Saunders Nursing Drug Handbook 2014 - E-Book

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Written by two expert nursing and pharmacy clinicians and organized alphabetically by generic drug name, Saunders Nursing Drug Handbook 2014 provides essential information for over 1,000 generic name and 4,000 trade name drugs in one quick, convenient source. With comprehensive coverage of IV drug administration as well as guidance through clinical priorities in the practice setting, this resource offers the precautionary information you need to provide safer patient care.

  • Over 1,000 generic name drugs (encompassing over 4,000 trade name drugs) organized alphabetically with A to Z tabs to make accessing important information quick and easy.
  • Detailed drug information distinguishing side effects and adverse reactions helps you identify which are most likely to occur.
  • Special text treatment for "High Alert" drugs that pose the greatest risk for patient harm promotes safe drug administration.
  • UNIQUE! ( for ebook only) Frequently-used herb monographs as well as additional herb information keep you informed of commonly encountered herbs.
  • Top 200 Drugs helps you identify the most frequently administered drugs.
  • Lifespan and disorder-related dosage variations content equips you with special considerations for specific patient populations.
  • Therapeutic and toxic blood level information shows you patient implications for drug administration.
  • Comprehensive IV Compatibility Chart foldout arms you with compatibility information for 65 intravenous drugs.
  • NEW! Drug monographs for approximately 28 newly approved drugs by the FDA provide you with the most current drug information.
  • NEW! Updated monographs with new interactions, precautions, alerts and patient teaching instructions boost your confidence in accuracy and help prevent medication dispensing errors.
  • NEW! Nearly 300 Black Box Alerts highlight drugs found to carry a significant risk of serious or even life-threatening adverse effects.
  • NEW! Enhanced Pageburst eBook works on any mobile device giving you access to drug information from virtually anywhere.

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Published 15 May 2013
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EAN13 9780323222570
Language English
Document size 4 MB

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BARBARA B. HODGSON, RN, OCN
Morton Plant Mease Northbay Hospital
Former Staff Nurse
New Port Richey, Florida;
St. Joseph’s Hospital
Former Staff Nurse in the Cancer Institute
Tampa, Florida
ROBERT J. KIZIOR, BS, RPh
Education Coordinator
Department of Pharmacy
Alexian Brothers Medical Center
Elk Grove Village, IllinoisTable of Contents
Cover Image
Title Page
General Index
IV Compatibilities
Front Matter
How to Use
Copyright
Dedication
Author Biographies
Consultants
Reviewers
Preface
Acknowledgments
Newly Approved Medications
Drugs by Disorder
Drug Classifications
A-Z Drug Entries
A F L Q V
B G M R W
C H N S Z
D I O T
E K P U
Appendixes
Commonly Used Abbreviations
Dangerous Abbreviation List
Pageburst Integrated ResourcesGeneral Index
A F K P U
B G L Q V
C H M R W
D I N S X
E J O T Y
ZIV CompatibilitiesHow to Use3251 Riverport Lane
St. Louis, Missouri 63043
ISBN: 978-1-4557-0739-3SAUNDERS NURSING DRUG HANDBOOK 2014
ISSN: 1098-8661
Copyright © 2014, 2013, 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004,
2003, 2002, 2001, 2000, 1999, 1998, 1997, 1996, 1995, 1994, 1993 by Saunders, an
imprint of Elsevier Inc.
All rights reserved. No part of this publication may be reproduced or transmitted in any
form or by any means, electronic or mechanical, including photocopying, recording, or
any information storage and retrieval system, without permission in writing from the
publisher. Details on how to seek permission, further information about the Publisher’s
permissions policies and our arrangements with organizations such as the Copyright
Clearance Center and the Copyright Licensing Agency, can be found at our website:
www.elsevier.com/permissions.
This book and the individual contributions contained in it are protected under copyright
by the Publisher (other than as may be noted herein).
NOTICES
Knowledge and best practice in this field are constantly changing. As new research
and experience broaden our understanding, changes in research methods,
professional practices, or medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and
knowledge in evaluating and using any information, methods, compounds, or
experiments described herein. In using such information or methods, they should be
mindful of their own safety and the safety of others, including parties for whom they
have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised
to check the most current information provided (i) on procedures featured or (ii) by
the manufacturer of each product to be administered, to verify the recommended dose
or formula, the method and duration of administration, and contraindications. It is
the responsibility of practitioners, relying on their own experience and knowledge of
their patients, to make diagnoses, to determine dosages and the best treatment for
each individual patient, and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors,
or editors, assume any liability for any injury and/or damage to persons or property
as a matter of products liability, negligence or otherwise, or from any use or
operation of any methods, products, instructions, or ideas contained in the material
herein.
ISBN: 978-1-4557-0739-3Director, eContent Solutions: Robin Carter
Content Manager: Lauren Lake
Publishing Services Manager: Pat Joiner
Senior Project Manager: Joy Moore
Designer: Ashley EbertsI dedicate this work to my daughter Lauren, a true friend, for her unconditional love;
my daughter Kathryn, always supportive, always encouraging; and my son Keith, a
source of great pride to us all. This is also dedicated to my sons-in-law, Jim and Andy,
who have added so very much to my family, and to my grandchildren, Paige Olivia,
Logan James, Ryan James, and Dylan Boyd. I couldn’t love you more.
Barbara B. Hodgson, RN, OCN
To all health care professionals, who in the expectation of little glory or material
reward, dedicate themselves to the art and science of healing.
Robert J. Kizior, BS, RPh




AUTHOR BIOGRAPHIES
Barbara B. Hodgson, RN, OCN
Born and raised in Michigan, Barbara was married and raising a young family in
Chicago when she decided to ful ll a lifelong dream and become a nurse. After
graduation, she started her own business as author and publisher of Medcards, The
Total Medication Reference Guide, the rst of its kind. These drug cards were
designed to assist nursing students in understanding drug information to give
knowledgeable care to their patients.
In 1981, she met co-author Robert (Bob) Kizior, who was teaching a
pharmacology class. After class, Barbara approached him and asked if he would be
interested in working on Medcards with her. He agreed, and together they became so
successful that a few years later Barbara was able to ful ll another dream and move to
Florida.
By 1987, Barbara was approached by W.B. Saunders and asked to author the
Saunders Nursing Drug Handbook. Since then, Barbara and Bob have worked
together on this handbook and on two more drug resources, the Saunders Electronic
Nursing Drug Cards and the Saunders Drug Handbook for Health Professions.
Barbara specialized in oncology at the Cancer Institute, St. Joseph’s Hospital, in
Tampa, Florida, and at Morton Plant Mease Northbay Hospital in New Port Richey,
Florida. Barbara’s daughter Lauren is a nurse manager, and her daughter Kathryn, her
son Keith, and her son-in-law Jim are all nurses, working in their respective elds of
patient care.
Barbara’s favorite interests are spending time with her very busy, tight-knit family
and, when she has a rare moment, getting her hands full of dirt working in her garden.
Robert (Bob) J. Kizior, BS, RPh
Bob graduated from the University of Illinois School of Pharmacy and is licensed to
practice in the state of Illinois. He has worked as a hospital pharmacist for more than
40 years at Alexian Brothers Medical Center in Elk Grove Village, Illinois—a suburb of
Chicago. Bob is the Pharmacy Surgery Coordinator for the Department of Pharmacy,
where he participates in educational programs for pharmacists, nurses, physicians, and
patients. He plays a major role in coordinating pharmacy services in the OR satellite.
Bob is a former adjunct faculty member at William Rainey Harper Community College
in Palatine, Illinois. It was there that Bob rst met Barbara and commenced their
longstanding professional association.
An avid fan of Big Ten college athletics, Bob also has eclectic tastes in music that
range from classical, big band, rock ’n’ roll, and jazz to country and western. Bob
spends much of his free time reviewing the professional literature to stay current on
new drug information.CONSULTANTS*
Katherine B. Barbee, MSN, ANP, F-NP-C
Kaiser Permanente
Washington, DC
Lisa Brown
Jackson State Community College
Jackson, Tennessee
Marla J. DeJong, RN, MS, CCRN, CEN, Capt
Wilford Hall Medical Center
Lackland Air Force Base, Texas
Diane M. Ford, RN, MS, CCRN
Andrews University
Berrien Springs, Michigan
Denise D. Hopkins, PharmD
College of Pharmacy
University of Arkansas
Little Rock, Arkansas
Barbara D. Horton, RN, MS
Arnot Ogden Medical Center School of Nursing
Elmira, New York
Mary Beth Jenkins, RN, CCRN, CAPA
Elliott One Day Surgery Center
Manchester, New Hampshire
Kelly W. Jones, PharmD, BCPS
McLeod Family Medicine Center
McLeod Regional Medical Center
Florence, South Carolina
Autumn E. Korson
Western Michigan University, Bronson School of Nursing
Kalamazoo, Michigan
Linda Laskowski-Jones, RN, MS, CS, CCRN, CEN
Christiana Care Health System
Newark, Delaware
Jessica K. Leet, RN, BSN
Cardinal Glennon Children’s Hospital
St. Louis, Missouri
Denise Macklin, BSN, RNC, CRNIPresident, Professional Learning Systems, Inc.
Marietta, Georgia
Nancy L. McCartney
Valencia Community College
Orlando, Florida
Judith L. Myers, MSN, RN
Health Sciences Center
St. Louis University School of Nursing
St. Louis, Missouri
Kimberly R. Pugh, MSEd, RN, BS
Nurse Consultant
Baltimore, Maryland
Regina T. Schiavello, BSN, RNC
Wills Eye Hospital
Philadelphia, Pennsylvania
Gregory M. Susla, PharmD, FCCM
National Institutes of Health
Bethesda, Maryland
Elizabeth Taylor
Tennessee Wesleyan College of Nursing
Fort Saunders Regional
Knoxville, Tennessee
*The author acknowledges the work of the consultants in previous edition(s).REVIEWERS
James Anthony Graves, PharmD
Pharmacist, St. Mary’s Health Center, Jefferson City, Missouri
Joshua J. Neumiller, PharmD, CDE, CGP, FASCP
Assistant Professor, Department of Pharmacotherapy, College of Pharmacy, Washington
State University, Spokane, Washington'
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PREFACE
Nurses are faced with the ever-challenging responsibility of ensuring safe and e ective
drug therapy for their patients. Not surprisingly, the greatest challenge for nurses is
keeping up with the overwhelming amount of new drug information, including the
latest FDA-approved drugs and changes to already approved drugs, such as new uses,
dosage forms, warnings, and much more. Nurses must integrate this information into
their patient care quickly and in an informed manner.
Saunders Nursing Drug Handbook 2014 is designed as an easy-to-use source of
current drug information to help the busy nurse meet these challenges. What separates
this book from others is that it guides the nurse through patient care to better practice
and better care.
This handbook contains the following:
1 . An IV compatibility chart. This handy chart is bound into the handbook to
prevent accidental loss.
2. The Classi cations section. The action and uses for some of the most common
clinical and pharmacotherapeutic classes are presented. Unique to this handbook,
each class provides an at-a-glance table that compares all the generic drugs within
the classi cation according to product availability, dosages, side e ects, and other
characteristics. Its blue half-page color tab ensures you can’t miss it!
3. An alphabetical listing of drug entries by generic name. Blue letter thumb tabs
help you page through this section quickly. Information on medications that contain
a Black Box Alert is an added feature of the drug entries. This alert identi es those
medications for which the FDA has issued a warning that the drugs may cause
serious adverse e ects. Tall Man lettering, with emphasis on certain syllables to
avoid confusing similar sounding/looking medications, is shown in slim blue
capitalized letters (e.g., *acetaZOLAMIDE). High Alert drugs with a blue icon
are considered dangerous by The Joint Commission and the Institute for Safe
Medication Practices (ISMP) because if they are administered incorrectly, they may
cause life-threatening or permanent harm to the patient. The entire High Alert
generic drug entry sits on a blue-shaded background so that it’s easy to spot! To
make scanning pages easier, each new entry begins with a shaded box containing
the generic name, pronunciation, trade name(s), xed-combination(s), and
classification(s).
4. Herbal entries. In this edition, each herb is cross-referenced to Herbals: Common
Natural Medicines (Appendix G) so that you have the most comprehensive view of
herbal therapies related to patient care.
5 . A comprehensive reference section. Appendixes include vital information on
calculation of doses; controlled drugs; chronic wound care; drugs of abuse;
equianalgesic dosing; FDA pregnancy categories; herbals: common natural'
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medicines; lifespan, cultural aspects, and pharmacogenomics of drug therapy;
normal laboratory values; cytochrome P450 enzymes; poison antidotes; preventing
medication errors; recommended childhood and adult immunizations; parenteral
fluid administration; and Spanish phrases often used in clinical settings.
6. Drugs by Disorder. You’ll nd Drugs by Disorder in the front of the book for easy
reference. It lists common disorders and the drugs most often used for treatment.
7. The index. The comprehensive index is located at the back of the book on light
blue pages. Undoubtedly the best tool to help you navigate the handbook, the
comprehensive index is organized by showing generic drug names in bold, trade
names in regular type, classi cations in i t a l i c s , and the page number of the main
drug entry listed first and in bold.
A DETAILED GUIDE TO THE SAUNDERS NURSING
DRUG HANDBOOK
An intensive review by consultants and reviewers helped us to revise the Saunders
Nursing Drug Handbook so that it is most useful in both educational and clinical
practice. The main objective of the handbook is to provide essential drug information
in a user-friendly format. The bulk of the handbook contains an alphabetical listing of
drug entries by generic name.
To maintain the portability of this handbook and meet the challenge of keeping
content current, we have also included additional information for some medications on
®the Evolve Internet site. Users can also choose from 200 monographs for the most
®commonly used medications and customize and print drug cards. Evolve also
includes drug alerts (e.g., medications removed from the market) and drug updates
(e.g., new drugs, updates on existing entries). Information is periodically added,
allowing the nurse to keep abreast of current drug information.
You’ll also notice that some entries for infrequently used medications are
condensed to reDect only the absolutely essential points the nurse should know when
called on to administer them.
We have incorporated the IV Incompatibilities/Compatibilities heading. The
drugs listed in this section are compatible or incompatible with the generic drug when
administered directly by IV push, via a Y-site, or via IV piggyback. We have
highlighted the intravenous drug administration and handling information with a
special heading icon and have broken it down by Reconstitution, Rate of
Administration, and Storage.
We present entries in an order that follows the logical thought process the nurse
undergoes whenever a drug is ordered for a patient:
• What is the drug?
• How is the drug classified?
• What does the drug do?
• What is the drug used for?
• Under what conditions should you not use the drug?'
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• How do you administer the drug?
• How do you store the drug?
• What is the dose of the drug?
• What should you monitor the patient for once he or she has received the drug?
• What do you assess the patient for?
• What interventions should you perform?
• What should you teach the patient?
The following are included within the drug entries:
Generic Name, Pronunciation, Trade Names. Each entry begins with the generic
name and pronunciation, followed by the U.S. and Canadian trade names. Exclusively
Canadian trade names are followed by a blue maple leaf . Trade names that were
most prescribed in the year 2012 are underlined in this section.
Black Box Alert. This feature highlights drugs that carry a signi cant risk of serious or
life-threatening adverse effects. Black Box Alerts are ordered by the FDA.
Do Not Confuse With. Drug names that sound similar to the generic and/or trade
names are listed under this heading to help you avoid potential medication errors.
Fixed-Combination Drugs. Where appropriate, fixed-combinations, or drugs made up
of two or more generic medications, are listed with the generic drug.
Pharmacotherapeutic and Clinical Classi cation Names. Each full entry includes
both the pharmacotherapeutic and clinical classi cations for the generic drug. The
page number of the classification description in the front of the book is provided in this
section as well.
Action/Therapeutic E ect. This section describes how the drug is predicted to
behave, with the expected therapeutic effect(s) under a separate heading.
Pharmacokinetics. This section includes the absorption, distribution, metabolism,
excretion, and half-life of the medication. The half-life is bolded in blue for easy
access.
Uses/Off-Label. The listing of uses for each drug includes both the FDA uses and the
off-label uses. The off-label heading is shown in bold blue for emphasis.
Precautions. This heading incorporates a discussion about when the generic drug is
contraindicated or should be used with caution. The cautions warn the nurse of
specific situations in which a drug should be closely monitored.
Lifespan Considerations . This section includes the pregnancy category and
lactation data and age-specific information concerning children and elderly people.
Interactions. This heading enumerates drug, food, and herbal interactions with the
generic drug. As the number of medications a patient receives increases, awareness of
drug interactions becomes more important. Also included is information about
therapeutic and toxic blood levels in addition to the altered lab values that show what
effects the drug may have on lab results.
Product Availability. Each drug monograph gives the form and availability of the
drug. The icon identifies non-crushable drug forms.
Administration/Handling. Instructions for administration are given for each route of
administration (e.g., IV, IM, PO, rectal). Special handling, such as refrigeration, is also
included where applicable. The routes in this section are always presented in the order
IV, IM, Subcutaneous, and PO, with subsequent routes in alphabetical order (e.g.,
Ophthalmic, Otic, Topical). IV administration is broken down by reconstitution,
rate of administration (how fast the IV should be given), and storage (including how
long the medication is stable once reconstituted).'


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IV Incompatibilities/IV Compatibilities . These sections give the nurse the most
comprehensive compatibility information possible when administering medications by
direct IV push, via a Y-site, or via IV piggyback. This edition includes information
about lipids.
Indications/Routes/Dosage. Each full entry provides speci c dosing guidelines for
adults, elderly people, children, and patients with renal and/or hepatic impairment.
Dosages are clearly indicated for each approved indication and route.
Side E ects. Side e ects are de ned as those responses that are usually predictable
with the drug, are not life-threatening, and may or may not require discontinuation of
the drug. Unique to this handbook, side e ects are grouped by frequency listed from
highest occurrence percentage to lowest so that the nurse can focus on patient care
without wading through myriad signs and symptoms of side effects.
Adverse Effects/Toxic Reactions. Adverse e ects and toxic reactions are very serious
and often life-threatening undesirable responses that require prompt intervention from
a health care provider.
Nursing Considerations. Nursing considerations are organized as care is organized.
That is:
• What needs to be assessed or done before the rst dose is administered?
(Baseline Assessment)
• What interventions and evaluations are needed during drug therapy?
(Intervention/Evaluation)
• What explicit teaching is needed for the patient and family? (Patient/Family
Teaching)
Saunders Nursing Drug Handbook is an easy-to-use source of current drug
information for nurses, students, and other health care providers. It is our hope that
this handbook will help you provide quality care to your patients.
We welcome any comments you may have that would help us to improve future
editions of the handbook. Please contact us via the publisher at
h t t p : / / e v o l v e . e l s e v i e r . c o m / S a u n d e r s N D H .
Barbara B. Hodgson, RN, OCN
Robert J. Kizior, BS, RPh



ACKNOWLEDGMENTS
I o er a special heartfelt thank you to my co-author, Bob Kizior, for his continuing,
superb work. Without Bob’s e ort in this major endeavor, this book would not have
reached the par excellence it has achieved. Bob and I particularly and especially thank
Sandra Clark, our clinical manager, for her total dedication to making this edition one
of Saunders’s &nest works. We gratefully acknowledge Lauren Lake, our content editor,
in helping ease our workload. Our thanks also go to Amy Simpson and the sta at
Graphic World for their tenacious detail work. It takes many eyes to transform a book
into a work of art. Without their e orts, this would not have happened. I especially
thank Jim Witmer, BSN, CEN, and Keith Hodgson, RN, BSN, for their unending
encouragement, support, meticulous eye for detail, and nursing knowledge.
Barbara B. Hodgson, RN, OCN
BIBLIOGRAPHY
Briggs GG, Freeman RK, Yaffe SJ: Drugs in Pregnancy and Lactation: A Reference Guide to
Fetal and Neonatal Risk, ed 9, Philadelphia, 2011, Lippincott Williams & Wilkins.
Drug Facts and Comparisons 2012, Philadelphia, 2012, Lippincott Williams & Wilkins.
Generali J, Paxton L: Black Box Warnings Study Guide 2012, Black Box Rx LLC.
Lacy CF, Armstrong LL, Goldman MP, Lance LL: Lexi-Comp’s Drug Information Handbook,
ed 21, Hudson, OH, 2012–2013, Lexi-Comp.
Lexi-Comp’s Drug Information Handbook for Oncology, ed 9, Hudson, OH, 2011, Lexi-Comp.
Natural Medicines Comprehensive Database, 2009.
Takemoto CK, Hodding JH, Kraus DM: Lexi-Comp’s Pediatric Dosage Handbook, ed 19,
Hudson, OH, 2012–2013, Lexi-Comp.
Trissel LA: Handbook of Injectable Drugs, ed 15, Bethesda, MD, 2008, American Society of
Health-System Pharmacists.
ILLUSTRATION CREDITS
Kee JL, Hayes ER, McCuiston LE (eds): Pharmacology: A Nursing Process Approach, ed 7,
Philadelphia, 2012, Saunders.
Mosby’s GenRx, ed 12, St. Louis, 2004, Mosby.NEWLY APPROVED MEDICATIONS
Name Indication
Aclidinium (Tudorza) Anticholinergic oral inhaler for COPD
Apixaban (Eliquis)* Factor Xa inhibitor anticoagulant indicated to reduce
the risk of stroke and dangerous blood clots
(systemic embolism) in patients with atrial
fibrillation that is not caused by a heart valve
problem
Avanafil (Stendra) PDE5 inhibitor for erectile dysfunction
Axitinib (Inlyta) Kinase inhibitor for advanced renal cell carcinoma
Bedaquiline (Sirturo)* Oral diarylquinoline antimycobacterial drug
indicated for the treatment of pulmonary
multidrug-resistant tuberculosis
Bosutinib (Bosulif) Kinase inhibitor for treatment of adults with chronic,
+accelerated, or blast phase Ph chronic
myelogenous leukemia
Cabozantinib (Cometriq) Kinase inhibitor for treatment of progressive,
metastatic medullary thyroid cancer
Carfilzomib (Kyprolis) Proteasome inhibitor for advanced multiple
myeloma
Crofelemer (Fulyzaq)* Proanthocyanidin oligomer indicated to relieve
symptoms of diarrhea in HIV/AIDS patients taking
antiretroviral therapy
Enzalutamide (Xtandi) Androgen receptor inhibitor for treatment of
metastatic castration-resistant prostate cancer in
patients who previously received docetaxel
Glucarpidase (Voraxaze) Injectable carboxypeptidase enzyme for treatment of
toxic methotrexate blood levels due to kidney
failure
Icosapent (Vascepa) Omega-3 fatty acid for severe hypertriglyceridemia
Ivacaftor (Kalydeco) Cystic fibrosis transmembrane conductance regulator
potentiator for cystic fibrosis patients who have a
gene mutation
Linaclotide (Linzess) A guanylate cyclase-C agonist for treatment of
irritable bowel syndrome with constipation and
chronic idiopathic constipation
Lomitapide (Juxtapid) Microsomal triglyceride transfer protein inhibitor
indicated for treatment of patients with
homozygous familial hypercholesterolemia
Lorcaserin (Belviq) Serotonin 2C agonist for chronic weight
management
Loxapine (Adasuve) Antipsychotic for acute treatment of agitation
associated with schizophrenia or bipolar 1 disorder
in adults
Lucinactant (Surfaxin) Synthetic surfactant for prevention of respiratory
distress syndrome in premature infantsName IndicationMirabegron (Myrbetriq) Beta -adrenergic agonist for overactive bladder3
Omacetaxine (Synribo) Treatment of adults with chronic or accelerated
phase chronic myeloid leukemia
Pasireotide (Signifor) Somatostatin analog for treatment of Cushing’s
disease
Peginesatide (Omontys) Erythropoiesis-stimulating agent for anemia in
dialysis patients
Perampanel (Fycompa) AMPA antagonist in adjunctive therapy for
treatment of partial-onset seizures with or without
secondary generalized seizures
Pertuzumab (Perjeta) HER2/neu receptor antagonist for HER2-positive
metastatic breast cancer
Ponatinib (Iclusig) Kinase inhibitor for treatment of chronic myeloid
leukemia and Philadelphia chromosome–positive
acute lymphoblastic leukemia
Regorafenib (Stivarga) Kinase inhibitor for treatment of metastatic
colorectal cancer previously treated
Stribild (cobicistat, elvitegravir, Complete once-daily single-tablet regimen for HIV-1
emtricitabine, and tenofovir) infection in treatment-naïve adults
Tbo-filgrastim Leukocyte growth factor for reduction in duration of
severe neutropenia in patients with nonmyeloid
malignancies receiving myelosuppressive
anticancer drugs
Teduglutide (Gattex) Recombinant analog of human glucagon-like peptide
2 for treatment of short bowel syndrome in adults
Teriflunomide (Aubagio) Oral immunomodulatory, disease-modifying drug
with anti-inflammatory properties for treatment of
relapsing forms of multiple sclerosis
Tofacitinib (Xeljanz) Treatment of moderate to severe rheumatoid
arthritis
Vismodegib (Erivedge) Hedgehog pathway inhibitor for advanced basal cell
carcinoma
*Selected new drugs approved by the FDA in late 2012. Monographs for these drugs are
on Evolve and on pages e2–e5 of the e-book.<
<
<
apixaban
a-pix-a-ban
(Eliquis)
Do not confuse apixaban with rivaroxaban, argatroban, or dabigatran.
BLACK BOX ALERT Discontinuation in absence of alternative anticoagulation
increases risk for thrombotic events. An increased rate of stroke noted following
discontinuation in pts with non-valvular atrial fibrillation. If apixaban must be
discontinued based on other than pathologic bleeding, coverage with another
anticoagulant should be strongly considered.
CLASSIFICATION
PHARMACOTHERAPEUTIC: Factor Xa inhibitor. CLINICAL: Anticoagulant.
ACTION
Selectively blocks active site of factor Xa, a key factor in the intrinsic and extrinsic
pathway of blood coagulation cascade. Prevents new clot formation, secondary
thromboembolic complications. Catalyzes conversion of prothrombin to thrombin.
Therapeutic Effect: Inhibits platelet activation, fibrin clot formation.
PHARMACOKINETICS
Readily absorbed after PO administration. Peak plasma concentration: 3–4 hrs. Protein
binding: 87%. Metabolized in liver. Excreted primarily in urine, feces. Half-life: 12
hrs.
USES
Reduces risk for stroke, systemic embolism in pts with nonvalvular atrial 5brillation.
OFF-LABEL: Reduces risk of recurrent DVT and/or PE.
PRECAUTIONS
Contraindications: Active pathologic bleeding. Cautions: Mild to moderate hepatic
impairment, severe renal impairment. Avoid use in those with severe hepatic
impairment, prosthetic heart valve.
LIFESPAN CONSIDERATIONS
Pregnancy/Lactation: Unknown if distributed in breast milk. Pregnancy Category
B. Children: Safety and e: cacy not established. Elderly: No age-related precautions
noted.
INTERACTIONS
DRUG: CYP3A4 inducers (e.g., carbamazepine, rifampin) may decrease
levels/e ects. Aspirin, NSAIDs, warfarin, heparin, antiplatelet agents, CYP3A4
inhibitors, (e.g., ketoconazole, clarithromycin) may increase concentration,
bleeding risk. HERBAL: St. John’s wort may decrease levels/e ects. FOOD:
Grapefruit juice may increase levels/adverse e ects. LAB VALUES: May decrease
platelet count, Hgb, LFTs.
AVAILABILITY (Rx)Tablets: 2.5 mg, 5 mg.
ADMINISTRATION/HANDLING
Discontinuation in absence of alternative anticoagulation increases risk for
thrombotic events.
PO
• Give without regard to meals. • If elective surgery or invasive procedures with
moderate or high risk for bleeding, discontinue apixaban 24 hrs prior to procedure.
INDICATIONS/ROUTES/DOSAGE
Calculator
Usual Dosage
PO: ADULTS, ELDERLY: 5 mg twice daily, in those with at least 2 of the following
characteristics: age 80 yrs or older, body weight 60 kg or less, serum creatinine 1.5
mg/dl or greater, concurrent use with CYP3A4, P-gp inhibitors (e.g., ketoconazole,
ritonavir).
Usual Dosage
PO: ELDERLY: 2.5 mg daily twice daily.
SIDE EFFECTS
Rare (3%–1%): Nausea, ecchymosis.
ADVERSE EFFECTS/TOXIC REACTIONS
Increased risk for bleeding/hemorrhagic events. May cause serious, potentially fatal,
bleeding, accompanied by one or more of the following: a decrease in Hgb of 2 g/dl or
more; a need for 2 or more units of packed RBCs; bleeding occurring at one of the
following sites: intracranial, intraspinal, intraocular, pericardial, intra-articular,
intramuscular with compartment syndrome, retroperitoneal. Serious reactions include
jaundice, cholestasis, cytolytic hepatitis, Stevens-Johnson syndrome, hypersensitivity
reaction, anaphylaxis.
NURSING CONSIDERATIONS
BASELINE ASSESSMENT
Obtain baseline coagulation studies, CBC, PT/INR. Question history of bleeding
disorders, recent surgery, spinal punctures, intracranial hemorrhage, bleeding ulcers,
open wounds, anemia, hepatic impairment. Obtain full medication history including
herbal products.
INTERVENTION/EVALUATION
Periodically monitor CBC, platelet count, stool for occult blood. Be alert for
complaints of abdominal/back pain, headache, confusion, weakness, vision change
(may indicate hemorrhage). Question for increased menstrual bleeding/discharge.
Assess for any sign of bleeding: bleeding at surgical site, hematuria, blood in stool,
bleeding from gums, petechiae, ecchymosis.
PATIENT/FAMILY TEACHING• Do not take/discontinue any medication except on advice from physician. • Avoid
alcohol, aspirin, NSAIDs. • Consult physician before surgery, dental work. • Use
electric razor, soft toothbrush to prevent bleeding. Report blood tinged mucus from
coughing, heavy menstrual bleeding, headache, vision problems, weakness,
abdominal pain, frequent bruising, bloody urine or stool, joint pain or swelling.
Canadian trade name Non-Crushable Drug High Alert drug
underlined – top prescribed drug

bedaquiline
bed-ak-wi-leen
(Sirturo)
Do not confuse bedaquiline with quinidine or quetiapine.
BLACK BOX ALERT QT prolongation may occur. Concurrent use with other drugs
that may prolong QT interval may produce additive QT prolongation. To be used
only when current treatment regimen is ineffective. Placebo-controlled trial:
increased risk of death (11.4% bedaquiline vs. 2.5% placebo).
CLASSIFICATION
PHARMACOTHERAPEUTIC: Diarylquinoline antimycobacterial. CLINICAL:
Antitubercular.
ACTION
Inhibits mycobacterial adenosine triphosphate (ATP) synthase, an enzyme essential for
generation of energy in mycobacterium tuberculosum. Therapeutic Effect: Treatment
of multi-drug resistant mycobacterium tuberculosis (TB).
PHARMACOKINETICS
Absorbed from GI tract. Peak plasma concentration: 5 hrs. Metabolized in liver. Mainly
excreted in feces. Protein binding: 99.9%. Half-life: 5.5 mos.
USES
Treatment of pulmonary multidrug-resistant TB in adults 18 yrs and older when other
alterations are not available. Not recommended for use in those with extrapulmonary
TB (e.g., central nervous system), latent or drug-sensitive TB.
PRECAUTIONS
Contraindications: None known. Cautions: Severe hepatic/renal impairment, history
of or risk of QT prolongation (e.g., torsades de pointes, bradyarrhythmias,
hypothyroidism).
LIFESPAN CONSIDERATIONS
Pregnancy/Lactation: Unknown if distributed in breast milk. Pregnancy Category
B. Children: Safety and e: cacy not established in those younger than 18 yrs.
Elderly: No age-related precautions noted.@
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INTERACTIONS
DRUG: CYP3A4 inducers (e.g., carbamazepine, rifampin) may reduce
concentration, therapeutic e ect. CYP3A4 inhibitors (e.g., ketoconazole) may
increase concentration, risk of adverse reactions. Macrolide antibacterial (e.g.,
clarithromycin), uoroquinolones (e.g., levo oxacin), clofazimine may increase
risk of prolonged QT interval. HERBAL: St. John’s wort decreases
concentration/e ects. FOOD: Food enhances bioavailability. LAB VALUES: May
increase serum ALT, AST, alkaline phosphatase, aminotransferase, amylase.
AVAILABILITY (Rx)
Tablets: 100 mg.
ADMINISTRATION/HANDLING
PO
• Give with food (increases bioavailability). • Swallow tablet whole with water.
INDICATIONS/ROUTES/DOSAGE
Calculator
Tuberculosis
PO: ADULTS 18 YRS AND OLDER, ELDERLY: Note: Initiate medication with at least
3 other antitubercular drugs.
Weeks 1–2: 400 mg (4 tablets of 100 mg) once daily with food. Weeks 3–24: 200 mg
(2 tablets of 100 mg) 3 times per week with food (at least 48 hrs between doses) for a
total dose of 600 mg per wk. Total duration of treatment: 24 wks.
SIDE EFFECTS
Frequent (33%–28%): Arthralgia, nausea, headache. Occasional (9%–8%):
Anorexia, rash.
ADVERSE EFFECTS/TOXIC REACTIONS
Hemoptysis, chest pain occur in 18% and 11%, respectively. May prolong QT interval.
NURSING CONSIDERATIONS
BASELINE ASSESSMENT
Obtain baseline laboratory results prior to initiation of treatment, particularly serum
potassium, calcium, magnesium (may alter QT interval), aminotransferase, ALT, AST,
alkaline phosphatase, bilirubin and correct if abnormal. Obtain EKG and assess for
prolonged QT. Test for viral hepatitis.
INTERVENTION/EVALUATION
Follow-up monitoring of electrolytes should be performed if QT prolongation is
detected. If baseline EKG presents with prolonged QT interval, monitor EKG
frequently to con5rm QT interval has returned to baseline (monitor for syncope).
Monitor serum chemistries monthly while on treatment. Aminotransferase 3 × the
ULN or higher should be followed by repeat testing within 48 hrs. Diligently monitor
for any signs or symptoms of bleeding, fatigue, anorexia, nausea, jaundice, melanuria,hepatic tenderness, hepatomegaly.
PATIENT/FAMILY TEACHING
• Avoid alcohol. • Report fatigue, loss of appetite, nausea, yellowing of skin or eyes,
change in urine color, abdominal tenderness. • Strict compliance with drug regimen is
essential.
Canadian trade name Non-Crushable Drug High Alert drug
underlined – top prescribed drug

crofelemer
crow-fel-e-mur
(Fulyzaq)
CLASSIFICATION
PHARMACOTHERAPEUTIC: Chloride ion inhibitor. CLINICAL: Antidiarrheal agent.
ACTION
Inhibits calcium-activated chloride channel at the luminal membrane of enterocytes,
blocking secretion and high-volume water loss in diarrhea, normalizing the Mow of
chloride and water in the gastrointestinal tract. Therapeutic Effect: Antidiarrheal.
PHARMACOKINETICS
Minimal absorption. Half-life: N/A.
USES
Symptomatic relief of noninfectious diarrhea in adult pts with HIV, AIDS who are
receiving antiretroviral therapy.
PRECAUTIONS
Contraindications: None known. Cautions: Do not use in those with infectious
diarrhea. Electrolyte imbalance, fluid depletion.
LIFESPAN CONSIDERATIONS
Pregnancy/Lactation: Unknown if distributed in breast milk. Pregnancy Category
C. Children: Safety and e: cacy not established in those younger than 18 yrs of age.
Elderly: No age-related precautions noted.
INTERACTIONS
DRUG: None signi5cant. HERBAL: None signi5cant. FOOD: None known. LAB
VALUES: May increase serum bilirubin, AST. May decrease WBC count.
AVAILABILITY (Rx)
Tablets, Delayed-Release: 125 mg.
ADMINISTRATION/HANDLINGADMINISTRATION/HANDLING
PO
• Give without regard to food. • Swallow whole. • Do not break, crush, dissolve, or
divide tablet.
INDICATIONS/ROUTES/DOSAGE
Calculator
Diarrhea
PO: ADULTS, ELDERLY: One tablet two times daily.
SIDE EFFECTS
Occasional (4%–3%): Cough, Matulence, nausea, back pain, arthralgia. Rare (2%–
1%): Nasopharyngitis, musculoskeletal pain, anxiety, abdominal distention, dry
mouth, constipation.
ADVERSE EFFECTS/TOXIC REACTIONS
Upper respiratory tract infection occurs in 6% of pts, bronchitis in 4%, urinary tract
infection in 2%.
NURSING CONSIDERATIONS
BASELINE ASSESSMENT
Do not administer in presence of bloody diarrhea or temperature higher than 101°F.
INTERVENTION/EVALUATION
Encourage adequate Muid intake. Assess bowel sounds for peristalsis. Monitor daily
pattern of bowel activity, stool frequency and consistency (watery, loose, soft,
semisolid, solid). Withhold drug and notify physician promptly in event of abdominal
pain, distention, fever. Question for presence of nausea, back pain, arthralgia.
PATIENT/FAMILY TEACHING
• Do not exceed prescribed dose. • Do not break, chew, dissolve, or divide tablet. •
Avoid tasks that require alertness, motor skills until response to drug is established. •
Notify physician if diarrhea does not stop within 3 days, if abdominal distention or
pain occurs, or if fever develops.
Canadian trade name Non-Crushable Drug High Alert drug
underlined – top prescribed drugDrugs by Disorder
Alcohol dependence
Allergic rhinitis
Allergy
Alzheimer’s disease
Angina
Anxiety
Arrhythmias
Arthritis, rheumatoid (RA)
Asthma
Attention-deficit hyperactivity disorder (ADHD)
Benign prostatic hypertrophy (BPH)
Bipolar disorder (mania)
Bladder hyperactivity
Bronchospasm
Cancer
Cerebrovascular accident (CVA)
Chronic obstructive pulmonary disease (COPD)
Congestive heart failure (CHF)
Constipation
Crohn’s disease
Deep vein thrombosis (DVT)
Depression
Diabetes mellitus
Diabetic peripheral neuropathy
Diarrhea
Duodenal, gastric ulcer
Edema
Epilepsy
Esophageal reflux, esophagitis
Fever
Fibromyalgia
Gastritis
Gastroesophageal reflux disease (GERD)
Glaucoma
Gout
Hepatitis B
Hepatitis C
Human immunodeficiency virus (HIV)
Hypercholesterolemia
Hyperphosphatemia
Hypertension
Hypertriglyceridemia
Hyperuricemia
Hypotension
Hypothyroidism
Idiopathic thrombocytopenic purpura (ITP)
InsomniaMigraine headaches
Multiple sclerosis (MS)
Myelodysplastic syndrome
Myocardial infarction (MI)
Nausea
Obesity
Obsessive-compulsive disorder (OCD)
Organ transplant, rejection prophylaxis
Osteoarthritis
Osteoporosis
Paget’s disease
Pain, mild to moderate
Pain, moderate to severe
Panic attack disorder
Parkinsonism
Peptic ulcer disease
Pneumonia
Pneumonia, pneumocystis jiroveci
Post-traumatic stress disorder
Pruritus
Psychosis
Pulmonary arterial hypertension
Respiratory distress syndrome (RDS)
Restless legs syndrome
Schizophrenia
Smoking cessation
Thrombosis
Thyroid disorders
Transient ischemic attack (TIA)
Tremor
Tuberculosis (TB)
Urticaria
Vertigo
Vomiting
Zollinger-Ellison syndromeDRUGS BY DISORDER
Note: Not all medications appropriate for a given condition are listed, nor are
those not listed inappropriate.
Generic names appear first, followed by brand names in parentheses.
Alcohol dependence
Acamprosate (Campral)
Disulfiram (Antabuse)
Naltrexone (Depade, ReVia, Vivitrol)
Allergic rhinitis
Azelastine (Astepro)
Azelastine/fluticasone (Dymista)
Beclomethasone (Beconase AQ)
Budesonide (Rhinocort Aqua)
Ciclesonide (Omnaris)
Flunisolide (Nasarel)
Fluticasone (Flonase)
Mometasone (Nasonex)
Olopatadine (Patanase)
Triamcinolone (Nasacort)
Allergy
Beclomethasone (Beclovent, Vanceril)
Betamethasone (Celestone)
Brompheniramine (Dimetane)
Budesonide (Pulmicort, Rhinocort)
Cetirizine (Zyrtec)
Chlorpheniramine (Chlor-Trimeton)
Clemastine (Tavist)
Cyproheptadine (Periactin)
Desloratadine (Clarinex)
Dexamethasone (Decadron)
Dimenhydrinate (Dramamine)
Diphenhydramine (Benadryl)
Epinephrine (Adrenalin)
Fexofenadine (Allegra)
Flunisolide (AeroBid, Nasalide)
Fluticasone (Flovent)
Hydrocortisone (Solu-Cortef)
Levocetirizine (Xyzal)
Loratadine (Claritin)
Prednisolone (Prelone)
Prednisone (Deltasone)
Promethazine (Phenergan)
Triamcinolone (Kenalog)Alzheimer’s disease
Donepezil (Aricept, Aricept ODT)
Galantamine (Razadyne, Razadyne ER)
Memantine (Namenda)
Rivastigmine (Exelon, Exelon Patch)
Angina
Amlodipine (Norvasc)
Atenolol (Tenormin)
Diltiazem (Cardizem, Dilacor)
Isosorbide (Imdur, Isordil)
Metoprolol (Lopressor)
Nadolol (Corgard)
Nicardipine (Cardene)
Nifedipine (Adalat, Procardia)
Nitroglycerin
Propranolol (Inderal)
Verapamil (Calan, Isoptin)
Anxiety
Alprazolam (Xanax)
Buspirone (BuSpar)
Diazepam (Valium)
Hydroxyzine (Atarax, Vistaril)
Lorazepam (Ativan)
Oxazepam (Serax)
Paroxetine (Paxil)
Trazodone (Desyrel)
Venlafaxine (Effexor)
Arrhythmias
Acebutolol (Sectral)
Adenosine (Adenocard)
Amiodarone (Cordarone, Pacerone)
Digoxin (Lanoxin)
Diltiazem (Cardizem, Dilacor)
Disopyramide (Norpace)
Dofetilide (Tikosyn)
Dronedarone (Multaq)
Esmolol (Brevibloc)
Flecainide (Tambocor)
Ibutilide (Corvert)
Lidocaine
Magnesium sulfate
Metoprolol (Lopressor)
Mexiletine (Mexitil)
Procainamide (Procan, Pronestyl)
Propafenone (Rythmol)Propranolol (Inderal)
Quinidine
Sotalol (Betapace)
Tocainide (Tonocard)
Verapamil (Calan, Isoptin)
Arthritis, rheumatoid (RA)
Abatacept (Orencia)
Adalimumab (Humira)
Anakinra (Kineret)
Aspirin
Auranofin (Ridaura)
Aurothioglucose (Solganal)
Azathioprine (Imuran)
Capsaicin (Zostrix)
Celecoxib (Celebrex)
Certolizumab (Cimzia)
Cyclosporine (Sandimmune)
Diclofenac (Cataflam, Voltaren)
Diflunisal (Dolobid)
Etanercept (Enbrel)
Golimumab (Simponi)
Hydroxychloroquine (Plaquenil)
Infliximab (Remicade)
Leflunomide (Arava)
Methotrexate
Penicillamine (Cuprimine)
Prednisone (Deltasone)
Rituximab (Rituxan)
Sulfasalazine (Azulfidine-EN)
Tocilizumab (Actemra)
Tofacitinib (Xeljanz)
Asthma
Albuterol (Proventil, Ventolin)
Aminophylline (Theophylline)
Arformoterol (Brovana)
Beclomethasone (Beclovent, Vanceril)
Budesonide (Pulmicort)
Ciclesonide (Alvesco)
Epinephrine (Adrenalin)
Flunisolide (AeroBid)
Fluticasone (Flovent)
Formoterol (Foradil)
Hydrocortisone (Solu-Cortef)
Ipratropium (Atrovent)
Levalbuterol (Xopenex)
Metaproterenol (Alupent)
Methylprednisolone (Solu-Medrol)Mometasone (Asmanex)
Montelukast (Singulair)
Nedocromil (Tilade)
Prednisolone (Prelone)
Prednisone (Deltasone)
Salmeterol (Serevent)
Terbutaline (Brethine)
Theophylline (SloBid)
Zafirlukast (Accolate)
Zileuton (Zyflo, Zyflo CR)
Attention-deficit hyperactivity disorder (ADHD)
Atomoxetine (Strattera)
Bupropion (Wellbutrin)
Clonidine (Catapres, Kapvay)
Desipramine (Norpramin)
Dexmethylphenidate (Focalin, Focalin XR)
Dextroamphetamine (Dexedrine, Dextrostat)
Guanfacine (Intuniv)
Imipramine (Tofranil)
Lisdexamfetamine (Vyvanse)
Methylphenidate (Concerta, Daytrana, Focalin, Methylin, Ritalin)
Mixed amphetamine (dextroamphetamine and amphetamine salts) (Adderall, Adderall
XR)
Modafinil (Provigil)
Nortriptyline (Aventyl, Pamelor)
Venlafaxine (Effexor)
Benign prostatic hypertrophy (BPH)
Alfuzosin (Uroxatral)
Doxazosin (Cardura)
Dutasteride (Avodart)
Finasteride (Proscar)
Mirabegron (Myrbetriq)
Silodosin (Rapaflo)
Tadalafil (Cialis)
Tamsulosin (Flomax)
Terazosin (Hytrin)
Bipolar disorder (mania)
Carbamazepine (Tegretol)
Lamotrigine (Lamictal)
Lithium (Lithobid)
Oxcarbazepine (Trileptal)
Quetiapine (Seroquel)
Valproic acid (Depakene, Depakote)
Bladder hyperactivity
Darifenacin (Enablex)Oxybutynin (Ditropan, Gelnique)
Solifenacin (VESIcare)
Tolterodine (Detrol)
Trospium (Sanctura)
Bronchospasm
Albuterol (Proventil, Ventolin)
Levalbuterol (Xopenex)
Metaproterenol (Alupent)
Salmeterol (Serevent)
Terbutaline (Brethine)
Cancer
Abiraterone (Zytiga)
Aldesleukin (Proleukin)
Alemtuzumab (Campath)
Alitretinoin (Panretin)
Altretamine (Hexalen)
Anastrozole (Arimidex)
Arsenic trioxide (Trisenox)
Asparaginase (Elspar)
Axitinib (Inlyta)
Azacitidine (Vidaza)
BCG (TheraCys, Tice BCG)
Bendamustine (Treanda)
Bevacizumab (Avastin)
Bexarotene (Targretin)
Bicalutamide (Casodex)
Bleomycin (Blenoxane)
Bortezomib (Velcade)
Bosutinib (Bosulif)
Brentuximab (Adcetris)
Busulfan (Myleran)
Cabazitaxel (Jevtana)
Cabozantinib (Cometriq)
Capecitabine (Xeloda)
Carboplatin (Paraplatin)
Carfilzomib (Kyprolis)
Carmustine (BiCNU)
Cetuximab (Erbitux)
Chlorambucil (Leukeran)
Cisplatin (Platinol)
Cladribine (Leustatin)
Clofarabine (Clolar)
Crizotinib (Xalkori)
Cyclophosphamide (Cytoxan)
Cytarabine (Ara-C, Cytosar)
Dacarbazine (DTIC)
Dactinomycin (Cosmegen)Dasatinib (Sprycel)
Daunorubicin (Cerubidine, DaunoXome)
Degarelix (Firmagon)
Denileukin (Ontak)
Docetaxel (Taxotere)
Doxorubicin (Adriamycin, Doxil)
Enzalutamide (Xtandi)
Epirubicin (Ellence)
Eribulin (Halaven)
Erlotinib (Tarceva)
Estramustine (Emcyt)
Etoposide (VePesid)
Everolimus (Afinitor)
Fludarabine (Fludara)
Fluorouracil
Flutamide (Eulexin)
Fulvestrant (Faslodex)
Gefitinib (Iressa)
Gemcitabine (Gemzar)
Goserelin (Zoladex)
Hydroxyurea (Hydrea)
Ibritumomab (Zevalin)
Idarubicin (Idamycin)
Ifosfamide (Ifex)
Imatinib (Gleevec)
Interferon alfa-2b (Intron A)
Ipilimumab (Yervoy)
Irinotecan (Camptosar)
Ixabepilone (Ixempra)
Lapatinib (Tykerb)
Letrozole (Femara)
Leuprolide (Lupron)
Lomustine (CeeNU)
Mechlorethamine (Mustargen)
Megestrol (Megace)
Melphalan (Alkeran)
Mercaptopurine (Purinethol)
Methotrexate
Mitomycin (Mutamycin)
Mitotane (Lysodren)
Mitoxantrone (Novantrone)
Nelarabine (Arranon)
Nilotinib (Tasigna)
Nilutamide (Nilandron)
Ofatumumab (Arzerra)
Omacetaxine (Synribo)
Oxaliplatin (Eloxatin)
Paclitaxel (Taxol)
Panitumumab (Vectibix)Pazopanib (Votrient)
Pemetrexed (Alimta)
Pentostatin (Nipent)
Pertuzumab (Perjeta)
Plicamycin (Mithracin)
Ponatinib (Iclusig)
Pralatrexate (Folotyn)
Procarbazine (Matulane)
Rasburicase (Elitek)
Regorafenib (Stivarga)
Rituximab (Rituxan)
Romidepsin (Istodax)
Sipuleucel-T (Provenge)
Sorafenib (Nexavar)
Streptozocin (Zanosar)
Sunitinib (Sutent)
Tamoxifen (Nolvadex)
Temozolomide (Temodar)
Temsirolimus (Torisel)
Teniposide (Vumon)
Thioguanine
Thiotepa (Thioplex)
Tipifarnib (Zarnestra)
Topotecan (Hycamtin)
Toremifene (Fareston)
Tositumomab (Bexxar)
Trastuzumab (Herceptin)
Tretinoin (ATRA, Vesanoid)
Valrubicin (Valstar)
Vandetanib (Caprelsa)
Vemurafenib (Zelboraf)
Vinblastine (Velban)
Vincristine (Oncovin)
Vinorelbine (Navelbine)
Vismodegib (Erivedge)
Vorinostat (Zolinza)
Cerebrovascular accident (CVA)
Aspirin
Clopidogrel (Plavix)
Heparin
Nimodipine (Nimotop)
Prasugrel (Effient)
Ticlopidine (Ticlid)
Warfarin (Coumadin)
Chronic obstructive pulmonary disease (COPD)
Aclidinium (Tudorza)
Albuterol (Proventil HFA, Ventolin HFA)Aminophylline (Theophylline)
Arformoterol (Brovana)
Budesonide (Pulmicort)
Budesonide/formoterol (Symbicort)
Formoterol (Foradil)
Indacaterol (Arcapta)
Ipratropium (Atrovent HFA)
Levalbuterol (Xopenex)
Pirbuterol (Maxair)
Roflumilast (Daliresp)
Salmeterol (Serevent)
Salmeterol/fluticasone (Advair)
Theophylline (Theochron, Theo ZY)
Tiotropium (Spiriva)
Congestive heart failure (CHF)
Bisoprolol (Zebeta)
Bumetanide (Bumex)
Candesartan (Atacand)
Captopril (Capoten)
Carvedilol (Coreg)
Digoxin (Lanoxin)
Dobutamine (Dobutrex)
Dopamine (Intropin)
Enalapril (Vasotec)
Eplerenone (Inspra)
Fosinopril (Monopril)
Furosemide (Lasix)
Hydralazine (Apresoline)
Isosorbide (Isordil)
Lisinopril (Prinivil, Zestril)
Losartan (Cozaar)
Metoprolol (Lopressor)
Milrinone (Primacor)
Nitroglycerin
Quinapril (Accupril)
Ramipril (Altace)
Spironolactone (Aldactone)
Torsemide (Demadex)
Valsartan (Diovan)
Constipation
Bisacodyl (Dulcolax)
Docusate (Colace)
Lactulose (Kristalose)
Lubiprostone (Amitiza)
Methylcellulose (Citrucel)
Milk of magnesia (MOM)
Polyethylene glycol (MiraLax)Psyllium (Metamucil)
Senna (Senokot)
Crohn’s disease
Adalimumab (Humira)
Azathioprine (Azasan)
Budesonide (Entocort EC)
Certolizumab (Cimzia)
Hydrocortisone (Cortenema)
Infliximab (Remicade)
Mesalamine (Asacol, Pentasa)
Natalizumab (Tysabri)
Sulfasalazine (Azulfidine)
Deep vein thrombosis (DVT)
Dalteparin (Fragmin)
Enoxaparin (Lovenox)
Heparin
Tinzaparin (Innohep)
Warfarin (Coumadin)
Depression
Amitriptyline (Elavil, Endep)
Bupropion (Wellbutrin)
Citalopram (Celexa)
Clomipramine (Anafranil)
Desipramine (Norpramin)
Desvenlafaxine (Pristiq)
Doxepin (Sinequan)
Duloxetine (Cymbalta)
Escitalopram (Lexapro)
Fluoxetine (Prozac)
Fluvoxamine (Luvox)
Imipramine (Tofranil)
Maprotiline (Ludiomil)
Mirtazapine (Remeron)
Nortriptyline (Aventyl, Pamelor)
Paroxetine (Paxil)
Phenelzine (Nardil)
Selegiline (Emsam)
Sertraline (Zoloft)
Tranylcypromine (Parnate)
Trazodone (Desyrel)
Venlafaxine (Effexor)
Vilazodone (Viibryd)
Diabetes mellitus
Acarbose (Precose)
Bromocriptine (Cycloset)Colesevelam (Welchol)
Exenatide (Byetta)
Glimepiride (Amaryl)
Glipizide (Glucotrol)
Glyburide (Micronase)
Insulin preparations
Linagliptin (Tradjenta)
Liraglutide (Victoza)
Metformin (Glucophage)
Miglitol (Glyset)
Nateglinide (Starlix)
Pioglitazone (Actos)
Pramlintide (Symlin)
Repaglinide (Prandin)
Rosiglitazone (Avandia)
Saxagliptin (Onglyza)
Sitagliptin (Januvia)
Diabetic peripheral neuropathy
Amitriptyline (Elavil)
Bupropion (Wellbutrin)
Capsaicin (Trixaicin)
Carbamazepine (Tegretol)
Citalopram (Celexa)
Desipramine (Norpramin)
Duloxetine (Cymbalta)
Gabapentin (Neurontin)
Lamotrigine (Lamictal)
Lidocaine patch (Lidoderm)
Nortriptyline (Pamelor)
Oxcarbazepine (Trileptal)
Oxycodone (OxyContin)
Paroxetine (Paxil)
Pregabalin (Lyrica)
Tramadol (Ultram)
Valproic acid (Depakote)
Venlafaxine, extended-release (Effexor XR)
Diarrhea
Bismuth subsalicylate (Pepto-Bismol)
Diphenoxylate and atropine (Lomotil)
Fidaxomicin (Dificid)
Kaolin-pectin (Kaopectate)
Loperamide (Imodium)
Octreotide (Sandostatin)
Rifaximin (Xifaxan)
Duodenal, gastric ulcer
Cimetidine (Tagamet)Esomeprazole (Nexium)
Famotidine (Pepcid)
Lansoprazole (Prevacid)
Misoprostol (Cytotec)
Nizatidine (Axid)
Omeprazole (Prilosec)
Pantoprazole (Protonix)
Rabeprazole (Aciphex)
Ranitidine (Zantac)
Sucralfate (Carafate)
Edema
Amiloride (Midamor)
Bumetanide (Bumex)
Chlorthalidone (Hygroton)
Ethacrynic acid (Edecrin)
Furosemide (Lasix)
Hydrochlorothiazide (HydroDIURIL)
Indapamide (Lozol)
Metolazone (Zaroxolyn)
Spironolactone (Aldactone)
Torsemide (Demadex)
Triamterene (Dyrenium)
Epilepsy
Acetazolamide (Diamox)
Carbamazepine (Tegretol)
Clobazam (Onfi)
Clonazepam (Klonopin)
Clorazepate (Tranxene)
Diazepam (Valium)
Ezogabine (Potiga)
Fosphenytoin (Cerebyx)
Gabapentin (Neurontin)
Lamotrigine (Lamictal, Lamictal ODT, Lamictal XR)
Levetiracetam (Keppra)
Lorazepam (Ativan)
Oxcarbazepine (Trileptal)
Perampanel (Fycompa)
Phenobarbital
Phenytoin (Dilantin)
Primidone (Mysoline)
Tiagabine (Gabitril)
Topiramate (Topamax)
Valproic acid (Depakene, Depakote)
Vigabatrin (Sabril)
Zonisamide (Zonegran)
Esophageal reflux, esophagitisCimetidine (Tagamet)
Dexlansoprazole (Kapidex)
Esomeprazole (Nexium)
Famotidine (Pepcid)
Lansoprazole (Prevacid)
Nizatidine (Axid)
Omeprazole (Prilosec)
Pantoprazole (Protonix)
Rabeprazole (Aciphex)
Ranitidine (Zantac)
Fever
Acetaminophen (Tylenol)
Aspirin
Ibuprofen (Advil, Caldolor, Motrin)
Naproxen (Aleve, Anaprox, Naprosyn)
Fibromyalgia
Acetaminophen (Tylenol)
Amitriptyline (Elavil)
Carisoprodol (Soma)
Citalopram (Celexa)
Cyclobenzaprine (Flexeril)
Duloxetine (Cymbalta)
Fluoxetine (Prozac)
Gabapentin (Neurontin)
Milnacipran (Savella)
Paroxetine (Paxil)
Pregabalin (Lyrica)
Tramadol (Ultram)
Venlafaxine (Effexor)
Gastritis
Cimetidine (Tagamet)
Famotidine (Pepcid)
Nizatidine (Axid)
Ranitidine (Zantac)
Gastroesophageal reflux disease (GERD)
Cimetidine (Tagamet)
Dexlansoprazole (Kapidex)
Esomeprazole (Nexium)
Famotidine (Pepcid)
Lansoprazole (Prevacid)
Metoclopramide (Metozolv ODT, Reglan)
Nizatidine (Axid)
Omeprazole (Prilosec)
Pantoprazole (Protonix)
Rabeprazole (Aciphex)Ranitidine (Zantac)
Glaucoma
Acetazolamide (Diamox)
Apraclonidine (Iopidine)
Betaxolol (Betoptic)
Bimatoprost (Lumigan)
Brimonidine (Alphagan)
se (Azopt)
Carbachol
Carteolol (Ocupress)
Dipivefrin (Propine)
Dorzolamide (Trusopt)
Echothiophate iodide (Phospholine)
Latanoprost (Xalatan)
Levobunolol (Betagan)
Metipranolol (OptiPranolol)
Pilocarpine (Isopto Carpine)
Timolol (Timoptic)
Travoprost (Travatan)
Gout
Allopurinol (Zyloprim)
Colchicine (Colcrys)
Febuxostat (Uloric)
Ibuprofen (Motrin)
Indomethacin (Indocin)
Naproxen (Naprosyn)
Pegloticase (Krystexxa)
Piroxicam (Feldene)
Probenecid (Benemid)
Sulindac (Clinoril)
Hepatitis B
Adefovir (Hepsera)
Entecavir (Baraclude)
Lamivudine (Epivir)
Peginterferon alpha-2a (Pegasys)
Telbivudine (Tyzeka)
Tenofovir (Viread)
Hepatitis C
Boceprevir (Victrelis)
Interferon alfa-2b (Intron-A)
Interferon alfacon-1 (Infergen)
Peginterferon alfa-2a (Pegasys)
Peginterferon alfa-2b (Pegintron)
Ribavirin (Copegus)
Telaprevir (Incivek)Human immunodeficiency virus (HIV)
Abacavir (Ziagen)
Atazanavir (Reyataz)
Darunavir (Prezista)
Delavirdine (Rescriptor)
Didanosine (Videx)
Efavirenz (Sustiva)
Emtricitabine (Emtriva)
Enfuvirtide (Fuzeon)
Etravirine (Intelence)
Fosamprenavir (Lexiva)
Indinavir (Crixivan)
Lamivudine (Epivir)
Lopinavir/ritonavir (Kaletra)
Maraviroc (Selzentry)
Nelfinavir (Viracept)
Nevirapine (Viramune)
Raltegravir (Isentress)
Rilpivirine (Edurant)
Ritonavir (Norvir)
Saquinavir (Invirase)
Stavudine (Zerit)
Stribild (cobicistat, elvitagravir, emtricitabine, tenafovir)
Tenofovir (Viread)
Tesamorelin (Egrifta)
Tipranavir (Aptivus)
Zidovudine (AZT, Retrovir)
Hypercholesterolemia
Atorvastatin (Lipitor)
Cholestyramine (Questran)
Colesevelam (Welchol)
Colestipol (Colestid)
Ezetimibe (Zetia)
Fenofibrate (Antara, Lofibra, Tricor)
Fish oil (Lovaza)
Fluvastatin (Lescol)
Gemfibrozil (Lopid)
Lomitapide (Juxapid)
Lovastatin (Altoprev, Mevacor)
Niacin (Niaspan, Slo-Niacin)
Pitavastatin (Livalo)
Pravastatin (Pravachol)
Rosuvastatin (Crestor)
Simvastatin (Zocor)
Hyperphosphatemia
Aluminum saltsCalcium salts
Lanthanum (Fosrenol)
Sevelamer (Renagel)
Hypertension
Aliskiren (Tekturna)
Amlodipine (Norvasc)
Atenolol (Tenormin)
Azilsartan (Edarbi)
Benazepril (Lotensin)
Bisoprolol (Zebeta)
Candesartan (Atacand)
Captopril (Capoten)
Clevidipine (Cleviprex)
Clonidine (Catapres)
Diltiazem (Cardizem, Dilacor)
Doxazosin (Cardura)
Enalapril (Vasotec)
Eplerenone (Inspra)
Eprosartan (Teveten)
Felodipine (Plendil)
Fosinopril (Monopril)
Hydralazine (Apresoline)
Hydrochlorothiazide (HydroDIURIL)
Indapamide (Lozol)
Irbesartan (Avapro)
Isradipine (DynaCirc)
Labetalol (Normodyne, Trandate)
Lisinopril (Prinivil, Zestril)
Losartan (Cozaar)
Methyldopa (Aldomet)
Metolazone (Diulo, Zaroxolyn)
Metoprolol (Lopressor)
Minoxidil (Loniten)
Moexipril (Univasc)
Nadolol (Corgard)
Nebivolol (Bystolic)
Nicardipine (Cardene)
Nifedipine (Adalat, Procardia)
Nitroglycerin
Nitroprusside (Nipride)
Olmesartan (Benicar)
Perindopril (Aceon)
Pindolol (Visken)
Prazosin (Minipress)
Propranolol (Inderal)
Quinapril (Accupril)
Ramipril (Altace)
Spironolactone (Aldactone)Telmisartan (Micardis)
Terazosin (Hytrin)
Timolol (Blocadren)
Trandolapril (Mavik)
Valsartan (Diovan)
Verapamil (Calan, Isoptin)
Hypertriglyceridemia
Atorvastatin (Lipitor)
Colesevelam (Welchol)
Fenofibrate (Tricor)
Fluvastatin (Lescol)
Gemfibrozil (Lopid)
Icosapent (Vascepa)
Lovastatin (Mevacor)
Niacin (Niaspan)
Omega-3 acid ethyl esters (Lovaza)
Pravastatin (Pravachol)
Rosuvastatin (Crestor)
Simvastatin (Zocor)
Hyperuricemia
Allopurinol (Zyloprim)
Febuxostat (Uloric)
Pegloticase (Krystexxa)
Probenecid (Benemid)
Hypotension
Dobutamine (Dobutrex)
Dopamine (Intropin)
Ephedrine
Epinephrine
Norepinephrine (Levophed)
Phenylephrine (Neo-Synephrine)
Hypothyroidism
Levothyroxine (Levoxyl, Synthroid)
Liothyronine (Cytomel)
Thyroid
Idiopathic thrombocytopenic purpura (ITP)
Cyclophosphamide (Cytoxan)
Dexamethasone (Decadron)
Hydrocortisone (Solu-Cortef)
Immune globulin intravenous
Methylprednisolone (Solu-Medrol)
Prednisone
Rh (D) immune globulin (RhoGam)o
Rituximab (Rituxan)Insomnia
Diphenhydramine (Benadryl)
Estazolam (ProSom)
Eszopiclone (Lunesta)
Flurazepam (Dalmane)
Ramelteon (Rozerem)
Temazepam (Restoril)
Zaleplon (Sonata)
Zolpidem (Ambien, Edluar)
Migraine headaches
Almotriptan (Axert)
Amitriptyline (Elavil, Endep)
Diclofenac (Cambia)
Dihydroergotamine
Eletriptan (Relpax)
Ergotamine (Ergomar)
Frovatriptan (Frova)
Naratriptan (Amerge)
Propranolol (Inderal)
Rizatriptan (Maxalt)
Sumatriptan (Imitrex)
Zolmitriptan (Zomig)
Multiple sclerosis (MS)
Dalfampridine (Ampyra)
Fingolimod (Gilenya)
Glatiramer (Copaxone)
Interferon beta-1a (Avonex, Rebif)
Interferon beta-1b (Betaseron, Extavia)
Mitoxantrone (Novantrone)
Natalizumab (Tysabri)
Teriflunomide (Aubagio)
Myelodysplastic syndrome
Azacitidine (Vidaza)
Clofarabine (Clolar)
Decitabine (Dacogen)
Lenalidomide (Revlimid)
Myocardial infarction (MI)
Alteplase (Activase)
Aspirin
Atenolol (Tenormin)
Captopril (Capoten)
Clopidogrel (Plavix)
Dalteparin (Fragmin)
Diltiazem (Cardizem, Dilacor)Enalapril (Vasotec)
Enoxaparin (Lovenox)
Heparin
Lidocaine
Lisinopril (Prinivil, Zestril)
Metoprolol (Lopressor)
Morphine
Nitroglycerin
Propranolol (Inderal)
Quinapril (Accupril)
Ramipril (Altace)
Reteplase (Retavase)
Timolol (Blocadren)
Warfarin (Coumadin)
Nausea
Aprepitant (Emend)
Chlorpromazine (Thorazine)
Dexamethasone (Decadron)
Dimenhydrinate (Dramamine)
Dolasetron (Anzemet)
Dronabinol (Marinol)
Droperidol (Inapsine)
Fosaprepitant (Emend)
Granisetron (Kytril)
Hydroxyzine (Vistaril)
Lorazepam (Ativan)
Meclizine (Antivert)
Metoclopramide (Reglan)
Ondansetron (Zofran)
Palonosetron (Aloxi)
Prochlorperazine (Compazine)
Promethazine (Phenergan)
Trimethobenzamide (Tigan)
Obesity
Bupropion (Wellbutrin)
Diethylpropion (Tenuate)
Exenatide (Bydureon, Byetta)
Lorcaserin (Belviq)
Methamphetamine (Desoxyn)
Orlistat (Alli, Xenical)
Phendimetrazine (Bontril)
Phentermine (Ionamin)
Phentermine and topiramate (Qsymia)
Obsessive-compulsive disorder (OCD)
Citalopram (Celexa)
Clomipramine (Anafranil)Escitalopram (Lexapro)
Fluoxetine (Prozac)
Fluvoxamine (Luvox)
Paroxetine (Paxil)
Sertraline (Zoloft)
Organ transplant, rejection prophylaxis
Azathioprine (Imuran)
Basiliximab (Simulect)
Belatacept (Nulojix)
Cyclophosphamide (Cytoxan, Neosar)
Cyclosporine (Sandimmune)
Daclizumab (Zenapax)
Everolimus (Zortress)
Mycophenolate (CellCept)
Sirolimus (Rapamune)
Tacrolimus (Prograf)
Osteoarthritis
Acetaminophen (Tylenol)
Celecoxib (Celebrex)
Diclofenac (Cataflam, Pennsaid, Voltaren)
Etodolac (Lodine)
Flavocoxid (Limbrel)
Flurbiprofen (Ansaid)
Ibuprofen (Motrin)
Ketoprofen (Orudis)
Meloxicam (Mobic)
Nabumetone (Relafen)
Naproxen (Naprosyn)
Oxaprozin (Daypro)
Piroxicam (Feldene)
Salicylates (Aspirin)
Sulindac (Clinoril)
Tramadol (Ultram)
Osteoporosis
Alendronate (Fosamax)
Calcitonin (Miacalcin)
Calcium salts
Denosumab (Prolia)
Ibandronate (Boniva)
Raloxifene (Evista)
Risedronate (Actonel)
Teriparatide (Forteo)
Vitamin D
Zoledronic acid (Reclast)
Paget’s diseaseAlendronate (Fosamax)
Calcitonin (Miacalcin)
Etidronate (Didronel)
Pamidronate (Aredia)
Risedronate (Actonel)
Tiludronate (Skelid)
Zoledronic acid (Reclast)
Pain, mild to moderate
Acetaminophen (Tylenol)
Aspirin
Celecoxib (Celebrex)
Codeine
Diclofenac (Cataflam, Voltaren, Zipsor)
Diflunisal (Dolobid)
Etodolac (Lodine)
Flurbiprofen (Ansaid)
Ibuprofen (Advil, Caldolor, Motrin)
Ketorolac (Toradol)
Naproxen (Anaprox, Naprosyn)
Salsalate (Disalcid)
Tramadol (Ultram)
Pain, moderate to severe
Butorphanol (Stadol)
Fentanyl (Onsolis, Sublimaze)
Hydromorphone (Dilaudid)
Meperidine (Demerol)
Methadone (Dolophine)
Morphine (MS Contin)
Morphine/naltrexone (Embeda)
Nalbuphine (Nubain)
Oxycodone (OxyFast, Roxicodone)
Oxymorphone (Opana)
Ziconotide (Prialt)
Panic attack disorder
Alprazolam (Xanax)
Clonazepam (Klonopin)
Paroxetine (Paxil)
Sertraline (Zoloft)
Venlafaxine (Effexor)
Parkinsonism
Amantadine (Symmetrel)
Apomorphine (Apokyn)
Bromocriptine (Parlodel)
Carbidopa/levodopa (Sinemet, Sinemet CR)
Diphenhydramine (Benadryl)Entacapone (Comtan)
Pramipexole (Mirapex)
Rasagiline (Azilect)
Ropinirole (Requip)
Rotigotine (Neupro)
Selegiline (Eldepryl, Zelapar)
Tolcapone (Tasmar)
Peptic ulcer disease
Cimetidine (Tagamet)
Esomeprazole (Nexium)
Famotidine (Pepcid)
Lansoprazole (Prevacid)
Misoprostol (Cytotec)
Nizatidine (Axid)
Omeprazole (Prilosec)
Pantoprazole (Protonix)
Rabeprazole (Aciphex)
Ranitidine (Zantac)
Sucralfate (Carafate)
Pneumonia
Amoxicillin (Amoxil)
Amoxicillin/clavulanate (Augmentin)
Ampicillin (Polycillin)
Azithromycin (Zithromax)
Cefaclor (Ceclor)
Cefpodoxime (Vantin)
Ceftriaxone (Rocephin)
Cefuroxime (Kefurox, Zinacef)
Clarithromycin (Biaxin)
Co-trimoxazole (Bactrim, Septra)
Erythromycin
Gentamicin (Garamycin)
Levofloxacin (Levaquin)
Linezolid (Zyvox)
Moxifloxacin (Avelox)
Piperacillin/tazobactam (Zosyn)
Tobramycin (Nebcin)
Vancomycin (Vancocin)
Pneumonia, pneumocystis jiroveci
Atovaquone (Mepron)
Clindamycin (Cleocin)
Co-trimoxazole (Bactrim, Septra)
Pentamidine (Pentam)
Trimethoprim (Proloprim)
Post-traumatic stress disorderAmitriptyline (Elavil)
Aripiprazole (Abilify)
Citalopram (Celexa)
Escitalopram (Lexapro)
Fluoxetine (Prozac)
Imipramine (Tofranil)
Lamotrigine (Lamictal)
Olanzapine (Zyprexa)
Paroxetine (Paxil)
Phenelzine (Nardil)
Prazosin (Minipress)
Propranolol (Inderal)
Quetiapine (Seroquel)
Risperidone (Risperdal)
Sertraline (Zoloft)
Topiramate (Topamax)
Valproic acid (Depakote)
Venlafaxine (Effexor)
Ziprasidone (Geodon)
Pruritus
Amcinonide (Cyclocort)
Brompheniramine (Dimetane)
Cetirizine (Zyrtec)
Chlorpheniramine (Dimetane)
Clemastine (Tavist)
Clobetasol (Temovate)
Cyproheptadine (Periactin)
Desloratadine (Clarinex)
Desonide (Tridesilon)
Desoximetasone (Topicort)
Diphenhydramine (Benadryl)
Fluocinolone (Synalar)
Fluocinonide (Lidex)
Halobetasol (Ultravate)
Hydrocortisone (Cort-Dome, Hytone)
Hydroxyzine (Atarax, Vistaril)
Prednisolone (Prelone)
Prednisone (Deltasone)
Promethazine (Phenergan)
Psychosis
Aripiprazole (Abilify)
Chlorpromazine (Thorazine)
Clozapine (Clozaril)
Fluphenazine (Prolixin)
Haloperidol (Haldol)
Iloperidone (Fanapt)
Loxapine (Adasuve)Lurasidone (Latuda)
Olanzapine (Zyprexa)
Perphenazine (Trilafon)
Quetiapine (Seroquel, Seroquel XR)
Risperidone (Risperdal)
Thioridazine (Mellaril)
Thiothixene (Navane)
Ziprasidone (Geodon)
Pulmonary arterial hypertension
Ambrisentan (Letairis)
Bosentan (Tracleer)
Epoprostenol (Flolan)
Iloprost (Ventavis)
Sildenafil (Revatio)
Tadalafil (Adcirca)
Treprostinil (Remodulin, Tyvaso)
Respiratory distress syndrome (RDS)
Beractant (Survanta)
Calfactant (Infasurf)
Poractant alfa (Curosurf)
Restless legs syndrome
Cabergoline (Dostinex)
Carbidopa/levodopa (Sinemet)
Clonazepam (Klonopin)
Gabapentin (Horizant, Neurontin)
Levodopa
Oxycodone (Roxicodone)
Pramipexole (Mirapex)
Ropinirole (Requip)
Rotigotine (Neupro)
Tramadol (Ultram)
Zaleplon (Sonata)
Zolpidem (Ambien)
Schizophrenia
Aripiprazole (Abilify)
Chlorpromazine (Thorazine)
Clozapine (Clozaril)
Fluphenazine (Prolixin)
Haloperidol (Haldol)
Iloperidone (Fanapt)
Lurasidone (Latuda)
Olanzapine (Zyprexa)
Paliperidone (Invega, Invega Sustenna)
Perphenazine (Trilafon)
Quetiapine (Seroquel, Seroquel XR)Risperidone (Risperdal)
Thioridazine (Mellaril)
Thiothixene (Navane)
Ziprasidone (Geodon)
Smoking cessation
Bupropion (Zyban)
Clonidine (Catapres)
Nicotine (Nicoderm, Nicotrol)
Nortriptyline (Pamelor)
Varenicline (Chantix)
Thrombosis
Apixaban (Eliquis)
Dalteparin (Fragmin)
Enoxaparin (Lovenox)
Fondaparinux (Arixtra)
Heparin
Tinzaparin (Innohep)
Warfarin (Coumadin)
Thyroid disorders
Levothyroxine (Levoxyl, Synthroid)
Liothyronine (Cytomel)
Thyroid
Transient ischemic attack (TIA)
Aspirin
Clopidogrel (Plavix)
Prasugrel (Effient)
Ticlopidine (Ticlid)
Warfarin (Coumadin)
Tremor
Atenolol (Tenormin)
Chlordiazepoxide (Librium)
Diazepam (Valium)
Lorazepam (Ativan)
Metoprolol (Lopressor)
Nadolol (Corgard)
Propranolol (Inderal)
Tuberculosis (TB)
Bedaquiline (Sirturo)
Ethambutol (Myambutol)
Isoniazid (INH)
Pyrazinamide
Rifabutin (Mycobutin)
Rifampin (Rifadin)Rifapentine (Priftin)
Streptomycin
Urticaria
Cetirizine (Zyrtec)
Cimetidine (Tagamet)
Clemastine (Tavist)
Cyproheptadine (Periactin)
Diphenhydramine (Benadryl)
Hydroxyzine (Atarax, Vistaril)
Loratadine (Claritin)
Promethazine (Phenergan)
Ranitidine (Zantac)
Vertigo
Dimenhydrinate (Dramamine)
Diphenhydramine (Benadryl)
Meclizine (Antivert)
Scopolamine (Trans-Derm Scop)
Vomiting
Aprepitant (Emend)
Chlorpromazine (Thorazine)
Dexamethasone (Decadron)
Dimenhydrinate (Dramamine)
Dolasetron (Anzemet)
Dronabinol (Marinol)
Droperidol (Inapsine)
Fosaprepitant (Emend)
Granisetron (Kytril)
Hydroxyzine (Vistaril)
Lorazepam (Ativan)
Meclizine (Antivert)
Metoclopramide (Reglan)
Ondansetron (Zofran)
Palonosetron (Aloxi)
Prochlorperazine (Compazine)
Promethazine (Phenergan)
Scopolamine (Trans-Derm Scop)
Trimethobenzamide (Tigan)
Zollinger-Ellison syndrome
Aluminum salts
Cimetidine (Tagamet)
Esomeprazole (Nexium)
Famotidine (Pepcid)
Lansoprazole (Prevacid)
Omeprazole (Prilosec)
Pantoprazole (Protonix)Rabeprazole (Aciphex)
Ranitidine (Zantac)Drug Classification
allergic rhinitis nasal preparations
anesthetics: general
anesthetics: local
anesthetics: local topical
angiotensin-converting enzyme (ACE) inhibitors
angiotensin II receptor antagonists
antacids
antianxiety agents
antiarrhythmics
antibiotics
antibiotic: aminoglycosides
antibiotic: cephalosporins
antibiotic: fluoroquinolones
antibiotic: macrolides
antibiotic: penicillins
anticoagulants/antiplatelets/thrombolytics
anticonvulsants
antidepressants
antidiabetics
antidiarrheals
antifungals: systemic mycoses
antifungals: topical
antiglaucoma agents
antihistamines
antihyperlipidemics
antihypertensives
antimigraine (triptans)
antipsychotics
antivirals
beta-adrenergic blockers
bronchodilators
calcium channel blockers
chemotherapeutic agents
cholinergic agonists/anticholinesterase
contraception
corticosteroids
corticosteroids: topical
diuretics
fertility agents
H antagonists2
hematinic preparations
hormones
human immunodeficiency virus (HIV) infection
immunosuppressive agents
laxatives
neuromuscular blockers
nitrates
nonsteroidal anti-inflammatory drugs (NSAIDs)nutrition: enteral
nutrition: parenteral
obesity management
ophthalmic medications for allergic conjunctivitis
opioid analgesics
osteoporosis
Parkinson’s disease treatment
proton pump inhibitors
sedative-hypnotics
skeletal muscle relaxants
smoking cessation agents
sympathomimetics
thyroid
vitaminsabacavir
abatacept
abciximab
abiraterone
acarbose
acetaminophen
acetazolamide
acetylcysteine
acetylsalicylic acid
aclidinium
acyclovir
adalimumab
adefovir
adenosine
albumin, human
albuterol
aldesleukin
alemtuzumab
alendronate
alfuzosin
aliskiren
allopurinol
almotriptan
alprazolam
alprostadil
alteplase
alvimopan
amantadine
ambrisentan
amikacinamiodarone
amitriptyline
amlodipine
amoxicillin
amoxicillin/clavulanate
amphotericin B
ampicillin
ampicillin/sulbactam
amturnide
anakinra
anastrozole
anidulafungin
antihemophilic factor
aprepitant
argatroban
aripiprazole
armodafinil
arsenic trioxide
ascorbic acid
asenapine
asparaginase
aspirin
atazanavir
atenolol
atomoxetine
atorvastatin
atovaquone
atropine
avanafil
axitinibazacitidine
azathioprine
azelastine
azilsartan
azithromycin
aztreonambacitracin
baclofen
basiliximab
beclomethasone
belatacept
belimumab
benazepril
bendamustine
benzonatate
benztropine
beractant
betamethasone
bethanechol
bevacizumab
bexarotene
bicalutamide
bisacodyl
bismuth
bisoprolol
bivalirudin
bleomycin
boceprevir
bortezomib
bosentan
bosutinib
brentuximab vedotin
bromocriptine
budesonide
bumetanide
buprenorphinebupropion
buspirone
busulfancabazitaxel
cabozantinib
caffeine citrate
calcitonin
calcitriol
calcium acetate
calcium carbonate
calcium chloride
calcium citrate
calcium glubionate
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calfactant
candesartan
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carmustine
carvedilol
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cefaclor
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cefdinir
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cefotaximecefoxitin
cefpodoxime
cefprozil
ceftaroline
ceftazidime
ceftibuten
ceftriaxone
cefuroxime
celecoxib
cephalexin
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cisplatin
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citrovorum factor
cladribine
clarithromycin
clevidipineclindamycin
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clonidine
clopidogrel
clorazepate
clozapine
codeine
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colesevelam
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eribulin
erlotinib
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etanerceptethambutol
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etravirine
everolimus
exemestane
exenatide
ezetimibe
ezogabinefactor VIII
famciclovir
famotidine
febuxostat
felodipine
fenofibrate
fenofibric acid
fenoldopam
fentanyl
ferrous fumarate
ferrous gluconate
ferrous sulfate
fesoterodine
fexofenadine
fidaxomicin
filgrastim
finasteride
fingolimod
fluconazole
fludarabine
flumazenil
flunisolide
fluorouracil
fluoxetine
fluphenazine
flurazepam
flurbiprofen
flutamide
fluticasone
fluvastatinfluvoxamine
folic acid
folinic acid
fondaparinux
formoterol
fosamprenavir
fosaprepitant
foscarnet
fosinopril
fosphenytoin
frovatriptan
fulvestrant
furosemidegabapentin
galantamine
ganciclovir
gefitinib
gemcitabine
gemfibrozil
gemifloxacin
gentamicin
glatiramer
glimepiride
glipizide
glucagon
glucarpidase
glyburide
golimumab
goserelin
granisetron
granulocyte macrophage colony-stimulating factor
griseofulvin
guaifenesin
guanfacineh a l o p e r i d o l
h C G
h e p a r i n
h y d r a l a z i n e
h y d r o c h l o r o t h i a z i d e
h y d r o c o d o n e
h y d r o c o r t i s o n e
h y d r o m o r p h o n e
h y d r o x y c h l o r o q u i n e
h y d r o x y u r e a
h y d r o x y z i n e
h y o s c y a m i n eibandronate
ibritumomab
ibuprofen
icatibant
icosapent
idarubicin
ifosfamide
iloperidone
iloprost
imatinib
imipenem/cilastatin
imipramine
immune globulin IV
immune globulin subcutaneous
indacaterol
indapamide
indinavir
indomethacin
infliximab
insulin
insulin aspart
insulin detemir
insulin glargine
insulin glulisine
insulin lispro
interferon alfa-2b
interferon beta-1a
interferon beta-1b
interferon gamma-1b
interleukin-2ipilimumab
ipratropium
irbesartan
irinotecan
iron dextran
iron sucrose
isoniazid
isosorbide dinitrate
isosorbide mononitrate
isotretinoin
isradipine
itraconazole
ivacaftor
ixabepilonek e t a m i n e
k e t o c o n a z o l e
k e t o p r o f e n
k e t o r o l a clabetalol
lacosamide
lactulose
lamivudine
lamotrigine
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lanthanum
lapatinib
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levocetirizine
levofloxacin
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lidocaine
linaclotide
linagliptin
linezolid
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lisinopril
lithium
lomitapide
lomustine
loperamidelopinavir/ritonavir
loratadine
lorazepam
losartan
lovastatin
loxapine
lubiprostone
lucinactant
lurasidone
lymphocyte immune globulin Nmagnesium
magnesium chloride
magnesium citrate
magnesium hydroxide
magnesium oxide
magnesium protein complex
mannitol
maraviroc
meclizine
medroxyprogesterone
megestrol
meloxicam
melphalan
memantine
meperidine
meropenem
mesalamine
mesna
metaxalone
metformin
methadone
methocarbamol
methotrexate
methylergonovine
methylnaltrexone
methylphenidate
methylprednisolone
methylprednisolone acetate
methylprednisolone sodium succinate
metoclopramidemetolazone
metoprolol
metronidazole
micafungin
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midazolam
midodrine
mifepristone
milnacipran
milrinone
minocycline
minoxidil
mirabegron
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modafinil
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morphine
moxifloxacin
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mycophenolatenabumetone
nadolol
nafcillin
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naloxone
naltrexone
naproxen
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natalizumab
nateglinide
nebivolol
nelarabine
nelfinavir
neostigmine
nesiritide
nevirapine
niacin
nicardipine
nicotine
nicotinic acid
nifedipine
nilotinib
nilutamide
nimodipine
nitazoxanide
nitrofurantoin
nitroglycerin
nitroprusside
nizatidine
norepinephrinenorfloxacin
nortriptyline
nystatinoctreotide
ocular lubricant
ofatumumab
ofloxacin
olanzapine
olmesartan
olsalazine
omacetaxine
omalizumab
omega-3 acid ethyl esters
omeprazole
ondansetron
oprelvekin
orlistat
oseltamivir
oxaliplatin
oxaprozin
oxcarbazepine
oxybutynin
oxycodone
oxymorphone
oxytocinpaclitaxel
palifermin
paliperidone
palivizumab
palonosetron
pamidronate
pancrelipase
panitumumab
pantoprazole
paricalcitol
paroxetine
pasireotide
pazopanib
pegfilgrastim
peginterferon alfa-2a
peginterferon alfa-2b
pegloticase
pegvisomant
pemetrexed
penicillamine
penicillin G benzathine
penicillin G potassium
penicillin V potassium
pentamidine
pentoxifylline
perampanel
pertuzumab
phenazopyridine
phenelzine
phenobarbitalphentolamine
phenylephrine
phenytoin
phosphates
phytonadione
pimecrolimus
pioglitazone
piperacillin sodium/tazobactam sodium
piroxicam
pitavastatin
plerixafor
polyethylene glycol
polyethylene glycol-electrolyte solution
ponatinib
poractant alfa
posaconazole
potassium acetate
potassium bicarbonate/citrate
potassium chloride
potassium gluconate
pralatrexate
pramipexole
pramlintide
prasugrel
pravastatin
prazosin
prednisolone
prednisone
pregabalin
primidoneprobenecid
procainamide
procarbazine
prochlorperazine
progesterone
promethazine
propafenone
propofol
propranolol
propylthiouracil
prostaglandin E1
protamine
pseudoephedrine
psyllium
pyrazinamide
pyridostigmine
pyridoxineq u e t i a p i n e
q u i n a p r i l
q u i n u p r i s t i n - d a l f o p r i s t i nrabeprazole
raloxifene
raltegravir
ramelteon
ramipril
ranitidine
ranolazine
rasagiline
rasburicase
regorafenib
regular insulin
repaglinide
reteplase
ribavirin
rifabutin
rifampin
rifaximin
rilpivirine
rimantadine
risedronate
risperidone
ritonavir
rituximab
rivaroxaban
rivastigmine
rizatriptan
roflumilast
romidepsin
romiplostim
ropinirolerosiglitazone
rosuvastatin
rufinamide
ruxolitinibsalmeterol
saquinavir
sargramostim
saxagliptin
scopolamine
selegiline
senna
sertraline
sevelamer
sildenafil
silodosin
silver sulfadiazine
simethicone
simvastatin
sirolimus
sitagliptin
sodium bicarbonate
sodium chloride
sodium ferric gluconate complex
sodium polystyrene sulfonate
solifenacin
somatropin
sorafenib
sotalol
spironolactone
stavudine
sucralfate
sulfamethoxazole-trimethoprim
sulfasalazine
sulindacsumatriptan
sunitinibtacrolimus
tadalafil
tamoxifen
tamsulosin
tapentadol
tbo-filgrastim
teduglutide
telaprevir
telavancin
telmisartan
temazepam
temozolomide
temsirolimus
tenecteplase
tenofovir
terazosin
terbinafine
terbutaline
teriflunomide
teriparatide
testosterone
tetracycline
thalidomide
theophylline
thiamine
thioridazine
thiotepa
thiothixene
tiagabine
ticagrelorticlopidine
tigecycline
tiludronate
timolol
tinzaparin
tiotropium
tipranavir
tizanidine
tobramycin
tocilizumab
tofacitinib
tolterodine
tolvaptan
topiramate
topotecan
toremifene
torsemide
131tositumomab and iodine I-tositumomab
tramadol
tranexamic acid
tranylcypromine
trastuzumab
trazodone
treprostinil
tretinoin
triamcinolone
triamcinolone acetonide
triamcinolone hexacetonide
triamterene
trifluoperazinetrihexyphenidyl
trimethoprim
triptorelin
trospiumu s t e k i n u m a bvalacyclovir
valganciclovir
valproic acid
valsartan
vancomycin
vandetanib
vardenafil
varenicline
vasopressin
vemurafenib
venlafaxine
verapamil
vilazodone
vinblastine
vincristine
vinorelbine
vismodegib
vitamin A
vitamin B6
vitamin C
vitamin D
vitamin E
vitamin K
vitamin K1
voriconazole
vorinostatw a r f a r i nzafirlukast
zaleplon
zanamivir
zidovudine
ziprasidone
zoledronic acid
zolmitriptan
zolpidem
zonisamide
"
Allergic Rhinitis Nasal Preparations
USES
Relieves symptoms associated with allergic rhinitis. These symptoms include rhinorrhea, nasal
congestion, pruritus, sneezing, postnasal drip, nasal pain.
Allergic rhinitis or hay fever is an in ammation of the nasal airways occurring when an
allergen (e.g., pollen) is inhaled. This triggers antibody production. The antibodies bind to
mast cells, which contain histamine. Histamine is released, causing symptoms of allergic
rhinitis.
ACTION
Intranasal corticosteroids: Depresses migration of polymorphonuclear leucocytes and
broblasts, reverses capillary permeability, and stabilizes nasal membranes to prevent/control
inflammation.
Intranasal antihistamines: Reduces histamine mediated symptoms of allergic rhinitis,
including pruritus, sneezing, rhinorrhea, watery eyes.
Intranasal mast cell stabilizers: Inhibits the mast cell release of histamine and other
inflammatory mediators.
Intranasal anticholinergics: Blocks acetylcholine in the nasal mucosa. E( ective in treating
rhinorrhea associated with allergic rhinitis.
Intranasal decongestants: Vasoconstricts the respiratory mucosa, provides short-term relief of
nasal congestion.
CORTICOSTEROIDS
Generic (Brand) Adult Dose Pediatric Dose Side Effects
Beclomethasone (p. Beconase AQ: 1–2 Beconase AQ: 5–11 yrs: 1–2 Altered taste and
113) (Beconase AQ) sprays in each sprays in each nostril 2 smell, epistaxis,
(QNASL) nostril 2 times/day burning, stinging,
times/day headache, nasal
QNASL: 2 sprays septum perforation
in each nostril
once daily
Budesonide (p. 152) 2 sprays in each 6–11 yrs: 1–2 sprays in each Same as
(Rhinocort Aqua) nostril daily nostril daily beclomethasone
Ciclesonide (p. 237) Omnaris: 2 sprays Omnaris: 6–11 yrs: (only Same as
(Omnaris, Zetonna) in each nostril seasonal allergic rhinitis) 2 beclomethasone
daily sprays in each nostril daily
Zetonna: 1 spray
in each nostril
daily
Flunisolide (p. 492) 2 sprays in each 6–14 yrs: 2 sprays in each Same as
(Nasarel) nostril 2 or 3 nostril 2 times/day or 1 beclomethasone
times/day spray in each nostril 3
(maximum: 8 times/day (maximum: 4
sprays in each sprays in each nostril daily)
nostril daily)
Fluticasone (p. 503) 1–2 sprays in 4–17 yrs: 1–2 sprays in each Same as
(Flonase) each nostril daily nostril daily beclomethasone
Fluticasone/Azelastine 1 spray in each Not indicated in children Same as
(Dymista) nostril 2 younger than 12 yrs beclomethasone
times/day and azelastine
Fluticasone (p. 503) 1–2 sprays in 2–11 yrs: 1–2 sprays in each Same as(Veramyst) each nostril daily nostril once daily beclomethasoneGeneric (Brand) Adult Dose Pediatric Dose Side EffectsMometasone (p. 794) 2 sprays in each 2–11 yrs: 1 spray in each Same as
(Nasonex) nostril daily nostril daily beclomethasone
Triamcinolone (p. 1–2 sprays in 2–5 yrs: 1 spray in each Same as
1208) (Nasacort AQ) each nostril daily nostril once daily beclomethasone
6–11 yrs: 1–2 sprays in each
nostril daily
ANTIHISTAMINES
Generic (Brand) Adult Dose Pediatric Dose Side Effects
Azelastine (p. 102) Astelin: 1–2 sprays in each nostril Astelin: 5–11 yrs: 1 Sedation,
(Astelin) Astepro 2 times/day spray in each epistaxis,
0.15% Astepro 0.15%: 1–2 sprays in each nostril 2 times/day nasal
nostril two times/day or 2 sprays irritation
each nostril once daily
Azelastine/Fluticasone 1 spray in each nostril 2 Not approved for Same as
(p. 102, 503) (Dymista) times/day children younger azelastine
than 12 yrs and
fluticasone
Olopatadine 2 sprays in each nostril 2 6–11 yrs: 1 spray Same as
(Patanase) times/day in each nostril 2 azelastine
times/day
MAST CELL STABILIZERS
Generic Adult Dose Pediatric Dose Side Effects
(Brand)
Cromolyn 1 spray in each nostril 2–11 yrs: 1 spray in each Nasal irritation,
(Nasalcrom) 3–6 times/day nostril 3–6 times/day unpleasant taste
ANTICHOLINERGICS
Generic (Brand) Adult Dose Pediatric Dose Side Effects
Ipratropium (p. 2 sprays in each 6–11 yrs: 2 sprays in Nasal irritation, epistaxis,
627) (Atrovent) nostril 2–3 each nostril 2–3 dizziness, headache, blurry
0.03% times/day times/day vision
Ipratropium (p. 2 sprays in each 5–11 yrs: 2 sprays in Same as ipratropium 0.03%
627) (Atrovent) nostril 4 each nostril 4
0.06% times/day times/day
DECONGESTANTS
Generic (Brand) Adult Dose Pediatric Side Effects
Dose
Oxymetazoline 2–3 drops or 2–3 drops or Insomnia, tachycardia, nervousness,
(Afrin) sprays 2 sprays 2 nausea, vomiting, transient burning,
times/day times/day headache, rebound congestion if used
longer than 72 hrs
Phenylephrine 2–3 drops or 1–2 6–11 yrs: 2–3 Restlessness, nervousness, headache,
(p. 942) (Neo- sprays q4h as drops rebound nasal congestion, burning,
Synephrine) needed (0.25% or (0.25%) q4h stinging, dryness
0.5%) as needed
1–5 yrs: 2–3
drops

"
(0.125%) q4hGeneric (Brand) Adult Dose Pediatric Side Effects
as neededDose
Anesthetics: General
USES
IV anesthetic agents are used to induce general anesthesia. The general anesthetic state consists
of unconsciousness, amnesia, analgesia, immobility, and attenuation of autonomic responses to
noxious stimuli.
Volatile inhalation agents produce all the components of the anesthetic state but are administered
through the lungs via an anesthesia machine. Agents for use include des urane, sevo urane,
isoflurane, enflurane, and halothane.
General anesthetics are medications producing un-consciousness and a lack of response to all
painful stimuli.
ACTION
IV anesthetic agents: Most agents produce CNS depression by action on the gamma-aminobutyric
acid (GABA) receptor complex. GABA is the primary inhibitory neurotransmitter in the CNS.
Ketamine produces dissociation between the thalamus and the limbic system.
Volatile inhalation agents: The action of these agents is not fully understood, but they may
disrupt neuronal transmission throughout the CNS. These agents may either block excitatory or
enhance inhibitory transmission through axons or synapses.
ANESTHETICS: GENERAL
Name Availability Uses Dosage Side Effects
Range
Etomidate I: 2 mg/ml IV induction 0.2–0.6 Myoclonus, pain on injection,
(Amidate) mg/kg nausea, vomiting, respiratory
depression
Ketamine I: 10 mg/ml, Analgesia, 1–4.5 Delirium, euphoria, nausea,
(Ketalar) 50 mg/ml, sedation, IV mg/kg vomiting
100 mg/ml induction
Methohexital Powder for IV induction, 50–120 mg Cardiovascular depression,
(Brevital) injection: sedation myoclonus, nausea, vomiting,
500 mg respiratory depression
Midazolam I: 1 mg/ml, 5 Anxiolytic, 1–5 mg Respiratory depression
(p. 774) mg/ml amnesic, titrated
(Versed) sedation slowly
Propofol (p. I: 10 mg/ml Sedation 0.5 mg/kg Cardiovascular depression,
994) IV induction 2–2.5 delirium, euphoria, pain on
(Diprivan) Maintenance mg/kg injection, respiratory depression
100–200
mcg/kg/min
I, Injection.
Anesthetics: Local
USES
Local anesthetics suppress pain by blocking impulses along axons. Suppression of pain does not
cause generalized depression of the entire nervous system. Local anesthetics may be given
topically and by injection (local in ltration, peripheral nerve block [axillary], IV regional [Bierblock], epidural, and spinal).
ACTION
Most local anesthetics fall into one of two groups: esters or amides. Both provide anesthesia
and analgesia by reversibly binding to and blocking sodium (Na) channels. This slows the rate
of depolarization of the nerve action potential; thus, propagation of the electrical impulses
needed for nerve conduction is prevented.
ANESTHETICS: LOCAL
Name Uses Onset Duration Side Effects
(min) (hrs)
Esters
Chloroprocaine Local infiltrate, 6–12 0.5–1 Seizures, bradycardia, cardiac arrest,
(Nesacaine) nerve block, hypotension, arrhythmias, anxiety,
spinal dizziness, restlessness, erythema,
pruritus, urticaria, blurred vision, allergic
reaction
Procaine Local infiltrate, 2–5 0.5–1.5 Burning sensation/pain at site of
(Novocaine) nerve block, injection, tissue irritation, CNS
spinal stimulation followed by CNS depression,
chills
Amides
Bupivacaine Local infiltrate, 5 2–9 Cardiac arrest, hypotension, bradycardia,
(Marcaine, nerve block, palpitations, seizures, restlessness,
Sensorcaine) epidural, spinal anxiety, dizziness, nausea, vomiting,
blurred vision, weakness, tinnitus, apnea
Lidocaine (p. Local infiltrate, Less 0.5–1 Bradycardia, hypotension, arrhythmias,
687) nerve block, than agitation, anxiety, dizziness, seizures,
spinal, epidural, 2 pruritus, rash, nausea, vomiting, altered
topical, IV taste, visual changes, tinnitus, respiratory
regional depression, allergic reaction
Mepivacaine Local infiltrate, 3–20 2–2.5 Bradycardia, syncope, arrhythmias,
(Carbocaine, nerve block, anxiety, seizures, dizziness, restlessness,
Polocaine) epidural chills, pruritus, urticaria, nausea,
vomiting, incontinence, blurred vision,
tinnitus, allergic reaction
Ropivacaine Local infiltrate, 1–15 3–15 Hypotension, bradycardia, headache,
(Naropin) nerve block, pruritus, nausea, vomiting, dizziness,
epidural, spinal anxiety, tinnitus, dyspnea, cardiac arrest,
arrhythmias, seizures, syncope, chills
Note: Most side effects are manifestations of excessive plasma concentrations.

Anesthetics: Local Topical
ANESTHETICS: LOCAL TOPICAL
Name Indications Peak Effect (min) Duration (min)
Amides
Dibucaine (Nupercainal) Skin Less than 5 15–45Name Indications Peak Effect (min) Duration (min)Lidocaine (p. 687) Skin, mucous membranes 2–5 15–45
Esters
Benzocaine Skin, mucous membranes Less than 5 15–45
Cocaine Mucous membranes 2–5 30–60
Tetracaine (Pontocaine) Skin, mucous membranes 3–8 30–60

Angiotensin-Converting Enzyme (ACE) Inhibitors
USES
Treatment of hypertension (HTN), adjunctive therapy for CHF.
ACTION
Antihypertensive: Exact mechanism unknown. May be related to competitive inhibition of
angiotensin I converting enzyme (ACE) activity causing decreased conversion of angiotensin I
to angiotensin II, a potent vasoconstrictor. Reduces peripheral arterial resistance.
Congestive heart failure: Decreases peripheral vascular resistance (afterload), pulmonary
capillary wedge pressure (preload); improves cardiac output, exercise tolerance.
ACE INHIBITORS
Name Availability Uses Dosage Range Side Effects
(per day)
Benazepril T: 5 mg, 10 mg, HTN HTN: 5–80 mg Headaches, dizziness, fatigue,
(p. 119) 20 mg, 40 mg cough
(Lotensin)
Captopril (p. T: 12.5 mg, 25 HTN HTN: 50–450 mg Insomnia, headaches, dizziness,
177) mg, 50 mg, 100 CHF CHF: 12.5–450 fatigue, GI complaints, cough,
(Capoten) mg mg rash
Enalapril (p. T: 2.5 mg, 5 mg, HTN HTN: 10–40 mg; Chest pain, hypotension,
406) 10 mg, 20 mg IV: CHF (IV: 1.25 mg q6h) headaches, fatigue, dizziness
(Vasotec) 1.25 mg/ml CHF: 5–20 mg
Fosinopril (p. T: 10 mg, 20 mg, HTN HTN: 10–80 mg Hypotension, nausea, vomiting,
517) 40 mg CHF CHF: 20–40 mg cough
(Monopril)
Lisinopril (p. T: 2.5 mg, 5 mg, HTN HTN: 10–40 mg Chest pain, hypotension,
697) 10 mg, 20 mg, 40 CHF CHF: 5–20 mg headaches, dizziness, fatigue,
(Prinivil, mg diarrhea
Zestril)
Moexipril T: 7.5 mg, 15 mg HTN HTN: 7.5–30 mg Dizziness, fatigue, diarrhea,
(Univasc) cough
Perindopril T: 2 mg, 4 mg, 6 HTN HTN: 4–16 mg Hypotension, dizziness, fatigue,
(Aceon) mg syncope, cough
Quinapril (p. T: 5 mg, 10 mg, HTN HTN: 10–80 mg Chest pain, hypotension,
1009) 20 mg, 40 mg CHF CHF: 10–40 mg headaches, dizziness, fatigue,
(Accupril) diarrhea, nausea, vomiting,
cough
Ramipril (p. C: 1.25 mg, 2.5 HTN HTN: 2.5–20 mg Hypotension, headaches,
1018) mg, 5 mg, 10 mg CHF CHF: 1.25–10 mg dizziness, cough(Altace)Name Availability Uses Dosage Range Side Effects
(per day)Trandolapril T: 1 mg, 2 mg, 4 HTN HTN: 1–4 mg Dizziness, dyspepsia, cough,
(Mavik) mg CHF CHF: 1–4 mg asthenia (loss of strength,
energy), syncope, myalgia
C, Capsules; CHF, congestive heart failure; HTN, hypertension; IV, intravenous; T, tablets.

Angiotensin II Receptor Antagonists
USES
Treatment of hypertension (HTN) alone or in combination with other antihypertensives.
Treatment of heart failure (HF).
ACTION
Angiotensin II receptor antagonists (AIIRA) block vasoconstrictor and aldosterone-secreting
e( ects on angiotensin II by selectively blocking the binding of angiotensin II to AT receptors1
in vascular smooth muscle and adrenal gland, causing vasodilation and a decrease in
aldosterone effects.
ANGIOTENSIN II RECEPTOR ANTAGONISTS
Name Availability Uses Dosage Side Effects
Range
(per
day)
Azilsartan T: 40 mg, HTN 40–80 Diarrhea, hypotension
(p. 103) 80 mg mg
Candesartan T: 4 mg, 8 HTN 8–32 Headaches, upper respiratory tract
(p. 174) mg, 16 mg, HF mg infection, pain, dizziness
(Atacand) 32 mg 4–32
mg
Eprosartan T: 400 mg, HTN 400– Headaches, upper respiratory tract
(p. 424) 600 mg 800 infection, myalgia
(Teveten) mg
Irbesartan T: 75 mg, HTN 75– Headaches, upper respiratory tract infection
(p. 629) 150 mg, Nephropathy 300
(Avapro) 300 mg mg
300
mg
Losartan (p. T: 25 mg, HTN 25– Dizziness, headaches, upper respiratory
713) 50 mg, 100 Nephropathy 100 tract infection, diarrhea, fatigue, cough
(Cozaar) mg mg
100
mg
Olmesartan T: 5 mg, 20 HTN 20–40 Headaches, upper respiratory tract
(p. 866) mg, 40 mg mg infection, flu-like symptoms, dizziness,
(Benicar) bronchitis, rhinitis, back pain, pharyngitis,
sinusitis, diarrhea, peripheral edema
Telmisartan T: 40 mg, HTN 20–80 Upper respiratory tract infection, dizziness,
(p. 1133) 80 mg CV risk mg back pain, sinusitis, diarrhea
(Micardis) reduction 80 mg"

Valsartan T: 80 mg, HTN 80– Dizziness, headaches, upper respiratoryNme Availability Uses Dosage Side Effects
(p. 1225) 160 mg HF 320 tract infection, diarrhea, fatigueRange
(Diovan) Post MI mg(per
80–day)
320
mg
40–
320
mg
CV, Cardiovascular; HF, heart failure; HTN, hypertension; MI, myocardial infarction; T, tablets.

Antacids
USES
Relief of symptoms associated with hyperacidity (e.g., heartburn, acid indigestion, sour
stomach), hyperacidity associated with gastric/duodenal ulcers, treatment of pathologic gastric
hypersecretion associated with Zollinger-Ellison syndrome, symptomatic treatment of
gastroesophageal re ux disease (GERD), prevention and treatment of upper GI stress-induced
ulceration and bleeding (esp. in ICU).
Aluminum hydroxide in conjunction with a low-phosphate diet to reduce elevated phosphate in
pts with renal insuK ciency. Calcium for calcium de ciency, magnesium for magnesium
deficiency.
ACTION
Antacids act primarily in the stomach to neutralize gastric acid (increase pH). Antacids do not
have a direct e( ect on acid output. The ability to increase pH depends on the dose, dosage
form used, presence or absence of food in the stomach, and acid-neutralizing capacity (ANC).
ANC is the number of mEq of hydrochloric acid that can be neutralized by a particular weight
or volume of antacid.
Antacids reduce elevated phosphate by binding with phosphate in the intestine to form an
insoluble complex, which is then eliminated.
ANTACIDS
Antacid Brand Availability Dosage Side Effects
Names Range
Aluminum
Hydroxide Amphojel, T: 300 mg, 500–1,500 Chalky taste, mild constipation,
Alu-Tab, 500 mg, 600 mg 3–6 abdominal cramps
Dialume mg times/day Long-term use: Neurotoxicity in dialysis
C: 500 mg pts, hypercalcemia, osteoporosis Large
doses: Fecal impaction, peripheral edema
Calcium
Carbonate Tums, T 500–1,500 Chalky taste
(p. 170) Caltrate (chewable): mg as Large doses: Fecal impaction, peripheral
600, Oyst- 500 mg, 750 needed edema, metabolic alkalosis Long-term use:
Cal 500 mg, 1,000 mg (Maximum: Difficult/painful urination
T: 1,250 mg 7,000 mg in
24 hrs)
Citrate Calcitrate C: 225 mg 500–2,000 Constipation, nausea, vomiting
T: 200 mg mg
Magnesium"
Hydroxide Milk of T T: 622– Chalky taste, diarrhea, laxative effect,Antacid Brand Availability Dosage Side Effects
(p. 723) Magnesia (chewable): 1,244 mg electrolyte imbalance (dizziness,Names Range
311 mg up to 4 irregular heartbeat, fatigue)
L: 400 mg/5 times/day
ml, 800 mg/5 L: 2.5–7.5
ml ml up to 4
times/day
Oxide (p. Mag-Ox T: 400 mg, 400–800 Same as above
724) 400 420 mg, 500 mg/day
mg
C, Capsules; L, liquid; T, tablets.

Antianxiety Agents
USES
Treatment of anxiety including generalized anxiety disorder (GAD), panic disorder,
obsessivecompulsive disorder (OCD), social anxiety disorder (SAD), posttraumatic stress disorder (PTSD),
and acute stress disorder. In addition, some benzodiazepines are used as hypnotics,
anticonvulsants to prevent delirium tremors during alcohol withdrawal, and as adjunctive
therapy for relaxation of skeletal muscle spasms. Midazolam, a short-acting benzodiazepine, is
used for preop sedation and relief of anxiety for short diagnostic/endoscopic procedures (see
individual monograph for midazolam).
ACTION
Benzodiazepines are the largest and most frequently prescribed group of antianxiety agents.
The exact mechanism is unknown, but they may increase the inhibiting e( ect of
gammaaminobutyric acid (GABA), which inhibits nerve impulse transmission by binding to speci c
benzodiazepine receptors in various areas of the central nervous system (CNS).
Refer to individual entries of nonbenzodiazepine drugs for more information on uses
and actions.
ANTIANXIETY AGENTS
Name Availability Uses Dosage Side Effects
Range
(per
day)
Benzodiazepine
Alprazolam (p. T: 0.25 mg, Anxiety, panic 0.75– Drowsiness, weakness, fatigue,
38) (Xanax) 0.5 mg, 1 disorder 10 mg ataxia, slurred speech, confusion,
mg, 2 mg lack of coordination, impaired
S: 0.5 memory, paradoxical agitation,
mg/5 ml, 1 dizziness, nausea
mg/ml
ER: 0.5
mg, 1 mg,
2 mg, 3 mg
ODT: 0.25
mg, 0.5
mg, 1 mg,
2 mg
Chlordiazepoxide C: 5 mg, 10 Anxiety, alcohol 5–300 Same as alprazolam
(p. 231) mg, 25 mg withdrawal mg
(Librium) T: 10 mg,25 mgName Availability Uses Dosage Side Effects
I: 100 mg Range
(per
Clorazepate (p. C: 3.75 mg, Anxiety, alcohol 7.5–90 Same as alprazolamday)
269) (Tranxene) 7.5 mg, 15 withdrawal, mg
mg anticonvulsant
SD: 11.25
mg, 22.5
mg
Diazepam (p. T: 2.5 mg, Anxiety, alcohol 2–40 Same as alprazolam
342) (Valium) 5 mg, 10 withdrawal, mg
mg anticonvulsant,
S: 5 mg/5 muscle relaxant
ml, 5
mg/ml
I: 5 mg/ml
Lorazepam (p. T: 0.5 mg, Anxiety 0.5–10 Same as alprazolam
710) (Ativan) 1 mg, 2 mg mg
S: 2 mg/ml
I: 2 mg/ml,
4 mg/ml
Oxazepam C: 10 mg, Anxiety, alcohol 30– Same as alprazolam
(Serax) 15 mg, 30 withdrawal 120
mg mg
T: 15 mg
Nonbenzodiazepine
Buspirone (p. T: 5 mg, 10 Anxiety 7.5–60 Dizziness, light-headedness,
160) (BuSpar) mg, 15 mg, mg headaches, nausea, restlessness
30 mg
Hydroxyzine (p. T: 10 mg, Anxiety, 100– Drowsiness; dry mouth, nose, and
577) (Atarax, 25 mg, 50 rhinitis, 400 throat
Vistaril) mg, 100 pruritus, mg
mg urticaria,
nausea or
vomiting
Paroxetine (p. S: 10 mg/5 Anxiety, 10–50 Drowsiness; dry mouth, nose, and
907) (Paxil) ml depression, mg throat; dizziness; diarrhea;
T: 10 mg, obsessive- diaphoresis; constipation; vomiting;
20 mg, 30 compulsive tremors
mg, 40 mg disorder, panic
T (CR): disorder
12.5 mg,
25 mg,
37.5 mg
Trazodone (p. T: 50 mg, Anxiety, 100– Drowsiness, dizziness, headaches,
1203) (Desyrel) 100 mg, depression 400 dry mouth, nausea, vomiting,
150 mg, mg unpleasant taste
300 mg
Venlafaxine (p. C: 37.5 mg, Anxiety, 37.5– Drowsiness, nausea, headaches, dry
1237) (Effexor) 75 mg, 150 depression 225 mouth
mg mg
ER: 37.5
mg, 75 mg,
150 mg
C, Capsules; CR, controlled-release; ER, extended-release; I, injection; ODT, orally-disintegrating
tablet; S, solution; SD, single dose; T, tablets.

Antiarrhythmics
USES
Prevention and treatment of cardiac arrhythmias, such as premature ventricular contractions,
ventricular tachycardia, premature atrial contractions, paroxysmal atrial tachycardia, atrial
fibrillation and flutter.
ACTION
The antiarrhythmics are divided into four classes based on their e( ects on certain ion channels
and/or receptors located on the myocardial cell membrane. Class I is further divided into three
subclasses (IA, IB, IC) based on electrophysiologic effects.
Class I: Block cardiac sodium channels and slow conduction velocity, prolonging refractoriness
and decreasing automaticity of sodium-dependent tissue.
Class IA: Block sodium and potassium channels.
Class IB: Shorten the repolarization phase.
Class IC: No effect on repolarization phase, but slow conduction velocity.
Class II: Slow sinus and atrioventricular (AV) nodal conduction.
Class III: Block cardiac potassium channels, prolonging the repolarization phase of electrical
cells.
Class IV: Inhibit the in ux of calcium through its channels, causing slower conduction through
the sinus and AV nodes.
ANTIARRHYTHMICS
Name Availability Uses Dosage Range Side Effects
Class IA
Disopyramide C: 100 mg, AF, WPW, 400–800 Dry mouth, blurred vision, urinary
(p. 367) 150 mg PSVT, mg/day retention, CHF, proarrhythmia, heart
(Norpace, C (ER): PVCs, VT block, nausea, vomiting, diarrhea,
Norpace CR) 100 mg, hypoglycemia, nervousness
150 mg
Procainamide T: 250 mg, AF, WPW, A (PO): 250– Hypotension, fever, agranulocytosis,
(p. 983) 375 mg, PVCs, VT 500 mg q3h; SLE, headaches, proarrhythmia,
(Procan-SR, 500 mg (ER): 250– confusion, disorientation, GI
Pronestyl) C: 250 mg, 750 mg q6h symptoms, hypotension
375 mg,
500 mg
T (SR): 250
mg, 500
mg, 750
mg, 1,000
mg
I: 100
mg/ml,
500 mg/ml
Quinidine T: 200 mg, AF, WPW, A (PO): 200– Diarrhea, hypotension, nausea,
(Quinaglute, 300 mg PVCs, VT 600 mg q2– vomiting, cinchonism, fever, bitter
Quinidex) T (ER): 4h; (ER): taste, heart block,
300 mg, 300–600 mg thrombocytopenia, proarrhythmia
324 mg q8hI: 80Name Availability Uses Dosage Range Side Effects
mg/ml
Class IB
Lidocaine (p. I: 300 mg PVCs, VT, IV: 50–100 Drowsiness, agitation, muscle
687) for IM VF mg bolus, twitching, seizures, paresthesia,
(Xylocaine) IV then 1–4 proarrhythmia, slurred speech,
Infusion: 2 mg/min tinnitus, cardiac depression,
mg/ml, 4 infusion bradycardia, asystole
mg/ml
Mexiletine C: 150 mg, PVCs, VT, A: 600–1,200 Drowsiness, agitation, muscle
(Mexitil) 200 mg, VF mg/day twitching, seizures, paresthesia,
250 mg proarrhythmia, nausea, vomiting,
blood dyscrasias, hepatitis, fever
Tocainide T: 400 mg, PVCs, VT, A: 1,200– Drowsiness, agitation, muscle
(Tonocard) 600 mg VF 1,800 mg/day twitching, seizures, paresthesia,
proarrhythmia, nausea, vomiting,
diarrhea, agranulocytosis
Class IC
Flecainide T: 50 mg, AF, PSVT, A: 200–400 Dizziness, tremors, light-headedness,
(Tambocor) 100 mg, life- mg/day bradycardia, heart block, heart
150 mg threatening failure, GI upset, neutropenia,
ventricular flushing, blurred vision, metallic
arrhythmias taste, proarrhythmia
Propafenone T: 150 mg, PAF, WPW, A: 450–900 Dizziness, blurred vision, altered
(p. 992) 225 mg, life- mg/day taste, nausea, exacerbation of
(Rythmol) 300 mg threatening asthma, proarrhythmia, bradycardia,
ventricular heart block, heart failure, GI upset,
arrhythmias bronchospasm, hepatotoxicity
Class II (Beta-Blockers)
Acebutolol C: 200 mg, AF, A A: 600–1,200 Bradycardia, hypotension,
(Sectral) 400 mg flutter, mg/day depression, nightmares, fatigue,
PSVT, PVCs sexual dysfunction, SLE, arthritis,
myalgia
Esmolol (p. I: 10 AF, A A: 50–200 Hypotension, heart block, heart
436) mg/ml, 20 flutter, mcg/kg/min failure, bronchospasm
(Brevibloc) mg/ml PSVT, PVCs
Propranolol T: 10 mg, AF, A A: 10–30 mg Bradycardia, hypotension,
(p. 996) 20 mg flutter, 3–4 depression, nightmares, fatigue,
(Inderal) PSVT, PVCs times/day sexual dysfunction, heart block,
bronchospasm
Class III
Amiodarone T: 200 mg, AF, PAF, A (PO): 800– Blurred vision, photophobia,
(p. 50) 400 mg PSVT, life- 1,600 mg/day constipation, ataxia, proarrhythmia,
(Cordarone, I: 50 threatening for 1–3 wks, pulmonary fibrosis, bradycardia,
Pacerone) mg/ml ventricular then 600–800 heart block, hyperthyroidism or
arrhythmias mg/day hypothyroidism, peripheral
(IV): 150 mg neuropathy, GI upset, blue-gray skin,
bolus, then IV optic neuritis, hypotension
infusion
Dofetilide (p. C: 125 AF, A A: Torsade de pointes, hypotension
373) mcg, 250 flutter Individualized
(Tikosyn) mcg, 500
"


"

mcgName Availability Uses Dosage Range Side Effects
Dronedarone T: 400 mg AF, A A (PO): 400 Diarrhea, nausea, abdominal pain,
(p. 391) flutter mg 2 vomiting, asthenia (loss of strength,
(Multaq) times/day energy)
Ibutilide I: 0.1 AF, A A (greater Torsade de pointes
(Corvert) mg/ml flutter than 60 kg):
1 mg over 10
min; (less
than 60 kg):
0.01 mg/kg
over 10 min
Sotalol (p. T: 80 mg, AF, PAF, A: 160–640 Fatigue, dizziness, dyspnea,
1100) 120 mg, PSVT, life- mg/day bradycardia, proarrhythmia, heart
(Betapace) 160 mg, threatening block, hypotension, bronchospasm
240 mg ventricular
arrhythmias
Class IV (Calcium Channel Blockers)
Diltiazem (p. I: 25 AF, A A (IV): 20–25 Hypotension, bradycardia, dizziness,
356) mg/ml flutter, mg bolus, headaches, heart block, asystole,
(Cardizem) vials PSVT then infusion heart failure
Infusion: 1 of 5–15
mg/ml mg/hr
Verapamil (p. I: 5 mg/2 AF, A A (IV): 5–10 Hypotension, bradycardia, dizziness,
1239) (Calan, ml flutter, mg headaches, constipation, heart block,
Isoptin) PSVT heart failure, asystole, fatigue,
edema, nausea
A, Adults; AF, atrial brillation; A utter, atrial utter; C, capsules; CHF, congestive heart
failure; ER, extended-release; I, injection; PAF, paroxysmal atrial brillation; PSVT, paroxysmal
supraventricular tachycardia; PVCs, premature ventricular contractions; SLE, systemic lupus
erythematosus; SR, sustained-release; T, tablets; VT, ventricular tachycardia; WPW, Wol( -
Parkinson-White syndrome.
Antibiotics
USES
Treatment of wide range of gram-positive or gram-negative bacterial infections, suppression of
intestinal ora before surgery, control of acne, prophylactically to prevent rheumatic fever,
prophylactically in high-risk situations (e.g., some surgical procedures or medical conditions) to
prevent bacterial infection.
ACTION
Antibiotics (antimicrobial agents) are natural or synthetic compounds that have the ability to
kill or suppress the growth of microorganisms.
One means of classifying antibiotics is by their anti-microbial spectrum. Narrow-spectrum
agents are e( ective against few microorganisms (e.g., aminoglycosides are e( ective against
gram-negative aerobes), whereas broad-spectrum agents are e( ective against a wide variety of
microorganisms (e.g., uoroquinolones are e( ective against gram-positive cocci and
gramnegative bacilli).
Antimicrobial agents may also be classified based on their mechanism of action.
• Agents that inhibit cell wall synthesis or activate enzymes that disrupt the cell wall, causing a
weakening in the cell, cell lysis, and death. Include penicillins, cephalosporins, vancomycin,
imidazole antifungal agents."
• Agents that act directly on the cell wall, a( ecting permeability of cell membranes, causing
leakage of intracellular substances. Include antifungal agents amphotericin and nystatin,
polymyxin, colistin.
• Agents that bind to ribosomal subunits, altering protein synthesis and eventually causing cell
death. Include aminoglycosides.
• Agents that a( ect bacterial ribosome function, altering protein synthesis and causing slow
microbial growth. Do not cause cell death. Include chloramphenicol, clindamycin,
erythromycin, tetracyclines.
• Agents that inhibit nucleic acid metabolism by binding to nucleic acid or interacting with
enzymes necessary for nucleic acid synthesis. Inhibit DNA or RNA synthesis. Include rifampin,
metronidazole, fluoroquinolones (e.g., ciprofloxacin).
• Agents that inhibit speci c metabolic steps necessary for microbial growth, causing a
decrease in essential cell components or synthesis of nonfunctional analogues of normal
metabolites. Include trimethoprim, sulfonamides.
• Agents that inhibit viral DNA synthesis by binding to viral enzymes necessary for DNA
synthesis, preventing viral replication. Include acyclovir, vidarabine.
SELECTION OF ANTIMICROBIAL AGENTS
The goal of therapy is to achieve antimicrobial action at the site of infection suK cient to
inhibit the growth of the microorganism. The agent selected should be the most active against
the most likely infecting organism, least likely to cause toxicity or allergic reaction. Factors to
consider in selection of an antimicrobial agent include the following:
• Sensitivity pattern of the infecting microorganism
• Location and severity of infection (may determine route of administration)
• Pt’s ability to eliminate the drug (status of renal and hepatic function)
• Pt’s defense mechanisms (includes both cellular and humoral immunity)
• Pt’s age, pregnancy status, genetic factors, allergies, CNS disorder, preexisting medical
problems
CATEGORIZATION OF ORGANISMS BY GRAM STAINING
Gram-Positive Cocci Gram-Negative Gram-Positive Bacilli Gram-Negative Bacilli
Cocci
Aerobic Aerobic Aerobic Aerobic
Staphylococcus aureus Neisseria Listeria monocytogenes Escherichia coli
Staphylococcus gonorrhoeae Bacillus anthracis Klebsiella pneumoniae
epidermidis Neisseria Corynebacterium Proteus mirabilis
Streptococcus meningitidis diphtheriae Serratia marcescens
pneumoniae Moraxella catarrhalis Anaerobic Acinetobacter spp.
Streptococcus pyogenes Clostridium difficile Pseudomonas
Viridans streptococci Clostridium perfringens aeruginosa
Enterococcus faecalis Clostridium tetani Enterobacter spp.
Enterococcus faecium Actinomyces spp. Haemophilus
Anaerobic influenzae
Peptostreptococcus spp. Legionella pneumophila
Peptococcus spp. Anaerobic
Bacteroides fragilis
Fusobacterium spp.

Antibiotic: Aminoglycosides
USES
Treatment of serious infections when other less toxic agents are not e( ective, are
contraindicated, or require adjunctive therapy (e.g., with penicillins or cephalosporins). Used
primarily in the treatment of infections caused by gram-negative microorganisms, such as those"
"
caused by Proteus, Klebsiella, Pseudomonas, Escherichia coli, Serratia, and Enterobacter. Inactive
against most gram-positive microorganisms. Not well absorbed systemically from GI tract (must
be administered parenterally for systemic infections). Oral agents are given to suppress
intestinal bacteria.
ACTION
Bactericidal. Transported across bacterial cell membrane; irreversibly bind to speci c receptor
proteins of bacterial ribosomes. Interfere with protein synthesis, preventing cell reproduction
and eventually causing cell death.
ANTIBIOTIC: AMINOGLYCOSIDES
Name Availability Dosage Side Effects
Range
Amikacin (p. I: 50 A: 15 Nephrotoxicity, neurotoxicity, ototoxicity (both
48) (Amikin) mg/ml, mg/kg/day auditory and vestibular), hypersensitivity (skin
250 mg/ml C: 15 itching, redness, rash, swelling)
mg/kg/day
Gentamicin I: 10 A: 3–5 Same as amikacin
(p. 537) mg/ml, 40 mg/kg/day
(Garamycin) mg/ml C: 6–7.5
mg/kg/day
Neomycin T: 500 mg A: 1 g for 3 Nausea, vomiting, diarrhea
doses as
preop
Tobramycin I: 10 A: 3–5 Same as amikacin
(p. 1177) mg/ml, 40 mg/kg/day
(Nebcin) mg/ml C: 6–7.5
mg/kg/day
A, Adults; C (dosage), children; I, injection; T, tablets.
Antibiotic: Cephalosporins
USES
Broad-spectrum antibiotics, which, like penicillins, may be used in a number of diseases,
including respiratory diseases, skin and soft tissue infection, bone/joint infections, GU
infections, prophylactically in some surgical procedures.
First-generation cephalosporins have activity against gram-positive organisms (e.g., streptococci
and most staphylococci) and activity against most gram-negative organisms, including
Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Salmonella, and Shigella.
ACTION
Second-generation cephalosporins have same e( ectiveness as rst-generation and increased
activity against gram-negative organisms, including H. in, uenzae, Neisseria, Enterobacter, and
several anaerobic organisms.
Third-generation cephalosporins are less active against gram-positive organisms but more active
against the Enterobacteriaceae with some activity against Pseudomonas aeruginosa, Serratia
spp., and Acinetobacter spp.
Fourth-generation cephalosporins have good activity against gram-positive organisms (e.g.,
Staphylococcus aureus) and gram-negative organisms (e.g., Pseudomonas aeruginosa, E. coli,
Klebsiella, and Proteus).
Fifth-generation cephalosporins have good activity against gram-positive organisms (e.g.,
Staphylococcus aureus, Streptococcus spp.) and gram-negative organisms (e.g., E. coli, Klebsiella
spp.).Cephalosporins inhibit cell wall synthesis or activate enzymes that disrupt the cell wall, causing
cell lysis and cell death. May be bacteriostatic or bactericidal. Most e( ective against rapidly
dividing cells.
ANTIBIOTIC: CEPHALOSPORINS
Name Availability Dosage Range Side Effects
First-Generation
Cefadroxil (p. C: 500 mg A: 1–2 g/day Abdominal cramps/pain, fever,
196) (Duricef) T: 1 g C: 30 mg/kg/day nausea, vomiting, diarrhea,
S: 125 mg/5 ml, headaches, oral/vaginal
250 mg/5 ml, 500 candidiasis
mg/5 ml
Cefazolin (p. I: 500 mg, 1 g, 2 g A: 0.75–6 g/day Same as cefadroxil
198) (Ancef) C: 25–100
mg/kg/day
Cephalexin (p. C: 250 mg, 500 mg A: 1–4 g/day Same as cefadroxil
223) (Keflex, T: 250 mg, 500 mg, C: 25–100
Keftab) 1 g mg/kg/day
Second-Generation
Cefaclor (p. C: 250 mg, 500 mg A: 250–500 mg Same as cefadroxil
195) (Ceclor) T (ER): 500 mg q8h May have serum sickness–like
S: 125 mg/5 ml, C: 20–40 reaction
187 mg/5 ml, 250 mg/kg/day
mg/5 ml, 375 mg/5
ml
Cefotetan I: 1 g, 2 g A: 1–6 g/day Same as cefadroxil
May cause unusual
bleeding/ecchymoses
Cefoxitin (p. I: 1 g, 2 g A: 3–12 g/day Same as cefadroxil
207) (Mefoxin)
Cefprozil (p. T: 250 mg, 500 mg A: 0.5–1 g/day Same as cefadroxil
211) (Cefzil) S: 125 mg/5 ml, C: 30 mg/kg/day
250 mg/5 ml
Cefuroxime (p. T: 125 mg, 250 mg, A (PO): 0.25–1 Same as cefadroxil
219) (Ceftin, 500 mg g/day; (IM/IV):
Kefurox, S: 125 mg/5 ml, 2.25–9 g/day
Zinacef) 250 mg/5 ml C (PO): 250–500
I: 750 mg, 1.5 g mg/day; (IM/IV):
50–100
mg/kg/day
Third-Generation
Cefdinir (p. 200) C: 300 mg A: 600 mg/day Same as cefadroxil
(Omnicef) S: 125 mg/5 ml C: 14 mg/kg/day
Cefditoren T: 200 mg A: 400–800 Same as cefadroxil
(Spectracef) mg/day
Cefotaxime (p. I: 500 mg, 1 g, 2 g A: 2–12 g/day Same as cefadroxil
205) (Claforan) C: 100–200
mg/kg/day
Cefpodoxime (p. T: 100 mg, 200 mg A: 200–800 Same as cefadroxil
209) (Vantin) S: 50 mg/5 ml, 100 mg/daymg/5 ml C: 10 mg/kg/dayName Availability Dosage Rane Side Effects
Ceftazidime (p. I: 500 mg, 1 g, 2 g A: 0.5–6 g/day Same as cefadroxil
214) (Fortaz, C: 90–150
Tazicef, mg/kg/day
Tazidime)
Ceftibuten (p. C: 400 mg A: 400 mg/day Same as cefadroxil
216) (Cedax) S: 90 mg/5 ml, 180 C: 9 mg/kg/day
mg/5 ml
Ceftizoxime I: 500 mg, 1 g, 2 g A: 1–12 g/day Same as cefadroxil
(Cefizox) C: 150–200
mg/kg/day
Ceftriaxone (p. I: 250 mg, 500 mg, A: 1–4 g/day Same as cefadroxil
217) (Rocephin) 1 g, 2 g C: 50–100
mg/kg/day
Fourth-Generation
Cefepime (p. I: 500 mg, 1 g, 2 g A: 1–6 g/day Same as cefadroxil
201)
(Maxipime)
Fifth-Generation
Ceftaroline (p. I: 500 mg A: 600 mg q12h Same as cefadroxil
212) (Teflaro)
A, Adults; C, capsules; C (dosage), children; ER, extended-release; I, injection; S, suspension; T,
tablets.

Antibiotic: Fluoroquinolones
USES
Fluoroquinolones act against a wide range of gram-negative and gram-positive organisms.
They are used primarily in the treatment of lower respiratory infections, skin/skin structure
infections, UTIs, and sexually transmitted diseases.
ACTION
Bactericidal. Inhibit DNA gyrase in susceptible microorganisms, interfering with bacterial DNA
replication and repair.
ANTIBIOTIC: FLUOROQUINOLONES
Name Availability Dosage Range Side Effects
Ciprofloxacin T: 100 mg, A (PO): 250–750 Dizziness, headaches, anxiety, drowsiness,
(p. 244) 250 mg, 500 mg q12h; (IV): insomnia, abdominal pain, nausea, diarrhea,
(Cipro) mg, 750 mg 200–400 mg q12h vomiting, phlebitis (parenteral)
S: 250 mg/5
ml, 500
mg/5 ml
I: 200 mg,
400 mg
Gemifloxacin T: 320 mg A: 320 mg/day Same as ciprofloxacin
(p. 536)
(Factive)Levofloxacin T: 250 mg, A (PO/IV): 250– Same as ciprofloxacinName Availability Dosage Rangeide Effets
(p. 682) 500 mg, 750 750 mg/day as
(Levaquin) mg single dose
I: 250 mg,
500 mg, 750
mg
OS: 250
mg/10 ml
Moxifloxacin T: 400 mg A: 400 mg/day Same as ciprofloxacin; may prolong QT
(p. 801) I: 400 mg interval
(Avelox)
Norfloxacin T: 400 mg A: 400 mg q12h Same as ciprofloxacin
(p. 852)
(Noroxin)
Ofloxacin (p. T: 200 mg, A: 200–400 mg Same as ciprofloxacin
861) 300 mg, 400 q12h
mg
A, Adults; I, injection; OS, oral solution; S, suspension; T, tablets.

Antibiotic: Macrolides
USES
Macrolides act primarily against most gram-positive microorganisms and some gram-negative
cocci. Azithromycin and clarithromycin appear to be more potent than erythromycin.
Macrolides are used in the treatment of pharyngitis/tonsillitis, sinusitis, chronic bronchitis,
pneumonia, uncomplicated skin/skin structure infections.
ACTION
Bacteriostatic or bactericidal. Reversibly bind to the P site of the 50S ribosomal subunit of
susceptible organisms, inhibiting RNA-dependent protein synthesis.
ANTIBIOTIC: MACROLIDES
Name Availability Dosage Range Side Effects
Azithromycin (p. T: 250 mg, 600 mg A (PO): 500 mg PO: Nausea, diarrhea,
104) (Zithromax) S: 100 mg/5 ml, 200 once, then 250 mg vomiting, abdominal
mg/5 ml, 1-g packet on days 2–5; (IV): pain
I: 500 mg 500 mg/day IV: Pain, redness,
C (PO): 10 mg/kg swelling at injection site
once, then 5
mg/kg/day on days
2–5
Clarithromycin (p. T: 250 mg, 500 mg A: 250–500 mg Headaches, loss of taste,
253) (Biaxin) T (XL): 500 mg q12h nausea, vomiting,
S: 125 mg/5 ml C: 7.5 mg/kg q12h diarrhea, abdominal
pain/discomfort
Erythromycin (p. T: 200 mg, 250 mg, A (PO): 250–500 mg PO: Nausea, vomiting,
432) (EES, Eryc, 333 mg, 400 mg, 500 q6h diarrhea, abdominal
EryPed, Ery-Tab, mg C (PO): 30–50 pain
Erythrocin, PCE) C: 250 mg mg/kg/day IV: Inflammation,
S: 100 mg/2.5 ml, 125 A, C (IV): 15–20 phlebitis at injection site
mg/5 ml, 200 mg/5 mg/kg/day
ml, 250 mg/5 ml, 400 Maximum: 4 g/daymg/5 mlName Availability Dosage Range Side Effects
A, Adults; C, capsules; C (dosage), children; I, injection; S, suspension; T, tablets; XL,
longacting.

Antibiotic: Penicillins
USES
Penicillins (also referred to as beta-lactam antibiotics) may be used to treat a large number of
infections, including pneumonia and other respiratory diseases, UTIs, septicemia, meningitis,
intra-abdominal infections, gonorrhea and syphilis, bone/joint infection.
Penicillins are classified based on an antimicrobial spectrum:
Natural penicillins are very active against gram-positive cocci but ine( ective against most
strains of Staphylococcus aureus (inactivated by enzyme penicillinase).
Penicillinase-resistant penicillins are e( ective against penicillinase-producing Staphylococcus
aureus but are less effective against gram-positive cocci than the natural penicillins.
Broad-spectrum penicillins are e( ective against gram-positive cocci and some gram-negative
bacteria (e.g., Haemophilus in, uenzae, Escherichia coli, Proteus mirabilis, Salmonella, and
Shigella).
Extended-spectrum penicillins are e( ective against gram-negative organisms, including
Pseudomonas aeruginosa, Enterobacter, Proteus spp., Klebsiella, Serratia spp., and Acinetobacter
spp.
ACTION
Penicillins inhibit cell wall synthesis or activate enzymes, which disrupt the bacterial cell wall,
causing cell lysis and cell death. May be bacteriostatic or bactericidal. Most e( ective against
bacteria undergoing active growth and division.
ANTIBIOTIC: PENICILLINS
Name Availability Dosage Side Effects
Range
Natural
Penicillin G benzathine I: 600,000 A: 1.2 Mild diarrhea, nausea, vomiting,
(p. 926) (Bicillin, units, 1.2 million headaches, sore mouth/tongue,
Bicillin LA) million units, units/day vaginal itching/discharge, allergic
2.4 million C: 0.3–1.2 reaction (including anaphylaxis, skin
units million rash, urticaria, pruritus)
units/day
Penicillin G potassium I: 1, 2, 3, 5 A: 2–24 Same as penicillin G benzathine
(p. 927) (Pfizerpen) million-unit million
vials units/day
C: 100,000–
250,000
units/kg/day
Penicillin V potassium T: 250 mg, A: 0.5–2 Same as penicillin G benzathine
(p. 928) (Apo-Pen-VK) 500 mg g/day
S: 125 mg/5 C: 25–50
ml, 250 mg/5 mg/kg/day
ml
Penicillinase-ResistantDicloxacillin (Dynapen, C: 125 mg, A: 1–2 g/day Same as penicillin G benzathineName Availability Dosageide Effects
Pathocil) 250 mg, 500 C: 12.5–25 Increased risk of hepatotoxicityRange
mg mg/kg/day
S: 62.5 mg/5
ml
Nafcillin (p. 809) C: 250 mg A (PO): 1–6 Same as penicillin G benzathine
(Unipen) I: 500 mg, 1 g/day; (IV): Increased risk of interstitial nephritis
g, 2 g 2–6 g/day
C (PO): 25–
50
mg/kg/day;
(IV): 50
mg/kg/day
Oxacillin (Bactocill) C: 250 mg, A (PO/IV): Same as penicillin G benzathine
500 mg 2–6 g/day Increased risk of hepatotoxicity,
S: 250 mg/5 C (PO/IV): interstitial nephritis
ml 50–100
I: 250 mg, mg/kg/day
500 mg, 1 g,
2 g
Broad-Spectrum
Amoxicillin (p. 56) T: 125 mg, A: 0.75–1.5 Same as penicillin G benzathine
(Amoxil, Trimox) 250 mg, 500 g/day
mg, 875 mg C: 20–40
C: 250 mg, mg/kg/day
500 mg
S: 50 mg/ml,
125 mg/5 ml,
250 mg/5 ml
Amoxicillin/clavulanate T: 250 mg, A: 0.75–1.5 Same as penicillin G benzathine
(p. 58) (Augmentin) 500 mg, 875 g/day
mg C: 20–40
T mg/kg/day
(chewable):
125 mg, 200
mg, 250 mg,
400 mg
S: 125 mg/5
ml, 200 mg/5
ml, 250 mg/5
ml, 400 mg/5
ml
Ampicillin (p. 62) C: 250 mg, A: 1–12 Same as penicillin G benzathine
(Principen) 500 mg g/day
S: 125 mg/5 C: 50–200
ml, 250 mg/5 mg/kg/day
ml
I: 125 mg,
250 mg, 500
mg, 1 g, 2 g
Ampicillin/sulbactam I: 1.5 g, 3 g A: 6–12 Same as penicillin G benzathine
(p. 64) (Unasyn) g/day
C: 100–200
mg/kg/day
Extended-Spectrum"
"
"
"
"
"
"
"
Piperacillin/tazobactam I: 2.25 g, A: 2.25–4.5 Same as penicillin G benzathineName Availability Dosageide Effects
(p. 951) (Zosyn) 3.375 g, 4.5 g q6–8hRange
g C: 200–400
mg/kg/day
Ticarcillin/clavulanate I: 3.1 g A: 3.1 g q4– Same as penicillin G benzathine
(Timentin) 6h
C: 200–300
mg/kg/day
A, Adults; C, capsules; C (dosage), children; I, injection; S, suspension; T, tablets.
Anticoagulants/Antiplatelets/Thrombolytics
USES
Treatment and prevention of venous thromboembolism, acute MI, acute cerebral embolism;
reduce risk of acute MI; reduce total mortality in pts with unstable angina; prevent occlusion of
saphenous grafts following open heart surgery; prevent embolism in select pts with atrial
brillation, prosthetic heart valves, valvular heart disease, cardiomyopathy. Heparin also used
for acute/chronic consumption coagulopathies (disseminated intravascular coagulation).
ACTION
Anticoagulants: Inhibit blood coagulation by preventing the formation of new clots and
extension of existing ones but do not dissolve formed clots. Anticoagulants are subdivided into
three classes. Heparin (including low molecular weight heparin): Indirectly interferes with
blood coagulation by blocking the conversion of prothrombin to thrombin and brinogen to
brin. Coumarin: Acts indirectly to prevent synthesis in the liver of vitamin K–dependent
clotting factors. Direct Thrombin Inhibitors: Inhibit thrombin from converting brinogen to
fibrin.
Antiplatelets: Interfere with platelet aggregation. E( ects are irreversible for life of platelet.
Medications in this group act by di( erent mechanisms. Aspirin irreversibly inhibits
cyclooxygenase, irreversibly inhibits formation of thromboxane A . Clopidogrel, dipyridamole,z
prasugrel, and ticlopidine have similar e( ects as aspirin and are known as adenosine
diphosphate (ADP) inhibitors. Abciximab, epti batide, and tiro ban block binding of
brinogen to the glycoprotein IIb/IIIa receptor on platelet surface (known as platelet
glycoprotein IIb/IIIa receptor antagonists).
Thrombolytics: Act directly or indirectly on brinolytic system to dissolve clots (converting
plasminogen to plasmin, an enzyme that digests fibrin clot).
ANTICOAGULANTS/ANTIPLATELETS/THROMBOLYTICS
Name Availability Uses Side Effects
Anticoagulants
Direct Thrombin Inhibitors
Argatroban I: 100 mg/ml Prevent/treat VTE in pts Bleeding,
(p. 73) with HIT or at risk for HIT hypotension
undergoing PCI
Bivalirudin I: 250-mg vials Pts with unstable angina Bleeding,
(p. 137) undergoing PTCA hypotension, pain,
(Angiomax) headache, nausea
Dabigatran C: 75 mg, 150 mg Reduce risk for Bleeding, gastritis
(Pradaxa) stroke/embolism with
nonvalvular atrial
fibrillation
Desirudin I: 15 mg Hip surgery Bleeding(Iprivask)Name Availability Uses Side Effects
Lepirudin (p. I: 50-mg vials Prevent VTE in pts with Anemia
671) HIT
(Refludan)
Heparin, Low Molecular Weight Heparins
Dalteparin I: 2,500 units, 5,000 units, Hip surgery, abdominal Bleeding, hematoma,
(p. 299) 7,500 units, 10,000 units surgery, unstable angina increased ALT, AST,
(Fragmin) or non–Q-wave MI pain at injection site,
bruising
Enoxaparin I: 30 mg, 40 mg, 60 mg, 80 Hip surgery, knee surgery, Bleeding,
(p. 409) mg, 100 mg, 120 mg, 150 abdominal surgery, thrombocytopenia,
(Lovenox) mg unstable angina or non–Q- hematoma, increased
wave MI, acute illness ALT, AST, nausea,
bruising
Fondaparinux I: 2.5 mg Hip surgery, knee surgery Bleeding,
(p. 510) thrombocytopenia,
(Arixtra) hematoma, fever,
nausea, anemia
Heparin (p. I: 1,000 units/ml, 2,500 Prevent/treat VTE Bleeding,
560) units/ml, 5,000 units/ml, thrombocytopenia,
7,500 units/ml, 10,000 skin rash, itching,
units/ml, 20,000 units/ml burning
Rivaroxaban T: 10 mg Prevent DVT post knee, Bleeding
(p. 1049) hip replacement
(Xarelto) Prevent thromboembolism
in atrial fibrillation
Tinzaparin I: 20,000 units/ml vials Treatment of VTE (with Bleeding,
(p. 1171) warfarin) thrombocytopenia,
(Innohep) increased ALT,
injection site
hematoma
HIT, Heparin-induced thrombocytopenia; I, injection; MI, myocardial infarction; PCI,
percutaneous coronary intervention; PO, oral; PTCA, percutaneous transluminal coronary
angioplasty; T, tablet; VTE, venous thromboembolism.
Name Availability Uses Side Effects
Coumarin
Warfarin (p. PO: 1 mg, Prevent/treat VTE in pts; prevent Bleeding, skin necrosis,
1262) 2 mg, 2.5 systemic embolism in pts with heart anorexia, nausea, vomiting,
(Coumadin) mg, 3 mg, valve replacement, valve heart diarrhea, rash, abdominal
4 mg, 5 disease, MI, atrial fibrillation cramps, purple toe
mg, 6 mg, syndrome
7.5 mg, 10
mg
I: 5 mg
Antiplatelets
Abciximab I: 2 mg/ml Adjunct to PCI to prevent acute Bleeding, hypotension,
(p. 4) cardiac ischemic complications nausea, vomiting, back
(ReoPro) (with heparin and aspirin) pain, allergic reactions,
thrombocytopenia
Aspirin (p. PO: 81 mg, TIA Tinnitus, dizziness,83) 165 mg, Prevention of reinfarction and hypersensitivity, dyspepsia,Name Availability Uss Side Effects
325 mg, thromboembolism post MI minor bleeding, GI
500 mg, ulceration
650 mg
Clopidogrel PO: 75 mg Reduce risk of stroke, MI, or Bleeding
(p. 268) vascular death in pts with recent
(Plavix) MI, noncardioembolic stroke,
peripheral artery disease. Reduce
CV death, MI, stroke, reinfarction in
pts with non-STEMI/STEMI
Dipyridamole PO: 25 mg, Prevent postop thromboembolic Dizziness, GI distress
(p. 365) 50 mg, 75 complications following cardiac
(Persantine) mg valve replacement
Eptifibatide I: 0.75 Treatment of acute coronary Bleeding, hypotension
(p. 426) mg/ml, 2 syndrome
(Integrilin) mg/ml
Prasugrel PO: 5 mg, Reduce thrombotic cardiovascular Bleeding, hypotension
(Effient) 10 mg events in pts with ACS to be
managed with PCI (including
stenting)
Ticagrelor PO: 90 mg Reduce thrombotic cardiovascular Bleeding, dyspnea
(p. 1164) events in pts with ACS
(Brilinta)
Ticlopidine PO: 250 Reduce risk stroke in pts with CVA Neutropenia,
(p. 1165) mg precursors, TIA agranulocytosis,
(Ticlid) Prevention of stent thrombosis thrombocytopenia, aplastic
anemia, increased serum
cholesterol/triglycerides,
rash, diarrhea, nausea,
vomiting, GI pain
Tirofiban I: 50 Treatment of acute coronary Bleeding, thrombocytopenia
(Aggrastat) mcg/ml, syndrome
250
mcg/ml
Thrombolytics
Alteplase (p. I: 50 mg, Acute MI, acute ischemic stroke, Bleeding, cholesterol
41) 100 mg pulmonary embolism embolism, arrhythmias
(Activase)
Reteplase (p. I: 10.4 Acute MI Bleeding, cholesterol
1030) units embolism, arrhythmias
(Retavase)
Tenecteplase I: 50 mg Acute MI Bleeding, cholesterol
(p. 1139) embolism, arrhythmias
(TNKase)
ACS, Acute coronary syndrome; CVA, cerebrovascular attack; I, injection; MI, myocardial
infarction; PCI, percutaneous coronary intervention; PO, oral; TIA, transient ischemic attack.

Anticonvulsants

Anticonvulsants
USES
Anticonvulsants are used to treat seizures. Seizures can be divided into two broad categories:
partial seizures and generalized seizures. Partial seizures begin focally in the cerebral cortex,
undergoing limited spread. Simple partial seizures do not involve loss of consciousness but may
evolve secondarily into generalized seizures. Complex partial seizures involve impairment of
consciousness.
Generalized seizures may be convulsive or nonconvulsive and usually produce immediate loss of
consciousness.
ACTION
Anticonvulsants can prevent or reduce excessive discharge of neurons with seizure foci or
decrease the spread of excitation from seizure foci to normal neurons. The exact mechanism is
unknown but may be due to (1) suppressing sodium in ux, (2) suppressing calcium in ux, or
(3) increasing the action of gamma-aminobutyric acid (GABA), which inhibits neurotransmitters
throughout the brain.
ANTICONVULSANTS
Name Availability Uses Dosage Side Effects
Range
Carbamazepine S: 100 mg/5 ml Complex partial, A: 800– Dizziness, diplopia,
(p. 180) T (chewable): 100 tonic-clonic, mixed 1,200 leukopenia,
(Carbatrol, mg seizures; trigeminal mg/day drowsiness, blurred
Tegretol, T: 200 mg neuralgia C: 400–800 vision, headache,
Tegretol XR) T (ER): 100 mg, 200 mg/day ataxia, nausea,
mg, 400 mg vomiting,
C (ER): 200 mg, 300 hyponatremia
mg
Clonazepam (p. T: 0.5 mg, 1 mg, 2 Petit mal, akinetic, A: 1.5–20 CNS depression,
264) mg myoclonic, absence mg/day sedation, ataxia,
(Klonopin) seizures confusion,
depression,
behavior disorders,
respiratory
depression
Ezogabine (p. T: 50 mg, 200 mg, Partial onset A: 600– Dizziness,
460) (Potiga) 300 mg, 400 mg seizures 1,200 somnolence,
mg/day fatigue, confusion,
vertigo, tremor,
diplopia, blurred
vision, balance
disorder
Fosphenytoin I: 50 mg PE/ml Status epilepticus, A: 15–20 mg Burning, itching,
(p. 519) seizures occurring PE/kg bolus, paresthesia,
(Cerebyx) during then 4–6 mg nystagmus, ataxia
neurosurgery PE/kg/day
maintenance
Gabapentin (p. C: 100 mg, 300 mg, Partial seizures A: 900– CNS depression,
525) 400 mg with and without 1,800 fatigue, drowsiness,
(Neurontin) secondary mg/day dizziness, ataxia,
generalization nystagmus, blurred
vision, confusion
Lacosamide (p. T: 50 mg, 100 mg, Adjunctive A: 200–400 Diplopia, headache,
655) (Vimpat) 150 mg, 200 mg therapy, partial mg/day dizziness, nausea
S: 10 mg/ml seizuresI: 10 mg/mlName Availability Uses Dosage Side Effects
Lamotrigine (p. T: 25 mg, 100 mg, Partial seizures, A: 100–600 Dizziness, ataxia,Range
660) (Lamictal) 150 mg, 200 mgT primary mg/day drowsiness,
(ER): 25 mg, 50 mg, generalized tonic- diplopia, nausea,
100 mg, 200 mgT clonic seizures, rash, headache,
(ODT): 25 mg, 50 generalized vomiting,
mg, 100 mg, 200 mg seizures of Lennox- insomnia,
Gastaut syndrome incoordination
Levetiracetam T: 250 mg, 500 mg, Adjunctive A: 1,000– Dizziness,
(p. 679) 750 mg, 2,000 mg therapy, partial 3,000 drowsiness,
(Keppra) S: 100 mg/ml seizures, primary mg/day weakness,
tonic-clonic irritability,
seizures, myoclonic hallucinations,
seizures psychosis
Oxcarbazepine T: 150 mg, 300 mg, Partial seizures A: 900– Drowsiness,
(p. 884) 600 mg 1,800 dizziness,
(Trileptal) mg/day headaches,
diplopia, ataxia,
nausea, vomiting
Phenobarbital T: 30 mg, 60 mg, Tonic-clonic, A (PO): CNS depression,
(p. 939) 100 mg partial seizures; 100–300 sedation,
I: 65 mg, 130 mg status epilepticus mg/day; paradoxical
(IM/IV): excitement and
200–600 mg hyperactivity, rash
C (PO): 3–5
mg/kg/day;
(IM/IV):
100–400 mg
Phenytoin (p. C: 100 mg Tonic-clonic, A (PO): Nystagmus, ataxia,
945) (Dilantin) T (chewable): 50 psychomotor 300–600 hypertrichosis,
mg seizures mg/day; IV: gingival
S: 125 mg/5 ml 150–250 mg hyperplasia, rash,
I: 50 mg/ml C (PO): 4–8 osteomalacia,
mg/kg/day; lymphadenopathy
(IV): 10–15
mg/kg
Pregabalin (p. C: 25 mg, 50 mg, 75 Adjunctive A: 150–600 Confusion,
978) (Lyrica) mg, 100 mg, 150 therapy, partial mg/day drowsiness,
mg, 200 mg, 225 seizures dizziness, ataxia,
mg, 300 mg weight gain, dry
mouth, blurred
vision, peripheral
edema
Primidone (p. T: 50 mg, 250 mg Complex partial, A: 750– CNS depression,
980) S: 250 mg/5 ml akinetic, tonic- 2,000 sedation,
(Mysoline) clonic seizures mg/day paradoxical
C: 10–25 excitement and
mg/kg/day hyperactivity, rash,
dizziness, ataxia
Tiagabine (p. T: 4 mg, 12 mg, 16 Partial seizures A: Initially, Dizziness, asthenia
1163) mg, 20 mg 4 mg up to (loss of strength,
(Gabitril) 56 mg energy),
C: Initially, nervousness,
4 mg up to anxiety, tremors,
32 mg abdominal pain
Topiramate (p. T: 25 mg, 100 mg, Partial seizures A: 25–400 Drowsiness,1187) 200 mg mg/day dizziness,Name Availability Uses Dosage Side Effects
(Topamax) C: 1–9 headache, ataxia,Range
mg/kg/day confusion, weight
loss, diplopia
Valproic acid C: 250 mg Complex partial, A, C: 15–60 Nausea, vomiting,
(p. 1223) S: 250 mg/5 ml absence seizures mg/kg/day tremors,
(Depakene, Sprinkles: 125 mg thrombocytopenia,
Depakote) T: 125 mg, 250 mg, hair loss, hepatic
500 mg dysfunction, weight
T (ER): 500 mg gain, decreased
I: 100 mg/ml platelet function
Vigabatrin T: 500 mg PS: 500 Infantile spasms, A: 1,000– Vision changes, eye
(Sabril) mg refractory complex 4,000 pain, abdominal
partial seizures mg/day pain, agitation,
C: 40–100 confusion,
mg/kg/day mood/mental
changes, abnormal
coordination
Zonisamide (p. C: 100 mg Partial seizures A: 500 Drowsiness,
1276) mg/day dizziness, anorexia,
(Zonegran) diarrhea, weight
loss, agitation,
irritability, rash,
nausea
A, Adults; C, capsules; C (dosage), children; ER, extended-release; I, injection; ODT,
orallydisintegrating tablets; PE, phenytoin equivalent; PS, powder sachet; S, suspension; T, tablets.

Antidepressants
USES
Used primarily for the treatment of depression. Depression can be a chronic or recurrent
mental disorder presenting with symptoms such as depressed mood, loss of interest or pleasure,
guilt feelings, disturbed sleep/appetite, low energy, and diK culty in thinking. Depression can
also lead to suicide.
ACTION
Antidepressants include tricyclics, monoamine oxidase inhibitors (MAOIs), selective serotonin
reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and other
antidepressants. Depression may be due to reduced functioning of monoamine
neurotransmitters (e.g., norepinephrine, serotonin [5-HT], dopamine) in the CNS (decreased
amount and/or decreased e( ects at the receptor sites). Antidepressants block metabolism,
increase amount/e( ects of monoamine neurotransmitters, and act at receptor sites (change
responsiveness/sensitivities of both presynaptic and postsynaptic receptor sites).
ANTIDEPRESSANTS
Name Availability Uses Dosage Side Effects
Range
(per
day)
Tricyclics
Amitriptyline (p. T: 10 mg, Depression, 40– Drowsiness, blurred vision,
52) (Elavil) 25 mg, 50 neuropathic pain 300 constipation, confusion, posturalmg, 75 mg, mg hypotension, cardiac conductionName Availability Uses Dosage Side Effects
100 mg, defects, weight gain, seizures, dryRange
150 mg mouth(per
day)Clomipramine C: 25 mg, OCD 25– Same as amitriptyline
(p. 262) 50 mg, 75 250
(Anafranil) mg mg
Desipramine (p. T: 10 mg, Depression, 25– Same as amitriptyline
326) 25 mg, 50 neuropathic pain 100
(Norpramin) mg, 75 mg, mg
100 mg,
150 mg
Doxepin (p. 383) C: 10 mg, Depression, 25– Same as amitriptyline
(Sinequan) 25 mg, 50 anxiety, 300
mg, 75 mg, neuropathic pain mg
100 mg,
150 mg
OC: 10
mg/ml
Imipramine (p. T: 10 mg, Depression, 30– Same as amitriptyline
599) (Tofranil) 25 mg, 50 enuresis, 300
mg neuropathic pain, mg
C: 75 mg, panic disorder,
100 mg, ADHD
125 mg,
150 mg
Nortriptyline (p. C: 10 mg, Depression, 25– Same as amitriptyline
854) (Aventyl, 25 mg, 50 neuropathic pain, 100
Pamelor) mg, 75 mg smoking cessation mg
S: 10 mg/5
ml
Monoamine Oxidase Inhibitors
Phenelzine (p. T: 15 mg Depression 15–90 Sedation, hypertensive crisis,
937) (Nardil) mg weight gain, orthostatic
hypotension
Tranylcypromine T: 10 mg Depression 30–60 Same as phenelzine
(p. 1199) mg
(Parnate)
Selective Serotonin Reuptake Inhibitors
Citalopram (p. T: 20 mg, Depression, OCD, 25–60 Insomnia or sedation, nausea,
250) (Celexa) 40 mg panic disorder mg agitation, headaches
S: 10 mg/5
ml
Escitalopram (p. T: 5 mg, 10 Depression, GAD 10–20 Insomnia or sedation, nausea,
434) (Lexapro) mg, 20 mg mg agitation, headaches
Fluoxetine (p. C: 10 mg, Depression, OCD, 10–80 Akathisia, sexual dysfunction, skin
495) (Prozac) 20 mg, 40 bulimia, panic mg rash, urticaria, pruritus, decreased
mg disorder, appetite, asthenia (loss of
T: 10 mg anorexia, bipolar strength, energy), diarrhea,
S: 20 mg/5 disorder, drowsiness, headaches,
ml premenstrual diaphoresis, insomnia, nausea,
syndrome tremors
Fluvoxamine (p. T: 25 mg, OCD, SAD 100– Sexual dysfunction, fatigue,
507) (Luvox, 50 mg, 100 300 constipation, dizziness,"
Luvox CR) mg mg drowsiness, headaches, insomnia,Name Availability Uses Dosage Side Effects
C (SR): nausea, vomitingRange
100 mg, (per
150 mg day)
Paroxetine (p. T: 10 mg, Depression, OCD, 20–50 Asthenia (loss of strength,
907) (Paxil) 20 mg, 30 panic attack, SAD mg energy), constipation, diarrhea,
mg, 40 mg diaphoresis, insomnia, nausea,
S: 10 mg/5 sexual dysfunction, tremors,
ml vomiting, urinary frequency or
retention
Sertraline (p. T: 25 mg, Depression, OCD, 50– Sexual dysfunction, dizziness,
1077) (Zoloft) 50 mg, 100 panic attack 200 drowsiness, anorexia, diarrhea,
mg mg nausea, dry mouth, abdominal
S: 20 cramps, decreased weight,
mg/ml headaches, increased diaphoresis,
tremors, insomnia
Serotonin-Norepinephrine Reuptake Inhibitors
Desvenlafaxine T: 50 mg, Depression 50– Nausea, dizziness, insomnia,
(p. 331) (Pristiq) 100 mg 100 hyperhidrosis, constipation,
mg drowsiness, decreased appetite,
anxiety, male sexual function
disorders
Duloxetine (p. C: 20 mg, Depression, 40–60 Nausea, dry mouth, constipation,
394) (Cymbalta) 30 mg, 60 fibromyalgia, mg decreased appetite, fatigue,
mg neuropathic pain diaphoresis
Venlafaxine (p. T: 25 mg, Depression, 75– Increased blood pressure,
1237) (Effexor) 37.5 mg, anxiety 375 agitation, sedation, insomnia,
50 mg, 75 mg nausea
mg, 100
mg
T (ER):
37.5 mg,
75 mg, 150
mg
Other
Bupropion (p. T: 75 mg, Depression, 150– Insomnia, irritability, seizures
158) 100 mg smoking 450
(Wellbutrin) SR: 100 cessation, ADHD, mg
mg, 150 bipolar disorder
mg
Mirtazapine (p. T: 15 mg, Depression 15–45 Sedation, dry mouth, weight gain,
786) (Remeron) 30 mg, 45 mg agranulocytosis, hepatic toxicity
mg
Trazodone (p. T: 50 mg, Depression 50– Sedation, orthostatic hypotension,
1203) (Desyrel) 100 mg, 600 priapism
150 mg, mg
300 mg
Vilazodone (p. T: 10 mg, Depression 40 mg Diarrhea, nausea, dizziness, dry
1242) (Viibyrd) 20 mg, 40 mouth, insomnia, vomiting,
mg decreased libido
ADHD, Attention de cit hyperactivity disorder; C, capsules; ER, extended-release; GAD,
generalized anxiety disorder; OC, oral concentrate; OCD, obsessive-compulsive disorder; S,suspension; SAD, social anxiety disorder; SR, sustained-release; T, tablets.

Antidiabetics
USES
Insulin: Treatment of insulin-dependent diabetes (type 1) and non–insulin-dependent diabetes
(type 2). Also used in acute situations such as ketoacidosis, severe infections, major surgery in
otherwise non–insulin-dependent diabetics. Administered to pts receiving parenteral nutrition.
Drug of choice during pregnancy. All insulins, including long-acting insulins, can cause
hypoglycemia and weight gain.
Alpha-glucosidase inhibitors: Adjunct to diet and exercise for management of type 2 diabetes
mellitus.
Biguanides: Adjunct to diet and exercise for management of type 2 diabetes mellitus.
Dipeptidyl peptidase 4 inhibitors (DPP-4): Adjunct to diet and exercise for management of type 2
diabetes mellitus.
Meglitinide: Adjunct to diet and exercise for management of type 2 diabetes mellitus.
Sulfonylureas: Adjunct to diet and exercise for management of type 2 diabetes mellitus.
Thiazolidinediones: Adjunct to diet and exercise for management of type 2 diabetes mellitus.
ACTION
Insulin: A hormone synthesized and secreted by beta cells of Langerhans’ islet in the pancreas.
Controls storage and utilization of glucose, amino acids, and fatty acids by activated transport
systems/enzymes. Inhibits breakdown of glycogen, fat, protein. Insulin lowers blood glucose by
inhibiting glycogenolysis and gluconeogenesis in liver; stimulates glucose uptake by muscle,
adipose tissue. Activity of insulin is initiated by binding to cell surface receptors.
Alpha-glucosidase inhibitors: Work locally in small intestine, slowing carbohydrate breakdown
and glucose absorption.
Biguanides: Inhibit hepatic gluconeogenesis, glycogenolysis; enhance insulin sensitivity in
muscle and fat.
DPP-4: Inhibits degradation of endogenous incretins, which increases insulin secretion,
decreases glucagon secretion.
Meglitinide: Stimulates pancreatic insulin secretion.
Sulfonylureas: Stimulate release of insulin from beta cells of the pancreas.
Thiazolidinediones: Enhance insulin sensitivity in muscle and fat.
ANTIDIABETICS
INSULIN (p. 613)
Type Onset Peak Duration Comments
Rapid-Acting
Apidra, glulisine 10–15 1–1.5 hrs 3–5 hrs Stable at room temp for 28
min days
Can mix with NPH
Humalog, lispro 15–30 0.5–2.5 hrs 6–8 hrs Stable at room temp for 28
min days
Can mix with NPH
Novolog, aspart 10–20 1–3 hrs 3–5 hrs Stable at room temp for 28
min days
Can mix with NPH
Short-Acting
Humulin R, Novolin R, 30–60 1–5 hrs 6–10 hrs Stable at room temp for 28
regular min daysCan mix with NPHINSULIN (p. 613)
Intermediate-ActingType Onset Peak Duration Comments
Humulin N, Novolin N, 1–2 hrs 6–14 hrs 16–24 hrs Stable at room temp for 28
NPH days
Can mix with aspart, lispro,
glulisine
Long-Acting
Lantus, glargine 1.1 hrs No significant 24 hrs Do NOT mix with other
peak insulins
Stable at room temp for 28
days
Levemir, detemir 0.8–2 Relatively flat 12–24 hrs Do NOT mix with other
hrs (dose insulins
dependent) Stable at room temp for 42
days
ORAL AGENTS
Name Availability Dosage Side Effects
Range
Sulfonylureas
Glimepiride T: 1 mg, 2 1–8 mg/day Hypoglycemia, weight gain
(p. 541) mg, 4 mg
(Amaryl)
Glipizide (p. T: 5 mg, 10 T: 2.5–40 Same as glimepiride
542) mg mg/day
(Glucotrol) T (XL): 5 XL: 5–20
mg mg/day
Glyburide (p. T: 1.25 mg, T: 1.25–20 Same as glimepiride
547) (DiaBeta, 2.5 mg, 5 mg/day
Micronase) mg PT: 1–12
PT: 1.5 mg, mg/day
3 mg
Alpha-Glucosidase Inhibitors
Acarbose (p. T: 25 mg, 75–300 Flatulence, diarrhea, abdominal pain, increased
8) (Precose) 50 mg, 100 mg/day risk of hypoglycemia when used with insulin or
mg sulfonylureas
Miglitol T: 25 mg, 75–300 Same as acarbose
(Glyset) 50 mg, 100 mg/day
mg
Dipeptidyl Peptidase Inhibitors
Linagliptin (p. T: 5 mg 5 mg/day Arthralgia, back pain, headache
691)
Saxagliptin T: 2.5 mg, 2.5–5 Upper respiratory tract infection, urinary tract
(p. 1071) 5 mg mg/day infection, headache
Sitagliptin (p. T: 25 mg, 25–100 Nasopharyngitis, upper respiratory infection,
1088) 50 mg, 100 mg/day headaches, modest weight gain, increased incidence
(Januvia) mg of hypoglycemia when added to a sulfonylurea
Biguanides
Metformin (p. T: 500 mg, T: 0.5–2.5 Nausea, vomiting, diarrhea, loss of appetite,747) 850 mg g/day metallic taste, lactic acidosis (rare but potentiallyORAL AGENTS
(Glucophage) XR: 500 XR: 1,500– fatal complication)
Name Availability Dosage Side Effectsmg 2,000
Rangemg/day
Glucagon-Like Peptide-1 (GLP-1)
Exenatide (p. I: 5 mcg, 5–10 mcg 2 Diarrhea, dizziness, dyspnea, headaches, nausea,
457) (Byetta) 10 mcg times/day vomiting
Exenatide I: 2 mg 2 mg once Diarrhea, nausea, headache
extended- weekly
release (p.
457)
(Bydureon)
Liraglutide (p. I: 0.6 mg, 0.6–1.8 Headache, nausea, diarrhea
694) (Victoza) 1.2 mg, 1.8 mg/day
mg (6
mg/ml)
Meglitinides
Nateglinide T: 60 mg, 60–120 mg Hypoglycemia, weight gain
(p. 821) 120 mg 3 times/day
(Starlix)
Repaglinide T: 0.5 mg, 0.5–1 mg Same as nateglinide
(p. 1028) 1 mg, 2 mg with each
(Prandin) meal
(Maximum:
16 mg/day)
Thiazolidinediones
Pioglitazone T: 15 mg, 15–45 Mild to moderate peripheral edema, weight gain,
(p. 949) 30 mg, 45 mg/day increased risk of CHF, associated with reduced bone
(Actos) mg mineral density and increased incidence of
fractures
Rosiglitazone T: 2 mg, 4 4–8 mg/day Same as pioglitazone
(p. 1059) mg, 8 mg
(Avandia)
Miscellaneous
Bromocriptine T: 0.8 mg 1.6–4.8 Nausea, fatigue, dizziness, vomiting
(p. 150) mg/day
Colesevelam T: 625 mg 3.75 g/day Constipation, dyspepsia, nausea
(p. 276) S: 1.875 g,
(Welchol) 3.75 g
packet
Pramlintide I: 0.6 15–60 mcg Abdominal pain, anorexia, headaches, nausea,
(p. 968) mg/ml immediately vomiting, severe hypoglycemia may occur when
(Symlin) prior to used in combination with insulin (reduction in
meals dosages of short-acting, including premixed,
insulins recommended)
CHF, Congestive heart failure; I, injection; PT, prestab; S: suspension; T, tablets; XL,
extendedrelease; XR, extended-release.
Antidiarrheals


USES
Acute diarrhea, chronic diarrhea of in ammatory bowel disease, reduction of uid from
ileostomies.
ACTION
Systemic agents: Act as smooth muscle receptors (enteric) disrupting peristaltic movements,
decreasing GI motility, increasing transit time of intestinal contents.
Local agents: Adsorb toxic substances and uids to large surface areas of particles in the
preparation. Some of these agents coat and protect irritated intestinal walls. May have local
anti-inflammatory action.
ANTIDIARRHEALS
Name Availability Type Dosage Range
Bismuth (p. 135) (Pepto- T: 262 mg Local A: 2 T or 30 ml
Bismol) C: 262 mg C (9–12 yrs): 1 T or 15
L: 130 mg/15 ml, 262 ml
mg/15 ml, 524 mg/15 ml C (6–8 yrs): 2/3 T or
10 ml
C (3–5 yrs): 1/3 T or 5
ml
Diphenoxylate with T: 2.5 mg Systemic A: 5 mg 4 times/day
atropine (p. 364) (Lomotil) L: 2.5 mg/5 ml C: 0.3–0.4 mg/kg/day
in 4 divided doses (L)
Kaolin (with pectin) S: 262 mg/15 ml, 525 Local A: 60–120 ml after
(Kaopectate) mg/15 ml each bowel movement
C (6–12 yrs): 30–60
ml
C (3–5 yrs): 15–30 ml
Loperamide (p. 705) C: 2 mg Systemic A: Initially, 4 mg
(Imodium) T: 2 mg (Maximum: 16
L: 1 mg/5 ml, 1 mg/ml mg/day)
C (9–12 yrs): 2 mg 3
times/day
C (6–8 yrs): 2 mg 2
times/day
C (2–5 yrs): 1 mg 3
times/day (L)
A, Adults; C, capsules; C (dosage), children; L, liquid; S, suspension; T, tablets.
Antifungals: Systemic Mycoses
Systemic mycoses are subdivided into opportunistic infections (candidiasis, aspergillosis,
cryptococcosis, and mucormycosis) that are seen primarily in debilitated or
immunocompromised hosts and nonopportunistic infections (blastomycosis, histoplasmosis, and
coccidioidomycosis) that occur in any host. Treatment can be diK cult because these infections
often resist treatment and may require prolonged therapy.
ANTIFUNGALS: SYSTEMIC MYCOSES
Name Indications Side Effects
Amphotericin Potentially life-threatening fungal Fever, chills, headache, nausea,
B (p. 59) infections, including aspergillosis, vomiting, nephrotoxicity,
blastomycosis, coccidioidomycosis, hypokalemia, hypomagnesemia,
cryptococcosis, histoplasmosis, hypotension, dyspnea, arrhythmias,systemic candidiasis abdominal pain, diarrhea, increasedName Indications Side Effects
hepatic function tests
Amphotericin Invasive fungal infections Same as amphotericin B
B lipid
complex
(Abelcet) (p.
59)
Amphotericin Empiric therapy for presumed fungal Same as amphotericin B
B liposomal infections in febrile neutropenic pts,
(AmBisome) treatment of cryptococcal meningitis
(p. 59) in HIV-infected pts, treatment of
Aspergillus, Candida, Cryptococcus
infections, treatment of visceral
leishmaniasis
Amphotericin Invasive Aspergillus Same as amphotericin B
colloidal
dispersion
(Amphotec)
(p. 59)
Anidulafungin Candidemia, esophageal candidiasis Diarrhea, hypokalemia, increased
(Eraxis) (p. hepatic function tests, headache
68)
Caspofungin Candidemia, invasive aspergillosis, Headache, nausea, vomiting, diarrhea,
(Cancidas) (p. empiric therapy for presumed fungal increased hepatic function tests
193) infections in febrile neutropenic pts
Fluconazole Treatment of vaginal candidiasis; Nausea, vomiting, abdominal pain,
(Diflucan) (p. oropharyngeal, esophageal diarrhea, dysgeusia, increased hepatic
486) candidiasis; and cryptococcal function tests, liver necrosis, hepatitis,
meningitis. Prophylaxis to decrease cholestasis, headache, rash, pruritus,
incidence of candidiasis in pts eosinophilia, alopecia
undergoing bone marrow transplant
receiving cytotoxic chemotherapy
and/or radiation
Itraconazole Blastomycosis, histoplasmosis, Congestive heart failure, peripheral
(Sporanox) (p. aspergillosis, onychomycosis, empiric edema, nausea, vomiting, abdominal
642) therapy of febrile neutropenic pts pain, diarrhea, increased hepatic
with suspected fungal infections, function tests, liver necrosis, hepatitis,
treatment of oropharyngeal and cholestasis, headache, rash, pruritus,
esophageal candidiasis eosinophilia
Ketoconazole Candidiasis, chronic mucocutaneous Nausea, vomiting, abdominal pain,
(Nizoral) (p. candidiasis, oral thrush, candiduria, diarrhea, gynecomastia, increased
647) blastomycosis, coccidioidomycosis hepatic function tests, liver necrosis,
hepatitis, cholestasis, headache, rash,
pruritus, eosinophilia
Micafungin Esophageal candidiasis, Candida Fever, chills, hypokalemia,
(Mycamine) infections, prophylaxis in pts hypomagnesemia, hypocalcemia,
(p. 772) undergoing hematopoietin stem cell myelosuppression, thrombocytopenia,
transplantation nausea, vomiting, abdominal pain,
diarrhea, increased hepatic function
tests, dizziness, headache, rash,
pruritus, pain or inflammation at
injection site, fever
Posaconazole Prevent invasive aspergillosis and Fever, headaches, nausea, vomiting,(Noxafil) (p. Candida infections in pts 13 yrs and diarrhea, abdominal pain,Name Indicatios Side Effects
961) older who are immunocompromised, hypokalemia, cough, dyspnea
treatment of oropharyngeal
candidiasisVoriconazole Invasive aspergillosis, candidemia, Visual disturbances, nausea, vomiting,
(Vfend) (p. esophageal candidiasis, serious abdominal pain, diarrhea, increased
1258) fungal infections hepatic function tests, liver necrosis,
hepatitis, cholestasis, headache, rash,
pruritus, eosinophilia
Antifungals: Topical
USES
Treatment of tinea infections, cutaneous candidiasis (moniliasis) due to Candida albicans.
ACTION
Exact mechanism unknown. May deplete essential intracellular components by inhibiting
transport of potassium, other ions into cells; alter membrane permeability, resulting in loss of
potassium, other cellular components.
ANTIFUNGALS: TOPICAL
Name Availability Dosage Side Effects
Range
Butenafine (Mentax) C: 1% 2 Burning, stinging, pruritus,
times/day contact dermatitis,
erythema
Ciclopirox (Loprox) C: 1% 2 Irritation, pruritus, redness
L: 1% times/day
Clioquinol (Vioform) C: 3% 2–3 Irritation, stinging,
O: 3% times/day swelling
Clotrimazole (Lotrimin, C: 1% 2 Erythema, stinging,
Mycelex) L: 1% times/day blistering, edema, pruritus
S: 1%
Econazole (Spectazole) C: 1% 1–2 Burning, stinging,
times/day irritation, erythema
Ketoconazole (p. 647) C: 2% 1–2 Irritation, pruritus, stinging
(Nizoral) times/day
Miconazole (p. 773) C: 2% 2 Irritation, burning, allergic
(Micatin, Monistat) P: 2% times/day contact dermatitis
Nystatin (p. 855) C: 100,000 g 2–3 Irritation
(Mycostatin, Nilstat) O: 100,000 g times/day
P: 100,000 g
Oxiconazole (Oxistat) C: 1% 1–2 Pruritus, burning, stinging,
L: 1% times/day irritation, pain, tingling
Sertaconazole (Ertaczo) C: 2% 2 Dry skin, burning, pruritus,
times/day erythema
Terbinafine (p. 1143) C: 1% 1–2 Irritation, burning,
(Lamisil) G: 10 mg times/day pruritus, dryness
Tolnaftate (Tinactin) C: 1% 2 Mild irritation
G: 1% times/day
S: 1%Name Availability Dosage Side EffectsTriacetin (Fungoid) C: 1% 3 Irritation
RangeS: 1% times/day
Undecylenic acid C: 8%, 20%P: 10%, 12%, As needed None significant
(Caldesene, Cruex, 15%, 19%, 25%O: 25%
Desenex)
C, Cream; G, gel; L, lotion; O, ointment; P, powder; S, solution.
Antiglaucoma Agents
USES
Reduction of elevated intraocular pressure (IOP) in pts with open-angle glaucoma and ocular
hypertension.
ACTION
Medications decrease IOP by two primary mechanisms: decreasing aqueous humor (AH)
production or increasing AH outflow.
• Miotics (direct acting and indirect acting): Constrict pupils, opening channels in the trabecular
meshwork, reducing resistance to outflow of AH.
• Alpha -agonists: Activate receptors in ciliary body, inhibiting aqueous secretion and increasing2
uveoscleral aqueous outflow.
• Beta-blockers: Reduce production of aqueous humor.
• Carbonic anhydrase inhibitors: Decrease production of AH by inhibiting enzyme carbonic
anhydrase.
• Prostaglandins: Increase outflow of aqueous fluid through uveoscleral route.
ANTIGLAUCOMA AGENTS
Name Availability Dosage Range Side Effects
Miotics
Carbachol S: 0.01% 1 ml to anterior Ciliary or accommodative spasm, blurred
(Miostat) chamber of eye vision, reduced night vision, diaphoresis,
increased salivation, urinary frequency,
nausea, diarrhea
Echothiophate S: 0.125% 1 drop 2 Headaches, accommodative spasm,
(Phospholine times/day diaphoresis, vomiting, nausea, diarrhea,
Iodide) tachycardia
Pilocarpine G: 4% ½-inch ribbon Same as carbachol
(Pilipine HS) on lower
conjunctiva at
bedtime
Alpha -Agonists2
Apraclonidine S: 0.5% 1–2 drops 3 Hypersensitivity reaction, change in
(Iopidine) times/day visual acuity, lethargy
Brimonidine S: 0.1%, 1 drop 2–3 Hypersensitivity reaction, headaches,
(Alphagan) 0.15%, 0.2% times/day drowsiness, fatigue
Prostaglandins
Bimatoprost S: 0.03% 1 drop daily in Ocular hyperemia, eyelash growth,
(Lumigan) evening pruritus
Latanoprost S: 0.005% 1 drop daily in Burning, stinging, iris pigmentation
(Xalatan) eveningTafluprost S: 0.0015% 1 drop daily in Ocular hyperemia, eye stinging, ocularNme Availability Dosage Range Side Effects
(Zioptan) evening pruritus, headache
Travoprost S: 0.004% 1 drop daily in Ocular hyperemia, eye discomfort,
(Travatan) evening foreign body sensation, pain, pruritus
Beta-Blockers
Betaxolol Suspension Betoptic-S: 1 Transient irritation, burning, tearing,
(Betoptic, (Betoptic-S): drop 2 blurred vision
Betoptic-S) 0.25% S times/day
(Betoptic): Betoptic: 1–2
0.5% drops 2
times/day
Carteolol S: 1% 1 drop 2 Mild, transient ocular stinging, burning,
(Ocupress) times/day discomfort
Levobunolol S: 0.25%, 1–2 drops 1–2 Local discomfort, conjunctivitis, brow
(Betagan) 0.5% times/day ache, tearing, blurred vision, headaches,
anxiety
Metipranolol S: 0.3% 1 drop 2 Transient irritation, burning, stinging,
(OptiPranolol) times/day blurred vision
Timolol (p. S: 0.25%, S: 1 drop 2 Drowsiness, difficulty sleeping, fatigue,
1145) (Betimol, 0.5% G, times/day weakness
Istalol, Timoptic XE: (Istalol): 1 drop
Timoptic, 0.25%, 0.5% daily G: 1 drop
Timoptic XE) daily
Carbonic Anhydrase Inhibitors
Acetazolamide T: 250 mg C: 0.25–1 g/day Diarrhea, loss of appetite, metallic taste,
(p. 12) (Diamox) 500 mg nausea, paresthesia
Brinzolamide Suspension: 1 drop 3 Blurred vision, bitter taste
(Azopt) 1% times/day
Dorzolamide S: 2% 1 drop 3 Burning, stinging, blurred vision, bitter
(Trusopt) times/day taste
C, Capsules; G, gel; O, ointment; S, solution; T, tablets.
Antihistamines
USES
Symptomatic relief of upper respiratory allergic disorders. Allergic reactions associated with
other drugs respond to antihistamines, as do blood transfusion reactions. Used as a
secondchoice drug in treatment of angioneurotic edema. E( ective in treatment of acute urticaria and
other dermatologic conditions. May also be used for preop sedation, Parkinson’s disease, and
motion sickness.
ACTION
Antihistamines (H antagonists) inhibit vasoconstrictor e( ects and vasodilator e( ects on1
endothelial cells of histamine. They block increased capillary permeability, formation of
edema/wheal caused by histamine. Many antihistamines can bind to receptors in CNS, causing
primarily depression (decreased alertness, slowed reaction times, drowsiness) but also
stimulation (restlessness, nervousness, inability to sleep). Some may counter motion sickness.
ANTIHISTAMINES
Name Availability Dosage Range Side EffectsBrompheniramine T: 4 mg A: 4–8 mg q4–6h or T (SR): Dry mouth, urinaryName Availability Dosage Range Side Effects
(Brovex) T (SR): 4 mg, 6 8–12 mg q12–24h retention, blurred
mg C: 0.5 mg/kg/day vision
S: 2 mg/5 ml
Cetirizine (p. 226) T: 5 mg, 10 mg A: 5–10 mg/day Minimal CNS and
(Zyrtec) S: 5 mg/5 ml C (6–12 yrs): 5–10 mg/day anticholinergic side
C (2–5 yrs): 2.5–5 mg/day effects
Chlorpheniramine T: 4 mg A: 2–4 mg q4–6h or SR: 8– Same as
(Chlor-Trimeton) T (chewable): 12 mg q12–24h brompheniramine
2 mg C: 0.35 mg/kg/day
T (SR): 8 mg,
12 mg
S: 2 mg/5 ml
Clemastine (Tavist T: 1.34 mg, A: 1.34–2.68 mg q8–12h Same as azatadine
Allergy) 2.68 mg C (6–12 yrs): 0.67–1.34 mg
S: 0.67 mg/5 ml q8–12h
Cyproheptadine T: 4 mg A: 4 mg q8h Same as azatadine
(Periactin) S: 2 mg/5 ml C: 0.25 mg/kg/day
Desloratadine (p. T: 5 mg A, C (12 yrs and older): 5 Same as cetirizine
327) (Clarinex) ODT: 2.5 mg, 5 mg/day
mg C (6–11 yrs): 2.5 mg/day
S: 0.5 mg/ml C (1–5 yrs): 1.25 mg/day
C (6–11 mos): 1 mg/day
Dexchlorpheniramine T: 2 mg A: 2 mg q4–6h Same as
(Polaramine) S: 2 mg/5 ml C: 0.5–1 mg q4–6h brompheniramine
Dimenhydrinate (p. T: 50 mg A: 50–100 mg q4–6h Same as azatadine
354) (Dramamine) L: 12.5 mg/5 ml C: 12.5–50 mg q6–8h
Diphenhydramine (p. T: 25 mg, 50 A: 25–50 mg q6–8h Same as azatadine
359) (Benadryl) mg C (6–11 yrs): 12.5–25 mg
C: 25 mg, 50 q4–6h
mg C (2–5 yrs): 6.25 mg q4–6h
L: 6.25 mg/5
ml, 12.5 mg/5
ml
Fexofenadine (p. 479) T: 30 mg, 60 A: 60 mg q12h or 180 Same as cetirizine
(Allegra) mg, 180 mg mg/day C (6–11 yrs): 30 mg
q12h
Hydroxyzine (p. 577) T: 10 mg, 25 A: 25 mg q6–8h Same as azatadine
(Atarax) mg, 50 mg, 100 C: 2 mg/kg/day
mg
C: 25 mg, 50
mg, 100 mg
S: 10 mg/5 ml,
25 mg/5 ml
Levocetirizine (p. T: 5 mg A, C (12 yrs and older): 5 Same as cetirizine
681) (Xyzal) mg once daily in evening
C (6–11 yrs): 2.5 mg once
daily in evening
Loratadine (p. 708) T: 10 mg A: 10 mg/day Same as cetirizine
(Claritin) S: 1 mg/ml C (6–12 yrs): 10 mg/day
Promethazine (p. T: 12.5 mg, 25 A: 25 mg at bedtime or 12.5 Same as azatadine
990) (Phenergan) mg, 50 mg mg q8hS: 6.25 mg/5 C: 0.5 mg/kg at bedtime orName Availability Dosage Rane Side Effects
ml, 25 mg/5 ml 0.1 mg/kg q6–8h
A, Adults; C, capsules; C (dosage), children; L, liquid; ODT, orally-disintegrating tablet; S, syrup;
SR, sustained-release; T, tablets.
Antihyperlipidemics
USES
Cholesterol management.
ACTION
Bile acid sequestrants: Bind bile acids in the intestine; prevent active transport and reabsorption
and enhance bile acid excretion. Depletion of hepatic bile acid results in the increased
conversion of cholesterol to bile acids.
HMG-CoA reductase inhibitors (statins): Inhibit HMG-CoA reductase, the last regulated step in the
synthesis of cholesterol. Cholesterol synthesis in the liver is reduced.
Niacin (nicotinic acid): Reduces hepatic synthesis of triglycerides and secretion of VLDL by
inhibiting the mobilization of free fatty acids from peripheral tissues.
Fibric acid: Increases the oxidation of fatty acids in the liver, resulting in reduced secretion of
triglyceride-rich lipoproteins, and increases lipoprotein lipase activity and fatty acid uptake.
Cholesterol absorption inhibitor: Acts in the gut wall to prevent cholesterol absorption through the
intestinal villi.
Omega fatty acids: Exact mechanism unknown. Mechanisms may include inhibition of acyl-CoA,
decreased lipogenesis in liver, increased lipoprotein lipase activity.
ANTIHYPERLIPIDEMICS
Name Primary Dosage Comments/Side Effects
Effect
Bile Acid Sequestrants
Cholestyramine Decreases 4 g once or May bind drugs given concurrently. Take at least
(Prevalite, LDL twice daily 1 hr before or 4–6 hrs after cholestyramine.
Questran) (p. Side Effects: Constipation, heartburn, nausea,
234) vomiting, stomach pain
Colesevelam (p. Decreases 6–7 625-mg Take with food.
276) (Welchol) LDL tablets once Side Effects: Constipation, dyspepsia, weakness,
daily or 2 myalgia, pharyngitis
divided doses
with meals
Colestipol Decreases T: 2–16 g Do not crush tablets. May bind drugs given
(Colestid) LDL daily concurrently. Take at least 1 hr before or 4–6 hrs
G: 5–30 g after colestipol.
daily Side Effects: Constipation, headache, dizziness,
anxiety, vertigo, drowsiness, nausea, vomiting,
diarrhea, flatulence
Cholesterol Absorption Inhibitor
Ezetimibe Decreases 10 mg once Administer at least 2 hrs before or 4 hrs after bile
(Zetia) (p. 458) LDL daily acid sequestrants.
Side Effects: Dizziness, headache, fatigue,
diarrhea, abdominal pain, arthralgia, sinusitis,
pharyngitis
Fibric AcidFenofibrate Decreases Antara: 43– May increase levels of ezetimibe. Concomitant useName Primary Dosge Comments/Sid Effects
(Antara, TG 130 mg/day of statins may increase rhabdomyolysis, elevateEffect
Lofibra, Tricor, Lofibra: 67– CPK levels, and cause myoglobinuria.
Triglide) (p. 200 mg/day Side Effects: Abdominal pain, constipation,
468) Tricor: 48– diarrhea, respiratory complaints, headache, fever,
145 mg/day flu-like syndrome, asthenia (loss of strength,
Triglide: 50– energy)
160 mg/day
Fenofibric acid Decreases 45–135 May give without regard to meals. Concomitant
(p. 469) TG, LDL mg/day use of statins may increase rhabdomyolysis.
(Fibricor, Increases Side Effects: Headache, upper respiratory tract
Trilipix) HDL infection, pain, nausea, dizziness, nasopharyngitis
Gemfibrozil Decreases 600 mg 2 Give 30 min before breakfast and dinner.
(Lopid) (p. 534) TG times/day Concomitant use of statins may increase
rhabdomyolysis, elevate CPK levels, and cause
myoglobinuria.
Side Effects: Fatigue, vertigo, headache, rash,
eczema, diarrhea, abdominal pain, nausea,
vomiting, constipation
Niacin
Niacin, Decreases Regular- Diabetics may experience a dose-related elevation
nicotinic acid LDL, TG release in glucose.
(Niacor, Increases (Niacor): Side Effects: Increased hepatic function tests,
Niaspan) (p. HDL 1.5–6 g/day hyperglycemia, dyspepsia, itching, flushing,
831) in 3 divided dizziness,
insomnia
doses
Extendedrelease
(Niaspan):
375 mg to 2 g
once daily at
bedtime
Statins
Atorvastatin Decreases 10–80 May interact with CYP3A4 inhibitors (e.g.,
(Lipitor) (p. 90) LDL, TG mg/day amiodarone, diltiazem, cyclosporine, grapefruit
Increases juice) increasing risk of myopathy.
HDL Side Effects: Myalgia, myopathy,
rhabdomyolysis, headache, chest pain, peripheral
edema, dizziness, rash, abdominal pain,
constipation, diarrhea, dyspepsia, nausea,
flatulence, increased hepatic function tests, back
pain, sinusitis
Fluvastatin Decreases 20–80 Primarily metabolized by CYP2C9 enzyme system.
(Lescol) (p. LDL, TG mg/day May increase levels of phenytoin, rifampin. May
506) Increases lower fluvastatin levels.
HDL Side Effects: Headache, fatigue, dyspepsia,
diarrhea, nausea, abdominal pain, myalgia,
myopathy, rhabdomyolysis
Lovastatin Decreases 10–80 May interact with CYP3A4 inhibitors (e.g.,
(Mevacor) (p. LDL, TG mg/day amiodarone, diltiazem, cyclosporine, grapefruit
715) Increases juice) increasing risk of myopathy.
HDL Side Effects: Increased CPK levels, headache,
dizziness, rash, constipation, diarrhea, abdominal
pain, dyspepsia, nausea, flatulence, myalgia,
myopathy, rhabdomyolysisPitavastatin (p. Decreases 1–4 mg/day Erythromycin, rifampin may increaseName Primary Dosage Comments/Side Effects
954) (Livalo) LDL, TG concentration.Effect
Increases Side Effects: Myalgia, back pain, diarrhea,
HDL constipation, pain in extremities
Pravastatin Decreases 10–80 May be less likely to be involved in drug
(Pravachol) (p. LDL, TG mg/day interactions. Cyclosporine may increase
972) Increases pravastatin levels.
HDL Side Effects: Chest pain, headache, dizziness,
rash, nausea, vomiting, diarrhea, increased
hepatic function tests, cough, flu-like symptoms,
myalgia, myopathy, rhabdomyolysis
Rosuvastatin Decreases 5–40 mg/day May be less likely to be involved in drug
(Crestor) (p. LDL, TG interactions. Cyclosporine may increase
1061) Increases rosuvastatin levels.
HDL Side Effects: Chest pain, peripheral edema,
headache, rash, dizziness, vertigo, pharyngitis,
diarrhea, nausea, constipation, abdominal pain,
dyspepsia, sinusitis, flu-like symptoms, myalgia,
myopathy, rhabdomyolysis
Simvastatin Decreases 5–80 mg/day May interact with CYP3A4 inhibitors (e.g.,
(Zocor) (p. LDL, TG amiodarone, diltiazem, cyclosporine, grapefruit
1084) Increases juice) increasing risk of myopathy.
HDL Side Effects: Constipation, flatulence, dyspepsia,
increased hepatic function tests, increased CPK,
upper respiratory tract infection
Omega Fatty Acids
Lovaza (p. 872) Decreases 2 g twice Side Effects: Eructation, dyspepsia, taste
TG daily or 4 g perversion
once daily
Vascepa Decreases 2 g twice Side Effects: Arthralgia
TG daily
CPK, Creatine phosphokinase; G, granules; HDL, high-density lipoprotein; LDL, low-density
lipoprotein; T, tablets; TG, triglycerides.
Antihypertensives
USES
Treatment of mild to severe hypertension.
ACTION
Many groups of medications are used in the treatment of hypertension.
ACE inhibitors: Decrease conversion of angiotensin I to angiotensin II, a potent vasoconstrictor,
reducing peripheral vascular resistance and B/P.
Alpha-agonists (central action): Stimulate alpha -adrenergic receptors in the cardiovascular2
centers of the CNS, reducing sympathetic outflow and producing an antihypertensive effect.
Alpha-antagonists (peripheral action): Block alpha -adrenergic receptors in arterioles and veins,1
inhibiting vasoconstriction and decreasing peripheral vascular resistance, causing a fall in B/P.
Angiotensin receptor blockers: Block vasoconstrictor e( ects of angiotensin II by blocking the
binding of angiotensin II to AT1 receptors in vascular smooth muscle, helping blood vessels to
relax and reduce B/P.
Beta-blockers: Decrease B/P by inhibiting beta -adrenergic receptors, which lowers heart rate,1
heart workload, and the heart’s output of blood.
Calcium channel blockers: Reduce B/P by inhibiting ow of extracellular calcium across cell
membranes of vascular tissue, relaxing arterial smooth muscle.
Diuretics: Inhibit sodium (Na) reabsorption, increasing excretion of Na and water. Reduce
plasma, extracellular fluid volume, and peripheral vascular resistance.
Renin inhibitors: Directly inhibit renin, decreasing plasma renin activity (PRA), inhibiting
conversion of angiotensinogen to angiotensin, producing antihypertensive effect.
Vasodilators: Directly relax arteriolar smooth muscle, decreasing vascular resistance. Exact
mechanism unknown.
ANTIHYPERTENSIVES
Name Availability Dosage Side Effects
Range
(ACE) Inhibitors
Benazepril (p. 119) T: 5 mg, 10 10–40 Same as enalapril
(Lotensin) mg, 20 mg, 40 mg/day
mg
Enalapril (p. 406) T: 2.5 mg, 5 2.5–10 Cough, rash, hyperkalemia, hypotension
(Vasotec) mg, 10 mg, 20 mg/day (volume-depleted pts), acute renal failure,
mg angioedema
Lisinopril (p. 697) T: 2.5 mg, 5 10–40 Same as enalapril
(Prinivil, Zestril) mg, 10 mg, 20 mg/day
mg, 30 mg, 40
mg
Quinapril (p. 1009) T: 5 mg, 10 10–40 Same as enalapril
mg, 20 mg, 40 mg/day
mg
Ramipril (p. 1018) T or C: 1.25 2.5–20 Same as enalapril
(Altace) mg, 2.5 mg, 5 mg/day
mg, 10 mg
Alpha-Agonists: Central Action
Clonidine (p. 265) T: 0.1 mg, 0.2 PO: 0.2– Sedation, dry mouth, constipation, sexual
(Catapres) mg, 0.3 mg 0.8 dysfunction, bradycardia
P: 0.1 mg/hr, mg/day
0.2 mg/hr, 0.3 Topical:
mg/hr 0.1–0.6
mg/wk
Methyldopa T: 125 mg, 250 PO: 0.5– Same as clonidine
(Aldomet) mg, 500 mg 3 g/day Impaired memory, depression, nasal
congestion
Alpha-Agonists: Peripheral Action
Doxazosin (p. 381) T: 1 mg, 2 mg, PO: 2– Dizziness, vertigo, headaches
(Cardura) 4 mg, 8 mg 16
mg/day
Prazosin (p. 973) C: 1 mg, 2 mg, PO: 6– Dizziness, light-headedness, headaches,
(Minipress) 5 mg 20 drowsiness
mg/day
Terazosin (p. 1142) C: 1 mg, 2 mg, PO: 1– Dizziness, headaches, asthenia (loss of
(Hytrin) 5 mg, 10 mg 20 strength, energy)
mg/day
Angiotensin Receptor Blockers
Azilsartan (p. 103) T: 40 mg, 80 40–80 Diarrhea, hypotensionmg mg/dayName Availability Dosage Side Effects
Range
Candesartan T: 4 mg, 8 mg, 8–32 Same as losartan
(Atacand) 16 mg, 32 mg mg/day
Losartan (p. 713) T: 25 mg, 50 25–100 Headache, dizziness, hyperkalemia,
(Cozaar) mg, 100 mg mg/day hypotension (volume-depleted pts),
angioedema (very rare)
Olmesartan (p. 866) T: 5 mg, 20 20–40 Same as losartan
mg, 40 mg mg/day
Valsartan (Diovan) T: 80 mg, 160 80–320 Same as losartan
mg, 320 mg mg/day
Beta-Blockers
Atenolol (p. 86) T: 25 mg, 50 25–100 Fatigue, bradycardia, reduced exercise
(Tenormin) mg, 100 mg mg/day tolerance, increased triglycerides,
bronchospasm, sexual dysfunction, masked
hypoglycemia
Metoprolol (p. 766) T: 25 mg, 50 50–200 Same as atenolol
mg, 100 mg mg/day
Metoprolol XL (p. T: 25 mg, 50 50–300 Same as atenolol
766) (Toprol XL) mg, 100 mg, mg/day
200 mg
Calcium Channel Blockers
Amlodipine (p. 54) T: 2.5 mg, 5 2.5–10 Headache, fatigue, peripheral edema,
(Norvasc) mg, 10 mg mg/day flushing, worsening heart failure
Diltiazem CD (p. C: 120 mg, 180 180–420 Dizziness, headache, bradycardia, heart
356) (Cardizem CD) mg, 240 mg, mg/day block, worsening heart failure, edema,
300 mg constipation
Felodipine (p. 466) T: 2.5 mg, 5 2.5–20 Same as amlodipine
mg, 10 mg mg/day
Nifedipine XL (p. T: 30 mg, 60 30–120 Same as amlodipine
837) (Adalat CC) mg, 90 mg mg/day
Verapamil SR (p. T: 120 mg, 180 120–480 Same as diltiazem CD
1239) (Calan SR) mg, 240 mg mg/day
Diuretics
Chlorthalidone T: 25 mg, 50 6.25–25 Same as hydrochlorothiazide
(Hygroton) mg, 100 mg mg/day
Hydrochlorothiazide T: 25 mg, 50 12.5–50 Hypokalemia, hyperuricemia,
(p. 564) mg mg/day hypomagnesemia, hyperglycemia
(Hydrodiuril)
Renin Inhibitor
Aliskiren (p. 33) T: 150 mg, 300 PO: Diarrhea, dyspepsia, headache, dizziness,
(Tekturna) mg 150–300 fatigue, upper respiratory tract infection
mg/day
Vasodilators
Hydralazine (p. 562) T: 10 mg, 25 PO: 40– Anorexia, nausea, diarrhea, vomiting,
(Apresoline) mg, 50 mg, 300 headaches, palpitations
100 mg mg/day
Minoxidil (p. 783) T: 2.5 mg, 10 PO: 10– Rapid/irregular heartbeat, hypertrichosis,
(Loniten) mg 40 peripheral edemaName Availability Dosage Side Effects
mg/dayRange
C, Capsules; P, patch; T, tablets.
Antimigraine (Triptans)
USES
Treatment of migraine headaches with or without aura in adults 18 yrs and older.
ACTION
Triptans are selective agonists of the serotonin (5-HT) receptor in cranial arteries, which cause
vasoconstriction and reduce in ammation associated with antidromic neuronal transmission
correlating with relief of migraine headache.
TRIPTANS
Name Availability Dosage Range Contraindications Side Effects
Almotriptan T: 6.25 mg, 6.25–12.5 mg; Ischemic heart Drowsiness, dizziness,
(p. 37) 12.5 mg may repeat disease, angina fatigue, hot flashes, chest
(Axert) after 2 hrs pectoris, arrhythmias, pain/discomfort,
previous MI, paresthesia, nausea,
uncontrolled vomiting
hypertension
Eletriptan T: 20 mg, A: 20–40 mg; Same as almotriptan Asthenia (loss of strength,
(p. 402) 40 mg may repeat energy), nausea,
(Relpax) after 2 hrs dizziness, drowsiness
Frovatriptan T: 2.5 mg 2.5 mg; may Same as almotriptan Hot/cold sensations,
(p. 520) repeat after 2 dizziness, fatigue,
(Frova) hrs; no more headaches, chest pain,
than 3 T/day skeletal pain, dry mouth,
dyspepsia, flushing
Naratriptan T: 1 mg, 2.5 mg; may Same as almotriptan Atypical sensations, pain,
(p. 818) 2.5 mg repeat once nausea
(Amerge) after 4 hrs
Rizatriptan T: 5 mg, 10 5 or 10 mg; Same as almotriptan Atypical sensations, pain,
(p. 1052) mg may repeat nausea, dizziness,
(Maxalt, DT: 5 mg, after 2 hrs drowsiness, asthenia (loss
Maxalt-MLT) 10 mg of strength, energy),
fatigue
Sumatriptan T: 25 mg, PO: 25–100 Same as almotriptan Oral: Atypical sensations,
(p. 1115) 50 mg, 100 mg; may pain, malaise, fatigue
(Imitrex, mg repeat after 2 Injection: Atypical
Sumavel NS: 5 mg, hrs sensations, flushing, chest
DosePro) 20 mg NS: 5–20 mg; pain/discomfort, injection
I: 4 mg, 6 may repeat site reaction, dizziness,
mg after 2 hrs vertigo
Subcutaneous: Nasal: Discomfort,
4–6 mg; may nausea, vomiting, altered
repeat after 1 taste
hr
Zolmitriptan T: 2.5 mg, 2.5–5 mg; may Same as almotriptan Atypical sensations, pain,
(p. 1272) 5 mg repeat after 2 nausea, dizziness,
(Zomig, DT: 2.5 hrs asthenia (loss of strength,
Zomig-ZMT) mg, 5 mg energy), drowsinessA, Adults; DT, disintegrating tablets; I, injection; NS, nasal spray; T, tablets.
Antipsychotics
USES
Primarily used in managing psychotic illness (esp. in pts with increased psychomotor activity).
Also used to treat the manic phase of bipolar disorder, behavioral problems in children, nausea
and vomiting, intractable hiccups, anxiety and agitation, as adjunct in treatment of tetanus,
and to potentiate effects of narcotics.
ACTION
E( ects of these agents occur at all levels of the CNS. Antipsychotic mechanism unknown but
may antagonize dopamine action as a neurotransmitter in basal ganglia and limbic system.
Antipsychotics may block postsynaptic dopamine receptors, inhibit dopamine release, increase
dopamine turnover. These medications can be divided into the phenothiazines and
nonphenothiazines (miscellaneous). In addition to their use in the symptomatic treatment of
psychiatric illness, some have antiemetic, antinausea, antihistamine, anticholinergic, and/or
sedative effects.
ANTIPSYCHOTICS
Relative Side Effect Profile
Name Availability Dosage EPS Anticholinergic Sedation Hypotension
Aripiprazole (p. T: 2 mg, 5 PO: 15– Low Very low Very low Low
75) (Abilify) mg, 10 mg, 30
15 mg, 20 mg/day
mg, 30 mg I: Up to
DT: 10 mg, 30
15 mg mg/day
I: 9.75 mg
Asenapine TSL: 5 mg, 10 Low Very low Moderate Low/moderate
(Saphris) 10 mg mg/day
Chlorpromazine T: 10 mg, 50– Moderate Moderate High High
(p. 232) 25 mg, 50 2,000
(Thorazine) mg, 100 mg/day
mg, 200
mg
SR: 30 mg,
75 mg, 100
mg
OC: 30
mg/ml,
100 mg/ml
Clozapine (p. T: 25 mg, 75–900 Very low High High High
271) (Clozaril, 100 mg mg/day
FazaClo) DT: 25 mg,
100 mg
Fluphenazine T: 1 mg, PO: 2– High Low Low Low
(p. 497) 2.5 mg, 5 40
(Prolixin) mg, 10 mg mg/day
I: 25 I: 12.5–
mg/ml 75 mg
OC: 5 q2wks
mg/mlHaloperidol (p. T: 0.5 mg, 2–40 High Low Low LowRelative Side Effect Profile
557) (Haldol) 1 mg, 2 mg/day
Name Availability Dosage EPS Anticholinergic Sedation Hypotensionmg, 5 mg,
10 mg, 20
mg
I: 5 mg/ml
OC: 2
mg/ml
Iloperidone (p. T: 1 mg, 2 12–24 Low Very low Low Low/moderate
592) (Fanapt) mg, 4 mg, mg/day
6 mg, 8
mg, 10 mg,
12 mg
Loxapine (p. C: 5 mg, 10 20–250 Moderate Low Moderate Low
717) (Adasuve) mg, 25 mg, mg/day
50 mg
OC: 25
mg/ml
I: 50
mg/ml
Olanzapine (p. T: 2.5 mg, 10–20 Low Moderate Moderate/high Moderate
863) (Zyprexa) 5 mg, 7.5 mg/day
mg, 10 mg,
15 mg, 20
mg
DT: 5 mg,
10 mg
I: 10 mg
Paliperidone (p. T: 1.5 mg, 3–12 Low Very low Low/moderate Moderate
897) (Invega) 3 mg, 6 mg/day
mg, 9 mg IM:
I: 39 mg, Initially,
78 mg, 117 234 mg
mg, 234 once,
mg then
156 mg
1 wk
later,
then 39–
234 mg
monthly
Quetiapine (p. T: 25 mg, 100–800 Very low Moderate Moderate/high Moderate
1007) 50 mg, 100 mg/day
(Seroquel) mg, 200
mg, 300
mg, 400
mg
ER: 50 mg,
150 mg,
200 mg,
300 mg,
400 mg
Risperidone (p. T: 0.25 mg, 2–6 Low Very low Low/moderate Moderate
1043) 0.5 mg, 1 mg/day
(Risperdal) mg, 2 mg, IM: 25–
3 mg, 4 mg 50 mg"
OC: 1 q2wksRelative Side Effect Profile
mg/ml
Name Availability Dosage EPS Anticholinergic Sedation HypotensionI: 25 mg,
37.5 mg,
50 mg
Thioridazine (p. T: 10 mg, 50–800 Low High High Moderate/high
1158) (Mellaril) 15 mg, 25 mg/day
mg, 50 mg,
100 mg,
150 mg,
200 mg
OC: 30
mg/ml,
100 mg/ml
Thiothixene (p. C: 1 mg, 2 5–60 High Low Low Low/moderate
1161) (Navane) mg, 5 mg mg/day
Trifluoperazine T: 1 mg, 2 5–80 High Low Low Low
(p. 1212) mg, 5 mg, mg/day
(Stelazine) 10 mg
I: 5 mg/ml
OC: 2
mg/ml
Ziprasidone (p. C: 20 mg, 40–160 Low Very low Low to Low to
1269) (Geodon) 40 mg, 60 mg/day moderate moderate
mg, 80 mg
I: 20 mg
C, Capsules; DT, disintegrating tablets; EPS, extrapyramidal symptoms; ER, extended-release; I,
injection; OC, oral concentrate; SR, sustained-release; T, tablets; TSL, sublingual tablets.
Antivirals
USES
Treatment of HIV infection. Treatment of cytomegalovirus (CMV) retinitis in pts with AIDS,
acute herpes zoster (shingles), genital herpes (recurrent), mucosal and cutaneous herpes
simplex virus (HSV), chickenpox, and influenza A viral illness.
ACTION
E( ective antivirals must inhibit virus-speci c nucleic acid/protein synthesis. Possible
mechanisms of action of antivirals used for non-HIV infection may include interference with
viral DNA synthesis and viral replication, inactivation of viral DNA polymerases, incorporation
and termination of the growing viral DNA chain, prevention of release of viral nucleic acid into
the host cell, or interference with viral penetration into cells.
ANTIVIRALS
Name Availability Uses Side Effects
Abacavir (p. 1) T: 300 mg HIV infection Nausea, vomiting, loss of
(Ziagen) OS: 20 appetite, diarrhea,
mg/ml headaches, fatigue
Acyclovir (p. 17) T: 400 mg, Mucosal/cutaneous HSV-1 Malaise, anorexia, nausea,
(Zovirax) 800 mg and HSV-2, varicella-zoster vomiting, light-headedness
C: 200 mg (shingles), genital herpes,
I: 50 mg/ml herpes simplex, encephalitis,
chickenpoxAdefovir (p. 22) T: 10 mg Chronic hepatitis B Asthenia (loss of strength,Name Availability Uses Side Effects
(Hepsera) energy), headaches,
abdominal pain, nausea,
diarrhea, flatulence,
dyspepsia
Amantadine (p. 45) C: 100 mg Influenza A Anxiety, dizziness,
light(Symmetrel) S: 50 mg/5 headedness, headaches,
ml nausea, loss of appetite
Cidofovir (p. 239) I: 75 mg/ml CMV retinitis Decreased urination, fever,
(Vistide) chills, diarrhea, nausea,
vomiting, headaches, loss
of appetite
Darunavir (p. 308) T: 300 mg HIV infection Diarrhea, nausea,
(Prezista) vomiting, headaches, skin
rash, constipation
Delavirdine (p. T: 100 mg, HIV infection Diarrhea, fatigue, rash,
321) (Rescriptor) 200 mg headaches, nausea
Didanosine (p. 349) T: 25 mg, HIV infection Peripheral neuropathy,
(Videx) 50 mg, 100 anxiety, headaches, rash,
mg, 150 mg, nausea, diarrhea, dry
200 mg mouth
C: 125 mg,
200 mg
Powder for
suspension:
100 mg, 167
mg, 250 mg
Efavirenz (p. 400) C: 50 mg, HIV infection Diarrhea, dizziness,
(Sustiva) 100 mg, 200 headaches, insomnia,
mg nausea, vomiting,
drowsiness
Etravirine (p. 452) T: 100 mg HIV infection Rash, nausea, abdominal
(Intelence) pain, vomiting
Famciclovir (p. T: 125 mg, Herpes zoster, genital herpes Headaches
461) (Famvir) 250 mg, 500
mg
Foscarnet (p. 515) I: 24 mg/ml CMV retinitis, HSV infections Decreased urination,
(Foscavir) abdominal pain, nausea,
vomiting, dizziness,
fatigue, headaches
Ganciclovir (p. C: 250 mg, CMV retinitis, CMV disease Sore throat, fever, unusual
528) (Cytovene) 500 mg bleeding/bruising
I: 500 mg
Indinavir (p. 607) C: 200 mg, HIV infection Blood in urine, weakness,
(Crixivan) 400 mg nausea, vomiting,
diarrhea, headaches,
insomnia, altered taste
Lamivudine (p. T: 100 mg, HIV infection Nausea, vomiting,
658) (Epivir) 150 mg abdominal pain,
OS: 5 paresthesia
mg/ml, 10
mg/mlLopinavir/ritonavir C: 133/33 HIV infection Diarrhea, nauseaName Availability Uses Side Effects
(p. 707) (Kaletra) mg
OS: 80/20
mg
Maraviroc (p. 729) T: 150 mg, HIV infection Cough, pyrexia, upper
(Selzentry) 300 mg respiratory tract infection,
rash, musculoskeletal
symptoms, abdominal
pain, dizziness
Nelfinavir (p. 825) T: 250 mg HIV infection Diarrhea
(Viracept) Powder: 50
mg/g
Oseltamivir (p. C: 75 mg Influenza Diarrhea, nausea, vomiting
879) (Tamiflu) S: 12 mg/ml
Raltegravir (p. T: 400 mg HIV infection Nausea, headache,
1015) (Isentress) diarrhea, pyrexia
Ribavirin (p. 1033) Aerosol: 6 Lowers respiratory infections Anemia
(Virazole) g in infants, children due to
respiratory syncytial virus
(RSV)
Ritonavir (p. 1046) C: 100 mg HIV infection Weakness, diarrhea,
(Norvir) OS: 80 nausea, decreased
mg/ml appetite, vomiting, altered
taste
Saquinavir (p. C: 200 mg HIV infection Weakness, diarrhea,
1067) (Invirase) nausea, oral ulcers,
abdominal pain
Stavudine (p. 1104) C: 15 mg, HIV infection Paresthesia, decreased
(Zerit) 20 mg, 30 appetite, chills, fever, rash
mg, 40 mg
OS: 1
mg/ml
Tenofovir (p. 1140) T: 300 mg HIV infection Diarrhea, nausea,
(Viread) pharyngitis, headaches
Valacyclovir (p. T: 500 mg Herpes zoster, genital herpes Headaches, nausea
1219) (Valtrex)
Valganciclovir (p. T: 450 mg CMV retinitis Anemia, abdominal pain,
1221) (Valcyte) diarrhea, headaches,
nausea, vomiting,
paresthesia
Zalcitabine (Hivid) T: 0.375 HIV infection Paresthesia, arthralgia,
mg, 0.75 mg rash, nausea, vomiting
Zanamivir (p. Inhalation: Influenza Cough, diarrhea, dizziness,
1266) (Relenza) 5 mg headaches, nausea,
vomiting
Zidovudine (p. T: 300 mg HIV infection Fatigue, fever, chills,
1267) (Retrovir) C: 100 mg headaches, nausea, muscle
S: 50 mg/5 pain
ml
C, Capsules; I, injection; OS, oral solution; S, syrup; T, tablets.Beta-Adrenergic Blockers
USES
Management of hypertension, angina pectoris, arrhythmias, hypertrophic subaortic
stenosis, migraine headaches, MI (prevention), glaucoma.
ACTION
Beta-adrenergic blockers competitively block beta -adrenergic receptors, located1
primarily in myocardium, and beta -adrenergic receptors, located primarily in2
bronchial and vascular smooth muscle. By occupying beta-receptor sites, these agents
prevent naturally occurring or administered epinephrine/norepinephrine from exerting
their effects. The results are basically opposite to those of sympathetic stimulation.
E%ects of beta -blockade include slowing heart rate, decreasing cardiac output and1
contractility; e%ects of beta -blockade include bronchoconstriction, increased airway2
resistance in pts with asthma or COPD. Beta-blockers can a%ect cardiac
rhythm/automaticity (decrease sinus rate, SA/AV conduction; increase refractory period
in AV node). Decrease systolic and diastolic B/P; exact mechanism unknown but may
block peripheral receptors, decrease sympathetic out/ow from CNS, or decrease renin
release from kidney. All beta-blockers mask tachycardia that occurs with hypoglycemia.
When applied to the eye, reduce intraocular pressure and aqueous production.
BETA-ADRENERGIC BLOCKERS
Name Availability Indication Dosage Range Selectivity
Acebutolol C: 200 mg, HTN, arrhythmias 200–1,200 Beta1
(Sectral) 400 mg mg/day
Atenolol (p. T: 25 mg, 50 HTN, angina, MI 50–100 mg/day Beta1
86) mg, 100 mg
(Tenormin)
Bisoprolol T: 5 mg, 10 HTN 2.5–20 mg/day Beta1
(p. 136) mg
(Zebeta)
Carvedilol T: 3.125 mg, HF, LVD after MI, HTN 12.5–100 Alpha ,1
(p. 191) 6.25 mg, 12.5 mg/day Beta ,1
(Coreg) mg, 25 mg Beta2
C (SR): 10
mg, 20 mg, 40
mg, 80 mg
Esmolol (p. I: 10 mg/ml, HTN, arrhythmias 50–200 Beta1
436) 20 mg/ml mcg/kg/min
(Brevibloc)
Labetalol T: 100 mg, HTN 200–2,400 Alpha ,1
(p. 653) 200 mg, 300 mg/day Beta ,1
(Trandate) mg I: 20–80 mg at Beta2
I: 5 mg/ml 10-min intervals
(Maximum: 300
mg)
Metoprolol T: 50 mg, 100 HTN, angina, HF, MI T: 50–450 Beta1
(p. 766) mg/ml mg/day
(Lopressor) I: 1 mg/ml I: 1.25–5 mg q6–
T (SR): 25 12hName Availability Indication Dosage Range Selectivity
mg, 50 mg SR: Up to 200
mg/day
Nadolol (p. T: 20 mg, 40 HTN, angina 40–320 mg/day Beta ,1
808) mg, 80 mg, Beta2
(Corgard) 120 mg, 160
mg
Nebivolol T: 2.5 mg, 5 HTN 5–40 mg/day Beta1
(p. 822) mg, 10 mg
Pindolol T: 5 mg, 10 HTN 10–60 mg/day Beta ,1
(Visken) mg Beta2
Propranolol T: 10 mg, 20 HTN, angina, MI, 80–320 mg/day Beta ,1
(p. 996) mg, 40 mg, 60 arrhythmias, migraine, Beta2
(Inderal) mg, 80 mg, 90 essential tremor,
mg hypertrophic subaortic
C (SR): 60 stenosis
mg, 80 mg,
120 mg, 160
mg
S: 4 mg/ml, 8
mg/ml
I: 1 mg/ml
Sotalol (p. T: 80 mg, 120 Arrhythmias 160–640 Beta ,1
1100) mg, 160 mg, mg/day Beta2
(Betapace) 240 mg
Timolol (p. T: 5 mg, 10 HTN, migraine 10–60 mg/day Beta ,1
1169) mg, 20 mg Beta2
(Blocadren)
C , Capsules; H F , heart failure; H T N , hypertension; I , injection; L V D , left ventricular
dysfunction; M I , myocardial infarction; S , solution; S R , sustained-release; T , tablets.

Bronchodilators
USES
Relief of bronchospasm occurring during anesthesia and in bronchial asthma,
bronchitis, emphysema.
ACTION
Inhaled corticosteroids: Exact mechanism unknown. May act as anti-in/ammatories,
decrease mucus secretion.
Beta -adrenergic agonists: Stimulate beta-receptors in lung, relax bronchial smooth2
muscle, increase vital capacity, decrease airway resistance.
Anticholinergics: Inhibit cholinergic receptors on bronchial smooth muscle (block
acetylcholine action).
Leukotriene modi ers: Decrease e%ect of leukotrienes, which increase migration of
eosinophils, producing mucus/edema of airway wall, causing bronchoconstriction.Methylxanthines: Directly relax smooth muscle of bronchial airway, pulmonary blood
vessels (relieve bronchospasm, increase vital capacity). Increase cyclic 3,5-adenosine
monophosphate.
BRONCHODILATORS
Name Availability Dosage Range Side Effects
Anticholinergics
Aclidinium (p. 16) Inhalation powder: A: 400 mcg Headache,
(Tudorza) 400 mcg/actuation twice daily nasopharyngitis,
cough
Ipratropium (p. 627) NEB: 0.02% A (NEB): Upper respiratory
(Atrovent) MDI: 18 0.02% q3–4h tract infection,
mcg/actuation A (MDI): 2 bronchitis,
puffs 4 sinusitis, headache,
times/day dyspnea
Tiotropium (p. 1173) Inhalation powder: A: Once/day Xerostomia, upper
(Spiriva) 18 mcg/capsule respiratory tract
infection, sinusitis,
pharyngitis
Bronchodilators
Albuterol (p. 26) MDI: 90 MDI: 2 Tachycardia,
(AccuNeb, ProAir HFA, mcg/actuation inhalations skeletal muscle
Proventil HFA, Ventolin NEB: 2.5 mg/3 ml, 2.5 q4–6h as tremors, muscle
HFA) mg/0.5 ml, needed cramping,
( A c c u N e b ) : 0.63–1.25 NEB: 2.5 mg palpitations,
mg/3 ml q6–8h as insomnia,
needed hypokalemia,
increased serum
glucose
Albuterol/ipratropium MDI: 90 mcg MDI: 2 Same as individual
(pp. 26, 628) albuterol/18 mcg inhalations 4 listing for albuterol
(Combivent, DuoNeb) ipratropium/actuation times/day as and ipratropium
NEB: 2.5 mg needed
albuterol/0.5 mg NEB: 2.5
ipratropium/3 ml mg/0.5 mg 4
times/day as
needed
Arformoterol (Brovana) NEB: 15 mcg/2 ml NEB: 15 mcg Same as formoterol
2 times/day
Formoterol (p. 512) DPI: 12 mcg/capsule DPI: 12 mcg 2 Diarrhea, nausea,
(Foradil, Perforomist) NEB: 20 mcg/2 ml times/day asthma
NEB: 20 mcg exacerbation,
2 times/day bronchitis,
infection
Formoterol/budesonide MDI: 80, 160 mcg/4.5 MDI: 2 Same as individual
(pp. 152, 512) mcg/inhalation inhalations 2 listing for
(Symbicort) times/day formoterol and
budesonide
Formoterol/mometasone MDI: 5 mcg/100 mcg, MDI: 2 Same as individual(pp. 512, 794) (Dulera) 5 mcg/200 mcg inhalations 2 listing forName Availability Dosge Range Side Efects
times/day formoterol and
beclomethasone
Indacaterol (p. 604) DPI: 75 mcg/capsule DPI: 75 mcg Cough,
(Arcapta) once/day oropharyngeal
pain,
nasopharyngitis,
headache, nausea
Levalbuterol (p. 678) MDI: 45 MDI: 2 Tremor, rhinitis,
(Xopenex) mcg/actuation inhalations viral infection,
NEB: 0.31, 0.63, 1.25 q4–6h as headache,
mg/3 ml needed nervousness,
NEB: 0.63– asthma,
1.25 mg q6-8h pharyngitis, rash
Salmeterol (p. 1066) DPI: 50 mcg/blister DPI: 50 mcg 2 Headache, pain,
(Serevent Diskus) times/day throat irritation,
nasal congestion,
bronchitis,
pharyngitis
Salmeterol/fluticasone DPI: 100, 250, 500 DPI: 1 Same as individual
(pp. 503, 1066) (Advair mcg/50 mcg/blister inhalation 2 listing for
Diskus, Advair HFA) MDI: 45, 115, 230 times/day salmeterol and
mcg/21 MDI: 2 fluticasone
mcg/inhalation inhalations 2
times/day
Inhaled Corticosteroids
Beclomethasone (p. 113) MDI: 40, 80 MDI: 40–320 Cough, hoarseness,
(QVAR) mcg/inhalation mcg 2 headache,
times/day pharyngitis
Budesonide (p. 152) DPI: (Flexhaler): 90, DPI: Headache, nausea,
(Pulmicort Flexhaler, 180 mcg/inhalation (Flexhaler): respiratory
Pulmicort Respules) DPI: (Turbuhaler): 360–720 mcg infection, rhinitis
200 mcg/inhalation 2 times/day
NEB: (Respules): DPI:
0.25, 0.5 mg/2 ml (Turbuhaler):
200–800 mcg
2 times/day
NEB:
(Respules):
250–500 mcg
1–2 times/day
or 1 mg once
daily
Ciclesonide (p. 237) HFA: 80 HFA: 160–320 Headache,
(Alvesco HFA) mcg/inhalation mcg 2 nasopharyngitis,
times/day upper respiratory
infection, epistaxis,
nasal congestion,
sinusitis
Fluticasone (p. 503) DPI: (Flovent DPI: (Flovent Headache, nasal(Flovent Diskus, Flovent Diskus): 50, 100, 250 Diskus): 100– congestion,Name Availabilityoage Range Side Effects
HFA) mcg/blister 500 mcg 2 pharyngitis,
MDI: (Flovent HFA): times/day sinusitis,
44, 110, 220 MDI: respiratory
mcg/inhalation (Flovent infections
HFA): 88–440
mcg 2
times/day
Formoterol/budesonide MDI: 80, 160 mcg/4.5 MDI: 2 Same as individual
(pp. 152, 512) mcg/inhalation inhalations 2 listing for
(Symbicort) times/day formoterol and
budesonide
Mometasone (p. 794) DPI: 220 DPI: 220–440 Same as
(Asmanex Twisthaler) mcg/inhalation mcg 1–2 beclomethasone
times/day
Salmeterol/fluticasone DPI: 100, 250, 500 DPI: 1 Same as individual
(pp. 503, 1066) (Advair mcg/50 mcg/blister inhalation 2 listing for
Diskus, Advair HFA) MDI: 45, 115, 230 times/day salmeterol and
mcg/21 MDI: 2 fluticasone
mcg/inhalation inhalations 2
times/day
Leukotriene Modifiers
Montelukast (p. 796) T: 4 mg, 5 mg, 10 mg A: 10 mg/day Dyspepsia,
(Singulair) C (6–14 yrs): increased hepatic
5 mg/day function tests,
C (2–5 yrs): 4 cough, nasal
mg/day congestion,
headache,
dizziness, fatigue
Zafirlukast (p. 1263) T: 10 mg, 20 mg A, C (12 yrs Headache, nausea,
(Accolate) and older): diarrhea, infection
20 mg 2
times/day
C (5–11 yrs):
10 mg 2
times/day
A , Adults; C (dosage), children; D P I , dry powder inhaler; H F A , hydro/uoroalkane; M D I ,
metered dose inhaler; N E B , nebulization; T , tablets.


Calcium Channel Blockers
USES
Treatment of essential hypertension, treatment of and prophylaxis of angina pectoris
(including vasospastic, chronic stable, unstable), prevention/control of supraventricular
tachyarrhythmias, prevention of neurologic damage due to subarachnoid hemorrhage.
ACTION
2+Calcium channel blockers inhibit the ow of extracellular Ca ions across cell
membranes of cardiac cells, vascular tissue. They relax arterial smooth muscle, depress
the rate of sinus node pacemaker, slow AV conduction, decrease heart rate, produce
negative inotropic e%ect (rarely seen clinically due to re ex response). Calcium
channel blockers decrease coronary vascular resistance, increase coronary blood ow,
reduce myocardial oxygen demand. Degree of action varies with individual agent.
CALCIUM CHANNEL BLOCKERS
Name Availability Dosage Side Effects Indications
Range
Amlodipine T: 2.5 mg, 5 mg, 2.5–10 Abdominal pain, HTN, angina
(p. 54) 10 mg mg/day flushing,
(Norvasc) headaches,
peripheral edema
Diltiazem T: 30 mg, 60 mg, PO: 120–360 Dizziness, PO: HTN
(p. 356) 90 mg mg/day drowsiness, IV: Arrhythmias
(Cardizem) T (SR): 120 mg, I: 20–25 mg edema, headache
180 mg, 240 mg IV bolus,
C (SR): 60 mg, 90 then 5–15
mg, 120 mg, 180 mg/hr
mg, 240 mg, 300 infusion
mg, 360 mg
I: 5 mg/ml
Felodipine T: 2.5 mg, 5 mg, 5–10 mg/day Peripheral HTN
(p. 466) 10 mg edema,
(Plendil) headaches
Isradipine T (CR): 5 mg, 10 5–20 mg/day Headaches HTN
(p. 640) mg
(DynaCirc) C: 2.5 mg, 5 mg
Nicardipine C: 20 mg, 30 mg PO: 60–120 Flushing, HTN, angina
(p. 832) C (ER): 30 mg, 45 mg/day peripheral
(Cardene) mg, 60 mg edema, headache,
I: 2.5 mg/ml dizziness
Nifedipine C: 10 mg, 20 mg 30–120 Peripheral HTN, angina
(p. 837) T (ER): 30 mg, 60 mg/day edema, dizziness,
(Adalat, mg, 90 mg flushed face,
Procardia) headaches,
nausea
Nimodipine C: 30 mg 60 mg q4h Nausea, reduced Prevent neurologic
(p. 841) for 21 days B/P, headache, damage following
(Nimotop) rash, diarrhea subarachnoidhemorrhageName Availability Dosage Side Effects Indications
Verapamil T: 40 mg, 80 mg, 120–480 Nausea, gingival HTN, angina,Range
(p. 1239) 120 mg mg/day hyperplasia, arrhythmias
(Calan, T (SR): 120 mg, headache,
Isoptin) 180 mg, 240 mg fatigue, dizziness
C , Capsules; C R , controlled-release; E R , extended-release; H T N , hypertension; I ,
injection; S R , sustained-release; T , tablets.

Chemotherapeutic Agents
USES
Treatment of a variety of cancers; may be palliative or curative. Treatment of choice in
hematologic cancers. Often used as adjunctive therapy (e.g., with surgery or
irradiation); most e%ective when tumor mass has been removed or reduced by
radiation. Often used in combinations to increase therapeutic results, decrease toxic
e%ects. Certain agents may be used in nonmalignant conditions: polycythemia vera,
psoriasis, rheumatoid arthritis, or immunosuppression in organ transplantation (used
only in select cases that are severe and unresponsive to other forms of therapy). Refer
to individual monographs.
ACTION
Most antineoplastics can be divided into alkylating agents, antimetabolites,
anthracyclines, plant alkaloids, and topoisomerase inhibitors. These agents a%ect cell
division or DNA synthesis. Newer agents (monoclonal antibodies and tyrosine kinase
inhibitors) directly target a molecular abnormality in certain types of cancer. Hormones
modulate tumor cell behavior without directly attacking those cells. Some agents are
classified as miscellaneous.
CHEMOTHERAPEUTIC AGENTS
Name Availability Category Side Effects
Abiraterone (p. 6) T: 250 mg CYP17 inhibitor Joint swelling, hypokalemia,
(Zytiga) edema, muscle discomfort, hot
flashes, diarrhea, UTI, cough,
hypertension, arrhythmia,
dyspepsia, upper respiratory
tract infection
Aldesleukin (p. I: 22 million Biologic Hypotension, sinus tachycardia,
623) (Proleukin) units response nausea, vomiting, diarrhea,
modifier renal impairment, anemia, rash,
fatigue, agitation, pulmonary
congestion, dyspnea, fever,
chills, oliguria, weight gain,
dizziness
Alemtuzumab (p. I: 30 mg/3 Monoclonal Rigors, fever, fatigue,
29) (Campath) ml antibody hypotension, neutropenia,
anemia, sepsis, dyspnea,
bronchitis, pneumonia, urticariaAlitretinoin Gel: 0.1% Retinoic acid Burning, pain, edema,Nam Availability Caegry Side Effects
(Panretin) derivative dermatitis, rash, skin disorders
Altretamine C: 50 mg Miscellaneous Nausea, vomiting,
(Hexalen) myelosuppression, peripheral
neuropathy, altered mood,
ataxia, dizziness, anxiety,
vertigo
Anastrozole (p. T: 1 mg Aromatase Peripheral edema, chest pain,
67) (Arimidex) inhibitor nausea, vomiting, diarrhea,
constipation, abdominal pain,
anorexia, pharyngitis, vaginal
hemorrhage, anemia,
leukopenia, rash, weight gain,
diaphoresis, increased appetite,
pain, headaches, dizziness,
depression, paresthesia, hot
flashes, increased cough, dry
mouth, asthenia (loss of
strength, energy), dyspnea,
phlebitis
Arsenic trioxide I: 10 mg/ml Miscellaneous AV block, GI hemorrhage,
(p. 78) (Trisenox) hypertension, hypoglycemia,
hypokalemia, hypomagnesemia,
neutropenia, oliguria, prolonged
QT interval, seizures, sepsis,
thrombocytopenia
Asparaginase (p. I: 10,000 Miscellaneous Anorexia, nausea, vomiting,
81) (Elspar) units hepatic toxicity, pancreatitis,
nephrotoxicity, clotting factor
abnormalities, malaise,
confusion, lethargy, EEG
changes, respiratory distress,
fever, hyperglycemia,
depression, stomatitis, allergic
reactions, drowsiness
Axitinib (p. 96) T: 1 mg, 5 Kinase inhibitor Diarrhea, hypertension, fatigue,
(Inlyta) mg decreased appetite, nausea,
dysphoria, vomiting, asthenia
(loss of strength, energy),
constipation
Azacitidine (p. 98) I: 100 mg DNA Edema, hypokalemia, weight
(Vidaza) methylation loss, myalgia, cough, dyspnea,
inhibitor upper respiratory tract infection,
back pain, pyrexia, weakness
BCG (TheraCys, I: 50 mg, 81 Biologic Nausea, vomiting, anorexia,
Tice BCG) mg response diarrhea, dysuria, hematuria,
modulator cystitis, urinary urgency,
anemia, malaise, fever, chills
Bendamustine (p. I: 100 mg Alkylating agent Neutropenia, pyrexia,
121) (Treanda) thrombocytopenia, nausea,
anemia, leukopenia, vomitingBevacizumab (p. I: 25 mg/ml Monoclonal Increased B/P, fatigue, bloodName Availability Category Side Effcts
129) (Avastin) antibody clots, diarrhea, decreased WBCs,
headaches, decreased appetite,
stomatitis
Bexarotene (p. C: 75 mg Miscellaneous Anemia, dermatitis, fever,
131) (Targretin) Gel: 1% hypercholesterolemia, infection,
leukopenia, peripheral edema
Bicalutamide (p. T: 50 mg Antiandrogen Gynecomastia, hot flashes,
132) (Casodex) breast pain, nausea, diarrhea,
constipation, nocturia,
impotence, pain, muscle pain,
asthenia (loss of strength,
energy), abdominal pain
Bleomycin (p. 139) I: 15 units, Antibiotic Nausea, vomiting, anorexia,
(Blenoxane) 30 units stomatitis, hyperpigmentation,
alopecia, pruritus,
hyperkeratosis, urticaria,
pneumonitis progression to
fibrosis, weight loss, rash
Bortezomib (p. I: 3.5 mg Proteasome Anxiety, dizziness, headaches,
143) (Velcade) inhibitor insomnia, peripheral
neuropathy, pruritus, rash,
abdominal pain, decreased
appetite, constipation, diarrhea,
dyspepsia, nausea, vomiting,
arthralgia, dyspnea, asthenia
(loss of strength, energy),
edema, pain
Bosutinib (p. 146) T: 100 mg, Kinase inhibitor Nausea, diarrhea,
(Bosulif) 500 mg thrombocytopenia, vomiting,
abdominal pain, anemia, fever,
fatigue
Brentuximab I: 50 mg Miscellaneous Neutropenia, peripheral sensory
(Adcetris) neuropathy, fatigue, nausea,
anemia, upper respiratory tract
infection, diarrhea, pyrexia,
thrombocytopenia, cough,
vomiting
Busulfan (p. 161) T: 2 mg Alkylating agent Nausea, vomiting,
(Myleran) hyperuricemia,
myelosuppression, skin
hyperpigmentation, alopecia,
anorexia, weight loss, diarrhea,
stomatitis
Cabazitaxel (p. I: 60 mg/1.5 Microtubule Neutropenia, anemia,
163) (Jevtana) ml inhibitor leukopenia, thrombocytopenia,
diarrhea, fatigue, nausea,
vomiting, constipation, asthenia
(loss of strength, energy),
abdominal pain, hematuria,anorexia, peripheralName Availability Category Side Effects
neuropathy, dyspnea, alopeciaCapecitabine (p. T: 150 mg, Antimetabolite Nausea, vomiting, diarrhea,
176) (Xeloda) 300 mg stomatitis, myelosuppression,
palmar-plantar
erythrodysesthesia syndrome,
dermatitis, fatigue, anorexia
Carboplatin (p. I: 50 mg, Alkylating agent Nausea, vomiting,
184) (Paraplatin) 150 mg, 450 nephrotoxicity,
mg myelosuppression, alopecia,
peripheral neuropathy,
hypersensitivity, ototoxicity,
asthenia (loss of strength,
energy), diarrhea, constipation
Carfizomib I: 60 mg Proteasome Anemia, fatigue, nausea,
(Kyprolis) inhibitor thrombocytopenia, dyspnea,
diarrhea, pyrexia
Carmustine (p. I: 100 mg Alkylating agent Anorexia, nausea, vomiting,
189) (BiCNU) myelosuppression, pulmonary
fibrosis, pain at injection site,
diarrhea, skin discoloration
Cetuximab (p. 228) I: 2 mg/ml Monoclonal Dyspnea, hypotension, acne-like
(Erbitux) antibody rash, dry skin, weakness,
fatigue, fever, constipation,
abdominal pain
Chlorambucil (p. T: 2 mg Alkylating agent Myelosuppression, dermatitis,
229) (Leukeran) nausea, vomiting, hepatic
toxicity, anorexia, diarrhea,
abdominal discomfort, rash
Cisplatin (p. 248) I: 50 mg, Alkylating agent Nausea, vomiting,
(Platinol-AQ) 100 mg nephrotoxicity,
myelosuppression, neuropathies,
ototoxicity, anaphylactic-like
reactions, hyperuricemia,
hypomagnesemia,
hypophosphatemia,
hypokalemia, hypocalcemia,
pain at injection site
Cladribine (p. 251) I: 1 mg/ml Antimetabolite Nausea, vomiting, diarrhea,
(Leustatin) myelosuppression, chills,
fatigue, rash, fever, headaches,
anorexia, diaphoresis
Crizotinib (p. 284) C: 200 mg, Tyrosine kinase Vision disorders, nausea,
(Xalkori) 250 mg inhibitor vomiting, diarrhea, edema,
constipation
Cyclophosphamide I: 100 mg, Alkylating agent Nausea, vomiting, hemorrhagic
(p. 289) (Cytoxan) 200 mg, 500 cystitis, myelosuppression,
mg, 1 g, 2 g alopecia, interstitial pulmonary
T: 25 mg, 50 fibrosis, amenorrhea,
mg azoospermia, diarrhea,
darkening skin/fingernails,headaches, diaphoresisName Availability Category Side Effects
Cytarabine (p. I: 100 mg, Antimetabolite Anorexia, nausea, vomiting,
293) (Ara-C, 500 mg, 1 g, stomatitis, esophagitis, diarrhea,
Cytosar) 2 g myelosuppression, alopecia,
rash, fever, neuropathies,
abdominal pain
Dacarbazine (p. I: 200 mg Alkylating agent Nausea, vomiting, anorexia,
296) (DTIC) hepatic necrosis,
myelosuppression, alopecia,
rash, facial flushing,
photosensitivity, flu-like
symptoms, confusion, blurred
vision
Dasatinib (p. 309) T: 20 mg, 50 Tyrosine kinase Pyrexia, pleural effusion, febrile
(Sprycel) mg, 70 mg inhibitor neutropenia, GI bleeding,
pneumonia, thrombocytopenia,
dyspnea, anemia, cardiac
failure, diarrhea
Daunorubicin (p. I: 20 mg Anthracycline CHF, nausea, vomiting,
305) (Cerubidine) stomatitis, mucositis, diarrhea,
hematuria, myelosuppression,
alopecia, fever, chills,
abdominal pain
Daunorubicin I: 50 mg Anthracycline Nausea, diarrhea, abdominal
liposomal (p. 311) pain, anorexia, vomiting,
(DaunoXome) stomatitis, myelosuppression,
rigors, back pain, headaches,
neuropathy, depression,
dyspnea, fatigue, fever, cough,
allergic reactions, diaphoresis
Denileukin (p. I: 300 mcg/2 Miscellaneous Hypersensitivity reaction, back
323) (Ontak) ml pain, dyspnea, rash, chest pain,
tachycardia, asthenia (loss of
strength, energy), flu-like
symptoms, chills, nausea,
vomiting, infection
Docetaxel (p. 370) I: 20 mg, 80 Antimicrotubular Hypotension, nausea, vomiting,
(Taxotere) mg diarrhea, mucositis,
myelosuppression, rash,
paresthesia, hypersensitivity,
fluid retention, alopecia,
asthenia (loss of strength,
energy), stomatitis, fever
Doxorubicin (p. I: 10 mg, 20 Anthracycline Cardiotoxicity, including CHF;
385) (Adriamycin) mg, 50 mg, arrhythmias, nausea, vomiting,
75 mg, 150 stomatitis, esophagitis, GI
mg, 200 mg ulceration, diarrhea, anorexia,
hematuria, myelosuppression,
alopecia, hyperpigmentation of
nail beds and skin, localinflammation at injection site,Name Availability Category Side Effecs
rash, fever, chills, urticaria,
lacrimation, conjunctivitisDoxorubicin I: 20 mg, 50 Anthracycline Neutropenia, palmar-plantar
liposomal (p. 385) mg erythrodysesthesia syndrome,
(Doxil) cardiomyopathy, CHF
Enzalutamide C: 40 mg Antiandrogen Fatigue, weakness, back pain,
(Xtandi) diarrhea, tissue swelling,
musculoskeletal pain, headache,
upper respiratory tract
infections, blood in urine, spinal
cord compression
Epirubicin (p. 418) I: 2 mg/ml Anthracycline Anemia, leukopenia,
(Ellence) neutropenia, infection, mucositis
Erlotinib (p. 428) T: 25 mg, Tyrosine kinase Diarrhea, rash, nausea, vomiting
(Tarceva) 100 mg, 150 inhibitor
mg
Estramustine (p. C: 140 mg Alkylating agent Increased risk of thrombosis,
443) (Emcyt) gynecomastia, nausea, vomiting,
diarrhea, thrombocytopenia,
peripheral edema
Etoposide (p. 450) I: 20 mg/ml Podophyllotoxin Nausea, vomiting, anorexia,
(VePesid) C: 50 mg derivative myelosuppression, alopecia,
diarrhea, drowsiness, peripheral
neuropathies
Everolimus (p. T (Afinitor): mTOR kinase Stomatitis, infections, asthenia
454) (Afinitor, 5 mg, 10 mg inhibitor (loss of strength, energy),
Zortress) T (Zortress): fatigue, cough, diarrhea
0.25 mg, 0.5
mg, 0.75 mg
Exemestane (p. T: 25 mg Aromatase Dyspnea, edema, hypertension,
456) (Aromasin) inactivator mental depression
Fludarabine (p. I: 50 mg Antimetabolite Nausea, diarrhea, stomatitis,
488) (Fludara) bleeding, anemia,
myelosuppression, skin rash,
weakness, confusion, visual
disturbances, peripheral
neuropathy, coma, pneumonia,
peripheral edema, anorexia
Fluorouracil (p. I: 50 mg/ml Antimetabolite Nausea, vomiting, stomatitis, GI
493) (Adrucil, Cream: 1%, ulceration, diarrhea, anorexia,
Efudex) 5% myelosuppression, alopecia, skin
Solution: hyperpigmentation, nail
1%, 2%, 5% changes, headaches, drowsiness,
blurred vision, fever
Flutamide (p. 502) C: 125 mg Antiandrogen Hot flashes, nausea, vomiting,
(Eulexin) diarrhea, hepatitis, impotence,
decreased libido, rash, anorexia
Fulvestrant (p. I: 125 Estrogen Asthenia (loss of strength,521) (Faslodex) mg/2.5 ml, receptor energy), pain, headaches,Name Availability Catgory Side Effects
250 mg/5 ml antagonist injection site pain, flu-like
syringes symptoms, fever, nausea,
vomiting, constipation,
anorexia, diarrhea, peripheral
edema, dizziness, depression,
anxiety, rash, increased cough,
UTI
Gefitinib (p. 531) T: 250 mg Tyrosine kinase Diarrhea, rash, acne, nausea,
(Iressa) inhibitor dry skin, vomiting, pruritus,
anorexia
Gemcitabine (p. I: 200 mg, 1 Antimetabolite Increased hepatic function tests,
532) (Gemzar) g nausea, vomiting, diarrhea,
stomatitis, hematuria,
myelosuppression, rash, mild
paresthesia, dyspnea, fever,
edema, flu-like symptoms,
constipation
Goserelin (p. 550) I: 3.6 mg, Hormone Hot flashes, sexual dysfunction,
(Zoladex) 10.8 mg agonist erectile dysfunction,
gynecomastia, lethargy, pain,
lower urinary tract symptoms,
headaches, nausea, depression,
diaphoresis
Hydroxyurea (p. C: 500 mg Antimetabolite Anorexia, nausea, vomiting,
575) (Hydrea) stomatitis, diarrhea,
constipation, myelosuppression,
fever, chills, malaise
Ibritumomab (p. Injection kit Monoclonal Neutropenia, thrombocytopenia,
582) (Zevalin) antibody anemia, infection, asthenia (loss
of strength, energy), abdominal
pain, fever, pain, headaches,
nausea, peripheral edema,
allergic reaction, GI
hemorrhage, apnea
Idarubicin (p. 588) I: 5 mg, 10 Anthracycline CHF, arrhythmias, nausea,
(Idamycin PFS) mg, 20 mg vomiting, stomatitis,
myelosuppression, alopecia,
rash, urticaria, hyperuricemia,
abdominal pain, diarrhea,
esophagitis, anorexia
Ifosfamide (p. 590) I: 1 g, 3 g Alkylating agent Nausea, vomiting, hemorrhagic
(Ifex) cystitis, myelosuppression,
alopecia, lethargy, drowsiness,
confusion, hallucinations,
hematuria
Imatinib (p. 595) C: 100 mg Tyrosine kinase Nausea, fluid retention,
(Gleevec) inhibitor hemorrhage, musculoskeletal
pain, arthralgia, weight gain,
pyrexia, abdominal pain,
dyspnea, pneumoniaInterferon alfa-2b I: 3 million Miscellaneous Mild hypotension, hypertension,Name Availability Category Side Effects
(p. 616) (Intron-A) units, 5 tachycardia with high fever,
million nausea, diarrhea, altered taste,
units, 10 weight loss, thrombocytopenia,
million myelosuppression, rash,
units, 18 pruritus, myalgia, arthralgia
million associated with flu-like
units, 25 symptoms
million
units, 50
million units
Ipilimumab (p. I: 5 mg/ml Miscellaneous Fatigue, diarrhea, pruritus, rash,
625) (Yervoy) colitis
Irinotecan (p. 630) I: 40 mg, Camptothecin Diarrhea, nausea, vomiting,
(Camptosar) 100 mg abdominal cramps, anorexia,
stomatitis, increased AST, severe
myelosuppression, alopecia,
diaphoresis, rash, weight loss,
dehydration, increased serum
alkaline phosphatase,
headaches, insomnia, dizziness,
dyspnea, cough, asthenia (loss of
strength, energy), rhinitis, fever,
back pain, chills
Ixabepilone (p. I: 15 mg, 45 Antimicrotubular Peripheral sensory neuropathy,
645) (Ixempra) mg fatigue, myalgia, alopecia,
nausea, vomiting, stomatitis,
diarrhea, anorexia, abdominal
pain
Lapatinib (p. 665) T: 250 mg Tyrosine kinase Diarrhea, palmar-plantar
(Tykerb) inhibitor erythrodysesthesia, nausea, rash,
vomiting, fatigue
Letrozole (p. 672) T: 2.5 mg Aromatase Hypertension, nausea, vomiting,
(Femara) inhibitor constipation, diarrhea,
abdominal pain, anorexia, rash,
pruritus, musculoskeletal pain,
arthralgia, fatigue, headaches,
dyspnea, coughing, hot flashes
Leuprolide (p. I: 3.75 mg, 5 Hormone Hot flashes, gynecomastia,
676) (Lupron) mg, 7.5 mg, agonist nausea, vomiting, constipation,
11.25 mg, 15 anorexia, dizziness, headaches,
mg, 22.5 mg, insomnia, paresthesia, bone
30 mg pain
Lomustine (p. 703) C: 10 mg, 40 Alkylating agent Anorexia, nausea, vomiting,
(CeeNU) mg, 100 mg stomatitis, hepatotoxicity,
nephrotoxicity,
myelosuppression, alopecia,
confusion, slurred speech
Mechlorethamine I: 10 mg/ml Alkylating agent Severe nausea and vomiting,
(Mustargen) metallic taste, diarrhea,myelosuppression, alopecia,Name Availability Category Sid Effects
phlebitis, vertigo, tinnitus,
hyperuricemia, infertility,
azoospermia, anorexia,
headaches, drowsiness, feverMegestrol (p. 733) T: 20 mg, 40 Hormone Deep vein thrombosis,
Cushing(Megace) mg like syndrome, alopecia, carpal
Suspension: tunnel syndrome, weight gain,
40 mg/ml nausea
Melphalan (p. T: 2 mg Alkylating agent Anorexia, nausea, vomiting,
736) (Alkeran) myelosuppression, diarrhea,
stomatitis
Mercaptopurine T: 50 mg Antimetabolite Anorexia, nausea, vomiting,
(Purinethol) stomatitis, hepatic toxicity,
myelosuppression,
hyperuricemia, diarrhea, rash
Methotrexate (p. T: 2.5 mg, 5 Antimetabolite Nausea, vomiting, stomatitis, GI
753) (Rheumatrex) mg, 7.5 mg, ulceration, diarrhea, hepatic
10 mg, 15 toxicity, renal failure, cystitis,
mg myelosuppression, alopecia,
I: 5 mg, 50 urticaria, acne, photosensitivity,
mg, 100 mg, interstitial pneumonitis, fever,
200 mg, 250 malaise, chills, anorexia
mg
Mitomycin (p. I: 20 mg, 40 Antibiotic Anorexia, nausea, vomiting,
789) (Mutamycin) mg stomatitis, diarrhea, renal
toxicity, myelosuppression,
alopecia, pruritus, fever,
hemolytic uremic syndrome,
weakness
Mitotane T: 500 mg Miscellaneous Anorexia, nausea, vomiting,
(Lysodren) diarrhea, skin rashes,
depression, lethargy, drowsiness,
dizziness, adrenal insufficiency,
blurred vision, impaired hearing
Mitoxantrone (p. I: 20 mg, 25 Anthracenedione CHF, tachycardia, ECG changes,
791) (Novantrone) mg, 30 mg chest pain, nausea, vomiting,
stomatitis, mucositis,
myelosuppression, rash,
alopecia, urine discoloration
(bluish green), phlebitis,
diarrhea, cough, headaches,
fever
Nelarabine (p. I: 5 mg/ml Antimetabolite Anemia, neutropenia,
824) (Arranon) thrombocytopenia, nausea,
vomiting, diarrhea, fatigue,
fever, dyspnea, severe
neurologic events (convulsions,
peripheral neuropathy)
Nilotinib (p. 838) C: 200 mg Tyrosine kinase Rash, pruritus, nausea, fatigue,
(Tasigna) inhibitor headache, constipation,diarrhea, vomiting,Name Availability Category Side Effects
thrombocytopenia, neutropenia
Nilutamide (p. T: 50 mg Antiandrogen Hypertension, angina, hot
840) (Nilandron) flashes, nausea, anorexia,
increased hepatic enzymes,
dizziness, dyspnea, visual
disturbances, impaired
adaptation to dark,
constipation, decreased libido
Oxaliplatin (p. I: 50 mg, Alkylating agent Fatigue, neuropathy, abdominal
881) (Eloxatin) 100 mg pain, dyspnea, diarrhea, nausea,
vomiting, anorexia, fever,
edema, chest pain, anemia,
thrombocytopenia,
thromboembolism, altered
hepatic function tests
Paclitaxel (p. 893) I: 30 mg, Antimicrotubular Hypertension, bradycardia, ECG
(Taxol) 100 mg changes, nausea, vomiting,
diarrhea, mucositis,
myelosuppression, alopecia,
peripheral neuropathies,
hypersensitivity reaction,
arthralgia, myalgia
Panitumumab (p. I: 20 mg/ml Monoclonal Pulmonary fibrosis, severe
904) (Vectibix) antibody dermatologic toxicity, infusion
reactions, abdominal pain,
nausea, vomiting, constipation,
skin rash, fatigue
Pegaspargase I: 750 Miscellaneous Hypotension, anorexia, nausea,
(Oncaspar) international vomiting, hepatotoxicity,
units/ml pancreatitis, depression of
clotting factors, malaise,
confusion, lethargy, EEG
changes, respiratory distress,
hypersensitivity reaction, fever,
hyperglycemia, stomatitis
Pemetrexed (p. I: 500 mg Antimetabolite Anorexia, constipation, diarrhea,
922) (Alimta) neuropathy, anemia, chest pain,
dyspnea, rash, fatigue
Pentostatin I: 10 mg Antibiotic Nausea, vomiting, hepatic
(Nipent) disorders, elevated hepatic
function tests, leukopenia,
anemia, thrombocytopenia,
rash, fever, upper respiratory
infection, fatigue, hematuria,
headaches, myalgia, arthralgia,
diarrhea, anorexia
Pertuzumab (p. I: 420 HERZ/neu Alopecia, diarrhea, nausea,
935) (Perjeta) mg/14 ml receptor neutropenia, rash, fatigue,
antagonist peripheral neuropathyProcarbazine (p. C: 50 mg Alkylating agent Nausea, vomiting, stomatitis,Name Availability Category Side Effects
984) (Matulane) diarrhea, constipation,
myelosuppression, pruritus,
hyperpigmentation, alopecia,
myalgia, paresthesia, confusion,
lethargy, mental depression,
fever, hepatic toxicity,
arthralgia, respiratory disorders
Rituximab (p. I: 100 mg, Monoclonal Hypotension, arrhythmias,
1047) (Rituxan) 500 mg antibody peripheral edema, nausea,
vomiting, abdominal pain,
leukopenia, thrombocytopenia,
neutropenia, rash, pruritus,
urticaria, angioedema, myalgia,
headaches, dizziness, throat
irritation, rhinitis,
bronchospasm, hypersensitivity
reaction
Sipuleucel-T I: Minimum Miscellaneous Chills, fatigue, fever, back pain,
(Provenge) of 50 million nausea, headache, joint ache
autologous
+CD54 cells
in lactated
Ringer’s
Sorafenib (p. T: 200 mg Tyrosine kinase Fatigue, alopecia, nausea,
1099) (Nexavar) inhibitor vomiting, anorexia,
constipation, diarrhea,
neuropathy, dyspnea, cough,
asthenia (loss of strength,
energy), pain
Streptozocin I: 1 g Alkylating agent May lead to insulin-dependent
(Zanosar) diabetes, nausea, vomiting,
nephrotoxicity, renal tubular
acidosis, myelosuppression,
lethargy, diarrhea, confusion,
depression
Sunitinib (p. 1117) C: 12.5 mg, Tyrosine kinase Hypotension, edema, fatigue,
(Sutent) 25 mg, 50 inhibitor headache, fever, dizziness, rash,
mg hyperpigmentation, diarrhea,
nausea, dyspepsia, altered taste,
vomiting, neutropenia,
thrombocytopenia, increased
ALT/AST
Tamoxifen (p. T: 10 mg, 20 Estrogen Skin rash, nausea, vomiting,
1122) (Nolvadex- mg receptor anorexia, menstrual
D) antagonist irregularities, hot flashes,
pruritus, vaginal discharge or
bleeding, myelosuppression,
headaches, tumor or bone pain,
ophthalmic changes, weight
gain, confusion
Temozolomide (p. C: 5 mg, 20 Alkylating agent Amnesia, fever, infection,1136) (Temodar) mg, 100 mg, leukopenia, neutropenia,Name Availability Category Side Effects
250 mg peripheral edema, seizures,
thrombocytopenia
Temsirolimus (p. I: 25 mg/ml mTOR kinase Rash, asthenia (loss of strength,
1137) (Torisel) inhibitor energy), mucositis, nausea,
edema, anorexia,
thrombocytopenia, leukopenia
Teniposide I: 50 mg/5 Miscellaneous Hypotension with rapid
(Vumon) ml infusion, diarrhea, nausea,
vomiting, mucositis,
myelosuppression, alopecia,
anemia, rash, hypersensitivity
reaction
Thioguanine T: 40 mg Antimetabolite Anorexia, stomatitis,
(Tabloid) myelosuppression,
hyperuricemia, nausea,
vomiting, diarrhea
Thiotepa (p. 1159) I: 15 mg Alkylating agent Anorexia, nausea, vomiting,
(Thioplex) mucositis, myelosuppression,
amenorrhea, reduced
spermatogenesis, fever,
hypersensitivity reactions, pain
at injection site, headaches,
dizziness, alopecia
Topotecan (p. I: 4 mg Camptothecin Nausea, vomiting, diarrhea,
1189) (Hycamtin) constipation, abdominal pain,
stomatitis, anorexia,
neutropenia, leukopenia,
thrombocytopenia, anemia,
alopecia, headaches, dyspnea,
paresthesia
Toremifene (p. T: 60 mg Estrogen Elevated hepatic function tests,
1191) (Fareston) receptor nausea, vomiting, constipation,
antagonist skin discoloration, dermatitis,
dizziness, hot flashes,
diaphoresis, vaginal discharge or
bleeding, ocular changes,
cataracts, anxiety
Tositumomab (p. I: 14 mg/ml Monoclonal Headaches, rash, pruritus,
1194) (Bexxar) antibody abdominal pain, anorexia,
diarrhea, nausea, vomiting,
arthralgia, myalgia, cough,
dyspnea, asthenia (loss of
strength, energy), chills, fever,
infection
Trastuzumab (p. I: 440 mg Monoclonal CHF, heart murmur (S gallop),3
1201) (Herceptin) antibody nausea, vomiting, diarrhea,
abdominal pain, anorexia, rash,
peripheral edema, back or bone
pain, asthenia (loss of strength,
energy), headaches, insomnia,dizziness, cough, dyspnea,Name Availability Category Side Effects
rhinitis, pharyngitis
Tretinoin (p. C: 10 mg Miscellaneous Flushing, nausea, vomiting,
1206) (Vesanoid) diarrhea, constipation,
dyspepsia, mucositis,
leukocytosis, dry skin/mucous
membranes, rash, pruritus,
alopecia, dizziness, anxiety,
insomnia, headaches,
depression, confusion,
intracranial hypertension,
agitation, dyspnea, shivering,
fever, visual changes, earaches,
hearing loss, bone pain,
myalgia, arthralgia
Valrubicin I: 200 mg/5 Anthracycline Dysuria, hematuria, urinary
(Valstar) ml frequency/incontinence/urgency
Vandetanib (p. T: 100 mg, Tyrosine kinase Diarrhea, rash, acne, nausea,
1229) (Caprelsa) 300 mg inhibitor hypertension, headache, fatigue,
decreased appetite, abdominal
pain
Vinblastine (p. I: 10 mg Vinca alkaloid Nausea, vomiting, stomatitis,
1243) (Velban) constipation, myelosuppression,
alopecia, peripheral neuropathy,
loss of deep tendon reflexes,
paresthesia, diarrhea
Vincristine (p. I: 1 mg, 2 Vinca alkaloid Nausea, vomiting, stomatitis,
1245) (Oncovin) mg, 3 mg constipation, pharyngitis,
polyuria, myelosuppression,
alopecia, numbness, paresthesia,
peripheral neuropathy, loss of
deep tendon reflexes, headaches,
abdominal pain
Vincristine I: 5 mg/31 Vinca alkaloid Constipation, nausea, pyrexia,
liposomal ml fatigue, peripheral neuropathy,
(Marqibo) febrile neutropenia, diarrhea,
anemia, reduced appetite,
insomnia
Vinorelbine (p. I: 10 mg, 50 Vinca alkaloid Elevated hepatic function tests,
1247) (Navelbine) mg nausea, vomiting, constipation,
ileus, anorexia, stomatitis,
myelosuppression, alopecia,
vein discoloration, venous pain,
phlebitis, interstitial pulmonary
changes, asthenia (loss of
strength, energy), fatigue,
diarrhea, peripheral neuropathy,
loss of deep tendon reflexes
Vismodegib (p. C: 150 mg Hedgehog Alopecia, muscle spasms,
1250) (Erivedge) pathway dysgensia, weight loss, fatigue,
inhibitor nausea, diarrhea, reducedappetite, vomiting, arthralgiaName Availability Category Side Effcts
Vorinostat (p. C: 100 mg Histone Diarrhea, fatigue, nausea,
1260) (Zolinza) deacetylase thrombocytopenia, anorexia,
inhibitor dysgeusia
ziv-aflibercept I: 25 mg/ml Miscellaneous Leukopenia, neutropenia,
(Zaltrap) diarrhea, proteinuria, increased
ALT/AST, stomatitis,
thrombocytopenia,
hypertension, epistaxis,
headache, abdominal pain
C , Capsules; I , injection; T , tablets.

Cholinergic Agonists/Anticholinesterase
USES
Paralytic ileus and atony of urinary bladder. Myasthenia gravis (weakness, marked
fatigue of skeletal muscle). Terminates, reverses e%ects of neuromuscular blocking
agents.
ACTION
Cholinergic agonists: Referred to as muscarinics or parasympathetics and consist of two
basic drug groups: choline esters and cholinomimetic alkaloids. Primary action mimics
actions of acetylcholine at postganglionic parasympathetic nerves. Primary properties
include the following:
Cardiovascular system: Vasodilation; decreased cardiac rate; decreased conduction in SA,
AV nodes; decreased force of myocardial contraction.
Gastrointestinal: Increased tone, motility of GI smooth muscle, increased secretory
activity of GI tract.
Urinary tract: Increased contraction of detrusor muscle of urinary bladder, resulting in
micturition.
Eye: Miosis, contraction of ciliary muscle.
Anticholinesterase (anti-ChE), also known as cholinesterase inhibitors: Inactivates
cholinesterase, which prevents acetylcholine breakdown, causing acetylcholine to
accumulate at cholinergic receptor sites. These agents can be considered indirect-acting
cholinergic agonists. Primary properties include action of cholinergic agonists just
noted.
Skeletal neuromuscular junction: E%ects are dose dependent. At therapeutic doses,
increases force of skeletal muscle contraction; at toxic doses, reduces muscle strength.
CHOLINERGIC AGONISTS/ANTICHOLINESTERASE
Name Availability Uses Dosage Range Side Effects
Bethanechol T: 5 mg, 10 Nonobstructive PO: 10–50 mg Increased urinary
(p. 128) mg, 25 mg, urinary retention 3–4 times/day frequency,
(Urecholine) 50 mg Subcutaneous: salivation,
2.5–5 mg 3–4 belching, nausea,
times/day dizziness, diarrhea
Edrophonium I: 10 Diagnosis of IV: 10 mg over Bradycardia,
(Tensilon) mg/ml myasthenia gravis, 30 sec up to 40 nausea, vomiting,reverses mg diarrhea, urinaryName Availability Uses Dosage Range Side Effects
tubocurarine frequency
Neostigmine T: 15 mg Symptomatic PO: 15–365 Diarrhea,
(p. 826) I: 0.25 control of mg/day diaphoresis,
(Prostigmin) mg/ml, 0.5 myasthenia gravis, Subcutaneous, nausea, vomiting,
mg/ml, 1 neuromuscular IM: 0.5 mg abdominal cramps
mg/ml blocker IV: 0.5–2 mg
Pyridostigmine T: 60 mg Treats myasthenia PO: 60–1,500 Diarrhea,
(p. 1004) T (ER): gravis, reverses mg/day diaphoresis,
(Mestinon) 180 mg tubocurarine IM: 0.5–1.5 nausea, vomiting,
S: 60 mg/5 mg/kg abdominal cramps
ml IV: 0.1–0.25
I: 5 mg/ml mg/kg
E R , Extended-release; I , injection; S , suspension; T , tablets.

Contraception
ACTION
Combination oral contraceptives decrease fertility primarily by inhibition of ovulation.
In addition, they can promote thickening of the cervical mucus, thereby creating a
physical barrier for the passage of sperm. Also, they can modify the endometrium,
making it less favorable for nidation.
CLASSIFICATION
Oral contraceptives either contain both an estrogen and a progestin (combination oral
contraceptives) or contain only a progestin (progestin-only oral contraceptives). The
combination oral contraceptives have three subgroups:
Monophasic: Daily estrogen and progestin dosage remains constant.
Biphasic: Estrogen remains constant, but the progestin dosage increases during the
second half of the cycle.
Triphasic: Progestin changes for each phase of the cycle.
Over the past several years, options have expanded to include a combined hormonal
patch (Ortho Evra), vaginal ring (NuvaRing), and extended cycle contraceptives (e.g.,
Loestrin-24 FE, Seasonale, Seasonique, Yaz). The latest oral contraceptive, Natazia, is a
four-phase dosing regimen (estradiol steps down and dienogest, a progestin, steps up
during the cycle to help avoid breakthrough bleeding).
COMMON COMPLAINTS WITH ORAL CONTRACEPTIVES
Too Nausea, bloating, breast tenderness, increased B/P, melasma, headache
much
estrogen
Too little Early or midcycle breakthrough bleeding, increased spotting,
estrogen hypomenorrhea
Too Breast tenderness, headache, fatigue, changes in mood
muchprogestin
Too little Late breakthrough bleeding
progestin
Too Increased appetite, weight gain, acne, oily skin, hirsutism, decreased libido,
much increased breast size, breast tenderness, increased LDL cholesterol,
androgen decreased HDL cholesterol
CONTRACEPTIVES
Name Estrogen Content Progestin Content
Low-Dose Monophasic Pills
Aviane-28 EE 20 mcg Levonorgestrel 0.1 mg
Lessina
Lutera
Sronyx
Junel 1/20 EE 20 mcg Norethindrone 1 mg
Junel Fe 1/20
Loestrin Fe 1/20
Microgestin Fe 1/20
Levora EE 30 mcg Levonorgestrel 0.15 mg
Nordette-28
Portia-28
Cryselle-28 EE 30 mcg Norgestrel 0.3 mg
Lo/Ovral-28
Low-Ogestrel-21, -28
Junel 1.5/30 EE 30 mcg Norethindrone acetate 1.5 mg
Junel Fe 1.5/30
Loestrin Fe 1.5/30
Microgestin 1.5/30
Microgestin Fe
1.5/30
Apri EE 30 mcg Desogestrel 0.15 mg
Desogen
Ortho-Cept
Reclipsen
Solia
Yasmin EE 30 mcg Drospirenone 3 mg
Ocella
Kelnor 1/35 EE 35 mcg Ethynodiol diacetate 1 mg
Zovia 1/35
Ortho-Cyclen-28 EE 35 mcg Norgestimate 0.25 mg
Mononessa
Previfem
Sprintec
Necon 1/50 Mestranol 50 mcg Norethindrone 1 mg
Norinyl 1+50
Balziva EE 35 mcg Norethindrone 0.4 mg
Femcon FeOvcon-35Name Estrogen Content Progestin Content
Zenchent
Brevicon-28 EE 35 mcg Norethindrone 0.5 mg (total
Modicon-28 of 10.5 mg/cycle)
Necon 0.5/35
Nortrel 0.5/35
Necon 1/35-28 EE 35 mcg Norethindrone 1 mg (total of
Norinyl 1+35-28 21 mg/cycle)
Nortrel 1/35-28
Ortho-Novum
1/3528
High-Dose Monophasic Pills
Zovia 1/50-28 EE 50 mcg Ethynodiol diacetate 1 mg
Ogestrel 0.5/50-28 EE 50 mcg Norgestrel 0.5 mg
Ovcon-50 EE 50 mcg Norethindrone 1 mg
Biphasic Pills
Azurette EE 20 mcg × 21 days, placebo Desogestrel 0.15 mg × 21
Kariva × 2 days, 10 mcg × 5 days days
Mircette
Necon 10/11 EE 35 mcg Norethindrone 0.5 mg × 10
days, 1 mg × 11 days
Triphasic Pills
Estrostep Fe EE 20 mcg × 5 days, 30 mcg × Norethindrone 1 mg × 21
Tilia 7 days, 35 mcg × 9 days days
Tilia Fe
Tri-Legest Fe
Ortho Tri-Cyclen Lo EE 25 mcg × 21 days Norgestimate 0.18 mg × 7
Tri Lo Spriutec days, 0.215 mg × 7 days,
0.25 mg × 7 days
Caziant EE 25 mcg × 21 days Desogestrel 0.1 mg × 7 days,
Cesia 0.125 mg × 7 days, 0.15 mg
Cyclessa × 7 days
Velivet
Enpresse EE 30 mcg × 6 days, 40 mcg × Levonorgestrel 0.05 mg × 6
Trivora 5 days, 30 mcg × 10 days days, 0.075 mg × 5 days,
0.125 mg × 10 days
Ortho Tri-Cyclen EE 35 mcg × 21 days Norgestimate 0.18 mg × 7
Trinessa days, 0.215 mg × 7 days,
Tri-Previfem 0.25 mg × 7 days
Tri-Sprintec
Aranelle EE 35 mcg × 21 days Norethindrone 0.5 mg × 7
Leena days, 1 mg × 9 days, 0.5 mg
Tri-Norinyl × 5 days
Ortho-Novum 7/7/7 EE 35 mcg × 21 days Norethindrone 0.5 mg × 7
Nortrel 7/7/7 days, 0.75 mg × 7 days, 1 mg
Necon 7/7/7 × 7 daysFour PhasicName Estrogen Content Progestin Content
Natazia Estradiol 3 mg × 2 days, then 2 Dienogest none × 2 days,
mg × 22 days, then 1 mg × 2 then 2 mg × 5 days, then 3
days, then 2-day pill-free mg × 17 days, then none for
interval 4 days
Extended-Cycle Pills
Loestrin-24 FE EE 20 mcg × 24 days Norethindrone 1 mg × 24
days
Jolessa EE 30 mcg × 84 days Levonorgestrel 0.15 mg × 84
Quasense days
Seasonale
Seasonique EE 30 mcg × 84 days, 10 mcg Levonorgestrel 0.15 mg × 84
× 7 days days
Yaz EE 20 mcg × 24 days Drospirenone 3 mg × 24 days
Gianvi
Continuous Cycle Pill
Lybrel EE 20 mcg Levonorgestrel 90 mcg
Progestin-Only Pills
Camilia N/A Norethindrone 0.35 mg
Errin
Jolivette
Micronor
Nor-QD
Nora-BE
Emergency Contraception
Plan B N/A Levonorgestrel 0.75-mg
Next Choice tablets taken 12 hrs apart
Ella (Ulipristal) N/A Ulipristal 30 mg one time
within 5 days after
unprotected intercourse
Hormonal Alternative to Oral Contraception
Depo-Provera Cl None Medroxyprogesterone 150 mg
Medroxyprogesterone
Acetate
Depo-SubQ Provera None Medroxyprogesterone 104 mg
104
Implanon None Etonogestrel (release rate
varies over time)
Mirena None Levonorgestrel 20 mcg/day
for 5 yrs
NuvaRing Ethinyl estradiol 15 mcg/day Etonogestrel 0.12 mg/day
Ortho Evra Ethinyl estradiol 20 mcg/day Norelgestromin 150 mcg/day

Corticosteroids
USES
Replacement therapy in adrenal insuN ciency, including Addison’s disease.
Symptomatic treatment of multiorgan disease/conditions. Rheumatoid arthritis (RA),
osteoarthritis, severe psoriasis, ulcerative colitis, lupus erythematosus, anaphylactic
shock, acute exacerbation of asthma, status asthmaticus, organ transplant.
ACTION
Suppress migration of polymorphonuclear leukocytes (PML) and reverse increased
capillary permeability by their anti-in ammatory e%ect. Suppress immune system by
decreasing activity of lymphatic system.
CORTICOSTEROIDS
Name Availability Route of Side Effects
Administration
Beclomethasone (p. Inhalation, Inhalation, I: Cough, dry mouth/throat,
113) (Beconase) nasal: 42 intranasal headaches, throat irritation,
mcg/spray, 84 increased blood glucose
mcg/spray Nasal: Headaches, sore throat,
intranasal ulceration, increased
blood glucose
Betamethasone (p. I: 4 mg/ml IV, Nausea, vomiting, increased
126) (Celestone, intralesional, appetite, weight gain,
Diprolene) intra-articular insomnia, increased blood
glucose
Budesonide (p. 152) Nasal: 32 Intranasal Headaches, sore throat,
(Pulmicort, mcg/spray intranasal ulceration, increased
Rhinocort) blood glucose
Cortisone (p. 281) T: 5 mg, 10 PO Insomnia, nervousness,
(Cortone) mg, 25 mg increased appetite, indigestion,
increased blood glucose
Dexamethasone (p. T: 0.5 mg, 1 PO, parenteral Insomnia, weight gain,
332) (Decadron) mg, 4 mg, 6 increased appetite, increased
mg blood glucose
OS: 0.5 mg/5
ml
I: 4 mg/ml
Fludrocortisone T: 0.1 mg PO Edema, headache, peptic ulcer,
(Florinef) increased blood glucose
Flunisolide (p. 492) Inhalation, Inhalation, Headache, nasal congestion,
(Nasalide) nasal: 25 intranasal pharyngitis, upper respiratory
mcg/spray infections, altered taste/smell,
increased blood glucose
Fluticasone (p. 503) Inhalation: Inhalation, Headache, burning/stinging,
(Flonase, Flovent) 44 mcg, 110 intranasal nasal congestion, upper
mg, 220 mcg respiratory infections,




Nasal: 50 mg, increased blood glucoseName Availability Route of Side Effects
100 mcg Administration
Hydrocortisone (p. T: 5 mg, 10 PO, parenteral Insomnia, headache, nausea,
568) (Solu-Cortef) mg, 25 mg vomiting, increased blood
I: 100 mg, 250 glucose
mg, 500 mg, 1
g
Methylprednisolone T: 4 mg PO, parenteral Headache, insomnia,
(p. 760) (Solu- I: 40 mg, 125 nervousness, increased
Medrol) mg, 500 mg, 1 appetite, nausea, vomiting,
g, 2 g increased blood glucose
Prednisolone (p. T: 5 mg PO Headache, insomnia, weight
975) (Prelone) OS: 5 mg/5 ml, gain, nausea, vomiting,
15 mg/5 ml increased blood glucose
Prednisone (p. 976) T: 1 mg, 2.5 PO Headache, insomnia, weight
mg, 5 mg, 10 gain, nausea, vomiting,
mg, 20 mg, 50 increased blood glucose
mg
Triamcinolone (p. T: 4 mg, 8 mg PO, inhalation PO: Insomnia, increased
1208) (Kenalog) Inhalation: appetite, nausea, vomiting,
100 mcg increased blood glucose
I: Cough, dry mouth/throat,
headaches, throat irritation,
increased blood glucose
I , Injection; O S , oral suspension; T , tablets.

Corticosteroids: Topical
USES
Provide relief of in ammation/pruritus associated with corticosteroid-responsive
disorders (e.g., contact dermatitis, eczema, insect bite reactions, Orst- and
seconddegree localized burns/sunburn).
ACTION
Di%use across cell membranes, form complexes with cytoplasm. Complexes stimulate
protein synthesis of inhibitory enzymes responsible for anti-in ammatory e%ects (e.g.,
inhibit edema, erythema, pruritus, capillary dilation, phagocytic activity).
Topical corticosteroids can be classified based on potency:
May use for facial and intertriginous application for only limited time.
High potency: For more severe in ammatory conditions (e.g., lichen simplex chronicus,
psoriasis). May use for facial and intertriginous application for short time only. Used in
areas of thickened skin due to chronic conditions.
Low potency: Modest anti-in ammatory e%ect, safest for chronic application, facial and
intertriginous application, with occlusion, for infants/young children.
Medium potency: For moderate in ammatory conditions (e.g., chronic eczematous
dermatoses).
Very high potency: Alternative to systemic therapy for local e%ect (e.g., chronic lesionscaused by psoriasis). Increased risk of skin atrophy. Used for short periods on small
areas. Avoid occlusive dressings.
CORTICOSTEROIDS: TOPICAL
Name Availability Potency Side Effects
Alclometasone C, O: Low Skin atrophy, contact dermatitis, stretch
(Aclovate) 0.05% marks on skin, enlarged blood vessels in the
skin, hair loss, pigment changes, secondary
infections
Amcinonide C, O, L: High Same as alclometasone
(Cyclocort) 0.1%
Betamethasone C, O, G, L: High Same as alclometasone
dipropionate (p. 0.05%
126)
Betamethasone C: 0.01%, High Same as alclometasone
valerate (p. 126) 0.05%,
0.1%
O: 0.1%
L: 0.1%
Clobetasol C, O: High Same as alclometasone
(Temovate) 0.05%
Desonide C, O, L: Low Same as alclometasone
(Tridesilon) 0.05%
Desoximetasone C: 0.25%, High Same as alclometasone
(Topicort) 0.5%
O: 0.25%
G: 0.05%
Dexamethasone C: 0.1% Medium Same as alclometasone
(p. 332)
(Decadron)
Fluocinolone C: 0.01%, High Same as alclometasone
(Synalar) 0.025%,
0.2%
O: 0.025%
Fluocinonide C, O, G: High Same as alclometasone
(Lidex) 0.05%
Flurandrenolide C, O, L: Medium Same as alclometasone
(Cordran) 0.025%,
0.05%
Fluticasone (p. C: 0.05% Medium Same as alclometasone
503) (Cutivate) O: 0.005%
Halobetasol C, O: High Same as alclometasone
(Ultravate) 0.05%
Hydrocortisone C, O: 0.5%, Medium Same as alclometasone
(p. 568) 1%, 2.5%
(Hytone)Mometasone (p. C, O, L: Medium Same as alclometasoneNae Availability Potencyide Effects
794) (Elocon) 0.1%
Prednicarbate C: 0.1% — Same as alclometasone
(Dermatop)
Triamcinolone C, O, L: Medium Same as alclometasone
(p. 1208) 0.025%,
(Aristocort, 0.1%, 0.5%
Kenalog)
C , Cream; G , gel; L , lotion; O , ointment.'
Diuretics
USES
T h i a z i d e s : Management of edema resulting from a number of causes (e.g., CHF, hepatic
cirrhosis); hypertension either alone or in combination with other antihypertensives.
L o o p : Management of edema associated with CHF, cirrhosis of the liver, and renal
disease. Furosemide used in treatment of hypertension alone or in combination with
other antihypertensives.
P o t a s s i u m - s p a r i n g : Adjunctive treatment with thiazides, loop diuretics in treatment of
CHF and hypertension.
ACTION
Act to increase the excretion of water/sodium and other electrolytes via the kidneys.
Exact mechanism of antihypertensive e ect unknown; may be due to reduced plasma
volume or decreased peripheral vascular resistance. Subclassi) cations of diuretics are
based on their mechanism and site of action.
T h i a z i d e s : Act at the cortical diluting segment of nephron, block reabsorption of Na, Cl,
and water; promote excretion of Na, Cl, K, and water. L o o p : Act primarily at the thick
ascending limb of Henle’s loop to inhibit Na, Cl, and water absorption.
P o t a s s i u m - s p a r i n g : Spironolactone blocks aldosterone action on distal nephron (causes K
retention, Na excretion). Triamterene, amiloride act on distal nephron, decreasing Na
reuptake, reducing K secretion.
DIURETICS
Name Availability Dosage Range Side Effects
Thiazide, Thiazide-related
Chlorothiazide T: 250 mg, 0.5–1 g 1–2 Confusion, fatigue, muscle
(Diuril) 500 mg times/day cramps, abdominal discomfort
S: 250 mg/5
ml
I: 500 mg
Chlorthalidone T: Thalitone: 25–200 Same as chlorothiazide
(Thalitone, 15 mg mg/day
Hygroton) Hygroton: 25
mg, 50 mg
Hydrochlorothiazide T: 25 mg, 50 25–100 Orthostatic hypotension,
(p. 564) mg mg/day photosensitivity, hypokalemia,
(HydroDIURIL) C: 12.5 mg anorexia, epigastric distress,
increased blood glucose
Indapamide (p. 605) T: 1.25 mg, 1.25–5 Loss of appetite, diarrhea,
(Lozol) 2.5 mg mg/day headaches, dizziness,
lightheadedness, insomnia, upset
stomach
Metolazone (p. 765) T: 2.5 mg, 5 2.5–20 Orthostatic hypotension,
(Zaroxolyn) mg, 10 mg mg/day dizziness, hypokalemia, nausea,
diarrhea, abdominal pain
Loop
Bumetanide (p. 154) T: 0.5 mg, 1 Edema: 1–10 Orthostatic hypotension,(Bumex) mg, 2 mg mg/day cramps or pain, hypokalemiaNae Availability Dosage Range Side Effects
I: 0.25 mg/ml (dry mouth, fatigue, muscle
cramps), blurred vision,
headaches
Furosemide (p. 522) T: 20 mg, 40 HTN: 20–40 Orthostatic hypotension,
(Lasix) mg, 80 mg mg/day cramps or pain, hypokalemia
OS: 10 Edema: Up to (dry mouth, fatigue, muscle
mg/ml, 40 600 mg/day cramps), blurred vision,
mg/5 ml headaches
I: 10 mg/ml
Torsemide (p. 1192) T: 5 mg, 10 Edema: 10– Constipation, dizziness, upset
(Demadex) mg, 20 mg, 200 mg/day stomach, headache,
100 mg HTN: 5–10 hypokalemia (dry mouth,
I: 10 mg/ml mg/day fatigue, muscle cramps)
Potassium-sparing
Amiloride T: 5 mg 5–20 mg/day Hyperkalemia, nausea,
(Midamor) abdominal pain, diarrhea
Eplerenone (p. 420) T: 25 mg, 50 Heart Hyperkalemia,
(Inspra) mg Failure: 25–50 hypertriglyceridemia
mg/day
HTN: 50–100
mg/day
Spironolactone (p. T: 25 mg, 50 Edema: 100 Hyperkalemia, nausea,
1102) (Aldactone) mg, 100 mg mg/day vomiting, abdominal cramps,
HTN: 50–200 diarrhea
mg/day
Hypokalemia:
25–100
mg/day
Heart
Failure: 25–50
mg/day
Triamterene (p. C: 50 mg, 100 Edema: 100– Same as amiloride
1210) (Dyrenium) mg 300 mg/day
C , Capsules; H T N , hypertension; I , injection; O S , oral solution; S , suspension; T , tablets.Fertility Agents
Infertility is defined as unsuccessful conception after 12 months of attempting to
conceive, as opposed to sterility, the inability to reproduce. Infertility may be due to
reproduction dysfunction of the male, female, or both.
Female infertility can be due to disruption of any phase of the reproductive process.
The most critical phases include follicular maturation, ovulation, transport of the ovum
through the fallopian tubes, fertilization of the ovum, nidation, and
growth/development of the conceptus. Causes of infertility include the following:
Anovulation, failure of follicular maturation: Absence of adequate hormonal stimulation;
ovarian follicles do not ripen, and ovulation will not occur.
Unfavorable cervical mucus: Normally the cervical glands secrete large volumes of thin,
watery mucus, but if the mucus is unfavorable (scant, thick, or sticky), sperm is unable
to pass through to the uterus.
Hyperprolactinemia: Excessive prolactin secretion may cause amenorrhea, galactorrhea,
and infertility.
Luteal phase defect: Progesterone secretion by the corpus luteum is insu, cient to
maintain endometrial integrity.
Endometriosis: Endometrial tissue is implanted in abnormal locations (e.g., uterine wall,
ovary, extragenital sites).
Androgen excess: May decrease fertility (most common condition is polycystic ovary).
Male infertility is due to decreased density or motility of sperm or semen of abnormal
volume or quality. The most obvious manifestation of male infertility is impotence
(inability to achieve erection). Whereas in female infertility an identi/ able endocrine
disorder can be found, most cases of male infertility are not associated with an
identifiable endocrine disorder.
ACTION
Antiestrogens: Nonsteroidal estrogen antagonist that increases follicle-stimulating
hormone (FSH) and leutinizing hormone (LH) levels by blocking estrogen-negative
feedback at the hypothalamus.
Gonadotropins: Produce ovulation induction in women with hypogonadotropic
hypogonadism and polycystic ovary syndrome (PCOS). Ovaries must be able to respond
normally to FSH and LH stimulation.
Gonadotropin-releasing hormone (GnRH) agonists: Causes down-regulation of endogenous
FSH and LH levels. GnRH agonists stimulate release of pituitary gonadotropins.
Suppression of endogenous LH can decrease number of oocytes released prematurely,
improve oocyte quality, and increase pregnancy rates.
Gonadotropin-releasing hormone (GnRH) antagonists: Suppress endogenous LH surges
during ovarian stimulation. GnRH antagonists avoid initial 7are-up seen with GnRH
agonists, shortening the number of days needed for LH suppression and allowing
ovarian stimulation to begin within the spontaneous cycle.
MEDICATIONS TO INDUCE OVULATION
Name Category Availability Uses Side Effects
Cetrorelix GnRH I: 0.25 mg, 3 Inhibition of OHSS (ovarian
(Cetrotide) antagonist mg premature LH hyperstimulation
surges in women syndrome):
undergoing ovarian Abdominal pain,
hyperstimulation indigestion, bloating,
decreased urinaryoutput, nausea,Name Category Availability Uses Side Effects
vomiting, diarrhea,
rapid weight gain,
shortness of breath,
peripheral/dependent
edema; headaches,
pain/redness at
injection site, mood
swings, hot flashes,
insomnia, vaginal
dryness
Chorionic Gonadotropin I: 5,000 In conjunction with OHSS (ovarian
gonadotropin units, 10,000 clomiphene, human hyperstimulation
(p. 236) units, 20,000 menotropins or syndrome):
(Novarel, units urofolitropin to Abdominal pain,
Ovidrel, stimulate ovulation indigestion, bloating,
Pregnyl) decreased urinary
output, nausea,
vomiting, diarrhea,
rapid weight gain,
shortness of breath,
peripheral/dependent
edema; ovarian
enlargement, ovarian
cyst formation,
headache, pain at
injection site
Clomiphene Antiestrogen T: 50 mg Anovulation, oligo- Ovarian cyst
(Clomid, ovulation with formation, ovarian
Milophene, intact enlargement, visual
Serophene) pituitary/ovarian disturbances,
response and premenstrual
endogenous syndrome, hot
estrogen flashes, headaches,
blurred vision,
nausea, breast
tenderness
Follitropin Gonadotropin I: 37.5 In conjunction with OHSS (ovarian
alpha (Gonal- international human chorionic hyperstimulation
F) units FSH, 75 gonadotropin to syndrome):
international stimulate ovarian Abdominal pain,
units FSH, follicular indigestion, bloating,
150 development in pts decreased urinary
international with ovulatory output, nausea,
units FSH dysfunction not due vomiting, diarrhea,
to primary ovarian rapid weight gain,
failure (e.g., shortness of breath,
anovulation, oligo- peripheral/dependent
ovulation) edema; flu-like
symptoms, upper
respiratory tract
infections, bleeding
between menstrual
periods, nausea,ovarian enlargement,Name Category Availability Uses Side Effects
ovarian cysts, acne,
breast
pain/tenderness,
mood swings
Follitropin Gonadotropin I: 75 In conjunction with OHSS (ovarian
beta international human chorionic hyperstimulation
(Follistim AQ) units FSH gonadotropin to syndrome):
stimulate ovarian Abdominal pain,
follicular indigestion, bloating,
development in decreased urinary
patients with output, nausea,
ovulatory vomiting, diarrhea,
dysfunction not due rapid weight gain,
to primary ovarian shortness of breath,
failure (e.g., peripheral/dependent
anovulation, oligo- edema; flu-like
ovulation) symptoms, breast
tenderness, dry skin,
rash, dizziness, fever,
headaches, nausea,
fatigue, mood swings
Ganirelex GnRH I: 250 Inhibition of OHSS (ovarian
(Antagon) antagonist mcg/0.5 ml premature LH hyperstimulation
surges in women syndrome):
undergoing ovarian Abdominal pain,
hyperstimulation indigestion, bloating,
decreased urinary
output, nausea,
vomiting, diarrhea,
rapid weight gain,
shortness of breath,
peripheral/dependent
edema; headaches,
nausea, pain/redness
at injection site,
mood swings, hot
flashes, insomnia,
vaginal dryness
Goserelin (p. GnRH agonist Implant: 3.6 Endometriosis, Hot flashes,
550) mg, 10.8 mg adjunct to amenorrhea, blurred
(Zoladex) menotropins for vision, edema,
ovulation induction headaches, nausea,
vomiting, breast
tenderness, weight
gain, mood swings,
insomnia, vaginal
dryness
Leuprolide (p. GnRH agonist 5 mg/ml for Endometriosis, Hot flashes,
676) (Lupron) subcutaneous adjunct to amenorrhea, blurred
injection menotropins/human vision, edema,
chorionic headaches, nausea,
gonadotropin for vomiting, breastovulation induction tenderness, weightName Category Availability Uses Side Effcts
gain, mood swings,
insomnia, vaginal
dryness
Menotropins Gonadotropin 75 units FSH, In conjunction with OHSS (ovarian
(Menopur, 75 units LH chorionic hyperstimulation
Repronex) activity; 150 gonadotropin for syndrome):
units FSH, ovulation Abdominal pain,
150 units LH stimulation in pts indigestion, bloating,
activity with ovulatory decreased urinary
dysfunction due to output, nausea,
primary ovarian vomiting, diarrhea,
failure rapid weight gain,
shortness of breath,
edema of lower
extremities; ovarian
enlargement, ovarian
cyst formation, breast
tenderness, mood
swings
Nafarelin GnRH 2 mg/ml Endometriosis, Loss of bone mineral
(Synarel) nasal spray adjunct to density, breast
menotropins/human enlargement,
chorionic bleeding between
gonadotropin for regular menstrual
ovulation induction periods, acne, mood
swings, seborrhea,
hot flashes, headache,
insomnia, vaginal
dryness
Urofollitropin Gonadotropin 75 units FSH In conjunction with OHSS (ovarian
(Bravelle) activity, 150 human chorionic hyperstimulation
units FSH gonadotropin for syndrome):
activity ovulation Abdominal pain,
stimulation in pts indigestion, bloating,
with polycystic decreased urinary
ovary syndrome output, nausea,
who have elevated vomiting, diarrhea,
LH:FSH ratio and rapid weight gain,
have failed shortness of breath,
clomiphene therapy edema of lower
extremities; ovarian
enlargement, ovarian
cyst formation,
pain/redness at
injection site, breast
tenderness, nausea,
vomiting, diarrhea,
mood swings
I , Injection; T , tablets.!
<
H Antagonists2
USES
Short-term treatment of duodenal ulcer (DU), active benign gastric ulcer (GU), maintenance therapy of
DU, pathologic hypersecretory conditions (e.g., Zollinger-Ellison syndrome), gastroesophageal re ux
disease (GERD), and prevention of upper GI bleeding in critically ill pts.
ACTION
Inhibit gastric acid secretion by interfering with histamine at the histamine H receptors in parietal2
cells. Also inhibit acid secretion caused by gastrin. Inhibition occurs with basal (fasting), nocturnal,
foodstimulated, or fundic distention secretion. H antagonists decrease both the volume and H2 2
concentration of gastric juices.
H ANTAGONISTS2
Name Availability Dosage Range Side Effects
Cimetidine T: 200 mg, 300 Treatment of DU: 800 mg at Headaches, fatigue, dizziness,
(p. 242) mg, 400 mg, bedtime, 400 mg 2 times/day or 300 confusion, diarrhea,
(Tagamet) 800 mg mg 4 times/day gynecomastia
L: 300 mg/5 ml Maintenance of DU: 400 mg at
I: 150 mg/ml bedtime
Treatment of GU: 800 mg at bedtime
or 300 mg 4 times/day
GERD: 1,600 mg/day
Hypersecretory: 1,200–2,400
mg/day
Famotidine T: 10 mg, 20 Treatment of DU: 40 mg/day Headaches, dizziness, diarrhea,
(p. 463) mg, 40 mg Maintenance of DU: 20 mg/day constipation, abdominal pain,
(Pepcid) T (chewable): Treatment of GU: 40 mg/day tinnitus
10 mg GERD: 40–80 mg/day
DT: 20 mg, 40 Hypersecretory: 80–640 mg/day
mg
Gelcap: 10 mg
OS: 40 mg/5 ml
I: 10 mg/ml
Nizatidine T: 75 mg Treatment of DU: 300 mg/day Fatigue, urticaria, abdominal
(p. 849) C: 150 mg, 300 Maintenance of DU: 150 mg/day pain, constipation, nausea
(Axid) mg
Ranitidine T: 75 mg, 150 Treatment of DU: 300 mg/day Blurred vision, constipation,
(p. 1020) mg, 300 mg Maintenance of DU: 150 mg/day nausea, abdominal pain
(Zantac) C: 150 mg, 300 Treatment of GU: 300 mg/day
mg GERD: 300 mg/day
Syrup: 15 Hypersecretory: 0.3–6 g/day
mg/ml
Granules: 150
mg
I: 0.5 mg/ml,
25 mg/ml
C , Capsules; D T , disintegrating tablets; I , injection; L , liquid; O S , oral suspension; T , tablets.

Hematinic Preparations
USES
Prevention or treatment of iron de ciency resulting from improper diet, pregnancy, impaired
absorption, or prolonged blood loss.
ACTION<
<
<
<
!
<
<
Iron supplements are provided to ensure adequate supplies for the formation of hemoglobin, which is
needed for erythropoiesis and O transport.2
HEMATINIC (IRON) PREPARATIONS
Name Availability Elemental Side Effects
Iron
Ferrous fumarate (p. T: 63 mg, 200 mg, 324 mg S: 33 Constipation, nausea, vomiting,
476) (Femiron, 100 mg/5 ml D: 45 mg/0.6 ml diarrhea, abdominal
Feostat) pain/cramps
Ferrous gluconate (p. T: 240 mg, 325 mg 12 Same as ferrous fumarate
476) (Fergon)
Ferrous sulfate (p. 476) T: 325 mg Syrup: 90 mg/5 ml E: 20 Same as ferrous fumarate
(Fer-In-Sol) 220 mg/5 ml D: 75 mg/0.6 ml
Ferrous sulfate T: 187 mg, 200 mg T (SR): 160 30 Same as ferrous fumarate
exsiccated (Slow-Fe) mg C (ER): 160 mg
C , Caplets; D , drops; E , elixir; E R , extended-release; S , suspension; S R , sustained-release; T , tablets.

Hormones
USES
Functions of the body are regulated by two major control systems: the nervous system and the endocrine
(hormone) system. Together they maintain homeostasis and control diAerent metabolic functions in the
body.
Hormones are concerned with control of diAerent metabolic functions in the body (e.g., rates of
chemical reactions in cells, transporting substances through cell membranes, cellular metabolism
[growth/secretions]). By de nition, a hormone is a chemical substance secreted into body uids by cells
and has control over other cells in the body.
Hormones can be local or general:
• Local hormones have speci c local eAects (e.g., acetylcholine, which is secreted at parasympathetic and
skeletal nerve endings).
• General hormones are mostly secreted by speci c endocrine glands (e.g., epinephrine/norepinephrine
are secreted by the adrenal medulla in response to sympathetic stimulation), transported in the blood
to all parts of the body, causing many different reactions.
Some general hormones aAect all or almost all cells of the body (e.g., thyroid hormone from the thyroid
gland increases the rate of most chemical reactions in almost all cells of the body); other general
hormones aAect only speci c tissue (e.g., ovarian hormones are speci c to female sex organs and
secondary sexual characteristics of the female).
ACTION
Endocrine hormones almost never directly act intracellularly aAecting chemical reactions. They rst
combine with hormone receptors either on the cell surface or inside the cell (cell cytoplasm or nucleus).
The combination of hormone and receptors alters the function of the receptor, and the receptor is the
direct cause of the hormone effects. Altered receptor function may include the following:
Altered cell permeability, which causes a change in protein structure of the receptor, usually opening or
closing a channel for one or more ions. The movement of these ions causes the effect of the hormone.
Activation of intracellular enzymes immediately inside the cell membrane (e.g., hormone combines with
receptor that then becomes the activated enzyme adenyl cyclase, which causes formation of cAMP).
cAMP has effects inside the cell. It is not the hormone but cAMP that causes these effects.
Regulation of hormone secretion is controlled by an internal control system, the negative feedback
system:
• Endocrine gland oversecretes.
• Hormone exerts more and more of its effect.
• Target organ performs its function.
• Too much function in turn feeds back to endocrine gland to decrease secretory rate.
The endocrine system contains many glands and hormones. A summary of the important glands and<
their hormones secreted are as follows:
The pituitary gland (hypophysis) is a small gland found in the sella turcica at the base of the brain. The
pituitary is divided into two portions physiologically: the anterior pituitary (adenohypophysis) and the
posterior pituitary (neurohypophysis). Six important hormones are secreted from the anterior pituitary
and two from the posterior pituitary.
Anterior pituitary hormones:
• Growth hormone (GH)
• Adrenocorticotropin (corticotropin)
• Thyroid-stimulating hormone (thyrotropin) (TSH)
• Follicle-stimulating hormone (FSH)
• Luteinizing hormone (LH)
• Prolactin
Posterior pituitary hormones:
• Antidiuretic hormone (vasopressin)
• Oxytocin
Almost all secretions of the pituitary hormones are controlled by hormonal or nervous signals from the
hypothalamus. The hypothalamus is a center of information concerned with the well-being of the body,
which in turn is used to control secretions of the important pituitary hormones just listed. Secretions
from the posterior pituitary are controlled by nerve signals originating in the hypothalamus; anterior
pituitary hormones are controlled by hormones secreted within the hypothalamus. These hormones are
as follows:
• Thyrotropin-releasing hormone (TRH) releasing thyroid-stimulating hormone
• Corticotropin-releasing hormone (CRH) releasing adrenocorticotropin
• Growth hormone-releasing hormone (GHRH) releasing growth hormone and growth hormone
inhibitory hormone (GHIH) (same as somatostatin)
• Gonadotropin-releasing hormone (GnRH) releasing the two gonadotropic hormones LH and FSH
• Prolactin inhibitory factor (PIF) causing inhibition of prolactin and prolactin-releasing factor
Anterior Pituitary Hormones
All anterior pituitary hormones (except growth hormone) have as their principal eAect stimulating
target glands.
GROWTH HORMONE (GH)
Growth hormone aAects almost all tissues of the body. GH (somatopropin) causes growth in almost all
tissues of the body (increases cell size, increases mitosis with increased number of cells, and
diAerentiates certain types of cells). Metabolic eAects include increased rate of protein synthesis,
mobilization of fatty acids from adipose tissue, decreased rate of glucose utilization.
THYROID-STIMULATING HORMONE (TSH)
Thyroid-stimulating hormone controls secretion of the thyroid hormones. The thyroid gland is located
immediately below the larynx on either side of and anterior to the trachea and secretes two signi cant
hormones, thyroxine (T ) and triiodothyroxine (T ), which have a profound eAect on increasing the4 3
metabolic rate of the body. The thyroid gland also secretes calcitonin, an important hormone for calcium
metabolism. Calcitonin promotes deposition of calcium in the bones, which decreases calcium
concentration in the extracellular fluid.
ADRENOCORTICOTROPIN
Adrenocorticotropin causes the adrenal cortex to secrete adrenocortical hormones. The adrenal glands lie
at the superior poles of the two kidneys. Each gland is composed of two distinct parts: the adrenal
medulla and the cortex. The adrenal medulla, related to the sympathetic nervous system, secretes the
hormones epinephrine and norepinephrine. When stimulated, they cause constriction of blood vessels,
increased activity of the heart, inhibitory eAects on the GI tract, and dilation of the pupils. The adrenal
cortex secretes corticosteroids, of which there are two major types: mineralocorticoids and
glucocorticoids. Aldosterone, the principal mineralocorticoid, primarily aAects electrolytes of the
extracellular fluids. Cortisol, the principal glucocorticoid, affects glucose, protein, and fat metabolism.
LUTEINIZING HORMONE (LH)
Luteinizing hormone plays an important role in ovulation and causes secretion of female sex hormones
by the ovaries and testosterone by the testes.
FOLLICLE-STIMULATING HORMONE (FSH)
Follicle-stimulating hormone causes growth of follicles in the ovaries before ovulation and promotes
formation of sperm in the testes.
Ovarian sex hormones are estrogens and progestins. Estradiol is the most important estrogen;
progesterone is the most important progestin.<
Estrogens mainly promote proliferation and growth of speci c cells in the body and are responsible for
development of most of the secondary sex characteristics. Primarily cause cellular proliferation and
growth of tissues of sex organs/other tissue related to reproduction. Ovaries, fallopian tubes, uterus,
vagina increase in size. Estrogen initiates growth of breast and milk-producing apparatus, external
appearance.
Progesterone stimulates secretion of the uterine endometrium during the latter half of the female sexual
cycle, preparing the uterus for implantation of the fertilized ovum. Decreases the frequency of uterine
contractions (helps prevent expulsion of the implanted ovum). Progesterone promotes development of
breasts, causing alveolar cells to proliferate, enlarge, and become secretory in nature.
Testosterone is secreted by the testes and formed by the interstitial cells of Leydig. Testosterone
production increases under the stimulus of the anterior pituitary gonadotropic hormones. It is
responsible for distinguishing characteristics of the masculine body (stimulates the growth of male sex
organs and promotes the development of male secondary sex characteristics, e.g., distribution of body
hair, effect on voice, protein formation, and muscular development).
PROLACTIN
Prolactin promotes the development of breasts and secretion of milk.
POSTERIOR PITUITARY HORMONES
ANTIDIURETIC HORMONE (ADH) (VASOPRESSIN)
ADH can cause antidiuresis (decreased excretion of water by the kidneys). In the presence of ADH, the
permeability of the renal-collecting ducts and tubules to water increases, which allows water to be
absorbed, conserving water in the body. ADH in higher concentrations is a very potent vasoconstrictor,
constricting arterioles everywhere in the body, increasing B/P.
OXYTOCIN
Oxytocin contracts the uterus during the birthing process, esp. toward the end of the pregnancy, helping
expel the baby. Oxytocin also contracts myoepithelial cells in the breasts, causing milk to be expressed
from the alveoli into the ducts so that the baby can obtain it by suckling.
PANCREAS
The pancreas is composed of two tissue types: acini (secrete digestive juices in the duodenum) and islets
of Langerhans (secrete insulin/glucagons directly into the blood). The islets of Langerhans contain three
cells: alpha, beta, and delta. Alpha cells secrete glucagon, beta cells secrete insulin, and delta cells
secrete somatostatin.
Insulin promotes glucose entry into most cells, thus controlling the rate of metabolism of most
carbohydrates. Insulin also affects fat metabolism.
Glucagon eAects are opposite those of insulin, the most important of which is increasing blood glucose
concentration by releasing it from the liver into the circulating body fluids.
Somatostatin (same chemical as secreted by the hypothalamus) has multiple inhibitory eAects: depresses
secretion of insulin and glucagon, decreases GI motility, decreases secretions/absorption of the GI tract.

Human Immunodeficiency Virus (HIV) Infection
USES
Antiretroviral agents are used in the treatment of HIV infection.
ACTION
Seven classes of antiretroviral agents are used in the treatment of HIV disease. Nucleoside reverse
transcriptase inhibitors (NRTIs) compete with natural substrates for formation of proviral DNA by reverse
transcriptase inhibiting viral replication.
Nucleotide reverse transcriptase inhibitors (NtRTIs) inhibit reverse transcriptase by competing with the
natural substrate deoxyadenosine triphosphate and by DNA chain termination.
Non-nucleoside reverse transcriptase inhibitors (NNRTIs) directly bind to reverse transcriptase and block
RNA-dependent and DNA-dependent DNA polymerase activities by disrupting the enzyme’s catalytic site.
Protease inhibitors (PIs) bind to the active site of HIV-1 protease and prevent the processing of viral gag
and gag-pol polyprotein precursors resulting in immature, noninfectious viral particles.
Fusion inhibitors interfere with the entry of HIV-1 into cells by inhibiting fusion of viral and cellular
membranes.
CCR5 co-receptor antagonist selectively binds to human chemokine receptor CCR5 present on cell
membrane preventing HIV-1 from entering cells.
Integrase inhibitor inhibits catalytic activity of HIV-1 integrase, an HIV-1 encoded enzyme required forviral replication.
ANTIRETROVIRAL AGENTS FOR TREATMENT OF HIV INFECTION
Name Availability Dosage Range Side Effects
Nucleoside Analogues
Abacavir (p. 1) (Ziagen) T: 300 mg A: 300 mg 2 Nausea, vomiting,
OS: 20 mg/ml times/day or malaise, rash,
600 mg fever, headaches,
once/day asthenia (loss of
strength, energy),
fatigue
Abacavir/lamivudine (Epzicom) T: 600 mg A: once/day Allergic reaction,
abacavir/300 mg insomnia,
lamivudine headaches,
depression,
dizziness, fatigue,
diarrhea, fever,
abdominal pain,
anxiety
Didanosine (p. 349) (Videx EC) DR: 125 mg, 200 DR (weighing Peripheral
mg, 250 mg, 400 60 kg or neuropathy,
mg more): 400 mg pancreatitis,
OS: 2 g/bottle, 4 once/day; diarrhea, nausea,
g/bottle (weighing 25– vomiting,
59 kg): 250 headaches,
mg once/day; insomnia, rash,
(weighing 20– hepatitis, seizures
24 kg): 200 mg
once/day
OS (weighing
more than 60
kg): 200 mg
q12h or 400
mg once/day;
(weighing
less than 60
kg): 125 mg
q12h or 250
mg once/day
Emtricitabine (p. 404) (Emtriva) C: 200 mg A: 200 mg/day Headaches,
OS: 10 mg/ml (C) insomnia,
240 mg/day depression,
(OS) diarrhea, nausea,
vomiting, rhinitis,
asthenia (loss of
strength, energy),
rash
Emtricitabine/efavirenz/tenofovir (Atripla) T: 200 mg A: once/day Lactic acidosis,
emtricitabine/600 headaches,
mg efavirenz/300 dizziness,
mg tenofovir abdominal pain,
nausea, vomiting,
rash
Emtricitabine/rilpivirine/tenofovir (Complera) T: 200 mg A: 1 tablet Insomnia,
emtricitabine/25 once daily with headache, diarrhea,
mg food nausea, fatigue,
rilpivirine/300 dizziness,
mg tenofovir depression, rash
Emtricitabine/tenofovir (Truvada) T: 200 mg A: 1 tablet Dizziness, diarrhea,
emtricitabine/300 once daily with headaches, rash,mg tenofovir food belching/flatulence,Name Availability Dosage Range Side Effects
skin discoloration
Emtricitabine/elvitegravir/cobicistat/tenofovir T: 200 mg A: 1 tablet Nausea, diarrhea
(Stribild) emtricitabine 150 once daily with
mg elvitegravir food
150 mg cobicistat
300 mg tenofovir
Lamivudine (p. 658) (Epivir) T: 100 mg, 150 A: 150 mg 2 Diarrhea, malaise,
mg, 300 mg times/day or fatigue, headaches,
OS: 5 mg/ml, 10 300 mg nausea, vomiting,
mg/ml once/day abdominal pain,
C: 4 mg/kg 2 peripheral
times/day neuropathy,
arthralgia, myalgia,
skin rash
Stavudine (p. 1104) (Zerit) C: 15 mg, 20 mg, A (weighing Peripheral
30 mg, 40 mg more than 60 neuropathy,
OS: 1 mg/ml kg): 40 mg 2 anemia,
times/day (20 leukopenia,
mg 2 neutropenia
times/day if
peripheral
neuropathy
occurs);
(weighing 60
kg or less): 30
mg 2
times/day (15
mg 2
times/day if
peripheral
neuropathy
occurs)
Zidovudine (p. 1267) (Retrovir) C: 100 mg A: 500–600 Anemia,
T: 300 mg mg/day (100 granulocytopenia,
Syrup: 50 mg/5 mg 5 myopathy, nausea,
ml, 10 mg/ml times/day or malaise, fatigue,
300 mg 2 insomnia
times/day)
Zidovudine/lamivudine (AZT/3TC) (Combivir) C: 300 mg A: 1 capsule 2 Myelosuppression,
AZT/150 mg 3TC times/day peripheral
neuropathy,
pancreatitis
Zidovudine/lamivudine/abacavir C: 300 mg A: 1 capsule 2 Myelosuppression,
(AZT/3TC/ABC) (Trizivir) AZT/150 mg times/day peripheral
3TC/300 mg ABC neuropathy,
anaphylactic
reaction
Nucleotide Analogues
Tenofovir (p. 1140) (Viread) T: 300 mg A: 300 mg/day Nausea, vomiting,
diarrhea, headache,
fatigue
Tenofovir/elvitegravir/cobicistat/emtricitabine T: 300 mg A: 1 tablet Nausea, diarrhea
(Stribild) tenofovir 150 mg daily with food
elvitegravir 150
mg cobicistat 200
mg emtricitabine
Non-nucleoside Analogues
Delavirdine (p. 321) (Rescriptor) T: 100 mg, 200 A: 200 mg 3 Rash, nausea,mg times/day for headaches, elevatedName Availability Dosage Range Side Effects
14 days, then hepatic function
400 mg 3 tests
times/day
Efavirenz (p. 400) (Sustiva) C: 50 mg, 200 mg A: 600 mg/day Headaches,
T: 600 mg C: 200–600 dizziness, insomnia,
mg/day based fatigue, rash,
on weight nightmares
Etravirine (p. 452) (Intelence) T: 100 mg, 200 A: 200 mg 2 Skin reactions (e.g.,
mg times/day Stevens-Johnson
syndrome,
erythema
multiforme),
nausea, abdominal
pain, vomiting
Nevirapine (p. 829) (Viramune, Viramune XR) T: 200 mg A: 200 mg/day Rash, nausea,
T (ER): 400 mg for 14 days, fatigue, fever,
S: 50 mg/ml then (if no headaches,
rash) 200 mg 2 abnormal hepatic
times/day function tests
Rilpivirine (p. 1039) T: 25 mg A: 25 mg Depression,
once/day with insomnia,
a meal headache, rash
Protease Inhibitors
Atazanavir (p. 85) (Reyataz) C: 100 mg, 150 A: 400 mg/day Headaches,
mg, 200 mg, 300 or 300 mg diarrhea,
mg (with 100 mg abdominal pain,
ritonavir) nausea, rash
once/day
Darunavir (p. 308) (Prezista) T: 400 mg, 600 A: 600 mg 2 Diarrhea, nausea,
mg times/day vomiting,
(with ritonavir headaches, skin
100 mg) or 800 rash, constipation
mg once/day
with ritonavir
100 mg
Fosamprenavir (p. 513) (Lexiva) T: 700 mg A: 1,400–2,800 Headaches, fatigue,
OS: 50 mg/ml mg/day with rash, nausea,
100 mg diarrhea, vomiting,
ritonavir abdominal pain
Indinavir (p. 607) (Crixivan) C: 200 mg, 400 A: 800 mg q8h Nephrolithiasis,
mg or 800 mg 2 hyperbilirubinemia,
times/day with abdominal pain,
ritonavir 100 asthenia (loss of
mg strength, energy),
fatigue, flank pain,
nausea, vomiting,
diarrhea,
headaches,
insomnia, dizziness,
altered taste
Lopinavir/ritonavir (p. 707) (Kaletra) C: 133/33 mg A: 400 mg/100 Diarrhea, nausea,
OS: 80/20 mg mg 2 vomiting,
times/day or abdominal pain,
800 mg/200 headaches, rash
mg once/day
C (4–12 yrs):
10–13 mg/kg 2
times/dayNelfinavir (p. 825) (Viracept) T: 250 mg A: 750 mg q8h Diarrhea, fatigue,ame Availability Dosage Range Side Effects
Oral Powder: 50 or 1,250 mg 2 asthenia (loss of
mg/g times/day strength, energy),
C: 20–25 headaches,
mg/kg q8h hypertension,
impaired
concentration
Ritonavir (p. 1046) (Norvir) C: 100 mg A: Titrate up to Nausea, vomiting,
OS: 80 mg/ml 800 mg/day diarrhea, altered
based on taste, fatigue,
protease elevated hepatic
inhibitor function tests and
triglyceride levels
Saquinavir (p. 1067) (Invirase) C: 200 mg A: 1,000 mg 2 Diarrhea, elevated
T: 500 mg times/day with hepatic function
ritonavir 100 tests,
mg hypertriglycerides,
cholesterol,
abnormal fat
accumulation,
hyperglycemia
Tipranavir (p. 1174) (Aptivus) C: 250 mg A: 500 mg Diarrhea, nausea,
OS: 100 mg/ml (with 200 mg fatigue, headaches,
ritonavir) 2 vomiting
times/day
Fusion Inhibitors
Enfuvirtide (p. 408) (Fuzeon) I: 108 mg (90 mg Subcutaneous: Insomnia,
when 90 mg 2 depression,
reconstituted) times/day peripheral
neuropathy,
decreased appetite,
constipation,
asthenia (loss of
strength, energy),
cough
CCR5 Antagonists
Maraviroc (p. 729) (Selzentry) T: 150 mg, 300 A: 300 mg 2 Cough, pyrexia,
mg times/day upper respiratory
CYP3A4 tract infections,
inducers: 600 rash,
mg 2 musculoskeletal
times/day symptoms,
CYP3A4 abdominal pain,
inhibitors: dizziness
150 mg 2
times/day
Integrase Inhibitor
Raltegravir (p. 1015) (Isentress) T: 400 mg A: 400 mg 2 Nausea, headache,
times/day diarrhea, pyrexia
A , Adults; C , capsules; C (dosage), children; D R , delayed-release; E R , extended-release; I , injection; O S ,
oral solution; S , suspension; T , tablets.Immunosuppressive Agents
USES
Improvement of both short- and long-term allograft survivals.
ACTION
B a s i l i x i m a b : An interleukin-2 (IL-2) receptor antagonist inhibiting IL-2 binding. This
prevents activation of lymphocytes, and the response of the immune system to antigens
is impaired.
C y c l o s p o r i n e : Inhibits production and release of IL-2.
D a c l i z u m a b : An IL-2 receptor antagonist inhibiting IL-2 binding.
M y c o p h e n o l a t e : A prodrug that reversibly binds and inhibits inosine monophosphate
dehydrogenase (IMPD), resulting in inhibition of purine nucleotide synthesis, inhibiting
DNA and RNA synthesis and subsequent synthesis of T and B cells.
S i r o l i m u s : Inhibits IL-2–stimulated T-lymphocyte activation and proliferation, which
may occur through formation of a complex.
T a c r o l i m u s : Inhibits IL-2–stimulated T-lymphocyte activation and proliferation, which
may occur through formation of a complex.
IMMUNOSUPPRESSIVE AGENTS
Name Availability Dosage Side Effects
Basiliximab (p. I: 20 mg 20 mg for Abdominal pain, asthenia (loss of strength,
112) (Simulect) 2 doses energy), cough, dizziness, dyspnea, dysuria,
edema, hypertension, infection, tremors
Cyclosporine C: 25 mg, 7–10 Hypertension, hyperkalemia,
(p. 291) 50 mg, 100 mg/kg/day nephrotoxicity, coarsening of facial
(Neoral, mg features, hirsutism, gingival hyperplasia,
Sandimmune) S: 100 nausea, vomiting, diarrhea, hepatotoxicity,
mg/ml hyperuricemia, hypertriglyceridemia,
I: 50 hypercholesterolemia, tremors, paresthesia,
mg/ml seizures, risk of infection/malignancy
Mycophenolate C: 250 mg 1 g 2 Diarrhea, vomiting, leukopenia,
(p. 804) I: 500 mg times/day neutropenia, infections
(CellCept) S: 200
mg/ml
T: 500 mg
Sirolimus (p. S: 1 mg/ml 2–10 Dyspnea, leukopenia, thrombocytopenia,
1086) T: 1 mg mg/day hyperlipidemia, abdominal pain, acne,
(Rapamune) arthralgia, fever, diarrhea, constipation,
headaches, vomiting, weight gain
Tacrolimus (p. C: 0.5 mg, 0.1–0.15 Nephrotoxicity, neurotoxicity,
1118) 1 mg, 5 mg mg/kg/day hyperglycemia, nausea, vomiting,
(Prograf) I: 5 mg/ml photophobia, infections, hypertension,
hyperlipidemia
C , Capsules; I , injection; S , oral solution or suspension; T , tablets.&
&
&
#
"
Laxatives
USES
Short-term treatment of constipation; colon evacuation before rectal/bowel
examination; prevention of straining (e.g., after anorectal surgery, MI); to reduce
painful elimination (e.g., episiotomy, hemorrhoids, anorectal lesions); modi cation of
e uent from ileostomy, colostomy; prevention of fecal impaction; removal of ingested
poisons.
ACTION
Laxatives ease or stimulate defecation. Mechanisms by which this is accomplished
include (1) attracting, retaining uid in colonic contents due to hydrophilic or osmotic
properties; (2) acting directly or indirectly on mucosa to decrease absorption of water
and NaCl; or (3) increasing intestinal motility, decreasing absorption of water and
NaCl by virtue of decreased transit time.
Bulk-forming: Act primarily in small/large intestine. Retain water in stool, may bind
water, ions in colonic lumen (soften feces, increase bulk); may increase colonic bacteria
growth (increases fecal mass). Produce soft stool in 1–3 days.
Osmotic agents: Act in colon. Similar to saline laxatives. Osmotic action may be
enhanced in distal ileum/colon by bacterial metabolism to lactate, other organic acids.
This decrease in pH increases motility, secretion. Produce soft stool in 1–3 days.
Saline: Acts in small/large intestine, colon (sodium phosphate). Poorly, slowly
absorbed; causes hormone cholecystokinin release from duodenum (stimulates uid
secretion, motility); possesses osmotic properties; produces watery stool in 2–6 hrs
(small doses produce semifluid stool in 6–12 hrs).
Stimulant: Acts in colon. Enhances accumulation of water/electrolytes in colonic lumen,
enhances intestinal motility. May act directly on intestinal mucosa. Produces semi uid
stool in 6–12 hrs.
Bisacodyl suppository acts in 15–60 min.
Stool softener: Acts in small/large intestine. Hydrates and softens stools by its surfactant
action, facilitating penetration of fat and water into stool. Produces soft stool in 1–3
days.
LAXATIVES
Name Onset of Action Uses Side Effects/Precautions
Bulk-forming
Methylcellulose 12–24 hrs up Treatment of constipation Gas, bloating,
(Citrucel) to 3 days for postpartum women, esophageal obstruction,
elderly, pts with colonic obstruction,
diverticulosis, irritable calcium and iron
bowel syndrome, malabsorption
hemorrhoids
Psyllium (p. Same as Treatment of chronic Diarrhea, constipation,
1002) methylcellulose constipation and abdominal cramps,
(Metamucil) constipation associated esophageal/colon
with rectal disorders; obstruction,
management of irritable bronchospasm
bowel syndrome
Stool SoftenerDocusate (p. 1–3 days Treatment of constipation Stomachache, mildName Onset of Action Usside Effects/Precautions
372) (Colace, due to hard stools, in nausea, cramping,
Surfak) painful anorectal diarrhea, irritated throat
conditions, and for those (with liquid and syrup
who need to avoid dose forms)
straining during bowel
movements
Saline
Magnesium 30 min–3 hrs Bowel evacuation prior to Hypotension, abdominal
citrate (p. 723) certain surgical and cramping, diarrhea, gas
(Citrate of diagnostic procedures formation, electrolyte
Magnesia, abnormalities
Citro-Mag)
Magnesium 30 min–3 hrs Short-term treatment of Electrolyte
hydroxide (p. occasional constipation abnormalities can occur;
723) use caution in pts with
renal or cardiac
impairment; diarrhea,
abdominal cramps,
hypotension
Sodium 2–15 min Relief of occasional Electrolyte
phosphate constipation; bowel abnormalities; do not
(Fleet Phospho- evacuation prior to use for pts with CHF,
Soda) certain surgical and severe renal
diagnostic procedures impairment, ascites, GI
obstruction, active
inflammatory bowel
disease
Osmotic
Lactulose (p. 24–48 hrs Short-term relief of Nausea, vomiting,
657) constipation diarrhea, abdominal
(Kristalose) cramping, bloating, gas
Polyethylene 24–48 hrs Short-term relief of Bitter taste, diarrhea
glycol (p. 957) constipation
(MiraLax)
Stimulant
Bisacodyl (p. PO: 6–12 hrs Short-term relief of Elecrolyte imbalance,
133) (Dulcolax) Rectal: 15–60 constipation abdominal discomfort,
min gas, potential for
overuse/abuse
Senna (p. 1075) 6–12 hrs Short-term relief of Abdominal discomfort,
(Senokot) constipation crampsNeuromuscular Blockers
USES
Adjuvant in surgical anesthesia to relax skeletal muscle (esp. abdominal wall) for
surgery (allows lighter level of anesthesia; valuable in orthopedic procedures).
Neuromuscular blocking agents of short duration often used to facilitate endotracheal
intubation, laryngoscopy, bronchoscopy, and esophagoscopy in combination with
general anesthetics. Provide muscle relaxation in pts undergoing mechanical
ventilation, muscle relaxation in diagnosis of myasthenia gravis. Prevent convulsive
movements during electroconvulsive therapy.
ACTION
Paralysis results from blocking of normal neuromuscular transmission. Succinylcholine,
a depolarizing agent, attaches to the acetylcholine (ACh) receptor on the motor end
plate, causing depolarization. It prevents the binding of ACh to the receptor.
Nondepolarizing agents also bind to the receptor at the motor end plate but
competitively block ACh from attaching to the receptor. These agents also block
presynaptic channels that cause the release of ACh.
NEUROMUSCULAR BLOCKERS
Name Class Intubation ICU Dose Side Effects
Dose
Cisatracurium Intermediate 0.15–2 0.10–0.2 Skin rash, flushing
(Nimbex) mg/kg mg/kg
bolus, then
2.5–3
mcg/kg/min
Doxacurium Long 0.05 0.025–0.05 Injection site reaction,
(Nuromax) mg/kg mg/kg urticaria
bolus, then
0.3–0.5
mg/kg/min
Mivacurium Short 0.15–0.2 0.15–0.25 Flushing, hypotension,
(Mivacron) mg/kg mg/kg dizziness, muscle spasm
bolus, then
9–10
mcg/kg/min
Pancuronium Long 0.06–0.1 0.05–0.1 Increased B/P, increased
(Pavulon) mg/kg mg/kg salivation, pruritus
bolus, then
1–2
mcg/kg/hr
Rocuronium Intermediate 0.45–1.2 0.15–0.25 Pain at injection site,
(Zemuron) mg/kg mg/kg hypertension, hypotension
bolus, then
10–12
mcg/kg/min
Succinylcholine Ultrashort 1–2 NA Increased intracranial
(Anectine, mg/kg pressure, increased?
<
Quelicin) intraocular pressure, postopName Class Intubation ICU Dose Side Effects
muscle pain, weakness,Dose
increased salivation,
bradycardia, cardiac
arrhythmias
Vecuronium Intermediate 0.08–0.1 0.08–0.1 Skeletal muscle weakness
(Norcuron) mg/kg mg/kg with prolonged use
bolus, then
0.8–1.2
mcg/kg/min

Nitrates
USES
Sublingual: Acute relief of angina pectoris.
Oral, topical: Long-term prophylactic treatment of angina pectoris.
Intravenous: Adjunctive treatment in CHF associated with acute MI. Produce controlled
hypotension during surgical procedures; control B/P in perioperative hypertension,
angina unresponsive to organic nitrates or beta-blockers.
ACTION
Relax most smooth muscles, including arteries and veins. E ect is primarily on veins
(decrease left/right ventricular end-diastolic pressure). In angina, nitrates decrease
myocardial work and O requirements (decrease preload by venodilation and afterload2
by arteriodilation). Nitrates also appear to redistribute blood ow to ischemic
myocardial areas, improving perfusion without increase in coronary blood flow.
NITRATES
Name Availability Dosage Side Effects
Range
Isosorbide dinitrate T: 5 mg, 10 mg, 20 mg, SL: 2.5– Flushing, headaches,
(p. 637) (Isordil) 30 mg, 40 mg 10 mg nausea, vomiting,
T (ER): 30 mg, 40 mg, q2–3h orthostatic hypotension,
60 mg, 120 mg PO: 10– restlessness, tachycardia
SL: 2.5 mg, 5 mg 40 mg
T (chewable): 5 mg, q6h
10 mg PO (SR):
C (SR): 40 mg 40–80 mg
q8–12h
Isosorbide T: 30 mg, 60 mg, 120 PO: 30– Same as isosorbide dinitrate
mononitrate (p. mg 240 mg
637) (Imdur, ISMO) once/day
Nitroglycerin (p. SL: 0.4 mg SL: 0.4 Same as isosorbide dinitrate
845) (Minitran, T (SR): 2.6 mg, 6.5 mg up to
Nitro-Bid, Nitro- mg, 9 mg 3 times
Dur, Nitrostat) C (SR): 2.5 mg, 6.5 q15min
mg, 9 mg, 13 mg SR: 2.5–
Topical: 2% ointment 26 mg 3–<
?
?
Trans: 0.1 mg/hr, 0.2 4Name Avilability Dosage Side Effects
mg/hr, 0.3 mg/hr, 0.4 times/dayRange
mg/hr, 0.6 mg/hr, 0.8 Trans:
mg/hr 0.1–0.8
I: 0.5 mg/ml, 5 mg/ml mg/hr
Infusion: 100 mcg/ml, T: 1–2
200 mcg/ml inches up
to 4–5
inches
q4h
C , Capsules; E R , extended-release; I , injection; S L , sublingual; S R , sustained-release; T ,
tablets; T r a n s , transdermal.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
USES
Provide symptomatic relief from pain/inflammation in the treatment of musculoskeletal
disorders (e.g., rheumatoid arthritis [RA], osteoarthritis, ankylosing spondylitis),
analgesic for low to moderate pain, reduction in fever (many agents not suited for
routine/prolonged therapy due to toxicity). By virtue of its action on platelet function,
aspirin is used in treatment or prophylaxis of diseases associated with
hypercoagulability (reduces risk of stroke/heart attack).
ACTION
Exact mechanism for anti-in ammatory, analgesic, antipyretic e ects unknown.
Inhibition of enzyme cyclo-oxygenase, the enzyme responsible for prostaglandin
synthesis, appears to be a major mechanism of action. May inhibit other mediators of
in ammation (e.g., leukotrienes). Direct action on hypothalamus heat-regulating center
may contribute to antipyretic effect.
NSAIDS
Name Availability Dosage Range Side Effects
Aspirin (p. T: 81 mg, 160 P (A): 325–650 mg GI discomfort, dizziness,
83) mg, 325 mg q4h as needed headaches, increased risk of
Supplement: C: Up to 60–80 bleeding
300 mg, 600 mg/kg/day
mg Arthritis: 3.2–6 g/day
JRA: 60–110
mg/kg/day
RF (A): 5–8 g/day
C: 75–100 mg/kg/day
TIA: 1,300 mg/day
MI: 81–325 mg/day
Celecoxib (p. C: 50 mg, 100 OA: 200 mg/day Diarrhea, back pain,
222) mg, 200 mg, RA: 100–200 mg 2 dizziness, heartburn,
(Celebrex) 400 mg times/day headaches, nausea,
FAP: 400 mg 2 abdominal pain
times/dayDiclofenac (p. T: 25 mg, 50 Arthritis: 100–200 Indigestion, constipation,Name Availability Dosage Range Sie Effects
345) mg, 75 mg, 100 mg/day diarrhea, nausea, headaches,
(Voltaren) mg fluid retention, abdominal
cramps
Diflunisal T: 250 mg, 500 Arthritis: 0.5–1 g/day Headaches, abdominal
(Dolobid) mg P: 0.5 g q8–12h cramps, indigestion, diarrhea,
nausea
Etodolac (p. T: 400 mg, 500 Arthritis: 600–800 Indigestion, dizziness,
448) (Lodine) mg mg/day headaches, bloated feeling,
T (ER): 400 P: 200–400 mg q6–8h diarrhea, nausea, weakness,
mg, 500 mg, abdominal cramps
600 mg
C: 200 mg, 300
mg
Fenoprofen C: 200 mg, 400 Arthritis: 300–600 mg Nausea, indigestion, anxiety,
(Nalfon) mg 3–4 times/day constipation, shortness of
T: 600 mg P: 200 mg q4–6h as breath, heartburn
needed
Flurbiprofen T: 50 mg, 100 Arthritis: 200–300 Indigestion, nausea, fluid
(p. 500) mg mg/day retention, headaches,
(Ansaid) abdominal cramps, diarrhea
Ibuprofen (p. I: 100 mg/ml Arthritis: 1.2–3.2 Dizziness, abdominal cramps,
583) (Advil, T: 100 mg, 200 g/day abdominal pain, heartburn,
Caldolor, mg, 400 mg, P: (PO): 400 mg q4–6h nausea
Motrin) 600 mg, 800 as needed; (I): 400–
mg 800 mg q6h as needed
T (chewable): Fever: (PO): 200 mg
50 mg, 100 mg q4–6h as needed; (I):
C: 200 mg 400 mg q4–6h as
S: 100 mg/5 needed or 100–200 mg
ml, 100 mg/2.5 q4h as needed
ml JA: 30–40 mg/kg/day
Drops: 40
mg/ml
Indomethacin C: 25 mg, 50 Arthritis: 50–200 Fluid retention, dizziness,
(p. 608) mg C (SR): 75 mg/day headaches, abdominal pain,
(Indocin) mg S: 25 mg/5 Bursitis/tendonitis: indigestion, nausea
ml 75–150 mg/day GA:
Supplement: 150 mg/day
50 mg
Ketoprofen T: 12.5 mg C: Arthritis: 150–300 Headaches, anxiety,
(p. 649) 25 mg, 50 mg, mg/day P: 25–50 mg abdominal pain, bloated
(Orudis KT) 75 mg C (ER): q6–8h as needed feeling, constipation,
100 mg, 150 diarrhea, nausea
mg, 200 mg
Ketorolac (p. T: 10 mg I: 15 P: (PO): 10 mg q4–6h Fluid retention, abdominal
650) mg/ml, 30 as needed; (IM/IV): pain, diarrhea, dizziness,
(Toradol) mg/ml 60–120 mg/day headaches, nausea
Meloxicam C: 7.5 mg, 15 Arthritis: 7.5–15 Heartburn, indigestion,
(p. 735) mg mg/day nausea, diarrhea, headaches
(Mobic) S: 7.5 mg/5 mlNabumetone T: 500 mg, 750 Arthritis: 1–2 g/day Fluid retention, dizziness,me Availability Dosage Range Side Effects
(p. 806) mg headaches, abdominal pain,
(Relafen) constipation, diarrhea,
nausea
Naproxen (p. T: 200 mg, 250 Arthritis: 250–550 Tinnitus, fluid retention,
816) mg, 375 mg, mg/day P: 250 mg q6– shortness of breath, dizziness,
(Anaprox, 500 mg T (CR): 8h JA: 10 mg/kg/day drowsiness, headaches,
Naprosyn) 375 mg S: 125 GA: 750 mg once, then abdominal pain,
mg/5 ml 250 mg q8h constipation, heartburn,
nausea
Oxaprozin (p. C: 600 mg Arthritis: 600–1,800 Constipation, diarrhea,
883) (Daypro) mg/day nausea, indigestion
Piroxicam (p. C: 10 mg, 20 Arthritis: 20 mg/day Abdominal pain, stomach
953) mg pain, nausea
(Feldene)
Sulindac (p. T: 150 mg, 200 Arthritis: 300 mg/day Dizziness, abdominal pain,
1113) mg GA: 400 mg/day constipation, diarrhea,
(Clinoril) nausea
Tolmetin T: 200 mg, 600 Arthritis: 600–1,800 Fluid retention, dizziness,
(Tolectin) mg C: 400 mg mg/day JA: 15–30 headaches, weakness,
mg/kg/day abdominal pain, diarrhea,
indigestion, nausea, vomiting
A , Adults; C , capsules; C (dosage), children; C R , controlled-release; E R , extended-release;
F A P , familial adenomatous polyposis; G A , gouty arthritis; I, injection; J A , juvenile
arthritis; J R A , juvenile rheumatoid arthritis; M I , myocardial infarction; O A ,
osteoarthritis; P , pain; R A , rheumatoid arthritis; R F , rheumatic fever; S , suspension; S R ,
sustained-release; T , tablets; T I A , transient ischemic attack.

Nutrition: Enteral
Enteral nutrition (EN), also known as tube feedings, provides food/nutrients via the GI
tract using special formulas, delivery techniques, and equipment. All routes of EN
consist of a tube through which liquid formula is infused.
INDICATIONS
Tube feedings are used in pts with major trauma, burns; those undergoing radiation
and/or chemotherapy; pts with hepatic failure, severe renal impairment, physical or
neurologic impairment; preop and postop to promote anabolism; prevention of
cachexia, malnutrition.
ROUTES OF ENTERAL NUTRITION DELIVERY
NASOGASTRIC (NG):
INDICATIONS: Most common for short-term feeding in pts unable or unwilling to
consume adequate nutrition by mouth. Requires at least a partially functioning GI tract.
ADVANTAGES: Does not require surgical intervention and is fairly easily inserted.?
<
Allows full use of digestive tract. Decreases abdominal distention, nausea, vomiting that
may be caused by hyperosmolar solutions.
DISADVANTAGES: Temporary. May be easily pulled out during routine nursing care.
Has potential for pulmonary aspiration of gastric contents, risk of re ux esophagitis,
regurgitation.
NASODUODENAL (ND), NASOJEJUNAL (NJ):
INDICATIONS: Pts unable or unwilling to consume adequate nutrition by mouth.
Requires at least a partially functioning GI tract.
ADVANTAGES: Does not require surgical intervention and is fairly easily inserted.
Preferred for pts at risk for aspiration. Valuable for pts with gastroparesis.
DISADVANTAGES: Temporary. May be pulled out during routine nursing care. May be
dislodged by coughing, vomiting. Small lumen size increases risk of clogging when
medication is administered via tube, more susceptible to rupturing when using infusion
device. Must be radiographed for placement, frequently extubated.
GASTROSTOMY:
INDICATIONS: Pts with esophageal obstruction or impaired swallowing; pts in whom
NG, ND, or NJ not feasible; when long-term feeding indicated.
ADVANTAGES: Permanent feeding access. Tubing has larger bore, allowing
noncontinuous (bolus) feeding (300–400 ml over 30–60 min q3–6h). May be inserted
endoscopically using local anesthetic (procedure called percutaneous endoscopic
gastrostomy [PEG]).
DISADVANTAGES: Requires surgery; may be inserted in conjunction with other surgery
or endoscopically (see ADVANTAGES). Stoma care required. Tube may be inadvertently
dislodged. Risk of aspiration, peritonitis, cellulitis, leakage of gastric contents.
JEJUNOSTOMY:
INDICATIONS: Pts with stomach or duodenal obstruction, impaired gastric motility; pts
in whom NG, ND, or NJ not feasible; when long-term feeding indicated.
ADVANTAGES: Allows early postop feeding (small bowel function is least a ected by
surgery). Risk of aspiration reduced. Rarely pulled out inadvertently.
DISADVANTAGES: Requires surgery (laparotomy). Stoma care required. Risk of
intraperitoneal leakage. Can be dislodged easily.
INITIATING ENTERAL NUTRITION
With continuous feeding, initiation of isotonic (about 300 mOsm/L) or moderately
hypertonic feeding (up to 495 mOsm/L) can be given full strength, usually at a slow
rate (30–50 ml/hr) and gradually increased (25 ml/hr q6–24h). Formulas with
osmolality greater than 500 mOsm/L are generally started at half strength and
gradually increased in rate, then concentration. Tolerance is increased if the rate and
concentration are not increased simultaneously.
SELECTION OF FORMULAS
Protein: Has many important physiologic roles and is the primary source of nitrogen in
the body. Provides 4 kcal/g protein. Sources of protein in enteral feedings: sodium
caseinate, calcium caseinate, soy protein, dipeptides.
Carbohydrate (CHO): Provides energy for the body and heat to maintain body
temperature. Provides 3.4 kcal/g carbohydrate. Sources of CHO in enteral feedings:
corn syrup, cornstarch, maltodextrin, lactose, sucrose, glucose.
Fat: Provides concentrated source of energy. Referred to as kilocalorie dense or protein
sparing. Provides 9 kcal/g fat. Sources of fat in enteral feedings: corn oil, saI ower oil,
medium-chain triglycerides.
Electrolytes, vitamins, trace elements: Contained in formulas (not found in specialized
products for renal/hepatic insufficiency).
All products containing protein, fat, carbohydrate, vitamin, electrolytes, trace elements?
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are nutritionally complete and designed to be used by pts for long periods.
COMPLICATIONS
MECHANICAL: Usually associated with some aspect of the feeding tube.
Aspiration pneumonia: Caused by delayed gastric emptying, gastroparesis,
gastroesophageal re ux, or decreased gag re ex. May be prevented or treated by
reducing infusion rate, using lower-fat formula, feeding beyond pylorus, checking
residuals, using small-bore feeding tubes, elevating head of bed 30°–45° during and for
30–60 min after intermittent feeding, and regularly checking tube placement.
Esophageal, mucosal, pharyngeal irritation, otitis: Caused by using large-bore NG tube.
Prevented by use of small bore whenever possible.
Irritation, leakage at ostomy site: Caused by drainage of digestive juices from site.
Prevented by close attention to skin/stoma care.
Tube, lumen obstruction: Caused by thickened formula residue, formation of
formulamedication complexes. Prevented by frequently irrigating tube with clear water (also
before and after giving formulas/medication), avoiding instilling medication if
possible.
GASTROINTESTINAL: Usually associated with formula, rate of delivery, unsanitary
handling of solutions or delivery system.
Diarrhea: Caused by low-residue formulas, rapid delivery, use of hyperosmolar formula,
hypoalbuminemia, malabsorption, microbial contamination, or rapid GI transit time.
Prevented by using ber supplemented formulas, decreasing rate of delivery, using
dilute formula, and gradually increasing strength.
Cramps, gas, abdominal distention: Caused by nutrient malabsorption, rapid delivery of
refrigerated formula. Prevented by delivering formula by continuous methods, giving
formulas at room temperature, decreasing rate of delivery.
Nausea, vomiting: Caused by rapid delivery of formula, gastric retention. Prevented by
reducing rate of delivery, using dilute formulas, selecting low-fat formulas.
Constipation: Caused by inadequate uid intake, reduced bulk, inactivity. Prevented by
supplementing uid intake, using ber-supplemented formula, encouraging
ambulation.
METABOLIC: Fluid/serum electrolyte status should be monitored. Refer to monitoring
section. In addition, the very young and very old are at greater risk of developing
complications such as dehydration or overhydration.
MONITORING
Daily: Estimate nutrient intake, fluid intake/output, weight of pt, clinical observations.
Weekly: Serum electrolytes (potassium, sodium, magnesium, calcium, phosphorus),
blood glucose, BUN, creatinine, hepatic function tests (e.g., AST, alkaline phosphatase),
24-hr urea and creatinine excretion, total iron-binding capacity (TIBC) or serum
transferrin, triglycerides, cholesterol.
Monthly: Serum albumin.
Other: Urine glucose, acetone (when blood glucose is greater than 250), vital signs
(temperature, respirations, pulse, B/P) q8h.
DRUG THERAPY: DOSAGE FOR SELECTION/ADMINISTRATION:
Drug therapy should not have to be compromised in pts receiving enteral nutrition:
• Temporarily discontinue medications not immediately necessary.
• Consider an alternate route for administering medications (e.g., transdermal, rectal,
intravenous).
• Consider alternate medications when current medication is not available in alternate
dosage forms.
ENTERAL ADMINISTRATION OF MEDICATIONS:
Medications may be given via feeding tube with several considerations:K
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• Tube type
• Tube location in the GI tract
• Site of drug action
• Site of drug absorption
• Effects of food on drug absorption
• Use of liquid dosage forms is preferred whenever possible; many tablets may be
crushed; contents of many capsules may be emptied and given through large-bore
feeding tubes.
• Many oral products should not be crushed (e.g., sustained-release, enteric coated).
• Some medications should not be given with enteral formulas because they form
precipitates that may clog the feeding tube and reduce drug absorption.
• Feeding tube should be ushed with water before and after administration of
medications to clear any residual medication.

Nutrition: Parenteral
Parenteral nutrition (PN), also known as total parenteral nutrition (TPN) or
hyperalimentation (HAL), provides required nutrients to pts by IV route of
administration. The goal of PN is to maintain or restore nutritional status caused by
disease, injury, or inability to consume nutrients by other means.
INDICATIONS
Conditions when pt is unable to use alimentary tract via oral, gastrostomy, or
jejunostomy route. Impaired absorption of protein caused by obstruction,
in ammation, or antineoplastic therapy. Bowel rest necessary because of GI surgery or
ileus, stulas, or anastomotic leaks. Conditions with increased metabolic requirements
(e.g., burns, infection, trauma). Preserve tissue reserves (e.g., acute renal failure).
Inadequate nutrition from tube feeding methods.
COMPONENTS OF PN
To meet IV nutritional requirements, six essential categories in PN are needed for tissue
synthesis and energy balance.
Protein: In the form of crystalline amino acids (CAA), primarily used for protein
synthesis. Several products are designed to meet speci c needs for pts with renal failure
(e.g., NephrAmine), hepatic disease (e.g., HepatAmine), stress/trauma (e.g., Aminosyn
HBC), use in neonates and pediatrics (e.g., Aminosyn PF, TrophAmine). Calories: 4
kcal/g protein.
Energy: In the form of dextrose, available in concentrations of 5%–70%. Dextrose less
than 10% may be given peripherally; concentrations greater than 10% must be given
centrally. Calories: 3.4 kcal/g dextrose.
IV fat emulsion: Available in 10% and 20% concentrations. Provides a concentrated
source of energy/calories (9 kcal/g fat) and is a source of essential fatty acids. May be
administered peripherally or centrally.
Electrolytes: Major electrolytes (calcium, magnesium, potassium, sodium; also acetate,
chloride, phosphate). Doses of electrolytes are individualized, based on many factors
(e.g., renal/hepatic function, fluid status).
Vitamins: Essential components in maintaining metabolism and cellular function;
widely used in PN.
Trace elements: Necessary in long-term PN administration. Trace elements include zinc,
copper, chromium, manganese, selenium, molybdenum, iodine.
Miscellaneous: Additives include insulin, albumin, heparin, and histamine blockers2<
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(e.g., cimetidine, ranitidine, famotidine). Other medication may be included, but
compatibility for admixture should be checked on an individual basis.
ROUTE OF ADMINISTRATION
PN is administered via either peripheral or central vein.
Peripheral: Usually involves 2–3 L/day of 5%–10% dextrose with 3%–5% amino acid
solution along with IV fat emulsion. Electrolytes, vitamins, trace elements are added
according to pt needs. Peripheral solutions provide about 2,000 kcal/day and 60–90 g
protein/day.
ADVANTAGES: Lower risks vs. central mode of administration.
DISADVANTAGES: Peripheral veins may not be suitable (esp. in pts with illness of long
duration); more susceptible to phlebitis (due to osmolalities over 600 mOsm/L); veins
may be viable only 1–2 wks; large volumes of uid are needed to meet nutritional
requirements, which may be contraindicated in many pts.
Central: Usually utilizes hypertonic dextrose (concentration range of 15%–35%) and
amino acid solution of 3%–7% with IV fat emulsion. Electrolytes, vitamins, trace
elements are added according to pt needs. Central solutions provide 2,000–4,000
kcal/day. Must be given through large central vein with high blood ow, allowing
rapid dilution, avoiding phlebitis/thrombosis (usually through percutaneous insertion of
catheter into subclavian vein then advancement of catheter to superior vena cava).
ADVANTAGES: Allows more alternatives/ exibility in establishing regimens; allows
ability to provide full nutritional requirements without need of daily fat emulsion;
useful in pts who are uid restricted (increased concentration), those needing large
nutritional requirements (e.g., trauma, malignancy), or those for whom PN indicated
more than 7–10 days.
DISADVANTAGES: Risk with insertion, use, maintenance of central line; increased risk
of infection, catheter-induced trauma, and metabolic changes.
MONITORING
May vary slightly from institution to institution.
Baseline: CBC, platelet count, PT, weight, body length/head circumference (in infants),
serum electrolytes, glucose, BUN, creatinine, uric acid, total protein, cholesterol,
triglycerides, bilirubin, alkaline phosphatase, LDH, AST, albumin, other tests as needed.
Daily: Weight, vital signs (temperature, pulse, respirations [TPR]), nutritional intake
(kcal, protein, fat), serum electrolytes (potassium, sodium chloride), glucose (serum,
urine), acetone, BUN, osmolarity, other tests as needed.
2–3 times/wk: CBC, coagulation studies (PT, PTT), serum creatinine, calcium,
magnesium, phosphorus, acid-base status, other tests as needed.
Weekly: Nitrogen balance, total protein, albumin, prealbumin, transferrin, hepatic
function tests (AST, ALT), serum alkaline phosphatase, LDH, bilirubin, Hgb, uric acid,
cholesterol, triglycerides, other tests as needed.
COMPLICATIONS
Mechanical: Malfunction in system for IV delivery (e.g., pump failure; problems with
lines, tubing, administration sets, catheter). Pneumothorax, catheter misdirection,
arterial puncture, bleeding, hematoma formation may occur with catheter placement.
Infectious: Infections (pts often more susceptible to infections), catheter sepsis (e.g.,
fever, shaking chills, glucose intolerance where no other site of infection is identified).
Metabolic: Includes hyperglycemia, elevated serum cholesterol and triglycerides,
abnormal serum hepatic function tests.
Fluid, electrolyte, acid-base disturbances: May alter serum potassium, sodium, phosphate,
magnesium levels.
Nutritional: Clinical e ects seen may be due to lack of adequate vitamins, traceelements, essential fatty acids.
DRUG THERAPY/ADMINISTRATION METHODS: Compatibility of other intravenous
medications pts may be administered while receiving parenteral nutrition is an
important concern.
Intravenous medications usually are given as a separate admixture via piggyback to the
parenteral nutrition line, but in some instances may be added directly to the parenteral
nutrition solution. Because of the possibility of incompatibility when adding medication
directly to the parenteral nutrition solution, specific criteria should be considered:
• Stability of the medication in the parenteral nutrition solution
• Properties of the medication, including pharmacokinetics that determine if the
medication is appropriate for continuous infusion
• Documented chemical and physical compatibility with the parenteral nutrition
solution
In addition, when medication is given via piggyback using the parenteral nutrition line,
important criteria should include:
• Stability of the medication in the parenteral nutrition solution
• Documented chemical and physical compatibility with the parenteral nutrition
solutionObesity Management
USES
Adjunct to diet and physical activity in the treatment of chronic, relapsing obesity.
ACTIONS
Two categories of medications are used for weight control.
Appetite suppressants: Block neuronal uptake of norepinephrine, serotonin, dopamine,
causing a feeling of fullness or satiety.
Digestion inhibitors: Reversible lipase inhibitors that block the breakdown and absorption
of fats, decreasing appetite and reducing calorie intake.
ANOREXIANTS
Name Availability Dosage Side Effects
Diethylpropion (Tenuate, T: 25 mg, 25 mg 3 Headaches, insomnia,
Tenuate Dospan) 75 mg times/day nervousness, anxiety,
or 75 mg irritability, dry mouth,
once/day in constipation, euphoria,
midmorning palpitations, hypertension,
pulmonary hypertension,
valvular heart disease,
seizures, bone marrow
depression
Lorcaserin (BelViq) C: 10 mg 10 mg twice Nausea, headache, dizziness,
daily fatigue, dry mouth, diarrhea,
constipation, hypoglycemia,
hallucinations, decreased
white/red blood cells
Orlistat (p. 878) (Alli, C: 60 mg, 60–120 mg Flatulence, rectal incontinence,
Xenical) 120 mg 3 times/day oily stools, cholelithiasis,
with meals abdominal/rectal pain,
hepatitis, pancreatitis
Phenteramine (Apidex-P) C: 15 mg, 15–37.5 Headaches, insomnia,
30 mg, mg/day in nervousness, anxiety,
37.5 mg 1 or 2 irritability, dry mouth,
T: 37.5 mg divided constipation, euphoria,
doses palpitations, hypertension,
pulmonary hypertension,
valvular heart disease, tremor
Phenteramine/topiramate C: 13.75 3.75 mg/23 Paresthesia, dizziness,
(Qsymia) mg/23 mg mg to 15 insomnia, depression,
mg/92 mg tachycardia, cognitive
once daily impairment, angle-closure
glaucoma, hypokalemia,
metabolic acidosis
A S , Appetite suppressant; C , capsules; D I , digestion inhibitor; T , tablets.
Ophthalmic Medications For Allergic Conjunctivitis
Ophthalmic products used for allergic conjunctivitis include antihistamines, mast cell
stabilizing agents, combination antihistamine/decongestants, and corticosteroids.
Antihistamines selectively inhibit the H histamine receptor, thus antagonizing1
histamine-stimulated vascular permeability in the conjunctiva.
Mast cell stabilizing agents block the release of mediators of hypersensitivity
reactions from mast cells, eosinophils, neutrophils, macrophages, monocytes, and
platelets. They inhibit the release of histamine from mast cells. Combination
antihistamine/decongestants are used only for a short time because the regular use
of a decongestant may cause rebound congestion.
Mast cell stabilizers/antihistamine combinations provide both the quick action of
the antihistamine and more delayed action of the mast cell stabilizer. This latter
combination is used for mild to moderately severe allergic conjunctivitis.
Corticosteroids, although having no de6nite mechanism of action, exert their e7ect by
controlling the biosynthesis of potent mediators of inflammation.
ANTIHISTAMINE
Names Dosage Comments/Side Effects
Alcaftadine One drop each Eye irritation, burning/stinging on instillation, eye
0.25% eye once daily redness/pruritus, nasopharyngitis, headache,
(Lastacaft) influenza
ANTIHISTAMINE/DECONGESTANTS
Names Dosage Comments/Side Effects
Naphazoline/pheniramine One or two drops Remove contact lenses prior to
(Naphcon-A, Opcon-A, into affected eye(s) using
Visine-A) up to 4 times/day Do not use for more than 3 days
Not for use in pts with heart
disease, enlarged prostate, high
blood pressure, and/or glaucoma
Side effects: headache, mydriasis,
pain in eye
MAST CELL STABILIZER
Names Dosage Comments/Side Effects
Lodoxamine One to two drops Avoid wearing contact lenses during treatment
0.1% in affected eye(s) Side effects: burning, stinging, or irritation of eyes;
(Alomide) 4 times/day watery, itching eyes; blurred vision; headache;
dizziness; nausea or stomach discomfort
Nedocromil One or two drops Remove contact lenses prior to using; may reinsert
2% (Alocril) in affected eye(s) after 15 min if eyes are not red
2 times/day Side effects: headache, dizziness, blurring sensation
in eye, light intolerance
Pemirolast One or two drops Avoid wearing contact lenses if eyes are red
0.1% in affected eye(s) Remove contact lenses prior to using; may reinsert
(Alamast) 4 times/day after 10 min if eyes are not red
Side effects: foreign body sensation, headache, dry
eyes, burning sensationANTIHISTAMINE/MAST CELL STABILIZER
Names Dosage Comments/Side Effects
Azelastine 0.05% One drop in Avoid wearing contact lenses if eyes are red
(p. 102) (Optivar) affected eye(s) 2 Remove soft contact lenses prior to using;
times/day may reinsert after 10 min if eyes are not red
Side effects: headache, drowsiness, burning
sensation in eye
Epinastine 0.05% One drop in Avoid wearing contact lenses if eyes are red
(Elestat) affected eye(s) 2 Remove soft contact lenses prior to using;
times/day may reinsert after 10 min if eyes are not red
Side effects: headache, burning sensation in
eye
Ketotifen 0.025% One drop in Avoid wearing contact lenses if eyes are red
(Alaway, Zaditor) affected eye(s) 2 Remove soft contact lenses prior to using;
times/day may reinsert after 10 min if eyes are not red
Side effects: headache, dry eyes, eye
irritation, pain in eye
Olopatadine 0.1% One drop in Avoid wearing contact lenses if eyes are red
(Patanol) affected eye(s) 2 Remove soft contact lenses prior to using;
times/day may reinsert after 10 min if eyes are not red
Side effects: headache, burning sensation in
eye
CORTICOSTEROIDS
Names Dosage Comments/Side Effects
Loteprednol One drop in affected Recommended for short-term use only
0.2% (Alrex) eye(s) 4 times/day Remove soft contact lenses prior to using;
may reinsert after 10 min if eyes are not red
Side effects: abnormal vision, blurred vision,
burning sensation in eye, itching in eye, light
intolerance
Loteprednol One or two drops in Recommended for short-term use only
0.5% affected eye(s) 4 Remove soft contact lenses prior to using;
(Lotemax) times/day may reinsert after 10 min if eyes are not red
Side effects: abnormal vision, blurred vision,
burning sensation in eye, itching in eye, light
intolerance
Prednisolone Two drops in Recommended for short-term use only
1% (p. 975) affected eye(s) 2–4 Remove soft contact lenses prior to using;
(AK-Pred) times/day may reinsert after 10 min if eyes are not red
Side effects: blurred vision, burning sensation
or irritation in eye, pain in eye

Opioid AnalgesicsUSES
Relief of moderate to severe pain associated with surgical procedures, MI, burns,
cancer, or other conditions. May be used as an adjunct to anesthesia, either as a preop
medication or intraoperatively as a supplement to anesthesia. Also used for obstetric
analgesia. Codeine and hydrocodone have an antitussive e7ect. Opium tinctures, such
as paregoric, are used for severe diarrhea. Methadone relieves severe pain but is used
primarily as part of heroin detoxification.
ACTION
Opioids refer to all drugs having actions similar to morphine and to receptors
combining with these agents. Major e7ects are on the CNS (produce analgesia,
drowsiness, mood changes, impaired concentration, analgesia without loss of
consciousness, nausea and vomiting) and GI tract (decrease HCl secretion; diminish
biliary, pancreatic, and intestinal secretions; diminish propulsive peristalsis). Also
a7ect respiration (depressed) and cardiovascular system (peripheral vasodilation,
decrease peripheral resistance, inhibit baroreceptor reflexes).
OPIOID ANALGESICS
Analgesic Effect
Names Equianalgesic Onset Peak Duration Dosage Range
Dose (min) (min) (hrs)
Butorphanol (Stadol) IM: 2 mg IM: IM: IM: 3–4 IM: 1–4 mg q3–4h
IV: — 10– 30– IV: 2–4 IV: 0.5–2 mg q3–4h
30 60
IV: IV:
2–3 30
Codeine (p. 273) IM: 15–30 IM: IM: IM/PO: IM/PO (A): 15–60 mg
mg 10– 30– 4–6 q4–6h; (C): 0.5 mg/kg
PO: 15–30 30 60 q4–6h
mg PO: PO:
30– 60–
45 120
Fentanyl (p. 472) IM: 0.1–0.2 IM: IM: IM: 1–2 IM: 50–100 mcg q1–2h
(Sublimaze) mg 7–15 20– IV: 0.5–
IV: — IV: 30 1
1–2 IV:
3–5
Hydrocodone (p. 566) PO: 5–10 mg 10– 30– 4–6 5–10 mg q4–6h
30 60
Hydromorphone (p. PO: 7.5 mg PO: PO: PO: 4–5 PO: 1–4 mg q3–6h
571) (Dilaudid) IM: 1.5 mg 30 90– IM: 4–5 IM: 1–4 mg q3–6h
IM: 120 IV: 4 IV: 0.5–1 mg q3h
15 IM: R: 3 mg q4–8h
IV: 30–
10– 60
15 IV:
15–
30
Meperidine (p. 739) PO: 300 mg PO: PO: 2–4 PO, IM (A): 50–150 mg
(Demerol) IM: 75 mg 15 60– q3–4h; (C): 1–1.8IV: — IM: 90 mg/kg q3–4hAnalgesic Effect
10– IM:
Names Equianalgesic Onset Peak Duration Dosage Range15 30–
Dose (min) (min) (hrs)IV: 1 60
IV:
5–7
Methadone (p. 749) PO: 10–20 PO: PO: PO: 4–6 IM, PO: 2.5–10 mg q3–
(Dolophine) mg 30– 90– IM: 4–5 4h
IM: 10 mg 60 120 IV: 3–4
IM: IM:
10– 60–
20 120
IV: — IV:
15–
30
Morphine (p. 797) PO: 30 mg PO: PO: PO: 4 PO: 10–30 mg q4h
(MS Contin, Roxanol) IM: 10 mg 30– 90 IM/IV: IM: 5–20 mg q4h
IV: — 60 IM: 4–5 IV: 0.05–0.1 mg/kg
IM: 30– q4h
10– 60
30 IV:
IV: — 20
Nalbuphine (p. 811) IM: 10 mg IM: IM: IM: 3–6 IM/IV: 10–20 mg q3–
(Nubain) IV: — 2–15 60 IV: 3–4 6h
IV: IV:
2–3 30
Oxycodone (p. 888) PO: 20–30 30 60 3–4 5–15 mg or 5 ml q4–
(Roxicodone) mg 6h; (ER): q12h (dose
titrated)
Oxymorphone (p. PO: 10 mg IM: N/A IM/IV: PO: 10–20 mg q4–6h
890) (Opana, Opana IM: 1 mg 5–10 3–6 ER: Half PO total daily
ER) min dose q12h
A , Adults; C , children; E R , extended-release

Osteoporosis
HISTORY
Osteoporosis is a bone disease that can lead to fractures. Bone mineral density (BMD) is
reduced, bone micro-architecture is disrupted, and the amount and variety of proteins
in bone are altered. Osteoporosis primarily a7ects women after menopause
(postmenopausal osteoporosis) but may develop in men, in anyone in the presence of
particular hormonal disorders (e.g., parathyroid glands), after overconsumption of
dietary proteins, or as a result of medications (e.g., glucocorticoids). Several
pharmacologic options, along with lifestyle changes, that can be used to prevent
and/or treat osteoporotic fractures include bisphosphonates, selective estrogen receptor
modulator (SERM), parathyroid hormone (PTH), calcitonin, and monoclonal
antibodies.ACTION
Bisphosphonates: Inhibit bone resorption via actions on osteoclasts or osteoclast
precursors, decrease the rate of bone resorption, leading to an indirect increase in
BMD.
Selective estrogen receptor modulator (SERM): Decreases bone resorption, increasing BMD
and decreasing the incidence of fractures.
Parathyroid hormone: Stimulates osteoblast function, increasing gastrointestinal calcium
absorption and increasing renal tubular reabsorption of calcium. This increases BMD,
bone mass, and strength, resulting in a decrease in osteoporosis-related fractures.
Calcitonin: Inhibitor of bone resorption. EB cacy not observed in early postmenopausal
women and is used only in women with osteoporosis who are at least 5 yrs beyond
menopause.
Monoclonal antibody: Inhibits the RANK ligand (RANKL), a cytokine member of the
tumor necrosis factor family. This inhibits osteoclast formation, function, and survival,
which decreases bone resorption and increases bone mass and strength in cortical and
trabecular bone.
BISPHOSPHONATES
Name Availability Dosage Side Effects
Alendronate T: 5 mg, 10 Prevention: 5 Transient, mild hypocalcemia,
(p. 30) mg, 35 mg, mg/day or 35 hypophosphatemia, dysphagia,
(Fosamax) 40 mg, 70 mg/wk esophagitis, esophageal and gastric
mg Treatment: 10 ulcer, abdominal pain, diarrhea,
S: 70 mg/day or 70 musculoskeletal pain
mg/75ml mg/wk
Ibandronate T: 2.5 mg, Prevention and Dyspepsia, back pain, dysphagia,
(p. 580) 150 mg treatment: 2.5 esophagitis, esophageal and gastric
(Boniva) I: 1 mg/ml mg/day or 150 ulcer, abdominal pain, diarrhea,
mg/mo musculoskeletal pain
IV Injection:
Treatment: 3
mg/3 mos
Risedronate T: 5 mg, 30 Prevention and Hypertension, headache, rash,
(p. 1042) mg, 35 mg, treatment: 5 dysphagia, esophagitis, esophageal and
(Actonel) 150 mg mg/day, 35 gastric ulcer, abdominal pain, diarrhea,
mg/wk, or 150 musculoskeletal pain
mg/month
Zoledronic I: 5 mg Prevention: IV: Hypertension, pain, fever, headache,
acid (p. 5 mg every 2 yrs chills, fatigue, nausea, musculoskeletal
1271) Treatment: IV: 5 pain
(Aclasta) mg every yr
SERM
Name Availability Dosage Side Effects
Raloxifene T: 60 mg Prevention and Peripheral edema, hot flashes,
(p. 1014) treatment: 60 arthralgia, leg cramps, muscle spasms,
(Evista) mg/day flu syndrome, infection
PARATHYROID HORMONEName Availability Dosage Side Effects
Teriparatide I: 250 mcg/ml Treatment: 20 mcg Hypercalcemia, muscle
(p. 1148) syringe delivers 20 subcutaneously once cramps, nausea, dizziness,
(Forteo) mcg/dose daily headache
CALCITONIN
Name Availability Dosage Side Effects
Calcitonin I (Miacalcin): Treatment: Rhinitis, local nasal irritation.
(p. 168) 200 units/ml IM/Subcutaneous Injection: nausea, local
(Fortical, Nasal (Miacalcin): 100 units inflammation, flushing of
Miacalcin) (Fortical, every other day face, hands
Miacalcin): Nasal: 200 units in 1
200 nostril daily
units/activation
MONOCLONAL ANTIBODY RANKL INHIBITOR
Name Availability Dosage Side Effects
Denosumab I: 60 Subcutaneous: 60 Back pain, pain in extremity,
(p. 324) mg/ml mg once every 6 hypercholesterolemia, musculoskeletal
(Prolia) mos pain, cystitis
I , injection; I M , intramuscular; I V , intravenous; S , solution (oral); T , tabletParkinson’s Disease Treatment
USES
To slow or stop clinical progression of Parkinson’s disease and to improve function and
quality of life in pts with Parkinson’s disease, a progressive neurodegenerative disorder.
ACTION
Normal motor function is dependent on the synthesis and release of dopamine by
neurons projecting from the substantia nigra to the corpus striatum. In Parkinson’s
disease, disruption of this pathway results in diminished levels of the neurotransmitter
dopamine. Medication is aimed at providing improved function using the lowest
effective dose.
TYPES OF MEDICATIONS FOR PARKINSON’S DISEASE DOPAMINE PRECURSOR
Levodopa/carbidopa:
Levodopa: Dopamine precursor supplementation to enhance dopaminergic
neurotransmission. A small amount of levodopa crosses the blood-brain barrier and is
decarboxylated to dopamine, which is then available to stimulate dopaminergic
receptors.
Carbidopa: Inhibits peripheral decarboxylation of levodopa, decreasing its conversion
to dopamine in peripheral tissues, which results in an increased availability of
levodopa for transport across the blood-brain barrier.
COMT INHIBITORS
Entacapone, tolcapone: Reversible inhibitor of catechol-O-methyltransferase
(COMT). COMT is responsible for catalyzing levodopa. In the presence of a
decarboxylase inhibitor (carbidopa), COMT becomes the major metabolizing enzyme
for levodopa in the brain and periphery. By inhibiting COMT, higher plasma levels of
levodopa are attained, resulting in more dopaminergic stimulation in the brain and
lessening the symptoms of Parkinson’s disease.
DOPAMINE RECEPTOR AGONISTS
Bromocriptine: Stimulates postsynaptic dopamine type 2 receptors in the neostriatum
of the CNS.
Pramipexole: Stimulates dopamine receptors in the striatum of the CNS.
Ropinirole: Stimulates postsynaptic dopamine D2 type receptors within the caudate
putamen in the brain.
MONOAMINE OXIDASE B INHIBITORS
Rasagiline, Selegiline: Increase dopaminergic activity due to irreversible inhibition of
monoamine oxidase type B (MAO B). MAO B is involved in the oxidative deamination
of dopamine in the brain.
MEDICATIONS FOR TREATMENT OF PARKINSON’S DISEASE
Name Type Availability Dosage Side Effects
Bromocriptine (p. Dopamine T: 2.5 mg 15–45 Nausea, drowsiness,
150) (Parlodel) agonist C: 5 mg mg/day lower extremity edema,
in 2–3 postural hypotension,
divided confusion, toxicdoses psychosis (avoid use inName Type Availability Dage Side Effects
pts with dementia)
Carbidopa/levodopa Dopamine Orally- Parcopa: Anorexia, nausea,
(p. 182) (Parcopa, precursor disintegrating 300– vomiting, orthostatic
Sinemet, Sinemet (Parcopa): 1,500 mg hypotension initially;
CR) 10/100 mg, levodopa vivid dreams,
25/100 mg, in divided hallucinations,
25/250 mg doses delusions, confusion,
Immediate- Sinemet: and sleep disturbances
release 300– with chronic use
(Sinemet): 1,500 mg
10/100 mg, levodopa
25/100 mg, in divided
25/250 mg doses
Controlled- Sinemet
release CR: 400–
(Sinemet CR): 2,200 mg
25/100 mg, levodopa
50/200 mg in divided
doses
Entacapone (p. 412) COMT T: 200 mg 200 mg Dyskinesias, nausea,
(Comtan) inhibitor 3–4 diarrhea, urine
times/day discoloration
Pramipexole (p. 967) Dopamine T: 0.125 mg, T: 0.5–1.5 Nausea, drowsiness,
(Mirapex, Mirapex agonist 0.25 mg, 0.5 mg 3 lower extremity edema,
ER) mg, 1 mg, 1.5 times/day postural hypotension,
mg ER: confusion, toxic
ER: 0.375 mg, 0.375–4.5 psychosis (avoid use in
0.75 mg, 1.5 mg/day pts with dementia)
mg, 3 mg, 4.5
mg
Rasagiline (p. 1023) MAO B T: 0.5 mg, 1 0.5–1 mg Nausea, orthostatic
(Azilect) inhibitors mg once hypotension
daily
Ropinirole (p. 1058) Dopamine T: 0.25 mg, 0.5 T: 3–8 mg Nausea, drowsiness,
(Requip, Requip XL) agonist mg, 1 mg, 2 3 lower extremity edema,
mg, 3 mg, 4.5 times/day postural hypotension,
mg XL: Up to confusion, toxic
XL: 2 mg, 4 24 psychosis (avoid use in
mg, 6 mg, 8 mg/day pts with dementia)
mg, 12 mg
Selegiline (p. 1074) MAO B C (Eldepryl): 5 C: 5 mg Nausea, orthostatic
(Eldepryl, Zelapar) inhibitor mg with hypotension
OD (Zelapar): breakfast
1.25 mg and lunch
OD: 1.25–
2.5 mg
daily in
the
morning
Tolcapone (Tasmar) COMT T: 100 mg, 200 100 mg 3 Dyskinesias, nausea,
inhibitor mg times/day diarrhea, urine=
discolorationName Type Availability Dosage Side Effects
C, Capsules; COMT, catechol-O-methyltransferase; ER, extended-release; I, injection;
MAO B, monoamine oxidase B; OD, orally-disintegrating; T, tablets; XL,
extendedrelease.

Proton Pump Inhibitors
USES
Treatment of various gastric disorders, including gastric and duodenal ulcers,
gastroesophageal reflex disease (GERD), pathologic hypersecretory conditions.
ACTION
Suppress gastric acid secretion by speci c inhibition of the
hydrogen-potassium+ +adenosine triphosphatase (H /K ATPase) enzyme system, which transports the acid
at the gastric parietal cells. These agents do not have anticholinergic or histamine
receptor antagonistic properties.
PROTON PUMP INHIBITORS
Name Availability Indications Usual Side Effects
Dosage
Dexlansoprazole C: 30 mg, Erosive esophagitis, heartburn 30 Diarrhea,
(p. 335) 60 mg associated with nonerosive mg/day abominal
(Dexilant) GERD pain, nausea,
upper
respiratory
tract
infection,
vomiting,
flatulence
Esomeprazole (p. C: 20 mg, H. pylori eradication, GERD, 20–40 Headaches,
437) (Nexium) 40 mg erosive esophagitis mg/day diarrhea,
I: 20 mg abdominal
pain, nausea
Lansoprazole (p. C: 15 mg, Duodenal ulcer, gastric ulcer, 15–30 Diarrhea, skin
663) (Prevacid) 30 mg NSAID-associated gastric ulcer, mg/day rash, pruritus,
I: 30 mg hypersecretory conditions, H. headaches
pylori eradication, GERD,
erosive esophagitis
Omeprazole (p. C: 10 mg, Duodenal ulcer, gastric ulcer, 20–40 Headaches,
873) (Prilosec) 20 mg, 40 hypersecretory conditions, H. mg/day diarrhea,
mg pylori eradication, GERD, abdominal
erosive esophagitis pain, nausea
Omeprazole and C: 20 mg, Duodenal ulcer, benign gastric 20–40 Headaches,
Sodium 40 mg ulcer, GERD, erosive mg/day abdominal
Bicarbonate (p. P: 20 mg, esophagitis pain,
873) (Zegerid) 40 mg diarrhea,
nauseaPantoprazole (p. T: 20 mg, Erosive esophagitis, 40 Diarrhea,Name Availability Indcations Usual Side Effects
906) (Protonix) 40 mg hypersecretory conditions mg/day headachesDosage
I: 40 mg
Rabeprazole (p. T: 20 mg Duodenal ulcer, 20 Headaches
1013) (Aciphex) hypersecretory conditions, H. mg/day
pylori eradication, GERD,
erosive esophagitis
C, Capsules; GERD, gastroesophageal reAux disease; I, injection; NSAID, nonsteroidal
anti-inflammatory drug; P, powder for suspension; T, tablets.
"
Sedative-Hypnotics
USES
Treatment of insomnia (i.e., di culty falling asleep initially, frequent awakening,
awakening too early).
ACTION
Benzodiazepines are the most widely used agents and largely replace barbiturates due to
greater safety, lower incidence of drug dependence. Benzodiazepines nonselectively
bind to at least three receptor subtypes accounting for sedative, anxiolytic, relaxant,
and anticonvulsant properties. Benzodiazepines enhance the e ect of the inhibitory
neurotransmitter gamma-aminobutyric acid (GABA), which inhibits impulse
transmission in the CNS reticular formation in brain. Benzodiazepines decrease sleep
latency, number of nocturnal awakenings, and time spent in awake stage of sleep;
increase total sleep time. The nonbenzodiazepines zaleplon and zolpidem preferentially
bind with one receptor subtype, reducing sleep latency and nocturnal awakenings and
increasing total sleep time.
SEDATIVE-HYPNOTICS
Name Availability Dosage Side Effects
Range
Benzodiazepines
Estazolam (ProSom) T: 1 mg, 2 A: 1–2 Daytime sedation, memory and
mg mg psychomotor impairment, tolerance,
E: 0.5– withdrawal reactions, rebound
1 mg insomnia, dependence
Flurazepam (p. 499) C: 15 mg, 30 A/E: Headaches, unpleasant taste, dry
(Dalmane) mg 15–30 mouth, dizziness, anxiety, nausea
mg
Quazepam (Doral) T: 7.5 mg, 15 A: 7.5– Same as flurazepam
mg 15 mg
E: 7.5
mg
Temazepam (p. 1134) C: 7.5 mg, 15 A: 15– Same as flurazepam
(Restoril) mg, 30 mg 30 mg
E: 7.5–
15 mg
Nonbenzodiazepines
Eszopiclone (p. 444) T: 1 mg, 2 A: 2–3 Headaches, unpleasant taste, dry
(Lunesta) mg, 3 mg mg mouth, dizziness, anxiety, nausea
E: 1–2
mg
Ramelteon (p. 1017) T: 8 mg A, E: 8 Headaches, dizziness, fatigue, nausea
(Rozerem) mg
Zaleplon (p. 1264) C: 5 mg, 10 A: 5– Headaches, dizziness, myalgia,
(Sonata) mg 10 mg drowsiness, asthenia (loss of strength,
E: 5 energy), abdominal pain
mgZolpidem (p. 1274) T: 5 mg, 10 A: 10 Dizziness, daytime drowsiness,Name Availability Dosage Side Effects
(Ambien, Ambien CR, mg mg, headaches, confusion, depression,Range
Edluar, Zolpimist) CR: 6.25 mg, 12.5 hangover, asthenia (loss of strength,
12.5 mg mg energy)
SL: 5 mg, 10 E: 5
mg mg,
OS: 5 6.25
mg/actuation mg
A , Adults; C , capsules; C R , controlled-release; E , elderly; O S , oral solution; S L ,
sublingual; T , tablets.

Skeletal Muscle Relaxants
USES
Central acting muscle relaxants: Adjunct to rest, physical therapy for relief of discomfort
associated with acute, painful musculoskeletal disorders (i.e., local spasms from muscle
injury).
Baclofen, dantrolene, diazepam: Treatment of spasticity characterized by heightened
muscle tone, spasm, loss of dexterity caused by multiple sclerosis, cerebral palsy, spinal
cord lesions, CVA.
ACTION
Central acting muscle relaxants: Exact mechanism unknown. May act in CNS at various
levels to depress polysynaptic reflexes; sedative effect may be responsible for relaxation
of muscle spasm.
Baclofen, diazepam: May mimic actions of gamma-aminobutyric acid on spinal neurons;
does not directly affect skeletal muscles.
Dantrolene: Acts directly on skeletal muscle, relieving spasticity.
SKELETAL MUSCLE RELAXANTS
Name Indication Dosage Range Side Effects/Comments
Baclofen (p. Spasticity Initially 5 mg 3 Drowsiness, dizziness, GI
110) (Lioresal) associated with times/day effects
multiple Increase by 5 mg Caution with renal
sclerosis, spinal 3 times/day impairment, seizure disorders
cord injury q3days Withdrawal syndrome (e.g.,
Maximum: 20 mg hallucinations, psychosis,
4 times/day seizures)
Carisoprodol Discomfort due 250–350 mg 4 Drowsiness, dizziness, GI
(Rela) to acute, times/day effects
painful, Hypomania at higher than
musculoskeletal recommended doses
conditions Withdrawal syndrome
Hypersensitivity reaction
(skin reaction,
bronchospasm, weakness,
burning eyes, fever) oridiosyncratic reactionName Indication Dosage Range Side Effects/Commets
(weakness, visual or motor
disturbances, confusion)
usually occurring within first
4 doses
Chlorzoxazone Discomfort due Initially 250–500 Drowsiness, dizziness, GI
(Parafon Forte) to acute, mg 3–4 times/day effects; rare hepatotoxicity
painful, Maximum: 750 Hypersensitivity reaction
musculoskeletal mg 3–4 times/day (urticaria, itching)
conditions Urine discoloration to
orange, red, or purple
Cyclobenzaprine Muscle spasm, Initially 5–10 mg Drowsiness, dizziness, GI
(p. 287) pain, 3 times/day effects
(Flexeril) tenderness, Maximum: 20 mg Anticholinergic effects (dry
restricted 3 times/day mouth, urinary retention)
movement due Quinidine-like effects on
to acute, heart (QT prolongation)
painful, Long half-life
musculoskeletal
conditions
Dantrolene (p. Spasticity Initially 25 Drowsiness, dizziness, GI
301) (Dantrium) associated with mg/day for 1 effects
multiple week, then 25 mg Contraindicated with hepatic
sclerosis, 3 times/day for 1 disease
cerebral palsy, week, then 50 mg Dose-dependent
spinal cord 3 times/day for 1 hepatotoxicity
injury week, then 100 Diarrhea that is dose
mg 3 times/day dependent and may be
Maximum: 100 severe, requiring
mg 4 times/day discontinuation
Diazepam (p. Spasticity 2–10 mg 3–4 Drowsiness, dizziness, GI
342) (Valium) associated with times/day effects
cerebral palsy, Abuse potential
spinal cord
injury; reflex
spasm due to
muscle, joint
trauma or
inflammation
Metaxalone (p. Discomfort due 800 mg 3–4 Drowsiness (low risk),
746) (Skelaxin) to acute, times/day dizziness, GI effects
painful, Paradoxical muscle cramps
musculoskeletal Mild withdrawal syndrome
conditions Contraindicated in serious
hepatic or renal disease
Methocarbamol Discomfort due Initially 1,500 mg Drowsiness, dizziness, GI
(p. 752) to acute, 4 times/day effects
(Robaxin) painful, Maintenance: Urine discoloration to brown,
musculoskeletal 1,000 mg 4 brown-black, or green
conditions times/day
Orphenadrine Discomfort due 100 mg 2 Drowsiness, dizziness, GI
(Norflex) to acute, times/day effectspainful, Long half-lifeName Indication Dosage Range Side Effects/Comments
musculoskeletal Anticholinergic effects (dry
conditions mouth, urinary retention)
Rare aplastic anemia
Some products may contain
sulfites
Tizanidine (p. Spasticity Initially 4 mg q6– Drowsiness, dizziness, GI
1176) (Zanaflex) 8h (Maximum 3 effects
times/day), may Hypotension (20% decrease
increase by 2–4 in B/P)
mg as Hepatotoxicity (usually
needed/tolerated reversible)
Maximum: 36 mg Withdrawal syndrome
(limited (hypertension, tachycardia,
information on hypertonia)
doses greater than Effect is short lived (3–6 hrs)
24 mg) Dose cautiously with
creatinine clearance less than
25 ml/min

Smoking Cessation Agents
Tobacco smoking is associated with the development of lung cancer and chronic
obstructive pulmonary disease. Smoking is harmful not just to the smoker but also to
family members, coworkers, and others breathing cigarette smoke.
Quitting smoking decreases the risk of developing lung cancer, other cancers, heart
disease, stroke, and respiratory illnesses. Several medications have proved useful as
smoking cessation aids. Nausea and light-headedness are possible signs of overdose of
nicotine warranting a reduction in dosage.
SMOKING CESSATION AGENTS
Name Availability Dose Duration Cautions/Side Effects Comments
Bupropion T: 150 mg 150 mg every History of seizure, Stop smoking
(p. 158) morning for 3 eating disorder, use during second wk
(Zyban) days, then 150 of MAOI within of treatment and
mg 2 times/day previous 14 days, use counseling
Start 1–2 wks bipolar disorder support services
before quit date Side Effects: along with
Duration: 7–12 Insomnia, dry mouth, medication
wks up to 6 tremor, rash
mos for
maintenance
Clonidine (p. T: 0.1 mg, Oral: 0.15–0.75 Rebound Abrupt
265) 0.2 mg mg/day hypertension. discontinuation
(Catapres, Patch: 0.1 Patch: 0.1–0.2 Side Effects: Dry can result in
Catapres- mg/24 hrs, mg daily mouth, drowsiness, anxiety, agitation,
TTS) 0.2 mg/24 Duration: 3–10 dizziness, sedation, headaches,
hrs, 0.3 weeks constipation tremorsmg/24 hrs accompanied orName Availability Dose Duration Cautions/Side Effects Coments
followed by rapid
rise in B/P
Nicotine Squares: 2 1 gum q1–2h Recent MI (within 2 2 mg
gum (p. 835) mg, 4 mg for 6 wks, then wks), serious recommended for
(Nicorette, q2–4h for 3 wks arrhythmias, serious pts smoking less
Thrive) Maximum: 24 or worsening angina than 25
pieces/day pectoris cigarettes/day, 4
Duration: up to Side Effects: mg for pts
12 wks Dyspepsia, mouth smoking 25 or
soreness, hiccups more
cigarettes/day
Chew until a
peppery or minty
taste emerges and
then “park”
between cheek
and gums to
facilitate nicotine
absorption
through oral
mucosa
Chew slowly and
intermittently to
avoid jaw ache
and achieve
maximum benefit
Only water should
be taken 15 min
before and during
chewing
Nicotine Cartridge: 6–16 cartridges Recent MI (within 2 Use at or above
inhaler (p. 10 mg daily; taper wks), serious room temperature
835) (delivers 4 frequency of arrhythmias, serious (cold temperatures
(Nicotrol) mg use over the or worsening angina decrease amount
nicotine) last 6–12 wks pectoris of nicotine
Duration: up to Side Effects: Local inhaled)
6 mos irritation of mouth
and throat, coughing,
rhinitis
Nicotine Lozenges: One lozenge Recent MI (within 2 First cigarette
lozenge (p. 2 mg, 4 mg q1–2h for 6 wks), serious smoked within 30
835) wks, then q2– arrhythmias, serious min of waking,
(Commit) 4h for 3 wks, or worsening angina use 4 mg; after 30
then q4–8h for pectoris min of waking,
3 wks Side Effects: Local use 2 mg
Duration: 12 skin reaction, Use at least 9
wks insomnia, nausea, lozenges/day first
sore throat 6 wks
Only 1 lozenge at
a time, 5 per 6 hrs
and 20 per 24 hrs
Do not chew or
swallowNicotine 10 mg/ml 8–40 doses/day Recent MI (within 2 Do not sniff,ame Availability Dose Duration Cautions/Side Effects Cmments
nasal spray (delivers A dose consists wks), serious swallow, or inhale
(p. 835) 0.5 of one 0.5 mg arrhythmias, serious through nose
(Nicotrol NS) mg/spray) delivery to each or worsening angina while
nostril; initial pectoris administering
dose is 1–2 Side Effects: Nasal nicotine doses
sprays/hr, irritation (may increase
increasing as irritation)
needed Tilt head back
Duration: 3–6 slightly for best
mos results
Nicotine Nicoderm Apply upon Recent MI (within 2 The 16- and 24-hr
patch (p. CQ: 7 waking on quit wks), serious patches are of
835) mg/24 hrs, date: arrhythmias, serious comparable
(NicoDerm 14 mg/24 Nicoderm CQ: or worsening angina efficacy
CQ) hrs, 21 21 mg/24 hrs pectoris Begin with a
mg/24 hrs for 4 wks, then Side Effects: Local lower-dose patch
Nicotrol: 5 14 mg/24 hrs skin reaction, in pts smoking 10
mg/16 hrs, for 2 wks, then insomnia or fewer
10 mg/16 7 mg/24 hrs for cigarettes/day
hrs, 15 2 wks Place new patch
mg/16 hrs Nicotrol: 15 on relatively
hairmg/16 hrs for 6 free location,
wks, then 10 usually between
mg/16 hrs for 2 neck and waist,
wks, then 5 in the morning
mg/16 hrs for 2 If insomnia
wks occurs, remove the
24-hr patch prior
to bedtime or use
the 16-hr patch
Rotate patch site
to diminish skin
irritation
Nortriptyline T: 25 mg, Initially 25 Risk of arrhythmias Initiate therapy
(p. 854) 50 mg, 75 mg/day, Side Effects: 10–28 days before
(Pamelor) mg, 100 increasing Sedation, dry mouth, the quit date to
mg gradually to blurred vision, allow steady state
target dose of urinary retention, of nortriptyline at
75–100 mg/day light-headedness, target dose
Duration: up to shaky hands
12 wks
Varenicline T: 0.5 mg, Days 1–3: 0.5 Side Effects: Nausea; Use lower dosage
(p. 1232) 1 mg mg daily; days sleep disturbances; if not able to
(Chantix) 4–7: 0.5 mg 2 headaches; may tolerate nausea
times/day; day impair ability to and vomiting
8 to end of drive, operate Use counseling
treatment: 1 machinery; depressed support services
mg 2 times/day mood; altered along with
Duration: behavior; suicidal medication
begin 1 wk ideation reported
before set quit
date continue"
for 12 wks.Name Availability Dose Duration Cautions/Side Effects Comments
May use
additional 12
wks if failed to
quit after first
12 wks
M A O I , Monoamine oxidase inhibitor; M I , myocardial infarction; T , tablets.

Sympathomimetics
USES
Stimulation of alpha -receptors: Induce vasoconstriction primarily in skin and mucous1
membranes, nasal decongestion; combine with local anesthetics to delay anesthetic
absorption; increases B/P in certain hypotensive states; produce mydriasis, facilitating
eye exams, ocular surgery.
Stimulation of beta -receptors: Treatment of cardiac arrest, heart failure, shock, AV block.1
Stimulation of beta -receptors: Treatment of asthma.2
Stimulation of dopamine receptors: Treatment of shock.
ACTION
The sympathetic nervous system (SNS) is involved in maintaining homeostasis
(involved in regulation of heart rate, force of cardiac contractions, B/P, bronchial
airway tone, carbohydrate, fatty acid meters [primarily norepinephrine, epinephrine,
and dopamine]), which act on adrenergic receptors. These receptors include beta ,1
beta , alpha , alpha , and dopaminergic. Sympathomimetics di er widely in their2 1 2
actions based on their specificity to affect these receptors.
• Alpha : Causes mydriasis, constriction of arterioles, veins.1
• Alpha : Inhibits transmitter release.2
• Beta : Increases rate, force of contraction, conduction velocity of heart; releases renin1
from kidney.
• Beta : Dilates arterioles, bronchi, relaxes uterus.2
• Dopaminergic: Dilates kidney vasculature.
SYMPATHOMIMETICS
Name Availability Receptor Uses Dosage Range
Specificity
Dobutamine (p. I: 12.5 mg/ml, 500 Beta , beta , Inotropic IV infusion:1 2
368) (Dobutrex) mg/250 ml alpha support in 2.5–101
cardiac mcg/kg/min
decompensation
Dopamine (p. I: 40 mg/ml, 80 Beta , Vasopressor, Dopaminergic:1
377) (Intropin) mg/ml, 160 mg/ml alpha , cardiac 0.5–31
vials, 800 mcg/ml, dopaminergic stimulant mcg/kg/min
1,600 mcg/ml Beta : 2–101
mcg/kg/min
Alpha : more1
than 10