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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5230_Библиотеки_им_академика_М_И_Перельмана.pdf
Clobetasol propionate creamSee topical corticosteroids.
Clopidogrel $ Antiplatelet. Dose Loading 300mg/ STAT PO;
Maintenance 75mg/ 24hPO Indication Prevention of atherothrombotic
events following MI/ ACS/ CVA
tive bleeding
Caution Hepatic impairment, increased risk of bleeding,
recent trauma/ surgery
InteractionIncreased risk of bleeding with NSAIDs and anticoagulants;
CI Pregnancy, breastfeeding, ac-
SE GI disturbance, bleeding disorders
proton pump inhibitors may reduce eectiveness of clopidogrel.
Clotrimazole$ Imidazole antifungal. Dose% cream 2– 3 applications/
24h
Indication Fungal skin infections, vaginal candidiasis Caution Avoid
contact with eyes and mucous membranes, can damage condoms and
diaphragms
SELocal irritation.
Co- amoxiclav $ Beta- lactam with clavulanicacid. Dose375– 625mg/
8h PO; .2g/ 8h IV
propriate
CMV infection, ALL/ CLL
IndicationInfection; where amoxicillin alone is not ap-
CI Penicillin allergyCaution Renal impairment, glandular fever,
SEN+V, diarrhoea,rash.
Co- beneldopa $ Levodopa and dopa- decarboxylase inhibitor
(benserazide).
Dose Initially 50mg/ 6– 8h PO, increased to 00mg/
24h or 00mg/ twice a week according to response; usual maintenance dose 400– 800mg/ day in divided doses
disease
CautionSevere pulmonary or cardiovascular disease, psychiatric
illness, endocrine disorders, pregnancy and breastfeeding
Indication Parkinson’s
SEGI disturb-
ances, taste disturbances, dry mouth, anorexia, arrhythmias and palpitations, postural hypotension, drowsiness, dystonia, dyskinesia.
Co- careldopa $ Levodopa and dopa- decarboxylase inhibitor
(carbidopa).
Parkinson’s disease
psychiatric illness, endocrine disorders, pregnancy and breastfeeding
Dose Depends upon preparation, consult BNF Indication
CautionSevere pulmonary or cardiovascular disease,
SE
GI disturbances, taste disturbances, dry mouth, anorexia, arrhythmias
and palpitations, postural hypotension, drowsiness, dystonia, dyskinesia.
Co- codamol $ Weak opioids with paracetamol. Dose 8/ 500mg Two
tablets/ 4– 6h PO (max eight tablets/ 24h in divided doses);
Two tablets/ 4– 6h PO (max eight tablets/ 24h in divideddoses)
Pain
CI Acute respiratory depression, paralytic ileus; codeine-containing
30/ 500mg
Indication
medicines should not be used in children under 2yr, or in any patient
under the age of 8yr who undergoes removal of tonsils or adenoids for
the treatment of sleep apnoea
COPD, asthma, renal impairment, hepatic impairment
pation
InfoCo- prescribe laxatives if using opioids for>24h.
Caution Pregnancy (especially delivery),
SE N+V, consti-
Codeine phosphate $ Weak opioid. Dose 30– 60mg/ 4h PO/ IM
(max 240mg/ 24h in divided doses)
Indication PainCI Acute respiratory
depression, paralytic ileus; codeine-containing medicines should not be
used in children under 2yr, or in any patient under the age of 8yr who
undergoes removal of tonsils or adenoids for the treatment of sleep apnoea
Caution Pregnancy (especially delivery), COPD, asthma, renal im-
pairment, hepatic impairment; never give codeine phosphate IV
constipation
InfoCo- prescribe laxatives if using opioids for>24h.
SEN+V,
193PHARMACOPOEIA
194 CHAPTER 5 Pharmacopoeia
Combivent
ipratropium bromide with 2.5mg salbutamol/ PRN NEB
and other reversible airway obstruction, COPD
plasia, glaucoma
®
$ Antimuscarinic with β2 agonist. Dose500micrograms
SE Antimuscarinic eects (commonly dry mouth), ne
Indication Asthma
CautionProstatic hyper-
tremor, tension headaches, arrhythmias.
Cyclizine $ Antihistamine (H
Dabigatran $ Direct thrombin inhibitor.
laxisafter hip/ knee replacement
antagonist). See antiemetics.
Indication and dose VTE prophy-
0mg – 4h after surgery, followed by 220mg/
2h for 0 d (28–35d in hips) start 2– 24h after rst dose. If >75yr then initial
dose is 75mg, followed by 50mg/ 2h for 0d (28–35d in hips).
ofDVT/ PE and prophylaxis ofrecurrent PE/ DVT
Initial dose must follow at least
Treatment
5d treatment with a parenteral anticoagulant: 50mg/ 2h. If >75yr, renal impairment or at increased risk of bleeding: 0mg/ 2h.
and systemic embolism innon- valvular AF and one risk factor
Prophylaxis of stroke
(Such as previous
stroke or TIA, symptomatic heart failure, DM, HTN, or >75yr):50mg/ 2h.
If >75yr:0mg/ 2h.
haemorrhage, nausea
risk. Wait 6h after epidural catheter removal to restart dabigatran
SE
Abdominal pain, anaemia, diarrhoea, dyspepsia,
Caution
Avoid in patients with signicant bleeding
Info
Dose
changes if receiving concomitant amiodarone or verapamil. No routine anticoagulant monitoring required (INR tests are unreliable).
Dalteparin $ Low- molecular- weight heparin. Dose Consult BNF
Indication DVT/ PE treatment and prophylaxis, ACS CI Bleeding dis-
orders, thrombocytopenia, severe hypertension, recent trauma
Caution Hyperkalaemia, hepatic or renal impairment SE Haemorrhage,
thrombocytopenia, hyperkalae-mia
InteractionNSAIDs increase bleeding
risk, eects increased byGTN.
DapagliozinSeeSGLT2 inhibitors.
Desloratadine $ Antihistamine (H
antagonist). See antihistamines.
Dexamethasone $ Corticosteroid. DoseSee BNF IndicationCerebral
oedema (malignancy), suppression of inammation/ allergic disorders, diagnosis of Cushing’s disease, chemotherapy induced N+V
CI Systemic infectionCaution Adrenal suppression, may precipitate tu-
mour lysis syndrome in patients with some haematological malignancies
SE Cushing’s syndrome, deranged blood glucose, osteoporosis, psychi-
atric reactions, raised WCC (specically neutrophilia).
Diamorphine $ Opioid.
Dose
2.5– 5mg/ 4h SC/ IM/ IV
Indication
Severe pain, ACS/ acute MI, acute pulmonary oedema, palliative care
Respiratory depression, paralytic ileus, raised ICP/ head trauma, comatose
patients, phaeochromocytoma
COPD, asthma, renal impairment, hepatic impairment
tion, respiratory depression, dry mouth
Caution
Pregnancy (especially delivery),
Interaction
MAOI;
SE
N+V, constipa-
Info
Co- prescribe
laxatives if using opioids for>24h.
Diazepam $ Benzodiazepine. Dose Status epilepticus5– 0mg over 0min
IV (max 20mg) or 0– 40mgPR;
30mg/ 24h in divided doses)
Anxiety, alcohol withdrawal, muscle spasms CI Respiratory depres-
term
sion, sleep apnoea, unstable myasthenia gravis, hepatic impairment
Other short- term usage 2mg/ 8h PO (max
Indication Seizures, status epilepticus; Short
Caution
Pregnancy, breastfeeding, history of drug abuse, respiratory disease, muscle
weakness, renal impairment
SEDrowsiness, confusion, muscle weakness.
CI
Diclofenac $ NSAID. Dose 50mg/ 8h PO/ PR (max 50mg/ 24h
in divided doses)
Indication Pain, inammation CI Pregnancy, peptic
ulcer disease, hepatic impairment, congestive heart failure, ischaemic
heart disease, peripheral arterial disease, cerebrovascular disease
Caution Breastfeeding, renal impairment, asthma, GI disease, pa-
tients with signicant risk factors for cardiovascular events (eg iB P,
ilipids, DM, smoking)
ness
Info Arthrotec
SE GI disturbance/ bleeding, headache, dizzi-
®
is a preparation of diclofenac with misoprostol
and may reduce GI side eects.
Digoxin $ Cardiac glycoside. Emergency IV loading dose0.75– mg over at
least 2h IV
Rapid oral loading dose0.75– .5mg over 24h in 3 divided doses PO
(typically 500micrograms PO initially, followed by 250micrograms PO 6h
later, and further 250micrograms PO 2h later if still tachycardic
62.5– 25micrograms/ 24h PO Indications Often 2nd- line agent in
dose
Maintenance
supraventricular tachyarrhythmias (commonly AF and atrial utter), heart
failure
CI 2nd- or 3rd- degree AV dissociation, accessory conducting path-
ways (eg WPW)
impairment, elderly patients, dK
Caution Pregnancy, recent MI, sick sinus syndrome, renal
+
, dMg2+ or iCa
2+
SE N+V, diarrhoea,
bradyarrhythmias, tachyarrhythmias, dizziness, blurred or yellow vision
Therapeutic monitoring(Table5.3) should be undertaken if toxicity is con-
sidered (usually presents with N+V) or if rate control is poor
InfoDigoxin is
now rarely used for rapid rate control, with other agents often being used in
preference (E pp. 264–69) or DC cardioversion (E p. 560). Digoxin is most
often used in the chronic rate control of supraventricular tachyarrhythmias
and in heart failure. Digoxin does not restore sinus rhythm, it merely slows
conduction at the AV node, limiting the number of impulses passing from
the atria through to the ventricles thus controlling ventricular rate. It also
acts as a positive inotrope, increasing the force of ventricular contraction
If rate not adequately controlled After loading with digoxin, discuss with senior
or cardiologist.
Monitoring
digoxin
Optimum sampling time 6– 2h post oral dose – 2.6nmol/ L (0.8–
2micrograms/ L); typically takes 7d to get to steady state
2
Toxic >2.6nmol/ L (>2micrograms/ L). Toxicity can occur at
levels <.3nmol/ L if patient hasdK
2
Signs of toxicity (Table5.3; E OHAM4 p. 755)
+
195PHARMACOPOEIA
Table5.3 Digoxin toxicity
Symptoms N+V, confusion, diarrhoea, yellow and blurred vision
Bloods
ECG Tachy- and bradyarrhythmias. ST depression/ T- wave inversion
Complications
Management Airway, breathing, and circulation
Toxicity precipitated by renal failure, dK+, dMg2+,dT
Check digoxin level (see ‘Monitoring digoxin’); toxic if
>2.6nmol/ L (>2micrograms/ L)
iK+, cardiac dysrhythmias (tachy- and bradyarrhythmias)
Continuous ECG monitoring
Treat arrhythmias
Consider digoxin- binding antibody fragments (DigiFab
if known or suspected digoxin overdose
4
®
, see BNF)
196 CHAPTER 5 Pharmacopoeia
Dihydrocodeine $ Weak opioid. Dose 30mg/ 4– 6h PO (max 240mg/
24h in divided doses); 50mg/ 4– 6h IM
depression, paralytic ileus
Caution Pregnancy (especially delivery), COPD,
Indication Pain CI Acute respiratory
asthma, renal impairment, hepatic impairment; never give dihydrocodeine
IV
SEN+V, constipationInfoCo- prescribe laxatives if using opioids for>24h.
DiltiazemSee calcium- channel blockers.
Dipyridamole $ Antiplatelet. Dose 200mg modied- release/
2h PO (max 600mg/ 24h in divided doses), non- modied- release
preparations also available (see BNF)
Indication Secondary preven-
tion of ischaemic stroke and TIA, adjunct to oral anticoagulation for
prophylaxis of thromboembolism associated with prosthetic heart
valves
Caution Breastfeeding, aortic stenosis, unstable angina, recent
MI
SE GI disturbance, dizziness, headache, myalgiaInteraction Increases
eect of warfarin, decreases eect of cholinesterase inhibitors.
Docusate sodiumSee laxatives.
Doxazosin $ α
2– 4mg/ 24h (max 6mg/ 24h)
hypertension
impairment
tinence
InteractionIncreases eects of antihypertensives.
antagonist. Dosemg/ 24h PO; increase gradually to
CI Breastfeeding, hypotension Caution Pregnancy, hepatic
SEPostural hypotension, headache, dizziness, urinary incon-
Indication Benign prostatic hyperplasia,
Doxycycline $ Tetracycline. Dose 00– 200mg 2– 24h PO (consult
BNF)
Indication Respiratory tract infections, GU infections, anthrax, mal-
aria prophylaxis
(stains growing teeth and bones)
exacerbates SLE
tion, photosensitivity
CIPregnancy, breastfeeding, renal impairment, age <2yr
Caution Myasthenia gravis may worsen,
SEGI disturbance including dysphagia/ oesophageal irrita-
InteractionDecreased absorption with milk, decreases
eects of oral contraceptive pill, mildly increases eects of warfarin.
DPP-4 inhibitors $ Inhibit dipeptidylpeptidase-4, increasing release of
insulin via incretin Includes alogliptin, linagliptin, sitagliptin, saxagliptin, and
vildagliptin.
ketoacidosis, severe hepatic impairment
impairment
DoseSee Table5.4Indications T2DM CI pregnancy, breastfeeding,
Cautionprevious pancreatitis, renal
SE GORD, pancreatitis, deranged LFTs Info Weight-neutral,
lower incidence hypoglycaemia compared with sulfonylureas.
Table5.4 Common DPP-4 inhibitors
Alogliptin Dose 25mg/24h PO
Linagliptin Dose 5mg/24h PO
Sitagliptin Dose 00mg/24h PO
Edoxaban $ Direct factor Xa inhibitor. Dose30mg/ 24 if <60kg, 60mg/
24 if >6kg
AF and one risk factor
failure, DM, HTN, or >75yr);
PE/ DVT
with signicant bleeding risk
pruritus, rash (rare=allergic oedema)
Indication Prophylaxis ofstroke and systemic embolism innon- valvular
(Such as previous stroke or TIA, symptomatic heart
Treatment ofDVT/ PE and prophylaxis ofrecurrent
CautionMitral stenosis and prosthetic heart valves. Avoid in patients
SE Anaemia, epistaxis, haemorrhage, nausea,
InfoNo routine anticoagulant moni-
toring required (INR tests are unreliable). Monitor LFTs for the rstyear.
EmpagliozinSeeSGLT2 inhibitors.
EnalaprilSeeACEi.
Enoxaparin $ Low- molecular- weight heparin. Dose DVT/ PE prophy-
laxis 20– 40mg/ 24h SC (E pp. 428–30); DVT/ PE treatment .5mg/
kg/ 24h SC;
and prophylaxis, ACS
vere hypertension, recent trauma
renal impairment
ACS treatment mg/ kg/ 2h Indication DVT/ PE treatment
CI Bleeding disorders, thrombocytopenia, se-
Caution Hyperkalaemia, hepatic or
SE Haemorrhage, thrombocytopenia, hyperkalaemia
Interaction NSAIDs increase bleeding risk, eects increased byGTN.
ErtugliozinSeeSGLT2 inhibitors.
Erythromycin $ Macrolide antibiotic. Dose500– 000mg/ 6h PO; 50mg/
kg/ 24h IV in divided dose (typically 500– 000mg/ 6h IV)
IndicationInfection,
atypical pneumonias. Commonly used in patients allergic to penicillins
CI AllergyCautionPregnancy, breastfeeding, hepatic or renal impairment,
concomitant use with statins
SEGI upset, irritant toveins.
Esomeprazole $ Proton pump inhibitor. Dose 20– 40mg/ 24h PO
Indication PUD, GORD, H. pylori eradication CI Breastfeeding Caution
Pregnancy, hepatic impairment, gastric cancer
SEGI disturbance, headache
InteractionProton pump inhibitors may reduce eectiveness of clopidogrel.
FelodipineSee calcium- channel blockers.
Ferrous preparations $ Iron supplement. See iron.
Fibrinolytic drugs $ Plasminogen activator. Dose and indications Depends
upon specic agent (Table 5.5, also E p. 565)
CI Recent haemorrhage,
trauma or surgery, coagulopathies, aortic dissection, aneurysm, coma, history
of cerebrovascular disease, peptic ulceration, menorrhagia, hepatic impairment;
streptokinase should not be used again beyond 4d of rst administration due to
antibody formation and risk of allergic reactions
ternal chest compression, old age, hypertension
CautionPregnancy, following ex-
SEN+V, bleeding, hypotension.
197PHARMACOPOEIA
Table5.5 Fibrinolyticdrugs
In acute STEMI, brinolytic drugs should be used where primary cutaneous
intervention (PCI) is not immediately available
Alteplase Indications Acute MI, massive PE, acute ischaemic stroke
Reteplase Indications Acute MI
Streptokinase Indications Acute MI, DVT, PE, acute arterial thromboembolism,
Tenecteplase Indications Acute MI
Urokinase Indications Thromboembolic occlusive vascular disease; DVT,
Dose Consult BNF; given as an IV bolus followed by an IV
infusion, followed by heparin infusion
Dose Consult BNF; given as two IV boluses 30min apart,
followed by heparin infusion
central retinal venous or arterial thrombosis
Dose Consult BNF; typically .5million units in 00mL 0.9% saline
over h IV. Do not repeat administration after 4d of initial dose
due to risk of allergic reaction
Dose Consult BNF; given as an IV bolus, followed by heparin infusion
PE, and peripheral vascular occlusion; occluded IV catheters
and cannulae blocked by brin clot
Dose Consult BNF
198 CHAPTER 5 Pharmacopoeia
Finasteride $ Antiandrogen. Dose BPH 5mg/ 24h PO; Male- pattern
mg/ 24hPO IndicationBPH, male- pattern baldnessCIFemales
baldness
and adolescents
tion
SEGynaecomastia, testicular pain, sexual dysfunction.
®
Flagyl
$ Antibiotic. See metronidazole.
Caution Prostate cancer, urinary tract obstruc-
Flecainide $ Class C antiarrhythmic. Dose Initial 00mg/ 2h PO;
Reduce tolowest eective dose over 3– 5d; 2mg/ kg over 0– 30min slow
IV (max 50mg)
bundle branch block
turbance, dizziness, oedema, fatigue
Indication VT, SVT CI HF, history of MI, heart block,
Caution Patients with pacemakers, AF SE GI dis-
Interaction Duration of action in-
creased by amiodarone, uoxetine, quinine; myocardial depression with
β- blockers/ verapamil.
Flixotide
®
$ Corticosteroid. See uticasone.
Flucloxacillin $ Beta- lactam. Dose 250– 500mg/ 6h PO; 250– 2000mg/
6h IV
Indication Penicillin-sensitive infections, endocarditis, osteomyelitis CI
History of ucloxacillin- related jaundice, penicillin allergy
abdominal pain
Caution Renal impairment Interaction Decrease eects of oral
SE Diarrhoea,
contraceptive pill, allopurinol increases risk ofrash.
Fluconazole $ Triazole antifungal. Dose 50– 400mg/ 24h PO/ IV
Dependent on indication
prophylaxis
CIPregnancy, acute porphyriaCautionBreastfeeding, hepatic
or renal impairment
Indication Fungal meningitis, candidiasis, fungal
SEGI disturbance.
Fludrocortisone $ Mineralocorticoid. Dose 50– 300micrograms/
24h PO
Indication Addison’s disease, other adrenal insuciency, pos-
tural hypotension
Adrenal suppression
CISystemic infection without antibiotic coverCaution
SESodium and water retention, hypertension.
Flumazenil $ Benzodiazepine antagonist. Dose200micrograms/ STAT
IV, followed by 00micrograms/ min if required (max mg)
Benzodiazepine OD/ toxicity
ines, eg status epilepticus
OD
SE N+V, dizziness, arrhythmias.
CIConditions dependent on benzodiazep-
Caution Benzodiazepine dependence, mixed
Fluoxetine $ Selective serotonin re- uptake inhibitor. Dose 20mg/
24h PO (max 60mg/ 24h)
OCD
CI Active maniaCautionPregnancy, epilepsy, cardiac disease, DM,
bleeding disorders, glaucoma
+
dNa
, agitationInteractionMAOI within2wk.
Indication Depression, bulimia nervosa, and
SEGI disturbance, anorexia, weight loss,
Fluticasone $ Corticosteroid. Dose 00– 500micrograms/ 2h INH
(consult BNF)
TB
SEOral candidiasis, hoarse voice, paradoxical bronchospasm (rare).
Folic acid $ Vitamin B
ception and until week 2 of pregnancy; 5mg/ wk for preventing methotrexate side eects
anaemia, long- term methotrexate
IndicationChronic asthma (step 2 BTS guidelines) Caution
. Dose 400micrograms/ 24h PO before con-
9
Indication Pregnancy, folate decient megaloblastic
CI Malignancy Caution Never give
alone for pernicious anaemia; can cause degeneration of spinal cord, undiagnosed megaloblastic anaemia
SEGI disturbance.
Indication
Fondaparinux $ Factor Xa inhibitor. Dose2.5mg/ 24h SC (2.5mg loading
dose 6h post- op)
bleeding, bacterial endocarditis
IndicationVTE prophylaxis and treatment, ACSCI Active
Caution Pregnancy, breastfeeding, bleeding
disorders, active PUD, recent surgery, epidural/ spinal anaesthesia, hepatic
or renal impairment
SEBleeding, purpura, anaemia, thrombocytopenia.
Furosemide $ Loop diuretic. Dose Typically 20– 80mg/ 24h PO/
IV
Indication Oedema (LVF, pulmonary oedema), resistant hyperten-
sion
CI Severe dK
Hypotension
+
(dK
, dNa+, dMg2+)InteractionIncreases toxicity of gentamicin, digoxin,
NSAIDs
+
and dNa+, hypovolaemia, renal impairment Caution
SE GI disturbance, hypotension, electrolyte disturbances
Info IV doses >80mg should be infused at <4mg/ min (risk of
deafness).
Fusidic acid $ Antibiotic.Dose2% topical cream 3– 4 applications/ 24h;
oral and IV preparations available (see BNF)
skin infections;
coccal infections
IV treatment Osteomyelitis, penicillin- resistant staphylo-
Caution Pregnancy, breastfeeding, monitor LFTsSE GI
Indication Staphylococcal
disturbance, reversible jaundice.
Fybogel
®
See laxatives.
Gabapentin $ Antiepileptic. Dose day 300mg/ 24h PO; Continued
Increase by 300mg/ 24h PO up to max 3.6g/ 24h in 3 divided doses
Indication Epilepsy, neuropathic pain Caution Pregnancy, breastfeeding,
renal impairment, DM, avoid abrupt withdrawal
ache, sleep disturbance
Interaction Eects decreased by antidepressants.
SEGI disturbance, head-
Gentamicin $ Aminoglycoside. Dose Once daily 5– 7mg/ kg/ 24h IV
adjust to serum concentration; other dosing regimens may be used
(consult local guidelines)
carditis
CIMyasthenia gravisCautionPregnancy, breastfeeding, renal im-
pairment
SEOtotoxic, nephrotoxicInteraction Eects increased by loop
Indication Infection; sepsis, meningitis, endo-
diuretics, increases eects of warfarin.
Levels are typically taken h before next dose is due (but check local
guidelines rst)
Monitoring
gentamicin
Peak h post IV dose 9– 8micromol/ L (5– 0mg/ L)
Trough <4.2micromol/ L (<2mg/ L)
2
Toxic >2mg/ L (22micromol/ L)
2
Signs of toxicity Tinnitus, deafness, nystagmus, vertigo, renal failure
(OHCM11 E p. 740). Will vary with once- daily regimen, check locally
GlibenclamideSee sulfonylureas.
GliclazideSee sulfonylureas.
GlipizideSee sulfonylureas.
Glucagon $ Peptide hormone. Dose mg/ PRN IM/ SC/ slow IV
Indication Hypoglycaemia, in treatment of β- blocker overdose CI Phaeo-
chromocytoma
caemia
SEGI disturbance, dK
Caution Insulinoma, glucagonoma, chronic hypogly-
+
, hypotension.
Glycerin suppositoriesSee laxatives.
199PHARMACOPOEIA
200 CHAPTER 5 Pharmacopoeia
Glyceryl $ Trinitrate nitrate. SeeGTN.
GTN sublingual/ transdermal $ Nitrate. Dose– 2 sprays/ PRN SL;
400–800micrograms/ PRN SL
gina, left ventricular failure
stenosis
CautionPregnancy, breastfeeding, hypothyroidism, recent MI, head
trauma
SE Postural hypotension, tachycardia, headache Info Transdermal
Indication Prophylaxis and treatment of an-
CI Hypotensive conditions, hypovolaemia, aortic
patches are available, see BNF— patients may develop tolerance (tachyphylaxis) to nitrates and as such it is suggested to ensure patients have a nitratefree period for 4– 8h to prevent this; it is usual to have this period overnight
when the eects of nitrates are least likely to be needed.
GTN IV infusion $ Nitrate. Dose0– 200micrograms/ min IVI GTN.
For typical prescription see Fig.5.2.
going ischaemic chest pain refractory to SL nitrates
ditions, hypovolaemia, aortic stenosis
hypothyroidism, recent MI, head trauma
cardia, headache
InfoPatients may develop tolerance (tachyphylaxis) to
IndicationLeft ventricular failure, on-
CI Hypotensive con-
Caution Pregnancy, breastfeeding,
SEPostural hypotension, tachy-
nitrates and as such it is suggested to ensure patients have a nitrate- free
period for 4– 8h to prevent this; it is usual to have this period overnight
when the eects of nitrates are least likely to be needed.
Date
13.08.2024 IV 0.9%
Fig.5.2 Example of a GTN infusion.
Route Fluid Additives Vol Rate Notes Signature
saline
50mg of
Glyceryl
Trinitrate
(GTN)
Start at 2mL/h,
titrate up by 2mL/h
every 10min
according to chest
pain and BP
This infusion
will drop BP,
titrate rate to
keep systolic
BP>90mmHg
Haloperidol $ Antipsychotic (butyrophenone). Dose Antiemetic 0.5–
3mg/ 8hPO/ IV;
agitation, N+V, motor tics, intractable hiccups
pression
cardiovascular disease, Parkinson’s, epilepsy
Other0.5– 0mg/ 8h PO/ IM/ IV IndicationSchizophrenia,
CI Comatose/ CNS de-
CautionPregnancy, breastfeeding, hepatic or renal impairment,
SE Extrapyramidal symp-
toms, cardiac arrhythmias (QTc prolongation).
Heparin $ Glycosaminoglycan (potentiates antithrombin III).
Dose Loading dose 5000units or 75units/ kgIV; Maintenance 8units/ kg/
h IVI (titrate dose to keep APTT within therapeutic range);
5000units/ 2h SC (seldom used as LMWH have similar benets
dose
and fewer side eects)
prophylaxis of DVT/ PE, ACS
penia, severe hypertension, recent trauma, history of heparin- induced
thrombocytopenia (HIT, E p. 427)
pairment
SE Haemorrhage, thrombocytopenia, iK+Interaction NSAIDs
Indication Rapid anticoagulation, treatment and
CI Bleeding disorders, thrombocyto-
Caution iK
+
, hepatic or renal im-
increase bleeding risk, eects increased byGTN.
Humalog
®
See insulin.
N. Petit50mL
Prophylactic
201PHARMACOPOEIA
Humulin
®
See insulin.
Hydralazine $ Vasodilator (arterial >> venous). Dose Hyperten-
sion 25– 50mg/ 2h PO; 5– 0mg slow IV titrated to eect (can repeat
after 30min);
heart failure
ciency
ischaemic heart disease, cerebrovascular disease
Heart failure 25– 75mg/ 6h PO Indication Hypertension,
CI SLE, severe tachycardia, myocardial insu-
Caution Pregnancy, breastfeeding, hepatic or renal impairment,
SE Tachycardia, palpi-
tation, hypotension, SLE- like syndrome after long- term, rebound hypertension on stopping therapy, uid retention.
Hydrocortisone creamSee topical corticosteroids.
Hydrocortisone IV/ PO $ Corticosteroid. Dose Acute 00–
250mg/ 6h IV;
Chronic 20– 30mg/ 24h PO in divided doses Indication
Adrenocortical insuciency, acute allergic/ inammatory reactions
Systemic infection
Caution Adrenal suppressionSECushing’s syndrome,
DM, osteoporosis, dyspepsia.
Hydroxocobalamin $ VitaminB
neurological involvement
mg/ 3mth IM;
Initially mg three times a week IM, after 2wk
Macrocytic anaemia with neurological involvement Initially
. Dose Macrocytic anaemia without
2
mg on alternate days IM until no further improvement, then mg/
2mthIM
Indication Pernicious anaemia, other macrocytic anaemias with
neurological involvement
tablished
SEN+V, headache, dizziness.
Caution Do not give before diagnosis fully es-
Hyoscine butylbromide $ Anticholinergic. Dose20mg/ 6h PO (max
80mg/ 24h in divided doses); 20mg/ STAT IV/ IM repeated after 30min
(max 00mg/ 24h in divided doses)
spasm
CI Myasthenia gravis Caution Pregnancy, glaucoma, GI obstruc-
tion, prostatic hyperplasia, urinary retention
Indication GI/ GU smooth muscle
SE Antimuscarinic eects,
drowsiness.
Hyoscine hydrobromide $ Anticholinergic. Dose Antiemetic
300micrograms/ 6h PO (max 900micrograms/ 24h in divided doses);
Excessive respiratory secretions 200– 600micrograms/ 4– 8h SC Indication
Motion sickness, excessive respiratory secretions
CI Glaucoma Caution
Pregnancy, GI obstruction, prostatic hyperplasia, urinary retention
SE Antimuscarinic eects, sedative Interaction Decreases eects of
sublingualGTN.
Ibuprofen $ NSAID. Dose 200– 400mg/ 6h PO (max 2.4g/ 24h in
divided doses)
disease
disease
Indication Pain, inammation CI Pregnancy, peptic ulcer
Caution Breastfeeding, hepatic or renal impairment, asthma, GI
SE GI disturbance/ bleeding, headacheInteraction Decreases ef-
fects of antihypertensives, increases toxicity of methotrexate.
Insulatard
®
See insulin.
CI
202 CHAPTER 5 Pharmacopoeia
Insulin Dose When starting or changing SC doses, liaise with diabetes
team (eg diabetes nurse specialist); infusion, see Table5.6
IndicationsDM,
diabetic ketoacidosis, hyperkalaemia, maintenance of euglycaemia in
critical care and post MI
CI HypoglycaemiaCaution May need dose ad-
justments in pregnancy, breastfeeding, renal and hepatic impairment, see
BNF
SE Hypoglycaemia, local reactions and fat hypertrophy at injection
site, rarely allergic reactions
Info Table5.7 is not an exhaustive list of
insulins. In addition to these single preparations of insulin, so- called biphasic mixtures of two dierent insulins are also used and often consist
of a rapid- or short- acting insulin and a longer- acting insulin (in dierent
proportions).
Table5.6 IV infusions ofinsulins
Indication Infusion
Hyperkalaemia
(E pp. 407–11)
Sliding scale
(E p. 341)
50mL of 50% glucose with 0units soluble insulin
(eg Actrapid®) IVI over 0min
50mL of 0.9% saline with 50units soluble insulin (eg
Actrapid®), often infused at 0– 7mL/ h depending upon the
patient’s blood sugar
Table5.7 Properties ofcommon subcutaneous insulins
Type of insulin Example Onset Peak Max duration
Rapid acting
Aspart Novorapid®5– 30min 0.5– .25h 4– 6h
Lispro Humalog
Glulisine Apidra
Short acting
Soluble Actrapid®30– 60min 2– 3h 6– 8h
Intermediate and long acting
Isophane Insulatard®2– 4h 6– 0h 4– 8h
Glargine Lantus
Detemir Levemir
®
5– 30min 0.5– .25h 4– 6h
®
5– 30min 0.5– .25h 4– 6h
®
3– 4h 8– 6h 20– 24h
®
3– 4h 6– 8h
720h
Ipratropium $ Anticholinergic. Dose Chronic 20– 40micrograms/ 6h
INH (max 80micrograms/ 6h);
IndicationBronchospasm; chronic and acuteCautionGlaucoma, prostatic
hyperplasia
SEMinimal antimuscarinic eects.
Acute 250– 500micrograms/ 4– 6h NEB