloblastic anemia, phlebitis at IV site, ERYTHEMA MULTIFORME,
STEVENS-JOHNSON SYNDROME, fever.
■ CONTRAINDICATIONS: Hypersensitivity, megaloblastic anemia sec-
ondary to folate deficiency, severe renal impairment. OB/Lactation/
Pedi: Potential for harm to fetus, nursing infant, or infants <2 mo.
■ CAUTIONS: May enhance the effects of sulfonylurea oral antidiabet-
ics and warfarin. Increases the risk of thrombocytopenia from thi-
azide diuretics (increased in geriatric patients). • Decreases efficacy of
cyclosporine and increases risk of nephrotoxicity.
VALACYCLOVIR (val-ay-sye-kloe-veer) Valtrex Antiviral Pregnancy
Category B
■ INDICATIONS: Herpes zoster, genital herpes, herpes labialis (cold
sores).
■ THERAPEUTIC EFFECTS: Inhibited viral replication, decreased viral
shedding, and reduced time of healing of lesions.
■ DOSAGE: PO: Adults: Herpes zoster 1 g three times daily for 7 d.
Genital herpes: Initial treatment: 1 g twice daily for 10 d. Recurrence:
500 mg twice daily for 3 d. Suppression of recurrence: 500 mg to 1 g
daily. Herpes labialis: 2 g then 2 g 12 h later.
■ 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 h of the onset of zoster
rash.
nausea, anorexia, diarrhea, THROMBOTIC THROMBOCYTOPENIC
PURPURA/HEMOLYTIC UREMIC SYNDROME (very high doses in
immunosuppressed patients).
■ CAUTIONS: Probenecid and cimetidine increase blood levels; this
interaction is only significant in patients with renal impairment.
• Monitor patient for signs of thrombotic thrombocytic purpura/
hemolytic uremic syndrome (microangiopathic hemolytic anemia,
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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 immunosup-
pressed until all lesions have crusted. • Genital herpes: Does not pre-
vent the spread of infection to others. Advise patient to avoid contact
with lesions and to avoid intercourse while lesions or symptoms are
present.
VALPROIC ACID (val-proe-ik as-id) Depakote, Depakote ER, Depakene,
Epival, Anticonvulsant, vascular headache suppressant Pregnancy
Category D
■ INDICATIONS: Seizures, manic episodes associated with bipolar dis-
order (delayed-release only); migraine headache prevention (delayed-
and extended-release).
■ THERAPEUTIC EFFECTS: Suppression of seizures, decreased manic
behavior and frequency of migraine headaches.
■ DOSAGE: PO, IV: Adults: Anticonvulsant: Single-agent therapy:
Initial dose of 5–15 mg/kg daily; increase by 5–10 mg/kg daily q wk.
Polytherapy: Initial dose of 10–30 mg/kg daily; increase by 5–10 mg/kg
daily q wk. Children: Anticonvulsant: Single-agent therapy: Initial
dose of 15–45 mg/kg/d; increase by 5–10 mg/kg daily q wk.
Polytherapy: Initial dose of 30–100 mg/kg daily.
■ ADMINISTRATION: PO: Administer with or immediately after meals.
IV: Rate: Administer over 60 min (20 mg/min).
HEPATOTOXICITY, PANCREATITIS, nausea, vomiting, diarrhea, pro-
longed 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 mo
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
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thrombolytic agents, or warfarin. • Additive CNS depression with
CNS depressants, alcohol, antihistamines, antidepressants, opioid
analgesics, MAO inhibitors, and sedative/hypnotics.
VALSARTAN (val-sar-tan) Diovan Antihypertensive (angiotensin II recep-
tor antagonist) Pregnancy Category C (first trimester), D (second and third
trimesters)
■ DOSAGE: PO: Adults: 80–320 mg/d.
headache, hypotension, diarrhea, drug-induced hepatitis, RENAL
FAILURE, hyperkalemia.
■ CONTRAINDICATIONS: Hypersensitivity. OB/Lactation: Potential
adverse effects to fetus if taken during pregnancy or while breast-
feeding.
■ CAUTIONS: NSAIDs may decrease antihypertensive effects. Additive
antihypertensive effects with other antihypertensives and diuretics.
• Risk of hypotension is increased by concurrent diuretic therapy (use
lower initial doses). • Telmisartan increases serum digoxin levels.
• Concurrent use of potassium-sparing diuretics or potassium supple-
ments may increase the risk of hyperkalemia. • Caution patient to
avoid sudden changes in position to decrease orthostatic hypoten-
sion. • Use of alcohol, standing for long periods, exercising, and hot
weather may increase orthostatic hypotension. • May cause dizziness.
Caution patient to avoid driving or other activities requiring alertness
until response to medication is known. • OB: Advise women of child-
bearing age to use contraception and notify health-care professional
if pregnancy is suspected or planned.
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.
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organisms.
■ DOSAGE: PO: Adults: 125–500 mg q 6 h. Children: 10 mg/kg q 6 h (up
to 125 mg/dose; not to exceed 2 g/d). IV: Adults: 500 mg q 6 h or 1 g
q 12 h (up to 3–4 g/d). Children >1 mo: 10 mg/kg q 6 h or 20 mg/kg q
12 h. Neonates 1 wk–1 mo: 15 mg/kg initially, then 10 mg/kg q 8 h.
Neonates <1 wk: 15 mg/kg initially, then 10 mg/kg q 12 h. Renal
Impairment: IV Adults: An initial loading dose of 750 mg to 1 g, then
if CCr 50–80 mL/min: 1 g q 1–3 d; CCr 10–50 mL/min: 1 g q 3–7 d; CCr
<10 mL/min: 1 g q 7–14 d.
■ 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.
■ CAUTIONS: Use cautiously in renal impairment, hearing impairment,
intestinal obstruction or inflammation. • May cause additive ototoxici-
ty and nephrotoxicity with other ototoxic and nephrotoxic drugs,
aspirin, aminoglycosides, cyclosporine, cisplatin, loop diuretics).
• May enhance neuromuscular blockade from nondepolarizing
neuromuscular blocking agents. • Pedi: Increased risk of histamine
flush when used with general anesthetics in children.
VARENICLINE (ver-en-i-cline) Chantix Smoking deterrent, nicotine ago-
nist Pregnancy Category C
■ INDICATIONS: Treatment of nicotine addiction; in conjunction with
nonpharmacological support (educational materials/counseling).
■ THERAPEUTIC EFFECTS: Decreased desire to smoke.
■ DOSAGE: PO: Adults: Treatment is started 1 wk prior to planned
smoking cessation 0.5 mg once daily on the first 3 d, then 0.5 mg
twice daily for the next 4 d, then 1 mg twice daily. Renal Impairment:
CCr <30 mL/min—0.5 mg daily, may increase to 0.5 mg twice daily.
■ ADMINISTRATION: Administer after eating with a full glass of water.
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■ ADVERSE REACTIONS AND SIDE EFFECTS: Decreased attention
span, anxiety, depression, insomnia, irritability, dizziness, restless-
ness, abnormal dreams, agitation, aggression, amnesia, disorienta-
tion, dissociation, migraine, psychomotor hyperactivity, suicidal
thoughts/behaviors, syncope, diarrhea, gingivitis, nausea , ↑ appetite,
constipation, dyspepsia, dysphagia, enterocolitis, ↑ liver function
tests, vomiting, flushing, hyperhydrosis, arthralgia, back pain, muscu-
loskeletal pain, muscle cramps, myalgia, restless legs, chills, fever,
hypersensitivity, mild physical dependence.
■ CONTRAINDICATIONS: Hypersensitivity, lactation. Pedi: Safety not
established in children <18 yr.
■ CAUTIONS: Use with caution in patients with severe renal impair-
ment (lower dose recommended if CCr <30 mL/min); psychiatric ill-
ness; smoking cessation may ↓ metabolism of theophylline, warfarin,
and insulin resulting in ↑ effects; careful monitoring is recommended.
Risk of adverse reactions (nausea, vomiting, dizziness, fatigue,
headache) may be ↑ with nicotine replacement therapy (nicotine
transdermal patches). OB: Use only if maternal benefit outweighs
fetal risk. Geri: Consider age-related decline in renal function when
deciding dosage.
VENLAFAXINE (ven-la-fax-een) Effexor, Effexor XR Antidepressant,
antianxiety agent Pregnancy Category C
■ INDICATIONS: Major depressive illness or relapse, generalized
anxiety disorder (Effexor XR only).
■ THERAPEUTIC EFFECTS: Improved mood, decreased anxiety.
■ DOSAGE: PO: Adults: 75 mg daily in 2–3 divided doses; may increase
up to 225 mg/d (not to exceed 375 mg/d in 3 divided doses); extended-
release (XR) formulation can be given as a single daily dose.
■ ADMINISTRATION: Administer with food.
■ ADVERSE REACTIONS AND SIDE EFFECTS: SEIZURES, abnormal
dreams, anxiety, dizziness, headache, insomnia, nervousness, weak-
ness, agitation, confusion, rhinitis, visual disturbances, tinnitus, chest
pain, hypertension, palpitations, abdominal pain, altered taste,
anorexia, constipation, diarrhea, dry mouth, dyspepsia, nausea, vomi-
ting, weight loss, sexual dysfunction, urinary retention, ecchymoses,
photosensitivity, paresthesia, chills.
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therapy.
■ CAUTIONS: Use with MAO inhibitors may result in serious, potential-
ly fatal reactions. • Use cautiously in cardiovascular disease, hepatic
impairment, impaired renal function, history of seizures, neurological
impairment, mania, or drug abuse. • Alcohol or other CNS depres-
sants, including sedative/hypnotics, antihistamines, and opioid anal-
gesics, 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 wk should have dose gradually decreased
before discontinuation. OB/Lactation/Pedi: Weigh risk to fetus or
nursing infant against potential benefit. Safety not established in
children <18 yr.
VERAPAMIL (ver-ap-a-mil) Calan, Isoptin, Verelan Antianginal, anti-
arrhythmic, antihypertensive (calcium channel blocker) Pregnancy
Category C
■ INDICATIONS: Hypertension, angina pectoris, and/or vasospastic
(Prinzmetal) angina, supraventricular arrhythmias and rapid ventricu-
lar rates in atrial flutter or fibrillation.
■ THERAPEUTIC EFFECTS: Decreased blood pressure and angina
attacks, suppression of ventricular tachyarrhythmias.
■ DOSAGE: PO: Adults: 80–120 mg three times daily, increased as
needed. Poor ventricular function, hepatic impairment, or geriatric
patients: 40 mg three times daily. Extended-release preparations:
120–240 mg daily (up to 240–480 mg/d). Children up to 15 yr:
4–8 mg/kg daily in divided doses. IV: Adults: 5–10 mg. Children
1–15 yr: 2–5 mg (100–300 mcg/kg). Children <1 yr: 0.75–2 mg
(100–200 mcg/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.
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■ CONTRAINDICATIONS: Hypersensitivity, sick sinus syndrome, 2nd or
3rd AV block, systolic BP <90, CHF, ventricular dysfunction, or cardio-
genic shock, unless associated with supraventricular tachyarrhyth-
mias, IV beta blocker therapy.
■ CAUTIONS: Use cautiously in hepatic impairment, geriatric patients,
ventricular arrhythmias, CHF. • Additive hypotension may occur when
used concurrently with fentanyl, other antihypertensives, nitrates,
acute ingestion of alcohol, or quinidine. • Serum digoxin levels may
be increased. • Concurrent use with beta blockers, digoxin, disopyra-
mide, or phenytoin may result in bradycardia, conduction defects, or
CHF. • Teach patient to take pulse and to contact health-care profes-
sional if heart rate is <50 bpm. OB/Lactation: Use with caution during
pregnancy or while breastfeeding.
WARFARIN (war-fa-rin) Coumadin, Warfilone Anticoagulant Pregnancy
Category X
■ INDICATIONS: Venous thrombosis, pulmonary embolism, atrial fibril-
lation with embolization, MI, prevention of thrombus formation post
prosthetic valve placement.
■ THERAPEUTIC EFFECTS: Prevention of thromboembolic events.
■ DOSAGE: PO: Adults: 2.5–10 mg/d for 2–4 d; then adjust daily dose by
results of prothrombin time or international normalized ratio (INR).
■ ADMINISTRATION: PO: Administer at same time daily.
■ ADVERSE REACTIONS AND SIDE EFFECTS: Cramps, nausea, dermal
necrosis, BLEEDING, fever.
■ CONTRAINDICATIONS: Uncontrolled bleeding, open wounds, active
ulcer disease; recent brain, eye, or spinal cord injury or surgery;
severe liver disease, uncontrolled hypertension, pregnancy.
■ CAUTIONS: HIGH ALERT MED: Assess for signs of bleeding and hem-
orrhage (bleeding gums; nosebleed; bruising; tarry, black stools).
• Monitor PT or INR and other clotting factors frequently during
therapy. • Androgens, cefotetan, chloral hydrate, chloramphenicol,
fluconazole, fluoroquinolones, itraconazole, metronidazole, throm-
bolytic agents, sulfonamides, quinidine, quinine, NSAIDs, valproates,
and aspirin may increase response and risk of bleeding. • Chronic
acetaminophen use may increase risk of bleeding. • Alcohol, barbitu-
rates, and hormonal contraceptives containing estrogen decrease
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response. • Large quantities of foods high in vitamin K may antago-

nize anticoagulant effect. • Antidote is vitamin K (phytonadione,
AquaMEPHYTON). • Avoid IM injections and activities leading to
injury. Inform all health-care personnel about anticoagulant therapy
before laboratory tests, treatment, or surgery. • Increased bleeding
risk with arnica, chamomile, clove, dong quai, feverfew, garlic, ginger,
ginkgo, Panax ginseng, and other natural products.
ZAFIRLUKAST (za-feer-loo-kast) Accolate Antiasthmatic, bronchodila-
tors leukotriene antagonist Pregnancy Category B
■ THERAPEUTIC EFFECTS: Decreases frequency and severity of asthma
attacks. Decreases airway edema and smooth muscle constriction,
resulting in decreased inflammatory process that is part of asthma.
■ DOSAGE: PO: Adults and Children ≥12 yr: 20 mg twice daily. Children
7–11 yr: 10 mg twice daily.
■ ADMINISTRATION: Administer at regular intervals on an empty stom-
ach, 1 h before or 2 h after meals.
weakness, abdominal pain, diarrhea, drug-induced hepatitis
(females), dyspepsia, nausea, vomiting, arthralgia, back pain, myal-
gia, CHURG-STRAUSS SYNDROME, fever, infection (geriatric
patients), pain.
■ CAUTIONS: Advise patient to notify health-care professional if symp-
toms 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 eryth-
romycin 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 medica-
tions 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.
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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, decreas-
es risk of transmission of HIV to infants born to HIV-infected mothers.
■ DOSAGE: PO: Adults and Children >13 yr: Management of HIV infec-
tion: 100 mg q 4 h while awake or 200 mg three times daily or
300 mg twice daily. Prevention of maternal/fetal transmission of
HIV infection: Adults >14 wk Pregnant: 100 mg five times daily until
onset of labor. Children 3 mo–12 yr: Management of HIV infection:
90–180 mg/m2 every 6 h (not to exceed 200 mg q 6 h). Infants:
Prevention of maternal/fetal transmission of HIV infection: 2 mg/kg
q 6 h, started within 12 h of birth and continued for 6 wk. IV: Adults
and Children >12 yr: Management of HIV infection: 1 mg/kg infused
over 1 h q 4 h. Prevention of maternal/fetal transmission of HIV infec-
tion: Adults During Labor and Delivery: 2 mg/kg over 1 h, then contin-
uous 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, nau-
sea, anorexia, hepatitis, anemia, granulocytopenia.
■ CAUTIONS: Additive bone marrow depression with other agents hav-
ing bone marrow–depressing properties; additive neurotoxicity with
acyclovir.
ZOLPIDEM (zole-pi-dem) Ambien Sedative/hypnotic Pregnancy Category B
■ INDICATIONS: Short-term treatment of insomnia.
■ THERAPEUTIC EFFECTS: Sedation and induction of sleep.
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■ 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, ANAPHYLAXIS,
daytime drowsiness, sleep-related behaviors including driving or
cooking while asleep, dizziness, “drugged” feeling, diarrhea, nausea,
vomiting, hypersensitivity reactions, physical dependence, psycholog-
ical dependence, tolerance.
■ CONTRAINDICATIONS: Hypersensitivity, sleep apnea.
■ CAUTIONS: Use cautiously in history of previous psychiatric illness,
suicide attempt, drug or alcohol abuse, geriatric patients, 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, phe-
nothiazines, tricyclic antidepressants, opioid analgesics, or antihista-
mines. • Concomitant use of kava, valerian, skullcap, chamomile, or
hops can increase CNS depression. • Protect patient from injury—
raise bedside rails or assist with ambulation.
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Emergency Drugs
(NAME: initial dose [indication])
ADENOSINE: 6 mg rapid IVP; rpt 12 mg 2 [SVT]
AMIODARONE: 300 mg IVP [VF, VT, SVT]
ATROPINE: 0.5–1 mg q 3–5 min up to 2 mg [bradycardia]
EPINEPHRINE: 1 mg q 3–5 min [cardiac arrest]
LASIX: 0.5–1 mg/kg IV [pulmonary edema]
LIDOCAINE: 1–1.5 mg/kg IV q 5–10 min; maximum 3 mg/kg [VF, VT]
MAGNESIUM: 1–2 g IVP [VT r/t hypo-Mg]
MORPHINE: 1–3 mg [CP, pulmonary edema]
NARCAN: 0.02–0.2 mg q 2–3 min [narcotic-respiratory depression]
NITROGLYCERIN: 0.3–0.6 mg SL q 5 min 3 [CP, pulmonary edema]
ROMAZICON: 0.2 mg q min up to 1 mg [benzodiazepine OD]
SOLU-MEDROL: 1–2 mg/kg [allergic reaction]
VASOPRESSIN: 40 units IVP [cardiac arrest]
Drug Suffixes and Meaning
Drugs with these ending....................................usually belong to this class:

-azole .............................................................Antifungal
-bital ............................Barbiturate sedative/hypnotic
-caine .................................................Local anesthetics
-cillin ............................................................Antibiotics
-ceph or cef ......................................................Cephalosporin
-cycline ..............................................................Antibiotic
-dine ..........Antiulcer agents (histamine H2 blockers)
Continued
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Drugs with these endings usually belong to this class:

-done ................................................Opioid analgesics
-ide .............................................Oral hypoglycemics
-ipine .....................................Calcium channel blocker
-lam ...............................................Antianxiety agents
-mab ..........................................Monoclonal antibody
-micin ............................................................Antibiotics
-mide ...............................................................Diuretics
-mycin ............................................................Antibiotics
-navir ................................................Protease inhibitor
-nium ........................Neuromuscular blocking agents
-olol ........................................................Beta blockers
-oxacin ............................................................Antibiotics
-pam or -lam ...............................................Antianxiety agents
-prazole ........................................Proton pump inhibitor
-pril ......................................................ACE inhibitors
-sartan ....................Angiotensin II receptor antagonist
-sone ................................................................Steroids
-statin ............................................Antihyperlipidemics
-tidine .............................................................H2 agonist
-tropin ................................................Pituitary hormone
-vir ..............................................................Antivirals
-zide ...............................................................Diuretics
-zosin .......................................................Alpha blocker
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Controlled-Release Suffixes
CD Controlled dose, controlled diffusion (Cardizem CD) or
continuous delivery (Metadate CD)
CR Controlled release
CRT Controlled-release tablet
ER Extended release
LA Long-acting
SA Sustained action
SR Sustained release
TD Time delay
TR Time release
XL Extended release
XR Extended release
Common Combination Drugs
Brand Name/Medications
with Sample Dosages Indication
Accuretic 10/12.5—quinapril 10 mg Hypertension; heart failure (ACE
+ hydrochlorothiazide 12.5 mg. inhibitor + diuretic).
Activella Tablets 0.5/0.1—estradiol Menopausal symptoms such as hot
0.5 mg + norethindrone 0.1 mg. flashes and vaginal dryness.
Actoplus Met 15/850—pioglitazone Type 2 diabetes.
15 mg + metformin 850 mg.
Adderall 5 mg—dextroamphetamine Attention-deficit hyperactivity dis-
sulfate 1.25 mg + dextroampheta- order (ADHD); narcolepsy.
mine saccharate 1.25 mg +
amphetamine aspartate 1.25 mg +
amphetamine sulfate 1.25 mg.
Advair Diskus 100—(per actuation) Asthma; chronic obstructive pul-
fluticasone 100 mcg + salmeterol monary disease associated with
50 mcg. bronchitis.
Continued
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Common Combination Drugs—cont’d
Advicor 500/20—extended-release Hypercholesterolemia.
niacin 500 mg + lovastatin 20 mg.
Aggrenox—aspirin 25 mg + extended- Prevention of stroke in patients
release dipyridamole 200 mg. with history of transient ischemic
attack (TIA) or stroke.
Aldactazide 25/25—hydrochloro- Hypertension, cirrhosis, heart
thiazide 25 mg + spironolactone failure, kidney disease.
25 mg.
Angeliq—drosperinone 0.5 mg + Menopausal symptoms such as hot
estradiol 1 mg. flashes and vaginal dryness.
Arthrotec 50/200—diclofenac 50 mg Arthritis in patients prone to ulcer
+ misoprostol 200 mcg. disease.
Atacand HCT 16/12.5—candesartan Hypertension (angiotensin II recep-
16 mg + hydrochlorothiazide tor antagonist + diuretic).
12.5 mg.
Atripla—efavirenz 600 mg + HIV (three reverse transcriptase
emtricitabine 200 mg + tenofovir inhibitors).
300 mg.
Augmentin 250—amoxicillin 250 mg Lower respiratory, middle ear,
+ clavulanic acid 62.5 mg. sinus, skin, and urinary tract
infections.
Avalide 300/12.5—irbesartan Hypertension (angiotensin II recep-
12.5 mg.
Avandamet 2/500—rosiglitazone Type 2 diabetes.
2 mg + metformin 500 mg.
Avandaryl 8/4—rosiglitazone 8 mg + Type 2 diabetes.
glimepiride 4 mg.
Azdone—aspirin 500 mg + Moderate-to-severe pain.
hydrocodone 5 mg.
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Azor 10/40—amlodipine 10 mg + Hypertension (angiotensin II recep-
olmesartan 40 mg. tor antagonist + calcium channel
blocker).
B & O Supprettes No. 16A— Ureteral or bladder spasm.
belladonna extract 16.2 mg +
opium 60 mg.
Bactrim DS—trimethoprim 160 mg Ear infections, urinary tract infec-
+ sulfamethoxazole 800 mg. tions, bronchitis, traveler’s diar-
rhea, Pneumocystis carinii.
Balziva—norethindrone 0.4 mg + Pregnancy prevention.
ethinyl estradiol 35 mcg.
Benicar HCT 20/12.5—olmesartan Hypertension (angiotensin II recep-
12.5 mg.
Bicitra Solution—(per 5 mL) sodium Cystine renal calculi, metabolic aci-
citrate 500 mg + citric acid 334 mg dosis, renal tubular acidosis.
(C Oracit).
Bidil—isosorbide dinitrate 20 mg Heart failure; may be particularly
+ hydralazine hydrochloride effective in patients of African
37.5 mg. descent.
Caduet 10/10—amlodipine 10 mg + High cholesterol and hypertension;
atorvastatin 10 mg. high cholesterol and angina (statin
drug + calcium channel blocker).
Clavulin 400 Suspension— Lower respiratory, middle ear,
(per 5 mL) amoxicillin 400 mg sinus, skin, and urinary tract
+ clavulanic acid 57 mg. infections.
Clorpres 15/0.1—chlorthalidone Hypertension (centrally acting anti-
15 mg + clonidine 0.1 mg. hypertensive agent + diuretic).
Col-Probenecid—probenecid 500 mg Gout.
+ colchicine 0.5 mg.
Combivent—(per actuation) ipra- COPD, prevention of bron-
tropium bromide 18 mcg + chospasm in patients with COPD.
albuterol 103 mcg.
Continued
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Combivir—lamivudine 150 mg HIV (reverse transcriptase
+ zidovudine 300 mg. inhibitors).
Corzide 40/5—nadolol 40 mg + ben- Hypertension (beta blocker
droflumethiazide 5 mg. + thiazide diuretic).
Coversyl Plus—perindopril 4 mg Hypertension (ACE inhibitor
+ indapamide 1.25 mg. + diuretic).
Creon 5—lipase 5000 units + Pancreatic insufficiency, which
amylase 16,600 units + protease may be associated with cystic
18,750 units. fibrosis, pancreatitis, intestinal
bypass surgery.
Diovan HCT 80/12.5—valsartan 80 mg Hypertension (angiotensin receptor
+ hydrochlorothiazide 12.5 mg. blocker + diuretic).
Duac Topical Gel—1% clindamycin Acne.
+ 5% benzoyl peroxide.
Duetact 2/30—glimepiride 2 mg Type 2 diabetes.
+ pioglitazone 30 mg.
DuoNeb—(per 3 mL) albuterol Bronchospasm associated with
sulfate 2.5 mg + ipratroprium bro- COPD.
mide 0.5 mg inhalation solution.
Dyazide—hydrochlorothiazide Hypertension (when potential
25 mg + triamterene 37.5 mg. hypokalemia is too risky).
EMLA Topical Cream—2.5% Cream local anesthetic. May be
lidocaine + 2.5% prilocaine. used on intact skin and genital
mucous membranes.
Epzicom—abacavir 600 mg + HIV infection.
lamivudine 300 mg.
Eryzole Oral Suspension—(per 5 mL) Bacterial infection in most body
erythromycin ethylsuccinate sites (respiratory tract, urinary
200 mg + sulfisoxazole 600 mg. tract, heart).
Exforge 5/160—amlodipine 5 mg Hypertension (calcium channel blocker
+ valsartan 160 mg. + angiotensin receptor blocker).
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Fansidar—sulfidoxine 500 mg + Treatment or prevention of malaria.
pyrimethamine 25 mg.
Fosamax Plus D 70/2800— Postmenopausal osteoporosis.
alendronate 70 mg + cholecalcif-
erol 2800 IU.
Glucovance 1.25/250—glyburide Type 2 diabetes.
1.25 mg + metformin 250 mg.
Hyzaar 50/12.5—losartan 50 mg + Hypertension (angiotensin receptor
hydrochlorothiazide 12.5 mg. blocker + diuretic).
Inderide 40/25—propranolol 40 mg Hypertension (beta blocker +
+ hydrochlorothiazide 25 mg. diuretic).
Janumet 50/500—sitagliptan 50 mg Type 2 diabetes.
+ metformin 500 mg.
Kaletra 100/25 capsules—lopinavir HIV infection.
100 mg + ritonavir 25 mg.
Lexxel 5/2.5—enalapril 5 mg + Hypertension (ACE inhibitor
felodipine 2.5 mg. + calcium channel blocker).
Limbitrol 5/12.5—chlordiazepoxide Depression and anxiety (tricyclic
5 mg + amitriptyline 12.5 mg. antidepressant + benzodiazepine).
Lopressor HCT 50/25—metoprolol Hypertension (beta blocker +
tartrate 50 mg + hydrochloro- diuretic).
thiazide 25 mg.
Losec 1-2-3 A—omeprazole 20 mg Peptic ulcer disease associated
(14 doses), clarithromycin 500 mg with Helicobacter pylori.
(14 doses), amoxicillin 1 g (14
doses) in a convenience package.
Losec 1-2-3 M—omeprazole Peptic ulcer disease associated
20 mg (14 doses), clarithromycin with Helicobacter pylori.
250 mg (14 doses), metronidazole
500 mg (14 doses) in a conve-
nience package.
Continued
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Lotensin HCT 5/6.25—benazepril Hypertension (ACE inhibitor
5 mg + hydrochlorothiazide + diuretic).
6.25 mg.
Lotrel 10/40—amlodipine 10 mg Hypertension (ACE inhibitor
+ benazepril 40 mg. + angiotensin II receptor
antagonist).
Maxzide-25—hydrochlorothiazide Hypertension.
25 mg + triamterene 37.5 mg.
Metaglip 5/500—glipizide 5 mg Type 2 diabetes.
+ metformin 500 mg.
Micardis HCT 80/25—telmisartan Hypertension (angiotensin II recep-
25 mg.
Midrin—isometheptene 65 mg Tension and vascular headaches.
+ acetaminophen 325 mg
+ dichloralphenazone 100 mg.
Migergot Suppositories— Migraine headache.
ergotamine 2 mg + caffeine
100 mg.
Moduret—amiloride 5 mg + Hypertension or heart in patients
hydrochlorothiazide 50 mg. with failure who are prone to
hypokalemia.
Monopril-HCT 10/12.5—fosinopril Hypertension (ACE inhibitor
10 mg + hydrochlorothiazide + diuretic).
12.5 mg
Motofen—difenoxin 1 mg + atropine Diarrhea.
0.025 mg.
Parcopa 25/250—carbidopa 25 mg Parkinson’s disease or Parkinson-
+ levodopa 250 mg. like symptoms (e.g., shakiness,
stiffness, difficulty moving).
Polycitra Syrup—(per 5 mL) potassium Cystine renal calculi, metabolic
citrate 550 mg + sodium citrate acidosis, renal tubular acidosis.
500 mg + citric acid 334 mg.
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Prinzide 10/12.5—lisinopril 10 mg Hypertension (ACE inhibitor
+ hydrochlorothiazide 12.5 mg. + diuretic).
Quinaretic 20/25—quinapril 20 mg Hypertension (ACE inhibitor
+ hydrochlorothiazide 25 mg. + diuretic).
Renese-R—polythiazide 2 mg Hypertension.
+ reserpine 0.25 mg.
Rifamate—isoniazid 150 mg Tuberculosis (TB).
+ rifampin 300 mg
Rifater—rifampin 120 mg + isoniazid Tuberculosis (TB).
50 mg + pyrazinamide 300 mg.
Septra—trimethoprim 80 mg + sul- Infections of different body sites
famethoxazole 400 mg. including middle ear in children,
recurrent bronchitis, UTI.
Sinemet 10/100—carbidopa 10 mg Parkinson’s disease or Parkinson-
+ levodopa 100 mg. like symptoms (e.g., shakiness,
stiffness, difficulty moving).
Stalevo 150—carbidopa 37.5 mg Parkinson’s disease or Parkinson-
+ entacapone 200 mg + levodopa like symptoms (e.g., shakiness,
150 mg. stiffness, difficulty moving).
Symbicort—(per actuation) budes- Prevent bronchospasm in people
onide 80 mcg + formoterol with asthma or chronic obstructive
45 mcg. pulmonary disease (COPD).
Symbyax 12/50—olanzapine 12 mg Treatment of depression in patients
+ fluoxetine 50 mg. with bipolar disorder (antidepres-
sant + antipsychotic).
Tarka 4/240—trandolapril 4 mg Hypertension (ACE inhibitor
(immediate release) + verapamil + calcium channel blocker).
240 mg (sustained release).
Tenoretic 50—chlorthalidone 25 mg Hypertension (beta blocker +
+ atenolol 50 mg. diuretic).
Teveten HCT 600/25—eprosartan Hypertension (angiotensin II recep-
600 mg + hydrochlorothiazide 25 mg. tor antagonist + diuretic).
Continued
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Trizivir—abacavir 300 mg + lamivu- HIV infection.
dine 150 mg + zidovudine 300 mg.
Truvada—emtricitabine 200 mg HIV infection.
+ tenofovir 300 mg.
Uniretic 15/25—moexipril 15 mg Hypertension (ACE inhibitor
Vaseretic 5/12.5—enalapril 5 mg Hypertension (ACE inhibitor
Zestoretic 20/25—lisinopril 20 mg Hypertension (ACE inhibitor
Ziac 10/6.25—bisoprolol 10 mg Hypertension (beta blocker
IV Potassium Compatibilities
Medications Compatible With IV Potassium Chloride
acyclovir indomethacin
alatrovafloxacin insulin
aldesleukin isoproterenol
allopurinol kanamycin
amifostine labetalol
aminophylline lidocaine
amiodarone linezolid
ampicillin lorazepam
amrinone magnesium sulfate
atropine melphalan
aztreonam menadiol
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Medications Compatible With IV Potassium Chloride—cont’d

betamethasone meperidine
calcium gluconate methoxamine
chlordiazepoxide methylergonovine
chlorpromazine midazolam
cimetidine minocycline
ciprofloxacin morphine
cisatracurium neostigmine
cladribine norepinephrine
conjugated estrogens ondansetron
cyanocobalamin oxacillin
dexamethasone oxytocin
digoxin paclitaxel
diltiazem penicillin G potassium
diphenhydramine pentazocine
dobutamine phytonadione
docetaxel piperacillin/tazobactam
dopamine procainamide
doxorubicin liposome prochlorperazine edisylate
droperidol propofol
droperidol/fentanyl propranolol
edrophonium pyridostigmine
enalaprilat ranitidine
epinephrine remifentanil
esmolol sargramostim
ethacrynate sodium scopolamine
etoposide sodium bicarbonate
famotidine succinylcholine
fentanyl tacrolimus
filgrastim teniposide
fludarabine theophylline
Continued
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Medications Compatible With IV Potassium Chloride—cont’d
fluorouracil thiotepa
furosemide tirofiban
gatifloxacin trimethaphan
gemcitabine trimethobenzamide
granisetron vinorelbine
heparin warfarin
hydralazine zidovudine
idarubicin potassium
Medications Incompatible With IV Potassium
adrenaline HCl ergotamine tartrate

amphotericin B cholesteryl methicillin sodium
sulfate complex
atropine sulphate phenytoin
cephalothin sodium phenytoin sodium
chloramphenicol sulphadiazine sodium
sodium succinate
chlorpromazine HCl suxamethonium chloride
diazepam thiopentone sodium
IV Fluid Rates in Drops per Minute
mL/h 50 75 80 100 125 150 175 200 250

10 gtt 8 13 13 17 21 25 29 33 42
15 gtt 12 19 20 25 31 37 44 50 62
60 gtt 50 75 80 100 125 150 175 200 250
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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
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
Continued
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Weight Temperature Height

lb kg ˚F ˚C cm in. ft/in.
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 ⴛ 2.2............................................kg = lb ⴛ 0.45
°F = (°C ⴛ 1.8) + 32.................................°C = (°F – 32) ⴛ 5/9
inches = cm ⴛ 0.394.................................cm = inches ⴛ 2.54
Volume Weight
1 tsp.......................................5 mL 1 mg..................................1000 mcg
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
Administering Medication to Children

Oral Liquids
Use plastic medicine cups, oral syringes, oral droppers, or cylindrical dos-
ing spoons. Never use household utensils, and do not interchange meas-
uring devices between products. For young children, squirt small
amounts of the dose into the side of the cheek away from the bitter taste
buds at the back of the tongue.
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Eye Drops/Ointments
Tilt the child’s head back, gently press skin under lower eyelid, and pull
lower lid slightly away until small pouch is visible. Insert drop (1 at a time)
or ointment. Close the eye for a few minutes.
Ear Drops
Shake otic suspensions well. If child <3 yr, pull outer ear out and down. If
child ≥3 yr, pull the outer ear out and up. Instill drops. Keep child on side
for 2 min, place cotton plug into ear.
Nose Drops
Use a bulb syringe or a cotton swab for infants and young children to
clear nose of secretions. Older child can blow own nose. Tilt child’s head
back over a pillow and squeeze dropper without touching the nostril. Keep
child’s head back for 2 min.
Suppositories
Keep refrigerated for easier administration. Wearing gloves, moisten the

rounded end with water or petroleum jelly prior to insertion. Using your
pinky finger for children <3 yr and your index finger for those ≥3 yr, insert
the suppository into the rectum about 1/2 to 1 inch beyond the sphincter.
If the suppository slides out, insert it a little farther than before. Hold the
buttocks together for a few minutes and have the child hold the position
for about 20 min, if possible.
Topicals
Clean affected area, and dry well prior to application. Apply a thin layer to
the skin, and rub in gently. Do not apply coverings over the area unless
instructed to do so by the prescriber.
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Pediatric Dosage Calculations

Most drugs in children are dosed according to body weight (mg/kg) or
body surface area (BSA) (mg/m2). Care must be taken to convert body
weight from pounds to kilograms (1 kg = 2.2 lb) before calculating doses
based on body weight. Doses are often expressed as mg/kg/day or
mg/kg/dose; therefore, orders written mg/kg/d require further clarification
from the prescriber.
Chemotherapeutic drugs are commonly dosed according to BSA, which
requires an extra verification step (BSA calculation) prior to dosing.
Medications are available in multiple concentrations; therefore, orders
written in mL rather than mg are not acceptable and require further clari-
fication.
Dosing also varies by indication; therefore, diagnostic information is
helpful when calculating doses. The following examples are typically
encountered when dosing medication in children.
Example 1. Calculate the dose of amoxicillin suspension in mL for otitis
media for a 1-year-old child weighing 22 lb. The dose required is
40 mg/kg/day divided bid, and the suspension comes in a concentra-
tion of 400 mg/5 mL.
Step 1. Convert pounds to kg: 22 lb 1 kg/2.2 lb = 10 kg
Step 2. Calculate the dose in mg: 10 kg 40 mg/kg/d = 400 mg/d
Step 3. Divide the dose by the frequency: 400 mg/d ÷ 2 (bid) =
200 mg/dose bid
Step 4. Convert the mg dose to mL: 200 mg/dose ÷ 400 mg/5 mL =
2.5 mL bid
Example 2. Calculate the dose of ceftriaxone in mL for meningitis for a
5-year-old child weighing 18 kg. The dose required is 100 mg/kg/d
given IV once daily; the drug comes prediluted in a concentration of
40 mg/mL.
Step 1. Calculate the dose in mg: 18 kg 100 mg/kg/d = 1800 mg/d
Step 2. Divide the dose by the frequency: 1800 mg/d ÷ 1 (daily) =
1800 mg/dose
Step 3. Convert the mg dose to mL: 1800 mg/dose ÷ 40 mg/mL = 45 mL
once daily
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Example 3. Calculate the dose of vincristine in mL for a 4-year-old child,
with leukemia, weighing 37 lb and is 97 cm tall. The dose required in
2 mg/m2, and the drug comes in 1 mg/mL concentration.
Step 1. Convert pounds to kg: 37 lb 1 kg/2.2 lb = 16.8 kg
Step 2. Calculate BSA: 16.8 kg 97 cm/3600 = 0.67 m2
Step 3. Calculate the dose in mg: 2 mg/m2 0.67 m2 = 1.34 mg
Step 4. Calculate the dose in mL: 1.34 mg ÷ 1 mg/mL = 1.34 mg
Pediatric Fluid and Electrolyte Requirements

How to Calculate Maintenance Fluid
Requirements in Children
Body Surface Area (BSA) Method

(commonly used in children >10 kg):
1500–2000 mL/m2/d ÷ 24 = fluid rate in mL/h
Example: Calculate maintenance fluids in mL/h for a child with a BSA
= 0.8 m2
Answer: 1500 mL/m2/d 0.8 m2 = 1200 mL/d ÷ 24 hr = 50 mL/h
2000 mL/m2/d 0.8 m2 = 1600 mL/d ÷ 24 hr = 66.6 mL/h
Answer: Range is 50–66.6 mL/h
Body Weight Method
<10 kg 100 mL/kg/d
11–20 kg 1000 mL + 50 mL/kg for each kg >10
>20 kg 1500 mL + 20 mL/kg for each kg >20
Example: Calculate maintenance fluids in mL/h for a child weighing
25 kg
Answer: 1500 mL + 20 mL/kg 5 kg = 1500 mL + 100 mL = 1600 mL
1600 mL ÷ 24 h = 66.6 mL/h
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Daily Electrolyte Requirements in Children
Sodium 2–6 mEq/kg/d

Potassium 2–4 mEq/kg/d
Calcium 1–4 mEq/kg/d*
Magnesium 0.3–0.5 mEq/kg/d
Phosphorus 0.5–2 mmol/kg/d*
*Neonates may require the higher end of the calcium and phosphorus dosage
range due to rapid bone development.
Conditions That May Alter Fluid

Requirements in Children
Fever Hyperthyroidism
Hyperventilation Renal failure
Sweating Diarrhea
Oral Rehydration Therapy (ORT)

ORT is as effective as IV therapy in managing fluid and electrolytes in chil-
dren with mild-to-moderate dehydration due to diarrhea. Commercially
available premixed ORT solutions typically contain low concentrations
of glucose (2%–3%), 45–75 mEq/L sodium, 20–25 mEq/L potassium,
30–35 mEq/L of citrate (bicarbonate source). Low sugar content provides lit-
tle caloric support but facilitates intestinal sodium and water absorption. All
commercially available ORT solutions are equally safe and effective and are
preferred over household remedies (e.g., colas, juices, chicken broth),
which are not formulated based on the physiology of acute diarrhea.
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Common Laboratory Values
General Chemistry
Laboratory Conventional Sl Units

Albumin 3.5–5.0 g/100 mL 35–50 g/L
Aldolase 1.3–8.2 U/L 22–137 nmol . s–1/L
Alkaline 13–39 U/L, infants and 217–650 nmol . s–1/L, up
phosphatase adolescents up to to 1.26 µmol/L
104 U/L
Ammonia 12–55 µmol/L 12–55 µmol/L
Amylase 4–25 units/mL 4–25 arb. unit
Anion gap 8–16 mEq/L 8–16 mmol/L
AST, SGOT Male: 8–46 U/L 0.14–0.78 µkat/L
Female: 7–34 U/L 0.12–0.58 µkat/L
Bilirubin, direct Up to 0.4 mg/100 mL Up to 7 µmol/L
Bilirubin, total Up to 1.0 mg/100 mL Up to 17 µmol/L
BUN 8–25 mg/100 mL 2.9–8.9 mmol/L
Calcitonin Male: 0–14 pg/mL 0–4.1 pmol/L
Female: 0–28 pg/mL 0–8.2 pmol/L
Calcium (Ca+) 8.5–10.5 mg/100 mL 2.1–2.6 mmol/L
Carbon dioxide 24–30 mEq/L 24–30 mmol/L
Chloride (Cl–) 100–106 mEq/L 100–106 mmol/L
Cholesterol <200 mg/dL <5.18 mmol/L
Cortisol a.m. 5–25 mcg/100 mL 0.14–0.69 µmol/L
p.m. <10 mcg/100 mL 0–0.28 µmol/L
Creatine Male: 0.2–0.5 mg/dL 15–40 µmol/L
Female: 0.3–0.9 mg/dL 25–70 µmol/L
Creatine kinase Male: 17–148 U/L 283–2467 nmol . s–1/L
(CK)
Female: 10–79 U/L 167–1317 nmol . s–1/L
Continued
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General Chemistry—cont’d

Creatinine 0.6–1.5 mg/100 mL 53–133 µmol/L
Ferritin 10–410 ng/dL
Folate 2.0–9.0 ng/mL 4.5–20.4 nmol/L
Glucose 70–110 mg/100 mL 3.9–5.6 mmol/L
Ionized calcium 4.26–5.25 mg/dL 1.1–1.3 mmol/L
Iron (Fe) 50–150 mcg/100 mL 9.0–25.9 µmol/L
Iron-binding 250–410 mcg/100 mL 44.8–73.4 µmol/L
capacity (IBC)
Lactic acid 0.5–1.8 mEq/L 0.8–1.8 mmol/L
Lactic dehy- 45–90 U/L 750–1500 nmol s–1/L
drogenase (LDH)
Lipase 2 units/mL or less Up to 2 arb. unit
Magnesium (Mg++) 1.5–2.0 mEq/L 0.8–1.3 mmol/L
Osmolality 280–296 mOsm/kg water 280–296 mmol/kg
Phosphorus 3.0–4.5 mg/100 mL 1.0–1.5 mmol/L
Potassium (K+) 3.5–5.0 mEq/L 3.5–5.0 mmol/L
Prealbumin 18–32 mg/dL
Protein, total 6.0–8.4 g/100 mL 80–84 g/L
PSA 0.0–4.0 ng/mL
Pyruvate 0–0.11 mEq/L 0–0.11 mmol/L
Sodium (Na+) 135–145 mEq/L 135–145 mmol/L
T3 75–195 ng/100 mL 1.16–3.00 nmol/L
T4, free Male: 0.75–2.0 ng/dL
Female: 0.75–2.0 ng/dL
T4, total 4–12 mcg/100 mL 52–154 nmol/L
Thyroglobulin 3–42 mc/mL 3–42 mcg/L
Triglycerides 40–150 mg/100 mL 0.4–1.5 g/L
TSH 0.5–5.0 µU/mL 0.5–5.0 arb. unit
Urea nitrogen 8–25 mg/100 mL 2.9–8.9 mmol/L
Uric acid 3.0–7.0 mg/100 mL 0.18–0.42 mmol/L
196
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Hematology (ABC, CBC, Blood Counts)
Blood volume 8.5–9.0% of body weight in kg 80–85 mL/kg

Male: 4.6–6.2 million/mm3 4.6–6.2 1012/L
Red blood cell Female: 4.2–5.9 million/mm3 4.2–5.9 1012/L
(RBC)
Hemoglobin (Hgb) Male: 13–18 g/100 mL 8.1–11.2 mmol/L
Female: 12–16 g/100 mL 7.4–9.9 mmol/L
Hematocrit (Hct) Male: 45%–52% 0.45–0.52
Female: 37%–48% 0.37–0.48
Leukocytes (WBC) 4.300–10.800/mm3 4.3–10.8 109/L
• Bands 0–5% 0.03–0.08
• Basophils 0–1% 0–0.01
• Eosinophils 1%–4% 0.01–0.04
• Lymphocytes 25%–40% 0.25–0.40
• B Lymphocytes 10%–20% 0.10–0.20
• T Lymphocytes 60%–80% 0.60–0.80
• Monocytes 2%–8% 0.02–0.08
• Neutrophils 54%–75% 0.54–0.75
Platelets 150,000–350,000/mm3 150–350 109/L
Erythrocyte Male: 1–13 mm/h 1–13 mm/h
sedimentation Female: 1–20 mm/h 1–20 mm/h
rate (ESR)
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Coagulation

ACT 90–130 s
PTT (activated) 21–35 s 21–35 s
Bleeding time 3–7 min 3–7 min
Fibrinogen 160–450 mg/dL 1.6–4.5 g/L
INR (target 2–3 2–3
therapeutic)
Plasminogen 62–130% 0.62–1.30
Platelets 150,000–300,000/mm3 106/L
PT (prothrombin 10–12 s 10–12 s
time)
PTT (partial 30–45 s 30–45 s
thromboplastin time)
Thrombin time 11–15 s 11–15 s
Normal Blood Gases

pH 7.35–7.45 35–45 µmol/L
PO2 75–100 mm Hg 10.0–13.3 kPa
PCO2 35–45 mm Hg 4.7–6.0 kPa
HCO3 22–26 mmol/L 22–26 mmol/L
Base excess (–2)–(+2) mEq/L (–2)–(+2) mmol/L
CO2 19–24 mEq/L 19–24 mmol/L
SaO2 96–100% 0.96–1.00
198
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Drug Levels, Therapeutic and Toxic
Conventional (US System of Measurements)

Drug Therapeutic Level Toxic Level
acetaminophen 5–20 mcg/mL >40 mcg/mL
alprazolam 10–50 ng/mL >75 ng/mL
amikacin peak: 20–30 mcg/mL peak: >35 mcg/mL
trough: 4–8 mcg/mL trough: >10 mcg/mL
aminocaproic acid 100–400 mcg/mL >400 mcg/mL
aminophylline 10–20 mcg/mL >20 mcg/mL
amiodarone 0.5–2.5 mcg/mL >2.5 mcg/mL
amitriptyline 120–150 ng/mL >500 ng/mL
amoxapine 200–400 ng/mL >500 ng/mL
atenolol 200–500 ng/mL >500 ng/mL
bepridil HCl 1–2 ng/mL >2 ng/mL
carbamazepine 5–12 mcg/mL >12 mcg/mL
chloral hydrate 2–12 mcg/mL >20 mcg/mL
chloramphenicol 10–20 mcg/mL >25 mcg/mL
chlordiazepoxide 1–5 mcg/mL >5 mcg/mL
chlorpromazine 50–300 ng/mL >750 ng/mL
chlorpropamide 75–250 mcg/mL >250 mcg/mL
clonazepam 15–60 ng/mL >80 ng/mL
cyclosporine 100–300 ng/mL <85 or >500 ng/mL
desipramine 150–300 ng/mL >500 ng/mL
diazepam 0.5–2 mg/L >3 mg/L
digoxin 0.8–2 ng/mL >2 ng/mL
diltiazem 50–200 ng/mL >200 ng/mL
disopyramide 2–5 mcg/mL >7 mcg/mL
doxepin 150–300 ng/mL >400 ng/mL
ethosuximide 40–100 mcg/mL >150 mcg/mL
Continued
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Drug Levels, Therapeutic and Toxic—cont’d

flecainide 0.2–1 mcg/mL >1 mcg/mL
gentamicin peak: 6–10 mcg/mL peak: >12 mcg/mL
trough: < 2 mcg/mL trough: >2 mcg/mL
haloperidol 3–20 ng/mL >42 ng/mL
hydromorphone 1–30 ng/mL >100 ng/mL
imipramine 150–300 ng/mL >500 ng/mL
kanamycin 20–25 mcg/mL >35 mcg/mL
lidocaine 1.5–5 mcg/mL >5 mcg/mL
lithium 0.5–1.5 mEq/L >1.5 mEq/L
meperidine 0.4–0.7 mcg/mL >1 mcg/mL
methotrexate > 0.01 µmol >10 µmol in 24 h
mexiletine 0.5–2 mcg/mL >2 mcg/mL
mezlocillin sodium 35–45 mcg/mL >45 mcg/mL
milrinone 150–250 ng/mL >250 ng/mL
morphine 10–80 ng/mL >200 ng/mL
nicardipine 0.028–0.05 mcg/mL >0.05 mcg/mL
nifedipine 0.025–0.1 mcg/mL >0.1 mcg/mL
nortriptyline 50–150 ng/mL >500 ng/mL
phenobarbital 15–30 mcg/mL >40 mcg/mL
phenytoin 10–20 mcg/mL >20 mcg/mL
primidone 5–12 mcg/mL >12 mcg/mL
procainamide 4–10 mcg/mL >10 mcg/mL
propafenone 0.5–3 mcg/mL >3 mcg/mL
propranolol 50–100 ng/mL >150 ng/mL
quinidine 2–5 mcg/mL >6 mcg/mL
salicylate 10–30 mg/dL >35 mg/dL
theophylline 10–20 mcg/mL >20 mcg/mL
tobramycin peak: 6–10 mcg/mL peak: >12 mcg/mL
trough: < 2 mcg/mL trough: >2mcg/mL
200
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201

tocainide HCl 4–10 mcg/mL >12 mcg/mL
trazadone 500–2000 ng/mL >4000 ng/mL
valproic acid 50–100 mcg/mL >100 mcg/mL
vancomycin peak: 20–40 mcg/mL peak: >80 mcg/mL
trough: 5–10 mcg/mL trough: >10 mcg/mL
verapamil 0.08–0.3 mcg/mL >0.3 mcg/mL
Drug Levels, Therapeutic and Toxic
SI Units (International System of Units)

Drug Therapeutic Range Toxic Level
amikacin peak: 34–51 µmol/L peak: >60 µmol/L
trough: 7–14 µmol/L
amitriptyline 360–900 nmol/L >0.5 mcg/mL
carbamazepine 21–51 µmol/L >51 µmol/L
clonazepam 40–200 nmol/L >260 nmol/L
desipramine 281–1125 nmol/L >1500 nmol/L
diazepam 0.35–3.5 nmol/L >17.5 nmol/L
digoxin 1–2.6 nmol/L >2.6 nmol/L
disopyramide 9–18 µmol/L > 21 µmol/L
ethosuximide 280–708 µmol/L >1062 µmol/L
flecainide 0.5–2.4 µmol/L >2.4 µmol/L
gentamicin peak:12–21 µmol/L peak: >21 µmol/L
trough: <4 µmol/L
imipramine 610–1670 nmol/L >1785 nmol/L
lignocaine 6–21 µmol/L >39 µmol/L
Continued
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Drug Therapeutic Range Toxic Level

lithium 0.5–1.5 mmol/L >2 mmol/L
nortriptyline 190–570 nmol/L >1900 nmol/L
phenobarbitone 86–172 µmol/L >172 µmol/L
phenytoin 40–80 µmol/L >158 µmol/L
primidone 23–55 µmol/L >55 µmol/L
procainamide 17–42 µmol/L >51 µmol/L
quinidine 6–15 µmol/L >29 µmol/L
salicylic acid 1–2 mmol/L >3.6 mmol/L
theophylline 28–111 µmol/L >111 µmol/L
tobramycin peak: 13–21 µmol/L peak: >21 µmol/L
trough: < 4 µmol/L
valproic acid 350–700 µmol/L >1386 µmol/L
vancomycin peak: 14–28 µmol/L peak: >28 µmol/L
trough: 3–7 µmol/L
Wound Care Products
Product Nursing
Product Characteristics Indications Considerations
Transparent • Semipermeable • Stage I & II • Transparency
films membrane wounds allows visual
• Waterproof • Tegaderm • Work best on inspection of
• CarraFilm • Permeable to superficial wound
oxygen and wounds, blis- • Can be used as
water vapor ters, skin tears a secondary
202
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203
Wound Care Products—cont’d
Product Nursing
• OpSite • Provide moist • Dressing dressing over
• BIOCLUSIVE healing environ- change is up to alginates or gels
ment and pre- 3 times per
vent bacterial week; do not
contamination absorb exudates
and need to be
changed when
fluid collects
underneath
them
Hydrogels • Water- or • Stage II, III and • Reduce pain
• Hypergel glycerin-based IV wounds and promote
• CarraSorb gels, impreg- • Require second- soothing effect;
• Nu-gel nated gauzes, or ary dressing easy to apply
• Curafil sheet dressings • Change once and remove
• Provide moist daily
wound environ-
ment; help
clean and
débride by sup-
plying liquid to
dry, sloughy
wounds
• Due to large
water content,
do not absorb
large amounts
of exudate
Hydrocolloid • Occlusive and • Stage I and II • Conformable
Dressings adhesive wafer wounds for easy appli-
• Tegasorb dressings, or • Granulating and cation and help
• Comfeel hydrocolloid pow- epithelizing reduce pain at
ders and pastes wounds with wound site
Continued
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Product Nursing
• DuoDERM • Facilitate rehy- low to moderate • Breakdown of
• Restore dration and amounts of product may
autolytic exudate produce
débridement of • Usually residue and
dry, sloughy, or changed up to foul odor; do
necrotic wounds 3 times per not confuse
week with infectious
process
Alginates • Soft nonwoven • Stage III and IV • Highly
• CURASORB fibers derived wounds with absorbent,
• AlgiDERM from seaweed moderate to therefore good
• Sorbsan • Available in heavy exudate, for packing
• Algosteril pads, ropes, or but not wounds exuding
ribbons with eschar or wounds
• Can absorb up dry wound beds • Require second-
to 20 times changed once ary dressing
their weight daily • Usually
• Stage III and IV changed once
wounds; may be daily
used on drain-
ing Stage II
wounds
204
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205
Product Nursing
Foam • Highly • Heavily exuding • Highly
Dressings absorbent dress- wounds, espe- absorbent foam
• Flexzan ings made from cially during may allow less
• CURAFOAM hydrophilic inflammatory frequent dress-
• Mepilex polyurethane phase following ing changes
foam, which can débridement • Can be left
hold wound and sloughing undisturbed
exudates away • Deep cavity for 3–4 days
from the wound wounds and • Decrease mac-
bed weeping ulcers, eration of sur-
• Some have such as venous rounding tissue
adhesive borders stasis ulcers • Comfortable and
• Stage III and IV conformable
wounds • Usually
• Tunneling changed up to
wounds (may 3 times per
remove debris week
in areas that • Surgical
cannot be visu- débridement
alized) may be avoided
in some cases
with use of
enzymatic
débriding
agents
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MedNotes ALLERGIES*
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INDEX
Name:
Page 206
Diagnosis and PMH:

Medication/Dose/ Date and Time(s) Comment/Caution/Medication Effect (pre- and
Route/Frequency Given: post-VS, pain rating, or other measure)
11:47 AM
206
7/8/09
2139_Tab07_177-207
* Not a legal record. Document promptly and thoroughly in the patient record.
2139_Tab07_177-207 7/8/09 11:47 AM Page 207
207
Formulas & BSA
Common Formulas
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 ⴛ gtt factor Volume ⴛ gtt factor
(Total in mL) (i.e., 10 gtt/mL) (i.e., 150 mL/h) (i.e., 10 gtt/mL)
–––––––––––––––––––––––––––– ––––––––––––––––––––––––––––––––
Time (No. of hours in minutes)
Time (in minutes)
To figure out IV running time Drops per minute 60 min

–––––––––––––––––––––––––––
(mL/h) Drip factor
Body Surface Area (BSA)
Using cm and kg: Using inches and pounds:
√Ht (cm) Wt (kg) √Ht (in) Wt (lb)
––––––––––––––––– –––––––––––––––––
3600 3131
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Index
Note: Proprietory names are in Italic type; page numbers followed by “f”
and “t” indicate figures and tables, respectively.
A Allergy notes form, 206

Abbreviations Allopurinol (Apo-Allopurinol,
medication errors associated Lopurin, Zyloprim), 19
with, 3, 4t–5t Alprazolam (Apo-Alpraz, Nu-Alpraz,
Accolate. See Zafirlukast Xanax), 20
Accupril. See Quinapril Altace. See Ramipril
Accuretic 10/12.5, 179t Alteplase (Activase, Activase rt-PA,
Aciphex. See Rabeprazole Cathflo Activase, tissue plas-
Activase. See Alteplase minogen activator, t-PA), 20–22
Activase rt-PA. See Alteplase Amaryl. See Glimepiride
Activella Tablets 0.5/0.1, 179t Ambien. See Zolpidem
Actoplus Met 15/850, 179t A-methaPred. See
Actos. See Pioglitazone Methylprednisolone
Acyclovir (Avirax, Zovirax), 16 Amiodarone (Cordarone,
Adalat. See Nifedipine Pacerone), 22–23
Adderall 5 mg, 179t Amitriptyline (Elavil, Levate,
Adrucil. See Fluorouracil Novotriptyn), 23–24
Advair Diskus 100, 179t Amlodipine (Norvasc), 24
Advicor 500/20, 180t Amoxicillin (Amoxil, Novamoxin,
Aggrenox, 180t Trimox), 25–26, 180t–181t
A-hydroCort. See Hydrocortisone Amoxicillin/clavulanate
Airet. See Albuterol (Augmentin, Augmentin ES,
Alavert. See Loratadine Augmentin XR, Clavulin), 25
Albuterol (Airet, Proventil, Amoxil. See Amoxicillin
Ventodisk, Ventolin), 16–17 Anaprox. See Naproxen
Aldactazide 25/25, 180t Anergan. See Promethazine
Aldactone. See Spironolactone Angeliq, 180t
Alendronate (Fosamax), 17–18 Apo-Allopurinol. See Allopurinol
Aleve. See Naproxen Apo-Alpraz. See Alprazolam
Aliskiren (Tekturna), 18 Apo-Atenolol. See Atenolol
Allegra. See Fexofenadine Apo-Benztropine. See Benztropine
208
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209
Apo-Cephalex. See Cephalexin Avirax. See Acyclovir
Apo-Diazepam. See Diazepam Azdone, 180t
Apo-Diltiaz. See Diltiazem Azilect. See Rasagiline
Apo-Doxy. See Doxycycline Azithromycin (Zithromax, Zmax),
Apo-Furosemide. See Furosemide 28–29
Apo-Haloperidol. See Haloperidol Azmacort. See Triamcinolone
Apo-hydro. See Azor 10/40, 181t
Hydrochlorothiazide Azo-Standard. See
Apo-Hydroxyzine. See Hydroxyzine Phenazopyridine
Apo-Lorazepam. See Lorazepam AZT. See Zidovudine
Apo-Nifed. See Nifedipine
Apo-Nitrofurantoin. See B
Nitrofurantoin B & O Supprettes No. 16A, 181t
Apo-Propranolol. See Propranolol Baclofen (Lioresal, Kemstro), 29–30
Apo-Ranitidine. See Ranitidine Bactrim. See Trimethoprim/
Apo-Zidovudine. See Zidovudine sulfamethoxazole
Aricept. See Donepezil Bactroban. See Mupirocin
Arixtra. See Fondaparinux Bactroban Nasal. See Mupirocin
Arthrotec 50/200, 180t Balziva, 181t
Atacand HCT 16/12.5, 180t Beclomethasone (QVAR), 30
Atarax. See Hydroxyzine Benazepril (Lotensin), 30–31
Atenolol (Apo-Atenolol, Benicar HCT 20/12.5, 181t
Novo-Atenolol, Tenormin), 26–27 Benztropine (Apo-Benztropine,
Ativan. See Lorazepam Cogentin), 31–32
Atorvastatin (Lipitor), 27–28 Betachron E-R. See Propranolol
Atripla, 180t Betaloc. See Metoprolol
Atrovent. See Ipratropium Bicitra, 181t
Augmentin. See Amoxicillin/ Bidil, 181t
clavulanate Biocef. See Cephalexin
Augmentin ES. See Bisoprolol (Monocor, Zebeta), 32–33
Amoxicillin/clavulanate Blood gases
Augmentin XR. See normal values of, 198t
Amoxicillin/clavulanate Blood/blood products, 9t–10t
Avalide 300/12.5, 180t common values of, 197t
Avandamet 2/500, 180t coagulation studies, 198t
Avandaryl 8/4, 180t general chemistry, 195t–196t
Avandia. See Rosiglitazone
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Body surface area (BSA) Chantix. See Varenicline

calculation, 207 Cimetidine (Novocimetine,
Budesonide (Pulmicort), 33–34 Tagamet), 44
Bumetanide (Bumex), 34 Cimzia. See Certolizumab pegol
Bumex. See Bumetanide Cipro. See Ciprofloxacin
Bupropion (Wellbutrin, Wellbutrin Ciprofloxacin (Cipro), 44–45
SR, Zyban), 34–35 Citalopram (Celexa), 45–46
BuSpar. See Buspirone Claritin. See Loratadine
Buspirone (BuSpar), 35–36 Claritin RediTabs. See Loratadine
Bystolic. See Nebivolol Clavulin. See Amoxicillin/
clavulanate
C Cleocin. See Clindamycin
Caduet 10/10, 181t Clindamycin (Cleocin, Dalacin C),
Calan. See Verapamil 46–47
Calcilean. See Heparin Clonazepam (Klonopin, Rivotril,
Calciparine. See Heparin Syn-Clonazepam), 47–48
Capoten. See Captopril Clonidine (Catapres, Catapres-TTS,
Captopril (Capoten), 36–37 Duracion), 48–49
Carbamazepine (Tegretol, Tegretol Clopidogrel (Plavix), 49
CR), 37–38 Clorpres 15/0.1, 181t
Carbolith. See Lithium Clozapine (Clozaril, FazaClo), 50
Cardizem. See Diltiazem Clozaril. See Clozapine
Cardura. See Doxazosin Cogentin. See Benztropine
Carisoprodol (Soma, Vanadom), Colchicine, 51
38–39 Col-Probenecid, 181t
Carvedilol (Coreg), 39–40 Combivent, 181t
Catapres. See Clonidine Combivir, 182t
Catapres-TTS. See Clonidine Conversions, 189t–190t
Cathflo Activase. See Alteplase Cordarone. See Amiodarone
Cefepime (Maxipime), 40 Coreg. See Carvedilol
Celebrex. See Celecoxib Cortef. See Hydrocortisone
Celecoxib (Celebrex), 41 Corzide 40/5, 182t
Celexa. See Citalopram Coumadin. See Warfarin
Cephalexin (Apo-Cephalex, Biocef, Coversyl Plus, 182t
Keflex, Novo-Lexin), 41–42 Cozaar. See Losartan
Certolizumab pegol (Cimzia), 42–43 Creon 5, 182t
Cetirizine (Zyrtec), 43 Crestor. See Rosuvastatin
Cyclobenzaprine (Flexeril), 51–52
210
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211
D Doxy Caps. See Doxycycline
Dalacin C. See Clindamycin Doxycin. See Doxycycline
Dalteparin (Fragmin), 53 Doxycycline (Apo-Doxy, Doryx,
Darunavir (Prezista), 53–55 Doxy, Doxy Caps, Doxycin,
Deltasone. See Prednisone Monodox, Novodoxylin,
Depakene. See Valproic acid Periostat, Vibramycin,
Depakote. See Valproic acid Vibra-Tabs), 62–64
Depakote ER. See Valproic acid DPH. See Phenytoin
Desyrel. See Trazodone Drugs. See Medications; specific
Detrol. See Tolterodine drugs
Detrol LA. See Tolterodine Duac Topical Gel, 182t
Dexamethasone (DexPak), 55 Duetact 2/30, 182t
DexPak. See Dexamethasone DuoNeb, 182t
DiaBeta. See Glyburide Duracion. See Clonidine
Diastat. See Diazepam Duragesic. See Fentanyl
Diazepam (Apo-Diazepam, Diastat, (transdermal)
Novodipam, Valium, Vivol), Duralith. See Lithium
55–57 Duramorph. See Morphine
Diclofenac (Flector), 57–58 Dyazide, 182t
Diflucan. See Fluconazole
Digitek. See Digoxin E
Digoxin (Digitek, Lanoxicaps, Effexor. See Venlafaxine
Lanoxin), 58–60 Effexor XR. See Venlafaxine
Dilantin. See Phenytoin Efudex. See Fluorouracil
Dilatrate-SR. See Isosorbide Elavil. See Amitriptyline
dinitrate EMLA Topical Cream, 182t
Dilaudid. See Hydromorphone Emsam. See Selegiline
Diltia XT. See Diltiazem transdermal
Diltiazem (Apo-Diltiaz, Cardizem, Enalapril (Vasotec), 64–65
Diltia XT, Nu-Diltiaz), 60 Enalaprilat (Vasotec IV), 64–65
Diovan. See Valsartan Enoxaparin (Lovenox), 65–66
Diovan HCT 80/12.5, 182t Epival. See Valproic acid
Diphenylan. See Phenytoin Epivir. See Lamivudine
Diphenylhydantoin. See Phenytoin Epivir HBV. See Lamivudine
Donepezil (Aricept), 61 Eplerenone (Inspra), 66
Doryx. See Doxycycline Epzicom, 182t
Doxazosin (Cardura), 62 Eryzole Oral Suspension, 182t
Doxy. See Doxycycline
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Esidrix. See Hydrochlorothiazide -FU. See Fluorouracil

Eskalith. See Lithium Furadantin. See Nitrofurantoin
Eskalith-CR. See Lithium Furosemide (Apo-Furosemide,
Estrace. See Estradiol Lasix, Lasix Special), 77–78
Estradiol (Estrace, Gynodiol), 67
Etravirine (Intelence), 67–69 G
Evista. See Raloxifene Gabapentin (Neurontin), 78–79
Exforge 5/160, 182t Gemfibrozil (Lopid), 79–80
Glimepiride (Amaryl), 80
F Glipizide (Glucotrol, Glucotrol XL),
Fansidar, 183t 81
FazaClo. See Clozapine Glucophage. See Metformin
Fentanyl (buccal) (Fentora), 69–70 Glucophage XR. See Metformin
Fentanyl (transdermal) (Duragesic), Glucotrol. See Glipizide
70–71 Glucotrol XL. See Glipizide
Fentora. See Fentanyl (buccal) Glucovance 1.25/250, 183t
Fexofenadine (Allegra), 71 Glyburide (DiaBeta, Micronase,
Finasteride (Propecia, Proscar), Glynase PresTab), 81–82
71–72 Glynase PresTab. See Glyburide
Flagyl. See Metronidazole Gynodiol. See Estradiol
Flector. See Diclofenac
Flexeril. See Cyclobenzaprine H
Flomax. See Tamsulosin Haldol. See Haloperidol
Flovent. See Fluticasone Haldol Decanoate. See Haloperidol
Flovent HFA. See Fluticasone Haloperidol (Apo-Haloperidol,
Fluconazole (Diflucan), 72–73 Haldol, Haldol Decanoate), 82–84
Fluoroplex. See Fluorouracil HCTZ. See Hydrochlorothiazide
Fluorouracil (Adrucil, Efudex, Hematology
Fluoroplex, 5-FU), 73–74 common values in, 197t
Fluoxetine (Prozac, Prozac Weekly, Hepalean. See Heparin
Sarafem), 74–75 Heparin (Calcilean, Calciparine,
Fluticasone (Flovent HFA, Hepalean), 84–85
Flovent), 75 Humalog. See Insulin, lispro
Fondaparinux (Arixtra), 75–76 Humulin 50/50. See Insulin,
Fosamax. See Alendronate premixed combinations
Fosamax Plus D 70/2800, 183t Humulin 70/30. See Insulin, pre-
Fosinopril (Monopril), 76–77 mixed combinations
Fragmin. See Dalteparin
212
2139_Index_208-219 7/8/09 11:21 AM Page 213
213
Humulin N. See Insulin, isophane Innohep. See Tinzaparin
(NPH) Inspra. See Eplerenone
Humulin R. See Insulin, injection Insulin
(regular) aspart (Novolog), 90–91
Hydrochlorothiazide (Apo-hydro, detemir (Levemir), 91–92
Esidrix, HCTZ, Oretic), 85–86 glargine (Lantus), 92–93
Hydrocortisone (A-hydroCort, injection (concentrated) (Iletin II
Cortef, Solu-Cortef), 86–87 Regular (Concentrated) U-500),
Hydromorphone (Dilaudid, 93
Hydrostat IR), 87–88 injection (regular) (Humulin R,
Hydrostat IR. See Hydromorphone Insulin-Toronto, Novolin R,
Hydroxyzine (Apo-Hydroxyzine, Iletin II Regular, Velosulin BR),
Atarax, Hyzine-50, Multipax, 93–94
Novohydroxyzin, Vistaril), 88–89 isophane (NPH) (Humulin N, NPH
Hytrin. See Terazosin Iletin II, Novolin Ge NPH,
Hyzaar 50/12.5, 183t Novolin N), 94–95
Hyzine-50. See Hydroxyzine lispro (Humalog), 95–96
mixing of, 15f
I premixed combinations
Iletin II Regular. See Insulin, injec- (Humulin 50/50, Humulin
tion (regular) 70/30, Novolin 70/30), 96–97
Iletin II Regular (Concentrated) Insulin-Toronto. See Insulin, injec-
U-500. See Insulin, injection tion (regular)
(concentrated) Intelence. See Etravirine
Imdur. See Isosorbide mononitrate Invega. See Paliperidone
Imitrex. See Sumatriptan Ipratropium (Atrovent), 97
Imodium. See Loperamide Isentress. See Raltegravir
Inderal. See Propranolol Ismo. See Isosorbide mononitrate
Inderal LA. See Propranolol Isoptin. See Verapamil
Inderide 40/25, 183t Isorbid. See Isosorbide dinitrate
Infliximab (Remicade), 90 Isordil. See Isosorbide dinitrate
Injections/injection sites Isosorbide dinitrate (Dilatrate-SR,
angle of, 13f Isorbid, Isordil, Isotrate,
intradermal, 12t Sorbitrate), 98
intramuscular, 9f, 10, 12t Isosorbide mononitrate (Imdur,
Z-track method for, 12f Ismo, Monoket), 98–99
subcutaneous, 12t, 14f Isotrate. See Isosorbide dinitrate
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Itraconazole (Sporanox), 99–100 Lasix. See Furosemide

IVs Lasix Special. See Furosemide
catheter flushing in, 10t Levaqion. See Levofloxacin
colloid solutions in, 8, 9t Levate. See Amitriptyline
crystalloid solutions in, 8, 8t Levemir. See Insulin, detemir
drip rates of, in drops per Levofloxacin (Levaquin), 104–105
minute, 188t Levo-T. See Levothyroxine
insertion guide for, 7f Levothroid. See Levothyroxine
potassium chloride Levothyroxine (Levo-T, Levothroid,
medications compatible with, Levoxyl, Synthroid), 105
186t–188t Levoxyl. See Levothyroxine
medications incompatible with, Lexxel 5/2.5, 183t
188t Limbitrol 5/12.5, 183t
starting, 6 Lioresal. See Baclofen
Lipitor. See Atorvastatin
J Lisinopril (Prinivil, Zestril), 106
Janumet 50/500, 183t Lithium (Carbolith, Duralith,
Januvia. See Sitagliptin Eskalith, Eskalith-CR, Lithobid,
Lithonate), 106–107
Lithobid. See Lithium
K Lithonate. See Lithium
Kaletra 100/25, 183t Loperamide (Imodium, Kaopectate
Kaopectate II Caplets. See II Caplets, Pepto Diarrhea
Loperamide Control), 107–108
Keflex. See Cephalexin Lopid. See Gemfibrozil
Kemstro. See Baclofen Lopressor. See Metoprolol
Ketorolac (Toradol), 100–101 Lopressor HCT 50/25, 183t
Klonopin. See Clonazepam Lopressor SR. See Metoprolol
Lopurin. See Allopurinol
L Loratadine (Alavert, Claritin, Caritin
Lamivudine (Epivir, Epivir HBV, RediTabs), 108–109
3TC), 101–102 Lorazepam (Apo-Lorazepam,
Lanoxicaps. See Digoxin Ativan, Novo-Lorazepam),
Lanoxin. See Digoxin 109–110
Lansoprazole (Prevacid), 102–103 Losartan (Cozaar), 110
Lantus. See Insulin, glargine Losec. See Omeprazole
Lapatinib (Tykerb), 103–104 Losec 1–2–3 A and M, 183t
214
2139_Index_208-219 7/8/09 11:21 AM Page 215
215
Lotensin. See Benazepril Methylprednisolone (A-methaPred,
Lotensin HCT 5/6.25, 184t Medrol, Solu-Medrol), 113
Lotrel 10/40, 184t Metoprolol (Betaloc, Lopressor,
Lovenox. See Enoxaparin Lopressor SR, Toprol-XL),
Lyphocin. See Vancomycin 113–114
Metronidazole (Flagyl,
M Novonidazol, Protostat), 114–115
Macrodantin. See Nitrofurantoin Micardis HCT 80/25, 184t
Maxipime. See Cefepime Micronase. See Glyburide
Maxzide-25, 184t Midrin, 184t
Medication administration. See Minergot Suppositories, 184t
also Injections/injection sites; IVs Mircera. See Methoxypolyethylene
pediatric glycol-epoetin beta
dosage calculations in, Moduret, 184t
192–193 Monocor. See Bisoprolol
guidelines for, 190–191 Monodox. See Doxycycline
safety guidelines for, 2 Monoket. See Isosorbide mononi-
Medications. See also specific trate
medications Monopril. See Fosinopril
common combination, 179t–186t Monopril-HCT 10/12.5, 184t
common formulas for, 207 Montelukast (Singulair), 115–116
compatible with IV potassium Morphine (Duramorph MS Contin,
chloride, 186t–188t Roxanol), 116–117
emergency, 177 Motofen, 184t
high alert, 1t–2t MS Contin. See Morphine
incompatible with IV potassium Multipax. See Hydroxyzine
chloride, 188t Mupirocin (Bactroban, Bactroban
suffixes and meaning, 177t–179t Nasal), 117–118
therapeutic/toxic levels of,
199t–202t N
Medrol. See Methylprednisolone Napron X. See Naproxen
Metaglip 5/500, 184t Naprosyn. See Naproxen
Metformin (Glucophage, Naproxen (Aleve, Anaprox, Napron
Glucophage XR, Novo- X, Naprosyn), 119
Metformin), 110–111 Nebivolol (Bystolic), 119–120
Methoxypolyethylene glycol-epoet- Neurontin. See Gabapentin
in beta (Mircera), 111–112 Nifedical. See Nifedipine
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Nifedipine (Adalat, Apo-Nifed, Omeprazole (Losec, Prilosec,

Nifedical XL, Procardia), 121 Prilosec OTC, Zegerid), 123–124
Nitrofurantoin (Apo-Nitrofurantoin, Ondansetron (Zofran), 124–125
Furadantin, Macrodantin), 121–122 Oral rehydration therapy (ORT),
Nolvadex. See Tamoxifen 194
Norvasc. See Amlodipine Orasone. See Prednisone
Novamoxin. See Amoxicillin Oretic. See Hydrochlorothiazide
Novo-Atenolol. See Atenolol
Novo-AZT. See Zidovudine P
Novocimetine. See Cimetidine Pacerone. See Amiodarone
Novodipam. See Diazepam Paliperidone (Invega), 125–126
Novodoxylin. See Doxycycline Pantoprazole (Protonix, Protonix
Novohydroxyzin. See Hydroxyzine IV), 127
Novo-Lexin. See Cephalexin Parcopa 25/250, 184t
Novolin 70/30. See Insulin, pre- Paroxetine (Paxil, Paxil CR),
mixed combinations 127–128
Novolin Ge NPH. See Insulin, iso- Patient education standards, 2–3
phane (NPH) Paxil. See Paroxetine
Novolin N. See Insulin, isophane Paxil CR. See Paroxetine
(NPH) Pediatrics
Novolin R. See Insulin, injection fluid/electrolyte requirements in,
(regular) 193–194
Novolog. See Insulin, aspart medication administration in
Novo-Lorazepam. See Lorazepam dosage calculations for,
Novo-Metformin. See Metformin 192–193
Novonidazol. See Metronidazole guidelines for, 190–191
Novopranol. See Propranolol Pentoxifylline (Trental), 128–129
Novospiroton. See Spironolactone Pepto Diarrhea Control. See
Novotriptyn. See Amitriptyline Loperamide
Noxafil. See Posaconazole Periostat. See Doxycycline
NPH Iletin II. See Insulin, isophane Phenazopyridine (Azo-Standard,
(NPH) Pyridium, Urodine), 129–130
Nu-Alpraz. See Alprazolam Phenergan. See Promethazine
Nu-Diltiaz. See Diltiazem Phenoject. See Promethazine
Phenytoin (Dilantin, Diphenylan,
O diphenylhydantoin, DPH),
Olanzapine (Zyprexa, Zyprexa 130–131
Zydis), 122–123 Pioglitazone (Actos), 131–132
216
2139_Index_208-219 7/8/09 11:21 AM Page 217
217
Plavix. See Clopidogrel Pulmicort. See Budesonide
Polycitra Syrup, 184t Pyridium. See Phenazopyridine
Posaconazole (Noxafil), 132–133
Potassium chloride Q
IV Quetiapine (Seroquel), 138–139
medications compatible with, Quinapril (Accupril), 139–140
186t–188t Quinaretic 20/25, 185t
medications incompatible with, QVAR. See Beclomethasone
188t
oral/injection concentrate,
133–134 R
Prandin. See Repaglinide Rabeprazole (Aciphex), 140
Pravachol. See Pravastatin Raloxifene (Evista), 140–141
Pravastatin (Pravachol), 134 Raltegravir (Isentress), 141–142
Prednicot. See Prednisone Ramipril (Altace), 142–143
Prednisone (Deltasone, Orasone, Ranexa. See Ranolazine
Pred-Pak, Prednicot), 135 Ranitidine (Apo-Ranitidine, Zantac,
Pred-Pak. See Prednisone Zantac-C, Zantac 75), 143–144
Prevacid. See Lansoprazole Ranolazine (Ranexa), 145
Prezista. See Darunavir Rasagiline (Azilect), 145–146
Prilosec. See Omeprazole Remicade. See Infliximab
Prilosec OTC. See Omeprazole Renese-R, 185t
Prinivil. See Lisinopril Repaglinide (Prandin), 147
Prinzide 10/12.5, 185t Restoril. See Temazepam
Procardia. See Nifedipine Retrovir. See Zidovudine
Promethazine (Anergan, Rifadin. See Rifampin
Phenergan, Phenoject), 136 Rifamate, 185t
Propecia. See Finasteride Rifampin (Rifadin, Rimactane,
Propranolol (Apo-Propranolol, Rofact), 148
Betachron E-R, Inderal, Inderal Rifater, 185t
LA, Novopranol), 136–138 Rimactane. See Rifampin
Proscar. See Finasteride Risperdal. See Risperidone
Protonix. See Pantoprazole Risperidone (Risperdal), 148–149
Protonix IV. See Pantoprazole Rivotril. See Clonazepam
Protostat. See Metronidazole Rofact. See Rifampin
Proventil. See Albuterol Rosiglitazone (Avandia), 149–150
Prozac. See Fluoxetine Rosuvastatin (Crestor), 150–151
Prozac Weekly. See Fluoxetine Roxanol. See Morphine
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S Tamoxifen. See Tamoxifen

Salmeterol (Serevent), 152 Tamoxifen (Nolvadex, Tamoxifen,
Sarafem. See Fluoxetine Tamofen), 159
Selegiline transdermal (Emsam), Tamsulosin (Flomax), 159–160
152–154 Tarka 4/240, 185t
Septra. See Trimethoprim/sul- Tegretol. See Carbamazepine
famethoxazole Tegretol CR. See Carbamazepine
Serevent. See Salmeterol Tekturna. See Aliskiren
Seroquel. See Quetiapine Temazepam (Restoril), 160–161
Sertraline (Zoloft), 154–155 Tenoretic 50, 185t
Simvastatin (Zocor), 155 Tenormin. See Atenolol
Sinemet 10/100, 185t Terazosin (Hytrin), 161–162
Singulair. See Montelukast Teveten HCT 600/25, 185t
Sitagliptin (Januvia), 156 3TC. See Lamivudine
Solu-Cortef. See Hydrocortisone Tinzaparin (Innohep), 162–163
Solu-Medrol. See Tissue plasminogen activator. See
Methylprednisolone Alteplase
Soma. See Carisoprodol TMP/SMZ. See Trimethoprim/sul-
Sorbitrate. See Isosorbide dinitrate famethoxazole
Spironolactone (Aldactone, Tolterodine (Detrol, Detrol LA), 163
Novospiroton), 156 Toprol-XL. See Metoprolol
Sporanox. See Itraconazole Toradol. See Ketorolac
Stalevo 150, 185t t-PA. See Alteplase
Sumatriptan (Imitrex), 157–158 Tramadol (Ultram), 163–164
Sunitinib (Sutent), 158 Trazodone (Desyrel, Trialodine,
Sutent. See Sunitinib Trazon), 164–165
Symbicort, 185t Trazon. See Trazodone
Symbols Trental. See Pentoxifylline
medication errors associated Trialodine. See Trazodone
with, 3, 4t–5t Triamcinolone (Azmacort), 165–166
Symbyax 12/50, 185t Trimethoprim/sulfamethoxazole
Syn-Clonazepam. See Clonazepam (Bactrim, Septra, TMP/SMZ),
Synthroid. See Levothyroxine 166–167, 181t, 185t
Trimox. See Amoxicillin
T Trizivir, 186t
Tagamet. See Cimetidine Truvada, 186t
Tamofen. See Tamoxifen Tykerb. See Lapatinib
218
2139_Index_208-219 7/8/09 11:21 AM Page 219
219
U W
Ultram. See Tramadol Warfarin (Coumadin, Warfilone),
Uniretic 15/25, 186t 173–174
Urodine. See Phenazopyridine Warfilone. See Warfarin
Wellbutrin. See Bupropion
V Wellbutrin SR. See Bupropion
Valacyclovir (Valtrex), 167–168 Wound care products, 202t–205t
Valium. See Diazepam
Valproic acid (Depakote, Depakote X
ER, Depakene, Epival), 168–169 Xanax. See Alprazolam
Valsartan (Diovan), 169
Valtrex. See Valacyclovir Z
Vanadom. See Carisoprodol Zafirlukast (Accolate), 174
Vancocin. See Vancomycin Zantac. See Ranitidine
Vancoled. See Vancomycin Zantac 75. See Ranitidine
Vancomycin (Lyphocin, Vancocin, Zantac-C. See Ranitidine
Vancoled), 169–170 Zebeta. See Bisoprolol
Varenicline (Chantix), 170–171 Zegerid. See Omeprazole
Vaseretic 5/12.5, 186t Zestoretic 20/25, 186t
Vasotec. See Enalapril Zestril. See Lisinopril
Vasotec IV. See Enalaprilat Ziac 10/6.5, 186t
Velosulin BR. See Insulin, injection Zidovudine (Apo-Zidovudine, AZT,
(regular) Novo-AZT, Retrovir), 175
Venlafaxine (Effexor, Effexor XR), Zithromax. See Azithromycin
171–172 Zmax. See Azithromycin
Ventodisk. See Albuterol Zocor. See Simvastatin
Ventolin. See Albuterol Zofran. See Ondansetron
Verapamil (Calan, Isoptin, Verelan), Zoloft. See Sertraline
172–173 Zolpidem (Ambien), 175–176
Verelan. See Verapamil Zovirax. See Acyclovir
Vibramycin. See Doxycycline Zyban. See Bupropion
Vibra-Tabs. See Doxycycline Zyloprim. See Allopurinol
Vistaril. See Hydroxyzine Zyprexa. See Olanzapine
Vivol. See Diazepam Zyprexa Zydis. See Olanzapine
Zyrtec. See Cetirizine
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1364-FM_i-xxxvi 02/03/11 3:16 PM Page viii

2139_FM_i-v.qxd 7/8/09 2:44 PM Page 2

Judith Hopfer Deglin, PharmD

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High Alert Medications

Classes/Categories of Medications Specific Medications

Classes/Categories of Medications Specific Medications

Safe Medication Administration

Standards for Patient Education

Abbreviations and Symbols Associated

Adapted from the Institute for Safe Medication Practices, 2007.

IV Solutions: Crystalloids and Colloids

Type of Solution Components Indications

Volume Expanders (Colloids)

Type of Solution Components Indications

Blood and Blood Products

Blood Product Components Indications

Blood Product Components Indications

Catheter Type Solution Strength Frequency

Intramuscular (IM) Injection Sites

Z-Track Method for Giving IM Injections

Injections: Intradermal (ID), Subcutaneous (SC),

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

Key: underline = most common CAPS = life-threatening

■ ADVERSE REACTIONS AND SIDE EFFECTS: Headache, abdominal

Key: underline = most common CAPS = life-threatening

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

Key: underline = most common CAPS = life-threatening

■ CONTRAINDICATIONS: Active internal bleeding; history of CVA;

■ CONTRAINDICATIONS: Narrow-angle glaucoma, pregnancy, and lac-

Key: underline = most common CAPS = life-threatening

■ THERAPEUTIC EFFECTS: Bactericidal action. Spectrum is broader

Key: underline = most common CAPS = life-threatening

■ CAUTIONS: Blood levels and the risk of myopathy are increased by

an acute withdrawal reaction (hallucinations, increased spasticity,

Key: underline = most common CAPS = life-threatening

■ ADVERSE REACTIONS AND SIDE EFFECTS: Depression, hallucina-

bronchodilators. • Caution patient to avoid smoking, known allergens,

Key: underline = most common CAPS = life-threatening

■ ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness, drowsiness,

Key: underline = most common CAPS = life-threatening

■ CONTRAINDICATIONS: Hypersensitivity, bone marrow depression.

myocardial depression. • Additive bradycardia may occur with

Key: underline = most common CAPS = life-threatening

■ THERAPEUTIC EFFECTS: Bactericidal action against susceptible

Key: underline = most common CAPS = life-threatening

CIMETIDINE (sye-meh-tih-deen) Novocimetine, Tagamet Antiulcer agent

Key: underline = most common CAPS = life-threatening

■ ADVERSE REACTIONS AND SIDE EFFECTS: Apathy, confusion,

■ CAUTIONS: Additive CNS depression with alcohol, antidepressants,

Key: underline = most common CAPS = life-threatening

CLOZAPINE (kloe-za-peen) Clozaril, FazaClo Antipsychotics Pregnancy

■ THERAPEUTIC EFFECTS: Reduction in muscle spasm and hyper-

Key: underline = most common CAPS = life-threatening

■ ADMINISTRATION: Must be administered with a meal or light snack