Littmann's heart sounds in Macromedia format!!!
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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
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