medical cafe

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Devendra Bhole -about me





►MIMER MEDICAL COLLEGE











►SITES
1. www.cafemedico.com

here
huge collection of
discussion
entrance exam preparation
ebooks software
mcqs
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2.www.googlelover.net

with all medical content

3.journal
www.content.nejm.org

www.cardiosource.com/jacc

www.bmj.com

www.thelancet.com

www.heart.bmjjournals.com

www.eurheartj.oxfordjournals.org

www.aafp.org/afp

www.circ.ahajournals.org

www.annals.org

www.diabetes.diabetesjournals.org

www.care.diabetesjournals.org

www.endo.endojournals.org

www.stroke.ahajournals.org

4.Genral search

www.rxlist.com

www.medscape.com

www.cdc.gov

www.emedicine.com

www.online-medical-dictionary.org


5.association
www.escardio.org

www.americanheart.org

www.acc.org

www.tctmd.com

www.nice.org.uk

www.nih.gov

www.strokeassociation.org

www.diabetes.org

www.fda.gov

www.bcs.com






THESE ARE THE MOST POPULAR MEDICINE BOOKS AVAILABLE WORLD WIDE FOR MEDICAL STUDENTS. .KEEP VISITING FOR UPDATED LIST. IF THE ,

WISHING YOU A GREAT SUCCESS IN MEDICAL PROFESSION.

1. Harrison's Principles of Internal Medicine17
2. clinical medicine kumar & clark
3.Davidson's Principles and Practice of Medicine
4.HUTCHISON'S CLINICAL METHODS
5.McLeod
6. The The Washington Manual of Medical Therapeutics
7. Cecil Essentials of Medicine
8. Oxford Handbook of Medical Sciences
9.API Textbook of Medicine - 6th Edition
10.ACP Medicine
11.Roitt's Essential Immunology
12.Merck Manual 17ed
13.CURRENT MEDICAL DIAGNOSIS & TREATMENT -2008
14.The Johns Hopkins Internal Medicine Board Review 1
5.HIV Medicine 2008
16.Kaplan & Sadock's Comprehensive Textbook of Psychiatry
17. Miller's Anesthesia
18.Grainger & Allison's Diagnostic Radiology
19.Fitzpatrick's Color Atlas of dermatology Color Atlas & Synopsis
20.Current Diagnosis & Treatment in Infectious Diseas2008

MIMER MEDICAL COLLEGE

MCQ,s

following are the signs of Ischaemia of the lower limb EXCEPT:
A .Ulcer at Halluces
B .Intermittent claudication
c .Rest pain
d. Ulcer above medial malleolus ***
e .Hair loss on lower limb

2. A painful lump in the groin of sudden onset in an otherwise healthy young man is MOST LIKELY to be?
a. Direct Inguinal hernia
b .Indirect Inguinal hernia
c .Femoral hernia
d. Enlarged groin lymph node
e. Spigelian hernia
i'll go for indirect inguinal hernia(more likely to strangulate)..dont know abt spigelian hernia..

3.A patient had undergone a partial gastrectomy 24 hours ago. His fluid input is 2 Lt and urineoutputs is 2 Lt., Naso gastric aspiration- 700 ml and drain 500 ml. His K is 3.5, Na 130 and Cl is 80.Which of the following is the MOST appropriate fluid replacement regimen?
a..2L N. saline + 1L 5% Dextrose + 50 mmol KCI
b.2L N. saline + 2L 5% Dextrose + 50 mmol KCI
c.3L N. saline + 1L 5% Dextrose + 50 mmol KCI
d.3L N. saline + 2L 5% Dextrose + 100 mmol KCI****
e.2L N. saline + 2L 5% Dextrose + 100 mmol KCI
agreee

4. A 46 years old woman had left mastectomy done for breast cancer two years ago.Now she comes to you with a painless, firm and mobile lump in her right breast. She is otherwise well. What is the MOST LIKELY diagnosis?
a.New primary cancer in the right breast
b Metastases from the previous breast cancer ***
c.Benign growth
d.Metastasis from another malignant tumour elsewhere
e.Lymph node swelling

there must be some remnants left which gave rise to metastasis
5. An X ray showing dislocation of shoulder. Which of the following is CORRECT?
a. Posterior Dislocation of the shoulder.
b.Sensory loss of the lateral aspect of the arm.**
c.Weakness of the hand
d.Sensory loss of the medial aspect of the arm.
e.Fracture of the Humerus

6 Which of the following is MOST suggestive of disruption of deep layers of a post operative abdominal wound?
a. Persistent pain in wound
b.serosanguineous discharge
c. Persistent abdominal distension
d.Gaping in the skin after the removal of the sutures ***
e.Unexplained fever and tachycardia
not sure
i want to disuss about IUGR in gest. DM -
WILLIAM'S obstetrics says that there in unexplained fetal demise not known to be due to causes like IUGR,placental insuffeciency etc.
so guys there is "NO IUGR" in gest DM

PAED
A 14 years old girl has breast enlargement, normal growth of pubic and axillary hair but she is still
not menstruating. Which of the following is CORRECT?
a.She is likely to start menstruating two years after the start of pubic hair growth
b.She is likely to start menstruating two years after the start of axillary hair growth
c.She is likely to start menstruating within two years from the time of her breast budding.
d..She is likely to start menstruating within two years from growth spurt.
e.This is a case of delayed puberty ***
thelarche is first to come(which has already developed).last to develop is menarche..so this is a case of pubertal delay


A 16 years old girl presents with fever, headache and rash on her body. She also has profuse bleeding from all venipuncture sites. What is the MOST probable diagnosis?
a.Thrombocytopenia
b.'Disseminated Intravascular coagulation
c.Henoch Schonlein Purpura ***
d.Allergic reaction
why fever in thrombocytopenia?moreover age group belongs to HSP.also know that HSP is one the most common cause of purpura in this age group

A 12 months old baby has fever. Recently, two other family members had an upper respiratory tract infection. On examination of the baby you find that his body temperature is 37.5 CTand chest auscultation reveals bilateral wheezing. What is the MOST LIKELY cause?
a.Acute bronchiolitis ***
b.Viral croup
c.Bronchial Asthma
d.Pneumonia
e.Foreign body
age group suggests it

A neonate with cough and fever is found to be grunting. Chest X ray shows round lesions with little pleural effusion. Which of the following is the BEST the treatment?
a.Crystalline Penicillin ??
b.Gentamycin
d.Amoxicillin
e.Flucloxacillin ***
as staph is common cause of pneumonia in this age grp.Plz correct me

A ten years old girl has a history of repeated episodes of hemiparesis from which she recovers completely. What is the MOST LIKELY diagnosis?
a.Middle cerebral artery occlusion
b.Petit mal epilepsy **
c.Migraine ??
d.Subarachnoid haemorrhage
migraine is unlikely in this age grp but it rarely presents with hemiparesis...can hemiaparesis be present in petit mal epilepsy..if yes then this is the answer


The parents with their 10 years old child come to see you with complaints that the child has enuresis since birth. The child has no problems during the day time. Physical examination does not reveal any other abnormality. Which of the following statements is TRUE in more than 20 % of such cases?
a.He has chronic pyelonephritis
b.He has congenital abnormalities of the urinary tract
c.There is an associated family history ****
d.he has small urinary bladder.
e.It is associated with spina bifida occulta

enuresis is frequently found in patients with disturbed family env.

A 5 years old boy presents with vomiting every morning and morning headache for the last two weeks. What is the MOST LIKELY cause?
a.Meningitis
b.Migraine
c.Craniopharyngioma **
d.MeduJloblastoma
e.Wilm's tumour

will check and tell but most likely the ansewer is craniopha..

An adolescent boy complains of slight pain in the right knee which gets worse after exercise. On
examination you find a lump on the tibia tubercle with slight tenderness. The boy can't remember if
he has had any recent trauma. Which of the following statements is CORRECT?
a.Reassure that there is nothing wrong
b.Biopsy should be done to exclude malignancy ***
c.Knee aspirate shows organism
d. Osteochondritis is the most likely cause


A 6 day old baby who is suspected to have Down's syndrome presents with non projectile bilestained vomiting for the last two days. On abdominal examination you find an olive shapedpalpable mass in the epigastrium. Which of the following is the MOST LIKELY diagnosis?
a.Volvulus
b.Duodenal Atresia.***
c.Intussusception
d.Malabsorption

A two years old child presents with failure to thrive for the last 6 months and right buttock wasting. He passes bulky stools 2-3 times a day. Which of the following is the MOST appropriate investigation?
a.C13 breath test
b.Duodenal biopsy ***
c.Stool culture
d.Stool microscopy
e.Sweat test

A diabetic mother gives birth to a child weight 4240 gm and with an Apgar score of 7/10. On examination you find cyanosis of his hands and feet and the child is jittery. Axillary temperature measure shows a reading of 37.2 C. His condition improved after meconium aspiration and 100% O2. Which of the following is the MOST LIKELY cause?
a.Hypoglycaemia
b.Heart disease ***
c.Lung disease.
d.Hyperglycaemia
e.His jaundice is caused by breast milk.

cyanotic heart disease may be the cause which is common in baby of diabetic mother

A six years old boy presents with delayed development of speech after a period of normal development. On examination you find that he avoids eye contact and reveals a history of unusual liking for dinosaurs. Which of the following is the MOST LIKELY diagnosis?
a.Autism ***
b.ADHD
c.Deafness
regression of normal milestones which are already developed is a feature of autism

A young woman with anovulatory cycles for the long time is MOST LIKELY to develop which of the following?
a.Cervical cancer
b.Endometrial Cancer
c.Ovarian cancer ***
d.Vaginal cancer
e.Cancer of the Vulva


In which of the following conditions you will find DECREASED amniotic fluid?
a.Foetus's Bladder neck obstruction of the foetus(renal agenesis)
b.T.O fistula
c.Rhesus incompatibity
d.Multiple pregnancy
explanation-since baby bathes in amniotic fluid it absorbs and excrets only amniotic fluid.so in renal agenesis no urine is produced therefore amniotic fluid is reduced(oligohydramnios)..in esophageal atresia amniotic fluid is not absorbed causing polyhydramnios


A 52 years old obese post menopausal woman presents with no signs of Menopause and amenorrhoea. What could be the cause?
A Low oestrogen and Low FSH
B High oestrogen and high FSH
c. Normal oestrogen and high FSH
d.High oestrogen and low FSH ***
e.Low oestrogen and High FSH

since hot flushes and other symptoms are produced due to high amt of FSH..here the case is revrsed

A 16 years old student asks for a prescription for contraceptive pill. She says she doesn't have sexual partner. Which of the following is the MOST APPROPRIATE management?
a. Oral contraceptive pill
b.Minipill
c.Depot
d.Oral contraceptive pill + condoms
e.Call her parents.

why does she need a contraceptive pill if she has no partner????
ocp is the best bet for emergencies

A pregnant woman in 1st trimester is found to have CIN III. What is your NEXT step?
a. Terminate the pregnancy
b. Cone biopsy
c.Hysterectomy
d.Colposcopy
e.Observe

not sure

14. A pregnant woman in 1st trimester presents with skin dimpling over the right breast. Examination and clinical tests reveals cancer of the right breast. Which of the following is your management?
a.Terminate the pregnancy
b.Start radiotherapy
c.Wait till delivery and then start the treatment ???
d.Surgery

if dimpling is present it means it is T4..why surgery if T4...

A 19 years old female comes to your clinic for consultation. She has never had periods. On examination her breast development is normal. Pubic and axillary hair growth is also normal. The
development of her genitals is also in normal range. What is the MOST LIKELY cause of her amenorrhea?
a. Turner's syndrome
b. Prolactinoma
c. Absent uterus ***d. Pituitary lesion
e. Lesion in Hypothalamus

you cant be sure whether it is imperforate or not

A 42 years man who is a patient of yours is arrested for attacking his wife in a supermarket. The police come to you and ask you to write a report about this patient. Which of the following is TRUE for good practice?
a.You will write a report about the patient's bad mental state
b.You will tell the patient never to come to your surgery again
c.You will write a general, unbiased and balanced report about health of the patient.
d.You will tell the police that you don't want to give any reports
e. Arrange for a meeting with the patient

please tell me where to read ethics from guys!!!

Which of the following will cause SEROTONIN syndrome if given together with SSRI like Fluoxetine EXCEPT?
a.L-tryptophan
b.Haloperidol
c.Moclobemide
'd. Chlorpromazine
e.Citalopram

no idea...what is sertonin syndrome

In Australia , almost every year there are several incidences of bush fire. Usually it is caused by
young people and teenagers. Which of the following is TRUE?
a. Juvenile pyromania is the main cause of fires in Australia . ****
-b. It is due to accidental fire caused by youngster who get scared after the fire starts to
spread uncontrollably and they run away.
c.It has no serious consequences
d.Youngsters like to ignite and play with fire.
e.It is done to hide crimes

A schizophrenic woman thinks that she is perfectly well and denies any illness. She also refuses to
take medication and thinks that she can talk with Angels. What is this called in Psychiatry ?

a.Lack of insight
b.Overvalued idea
c.Rejection
d.Delusion
e..Formal thought****









which is the best nerve in grafting?
a) median nerve ***
b)radial nerve
c) digital nerve
thicker nerves are better for grafts


patient presents with sudden rupture of extensor pollicis longus tendon,dx?
a) tendonities***
b) tenosynovitis
c) RA
not very sure but more likely

A patient with cancer breast develop osteoprposis.what is the treatment
a) bisphosphonate ***
b) cyclical estrogen and progesterone
c) continuous estrogen and progesterone
increase diatery calcium 2000g / day

You are called to review a patient who developed restlessness and difficulty breathing eight hours
after thyroidectomy. What will you do FIRST?
a. Endotracheal intubation.
b.Remove superficial sutures
c.Remove superficial and deep sutures ***
d.Salbutamol inhalation as patient probably has Asthma

A 43 years old man was brought to the emergency department with severe upper abdominal pain
and signs of shock. Physical examination reveals abdominal wall rigidity and guarding. Which of
the following is the MOST LIKELY Diagnosis?
a.Perforated gastric ulcer ***
b.Penetrating duodenal ulcer
c. Mesenteric ischemia
d. Acute pancreatitis

patient is in shock with upper abdominal pain..guarding and rigidity is suggestive of peritonitis..

A young male fell from a height but sustained minor injuries. After two hours he lost
consciousness and was brought to you in Northern Queensland hospital with limited radiographic
facilities by his friend. On examination you find that his pupils are fixed and dilated. What is our
NEXT step?
a.Arrange for transportation to another hospital by helicopter.
b.Give IV mannitol
c Give IV corticosteroid d. d Burr holes ***
case of EDH


An elderly man came to see you with complaints of sudden pain in the lower back while lifting a heavy box. On examination you find that the lumbar spine has limited movement with pain in his lower back on movement. There are no neurological abnormalities. What is the NEXT investigation that you'll do?
a.X Ray of the lumbar spine ***
b.CTScan
c.MRI of the spine
d.Lumbar puncture

A 70 years old woman had Upper GIB. She was on treatment with NSAID for knee pain which was
stopped a few months ago. You do an endoscopy of upper Gl tract and find a duodenal ulcer with
recent bleeding. What is the BEST management?
a.Omeprazol I.V. + Ampicillin + Metronidazole ***
b.Omeprazol I.V.
c.Highly selective vagotomy
d.Vagotomy
e.Ranitidine I.V. + Ampicillin + Metronidazole

highly selective vagotomy will only stop the acid secretion.ideally somatostatin infusion or application of adrenaline locally should be done otherwise conventional therapy for ulcer is recommended

Which of the following is MOST COMMON cause of acute pancreatitis?
a.Gallstones,
b.Cholecystitis
c.Alcohol abuse ***
d.Spicy food
e.Gastroenteritis

What is the MOST COMMON cause of death after burn injury in Australia ?
a.Shock***
b.Respiratory failure
c.Cardiac failure
d.Renal failure
most likely hypovolemic shock


patient presents with sudden rupture of extensor pollicis longus tendon,dx?
a) tendonities
b) tenosynovitis
c) RA

Probably

A patient with cancer breast develop osteoprposis.what is the treatment
a) bisphosphonate
b) cyclical estrogen and progesterone
c) continuous estrogen and progesterone
d)increase diatery calcium 2000g / day

obvious choice

You are called to review a patient who developed restlessness and difficulty breathing eight hours
after thyroidectomy. What will you do FIRST?
a. Endotracheal intubation.
b.Remove superficial sutures
c.Remove superficial and deep sutures
d.Salbutamol inhalation as patient probably has Asthma

This is hypoparathyroidism secondary to surgery leading to hypocalcemia and eventually life threatening laryngeal edema


A young male fell from a height but sustained minor injuries. After two hours he lost
consciousness and was brought to you in Northern Queensland hospital with limited radiographic
facilities by his friend. On examination you find that his pupils are fixed and dilated. What is our
NEXT step?
a.Arrange for transportation to another hospital by helicopter.
b.Give IV mannitol
c Give IV corticosteroid d.
d Burr holes

This is epidural hemorrhage - so need burr hole operation. Clue - lucid interval followed by unconciousness.

An elderly man came to see you with complaints of sudden pain in the lower back while lifting a heavy box. On examination you find that the lumbar spine has limited movement with pain in his lower back on movement. There are no neurological abnormalities. What is the NEXT investigation that you'll do?

a.X Ray of the lumbar spine
c.MRI of the spine
d.Lumbar puncture

Since the patient is more than 50 years of age - this is a red flag sign (Davidson 19th page [snip]). So patent has to be evaluated with investigation. Patient needs both Xray and MRI(Davidson page [snip]). Since it is the next investigation in the question - I go for xray.



A 70 years old woman had Upper GIB. She was on treatment with NSAID for knee pain which was
stopped a few months ago. You do an endoscopy of upper Gl tract and find a duodenal ulcer with
recent bleeding. What is the BEST management?
a.Omeprazol I.V. + Ampicillin + Metronidazole
b.Omeprazol I.V.
c.Highly selective vagotomy
d.Vagotomy
e.Ranitidine I.V. + Ampicillin + Metronidazole

Bleeding has stopped. So now the patient needs treatment for healing of ulcer as well as eradication therapy for H. pylori.

Which of the following is MOST COMMON cause of acute pancreatitis?
a.Gallstones,
b.Cholecystitis
c.Alcohol abuse
d.Spicy food
e.Gastroenteritis

What is the MOST COMMON cause of death after burn injury in Australia ?
a.Shock
b.Respiratory failure
c.Cardiac failure
d.?Renal failure

Its a guess. I assume that being a country with good medical facilities - fluid resuscitation should be available and shock should be treated. But renal failure in burn can be caused by shock, myoglobinuria, hemoglobinuria etc.

PAED
A 14 years old girl has breast enlargement, normal growth of pubic and axillary hair but she is still
not menstruating. Which of the following is CORRECT?
a.She is likely to start menstruating two years after the start of pubic hair growth
b.She is likely to start menstruating two years after the start of axillary hair growth
c.She is likely to start menstruating within two years from the time of her breast budding.
d..She is likely to start menstruating within two years from growth spurt.
e.This is a case of delayed puberty

Reference Robertson page 156


A 16 years old girl presents with fever, headache and rash on her body. She also has profuse bleeding from all venipuncture sites. What is the MOST probable diagnosis?
a.Thrombocytopenia
b.'Disseminated Intravascular coagulation
c.Henoch Schonlein Purpura
d.Allergic reaction

Meningococcal infection leading to DIC

A 12 months old baby has fever. Recently, two other family members had an upper respiratory tract infection. On examination of the baby you find that his body temperature is 37.5 CTand chest auscultation reveals bilateral wheezing. What is the MOST LIKELY cause?
a.Acute bronchiolitis
b.Viral croup
c.Bronchial Asthma
d.Pneumonia
e.Foreign body

Viral ailment caused by RSV in children leading to wheezing. Some of these children will go on to develop asthma when adult.

A neonate with cough and fever is found to be grunting. Chest X ray shows round lesions with little pleural effusion. Which of the following is the BEST the treatment?
a.Crystalline Penicillin
b.Gentamycin
d.Amoxicillin
e.Flucloxacillin

I am not sure. But considering that E.coli and gm negative organism are the commonest bacterial etiology in this group - I go for Gentamycin.

A ten years old girl has a history of repeated episodes of hemiparesis from which she recovers completely. What is the MOST LIKELY diagnosis?
a.Middle cerebral artery occlusion
b.Petit mal epilepsy
c.Migraine
d.Subarachnoid haemorrhage

Don't know. Anyone?

The parents with their 10 years old child come to see you with complaints that the child has enuresis since birth. The child has no problems during the day time. Physical examination does not reveal any other abnormality. Which of the following statements is TRUE in more than 20 % of such cases?
a.He has chronic pyelonephritis
b.He has congenital abnormalities of the urinary tract
c.There is an associated family history
d.he has small urinary bladder.
e.It is associated with spina bifida occulta

A 5 years old boy presents with vomiting every morning and morning headache for the last two weeks. What is the MOST LIKELY cause?
a.Meningitis
b.Migraine
c.Craniopharyngioma
d.MeduJloblastoma
e.Wilm's tumour

Morning headache and morning vomiting suggestive of brain tumor. Medulloblastoma is a common childhood tumor

An adolescent boy complains of slight pain in the right knee which gets worse after exercise. On
examination you find a lump on the tibia tubercle with slight tenderness. The boy can't remember if
he has had any recent trauma. Which of the following statements is CORRECT?

a.Reassure that there is nothing wrong
b.Biopsy should be done to exclude malignancy
c.Knee aspirate shows organism
d. Osteochondritis is the most likely cause

This is Osgood Schlatter Diseas. It is self limiting. Only conservative treatment is required in most of the cases. Osteochondritis presents with locked knee, knee effusion etc.(John Murtag 739)

A 6 day old baby who is suspected to have Down's syndrome presents with non projectile bilestained vomiting for the last two days. On abdominal examination you find an olive shapedpalpable mass in the epigastrium. Which of the following is the MOST LIKELY diagnosis?
a.Volvulus
b.Duodenal Atresia.
c.Intussusception
d.Malabsorption

Common complication of Down's syndrome

A two years old child presents with failure to thrive for the last 6 months and right buttock wasting. He passes bulky stools 2-3 times a day. Which of the following is the MOST appropriate investigation?
a.C13 breath test
b.Duodenal biopsy
c.Stool culture
d.Stool microscopy
e.Sweat test

It seems like a coeliac diseas. But only thing that is puzzling is one sided buttock wasting which should be both sided(Robertson clinical example page 571).

A diabetic mother gives birth to a child weight 4240 gm and with an Apgar score of 7/10. On examination you find cyanosis of his hands and feet and the child is jittery. Axillary temperature measure shows a reading of 37.2 C. His condition improved after meconium aspiration and 100% O2. Which of the following is the MOST LIKELY cause?
a.?Hypoglycaemia
b.Heart disease
c.Lung disease.
d.Hyperglycaemia
e.His jaundice is caused by breast milk.

Hypoglycemia is common in infant of Diabetic mothers, so is polycythemia. Probably the child was jittery due to hypoglycemia. Not sure though.

A six years old boy presents with delayed development of speech after a period of normal development. On examination you find that he avoids eye contact and reveals a history of unusual liking for dinosaurs. Which of the following is the MOST LIKELY diagnosis?
a.Autism
b.ADHD
c.Deafness
Obs

A young woman with anovulatory cycles for the long time is MOST LIKELY to develop which of the following?
a.Cervical cancer
b.Endometrial Cancer
c.Ovarian cancer
d.Vaginal cancer
e.Cancer of the Vulva

In which of the following conditions you will find DECREASED amniotic fluid?
a.Foetus's Bladder neck obstruction of the foetus
b.T.O fistula
c.Rhesus incompatibity
d.Multiple pregnancy

A 52 years old obese post menopausal woman presents with no signs of Menopause and amenorrhoea. What could be the cause?
A Low oestrogen and Low FSH
B High oestrogen and high FSH
c. Normal oestrogen and high FSH
d.High oestrogen and low FSH •
e.Low oestrogen and High FSH

A 16 years old student asks for a prescription for contraceptive pill. She says she doesn't have
sexual partner. Which of the following is the MOST APPROPRIATE management?
a. Oral contraceptive pill
b.Minipill
c.Depot
d.Oral contraceptive pill + condoms
e.Call her parents.

A pregnant woman in 1st trimester is found to have CIN III. What is your NEXT step?
a. Terminate the pregnancy
b. Cone biopsy
c.Hysterectomy
d.Colposcopy
e.?Observe

14. A pregnant woman in 1st trimester presents with skin dimpling over the right breast. Examination and clinical tests reveals cancer of the right breast. Which of the following is your management?
a.Terminate the pregnancy
b.Start radiotherapy
c.Wait till delivery and then start the treatment
d.?Surgery

A 42 years man who is a patient of yours is arrested for attacking his wife in a supermarket. The police come to you and ask you to write a report about this patient. Which of the following is TRUE for good practice?
a.You will write a report about the patient's bad mental state
b.You will tell the patient never to come to your surgery again
c.You will write a general, unbiased and balanced report about health of the patient.
d.You will tell the police that you don't want to give any reports
e. Arrange for a meeting with the patient

Which of the following will cause SEROTONIN syndrome if given together with SSRI like Fluoxetine EXCEPT?
a.L-tryptophan
b.Haloperidol
c.Moclobemide
'd. Chlorpromazine
e.Citalopram

Dont know

In Australia , almost every year there are several incidences of bush fire. Usually it is caused by
young people and teenagers. Which of the following is TRUE?

a. ?Juvenile pyromania is the main cause of fires in Australia .
b. It is due to accidental fire caused by youngster who get scared after the fire starts to
spread uncontrollably and they run away.
c.It has no serious consequences
d.Youngsters like to ignite and play with fire.
e.It is done to hide crimes

A schizophrenic woman thinks that she is perfectly well and denies any illness. She also refuses to
take medication and thinks that she can talk with Angels. What is this called in Psychiatry ?

a.Lack of insight
b.Overvalued idea
c.Rejection
d.Delusion
e..Formal thought disorder [/b]


You are called to review a patient who developed restlessness and difficulty breathing eight hours
after thyroidectomy. What will you do FIRST?
a. ENDOTRACHEAL INTUBATION
b.Remove superficial sutures
c.Remove superficial and deep sutures
d.Salbutamol inhalation as patient probably has Asthma

This is hypoparathyroidism secondary to surgery leading to hypocalcemia and eventually life threatening laryngeal SPASM(not edema)








CAUSE OF ACUTE PANCREATITIS

Gall Stone: At least 30-40% of cases. In some series it has been placed as high as 90%

Alcoholism: At least 25% of cases






Lady Talking with the angels

A schizophrenic woman thinks that she is perfectly well and denies any illness. She also refuses to
take medication and thinks that she can talk with Angels. What is this called in Psychiatry ?

a.Lack of insight
b.Overvalued idea
c.Rejection
d.Delusion
e..Formal thought disorder

Actually it is lack of insight.

I am quoting from Oxford Core Psychiatry p18

"As s technical term insight means a correct awareness of one's own mental condition.

It is best described in terms of four criteria:

1. Awareness of oneself as presenting phenomena that other people consider abnormal.
2. Recognition that these phenomena are abnormal.
3. Acceptance that these abnormal phenomena are caused by one's own mental illness
4. Awareness that treatment is required.




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gorani
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Posted: Fri Sep 29, 2006 1:00 pm Post subject:

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You are called to review a patient who developed restlessness and difficulty breathing eight hours
after thyroidectomy. What will you do FIRST?
a. Endotracheal intubation.
b.Remove superficial sutures
c.Remove superficial and deep sutures
d.Salbutamol inhalation as patient probably has Asthma




A 70 years old woman had Upper GIB. She was on treatment with NSAID for knee pain which was
stopped a few months ago. You do an endoscopy of upper Gl tract and find a duodenal ulcer with
recent bleeding. What is the BEST management?
a.Omeprazol I.V. + Ampicillin + Metronidazole
b.Omeprazol I.V.
c.Highly selective vagotomy
d.Vagotomy
e.Ranitidine I.V. + Ampicillin + Metronidazole

The treatment for NSAID induced ulcer includes giving PPI and if pain can not be tolerated give NSAID+PPI. No mention of giving antibiotics. --- Toronto notes

A two years old child presents with failure to thrive for the last 6 months and right buttock wasting. He passes bulky stools 2-3 times a day. Which of the following is the MOST appropriate investigation?
a.C13 breath test
b.Duodenal biopsy*****
c.Stool culture
d.Stool microscopy
e.Sweat test

Celiac dse does have failure to thrive, muscle wasting and flat buttocks. ----Nelson's pediatrics


A ten years old girl has a history of repeated episodes of hemiparesis from which she recovers completely. What is the MOST LIKELY diagnosis?
a.Middle cerebral artery occlusion
b.Petit mal epilepsy
c.Migraine ****
d.Subarachnoid haemorrhage

Atypical migraine can present with hemisensory loss or hemiparesis ---Adams

A young woman with anovulatory cycles for the long time is MOST LIKELY to develop which of the following?
a.Cervical cancer
b.Endometrial Cancer
c.Ovarian cancer
d.Vaginal cancer
e.Cancer of the Vulva



A schizophrenic woman thinks that she is perfectly well and denies any illness. She also refuses to
take medication and thinks that she can talk with Angels. What is this called in Psychiatry ?

a.Lack of insight ------?????
b.Overvalued idea
c.Rejection Havila- yr comment?
d.Delusion
e..Formal thought disorder-----????


patient presents with sudden rupture of extensor pollicis longus tendon,dx?
a) tendonities-----??
b) tenosynovitis Trick again
c) RA-----????

What is the MOST COMMON cause of death after burn injury in Australia ?
a.Shock
b.Respiratory failure
c.Cardiac failure
d.?Renal failure

A 14 years old girl has breast enlargement, normal growth of pubic and axillary hair but she is still
not menstruating. Which of the following is CORRECT?
a.She is likely to start menstruating two years after the start of pubic hair growth
b.She is likely to start menstruating two years after the start of axillary hair growth
c.She is likely to start menstruating within two years from the time of her breast budding. *****( this one also correct)
d..She is likely to start menstruating within two years from growth spurt.
e.This is a case of delayed puberty *******

A 16 years old girl presents with fever, headache and rash on her body. She also has profuse bleeding from all venipuncture sites. What is the MOST probable diagnosis?
a.Thrombocytopenia
b.'Disseminated Intravascular coagulation******( cooldude-U r wrong)
c.Henoch Schonlein Purpura
d.Allergic reaction

Meningococcal infection leading to DIC

A neonate with cough and fever is found to be grunting. Chest X ray shows round lesions with little pleural effusion. Which of the following is the BEST the treatment?
a.Crystalline Penicillin******
b.Gentamycin Havila- your comment
d.Amoxicillin
e.Flucloxacillin****

A ten years old girl has a history of repeated episodes of hemiparesis from which she recovers completely. What is the MOST LIKELY diagnosis?
a.Middle cerebral artery occlusion
b.Petit mal epilepsy
c.Migraine ??????
d.Subarachnoid haemorrhage

An adolescent boy complains of slight pain in the right knee which ***gets worse after exercise. On examination you find a lump on the tibia tubercle with slight tenderness. The boy can't remember if
he has had any recent trauma. Which of the following statements is CORRECT?

a.Reassure that there is nothing wrong
b.Biopsy should be done to exclude malignancy ----????something wrong- the boy has symptom

c.Knee aspirate shows organism
d. Osteochondritis is the most likely cause

A two years old child presents with ***failure to thrive for the last 6 months and **right buttock wasting. He passes ***bulky stools 2-3 times a day. Which of the following is the MOST appropriate investigation?
a.C13 breath test
b.Duodenal biopsy----???
c.Stool culture
d.Stool microscopy
e.Sweat test ----------------??

A diabetic mother gives birth to a child weight 4240 gm and with an Apgar score of 7/10. On examination you find cyanosis of his hands and feet and the child is jittery. Axillary temperature measure shows a reading of 37.2 C. His condition improved after meconium aspiration and 100% O2. Which of the following is the MOST LIKELY cause?
a.Hypoglycaemia******** ( we are sure- cooldude)
b.Heart disease
c.Lung disease.
d.Hyperglycaemia
e.His jaundice is caused by breast milk.

A ***young woman with **anovulatory cycles for the long time is MOST LIKELY to develop which of the following?
a.Cervical cancer
b.Endometrial Cancer ( age is older)
c.Ovarian cancer *********
d.Vaginal cancer
e.Cancer of the Vulva

A 52 years old ***obese post menopausal woman presents with **no signs of Menopause and **amenorrhoea. What could be the cause?
A Low oestrogen and Low FSH
B High oestrogen and high FSH*****
c. Normal oestrogen and high FSH
d.High oestrogen and low FSH
e.Low oestrogen and High FSH

A 16 years old student asks for a prescription for contraceptive pill. She says she doesn't have
sexual partner. Which of the following is the MOST APPROPRIATE management?
a. Oral contraceptive pill**** ( here in OZ-- sexually active since 11yrof age-- cool-dude-- follow her request)

b.Minipill ( by the way what is that?-- haven't read)
c.Depot
d.Oral contraceptive pill + condoms

A pregnant woman in 1st trimester is found to have CIN III. What is your NEXT step?
a. Terminate the pregnancy
b. Cone biopsy
c.Hysterectomy help
d.Colposcopy
eObserve

14. A pregnant woman in 1st trimester presents with skin dimpling over the right breast. Examination and clinical tests reveals cancer of the right breast. Which of the following is your management?
a.Terminate the pregnancy
b.Start radiotherapy
c.Wait till delivery and then start the treatment*** ( I can agree with cool-dude)

Which of the following will cause SEROTONIN syndrome if given together with SSRI like Fluoxetine EXCEPT?
a.L-tryptophan
b.Haloperidol
c.Moclobemide
'd. Chlorpromazine
e.Citalopram

A schizophrenic woman thinks that she is perfectly well and denies any illness. She also refuses to
take medication and thinks that she can talk with Angels. What is this called in Psychiatry ?

a.Lack of insight *****( most likely)
b.Overvalued idea
c.Rejection
d.Delusion
e..Formal thought disorder ****
A ten years old girl has a history of repeated episodes of hemiparesis from which she recovers completely. What is the MOST LIKELY diagnosis?
a.Middle cerebral artery occlusion
b.Petit mal epilepsy
c.Migraine i think hemiplegic migraine not sure
d.Subarachnoid haemorrhage









A 70 years old woman had Upper GIB. She was on treatment with NSAID for knee pain which was
stopped a few months ago. You do an endoscopy of upper Gl tract and find a duodenal ulcer with
recent bleeding. What is the BEST management?
a.Omeprazol I.V. + Ampicillin + Metronidazole
b.Omeprazol I.V.
c.Highly selective vagotomy
d.Vagotomy
e.Ranitidine I.V. + Ampicillin + Metronidazole

The treatment for NSAID induced ulcer includes giving PPI and if pain can not be tolerated give NSAID+PPI. No mention of giving antibiotics. --- Toronto notes

All patients with proven acute or chronic duodenal ulcer and those with gastric ulcer who are H pylori positive should be offered eradicaiton of H. pylori. (Davidson 20th p887)

Omeprazole for healing of ulcer and amoxy+metro for eradication of H. pylori



A two years old child presents with failure to thrive for the last 6 months and right buttock wasting. He passes bulky stools 2-3 times a day. Which of the following is the MOST appropriate investigation?
a.C13 breath test
b.Duodenal biopsy*****
c.Stool culture
d.Stool microscopy
e.Sweat test

Celiac dse does have failure to thrive, muscle wasting and flat buttocks. ----Nelson's pediatrics

A young woman with anovulatory cycles for the long time is MOST LIKELY to develop which of the following?
a.Cervical cancer
b.Endometrial Cancer
c.Ovarian cancer
d.Vaginal cancer
e.Cancer of the Vulva


Development of endometrial carcinoma is related to unopposed action of estrogen. It is more likely to occur in women who are relatively infertile.(LJ 281)












A young woman with anovulatory cycles for the long time is MOST LIKELY to develop which of the following?
a.Cervical cancer
b.Endometrial Cancer
c.Ovarian cancer
d.Vaginal cancer
e.Cancer of the Vulva

I think I ignored the age factor here. So, now I think ovarian carcinoma should be a better option here. Sorry!

I am following your questions Bulimia.

Please note that I have attached references to a lot of my answers.

Regarding your post op fluid therapy question(Bulimia) - I went through the AMC commentary you referred to. That was a different scenerio. A man who was dehydrated and had pyloric stenosis. This is not the same as post op fluid therapy. I request you to go through the perioperative and postoperative care from SCOTT before you make up your mind.


a lady came to you at 12 weeks pregnancy for antenatal check.Her 1st child was born with spina bifida.Which of the following investigation would not be useful in assesing the second baby...

a-maternal triple or tetra test at 16-18 week
b-amniocentesis for acetylcholine estrase at 11-13 weeks
c-USG for nuchal fold measurement at 11-13 weeks ??
d-USG for spinal abnormalities at 16-18 weeks
e-Do chorion villous sampling at 8-10 weeks ??




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gorani
Guest






Posted: Fri Sep 29, 2006 1:02 pm Post subject: Spigelian hernia

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Spigelian hernia


A Spigelian hernia is an acquired ventral hernia through the linea semilunaris, the line where the sheaths of the lateral abdominal muscles fuse to form the lateral rectus sheath. Spigelian hernias are nearly always found above the level of the inferior epigastric vessels, and most often occur where the semicircular line - fold of Douglas - cross the linea semilunaris. Commonly, the patient is over the age of 50 years. Men and women are equally affected.

The patient presents with pain that is localised to the hernial site and is aggravated by any movement that raises intra-abdominal pressure. Later, the pain becomes more dull, constant, and diffuse.

A soft, reducible mass may be present in the lower abdominal area which disappears on pressure. When the mass is reduced, the hernial orifice can usually be palpated. Diagnosis is more difficult when the hernia dissects within the layers of the abdominal wall - internal and external obliques - or may be located at a distance from the linea semilunaris. Ultrasound and CT scan may help to confirm the diagnosis.

Spigelian hernias have a high incidence of incarceration and should be repaired. Treatment is by primary aponeurotic closure.




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gorani
Guest






Posted: Fri Sep 29, 2006 1:03 pm Post subject:

--------------------------------------------------------------------------------

patient presents with sudden rupture of extensor pollicis longus tendon,dx?
a) tendonities?
b) tenosynovitis
c) RA???

A patient with cancer breast develop osteoprposis.what is the treatment
a) bisphosphonate
b) cyclical estrogen and progesterone
c) continuous estrogen and progesterone
increase diatery calcium 2000g / day

You are called to review a patient who developed restlessness and difficulty breathing eight hours
after thyroidectomy. What will you do FIRST?
a. Endotracheal intubation.
b.Remove superficial sutures
c.Remove superficial and deep sutures
d.Salbutamol inhalation as patient probably has Asthma

A 43 years old man was brought to the emergency department with severe upper abdominal pain
and signs of shock. Physical examination reveals abdominal wall rigidity and guarding. Which of
the following is the MOST LIKELY Diagnosis?
a.Perforated gastric ulcer
b.Penetrating duodenal ulcer
c. Mesenteric ischemia
d. Acute pancreatitis

A young male fell from a height but sustained minor injuries. After two hours he lost
consciousness and was brought to you in Northern Queensland hospital with limited radiographic
facilities by his friend. On examination you find that his pupils are fixed and dilated. What is our
NEXT step?
a.Arrange for transportation to another hospital by helicopter.
b.Give IV mannitol
c Give IV corticosteroid d. d Burr holes

An elderly man came to see you with complaints of sudden pain in the lower back while lifting a heavy box. On examination you find that the lumbar spine has limited movement with pain in his lower back on movement. There are no neurological abnormalities. What is the NEXT investigation that you'll do?
a.X Ray of the lumbar spine
b.CTScan
c.MRI of the spine
d.Lumbar puncture

A 70 years old woman had Upper GIB. She was on treatment with NSAID for knee pain which was
stopped a few months ago. You do an endoscopy of upper Gl tract and find a duodenal ulcer with
recent bleeding. What is the BEST management?
a.Omeprazol I.V. + Ampicillin + Metronidazole
b.Omeprazol I.V.
c.Highly selective vagotomy
d.Vagotomy
e.Ranitidine I.V. + Ampicillin + Metronidazole


Which of the following is MOST COMMON cause of acute pancreatitis?
a.Gallstones,
b.Cholecystitis
c.Alcohol abuse
d.Spicy food
e.Gastroenteritis

What is the MOST COMMON cause of death after burn injury in Australia ?
a.Shock???
b.Respiratory failure???
c.Cardiac failure
d.Renal failure

PAED
A 14 years old girl has breast enlargement, normal growth of pubic and axillary hair but she is still
not menstruating. Which of the following is CORRECT?
a.She is likely to start menstruating two years after the start of pubic hair growth
b.She is likely to start menstruating two years after the start of axillary hair growth
c.She is likely to start menstruating within two years from the time of her breast budding.
d..She is likely to start menstruating within two years from growth spurt.
e.This is a case of delayed puberty


A 16 years old girl presents with fever, headache and rash on her body. She also has profuse bleeding from all venipuncture sites. What is the MOST probable diagnosis?
a.Thrombocytopenia
b.'Disseminated Intravascular coagulation
c.Henoch Schonlein Purpura
d.Allergic reaction

A 12 months old baby has fever. Recently, two other family members had an upper respiratory tract infection. On examination of the baby you find that his body temperature is 37.5 CTand chest auscultation reveals bilateral wheezing. What is the MOST LIKELY cause?
a.Acute bronchiolitis
b.Viral croup
c.Bronchial Asthma
d.Pneumonia
e.Foreign body

A neonate with cough and fever is found to be grunting. Chest X ray shows round lesions with little pleural effusion. Which of the following is the BEST the treatment?
a.Crystalline Penicillin
b.Gentamycin
d.Amoxicillin
e.Flucloxacillin

A ten years old girl has a history of repeated episodes of hemiparesis from which she recovers completely. What is the MOST LIKELY diagnosis?
a.Middle cerebral artery occlusion
b.Petit mal epilepsy
c.Migraine
d.Subarachnoid haemorrhage

The parents with their 10 years old child come to see you with complaints that the child has enuresis since birth. The child has no problems during the day time. Physical examination does not reveal any other abnormality. Which of the following statements is TRUE in more than 20 % of such cases?
a.He has chronic pyelonephritis
b.He has congenital abnormalities of the urinary tract
c.There is an associated family history
d.he has small urinary bladder.
e.It is associated with spina bifida occulta

A 5 years old boy presents with vomiting every morning and morning headache for the last two weeks. What is the MOST LIKELY cause?
a.Meningitis
b.Migraine
c.Craniopharyngioma
d.MeduJloblastoma
e.Wilm's tumour

An adolescent boy complains of slight pain in the right knee which gets worse after exercise. On
examination you find a lump on the tibia tubercle with slight tenderness. The boy can't remember if
he has had any recent trauma. Which of the following statements is CORRECT?
a.Reassure that there is nothing wrong
b.Biopsy should be done to exclude malignancy
c.Knee aspirate shows organism
d. Osteochondritis is the most likely cause

A 6 day old baby who is suspected to have Down's syndrome presents with non projectile bilestained vomiting for the last two days. On abdominal examination you find an olive shapedpalpable mass in the epigastrium. Which of the following is the MOST LIKELY diagnosis?
a.Volvulus
b.Duodenal Atresia.
c.Intussusception
d.Malabsorption

A two years old child presents with failure to thrive for the last 6 months and right buttock wasting. He passes bulky stools 2-3 times a day. Which of the following is the MOST appropriate investigation?
a.C13 breath test
b.Duodenal biopsy
c.Stool culture
d.Stool microscopy
e.Sweat test

A diabetic mother gives birth to a child weight 4240 gm and with an Apgar score of 7/10. On examination you find cyanosis of his hands and feet and the child is jittery. Axillary temperature measure shows a reading of 37.2 C. His condition improved after meconium aspiration and 100% O2. Which of the following is the MOST LIKELY cause?
a.Hypoglycaemia
b.Heart disease
c.Lung disease.
d.Hyperglycaemia
e.His jaundice is caused by breast milk.

A six years old boy presents with delayed development of speech after a period of normal development. On examination you find that he avoids eye contact and reveals a history of unusual liking for dinosaurs. Which of the following is the MOST LIKELY diagnosis?
a.Autism
b.ADHD
c.Deafness
Obs

A young woman with anovulatory cycles for the long time is MOST LIKELY to develop which of the following?
a.Cervical cancer
b.Endometrial Cancer
c.Ovarian cancer
d.Vaginal cancer
e.Cancer of the Vulva

In which of the following conditions you will find DECREASED amniotic fluid?
a.Foetus's Bladder neck obstruction of the foetus
b.T.O fistula
c.Rhesus incompatibity
d.Multiple pregnancy

A 52 years old obese post menopausal woman presents with no signs of Menopause and amenorrhoea. What could be the cause?
A Low oestrogen and Low FSH
B High oestrogen and high FSH
c. Normal oestrogen and high FSH *
d.High oestrogen and low FSH •
e.Low oestrogen and High FSH

A 16 years old student asks for a prescription for contraceptive pill. She says she doesn't have
sexual partner. Which of the following is the MOST APPROPRIATE management?
a. Oral contraceptive pill
b.Minipill
c.Depot
d.Oral contraceptive pill + condoms
e.Call her parents.

A pregnant woman in 1st trimester is found to have CIN III. What is your NEXT step?
a. Terminate the pregnancy
b. Cone biopsy
c.Hysterectomy
d.Colposcopy
e.Observe

14. A pregnant woman in 1st trimester presents with skin dimpling over the right breast. Examination and clinical tests reveals cancer of the right breast. Which of the following is your management?
a.Terminate the pregnancy
b.Start radiotherapy
c.Wait till delivery and then start the treatment
d.Surgery

A 19 years old female comes to your clinic for consultation. She has never had periods. On examination her breast development is normal. Pubic and axillary hair growth is also normal. The
development of her genitals is also in normal range. What is the MOST LIKELY cause of her amenorrhea?
a. Turner's syndrome
b. Prolactinoma
c. Absent uterus d. Pituitary lesion
e. Lesion in Hypothalamus

A 42 years man who is a patient of yours is arrested for attacking his wife in a supermarket. The police come to you and ask you to write a report about this patient. Which of the following is TRUE for good practice?
a.You will write a report about the patient's bad mental state
b.You will tell the patient never to come to your surgery again
c.You will write a general, unbiased and balanced report about health of the patient.
d.You will tell the police that you don't want to give any reports
e. Arrange for a meeting with the patient

Which of the following will cause SEROTONIN syndrome if given together with SSRI like Fluoxetine EXCEPT?
a.L-tryptophan
b.Haloperidol
c.Moclobemide
'd. Chlorpromazine
e.Citalopram

In Australia , almost every year there are several incidences of bush fire. Usually it is caused by
young people and teenagers. Which of the following is TRUE?
a. Juvenile pyromania is the main cause of fires in Australia .
-b. It is due to accidental fire caused by youngster who get scared after the fire starts to
spread uncontrollably and they run away.
c.It has no serious consequences
d.Youngsters like to ignite and play with fire.
e.It is done to hide crimes

A schizophrenic woman thinks that she is perfectly well and denies any illness. She also refuses to
take medication and thinks that she can talk with Angels. What is this called in Psychiatry ?

a.Lack of insight
b.Overvalued idea
c.Rejection
d.Delusion
e..Formal thought disorder




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ElliEL
Guest






Posted: Sat Sep 30, 2006 12:51 pm Post subject:

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Clinical Exam, May 20th , 2006 Sydney




1.Febrile Convulsion – talk to pt.



2.Mid-cycle bleeding on OCP – talk to pt.



3.Carpal tunnel syndrome – examination



4.PHOTO lump on the neck – find primary site,/examination/DDx




5.Benzodiazepines dependency – talk to pt / SE


6.Delirium – Examine pt / MS/ Mx.



7.Gastrointestinal system examination – alcoholic pt
.


8.Headache/Meningitis – Take History/Examine the pt/ DDx



9.Enuresis – talk to parents



10.Pregancy & Pneumonia pt on Doxycycline – History/Examination/Mx
Change Doxycycline to Erythromycin (Safe or relatively safe during the pregnancy: Amoxycillin/Ampicillin/Cephalosporine/Erythomycin/Rifampicin/
Trimethoprim/Methyldopa/ - Beischer , p 105)



11.Pain relief in labour – talk to pt.who is 20/40 pregnant; P0G1.She is very concerned about pain in labour. ( Beischer, p. 411)
Ask why she is worried about pain? Any particular reason? What is her understanding about pain relief during the labour ? CS / normal labour.
Discuss pharmacological, sedative ( Diazepam max 20 mg ) and hypnotics, tranquillisers ( major: phenothiazines - chlorpromazine, promethazine, or minor: diazepam ), ( analgesics (non-narcotic: aspirin, paracetamol, codeine; narcotic: pethidine 50-100 mg IM; Morphine 10-15mg IM; SE: respiratory depression, nausea & vomiting, tachycardia, postural hypotension and delayed gastric emptying). Pethidine is preferred and usually given IM 100 mg; it is given by I>V route in some centres either intermittently in small doses 25mg over 1-2 minutes every 1-3 hours or self administered by the women ( PCA – patient controlled analgesia)The usual duration of narcotics drugs is 2-4 hours. Preferably such drugs should not be administered within 1 hour of delivery – and if it is the baby should be given Naloxone ( 0.02mg) IM immediately after birth. During this period inhalation or regional block are preferable; Narcotics are CI in women receiving MAO inhibitors.
The use of sedatives, hypnotics and minor tranquillisers varies considerably in obstetric practice in different communities. Many practitioners rely on single injection of Pethidine 100 mg IM with either prochlorperazine (Stemetil) 12,5 mg or metoclopramide HCL (Maxolon) 10 mg ± epidural analgesia for pain relief in labour.
Inhalational analgesics: Nitrous Oxide (NO) in concentration of 50% is equivalent to 15 mg of Morphine. Nitrous oxide/oxygen given by mask “on demand”; It is useful for analgesia during the late first stage and second stage (i.e. during delivery) in a 50-70% concentration with the oxygen. In their late fist stage of labour the women sleeps between contractions but rouses and breathes on the mask when the contraction begins. Advantages: safety, reasonable analgesia, on-toxic and non-irritating to respiratory passages, quickly absorbed and eliminated, uterine contractions unaffected (no prolongation of labour or postpartum atonicity), vomiting rare; Disadvantages: requirement of machine to deliver the gas and disorientation of some women ;Occasionally, women will not use the mask because of felling of suffocation or because of disorientation.
Mention : Local analgesia/Epidural/Paracervical block. Discuss if you have time.

Epidural nerve block: the local analgesic is injected extrathecally into epidural space; the extent of analgesia is determined largely by the volume and concentration of drug injected; to control pain of late labour, a block of segments T10 – L1 is adequate; for Caesarean section a higher block – T8 or even T6 is needed; low dose epidural analgesia (0.125 Bupivacaine) increases mobility in labour and abolish the urge to push (pushing reflex) but not ability to push so that normal spontaneous delivery is still possible. Although epidural analgesia is associated with a higher incidence of forceps delivery it must be recognised that women who require epidural analgesia for pain relief are more likely to require forces delivery, usually because of dystocia resulting from occipitoposterior position.
Indication for epidural: pain relief; symptomatic heart disease – the pain and distress of labour is relieved, however extreme care is necessary if women has a fixed cardiac output (e.g. mitral or aortic stenosis, pulmonary hypertension); hypertensive disorders (preeclampsia/eclampsia, chronic hypertension), cerebrovascular disease (intracranial aneurism and angioma are usual indication); incoordinate uterine action (elimination of pain and fear often help normalize the activity); breech and twin delivery( opinion is divide on the value of epidural analgesia in these conditions: the relaxation of pelvic floor is advantageous but the lack of stimulus for the woman to push can lead to a higher interference rate; Contraindications for epidural analgesia: opposition by the woman; Recent antepartum haemorrhage( because compensatory vascular reflexes are partly abolished, sudden haemorrhage may produce marked hypotension; suspected cephalopelvic disproportion; sepsis ( in proposed area of operation);sensitivity to local analgesic agents; DIC ( sever preeclampsia - predispose to haemorrhage in the epidural space ).
Complication of epidural analgesia: toxicity (from overdosage and/or intravascular injection; hypotension; uterine hypotonia- occurs in 5-10% of women in early labour but usually activity return in 15-30 minutes; collapse (with hypotension and apnoea may be due to toxic effect of the drug); headache (may result from accidental puncture of the dura and leakage of CSF; this can be treated by insertion of epidural at higher level; after the delivery Hartmann solution is infused into epidural catheter; woman should be nursed flat, adequately hydrated ± aspirin, codeine, paracetamol ; loss of sensation may occur in bladder ( causing over distension);loss of bearing -down reflex, resulting in higher incidence of assisted delivery; backache
Majority of the above complications are rare, however they need experienced personnel in this type of analgesia; Advantages of epidural analgesia: woman alert, cooperative reduced risk of inhalation of vomitus; Disadvantage of epidural analgesia: need for skilled personnel, the occasional serious complication, tendency to slow the labour (particularly second stage) increased incidence of operative delivery; intraoperative nausea, vomiting or restlessness in some women.
In Caesarean section, regional analgesia has a number of advantages over general anaesthesia – participation of the parents in the birth, better postoperative pain relief, early mobility, less fever, blood loss is 50 % less than with general anaesthesia. Disadvantages are that the method may fail, the woman feels pain and may require a general anaesthetic; it is technically more difficult to extract the infant’s head from the uterus, especially if a Pfannestiniel incision is used, because abdominal muscles are not completely relaxed;
Paracervical block: LA (6-10 mg of 0.25 Bupivacaine) injected beneath the mucosa of vagina in each lateral fornix. Acupuncture;
Incidence of serious neurological complications due to epidural analgesia:
Paraplegia, a severe complication to epidural analgesia – rare.
Because of the rarity of permanent neurological damage resulting from epidural analgesia, it is difficult to estimate its incidence. In a combined series of more than 50 000 epidural anaesthetics, only three patients suffered permanent leg weakness (0.006% - American Journal of Anaesthesia , Kane 1981)



12.Obese patent / BMI 45 – counselling




13.Dizzines/Vertigo 60 yo – history/DDX




14. CHEST PAIN: – History/ (Pericarditis) DDx: MI/Angina/PE/Aorta dissection

50-year-old train driver, c/o chest pain. From the history: pain for the last 6 hours, constant, 8/10, radiates to the back (alleviating/aggravating factors?). Non-smoker, had history of chest infection a 3/52 ago. Vital signs – pulse 96 regular, BP 140/97, Temp. 37.4 º C. Physical exam – constant noise during auscultation? Not murmur; probably pleural rub

ACUTE PERICARDITIS: chest pain, which may be intense, mimicking acute MI, but characteristically sharp, pleuritic and positional (relived by leaning forward) worse on inspiration; fever and palpitations are common
Common causes: idiopathic; infections (particularly viral – influenza, Coxsackie A/B) acute MI, metastatic neoplasm, radiation therapy for the tumour (up to 20 years earlier), connective tissue disease (SLE, RA) drug reactions (procainamide, hydralazine), “autoimmune “following heart surgery of MI – several weeks/months later (Dressler’s sy).
Physical Examination: rapid or irregular pulse, coarse pericardial friction rub which may vary in intensity and is loudest with pt. sitting forward.
Laboratory/ECG: Diffuse ST elevation (concave upwards) usually present in all leads except aVR and V1.CXR: increased size of cardiac silhouette if large (> 250 ml) pericardial effusion is present, with “water bottle” configuration ECHO: most sensitive test for detection of pericardial effusion which commonly accompanies acute pericarditis;
Treatment: Aspirin 650 –975 mg qid or NSAID (e.g. indomethacin 25 –75 mg qid); for severe refractory pain, Prednisone 40-60mg daily and tapered over several weeks or months. Anticoagulants are relatively contraindicated in acute pericarditis because of risk of pericardial haemorrhage. ( Harrison, p583)


15.Intusussepction





16.Intermitent claudications




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NadiaAl
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Posted: Sat Sep 30, 2006 12:57 pm Post subject:

--------------------------------------------------------------------------------

AMC MCQ EXAM 2004 Melbourne

Nadia recollection paper

(*) - denotes STAR Questions ( 60 questions)
P - denotes PILOT Questions ( probably will appear as (*) in next exam ? )


1.All of the following drugs can cause gynecomastia EXCEPT:

A/ spironolactone
B/ digoxin
C/ methyldopa
D/ furosemide
E/

2. Which of the following joints is not included in rheumatic arthritis and is more common in osteoarthritis?

A/ carpometacarpal joint of the thumb P
B/ temporomandibular joint
C/ cervical spine
D/
E/

3. All of the following statements about intravenous solutions are true EXCEPT:

A/ normal (0.9%) sodium chloride solution has an approximately 150 mmol/l Na + 150 mmol/l Cl
B/ Hartman solution is sodium lactate which consist sodium 135 mmol, calcium 2 mmol and some potassium
C/ if 1 litre of Hartman solution is given in 24 hours it will be sufficient for daily potassium requirement (*)
D/ N/5 contains 30 ml Cl and 30 ml Sodium
E/ 5 % dextrose …



4.Hand X – ray, carpal bones, fractured scaphoid. Which of the following is correct:

A/ it will result in avascular necrosis of distal pole
B/ internal fixation is best treatment because of malunion
C/crepe bandage from elbow to the wrist
D/immobilization from elbow to the end of the thumb for 6 weeks (*)
E/ plaster from elbow to the wrist

5.Photo of leg from AMC book ( SU-C130 ) page 262

A/ chronic infection
B/ necrotizing fasciitis
C/chronic venous hypertension (*)
D/arterial insufficiency
E/


6.Patient with a fourth attach of gout in the last 2 years. Knee is swollen, painful. What is most appropriate management?

A/ allopurinol in the first 24 hours
B/indomethacin 150 mg in the first 24 hours (*)
C/hydrocortisone intraarticular
D/colchicine
E/


7.Urticaria can be associated with all of the following EXCEPT:

A/ vasculitis P
B/aspirin sensitivity
C/
D/
E/

8. Which cause shock in gall-bladder sepsis?

A/staphylococcus aureus
B/Pseudomonas aeruginosa
C/Enterococcus faecalis
D/ Escherichia coli P
E/


9.Patient with severe chest pain, radiating to his back. CXR show widened mediastinum, diastolic murmur ECG – acute inferior M.I. What is appropriate Mx?


A/give streptokinase
B/give aspirin plus IV morphine
C/Give morphine, B-blocker and arrange for T O E
D/
E/





10.What is most likely to become chronic?

A/Hepatitis A
B/ Hepatitis C (*)
C/ Hepatitis B
D/ EBV
E/

11.Spinal cors lesion at level L4 – L5 :

A/ absent knee jerk
B/ absent ankle jerk
C/ lost of dorsiflexion of the ankle
D/ lost of sensation sole of the foot
E/


12. Patient with chronic cardiac failure on Captopril for hypertension. On long-term Chlorothiazide.

A/ sodium is reduced
B/ K is decreased
C/cholesterol is increased
D/
E/

13.Patient 3 days after cranial surgery. Na 117, Plasma osmolarity 205 Urine osmolarity 825

A/ D . III
B/ S I A D H (*)
C/water intoxication
D/
E/

14. All of the following are features of Hypercalcemia EXCEPT:

A/ depression
B/ diarrhoea
C/polyuria
D/ polydipsia
E/


15.Which of the following is the most urgent requirement for the patient in D K A:

A/ infusion of sodium bicarbonate
B/ 5% dextrose
C/ infusion of normal saline (*)
D/ glucagon
16. Builder come to ER with 15 % of burns, his weight is 80 kg. Which of the following fluid replacement will be required for the first 24 hours?

A/2 L Hartman + 2 L blood
B/ 2 L Nacl + 1 L blood
C/ 3 L Hartmann + 2 L 5 % Dextrose
D/ 3 L Hartmann + 2 L blood
E/

17. After splenectomy for hereditary spherocytosis all can be expected EXCEPT:

A/ persistence of anaemia
B/ persistence of spherocytes
C/ normal RBC life span see Merck P 876
D/reticulocytosis
E/

18. Which of the following is not feature of Mycoplasma pneumoniae:

A/ headache
B/pleuritic pain P
C/temperature
D/ myalgia
E/cough

19.Which of the following drugs if stopped during the operation will cause intra operative hypertension?

A/clonidine
B/methyldopa
C/enalapril
D/propranolol
E/felodipine

20. Peripheral pulse will be increased in all of the following EXCEPT:

A/ A – V fistulae
B/Paget disease of the bone
C/V S D
D/patent ductus arteriosus
E/ASD


21. Q about Pseudobulbar palsy. All is associated EXCEPT:

A/ gag – reflex ( vagus ) P
B/
C/
D/

22.Patient playing game, squash court suddenly pain in ankle, no planar flexion, dorsal flexion limited and painful:

A/ rupture of medial ankle ligament
B/ complete rupture of Achilles tendon
C/ rupture of medial head m. solei
D/
E/

DRUGS site,more download

Littmann's heart sounds in Macromedia format!!!

here is the link

hope u like it!


http://rapidshare.com/files/115308220/Littmann_s_Heart_Sounds.rar


http://www.medicalhubinfo.com/

devendra b



www.cimsasia.com

this is new site containing drugs intraction /dignosis /indication/dosage
progress of drugs institute,research,events (devendra)
www.cimsasia.com

Halazepam

Trade Name(s): Paxipam

Chemically Related To: Benzodiazepines

Scheduled Class: IV

Pregnancy Category: D

Medical Category: Antianxiety agent, sedative-hypnotic

Accepted Indications: Anxiety

Mechanism of Action: Enhances GABA receptors

Absorption/Distribution: Well absorbed from GI tract

Half life: 14 h

PO: 1–{endash}3 h

Metabolism: Hepatic

Elimination: Renal

Adult Dosage: 20–{endash}40 mg t.i.d. or q.i.d.

Elderly Dosage: 20 mg once or twice daily

Child Dosage: Up to 18 y: safety and efficacy not established

Infant Dosage: Safety and efficacy not established

Dosage Forms: Tablets: 20 mg and 40 mg

Warnings: Avoid alcohol

Frequent Side Effects: Ataxia, dizziness, drowsiness, slurred speech

Occasional Side Effects: Mental depression, abdominal cramps, blurred vision, change in sex drive, dry mouth, headache, euphoria, watering mouth, muscle spasms, vomiting, nausea, tachycardia, trembling

Rare Side Effects: Seizures, neutropenia, venous thrombosis, allergic reaction, behavior problems, blood dyscrasias, anemia, leukopenia, thrombocytopenia, extrapyramidal effects, yellow eyes or skin, memory impairment, muscle weakness, paradoxical reactions, phlebitis, withdrawal symptoms

Contraindications: Glaucoma, myasthenia gravis, pulmonary disease

Overdosage: Bradycardia, troubled breathing, severe weakness

Antidotal Therapy: May include emesis, gastric lavage, IV fluids, flumazenil

Disease States: Severe mental depression, coma, intoxication

Other Drugs: Alcohol, CNS depressants, cimetidine, antacids, fentanyl, levodopa, erythromycin

Lab Tests: Metyrapone, sodium iodide I 123 or sodium iodide I 131

Halcinonide

Trade Name(s): Halog

Chemically Related To: Corticosteroids

Pregnancy Category: C

Medical Category: Topical adrenocorticoid, anti-inflammatory

Accepted Indications: Severe inflammatory skin conditions, psoriasis, lichen simplex

Unaccepted Indications: Acne, routine gingivitis

Mechanism of Action: Stimulates enzyme responsible for anti-inflammation

Absorption/Distribution: Some systemic absorption

Metabolism: Dermal, hepatic

Research Notes: High potentcy corticosteroid

Adult Dosage: Topically to skin once daily to t.i.d.

Elderly Dosage: Pre-existing skin atrophy may cause problems

Child Dosage: Topically to skin once daily

Infant Dosage: Absorption increased in premature infants

Dosage Forms: Cream: 0.025%; ointment: 0.1%; topical solution: 0.1%

By System: Dermal

Warnings: Do not use in or around the eyes

Precautions: Do not bandage treated area

Occasional Side Effects: Contact dermatitis, purpura, numbness in fingers

Rare Side Effects: Acne, burning, itching, rash, hypopigmentation, gastric ulcer, skin fragility

Antidotal Therapy: No specific antidote; may include dilution with fluids

Disease States: Infection at treatment site, skin atrophy

Lab Tests: Glucose, eosinophil count, hypothalamic-pituitary-adrenal axis function, adrenal function

Administrative Notes: Store in closed container; do not freeze

Halobetasol Propionate

Trade Name(s): Ultravate

Chemically Related To: Corticosteroids

Pregnancy Category: C

Medical Category: Topical corticosteroid, topical steroidal anti-inflammatory

Accepted Indications: Alopecia areata, atopic dermatitis, exfoliative dermatitis, inflammatory dermatoses, granuloma annulare, keloids, lichen planus, lichen simplex chronicus, lichen striatus, discoid and subacute cutaneous lupus erythematosus, myxedema, necrobiosis lipoidica diabeticorum, pemphigoid, pemphigus, pityriasis rosea, psoriasis, sarcoidosis, sunburn

Unaccepted Indications: Rosacea, perioral dermatitis, acne, routine gingivitis

Mechanism of Action: Induces inhibitory proteins that control inflammation

Absorption/Distribution: 2% enters circulation

Metabolism: Dermal, hepatic

Research Notes: Treatment beyond 2 w consecutively not recommended; very high potency corticosteroid

Adult Dosage: Apply to skin once daily or b.i.d.

Elderly Dosage: May require lower dose

Child Dosage: Not established

Infant Dosage: Not established

Dosage Forms: Cream: 0.05%; ointment: 0.05%

By System: Dermal

Warnings: Do not use with occlusive dressings. Can be absorbed enough to produce systemic effect

Precautions: Avoid contact with eyes

Occasional Side Effects: Stinging, burning sensation, folliculitis, irritation, contact dermatitis, acne, itching, tingling, skin atrophy

Rare Side Effects: Acne, cataracts, Cushing's syndrome, glaucoma, hirsutism, hypopigmentation, skin maceration

Lab Tests: Adrenal function as assessed by corticotropin, hypothalamic-pituitary-adrenal axis function, total eosinophil count, glucose

Administrative Notes: Systemic absorption can lead to hypothalamic-pituitary-adrenal axis suppression

Haloperidol

Trade Name(s): Haldol

Chemically Related To: Butyrophenone

Pregnancy Category: C

Medical Category: Antipsychotic, antidyskinetic (Tourette's syndrome or Huntington's chorea), antiemetic in nausea and vomiting induced by cancer chemotherapy

Accepted Indications: Psychotic disorders, severe behavior problems, Tourette's syndrome, infantile autism, Huntington's chorea, nausea and vomiting induced by cancer chemotherapy

Mechanism of Action: Competitive blockade of dopamine receptors

Absorption/Distribution: 60% absorbed orally

Half life: 10–{endash}37 h

PO: 3–{endash}6 h

IM: 10–{endash}20 min

Metabolism: Hepatic

Elimination: Renal/biliary

Adult Dosage: 500 m{mu}g–{endash}5 mg b.i.d. or t.i.d. up to 100 mg/d

Child Dosage: Oral solution and tablets, up to 3 y: safety and efficacy not established; 3–{endash}12 y: 0.5 mg/kg/d in 2–{endash}3 divided doses initially, dosage increased as tolerated

Dosage Forms: Oral solution: 2 mg/mL; tablets: 500 m{mu}g, l mg, 2 mg, 5 mg, 10 mg, and 20 mg; injection: 5 mg/mL

By System: CNS

Warnings: Causes drowsiness; avoid alcohol; elderly may require lower initial dosage and gradual titration of dose

Precautions: Use caution during exercise or hot weather and if surgery planned

Frequent Side Effects: Akathisia, dystonic extrapyramidal effects, blurred vision, weight gain, tardive dyskinesia

Occasional Side Effects: Orthostatic hypotension, decreased thirst, nausea and vomiting, photosensitivity

Rare Side Effects: Agranulocytosis, heat stroke, neuroleptic malignant syndrome

Contraindications: Drug-induced CNS depression

Overdosage: Disturbed respiration, dizziness, drowsiness, muscle trembling, weakness

Antidotal Therapy: May include symptomatic and supportive treatment; emesis or gastric lavage, establishment of an airway, vasopressor agents

Disease States: Alcoholism; heart, liver, or kidney problems; pulmonary insufficiency; epilepsy

Other Drugs: Epinephrine, MAO inhibitors, lithium, extrapyramidal reaction–{endash}causing medicines, antihistamines, phenytoin, heparin

Administrative Notes: Take with food; however, the oral solution is incompatible with coffee, tea, and some fruit juices

Haloperidol Decanoate

Trade Name(s): Haldol Decanoate

Chemically Related To: Butyrophenone

Pregnancy Category: C

Medical Category: Antipsychotic

Accepted Indications: Psychotic disorders, severe behavior problems

Mechanism of Action: Competitive blockade of dopamine receptors

Absorption/Distribution: High protein binding

Half life: 3 w

IM: 3–{endash}9 d

Metabolism: Hepatic

Elimination: Renal/biliary

Research Notes: Decanoate form acts as a prodrug, slowly releasing haloperidol into system

Adult Dosage: 10–{endash}15 times the previous daily oral dose, up to a maximum of 300 mg/m

Child Dosage: Safety and efficacy not established

Infant Dosage: Safety and efficacy not established

Dosage Forms: Injection: 50 mg/mL and 100 mg/mL

By System: CNS

Warnings: May cause drowsiness; avoid alcohol; elderly may require lower initial dosage and gradual titration of dose

Precautions: Use caution during exercise or hot weather and if surgery required

Frequent Side Effects: Blurred vision, constipation, dry mouth, weight gain, changes in menstrual period, akathisia

Occasional Side Effects: Drowsiness, photosensitivity, nausea and vomiting, allergic reactions, hypotension

Rare Side Effects: Agranulocytosis, tardive dyskinesia, heat stroke, obstructive jaundice, neuroleptic malignant syndrome

Contraindications: Drug-induced CNS depression

Overdosage: Severe respiratory problems, dizziness, drowsiness, muscle jerking, weakness

Antidotal Therapy: May include supportive treatment; emesis or gastric lavage, benztropine, IV fluids, establishment of an airway

Disease States: Alcoholism, epilepsy, Parkinson's disease, urinary retention, glaucoma, hyperthyroidism

Other Drugs: Lithium, epinephrine, levodopa, CNS depressants, anticonvulsants, anticoagulants

Administrative Notes: Administration is by deep IM injection using Z-track technique; do not administer IV

Haloprogin

Trade Name(s): Halotex

Pregnancy Category: B

Medical Category: Antifungal (topical)

Accepted Indications: Tinea barbae, tinea capitis, tinea corporis, tinea cruris, tinea manuum, tinea pedis, pityriasis versicolor

Unaccepted Indications: Not all species may be susceptible to haloprogin

Research Notes: Use could lead to skin sensitization

Adult Dosage: Topically to skin b.i.d. for 2–{endash}4 w

Child Dosage: Safety and efficacy not established

Infant Dosage: Safety and efficacy not established

Dosage Forms: Cream: 1%; topical solution: 1%

By System: Dermal

Warnings: For external use only; take for full length of prescription

Precautions: Avoid contact with eyes; rub medicine in gently

Frequent Side Effects: Blistering, burning, itching (frequencies not given)

Hemophilus b Conjugate Vaccine

Trade Name(s): HibTITER, PedvaxHIB, ProHIBiT

Pregnancy Category: C

Medical Category: Immunizing agent

Accepted Indications: Haemophilus influenzae type b disease prophylaxis

Mechanism of Action: Stimulates production of anticapsular antibodies and provides active immunity

Research Notes: 1–{endash}2 w onset of protective effect

Adult Dosage: Use not recommended

Elderly Dosage: Use not recommended

Child Dosage: 15 m and over: 1 dose

Infant Dosage: Under 2 m: not recommended; doses at 2 m, 4 m, 6 m, and 15 m

Dosage Forms: Injection: 10 m{mu}g hemophilus b/25 m{mu}g diphtheria/0.5 mL. Powder for injection: 15 m{mu}g hemophilus b/250 m{mu}g Neisseria meningitidis/dose. Injection: 25 m{mu}g hemophilus b/18 m{mu}g conjugated diphtheria toxoid/0.5 mL.

Frequent Side Effects: Anorexia, fever, pain at injection site, lethargy, irritability

Occasional Side Effects: Diarrhea, hard lump at injection site, rash, hives, vomiting

Rare Side Effects: Anaphylaxis

Contraindications: Febrile illness

Overdosage: Anaphylaxis, convulsions

Antidotal Therapy: May include antihistamines, glucocorticoids, epinephrine

Other Drugs: Immunosuppressive agents, radiation therapy

Heparin

Trade Name(s): Liquaemin

Pregnancy Category: C

Medical Category: Anticoagulant

Accepted Indications: Deep venous thrombosis, blood clotting, thromboembolism, disseminated intravascular coagulation, cerebral thrombosis prophylaxis

Unaccepted Indications: Use in bleeding disorders

Mechanism of Action: Inhibits action of clotting factors

Half life: 1–{endash}6 h

Metabolism: Hepatic

Elimination: Renal

Adult Dosage: Varies by form and regimen

Elderly Dosage: May require lower dose

Child Dosage: Varies by form and regimen

Infant Dosage: Varies by form and regimen

Dosage Forms: Heparin sodium injection: 1000 units/mL, 5000 units/mL, 10,000 units/mL and 20,000 units/mL. Heparin calcium injection: 25,000 units/mL. Heparin sodium in dextrose injection: 20 units/mL, 40 units/mL, 50 units/mL, and 100 units/mL. Heparin sodium in sodium chloride injection: 2 units/mL, 50 units/mL, and 100 units/mL.

Occasional Side Effects: Chest pain, hematoma, bluish color of skin, priapism, itching or burning, bleeding

Rare Side Effects: Histamine-like reaction, black stools, osteoporosis, thrombocytopenia

Contraindications: Threatened abortion, blood dyscrasias, recent spinal puncture

Overdosage: Bleeding from gums, unexplained bruising, nose bleeds

Antidotal Therapy: May include withdrawal of heparin, protamine sulfate

Disease States: Hemorrhage, cerebral aneurysm, endocarditis, hypertension, thrombocytopenia, hepatic impairment, GI ulcerations, ophthalmic surgery, recent childbirth, neurosurgery

Other Drugs: Anticoagulants, aspirin, cefotetan, thrombolytic agents, sulfinpyrazone, cefamandole, cefoperazone, plicamycin, valproic acid, methimazole, propylthiouracil, probenecid

Lab Tests: Radionuclide imaging

Hepatitis B Vaccine (Recombinant)

Trade Name(s): Engerix-B, Recombivax HB

Chemically Related To: Biologic product; produced from baker's yeast

Pregnancy Category: C

Medical Category: Active immunizing agent

Accepted Indications: Hepatitis B virus prophylaxis

Unaccepted Indications: Hepatitis caused by other hepatitis viruses or other viruses that infect the liver

Absorption/Distribution: Antibody levels decline steadily and are often low after 7 y

Adult Dosage: 20 y and over: IM in deltoid, 10 m{mu}g (Recombivax HB), 20 m{mu}g (Engerix-B), followed by booster doses at 1 and 6 m

Elderly Dosage: Adult response inversely related to age; booster shot may be needed

Infant Dosage: Varies by age and preparation

Dosage Forms: Suspension: 5 m{mu}g/0.5 mL, 10 m{mu}g/mL, 10 m{mu}g/0.5 mL, 20 m{mu}g/mL and 40 m{mu}g/mL

By System: Plasma proteins

Warnings: Do not freeze; shake well

Precautions: Storing above recommended temperatures may reduce potency

Frequent Side Effects: Soreness at injection site

Occasional Side Effects: Fatigue, fever, headache, dizziness, erythema, hard lump at injection site

Rare Side Effects: Serum sickness–{endash}like reaction, optic neuritis, anorexia, back pain, hypotension, arthralgia, anaphylaxis, neuropathy, diarrhea, flushing, vomiting, nausea, pruritus, urticaria, stiff neck, increased sweating, swollen glands, malaise

Overdosage: Respiratory difficulties, hives, itching, swelling of face and eyes, tiredness, flushing

Antidotal Therapy: May include 0.2–{endash}0.5 mg of epinephrine IM or SQ

Disease States: Allergy to yeast, severe heart problems or febrile illness, immune deficiency

Other Drugs: Immunosuppressive agents, radiation therapy

Lab Tests: Erythrocyte sedimentation

Administrative Notes: Freezing destroys potency; do not dilute vaccine

Hexachlorophene

Trade Name(s): pHisoHex, pHiso-Scrub, SeptiSol

Chemically Related To: Polychlorinated biphenyl

Pregnancy Category: C

Medical Category: Topical antiseptic

Accepted Indications: Surgical antisepsis, skin cleansing, gram-positive infections

Unaccepted Indications: Not active against Propionibacterium acnes

Mechanism of Action: Bacteriostatic

Absorption/Distribution: Crosses the placenta; absorbed systemically

Half life: 6.1–{endash}44.2 h

Research Notes: Cumulative antibacterial action develops with continued use

Adult Dosage: Topically to skin in concentrations of 0.23%–{endash}3%

Child Dosage: Same as adult dose

Infant Dosage: Particularly susceptible to effects of absorption; do not use routinely

Dosage Forms: Aerosol foam suspension: 0.23%; emulsion: 3%; solution: 0.25%

By System: Dermal

Warnings: Do not apply to mucous membranes; do not use as an occlusive dressing

Precautions: Do not use routinely for preventive body washing

Side/Adverse Effects: Dermatitis, photosensitivity, mild scaling of skin

Rare Side Effects: Sensitivity

Contraindications: Burned skin

Overdosage: Anorexia, vomiting, abdominal cramps, diarrhea, dehydration, seizures, hypotension, shock

Antidotal Therapy: May include emesis/gastric lavage, olive or vegetable oil, saline cathartics, treat dehydration and electrolyte disturbances, vasopressors

Administrative Notes: Prolonged exposure to strong light may cause surface brownish color that does not affects its potency. Shake to disperse color

Histrelin Acetate

Trade Name(s): Supprelin

Pregnancy Category: X

Medical Category: Gonadotropin inhibitor

Accepted Indications: Acute intermittent porphyria, hereditary coproporphyria, variegate porphyria, precocious puberty

Mechanism of Action: Inhibits gonadotropin secretion

Adult Dosage: Not established

Elderly Dosage: Not established

Child Dosage: Not established

Infant Dosage: Safety and efficacy not established

Dosage Forms: Parenteral: 200 m{mu}/mL, 500 m{mu}g/mL and 1000 m{mu}g/mL

Frequent Side Effects: No incidence given for angioedema, urticaria, cardiovascular collapse, hypotension, tachycardia, coma, bronchospasm, dyspnea, flushing, pruritus

Antidotal Therapy: May include discontinuation of histrelin therapy

Homatropine Hydrobromide

Trade Name(s): Isopto Homatropine

Chemically Related To: Atropine

Pregnancy Category: Not documented

Medical Category: Cycloplegic, mydriatic

Accepted Indications: Cycloplegic refraction, uveitis, post- or preoperative mydriasis, axial lens opacities

Mechanism of Action: Anticholinergic action

Research Notes: Shorter duration of action than atropine

Adult Dosage: To the conjunctiva, 1 drop; may be repeated at 2–{endash}10–{endash}min intervals

Elderly Dosage: Same as adult dose

Child Dosage: 1 drop to conjunctiva every 10 min for 2–{endash}3 doses.

Infant Dosage: Use extreme caution in infants and young children with blond hair, blue eyes, Down syndrome, or brain damage

Dosage Forms: Ophthalmic solution 2% and 5%

By System: Ocular

Warnings: For the eye only

Precautions: May cause photosensitivity and/or blurred vision

Side/Adverse Effects: Side effects of blurred vision, eye irritation, sensitivity of eye to light, and swelling of eyelids

Overdosage: Clumsiness, confusion, dry skin, flushing, hallucinations, slurred speech, tachycardia, excessive thirst, weakness

Antidotal Therapy: May include emesis or gastric lavage, IV physostigmine, diazepam, oxygen, assisted respiration

Disease States: Brain damage in children, Down syndrome, glaucoma, keratoconus, spastic paralysis

Other Drugs: Anticholinergics, antiglaucoma agents, pilocarpine, CNS depressants, potassium supplements

Homatropine Methylbromide/Hydrocodone Bitartrate

Trade Name(s): Hycodan, Hydromet

Scheduled Class: III

Abuse Potential: Moderate

Pregnancy Category: C

Medical Category: Antitussive

Accepted Indications: Colds and coughs

Adult Dosage: Syrup: 5 mL q4–{endash}6h; tablets, 1 tablet q4–{endash}6h

Child Dosage: Syrup: less than 2y, 1.25 mL q4–{endash}6h; 2–{endash}12 y, 2.5 mL q4–{endash}6h. Tablets, less than 2y, ¼ tablet q4–{endash}6h; 2-12 y, ½ tablet q4–{endash}6h

Dosage Forms: Syrup: 1.5 mg/5 mg/5 mL; tablets: 1.5 mg/5 mg

Hydralazine Hydrochloride

Trade Name(s): Apresoline

Pregnancy Category: C

Medical Category: Antihypertensive, vasodilator

Accepted Indications: Hypertension, CHF

Mechanism of Action: Vasodilation of arterioles

Absorption/Distribution: Well absorbed, 90%

Half life: 3–{endash}7 h

PO: 1–{endash}2 h

IV: 15–{endash}30 min

Metabolism: Hepatic

Elimination: Renal

Research Notes: PO onset of action, 45 min; IV onset of action, 10–{endash}20 min; PO and IV duration of action, 3–{endash}8 h

Adult Dosage: Tablets, initial: 10 mg q.i.d. for 2–{endash}4 d, followed by 25 mg q.i.d. for balance of 1 w; maintenance: 50 mg q.i.d. up to 300 mg/d maximum

Elderly Dosage: Lower dosage may be required

Child Dosage: Tablets: 0.75 mg/kg/d in divided doses, maximum 7.5 mg/kg/d; injection IM or IV: 1.7–{endash}3.5 mg/kg/d in 4–{endash}6 divided doses

Infant Dosage: Same as child dose

Dosage Forms: Tablets: 10 mg, 25 mg, 50 mg, and 100 mg; injection: 20 mg/mL

By System: Vascular

Frequent Side Effects: Diarrhea, palpitations, tachycardia, anorexia, headache, nausea, vomiting

Occasional Side Effects: Constipation, watering eyes, allergic reaction, angina pectoris, cutaneous vasculitis, lymphadenopathy, peripheral neuritis, sodium and water retention, edema, systemic lupus erythematosus–{endash}like syndrome, hypotension, flushing of face, dyspnea, nasal congestion

Contraindications: Coronary artery disease, rheumatic heart disease

Antidotal Therapy: May include supportive treatment, volume expanders

Disease States: Aortic aneurysm, CHF, renal function impairment, cerebrovascular disease or accident

Other Drugs: NSAIDs, diazoxide, hypotension–{endash}producing medications, estrogens, sympathomimetics

Lab Tests: Antinuclear antibody titer, lupus cell preparations

Administrative Notes: Injection should be used immediately after opening

Hydralazine Hydrochloride/Hydrochlorothiazide

Trade Name(s): Apresazide, Hydra-Zide, Hydralazine with Hydrochlorothiazide 25/25, Hydralazine with Hydrochlorothiazide 50/50

Pregnancy Category: C

Medical Category: Antihypertensive

Accepted Indications: Hypertension

Adult Dosage: 1 capsule or tablet b.i.d. as determined by individual titration

Elderly Dosage: May be more sensitive to drug's effects

Child Dosage: Must be individualized

Dosage Forms: Capsules: 25 mg/25 mg, 50 mg/50 mg, and 100 mg/50 mg; tablets: 25 mg/15mg, 25 mg/25mg, 50mg/50mg, and 100mg/50mg

Hydralazine Hydrochloride/Hydrochlorothiazide/Reserpine

Trade Name(s): Cherapas, Ser-A-Gen, Ser-Ap-Es, Serpazide, Tri-Hydroserpine, Unipres

Pregnancy Category: C

Medical Category: Antihypertensive

Accepted Indications: Hypertension

Adult Dosage: 1–{endash}2 tablets t.i.d. as determined by individual titration

Elderly Dosage: May be more sensitive to drug's effects

Child Dosage: Safety and efficacy not established

Infant Dosage: Safety and efficacy not established

Dosage Forms: Tablets: 25 mg/15 mg/0.1 mg

Hydrochlorothiazide

Trade Name(s): Esidrix, Hydro-D, HydroDiuril, Oretic

Chemically Related To: Sulfonamide

Pregnancy Category: B

Medical Category: Diuretic, antihypertensive, antidiuretic in diabetes insipidus, antiurolithic

Accepted Indications: Edema, hypertension

Unaccepted Indications: Diabetes insipidus, renal calculi

Mechanism of Action: As diuretic, increases urinary excretion of sodium and water by inhibiting sodium reabsorption in the early distal tubules; as antihypertensive, reduces plasma and extracellular fluid volume, has direct peripheral effect on blood vessels

Absorption/Distribution: Quick absorption

Half life: 5.6–{endash}14.8 hours

PO: 4 hours

Metabolism: None

Elimination: Renal, bile

Research Notes: Onset of action 2 hours, duration of action 6–{endash}12 hours

Adult Dosage: 25–{endash}200 mg/d

Child Dosage: 1–{endash}2 mg/kg/day

Infant Dosage: Under six m: up to 3 mg/kg/d

Dosage Forms: Oral solution 10 and 100 mg/mL; tablets 25, 50, 100 mg

By System: Renal

Warnings: Avoid sunlight/sun lamp; do not take unprescribed medications; elderly may be more sensitive to drug's effects

Precautions: May increase blood glucose levels in diabetic patients; to prevent dehydration, check with physician if severe nausea, vomiting, or diarrhea occurs and continues

Frequent Side Effects: Electrolyte imbalance, hypokalemia

Occasional Side Effects: Appetite decline, diarrhea, lessened sexual function, GI distress, photosensitivity

Rare Side Effects: Agranulocytosis, thrombocytopenia, gout, liver problems, pancreatitis, rashes, hyperglycemia

Overdosage: Potassium loss–{endash}dryness of mouth, increased thirst, irregular heartbeat, mood or mental changes, muscle cramps, nausea and vomiting, weak pulse

Antidotal Therapy: May include emesis or gastric lavage; monitor kidney function and electrolyte levels

Disease States: Anuria, gout, systemic lupus erythematosus, diabetes mellitus, pancreatitis

Other Drugs: Sympathomimetics, lithium, neuromuscular blockers, digitalis glycosides, cholestyramine, colestipol, NSAIDs

Lab Tests: Bentiromide, phenolsulfonphthalein excretion test, phentolamine and tyramine test, bilirubin, blood and urine glucose, protein-bound iodine

Administrative Notes: Do not confuse oral solution with concentrated oral solution; additional potassium in diet may be needed

Hydrochlorothiazide/Propranolol Hydrochloride

Trade Name(s): Inderide

Pregnancy Category: C

Medical Category: Antihypertensive

Accepted Indications: Hypertension

Adult Dosage: Tablets, 1–{endash}2 tablets b.i.d., extended-release capsules, 1 capsule once daily

Elderly Dosage: May have increased or decreased sensitivity to adult dose

Child Dosage: Not established

Dosage Forms: Tablets: 25 mg/40 mg and 25 mg/80 mg; extended-release capsules: 50 mg/80 mg, 50 mg/120 mg, and 50 mg/160 mg

Hydrocodone Bitartrate

Trade Name(s): Not available as a single agent in the United States

Chemically Related To: Opioids

Abuse Potential: High

Pregnancy Category: C

Medical Category: Analgesic, antitussive

Accepted Indications: Moderate to severe pain, cough

Mechanism of Action: Agonist binding at mu receptor

Half life: 3.8 h

PO: 0.5–{endash}1 h

Metabolism: Hepatic, intestinal mucosa

Elimination: Renal

Research Notes: Onset of action, 10–{endash}30 min; duration, 4–{endash}6 h

By System: CNS

Warnings: May be habit-forming; avoid alcohol; may cause drowsiness

Precautions: Use sugarless candy or gum for dry mouth; use caution when getting up suddenly

Frequent Side Effects: Drowsiness, histamine release, dizziness, hypotension, unusual tiredness

Occasional Side Effects: Trouble breathing; confusion; decreased urination; blurred vision; dry mouth; tachycardia or bradycardia; constipation; headache; loss of appetite

Rare Side Effects: Seizures, hallucinations, mental depression, muscle rigidity, trembling, stomach cramps, allergic reaction, paradoxical CNS stimulation, increased blood pressure, paralytic ileus or toxic megacolon, tinnitus, nightmares, trouble sleeping

Contraindications: Diarrhea associated with pseudomembranous colitis or poisoning, acute respiratory depression

Overdosage: Clammy skin, confusion, seizures, hypotension, bradycardia, weakness

Antidotal Therapy: May include emesis/gastric lavage, establish respiration, naloxone, IV fluids, vasopressors

Disease States: Acute asthma, respiratory disease, inflammatory bowel disease, cardiac arrhythmias, seizures, head injury

Other Drugs: CNS depressants, anticholinergics, antihypertensives, MAO inhibitors, neuromuscular blocking agents, alcohol, antidiarrheals, buprenorphine, metoclopramide, hydroxyzine, naloxone, naltrexone, opioid agonist analgesics

Lab Tests: Gastric emptying studies, CSF pressure, plasma amylase and plasma lipase, serum bilirubin

Administrative Notes: Gradual reduction of dose to avoid withdrawal

Hydrocodone Bitartrate/Pheniramine Maleate/Phenylephrine Hydrochloride/Phenylpropanolamine Hydrochloride/Pyrilamine Maleate

Trade Name(s): Rolatuss with Hydrocodone, Ru-Tuss w/ Hydrocodone, Statuss Green Liquid

Scheduled Class: III

Abuse Potential: Moderate

Pregnancy Category: C

Medical Category: Antitussive, decongestant

Accepted Indications: Cough and cold

Adult Dosage: 10 mL q4–{endash}6 h

Elderly Dosage: Same as adult dose

Dosage Forms: Oral solution: 1.7 mg/3.3 mg/5 mg/3.3 mg/3.3 mg

Hydrocodone Bitartrate/Phenylephrine Hydrochloride/Pyrilamine Maleate

Trade Name(s): Codimal, Codimal DH

Scheduled Class: III

Abuse Potential: Moderate

Pregnancy Category: C

Medical Category: Antitussive, decongestant

Accepted Indications: Cough, cold

Adult Dosage: 5–{endash}10 mL q4–{endash}6h

Dosage Forms: Syrup: 10 mg/5 mg/8.33 mg

Hydrocodone Bitartrate/Phenylpropanolamine Hydrochloride

Trade Name(s): Codamine, Hycomine, Hydromine, Hydrophen

Scheduled Class: III

Abuse Potential: Moderate

Pregnancy Category: C

Medical Category: Antitussive, decongestant

Accepted Indications: Cough, cold

Adult Dosage: Syrup: 5 mL q4–{endash}6h

Elderly Dosage: Same as adult dose

Child Dosage: Pediatric syrup, 2–{endash}6 y: 2.5 mL q4–{endash}6h; 6–{endash}12 y: 5 mL q4–{endash}6h

Dosage Forms: Pediatric syrup: 2.5 mg/12.5 mg/5 mL; syrup: 5 mg/25 mg/5 mL

Hydrocodone Bitartrate/Pseudoephedrine Hydrochloride

Trade Name(s): Detussin, Entuss-D

Scheduled Class: III

Abuse Potential: Moderate

Medical Category: Antitussive

Accepted Indications: Cough

Adult Dosage: 5 mL q4–{endash}6h

Elderly Dosage: Same as adult dose

Child Dosage: 2–{endash}6 y: 1.25 mL q4–{endash}6h; 6–{endash}12 y: 2.5 mL q4–{endash}6h

Dosage Forms: Liquid: 5 mg/30 mg/5 mL and 5 mg/60 mg/5 mL

Hydrocortisone

Trade Name(s): A-hydroCort, Acticort, Ala-Cort, Ala-Scalp, Allercort, Alphaderm, Anucort-HC, Anusol-HC, Beta-HC, Carmol-HC, Cetacort, Cort-Dome, Cortaid, Cortef, Cortenema, Cortifair, Cortifoam, Dermacort, Epifoam, Gly-Cort, Hemril-HC, Hi-Cor, Hydro-Tex, Hydrocortone, Hytone, Lacti-Care-HC, Lemoderm, Locoid, Nutracort, Orabase-HCA, Penecort, Pentacort, Proctocort, Solu-Cortef, Texacort

Chemically Related To: Corticosteroids

Pregnancy Category: C

Medical Category: Corticosteroid, topical corticosteroid, topical steroidal anti-inflammatory, immunosuppressant, antiemetic

Accepted Indications: Skin disorders, moderate inflammatory dermatoses, intertrigo, psoriasis, hand eczema, atopic eczema, lichen planus, systemic lupus erythematosus, pruritus, xerosis

Unaccepted Indications: Acne, routine gingivitis

Mechanism of Action: Increases protein synthesis of inhibitory enzymes

Absorption/Distribution: Some systemic absorption through abraded skin; absorbed systemically across the stratum corneum

Metabolism: Dermal, hepatic, renal, tissue

Research Notes: Medium potency corticosteroid

Adult Dosage: Varies by form and indication

Dosage Forms: Dental paste: 0.5%; rectal cream: 1%; rectal cream (hydrocortisone acetate): 0.5% and 1%; suppositories (hydrocortisone acetate): 25 mg; Cream: 0.25%, 0.5%, 1% and 2.5%; lotion: 0.25%, 0.5%, 1%, 2% and 2.5%; ointment: 0.5%, 1% and 2.5%; topical solution: 0.5%, 1%, and 2.5%; cream (hydrocortisone acetate): 0.5% and 1%; topical aerosol foam (hydrocortisone acetate): 1%; lotion (hydrocortisone acetate): 0.5%; ointment (hydrocortisone acetate): 0.5% and 1%; cream (hydrocortisone butyrate): 0.1%; ointment (hydrocortisone butyrate): 0.1%; cream (hydrocortisone valerate): 0.2%; ointment (hydrocortisone valerate): 0.2%; tablets: 5 mg, 10 mg, and 20 mg; oral suspension (hydrocortisone cypionate): 10 mg/5 mL; sterile suspension: 25 mg/mL and 50 mg/mL; sterile suspension (hydrocortisone acetate): 25 mg/mL and 50 mg/mL; injection (hydrocortisone sodium phosphate): 50 mg/mL; for injection (hydrocortisone sodium succinate): 100 mg, 250 mg, 500 mg, and 1 g; enema: 100 mg/60 mL; rectal aerosol foam (hydrocortisone acetate): 10%

By System: Dermal, immunomodulation

Warnings: Topical forms for external use only; do not use in or around the eyes

Precautions: Do not use tight diapers or plastic pants on area being treated with topical forms; do not bandage areas being treated with topical forms; in elderly patients, pre-existing skin atrophy could require lower dosage

Occasional Side Effects: Contact dermatitis, numbness in fingers, purpura, itching, scaling, rectal irritation, burning sensation, skin atrophy, dry skin

Rare Side Effects: Acne, Cushing's syndrome, glaucoma, hypopigmentation, hirsutism, cataracts, hypertension, unusual loss of hair, edema, gastric ulcer

Antidotal Therapy: No specific antidote; may include dilution with fluids

Disease States: Infection at treatment site, pre-existing skin atrophy

Lab Tests: Glucose, eosinophil count, hypothalamic-pituitary adrenal axis function, ACTH stimulation

Administrative Notes: Protect from freezing

Hydrocortisone Acetate

Trade Name(s): Cortifoam, Hydrocortone Acetate

Chemically Related To: Corticosteroids

Pregnancy Category: C

Medical Category: Adrenocorticoid, anti-inflammatory, immunosuppressant

Accepted Indications: Inflammatory disorders

Unaccepted Indications: Secondary adrenocortical insufficiency

Mechanism of Action: Inhibits mediators of inflammation

Absorption/Distribution: Poorly soluble IM, 20% absorbed rectally, high protein binding

Half life: 8–{endash}12 h

Peak activity: Intra-articular 24–{endash}48 h

Metabolism: Hepatic, renal, tissue

Elimination: Renal

Research Notes: Parenteral form has duration of action of 3 d to 4 w

Adult Dosage: Suspension: intra-articular, soft tissue or intralesional injection 5–{endash}75 mg at 1–{endash}3 w intervals

Elderly Dosage: More likely to develop high blood pressure

Child Dosage: Dosage not established

Infant Dosage: Dosage not established

Dosage Forms: Parenteral sterile suspension 25 and 50 mg/mL, rectal aerosol (foam) 10%

By System: Affects immune system white blood cells

Warnings: Shake suspension well; foam for rectal use only

Precautions: Caution if surgery required; caution in receiving immunizations

Frequent Side Effects: Increased appetite, indigestion, trouble sleeping, nervousness

Occasional Side Effects: Changes in skin color, dizziness, joint pain, increased sweating

Rare Side Effects: Skin rash, hives, infection at injection site, sudden blindness, hallucinations, mental depression, glucose intolerance

Contraindications: Arthroplasty of joint, blood clotting disorder, infection, osteoporosis, unstable joint

Disease States: AIDS, HIV infection, heart problems, hypertension, liver or kidney problems, myasthenia gravis, SLE, tuberculosis

Other Drugs: Vaccines, digitalis glycosides, estrogens, antacids, insulin, androgens, mitotane

Lab Tests: Eosinophil count, uric acid, cholesterol and fatty acid, platelet count, potassium and sodium concentrations

Administrative Notes: Do not administer sterile suspension IV

Hydrocortisone Acetate/Neomycin Sulfate/Polymyxin B Sulfate

Trade Name(s): AK-Spore HC, Cortisporin, Lazer-Sporin-C, Octicair, Otocort

Medical Category: Topical anti-infective

Accepted Indications: Ear canal infections, mastoidectomy cavity infections

Dosage Forms: Solution, otic: 1%/3.5 mg/10,000 unit/ mL; Suspension, ophth: 1%/3.5 mg/10,000 unit/mL; otic: 1%/3.5 mg/10,000 unit/mL

Hydrocortisone Acetate/Oxytetracycline Hydrochloride

Trade Name(s): Terra-Cortril

Medical Category: Ophthalmic anti-infective

Accepted Indications: Bacterial eye infections caused by Staphylococcus aureus, streptococci, Escherichia coli, Neisseria

Unaccepted Indications: Infections caused by Haemophilus influenza, Klebsiella/Enterobacter, Pseudomonas aeruginosa, Serratia marcescens

Adult Dosage: 1–{endash}2 drops instilled into the eye t.i.d.

Dosage Forms: Ophthalmic suspension: 15 mg/5 mg

Hydrocortisone Acetate/Polymyxin B Sulfate

Trade Name(s): Otobiotic, Otic

Medical Category: Anti-inflammatory, anti-infective

Accepted Indications: Superficial external auditory bacterial infections

Adult Dosage: Instill 4 drops into the ear canal t.i.d. or q.i.d.

Elderly Dosage: Same as adult dose

Dosage Forms: Otic solution: 0.5%/10,000 units

Hydrocortisone Acetate/Pramoxine Hydrochloride

Trade Name(s): Analpram-HC, Cortane, Derma-Sone, Oticol, Pramosone, Proctofoam-HC

Medical Category: Anti-inflammatory, antipruritic

Accepted Indications: Pruritus, inflammation

Dosage Forms: Aerosol: 1%/1%, 1 gm/1 gm; 1%; cream: 1%, 0.5%/1%, other various strengths; lotion: 1%, 2.5%/1%, other various strengths; ointment: 2.5%

Hydrocortisone Acetate/Urea

Trade Name(s): Carmol HC

Medical Category: Topical anti-inflammatory

Accepted Indications: Dry, inflamed tissue

Adult Dosage: Apply topically to the affected area once daily–{endash}t.i.d.

Elderly Dosage: Same as adult dose

Dosage Forms: Cream: 1%/10%

Hydrocortisone Butyrate

Trade Name(s): Locoid

Chemically Related To: Corticosteroid

Pregnancy Category: C

Medical Category: Adrenocorticoid, anti-inflammatory (topical)

Accepted Indications: Skin disorders, eczema, dermatitis, psoriasis

Unaccepted Indications: Acne, routine gingivitis

Mechanism of Action: Stimulate RNA to synthesize more inhibitory enzymes

Absorption/Distribution: Some systemic absorption which increases when skin is abraded

Metabolism: In skin, systemically in liver

Research Notes: Medium potency corticosteroids

Adult Dosage: Apply to skin b.i.d. or t.i.d.

Elderly Dosage: Pre-existing skin atrophy indicates infrequent use for brief periods only

Child Dosage: Apply to skin once daily or b.i.d.

Infant Dosage: Absorption increased in premature babies

Dosage Forms: Ointment .1%, cream .1%

By System: Topical

Warnings: External use; do not use in or near the eye

Precautions: Do not bandage treated area

Occasional Side Effects: Dermatitis, numbness in fingers, purpura, rectal irritation, burning

Rare Side Effects: Acneiform eruptions, glaucoma, hirsutism, itching

Antidotal Therapy: No specific antidote; may include dilution with fluids

Disease States: Infection at treatment site, pre-existing skin atrophy

Lab Tests: Glucose, total eosinophil count, adrenal function

Administrative Notes: Protect from freezing

Hydrocortisone Valerate

Trade Name(s): Westcort

Chemically Related To: Corticosteroids

Pregnancy Category: C

Medical Category: Topical adrenocorticoid, topical anti-inflammatory

Accepted Indications: Skin disorders, moderate inflammatory dermatoses, hand eczema, atopic eczema

Unaccepted Indications: Acne, routine gingivitis

Mechanism of Action: Increases protein synthesis of inhibitory enzymes

Absorption/Distribution: Can be absorbed systemically

Metabolism: Skin, can be absorbed systemically

Research Notes: Medium potency

Adult Dosage: Topical to skin b.i.d. or t.i.d.

Elderly Dosage: Pre-existing skin atrophy may cause problems

Child Dosage: Topical to skin once daily

Infant Dosage: Topical to skin once daily

Dosage Forms: Cream .2%, ointment .2%

By System: Topical

Warnings: For external use only; do not use in and around the eyes

Precautions: Do not use tight diapers or plastic pants on area being treated

Occasional Side Effects: Contact dermatitis, numbness in fingers, purpura, itching skin, scaling

Rare Side Effects: Acne, Cushing's syndrome, glaucoma, hypopigmentation, hirsutism

Antidotal Therapy: No specific antidote; may include dilution with fluids

Disease States: Infection at treatment site, pre-existing skin atrophy

Lab Tests: Glucose, eosinophil count, HPA axis function, ACTH stimulation

Hydrocortisone/Iodoquinol

Trade Name(s): Vytone

Pregnancy Category: C

Medical Category: Anti-inflammatory, antifungal, antibacterial

Accepted Indications: Dermatitis, eczema, pyoderma, acne urticata, lichen simplex chronicus, folliculitis, moniliasis, intertrigo

Adult Dosage: Topical, a thin layer to the affected area, t.i.d. to q.i.d

Dosage Forms: Cream: 1%/1%; ointment: 1%/3%

Hydrocortisone/Neomycin Sulfate

Trade Name(s): Neo-Cortef

Pregnancy Category: Adequate studies not done

Medical Category: Antibacterial, adrenocorticoid, anti-inflammatory, antipruritic

Accepted Indications: Corticosteroid-responsive dermatoses with secondary infection

Unaccepted Indications: Extensive burns, trophic ulceration

Adult Dosage: To the skin, a small amount once daily to t.i.d.

Dosage Forms: Cream: 1%/0.5%; ointment: 0.5%/0.5% and 1%/0.5%

Frequent Side Effects: No incidence given for hypersensitivity, localized skin atrophy, striae, fungal overgrowth, burning sensation, itching, irritation, dryness, folliculitis, secondary infection, acneiform eruption, hypopigmentation, ototoxicity, nephrotoxicity

Contraindications: Cutaneous tuberculosis, herpes simplex, fungus, infections, vaccinia, varicella

Administrative Notes: Do not use for more than 10 d

Hydroflumethiazide

Trade Name(s): Diucardin, Saluron

Chemically Related To: Thiazides

Pregnancy Category: C

Medical Category: Diuretic, antihypertensive, antiurolithic (calcium calculi)

Accepted Indications: Edema, hypertension, renal calculi

Mechanism of Action: Inhibits sodium reabsorption in the early renal distal tubules, thereby reducing plasma and extracellular fluid volume

Absorption/Distribution: Absorbed relatively rapidly

Half life: 17 h

PO: 3–{endash}4 h

Elimination: Renal

Research Notes: Long duration of action

Adult Dosage: Up to 200 mg/d in divided doses

Child Dosage: 1 mg/kg/d

Infant Dosage: Same as child dose

Dosage Forms: Tablets: 50 mg

By System: Cardiovascular and renal

Warnings: Avoid overexposure to the sun or sun lamp; elderly may be more sensitive to drug's effects

Frequent Side Effects: Electrolyte imbalance

Occasional Side Effects: Anorexia, decreased sexual ability, diarrhea, orthostatic hypotension, photosensitivity, GI distress

Rare Side Effects: Agranulocytosis, allergic reactions, pancreatitis, gout, hepatic impairment, thrombocytopenia, glucose intolerance

Antidotal Therapy: May include supportive, symptomatic treatment

Disease States: Severe renal function impairment, diabetes mellitus, history of gout or systemic lupus erythematosus, pancreatitis, hypercalcemia

Nutrition: Possible need for additional potassium in diet

Other Drugs: Anticoagulants, oral antidiabetic agents, digitalis glycosides, hypotension–{endash}producing medications, lithium, sympathomimetics

Lab Tests: Bilirubin, calcium, glucose, uric acid, protein-bound iodine, potassium, magnesium, and sodium

Hydroflumethiazide/Reserpine

Trade Name(s): Genutensin, Salazide, Salutensin, Serflugen

Medical Category: Antihypertensive

Accepted Indications: Hypertension

Dosage Forms: Tablets: 25 mg/0.125 mg and 50 mg/0.125 mg

Hydromorphone Hydrochloride

Trade Name(s): Dilaudid

Chemically Related To: Morphine

Scheduled Class: II

Abuse Potential: High

Pregnancy Category: C

Medical Category: Analgesic, adjunct in anesthesia, antitussive

Accepted Indications: Moderate to severe pain, anesthesia adjunct, cough

Mechanism of Action: Exerts agonist activity primarily at mu receptor

Half life: 2.6–{endash}4 h

PO: 90–{endash}120 min

IM: 30–{endash}60 min

IV: 15–{endash}30 min

Metabolism: Hepatic

Elimination: Renal

Adult Dosage: 2–{endash}20 mg/d

Elderly Dosage: Especially susceptible to the respiratory depressant effects

Child Dosage: Dosage must be individualized by physician on the basis of patient's age and size

Infant Dosage: Same as child dose

Dosage Forms: Tablets: 1 mg, 2 mg, 3 mg, and 4 mg; injection: USP 1 mg/mL, USP 2 mg/mL, USP 3 mg/mL, USP 4 mg/mL; suppositories: 3 mg

By System: CNS

Warnings: May cause drowsiness, avoid alcohol, may be habit-forming

Precautions: Caution if dizziness, drowsiness, lightheadedness, or false sense of well-being occurs; lie down if nausea occurs

Frequent Side Effects: Dizziness, drowsiness, hypotension, loss of appetite, extreme tiredness

Occasional Side Effects: Confusion, tachycardia or bradycardia, histamine release, trembling, decreased urination, stomach cramps, blurred vision

Rare Side Effects: Allergic reaction, paradoxical CNS stimulation, hallucinations, mental depression, trouble sleeping

Contraindications: Diarrhea associated with pseudomembranous colitis or with poisoning; acute respiratory depression

Overdosage: Cold, clammy skin; confusion; convulsions; severe dizziness; bradycardia; slow or troubled breathing; severe weakness

Antidotal Therapy: May include emesis or gastric lavage; establish adequate respiratory exchange; administer naloxone, IV fluids, and/or vasopressors

Disease States: Acute abdominal conditions, asthma, chronic respiratory depression, convulsions, emotional instability, head injury, hepatic function impairment

Nutrition: Take with food if GI irritation occurs

Other Drugs: CNS depressants, anticholinergics, hypotension–{endash}producing medications, MAO inhibitors, naloxone, neuromuscular blocking agents

Lab Tests: Gastric emptying studies, serum bilirubin, plasma lipase

Administrative Notes: When given parenterally, the patient usually should be lying down and should remain recumbent for some time to minimize side effects

Hydroquinone

Trade Name(s): Eldopaque, Eldoquin, Esoterica, Melanex, Melpaque, Melquin, Nuquin, Porcelana, Solaquin

Chemically Related To: Phenol

Pregnancy Category: C

Medical Category: Depigmenting agent

Accepted Indications: Freckling, inactive chloasma, lentigo, melanin hyperpigmentation

Unaccepted Indications: Sunburn (prophylaxis)

Mechanism of Action: Inhibits conversion of tyrosine to melanin

Research Notes: Depigmentation not permanent; may take 1-6 m to occur fully

Adult Dosage: 2–{endash}4% concentration b.i.d.

Child Dosage: Over 12 y: 2%–{endash}4% concentration b.i.d.; under 12 y: safety not established

Infant Dosage: Safety not established

Dosage Forms: Topical cream: 2% and 4%; solution 3%; lotion: 2%

By System: Dermal

Warnings: Do not use near eyes; test for sensitivity

Precautions: Use opaque sunscreen outside, avoid unnecessary exposure to sunlight

Side/Adverse Effects: Rash, irritation, burning, stinging, contact dermatitis, erythema

Contraindications: Sunburn, prickly heat, irritated skin

Overdosage: Systemic: tremors, seizures, hemolytic anemia

Antidotal Therapy: May include activated charcoal, gastric lavage, supportive therapy

Other Drugs: Oxidizing agents, alkalis, ferric salts

Administrative Notes: If no depigmentation is evident within 2 m, discontinue drug

Hydroxocobalamin

Trade Name(s): Hydrobexan, Hydro-Cobex, Hydro-Crysti-12, LA-12

Chemically Related To: Vitamin B12

Pregnancy Category: C

Medical Category: Nutritional supplement, antianemic, diagnostic aid

Accepted Indications: Pernicious anemia, vitamin deficiency

Unaccepted Indications: Aging, viral hepatitis, sterility, allergies, amblyopia, delayed growth, poor appetite, malnutrition, dermatologic disorders, fatigue, mental disorders, multiple sclerosis, thyrotoxicosis, trigeminal neuralgia

Mechanism of Action: Acts as metabolic coenzyme

Absorption/Distribution: Readily absorbed from GI tract

Half life: 6 d

IM: 1 h

Metabolism: Hepatic

Elimination: Biliary

Adult Dosage: IM or SQ: 0.03–{endash}0.05 mg/d for 5–{endash}10 d; maintenance: 0.1–{endash}0.2 mg/m

Child Dosage: Initial, IM or SQ: 0.03–{endash}0.05 mg/d for 2 w; maintenance: 0.1 mg/m

Dosage Forms: Injection: 0.1 mg/mL and 1 mg/mL

Occasional Side Effects: Diarrhea, itching

Rare Side Effects: Anaphylactic reaction

Other Drugs: Alcohol, colchicine, antibiotics, aminosalicylates, folic acid, ascorbic acid

Lab Tests: Folic acid, hematocrit, potassium concentrations

Hydroxychloroquine Sulfate

Trade Name(s): Plaquenil

Chemically Related To: Unique compound

Pregnancy Category: C

Medical Category: Antiprotozoal, antirheumatic, antisystemic lupus erythematosus

Accepted Indications: Malaria, rheumatoid arthritis, systemic lupus erythematosus

Unaccepted Indications: Not active versus Plasmodium vivax or P. ovale malaria

Mechanism of Action: Binds and alters properties of protozoal and lymphocytic DNA, has mild immunosuppressant activity

Absorption/Distribution: Well absorbed; widely distributed in hematopoietic system

Half life: In erythrocytes, 50 d; in plasma, 32 d

PO: 3.2 h

Metabolism: Hepatic

Elimination: Renal

Research Notes: Toxic in infants and children; fatalities have occurred with the ingestion of as few as 3–{endash}4 tablets

Adult Dosage: Malaria suppressive regimen: 400 mg once every 7 d; therapeutic malaria regimen: 800 mg as a single dose, or 800 mg followed by 400 mg in 6–{endash}8 h and 400 mg once daily on the second and third days; antirheumatic dosage: up to 6.5 mg/kg/d

Elderly Dosage: Decrease dose

Child Dosage: Malaria suppressive regimen: 6.4 mg/kg/d for 7 d; therapeutic malaria regimen: 32 mg/kg administered over 3 d, then 6.4 mg/kg 6 h, 24 h, and 48 h after the first dose

Dosage Forms: Tablets: 200 mg

By System: CNS and hematopoietic system

Warnings: May cause dizziness; continue medicine for full time of treatment

Precautions: Keep out of reach of children

Frequent Side Effects: Ciliary muscle dysfunction, headache, itching

Occasional Side Effects: Ocular toxicity; bleaching of hair or increased loss; blue-black discoloration of skin, fingernails, or inside of mouth; dizziness

Rare Side Effects: Blood dyscrasias, emotional changes, ototoxicity, seizures

Overdosage: Cardiac conduction disturbances, hypotension, drowsiness, headache, hyperexcitability, seizures, coma, respiratory and cardiac arrest, blurred vision

Antidotal Therapy: May include symptomatic and supportive therapy

Disease States: Severe blood, GI, or neurologic disorders; psoriasis; porphyria; hepatic function impairment

Other Drugs: Penicillamine

Administrative Notes: Consider dispensing in unit-dose packaging in child-resistant containers (double-barrier packaging)

Hydroxyprogesterone Caproate

Trade Name(s): Hy/gestrone, Hylutin, Prodrox, Pro-Span

Chemically Related To: Progesterone

Pregnancy Category: D

Medical Category: Progestin; antineoplastic

Accepted Indications: Female hormonal imbalance, test for endogenous estrogen production, metastatic endometrial carcinoma, uterine carcinoma, metastatic renal carcinoma, polycystic ovary syndrome, precocious puberty

Unaccepted Indications: PMS, pregnancy tests

Mechanism of Action: Inhibits release of LH

Metabolism: Hepatic

Elimination: Renal, fecal

Adult Dosage: IM, 375 mg following cyclic schedule

Dosage Forms: Injection: 125 mg/mL and 250 mg/mL

Frequent Side Effects: Changes in weight, appetite, vaginal bleeding pattern, edema, pain at injection site, tiredness

Occasional Side Effects: Acne, fever, increased body hair, breast tenderness, melasma, nausea, loss of some scalp hair, trouble sleeping

Contraindications: Suspected pregnancy, incomplete abortion, vaginal bleeding

Disease States: Asthma, migraines, breast carcinoma, mental depression, hepatic disease, cardiac insufficiency, epilepsy, renal dysfunction, diabetes, ectopic pregnancy, hyperlipidemia, thrombophlebitis

Other Drugs: Bromocriptine

Lab Tests: LDL, HDL, alkaline phosphate

Hydroxypropyl Cellulose

Trade Name(s): Lacrisert, Tears Naturale

Chemically Related To: Cellulose polymer

Pregnancy Category: A

Medical Category: Protectant tears

Accepted Indications: Keratoconjunctivitis sicca, corneal erosions, decreased corneal sensitivity, keratitis

Mechanism of Action: Stabilizes and thickens precorneal tear film; prolongs tear film breakup time

Research Notes: Mechanical lubricant for artificial eyes

Adult Dosage: Topically 5 mg once daily

Elderly Dosage: Same as adult dose

Child Dosage: Same as adult dose

Infant Dosage: Same as adult dose

Dosage Forms: Ocular system: USP 5 mg

By System: Ophthalmic

Precautions: Caution if blurred vision develops; possible increased sensitivity to light; wear sunglasses for relief

Occasional Side Effects: Blurred vision, eye redness, increased sensitivity of eyes to light, stickiness of eyelashes, watering of eyes, swelling eyelids

Hydroxyurea

Trade Name(s): Hydrea

Chemically Related To: Urea

Pregnancy Category: D

Medical Category: Antineoplastic

Accepted Indications: Carcinoma of head and neck, ovary, or cervix; chronic myelocytic leukemia; polycythemia vera

Mechanism of Action: Interferes with synthesis of DNA in rapidly growing cells

Absorption/Distribution: Well absorbed; crosses blood-brain barrier

Half life: 3–{endash}4 h

PO: 2 h

Metabolism: Hepatic

Elimination: Renal 80%, respiratory 20%

Adult Dosage: 60–{endash}80 mg/kg every third d (head and neck carcinoma, ovarian carcinoma, malignant melanoma); 20–{endash}30 mg/kg/d (resistant chronic myelocytic leukemia)

Child Dosage: Not established

Dosage Forms: Capsules: 500 mg

Warnings: Avoid immunizations; elderly may be more sensitive to drug's effects

Precautions: In combination chemotherapy, take each medicine at the right time; continue medication despite GI distress

Frequent Side Effects: Anemia, leukopenia, diarrhea, drowsiness, loss of appetite, nausea and vomiting

Occasional Side Effects: Stomatitis, thrombocytopenia, constipation, rash and itching

Rare Side Effects: Hyperuricemia, neurotoxicity, renal function impairment

Disease States: Anemia, bone marrow depression, infection, renal function impairment, chickenpox, history of gout

Other Drugs: Blood dyscrasia–{endash}causing medications, bone marrow depressants, live and killed vaccines, colchicine

Lab Tests: BUN, serum uric acid, serum creatinine

Administrative Notes: Capsule may be emptied into a glass of water; ample fluid intake important

Hydroxyzine

Trade Name(s): Anxanil, Atarax, E-Vista, Hydroxacen, Hyzine, Quiess, Vistaject, Vistaril, Vistazine

Chemically Related To: Piperazines

Pregnancy Category: Adequate studies in humans have not been done

Medical Category: Antihistamine, antianxiety agent, antiemetic, sedative-hypnotic

Accepted Indications: Rhinitis, conjunctivitis, urticaria, pruritus, angioedema, dermatographism, rhinorrhea, anaphylactoid reactions, sneezing, anxiety, tension, alcohol withdrawal, nausea, vomiting, sedation, anesthesia adjunct

Mechanism of Action: Competes with histamine for receptor site

Absorption/Distribution: Well absorbed

Half life: 20–{endash}25 h

Metabolism: Hepatic, renal

Elimination: Renal

Adult Dosage: Tablets, syrup and oral suspension: 50–{endash}100 mg as a single dose; 25–{endash}100 mg t.i.d. or q.i.d. Capsules: 50–{endash}100 mg as a single dose; 25–{endash}100 mg t.i.d. to q.i.d. as antiemetic. Injection: 50–{endash}600 mg/d

Elderly Dosage: May be more sensitive to effects of drug

Child Dosage: Tablets, syrup and oral suspension: 600 m{mu}g/kg as a single dose; 500 m{mu}g/kg q.i.d. as antiemetic. Capsules (pamoate): 600 m{mu}g/kg as a single dose; 500 m{mu}g/kg q.i.d. as anti-emetic. Injection: 1 mg/kg as single dose

Infant Dosage: Same as child dose

Dosage Forms: Capsules (pamoate): 25 mg, 50 mg, and 100 mg. Oral suspension: 25 mg/5 mL. Syrup: 10 mg/5 mL. Tablets: 10 mg, 25 mg, 50 mg and 100 mg. Injection: 25 mg/mL and 50 mg/mL

By System: CNS antihistaminic

Warnings: May cause drowsiness

Precautions: Avoid alcohol

Frequent Side Effects: Drowsiness, thick mucus

Occasional Side Effects: Blurred vision, confusion, tachycardia, GI distress, blood dyscrasias, cardiac arrhythmias, painful urination, dizziness, dry mouth, weight gain, increased sweating, loss of appetite, paradoxical reaction, photosensitivity, tinnitus, rash

Contraindications: Hepatic impairment

Overdosage: Clumsiness, seizures, severe drowsiness, hallucinations, flushing, shortness of breath

Antidotal Therapy: No specific antidote; may include emesis, gastric lavage, saline cathartic, vasopressor, oxygen, and IV fluids

Disease States: Urinary retention, glaucoma, bladder neck obstruction, prostatic hypertrophy, hypokalemia

Other Drugs: Anticholinergics, CNS depressants, MAO inhibitors, erythromycin, alcohol, clarithromycin, troleandomycin, traconazole, ketoconazole

Lab Tests: Skin tests with allergic extracts; urine 17-hydroxycorticosteroid determination

Administrative Notes: May possibly interfere with diagnosis of appendicitis. Inform physician if on low-sodium or low-sugar diet

Hydroxyzine Pamoate

Trade Name(s): Vistaril

Chemically Related To: Piperazine

Pregnancy Category: C

Medical Category: Antihistaminic (H1-receptor), antianxiety agent, antiemetic

Accepted Indications: Rhinitis, allergic conjunctivitis, pruritus, urticaria, angioedema, transfusion reactions (urticarial), sneezing, nausea/vomiting, tension, sedation

Mechanism of Action: Depresses CNS at limbic and subcortical levels of brain

Absorption/Distribution: Well absorbed

Half life: 2 h

PO: 1 h

Metabolism: Hepatic, renal

Elimination: Renal

Research Notes: Onset of action is 15–{endash}30 min, duration of action is 4-6 h

Adult Dosage: 50-100 mg in 3–{endash}4 divided doses

Elderly Dosage: Decrease dose by 1/3

Child Dosage: 600 m{mu}g/kg - over 6 y - 12.5–{endash}25 mg/6 h

Infant Dosage: Not recommended in newborns or premature babies

Dosage Forms: Capsules 25, 50 and 100 mg, oral suspension 25 mg/5mL

By System: CNS

Warnings: Avoid alcohol; drowsiness

Frequent Side Effects: Drowsiness, thick mucus

Occasional Side Effects: Blood dyscrasias, cardiac arrhythmias

Rare Side Effects: Blurred vision, painful urination, dryness of mouth, increased sweating, buzzing in ears

Contraindications: Liver problems

Overdosage: Anticholinergic effects, cardiac arrhythmias, CNS stimulation/depression, hypotension

Antidotal Therapy: No specific antidote; may include emesis/gastric lavage, saline cathartics, vasopressors, oxygen and IV fluids

Disease States: Bladder neck obstruction, prostatic hypertrophy, urinary retention, glaucoma

Other Drugs: CNS depressants, anticholinergics, MAO inhibitors, apomorphine, erythromycin, ototoxic medications

Lab Tests: Skin tests using allergens

Administrative Notes: Protect suspension from light

Hyoscyamine

Trade Name(s): Anaspaz, Cystospaz, Gastrosed, Levsin, Levsinex

Chemically Related To: Atropine

Pregnancy Category: C

Medical Category: Anticholinergic, antiarrhythmic

Accepted Indications: Peptic ulcer (adjunctive therapy), irritable bowel syndrome, urologic disorders, biliary tract disorders, arrhythmias

Unaccepted Indications: Infant colic

Mechanism of Action: Inhibits muscarinic action of acetylcholine at receptor sites

Absorption/Distribution: Well absorbed

Half life: 3.5 h (elimination)

Metabolism: Hepatic

Elimination: Renal

Research Notes: Onset of action: oral 20–{endash}30 min, parenteral 2–{endash}3 min; duration of action: 4–{endash}6 h

Adult Dosage: 375–{endash}2000 m{mu}g/d in 3–{endash}4 divided doses

Elderly Dosage: Use with caution

Child Dosage: Must be individualized

Infant Dosage: Must be individualized

Dosage Forms: Extended-release capsules (sulfate): 375 m{mu}g; elixir (sulfate): 125 m{mu}g/5 mL; oral solution (sulfate): 125 m{mu}g/mL; tablets: 150 m{mu}g; tablets (sulfate): 125 m{mu}g; injection (sulfate): 500 m{mu}g/mL

By System: Parasympathetic nervous system

Warnings: May cause blurred vision, dizziness, lightheadedness, or dry mouth; elderly may be more sensitive to drug's effects

Precautions: Caution during exercise or hot weather; overheating may result in heat stroke; increased sensitivity of eyes to light possible

Frequent Side Effects: Decreased sweating; dryness of mouth, nose, throat, or skin; redness or irritation at injection site

Occasional Side Effects: Constipation, decreased flow of breast milk, urine retention

Rare Side Effects: Confusion, increased intraocular pressure, bloated feeling, drowsiness, headache, extreme tiredness

Overdosage: Blurred vision; dry, hot, flushed skin; confusion; difficulty in breathing; tachycardia; fever; hallucinations; muscle weakness; seizures; slurred speech

Antidotal Therapy: May include administration of aqueous slurry of activated charcoal, slow IV physostigmine, short-acting barbiturate, infusion of norepinephrine

Disease States: Brain damage in children, cardiac disease, fever, GI tract obstructive disease, glaucoma, myasthenia gravis, ulcerative colitis

Other Drugs: Urinary alkalizers, antidiarrheals, anticholinergics, antimyasthenics, haloperidol, narcotic analgesics, potassium chloride

Lab Tests: Gastric acid secretion, radionuclide gastric emptying

Administrative Notes: Dosage adjustments are often required for infants, for patients with Down syndrome, and for children with brain damage or spasticity

Hyoscyamine Sulfate/Phenobarbital

Trade Name(s): Levsin with Phenobarbital; Levsin-PB Drops

Pregnancy Category: C

Medical Category: Antispasmodic

Accepted Indications: Peptic ulcer therapy adjunct, GI and biliary spasms, functional GI disorders, irritable bowel syndrome

Adult Dosage: Elixir: 15–{endash}40 mL/d; drops: 1–{endash}2 mL/d; tablets: 3–{endash}8 tablets/d; sustained-release capsules: 2–{endash}4 capsules/d

Elderly Dosage: Use with caution

Child Dosage: Drops: 0.5–{endash}1 mL/d; other forms: safety and efficacy not established

Infant Dosage: Safety and efficacy not established

Dosage Forms: Elixir: 0.125 mg/15 mg/mL; drops: 0.125 mg/15 mg; tablet: 0.125 mg/15 mg; sustained-release capsules: 0.375 mg/45 mg

Ibuprofen

Trade Name(s): Advil, Children's Advil, Motrin, Nuprin

Chemically Related To: Propionic acid derivative

Pregnancy Category: Adequate studies have not been done

Medical Category: Antirheumatic, analgesic, antipyretic, antidysmenorrheal

Accepted Indications: Arthritis, pain, fever, dysmenorrhea, headache

Mechanism of Action: Inhibits an enzyme, resulting in a decrease in the precursors that form prostaglandins and thromboxanes

Absorption/Distribution: Rapid

Half life: 1.8–{endash}2 h

Peak activity: 1.2–{endash}2.1 h

PO: 30–{endash}90 min

Metabolism: Hepatic

Elimination: Renal (100% in 24 h)

Research Notes: In the treatment of arthritis, improvement in condition may occur within 7–{endash}14 d

Adult Dosage: 1.2–{endash}3.2 g/d for rheumatoid arthritis; and 200–{endash}400 mg every 4–{endash}6 h for dysmenorrhea

Elderly Dosage: Same as adult dose

Child Dosage: 30–{endash}40 mg/kg/d for rheumatoid arthritis and 5 mg/kg every 4–{endash}6 h as needed for fever

Infant Dosage: Up to 6 m: Safety and efficacy not established

Dosage Forms: Tablets: 200 mg, 300 mg, 400 mg, 600 mg, and 800 mg; oral suspension: 100mg/5 mL

By System: Pain and fever inhibitory response

Precautions: Take with food or antacids; avoid alcohol

Frequent Side Effects: Rash

Occasional Side Effects: Itching, GI irritation

Rare Side Effects: CHF, increased blood pressure, arrhythmia, nosebleeds, confusion, hallucinations, meningitis, mental depression, neuropathy

Contraindications: Symptoms of nasal polyps associated with bronchospasm or angioedema

Overdosage: Lethargy, drowsiness, GI symptoms, hemorrhage, acute renal failure, convulsions, coma

Antidotal Therapy: May include supportive and maintenance treatments

Disease States: Anemia or asthma (may be exacerbated), peptic ulcer, hemophilia, hepatic or renal function impairment, stomatitis, bronchospasms

Other Drugs: Acetaminophen, potassium supplements, digitalis glycosides, anticoagulants, insulin, triamterene, aspirin, radiation therapy, plicamycin, colchicine, gold compounds, lithium methotrexate, nifedipine, verapamil, photosensitizing medications, platelet aggregation inhibitors, probenecid

Lab Tests: Bleeding time, blood glucose concentration, BUN, serum creatinine and potassium concentrations, creatinine clearance, hematocrit, hemoglobin, serum transaminase activity

Administrative Notes: If a fever lasts more than 3 d, see physician

Idarubicin

Trade Name(s): Idamycin

Pregnancy Category: D

Medical Category: Antineoplastic

Accepted Indications: Acute myelocytic leukemia

Mechanism of Action: Intercalcates DNA and inhibits DNA synthesis

Absorption/Distribution: High volume of distribution

Half life: 22 h

IV: Several min

Metabolism: Hepatic

Elimination: Biliary, renal

Adult Dosage: IV, slow, 12 mg/m2/d for 3 d given with cytarabine

Elderly Dosage: Lower dose may be required

Child Dosage: Safety and efficacy not established

Infant Dosage: Safety and efficacy not established

Dosage Forms: Injection: 5 mg and 10 mg

Warnings: Protect from light

Frequent Side Effects: Diarrhea, nausea, leukopenia, infection, mucositis, thrombocytopenia, reddish urine, stomach cramps, headache, vomiting, loss of hair

Occasional Side Effects: Peripheral neuropathy, cardiotoxicity, CHF, arrhythmias, hyperuricemia, recall postirradiation erythema

Rare Side Effects: Enterocolitis, rash, hives

Contraindications: Bone marrow depression, chickenpox, heart disease

Other Drugs: Probenecid, radiation therapy, sulfinpyrazone, bone marrow depressants, live virus vaccines

Lab Tests: EKG, bilirubin

Idoxuridine

Trade Name(s): Herplex Liquifilm

Chemically Related To: Thymidine

Pregnancy Category: Studies not done

Medical Category: Antiviral

Accepted Indications: Treatment of keratitis due to herpes simplex virus

Mechanism of Action: Causes production of faulty DNA by taking place of thymidine

Absorption/Distribution: Penetrates cornea poorly

Metabolism: Rapidly inactivated by deaminases or nucleotidases in blood

Elimination: Renal

Research Notes: Crosses the placenta

Adult Dosage: Topical to the conjunctiva up to 8 times/d

Elderly Dosage: Same as adult dose

Child Dosage: Same as adult dose

Infant Dosage: Same as adult dose

Dosage Forms: Ointment: 0.5%; solution: 0.1%

By System: Ophthalmic

Precautions: May cause photophobic reaction; wear sunglasses and avoid prolonged exposure to bright light

Occasional Side Effects: Increased sensitivity of eyes to light, excess flow of tears

Rare Side Effects: Corneal clouding

Other Drugs: Boric acid

Administrative Notes: At night, use the ophthalmic ointment; use solution by day

Ifosfamide

Trade Name(s): Ifex

Pregnancy Category: D

Medical Category: Antineoplastic

Accepted Indications: Testicular tumors, soft-tissue sarcomas, Ewing's sarcoma, non-Hodgkin's lymphomas, lung carcinoma, pancreatic carcinoma

Mechanism of Action: Cytotoxic, cross-links strands of DNA and RNA, inhibits protein synthesis

Absorption/Distribution: Some crossing of blood-brain barrier

Half life: 15 h (terminal)

Metabolism: Hepatic

Elimination: Renal

Adult Dosage: Varies by indication. Example: IV infusion, 1.2 g/m2 for 5 d, repeated every 3 w for testicular tumor. Mesna is administered to reduce hemorrhagic cystitis

Elderly Dosage: May require lower dose

Child Dosage: Not established

Infant Dosage: Not established

Dosage Forms: Sterile injection: 1 g and 3 g

Warnings: Stable for 1 w

Frequent Side Effects: Nausea, loss of hair, CNS effects, leukopenia, thrombocytopenia, urotoxicity, vomiting

Occasional Side Effects: Hepatotoxicity, infection, nephrotoxicity, phlebitis

Rare Side Effects: Cardiotoxicity, hemorrhagic cystitis, polyneuropathy, pulmonary toxicity, stomatitis

Contraindications: Bone marrow depression, herpes zoster, chickenpox

Disease States: Infection, renal impairment, hepatic function impairment

Other Drugs: Radiation therapy, live virus vaccines, bone marrow depressants

Lab Tests: Hematocrit, platelet, leukocyte count

Imipenem

Trade Name(s): Not available as a single agent

Chemically Related To: Beta lactam antibiotics

Pregnancy Category: C

Medical Category: Antibacterial

Accepted Indications: Most gram-positive and gram-negative aerobic and anaerobic bacterial species

Mechanism of Action: Binds to penicillin-binding proteins, inhibits bacterial cell wall synthesis

Absorption/Distribution: 95% absorption, rapidly and widely distributed

Half life: 1 h (IV), 2–{endash}3 h (IM)

IM: Within 2 h

Metabolism: Renal

Elimination: Renal

Imipramine

Trade Name(s): Norfranil, Tipramine, Tofranil-PM

Chemically Related To: Tricyclic antidepressants

Pregnancy Category: C

Medical Category: Antidepressant, antienuretic, antipanic agent, antinarcolepsy adjunct, anticataplectic, antibulimic

Accepted Indications: Mental depression, enuresis, panic disorder, neurogenic pain, attention deficit hyperactivity disorder, narcolepsy, bulimia, cocaine withdrawal

Mechanism of Action: Blocks reuptake of norepinephrine and/or serotonin

Absorption/Distribution: Rapidly and well absorbed; high protein binding

PO: 1–{endash}2 h

Metabolism: Hepatic

Elimination: Renal

Research Notes: Onset of action as an antidepressant, 2–{endash}3 w

Adult Dosage: Capsules and tablets: 75 mg/d up to 200 mg (outpatients) or 300 mg (hospitalized patients), injection: up to 300 mg/d in divided doses

Elderly Dosage: May require lower dosage

Child Dosage: Up to 12 y: not recommended

Infant Dosage: Not recommended

Dosage Forms: Capsules: 75 mg, 100 mg, 125 mg, and 150 mg, tablets: 10 mg, 25 mg and 50 mg, injection 12.5 mg/mL

By System: CNS

Warnings: May cause drowsiness; avoid alcohol

Precautions: Caution if surgery required; avoid sun lamp or tanning booth

Frequent Side Effects: Dizziness, drowsiness, dry mouth, headache, increased appetite, nausea, weight gain, tiredness

Occasional Side Effects: Anticholinergic effects, arrhythmia, hypotension, nervousness, parkinsonism, diarrhea

Rare Side Effects: Agranulocytosis, allergic reaction, testicular swelling, tinnitus

Contraindications: Acute recovery after myocardial infarction

Overdosage: Confusion, seizures, hallucinations, shortness of breath, vomiting, weakness, drowsiness

Antidotal Therapy: May include gastric lavage, activated charcoal slurry, lidocaine; maintain respiration

Disease States: Blood disorders; bipolar disorders; convulsions; liver, kidney, heart, or GI problems; urinary retention

Nutrition: Take with food; may need additional riboflavin

Other Drugs: CNS depressants, antithyroid agents, phenothiazines, estrogens, MAO inhibitors, sympathomimetics

Lab Tests: EKG, metyrapone test, blood glucose concentrations

Administrative Notes: Store in a tight container

Immune Serum Globulin Human

Trade Name(s): Gamimune-N, Gammagard, Iveegam, Polygam S/D, Venoglobulin-I, Sandoglobulin, Gammar-IV

Chemically Related To: Immunoglobulins

Pregnancy Category: C

Medical Category: Immunizing agent (passive), platelet count stimulator, antibacterial, antiviral

Accepted Indications: Primary immunodeficiency, Kawasaki disease, idiopathic thrombocytopenic purpura, leukemia treatment adjunct

Mechanism of Action: Increases antibody titer and antigen-antibody capacity

Absorption/Distribution: 100% distributed in serum

Half life: 21–{endash}29 d

Peak activity: Immediate

IV: Immediate

Research Notes: Duration of action, several d to a few w

Adult Dosage: 100–{endash}400 mg/kg/m

Elderly Dosage: Same as adult dose

Child Dosage: Same as adult dose

Infant Dosage: Same as adult dose

Dosage Forms: Injection: 500 mg of protein in 10 mL, 2.5 g of protein in 50 mL, 5 g of protein in 100 mL, 12.5 mg of protein in 250 mL. For injection: 0.5 g/10 mL, 1 g/20 mL, 1 g/33 mL, 2.5 g/50 mL, 3 g/100 mL, 5 g/100 mL, 6 g/200 mL and 100 g/200 mL

Warnings: Do not freeze solution

Precautions: Discard vial even if only partially used

Frequent Side Effects: Backache, headache, joint pain, feeling of illness, troubled breathing, tachycardia, dyspnea, myalgia, malaise

Occasional Side Effects: Hip pain, redness at injection site, cramps, faintness, cyanosis, fatigue, chest pain, erythema, hives, burning sensation in head, wheezing

Contraindications: Immunoglobulin A deficiency

Overdosage: Chest tightness, diaphoresis, chills, flushing, hypotension, nausea, fever, vomiting

Antidotal Therapy: May include antihistamines, glucocorticoids, epinephrine

Disease States: Heart problems, hypogammaglobulinemia, poor acid-base compensation

Other Drugs: Live virus vaccines

Administrative Notes: Do not mix with other IV solutions; use a separate line

Indapamide

Trade Name(s): Lozol

Chemically Related To: Thiazide diuretics

Pregnancy Category: B

Medical Category: Antihypertensive, diuretic

Accepted Indications: Water retention, hypertension

Mechanism of Action: Inhibits reabsorption of water and electrolytes

Absorption/Distribution: Rapidly absorbed

Half life: 14 h

PO: 2 h

Metabolism: Hepatic

Elimination: Renal

Research Notes: Onset of action with a multiple dose, 1–{endash}2 w

Adult Dosage: 2.5–{endash}5 mg once daily

Elderly Dosage: May exhibit side effects relating to electrolyte imbalance and hypotension

Child Dosage: Safety and efficacy not established

Infant Dosage: Safety and efficacy not established

Dosage Forms: Tablets: 2.5 mg

By System: Cardiovascular

Warnings: Continue to take medication even when symptoms have disappeared

Precautions: Consult physician if electrolyte imbalance leads to GI distress and diarrhea

Occasional Side Effects: Diarrhea, headache, dizziness, GI distress

Rare Side Effects: Electrolyte imbalance, hypokalemia, rashes, hyperglycemia, photosensitivity

Overdosage: Symptoms of electrolyte imbalance

Antidotal Therapy: May include emesis, symptomatic support, monitoring of electrolytes

Disease States: Diabetes mellitus, gout, sympathectomy

Other Drugs: Adrenocorticoids, glucocorticoids, mineralocorticoids, ACTH, digitalis glycosides, lithium, other antihypertensives

Lab Tests: Protein-bound iodine, uric acid, potassium and sodium levels

Administrative Notes: Drug is light sensitive; potassium supplementation needed; salt intake should be restricted; patient's weight should be controlled

Indomethacin

Trade Name(s): Indameth, Indocin

Chemically Related To: Phenylbutazone

Pregnancy Category: Not recommended

Medical Category: Antirheumatic, antigout agent, anti-inflammatory, antipyretic, antidysmenorrheal, vascular headache (suppressant and prophylactic), patent ductus arteriosus (closure adjunct)

Accepted Indications: Rheumatic disease, pain, gouty arthritis, ankylosing spondylitis, nonrheumatic inflammation, vascular headache, Bartter's syndrome, pericarditis, patent ductus arteriosus

Unaccepted Indications: Fever

Mechanism of Action: Inhibition of prostaglandin synthesis

Absorption/Distribution: Rapid absorption

Half life: 1.5–{endash}4 h

PO: 0.5–{endash}2 h

Metabolism: Hepatic

Elimination: Renal, biliary/fecal

Research Notes: Drug of first choice for ankylosing spondylitis

Adult Dosage: 25–{endash}50 mg b.i.d. to q.i.d. up to 200 mg/d

Elderly Dosage: Confusion more likely to occur; reduce dose

Child Dosage: Use should be limited; 1.5–{endash}2.5 mg/kg t.i.d. or q.i.d.

Infant Dosage: Same as child dose

Dosage Forms: Capsules: 25 mg and 50 mg; extended-release capsules: 75 mg; oral suspension: 25 mg/5 mL; suppositories: 50 mg

By System: CNS and peripheral pain receptors

Warnings: Avoid alcohol; take with food

Frequent Side Effects: Headache, dizziness, stomach cramps, heartburn, nausea

Occasional Side Effects: Mental depression, tinnitus, fluid retention, drowsiness, constipation, increased sweating, lightheadedness, diarrhea, vomiting

Rare Side Effects: Chest pain, confusion, convulsions, hallucinations, dermatitis, muscle cramps, blurred vision, nosebleed, cardiac arrhythmia, CHF, pulmonary edema, increased blood pressure

Contraindications: Nasal polyps associated with aspirin or NSAIDs; hemophilia or other bleeding problems; renal function impairment

Overdosage: Lethargy, nausea/vomiting, renal failure, convulsions, coma

Antidotal Therapy: May include emesis/gastric lavage, activated charcoal, urinary alkalizes, plasma volume expanders if needed

Disease States: Heart, liver, or kidney problems, hemophilia, stomatitis, systemic lupus erythematosus, mental depression

Other Drugs: Acetaminophen, anticoagulants, antihypertensives, bone marrow depressants, gold compounds, lithium, methotrexate

Lab Tests: Dexamethasone suppression, bleeding time, blood glucose concentration, BUN, platelet count, plasma resin activity

Administrative Notes: Do not mix indomethacin oral solution with antacids or any liquid with alkaline pH

Influenza Virus Vaccine

Trade Name(s): Fluogen, FluShield, Fluzone

Pregnancy Category: C

Medical Category: Immunizing agent

Accepted Indications: Influenza prophylaxis

Mechanism of Action: Stimulates production of specific antibodies

Research Notes: Time to protective efficacy is 2 w

Adult Dosage: Split virus: IM, 0.5 mL as single dose. Whole virus: IM, 0.5 mL as single dose.

Elderly Dosage: Same as adult dose

Child Dosage: Split virus: 6–{endash}36 m: IM, 0.25 mL repeated in 4 w; 3–{endash}9 y: IM, 0.5 mL repeated in 4 w; 9–{endash}13 y: IM, 0.5 mL as single dose. Whole virus: not recommended up to 13 y.

Infant Dosage: Split virus: under 6 m: not recommended; 6–{endash}36 m: IM, 0.25 mL, repeated in 4 w. Whole virus: not recommended.

Dosage Forms: Injection (split virus): 0.5 mL. Injection (whole virus):. 0.5 mL

Frequent Side Effects: Redness or hard lump at injection site

Occasional Side Effects: Fever, myalgia, malaise

Rare Side Effects: Anaphylactic reaction

Contraindications: Guillain-Barré{acute-e} syndrome, febrile illness, acute respiratory disease

Antidotal Therapy: May include antihistamines, corticosteroids, epinephrine

Disease States: Allergy to eggs, neurologic disorders

Other Drugs: Radiation therapy, warfarin

Insulin

Trade Name(s): Humulin, Iletin, Velosulin

Medical Category: Antidiabetic

Accepted Indications: Diabetes mellitus

Mechanism of Action: Controls storage and metabolism of carbohydrates, proteins, and fats

Adult Dosage: SQ, as directed by physician

Child Dosage: Individualized according to size

Dosage Forms: Injection: 100 units/mL and 500 units/mL

Warnings: Do not freeze

Contraindications: High fever, severe infections, trauma

Disease States: Hypothyroidism, hyperthyroidism, ketoacidosis, diarrhea, eating disorders, hepatic function impairment, nausea, vomiting, renal function impairment

Other Drugs: Beta blockers, alcohol, tobacco, amphetamines, baclofen, oral contraceptives, corticosteroids, corticotropin, danazol, dextrothyroxine, diuretics, epinephrine, estrogens, ethacrynic acid, furosemide, glucagon, molindone, phenytoin, thyroid hormones, triamterene, anabolic steroids, androgens, disopyramide, guanethidine, MAO inhibitors, salicylates, antidiabetic agents, NSAIDs, appetite suppressants, carbonic anhydrase inhibitors, diazoxide

Lab Tests: Blood glucose, serum pH

Interferon Alfa-2a, Recombinant

Trade Name(s): Roferon-A

Chemically Related To: Biogenic product; protein chain of 165 amino acids with a lysine group at position 23

Pregnancy Category: C

Medical Category: Biologic response modifier, antineoplastic

Accepted Indications: Hairy cell leukemia, chronic hepatitis, AIDS-associated Kaposi's sarcoma, renal and bladder carcinoma, chronic myelocytic leukemia, mycosis fungoides

Mechanism of Action: Antiproliferation action based on changes in synthesis of RNA, DNA, and oncogenes

Absorption/Distribution: 80% absorption (IM or subcutaneous)

Half life: IM, 6–{endash}8 h; IV, 3.7–{endash}8.5 h

IM: 3.8 h

Metabolism: Renal

Elimination: Renal

Research Notes: Onset of action in hepatitis, within 2 w

Adult Dosage: Varies by indication

Elderly Dosage: Neurotoxicity and cardiotoxicity more likely to occur

Infant Dosage: Not established

Dosage Forms: Injection: 3,000,000 units/mL, 6,000,000 units/mL, and 36,000,000 units/mL; for injection: 18,000,000 units

By System: Hematopoietic

Warnings: May cause dizziness; do not change brand without permission

Precautions: Caution when ingesting alcohol

Frequent Side Effects: Aching muscles, metallic taste, fever, nausea and vomiting, tiredness, thrombocytopenia, leukopenia

Occasional Side Effects: Confusion, mental depression, back pain, dry skin, weight loss, joint pain

Rare Side Effects: Black, tarry stools; blood in urine; bruising; cardiotoxicity

Disease States: Heart, liver, or kidney problems; diabetes mellitus; convulsive disorders; chickenpox; psychiatric conditions

Nutrition: Ample fluid intake needed

Other Drugs: CNS depressants, blood dyscrasia–{endash}producing medications, bone marrow depressants, radiation therapy

Lab Tests: Blood pressure, hematocrit, platelet counts, prothrombin time, lactate dehydrogenase

Administrative Notes: Reconstituted solution should be used within 30 d.

Interferon Alfa-2b, Recombinant

Trade Name(s): Intron A

Chemically Related To: Biogenic product; protein chain of 165 amino acids with arginine group at position 23

Pregnancy Category: C

Medical Category: Biologic response modifier, antineoplastic

Accepted Indications: Hairy cell leukemia; treatment of condylomata acuminata; chronic hepatitis; AIDS-associated Kaposi's sarcoma; cervical, bladder, and renal cancer

Mechanism of Action: Antiproliferation action based on changes in synthesis of RNA, DNA, and oncogenes

Absorption/Distribution: 80% (IM, subcutaneous)

Half life: 2–{endash}3 h

IM: 3–{endash}12 h

Metabolism: Renal

Elimination: Renal

Research Notes: Onset of action in hepatitis, within 2 w

Adult Dosage: Varies by indication

Elderly Dosage: Neurotoxicity and cardiotoxicity seen more often in elderly patients

Dosage Forms: For injection: 3,000,000 units, 5,000,000 units, 10,000,000 units, 25,000,000 units, and 50,000,000 units

By System: Hematopoietic

Warnings: May cause dizziness; do not change brands without permission

Precautions: Use caution when ingesting alcohol

Frequent Side Effects: Aching muscles, metallic taste, fever, nausea and vomiting, tiredness, leukopenia, thrombocytopenia

Occasional Side Effects: Confusion, mental depression, back pain, dry skin, weight loss, joint pain

Rare Side Effects: Black, tarry stools; blood in urine; bleeding or bruising

Disease States: Heart problems, diabetes mellitus, convulsions, chickenpox, psychiatric problems, hepatic or renal disorders

Other Drugs: CNS depressants, blood dyscrasia–{endash}producing medications, bone marrow depressants, radiation therapy

Lab Tests: Blood pressure, hematocrit, platelet counts, prothrombin time, lactate dehydrogenase

Administrative Notes: Reconstituted solution should be used within 24 h, unless reconstituted with bacteriostatic water

Interferon Beta-1b

Trade Name(s): Betaseron

Pregnancy Category: C

Medical Category: Antiviral, immunoregulatory

Accepted Indications: Relapsing-remitting multiple sclerosis, AIDS, malignant melanoma, AIDS-related Kaposi's sarcoma, metastatic renal-cell carcinoma, cutaneous T-cell lymphoma, acute non-A/non-B hepatitis

Half life: 1–{endash}8 h (SQ)

Adult Dosage: SQ: 0.25 mg every other d

Child Dosage: Safety and efficacy not established

Infant Dosage: Safety and efficacy not established

Dosage Forms: For injection: 0.3 mg (9,600,000 units)

Frequent Side Effects: Incidence not given for pain at injection site, headache, flulike symptoms, fever, mental depression, anxiety, suicidal ideation, photosensitivity

Interferon Gamma-1b, Recombinant

Trade Name(s): Actimmune

Pregnancy Category: C

Accepted Indications: Chronic granulomatous disease

Mechanism of Action: Antiviral, antiproliferative, and immunomodulatory effects

Absorption/Distribution: Slow

Half life: 2.9 h (IM), 38 min (IV), 5.9 h (SQ)

Peak activity: 4 h (SQ)

IM: 4 h

Metabolism: Unknown

Elimination: Hepatic, renal

Adult Dosage: SQ, 50 m{mu}g/m2 3 times/w

Elderly Dosage: Same as adult dose

Child Dosage: Body surface less than 0.5 m2: SQ, 1.5 m{mu}g/kg 3 times/w

Infant Dosage: Body surface less than 0.5 m2: SQ, 1.5 m{mu}g/kg 3 times/w

Dosage Forms: Injection: 200 m{mu}g/mL

Frequent Side Effects: Leukopenia, flulike syndrome, diarrhea, vomiting, nausea, rash, tiredness

Occasional Side Effects: Dizziness, anorexia, weight loss

Rare Side Effects: Hypotension, neurotoxicity, thrombocytopenia

Disease States: Cardiac disease, seizure disorders, multiple sclerosis, compromised CNS function, systemic lupus erythematosus

Other Drugs: Blood dyscrasia–{endash}causing medications, bone marrow depressants, radiation therapy

Iodinated Glycerol

Trade Name(s): Iophen, Organic-1

Chemically Related To: Iodide

Pregnancy Category: X

Medical Category: Mucolytic-expectorant

Accepted Indications: None

Unaccepted Indications: Bronchitis, bronchial asthma, pulmonary emphysema, cystic fibrosis, chronic sinusitis (efficacy not proven)

Mechanism of Action: Increases respiratory tract secretions

Absorption/Distribution: Readily absorbed

Metabolism: Unknown

Elimination: Renal

Research Notes: Children with cystic fibrosis have greater susceptibility to goiter effect; if no response within 4 w, discontinue drug

Adult Dosage: 60 mg q.i.d.

Child Dosage: Up to 50% of adult dose, based on weight of child

Infant Dosage: Not recommended in newborns

Dosage Forms: Elixir: 60 mg; oral solution: 50 mg; tablets: 30 mg

By System: Respiratory

Warnings: Keep elixir container tightly closed

Precautions: Visit physician often

Frequent Side Effects: Diarrhea, nausea/vomiting, stomach pain

Rare Side Effects: Allergic reaction; acute parotitis

Contraindications: Allergy to iodine

Overdosage: Iodism; burning sensation in mouth and throat; severe headache; irritation of eyes; sneezing; sore gums

Antidotal Therapy: May include abundant fluid and sodium chloride intake

Disease States: Acne, cystic fibrosis, thyroid disease

Other Drugs: Lithium, antithyroid agents

Lab Tests: Thyroid function tests

Administrative Notes: One drop of solution is equal to 3 mg of iodinated glycerol; drink a glassful of water after each dose

Iodinated Glycerol/Theophylline

Trade Name(s): Iophylline, Theo-Organidin, Theo-Oridol, Theo-R, Theo-R-Gen

Pregnancy Category: C

Medical Category: Bronchodilator, expectorant

Accepted Indications: Asthma

Dosage Forms: Elixir: 30 mg/120 mg; Liquid: 30 mg/120 mg

Iodine, strong

Trade Name(s): Generic only

Pregnancy Category: Not recommended

Medical Category: Antihyperthyroid agent, radiation protectant, iodine replenisher

Accepted Indications: Hyperthyroidism, radiation protection, preoperative thyroid involution, thyrotoxic crisis, iodine deficiency

Adult Dosage: 1 mL t.i.d.

Elderly Dosage: Same as adult dose

Child Dosage: Same as adult dose

Infant Dosage: Not recommended

Dosage Forms: Oral solution: 50 mg iodine/100 mg potassium iodide/mL

Occasional Side Effects: Angioedema, arthralgia, eosinophilia, lymph node swelling, hives, diarrhea, nausea, vomiting, stomach pain

Contraindications: Bronchitis, pulmonary edema, hyperkalemia

Overdosage: Iodism, GI irritation, metallic taste

Disease States: Tuberculosis, hyperthyroidism, renal function impairment

Other Drugs: Antithyroid agents, lithium, diuretics, captopril, enalapril, lisinopril, sodium iodide I 131

Lab Tests: Thyroid function

Administrative Notes: Protect from freezing

Iohexol

Trade Name(s): Omnipaque

Chemically Related To: Radiopaque compounds

Pregnancy Category: B

Medical Category: Radiopaque diagnostic aid

Accepted Indications: Intrathecal: myelography; intravascular: angiocardiography, venography, urography, brain and body imaging; intraductal: pancreatography, oral-abdominal imaging

Mechanism of Action: Increases absorption of x-rays

Absorption/Distribution: Rapidly distributed, low protein binding

Half life: 2 h

Peak activity: Opacification: urography: 5–{endash}15 min; arteriography: immediate

Elimination: Renal

Research Notes: Carcinogenic and mutagenic studies have not been done

Adult Dosage: Myelography: 10–{endash}17 mL

Elderly Dosage: Lower doses recommended when kidney problems are present

Child Dosage: Myelography: 3 m–{endash}3 y: 4–{endash}8 mL; 3–{endash}7 y: 5–{endash}10 mL; 7–{endash}13 y: 5–{endash}12 mL; 13–{endash}18 y: 6–{endash}15 mL

Infant Dosage: Myelography: Under 3 m: 2–{endash}4 mL

Dosage Forms: Differing concentrations of iohexol: 240–{endash}350 mg/iodine/mL

By System: Systemic

Warnings: With intrathecal use, avoid movement during and several hours after administration

Precautions: Possible interference with further thyroid tests

Frequent Side Effects: Headache, backache, dizziness, stiff neck, joint pain, transient diarrhea

Occasional Side Effects: Ringing in ears, difficult urination, drowsiness, photosensitivity, nausea/vomiting

Rare Side Effects: Skin rash, pulmonary edema, hypotension, tachycardia, convulsions, renal impairment

Antidotal Therapy: Major toxic reaction: may include monitoring of vital signs, oxygen, IV infusion of epinephrine

Disease States: Dehydration, kidney problems, hyperthyroidism, cardiac failure, diabetes mellitus, infection, pheochromocytoma

Nutrition: Diet requirements vary with each type of procedure

Other Drugs: Beta-adrenergic blocking agent, oral cholecystographic agents, tricyclic antidepressants, MAO inhibitors, phenothiazines

Lab Tests: Leukocyte counts, red cell counts, prothrombin time, thyroid imaging, urinalysis

Iopamidol

Trade Name(s): Isovue

Chemically Related To: Radiopaque chemicals

Pregnancy Category: B

Medical Category: Radiopaque diagnostic aid

Accepted Indications: Intrathecal myelography, cisternography, intravascular angiocardiography, venography, brain and body imaging, urography, intraductal and intrasynovial

Mechanism of Action: Increases the absorption of x-rays

Absorption/Distribution: Rapidly distributed

Half life: 2 h

Peak activity: Intravascular: 5–{endash}40 min to peak opacification

Elimination: Renal

Research Notes: Impaired renal function prolongs excretion

Adult Dosage: Intrathecal: up to 4.5 g of iodine containing no more than 300 mg of iodine/mL

Elderly Dosage: Lower doses recommended especially if kidney function impaired

Child Dosage: 2–{endash}9 y: 15–{endash}30 mL as a single dose; 10–{endash}18 y: 20–{endash}50 mL as a single dose

Infant Dosage: Intravenous: up to 2 y –{endash} 10–{endash}15 mL as a single dose

Dosage Forms: Parenteral: various combinations of iopamidol and iodine/mL

By System: Systemic

Warnings: Do not use if solution is discolored or cloudy

Precautions: Intrathecal: avoid movement during and for several hours after administration

Frequent Side Effects: Headache, nausea/vomiting, backache, dizziness, stiff neck

Occasional Side Effects: Ringing in ears, blurred vision, loss of appetite, increased sweating

Rare Side Effects: Ventricular fibrillation or tachycardia, paralysis of legs, hypotension, renal impairment

Contraindications: Iodine sensitivity may cause anaphylactic shock

Antidotal Therapy: Major reaction: if needed, may include oxygen, cardiac massage, slow IV epinephrine, vasopressors, diazepam

Disease States: Dehydration, bleeding, significant infections, sickle cell disease, pheochromocytoma, diabetes mellitus

Other Drugs: Nephrotoxic medications, tricyclic antidepressants, beta-adrenergic blockers, antihypertensives, phenothiazines

Lab Tests: Leukocyte and red cell counts, thyroid imaging, urinalysis, platelet aggregation

Administrative Notes: Physically incompatible with other medications

Ipecac Syrup

Trade Name(s): Generic only

Pregnancy Category: C

Medical Category: Emetic

Accepted Indications: Nonspecific toxicity treatment

Mechanism of Action: Irritates gastric lavage mucosa and stimulates medullary trigger zone to induce vomiting

Adult Dosage: 15–{endash}30 mL with full glass of water, may be repeated in 20–{endash}30 min

Elderly Dosage: Same as adult dose

Child Dosage: 1–{endash}12 y: 15 mL with 1/2 to 1 full glass of water

Infant Dosage: Up to 6 m: administer only under physician's supervision; 6 m–{endash}1y: 5–{endash}10 mL with 1/2 to 1 full glass of water

Dosage Forms: Syrup: 15 mL and 30 mL

Contraindications: Seizures, decreased patient alertness, depressed gag reflux

Overdosage: Diarrhea, fast heartbeat, vomiting, stomach cramps, troubled breathing, tiredness, weakness

Disease States: Heart disease, strychnine poisoning, shock, unconsciousness, ingestion of corrosive materials or petroleum distillates

Other Drugs: Activated charcoal, carbonated beverages, antiemetics, milk or milk products

Ipratropium Bromide

Trade Name(s): Atrovent

Chemically Related To: Atropine

Pregnancy Category: B

Medical Category: Bronchodilator

Accepted Indications: Pulmonary emphysema, bronchitis

Unaccepted Indications: Bronchospasm (acute)

Mechanism of Action: Competitive inhibition of cholinergic receptors

Absorption/Distribution: Minimal absorption

Half life: 2 h

Peak activity: 1–{endash}2 h

Metabolism: Hepatic

Elimination: Fecal

Research Notes: Onset within 5–{endash}15 min; duration of action 3–{endash}4 h; no overdosage reported

Adult Dosage: Aerosol: 1–{endash}2 inhalations three or four times a day at least 4 h apart; inhalational solution: 0.125–{endash}0.25mg diluted to 3–{endash}5 mL administered via nebulization over 10–{endash}15 minutes and repeated q4–{endash}6h

Elderly Dosage: Same as adult dose

Child Dosage: Ages 5–{endash}12: for solution 0.125–{endash}0.25mg diluted to 3–{endash}5 mL administered via nebulization over 10–{endash}15 minutes q4–{endash}6h

Infant Dosage: Not established

Dosage Forms: Inhalation aerosol: 18 m{mu}g per metered spray; inhalation solution: .025%

By System: Respiratory

Precautions: Do not mix with cromolyn inhalation solution

Frequent Side Effects: Cough, headache, dizziness, nervousness, GI distress, dry mouth

Occasional Side Effects: Vision changes, difficulty in urination, metallic taste, nasal congestion, weakness

Rare Side Effects: Rash, stomatitis

Disease States: Bladder neck obstruction, prostatic hypertrophy, glaucoma, urinary retention

Other Drugs: Oral inhalation products of adrenocorticoids, glucocorticoids, cromolyn sodium, sympathomimetics, and antimuscarinics

Administrative Notes: Solutions diluted with NaCl injection (0.9% bacteriostatic) may be stored at room temperature for up to 7 d

Iron Dextran

Trade Name(s): InFeD

Pregnancy Category: C

Medical Category: Antianemic

Accepted Indications: Iron deficiency anemia

Absorption/Distribution: Majority absorbed within 72 h

Half life: 5–{endash}20 h

Adult Dosage: Dependent on patient weight

Elderly Dosage: Same as adult dose

Child Dosage: Same as adult dose

Infant Dosage: Under 4 m: not recommended

Dosage Forms: Injection: 50 mg/mL

Warnings: Protect from freezing

Frequent Side Effects: Tingling of hands, allergic reaction, backache, muscle pain, chills, dizziness, fever, increased sweating, headache, metallic taste, nausea, vomiting, pain at injection site, brown discoloration of skin

Antidotal Therapy: May include ipecac, gastric emesis, deferoxamine

Disease States: Hemochromatosis, hemosiderosis, anemic conditions, alcoholism, allergies, asthma, hepatitis, hepatic function impairment, kidney disease, intestinal tract inflammatory conditions, peptic ulcer, rheumatoid arthritis

Other Drugs: Acetohydroxamic acid, alcohol, antacids, calcium supplements, coffee, eggs, milk or milk products, tea, whole-grain breads, cimetidine, ciprofloxacin, deferoxamine, dimercaprol, etidronate, pancreatin, pancrelipase, penicillamine, trientine, oral tetracyclines, oral zinc supplements

Lab Tests: Ferritin concentrations, hemoglobin and hematocrit

Administrative Notes: Injection only in buttock

Isocarboxazid

Trade Name(s): Marplan

Chemically Related To: Isoniazid

Pregnancy Category: Increased risk of fetal malformations in 1st trimester

Medical Category: Antidepressant, antipanic agent, vascular headache prophylactic

Accepted Indications: Mental depression, panic disorders, vascular headache prophylaxis

Mechanism of Action: Inhibits MAO activity

Absorption/Distribution: Well absorbed

PO: 3–{endash}5 h

Metabolism: Hepatic

Elimination: Renal

Research Notes: Onset of action, 7–{endash}10 d; duration of action, 10 d

Adult Dosage: 10–{endash}60 mg/d

Elderly Dosage: Over 60 y: use extreme caution

Child Dosage: Up to 16 y: safety not established

Infant Dosage: Safety not established

Dosage Forms: Tablets: 10 mg

By System: CNS

Warnings: May cause drowsiness; avoid alcohol and food and drinks containing tyramine

Frequent Side Effects: Orthostatic hypotension, anticholinergic effects, blurred vision, headache, increased appetite, weakness

Occasional Side Effects: Diarrhea, edema, anorexia, chills, constipation, dry mouth

Rare Side Effects: Hepatitis, leukopenia, parkinsonism, hypertensive crisis

Contraindications: Alcoholism, CHF, liver or kidney problems, pheochromocytoma

Overdosage: Severe anxiety, confusion, seizures, dizziness, drowsiness, fever, hallucinations, muscle stiffness

Antidotal Therapy: May include vomiting or gastric lavage, diazepam (IV), IV fluids; dilute pressor agent

Disease States: Heart problems, headaches, hypertension, diabetes mellitus, schizophrenia, liver problems, parkinsonism

Other Drugs: Alcohol, anticoagulants, tricyclic antidepressants, beta-adrenergic blockers, insulin, rauwolfia, phenothiazines, methyldopa, trazodone, fluoxetine, cocaine, buspirone, cyclobenzaprine, guanethidine, levodopa, narcotics, sympathomimetics

Administrative Notes: Limit amount of drug given to persons with suicidal tendencies

Isoetharine Hydrochloride

Trade Name(s): Arm-A-Med Isoetharine, Bronkosol, Dey-Dose Isoetharine

Chemically Related To: Isoproterenol

Pregnancy Category: C

Medical Category: Bronchodilator, asthma prophylactic

Accepted Indications: Bronchial asthma, bronchitis, bronchospasm, emphysema, obstructive pulmonary disease, anaphylactic reaction, insect bites

Mechanism of Action: Stimulates beta-adrenergic receptors to relax bronchial smooth muscle

Absorption/Distribution: Rapidly absorbed from respiratory tract

Peak activity: Inhalation 15 min–{endash}1 h

Metabolism: GI tract, lungs, liver

Elimination: Renal

Research Notes: Onset of action, 1–{endash}6 h; duration of action, 1–{endash}4 h

Adult Dosage: Dosage depends on method of administration: hand-bulb nebulizer, intermittent positive-pressure breathing, or oxygen aerosolization

Child Dosage: Not established

Infant Dosage: Not established

Dosage Forms: Inhalation solution: 0.062%, 0.08%, 0.1%, 0.125%, 0.14%, 0.16%, 0.17%, 0.2%, 0.25%, 0.5%, and 1%

By System: Respiratory

Warnings: For oral inhalation only

Precautions: Do not take extra medication; understand administration technique

Frequent Side Effects: Nervousness, trembling

Occasional Side Effects: Coughing, dizziness, tachycardia, headache, muscle cramps

Rare Side Effects: Chest pain, numbness in extremities, bruising

Overdosage: Chest pain, chills, seizures, headache, nausea/vomiting, weakness, respiratory distress

Antidotal Therapy: May include supportive therapy, cardioselective beta-adrenergic blocker

Disease States: Brain damage, seizures, cardiovascular problems, hyperthyroidism

Other Drugs: Beta blockers, cocaine, digitalis, MAO inhibitors, ergotamine, tricyclic antidepressants

Lab Tests: Serum potassium concentrations

Administrative Notes: Do not use dark, discolored solution or any solution containing particulate matter

Isoetharine Mesylate

Trade Name(s): Bronkometer

Chemically Related To: Phenylethyl amines

Pregnancy Category: C

Medical Category: Bronchodilator, asthma prophylactic

Accepted Indications: Bronchial asthma, bronchitis, bronchospasm, emphysema, obstructive pulmonary disease, allergic reactions, anaphylactic reactions

Mechanism of Action: Relaxes bronchial smooth muscle

Absorption/Distribution: Rapidly absorbed from respiratory tract

Peak activity: 5–{endash}15 min

Metabolism: GI tract, lungs, liver

Elimination: Renal

Research Notes: Bronchodilation lasts 1-4 h

Adult Dosage: 340 m{mu}g repeated after 1–{endash}2 min; repeat q4h

Child Dosage: Not established

Infant Dosage: Not established

Dosage Forms: Inhalation aerosol: 0.61%, 340 m{mu}g/metered spray

By System: Respiratory

Occasional Side Effects: Dizziness, dry mouth, tachycardia, headache, nausea, trembling, weakness

Overdosage: Chest pain, chills, seizures, headache, nausea/vomiting, weakness, respiratory distress

Antidotal Therapy: May include gastric lavage, cardioselective beta-adrenergic blocker

Disease States: Coronary artery disease, hypertension, hyperthyroidism, pheochromocytoma

Other Drugs: Hydrocarbon anesthetics, antihypertensives, beta-adrenergic blockers, CNS stimulants, digitalis glycosides, levodopa, nitrates

Lab Tests: Serum potassium concentrations

Administrative Notes: Instruct patient in use of aerosol and mouthpiece

Isoflurophate

Trade Name(s): Floropryl

Pregnancy Category: X

Medical Category: Antiglaucoma agent

Accepted Indications: Glaucoma, esotropia

Mechanism of Action: Cholinesterase inhibitor

Peak activity: Within 24 h

Adult Dosage: Antiglaucoma: topical, to the conjunctiva, 0.5 cm of 0.025% ointment once q3d to t.i.d.; cyclostimulant: topical, to the conjunctiva, 0.5 cm of 0.025% ointment once daily at bedtime for 2 w, then once a w to once q2d for 2 m; diagnostic aid: topical, to the conjunctiva, 0.5 cm of 0.025% ointment once daily at bedtime for 2 w

Elderly Dosage: Use with caution

Child Dosage: Young children: not recommended; older children: same as adult dose

Infant Dosage: Not recommended

Dosage Forms: Ophthalmic ointment: 0.025%

Warnings: Protect from freezing

Frequent Side Effects: No incidence given for accommodative myopia, browache, headache, miosis, twitching eyelids, watering eyes

Rare Side Effects: Retinal detachment, burning of eyes, eye pain

Contraindications: Retinal detachment, active uveitis

Overdosage: Burning of eyes, bradycardia bronchospasm, severe hypotension, watering of mouth

Antidotal Therapy: May include atropine sulfate, IV pralidoxime chloride

Disease States: Asthma, recent myocardial infarction, epilepsy, hypertension, iritis

Other Drugs: Anticholinergics, cocaine, succinylcholine, physostigmine, anesthetics, antimyasthenics, cholinesterase inhibitors

Lab Tests: Gonioscopy

Isometheptene Mucate

Trade Name(s): Not available as a single agent

Medical Category: Vascular headache suppressant (migraine), sympathomimetic

Mechanism of Action: Indirect-acting sympathomimetic–{endash}constricts arterioles

Metabolism: Hepatic

Elimination: Renal

By System: Sympathetic nervous system

Antidotal Therapy: May include emesis/gastric lavage, treat symptoms of excessive sympathetic stimulation

Isoniazid

Trade Name(s): INH, Laniazid, Nydrazid, Tubizid

Chemically Related To: Para-aminobenzoic acid

Pregnancy Category: C

Medical Category: Antimycobacterial

Accepted Indications: Tuberculostatic, mycobacterial infections

Mechanism of Action: Inhibition of mycolic acid synthesis and disruption of the cell wall

Absorption/Distribution: Rapidly absorbed after oral administration; first-pass elimination; widely distributed, including CSF

Half life: 0.5-1.6 h

PO: 1–{endash}2 h

Metabolism: Hepatic

Elimination: Renal

Research Notes: Half-life varies; 2-20 h if slow acetylator

Adult Dosage: Up to 300 mg/d

Elderly Dosage: Same as adult dose

Child Dosage: 10 mg/kg/d up to 300 mg/d

Infant Dosage: Decrease dose

Dosage Forms: Syrup: 50 mg/5 mL; tablets: 50 mg, 100 mg, and 300 mg; injection: 100 mg/mL

Warnings: Continue medicine for full length of treatment; avoid alcohol and tyramine–{endash}containing foods (tuna, skipjack, certain cheeses)

Precautions: Take pyridoxine concurrently to prevent or minimize symptoms of peripheral neuritis; in elderly patients, watch for incidence of hepatitis; newborns may have prolonged elimination

Frequent Side Effects: Hepatitis, peripheral neuritis, GI disturbances

Rare Side Effects: Blood dyscrasias, neurotoxicity, optic neuritis

Overdosage: GI disturbances, metabolic acidosis, dizziness, slurred speech, lethargy, disorientation, seizures

Antidotal Therapy: May include establishing an airway and adequate respiration exchange, administer IV pyridoxine, control seizures with diazepam, do not use syrup of ipecac

Disease States: Alcoholism, hepatic function impairment, severe renal failure, seizure disorders

Nutrition: Avoid tuna or skipjack, cheese such as Swiss or Cheshire (tyramine foods).

Other Drugs: Acetaminophen, alcohol, benzodiazepines, theophylline, phenytoin, neurotoxic medications, enflurane, hepatotoxic medications

Lab Tests: Urine glucose determinations, serum bilirubin

Administrative Notes: With injection, crystallization may occur at low temperature; upon warming to room temperature, crystals redissolve. When dispensing syrup, include a calibrated liquid-measuring device. Use pyridoxine supplement.

Isoniazid/Rifampin

Trade Name(s): Rifamate, Rimactane/INH

Medical Category: Antibacterial, antimycobacterial

Accepted Indications: Tuberculosis

Unaccepted Indications: Initial treatment or prophylaxis of pulmonary tuberculosis, meningococcal infections, treatment of asymptomatic meningococcal carriers

Adult Dosage: 600 mg of rifampin and 300 mg of isoniazid once daily

Elderly Dosage: Same as adult dose

Child Dosage: Not recommended

Dosage Forms: Capsules: 150 mg/300 mg, 300 mg/300 mg; pack of 30 30-mg isoniazid tablets and 60 300-mg rifampin capsules

Isosorbide Dinitrate

Trade Name(s): Dilatrate-SR, Isobid, Isorbid, Isordil, Isotrate, Sorbitrate

Chemically Related To: Nitroglycerin

Pregnancy Category: C

Medical Category: Antianginal, vasodilator

Accepted Indications: Angina pectoris, CHF

Mechanism of Action: Dilates coronary arteries, increases myocardial oxygen supply

Absorption/Distribution: Bioavailability is 59% after sublingual administration; 22% after oral administration

Half life: Sublingual, 60 min; oral, 4 h

Metabolism: Hepatic

Elimination: Renal

Research Notes: Duration of action: oral capsules and tablets, 4–{endash}6 h; chewable tablets, 1–{endash}2 h; sublingual tablets, 1–{endash}2 h; extended-release tablets, 12 h

Adult Dosage: 20–{endash}160 mg/d

Elderly Dosage: May be more sensitive to hypotensive effects

Child Dosage: Dosage not established

Infant Dosage: Dosage not established

Dosage Forms: Capsules: 40 mg; extended-release capsules: 40 mg; tablets 2.5 mg, 5 mg, 10 mg, 20 mg, 30 mg, and 40 mg; chewable tablets: 5 mg and 10 mg; extended-release tablets: 40 mg; sublingual tablets: 2.5 mg, 5 mg, and 10 mg

By System: Cardiovascular

Precautions: Swallow tablets whole; caution with alcohol, tolerance may occur

Frequent Side Effects: Tachycardia, flushing of face and neck, headache, nausea and vomiting, orthostatic hypotension

Occasional Side Effects: Sore reddened skin

Rare Side Effects: Blurred vision, dry mouth, rash

Overdosage: Bluish lips, fingernails, or palms of hands (methemoglobinemia); dizziness; feeling of extreme pressure in head; shortness of breath; extreme tiredness; convulsions; fever; weak tachycardia

Antidotal Therapy: If excessive hypotension occurs, elevate the legs to aid venous return; if necessary, administer IV alpha-adrenergic agonist

Disease States: Severe anemia, cerebral hemorrhage, recent head trauma, glaucoma, renal and hepatic function impairment, hyperthyroidism, recent myocardial infarction

Other Drugs: Alcohol, antihypertensives, vasodilators, heparin, sympathomimetics, acetylcholine

Lab Tests: Serum cholesterol determination, methemoglobin concentration, urine catecholamine concentrations, urine vanillymandelic acid concentration

Administrative Notes: Do not dispense sublingual tablets in child-resistant containers

Isosorbide Mononitrate

Trade Name(s): IMDUR, ISMO, Monoket

Chemically Related To: Nitrates

Pregnancy Category: C

Medical Category: Antianginal

Accepted Indications: Angina pectoris due to coronary artery disease (treatment and prophylaxis)

Unaccepted Indications: Acute angina attacks

Mechanism of Action: Thought to cause reduction of myocardial oxygen demand

Absorption/Distribution: Nearly 100% absorbed

Half life: 5 h

Metabolism: Hepatic

Elimination: Renal

Research Notes: Onset of action for oral tablets 1 h

Adult Dosage: Tablets: 20 mg b.i.d., with the 2 doses given 7 h apart; extended-release tablets: 30–{endash}60 mg b.i.d., the dosage being increased after several d to 120 mg daily in divided doses as tolerated

Elderly Dosage: Same as adult dose

Child Dosage: Not established

Infant Dosage: Not established

Dosage Forms: Tablets: 10 mg and 20 mg; extended-release tablets: 60 mg

By System: Cardiovascular

Frequent Side Effects: Flushing of face and neck, headache, nausea or vomiting, orthostatic hypotension, restlessness, tachycardia

Occasional Side Effects: Sore, reddened skin

Rare Side Effects: Blurred vision, dry mouth, headache, rash

Overdosage: Bluish-colored lips, fingernails, or palms of hands (methemoglobinemia); extreme dizziness or fainting; feeling of extreme pressure in head; shortness of breath; unusual tiredness or weakness; weak and fast heartbeat, fever, and convulsions

Antidotal Therapy: May include elevating legs; monitoring of methemoglobin concentrations in blood

Disease States: Anemia, cerebral hemorrhage, recent head trauma, glaucoma, hyperthyroidism, recent myocardial infarction

Other Drugs: Alcohol, antihypertensives, other vasodilators

Lab Tests: Blood pressure and heart rate determinations

Isotretinoin

Trade Name(s): Accutane

Chemically Related To: Vitamin A

Pregnancy Category: X, highly teratogenic

Medical Category: Antiacne agent, antirosacea agent, keratinization stabilizer

Accepted Indications: Acne vulgaris, severe rosacea, severe keratinization disorders

Unaccepted Indications: Mild to moderate acne vulgaris

Mechanism of Action: Reduces sebaceous gland size and inhibits sebaceous gland activity

Absorption/Distribution: PO: rapidly absorbed from GI tract

Half life: 10–{endash}20 h

PO: 3 h

Metabolism: Hepatic

Elimination: Biliary, renal

Research Notes: Has caused major human fetal abnormalities

Adult Dosage: 0.5–{endash}2 mg/kg/d for 15–{endash}20 w

Elderly Dosage: Not established

Child Dosage: Not recommended

Infant Dosage: Not recommended

Dosage Forms: Capsules 10 mg, 20 mg, and 40 mg

Warnings: Do not donate blood for 30 d after therapy, to prevent pregnant patients from receiving the drug in the blood; Avoid concurrent ingestion of vitamin A and vitamin supplements containing vitamin A

Precautions: Avoid pregnancy

Frequent Side Effects: Burning, redness, itching, nosebleeds, scaling, dry mouth

Occasional Side Effects: Mental depression, skin infection, rash, dry eyes, headache, GI upset

Rare Side Effects: Bleeding or inflammation of gums, cataracts, hepatitis, inflammatory bowel disease, thinning of hair, mood changes, optic neuritis

Contraindications: During pregnancy and in women of childbearing potential

Disease States: High alcohol intake, obesity, diabetes mellitus

Other Drugs: Abrasive or medicated soaps or cleansers, alcohol–{endash}containing preparations, photosensitizing medications, tetracyclines, vitamin A, etretinate, tretinoin

Lab Tests: White blood cell counts, serum cholesterol concentrations, uric acid concentration, fasting blood glucose concentrations, platelet count

Isoxsuprine Hydrochloride

Trade Name(s): Vasodilan

Chemically Related To: Isoproterenol

Pregnancy Category: Safety not established

Medical Category: Vasospastic therapy adjunct, senility symptoms treatment adjunct, premature labor inhibitor, antidysmenorrhea agent

Accepted Indications: Cerebrovascular insufficiency, peripheral vascular disease, premature labor (possibly effective)

Mechanism of Action: Direct effect on vascular smooth muscle; vitamin low B2 activity

Absorption/Distribution: Well absorbed

Half life: 1.25 h

Metabolism: Hemic

Elimination: Renal

Research Notes: Onset of action: IV, 10 min; PO, 1 h

Adult Dosage: 10–{endash}20 mg t.i.d. or q.i.d.

Elderly Dosage: Danger of hypothermia may be increased

Dosage Forms: Tablets: 10 mg and 20 mg

By System: Vascular

Warnings: Avoid smoking

Precautions: Use of drug in premature labor should be discontinued when delivery is imminent

Frequent Side Effects: Nausea/vomiting (with injection only)

Occasional Side Effects: Nausea/vomiting (PO)

Rare Side Effects: Chest pain, hypotension, shortness of breath, allergy, pulmonary edema

Contraindications: Avoid use in premature labor if patient has hemorrhage, toxemia, pulmonary hypertension, or cardiac disorders

Disease States: Bleeding disorders, glaucoma, severe heart problems, hypotension, tachycardia

Other Drugs: Tobacco

Lab Tests: Serum potassium, free fatty acids, blood glucose, serum insulin

Administrative Notes: Take with food

Isradipine

Trade Name(s): DynaCirc

Chemically Related To: Nifedipine

Pregnancy Category: C

Medical Category: Antianginal, antihypertensive

Accepted Indications: Angina pectoris, hypertension, Raynaud's phenomenon

Mechanism of Action: Decreases calcium ion movement into cardiac and smooth muscle

Absorption/Distribution: Rapid and nearly complete

Half life: Early phase, 1.5–{endash}2 h; terminal phase, 8 h

PO: 2–{endash}4 w

Metabolism: Hepatic

Elimination: Renal, biliary, fecal

Research Notes: Onset of action, 2–{endash}3 h; duration of action, more than 12 h

Adult Dosage: 2.5 mg b.i.d. up to 10 mg b.i.d.

Elderly Dosage: Over 65 y: bioavailability increases

Dosage Forms: Capsules: 2.5 mg and 5 mg

By System: Cardiovascular

Precautions: Practice good dental hygiene

Frequent Side Effects: Headache

Occasional Side Effects: Skin rash, angina, hypotension, swelling of extremities, tachycardia, diarrhea

Rare Side Effects: CHF, constipation, bleeding gums

Contraindications: Severe hypotension, second- or third-degree heart block, sick sinus syndrome

Antidotal Therapy: May include IV fluids, IV dopamine, IV lidocaine, IV atropine

Disease States: Heart failure, cardiogenic shock, liver or kidney problems, hypotension

Other Drugs: Hypokalemia–{endash}producing medications, estrogens, digitalis glycosides, beta-adrenergic blockers

Lab Tests: EKG, hepatic enzymes, prolactin, arterial blood pressure

Itraconazole

Trade Name(s): Sporanox

Chemically Related To: Ketoconazole

Pregnancy Category: C

Medical Category: Antifungal

Accepted Indications: Systemic fungal infections, histoplasmosis, pulmonary or extrapulmonary blastomycosis

Mechanism of Action: Inhibits cytochrome P450 functions that deplete cell membranes of ergosterol

Absorption/Distribution: Complete absorption

Half life: 64 h

Metabolism: Hepatic

Research Notes: Therapy should be continued at least 3 w

Adult Dosage: 200 mg once or twice daily

Elderly Dosage: Same as adult dose

Child Dosage: Safety and efficacy not established

Infant Dosage: Safety and efficacy not established

Dosage Forms: Capsules: 100 mg

Warnings: Inadequate length of treatment could result in return of infection

Other Drugs: Astemizole, terfenadine, didanosine, H2receptor antagonists, cyclosporine, warfarin, antiepileptic drugs, cisapride, simvastatin

Administrative Notes: Food increases bioavailability

Kanamycin Sulfate

Trade Name(s): Kantrex

Chemically Related To: Aminoglycosides

Pregnancy Category: D

Medical Category: Systemic antibacterial

Accepted Indications: Serious systemic infections, including infections by aerobic gram-negative bacilli, some gram-positive organisms, and most enterobacteriaceae; oral preparation; preoperative bowel preparation; hepatic coma

Unaccepted Indications: Staphylococcal infections (routine treatment); and uncomplicated urinary tract infections (initial treatment)

Mechanism of Action: Disruption of bacterial cytoplasmic membranes leading to cell death

Absorption/Distribution: Rapidly and completely absorbed after injection; distributed to all extracellular fluid. Negligible absorption after oral administration

Half life: 2–{endash}4 h

IM: 0.5–{endash}1.5 h

IV: 30 min after end of 30–{endash}min infusion

Elimination: Renal

Adult Dosage: Injection: up to 15 mg/kg/d; capsules: up to 12 g/d

Elderly Dosage: Decreased dose may be required

Child Dosage: Same as adult dose

Infant Dosage: Caution in premature infants and neonates because of immature renal capability

Dosage Forms: Injection: 37.5 mg/mL, 250 mg/mL and 333.3 mg/mL; capsules: 500 mg

By System: Systemic antibacterial

Precautions: Important to receive medication for full course of therapy and on schedule

Frequent Side Effects: Nephrotoxicity, muscle twitching, numbness, seizures, ototoxicity, clumsiness, dizziness, nausea and vomiting, unsteadiness

Occasional Side Effects: Optic neuritis

Rare Side Effects: Neuromuscular blockade

Antidotal Therapy: May include symptomatic and supportive treatment

Disease States: Myasthenia gravis, parkinsonism, eighth cranial nerve impairment, dehydration, renal function impairment, intestinal obstruction, ulcerative lesions of the bowel

Other Drugs: Antimyasthenics, beta-lactam antibiotics, IV indomethacin, ototoxic medications, neuromuscular blocking agents

Lab Tests: BUN; serum calcium, magnesium, potassium, sodium and creatinine

Administrative Notes: May also be administered as an irrigation in a concentration of 0.25%, administered as an aerosol nebulization, and administered intraperitoneally in a concentration of 2.5%

Kaolin

Trade Name(s): Not available as a single agent

Chemically Related To: Aluminum silicate

Medical Category: Pharmaceutical adjunct, adsorbent

Kaolin/Paregoric/Pectin

Trade Name(s): Kaopectolin-Pg, Parepectolin

Pregnancy Category: C

Medical Category: Antidiarrheal

Accepted Indications: Diarrhea

Dosage Forms: Suspension

Kaolin/Pectin

Trade Name(s): Kao-Spen, Kapectolin

Pregnancy Category: Problems in humans not documented

Medical Category: Adsorbent antidiarrheal

Accepted Indications: Diarrhea

Mechanism of Action: Adsorbent and protectant

Absorption/Distribution: Not absorbed

Adult Dosage: 60–{endash}120 mL after each loose bowel movement

Elderly Dosage: Use with caution

Child Dosage: Up to 3 y: not recommended; 3–{endash}6 y: 15–{endash}30 mL after each loose bowel movement; 6–{endash}12 y: 30–{endash}60 mL after each loose bowel movement; 12 y and over: 45–{endash}60 mL after each loose bowel movement

Infant Dosage: Up to 3 y: not recommended

Dosage Forms: Oral suspension: 5.2 g/260 mg/30 mL and 5.85 g/130 g/30 mL

Warnings: Protect from freezing; shake well

Frequent Side Effects: Constipation-dose related

Contraindications: Dehydration, acute dysentery

Disease States: Parasite-associated diarrhea

Other Drugs: Anticholinergics, Loxapine, Xanthines, antidyskinetics, digitalis glycosides, lincomycins, phenothiazines, thioxanthenes, theophylline

Ketamine Hydrochloride

Trade Name(s): Ketalar

Pregnancy Category: Not shown to cause adverse effects

Medical Category: General anesthetic

Accepted Indications: General anesthesia, local anesthesia

Mechanism of Action: Unknown

Absorption/Distribution: Rapidly distributed to tissues, fat, liver, and lung

Half life: 7–{endash}11 min (distribution), 2–{endash}3 h (elimination)

IM: 3–{endash}4 min

IV: 30 sec

Metabolism: Hepatic

Elimination: Renal, fecal

Adult Dosage: IV: 1–{endash}2 mg/kg as single dose, up to 4.5 mg/kg. IM: 5–{endash}10 mg/kg as a single dose, up to 13 mg/kg

Elderly Dosage: Same as adult dose

Child Dosage: Same as adult dose

Dosage Forms: Injection: 10 mg/mL, 50 mg/mL, and 100 mg/mL

Warnings: Protect from freezing

Frequent Side Effects: Increased blood pressure, tonic and clonic muscle movements, tachycardia, tremor, mood changes, vivid dreams, hallucinations

Occasional Side Effects: Bradycardia, hypotension, respiratory depression, vomiting

Rare Side Effects: Nausea, double vision, nystagmus, rash

Contraindications: Heart failure, hypertension, MI, stroke

Antidotal Therapy: May include mechanical respiration, barbiturate

Disease States: Alcohol abuse, CHF, eye injury, thyrotoxic, increased CSF pressure, increased intraocular pressure, psychiatric disorders

Other Drugs: Anesthetics, CNS depressants

Lab Tests: CSF pressure

Ketoconazole

Trade Name(s): Nizoral

Chemically Related To: Unique compound

Pregnancy Category: C

Medical Category: Antifungal (systemic and topical), antiadrenal, antineoplastic

Accepted Indications: Blastomycosis, candidiasis, chromomycosis, coccidioidomycosis, histoplasmosis, paracoccidioidomycosis, tinea corporis, tinea cruris, tinea pedis, pityriasis versicolor, cutaneous candidiasis, seborrheic dermatitis, dandruff, Cushing's syndrome

Unaccepted Indications: Fungal meningitis, Aspergillus infection, Zygomycetes infection

Mechanism of Action: Fungistatic; inhibits biosynthesis of ergosterol

Absorption/Distribution: Oral forms readily absorbed and well distributed; topical forms have little or no absorption

Half life: Alpha phase 1.4–{endash}3.3 h; beta phase 8 h

PO: 1–{endash}4 h

Metabolism: Hepatic

Elimination: Biliary, renal

Adult Dosage: Tablets: 200–{endash}400 mg once daily up to 1.2 g; cream: topical to the affected area once daily or b.i.d.; shampoo: topical as a shampoo every 4 d for 4 w, then once every 1–{endash}2 w

Elderly Dosage: Same as adult dose

Child Dosage: Over 2 y, tablets: 3.3–{endash}10 mg/kg once daily. Under 2y: dosage not established. Cream and shampoo, safety not established

Dosage Forms: Tablets: 200 mg; cream: 2%; shampoo: 2%

Warnings: May cause dizziness; avoid alcohol

Precautions: Wear sunglasses and avoid bright light

Frequent Side Effects: Phlebitis, itching, stinging, irritation

Occasional Side Effects: GI upset, hypersensitivity, flushing of face or skin

Rare Side Effects: Hepatitis, CNS effects, gynecomastia, impotence, photophobia, menstrual irregularities, agranulocytosis, anemia, exfoliative skin disorders, hepatotoxicity, thrombocytopenia

Antidotal Therapy: No specific antidote; may include symptomatic treatment; gastric lavage with sodium bicarbonate solution

Disease States: Achlorhydria, hypochlorhydria, alcoholism, liver problems

Other Drugs: Alcohol, hepatotoxic drugs, rifampin, cyclosporine, terfenadine, antacids, anticholinergics, antispasmodics, histamine H2-receptor antagonists, omeprazole, astemizole, didanosine, sucralfate, isoniazid, phenytoin, warfarin

Lab Tests: Bilirubin, alanine phosphatase, aspartate aminotransferase, testosterone, corticosteroids

Ketoprofen

Trade Name(s): Orudis, Rhodis

Chemically Related To: Propionic acid derivative

Pregnancy Category: B

Medical Category: Antirheumatic, analgesic, antigout, antidysmenorrheal, vascular headache suppressant

Accepted Indications: Rheumatic disease, pain treatment, gouty arthritis, inflammation, dysmenorrhea, vascular headache

Mechanism of Action: Decreases production of prostaglandins

Absorption/Distribution: Rapid, complete absorption

Half life: 30 min

PO: 2 h

Metabolism: Hepatic, other tissues

Elimination: Renal

Adult Dosage: 150–{endash}300 mg/d divided into 3 or 4 doses

Elderly Dosage: Decreased dose may be necessary because of prolonged half-life and serum concentration

Dosage Forms: Capsules: 25 mg, 50 mg, and 75 mg; delayed-release tablets: 50 mg and 100 mg

By System: CNS

Warnings: Avoid alcohol; swallow delayed-release tablets whole

Precautions: Caution if surgery required

Frequent Side Effects: Stomach cramps, gas, constipation, diarrhea, nausea, nervousness, fluid retention

Occasional Side Effects: Vomiting, drowsiness, dizziness, GI irritation

Rare Side Effects: Photosensitivity, tachycardia, thirst, change in hearing, muscle cramps, peptic ulcer

Contraindications: Nasal polyps associated with aspirin-induced bronchospasm

Antidotal Therapy: May include emesis or gastric lavage; activated charcoal; antacids; plasma expanders; vital function support

Disease States: Hypertension, sepsis, hemophilia, liver problems, stomatitis, systemic lupus erythematosus

Other Drugs: Anticoagulants, antidiabetics, antihypertensives, NSAIDs, gold compounds, lithium, methotrexate

Lab Tests: Bleeding time, serum sodium concentration, liver function, hematocrit, hemoglobin

Administrative Notes: Analgesic action subject to a ceiling effect

Ketorolac Tromethamine

Trade Name(s): Toradol

Chemically Related To: NSAIDs

Pregnancy Category: C

Medical Category: Analgesic

Accepted Indications: Pain

Unaccepted Indications: Chronic rheumatic disease, chronic pain, obstetric analgesia

Mechanism of Action: Inhibits activity of cyclo-oxygenase

Absorption/Distribution: Rapid and complete

Half life: IM: 3.5–{endash}9.2 h (elimination); PO: 2.4–{endash}9 h (elimination)

PO: 20–{endash}60 min

IM: 0.5–{endash}1 h

Elimination: Renal

Research Notes: Onset of action 0.5–{endash}1 h;duration of action, oral: 4–{endash}6 h, IM: 6 h

Adult Dosage: Tablets: 10 mg q.i.d.; injection: 30 mg q.i.d.

Elderly Dosage: Tablets: same as adult dose; injection: 15 mg q.i.d.

Child Dosage: Not established

Infant Dosage: Not established

Dosage Forms: Tablets: 10 mg; injection: 15 mg/mL and 30 mg/mL

Warnings: Chronic use not recommended; potential for GI toxicity

Frequent Side Effects: Edema, abdominal pain, indigestion, nausea, bruising at injection site, drowsiness

Occasional Side Effects: Hypertension, purpura, rash, stomatitis, diarrhea, dizziness, headache, burning at injection site, increased sweating, impaired renal function, GI irritation

Rare Side Effects: Anaphylaxis, asthma, bronchospasm, dyspnea, postoperative bleeding from wound, bloody stools, convulsions, edema of tongue, exfoliative dermatitis, fainting, pain in lower back, cloudy urine, hallucinations, laryngeal edema, nephritis, nosebleeds, oliguria, peptic ulceration, pulmonary edema, rectal bleeding, renal failure, Stevens-Johnson syndrome, thrombocytopenia, toxic epidermal necrolysis, pain at injection site, bloating, constipation, vomiting, feeling of fullness in GI tract

Contraindications: Peptic ulcer, hemophilia, renal impairment

Antidotal Therapy: May include supportive treatment, dialysis in cases of renal failure

Disease States: CHF, hypertension, diabetes mellitus, asthma, sepsis, allergic reaction, cholestasis, hepatitis, alcoholism, tobacco use, compromised cardiac function, edema, extracellular volume depletion, hepatic function impairment, systemic lupus erythematosus

Other Drugs: Heparin, thrombolytics, NSAIDs, cefotetan, lithium, valproic acid, anticoagulants, aspirin and other salicylates, cefamandole, cefoperazone, moxalactam, plicamycin, methotrexate, probenecid

Lab Tests: Bleeding time, BUN, creatinine

Administrative Notes: Protect from light; not recommended for chronic use

Labetalol Hydrochloride

Trade Name(s): Normodyne, Trandate

Chemically Related To: Propranolol

Pregnancy Category: C

Medical Category: Antiadrenergic, antianginal, antihypertensive, pheochromocytoma therapy adjunct

Accepted Indications: Angina pectoris, hypertension, adjunct pheochromocytoma

Mechanism of Action: Competitively blocks sympathetic neurotransmitters

Absorption/Distribution: Low lipid solubility, totally absorbed

Half life: 6–{endash}8 h

PO: 2–{endash}4 h

IV: 5 min

Metabolism: Hepatic

Elimination: Renal, biliary/fecal

Research Notes: Bioavailability reduced by first-pass elimination

Adult Dosage: Tablets, initial 100 mg b.i.d. maintenance 200-400 mg b.i.d., injection 20 mg initially, additional injections of 40 mg and 80 mg may be given at 10 minute intervals

Elderly Dosage: Chances of hypothermia and myocardial depression may be increased

Dosage Forms: Tablets: 100 mg, 200 mg, and 300 mg; injection: 5 mg/mL

By System: Cardiovascular

Warnings: Increases sensitivity to cold, may cause drowsiness

Precautions: Caution if surgery required

Frequent Side Effects: Decreased sexual ability

Occasional Side Effects: CHF, dizziness, bronchospasm, postural hypotension

Rare Side Effects: Bradycardia, leukopenia, depression, diarrhea

Contraindications: Cardiac failure, cardiogenic shock, heart block, sinus bradycardia, hypotension

Overdosage: Bradycardia, dizziness, fainting, arrhythmia, bluish fingernails

Antidotal Therapy: May include gastric lavage. Supportive measures could include atropine sulfate, glucagon, inotropic agents

Disease States: Allergy, asthma, emphysema, CHF, diabetes mellitus, depression, renal and liver problems, psoriasis

Nutrition: Sodium restriction/diet

Other Drugs: Cocaine, estrogens, MAO inhibitors, xanthines, sympathomimetics, allergen immunotherapy, clonidine, guanabenz

Lab Tests: Glaucoma screening test; urinary amphetamine determination; blood glucose; BUN, and serum uric acid concentrations

Administrative Notes: May be given by IV injection or continuous IV infusion

Lactic Acid

Trade Name(s): Lactinol

Chemically Related To: Lactic acid

Pregnancy Category: A

Medical Category: Humectant

Accepted Indications: Moisturizing and softening of dry, scaly skin, ichthyosis vulgaris, itching

Research Notes: Vitamin E sometimes added as a healing agent

Adult Dosage: Rub thoroughly b.i.d. on affected area

Dosage Forms: Lotion: 8 oz bottle; cream: 4 oz jar

By System: Topical

Warnings: External use only; avoid contact with eyes or lips

Precautions: Keep out of reach of children

Lactic Acid/Salicylic Acid

Trade Name(s): Bifilm, Co-flex, Duofilm, Lactisol, Salactic Film, Verukan

Medical Category: Keratolytic

Accepted Indications: Wart removal

Dosage Forms: Topical solution: 16.7%/16.7%, 17%/17%, 10%/20%, 20%/20%

Lactulose

Trade Name(s): Cholac, Chronulac, Constilac, Constulose, Duphalac, Portalac

Chemically Related To: Glucose

Pregnancy Category: C

Medical Category: Laxative, hyperosmotic, antihyperammonemic

Accepted Indications: Hyperammonemia

Mechanism of Action: Hyperosmotic

Absorption/Distribution: Minimal absorption

PO: 30–{endash}60 min

Metabolism: By colonic bacteria

Elimination: Renal

Research Notes: Soft, formed stool. Has no effect on small intestine. Lowers pH of colon

Adult Dosage: 15–{endash}30 mL/d up to maximum of 60 mL

Child Dosage: Not established

Infant Dosage: Laxatives should not be given up to 6 y unless prescribed by a physician

Dosage Forms: Syrup

By System: GI tract

Warnings: Use with caution in diabetics; high in sodium

Precautions: Drink a full glass of liquid or more with each dose to prevent dehydration

Occasional Side Effects: Cramping, diarrhea, gas formation, increased thirst

Contraindications: Dehydration, renal impairment

Other Drugs: Anticoagulants, oral contraceptives, digitalis glycosides, fat-soluble vitamins, stool softeners

Lab Tests: Blood glucose and serum potassium concentrations

Administrative Notes: Concurrent use of other laxatives during initial phase of therapy for portal–{endash}systemic encephalography may result in loose stools and falsely suggest that adequate lactulose dosage has been established

DRUGS--G

Gallamine Triethiodide

Trade Name(s): Flaxedil

Pregnancy Category: Problems in humans have not been documented

Medical Category: Neuromuscular blocking agent

Accepted Indications: Muscle relaxation, convulsions

Mechanism of Action: Nondepolarizing neuromuscular blocking agent

Half life: 16 min (distribution), 150 min (elimination)

IV: 3–{endash}5 min

Metabolism: Not metabolized

Elimination: Renal

Research Notes: Onset of action 1–{endash}2 min, duration of peak effect 15–{endash}30 min

Adult Dosage: IV: 1 mg/kg initially, then 500 m{mu}g–{endash}1 mg/kg after 30–{endash}40 min if necessary

Elderly Dosage: May require lower dose

Child Dosage: Same as adult dose

Infant Dosage: Use with caution

Dosage Forms: Injection: 20 mg/mL

Warnings: Protect from freezing

Frequent Side Effects: Increased blood pressure, flushing, tachycardia

Occasional Side Effects: Decreased blood pressure

Rare Side Effects: Bronchospasm, hypersensitivity reaction, bradycardia, circulatory depression, edema, erythema, laryngospasm, itching, rash

Contraindications: Dehydration, hypotension, cardiac disease

Disease States: Hypothermia, respiratory depression, myasthenia gravis

Other Drugs: Aminoglycosides, clindamycin, capreomycin, parenteral/local anesthetics, lincomycin, polymyxins, citrate-anticoagulated blood, antimyasthenics, edrophonium, calcium salts, beta blockers, doxapram, lithium, procainamide, quinidine, neuromuscular blocking agents, physostigmine, potassium-depleting medications

Lab Tests: Serum potassium

Ganciclovir Sodium

Trade Name(s): Cytovene

Pregnancy Category: C

Medical Category: Systemic antiviral

Accepted Indications: Cytomegalovirus retinitis, severe disease caused by cytomegalovirus

Mechanism of Action: Inhibits DNA synthesis

Absorption/Distribution: Poorly absorbed after oral administration, widely distributed to all tissues

Half life: 2.5–{endash}3.6 h

IV: End of infusion

Metabolism: Little or no metabolism

Elimination: Renal

Adult Dosage: IV: 5 mg/kg b.i.d. for 14–{endash}21 d initially; maintenance: 5 mg/kg once daily for 7 d or 6 mg/kg once daily for 5 d

Elderly Dosage: May require lower dose

Child Dosage: Not established

Infant Dosage: Not established

Dosage Forms: Sterile injection: 500 mg

Frequent Side Effects: Granulocytopenia, thrombocytopenia

Occasional Side Effects: Anemia, CNS effects, hypersensitivity, phlebitis, GI disturbances, bacterial endophthalmitis, conjunctival scarring, detached retina, subconjunctival hemorrhage

Contraindications: Low neutrophil count

Disease States: Renal function impairment

Other Drugs: Radiation therapy, blood dyscrasia–{endash}causing medications, bone marrow depressants, imipenem with cilastin, zidovudine, probenecid

Lab Tests: Serum bilirubin, platelet count

Gemfibrozil

Trade Name(s): Lopid

Chemically Related To: Clofibrate

Pregnancy Category: C

Medical Category: Antihyperlipidemic

Accepted Indications: Hyperlipidemia

Mechanism of Action: Reduces LDLs, increases HDLs

Absorption/Distribution: Well absorbed from GI tract

Half life: 1–{endash}5 h

PO: 1–{endash}2 h

Metabolism: Hepatic

Elimination: 70% renal; 6% fecal

Research Notes: If response is inadequate after 3 m of treatment, withdraw therapy

Adult Dosage: Oral 1.2 g/d taken in 2 divided doses

Elderly Dosage: Reduced dosage may be required

Dosage Forms: Tablets: 600 mg; capsules: 300 mg

By System: Cardiovascular

Warnings: Comply with prescribed diet; if gallstones are found, discontinue therapy

Precautions: Check with physician before discontinuing medication because blood lipid levels may increase significantly

Frequent Side Effects: Stomach pain, gas, heartburn

Occasional Side Effects: Diarrhea, nausea or vomiting, rash, extreme tiredness

Rare Side Effects: Anemia or leukopenia, gallstones, myositis

Contraindications: Primary biliary cirrhosis

Disease States: Gallbladder disease, gallstones, hepatic function impairment, severe renal function impairment

Other Drugs: Anticoagulants, lovastatin

Lab Tests: Hematocrit, potassium, leukocyte counts, hemoglobin, bilirubin, creatine kinase

Administrative Notes: If patient experiences muscle pain or weakness, evaluate myositis

Gentamicin Sulfate

Trade Name(s): G-Mycin, Garamycin, Jenamicin

Chemically Related To: Aminoglycosides

Pregnancy Category: C

Medical Category: Antibacterial

Accepted Indications: Serious systemic infections

Unaccepted Indications: Staphylococcal infections, uncomplicated urinary tract infections

Mechanism of Action: Interferes with messenger RNA

Absorption/Distribution: Rapidly and completely absorbed after IM administration

Half life: 5–{endash}15 min (distribution); 2–{endash}4 h (elimination)

IM: 0.5–{endash}1.5 h

IV: 30 min after end of infusion

Metabolism: Not metabolized

Elimination: Renal

Adult Dosage: Up to 3–{endash}8 mg/kg/d

Elderly Dosage: Use with caution

Child Dosage: 2–{endash}2.5 mg/kg t.i.d. for 7–{endash}10 d

Infant Dosage: Up to 1 w: 2.5 mg/kg once daily or b.i.d. for 7–{endash}10 d; over 1 w: 2.5 mg/kg q8–{endash}16h for 7–{endash}10 d

Dosage Forms: In sodium chloride injection: 40 mg/50 mL, 40 mg/100 mL, 60 mg/50 mL, 60 mg/100 mL, 70 mg/50 mL, 80 mg/50 mL, 80 mg/100 mL, 90 mg/100 mL, 100 mg/50 mL, 100 mg/100 mL, 120 mg/100 mL, 160 mg/100 mL, and 180 mg/100 mL; injection: 10 mg/mL, 40 mg/mL, and 2 mg/mL (intrathecal)

Frequent Side Effects: Nephrotoxicity, ototoxicity, neurotoxicity, peripheral neuritis

Occasional Side Effects: Hypersensitivity, optic neuritis

Rare Side Effects: Neuromuscular blockade

Contraindications: Botulism, eighth cranial nerve function impairment

Overdosage: Loss of hearing, dizziness, vomiting

Antidotal Therapy: May include dialysis, calcium salts

Disease States: Dehydration, parkinsonism, myasthenia gravis, renal function impairment

Other Drugs: Nephrotoxic medications, ototoxic medications, polymyxins, aminoglycosides, capreomycin, methoxyflurane, neuromuscular blocking agents

Lab Tests: BUN, creatinine

Gentamicin Sulfate (Ophthalmic)

Trade Name(s): Garamycin, Genoptic Liquifilm, Gentacidin, Gentafair, Gentak, Gentrasul, Ocu-Mycin, Spectro-Genta

Chemically Related To: Aminoglycosides

Pregnancy Category: Problems not documented

Accepted Indications: Blepharitis, blepharoconjunctivitis, conjunctivitis, dacryocystitis, keratitis, keraconjunctivitis, meibomianitis

Mechanism of Action: Binds to specific receptor protein on the 30S subunit of bacterial ribosomes, interferes with messenger RNA

Absorption/Distribution: May be absorbed in very small quantities

Adult Dosage: Ophthalmic solution: up to 1 drop/h; ophthalmic ointment: topical, to the conjunctiva, 1 cm b.i.d. to t.i.d.

Elderly Dosage: Same as adult dose

Child Dosage: Same as adult dose

Dosage Forms: Ophthalmic solution: 5 mg gentamicin sulfate (equal to 3 mg gentamicin base)/mL; ophthalmic ointment: 5 mg gentamicin sulfate (equal to 3 mg gentamicin base)/g

Frequent Side Effects: Blurred vision

Occasional Side Effects: Hypersensitivity, burning sensation, stinging

Gentamicin Sulfate/Prednisolone Acetate

Trade Name(s): Pred-G, Pred-G S.O.P.

Medical Category: Ophthalmic anti-infective

Accepted Indications: Steroid-responsive inflammatory ocular conditions; ocular bacterial infections; chronic anterior uveitis; corneal injury from chemical, radiation, or thermal burns or from foreign bodies

Adult Dosage: Ointment: apply to the affected eye q3–{endash}4h; suspension: 1–{endash}2 drops in the affected eye q3–{endash}4h

Dosage Forms: Ophthalmic ointment: 0.37%/0.6%; ophthalmic suspension: 0.3%/1%

Glipizide

Trade Name(s): Glucotrol

Chemically Related To: Sulfonamides

Pregnancy Category: C

Medical Category: Antidiabetic

Accepted Indications: Noninsulin-dependent diabetes mellitus

Unaccepted Indications: Insulin-dependent diabetes

Mechanism of Action: Promotes release of insulin from beta cells of the pancreas

Absorption/Distribution: Rapid absorption

Half life: 2–{endash}4 h

PO: 1–{endash}3 h

Metabolism: Liver

Elimination: Renal

Adult Dosage: 5–{endash}40 mg/d

Dosage Forms: Tablets: 5 mg and 10 mg

By System: Endocrine, pancreas

Warnings: Elderly may require reduced dosage

Precautions: Photosensitivity possible; carry medical identification card or bracelet

Frequent Side Effects: Constipation, diarrhea, dizziness, mild drowsiness, headache, heartburn, nausea and vomiting, stomach pain

Occasional Side Effects: Photosensitivity; skin redness, itching, or rash

Rare Side Effects: Agranulocytosis, aplastic anemia, bone marrow depression, thrombocytopenia, hepatitis, cholestatic jaundice

Contraindications: Severe burns, infections, or trauma; diabetic coma; major surgery; significant ketosis or acidosis

Overdosage: Cold sweats; coma; confusion; cool pale skin; seizures; continuing headache; tachycardia; unsteady gait; extreme tiredness; vision changes

Antidotal Therapy: May include immediate ingestion of sugar or administration of IV glucose

Disease States: Adrenal or pituitary insufficiency (untreated), high fever, prolonged nausea and vomiting, hepatic function impairment, malnourishment

Nutrition: Follow prescribed diet low in refined carbohydrates

Other Drugs: Alcohol, coumarin anticoagulants, sulfonamides, beta-adrenergic blockers, bone marrow depressants, insulin, fluconazole, miconazole

Lab Tests: BUN, uric acid, creatinine, alkaline phosphatase

Glucagon

Trade Name(s): Glucagon Emergency Kit

Pregnancy Category: B

Medical Category: Antihypoglycemic, diagnostic aid adjunct, antispasmodic, antidote

Accepted Indications: Hypoglycemia, GI radiography adjunct, abdominal imaging adjunct, pelvic imaging adjunct, GI bleeding diagnosis adjunct, beta blocker and calcium channel blocker toxicity antidote, foreign body esophageal obstruction

Unaccepted Indications: Birth asphyxia or hypoglycemia in infants, chronic hypoglycemia

Mechanism of Action: Promotes hepatic glycogenolysis and gluconeogenesis

Half life: 10 min

Metabolism: Hepatic, renal

Adult Dosage: IM, IV or SQ: 0.5–{endash}1 mg, repeated in 20 min if necessary

Child Dosage: IM, IV or SQ: 25 m{mu}g/kg, repeated in 20 min if necessary

Dosage Forms: Parenteral: 1 mg and 10 mg

Occasional Side Effects: Allergic reaction, nausea, vomiting

Contraindications: Hyperglycemia, insulinoma, pheochromocytoma

Overdosage: Nausea, vomiting, hypokalemic syndrome

Antidotal Therapy: May include potassium, fluids

Disease States: Allergy to beef or porcine proteins, pheochromocytoma

Other Drugs: Anticoagulants

Administrative Notes: Check expiration date

Glutethimide

Trade Name(s): Generic only

Scheduled Class: II

Pregnancy Category: C

Medical Category: Sedative-hypnotic

Unaccepted Indications: Has generally been replaced by safer, more effective agents

Mechanism of Action: Unknown

Absorption/Distribution: Absorbed erratically from GI tract

Half life: 10–{endash}12 h

Peak activity: 1–{endash}6 h

Metabolism: Hepatic

Elimination: Renal, fecal

Research Notes: Onset of action, 0.5 h; duration of action, 4–{endash}8 h

Adult Dosage: Capsules and tablets: 200–{endash}500 mg at bedtime; dose may be repeated if necessary, but not less than 4 h before patient arises

Elderly Dosage: Lower dosage may be required

Child Dosage: Safety and efficacy not established

Infant Dosage: Safety and efficacy not established

Dosage Forms: Capsules: 500 mg; tablets: 500 mg

Frequent Side Effects: Daytime drowsiness

Occasional Side Effects: Rash, blurred vision, clumsiness, confusion, dizziness

Rare Side Effects: Blood dyscrasias, blurred vision

Contraindications: Porphyria

Overdosage: Bluish skin, convulsions, fever, low body temperature, muscle spasms

Antidotal Therapy: May include induced vomiting, gastric lavage

Disease States: Glaucoma, peptic ulcer, bladder neck obstruction, porphyria

Other Drugs: Alcohol, CNS depressants, anticoagulants

Lab Tests: Phentolamine, urinary steroid

Administrative Notes: Prolonged use may result in dependence

Glyburide

Trade Name(s): Diab{beta}eta, Micronase

Chemically Related To: Tolbutamide

Pregnancy Category: B

Medical Category: Antidiabetic (sulfonylurea)

Accepted Indications: Noninsulin-dependent diabetes mellitus

Unaccepted Indications: Insulin-dependent diabetes

Mechanism of Action: Promotes release of insulin from the beta cells of pancreatic tissue

Absorption/Distribution: Rapid absorption

Half life: 10 h

PO: 4 h

Metabolism: Hepatic

Elimination: Renal

Research Notes: Duration of action, 24 h

Adult Dosage: 2.5–{endash}20 mg/d

Elderly Dosage: Initially, 1.25–{endash}2.5 mg/d

Dosage Forms: Tablets: 1.25 mg, 2.5 mg, and 5 mg

By System: Endocrine, pancreas

Warnings: Avoid alcohol

Precautions: Carry medical identification card or bracelet; photosensitivity possible

Frequent Side Effects: Changes in taste; constipation; diarrhea; dizziness; mild drowsiness; headache; heartburn; increase in appetite; nausea

Occasional Side Effects: Hives; photosensitivity; skin redness, itching, or rash

Rare Side Effects: Agranulocytosis, aplastic anemia, bone marrow depression, jaundice, hepatic function impairment, thrombocytopenia

Contraindications: Significant acidosis or ketosis; severe burns, infections, or trauma; diabetic coma; major surgery; ketoacidosis

Overdosage: Hypoglycemia, difficulty in concentrating, drowsiness, excessive hunger, continuing headache, seizures, unsteady gait

Antidotal Therapy: May include immediate ingestion of sugar; if severe, rapid IV administration of 50% dextrose

Disease States: Adrenal or pituitary insufficiency (untreated); high fever; prolonged nausea and vomiting; thyroid, hepatic, or renal function impairment; malnourishment

Nutrition: Adhere to a diet low in refined carbohydrates that provides a counted caloric intake

Other Drugs: Alcohol, anticoagulants, MAO inhibitors, beta-adrenergic blocking agents, insulin, bone marrow depressants

Lab Tests: BUN, uric acid, lactate dehydrogenase, creatinine, alkaline phosphatase

Administrative Notes: In some patients receiving a maintenance dose of 10 mg/d or more, administration in divided doses b.i.d. may improve the control of hyperglycemia

Glycerin

Trade Name(s): Fleet Babylax, Osmoglyn, Sani-Supp

Pregnancy Category: C for diuretic and antiglaucoma agent

Medical Category: Hyperosmotic laxative; diuretic; systemic antiglaucoma agent

Accepted Indications: Constipation, bowel evacuation, laxative dependency treatment, glaucoma, cerebral edema

Mechanism of Action: Attracts water into stool, lubricates and softens fecal mass; elevates blood plasma osmolality

PO: 60–{endash}90 min

Elimination: Poor absorption; fecal elimination

Adult Dosage: Suppositories: 1 adult suppository once daily; oral solution: 1–{endash}1.5 g/kg as single dose, additional doses may be given at 6 h intervals

Elderly Dosage: Use with caution

Child Dosage: Under 6 y: 1 pediatric suppository once daily; 6 y and over: 1 adult suppository once daily; pediatric rectal solution: over 1 y: entire contents of applicator once daily; oral solution: 1–{endash}1.5 g/kg as single dose, may be repeated in 4–{endash}8 h

Infant Dosage: Suppositories and rectal pediatric solution: not recommended; oral solution: 1–{endash}1.5 g/kg as single dose may be repeated in 4–{endash}8 h

Dosage Forms: Suppositories: adult, pediatric; pediatric rectal solution; oral solution: 50% and 75%

Frequent Side Effects: Headache, nausea, vomiting

Occasional Side Effects: Rectal irritation, confusion, diarrhea, dizziness, dry mouth

Rare Side Effects: Arrhythmias

Contraindications: Appendicitis, CHF, hypertension

Disease States: Diabetes, rectal bleeding, intestinal obstruction, cardiac disease, confused mental states, severe dehydration, hypovolemia, renal disease

Other Drugs: Potassium-sparing diuretics, potassium supplements

Glycopyrrolate

Trade Name(s): Robinul

Pregnancy Category: B

Medical Category: Anticholinergic, antiarrhythmic, antidiarrheal

Accepted Indications: Peptic ulcer, irritable bowel syndrome, gastric hypersecretory conditions in anesthesia prophylaxis, cholinesterase inhibitor toxicity prophylaxis, diarrhea

Mechanism of Action: Decreases motility of GI tract

Half life: 1.7 h

Metabolism: Hepatic

Elimination: Renal

Adult Dosage: Tablets: 1–{endash}2 mg b.i.d. or t.i.d., up to 8 mg/d; injection: 100–{endash}200 m{mu}g up to q.i.d.

Elderly Dosage: May require lower dose

Child Dosage: Not established

Infant Dosage: Not established

Dosage Forms: Tablets: 1 mg and 2 mg. Injection: 200 m{mu}g/mL

Frequent Side Effects: Constipation, dryness of mouth, decreased sweating, redness at injection site

Occasional Side Effects: Decreased breast milk flow, decreased salivation

Rare Side Effects: Confusion, bloating, allergic reaction, increased intraocular pressure, difficult urination, blurred vision, drowsiness, headache, dizziness, memory loss, sensitivity of eyes to light, nausea, vomiting, tiredness, weakness

Contraindications: Cardiac disease, glaucoma, acute hemorrhage

Overdosage: Blurred vision, confusion, tachycardia

Antidotal Therapy: May include 4% tannic acid, adequate hydration

Disease States: Brain damage, Down syndrome, hiatal hernia, reflux esophagitis, GI tract obstructive disease, intestinal atony, paralytic ileus, myasthenia gravis, prostatic hypertrophy, urinary retention, obstructive uropathy, pyloric obstruction, tachycardia, ulcerative colitis

Other Drugs: Antacids, haloperidol, antidiarrheals, anticholinergics, cyclopropane, potassium chloride, ketoconazole

Lab Tests: Gastric acid secretion, thyroid function, serum uric acid

Gonadorelin Acetate

Trade Name(s): Lutrepulse

Pregnancy Category: B

Medical Category: Gonad stimulating principle

Accepted Indications: Primary hypothalamic amenorrhea

Mechanism of Action: Induces ovulation by synthesizing and releasing LH

Half life: 2–{endash}10 min (initial); 10–{endash}40 min (terminal)

Elimination: Renal

Research Notes: Intended for use only with Lutrepulse pump

Adult Dosage: IV: 5 m{mu}g/90 min initially

Child Dosage: Under 18 y: safety and efficacy not established

Infant Dosage: Safety and efficacy not established

Dosage Forms: For injection: 0.8 mg/vial and 3.2 mg/vial

Frequent Side Effects: No incidence given for ovarian hyperstimulation, inflammation, infection, mild phlebitis, hematoma at catheter site

Gonadorelin Hydrochloride

Trade Name(s): Factrel

Pregnancy Category: B

Medical Category: Gonad-stimulating principle; diagnostic aid

Accepted Indications: Hypogonadism (diagnosis), delayed puberty, amenorrhea, infertility

Mechanism of Action: Stimulates release of LH

Half life: 2–{endash}10 min (initial), 10–{endash}40 min (terminal)

Metabolism: Rapidly metabolized

Elimination: Renal

Adult Dosage: SQ or IV, 100 m{mu}g

Child Dosage: 12 y and over: same as adult dose

Infant Dosage: Not recommended

Dosage Forms: For injection: 100 m{mu}g and 500 m{mu}g

Warnings: Store at room temperature

Frequent Side Effects: No incidence given for anaphylaxis, rash, itching, pain at injection site

Rare Side Effects: Stomach discomfort, flushing, headache, lightheadedness, nausea

Other Drugs: Digoxin, estrogens, adrenocorticoids, androgens, progestins, oral contraceptives, levodopa, spironolactone, metoclopramide, phenothiazines

Lab Tests: LH levels

Goserelin Acetate

Trade Name(s): Zoladex

Medical Category: Antineoplastic, synthetic luteinizing hormone releasing hormone (LHRH) analog

Accepted Indications: Prostatic carcinoma

Mechanism of Action: Suppresses secretion of LH and FSH and results in fall in testosterone concentrations

Half life: 4.2 h

Peak activity: 12–{endash}15 d (implants)

Adult Dosage: SQ: 3.6 mg every 28 d

Elderly Dosage: Same as adult dose

Child Dosage: Not recommended

Infant Dosage: Not recommended

Dosage Forms: Implants: 3.6 mg (base)

Frequent Side Effects: Hot flashes, impotence

Occasional Side Effects: Anemia, MI, arrhythmias, cerebrovascular accident, hypertension, gout, rash, anxiety, mental depression, COPD, CHF, edema, diarrhea, constipation, weight gain, trouble sleeping, breast tenderness, nausea, vomiting, dizziness, headache, appetite loss

Disease States: Vertebral metastases, obstructive uropathy

Lab Tests: Serum acid phosphatase

Gramicidin

Trade Name(s): Not available as a single agent

Chemically Related To: Polypeptides; produced by growth of Bacillus brevis

Medical Category: Antibacterial

Accepted Indications: External infections caused by gram positive organisms

Mechanism of Action: Cationic membrane dissolver

Gramicidin/Neomycin Sulfate/Polymyxin B Sulfate

Trade Name(s): AK-Spore, Neosporin, Ocu-Spor-G, Ocutricin

Medical Category: Antibiotic

Accepted Indications: Ocular infections

Adult Dosage: Acute infections: topical to the conjunctiva, 1 drop every 15–{endash}30 min initially, frequency reduced gradually; other infections: topical to the conjunctiva, 1 drop b.i.d. to q.i.d. for 7–{endash}10 d

Elderly Dosage: Same as adult dose

Child Dosage: Same as adult dose

Dosage Forms: Ophthalmic solution: 0.025 mg/1.75 mg/10,000 units/mL

Griseofulvin

Trade Name(s): Fulvicin P/G, Fulvicin-U/F, Grifulvin V, Grisactin, Grisactin Ultra, Gris-PEG

Chemically Related To: Furantoins

Pregnancy Category: C

Medical Category: Antifungal (systemic)

Accepted Indications: Tinea barbae, tinea capitis, tinea corporis, tinea cruris, tinea pedis, and tinea unguium

Unaccepted Indications: Minor or trivial infections, bacterial infections

Mechanism of Action: Stops division of fungus at metaphase

Absorption/Distribution: Absorption: 25%–{endash}70% of oral dose; distributed to keratin layer of skin, hair, and nails

Half life: 24 h

PO: 4 h

Metabolism: Hepatic

Elimination: Renal

Research Notes: Diseased keratin is lost and replaced with healthy tissue

Adult Dosage: 250–{endash}500 mg b.i.d.

Elderly Dosage: Same as adult dose

Child Dosage: 2.75–{endash}5 mg/kg b.i.d.

Infant Dosage: Up to 2 y: no studies available

Dosage Forms: Capsules (microsize): 250 mg; oral suspension (microsize): 125 mg/5 mL; tablets (microsize): 250 mg and 500 mg; tablets (ultramicrosize): 125 mg, 165 mg, 250 mg, and 330 mg

By System: Systemic

Warnings: May cause dizziness; avoid alcohol and sun/sun lamp

Frequent Side Effects: Headache

Occasional Side Effects: Confusion, hives, thrush, photosensitivity

Rare Side Effects: Leukopenia, granulocytopenia, hepatitis, peripheral neuropathy

Disease States: Liver problems, lupuslike syndrome, porphyria

Other Drugs: Anticoagulants, estrogen contraceptives, barbiturates, alcohol, primidone

Administrative Notes: Include measuring device with oral suspension

Guaifenesin

Trade Name(s): Anti-Tuss, Breonesin, Glycotuss, Hytuss-2X, Nortussin, Robitussin

Chemically Related To: Unique compound

Pregnancy Category: C

Medical Category: Expectorant

Accepted Indications: Productive cough

Unaccepted Indications: As a cough suppressant; dry, persistent cough

Mechanism of Action: Reduces viscosity of respiratory secretions

Absorption/Distribution: Readily absorbed

Elimination: Renal

Research Notes: Therapy should be combined with deep breathing exercises

Adult Dosage: 200–{endash}400 mg q4h, not to exceed 2400 mg/d

Elderly Dosage: Same as adult dose

Child Dosage: 2–{endash}6 y: 300 mg b.i.d. up to 600 mg/d; 6–{endash}12 y: 600 mg b.i.d. not to exceed 1200 mg/d

Infant Dosage: Up to 2 y: individualize dose

Dosage Forms: Capsules: 200 mg; extended-release capsules: 300 mg; oral solution: 200 mg/5 mL; syrup: 100 mg/5 mL; tablets: 100 mg and 200 mg; extended-release tablets: 600 mg

By System: Respiratory

Warnings: Swallow extended-release tablets whole

Precautions: Monitor cough type and frequency

Occasional Side Effects: Diarrhea, drowsiness, GI upset

Overdosage: Vomiting

Other Drugs: Heparin

Lab Tests: Urine tests of 5-hydroxyindoleacetic acid and vanillylmandelic acid, platelet aggregation

Administrative Notes: Drink water after each dose

Guaifenesin/Hydrocodone Bitartrate

Trade Name(s): Bertuss, Codiclear DH; Entuss, Hycotuss, Kwelcof, Prolex DH

Scheduled Class: III

Abuse Potential: Moderate

Pregnancy Category: C

Medical Category: Antitussive

Accepted Indications: Cough

Dosage Forms: Syrup: 100 mg/5 mg, 10%/100 mg/5 mg; tablet: 300 mg/20 mg

Guaifenesin/Hydrocodone Bitartrate/Phenindamine Tartrate

Trade Name(s): P-V-Tussin

Scheduled Class: III

Abuse Potential: Moderate

Pregnancy Category: C

Medical Category: Antitussive, decongestant

Accepted Indications: Cough, cold

Dosage Forms: Tablet: 200 mg/5 mg/25 mg

Guaifenesin/Hydrocodone Bitartrate/Pheniramine Maleate/Phenylpropanolamine Hydrochloride/Pyrilamine Maleate

Trade Name(s): Triaminic Expectorant DH

Scheduled Class: III

Abuse Potential: Moderate

Pregnancy Category: C

Medical Category: Antitussive, decongestant

Accepted Indications: Cough, cold

Adult Dosage: 10 mL q4h

Elderly Dosage: Same as adult dose

Child Dosage: 1–{endash}6 y: 2.5 mL q4h; 6–{endash}12 y: 5 mL q4h

Dosage Forms: Oral solution: 100 mg/1.67 mg/6.25 mg/12.5 mg/6.25 mg/5 mL

Guaifenesin/Hydrocodone/Phenylephrine Hydrochloride

Trade Name(s): Donatussin DC

Scheduled Class: III

Abuse Potential: Moderate

Pregnancy Category: C

Medical Category: Antitussive, decongestant

Accepted Indications: Cough, cold

Dosage Forms: Syrup: 50 mg/2.5 mg/7.5 mg

Guaifenesin/Hydromorphone Hydrochloride

Trade Name(s): Dilaudid Cough Syrup

Scheduled Class: III

Abuse Potential: Moderate

Pregnancy Category: C

Medical Category: Antitussive

Accepted Indications: Cough

Dosage Forms: Syrup: 100 mg/1 mg

Guaifenesin/Oxtriphylline

Trade Name(s): Brondelate, Theocon

Pregnancy Category: C

Medical Category: Antiasthmatic, bronchodilator

Accepted Indications: Asthma

Dosage Forms: Elixir: 50 mg/100 mg/5 mL; some preparations contain 20% alcohol. Tablet: 100 mg/200 mg

Guaifenesin/Phenylephrine Hydrochloride

Trade Name(s): Chemdal; Deconsal; Endal; Guaifed; Phenmax; Quindal

Pregnancy Category: C

Medical Category: Decongestant, mucolytic

Accepted Indications: Cough, cold, allergy

Dosage Forms: Tablet: 300 mg/20 mg

Guaifenesin/Phenylephrine Hydrochloride/Phenylpropanolamine Hydrochloride

Trade Name(s): Contuss, Despec, Dura-Gest, Enomine, Entex

Pregnancy Category: C

Medical Category: Antihistamine, decongestant, mucolytic

Accepted Indications: Cough and colds

Adult Dosage: Oral solution, 10 mL q.i.d., capsules, 1 capsule q.i.d.

Dosage Forms: Capsules: 200 mg/5 mg/45 mg; oral solution: 100 mg/5 mg/20 mg/alcohol 5%

Guaifenesin/Phenylpropanolamine Hydrochloride

Trade Name(s): Contuss TD; Enomine LA; Entex LA; Guaipax; Lantex-LA; Vanex-LA

Pregnancy Category: C

Medical Category: Decongestant, mucolytic

Accepted Indications: Cough and cold, allergy

Dosage Forms: Tablet: 400 mg/75 mg, 200 mg/75 mg

Guaifenesin/Pseudoephedrine Hydrochloride

Trade Name(s): Anatuss LA; Entex PSE; Guaifed-PD; Nasatab LA, Respinol-G; Sinufed

Pregnancy Category: C

Medical Category: Decongestant, mucolytic

Accepted Indications: Cough, cold, allergy

Dosage Forms: Capsule: 250 mg/30 mg, various other strengths; syrup; tablet: 200 mg/120 mg, various other strengths

Guaifenesin/Theophylline

Trade Name(s): Asbron G, Broncomar GG, Ed-Bron G, Elixophyllin GG, Equibron G, Glyceryl-T, Mudrane GG-2, Slo-Phyllin, Synophylate-GG, Theolate

Pregnancy Category: C

Medical Category: Bronchodilator, expectorant

Accepted Indications: Bronchial asthma, bronchitis, pulmonary emphysema, chronic obstructive pulmonary disease

Metabolism: Hepatic

Elimination: Renal (10% unchanged)

Adult Dosage: 5–{endash}8 mg of anhydrous theophylline/kg/d to a maximum of 400 mg/d in 3 or 4 divided doses

Elderly Dosage: 3–{endash}5 mg/kg/d

Child Dosage: Varies by indication and form

Dosage Forms: Varies by preparation

By System: Respiratory

Frequent Side Effects: Nausea, nervousness, palpitations

Occasional Side Effects: Gastroesophageal reflux, nausea

Overdosage: Confusion, convulsions, diarrhea, tachypnea, tachycardia, GI tract bleeding, headache, increased urination, irritability, loss of appetite, muscle twitching, nausea, tremor, arrhythmia, vomiting

Disease States: Gastritis, peptic ulcer

Nutrition: Caution in eating or drinking large amounts of xanthine–{endash}containing foods or beverages during therapy with this medication

Other Drugs: Adrenocorticoids, phenytoin, beta-adrenergic blocking agents, cimetidine, erythromycin, ranitidine, troleandomycin, ciprofloxacin, norfloxacin, nicotine chewing gum, smoking tobacco

Lab Tests: Serum theophylline determinations

Administrative Notes: May be taken with meals to lessen GI irritation

Guanabenz Acetate

Trade Name(s): Wytensin

Pregnancy Category: C

Medical Category: Antihypertensive

Accepted Indications: Hypertension

Mechanism of Action: Alpha2-adrenergic agonist

Absorption/Distribution: 75% absorbed from GI tract

Half life: 6 h

Peak activity: 2–{endash}4 h

Metabolism: Hepatic

Elimination: Renal, fecal

Research Notes: Onset of action, 1 h; duration of action, 12 h

Adult Dosage: 4–{endash}8 mg b.i.d. up to 32 mg/d

Elderly Dosage: Lower dosage may be required

Child Dosage: Safety and efficacy not established

Infant Dosage: Safety and efficacy not established

Dosage Forms: Tablets: 4 mg and 8 mg

Frequent Side Effects: Dizziness, dry mouth, drowsiness, weakness

Occasional Side Effects: Nausea, headache, decreased sexual ability

Overdosage: Severe dizziness, pinpoint pupils, bradycardia, irritability, nervousness, extreme tiredness or weakness

Disease States: Cerebrovascular disease, recent myocardial infarction, hepatic/renal impairment, coronary insufficiency

Other Drugs: Beta blockers, estrogens, alcohol, NSAIDs, hypotension–{endash}producing medications, sympathomimetics

Lab Tests: Cholesterol, blood pressure

Administrative Notes: Need for lifelong therapy possible; withdrawal syndrome possible

Guanadrel Sulfate

Trade Name(s): Hylorel

Chemically Related To: Adrenergic blockers

Pregnancy Category: B

Medical Category: Antihypertensive

Accepted Indications: Hypertension

Mechanism of Action: Postganglionic adrenergic blockade. Decreases release of norepinephrine

Absorption/Distribution: Rapidly absorbed from GI tract

Half life: Approximately 10 h

Peak activity: 4–{endash}6 h

Metabolism: Hepatic

Elimination: Renal

Research Notes: Onset of action, 2 h; duration of action, 9 h

Adult Dosage: Initial: 5 mg b.i.d., increased as necessary; maintenance: 20–{endash}75 mg/d in 2–{endash}4 divided doses

Elderly Dosage: Lower dose may be required

Child Dosage: Safety and efficacy not established

Infant Dosage: Safety and efficacy not established

Dosage Forms: Tablets: 10 mg and 25 mg

Warnings: Do not take other medicines without physician's permission

Frequent Side Effects: Peripheral edema, difficulty in ejaculation, drowsiness, tiredness, orthostatic hypotension

Occasional Side Effects: Angina, dyspnea, diarrhea, dry mouth, headache, muscle pain, tremors, nocturia

Contraindications: CHF, pheochromocytoma

Overdosage: Blurred vision, severe dizziness

Antid