Drug dosing/Dose Conversions

Apixaban

5 mg BID

AFib dosing adjustment —> 2.5 mg BID

• if ≥ 2:

  • ≥ 80 years old

  • ≤ 60 kg

  • SCr ≥ 1.5

KCl Solution (PO) —> Tablets

KCL 10% = 20 mEq/15 mL

Calcium Salts

Calcium carbonate = 40% elemental calcium

Calcium citrate = 21% elemental calcium

Aminophylline ←→ Theophylline

Aminophylline —> Theophylline: Multiply by 0.8 (ATM)

Theophylline —> Aminophylline: Divide by 0.8

Statin Equivalents

Pitavastatin 2 mg

Rosuvastatin 5 mg

Atorvastatin 10 mg

Simvastatin 20 mg

Lovastatin 40 mg

Pravastatin 40 mg

Fluvastatin 80 mg

Metoprolol IV: PO ratio

Metoprolol tartrate IV: PO = 1:2.5

Tartrate —> succinate (TDD must be the same)

Furosemide IV:PO ratio

1:2

Loop diuretic equivalent conversions

Furosemide 40 mg = Torsemide 20 mg = Bumetanide 1 mg = Ethacrynic acid 50 mg

Insulin Conversions

Most = 1:1

Exceptions (2):

• NPH BID —> glargine QD: 80% NPH dose

• Toujeo —> other glargine forms: 80% Toujeo dose

Levothyroxine IV:PO ratio

0.75:1

Steroid Equivalents

Cortisone 25 mg

Hydrocortisone 20 mg

Prednisone 5 mg

Prednisolone 5 mg

Methylprednisolone 4 mg

Triamcinolone 4 mg

Dexamethasone 0.75 mg

Betamethasone 0.6 mg

Lithium Conversions

5 mL lithium citrate syrup = 300 mg lithium carbonate = 8 mEq Li+ ion

Warfarin Colors/Dose strengths

Pink (1 mg)

Lavender (2 mg)

Green (2.5 mg)

Brown/Tan (3 mg)

Blue (4 mg)

Peach (5 mg)

Teal (6 mg)

Yellow (7.5 mg)

White (10 mg)

Levothyroxine Strengths & Tablet colors (12)

25 mg = orange

50 mg = white

75 mg = violet

88 mg = olive

100 mg = yellow

112 mg = rose

125 mg = brown

137 mg = turquoise

150 mg = blue

175 mg = lilac

200 mg = pink

300 mg = green

Elemental % of dietary supplements

Calcium:

• Carbonate: 1g = 400 mg elemental Ca²⁺ (40%)

  • acid-dependent absorption (+food)

• Citrate: 1g = 210 mg elemental Ca²⁺ (21%)

Ferrous sulfate 325 mg = 65 mg elemental iron (20%)

Loperamide (Immodium)

4 mg PO after the first loose stool —> 2 mg after each subsequent loose stool

MAX:

• 8 mg/day (OTC)

• 16 mg/day (Rx)

Cochicine (Colcrys)

Tx: 1.2 mg PO (0.6 mg x 2 tabs) —> 0.6 mg in 1 hour

• Total dose on day 1 = 1.8 mg

PDE-5 (-) Starting Doses

Sildenafil: 50 mg (tk ~ 1 hr before IC)

• Viagra - ED

• Revatio - PAH

Tadalafil: 10 mg (tk ~ 30 min before IC)

• Cialis - ED & BPH

• Adcirca - PAH

Vardenafil: 10 mg (tk ~ 1 hr before IC)

Avanafil: 100 mg (tk ~ 15-30 min before IC)

Reduce dose by 50% if:

• ≥ 65 years old

• concurrent alpha-blocker

• concurrent CYP3A4 inhibitor

• severe renal/liver disease

Therapeutic Drug Levels

• Antiseizure Medications (3)

• Lithium (BPD)

• Theophylline (Asthma)

Valproate Acid: 50 - 100 mcg/mL (total level)

Phenytoin:

• 10 - 20 mcg/mL

• free level: 1-2 mcg/mL

Carbamazepine: 4-12 mcg/mL

Lithium: 0.6-1.2 mEq/L (trough level)

Theophylline: 5-15 mcg/mL (peak at steady state)

Potencies of Topical Steroids

Very High Potency:

Clobetasol propionate 0.05% (lotion/shampoo/spray (clobex); cream/ointment; foam (olux); gel)

Fluocinonide 0.1% Cream (Vanos)

betamethasone dipropionate 0.05% ointment/gel/lotion

halobetasol propionate 0.05%

High Potency:

Betamethasone diproprionate 0.05% cream

Fluocinonide 0.05% Ointment

Mometasone furoate 0.1% ointment

High-Medium Potency:

Fluocinonide 0.05% Cream

Medium Potency:

Mometasone furoate 0.1% Lotion

Triamcinolone acetonide 0.1% Cream/Spray

• 0.025%

Lower Potency: (see p. 622 but not bolded)

Mild Potency: (see p. 622 but not bolded)

Lowest Potency:

Hydrocortisone Cream - 0.05%, 1% (cortizone-10), 2.5%; lotion & ointments