ACE INHIBITORS

Enalapril (Vasotec ):
Dosing (Adults) [Use lower listed initial dose in patients with hyponatremia, hypovolemia, severe congestive heart failure, decreased renal function, or in those receiving diuretics.] Hypertension: Start (Oral): 2.5-5 mg/day then increase as required, usually at 1- to 2-week intervals; usual dose range (JNC 7): 2.5-40 mg/day in 1-2 divided doses. Note: Initiate with 2.5 mg if patient is taking a diuretic which cannot be discontinued. May add a diuretic if blood pressure cannot be controlled with enalapril alone. I.V. (Start): 1.25 mg/dose, given over 5 minutes every 6 hours; doses as high as 5 mg/dose every 6 hours have been tolerated for up to 36 hours. Note: If patients are concomitantly receiving diuretic therapy, begin with 0.625 mg I.V. over 5 minutes; if the effect is not adequate after 1 hour, repeat the dose and administer 1.25 mg at 6-hour intervals thereafter; if adequate, administer 0.625 mg I.V. every 6 hours.

Asymptomatic left ventricular dysfunction: Oral: 2.5 mg twice daily, titrated as tolerated to 20 mg/day Heart failure: Oral: Initial: 2.5 mg once or twice daily (usual range: 5-40 mg/day in 2 divided doses). Titrate slowly at 1- to 2-week intervals. Target dose: 10-20 mg twice daily (ACC/AHA 2005 Heart Failure Guidelines). Renal Dosing: Hypertension: CrCl 30-80 mL/minute: Oral: Administer 5 mg/day titrated upwards to maximum of 40 mg. CrCl <30 mL/minute: Oral: Administer 2.5 mg day titrated upward until blood pressure is controlled up to a maximum of 40 mg. For heart failure patients with sodium <130 mEq/L or serum creatinine >1.6 mg/dL, initiate dosage with 2.5 mg/day, increasing to twice daily as needed; increase further in increments of 2.5 mg/dose at >4-day intervals to a maximum daily dose of 40 mg. I.V.: CrCl >30 mL/minute: Initiate with 1.25 mg every 6 hours and increase dose based on response. CrCl <30 mL/minute: Initiate with 0.625 mg every 6 hours and increase dose based on response. Supplied: [2.5 mg, 5 mg, 10 mg, 20 mg tablets. Injection (soln): 1.25

mg/mL (1 mL, 2 mL)].

Captopril (Capoten ):
Dosing (Adults) Hypertension: Start: 12.5 to 25 mg 2-3 times/day; may increase by 12.5 to 25 mg/dose at 1- to 2-week intervals up to 50 mg 3 times/day. Maximum: 150 mg 3 times/day. Add diuretic before further dosage increases. CHF: Start 6.25 to 12.5 mg three times daily. Initial dose depends upon patient's fluid/electrolyte status. Target: 50 mg 3 times/day. Prevention of LV dysfunction following MI: Oral: Initial: 6.25 mg; followed by 12.5 mg 3 times/day; increase to 25 mg 3 times/day over the next few days; following by gradual increase to a goal of 50 mg tid. Acute hypertension (urgency/emergency): Oral: 12.5 to 25 mg, may repeat as needed (may be given sublingually, but no therapeutic advantage demonstrated) Maximum: 450 mg/day. Renal Dosing: CrCl 10-50 mL/minute: Administer 75% of normal dose. CrCl <10 mL/minute: Administer 50% of normal dose. Supplied: [12.5 mg, 25 mg, 50 mg, 100 mg tablets]

Actinic keratosis (topical therapy)

Actinic keratoses (AKs) are premalignant lesions that develop only on sundamaged skin.

declofenac (Solaraze )
Apply to lesion areas twice daily (smoothed onto the affected skin gently). Recommended duration of therapy: 60 days to 90 days. Complete healing of the lesion(s) or optimal therapeutic effect may not be evident for up to 30 days following cessation of therapy. Lesions that do not respond to therapy should be carefully re-evaluated and management reconsidered. Appears to be significantly better tolerated than twice daily application of 5-FU, although it may be somewhat less effective.

[Supplied: Gel: 25 and 50 gram tubes. Each gram of gel contains 30 mg of diclofenac sodium.]

fluorouracil (Efudex ):
Superficial basal cell carcinomas: apply 5% cream/solution twice daily. Actinic keratoses: Carac: Apply thin film to lesions once daily for up to 4 weeks, as tolerated. Efudex: Apply to lesions twice daily for 2-4 weeks; complete healing may not be evident for 1-2 months following treatment. Fluoroplex: Apply to lesions twice daily for 2-6 weeks Supplied: Cream, topical: Carac: 0.5% (30 g). Efudex: 5% (25 g, 40 g). Fluoroplex: 1% (30 g).

Alpha-1 Adrenergic Blockers Mechanism of action

prazosin (Minipress ) Mechanism of Action Prazosin causes a decrease in total peripheral resistance and was originally thought to have a direct relaxant action on vascular smooth muscle. Recent animal studies, however, have suggested that the vasodilator effect of prazosin is also related to blockade of postsynaptic alpha-adrenoceptors. Oral: Adults: Hypertension: Initial: 1 mg/dose 2-3 times/day; usual maintenance dose: 3-15 mg/day in divided doses 2-4 times/day; maximum daily dose: 20 mg Hypertensive urgency: 10-20 mg once, may repeat in 30 minutes Raynaud's (unlabeled use): 0.5-3 mg twice daily [Supplied: 1, 2, 5mg capsules]

doxazosin (Cardura )
Mechanism of Action The mechanism of action of CARDURA (doxazosin mesylate) is selective blockade of the alpha1 (postjunctional) subtype of adrenergic receptors. Studies in normal human subjects have shown that doxazosin competitively antagonized the pressor effects of phenylephrine (an alpha1 agonist) and the systolic pressor effect of norepinephrine. Doxazosin and prazosin have similar abilities to antagonize phenylephrine. Oral: Adults: 1 mg once daily in morning or evening; may be increased to 2 mg once daily. Thereafter titrate upwards, if needed, over several weeks, balancing therapeutic benefit with doxazosin-induced postural hypotension Hypertension: Maximum dose: 16 mg/day BPH: Goal: 4-8 mg/day; maximum dose: 8 mg/day Elderly: Initial: 0.5 mg once daily [Supplied 1 mg, 2 mg, 4 mg, 8 mg tablets]

Aminoglycosides
Streptomycin
Dosing (Adults): Usual dose: 15 mg/kg (or 1 g) IM every 12 hours. Renal Dosing: CRCL 10-50 mL/minute: Administer every 24-72 hours. CRCL <10 mL/minute: Administer every 72-96 hours. Supplied: Injection, powder for reconstitution: 1 g

Neomycin
INDICATIONS Orally to prepare GI tract for surgery; topically to treat minor skin infections; treatment of diarrhea caused by E. coli ; adjunct in the treatment of hepatic encephalopathy; bladder irrigation

Dosage Children: Oral: Preoperative intestinal antisepsis: 90 mg/kg/day divided every 4 hours for 2 days; or 25 mg/kg at 1 PM, 2 PM, and 11 PM on the day preceding surgery as an adjunct to mechanical cleansing of the intestine and in combination with erythromycin base Hepatic encephalopathy: 50-100 mg/kg/day in divided doses every 6-8 hours or 2.5-7 g/m 2 /day divided every 4-6 hours for 5-6 days not to exceed 12 g/day Children and Adults: Topical: Topical solutions containing 0.1% to 1% neomycin have been used for irrigation =================== Adults: Oral: Preoperative intestinal antisepsis: 1 g each hour for 4 doses then 1 g every 4 hours for 5 doses; or 1 g at 1 PM, 2 PM, and 11 PM on day preceding surgery as an adjunct to mechanical cleansing of the bowel and oral erythromycin; or 6 g/day divided every 4 hours for 2-3 days Hepatic encephalopathy: 500-2000 mg every 6-8 hours or 4-12 g/day divided every 4-6 hours for 5-6 days Chronic hepatic insufficiency: 4 g/day for an indefinite period =================== Supplied Powder, micronized, as sulfate [for prescription compounding] (Neo-Rx): (10 g, 100 g) Solution, oral, as sulfate (Neo-Fradin): 125 mg/5 mL (60 mL, 480 mL) [contains benzoic acid; cherry flavor] Tablet, as sulfate: 500 mg

Antacids
Aluminum hydroxide ( AlternaGel)
Dosing (Adults): Hyperphosphatemia: Oral: Initial: 300-600 mg 3 times/day with meals. Hyperacidity: Oral: 600-1200 mg between meals and at bedtime. Renal Dosing: Aluminum may accumulate in renal impairment.

Supplied: Oral Suspension: 320 mg/5 mL (473 mL). AlternaGel: 600 mg/5 mL (360 mL).

Maalox Maximum Strength Chewable Tablets:

Supplied (in each tablet): Calcium carbonate 1000 mg (equivalent to 400 mg calcium) Simethicone 60 mg Antigas USES: For the relief of acid indigestion, heartburn, sour stomach, upset stomach associated with these symptoms, and bloating and pressure commonly referred to as gas. DIRECTIONS Chew 1 to 2 tablets as symptoms occur or as directed by a physician. Do not take more than 8 tablets in a 24-hour period or use the maximum dosage for more than 2 weeks except under the advice and supervision of a physician.

General Administration Guidelines

Anticholinergic agents

Gastrointestinal antispasmotic agents: Urinary antispasmotic agents: Dicyclomine(Bentyl ):

Atropine, Dicyclomine, Glycopyrrolate, Hyoscyamine, Donnatal, Propantheline. Flavoxate, Oxybutynin , Propantheline ,Tolterodine Indications: Treatment of functional disturbances of GI motility such as irritable bowel syndrome. Onset: 12hrs. Duration: up to 4 hours. Dosing: 20mg orally or intramuscularly every 6 hours (up to 40 mg every 6 hours). Do not give IV. [Hyoscyamine 0.1037mg + atropine 0.019mg +scopolamine 0.007mg + phenobarbital 16.2mg]Indications: Adjunct in the treatment of PUD, irritable bowel, spastic colitis, spastic bladder, and renal colic. Dosing: 1-2 capsules or tablets three to four times daily or 1 extentab orally every 12

Donnatal :

hours; or 5-10 ml of elixir three to four times daily. Flavoxate(Urispas ): Indications: Antispasmotic used to provide symptomatic relief of dysuria, nocturia, supra-pubic pain, urgency, and incontinence. Especially useful for treatment of bladder spasticity. Onset: 55-60 min. Dosing: 100-200mg orally three to four times daily.

Glycopyrrolate(Robinul Indications: Adjunct in the treatment of PUD; inhibits ): salivation and excessive secretions of the respiratory tract preoperatively; reversal of neuromuscular blockade; control of upper airway secretions. Onset: Oral: with in 50 min; IM: 20-40min ; IV: 10-15min. Dosing: Intraoperative: IV: 0.1 mg q2-3min as needed; Peptic ulcer: Oral: 1-2mg 2 to 3 times daily. Decrease secretions: 0.1 to 0.2 mg 3 to 4 times daily IM/IV or 1 mg orally 2 to 3 times a day. Hyoscyamine(Levsin ): Belladonna alkaloid. Indications: Adjunctive therapy of gastrointestinal disorders caused by spasm; treatment of urinary hypermotility as well as bladder spasm. Onset: 2-3 min. Duration: 4-6hrs. Dosing: Oral or S.L. : 0.125 to 0.25 mg (1-2 tabs) three to four times daily before meals. Levsinex : 0.375 to 0.75 mg (1-2 caps) orally every 12 hours. IV, IM, SC: 0.25-0.5 mg every 6 hours. Ditropan Indications: (Overactive bladder) Antispasmotic for neurogenic bladder (urgency, frequency, urge incontinence) and uninhibited bladder. Onset: 30-60min. Peak effect: 3-6 hours. Duration: 6-10 hrs. Dosing: 5 mg orally 2 to 3 times daily (up to 4 times a day--maximum). [Supplied: 5 mg tablet and syrup: 5 mg/5 ml] Ditropan XL : 5 to 10 mg orally once daily. May increase dose if needed by 5 mg increments at weekly intervals to a maximum dose of 30mg per day. [Supplied: 5 mg, 10mg , 15mg tablets] Oxytrol : Transdermal Patch (3.9 mg/day). Apply patch twice weekly (every 3 to 4 days). Use a new application site for each new patch. Propantheline(ProBanthine ): Indications: Adjunctive therapy of peptic ulcer, irritable bowel syndrome, pancreatitis, ureteral and urinary bladder spasm; reduce duodenal motility during radiologic procedures. Onset: 30-45min. Duration: 4-6hrs. Dosing: 15mg orally 3 times a day before meals and 30mg Supplied: [7.5mg, 15mg tab] at bedtime.

Oxybutynin(Ditropan ):

Tolterodine(Detrol ): Selective anticholinergic agent (increased selectivity for urinary bladder) Indications: Therapy of urinary frequency; urgency; urge incontinence. Reduces bladder

spasm. Onset: 1 hr. Dosing: 2 mg orally twice a day, decreasing to 1 mg twice a day in the event of bothersome anticholinergic effects. Extented release tablets: 4 mg once daily. May decrease dose to 2 mg once daily if there are bothersome anticholinergic effects. Supplied: [1 mg, 2 mg tablets. Extended release capsules: 2mg, 4 mg.]

Anti- Diarrheals:
Loperamide ( Imodium ):
Adults: DOSING: [2 mg capsule /tablet] Acute diarrhea: Oral: Initial: 4 mg, followed by 2 mg after each loose stool, up to 16 mg/day Chronic diarrhea: Oral: Initial: Follow acute diarrhea; maintenance dose should be slowly titrated downward to minimum required to control symptoms (typically, 4-8 mg/day in divided doses) Traveler's diarrhea: Oral: Initial: 4 mg after first loose stool, followed by 2 mg after each subsequent stool (maximum dose: 8 mg/day)

Lomotil (dephenoxylate + atropine):

Adults: DOSING: Diarrhea: Oral: The initial oral dose of diphenoxylate is 2 tablets (5 mg) or (10 ml) 4 times daily. Most patients will require this dosage until control has been attained, after which the dose may be adjusted according to the individual response. Control may be maintained with 2 tablets or 10 mL daily Diphenoxylate: Onset of action: Antidiarrheal: 45-60 minutes Peak effect: Antidiarrheal: ~2 hours Duration: Antidiarrheal: 3-4 hours. Half-life: 2.5 hours. If there is no response with 48 hours, the drug is unlikely to be effective and should be discontinued; if chronic diarrhea is not improved symptomatically within 10 days at maximum dosage of 20 mg/day, control is unlikely with further use. Supplied Solution, oral: Diphenoxylate hydrochloride 2.5 mg and atropine sulfate 0.025 mg per 5 mL. Tablet (Lomotil, Lonox): Diphenoxylate hydrochloride 2.5 mg and atropine sulfate 0.025 mg.