jan 29 2024.pdf

Abilify, Abilify Maintena IM, Aristada IM Aripiprazole [SGA-Atypical] 📄 MedGuide A&D ointment Petrolatum [Diaper rash] - OTC Contains vitamin A & D Note: Refer if <6m or appears serious FDA: BPD, schizophrenia, tx-resistant MDD adjunctive, Tourette's syndrome, irritability assoc. w/ autistic beh...

Abilify, Abilify Maintena IM, Aristada IM Aripiprazole [SGA-Atypical] 📄 MedGuide A&D ointment Petrolatum [Diaper rash] - OTC Contains vitamin A & D Note: Refer if <6m or appears serious FDA: BPD, schizophrenia, tx-resistant MDD adjunctive, Tourette's syndrome, irritability assoc. w/ autistic behavior Depression: Start 2-5mg po QAM (can ↑ to 15mg/day) Schizophrenia: 10-30mg po QAM - Maintena (IM-monthly) + Aristada (IM q4-8w)- only for BP mania + schizo BBW: ↑mortality in elderly with dementia related psychosis Warnings: neuroleptic malignant syndrome, tardive dys, falls, neutropenia, pathologic gambling & other compulsive behaviors, 3A4 substrate SE: anxiety, insomnia, akathisia, constipation, agitation, dizziness, orthostasis, metabolic issues *less metabolic issues & sedation than other antipsychotics Abreva Docosanol - OTC cream I: herpes labialis Apply 5x daily at first sign of outbreak + cont' until healed Accupril (I,D,BBW,SE) Absorica, Amnesteem, Clavaris, Myorisan Isotretinoin [PO retinoid] - Severe, nodular acne RxPO: 0.5-1 mg/kg/d divided BID WITH FOOD x15-20w BBW: birth defects (sign consent form + 2 negative tests prior + 2 forms of birth control, no POP). Don't get pregnant a 1m before or after using. AE: eye irritation+dryness, dry skin, chapped lips, ↑TG + BG *Can only dispense if REMS iPLEDGE pharmacy Only 1-month Rx at a time, fill within 7d w/ yellow sticker Accolate (I,D) Zafirlukast I: asthma D: 20 mg BID Quinapril [ACEI] I: HTN, HF RxPO: HF target: 20 mg BID BP: 5-40mg QD, max 80 mg/d Renal dose adjust CI: hx of angioedema, within. 36h of ARNI (Entresto) BBW: pregnancy, bilateral renal artery stenosis SE: metabolic acidosis, ↑K+, ↓dry cough + angioedema *Avoid w/ NSAIDs - renal damage ↓Lithium renal CL = ↑Lithium toxicity Aciphex Accutane, Absorica, Amnesteem, Claravis, Myorisan, Sotret, Zenatane (I,BBW,SE) Isotrentinoin Med Guide, iPLEDGE REMS I: severe acne BBW: pregnancy (2 forms of BC, informed consent) *No pregnancy one month before, during & x1 month after tx *Full effect in 3-5 months *SE: dryness 📄 Rabeprazole [PPI] MedGuide - TAPER off to avoid acid rebound I: duodenal ulcer, GERD, H. Pylori D: 20 mg QD <4-8 weeks Take WITHOUT regard to MEALS Warnings: C-diff associated diarrhea, hypoMg, ↑incidence of osteoporosis bone fractures w/ high doses or longterm therapy (≥1Y) SE: H/N/D (infrequent) C. Diff, fractures, GI infection, hypomag, VitB12 deficiency *20mg Ome/Rabe/Eso = 15mg Lanso = 40mg Panto 📄 Actiq (D, I) Fentanyl IR transmucosal lozenge Med Guide Only indicated for cancer BTP 200mcg x up to 4 BTP episodes/day. REMS: requires documentation of pt's opioid tolerance with each Rx BBW: mod-strong 3A4 inhibitors ↑ effects; potential med errors when converting between dosage forms 📄 Actonel, Atelvia Risedronate [PO Bisphosphonate] I: Osteoporosis PPX+TX: 5mg QD or 35mg qW (Atelvia) or 150mg monthly (DR) *Atelvia DR requires acidic gut - DNU w/ H2RA/PPIs CI: inability to stand/sit upright for 60min, hypoCa, pts w/ abnormalities of the esophagus Warnings: osteonecrosis of jaw, atypical femur fractures, esophagitis, esophageal ulcers, erosions, renal imp (DNU if CrCl <30) SE: hypoCa, esophagitis, musculoskeletal sxs, dyspepsia, N/V, dysphagia, heartburn *Separate admin from Ca, antacids, Fe, Mg ~2h *Take BEFORE EAT/DRINK QAM w/ 6-8oz water. ATELVIA - take AFTER BKF w/ 4oz water Actos (BBW,I,D,SE) Pioglitazone [TZD] 📄 MedGuide I: T2DM, ↓A1c 0.5-1.5% RxPO: 15-30mg QD (max 45mg/d) BBW: Can cause/exacerbate HF CI: NYHA Class III/IV HF Warnings: hepatotoxicity, edema, weight gain, risk of fractures, urinary bladder tumors (DNU if active bladder cancer) SE: peripheral edema, weight gain Actos (BBW,I,D,SE) Pioglitazone [TZD -PPARgamma agonist] D: 15-30mg QD (max 45mg/d) Med Guide BBW: Can cause or exacerbate HF CI: NYHA Class III/IV HF SE: bladder cancer, edema, weight gain, fractures, hepatotoxicity 📄 Adacel, Boostrix Tdap Vaccine 1 booster of either Td or Tdap q10years Store in FRIDGE [2 - 8℃] or [36 - 46℉] Shake prefilled syringe or vial before use. Give IM Recommended in: 1. Pregnant/postpartum women with each pregnancy 2. Close contact of infants <12 months if not up-to-date 3. HCP with direct patient contact, if not up-to-date 4. Children 7-10yo not fully vaccinated with the 5-dose DTaP series; give a single dose of Tdap instead of DTaP 5. Children ≥11yo w/o previous record of TDaP AND who received Tdap between 7-10yo as part of a catch-up schedule 6. A single dose of Tdap for adults ≥65 years *Boostrix: indicated for ≥10yo *Adacel: indicated for 10-64yo Adcirca, Alyq, Cialis (I,D) Tadalafil I: PAH D: 40mg QD? *Advirca, Alyq - PAH RxPO: Daily dosing 2.5-5mg daily On demand dosing: 5-20 mg daily PRN *Start at 10mg, at least 30 min before activity *Start 5mg if >65 years, using an alpha-blocker, using a CYP3A4 inhibitor Renal adjust 30-50mL: 5mg PRN CrCl < 30 mL/min: 5mg PRN Q72H Adalat CC, Procardia XL, Afeditab CR, Nifedical XL Adasuve (inhalation), Loxitane (po) (I, REMS, CI, M) Nifedipine ER [DHP-CCB] I: HTN, angina RxPO: 30-90 mg/d DOC for pregnancy CI: CHF, DNU w/ BB if acute MI (AV block + bradycardia) SE: reflex tachycardia, HA, flushing, edema DDI: Major 3A4 substrate - avoid grapefruit Loxapine (oral inhalation, po) I: Acute tx of agitation associated with schizophrenia or BPD REMS: Serious bronchospasm (↓FEV1 persists over 24H in asthma/COPD pts) CI: asthma/COPD, current inhaler use, acute respiratory sx (wheezing) Oral inhalation must be administered in an enrolled health care setting by HCP *Monitor breathing Q15min x1 hour Adderall, Adderall XR (ER cap), Mydayis (ER cap) Adipex-P, Lomaira tab Dextroamp. + Amphetamine IR+ER C-II [Stimulant] Med Guide I: ADHD, narcolepsy RxPO: 5mg QAM or BID (max 40mg/d) BBW: abuse/dependence, misuse can cause sudden death + serious CV events CI: within 14d of MAOi Warnings: exacerbate mania, ↑seizure risk, loss of appetite AEs: N, insomnia, HA, irritability, blurry vision, dry mouth Monitor: ECG prior, BP, HR, height, weight AAP not recommend IR for ≤ 5YO (approved for ≥3Y) Acidic foods can ↓ amphetamine levels Phentermine [Appetite suppressant] - C-IV I: For BMI ≥30 kg/m2 or ≥27 kg/m2 w/ risk factors (DM, HLD, controlled HTN) Available as cap, tab, ODT RxPO: 15-37.5 mg PO QD, BEFORE/AFTER BKF Lomaira: 8 mg 3 times daily Qsymia (+ topiramate) CI: CV disease, hyperthyroidism, glaucoma, pregnancy/ breast feeding, hx of drug abuse, agitated state, within 14d of MAOi Warnings: PPHTN, Valvular heart disease, HF, CNS effects AE: tachycardia, agitation, ↑BP *Use short term, up to 12 weeks 📄 Adlyxin (I, W, SE, D) Adlyxin (I, W, SE, D) Lixisenatide [GLP1 agonist] T2DM, ↓A1c 0.5-1.5% RxInj: 10mcg SC WITHIN 60MIN OF MEALS x14days then ↑ to 20mcg daily Fridge + Protect from light *After open @RT/Fridge x14d* Warnings: pancreatitis; avoid in severe GI dz, including gastroparesis eGFR <15: not recommended Adlyxin - Pens needles not provided Lixisenatide GLP 1 aognist -> pancreatitis (no boxed warning for byetta and adylxin) for rosk of thyroid c-cell carcinoma T2DM, ↓A1c 0.5-1.5% W: pancreatitis; avoid in severe GI dz, including gastroparesis SE: nausea, weight loss 10mcg SC daily within 60min before BF x14days then ↑ to 20mcg daily eGFR <15: not recommended *needles needs to be purchased Fluticasone/salmeterol I: asthma/COPD RxDPI: 1 inhalaiton BID B/g Advair Diskus, Wixela Inhub Afluria Quadri, Fluarix Quadri, FluLaval, Fluzone Quadri, Flublok, Flucelvax, Fluzone Intradermal, FluMist Advil (I,Dmax) Ibuprofen Advil, Caldolor, Motrin IB, NEoprofen I: analgesia RxOTC: 200-400mg Q4-6H (Max 1.2 g/day) Rx: 400-800 mg Q6-8 H (max 3.2 g/day) Peds: 5-10 mg/kg/dpse Q6-8H (max 40mg /kg/dau) OTC limit is <10 days SEvere skin reaction D: 200-800mg TID-QID (max: 3200mg/d) Advair (I,D) Afinitor, Zortress Everolimus [mTOR kinase inhibitor] I: transplant, cancer (Afinitor) SE: peripheral edema, HTN, DNU within 30d of transplant *3A4 substrate Quadrivalent Inactivated Flu (Two A + two B) Store in FRIDGE [2 - 8℃] or [36 - 46℉] *Flucelvax - age ≥ 4Y, has latex *Flublok - age ≥ 18Y, no eggs *Fluzone - age ≥ 6m (MultiDV) or ≥ 3Y (prefilled syringe) *Fluzone ID - for 18-64Y, smaller needle, but ↑local rxns *FluMist - healthy people b/w 2-49Y, live, give 0.2mL divided b/w two nostrils Aldactone, CaroSpir (Suspension) Afluria, Fluvirin, Fluzone HD, Fluad Aggrenox Trivalent Inactivated Flu (Two influenza A + one B) Store in FRIDGE [2 - 8℃] or [36 - 46℉] Give IM annually *Afluria - age ≥ 9Y (needle); 18-64Y (jet injector) *Fluvirin - age ≥ 4Y, has latex *Fluzone HD - age ≥ 65Y, has 4x antigen dose *Fluad - age ≥ 65Y, has MF59 adjuvant to ↑immunity Aldomet Methyldopa [Alpha2 Agonist] - only PO RxPO: 250 - 1,000 mg divided BID (max 3,000 mg/day) Renal adjustment recommended DOC in pregnancy SE: DILE (lupus), hepatitis, hemolytic anemia Caution: bradycardia, dry mouth, fatigue, depression, psych rxns, impotence, rebound HTN, Edema, sedation Must taper off Dipyridamole + ASA [AntiPlatelet] - Only generic I: TIA/stroke prevention RxPO: 200mg/25mg BID SE: HA, diarrhea Warnings: Hypotension Spironolactone [Aldosterone Antagonist/K+ sparing] I: HF (↑survival in EF <35%), HTN (resistant HTN), ascites HF target: 50 mg/d divided QD-BID ?HF target: 25mg QD-BID? HTN dose: 25-100 mg QD *Take WITH FOOD to ↑ absorption + ↓GI effects *Nonselective - blocks androgen - To start; Scr ≤2.5 mg/dL M and ≤2 mg/dL F or eGFR >30 and K <5 mEq/L Warnings: hyperkalemia, gout, gynecomastia SE: ↑ K+, ↓ Ca2+, gout, irregular menses, impotence, breast tenderness (d/t androgen block) CI: hyperkalemia *Suspension is not therapeutically equivalent to tablets Renal dose adjust **↑survival, manage edema, ↓hospita. in NYHA III-IV Aldomet (D,SE) Methyldopa [Alpha2 Agonist] RxPO: 250 mg BID-TID; max dose is 3g daily DOC in pregnancy SE: DILE (lupus), hepatitis, hemolytic anemia Caution: bradycardia, dry mouth, fatigue, depression, psych rxns, impotence, rebound HTN Must taper off Alka-Seltzer Na bicarbonate + ASA + citric acid [Antacid] - OTC Onset: < 5m, Duration: 30-60 min Use 30 MIN AFTER MEAL Mix 2 tablets with 120 mL H2O Aloprim, Zyloprim (I,W,SE,D) Allegra (I,D) Fexofenadine I: upper resp. allergy D: 60mg BID (max 120mg/d) or 180mg QD Allopurinol - XO inhibitor, ↓ UA production I: Chronic management of gout (ppx of future attacks) W: HLA-B*5801 testing in Asians: ↑risk of SJS; BM suppression, hepatotoxicity SE: Rash, acute gout attacks, nausea, diarrhea, ↑LFTs Start: 100mg po once daily after a meal (to ↓nausea) ↑by 100mg/day q2-5wks until UA <6mg/dL *doses >300mg should be divided BID *max 800mg/day Ppx for acute gout flares (NSAIDs or colchicine) recommended for first 3-6 months Alora, Climara, Delestrogen, Divigel, Dotti, Elestrin, Estrace, Evamist, Femring, Minivelle, Vivelle-dot (BW) Estradiol BBW: endometrial cancer, CV disease, breast cancer, dementia I: vasomotor sx of menopause including hot flashes & night sweats Alora, Climara, Vivelle-Dot, Estraderm ClimaraPro, Combi-Patch Altace (I,D,BBW,SE) Estrogen patch I: HRT in WOMEN WITHOUT UTERUS Vivelle / Alora: apply twice weekly Climara: once weekly ClimaraPro / Combi-Patch: has progesterone BBW: endometrial cancer, dementia, ↑risk of VTE + Stroke, breast cancer CI: breast cancer, uterine bleeding, active VTE, pregnancy Warnings: ↑risk of breast cancer, ↑TG + HDL Counseling: apply to lower abdomen, below the waistline. Do not apply to breast CombiPatch - Fridge or RT x6m Aloxi Palonosetron [5HT3 R-antagonist] I: CINV CI: DNU w/ apomorphine = Apokyn (severe hypoTN). Warnings: serotonin syndrome SE: HA, constipation *Apokyn = DA promoter; treats loss of muscle movement control in PD Ramipril [ACEi] I: HTN, HF RxPO: 2.5-20 mg QD HF target: 10mg QD ?5 mg BID? Renal dose adjust CI: hx of angioedema, within. 36h of ARNI (Entresto) BBW: pregnancy, bilateral renal artery stenosis SE: metabolic acidosis, ↑K+, ↓dry cough + angioedema *Avoid w/ NSAIDs - renal damage ↓Lithium renal CL = ↑Lithium toxicity Altoprev ER AmBisome (Use, BBW, SE) Lovastatin [Statin] RxPO: 20-80mg WITH FOOD + IR w/ PM meal *Altoprev ER take qHS *Max 20-40mg QD w/ 3A4 inhibitors (CCBs, amiodarone, danazol (androgen)) CI: Pregnancy, breastfeeding, active LD (↑ LFTs), strong 3A4 inhibitors Warning: rhabdomyolysis, myopathy (↑risk w/ age ≥65Y + 3A4 inhibitors + niacin), hepatotoxic AEs: myalgias, arthalgias, myopathy (w/ Colchicine) Monitor: LFTs + lipid panel @baseline + 4-12 weeks after Avoid with gemfibrozil + niacin ≥ 1g AmBisome Liposomal amphotericin B [Antifungal] - IV RxIV: 3-6 mg/kg/day D5W only SE: infusion-reactions (fever, chills, HA, malaise, rigors), ↓K, ↓Mg, nephrotoxicity ↓Risk of infusion reactions + nephrotoxicity Liposomal Amphotericin B Used as initial tx for many invasive infxns including Cryptococcal meningitis, histoplasmosis, mucormycosis BBW: Death d/t errors confusing lipid based (AmBisome, Abelcet) & conventional deoxycholate→ max 1.5mg/kg/day, requires pre-med *verify product name/dose if >1.5mg/kg/day *OD can cause cardiopulmonary arrest SE: infusion-rxns; thrombophlebitis, ↓K, MG, nephrotoxicity Injection: 3-6mg/kg/day Ambien, Edluar, Intermezzo Amaryl Glimepiride [SU] I: T2DM, ↓A1c 1-2% RxPO: 1-2mg WITH BF (max: 8mg/d) SE: hypogly, weight gain, N, hemolytic anemia in G6PD deficiency CI: DKA, sulfa allergy On Beers List XL Formulation - OROS system - ghost cap Zolpidem C-IV [Non-BZDP Re. Agonist] - insomnia MedGuide DNU w/ fatty food (increases sleep onset), heavy meal or alcohol *For middle of night awakenings*. Ambien: 5-10 mg PO QHS, max 5mg in females + elderly 📄 ♂️ ) CR: 6.25mg (♀/elderly) QHS or 6.25-12.5mg (♂️ )? ?IR/SL: 5mg (♀/elderly) QHS or 5-10mg ( BBW: complex sleep behaviors (sleep-walking, driving, etc. -D/C if occurs) Warnings: CNS depression, abuse + dependence potential SE: somnolence, ataxia, dizziness, parasomnias, Preferred over BZDPs Amitiza Lubiprostone [IBS, CIConstipation, Opioid I.Const] RxPO: 24 mcg BID WITH FOOD IBS w/ constipation: 8 mcg BID (females ≥18 YO) *Dose adjust in CP Class B and C Amphoterin. B Deoxycholate Amoxil Amoxicillin [B-Lactam] TAB + CAP + SUSP q8-12h DOC: acute OM, H.Pylori, Endocarditis Take WITH FOOD + Refrigerate *Ok @ room temp ~14days Renal metabolism Amphojel, DermaMed (I) Aluminum hydroxide I: antacid, skin protectant Amrix, Flexeril, Fexmid Anafranil (BW,I,SE) Cyclobenzaprine [Muscle relaxant] TAB + CAP IR 5-10mg TID / ER 15-30mg QD AEs: sedation, dizziness, confusion, dry mouth Warnings: Serotonergic, DNU w/ other 5HT drugs Analgesic - similar to Tizanidine & Baclofen *Additive CNS depression w/ alcohol, opioids, BZDPs Clomipramine (TCA, 3° amine) 📄 MedGuide, suicidality BBW I: OCD RxPO: No dose SE: QT prolongation (fatal arrhythmias w/ OD), orthostasis, tachycardia, anticholinergic effects, vivid dreams, weight gain, sedation, sweating, muscle twitching (toxicity sx), ↑fall risk AmphoB [Antifungal] - INJ RxIV: 0.1 - 1.5 mg/kg/d BBW: Doses > 1.5 mg/kg/d → cardiopulmonary arrest SE: infusion-reactions (fever, chills, HA, malaise, rigors), ↓K, ↓Mg, nephrotoxicity Premedicate: 30-60min prior w/ APAP/NSAID, diphenhydramine and/or hydrocortisone Ancef, Kefzol Cefazolin [1st gen] - IV + IM C: Staph, Strep, PEK (Proteus, E.coli, Klebsi) DOC: surgical ppx Renal metabolism + toxicity, dose adjust CrCl AndroGel Ancobon (use, BBW, SE) Flucytosine (5-FC) Rx: 50-150 mg/kg/day PO divided Q6H CrCl <= 40 mL/min Used with amphoB for invasive Cryptococcal meningitis or Candida infxns BBW: Extreme caution in pts with RI, monitor hematologic, renal & hepatic status closely SE: myelosuppresion (dose related), ↑Sc, BUN, hepatitis, ↑bilirubin, many CNS effects, hypoglycemia, ↓K Gels: apply at same time each morning; flammable until dry. ⋄1% - upper arms, shoulders and/or abdomen ⋄1.62% should only be applied to upper arms or shoulders (not the abdomen) BBW: secondary exposure to testosterone in children can occur causing virilization; children should avoid contact w/ any unwashed or unclothed application sites CI: breast/prostate cancer, pregnancy, breast-feeding W: ↑ risk of breast/prostate ca, CV events, VTE, dyslipidemia, gynecomastia HI, priapism, may worsen BPH SE: ↑ appetite, ↑ Scr, sensitive nipples, acne, edema, hepatotoxicity, ↓ sperm count Androgel 1%, 1.62%, Fortesa 2%, Testim 1% Testosterone gel [C-III] 📝 Medguide I: hypogonadism (HRT for males), sexual dysFXN in M+F, hot flashes in females Counseling: Apply to upper arms, shoulders, and/or abdomen. Apply same time each morning. BBW: secondary exposure in children SE: acne, edema, hepatotoxicity, male infertility, ↑appetite, worsen BPH, prostate/breast cancer, hyperlipidemia, aggression, stroke, heart attack Withdrawal sxs: depression, fatigue, ↓appetite, ↓libido, insomnia PO testosterone not recommended d/t hepatotoxicity (Androxy, Android, Methitest, Testred, Jatenzo) - dosed QD Antara, Tricor, TriLipix Antabuse (BW,I,D) Disulfiram BW: alcohol intoxication I: alcohol use disorder D: up to 500mg QDx1-2wks; MD 250mg QD (max 500mg/d) Fenofibrate [fibrate] I: high TG Multiple products = multiple doses *Fenoglide/Lipofen take WITH MEALS Renal dose adjust CI: hepatic severe LD (incl. primary biliary cirrhosis),, or severe renal dysfunction CrCl <30mL/min, gallbladder disease Warnings: myopathy (↑risk w/ statins) *DNU w/ statins or ezetimibe SE: dyspepsia (indigestion) *Can ↑LDL if TG are high AND ↑effects of SU+warfarin Apidra Glulisine [Rapid acting insulin]. Give 15MIN BEFORE/IMMEDIATELY AFTER MEAL Refrigerate; stable at room temp for 28 days CI: acute hypoglycemia Warnings: hypoBG, hypokalemia SEs: weight gain, lipodystrophy Apokyn Aplenzin, Forfivo XL, Wellbutrin SR/XL (BW,I,D) Bupropion BW: suicidality/antidepressant I: MDD, SAD, smoking cessation D: IR= 100mg BID (max 450mg/d); 12H ER(SR)= 150mg QAM (max 200mg bid); 24H ER= 150mg QAM (max 450mg QD) Apomorphine [DA - Rescue movement agent] I: PD (off episodes) Rx: SQ 0.2mL (= 2mg) (max 0.6ml) CI: DNU w/ 5HT3 antagonists (ondansetron) d/t severe hypotension + loss of consciousness SE: severe N/V, hypotension hallucinations, impulse control disorder, orthostasis, priapism, somnolence Notes: give Tigan 300mg TID for emesis prevention Apresoline Hydralazine [Direct Vasodilator] - generic only I: HTN RxPO: 100-200 mg/d divided QID SE: DILE (with doses >200 mg/day) AEs: HA, hypotension, reflex tachycardia, palpitations, peripheral neuritis Combo tab: + Isosorbide dinitrate (BiDil) Aranesp Darbepoetin alfa [ESA] - Anemia 📄 Med Guide Apriso ER 24H, Delzicol DR, Pentasa ER Asacol HD DR, Lialda DR Rowasa rectal kit, SfRowasa enema Canasa supp Mesalamine ER [Aminosalicylates] I: UC induction + maintenance Induction PO 6-8wks, Rectal 3-6wks Canasa: Suppository (retain ≥1-3H) Rowasa: Enema (retain ≥30min) Asacol HD, Lialda: ER tabs Apriso, Delzicol, Pentasa: ER caps CI: HSR to salicylates or aminosalicylates *Rectal more effective for distal disease/proctitis UC Counseling: suppositories/enemas stain fabric, flooring, painted surfaces, marble, granite, vinyl & enamel *Asacol HD - Ghost tablet in feces CKD: 0.45 mcg/kg IV/SC WEEKLY Cancer: 2.25 mcg/kg SC WEEKLY or 500mcg Q3W *T1/2 is 3x longer than EPO - give weekly Refrigerate + protect from light + MD vials x21d *DO NOT shake BBW: ↑death, MI, stroke, VTE, thrombosis, and tumor progression. use lowest effective dose to ↓ blood transfusions CKD: ↑death when Hgb > 11 g/dL Warning: HTN -Cancer: tumor progression or recurrence; not indicated when anticipated outcome is cure; d/c when chemo completed -CKD: ↑MACE when Hgb >11 -Peri-surgical: DVT ppx recommended d/t ↑DVT risk CI: uncontrolled HTN; IV route recommended for pts on HD Monitor: H/H, TSAT, serum ferritin, BP IV route for HD patients ❄️ Aptivus Tipranavir (PI) - BID WITH FOOD w/ Norvir BID **DNU w/ any other PIs - Sulfa allergy *I: CKD or Cancer (on chemo) when Hgb <10 *IV/SC: given every 1-4 weeks (t½ ix 3x longer than epoetin alfa). *Titrate based on Hgb levels; do not ↑ dose more frequently than once every 4wks. Arixtra Aricept Arcapta Neohaler (I,D) Indacaterol I: COPD D: 1 cap inh QD Donepezil [Acetylcholinesterase inhibitor] (tablet, ODT) I: Alzheimer's RxPO: 5mg QHS can titrate to 10mg QHS **Can ↑ to 10mg after 4-6wks; up to 23mg after >3months on 10mg Give QHS to ↓N ODT has ↓GI side effects Warnings: bradycardia, fainting, QT prolongation SE: insomnia, N/V, tremors, wt loss If stable, can switch to Namzaric (Donepezil + Memantine) Fondaparinux (SQ/IV) I: acute DVT/PE, VTE ppx DVT Ppx: ≥50kg: 2.5mg SC daily | <50kg: CI DVT Tx: >100kg: 10mg SC daily | 50-100kg: 7.5mg | <50kg: 5mg BBW: spinal/epidural hematomas CI: CrCl <30, active major bleed, bacterial endocarditis SE: bleeding, injxn site rxns (rash, pruritus, bruising) thrombocytopenia, hypokalemia, hypotension Monitor: Anti-Xa levels (3H post-dose-peak), PLT, H/H, SCr - Anti-Xa: 1.2 to 1.26 mg/L Store at room tempe Do not expel air bubble prior to injection. Store at room tempe Artane (I,D) Asmanex (I,D) Trihexyphenidyl I: drug induced EPS, PD D: 1mg/d (upto 5-15mg/d 3-4 divided doses) Mometasone I: asthma D: 2 inh BID Armour Thyroid Desiccated thyroid I: Hypothyroidism RxPO: 60-120 mg QD Warnings: ↓dose if CVD (pts are predisposed to CAD), ↓BMD Monitor: TSH levels + clinical sxs q4-6w until normal levels *Less predictable potency + stability Normal TSH: 0.3 - 3 mIU/L *Natural porcine-derived thyroid with both T3 & T4 *Not preferred, but some feel better using it BBW: thyroid supplements are ineffective & potentially toxic when used for obesity or weight loss, esp. if euthyroid; high doses ↑ risk of serious or life-threatening effects esp. with anorectic drugs (e.g. sympathomimetic amines) CI: uncorrected adrenal insufficiency SE: ↓BMD; If dose too high: ↑HR, palpitations, sweating, wt loss, arrhythmias, irritability Ativan Lorazepam C-IV [BZDP] 📄 Atacand Candesartan [ARB] - HTN, HF HF Target: 32mg QD CI: hx of angioedema BBW: pregnancy, bilateral renal artery stenosis SE: metabolic acidosis, ↑K+, ↓dry cough + angioedema ↓Lithium renal CL = ↑Lithium toxicity Hepatic dose adjust *Avoid NSAIDs - renal damage Atarax (ROA,I,D,SE) Hydroxyzine HCl (IM/PO) I: antiemetic D: Im 25-100mg/d SE: CNS depression, QT risk RxPO: 25mg TID-QID MedGuide I: anxiety (UN-CLAD), seizures, ICU agitation/sedation, alcohol withdrawal , insomnia IM/IV/PO: 0.5-2mg Q4-6H PRN (max 10mg/d) BBW: concomitant use opioids = resp. depression Warnings: anterograde amnesia, CNS depression, paradoxical rxns (hyperactive/aggression, abuse potential, pregnancy D SE: somnolence, dizziness, ataxia *Not extensively metab. by liver (LOT) - pref in elderly Antidote: Flumazenil **Injxn doses as low as 1mg/kg/d can cause propylene glycol toxicity (acute renal failure & metabolic acidosis) Atralin, Renova, Retin-A Micro, Retin-A Tretinoin [Topical retinoid] - Acne Effects take 4-12 weeks Warnings: Avoid in pregnancy/breastfeeding Counseling - limit sun exposure, apply qPM about 20min after washing face, use pea-sized amount *Retin-A Micro - slower release has less skin irritation d/t microsphere gel formulation *Adapalene (Differin) OCT gel 0.1% Atripla Efavirenz + TDF + Emtricitabine *Take on EMPTY STOMACH + bedtime (drowsiness) Efavirenz: CNS effects Atrovent (I,D) Ipratropium I: COPD D: 2 inh QID Avandia Augmentin Amoxicillin + Clavulanate [B-Lactam] TAB + SUSP (IR + ER) DOC: acute OM, H.Pylori, Endocarditis Take WITH FOOD + Refrigerate *Ok @ room temp ~14days C: MSSA, B.fragilis + all other populars (except Moraxella) Renal metabolism Austedo (I,D) Deutetrabenazine I: Huntington dz, tardive dyskinesia D: 6mg BID (max 48mg/d) Rosiglitazone [TZD] Med Guide I: T2DM, ↓A1c 0.5-1.5% RxPO: 4-8mg QD (max 8mg/d) BBW: Can cause/exacerbate HF, ↑ risk of MI CI: NYHA Class III/IV HF SE: edema, weight gain, HF, fractures, hepatotoxicity, ovulation in premenopausal women 📄 Avelox, Vigamox Moxifloxacin [FQ] - TAB + IV (1:1 conversion) Avapro Irbesartan [ARB] - HTN, diabetic nephropathy HTN: 150-300mg QD (start 75mg if volume depleted) DN: 300 mg QD CI: hx of angioedema BBW: pregnancy, bilateral renal artery stenosis SE: metabolic acidosis, ↑K+, ↓dry cough + angioedema ↓Lithium renal CL = ↑Lithium toxicity Aveed Testosterone undecanoate - IM Long acting Rx: IM q4w x2 doses, then q10w REMS - d/t anaphylaxis and serious pulmonary oil microembolism 📄 Medguide *Avoid use w/ antacids + sun exposure Moxi IV (Avelox)- DO NOT refrigerate Vigamox - bacterial conjunctivitis DDI: separate ≥4hr before/ ≥8hr after Mg, Al, Fe, Zinc, Mis, antacids, ↑AC effects (monitor INR w/ warfarin) AE: photosensitivity, dizzy + drowsy, QT prolongation, ↓BG BBW: tendon inflammation/rupture, peripheral neuropathy, CNS effects, exacerbation of myasthenia gravis DNU in UTIs - do not achieve adequate [ ] in the urine Avodart Dutasteride [5Alpha Reductase Inhibitor] I: BPH RxPO: 0.5mg QD CI: women of childbearing age, pregnancy X, children SE: impotence, ↓libido, ejaculation disturbances, breast enlargement + tenderness *TX for 6m or more for max efficacy *DO shrink prostate + ↓PSA levels *Dutasteride + Tamsulosin = Jalyn *Dutasteride + Alfuzosin = Afdura Azo, Uristat, Pyridium Phenazopyridine - PO I: Dysuria (painful urination), UTI sxs relief RxPO: 200mg TID x2d OTC-PO: 99.5mg TID x2d CI: renal insufficiency AE: Red-orange urine discoloration, acute renal failure Axid (Rx), Axid AR (OTC) Nizatidine [H2 R-antagonist] - generic only I: GERD, GI ulcer, H. pylori (off-label) Onset: 1h / Duration: 4-10h Warnings: confusion (elderly, ill, renal impairment) CrCl < 50 ↓ dose *Tab + solution ?150mg po BID x12wks? Azactam Aztreonam [Monobactam] - IV only C: StrepV + StrepPn + Neisseria + Enteroc. + Pseudomas *Rescue drug for AG nephrotoxicity Renal metabolism + toxicity, dose adjust CrCl Azulfidine, Sulfazine Bactocill Sulfasalazine [Aminosalicylates] I: UC, RA, spondylitis, Crohn's Disease (off-label) RxPO: 4-6 g/day WITH FOOD to ↓GI upset + H2O to ↓risk of kidney stones. CI: sulfa allergy + salicylate allergy SE: report rashes, yellow-orange skin/urine, ↓folate absorption, photosensitivity Oxacillin [Penicillinase-resistant PCN] IV only DOC: SSTIs, Endocarditis, Bone + Joints infections C: MSSA, Strep, Neisseria (Gram- cocci) NO renal adjustment Bactrim, Septra Sulfamethoxazole + trimethoprim - TAB + SUSP + IV - D5W only With ≥8oz WATER+FOOD to prevent kidney stones + GI upset IV - Stable at room temp ≤6h + DNRefrigerate Protect from light if undiluted AE: photosensitivity, ↑K+ CI: Pregnancy cat. D (malformations) Sulfa Allergy = rash (SJS) Renal adjust ?-SS: 400mg SMX/80mg TMP -DS: 800mg SMX/160 mg TMP CI: sulfa allergy, pregnancy/bf, folate deficiency anemia, severe RI/HI, <2months old Warnings: G6PD def; Blood dyscrasias; SJS/TEN, TTP; Teratogenic *Mod-strong CYP2C8 and 2C9 inhibitor SE: -crystalluria, photosensitivity hemolytic anemia, hyperkalemia? Baxdela Bactroban Mupirocin [Burns] - RX *Good staph + strep coverage, used for MRSA nasal colonization too Delafloxacin [FQ] - IV + PO Medguide Can be used for MRSA *Avoid use w/ antacids + sun exposure DDI: separate ≥2hr from Mg, Al, Fe, Zinc, Mis, antacids,↑AC effects (watch for ↑INR w/ warfarin) Renally adjust - DNU in ERSD (eGFR < 15) AE: photosensitivity, dizzy + drowsy, ↓BG BBW: tendon inflammation/rupture, peripheral neuropathy, CNS effects, exacerbation of myasthenia gravis 📄 UTI dosing: 1 DS tab BID x 3 days Benemid Bayer, Bufferin, Ecotrin Aspirin [COX1+2 Irreversible inhibitor] I: stroke ppx (1° + 2°) RxPO: 50-325mg QD CI: NSAID/salicylate allergy, children/teenagers w/ viral infection (Reye's syndrome) Warnings: bleeding SE: dyspepsia, heartburn, N *Yosprala (+omeprazole) - pts @risk of ASA-associated gastric ulcers Benadryl (I,D) Diphenhydramine (PO/IM/IV) I: allergy, cold, motion sickness, uritcaria D: 25mg Q4-6H or 50mg Q6-8H Probenecid [Uricosuric] I: gout ppx (↑ UA excretion) RxPO: 500 mg QD ?(max 2g/d)? *Avoid in CrCl <50 Warnings: Sulfa drug Must have adequate renal function Probenecid ↓ renal CL of other meds: - Beta lactams: PCNs/Cephs/Carbapenems - Methotrexate - Salicylates Benicar, (I,D,BBW,SE) Benlysta Olmesartan [ARB] I: HTN, HF RxPO: 40mg po qd Belimumab [IgG1 MaB] - Lupus Med Guide I: SLE (biologic DMARD) Rx: 200mg SC weekly or 10mg/kg IV q4w ?D, IV: 10mg/kg IV q2wks x3 doses then q4wks D, SC: 200 mg SC once weekly? Warnings: infections, DNU w/ other biologics or live vaccines ? serious/fatal infxns, PML, acute hypersensitivity rxns, malignancy, psychiatric events, do not give with other biologic DMARDs or live vaccines? CI: hx of angioedema, within. 36h of ARNI (Entresto) BBW: pregnancy, bilateral renal artery stenosis SE: spruce-like enteropathy, metabolic acidosis, ↑K+, ↓dry cough + angioedema -SLE = severe/chronic diarrhea w/weight loss, abd pain, fatigue, bloating, N/V, anemia *Avoid w/ NSAIDs - renal damage ↓Lithium renal CL = ↑Lithium toxicity 📄 Bentyl Dicyclomine [Antispasmodic] I: D w/ IBS RxPO: 10mg AC and QH Warnings: anticholinergic (caution if ≥65Y), toxic megacolon, paralytic ileus SE: N and dizziness, anticholinergic effects (dry mouth, dry eyes, constipation, urinary retention, blurred Vision) Betapace (I,D,SE) Betoptic Bepreve Bepotastine eye drops 2nd gen antihistamine Sotalol [Class III block K+ channels + BB] RxPO: 160mg PO BID; CrCl <60: ↓frequency BBW: Initiate/↑dose in hospital w/ cont ECG monitoring; dose interval adjusted per CrCl to ↓QT prolongation (risk related to concentration) CI: QTc >450 msec, bronchospastic condition, CrCl <40, K <4 SE: bradycardia, fatigue, bronchoconstriction, HF Betaxolol [B-Blocker] - ↓aqueous humor production I: glaucoma CI: asthma/COPD, HR<55, CHF, depression, MG SE: bronchospasm, bradycardia, ↓BP & libido, CNS depression Biaxin Clarithromycin [macrolide] - TAB + SUSP Biaxin XL - take WITH FOOD PO: 250-500mg Q12H or 1g XL daily AltPO: IR 500mg BID Warnings: -QT prolongation -Hepatotoxicity -Major CYP3A4 inhibitor -Caution in pts with CAD CI: hepatic dysfxn w/ prior use;current lovastatin or simvastatin use; colchicine in RI/HI; h/o QT prolongation or ventricular arrhythmias AE: metallic taste Hepatic metabolism - 3A4 + 1A2 strong inhibitor Renal adjustment - CrCl < 30mL/min ↓dose by 50% DNU: pregnancy, hx of QT prolongation or arrhythmia, or w/ simvastatin *DO NOT refrigerate reconstituted oral suspension- thickens + bitter Biktarvy Bio-Statin Bictegravir + TAF + Emtricitabine Bictegravir DNU if CrCl < 30 and severe hepatic impairment Nystatin [Antifungal] - SUSP+tab Oral Candidiasis: QID swish in mouth, retain several min, swallow. Boniva Blocadren Timolol [Nonselective BB] RxPO: 10-30 mg BID BBW: Do not stop abruptly CI:↓HR, heart block - Monitor w/ diltiazam, verapamil, clonidine, digoxin, amiodarone Caution: DM (worsen BG + mask ↓BG) + COPD/asthma SE: ↓HR, hypoTN, depression, ↓libido, fatigue, dizziness Timoptic - opthalamic solution Ibandronate [Bisphosphonate] MedGuide I: Osteoporosis PO PPX+TX: 150mg monthly (stay upright x60min) INJ: 3mg IV q3m *pref if risk of esophageal cancer* CI: inability to stand/sit upright for 60min, hypoCa, pts w/ abnormalities of the esophagus Warnings: osteonecrosis of jaw, atypical femur fractures, esophagitis, esophageal ulcers, erosions, renal imp (DNU if CrCl <30) SE: hypoCa, esophagitis, musculoskeletal sxs, dyspepsia, N/V, dysphagia, heartburn *Separate admin from Ca, antacids, Fe, Mg ~2h *Take BEFORE EAT/DRINK QAM w/ 6-8oz water. Brethine (PO/SQ) (BW,I,D) Terbutaline BW: prolonged tocolysis (avoid in prego) I: ashtma D: 5mg TID PO; 0.25mg SQ/dose Brevibloc Brillinta Esmolol [β1-Blocker] *IV only for HTN emergency BBW: Do not stop abruptly to avoid acute tachycardia, HTN and/or ischemia CI:↓HR, heart block diabetes, asthma/COPD - Monitor w/ diltiazam, verapamil, clonidine, digoxin, amiodarone Caution: DM (worsen BG + mask ↓BG) + COPD/asthma SE: ↓HR, hypoTN, depression, ↓libido, fatigue, dizziness, dyslipidemia, weight gain, fluid retention, Ticagrelor [P2Y12 reversible inhibitor] I: ACS RxPO: LD 180mg + MD 90mg BID x1Y, then 60mg BID BBW: ASA MD >100mg ↓Ticagrelor effectiveness, avoid in severe hepatic impairment SEs: bleeding, dyspnea Counseling: Tablets can be crushed & mixed w/ water to be swallowed or given via NG tube. *Major 3A4 substrate, avoid strong inducers/ inhibitors BuSpar (Generic only) Buspirone [5HT1 Partial Agonist] I: GAD (takes 2-4 weeks) RxPO: 10-15mg/d BID-TID (max 60mg/d) Warnings: DNU w/ MAOi or within 14d SE: akathisia (restlessness), CNS depression, serotonin syndrome No potential for abuse/withdrawal *Take w/ or w/o food, but be consistent Bumex Bufferin Aspirin [COX Irreversible inhibitor] PO: 81, 162mg, 325 mg Caution: Reye's Syndrome pts < 16Y, overdose sxs include tinnitus S/sx: lethargy, vomiting, sleepiness Pregnancy C/D Bumetanide [Loop] - HF edema only RxPO: 0.5-1mg po BID ?RxPO: 1mg po bid? CI: sulfa allergy Warnings: ototoxicity, nephrotoxicity, hyperUA SE: metab. alkalosis, ↓K+, Na+, Mg2+, Ca2+, BMD, ↑BG, TG, Chol, UA *IV: Ototoxicity and avoid use w/ aminoglycosides Equivalency: BTFE = 1:20:40:50 Torse 20mg = bume 1mg = furo 40mg = ethacry 50mg Butrans, Suboxone, Belbuca Buprenorphine [C-III] 📄 Med Guide + REMS Butrans - patch; Change weekly, apply to upper outer arm, fold & flush Suboxone - +naloxone Belbuca - buccal film Bydureon, Bydureon BCise Byetta Exenatide ER [GLP1 agonist] Exenatide IR [GLP1 agonist] MedGuide T2DM, ↓A1c 0.5-1.5% RxInj: 5 mcg SC BID WITHIN 60MIN OF MEALS x1month; then can ↑ to 10 mcg SC BID Fridge + Protect from light *After open @RT/Fridge x30d* Warnings: pancreatitis; avoid in severe GI dz (inc. gastroparesis) SE: nausea, weight loss *Discard pen after 30days *ESRD or CrCl <30: not recommended Pens needles not provided 📄 Med Guide T2DM, ↓A1c 0.5-1.5% D: 2mg SC once WEEKLY Fridge + Protect from light x4 weeks BBW: risk of thyroid C-cell carcinomas CI: personal or family h/o thyroid cancer or multiple endocrine neoplasia (MEN2) Warnings: pancreatitis; avoid in severe GI dz, including gastroparesis SE: nausea, weight loss, serious inj site rxns (w/without nodules) ESRD or CrCl <30: not recommended 📄 Calan, Isoptin, Verelan, Covera Verapamil [NDHP-CCB] I: HTN, angina, arrhythmia RxPO: 240-480 mg/day ?Max dose: 120mg/day (Dosed qd, bid, tid)? *Preferred if CKD and nephropathy *More negative inotropic effects = ↓HR Warnings: AV block/sinus bradycardia, skin rxns (SJS, TEN, etc. dc if it persists) SE: bradycardia, gingival hyperplasia, constipation, edema, hypoTN, dizziness DDI: 3A4 inhibitor + substrate (use ↓dose with Simva, Lova, Atorva) + Pgp substrate - avoid grapefruit May worsen s/sxs of HF Bystollic Nebivolol [β1B-NO dependent vasodilation] Max dose 40mg/day BBW: Do not stop abruptly to avoid acute tachycardia, HTN and/or ischemia CI:↓HR, heart block, Child-Pugh class C - Monitor w/ diltiazam, verapamil, clonidine, digoxin, amiodarone Caution: DM (worsen BG + mask ↓BG) + COPD/asthma SE: ↓HR, hypoTN, depression, ↓libido, fatigue, dizziness Canasa Rowasa Asacol HD, Lialda Apriso, Delzicol, Pentasa (I, formulations) Caldolor (IV) (i,D) Ibuprofen I: analgesia Dose: 400-800mg Q6H prn (max: 3200mg/d) Mesalamine (5-ASA) Canasa: Suppository (retain ≥1-3H) Rowasa: Enema (retain ≥30min) Asacol HD, Lialda: ER tabs Apriso, Delzicol, Pentasa: ER caps I: ulcerative colitis, induction tx for acute flares, and maintenance Counseling: suppositories/enemas stain fabric, flooring, painted surfaces, marble, granite, vinyl & enamel Capoten (Canada) Cancidas Caspofungin (IV) Candidemia RxIV: 70mg IV on day 1, then 50mg IV QD Moderate hepatic impairment: 7- mg IV on day 1, then 35 mg daily Given once daily; no renal dose adjustment Warnings: histamine mediated rxns, ↑ LFTs, SJS Cardene Nicardipine [DHP-CCB] - IV + PO I: HTN, angina RxPO: 20-40 mg TID (usual 60mg/day) CI: CHF, DNU w/ BB if acute MI (AV block + bradycardia) SE: reflex tachycardia, HA, flushing, edema DDI: Major 3A4 substrate - avoid grapefruit Captopril [ACEi] - generic only I: HTN, HFrEF, diabetic nephropathy, MI w/ LV dysFXN RxPO: 50 mg TID (max) ?RxPO: 12.5-100 mg BID? CI: hx of angioedema, within 36h of ARNI (Entresto) BBW: pregnancy, bilateral renal artery stenosis SE: metab. acidosis, ↑K+, dry cough, angioedema, cholestatic jaundice *Avoid w/ NSAIDs - renal damage ↓Lithium renal CL = ↑Lithium toxicity Renal dose adjust Sucralfate [PGE1 Analog] - ↑mucosal protection I: NSAID-induced gastric ulcers RxPO: 1g PO QID BEFORE MEALS + QHS SEs: constipation (d/t Aluminum component) Avoid if renal disease *Binding interactions w/ other drugs Cardizem, Cartia XT, Tiazac Cardura, Cardura XL Diltiazem [NDHP-CCB] I: HTN, angina, arrhythmias RxPO: 120-360 mg/day *More negative inotropic effects = ↓HR ?Max dose: 120mg/day (Dosed qd, bid, tid)? Warnings: AV block/sinus bradycardia, skin rxns (SJS, TEN, etc. dc if it persists), hepatic effects DDI: 3A4 inhibitor + substrate (use ↓dose with Simva, Lova, Atorva) + Pgp substrate - avoid grapefruit SE: bradycardia, gingival hyperplasia, constipation, hypoTN, edema, dizziness Doxazosin [Non-Selective α1-blocker] I: BPH, 2nd/3rd line for HTN IR: 1mg qHS - max 4-8mg XL: 4mg WITH BKF - max 8mg HTN: 16mg QHS Warnings: orthostatic hypoTN, intraoperative floppy eye syndrome in cataract surgery, Pregnancy X SE: dizzy, fatigue, HA, abnormal ejaculation *Give at bedtime to minimize dizziness - additive effect with PDE5inhibitors *Do NOT shrink the prostate or change PSA levels. Carafate Carimune NF, Flebogamma DIF, Gammagard, Gamunex-C, Octagam, Privigen (BBW, CI, W, SE) IVIG: pooled IgG from 1,000+ human blood donors BBW: acute renal failure (primarily in products w/ sucrose & in preexisting risk for renal damage); Use lowest concentration & minimum rate, avoid nephrotoxic drugs if possible; thrombosis CI: IgA deficiency (use products w/ lowest amount of IgA) Warnings: caution in CVD, use low infusion rates SE: HA, infusion rxns *Use IBW to calculate dose Catapres, Catapress Clonidine [Alpha2 Agonist] I: resistant HTN or pts who can't swallow Off-Label: opioid withdrawal, anxiety and sleep RxPO: 0.1-0.3 mg po BID RxPatch: 0.1, 0.2, 0.3 mg/24 hr/wk *Apply to upper outer arm/chest + rotate site weekly Caution: bradycardia, dry mouth, fatigue, somnolence, dizziness, constipation, hypotension Must taper off Ceclor, Raniclor Cefaclor [2nd gen] - PO + SUSP Refrigerate, ok @room temp ~1 day C: Gram-, some anaerobes Accumulation = seizures Renal metabolism + toxicity, dose adjust CrCl Ceftin (PO), Zinacef (IV/IM) Cedax Cefotan Ceftibuten [3rd Gen] - PO + SUSP Refrigerate, ok @room temp ~1 day Renal adjustment Cefotetan [2nd gen] - IV + IM C: Gram-, some anaerobes Renal metabolism + toxicity, dose adjust CrCl Cefuroxime [2nd gen] - PO + SUSP + IM + IV *Don't crush/chew tab (bitter), tab ≠ SUSP C: Gram-, some anaerobes Ceftin take WITH FOOD ↑absorption *Shake and refrigerate x10d DNU w/ antacids, Fe (Separate by ≥ 2h) Accumulation = seizures Renal metabolism + toxicity, dose adjust CrCl Celebrex Celexa Celecoxib - NSAID - COX2, no anti platelet activity RxPO: 50, 100, 200, 400 mg Citalopram [SSRI] - MD MedGuide RxPO: 20-40mg QD max 40mg/d (20mg if ≥60Y d/t QT risk) CI: use w/ MAOi, linezolid, methylene blue Warnings: QT prolongation, SIADH, hyponatremia, bleeding SE: insomnia, somnolence, sexual side effects, N, dry mouth, diaphoresis, weakness, tremor, dizziness, HA Cefzil Cefprozil [2nd gen] - PO + SUSP C: Gram-, some anaerobes *Shake and refrigerate x14d, ok @room temp ~1 day Accumulation = seizures Renal metabolism + toxicity, dose adjust CrCl 📄 Med Guide BBW: DNU for post-op pain after CABG, risk of GI bleed (lower) + CV events *SULFA allergy Not recommended for renal/hepatic impairment 📄 CellCept Mycophenolate Mofetil [Antiproliferative] 📄 MedGuide + REMS I: transplant RxPO: 1-1.5g PO/IV BID BBW: ↑risk of infections, ↑skin malignancies, ↑congenital malformations + spontaneous abortions. SE: GI upset, diarrhea IV only stable in D5W ↓Levels of hormonal contraceptives Cerebyx Fosphenytoin [AED] Prodrug of phenytoin - IV/IM only Max infusion rate: 150mg PE/min d/t hypotension + cardiac arrhythmias Cesamet Nabilone [Cannabinoid] - C-II SE: somnolence, euphoria, ↑appetite Chantix (I,D) Varenicline BBW: suicidal ideation I: smoking cessation Days 1-3: 0.5mg QD; Days 4-7: 0.5mg BID Days 8 (quit date) and beyond: 1mg BID *Start 1 week before quit date B/G Chantix Start Month Pak: 0.5mg tablets (11) and 1mg tablets (42) Chantix: Continuing Month Pak: contains 1mg tablets *Tryvaya = nasal spray for dry eyes Warning: Sseroius neuropsychiatric events, seizure SE: Nausea (30%), insomnia, abnormal dreams, headache Chlor-Trimeton Chlorpheniramine [1st Gen Anti-H1] I: allergy, urticaria/pruritus, N/V, motion sickness RxPO: IR 4mg Q4-6H; ER 12mg Q12H (max 24mg/24H) SE: CNS depression Cialis (I,D) Tadalafil I: BPH, ED BPH: 5mg QD ED: 10mg 30min before activity Cialis, Adcirca Tadalafil [PDE-5 Inhibitor] I: ED + BPH (Cialis), PAH (Adcirca) ED → 2.5-5mg QD or 10mg 30min before sex - Use 5mg if ≥65, w/ α-blocker (Terazosin, doxazosin, tamsulosin), w/ 3A4 inhibitor, severe renal/liver DZ) BPH: 5mg QD, 2.5mg if 3A4 inhibitor or CrCl 30-50 PAH: 40mg QD CI: w/ nitrates or riociguat. (48h) Warnings: impaired color discrimination, hearing + vision loss, hypoTN, priapism for >4h, CVD w/ chest pain. SE: HA, flushing, dizzy, dyspepsia, back pain (highest) *Longest - "weekend pill" DDI: *3A4 inhibitors ↑drug levels, 3A4 inducers ↓levels Cipro Cimzia Certolizumab [Anti-TNF Biologi DMARD] Rx: 200mg SC every other week BBW: serious infections (Screen for latent TB), malignancies + lymphoma Warnings: demyelinating disease, hepB reactivation, HF, hepatotoxicity, lupus-like syndrome *DNU w/ other biologic DMARDs or live vaccines Ciprofloxacin [FQ] - TAB + SUSP + IV + OPTH + OTIC - D5W only 📄 Medguide *Avoid use w/ antacids + sun exposure DDI: strong 1A2 inhibitor, separate ≥2hr before/≥6h after Mg, Al, Fe, Zinc,↑AC effects (watch for ↑INR w/ warfarin) Renally adjust AE: photosensitivity, dizzy + drowsy, QT prolongation, ↓BG BBW: tendon inflammation/rupture, peripheral neuropathy, CNS effects, exacerbation of myasthenia gravis DNU for pneumonia - not active vs strep pneumo Claritin (I,D) Ciprodex Ciprofloxacin/dexamethasone ear drops Clarofan Cefotaxime [3rd gen] - IV + IM C: gram- , N. gonorrhea + N.meningitidis Renal metabolism + toxicity, dose adjust CrCl Clarinex (I,D) Desloratadine I: chronic itiopathic urticaria, allergic rhinitis D: 5mg QD Cleocin Clindamycin - PO + SUSP + IV BBW: prolong use can cause infection, Cdiff, colitis DO NOT refrigerate = thickens Drink w/ ≥ 8oz water to ↓esophageal ulceration Loratadine 2nd generation ORal Antihistamine I: allergic rhinitis, uritcaria RxPO: for adult and children >6 yo: 10mg PO daily or 5mg PO BID (RediTAbs) Age 2-5 years: 5 mg PO Daily B/G Claritin, Claritin Childrens, Alavert F: Tablet, capsule, chewable, solution, syrup ODT OTC +pseudoephedrine (Claritin-D) OTC SE: somnolence (more with ceterizine/levoceterizine) more sedating Clinoril Sulindac - NSAID Max 400 mg/d 📄 Med Guide BBW: DNU for post-op pain after CABG, risk of GI bleed + CV events *Preferred in reduced renal FXN Clozaril, Versacloz Clozapine [SGA-Atypical] I: schizophrenia (3rd line d/t severe SEs) RxPO: 12.5mg QD-BID; target dose 300-450 mg/d, max 900mg/day BBW: 1. Neutropenia/ agranulocytosis (REMS) 2. Bradycardia, orthostasis, syncope, cardiac arrest 3. Myocarditis, cardiomyopathy 3. Seizures 4. ↑mortality in dementia SE: weight gain, ↑lipids, ↑glucose, QT prolongation, agranulocytosis, hypersalivation (sialorrhea) * ↓risk of EPS/TD Monitoring: baseline ANC must be >1500/mm^3; Check ANC weekly x6months then Q2wks x6months, then monthly Stop therapy if ANC <1,000/mm^3 Note: prescribers + pharmacies must be certified Note: smoking ↓ drug levels - 1A2 substrate DDI: Bactrim + Carbamazepine ↑risk of agranulocytosis, DNU w/ bupropion or fluvoxamine Codeine (CV) Cogentin I: pain, cough *Converted to morphine by 2D6: avoid 2D6 inhibitors; risk of respiratory depression in ultra-rapid metabolizers BBW: resp. depression / death (including children who received codeine after tonsillectomy or adenoidectomy & nursing infants of mothers who were ultra-rapid metabolizers) CI: <12 yo; <18 yo following tonsillectomy/adenoidectomy Benztropine [Anticholinergic] I: drug induced EPS, Parkinson's tremors RxPO: 0.5-2mg TID (start QHS) AEs: dry mouth, constipation, urinary retention, blurred vision, somnolence, confusion Colcrys, Gloperba oral solution Colace Docusate sodium [Emollient] I: stool softener for constipation OTC: 100mg QD; rectal 1 enema QD-TID Onset 12h-72h (PO) or 2-15min (rectal) Pregnancy C Require increased fluid intake to soften stool *Preferred when straining should be a voided Colchicine [Gout] Colace (I,ROA,D) Docusate sodium (PO/rectal) I: stool softener D: PO 240mg QD; rectal 1 enema QD-TID 📝 Medguide TX: 1.2mg, then 0.6mg in 1h (Max 1.8mg/h or 2.4mg/d) PPX: 0.6 mg QD-BID CI: w/ Pgp (cyclosporine) or strong 3A4 inhibitors (clarithromycin) fetal toxicity Warnings: GI sxs, myopathy SE: N/V/D, myelosuppression, myopathy, neuropathy *Start within 36h of sxs onset + wait 12h b/w TX and PPX doses Combivent Respimat (I,D) Colestid Colestipol [Bile acid sequestrant] I: high cholesterol RxPO: 2g QD-BID (max 16g/d) - also as granules CI: bowel obstruction Warnings: constipation, acidosis, bleeding SE: constipation, abd pain, cramping, bloating, gas, ↑TG Take all other drugs 1-4h before or 4-6h after *All ↓absorption of fat-soluble vitamins (ADEK) Ipratropium/albuterol 20 mcg ipratropium + 100 mcg albuterol/inh Nebulizer solution: 0.5 mg ipratropium + 2.5 mg albuterol per 3mL Muscarinic Antaognist I: COPD RxINH: *MDI: 1 inhalaiton QID Nebulizer: 3mL QID Side effect: Dry mouth, upper respiratory tract infection (nasopharngitis, sinusutis), cough, bitte rtaste Monitor: smoking status, COPD questionaires annual spirometry Commit lozenge Nicotine polacrilex: 2mg, 4mg Counseling: Don't eat/drink 15min before use. Don't chew or swallow AE: N, sore throat, hiccups Warnings: ↑BP, ↑HR, vasoconstriction - caution in CVD, Pregnancy D Dosing: max 20 lozenges/day - 1st cig > 30min upon waking: 2mg - 1st cig ≤ 30min upon waking: 4mg *Use q1-2h x6w, q2-4h x3w, q4-8h x3w Compro, Compazine (I, BBW,W,SE, D) Compazine, Compro (Supp) Prochlorperazine [DA R-antagonist] - PO/SUPP/IV I: N/V D: 10mg IV/PO q6h PRN or 25mg SUPP q12h BBW: ↑mortality elderly w/ dementia-related psychosis SE: sedation, lethargy, acute EPS, can ↓seizure threshold. *Avoid in Parkinson's disease + children <2Y Complera Rilpivirine + TDF + Emtricitabine Take WITH FOOD DNU w/ PPIs. Prochlorperazine (tab/IM/IV/suppository) I: DA-R antagonist for CINV BBW: ↑mortality in elderly w/ dementia W: Avoid use in Parkinson's SE: sedation, NMS, QT prolongation, acute EPS, can ↓ seizure threshold RxIV/PO: 10mg Q6H PRN (max 40mg/d) *may give 25 mg suppository PR Q12H PRN Concerta OROS, Adhansia XR, Aptensio XR, Jornay PM, Ritalin LA/SR, Quillivant XR (suspension), Metadate ER, Relexxii Comtan Methylphenidate ER C-II [Stimulant] Entacapone [COMT inhibitor] I: PD - for wearing off sxs RxPO: 200mg PO w/ each Sinemet dose - max 1600mg/d *Only use with Levodopa Stalevo = Levodopa + Carbidopa + Entacapone I: ADHD, Narcolepsy RxPO: 18-36mg QAM (Max 72mg/day) BBW: abuse/dependence CI: within 14d of MAOi Warnings: exacerbate mania, ↑seizure risk, loss of appetite AEs: N, insomnia, HA, irritability, blurry vision, dry mouth Monitor: ECG prior, BP, HR, height, weight Note: OROS - ghost tablet, ↓abuse potential + Mimics TID dosing 📄 MedGuide Constulose, Enulose, Kristalose (PO Packets) Lactulose [Osmotic] I: constipation, portal systemic encephalopathy, overt hepatic encephalopathy I: constipation RxPO: 10-20 g (15-30 mL or 1-2 packets) QD ?16.7g (25mL) Q1-2h until at least 2 loose stools, titrate to 2-3 bowel movements? Onset 30min - 96h SE: electrolyte imbalance Cordarone, Nexterone, Pacerone Amiodarone [Class III: Blocks K+ channel] 📄 MedGuide Contrave Bupropion + naltrexone I: weight management CI: seizure disorder, h/o anorexia/bulimia, abrupt discontinuation of ethanol or sedatives avoid in HTN ER tablet: 8mg/90mg Week 1: 1 tab PO QAM Week 2: 1 tab PO QAM, 1 tab PO QPM Weel 3: 2 tabs PO QAM, 1 tab PO QPM Week 4+ 2 tabs PO QAMm 2 tabs PO QPM do not cut chew or crush, swallow whole fatty food increase drug levels CI: pregnancy Warning: psychiatric Copaxone Glatiramer acetate [Immune modulator] - MS Rx: 20mg SC QD or 40mg SC 3x/week q48h SE: injection site rxns, diaphoresis, dyspnea Preferred in pregnancy DOC in pts w/ HF Take WITH FOOD to ↓N + water to ↓constipation BBW: pulmonary toxicity + hepatotoxicity - only for life-threatening arrhythmias. Hospitalize pts for LD admin CI: iodine hypersensitivity Warnings: Hyper + hypothyroid (hypo > common, inhibits conversion T4→T3), optic neuropathy, photosensitivity (blue skin discoloration), peripheral neuropathy, SJS SE: hypotension, bradycardia, corneal microdeposits, dizziness, ataxia, N/V, constipation, DILE Monitor: ECG, BP, HR, e-lytes, pulm fxn, LFTs, TSH, eye exams Notes: Avoid in pregnancy/BF + use Non-PVC container for infusions >2H + 0.22micron filter. *Incompatible w/ heparin (flush line) Premixed IV bags - longer stability, non-PVC DDI: 3A4/2C8/Pgp substrate; mod 2C9/2D6 inhibitor + 3A4/Pgp weak inhibitor - When starting amio, ↓digoxin 50% & warfarin 30-50% - Max 20mg simva & 40mg lovastatin DNU w/ sofosbuvir d/t bradycardia Additive ↓HR w/ N-DHP CCB, digoxin, BBs, clonidine Coreg Carvedilol [α1-blocker + BB] HTN: 3.125-25 mg po BID take WITH FOOD ↓absorption rate + orthostatic hypoTN HF target dose: 25mg BID (≤85KG), 50mg BID (>85KG) HF CR: start 10mg QD for 2wks, titrate to max 80mg QD IR:CR conversion → 3.125 BID = 10 mg QD ?3.125-25 mg po BID with food HF target dose: 25mg po BID 6.25mg IR = 20 mg CR? BBW: Do not stop abruptly to avoid acute tachycardia, HTN and/or ischemia CI:↓HR, heart block; diabetes, asthma/COPD - Monitor w/ diltiazem, verapamil, clonidine, digoxin, amiodarone Caution: DM (worsen BG + mask ↓BG) + COPD/asthma SE: ↓HR, hypoTN, depression, ↓libido, fatigue, dizziness, dyslipidemia, wt gain, fluid retentio Corgard Nadolol [Nonselective BB] I: HTN, angina RxPO: 40 - 120 mg QD Renal adjustment + Pgp substrate BBW: Do not stop abruptly to avoid acute tachycardia, HTN and/or ischemia CI:↓HR, heart block - Monitor w/ diltiazam, verapamil, clonidine, digoxin, amiodarone Caution: DM (worsen BG + mask ↓BG) + COPD/asthma SE: ↓HR, hypoTN, depression, ↓libido, fatigue, dizziness Corlanor Ivabradine [Inhibits I-f Current] RxPO: 2.5-7.5mg BID for HF SinusTach target dose 7.5mg BID FDA approved for HF only Off-label use for angina and sinus tach *Fetal toxicity Cotempla XR Cosopt, Cosopt PF Cortisporin Polymyxin B + bacitracin + neomycin + hydrocortisone - RX Timolol + Dorzolamide [BB + Carbonic Anhydrase Inhibitor] I: IOP 1 drop BID Cosopt PF: single use container, Preservative Free *Separate from other ophthalmics by at least 5 min SE: burning, stinging Warnings: sulfonamide allergy Methylphenidate XR ODT C-II [Stimulant] - ADHD 📄 MedGuide RxPO: 17.3mg qAM for 6-17 YO BBW: abuse/dependence CI: within 14d of MAOi Warnings: exacerbate mania, ↑seizure risk, loss of appetite AEs: N, insomnia, HA, irritability, blurry vision, dry mouth Monitor: ECG prior, BP, HR, height, weight Coumadin, Jantoven Warfarin. [VitK antagonist - Factors II, VII, IX, X] 📄 MedGuide RxPO: 10mg QD x2d then INR adjust (healthy), ≤5mg if elder, malnourished, if DDIs, liver disease, HF, or high bleeding risk. *Racemic mix - S-enantiomer is 2.7-3.8x more potent Acute DVT/PE - start warfarin w/ IV AC and continue for a minimum of 5d AND until INR ≥2 for at least 24h CI: pregnancy (except w/ mechanical heart valve) Warnings: tissue necrosis/gangrene, CYP2C9*2 or *3 alleles or VKORC1 (↑bleeding risk) VKORC1 (↑ bleeding risk) SE: bleeding, skin necrosis, purple toe syndrome Monitoring: INR after 2-3 initial doses, then Q4-12wks Goal INR 2-3 (most indications) Goal INR 2.5-3.5 (mech. mitral valve or 2 mech. valves) Goal INR 1.5-2.5 (PAH) PT: 12-14 sec Antidote: Vit K, Kcentra DDIs: 2C9 inducers (rifampin) ↓INR, 2C9 inhibitors ↑INR (amiodarone, fluconazole, metronidazole, TMP/SMX). SJWs ↓effectiveness,↑bleeding risk w/ 5Gs, NSAIDs, antiPLTs, SSRIs, SNRIs, fish oil, willow bark, wintergreen oil HIT: dc warfarin (↑risk of warfarin-induced limb gangrene w/ low PLTs). Restart when PTLs ≥ 150,000/mm^3. 1mg (Pink)..............................5mg (Peach) 2mg (Purple).........................6mg (Forest) 2.5mg (Green, Xmas).........7.5mg (Bananas) 3mg (Tan)................................10mg (White Clouds) 4mg (Blue) Cozaar Losartan [ARB] - HTN, Proteinuric CKD HF target: 150 mg QD (off label) RxPO: 25-50 mg QD (max 100mg/d) CI: hx of angioedema BBW: pregnancy, bilateral renal artery stenosis SE: metabolic acidosis, ↑K+, ↓dry cough + angioedema ↓Lithium renal CL = ↑Lithium toxicity Avoid NSAIDs Creon, Viokase, Zenpep Pancrelipase (lipase, amylase & protease from porcine pancreatic glands) I: CF, titrated to normalize stool; take w/ all meals & snacks Warnings: fibrosing colonopathy, mucosal irritation, hyperuricemia *Pancreatic enzyme products are not interchangeable Crestor Rosuvastatin [Statin] RxPO: 5-40mg QD (high = 20-40mg, moderate = 5-10mg) CI: Pregnancy, breastfeeding, active LD (↑ LFTs) Warning: rhabdomyolysis, myopathy (↑risk w/ age ≥65Y + niacin), hepatotoxic AEs: myalgias, arthalgias, myopathy Monitor: LFTs + lipid panel @baseline + 4-12 weeks after Myopathies w/ Colchicine co-use Avoid with gemfibrozil + niacin ≥ 1g Criteria for Initiating Osteoporosis treatment: Osteoporosis: - PostM women/men >50YO w/ BMD T-score ≤ -2.5 at femoral neck, total hip or lumbar spine, OR - Presence of a fragility fracture, regardless of BMD Osteopenia (if high risk): - Low BMD (T-score b/w -1 and -2.5) at femoral neck, total hip or lumbar spine, AND - FRAX score with 10Y probability of a major osteoporosis-related fracture ≥ 20% or a 10Y hip fracture probability ≥3% Crixivan Indinavir (PI) - Take q8h on EMPTY STOMACH or BID w/ Norvir w/ or w/o food. - Drink min. 48 oz water daily to prevent kidney stones Cyanocobalamin (B12) -Formulations,CI,Warnings Cubicin (Warnings, monitoring, use) Daptomycin - IV - NS only C: Gram+; Approved for complicated SSTI, MRSA; active against both sp. of VRE, E. faecium & E. faecalis RxIV: 6mg/kg IV once daily Warnings: -Eosinophilic pneumonia (Not used for pneumonia!) *Can cause easinophilic pneumonia -Myopathy/rhabdo -False ↑PT/INR (but not bleed risk) -Peripheral neuropathy Monitor CPK weekly (dc if >10,000 units/L or >1,000 + muscle pain) neuropathy, dyspnea SE: Rhabomyolysis (careful if taking statins) Injection (IM/deep SC) Lozenges, tablets, SL liquid RxInj: IM or deep SC: 100-1000 mcg daily/weekly/month RxOral/sublingual: 1000-2000 mcg daily Nasocobal: 500 mcg in one nostril once weekly M: Hgb, Hct, vitamin B12, reticulocyte count SE: pain with injection DDI: Chloramphenicol and avoid raltitrexed (chemotherapuetic agent) Nasal solution (Nascobal): one nostril once weekly CI: Cobalt or vitamin B12 allergy (intradermal test dose recommended if suspected sensitivity prior to intranasal or injectable use) Warnings: parenteral products may contain aluminum (accumulation can cause CNS & bone toxicity in RI) or benzyl alcohol (can cause fatal toxicity & "gasping syndrome" in neonates) *b/g B-12 Complaiance, Nasocobal, Physician EZ Use B-12) F: Ijection, lozenges, tablets (icluding ER and SL forms) SL liquid, nasal solutiton Cymbalta, Drizalma Sprinkle Duloxetine [SNRI] - MD 📄 MedGuide I: Depression, Peripheral neuropathy, GAD, fibromyalgia, chronic musculoskeletal pain RxPO: 40-60mg/day (Max 120 mg/d) Renal dose adjust - if CrCl < 30 DNU BBW: risk of suicide CI: with MAOi or SNRIs (5-14d wash out), uncontrolled narrow angle glaucoma SE d/t ↑NE: ↑HR, dilated pupils, dry mouth, excessive sweating, constipation, bleed risk, ↑BP, glaucoma, ↑ fall risk 2D6 inhibitor - ↓tamoxifen metabolism to active form Cytomel, Triostat Liothyronine I: Hypothyroidism RxPO: 25-75 mcg QD Warnings: ↓dose if CVD (pts are predisposed to CAD), ↓BMD BBW: thyroid supplements are ineffective & potentially toxic when used for wt loss, esp. if euthyroid; high doses ↑ risk of serious or lifethreatening effects esp. with anorexants (e.g. sympathomimetic amines) CI: uncorrected adrenal insufficiency SE: ↓BMD; If dose too high: ↑HR, palpitations, sweating, wt loss, arrhythmias, irritability Monitor: TSH levels + clinical sxs q4-6w until normal levels *Shorter half-life - fluctuations in T3 levels Normal TSH: 0.3 - 3 mIU/L Cytovene Cytotec Misoprostol [PGE1 Analog] - ↑mucosal protection I: NSAID-induced gastric ulcers RxPO: 200mcg QID PO BBW: abortifacient, DNU in women of childbearing age SE: D, abdominal cramps D.H.E. 45, Migranal Daliresp (I,D) Dihydroergotamine. [5HT Agonist - Nonselective] I: Migraines - for pts w/ CI/no relieve from Triptans INJ + Nasal Spray BBW: DNU w/ potent 3A4 inhibitor (life threatening peripheral ischemia) CI: uncontrolled HTN, pregnancy, ischemic heart DZ Warnings: CV effects, cerebrovascular events, drug interactions Counseling: NS prime by pumping 4 times Roflumilast I: COPD RxPO: Start 250 mcg QDx 4wks, then 500 mcg QD CI: moderate to severe live impaimrent Warning: psychiatric events SE: Diarreha: weight loss, nausea, insomnia Monitor: s/sx at each visit, LFT, smoking status Ganciclovir [Antiviral] - INJ+gel I: CMV 5mg/kg IV BID BBW: myelosuppression carcinogenic, teratogenic SE: thrombocytopenia, neutropenia, leukopenia; ↑ Scr Hazardous Drug: special handling req'd Reproductive potential: females should use contraception during tx + 30 days after, males for 90 days *Reduce dose + extend interval if CrCl < 70 mL/min *Prepare in sterile water - NOT bacteriostatic Dalmane (BW,I,D,SE) Flurazepam (CIV) MedGuide BW: concomitant use of BZDs + opioids = resp. depression I: insomnia RxPO: 15-30 mg QHS SE: anterograde amnesia, CNS depression, paradoxical rxns (hyperactive/aggression) Drowsiness, dizzinesss/ increase fall risk, cognitive impairment Daytrana Patch Methylphenidate patch C-II [Stimulant] - ADHD Daypro Oxaprozin - NSAID Max. 1200 mg/d (<50kg) or 1800 mg/d (> 50 kg) 📄 MedGuide BBW: DNU for post-op pain after CABG, risk of GI bleed + CV events Highest risk of GI 📄 MedGuide RxPO: 10mg/9h qAM 2h before desired effect. Max wear 9h BBW: abuse/dependence CI: within 14d of MAOi Warnings: exacerbate mania, ↑seizure risk, loss of appetite AEs: N, insomnia, HA, irritability, blurry vision, dry mouth Monitor: ECG prior, BP, HR, height, weight Counseling: Apply to alternate hips daily at the same time. Press down for 30sec to ensure adherence. Permanent loss of skin color at application area. Avoid exposure of application site to external heat source, ↑drug absorption. Can discard in toilet. Decadron Dexamethasone [Corticosteroid] I: CINV off-label SEs: fluid retention, insomnia, ↑appetite Demerol Deltasone Prednisone [Steroid] - prodrug of prednisolone PO doses WITH FOOD to ↓ GI upset Intermediate actin