Home Medication Packet

Paramedic Pharmacology

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Table of Contents

Nortriptyline………………………………………………..………………………………………………...4

Diltiazem………………………………….……….………………………….……………………………5-6

HCTZ………………………………………..….…………………………………………………………..6-7

Azmacort……………………………….…….…………………………………………………………….7-8

Elavil………………………………….……………….…………………………………………………...8-9

Cartrol…………………………………..……………….………………………………………..……….9-10

Reglan…………………………………………………………………………………………………....10-11

Celexa………………………………..……….………….……………………………………………….…12

Dipyridamole……………………..………………………….……………………………………..……12-13

Neurontin……………………………..………………….………………………………………………13-14

Adalat………………………………..……………….………………………….…………………....…14-15

Fexofenadine………………………….……..………………….…………………………………………...15

Labetalol……………………………………………..…….…………………………………………..……16

Isordil……………………………………………….…………………………………………………....16-17

Carbamazipine……………………………………………….………………………………...……...…17-18

Metolazone……………………………………………….……………………………...………………18-19

Phenelzine……………………………………………….……………………………............…………19-20

Lipitor……………………………………………….……………………………...…………....………20-21

Zovirax……………………………………………….……………………………...……………..……21-22

Digoxin……………………………………………….……………………………...……………...………23

Temazepam……………………………………………….…………………………….………...…………24

Atenolol……………………………………………….……………………………...……………..………25

Feldene……………………………………………….…………………………………………...…………26

Levodopa……………………………………………….……………………………...……………………27

Benztropine……………………………………………….……………………………...……………...27-28

Dilaudid……………………………………………….……………………………...………….………28-29

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Glucophage……………………………………………….…………………………………...…………29-30

Captopril……………………………………………….……………………………...…………………30-31

Metaxalone……………………………………………….……………………………...………………31-32

Timolol……………………………………………….……………………………...……………………...32

Reference Page……………………………………………………………………………………………...33

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Nortriptyline

Generic and Trade Names: Aventyl, Pamelor

Classifications:-Therapeutic: Antidepressants-Pharmacologic: Tricyclic Antidepressant

Pharmacodynamics:-Potentiates the effect of serotonin and norepinephrine. This drug also has significant anticholinergic properties. Antidepressant action develops slowly over several weeks.

Pharmacokinetics: -Absorption: Well absorbed after oral administration.-Distribution: Widely distributed. Enters the breast milk in small doses. It probably crosses the placental barrier-Protein Binding: 92%-Metabolism and Excretion: Extensively metabolized by the liver much on its first pass. Some of the drug is converted to active compounds. This drug undergoes enterohepatic recirculation and secretion into gastric juices.-Half-life: 18-28 hrs.

Indications:-Used in the treatment of various forms of depression with psychotherapy incorporated in. -Another use is in the treatment of neurogenic pain.

Contraindications:-Hypersensitivity.-Pregnant and lactating females.-Narrow angle glaucoma.-Alcohol intolerance

Adverse Reactions and Side Effects:-CNS: Drowsiness-fatigue-lethargy-agitation-confusion-EPE-headache-insomnia-hallucinations-EENT: Blurred vision-dry eyes-dry mouth-Cardiovascular: Arrythmias-hypotension-ECG changes-Gastrointestinal: Constipation-nausea-unpleasant taste-paralytic ileus-Urinary: urinary retention-Integumentary: photosensitivity-Endocrine: gynecomastia-Hematology: blood dyscrasias-Metabolism: weight gain

Average Dosages:-PO: Children (6-12y/o) 10-20mg/day or 1-3mg/kg/day in divided doses.-PO: Children (>12y/o) 25-50mg/day or 1-3 mg/kg/day in divided doses initially.-PO: Adult 25mg 3-4 times daily to max of 150 mg/day.-PO: Geriatrics 30-50 mg/day in divided doses.

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Diltiazem

Generic and Trade Names: Cardizem-Cardizem LA-CartiaXT-Dilacor XR-Diltia XT-Tiamate-Tiazac.

Classifications:-Therapeutic: Antianginals-antihypertensives-class IV antiarrythmics-Pharmacologic: Calcium channel blockers

Pharmacodynamics:-Inhibits the transport of calcium into myocardial and vascular smooth cells, resulting in inhibition of excitation-contraction coupling and each other contraction. Provides systemic vasodilation resulting in a decrease in blood pressure. Coronary vasodilation results in less frequency and severity of angina.

Pharmacokinetics:-Absorption: Well absorbed, but rapidly metabolized after oral administration.-Distribution: This is unknown in this drug.-Protein Binding: 70-80%-Metabolism and Excretion: Mostly metabolized by the liver.-Half-life: 3.5-9 hrs.

Indications:-Hypertension-Chest pain and Prinzmetals angina-Supraventricular tachyarrythmias and rapid ventricular rates in Afib anf flutter.-Management of Raynaud’s syndrome (unlabeled use)

Contraindications:-Hypersensitivity-Sick sinus syndrome-2nd or 3rd degree heart block (unless pacemaker is implanted)-Blood pressure <90systolic-Recent MI or pulmonary congestion.-Concurrent use of rifampin (a TB drug)

Adverse Reactions and Side Effects:-CNS: Abnormal dreams-anxiety-confusion-dizziness-drowsiness-headache-nervousness-psychiatric disturbances-weakness.-EENT: Blurred vision-disturbed equilibrium-epistaxis-tinnitus.-Respiratory: Cough-Dyspnea.-Cardiovascular: Arrythmias-CHF-peripheral edema-bradycardia-chest pain-hypotension-palpitations-syncope-tachycardia-Gastrointestinal: Abnormal liver function tests-anorexia-constipation-diarrhea-dry mouth-dyspepsia-dysgeusia-nausea-vomiting.-Urinary: Dysuria-nocturia-polyuria-sexual dysfunction-urinary frequency.-Integumentary: Dermatitis-erythema multiforme-flushing-increased sweating-photosensitivity-urticaria-rash-pruritus.-Endocrine: Gynecomastia-hyperglycemia.-Hematology: Anemia-leukopenia-thrombocytopenia-Metabolism: Weight gain.-Musculo-skeletal: Joint stiffness-muscle cramps.-Neurological: Paresthesia-tremor-Misc.: Stevens-Johnson syndrome-gingival hyperplasia.

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Average Doses:-PO: Adults 30-120mg 3-4 times daily or-60-120mg 2 times daily as SR capsules or-180-240mg once daily as CD or XR capsules or LA tablets (up to 360mg/day)-IV: Adult 0.25mg/kg may rpt in 15min with dose of 0.35mg/kg. May follow with continuous infusion of 10mg/hr (range of 5-15mg/hr) for up to 24 hrs.

Hydrochlorothiazide (HCTZ)

Generic and Trade Names: Esidrex-HCTZ-Hydro_chlor-Hydro_D-HydroDIURIL-Microzide-Novo_Hydrazide-Oretic.

Classification:-Therapeutic: Antihypertensives-diuretics-Pharmacologic: Thiazide diuretics-Thiazide like diuretics

Pharmacodynamics:-Increases secretion of sodium and water by inhibiting sodium reabsorption in the distal tubule. -Promotes excretion of chloride, potassium, magnesium, and bicarbonate. -May produce arteriolar dilation. -Lowers blood pressure in hypertensive patients and diuresis with mobilization of edema.

Pharmacokinetics:-Absorption: Rapidly absorbed after oral administration.-Distribution: This drug is distributed into the extracellular space. Also this drug does cross the placental barrier and will enter breast milk.-Metabolism and Excretion: Excreted mainly unchanged by the kidneys.-Half-life: 6-15 hrs.

Indications:-Management of mild to moderate hypertension.-Treatment of edema associated with:

1. CHF2. Renal dysfunction3. Cirrhosis4. Corticosteroid therapy5. Estrogen therapy

Contraindications:-Hypersensitivity-Cross sensitivity with other thiazides or sulfonamides may exist-Tartrazine intolerance-Anuria-Lactation

Adverse Reactions and Side Effects:-CNS: Dizziness-drowsiness-lethargy-weakness-Cardiovascular: Hypotension-Gastrointestinal: Anorexia-cramping-hepatitus-nausea-vomiting-Integumentary: Photosensitivity-rashes-Endocrine: Hyperglycemia-Hematology: Blood dyscrasias-Metabolism: Hyperuricemia-elevated lipids-Musculo-skeletal: Muscle cramps

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-F and E: Hypokalemia-dehydration-hypercalcemia-hypochloremic alkalosis-hypomagnesemia-hyponatremia-hypophosphatemia-hypovolemia.-Misc.: Pancreatitis

Average Doses-PO: Children (<6months) Up to 3mg/kg/day.-PO: Children (>6months) 1-2 mg/kg (30-60mg/m2/day) in 1-2 divided doses.-PO: Adults hypertension 12.5mg/day initially. (range 12.5-100mg/day in 1-2 doses up to 200mg/day; not to exceed 50mg/day for hypertension.

Azmacort

Generic and Trade Names: Azmacort HFA, Flovent, Aerobid, Pulmicort, QVAR

Classification:-Theraputic: Antiasthmatics, corticosteroids-Pharmacologic- Corticosteroids (Inhalation)

Pharmacodynamics:-Potent, locally acting anti-inflammatory and immune modifier-Decreased frequency and severity of asthma-Prevention of pulmonary damage from asthma

Pharmacokinetics:-Absorption: Beclomethasone-20%; budesonide-39%; flunisolide-40%; fluticasone-30%(aerosol);13.5% (powder); triamcinolone-25%. Action is primarily local after inhalation.-Distribution: 10-25% is deposited in airways if a spacer device is not used. With a spacer, more drug may reach the respiratory tract. All cross the placenta and enter breast milk in small amounts.-Protein Binding: Budensoside-85-90%; fluticasone-91%-Metabolism and Excretion: Beclomethasone-after inhalation, beclomethasone dipropionate is converted to beclomethasone monopropionate, an active metabolite that adds to its potency.- Half-life: Beclomethasone —0.5 hr; budesonide —2–3 hr; flunisolide —1.8 hr; fluticasone —7.8 hr; triamcinolone —88 min.

Indications:-Asthma-May decrease the need for systemic corticosteroids and delay lung damage associated with asthma.

Contraindications:-Some products contain chlorofluorocarbon (CFC) propellants, alcohol, propylene, or polyethylene glycol and should be avoided in patients with known hypersensitivity or intolerance -Acute attack of asthma/status asthmaticus.

Adverse Reactions and Side Effects:-CNS: headache, fatigue, insomnia, restlessness-Respiratory: bronchospasm, cough, wheezing-Gastrointestinal: dry mouth, esophageal candidiasis, dyspepsia, gastroenteritis, nausea-Endo: adrenal suppression, decreased growth in children-MS: back pain, muscle soreness-Misc: flu-like syndrome

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Average Doses:Beclomethasone

-Inhaln (Adults and adolescents): Previously therapy of bronchodilators alone 40 – 80 mcg twice daily; previously therapy of inhaled

corticosteroids 40 – 160 mcg twice daily (up to 320 mcg twice daily).

-Inhaln (Children 5–11 yr): 40 mcg twice daily (up to 80 mcg twice daily).

Budesonide -Inhaln (Adults [Pulmicort turbuhaler dose form]): Previous control with

bronchodilators alone 1–2 inhalations twice daily (200 mcg/inhalation); previous control on other inhaled corticosteroids 1–2 inhalations twice

daily (up to 4 inhalations twice daily); previous control on oral corticosteroids 2–4 inhalations twice daily (up to 4 inhalations

twice daily). -Inhaln (Children ³ 6 yr [Pulmicort Turbhaler dose form]): Previous

control on bronchodilators alone 1–2 inhalations twice daily (200 mcg/inhalation); previous control on other inhaled corticosteroids 1–2

inhalations twice daily; previous control on oral corticosteroids Not to exceed 2 inhalations twice daily.

-Inhaln (Children 12 mos–8 yr [Pulmicort Respules dose form]): Previous control on bronchodilators alone 0.25 mg/day as a single dose

or twice daily in divided doses; previous control on other inhaled corticosteroids 0.5 mg/day as a single dose or twice daily in

divided doses; previous control on oral corticosteroids 1 mg/day as a single dose or twice daily in divided doses.

Flunisolide -Inhaln (Adults and Children >6 yr): 2 inhalations twice daily (250 mcg/ inhalation; not

to exceed 8 inhalations/day in adults or 4 inhalations/day in children).

Fluticasone (Aerosol Inhaler) -Inhaln (Adults and Adolescents): Previous control on bronchodilators alone —88 mcg

twice daily initially, may be increased up to 440 mcg twice daily; previous control on other inhaled corticosteroids 88–220 mcg twice daily initially, up to 440 mcg twice daily; previous control included systemic corticosteroids 880 mcg twice daily.

Fluticasone (Dry Powder Inhaler) -Inhaln (Adults and Adolescents): Previous control on bronchodilators alone 100 mcg

twice daily initially, may be increased up to 500 mcg twice daily; previous control on other inhaled corticosteroids 100–250 mcg twice daily initially, up to 500 mcg twice daily; previous control on systemic corticosteroids 1000 mcg twice daily.

-Inhaln (Children 4–11 yr): 50 mcg twice daily initially, may be increased up to 100 mcg twice daily.

Elavil

Generic and Trade Names: Amitriptyline-Endep

Classifications:-Therapeutic: Antidepressants-Pharmacologic: Tricyclic antidepressants

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Pharmacodynamics:-Potentiates the effect of serotonin and norepinephrine in the CNS.-Has significant anticholinergic properties-Antidepressant action.

Pharmacokinetics:-Absorption: Well absorbed from the GI tract.-Distribution: Widely distributed.-Protein Binding: 95% bound to plasma proteins.-Metabolism and Excretion: Extensively metabolized by the liver. Some metabolites have antidepressant activity. Undergoes enterohepatic recirculation and secretion into gastric juices. Probably crosses the placental barrier and enters breast milk.-Half-life: 10-50hrs.

Indications:-Treatment of depression usually in conjunction with psychotherapy.-Used in chronic pain syndromes. (unlabeled use)

Contraindications:-Narrow angle glaucoma-Pregnant and lactating females.

Adverse Reactions and Side Effects:-CNS: Lethargy-sedation-EENT: Blurred vision-dry eyes-dry mouth.-Cardiovascular: Arrythmias-hypotension-ECG changes.-Gastrointestinal: Constipation-hepatitus-paralytic ileus.-Urinary: Urinary retention.-Integumentary: Photosensitivity.-Endocrine: Changes in blood glucose-gynecomastia.-Hematology: Blood dyscrasias.-Misc.: Increased appetite-weight gain

Average Doses:-IM: Adults 20-30mg four times daily.-PO: Adults 75mg/day in divided doses. May be increased up to 150mg/day or 50-100mg at bedtime, may increase by 25-50mg up to 150mg. (hospitalized patients may initiate with 100mg/day, increasing total dose up to 300mg.)-PO: Geriatric and adolescents 10mg 3 times per day and 20mg at bedtime or 25mg at bedtime initially, slowly increased to 100mg/day as a single bedtime dose or divided doses.

Cartrol

Generic and Trade Names: Carteolol

Classifications: -Therapeutic: Antianginals, antihypertensives-Pharmacologic: Beta blockers

Pharmacodynamics:

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-Blocks stimulation of Beta 1 (myocardial)- and Beta 2 (pulmonary, vascular, and uterine)- drenergic receptor sites-Also has intrinsic symathomimetic activity (ISA), which may reduce Bradycardia-Therapeutic Effects: decreased heart rate and blood pressure

Pharmacokinetics:-Absorbtion: 85% absorbed following oral administration-Distribution: Unknown-Metabolism and Excretion: Some metabolism by the liver, with conversion two at least one active compound; 50-70% excreted unchanged by the kidneys-Half-life: 6-8 hrs

Indications:-Management of hypertension-Management of angina pectoris

Contraindications:-Uncompensated CHF-Pulmonary edema-Cardiogenic shock-Bradycardia or heart block

Adverse Reactions and Side Effects:-CNS: fatigue, weakness, anxiety, depression, dizziness, drowsiness, insomnia, memory loss-EENT: blurred vision, dry eyes, nasal stuffiness-Respiratory: bronchospasm, wheezing-Cardiovascular: bradycardia, CHF, pulmonary edema, orthostatic hypotension, peripheral vasoconstriction-Gastrointestinal: constipation, diarrhea, nausea

Average Doses:-PO: Adults 2.5 mg once daily, may increase up to 10 mg/day-Renal Impairment-PO: Adults CCr 20-60 ml/min-increase dosing interval to q 48 hr; CCr <20ml/min-increase dosing interval to q 72 hr

Reglan

Generic and Trade Names: Metoclopramide-Clopra-Octamide-Octamide PFS-Reclomide.

Classification: -Therapeutic: Antiemetic

Pharmacodynamics:-Blocks dopamine receptors in chemoreceptor trigger zone of CNS.-Stimulates gastric motility in the upper GI tract and accelerates gastric emptying.-Decreases nausea and vomiting.-Decreases symptoms of gastric stasis.-Easier passage of NG tube into small bowel.

Pharmacokinetics:-Absorption: Well absorbed from the GI tract, from rectal mucosa, and from IM sites.-Distribution: Widely distributed into body tissues and fluid. Crosses blood brain barrier and placenta. Enters breast milk in concentrations greater than plasma.

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-Metabolism and Excretion: Partially metabolized by the liver; 25% eliminated unchanged in the kidneys.-Half-life: 2.5-5hrs.

Indications:-Prevention of chemotherapy induced emesis.-Treatment of postsurgical and diabetic gastric stasis-Facilitation of small bowel intubation in radiographic procedures.-Management of esophageal reflux.-Treatment and prevention of postoperative nausea and vomiting when NG suctioning is undesirable.-Treatment of hiccups. (unlabeled)-Adjunct management of migraines. (unlabeled)

Contraindications:-Hypersensitivity-Possible GI obstruction or hemorrhage.-History of seizures.-Pheochromocytoma-Parkinson’s disease.

Adverse Reactions and Side Effects:-CNS: Drowsiness-EPE-restlessness-anxiety-depression-irritability-tardive dyskinesia.-Cardiovascular: Arrythmias (SVT/bradycardia)-hypertension-hypotension.-Gastrointestinal: Constipation-diarrhea-dry mouth-nausea.-Endocrine: Gynecomastia

Average Doses:Prevention of chemotherapy induced vomiting:

-IV: Adults 1-2mg/kg 30 min before chemotherapy. Additional dose of 1-2mg/kg may be given every 2hrs for 2 doses. Then every 3hrs for 3 additional doses. May also be given 3mg/kg before chemotherapy followed by 0.5mg/kg/hr for 8hrs. (unlabeled)

Facilitation of small bowel intubation:-IV: Children <6y/o 0.1mg/kg-IV: Children 6-14y/o 2.5-5mg (dose should not exceed 0.5mg/kg)-IV: Adults 10mg

Diabetic Gastroparesis:-PO: Adults 10mg 30 minutes before meals and at bedtime.

Gastroesophageal reflux:-PO: Adults 10-15mg 30 minutes before meals and at bedtime. (not to exceed 0.5mg/kg/day). A single dose of 20mg may be given preventively. Some patients respond to doses as small as 5mg.

Postoperative nausea and vomiting:-IM: Adults 10-20mg

Treatment of hiccups:-PO, IM: Adults 10-20mg 4 times daily PO. May be preceded by a single 10mg dose IM. (unlabeled)

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Celexa

Generic and Trade Names: Citalopram

Classification: -Theraputic: Antidepressants-Pharmacologic: Selective serotonin reuptake inhibitors (SSRIs)

Pharmacodynamics:-Selectively inhibits the reuptake of serotonin in the CNS-Antidepressant action

Pharmacokinetics:-Absorption: 80% absorbed after oral administration.-Distribution: Enters breast milk.-Metabolism and Excretion: Mostly metabolized by the liver; excreted unchanged in urine.-Half-life: 35 hrs

Indications:-Treatment of depression, often in conjunction with psychotherapy.

Contraindications:-Hypersensitivity-Concurrent MAO inhibitor therapy

Adverse Reactions and Side Effects:-CNS: Apathy, confusion, drowsiness, weakness, insomnia, agitation, amnesia, anxiety-EENT: Abnormal accommodation-Respiratory: Cough-Cardiovascular: Postural hypotension, tachycardia-Gastrointestinal: abdominal pains, anorexia, diarrhea, dry mouth, dyspepsia, flatulence-Neurological: tremor, paresthesia

Average Doses:-PO: Adults 20 mg once daily initially, may be increased by 20 mg/day at weekly intervals, up to 60 mg/day (usual dose s 40 mg/day).-PO: Geriatric patients 20 mg once daily initially, may be increased tp 40 mg/day only in nonresponding patients.

Dipyridamole

Generic and Trade Names: Dipridacot, Persantine, Persantine IV

Classification: -Theraputic: Antiplatelet agents, diagnostic agents (coronary vasodilators)-Pharmacologic: Platelet adhesion inhibitors

Pharmacodynamics:-PO: Decreases platlet aggregation by inhibiting the enzyme phosphodiesterase-IV: Produces coronary vasodilation by inhibiting adenosine uptake

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Pharmacokinetics:-Absorption: Moderately absorbed (30-60%) after oral administration.-Distribution: Widely distributed. Crosses the placenta; enters breast milk.-Metabolism and Excretion: Metabolized by the liver; excreted in the bile.-Half-life: 10 hrs

Indications:-PO: Prevention of thromboembolism in patient with prosthetic heart valves.-Maintains patency after surgical grafting procedures, including coronary artery bypass.-IV: Diagnostic agent in lieu of exercise during thallium myocardial perfusion imaging.

Contraindications:-Hypersensitivity

Adverse Reactions and Side Effects:-CNS: Dizziness, headache, syncope; IV only-transient cerebral ischemia, weakness-Respiratory: IV only-bronchospasm-Cardiovascular: IV only- MI, hypotension, arrhythmias, flushing-Gastrointestinal: nausea, diarrhea, GI upset, vomiting

Average Doses:-PO: Adults 225-400 mg/day in 3-4 divided doses.-IV: Adults 570 mcg/kg; maximum dose 60 mg.

Neurontin

Generic and Trade Names: Gabapentin

Classification:-Therapeutic: Analgesic adjunct-anticonvulsant.

Pharmacodynamics:-Mechanism of action is unknown.-May affect transport of amino acids across and stabilize neuronal membranes.-Decreased incidence of seizures.-Decreased postherpetic pain.

Pharmacokinetics:-Absorption: Well absorbed after oral administration by active transport. At larger doses transport becomes saturated and absorption decreases.-Distribution: Crosses blood brain barrier. Enters breast milk.-Metabolism and Excretion: Eliminated mostly by renal excretion of unchanged drug.-Half-life: 5-7hrs in normal renal function. Up to 132hrs in anuria.

Indications:-Partial seizures with and without secondary generalization.-Postherpetic neuralgia.-Chronic pain. (unlabeled)-Prevention of migraine headache. (unlabeled)

Contraindications:-Hypersensitivity

Adverse Reactions and Side Effects:

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-CNS: Confusion-depression-drowsiness-anxiety-dizziness-hostility-hyperkinesia (children)-emotional lability (children)-malaise-vertigo-weakness.-EENT: Abnormal vision-nystagmus.-Cardiovascular: Hypertension.-Gastrointestinal: Anorexia-flatulence-gingivitis.-Musculoskeletal: Athralgia.-Neurological: Ataxia-altered reflexes-hyperkinesia-paresthesia.-Misc.: Facial edema.

Average Dose:Epilepsy:

-PO: Children (3-4y/o) 10-15mg/kg/day in 3 divided doses initially titrated upward over 3 days to 40mg/kg/day in 3 divided doses. Dosage interval should not exceed 12hrs.-PO: Children (5-12y/o) 10-15mg/kg/day in 3 divided doses initially titrated upward over 3 days to 25-35mg/kg/day in 3 divided doses. Dosage interval should not exceed 12hrs.-PO: Adult and Children (>12y/o) 300mg 3 times daily initially. Titration may be continued until desired. ( range is 900-1800mg/day in 3 divided doses. Doses should not be more than 12hrs apart.) Doses up to 2400-3600mg/day have been well tolerated.

Adalat

Generic and Trade Names: Adalat CC-Nifedical XL-Procardia-Procardia XL-Nifedipine.

Classification:-Therapeutic: Antianginals-Antihypertensives.-Pharmacologic: Calcium channel blockers.

Pharmacodynamics:-Inhibits calcium transport into myocardial and vascular smooth muscle cells resulting in inhibition of excitation/contraction and subsequent contractions.-Systemic vasodilation resulting in a decrease in blood pressure.-Coronary vasodilation resulting in decreased frequency and severity of angina.

Pharmacokinetics:-Absorption: Well absorbed after oral administration, but large amounts are rapidly metabolized.-Distribution: Unknown.-Protein binding: 92-98%-Metabolism and Excretion: Mostly metabolized by the liver.-Half-life: 2-5 hrs.

Indications:-Management of:

1. Hypertension2. Angina Pectoris3. Vasospastic angina

Contraindications:-Hypersensitivity.-Sick sinus syndrome.-2nd and 3rd degree heart blocks. (unless pacemaker is in place)-Blood pressure less than 90systolic.-Coadministration with grapefruit juice.

Adverse Reactions and Side Effects:

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-CNS: Headache-abnormal dreams-anxiety-confusion-dizziness-drowsiness-jitteriness-nervousness-psychiatric disturbances-weakness.-EENT: Blurred vision-disturbed equilibrium-epistaxis-tinnitus.-Respiratory: Cough-dyspnea-SOB.-Cardiovascular: Arrhythmias-CHF-peripheral edema-bradycardia-chest pain-hypotension-palpitations-syncope-tachycardia.-Gastrointestinal: Abnormal liver function tests-anorexia-constipation-diarrhea-dry mouth-nausea-vomiting-dysgeusia-dyspepsia.-Urinary: Dysuria-nocturia-polyuria-sexual dysfunction-urinary frequency.-Integumentary: Flushing-dermatitis-erythema multiforme-increased sweating-photosensitivity-urticaria/pruritis-rash.-Endocrine: Gynecomastia-hyperglycemia.-Hematology: Anemia-leukopenia-thrombocytopenia.-Metabolism: Weight gain.-Musculoskeletal: Joint stiffness-muscle cramps.-Neurological: Paresthesia-tremors.-Misc.: Stevens Johnson syndrome-gingival hyperplasia.

Average Dose:-PO: Adults 10-30mg 3 times daily (not to exceed 180mg/day) or 10-20mg twice daily as PA form, or30-90 mg once daily as sustained release form. (not to exceed 90-120mg/day)

Fexofenadine

Generic and Trade Names: Allegra

Classification:-Therapeutic: Allergy, cold, and cough remedies, antihistamines

Pharmacodynamics:-Antagonizes the effects of histamine at peripheral histamine receptors, including pruritus and urticaria-Also has a drying effect on the nasal mucosa

Pharmacokinetics:-Absorption: Rapidly absorbed after oral administration.-Distribution: Unknown-Metabolism and Excretion: 80% excreted in urine, 11% excreted in feces.-Half-life: 14.4 hrs

Indications:-Relief of symptoms of seasonal allergic rhinitis.-Management of chronic idiopathic urticaria.

Contraindications:-Hypersensitivity

Adverse Reactions and Side Effects:-CNS: Drowsiness, fatigue-Gastrointestinal: dyspepsia-Endo: dysmenorrheal

Average Dose:-PO: Adult and Children >12yrs 60mg BID or 180mg once daily

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-PO: Children 6-11 yrs 30mg BID

Labetalol

Generic and Trade Names: Normodyne, trandate

Classification:-Therapeutic: Antianginals, antihypertensives-Pharmacologic: Beta blockers

Pharmacodynamics:-Blocks stimulation of beta 1 and beta 2 adrenergic receptor sites.-Also has alpha 1 adrenergic blocking activity, which may result in more orthostatic hypotension.

Pharmacokinetics:-Absorption: Well absorbed but rapidly undergoes extensive first-pass hepatic metabolism, resulting in 25% bioavailability.-Distribution: Some CNS penetration; crosses the placenta.-Metabolism and Excretion: Undergoes extensive hepatic metabolism.-Half-life: 3-8 hrs

Indications:-Management of hypertension.

Contraindications:-Uncompensated CHF.-Pulmonary edema.-Cardiogenic shock.-Bradycardia or heart block.

Adverse Reactions and Side Effects:-CNS: fatigue, weakness, anxiety, depression, dizziness, drowsiness, insomnia, memory loss-EENT: Blurred vision, dry eyes, nasal stuffiness-Respiratory: Bronchospasm, wheezing-Cardiovascular: Arrhythmias, bradycardia, CHF, pulmonary edema-Gastrointestinal: Constipation, diarrhea, nausea

Average Dose:-PO: Adults 100mg twice a daily initially, may be increased by 100mg twice daily q 2-3 days as needed.-IV: Adults 20mg initially, additional doses of 40-80mg may be given q 10 min as needed.

Isordil

Generic and Trade Names: Dilatrate SR-ISDN-Iso bid-Isonate-Isorbid-Isotrate-Sorbitrate.

Classification:-Therapeutic: Antianginals-Pharmacologic: Nitrates

Pharmacodynamics:-Produces vasodilation-Decreases left ventricular end diastolic pressure and left ventricular end diastolic volume.

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-Increases coronary blood flow by dilating coronary arteries improving collateral flow to ischemic region.-Relief of chest pain and increase cardiac output.

Pharmacokinetics:-Absorption: Well absorbed after PO and SL administration.-Distribution: Unknown.-Metabolism and Excretion: Mostly metabolized by the liver.-Half-life: 50min.

Indications:-Acute treatment of anginal attacks. (SL only)-Prophylactic management of angina pectoris.-Treatment of chronic CHF.

Contraindications:-Hypersensitivity-Severe anemia.-Concurrent use of Sildenafil.

Adverse Reactions and Side Effects:-CNS: Dizziness-headache-apprehension-weakness.-Cardiovascular: Hypotension-tachycardia-paradoxic bradycardia-syncope.-Gastrointestinal: ABD pain-nausea-vomiting.-Misc: Cross tolerance-flushing-tolerance.

Average Dose:-SL, Buccal: Adults (acute attack of chest pain) 2.5-5mg every 5-10min to max of 3 doses.

(prophylaxis of chest pain) 2.5-10mg every 2-3hrs or 15min prior to activities known to produce angina.-PO: Adults (prophylaxis of angina pectoris) 5-20mg initially. Maintenance dose is usually 10-40mg every 6 hrs. or 40-80mg every 8-12hrs as sustained release.

Carbamazipine

Generic and Trade Names: Atretol-Carbatrol-Epitol-Tegretol-Tegretol XR-Teril

Classifications: -Therapeutic: Anticonvulsant.

Pharmacodynamics:-Decreases synaptic transmission in the CNS by affecting sodium channels in neurons.-Prevention of seizures.-Relief of pain in trigeminal neuralgia.

Pharmacokinetics:-Absorption: Slow but complete. Suspension produces earlier higher peak and lower trough levels.-Distribution: Widely distributed. Crosses the blood brain barrier. Crosses the placenta barrier and rapidly enters the breast milk in large doses.-Metabolism and Excretion: Extensively metabolized by the liver-Half-life: 25-65 hrs. single dose. 8-29hrs chronic dose. 5-8hrs epoxide.

Indications:-Prophylaxis of tonic-clonic, mixed, and complex partial seizures.-Management of pain in trigeminal neuralgia.

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-Management of other forms of neurogenic pain. (unlabeled)-Prophylaxis and treatment of bipolar disorder. (unlabeled

Contraindications:-Hypersensitivity.-Bone marrow depression.-Pregnancy (unless benefits outweigh risk to fetus)-Lactation.

Adverse Reactions and Side Effects:-CNS: Ataxia-drowsiness-fatigue-psychosis-vertigo.-EENT: Blurred vision-corneal opacities.-Respiratory: Pneumonitis-Cardiovascular: CHF-HTN-hypotension-syncope.-Gastrointestinal: Hepatitus.-Urinary: Hesitancy-urinary retention.-Integumentary: Photosensitivity-rashes-urticaria.-Endocrine: syndrome of inappropriate antidiuretic hormone.-Hematology: Agranulocytosis-aplastic anemia-thrombocytopenia-eosinophillia-leukopenia.-Misc: Chills-fever-lymphadenopathy.

Average Dose:-PO (Adults): Anticonvulsant— 200 mg twice daily (tablets) or 100 mg 4 times daily (suspension); increase by 200 mg/day q 7 days until therapeutic levels are achieved (range is 600–1200 mg/day in divided doses q 6–8 hr; not to exceed 1 g/day in 12–15-yr-olds. Extended-release products are given twice daily (XR, CR). Antineuralgic— 100 mg twice daily or 50 mg 4 times daily (suspension); increase by up to 200 mg/day until pain is relieved, then maintenance dose of 200–1200 mg/day in divided doses (usual range, 400–800 mg/day). -PO (Children 6–12 yr): 100 mg twice daily (tablets) or 50 mg 4 times daily (suspension) increased by 100 mg weekly until therapeutic levels are obtained (usual range 400–800 mg/day; not to exceed 1 g/day). Extended-release products (XR, CR) are given twice. -PO (Children <6 yr): 10–20 mg/kg/day in 2–3 divided doses; may be increased by 100 mg/day at weekly intervals. Usual maintenance dose is 250–350 mg/day (not to exceed 400 mg/day).

Metolazone

Generic and Trade Names: Zaroxolyn, mykrox

Classifications: -Therapeutic: Antihypertensives, diuretics-Pharmacologic: Thiazide-like diuretics

Pharmacodynamics:-Increases excretion of sodium and water by inhibiting sodium reabsorption in the distal tubule.-Promotes excretion of chloride, potassium, magnesium, and bicarbonate.-May produce arteriolar dilation.

Pharmacokinetics:-Absorption: Absorption is more rapid and more complete with prompt tablet. Absorption is more variable with extended tablet.-Distribution: Unknown-Metabolism and Excretion: Excreted mainly unchanged by the kidneys.-Half-life: Extended tablet 8 hrs; prompt tablet 14 hrs

Indications:

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-Mild to moderate hypertension.-Edema associated with CHF or the nephritic syndrome.

Contraindications:-Hypersensitivity-Crosssensitivity with other sulfonamides may exist.-Anuria-Lactation

Adverse Reactions and Side Effects:-CNS: Drowsiness, lethargy-Cardiovascular: Chest pain, hypotension, palpitations-Gastrointestinal: Anorexia, bloating, cramping, drug-induced hepatitis, nausea-Misc: Chills, pancreatitis

Average Dose:Mykrox

-PO: Adult hypertension 0.5-1 mg/day

Zaroxolyn-PO: Hypertension 2.5-5 mg/day; edema 5-20 mg/day

Phenelzine

Generic and Trade Names: Nardil

Classification:-Therapeutic: Antidepressants.-Pharmacologic: MAO inhibitors.

Pharmacodynamics:-Inhibits the enzyme monoamine oxidase resulting in an accumulation of various neurotransmitters such as dopamine, epinephrine, serotonin, and norepinephrine in the body.-Improved mood in depressed patients.

Pharmacokinetics:-Absorption: Well absorbed in the GI tract.-Distribution: Cross the placental barrier and probally enter breast milk.-Metabolism and Excretion: Mostly metabolized by the liver.-Half-life: Unknown.

Indications:-Treatment of neurotic and atypical depression.-Used when patients may not tolerate other forms of therapy. (TCA’s, SSRI’s)

Contraindications:-Hypersensitivity.-Liver disease.-Severe renal disease.-Cerebrovascular disease.-Pheochromocytoma.-CHF.-Hx of headache.-Concurrent meperidine, SSRI, nefazodone, and trazadone administration.

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Adverse Reactions and Side Effects:-CNS: Seizures-dizziness-headache-insomnia-restlessness-weakness-confusion-drowsiness.-EENT: Blurred vision-glaucoma-nystagmus.-Cardiovasular: HTN crisis-arrythmias-orthostatic hypotension-edema-Gastrointestinal: Diarrhea-ABD pain-anorexia-constipation-nausea-vomiting.-Urinary: Dysuria-incontinence-urinary retention.-Integumentary: Rash-Endocrine: Hypoglycemia.-Muscaloskeletal: Arthralgia.

Average Dose:-PO: Adults 15mg 3 times per day. Increase to 60-90mg/day in divided doses. Then gradually reduce to smallest effective dose.-PO: Geriatrics 15mg/day initially with slow dose titration.

Lipitor

Generic and Trade Names: Atorvastatin

Classification:-Therapeutic: Lipid lowering agent.-Pharmacologic: HMG-CoA reductase inhibitors

Pharmacodynamics:-Inhibits HMG-CoA which is responsible for catalyzing an early step in the synthesis of cholesterol. -Lowering of total and LDL cholesterol.-Increase HDL and decrease VLDL cholesterol and triglycerides.-Slows progression of coronary artery disease.

Pharmacokinetics:-Absorption: Rapidly absorbed but undergoes extensive GI and hepatic metabolism.-Distribution: Probally enters breast milk.-Metabolism and Excretion: Extensively metabolized by the liver and small amounts are excreted by kidneys.-Half-life: 14hrs.

Indications:-Adjunct to dietary therapy in the management of primary hypercholesterolemia and mixed dyslipidemias -Reduction of lipids/cholesterol reduces the risk of MI and stroke sequelae (primary prevention and secondary prevention) and decreases the need for bypass procedures/angioplasty.

Contraindications:-Hypersensitivity -Cross-sensitivity among agents may occur -Sepsis, acute hypotension, major surgery, trauma, severe metabolic disturbances, endocrine or electrolyte disorders, uncontrolled seizures (↑ risk of rhabdomyolysis; temporarily discontinue use until condition is resolved) -Active liver disease -Pregnancy or lactation. -Concurrent use of gemfibrozil or azole antifungals

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Adverse Reactions and Side Effects:-CNS: Dizziness-headache-insomnia-weakness.-EENT: Rhinitis-Respiratory: Bronchitis.-Gastrointestinal: ABD cramps-constipation-diarrhea-flatus-heartburn-altered taste-drug induced hepatitis-elevated liver enzymes-nausea-pancreatitis.-Urinary: Impotence.-Integumentary: Rashes-pruritis.-Muscaloskeletal: Rhabdomyolysis-arthritis-myalgia-myositis-arthralgia.Misc: Hypersensitivity reactions.

Average Dose:-PO (Adults): 10—20 mg once daily initially (may start with 40 mg/day if LDL-C should be lowered by > 45%); may be increased q 2–4 wk up to 80 mg/day.

Zovirax

Generic and Trade Names: Acyclovir

Classification:-Therapeutic: Antivirals.-Pharmacologic: Purine analogues.

Pharmacodynamics:-Interferes with viral DNA synthesis-Inhibition of viral replication, decreased viral shedding, and reduced time for healing lesions.

Pharmacokinetics:-Absorption: Despite poor absorption, therapeutic blood levels are achieved.-Distribution: Widely distributed. CSF concentrations are 50% of plasma. Crosses placental barrier and enters breast milk.-Metabolism and Excretion: >90% eliminated unchanged by the kidneys. The remainder is metabolized by the liver.-Half-life: 2.1-3.5 hrs. Increased in renal failure.

Indications:-PO: Recurrent genital herpes infections. Localized cutaneous herpes zoster infections (shingles) and chickenpox (varicella) -IV: Severe initial episodes of genital herpes in nonimmunosuppressed patients. Mucosal or cutaneous herpes simplex infections or herpes zoster infections (shingles) in immunosuppressed patients. Herpes simplex encephalitis -Topical: Cream— Recurrent herpes labialis (cold sores). Ointment— Treatment of limited non–life-threatening herpes simplex infections in immunocompromised patients (systemic treatment is preferred).

Contraindications:-Hypersensitivity to acyclovir and valacyclovir.

Adverse Reactions and Side Effects:-CNS: Seizures-dizziness-headache-hallucinations-trembling.-Gastrointestinal: Diarrhea-nausea-vomiting-ABD pain-anorexia.-Urinary: Renal failure-crystalluria-hematuria.

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-Integumentary: Acne-hives-skin rashe-unusual sweating.-Endocrine: Changes in menstrual cycle.-Hematology: Thrombotic thrombocytopenic purpura/Hemolytic uremic syndrome.-Local: Pain phlebitis-local irritation.-Muscaloskeletal: Joint pain.-Misc.: Polydipsia.

Average Dose:Initial Genital Herpes

-PO (Adults): 200 mg q 4 hr while awake (5 times/day) for 7–10 days. -IV (Adults): 5 mg/kg q 8 hr for 5 days.

Chronic Suppressive Therapy for Recurrent Genital Herpes -PO (Adults): 400 mg twice daily or 200 mg 3–5 times/day for up to 12 mo.

Intermittent Therapy for Recurrent Genital Herpes -PO (Adults): 200 mg q 4 hr while awake (5 times/day) for 5 days, start at first sign of symptoms.

Acute Treatment of Herpes Zoster -PO (Adults): 800 mg q 4 hr while awake (5 times/day) for 7–10 days.

Chickenpox -PO (Adults and Children): 20 mg/kg (not to exceed 800 mg/dose) qid for 5 days.

Mucosal and Cutaneous Herpes Simplex Infections in Immunosuppressed Patients -IV (Adults and Children >12 yr): 5 mg/kg q 8 hr for 7 days. -IV (Children <12 yr): 10 mg/kg q 8 hr for 7 days. -Topical (Adults): 0.5 in. ribbon of 5% ointment for every 4-square-in. area q 3 hr (6 times/day) for 7 days.

Herpes Simplex Encephalitis -IV (Adults): 10 mg/kg q 8 hr for 10 days. -IV (Children 3 mo–12 yr): 20 mg/kg q 8 hr for 10 days. -IV (Children birth–3 mo): 10 mg/kg q 8 hr for 10 days.

Varicella Zoster Infections in Immunosuppressed Patients -IV (Adults): 10 mg/kg q 8 hr for 7 days. -IV (Children <12 yr): 20 mg/kg q 8 hr for 7 days.

Herpes labialis -Topical (Adults and Children > 12 yr): Apply 5 times/day, start at first symptoms.

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Digoxin

Generic and Trade Names: Digitek-Lanoxicaps-Lanoxin.

Classification:-Therapeutic: Antiarrythmics, Inotropics.-Pharmacologic: Digitalis glycosides.

Pharmacodynamics:-Increases the force of myocardial contractions.-Prolongs the refractory period of the AV node.-Decreases conduction through the SA and AV nodes.-Increases cardiac output and slowing of the heart rate.

Pharmacokinetics:-Absorption: 60–85% absorbed after oral administration of tablets; 75–80% absorbed after administration of elixir. Absorption from liquid-filled capsules is 90–100%; 80% absorbed from IM sites, but this route is not recommended because of extreme pain and irritation. -Distribution: Widely distributed; crosses the placenta and enters breast milk.-Metabolism and Excretion: Excreted almost entirely unchanged by the kidneys.-Half-life: 36–48 hr (increased in renal impairment).

Indications:-Treatment of CHF and tachydysrrythmias.-Treatment of AFIB/AFL.-Treatment of paroxysmal atrial tachycardia.

Contraindications:-Hypersensitivity -Uncontrolled ventricular arrhythmias -AV block -Idiopathic hypertrophic subaortic stenosis -Constrictive pericarditis -Known alcohol intolerance (elixir only).

Adverse Reactions and Side Effects:-CNS: Fatigue-headache-weakness.-EENT: Blurred vision-yellow vision.-Cardiovascular: Arrythmias-bradycardia-ECG changes.-Gastrointestinal: Anorexia-nausea-vomiting-diarrhea.-Endocrine: Gynecomastia.-Hematology: Thrombocytopenia.

Average Dose:-PO (Adults): Digitalizing dose -0.75–1.25 mg (10–15 mg/kg) given as 50% of the dose initially and additional fractions given at 4–8-hr intervals. Maintenance dose 0.063–0.5 mg/day as tablets or 0.350–0.5 mg/day as gelatin capsules, depending on patient’s lean body weight, renal function, and serum level. -PO (Adults): Maintenance dose = Loading dose (daily loss/100); where percentage of daily

loss = 14+ (CCr/5). CCr should be corrected to 70 kg body weight or 1.73 m 2 .

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Temazepam

Generic and Trade Names: Restoril

Classification:-Therapeutic: Sedative, mypnotics-Pharmacologic: Benzodiazepines

Pharmacodynamics:-Acts at many levels in the CNS, producing generalized depression-Effects may be mediated by GABA, an inhibitory neurotransmitter-Relief of insomnia

Pharmacokinetics:-Absorption: Well absorbed after oral administration-Distribution: Widely distributed; crosses blood-brain barrier. Probably causes the placenta and enters breast milk. Accumulation of drug occurs with chronic dosing.-Protein binding: 96%-Metabolism and Excretion: Metabolized by the liver-Half-life: 10-20 hrs

Indications:-Short-term management of insomnia

Contraindications:-Hypersensitivity-Crosssensitivity with other benzodiazepines may exist-Pre-existing CNS depression-Severe uncontrolled pain-Narrow-angle glaucoma-Pregnancy or lactation

Adverse Reactions and Side Effects:-CNS: hangover, dizziness, drowsiness, lethargy, paradoxic excitation-EENT: blurred vision-Gastrointestinal: constipation, diarrhea, nausea, vomiting-Dermatology: rashes-Misc: physical dependence, psychological dependence, tolerance

Average Dose:-PO: Adults 15-30mg at bedtime initially if needed; some patients may require only 7.5mg-PO: Geriatric patients or debilitated patients 7.5mg at bedtime

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Atenolol

Generic and Trade Names: Tenormin

Classification:-Therapeutic: Antianginals-antihypertensives-Pharmacologic: Beta blockers.

Pharmacodynamics:-Blocks stimulation of beta1 adrenergic receptor sites.-Decreases blood pressure and heart rate.-Decreased frequency of attacks of angina pectoris.-Prevention of MI.

Pharmacokinetics:-Absorption: 50-60% absorbed after oral administration.-Distribution: Minimal penetration of CNS. Crosses the placenta and enters breast milk.-Metabolism and Excretion: 40-50% excreted unchanged by the kidneys. The remainder is excreted in feces as unabsorbed drud.-Half-life: 6-9hrs.

Indications:-Management of HTN-Management of angina pectoris-Prevention of MI

Contraindications:-Uncompensated CHF-Pulmonary edema-Cardiogenic shock-Bradycardia or heart block

Adverse Reactions and Side Effects:-CNS: Fatigue-weakness-anxiety-depression-dizziness-drowsiness-insomnis-memory loss-mental status changes-nervousness-nightmares.-EENT: Blurred vision-stuffy nose.-Respiratory: Bronchospasm-wheezing.-Cardiovascular: Bradycardia-CHF-pulmonary edema-hypotension-peripheral vasoconstriction.-Gastrointestinal: Constipation-diarrhea-liver function abnormalities-nausea-vomiting.-Urinary: Impotence-decreased libido-urinary frequency.-Endocrine: Hypoglycemia-hyperglycemia.-Musculoskeletal: Arthralgia-back pain-joint pain.-Misc.: Drug induced lupus syndrome.

Average Dose:-PO (Adults): Antianginal -50 mg once daily; may be increased after 1 wk to 100 mg/day (up to 200 mg/day). Antihypertensive -25–50 mg once daily; may be increased after 2 wk to 50-100 mg once daily. MI -50 mg (given 10 min after last IV dose), then 50 mg 12 hr later, then 100 mg/day as a single dose or in 2 divided doses for 6–9 days or until hospital discharge.

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Feldene

Generic and Trade Names: Piroxicam

Classification:-Therapeutic: Antirheumatics-NSAID

Pharmacodynamics:-Inhibits prostaglandin synthesis.-Suppression of pain and inflammation.

Pharmacokinetics:-Absorption: Well absorbed from GI tract.-Distribution: Unknown. Enters the breast milk in small amounts.-Metabolism and Excretion: Mostly metabolized by the liver.Minimal amounts excreted by the kidneys.-Half-life: 50hrs.

Indications:-Management of dysmenorrheal-Management of inflammatory disorders including:

1. Rheumatoid arthritis2. Osteoarthritis.

Contraindications:-Hypersensitivity -Cross-sensitivity may exist with other NSAIDs, including aspirin -Active GI bleeding or ulcer disease -Lactation.

Adverse Reactions and Side Effects:-CNS: Drowsiness-headache-dizziness.-EENT: Blurred vision-tinnitus-Cardiovascular: Edema.-Gastrointestinal: Drug induced hepatitis-GI bleeding-discomfort-dyspepsia-nausea-vomiting-anorexia-constipation-diarrhea-flatulence.-Urinary: Renal failure.-Hematology: Blood dyscrasias-prolonged bleeding time.-Misc.: Anaphylaxis.

Average Dose:-PO (Adults): Anti-inflammatory 10–20 mg/day; may be given as single dose or 2 divided doses. Antidysmenorrheal 40 mg initially, then 20 mg/day. -PO (Geriatric Patients): 10 mg/day initially.

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Levodopa

Generic and Trade Names: Dopa-Larodopa-L dopa.

Classification:-Therapeutic: Antiparkinson agents.-Pharmacologic: Dopamine agonists.

Pharmacodynamics:-Levodopa is converted to dopamine in the CNS where it serves as a neurotransmitter.-Relief of tremor and rigidity in Parkinson’s syndrome.

Pharmacokinetics:-Absorption: Well absorbed following oral administration.-Distribution: Widely distributed. Enters the CNS. Enters breast milk.-Metabolism and Excretion: Mostly metabolized by the GI tract and the liver.-Half-life: 1hr.

Indications:-Parkinson’s disease.-Not useful for drug induced EPE.

Contraindications:-Hypersensitivity -Narrow-angle glaucoma -MAO inhibitor therapy -Malignant melanoma -Undiagnosed skin lesions -Lactation-Some products contain tartrazine and should be avoided in patients with known hypersensitivity

Adverse Reactions and Side Effects:-CNS: Involuntary movements-anxiety-dizziness-hallucinations-memory loss-psychiatric problems.-EENT: Blurred vision-mydriasis.-Gastrointestinal: Nausea-vomitin-anorexia-dry mouth-hepatotoxicity.

Average Dose:-PO (Adults): 250 mg 2–4 times daily; may increase by 100–750 mg q 3–7 days until desired effect is achieved (not to exceed 8 g/day).

Benztropine

Generic and Trade Names: Cogentin

Classification:-Therapeutic: Antiparkinson agents-Pharmacologic: Anticholinergics

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Pharmacodynamics:-Blocks cholinergic activity in the CNS which is partially responsible for the symptoms of Parkinson’s.-Restores the natural balance of neurotransmitters in the CNS.-Reduction of rigidity and tremors.

Pharmacokinetics:-Absorption: Well absorbed following PO and IM administration.-Distribution: Unknown-Metabolism and Excretion: Unknown.-Half-life: Unknown.

Indications:-Adjunctive treatment of all forms of Parkinson’s disease, including drug-induced extrapyramidal effects and acute dystonic reactions.

Contraindications:-Hypersensitivity -Children <3 yr -Narrow-angle glaucoma -Tardive dyskinesia.

Adverse Reactions and Side Effects:-CNS: Confusion-depression-dizziness-hallucinations-headache-sedation-weakness.-EENT: Blurred vision-dry eyes-mydriasis.-Cardiovascular: Arrythmias-hypotension-palpitations-tachycardias.-Gastrointestinal: Constipation-dry mouth-ileus-nausea.

Average Dose:Parkinsonism

-PO (Adults): 1–2 mg/day in 1–2 divided doses (range 0.5–6 mg/day).

Acute Dystonic Reactions -IM, IV (Adults): 1–2 mg, then 1–2 mg PO twice daily.

Drug-Induced Extrapyramidal Reactions -PO, IM, IV (Adults): 1–4 mg given once or twice daily (1–2 mg 2–3 times daily may also be used PO).

Dilaudid

Generic and Trade Names: Hydromorphone-Dilaudid HP-Hydrostat IR-PMS Hydromorphone.

Classification:-Therapeutic: Antitussives and opioid analgesic-Pharmacologic: Opioid agonists.

Pharmacodynamics:-Binds to opiate receptors in the CNS -Alters the perception of and response to painful stimuli while producing generalized CNS depression -Suppresses the cough reflex via a direct central action.

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-Decrease in moderate to severe pain -Suppression of cough.

Pharmacokinetics:-Absorption: Well absorbed following PO, PR, SQ, and IM administration.-Distribution: Widely distributed. Crosses the placental barrier and enters breast milk.-Metabolism and Excretion: Mostly metabolized by the liver.-Half-life: 2-4hrs.

Indications:-Moderate to severe pain (alone and in combination with nonopioid analgesics) -Antitussive (lower doses).

Contraindications:-Hypersensitivity -Some products contain bisulfites and should be avoided in patients with known hypersensitivity -Avoid chronic use during pregnancy or lactation.

Adverse Reactions and Side Effects:-CNS: Confusion-sedation-dizziness-dysphoria-euphoria-floating feeling-headache-hallucinations-unusual dreams.-EENT: Blurred vision-diplopia-miosis.-Respiratory: Respiratory depression-Cardiovascular: Hypotension-bradycardia.-Gastrointestinal: Constipation-nausea-vomiting.

Average Dose:Analgesic

-PO (Adults 50 kg): 4–8 mg q 3–4 hr initially (some patients may respond to doses as small as 2 mg initially). -PO (Adults and Children <50 kg): 0.06 mg/kg q 3–4 hr initially. -Rect (Adults): 3 mg q 4–8 hr initially as needed.

Antitussive -PO (Adults): 1 mg q 3–4 hr. -PO (Children 6–12 yr): 0.5 mg q 3–4 hr.

Glucophage

Generic and Trade Names: Glucophage XR-Metformin.

Classification:-Therapeutic: Antidiabetics.-Pharmacologic: Biguanides.

Pharmacodynamics:-Decreases hepatic glucose production.-Decreases intestinal glucose absorption.-Increases sensitivity to insulin.-Maintenance of blood glucose.

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Pharmacokinetics:-Absorption: 50-60% absorbed after oral administration.-Distribution: Enters breast milk in concentrations similar to plasma.-Metabolism and Excretion: Eliminated almost entirely by the kidneys.-Half-life: 17.6hrs.

Indications:-Management of type II diabetes mellitus. May be used with diet, insulin, or sulfonylurea oral hypoglycemics.

Contraindications:-Hypersensitivity -Metabolic acidosis -Dehydration, sepsis, hypoxemia, hepatic impairment, excessive alcohol use (acute or chronic) -Renal dysfunction (serum creatinine >1.5 mg/dl in men or >1.4 mg/dl in women) -Radiographic studies requiring IV iodinated contrast media (withhold metformin) -CHF.

Adverse Reactions and Side Effects:-Gastrointestinal: ABD bloating-diarrhea-nausea-vomiting-unpleasant metallic taste.-Endocrine: Hypoglycemia.-F and E: Lactic acidosis.-Misc.: Decreased vitamin B12 levels.

Average Dose:-PO (Adults and children >17 yr): 500 mg twice daily; may increase by 500 mg up at weekly intervals to 2000 mg/day. If doses >2000 mg/day are required, give in 3 divided doses (not to exceed 2500 mg/day) or 850 mg once daily; may increase by 850 mg at 2-wk intervals (in divided doses) up to 2550 mg/day in divided doses (up to 850 mg 3 times daily); Extended-release tablets 500 mg once daily with evening meal, may increase by 500 mg at weekly intervals up to 2000 mg once daily. If 2000 mg once daily is inadequate, 1000 mg twice daily may be used. -PO (Children >10 yr): 500 mg twice daily, may be increased by 500 mg/day at 1–wk intervals, up to 2000 mg/day in 2 divided doses.

Captopril

Generic and Trade Names: Capoten.

Classification: -Therapeutic: antihypertensives.-Pharmacologic: ACE inhibitors.

Pharmacodynamics:-ACE inhibitors block the conversion of angiotensin I to the vasoconstrictor angiotensin II. ACE also inactivates the vasodilator bradykinin and other vasodilatory prostaglandins. ACE inhibitors also increase plasma renin levels and reduce aldosterone levels. Net result is systemic vasodilation. -Lowering of blood pressure in hypertensive patients -Decreased afterload in patients with CHF -Decreased development of overt heart failure -Increased survival after MI (selected agents only) -Decreased progression of diabetic nephropathy (captopril only).

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Pharmacokinetics:-Absorption: At least 75% following oral administration. (decreased to 30-55% with food.)-Distribution: Crosses the placenta. Enters the breast milk in small amounts.-Metabolism and Excretion: 50% metabolized by the liver and 50% excreted unchanged by the kidneys.-Half-life: <2 hrs.

Indications:-Management of HTN.-Management of CHF.-Reduction of risk of death or development of CHF following MI.-Slowed progression of LV dysfunction into overt heart failure.-Decreased progression of diabetic nephropathy.

Contraindications:-Hypersensitivity -Cross-sensitivity among ACE inhibitors may occur -Pregnancy -Angioedema (hereditary or idiopathic).

Adverse Reactions and Side Effects:-CNS: Dizziness-fatigue-headache-insomnia-weakness.-Respiratory: Cough-eosinophilic pneumonitis.-Cardiovascular: Hypotension-angina pectoris-tachycardia.-Gastrointestinal: Taste disturbances-anorexia-diarrhea-nausea.

Average Dose:-PO (Adults): Hypertension 12.5–25 mg 2–3 times daily, may be increased at 1–2 wk intervals up to 150 mg 3 times daily (usual dose 50 mg 3 times daily; begin with 6.25–12.5 mg 2–3 times daily in patients receiving diuretics). CHF 12.5 mg 2–3 times daily, may be increased up to 50–100 mg 3 times daily (range 12.5–450 mg/day). Post-MI 6.25-mg test dose, followed by 12.5 mg 3 times daily, may be increased up to 50 mg 3 times daily. Diabetic nephropathy 25 mg 3 times daily.

Metaxalone

Generic and Trade Names: Skelaxin

Classification: -Therapeutic: Skeletal muscle relaxants (centrally acting)

Pharmacodynamics:-Skeletal muscle relaxation, probably as a result of CNS depression-Skeletal muscle relaxation

Pharmacokinetics:-Absorption: Well absorbed following oral administration-Distribution: Unknown-Metabolism and Excretion: Mostly metabolized-Half-life: 2-3 hrs

Indications:-Muscle spasm associated with acute painful musculoskeletal conditions

Contraindications:

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-Hypersensitivity-Significant hepatic/renal impairment-History of drug-induced hemolytic anemia or other anemia

Adverse Reactions and Side Effects:-CNS: Drowsiness, dizziness, confusion, headache, irritability, nervousness-Gastrointestinal: Nausea, anorexia, dry mouth, GI upset, vomiting

Average Dose:-PO (Adults): 800mg 3-4 times a day

Timolol

Generic and Trade Names: Blocadren

Classification: -Therapeutic: Antihypertensives, vascular headache suppressants-Pharmacologic: Beta blockers

Pharmacodynamics:-Blocks stimulation of beta 1 and beta 2 adrenergic receptor sites-Decreased heart rate and blood pressure-Prevention of MI-Decreased frequency of migraine headache

Pharmacokinetics:-Absorption: Well absorbed after oral administration-Distribution: Enters breast milk-Metabolism and Excretion: Extensively metabolize by the liver-Half-life: 3-4 hrs

Indications:-Hypertension-Prevention of MI-Prevention of migraine headaches-Ventricular arrhythmias-Essential tremor-Anxiety

Contraindications:-Uncompensated CHF-Pulmonary edema-Cardiogenic shock-Bradycardia of heart block

Adverse Reactions and Side Effects:-CNS: fatigue, weakness, anxiety, depression, dizziness, drowsiness, insomnia, memory loss-EENT: blurred vision, dry eyes, nasal stuffiness-Respiratory: bronchospasm, wheezing-Cardiovascular: arrhythmias, bradycardia, CHF, pulmonary edema, peripheral vasoconstriction-Gastrointestinal: constipation, diarrhea, nausea

Average Dose:-PO (adults): Antihypertensives 10mg BID; prevention of MI 10mg BID; prevention of vascular headache 10mg BID.

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References

1.) Davis Drug Guide For Nurses-Ninth Edition-Judith Hopper Deglin-April Hazard Vallerand

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