Adrenergics

Alpha and beta agonists

Epinephrine (Adrenalin)-SC or IM 0.1-1 mg in 1:1000 solution; IV-intracardiac 1:10,000 solution; ophthalmic 1:1000-1:50,000 solution

Asystole, bronchospasm anaphylaxis, glaucoma

Stimulates pacemaker cells; inhibits histamine and mediates bronchial relaxation; intraocular pressure decreased

Ventricular arrhythmias, fear, anxiety, anginal pain, decreased renal blood flow, burning of eyes, headache

Norepinephrine (Levophed)-IV 8-12 p-g/minutes titrated to desired response

Acute hypotension, cardiogenic shock

Increases rate and strength of heartbeat; increases vasoconstriction

Palpitations, pallor, headache, hypertension, anxiety, insomnia, dilated pupils, nausea, vomiting, glycosuria, tissue sloughing

Beta agonists

Dobutamine (Dobutrex)-IV Acute heart failure 1.5-10 µg/kg/minutes

Acute heart failure

Stimulates cardiac contractile force (positive inotropy); fewer changes in heart rate than dopamine or isoproterenol

Tachycardia, arrhythmias

Dopamine (Inotropin)-IV 1-5 µg/kg/minutes titrated to desired response; gradually increase to 1-4 p-g/kg/minutes increments at 10-30 minutes intervals; must maintain at 20 µg/kg/minutes or less.

Acute heart failure

Cardiac contractility increased; Renal blood flow increased

Ectopic beats, nausea, vomiting, tachycardia, anginal pain, dyspnea, hypotension

Isoproterenol (Isuprel)-10-15 mg sublingually; IV 0.5-5.0 µg/minutes in solution

Cardiogenic shock, heart block, bronchospasm asthma, emphysema

↑ Cardiac contractility; facilitates AV conduction and pacemaker automaticity

Tachyarrhythmias, hypo ten sion, headache, flushing of skin, nausea, tremor, dizziness

Analgesics

Acetaminophen (Tylenol, Datril, Panadol)-PO 325-650 mg q4h

Simple fever or pain

Analgesic and antipyretic actions; no anti-inflammatory or anticoagulant effects

No remarkable side effects when taken for a short period

Aspirin (acetylsalicylic acid)-PO or rectal 0.3-0.6 g

Minor aches and pains; fever from colds and influenza; rheumatoid arthritis; anticoagulant therapy

Selectively depresses subcortical levels of CNS

Erosive gastritis with bleeding, coryza, urticaria, nausea, vomiting, tinnitus, impaired hearing, and respiratory alkalosis

Butorphanol (Stadol)

IM: 1-2 mg

IV: 0.5-2 mg

Obstetric use: Control pain, especially during labor. Avoid in opioid-addicted patients.

30-40 times more potent than meperidine; onset: 2-15 minutes; duration: 0.5-2 hours

No excessive sedation. Neonatal respiratory depression less than with meperidine. Sinusoidal FHR pattern after administration.

Codeine-PO, IM, or SC 15-60 mg (gr ¼ to 1)

Control pain; may be used during the puerperium

Nonsynthetic narcotic analgesic

Of little use during labor; allergic response; constipation; GI upset

Ecotrin (enteric-coated aspirin)

See Aspirin

See Aspirin

See Aspirin

Eiodolac (Lodine)-PO

400-1200 mg/day, 300-400 q6-8h

Management of osteoarthritis; mild to moderate pain

Inhibits prostaglandin synthesis; suppression of inflammation and pain (NSAID)

Dyspepsia, asthma, drowsiness, rash, tinnitus, anaphylaxis

Fentanyl transdermal (Duragesic)-25-100 µg/hour

Chronic pain; not recommended for postoperative pain

Obstetric use: Short-acting pain control during labor.

Binds to opiate receptors in the CNS to alter response and perception of pain

Drowsiness, confusion, weakness, constipation, dry mouth, nausea, vomiting, anorexia, sweating

Hydrocodone/Acetaminophen (Vicodin)-PO 5-10 mg q4-6h

Moderate to severe pain

Bind to opiate receptors in Confusion, sedation, hypotenCNS; alter perception of and sion, constipation response to painful stimuli

Confusion, sedation, hypotension, constipation

Hydromorphone (Dilaudid)-PO 2-4 mg q3-6h; IM 1-2 mg q3-6h up to 2-4 mg q4-6h; IV 0.5-1.0 mg q3h

Moderate to severe pain; anti-tussive

Bind to opiate receptors in the CNS; alter perception and response to pain

Sedation, confusion, hypotension, constipation

Ibuprofen (Motrin)-300-800 mg oral 3-4/days not to exceed 3200 mg/day

Nonsteroid anti-inflammatory, antirheumatic used in chronic arthritis pain

Inhibition of prostaglandin synthesis or release

GI upset, leukopenia; sodium/water retention

Indomethacin (Indocin)-PO 25 mg 3-4/days; increase to max 200 mg daily in divided doses

Rheumatoid arthritis; bursitis; gouty arthritis

Antipyretic/anti-inflammatory action; inhibits prostaglandin biosynthesis

GI distress, bleeding; rash; headache; blood dyscrasias; corneal changes

Ketorolac (toradol)-PO, IV 10 mg q4-6h; IM 30-60 mg initially, then 15-30 mg q6h; ophthalmic 1 gtt qid for 1 week

Short-term management of pain; ocular itching due to allergies (NSAID)

Inhibits prostaglandin synthesis producing peripherally mediated analgesia; antipyretic/ anti-inflammatory

Drowsiness, dizziness, dyspnea, prolonged bleeding time, dyspepsia

Meperidine HCI (Demerol)-PO or IM 50-100 mg q3-4h

Pain due to trauma or surgery; allay apprehension before surgery

Acts on CNS to produce analgesia, sedation, euphoria, and respiratory depression

Palpitations, bradycardia, hypotension, nausea, vomitine, syncope, sweating, tremors, convulsions

Obstetric use: maternal relaxation may either slow labor or speed up labor

Depresses CNS, maternal and fetal; allays apprehension; PO peak action-1-2 hours; IM peak action first hour

Maternal side effects same as above; also can depress fetus

Morphine SO₄-PO 10-30 mg (Roxanol, MS Contin); SC 8-15 mg; IV 4-10 mg; rectal 10-20 mg

Control pain and relieve fear, apprehension, restlessness, as in pulmonary edema

Depresses CNS reception of pain and ability to interpret stimuli; depresses respiratory center in medulla

Nausea, vomiting, flushing, confusion, urticaria, depressed rate and depth of respirations, decreased blood pressure

Obstetric use: preeclampsia, eclampsia; uterine dysfunction; pain relief

Increases cerebral blood flow; provides antihypertensive action; CNS depressant

Respiratory and circulatory depression in mother and neonate; may depress contractions

Nalbuphine (Nubain) IV: 1 mg at 6-10 minutes intervals

Obstetric use: pain relief during labor. Avoid in opioid addicted patients.

Onset: 2-15 minutes; duration: 1-4 hours

Increased sedation and limited ceiling effect; ceiling effect for neonatal respiratory depression

Naproxen (Naprosyn)-PO 250-500 mg bid

Mild to moderate pain; dysmenorrhea; rheumatoid arthritis; osteoarthritis (NSAID).

Inhibits prostaglandin synthesis; suppression of inflammation

Headache, drowsiness, dizziness, nausea, dyspepsia, constipation, bleeding

Oxycodone HO (Percodan, Tylox)-PO 3-20 mg; SC 5 mg

Postpartum use: control pain; may be used during puerperium; 5-6 times more potent than codeine

Less potent and addicting than morphine; for moderate pain-episiotomy and “afterpains”; peak action 1 hour

See Morphine SO₄

Pentazocine (Talwin)-PO 50-100 mg; IM 30-60 mg q3-4h

Relief of moderate to severe

Narcotic antagonist, opioid antagonist properties, equivalent to codeine

Respiratory depression, nausea, vomiting, dizziness, lightheadedness, seizures

Antacids

Antiadrenal

Aminoglutethimide (Cytadren)-250 mg q6h

Cushing’s

Inhibits enzymatic conversion of cholesterol to pregnenolone, thus reducing synthesis of adrenal glucocorticoids/ mineralocorticoids

Cortical hypofunction, hypotension, hypothyroidism

Antianemics

Ferrous sulfate (Feosol, Fer-inSoD-adults, PO 300 rng-1.2 g qd; children under 6 years, PO 75-225 mg qd; 6-12 years, PO 120-600 mg qd

Iron deficiency anemia; pro-phylactically during infancy, childhood, pregnancy

Corrects nutritional iron deliciency anemia

Nausea, vomiting, anorexia, constipation, diarrhea; yellow-brown discoloration of eyes, teeth

Antianginals

Atenolol (Tenormin)-PO 50-150 mg daily; IV 5 mg initially, wait 10 minutes, then another 5 mg

Hypertension: angina; arrhythmias

Blocks (cardiac) beta adrenergic receptors

Fatigue, weakness, bradycardia, heart failure, pulmonary edema

Isosorbide dinitrate (Isordil, Isorbid)-sublingual 2.5-10.0 mgq5-l0min for 3 doses; PO 5-10 mg initially, 10-40 mg q6h

Acute angina: long-term pro-Produces vasodilation, dephylaxis for angina; heart creases preload failure

Produces vasolidation, decreases preload

Headache, dizziness, hypotension, tachycardia

Nitroglycerin-sublingual 0.25-0.6 mg prn; transdermal (patch) 2.5-15.0 mg/day; topical 2-3 inches q8h; IV 10-20 µg/minutes

Angina pectoris; adjunctive treatment in Ml, heart failure, hypertension (IV form)

Directly relaxes smooth muscle, dilating blood vessels; lowers peripheral vascular resistance; increases blood flow

Faintness, throbbing headache, vomiting, flushing, hypotension, visual disturbances

Antiarrhythmics

Bretylium (Brelylol)-IV Ventricular fibrillation; ven0.5-10 mg/kg q6h; IM 5-10 tricular tachycardia mg/kg (max 250 mg in one site)

Ventricular fibrillation; ventricular tachycardia

Inhibits norepinephrine release from sympathetic nerve endings; increased fibrillation threshold

Worsening of arrhythmia; tachycardia and increased BP initially; nausea, vominity; hypotension later

Antiarrhythmics

Diphenylhydantoin (Dilantin)-PO 100-200 mg 3-4 times daily; IV loading dose 10-15 mg/kg (not to exceed 50 mg/minutes), 50-100 mg over 5-10 minutes

Digitalis toxicity; ventricular ectopy

Depresses pacemaker activity in SA node and Purkinje tissue without slowing con-duction velocity

Severe pain if administered in small vein; ataxia, vertigo, small vein; ataxia, vertigo, nystagmus, seizures, confusion, skin eruptions, hypotension if administered too fast

Lidocaine HCI-IV 50-100 mg; bolus; 1.-4 mg/kg/minutes, IV drip

Ventricular taelovartlia; PVCs

Depresses myocardial response to abnormally generated impulses

Drowsiness, dizziness, nervousness, confusion. paresthesias

Procainamide HCI (PronestyI)-PO, IM 500-1000 mg 4-6 times qd: IV 1 g

Atrial and ventricular arrhythmias; PVCs; overdose of digitalis; general anesthesia

Depresses myocardium; lengthens conduction time between atria and ventricles

Polyarthralgia, fever, chills, urticaria, nausea, vomiting, urticaria, nausea, vomiting, psychoses, rapid decrease in BP

Propranolol HCI (Inderal)-0.5-3.0 mg IV push (up to 3 mg); 20-60 mg orally 3-4 times daily

Ventricular ectopy; angina unesponsive to nitrites, paroxysmal atrial tachycardia; hypertension

Beta-adrenergic blocker, cardiac contractility decreased. Heart rate decreased. Myocardial oxygen requirement decreased

Bradycardia, hypotension, vertigo, paresthesia of hands

Quinidine SO₄-PO 0.2-0.6 g q2h loading dose: maintenance: 400-1000 mg tid-qid; IV 5-10 mg/kg over 30-60 minutes

Atrial fibrillation; PAT; ventricular tachycardia; PVCs

Lengthens conduction time in atria and ventricles; blocks vagal stimulation of heart

Nausea, vomiting, diarrhea, vertigo, tremor, headache, abdominal cramps, AV block, cardiac arrest

Antiasthmatics

Cromolyn sodium-inhale, 1 cap 4 times qd

Perennial bronchial asthma (not acute asthma or status asthmaticus)

Inhibits release of bronchocon, strictors-histamine and SRS-A; suppresses allergic response

Cough. hoarseness. wheezing, dry mouth, bitter aftertaste, urticaria, urinary frequency

Anticholelithics

Ursodeoxycholic (Actigal)

Gallstones

Dissolves gallstones

Diarrhea, avoid concurrent use with bile acid sequestrants with bile acid sequestrants

Anticholinergics (antimuscarinis)

Anticholinergics (antimuscarinis)

Atropine, SO₄-0.3-1.2 mg PO, SC, IM, or IV; ophthalmic 0.5-1.0% up to 6 times qd

Peptic ulcer; spasms of GI tract. Stokes-Adams syndrome; control excessive secretions during surgery

Blocks parasympathomimetic effects of acetylcholine on effector organs

Dry mouth, tachycardia, blurred vision, drowsiness, skin Bushing, urinary retention; contraindications: glaucoma and paralytic ileus

mg 3-4 x day

Diverticulosis

Antispasmodic

Blurred vision, constipation. dry eyes, dry mouth

1-2 mg bid/tid; IM, IV 4.4 mcg/kg (preop); 100-200 mcg qid (ulcer)

Inhibit salivation and respiratory secretions; peptic ulcer disease

Inhibits action of acetylcholine (antimuscarinic action)

Tachycardia, dry mouth, urinary hesitancy

0.125-0.5 mg 3-4 x day; or 0.375 mg twice a day in released tablets

Diverticulosis

Manages spasms of irritable bowel syndrome

Constipation, dry mouth, blurred vision

(Banthine)-P0 15 mg qid; IM or IV 30 mg

Decreases hypertonicity and hypersecretion of GI tract; ulcerative colitis; peptic ulcer

Blocks neural transmission at ganglia of autonomic nervous system and at parasympathetic effector organs

Nausea, gastric fullness, constipation, mydriasis

0.3-0.6 mL tid

bowel, biliary, and renal colic; prostatitis

Blocks parasympathomimetic effects of acetylcholine

Dry mouth, thirst, dilated pupils, skin flushing, elevated temperature, delirium

Anticoagulants

Enoxaparin (Lovenox)-30-40mg bid SC, 7-10 days; or 1 mg/kg q12h

Deep vein thrombosis; prophylaxis before knee and abdominal surgery

Potentiates inhibitory effect of antithrombin

Bleeding, anemia, thromhocytopenia

Heparin-initial dose: IV 5,000-20,000-40,000 U followed by infusion over 24 hours

Acute thromboembolic emergencies

Prevents thrombin formation

Hematuria, bleeding gums, ecchymosis

Warfarin sodium (Coumadin)-initial dose: PO 10-15 mg; maintenance dose: PO 2-10 mg qd

Venous thrombosis atrial fibrillation with embolixation; pulmonary emboli; myocardial infarction

Depresses liver synthesis of prothromhin and factors VII, IX, and X

Minor or major hemorrhage, alopecia, fever, nausea, diarrhea, dermatitis

Anticoagulant Antidotes

Protamine sulfate 1%-IV 10 mg/mL slowly; 1 mg/100 U heparin

Overdose of heparin

Positive electrostatic charge inactivates negatively charged heparin molecules

Excessive coagulation; hypotension, bradycardia, dyspnea

(Konakion)-PO, IM, SC 2.5-25.0 mg; 0.5-1.0 mg in newborns

Warfarin (Coumadin) hypoprothrombinemia; hemorrhagic disease in newborns

Counteracts the inhibitory effects of oral anticoagulants on hepatic synthesis of vitamin K-dependent clotting factors

Flushing, hypotension, allergic reactions; reappearance of clotting problems (high doses)

Anticonvulsants

Carbamazepine (Tegretol) 200 mg twice/day (range: 600-1200/day in divided doses)

Multiple sclerosis

Decreases synaptic transmis-sion in CNS by affecting sodium channels in neurons

Contraindicated in hypersensitivity, bone marrow depres. sion; drowsiness, ataxia, agranulocytosis, aplastic anemia

Clonazepam (Klonopin)-PO 1.5 mg in 3 doses initially, 0.5-1.0 mg every third day

Absence seizures (petit mal seizures, myoclonic seizures)

Produces anticonvulsant and sedative effects in the CNS, mechanism unknown

Drowsiness, ataxia, behavioral changes

Diazepam (Valium)-PO 2-10 mg bid-qid; IM or IVE 5-10 mg

All types of seizures

Induces calming effect on limbic system, thalamus, and hypothalamus

Drowsiness, ataxia, paradoxical increase in CNS excitability

500 mg/day, increase by 250 mg/day until effective

Absence seizures

Depresses motor cortex and reduces CNS sensitivity to convulsive nerve stimuli

GI distress: nausea, vomiting, cramps, diarrhea, anorexia; blood dyscrasias

Magnesium salts 4-5 g by IV infusion

cirrhosis

Osmotically active in GI tract

Use caution in renal failure: contraindicated in: hypermagnesemia, anuria, heart block

Magnesium Sulfate-PO 1-3 g/IM or IVE 1-4 g loaing dose.followede bye continuous infusion

Control seizures in pregnancy, epilepsy; relief of acute constipation; reduces edema, inflammation, and itching of skin; may inhibit preterm contractions

Depresses CNS and smooth, cardiac, and skeletal muscle; promotes osmotic retention of fluid

Flushing, sweating. extreme thirst, complete heart block. dehydration, depressed or absent reflexes, ↓ respirations

Phenytoin or diphenylhydantoin (Dilantin) SO₄-PO 30-100 mg 3-4 times qd; IV 150-250 mg

Psychomotor epilepsy, convulsive seizures; ventricular arrhythmias

Depresses motor cortex by preventing spread of abnormal electrical impulses

Nervousness, ataxia, gastric distress, nystagmus, slurred tress, nystagmus, slurred speech, hallucinations, gingival hyperplasia

Primidone (Mysoline)-PO 100-250 mg, increase over 10 days not to exceed 2 g/day

Tonic-clonic,focal, or local seizures

Inhibits abnormal brain electrical activity; dose-dependent CNS depression

Excessive sedation or ataxia, vertigo

Valproic acid (depakene)-PO 15 mg/kg/day, increase up to 60 mg/kg/day

Absense, tonic-clonic, myoclonic, focal, or local seizures

Inhibits spread of abnormal discharges through brain

Nausea, vomiting, diarrhea (disappear over time); drowsiness or sedation if taken in combination with other anticonvulsants

Antidiarrheals

Antidiarrheals

Diphenoxylate HCI with atroptne sulfate (Lomotil)-PO 5-10 mg tid-qid

Diarrhea

Increases intestinal tone and decreases propulsive peristalsis

Rash, drowsiness, dizziness, depression, abdominal distention, headache, blurred vision, nausea

Kaolin with pectin (Kaopectate)-adults, PO 60-120 mL after each bowel movement (BM); children over 12, PO 60 mL; 6-12 years, PO 30-60 mL; 3-6 years, PO 15-30 mL after each BM

Diarrhea

Reported to absorb irritants and soothe

Granuloma of the stomach

Paregoric or camphorated opium tincture-5-10 mL q2h, not more than qid

Diarrhea

Acts directly on intestinal smooth muscle to increase tone and decrease propulsive peristalsis

Occasional nausea; prolonged use may produce dependence

Antiemetics

Antiemetics

Chlorpromazine (Thorazine-preop IM 12.5-25.0 g 1-2 hours before; IV 25-50 mg; PO 10-25 mg q4-6h; IM 25-50 mg q3-4h; suppository 50-100 mg q6-8h

Nausea, vomiting, hiccup, preoperative sedation, psychoses

Alters the effects of dopamine in the CNS; anticholinergic, alpha-adrenergic blocking

Sedation, extrapyramidal reactions, dry eyes, blurred vision, hypotension, constipation, dry mouth, photosensitivity

Prochlorperazine dimaleate (Compazine)-5-30 mg qid PO, IM, rectal

Nausea, vomiting, and retching

See Trimethobenzamide HCI

Drowsiness, orthostatic hypotension, palpitations, blurred vision, diplopia, headache

Antiemetics

Trimethobenzamide HCI (Tigan)-250 mg qid, PO, IM, rectal

Nausea: vomiting

Suppresses chemoreceptors in the trigger zone located in the medulla oblongata

Drowsiness, vertigo; diarrhea, headache, hypotension; jaundice; blurred vision; rigid muscles

Antifungal

Amphotericin B (Fungi-zone)-IV 5 mg/250 mL dextrose over 4-6 hours (to 1 mg/kg body weight)

Severe fungal infections; histoplasmosis

Fungistatic or fungicidal; binds to sterols in fungal cell membrane, altering cell permeability

Febrile reactions; chills. nausea; vomiting; muscle/joint pain; renal damage; hypotension, tachycardia, arrhythmias; hypokalemia

Ketoconazole (Nizoral)-oral 200-400 mg

Histoplasmosis, systemic fungal infections

Antifungal

Headache, faitgue, dizziness; nausea, vomiting; decreased libido, impotence; gynecomastia, especially in men

Nystatin (Nilstat, Myco-Nystatin)-PO, rectal, vaginal: 100,000-1,000,000 U 3-4 times qd

Skin, mucous membrane infections (candila albicans); oral thrush, vaginits; intestinal candidiasis

Fungaistatic and fungicidal; binds to sterols in fungal cell membrane

Nausea, vomiting, GI distress diarrhea

Antigout

Antigout Allopurinol (Lopurin,Zyloprim)-P0 100 mg initially, 300 mg daily with meals

Primary hyperuricemia, secondary hyperuricemia with cancer therapy

Lowers plasma and urinary uric acid levels; no analgesic, anti-infammatory. or uricosuric actions

Rash, itching; nausea, vomiting; anemia; drowsiness

Colchicine-PO 1.0-1.2 mg acute phase; 0.5-2.0 mg nightly with milk or food; IV 1-2 mg initially

Gouty arthritis, acute gout

Inhibits leukocyte migration and phagocytosis in gouty joints; nonanalgesic, nonucricosuric

Nausea, vomiting, diarrhea, abdominal pain, peripheral neuritis, bone marrow despression (sore throat, bleeding gums, sore mouth), tissue and nerve necrosis with IV use

Probenecid (Benemid)-PO 0.25-0.50 g twice daily pc

Chronic gouty arthritis, no value in acute, adjuvant therapy with penicillin to increase plasma level. Relief of allergic symptoms

Inhibits renal tubular resorption of uric acid; no analgesic or anti-inflammatory activity; competitively inhibits renal tubular secretion of penicillin and many weak organic acids

Headache, nausea, vomiting. anorexia, sore gums, urinary frequency, flushing

Antihistamines

Astemizole (Hismanal)-PO 10 mg/day

(rhinitis, urticaria); less sedating

Block the effecrts of histamine

Drowsiness, headache, fatigue, stimulation, dry mouth, rash, incread appetite (none of these are frequent)

Chlorpheniramine maleate (Chlor-Trimeton)-PO 2-4 mg tid-qid; SC, IM, or IV 10-20 mg

Asthma; hay fever; serum reactions; anaphylaxis

Inhibits action of histamine

Nausea, gastritis, diarrhea, headache, dryness of mouth and nose, nervousness, irritability

Diphenhydramine HCI (Benadryl)-PO 25-50 mg tid-qid; IM or IV 10-20 mg

Allergic and pyrogenic reactions; motion sickness; radiation sickness; hay feverl Parkinson's disease

Inhibits action of histamine on receptor cells; decreases action of acetylcholine

Sedation, dizziness, inability to concentrate, headache, anorexia, dermatitis, nausea, diplopia, insomnia

Nedocromil (Tilade) inhalation, 2 sprays

Asthma

Prevents the release of histamine frome sensitized mastcells

Hypersensitivity, acute asthma attacks; does not relieve (may accelerate) bronchospasm

Terfenadine (Seldane)-PO 60 mg 2 times daily

Relief of allergic symptoms, nasal and dermatoses

Blocks the effects of histamine

Drowsiness, sedation, headache, nausea, adbdominal pain, dry mouth

Antihyperglycemics

Aplha-glucosidase inhibitor

Acarbose (Precose) 25 mg 3 x day; may be increased q4-8 weeks (range; 50-100 mg 3 X day)

Diabete

Alpha-glucosidase inhibitors/ oral hypoglycemic

Overdose signs: flatulence, diarrhea, abdominal discomfort

Biguanide

Metformin (Glucophage) 500 mg 2 x day; may increase by 500 mg to 2,000 mg/day

Diabetes

Decreases hepatic prodiction of glucose; decreases intestinal absoption of glucose

Lactic acidosis; nausea, vomiting, diarrhea, abdominal bloating

Sulfonylureas

Acelohexamide (Dymelor)-PO 200-1,500 mg qd; 1-2/days; duration 12-24 hours

Oral hypoglycemic; antidiabetic

Lowers blood glucose by stimulating insulin release from beta cells; effective only of pancreas has ability to produce insulin

Hypoglycemia(profuse sweating, hunger, headache, nausea, confusion, ataxia, coma), skins rashes, bone marrow depression, liver toxicity

Antilhyperglycemica

Chlorpropamide (Diabinese)-PO 100-500 mg maintenance; not to exceed 750 mg/day; duration 30-60 hours

See Acetohexamide

See Acetohexamide

See Acetohexamide

Glimepiride (Amaryl), glipizide (Glucotrol); 1-2 mg once daily; increase slowly up to 8 mg in one dose; 15 mg/day in divided dose

Diabetes mellitus, adult onset

Stimulate release of insulin from pancreas

Photosensivitity, hypoglycemia; ingestion of alcohol may induce reaction

Glyburide (Micronase)-PO 2.5-5 mg initially; 1.25-20 mg/day

See Acetohexamide

See Acetohexamide

See Acetohexamide

Tolazamide (Tolinase)-PO 100-500 mg; 1/day; duration 10-14 hours

See Acetohexamide

See Acetohexamide

See Acetohexamide

Tolbutamide (Orinase)-PO 500-3000 mg; 2-3/days; duration 6-12 hours

See Acetohexamide

See Acetohexamide

See Acetohexamide

Insulin-rapid acting

Crystalline zinc (Regular) (Humulin R) (clear)-onset 0.5-1.0 hour; peak 2-4 hours; duration 6-8 hours

Poorly controlled diabetes; trauma; surgery, coma

Enhances trasmembrane passage of glucose into cells; promotes carbohydrate, fat, and protein metabolism

Hypoglycemia (profuse sweating, nausea, hunger, headache, confusion, ataxia, coma) allergic reaction at injection site

Prompt insulin zinc suspension (Semilente) purified pork (cloudy)-onset 1-2 hours; peak 4-10 hourshr; duration 12-16 hours

Patients allergic to Regular; used in combination with longer-lasting insulin

See Crystalline zinc (Regular)

See Crystalline zinc (Regular)

Insulin-intermediate acting NPH insulin (isophane insulin suspension) purified pork (Humulin N⁺) (cloudy)-onset 1-2 hours; peak 5-12 hours; duration 18-24 hours

Patients who can be controlled by one dose per day

See Crystalline zinc (Regular)

See Crystalline zinc (Regular)

Antihyperglycemics

Insulin zinc suspension (Lente insulin) (cloudy)-onset 1-3 hours; peak 6-12 hours; duration 18-24 hours

Patients allergic to NPH

See Crystalline zinc (Regular)

See Crystalline zinc (Regular)

Insulin-slow acting

Extended insulin zinc suspension (Ultralente, Humulin U) purified beef (cloudy)-onset 4-8 hours; peak 12-24 hours;

Often mixed with Semilente for 24 hours curve

See Crystalline zinc (Regular)

See Crystalline zinc (Regular)

Antihypertensives

Captopril (Capoten)-PO 50 mg tid

Hypertension, heart failure

Prevents production of angiotensin II; vasodilation

Hypotension, loss of taste perception, proteinuria, rashes

Clonidine (Catapres)-PO 200-600 mcg/day; transdermal 100-300 mcg applied every 7 days

Mild to moderate hypertension; also used for epidural pain management

Stimulates alpha-adrenergic receptors in CNS

Drowsiness; dry mouth; postural hypotension

Guanadrel (Hylorel)-PO 5 mg bid (range: 20-75 mg/d)

Moderate to severe hypertension

Prevents release of norepinephrine in response to sympathetic stimulation

Confusion; fainting; fatigue; diarrhea; orthostatic hypotension; dizziness

Guanfacine hydrochloride (Tenex)-PO 1 mg daily to maximum dose of 3 mg/day

Hypertension combination with thiazide-like diuretics

Centrally acting alphaadrenergic receptor agonist

Drowsiness; weakness; dizziness; dry mouth; constipation; impotence

Guanethidine SO₄ (Ismelic)-PO 10-50 mg qd in divided doses

Severe to moderately severe hypertension

Blocks norepinephrine at post-ganglionic synapses

Orthostatic hypotension, diarrhea, inhibition of ejaculation

Hydralazine HCI (Apresoline)-PO 10-50 mg qid

Moderate hypertension

Dilates peripheral blood vessels, increases renal blood flow

Palpitations, tachycardia, angina pectoris, tremors, depression

eclampsia

Relaxes peripheral blood vessels (opens vascular bed-physiological dehydration)

Headache, heart palpitations, gastric, irritation, coronary insufficiency, edema, chills, fever, sever depression

Antihypertensives

Methyldopa (Aldomet)-PO 500mg-2 g in divided doses

Severe to moderately severe hypertension

Inhibits formation of dopamine, a precursor of norepinephrine

Initial drowsiness, depression with feelings of unreality, edema, jaundice, dry mouth

Minoxidil (Loniten)-PO 5 mg/day (range: 10-40 mg/day)

Severe hypertension, end-stage organ failure

Relaxes vascular smooth muscle

ECG changes; tachycardia; Na⁺, water retention, hypertrichosis

Phentolamine hydrochloride (Regitine)-PO 50 mg 4-6 doses daily; IV, IM. or local 5-10 mg, diluted in minimum 10 mL normal saline

Prevents dermal necrosis, hypertensive crisis; pheochromocytoma

Blocks alpha-adrenergic receptors

Weakness, dizziness, orthostatic hypotension, nausea, vomiting, abdominal pain

Prazosin (Minipress)-PO 6-15 mg/d bid or tid

Mild to moderate hypertension

Dilates arteries and veins by blocking postsynaptic alpha₁-adrenergic recptors

Dizziness, headache, weakness, palpitations; orthostatic hypotension with first dose

Reserpine (serpasil)-PO 0.25 mg qd

Mild to moderate hypertension

Depletes catecholamines and decreases peripheral vasoconstriction, heart rate, and BP

Depression, nasal stuffiness, increased gastric secretions, rash pruritus

Obstetric use: Pre-eclampsia

CNS=depressant tranquilizer; sedation is major effect; decreases neutral transmission to nerves; decreases tone in blood vessels

Low level of toxicity; weight gain; diarrhea; allergic reactions-dry mouth, itching, skin eruptions

Timolo (Timoptic)-PO 20-40 mg/day; ophthalmic 1 gtt 1-2 times/day

Hypertension, migraine, glaucoma

Blocks stimulation of myocardia l(beta₁) and pulmonary/vascular (beta₂) receptors

Fatigue, weakness, depression, insomnia, peripheral vasoconstruction, diarrhea, nausea, vomiting

Metaraminol (Aramine)-2-10 mg IM or 15-100 mg in 500 mL sodium

Adrenalectomy

Elevated systolic and diastolic BP by vasoconstriction

Hypertension, cardiac arrhythmias; may cause hypertensive crisis, if on MAO inhibitors or anti depressants

Anti-infectives

Cefazolin (ancef, Kefzol)-IM or IV 250 mg-1.5g q6-12h

Staphylococcus aureus; Escherichia coli; Klebsiella; group A and B Streptococcus; Pneumococcus

Batericidal

Allergic reaction: urticaria, rash; abnormal bleeding

Anti-infectives

Cephalexin (Keflex)-PO 1-4 g daily in 2-4 equally divided doses

Infections caused by gram-positive cocci; infections: respiratory, biliary, urinary, bone, septicemia, abdominal; surgical prophylaxis

Bactericidal effects on suspectible organisms; inhibition of bacterial cell wall synthesis

Nausea, vominting; urticaria; toxic paranoid reactions; dizziness; incread alkaline phosphatase; nephrotoxicity; bone marrow suppression

Cephalothin (Keflin, Seffin)-IM, IV 2-12 g/day in 4-6 equally divided doses

Same as cephalexin except not recommended for biliary tract infections

Same as Cephalexin

See Cephalexin

Ciprofloxacin (Cipro)-PO 250-750 mg q12h; IV 200-400 mg q12h; ophthalmic 1-2 gtt q15-30min, then 4-6 times daily

Lower respiratory tract infections; skin bone, and joint infections; UTI

Inhibits bacterial DNA synthesis

Restlessness, nausea, diarrehea, vomiting, abdominal pain

Clarithromycin (Biaxin)-7.5 mg/kg q12h; usual 500 mg q12h

Peptic ulcer

Inhibits protein synthesis of bacterial ribosome

Hypersensitivity to other antibiotics; use with caution in liver/renal impairment

Cloxacillin (Tegopen)-PO 250-500 mg q6h

Penicillinase-producing staphylococci infections: respiratory, sinus, and skin

Binds to bacterial cell wall, leading to cell death

Nausea, vomiting, diarrhea, rashes, allergic reactions, seizures (high doses)

Co-trimoxazole (bactrim, Septra)-PO 160 mg twice daily or 20 mg/kg/day for P.carinii pnuemonia

acute otitis media; urinary tract infection; shigellosis; P. carinii pneumonia; prostatitis

Bacteriostatic; anti-infective; antagonizes folic acid production; combination of sulfamethoxazole and trimethoprim

Hypersensitivity; see Sulfisoxazole

Doxycycline (vibramycin)-PO 100 mg q12h on day 1 them 100 mg/day x 7 days; IV-200 mg in 1-2 inf. on day 1; then 100-200 mg/day

chlamydia, other STDs lym disease

Inhibits bacterial protein of the 30S bacterial ribosome

Urticaria, diarrhea; nausea, vomiting; photosensitivity

Erythromycin-adults, PO 250 mg q6h; children, PO 30-50 mg/kg qd

Pnuemonia; pelvic inflammatory disease; intestinal amebiasis; ocular infections; used if allergic to penicillin

Inhibits protein synthesis of microorganism; more effective against gram-positive organisms

Abdominal cramping, distention, diarrhea

Anti-infectives

Gentamicin (Garamycin)-IM, IV 3-5 mg/kg/day in 3-4 divided doses; topical; skin, eye

Serious gram-negative infections; posssible S. aureus, uncomplicated urinary infections

Bactericidal effects on susceptible gram-positive and gram-negative organisms and my-cobacteria

Serious toxic effects: kidneys, ear; causes muscle weakness/paralysis

Metronidazole (Flagyl) 7.5 mg/kg q6h (not to exceed 4g/day)

Diverticulosis

Disrupts DNA and protein synthesis in suspecible organisms

Cimetidine may decrease metabolism; seizures, dizziness, abdominal paini

Penicillin-penicillin G, penicillin G potassium, penicillin G procaine, ampicillin 400,00-1.2 mil U g8h x 10 days, or single dose of 2.4 mil U

Streptococcus; staphylococcus; Pneumococcus; Gonococcus; Treponema pallidum

Primarily bactericidal

Dermatitis and delayed or immediate anaphylaxis

Pentamidine (Pentam)-IV 4 mg/kg once daily; inhale 300 mg via nebulizer

Prevention or treament of P. carinii pneumonia

Appears to disrupt DNA or RNA synthesis to protozoa

Anxiety, headache, bronchospasm, cough, hypotension, arrhythmias, nephrotoxicity, hypoglycemia, leukopenia, thrombocytopenia, anemia, chills

Sulfisoxazole (Gantrisin), sulfamethizole (Thiosulfil), and sulfisomidine (Elkosin)-PO 2.4 g loading dose, then 1-2 g qid x 7-10 days

Acute, chronic, and recurrent urinary tract infections

Bacteriostatic and bactericidal

Nausea, vomiting, oliguria, anuria, anemia, leukopenia, dizziness, jaundice, skin rashes, and photosensitivity

Tetracycline-doxycycline hyclate (Vibramycin), oxytetracycline (terramycin) tetracycline HCI (Sumycin)-PO 250-500 mg q6h; IM 250 mg/day; or IV 250-500 mg q8-12h

Broad-spectrum antibiotic

Primarily bateriostatic

GI upsets such as diarrhea, nausea, vomiting; sore throat; black, hairt tounge; glossitis; inflammatory lesions in anogenital region

Trimethoprim (TMP)/sulfamethoxazole (SMZ) (Bactrim)-PO 160 mg TMP or 800 mg SMZ q12h for 14-21 days; IV 8-10 mg/kg TMP/40-50 mg/kg SMZ q6-12h

Bronchitis, shigella enteritis, otitis media, P. carinii pneumonia, UTI, traveler's diarrhea

Combination inhibits the metabolism of folic acid in bacteria; bactericidal

Nausea, vomiting, rasher, phlebitis at IV site, aplastic anemia, hepatic cerosis

Anti-Inflamatory

Gastrointestinal

Mesalamine (Asacol, Pentusa, Rowasa)-800 mg 3 X day for 6 weeks

Local-acting antiinflammatory in GI tract

Contraindicated if patient has allergy to sulfonamides or salicylates; acceleration of symptoms; abdominal pain

See Mesalamine

See Mesalamine

See Mesalamine

Sulfasalazine (Azulifidine)-see mesalamine-PO 3-4 g/day in divided doses

See Mesalamine

See Mesalamine

See Mesalamine

Glucocorticoids-inhalants Bedomethasone (Beclovent, Vanceril)-42-50 p.g/spray; 2 metered sprays 3-4 X day

Emphysema

Glucocorticoid (inhalation)

Headache, hypersensitivity to fluorocarbon propellant; used with caution in diabetes or glaucoma

Plunisolide (AeroBid) 42-50 pg/spray; 2 metered sprays 2-4/days

Emphysema

Potent locally acting anti-inflammatory and immune modifier

Headache, dysphonia, fungal infections; adrenal suppression with long-term use

Tïiaminolone (Azmacort)-See Bedomethasone

Asthma

See Bedomethasone

See Bedomethasone

Glucocorticoids-systemic

Cortisone acetate-PO or IM 20-100 mg qd in single or divided doses

ACTH insufficiency; rheumatoid arthritis; allergies; ulcerative colitis; nephrosis

Anti-inflammatory effect of unknown action

Moon facies, hirsutismm, thinning of skin, striae, hypertension, menstrual irregularities, delayed healing, psychoses

Desoxycorticosterone acetate ( hydrocortisone)-IM/IV 100-500 mg q2-6h; PO 3-5 mg bid qid

Addison s disease; burns; surgical shock; adrenal surgery

Promotes reabsorption of sodium; restores plasma volume, BP, and electrolyte balance

Edema, hypertension, pulmonary congestion, hypokalemia

Dexamelhasone (Decadron)-PO 0.5-5.0 mg qd; IM or IV 4-20 mg qd

Addison’s disease; allergic reactions; leukemia; Hodgkin's disease; iritis; dermatitis; rheumatoid arthritis

Anti-inflammatory effect

See Cortisone acetate

Glucocorticoid, corticosteroid

See Dexamethasone

See Dexamethasone

Prednisolone (Deltsone)-5-60 mg/day single or divided dose

Multiple sclerosis

Suppress inflammation and normal immune response

Depression, euphoria, peptic ulceration; thromboembolism

Prednisone-PO 2.5-15.0 mg qd

Rheumatoid arthritis; cancer therapy

Anti-inflammatory effect of unknown action

Insomnia and gastric distress

Antilipemics

Cholestyramine (Questran)-PO 4 g 1-4 times/day

Hypercholesterolemia; pruritus from increased bile

Binds bile acids in GI tract, increased clearance of cholesterol

Nausea, constipation, abdominal discomfort

Gemfibrozil (Lopid)-PO 1200 mg/day

Hypercnoiesteroiemia

May inhibit peripheral lipolysis and reduce triglyceride synthesis in liver

GI upset (abdominal pain, epigastric pain, diarrhea, nausea, vomiting), rash, vision

Lovastatin (Mevacor)-PO 20-80 mg daily with evening meal

Primary hypercholesterolemia

Inhibits enzyme that catalyzes synthesis of cholesterol; decreases synthesis of LDL

Headache, constipation, diarrhea, altered taste, blurred vision, muscle cramps

Niacin (vitamin B„ nicotinic acid)-PO 1.5-6.0 g

Hypercholesterolemia

Decreases liver’s production of LDLs and synthesis of triglycerides

GI upset, flushing, pruritus, hy-

Simvastatin (Zocor)-10-20 mg qd

See Lovastatin

See Lovastatin

See Lovastatin

Antineoplastics

6 mercaptopurine

(Purinethol)-PO 2.5 mg/kg/day; may increase to 5 mg/kg after 4 weeks; maintenance 1.5-2.5 mg/kg/day

Leukemia (ulcerative)

Antineoplastic

Bone marrow depression, severe hepatotoxicity

Methotrexate (Rheumatrex)

15-30 mg/day for 5 days; repeat after 1 week for 3-5 courses

Leukemia

Breast, lung cancer

Interferes with folic acid metabolism, resulting in inhibition of DNA synthesis and cell reproduction

Pulmonary fibrosis, hepatotoxicity, stomatitis, signs and symptoms of chemotherapy side effects

Mitotane (Lysodren) 9-10 g/day in 3-4 divided doses initially; decrease for maintenance

Adrenocortical carcinoma

Affects pituitary disorders

GI complaints; lethargy, somnolence

Antiparkinson Agents

Benztropine (Cogentin)-1-2 mg/day (range: 0.5-6 mg/day)

Parkinson’s disease

Blocks cholinergic activity in CNS

Blurred vision, dry eyes; constipation; caution with antihistamines, phenothiazines

Carbidopà/levodopa (Sinemet)-10/100,25/100, 25/250 carbidopa/levodopa ratio

Parkinson’s disease

Levodopa is converted to dopamine in CNS, where it serves as a neurotransmitter

Use with MAO inhibitors; may result in hypertensive crisis; some drugs can reverse effects, e.g., phenothiazines, reserpine

Biperiden (Akineton)-2 mg 3-4X/day; not to exceed 16 mg/day

Parkinson’s disease

Restores natural balance of neurotransmitters in CNS

Same as Benztropine (Cogentin)

Trihexyphenidyl (Artane)-1-2 mg daily; usual maintenance dose: 5-15 mg/day in divided dose

Parkinson’s disease

Inhibits action of acetylcholine

Antiplatelet

Clopidogrel (Plavix)-PO 75 mg qd

Reduce risk of atherosclerotic event (Ml, stroke)

Inhibits platelet aggregation

Bleeding; neutropenia; reactions similar to aspirin

Dipyridamole (Persantine)-PO 70-100 mg 4 times/day; IV 570 p.g/kg

Prevent thromboembolism;

surgical graft patency; diagnostic agent in myocardial perfusion studies

Decreases platelet aggregation; coronary vasodilator

Headache, dizziness, hypotension, nausea; MI, arrhythmias with IV

Tidopidine (Tidid)-PO 250

Stroke prevention; prevent early restenosis of coronary stents

Inhibits platelet aggregation; prolongs bleeding time

Diarrhea, rashes, bleeding, intracerebral bleeding

Antituberculous

First-line drugs

Isoniazid-5-10 mg/kg up to 300 mg PO or IM

Tuberculosis

Supress or interferes with biosynthesis; bacteriostatic

Peripheral neuritis, hepatitis, hypersensitivity

Ethambutol-15-25 mg/kg PO

See Isoniazid

See Isoniazid

Optic neuritis (reversible with discontinuation of drug; very rare at 15 mg/kg); skin rash

Rifamate combination (isoniazid with rifampin)

Rifater combination (isoniazid and pyrazinamide with rifampin)-see Rifampin

See Rifampin

See Rifampin

See Rifampin

Rifampin-10-20 mg/kg PO mg IV

tuberculosis, meningitis, H. influenzae

Impairs RNA synthesis; bactericidal

Hepatitis, febrile reaction, purpura (rare)

Streptomycin-15-20 mg/kg up to 1 g IM

Tuberculosis, endocarditis, tularemia

Inhibits protein synthesis;

bactericidal

Eighth cranial nerve damage, nephrotoxicity

Pyrazinamide-15-30 mg/kg up to 3 g PO

Tuberculosis

Bactericidal

Hyperuricemia, hepatotoxicity

Antiulcer

Aluminum hydroxide gel (Amphojel)-PO 5-10 mL q2-4h or 1 hour pc

Gastric acidity; peptic ulcer; phosphatic urinary calculi; J. phosphorus level in chronic renal failure

Buffers HCI in gastric juices without interfering with electrolyte balance

Constipation and fecal im-

Calcium carbonate

(Titralac)-PO 1-2 g taken with H,O after meals and at bedtime

Peptic ulcer and chronic

Reduces hyperacidity

Constipation or laxative effect

Cimetidine (Tagamet)-PO 300-600 mg q6h (qid); IM, IV 300 mg q6h

Duodenal ulcers, GERD, gastric hypersecretion; peptic acid gastritis, heart burn; esophagitis

Inhibits action of histamine at PL-receptor site, inhibits gastric acid secretion; neutralizes and absorbs excess acid

Confusion, dizziness; nausea; rash; diarrhea, constipation; hypermagnesemia

Cisapride (Propulsid)-5-10 mg 3-4X/day

Peptic ulcer

Enhances the release of acetylcholine at the myenteric plexus

Anticholinergics will decrease effects; effects of alcohol accelerated

Famotidine (Pepcid)-40 mg/day at bedtime or 20mg twice a day

Peptic ulcer

Inhibits gastric acid secretion by inhibiting histamine at H,-receptor site

Use with caution: elderly, renal failure; confusion, arrhythmias, aranugloctosis, aspaltic anemia

Lansoprazole (Prevacid)-15 mg/day; with H. pylori: 30 mg twice a day with amoxicillin

Peptic ulcer

Binds to an enzyme in presence of gastric acid; prevents final transport of hydrogen ions into gastric lumen

Hypersensitivity; use with caution in elderly; dose change needed with hepatic impairment

Magnesium and aluminum hydroxides (Maalox suspension)-PO 5-30 mL ql-3h pc and hs

Gastric hyperacidity; peptic ulcer; heartburn; reflux esophagitis

Neutralizes and binds gastric acids, heals ulcers

Constipation from aluminum hydroxide; diarrhea from magnesium hydroxide

Misoprostol (Cytotec) 200 mcg 4 X day

Peptic ulcer

Prostaglandin analogue

Hypersensitivity to prostaglandins; diarrhea; avoid during pregnancy

Nizatidine (Axid) see cimetidine

See Cimetidine

See Cimetidine

See Cimetidine

Omeprazole (Prilosec) 20 mg once daily

Peptic ulcer GERD

Gastric acid-pump inhibitor

Abdominal pain; contraindicated: hypersensitivity

Ranitidine (Zantac)-PO 150mg bid; IM 50 mg q6-8h; IV 50 mg q6-8h

Duodenal ulcer, gastric ulcer, GERD, gastric hyper secretion

Inhibits action of histamine at H.-receptor site, inhibits gastric acid secretion

Headache, malaise, nausea, constipation, diarrhea

Sucralfate (Carafate)-PO 1 g qid

Prevention and treatment of duodenal ulcer

Reacts with gastric acid to form a thick paste that adheres to the ulcer surface

Constipation

Antiviral

Acyclovir (Zovirax)-PO 200 mg, 3-5 times/day; IV 5 mg/kg q8h over 1 hour; topical 6 times daily for 1 week

Herpes simplex (1,2)

Converts to an active cytotoxic metabolite that inhibits viral DNA replication

Headache, nausea, vomitin diarrhea, increased serum BUN and creatinine

Indinavir (Crixivan)-PO 800 mg q8h

HIV; possible prevention in combination therapy

Inhibits action of HIV protease and cleavage of viral polyproteins

Ketoacidosis; kidney stones; hyperglycemia; altered taste; acid regurgitation

Nevirapine (Viramune)-PO200 mg qd for 2 weeks, then bid

HIV; delays disease progression

Binds to the enzyme reverse transcriptase; disrupts DNA synthesis

Rash; Stevens-Johnson syndrome (severe erythema multiforme)

Zidovudine (AZT, Retrovir)- PO 200 mg q4h

AIDS and related disorders

Inhibits HIV replication

Blood disorders, especially anemia and granulocytopenia; headache; nausea; insomnia; myalgia

Blood Viscosity-Reducing Agent

Pentoxifylline (Trental)-PO 400 mg tid

Peripheral vascular disease (intermittent claudication)

Increases flexibility of RBCs; inhibits platelet aggregation

Nausea, vomiting, GI upset; drowsiness; dizziness; headache

Bronchodilators

Albuterol (Ventolin)-PO 2-6 mg 3-4 times/day; inhale q4-6h or 2 puffs 15 minutes before exercise

Bronchodilator

Results in accumulation of cyclic adenosine monophosphate (cAMP) at betaadrenergic receptors

Nervousness, restlessness, tremor, hypertension, nausea

Aminophylline-PO 250 mg bid-qid: rectal 250-500 mg; IV 250-500 mg over 10-20 minutes

Rapid relief of bronchospasm; asthma; pulmonary edema

Relaxes smooth muscles and increases cardiac contractility; interferes with reabsorption of Na’ and Cl’ in proximal tubules

Nausea, vomiting, cardiac arrhythmias, intestinal bleeding, insomnia, restlessness, and rectal irritation from suppository

Ephedrine SO₄-PO, SC, or IM 25 mg tid-qid

Asthma: allergies; bradycardia; nasal decongestant

Relaxes hypertonic muscles in bronchioles and GI tract

Wakefulness, nervousness, dizziness, palpitations, hypertension

Ipratropium (Atrovent) 1-4 inhalations

Emphysema

Inhibits cholinergic receptors in bronchial smooth muscle

Nasal dryness, epistaxis; fluorocarbon toxicity when used with other inhalants

Isoproterenol HC1 (Isuprel)-inhalation of 1:100 or 1:200 solution

Mild to moderately severe asthma attack; bronchitis; pulmonary emphysema

Relaxes hypertonic bronchioles

Nervousness, tachycardia, hypertension, insomnia

Bronchodilators

Metaproterenol (Alupent) 20 mg 3-4 times/day; ininhalations

Asthma

Bronchodilation

Nervousness, restlessness, tremor, paradoxical bronchospasm

Salmeterol (Serevent)-50 pg twice a day (two inhalations)

Asthma

Produces accumulation of cAMP al beta-adrenergic receptors

Headache, palpitations, abdominal pain; avoid when using beta-adrenergic agents (decreases effectiveness)

Theophylline-PO 400 mg/day in divided doses; max adult dose. 900 mg divided dose

Treatment/prevention of em-Bronchodilation physema, asthma (bronchoconstriction); chronic bronchitis

Bronchodilation

Restlessness; increased respiration, heart rate; palpitations, arrhythmias; nausea, vomiting; increased urine output-> dehydration

Terbutaline (Brethine)-PO 2.5-5.0 mg q6h (not to exceed 20 mg/24 hours); SC 0,25 mg, repeat 15-30 minutes (not to exceed 0.5 mg/hour); inhalation-2 puffs (0.2 mg each) q4-6h

Bronchospasm

Obstetric use: may be used for premature labor; currently not FDA approved for use as tocolytic agent, but used

See Isoproterenol

See Isoproterenol

If used in pregnancy: maternal and fetal tachycardia

Zafirlukast (Accolate)-20 mg twice daily

Asthma

Antagonizes the effects of leukotrienes

Headache, fever, infection, pain

Zileuton (Zyflo)-600mg qid

Asthma

Enzyme inhibitor

Headache, fever, infection, chest pain increases blood level of theophylline, propranolol, warfarin

Calcium Channel Blockers

Amlodipine (Norvasc)-PO 5-10 mg qd

Hypertension, angina pectoris, vasospastic angina (Prinzmetal’s), muscle cells

Inhibits the transport of calcium into myocardial and vascular smooth muscle

Arrhythmias, peripheral edema, heart failure, photosensitivity, gingival hyperplasia

Dilitiazem (Cardizem)-PO 30-120 mg 3-4 times/dat; IV 5-15 mg/hours

Angina, hypertension, artial arrhythmias

Inhiabits excitation-contraction; decreased SA, AV node conduction

Headache, fatigue, arrhythmias, edema, hypotension, constipation, rash

Metoprolol (Lopressor)-100 mg/day up to 450 mg/day

Hypertension

Blocks stimulation of myocardial adrenergic receptors (beta,)

Contraindictated in CFG, pulmonary edema; caution with renal impairment

Nicardipine (Cardene)-PO 20-40 mg tid

Angina, hypertension

Calcium channel blocker, inhibits excitation-contraction

Dizziness, light-headedness, headache, peripheral edema, flushing

Nifedipine (Procardia)-PO 10-30 mg tid (not to exceed 180 mg/day); sublingual 10 mg repeated in 15 minutes

Angina, hypertension

Obstetric use: may be used for premature labor. Currently not FDA approved for use as tocolytic agent

Calcium channel blocker, vasodilation

Dizziness, light-headedness, giddiness, headache, nervousness, nasal congestion, sore throat, dyspnea, cough, wheezing, nausea, flushing, warmth

Verapamil (Calan, Isopten)-PO 240-480 mg, 3-4 limes/day; IV 75-150 pg/kg

Angina; supraventricular arrhythmias; essential hypertension

Inhibits calcium movement into smooth-muscle cells; lowers pressure by reducing cardiac contractility

Constipation, AV block, hepatotoxicity

Cardiac Glycosides

Digitoxin-digitalizing dose: PO 200 pg twice/day; IM or IV 200-400 pg; maintenance dose: PO 50-300 pg qd

Heart failure: atrial fibrillation and flutter; supraventricular tachycardia

Increases force of cardiac contractility, slows heart rate, decreases right atrial pressures, promotes diuresis

Arrhythmias; nausea, vomiting; anorexia, malaise; color vision, yellow or blue

Digoxin (Lanoxin)-digitalizing dose: PO 10-J 5 pg/kg; IV 0.6-1 mg/kg; maintenance dose: PO 0.125-0.375 mg qd

See Digitoxin

See Digitoxin

See Digitoxin

Chemotherapy (see Tables 7-41 and Antineoplastica 10-8)

Cholinergic

Bethanechol chloride (Urecholine)--PO 5-30 mg; SC 2.5-5.0mg

Postoperative abdominal atony and distention; bladder atony with retention; postsurgical or postpartum urinary retention; myasthenia gravis

Increases GI and bladder tone; decreases sphincter tone

Belching, abdominal cramps, diarrhea, nausea, vomiting, incontinence, profuse sweating, salivation, respiratory depression

Edrophonium (Tensilon)-IV 2 mg; IM 10 mg

Diagnosis of myasthenia gravis; reversal of neuromuscular blockers

Inhibits breakdown of acetylcholine; anticholinesterase, cholinergic

Excess secretions, bronchospasm, bradycardia, abdominal cramps, vomiting, diarrhea, excess salivation, sweating

Neostigmine (Prostigmin)-PO 15-30 mg q3-4h; SC, IM 0.25-1 mg

Myasthenia gravis, postoperative bladder distention, urinary retention, reversal of neuromuscular blockers

Inhibits breakdown of acetylcholine; cholinergic

Excess secretions, bronchospasm, bradycardia, abdominal cramps, vomiting, diarrhea, excess salivation, sweating

Pilocarpine HCI-1-2 gtts 1-2% solution up to 6 times/days

Chronic open-angle and acute closed angle glaucome

Contraction of the sphincter muscle of iris, resulting in miosis

Brow ache, headache, occular pain, blurring and dimness of vision, allergic conjunctivitis, nausea, vomiting, profuse sweating; bronchoconstriction in patients with bronchial asthma

Physostigmine salicylate (Eserine)-0.1 mL of 0.25-10% solution: not more than qid; IM, IV 0.5-3 mg

Glaucoma, reverse effects of tricyclic antidepressants, overdose, toxic effects of atropine and diazepam

Increases concentration of acetylcholine

Sweating, marked miosis, lacrimation, nausea, diarrhea

Pyridostigmine (Mestinon)-PO 60 mg/day X 3 days; IM, IV 2 mg q2-3h Maintenance: 60-150 mg/day

Myasthenia gravis, reversal of neuromuscular blockers

Inhibits breakdown of acetylcholine and prolongs its effects

See Neostigmine

Central Nervous System Stimulants

Amphetamine SO₄-PO 5-60 mg qd in divided doses

Mild depressive states; narcolepsy; postencephalitic parkinsonism; obesity control; minimal brain dysfunction in children (attention deficit disorder)

Raises BP, decreases sense of fatigue, elevates mood

Restlessness, dizziness, tremors, insomnia; increased libido; suicidal and homicidal tendencies; palpitations; anginal

Methylphenidate hydrochloride (Ritalin)-PO 0.3 mg/kg/day or adults 20-60 mg in divided doses

Childhood hyperactivity; narcolepsy; attention deficit disorder in children

Mild CNS and respiratory stimulation

Anorexia, dizziness, drowsiness, insomnia, nervousness, BP and pulse changes

Decongestants

Phenylephrine (NeoSynephrine, Sinex)-SC, IM

2-5 mg q!0-15min not to exceed 5 mg; IV 40-60 pg/minutes; nasal 2-3 gtts or 1-2 sprays q3-4h; ophthalmic 3 gtt/day

Shock, hypotension, decongestant, adjunct to spinal anesthesia, mydriatic

Constricts blood vessels by stimulating alpha-adrenergic receptors

Dizziness restlesness, dyspnea, tachycardia, arrhythmias; ophthalmological: burning, photophobia, tearing

Pseudoephedrine (Sudafed)-PO 60 mg q4~6h

Nasal congestion, allergies, chronic ear infections

Produces vasoconstriction in respiratory tract and possibly bronchodilation

Nervousness, anxiety, palpitations, anorexia

Diuretics

Acetazolamide (Diamox)-PO 250-1000 mg/day; IV 500 mg

Glaucoma; heart failure; convulsive disorders

Weak diuretic; produces acidosis; self-limiting effect; increases bicarbonate excretion

Electrolyte depletion symptomatalogy-lassitude, apathy, decreased urinary output, mental confusion

Ethacrynic acid (Edecrin)-PO 50-200 mg qd in divided

Pulmonary edema; ascites; edema of heart failure

Inhibits the reabsorption of Na' in the ascending loop of Henle

Nausea, vomiting, diarrhea, hypokalemia, hypotension, gout, dehydration, deafness, metabolic acidosis

Furosemide (Lasix)-PO 40-80 mg qd in divided

Edema and associated heart failure; cirrhosis; renal disease; nephrotic syndrome: hypertension

Inhibits Na* and Cl* reabsorption in the loop of Henle

Dermatitis, pruritis, paresthesia, blurring of vision, postural hypotension, nausea, vomiting, diarrhea, dehydration, electrolyte depletion, hearing loss (usually reversible)

Hydrochlorothiazide (HydroDlURIL and Esidrix 25-100 mg tid)-PO Diuril 0.5-1.0 qd

Edema; heart failure; Na* retention in steroid therapy; hypertension

Inhibits NaCI and water reabsorption in the distal ascending loop and the distal convoluted tubule of the kidneys

Hypokalemia, nausea, vomiting, diarrhea, dizziness, paresthesias; may exacerbate diabetes

Mannitol (Osmitrol)-50-100 gm/24 hours as 15-20% solution

Cerebral edema, oliguria, acute renal failure, drug intoxication

Hypertonic solution that kidney tubules cannot reabsorb. thereby causing obligatory water loss

Diarrhea; water intoxication, thirst, headache

Spironolactone (Aldactone)-PO 25 mg bid-qid

Cirrhosis of liver; when other diuretics are ineffective

Inhibits effects of aldosterone in distal tubules of kidney

Headache, lethargy, diarrhea, ataxia, skin rash, gynecomastia

Emetic

Ipecac syrup-PO 15-30 mL for emesis, followed by 1-2 glasses H₂O (adults and children > 1 year); 5-10 mL followed by 1/2-1 glass H₂0 (children < 1 year)

Emergency emetic for poison ingestion

NH, ions cause gastric irritatom

Violent emesis, tachycardia, decreased BP, dyspnea

Enzyme

Pancrelipase (Viokase)-adults, PO 325 mg-1 g qd, during meals; children, PO 300-600 mg lid

Chronic pancreatitis; cystic fibrosis; gastrectomy; pancreatectomy; sprue

Assists in digestion of starch, protien, and fats; decreases nitrogen and fat content of stool

Anorexia, nausea, vomiting, diarrhea, buccal/anal soreness (infants), sneezing, skin rashes, diabetes

Expectorats

Guaifenesin (Robitussin)-100-400 mg q4h

Respiratory congestion

Increases expectoration by Low incidence of GI upset; causing irritation of gastric muscoa; reduce adhesiveness/surface tension of respiratory tract fluid

Low incidence of GI upset; drowsiness

Terpin hydrate-PO 5-10 mL, q3-4h

Bronchitis; emphysema>

Liquefies bronchial secretions

Nausea, vomiting, gastric irritation

Fibrinolytic Agents

Alteplase, recombinant (Activase, tPA)-IV bolus 100 mg given over 1-2 minutes; then 50 mg over 30 minutes; 35mg over 60min

Acute MI; under investigation for pulmonary emboli, deep-vein thrombosis, and peripheral artery thrombosis

Promotes conversion of plasminogen to plasmin, which is fibrinolytic

Internal or local bleeding; urticaria; dysrhythmias related to reperfusion; hypotension; nausea, vomiting

Streptokinase-IV 1.5 million U diluted to 45 mL infused over 60 minutes

Lysis of pulmonary or systemic emboli or thrombi; acute MI

Reacts with plasminogen, dissolves fibrin clots

Prolonged coagulation; allergic reactions; mild fever

Urokinase-IV 4400 lU/kg over 10min; 1.0-1.8 mL of 5000 lU/mL into catheter

Massive pulmonary emboli, coronary artery thrombi, occluded IV catheter

Directly activates plasminogen

Bleeding, anaphylaxis, rash

Fibrinolytic Antidote

Aminocaproic acid (Amicar)-PO, IV 5 g loading dose; 1 g/hour to 30 g in 24 hours

Management of streptokinase or urokinase overdose

Inhibits plasminogen activator and atagonize plasmin

Hypotension, bradycardia, cardiac arrhythmias

Hormones

Chlorotrianisene (TACE), estrogen-PO 12-50 mg

Prostatic cancer; menopause

Nonsteroidal synthetic estrogen

Rare after one course of treatment; thromboembolism; impotence and gynecomastia in men

Diethylstilbestrol (DES)-PO or IM 0.2-5.0 mg qd; vaginal suppository 0.1-0.5 mg at bedtime

Prostate carcinoma;

menopausal symptoms; osteoporosis; pain; mammary carcinoma; atrophic vaginitis

Synthetic nonsteroidal compound with estrogenic effects on pituitary, ovaries, myometrium, endometrium, and other tissues

Anorexia, nausea, vomiting. headache, diarrhea, dizziness, fainting-many side effects with long-term use

Estradiol-PO 1-2 mg for replacement therapy; up to 10 mg for cancer qd-tid; cyclic (on 3 weeks, off 1 week)

Menopausal symptoms; osteoporosis; hypogenitalism; sexual infantilism; breast and prostatic carcinoma

Inhibits release of pituitary gonadotropins; promotes growth of female genital tissues

Anorexia, nausea, vomiting, diarrhea, fluid retention, mental depression, headache, thromboembolism; feminization in men

Medroxyprogesterone (Provera)-PO 2.5-10.0 mg; IM 400-1000 mg weekly

Amenorrhea; functional uterine bleeding; threatened abortion; dysmenorrhea; adjunctive and palliative with renal cancer and endometriosis; PMS

Similar to progesterone, but can be taken orally; thickens uterine decidua

Drowsiness, cyclic menstrual withdrawal bleeding, GI upset, headache, edema, breast congestion

Menotropins (Pergonal)-IM 1 amp (FSH + LH)/day for 9-12 days (followed by 5000-10,000 U HCG, if ovulation does not occur, repeat with 2 amp)

Infertility use: treatment of secondary anovulation; stimulation of spermatogenesis

Human gonadatropic responses; induces ovulation; sperm stimulation

Abortions occur in 25%; failure rate 55-80% of patients; possible multiple births; ovarian enlargement; gynecomastia in men

Progesterone-SC or IM 5-10 mg qd; sublingual 5-10 mg

Amenorrhea; dysmenorrhea; endometriosis; habitual abortion

Converts endometrium into secreting structure; prevents of mammary tissue

Nausea, vomiting, dizziness, edema, headache, protein metabolism

Testosterone-PO 5-10 mg qd; IM 25-50 mg 2-3 times/weeks; 200-400 mg IM q2-4wk for breast cancer

Hypogonadism; eunuchism; impotence; advanced cancer of breast

Growth of sex organs and appearance of secondary male sex characteristics; counteracts excessive amounts of estrogen

Nausea, dyspepsia, masculinization, hypercalcemia, menstrual irregularities, renal calculi; Na⁺, K⁺, and H₂O retention

Vasopressin (Pitressin)-IM/SC 5-10 |x bid/qid; IM/SC 2.5-5 p. q2-3d for chronic therapy

Diabetes insipidus

Antidiuretic

Nausea, flatus, tremor, pounding in head, water intoxication

Immune Modifiers

Glatiramer acetate (Copaxone)-20 mg/day

Multiple sclerosis

Management of relapsingremitting MS

Allergic reactions, anxiety, chest pain, weight gain, cough

Interferon p-lb (Betaseron)-30 p.g once a week

Multiple sclerosis

Reduce incidence of relapse

Seizures, GI symptoms, flulike symptoms, neutropenia, injection site reactions

Immunosuppressant Agents

Azathioprine (Imuran)-3-5 mg/kg/day initially; maintenance: 1-3 mg/kg/day

Prevent renal transplant rejection

Ulcerative colitis

Rheumatoid arthritis

Antagonizes purine metabolism/inhibition ofDNA/RNA synthesis

Hypersensitivity; additive myelosuppression with antineoplasties; hepatotoxicity, leukopenia

Cyclosporine (Sandimmune)-PO 5-10 mg/kg several hours before surgery; daily for 2 weeks; reduce dosage by 2.5 mg/kg/week to 5-10 mg/kg/day. IV 5-6 mg/kg several hours before surgery daily; switch to PO form as soon as possible

Prevent organ rejection Ulcerative colitis Rheumatoid arthritis

Inhibits interleukin-2, which is necessary for initiation of T-cell activity

Hypersensitivity; caution with alcohol, renal impairment

Muromonab-CD3 (Orthoclone OKT3)-IV 5 mg/day, 10-14 days

Renal, liver, or cardiac transplant rejection

Immunosuppression of T-cell function

Tremor; dyspnea, shortness of breath; wheezing; chest pains; diarrhea; nausea, vomiting; chills, fever

Mycophenolate (CellCept)-PO 1 g bid

Prevent renal transplant rejection

Inhibits purine synthesis; sup-Diarrhea; vomiting; leukopenia; presses T and B lymphocytes

Diarrhea; vomiting; leukopenmia; sepsis

Tracrolimus-PO 0.075-0.15 mg/kg ql2h; IV 0.05-0.1 mg/kg/day

Prevent rejection in liver transplant

Inhibits T-lymphocyte activation

Headache, insomnia, tremor, ascites, hypertension, peripheral edema, abdominal pain, rash, hyperglycemia, anemia

Mineralocorticoid Agent

Fludrocortisone (Florinef)-PO 0.1-0.2 mg qd

Addison’s

Causes sodium reabsorption, hydrogen and potassium excretion, and water retention

Heart failure; adrenal suppression, hypertension

Mucolytic Agent

Acetylcysteine (Mucomysl)-1-5 mL of 20% solution or 1-10 mL of 10% solution per nebulizer tid

Emphysema; pneumonia; tracheostomy care; atelectasis; cystic fibrosis

Lowers viscosity of respiratory secretions by opening disulfide linkages in mucus

Stomatitis, nausea, rhinorrhea, bronchospasm

Muscle Relaxants

Baclofen (Lioresal)-5 mg tid up to 10-20 mg 4 times/day maintenance dose

Relief of spasticity of multiple sclerosis, spinal cord injury

Centrally acting skeletal-muscle relaxant; depresses polysynaptic afferent reflex activity at spinal cord level

Pruritis, tinnitus; nausea, vomiting; diarrhea or constipation; drowsiness

Dantrolene sodium (Dantrium)-25 mg/day to 25 mg bid-tid to 100 mg qid max

See Baclofen

See Baclofen

See Baclofen

Narcotic Antagonist

Naloxone HC1 (Narcan)-IV 0.1-0.2 mg repeated q2-3 minutes p.r.n up to 0.4-2 mg for narcotic-induced respiratory depression

Reverses respiratory depression due to narcotics

Reverses respiratory depression of morphine SO₄, meperidine HC1, and methadone HC1; does not itself cause respiratory depression, sedation, or analgesia

No common side effects; tachycardia, hypertension, nausea and vomiting with high

Sedatives and Hypnotics

Chlordiazepoxide HCI (Librium)-PO 5-10 mg; IM or IV 50-100 mg

Psychoneuroses; preoperative apprehension; chronic alcoholism; anxiety

CNS depressant resulting in mild sedation; appetite stimulant; anticonvulsant

Ataxia, fatigue, blurred vision, diplopia, lethargy, nightmares, confusion

Chloral hydrate-PO 250 mg tid; hypnotic: PO 0.5-1.0 g; rectal supplement 0.3-0.9 g

Sedation for elderly; delirium tremens; pruritus; mania; barbiturate and alcohol withdrawal

Depresses sensorimotor areas of cerebral cortex

Nausea, vomiting, gastritis; pinpoint pupils; delirium; rash; decreased BP, pulse, respirations, temperature; hepatic damage

Diazepam (Valium)-PO 2-10 mg tid-qid; IM or IV 2-10 mgq3-4h

Anxiety disorders; alcohol withdrawal; adjunctive therpreoperative or preprocedural sedation (also see Midazolam)

Induces calming effect on limbic system, thalamus, and hypothalamus

CNS depression-sedation or ataxia (dose related); dry mouth; blurred vision; mydriasis; constipation; urinary retenstion

Flurazepam (Dalmane)-PO > 15 years, 30 mg hs; elderly or debilitated, 15 mg hs

Hypnotic

Fastest acting; see Diazepam

See Diazepam

Hydroxyzine pamoate (Vistaril)-PO 25-100 mg qid

See Chlordiazepoxide (Librium); antiemetic in postoperative conditions; adjunctive therapy

CNS relaxant with sedative effect on limbic system and thalamus

Drowsiness, headache, itching, dry mouth, tremor

Lorazepam (Ativan)-PO 1-2 mg bid-tid (up to 10 mg); 2-4 mg hs; IM 4 mg max; IV 2 mg max

Anxiety disorders; insomnia; alternative to diazepam for status epilepticus preanesthesia

See Diazepam

See Diazepam

Meprobamate (Equanil, Miltown)-PO 400 mg tid-qid

Anxiety; stress; absence seizures

See Hydroxyzine pamoate (Vistaril)

Voracious appetite, dryness of mouth, ataxia

Midazolam (Versed)-IM 0.05-0.08 mg/kg; IV 0.1-0.15 mg/kg

Preanesthesia; prediagnostic procedures; induction of general anesthesia

Penetrates blood-brain barrier to produce sedation and amnesia

Respiratory depression, apnea, disorientalion, behavioral excitement

Phenobarbital-sedative, PO 20-30 mg tid; hypnotic, PO 50-100 mg; IV or IM 100-300 mg; butabarbital (Butisol), pentobarbital (Nembutal), secobarbital (Seconal)

Preoperative sedation; emergency control of convulsions; absence seizures

Depresses CNS, promoting drowsiness

Cough, hiccups, restlessness, pain, hangover; CNS and circulatory depression

Promethazine (Phenergan)-IV, IM, PO 25-50 mg

Preoperative sedation; postoperative sedation

Antihistaminic; sedative, antiemetic, anti-motion sickness

Drowsiness; coma; hypotension, hypertension; leukopenia; photosensitivity; irregular respirations; blurred vision; urinary retention; dry mouth, nose, throat

Serum

Immune globulin-IM 0.02 mL/kg

Hepatitis

Provides passive immunity

Do not use if patient is hypersensitive

Thyroid Hormone Inhibitors

Lugol's solution-PO 2-6 drops tid 10 days before thyroidectomy

To reduce size, vascularity of thyroid before thyroidsurgery; emergency treatment of thyroid storm; or control of hyperthyroid symptoms after radioiodine (¹³¹I) therapy

Inhibits thyroid hormone secretion, synthesis

GI distress; stained teeth; increased respiratory secretions; rashes, acne

Propylthiouracil-PO 300-400 mg/day, divided initial dose; 100-150 mg/day maintenance dose; methimazole (Tapazole) 15-60 mg/day initial dose; 5-15 mg/day maintenance dose

Hyperthyroidism; return patient to euthyroid state; also used preoperatively

Inhibits functional thyriod hormone synthesis by blocking reactions; responsible for iodide conversion to iodine; inhibition of T₄ conversion to T₃

Blood dyscrasias, hepatotoxicity, hypothyroidism

Saturated potassium iodide See Lugol’s solution (SSKI)-300 mg tid-qid

See Lugol’s solution

See Lugol’s solution

See Lugol’s solution

Thyroid Hormone Replacement

Levothyroxine (Levothroid, Synthroid)-PO 0.05-0.10 mg/day; IV 200-500 p.g

Hypothyroidism

Myxedema coma

Replacement therapy to alleviate symptoms

Emergency replacement therapy

Symptoms of hyperthyroidism

Liothyronine (Cytomel)-PO 25 ug/day to maintenance dose 25-75 ug

Mild hypothyroidism in adults

Replacement therapy

See Levothyroxine

Uterine Contractants

Ergonovine maleate (Ergotrate)-PO, IM, IV 0.2 mg (gr 1/320)

Postabortal or postpartum hemorrhage; promotes involution after delivery of placenta

Stimulates uterine contractions for 3 hours or more

Nausea, vomiting; occasional transient hypertension, especially if given IV; cramping

Methylergonovine maleate (Methergine)-PO 0.2 mg; IM, IV, 0.2 mg (gr 1/320)

Postpartum hemorrhage, after delivery of placenta

Stimulates stronger and longer contractions than ergonovine maleate (Ergotrate)

Nausea, vomiting, transient hypertension, dizziness, tachycardia; cramping

Oxytocin (Pitocin, Syntocinon) IM 0.3 1.0 mL; IV 1 mL (10 U) in 1000 mL solution

Stimulates rhythmic contractions of uterus

Induces labor; augments contractions; prevents or controls postpartum atony; antidiuretic effect

Tetanic contractions, uterine rupture, cardiac arrhythmias FHR deceleration

Volume Expander

Albumin-IV 5%, 25% 500 mL as needed

Cirrhosis

Provides colloidal oncotic pressure, which mobilizes fluid from extracellular back into intravascular space

Hypersensitivity, CHF, hepatic failure