AMINOPHYLLINE

USE — Bronchodilator in reversible airway obstruction due to asthma or COPD; increase diaphragmatic
contractility

MECHANISM OF ACTION — Causes bronchodilatation, diuresis, CNS and cardiac stimulation, and
gastric acid secretion by blocking phosphodiesterase which increases tissue concentrations of cyclic
adenine monophosphate (cAMP) which in turn promote catecholamine stimulation of lipolysis,
glycogenolysis, and gluconeogenesis and induce release of epinephrine from adrenal medulla cells

PATIENT INFORMATION — Do not drink or eat large quantities of caffeine-containing beverages or food
(colas, coffee, chocolate).

DOSAGE FORMS — Excipient information presented when available (limited, particularly for generics);
consult specific product labeling.

Injection, solution, as dihydrate: 25 mg/mL (10 mL, 20 mL)

Injection, solution, as dihydrate [preservative free]: 25 mg/mL (10 mL, 20 mL)

Tablet, as dihydrate: 100 mg

DOSAGE FORMS: CONCISE

Injection, solution: 25 mg/mL (10 mL, 20 mL)

Injection, solution, [preservative free]: 25 mg/mL (10 mL, 20 mL)

Tablet: 100 mg

ADMINISTRATION — Dilute with I.V. fluid to a concentration of 1 mg/mL and infuse over 20-30 minutes;
maximum concentration: 25 mg/mL; maximum rate of infusion: 0.36 mg/kg/minute, and no greater than 25
mg/minute. I.M. administration is not recommended. Oral and I.V. should be administered around-the-
clock rather than 4 times/day, 3 times/day, etc (eg, 12-6-12-6, not 9-1-5-9) to promote less variation in
peak and trough serum levels.

Adalat®

CC; Afeditab™ CR; Nifediac™ CC; Nifedical™ XL; Procardia XL®; Procardia®

USE — Angina and hypertension (sustained release only), pulmonary hypertension

ONTRAINDICATIONS — Hypersensitivity to nifedipine or any component of the formulation; immediate

release preparation for treatment of urgent or emergent hypertension; acute MI

MECHANISM OF ACTION — Inhibits calcium ion from entering the "slow channels" or select voltage-
sensitive areas of vascular smooth muscle and myocardium during depolarization, producing a relaxation
of coronary vascular smooth muscle and coronary vasodilation; increases myocardial oxygen delivery in
patients with vasospastic angina

PHARMACOLOGIC CATEGORY
Calcium Channel Blocker
REASONS NOT TO TAKE THIS MEDICINE

• If you have an allergy to nifedipine or any other part of this medicine.

• Tell healthcare provider if you are allergic to any medicine. Make sure to tell about the allergy and
how it affected you. This includes telling about rash; hives; itching; shortness of breath; wheezing;
cough; swelling of face, lips, tongue, or throat; or any other symptoms involved.

• Long-acting products: If you have a narrowing of the gastrointestinal tract or an intestinal

blockage.

What is this medicine used for?

• This medicine is used to prevent high pressure in the lungs.

• This medicine is used to prevent migraine headaches.

• This medicine is used to treat chest pain or pressure.

• This medicine is used to treat high blood pressure.

• This medicine is used to treat Raynaud's disease.

• This medicine is used to stop early labor.

How does it work?

• Nifedipine relaxes blood vessels, lowering blood pressure.

• It works to decrease uterine contractions.

AQUAMEPHYTONE

USE — Prevention and treatment of hypoprothrombinemia caused by coumarin derivative-induced or

other drug-induced vitamin K deficiency, hypoprothrombinemia caused by malabsorption or inability to
synthesize vitamin K; hemorrhagic disease of the newborn

DOSAGE FORMS — Excipient information presented when available (limited, particularly for generics);
consult specific product labeling.

Injection, aqueous colloidal: 2 mg/mL (0.5 mL); 10 mg/mL (1 mL)

Tablet: 100 mcg [OTC]

Mephyton®: 5 mg

DOSAGE FORMS: CONCISE

Injection, aqueous colloidal: 2 mg/mL (0.5 mL); 10 mg/mL (1 mL)
Tablet: 100 mcg [OTC]
Mephyton®: 5 mg

ADMINISTRATION
I.V. administration: Infuse slowly; rate of infusion should not exceed 1 mg/minute (3 mg/m2/minute in
children and infants). The injectable route should be used only if the oral route is not feasible or there is a
greater urgency to reverse anticoagulation.

Oral: The parenteral preparation has been administered orally to neonates.

USE — Prevention and treatment of hypoprothrombinemia caused by coumarin derivative-induced or

other drug-induced vitamin K deficiency, hypoprothrombinemia caused by malabsorption or inability to
synthesize vitamin K; hemorrhagic disease of the newborn

USE - UNLABELED / INVESTIGATIONAL — Treatment of hypoprothrombinemia caused by

anticoagulant rodenticides

CONTRAINDICATIONS — Hypersensitivity to phytonadione or any component of the formulation

MECHANISM OF ACTION — Promotes liver synthesis of clotting factors (II, VII, IX, X); however, the
exact mechanism as to this stimulation is unknown. Menadiol is a water soluble form of vitamin K;
phytonadione has a more rapid and prolonged effect than menadione; menadiol sodium diphosphate (K4)
is half as potent as menadione (K3).

ATROPINE SO4

U.S. BRAND NAMES — AtroPen®; Atropine-Care®; Isopto® Atropine; Sal-Tropine™

PHARMACOLOGIC CATEGORY
Anticholinergic Agent
Anticholinergic Agent, Ophthalmic
Antidote
Antispasmodic Agent, Gastrointestinal
Ophthalmic Agent, Mydriatic

DOSAGE FORMS: CONCISE

Injection, solution: 0.05 mg/mL (5 mL); 0.1 mg/mL (5 mL, 10 mL); 0.4 mg/0.5 mL (0.5 mL); 0.4 mg/mL (0.5
mL, 1 mL, 20 mL); 1 mg/mL (1 mL)
AtroPen®: 0.25 mg/0.3 mL (0.3 mL); 0.5 mg/0.7 mL (0.7 mL); 1 mg/0.7 mL (0.7 mL); 2 mg/0.7 mL (0.7
mL) [prefilled autoinjector]

Ointment, ophthalmic: 1% (3.5 g)

Solution, ophthalmic: 1% (2 mL, 5 mL, 15 mL)

Atropine-Care®: 1% (2 mL) [contains benzalkonium chloride]
Isopto® Atropine: 1% (5 mL, 15 mL) [contains benzalkonium chloride]

Tablet:
Sal-Tropine™: 0.4 mg

GENERIC EQUIVALENT AVAILABLE — Yes: Excludes tablet

ADMINISTRATION
I.M.: AtroPen®: Administer to outer thigh. May be given through clothing as long as pockets at the
injection site are empty. Hold autoinjector in place for 10 seconds following injection; massage the
injection site.

I.V.: Administer undiluted by rapid I.V. injection; slow injection may result in paradoxical bradycardia.

Intratracheal: Dilute in NS or distilled water. Absorption is greater with distilled water, but causes more
adverse effects on PaO2. Pass catheter beyond tip of tracheal tube, stop compressions, spray drug
quickly down tube. Follow immediately with several quick insufflations and continue chest compressions.

COMPATIBILITY
Y-site administration: Compatible: Etomidate, famotidine, heparin, hydrocortisone sodium succinate,
inamrinone, meropenem, nafcillin, potassium chloride, propofol, sufentanil, vitamin B complex with C.
Incompatible: Thiopental.

Compatibility in syringe: Compatible: Butorphanol, chlorpromazine, cimetidine, dimenhydrinate,

diphenhydramine, droperidol, fentanyl, glycopyrrolate, heparin, hydromorphone, hydroxyzine, hydroxyzine
with meperidine, meperidine, meperidine with promethazine, metoclopramide, midazolam, milrinone,
morphine, nalbuphine, ondansetron, pentazocine, perphenazine, prochlorperazine, promazine,
promethazine, propiomazine, ranitidine, scopolamine, sufentanil. Incompatible: Cimetidine with
pentobarbital. Variable (consult detailed reference): Pentobarbital.

Compatibility when admixed: Compatible: Dobutamine, furosemide, meropenem, sodium bicarbonate,

verapamil. Incompatible: Floxacillin, metaraminol, methohexital, norepinephrine.

USE
Injection: Preoperative medication to inhibit salivation and secretions; treatment of symptomatic sinus
bradycardia; AV block (nodal level); ventricular asystole; antidote for anticholinesterase inhibitor poisoning
(carbamate insecticides, nerve agents, organophosphate insecticides)

Ophthalmic: Produce mydriasis and cycloplegia for examination of the retina and optic disc and accurate
measurement of refractive errors; uveitis

Oral: Inhibit salivation and secretions

USE - UNLABELED / INVESTIGATIONAL — Pulseless electric activity, asystole, neuromuscular

blockade reversal

ADVERSE REACTIONS SIGNIFICANT — Severity and frequency of adverse reactions are dose related
and vary greatly; listed reactions are limited to significant and/or life-threatening.

Cardiovascular: Arrhythmia, flushing, hypotension, palpitation, tachycardia

Central nervous system: Ataxia, coma, delirium, disorientation, dizziness, drowsiness, excitement, fever,
hallucinations, headache, insomnia, nervousness

Dermatologic: Anhidrosis, urticaria, rash, scarlatiniform rash

Gastrointestinal: Bloating, constipation, delayed gastric emptying, loss of taste, nausea, paralytic ileus,
vomiting, xerostomia, dry throat, nasal dryness

Genitourinary: Urinary hesitancy, urinary retention

Neuromuscular & skeletal: Weakness

Ocular: Angle-closure glaucoma, blurred vision, cycloplegia, dry eyes, mydriasis, ocular tension increased

Respiratory: Dyspnea, laryngospasm, pulmonary edema

Miscellaneous: Anaphylaxis

CONTRAINDICATIONS — Hypersensitivity to atropine or any component of the formulation; narrow-

angle glaucoma; adhesions between the iris and lens; tachycardia; obstructive GI disease; paralytic ileus;
intestinal atony of the elderly or debilitated patient; severe ulcerative colitis; toxic megacolon complicating
ulcerative colitis; hepatic disease; obstructive uropathy; renal disease; myasthenia gravis (unless used to
treat side effects of acetylcholinesterase inhibitor); asthma; thyrotoxicosis; Mobitz type II block

USE
Injection: Preoperative medication to inhibit salivation and secretions; treatment of symptomatic sinus
bradycardia; AV block (nodal level); ventricular asystole; antidote for anticholinesterase inhibitor poisoning
(carbamate insecticides, nerve agents, organophosphate insecticides)

Ophthalmic: Produce mydriasis and cycloplegia for examination of the retina and optic disc and accurate
measurement of refractive errors; uveitis

Oral: Inhibit salivation and secretions

USE - UNLABELED / INVESTIGATIONAL — Pulseless electric activity, asystole, neuromuscular

blockade reversal

MECHANISM OF ACTION — Blocks the action of acetylcholine at parasympathetic sites in smooth

muscle, secretory glands, and the CNS; increases cardiac output, dries secretions. Atropine reverses the
muscarinic effects of cholinergic poisoning. The primary goal in cholinergic poisonings is reversal of
bronchorrhea and bronchoconstriction. Atropine has no effect on the nicotinic receptors responsible for
muscle weakness, fasciculations, and paralysis.

PATIENT INFORMATION — Maintain good oral hygiene habits because lack of saliva may increase
chance of cavities. Observe caution while driving or performing other tasks requiring alertness, as drug
may cause drowsiness, dizziness, or blurred vision. Notify prescriber if rash, flushing, or eye pain occurs,
or if difficulty in urinating, constipation, or sensitivity to light becomes severe or persists. Do not allow
dropper bottle or tube to touch eye during administration.

BENADRYL

PHARMACOLOGIC CATEGORY
Histamine H1 Antagonist
Histamine H1 Antagonist, First Generation

USE — Symptomatic relief of allergic symptoms caused by histamine release including nasal allergies
and allergic dermatosis; adjunct to epinephrine in the treatment of anaphylaxis; nighttime sleep aid;
prevention or treatment of motion sickness; antitussive; management of Parkinsonian syndrome including
drug-induced extrapyramidal symptoms; topically for relief of pain and itching associated with insect bites,
minor cuts and burns, or rashes due to poison ivy, poison oak, and poison sumac

CONTRAINDICATIONS — Hypersensitivity to diphenhydramine or any component of the formulation;

acute asthma; neonates or premature infants; breast-feeding; use as a local anesthetic (injection)

MECHANISM OF ACTION — Competes with histamine for H1-receptor sites on effector cells in the
gastrointestinal tract, blood vessels, and respiratory tract; anticholinergic and sedative effects are also
seen

PATIENT INFORMATION — May cause drowsiness; swallow whole, do not crush or chew sustained
release product; avoid alcohol, may impair coordination and judgment

DOSAGE FORMS: CONCISE

Caplet: 25 mg, 50 mg
Aler-Dryl [OTC], AllerMax® [OTC], Compoz® Nighttime Sleep Aid [OTC], Sleep-ettes D [OTC],
Sominex® Maximum Strength [OTC], Twilite® [OTC]: 50 mg
Nytol® Quick Caps [OTC], Simply Sleep® [OTC]: 25 mg

Capsule: 25 mg, 50 mg
Aler-Cap [OTC], Banophen® [OTC], Benadryl® Allergy [OTC], Diphen® [OTC], Diphenhist [OTC],
Genahist® [OTC]: 25 mg
Sleepinal® [OTC]: 50 mg

Capsule, softgel: 50 mg
Benadryl® Dye-Free Allergy [OTC]: 25 mg
Compoz® Nighttime Sleep Aid [OTC], Nytol® Quick Gels [OTC], Sleepinal® [OTC], Unisom® Maximum
Strength SleepGels® [OTC]: 50 mg

Captab: 25 mg
Diphenhist® [OTC]: 25 mg

Cream: 2% (30 g)
Banophen® Anti-Itch [OTC], Benadryl® Itch Stopping Extra Strength [OTC], Diphenhist® [OTC]: 2% (30
g)
Benadryl® Itch Stopping [OTC]: 1% (30 g)

Elixir:
Altaryl [OTC], Banophen® [OTC], Diphen AF [OTC]: 12.5 mg/5 mL

Gel, topical: 2% (120 mL, 28 g, 42 g)

Benadryl® Itch Stopping Extra Strength [OTC]: 2% (120 mL)

Injection, solution: 50 mg/mL (1 mL, 10 mL)

Liquid, as hydrochloride:
AllerMax® [OTC], Benadryl® Allergy [OTC], Benadryl® Children's Dye-Free Allergy [OTC], Genahist®
[OTC], Hydramine® [OTC], Siladryl® Allergy [OTC]: 12.5 mg/5 mL

Liquid, topical [stick]:

Benadryl® Itch Stopping Extra Strength [OTC]: 2% (14 mL)
Solution, oral:
Diphenhis [OTC]: 12.5 mg/5mL

Solution, topical [spray]: 2% (60 mL)

Benadryl® Itch Stopping Extra Strength [OTC], Dermamycin® [OTC]: 2% (60 mL)

Strips, oral:
Benadryl® Allergy [OTC]: 25 mg (10s)
Benadryl® Children's Allergy [OTC]: 12. 5 mg (10s)
Triaminic® Thin Strips™ Cough and Runny Nose [OTC]: 12. 5 mg (16s)

Suspension:
Ben-Tann: 25 mg/5 mL

Syrup: 12.5 mg/5 mL

Silphen® Cough [OTC]: 12.5 mg/5 mL

Tablet: 25 mg, 50 mg
Aler-Tab [OTC], Benadryl® Allergy [OTC], Genahist® [OTC], Sominex® [OTC]: 25 mg

Tablet, chewable:
Benadryl® Children's Allergy [OTC]: 12.5 mg
Dytan™: 25 mg

Tablet, orally disintegrating:

Benadryl® Children's Allergy Fastmelt® [OTC]: 19 mg

U.S. BRAND NAMES — Entocort® EC; Pulmicort Flexhaler™; Pulmicort Respules®; Rhinocort® Aqua®

PHARMACOLOGIC CATEGORY
Corticosteroid, Inhalant (Oral)
Corticosteroid, Nasal
Corticosteroid, Systemic

DOSING: ADULTS
Asthma:Oral inhalation:
Pulmicort Flexhaler™: Initial: 360 mcg twice daily (selected patients may be initiated at 180 mcg twice
daily); maximum 720 mcg twice daily
NIH Asthma Guidelines (NIH, 2007) (administer in divided doses twice daily):
"Low" dose: 180-600 mcg/day
"Medium" dose: >600-1200 mcg/day
"High" dose: >1200 mcg/day
Pulmicort® Turbuhaler®: [CAN, not available in the U.S.]: Initial (during periods of severe asthma or
when switching from oral corticosteroid therapy): 400-2400 mcg daily in 2-4 divided doses; Maintenance:
200-400 mcg twice daily (higher doses may be needed for short periods of time). Note: Patients taking
400 mcg/day may take as a single daily dose

Crohn's disease (active):Oral: 9 mg once daily in the morning for up to 8 weeks; recurring episodes may
be treated with a repeat 8-week course of treatment. Note: Patients receiving CYP3A4 inhibitors should
be monitored closely for signs and symptoms of hypercorticism; dosage reduction may be required. If
switching from oral prednisolone, prednisolone dosage should be tapered while budesonide (Entocort™
EC) treatment is initiated.
Maintenance of remission: Following treatment of active disease (control of symptoms with CDAI <150),
treatment may be continued at a dosage of 6 mg once daily for up to 3 months. If symptom control is
maintained for 3 months, tapering of the dosage to complete cessation is recommended. Continued
dosing beyond 3 months has not been demonstrated to result in substantial benefit.

Nasal polyps:Nasal inhalation:

Canadian labeling:
Rhinocort® Aqua®: 256 mcg/day administered as a single 64 mcg spray in each nostril twice daily;
maximum dose: 256 mcg/day
Rhinocort® Turbuhaler®: 100 mcg into each nostril twice daily; maximum: 400 mcg/day

Rhinitis:Nasal inhalation:
U.S. labeling (Rhinocort® Aqua®): 64 mcg/day as a single 32 mcg spray in each nostril. Some patients
who do not achieve adequate control may benefit from increased dosage. A reduced dosage may be
effective after initial control is achieved
Maximum dose: Children <12 years: 128 mcg/day; Adults: 256 mcg/day)
Canadian labeling:
Rhinocort® Aqua®: Initial: 256 mcg/day administered as two 64 mcg sprays in each nostril once daily
or a single 64 mcg spray in each nostril twice daily; Maintenance: Individualize, lowest effective dose
(maximum dose: 256 mcg/day)
Rhinocort® Turbuhaler®: Initial: 200 mcg into each nostril once daily; Maintenance: Individualize,
lowest effective dose (maximum: 400 mcg/day)

USE
Intranasal: Management of symptoms of seasonal or perennial rhinitis
Canadian labeling: Additional use (not in U.S. labeling): Prevention and treatment of nasal polyps

Nebulization: Maintenance and prophylactic treatment of asthma

Oral capsule: Treatment of active Crohn's disease (mild-to-moderate) involving the ileum and/or
ascending colon; maintenance of remission (for up to 3 months) of Crohn's disease (mild-to-moderate)
involving the ileum and/or ascending colon

Oral inhalation: Maintenance and prophylactic treatment of asthma; includes patients who require oral
corticosteroids and those who may benefit from systemic dose reduction/elimination

MECHANISM OF ACTION — Controls the rate of protein synthesis; depresses the migration of
polymorphonuclear leukocytes, fibroblasts; reverses capillary permeability and lysosomal stabilization at
the cellular level to prevent or control inflammation. Has potent glucocorticoid activity and weak
mineralocorticoid activity

PATIENT INFORMATION — Use as directed; do not increase dosage or discontinue abruptly without
consulting prescriber. Avoid grapefruit juice while taking this medication. Report acute nervousness or
inability to sleep; severe sneezing or nosebleed; difficulty breathing, sore throat, hoarseness, or
bronchitis; respiratory difficulty or bronchospasms; disturbed menstrual pattern; vision changes; loss of
taste or smell perception; or worsening of condition or lack of improvement. May be more susceptible to
infection; avoid exposure to chickenpox and measles unless immunity has been established

CA GLUCONATE

PHARMACOLOGIC CATEGORY
Calcium Salt
Electrolyte Supplement, Oral
Electrolyte Supplement, Parenteral
DOSING: ADULTS
Adequate Intake (as elemental calcium):
Adults, Male/Female:
19-50 years: 1000 mg/day
≥51 years: 1200 mg/day
Female: Pregnancy/Lactating: Same as for Adults, Male/Female

Dosage note: Calcium chloride has 3 times more elemental calcium than calcium gluconate. Calcium
chloride is 27% elemental calcium; calcium gluconate is 9% elemental calcium. One gram of calcium
chloride is equal to 270 mg of elemental calcium; 1 gram of calcium gluconate is equal to 90 mg of
elemental calcium. The following dosages are expressed in terms of the calcium gluconate salt based on
a solution concentration of 100 mg/mL (10%) containing 0.465 mEq (9.3 mg)/mL elemental calcium:

Hypocalcemia:
I.V.: 2-15 g/24 hours as a continuous infusion or in divided doses
Oral: 500 mg to 2 g 2-4 times/day

Hypocalcemia secondary to citrated blood infusion: I.V.: 500 mg to 1 g per 500 mL of citrated blood
(infused into another vein). Single doses up to 2 g have also been recommended.
Note: Routine administration of calcium, in the absence of signs/symptoms of hypocalcemia, is generally
not recommended. A number of recommendations have been published seeking to address potential
hypocalcemia during massive transfusion of citrated blood; however, many practitioners recommend
replacement only as guided by clinical evidence of hypocalcemia and/or serial monitoring of ionized
calcium.

Hypocalcemic tetany: I.V.: 1-3 g/dose may be administered until therapeutic response occurs

Magnesium intoxication or cardiac arrest in the presence of hyperkalemia or hypocalcemia: I.V.: 500-800
mg/dose (maximum: 3 g/dose)

Maintenance electrolyte requirements for TPN: I.V.: Daily requirements: 1.7-3.4 g/1000 kcal/24 hours

Calcium channel blocker overdose (unlabeled use): I.V. infusion: 10% solution: 0.6-1.2 mL/kg/hour or I.V.
0.2-0.5 ml/kg every 15-20 minutes for 4 doses (maximum: 2-3 g/dose). In life-threatening situations, 1 g
has been given every 1-10 minutes until clinical effect is achieved (case reports of resistant hypotension
reported use of 12-18 g total).

USE — Treatment and prevention of hypocalcemia; treatment of tetany, cardiac disturbances of

hyperkalemia, cardiac resuscitation when epinephrine fails to improve myocardial contractions,
hypocalcemia; calcium supplementation; hydrofluoric acid (HF) burns

MECHANISM OF ACTION — As dietary supplement, used to prevent or treat negative calcium balance;
in osteoporosis, it helps to prevent or decrease the rate of bone loss. The calcium in calcium salts
moderates nerve and muscle performance and allows normal cardiac function.

PATIENT INFORMATION — Take with food. Do not take calcium supplements within 1-2 hours of taking
other medicine by mouth or when eating large amounts of fiber-rich foods. Do not drink large amounts of
alcohol or caffeine-containing beverages.

CATAPRES

U.S. BRAND NAMES — Catapres-TTS®; Catapres®; Duraclon®

PHARMACOLOGIC CATEGORY
Alpha2-Adrenergic Agonist

DOSING: ADULTS
Acute hypertension (urgency): Oral: Initial 0.1-0.2 mg; may be followed by additional doses of 0.1 mg
every hour, if necessary, to a maximum total dose of 0.6 mg
Unlabeled route of administration: Sublingual clonidine 0.1-0.2 mg twice daily may be effective in
patients unable to take oral medication

Hypertension:
Oral: Initial dose: 0.1 mg twice daily (maximum recommended dose: 2.4 mg/day); usual dose range
(JNC 7): 0.1-0.8 mg/day in 2 divided doses
Transdermal: Apply once every 7 days; for initial therapy start with 0.1 mg and increase by 0.1 mg at 1-
to 2-week intervals (dosages >0.6 mg do not improve efficacy); usual dose range (JNC 7): 0.1-0.3 mg
once weekly
Note: If transitioning from oral to transdermal, overlap oral for 1-2 days. Transdermal route takes 2-3
days to achieve therapeutic effects.
Conversion from oral to transdermal:
Day 1: Place Catapres-TTS® 1; administer 100% of oral dose.
Day 2: Administer 50% of oral dose.
Day 3: Administer 25% of oral dose.
Day 4: Patch remains, no further oral supplement necessary.

Nicotine withdrawal symptoms: 0.1 mg twice daily to maximum of 0.4 mg/day for 3-4 weeks

Pain management: Epidural infusion: Starting dose: 30 mcg/hour; titrate as required for relief of pain or
presence of side effects; minimal experience with doses >40 mcg/hour; should be considered an adjunct
to intraspinal opiate therapy

USE — Management of mild-to-moderate hypertension; either used alone or in combination with other
antihypertensives

MECHANISM OF ACTION — Stimulates alpha2-adrenoceptors in the brain stem, thus activating an

inhibitory neuron, resulting in reduced sympathetic outflow from the CNS, producing a decrease in
peripheral resistance, renal vascular resistance, heart rate, and blood pressure; epidural clonidine may
produce pain relief at spinal presynaptic and postjunctional alpha2-adrenoceptors by preventing pain
signal transmission; pain relief occurs only for the body regions innervated by the spinal segments where
analgesic concentrations of clonidine exist

PATIENT INFORMATION — Do not discontinue drug except on instruction of prescriber. Check daily to
be sure patch is present. May cause drowsiness, impaired coordination, and judgment; use extreme
caution while driving or operating machines.

CORDARONE

U.S. BRAND NAMES — Cordarone®; Pacerone®

PHARMACOLOGIC CATEGORY
Antiarrhythmic Agent, Class III
DOSING: ADULTS — Note: Lower loading and maintenance doses are preferable in women and all
patients with low body weight.

Ventricular arrhythmias: Oral: 800-1600 mg/day in 1-2 doses for 1-3 weeks, then 600-800 mg/day in 1-2
doses for 1 month; maintenance: 400 mg/day; lower doses are recommended for supraventricular
arrhythmias.

Breakthrough VF or VT: I.V.: 150 mg supplemental doses in 100 mL D5W over 10 minutes

Pulseless VF or VT: I.V. push: Initial: 300 mg in 20-30 mL NS or D5W; if VF or VT recurs, supplemental
dose of 150 mg followed by infusion of 1 mg/minute for 6 hours, then 0.5 mg/minute (maximum daily
dose: 2.1 g)

I.V. to oral therapy conversion: Use the following as a guide:

<1 week I.V. infusion: 800-1600 mg/day
1- to 3-week I.V. infusion: 600-800 mg/day
>3 week I.V. infusion: 400 mg

USE — Management of life-threatening recurrent ventricular fibrillation (VF) or hemodynamically-unstable

ventricular tachycardia (VT) refractory to other antiarrhythmic agents or in patients intolerant of other
agents used for these conditions

DOSAGE FORMS: CONCISE

Injection, solution: 50 mg/mL (3 mL, 9 mL, 18 mL)

CONTRAINDICATIONS — Hypersensitivity to amiodarone, iodine, or any component of the formulation;

severe sinus-node dysfunction; second- and third-degree heart block (except in patients with a functioning
artificial pacemaker); bradycardia causing syncope (except in patients with a functioning artificial
pacemaker); cardiogenic shock; pregnancy

MECHANISM OF ACTION — Class III antiarrhythmic agent which inhibits adrenergic stimulation (alpha-
and beta-blocking properties), affects sodium, potassium, and calcium channels, prolongs the action
potential and refractory period in myocardial tissue; decreases AV conduction and sinus node function

PATIENT INFORMATION — Take with food; use sunscreen or stay out of sun to prevent burns; skin
discoloration is reversible; photophobia may make sunglasses necessary; do not discontinue abruptly;
regular blood work for thyroid functions tests and ophthalmologic exams are necessary; notify prescriber if
persistent dry cough or shortness of breath occurs

HEMOSTAN

U.S. BRAND NAMES — Cyklokapron®

PHARMACOLOGIC CATEGORY
Antihemophilic Agent

DOSING: ADULTS — Hemophilia patients, during and following tooth extraction: I.V.: 10 mg/kg
immediately before surgery, then 25 mg/kg/dose orally 3-4 times/day for 2-8 days

Alternatively:
Oral: 25 mg/kg 3-4 times/day beginning 1 day prior to surgery
I.V.: 10 mg/kg 3-4 times/day in patients who are unable to take oral
USE — Short-term use (2-8 days) in hemophilia patients during and following tooth extraction to reduce
or prevent hemorrhage

CONTRAINDICATIONS — Acquired defective color vision; active intravascular clotting; subarachnoid

hemorrhage; concurrent factor IX complex or anti-inhibitor coagulant concentrates

MECHANISM OF ACTION — Forms a reversible complex that displaces plasminogen from fibrin resulting
in inhibition of fibrinolysis; it also inhibits the proteolytic activity of plasmin

PATIENT INFORMATION — Report any signs of bleeding or myopathy, changes in vision; GI upset
usually disappears when dose is reduced

DEXAMETHASONE

U.S. BRAND NAMES — Dexamethasone Intensol™; DexPak® 10 Day TaperPak®; DexPak®

TaperPak®; Maxidex®

PHARMACOLOGIC CATEGORY
Anti-inflammatory Agent
Anti-inflammatory Agent, Ophthalmic
Antiemetic
Corticosteroid, Ophthalmic
Corticosteroid, Otic
Corticosteroid, Systemic

DOSAGE FORMS: CONCISE

Elixir: 0.5 mg/5 mL

Injection, solution: 4 mg/mL (1 mL, 5 mL, 10 mL, 25 mL, 30 mL); 10 mg/mL (1 mL, 10 mL)

I.V.: Administer as a 5-10 minute bolus; rapid injection is associated with a high incidence of perineal
discomfort.

USE — Systemic: Primarily as an anti-inflammatory or immunosuppressant agent in the treatment of a

variety of diseases including those of allergic, dermatologic, endocrine, hematologic, inflammatory,
neoplastic, nervous system, renal, respiratory, rheumatic, and autoimmune origin; may be used in
management of cerebral edema, chronic swelling, as a diagnostic agent, diagnosis of Cushing's
syndrome, antiemetic

CONTRAINDICATIONS — Hypersensitivity to dexamethasone or any component of the formulation;

systemic fungal infections, cerebral malaria; ophthalmic use in viral (active ocular herpes simplex), fungal,
or tuberculosis diseases of the eye

MECHANISM OF ACTION — Decreases inflammation by suppression of neutrophil migration, decreased

production of inflammatory mediators, and reversal of increased capillary permeability; suppresses
normal immune response. Dexamethasone's mechanism of antiemetic activity is unknown.

PATIENT INFORMATION — Notify prescriber of any signs of infection or injuries during therapy. Inform
physician or dentist before surgery if you are taking a corticosteroid. May cause GI upset; take with food.
Do not overuse; use only as prescribed and for no longer than the period prescribed. Notify prescriber if
condition being treated persists or worsens.
DILANTIN

U.S. BRAND NAMES — Dilantin®; Phenytek®

PHARMACOLOGIC CATEGORY
Antiarrhythmic Agent, Class Ib
Anticonvulsant, Hydantoin

DOSING: ADULTS
Status epilepticus: I.V.: Loading dose: Manufacturer recommends 10-15 mg/kg, however, 15-20 mg/kg is
generally recommended; maximum rate: 50 mg/minute

Anticonvulsant: Oral: Loading dose: 15-20 mg/kg; based on phenytoin serum concentrations and recent
dosing history; administer oral loading dose in 3 divided doses given every 2-4 hours to decrease GI
adverse effects and to ensure complete oral absorption; maintenance dose: 300 mg/day or 5-6 mg/kg/day
in 3 divided doses or 1-2 divided doses using extended release (range 200-1200 mg/day)

Dosage adjustment in obesity: Loading dose: Use adjusted body weight (ABW) (Abernethy, 1985)
ABW = [(Actual body weight " IBW) x 1.33] + IBW
Maximum loading dose: 2000 mg (Erstad, 2004)
Maintenance doses should be based on ideal body weight, conventional daily doses with adjustments
based upon therapeutic drug monitoring and clinical effectiveness. (Abernethy, 1985; Erstad, 2002;
Erstad, 2004)

USE — Management of generalized tonic-clonic (grand mal), complex partial seizures; prevention of
seizures following head trauma/neurosurgery

CONTRAINDICATIONS — Hypersensitivity to phenytoin, other hydantoins, or any component of the

formulation; pregnancy

D5050

U.S. BRAND NAMES — B-D™ Glucose [OTC]; Dex4® Glucose [OTC]; Enfamil® Glucose; Glutol™
[OTC]; Glutose™ [OTC]; Insta-Glucose® [OTC]; Similac® Glucose

PHARMACOLOGIC CATEGORY
Hyperglycemic Agent
Intravenous Nutritional Therapy

I.V.: 10-25 g (40-100 mL of 25% solution or 20-50 mL of 50% solution)

Treatment of hyperkalemia: I.V. (in combination with insulin): 25-50 g dextrose (250-500 mL D10W)
combined with 10 units regular insulin administered over 30-60 minutes; repeat as needed or as an
alternative 25 g dextrose (50 mL D50W) combined with 5-10 units regular insulin infused over 5 minutes;
repeat as needed

USE
Oral: Treatment of hypoglycemia

5% and 10% solutions: Peripheral infusion to provide calories and fluid replacement
25% (hypertonic) solution: Treatment of acute symptomatic episodes of hypoglycemia in infants and
children to restore depressed blood glucose levels; adjunctive treatment of hyperkalemia when combined
with insulin

50% (hypertonic) solution: Treatment of insulin-induced hypoglycemia (hyperinsulinemia or insulin shock)

and adjunctive treatment of hyperkalemia in adolescents and adults

≥10% solutions: Infusion after admixture with amino acids for nutritional support

CONTRAINDICATIONS — Hypersensitivity to corn or corn products; diabetic coma with hyperglycemia;

hypertonic solutions in patients with intracranial or intraspinal hemorrhage; patients with delirium tremens
and dehydration; patients with anuria, hepatic coma, or glucose-galactose malabsorption syndrome

MECHANISM OF ACTION — Dextrose, a monosaccharide, is a source of calories and fluid for patients
unable to obtain an adequate oral intake; may decrease body protein and nitrogen losses; promotes
glycogen deposition in the liver. When used in the treatment of hyperkalemia (combined with insulin),
dextrose stimulates the uptake of potassium by cells, especially in muscle tissue, lowering serum
potassium.

MECHANISM OF ACTION — Dextrose, a monosaccharide, is a source of calories and fluid for patients
unable to obtain an adequate oral intake; may decrease body protein and nitrogen losses; promotes
glycogen deposition in the liver. When used in the treatment of hyperkalemia (combined with insulin),
dextrose stimulates the uptake of potassium by cells, especially in muscle tissue, lowering serum
potassium.

DOBUTREX

PHARMACOLOGIC CATEGORY
Adrenergic Agonist Agent

DOSING: ADULTS — Cardiac decompensation: I.V. infusion: 2.5-20 mcg/kg/minute; maximum: 40

mcg/kg/minute, titrate to desired response; see table.

I.V. Infusion Guidelines

To deliver 2.5 mcg/kg/minute:

• Using 500 mcg/mL solution1; infuse at 0.005 mL/kg/minute.

• Using 1000 mcg/mL solution2; infuse at 0.0025 mL/kg/minute.

To deliver 5 mcg/kg/minute:

• Using 500 mcg/mL solution1; infuse at 0.01 mL/kg/minute.

• Using 1000 mcg/mL solution2; infuse at 0.005 mL/kg/minute.

To deliver 7.5 mcg/kg/minute:

• Using 500 mcg/mL solution1; infuse at 0.015 mL/kg/minute.

• Using 1000 mcg/mL solution2; infuse at 0.0075 mL/kg/minute.

To deliver 10 mcg/kg/minute:
 • Using 500 mcg/mL solution1; infuse at 0.02 mL/kg/minute.
• Using 1000 mcg/mL solution2; infuse at 0.01 mL/kg/minute.

To deliver 12.5 mcg/kg/minute:

• Using 500 mcg/mL solution1; infuse at 0.025 mL/kg/minute.

• Using 1000 mcg/mL solution2; infuse at 0.0125 mL/kg/minute.

To deliver 15 mcg/kg/minute:

• Using 500 mcg/mL solution1;infuse at 0.03 mL/kg/minute.

• Using 1000 mcg/mL solution2;infuse at 0.015 mL/kg/minute.

1
500 mg/L or 250 mg per 500 mL of diluent.

2
1000 mg/L or 250 mg per 250 mL of diluent.

USE — Short-term management of patients with cardiac decompensation

USE - UNLABELED / INVESTIGATIONAL — Positive inotropic agent for use in myocardial dysfunction of
sepsis

MECHANISM OF ACTION — Stimulates beta1-adrenergic receptors, causing increased contractility and

heart rate, with little effect on beta2- or alpha-receptors

DOPAMINE

PHARMACOLOGIC CATEGORY
Adrenergic Agonist Agent

DOSING: ADULTS
Hemodynamic support: I.V. infusion: 1-5 mcg/kg/minute up to 50 mcg/kg/minute, titrate to desired
response; infusion may be increased by 1-4 mcg/kg/minute at 10- to 30-minute intervals until optimal
response is obtained

USE — Adjunct in the treatment of shock (eg, MI, open heart surgery, renal failure, cardiac
decompensation) which persists after adequate fluid volume replacement

USE - UNLABELED / INVESTIGATIONAL — Symptomatic bradycardia or heart block unresponsive to

atropine or pacing

MECHANISM OF ACTION — Stimulates both adrenergic and dopaminergic receptors, lower doses are
mainly dopaminergic stimulating and produce renal and mesenteric vasodilation, higher doses also are
both dopaminergic and beta1-adrenergic stimulating and produce cardiac stimulation and renal
vasodilation; large doses stimulate alpha-adrenergic receptors

EPINEPHRINE

U.S. BRAND NAMES — Adrenalin®; EpiPen®; EpiPen® Jr; Primatene® Mist [OTC]; Raphon [OTC]; S2®
[OTC]; Twinject™
PHARMACOLOGIC CATEGORY
Alpha/Beta Agonist
Antidote

DOSING: ADULTS
Asystole/pulseless arrest, bradycardia, VT/VF:
I.V., I.O.: 1 mg every 3-5 minutes; if this approach fails, higher doses of epinephrine (up to 0.2 mg/kg)
may be indicated for treatment of specific problems (eg, beta-blocker or calcium channel blocker
overdose)
Intratracheal: Administer 2-2.5 mg for VF or pulseless VT if I.V./I.O. access is delayed or cannot be
established; dilute in 5-10 mL NS or distilled water. Note: Absorption is greater with distilled water, but
causes more adverse effects on PaO2.

Bradycardia (symptomatic) or hypotension (not responsive to atropine or pacing):I.V. infusion: 2-10

mcg/minute; titrate to desired effect

Bronchodilator:
SubQ: 0.3-0.5 mg (1:1000) every 20 minutes for 3 doses
Nebulization: 1-3 inhalations up to every 3 hours using solution prepared with 10 drops of the 1:100
product (solution for oral inhalation [Adrenalin®])
S2® (racepinephrine, OTC labeling): 0.5 mL up to every 3-4 hours if needed. Solution should be diluted
if using jet nebulizer.
Inhalation: Primatene® Mist (OTC labeling): One inhalation, wait at least 1 minute; if not relieved, may
use once more. Do not use again for at least 3 hours.

Decongestant:Intranasal: Apply 1:1000 locally as drops or spray or with sterile swab

Hypersensitivity reaction:
SubQ, I.M.: 0.3-0.5 mg (1:1000) every 15-20 minutes if condition requires (I.M. route is preferred)
I.V.: 0.1 mg (1:10,000) over 5 minutes. May infuse at 1-4 mcg/minute to prevent the need to repeat
injections frequently.
Self-administration following severe allergic reactions (eg, insect stings, food):Note: The World Health
Organization (WHO) and Anaphylaxis Canada recommend the availability of one dose for every 10 to 20
minutes of travel time to a medical emergency facility. More than 2 doses should only be administered
under direct medical supervision.
Twinject™: SubQ, I.M.: 0.3 mg
EpiPen®: I.M.: 0.3 mg

Shock, fluid-resistant (unlabeled use):I.V. infusion: 2-10 mcg/minute, titrate dose to blood pressure effect
(AHA, 2005)

USE — Treatment of bronchospasms, bronchial asthma, nasal congestion, viral croup, anaphylactic
reactions, cardiac arrest; added to local anesthetics to decrease systemic absorption of local anesthetics
and increase duration of action; decrease superficial hemorrhage

USE - UNLABELED / INVESTIGATIONAL — ACLS guidelines: Ventricular fibrillation (VF) or pulseless

ventricular tachycardia (VT) unresponsive to initial defibrillatory shocks; pulseless electrical activity,
asystole, hypotension unresponsive to volume resuscitation; symptomatic bradycardia or hypotension
unresponsive to atropine or pacing; inotropic support

CONTRAINDICATIONS — Hypersensitivity to epinephrine or any component of the formulation; cardiac

arrhythmias; angle-closure glaucoma
MECHANISM OF ACTION — Stimulates alpha-, beta1-, and beta2-adrenergic receptors resulting in
relaxation of smooth muscle of the bronchial tree, cardiac stimulation, and dilation of skeletal muscle
vasculature; small doses can cause vasodilation via beta2-vascular receptors; large doses may produce
constriction of skeletal and vascular smooth muscle

ISOKET

U.S. BRAND NAMES — Dilatrate®-SR; Isochron™; Isordil®

PHARMACOLOGIC CATEGORY
Vasodilator

USE — Prevention and treatment of angina pectoris; for congestive heart failure; to relieve pain,
dysphagia, and spasm in esophageal spasm with GE reflux

USE - UNLABELED / INVESTIGATIONAL — Esophageal spastic disorders

CONTRAINDICATIONS — Hypersensitivity to isosorbide dinitrate or any component of the formulation;

hypersensitivity to organic nitrates; concurrent use with phosphodiesterase-5 (PDE-5) inhibitors
(sildenafil, tadalafil, or vardenafil); angle-closure glaucoma (intraocular pressure may be increased); head
trauma or cerebral hemorrhage (increase intracranial pressure); severe anemia

MECHANISM OF ACTION — Stimulation of intracellular cyclic-GMP results in vascular smooth muscle

relaxation of both arterial and venous vasculature. Increased venous pooling decreases left ventricular
pressure (preload) and arterial dilatation decreases arterial resistance (afterload). Therefore, this reduces
cardiac oxygen demand by decreasing left ventricular pressure and systemic vascular resistance by
dilating arteries. Additionally, coronary artery dilation improves collateral flow to ischemic regions;
esophageal smooth muscle is relaxed via the same mechanism.

PATIENT INFORMATION — Do not chew or crush sublingual or sustained release dosage form; do not
change brands without consulting your pharmacist or prescriber; keep tablets or capsules in original
container and keep container tightly closed; if no relief from sublingual tablets after 15 minutes, report to
nearest emergency room or seek emergency help

ISOPTIN

U.S. BRAND NAMES — Calan®; Calan® SR; Covera-HS®; Isoptin® SR; Verelan®; Verelan® PM

PHARMACOLOGIC CATEGORY
Antiarrhythmic Agent, Class IV
Calcium Channel Blocker

Arrhythmia (SVT): I.V.: 2.5-5 mg (over 2 minutes); second dose of 5-10 mg (~0.15 mg/kg) may be given
15-30 minutes after the initial dose if patient tolerates, but does not respond to initial dose; maximum total
dose: 20 mg

USE — Orally for treatment of angina pectoris (vasospastic, chronic stable, unstable) and hypertension;
I.V. for supraventricular tachyarrhythmias (PSVT, atrial fibrillation, atrial flutter)

USE - UNLABELED / INVESTIGATIONAL — Migraine; hypertrophic cardiomyopathy; bipolar disorder

(manic manifestations)
CONTRAINDICATIONS — Hypersensitivity to verapamil or any component of the formulation; severe left
ventricular dysfunction; hypotension (systolic pressure <90 mm Hg) or cardiogenic shock; sick sinus
syndrome (except in patients with a functioning artificial pacemaker); second- or third-degree AV block
(except in patients with a functioning artificial pacemaker); atrial flutter or fibrillation and an accessory
bypass tract (WPW, Lown-Ganong-Levine syndrome)

CONTRAINDICATIONS — Hypersensitivity to verapamil or any component of the formulation; severe left

ventricular dysfunction; hypotension (systolic pressure <90 mm Hg) or cardiogenic shock; sick sinus
syndrome (except in patients with a functioning artificial pacemaker); second- or third-degree AV block
(except in patients with a functioning artificial pacemaker); atrial flutter or fibrillation and an accessory
bypass tract (WPW, Lown-Ganong-Levine syndrome)

MECHANISM OF ACTION — Inhibits calcium ion from entering the "slow channels" or select voltage-
sensitive areas of vascular smooth muscle and myocardium during depolarization; produces a relaxation
of coronary vascular smooth muscle and coronary vasodilation; increases myocardial oxygen delivery in
patients with vasospastic angina; slows automaticity and conduction of AV node.

PATIENT INFORMATION — Sustained release products should be taken with food and not crushed.
Limit caffeine intake. Notify prescriber if angina pain is not reduced when taking this drug, or if irregular
heartbeat or shortness of breath occurs.

LIDOCAINE

U.S. BRAND NAMES — Akten™; Anestacon®; Anestafoam™ [OTC]; Band-Aid® Hurt-Free™ Antiseptic
Wash [OTC]; Burn Jel® [OTC]; Burn-O-Jel [OTC]; Burnamycin [OTC]; L-M-X™ 4 [OTC]; L-M-X™ 5
[OTC]; LidaMantle®; Lidoderm®; LTA® 360; Premjact® [OTC]; Solarcaine® Aloe Extra Burn Relief
[OTC]; Topicaine® [OTC]; Unburn®; Xylocaine®; Xylocaine® MPF; Xylocaine® Viscous; Zilactin-L®
[OTC]; Zingo™

PHARMACOLOGIC CATEGORY
Analgesic, Topical
Antiarrhythmic Agent, Class Ib
Local Anesthetic
Local Anesthetic, Ophthalmic

DOSING: ADULTS
Antiarrhythmic:
I.V.: 1-1.5 mg/kg bolus over 2-3 minutes; may repeat doses of 0.5-0.75 mg/kg in 5-10 minutes up to a
total of 3 mg/kg; continuous infusion: 1-4 mg/minute
Ventricular fibrillation or pulseless ventricular tachycardia (after defibrillation, CPR, and vasopressor
administration): I.V.: Initial: 1-1.5 mg/kg. Refractory ventricular tachycardia or ventricular fibrillation, a
repeat 0.5-0.75 mg/kg bolus may be given every 5-10 minutes after initial dose for a maximum of 3 doses.
Total dose should not exceed 3 mg/kg. Follow with continuous infusion (1-4 mg/minute) after return of
perfusion. Reappearance of arrhythmia during constant infusion: 0.5 mg/kg bolus and reassessment of
infusion.
E.T. (loading dose only): 2-2.5 times the I.V. dose

ADMINISTRATION
Endotracheal: Dilute in NS or distilled water. Absorption is greater with distilled water, but causes more
adverse effects on PaO2. Pass catheter beyond tip of tracheal tube, stop compressions, spray drug
quickly down tube. Follow immediately with several quick insufflations and continue chest compressions.

I.V.: Use microdrip (60 gtt/mL) or infusion pump to administer an accurate dose
Infusion rates: 2 g/250 mL D5W (infusion pump should be used):
 1 mg/minute: 7.5 mL/hour
2 mg/minute: 15 mL/hour
3 mg/minute: 22.5 mL/hour
4 mg/minute: 30 mL/hour
Buffered lidocaine for injectable local anesthetic: Add 2 mL of sodium bicarbonate 8.4% to 18 mL of
lidocaine 1%

USE — Local anesthetic and acute treatment of ventricular arrhythmias (such as from myocardial
infarction or cardiac manipulation)

MECHANISM OF ACTION — Class Ib antiarrhythmic; suppresses automaticity of conduction tissue, by

increasing electrical stimulation threshold of ventricle, His-Purkinje system, and spontaneous
depolarization of the ventricles during diastole by a direct action on the tissues; blocks both the initiation
and conduction of nerve impulses by decreasing the neuronal membrane's permeability to sodium ions,
which results in inhibition of depolarization with resultant blockade of conduction

LASIX

U.S. BRAND NAMES — Lasix®

PHARMACOLOGIC CATEGORY
Diuretic, Loop

DOSING: ADULTS
Edema, CHF, or hypertension (diuresis):

Usual dosage range for hypertension (JNC 7): 20-80 mg/day in 2 divided doses
I.M., I.V.: 20-40 mg/dose, may be repeated in 1-2 hours as needed and increased by 20 mg/dose with
each succeeding dose up to 1000 mg/day; usual dosing interval: 6-12 hours. Note: ACC/AHA 2005
guidelines for chronic congestive heart failure recommend a maximum single dose of 160-200 mg.
Continuous I.V. infusion: Initial I.V. bolus dose 20-40 mg, followed by continuous I.V. infusion doses of
10-40 mg/hour. If urine output is <1 mL/kg/hour, double as necessary to a maximum of 80-160 mg/hour.
The risk associated with higher infusion rates (80-160 mg/hour) must be weighed against alternative
strategies. Note: ACC/AHA 2005 guidelines for chronic congestive heart failure recommend 40 mg I.V.
load, then 10-40 mg/hour infusion.

USE — Management of edema associated with congestive heart failure and hepatic or renal disease;
alone or in combination with antihypertensives in treatment of hypertension

ADMINISTRATION
I.V.: I.V. injections should be given slowly. In adults, undiluted direct I.V. injections may be administered
at a rate of 40 mg over 1-2 minutes; maximum rate of administration for IVPB or continuous infusion: 4
mg/minute. In children, a maximum rate of 0.5 mg/kg/minute has been recommended.

ADMINISTRATION
I.V.: I.V. injections should be given slowly. In adults, undiluted direct I.V. injections may be administered
at a rate of 40 mg over 1-2 minutes; maximum rate of administration for IVPB or continuous infusion: 4
mg/minute. In children, a maximum rate of 0.5 mg/kg/minute has been recommended.

MECHANISM OF ACTION — Inhibits reabsorption of sodium and chloride in the ascending loop of Henle
and distal renal tubule, interfering with the chloride-binding cotransport system, thus causing increased
excretion of water, sodium, chloride, magnesium, and calcium
PATIENT INFORMATION — May be taken with food or milk. Take last dose of day early in the evening to
prevent nocturia. Rise slowly from a lying or sitting position to minimize dizziness, lightheadedness, or
fainting. Also use extra care when exercising, standing for long periods of time, and during hot weather.

LANOXIN

U.S. BRAND NAMES — Digitek®; Lanoxicaps® [DSC]; Lanoxin®

PHARMACOLOGIC CATEGORY
Antiarrhythmic Agent, Class IV
Cardiac Glycoside

ADMINISTRATION
I.M.: Inject no more than 2 mL per injection site. May cause intense pain.

I.V.: May be administered undiluted or diluted fourfold in D5W, NS, or SWFI for direct injection. Less than
fourfold dilution may lead to drug precipitation. Inject slowly over ≥5 minutes.

COMPATIBILITY — Stable in D51/2NS with KCl 20 mEq, D5W, D10W, LR, 1/2NS, and NS. May be diluted
fourfold in D5W, NS, or SWFI for direct injection (or may be administered undiluted).

Y-site administration: Compatible: Ciprofloxacin, cisatracurium, diltiazem, famotidine, gatifloxacin, heparin

with hydrocortisone sodium succinate, inamrinone, linezolid, meperidine, meropenem, midazolam,
milrinone, morphine, potassium chloride, remifentanil, tacrolimus, vitamin B complex with C. Incompatible:
Amphotericin B cholesteryl sulfate complex, fluconazole, foscarnet, propofol. Variable (consult detailed
reference): Insulin (regular).

Compatibility in syringe: Compatible: Heparin, milrinone. Incompatible: Doxapram.

Compatibility when admixed: Compatible: Bretylium, cimetidine, floxacillin, furosemide, lidocaine,

ranitidine, verapamil. Incompatible: Dobutamine.

USE — Treatment of congestive heart failure and to slow the ventricular rate in tachyarrhythmias such as
atrial fibrillation, atrial flutter, and supraventricular tachycardia (paroxysmal atrial tachycardia); cardiogenic
shock

CONTRAINDICATIONS — Hypersensitivity to digoxin or any component of the formulation;

hypersensitivity to cardiac glycosides (another may be tried); history of toxicity; ventricular tachycardia or
fibrillation; idiopathic hypertrophic subaortic stenosis; constrictive pericarditis; amyloid disease; second- or
third-degree heart block (except in patients with a functioning artificial pacemaker); Wolff-Parkinson-White
syndrome and atrial fibrillation concurrently

MECHANISM OF ACTION
Congestive heart failure: Inhibition of the sodium/potassium ATPase pump which acts to increase the
intracellular sodium-calcium exchange to increase intracellular calcium leading to increased contractility

Supraventricular arrhythmias: Direct suppression of the AV node conduction to increase effective

refractory period and decrease conduction velocity - positive inotropic effect, enhanced vagal tone, and
decreased ventricular rate to fast atrial arrhythmias. Atrial fibrillation may decrease sensitivity and
increase tolerance to higher serum digoxin concentrations.

PATIENT INFORMATION — Do not discontinue medication without checking with prescriber. Report loss
of appetite or vision changes.