remembering meds? anyone?

[AmyD_RN]

ok lets just say you are on page 659 of saunders and you are reading about the endocrine meds......lets just say.

and at the bottom of the page there are 4 medicines and what they are used for and what the side effects are for each one.

How in the heck are you supposed to remember these??? (and all the others?)

I mean is there a trick to the names?

one ends in -ide

one ends in -ine

one is somatrem and the other somatropin

I am just asking about these 4 cause it is what I am on at the moment. but lets just say I am asking about the other million meds tooo!!! can you feel my fustration?

please help me see the light at the end of the tunnel...LOL:o

AmyD

[Rozy]

Hello someone emailed me this and I am going to pass it on! I hope this HELPS EVERYONE! NURSE ROZY

DRUGS MOST COMMONLY COVERED ON NCLEX

SKIN:REPRO/GUT:

Psoralen,Sulfa

Tretinon,Mycostatin

Silverdene,Pyridium

Sulfamylon,Narcotics

Colchicine

NEURO:NEURO/MUSCULO:

Mannitol,Flexeril

Decadron,Baclofen

Dilantin,Dopernergic/Levodopa

Tegretol,Fosamax

EEN:BLOOD:

Timoptic,Iron

Miotic,Heparin

AT SO4,Lovenox

Erythromycin Ointment,Thrombolytics/Aspirin

Epogen

HEART: ANTIBIOTIC:

Digoxin,Cipro

Fusid,Doxycycline

Antihypertensive

Nitro,Viagra,Sandimmune

LUNGS:

Antitubercular

AntiAsthma/MDIs

ABT

Steroids

Zafirlukast

GIT:

H2 Receptors

Anticholinergics

Antacid/Mylanta

Proton Pump Inhibitors

Lactulose

ENDOCRINE:

Insulin

Hormones for Life

Tapazole

Synthroid

HERBAL MEDS

St. John's wort - antidepressant, photosensitive (C/I

in SULFA drugs)

Garlic - antihypertensive (avoid aspirin)

Ginseng - Anti stress (C/I in coumadin)

Green tea - antioxidant (check if risk for

calculi-oxalates)

Echinacea - immune stimulant (6-8 weeks only)(C/I in

SANDIMMUNE-Immunosuppressant)

Licorice - cough and cold

Ginger root - antinausea (C/I in Coumadin)

Ginkgo - improves circulation (C/I in anticoagulant,

headache side effect - check PT)

Ma huang - bronchodilator, stimulant (Ephedra)

[AmyD_RN]

awesome Rozy thanks so much!!!! already printed them off!

[eliza_mae017]

Thankz ROZY:Melody:

[BORI-BSNRN, BSN, RN]

Thanks Rozy RN!! God bless you!! That drug list its awsome!!

Bori

[inkbh]

Hello someone emailed me this and I am going to pass it on! I hope this HELPS EVERYONE! NURSE ROZY

DRUGS MOST COMMONLY COVERED ON NCLEX

SKIN:REPRO/GUT:

Psoralen,Sulfa

Tretinon,Mycostatin

Silverdene,Pyridium

Sulfamylon,Narcotics

Colchicine

NEURO:NEURO/MUSCULO:

Mannitol,Flexeril

Decadron,Baclofen

Dilantin,Dopernergic/Levodopa

Tegretol,Fosamax

EEN:BLOOD:

Timoptic,Iron

Miotic,Heparin

AT SO4,Lovenox

Erythromycin Ointment,Thrombolytics/Aspirin

Epogen

HEART: ANTIBIOTIC:

Digoxin,Cipro

Fusid,Doxycycline

Antihypertensive

Nitro,Viagra,Sandimmune

LUNGS:

Antitubercular

AntiAsthma/MDIs

ABT

Steroids

Zafirlukast

GIT:

H2 Receptors

Anticholinergics

Antacid/Mylanta

Proton Pump Inhibitors

Lactulose

ENDOCRINE:

Insulin

Hormones for Life

Tapazole

Synthroid

HERBAL MEDS

St. John's wort - antidepressant, photosensitive (C/I

in SULFA drugs)

Garlic - antihypertensive (avoid aspirin)

Ginseng - Anti stress (C/I in coumadin)

Green tea - antioxidant (check if risk for

calculi-oxalates)

Echinacea - immune stimulant (6-8 weeks only)(C/I in

SANDIMMUNE-Immunosuppressant)

Licorice - cough and cold

Ginger root - antinausea (C/I in Coumadin)

Ginkgo - improves circulation (C/I in anticoagulant,

headache side effect - check PT)

Ma huang - bronchodilator, stimulant (Ephedra)

what is it C/I

[loveleyday]

C/I should mean ContraIndicated.

[Rozy]

Hello Future Nurses!

YOU ALL ARE SOOOO WELCOME. I am so happy to sow seeds that will benefit others. If you need an answer or help with anything else pertaining to Nursing/NCLEX-RN please let me know. Nurse Rozy

[pagandeva2000, LPN]

Delmar's Comprehensive NCLEX-PN/RN has a nice summary of the medications, and they are infused throughout the book according to the disease process. They have the suffixes and narrow things down in a better way, and yes, Saunders does as well.

[BORI-BSNRN, BSN, RN]

hi everyone, i found this on my files..hope it help. just wanted to share it you can add it to rozy's list!! :) bori

ps. the other part its coming in another post it's too long!!

1. apap/hydrocodone (vicodin, lortab)

class: antitussive opioid analgesic; schedule iii

action: acts on cough center in medulla; binds to opiate receptors in cns to reduce pain

dosage: adult-po 5-10mg q4h prn

child-po 1.25-5mg q4hprn or 0.2mg/kg q3-4h

se: drowsiness, sedation, dizziness, light-headedness, nausea, anorexia, vomiting, and constipation, circulatory depression, respiratory depression.

contra: addiction

precautions: addictive personality, > intracranial p, acute mi, severe heart disease, respiratory depression, hepatic, renal

interactions: >cns depression:alcohol, opioids, sedative/hypnotics, phenothiazines, skeletal muscle relaxants, general anesthetics, tricyclics

pharmacokinetic: onset 10-20 min, duration 4-6h, t½ 3½-4½h

3. levothyroxine (synthroid)

class: thyroid hormone

action: >metabolic rate, controls protein synthesis, > cardiac output, renal bld flow, o2 consumption, body temp, bld volume, growth, development at cellular level, exact mechanism unknown

dosage: severe hypothyroidism- adult:po 50mcg qd, increased by 50-100 mcg q 1-4 wk until desired response, maintenance dose 75-125 mcg qd; im/iv 50-100mcg/d as a single dose or 50% of usual oral dosage. child: >12yr po 2-3mcg/kg/day, 6-12yr po 4-5mcg/kg/day; 1-5yr po 5-6 mcg/kg/day, 6-12mos po 6-8 mcg/kg/day, up to 6mos po 8-10 mcg/kg/day – all children's as single dose am; myxedema coma- adult: iv 200-500 mcg, may increase by 100-300mcg after 24 hr; use oral med asap

se: anxiety, insomnia, tremors, thyroid storm, tachycardia, palpitations, angina, dysrhythmias, cardiac arrest,

contra: adrenal insufficiency, recent mi, thyrotoxicosis, hypersensitivity to beef, alcohol intolerance (injection only)

precautions: elderly, angina pectoris, htn, ischemia, cardiac disease, diabetes

interactions: >risk cardiac insufficiency when used w/ epinephrine products; effects of anticoagulants, sympathomimetics, tricyclics;

pharmacokinetics: po onset 3-5 days, pk 1-3wks, duration 1-3wk; iv onset 6-8hr, pk 24h duration unknown. t ½ 6-7 days; distributed throughout body tissues

2. atorvastatin (lipitor)

class: [color=#7f0000]antilipidemic

action: inhibits hmg-coa reductase enzyme, which reduces cholesterol synthesis

dosage: po 10mg qd, usual range 10-80, adjustments may be made in 2-4wk intervals, max 80/d

se: abdominal cramps, constipation, diarrhea, flatus, heartburn, liver dysfunction, rhabdomyolysis

contra: active liver disease

precautions: past liver disease, alcoholism, severe acute infections, trauma, hypotn, uncontrolled seizure disorders, severe metabolic disorders, electrolyte imbalance

interactions: rhabdomyolysis: azole antifungals, cyclosporine, erythromycin, niacin, gemfibrozil, clofibrate; >serum digoxin; >levels oral contraceptives; >levels atorvastatin: erythromycin, itraconazole; >effects of warfarin (coumadin); grapefruit juice

pharmacokinetics: 98% protein bound, t½ 14h

35. lorazepam (ativan)

class: [color=#00ff00]sedative, hypnotic, antianxiety. benzodiazepine. controlled substance schedule iv.

action: potentiates the actions of gaba, esp in system and reticular formation

uses: anxiety, irritability in psychiatric or organic disorders, preop, insomnia, adjunct in endoscopic procedures

dosage: anxiety: adult po 2-6mg/day in divided doses, not to exceed 10mg/day. geriatric: po 0.5-1mg/day or 0.5-1mg hs. child po 0.05mg/kg/dose, q 4-8h. insomnia: po 2-4mg hs; only minimally effective after 2wk continuous therapy. preop: adult im 50mcg/kg 2h prior to surgery; iv 44mcg/kg 15-20min prior to surgery. child iv 0.05mg/kg. status epilepticus: neonate iv 0.05mg/kg. child iv 0.1mg/kg up to 4mg/dose; rectal (off label) 0.05-0.1mg x 2; wait 7 min before giving 2nd dose.

se: dizziness, drowsiness, orthostatic htn, ecg changes, tachycardia, apnea, cardiac arrest (iv, rapid), blurred vision

contra: narrow-angle glaucoma, psychosis, child

precautions: elderly, debilitated, hepatic, renal

interactions: effects of lorazepam: cns depressants, alcohol, disulfiram, oral contraceptives. herbal > cns depression: chamomile, hops, kava, skullcap, valerian

pharmacokinetics: po onset.5h, pk 1-6h, duration 24-48hr. im onset 15-30min, pk 1-1.5h, duration 24-48h. iv onset 5-15min, pk uk, duration 24-48h.

4. atenolol (tenormin)

class: antihypertensive,antianginal; beta blocker (b1, b2 high doses)

action: blocks stimulation of b adrenergic receptor within vascular smooth muscle; produces negative chronotropic activity (affecting the time or rate, as the rate of contraction of the heart), negative inotropic activity ( recovery time), slows conduction of av node,

uses: mild to moderate htn, prophylaxis of angina pectoris, suspected or known mi (iv)

dosage: adult: iv 5mg, repeat 10 min if initial dose well tolerated, then start po dose 10 min after last iv dose. adult: po 50mg qd, increasingq 1-2wk to 100mg qd; may increase to 200mg qd for angina. elderly: po 25mg/day initially. renal disease: adult- po ccr 15-35 ml/min, max 50mg/day; ccr

se: profound hypotn, bradycardia, chf, cold extremities, postural hypotn, 2nd or 3rd degree heartblock, insomnia, fatigue, dizziness, mental changes, nausea, diarrhea, mesenteric arterial thrombosis, ischemic colitis, agranulocytosis, thrombocytopenia, purpura, bronchospasm

contra: cardiogenic shock, 2nd or 3rd degree heart block, sinus bradycardia, cardiac failure

precautions: major surgery, diabetes, renal, thyroid, chf, copd, asthma, well-compensated heart failure

interactions: > hypotn, bradycardia: reserpine, hydralazine, methyldopa, prazosin, antichlinergics, digoxin, diltiazem, verapamil, cardiac glycosides, antihtn's; >hypoglycemic effect: insulin, oral antidiabetics; mutual inhibition: sympathomimetics(cough, cold preps)

pharmacokinetics: iv onset rapid, pk 5 mins, duration uk; po pk2-4 hr, onset 1 hr duration 24 hr; t½ 6-9hr, excrete unchanged in urine, 5-15% protein bound.

5. amoxicillin (amoxil, trimox)

class: antiinfective, antiulcer; aminopenicillin

action: interferes with cell wall replication of susceptible organisms; the cell wall, rendered osmotically unstable, swells and bursts from osmotic pressure.

uses: tx skin, respiratory, gi, gu infections; otitis media, gonorrhea

dosage: systemic infx: adult-po 750mg-1.5g qd in divided doses q8h; child- po 20-50 mg/kg/day in divided doses q8h; renal disease: adult- po ccr 10-50ml/min dose q 12 h; ccr

se: bone marrow depression, granulocytopenia, nausea, vomiting, diarrhea, pseudomembranous colitis, seizures, anaphylaxis, respiratory distress, serum sickness, uticaria, rash

precautions: hypersensitivity to chephalosporins, neonates, renal disease

interactions: > amox level: probenecid, anticoagulant action: warfain (coumadin), delayed or reduced absorption: khat so separate by 2hr

pharmacokinetics: po pk 2h, duration 6-8h, t½ 1-1 1/3 h

6. estrogens; conjugated tablets (premarin)

class: estrogen, hormone

action: needed for adequate fx female reproductive sys; affects release of pituitary gonadotropins, inhibits ovulation, adequate ca+ use in bone.

uses: menopausal sx, inoperable breast cancer, prostatic cancer, abnormal uterine bleeding, hypogonadism, primary ovarian failure, prevention of osteoporosis

dosage: menopause: po 0.3-1.25mg qd 3wk on, 1wk off; prevention of osteoporosis: po 0.625mg qd or in cycle; atrophic vaginitis: vag cream 2-4g ml qd x 21 days, off for 7 days, repeat; prostatic cancer: po 1.25-2.5mg tid; breast cancer: po 10mg tid x 3mo or longer; abnormal uterine bleeding iv/im 25mg, repeat in 6-12hr; castration/primary ovarian failure: po 1.25mg qd 3 wk on, 1wk off; hypogonadism po 2.5mg bid-tid x 20 days/mo

se: seizures, thromboembolism, stroke, pulmonary embolism, mi, nausea, cholestatic jaundice, hepatic adenoma, gynecomastia, testicular atrophy, impotence, > risk breast cancer, endometrial cancer

contra: breast cancer, thromboembolic disorders, reproductive cancer, genital bleeding, pregnancy, lactation

precautions: htn, asthma, blood dyscrasias, gallbladder disease, chf, diabetes, bone disease, depression, migraines, convulsive disorders, hepatic, renal, family hx of cancer of breast or repro tract, smoking

interactions: may need to increase thyroxine dose; >toxicity: cyclosporine, dantrolene, action of corticosteroids; > estrogen level: grapefruit juice.

7. furosemide oral (lasix)

class: loop [color=#ffff00]diuretic; sulfonamide derivative

action: inhibits reabsorption of na+ and chloride at proximal and distal tubule and in the loop of henle.

uses: pulmonary edema; edema in chf, liver disease, nephritic syndrome, ascites, htn

dosage: adult- po 20-80 mg/day in am; may give another dose in 6hr up to 600mg/day; im/iv 20-40mg, increased by 20mg q2hr until desired response. child- po/im/iv 2mg/kg; may increase by 1-2mg/kg/q6-8hr up to 6mg/kg. pulmonary edema- iv 40mg given over several min, repeated in 1 hr; increase to 80mg if needed. hypertensive crisis/acute renal failure: iv 100-200mg over 1-2min. antihypercalcemia: adult- im/iv 80-100mg q 1-4hr or po 120mg qd or divided bid; child- im/iv 25-50mg, repeat q4hr if needed

se: circulatory collapse, ototoxicity, hypokalemia, hypochloremic alkalosis, hypomagnesemia, hyperuricemia, hypocalcemia, hyponatremia, hyperglycemia, nausea, polyuria, renal failure, thrombocytopenia, agranulocytosis, leukopenia, neutropenia, anemia, rash, pruritis, stevens-johnson syndrome

contra: hypersensitivity to sulfonamides, anuria, hypovolemia, infants, electrolyte depletion

precautions: diabetes, dehydration, severe renal disease, cirrhosis, ascites

interactions: > toxicity: lithium, nondepolarizing skeletal muscle relaxants, digitalis; > hypotensive action of antihtn, nitrates; > ototoxicity: aminoglycosides, cisplatin, vancomycin

pharmacokinetics: po onset 1 hr pk 1-2hr, duration 6-8hr; absorbed 70%. iv onset 5min pk ½ hr, duration 2hr (metab by liver 30%). excreted in urine, some as unchanged drug, feces; t½ 1hr

8. amlodipine (norvasc)

class: antianginal, [color=#ffff00]antihypertensive, ca+ channel blocker

action: inhibits ca+ influx during depolarization, relaxes

coronary muscle, dilates coronary arteries; relaxing the muscles lining the arteries of the rest of the body lowers the blood pressure, which reduces the burden on the heart. reducing burden lessens the heart muscle's demand for oxygen, and further helps to prevent angina

dosage: angina- po 5-10mg qd; htn po 2.5-5mg qd initially,

max 10mg/day

se: most common-headache and edema(swelling) of lower extremities. less common- dizziness, flushing, fatigue, nausea, palpitations

contra: sick sinus syndrome, 2nd-3rd degree heart block, hypotn

precautions:chf, hypotn, hepatic injury, renal, elderly

interactions: high na diet, grapefruit juice; >hypotn: alcohol, fentanyl, quinidine, antihtn, nitrates; neurotoxicity: lithium;

pharmacokinetics: onset ?; pk 6-12h, t½ 30-50h, >95% protein bound.

9. albuterol

class: adrenergic b2 agonist, sympathomimeetic, [color=#00ffff]bronchodilator

action: bronchodilation by action on b2 (pulmonary)receptors by increasing levels of camp, which relaxes smooth muscle; produces bronchodilation, cns, cardiac stimulation, as well as > diuresis and gastric acid secretion; longer acting than isoproterenol

uses: prevention of exercise-induced asthma, acute bronchospasm, bronchitis, emphysema, bronchiectasis, or other reversible airway obstruction

dosage: exercise-induced bronchospasm: adult: inh (metered dose inhaler) 2 puffs 15mins before exercising. other resp conditions: adult and child> 12 yr: inh 2 puffs q4hr; po 2-4mg tid-qid, not to exceed 8mg; volmax xr 8mg q12h; repetabs4-8mg q12h; neb/ippb 2.5mg tid-qid. geriatric: po 2mg tid-qid, may increase gradually to 8mg tid-qid. child 2-12yr: inh 0.1mg/kg tid (max2.5mg tid-qid); neb/ippb 0.1-0.15mg/kg/dose tid-qid or 1.25mg tid-qid for child 10-15kg or 2.5mg tid-qid15kg. adult and child>4yr: inh cap (rotohaler inhalation) 200mcg cap inhaledq4-6hr; may use 15min before exercise

se: tremors, anxiety, restlessness, bronchospasm

contra: hypersensitivity to sympathomimetics, tachydysrhythmias, severe cardiac disease, heart block

precautions: cardiac disorders, hyperthyroidism, diabetes, htn, prostatic hypertrophy, narrow-angle glaucoma, seizures, exercise-induced bronchospasm (aerosol) in children

interactions: > action of aerosol bronchodilators, >action of albuterol: tricyclic antidepressants, maoi's, other adrenergics; do not use together. may inhibit action of abluterol: other b-blockers. severe hypotn: oxytoxics. toxicity:theophylline. ecg changes/hypokalemia: k+-losing diruretics. >stimulation: ephedra, caffeine (cola nut, green/black tea, guarana, mate, coffee, chocolate).

pharmacokinetics: well absorbed po, extensively metabolized in liver and tissues, crosses bld brain barrier. po onset ½ h, pk 2 ½ hr, duration 4-6h, t ½ 2 ½ h. po-xr onset ½ h; pk 2-3h; duration 12h. inh: onset 5min, pk 1-1 ½ h, duration 4-6h, t ½ 4h

10. alprazolam (zanax)

class: [color=#00ff00]antianxiety; benzodiazepine; schedule iv

action: depresses subcortical levels of cns, including limbic system, reticular formation

uses: anxiety, panic disorders, anxiety with depressive sx

dosage: anxiety disorder: po 0.25-0.5mg tid, not to exceed 4mg/day in divided doses. elderly: po 0.125-0.25 mg bid; increase by 0.125 as needed. panic disorder: po 0.5 mg tid may increase, max 10mg/day. premenstrual dysphoric disorders: po 0.25mg bid-qid, starting on day 16-18 of menses, taper over 2-3 days when menses occurs. social phobia: po 2-8mg/day. hepatic dose: reduce by 50%

se: dizziness, drowsiness, orthostatic hypotn, ecg changes, tachycardia, blurred vision

contra: hypersensitivity to benzodiazepines, narrow-angle glaucoma, psychosis, addiction

precautions: elderly, debilitated, hepatic

interactions: cns depression: anticonvulsants, alcholol, antihistamines, sedative/hypnotics, valerian, chamomile, hops, skullcap, cat's claw, kava, echinacea, golden-seal, licorice, st. john's wort, wild cherry. drug level with grapefruit juice.

pharmacokinetics: po onset 30min, pk 1-2 h, duration 4-6h, therapeutic response 2-3 days; excreted by kidneys, t ½ 12-15h

11. hydrochlorothiazide (hydrodiuril)

class: thiazide [color=#ffff00]diuretic, antihtn; sulfonamide derivative

action: acts on distal tubule and ascending limb of loop of henle by > excretion of water, na+, chloride, k+

uses: edema, htn, diuresis, chf, edema in corticosteriod, estrogen, nsaids, idiopathic lower extremity edema therapy

dosage: adult-po 25-100 mg/day; geriatric po 12.5mg/day, initially; child >6mo: po up to 2mg/kg/day in divided doses; child

se: urinary frequency, uremia, glucosuria, dizziness, fatigue, weakness, nausea, vomiting, anorexia, hepatitis, rash, hyperglycemia, hyperuricemia, aplastic anemia, hemolytic anemia, leukopenia, agranulcytosis, thrombocytopenia, neutropenia, hypokalemia

contra: anuria, renal decompensation, hypomagnesemia

precautions: hypokalemia, renal, hepatic, gout, copd, le, diabetes, hyperlipidemia, ccr

interactions: > toxicity of lithium, nondepolarizing skeletal muscle relaxants, cardiac glucosides. risk of renal failure: nsaids. hyperglycemia: glucocorticoids, amphotericin b. > effects: loop diuretics. k+ deficiency: aloe, buckthorn bark/bery, cascara sagrada bark, licorice root, senns pod/leaf. > effect: ginkgo

pharmacokinetics: po onset 2 h, pk 4h, duration 6-12h, t½ 6-15h, excreted unchanged by kidneys

12. sertraline (zoloft)

class: [color=#7f7f7f]antidepressant; ssri

action: inhibits serotonin reuptake in cns; >action of seotonin; does not affect dopamine, norepinephrine

dosage: adult-po 50mg qd; may > to max of 200mg/day; do not change dose at intervals of by 25mg q3days to desired dose. child 6-12 yr: po 25mg qd. child 13-17yr po 50mg qd.

uses: major depression, ocd, ptsd, panic disorder

se: insomnia, agitation, somnolence, dizziness, headache, tremor, fatigue, male sex dysfx, diarrhea, nausea, constipation, anorexia, dry mouth, vomiting, flatulence

contra: pimozide

precautions: elderly, hepatic, renal, epilepsy, recent mi

interactions: > effects of: antidepressants (tricyclics), diazepam, tobutamide, warfarin, benzodiapzepines, sumatriptan. fatal reactions: maoi's. > sertraline levels: cimetidine, warfarin, other highly protein bound drugs. altered lithium levels: lithium. sertraline in contraindicated with pimozide. potentiation of ssri, serotonin syndrome: st. john's wort, sam-e; do not use together.

pharmacokinetics: po pk 4.5-8.4h; steady state 1 wk; 99%plasma protein bound, t ½ 1-4days, extensively metabolized, metabolite excreted in urine, bile

13. paroxetine (paxil)

class: [color=#7f7f7f]antidepressant; ssri

action: inhibits cns neuron uptake of serotonin but not of norepinephrine or dopamine

uses: major depressive disorder, ocd, panic disorder, generalized anxiety disorder

dosage: po 20mg qd inam; after 4 wk if no improvement may > by 10mg/day q wk to desired response, max 60mg/day or controlled releases 25mg/day weekly up to 62.5mg/day. geriatric start at 10mg/day, max 40mg/day. renal:10mg/day in am, may increase to max 50mg/day. ocd: po 40mg/day, start w/ 20mg/day, > 10mg/day increments max 60mg/day. panic disorder: po 40mg/day start w/ 10mg/day > 10mg/day increments, max 60mg/day or controlled release 12.5 mg/day, max 75mg/day

se: upset stomach, drowsiness, weakness or tiredness, excitement or anxiety, insomnia, nightmares, dry mouth, changes in appetite or weight

contra: maoi's

precautions: children, elderly, seizure hx, pts w/ hx of mania, renal, hepatic disease

interactions: > bleeding w/ warfarin. no maoi's, potentially fatal reaction. cimetidine > paroxetine plasma levels. > agitation: l-tryptophan. phenobarbital and phytoin se's: highly protein bound drugs. paroxetine may theophylline levels: theophylline. possible serotonin syndrome: sam-e, st. john's wort.

pharmacokinetics: po pk5.2h, unchanged drugs and metabolites excreted in feces and urine; t ½ 21h; 95% protein bound.

14. apap/propoxyphene-n (darvon)

class: opiate analgesic; synthetic opiate

action: depresses pain impulse transmission at the spinal cord level by interacting with opioid receptors

uses: mild to moderate pain

dosage: po 65mg q4h prn (hcl); po 100mg q4h prn (napsylate)

se: drowsiness, dizziness, confusion, headache, sedation, seizures, hyperthermia(elderly), nausea, vomiting, anorexia, constipation, cramps, rash, dysrhythmias, respiratory depression

contra: addiction

precautions: addictive personality, > intracranial pressure, acute mi, severe heart disease, respiratory depression, hepatic, renal,

interactions: possible fatal: maoi's; > effects c other cns depressants- alcohol, opioids, sedative/hypnotics, antipsychotics, skeletal muscle relaxants; > cns depression c chamomile, hops, kava, skullcap, valerian

pharmacokinetics: po onset ½- 1h, pk 2-2 ½h, duration 4-6h. t 1/2 6-12h

15. azithromycin (zithromax, z-pak)

class: antiinfective; macrolide

action: binds to 50s ribosomal subunits of susceptible bacteria and suppresses protein synthesis; much greater spectrum of activity than erythromycin.\

uses: mild to moderate infx; upper resp, lower resp, uncomplicated skin infx, urethritis & cervicitis d/t chalmydia trachomatis, acute otitis media, tonsillitis, commuhity acquired pneumonia, mycobacterium avium complex (mac [hiv related])

dosage: most infx: adult –po 500mg/day on day 1, then 250mg qd on days 2-5 for a total dose of 1.5g. child2-15yr- po 10mg/kg on day 1, then 5mg/kg x 4 days. cervicitis, chlamydia, chancroid 1g single dose, gonorrhea 2g single dose. pelvic inflammatory disease po/iv 500mg iv q24hr x 2 doses, then 500mg po q24hr x 7-10 days. mac po 600mg/day in combination w/ ethambutol. pneumonia po/iv 500mg/ iv q24h x 2 doses, then 500mg po q 24h x 7-10days. endocarditis prophylaxis adult: po 500mg 1 hr prior to procedure. child po 15mg/kg 1 h prior to procedure.

se: nausea, vomiting, diarrhea, hepatotoxicity, cholestatic jaundice, pseudomembranous colitis, angioedema

contra: hypersensitivity to azithromycin, erythromycin, or any macrolide

precautions: hepatic, renal, cardiac disease; elderly,

interactions: toxicity: ergotamine. >effects of oral anticoagulants, digoxin, theophylline, methylprednisolone, cyclosporine, bromocriptine, disopyramide, triazolam, carbamazepine, phenytoin.

pharmacokinetics: po pk 2-4h, duration 24h, iv pk end of infx, duration 24h; t ½ 11-57h, excreted in bile, feces, urine primarily as unchanged drug

16. cephalexin (keflex)

class: antiinfective, 1st generation cephalosporin

action: inhibits bacterial cell wall synthesis, rendering cell wall osmotically unstable, leading to cell death by binding to cell wall membrane.

dosage: moderate infx: adult: po 250-500mg q6h, child: po 25-50mg/kg/day in 4 equal doses. moderate skin infections: adult –po 500mg q12h. endocarditis prophylaxis 2g 1 h before procedure. severe infx: adult po 500mg –1g q6h; child po 50-100 mg/kg/day in 4 equal doses

se: seizures (high doses), diarrhea, anorexia, pseudomembranous colitis, nephrotoxicity, renal failure, leukopenia, thrombocytopenia, agranulocytosis, neutropenia, lymphocytosis, eosinophilia, pancytopenia, hemolytic anemia, anaphylaxis, serum sickness

contra: infants

precautions: hypersensitivity to pcn's, renal

interactions: > toxicity: aminoglycosides, loop diuretics, probenecid

pharmacokinetics: pk 1 hr, duration 6-12h, t ½ 30-72 min, 5-15% plasma protein bound

17. simvastatin (zocor)

class: [color=#7f0000]antilipidemic; hmg-coa reductase inhibitor

action: inhibits hmg-coa reductase enzyme, which reduces cholesterol synthesis

dosage: po 5-10mg qd in pm initially; usual range 5-40mg/day qd in pm, not to exceed 80mg/day ; dosage adjustments may be made in 4wk intervals or more. elderly/renal po 5mg/day

se: liver dysfx, myositis, rhabdomyolysis

contra: active liver disease

precautions: past liver disease, alcoholism, severe acute infx, trauma, hypotn, uncontrolled seizure disorders, severe metabolic disorders, electrolyte imbalances

interactions: > effects of warfarin. > myalgia, myositis: cyclosporine, gemfibrozil, niacin, erythromycin, clofibrate, clarithromycin, itraconazole, protease inhibitors. > serum level of digoxin

pharmacokinetics: pk 1.5-2h, highly protein bound, excreted primarily in bile, feces (60%)

18. lansoprazole (prevacid)

class: [color=#7f0000]antiulcer, proton pump inhibitor; benzimidazole

action: suppresses gastric secretion by inhibiting h/k+ atpase enzyme system in gastric parietal cell; characterized as gastric acid pump inhibitor, since it blocks final step of acid production

uses: gerd, pathologic hypersecretory conditions (zollinger-ellison syndrome, systemic mastocytosis, multiple endocrine ademosas); ulcers

dosage: ng tube: use intact granules mixed in 40ml of apple juice and injected thru ng tube, then flush c apple juice. duodenal ulcer: po 15mg qd before eating for 4 wk then 15mg qd to maintain healing of ulcers; associated c helibacter pylori – 30mg + 500mg clarithromycin, 1g amoxicillan bid x14days or 30mg + 1g amoxicillan x 14d. erosive esophagitis: po 30mg qd before eating for up to 8wk, may use another 8 wk course if needed. hypersecretory conditions: po 60mg qd up to 90mg bid

se: constipation, diarrhea,cva, mi, shock, hematuria, hemolysis

interactions: delayed absorption of lansoprazole: sucralfate. may be

pharmacokinetics: absorption after granules leave stomach- rapid; plasma t½ 1.5h, 97%protein bound, clearance

19. ibuprofen (advil, motrin)

class: nsaid, antipyretic, non-opioid analgesic; propionic acid derivative

action: inhibits prostaglandin synthesis by

uses: rheumatoid arthritis, osteoarthritis, primary dysmenorrhea, gout, dental pain, musculoskeletal disorder, fever

dosage: analgesic:po 200-400mg q4-6h no to exceed 3.2g/day. child: po 4-10mg/kg/dose q6-8h. antipyretic: child 6mo-12yr: po 5mg/kg (temp 102.5), may repeat q4-6h, max 40mg/kg/day. anitinflammatory: po 300-800mg tid-qid, max 3.2g/d. child po 30-40 mg/kg/day in 3-4 divided doses, max 50mg/kg/day.

se: headache, nausea, anorexia, hepatitis, gi bleeding, nephrotoxicity, blood dyscrasias, anaphylaxis

contra: asthma, severe renal or hepatic

precautions: bleeding disorders, gi disorders, cardiac disorders, elderly, chf, ccr

interactions: risk of bleeding cefamandole, cefotetan, cefoperazone, valproic acid, thrombolytics, antiplatelets, warfarin. > possibility of blood dyscrasias: antineoplastics, radiation. > toxicity: digoxin, lithium, oral anticoagulants, cyclosporin, probenecid. > gi reactions: aspirin, corticosteroids, nsaids, alcohol. > hypoglycemia: oral antidiabetics, insulin. > risk of bleeding: arnica, chamomile, clove, dong quai, fenugreek, feverfew, garlic, ginger, ginkgo, ginseng (panax)

pharmacokinetics: well absorbed po. onset .5h, pk 1-2h, t½ 2-4h, 90-99%plasma protein binding, does not enter breast milk

21. hctz/triamterene (dyrenium)

class: k+ sparing [color=#ffff00]diuretic, pteridine derivative

action: acts of distal tubule to inhibit reabsorption of na+, chloride; > k+ retention

uses: edema, may be used c other diuretics; htn

dosage: po 100mg bid pc, not to exceed 300mg/day. geriatric: po 50mg qd, max 100mg/day

se: nausea, diarrhea, vomiting, liver disease, thrombocytopenia, megaloblastic anemia, azotemia, interstitial nephritis, > bun, creatinine

contra: anuria, severe renal or hepatic disease, hyperkalemia

precautions: dehydration, hepatic, renal, chf, cirrhosis

interactions: nephrotxic: indomethacin, enhanced action of antihtn- amantadine. > hyperkalemia: other k+ sparing diuretics, k+ products, ace inhibitors, salt substitutes.

pharmacokinetics: po onset 2 h, pk 6-8h, duration12-16h, t ½ 3h

26. metoprolol succinate (lopressor)

class: [color=#ffff00]antihypertensive, antianginal. b1-blocker

action: lowers bf by b-blocking effects; reduces elevated renin plasma levels; blocks b2 adrenergic receptors in brochial, vascular smooth muscle only at high doses

uses: mild to moderate htn, acute mi to reduce cardiovascular mortality, angina pectoris, nyha class ii, iii heart failure

dosage: htn: po 50mg bid, or 100mgqd; may give up to 200-450mg in divided doses. ext rel give qd. geriatric: po 25mg/day initially, > weekly as needed. mi early tx: iv bolus 5mg q2min x 3, then 50mg po 15 min after last dose and q6h x 48h; late tx po maintenance 100 mg bid for 3 mos. angina po 100mg qd, > qwk prn or 100mg ext rel qd.

se: bradycardia, chf, palpitations, cardiac arrest, av block, pulmonary edema, insomnia, dizziness, depression, nausea, vomiting, diarrhea, hiccups, agranulocytosis, eosinophilia, thrombocytopenia, purpura, bronchospasm

contra: cardiogenic shcok, 2nd, 3rd degree heart blcok, sinus bradycardia, bronchial asthma

precautions: major surgery, diabetes, renal, thyroid, copd, heart failure, cad, nonallergic bronchospasm, hepatic, chf

interactions: > hypotn, bradycardia: reserpine, hydralazine, methyldopa, prazosin, amphetamines, ephedrine, epinephrine, norepinephrine, h2-antagonists. > hypoglycemic effects: insulin oral antidiabetics. don't use c maoi's.

pharmacokinetics: po pk 2-4h, duration 13-19h, t 1/2 3-4h

30. fluoxetine (prozac)

class: [color=#7f7f7f]antidepressant, ssri (selective serotonin reuptake inhibitor)

action: inhibits cns neuron uptake of serotonin but not of norepinephrine

uses: major depressive disorder, obd, bulimia, sarafem: pmdd

dosage: depression: adult po 20mg qd in am; after 4wk if no clinical improvement is noted, dose may be > to 20mg bid in am, pm, not to exceed 80mg/day. geriatric 10mg/day, > as needed. child: 5-18yr po 5-10mg/day, max 20mg/day. pmdd po 10-20mg qd, may be taken qd week before menses.

se: headache, nervousness, insomnia, drowsiness, anxiety, tremor, dizziness, fatigue, sedation, poor concentration, abnormal dreams, agitation, seizures, nausea, diarrhea, dry mouth, anorexia, dyspepsia, constipation, cramps, vomiting, taste changes, flatulence,

precautions: diabetes

interactions: no maoi's with or 14 days prior. st. john's wort: do not use together.

> se: highly protein bound drugs. > effect: haloperidol. t ½ of diazepam. > levels or toxicity of carbamazepine, lithium, digoxin, warfarin, pheytoin. > levels of tricyclics, phenothiazines. paradoxical worsening of ocd: buspirone. > cns depression: alcohol, antidepressants, opioids, sedatives. > action c kava.

pharmacokinetics: po pk 6-8h, terminal t ½ 2-3days, steady state 28-35 days, 94% protein bound

35. lorazepam (ativan)

class: [color=#00ff00]sedative, hypnotic, antianxiety. benzodiazepine. controlled substance schedule iv.

action: potentiates the actions of gaba, esp in system and reticular formation

uses: anxiety, irritability in psychiatric or organic disorders, preop, insomnia, adjunct in endoscopic procedures

dosage: anxiety: adult po 2-6mg/day in divided doses, not to exceed 10mg/day. geriatric: po 0.5-1mg/day or 0.5-1mg hs. child po 0.05mg/kg/dose, q 4-8h. insomnia: po 2-4mg hs; only minimally effective after 2wk continuous therapy. preop: adult im 50mcg/kg 2h prior to surgery; iv 44mcg/kg 15-20min prior to surgery. child iv 0.05mg/kg. status epilepticus: neonate iv 0.05mg/kg. child iv 0.1mg/kg up to 4mg/dose; rectal (off label) 0.05-0.1mg x 2; wait 7 min before giving 2nd dose.

se: dizziness, drowsiness, orthostatic htn, ecg changes, tachycardia, apnea, cardiac arrest (iv, rapid), blurred vision

contra: narrow-angle glaucoma, psychosis, child

precautions: elderly, debilitated, hepatic, renal

interactions: effects of lorazepam: cns depressants, alcohol, disulfiram, oral contraceptives. herbal > cns depression: chamomile, hops, kava, skullcap, valerian

pharmacokinetics: po onset.5h, pk 1-6h, duration 24-48hr. im onset 15-30min, pk 1-1.5h, duration 24-48h. iv onset 5-15min, pk uk, duration 24-48h.

37. metformin (glucophage)

class: [color=#ffff00]antidiabetic

action: inhibits hepatic glucose production and > sensitivity of peripheral tissue to insulin

dosage: po 500mg bid initially, then > to desired response 1-3g; dosage adjustments q2-3wk or 850mg qd c morning meal c dosage > every other wk, max 2500mg/day, ext rel max 2000mg/day.

se: headache, weakness, dizziness, drowsiness, agitation, nausea, vomiting, diarrhea, thrombocytopenia, lactic acidosis

contra: hepatic, creatinine > 1.5mg/ml(males) >1.4(females), chf, alcoholism, cardiopulmonary disease, hx of lactic acidosis

precautions: thyroid disease

interactions: > metformin level: cimetidine, digoxin, morphine, procainamide, quindine, rantidine, triamterene, vancomycin. > hypoglycemia: cimetidine, ca+ channel blockers, corticosteroids, estroens, oral contraceptives, phenothiazines, sympathomimetics, diuretics, thyroid, isoniazid, phenytoin. do not give c radiologic contrast media; may cause renal failure. herbal: quinine: > metformin level. hyperglycemia: glucosamine. hypoglycemia: chromium, coenzyme q-10, fenugreek.

pharmacokinetics: t ½ 1.5-5h, terminal 6-20h, pk 1-3h

44. buproprion sustained-release (wellbutrin, zyban)

class: [color=#7f7f7f]antidepressant, smoking deterrent

action: inhibits reuptake of dopamine, serotonin, norephinephrine

dosage: po 100mg bid initially, then > after 3 days to 100mg tid if needed; may increase after 1 mo to 150 mg tid; sr 150bid, initially 150mg am, > to 300 mg/day if initial dose is tolerated.

se: headache, agitation, dizziness, akinesia, bradykinesia, confusion, seizures, insomnia, sedation, tremors, dysrhythmias, htn, tachycardia, complete av block, nausea, vomiting, dry mouth, constipation, menstrual irregularities, rash, sweating, blurred vision, auditory disturbance, weight loss or gain

contra: eating disorders, seizure disorders

precautions: renal, hepatic, recent mi, cranial trauma, seizure disorder

interactions: > adverse reactions, seizures: levodopa, maoi's, phenothiazines, antidepressants, benzodiazepines, alcohol, theophylline, systemic steroids. > bupropion toxicity: ritonavir. bupropion level: cimetidine. herbal: > cns depression: kava. may > anticholinergic effect: belladonna leaf/root.

pharmacokinetics: onset 2-4wk, t 1/2 14h, metabolized by liver, steady state 1.5-5wk

47. lisinopril (prinivil, zestril)

class: [color=#ffff00]antihypertensive, ace inhibitor

action: selectively suppresses renin-angiotensin aldosterone system; inhibits ace, preventing conversion of angiotensin i to angiotensin ii

uses: mild to moderat htn, adjunctive therapy of systolic chf, acute mi

dosage: htn:po 10-40mg qd; may > to 80mg qd if required.chf: po 5mg initially c diuretics/digitalis, range 5-20mg

se: proteinuria, renal insufficiency, vertigo, stroke, fatigue, angioedema

precautions: renal disease, hyperkalemia, renal artery stenosis

interactions: > hypotensive effect: diuretics, other hypertensives, probenecid, phenothiazines, nitrates, acute alcohol ingestion. hypersensitivity reactions: allopurinol. drug/food: hi k+ diet(bananas, oj, avocados, nuts, spinach) should be avoided, hyperkalemia may result.

pharmacokinetics: onset 1h, pk6-8h, duration 24h

56. ciprofloxacin (cipro)

class: broad spectrum antiinfective

action: interferes c conversion of intermediate dna fragments into hi-molecular-wt dna in bacteria; dna gyrase inhibitor

dosage: uti's: po 250mg q12h; iv 200mg q12h. complicated/severe uti's: po 500mg q12h, iv 400mg q12h. respiratory, bone, skin, joint, infx: po 500-750mg q12h; iv 400 mg q12h. renal disease: ccr

se: headache, restlessness, seizures, nausea, diarrhea, vomiting, pseudomembranous colitis, rash, anaphylaxis, stevens-johnson syndrome

precautions: renal, epilepsy

interactions: serum levels of cipro: probenecid; monitor for toxicity. > levels of: theophylline, warfarin, monitor bld levels. herbal possible toxicity: yerba mate. drug/food: >effect of caffeine; decreased absortption: dairy products, food.

pharmacokinetics: po pk 1h, t 1/2 3-4h

59. potassium chloride

class: electrolyte, mineral replacement

action: needed for adequate transmission of nerve impulses & cardiac ctx, renal fx, intracellular ion maintenance.

dosage: po 40-100meq in divided doses tid-qid; iv 20meq/hr when diluted to 40 meq/1000ml, not to exceed 150 meq/day. child: po 2-4meq/kg/day

se: cardiac depression, dysrhythmias, arrest, peaking t waves, lowered r and depressed rst, prolonged p-r interval, widened qrs complex, nausea, vomiting, cramps, diarrhea

contra: severe renal or hemolytic disease, addison's, hyperkalemia, acute dehydration, extensive tissue breakdown

precautions: cardiac disease, k+ sparing diruretics, systemic acidosis

interactions:kyperkalemia: k+ phosphate iv and products containing ca+ or magnesium; k+ sparing, diuretic, or other k+ products

pharmacokinetics: po excreted by kidneys and in feces, onset about 30 mins. iv immediate onset

64. warfarin [color=#7f7f7f](coumadin)

[color=#7f7f7f]class: [color=#7f7f7f]anticoagulant

[color=#7f7f7f]action: interferes c bld clotting by indirect means; depresses hepatic synthesis of vit k-dependent coagulation factors.

uses: pulmonary emboli, dvt, mi, atrial dysrhythmias, postcardiac valve replacement

dosage: po/iv 2.5-10mg/day x 3 days, then titrated to prothrombin time or inr qd. child 0.1 mg/kg/day titrated to inr

se: diarrhea, hepatitis, hematuria, rash, fever, hemorrhage, agranulocytosis, leukopenia, eosinophilia

contra: hemophilia, leukemia c bleeding, peptic ulcer, thrombocytopenic purpura, hpatic(severe), severe htn, subacute bacterial endocarditis, acute nephritis, blood dyscrasias, eclampsia, preeclampsia

precautions: alcoholism

interactions: > action of warfarin: allopurinol, chloramphenicol, amiodarone, diflunisal, heparin, steroids, cimetidine, disulfiram, thyroid, glucagons, metronidazole, quinidine, sulindac, sufinpyrazone, sulfonamides, clofibrate, salicylates, ethacrynic acids, indomethacin, mefenamic acid, oxyphenbutazones, phenybutazone, cefamandole, chloral hydrate, cotrimoxazole, erythromycin, quinolone antiinfectives, isoniazid, thrombolytic agents, tricyclics. toxicity: oral sulfonylureas, phenytoin. drug/food: grapefruit juice: may > action of oral warfarin. herbal: > risk of bleeding: bromelain, cinchona, cayenne, feverfew, garlic, dan shen, ginkgo biloba, quinine, ginger, horse chestnut, papain, sweet clover, sweet vernal grass leaves, tonka bean seeds, vanilla leaf, woodruff. metabolism of warfarin: crucifer.

pharmacokinetics: po onset12-24h, pk 1.5-3days, duration 3-5days, t ½ 1.5-2.5days, 99% bound to plasma proteins.

71. pantoprazole (protonix)

class: proton pump inhibitor; benzimidazole

action: suppresses gastric secretion by inhibiting h/k+ atpase enzyme system in gastric parietal cell; characterized as gastric acid pump inhibitor, since it blocks final step of acid production

uses: gerd, severe erosive esophagitis, pathologic hypersecretory conditions (zollinger-ellison syndrome)

dosage: gerd po 40mg qd x 8 wk, may repeat course. erosive esophagitis: iv 40mg qd x 7-10d, po 40mg qd x 8wk, may repeat. hypersecretory conditions: iv 80mg q12h; max 240 mg/day.

se: headache, diarrhea, abdominal pain, rash

interactions: may > serum levels of pantoprazole: diazepam, phenytoin, flurazepam, triazolam, clarithromycin. possible > bleeding: warfarin. may delay absorption: sucralfate.

pharmacokinetics: pk 2.4h, duration>24h, t 1/2 1.5h, 97%protein binding, in elederly elimination rate

83. apap/oxycodone (percocet)

class: opiate analgesic; schedule ii

action: inhibits ascending pain pathways in cns, > pain threshold, alters pain perception

dosage: po 10-30mg q4h (5mgq6h for oxyir, oxyfast- oxyfast conc. sol. is extremely concentrated; do not use interchangeably). child po 0.05-0.15mg/kg/dose up to 5mg/dose q4-6h; not recommended in children.

se: drowsiness, dizziness, confusion, headache, sedation, euphoria, nausea, vomiting, anorexia, constipation, cramps, rash, respiratory depression.

contra: addiction (opiate)

precautions: addictive personality, increased intracranial pressure, acute mi, severe heart disease, respiratory depression, hepatic, renal, child

interactions: > effect c other cns depressants: alcohol, opioids, sedative/hypnotics, antipsychotics, skeletal muscle relaxants.

pharmacokinetics: po onset 15-30min, pk 1hr, duration4-6h, detoxed by liver.

84. digoxin (lanoxin)

class: cardiac glycoside inotropic, antidysrhythmic; digitalis prep

action: inhibits the na+-k+ atpase, which makes more ca+ available for contractile proteins, resulting in > cardiac output; > force of ctx (+ inotropic effect);

uses: chf, atrial fib, atrial flutter, atrial tachy, cardiogenic shock, paroxysmal atrial tachy, rapid digitalization in these disorders

dosage: adult iv digitalizing dose 0.6-1.0mg given as 50% of the dose initially, additional fractions given at 4-8h intervals; po digitalizing dose 0.75-1.25mg given as 50% of the dose initially, additional fractions at 4-8h intervals; maintenance 0.063-0.5mg/day(tabs), or 0.350-0.5mg/day(gelatin cap). see drug guide for child.

se: headache, dysrhythmias, hypotn, av block

contra: ventricular fib, ventricular tach, carotid sinus syndrome, 2nd or 3rd degree heart block

precautions: renal, acute mi, av block, severe resp disease, hypothyroidism, elderly, sinus nodal disease, hypokalemia

interactions: digoxin bld levels: propantheline, quinidine, verapamil, amiodarone, anticholinergics, diltiazem, nifedipine. > bradycardia: b-adrenergic blockers, antidysrythmics. herbal: > action: aloe, buckthorn bark/berry, cascara sagrada bark, castor bean oil, may apple root, rhubarb root, senna pod/leaf, yellow dock root, oleander, pheasant's eye, purple foxglove, squill. dysrhythmias: ephedra. bradycardia: indian snakeroot. cardiac toxicity: hawthorn. digoxin toxicity: licorice. hypokalemia: cocoa seeds, coffee seeds, cola seeds, guarana seeds, horsetail, licorice, yerba mate.

pharmacokinetics: po onset.5-2h, pk 6-8h, duration 3-4days. iv onset 5-30min, pk 1-5h, duration variable. t 1/2 1.5 days.

95. rosiglitazone (avandia)

class: [color=#ffff00]antidiabetic, oral

action: improves insulin resistance by hepatic glucose metabolism, insulin receptor kinase activity, insulin receptor phsophorylation

uses: stable niddm, alone or in combo c sufonylureas, metformin, or insulin

dosage: po 4mg qd or in 2 divided doses, may > to 8mg qd or in 2 divided doses after 12wk

se: no common se's listed.others:weight gain, accidental injury, uri, sinusitis, anemia, back pain, diarrhea, edema, fatigue, headache, hyper/hypoglycemia.

contra: diabetic ketoacidosis

precautions: thyroid disease, hepatic, renal

interactions: may

pharmacokinetics: maximal reduction in fbs after 6-12wk, protein binding 99.8%, elimination t ½ 3-4h

[BORI-BSNRN, BSN, RN]

hi everyone, i found this on my files..hope it help. just wanted to share it you can add it to rozy's list!! bori

ps. the other part its coming in another post it's too long!! :)

1. apap/hydrocodone (vicodin, lortab)

class: antitussive opioid analgesic; schedule iii

action: acts on cough center in medulla; binds to opiate receptors in cns to reduce pain

dosage: adult-po 5-10mg q4h prn

child-po 1.25-5mg q4hprn or 0.2mg/kg q3-4h

se: drowsiness, sedation, dizziness, light-headedness, nausea, anorexia, vomiting, and constipation, circulatory depression, respiratory depression.

contra: addiction

precautions: addictive personality, > intracranial p, acute mi, severe heart disease, respiratory depression, hepatic, renal

interactions: >cns depression:alcohol, opioids, sedative/hypnotics, phenothiazines, skeletal muscle relaxants, general anesthetics, tricyclics

pharmacokinetic: onset 10-20 min, duration 4-6h, t½ 3½-4½h

3. levothyroxine (synthroid)

class: thyroid hormone

action: >metabolic rate, controls protein synthesis, > cardiac output, renal bld flow, o2 consumption, body temp, bld volume, growth, development at cellular level, exact mechanism unknown

dosage: severe hypothyroidism- adult:po 50mcg qd, increased by 50-100 mcg q 1-4 wk until desired response, maintenance dose 75-125 mcg qd; im/iv 50-100mcg/d as a single dose or 50% of usual oral dosage. child: >12yr po 2-3mcg/kg/day, 6-12yr po 4-5mcg/kg/day; 1-5yr po 5-6 mcg/kg/day, 6-12mos po 6-8 mcg/kg/day, up to 6mos po 8-10 mcg/kg/day - all children's as single dose am; myxedema coma- adult: iv 200-500 mcg, may increase by 100-300mcg after 24 hr; use oral med asap

se: anxiety, insomnia, tremors, thyroid storm, tachycardia, palpitations, angina, dysrhythmias, cardiac arrest,

contra: adrenal insufficiency, recent mi, thyrotoxicosis, hypersensitivity to beef, alcohol intolerance (injection only)

precautions: elderly, angina pectoris, htn, ischemia, cardiac disease, diabetes

interactions: >risk cardiac insufficiency when used w/ epinephrine products; effects of anticoagulants, sympathomimetics, tricyclics;

pharmacokinetics: po onset 3-5 days, pk 1-3wks, duration 1-3wk; iv onset 6-8hr, pk 24h duration unknown. t ½ 6-7 days; distributed throughout body tissues

2. atorvastatin (lipitor)

class: [color=#7f0000]antilipidemic[color=#7f0000]

action: inhibits hmg-coa reductase enzyme, which reduces cholesterol synthesis

dosage: po 10mg qd, usual range 10-80, adjustments may be made in 2-4wk intervals, max 80/d

se: abdominal cramps, constipation, diarrhea, flatus, heartburn, liver dysfunction, rhabdomyolysis

contra: active liver disease

precautions: past liver disease, alcoholism, severe acute infections, trauma, hypotn, uncontrolled seizure disorders, severe metabolic disorders, electrolyte imbalance

interactions: rhabdomyolysis: azole antifungals, cyclosporine, erythromycin, niacin, gemfibrozil, clofibrate; >serum digoxin; >levels oral contraceptives; >levels atorvastatin: erythromycin, itraconazole; >effects of warfarin (coumadin); grapefruit juice

pharmacokinetics: 98% protein bound, t½ 14h

35. lorazepam (ativan)

class: [color=#00ff00]sedative, hypnotic, antianxiety. benzodiazepine. controlled substance schedule iv.

action: potentiates the actions of gaba, esp in system and reticular formation

uses: anxiety, irritability in psychiatric or organic disorders, preop, insomnia, adjunct in endoscopic procedures

dosage: anxiety: adult po 2-6mg/day in divided doses, not to exceed 10mg/day. geriatric: po 0.5-1mg/day or 0.5-1mg hs. child po 0.05mg/kg/dose, q 4-8h. insomnia: po 2-4mg hs; only minimally effective after 2wk continuous therapy. preop: adult im 50mcg/kg 2h prior to surgery; iv 44mcg/kg 15-20min prior to surgery. child iv 0.05mg/kg. status epilepticus: neonate iv 0.05mg/kg. child iv 0.1mg/kg up to 4mg/dose; rectal (off label) 0.05-0.1mg x 2; wait 7 min before giving 2nd dose.

se: dizziness, drowsiness, orthostatic htn, ecg changes, tachycardia, apnea, cardiac arrest (iv, rapid), blurred vision

contra: narrow-angle glaucoma, psychosis, child

precautions: elderly, debilitated, hepatic, renal

interactions: effects of lorazepam: cns depressants, alcohol, disulfiram, oral contraceptives. herbal > cns depression: chamomile, hops, kava, skullcap, valerian

pharmacokinetics: po onset.5h, pk 1-6h, duration 24-48hr. im onset 15-30min, pk 1-1.5h, duration 24-48h. iv onset 5-15min, pk uk, duration 24-48h.

4. atenolol (tenormin)

class: antihypertensive,antianginal; beta blocker (b1, b2 high doses)

action: blocks stimulation of b adrenergic receptor within vascular smooth muscle; produces negative chronotropic activity (affecting the time or rate, as the rate of contraction of the heart), negative inotropic activity ( recovery time), slows conduction of av node,

uses: mild to moderate htn, prophylaxis of angina pectoris, suspected or known mi (iv)

dosage: adult: iv 5mg, repeat 10 min if initial dose well tolerated, then start po dose 10 min after last iv dose. adult: po 50mg qd, increasingq 1-2wk to 100mg qd; may increase to 200mg qd for angina. elderly: po 25mg/day initially. renal disease: adult- po ccr 15-35 ml/min, max 50mg/day; ccr

se: profound hypotn, bradycardia, chf, cold extremities, postural hypotn, 2nd or 3rd degree heartblock, insomnia, fatigue, dizziness, mental changes, nausea, diarrhea, mesenteric arterial thrombosis, ischemic colitis, agranulocytosis, thrombocytopenia, purpura, bronchospasm

contra: cardiogenic shock, 2nd or 3rd degree heart block, sinus bradycardia, cardiac failure

precautions: major surgery, diabetes, renal, thyroid, chf, copd, asthma, well-compensated heart failure

interactions: > hypotn, bradycardia: reserpine, hydralazine, methyldopa, prazosin, antichlinergics, digoxin, diltiazem, verapamil, cardiac glycosides, antihtn's; >hypoglycemic effect: insulin, oral antidiabetics; mutual inhibition: sympathomimetics(cough, cold preps)

pharmacokinetics: iv onset rapid, pk 5 mins, duration uk; po pk2-4 hr, onset 1 hr duration 24 hr; t½ 6-9hr, excrete unchanged in urine, 5-15% protein bound.

5. amoxicillin (amoxil, trimox)

class: antiinfective, antiulcer; aminopenicillin

action: interferes with cell wall replication of susceptible organisms; the cell wall, rendered osmotically unstable, swells and bursts from osmotic pressure.

uses: tx skin, respiratory, gi, gu infections; otitis media, gonorrhea

dosage: systemic infx: adult-po 750mg-1.5g qd in divided doses q8h; child- po 20-50 mg/kg/day in divided doses q8h; renal disease: adult- po ccr 10-50ml/min dose q 12 h; ccr

se: bone marrow depression, granulocytopenia, nausea, vomiting, diarrhea, pseudomembranous colitis, seizures, anaphylaxis, respiratory distress, serum sickness, uticaria, rash

precautions: hypersensitivity to chephalosporins, neonates, renal disease

interactions: > amox level: probenecid, anticoagulant action: warfain (coumadin), delayed or reduced absorption: khat so separate by 2hr

pharmacokinetics: po pk 2h, duration 6-8h, t½ 1-1 1/3 h

6. estrogens; conjugated tablets (premarin)

class: estrogen, hormone

action: needed for adequate fx female reproductive sys; affects release of pituitary gonadotropins, inhibits ovulation, adequate ca+ use in bone.

uses: menopausal sx, inoperable breast cancer, prostatic cancer, abnormal uterine bleeding, hypogonadism, primary ovarian failure, prevention of osteoporosis

dosage: menopause: po 0.3-1.25mg qd 3wk on, 1wk off; prevention of osteoporosis: po 0.625mg qd or in cycle; atrophic vaginitis: vag cream 2-4g ml qd x 21 days, off for 7 days, repeat; prostatic cancer: po 1.25-2.5mg tid; breast cancer: po 10mg tid x 3mo or longer; abnormal uterine bleeding iv/im 25mg, repeat in 6-12hr; castration/primary ovarian failure: po 1.25mg qd 3 wk on, 1wk off; hypogonadism po 2.5mg bid-tid x 20 days/mo

se: seizures, thromboembolism, stroke, pulmonary embolism, mi, nausea, cholestatic jaundice, hepatic adenoma, gynecomastia, testicular atrophy, impotence, > risk breast cancer, endometrial cancer

contra: breast cancer, thromboembolic disorders, reproductive cancer, genital bleeding, pregnancy, lactation

precautions: htn, asthma, blood dyscrasias, gallbladder disease, chf, diabetes, bone disease, depression, migraines, convulsive disorders, hepatic, renal, family hx of cancer of breast or repro tract, smoking

interactions: may need to increase thyroxine dose; >toxicity: cyclosporine, dantrolene, action of corticosteroids; > estrogen level: grapefruit juice.

7. furosemide oral (lasix)

class: loop [color=#ffff00]diuretic; sulfonamide derivative

action: inhibits reabsorption of na+ and chloride at proximal and distal tubule and in the loop of henle.

uses: pulmonary edema; edema in chf, liver disease, nephritic syndrome, ascites, htn

dosage: adult- po 20-80 mg/day in am; may give another dose in 6hr up to 600mg/day; im/iv 20-40mg, increased by 20mg q2hr until desired response. child- po/im/iv 2mg/kg; may increase by 1-2mg/kg/q6-8hr up to 6mg/kg. pulmonary edema- iv 40mg given over several min, repeated in 1 hr; increase to 80mg if needed. hypertensive crisis/acute renal failure: iv 100-200mg over 1-2min. antihypercalcemia: adult- im/iv 80-100mg q 1-4hr or po 120mg qd or divided bid; child- im/iv 25-50mg, repeat q4hr if needed

se: circulatory collapse, ototoxicity, hypokalemia, hypochloremic alkalosis, hypomagnesemia, hyperuricemia, hypocalcemia, hyponatremia, hyperglycemia, nausea, polyuria, renal failure, thrombocytopenia, agranulocytosis, leukopenia, neutropenia, anemia, rash, pruritis, stevens-johnson syndrome

contra: hypersensitivity to sulfonamides, anuria, hypovolemia, infants, electrolyte depletion

precautions: diabetes, dehydration, severe renal disease, cirrhosis, ascites

interactions: > toxicity: lithium, nondepolarizing skeletal muscle relaxants, digitalis; > hypotensive action of antihtn, nitrates; > ototoxicity: aminoglycosides, cisplatin, vancomycin

pharmacokinetics: po onset 1 hr pk 1-2hr, duration 6-8hr; absorbed 70%. iv onset 5min pk ½ hr, duration 2hr (metab by liver 30%). excreted in urine, some as unchanged drug, feces; t½ 1hr

8. amlodipine (norvasc)

class: antianginal, [color=#ffff00]antihypertensive, ca+ channel blocker

action: inhibits ca+ influx during depolarization, relaxes

coronary muscle, dilates coronary arteries; relaxing the muscles lining the arteries of the rest of the body lowers the blood pressure, which reduces the burden on the heart. reducing burden lessens the heart muscle's demand for oxygen, and further helps to prevent angina

dosage: angina- po 5-10mg qd; htn po 2.5-5mg qd initially,

max 10mg/day

se: most common-headache and edema(swelling) of lower extremities. less common- dizziness, flushing, fatigue, nausea, palpitations

contra: sick sinus syndrome, 2nd-3rd degree heart block, hypotn

precautions:chf, hypotn, hepatic injury, renal, elderly

interactions: high na diet, grapefruit juice; >hypotn: alcohol, fentanyl, quinidine, antihtn, nitrates; neurotoxicity: lithium;

pharmacokinetics: onset ?; pk 6-12h, t½ 30-50h, >95% protein bound.

9. albuterol

class: adrenergic b2 agonist, sympathomimeetic, [color=#00ffff]bronchodilator[color=#00ffff]

action: bronchodilation by action on b2 (pulmonary)receptors by increasing levels of camp, which relaxes smooth muscle; produces bronchodilation, cns, cardiac stimulation, as well as > diuresis and gastric acid secretion; longer acting than isoproterenol

uses: prevention of exercise-induced asthma, acute bronchospasm, bronchitis, emphysema, bronchiectasis, or other reversible airway obstruction

dosage: exercise-induced bronchospasm: adult: inh (metered dose inhaler) 2 puffs 15mins before exercising. other resp conditions: adult and child> 12 yr: inh 2 puffs q4hr; po 2-4mg tid-qid, not to exceed 8mg; volmax xr 8mg q12h; repetabs4-8mg q12h; neb/ippb 2.5mg tid-qid. geriatric: po 2mg tid-qid, may increase gradually to 8mg tid-qid. child 2-12yr: inh 0.1mg/kg tid (max2.5mg tid-qid); neb/ippb 0.1-0.15mg/kg/dose tid-qid or 1.25mg tid-qid for child 10-15kg or 2.5mg tid-qid15kg. adult and child>4yr: inh cap (rotohaler inhalation) 200mcg cap inhaledq4-6hr; may use 15min before exercise

se: tremors, anxiety, restlessness, bronchospasm

contra: hypersensitivity to sympathomimetics, tachydysrhythmias, severe cardiac disease, heart block

precautions: cardiac disorders, hyperthyroidism, diabetes, htn, prostatic hypertrophy, narrow-angle glaucoma, seizures, exercise-induced bronchospasm (aerosol) in children

interactions: > action of aerosol bronchodilators, >action of albuterol: tricyclic antidepressants, maoi's, other adrenergics; do not use together. may inhibit action of abluterol: other b-blockers. severe hypotn: oxytoxics. toxicity:theophylline. ecg changes/hypokalemia: k+-losing diruretics. >stimulation: ephedra, caffeine (cola nut, green/black tea, guarana, mate, coffee, chocolate).

pharmacokinetics: well absorbed po, extensively metabolized in liver and tissues, crosses bld brain barrier. po onset ½ h, pk 2 ½ hr, duration 4-6h, t ½ 2 ½ h. po-xr onset ½ h; pk 2-3h; duration 12h. inh: onset 5min, pk 1-1 ½ h, duration 4-6h, t ½ 4h

10. alprazolam (zanax)

class: [color=#00ff00]antianxiety; benzodiazepine; schedule iv

action: depresses subcortical levels of cns, including limbic system, reticular formation

uses: anxiety, panic disorders, anxiety with depressive sx

dosage: anxiety disorder: po 0.25-0.5mg tid, not to exceed 4mg/day in divided doses. elderly: po 0.125-0.25 mg bid; increase by 0.125 as needed. panic disorder: po 0.5 mg tid may increase, max 10mg/day. premenstrual dysphoric disorders: po 0.25mg bid-qid, starting on day 16-18 of menses, taper over 2-3 days when menses occurs. social phobia: po 2-8mg/day. hepatic dose: reduce by 50%

se: dizziness, drowsiness, orthostatic hypotn, ecg changes, tachycardia, blurred vision

contra: hypersensitivity to benzodiazepines, narrow-angle glaucoma, psychosis, addiction

precautions: elderly, debilitated, hepatic

interactions: cns depression: anticonvulsants, alcholol, antihistamines, sedative/hypnotics, valerian, chamomile, hops, skullcap, cat's claw, kava, echinacea, golden-seal, licorice, st. john's wort, wild cherry. drug level with grapefruit juice.

pharmacokinetics: po onset 30min, pk 1-2 h, duration 4-6h, therapeutic response 2-3 days; excreted by kidneys, t ½ 12-15h

11. hydrochlorothiazide (hydrodiuril)

class: thiazide [color=#ffff00]diuretic, antihtn; sulfonamide derivative

action: acts on distal tubule and ascending limb of loop of henle by > excretion of water, na+, chloride, k+

uses: edema, htn, diuresis, chf, edema in corticosteriod, estrogen, nsaids, idiopathic lower extremity edema therapy

dosage: adult-po 25-100 mg/day; geriatric po 12.5mg/day, initially; child >6mo: po up to 2mg/kg/day in divided doses; child

se: urinary frequency, uremia, glucosuria, dizziness, fatigue, weakness, nausea, vomiting, anorexia, hepatitis, rash, hyperglycemia, hyperuricemia, aplastic anemia, hemolytic anemia, leukopenia, agranulcytosis, thrombocytopenia, neutropenia, hypokalemia

contra: anuria, renal decompensation, hypomagnesemia

precautions: hypokalemia, renal, hepatic, gout, copd, le, diabetes, hyperlipidemia, ccr

interactions: > toxicity of lithium, nondepolarizing skeletal muscle relaxants, cardiac glucosides. risk of renal failure: nsaids. hyperglycemia: glucocorticoids, amphotericin b. > effects: loop diuretics. k+ deficiency: aloe, buckthorn bark/bery, cascara sagrada bark, licorice root, senns pod/leaf. > effect: ginkgo

pharmacokinetics: po onset 2 h, pk 4h, duration 6-12h, t½ 6-15h, excreted unchanged by kidneys

12. sertraline (zoloft)

class: [color=#7f7f7f]antidepressant; ssri

action: inhibits serotonin reuptake in cns; >action of seotonin; does not affect dopamine, norepinephrine

dosage: adult-po 50mg qd; may > to max of 200mg/day; do not change dose at intervals of by 25mg q3days to desired dose. child 6-12 yr: po 25mg qd. child 13-17yr po 50mg qd.

uses: major depression, ocd, ptsd, panic disorder

se: insomnia, agitation, somnolence, dizziness, headache, tremor, fatigue, male sex dysfx, diarrhea, nausea, constipation, anorexia, dry mouth, vomiting, flatulence

contra: pimozide

precautions: elderly, hepatic, renal, epilepsy, recent mi

interactions: > effects of: antidepressants (tricyclics), diazepam, tobutamide, warfarin, benzodiapzepines, sumatriptan. fatal reactions: maoi's. > sertraline levels: cimetidine, warfarin, other highly protein bound drugs. altered lithium levels: lithium. sertraline in contraindicated with pimozide. potentiation of ssri, serotonin syndrome: st. john's wort, sam-e; do not use together.

pharmacokinetics: po pk 4.5-8.4h; steady state 1 wk; 99%plasma protein bound, t ½ 1-4days, extensively metabolized, metabolite excreted in urine, bile

13.paroxetine (paxil)

class: [color=#7f7f7f]antidepressant; ssri

action: inhibits cns neuron uptake of serotonin but not of norepinephrine or dopamine

uses: major depressive disorder, ocd, panic disorder, generalized anxiety disorder

dosage: po 20mg qd inam; after 4 wk if no improvement may > by 10mg/day q wk to desired response, max 60mg/day or controlled releases 25mg/day weekly up to 62.5mg/day. geriatric start at 10mg/day, max 40mg/day. renal:10mg/day in am, may increase to max 50mg/day. ocd: po 40mg/day, start w/ 20mg/day, > 10mg/day increments max 60mg/day. panic disorder: po 40mg/day start w/ 10mg/day > 10mg/day increments, max 60mg/day or controlled release 12.5 mg/day, max 75mg/day

se: upset stomach, drowsiness, weakness or tiredness, excitement or anxiety, insomnia, nightmares, dry mouth, changes in appetite or weight

contra: maoi's

precautions: children, elderly, seizure hx, pts w/ hx of mania, renal, hepatic disease

interactions: > bleeding w/ warfarin. no maoi's, potentially fatal reaction. cimetidine > paroxetine plasma levels. > agitation: l-tryptophan. phenobarbital and phytoin se's: highly protein bound drugs. paroxetine may theophylline levels: theophylline. possible serotonin syndrome: sam-e, st. john's wort.

pharmacokinetics: po pk5.2h, unchanged drugs and metabolites excreted in feces and urine; t ½ 21h; 95% protein bound.

14. apap/propoxyphene-n (darvon)

class: opiate analgesic; synthetic opiate

action: depresses pain impulse transmission at the spinal cord level by interacting with opioid receptors

uses: mild to moderate pain

dosage: po 65mg q4h prn (hcl); po 100mg q4h prn (napsylate)

se: drowsiness, dizziness, confusion, headache, sedation, seizures, hyperthermia(elderly), nausea, vomiting, anorexia, constipation, cramps, rash, dysrhythmias, respiratory depression

contra: addiction

precautions: addictive personality, > intracranial pressure, acute mi, severe heart disease, respiratory depression, hepatic, renal,

interactions: possible fatal: maoi's; > effects c other cns depressants- alcohol, opioids, sedative/hypnotics, antipsychotics, skeletal muscle relaxants; > cns depression c chamomile, hops, kava, skullcap, valerian

pharmacokinetics: po onset ½- 1h, pk 2-2 ½h, duration 4-6h. t 1/2 6-12h

15. azithromycin (zithromax, z-pak)

class: antiinfective; macrolide

action: binds to 50s ribosomal subunits of susceptible bacteria and suppresses protein synthesis; much greater spectrum of activity than erythromycin.\

uses: mild to moderate infx; upper resp, lower resp, uncomplicated skin infx, urethritis & cervicitis d/t chalmydia trachomatis, acute otitis media, tonsillitis, commuhity acquired pneumonia, mycobacterium avium complex (mac [hiv related])

dosage: most infx: adult -po 500mg/day on day 1, then 250mg qd on days 2-5 for a total dose of 1.5g. child2-15yr- po 10mg/kg on day 1, then 5mg/kg x 4 days. cervicitis, chlamydia, chancroid 1g single dose, gonorrhea 2g single dose. pelvic inflammatory disease po/iv 500mg iv q24hr x 2 doses, then 500mg po q24hr x 7-10 days. mac po 600mg/day in combination w/ ethambutol. pneumonia po/iv 500mg/ iv q24h x 2 doses, then 500mg po q 24h x 7-10days. endocarditis prophylaxis adult: po 500mg 1 hr prior to procedure. child po 15mg/kg 1 h prior to procedure.

se: nausea, vomiting, diarrhea, hepatotoxicity, cholestatic jaundice, pseudomembranous colitis, angioedema

contra: hypersensitivity to azithromycin, erythromycin, or any macrolide

precautions: hepatic, renal, cardiac disease; elderly,

interactions: toxicity: ergotamine. >effects of oral anticoagulants, digoxin, theophylline, methylprednisolone, cyclosporine, bromocriptine, disopyramide, triazolam, carbamazepine, phenytoin.

pharmacokinetics: po pk 2-4h, duration 24h, iv pk end of infx, duration 24h; t ½ 11-57h, excreted in bile, feces, urine primarily as unchanged drug

16. cephalexin (keflex)

class: antiinfective, 1st generation cephalosporin

action: inhibits bacterial cell wall synthesis, rendering cell wall osmotically unstable, leading to cell death by binding to cell wall membrane.

dosage: moderate infx: adult: po 250-500mg q6h, child: po 25-50mg/kg/day in 4 equal doses. moderate skin infections: adult -po 500mg q12h. endocarditis prophylaxis 2g 1 h before procedure. severe infx: adult po 500mg -1g q6h; child po 50-100 mg/kg/day in 4 equal doses

se: seizures (high doses), diarrhea, anorexia, pseudomembranous colitis, nephrotoxicity, renal failure, leukopenia, thrombocytopenia, agranulocytosis, neutropenia, lymphocytosis, eosinophilia, pancytopenia, hemolytic anemia, anaphylaxis, serum sickness

contra: infants

precautions: hypersensitivity to pcn's, renal

interactions: > toxicity: aminoglycosides, loop diuretics, probenecid

pharmacokinetics: pk 1 hr, duration 6-12h, t ½ 30-72 min, 5-15% plasma protein bound

17.simvastatin (zocor)

class: [color=#7f0000]antilipidemic; hmg-coa reductase inhibitor

action: inhibits hmg-coa reductase enzyme, which reduces cholesterol synthesis

dosage: po 5-10mg qd in pm initially; usual range 5-40mg/day qd in pm, not to exceed 80mg/day ; dosage adjustments may be made in 4wk intervals or more. elderly/renal po 5mg/day

se: liver dysfx, myositis, rhabdomyolysis

contra: active liver disease

precautions: past liver disease, alcoholism, severe acute infx, trauma, hypotn, uncontrolled seizure disorders, severe metabolic disorders, electrolyte imbalances

interactions: > effects of warfarin. > myalgia, myositis: cyclosporine, gemfibrozil, niacin, erythromycin, clofibrate, clarithromycin, itraconazole, protease inhibitors. > serum level of digoxin

pharmacokinetics: pk 1.5-2h, highly protein bound, excreted primarily in bile, feces (60%)

18. lansoprazole (prevacid)

class: [color=#7f0000]antiulcer, proton pump inhibitor; benzimidazole

action: suppresses gastric secretion by inhibiting h/k+ atpase enzyme system in gastric parietal cell; characterized as gastric acid pump inhibitor, since it blocks final step of acid production

uses: gerd, pathologic hypersecretory conditions (zollinger-ellison syndrome, systemic mastocytosis, multiple endocrine ademosas); ulcers

dosage: ng tube: use intact granules mixed in 40ml of apple juice and injected thru ng tube, then flush c apple juice. duodenal ulcer: po 15mg qd before eating for 4 wk then 15mg qd to maintain healing of ulcers; associated c helibacter pylori - 30mg + 500mg clarithromycin, 1g amoxicillan bid x14days or 30mg + 1g amoxicillan x 14d. erosive esophagitis: po 30mg qd before eating for up to 8wk, may use another 8 wk course if needed. hypersecretory conditions: po 60mg qd up to 90mg bid

se: constipation, diarrhea,cva, mi, shock, hematuria, hemolysis

interactions: delayed absorption of lansoprazole: sucralfate. may be

pharmacokinetics: absorption after granules leave stomach- rapid; plasma t½ 1.5h, 97%protein bound, clearance

19. ibuprofen (advil, motrin)

class: nsaid, antipyretic, non-opioid analgesic; propionic acid derivative

action: inhibits prostaglandin synthesis by

uses: rheumatoid arthritis, osteoarthritis, primary dysmenorrhea, gout, dental pain, musculoskeletal disorder, fever

dosage: analgesic:po 200-400mg q4-6h no to exceed 3.2g/day. child: po 4-10mg/kg/dose q6-8h. antipyretic: child 6mo-12yr: po 5mg/kg (temp 102.5), may repeat q4-6h, max 40mg/kg/day. anitinflammatory: po 300-800mg tid-qid, max 3.2g/d. child po 30-40 mg/kg/day in 3-4 divided doses, max 50mg/kg/day.

se: headache, nausea, anorexia, hepatitis, gi bleeding, nephrotoxicity, blood dyscrasias, anaphylaxis

contra: asthma, severe renal or hepatic

precautions: bleeding disorders, gi disorders, cardiac disorders, elderly, chf, ccr

interactions: risk of bleeding cefamandole, cefotetan, cefoperazone, valproic acid, thrombolytics, antiplatelets, warfarin. > possibility of blood dyscrasias: antineoplastics, radiation. > toxicity: digoxin, lithium, oral anticoagulants, cyclosporin, probenecid. > gi reactions: aspirin, corticosteroids, nsaids, alcohol. > hypoglycemia: oral antidiabetics, insulin. > risk of bleeding: arnica, chamomile, clove, dong quai, fenugreek, feverfew, garlic, ginger, ginkgo, ginseng (panax)

pharmacokinetics: well absorbed po. onset .5h, pk 1-2h, t½ 2-4h, 90-99%plasma protein binding, does not enter breast milk

21. hctz/triamterene (dyrenium)

class: k+ sparing [color=#ffff00]diuretic, pteridine derivative

action: acts of distal tubule to inhibit reabsorption of na+, chloride; > k+ retention

uses: edema, may be used c other diuretics; htn

dosage: po 100mg bid pc, not to exceed 300mg/day. geriatric: po 50mg qd, max 100mg/day

se: nausea, diarrhea, vomiting, liver disease, thrombocytopenia, megaloblastic anemia, azotemia, interstitial nephritis, > bun, creatinine

contra: anuria, severe renal or hepatic disease, hyperkalemia

precautions: dehydration, hepatic, renal, chf, cirrhosis

interactions: nephrotxic: indomethacin, enhanced action of antihtn- amantadine. > hyperkalemia: other k+ sparing diuretics, k+ products, ace inhibitors, salt substitutes.

pharmacokinetics: po onset 2 h, pk 6-8h, duration12-16h, t ½ 3h

26.metoprolol succinate (lopressor)

class: [color=#ffff00]antihypertensive, antianginal. b1-blocker

action: lowers bf by b-blocking effects; reduces elevated renin plasma levels; blocks b2 adrenergic receptors in brochial, vascular smooth muscle only at high doses

uses: mild to moderate htn, acute mi to reduce cardiovascular mortality, angina pectoris, nyha class ii, iii heart failure

dosage: htn: po 50mg bid, or 100mgqd; may give up to 200-450mg in divided doses. ext rel give qd. geriatric: po 25mg/day initially, > weekly as needed. mi early tx: iv bolus 5mg q2min x 3, then 50mg po 15 min after last dose and q6h x 48h; late tx po maintenance 100 mg bid for 3 mos. angina po 100mg qd, > qwk prn or 100mg ext rel qd.

se: bradycardia, chf, palpitations, cardiac arrest, av block, pulmonary edema, insomnia, dizziness, depression, nausea, vomiting, diarrhea, hiccups, agranulocytosis, eosinophilia, thrombocytopenia, purpura, bronchospasm

contra: cardiogenic shcok, 2nd, 3rd degree heart blcok, sinus bradycardia, bronchial asthma

precautions: major surgery, diabetes, renal, thyroid, copd, heart failure, cad, nonallergic bronchospasm, hepatic, chf

interactions: > hypotn, bradycardia: reserpine, hydralazine, methyldopa, prazosin, amphetamines, ephedrine, epinephrine, norepinephrine, h2-antagonists. > hypoglycemic effects: insulin oral antidiabetics. don't use c maoi's.

pharmacokinetics: po pk 2-4h, duration 13-19h, t 1/2 3-4h

30. fluoxetine (prozac)

class: [color=#7f7f7f]antidepressant, ssri (selective serotonin reuptake inhibitor)

action: inhibits cns neuron uptake of serotonin but not of norepinephrine

uses: major depressive disorder, obd, bulimia, sarafem: pmdd

dosage: depression: adult po 20mg qd in am; after 4wk if no clinical improvement is noted, dose may be > to 20mg bid in am, pm, not to exceed 80mg/day. geriatric 10mg/day, > as needed. child: 5-18yr po 5-10mg/day, max 20mg/day. pmdd po 10-20mg qd, may be taken qd week before menses.

se: headache, nervousness, insomnia, drowsiness, anxiety, tremor, dizziness, fatigue, sedation, poor concentration, abnormal dreams, agitation, seizures, nausea, diarrhea, dry mouth, anorexia, dyspepsia, constipation, cramps, vomiting, taste changes, flatulence,

precautions: diabetes

interactions: no maoi's with or 14 days prior. st. john's wort: do not use together.

> se: highly protein bound drugs. > effect: haloperidol. t ½ of diazepam. > levels or toxicity of carbamazepine, lithium, digoxin, warfarin, pheytoin. > levels of tricyclics, phenothiazines. paradoxical worsening of ocd: buspirone. > cns depression: alcohol, antidepressants, opioids, sedatives. > action c kava.

pharmacokinetics: po pk 6-8h, terminal t ½ 2-3days, steady state 28-35 days, 94% protein bound

35. lorazepam (ativan)

class: [color=#00ff00]sedative, hypnotic, antianxiety. benzodiazepine. controlled substance schedule iv.

action: potentiates the actions of gaba, esp in system and reticular formation

uses: anxiety, irritability in psychiatric or organic disorders, preop, insomnia, adjunct in endoscopic procedures

dosage: anxiety: adult po 2-6mg/day in divided doses, not to exceed 10mg/day. geriatric: po 0.5-1mg/day or 0.5-1mg hs. child po 0.05mg/kg/dose, q 4-8h. insomnia: po 2-4mg hs; only minimally effective after 2wk continuous therapy. preop: adult im 50mcg/kg 2h prior to surgery; iv 44mcg/kg 15-20min prior to surgery. child iv 0.05mg/kg. status epilepticus: neonate iv 0.05mg/kg. child iv 0.1mg/kg up to 4mg/dose; rectal (off label) 0.05-0.1mg x 2; wait 7 min before giving 2nd dose.

se: dizziness, drowsiness, orthostatic htn, ecg changes, tachycardia, apnea, cardiac arrest (iv, rapid), blurred vision

contra: narrow-angle glaucoma, psychosis, child

precautions: elderly, debilitated, hepatic, renal

interactions: effects of lorazepam: cns depressants, alcohol, disulfiram, oral contraceptives. herbal > cns depression: chamomile, hops, kava, skullcap, valerian

pharmacokinetics: po onset.5h, pk 1-6h, duration 24-48hr. im onset 15-30min, pk 1-1.5h, duration 24-48h. iv onset 5-15min, pk uk, duration 24-48h.

37. metformin (glucophage)

class: [color=#ffff00]antidiabetic[color=#ffff00]

action: inhibits hepatic glucose production and > sensitivity of peripheral tissue to insulin

dosage: po 500mg bid initially, then > to desired response 1-3g; dosage adjustments q2-3wk or 850mg qd c morning meal c dosage > every other wk, max 2500mg/day, ext rel max 2000mg/day.

se: headache, weakness, dizziness, drowsiness, agitation, nausea, vomiting, diarrhea, thrombocytopenia, lactic acidosis

contra: hepatic, creatinine > 1.5mg/ml(males) >1.4(females), chf, alcoholism, cardiopulmonary disease, hx of lactic acidosis

precautions: thyroid disease

interactions: > metformin level: cimetidine, digoxin, morphine, procainamide, quindine, rantidine, triamterene, vancomycin. > hypoglycemia: cimetidine, ca+ channel blockers, corticosteroids, estroens, oral contraceptives, phenothiazines, sympathomimetics, diuretics, thyroid, isoniazid, phenytoin. do not give c radiologic contrast media; may cause renal failure. herbal: quinine: > metformin level. hyperglycemia: glucosamine. hypoglycemia: chromium, coenzyme q-10, fenugreek.

pharmacokinetics: t ½ 1.5-5h, terminal 6-20h, pk 1-3h

44.buproprion sustained-release (wellbutrin, zyban)

class: [color=#7f7f7f]antidepressant, smoking deterrent

action: inhibits reuptake of dopamine, serotonin, norephinephrine

dosage: po 100mg bid initially, then > after 3 days to 100mg tid if needed; may increase after 1 mo to 150 mg tid; sr 150bid, initially 150mg am, > to 300 mg/day if initial dose is tolerated.

se: headache, agitation, dizziness, akinesia, bradykinesia, confusion, seizures, insomnia, sedation, tremors, dysrhythmias, htn, tachycardia, complete av block, nausea, vomiting, dry mouth, constipation, menstrual irregularities, rash, sweating, blurred vision, auditory disturbance, weight loss or gain

contra: eating disorders, seizure disorders

precautions: renal, hepatic, recent mi, cranial trauma, seizure disorder

interactions: > adverse reactions, seizures: levodopa, maoi's, phenothiazines, antidepressants, benzodiazepines, alcohol, theophylline, systemic steroids. > bupropion toxicity: ritonavir. bupropion level: cimetidine. herbal: > cns depression: kava. may > anticholinergic effect: belladonna leaf/root.

pharmacokinetics: onset 2-4wk, t 1/2 14h, metabolized by liver, steady state 1.5-5wk

47. lisinopril (prinivil, zestril)

class: [color=#ffff00]antihypertensive, ace inhibitor

action: selectively suppresses renin-angiotensin aldosterone system; inhibits ace, preventing conversion of angiotensin i to angiotensin ii

uses: mild to moderat htn, adjunctive therapy of systolic chf, acute mi

dosage: htn:po 10-40mg qd; may > to 80mg qd if required.chf: po 5mg initially c diuretics/digitalis, range 5-20mg

se: proteinuria, renal insufficiency, vertigo, stroke, fatigue, angioedema

precautions: renal disease, hyperkalemia, renal artery stenosis

interactions: > hypotensive effect: diuretics, other hypertensives, probenecid, phenothiazines, nitrates, acute alcohol ingestion. hypersensitivity reactions: allopurinol. drug/food: hi k+ diet(bananas, oj, avocados, nuts, spinach) should be avoided, hyperkalemia may result.

pharmacokinetics: onset 1h, pk6-8h, duration 24h

56. ciprofloxacin (cipro)

class: broad spectrum antiinfective

action: interferes c conversion of intermediate dna fragments into hi-molecular-wt dna in bacteria; dna gyrase inhibitor

dosage: uti's: po 250mg q12h; iv 200mg q12h. complicated/severe uti's: po 500mg q12h, iv 400mg q12h. respiratory, bone, skin, joint, infx: po 500-750mg q12h; iv 400 mg q12h. renal disease: ccr

se: headache, restlessness, seizures, nausea, diarrhea, vomiting, pseudomembranous colitis, rash, anaphylaxis, stevens-johnson syndrome

precautions: renal, epilepsy

interactions: serum levels of cipro: probenecid; monitor for toxicity. > levels of: theophylline, warfarin, monitor bld levels. herbal possible toxicity: yerba mate. drug/food: >effect of caffeine; decreased absortption: dairy products, food.

pharmacokinetics: po pk 1h, t 1/2 3-4h

59. potassium chloride

class: electrolyte, mineral replacement

action: needed for adequate transmission of nerve impulses & cardiac ctx, renal fx, intracellular ion maintenance.

dosage: po 40-100meq in divided doses tid-qid; iv 20meq/hr when diluted to 40 meq/1000ml, not to exceed 150 meq/day. child: po 2-4meq/kg/day

se: cardiac depression, dysrhythmias, arrest, peaking t waves, lowered r and depressed rst, prolonged p-r interval, widened qrs complex, nausea, vomiting, cramps, diarrhea

contra: severe renal or hemolytic disease, addison's, hyperkalemia, acute dehydration, extensive tissue breakdown

precautions: cardiac disease, k+ sparing diruretics, systemic acidosis

interactions:kyperkalemia: k+ phosphate iv and products containing ca+ or magnesium; k+ sparing, diuretic, or other k+ products

pharmacokinetics: po excreted by kidneys and in feces, onset about 30 mins. iv immediate onset

64.warfarin[color=#7f7f7f](coumadin)[color=#7f7f7f]

[color=#7f7f7f]class: [color=#7f7f7f]anticoagulant[color=#7f7f7f]

[color=#7f7f7f]action: [color=#7f7f7f]interferes c bld clotting by indirect means; depresses hepatic synthesis of vit k-dependent coagulation factors.

uses: pulmonary emboli, dvt, mi, atrial dysrhythmias, postcardiac valve replacement

dosage: po/iv 2.5-10mg/day x 3 days, then titrated to prothrombin time or inr qd. child 0.1 mg/kg/day titrated to inr

se: diarrhea, hepatitis, hematuria, rash, fever, hemorrhage, agranulocytosis, leukopenia, eosinophilia

contra: hemophilia, leukemia c bleeding, peptic ulcer, thrombocytopenic purpura, hpatic(severe), severe htn, subacute bacterial endocarditis, acute nephritis, blood dyscrasias, eclampsia, preeclampsia

precautions: alcoholism

interactions: > action of warfarin: allopurinol, chloramphenicol, amiodarone, diflunisal, heparin, steroids, cimetidine, disulfiram, thyroid, glucagons, metronidazole, quinidine, sulindac, sufinpyrazone, sulfonamides, clofibrate, salicylates, ethacrynic acids, indomethacin, mefenamic acid, oxyphenbutazones, phenybutazone, cefamandole, chloral hydrate, cotrimoxazole, erythromycin, quinolone antiinfectives, isoniazid, thrombolytic agents, tricyclics. toxicity: oral sulfonylureas, phenytoin. drug/food: grapefruit juice: may > action of oral warfarin. herbal: > risk of bleeding: bromelain, cinchona, cayenne, feverfew, garlic, dan shen, ginkgo biloba, quinine, ginger, horse chestnut, papain, sweet clover, sweet vernal grass leaves, tonka bean seeds, vanilla leaf, woodruff. metabolism of warfarin: crucifer.

pharmacokinetics: po onset12-24h, pk 1.5-3days, duration 3-5days, t ½ 1.5-2.5days, 99% bound to plasma proteins.

71. pantoprazole (protonix)

class: proton pump inhibitor; benzimidazole

action: suppresses gastric secretion by inhibiting h/k+ atpase enzyme system in gastric parietal cell; characterized as gastric acid pump inhibitor, since it blocks final step of acid production

uses: gerd, severe erosive esophagitis, pathologic hypersecretory conditions (zollinger-ellison syndrome)

dosage: gerd po 40mg qd x 8 wk, may repeat course. erosive esophagitis: iv 40mg qd x 7-10d, po 40mg qd x 8wk, may repeat. hypersecretory conditions: iv 80mg q12h; max 240 mg/day.

se: headache, diarrhea, abdominal pain, rash

interactions: may > serum levels of pantoprazole: diazepam, phenytoin, flurazepam, triazolam, clarithromycin. possible > bleeding: warfarin. may delay absorption: sucralfate.

pharmacokinetics: pk 2.4h, duration>24h, t 1/2 1.5h, 97%protein binding, in elederly elimination rate

83. apap/oxycodone (percocet)

class: opiate analgesic; schedule ii

action: inhibits ascending pain pathways in cns, > pain threshold, alters pain perception

dosage: po 10-30mg q4h (5mgq6h for oxyir, oxyfast- oxyfast conc. sol. is extremely concentrated; do not use interchangeably). child po 0.05-0.15mg/kg/dose up to 5mg/dose q4-6h; not recommended in children.

se: drowsiness, dizziness, confusion, headache, sedation, euphoria, nausea, vomiting, anorexia, constipation, cramps, rash, respiratory depression.

contra: addiction (opiate)

precautions: addictive personality, increased intracranial pressure, acute mi, severe heart disease, respiratory depression, hepatic, renal, child

interactions: > effect c other cns depressants: alcohol, opioids, sedative/hypnotics, antipsychotics, skeletal muscle relaxants.

pharmacokinetics: po onset 15-30min, pk 1hr, duration4-6h, detoxed by liver.

84. digoxin (lanoxin)

class: cardiac glycoside inotropic, antidysrhythmic; digitalis prep

action: inhibits the na+-k+ atpase, which makes more ca+ available for contractile proteins, resulting in > cardiac output; > force of ctx (+ inotropic effect);

uses: chf, atrial fib, atrial flutter, atrial tachy, cardiogenic shock, paroxysmal atrial tachy, rapid digitalization in these disorders

dosage: adult iv digitalizing dose 0.6-1.0mg given as 50% of the dose initially, additional fractions given at 4-8h intervals; po digitalizing dose 0.75-1.25mg given as 50% of the dose initially, additional fractions at 4-8h intervals; maintenance 0.063-0.5mg/day(tabs), or 0.350-0.5mg/day(gelatin cap). see drug guide for child.

se: headache, dysrhythmias, hypotn, av block

contra: ventricular fib, ventricular tach, carotid sinus syndrome, 2nd or 3rd degree heart block

precautions: renal, acute mi, av block, severe resp disease, hypothyroidism, elderly, sinus nodal disease, hypokalemia

interactions: digoxin bld levels: propantheline, quinidine, verapamil, amiodarone, anticholinergics, diltiazem, nifedipine. > bradycardia: b-adrenergic blockers, antidysrythmics. herbal: > action: aloe, buckthorn bark/berry, cascara sagrada bark, castor bean oil, may apple root, rhubarb root, senna pod/leaf, yellow dock root, oleander, pheasant's eye, purple foxglove, squill. dysrhythmias: ephedra. bradycardia: indian snakeroot. cardiac toxicity: hawthorn. digoxin toxicity: licorice. hypokalemia: cocoa seeds, coffee seeds, cola seeds, guarana seeds, horsetail, licorice, yerba mate.

pharmacokinetics: po onset.5-2h, pk 6-8h, duration 3-4days. iv onset 5-30min, pk 1-5h, duration variable. t 1/2 1.5 days.

95.rosiglitazone (avandia)

class: [color=#ffff00]antidiabetic, oral

action: improves insulin resistance by hepatic glucose metabolism, insulin receptor kinase activity, insulin receptor phsophorylation

uses: stable niddm, alone or in combo c sufonylureas, metformin, or insulin

dosage: po 4mg qd or in 2 divided doses, may > to 8mg qd or in 2 divided doses after 12wk

se: no common se's listed.others:weight gain, accidental injury, uri, sinusitis, anemia, back pain, diarrhea, edema, fatigue, headache, hyper/hypoglycemia.

contra: diabetic ketoacidosis

precautions: thyroid disease, hepatic, renal

interactions: may

pharmacokinetics: maximal reduction in fbs after 6-12wk, protein binding 99.8%, elimination t ½ 3-4h

[hopeful007]

thanks a ton, bori-bsnrn....am going to take a print out of it....hows ur review getting along??when do u test??

[seesha]

wht is carlox & cilia medicines.