s1=new Array();s1[1]=new Array("druglist.htm","Drug / Medication Tables (Home page)","Ultimate drug list for pharmacists, nurses, physicians. Quick dosing guide. Ace-inhibitors, steroids, beta-blockers, calcium channel blockers, gastrointestinal agents, anti-emetics, rheumatoid","Search Globalrph Google Home back About Calculators Medline Contact Disclaimer GlobalRPh Drug Tables Dynamic list   -- Select an option here FIRST-- ANALGESICS (NSAIDS, opiates) ANESTHETICS / Sedatives / hypnotics Anti-ARRHYTHMICS (ACLS, Individual agents) ANTIBIOTICS / antifungals / Anti-TB Anti - HYPERTENSIVE Agents Anti-VIRAL Agents - Hepatitis, HIV, Herpes, Influenza COUGH / COLD / Allergy DERMATOLOGIC Conditions / TOPICALS ENDOCRINOLOGY (Diabetes, thyroid, etc) GASTROENTEROLOGY (diarrhea, IBD, PUD ..) GERD Gynecology HEENT (opthal, otic, nasal...) HEMATOLOGY (anticoagulants, thrombolytics ...) ICU Agents - VASOpressors VASOdilators INOtropes LIPID Lowering Agents (statins, fibrates, ...) NEPHROLOGY (diuretics, etc) NEUROLOGY (parkinsons, ALS, Alzheimers, NMBs) Prostate PSYCHOLOGY - Psychiatric PULMONARY (asthma, PAH, etc) RHEUMATOLOGY / Gout / Osteoporosis TOXICOLOGY UROLOGY - Urologic agents VASOPRESSORS -VASODILATORS - INOTROPES  (Make final selection below) Select option above first  >   Categories < A > Ace Inhibitors Anti- Emetics ACLS Pocket Guide Acne (topical Agents) Actinic Keratosis Aldosterone Antagonists Alpha Blockers ALS Agents anti-arrhythmics Anti-cholinergics Alzheimer's Disease Anesthetics / Sedatives Anticonvulsants Angiotensin II inhibitors Anti- Psychotics Antibiotics (Other) Antihypertensive (Other) Antihypertensive combinations Antidepressants Anti- Diarrheals Anti- fungals Anti-Hepatitis Agents Anti-Herpetic Agents Antihistamines Atopic Dermatitis Anti-Influenza Agents Anti-Platelet agents Anti-spasmotics (Bowel) Antitussives / Expectorants < B > Benzodiazepines Beta Blockers Bile Acid Sequestrants Bisphosphonates Bladder spasm Bowel - antispasmotics BPH Burn preparations < C > Calcium Channel Blockers Cephalosporins Colony Stimulating Factors Corticosteroids (Systemic) Cough < D > Diabetes (Anti-diabetic agents) Disease Modifying Agents Direct thrombin inhibitors Diuretics Decongestants Drug / Food Interactions < E - F - G > Endocrine / Other Erectile Dysfunction Fever inducing agents Fibrates Fluoroquinolones G6PD deficiency Gastrointestinal (Other) Gout < H - I - J > H2 Blockers Helicobacter Pylori Herpes Simplex Hypertensive Urgency (oral) Hypertensive Emergency (IV) Hemorrhoids HIV (anti) Agents Inflammatory bowel disease Interferons Intermittent Claudication Immunizations < K - L - M > Laxatives Low Molecular Weight Heparins macrolides Migraine Mouth & Lip preparations (topical) Muscle relaxants < N - O - P - Q > Nasal preparations Neurogenic bladder Neuromuscular blocking agents Neutropenia (Agents causing) Nitrates NSAID's Ophthalmic Preparations Otic Preparations Opiates / Combination Parkinsons Disease Penicillins Prostate Cancer Proton pump inhibitors Psoriasis < R - S - T > Renal Failure (agents) Respiratory Medications Rheumatoid arthritis Sore throat Statins Stimulants Tetracyclines Thrombocytopenia (causative) Thrombolytics Thyroid (Anti) Toxicology Tuberculosis agents Topicals (Other) Topicals (Antiviral) Topical (Antibacterials) Topical (Anti-fungals) Topical (Antiparasitics) Topical (Burns) Topical (Corticosteroids) < U - V - WXYZ > Urinary (Other) Urine discoloration (Urologic) Dysuria Vaginal Preparations Vasodilators Vasopressors and inotropes [TOP] David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc.  Contact . Privacy Policy . Disclaimer Copyright © 2006 GlobalRPh Inc. Author: David McAuley Keywords: Ace-inhibitors, steroids, beta-blockers, calcium channel blockers, gastrointestinal agents, anti-emetics, rheumatoid, diabetes, cough and cold, toxicology, gout, lipid lowering, ophthalmic, otic, antifungals");s1[2]=new Array("disclaimer.htm","Disclaimer","","GlobalRPh Inc. Web Site Agreement  Legal Disclaimer The GlobalRPH Web Site (the "Site") is an online information service provided by GlobalRPh Inc ("GlobalRPH "), subject to your compliance with the terms and conditions set forth below. PLEASE READ THIS DOCUMENT CAREFULLY BEFORE ACCESSING OR USING THE SITE. BY ACCESSING OR USING THE SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH BELOW. IF YOU DO NOT WISH TO BE BOUND BY THESE TERMS AND CONDITIONS, YOU MAY NOT ACCESS OR USE THE SITE. 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COPYRIGHT NOTICE.© 1999 PriorityDigital.com Prepared for: GlobalRPH Inc.,All rights reserved.");s1[3]=new Array("search.html","Globalrph Drug list Search Engine","","Drug Category Search Engine  Use the "Add*" key for wildcard searches e.g. vanco*  ");s1[4]=new Array("ace.htm","Ace-inhibitors - Dosing table","Ace-inhibitors dosing list for health care providers, pharmacists, nurses, physicians.","ACE Inhibitors Benazepril (Lotensin ®): Hypertension: Start 10 mg orally once daily. Usual maintenance dosage range is 20-40 mg per day administered as a single dose or in two equally divided doses. Maximum 80 mg per day. Supplied: [5, 10, 20, 40mg tablets] Captopril (Capoten ®): Hypertension: Start 25 mg orally twice or three times daily. Maximum 450 mg/day. CHF: Start 6.25 to 12.5 mg orally 2 to 3 times per day. Usual: 50-100 mg orally three times daily. Supplied: [12.5, 25, 50 , 100mg tablets] Enalapril (Vasotec ®): Hypertension: Start, 5 mg orally once a day or divided twice daily. Maximum: 40 mg/day. CHF: Start 2.5 mg orally twice daily. Usual: 10-20 mg orally twice daily. Supplied: [2.5, 5, 10, 20mg tablets] Fosinopril (Monopril ®): Hypertension: Start 10 mg orally once a day. Maximum: 80 mg orally once daily. CHF: Start 10 mg orally once a day, usual: 20-40 mg orally once daily. Supplied: [10, 20, 40mg tabs] Lisinopril (Prinivil ®): Hypertension: Start 10 mg orally once daily. Maximum: 80 mg/day. CHF: Start 5 mg orally once daily. Usual: 10-20mg orally once daily.   Supplied: [2.5, 5, 10, 20, 40mg tablets] Moexipril (Univasc ®): Hypertension: Start 7.5 mg orally once daily , Maximum: 30 mg/day.  Supplied:[7.5, 15 mg tabs] Perindopril (Aceon ®): Hypertension: Start 4 mg once a day. The dosage may be titrated upward to a maximum of 16 mg per day. Usual maintenance dose range is 4 to 8 mg once daily. May administer in divided doses twice daily. Use in the Elderly Patients (> 65): 4 mg daily, given in one or two divided doses. May titrate up to 8 mg per day (experience with doses exceeding 8 mg in the elderly is limited.) Supplied: [2,4,8 mg tabs] Quinapril (Accupril ®): Hypertension: 10 mg orally once daily or divided twice daily. Maximum: 80 mg/day.   CHF: Start 5mg orally twice a day. Usual: 20 mg orally twice a day.   Supplied: [5, 10, 20, 40mg tablets] Ramipril (Altace ®): Hypertension: Start: 2.5 mg orally once daily.  Maximum: 20 mg/day. CHF: Start 2.5 mg orally twice a day. Usual: 5 mg orally twice a day.   Supplied: [1.25, 2.5, 5, 10mg capsules] Trandolapril (Mavik ®): Hypertension: Start 1 mg orally once a day. Max: 8 mg/day. CHF/post MI: Start 1 mg orally once daily. Usual dose: 4 mg orally once a day. Supplied: [1, 2, 4 mg tablets]        Decreased renal perfusion                                                      Angiotensinogen                                                                            ¯ (Renin)                                                            Angiotensin I .                                                                 ¯Lungs (Angiotensin converting enzyme)                                                                                                      (XX) blocked by Ace-inhibitors                    Peripheral          ¬       ¬    Angiotensin II                              vasoconstriction                                 ¯                                 æ                   Increased Aldosterone                                     æ                          ¯                                               æ                  Water retention                                               æ              å                                   Increased renal perfusion  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP] Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc. Author: David McAuley Keywords: ace inhibitors, pharmacists, nursing, physicians,enalapril,quinapril, lisinopril, benazepril, fosinopril");s1[5]=new Array("antiemetics.htm","Anti-Emetic Medications","","Anti- Emetics: Aprepitant (Emend®) Substance P/Neurokinin 1 Receptor antagonist. Dosage: (Prevention of acute and delayed nausea and vomiting associated with highly-emetogenic chemotherapy in combination with a corticosteroid and 5-HT3 receptor antagonist): 125 mg orally on day 1, followed by 80 mg on days 2 and 3; should be used in combination with a corticosteroid (e.g. Dexamethasone: 12 mg po on day 1, followed 8 mg on days 2, 3, and 4) and 5-HT3 receptor antagonist (e.g. Ondansetron: 32 mg IV on day 1).   Supplied: 80 mg, 125 mg capsule dolasetron (Anzemet ®): Nausea (chemotherapy): 1.8 mg/kg up to 100mg IV/orally x 1.  Post-op: 12.5 mg IV x 1. Prevention: 100mg orally 2 hours preop. granisetron (Kytril ®): Nausea (chemotherapy): 10 mcg/kg IV over 5 minutes one-half hour prior to chemo. Oral: 1 mg orally twice daily x 1 day only. ondansetron (Zofran ®): Nausea (chemotherapy): 32 mg IV over 15 minutes or 0.15 mg/kg doses 30 minutes prior to chemo and repeated at 4 & 8 hours after first dose. Oral: 8 mg orally twice daily. Post-op nausea: 4 mg IV over 2-5 minutes x one dose or 16 mg orally 1 hour before anesthesia. droperidol (Inapsine ®):  Nausea - usual dose: 1.25 to 2.5 mg IV or IM metoclopramide (Reglan ®): 10 mg IV/IM every 2-3 hours as needed. 10-15 mg orally four times daily, 30 minutes before meals and at bedtime. prochlorperazine (Compazine ®): IV: 5-10mg IV over at least 2 minutes. IM: 5-10mg orally or IM 3 to 4 times daily Rectally: 25 mg rectally every 12 hours. scopolamine: Motion sickness: apply 1 disc behind ear 4 hours prior to event. Replace every 3 days. trimethobenzamide (Tigan ®): Oral: 250 mg orally every 6 to 8 hours IM / Rectal: 200mg IM or rectally every 6 to 8 hours.   Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP] Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.");s1[6]=new Array("acls_guide.htm","ACLS Pocket guide ","","Previous guidelines  ACLS Pocket Guide  VF/pulseless VT Defibrillation x 3 (200J,200J-300J,360J) , then Secondary ABCD (Airway, IV access) Vasopressin 40 U iv x 1 only (preferred first agent, Class 2b) or epinephrine1mg q3-5min (Class Indeterminant) Defibrillate at 360J or biphasic shock Amiodarone 300 mg iv push (diluted in 20 cc D5W). May rpt 150mg x 1 (Class 2b) May repeat 150 mg x 1 in 3-5 minutes Lidocaine 1.0-1.5mg/kg ivp q3-5 min up to 3 mg/kg (Class Inderterminate) Continuous infusion: 1 to 4 mg/min. Add 1 gram/250 ml. Rate (ml/hr)= mg/min x 15. Endotracheal tube: Give 2 to 2.5 x IV dose. Dilute up to 10ml with normal saline. Magnesium 1-2 g iv if polymorphic VT or hypomagnesiumic (Class 2b) Procainamide 30 mg/min up to 17mg/kg "acceptable but not recommended" in refractory VF (class 2b) Loading regimen: 20-30 mg/min. Add 1 gram/250 ml D5W. Rate: 20 mg/min= 300 ml/hr; 30 mg/min= 450 ml/hr. or Add 1 gram/50ml: 20mg/min: 60 ml/hr. 30mg/min: 90 ml/hr. Continuous infusion: 2 to 6 mg/min. Add 1 gram/250 ml D5W. Rate (ml/hr)= mg/min x 15 bicarbonate prolonged arrest (Class 2b), high K Defibrillate 360J or biphasic shock, repeat drug from above   Pulseless Electrical Activity/EMT Basic CPR/ABCD //   Secondary ABCD Rule out most common etiology: Hypovolemia, Hypoxia, Hyper/hypokalemia, Hypothermia ….. Consider bicarbonate Epinephrine 1 mg q3-5 min iv . Epinephrine strengthens myocardial contraction and increases cardiac output, which will help improve myocardial and cerebral blood flow. Continuous infusion: 1 to 4 mcg/min (range: 1-10 mcg/min). Add 1 mg/250 ml D5W or NS. Drip rate (ml/hr)= mcg/min x 15. Endotracheal tube: Give 2 to 2.5 x IV dose. (Dilute up to 10 ml with normal saline) Atropine If HR slow, 1 mg iv q3-5 min up to 0.04mg/kg   Asystole BAsic CPR/ABCD // confirm asystole: check monitor,lead,power and change leads Consider bicarbonate: prolonged arrest (Class 2b), high K Transcutaneous pacing, if used must be considered early, routine use not necessary Epinephrine 1mg iv q3-5min Atropine 1 mg iv q3-5 min up to 0.04mg/kg.  Endotracheal tube: Give 2 to 2.5 x IV dose. (Dilute up to 10ml with normal saline). Adverse reactions: CNS toxicity: tremor, delirium. Hypo/hypertension.   Bradycardia BAsic CPR/ABCD // Secondary ABCD: assess need for airway etc. Serious signs or symptoms of bradycardia? if yes, then do the sequence: Atropine 1 mg iv q3-5 min up to 0.04mg/kg. //    Then transcutaneous pacing, then Dopamine Dopamine 5-20 mcg/kg/min Epinephrine 2-10 mcg/min  (Add 1 mg/250 ml ) Is Type 2 second degree AV block or third degree AV block present? If yes: standby transcutaneous pacemaker, prepare for transvenous pacemaker.   PSVT EF normal: Priority: Ca-blocker> beta-blocker> digoxin> DC Cardioversion. Consider procainamide, sotalol, amiodarone. If unstable proceed to cardioversion EF<40%, CHF: Priority: No Cardioversion. Digoxin or amiodarone or diltiazem. If unstable proceed to cardioversion.   Atrial fibrillation/flutter: Category 1. Normal EF Rate control: Verapamil: 2.5 to 5 mg IV over 2 minutes. May repeat dose of 5-10mg 15-30 minutes after 1st dose. Diltiazem: 0.25 mg/kg over 2 minutes. If no response within 15 minutes, give second bolus of 0.35 mg/kg over 2 minutes. Subsequent doses should be individualized. If effective start continuous infusion: 5-15 mg/hr. Esmolol: 500 mcg/kg IV over 1 minute, followed by 50 mcg/kg/minute over 4 minutes. If ineffective, repeat load of 500 mcg/kg, followed by 100 mcg/kg/min. Cardiovert: If onset < 48 hours, consider DC cardioversion OR with one of the following agents: Amiodarone, ibutilide, procainamide, (flecainide,propafenone),sotalol. If onset > 48 hours: avoid drugs that may cardiovert (e.g. amiodarone). Either: Delayed cardioversion: anticoagulate adequately x 3weeks then Cardiovert then anticoagulate x 4 weeks . Ibutilide: 1mg IV over 10min. May repeat x 1 in 10 minutes if needed. Approved for acute termination. 1 mg/50 ml D5W or NS over 10 minutes. If patient is < 60kg give 0.01 mg/kg over 10 minutes. Amiodarone: (non-cardiac arrest) load 15 mg/min over 10 min (150 mg) (mix 150 mg in 100cc D5W in PVC or Glass, infuse over 10 min) then 1 mg/min x 6 hrs (mix 900 mg in 500 cc D5W) then 0.5 mg/min x 18 hrs and beyond. Anticoagulate if not contraindicated, if A fib > 48 hrs Category 2. EF<40% or CHF (Avoid verapamil, beta-blockers, ibutilide, procainamide (and propafenone/flecainide). A. Rate control: digoxin, diltiazem, amiodarone (avoid if onset of AF > 48 hours) B. Cardiovert: same as Category 1, except the only conversion agent allowed is amiodarone. C. Anticoagulate, if A fib > 49 hr. Catepory 3. WPW A fib Must not use adenosine, beta-blocker, Ca-blocker, Digoxin . If < 48 hour: If EF normal: one of the following for both rate control and cardioversion: amiodarone, procainamide, propafenone, sotalol, flecainide If EF abnormal or CHF: amiodarone or cardioversion If > 48 hour . Medication listed above may be associated with risk of emboli. Anticoagulate and DC cardioversion as in Category 1.   Wide complex tachycardia, STABLE If unable to make Dx: Note: no lidocaine and bretylium in protocol. EF normal: DC cardioversion or procainamide or amiodarone EF<40%,CHF: DC Cardioversion or amiodarone . Procainamide dosing: Loading regimen: 20-30 mg/min. Add 1 gram/250 ml D5W. Rate: 20 mg/min= 300 ml/hr; 30 mg/min= 450 ml/hr. Continuous infusion: 2 to 6 mg/min. Add 1 gram/250 ml D5W. Rate (ml/hr)= mg/min x 15 Monomorphic VT (May proceed directly to cardioversion) EF normal: one of the following procainamide (2a), sotalol (2a) OR amiodarone (2b), lidocaine (2b) EF poor: Step 1. Amiodarone 150 mg iv or 10 min OR lidocaine 0.5-0.75 mg/kg iv push .  Step 2. Synchromized cardioversion Intravenous Medications Amiodarone:       I.V. DOSE RECOMMENDATIONS -- FIRST 24 HOURS -- Loading infusions.   The recommended starting dose of Cordarone I.V. is about 1000 mg over the first 24 hours of therapy, delivered by the following infusion regimen.     First Rapid: 150 mg over the FIRST - 10 minutes (15 mg/min).  Add 3 mL of Cordarone I.V. (150 mg) to 100 mL D 5 W. Infuse 100 mL over 10 minutes.       Followed by Slow: 360 mg over the NEXT  6 hours (1 mg/min).  Add 18 mL of Cordarone I.V. (900 mg) to 500 mL D 5 W (conc = 1.8 mg/mL).      Maint infusion: 540 mg over the REMAINING  18 hours (0.5 mg/min).  After first 24 hours, the maint infusion rate of 0.5 mg/min (720 mg/24 hours) should be continued utilizing a concentration of 1 to 6 mg/mL (Cordarone I.V. concentrations greater than 2 mg/mL should be administered via a central venous catheter). In the event of breakthrough episodes of VF or hemodynamically unstable VT, Give 150-mg/100 ml D5W over 10min to minimize potential for hypotension. The rate of the maint inf may be inc to achieve effective arrhythmia suppression. // The initial infusion rate should not exceed 30 mg/min. The maintenance infusion of up to 0.5 mg/min can be cautiously continued for 2 to 3 weeks regardless of the patient's age, renal function, or LV fcn. limited experience in pts receiving Cordarone I.V. > 3 weeks.  Amrinone (Inocor): 0.75 mg/kg bolus IV over 2-3min, f/b infusion IV at 5-10 mcg/kg/min. Cisatracium: Intermittent IV dosing: initial dose 0.15 - 0.2 mg/kg IV bolus, followed by 0.03 mg/kg IV q40-60 minutes. Continuous infusion: 0.15-0.2 mg/kg bolus, followed by 1 to 3 mcg/kg/min. (range: 0.5 to 10 mcg/kg/min). Based on a standard dilution of 1 mg/ml (eg 100mg/100ml or 200mg/200ml) and a weight of 70kg: 1 mcg/kg/min =4.2 ml/hr 3 mcg/kg/min =12.6 ml/hr 0.15 mg/kg =10.5 mg 0.2 mg/kg=14 mg Digoxin: Loading dose: CHF: 8-12 mcg/kg in divided doses (q4-8h) over 12 to 24 hours. [Normally, give 50% of the total digitalizing dose in the initial dose, then give 25% of the total dose in each of the two subsequent doses at 8 to 12 hr intervals-Obtain EKG 6 hours after each dose to assess potential toxicity (AV block, sinus bradycardia, atrial or nodal ectopic beats, ventricular arrhythmias); Other: vision changes, confusion.] If pt has renal insufficiency give 6 to 10 mcg/kg IBW. A-fib: 10 to 15 mcg/kg IBW given as above. (If given IVPush-admin over at least 5 min) Diltiazem  0.25 mg/kg over 2min. If no response c/in 15min, give 2nd bolus of 0.35 mg/kg over 2min. Subsequent doses should be individualized. If effective start continuous infusion: 5-15 mg/hr Diprivan: ICU sedation: Usual initial dose 0.3 to 0.6 mg/kg/hr (equivalent to 5-10 mcg/kg/min) over 5-10 minutes. Infusion rate can then be increased by 0.3 to 0.6 mg/kg/hr at 3 to 5 minute intervals until the desired level of sedation is achieved. Give by slow infusion only - never bolus. Monitor for early signs of significant hypotension and/or cardiac depression, which may be profound. Usual dose required for maintenance: 1.5 to 4.5 mg/kg/hr. Based on the reported weight of 70kg, here are the recommended pump settings: Initial infusion rate: 0.3 mg/kg/hr (2.1 ml/hr) or 0.6 mg/kg/hr (4.2 ml/hr) x 5-10 minutes, then increase by 2.1 to 4.2 ml/hr q3-5 minutes until desired level of sedation. Usual maintenance rate: 1.5 mg/kg/hr (10.5 ml/hr) to 4.5 mg/kg/hr (31.5 ml/hr). Dobutamine: Drip rate (500mg/250 ml) ml /hr= wt(kg) x (mcg/min) x 0.03. Direct beta agonist that inc cardiac output with little direct effect on BP. Uses: refractory CHF or hypotensive pts in whom vasodilators cannot be used b/c of eff on BP. Usual range: 2-15 mcg/kg/min (up to 40). Little effect on heart rate. Dopamine: Calculation of drip rate (ml/hr) 400mg/250 ml: wt(kg) x mcg/min x 0.0375. Refractory CHF: ini 0.5 to 2 mcg/kg/min Renal: 1 to 5 mcg/kg/min. Severely ill pt: ini 5 mcg/kg/min, inc by 5 to 10 mcg/kg/min (q10 to 30 min) up to max of 50 mcg/kg/min. [0.5 to 2 mcg/kg/min-dopa; 2-10-dopa/beta; >10-primarily alpha. Used to support BP, CO and renal perfusion in shock. Epinephrine: 1 to 4 mcg/min or 0.05 to 2 mcg/kg/min. Anaphylaxis (adult): 0.1 to 0.5 SC / IM (1:1000) rpt q10 to 15 min prn or give 0.1 to 0.25 mg IV (1:10,000) over 5-10min rpt q5 to 15min prn or start cont inf: 1 to 4 mcg/min Eptifibatide (Integrilin): ACS: Bolus of 180 mcg/kg (maximum: 22.6 mg) over 1-2 minutes, begun ASAP following diagnosis, f/b a continuous inf of 2 mcg/kg/min (maximum: 15 mg/hour) until hospital discharge or initiation of CABG surgery, up to 72 hours. Concurrent aspirin (160-325 mg initially and daily thereafter) and heparin therapy (target aPTT 50-70 seconds) are recommended.    Percutaneous coronary intervention (PCI) with or without stenting: Bolus of 180 mcg/kg (maximum: 22.6 mg) administered immediately before the initiation of PCI, f/b a continuous inf of 2 mcg/kg/min (maximum: 15 mg/hour). A second 180 mcg/kg bolus (maximum: 22.6 mg) should be administered 10 min after the 1st bolus. Infusion should be continued until hospital discharge or for up to 18-24 hours, whichever comes first; minimum of 12 hours of infusion is recom. Concurrent aspirin (160-325 mg 1-24 hours before PCI and daily thereafter) and heparin therapy (ACT 200-300 seconds during PCI) are recommended. Heparin infusion after PCI is discouraged. In patients who undergo coronary artery bypass graft surgery, discontinue infusion prior to surgery.    Dosing adjustment in renal impairment: ACS: Scr >2 mg/dL and <4 mg/dL: Use 180 mcg/kg bolus (maximum: 22.6 mg) and 1 mcg/kg/mininfusion (maximum: 7.5 mg/hour) . Percutaneous coronary intervention (PCI) with or without stenting: Adults: Scr >2 mg/dL and <4 mg/dL: Use 180 mcg/kg bolus (maximum: 22.6 mg) administered immediately before the initiation of PCI and followed by a cont inf of 1 mcg/kg/min (maximum: 7.5 mg/hour). A second 180 mcg/kg (maximum: 22.6 mg) bolus should be admin 10 min after the first bolus.  Esmolol: Dosing: PSVT: 500 mcg/kg over 1 min, then 50 mcg/kg/min x 4 to 5min. If heart rate not controlled, rpt load of 500 mcg/kg and increase inf to 100 mcg/kg/min. Rpt load and increase infusion q5 to 10min as needed to max of 200 (up to 300?) mcg/kg/min. Watch BP. Calculation of drip rate (ml/hr): 2.5 grams/250 ml: wt (kg) x mcg/min x 0.006 Fenoldopam (Corlopam): severe HTN: Dosing: Usu initial rate: 0.1 mcg/kg/min, increased by increments of 0.05 to 0.1 mcg/kg/min at 15-20min intervals until target BP reached. Usual effective doses: 0.1 to 1.6 mcg/kg/min. Generally, lower initial doses (0.03 to 0.1 mcg/kg/min) titrated slowly, have been assoc c less reflex tachycardia. Never given by IV bolus.    10mg/250 ml NS/D5W Hydralazine: Parenteral (IV/IM) (Inject over 1 minute) Hypertension: Initial: 10-20 mg/dose every 4-6h prn, may increase to 40 mg/dose; change to oral therapy as soon as possible. Route is indicated only when oral therapy is not feasible. HTN emergency: 10 to 40 milligrams, repeated prn (q20-60 minutes), with frequent blood pressure monitoring. Ibutalide: 1 mg over 10 min. May rpt x 1 after 10 min. Class III agent—prolongs action potential (inc atrial and ventricular refractoriness.). Isoproterenol: (B1/B2) agonist. IV infusion: 2 to 20 mcg/ min. Usual initial rate: 5 mcg/min. Titrate to HR/BP. May give IVPush (must use 1:50,000 dilution). Calculation of drip rate 1 mg/250 ml (ml/hr) = 15 x mcg/min. eg: 5 mcg/min = 75 ml/hr.  Used to tx hemodynamically significant bradycardia. Also indicated for tx of asthma Labetalol: Dosing: ini 20 mg IVP over 2 min. May rpt 20 to 80 mg q10min (up to 300 mg total dose) until desired BP is reached or start continuous infusion: 2 mg/min (range: 1 to 3 mg/min)-titrate to BP. Milrinone (Primacor): Load 50 mcg/kg IV over 10 min, then begin IV infusion of 0.375 to 0.75 mcg/kg/min. Natrecor: IV bolus of 2 mcg/kg (over 1 minute) followed by a continuous infusion of 0.01 mcg/kg/min. Withdraw bolus dose from the infusion bag. Higher initial dosages are not recommended. At intervals of 3 hours, the dosage may be increased by 0.005 mcg/kg/minute (preceded by a bolus of 1 mcg/kg), up to a maximum of 0.03 mcg/kg/minute.   Indications: IV treatment of patients with acutely decompensated CHF who have dyspnea at rest or with minimal activity. Actions: venous and arterial vasodilation (decreased PCWP etc), plus mild diuretic effect.  Patients experiencing hypotension during the infusion: Hold infusion. May attempt to restart at a lower dose (reduce initial infusion dose by 30% and omit bolus). No adjustment required in renal failure. Nitroglycerin: (HTN/ CHF/ angina): ini inf rate 5 mcg/min. May inc by 5 mcg/min q3 to 5 min until response. If 20 mcg/min is inadequate, inc by 10 to 20 mcg/min q3 to 5min. Calculation of drip rate (50 mg/250 ml) ml/hr = mcg/min x 0.3 (eg 5 mcg/min=@ 2ml/hr ; 20mcg/min = 6 ml/hr etc.) Nitroprusside: Onset: immediate Duration: 1 to 10min. Tx htn emer. IV infusion rate: 0.5 to 10 mcg/ kg/ min-titrate to BP. Dosing: Initial: 0.3 to 0.5 mcg/kg/min—increase by 0.5 mcg/kg/min increments. (usual dose: 3 mcg/kg/min-rarely need > 4 mcg/kg/min). Note: when > 500 mcg/kg is admin by continuous infusion at > 2 mcg/kg/min-cyanide is produced faster than can be handled by endogenous mechanisms. Maximum infusion rate: 10 mcg/kg/min. Calculation of drip rate 50 mg/250 ml (ml/hr) = wt (kg) x mcg/min x 0.3 Norepinephrine: Used to maintain BP in hypotensive states. Most potent vasoconstrictor (Norepi >>> phenylephrine). Dosage: ini 8 to 12 mcg/min –titrate to BP(Usual target: SB:80-100 or MAP=80). Usual maint: 2 to 4 mcg/min. Note: doses as high as 0.5 to 1.5 mcg/kg/min for 1-10days have been used in septic shock.) Calculation of drip rate 8 mg/ 250 ml (ml/hr) = mcg/min x 1.875 Administer through a central line (large vein) Phenylephrine: Alpha agonist). May be given IM,SC, Ivpush, or by cont inf. TX mild/moderate hypotension, also PSVT. IV bolus tx: usu ini dose 0.5 mg [range: 0.1 to 1 mg (max)] rpt q10-15 min prn. IV infusion: usu ini rate: 0.1 to 0.18 mg/min (titrate). Maximum rate: 10-15 mcg/kg/min?.  PSVT: 0.5 mg rapid Ivpush, subsequent doses may be inc in increments of 0.1 to 0.2mg. Calculation of drip rate (40 mg/250) (ml/hr) = (mg/min) x 375. Procainamide: (Tx: PVC, VT, A-fib/flutter, PAT) Dosing: Loading: 100mg q5min (max 25 to 50 mg/min) until arrhy disappears or adverse effects up to (17 mg/kg max if nml renal fcn, otherwise max of 12 mg/kg). If arrhy disappears, start IV infusion: 2 to 6 mg/min (Usual maint dose c renal/cardiac failure: 1 to 2 mg/min) . If arrhy reappears, rpt bolus as above. Side effects: Severe hypotension c rapid infusion; bradycardia, AV block, V-fib. Alternate loading regimen: Add 1g/ 50 ml D5W-20 mg/min x 25 to 30 min, wait 10min for distribution, if no response continue c loading. (Note: 20 mg/min= 60 ml/hr-1 g/50ml). If pt responds start maint infusion: 2 to 6 mg/min. Stop infusion if QRS widens > 50%. Steady state: 24hrs (IV) / 48 hrs (oral). Calculation of drip rate (1 gram/250 ml) ml/hr: = (mg/min) x 15 Succinylcholine: Usual dosage: 0.6 mg/kg (range: 0.3 to 1.1 mg/kg) over 10-30 seconds (up to total dose of 150mg). Maintainance: 0.04-0.07 mg/kg q5-10 minutes prn. Continuous infusion: 0.5 to 10 mg/min. Add 500mg/250ml D5W or NS. Based on the entered weight of 70kg: 0.6mg/kg =42mg, and the maintenance dose of 0.04 to 0.07mg/kg is: (2.8 to 4.9 mg) q5-10 minutes. Tirofiban (Aggrastat): initial rate of 0.4 mcg/kg/min for 30 minutes and then continued at 0.1 mcg/kg/min. Patients with severe renal insufficiency (creatinine clearance <30 mL/min) dec by 50%: (0.2 mcg/kg/min x 30min, f/b 0.05 mcg/kg/min)   Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.");s1[7]=new Array("acne.htm","ACNE treatment - topical agents","","Acne Treatments adapalene (Differin ®) Topical retinoid-like compound. Acne vulgaris (adult): after washing, apply a thin film topically to affected area(s) once daily at bedtime.    [Supplied 0.1% cream/solution/gel] azelaic acid (Azelex ®) Adult (usual) Mild-to-moderate inflammatory acne: apply a thin film topically to affected area twice daily.  Indications: topical treatment of vulgaris. Azelaic acid is a naturally-occurring, saturated, straight-chained dicarboxylic acid.    [Supplied 20% cream] BenzaClin ®  Topical Gel Apply twice daily, morning and evening, or as directed by a physician, to affected areas after the skin is gently washed, rinsed with warm water and patted dry.    [Supplied: Each gram of BenzaClin Topical Gel contains, 10 mg (1%) clindamycin as phosphate and 50 mg (5%) benzoyl peroxide] Benzamycin ®  Topical Gel Apply twice daily, morning and evening, or as directed by a physician to affected areas after the skin is thoroughly washed, rinsed with warm water and gently patted dry.   [Supplied: Topical gel - erythromycin 3%-benzoyl peroxide 5% ] Benzoyl Peroxide Adult (usual) Acne: apply 2.5%-10% concentration topically once or twice daily. Benzoyl peroxide is an antibacterial, mildly comedolytic, and sebostatic agent. [Supplied: several dosage forms - gels, creams, suspensions, ...] clindamycin (Cleocin ®) Acne vulgaris: apply thin film of solution, lotion, or gel topically twice daily to affected areas [Supplied: 1% gel/lotion/solution] Duac ® Topical Gel Apply once daily in the evening or as directed by the physician, to affected areas after the skin is gently washed, rinsed with warm water and patted dry.  [Supplied: 1% clindamycin, and 5% benzoyl peroxide topical gel] Erythromycin ERYGEL® 2% Topical Gel should be applied sparingly as a thin film to affected area(s) once or twice a day after the skin is thoroughly cleansed and patted dry. If there has been no improvement after 6 to 8 weeks, or if the condition becomes worse, treatment should be discontinued, and the physician should be reconsulted. Spread the medication lightly rather than rubbing it in. There are no data directly comparing the safety and efficacy of b.i.d. versus q.d. dosing.  ERYGEL®  2% topical solution: wash skin with soap and warm water and pat dry. Apply to affected area bid with a dabbing motion. Glycolic Acid BioMedic ® Cellex-C ® Glytone ® Glycolic Acids have been reported to improve acne, pseudofoliculites, barbae, ichthyosis/xerosis, as well as premature aging of the skin. Seattle Dermatologist: "Glycolic Acid has been proven to be very effective in the treatment of acne as well as the cosmetic benefits one receives. I feel that the use of glycolic acid, especially for the treatment of acne, is the most exciting development in the field of facial skin care over the past decade. It is my prediction that glycolic acid will soon become the standard treatment approach for acne." Isotretinoin  (Accutane ®) Adult (usual) - Severe recalcitrant nodular acne: 0.5-2 mg/kg/day orally in 2 divided doses for 15-20 weeks.  [Supplied 10 mg, 20 mg, 40 mg capsule] Sulfacetamide with sulfur (Sulfacet-R ®) Indications: topical control of acne vulgaris, acne rosacea and seborrheic dermatitis.  Clean the affected area and apply a thin layer of medication to the skin 1 to 3 times daily; or use as directed by your doctor.  (Shake Well before using.) Expiration date after reconstituting: four months. [Supplied: sodium sulfacetamide 10% and sulfur 5% topical lotion] Tazarotene (Tazorac ®) Acne vulgaris: apply 0.1% gel or cream every night to affected area . [Supplied 0.05%, 0.1% cream.  0.05%, 0.1% gel] Tretinoin (Retin-A ®) Acne vulgaris: apply 0.025%-0.1% cream or 0.05% liquid topically at bedtime.   Fine wrinkles/ mottled hyperpigmentation /tactile roughness: apply 0.025%-0.05% cream at bedtime.  Retin-A Micro (tretinoin gel) microsphere, 0.1% and 0.04% - this formulation uses patented methyl methacrylate/glycol dimethacrylate crosspolymer porous microspheres (Microsponge® System) to enable inclusion of the active ingredient, tretinoin, in an aqueous gel. Retin-A Micro should be applied once a day, in the evening, to the skin where acne lesions appear, using enough to cover the entire affected area lightly. Application of excessive amounts of gel may result in "caking" of the gel, and will not provide incremental efficacy.   Supplied: cream/gel/liquid - various concentrations.  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.  ");s1[8]=new Array("actinic_keratosis.htm","Actinic keratosis - Topical agents ","Topical agents (corticosteroids, antibacterials, antiparasitics, psoriasis: dosing list for health care providers, pharmacists, nurses, physicians. ","Actinic keratosis (topical therapy) declofenac (Solaraze ®) Apply to lesion areas twice daily (smoothed onto the affected skin gently). Recommended duration of therapy: 60 days to 90 days. Complete healing of the lesion(s) or optimal therapeutic effect may not be evident for up to 30 days following cessation of therapy. Lesions that do not respond to therapy should be carefully re-evaluated and management reconsidered. [Supplied: Gel: 25 and 50 gram tubes. Each gram of gel contains 30 mg of diclofenac sodium.] fluorouracil (Efudex ®): Actinic keratoses: apply twice daily x 2-6 weeks. Superficial basal cell carcinomas: apply 5% cream/solution twice daily. [Supplied: 1 and 5% cream. 1,2 & 5% solution] masoprocol (Actinex ®) Actinic keratoses: apply twice daily. [Supplied: 10% cream]  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.   Author: David McAuley Keywords: Topicals, antibacterials, antiparasitic, topical corticosteroids,pharmacists, nursing, physicians,health care providers, bacitracin, bactroban, metrogel, neosporin, silvadene, Eurax, Elimite, Rid, Aclovate, hydrocortisone, Synalar, Desowen, Cordran, Kenalog, Locoid, Diprolene, Diprosone, Temovate, psorcon, psoriasis, Zostrix, Zonalon, Regranex");s1[9]=new Array("aldosterone_antag.htm","Aldosterone Antagonists ","Topical agents (corticosteroids, antibacterials, antiparasitics, psoriasis: dosing list for health care providers, pharmacists, nurses, physicians. ","Aldosterone Antagonists eplerenone (Inspra ®) CHF: 25mg orally once daily. May increase to max dose of 50mg once daily after 4 weeks.  HTN: 50mg orally once daily. May increase to max dose of 50mg twice daily after 4 weeks. Contraindicated in males with SCR>2.0 mg/dl or females with SCR >1.8 mg/dl. [Supplied: 25 mg, 50 mg tablets] spironolactone (Aldactone ®): Initial dosage: 50 to 100 mg orally once daily (may give in divided doses). Maximum dose: 400mg.  [Supplied: 25, 50, 100mg tablets]  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.   Author: David McAuley Keywords: Topicals, antibacterials, antiparasitic, topical corticosteroids,pharmacists, nursing, physicians,health care providers, bacitracin, bactroban, metrogel, neosporin, silvadene, Eurax, Elimite, Rid, Aclovate, hydrocortisone, Synalar, Desowen, Cordran, Kenalog, Locoid, Diprolene, Diprosone, Temovate, psorcon, psoriasis, Zostrix, Zonalon, Regranex");s1[10]=new Array("alpha-blockers.htm","Alpha-1 Adrenergic Blockers","","Alpha-1 Adrenergic Blockers Act at post-synaptic alpha-1 receptors to produce arteriole and venous vasodilation alfuzosin Uroxatral ® BPH: 10 mg orally once daily.   [ Supplied: 10mg extended release tablet.] doxazosin Cardura ® BPH: initial, 1 mg orally once daily. May increase dose at 1-2 week intervals. Maintenance: 1-8 mg orally once daily.   CHF: 1-16 mg orally once daily.  Hypertension: initial, 1 mg orally once daily. Maintenance, 1-16 mg po once daily.  [Supplied 1 mg, 2 mg, 4 mg, 8 mg tablets] prazosin Minipress ® HTN: Initial dose 1 mg bid to tid.  Usual range: 6 mg to 15 mg daily given in divided doses. Doses higher than 20 mg usually do not increase efficacy, however a few patients may benefit from further increases up to a daily dose of 40 mg given in divided doses.  [Supplied: 1, 2, 5mg capsules] tamsulosin Flomax ® BPH: 0.4 mg orally once daily, given 30 minutes after a meal. May increase dose after 2 to 4 weeks to a maximum of 0.8 mg/day. [Supplied: 0.4 mg capsule] terazosin Hytrin ® Adult (usual) - (BPH): initial, 1 mg orally qhs. Maintenance, 1-10 mg orally once daily (Maximum: 20 mg/day).  Hypertension (HTN): initial, 1 mg po qhs. Maintenance (HTN): 1-5 mg po qd - bid. Maximum: 20-40 mg/day [Supplied 1, 2, 5, 10 mg capsule]  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.  ");s1[11]=new Array("als.htm","ALS (Amyotrophic Lateral Sclerosis) - Therapeutic agent(s) ","","ALS (Amyotrophic Lateral Sclerosis) riluzole (Rilutek ®): MOA: Glutamate antagonist. Riluzole extends survival and/or time to tracheostomy. Recommended dose: 50 mg q12h. No increased benefit can be expected from higher daily doses, but adverse events are increased. Rilutek tablets should be taken at least an hour before, or two hours after, a meal to avoid a food-related decrease in bioavailability.  [Supplied: 50 mg tablet]  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.  ");s1[12]=new Array("antiarrhythmics.htm","Anti-arrhythmics - Dosing List","","Anti-Arrhythmics  adenosine (Adenocard ®) Dosing: Paroxysmal supraventricular tachycardia (PSVT): Initially 6 mg rapid bolus (over 1-2 seconds). If not effective within 1-2 minutes, 12 mg may be given; may repeat 12 mg bolus if needed; maximum single dose: 12 mg. (Each I.V. bolus of adenosine should be followed with normal saline flush.) Pharmacologic stress agent (Adenoscan®): Continuous I.V. infusion: 140 mcg/kg/minute for 6 minutes using syringe or columetric infusion pump; total dose: 0.84 mg/kg. Thallium-201 is injected at midpoint (3 minutes) of infusion. MOA: Slows conduction time through the AV node, interrupting the re-entry pathways through the AV node, restoring normal sinus rhythm Supplied: Adenocard®: 3 mg/ml (2 ml, 4 ml) Adenoscan®: 3 mg/ml (20 ml, 30 ml) amiodarone (Cordarone ®) Infusion: whenever possible administer through a central venous catheter. Also, an in-line filter should be used during administration. Cordarone I.V. concentrations greater than 3 mg/ml in D 5 W have been associated with a high incidence of peripheral vein phlebitis; however, concentrations of 2.5 mg/ml or less appear to be less irritating. Therefore, for infusions longer than 1 hour, Cordarone I.V. concentrations should not exceed 2 mg/ml unless a central venous catheter is used. Cordarone I.V. infusions exceeding 2 hours must be administered in glass or polyolefin bottles containing D5W. Use of evacuated glass containers for admixing Cordarone I.V. is not recommended as incompatibility with a buffer in the container may cause precipitation. Amiodarone: I.V. DOSE RECOMMENDATIONS -- FIRST 24 HOURS -- Loading infusions. The recommended starting dose of Cordarone I.V. is about 1000 mg over the first 24 hours of therapy, delivered by the following infusion regimen: First Rapid: 150 mg over the FIRST - 10 minutes (15 mg/min).  Add 3 ml of Cordarone I.V. (150 mg) to 100 ml D 5 W. Infuse 100 ml over 10 minutes. Followed by Slow: 360 mg over the NEXT  6 hours (1 mg/min).  Add 18 ml of Cordarone I.V. (900 mg) to 500 ml D 5 W (conc = 1.8 mg/ml). Maintenance infusion: 540 mg over the REMAINING  18 hours (0.5 mg/min). After the first 24 hours, the maintenance infusion rate of 0.5 mg/min (720 mg/24 hours) should be continued utilizing a concentration of 1 to 6 mg/ml (Cordarone I.V. concentrations greater than 2 mg/ml should be administered via a central venous catheter). In the event of breakthrough episodes of VF or hemodynamically unstable VT, Give 150-mg/100 ml D5W over 10 minutes to minimize potential for hypotension. The rate of the maintenance infusion may be increased to achieve effective arrhythmia suppression. The initial infusion rate should not exceed 30 mg/min. The maintenance infusion of up to 0.5 mg/min can be cautiously continued for 2 to 3 weeks regardless of the patient's age, renal function, or Left-ventricular function. There is limited experience in patients receiving Cordarone I.V. > 3 weeks. RECOMMENDATIONS FOR ORAL DOSAGE AFTER I.V. INFUSION Duration of Cordarone I.V. Infusion*: <1 week Initial Daily Dose of Oral Cordarone : 800-1600 mg Duration of Cordarone I.V. Infusion: 1 to 3 weeks Initial Daily Dose of Oral Cordarone : 600-800 mg Duration of Cordarone I.V. Infusion: >3 weeks Initial Daily Dose of Oral Cordarone : 400 mg  *Assuming a 720 mg/day infusion (0.5 mg/min). Cordarone I.V is not intended for maint therapy. Restated: Duration of IV infusion < 1 week: 800-1600mg/day po initially x 1-2 weeks or complete current week; 1-3 weeks: 600-800mg/day po initially - total therapy ~ 1 month counting IV infusion ; >3 weeks: 400mg po qd initially. Oral Loading - Half-life elimination: 40-55 days (range: 26-107 days); Administration of Cordarone in divided doses with meals is suggested for total daily doses of 1,000 mg or higher, or when gastrointestinal intolerance occurs.) If side effects become excessive, the dose should be reduced. Loading Dose (Daily): (Ventricular Arrhythmias) 800 to 1,600 mg x 1-3 weeks, then 600 to 800 mg x ~1 month, then start maintenance of 400mg/day. Recommendations for conversion to intravenous amiodarone after oral administration: During long-term amiodarone therapy (ie, 4 months), the mean plasma-elimination half-life of the active metabolite of amiodarone is 61 days. Replacement therapy may not be necessary in such patients if oral therapy is discontinued for a period <2 weeks, since any changes in serum amiodarone concentrations during this period may not be clinically significant. atropine Asystole: 1 mg IV - repeat in 3-5 minutes if asystole persists; total dose of 0.04 mg/kg.   Intratracheal: Administer 2 - 2.5 times the recommended I.V. dose; dilute in 10 ml NS. Bradycardia: 0.5 mg I.V every 5 minutes, not to exceed a total of 3 mg or 0.04 mg/kg; may give intratracheal in 1 mg/10 ml dilution only, intratracheal dose should be 2-2.5 times the I.V. dose. (Doses <0.5 mg have been associated with paradoxical bradycardia.) Inhibit salivation and secretions (preanesthesia):  0.4-0.6 mg (IM, IV, SQ) 30 to 60 minutes preop - repeat every 4-6 hours as needed.   Oral: 0.4 mg, may repeat every 4 to 6 hours. Organophosphate or carbamate poisoning: 2 mg IV, followed by 2 mg every 15 minutes until adequate response (initial doses of up to 6 mg may be used in life-threatening cases). bretylium Immediate life-threatening ventricular arrhythmias, ventricular fibrillation, unstable ventricular tachycardia: 5 mg/kg IVpush------shock------- Repeat in 5 minutes at 10 mg/kg. (maximum total: 30 to 35 mg/kg). Side effects: Bradycardia, hypotension, N&V.    Continuous infusion: 1 to 2 mg/min (Range: 0.5 to 4 mg/min).   Drip preparation: Add 1 gram to 250ml of D5W or normal saline. Rate (ml/hr)= mg/min x 15 [Supplied: 500mg/ 10 ml syringe] digoxin (Lanoxin ®) Loading dose: CHF: 8-12 mcg/kg in divided doses (q4-8h) over 12 to 24 hours. [Normally, give 50% of the total digitalizing dose in the initial dose, then give 25% of the total dose in each of the two subsequent doses at 8 to 12 hr intervals-Obtain EKG 6 hours after each dose to assess potential toxicity (AV block, sinus bradycardia, atrial or nodal ectopic beats, ventricular arrhythmias); Other: vision changes, confusion.] If pt has renal insufficiency give 6 to 10 mcg/kg IBW. A-fib: 10 to 15 mcg/kg IBW given as above. (If given IVPush-admin over at least 5 min). PSVT: (For patients not on digoxin): 0.25 to 0.5 mg IV. May follow with 0.125 to 0.25 mg IV q2-6h until 0.75 to 1.5 mg is given over 24hrs. [Loading: 10 to 15 mcg/kg IBW in divided doses (q4-8h) over 12-24hrs.]  Digoxin is considered to be a 3rd line drug in stable patients who fail to respond to adenosine/verapamil/esmolol. Not preferred drug for PSVT because it is not rapidly effective (may take up to 60 minutes). Maintenance dose: Digoxin clearance= [CRCL + 40] x 1.44 (add 20 instead of 40 if pt has CHF).   Predicted Css= (Dose) (0.65 to 0.8)/ Digoxin clearance.  Alternatively, maint dose= Loading dose x [0.14 x crcl / 500 ]            Avoid IM injections-can lead to severe pain (If it must be given by this route, give deep IM followed by massage). Monitoring: Obtain blood samples at least 4 hrs after IV dose and 6-8hrs after oral dose.  Serum levels: 0.5 to 2.0 ng/ml.  Obtain first level within 24 hours of digitalization. Monitor BUN and serum creatinine q2days (qd if unstable). Monitor apical pulse daily.. Onset/peak: IV: 5-30min/ 1-4hrs        Oral: 1-2hrs/ 2-8 hrs. Time to steady state: 5-7 days (average) ESRD: 15-20 days. Half-life: 38-48 hrs. (anephric: 4-6 days). Conversion from oral to IV: Decrease IV dose by 20 to 25%. When the maintenance dose is given IV, the onset and peak will occur earlier, however the duration of action is the same. Patients' on the "floors" may receive once daily IV maintenance doses, however, IV loading regimens (multiple doses) are restricted to pts on a monitor- ICU's. [Oral bioavailability (tablets): 70 to 80%]. Factors that increase likelihood of digoxin toxicity: Hypokalemia, hypomagnesaemia, hypothyroidism, renal dysfunction, interacting drugs (eg quinidine, verapamil). Adverse reactions: sinus bradyarrhythmias; AV block; N/V/D; yellow vision and hallucinations; supra and ventricular arrhythmias.  Contraindications: V-fibrillation; hypokalemia; WPW syndrome with wide complex. digoxin-Immune Fab (Digibind ®) Dilution: Prescribed dose/ 50 ml NS. (Must use 0.22 micron filter) Improvement in signs and symptoms usually begins in 30 minutes or less. Stability: Use promptly after mixing (may refrigerate up to 4 hours). Reconstitution: Dissolve each vial with 4 ml sterile water (do not shake). May be further diluted with normal saline.   Infuse over 30 minutes-- must use 0.22 micron filter. If cardiac arrest is imminent, may give as a bolus. Number of vials needed =[(steady state serum digoxin level (ng/ml) x weight (kg)] / 100. Each vial contains 38 mg which will bind approximately 0.5 mg of digoxin. Dosage for acute ingestion of unknown amount: 20 vials (760mg) of Digibind is adequate to treat most life-threatening ingestions. May consider giving 10 vials, observing the patient's response, and following with an additional 10 vials. Dosage for toxicity during chronic therapy: for adults, 6 vials (228mg) usually is adequate to reverse most cases of toxicity. This dose can be used in patients in acute distress or when a serum concentration is not available. disopyramide (Norpace ®) Dosing: <50 kg: 100 mg orally every 6 hours or 200 mg every 12 hours (controlled release) >50 kg: 150 mg every 6 hours or 300 mg every 12 hours (controlled release); if no response, may increase to 200 mg every 6 hours; maximum dose required for patients with severe refractory ventricular tachycardia is 400 mg every 6 hours. Renal Dosing:   CRCL 30-40 ml/minute: 100mg every 8 hours   CRCL 15-30 ml/minute: 100mg every 12 hours   CRCL <15 ml/minute: 100mg every 24 hours Supplied: (Norpace®): Capsule 100 mg, 150 mg (Norpace® CR): Capsule (controlled release) 100 mg, 150 mg dofetilide (Tikosyn ®) C lass III antiarrhythmic agent Warnings: Review package insert for additional comments. Consult cardiology. A-fib/Flutter: Dosing:  Usual initial dose: 500 mcg orally twice daily. Dosage modification: QTc interval should be measured 2-3 hours after the initial dose. If the QTc >15% of baseline, or if the QTc is >500 msec (550 msec in patients with ventricular conduction abnormalities), dofetilide should be adjusted. If the starting dose is 500 mcg twice daily, then adjust to 250 mcg twice daily. If the starting dose was 250 mcg twice daily, then adjust to 125 mcg twice daily. If the starting dose was 125 mcg twice daily, then adjust to 125 mcg every day. Continued monitoring for doses 2-5: QTc interval must be determined 2-3 hours after each subsequent dose of dofetilide for in-hospital doses 2-5. If the measured QTc is >500 msec (550 msec in patients with ventricular conduction abnormalities) dofetilide should be stopped. Renal Dosing: CRCL >60 ml/min: Administer 500 mcg twice daily. CRCL 40-60 ml/min: Administer 250 mcg twice daily. CRCL 20-39 ml/min: Administer 125 mcg twice daily. CRCL <20 ml/min: Contraindicated in this group Supplied: 125 mcg, 250 mcg, 500 mcg capsule epinephrine Dosing (adults): Asystole: 1 mg IV every 3-5 minutes. Intratracheal: Administer 2-2.5 times the recommended I.V. dose; dilute in 10 ml NS or distilled water. Bronchospasm: 0.1-0.5 mg  IM, SQ (1:1000): every 10-15 minutes to 4 hours.  Hypotension (refractory to dopamine/dobutamine): Initial (continuous infusion): 1 mcg/minute (range: 1-10 mcg/minute); titrate to desired effect; severe cardiac dysfunction may require doses >10 mcg/minute (up to 0.1 mcg/kg/minute). Hypersensitivity reaction: 0.2-0.5 mg IM, SQ every 20 minutes to 4 hours (maximum single dose: 1 mg) Esmolol (Brevibloc ®) PSVT: (note: IV beta blockers should not be given within 30 minutes of verapamil): 500 mcg/kg IV over 1 minute, followed by 50 mcg/kg/minute over 4 minutes. If ineffective, repeat load of 500 mcg/kg, followed by 100 mcg/kg/min. If needed, may repeat process of loading dose plus increase infusion by another 50 mcg/kg/min (up to max of 200 mcg/kg/min).   Half life: 10 minutes.  Contraindicated in: sinus bradycardia; > 1st degree heart block; overt cardiac failure. Adverse reactions: dose related hypotension; ventricular arrhythmias; heart failure. Drip preparation: Add 2.5 grams/ 250 ml D5W or NS [Drip rate (ml/hr)= wt(kg) x mcg/min x 0.006 ] flecainide (Tambocor ®) Dosing (adults): Life-threatening ventricular arrhythmias: Oral:   Initial: 100 mg every 12 hours; increase by 50-100 mg/day (given in 2 doses/day) every 4 days; maximum: 400 mg/day.  For patients receiving 400 mg/day who are not controlled and have trough concentrations <0.6 mcg/ml, dosage may be increased to 600 mg/day. Prevention of paroxysmal supraventricular arrhythmias: Oral: (In patients with disabling symptoms but no structural heart disease)  Initial: 50 mg every 12 hours; increase by 50 mg twice daily at 4-day intervals; maximum: 300 mg/day. Renal Dosing: CRCL <10 ml/minute: Decrease usual dose by 25% to 50% in severe renal impairment.  Supplied: 50 mg, 100 mg, 150 mg tablet. ibutilide (Corvert ®) FDA-approved for acute termination of A-flutter/A-fib (may be alternative to cardioversion): 1mg IV over 10min. May repeat x 1 in 10 minutes if needed. Approved for acute termination. Monitor ECG for at least 4hr . Effective in @30% of patients. Major adverse reactions: proarrhythmic events: VT, PVC's, BC, AV block, torsades de pointes, etc. IVPB: 0 to 1 mg/50 ml D5W or NS over 10 minutes. If patient is < 60kg give 0.01 mg/kg over 10 minutes. May repeat x 1 isoproternol (Isuprel ®)   Beta1/Beta2 agonist Dosing (adults): Cardiac arrhythmias: Initial: 2 mcg/minute IV; titrate to patient response (2-10 mcg/minute). Supplied: 0.02 mg/ml (10 ml); 0.2 mg/ml (1:5000) (1 ml, 5 ml). lidocaine (Xylocaine ®) Dosing (adults): Ventricular arrhythmia: 1-1.5 mg/kg IV bolus over 2-3 minutes; may repeat doses of 0.5-0.75 mg/kg in 5-10 minutes up to a total of 3 mg/kg; continuous infusion: 1-4 mg/minute.   Intratracheal: 2-2.5 times the recommended I.V. dose; dilute in 10 ml NS or distilled water. Prevention of ventricular fibrillation: Initial bolus: 0.5 mg/kg; repeat every 5-10 minutes to a total dose of 2 mg/kg.  Refractory ventricular fibrillation: Repeat 1.5 mg/kg bolus may be given 3-5 minutes after initial dose.   E.T. (loading dose only): 2-2.5 times the IV dose Note: Decrease dose in patients with CHF, elderly, hepatic disease. mexiletine (Mexitil ®) Class IB Antiarrhythmic Agent Dosing (adults): Arrhythmias: Oral: Initial: 200 mg every 8 hours with food (may load with 400 mg if necessary); adjust dose every 2-3 days; usual dose: 200-300 mg every 8 hours; maximum: 1.2 g/day (some patients respond to every 12-hour dosing). When switching from another antiarrhythmic, initiate a 200 mg dose 6-12 hours after stopping former agents, 3-6 hours after stopping procainamide. Supplied: 150 mg, 200 mg, 250 mg capsule. moricizine (Ethmozine ®) Dosing (adults): — Ventricular arrhythmias: Oral: 200-300 mg every 8 hours, adjust dosage at 150 mg/day at 3-day intervals. Hospitalization required to start therapy. Renal or hepatic impairment: Start at 600 mg/day or less. Supplied: 200 mg, 250 mg, 300 mg tablet procainamide (Pronestyl ®) VENTRICULAR FIBRILLATION/ PULSELESS V-tach: Give 20-30 mg/minute until (maximum total of 17 mg/kg) or side effects occur or arrhythmia subsides. Side effects: Severe hypotension with rapid infusion; bradycardia; AV block; V-fib.    Loading regimen: 20-30 mg/min. Add 1 gram/250 ml D5W. Rate: 20 mg/min= 300 ml/hr; 30 mg/min= 450 ml/hr. Continuous infusion: 1 to 4 mg/min (monitor levels). Add 1 gram/250 ml D5W. Rate (ml/hr)= mg/min x 15 Note: Reduce to 12 mg/kg in setting of cardiac or renal dysfunction Oral: 250-500 mg/dose every 3-6 hours or 500 mg to 1 g every 6 hours extended release; usual dose: 50 mg/kg/24 hours; maximum: 4 g/24 hours. Renal Dosing: crcl 10-50 ml/minute: Administer every 6-12 hours. crcl <10 ml/minute: Administer every 8-24 hours. Hepatic impairment: Reduce dose by 50%. Supplied: 250 mg, 500 mg capsule. ER Tab: 500 mg, 750 mg, 1000 mg. Injection: 100 mg/ml (10 ml); 500 mg/ml (2 ml). propafenone (Rythmol ®) Dosing (adults): Ventricular arrhythmias:  Immediate release tablet: Initial: 150 mg every 8 hours, increase at 3- to 4-day intervals up to 300 mg every 8 hours.   Extended release capsule: Initial: 225 mg every 12 hours; dosage increase may be made at a minimum of 5-day intervals; may increase to 325 mg every 12 hours; if further increase is necessary, may increase to 425 mg every 12 hours.  Note: Patients who exhibit significant widening of QRS complex or second- or third-degree AV block may need dose reduction. Supplied: 225 mg, 325 mg, 425 mg extended release cap. 150 mg, 225 mg, 300 mg tablet. quinidine Dosing (adults): Antiarrhythmic: (Oral) Sulfate: 100-600 mg/dose every 4-6 hours; begin at 200 mg/dose and titrate to desired effect (maximum daily dose: 3-4 g)    Gluconate: 324-972 mg every 8-12 hours.  ( 267 mg of quinidine gluconate = 275 mg of quinidine polygalacturonate = 200 mg of quinidine sulfate. ) Renal Dosing: Crcl <10 ml/minute: Administer 75% of normal dose. Supplied: 200 mg, 300 mg tab (sulfate). 300mg extended release tablet (sulfate). 324 mg extended release tab (gluconate). Injection: 80 mg/ml (10 ml) (gluconate) sotalol (Betapace ®) Dosing (adults): Ventricular arrhythmias - Initial: 80 mg orally twice daily; dose may be increased gradually to 240-320 mg/day; allow 3 days between dosing increments (to attain steady-state plasma concentrations and to allow monitoring of QT intervals). Usual range: Most patients respond to 160-320 mg/day in 2-3 divided doses.  Atrial fibrillation / atrial flutter: Initial: 80 mg orally twice daily. Note: If the initial dose does not reduce the frequency of relapses of atrial fibrillation/flutter and is tolerated without excessive QT prolongation (not >520 msec) after 3 days, the dose may be increased to 120 mg twice daily. This may be further increased to 160 mg twice daily if response is inadequate and QT prolongation is not excessive. Renal Dosing:  Ventricular arrhythmias (Betapace®):   Crcl >60 ml/min: Administer every 12 hours.   Crcl 30-60 ml/min: Administer every 24 hours.   Crcl 10-30 ml/min: Administer every 36-48 hours.   Crcl <10 ml/min: Individualize dose. Atrial fibrillation/flutter (Betapace AF®):   Crcl >60 ml/min: Administer every 12 hours.   Crcl 40-60 ml/min: Administer every 24 hours.   Crcl <40 ml/min: Use is contraindicated. Supplied: 80 mg, 120 mg, 160 mg, 240 mg tablet tocainide (Tonocard ®) Dosing (adults): Ventricular arrhythmias: Oral: 1200-1800 mg/day in 3 divided doses, up to 2400 mg/day Renal Dosing: Crcl <30 ml/min: Administer 50% of normal dose or 600 mg once daily. Hepatic impairment: Maximum daily dose: 1200 mg Supplied: 400, 600mg tab. verapamil PSVT: 2.5 to 5 mg IV over 2 minutes. May repeat dose of 5-10mg 15-30 minutes after 1st dose. Alternative initial choice in stable patients. Decrease dose by 30-50% in hepatic insufficiency. Adverse reactions: Severe hypotension; bradycardia; ventricular standstill in digitalized patients; asystole; respiratory failure.  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.  ");s1[13]=new Array("anticholinergic.htm","Anticholinergic agents","Anticholinergic agents--dosing list for health care providers, pharmacists, nurses, physicians.","Anticholinergic agents Gastrointestinal antispasmotic agents: Atropine, Dicyclomine, Glycopyrrolate, Hyoscyamine, Donnatal, Propantheline. Urinary antispasmotic agents: Flavoxate, Oxybutynin , Propantheline ,Tolterodine Dicyclomine (Bentyl ®): Indications: Treatment of functional disturbances of GI motility such as irritable bowel syndrome. Onset: 1-2hrs. Duration: up to 4 hours. Dosing: 20mg orally or intramuscularly every 6 hours (up to 40 mg every 6 hours).  Do not give IV. Donnatal ®: [Hyoscyamine 0.1037mg + atropine 0.019mg +scopolamine 0.007mg + phenobarbital 16.2mg] Indications: Adjunct in the treatment of PUD, irritable bowel, spastic colitis, spastic bladder, and renal colic. Dosing: 1-2 capsules or tablets three to four times daily or 1 extentab orally every 12 hours; or 5-10 ml of elixir three to four times daily. Flavoxate (Urispas ®): Indications: Antispasmotic used to provide symptomatic relief of dysuria, nocturia, supra-pubic pain, urgency, and incontinence. Especially useful for treatment of bladder spasticity. Onset: 55-60 min. Dosing: 100-200mg orally three to four times daily. Glycopyrrolate (Robinul ®): Indications: Adjunct in the treatment of PUD; inhibits salivation and excessive secretions of the respiratory tract preoperatively; reversal of neuromuscular blockade; control of upper airway secretions. Onset: Oral: with in 50 min; IM: 20-40min ; IV: 10-15min.   Dosing: Intraoperative: IV: 0.1 mg q2-3min as needed;  Peptic ulcer: Oral: 1-2mg 2 to 3 times daily.   Decrease secretions: 0.1 to 0.2 mg 3 to 4 times daily IM/IV or 1 mg orally 2 to 3 times a day. Hyoscyamine (Levsin ®): Belladonna alkaloid. Indications: Adjunctive therapy of gastrointestinal disorders caused by spasm;  treatment of urinary hypermotility as well as bladder spasm. Onset: 2-3 min. Duration: 4-6hrs.   Dosing: Oral or S.L. : 0.125 to 0.25 mg (1-2 tabs) three to four times daily before meals. Levsinex ®: 0.375 to 0.75 mg (1-2 caps) orally every 12 hours.  IV, IM, SC: 0.25-0.5 mg every 6 hours. Oxybutynin (Ditropan ®): Ditropan ® Indications: (Overactive bladder) Antispasmotic for neurogenic bladder (urgency, frequency, urge incontinence) and uninhibited bladder. Onset: 30-60min. Peak effect: 3-6 hours. Duration: 6-10 hrs. Dosing: 5 mg orally 2 to 3 times daily (up to 4 times a day--maximum). [Supplied: 5 mg tablet and syrup: 5 mg/5 ml] Ditropan XL ®: 5 to 10 mg orally once daily. May increase dose if needed by 5 mg increments at weekly intervals to a maximum dose of 30mg per day. [Supplied: 5 mg, 10mg , 15mg tablets] Oxytrol ®: Transdermal Patch (3.9 mg/day). Apply patch twice weekly (every 3 to 4 days). Use a new application site for each new patch. Propantheline (Pro-Banthine ®): Indications: Adjunctive therapy of peptic ulcer, irritable bowel syndrome, pancreatitis, ureteral and urinary bladder spasm; reduce duodenal motility during radiologic procedures. Onset: 30-45min. Duration: 4-6hrs.  Dosing: 15mg orally 3 times a day before meals and 30mg at bedtime.    Supplied: [7.5mg, 15mg tab] Tolterodine (Detrol ®): Selective anticholinergic agent (increased selectivity for urinary bladder) Indications: Therapy of urinary frequency; urgency; urge incontinence. Reduces bladder spasm. Onset: 1 hr. Dosing: 2 mg orally twice a day, decreasing to 1 mg twice a day in the event of bothersome anticholinergic effects.   Extented release tablets: 4 mg once daily. May decrease dose to 2 mg once daily if there are bothersome anticholinergic effects. Supplied: [1 mg, 2 mg tablets.  Extended release capsules: 2mg, 4 mg.]   Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.   Author: David McAuley Keywords: Anticholinergics, pharmacists, nursing, physicians,Donnatal, hyoscyamine, dicyclomine, propantheline, glycopyrrolate.");s1[14]=new Array("alzheimers.htm","Alzheimers Disease - Therapeutic agents ","","Alzheimer's Disease - Therapeutic agents Reversible, competitive acetylcholinesterase inhibitors donepezil (Aricept ®): Indications: mild to moderate dementia of the Alzheimer's type. Dosing (initial): 5 mg po qd. Usual range: 5 - 10 mg po qd. Because the incidence of untoward effects may be influenced by the rate of dose escalation, treatment with a dose of 10 mg should not be contemplated until patients have been on a daily dose of 5 mg for 4 to 6 weeks. [Supplied: 5,10mg tabs] Galantamine (Reminyl ®): Indications: mild to moderate dementia of the Alzheimer's type. Dosing (initial): 4 mg po bid. After a minimum of 4 weeks of treatment, if this dose is well tolerated, the dose should be increased to 8 mg twice a day (16 mg/day). A further increase to 12 mg twice a day (24 mg/day) should be attempted only after a minimum of 4 weeks at the previous dose. Recommended dosage range: 16-24 mg (e.g. 8-12 mg po bid). Reminyl ® should be administered twice a day, preferably with morning and evening meals. [Supplied: 4,8,12mg tabs] rivastigmine (Exelon ®): Indications: treatment of mild to moderate dementia of the Alzheimer's type. Initial dose: 1.5 mg po bid. If this dose is well tolerated, after a minimum of two weeks of treatment, the dose may be increased to 3 mg BID. Subsequent increases to 4.5 mg BID and 6 mg BID should be attempted after a minimum of 2 weeks at the previous dose. If adverse effects such as nausea & vomiting, abdominal pain or loss of appetite cause intolerance during treatment, the patient should be instructed to discontinue treatment for several doses and then restart at the same or next lower dose level. The maximum dose is 6 mg BID (12 mg/day). Exelon should be taken with meals in divided doses in the morning and evening. [Supplied: 1.5, 3, 4.5, 6mg caps] tacrine (Cognex ®): Initial dosing: 10mg po qid. This dose should be maintained for a minimum of 4 weeks with every other week monitoring of transaminase levels beginning 4 weeks after initiation of treatment. It is important that the dose not be increased during this period because of the potential for delayed onset of transaminase elevations. Dose Titration: Following 4 weeks of treatment at 40 mg/day (10 mg qid), the dose of Cognex® should then be increased to 80 mg/day (20 mg qid), providing there are no significant transaminase elevations and the patient is tolerating treatment. Patients should be titrated to higher doses (120 and 160 mg/day, in divided doses on a qid schedule) at 4-week intervals on the basis of tolerance. [Supplied: 10,20,30,40mg capsules] Non-competitive N-methyl-D-aspartate (NMDA) receptor antagonist memantine (Namenda ®): Indication: moderate to severe alzheimer's dementia. Starting dose: 5 mg orally once daily, with an eventual target dose of 10 mg orally twice daily (20mg/day).  The dose should be increased at 5 mg increments (wait at least 1 week between dosage increments). Sample regimen: 5 mg once daily --> (7 days later) 5 mg orally twice daily --> (7 days later) 5 mg in the morning and 10 mg in the evening, etc.  Reduce dose in patients with moderate renal insufficiency and AVOID use in patients with severe renal insufficiency.   [Supplied: 5mg , 10mg tablets]  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.  ");s1[15]=new Array("anesthetics.htm","Anesthetics / Sedatives","","Anesthetics /Sedatives dexmedetomidine (Precedex ®) Alpha2-adrenergic agonist sedative. Dosing (adults):  ICU sedation: Initial: Loading infusion of 1 mcg/kg IV over 10 minutes, followed by a maintenance infusion of 0.2-0.7 mcg/kg/hour (individualized and titrated to desired clinical effect); not indicated for infusions lasting >24 hours (Solution must be diluted prior to administration.) Supplied: 100 mcg/ml - 2 ml Injection etomidate (Amidate ®) Ultrashort-acting nonbarbiturate hypnotic. Dosing (adults): Anesthesia: Initial: 0.2-0.6 mg/kg IV over 30-60 seconds for induction of anesthesia; maintenance: 5-20 mcg/kg/minute. Produces rapid induction of anesthesia with minimal cardiovascular effects. Onset of action: 30-60 seconds.   Peak effect: 1 minute. Duration: 3-5 minutes ( terminated by redistribution). Supplied: 2 mg/ml (10 ml, 20 ml) injection. ketamine (Ketalar ®) Produces a cataleptic-like state in which the patient is dissociated from the surrounding environment by direct action on the cortex and limbic system. Releases endogenous catecholamines (epinephrine, norepinephrine) which maintain blood pressure and heart rate. Reduces polysynaptic spinal reflexes.   Dosing (adults): Anesthesia (sedation, analgesia): IM: 3-8 mg/kg.    IV: Range: 1-4.5 mg/kg; usual induction dosage: 1-2 mg/kg.  Maintenance: Supplemental doses of 1/3 to 1/2 of initial dose. Onset of action: (IV): General anesthesia: 1-2 minutes; Sedation: 1-2 minutes. (IM): General anesthesia: 3-8 minutes. Duration: 5-15 minutes IV; 12-25 minutes IM. Supplied: Injection, solution: 50 mg/ml (10 ml); 100 mg/ml (5 ml). Ketalar®: 10 mg/ml (20 ml); 50 mg/ml (10 ml); 100 mg/ml (5 ml). methohexital (Brevital ®) Ultra short-acting IV barbiturate anesthetic Dosing (adults): Anesthesia: IV: Induction: 50-120 mg to start; 20-40 mg every 4-7 minutes. (doses must be titrated to effect). Onset: IV: Immediately Duration: Single dose: 10-20 minutes Supplied: 500 mg, 2.5 g, 5 gram (powder for reconstitution) pentobarbital (Nembutal ®) Short-acting barbiturate with sedative, hypnotic, and anticonvulsant properties.   Dosing (adults): Hypnotic: IM: 150-200 mg.   IV: Initial: 100 mg, may repeat every 1-3 minutes up to 200-500 mg total dose.   Preoperative sedation: IM: 150-200 mg.     Barbiturate coma in head injury patients or status epilepticus: IV: Loading dose: 5-10 mg/kg given slowly over 1-2 hours; monitor blood pressure and respiratory rate; maintenance infusion: initial: 1 mg/kg/hour; may increase to 2-3 mg/kg/hour; maintain burst suppression on EEG.    Status epilepticus: IV: Loading dose: 2-15 mg/kg given slowly over 1-2 hours; maintenance infusion: 0.5-3 mg/kg/hour. Onset: IM: 10-15 minutes. IV: ~ 1 minute. Duration: IV: 15 minutes Supplied: Injection: 50 mg/ml (20 ml, 50 ml). propofol (Diprivan ®) Dosing (adults): Induction:   General anesthesia:  ASA I or II, <55 years: 2-2.5 mg/kg IV (~40 mg every 10 seconds until onset of induction).  Cardiac anesthesia: 0.5-1.5 mg/kg IV (~20 mg every 10 seconds until onset of induction). Neurosurgical patients: 1-2 mg/kg IV (~20 mg every 10 seconds until onset of induction). Maintenance:  ASA I or II, <55 years:  IV infusion: Initial: 150-200 mcg/kg/minute for 10-15 minutes; decrease by 30% to 50% during first 30 minutes of maintenance; usual infusion rate: 100-200 mcg/kg/minute (6-12 mg/kg/hour).    IV intermittent bolus: 20-50 mg increments as needed.  ICU sedation in intubated mechanically-ventilated patients: Avoid rapid bolus injection; individualize dose and titrate to response. Continuous infusion: Initial: 0.3 mg/kg/hour (5 mcg/kg/min); increase by 0.3-0.6 mg/kg/hour (5-10 mcg/kg/min) every 5-10 minutes until desired sedation level is achieved; usual maintenance: 0.3-4.8 mg/kg/hour (5-80 mcg/kg/min) or higher. Onset: Anesthetic: Bolus infusion (dose dependent): 9-51 seconds (average 30 seconds). Duration (dose and rate dependent): 3-10 minutes. Supplied: Injection: 10 mg/ml (20 ml, 50 ml, 100 ml). thiopental (Pentothal ®) Dosing (adults): Anesthesia: IV:  Induction: 3-5 mg/kg. Maintenance: 25-100 mg as needed.    Increased intracranial pressure: IV: Children and Adults: 1.5-5 mg/kg/dose; repeat as needed to control intracranial pressure.   Seizures: I.V.: 75-250 mg/dose, repeat as needed. Renal dosing: crcl <10 ml/minute: Administer 75% of normal dose. Onset: Anesthetic: IV: 30-60 seconds. Duration: 5-30 minutes. Supplied: Powder for reconstitution: 250 mg, 400 mg, 500 mg, 1 g.  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.  ");s1[16]=new Array("anticonvulsants.htm","Anticonvulsants (Adult dosing)","","Anticonvulsants (Adult dosing) carbamazepine (Tegretol ®) Adults: Epilepsy: initially 200 mg twice daily. Increase by 200 mg/day at weekly intervals until therapeutic levels are obtained. Usual range: 800-1200mg/day divided in 3 to 4 doses. Maximum recommended dose: 1600 mg/day. Doses as high as 2.4 grams/day have been given.   Trigeminal or glossopharyngeal neuralgia: Oral: Initial: 100 mg twice daily with food, gradually increasing in increments of 100 mg twice daily as needed. Maintenance: Usual: 400-800 mg daily in 2 divided doses; maximum dose: 1200 mg/day. Supplied: Extended release cap: 100 mg, 200 mg, 300 mg. Oral suspension: 100 mg/5 ml (10 ml, 450 ml). Tablet: 200 mg. Chewable tab: 100 mg. ER Tab: 100 mg, 200 mg, 400 mg. clonazepam (Klonopin ®): Start 0.5 mg orally three times daily. Maximum: 20 mg/day.  [Supplied: 0.5,1, 2mg tabs] diazepam (Valium ®): Adults: Status epilepticus: IV: 5-10 mg every 10-20 minutes, up to 30 mg in an 8-hour period; may repeat in 2-4 hours if necessary. Anxiety/sedation/skeletal muscle relaxation: Oral: 2-10 mg 2 to 4 times/day. IM, IV: 2-10 mg, may repeat in 3-4 hours if needed. ethosuximide (Zarontin ®): Initially, 250mg orally twice a day. Maintenance 20-30mg/kg/day in divided doses twice daily. Maximum: 1.5g/day felbamate (Felbatol ®): Start: 400mg orally three times daily. Range: 1200 to 3600 mg daily (divided in 3 to 4 doses).  Supplied: [400 , 600 mg tablets] fosphenytoin (Cerebyx ®): Load: 15-20 mg/kg IM/IV. Max rate: 100-150 mg/min. Maintenance: 4 to 6 mg/kg/day divided doses every 8 to 12 hours. gabapentin (Neurontin ®): General dosing: Start 300mg at bedtime. Increase over few days to 300 to 600mg orally three times daily. Maximum: 3600mg/day. Dosing (Adults): Anticonvulsant: Oral:  Initial: 300 mg 3 times/day, if necessary the dose may be increased up to 1800 mg/day.   Maintenance: 900-1800 mg/day administered in 3 divided doses; doses of up to 2400 mg/day have been tolerated in long-term clinical studies; up to 3600 mg/day has been tolerated in short-term studies. Postherpetic neuralgia: Day 1: 300 mg, Day 2: 300 mg twice daily, Day 3: 300 mg 3 times/day; dose may be titrated as needed for pain relief (range: 1800-3600 mg/day, daily doses >1800 mg do not generally show greater benefit) Renal dosing:   Crcl > 60 ml/minute: 300-1200 mg 3 times/day. Crcl >30-59 ml/minute:200-700 mg twice/day. Crcl >15-29 ml/minute: 200-700 mg/day.  Crcl 15 ml/minute: 100-300mg/day. Crcl <15 ml/minute: Reduce daily dose in proportion to creatinine clearance. Supplied: Capsule: 100 mg, 300 mg, 400 mg. Oral Solution: 250 mg/5 ml (480 ml). Tablet: 100 mg, 300 mg, 400 mg. levetiracetam (Keppra ®) Adjunctive therapy in the treatment of partial-onset seizures. Start 500mg orally twice daily. Maximum: 1500 mg orally twice daily.  (May adjust dose every 2 weeks).  There is no evidence that doses greater than 3000 mg/day confer additional benefit. Renal dosing:  CRCL 50-80: 500 to 1,000 q12h.  (30-50 ml/min): 250 to 750 q12h.  (CRCL <30 ml/min): 250 to 500 q12h.  ( ESRD - dialysis): 500 to 1,000mg q24h. Following dialysis, a 250 to 500 mg supplemental dose is recommended.  [Supplied: 250, 500, 750mg tablets] lamotrigine (Lamictal ®): Partial/secondary generalized seizures: start: 50-100mg/day, then titrate to 100-400 mg/day in 1-2 divided doses. Possible life-threatening rash. [Supplied: 25, 100, 150, 200mg tablets] lorazepam (Ativan ®):   Dosing (Adults): Antiemetic: Oral, IV: 0.5-2 mg every 4-6 hours as needed.   Anxiety and sedation: Oral: 1-10 mg/day in 2-3 divided doses; usual dose: 2-6 mg/day in divided doses; initial dose should not exceed 2 mg in debilitated patients. Insomnia: Oral: 2-4 mg at bedtime.    Preoperative:  IM: 0.05 mg/kg administered 2 hours before surgery; maximum: 4 mg/dose.  IV: 0.044 mg/kg 15-20 minutes before surgery; usual maximum: 2 mg/dose.  Status epilepticus: IV: 4 mg/dose given slowly over 2-5 minutes; may repeat in 10-15 minutes; usual maximum dose: 8 mg.    Rapid tranquilization of agitated patient (administer every 30-60 minutes):   Oral: 1-2 mg. IM: 0.5-1 mg.  Agitation in the ICU patient (unlabeled):  IV: 0.02-0.06 mg/kg every 2-6 hours. Alternatively - IV infusion: 0.01-0.1 mg/kg/hour. Onset:   Hypnosis: IM: 20-30 minutes. Sedation: IV: 5-20 minutes. Anticonvulsant: IV: 5 minutes, oral: 30-60 minutes. Duration: 6-8 hours. Supplied: Injection: 2 mg/ml (1 ml, 10 ml); 4 mg/ml (1 ml, 10 ml). Oral concentrate: 2 mg/ml (30 ml). Tablet: 0.5 mg, 1 mg, 2 mg. oxcarbazepine (Trileptal ®) Adjunctive treatment and monotherapy in the treatment of partial seizures in adults and as adjunctive treatment for partial seizures in children ages 4-16.  Adults (initial dosing) adjunctive therapy: 300mg orally twice daily. If clinically indicated, the dose may be increased by a maximum of 600 mg/day at approximately weekly intervals. Recommend dose: 600mg orally twice daily. Conversion to monotherapy: Patients receiving concomitant anticonvulsants may be converted to monotherapy by initiating with 300mg orally twice daily while simultaneously initiating the reduction of the dose of the concomitant anticonvulsants. The concomitant anticonvulsants should be completely withdrawn over 3-6 weeks, while the maximum dose of Trileptal should be reached in about 2-4 weeks. Trileptal may be increased as clinically indicated by a maximum increment of 600 mg/day at approximately weekly intervals to achieve the recommended daily dose of 2400 mg/day. [Supplied: 150, 300, 600mg tabs] phenobarbital: Dosing (Adults): Sedation: Oral, IM: 30-120 mg/day in 2-3 divided doses. Hypnotic: Oral, IM, IV, SQ: 100-320 mg at bedtime. Preoperative sedation: IM: 100-200 mg 1-1.5 hours before procedure.   Status epilepticus: Adults: 300-800 mg initially followed by 120-240 mg/dose at 20-minute intervals until seizures are controlled or a total dose of 20mg/kg. (Maintenance): 1 to 3 mg/kg/day in divided doses or 50-100 mg 2 to 3 times/day. Supplied: Tablet: 15 mg, 30 mg, 32 mg, 60 mg, 65 mg, 100 mg. Elixir: 20 mg/5 ml (473 ml).   Injection: 65 mg/ml (1 ml); 130 mg/ml (1 ml). phenytoin (Dilantin ®): Loading Dose (IV): 10 - 20 mg/kg. Maximum rate: 50 mg/min. Recommended infusion rate for adults: 40-50 mg/min. Elderly (>65): Recommended infusion rate: 20-25 mg/min.  Oral loading: Give in 3 to 4 divided doses at q2h intervals. (Divided doses increase bioavailability as well as decrease potential for GI side effects such as N&V). The maximum single oral dose should not exceed 400 mg in order to minimize GI side effects and also increase absorption (decrease likelihood of concretions). Maintenance: 4-6 mg/kg/day given in 2 to 3 divided doses. Equation used to estimate the dose required to increase current level to normal range if sub-therapeutic: [ 0.7 x IBW x (15 - current level)]. Oral suspension administration: Shake well prior to use. Divide the daily dose of phenytoin and withhold the administration of nutritional supplements for 1-2 hours before and after each phenytoin dose. Sampling: 18 to 24 hours after the loading dose, and then every 5 to 7 days to assess trend. Average time to steady state: 10-14 days. Half-life: 7 to 42 hours (average = 24 hours). Conversion to once daily dosing: Consider only after a divided dose regimen on extended phenytoin capsules is established. (Only extended release Dilantin caps are recommended for once daily administration.) A patient should never receive a once daily dose of elixir or injection as maintenance. When do you start the maintenance dose? The maintenance dose is started 18-24 hours after the loading dose. Capsules/injection= 92% phenytoin (sodium salt).   Elixir/tabs=100% phenytoin.  Equation used to estimate the dose required to increase current level to normal range if subtherapeutic: = [0.7 x IBW x (15 - current level) ] / 0.92* * (if capsules/injection used) Adjusted phenytoin concentration if low serum albumin = measured total concentration / [ (0.2 x albumin) + 0.1]. Renal failure: Cadjusted = Cmeasured / [ (0.1 x albumin) + 0.1) ] pregabalin (Lyrica ®): Dosing (Adults):  Diabetic peripheral neuropathy: initial, 50 mg orally three times a day (150 mg/day) and may be increased to 100 mg orally three times a day (300 mg/day) within 1 week based on efficacy and tolerability.   Postherpetic neuralgia: initial, 75 mg orally two times a day or 50 mg orally three times a day; may be increased to 300 mg/day within 1 week based on efficacy and tolerability. (Maintenance): 75 to 150 mg orally two times a day or 50 to 100 mg orally three times a day (150 to 300 mg/day). If patients do not experience sufficient pain relief following 2 to 4 weeks of treatment with 300 mg/day and are tolerating pregabalin -- may increase dose up to 300 mg two times a day, or 200 mg three times a day (600 mg/day). Renal dosing:   Crcl 30 to 60 ml/min: 75 to 300 mg/day in 2 to 3 divided doses. Crcl 15 to 30 ml/min: 25 to 150 mg/day given once daily or in 2 divided doses. Crcl < 15: 25 to 75 mg once daily. hemodialysis: see package insert. Supplied: Oral Capsule: 25, 50, 75, 100, 150, 200, 225, 300 mg. primidone (Mysoline ®): Start:100-125 mg orally at bedtime, increase over 10 days to 250mg orally 3 to 4 times daily. tiagabine (Gabitril ®): Start:4 mg orally once daily, increase as needed to maximum of 56mg/day divided doses (2 to 4 times daily).   [Supplied: 2, 4, 12, 16, 20mg tablets] topiramate (Topamax ®): Start: 50 mg at bedtime, then increase by 50mg/day (divided doses) once weekly to usual effective dose of 200mg orally twice a day. [Supplied: 15mg, 25mg capsules.  25, 50, 100, 200mg tablets] valproic acid: Seizures: 10-15 mg/kg/day oral / IV. Titrate to maximum of 60 mg/kg/day. Mania/migraine prophylaxis: 250 mg orally 2 to 3 times daily. zonisamide (Zonegran ®): (Chemical class: sulfonamide). Indications: adjunctive therapy for the treatment of partial seizures in adults.  Initial dose: 100 mg once daily. After two weeks, the dose may be increased to 200 mg/day for at least two weeks. It can be increased to 300 mg/day and 400 mg/day, with the dose stable for at least two weeks to achieve steady state at each level. Evidence from controlled trials suggests that doses of 100-600 mg/day are effective, but there is no suggestion of increasing response above 400 mg/day. Doses above 100mg may be administered once or twice daily.  [Supplied:25, 50, 100 mg capsule]  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP] Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.");s1[17]=new Array("angiotensin_ii.htm","Angiotensin II inhibitors","","Angiotensin II inhibitors: candesartan (Atacand ®): Hypertension: Start 16 mg orally once a day.  Maximum 32 mg/day.    [Supplied: 4, 8, 16, 32mg tablets] eprosartan mesylate (Teveten) ® Hypertension: Usual initial dose: 600mg once daily. Can be administered once or twice daily with total daily doses ranging from 400 mg to 800 mg. There is limited experience with doses beyond 800 mg/day. [Supplied: 400 and 600 mg tablets] irbesartan (Avapro ®): Hypertension: Start 150 mg orally once daily.  Maximum 300 mg/day.   [Supplied: 75, 150, 300mg tablets] losartan (Cozaar ®): Hypertension: Start 50 mg orally once daily.   Maximum: 100mg/day given once daily or divided doses twice a day. Start with 25 mg orally once daily if history of liver disease.  [Supplied: 25, 50, 100mg tablets] olmesartan (Benicar ®): Hypertension: Start 20 mg orally once daily when used as monotherapy in patients who are not volume-contracted. The dose may be increased to 40 mg after 2 weeks if needed. Doses above 40 mg do not appear to have greater effect. Twice-daily dosing offers no advantage. [Supplied: 5, 20, 40mg tabs] telmisartin (Micardis ®): Hypertension: Start 40 mg orally once daily, Range: 20-80mg/day. Maximum: 80 mg/day.  [Supplied: 40, 80mg tablets] valsartan (Diovan ®): Hypertension: Start 80 mg orally once daily, Maximum: 320 mg/day. [Supplied: 80, 160mg capsules]       Decreased renal perfusion                                                      Angiotensinogen                                                                            ¯ (Renin)                                                            Angiotensin I .                                                                 ¯Lungs (Angiotensin converting enzyme)                                                                                                      (XX) blocked by Ace-inhibitors                    Peripheral          ¬       ¬    Angiotensin II                              vasoconstriction                                 ¯  (XX) blocked by ANG II inhibitors                                 æ                   Increased Aldosterone                                     æ                          ¯                                               æ                  Water retention                                               æ              å                                   Increased renal perfusion  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc.  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.");s1[18]=new Array("antipsychotics.htm","Antipsychotics /  Mood Stabilizers","","Antipsychotics / Mood Stabilizers  High Potency fluphenazine (Prolixin ®): Dosing (Adults): Psychosis: Oral: 0.5-10 mg/day in divided doses at 6 to 8 hour intervals; some patients may require up to 40 mg/day.   IM: 2.5-10 mg/day in divided doses at 6 to 8 hour intervals (parenteral dose is 1/3 to 1/2 the oral dose for the hydrochloride salts). Depot (Long-acting maintenance injections): IM, SQ (decanoate): 12.5 mg every 3 weeks. Conversion from hydrochloride to decanoate IM: 0.5 ml (12.5 mg) decanoate every 3 weeks is approximately equivalent to 10 mg hydrochloride/day. Supplied: 1 mg, 2.5 mg, 5 mg, 10 mg tab. Oral concentrate: 5 mg/ml (120 ml). Injection (decanoate): 25 mg/ml (5 ml) haloperidol (Haldol ®): Butyrophenone antipsychotic. Dosing (Adults): Psychosis: Oral: 0.5-5 mg 2-3 times/day; usual maximum: 30 mg/day.  IM (as lactate): 2-5 mg every 4-8 hours as needed.  (decanoate): Initial: 10-20 times the daily oral dose administered at 4-week intervals. Maintenance dose: 10-15 times initial oral dose; used to stabilize psychiatric symptoms.   ICU- Delirium: 2-10 mg IV - may repeat bolus doses every 20-30 minutes until calm then administer 25% of the maximum dose every 6 hours. Monitor ECG and QTc interval. Alternatively: Continuous I.V. infusion: 3-25 mg/hour. Rapid tranquilization: Oral: 5-10 mg or  IM: 5 mg. Average total dose (oral or IM) for tranquilization: 10-20 mg. Supplied: Tablet: 0.5 mg, 1 mg, 2 mg, 5 mg, 10 mg, 20 mg.  Oral concentrate: 2 mg/ml (15 ml, 120 ml). Injection (decanoate): 50 mg/ml (1 ml, 5 ml); 100 mg/ml (1 ml, 5 ml). Injection (lactate): 5 mg/ml (1 ml, 10 ml). perphenazine (Trilafon ®): Piperazine phenothiazine. Dosing (Adults): Schizophrenia/psychoses: Oral: 4-16 mg 2-4 times/day not to exceed 64 mg/day. Nausea/vomiting: Oral: 8-16 mg/day in divided doses up to 24 mg/day. Supplied: 2 mg, 4 mg, 8 mg, 16 mg tab. pimozide (Orap ®): Dosing (Adults): Tourette's: Oral: Initial: 1-2 mg/day, then increase dosage as needed every other day; range is usually 7-16 mg/day; maximum: 10 mg/day or 0.2 mg/kg/day are not generally recommended. Note: Sudden unexpected deaths have occurred in patients taking doses >10 mg. Note: An ECG should be performed baseline and periodically thereafter, especially during dosage adjustment. Supplied: 1 mg, 2 mg tab. thiothixine (Navane ®): Dosing (Adults):  Mild / moderate psychosis: Oral: 2 mg 3 times/day, up to 20-30 mg/day. Severe psychosis: Initial: 5 mg 2 times/day, may increase gradually, if necessary; maximum: 60 mg/day.  Rapid tranquilization (administered every 30 to 60 minutes): Oral: 5-10 mg; average total dose for tranquilization: 15-30 mg Supplied:  1 mg, 2 mg, 5 mg, 10 mg cap. trifluoperazine (Stelazine ®): Piperazine phenothiazine. Dosing (Adults): Schizophrenia/ psychoses: Oral: Outpt: 1-2 mg twice daily.  Hospitalized / well supervised patient: Initial: 2-5 mg twice daily with optimum response in the 15-20 mg/day range; do not exceed 40 mg/day. Supplied: 1 mg, 2 mg, 5 mg, 10 mg tab. Mid Potency loxapine (Loxitane ®): Dibenzoxazepine antipsychotic. Dosing (Adults): Psychosis: Oral: 10 mg twice daily, increase dose until psychotic symptoms are controlled; usual dose range: 20-100 mg/day in divided doses 2-4 times/day. Dosages > 250 mg/day are not recommended. Supplied: 5 mg, 10 mg, 25 mg, 50 mg cap. molindone (Moban ®): Dosing (Adults): Schizophrenia/psychoses: Oral: 50-75 mg/day increase at 3- to 4-day intervals up to 225 mg/day. Supplied: 5 mg, 10 mg, 25 mg, 50 mg tab. Low Potency chlorpromazine (Thorazine ®): Dosing (Adults): Schizophrenia/psychoses: Oral: Range: 30-800 mg/day in 1-4 divided doses, initiate at lower doses and titrate as needed. Usual dose: 200 mg/day. Some patients may require 1-2 g/day.  IM, IV: Initial: 25 mg, may repeat (25-50 mg) in 1-4 hours - gradually increase to a maximum of 400 mg/dose every 4-6 hours until patient is controlled. Usual dose: 300-800 mg/day.   Intractable hiccups: Oral, IM: 25-50 mg 3-4 times/day.   N/V: Oral: 10-25 mg every 4-6 hours.  IM, IV: 25-50 mg every 4-6 hours. Supplied: 10 mg, 25 mg, 50 mg, 100 mg, 200 mg tab.  Injection: 25 mg/ml (2 ml). thioridazine (Mellaril ®): Dosing (Adults): Schizophrenia/psychosis: Oral: Initial: 50-100 mg 3 times/day with gradual increments as needed and tolerated. Maximum: 800 mg/day in 2-4 divided doses.  Depressive disorders, dementia: Oral: Initial: 25 mg 3 times/day; maintenance dose: 20-200 mg/day. Supplied: 10 mg, 15 mg, 25 mg, 50 mg, 100 mg, 150 mg, 200 mg tab. Atypical antipsychotics olanzepine (Zyprexa ®): Dosing (Adults): Schizophrenia: Oral: Usual starting dose: 5-10 mg once daily - increase to 10 mg once daily within 5-7 days, thereafter adjust by 5 mg/day at 1-week intervals, up to a maximum of 20 mg/day. Doses as high as 30-50 mg per day have been used.   Acute mania associated with bipolar disorder: Oral: Mono- therapy: Usual starting dose: 10-15 mg once daily - increase by 5 mg/day at intervals of not less than 24 hours. Maintenance: 5-20 mg/day. Maximum dose: 20 mg/day.  Combination therapy (with lithium or valproate): Initial: 10 mg once daily; dosing range: 5-20 mg/day.   Agitation (acute, associated with bipolar disorder or schizophrenia): IM: Initial dose: 5-10 mg (a lower dose of 2.5 mg may be considered when clinical factors warrant); additional doses (2.5-10 mg) may be considered; however, 2-4 hours should be allowed between doses to evaluate response (maximum total daily dose: 30 mg, per manufacturer's recommendation). Supplied: 2.5 mg, 5 mg, 7.5 mg, 10 mg, 15 mg, 20 mg tablet.   Orally-disintegrating tab (Zydis®): 5, 10, 15, 20 mg.  Injection: 10 mg (powder for reconstitution) quetiapine (Seroquel ®): Dosing (Adults): Schizophrenia/psychosis: Oral: 25-100 mg 2-3 times/day. Usual starting dose 25 mg twice daily, increased in increments of 25-50 mg 2-3 times/day on the second or third day. By the fourth day, the dose should be in the range of 300-400 mg/day in 2-3 divided doses. Further adjustments may be made, as needed, at intervals of at least 2 days in adjustments of 25-50 mg twice daily. Usual maintenance range: 150-750 mg/day. Mania: Oral: Initial: 50 mg twice daily on day 1, increase dose in increments of 100 mg/day to 200 mg twice daily on day 4; may increase to a target dose of 800 mg/day by day 6 at increments of </= 200 mg/day. Usual dosage range: 400-800 mg/day. Supplied: 25 mg, 100 mg, 200 mg, 300 mg tab. risperidone (Risperdal ®): Dosing (Adults):   Bipolar mania: Oral: Recommended starting dose: 2-3 mg once daily; if needed, adjust dose by 1 mg/day in intervals of at least 24 hours. Dosing range: 1-6 mg/day.   Schizophrenia: Oral: Recommended starting dose: 0.5-1 mg twice daily - slowly increase to the optimum range of 3-6 mg/day. May be given as a single daily dose once maintenance dose is achieved. Daily dosages >10 mg does not appear to confer any additional benefit, and the incidence of extrapyramidal symptoms is higher than with lower doses.  IM (Risperdal ® Consta): 25 mg every 2 weeks. Some patients may benefit from larger doses. Maximum dose not to exceed 50 mg every 2 weeks. Dosage adjustments should not be made more frequently than every 4 weeks.  Supplied: Tablet: 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg.  Oral solution: 1 mg/ml (30 ml). Oral disintegrating tablets (Risperdal M-Tabs): 0.5 mg, 1 mg , 2 mg.     Injection (Risperdal® Consta): 25 mg, 37.5 mg, 50 mg.  ziprasidone (Geodon ®): Dosing (Adults): Bipolar mania: Oral: Initial: 40 mg twice daily (with food).  Adjustment: May increase to 60 or 80 mg twice daily on second day of treatment. Average dose 40-80 mg twice daily. Schizophrenia: Oral: Initial: 20 mg twice daily (with food).  Adjustment: Increases (if indicated) should be made no more frequently than every 2 days; ordinarily patients should be observed for improvement over several weeks before adjusting the dose. Maintenance: Range 20-100 mg twice daily; however, dosages >80 mg twice daily are generally not recommended. Acute agitation (schizophrenia): 10 mg IM every 2 hours or 20 mg every 4 hours (maximum: 40 mg/day). Oral therapy should replace IM administration as soon as possible. Supplied: 20 mg, 40 mg, 60 mg, 80 mg cap. 20 mg - injection (powder for reconstitution). Other aripiprazole (Abilify ®): Dosing (Adults): Bipolar disorder (acute manic or mixed episodes):  Stabilization: Oral: 30 mg once daily; may require a decrease to 15 mg based on tolerability (15% of patients had dose decreased); safety of doses >30 mg/day has not been evaluated.  Maintenance: Continue stabilization dose for up to 6 weeks; efficacy of continued treatment >6 weeks has not been established.    Schizophrenia: Oral: 10-15 mg once daily; may be increased to a maximum of 30 mg once daily (efficacy at dosages above 10-15 mg has not been shown to be increased). Dosage titration should not be more frequent than every 2 weeks. Supplied: 5 mg, 10 mg, 15 mg, 20 mg, 30 mg tab. 1 mg/ml (150 ml) oral soln.  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP] Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.");s1[19]=new Array("antibiotics-other.htm","Antibiotics (other) dosing table ","","Antibiotics (other) Aztreonam Azactam ® [Mild infection] (i.e. UTI): 500mg to 1 gram IV q8-12h. [Usual dose]: 1-2 grams IV q8-12h. [Severe/life threatening infection]: 2 grams IV q6-8h. [Maximum dose]: 8 grams/day. Renal dosing: [CRCL >30 ml/min]: no change.  [10-30 ml/min]: Loading dose: 1-2 grams x 1, then give 50% of the usual dose (e.g. 0.5 – 1 gm) q6-12h. [<10 ml/min]: 1–2 grams x 1, then 25% of usual dose (e.g. 250-500 mg) q6-12 hours. Hemodialysis: 1 – 2 grams x 1, then 25% of usual dose q6-12h. (e.g., 250-500 mg q6-12 hours). For serious or life-threatening infections, give an additional 125mg after each hemodialysis session (1/8th of the usual dose). PD: 1 – 2 grams x 1, then 25% of usual dose q6-12h. (e.g., 250-500 mg q6-12 hours). TMP/SMX Bactrim ® Dosing: (IV): 8-10mg/kg/day divided q6-12h. PCP: 15-20mg/kg/day in 3 or 4 divided doses. (Oral): UTI: 1 DS tab (160mg TMP/800mg SMX) po q12h. Renal Dosing: [>30 ml/min]: no change .  [15-30] 50% of usual regimen. Alternatively: 8-10mg/kg/day divided q12h x 1-2 days, then 4-6mg/kg q24h.   [<15] not recommended by manufacturer.   Alternatively: Non PCP: 8-12 mg/kg/dose q48h (or 4-6 mg/kg/day divided q12-24h) .  PCP: 15-20 mg/kg/dose q48h (or 7-10 mg/kg/day divided q12-24h).  Hemodialysis: Not recommended by manufacturer. Chloramphenicol Chloromycetin ® Dosing: 12.5 mg/kg q6h. [Severe infections]: 25 mg/kg q6h. Renal Dosing: No adjustments needed. Hemodialysis:  No adjustments needed. Clindamycin Cleocin ® Dosing: (IV) 300 to 900 mg q6-8h. (Oral): 150 to 450 mg q6h. Renal Dosing: No adjustments required. Dapsone: Dosing: 100 mg po qd. [PCP]: 100mg po qd. [Dermatitis herpetiformis]: 50-300 mg qd. Renal Dosing:  Specific guidelines are not available Daptomycin Cubicin ® Cyclic Lipopeptide. Dosing (adults): Skin and/or skin structure infections (complicated): 4 mg/kg IV once daily for 7-14 days. Bacteremia, endocarditis (unlabeled use): 6 mg/kg IV once daily. Renal Dosing:  Crcl <30 mL/min: 4 mg/kg every 48 hours. Hemodialysis (administer after hemodialysis) and/or CAPD: 4 mg/kg every 48 hours. Supplied: 250 mg, 500 mg (Injection - powder for reconstitution) Ertapenem Invanz ® Dosing: Usual dose: 1 gram IM or IV qd. Renal Dosing: [CRCL > 30]: No changes.  [</= 30]: 500 mg IV/IM qd.    Hemodialysis:  500 mg IV/IM qd.  Give supplementary dose of 150 mg following the hemodialysis session if the 500mg dose was administered <6 hours prior to hemodialysis. Imipenem/ cilastatin Primaxin ® Dosing: 250mg to 1gm q6h (Maximum dose is 50mg/kg/day or 4 grams/day, whichever is lowest . Give in divided doses) Renal Dosing: [CRCL >71]: No changes.  [41 –70 ]: Max 37.5 mg/kg/day or 3 grams/day. (Range: 9.4 – 37.5mg/kg/day) divided q6-8h. [21-40]: Max 25 mg/kg/day or 2 grams/day. (Range: 6.25 – 25 mg/kg/day) divided q6-12h. [6-20 ]: Max 12.5 mg/kg/day (max dose 1 gram/day). Range: 6.25 – 12.5 mg/kg/day) divided q12h. (Usual: 250mg q12h).  Hemodialysis: 125 – 500 mg q12h. (Max 12.5 mg/kg/day). Give dose after dialysis. PD: 125 – 250 mg q12h Linezolid Zyvox ® Dosing: vancomycin-resistant Enterococcus faecium (VRE) infections: Oral, IV: 600 mg every 12 hours for 14-28 days. Nosocomial pneumonia, complicated skin and skin structure infections, community-acquired pneumonia including concurrent bacteremia: Oral, IV: 600 mg every 12 hours for 10-14 days.  Uncomplicated skin and skin structure infections: Oral: 400 mg every 12 hours for 10-14 days. Renal Dosing: no adjustment necessary. (Two primary metabolites of linezolid may accumulate in patients with renal insufficiency- more studies are needed to determine the clinical significance). Hemodialysis:  No adjustment necessary. On dialysis days, schedule dose after dialysis. (~30% extraction). Meropenem Merrem ® Dosing: 1 gram IV q8h Renal Dosing: [CRCL >50]: no change.  [26-50]: 1 gram q12h.  [10-25]: 500 mg q12h. [<10]: 500mg q24h.  Hemodialysis: 500mg q24h + 500mg after each HD.  PD: 500mg q24h. Metronidazole Flagyl ® Dosing: 500 mg po/IV q6-8h. Renal Dosing: [CRCL > 10]: no changes.   [<10]: 500mg q8-12h or (50% of usual dose at same interval). Hemodialysis: 500mg q8-12h (usually q12h) or (50% of usual dose at same interval). On dialysis days, schedule dose after dialysis. Nitrofurantoin Dosing: 50-100 mg q6h. Macrobid: 100 mg q12h. Renal Dosing: [CRCL >50]: Normal dose.  [0-49]: Avoid use.  Hemo: Avoid use. Quinupristin/ Dalfopristin Synercid ® Dosing: 7.5 mg/kg q8-12h. Renal Dosing: No adjustment necessary. Rifaximin Xifaxan ® Dosing (Adults): Travelers' diarrhea: Oral: 200 mg 3 times/day for 3 days. Supplied: 200 mg tab. Tigecycline Tygacil ® Glycylcycline antibiotic. Derivative of minocycline. Dosing (Adults): Complicated skin/skin structure or intra-abdominal infections: Initial: 100 mg IV as a single dose. Maintenance dose: 50 mg every 12 hours. Recommended duration of therapy: Intra-abdominal infections or complicated skin/skin structure infections: 5-14 days. Renal Dosing: No adjustment necessary. Supplied: 50 mg (Injection - powder for reconstitution) Telithromycin Ketek ® Ketolide antibiotic.  Dosing (Adults): Acute exacerbation of chronic bronchitis, acute bacterial sinusitis: 800 mg orally once daily for 5 days. Community-acquired pneumonia: 800 orally mg once daily for 7-10 days. Renal Dosing:  crcl <30 mL/minute: 600 mg once daily. When renal impairment is accompanied by hepatic impairment, reduce dosage to 400 mg once daily. Hemodialysis: Administer dose following dialysis. Supplied: 300 mg, 400mg tab. Tinidazole Tindamax ® Antiprotozoal.  Dosing (Adults): Amebiasis, intestinal: Oral: 2 g/day for 3 days.  Amebiasis, liver abscess: Oral: 2 g/day for 3-5 days. Giardiasis: Oral: 2 g as a single dose. Trichomoniasis: Oral: 2 g as a single dose; sexual partners should be treated at the same time. Renal Dosing:  no adjustment necessary. Supplied: 250 mg, 500 mg tab.  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.");s1[20]=new Array("antihypertensive-other.htm","Anti-hypertensives (Other) - Dosing","","Anti-hypertensive (Other) bosentan (tracleer ®) Endothelin receptor antagonist. Adult (usual) Pulmonary arterial hypertension (PAH): initial, 62.5 mg po bid x 4 weeks. Maintenance (PAH): up to 125 mg po bid. Doses above 125 mg b.i.d. did not appear to confer additional benefit sufficient to offset the increased risk of liver injury.  Monitoring: monitor liver function before and during therapy. Monitor hemoglobin levels after 1 and 3 months, then every 3 months monthly.  [Supplied: 62.5, 125 mg tablets]   epoprostenol (Flolan ®) Epoprostenol (PGI2, prostacyclin): a naturally occurring prostaglandin with potent vasodilatory activity and inhibitory activity of platelet aggregation. Indication: long-term intravenous treatment of primary pulmonary hypertension and pulmonary hypertension associated with the scleroderma spectrum of disease in NYHA Class III and Class IV patients who do not respond adequately to conventional therapy.  Dosage - Adult (usual) Pulmonary hypertension: initial, 2 ng/kg/min IV, titrate upward in increments of 2 ng/kg/min every 15 min or longer until dose-limiting pharmacological effects are elicited or until tolerance develops. Administration: reconstitute only with supplied diluent; do not give with other parenteral medications. Infuse continuous chronic infusion via a central venous catheter with an ambulatory infusion pump - may be administered peripherally until central catheter established. Avoid abrupt withdrawal. Anticipate need for periodic dose adjustments. fenoldopam (Corlopam ®) Indications: short-term (up to 48 hours) management of severe hypertension when rapid, but quickly reversible, emergency reduction of blood pressure is clinically indicated, including malignant hypertension with deteriorating end-organ function.  Dosage (adult): Hypertension: initial 0.03-0.1 mcg/kg/min IV; increase every 15 min by 0.05-0.1 mcg/kg/min based on response. Maximum: 1.6 mcg/kg/min.  In clinical trials, doses from 0.01-1.6 µg/kg/min have been studied. Most of the effect of a given infusion rate is attained in 15 minutes. A bolus dose should not be used. Hypotension and rapid decreases of blood pressure should be avoided. The initial dose should be titrated upward or downward, no more frequently than every 15 minutes (and less frequently as goal pressure is approached) to achieve the desired therapeutic effect. The recommended increments for titration are 0.05-0.1 µg/kg/min.    [Supplied: 10 mg/ml solution]     hydralazine (Apresoline ®) Direct arteriolar vasodilator with little or no effect on the venous circulation. Precautions are needed in patients with underlying coronary disease or an aortic dissection. Beta-blocker should be given concurrently to minimize reflex sympathetic stimulation. The hypotensive response to hydralazine is less predictable than that seen with other parenteral agents. Dosing (Adult): Initial (Acute hypertension): 10 mg slow IV bolus ( maximum dose being 20 mg) every 4 to 6 hours as needed. May increase to 40 mg/dose. Change to oral therapy as soon as possible. The fall in blood pressure begins within 10 to 30 minutes and lasts 2 to 4 hours. May also be given IM.   Hypertension (Oral): Initial: 10 mg 4 times/day. Increase by 10-25 mg/dose every 2-5 days (maximum: 300 mg/day). Usual dose range (JNC 7): 25-100 mg/day in 2 divided doses. Pre-eclampsia/eclampsia: 5 mg/dose (IM, IV) then 5-10 mg every 20-30 minutes as needed. CHF: Initial dose: 10-25 mg orally 3-4 times/day. Dosage must be adjusted based on individual response. Target dose: 75 mg 4 times daily in combination with isosorbide dinitrate (40 mg 4 times daily). Range: Typically 200-600 mg daily in 2-4 divided doses. Dosages as high as 3 grams per day have been used in some patients for symptomatic and hemodynamic improvement.  Renal dosing: crcl 10-50 ml/min: Administer every 8 hours. crcl <10 ml/min: Administer every 8 to 16 hours in fast acetylators and every 12-24 hours in slow acetylators. Supplied: Injection (soln): 20 mg/ml (1 ml vial). Tablet: 10 mg, 25 mg, 50 mg, 100 mg. minoxidil (Loniten ®) Severe Hypertension: initial, 5 mg/day orally as single dose or 2 divided doses.  Maintenance (HTN): 10-40 mg/day orally daily in 1-2 divided doses (Maximum: 100 mg/day) .  Acts directly on vascular smooth muscle with selective vasodilatation of the arteriolar resistance vessels and little or no effects on venous capacitance vessels and does not effect the functioning of the carotid or aortic baroreceptors.  [Supplied: 2.5, 5, 10mg tablet] nitroprusside (Nipride ®) Initial: 0.3 to 0.5 mcg/kg/min. Increase in increments of 0.5 mcg/kg/min while titrating to desired hemodynamic effect. Dosage rates well within the product labeling have resulted in toxicity. Additionally, dosage rates that are well tolerated over a short course of therapy may be toxic over prolonged therapy. Infusion rates of 2 mcg/kilogram/minute are suggested as safe, while rates greater than 4 micrograms/kilogram/minute may lead to cyanide toxicity within 3 hours. The range is 0.3 to 10 mcg/kilogram/minute. Doses exceeding 10 mcg/kg/min are rarely required. phentolamine (regitine ®) Extravasation - norepinephrine: 5-10 mg in 10 mL saline SC infiltrated within 12 hours into area of extravasation. Hypertensive crisis: 5-20 mg IV.   Pheochromocytoma (diagnosis): 5 mg IV or IM.  Tissue necrosis prevention: 10 milligrams may be added to each liter of solution containing norepinephrine to prevent dermal necrosis and sloughing associated with intravenous administration of norepinephrine. treprostinil (Remodulin ®) Indications: Pulmonary arterial hypertension (PAH) in patients with NYHA Class II-IV symptoms.  Dosage: Pulmonary arterial hypertension: initial, 1.25 ng/kg/min continuous SC infusion; decrease to 0.625 ng/kg/min if initial dose cannot be tolerated. Pulmonary arterial hypertension: adjustments, increase dose in increments of no more than 1.25 ng/kg/min per week for the first 4 weeks and then no more than 2.5 ng/kg/min per week for remaining duration.  Administration: administer by continuous subcutaneous infusion to diminish symptoms associated with exercise. avoid abrupt cessation of infusion. Chronic dosage adjustments should establish a dose at which PAH symptoms are improved, while minimizing side effects. Minimal experience with doses greater than 40 ng/kg/min.  [Supplied (20 ml vials) 1, 2.5 , 5, and 10 mg/ml solution]  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.");s1[21]=new Array("antihypertensive-combo.htm","Anti-hypertensive Combinations","","Anti-hypertensive Combinations ACE inhibitors & diuretics Benazepril & HCTZ (Lotensin HCT ®)      Benazepril (HTN) range: 10-80 mg qd (Initial: 10mg po qd).  HCTZ (Range): 12.5-50 mg per day. Lotensin HCT 10/12.5 or Lotensin HCT 20/12.5. The HCTZ dose should generally not be increased until 2-3 weeks have elapsed. Patients whose blood pressures are adequately controlled with 25 mg of daily HCTZ, but who experience significant potassium loss with this regimen, may achieve similar blood-pressure control without electrolyte disturbance if they are switched to Lotensin HCT 5/6.25.  Supplied: (5 mg/6.25 mg, 10 mg/12.5 mg, 20 mg/12.5 mg, 20 mg/25 mg) Captopril & HCTZ (Capozide ®) Adult (usual) Hypertension (HTN): initial, 1 tab (captopril 25 mg/HCTZ 15 mg) orally once daily. HTN: titration, allow 6-8 wk to achieve optimum antihypertensive effect - may administer daily dose in divided doses. HTN: maximum dose: 150 mg captopril and 50 mg HCTZ per day.   Supplied: (25 mg/15 mg, 25 mg/25 mg, 50 mg/15 mg, 50 mg/25 mg)  Enalapril & HCTZ (Vaseretic ®) Enalapril (Usual range): 10 to 40 mg per day administered in a single or two divided dose. HCTZ (range): 12.5 to 50 mg daily.   A patient whose blood pressure is not adequately controlled with either enalapril or HCTZ monotherapy may be given Vaseretic 5-12.5 or Vaseretic 10-25.  The HCTZ dose should generally not be increased until 2-3 weeks have elapsed. In general, patients do not require doses in excess of 20 mg of enalapril or 50 mg of HCTZ. The daily dosage should not exceed four tablets of Vaseretic 5-12.5 or two tablets of Vaseretic 10-25.  Supplied: (5 mg/12.5 mg, 10 mg/25 mg)  Lisinopril & HCTZ (Prinzide ®) (Zestoretic ®) Hypertension - Initial dose: 10/12.5 or 20/12.5. Further increases of either or both components could depend on clinical response. The HCTZ dose should generally not be increased until 2-3 weeks have elapsed. Maximum dose: 80/50 mg orally once daily. Patients whose blood pressures are adequately controlled with 25 mg of daily HCTZ, but who experience significant potassium loss with this regimen, may achieve similar or greater blood pressure control with less potassium loss if they are switched to 10/12.5. Dosage higher than lisinopril 80 mg and HCTZ 50 mg should not be used.   Supplied: (10 mg/12.5 mg, 20 mg/12.5 mg, 20 mg/25 mg) Moexipril & HCTZ (Uniretic ®) Moexipril (range) 7.5 to 30 mg daily- administered in a single or two divided doses. HCTZ (range): 12.5 to 50 mg daily. Initial dose: (7.5 mg /12.5 mg) or (15 mg /12.5 mg) or (15 mg /25 mg) one hour before a meal. Titrate: q2-3 weeks. Total daily doses above 30 mg /50 mg a day have not been studied in hypertensive patients. Patients whose blood pressures are adequately controlled with 25 mg of HCTZ daily, but who experience significant potassium loss with this regimen, may achieve blood pressure control without electrolyte disturbance if they are switched to moexipril 3.75 mg/HCTZ 6.25 mg (one-half 7.5 mg /12.5 mg tablet). For patients who experience an excessive reduction in blood pressure with 7.5 mg /12.5 mg, the physician may consider prescribing moexipril 3.75 mg/HCTZ 6.25 mg. Supplied: (7.5 mg/12.5 mg, 15mg/12.5 mg, 15 mg/25 mg) Angiotensin-II receptor antagonists & diuretics Losartan & HCTZ    (Hyzaar ®) Adult (usual) Hypertension (HTN): initial, 1 tab (50 mg losartan/12.5 mg HCTZ) po qd. HTN: titration, allow 3 wk to achieve optimum antihypertensive effect. HTN: titrate to maintenance, may increase to MAX dose of 100/50 mg orally once daily. Supplied: (50 mg/12.5 mg, 100 mg/25 mg) Valsartan & HCTZ   (Diovan HCT ®) Adult (usual) Hypertension: initial, 12.5 HCTZ/80 mg valsartan orally once daily. Hypertension: maintenance 12.5/80 mg to 25/160 mg po qd.  Titrate at intervals of 3-4 wekks. MAX 25/160 mg daily.  Supplied: (80 mg/12.5 mg, 160 mg/12.5 mg, 160mg/25 mg) Beta blockers & diuretics Atenolol & chlorthalidone (Tenoretic®) Dosage, Adult (usual): Hypertension (HTN): initial, 1 tab (50/25 mg) po qd. HTN: titration, allow 1-2 wk to achieve optimum antihypertensive effect. HTN: maintenance, may increase to 1 tab (100/25 mg) orally once daily.  Supplied: (50 mg/25 mg, 100 mg/25 mg) Bisoprolol & HCTZ (Ziac®)      Hypertension: initial, 1 tab (2.5/6.25 mg) orally once daily. Titration - allow 1-2 wk to achieve optimum antihypertensive effect. May increase to MAX dose of 20/12.5 mg orally once daily.  Supplied: (2.5 mg/6.25 mg, 5 mg/6.25 mg, 10 mg/6.5 mg) Metoprolol & HCTZ   (Lopressor HCT®) [ HCTZ (range): 12.5 to 50 mg per day. The usual initial dosage of Lopressor is 100 mg daily in single or divided doses. The effective dosage range is 100 to 450 mg per day. ] The following dosage schedule may be used to administer from 100 to 200 mg of Lopressor per day and from 25 to 50 mg of HCTZ per day: Lopressor HCT Dosage  Tablets of 50/25 - 2 tablets per day in single or divided doses. Tablets of 100/25 - 1 to 2 tablets per day in single or divided doses.  Tablets of 100/50 - 1 tablet per day in single or divided doses. Dosing regimens that exceed 50 mg of HCTZ per day are not recommended.   Supplied: (50 mg/25 mg, 100 mg/25 mg, 100 mg/50 mg) Nadolol & bendroflumethazide (Corzide ®) Initial dose: 40 mg/5 mg tablet once daily. When the antihypertensive response is not satisfactory, the dose may be increased by administering the 80 mg/5 mg tablet once daily. When necessary, another antihypertensive agent may be added gradually beginning with 50 percent of the usual recommended starting dose to avoid an excessive fall in blood pressure.    Supplied: (40 mg/5 mg, 80 mg/5 mg) Propranolol & HCTZ (Inderide ®)    HCTZ (range): 12.5 to 50 mg per day. The initial dose of propranolol is 80 mg daily. The usual effective dose when used alone is 160 to 480 mg per day. One Inderide tablet twice daily can be used to administer up to 160 mg of propranolol and 50 mg of HCTZ. For doses of propranolol greater than 160 mg the combination products are not appropriate, because their use would lead to an excessive dose of the thiazide component.  Supplied: (40 mg/25 mg, 80 mg/25 mg).      (Inderide LA ®) : (80 mg/50 mg, 120 mg/50 mg, 160 mg/50 mg) Timolol & HCTZ (Timolide ®) Initial dose (HTN): 1 tablet twice a day or 2 tablets once a day. HCTZ (range): 12.5 to 50 mg per day when used alone. If the antihypertensive response is not satisfactory, another nondiuretic antihypertensive agent may be added.  Supplied: (10 mg/25 mg) Calcium channel blockers & ACE inhibitors Amlodipine & benazepril  (Lotrel ®) Adult (usual)- Hypertension: initial 2.5/10 mg orally once daily - may increase to 5/10 mg or 5/20 mg orally once daily.  Amlodipine is an effective treatment of hypertension in once-daily doses of 2.5-10 mg while benazepril is effective in doses of 10-80 mg. In clinical trials of amlodipine/benazepril combination therapy using amlodipine doses of 2.5-10 mg and benazepril doses of 10-20 mg, the antihypertensive effects increased with increasing dose of amlodipine in all patient groups, and the effects increased with increasing dose of benazepril in nonblack groups.   Supplied: (2.5 mg/10 mg, 5 mg/10 mg, 5 mg/20 mg) Felodipine & enalapril  (Lexxel ®) Adult (usual) Hypertension: initial, 5mg/5mg tab po qd, may titrate to two 5mg/5mg tab po qd, then four 5mg/2.5 mg tab po qd. Supplied: (5mg/2.5 mg, 5 mg/5 mg) Verapamil &  trandolapril (Tarka ®) Adult (usual) - 1 tablet po qd.   Hypertension: 1-4 mg trandolapril/120-480 mg verapamil po qd or in 2 divided doses. The recommended usual dosage range of trandolapril for hypertension is 1 to 4 mg per day administered in a single dose or two divided doses. The recommended usual dosage range of Isoptin-SR for hypertension is 120 to 480 mg per day administered in a single dose or two divided doses.  Supplied: (180 mg/2 mg, 240 mg/1 mg, 240 mg/2 mg, 240 mg/4 mg). Diuretic combinations / Other Amiloride & HCTZ (Moduretic ®)   Give with food.  The usual starting dosage is 1 tablet a day. The dosage may be increased to 2 tablets a day, if necessary. More than 2 tablets of Moduretic daily usually are not needed and there is no controlled experience with such doses. HCTZ (range): 12.5 to 50 mg per day.  Supplied: (5 mg/50 mg) Spironolactone & HCTZ  (Aldactazide ®)     CHF, hepatic cirrhosis, or nephrotic syndrome: The usual maintenance dose of Aldactazide is 100 mg each of spironolactone and HCTZ daily, administered in a single dose or in divided doses, but may range from 25 mg to 200 mg of each component daily depending on the response to the initial titration. Hypertension: many patients will be found to have an optimal response to 50 mg to 100 mg each of spironolactone and HCTZ daily, given in a single dose or in divided doses. Supplied: (25 mg/50 mg, 50 mg/50 mg) Triamterene & HCTZ    (Dyazide ®, Maxzide ®) Adult (usual) Hypertension (HTN): initial, 1 tab/cap (25 mg HCTZ/37.5 mg triamterene) po qd.   HTN: titration, allow 2-3 wk to achieve optimum antihypertensive effect. HTN: titrate to maintenance, may increase to maximum dose of 50/75 mg po qd. Supplied: (37.5 mg/25 mg capsule and tablet, 75 mg/50 mg tablet) Clonidine & chlorthalidone  (Combipres ®)       Adult (usual) Hypertension: 15 mg/0.1 mg, 15 mg/0.2 mg, or 15 mg/0.3 mg po qd - bid. maximum dose of 30 mg/0.6 mg per day. Supplied: (0.1 mg/15 mg, 0.2 mg/15 mg, 0.3 mg/15 mg) Hydralazine & HCTZ  (Apresazide ®)  Usual Dosage: One capsule twice daily.  Supplied: (25 mg/25 mg, 50 mg/50 mg, 100 mg/50 mg)  Methyldopa & HCTZ  (Aldoril ®)     Usual starting dose: (250 mg/15 mg) two or three times a day or one tablet of (250 mg/25 mg) - two times a day. Alternatively, one tablet of 500 mg/30 mg or  500 mg/50 mg once daily may be used. HCTZ (range): 12.5 to 50 mg per day. methyldopa daily range: 500 mg to 2 g. The maximum recommended daily dose of methyldopa is 3 g.  Supplied: (250 mg/15 mg, 250 mg/25 mg, 500 mg/30 mg, 500 mg/50 mg) Prazosin & polythiazide  (Minizide ®) Usual - Adults: Oral: 1 capsule 2-3 times/day.  Supplied: (1 mg/0.5 mg, 2 mg/0.5 mg, 5 mg/0.5 mg)  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.");s1[22]=new Array("antidepressants.htm","Antidepressants--dosing","Antidepressants--dosing list for health care providers, pharmacists, nurses, physicians.","Antidepressants (Adult dosing) Tricyclics-Tertiary Amines amitriptyline  (Elavil ®): Initially, 25-100 mg orally at bedtime. Gradually increase to usual effective dose of 50-300mg/day. doxepin  (Sinequan ®): Initially, 25 mg orally at bedtime. Usual effective dose: 75-300mg/day. imipramine  (Tofranil ®): Initially, 25 mg orally at bedtime, increase gradually to usual effective dose 50-300 mg/day. Tricyclics-Secondary Amines desipramine  (Norpramin ®):  Initially, 25 mg orally once daily or divided doses. Gradually increase to usual effective dose: 100-300 mg/day. nortriptyline  (Pamelor ®): Initially, 25mg orally 1 to 4 times daily. Usual effective dose: 50-150 mg/day. Tetracyclics mirtazapine  (Remeron ®): Initially, 15 mg orally at bedtime. Usual effective dose: 15-45 mg/day. Triazolopyridine trazodone  (Desyrel ®):  Initially, 50-150 mg/day orally in divided doses. Usual effective dose: 400-600 mg/day in divided doses. Aminoketone buproprion  (Wellbutrin ®): Depression: Initially, 100mg orally twice daily, after 4-7 days may increase to 100 mg orally 3 times daily. Usual effective dose: 300-450mg per day. Maximum: 150mg/dose and 450 mg/day. (SR): Initially, 150mg orally once daily, after 4-7 days, may increase to 150mg twice a day. Maximum 400mg/day. //  (Zyban): start 150mg orally every morning for 3 days, then increase to 150mg orally twice a day for 7 to 12 weeks. Maximum dose: 150 mg orally twice daily. Phenethylamine (Non-tricyclic) venlafaxine  (Effexor ®) Initially, 75 mg/day divided in 2 to 3 doses. Usual effective dose: 150-225 mg/day. Maximum: 375 mg/day. (XR): 37.5 to 75 mg orally once daily. Maximum: 225 mg/day. Phenylpiperazine nefazodone  (Serzone ®): Initially, 100mg orally twice daily. Usual effective dose: 150-300mg orally twice daily. Maximum: 600 mg/day. Selective serotonin reuptake inhibitors citalopram  (Celexa ®): Initially, 20 mg orally once daily. Usual maximum: 40 mg/day. Alcohol abuse: 40 mg orally once daily. Depression: 20-60mg orally once daily . Diabetic neuropathy: 40 mg orally once daily. escitalopram  (Lexapro ® ) : Initially, 10mg po qd. Max: 20mg po qd. [Supplied: 5, 10, 20 mg tabs] fluoxetine  (Prozac® ) : Initially, 20mg orally every morning, usual effective dose: 20-40mg/day. Maximum: 80mg/day. Bulimia: 60 mg orally once daily. fluvoxamine  (Luvox ®): OCD: Initially, 50 mg orally at bedtime, usual effective: 100-300 mg/day divided into 2 doses. Maximum: 300mg/day. paroxetine  (Paxil ®): Depression: Initially, 20 mg orally every morning. Usual effective dose: 20-50 mg/day. Maximum: 50mg/day.   OCD / Panic attacks: Initially, 10-20mg/day. Usual effective dose: 10-60 mg/day.  Maximum: 60 mg/day. sertraline  (Zoloft ®): Depression / OCD: Initially, 50 mg orally once daily. Usual effective dose: 50-200 mg/day. Maximum: 200 mg/day. Panic attacks: Initially, 25mg orally once daily. Maximum: 200 mg/day. Norephinephrine / serotonin reuptake inhibitor duloxetine  (Cymbalta ®): Initially, 20 mg orally once daily. Usual maximum: 40 mg/day. Alcohol abuse: 40 mg orally once daily. Depression: 20-60mg orally once daily . Diabetic neuropathy: 40 mg orally once daily.  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.   Author: David McAuley Keywords: Antidepressants, pharmacists, nursing, physicians,health care providers,amitriptyline, doxepin, trazadone,buproprion, effexor, nefazodone, citalopram, prozac, paxil,luvox, zoloft.");s1[23]=new Array("antidiarrheals.htm","Antidiarrheals - Dosing list","","Anti- Diarrheals: Kaopectate: (1200mg/30 ml): Give 30 ml orally after each loose bowel movement. Maximum: 7 doses/day (9 grams). Lomotil (dephenoxylate + atropine): Adults: Dosing: 2 tablets or 10 ml orally four times daily. Loperamide (Imodium): Adults: Dosing: 4 mg orally initially, then 2mg after each un- formed stool to a maximum of 16 mg/day. [2 mg capsule /tablet] Pepto-Bismol (bismuth subsalicylate): Adults: Give 2 tablets or 30 ml orally every 30 minutes to 1 hour up to 8 doses/day.  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc.    Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.");s1[24]=new Array("antifungals.htm","Antifungals - systemic & topical","Antifungals--dosing list for health care providers, pharmacists, nurses, physicians.","Antifungals (systemic) Amphoterecin-B Test dose: (optional): 1 mg/20-50 ml D5W over 10-30 minutes. Monitor temp, pulse, RR and BP q30min x 4 hours. Do not give premeds with test dose. Maintenance dose: Initially give 0.25-0.3 mg/kg/day. Increase as tolerated by an equivalent amount once daily. Usual daily dose: 0.5-1 mg/kg/day or up to 1.5 mg/kg every other day. For life-threatening infection may give full dose the first day (usually 0.6-0.7 mg/kg IBW on Day # 1). Premedication: Prevention of fever/chills: Tylenol 650mg PO/PR + Benadryl 25-50mg PO/IVP 60min prior to maintenance infusion. May also add: Hydrocortisone 25-50mg IV/IM +/- Demerol 50mg IV. Renal dosing: <10/ q24-36h. During therapy if the BUN increases above 40 mg/dl or the serum creatinine exceeds 2.5-3 mg/dl, Hold Ampho B until renal function improves, then restart at a reduced dose or change to every other day dosing until Serum creatinine/BUN improve. Bladder irrigation: Add 30-50mg Ampho B to 1000ml (or less) sterile H2O administered intermittently or continuously for 2 to 14 days. (Note: use of D5W for Bladder irrigations is not recommended because of the possibility of enhancing microbial and fungal growth in the bladder). Ampho B lipid (Albecet ®): 5 mg/kg/day IV. caspofungin Cancidas ® 70mg x 1 on the first day, then 50mg IV qd Clotrimazole (Mycelex ®): oral troches 5 times per day x 14 days. fluconazole (Diflucan ®) Vaginal candidiasis: 150 mg x 1. Systemic candidiasis: 400 mg orally or IV once daily.  Esophageal candidiasis: 100-200 mg orally once daily (up to 400mg/day).  Cryptococcal meningitis: 400mg orally x 1, followed by 200mg once a day x 10-12 weeks (Suppression: 50-200mg orally once daily). Onychomycosis: 200-300mg once a week or 100-200mg orally every other day (further studies needed).  Coccidioides immitis. Therapy with oral fluconazole is currently preferred. The dosage used in reported clinical trials was 400 mg/day. Some physicians begin therapy with 800 or 1000 mg/day of fluconazole. Alternative: (meningitis) 800mg qd for life. Renal Dosing: Loading dose: [CRCL >50] No changes. [CRCL <50]: Multiple dose regimens only: Give 50% of usual dose q24h. Some sources recommend for CRCL <20: 50% of usual dose q48h.  Hemo: Give usual dose after each hemodialysis session. flucytosine (Ancobon ®): Dosing: 12.5-37.5 mg/kg q6h.   Renal Dosing: [CRCL >40] No change. [20-40]: 12.5-37.5 mg/kg q12h. [10-20]: 12.5-37.5 mg/kg q24h. [<10]: 12.5-37.5 mg/kg q24-48h. Hemo: Give usual dose (12.5 – 37.5mg/kg) after each dialysis. Some sources recommend giving 25-50 mg/kg after each dialysis. Griseofulvin: Microsize: Adults: 500mg orally once daily will give a satisfactory response in most patients with tinea corporis, tinea cruris, and tinea capitis. For those fungus infections more difficult to eradicate such as tinea pedis and tinea unguium, a daily dose of 1.0 g is recommended. [Supplied: Grifulvin V: 250 mg or 500 mg of griseofulvin microsize tablets.] Ultramicrosize: Adults: 375 mg (as a single dose or in divided doses) will give a satisfactory response in most patients with tinea corporis, tinea crurirs, and tinea capitis. For those fungal infections more difficult to eradicate, such as tinea pedis and tinea unguium, a divided dose of 750 mg is recommended.  [Supplied: Gris-PEG® (griseofulvin ultramicrosize) 125, 250mg tabs] Itraconazole (Sporanox ®): Systemic mycosis: 200mg orally once daily with food (up to maximum of 400mg/day if unsatisfactory clinical response with lower dose). Doses >200mg are given in 2 divided doses. Onychomycosis: 200mg orally twice daily for 1 week each month for 2 months (fingernails);  x 3-4 months (toenails).   Oropharyngeal candidiasis: 200mg (20ml)-oral solution-swish vigorously then swallow once daily x 1-2 weeks. Esophageal candidiasis: 100mg (10ml) oral solution--swish and swallow once daily x 3 weeks. May increase to 200mg/day. Life-threatening infections: Loading dose: 200mg orally 3 times daily should be given for the first 3 days of therapy, then 200-400mg/day. ketoconazole (Nizoral ®): Recommended starting dose: 200mg once daily. In very serious infections or if clinical responsiveness is insufficient within the expected time, the dose of Nizoral Tablets may be increased to 400 mg (two tablets) once daily. Micafungin  Mycamine ®: Dosing (Adults): Esophageal candidiasis: 150 mg IV daily x 14 days.    Prophylaxis of Candida infection in hematopoietic stem cell transplantation: 50 mg daily x ~18 days. Supplied: Injection - 50 mg (powder for reconstitution) nystatin (Mycostatin ®): Thrush: 4 to 6 ml orally (swish/swallow) 4 times a day. terbinafine (Lamisil ®): Superficial mycoses (tinea corporus, cruris, pedis, capitis; cutaneous candidiasis): 250 mg orally once daily. Onychomycosis: (fingernails) 250mg orally once daily x 6 weeks or pulse dosing: 500mg orally once daily for 1st week of month x 2 months. (Toenails): 250mg orally once daily x 12 weeks or pulse dosing: 500mg once daily for 1st week of month x 4 months. Systemic mycosis: 250-500mg orally once daily. voriconazole (Vfend ®): Dosing (Adults): Invasive aspergillosis and other serious fungal infections - 6 mg/kg IV q12h x 2 doses, then 4 mg/kg q12h.   Candidemia and other deep tissue Candida infections: Initial: Loading dose 6 mg/kg IV every 12 hours for 2 doses; followed by maintenance dose of 3-4 mg/kg every 12 hours. (Oral): Conversion to oral dosing:  Patients <40 kg: 100 mg every 12 hours; increase to 150 mg every 12 hours in patients who fail to respond adequately. Patients >/= 40 kg: 200 mg every 12 hours; increase to 300 mg every 12 hours in patients who fail to respond adequately. Esophageal candidiasis: Oral: Patients <40 kg: 100 mg every 12 hours.  Patients >/= 40 kg: 200 mg every 12 hours.  Note: Treatment should continue for a minimum of 14 days, and for at least 7 days following resolution of symptoms. Dosage adjustment in patients unable to tolerate treatment:  IV: Dose may be reduced to 3 mg/kg every 12 hours.  Oral: Dose may be reduced in 50 mg increments to a minimum dosage of 200 mg every 12 hours in patients weighing >/= 40 kg (100 mg every 12 hours in patients <40 kg). Renal Dosing: Oral: no adjustments necessary. [CRCL <50 ml/min]: IV voriconazole should be avoided, unless the benefit justifies the risk. Accumulation of the intravenous vehicle may occur. Supplied: Tablet: 50 mg, 200 mg.  Oral suspension: 200 mg/5 mL (70 mL).  200 mg (Inj - powder for reconstitution). Topical Antifungals butenafine (Mentax ®) Apply cream once or twice daily. [cream 1%] ciclopirox (Loprox ®): Apply cream or lotion twice daily [cream/lotion 1%] clotrimazole (Lotrimin ®): Apply twice daily.  Supplied: [1% cream /solution /lotion] enconazole (Spectazole ®): Tinea: apply once daily. Candida: apply twice daily.  Supplied:[1% cream] ketoconazole: (Nizoril ®) Tinea/candida: apply once a day Supplied: [2% cream]. Seborrheic dermatitis: apply shampoo/cream once or twice daily. Dandruff: shampoo 2 times per week. Miconazole: Tinea/candida: apply twice a day. Supplied: [2% cream/powder/spray] naftifine (Naftin ®): Tinea: apply once daily (cream) or twice a day- (gel) nystatin: candidiasis: apply 2 to 3 times daily.  Supplied: [cream / powder/ ointment] oxiconazole (Oxistat ®): Tinea: apply once or twice daily.  Supplied: [cream/lotion 1%] terbinafine (Lamisil ®): Tinea: apply once or twice daily.  Supplied: [cream 1%] tolnaftate (Tinactin ®):  Apply twice a day. Supplied: [1% cream /powder/ gel /solution]  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc. Author: David McAuley Keywords: Antifungals, pharmacists, nursing, physicians,health care providers,amphotericin, fluconazole, flucytosine, clotrimazole, sporanox,ketoconazole, terbinafine, nystatin, lamisil, griseofulvin,loprox, tolnaftate, naftidine, econazole");s1[25]=new Array("anti-hepatitis.htm","Anti-Hepatitis Agents","","Anti-Hepatitis Agents adefovir (Hepsera ®): Nucleoside Reverse Transcriptase Inhibitor. Activity against human hepatitis B virus.  Hepatitis B (chronic): Initial dosing - 10 mg orally once daily. Dose adjustments are indicated in renal impairment. It is no longer being considered for treatment of HIV.  Renal dosing:  (CrCl 20-49 ml/min): 10 mg every 48 hours  (CrCl 10-19 ml/min): 10 mg every 72 hours.  (CrCl < 10 ml/min): no recommendation available.   (Hemodialysis): 10 mg every 7 days following dialysis.  Supplied: 10 mg tablet. entecavir (Baraclude ®) Nucleoside Reverse Transcriptase Inhibitor. Dosing (Adults): Treatment of chronic hepatitis B infection: 1) Nucleoside treatment naive: 0.5 mg orally once daily. 2) Lamivudine-resistant viremia (or known lamivudine-resistant mutations): 1 mg orally once daily Renal dosing: CrCl 30-49 ml/min: Administer 50% of usual dose. CrCl 10-29 ml/min: Administer 30% of usual dose. CrCl <10 ml/min (including dialysis): Administer 10% of usual dose. Administer after hemodialysis. Supplied: 0.5 mg, 1 mg tablet. 0.05 mg/mL (210 mL) oral solution. lamivudine Epivir-HBV® Nucleoside Reverse Transcriptase Inhibitor. Dosing (Adults): hepatitis B: 100 mg daily. HIV: 150 mg twice daily or 300 mg once daily. <50 kg: 4 mg/kg twice daily (maximum: 150 mg twice daily). Renal dosing: See package insert. Supplied:  Epivir ®: 150 mg, 300 mg tablet. Epivir-HBV ®: 100 mg tab. Oral solution: Epivir®: 10 mg/mL (240 mL). Epivir-HBV®: 5 mg/mL (240 mL). peginterferon alfa-2a (Pegasys ®) Dosing (Adults):  Chronic hepatitis C: Monotherapy: 180 mcg SQ once weekly for 48 weeks.  Combination therapy with ribavirin: Recommended dosage: 180 mcg SQ once/week with ribavirin. Chronic hepatitis B: 180 mcg SQ once weekly for 48 weeks. Modification of dosing based on ADR: Moderate to severe adverse reactions: Initial: 135 mcg/week - may need decreased to 90 mcg/week in some cases. Based on hematologic parameters:     ANC <750/mm3: 135 mcg/week     ANC <500/mm3: Suspend therapy until >1000/mm3, then restart at 90 mcg/week and monitor.     Platelet count <50,000/mm3: 90 mcg/week.     Platelet count <25,000/mm3: Discontinue therapy. Depression (severity based on DSM-IV criteria):     - Mild depression: No dosage adjustment required; evaluate once weekly by visit/phone call. If depression remains stable, continue weekly visits. If depression improves, resume normal visit schedule.    - Moderate depression: Decrease interferon dose to 90-135 mcg once/week; evaluate once weekly with an office visit at least every other week. If depression remains stable, consider psychiatric evaluation and continue with reduced dosing. If symptoms improve and remain stable for 4 weeks, resume normal visit schedule; continue reduced dosing or return to normal dose.    - Severe depression: Discontinue interferon permanently. Obtain immediate psychiatric consultation. Discontinue ribavirin if using concurrently. Renal dosing: CrCl <50 ml/min: Use caution - monitor for toxicity. End-stage renal disease - hemodialysis: 135 mcg/week - monitor for toxicity. Supplied: Injection:  180 mcg/0.5 ml (0.5 ml) prefilled syringe.   180 mcg/mL (1 ml). peginterferon alfa-2b (PEG-Intron ®): Dosing (Adults): Chronic hepatitis C: Administer SQ dose once weekly. Note: Usual duration is for 1 year. After 24 weeks of treatment, if serum HCV RNA is not below the limit of detection of the assay, consider discontinuation: Monotherapy: Initial:   <= 45 kg: 40 mcg   46-56 kg: 50 mcg   57-72 kg: 64 mcg   73-88 kg: 80 mcg   89-106 kg: 96 mcg   107-136 kg: 120 mcg   137-160 kg: 150 mcg Combination therapy with ribavirin (400 mg twice daily): Initial: 1.5 mcg/kg/week   <40 kg: 50 mcg   40-50 kg: 64 mcg   51-60 kg: 80 mcg   61-75 kg: 96 mcg   76-85 kg: 120 mcg   >85 kg: 150 mcg Renal dosing: Monitor for signs and symptoms of toxicity and if toxicity occurs then adjust dose. Do not use in patients with CrCl <50 mL/minute. Patients were excluded from the clinical trials if serum creatinine >1.5 times the upper limits of normal. Supplied: Injection (powder for reconstitution) - syringe or vial: 50 mcg, 80 mcg, 120 mcg, 150 mcg. Rebetron ® (interferon alfa-2b + Ribavirin ): Rebetron Combination Therapy. Indications: treatment of chronic hepatitis C in patients with compensated liver disease previously untreated with alpha interferon or who have relapsed following alpha interferon therapy. Adult (usual):  (75 kg or less): ribavirin (1000 mg/day) 400 mg orally qam and 600 mg orally qpm (two 200 mg capsules in the morning and three 200 mg capsules in the evening) - plus interferon- 3 million IU SC 3 times a week. (>75 kg): ribavirin (1200 mg/day) - 600 mg orally bid (three 200 mg capsules in the morning and three 200 mg capsules in the evening) plus interferon- 3 million IU SC 3 times a week.   Renal dosing: Patients with CrCl <50 ml/min should not receive ribavirin. Supplied: [Rebetol Capsules - 200mg + Intron A Injection combination package]. Refrigerate. ribavirin (Rebetol ®): Indications: Use in combination with Intron A (interferon alfa-2b, recombinant) injection for the treatment of chronic hepatitis C in patients with compensated liver disease previously untreated with alpha interferon or who have relapsed following alpha interferon therapy. Adult (usual):  ( 75 kg or less): ribavirin, 400 mg orally qam and 600 mg orally qpm. (>75 kg): ribavirin, 600 mg orally bid (given in the morning and evening). Renal dosing: Patients with CrCl <50 ml/min should not receive ribavirin.  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.");s1[26]=new Array("anti_herpetic.htm","Anti-Herpetic (Herpes Simplex) Agents (Systemic and topical agents)","","Anti- Herpetic Agents acyclovir Zovirax ® Mucocutaneous herpes simplex: IV: 5 mg/kg/dose every 8 hours x 5-10 days.   Encephalitis: 10mg/kg/dose IV every 8 hours.   Primary HSV infection-genital (Oral therapy): 200mg every 4 hours while awake (5 times/day) or 400mg orally three times daily for 10 days.  Recurrent genital: 400mg orally three times daily for 5 days. Herpes Zoster: 800mg orally every 4 hours while awake (5 times/ day) for 7 days. If severe give 10-12 mg/kg IV every 8 hours x 7-14 days.   Chronic suppression (genital herpes): 400mg orally twice daily.    Zovirax ointment: apply ½" every 3 hours (6 times/day). Renal dosing: 50 - 90/ 5 to 12.4 mg/kg q8h || 10-50 / 5-12.4 mg/kg q12-24h || <10 / 2.5 to 6 mg/kg q24h. Alternatively: (Oral): 10-25 / dose q8h || <10 / dose q12h. (IV): 25-50/ 5-10mg/kg q12h || 10-25/ 5-10mg/kg q24h || <10/ 2.5 to 5mg/kg IV q24h. || HD: dose after dialysis || CAPD: see < 10. famciclovir Famvir ® First episode genital: 250 mg orally three times daily for 7-10 days. Recurrent herpes simplex (genital): 125 mg orally twice daily for 5 days. Prophylaxis (Chronic suppression): 250mg orally twice daily. Recurrent (HIV patient): 500mg orally twice daily for 7 days. Zoster: 500mg orally three times daily for 7 days.  Supplied: [125,250, 500 mg tabs]  Renal dosing: >60/ no change || 40-59/ 500mg q12h || 11-39/ 500mg q24h || <10/ 250 mg q48h || HD: 250mg after dialysis. valacyclovir Valtrex ® First episode genital: 1000mg orally twice daily for 10 days. Recurrent: 500mg orally twice daily for 5 days. Prophylaxis: 500-1000mg orally once daily. Zoster: 1000 mg orally three times daily for 7 days. Herpes labialis (cold sores) 2 gm q12h x 1 day.  Supplied: [500,1000mg tabs] Renal Dosing:  [CRCL >50]: No changes.  [30-49]: Zoster: 1 gram q12h. H. Labialis: 1 gram q12h x 2 doses. Initial episode GH: 1 gram q12h. Recurrent: 500mg q12h. Suppressive: 0.5 – 1 gm qd.   [10-29]: Zoster: 1 gram q24h. H. Labialis (lip): 500mg q12h x 2 doses. Initial episode G. Herpes: 1 gram q24h. Recurrent: 500mg q24h. Suppressive: 500mg q24-48h.  [<10]: Zoster: 500mg q24h. H. Labialis: 500mg x 1. Initial episode G. Herpes: 500mg q24h. Recurrent: 500mg q24h. Suppressive: 500mg q24-48h. Hemo: 500 mg PO q24h (on dialysis days give dose after dialysis) Anti- Herpetic (Topical): acyclovir Zovirax ® Apply every 3 hours (6 times / day) for 7 days.  Supplied: [5% ointment] docosanol Abreva ® Abreva Cream (Docosanol 10%): Uses: Treats cold sore/fever blisters on the face or lips. Shortens healing time and duration of symptoms: tingling, pain, burning, and/or itching. Directions: adults and children 12 years or over: wash hands before and after applying cream. Apply to affected area on face or lips at the first sign of cold sore/fever blister (tingle). Early treatment ensures the best results. Rub in gently but completely. Use 5 times a day until healed. penciclovir Denavir ®  Herpes labialis: apply 1% cream every 2 hours while awake for 4 days.  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.");s1[27]=new Array("antihistamines.htm","Antihistamines - Dosing","Cough/cold/allergies (Agents)--dosing list for health care providers, pharmacists, nurses, physicians.","Low or non-sedating antihistamines: cetirizine (Zyrtec): 5-10 mg orally once daily. desloratadine (Clarinex) Adults: Allergic rhinitis, seasonal/perennial: 5 mg po qd.  Chronic idiopathic urticaria: 5 mg po qd. In patients with liver or renal impairment, a starting dose of one 5 mg tablet every other day is recommended based on pharmacokinetic data. fexofenadine (Allegra): Adult (usual) Chronic idiopathic urticaria: 60 mg orally twice daily. Seasonal allergic rhinitis: 60 mg orally twice daily or 180 mg once daily.   A dose of 60 mg once daily is recommended as the starting dose in patients with decreased renal function loratadine (Claritin): 10 mg orally once daily. Combination decongestant/antihistamine (Formulary): Actifed (triprolidine 2.5mg + psuedoephedrine 60mg): 1 tablet orally every 4 to 6 hours as needed. Maximum of 4 tablets/day. Allegra D (pseudoephedrine 120mg + fexofenadine 60mg) Dosing: one tablet twice daily for adults and children 12 years of age and older (should be taken on an empty stomach). A dose of one tablet once daily is recommended as the starting dose in patients with decreased renal function. Claritin-D 24 hour (10mg loratadine + 240mg psuedophedrine) Dosing (Adult): one tablet po qd.   Claritin-D 24 Hour Extended Release Tablets should generally be avoided in patients with hepatic insufficiency. Patients with renal insufficiency (GFR <30 mL/min) should be given a lower initial dose (one tablet every other day) because they have reduced clearance of loratadine and pseudoephedrine. Patients who have a history of difficulty in swallowing tablets or who have known upper gastrointestinal narrowing or abnormal esophageal peristalsis should not use this product Other antihistamines: chlorpheniramine (Chlor-Trimeton) Adult (usual): 4 mg po every 4 to 6 hrs; maximum dose: 24 mg/day.  Sustained-release: 8 or 12 mg po every 8 to 12 hours. Maximum dose: 24 mg/day clemastine (Tavist) Tavist 12 Hour Allergy Tablets: Clemastine fumarate, USP 1.34 mg (equivalent to 1 mg clemastine). Adults and children 12 years of age and older: take 1 tablet every 12 hours, not more than 2 tablets in 24 hours unless directed by a doctor. cyproheptadine (Periactin): Start 4 mg orally three times a day. Maximum: 32 mg/day. dimenhydrinate (Dramamine): 50 to 100mg orally every 4 to 6 hours as needed. [Supplied: 25, 50mg] diphenhydramine (Benadryl): 25-50mg oral, IV or IM every 4 to 6 hours as needed. hydroxzine (Atarax, Vistaril): 25-100mg orally or IM 1 to 4 times daily or as needed. promethazine (Phenergan) Adult (usual) Allergy: 25 mg orally at bedtime or 12.5 mg orally before meals and at bedtime Allergy: 25 mg IV or IM, may repeat within 2 hrs if needed. Anesthesia adjunct: 25-50 mg IM or IV prior to surgery.  Motion sickness: 25 mg orally twice daily. Nausea and vomiting: 12.5-25 mg orally ,rectally, IV or IM every 4 to 6 hrs.  Sedation: 25-50 mg orally or 50 mg rectally. Administration: maximum rate of IV administration: 25 mg/min. maximum concentration for IV administration: 25 mg/mL.    [Supplied 25, 50 mg/ml Injection.  12.5, 25, 50mg suppository.  10 mg/5 ml Syrup.  10, 25 , 50mg Tablet]  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.   Author: David McAuley Keywords: cough, colds, allergies, pharmacists, nursing, physicians,health care providers, periactin, dramamine, diphenhydramine, zyrtec, allegra, fexofenadine, claritin");s1[28]=new Array("atopic_dermatitis.htm","Atopic Dermatitis - Agents","","Atopic Dermatitis  Other agents to be added during next update pimecrolimus (Elidel ®): Dosing (Adults): Mild to moderate atopic dermatitis: Apply thin layer to affected area twice daily - rub in gently and completely. Note: Continue as long as signs and symptoms persist. Discontinue if resolution occurs. Re-evaluate if symptoms persist >6 weeks. Supplied: 1% cream (30 g, 60 g, 100 g). tacrolimus (Protopic ®): Dosing (Adults): Atopic dermatitis (moderate to severe): Apply 0.03% or 0.1% ointment to affected area twice daily. Rub in gently and completely - continue applications for 1 week after symptoms have cleared. Supplied: 0.03% and 0.1% ointment (30 g, 60 g, 100 g).  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.");s1[29]=new Array("anti-influenza.htm","Anti-Influenza Agents","","Anti-Influenza Agents amantadine (Symmetrel ®): Influenza A: 100 mg orally twice daily. Elderly: 100mg orally once daily. oseltamivir phosphate (Tamiflu ®): Influenza A: 75 mg orally twice daily for 5 days. Treatment should begin within 2 days of onset of symptoms of influenza. If crcl< 30 ml/min: give 75mg orally once daily x 5 days. [75mg cap] rimantadine (Flumadine ®): Influenza A: 100 mg orally twice a day x 7 days. zanamivir (Relenza ®): Influenza therapy: 2 puffs twice daily x 5 days (rotadisk inhaler)  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.");s1[30]=new Array("antiplatelet.htm","Anti-platelet Agents","","Anti-platelet Agents abciximab (Reopro ®): Platelet aggregation inhibition: (PCI): 0.25 mg/kg IV 10–60 minute prior to PCI, then 0.125 mcg/kg/minute (Maximum 10 mcg/min) IV Infusion x 12 hours. Aggrenox ® (dipridamole/ASA): 1 capsule orally twice daily [200 mg /25 mg] anagrelide (Agrylin ®): Essential thrombocythemia: initially 0.5 mg orally four times daily or 1 mg orally twice daily, then after 1 week adjust to obtain lowest effective dose. Maximum: 10 mg/day. clopidogrel (Plavix ® ): Recent MI, Stroke or Established Peripheral Arterial Disease - The recommended daily dose of Plavix is 75 mg once daily. Acute Coronary Syndrome For patients with acute coronary syndrome (unstable angina/non-Q-wave MI), Plavix should be initiated with a single 300 mg loading dose and then continued at 75 mg once daily. Aspirin (75 mg-325 mg once daily) should be initiated and continued in combination with Plavix . In CURE, most patients with Acute Coronary Syndrome also received heparin acutely . dipyridamole (Persantine ®): 75-100 mg orally four times daily eptifabatide (Integrilin ®): Administration: Bolus: withdraw dose from 10ml vial and give by IV push over 1-2 minutes. Continuous infusion: administer calculated rate directly from 100ml vial.    Properties: Onset: within 1 hr. T1/2 = 2.5 hours.  Platelet fcn restored in @ 4hours after discontinuation.  [Supplied: 0.75 mg/ml (100ml) vial. 20 mg/10 ml vial.] Acute coronary syndrome: Bolus of 180 mcg/kg (maximum: 22.6 mg) over 1-2 minutes, begun as soon as possible following diagnosis, followed by a continuous infusion of 2 mcg/kg/minute (maximum: 15 mg/hour) until hospital discharge or initiation of CABG surgery, up to 72 hours. Concurrent aspirin (160-325 mg initially and daily thereafter) and heparin therapy (target aPTT 50-70 seconds) are recommended. Dosing adjustment in renal impairment: Acute coronary syndrome: Scr >2 mg/dL and <4 mg/dL: Use 180 mcg/kg bolus (maximum: 22.6 mg) and 1 mcg/kg/minute infusion (maximum: 7.5 mg/hour) Percutaneous coronary intervention (PCI) with or without stenting: Bolus of 180 mcg/kg (maximum: 22.6 mg) administered immediately before the initiation of PCI, followed by a continuous infusion of 2 mcg/kg/minute (maximum: 15 mg/hour). A second 180 mcg/kg bolus (maximum: 22.6 mg) should be administered 10 minutes after the first bolus. Infusion should be continued until hospital discharge or for up to 18-24 hours, whichever comes first; minimum of 12 hours of infusion is recommended. Concurrent aspirin (160-325 mg 1-24 hours before PCI and daily thereafter) and heparin therapy (ACT 200-300 seconds during PCI) are recommended. Heparin infusion after PCI is discouraged. In patients who undergo coronary artery bypass graft surgery, discontinue infusion prior to surgery. Dosing adjustment in renal impairment: Percutaneous coronary intervention (PCI) with or without stenting: Adults: Scr >2 mg/dL and <4 mg/dL: Use 180 mcg/kg bolus (maximum: 22.6 mg) administered immediately before the initiation of PCI and followed by a continuous infusion of 1 mcg/kg/minute (maximum: 7.5 mg/hour). A second 180 mcg/kg (maximum: 22.6 mg) bolus should be administered 10 minutes after the first bolus. ticlopidine (Ticlid ®): 250 mg orally twice daily with food. tirofiban (Aggrastat ®): Dosing: 0.4 mcg/kg/min for 30 minutes, followed by 0.1 mcg/kg/min. Therapy should continue through angiography and for 12-24 hours after angioplasty or atherectomy. (Note: Reduce dose by 50% if CRCL < 30 ml/min - 0.2 mcg/kg/min x 30min, followed by 0.05 mcg/kg/min). Preparation: Add 12.5 mg (50 ml) to 200ml NS or D5W. Total volume= 250ml. Concentration= 50 mcg/ml. Or add 25 mg (100ml) to 400 ml D5W or NS. Supplied: 250 mcg/ml-50 ml vial (12.5 mg/50ml). Calculation of rate: Loading dose (ml/hr) = 0.48 x wt(kg). Infuse for 30 minutes. Continuous infusion (ml/hr) = 0.12 x wt(kg)  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.");s1[31]=new Array("antispasmotic.htm","Antispasmotics - Bowel spasm/cramping","","Bowel spasm/cramping: Dicyclomine (Bentyl ®) 10-20 mg orally or IM four times daily (up to 40 mg orally four times daily). Donnatal: 1-2 tablets or capsules or 5-10 ml orally three to four times daily. Propantheline (Pro-Banthine ®) 7.5 to 15 mg orally 30 minutes before meals and at bedtime. [7.5, 15mg] Simethicone (Mylicon ®) 40-160 mg orally four times daily as needed. Hypermotility / IBS: Bellergal-S (phenobarbitol 40 mg +  belladonna 0.2mg +ergotamine 0.6mg) Menopausal disorders, recurrent headaches, other: 1 tablet twice daily (in the morning and at bedtime). hyoscyamine (Levsin ®) Conventional hyoscyamine tablets may be administered orally or sublingually. The usual dose is 1 to 2 tablets (0.125 to 0.25 milligram) every 4 hours or as needed. No more than 12 tablets should be ingested per 24 hours. (Sustained-release): 1 to 2 capsules or tablets (0.375 to 0.75 milligram) every 12 hours; the dose may be adjusted to 1 capsule every 8 hours if needed. The tablets are scored so that they may be broken to allow for easier titration of dose. Do not exceed 4 sustained-released capsules or tablets per 24 hours. (Hyoscyamine Drops): 1 to 2 milliliters (0.125 to 0.25 milligram) every 4 hours or as needed; do not exceed 12 milliliters/24 hours. (Hyoscyamine Elixir): 5 to 10 milliliters (0.125 to 0.25 milligram) every 4 hours or as needed - do not exceed 60 ml/24 hours. Hypermotility of the lower urinary tract: 1 to 2 tablets (0.15 to 0.3 mg) 4 times daily or fewer if possible. [Supplied: 0.125 mg/5 ml elixir; 0.375 mg extended release cap/Tablet; 0.5 mg/ml solution for injection; 0.125 mg SL Tab] Librax (clininium 2.5 mg + chlordiazepoxide 5 mg): Adjunct treatment of peptic ulcer; treatment of IBS: 1-2 capsules 3-4 times/day (before meals and at bedtime). tegaserod (Zelnorm ®) Indicated for the short-term treatment of women with irritable bowel syndrome (IBS) whose primary bowel symptom is constipation. Recommended dosage: 6 mg taken twice daily orally before meals for 4 to 6 weeks. For those patients who respond to therapy at 4-6 weeks, an additional 4-6 week course can be considered. Supplied: [2, 6mg tablets]    Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.");s1[32]=new Array("anti_tussives.htm","Antitussives - Expectorants","Cough/cold/allergies (Agents)--dosing list for health care providers, pharmacists, nurses, physicians.","Antitussives/Expectorants: benzonatate (Tessalon) Cough (initial): 100 mg orally tid prn. Maximum dose: 600 mg per day. guaifenesin (Robitussin) 200-400 mg (2 to 4 teaspoonfuls) orally every 4 hours as needed. Maximum of 24 teaspoonfuls per day. Humabid LA (600mg tabs): 1-2 tabs every 12 hours. Maximum 4 tabs/day. Robitussin DM (dextromethorphan 10mg + guaifenesin 100mg/ 5 ml): 2 teaspoonfuls orally every 3 to 4 hours as needed. (Maximum 16 tsp/day). Robitussin CF (pseudoephedrine 30mg / guaifenesin 100mg/ dextromethorphan 10mg) per 5 ml Adult dose: 2 teaspoonfuls every 4 hrs. Do not take more than 4 doses in any 24 hour period.  Supplied: Each teaspoonful (5 ml) contains: Guaifenesin 100 mg, Pseudoephedrine hcl 30 mg, Dextromethorphan Hydrobromide 10 mg.   Robitussin PE (pseudoephedrine 30mg / guaifenesin 100mg) per 5 ml Adult dose (and children 12 years and over): 2 teaspoonfuls every 4 hrs.  Do Not Exceed 4 Doses in any 24-Hour Period. Supplied: Each teaspoonful of Robitussin-PE (5 ml) contains: Guaifenesin 100 mg, Pseudoephedrine HCl 30 mg.   Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc. Author: David McAuley Keywords: cough, colds, allergies, pharmacists, nursing, physicians,health care providers,robitussin, guaifenesin, cepacol, sore throat, pseudoephedrine, periactin, dramamine, diphenhydramine, zyrtec, allegra, fexofenadine, claritin");s1[33]=new Array("benzodiazepines.htm","Benzodiazepines - Sedatives / Anxiolytics","","Benzodiazepines Short half-life alprazolam (Xanax ®): Initial: 0.25 to 0.5 mg orally 2 to 3 times daily. Usual maximum: 4 mg/day. [0.25, 0.5, 1, 2 mg tabs] oxazepam (Serax ®): 10-30 mg orally 3 to 4 times daily. [10, 15, 30 mg] triazolam (Halcion ®): 0.125 to 0.5 mg orally at bedtime Intermediate half-life estazolam (ProSom ®): 1-2 mg orally at bedtime lorazepam (Ativan ®): Anxiety/sedation: 1-10 mg orally in 2-3 divided doses. Usual dose: 2-6 mg/day in divided doses. Initial dose should not exceed 2 mg in debilitated patients. Insomnia: 2-4 mg orally at bedtime. Status epilepticus: 4 mg IV over 2 to 5 min. May repeat in 10-15 minutes. Continuous infusion: (ICU): 1 to 20 mg/hr (0.01-0.1 mg/kg/hour). midazolam (Versed ®): Sedation: 5 mg IM. Intubated patients (Continuous infusion): 1 to 7 mg/hr. temazepam (Restoril ®): 7.5 to 30 mg orally at bedtime Long half-life chlordiazepoxide (Librium ®): Anxiety: 5 to 25 mg orally or 25-50mg IM/IV 3 to 4 times a day.  Alcohol withdrawal: 50-100mg oral, IM or IV every 3 to 4 hours as needed. Normally, do not exceed 300mg / day. clonazepam (Klonopin ®): Start 0.25 to 0.5 mg orally three times daily. Maximum: 20mg/day. chlorazepate (Tranxene ®): 7.5 to 15 mg orally 1 to 3 times per day. diazepam (Valium ®): Anxiety: 2-10 mg orally 2 to 4 times per day. Status epilepticus: 5-10 mg IV q10-20min, up to 30 mg in an 8 hour period. Muscle relaxant: 2 to 5 mg orally 2 to 4 times per day. flurazepam (Dalmane ®): 15-30mg orally at bedtime. Non-Benzodiazepines (Sedatives) eszcpiclone (Lunesta ® ): Insomnia: Initial: 2 mg before bedtime (maximum dose: 3 mg). Concurrent use with strong CYP3A4 inhibitor: 1 mg before bedtime; if needed, dose may be increased to 2 mg. Supplied: 1 mg, 2 mg, 3 mg tablet. ramelteon (Rozerem ® ): Melatonin receptor agonist. Dosage (Adult): Insomnia: 8 mg orally taken within 30 min of bedtime. Supplied: 8 mg tablet. zaleplon (Sonata ® ):  5-10mg orally at bedtime as needed. zolpidem (Ambien ®): 5-10 mg orally at bedtime. Non-Benzodiazepines (Anxiolytics) buspirone (BuSpar ® ):  Dosage ( Adult): Anxiety disorders (GAD): 15 mg/day (7.5 mg twice daily). May increase in increments of 5 mg/day every 2-4 days to a maximum of 60 mg/day. Target dose for most people is 30 mg/day (15 mg twice daily). Supplied: 5 mg, 7.5 mg, 10 mg, 15 mg, 30 mg tablet.  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.");s1[34]=new Array("beta.htm","Beta blockers: Dosing table","","Beta Blockers atenolol (Tenormin ®): Acute MI: 5 mg IV over 5 minutes, repeat in 10 minutes. Hypertension/angina: initially: 25-50 mg orally once daily.   Maximum: 100 mg/day. [Supplied: 25, 50, 100mg tablets.    Injection: 10ml (0.5mg/ml) ] ß1 betaxolol (Kerlone ®): Initially: 5-10 mg orally once daily. Maximum: 20 mg/day. [Supplied: 10, 20mg tablet] ß1 bisoprolol (Zebeta ®): Initially: 2.5 to 5 mg orally once daily. Maximum dose: 20 mg/day. [Supplied: 5, 10 mg tablets] ß1 carvedilol (Coreg ®): CHF: initially: 3.125 mg orally twice a day, double dose every two weeks as tolerated up to maximum of 25 mg orally twice a day (if 85 kg: maximum: 50 mg orally twice a day.  Hypertension: 6.25 mg orally twice a day. May adjust dose every 1-2 weeks. Maximum: 50 mg/day.   [Supplied: 3.125, 6.25, 12.5, 25 mg tablets] ß1,ß2, alpha esmolol (Brevibloc ®): Dosing: PSVT: 500 mcg/kg over 1 min, then 50 mcg/kg/min for 4 to 5 minutes. If heart rate not controlled, repeat load of 500 mcg/kg and increase infusion to 100 mcg/kg/min. Repeat load and increase infusion every 5 to 10 minutes as needed to maximum of 200 (possibly 300?) mcg/kg/min. Watch blood pressure.   Calculation of drip rate (ml/hr): 2.5 grams/250 ml: wt (kg) x mcg/min x 0.006 ß1 labetalol (Normodyne ®) Oral: initial: 100 mg orally twice a day. Usual: 200-400mg orally twice a day. Maximum: 2400 mg/day.  Hypertensive emergency: 20mg IV slow injection, then 40-80 mg IV every 10 minutes as needed. (up to 300 mg total dose) until desired BP is reached or start continuous infusion: 2 mg/min (range: 1 to 3 mg/min)--titrate to BP.    [Supplied: 100, 200, 300mg tablets; 5 mg/ml--20ml vial] ß1,ß2, alpha metoprolol (Lopressor ®) Acute MI: 5 mg IV q5-15min up to 15 mg, followed by 50mg orally every 6 hours x 48 hours. Hypertension: Initially 25 to 50mg orally twice a day. Maximum: 450 mg/day.  (Toprol XL): initially 50-100mg orally once daily. Maximum: 400mg/day. ß1 nadolol (Corgard ®) (Hypertension / angina): Initially 20-40mg orally once daily. Maximum: 320mg/day.   [Supplied: 20, 40, 80, 120, 160mg tablets] ß1,ß2 pindolol (Visken ®) Start 5 mg orally twice a day . Increase as necessary by 10 mg/day every 3-4 weeks. Maximum of 60mg/day. [Supplied: 5, 10mg tablet] ß1,ß2, ISA propranolol (Inderal ®) Initially 20-40 mg orally twice a day. Maximum 640 mg/day. Angina: 80-320 mg/day in 2 to 4 divided doses. Inderal LA: Start 80 mg orally once daily.  IV : Life-threatening arrhythmia: usually 1- 3 mg (maximum rate: 1 mg/min)-may dilute in D5W-50ml. May repeat 1 mg dose q5 minutes to maximum of 5 mg total. Subsequent doses no sooner than 4 hours. May start IV infusion: usual rate: 2 to 3 mg/hr. Titrate to HR/BP. ß1,ß2 sotalol (Betapace ®) Ventricular arrythmias: initially 80mg orally twice a day. Usual maintenance dose: 160-320mg/day in 2 to 3 divided doses. [Supplied: 80,120,160,240mg tablets] ß1,ß2 timolol (Blocadren ®) Start 10 mg orally twice a day. Usual dosage: 20-40 mg/day. Maximum: 60 mg/day. [Supplied: 5, 10, 20mg tablet] ß1,ß2  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.");s1[35]=new Array("bile_acid_sequest.htm","Bile acid sequesterants","Lipid lowering agents: dosing list for health care providers, pharmacists, nurses, physicians. Lipitor, Baycol, Lescol, Pravachol, Zocor, Tricor.","Bile acid sequestrants: Bile acid sequestering agents (Resins): The liver uses cholesterol to produce bile acids, which are used in the digestive process. The bile acid sequestrants bind to these acids, reducing their supply. In turn, this stimulates the liver to produce more bile acids, which uses more cholesterol. Unfortunately, the resins can increase triglyceride levels. When the statins are not sufficient to lower high cholesterol, these drugs can be added. Their use is often limited by side effects, which are primarily gastrointestinal. They can include nausea, bloating, cramping, and an increase in liver enzymes. cholestyramine (Questran ®): Adult (usual) Hypercholesterolemia/pruritis: initial, 4 grams orally qd to bid; maintenance, 8-16 g in divided doses, Max of 24 g daily. colesevelam (Welchol ®): Colesevelam is a high capacity bile acid binding molecule. Adult (usual)- hypercholesterolemia: 3 tabs (1875 mg) orally bid or 6 tabs orally qd - may increase to 7 tabs (4375 mg) daily [Supplied: 625 mg tablet ] colestipol (Colestid ®): Adults: Recommended dose (Maintenance) - (Tablets): 2 to 16 grams/day given once or in divided doses. The starting dose should be 2 grams once or twice daily. Dosage increases of 2 grams, once or twice daily should occur at 1 or 2 month intervals. If the desired therapeutic effect is not obtained at a dose of 2 to 16 grams/day with good compliance and acceptable side effects, combined therapy or alternate treatment should be considered. Adult (usual): powder: 5-30 g orally (mixed with liquid) once daily or in divided doses. Colestipol tablets must be taken one at a time and be promptly swallowed whole, using plenty of water or other appropriate liquid. Do not cut, crush, or chew the tablets. Patients should take other drugs at least one hour before or four hours after colestipol tablets to minimize possible interference with their absorption.   [Supplied: 1 gram coated tablet. 5 grams/dose granules for oral suspension. ]  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc. Author: David McAuley Keywords: HMG COA reducase inhibitors,pharmacists, nursing, physicians,health care providers,Lipitor, Baycol, Lescol, Mevacor, Pravachol, Zocor, Tricor, Lopid.");s1[36]=new Array("biphos.htm","Bisphosphonate's: Dosing table. Fosamax, Aredia, Didronel, Actonel, Skelid","","Bisphosphonates: Corrected calcium= serum calcium + 0.8 (4 - serum albumin) Bisphosphonates inhibit bone resorption via actions on osteoclasts or on osteoclast precursors which leads to decreases in the rate of bone resorption and an indirect increase in bone mineral density. alendronate (Fosamax ®): Postmenopausal osteoporosis prevention: 5 mg orally once daily or treatment: 10 mg orally once daily. Glucocorticoid induced: 5-10 mg orally once daily. Paget's disease: 40 mg orally once daily x 6 months. May cause esophagitis. Alendronate should be taken in the morning with a full glass (eg, 6 to 8 ounces) of plain water at least one-half hour before food, beverages, or other medications. etidronate (Didronel ®): Hypercalcemia: 7.5 mg/kg IV over 2 hours once daily x 3 days. Paget's disease: 5-10 mg/kg orally once daily x 6 months or 11-20 mg/kg x 3 months. ibandronate (Boniva ®): Bisphosphonate. Adults (usual): Treatment of postmenopausal osteoporosis: 2.5 mg orally once day or 150 mg once a month. Prevention of postmenopausal osteoporosis: 2.5 mg orally once daily. 150 mg once a month may be considered. Supplied: 2.5 mg tablet (once-daily formulation), 150 mg tablet - (once-monthly formulation). pamidronate (Aredia ®): Hypercalcemia: 60-90mg IV single dose. Wait at least 7 days before considering retreatment. Usual recommendation for moderate hypercalcemia (corrected serum calcium of 12 to 13.5 milligrams/dL) is 60 to 90 milligrams. The 90 mg dose is recommended for severe hypercalcemia (corrected calcium greater than 13.5 milligrams/dL) risedronate (Actonel ®): Paget's disease: 30 mg orally once daily x 2 months. May cause esophagitis. (100 times more potent than pamidronate or alendronate). Should be taken on an empty stomach in an upright position with at least 6 ounces of plain water. The upright position and empty stomach should be maintained for at least 30 minutes to minimize gastrointestinal adverse events and increase absorption.  [Supplied: 30mg tablet] tiludronate (Skelid ®): Paget's disease: 400mg orally once daily x 3 months. Each dose should be taken with 6 to 8 ounces of water. Tiludronate should not be taken within 2 hours of food or other medications. Zoledronic acid (Zometa®) Adult (usual): Hypercalcemia of malignancy: 4 mg IV given as a single dose infusion over no less than 15 min; may repeat after a minimum of 7 days if serum calcium does not return to normal or remain normal after initial treatment. Multiple myeloma/metastatic bone lesions from solid tumors: 4 mg IV infused over 15 min every 3-4 weeks; administer with an oral calcium supplement of 500 mg and a multiple vitamin containing 400 International Units of vitamin D. Paget's disease: 100-400 mcg as a single infusion infused over 1 hr.   Vigorous saline hydration alone may be sufficient to treat mild, asymptomatic hypercalcemia. The maximum recommended dose of Zometa in hypercalcemia of malignancy (albumin-corrected serum calcium * >/=12 mg/dL [3.0 mmol/L]) is 4 mg.  The 4-mg dose must be given as a single-dose intravenous infusion over no less than 15 minutes. Patients should be adequately rehydrated prior to administration of Zometa.  Renal function must be carefully monitored in all patients receiving Zometa and possible deterioration in renal function must be assessed prior to retreatment with Zometa. Osteoporosis - other: Raloxifene (Evista®) Adult (usual): Osteoporosis prevention: 60 mg orally qd.  Osteoporosis treatment: 60 mg orally qd. Teriparatide (Forteo®) Adult (usual): Osteoporosis: 20 mcg SC once daily.  Administration: give as SC injection into the thigh or abdominal wall. Initial injection should occur where the patient is able to sit or lie down in case symptoms of orthostatic hypertension occur.  Use for more than 2 years is not recommended. Teriparatide is the biologically active N-terminal region of the human parathyroid hormone. Supplied: Solution for injection: 250 mcg/ml (3 ml). Prefilled syringe, delivers teriparatide 20 mcg/dose. Refrigerated.  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.");s1[37]=new Array("bladder_spasm.htm","Urology (Common agents): dosing list for health care providers, pharmacists, nurses, physicians. bladder spasm","","Urology Bladder spasm B&O Supprettes ® Dosing (Adults): 1 suppository rectally once or twice daily. Max 4 doses/day. Supplied: #15 A: Belladonna extract 16.2 mg and opium 30 mg. #16 A: Belladonna extract 16.2 mg and opium 60 mg. flavoxate Urispas ® Dosing (Adults): 100-200 mg orally 3 to 4 times daily. hyoscyamine Levsin ® Dosing (Adults): 0.125 to 0.375 mg orally or sublingual every 4 hours as needed. Max 1.5 grams/ day.   Long acting (XL): 0.375 - 0.75 mg orally every 12 hours. Bladder instability (Overactive bladder) darifenacin Enablex ® Anticholinergic agent. Dosing (Adults): Symptoms of bladder overactivity - Initial: 7.5 mg orally once daily. If response is not adequate after a minimum of 2 weeks, dosage may be increased to 15 mg once daily. Dosage should not be increased in patients with hepatic impairment or in those receiving potent inhibitors of CYP3A4. Hepatic dosing: Moderate impairment (Child-Pugh Class B): Daily dosage should not exceed 7.5 mg/day. Severe impairment (Child-Pugh Class C): Use is not recommended. Supplied: Extended release tablet: 7.5 mg, 15 mg. oxybutynin Ditropan ® Exhibits 20% of the anticholinergic activity of atropine, however, has 4 to 10 times the antispasmodic activity. Dosing (Adults): Bladder spasms: Regular release: 5 mg orally 2 to 3 times daily up to maximum of 5 mg 4 times/day. Extended release (XL): Initial: 5-10 mg once daily- may increase in 5-10 mg increments. Maximum: 30 mg daily. Transdermal: Apply one 3.9 mg/day patch twice weekly (every 3-4 days). Note: Should be discontinued periodically to determine whether the patient can manage without the drug and to minimize resistance to the drug. Supplied: Regular release tablet: 5 mg. Extended release tablet: 5 mg, 10 mg, 15 mg. Syrup: 5 mg/5 ml.  Transdermal system (Oxytrol ®): 3.9 mg/day. solifenacin Vesicare ® Anticholinergic agent -Inhibits muscarinic receptors resulting in decreased urinary bladder contraction, increased residual urine volume, and decreased detrusor muscle pressure.   Dosing (Adults): Overactive bladder: 5 mg orally once daily. If tolerated, may increase to 10 mg orally once daily. Renal dosing: Use with caution in patients with reduced renal function ( Clcr <30 ml/minute: 5 mg/day). Hepatic impairment: Use with caution in reduced hepatic function: Moderate: 5 mg/day. Severe impairment: Not recommended. Supplied: 5 mg, 10 mg tablet. tolterodine Detrol ® Anticholinergic agent -demonstrates selectivity for urinary bladder receptors over salivary receptors.  Dosing (Adults): Immediate release tablet: 2 mg orally twice daily. The dose may be lowered to 1 mg twice daily based on individual response and tolerability. Extended release capsule: 4 mg once a day- dose may be lowered to 2 mg daily based on individual response and tolerability. Renal dosing (Crcl 10-30)/ hepatic impairment: Use with caution. 1 mg twice daily (regular release) or 2 mg daily (extended release). Supplied: 1 mg, 2 mg tablet. 2 mg, 4mg extended release capsule. trospium Sanctura ® Dosing (Adults): Overactive bladder - 20 mg orally twice daily. In patients >75 years old or if crcl < 30 ml/min decrease dose to 20 mg once daily at bedtime. Supplied: 20 mg tablet.  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.");s1[38]=new Array("bph.htm","BPH (Benign prostatic hypertrophy )","","Urology Benign prostatic hypertrophy (BPH) alfuzosin (UroXatral ®) BPH: 10 mg orally once daily.   [ Supplied: 10mg extended release tablet.] doxazosin (Cardura ®) BPH: initial, 1 mg orally once daily. May increase dose at 1-2 week intervals. Maintenance: 1-8 mg orally once daily.   CHF: 1-16 mg orally once daily.  Hypertension: initial, 1 mg orally once daily. Maintenance, 1-16 mg po once daily.  [Supplied 1 mg, 2 mg, 4 mg, 8 mg tablets] dutasteride (Avodart ®) Adult (usual) - (BPH): 0.5 mg orally once daily. [Supplied: 0.5 mg capsule] Mechanism: competitive, selective inhibitor of both reproductive tissues (type 2) and skin and hepatic (type 1) 5alpha-reductase. This results in inhibition of the conversion of testosterone to dihydrotestosterone and markedly suppresses serum dihydrotestosterone levels. finasteride (Proscar ®): 5 mg orally once daily. tamsulosin  (Flomax ®): BPH: 0.4 mg orally once daily, given 30 minutes after a meal. May increase dose after 2 to 4 weeks to a maximum of 0.8 mg/day. [Supplied: 0.4 mg capsule] terazosin  (Hytrin ®): Adult (usual) - (BPH): initial, 1 mg orally qhs. Maintenance, 1-10 mg orally once daily (Maximum: 20 mg/day).  Hypertension (HTN): initial, 1 mg po qhs. Maintenance (HTN): 1-5 mg po qd - bid. Maximum: 20-40 mg/day [Supplied 1, 2, 5, 10 mg capsule]  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.");s1[39]=new Array("burn.htm","Burn preparations (Antibacterial)","","Burn preparations: mafenide acetate Sulfamylon ® Apply cream (with sterile glove) once or twice daily to affected area. The burned area should be covered with cream at all times. silver sulfadiazine  SSD ® , Silvadene ® Apply (with sterile glove) once or twice daily to the affected area. The burned area should be covered with cream at all times. [Supplied: 1% cream (25 g, 50 mg, 85 g, 400 g)]  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.");s1[40]=new Array("calcium_channel_blockers.htm","Calcium Channel Blockers - Dosing Table","","Calcium Channel Blockers amlodipine (Norvasc®): Adult (usual) Angina: 5-10 mg po qd. Hypertension initial: 5 mg po qd; maintenance 5-10 mg po qd.  FDA labeled indications: Angina, stable or unstable; Hypertension.  Small, fragile, or elderly individuals, or patients with hepatic insufficiency may be started on 2.5 mg once daily and this dose may be used when adding Norvasc® to other antihypertensive therapy.   In general, titration should proceed over 7 to 14 days so that the physician can fully assess the patient's response to each dose level.  [Supplied 2.5, 5, 10mg tab] bepridil (Vascor®): Adult (usual) Angina: 200-300 mg po qd; Maximum 400 mg once daily.  [Supplied 200, 300 mg tab] FDA labeled indications: Angina (second-line therapy) diltiazem (Cardizem®): Adult (usual) Oral: Angina: (regular release tablets) initial 30 mg po qid; usual dose 180-360 mg po daily (maximum 360 mg daily).  Angina: (extended release capsule; Dilacor(R) XR), initial 120 mg po qd; usual dose 120-480 mg once daily, maximum 540 mg/day.   Hypertension: (Cardizem SR), initial 60-120 mg po q12h.; usual dose 120-180 mg bid, maximum 360 mg/day.  Hypertension: ( Dilacor(R) XR): initial, 120-240 mg orally once daily; titrate after 14 days; usual dose, 240-360 mg orally once daily, maximum 540 mg/day. Arrhythmia: (IV bolus), initial 0.25 mg/kg (or 20 mg) IV over 2 minutes; if inadequate response, may give second bolus 0.35 mg/kg (25 mg) after 15 min   Arrhythmia: (IV continuous infusion), initial 5-10 mg/hr; increase in 5 mg/hr increments up to 15 mg/hr maintained for up to 24 hr.      [Supplied: Immediate release tablets: 30, 60, 90, 120 mg.   Sustained released capsules (SR): 60, 90, 120mg.  Extended release capsules (CD): 120,180,240,300,360 mg.  Vials (IV): 25, 50, 125 mg (5 mg/ml) ] felodipine (Plendil®): Adult (usual) Angina: 2.5-5 mg po bid.  CHF: initial, 5 mg po qd (Maint: 5 mg po bid).  HTN: initial, 5 mg po qd. (Maint: 2.5-10 mg po qd.) Raynaud's phenomenon: 10-20 mg po qd.  Administration: avoid taking with grapefruit juice. Dose adjustments should be made at intervals of not less than 2 weeks. [Supplied 2.5 mg, 5 mg, 10 mg ER tab] isradipine (Dynacirc®): Adult (usual) HTN: initial: 2.5 mg po bid (maintenance: 2.5-10 mg po bid); maximum 20 mg/day. HTN: (controlled release tablet) initial: 5 mg po qd, maintenance: 5-10 mg once daily; maximum 20 mg/day.    [Supplied 2.5 mg, 5 mg capsule.  5 mg, 10 mg controlled release tablet]   nicardipine (cardene®): Adult (usual) Oral: Angina, Hypertension: (immediate release): Initial, 20 mg po tid.  Maintenance, 20-40 mg po tid.   Hypertension: (sustained release capsule): Initial - 30 mg po bid. Maintenance: 30-60 mg po bid.    IV: Hypertension: initial, 5 mg/hr IV infusion. Titrate 2.5 mg/hr at 5-15 min intervals. Maximum rate of 15 mg/hr.  Hypertension: maintenance (after reaching BP goal): 3 mg/hr IV .   [Supplied 20, 30mg capsule. 2.5 mg/ml soln -inj.  30, 45, 60mg SR capsule.] nifedipine (Procardia®): Adult (usual) Angina: (immediate-release): Initial: 10 mg orally tid. Maintenance: 10-30 mg po 3-4 times daily - maximum 180 mg/day.   Angina: (sustained-release): Initial 30-60 mg po qd. Maximum 120 mg/day.  Hypertension: sustained release tablet: initial 30-60 mg po qd. Maintenance: 30-90 mg po qd with a maximum dose of 120 mg/day.  Preeclampsia: (immediate-release): 10 mg po or SL q4h. May switch to sustained-release tablet for maintenance. Raynaud's Disease (immediate-release capsule): 10-20 mg orally tid or 30 to 60 mg (sustained-release) tablet orally once daily. [Supplied: immediate release 10mg, 20mg capsule. Extended release tablet: 30, 60, 90mg] nisoldipine (Sular®): Adult (usual): Hypertension: initial: 20 mg po qd (Maint: 20-40 mg po qd - maximum 60 mg daily)  [Supplied 10, 20, 30, 40mg ER Tablet] verapamil (Isoptin®): Adult (usual): Angina: (extended-release) initial: 180 mg po qd at bedtime. Titrate up to 480 mg at bedtime- maximum 540 mg at bedtime.  (immediate release) initial: 80 mg po tid - may titrate at daily or weekly intervals to 360 mg daily. Arrhythmias, supraventricular: (immediate-release) initial: 240-320 mg po daily in 3-4 divided doses. Non-digitalized patients may require up to 480 mg daily in 3-4 divided doses. Arrhythmias, supraventricular: 5-10 mg IV (0.075-0.15 mg/kg) IV bolus over 2 min. May give additional 10 mg after 30 minutes if no response.   Hypertension: (extended-release) initial, 180 mg tablet po qd at bedtime OR 200 mg capsule po qd at bedtime. Maintenance: titrate up to 480 mg TAB qd at hs or 400 mg capsule po qd at hs.  Hypertension: (immediate-release) initial- 80 mg po tid. May titrate at daily or weekly intervals to 360-480 mg daily.  Hypertension: (sustained-release) initial: 240 mg orally once daily in the morning. Maintenance (based on response): titrate up to 240 mg bid (tablet) or 480 mg (capsule) once a day in the morning.   Migraine headache, prophylaxis: 80 mg po 3-4 times daily. [Supplied: Immediate release tablet: 40, 80, 120mg.  Sustained release tablets (SR): 120, 180, 240 mg.   Sustained released capsules (Verelan): 120,180,240,360mg. Covera HS (extended release tab): 180,240mg. Verelan PM (ER cap): 100,200,300mg. ]  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.");s1[41]=new Array("cephalosporins.htm","Cephalosporins - Dosage, renal dosing. Cephalosporin generations","","Cephalosporins First Generation Cefadroxil Duricef ® Dosing: 1-2 grams per day divided qd or q12h.   Renal Dosing: [CRCL >50 ]: No change.  [25-50 ]: 1 gram x 1, then 500mg q12h. [10-25 ]: 1 gram po x 1, then 500mg q24h. [<10 ]: 1 gram x 1, then 500 mg q36h. Hemodialysis: 1 gram x 1, then 500 mg q36h. Dose should be given after dialysis on dialysis days. Alternatively, give 1 gram after each hemodialysis session plus an additional 1 gram dose q72h. Cefazolin Ancef ® [Dosing -Usual]: 500mg to 1g IV q8h. [Moderate to severe]: 500mg – 1 gram q6-8h. [life-threatening]: 1–1.5g q6h. [Maximum dosage/day]: 12 grams. Renal dosing: [CRCL >55 ml/min]: no change.  [35-54 ml/min]: Maximum interval: q8h. 500mg – 1.5g q8h. [11-34 ml/min]: 500mg – 1.5g x 1, then 0.5 - 1 gram q12h. [<10 ml/min]: 500 mg - 1 gram q18-24h. Hemodialysis: 500 mg – 1 gram IV q24h. (Give dose post-dialysis on dialysis days.) PD: 500 mg q12h. Cephan Keflex ® Dosing (usual): 250 – 500mg po q6h. [Severe infections]: 1 gm q6h. Renal Dosing: [CRCL >30 ]: no changes. [10-30 ]: 250-500 mg q8-12h.  [<10 ]: 250-500mg q12-24h. Hemodialysis: 250-500mg q12-24h (Dose should be given after dialysis on dialysis days). Second Generation Cefaclor Ceclor ® Dosing: 250–500 mg po q8h or if the extended release form is used: 375–500 mg q12h.   Renal dosing: [CRCL >10 ]: no change.  [<10 ]: Give 50% of usual dose at same interval.  Hemodialysis: 250mg q8-12 hours. Make sure dose is given after dialysis. Cefdinir: Omnicef ® Dosing: 300 mg q24h or 600 mg q24h. Renal Dosing: [CRCL >30 ml/min]: no change. [<30 ]: 300 mg q24h. Hemodialysis: Give 300mg qod. On dialysis days, give 300mg after dialysis. Cefotetan Dosing: 1-2 grams q12h. [Life-threatening]: 3 grams IV q12h. Renal Dosing: [CRCL >30 ml/min]: No changes.  [10-30 ]: 1-2g q24h or 500mg-1g q12h.  [<10 ]: 1-2 grams q48h or 250-500mg q12h.  Hemodialysis: 250 - 500 mg q24h on non-HD days and 500 mg - 1 gm q24h on HD days. PD: 1 gram q24h Cefoxitin Mefoxin ® Dosing: [Uncomplicated]: 1 gm q6-8h. [Moderate to severe]: 1 gram q4h or 2 gm q6-8h. [Life-threatening]: 2 gm q4h or 3 gm q6h. Renal Dosing: [CRCL >50 ml/min]: No changes.  [30-50 ]: 1-2 grams q8-12 hours.   [10-29 ]: 1-2 grams q12-24 hours. [5-9 ]: 0.5 - 1 gm q12-24h.  [<5 ]: 0.5 to 1 gram q24-48h.  Hemodialysis: 500mg to 1 gram q24-48h. Also, give a supplemental dose after each dialysis (usual dose: 1 gram). PD: 1 gram q24h Cefpodoxime Vantin ® Dosing: 100 to 400 mg po q12h. Renal Dosing: [CRCL >30 ml/min]: no changes.  [<30 ]: 100 to 400mg q24h. Hemodialysis: Give 100 to 400 mg 3 times per week (after dialysis). Cefprozil Cefzil ® Dosing: 250 – 500 mg po q12h. Renal Dosing: [CRCL >30 ]: No changes.   [<29 ]: 50% of usual dosage q12-24h.  Hemodialysis: 50% of usual dosage q12-24h. (Administer after the completion of hemodialysis on dialysis days). Cefuroxime Zinacef ® Dosing: 750 mg to 1.5 gm IV q8h. Renal Dosing: [CRCL >20 ml/min]: no changes (750 mg to 1.5 gm IV q8h). [10-20 ]: 750 mg q12h.  [<10 ]: 750 mg q24h. Hemodialysis: 750mg q24h. Repeat the dose at the end of dialysis.  PD: 750 mg q24h. Cefuroxime axetil Ceftin ® Dosing: 250 – 500mg orally q12h. Renal Dosing: [CRCL >10 ml/min]: no changes.  [<10 ]: give 250mg q24h.  Hemodialysis: Give 250 mg q24h. Repeat the dose after dialysis. loracarbef Lorabid ® Skin and soft tissue infections: 200 mg orally every 12 hours x 7 days.   Uncomplicated urinary tract infections: 200 mg once daily for 7 days.   Uncomplicated pyelonephritis: 400 mg orally every 12 hours for 14 days.  Pharyngitis/tonsillitis: 200 mg orally every 12 hours for 10 days.  Sinusitis: 400 mg orally every 12 hours for 10 days. Upper/lower respiratory tract infection: 400 mg orally every 12 hours for 7-14 days. Renal Dosing: [CRCL >50 ml/min]: no changes.  [CRCL 10-49 ml/min]: Administer 50% of usual dose at usual interval or usual dose given half as often. [CRCL <10 mL/min]: Administer usual dose every 3-5 days. [Hemodialysis]: Doses should be administered after dialysis sessions. Supplied: 200 mg, 400 mg capsule.  Powder for oral suspension: 100 mg/5 ml (100 ml); 200 mg/5 ml (100 ml). Third Generation Cefoperazone Cefobid ® Dosing: 1-2 grams q8-12 hours. Renal dosing: no changes needed. Hemodialysis: No changes needed. (Ideally, dosage should be scheduled following a dialysis period). Cefotaxime Claforan ® Dosing: [Uncomplicated]: 1 gram IV/IM q12h. [Moderate to severe]: 1-2 grams IV/IM q8h. [Severe]: 2 grams IV q6-8h. [Life-threatening]: 2 grams IV q4h Renal Dosing: [CRCL >50 ml/min]: no change.  [10-50 ]: 1-2 grams q8-12h.  [<10 ] : 1-2 grams q24h. Hemodialysis: 500mg to 2 grams q24h, plus give a supplemental dose post-dialysis. PD: 1 gram q24h Ceftazidime Fortaz ® Dosing (usual): 1 gram IV q8-12 hours. [Severe]: 2 grams q8 hours. Renal Dosing: [CRCL >50 ]: No changes.  [31-50 ]: 1 gram q12h.  [16-30 ]: 1 gram q24h.   [6-15 ]: 500 mg q24h.  [<5 –dialysis]: 500 mg q48h. Note: all dosages listed for renal insufficiency may be increased by 50% in severe infections.   Hemodialysis: Loading dose: 1 gram x 1, then 1 gram after each hemodialysis session.  [Alternatively]: Give 1 gram q48h, plus give an additional 1 gram dose after each dialysis session. CAPD: 1 gram x 1, followed by 500mg q24h. Ceftibuten Cedax ® Dosing: 400 mg orally q24h. Renal Dosing: [CRCL > 50 ]: no changes.  [30-49 ]: 200 mg q24h.  [0-29 ]: 100 mg q24h. Hemodialysis: Give 400mg after each hemodialysis session. Ceftizoxime Cefizox ® Dosing: 1-2 grams IV/IM q8-12 hours. [Life-threatening]: 3-4 gm IV q8h or 2 gm q4h. Renal Dosing: [CRCL >79 ]: no changes.  [50-79 ]: 500 mg to 1.5 gm q8h.  [5-49 ]: 250mg – 1 gm q12h.  [0-4 – dialysis pt]: 250-500 mg q24h or 500mg to 1 gm q48h.  Hemodialysis: 250-500 mg q24h or 500mg to 1 gram q48h (dosages should be timed after hemodialysis on dialysis days.) PD: 500mg – 1 gram q24h. Ceftriaxone Rocephin ® Dosing: 1-2 grams q24h. [Meningitis]: Give 100 mg/kg/day (not to exceed 4 grams) qd or in divided doses q12h. Renal Dosing: No adjustments are necessary, however, blood levels are recommended in dialysis patients. Adults with both renal and hepatic failure should not receive more than 2 gm/day.  Hemodialysis: No specific recommendations per manufacturer except that blood levels are recommended in dialysis patients. The dosage should not exceed 2 grams per day. Some studies have recommended giving cefriaxone 1 gram q48h making sure the dose is given after hemodialysis on dialysis days. PD: 750mg q12h. Forth Generation Cefepime Maxipime ® Dosing: [Mild to moderate]: 500 mg to 1 gram IV q12h. [Moderate to severe]: 1-2 grams IV q12h. [Febrile neutropenic patients]: 2 grams IV q8h. Renal Dosing: [CRCL >60 ml/min]: no change. [30-60 ]: 500mg to 2 grams q24h. Neutropenic: 2 grams q12h. [11-29 ]: 500 mg to 1 gram q24h. Neutropenic: 2 grams q24h. [<11 ]: 250 – 500 mg q24h. Neutropenic: 1 gram q24h. Hemodialysis: 250 – 500 mg q24h. Neutropenic: 1 gram q24h. // Give additional dose post dialysis. PD: 1-2 grams q48h  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.");s1[42]=new Array("colony_stim_factors.htm","Colony Stimulating Factors","","Colony Stimulating Factors darbepoietin alfa  (Aranesp ®): Correction of anemia associated with CRF: Initial: 0.45 mcg/kg (IV, SQ) once weekly. Dosage should be titrated to limit increases in hemoglobin to <1 g/dL over any 2-week interval, with a target concentration of <12 g/dL. Maintenance: Titrated to hematologic response. Some patients may require doses <0.45 mcg/kg once weekly. Selected patients may be managed by administering SQ doses every 2 weeks. Conversion from epoetin alfa to darbepoetin alfa: Previous dosage of epoetin alfa: <2500 units/week, then darbepoetin alfa dosage: 6.25 mcg/week. Previous dosage of epoetin alfa: 2500-4999 units/week, then darbepoetin alfa dosage: 12.5 mcg/week. Previous dosage of epoetin alfa: 5000-10,999 units/week,then darbepoetin alfa dosage: 25 mcg/week. Previous dosage of epoetin alfa: 11,000-17,999 units/week,then darbepoetin alfa dosage: 40 mcg/week. Previous dosage of epoetin alfa: 18,000-33,999 units/week,then darbepoetin alfa dosage: 60 mcg/week. Previous dosage of epoetin alfa: 34,000-89,999 units/week,then darbepoetin alfa dosage: 100 mcg/week Previous dosage of epoetin alfa: 90,000 units/week, then darbepoetin alfa dosage: 200 mcg/week. Note: In patients receiving epoetin alfa 2-3 times per week, darbepoetin alfa is administered once weekly. In patients who are receiving epoetin alfa once weekly, darbepoetin should be administered once every 2 weeks. Dosage adjustment: Goal: Dose should be adjusted to achieve and maintain a target hemoglobin not to exceed 12 g/dL. Inadequate response: Hemoglobin increases <1 g/dL over 4 weeks and iron stores are adequate: Increase by ~25% of the previous dose; increases should not be made more frequently than once monthly. Excessive response: Hemoglobin increases >1 g/dL in any 2-week period: Decrease dose Hemoglobin increases and approaches the target value of 12 g/dL: Decrease weekly dosage by ~25%. If hemoglobin continues to increase, hold dose temporarily until hemoglobin begins to decrease, then restart at a dose 25% below the previous dose. Correction of anemia associated with cancer patients receiving chemotherapy: Initial: 2.25 mcg/kg SQ once weekly. Adjust dose as follows to achieve and maintain a target hemoglobin: Inadequate response: Hemoglobin increases <1 g/dL after 6 weeks of therapy: Increase dose to 4.5 mcg/kg. Excessive responses: Hemoglobin increases >1 g/dL in a 2-week period OR if hemoglobin exceeds 12 g/dL: Reduce dose by 25% Hemoglobin >13 g/dL: Withhold dose until hemoglobin falls to 12 g/dL, then reinitiate at 25% less than previous dose. Darbepoetin's T1/2 is approximately 3 times that of epoetin alfa. erythropoietin (Epogen ®): Anemia: (Renal failure): 50-100 units/kg IV/SC 3 times per week. AZT: 100 units/kg IV/SC three times per week. Chemo: 150 units/kg 3 times per week. filgrastim (G-CSF, Neupogen ®): Neutropenia (chemotherapy-induced): 5 mcg/kg SC/IV for </= 2 weeks until post-nadir NC is greater or equal to 10,0000/ml. Can increase by 5 mcg/kg/day with each cycle as needed. oprelvekin (Neumega ® ): Thrombocytopenia: 50 mcg/kg SC once daily starting 6-24 hours after chemo and continuing until post-nadir platelet count is greater or equal to 50,000 cells/mcL. pegfilgrastim (Neulasta ®): Neutropenia (chemotherapy-induced): Recommended dosage: 6mg S.C. administered once per chemotherapy cycle.  Should not be administered in the period between 14 days before and 24 hours after administration of cytotoxic chemotherapy. The 6 mg fixed dose formulation should not be used in infants, children, and smaller adolescents weighing less than 45 kg. Indicated to decrease the incidence of infection, as manifested by febrile neutropenia, in patients with non-myeloid malignancies receiving myelosuppressive anti-cancer drugs associated with a clinically significant incidence of febrile neutropenia. sargramostim (GM-CSF): See package insert.  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.");s1[43]=new Array("corticosteroids.htm","corticosteroids (systemic)","corticosteroids--dosing list for health care providers, pharmacists, nurses, physicians.","Corticosteroids (systemic) cortisone acetate (Cortone): Adults: 25-300 mg orally once daily or divided doses every 12 hours. dexamethasone (Decadron): Anti-inflammatory: 0.75 to 9 mg/day in divided doses every 6 to 12 hours. Spinal cord compression: 10 to 100mg (Usually 10mg) IV stat, followed by 4 to 24 mg IV every 6 hours. Use larger doses (eg up to 100mg) in patients with profound neurologic injury and lower doses in patients with mild or equivocal signs. fludrocortisone (Florinef): 0.1 mg orally 3 times per week. Doses up to 0.2mg once daily may be given. hydrocortisone (Cortef, Solu-Cortef): Usual dose: 0.5 to 2 mg/kg every 6 hours. range: 100-500mg IV/IM q2-10h as needed. methylprednisolone (Solu-medrol): Asthma: (severe): 2 mg/kg IV every 6 hours, followed by 0.5 to 1mg/kg every 6 hours. Multiple sclerosis acute exacerbation: 500mg IV once daily for 5 days. Spinal cord injury: 30 mg/kg over 15-30min IV, then 5.4 mg/kg/hr x 23 hours. PCP: 40-60mg IV every 6 hours or pulse dosing: 250-1000 mg IV x 3-5 days. prednisone: Usual: 5 to 60mg orally once daily. Corticosteroids Intra-articular Depo-Medrol (methylpred acetate): (40mg/ml-5 ml vial): Large joints (knee,ankle,shoulder): 20-80mg.     Medium joints (elbow,wrist): 10-40 mg intrasynovial. Small joints(fingers etc): 4-10mg.  // Not for IV use. Routes: IM, intrasynovial, intralesional, soft-tissue. Triamcinolone Acetonide (Kenalog) (Kenalog-10:10mg/ml) (Kenalog-40: 40mg/ml): Kenalog-10:  May be given intradermal or intra-articular.    Small joints: 2.5 to 5mg.    Large joints: 5 to 15mg. Kenalog-40: May be given IM (usual range: 40-80mg) or Intra-articular (Smaller joints): 2.5- 5mg; (large joints): 40mg.  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc. Author: David McAuley Keywords: corticosteroids, pharmacists, nursing, physicians,health care providers,cortisone, dexamethasone, florinef, hydrocortisone, solu-medrol, Depo-medrol, prednisone, triamcinolone,");s1[44]=new Array("diabetes.htm","Diabetes--Therapeutic agents","Diabetes--dosing list for health care providers, pharmacists, nurses, physicians.","Anti- Diabetic Agents Alpha-glucosidase Inhibitors acarbose (Precose ®): Alpha-glucosidase inhibitor. Start: 25mg orally three times daily with meals, gradually increase as tolerated to maintenance of 50-100mg orally three times daily. Miglitol (Glycet ®): Alpha-glucosidase inhibitor. Start: 25 mg orally three times daily with meals. Maintenance: 50-100mg three times daily. Biguanides metformin (Glucophage ®): Decreases hepatic glucose production, decreasing intestinal absorption of glucose and improves insulin sensitivity (increases peripheral glucose uptake and utilization). Management of type 2 diabetes mellitus:   Standard release tablet or oral solution: Start: 500 mg twice daily (give with the morning and evening meals) or 850 mg once daily; increase dosage incrementally.   (A lower recommended starting dose and gradual increased dosage is recommended to minimize gastrointestinal symptoms). Adjustment: Incremental dosing recommendations are based on dosage form:       500 mg tablet: One tablet/day at weekly intervals.       850 mg tablet: One tablet/day every other week.       Oral solution: 500 mg twice daily every other week. Note: Doses of up to 2000 mg/day may be given in divided doses twice daily. If a dose >2000 mg/day is required, it may be better tolerated in three divided doses. Maximum recommended dose: 2550 mg/day. Extended release tablet: Initial: 500 mg once daily (with the evening meal). Dosage may be increased by 500 mg weekly. Maximum dose: 2000 mg once daily. If glycemic control is not achieved at maximum dose, may divide dose to 1000 mg twice daily. If doses >2000 mg/day are needed, switch to regular release tablets and titrate to maximum dose of 2550 mg/day. Renal dosing: Metformin is contraindicated in the presence of renal dysfunction defined as a serum creatinine >1.5 mg/dL in males, or >1.4 mg/dL in females and in patients with abnormal clearance. Hepatic impairment: Avoid metformin.  Supplied: Tablet: 500 mg, 850 mg, 1000 mg. Extended release tablet: 500 mg, 750 mg, 1000 mg. Oral solution: 100 mg/ml (118 ml, 473 ml). Avandamet® (Rosiglitazone + Metformin) Management of type 2 diabetes mellitus: initial (previously receiving rosiglitazone 4 mg/day):  Avandamet® 2/500mg po bid.  (previously receiving rosiglitazone 8 mg/day): 4/500mg po bid. (previously receiving metformin 1000 mg/day): 2/500mg po bid.  (previously receiving metformin 2000 mg/day):  2/1000mg po bid. Titrate in increments of rosiglitazone 4 mg and/or metformin 500 mg po daily. Maximum: 8 mg/2000 mg daily. Other: take with meals. When switching from metformin and rosiglitazone therapy given as separate tablets, starting dose of Avandamet is the dose of each drug previously taken. Dose titration should occur at 1 to 2 week intervals. If the dose of metformin is increased, dose titration should occur at 8 to 12 week intervals. If the dose of rosiglitazone is increased therapeutic response evaluation should be based on fasting plasma glucose values. Monitoring: renal function, baseline and at least annually.  [Supplied: 1 mg/500 mg, 2 mg/500 mg, 4 mg/500 mg] . Glucovance (Glyburide + Metformin) Management of type 2 diabetes mellitus: Dosing (initial): 1.25 mg/250 mg once or twice daily with meals. Dosage increases should be made in increments of 1.25 mg/250 mg per day every two weeks up to the minimum effective dose necessary to achieve adequate control of blood glucose. Glucovance 5 mg/500 mg should not be used as initial therapy due to an increased risk of hypoglycemia. Maximum recommended daily dose: 20 mg glyburide/2000 mg metformin.   Administration: Glucovance should be given with meals and should be initiated at a low dose, with gradual dose escalation in order to avoid hypoglycemia (largely due to glyburide), to reduce GI side effects (largely due to metformin), and to permit determination of the minimum effective dose for adequate control of blood glucose for the individual patient.  Glucovance Use in Previously Treated Patients: Recommended starting dose: 2.5 mg/500 mg or 5 mg/500 mg twice daily with meals. In order to avoid hypoglycemia, the starting dose of Glucovance should not exceed the daily doses of glyburide or metformin already being taken. The daily dose should be titrated in increments of no more than 5 mg/500 mg up to the minimum effective dose to achieve adequate control of blood glucose or to a maximum dose of 20 mg/2000 mg per day.  [Supplied: 1.25 mg/250 mg, 2.5 mg/500 mg, 5 mg/500 mg tablet ] Metaglip (Glipizide + Metformin) [Supplied: 2.5 mg/250 mg, 2.5 mg/500 mg,  5 mg/500 mg tablet ] Management of type 2 diabetes mellitus: Dosing (initial): 2.5 mg/250 mg qd with a meal. For patients whose FPG is 280 to 320 mg/dl a starting dose of Metaglip 2.5 mg/500 mg twice daily should be considered. The efficacy of Metaglip in patients whose FPG exceeds 320 mg/dl has not been established. Dosage increases to achieve adequate glycemic control should be made in increments of one tablet per day every two weeks up to maximum of 10 mg/1000 mg or 10 mg/2000 mg per day given in divided doses.   Maximum recommended daily dose: 20 mg glipizide/2000 mg metformin. Second-Line Therapy For patients not adequately controlled on either glipizide (or another sulfonylurea) or metformin alone: 2.5 mg/500 mg or 5mg/500mg bid with the morning and evening meals. In order to avoid hypoglycemia, the starting dose of Metaglip should not exceed the daily doses of glipizide or metformin already being taken. The daily dose should be titrated in increments of no more than 5 mg/500 mg up to the minimum effective dose to achieve adequate control of blood glucose or to a maximum dose of 20 mg/2000 mg per day. [Supplied: 2.5 mg/250 mg, 2.5 mg/500 mg, 5 mg/500 mg tablet ] Glitazones - Thiazolidinediones pioglitazone (Actos ®): Acts primarily by decreasing insulin resistance. Start: 15-30 mg orally once daily. Maximum: 45 mg/day. rosiglitazone (Avandia ®): Monotherapy or combine with metformin. Start: 4 mg orally once daily or divided twice daily.  Max 8 mg/day. Monitor LFT's every 2 months for first year. Meglitinides Nateglinide (Starlix) Usual: 120 mg po tid (1-30 minutes before meals). Give alone or in combination with metformin. MOA: stimulates insulin release. repaglinide (Prandin ®): (Non-sulfonylurea insulin releasing oral hypoglycemic agent) Start: 0.5 - 2 mg orally three times daily before meals.  Maintenance: 0.5 - 4 mg three to four times daily.  Maximum: 16 mg/day. Sulfonylureas Chlorpropamide (Diabinese ®): Adult (usual): initial, 250 mg orally daily (usually as a single dose with breakfast). Maintenance 100-500 mg orally daily. Maximum 750 mg a day.  Diabetes insipidus: 100-250 mg orally once daily, adjusted at 2-3 day intervals as needed. glimepiride (Amaryl ®): Sulfonylurea. Start: 1-2 mg orally once daily. Usual: 1-4 mg/day. Maximum: 8 mg/day. glyburide (Micronase ®, Diabeta ®): Sulfonylurea. Start 1.25 to 5 mg orally once daily. Usual: 1.25 to 20 mg orally once daily or divided twice daily. Max: 20 mg/day. glipizide (Glucotrol ®): Sulfonylurea. start 5 mg orally once daily. Usual: 10-20mg orally once daily. Max: 40mg/day.  Glucotrol XL: start 5 mg orally once daily.  Max: 20mg/day. Tolazamide (Tolinase ®): Adult (usual): initial: 100-250 mg orally once daily. maintenance (dose range): 100-1000 mg orally daily. Max 1000 mg daily. [Supplied 100 mg , 250 mg , 500 mg tablet] Tolbutamide (Orinase ®): Adult (usual): initial: 1-2 g orally once daily in the morning or in divided doses. Maintenance, usual range 0.25-3 g orally daily. Max: 3 g daily   [Supplied 500 mg tablet] Other Glucagon: Hypoglycemia: 1 mg IV/IM/SC. Onset 5-20min. Beta-blocker overdose: Separate glucagon receptors stimulate adenylcyclase improving heart rate, blood pressure and conduction defects. Adults: 3 - 5 mg (up to 10 mg) rapid IV push followed by an IV drip of 0.07 mg/kg/hr (usually 1 to 5 mg/hour) (The dose used to increase glucose in hypoglycemic patients is only 0.5 - 1 mg IV push). Note: bolus dose may be repeated in 10 minutes. Usually causes nausea and vomiting. May give Reglan IV, Compazine or Tigan. Monitor blood glucose levels in hypoglycemic patients until they are asymptomatic; effective in treating hypoglycemia only if sufficient liver glycogen is present; since liver glycogen availability is necessary to treat hypoglycemic patients, glucagon has virtually no effects on patients in states of starvation, adrenal insufficiency, or chronic hypoglycemia. (recommended routes): IM, IV, or SC.    Half-life: 8 to 18 minutes. extenatide (Byetta ®): Mechanism: Analog of the hormone incretin (glucagon-like peptide 1 or GLP-1) which increases insulin secretion, increases b-cell growth/replication, slows gastric emptying, and may decrease food intake. When added to sulfonylureas and/or metformin, it results in additional lowering of hbA1c by approximately 0.5% to 1%. Dosing (Adjunctive therapy of type 2 diabetes): Initial: 5 mcg SQ bid within 60 min prior to a meal (morning and evening). After 1 month, may be increased to 10 mcg SQ twice daily (based on response). Not recommended in patients CRCL < 30 ml/min. Supplied: Injection: [prefilled pen]: 250 mcg/ml (1.2 ml) [provides 5 mcg/dose]. 2.4 ml - [provides 10 mcg/dose] pramlintide Symlin ® Indications: (1) Adjunctive treatment with mealtime insulin in type 1 diabetes mellitus (insulin dependent, IDDM) patients who have failed to achieve desired glucose control despite optimal insulin therapy. (2) Adjunctive treatment with mealtime insulin in type 2 diabetes mellitus (noninsulin dependent, NIDDM) patients who have failed to achieve desired glucose control despite optimal insulin therapy, with or without concurrent sulfonylurea and/or metformin. Mechanism: Synthetic analog of human amylin cosecreted with insulin by pancreatic beta cells. Reduces postprandial glucose increases via the following mechanisms: 1) prolongation of gastric emptying time, 2) reduction of postprandial glucagon secretion, and 3) reduction of caloric intake through centrally-mediated appetite suppression. Dosage: Adult (usual): Type 1 diabetes mellitus (insulin dependent) Initial: 15 mcg SQ immediately prior to meals. Titrate in 15 mcg increments every 3 days (if no significant nausea occurs) to target dose of 30-60 mcg (consider discontinuation if intolerant of 30 mcg dose).  Note: When initiating pramlintide, reduce current insulin dose (including rapidly and mixed-acting preparations) by 50% to avoid hypoglycemia. Type 2 diabetes mellitus: Initial: 60 mcg SQ immediately prior to meals. After 3-7 days, increase to 120 mcg prior to meals if no significant nausea occurs (if nausea occurs at 120 mcg dose, reduce to 60 mcg). If pramlintide is discontinued for any reason, restart therapy with same initial titration protocol. Administration: Do not mix with other insulins. Administer SQ into abdominal or thigh areas at sites distinct from concomitant insulin injections (do not administer into arm due to variable absorption). Rotate injection sites frequently. For oral medications in which a rapid onset of action is desired, administer 1 hr before, or 2 hrs after pramlintide, if possible. Supplied: Injection: Pramlintide acetate 0.6 mg/ml (5 ml).  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP] Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc. Author: David McAuley Keywords: Diabetes,pharmacists, nursing, physicians,health care providers,acarbose, amaryl, glucotrol, glucagon, glyburide, miglitol, glycet, metformin, actos, repaglinide, prandin, avandia");s1[45]=new Array("rheumatic.htm","Disease modifying agents: Rheumatoid arthritis.  Arava, plaquenil, azulfidine, methotrexate","Disease modifying agents: Rheumatoid arthritis.  Arava, plaquenil, azulfidine, methotrexate. ","Disease modifying agents (Anti-rheumatic agents) adalimumab (Humira ®): A recombinant, anti-tumor necrosis factor (TNF)-alpha monoclonal antibody. Dosing: rheumatoid arthritis: 40 mg SQ every other week. The drug can be given concomitantly with methotrexate. Whether adalimumab will offer a significant advantage over infliximab or etanercept remains to be determined. anakinra Kineret ® A recombinant, nonglycosylated form of the human interleukin-1 receptor antagonist (IL-1Ra). Rheumatoid arthritis:  100 mg/day SQ daily. Higher doses did not result in a higher response. The dose should be administered at approximately the same time every day. auranofin Ridaura ® Oral gold compound.  Normal dose (rheumatoid arthritis): 3 mg orally twice daily or 6 mg once daily. Maximum dose: 3 mg three times daily. azathioprine Imuran ® An immunosuppressive agent.  (Rheumatoid arthritis): Initial dose: 1 mg/kg (50-100mg) orally once daily or divided twice daily. In the absence of serious toxicity and if response is unsatisfactory, the dose can be increased, beginning at 6 to 8 weeks and thereafter at 4 week intervals, in increments of 0.5 milligrams/kilogram/day up to a maximum dose of 2.5 milligrams/kilogram/day. Patients who do not improve after 12 weeks of therapy can be considered refractory. etanercept Enbrel ® Tumor necrosis factor receptor fused to the Fc fragment of human immunoglobulin G1. Indicated for the reduction of signs and symptoms of moderate to severe, active rheumatoid arthritis in patients who have had an inadequate response to one or more disease-modifying antirheumatic drugs. Can be used in combination with methotrexate for those patients not responding to methotrexate monotherapy. Usual dose: 25 mg SQ twice weekly. hydroxychloroquine Plaquenil ® Antimalarial agent that possesses anti-inflammatory activity.  (Rheumatoid arthritis) Initial dose: 400 to 600 mg orally once daily with food or milk. qd--then taper dose (usually after 4 to 12 weeks) to 200-400mg orally once daily. If there is no improvement after 6 months, discontinue drug. infliximab Remicade ® Rheumatoid Arthritis. The recommended dose of Remicade is 3 mg/kg given as an intravenous infusion followed with additional similar doses at 2 and 6 weeks after the first infusion then every 8 weeks thereafter. Should be given in combination with methotrexate. For patients who have an incomplete response, consideration may be given to adjusting the dose up to 10 mg/kg or treating as often as every 4 weeks. leflunomide Arava ® Immunomodulatory agent. Dosing (active rheumatoid arthritis): (Loading regimen) 100 mg orally once daily for three days, then start maintenance dose of 10 to 20 mg orally once daily. methotrexate Rheumatrex ® Antineoplastic agent - can be used for immunosuppressive therapy in severe rheumatoid arthritis, psoriasis, and systemic lupus erythematosus.   Rheumatoid arthritis: Starting dose: 7.5 milligrams orally once a week. This dosage may be administered as a single dose or as a divided dose of 2.5 mg every 12 hours for 3 doses once a week. Once a response has been achieved, reduce the dosage if possible to the lowest effective dose. Maximum recommended dose: 20 mg/week.  Consider folate supplementation. sulfasalazine Azulfidine ® Indicated in the treatment of rheumatoid arthritis in patients who have responded inadequately to salicylates or other non-steroidal anti-inflammatory drugs. Recommended daily dose: 500 mg orally once or twice daily after meals up to 2 grams divided twice daily.  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc. Author: David McAuley Keywords: Disease modifying agents: Rheumatoid arthritis. Arava, plaquenil, azulfidine, methotrexate");s1[46]=new Array("direct_thrombin_inh.htm","Direct Thrombin Inhibitors","","Direct Thrombin Inhibitors argatroban Heparin-Induced Thrombocytopenia (HIT/HITTS) Initial Dosage: Before administering Argatroban, discontinue heparin therapy and obtain a baseline aPTT. The recommended initial dose of Argatroban for adult patients without hepatic impairment is 2 µg/kg/min, administered as a continuous infusion. Monitoring therapy: In general, therapy with Argatroban is monitored using the aPTT. Tests of anticoagulant effects (including the aPTT) typically attain steady-state levels within 1-3 hours following initiation of Argatroban. Dose adjustment may be required to attain the target aPTT. Check the aPTT 2 hours after initiation of therapy to confirm that the patient has attained the desired therapeutic range. Dosage adjustment: After the initial dose of Argatroban, the dose can be adjusted as clinically indicated (not to exceed 10 µg/kg/min), until the steady-state aPTT is 1.5 to 3 times the initial baseline value (not to exceed 100 seconds). Percutaneous Coronary Interventions (PCI) in HIT/HITTS Patients Initial Dosage: An infusion of Argatroban should be started at 25 µg/kg/min and a bolus of 350 µg/kg administered via a large bore intravenous (IV) line over 3 to 5 minutes. Activated clotting time (ACT) should be checked 5 to 10 minutes after the bolus dose is completed. The procedure may proceed if the ACT is greater than 300 seconds. Dosage Adjustment: If the ACT is less than 300 seconds, an additional IV bolus dose of 150 µg/kg should be administered, the infusion dose increased to 30 µg/kg/min, and the ACT checked 5 to 10 minutes later. If the ACT is greater than 450 seconds, the infusion rate should be decreased to 15 µg/kg/min, and the ACT checked 5 to 10 minutes later. Once a therapeutic ACT (between 300 and 450 seconds) has been achieved, this infusion dose should be continued for the duration of the procedure. In case of dissection, impending abrupt closure, thrombus formation during the procedure, or inability to achieve or maintain an ACT over 300 seconds, additional bolus doses of 150 µg/kg may be administered and the infusion dose increased to 40 µg/kg/min. The ACT should be checked after each additional bolus or change in the rate of infusion. Bivalirudin (Angiomax ®) Anticoagulant in patients with unstable angina undergoing PTCA (treatment should be started just prior to PTCA): Initial: Bolus: 1 mg/kg IV, followed by continuous infusion: 2.5 mg/kg/hour over 4 hours. If needed, infusion may be continued at 0.2 mg/kg/hour for up to 20 hours. Patients should also receive aspirin 300-325 mg/day. Dosage adjustment in renal impairment: Infusion dose should be reduced based on degree of renal impairment. Initial bolus dose remains unchanged. Monitor activated coagulation time (ACT). CRCL 60 ml/min: No adjustment required CRCL 30-59 ml/min: Decrease infusion dose by 20% CRCL 10-29 ml/min: Decrease infusion dose by 60% Dialysis-dependent patients (off dialysis): Decrease infusion dose by 90%. lepirudin (Refludan ®): Lepirudin provides more stable level of anticoagulation than heparin. Lepirudin does not require endogenous cofactors and acts independently of antithrombin-III. Dosing: Initially give bolus: 0.4 mg/kg (use maximum weight of 110kg) over 15-20 seconds followed by maintenance dose of 0.15 mg/kg/hr (use maximum weight of 110kg) x 2-10 days as needed. Monitoring: Monitor aPTT 4 hours after beginning treatment and at least daily (Target aPTT: 1.5 to 2.5x control) Dose adjustments: If aPTT ratio > 2.5, hold infusion for 2 hours, and decrease rate by 50%. Repeat aPTT in 4hrs. If aPTT ratio < 1.5, increase rate by 20% and repeat aPTT in 4 hrs. Maximum dose: Do not exceed 0.21 mg/kg/hour unless an evaluation of coagulation abnormalities limiting response has been completed. Dosing is weight-based, however, patients weighing >110 kg should not receive doses greater than the recommended dose for a patient weighing 110 kg (44 mg bolus and initial maximal infusion rate of 16.5 mg/hour). Heparin-induced thrombocytopenia: Bolus dose: 0.4 mg/kg IVP (over 15-20 seconds), followed by continuous infusion at 0.15 mg/kg/hour; bolus and infusion must be reduced in renal insufficiency.  Concomitant use with thrombolytic therapy: Bolus dose: 0.2 mg/kg IVP (over 15-20 seconds), followed by continuous infusion at 0.1 mg/kg/hour Dosing adjustments during infusions: Monitor first aPTT 4 hours after the start of the infusion. Subsequent determinations of aPTT should be obtained at least once daily during treatment. More frequent monitoring is recommended in renally impaired patients. Any aPTT ratio measurement out of range (1.5-2.5) should be confirmed prior to adjusting dose, unless a clinical need for immediate reaction exists. If the aPTT is below target range, increase infusion by 20%. If the aPTT is in excess of the target range, decrease infusion rate by 50%. A repeat aPTT should be obtained 4 hours after any dosing change. Use in patients scheduled for switch to oral anticoagulants: Reduce lepirudin dose gradually to reach aPTT ratio just above 1.5 before starting warfarin therapy; as soon as INR reaches 2.0, lepirudin therapy should be discontinued. Dosing adjustment in renal impairment: All patients with a creatinine clearance of <60 ml/min or a serum creatinine of >1.5 mg/dl should receive a reduction in lepirudin dosage. There is only limited information on the therapeutic use of lepirudin in HIT patients with significant renal impairment; the following dosage recommendations are mainly based on single-dose studies in a small number of patients with renal impairment. Initial: Bolus dose: 0.2 mg/kg IVP (over 15-20 seconds), followed by adjusted infusion based on renal function. [CRCL 45-60 ml/min or Scr 1.6-2.0]: Adjust rate to 50% of standard infusion rate: 0.075 mg/kg/hour [CRCL 30-44ml/min ; Scr 2.1-3.0]: Adjust rate to 30% of standard infusion rate: 0.045 mg/kg/hour. [CRCL 15-29ml/min ; Scr 3.1-6.0]: Adjust rate to 15% of standard infusion rate: 0.0225 mg/kg/hour. [CRCL <15ml/min ; Scr >6.0]: Avoid or STOP infusion. Note: Acute renal failure or hemodialysis: Infusion is to be avoided or stopped. Following the bolus dose, additional bolus doses of 0.1 mg/kg may be administered every other day (only if aPTT falls below lower therapeutic limit). Supplied: 50 mg (powder for reconstitution).  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.");s1[47]=new Array("diuretics.htm","Diuretics -classes, dosing ","","Diuretics Carbonic anhydrase inhibitors Acetazolamide  Diamox ® Glaucoma: 250mg qd - qid or 500mg SR bid.  Secondary (acute) closed angle: IV: 250-500mg. May rpt in 2-4 hrs to a Maximum of 1 gram.  Edema: 250-375 mg po qd in the morning for 1 or 2 days, alternating with day of rest (reduce resistance). Epilepsy: 8-30 mg/kg po daily, divided q8-12h.  [Supplied: 125, 250 mg tablet. 500mg SR capsule. 500mg powder for injection.] Dichlorphenamide ( Daranide ®) Adults: Oral: 100-200 mg to start followed by 100 mg every 12 hours until desired response is obtained; maintenance dose: 25-50 mg 1-3 times per day.  [Supplied: 50 mg tablet] Methazolamide Neptazane ® Adult (usual) - Glaucoma: 50-100 mg po bid - tid. Altitude sickness: 150-200 mg po daily.   [Supplied: 25, 50 mg tablet] Thiazides Bendroflumethiazide Naturetin ® Adult (usual) Edema: initial, up to 20 mg po daily (divided once or twice daily). Maint: 2.5-5 mg po qd. Hypertension: initial, 5-20 mg po daily (divided once or twice daily). Maint: 2.5-15 mg po qd. Avoid use in pts with SCR >2.5 mg/dl.    [Supplied: 2.5, 5, 10 mg tablet] Chlorothiazide Diuril ® HTN: 500 mg - 1000 mg mg po qd or divided bid.   Edema: 500 - 1000 mg po or IV qd or bid - may give every other day or 3-5 days each week.  [Supplied: 250, 500mg tablet. 250mg/5ml suspension.] Chlorthalidone Hygroton ® Edema: initial, 30-60 mg po qd or 60 mg qod; some patients may require up to 120 mg daily. Alternatively: 50-100 mg po qd or 100mg po qod or 100mg 3 times per week. Maximum: 200mg /day. Hypertension: initially: 12.5 to 25 mg po qd. Usual maint: 12.5 to 50mg /day. Maximum: 50mg qd. Alternatively: initially 15 mg po qd. Usual Maint: 30-45 mg/day.   [Supplied 15, 25 mg compressed tablet.  50, 100mg scored tablet.] Hydrochlorothiazide (Esidrix ®, HydroDiuril ®, Microzide™) Edema: 25-100 mg po daily in single or divided doses.  Hypertension (HTN): initial, 12.5-25 mg po once daily. Titration: allow 2-3 weeks to achieve optimum antihypertensive effect. Usual maintenance dose: 12.5 - 50mg/day. Maximum 50mg/day.  Renal impairment: GFR less than 15-25 mL/min, use not recommended. Patients with edema may respond to intermittent therapy (ie, administer on alternate days or 3-5 days / week).   [Supplied: 25, 50, 100mg tablet. 12.5 mg capsule. 50mg/5 ml solution] Hydroflumethiazide ( Diucardin ®) Edema: usual - 50 to 100 mg daily initially. Doses of 25 or 200 mg daily are used for maintenance therapy. HTN: usual adult dose - 12.5 to 50 mg daily.   [Supplied: 50mg tablet] Indapamide Lozol ® Edema: initial: 2.5 mg po qd in the morning - may increase to 5 mg po qd after 1 week.  HTN: initial: 1.25 mg po qd in the morning. Titration: allow 4 weeks to achieve optimum antihypertensive effect. Maintenance: 2.5-5 mg po qd.  [Supplied 1.25, 2.5 mg tablet] Methyclothiazide Enduron ® Edema: Initially: 2.5mg po qd. Range: 2.5-10 mg po qd.  Hypertension: 2.5-5 mg po qd.   [Supplied: 2.5, 5mg tablet] Metolazone Zaroxolyn ®, Mykrox ®) Edema: initial, 5-10 mg po qd. May increase up to 20mg in renal disease.   HTN: 2.5-5 mg po qd (Maximum: 10mg po qd).  HTN (Mykrox®): initial, 0.5 mg po qd. Maximum: 1 mg/day.  HTN (Zaroxolyn®): 2.5 - 5 mg po qd (Maximum: 10mg/day). [Supplied: Mykrox® 0.5 mg tablet.   Zaroxolyn®: 2.5, 5, 10mg tablet] Polythiazide (Renese ®) Edema (Adult): 1-4 mg po qd.  HTN: 2-4 mg po qd.  [Supplied: 1, 2, 4 mg tablet] Trichlormethiazide (Naqua ®) HTN/Edema: Initially - 2 mg po qd. Usual Maint: 2-4 mg po qd. [Supplied: 4 mg tablet] Loop Diuretics Bumetanide Bumex ® Edema (adult): 0.5-2 mg po qd - maximum 10 mg/day.  Edema: 0.5-1 mg IV or IM, given over 1-2 min; can give a second and third dose at intervals of 2-3 hr to maximum of 10 mg/day.  Continuous I.V. infusion: 0.9-1 mg/hour.  Hypertension: Oral: 0.5 mg daily (range: 1-4 mg/day, maximum dose: 5 mg/day); for larger doses, divide into 2-3 doses daily. Administer I.V. slowly, over 1-2 minutes. An alternate-day schedule or a 3-4 daily dosing regimen with rest periods of 1-2 days in between may be the most tolerable and effective regimen for the continued control of edema.  [Supplied 0.25 mg/ml soln for inj.  0.5, 1, 2 mg tablet]   Ethacrynic acid Edecrin ® Edema (adult): initial, 50-100 mg po qd; Maintenance: 50-200 mg po qd; adjust dose in 25-50 mg increments.  Edema: 0.5-1 mg/kg IV; Maximum IV dose 100 mg/dose.   [Supplied: 50 MG powder for inj. 25, 50mg tablet] Furosemide  Lasix ® Edema: initial: 20-40 mg IV/IM over 1-2 min. May repeat in 1 to 2 hours or may be increased by 20 mg until desired response. This individually determined dose may be given once or twice daily.   Edema (oral): initial: 20-80 mg po qd - may repeat in 6-8 hrs. Maximum: 600 mg/day.   HTN: initial: 80 mg po daily (divided twice daily).   CHF: 250 to 4000 mg daily (IV or PO) Acute pulmonary edema: usual dose - 40 mg IV over 1-2 minutes. If not adequate, may increase dose to 80 mg.  Continuous I.V. infusion: Initial IV bolus dose of 0.1 mg/kg followed by continuous I.V. infusion doses of 0.1 mg/kg/hour doubled q2h to a maximum of 0.4 mg/kg/hour if urine output is <1 ml/kg/hour. Other studies have used a rate of 4 mg/minute as a continuous IV infusion.   Elderly: Oral, IM, IV: Initial: 20 mg/day; increase slowly to desired response.  Refractory heart failure: Oral, IV: Doses up to 8 g/day have been used.  Acute renal failure: High doses (up to 1-3 g/day - oral/IV) have been used to initiate desired response. Avoid use in oliguric states.   Administration: IV injections should be given slowly over 1-2 minutes. Maximum rate of administration for IVPB or infusion: 4 mg/minute. Replace parenteral therapy with oral therapy as soon as possible. [Supplied 10 mg/ml, 40 mg/5 ml oral soln. 10 mg/ml soln for inj.  20,40, 50, 80mg tablet] Torsemide Demadex ® Edema (CHF): initial: 10-20 mg po or IV qd. Maintenance: may increase by doubling the dose. Maximum: 200 mg po or IV qd.    Edema (liver disease): initial: 5-10 mg po or IV qd along with an aldosterone antagonist or potassium-sparing diuretic.   Edema (renal failure): initial 20 mg po or IV qd. Maintenance: may increase by doubling the dose. Maximum: 200 mg po or IV qd.   (HTN): initial 5 mg po qd. Allow 4-6wk to achieve optimum antihypertensive effect. May increase to 10 mg po qd.    [Supplied: 10 mg/ml injection.  5, 10, 20 , 100mg tablet] Potassium sparing Amiloride  Midamor ® Diuresis: Start 5 mg po qd. Maintenance: 5-20 mg po qd. Maximum: 20mg/day. [Supplied: 5 mg tab] Eplenerone  Inspra ® HTN: Initial: 50 mg qd - may increase to 50 mg bid if response is not adequate. May take up to 4 weeks for full therapeutic response. Doses >100 mg/day are associated with increased risk of hyperkalemia and no greater therapeutic effect. Concurrent use with weak CYP3A4 inhibitors: Initial: 25 mg qd. Contraindicated with Clcr<50 ml/minute or serum creatinine >2.0 mg/dl in males or >1.8 mg/dl in females ( risk of hyperkalemia increases with decreased renal function). Spironolactone  Aldactone ® Edema (cirrhosis, nephrotic syndrome): initial, 100 mg po qd or divided bid - after 5 days if response is inadequate, adjust dosage (Maximum: 400 mg/day). (Maint range: 25-200 mg/day in single or divided doses). Consider adding another diuretic if response is inadequate. Hirsutism in women: 50-200 mg po daily OR 200 mg/day po for 20 days per month; duration of therapy, several months up to 1 yr. Hyperaldosteronism (diagnosis): long test, 400 mg po daily for 3-4 weeks; short test, 400 mg po daily for 4 days. Hyperaldosteronism (treatment): 100-400 mg/day po (use lowest effective dosage). Hypertension: Start: 50-100 mg/day po in 1-2 divided doses; continue for 2 weeks, then adjust to response (Maximum: 400 mg/day). Elderly: Initial: 25-50 mg/day in 1-2 divided doses, increasing by 25-50 mg every 5 days as needed. Renal impairment: crcl 10-50 mL/minute: Administer every 12-24 hours. crcl <10 ml/minute: Avoid use.  [Supplied: 25, 50, 100mg tablet] Triamterene Dyrenium ® Edema (cirrhosis, CHF, nephrotic syndrome) / HTN: Start: 100 mg po daily in 1-2 divided doses. (Maximum: 300 mg po daily).  [Supplied: 50, 100mg capsule]. Combination Potassium sparing and Thiazide Amiloride and HCTZ Moduretic ® Adult (usual) - Diuresis: 1 tab po daily - may increase to 2 tabs po daily.  [Supplied: 5mg amiloride/50mg(hctz) tablet] HCTZ /Triampterene Dyazide ®, Maxzide ® HTN: initial, 1 tab or capsule (25 mg hydrochlorothiazide/37.5 mg triamterene) po qd. Allow 2-3 weeks to achieve optimum antihypertensive effect. May increase to max dose of 50/75 mg po qd.   [Supplied 25 mg-37.5 mg capsule/tablet. 50 mg-75 mg tablet]. Spironolactone and HCTZ Aldactazide ® Adults: (25/25mg tablet): 0.5 to 8 tablets qd. (50/50 mg tablet): 0.5 to 4 tablets qd in 1-2 doses   [Supplied: 25/25mg and 50/50mg tablets].  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.");s1[48]=new Array("decongestants.htm","Decongestants","","Decongestants Phenylephrine (Neo-Synephrine®): Nasal congestion: Dosing (adult): 10mg (1 tablet) every 4 hours as needed. Maximum: 60mg per day. Sample product: Sudafed PE™ Intranasal: Instill 1-2 sprays or instill 1-2 drops every 4 hours of 0.25% to 0.5% solution as needed. 1% solution may be used in adults in cases of extreme nasal congestion. Do not use nasal solutions more than 3 days. Pseudoephedrine (Sudafed): Congestion: 30-60 mg orally every 4 to 6 hours as needed. Maximum 240mg/day.  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP] Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.");s1[49]=new Array("drugfoodrxn.htm","Drug-Food interactions: what medications should be taken on an empty stomach or with food. Includes newer agents as well","","Drug food Interactions  Medications which should be taken on an EMPTY stomach Alendronate (Fosamax) Ampicillin Astemizole Bethanechol Bisacodyl Captopril (Take 1 hour before meals) Cefibuten (Cedax) Cilostazol (Pletal) Demeclocycline Dicloxacillin Didanosine (Videx) Etidronate (Didronel) Felodipine (Plendil) Indinavir (Crixivan) Lansoprazole (take before eating) Levothyroxine loratadine (Claritin) loracarbef (Lorabid) Methotrexate Moexipril (Univasc) Mycophenolate (Cellcept) Omeprazole Take before eating Oxacillin Penicillamine Perindopril (Aceon) Repaglinide (Prandin) Rifampin Rifabutin (Mycobutin) Riluzole (Rilutek) Roxithromycin (take at least 15 minutes before or after a meal) Sucralfate (Carafate) Sulfamethoxazole - trimethoprim (Bactrim) Sulfadiazine Tetracycline (Do not take with milk or other dairy products) Tolcapone (Tasmar) Zafirlukast (Accolate) Zalcitabine (Hivid)     Medications which should be Taken with FOOD Allopurinol (take after meal) Atovaquone (Mepron) Augmentin Aspirin Amiodarone (Cordarone) Baclofen (Lioresal) Bromocriptine (Parlodel) clofazimine (Lamprene) Carvedilol (Coreg) Carbamazepine (Tegretol) Chloroquine Cimetidine (Tagamet) Cefpodoxime (Vantin) Diclofenac (Voltaren_ Divalproex sodium (Depakote) Doxycycline Felbamate (Felbatol) fenofibrate (TriCor) Fiorinal Fludrocortisone fenoprofen Griseofulvin glyburide (take with breakfast) Hydrocortisone Hydroxychloroquine (Plaquenil) Indomethacin Iron preparations (Take between meals--if GI upset occurs take with food) Itraconazole capsules Ketorolac Lithium Metronidazole Misoprostol (Cytotec) methanamine mebendazole methylprednisolone naltrexone Naproxen Nelfinavir (Viracept) Nitrofurantoin Niacin Olsalazine Perphenazine Pentoxifylline Pergolide Piroxicam Potassium salts Prednisone Procainamide Ritonavir (Norvir) Salsalate Saquinavir Sevelamer (Renagel) Spironolactone Sulfasalazine Sulfinpyrazone Sulindac Ticlopidine Tolmetin Trazodone Troglitazone Valproic acid     Drug - grapefruit interactions: Drugs which may exhibit increased serum concentrations based on this interaction amiodarone astemizole alprazolam atorvastatin benzodiazepines buspirone carbamazepine carvedilol cerivastatin cilostazol clarithromycin Clomipramine codeine cyclosporine dapsone dextromethorphan diazepam diltiazem estrogens erythromycin felodipine fentanyl finasteride haloperidol indinavir lercanidipine lidocaine lovastatin midazolam methadone nelfinavir nifedipine nicardipine nimodipine nisoldipine nitrendipine ondansetron paclitaxel progestins progesterone quinidine ritonavir salmeterol saquinavir simvastatin tacrolimus trazodone triazolam vincristine zaleplon zolpidem  Note: there may be omissions on this list. Absence of a drug does not necessarily indicate that the drug lacks this potential interaction.  Warfarin - food Interactions Web site link Management of Dietary Interactions and Vitamin K: dietary consistency is the key to maintaining a sustained, stable response during warfarin therapy. Patients should be aware of vitamin K content in common foods, particularly foods high in vitamin K (green leafy vegetables (broccoli, Brussel sprouts, turnip greens, kale, spinach, beet greens), Cauliflower , legumes, mayonnaise, canola and soybean oils), and should maintain a consistent amount of these foods in their diet. The following foods should be avoided or limited, since they also can effect warfarin therapy: caffeinated beverages (cola, coffee, tea, hot chocolate, chocolate milk). Alcohol intake greater than 3 drinks daily can increase the effect of Coumadin. As long as alcohol intake does not exceed 3 drinks daily, clotting times should not be affected. This amount of alcohol is present in 12 ounces of table wine or three 12 ounce beers. (Acute binges can raise INR. Chronic alcohol ingestion may decrease INR. ) Herbal supplements can affect bleeding time. Coenzyme Q10 is an herbal supplement whose chemical structure is similar to vitamin K, so it has the potential to affect bleeding time. Herbal teas: green tea, buckeye, horsechestnut, tonka, bean, meliot, and woodruff. Other examples include: feverfew, garlic, and ginseng. Herbal medications should either be avoided or used consistently while on warfarin therapy.   Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.");s1[50]=new Array("endocrine.htm","Endocrine (Other) - Dosing table","","Endocrine / Other bromocriptine Parlodel ® Dopamine Agonist. Initial: 1.25 mg orally twice daily. Usual: 10-40mg/day. Dosing (Adults):Parkinsons: 1.25 mg orally twice daily. Increased by 2.5 mg/day in 2 to 4 week intervals (usual dose range is 30-90 mg/day in 3 divided doses).  Max: 100 mg/day. Neuroleptic malignant syndrome: Oral: 2.5 to 5 mg tid. Hyperprolactinemia: 2.5 mg orally bid - tid. Acromegaly: Initial: 1.25-2.5 mg orally. Increasing as necessary every 3-7 days. Usual dose: 20-30 mg/day. Supplied: Capsule: 5 mg. Tablet: 2.5 mg cabergoline Dostinex ® Long acting dopamine receptor agonist with a high affinity for D2 receptor. Dosing (Adults): Hyperprolactinemic disorders: Initial dose: 0.25 mg orally twice weekly. The dose may be increased by 0.25 mg twice weekly up to a maximum of 1 mg twice weekly according to the patient's serum prolactin level. Dosage increases should not occur more rapidly than every 4 weeks. Once a normal serum prolactin level is maintained for 6 months, the dose may be discontinued and prolactin levels monitored to determine if cabergoline is still required. The durability of efficacy beyond 24 months of therapy has not been established. Supplied: 0.5 mg tab. calcitonin Calcimar ® Structurally similar to human calcitonin; it directly inhibits osteoclastic bone resorption; promotes the renal excretion of calcium, phosphate, sodium, magnesium and potassium by decreasing tubular reabsorption. Dosing (Adults): Paget's disease: 100 units/day IM/SQ to start. Maint: 50 units/day or 50-100 units every 1-3 days. Hypercalcemia: Initial: 4 units/kg IM/SQ q12h. May increase up to 8 units/kg q12h to a maximum of q6h. Osteoporosis prevention (in postmenopausal women): 100 units/day (IM/SQ).  Intranasal: 200 units (1 spray)/day Supplied: Injection: 200 IU/ml (2 ml) (calcitonin-salmon).  Nasal spray:200 IU/0.09 ml (3.7 ml) cinacalcet Sensipar ® MOA: Increases the sensitivity of the calcium-sensing receptor on the parathyroid gland. Dosing (Adults):  Secondary hyperparathyroidism: Initial: 30 mg orally once daily (maximum daily dose: 180 mg). Increase dose incrementally (60 mg, 90 mg, 120 mg, 180 mg once daily) as necessary to maintain iPTH level between 150-300 pg/mL. Note: Do not titrate dose more frequently than every 2-4 weeks. Parathyroid carcinoma: Initial: 30 mg orally twice daily (maximum daily dose: 360 mg daily as 90 mg 4 times/day). Increase dose incrementally (60 mg twice daily, 90 mg twice daily, 90 mg 4 times/day) as necessary to normalize serum calcium levels. Supplied: Tablet: 30 mg, 60 mg, 90 mg. cosyntropin Cortrosyn ® Stimulates the adrenal cortex to secrete adrenal steroids. Dosing (Adults): Diagnosis of adrenocortical insufficiency: IM, IV (over 2 minutes): Peak plasma cortisol concentrations usually occur 45-60 minutes after cosyntropin administration: 0.25-0.75 mg. When greater cortisol stimulation is needed, an I.V. infusion may be used: 0.25 mg administered at 0.04 mg/hour over 6 hours Supplied: Inj (powder for reconstitution): 0.25 mg desmopressin DDAVP ® Indications: Hemophilia (increases factor VIII levels): 0.3 mcg/kg in 50ml normal saline over 15-30 minutes. Diabetes insipidus: 2-4 mcg/day IV push or SC. Decrease bleeding following cardiac bypass: 0.3 mcg/kg ivpb.  Provide short term protection for uremic hemorrhagic tendency: 0.3 mcg/kg ivpb q8h x 2 doses (diminishing response). Greatly enhanced ADH activity. Less vasopressor activity. Longer DOA. (Synthetic analog of vasopressin-posterior pituitary hormone). ADH activity : Pressor activity [DDAVP: 2000-4000: 1  Vasopressin: 1:1] octreotide Sandostatin ® Somatostatin analog. Dosing (Adults): Carcinoid tumors: Initial: 50 mcg IV/SQ qd-bid. Titrate dose based on response/tolerance. Range: 100-600 mcg/day in 2-4 divided doses. VIPomas: Initial 2 weeks: 200-300 mcg/day IV/SQ in 2-4 divided doses. Titrate dose based on response/tolerance. Range: 150-750 mcg/day (doses >450 mcg/day are rarely required). Diarrhea:Initial: 50-100 mcg IV q8h - increase by 100 mcg/dose at 48-hour intervals. Maximum dose: 500 mcg q8h. Bleeding esophageal varices: IV bolus: 25-50 mcg followed by continuous IV infusion of 25-50 mcg/hour vasopressin Pitressin ® ADH analog (Posterior pituitary hormone). Dosing (Adults): Diabetes insipidus: Note: Dosage is highly variable - titrated based on serum and urine sodium and osmolality in addition to fluid balance and urine output. 5-10 units IM/SQ 2-4 times daily as needed (dosage range 5-60 units/day). Abdominal distention: 5 units IM stat, then 10 units every 3-4 hours.  GI hemorrhage: Continuous IV infusion: 0.5 milliunits/kg/hour (0.0005 unit/kg/hour). Double dosage as needed every 30 minutes to a maximum of 10 milliunits/kg/hour. IV: Initial: 0.2-0.4 unit/minute, then titrate dose as needed. If bleeding stops, continue at same dose for 12 hours, taper off over 24-48 hours. Out-of-hospital asystole (unlabeled use): Adults: 40 units IV. If spontaneous circulation is not restored in 3 minutes, then repeat dose. Pulseless VT/VF: 40 units IV (as a single dose only). If no IV access - administer 40 units diluted with NS (to a total volume of 10 ml) endotracheally. Vasodilatory shock/septic shock: Vasopressin may be used in patients with refractory shock despite adequate fluid resuscitation and the use of high-dose conventional catecholamines such as norepinephrine and dopamine, however, further studies are needed to determine its exact place in therapy. Current evidence does not support the use of vasopressin as a replacement for norepinephrine or dopamine as a first-line agent.  The recommended infusion rate for vasopressin in the treatment of shock in adults is 0.01– 0.04 units/min. This dosage range is reported to be effective in about 85% of patients with norepinephrine resistant hypotension. Doses greater than 0.04 units/min may lead to cardiac arrest. O'Brien A et al reported rapid rebound hypotension as a common problem after treatment with vasopressin is stopped. Potential side effects of vasopressin infusion range from ischemic skin lesions to possible intestinal ischemia. Vasopressin therapy may also result in decreased cardiac output and hepatosplanchnic flow. Supplied: Injection: 20 units/ml (0.5 ml, 1 ml, 10 ml)  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.");s1[51]=new Array("erectile_dysfunction.htm","Erectile dysfunction -  PDE-5 inhibitors","","Erectile dysfunction Sildenafil Viagara ® Phosphodiesterase-5 Enzyme Inhibitor. Dosing (Adults): Start 50 mg orally 0.5 to 4 hours prior to intercourse. The maximum recommended dosing frequency is once daily. Usual effective range: 25-100mg. Start at 25mg if >65 years old or liver/renal impairment. Renal dosing: Crcl <30 ml/min: Initial: 25 mg, 1 hr before sexual activity.  Supplied: Viagra®: 25 mg, 50 mg, 100 mg tablet. tadalafil Cialis ® PDE-5 enzyme inhibitor.  Dosing (Adults): Erectile dysfunction: 10 mg orally prior to anticipated sexual activity (dosing range: 5-20 mg) - to be given as a single dose and not given more than once daily (Erectile function may be improved for up to 36 hours following a single dose). Drug interactions: Alpha blockers: If stabilized on either alpha blockers or tadalafil therapy, initiate new therapy with the other agent at the lowest possible dose.  CYP3A4 inhibitors: Dose reduction of tadalafil is recommended with strong CYP3A4 inhibitors. The dose of tadalafil should not exceed 10 mg, and tadalafil should not be taken more frequently than once every 72 hours. Some examples include: (azole antifungals, clarithromycin, doxycycline, erythromycin, grapefruit juice, imatinib, isoniazid, nefazodone, protease inhibitors, others...)   Renal dosing:   Crcl 31-50 ml/min: Initial dose 5 mg once daily - maximum dose 10 mg not to be given more frequently than every 48 hours.  Crcl <30 ml/min or hemodialysis: Maximum dose 5 mg. Hepatic impairment: Mild-to-moderate hepatic impairment (Child-Pugh class A or B): Do not exceed 10 mg once daily. Severe hepatic impairment: Use is not recommended. Supplied: 5 mg, 10 mg, 20 mg tablet. vardenafil Levitra ® PDE-5 enzyme inhibitor. Dosing (Adults): Erectile dysfunction: 10 mg orally 1 hour prior to sexual activity. Dosing range: 5-20 mg (given as one single dose and not given more than once daily). Patients >/= 65 yrs old: Initial: 5 mg 1 hr prior to sexual activity- to be given as one single dose and not given more than once daily. Drug interactions: Alpha blocker (dose should be stable at time of vardenafil initiation): Initial vardenafil dose: 5 mg/24 hrs. If an alpha blocker is added to vardenafil therapy, it should be initiated at the smallest possible dose, and titrated carefully. Other: Erythromycin: Max vardenafil dose: 5 mg/24 hrs. Indinavir: Max dose: 2.5 mg/24 hrs. Itraconazole: 200 mg/day: Max dose: 5 mg/24 hours. 400 mg/day: Max dose: 2.5 mg/24 hrs. Ketoconazole: 200 mg/day: Max dose: 5 mg/24 hrs. 400 mg/day: Max dose: 2.5 mg/24 hrs. Ritonavir: Max dose: 2.5 mg/72 hrs. Hepatic impairment: Child-Pugh class B: Initial: 5 mg 1 hr prior to sexual activity (max dose: 10 mg)- to be given as one single dose and not given more than once daily. Supplied: 2.5 mg, 5 mg, 10 mg, 20 mg tablet. [TOP]  Listed dosages are for - Adult patients ONLY David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc.  PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon.  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.  ");s1[52]=new Array("fever.htm","Medications which may induce fever (Adverse effect).","Medications which may induce fever (Adverse effect)","Medications with a Potential for inducing a fever allopurinol antihistamines azathioprine barbiturates carbamazepine cephalosporins cimetidine folic acid hydralazine hydroxyurea ibuprofen  isoniazid methyldopa nitrofurantoin penicillins phenytoin procainamide prophylthiouracil quinidine streptomycin sulfonamides sulindac triamterene vancomycin  Current Medical Diagnosis and Treatment, edited by Lawrence M. Tierney, Jr., et al. Stamford, CT: Appleton & Lange, 1996.  Globalrph visitor input - Package insert. Knockaert DC, Dujardin KS, Bobbaers HJ. Long-term follow-up of patients with undiagnosed fever of unknown origin. Arch Intern Med 1996; 156(6):618-20. Lipsky BA, Hirschmann JV. Drug fever. JAMA 1981; 245(8):851-4. Mackowiak PA, LeMaistre CF. Drug fever: A critical appraisal of conventional concepts through an analysis of 51 episodes diagnosed in two Dallas hospitals and 97 episodes reported in the English literature. Ann Intern Med 1987;106:728.  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc. Author: David McAuley Keywords: drug reaction,fever, temperature");s1[53]=new Array("fibrates.htm","Fibrates","","Fibrates The fibrates, or fibric acid derivatives, act in part to stimulate the activity of peroxisome proliferator-activated receptors (PPARs), which are involved in fatty acid breakdown. The main action of fibrates is to lower triglyceride levels (by 35 to 50 percent).  Fibrates also raise serum high density lipoprotein (HDL) by 15 to 25 percent. Fibrates are the drugs of choice when treating isolated elevated triglycerides. They can be combined with statins to treat combinations of high triglycerides and LDL cholesterol. clofibrate Usual dosage (dyslipidemia): 500 mg orally 4 times/day. Some patients may respond to lower doses. Renal Dosing: crcl >50 ml/min: Administer every 6-12 hours. crcl 10-50 ml/min: Administer every 12-18 hours. crcl <10 ml/min: Avoid use. Supplied: 500 mg capsule fenofibrate (Tricor ®): Initially: 67 mg (1 cap) orally once daily with meal.  Maximum: 3 caps once daily. gemfibrozil (Lopid ®): Usual dosage: 600mg orally twice daily.  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]   Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.  ");s1[54]=new Array("fluoroquinolones.htm","Fluoroquinolones","","Fluoroquinolones: Ciprofloxacin Cipro ® Dosing: (Oral): 250- 750mg q12h. (IV): 200-400 mg IV q12h. [Febrile neutropenia]: 400 mg IV q8h. Renal Dosing: [CRCL >30 ]: no changes .  [5-30 ]:  (IV): 200-400mg q18-24h or give 200mg q12h.  (Oral): 250 q12h or, 250-500mg q18 to 24 hours.     Hemodialysis: (IV): 200-400mg q24h or 200mg q12h. Schedule dose after dialysis on dialysis days.  (Oral): 250mg q12h or 250-500mg q24h. Schedule dose after dialysis on dialysis days. Gatifloxacin Tequin ® Dosing: 400 mg po/IV qd Renal Dosing: [CRCL >40]: No changes.  [<40 ]: 400mg x 1, then 200mg qd.  Hemodialysis: 400 mg x 1, then 200mg qd. (On dialysis days, schedule dose after dialysis.).   PD: 400 mg x 1, then 200mg qd Levofloxacin Levaquin ® Dosing: 250-500 mg po/IV q24h. Complicated skin/structure: 750 mg q24h. Renal Dosing: [CRCL >50] No change.  [20-49]: 500 x 1, then 250mg q24h.  Complicated skin/structure: 750 mg x 1, then 750mg q48h.  [10-19]: 500mg x 1, 250mg q48h. Complicated skin/structure: 750 mg x 1, then 500mg q48h. [<10] same as above.  Hemodialysis or PD:  500mg x 1, 250mg q48h. Complicated skin/structure: 750 mg x 1, then 500mg q48h. On dialysis days, schedule dose after dialysis. Moxifloxacin Avelox ® Dosing: 400 mg orally or IV q24h. Bacterial conjunctivitis (ophthalmic soln): Instill 1 drop into affected eye(s) 3 times/day x 7 days. Renal Dosing: No adjustment necessary. Hemo: No specific guidelines available. Supplied: Tablet: 400mg.  Avelox® ABC Pack: contains 5 unit dose 400mg tablets. IV (premixed): 400mg/250 ml NS. Ophthalmic soln ( Vigamox ®): 0.5% (3 ml). Norfloxacin Noroxin ® Dosing: 400 mg po q12h. Renal Dosing: [CRCL > 30]: normal dose.  [<30]: 400 mg q24h.  Hemodialysis:  400 mg q24h. Ofloxacin Floxin ® Dosing: 200-400 mg po or IV q12h. Renal Dosing: [> 50 ml/min]: no changes.  [20-50]: 200-400mg q24h.  [<20]: 100-200mg q24h (1/2 of usual dose q24h.).   Hemodialysis:  Manufacturer states: For CRCL <20 ml/min give 50% of usual dose q24h. No specific info for hemodialysis.  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.");s1[55]=new Array("g6pd.htm","G6PD.  Medication concerns","","G6PD Deficiency Most common inherited enzyme deficiency affecting red blood cells. G6PD is a critical antioxidant—a deficiency can predispose to oxidation and subsequent hemolysis of the red blood cell. Common oxidants include: sulfonamides, furantoins, chloramphenicol, large doses of ascorbic acid, dapsone(>200mg/day), chloroquine, methylene blue, nalidixic acid, penicillamine, primaquine, quinadine & quinine. The degree of hemolysis induced by a drug may be accentuated by the presence of additional factors (infection or disease state etc).The severity of the reaction is dependent on the type of G6PD deficiency (Mediterranean deficiency-Caucasian (most severe) ; Blacks (usually mild to moderate). The sex of the patient is also important—males are at greater risk based on severity compared to females. Conclusion: G6PD is not an absolute contraindication to the use of oxidizing agents. Decisions should be based on a risk vs benefit analysis (consider severity of disease; sex of patient; availability of other agents; type of deficiency). If therapy is initiated, the patient should be monitored closely for adverse effects. Patients with G6PD deficiency will exhibit signs within 1-3 days of initiation of treatment. Symptoms may include abdominal or back pain in severe cases. The urine of the patient will darken in color.  References 1) Aderka D, Garfinkel D, Bograd H, Friedman J, Pinkhas J. Isosorbide dinitrate-induced hemolysis in G6PD-deficient subjects. Acta Haematol. 1983;69(1):63-4. 2) Beutler E. G6PD: population genetics and clinical manifestations. Blood Rev. 1996 Mar;10(1):45-52. 3) Eldad A, Neuman A, Weinberg A, Benmeir P, Rotem M, Wexler MR. Silver sulphadiazine-induced haemolytic anaemia in a glucose-6-phosphate dehydrogenase-deficient burn patient. Burns. 1991 Oct;17(5):430-2. 4) Grossman S, Budinsky R, Jollow D. Dapsone-induced hemolytic anemia: role of glucose-6-phosphate dehydrogenase in the hemolytic response of rat erythrocytes to N-hydroxydapsone. J Pharmacol Exp Ther. 1995 May;273(2):870-7. 5) Herman J, Ben-Meir S. Overt hemolysis in patients with glucose-6-phosphate dehydrogenase deficiency: a survey in general practice. Isr J Med Sci. 1975 Apr;11(4):340-6. 6) Hohl RJ, Kennedy EJ, Frischer H. Defenses against oxidation in human erythrocytes: role of glutathione reductase in the activation of glucose decarboxylation by hemolytic drugs. J Lab Clin Med. 1991 Apr;117(4):325-31. 7) Lavelle KJ, Atkinson KF, Kleit SA. Hyperlactatemia and hemolysis in G6PD deficiency after nitrofurantoin ingestion. Am J Med Sci. 1976 Sep-Oct;272(2):201-4. 8) Magon AM, Leipzig RM, Zannoni VG, Brewer GJ. Interactions of glucose-6-phosphate dehydrogenase deficiency with drug acetylation and hydroxylation reactions. J Lab Clin Med. 1981 Jun;97(6):764-70. 9) Myat-Phone-Kyaw, Myint-Oo, Aung-Naing, Aye-Lwin-Htwe. The use of primaquine in malaria infected patients with red cell glucose-6-phosphate dehydrogenase (G6PD) deficiency in Myanmar. Southeast Asian J Trop Med Public Health. 1994 Dec;25(4):710-3. 10) Reinke CM, Thomas JK, Graves AH. Apparent hemolysis in an AIDS patient receiving trimethoprim/sulfamethoxazole: case report and literature review. J Pharm Technol. 1996 Nov-Dec;11(6):256-62; quiz 293-5. 11) Tabbara IA. Related Articles Hemolytic anemias. Diagnosis and management. Med Clin North Am. 1992 May;76(3):649-68. 12) Vanella A, Campisi A, Castorina C, Sorrenti V, Attaguile G, Samperi P, Azzia N, Di Giacomo C, Schiliro G. Antioxidant enzymatic systems and oxidative stress in erythrocytes with G6PD deficiency: effect of deferoxamine. Pharmacol Res. 1991 Jul;24(1):25-31.  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.");s1[56]=new Array("gastrointestinal.htm","Gastrointestinal (Other) - Dosage of miscellaneous agents","","Gastrointestinal ( Other) infliximab (Remicade ®): Monoclonal antibody that binds to tumor necrosis factor. Biological activities of TNFa include the induction of proinflammatory cytokines (interleukins), enhancement of leukocyte migration, activation of neutrophils and eosinophils, and the induction of acute phase reactants and tissue degrading enzymes. Dosage (adult):  Ankylosing spondylitis: 5 mg/kg IV at 0, 2, and 6 weeks, followed by 5 mg/kg every 6 weeks thereafter. Crohn's disease:   Induction regimen: 5 mg/kg IV over 2 hours. Repeat dose at 2 and 6 weeks, followed by 5 mg/kg every 8 weeks. Dose may be increased to 10 mg/kg in patients who respond but then lose their response. If no response by week 14, consider discontinuing therapy. Psoriatic arthritis (with or without methotrexate): 5 mg/kg IV at 0, 2, and 6 weeks, then every 8 weeks. Rheumatoid arthritis: (In combination with methotrexate therapy): 3 mg/kg IV at 0, 2, and 6 weeks then every 8 weeks thereafter. Doses have ranged from 3-10 mg/kg intravenous infusion repeated at 4 to 8 week intervals. Mesalamine Asacol ® 800mg orally three times daily. (Pentasa): 1000mg orally four times daily. misoprostol Cytotec ® 200 mcg orally four times daily with food. If poorly tolerated may decrease dose to 100 mcg orally four times daily or 200mcg orally twice daily.  Supplied: [100, 200 mcg tablets]. Neomycin: Hepatic encephalopathy: 4-12 grams/day orally divided every 6 hours. octreotide Sandostatin ® Variceal bleed: Bolus 25-50 mcg IV, followed by 25-50 mcg/hr. AIDs diarrhea: 100-500 mcg SC three times daily. osalazine Dipentum ® Ulcerative colitis: 500mg orally bid. Orlistat Xenical ® lipase inhibitor for obesity management that acts by inhibiting the absorption of dietary fats. Weight loss: 120mg orally three times daily with meals [120] sucralafate Carafate ®  Active duodenal ulcer: 1 gram orally four times daily on an empty stomach. Prophylaxis: 1 gram orally twice daily. [Supplied: 1 gram tablet; susp: 1 gram/10ml] Sulfasalazine Azulfadine ® 500-1000mg orally four times daily. Ursodiol Actigall ® 8-10 mg/kg/day orally in 2 to 3 divided doses. Supplied: [Supplied: 300 capsule] vasopressin Pitressin ® , ADH Bleeding esophageal varices and other types of upper GI bleeds: initially 0.2 u/min, then increase each hour by 0.2 u/min until the hemorrhage is controlled. Doses as high as 2 u/min may be tolerated, but a more prudent dosage limit is 1 u/min. After 12 hours of control of the hemorrhage the dose of vasopressin may be decreased by 50%, then may discontinue in the next 12-24 hrs. Intravenous nitroglycerin should be administered concomitantly to control side effects. MOA: ADH and pressor activity. Portal blood pressure is significantly decreased. A decrease in porto-systemic collateral flow and an increase in the muscular tone of the lower esophagus reduces blood flow to esophageal varices. The smooth muscle of the GI tract is also effected by large doses and peristaltic activity of the bowel and smooth muscles of the uterus are stimulated.  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.");s1[57]=new Array("gout.htm","Gout agents: dosing list for health care providers","Gout agents: dosing list for health care providers, pharmacists, nurses, physicians.","Gout Treatment / Elevated uric acid levels allopurinol (Zyloprim ®): Indications: uric acid stones, tophaceous gout,  frequent attacks, >3mg/dl over upper limits of normal uric acid level, underexcretor or overproducer.  If renal function normal, initial dose should be 100 mg/day, gradually increased to 300-400 mg with a maximum daily dose of 800 mg/day [Renal Failure: 100mg/day] Gout: initially 100mg qd. Increase by 100mg/day q7days, titrate to desired uric acid level. Usual range: (Mild gout): 200-300mg/day. Moderate-severe: 400-600mg/day. Maximum dose/day: 800mg Renal dosing: [>50 ml/min]: No changes [20-50]: 100-300mg q24h. [10-20]: 100-200mg q24h. [<10]: 100mg q24-48h. [Hemodialysis]: 100mg q24-48h (give dose after dialysis on dialysis days.).  colchicine: Acute gouty arthritis: initially 1 to 1.2 mg x 1, then 0.5 to 1.2 mg orally every 1 to 2 hours until pain relief or unacceptable side effects (diarrhea, GI upset) Alternative: 2 mg IV over 2 to 5 min, followed by 0.5 mg IV every 6 hours. Maximum: 8 mg/day orally, or 4 mg/day IV. Gout prophylaxis: 0.5-1 mg orally once or twice daily. Start low- 0.6 mg daily or twice daily . probenecid (Benemid ®): Gout: 250 mg orally twice daily x 7 days, then 500mg twice daily. Rasburicase (Elitek®): Indicated for the initial management of plasma uric acid levels in pediatric patients with leukemia, lymphoma, and solid tumor malignancies who are receiving anti-cancer therapy expected to result in tumor lysis and subsequent elevation of plasma uric acid. Recommended dose: 0.15 or 0.20 mg/kg as a single daily dose for 5 days. Because the safety and effectiveness of other schedules have not been established, dosing beyond 5 days or administration of more than one course is not recommended. Chemotherapy should be initiated 4 to 24 hours after the first dose of rasburicase. Rasburicase should be administered as an intravenous infusion over 30 minutes (NEVER as a bolus infusion).  Rasburicase is contraindicated in individuals deficient in glucose-6-phosphate dehydrogenase (G6PD). sulfinpyrazone (Anturane ®) Uricosuric agent. Gout: Initially: 100-200mg orally twice daily with meals. Maintenance: 200mg orally twice daily with meals. Maximum daily dose: 800mg. Do not use if crcl<50 ml/min. Principles of treatment: Do not treat asymptomatic hyperuricemia. Also, do not treat hyperuricemia during acute gouty arthritis attack. Treat patients with tophi or polyarticular gout. Probably treat patients with recurrent attacks and serum uric acid >9 mg/dl--Start with low dose and gradually increase (titrate to serum uric acid) over weeks to months. Monitor serum uric acid and aim for uric acid <6.0 mg/dl (or <5.0 with tophi). Use concomitant colchicine prophylaxis until uric acid has been at desired level for some months and no recent gouty attacks have occurred (6-12 months). Use uricosuric drugs (probenecid, sulfinpyrazone) when possible because of low toxicity. Use allopurinol in patients with renal calculi, renal insufficiency, concomitant diuretic therapy, cyclosporine therapy, urate overproduction. Things to Remember 1. Uric acid may be low, normal, or high during an attack. 2. Low dose colchicine should be started when initiating uric acid lowering drugs. 3. Do not initiate uric acid altering drugs during an acute attack. Wait until attack fully resolved. 4. Indications for Allopurinol use (stated above) 5. Place patient on a low purine diet (seafood, organ meats, spinach, asparagus), alcohol abstinence, weight loss if obese.  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc. Author: David McAuley Keywords: gout, uric acid,pharmacists, nursing, physicians,health care providers, allopurinol, colchicine, probenecid, uricosuric");s1[58]=new Array("h2blockers.htm","H2 Blockers","","H2 blockers cimetidine Tagamet ® Active ulcer: Oral: 800 mg orally at bedtime or 300mg orally four times daily or 400 mg orally twice daily. IM/IV: 300mg every 6 hours or 37.5 mg/hr continuous infusion. Active bleed: 37.5 mg/hr continuous IV (maximum 2400mg/day). Maintanance (duodenal ulcer prophylaxis): 400mg orally at bedtime. Gastric hypersecretory conditions: 300-600mg every 6 hours. Renal dosing: >40 ml/min: no change || 20-40 ml/min: give usual dose q8h or give 75% of usual dose. || 0-20 ml/min: Usual dose q12h or give 50% of usual dose. famotidine Pepcid ® Usual dose (Acute): 40mg orally at bedtime or 20mg orally twice daily. Maintenance: 20 mg orally at bedtime. Hypersecretory conditions: 20mg orally every 6 hours. May increase up to 160mg orally every 6 hours nizatidine Axid ® Usual: 300mg orally at bedtime or 150 mg orally twice daily. Maintenance: 150mg orally at bedtime. Supplied: [150, 300mg capsule] ranitidine Zantac ® Usual dose: 150mg orally twice daily or 300mg orally at bedtime.  Maintenance: 150mg orally at bedtime. Gastric hypersecretory conditions: 150mg orally 2 to 4 times daily.  IVPB: 50mg every 6 to 8 hours (Maximum: 400mg/day) Continuous infusion: (preferred in actively bleeding patients): 6.25 mg/hr titrated to gastric pH >4 for prophylaxis or >7.0 for treatment. [TOP]  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc.  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.");s1[59]=new Array("helicobacter.htm","Helicobacter pylori","","Helicobacter pylori First option (Preferred option): proton pump inhibitor (eg, lansoprazole 30 mg twice daily, omeprazole 20 mg twice daily, pantoprazole 40 mg twice daily, rabeprazole 20 mg twice daily, or esomeprazole 40 mg once daily) PLUS Biaxin 500mg orally twice daily PLUS Amoxicillin 1 gram orally twice daily x 14 days. Second option (penicillin allergic): proton pump inhibitor (eg, lansoprazole 30 mg twice daily, omeprazole 20 mg twice daily, pantoprazole 40 mg twice daily, rabeprazole 20 mg twice daily, or esomeprazole 40 mg once daily) PLUS Biaxin 500mg orally twice daily PLUS Flagyl 500mg orally twice daily x 14 days. Third option : proton pump inhibitor (eg, lansoprazole 30 mg twice daily, omeprazole 20 mg twice daily, pantoprazole 40 mg twice daily, rabeprazole 20 mg twice daily, or esomeprazole 40 mg once daily) PLUS Pepto Bismol (2 tablets) orally four times daily PLUS flagyl 500mg orally three times daily for 14 days. Dual therapy regimens using a PPI plus one antibiotic (amoxicillin or clarithromycin) are frequently cited in the literature. However, they cannot be recommended as primary therapy because their eradication rates are significantly lower (60 to 85 percent) than the standard regimens. Combination products: Helidac (bismuth subsalicylate + metronidazole + Tetracycline). PrevPac (lansoprazole + amoxicillin + clarithromycin)  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.");s1[60]=new Array("hypertensive_emer_oral.htm","Management of Hypertensive Urgencies: Oral Agents ","","Management of Hypertensive Urgencies: Oral Agents Hypertensive urgency: Acutely elevated blood pressure, particularly diastolic pressure > 120–130 mmHg without evidence of target organ damage. Goals: Lower mean arterial pressure to goal or near goal within several hours. Oral medications can be used. Hypertensive emergency: Hypertension with evidence of target organ damage ( brain, heart, kidneys, eyes). Goals: The goal of initial therapy is to terminate ongoing target organ damage. Lower mean arterial pressure by 20- 25% or diastolic pressure to <100 to 110 mmHg within 30–60 minutes. Captopril Dose: 12.5 to 25 mg orally repeat as needed or give SL. Onset/ duration: 15-30 min/6-8 hr,  SL 10-20 min/2-6 hr. Clonidine Dose: Clonidine 0.1-0.2 mg orally x 1, followed by 0.05 to 0.1 mg every 1 to 2 hours to a maximum dose of 0.6 to 0.7 mg.   Onset/ duration: 30-60 min/8-16 hr. Labetalol Dose: 200-400 mg orally, repeat every 2-3 hours.  Onset/ duration: 1-2 hr/2-12 hr. Many patients may require at least 2 agents. Additional agents to consider are (1) lasix 20mg (rpt as necessary) (2) nifedipine SR 30mg x1 (3) felodipine 5 mg x 1.  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]   Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.");s1[61]=new Array("hypertensive_emer.htm","Hypertensive Emergency - IV Agents ","","Hypertensive Emergency - IV Agents Hypertensive emergency - definition: Severe hypertension that is associated with acute end-organ damage. Examples include malignant hypertension, with or without hypertensive encephalopathy, subarachnoid or intracerebral hemorrhage, acute pulmonary edema, aortic dissection, and rebound after withdrawal of antihypertensive medications. Immediate but careful reduction in blood pressure is indicated in these settings. However, an excessive hypotensive response is potentially dangerous, possibly leading to ischemic complications such as stroke, myocardial infarction or blindness in some cases. Thus, in patients who are severely hypertensive but asymptomatic, slower reductions in blood pressure should be provided with oral agents. Source: UpToDate ® Enalaprilat - Vasotec ® ACE-inhibitor with a rapid onset of action and long duration of action.   Dosing (Adult):  Initial dose 1.25 mg IVP (over 2-5 min) q6h. May increase up to 5 mg q6h. Reduce dose in azotemic patients. Contraindicated in renal artery stenosis. Onset/duration: Within 15 to 30 minutes/12-24 hr. Note: peak effect may not be seen for four hours. Esmolol - Brevibloc ® Beta-1 selective blocker. Rapidly metabolized by blood esterases (short half-life ~ 9 minutes) and total duration of action ~ 30 minutes. Its effects begin almost immediately.   Dosing (Adult):  500 mcg/kg IV bolus over 1 minute, and start infusion at 50 - 100 mcg/kg/min => repeat bolus dose of 500 mcg/kg if no effect within 5 minutes and increase dose by 50 mcg/kg/min. Repeat cycle every 5 minutes until maximum infusion dose of 300 mcg/kg/min.  Contraindicated in cocaine toxicity (if used alone) and LVF and COPD/asthma and high-grade heart block. Causes phlebothrombophlebitis - use large vein's. Causes local necrosis if extravasation occurs. Onset/duration:1-5 min/15-30 min. Fenoldopam mesylate - Corlopam ® Fenoldopam is a rapid-acting vasodilator. It is an agonist for D1-like dopamine receptors and binds with moderate affinity to α2-adrenoceptors. Fenoldopam: effective as nitroprusside, however, it has the advantages of increasing renal blood flow (6 times as potent as dopamine in producing renal vasodilitation) and sodium excretion, of not being associated with the accumulation of toxic metabolites, and not requiring shielding from light. Fenoldopam can be safely used in all hypertensive emergencies, and may be particularly beneficial in patients with renal insufficiency. Dosing (Adult): After a starting dose of 0.1 to 0.3 mcg/kg/minute, the dose is titrated at 15 minute intervals, depending on the BP response.  May be increased in increments of 0.05 to 0.1 mcg/kg/minute every 15 minutes until target blood pressure is reached. Maximal infusion rate reported in clinical studies: 1.6 mcg/kg/minute. Onset/duration: 5-10 minutes/~ 1 hour. Supplied: Injection (soln): 10 mg/mLl(1 ml, 2 ml) Hydralazine - APRESOLINE ® Direct arteriolar vasodilator with little or no effect on the venous circulation. Precautions are needed in patients with underlying coronary disease or an aortic dissection. Beta-blocker should be given concurrently to minimize reflex sympathetic stimulation. The hypotensive response to hydralazine is less predictable than that seen with other parenteral agents. Dosing (Adult): Initial (Acute hypertension): 10 mg slow IV bolus (maximum dose being 20 mg) every 4 to 6 hours as needed. May increase to 40 mg/dose (generally speaking - do not exceed 20mg/dose). Change to oral therapy as soon as possible. The fall in blood pressure begins within 10 to 30 minutes and lasts 2 to 4 hours. May also be given IM.   Supplied: Injection (soln): 20 mg/ml (1 ml vial). Tablet: 10 mg, 25 mg, 50 mg, 100 mg. Labetalol - Trandate ® Combined beta-adrenergic (B1 and B2) and alpha-adrenergic blocker. Its rapid onset of action (~ 5 minutes) makes it the only beta-blocker that is useful in the treatment of hypertensive emergencies. Safe in patients with active coronary disease, since it does not increase the heart rate. Labetalol should generally be avoided in patients with asthma, COPD, CHF, bradycardia, or greater than first-degree heart block. Causes marked orthostatic effects. Dosing (Adult): can be given as an IV bolus or infusion. The bolus dose is 20 mg initially (over 2 min), followed by 20 to 80 mg every 10 minutes to a total dose of 300 mg. The infusion rate is 0.5 to 2 mg/min. Onset/duration: 5-10 min/2-6 hr. Peak effect in 30 minutes. Hypertension (Oral): Initial: 100 mg twice daily - may increase as needed every 2-3 days by 100 mg until desired response is obtained. Usual dose: 200-400 mg twice daily - not to exceed 2.4 grams/day.  Supplied: Injection (soln): 5 mg/ml: (4 ml, 20 ml, 40 ml). Tablet: 100 mg, 200 mg, 300 mg. Nicardipine - Cardene ® Dihydropyridine calcium channel blocker. Advantages: Does not depress LV function; does not adversely increase ICP (acceptable choice in stroke patients). Major limitation: longer half-life, which precludes rapid titration. Contraindicated in heart block, recent AMI, and renal failure. Dosing (Adult):  (Acute hypertension) - The initial dose is 5 mg/hour and can be increased to a maximum of 15 mg/hour. Effects seen within 15 minutes. Initial dose of 5 mg/hr can be increased by 2.5 mg/hour every 15 minutes to the previously listed maximum of 15 mg/hour. Consider reduction to 3 mg/hour after response is achieved. Monitor and titrate to lowest dose necessary to maintain stable blood pressure. Preparation: Dilute to 0.1 mg/ml (25 mg in D5W 250 ml). Substitution IV to oral therapy (approximate):    0.5 mg/hr IV = ~ 20mg po q8h.    1.2 mg/hr IV = ~ 30mg po q8h.    2.2 mg/hr IV = ~ 40mg po q8h. (Other indications): Angina: Immediate release capsule: 20 mg orally 3 times daily. Usual range: 60-120 mg/day. Increase dose at 3 day intervals.  Hypertension: Immediate release capsule: Initial: 20 mg orally 3 times daily. Usual: 20-40 mg 3 times daily (allow 3 days between dose increases). Sustained release capsule: Initial: 30 mg orally twice daily - titrate up to 60 mg twice daily. Note: The total daily dose of immediate-release product may not automatically be equivalent to the daily sustained-release dose - use caution in converting. Supplied: Injection (soln): 2.5 mg/ml (10 ml). Capsule (IR): 20 mg, 30 mg. Capsule (SR): 30 mg, 45 mg, 60 mg Nitroglycerin Primarily a venous dilator (lesser degree - arteriolar dilator).  It may be most useful in patients with symptomatic coronary disease and in those with hypertension following coronary bypass.  Drug of choice for hypertensive emergencies with coronary ischemia. It should not be used with hypertensive encephalopathy because it increases ICP. Tolerance may occur within 24-48 hours. Nitrate-free interval (10-12 hours/day) is recommended to avoid tolerance development. Dosing (Adult) - (IV):  Initial dose: 5 mcg/min IV infusion. Increase by 5 mcg/minute every 3-5 minutes to 20 mcg/minute. If no response at 20 mcg/minute increase by 10 mcg/minute every 3-5 minutes, up to a maximum of 100 mcg/minute. Onset: 2 to 5 minutes. Duration: 5 to 10 minutes. ------------ Angina/coronary artery disease: Oral: 2.5mg to 9 mg bid - qid (up to 26 mg qid). Topical ointment: Apply 0.5" to 2" every 6 hours with a nitrate free interval (10-12hrs). Patch (transdermal): 0.2-0.4 mg/hour initially and titrate to doses of 0.4-0.8 mg/hour. Remove patch to provide nitrate free interval (10-12hrs).  Sublingual: 0.2-0.6 mg every 5 minutes for maximum of 3 doses in 15 minutes. Supplied: Capsule (ER): 2.5 mg, 6.5 mg, 9 mg. Injection (Soln): 5 mg/ml (5 ml, 10 ml). Ointment: 2% (1 g, 30 g, 60 g).   Sublingual tablet: 0.3 mg, 0.4 mg, 0.6 mg. Patch (Transdermal ): 0.1 mg/hour; 0.2 mg/hour; 0.4 mg/hour; 0.6 mg/hour. Sodium nitroprusside - Nipride ® Arteriolar and venous dilator.  Considered to be the most effective parenteral drug for most hypertensive emergencies (except myocardial ischemia or renal impairment). It dilates both arteries and veins, and it reduces afterload and preload.  Onset: within seconds. Duration: 2-3 minutes. Constant monitoring of the blood pressure is required. Alternatives to nitroprusside include intravenous labetalol, nicardipine, and fenoldopam. Hypotension is uncommon with these drugs and cyanide toxicity is not an issue.  Dosing (Adult): Initial: 0.3-0.5 mcg/kg/minute. Increase in increments of 0.5 mcg/kg/minute -- titrating to the desired hemodynamic effect or the appearance of headache or nausea. Usual dose: 3 mcg/kg/minute (rarely need >4 mcg/kg/minute). Maximum: 10 mcg/kg/minute.  When treatment is prolonged (>24 to 48 hours) or when renal insufficiency is present, the risk of cyanide and thiocyanate toxicity is increased. Doses > 2 mcg/kg/min exceed the capacity of the body to detoxify cyanide. Maximum doses of 10 mcg/kg/min should never be given for more than 10 minutes. An infusion of sodium thiosulfate can be used in affected patients to provide a sulfur donor to detoxify cyanide into thiocyanate. Supplied: Injection (Soln): 25 mg/ml - 2 ml (vial).  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.");s1[62]=new Array("hemorrhoids.htm","Hemorrhoidal preparations","","Hemorrhoidal Preparations Anusol HC (pramoxine + HC): Cream: apply 3 to 4 times daily prn. suppository: insert rectally bid. 10% Rectal foam: apply qd-bid. Anusol Suppository Suppository: use up to 6 times/day as needed. [Supplied: 51% topical starch, soy bean oil, tocopheryl acetate] Mechanism: lubricant. Dibucaine (Nupercainal): Apply cream or ointment 3 to 4 times daily as needed. supplied: [0.5% cream, 1% ointment] pramoxine 1% (Anusol, Itch-X, Proctofoam, Tronolane): Cream/solution/Gel: Apply q3-4h prn or as directed. Ointment: use up to 5 x/day.  [Supplied: gel/Solution (Itch-X); Lotion (Prax®); Ointment (Anusol®); ] Proctofoam-HC; Analpram-HC (Pramoxine and hydrocortisone) Perianal or anorectal swelling: apply to affected areas 3-4 times daily. [Supplied: Cream: Pramoxine HCL 1% + HC 1%; Pramoxine 1% & HC 2.5%. Rectal foam / Lotion: Pramoxine HCL 1% + HC 1%]  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.");s1[63]=new Array("antivirals.htm","Anti-HIV agents.  AIDS","","Anti - HIV Agents The CD4 cell count should be measured approximately four weeks after starting therapy and then every three months. - Nucleoside Reverse Transcriptase Inhibitors- - Non-nucleoside RTI's - - Protease inhibitors - - Fusion Protein Inhibitor -  Listed dosages are for Adult patients ONLY David F. McAuley, Pharm. D., R.Ph. GlobalRPh Inc. Nucleoside Reverse Transcriptase Inhibitors abacavir Ziagen ® Dosing (adult): 300 mg orally once a day. Warn about hypersensitivity reactions which can be lethal with rechallenge. Combivir ® (AZT 300mg+150 mg lamivudine): Dosing (adult): 1 tablet orally twice daily Supplied: coated tablet (zidovudine 300mg + lamivudine 150mg). Renal failure: Use each agent independently and adjust accordingly. didanosine Videx ® Dosing (adult): Medication must be given on an empty stomach. In order to provide adequate buffering, patients must take at least 2 of the appropriate strength tablets at each dose when using either the once daily or twice daily regimens. Patient weight <60 kg: (Tablets): 125 mg orally twice daily or 250mg once daily or 167 mg (Buffered powder) twice daily.  Patient weight > 60kg: (Tablets): 200mg orally twice daily or 400mg orally once daily. (Buffered Powder): 250mg orally twice daily.  Supplied: chewable tablet: (25, 50, 100, 150, and 200mg); Oral powder for solution (100, 167, and 200mg packets). Renal Dosing: Patients > 60 kg  Tablets Powder 30-59 100 bid or 200mg qd 100 mg bid 10-29 150mg qd 167mg qd <10 100mg qd 100mg qd Patients < 60kg  Tablets Powder 30-59 75mg bid or 150mg qd 100mg bid 10-29 100 mg qd 100 mg qd <10 75 mg qd 100mg qd emtricitabine Emtriva ® Dosing (adult): 200 mg orally once daily Renal Dosing: crcl 30-49 ml/min: 200 mg every 48 hours. crcl 15-29 ml/min: 200 mg every 72 hours. crcl <15 ml/min: 200 mg every 96 hours. Supplied: Capsule: 200 mg Epzicom ® (abacavir 600mg + lamivudine 300mg): Dosing (adult): One tablet (abacavir 600 mg and lamivudine 300 mg) once daily. Renal Dosing: crcl <50 ml/min: Use not recommended. Hepatic Impairment: Use not recommended. Supplied: Tablet: Abacavir 600 mg & lamivudine 300 mg lamivudine Epivir ® Dosing (adult): 150 mg orally twice daily.  Supplied: [150mg tablet; 10 mg/ml oral solution]. Lamivudine should not be co-administered with zalcitabine. Renal dosing: crcl >50/ no change; 30-49/ 150mg once daily;  15-29/ 150mg x1, then 100mg once daily; 5-14/ 150mg x 1, then 50 mg once daily; <5/ 50mg x1, then 25mg once daily. stavudine Zerit ® Dosing: Patient weight >60 kg: 40mg orally twice daily . Patient weight < 60kg: 30mg orally twice daily. Dosages may be decreased by 50% if peripheral neuropathy occurs. May be taken without regard to meals. Must decrease dose in renal dysfunction.  Stavudine and Zidovudine should not be co-administered. Supplied: [15, 20, 30, 40mg capsules; 1 mg/ml oral powder for solution]. Renal dosing: CRCL (ml/min) WT > 60kg WT <60kg > 50 40mg q12h 30mg q12h 26-50 20mg q12h 15mg q12h 10-25 20mg q24h 15mg q24 tenofovir Viread ® Dosing (adult): 300 mg orally once daily with a meal. Renal Dosing: crcl 30-49 ml/min: 300 mg every 48 hours crcl 10-29 ml/min: 300 mg twice weekly crcl <10 ml/min: No recommendation available. Hemodialysis: 300 mg every 7 days or after a total of 12 hours of dialysis (usually once weekly assuming 3 dialysis sessions lasting about 4 hours each). Supplied: Tablet: 300 mg Trizivir ® abacavir 300mg + lamivudine 150mg + zidovudine 300mg (>40 kg): 1 tablet orally twice daily. Truvada ® (emtricitabine 200mg + tenofovir 300mg): Dosing (adult): One tablet (emtricitabine 200 mg and tenofovir 300 mg) once daily. Renal Dosing: crcl 30-49 ml/min: 1 tab every 48 hours crcl <30 ml/min: Not recommended. Supplied:Tablet: Emtricitabine 200 mg and tenofovir 300mg. zalcitabine Hivid ® Dosing (adult): 0.75 mg orally three times daily. Lamivudine should not be co-administered with zalcitabine.  Renal dosing: >40/ no change; 10-40/ 0.75 mg twice daily; <10/ 0.75 mg once daily.  Supplied: [0.375mg , 0.75mg tablet] zidovudine Retrovir ® Dosing (adult): 300mg orally twice daily or 200mg orally three times daily or 100mg every 4 hours 5 times daily.  Stavudine and Zidovudine should not be co-administered. Supplied: 100mg capsule; 300mg tablet; 50mg/5ml oral solution. Dosing in renal failure (<10 ml/min): 100mg every 6 to 8 hours. GI intolerance is common and may improve if given with meals or more frequent smaller doses. Also may cause headaches and asthenia. Main side effects are anemia and neutropenia. [TOP]  Non-nucleoside RTI's delavirdine Rescriptor ® Dosing (adult): 400mg orally three times daily. Supplied: 100, 200mg tablets. Warn of rash. efavirenz Sustiva ® Dosing (adult): > 40kg: 600 mg orally at bedtime. Supplied: [50,100,200mg capsule].  Warn of CNS toxicity that is usually self-limited to the first three weeks of treatment. May need to avoid driving or work during this period. nevirapine Viramune ® Dosing (adult): Initially, 200mg orally once a day for 14 days, then 200mg orally twice daily (may reduce risk of rash).  Supplied: [200mg tablet; 50mg/5 ml oral suspension].  Warn of hepatotoxicity with need to monitor liver function tests, especially during the first 12 weeks.  [TOP] Protease inhibitors amprenavir Agenerase ® Protease Inhibitor. Dosing (adult): 1200 mg orally twice daily.  Supplied: [50, 150 mg caps. 15mg/ml oral solution.] ( large pill burden. Must warn of gastrointestinal (GI) intolerance and rash.) atazanavir Reyataz ® Protease Inhibitor. Dosing (adult): Antiretroviral-naive patients: 400 mg once daily with food. Antiretroviral-experienced patients: 300 mg once daily plus ritonavir 100 mg once daily with food. Coadministration with efavirenz: Antiretroviral-naive patients: It is recommended that atazanavir 300 mg plus ritonavir 100 mg be given with efavirenz 600 mg (all as a single daily dose). Administer with food. Antiretroviral-experienced patients: Recommendations have not been established. Coadministration with didanosine buffered formulations: Administer atazanavir 2 hours before or 1 hour after didanosine buffered formulations. Coadministration with tenofovir: The manufacturer recommends that atazanavir 300 mg plus ritonavir 100 mg be given with tenofovir 300 mg (all as a single daily dose). Administer with food. Supplied: Capsule: 100 mg, 150 mg, 200 mg. fosamprenavir Lexiva ® Protease Inhibitor. Dosing (adult): Antiretroviral therapy-naive patients: Unboosted regimen: 1400 mg twice daily (without ritonavir).    Ritonavir-boosted regimens: Once-daily regimen: Fosamprenavir 1400 mg plus ritonavir 200 mg once daily.  Twice-daily regimen: Fosamprenavir 700 mg plus ritonavir 100 mg twice daily. Note: Also used in protease inhibitor-experienced patients. Protease inhibitor-experienced patients: Fosamprenavir 700 mg plus ritonavir 100 mg twice daily. Note: Once-daily administration is not recommended in protease inhibitor-experienced patients.   Combination therapy with efavirenz (ritonavir-boosted regimen): Once-daily regimen: Fosamprenavir 1400 mg daily plus ritonavir 300 mg once daily.  Twice-daily regimen: No dosage adjustment recommended for twice-daily regimen. Supplied: 700 mg tablet. indinavir Crixivan ® Protease Inhibitor. Dosing (adult): 800mg orally every 8 hours without food or 1200mg orally every 12 hours.  (must be taken on an empty stomach).  Supplied: [200, 333, and 400mg capsules]. Kaletra ® (Lopinavir 133 mg + Ritonavir 33.3 mg ): Protease Inhibitor. Dosing (adult): (take with food): Therapy-naive: Lopinavir 800 mg/ritonavir 200 mg once daily or lopinavir 400 mg/ritonavir 100 mg twice daily. Therapy-experienced: Lopinavir 400 mg/ritonavir 100 mg twice daily. Note: Once-daily dosing regimen has not been evaluated with concurrent indinavir or saquinavir and should not be used with concomitant phenytoin, carbamazepine, or phenobarbital therapy. Dosage adjustment when taken with amprenavir, efavirenz. nelfinavir, or nevirapine: Lopinavir 533 mg/ritonavir 133 mg twice daily. Note: Once-daily dosing regimen should not be used when concomitantly taking amprenavir, efavirenz, nelfinavir, or nevirapine therapy. Supplied: Capsule: Lopinavir 133.3 mg and ritonavir 33.3 mg. oral soln: Lopinavir 80 mg and ritonavir 20 mg/ml. nelfinavir Viracept ® 750 mg orally three times a day or 1250mg orally twice daily. Take with high fat meal and warn of diarrhea that usually responds to loperamide or calcium. Supplied: [250mg tablet]. ritonavir Norvir ® Protease Inhibitor. Dosing (adult): (Day 1): 300mg orally twice daily (Days 2-4): 400 mg orally twice daily. (Day 5): 500mg orally twice daily; (Day 6 or longer): 600mg orally twice a day. Take with food. Supplied: [100mg capsule; 80mg/ml -240ml soln] GI intolerance is a major problem and is dose-related. saquinavir Fortovase ® , Invirase ® Protease Inhibitor. Dosing (adult): Fortovase: 1200mg orally three times a day after meals. Invirase: 600mg orally three times a day with meals. Supplied: [200mg capsule] tipranavir Aptivus ® Protease Inhibitor. Dosing (adult): 500 mg twice daily with a high-fat meal. Note: Coadministration with ritonavir (200 mg twice daily) is required. Supplied: 250 mg capsule.  [TOP] Fusion Protein Inhibitor Enfuvirtide Fuzeon ® Fusion protein inhibitor. Dosing (adult): 90 mg SQ twice daily. (Administer subcutaneously into upper arm, abdomen, or anterior thigh.) Supplied: Injection (powder for reconstitution): 108 mg (90 mg/ml following reconstitution). [TOP]  PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. This website, including other software and databases offered by GlobalRPh INC or partners or affiliates are intended to be for INFORMATIONAL PURPOSES ONLY. The information contained herein does not constitute medical or pharmaceutical advice and should not be relied upon as a substitute for qualified medical consultation with health professionals. New discoveries are being made everyday in the medicine and science and the information contained herein might not be current, complete, reliable, or accurate. Each medical situation depends on individual symptoms and diagnosis. Because of these differences, you should not act or rely on any information on our Website or our software products without seeking the advice of a licensed physician or other qualified medical practitioner. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon.  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.");s1[64]=new Array("bowel.htm","Inflammatory bowel disease: pharmacotherapy. Asacol, Dipentum, sulfasalazine.","Inflammatory bowel disease: pharmacotherapy. Asacol, Dipentum, sulfasalazine","Inflammatory bowel disease: balsalazide Colazal ® Indication: treatment of mildly to moderately active ulcerative colitis. Safety and effectiveness of Colazal ® beyond 12 weeks has not been established. Usual dose (adults): three 750 mg capsules taken three times a day for a total daily dose of 6.75 grams for a duration of 8 weeks. Some patients in the clinical trials required treatment for up to 12 weeks. [Supplied: 750mg capsule] budesonide Entocort EC ® Indication: treatment of mild to moderate active Crohn's disease involving the ileum and/or the ascending colon. Budesonide has a high topical glucocorticosteroid (GCS) activity and a substantial first pass elimination. Usual dose ( adults): 9 mg taken once daily in the morning for up to 8 weeks. Safety and efficacy have not been established beyond 8 weeks. For recurring episodes of active Crohn's Disease, a repeat 8 week course of Entocort EC ® can be given. Treatment can be tapered to 6 mg daily for 2 weeks prior to complete cessation. Patients with mild to moderate active Crohn's disease have been switched from oral prednisolone to Entocort EC ® with no reported episodes of adrenal insufficiency. Since prednisolone should not be stopped abruptly, tapering should begin concomitantly with initiating Entocort EC ® treatment. [supplied: 3 mg capsule] infliximab Remicade ® Monoclonal antibody to tumor necrosis factor. TX crohn's disease: 5 mg/kg IV infusion over 2 hrs. In pts with fistulizing disease, an initial 5 mg/kg dose should be followed by additional 5 mg/kg doses at 2 and 6 weeks after the first infusion. mesalamine Asacol ®, Pentasa ®  Indications: remission and treatment of ulcerative colitis. (Usual course of therapy: 3-6 weeks). (Asacol): 800mg orally three times daily for 3 - 6 weeks [supplied: 400mg tab],   (Pentasa): 1000mg orally four times daily for up to 8 weeks. [supplied: 250mg capsule]      Rowasa (rectal suspension 4 g/60 ml): one rectal instillation once a day and retained for approximately 8 hours. (usually given at bedtime).   (rectal suppository 500mg): Insert one suppository rectally bid. Retained for 1-3 hours. olsalazine Dipentum ® Indications: maintenance of remission of ulcerative colitis in patients intolerant to sulfasalazine.  500mg orally twice daily.  [supplied: 250mg capsule]. sulfasalazine Azulfidine ® Indications: management of ulcerative colitis. Dosage (adults) initial: 1 gram 3 to 4 times daily. Maintenance: 2 grams/day in divided doses. May initiate therapy with 0.5 to 1 gram/day with enteric-coated tablets. [ supplied: 500mg tablet, 500mg enteric-coated tablet]  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc. Author: David McAuley Keywords: Inflammatory bowel disease: pharmacotherapy. Asacol, Dipentum, sulfasalazine");s1[65]=new Array("interferons.htm","Interferons: dosing list for health care providers.","Interferons: dosing list for health care providers, pharmacists, nurses, physicians. Multiple sclerosis, Intron, Betaseron, Avonex","Interferons Interferons are a family of proteins, produced by nucleated cells, that have anti-viral, anti-proliferative, and immune-regulating activity. There are 16 known subtypes of alpha interferons. Interferons interact with cells through high affinity cell surface receptors. Multiple effects have been detected: inhibition of cellular growth, alteration in surface antigen expression, increased phagocytic activity of macrophages, augmentation of cytotoxicity of lymphocytes for target cells. Interferon Alfa-2A (Roferon-A): Indications: Patients> 18 years old: hairy cell leukemia, Kaposi's Sarcoma, chronic hepatitis C, adjuvant treatment to surgery for malignant Melanoma; multiple unlabeled uses. Dosing: hairy cell leukemia: Induction: 3 mu/day IM/SC x 16-24 weeks. Maintenance: 3 million units 3 times/week. Kaposi's sarcoma: induction: 36 million units/day x 10-12 weeks. Maint: 36 million units 3x/week. [Supplied: 3 mu (1 ml); 6 mu/ml (3ml); 9 mu/ml (0.9ml, 3 ml); 36 mu/ml (1 ml)] note: mu=million units. Interferon Alfa-2b (Intron-A): Indications: Hairy cell leukemia (>18 years old), condylomata acuminata, AID's releate kaposi's sarcoma, chronic (non-A, non-B) hepatitis C, and hepatitis B. Dosing: Leukemia: 2 mu/M2 IM/SC 3x/week fro 2-6 months. Kaposi sarcoma: 30 mu/M2 IM/SC 3x/week. Condylomata: 1 mu/lesion 3 x/week x 4-8 weeks. Chronic hepatitis C: 3 mu IM/SC 3x/week x 6 months. Chronic hepatitis B: 5 mu/day or 10mu 3x/week for 16 weeks. [Supplied: 3 mu (0.5ml); 5 mu (0.5ml); 10mu (1 ml); 25 mu. Powder for inj: 18mu and 50 mu). Refrigerate. Note: mu= million units. Interferon Alfa-2b and Ribavirin combo Pack (Rebetron): Indications: chronic Hepatitis C in patients with compensated liver disease who have relapsed after alpha interferon treatment. Dosage: Intron A: 3 mu SC 3 times per week and Ribavirin 500-600mg twice daily x 24 weeks. Patients <75kg: 400mg every morning and 600mg orally every evening. Patients > 75kg: 600mg every morning and evening. Interferon Alfa-N3 (Alferon N): Indications: interlesional treatment of condylomata acuminata (recurring or refractory cases ): 250,000 units (0.05 ml) in each wart twice weekly to a maximum of 8 weeks. [5 million units (1 ml)]  Interferon Beta-1A (Avonex): Indications: Treatment of relapsing forms of multiple sclerosis. MOA: interferon beta differs from naturally occurring human protein by 1 amino acid. Mechanism of action in multiple sclerosis is unknown. Dosage: 30 mcg IM once weekly. (reconstitute with 1.1 ml of diluent; refrigerate). Interferon Beta-1B (Betaseron): Reduces the frequency of clinical exacerbations in ambulatory patients with relapsing-remitting multiple sclerosis. Dosing: 0.25 mg (8 million units) SC every other day. Supplied: 0.3 mg (9.6 million units).  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc. Author: David McAuley Keywords: interferons,pharmacists, nursing, physicians,health care providers, multiple sclerosis, roferon, Intron, Rebetron,Avonex, Betaseron, Alferon.");s1[66]=new Array("intermittent_claudication.htm","Intermittent Claudication - Pletal, Trental","","Intermittent Claudication cilostazol Pletal ® Antiplatelet agent. Phosphodiesterase III inhibitor => increased cyclic AMP => inhibition of platelet aggregation and vasodilation. Other effects of phosphodiesterase III inhibition include increased cardiac contractility, accelerated AV nodal conduction, increased ventricular automaticity, heart rate, and coronary blood flow. Dosing (Adults): Peripheral vascular disease: 100 mg orally twice daily taken at least 30 minutes before or 2 hours after breakfast and dinner. Dosage should be reduced to 50 mg twice daily during concurrent therapy with inhibitors of CYP3A4 or CYP2C19. Supplied: 50 mg, 100 mg tablet. pentoxifylline Trental ® MOA: Reduces blood viscosity via increased leukocyte and erythrocyte deformability and decreased neutrophil adhesion/activation. Improves peripheral tissue oxygenation presumably through enhanced blood flow. Dosing (Adults): Peripheral vascular disease: 400 mg orally 3 times/day with meals. Maximal therapeutic benefit may take 2-4 weeks to develop. Recommended to maintain therapy for at least 8 weeks. May reduce to 400 mg twice daily if GI or CNS side effects occur. Supplied: 400 mg extended release tablet.  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.");s1[67]=new Array("immunizations.htm","Adult Immunizations","","Immunizations BCG Vaccine BCG (BACILLUS CALMETTE-GUERIN) VACCINE is an immunization agent for tuberculosis. The intradermal and percutaneous administration of BCG vaccine is for tuberculosis vaccination. Intradermal (BCG sec Berna(R) ): A single dose of 0.1 mL is given over the deltoid area. The dose for adults, children, and infants is the same. Percutaneous (TICE(R) ): 0.2 mL to 0.3 mL is placed on the skin and administered by a multiple puncture device; infants less than one month old should be given one-half the adult percutaneous dose. Comvax [Hepatitis B Vaccine (5 mcg/0.5 ml) + haemophilus B vaccine (7.5 mcg/0.5 ml) ] Dosing: 0.5 ml IM diphtheria-tetanus toxoid (Td, DT) Dosing: 0.5 ml IM haemophilus B vaccine Dosing: 0.5 ml IM Hepatitis A vaccine (Havrix, Vaqta) Dosing (Adult): 1 ml IM, then repeat in 6 to 12 months Hepatitis B vaccine (Engerix-B, Recombivax HB) Adults: 1 ml (10 micrograms), with 2 subsequent 1 ml (10 micrograms) doses being given 1 month and 6 months after the initial dose. Administer in the deltoid region. Do not administer in the gluteal region (may give suboptimal response). Influenza vaccine The usual dose of whole or split virus influenza vaccine for persons older than 12 years is one 0.5 ml IM.  Administered starting in September through November. Lyme disease vaccine (LYMErix) Dosing: 30 mcg intramuscularly (IM) x 1, then repeat in 1 and 12 months after initial dose.  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.");s1[68]=new Array("laxatives.htm","Laxatives - list of available laxitives","","Laxatives Bisacodyl Dulcolax ® 10-15 mg orally as needed, or 10 mg rectally as needed. Cascara 325 mg orally at bedtime as needed or 5 ml (one teaspoonful) of extract orally at bedtime as needed. Docusate Colace ® 50-400mg orally divided 1-4 doses. Fleet Phospho-Soda Each 5 mL of Fleet-Phospho-soda® contains 2.4 g monobasic sodium phosphate monohydrate and 0.9 g dibasic sodium phosphate heptahydrate in a stable, buffered aqueous solution. Since Fleet® Phospho-soda is available in 2 sizes, prescribe by volume. Do not exceed the recommended dosage due to the potential of serious side effects.  Adults and children 12 years and older (Laxative): 20 to 45 mL. Dilute recommended dose with at least one-half glass (4 fl. oz.) of cold water or other clear liquid. Drink, then follow with at least one additional glass (8 fl. oz.) of water or other clear liquid. Glycerin Glycerin is a hyperosmotic laxative, which is given rectally, and it usually produces a bowel movement within 15 minutes to 1 hour. The laxative effect of glycerin is due to the local irritant effect of sodium stearate and glycerin's osmotic effect. Dosage: Adults and Children 6 years of age and older: One suppository. Lactulose constipation: 15-30 ml orally at bedtime. Hepatic encephalopathy: 35-45 ml orally three to four times daily or 300 ml retention enema.   Acute Hepatic encephalopathy or portosystemic encephalopathy (PSE): Adults: Oral: 20-30 g (30-45 ml) every 1-2 hours to induce rapid laxation. Adjust dosage daily to produce 2-3 soft stools. Doses of 30-45 ml may be given hourly to cause rapid laxation, then reduce to recommended dose. Usual daily dose: 60-100 g (90-150 mL) daily. Rectal administration: 200 g (300 ml) diluted with 700 ml of H20 or NS - administer rectally via rectal balloon catheter and retain 30-60 minutes every 4-6 hours Magnesium citrate 150-300 ml orally divided once or twice daily. Magnesium hydroxide MOM laxative: 30-60 ml orally x 1. Methylcellulose Citrucel ® Citrucel Orange Flavor Powder - Actions: Promotes elimination by providing additional fiber (bulk) to the diet. This product generally produces bowel movement in 12 to 72 hours. Indications: For relief of constipation (irregularity). May also be used for relief of constipation associated with other bowel disorders such as IBS, diverticular disease, and hemorrhoids as well as for bowel management during postpartum, postsurgical, and convalescent periods when recommended by a physician. Adult Dose: dissolve one leveled scoop (one heaping tablespoon - 19g) in 8 ounces of cold water up to three times daily at the first sign of constipation. Children age 6 to 12 years of age: one-half the adult dose stirred briskly in 8 ounces of cold water, once daily at the first sign of constipation. The mixture should be administered promptly and drinking another glass of water is highly recommended Mineral Oil Adult (usual) - Constipation: 15-45 ml orally once daily at bedtime (max of 45 ml).  Do not take within 2 hr of meals. Should not be used longer than 1 week, except under orders of a physician. Patient should not be reclining after oral administration to avoid aspiration of oil droplets. Bowel clearance: 118 ml rectally once daily as an enema.   Protect clothing - may have oil leakage from rectum.  Pericolace ® (docusate/ casanthranol): 1-2 capsules or (15-30ml) orally at bedtime as needed. Psyllium (Metamucil): 1 teaspoonful or 1 packet orally one to three times daily. Senna Senokot ® Adults and children > 12 years of age: 2 tablets qd. Senokot granules may be eaten plain, mixed with liquids such as milk to make a delicious drink, or sprinkled on foods. Take preferably at bedtime. [Supplied: Senokot tablets: Each tablet contains 8.6 mg sennosides. Senokot Granules: Each teaspoonful contains 15 mg sennosides. Senokot-S Tablets: Each tablet contains 8.6 mg sennosides and 50 mg of docusate sodium] Sorbitol 30-150 ml orally x 1.  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.");s1[69]=new Array("lmwh.htm","(Low Molecular Weight Heparins) LMWH's","","(Low Molecular Weight Heparins) LMWH's Thrombocytopenia incidence: LMWH's: 0.6%   Unfractionated heparin: 3.5%                     Protein binding: LMWH's: Low     Unfractionated heparin: high dalteparin (Fragmin ®): DVT prophylaxis, abdominal surgery: 2,500 units 1-2 hours preop and once daily postop x 5-10 days (High risk patients (e.g. malignancy): 5000 units SC 1-2 hrs prior to surgery and then qd x 5-10 days.) Prophylaxis (hip replacement): 2500 units 4-8 hrs postop, then 5000 units qd x 5-10 days (up to 14 days). Start at least 6hr after postop dose. Alternatively: 5000 units 10-14hrs preop and 4-8hrs postop. Maint: 5000 units qd up to 14 days. Unstable angina, non-Q-wave MI: 120 units/kg up to 10,000 units SC every 12 hours with aspirin (75-165mg) until stable. DVT treatment (not FDA approved): Dosing: 200 IU/kg SC qd (Max: 18,000 units/day) danaparoid (Orgaran ®): Removed from the market enoxaparin (Lovenox ®): DVT prophylaxis (hip / knee surgery): 30 mg SC every 12 hours starting 12-24 hours postop. Alternative for hip: 40 mg SC once daily starting 12 hours preop.   DVT treatment (Outpatient): 1 mg/kg SC every 12 hours until oral anticoagulation established.  DVT treatment (Inpatient): 1 mg/kg SC every 12 hours or 1.5 mg/kg SC once daily.   Unstable angina or non-Q-wave MI: 1 mg/kg SC every 12 hours Prophylaxis in acute medically ill patients (high risk): 40 mg SC qd x 6-11 days (up to 14 days). fondaparinux (Arixtra ®): DVT prophylaxis: 2.5 mg SC qd (After hemostasis has been established, the initial dose should be given 6 to 8 hours after surgery. ) Administration before 6 hours after surgery has been associated with an increased risk of major bleeding. The usual duration of administration is 5 to 9 days; and up to 11 days administration has been tolerated. tinzaparin (Innohep ®): Prevention of deep vein thrombosis, general surgery: 3500 units anti-Xa SC qd x 5-10 days. Prevention of deep vein thrombosis, orthopedic surgery: 50 units anti-Xa/kg SC qd.  Treatment of deep vein thrombosis / PE: 175 units anti-Xa/kg SC qd for at least 6 days and until the patient is adequately anticoagulated with warfarin (INR of 2 for at least 2 days)  Fragmin® versus Lovenox® DVT /PE Prophylaxis Indication Dalteparin (Fragmin) Enoxaparin (Lovenox) Knee replacement surgery prophylaxis Not FDA-approved 30mg q12h x 7-10 days Hip replacement surgery prophylaxis 5000 IU qd x 5-10 days 30mg q12h or 40mg qd x 7-10 days General surgery prophylaxis Moderate risk: 2500 IU qd x 5-10 days // high-risk patients: 5000 IU qd x 5-10 days Moderate risk: 30 mg SC qd. high-risk patients: 40mg qd x 7-10 days or 30mg SC q12h. Orthopedic surgery 2500 units 6-8 hours postop (omit if patient received spinal anesthesia), then 5000 units SC qd. 30mg q12h or 40mg qd x 7-10 days Abdominal Surgery 5,000 IU SC the evening prior to surgery and then once daily for 5 to 10 days 40 mg SC qd (initial dose given 2 hours prior to surgery.) Usual duration of administration: 7 to 10 days Acute trauma or spinal injury 2500 IU bid 30 mg SC qd Prophylaxis in acute medically ill patients (high risk) 5000 IU SC qd. 40mg SC qd x 6-11 days DVT / PE Treatment Treatment of DVT (with or without PE) Not FDA-approved. // Dosing: 200 IU/kg SC qd. Alternatively (patients with hypercoagulable states or with increased risk of bleeding): 100 IU/kg SC bid. (maximum of 18,000 IU qd or 9000 IU bid.) 1 mg/kg q12h or 1.5 mg/kg qd. Acute coronary syndrome treatment ACS (unstable angina / non-ST segment elevation MI) 120 IU/kg q12h x 5-8 days (maximum of 10,000 IU q12h) 1 mg/kg SC q12 x 2 to 8 days  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.");s1[70]=new Array("macrolides.htm","Macrolides","","Macrolides Azithromycin Zithromax ® Usual oral dose: 500mg x 1, then 250mg po qd x 4 days. Chlamydia: 1 gram po x 1. MAC prevention: 1200mg once a week. Uncomplicated gonococcal infection: 2 grams po x 1. CAP: 500mg IV qd x 2 days or more then 500mg po qd. PID: 500mg IV x 1-2days, then 250mg (IV/PO) for total of 7 days. Mild to moderate respiratory tract, skin, and soft tissue infections: 500 mg orally in a single loading dose on day 1 followed by 250 mg/day as a single dose on days 2-5.   Alternative regimen: Bacterial exacerbation of COPD: 500 mg/day for a total of 3 days Bacterial sinusitis: 500 mg orally once daily x 3 days. Extended release suspension (Zmax): 2 grams x 1. Community-acquired pneumonia: 500 mg IV qd at least 2 days, then 500 mg orally ( to complete a 7 to 10 day course of therapy). Urethritis/cervicitis: Due to C. trachomatis: 1 gram orally x 1.  Due to N. gonorrhoeae: 2 grams orally x 1. Chancroid due to H. ducreyi: 1 gram orally x 1. Pelvic inflammatory disease (PID): 500 mg IV qd x 1-2 days, then 250 mg orally once daily to complete a 7 day course of therapy. Disseminated MAC disease in patient with advanced HIV infection: Prophylaxis: 1200 mg orally once weekly (may be combined with rifabutin). Treatment: 600 mg orally once daily in combination with ethambutol 15 mg/kg. Renal dosing: No adjustments required in renal failure. Hemodialysis: No adjustments required in renal failure. Supplied:  Tablet: 250 mg, 500 mg, 600 mg.  Zithromax® TRI-PAK - 500 mg (Unit dose package: 3 tabs)   Zithromax® Z-PAK - 250 mg (Unit dose package: 6 tabs) Oral Suspension: 100 mg/5 ml (15 ml); 200 mg/5 ml (15 ml, 22.5 ml, 30 ml) ; 1 gram - single dose packet. Zmax: 2 gram single-dose bottle (extended release formulation). Injection (powder for reconstitution): 500mg vial. Clarithromycin Biaxin ® Dosing: 250-500mg q12h. Extended release: 1 gm q24h. Renal Dosing: [CRCL >30 ]: No changes.   [<30 ]: 500mg x 1, then 250 mg q12-24h.  Hemodialysis:  250 mg q12-24 hours. Schedule dose after HD on dialysis days. Erythromycin Dosing: (Oral): 500mg to 1g po q12h or 250mg to 1gm q6h. (IV ): 250mg to 1 gm q6h. Max 4 grams/day. Renal Dosing: [>10 ml/min]: No change.  [<10 ] 50-75% of usual dose at same interval. Max 2 grams/day.  [Hemo]: 50-75% of usual dose at same interval. Max 2 grams/day. No supplement.  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.");s1[71]=new Array("migraine.htm","Migraine treatment: dosing list","Migraine treatment: dosing list for health care providers, pharmacists, nurses, physicians. Amerge, Maxalt, Imitrex, Zomig, Midrin","Migraine Triptans almotriptan Axert ® Indications: acute treatment of migraine with or without aura in adults. Dosage: Adult (usual): Migraine: 6.25-12.5 mg po, may repeat after 2 hours. Maximum dose: 25 mg/day. [Supplied: 6.25 mg, 12.5 mg tab.] eletriptan Relpax ® Serotonin-1D (5-HT1D) receptor agonist. Dosage (initial): 20 to 40 mg. May repeat after 2 hours if headache returns. Maximum single dose 40 mg. Maximum of 80 mg per 24 hours. Oral eletriptan is effective in the treatment of acute migraine attacks, and may be faster-acting than oral sumatriptan. It will compete with oral rizatriptan and oral zolmitriptan (which also have a relatively rapid onset) as a substitute for oral sumatriptan in moderate-to-severe migraine headache. frovatriptan Frova ® Serotonin receptor agonist, 5-ht1. Adult (usual): Migraine headache: 2.5 mg orally. May repeat after 2 hr. Maximum 7.5 mg/24 hr. [Supplied: 2.5 mg tablet ] naratriptan Amerge ® Dosage: Initially take 1 to 2.5 mg orally. May repeat in 4 hours for maximum daily dose of 5 mg. rizatriptan Maxalt ® Dosage: Initially 5-10 mg orally, may repeat in 2 hours. Maximum dose of 30 mg/ day. sumatriptan Imitrex ® Dosage: Initially 6 mg subcutaneously, may repeat in 1 hour. Maximum of 12 mg/day. Oral dosing: 25 mg orally x 1, if no response, may give 25-100mg every 2 hours to a maximum of 200-300mg/ day. zolmitriptan Zomig ® Initially 1.25 to 2.5 mg orally every 2 hours. Maximum of 10 mg/day. Other Cafergot ® (ergotamine/caffeine) Dosage: Initially 2 tablets orally at onset. If no relief take 1 tablet every 30 minutes-- up to a maximum of 6 tablets per attack. ** Maximum of 10 tablets per week dihydroergotamine DHE 45 ® Dosage: Initially I mg IV/IM/SC, repeat in 1 hr as needed. Maximum 2 mg (IV) or 3 mg (IM/SC) per day. Midrin ® (isometheptine/ dichlorphenazone/apap): Dosage: Initially 2 tabs orally x 1 then 1 tablet every hour until relief. Maximum of 5 tablets in a 12 hour period.  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc. Author: David McAuley Keywords: Migraine,pharmacists, nursing, physicians,health care providers, Amerge, Maxalt, Imitrex, Zomig, Cafergot, naratriptan, Midrin, dihydroergotamine, rizatriptan");s1[72]=new Array("mouthlip.htm","Mouth/lip treatments: dosing list for health care providers, pharmacists, nurses, physicians. ","Mouth/lip treatments: dosing list for health care providers, pharmacists, nurses, physicians. ","Mouth/Lip Preparations Topical Agents  - Canker Sores/ Ulcers - Candidiasis - Cold Sores - Mucositis - Xerostomia Canker sores / ulcers                           [Top] amlexanox Aphthasol ® Aphthous ulcers: apply 1/4" paste four times daily.  Supplied: [paste 5%] Benzocaine Orabase-B ®, Hurricaine ® etc. Apply as directed (3-4 times daily as needed). Limit therapy to 2 days.  Supplied: [ Aerosol (oral spray): Hurricaine® 20%; Gel (oral): Anbesol® 6.3%, Orajel® 7.5%, Anbesol/Orajel Maximum strength-20%, Orabase-B 20%. Zilactin-B 10%;  Oral Liquid: Anbesol (6.3%), Orasol, Hurricaine (20%). Dental protective paste - Apply 3-4 times daily as needed. ] carbamide peroxide Gly-Oxide ® Canker sores: apply several drops up to four times/day (after meals and at bedtime). Kenalog in Orabase ® (triamcinolone 0.1% ) Indications: Treatment of steroid responsive disorders of the oral mucosa, including inflammatory and ulcerative lesions. Dosage: Coat the lesion with a thin film, preferably at bedtime. Do not rub in. It may be necessary to apply the preparation 2 or 3 times a day, preferably after meals. Prolonged and intensive treatment may cause atrophic changes in the skin, such loss of elasticity, thinning, dilation of superficial blood vessels, telangiectasis, ecchymosis and purpura particularly when occlusive dressings are used. Note: Should be used for short courses only. Phenol Chloroseptic ® spray Apply as needed for sore throat/mouth irritation (q2-4h as needed) chlorhexidine gluconate Peridex ® Gingivitis: 15 ml oral rinse 0.12% - swish for 30 seconds then expectorate - repeat twice daily.  Skin disinfection: 4% solution applied for 2 minutes, dry and repeat for 2 minutes.   Administration: Do not swallow oral rinse. Keep out of eyes/ears. Oral rinse should be used after toothbrushing - do not rinse with water, mouthwash, or eat immediately after using. Candidiasis                       [Top] clotrimazole Mycelex ® Candidiasis - oropharyngeal: dissolve 1 troche in mouth 5 times/day for 2 weeks. Candidiasis- oropharyngeal, prophylaxis: dissolve 1 troche in mouth 3 times/day during chemotherapy or until corticosteroids are reduced to maintenance levels. [Supplied: 10 mg troche] Nystatin Mycostatin ® Thrush: 5 ml (one teaspoonful) swish & swallow four times daily. Cold Sores                          [Top] Penciclovir Denavir ® herpes labialis (cold sores): apply cream every 2 hours while awake x 4 days. docosanol Abreva ® Adult (usual) Herpes labialis: apply topically to lesions 5 times a day until lesions have healed. Begin treatment at the first symptom or signs of an episode. [Supplied: 10% cream - 2 grams.] Mucositis                     [Top] Gelclair ®: (maltodextrin + propylene glycol) Bioadherent oral gel that provides rapid and durable oral pain relief. Oral mucositis - Directions for use: Pour the entire contents of the single-dose packet into a glass and add 40 ml or 3 tablespoonfuls of water. Stir mixture well and use at once. Rinse around the mouth for at least one minute or as long as possible to coat tongue, palate, throat, inside of cheeks and all oral tissue thoroughly. Gargle and spit out. If swallowed accidentally, no adverse effects are anticipated. Use at least 3 times a day or as needed. Do not eat or drink for at least one hour following treatment. In the unlikely event that water is not available, the product may be used undiluted. If the desired pain relief is not achieved when diluted, you may try diluting with less water or undiluted.  [Supplied: Gelclair Dose Pack: 21 single-dose, 15 ml packets.] lidocaine viscous Xylocaine ® 2% topical solution Indications: production of topical anesthesia of irritated or inflamed mucous membranes of the mouth and pharynx. It is also useful in reducing the gag reflex when taking oral x-rays or dental impressions. Dosage: the maximum recommended single dose for healthy patients should be such that the dose does not exceed 4.5 mg/kg of body weight and does not in any case exceed a total of 300mg. Symtomatic treatment of irritated or inflammed mucous membranes of the mouth and pharynx: Usual adult dose: 15 ml undiluted.  Mouth: swish around then spit out. Pharynx: gargle then may swallow. Do not give at smaller intervals than every 3 hours. Max 8 doses/day. Supplied: 2% topical solution (20 mg/ml) BMX Cocktail (Benadryl + Lidocaine viscous + Maalox) BMX cocktail (Benadryl : Maalox : Lidocaine) (1:1:1) // Lidocaine: 6.7 mg/ml ; Benadryl: 0.83 mg/ml. SHAKE WELL BEFORE USING. Note: the most significant drug-induced adverse reactions are attributable to lidocaine. The lowest dosage that results in effective anesthesia should be used to avoid high plasma concentrations. Indications: Topical anesthesia of irritated or inflamed mucous membranes. Commonly used for radiation mucositis or chemotherapy-induced stomatitis. The mixture may be swallowed, however, if the inflammation is limited to the oral cavity the mixture should be swished around the mouth then expectorated. Dosing: (Guidelines based on maximum single dose of lidocaine 4.5 mg/kg- not to exceed 300 mg/dose. Max of 8 doses/day). Patient weight (45kg): 5 to 30 ml q3-6h prn (max 8 doses/day). Patient weight (50 to 55kg): 5 to 35 ml q3-6h as needed (max 8 doses/day). Patient weight (60kg): 5 to 40 ml q3-6h as needed (max 8 doses/day). Patient weight (65kg and above): 5 to 45 ml q3-6h as needed (max 8 doses/day). Xerostomia (Dry Mouth)          [Top] Pilocarpine Salagen ® Cholinergic agonist.  Xerostomia:  following head and neck cancer: 5 mg orally 3 times per day. Titration up to 10 mg 3 times/day may be considered for patients who have not responded adequately. Do not exceed 2 tablets per dose Sjogren's syndrome: 5 mg 4 times/day Supplied: 5 mg tablet. Artificial saliva Moi-Stir ® Salivart ® Saliva Substitute Xerostomia: Use orally as needed.  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc. Author: David McAuley Keywords: Mouth, lips,pharmacists, nursing, physicians,health care providers, canker sores, gly-oxide, penciclovir, nystatin, amlexanox");s1[73]=new Array("relaxants.htm","Muscle relaxants: dosing list for health care providers, pharmacists, nurses, physicians. ","Muscle relaxants: dosing list for health care providers, pharmacists, nurses, physicians. ","Muscle Relaxants baclofen  Lioresal ® Start: 5 mg orally three times daily, increase every 3 days to 20 mg orally three times daily. Max dose: 20 mg orally four times daily. carisprodol  Soma ® 350 mg orally 3 to 4 times daily cyclobenzaprine Flexeril ® Start: 10 mg orally three times daily. Max: 60 mg/day dantrolene Dantrium ® Spasticity: Start: 25 mg/day orally, then increase. Max: 400mg/day in 2 to 4 divided doses. Diazepam  Valium ® 2-10 mg orally 3 to 4 times daily. Sustained release: 15-30 mg orally once daily. Metaxalone Skelaxin ® 800 mg orally 3 to 4 times daily Methocarbamol Robaxin ® Acute relief: 1,500 mg orally four times a day or 1000mg IM/IV three times a day x 48-72 hours. Maintenance: 1000mg orally four times daily, or 750 mg every 4 hours or 1500mg orally three times a day. Orphenadrine Norflex ® 100 mg orally twice daily. Tizanidine Zanaflex ® Spasticity: 4-8 mg orally every 6 to 8 hours as needed. Maximum: 36 mg/day.  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.    Author: David McAuley Keywords: Muscle relaxants,pharmacists, nursing, physicians,health care providers, baclofen, soma, carisprodol, flexeril, dantrium, valium, skelaxin, metaxolone, orphenadrine, Zanaflex, tizanidine, Robaxin");s1[74]=new Array("nasal.htm","Nasal treatments: dosing list for health care providers, pharmacists, nurses, physicians. ","Nasal treatments: dosing list for health care providers, pharmacists, nurses, physicians. ","Nasal Preparations azelastine Astelin ® Allergic rhinitis: use 2 sprays in each nostril twice daily. beclomethasone Vancenase ® Beconase ® Dosing: one spray 2 to 4 times daily. budesonide Rhinocort ® Allergic Rhinitis - Dosing: Two sprays twice daily or 4 sprays once daily.  (Rhinocort Aqua Nasal Spray®): - Recommended starting dose (adults): 1 spray in each nostril once daily. Maximum recommended dose for adults (12 years of age and older): 256 mcg per day administered as four sprays per nostril once daily [Supplied: Nasal Spray- 32 mcg/spray] cromolyn NasalCrom ® Allergic rhinitis: 1 spray/nostril 3-6 times/day flunisolide Nasalide ® Start: 2 sprays twice daily. Maximum: 8 sprays/day. fluticasone Flonase ® 2 sprays each nostril once daily. Ipratropium bromide Atrovent Nasal ® 2 sprays 2 to 4 times per day. [rhinitis: 0.03%, colds:0.06%] Common cold rhinorrhea: Recommended dose (Nasal Spray 0.06%): 2 sprays (84 mcg) per nostril 3-4 times daily in adults and children age 12 years and older.   Seasonal Allergic Rhinitis: 2 sprays (84 mcg) per nostril 2 to 4 times daily in adults and children age 5 years and older. The safety and effectiveness of the use of Atrovent Nasal ® Spray 0.06% beyond 4 days in patients with the common cold or beyond 3 weeks in patients with seasonal allergic rhinitis has not been established.  MOA: Anticholinergic agent - inhibits secretions from the serous and seromucous glands lining the nasal mucosa. [supplied: 0.03% and 0.06% Nasal Spray] mometasone Nasonex ® Allergic Rhinitis: Dosing: 2 sprays in each nostril once daily. oxymetazoline Afrin ® Nasal decongestant. Dosing: Use 2-3 sprays in each nostril twice daily. Maximum use: 72 hours. phenylephrine Neo-Synephrine ® Nasal decongestant. Use 2-3 sprays per nostril every 4 hours as needed. Supplied: [0.125, 0.25, 0.5, & 1 %] Saline nasal spray Ocean ®, SeaMist ® Dry nasal passages. Use 1-3 sprays in each nostril as needed. triamcinolone Nasacort ® Use 2 sprays in each nostril once or twice daily. Maximum: 8 sprays/day. Nasacort AQ ® Use 2 sprays in each nostril once daily.  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc. Author: David McAuley Keywords: Nasal preparations,pharmacists, nursing, physicians,health care providers, Astelin, Vancenase, Beconase, Rhinocort, Nasalide, Flonase, Atrovent, Nasonex, Afrin, Phenylephrine, Ocean spray, Nasacort, Ipratropium");s1[75]=new Array("neuromuscular.htm","Neuromuscular blocking agents: Dosing table. Nimbex, cisatracurium, pancuronium, mivacurium, vecuronium","Neuromuscular blocking agents: Dosing table. Nimbex, cisatracurium, pancuronium, mivacurium, vecuronium. Dosing list for health care providers, pharmacists, nurses, physicians. ","Neuromuscular blockers: Overview: Neuromuscular blocking agents are used in the ICU setting for 3 reasons: (1) to eliminate spontaneous breathing and promote mechanical ventilation (eg eliminate urge to fight the vent. (2) Cause a pharmacologic restraint so patients do not harm themselves. (3) To decrease oxygen consumption. Atracurium Tracrium ® May be given undiluted by IV bolus. Dosing (adult): initially 0.4 to 0.5 mg/kg IV bolus, followed by 0.08 to 0.1 mg/kg every 20 to 45 minutes after initial dose. Continuous infusion: initially 0.4 to 0.5 mg IV bolus, followed by 9 to 10 mcg/kg/min. Maintenance infusion rates of 5 to 9 mcg/kg/min are usually adequate. (Range: 2 to 15 mcg/kg/min). Toxic metabolite (laudanosine) may accumulate in renal failure. [Supplied: 50 mg/5 ml ; 100 mg/10ml vial] Cisatracurium Nimbex ® Dosing: Intermittent: initial dose: 0.15 to 0.2 mg/kg IV bolus followed by 0.03 mg/kg IV every 40 to 60 minutes. Continuous infusion: 0.15 to 0.2 mg/kg IV bolus followed by 1 to 3 mcg/kg/min. The average infusion rate for long term use in the ICU is @ 3 mcg/kg/min (range: 0.5 to 10.2 mcg/kg/min). In some cases, re-administration of the bolus dose may be req'd while titrating. Dosage reductions are not required in renal or hepatic failure. Drug of choice in the following cases: (1) hemodynamically significant increases in HR (eg >20%) while paralyzed with pancuronium or MAP>110. (2) Concurrent corticosteroid administration (>72hrs)  (3) Significant renal dysfunction (CRCL < 30 ml/min) (4)History of asthma or bronchospasm. doxacurium Nuromax ® Adult (usual) Anesthesia adjunct: initial, 0.05 mg/kg and 0.08 mg/kg IV to provide neuromuscular block for an average 100 min and 160 min, respectively. Maintenance, 0.005 mg/kg and 0.01 mg/kg IV to provide neuromuscular blockage for an average of 30 min and 45 min, respectively. Endotracheal intubation: 0.05 mg/kg IV. Endotracheal intubation: (with succinylcholine) initial, 0.025 mg/kg IV.  [ Supplied: 1 mg/ml Solution] mivacurium Mivacron ® Short-acting nondepolarizing neuromuscular blocking agent. Endotracheal intubation: 0.15 mg/kg IV bolus. For extended neuromuscular block, IV average infusion rates of 6 to 7 mcg/kg/min are used.   Recovery from muscular paralysis occurs within 15 to 30 minutes. pancuronium Pavulon ® Non-depolarizing skeletal muscle blocker--competes with acetylcholine at the neuromuscular junction. Intermittent dosing: 0.1 to 0.2 mg/kg (usually 0.1) every 1 to 3 hours  (range: 0.04 to 0.2 mg/kg).     Continuous infusion:  Loading dose: 0.04 to 0.10 mg/kg , followed by 1 to 1.7 mcg/kg/min or 0.06 to 0.1 mg/kg/hr Rocuronium Zemuron ® Adult (usual): Intubation(rapid sequence intubation): initial, 0.6-1.2 mg/kg IV. tracheal intubation: initial, 0.6 mg/kg IV. Maintenance, 0.1-0.2 mg/kg IV repeated as needed. Maintenance (continuous IV infusion): 0.01-0.012 mg/kg/minute. Skeletal muscle relaxation: initial, 0.6 mg/kg IV. Maintenance: 0.1-0.2 mg/kg IV repeated as needed. Alternatively: maintenance (continuous IV infusion): 0.01-0.012 mg/kg/minute Succinylcholine Depolarizing skeletal muscle blocker.  Indications: procedures of short duration such as endotracheal intubation. Dosing: Adults: 0.6 mg/kg (0.3 to 1.1) over 10-30 seconds, up to 150mg total dose.   Maintenance: 0.04 to 0.07 mg/kg every 5-10 minutes as needed.     Continuous infusion: 2.5 mg/min (0.5 to 10 mg/min). Dilute to 1-2 mg/ml. vecuronium Norcuron ® Intermittent dosing:  initially 0.08 to 0.1 mg/kg IBW IV bolus. (Higher initial doses-up to 0.3 mg/kg-may be used for rapid onset. Maintenance: 0.01 to 0.015 mg/kg every 25 to 45 minutes as needed.    Continuous infusion: initial IV bolus (0.08 to 0.3 mg/kg), followed by (after 20-40min), 1 mcg/kg/min infusion (usual range: 0.8 to 1.2 mcg/kg/min). Dosage reductions are not req'd in renal failure.  Neuromuscular Blocking Agents Agent Onset  of action Duration  of action ED90-95* (mg/kg) Short Acting Mivacurium (Mivacron) 2.5 min 15 - 20 min 0.07 Rapacuronium (Raplon) Mean: 90 seconds (35 - 219 sec) Mean: 15 min (6 - 30 min) 1.03 Rocuronium (Zemeron) 1 - 3 min 31 min (15 - 85 min) 0.3 Succinylcholine 30 - 60 seconds 5 - 8 min 0.3 Intermediate acting Atracurium (Tracrium) 2.5 - 5 min 20 - 45 min 0.2 Cisatracurium (Nimbex) 2 - 3 min 30 - 40 min 0.05 Pancuronium (Pavulon) 2 - 3 min 60 - 90 min 0.06 Vecuronium (Norcuron) 2 - 3 min 25 - 40 min 0.05 Long Acting Doxacurium (Nuromax) 6 min (2.5 - 13) 100 min (39 - 232) 0.025 Pipecuronium (Arduan) 2.5 - 5 min 75 min (35 - 175) 0.07 Tubocurarine 3 - 5 min 70 - 90 min 0.05 ED90-95 = Dose required to produce 90-95% suppression of muscle response Listed dosages are for Adult patients ONLY  David F. McAuley, Pharm D., R.Ph. GlobalRPh Inc.  [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc. Author: David McAuley Keywords: Neuromuscular blocking agents: Dosing table. Nimbex, cisatracurium, pancuronium, mivacurium, vecuronium");s1[76]=new Array("neutropenia.htm","Medications which may reduce the neutrophil count (neutropenia).","Medications which may reduce the neutrophil count (neutropenia).","Medications which may cause neutropenia acetazolamide alloprinol asparaginase captopril carbamazepine cephalosporins chloramphenicol chlordiazepoxide chlorpropamide chlorthalidone cimetidine cyclophosphamide ethacrynic acid fluorouracil furosemide gold salts ibuprofen imipramine indomethasone meprobamate methimazole methotrexate metronidazole nitrofurantoin penicillamine penicillins phenothiazines phenylbutazone phenytoin procainamide procarbazine propylthiouracil quinidine quinine rifampin spironolactone sulfonamides sulindac thioridazine tolbutamide Vancomycin   Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc. Author: David McAuley Keywords: neutropenia,drug induced neutropenia, hematological side effects");s1[77]=new Array("nitrates.htm","Nitrates: Dosing information table. Isordil, nitrobid, Ismo, isosorbide","Nitrates: Dosing information table. Isordil, nitrobid, Ismo, isosorbide. Dosing list for health care providers, pharmacists, nurses, physicians. ","Nitrates Isosorbide dinitrate Isordil ® Angina prophylaxis: 5-40 mg orally four times daily or 40 mg (sustained release) orally every 8 to 12 hours.  Isosorbide mononitrate Ismo ®, Monoket ® Angina: Regular release tablet: 5-10 mg twice daily with the two doses given 7 hours apart (8am and 3pm) to decrease tolerance development - then titrate to 10 mg twice daily in first 2-3 days.  Extended release tablet: Initial: 30-60 mg given in the morning as a single dose. Titrate upward as needed, giving at least 3 days between increases. Maximum daily single dose: 240 mg Tolerance to nitrate effects develops with chronic exposure. Dose escalation does not overcome this effect. Tolerance can only be overcome by short periods of nitrate absence from the body. Short periods (10-12 hours) of nitrate withdrawal help minimize tolerance. Supplied: Regular release tablets: 10 mg, 20 mg.  Extended release tablets: 30 mg, 60 mg, 120 mg Nitroglycerin ointment: Initially 0.5 inches q8h. Maintenance: 0.5 to 2 inches every 6 to 8 hours. Maximum: 4 inches every 4 to 6 hours. [0.5 inches = @ 7.5 mg] Nitrobid Initially 2.5mg orally 2 to 3 times daily. Titrate upward as needed. Usual dose: 2.5 to 9mg 2 to 4 times daily. Maximum: 26mg orally 4 times daily. Nitroglycerin transdermal Apply one patch each day (remove at bedtime).  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc. Author: David McAuley Keywords: Nitrates: Dosing information table.Isordil, nitrobid, Ismo, isosorbide");s1[78]=new Array("nsaids.htm","NSAID's: dosing list for health care providers, pharmacists, nurses, physicians. ","NSAID's: dosing list for health care providers, pharmacists, nurses, physicians. ","NSAID's Agent Dosing Maximum daily dose: Acetic acid derivatives Arthrotec (diclofenac/ misoprostol): Dosing: 1 tablet orally 3 to 4 times daily.  diclofenac (Voltaren ®, Cataflam ®): 50 mg orally 2 to 3 times daily.   75 mg orally twice daily.  or 100mg XR orally once or twice daily. 225 mg XR: 200 mg Etodolac (Lodine): 200-400 mg orally 2 to 3 times daily.  (XL): 400-1200 mg once daily. 1200 mg Indomethacin: Dosing: 25- 50 mg orally 3 times daily. (SR): 75 mg orally once or twice daily. Suppositories: 25-50mg rectally 3 times daily. 200 mg SR: 150mg Ketorolac (Toradol): Dosing: 15-30 mg IV/IM every 6 hours. Maximum daily dose: 120mg IV/IM. Max dose IV= 30mg. May give 60mg IM x1. Oral: 10 mg orally every 4 to 6 hours as needed -- Max 4 doses/day. IV/ IM:120 mg oral: 40mg Sulindac (Clinoril): 150 - 200 mg orally twice daily. 400 mg Tolmentin (Tolectin) Osteoarthritis and Rheumatoid Arthritis (Adult ): initial, 400 mg orally three times a day for 1-2 weeks. Maintenance, 200-600 mg orally three times a day. Maximum: 1800 mg/day. [Supplied 400 mg capsule. 200, 600 mg tab] 1800 mg Carboxylic acid derivatives Diflunisal (Dolobid): 500-1000 mg initially, then 250-500mg orally every 8 to 12 hours.  Salsalate (Disalcid): 3000 mg/day divided every 8 to 12 hours.  Enolic acid (oxicam) derivatives Meloxicam (Mobic) Dosing: Adult (usual) Osteoarthritis: 7.5 mg po qd. Max dose 15 mg po qd. Rheumatoid arthritis: 7.5 mg po qd. Max dose 15 mg po once a day. [Supplied 7.5 mg tab]. 15 mg piroxicam (Feldene): 20 mg orally once daily. 20 mg Napthylkanone derivatives Nabumetone (Relafen): 1000 mg orally once or twice daily 2000 mg Proprionic acid derivatives Flurbiprofen (Ansaid): Dosing: 200-300 mg/day in 2 to 4 divided doses. 300 mg Ibupropen (Motrin):  200-800 mg orally 3 to 4 times daily as needed. 3200 mg Ketoprofen (Orudis): Dosing: 25-75mg orally 3 to 4 times daily. (XL-Oruvail): 200mg once daily. 300 mg Naproxen (Naprosyn) 250-500 mg orally twice daily.   (XL): 750-1000 mg orally once daily. 1375 mg Oxaprozin (Daypro): 1200 mg orally once daily. [600mg] 1800 mg COX-2 inhibitors celecoxib (Celebrex): Osteoarthritis: 100 mg orally once or twice daily; Rheumatoid arthritis: 200 mg orally once or twice daily.  Rofecoxib (Vioxx):  Osteoarthritis: 12.5 - 25 mg orally once daily. Acute pain: 50 mg orally once daily.  Valdecoxib (Bextra) Osteoarthritis (adult): 10 mg orally once a day.  Primary dysmenorrhea: 20 mg orally twice a day as needed.  Rheumatoid Arthritis: 10 mg orally once a day. [Supplied 10,20 mg tablet]   Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc. Author: David McAuley Keywords: Nonsteroidal anti-inflammatories, NSAID's,pharmacists, nursing, physicians,health care providers, Celebrex, Cataflam, Motrin, Lodine, Toradol, Relafen, Naprosyn, Daypro, Lodine, Feldene, Vioxx, disalcid, Clinoril, ketorolac");s1[79]=new Array("ophthalmic.htm","Ophthalmic agents: dosing list for health care providers, pharmacists, nurses, physicians. ","Ophthalmic agents: dosing list for health care providers, pharmacists, nurses, physicians. ","Ophthalmic Agents  Anesthetics, antibacterials, antibacterial combinations, anti-viral, corticosteroids, decongestant- anti-allergy, glaucoma, mydriatics, NSAIDs  Anesthetics proparacaine Adult (usual) Deep corneal anesthesia: 1 drop 0.5% ophthalmic soln in each eye every 5-10 min for 5-7 doses.  Superficial corneal anesthesia: 1-2 drops 0.5% ophthalmic solution in each eye before surgery or diagnostic procedure.  [Supplied 0.25%, 0.5% oph soln.]  FDA labeled indications: Corneal anesthesia of short duration, for procedures such as tonometry, gonioscopy, removal of corneal foreign bodies, and for short corneal and conjunctival procedures. tetracaine (Pontocaine ) Adult (usual)- Anesthesia, ophthalmic: minor surgical procedures, instill 1-2 drops of 0.5% ophthalmic solution into eyes every 5-10 min for 1-3 instillations. Anesthesia, ophthalmic: prolonged anesthesia (ie, cataract extraction), instill 1-2 drops of 0.5% ophthalmic solution into eye(s) every 5-10 min for 3-5 doses. Anesthesia, ophthalmic: tonometry and other short procedures, instill 1-2 drops of 0.5% ophthalmic solution into eyes prior to evaluation. [Supplied: 0.5% ophthalmic solution]  Antibacterials Ciprofloxacin (Ciloxan ®) Use 1 drop every 1 to 6 hours or ½" ointment 2 to 3 times daily. Supplied: [0.3% ointment, solution] Erythromycin (Ilotycin ®) Dosing: ½" of ointment every 3 to 4 hours or use 2 to 4 times daily. [ointment 0.5%] Gentamcyin (Garamycin ®) Dosing: 1-2 drops every 4 hours or ½" ointment 2 to 3 times daily. [0.3% oint/soln] levofloxacin (Quixin ®) Dosing: Conjunctivitis: days 1-2, 1-2 drops every 2 hr while awake (Max 8 times/day); days 3-7, 1-2 drops every 4 hr while awake (Max 4 times/day) . [Supplied: 0.5% solution. ] Neosporin ®)  (neomycin, bacitracin, polymixin ): Dosing: 1-2 drops every 1 to 6 hours or ½" ointment every 3 to 4 hours. norfloxacin (Chibroxin ®) Dosing -adults and pediatric patients(> 1 year old) conjunctivitis: 1 or 2 drops applied topically to the affected eye(s) 4 times daily for up to 7 days. Depending on the severity of the infection, the dosage for the first day of therapy may be one or two drops every two hours during the waking hours. [0.3% soln]. Ofloxacin (Ocuflox ®)  Dosing: 1-2 drops every 1 to 6 hours depending on severity.  [0.3% soln] Polysporin ® (polymixin B + bacitracin): Ointment. Dosage and Administration: Apply the ointment every 3 or 4 hours for 7 to 10 days, depending on the severity of the infection. Polytrim (poly + trimethoprim): Dosing: 1 drop every 3 to 6 hours. Maximum: 6 drops/day. Sulfacetamide (Bleph-10 ®, Sulamyd ®) Dosing: 1-2 drops every 2 to 6 hours or ½" ointment every 3 to 8 hours. Tobramycin (Tobrex ®)  Dosing: 1-2 drops every 1 to 4 hours or ½" ointment every 3 to 4 hours or 2 to 4 times daily [0.3%] Antibacterial & Corticosteroid Combinations: Blephamide ® (sodium sufacetamide + prednisolone): A steroid/anti-infective combination is indicated for steroid-responsive inflammatory ocular conditions for which a corticosteroid is indicated and where superficial bacterial ocular infection or a risk of bacterial ocular infection exists. SHAKE WELL BEFORE USING. (Solution): Two drops should be instilled into the conjunctival sac q4h during the day and at bedtime. (Ointment) Apply 1/2 inch ribbon of ointment in the conjunctival sac three or four times daily and once or twice at night. Not more than 8 g should be prescribed initially. Cortisporin ® (neomycin, polymixin, HC 1%): Dosing: 1-2 drops or ½" ointment every 3 to 4 hours or more. Maxitrol ® (dexamethasone + neomycin + polymixin): Dosing:  1-2 drops every 1 to 8 hours or ½ to 1 inch ointment once or twice daily. Pred G ® (gentamicin + prednisolone): Suspension: Instill one drop into the conjunctival sac two to four times daily. During the initial 24 to 48 hours, the dosing frequency may be increased, if necessary, up to 1 drop every hour. Care should be taken not to discontinue therapy prematurely. If signs and symptoms fail to improve after two days, the patient should be re-evaluated.  PRED-G® (gentamicin 0.3% - prednisolone acetate 1.0% ophthalmic suspension)    Ointment: A small amount ( 1 / 2 inch ribbon) of ointment should be applied in the conjunctival sac one to three times daily. Care should be taken not to discontinue therapy prematurely. How Supplied: PRED-G® (gentamicin 0.3% and prednisolone acetate 0.6% ophthalmic ointment) TobraDex ® (Tobra + dexamethasone): Dosing: 1-2 drops every 2 to 6 hours or ½" ointment 2 to 4 times daily. Antiviral Agents: Fomivirsen (Vitravene ®)  Intravitreal injection for CMV retinitis. Trifluridine (Viroptic ®) Dosing: 1 drop every 2 to 4 hours x 7-14 days. Maximum: 9 drops/day. Vidarabine (Vira-A ®) ½" of ointment twice daily- up to 5 times daily. Corticosteroids Dexamethasone (Decadron, Maxidex ®) Dosing: 1-2 drops every 1 to 8 hours or ½ to 1 inch ointment 1 to 4 times daily. [0.1% susp, soln. 0.05% oint] Fluorometholone (FML, Flarex ®) Dosing: 1-2 drops every 1 to 12 hours or ½" ointment every 4 to 24 hours. Loteprednol (Lotemax ®, Alrex ®) Dosing: 1-2 drops 4 times daily [susp: 0.2, 0.5%] Prednisone (Pred Forte ®) Dosing: 1 drop every 1 to 12 hours. [susp/soln : 0.125%, 1%] Rimexolone (Vexol ®) Dosing: 1-2 drops every 1 to 6 hours. [susp: 1%] Ocular Decongestants/ Anti-allergy. azelastine (Optivar ®) Relatively selective H 1 -receptor antagonist for topical administration to the eyes. Indicated for the treatment of itching of the eye associated with allergic conjunctivitis. ADMINISTRATION: one drop instilled into each affected eye twice a day. [Supplied: 0.05% ophthalmic solution] Cromolyn sodium (Crolom ®) Dosing: 1-2 drops 4-6 times/day emedastine (Emadine ®) Allergic conjunctivitis: 1 drop 0.05% ophthalmic solution in affected EYE(s) up to four times daily. [Supplied 0.05% solution] .Emedastine is a selective H1-receptor antagonist with antiallergic and antiasthmatic properties. Epinastine (Elestat ®) H1 Blocker.  Allergic conjunctivitis: Instill 1 drop into each eye twice daily. Continue throughout period of exposure, even in the absence of symptoms. Supplied: Oph solution: 0.05% (5 ml). Ketotifen Fumarate Ophthalmic Solution 0.025% (Zaditor ®) temporary prevention of itching of the eye caused by allergic conjunctivitis. Noncompetitive histamine antagonist (H-1 receptor) and mast cell stabilizer. Levocabastine (Livostin ®)  Dosing:  1 drop four times daily. [susp: 0.05%] Lodoxamide tromethamine (Alomide ®)  Dosing: 1-2 drops four times daily. [soln: 0.1%] Naphazoline (Naphcon, Vasocon ®) Dosing: 1 drop every 3 to 4 hours as needed up to 4 times daily. Naphcon-A ® (naphazoline + pheniramine): Dosing: 1-2 drops 2 to 4 times daily as needed. nedocromil (Alocril ®) Mast cell stabilizer. Indication: allergic conjunctivitis. Instill one or two drops in each eye twice a day. [Supplied: 2% ophthalmic soln] Olopatadine (Patanol ®) 1-2 drops twice daily. [0.1% soln] pemirolast (Alamast ®) Mast cell stabilizer. Indication: allergic conjunctivitis. Instill one to two drops in each affected eye four times daily. Symptomatic response to therapy (decreased itching) may be evident within a few days, but frequently requires longer treatment (up to four weeks).  Glaucoma Agents Beta Blockers Betaxolol (Betoptic ®) Dosing: 1-2 drops twice daily [0.25% susp , 0.5% soln] Carteolol (Ocupress ®) 1 drop twice daily. [1% soln] Levobunolol (Betagan ®) Dosing: 1-2 drops once or twice daily. [0.25 & 0.5% soln] Timolol (Timoptic ®) Dosing: drop twice daily.  [soln 0.25 & 0.5%]. Timoptic XE: 1 drop once daily. [0.25 & 0.5% gel] Carbonic anhydrase inhibitors: Brinzolamide (Azopt ®) Dosing: 1 drop three times daily. [susp: 1%] Dorzolamide (Trusopt ®) Dosing: 1 drop three times daily [soln: 2%] Cholinergics Pilocarpine (Pilocar ®) Dosing: 1-2 drops 3 to 4 times daily or ½" gel at bedtime Prostaglandins bimatoprost (Lumigan ®) Instill one drop in the affected eye(s) once daily in the evening. The dosage should not exceed once daily since it has been shown that more frequent administration may decrease the intraocular pressure lowering effect. [Supplied: 0.03% soln] Latanoprost (Xalatan ®) Dosing: 1 drop at bedtime. [soln: 0.005 %] travoprost (Travatan ®) Instill one drop in the affected eye(s) once-daily in the evening. The dosage of TRAVATAN® should not exceed once-daily since it has been shown that more frequent administration may decrease the intraocular pressure lowering effect. [Supplied: 0.004% solution] unoprostone (Rescula ®) Instill one drop in the affected eye(s) twice daily. RESCULA ® may be used concomitantly with other topical ophthalmic drug products to lower intraocular pressure. If two drugs are used, they should be administered at least five minutes apart.  Structural analogue of an inactive biosynthetic cyclic derivative of arachidonic acid.  [ Supplied: 0.15% solution ] Other Apraclonidine (Iopidine ®)  Dosing: 1-2 drops three times daily. [ soln: 0.5, 1%] Brimonidine (Alphagan ®) Dosing: 1 drop three times daily. [soln: 0.2%] Cosopt ® (dorzolamide 2% + timolol 0.5%): Dosing: 1 drop twice daily. Dipivefrin (Propine ®) Dosing: 1 drop twice daily. [soln: 0.1%]  Mydriatics & Cycloplegics: Atropine (Isopto Atropine): Dosing: 1-2 drops before procedure. Or 1 to 4 times daily. Cyclopentolate (Cyclogyl ®)  Dosing: -2 drops x 1-2 doses before procedure. Homatropine (Isopto Homatropine): Dosing: 1-2 drops before procedure. Or 2 to 3 times daily. Phenylephrine (Mydfrin ®) mydriasis only. 1-2 drops before procedure. Tropicamide (Mydriacyl ®) Dosing: 1-2 drops before procedure   Nonsteroidal Anti-inflammatories: Diclofenac (Voltaren ®)  Dosing: 1 drop 4 times daily Flurbiprofen (Ocufen ®) Indications: inhibition of intraoperative miosis. Dosage and Administration: A total of four (4) drops should be administered by instilling 1 drop approximately every 1 / 2 hour beginning 2 hours before surgery. [Supplied: 0.03% oph solution] Ketorolac (Acular ®) Dosing: 1 drop four times daily. [0.5% soln]  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc. Author: David McAuley Keywords: Ophthalmic agents,pharmacists, nursing, physicians,health care providers, eye care, Ciloxan, Garamycin, Bleph-10, Tobrex, Tobradex, Glaucoma, Maxitrol, Viroptic, Dexamethasone, Vidarabine, Livostin, Alomide, Naphcon, Patanol,Latanaprost,Azopt, Trusoft, Betagan, Ocupress");s1[80]=new Array("otic.htm","Otic agents: dosing list for health care providers, pharmacists, nurses, physicians. ","Otic agents: dosing list for health care providers, pharmacists, nurses, physicians. ","Ear (Otic) Preparations Auralgan (benzocaine + antipyrine): Ear pain: Instill 2-4 drops into the affected ear 3 to 4 times daily as needed. carbamide peroxide  (Debrox ): Facilitate ear wax removal: Instill 5-10 drops into the affected ear twice daily. Cipro HC Otic: Instill 3 drops into the affected ear twice daily for 7 days. Cortisporin (HC, poly, neosporin): Instill 4 drops into the affected ear 3 to 4 times daily. Ofloxacin (Floxin otic): instill 10 drops into the affected ear twice daily. Triethanolamine (Cerumenex ): Facilitate ear wax removal: Fill ear canal and leave in place for 15 to 30 minutes to loosen cerumen. Vosol Otic (acetic acid + propylene glycol): Instill 5 drops into the affected ear 3 to 4 times daily.  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc. Author: David McAuley Keywords: Otic agents,pharmacists, nursing, physicians,health care providers,Auralgan, Debrox, Floxin, Cerumenex, Vosol, Ear, Otitis media");s1[81]=new Array("pain.htm","Pain management (Opiates): dosing list for health care providers, pharmacists, nurses, physicians. ","Pain management (Opiates): dosing list for health care providers, pharmacists, nurses, physicians. ","Pain Management Opiates: Codeine Dosing: Pain: Oral, M, IV, SC: 30 mg (15-60mg) q4-6h prn. (Max 360mg/day).  Cough (non-productive): 10-20mg q4-6h prn (Max: 120 mg/day). Comments: Oral dose = 2/3 effectiveness of IV route when converting. Adult doses > 60mg fail to give commensurate relief of pain but merely prolong analgesia and are associated with an appreciably increased incidence of side effects. [Supplied: codeine phosphate (inj): 30 mg (1,2 ml); 60 mg (1,2 ml); Solution: 15 mg/5 ml. Tablet: 30, 60 mg. Codeine sulfate: 15, 30, 60mg tablet.] Combinations: ACETAMINOPHEN/CODEINE PHOSPHATE: Tylenol #2: 15/300. Tylenol #3: 30/300mg. Tylenol #4: 60/300mg. Pain: acetaminophen 300-1000 mg (Max 4000 mg/day); codeine 15-60 mg (Max: 360 mg/day) orally every 4 hours as needed.  Pain: 15 ml (1 tbsp) orally every 4 hours as needed. [Supplied: Suspension: 120 mg-12 mg/5 ml.  Tablets: 300/15 mg, 300/30mg, 300/60mg, 650/30 mg] Fentanyl patch Duragesic ® Apply 1 patch every 3 days. Sedation for minor procedures: IM/IV: 0.5 - 1 mcg/kg. Higher doses for major procedures. Preoperative sedation /adjunct to regional anesthesia/ postop pain: IM/IV 50-100 mcg/dose. Continuous sedation (ICU etc): Start 25-50 mcg bolus, f/b continuous infusion of 1-3 mcg/kg/hr. Titrate to response. Breakthrough cancer pain: (Transmucosal - Antiq®): Start 200mcg x1. Monitor pt closely. May redose in 15min if necessary. Titrate dose so that can be treated with a single dose (usually requires 1-2 days to determine). Consumption should be limited to 4 doses/day, otherwise reevaluate maintenance opiate for an increase. Transdermal: Start 25 mcg/hr q72h. If patient is currently receiving opiates, convert to fentanyl patch equiv. Rarely patients may require q48h dosing schedule. Renal: consider 50% reduction of dose in renal failure. [Supplied: Fentanyl citrate (inj): 50 mcg/ml (2,5,10, 20, 30, 50ml). Sublimaze®: 50 mcg/ml (2, 5, 10, 20 ml) Lozenge Antiq®: 200, 400, 600, 800, 1200, 1600 mcg.  Transdermal (Duragesic®): 25, 50, 75, 100 mcg/hr ] Apply to non-irritated/non-irradiated flat skin surface (chest, back, flank or upper arm). Press firmly in place with the palm of the hand for 30 seconds, ensuring complete contact, especially around the edges hair at the application site should be clipped (not shaved) prior to system application. Clean site prior to application if needed with clear water only - do not use soaps, oils, lotions, alcohol. Dry completely prior to system application. Do not alter/cut the system. Hydrocodone Limit APAP to 4 grams/day or less. Dosing (tablets with 5 mg hydrocodone): 1-2 tablets q4-6h prn or 5-10 ml q4-6h prn. (Tablets with 7.5 or 10 mg hydrocodone): 1 tab q4-6h prn Maximum: 60 mg hydrocodone/day. [Supplied: Capsule: Bancap HC®, Ceta-Plus®, Hydrocet®, Hydrogesic®, Lorcet-HD® (5/500mg). Elixir Lortab®: 2.5 mg - 167mg/ 5 ml (480 ml)  Tabets: 2.5/500mg, 5/500mg, 7.5/500mg, 7.5/650 mg, 7.5/750 mg, 10mg/325mg, 10/500mg, 10/650mg. Anexsia ®(tablets): 5/325mg, 5/500mg, 7.5/325mg, 7.5/650mg, 10/660mg. Co-Gesic®: 5/500mg. Lorcet ®: 10/650mg. Lorcet® Plus: 7.5/650mg. Maxidone®: 10/750mg. Norco®: 5/325mg, 7.5/325mg,10/325mg. Vicodin®: 5/500mg. Vicodin ES ®: 7.5/750mg. Vicoden® HP: 10/660mg. Zydone®: 5/400mg, 7.5/400mg, 10/400mg. ] Hydromorphone Dilaudid ® Give 2 to 4 mg orally every 4 to 6 hours as needed.  1-4 mg IM/SC/IV every 4 to 6 hours as needed.  3 mg rectally every 6 to 8 hours as needed. (Higher doses/more frequent administration may be required in opiate tolerant patients). Oral: (opiate naive) Start 2-4 mg q3-4h prn. Usual range: 2-8 mg q3-4h prn. IV: (opiate naive) Start: 0.2 - 0.6 mg q2-3h prn. Pain, acute: 1-2 mg IV (slow - over 2-3 min) q3h prn. Mechanically-ventilated pts: 0.7 - 2 mg q1-2h prn or start infusion: 0.5 - 1 mg/hr. PCA: Usual concentration: 0.2 mg/ml. Demand dose (usual): 0.1 - 0.2 mg (range: 0.05 - 0.5mg). Lockout: 5-15 min. 4 hour limit: 4-6 mg. Epidural: Bolus: 1-1.5 mg. Infusion conc: 0.05 - 0.075 mg/ml. Infusion rate: 0.04 - 0.4 mg/hr. Demand dose: 0.15mg. Lockout: 30 minutes. IM/SC: (opiate naive) Start: 0.8 - 1 mg q4-6h prn. Usual range: 1-2 mg q3-6h prn. Acute pain: 1-2 mg IM/SC q4-6h prn. Rectal: 3 - 6mg q3-8h prn. [Supplied: Powder for injection (hydromorphone HCl): 250mg. Injection (HCl): 1 mg/ml (1 ml); 2 mg/ml (1, 20ml); 4 mg/ml (1 ml). Dilaudid-HP®: 10mg/ml (1, 5, 50ml). Oral liquid (hydromorphone HCl): 1 mg/ml (480 ml). Suppository (rectal): 3 mg. Tablet: 2, 4, 8mg. ] Levorphanol Levo-Dromoran ® 2 mg orally or SC every 6 to 8 hours as needed. Meperidine  Demerol ® 25-150 mg IM/SC/IV/orally every 3 to 4 hours as needed. Analgesic: Oral, IM, IV, SC: 50-150 mg q3-4h prn. Oral therapy is discouraged.  Oral dose: 50% effectiveness of IV route. 25-150 mg IM/SC/IV/orally every 3 to 4 hours as needed. [Supplied: infusion: 10mg/ml (30ml).   Injection (meperidine HCl): Multidose vial: 50mg/ml (30ml); 100mg/ml (20ml). Single dose: 25 mg(1 ml); 50mg/ml (1 ml); 75 mg(1 ml); 100mg (1 ml); Syrup: 50mg/5ml (500ml). Tablet: 50, 100mg ] Methadone Dolophine ® Severe pain: 2.5 to 10mg IM/SC/orally every 3 to 4 hours as needed. Detox: 15-40mg orally once daily to start. Important Note: Methadone accumulates with repeated doses and dosage may need to be adjusted downward after 3-5 days to prevent toxic effects. Some patients may benefit from q8-12h dosing intervals.  Analgesia: Oral, IM, SC: 2.5 - 10 mg q3-8h prn up to 5-20mg q6-8h. Detoxification: Oral: 15-40mg qd. Should not exceed 21 days and may not be repeated earlier than 4 weeks after completion. Maintenance of opiate dependence: 20-120mg qd. [Supplied: Injection: 10 mg/ml (20 ml). Oral solution: 5 mg/ml (5, 500ml); 10 mg/5 ml (500ml). Solution - oral concentrate: 10 mg/ml (30ml). Tablet: 5, 10 mg. Tablet-dispersable: 40mg disket ]   Morphine sulfate: (Regular release): 10-30mg orally every 4 hours. (MS Contin): 15-60mg orally every 8 to 12 hours. (Oral soln-Roxanol): 10-30 mg orally every 4 hours. (Injection): usual range: 2-15 mg IM/SC/IV every 4 hours as needed. Oral (Regular release): 5-30mg q4h prn. Controlled release MS Contin®: 15-60mg orally every 8 to 12 hours.  Sustained release (Kadian®): See below.    Extended release (Avinza®): 30 - 120mg qd.  The daily dose must be limited to a maximum of 1600 mg/day. Doses over 1600 mg/day contain a quantity of fumaric acid that has not been demonstrated to be safe, and which may result in serious renal toxicity. Patients receiving other oral morphine formulations may be converted to Avinza® by administering the patient's total daily oral morphine dose as Avinza® once-daily. Should not be given more frequently than every 24 hours. Rectal: 10-30 mg PR q4h prn.  IM, IV, SC: 2.5 to 20 mg q2-6h prn. Usual: 10mg q4h prn. IV/SC continuous infusion: 0.8 - 10 mg/hr. Titrate to response. Usual range: up to 80mg/hr. Epidural: Start 5 mg in lumbar region. If inadequate relief c/in 1 hr, give 1-2 mg. Max: 10 mg/24 hours. Intrathecal (1/10th epidural dose): 0.2 - 1 mg. Repeat doses are not recommended. [Supplied: Capsule - immediate release (MSIR®): 15, 30mg. Capsule - extended release (Avinza®): 30, 60, 90, 120mg. Capsule - sustained release (Kadian®): 20,30, 50, 60, 100mg. Infusion (premixed in D5W): 0.2 mg/ml (250, 500ml); 1 mg/ml (100, 250, 500ml) Injection: 0.5 mg/ml (10 ml); 1 mg/ml (10, 30, 50 ml); 2 mg/ml (1 ml); 4 mg/ml (1 ml); 5 mg/ml (1, 30, 50 ml); 8 mg/ml (1 ml); 10 mg/ml (1, 2, 10 ml); 15 mg/ml (1 , 20 ml); 25 mg/ml (4, 10, 20, 40, 50ml); 50 mg/ml (10, 20, 40, 50ml). Preservative free (Inj) Astramorph®: 0.5 mg/ml (2, 10ml); 1 mg/ml (2, 10 ml). Infumorph®: 10 mg/ml (20 ml); 25 mg/ml (20ml). Duramorph®: 0.5 and1 mg/ml (10 ml) Oral solution: 10 mg/5ml (5, 100, 500 ml); 20 mg/ml(30, 120, 240ml); 20mg/5ml(30, 120 ml). Roxanol®: 20 mg/ml(30, 120 ml). Roxanol 100®: 100mg/5ml (240 ml). Suppository: 5, 10, 20, 30mg.  Tablet (MSIR®): 15, 30mg. Tablet - Controlled release (MS Contin®): 15, 30, 60, 100, 200mg. (Oramorph®): 15, 30, 60, 100mg. ] Kadian® Conversion from Other Oral Morphine Formulations to Kadian® Patients on other oral morphine formulations may be converted to Kadian® by administering one-half of the patient's total daily oral morphine dose as Kadian® capsules every 12 hours (twice-a-day) or by administering the total daily oral morphine dose as Kadian® capsules every 24 hours (once-a-day). Kadian® should not be given more frequently than every 12 hours. [Supplied: capsule: 20, 30, 50, 60, 100mg] Oxycodone (Roxicodone): 5 mg orally every 6 hours as needed. [5 mg tab] (OxyContin- Extended release): 10-40 mg orally every 12 hours. [10, 20, 40, 80, 160mg ] Pain: (Regular release)- 2.5 - 5 mg po q6h prn. (Controlled release): 10 - 40 mg po q12h (Much higher doses possible in opiate tolerant patients). [Supplied: (oxycodone hydrochloride) Capsule - immediate release: OxyIR®: 5 mg. Oral solution (Roxicodone®): 5 mg/5ml (5 ml, 500ml). Oral solution concentrate (Oxydose®, Oxyfast®, Roxicodone Intensol®): 20mg/ml (30ml) Tablet: Precolone®: 5 mg. Roxicodone®: 5, 15, 30mg. Tablet - controlled release (Oxycontin®): 10, 20, 40, 80, 160mg ] Combinations: Initial dose based on oxycodone content. Max dose based on APAP content.  Dosing: 1 tab q4-6h prn. [Supplied: Caplet: (Roxicet®): 5/500mg. Capsule: Tylox®: 5/500mg Oral Solution: Roxicet®: 5 mg-325mg/5 ml (5ml, 500ml). Tablet: Endocet®: 5/325 mg.  Perocet®: 2.5/325mg, 5/325mg, 7.5/325mg, 7.5/500mg, 10/325mg, 10/650mg. Roxicet®: 5/325mg.  Percodan: 5/325mg - 1 tab q6h prn. Propoxyphene Darvon ® 65 mg orally every 4 hours as needed. [65mg] Pain: Propoxyphene HCL: 65 mg po q3-4h prn. Propoxyphene napsylate (100mg): 1 tab q4h prn. Combinations: Darvocet-N 50: 1-2 tabs q4h prn.  Darvocet-N 100: 1 tablet q4h prn. [Supplied: Darvocet N-50: 50/325mg.   Darvocet N-100: 100/650mg. Wygesic: propoxyphene 65mg/650mg APAP.] Darvon Compound-65 (propoxyphene 65mg + ASA 389mg + 32.4mg caffeine): 1-2 capsules q4-6h prn Non-Narcotic analgesics: Fioricet (apap 325mg + butalbital 50mg + caffeine 40mg): 1-2 tabs orally every 4 hours (Maximum of 6 tablets/day) Fiorinal (ASA 325mg + butalbital 50mg + caffeine 40mg): 1-2 tabs orally every 4 hours. (Maximum of 6 tablets/day) Soma compound (carisprodol 200mg + ASA 325mg): 1-2 tabs orally four times daily. Tramadol (Ultram): 50-100 mg orally every 4 to 6 hours as needed. Max 400 mg/day. Opiate Combinations Anexsia (hydrocodone/APAP 5/500, 7.5/650, 10/660): 1 tab orally every 4 to 6 hours as needed. Darvocet N-100 (propoxyphene 100mg/APAP 650mg): 1 tab orally every 4 to 6 hours as needed (Maximum of 6 tabs/day). Darvon Compound (propoxyphene 65mg + ASA 389mg + caffeine 32.4mg) 1 tab orally every 4 hours as needed. Lorcet (hydrocodone/APAP 5/500): 1-2 tabs orally every 4 to 6 hours as needed. // (7.5/650 & 10/650 ): 1 tab orally every 4 to 6 hours as needed. Lortab (hydrocodone/APAP 2.5/500, 5/500): 1-2 tabs orally every 4 to 6 hours as needed.  // (7.5/500, 10/500): 1 tab orally every 4 to 6 hours as needed. Percocet (oxycodone 5 mg/APAP 325 mg): 1 tab orally every 6 hours as needed. Percodan (Oxycodone 5 mg/ ASA 325mg): 1 tab orally every 6 hours as needed. Roxicet (oxycodone/APAP 5/325, 5/500): 1 tablet orally every 6 hours as needed. Tylenol with Codeine (APAP/codeine) #2: 300/15, #3: 300/30mg, #4: 300/60 mg: 1-2 tabs orally every 4 to 6 hours as needed. Tylox (oxycodone 5mg /APAP 500mg): 1 tab orally every 6 hours as needed. Vicodin (hydrocodone/APAP 5/500 or Vicodin ES (7.5/750):  1-2 tabs orally every 4 to 6 hours as needed. Max 8 tablets/day (Vicodin) or max 5 tablets/day (Vicodin ES).  Wygesic (propoxyphene/APAP 65/650mg): 1 tablet orally every 4 hours as needed. Agonist-Antagonists: Buprenorphene (Buprenex): 0.3 to 0.6 mg IV/IM every 6 to 8 hours as needed. Butorphanol (Stadol): 0.5 to 2 mg IV or 1-4 mg IM every 3 to 4 hours as needed. Nasal spray (Stadol NS): 1 spray every 3 to 4 hours as needed [1 mg/spray] Dezocine (Dalgan): 2.5 to 10 mg IV every 2 to 4 hours or 5-20mg IM every 3 to 6 hours as needed. Nalbuphine (Nubain): 10-20mg IV/IM/SC every 3 to 6 hours as needed. Pentazocine (Talwin): 30mg IV/IM every 3 to 4 hours as needed. Antagonists: Nalmefene (Revex): opioid overdose: 0.5 mg/70kg IV with 1mg/70 kg 2 to 5 minutes later if needed. Post-op opoid reversal: 0.25 mcg/kg every 2 to 5 minutes as needed. Naloxone (Narcan): 0.4 to 2 mg every 2 to 3 minutes as needed IV/IM/SC/ET. Other Suboxone ® (Buprenorphine and naloxone) Treatment of opioid dependence. Not recommended for use during the induction period. Initial treatment should begin using buprenorphine oral tablets. Patients should be switched to the combination product for maintenance and unsupervised therapy. Maintenance: Target dose (based on buprenorphine content): 16 mg/day - range: 4-24 mg/day. Supplied: sublingual tablet: Buprenorphine 2 mg and naloxone 0.5 mg; buprenorphine 8 mg and naloxone 2 mg. Ziconotide Prialt ® Non-opioid analgesic for the treatment of severe chronic pain. MOA: Binds to N-type voltage sensitive calcium channels located on the afferent nerves of the dorsal horn in the spinal cord. This binding is thought to block N-type calcium channels, leading to a blockade of excitatory neurotransmitter release and reducing sensitivity to painful stimuli. Dosage (adults): Initial dose: 2.4 mcg/day (0.1 mcg/hour) intrathecally. Dose may be titrated by less than 2.4 mcg/day (0.1 mcg/hour) at intervals no greater than 2-3 times/week to a maximum dose of 19.2 mcg/day (0.8 mcg/hour) by day 21. Average dose at day 21: 6.9 mcg/day (0.29 mcg/hour). A faster titration should be used only if the urgent need for analgesia outweighs the possible risk to patient safety. Effects are generally reversible within 2 weeks of discontinuation. Supplied: Injection (soln): 100 mcg/ml (1 ml, 2 ml, 5 ml).  25 mcg/ml (20 ml).  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc. Author: David McAuley Keywords: Pain management,pharmacists, nursing, physicians,health care providers,morphine, tylox, Lortab, Vicodin, Fentanyl, Dilaudid, Meperidine, Percodan, Oxycodone, hydromorphone, Duragesic, Stadol");s1[82]=new Array("parkinsons.htm","Parkinson's disease (management): dosing list for health care providers, pharmacists, nurses, physicians. ","Parkinson's disease (management): dosing list for health care providers, pharmacists, nurses, physicians. ","Parkinson's Disease amantadine Symmetrel ® Increases dopaminergic activity. Dosing: 100 mg orally twice daily. benztropine Cogentin ® Anticholinergic. Dosing: 0.5 - 2 mg IM, orally or IV once or twice daily. bromocriptine Parlodel ® Dopamine agonist. Initiate at 1.25 mg q hs. Titrate over 4-6 weeks. Usual dose 10-40 mg/day divided tid. entacapone Comtan ® Inhibitor of catechol-O-methyltransferase (COMT). Dosing: 200-mg tablet administered concomitantly with each carbidopa/levodopa dose to a maximum of eight times daily, (1,600 mg/day) . Entacapone should always be administered in association with carbidopa /levodopa, since entacapone has no antiparkinsonian effect of its own.[200] pergolide Permax ® A long-acting synthetic ergoline derivative with potent dopamine agonist activity at both D-1 and D-2 dopamine receptors. Initial: 0.05 mg orally once daily, then increase to 1 mg orally three times daily. Max: 5 mg/day. pramipexole (Mirapex ® Dopamine receptor agonist (D3>>D2). Initial: 0.125 mg orally three times daily, then increase to 0.5-1.5 mg orally three times daily. ropinirole Requip ® Dopamine-2 (D2)-receptor agonist. Primary indication is early Parkinson's disease, where it may delay the need for levodopa therapy. Initial: 0.25 mg orally three times daily, then increase to 1 mg orally three times daily. Maximum: 24 mg/day. selegiline Eldepryl ® Monoamine oxidase (MAO) inhibitor that is specific for the MAO-B isozyme. Dosing: 5 mg orally every morning and at noon daily. Sinemet ® (carbidopa/levodopa): Initially: 1 tab (10/100 to 25/100) orally three times daily, may increase every 1 to 4 days as needed to max 200mg carbidopa/day. tolcapone Tasmar ® First of new class of COMT inhibitors. Increases the elimination half-life of levodopa. Start 100 mg orally three times daily. Only as adjunct to Sinemet. Maximum: 600 mg/day. trihexyphenidyl Artane ® Anticholinergic. Initial: 1 mg/day, then increase slowly to 6-10mg/day in 3 divided doses. Max: 15 mg/day.  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc. Author: David McAuley Keywords: Parkinsons disease,pharmacists, nursing, physicians,health care providers,Cogentin, Parlodel, Comtan, Permax, Mirapex, Requip, Eldepryl, Sinemet, Tasmar, Artane, Pramipexole, entacapone");s1[83]=new Array("penicillins.htm","Penicillins","","Penicillins: Ampicillin:  (IV): 500mg to 2 grams IV q4-6h. [Severe infection]: 2 grams IV q4h (150-200mg/kg/day). (Oral): 250mg to 500mg orally q6h (50-100mg/kg/ day).  Renal Dosing: [CRCL >50]: no change. [30-49]: q6-8 hours. [10-29]: q8-12 hours. [<10 ]: q12-24 hours.Hemodialysis: [<10 ml/min]: Give usual dose every 12-24 hours. Schedule dose after dialysis on dialysis days. Ampicillin/ sulbactam: Unasyn ® 1.5-3 grams IV/IM q6-8 hours.   Renal Dosing:  [CRCL >30]: 1.5-3.0 grams q6-8h  [15-30]: 1.5-3.0 grams q12h.  [5-14 ]: 1.5-3.0 grams q24 hours.  Hemodialysis: 1.5-3.0 grams q24 hours – give dose after dialysis when patient is being dialyzed.  PD: 1.5-3.0 grams q24 hours Amoxicillin: Dosing: 250-500 mg po q8h or 875 mg q12h. Helicobacter pylori: 1000mg bid or tid x 14days.  Renal Dosing:  [CRCL >30 ]: No change.   [10-29 ml/min]: q8-12h. Do not use 875 mg tablet.   [<10 ml/min]: q24h. Do not use 875mg tablet.  Hemodialysis: 250-500mg q24h plus additional dose after dialysis. Amoxicillin/ Clavulanate Augmentin ® Dosing: 250-500mg q8h or 875mg q12h.  Renal Dosing:  [CRCL >30 ]: no change .  [10-30 ]: 250-500 mg q12h. Do not use the 875 mg tablet.    [<10 ml/min]: 250-500 mg q24h. Do not use the 875 mg tablet.   Hemodialysis: 250-500 mg q24h. Give additional dose after dialysis. Cloxacillin Tegopen ® Dosing: 250-500mg po q6h. Renal Dosing: No adjustments needed Dicloxacillin: Dynapen ® Dosing: 125-500mg po q6h. Renal Dosing: No adjustments needed. Nafcillin Dosing: 1-2 grams q4-6h. Renal Dosing: No adjustment in renal failure Penicillin G Dosing: 1 – 4 mu q4-6h. Renal Dosing: [CRCL >50] Normal dose.   [10-50]: Give 75% of usual dose q4-6h.  [<10 ]: Give 20-50% of usual dose q4-6h.   Hemo:  500,000 - 800,000 units q6h or Give 20-50% of usual dose q4-6h. Penicillin VK Dosing: 250-500mg po q6h. Renal Dosing: [CRCL > 10] no changes.   [<10] 250-500mg q8h.    Hemo: 250-500mg q8h. Piperacillin Pipracil ® No longer available.  Dosing: 3 grams q4-6h or 4 grams q6h. Renal Dosing: [>40 ml/min]: No changes.   [20-40]: 3-4 grams q8h.   [<20 ]: 4 grams q12h.  Hemo: Manufacturer: 2 grams IV q8h + 1 gram additional dose after each dialysis Piperacillin/ Tazobactam Zosyn ® Dosing: 3.375gm q4-6h or 4.5 grams q6-8h. Renal Dosing: [40-90 ml/min]: 3.375 grams q6h.   [20-40]: 2.25 gm q6h.   [<20]: 2.25 grams q8h.   Hemo: 2.25 grams q8h.  Plus 0.75 g Zosyn should be administered following each dialysis period.   PD: 2.25 grams q8h. Ticarcillin Dosing: 3 or 4 grams every 4 or 6 hours (200 to 300 milligrams/kilogram/day) Renal Dosing: [>60 ml/min]: No change.   [30-60]: 2 grams q4h.   [10-30]: 2 grams q8h.   [<10]: 1-2 grams q12h.    Hemo: 2 grams q12h + supplemental dose (2-3 grams) after dialysis. Ticarcillin/ Clavulanate Timentin ® Dosing: 3.1 grams q4-6h. Renal Dosing: [>60 ml/min]: no change.   [30-60]: 2 gm q4h or 3.1gm q8h.   [10-30]: 2 gm q8h or 3.1 gm q12h.   [<10]: 2 grams q12h.   [<10 + hepatic dysfcn]: 2g q24h.   Hemo: 2 grams q12h + additional 3.1 g after each dialysis.  PD: 3.1 grams q12h  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.");s1[84]=new Array("prostate_cancer.htm","Prostate cancer - Common pharmacologic agents","","Prostate Cancer bicalutamide Casodex ® 50 mg orally once daily [50 mg tablet] flutamide Eulexin ® 250 mg orally every 8 hours. [125 mg capsule] goserelin Zoladex ® 3.6 mg implant SC every 28 days or 10.8 mg SC every 12 weeks. [3.6, 10.8] leuprolide Lupron ® 1 mg SC once daily  or 7.5 mg IM once a month  or 22.5mg IM every 3 months or 30 mg IM every 4months. nilutamide Nilandron ® 300 mg orally once daily x 30 days, then 150 mg orally once daily.  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.");s1[85]=new Array("ppis.htm","Proton Pump Inhibitors","","Proton Pump Inhibitors: esomeprazole Nexium ® Healing of Erosive Esophagitis: 20 - 40 mg once daily x 4 to 8 weeks. May consider an additional 4-8 weeks of treatment if patient is not healed.  Maintenance of Healing of Erosive Esophagitis: 20 mg once daily. Symptomatic Gastroesophageal Reflux Disease: 20 mg once daily x 4 weeks. May consider an additional 4 weeks of treatment if symptoms do not resolve. Treatment of GERD (short-term): 20 mg or 40 mg IV once daily for </= 10 days. Change to oral therapy as soon as appropriate. H. pylori Eradication (Triple therapy): Nexium 40 mg qd x 10 days + Amoxicillin 1000 mg bid x 10 Days + Clarithromycin 500 mg bid for 10 days. [Supplied: 20, 40mg capsules. Injection (powder for reconstitution) 20 mg, 40 mg] Lansoprazole Prevacid ® GERD: 15-30mg orally once daily before meal. Hypersecretory: Maximum: 180mg/day. Duodenal ulcer: 15 mg orally once daily x 4 weeks. Maintenance therapy: 15 mg once daily. Gastric ulcer: 30 mg orally once daily for up to 8 weeks.   Erosive esophagitis: Short-term treatment: 30 mg orally once daily for up to 8 weeks. Continued treatment for an additional 8 weeks may be considered for recurrence or for patients that do not heal after the first 8 weeks of therapy. Maintenance therapy: 15 mg once daily. Alternatively: 30 mg IV once daily for up to 7 days. Patients should be switched to an oral formulation as soon as they can take oral medications. Hypersecretory conditions: Initially 60 mg orally once daily. Adjust dose based upon patient response and to reduce acid secretion to <10 mEq/hour (5 mEq/hour in patients with prior gastric surgery). Doses of 90 mg twice daily have been used. Administer doses >120 mg/day in divided doses Prevention of rebleeding in peptic ulcer bleed (unlabeled use): 60 mg IV, followed by 6 mg/hour infusion for 72 hours. Supplied: delayed release capsule: 15 mg, 30 mg. Oral suspension: 15 mg/packet, 30 mg/packet. Injection (powder for reconstitution): 30 mg.    Orally-disintegrating tablet: 15 mg, 30 mg. Omeprazole Prilosec ® Usual: 20-40mg orally once daily. Hypersecretory: 60mg once daily. Pantoprazole Protonix ® Adult (usual): Short-term treatment erosive esophagitis: 40 mg orally once daily for 8-16 weeks. Alternatively, 40 mg IV once daily infusion for 7-10 days. Gastroesophageal reflux disease (maintain healing erosive esophagitis): 40 mg orally once daily. Hypersecretory conditions: 80 mg IV infusion every 12 hours. Can increase to every 8 hours - Max: 240 mg/day. Alternatively: 40 mg orally twice daily. Max: 240 mg/day. Peptic ulcer: 40-80 mg orally once daily x 4-8 weeks. Prevention of rebleeding in peptic ulcer bleed (unlabeled use): 80 mg IV, followed by 8 mg/hour infusion for 72 hours [Supplied: Enteric coated tablet: 20, 40mg.   Lyophilized powder: 40mg vial.] Rabeprazole Sodium Aciphex ® 20 mg once daily. The recommended starting oral dose for the treatment of hypersecretory conditions is 60mg once daily (may increase up to 120 mg). Give on empty stomach before meals. Do not chew or crush. [Supplied: 20mg tab]  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.");s1[86]=new Array("psoriasis_topicals.htm","Topical agents-  psoriasis: dosing list for health care providers, pharmacists, nurses, physicians. ","","Psoriasis (Oral & Topical agents) acitretin Soriatane ® Retinoid. Individualization of dosage is required to achieve maximum therapeutic response while minimizing side effects. Dosing: ( treatment of severe psoriasis) Therapy should be initiated at 25 or 50 mg per day, given as a single dose with the main meal. Maintenance doses of 25 to 50 mg per day may be given after initial response to treatment. In general, therapy should be terminated when lesions have resolved sufficiently. Relapses may be treated as outlined for initial therapy.   [Supplied: 10, 25mg capsule] alefacept Amevive ® (Monoclonal antibody). Recombinant leukocyte function-associated antigen-3 (LFA-3)-immunoglobulin G1 (IgG1) fusion protein.  Net result: reduction in the activation of T-lymphocytes in psoriasis (inflammatory mediators reduced in etc). Dosing (adults): 7.5 mg IV weekly or 15 mg IM have been effective in plaque psoriasis. Optimal doses/schedules remain to be established. Usual duration of treatment is 12 weeks. Second course: A second course of treatment may be initiated at least 12 weeks after completion of the initial course of treatment, provided CD4+ T-lymphocyte counts are within the normal range. Monitoring: CD4+ T-lymphocyte counts should be monitored before initiation of treatment and weekly during therapy. Dosing should be withheld if CD4+ counts are <250 cells/µL, and dosing should be permanently discontinued if CD4+ lymphocyte counts remain at <250 cell/µL for longer than 1 month. [Supplied: Injection (powder for reconstitution): 7.5mg, 15 mg. ]  Anthralin  Drithocreme ® Synthetic tar derivative. Dosing: Apply once daily at bedtime, covered with dressing, and removed after 8 to 24 hours. Therapy is usually initiated with 0.1% topical cream, ointment, or paste, gradually increasing concentrations to an optimal response level within acceptable patient skin irritation limits. Alternatively, a short-contact regimen that uses higher initial concentrations of anthralin (1% to 3%) may be applied for 5 to 60 minutes. Anthralin concentrations are increased every 3 to 4 days until patient intolerance occurs. Therapy continues until psoriatic plaques clear. Maintenance therapy is infrequently used. Supplied: [ointment, cream: 0.1, 0.25, 0.5, 1%].  Calcipotriene Dovonex ® Synthetic vitamin D3 derivative.  Indicated for the treatment of plaque psoriasis. Apply twice daily. Supplied: 0.005% ointment /cream/ solution. efalizumab Raptiva ® Monoclonal antibody. Immunosuppressant (blocks multiple T-cell mediated responses involved in the pathogenesis of psoriatic plaques.)  Dosing (adults): Tx of psoriasis: 0.7 mg/kg SQ initially, followed by weekly dose of 1 mg/kg (maximum: 200 mg/dose). Supplied: Injection (powder for reconstitution): provides 125 mg/1.25 ml after dilution. Tazarotene Tazorac ® Retinoid.   Indicated for the topical treatment of patients with stable plaque psoriasis of up to 20% body surface area involvement. Psoriasis: Apply a thin film to lesions at bedtime (no more than 20% of body surface area). Avoid application to unaffected skin.  ACNE: apply a thin film to dry skin once a day in the evening. Supplied: gel: 0.05, 0.1%  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.");s1[87]=new Array("renalfx.htm","Renal failure (Commonly used agents): dosing list for health care providers, pharmacists, nurses, physicians. ","Renal failure (Commonly used agents): dosing list for health care providers, pharmacists, nurses, physicians. ","Renal Failure Renal failure/Oliguria (General guidelines)  (1) Avoid magnesium containing products (Maalox etc), NSAID’s, and nephrotoxins. (2) Consider fluid challenge to rule out pre-renal azotemia if not fluid overloaded. (3) Lasix: IV bolus 10-200 mg (usually every 2 hours). Doses > 200mg should be infused at 4 to 10 mg/min (usually 4 mg/min) to minimize ototoxicity. IV infusion of 0.25 to 0.4 mg/kg/hour titrated to urine output. (4) Metolazone (Zaroxylyn ® ) 5-10 mg po qd (max 20 mg/day) (5) Bumetanide (Bumex ®): IV bolus 0.5 to 4mg over 1-2min prn (usually q2-3 hr). IV infusion: usually 0.5 to 1 mg/hr. T1/2= 1 to 1.5hr Duration of action: 2-4hrs. (6) Torsemide (Demadex ®): IV bolus: 5 to 100 mg over 1-2 minutes. IV infusion: 5 to 20 mg/hr. [1 mg Bumex] = [10-20 mg Demadex] = [40 mg Lasix] (7) Mannitol: When instituting treatment with mannitol in patients with marked oliguria, a test dose should be used. Infusion of 0.2 grams/kg over 3 to 5 min should produce a diuresis of at least 30 to 50 ml/hr. A second test dose may be given if no response is seen—if no response with second dose—do not use. To treat oliguria: 12.5 to 25 grams IV every 2 to 4 hours. A 15 to 20% solution may be used. Rate should be adjusted to maintain urinary output at 30-50 ml/hr. (Usual test dose= 12.5 grams over 3 to 5 minutes. ) paricalcitol Zemplar ® Indicated for the prevention and treatment of secondary hyperparathyroidism associated with chronic renal failure. Synthetic vitamin D analogue. Dosing: 0.04 to 0.1 mcg/kg (2.8 to 7.0 mcg) IV 3 times/week at dialysis. Max dose 0.24 mcg/kg (16.8 mcg). sevelamer Renagel ® Calcium/aluminum free phosphate binder. Decreases phosphate levels without altering calcium, aluminum, or bicarbonate concentrations. ESRD (hyperphosphatemia): 2-4 (800-1600 mg) caps orally three times daily with meals. Note: the dose may be based on serum phosphorous. Initial phosphate level:     >6.0 mg/dl and <7.5 mg/dl: 800 mg 3 times/day     >7.5 mg/dl and <9.0 mg/dl: 1200-1600 mg 3 times/day     >9.0 mg/dl: 1600 mg 3 times/day Adjustment: Dosage should be adjusted based on serum phosphorous concentration, with a goal of lowering to <6.0 mg/dl.  Supplied: 400 mg, 800 mg tablet Calcium acetate PhosLo ® Hyperphosphatemia: Start 2 tablets (1334 mg) with each meal. Range: 2 to 4 tablets with each meal.  Can be increased gradually to bring the serum phosphate value <6 mg/dl as long as hypercalcemia does not develop. Usual dose: (3 to 4 tablets) 2001-2868 mg with each meal. [Supplied: 667mg tablet, Gelcap] Doxercalciferol Hectorol ® Management of secondary hyperparathyroidism in patients undergoing chronic renal dialysis. Synthetic vitamin D analog. Initial dose of doxercalciferol is 10 mcg administered three times weekly at dialysis. The maximum recommended dose of doxercalciferol is 20 mcg administered three times a week at dialysis for a total of 60 mcg/week Ferric Sodium Gluconate Ferrlecit ® Indicated for the treatment of iron deficiency anemia in patients undergoing chronic hemodialysis who are receiving supplemental erythropoietin therapy. The recommended dosage of ferric sodium gluconate for the repletion treatment of iron deficiency in hemodialysis patients is 10 ml of ferric sodium gluconate (125 mg of elemental iron) diluted in 100 ml of 0.9% sodium chloride solution administered intravenously over 1 hour. Most patients will require a minimum cumulative dose of 1 gram of elemental iron, administered over eight sessions at sequential dialysis treatments to achieve favorable hemoglobin or hematocrit response.  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc. Author: David McAuley Keywords: Renal failure,pharmacists, nursing, physicians,health care providers, Zemplar, Renagel, Phoslo, Hectoral, Ferrlecit, phosphate, creatinine");s1[88]=new Array("asthma.htm","Pulmonary Medications","Asthma--dosing list for health care providers, pharmacists, nurses, physicians.","Pulmonary Medications Anticholinergics | Beta-2 agonists | Combination products | Corticosteroids | Leukotriene Inhibitors | Mast cell stabilizers | Other Anticholinergics      [TOP] ipratropium Atrovent ® Blocks the action of acetylcholine at parasympathetic sites in bronchial smooth muscle causing bronchodilation. Adult (usual): Nebulization: 500 mcg (one vial) 3-4 times/day with doses 6-8 hours apart. Metered dose inhaler: 2 puffs 4 times/day - up to 12 puffs /24 hours. Supplied: Nebulization (soln): 0.02% (2.5 ml). MDI: 18 mcg/actuation. tiotropium Spiriva ® Anticholinergic agent (bronchodilator). Adult (usual): COPD: Oral inhalation: Contents of 1 capsule (18 mcg) inhaled once daily using HandiHaler® device. Beta-2 agonists (short acting)       [TOP] albuterol Proventil ® Beta-2 Agonist.  Adult (usual): Asthma: 1-2 puffs every 4-6 hours as needed. Maximum: 12 inhalations/day. Prophylaxis of exercise-induced bronchospasm: MDI: 2 puffs 5-30 minutes prior to exercise. Nebulized 2.5 mg 3-4 times daily. Tablets: 2-4 mg orally 3-4 times daily. Sustained release tablets: 4-8 mg q12h (Maximum dose: 32 mg/day). Acute treatment of bronchospasm: MDI (90 mcg/puff): 4-8 puffs every 20 minutes for up to 4 hours, then every 1-4 hours as needed. Nebulization: 2.5 mg (3ml)  3-4 times/day over 5-15 minutes. Bronchospasm in ICU patients (acute): Nebulization: 2.5-5 mg every 20 minutes for 3 doses, then 2.5-10 mg every 1-4 hours as needed, or 10-15 mg/hour continuously. bitolterol Tornalate ® (Beta-2 agonist):  Adult (usual): Bronchospasm, acute: MDI 2 puffs separated by 1-3 minutes, follow with third as needed.  Bronchospasm, prevention: MDI, 2 puffs q8h, Maximum of 3 puffs q6h or 2 puffs q4h.  Bronchospasm, prevention: (intermittent flow nebulizer) 0.5-1 ml (1-2 mg) 3-4 times per day (Maximum of 8 mg/day).  Bronchospasm, prevention: (continuous flow nebulizer) 1.25 ml (2.5 mg) 3-4 times/day. (Maximum of 14 mg/day).  Supplied [0.8% aerosol.  0.2% (2 mg/ml) inhalation Soln]. levalbuterol Xopenex ® Beta-2 agonist. Adult (usual): Bronchospasm:  MDI: Aerosol: 1-2 puffs every 4-6 hours.  Nebulization: 0.63 mg 3 times/day at intervals of 6-8 hours. Dosage may be increased to 1.25 mg 3 times/day with close monitoring for adverse effects. Most patients gain optimal benefit from regular use. pirbuterol Maxair ® Adult (usual): Asthma: 1-2 puffs every 4-6 hours (up to 12 puffs/day). metaproterenol Alupent ® Adult (usual): Asthma, bronchospasm:  20 mg orally 3-4 times/day. Oral aerosol inhalation: 2-3 puffs q3-4 hours (Max of 12 puffs/day).  Nebulizer: 0.3 ml (5%) in 2.5 ml NS q4-6 hours prn.  Beta-2 agonists (Long acting)      [TOP] formoterol Foradil ® (Long-acting Beta-2 agonist): Adult (usual): Asthma (maintenance therapy): Oral inhalation - 12 mcg (1 capsule) q12h via aerolizer inhaler. (Maximum of 24 mcg/day).  COPD: Oral inhalation 12 mcg (1 capsule) q12h via aerolizer inhaler.  Exercise-induced bronchospasm (EIB): 12 mcg (1 capsule) at least 15 min before exercise as needed.    Supplied: [12 mcg capsule] salmeterol Serevent ® MDI: Inhale 2 puffs twice a day. (Do not exceed). Serevent Diskus:      Asthma: usual dosage for adults and children 4 years of age and older is 1 inhalation (50 mcg) twice daily (morning and evening, approximately 12 hours apart). If symptoms arise in the period between doses, an inhaled, short-acting beta 2 -agonist should be taken for immediate relief.          COPD: usual dosage for adults is 1 inhalation (50 mcg) twice daily (morning and evening, approximately 12 hours apart).        Prevention of Exercise-Induced Bronchospasm (EIB): One inhalation at least 30 minutes before exercise. Additional doses should not be used for 12 hours after the administration of this drug. If regular, twice-daily dosing is not effective in preventing EIB, other appropriate therapy for EIB should be considered. Combination (Beta2 agonist + Corticosteroid)      [TOP] Advair ® fluticasone + salmeterol Adult (usual): Asthma: 1 puff twice daily (morning and evening) approximately 12 hours apart. More frequent administration (more than twice daily) or a higher number of inhalations (more than 1 puff twice daily) is not recommended.   [Supplied: Advair Diskus: 100/50, 250/50 ,500/50 ] Combivent ® albuterol + ipratropium Adult (usual): COPD: (MDI): 2 inhalations 4 times daily (Max of 12 puffs/day).   Inhalation solution: one 3 ml vial via nebulization 4 times daily (Max of 6 doses/day).  Symbicort ® budesonide + formoterol Adult (usual): 1-2 inhalations once or twice daily (Maximum daily maintenance dose: 4 inhalations).  Maximum dose during worsening asthma: 4 inhalations twice daily. [Supplied: 100/6 and 200/6] Inhaled Corticosteroids      [TOP] beclomethasone Vanceril ® Beclovent ® Inhale 2 puffs 3 to 4 times daily or 4 puffs twice a day. budesonide Pulmicort ® Adult (usual): Asthma: 1-4 puffs twice daily (Max of 4 puffs bid). Note: patients with mild symptoms may be converted to once daily administration (1-2 puffs qd).  [Supplied: MDI 200 mcg/inhalation] flunisolide Aerobid ® inhale 2-4 puffs twice a day. fluticasone Flovent ® Inhale 2-4 puffs twice a day.  Supplied: [44,110,220 mcg] triamcinolone Azmacort ® inhale: 2 puffs 3 to 4 times a day or 4 puffs twice a day. Maximum: 16 puffs/day. Leukotriene inhibitors      [TOP] montelukast Singulair ® Leukotriene Receptor Antagonist.  Adult (usual): Asthma or allergic seasonal rhinitis: 10 mg orally once daily in the evening. Supplied: 10 mg tablet.  4mg, 5mg chewable tablet. zafirlukast Accolate ® 20 mg orally twice daily between meals. zileuton Zyflo ® 600 mg orally 4 times a day. Mast Cell stabilizers      [TOP] cromolyn sodium Intal ® Inhale 2 puffs 4 times a day. nedocromil Tilade ® Inhale 2 puffs 4 times a day. Other      [TOP] acetylcysteine Mucomyst ® Acetadote ® Mucolytic agent. Adult (usual): Acetaminophen poisoning:  140 mg/kg orally, followed by 17 doses of 70 mg/kg every 4 hours. Repeat dose if emesis occurs within 1 hour of administration. Therapy should continue until all doses are administered even though the acetaminophen plasma level has dropped below the toxic range. Alternatively: Give Acetadote ®: Loading dose: 150 mg/kg IV over 15 minutes. Maintenance dose: 50 mg/kg infused over 4 hours followed by 100 mg /kg infused over 16 hours. Note: To avoid fluid overload in patients <40 kg and those requiring fluid restriction, decrease volume of D5W proportionally. Adjuvant therapy in respiratory conditions: Note: Patients should receive bronchodilator 15 minutes prior to dose. Inhalation, nebulization: 10% and 20% solution. Dilute 20% solution with sodium chloride or sterile water for inhalation. 10% solution may be used undiluted: 3-5 ml of 20% solution or 6-10 ml of 10% solution until nebulized - given 3-4 times/day. Dosing range: 1-10 ml of 20% solution or 2-20 ml of 10% solution every 2-6 hours. Into tracheostomy: 1-2 ml of 10% to 20% solution every 1-4 hours. Decrease risk of contrast-induced nephropathy: (4 doses total): 600 mg (3ml) po BID on the day before the contrast injection, then 600 mg (3ml) in a.m. on the day of the contrast injection (immediately before) and 600 mg (3ml) in the evening. In all cases the patient should be well hydrated. This is particularly important in patients with underlying renal dx or diabetes mellitus. Hydrate patient with saline concurrently. Supplied: (Mucomyst ® soln): 10% [100 mg/ml] - 4 ml, 10 ml, 30 ml. 20% [200 mg/ml] - 4 ml, 10 ml, 30 ml. (Acetadote ® injection): 20% [200 mg/ml] (30 ml) aminophylline /theophylline: Maximum rate: 25 mg/min. IV loading: 5 mg/kg TBW based on theophylline or 6 mg/kg based on aminophylline. Previous therapy: [Loading dose= 0.5 L/kg TBW x (desired level - current level)] IV maintenance dose based on IBW and theophylline. For aminophylline dosing divide result by 0.8. Adult non-smoker: 0.4 mg/kg/hr Adult (smoker): 0.7 mg/kg/hr Elderly (smoker): 0.5 mg/kg/hr Elderly (non-smoker)/ CHF/ Liver disease: 0.2 mg/kg/hr. Obtain level 24-48 hours after initiation of therapy. Average half-life: 3 to 12 hrs. Vd: 0.5 L/kg. Therapeutic range: 5-20 mcg/ml. IVPB is the least desirable route of admin. It is less effective than a continuous infusion. IVPB-cyclic improvement is seen at the peak with a rapid decline towards the trough.  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc. Author: David McAuley Keywords: Asthma, pharmacists, nursing, physicians,health care providers,vanceril, aerobid, azmacort, flovent, singulair,accolate, zyflo, tilade, serevent, intal");s1[89]=new Array("sore_throat.htm","Sore throat - dosing list for health care providers, pharmacists, nurses, physicians.","","Sore throat: Cepacol (benzocaine 10mg + menthol 2mg): Dissolve one lozenge in mouth every 2-4 hours as needed. Chloraseptic throat spray (phenol 1.4 %): Spray 5 times onto throat, gums or canker sore every 2-4 hours as needed.  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.  ");s1[90]=new Array("lipid.htm","HMG CoA Reductase Inhibitors","Lipid lowering agents: dosing list for health care providers, pharmacists, nurses, physicians. Lipitor, Baycol, Lescol, Pravachol, Zocor, Tricor.","HMG COA reductase inhibitors: atorvastatin Lipitor ® Initially: 10 mg orally once daily. Maximum of 80 mg/day fluvastatin Lescol ® Initially: 20-40 mg orally at bedtime, Maximum of 80 mg/day. lovastatin Mevacor ® Initially: 20 mg orally every evening. Maximum: 80 mg/day. pravastatin Pravachol ® Initially: 10-20 mg orally at bedtime,  Maximum of 40 mg/day. Rosuvastatin Crestor ® Initially: 10 mg once daily (20 mg in patients with severe hypercholesterolemia). Conservative dosing: Patients requiring less aggressive treatment or predisposed to myopathy (including patients of Asian descent): 5 mg once daily. Titration: After 2 weeks, may be increased by 5-10 mg once daily. Dosing range: 5-40 mg/day (maximum dose: 40 mg once daily) Dosage restrictions: Rosuvastatin dose should not exceed 5 mg/day if co-administered with Cyclosporine. Rosuvastatin dose should not exceed 10 mg/day co-administered with Gemfibrozil. Patients with crcl <30: Initial: 5 mg/day. Do not exceed 10 mg once daily. Supplied: 5 mg, 10 mg, 20 mg, 40 mg tablet. simvastatin Zocor ®  Initially: 20 mg orally every evening.  Max: 80 mg/day. Combination products: Advicor ® (lovastatin + niacin SR ): Indicated for the treatment of primary hypercholesterolemia (heterozygous familial and nonfamilial) and mixed dyslipidemia. Usual initial dose: 500 mg/20 mg. The dose of Advicor should not be increased by more than 500 mg daily (based on the niacin component) every 4 weeks. Doses > 2000 mg/40 mg daily are not recommended.   Supplied: 20/500, 20/750mg, 20/1000mg tablet. Vytorin ® (simvastatin + ezetimibe ): HMG-CoA reductase inhibitor + cholesterol absorption inhibitor.  Usual initial dose: Ezetimibe 10 mg and simvastatin 20 mg once daily in the evening.  Patients who require >55% reduction in LDL-C: Initial: Ezetimibe 10 mg and simvastatin 40 mg once daily. Renal dosing: In severe dysfunction, start only if patient tolerates 5 mg daily of simvastatin. Monitor closely. Supplied: ( Ezetimibe / simvastatin) 10/10 , 10/20, 10/40, 10/80. Other: ezetimibe Zetia ® Selective cholesterol absorption inhibitor. Adult (usual): Hypercholesterolemia: 10 mg po qd. Moderate reductions in low-density lipoprotein (LDL) cholesterol (less than 20%) have been reported with monotherapy in patients with hypercholesterolemia. As add-on therapy, it may enable reduced doses of statins. The drug is approved for primary hypercholesterolemia, for homozygous familial hypercholesterolemia (combined with atorvastatin or simvastatin), and for homozygous sitosterolemia. Supplied: 10 mg tablet.  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc. Author: David McAuley Keywords: HMG COA reducase inhibitors,pharmacists, nursing, physicians,health care providers,Lipitor, Baycol, Lescol, Mevacor, Pravachol, Zocor, Tricor, Lopid.");s1[91]=new Array("stimulants.htm","Simulants: dosing list for health care providers, pharmacists, nurses, physicians. ","Simulants: dosing list for health care providers, pharmacists, nurses, physicians. ","Stimulants atomoxetine Strattera ® Indication: attention-deficit/hyperactivity disorder (ADHD).  Dosing (usual): Treatment of ADHD in children and adolescents up to 70 kg body weight. Optimal doses appear to be 1.2 mg/kg daily, given once daily or in two divided doses. For children/adolescents over 70 kg body wt and adult patients, dose titration to 80 mg daily is recommended (single dose or two divided doses). Oral doses of 40 to 65 mg daily have administered for the treatment of depression in adults. benzphetamine Didrex ® Initial: 25-50 mg po qd. Titrate to 25-50 mg po 1-3 times daily. Max dose: 50 mg tid. [Supplied: 50 mg tablet] Caffeine  NoDoz ® Vivarin ® 100-200 mg orally every 3 to 4 hours as needed dexmethylphenidate Focalin ® CNS stimulant. d-threo -enantiomer of racemic methylphenidate hydrochloride. Indication: attention-deficit/hyperactivity disorder. Focalin is administered twice daily, at least 4 hours apart. Patients new to methylphenidate: recommended starting dose for patients who are not currently taking methylphenidate, or for patients who are on stimulants other than methylphenidate: 5 mg/day (2.5 mg twice daily). Dosage may be adjusted in 2.5 to 5 mg increments to a maximum of 20 mg/day (10 mg twice daily). In general, dosage adjustments may proceed at approximately weekly intervals. Patients currently using methylphenidate: recommended starting dose is half the dose of methylphenidate. The maximum recommended dose is 20 mg/day (10 mg twice daily). Dextroamphetamine Dexedrine ® Narcolepsy/ADHD: 2.5 to 10 mg orally every morning or 2 to 3 times daily. Long acting: 10-15mg orally once daily. diethylpropion Tenuate ® Adult (usual) Obesity: controlled release: 75 mg orally daily. Take mid-morning.  Obesity: immediate release: 25 mg orally 3 times a day, 1 hr before meals. May take 1 dose mid-evening, if desired, to overcome night hunger.    Supplied 75 mg CR,  25 mg tablet. Methylphenidate Ritalin ® Narcolepsy/ADHD: 5-10mg orally 2 to 3 times daily. (SR): 20mg orally once every morning. Modafinil  Provigil ® Narcolepsy: Usual dose: 200mg orally once daily.  [100, 200mg] Pemoline  Cylert ® Start 37.5 mg orally once daily in the morning. Usual effective dose: 56.25 to 75 mg/day. Max: 112.5 mg/day. Follow LFT's. phendimetrizine Bontril SR ® Prelu-2 ® Adult (usual) Obesity: sustained release forms: 105 mg orally once daily in the morning or before the morning meal. (Immediate release forms): 35 mg orally 2-3 times daily. Maximum: 70 mg 3 times daily. In some patients, one-half tablet (17.5 mg) was adequate.  [Supplied 105 mg SR, 35 mg tablet]   phentermine Fastin ® Ionamin ® 8 mg orally three times daily or 15 to 37.5 mg every morning. Supplied: 8, 15, 18.75, 30. 37.5 mg sibutramine Meridia ® Anorexiant. Start -Obesity: 10 mg orally every morning. After 4 weeks may titrate up to 15 mg once daily as needed and tolerated (may be used for up to 2 years).  Max: 15 mg/day. [Supplied: 5, 10, 15 mg capsule]  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc. Author: David McAuley Keywords: Stimulants, weight loss,pharmacists, nursing, physicians,health care providers, Vivarin, Dexedrine, Ritalin, Cylert, Fastin, Meridia, sibutramine");s1[92]=new Array("tetracyclines.htm","Tetracyclines","","Tetracyclines Doxycycline Vibramycin ® Dosing: 100mg po bid x 1 day then 100mg qd or divided bid  [Severe]: 100mg po bid or 100-200mg ivpb qd or divided doses q12h. Lyme disease: Oral: 100 mg twice daily for 14-21 days. 1) Acute gonococcal infection (PID) in combination with another antibiotic. 2)Community-acquired pneumonia, bronchitis. 3)Uncomplicated chlamydial infections: 100 mg every 12 hours. Sclerosing agent for pleural effusion injection: 500 mg as a single dose in 30-50 ml of NS or sterile water. Renal Dosing: No adjustments needed.  Hemodialysis: No adjustments needed. Minocycline Minocin ® Dosing: 200mg x 1, then 100mg q12h Renal Dosing: manufacturer recommends lower doses (specific regimen not mentioned). blood level should not exceed 15 mcg/ml. Tetracycline Achromycin ® Dosing: 250-500mg po q6h Renal Dosing: [>50 ml/min]: usual dose q8-12h.  [10-50]: usual dose q12-24h.  [<10]: q24h (recommend avoid use). Hemo: Usual dose q24h (recommend avoid use)  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.");s1[93]=new Array("thrombo.htm","Medications which may reduce the platelet count. Thrombocytopenia","Medications which may reduce the platelet count. Thrombocytopenia","Medications which may cause thrombocytopenia A | B | C | D | E |  F | G | H |  I  | J | K | L  M | N | O | P | Q | R | S | T | U | V W | X | Y | Z acetaminophen A acetazolamide top aminoglutethimide  amphotericin B  amrinone  amiodarone  atorvastatin  Augmentin  asparaginase  bactrim (TMP/SMX) B barbiturates top captopril C carbamazepine  cefotetan  cephalothin  chloramphenicol top chloroquine  chlorothiazide  chlorpromazine  chlorpropamide  cimetidine  codeine  cyclophosphamide  dalteparin D danazol  desipramine  diazepam top diazoxide  diclofenac  diethylstilbestrol  digoxin  enoxaparin E eptifibatide (Integrilin)  erythromycin  estrogen top ethambutol  famotidine F fluconazole  fluorouracil top furosemide  gemcitabine G gold salts  gentamicin  glyburide  haloperidol H heparin (including available LMWH's)  hydrochlorothiazide top Imipenem (Primaxin) I indinavir  indomethacin  interferon alfa  iopanoic acid top isoniazid  levamisole L linezolid (Zyvox)  lansoprazole  lithium  meloxicam M meperidine  meprobamate  mesalamine top methicillin  methyldopa  methimazole  minoxidil  methotrexate  nitroglycerin N omeprazole O pantoprazole P penicillamine  penicillins  pentoxifylline top phenothiazine's  phenylbutazone  phenytoin  piperacillin  prednisone  procarbazine  propylthiouracil  quinine Q quinidine top rabeprazole R ranitidine  reserpine top rifampin  Sinemet (levodopa component) S streptomycin  sulfasalazine  sulfonamides top sulindac  tamoxifen T tetracycline's  tirofiban (Aggrastat)  ticlopidine top tolbutamide  valproic acid (Depakote, Depakene) V vancomycin   top   Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc. Author: David McAuley Keywords: platelets, thrombocytopenia, reduced platelet count, hematological side effects");s1[94]=new Array("thrombolytics.htm","Thrombolytics","","Thrombolytics alteplase Activase ®, t-PA Acute MI: (>67kg): 15 mg IV bolus over 1-2 minutes, then 50 mg over 30 minutes, then 35 mg over next 60 minutes. (<67kg): 15 mg IV bolus, followed by 0.75 mg/kg (maximum 50mg) over 30 minutes, then 0.5 mg/kg (maximum 35mg) over the next 60 minutes.  Note: Concurrently, begin heparin 60 units/kg bolus (maximum: 4000 units) followed by continuous infusion of 12 units/kg/hour (maximum: 1000 units/hour) and adjust to aPTT target of 1.5-2 times the upper limit of control. Infuse remaining 35 mg of alteplase over the next hour. Acute PE: 100mg IV over 2 hours, then restart heparin when PTT < twice normal. Acute ischemic stroke: Doses should be given within the first 3 hours of the onset of symptoms. Recommended total dose: 0.9 mg/kg (maximum dose should not exceed 90 mg) infused over 60 minutes. Load with 0.09 mg/kg (10% of the 0.9 mg/kg dose) as an IV bolus over 1 minute, followed by 0.81 mg/kg (90% of the 0.9 mg/kg dose) as a continuous infusion over 60 minutes. Heparin should not be started for 24 hours or more after starting alteplase for stroke. Central venous catheter clearance: Intracatheter (Cathflo™ Activase® 1 mg/ml):  Patients <30 kg: 110% of the internal lumen volume of the catheter, not to exceed 2 mg/2 ml. Retain in catheter for 0.5-2 hours. May instill a second dose if catheter remains occluded.   Patients >30 kg: 2 mg/2ml- retain in catheter for 0.5-2 hours - may instill a second dose if catheter remains occluded. Acute peripheral arterial occlusive disease (unlabeled use): Intra-arterial: 0.02-0.1 mg/kg/hour for up to 36 hours. Supplied: 50 mg, 100 mg vial ( powder for reconstitution). Cathflo: 2 mg. reteplase Retavase ® Acute MI: 10 units IV over 2 minutes; repeat in 30 minutes. Each bolus injection should be given via an intravenous line in which no other medication is being simultaneously injected or infused. There is no experience with patients receiving repeat courses of therapy with Retavase ®. streptokinase: Adults: Antibodies to streptokinase remain for at least 3-6 months after initial dose: Administration requires the use of an infusion pump. An intradermal skin test of 100 units has been suggested to predict allergic response to streptokinase. If a positive reaction is not seen after 15-20 minutes, a therapeutic dose may be administered. Acute MI: 1.5 million units IV over 60 minutes.  ( Administer as soon as possible after onset of symptoms. The greatest benefit in mortality reduction was observed when Streptokinase was administered within four hours, but statistically significant benefit has been reported up to 24 hours).  Administration: Dilute two 750,000 unit vials of streptokinase with 5 mL dextrose 5% in water (D5W) each, gently swirl to dissolve. Add this dose of the 1.5 million units to 150 mL D5W. This should be infused over 60 minutes; an in-line filter 0.45 micron should be used. Monitor for the first few hours for signs of anaphylaxis or allergic reaction. Infusion should be slowed if blood pressure falls by 25 mm Hg or terminated if asthmatic symptoms appear. Following completion of streptokinase, initiate heparin, if directed, when aPTT returns to less than 2 times the upper limit of control; do not use a bolus, but initiate infusion adjusted to a target aPTT of 1.5-2 times the upper limit of control. If prolonged (>48 hours) heparin is required, infusion may be switched to subcutaneous therapy. Acute pulmonary embolism (APE): 3 million unit dose over 24 hours. Administration: Dilute four 750,000 unit vials of streptokinase with 5 mL dextrose 5% in water (D5W) each, gently swirl to dissolve. Add this dose of 3 million units to 250 mL D5W, an in-line filter 0.45 micron should be used. Administer 250,000 units (23 mL) over 30 minutes followed by 100,000 units/hour (9 mL/hour) for 24 hours. Monitor for the first few hours for signs of anaphylaxis or allergic reaction. Infusion should be slowed if blood pressure is lowered by 25 mm Hg or if asthmatic symptoms appear. Begin heparin 1000 units/hour about 3-4 hours after completion of streptokinase infusion or when PTT is <100 seconds. Monitor PT, PTT, and fibrinogen levels during therapy. Important note: Since human exposure to streptococci is common, antibodies to Streptokinase are prevalent. Thus, a loading dose of Streptokinase sufficient to neutralize these antibodies is required. A dose of 250,000 IU of Streptokinase infused into a peripheral vein over 30 minutes has been found appropriate in over 90% of patients. Furthermore, if the thrombin time or any other parameter of lysis after 4 hours of therapy is not significantly different from the normal control level, discontinue Streptokinase because excessive resistance is present. Thromboses: 250,000 units to start, then 100,000 units/hour for 24-72 hours depending on location. Cannula occlusion: 250,000 units into cannula, clamp for 2 hours, then aspirate contents and flush with normal saline; Not recommended. tenecteplase TNKase ® Treatment should be initiated as soon as possible after the onset of AMI symptoms. The recommended total dose should not exceed 50 mg and is based upon patient weight. A single bolus dose should be administered over 5 seconds based on patient weight. Dose Information Table Patient Wt (kg) TNKase (mg)  Volume (ml) over 5 seconds < 60                           30mg                  6ml 60 to < 70                   35                      7 70 to < 80                   40                      8 80 to < 90                   45                      9 Over 90                      50                     10  Preparation: dilute 50mg vial with 10ml sterile water (packaged with diluent and syringe). [Suppied: lyophilized powder in a 50 mg vial]. All patients received 150-325 mg of aspirin as soon as possible and then daily. Intravenous heparin was initiated as soon as possible and aPTT was maintained between 50-70 seconds. Do not shake when reconstituting. Slight foaming is normal and will dissipate if left standing for several minutes. The reconstituted solution is 5 mg/mL. Any unused solution should be discarded. Tenecteplase is incompatible with dextrose solutions. Dextrose-containing lines must be flushed with a saline solution before and after administration. Administer as a single I.V. bolus over 5 seconds. Supplied: 50 mg vial ( powder for reconstitution). urokinase Myocardial infarction: 6000 international units/minute infused into the occluded coronary artery for up to 2 hours (therapy should be continued until the artery is maximally opened, usually 15 to 30 minutes). Pulmonary embolism: loading dose, 4400 international units/kg IV over 10 minutes (90 mL/hr), followed by continuous infusion, 4400 international units/kg/hr IV for 12 hours (15 mL/hr), flush line at end of infusion. Occluded catheter: 5000 international units instilled into occluded catheter, up to 2 doses may be used. (attempt to aspirate blood after 5 minutes of dwell time, if successful, aspirate 4-5 mL of blood and flush gently with NS, if unsuccessful, repeat every 5 minutes, if catheter is not open in 30 minutes, allow to dwell 30-60 more minutes and repeat catheter clearance: if still unsuccessful, a second dose may be instilled.) Reconstitute vial with 5 mL sterile water c/o preservatives - DO NOT shake. Deep vein thrombosis (unlabeled use): I.V.: Loading: 4400 units/kg over 10 minutes, then 4400 units/kg/hour for 12 hours Adults: Acute pulmonary embolism: I.V.: Loading: 4400 units/kg over 10 minutes; maintenance: 4400 units/kg/hour for 12 hours. Following infusion, anticoagulation treatment is recommended to prevent recurrent thrombosis. Do not start anticoagulation until aPTT has decreased to less than twice the normal control value. If heparin is used, do not administer loading dose. Treatment should be followed with oral anticoagulants. Myocardial infarction (unlabeled use): Intracoronary: 750,000 units over 2 hours (6000 units/minute over up to 2 hours) Occluded I.V. catheters (unlabeled use): 5000 units in each lumen over 1-2 minutes, leave in lumen for 1-4 hours, then aspirate; may repeat with 10,000 units in each lumen if 5000 units fails to clear the catheter; do not infuse into the patient; volume to instill into catheter is equal to the volume of the catheter.  I.V. infusion: 200 units/kg/hour in each lumen for 12-48 hours at a rate of at least 20 ml/hour Dialysis patients: 5000 units is administered in each lumen over 1-2 minutes; leave urokinase in lumen for 1-2 days, then aspirate ADMINISTRATION — Solution may be filtered using a 0.22 or 0.45 micron filter during I.V. therapy. Administer using a pump which can deliver a total volume of 195 ml. The loading dose should be administered at 90 ml/hour over 10 minutes. The maintenance dose should be administered at 15 mL/hour over 12 hours. I.V. tubing should be flushed with NS or D5W to ensure total dose is administered.  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.");s1[95]=new Array("thyroid.htm","Anti-Thyroid agents:  PTU, methimazole (Tapazole)","","Anti-Thyroid Agents methimazole Tapazole ® Adults: Initially 5 mg every 8 hours for mild hyperthyroidism; 10 mg orally every 8 hours for moderate; and 20mg orally every 8 hours for severe hyperthyroidism.//  Usual maintenance: 5-15 mg/day. [5,10mg tablets] propylthiouracil PTU Adults: initially 100mg orally every 8 hours (50-100mg every 8 hours if elderly). // If patient has severe hyperthyroidism: 150 mg orally every 8 hours initially. Some patients may require up to 600-900mg/day. // Usual maintenance dose: 100-150mg/day divided doses every 8 to 12 hours. [50mg tablet]  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.");s1[96]=new Array("toxicology.htm","Toxicology (Common agents): dosing list for health care providers, pharmacists, nurses, physicians. ","Toxicology (Common agents): dosing list for health care providers, pharmacists, nurses, physicians. ","Toxicology acetylcysteine Mucomyst ® Dosage (adult): Acetaminophen overdose: initial: 140 mg/kg orally, then 70 mg/kg q4h x 17 doses starting 4 hr after loading dose. Mucolytic: nebulize 1-10 ml of 20% solution or 2 to 20 ml of 10% solution every 2-6 hr. Usual dose: 6-10 ml of 10% solution or 3-5 ml of 20% solution.  Decrease risk of contrast-induced nephropathy: (4 doses total): 600 mg (3ml) po BID on the day before the contrast injection, then 600 mg (3ml) in a.m. on the day of the contrast injection (immediately before) and 600 mg (3ml) in the evening. In all cases the patient should be well hydrated. This is particularly important in patients with underlying renal dx or diabetes mellitus. Oral administration: dilute to 5% with soft drinks. Nebulizer administration: Give undiluted or dilute with NS or SWFI.  Supplied: 10%, 20% soln Charcoal: Single dose: (Adults): 30-100 grams or 1- 2 grams/kg.  Multiple dose: 20-60 grams or 0.5 - 1 gram/kg every 2 to 6 hours. deferoxamine Desferal ® Iron-chelating agent. Dosage (adult): Acute iron intoxication: 1 g IV/IM initially, then 500 mg every 4 hr for 2 doses, then subsequent doses of 500 mg every 4-12 hr as needed. MAX 6 g/day. Note: IV route is used when severe toxicity is evidenced by systemic symptoms (coma, shock, metabolic acidosis, or severe gastrointestinal bleeding) or potentially severe intoxications (serum iron level >500 mcg/dl). When severe symptoms are not present, the I.M. route may be preferred (per manufacturer). Chronic iron overload: 0.5-1 g/day IM, plus 2 g IV per unit of blood. Max of 1 g/day with no transfusion, 6 g/day if 3 or more units of infused blood or packed red blood cells. Alternative: 1-2 g SC (20-40 mg/kg/day) infused over 8-24 hr . Administration: IM route preferred for all patients with acute iron intoxication not in shock. IV administration only for patients in state of cardiovascular collapse and then only by slow infusion. Maximum IV rate: 15 mg/kg/hr for first 1000 mg. Subsequent IV dosing, if needed - Maximum rate 125 mg/hr. Renal dosing: crcl <10 ml/min: Administer 50% of dose. Supplied: Injection (powder for reconstitution): 500 mg, 2 g digoxin immune fab Digibind ® Reconstitution: Dissolve each vial with 4 ml sterile water (do not shake). May be further diluted with normal saline. Infuse over 30 minutes-- must use 0.22 micron filter. If cardiac arrest is imminent, may give as a bolus. Number of vials needed =[(steady state serum digoxin level (ng/ml) x weight (kg)] / 100. Each vial contains 38 mg which will bind approximately 0.5 mg of digoxin. Dosage for acute ingestion of unknown amount: 20 vials (760mg) of Digibind is adequate to treat most life-threatening ingestions. May consider giving 10 vials, observing the patient's response, and following with an additional 10 vials. Dosage for toxicity during chronic therapy: for adults, 6 vials (228mg) usually is adequate to reverse most cases of toxicity. This dose can be used in patients in acute distress or when a serum concentration is not available. flumazenil Romazicon ® Sedation reversal: 0.2 mg IV over 15 seconds, then 0.2 mg every minute as needed up to 1 mg total (most patients respond to doses of 0.6-1 mg). If resedation occurs, repeated doses may be administered at 20-minute intervals as needed. For repeat treatment, no more than 1 mg (given as 0.2 mg/min) should be administered at any one time, and no more than 3 mg should be given in any one hour. Overdose reversal: 0.2 mg IV over 30 seconds. If the desired level of consciousness is not obtained after waiting 30 seconds, a further dose of 0.3 mg IV over another 30 seconds may be given. Additional doses of 0.5 mg IV over 30 seconds at 1 minute intervals may be given up to a cumulative dose of 3 mg. In the event of resedation, repeated doses may be given at 20 minute intervals if needed. For repeat treatment, no more than 1 mg (given as 0.5 mg/min) should be given at any one time and no more than 3 mg should be given in any one hour. fomepizole  Antizol ® Dosing: loading dose: 15 mg/kg, followed by 10 mg/kg every 12 hours x 4 doses, then 15 mg/kg every 12 hours thereafter until ethylene glycol levels <20 mg/dl. Dialysis should be considered in addition to fomepizole in the case of renal failure, significant or worsening metabolic acidosis, or a measured ethylene glycol level >50 mg/dl. Fomepizole is dialyzable and should be given q4h during hemodialysis. MOA: complexes and inactivates alcohol dehydrogenase thus preventing formation of the toxic metabolites of the alcohols. Given by slow IV infusion over 30 minutes. methylene blue: methemoglobinemia: 1-2 mg/kg IV over 2 to 5 min. May dilute with normal saline. naloxone Narcan ® Treat narcotic-induced respiratory depression: 0.4 to 2 mg IV/SC/IM - repeat every 2 to 3 minutes as needed (if no response after 10 mg --- ? narc). IV infusion: ( 2 mg/500 ml per manufacturer) - Usual infusion rate: @ 0.4 mg/hr (100 ml/hr)-titrate to respiratory rate/ level of consciousness. sodium polystyrene sulfonate Kayexalate ® Dosage (adult): Hyperkalemia: 15 to 30 grams (60 ml) orally 1 to 4 times daily or 30-50 g rectally every 6 hours. Alternatively: 15 to 50g orally (bid-qid). Onset: within 1 - 2 hours. Duration: 4 - 6 hours. Supplied: Suspension: 15 g/60 ml. sorbitol 30-50 ml of 70% solution orally.  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.   Author: David McAuley Keywords: Toxicology,pharmacists, nursing, physicians,health care providers, activated charcoal, Digibind, Romazicon, Antizol,Narcan");s1[97]=new Array("tuberculosis.htm","Tuberculosis(Common agents): dosing list for health care providers, pharmacists, nurses, physicians. ","Tuberculosis(Common agents): dosing list for health care providers, pharmacists, nurses, physicians. ","Anti-mycobacterial Agents Ethambutol 15-25 mg/kg up to 2500 mg orally once daily. Isoniazid 10-20 mg/kg up to 300 mg orally once daily. Pyrazinamide 15-30 mg/kg up to 2000 mg orally once daily. rifabutin (Mycobutin): 300 mg orally once daily or 150 mg orally twice a day. Rifamate (INH 150mg + rifampin 300mg): 2 capsules orally once daily. Rifampin 10-20 mg/kg up to 600 mg oral or IV once daily. Synergy gram (+): (900-1200 mg/day): Usual dose: 300 mg orally every 8 hours. Some recommend 600 mg orally once daily. Rifapentine (Priftin): Cyclopentyl derivative of rifampin (longer duration of action and greater efficacy compared to rifampin) 600 mg orally twice weekly x 2 months, then once weekly x 4 months. (Twice weekly if HIV). Rifater  (INH50mg+rif 120mg +pyr300mg): 6 tabs orally once daily (if > 55kg). 5 tabs orally once daily if < 55 kg.  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc. Author: David McAuley Keywords: Tuberculosis,pharmacists, nursing, physicians,health care providers, ethambutol, isoniazid, pyrazinamide, Mycobutin, Rifamate, Priftin, Rifater,");s1[98]=new Array("topicals.htm","Topical agents - Miscellaneous agents: dosing list for health care providers, pharmacists, nurses, physicians. ","","Topicals - Other- Alitretinoin Panretin ® Initially: apply twice a day to cutaneous Kaposi's sarcoma lesions. The application frequency can be gradually increased to three or four times daily according to individual lesion tolerance. [Gel 0.1%] Baceplermin Regranex ® Platelet derived growth factor for topical treatment of lower extremity diabetic neuropathic ulcers that extend into or beyond the subcutaneous tissue and have an adequate blood supply. Diabetic ulcers: apply gel qd. [0.01% gel] Calamine: Apply lotion 3 to 4 times daily as needed. Capsaicin Zostrix ® Arthritis, post-herpetic or diabetic neuralgia: apply cream up to 3 to 4 times daily [0.025% and HP: 0.075%] Doxepin Zonalon ® Pruritus: apply four times daily for up to 8 days [5% cream] EMLA ® (lidocaine/prilocaine) Topical anesthesia: apply 2.5g cream or 1 disc to region at least 1 hour before procedure. Cover cream with occlusive dressing. fluorouracil  Efudex ® Actinic keratoses: apply twice daily x 2-6 weeks. Superficial basal cell carcinomas: apply 5% cream/solution twice daily. [1 & 5% cream. 1,2 & 5% solution] Masoprocol  Actinex ® Actinic keratoses: apply twice daily. [10% cream] Pimecrolimus Elidel ® Indication: short-term and intermittent long-term therapy in the treatment of mild to moderate atopic dermatitis in non-immunocompromised patients 2 years of age and older, in whom the use of alternative, conventional therapies is deemed inadvisable because of potential risks, or in the treatment of patients who are not adequately responsive to or intolerant of alternative, conventional therapies . Directions: Apply a thin layer to the affected skin twice daily and rub in gently and completely. Elidel may be used on all skin surfaces, including the head, neck, and intertriginous areas. Elidel should be used twice daily for as long as signs and symptoms persist. Treatment should be discontinued if resolution of disease occurs. If symptoms persist beyond 6 weeks, the patient should be re-evaluated. Should not be used with occlusive dressings. Selenium sulfide Selsun ® Dandruff, seborrheic dermatitis: apply 5-10 ml lotion/shampoo twice weekly x 2 weeks then less frequently thereafter. Tinea versicolor: apply 2.5% lotion/shampoo once daily x 7 days. Tacrolimus Protopic ® Immunosuppressant.  Indication: short-term and intermittent long-term therapy in the treatment of patients with moderate to severe atopic dermatitis in whom the use of alternative, conventional therapies are deemed inadvisable because of potential risks, or in the treatment of patients who are not adequately responsive to or are intolerant of alternative, conventional therapies. Directions (adults): (Oint 0.03% and 0.1%) - Apply a thin layer to the affected skin areas twice daily and rub in gently and completely. Treatment should be continued for one week after clearing of signs and symptoms of atopic dermatitis. Supplied: Ointment (0.03% and 0.1% for adults, and only 0.03% for children aged 2 to 15 years).  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.");s1[99]=new Array("topicals_antiviral.htm","Topical anti-Viral agents","","Viral (Topical): acyclovir Zovirax ® apply every 3 hours (6 times / day) for 7 days. Supplied: [5% ointment] docosanol Abreva ® Abreva Cream (Docosanol 10%): Uses: Treats cold sore/fever blisters on the face or lips. Shortens healing time and duration of symptoms: tingling, pain, burning, and/or itching. Directions: adults and children 12 years or over: wash hands before and after applying cream. Apply to affected area on face or lips at the first sign of cold sore/fever blister (tingle). Early treatment ensures the best results. Rub in gently but completely. Use 5 times a day until healed. imiquimod Aldara ® Genital/perianal warts: apply 3 times weekly- put on at bedtime and wash off in 6-10 hours.   [5% cream-single use packet] penciclovir Denavir ®  Herpes labialis: apply 1% cream every 2 hours while awake for 4 days. podofilox Condylox ® External genital warts (gel and solution): and perianal Warts (gel only): apply twice daily for 3 consecutive days of a week and repeat for up to 4 weeks. [0.5% gel, solution] podophyllin Podofin ® Warts: apply by physician. May dilute with ethanol.  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.");s1[100]=new Array("topical_antibacterial.htm","Antibacterials (Topical) ","","Antibacterials (Topical) bacitracin: apply 1 to 3 times daily. [ointment] metronidazole  Metrogel ® Rosacea: apply twice daily [gel 0.75%, cream 1%] mupirocin  Bactroban ® Impetigo/infected wounds: apply three times daily. [ cream/oint 2%]. Nasal MRSA eradication: (bactroban nasal): 1 gram divided between nostrils twice daily x 5 days. [1 gram single use tube] Neosporin ® (bacit/neom/poly): apply 1-3 times/day Polysporin ® (bacitracin/polymyxin): apply 1-3 times/day. [oint/aerosol/powder] silver sulfadiazine Silvadene ® apply once or twice daily [1% cream]  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.");s1[101]=new Array("antifungals_topical.htm","Antifungals (Topical)","Antifungals--dosing list for health care providers, pharmacists, nurses, physicians.","Antifungals (Topical) butenafine Mentax ® Apply cream once or twice daily. [cream 1%] ciclopirox Loprox ® Apply cream or lotion twice daily [cream/lotion 1%] clotrimazole Lotrimin ® Apply twice daily.  Supplied: [1% cream /solution /lotion] enconazole Spectazole ® Tinea: apply once daily. Candida: apply twice daily.  Supplied:[1% cream] ketoconazole: Nizoril ® Tinea/candida: apply once a day Supplied: [2% cream]. Seborrheic dermatitis: apply shampoo/cream once or twice daily. Dandruff: shampoo 2 times per week. miconazole Micatin ® Tinea/candida: apply twice a day. Supplie: [2% cream/powder/spray] naftifine Naftin ® Tinea: apply once daily (cream) or twice a day- (gel) nystatin: candidiasis: apply 2 to 3 times daily.  Supplied: [cream / powder/ ointment] oxiconazole Oxistat ® Tinea: apply once or twice daily.  Supplied: [cream/lotion 1%] terbinafine Lamisil ® Tinea: apply once or twice daily.  Supplied: [cream 1%] tolnaftate Tinactin ®  Apply twice a day. Supplied: [1% cream /powder/ gel /solution]  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc. Author: David McAuley Keywords: Antifungals, pharmacists, nursing, physicians,health care providers,amphotericin, fluconazole, flucytosine, clotrimazole, sporanox,ketoconazole, terbinafine, nystatin, lamisil, griseofulvin,loprox, tolnaftate, naftidine, econazole");s1[102]=new Array("antiparasitics_topical.htm","Anti-Parasitic Agents (Topical)","","Anti- Parasitic Agents (Topical) Crotamiton Eurax ® Scabies: apply cream/lotion from chin to feet. Repeat In 24hrs. Bathe after 48 hours. Pruritus: massage as needed. [cream/lot 10%] Lindane  Kwell ® Scabies: apply 30-60 ml of lotion/cream in a thin layer from the neck to the toes. Bathe and remove after 8-12 hours. Repeat treatment in 7 days if still present. Pediculosis, lice: 15-30 ml of shampoo-lather for 4-5 minutes. Rinse hair thoroughly and comb with a fine tooth comb to remove nits. May repeat in 7 days is still present. Permethrin Elimite ® Rid ® A200 ® Scabies: apply cream from to soles of feet and wash after 8-14 hours. May reapply in 1 week if live mites appear. [5% cream]. Head Lice (Nix rinse - 1%): After hair has been washed with shampoo, rinsed with water and towel dried, apply a sufficient volume of creme rinse to saturate the hair and scalp. Also apply behind the ears and at the base of the neck. Leave on hair for 10 minutes before rinsing off with water. Remove remaining nits. May repeat in 1 week if lice or nits still present. In areas of head lice resistance to 1% permethrin, 5% permethrin has been applied to clean, dry hair and left on overnight (8-14 hours) under a shower cap. Supplied: Cream: Elimite®: 5%.  Liquid creme rinse: (Nix®): 1% (60 ml).  Lotion: 1% (59 ml). Spray [for bedding and furniture]:  A200® Lice: 0.5% (180 ml).  Nix®: 0.25% (148 ml).  Rid®: 0.5% (150 ml). (pyrethrins, piperonyl butoxide) RID ®, A-200 ® Lice: Apply shampoo, wash after 10 minutes. Re-apply in 5-7 days. Treatment of Pediculus humanus infestations (head lice, body lice, pubic lice and their eggs): Apply enough solution to completely wet infested area, including hair. Allow to remain on area for 10 minutes. Wash and rinse with large amounts of warm water. Use fine-toothed comb to remove lice and eggs from hair. Shampoo hair to restore body and luster. Treatment may be repeated if necessary once in a 24-hour period.  Repeat treatment in 7-10 days to kill newly hatched lice.  Note: Keep out of eyes when rinsing hair; protect eyes with a wash cloth or towel. Supplied: Cream: Pyrethrins 0.33% and piperonyl butoxide 4% (60 g). Foam [mousse] (RID® Maximum Strength): Pyrethrins 0.33% and piperonyl butoxide 4% (156 g). Gel (Tisit® Blue Gel): Pyrethrins 0.33% and piperonyl butoxide 3% (30 g). Liquid (Tisit®): Pyrethrins 0.33% and piperonyl butoxide 2% (60 mL, 120 mL). Shampoo: Pyrethrins 0.33% and piperonyl butoxide 4% (60 mL, 120 mL).  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.");s1[103]=new Array("corticosteroids_topical.htm","Corticosteroids (Topical)","","Corticosteroids (Topical) Low Potency Aclometasone diproprionate  Aclovate ® Apply 2 to 3 times daily. [0.05% cream/ointment] Desonide DesOwen ® apply 2 to 3 times daily. [0.05% cream] Flucinolone acetonide Synalar ® apply 2 to 4 times daily. [0.01% cream/solution] Hydrocortisone Hytone ®, Cortaid ®, other): Apply 3 to 4 times daily. [0.25%--liquid , 0.5%, 1%, 2.5%] Medium Potency Betamethasone dipropionate Diprosone ® (Lotion 0.05%): apply once or twice daily. betamethasone valerate: Apply once or twice daily. [0.1% cream] clocortolone pivalate Cloderm ® Apply three times daily. [0.1% cream] desoximetasone Topicort ® Apply 2 to 3 times daily. [0.05% cream] fluocinolone acetonide Synalar ® Apply 2 to 4 times daily. [0.025% cream/oint] flurandrenolide Cordran ® Apply 2 to 3 times daily. [0.025% cream/oint] [0.05% cream/oint/lotion] fluticasone propionate Cutivate ® Apply once ro twice daily. [0.05% cream, 0.005% oint] hydrocortisone butyrate Locoid ® Apply 2 to 3 times daily. [0.1% oint/soln] hydrocortisone valerate Westcort ® Apply 2 to 3 times daily. [0.2% cream/oint] mometasone furoate Elocon ® Apply once daily. [0.1% cream/oint/lotion] prednicarbate Dermatop ® Apply twice daily. [0.1% cream] triamcinolone Aristocort ®, Kenalog ® Apply 3 to 4 times daily. [0.025%, 0.1% cream, oint,lotion.] 0.5% cream,oint, aerosol] High Potency amcinonide Cyclocort ® Apply 2 to 3 times daily. [0.1% cream/oint/lotion] augmented betamethasone dipropionate  Diprolene ® Apply once or twice daily. [ 0.05% cream] betamethasone dipropionate Diprosone ® Apply once or twice daily. [0.05% cream, oint]. desoximetasone Topicort ® Apply twice daily. [0.25% cream/oint] [0.05% gel] diflorasone diacetate Maxiflor ® Apply twice daily. [0.05% cream, oint] fluocinolone acetonide Synalar ® Apply 2 to 4 times daily. [0.2% cream] fluocinonide Lidex ® Apply apply 2 to 4 times daily. [0.05% cream,oint,gel] halcinonide Halog ® Apply apply 2 to 3 times daily. [0.1% cream,oint] Very High Potency augmented betamethasone dipropionate Diprolene ® Apply once or twice daily. [0.05% ointment] clobetasol propionate Temovate ® Apply twice daily. [0.05% cream, oint] diflorasone diacetate Psorcon ® apply 1 to 3 times daily. [0.05% cream, oint] halobetasol propionate Ultravate ® Apply 2 to 3 times daily. [0.05% cream, oint]  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.");s1[104]=new Array("urology.htm","Urology(Common agents): dosing list for health care providers, pharmacists, nurses, physicians.  Urinary retention.","","Urology Interstitial cystitis pentosan polysulfate (Elmiron ®) Dosing (adult): 100mg orally three times a day. Urinary retention Bethanecol Urecholine ® Dosing (adult): 10-50mg orally 3 to 4 times a day. [5,10,25,50 mg] Hemorrhagic Cystitis Alum irrigation An astringent that induces hemostasis by precipitating protein over the bleeding surface. Since it has low cell permeability, its action is limited to the cell surface and interstitial spaces. Usual concentration: 1 percent alum bladder irrigation (base solution usually saline).  Reserved for moderate to severe hematuria/bladder hemorrhage. Average instillation rate:  250-300 ml/hour. In mild cases, saline continuous bladder irrigation or suprahydration may be used.  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc.  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.");s1[105]=new Array("urine.htm","Medications which may cause discoloration of urine (Table)","Medications which may cause discoloration of urine","Urine discoloration / Urinalysis  Urine discoloration Dark / Brown Cascara Chloroquine ferrous salts/ iron dextran Levodopa methocarbamol methyldopa metronidazole nitrates nitrofurantoin quinine Senna sulfonamides Yellow-brown Bismuth Chloroquine Cascara Metronidazole Nitrofurantoin Primaquine Senna Sulfonamides Blue or blue green amitriptyline methylene blue triamterene Methocarbamol Orange/yellow Chlorzoxazone Dihydroergotamine heparin phenazopyridine rifampin sulfasalazine warfarin Red / Pink daunorubicin or doxorubicin heparin ibuprofen methyldopa phenothiazines phenytoin phenylbutazone rifampin Salicylates senna  Urinalysis Normal urine output (minimum): 0.5 to 1 ml/kg/hr daily Oliguria: < 500 ml urine/ 24 hours Anuria: < 100 ml urine/ 24 hours. Low urine output: potential causes Prerenal: heart failure, shock, volume depletion, third spacing fluids, renal artery compromise Renal: acute tubular necrosis, end-stage renal disease, interstitial disease, glomerular disease, drug induced: (Aminoglycosides, amphotericin B, cisplatin, colistin, cyclosporin, dextran, gallium, hydroxyurea, lithium, methicillin, methotrexate, methoxyflurane, nitrofurantoin, pentamidime, plicamycin, streptozocin, and vancomycin.), bilateral cortical necrosis Post-renal: neurogenic bladder, obstruction of ureter, bladder neck, or urethra. Differential diagnosis Lab pre-renal renal Urine/serum creatinine >40 <20 fractional excreted sodium: [UNa/serum Na] / [Ucr/ serum creatinine] x 100 <1 >1 Urine osmolality >500 <350 Urinary sodium <20 >40  Normal values: Appearance straw or yellow colored / clear Specific gravity: infant: 1.002 - 1.006 child and adult: 1.001 - 1.035 pH Child and adult: 4.6 - 8 Following substances should be negative: acetone, bilirubin, blood, glucose, nitrite, protein, leukocyte esterase. WBC 0 - 4/HPF RBC Male: 0 - 3/HPF   female: 0 - 5/HPF Epithelial Occasional Hyaline casts Occasional Bacteria None Differential diagnosis: Bilirubin Positive hepatitis, obstructive jaundice Blood Positive tumors, infection, trauma, hemolytic anemia, coagulopathy, interstitial nephritis, polycystic kidneys, kidney stones, burns, cystitis, prostatitis, pyelonephritis Epithelial cells Positive acute tubular necrosis, necrotizing papillitis Glucose Positive diabetes, cushing's disease, burns, steroids, hyperthyroidism, pancreatitis, pancreatic carcinoma, shock Ketones Positive diarrhea, vomiting, DKA, starvation, high fat diet, hyperthyroidism, pregnancy, febrile states. Leukocyte esterase (detects 5 or > WBC).  Used along with test for nitrites to detect UTI (predictive capacity: approximately 74 %). If both nitrites and leukocyte esterase are negative, there is a 97% chance that a UTI is not present. Positive Infection Nitrite Positive Infection present. Nitrates are converted to nitrites by many strains of bacteria. Protein Positive glomerulonephritis, pyelonephritis, nephrotic syndrome, pre-eclampsia, malignancies, heavy exercise, stress, CHF, malignant hypertension  Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc. Author: David McAuley Keywords: urinary tract, urine,discoloration");s1[106]=new Array("dysuria.htm","Urology - Dysuria - agents","","Urology - Dysuria phenazopyridine Pyridium ® Urinary analgesic: 100-200 mg orally three times daily after meals x 2 days when used concomitantly with an antibacterial agent. [Supplied: 100mg ,200mg tab] Renal dosing: crcl 50-80 ml/min: Administer every 8-16 hours. crcl <50 ml/min: Avoid use. [TOP]  Listed dosages are for - Adult patients ONLY David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc.  PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon.  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.");s1[107]=new Array("vag.htm","Vaginal products: bacterial vaginosis; vulvovaginal candidiasis.","","Vaginal products Bacterial Vaginosis clindamycin (Cleocin): bacterial vaginosis: 1 applicatorful (100mg) intravaginally at bedtime x 7 days. metronidazole (Metrogel): Bacterial vaginosis: 1 applicatorful intravaginally once daily at bedtime or twice daily (morning and evening) for 5 days. [70g tube 0.75% gel] Vulvovaginal candidiasis: butoconazole (Femstat): insert one applicatorful intravaginally at bedtime x 3-6 days [2% cream 28g] clotrimazole (mycelex, Gyne-Lotrimin) 1 applicatorful at bedtime for 7 days. //Alternatively, 1 vaginal tab (100mg) intravaginally at bedtime for 7 days or 1 (500mg) vaginal tab x 1. [ supplied: 100, 500mg tablets, 1% vaginal cream-45 & 90 grams] miconazole (Monistat): 1 applicatorful intravaginally at bedtime for 7 days. Alternatively, Insert one 200mg vaginal suppository at bedtime for 3 days. terconazole (Terazol): 1 applicatorful (0.4%) intravaginally at bedtime for 7 days or (0.8%) at bedtime for 3 days. Alternatively, 80mg vaginal suppository at bedtime for 3 days. tioconazole (Vagistat): 1 applicatorful of 6.5% cream at bedtime x 1. [TOP]  Listed dosages are for - Adult patients ONLY David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc.  PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon.  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.");s1[108]=new Array("vasodilators.htm","Vasodilators used in the intensive care unit - nitroglycerin, natrecor, nitroprusside","","Vasodilators Nesiritide Natrecor ® Human B-type natriuretic peptide (hBNP). Indicated for the IV treatment of patients with acutely decompensated CHF who have dyspnea at rest or with minimal activity. There is limited experience with administering Natrecor for longer than 48 hours. Blood pressure should be monitored closely during Natrecor administration. Produces venous and arterial vasodilation, plus mild diuretic effect.  Patients experiencing hypotension during the infusion: Hold infusion. May attempt to restart at a lower dose (reduce initial infusion dose by 30% and omit bolus). Dosing (adults): IV bolus of 2 mcg/kg (over 1 minute) followed by a continuous infusion of 0.01 mcg/kg/min. Withdraw bolus dose from the infusion bag. Higher initial dosages are not recommended. At intervals of 3 hours, the dosage may be increased by 0.005 mcg/kg/minute (preceded by a bolus of 1 mcg/kg), up to a maximum of 0.03 mcg/kg/minute.   Supplied: Injection (pwd for reconstitution): 1.5 mg vial. Nitroglycerin Primarily a venous dilator (lesser degree - arteriolar dilator).  It may be most useful in patients with symptomatic coronary disease and in those with hypertension following coronary bypass.  Drug of choice for hypertensive emergencies with coronary ischemia. It should not be used with hypertensive encephalopathy because it increases ICP. Tolerance may occur within 24-48 hours. Nitrate-free interval (10-12 hours/day) is recommended to avoid tolerance development. Dosing (Adult) - (IV):  Initial dose: 5 mcg/min IV infusion. Increase by 5 mcg/minute every 3-5 minutes to 20 mcg/minute. If no response at 20 mcg/minute increase by 10 mcg/minute every 3-5 minutes, up to a maximum of 100 mcg/minute. Onset: 2 to 5 minutes. Duration: 5 to 10 minutes. ------------ Angina/coronary artery disease: Oral: 2.5mg to 9 mg bid - qid (up to 26 mg qid). Topical ointment: Apply 0.5" to 2" every 6 hours with a nitrate free interval (10-12hrs). Patch (transdermal): 0.2-0.4 mg/hour initially and titrate to doses of 0.4-0.8 mg/hour. Remove patch to provide nitrate free interval (10-12hrs).  Sublingual: 0.2-0.6 mg every 5 minutes for maximum of 3 doses in 15 minutes. Supplied: Capsule (ER): 2.5 mg, 6.5 mg, 9 mg. Injection (Soln): 5 mg/ml (5 ml, 10 ml). Ointment: 2% (1 g, 30 g, 60 g).   Sublingual tablet: 0.3 mg, 0.4 mg, 0.6 mg. Patch (Transdermal ): 0.1 mg/hour; 0.2 mg/hour; 0.4 mg/hour; 0.6 mg/hour. Sodium Nitroprusside Nipride ® Arteriolar and venous dilator.  Considered to be the most effective parenteral drug for most hypertensive emergencies (except myocardial ischemia or renal impairment). It dilates both arteries and veins, and it reduces afterload and preload.  Onset: within seconds. Duration: 2-3 minutes. Constant monitoring of the blood pressure is required. Alternatives to nitroprusside include intravenous labetalol, nicardipine, and fenoldopam. Hypotension is uncommon with these drugs and cyanide toxicity is not an issue.  Dosing (Adult): Initial: 0.3-0.5 mcg/kg/minute. Increase in increments of 0.5 mcg/kg/minute -- titrating to the desired hemodynamic effect or the appearance of headache or nausea. Usual dose: 3 mcg/kg/minute (rarely need >4 mcg/kg/minute). Maximum: 10 mcg/kg/minute.  When treatment is prolonged (>24 to 48 hours) or when renal insufficiency is present, the risk of cyanide and thiocyanate toxicity is increased. Doses > 2 mcg/kg/min exceed the capacity of the body to detoxify cyanide. Maximum doses of 10 mcg/kg/min should never be given for more than 10 minutes. An infusion of sodium thiosulfate can be used in affected patients to provide a sulfur donor to detoxify cyanide into thiocyanate. Supplied: Injection (Soln): 25 mg/ml - 2 ml (vial). [TOP]  Listed dosages are for - Adult patients ONLY David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc.  PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon.  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.");s1[109]=new Array("icu-agents.htm","ICU Agents - vasopressors and inotropes ","","Vasopressors and Inotropes Dobutamine Synthetic catecholamine (beta-1 agonist). Increases contractility and to a lesser extent heart rate. Little direct effect on BP. Uses: refractory CHF or hypotensive patients in whom vasodilators cannot be used because of effects on BP. Onset of action: 1-10 minutes. Peak effect: 10-20 minutes. Half-life: 2 minutes. Excretion: Urine (as metabolites).   Adult (usual): 2.5-20 mcg/kg/minute. Maximum: 40 mcg/kg/min. Titrate to desired response. Administer into large vein.   Usual doses to increase cardiac output are 2.5 to 15 mcg/kg/minute IV.   Drip rate (500mg/250 ml) ml/hr = wt(kg) x (mcg/min) x 0.03. Supplied: 12.5 mg/ml (20 ml, 40 ml, 100 ml) Dopamine Used to support BP, CO and renal perfusion in shock.   Dosing (Adult): Refractory CHF: initial dose: 0.5 to 2 mcg/kg/min. Renal: 1 to 5 mcg/kg/min.  Severely ill patient: initially 5 mcg/kg/min, increase by 5 to 10 mcg/kg/min (q10 to 30 min) up to max of 50 mcg/kg/min.   Cardiac life support (initial): 2 to 5 mcg/kg/min - titrated to effect.  Infusion may be increased by 1-4 mcg/kg/minute at 10 to 30 minute intervals until optimal response is obtained. If dosages >20-30 mcg/kg/minute are needed, a more direct-acting pressor may be more beneficial (ie, epinephrine, norepinephrine).  [0.5 to 2 mcg/kg/min-dopa; 2-10-dopa/beta; >10-primarily alpha.]  Used to support BP, CO and renal perfusion in shock. IMPORTANT NOTE: Renal shutdown may occur at doses greater than 50 micrograms/kilogram/minute. The infusion rate should be reduced if urine flow decreases without adequate peripheral effects. Administer into large vein to prevent the possibility of extravasation (central line administration). Calculation of drip rate (ml/hr) 400mg/250 ml: wt(kg) x mcg/min x 0.0375. The predominant effects of dopamine are dose-related At low rates of infusion (0.5-2 mcg/kg/min) dopamine causes vasodilation that is presumed to be due to a specific agonist action on dopamine receptors in the renal, mesenteric, coronary, and intracerebral vascular beds. The vasodilation in these vascular beds is accompanied by increased glomerular filtration rate, renal blood flow, sodium excretion, and urine flow. Hypotension sometimes occurs. An increase in urinary output produced by dopamine is usually not associated with a decrease in osmolality of the urine.  At intermediate rates of infusion (2-10 mcg/kg/min) dopamine acts to stimulate the beta1-adrenoceptors, resulting in improved myocardial contractility, increased SA rate and enhanced impulse conduction in the heart. There is little, if any, stimulation of the b2-adrenoceptors (peripheral vasodilation). Dopamine causes less increase in myocardial oxygen consumption than isoproterenol, and its use is not usually associated with a tachyarrhythmia. Clinical studies indicate that it usually increases systolic and pulse pressure with either no effect or a slight increase in diastolic pressure. Blood flow to the peripheral vascular beds may decrease while mesenteric flow increases due to increased cardiac output. At low and intermediate doses, total peripheral resistance (which would be raised by alpha activity) is usually unchanged.  At higher rates of infusion (10-20 mcg/kg/min) there is some effect on alpha-adrenoceptors, with consequent vasoconstrictor effects and a rise in blood pressure. The vasoconstrictor effects are first seen in the skeletal muscle vascular beds, but with increasing doses, they are also evident in the renal and mesenteric vessels. At very high rates of infusion (above 20 mcg/kg/min), stimulation of alpha-adrenoceptors predominates and vasoconstriction may compromise the circulation of the limbs and override the dopaminergic effects of dopamine, reversing renal dilation and naturesis. Epinephrine Dosing (Adult): Refractory hypotension (refractory to dopamine/dobutamine): Continuous IV infusion: 1 mcg/min (range: 1-10 mcg/minute) - titrate dosage to desired effect. Usual rate: 1 to 4 mcg/min. Severe cardiac dysfunction may require doses >10 mcg/minute (up to max of 20 mcg/min in a 70kg patient). Admin: Central line administration only. Endotracheal: Doses (2-2.5 x IV dose) should be diluted to 10 ml with NS or distilled water prior to administration. Anaphylaxis (adult): 0.3 mg IM (0.3 ml of a 1:1000 solution). May be repeated if severe anaphylaxis persists - repeat q10 to 15 minutes prn or give 0.1 to 0.25 mg IV (1:10,000) over 5-10min repeat q5 to 15 minutes as needed or start continuous infusion: 1 to 4 mcg/min.  Asthma: inhalational form: start with 1 inhalation, then wait at least 1 min. If not relieved, use once more. Do not use again for at least 3 hr. Asthma: subcutaneous (SC) form: 0.2-0.5 mg (0.2-0.5 ml of a 1:1000 solution) SC every 2 hr as required. In severe attacks, may repeat dose every 20 min for a maximum of 3 doses.   Cardiac arrest: 1 mg IV initially; may be repeated as necessary q 3-5 min.  inamrinone - INOCOR ® Phosphodiesterase inhibitor with positive inotropic and vasodilator activity.  FDA labeled indications: CHF, acute (short-term treatment). Non-FDA labeled indications: Cardiac surgery/low cardiac output states. Inotropic support (Advance cardiac life support).   Dosing (Adult): CHF (short term): initial: 0.75 mg/kg IV bolus over 2-3 min, may repeat in 30 minutes. Maint: 5-10 mcg/kg/min IV infusion. Recommended total daily dose, not to exceed 10 mg/kg.   Renal failure: Crcl<10 ml/min: Administer 50% to 75% of dose.  Midodrine - PROAMATINE ® Orthostatic hypotension: 10 mg po tid at 3-4 hr intervals (during daytime hours). Doses greater than 30 mg/day have been tolerated by some patients, but safety has not been established. Renal impairment: 2.5 mg tid - gradually increasing as tolerated. [Supplied 2.5, 5 mg tablet]   Milrinone  - PRIMACOR ® Phosphodiesterase inhibitor with positive inotropic and vasodilator activity. Venodilator: 0  Arterial dilator: ++ Inotropic effect: +++   Calculation of drip rate: 50 mg/250ml (ml/hr) = wt (kg) x 0.3 x mcg/kg/min. Dosing (Adult): CHF: initial loading dose, 50 mcg/kg IV over 10min, then 0.375 to 0.75 mcg/kg/min IV (Usual: 0.5 mcg/kg/min).  Cardiac surgery: 15min before separation from cardiopulmonary bypass, 50 mcg/kg IV over 20 minutes followed by a continuous infusion of 0.5 mcg/kg/min IV for a minimum of 4hr. Recommended infusion rates: renal insufficiency    Creatinine Clearance    (mL/min/1.73 m 2 ) Infusion Rate (mcg/kg/min)  5 0.20 10 0.23 20 0.28 30 0.33 40 0.38 50 0.43 Supplied: Injection (soln): 1 mg/ml (10 ml, 20 ml, 50 ml) Norepinephrine - LEVOPHED ® Alpha receptor & Beta-1 agonist. Used to maintain BP in hypotensive states. Most potent vasoconstrictor (Norepi >>> phenylephrine). Dosage (initial): 8 to 12 mcg/min -titrate to BP (Usual target: SB:80-100 or MAP=80).  Usual maintenance: 2 to 4 mcg/min. Note: doses as high as 0.5 to 1.5 mcg/kg/min for 1-10days have been used in septic shock.     Note: Norepinephrine dosage is stated in terms of norepinephrine base and intravenous formulation is norepinephrine bitartrate. Norepinephrine bitartrate 2 mg = Norepinephrine base 1 mg.   Usual range: 8-30 mcg/minute.  Range used in clinical trials: 0.01-3 mcg/kg/minute. ACLS dosage range: 0.5-30 mcg/minute. Administer into large vein to avoid the potential for extravasation. Calculation of drip rate 8 mg/ 250 ml (ml/hr) = mcg/min x 1.875.   Supplied: Injection (soln): 1 mg/ml - 4 ml Phenylephrine - NeoSynephrine ® Alpha agonist. May be given IM,SC, IV push, or by continuous infusion. Treat mild/moderate hypotension, also PSVT. IV infusion: usual initial rate: 0.1 to 0.18 mg/min (100 to 180mcg/min) (titrate). Usual maintenance rate: 40-60 mcg/min. Maximum rate: infusion rates as high as 10 mcg/kg/min may be required in shock. IV bolus therapy: usual dose: 0.5 mg [range: 0.1 to 1 mg (max)] repeat q10-15 min as needed. PSVT: 0.5 mg rapid IV push, subsequent doses may be increased in increments of 0.1 to 0.2mg. Adults: IM, SC: 2-5 mg/dose every 1-2 hours as needed (initial dose should not exceed 5 mg) IV bolus: 0.1-0.5 mg/dose every 10-15 minutes as needed (initial dose should not exceed 0.5 mg) Concentrations up to 100-500 mg in 250 ml have been used. Usual concentration: 10-40mg/250 ml. Calculation of drip rate (40 mg/250) (ml/hr) = (mg/min) x 375. Vasopressin  - Pitressin ® ADH analog (Posterior pituitary hormone). Dosing (Adults):  Vasodilatory shock/septic shock: Vasopressin may be used in patients with refractory shock despite adequate fluid resuscitation and the use of high-dose conventional catecholamines such as norepinephrine and dopamine, however, further studies are needed to determine its exact place in therapy. Current evidence does not support the use of vasopressin as a replacement for norepinephrine or dopamine as a first-line agent.  The recommended infusion rate for vasopressin in the treatment of shock in adults is 0.01– 0.04 units/min. This dosage range is reported to be effective in about 85% of patients with norepinephrine resistant hypotension. Doses greater than 0.04 units/min may lead to cardiac arrest. O'Brien A et al reported rapid rebound hypotension as a common problem after treatment with vasopressin is stopped. Potential side effects of vasopressin infusion range from ischemic skin lesions to possible intestinal ischemia. Vasopressin therapy may also result in decreased cardiac output and hepatosplanchnic flow. Pulseless VT/VF: 40 units IV (as a single dose only). If no IV access - administer 40 units diluted with NS (to a total volume of 10 ml) endotracheally. Supplied: Injection: 20 units/ml (0.5 ml, 1 ml, 10 ml) [TOP]  Listed dosages are for - Adult patients ONLY David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc.  PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon.  Contact . Privacy Policy . Disclaimer Copyright © 2005 GlobalRPh Inc.   Receptor pharmacology Agent Alpha-1 Beta-1 Beta-2 Dopaminergic 1° Clinical effects Dobutamine 0/+ ++++ ++ 0 CO+, SVR - Dopamine 0.5-2 ug/kg/min 5-10 ug/kg/min 10-20 ug/kg/min 0 + ++ + ++ ++ 0 0 0 ++ ++ ++ CO+, SVR+ CO+, SVR+ SVR++ Epinephrine +++ +++ ++ 0 CO++, SVR<-->/+ Norepinephrine +++ ++ 0 0 CO <-->/+ , SVR++ Phenylephrine +++ 0 0 0 CO <-->/+ , SVR++");s1[110]=new Array("acls.htm","acls agents - previous guidelines","","DISCLAIMER    Advanced cardiac life support (ACLS)  (Medication dosing only) VENTRICULAR FIBRILLATION/ PULSELESS V-tach Epinephrine 1 mg IVpush q3-5min.(use 1:10,000) // High dose epinephrine: 0.1 mg/kg IVpush q3-5min (use epi 1:1000)// Intermediate: 2 to 5 mg q3-5min // Escalating epi: 1mg-3mg-5mg IV push q3min apart. Epinephrine strengthens myocardial contraction and increases cardiac output, which will help improve myocardial and cerebral blood flow. Continuous infusion: 1 to 4 mcg/min (range: 1-10 mcg/min). Add 1 mg/250 ml D5W or NS. Drip rate (ml/hr)= mcg/min x 15. Endotracheal tube: Give 2 to 2.5 x IV dose. (Dilute up to 10 ml with normal saline) [If ineffective, administer medications of probable benefit. Medications are used to help boost the patients response to the shocks. 1st line=epi // 2nd-line agents include: Lidocaine--- bretylium --- Magnesium sulfate --- procainamide (in that order).] Lidocaine 1 to 1.5 mg/kg q3-5min. Maximum total: 3 mg/kg. Decrease by 50% in elderly, CHF or patients with hepatic disease. Side effects: Convulsions, hypotension, bradycardia. Do not exceed 3 mg/kg in a 1 hour period. Continuous infusion: 1 to 4 mg/min. Add 1 gram/250 ml. Rate (ml/hr)= mg/min x 15. Endotracheal tube: Give 2 to 2.5 x IV dose. Dilute up to 10ml with normal saline. Bretylium 5 mg/kg IVpush------shock------- Repeat in 5 minutes at 10 mg/kg. (maximum total: 30 to 35 mg/kg). Side effects: Bradycardia, hypotension, N&V.    Continuous infusion: 1 to 2 mg/min (Range: 0.5 to 4 mg/min).  Drip preparation: Add 1 gram to 250ml of D5W or normal saline. Rate (ml/hr)= mg/min x 15 [Supplied: 500mg/ 10 ml syringe] Procainamide Give 20-30 mg/min until (maximum total of 17 mg/kg) or side effects occur or arrhythmia subsides. //  Side effects: Severe hypotension with rapid infusion; bradycardia; AV block; V-fib.//     Loading regimen: 20-30 mg/min. Add 1 gram/250 ml D5W. Rate: 20 mg/min= 300 ml/hr; 30 mg/min= 450 ml/hr. Continuous infusion: 2 to 6 mg/min. Add 1 gram/250 ml D5W. Rate (ml/hr)= mg/min x 15 Asystole: Absence of both atrial and ventricular electrical activity manifested by a flat line on EKG. Etiology: Severe ischemic myocardial damage, complete heart block, and severe metabolic disorders, eg, hyperkalemia, hypokalemia, acidosis, hypoxia., Occasionally some drugs: phenytoin, lidocaine, beta-blockers, amiodarone. Findings: full cardiac arrest without BP or pulse, cyanosis and dilated pupils. Differential diagnosis: disconnected leads; fine V-fib. Mortality: Fewer than 2% of patients with asystolic arrest survive to hospital discharge. Epinephrine 1 mg IVpush q3-5min.(use 1:10,000) Atropine 1 mg rapid IV. Repeat q3-5 minutes up to maximum total dose of 0.04 mg/kg. IV route unavailable--endotracheal tube: Give 2 to 2.5 x IV dose. (Dilute up to 10ml with normal saline). Adverse reactions: CNS toxicity: tremor, delirium. Hypo/hypertension. PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIA (PSVT) If ventricular rate>150 BPM or serious sign/symptoms prepare for immediate cardioversion. May give brief trial of medications. Presentation: Regular, rapid rate (120-300 bpm); narrow complex with possible varying degrees of AV block .Etiology: May occur spontaneously. May be associated with stress; anxiety; fatigue; excess alcohol; hypoglycemia; mitral valve prolapse; digoxin toxicity; CAD; COPD; hypertensive heart disease. Adenosine 6 mg rapid IV, followed by saline flush. If no response in 1-2 minutes give 12 mg rapid IV. May repeat in 1-2 minutes if needed. Complex width (wide?): If complex width is wide, consider lidocaine 1 to 1.5 mg/kg IV-------Procainamide 20-30 mg/min (max total: 17 mg/kg)--------Synchronized cardioversion: 50j---100j- (Premedicate: sedative +/-analgesic.)  Complex width (narrow?): Continue below. BP low or unstable: Synchronized cardioversion as above Verapamil 2.5 to 5 mg IV over 2 minutes. May repeat dose of 5-10mg 15-30 minutes after 1st dose. Alternative initial choice in stable patients. Decrease dose by 30-50% in hepatic insufficiency. Adverse reactions: Severe hypotension; bradycardia; ventricular standstill in digitalized patients; asystole; respiratory failure. Hypotension can be reversed with calcium chloride 0.5-1 gram over 5 minutes.  Diltiazem 0.25 mg/kg over 2 minutes. If no response within 15 minutes, give second bolus of 0.35 mg/kg over 2 minutes. Subsequent doses should be individualized. If effective start continuous infusion: 5-15 mg/hr Digoxin (For patients not on digoxin): 0.25 to 0.5 mg IV. May follow with 0.125 to 0.25 mg IV q2-6h until 0.75 to 1.5 mg is given over 24hrs. [Loading: 10 to 15 mcg/kg IBW in divided doses (q4-8h) over 12-24hrs.]  Digoxin is considered to be a 3rd line drug in stable patients who fail to respond to adenosine/verapamil/esmolol. Not preferred drug for PSVT because it is not rapidly effective (may take up to 60 minutes). Adverse reactions: sinus bradyarrhythmias; AV block; N/V/D; yellow vision and hallucinations; supra and ventricular arrhythmias.  Contraindications: V-fibrillation; hypokalemia; WPW syndrome with wide complex. Esmolol (note: IV beta blockers should not be given within 30 minutes of verapamil): 500 mcg/kg IV over 1 minute, followed by 50 mcg/kg/minute over 4 minutes. If ineffective, repeat load of 500 mcg/kg, followed by 100 mcg/kg/min. If needed, may repeat process of loading dose + increase infusion by another 50 mcg/kg/min (up to max of 200 mcg/kg/min).  Half life: 10 minutes.  Contraindicated in: sinus bradycardia; > 1st degree heart block; overt cardiac failure. Adverse reactions: dose related hypotension; ventricular arrhythmias; heart failure. Drip preparation: Add 2.5 grams/ 250 ml D5W or NS [Drip rate (ml/hr)= wt(kg) x mcg/min x 0.006 ] ATRIAL FIBRILLATION/FLUTTER       Atrial Fibrillation: EKG: Irregularly irregular rhythm without recognizable P-wave activity. Etiology: alcoholism, AMI, hypotension ,pulmonary disease, valvular heart disease, head or cardiac trauma, metabolic causes(hypokalemia, hypomagnesemia), hyperthyroidism, hypoglycemia. Paroxysmal form may occur without underlying cardiac disease. Atrial rate is usually 350-600 bpm. VR: 150-200 bpm (untreated). Suspect digoxin toxicity if there is a regular ventricular response. Ventricular response depends on refractoriness of the AV node. Atrial flutter: Rarely occurs in absence of heart disease.  Etiology: CAD, alcoholism, thyrotoxicosis, pulmonary disease, cardiac trauma, digoxin or quinidine toxicity, atrial septal defect. May result from quinidine or procainamide effect on A-fib. Atrial rate: 250-300 bpm. Ventricular rate: 75-150 bpm.  Rhythm: variable. P wave: May show sawtooth or undulating pattern. Narrow QRS complex.   Unstable patient: (Serious signs/symptoms: include hypotension (SBP<80), heart failure, chest pain, MI, decreased mental status, dyspnea) and VR>110.   (1) Administer sedative such as valium 5-10mg (2) synchronous cardioversion(decreased energy requirements) 75-100j x1; repeat with higher charge up to 360j if needed. (3) If a-fib>24hr start anticoagulation therapy. Rate Control: Verapamil 2.5 to 5 mg IV over 2 min. May repeat dose of 5-10mg 15-30min after 1st dose. Diltiazem or esmolol. See above Digoxin Load with 0.5 mg IV, repeat in 30min, then administer 0.25mg IV q2h until rate is 80-90 bpm. [Loading: 10 to 15 mcg/kg IBW in divided doses (q4-8h) over 12-24hrs.] Rhythm Control: Procainamide 20-30 mg/min (max total 17 mg/kg) or side effects. Ibutilide 1mg IV over 10min. May repeat x 1 in 10 minutes if needed. Approved for acute termination. Monitor ECG for at least 4hr . Effective in @30% of patients. FDA-approved for acute termination of A-flutter/A-fib (may be alternative to cardioversion). Major adverse reactions: proarrhythmic events: VT, PVC's, BC, AV block, torsades de pointes, etc. IVPB: 0 to 1 mg/50 ml D5W or NS over 10 minutes. If patient is < 60kg give 0.01 mg/kg over 10 minutes. May repeat x 1 Ventricular Tachycardia          Stable patients: consider cough conversion followed by a trial of antiarrhythmic drug therapy (lidocaine-----procainamide-------bretylium); in unstable patients, immediate cardioversion should be performed: 100j. If recurrent, add lidocaine and cardiovert again starting at the energy level that was previously successful, then give procainamide or bretylium. If pt has hypotension, pulmonary edema, or unconsciousness is present, use lidocaine if cardioversion alone is unsuccessful, followed by bretylium. In all other patients, the recommended order of treatment is lidocaine-procainamide-bretylium. Lidocaine (not uniformly effective in sustained VT, especially in patients without acute myocardial ischemia or infarction. Dosing: 1 to 1.5 mg/kg IV bolus, may repeat 0.5 to 0.75 mg/kg q5-10min until VT resolves or max of 3 mg/kg. (after initial bolus start infusion at rate of 2 mg/min up to 4 mg/min).Adverse effects: May cause significant heart block, convulsions, respiratory depression or arrest, muscle twitching. Decrease by 50% in elderly/CHF/ or hepatic disease. Do not exceed 3 mg/kg in a 1 hour period. Continuous infusion: 1 to 4 mg/min. Add 1 gram/250 ml. Rate (ml/hr)= mg/min x 15. Endotracheal tube: Give 2-2.5 x IV dose. Dilute up to 10ml c NS Procainamide 2nd line drug in stable patients when lidocaine not effective. Dosing: 20-30mg/min in 100mg increments until one of following occurs (a)Max total of 17 mg/kg   (b) arrhythmia is suppressed  (c)Hypotension develops (d)QRS widens by 50% > baseline.    If loading regimen is successful, start continuous infusion: 2 mg/min. Side effects: Severe hypotension with rapid infusion; bradycardia; AV block; V-fib. Loading regimen: 20-30 mg/min. Add 1 gram/250 ml D5W. Rate: 20 mg/min= 300 ml/hr; 30 mg/min= 450 ml/hr. Continuous infusion: 2 to 6 mg/min. Add 1 gram/250 ml D5W. Rate (ml/hr)= mg/min x 15 Bretylium Not recommended as a 1st line agent. Use of bretylium should be considered when lidocaine & procainamide have failed. Dosing: 5-10 mg/kg over 8-10 minutes to a maximum total dose of 30 mg/kg over 24 hours.  If initial loading dose converts arrhythmia, start a continuous infusion: 1-2 mg/min. hyperthermia. Adverse rxns: Hypotension (usually 1 hr post injection), preceded by hypertension; respiratory depression; bradycardia; hyperthermia. Continuous infusion: 1 to 2 mg/min (range: 0.5 to 4 mg/min). Add 1 gram/250ml D5W or NS. Rate (ml/hr)= mg/min x 15  [Supplied: 500mg/ 10 ml syringe] Bradycardia: If no pulse is present with bradycardia--treat as EMD. CPR is rarely needed unless without pulse or severe refractory hypotension. Atropine 0.5 to 1mg IV q3-5min until adequate response or until 0.4 mg/kg (@ 2-3mg) has been given. Decrease dose in renal disease Dopamine Indications: shock, hypotension. Preferred initial pressor. If patient has had no response to atropine and pacemaker is not immediately available, a pressor agent should be started. Dosing (initially): 2-5 mcg/kg/min (may increase up to 20 mcg/kg/min). Calculation of drip rate: (ml/hr) 400mg/250 ml : wt(kg) x mcg/min x 0.0375 Epinephrine Indications: Hemodynamically significant bradycardia unresponsive to atropine, volume infusion, or pacemaker therapy. First line drug for EMD or asystole. Dosing: 1 mg q3-5min. If patient fails to respond, start one of the following: (1) Intermediate epi: 2 to 5 mg q3-5min  (2)Escalating: 1mg to 3mg to 5mg at 3 to 5min intervals  (3) high dose epinephrine: 0.1 mg/kg IV q3-5min Isoproterenol: (Should be used, if at all, with extreme caution. At low doses it is Class IIb (possibly helpful); at higher doses it is Class III (harmful). Dosing: initially 2 mcg/min. May increase up to 10 mcg/min if needed, titrating to heart rate and rhythm response. (B1/B2 agonist). Indications: unstable patients with bradycardia and hypotension who are unresponsive to atropine and/or volume infusion and when pacemaker is not available. Calculation of drip rate: 1 mg/250 ml (ml/hr) = 15 x mcg/min PULSELESS ELECTRICAL ACTIVITY (PEA)/ (EMD)          PEA includes: (1) Electromechanical dissociation (2) Idioventricular rhythms (3) Ventricular escape rhythms (4) Bradyasystolic rhythms (5) Post-defibrillation idioventricular rhythms. Consider possible causes: hypovolemia; hypoxia; cardiac tamponade; hypothermia; massive PE; Drug overdoses( digoxin, beta blockers, calcium channel blockers; TCA's); hyperkalemia; massive MI; acidosis. Epinephrine 1 mg IVpush q3-5min.(use 1:10,000) // High dose epi: 0.1 mg/kg IVpush q3-5min (use epi 1:1000).  If absolute bradycardia (< 60 bpm) or relative bradycardia, give   Atropine 1 mg rapid IV. Repeat q3-5min up to a total of 0.04 mg/kg.   Listed dosages are for - Adult patients ONLY.   PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. [TOP]");var sb=0;var sc=1;var sd=2;var se=3;var sf=4;var sg=5;var sh=6;var si=7;var sj=8;var sk;var sl;var sm;var sn; var s98 ; var sB=true;var sC=1;var sE=2;var sD=3;var sF=4;var sP=false;var sQ=true;var s46=true;var s83=true;var s73=true;var s14=true;var s17=false;var s90=-1;var s45=0;var sT;function SMPSetFocus() { document.formSearch.txtSearch.focus(); }
function sp(sq) {if ((sq>="a" && sq<="z") || (sq=="&") ||(sq>="A" && sq<="Z") || (sq>="0" && sq <="9")) { return true; } else { return false; } }function sr( st, su, sv ) {var sy;var sz, s7, s2; var s3=0; var s42; var s43=true; var s44;s1[st][sg]=0;for( s42=0; s42<s41.length; s42++ ){ if (s41[s42].length>0) { sy=s1[st][su];if ( !s17 ){ sy=sy.toUpperCase(); } sz=sy.indexOf( s41[s42] );s44=s1[st][sg];while (sz >= 0){ s3 = s3 + sz + 1;if(( sm== -2 ) || ( sm== -5 )) { s7 = false; } else { if (sz == 0) { s7=false; } else { s7=sp(sy.charAt(sz-1)); }  } if(( sm == -3 ) || ( sm == -5 )) { s2 = false; } else { if ( sy.length - sz == s41[s42].length) { s2 = false; } else { s2 = sp(sy.charAt(sz + s41[s42].length)); }  } if (!s7 && !s2) { s1[st][sj+s1[st][sg]] = s3 - 1;s1[st][sg] ++; } sy = sy.substring(sz+1,sy.length);while( sp(sy.charAt(0)) && sy.length > 0 ) { sy = sy.substring( 1, sy.length ) ;s3 ++; } sz = sy.indexOf(s41[s42]); } if( s1[st][sg] == s44) { s43=false; } } } if( (s45==2) && (s43==false) ) { s1[st][sg]=0; } } function s4(st, sv) { var su=-1, s5; var ak=54603873746222; s1[st][sf]=-1;while( ++su <= se && s1[st][sf]==-1 ) { s5 = su==0 ? sc : (su==1 ? sd : (su==2 ? sb : se));if( ((s5 == sc ) && ( s46 )) || ((s5 == sd ) && ( s83 )) || ((s5 == sb ) && ( s73 )) || ((s5 == se ) && ( s14 )) ) { sr( st, s5, sv ); } else { s1[st][sg]=0 } if ( s1[st][sg] > 0 ) { s1[st][sf] = s5; } } s="searchmaker";t=eval(s.charAt(2)+s.charAt(8)); } function s6() { var st, su, s79, s8;for( st=1; st<s1.length; st++ ) { s1[st][si] = st; } if( sB ) {for( st=1; st<s1.length; st++ ) { if( s1[st][sf] == sc ) { s1[st][sh] = (4-sC) * 15000; } else if( s1[st][sf] == sd ) { s1[st][sh] = (4-sE) * 15000; } else if( s1[st][sf] == sb ) { s1[st][sh] = (4-sD) * 15000; } else { s1[st][sh] = (4-sF) * 15000 + s1[st][sg]; } } for( st=2; st<s1.length; st++ ) { s79 = s1[st][sh]; s8 = s1[st][si];for( su=st; su>1 && s79 > s1[su-1][sh]; su--) { s1[su][sh] = s1[su-1][sh];s1[su][si] = s1[su-1][si]; }s1[su][sh] = s79;s1[su][si] = s8; } } } function s9(st) { var sA = s1[st][sg]==1 ? "match" : "matches";sk += ""; sk += "<font face=\"Arial\" size=\"2\" color=gray>"; if( s1[st][sf]==sc ) { sk += " - matched title"; } else { if( s1[st][sf]==sd ) {sk += " - matched description"; } else { if( s1[st][sf]==sb ) { sk += " - matched URL"; } else { sk += " - " + s1[st][sg] + " " + sA + "";  } } } sk += "</font>"; sk += ""; } function sG(st, sH) { var sI;var sJ;var sK = false; var sL=s1[st][sj + sH - 1]; sI = sL<35 ? sI=0 : sI=sL-35;sJ = (sL+35 > s1[st][se].length) ? sJ=s1[st][se].length : sJ=sL+35;while ((sI>=0) && !sK) { if(sp(s1[st][se].charAt(sI))) { sI--; } else { sK=true; } } sI++;sK=false;while ((sJ > sL) && !sK) { if(sp(s1[st][se].charAt(sJ))) { sJ--; } else { sK=true; } } sk += "<BR><font face=\"Arial\" size=\"2\" color=#000000>\".. "+s1[st][se].substring(sI,sL); sk += "<B>" + s1[st][se].substring(sL , sL + sl.length ) +"</B>";sk += s1[st][se].substring(sL + sl.length ,sJ) + " ..\"</font>"; } function sN( st ) { if( sP==false ) { var su=1; while ( (su < 9) && (su<=s1[st][sg])) { sG( st, su ); su++; } } } function sR( sy, sL ) { sk += sy.substring( 0, sL );sk += "<B>" + sy.substring( sL , sL + sl.length ) +"</B>";sk += sy.substring( sL + sl.length ,sy.length ); } function sU( st, sT ) { sk += "<p><font face=\"Arial\" size=\"2\" color=#000000>" + sT +".</font> ";sk += "<a href=\""+s1[st][sb]+"\"><font face=\"Arial\" size=\"3\" color=#0000FF>"+s1[st][sc]+"</font></a>";if (( s1[st][sf]==se ) && (s45==0)) { sN(st); } else { sk+=""; } if( (s1[st][sf]==sd ) && (s45==0)) { sk += "<br><font face=\"Arial\" size=\"2\" color=gray>Description:</font><font face=\"Arial\" size=\"2\" color=#000000> "; sk += "";sR( s1[st][sd], s1[st][sj] ); sk += "</font>"; } else { if( s1[st][sd].length > 0 ) { sk += "<br><font face=\"Arial\" size=\"2\" color=gray>Description:</font></font><font face=\"Arial\" size=\"2\" color=#000000> "; sk += "" + s1[st][sd]; } else {  } } sk += "</font>"; sk+= "<br>";sk += "<font face=\"Arial\" size=\"2\" color=#005500>"; if(( s1[st][sf]==sb ) && (s45==0)) { sR( s1[st][sb], s1[st][sj] ); } else { sk += s1[st][sb]; } sk += "</font>"; if( sQ ) { s9( st ); } sk += "<br>"; }; function sV() { sT = 0;if (! (sn )) { for( var st=1; st<s1.length; st++ ) { if(( s1[s1[st][si]][sg] > 0 ) && (( sT < s90 ) || ( s90 == -1 ))) { sU(s1[st][si], ++sT); } }  } else { if( sm == -4 ) { sk += "<BR><font face=\"Arial\" size=\"2\" color=#000000>ERROR: The wildcard character (*) must be at the beginning or end of the text.</font>"; } }  } function sW() { sk += "<html> <head> <title>Globalrph Drug list Search Engine</title> <script language=\"JavaScript\"> <!-- function ask(x){ var txtSearch=document.formSearch.txtSearch.value; txtSearch=txtSearch+x; document.formSearch.txtSearch.value=txtSearch; } //--> </scr"; sk +="ipt> <script language=\"JavaScript\" fptype=\"dynamicanimation\"> <!-- function dynAnimation() {} function clickSwapImg() {} //--> </scr"; sk +="ipt> <script language=\"JavaScript1.2\" fptype=\"dynamicanimation\" src=\"animate.js\"> </scr"; sk +="ipt> <script language=JavaScript src=\"search.js\"> <!-- //--> </scr"; sk +="ipt> <SCRIPT language=\"JavaScript1.2\"> <!-- function dblclick() { window.scrollTo(0,0) } if (document.layers) { document.captureEvents(Event.ONDBLCLICK); } document.ondblclick=dblclick; //--> </scr"; sk +="ipt> </head> <body link=#000066 alink=#000066 vlink=#000066 bgcolor=\"#000000\" topmargin=\"0\" leftmargin=\"0\" onload=\"dynAnimation();document.formSearch.txtSearch.focus();\" > <div align=\"center\"> <center> <table border=\"0\" cellpadding=\"0\" cellspacing=\"0\"> <tr> <td bgcolor=\"#4D4DF1\" height=\"30\"> <a onmouseover=\"document['fpAnimswapImgFP4'].imgRolln=document['fpAnimswapImgFP4'].src;document['fpAnimswapImgFP4'].src=document['fpAnimswapImgFP4'].lowsrc;\" onmouseout=\"document['fpAnimswapImgFP4'].src=document['fpAnimswapImgFP4'].imgRolln\" href=\"druglist.htm\"><img border=\"0\" src=\"homenow.gif\" id=\"fpAnimswapImgFP4\" name=\"fpAnimswapImgFP4\" dynamicanimation=\"fpAnimswapImgFP4\" lowsrc=\"homenowon.gif\" width=\"100\" height=\"37\"></a>&nbsp; <a onmouseover=\"document['fpAnimswapImgFP5'].imgRolln=document['fpAnimswapImgFP5'].src;document['fpAnimswapImgFP5'].src=document['fpAnimswapImgFP5'].lowsrc;\" onmouseout=\"document['fpAnimswapImgFP5'].src=document['fpAnimswapImgFP5'].imgRolln\" href=\"javascript:history.back(1)\"><img border=\"0\" src=\"back.gif\" id=\"fpAnimswapImgFP5\" name=\"fpAnimswapImgFP5\" dynamicanimation=\"fpAnimswapImgFP5\" lowsrc=\"backon.gif\" width=\"100\" height=\"37\"></a>&nbsp; &nbsp; </td> <td bgcolor=\"#4D4DF1\" height=\"30\" align=\"center\"><font face=\"Verdana\" color=\"#FFFFFF\" size=\"4\">Drug Category Search Engine</font></td> </tr> <tr> <td bgcolor=\"#4D4DF1\" height=\"30\" colspan=\"2\"> <img border=\"0\" src=\"new_nov_header.gif\"> </td> </tr> <tr> <td bgcolor=\"#F5F5F5\" align=\"center\" colspan=\"2\"> <form name=formSearch action=\"javascript:startsearch() //\"> <input name=txtSearch size=\"57\">&nbsp; <input name=send type=submit value=Search> <table border=\"0\" cellpadding=\"3\" cellspacing=\"0\"> <tr> <td align=\"center\"> <input type=button value=\"a\" onclick=\"ask('a')\" style=\"border-style: outset\" ><input type=button value=\"b\" onclick=\"ask('b')\" style=\"font-size: 10pt; border-style: outset\" ><input type=button value=\"c\" onclick=\"ask('c')\" ><input type=button value=\"d\" onclick=\"ask('d')\" ><input type=button value=\"e\" onclick=\"ask('e')\" ><input type=button value=\"f\" onclick=\"ask('f')\" ><input type=button value=\"g\" onclick=\"ask('g')\" ><input type=button value=\"h\" onclick=\"ask('h')\" ><input type=button value=\"i\" onclick=\"ask('i')\" ><input type=button value=\"j\" onclick=\"ask('j')\" ><input type=button value=\"k\" onclick=\"ask('k')\" ><input type=button value=\"l\" onclick=\"ask('l')\" ><input type=button value=\"m\" onclick=\"ask('m')\" ><input type=button value=\"n\" onclick=\"ask('n')\" ><input type=button value=\"o\" onclick=\"ask('o')\" ><input type=button value=\"p\" onclick=\"ask('p')\" ><input type=button value=\"q\" onclick=\"ask('q')\" ><input type=button value=\"r\" onclick=\"ask('r')\" ><input type=button value=\"s\" onclick=\"ask('s')\" ><input type=button value=\"t\" onclick=\"ask('t')\" ><input type=button value=\"u\" onclick=\"ask('u')\" ><input type=button value=\"v\" onclick=\"ask('v')\" ><input type=button value=\"w\" onclick=\"ask('w')\" ><input type=button value=\"x\" onclick=\"ask('x')\" ><input type=button value=\"y\" onclick=\"ask('y')\" ><input type=button value=\"z\" onclick=\"ask('z')\" > </td> </tr> <tr> <td height=\"40\" align=\"center\" bgcolor=\"#E0E0DE\"><input type=button value=\"Add *\" onclick=\"ask('*')\" ><font face=\"Verdana\" size=\"2\">Use the &quot;Add*&quot; key for wildcard searches e.g. vanco*</font><input type=\"reset\" value=\"Reset\" name=\"B2\"></td> </tr> </table> </form> </td> </tr> <tr> <td bgcolor=\"#FFFFFF\" colspan=\"2\"> "; sk += "<font face=\"Arial\" size=\"2\" color=#000000>";sk += "<p>You searched for <b>" + s98 +".</b>"; sk += "</font>" }; function sY() { if(sT==0) { sk += "<p><font face=\"Arial\" size=\"2\" color=#000000>No pages matched your search.&nbsp;&nbsp;</font>"; } else { var sA = sT==1 ? "page shown." : "pages shown."; sk += "<p><font face=\"Arial\" size=\"2\" color=#000000>" + sT + " " + sA + "&nbsp;</font>"; } sk += "<a href=\"javascript:history.go(-1)\"><font face=\"Arial\" size=\"2\">Search Again</font></a></p>"; sk += "</td> </tr> </table> </center> </div> <p>&nbsp;<center></p> </body> </html> "; } function s11() { var s23 = sk;document.open(); document.write(s23); document.close(); } function s03( sy ) { var sqh="";for( var st=0; st<sy.length; st++) { if( sy.charAt(st)=="<" ) { sqh += "&lt;"; } else if( sy.charAt(st)==">" ) { sqh += "&gt;"; } else if( sy.charAt(st)=="\"" ) { sqh += "&quot;"; } else { sqh += sy.charAt(st); } } return( sqh ); } function s93() { sm = sl.indexOf("*"); if( sm == 0 ) { sm = -2; sn = false; } else if (sm == sl.length -1) { sm = -3; sn = false; } else if (sm > 0 ) { sm = -4;sn = true; } else { sn = false; } if ( sl.indexOf("*") != sl.lastIndexOf("*") ) { if( sm == -2 ) { if( sl.lastIndexOf("*") == sl.length - 1 ) { sm = -5; } else { sm = -4; sn = true; } } }if( ( sm == -2 ) || (sm == -5 )) { sl = sl.substring( 1, sl.length ); } if( ( sm == -3 ) || (sm == -5 )) { sl = sl.substring( 0, sl.length - 1 ); } } function startsearch() { var sv;sl=document.formSearch.txtSearch.value;if (( sl.length > 0 )&&( sl != "*" )) { sk = "";s98 = sl; sl = s03(sl);s93();if( s17 ) { sv = sl; } else { sv = sl.toUpperCase(); }if (s45 != 0) { s41=sv.split(' '); } else { s41=sv.split(); }if ( !(sn ) ) { for( var st=1; st<s1.length; st++ ) { s4( st, sv ); } s6(); } sW();sV();sY();s11(); } }