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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5230_Библиотеки_им_академика_М_И_Перельмана.pdf
Iron Dose Ferrous fumarate Consult BNF as depends upon formula-
tion
Ferrous gluconate 600mg/max 8h PO Ferrous sulfate 200mg/ max 8h
PO
Ferric carboxymaltose (Ferinject®) Dose based on estimated iron need
and body weight, max g/wk
IndicationIron deciency anaemia Caution
avoid IV iron during infection SEGI disturbance, dark stools. Note that
once-daily or alternate daily doses of oral iron can be as eective for
replacement and are associated with fewer side eects.
ISMN $ Nitrate. See isosorbide mononitrate.
ISMO $ Nitrate. See isosorbide mononitrate.
®
Isoket
$ Nitrate. See isosorbide dinitrate.
Isosorbide dinitrate IV infusion $ Nitrate. Dose 2– 0mg/ h
IVI
IndicationLeft ventricular failure, ischaemic chest painCI Hypotensive
conditions, hypovolaemia, aortic stenosis
feeding, hypothyroidism, recent MI, head trauma
tension, tachycardia, headache
Info Patients may develop tolerance
Caution Pregnancy, breast-
SE Postural hypo-
(tachyphylaxis) to nitrates if infused for prolonged periods, though there
are obvious risks about stopping a nitrate infusion; consult senior.
Isosorbide mononitrate $ Nitrate. Dose Initially 0–20mg PO twice
daily, increased if necessary up to 20mg/24h in divided doses. Doses for
MR brands dier, consult BNF
congestive heart failure
cardia, headache
InfoPatients may develop tolerance (tachyphylaxis) to ni-
Indication Prophylaxis of angina, adjunct in
Caution As GTN SE Postural hypotension, tachy-
trates 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, hence prescribing them to be
given at breakfast and lunchtime rather than 8am and8pm.
®
Istin
See calcium- channel blockers.
LactuloseSee laxative.
Lamotrigine $ Antiepileptic. Dose Initially 25mg/ 24h PO for4d;
Then50mg/ 24h PO for 4d, increase by max 50– 00mg/ 24h every 7–
4d until seizures controlled (max 500mg/ 24h)
Indication EpilepsyCaution
Requires close monitoring of serum levels, pregnancy, breastfeeding,
hepatic or renal impairment, avoid rapid withdrawal
SE Rash/ severe
skin reactions, cerebellar symptoms, cytopenias.
Lansoprazole $ Proton pump inhibitor. Dose H. pylori eradica-
tion 30mg/ 2h PO for 7d Peptic ulcer 30mg/ 24h PO for 4–8wks;
Maintenance 5–30mg/ 24h PO Indication Prophylaxis and treatment
of peptic ulcers, GORD, H. pylori eradication, Zollinger– Ellison syndrome
CI Pregnancy Caution Breastfeeding, hepatic impairment, gastric
cancer
SE GI disturbance, headache Interaction Preferred proton pump
inhibitor for patients on clopidogrel
Info Also available as a FasTab
which dissolves in the mouth and is useful in patients who areNBM.
203PHARMACOPOEIA
®
204 CHAPTER 5 Pharmacopoeia
Laxative DoseSee Table5.8Indications Treatment and prophylaxis of
constipation (E pp. 324–5)
and consider causes of constipation
Caution Conrm the patient is constipated
SESee Table5.8InfoChronic use
of laxatives can lead to electrolyte imbalances and gut dysmotility. Ensure
adequate water intake and increase bre intake where possible. Always
consider faecal impaction and other causes of obstruction before commencing oral laxatives. Combinations of laxatives from dierent groups
can be used in severe constipation (eg lactulose and senna).
Table5.8 Laxatives
Classication
Bulk- forming
laxatives
®
Fybogel
Stimulant laxatives Eg bisacodyl, docusate, glycerol, senna
Bisacodyl 5– 0mg/ nocte PO or 0mg/ mane PR
Co- danthramer – 2 capsules/ nocte PO
Docusate sodium 200mg/ 2h PO (max 500mg/ 24h PO in divided doses)
Glycerin supps suppository/ PRN PR, max 4 in 24h
Senna 2 tablets/ nocte PO or 0mL/ nocte PO
Faecal softeners Eg arachis oil, liquid paran
Osmotic laxatives Eg lactulose, Movicol
Lactulose 0– 5mL/ 2h PO
®
Movicol
Phosphate enemas / PRN PR, max 2 in 24h
®
Microlette
Eg Fybogel®, Normacol®
CI Diculty in swallowing, intestinal obstruction, colonic
atony, faecal impaction
SE Diarrhoea, atulence, abdominal distension,
gastrointestinal obstruction
sachet or two 5mL spoons in water/ 2h PO
CI Intestinal obstruction, acute surgical abdomens, active
inammatory bowel disease, dehydration
SE Diarrhoea, hypokalaemia, abdominal pain, N+V
Info Co- danthramer should only be used in the terminally
ill as potentially carcinogenic
Info Infrequently used
CI Peanut allergy
®
(eg Fleet
enema), rectal sodium citrate (eg Microlette®)
CI Intestinal obstruction, colonic atony
SE Diarrhoea, atulence, abdominal distension and
discomfort, nausea; local irritation with rectal preparations
– 3 sachets/ 24h PO
/ PRN PR, max 2 in 24h
®
, magnesium salts, rectal phosphates
Levothyroxine $ Thyroid hormone (T
200micrograms/ 24h PO taken 30min before food, other medication or
caeine
Indication HypothyroidismCI Thyrotoxicosis Caution Pregnancy,
). Dose Typically 50–
4
breastfeeding, panhypopituitarism, adrenal insuciency, cardiovascular
disorders, DM
restlessness, ushing
SE Hyperthyroid- like symptoms; GI disturbance, tremors,
Interaction Increases eects of TCAs and warfarin,
decreases eects of propranolol.
Lidocaine $ Local anaesthetic (amide). Dose Local anaesthesia / 2/ 4%
solution SC (max 3mg/ kg (max total dose 200mg));
BNF
Indication Local anaesthesia, ventricular arrhythmias (alternative to
amiodarone)
node disorders
severe hypoxia/ hypovolaemia
nitus
CI Myocardial depression, atrioventricular block, sinoatrial
Caution Pregnancy, hepatic or renal impairment, epilepsy,
SE Dizziness, drowsiness, confusion, tin-
InteractionIncreased myocardial depression with β- blockers and other
Antiarrhythmic See
antiarrhythmics, increased risk of arrhythmias with antipsychotics.
Lignocaine $ Local anaesthetic (amide). See lidocaine.
LinagliptinSee DPP-4 inhibitors.
LisinoprilSeeACEi.
Lithium $ Lithium salt (mood stabilizer). DoseSee BNF IndicationMania,
bipolar disorder
Addison’s disease
upset, thirst, polyuria
CIPregnancy, breastfeeding, untreated hypothyroidism,
Caution Thyroid disease, myasthenia gravis SE GI
Interaction Diuretics, NSAIDs Info Lithium cit-
rate and lithium carbonate doses are not simply interchangeable, d/ w
senior/ pharmacist; on stable regimens monitor level every 3mth. The
NPSA have published guidance on the ‘safer use of lithium’ and this
should be consulted before commencing lithium therapy.
Monitoring
lithium
Optimum sampling time 4– 7d after commencing treatment 2h
post dose
0.4– mmol/ L
2
Early signs of toxicity (Li
twitching, thirst, polyuria,N+V
2
Late signs of toxicity (Li
arrhythmias, renal failure (E OHAM4 p. 762)
+
>.5mmol/ L) tremor, agitation,
+
>2mmol/ L) spasms, coma, ts,
Loperamide $ Opioid (antimotility). Dose 4mg PO initially then 2mg
PO following every loose stool (max 6mg/ 24h in divided doses)
Indication Diarrhoea, control of high output stoma CI Pregnancy, IBD, any
condition where peristalsis should not be stopped; constipation, ileus,
megacolon
lyte depletion in the young
Caution Hepatic impairment, can promote uid and electro-
SE Abdominal cramps, constipation, dizziness
Info Loperamide should not be used in infective diarrhoeas or diarrhoea
associated withIBD.
Loratadine $ H
antagonist. See antihistamine.
Lorazepam $ Benzodiazepine. Dose Sedation/ anxiety – 4mg/
24h PO/ IM/ IV;
needed)
Seizures 4mg slow IV (repeated once after 0min if
IndicationSedation, seizures, status epilepticusCI Respiratory
depression, sleep apnoea, unstable myasthenia gravis, severe hepatic
impairment
spiratory disease, muscle weakness, renal impairment
CautionPregnancy, breastfeeding, history of drug abuse, re-
SE Drowsiness,
confusion, muscle weakness.
LosartanSee AT II antagonists.
205PHARMACOPOEIA
Mwww.nrls.npsa.nhs.uk/resources/type/alerts/?entryid45=65426
206 CHAPTER 5 Pharmacopoeia
Magnesium sulfate $ Magnesiumsalt. Dose 2– 4g IV over 5– 5min
often followed by an infusion (see BNF)
vere asthma, pre- eclampsia/ eclampsia, dMg
BP, RR, urinary output, hepatic or renal impairment
thirst, ushed skin
blockers
InfoMagnesium sulfate g equivalent to 74mmol.
Monitoring
magnesium
0.7– .0mmol/ L Normal plasma range
.7– 3.5mmol/ L Therapeutic range
2.5– 5.0mmol/ L ECG changes (QRS widens)
4.0– 5.0mmol/ L Reduction in tendon reexes
>5.0mmol/ L Loss of deep tendon reexes
>7.5mmol/ L Heart block, respiratory paralysis, CNS depression
>2mmol/ L Cardiac arrest
Maxolon
Interaction Risk of hypotension with calcium- channel
Levels should be checked every 6h while on IV therapy or more
urgently if indicated;
®
$ Antiemetic (dopamine antagonist). See metoclopramide.
Indication Arrhythmias, MI, acute se-
2+
CautionPregnancy, monitor
SEN+V, hypotension,
Therapeutic range .7– 3.5mmol/ L
Mannitol $ Polyol (osmotic diuretic). Dose 0.25– 2g/ kg/ 4– 8h over
30– 60min IVI (max 3 doses)
CI Pulmonary oedema, cardiac failure Caution Pregnancy, breastfeeding,
renal impairment
SEhypotension, uid and electrolyte imbalance.
Indication Cerebral oedema, glaucoma
Mebeverine $ Antispasmodic (antimuscarinic). Dose35– 50mg/ 8h
PO (20min before food)
verticulitis
CI Paralytic ileusCaution Pregnancy, acute porphyriaSE Very
Indication GI smooth muscle cramps; IBS/ di-
rarely rash, urticaria.
Meropenem $ Carbapenem antibiotic. Dose500– 000mg/ 8h IV (dose
doubled in severe infections)
positive and Gram- negative infections
hepatic or renal impairment, sensitivity to beta- lactams
Indication Aerobic and anaerobic Gram-
Caution Pregnancy, breastfeeding,
SEGI disturbance
including antibiotic-associated colitis, headache, deranged LFTs.
Mesalazine $ Aminosalicylate. DoseDepends upon formulation, con-
sult BNF; PO and PR preparations available
tive ulcerative colitis and maintenance of remission
coagulopathies
ment
SEGI upset, bleeding disorders.
CautionPregnancy, breastfeeding, hepatic or renal impair-
IndicationMild/ moderate ac-
CISalicylate allergy,
Metformin $ Biguanide. Dose Initially500mg/ 24h PO with breakfast;
After wk 500mg/ 2h PO; After further wk 500mg/ 8h PO if required
(max 2g/ 24 in divideddoses)
syndrome
CI Hepatic or renal impairmentCaution Ketoacidosis, poten-
Indication Type 2 DM, polycystic ovarian
tial increased risk of lactic acidosis, iodine- containing contrast, general
anaesthesia
SEGI disturbance, metallictaste Info MR versions reduce GI
disturbance.
Methadone $ Opioid. DoseUsual range 60– 20mg/ 24h PO; should
not be given more frequently than 2h if on prolonged use; establish
the patient’s dose from the usual dispensing pharmacy, the patient
may not tell you accurate information
opioid dependence, chronic pain
Indication Aid in withdrawal from
CI Acute respiratory depression, para-
lytic ileus, raised ICP/ head trauma, comatose patients, phaeochromocytoma
Caution Pregnancy (especially delivery), arrhythmias, hepatic
or renal impairment
mouth
InteractionMAOI within2wk.
SE N+V, constipation, respiratory depression, dry
Methotrexate $ Dihydrofolate reductase inhibitor. Dose2.5– 0mg/
once weekly PO (max 25mg/ wk)
disease, psoriasis, ALL, non- Hodgkin’s lymphoma
Indication Rheumatoid arthritis, Crohn’s
CIPregnancy, breast-
feeding, hepatic or renal impairment, active infection, immunodecient
syndromes
ulcer, ulcerative colitis
pneumonitis, myelosuppression
methoprim
CautionBlood disorders, eusions (especially ascites), peptic
SEGI disturbance/ mucositis, pulmonary brosis,
InteractionNSAIDs, co- trimoxazole, tri-
Info Patients usually also prescribed folic acid during treat-
ment with methotrexate.
Methylprednisolone $ Corticosteroid. Dose 2– 40mg/ 24h PO;
0– 500mg/ 24h IV/ IM (exceptionally, up to g/ 24h for up to 3d)
Indication Acute inammatory disease, cerebral oedema (associated with
malignancy), graft rejection
pression
SECushing’s syndrome, DM, osteoporosisInteractionDuration
CI Systemic infectionCaution Adrenal sup-
decreased by rifampicin, carbamazepine, phenytoin; duration of action
increased by erythromycin, ketoconazole, ciclosporin.
Metoclopramide $ Dopamine antagonist. See antiemetic.
MetoprololSee beta- blockers.
Metronidazole $ Antibiotic. Dose 400mg/ 8h PO; 500mg/ 8h IV
Indication Anaerobic and protozoal infections, abdominal sepsis, Clostridium
dicile diarrhoea (3rd line)
pairment, alcohol use
Interaction Can increase lithium and phenytoin levels, increases eects of
Caution Pregnancy, breastfeeding, hepatic im-
SE GI disturbance, metallic taste, oral mucositis
warfarin.
Midazolam $ Benzodiazepine. Dose – 0mg IV titrated to eect
Indication Conscious sedation, sedation in anaesthesia CI Breastfeeding,
respiratory depression, sleep apnoea, unstable myasthenia gravis
Caution
Pregnancy, hepatic or renal impairment, history of drug abuse, respiratory
disease, muscle weakness
Misoprostol $ Prostaglandin E
grams/ 24h PO in divided dose;
IndicationProphylaxis and treatment of peptic ulcersCIPregnancy, breast-
feeding
CautionCardiovascular/ cerebrovascular diseaseSEDiarrhoea.
Mixtard
®
See insulin.
SEDrowsiness, confusion, muscle weakness.
analogue. Dose Treatment 800micro-
Prophylaxis 200micrograms/ 6– 2h PO
207PHARMACOPOEIA
208 CHAPTER 5 Pharmacopoeia
Montelukast $ Leukotriene receptor antagonist. Dose 0mg/ 24h
PO in evening
itis
Caution Pregnancy, breastfeeding SE Abdominal pain, headache,
IndicationChronic asthma (BTS guidelines), allergic rhin-
rarely Churg– Strauss syndrome.
Morphine $ Opioid. Dose 2.5– 0mg/ 4h IV titrated to eect; 5–
0mg/ 4h IM/ SC
MI, acute LVF
ICP/ head trauma, comatose patients
Indication Acute severe pain, chronic pain, acute
CI Acute respiratory depression, paralytic ileus, raised
Caution Pregnancy (espe-
cially delivery), COPD, asthma, arrhythmias, renal impairment, hepatic impairment
mouth
InfoCo- prescribe laxatives if using opioids for>24h.
MST Continus
SE N+V, constipation, respiratory depression, dry
®
$ Opioid. See oral morphine.
Mupirocin $ Antibacterial. Dose Apply to skin up to 3 times/ 24h
Indication Bacterial skin infections Caution Pregnancy, breastfeeding, renal
impairment
N
- acetylcysteine $ Amino acid derivative. See acetylcysteine.
Naloxone $ Opioid receptor antagonist.
repeat after 2min if needed (max 0mg)
OD/ overtreatment
cardiovascular disease
SELocal reactions; urticarial, pruritus, burning sensation, rash.
Dose
Caution
Pregnancy, physical dependence on opioids,
SE
N+V, hypotension
Indication
0.4– 2.0mg IV/ IM/ SC,
Opioid reversal during
BNF
Emergency treatment
of poisoning.
®
Narcan
$ Opioid receptor antagonist. Narcan® is a brand name for
naloxone that is no longer used. See naloxone for opioid overdose or reversal of narcosis.
Nefopam $ Centrally acting non- opioid analgesic. Dose 30– 60mg/
8h PO (max 90mg/ 8h PO)
orders
Caution Pregnancy, breastfeeding, hepatic or renal impairment,
elderly, urinary retention
Indication Moderate painCI Convulsive dis-
SE N+V, nervousness, urinary retention, dry
mouth, lightheadedness, may colour urinepink.
Nicorandil $ Potassium channel activator. Dose5– 0mg/ 2h PO (max
30mg/ 2h in divided doses)
ment (not st line)
pressures
MI
Caution Pregnancy, hypovolaemia, acute pulmonary oedema,
SE Headache, ushing, GI disturbance.
CI Breastfeeding, hypotension, LVF with low lling
Indication Angina prophylaxis and treat-
NifedipineSee calcium- channel blockers.
Nitrofurantoin $ Antibiotic. Dose50– 00mg/ 6h PO; take with food
Indication Urinary tract infectionsCI Pregnancy, breastfeeding, renal im-
pairment, G6PD deciency, infants <3mth, acute porphyria
Hepatic impairment, anaemia, DM, electrolyte imbalance, vitamin B
folate deciency, lung disease
SE Anorexia, GI disturbance, acute and
chronic pulmonary reactions.
Nurofen
®
$ NSAID. See ibuprofen.
Caution
2
/
Nystatin $ Polyene antifungal. Dose00,000 units (mL)/ 6h PO; top-
ical gel PRN
imal
IndicationCandidiasis; oral, skinCautionGI absorbance min-
SEGI disturbance (at high doses), oral irritation,rash.
Omeprazole $ Proton pump inhibitor. Dose 0– 40mg/ 24h PO; IV
preparation available for endoscopically proven bleeding ulcers (consult
BNF/ local guidelines)
cers, GORD, H.pylori eradication
than 20mg/ 24h), can mask gastric cancer
dizziness
Interaction Reduces eectiveness of clopidogrel.
OndansetronSee antiemetics (5HT
Indication Prophylaxis and treatment of peptic ul-
Caution Hepatic impairment (no more
SEGI disturbance, headache,
receptor antagonist).
3
Oral morphine $ Opioid. Dose Oral solution 5– 20mg/ 4h PO; Tab-
lets 5– 20mg/ 4h PO; 2h slow release preparations 0– 30mg/ 2h PO,
adjust to response (larger dose tablets available; seek senior/ specialist
advice)
IndicationSevere pain, chronic painCI Acute respiratory depres-
sion, paralytic ileus, raised ICP/ head trauma, comatose patients, phaeochromocytoma
arrhythmias, renal impairment, hepatic impairment
tion, respiratory depression, dry mouth
CautionPregnancy (especially delivery), COPD, asthma,
SE N+V, constipa-
Info Co- prescribe laxatives if
using opioids for>24h.
Oramorph
®
$ Opioid. See oral morphine.
Oseltamivir (Tamiu®) $ Antiviral. Dose Treatment of inu-
enza75mg/ 2h PO for5d; Prevention ofinuenza75mg/ 24h PO for0d
Indication Treatment of inuenza if started within 48h of the onset of
symptoms, post- exposure prophylaxis of inuenza
Caution Renal im-
pairment, pregnancy and breastfeeding (use only if potential benet
outweighs risk (eg during a pandemic))
SE GI disturbances, headache,
arrhythmias, convulsions, thrombocytopenia.
Oxybutynin $ Antimuscarinic. Dose 5mg/ 8– 2h PO, increase if re-
quired (max 20mg/ 24h in divided doses); modied- release preparations
also available
incontinence
myasthenia gravis
plasia, autonomic neuropathy
IndicationDetrusor instability; urinary frequency, urgency and
CIPregnancy, breastfeeding, bladder outow/ GI obstruction,
Caution Hepatic or renal impairment, prostatic hyper-
SE Antimuscarinic eects, GI disturbance.
Oxycodone $ Opioid. Dose5mg/ 4– 6h PO (max 400mg/ 24h); – 0mg/
4h IV/ SC titrated to eect
IndicationPain; moderate to severe CI Acute re-
spiratory depression, paralytic ileus, chronic constipation, acute abdomen,
raised ICP/ head trauma, hepatic or renal impairment if severe, acute
porphyria, cor pulmonale, comatose patients
asthma, arrhythmias, renal impairment, hepatic impairment
stipation, respiratory depression, dry mouth
Caution Pregnancy, COPD,
SE N+V, con-
Info 0mg PO oxycodone is
equivalent to 20mg PO morphine. mg IV oxycodone is equivalent to 2mg
PO oxycodone.
OxyContin
OxyNorm
InfoCo- prescribe laxatives if using opioids for>24h.
®
$ Opioid. Modied-release form of oxycodone.
®
$ Opioid. Immediate-acting form of oxycodone.
209PHARMACOPOEIA
210 CHAPTER 5 Pharmacopoeia
Oxytetracycline $ Tetracycline antibiotic. Dose 250– 500mg/ 6h PO
Indication Acne vulgaris, rosaceaCIPregnancy, breastfeeding, renal impairment,
age <2yr (irreversibly stains growing teeth and bones)
gravis may worsen, exacerbates SLE
oesophageal irritation
Interaction Decreased absorption with dairy products,
SEGI disturbance including, dysphagia/
Caution Myasthenia
decreases eects of oral contraceptive pill, mildly increases eects of warfarin.
Pabrinex
®
See thiamine.
Pantoprazole $ Proton pump inhibitor. Dose 20– 80mg/ 24h PO; IV
preparation available for endoscopically proven bleeding ulcers (consult BNF/ local guidelines)
ulcers, GORD, H. pylori eradication
IndicationProphylaxis and treatment of peptic
Caution Hepatic impairment (max
20mg/ 24h), renal impairment (max oral dose 40mg/ 24h), can mask
gastric cancer
SE GI disturbance, headache, dizziness Interaction Proton
pump inhibitors may reduce eectiveness of clopidogrel.
Paracetamol $ Simple analgesic. Dose 0.5– g/ 4– 6h PO/ IV (max
4g/ 24h in divided doses)
exia
Caution Alcohol dependence, hepatic impairment SE Rare; rash, hypo-
glycaemia, blood disorders, hepatic impairment
Indication Pain; mild to moderate, pyr-
InteractionProlonged use
can potentiate warfarin.
Paroxetine $ Selective serotonin re- uptake inhibitor. Dose20– 40mg/ 24h
PO (max 50– 60/ 24h)
disorder, panic disorder, post- traumatic stress disorder
epilepsy, cardiac disease, DM
+
dNa
, agitation; increased incidence of antimuscarinic, extrapyramidal, and
Indication Major depression, obsessive– compulsive
Caution Pregnancy,
SE GI disturbance, anorexia, weight loss,
withdrawal eects compared with uoxetine.
Penicillin G $ Beta- lactam. See benzylpenicillin.
Penicillin V $ Beta- lactam. See phenoxymethylpenicillin.
Pentasa
®
$ Aminosalicylate. See mesalazine.
Peppermint oil $ Antispasmodic. Dose – 2 capsules/ 8h PO be-
fore meals
CautionSensitivity to mentholSE Heartburn, perianal irritation.
Indication Abdominal colic and distension especially in IBS
PerindoprilSeeACEi.
Pethidine $ Opioid. Dose 25– 00mg/ 4h SC/ IM; 25– 50mg/ 4h slow
IV
Indication Pain; moderate to severe, obstetric, post- opCI Acute re-
spiratory depression, paralytic ileus, raised ICP/ head trauma, comatose
patients
CautionPregnancy (especially delivery), COPD, asthma, arrhyth-
mias, renal impairment, hepatic impairment
SE N+V, less constipation
than morphine, respiratory depression, drymouth.
Phenobarbital $ Barbiturate. Dose Epilepsy (not st line)60– 80mg/
24h PO atnight;
g) IV (see BNF)
breastfeeding, hepatic impairment
phyria
SE Respiratory depression, hypotension, sedation.
Monitoring
phenobarbital
Status epilepticus 0mg/ kg at max 00mg/ min (max
Indication Epilepsy, status epilepticus CI Pregnancy,
Trough 60– 80micromol/ L (5– 40mg/ L)
2
Toxic >80micromol/ L (>40mg/ L)
Caution Renal impairment, acute por-
Phenoxymethylpenicillin (penicillin V) $ Beta- lactam. Dose
0.5– g/ 6h PO
CIPenicillin allergyCaution History of allergySEdiarrhoea InteractionDecrease
Indication Oral infections, post- splenectomy (prophylaxis)
eects of oral contraceptive pill, allopurinol increases risk ofrash.
Phenytoin $ Antiepileptic. Dose Epilepsy 3– 4mg/ kg/ 24h PO increased
gradually as necessary;
Status epilepticus loading dose = 20mg/ kg IV at
no more than 50mg/ min with ECG monitoring, maintenance = 00mg/
6– 8h thereafter IV (see BNF); monitor level (see ‘Monitoring phenytoin’)
Indication Epilepsy, status epilepticusCIPregnancy, breastfeeding, sinus hypo-
tension
Caution Hepatic impairment, avoid abrupt withdrawal, acute por-
phyria; monitor blood count
arrhythmias, purple glove syndrome, blood disorders;
facies, hirsutism, gum hypertrophy
SEDrowsiness, cerebellar eects, hypotension,
Chronic use coarse
Info As drug highly protein bound, may
need to adjust monitored levels for low albumin (consult pharmacist).
Monitoring
phenytoin
Trough 40– 80micromol/ L (0– 20mg/ L)
2
Toxic >80micromol/ L (>20mg/ L)
2
Signs of toxicity Ataxia, nystagmus, dysarthria, diplopia
Phosphate enemaSee laxatives.
Phytomenadione $ VitaminK
upon indication— consult BNF and/ or d/ w haematologist
and/ or over- anticoagulation with warfarin
®
Picolax
See laxatives.
. Dose– 0mg/ STAT PO/ IV depending
Caution Pregnancy, give IV slowly.
Indication Bleeding
Piperacillin with tazobactam $ Beta- lactam with tazobactam. Dose
4.5g/ 6– 8h IV
(in combination with aminoglycoside)
breastfeeding, renal impairment, history of penicillin allergy
Piriton
Plavix
Indication Severe infection, infection in neutropenic patients
®
$ Antihistamine (H antagonist). See chlorphenamine.
®
$ Antiplatelet. See clopidogrel.
CIPenicillin allergy CautionPregnancy,
SEDiarrhoea.
Potassium oral supplement $ Potassium salt. Dose Potassium
chloride:2– 4g/ 24h PO (two tablets/ 8– 2h)
Serum potassium >5mmol/ L
tinal strictures, history of peptic ulcer
ation
InfoCheck serum Mg
Caution Renal impairment, elderly, intes-
2+
as this is also likely to be low indK+.
Indication Potassium loss CI
SEGI disturbance, upper GI ulcer-
Pravastatin $ HMG CoA reductase inhibitor. See statin.
Prednisolone $ Corticosteroid. Dose Initially 0– 20mg/ 24h mane
PO though often 30– 40mg/ 24 PO in severe disease (up to 60mg/
24h);
Maintenance 2.5– 5mg/ 24h PO Indication Suppression of inam-
matory and allergic disorders (eg IBD, asthma, COPD), immunosuppression
CI Systemic infection without antibiotic coverCaution Adrenal
suppression
porosis
SE Peptic ulceration, Cushing’s syndrome, DM, osteo-
Interaction Duration of action decreased by rifampicin, carba-
mazepine, phenytoin; duration of action increased by erythromycin,
ketoconazole, ciclosporin
Info Consider bone and GI protection strat-
egies when using long- term corticosteroids; E p. 75. Beware risk of
adrenal suppression (especially if taking >5mg/24h for >4wk).
211PHARMACOPOEIA
212 CHAPTER 5 Pharmacopoeia
Pregabalin $ Antiepileptic. Dose Epilepsy 25mg/ 2h PO increased
every 7d by 50mg to 00– 50mg/ 8– 2h (max 600mg/ 24h in divided
doses);
Pain/ anxiety75mg/ 2h increased every 3– 7d up to max 600mg/
24h in divided doses
anxiety disorder
severe congestive heart failure, avoid abrupt withdrawal
Indication Epilepsy, neuropathic pain, generalized
CI Pregnancy, breastfeeding Caution Renal impairment,
SE GI disturb-
ance, dry mouth, dizziness, drowsiness.
Prochlorperazine $ Phenothiazine. See antiemetics.
Procyclidine $ Anticholinergic. Dose 2.5mg/ 8h PO increased every
3d up to max 30mg/ 24h in divided doses;
IV
Indication Parkinsonism; drug- induced extrapyramidal symptoms
CI Urinary retention, glaucoma, myasthenia gravis Caution Pregnancy,
Acute dystonia 5– 0mg IM/
breastfeeding, hepatic or renal impairment, cardiovascular disease, prostatic hyperplasia, tardive dyskinesia
SE Antimuscarinic eects.
PropranololSee beta- blockers.
Protamine $ Heparin antagonist. Dose mg IV neutralizes 80– 00units
heparin IV in last 5min (max 50mg at rate <5mg/ min); mg IV neutralizes
00units heparin SC (max 50mg at rate <5mg/ min)
bleeding in patient on heparin therapy
vasectomy, or in infertile men, sh allergy
tension, dyspnoea
InfoProtamine can also be used to help reverse the eects
Caution Risk of allergy increased post-
SEGI disturbance, ushing, hypo-
Indication Heparin OD,
of LMWH but it is much less eective at this than for heparin.
®
Prozac
Pulmicort
$ Selective serotonin re- uptake inhibitor. See uoxetine.
®
$ Corticosteroid. See budesonide.
Quinine $ Plant alkaloid. Dose Nocturnal leg cramps 200– 300mg/ 24h
(nocte) PO;
treatment and prophylaxis of malaria
optic neuritis, tinnitus
Treatment of malaria See BNF Indication Nocturnal leg cramps,
CI Haemoglobinuria, myasthenia gravis,
CautionPregnancy (teratogenic in st trimester), breast-
feeding, hepatic or renal impairment, cardiac disease (AF, conduction defects,
heart block), elderly, G6PD deciency
SECinchonism (tinnitus, headache, hot
and ushed skin, nausea, abdominal pain, rashes, visual disturbances (including
temporary blindness), confusion), acute kidney injury, photosensitivity.
RamiprilSeeACEi.
Ranitidine $ Antihistamine (H
preparation available (see BNF)
antagonist). Dose50mg/ 2h PO; IV
2
Indication Peptic ulcers, GORD Caution
Pregnancy, breastfeeding, renal impairment, acute porphyria, may mask
symptoms of gastric cancer
SEGI upset, confusion, fatigue.
Reteplase $ Plasminogen activator. See brinolytic.
Rifampicin $ Antibiotic. Dose Tuberculosis consult BNF; Meningitis
prophylaxis
2h IV (usually after microbiology advice)
600mg/ 2h PO for 2d; Other serious infections 600mg/
Indication Tuberculosis,
N. meningitidis/ H. inuenzae meningitis prophylaxis, serious staphylococcal
infections
cohol dependence, acute porphyria
siness, hepatotoxicity, turns body secretions orange
CIJaundiceCautionPregnancy, hepatic or renal impairment, al-
SEGI disturbance, headache, drow-
Interaction Induces
P450, decreases eects of warfarin.