Hospital IPPE #1 exam

Alteplase (Activase)

Indication: Acute ischemic stroke, MI, pulmonary embolism

Class: Thrombolytic

Safety/warning 1: Intracranial hemorrhage, Subarachnoid hemorrhage, internal bleeding

Safety/warning 2: Stroke w/in 3 months, serious head trauma w/in 3 months, current severe uncontrolled HTN

DOSE: Acute ischemic stroke = 0.9 mg/kg, do not exceed 90 mg, 10% of total dose administered IV bolus over 1 min, infusion of the remainder total dose over 60 mins

High alert

Amiodarone (Cordarone)

Indication: Heart rhythm disorders (ventricular tachycardia or fibrillation)

Class: antiarrhythmic

Safety/warning 1: Pulmonary toxicity (pneumonitis), hepatotoxicity, heart block

Safety/warning 2: Thyrotoxicosis, optic neuropathy/neuritis

High alert in IV

Apixaban (Eliquis)

Indication: Thromboembolism treatment and prevention, stroke prevention

Class: anticoagulant - factor Xa inhibitor

Safety/warning 1: Thrombotic events after premature discontinuation

Safety/warning 2: Bleeding

DOSE:

VTE treatment = 10 mg PO BID x 7d, then 5 mg BID

VTE prevention = 2.5 mg PO BID

Stroke prevention in nonvalvular afib = 5 mg PO BID

High alert

Atropine (Atropen)

Indication: Bradycardia (advanced cardiac life support)

Class: Muscarinic antagonist

Safety/warning 1: Narrow angle glaucoma

Safety/warning 2: Myasthenia gravis

Bumetanide (bumex)

Indication: Edema

Class: Diuretic - loop

Safety/warning 1: Hypokalemia

Safety/warning 2: Profound diuresis, electrolyte loss, dehydration and acute renal failure w/ excessive amount

Clopidogrel (plavix)

Indication: Acute coronary syndrome, MI, Stroke prevention

Class: Antiplatelet

Safety/warning 1: Diminished antiplatelet activity in pt who are CYP2C19

Dabigatran (pradaxa)

Indication: Thromboembolism treatment and prevention, stroke prevention

Class: Anticoagulant - direct thrombin inhibitor

Safety/warning 1: Thrombotic events after premature discontinuation

Safety/warning 2: Bleeding

High alert

Digoxin (Lanoxin IV) (Digitek PO)

Indication: HF (inotrope), atrial fibrillation (rate controller)

Class: Cardiac Glycoside

Safety/warning 1: Sinus bradycardia

High alert

Diltiazem (Cardizem) (tiazac)

Indication: Atrial fibrillation (rate controller), angina, HTN

Class: CCB

Safety/warning 1: Bradycardia (HR <45 bpm), 2nd or 3rd degree heart block

Safety/warning 2: Severe hypotension

Dobutamine (dobutrex)

Indication: cardiac decompensation

Class: Inotrope - beta-adrenergic agonist

Safety/warning 1: Idiopathic hypertrophic subaortic stenosis

High alert

Dopamine (dopastat) (intropin)

Indication: Cardiovascular shock

Class: Inotrope - sympathomimetic amine

Safety/warning 1: Pheochromocytoma

Safety/warning 2: Vfib

High alert

Enoxaparin (lovenox)

Indication: Thromboembolism treatment and prevention, MI

Class: Low molecular weight heparin

Safety/warning 1: Thrombocytopenia or active bleeding

Safety/warning 2: Bleeding

DOSE:

Treatment = 1 mg/kg SQ Q12H or 1.5 mg/kg SQ daily

Prophylaxis = 30 mg SQ Q12 or 40 mg SQ daily

Renal dose adjustment, treatment = 1 mg/kg SQ daily

Prophylaxis = 30 mg SQ daily

High alert

Furosemide (lasix)

Indication: Edema

Class: Loop diuretic

Safety/warning 1: Hypokalemia

Safety/warning 2: Profound diuresis, electrolyte loss, dehydration and acute renal failure with excessive amounts

DOSE: 20-80 mg/dose for edema, 40 mg BID HTN

Heparin

Indication: Thromboembolism treatment and prevention, MI

Class: Anticoagulant

Safety/warning 1: Thrombocytopenia or active bleeding

Safety/warning 2: Bleeding

High alert

Hydralazine (apresoline)

Indication: HTN, HF

Class: Vasodilator

Labetalol (trandate)

Indication: HTN

Class: Beta adrenergic blocker (non-cardioselective) and alpha-1 adrenergic blocker

High alert

Metoprolol (Lopressor (tartrate)) (Toprol (succinate))

Indication: MI, HTN, angina, HF

Class: Beta adrenergic blocker

Safety/warning 1: Bradycardia (HR <45), 2nd or 3rd degree heart block

Safety/warning 2: Severe hypotension

DOSE:

IV MI = 5 mg IV inj x3 dose at 2-min intervals, then 50 mg PO Q6H

Maintenance = 100 mg PO BID

Nitroglycerin (nitrostat (SL))

Indication: Angina

Class: Nitrate

Safety/warning 1: Hypersensitivity to organic nitrates or any component of the formulation

Safety/warning 2: Concurrent use with PDE-5 inhibitors

High alert

Norepinephrine (levophed)

Indication: Acute hypotension

Class: Sympathomimetic

High alert

Rivaroxaban (xarelto)

Indication: Thromboembolism treatment and prevention, stroke prevention

Class: Anticoagulant - factor Xa inhibitor

Safety/warning 1: Thrombotic events after premature discontinuation

Safety/warning 2: Bleeding

DOSE:

VTE = 15 mg PO BID x 21 days then 20 mg PO daily

Afib = 20 mg PO daily

High alert

Sacubitril/valsartan (entresto)

Indication: HF

Class: Neprilysin inhibitor (sacubitril) and angiotensin receptor blocker ARB (valsartan)

Ticagrelor (brilinta)

Indication: Acute coronary syndromes, MI

Class: Antiplatelet

Safety/warning 1: Bleeding

Safety/warning 2: Do not use ASA >100 mg

DOSE:

LOAD = 180 mg PO, then 90 mg PO BID x 1st year after ACS event then 60 mg PO BID after

High alert

Verapamil

Indication: HTN, angina, tachyarrhythmia

Class: CCB

Warfarin (coumadin)

Indication: Thromboembolism treatment and prevention, clotting disorders

Class: Anticoagulant

DOSE:

Various dosage adjustment based on PT/INR lab, initial dosing varies but generally 2.5-7.5 mg is reasonable

Cyanocobalamin (Vitamin B12)

Indication: Dietary supplement

Class: Vitamin

Fentanyl (Sublimaze IV) (duragesic Transdermal)

Indication: Pain

Class: Opioid agonist

Safety/warning 1: Severe respiratory depression, risk of addiction, misuse, abuse

Safety/warning 2: CNS depression

High alert

Hydromorphone (dilaudid)

Indication: Pain

Class: Opioid agonist

Safety/warning 1: Severe respiratory depression, risk of addiction, misuse, abuse

Safety/warning 2: CNS depression

High alert

Insulin aspart (novolog)

Indication: DM

Class: Insulin - rapid acting

Safety/warning 1: Severe hypoglycemia

Safety/warning 2: Allergy of sensitivity

High alert

Insulin Detemir (levemir)

Indication: DM

Class: Insulin - long acting

Safety/warning 1: Severe hypoglycemia

Safety/warning 2: allergy of sensitivity

High alert

Insulin glargine (lantus)

Indication: DM

Class: Insulin - long acting

Safety/warning 1: Severe hypoglycemia

Safety/warning 2: allergy of sensitivity

High alert

Insulin lispro (humalog)

Indication: DM

Class: Insulin - rapid acting

Safety/warning 1: severe hypoglycemia

Safety/warning 2: allergy of sensitivity

High alert

Insulin NPH (human) (humulin N)

Indication: DM

Class: Insulin - intermediate acting

Safety/warning 1: severe hypoglycemia

Safety/warning 2: allergy of sensitivity

High alert

Insulin regular (human) (humulin R)

Indication: DM

Class: Insulin - short acting

Safety/warning 1: severe hypoglycemia

Safety/warning 2: allergy of sensitivity

High alert

Ketorlac (toradol)

Indication: Pain, inflammation

Class: NSAID

Safety/warning 1: active history of PUD, recent or history of GI bleeding or perforation

Safety/warning 2: pt w/ advanced renal disease or risk of renal failure

Lidocaine (xylocaine)

Indication: Pain

Class: Anesthetic - local regional

Safety/warning 1: Hypersensitivity to another local anesthetic of the amide type

Safety/warning 2: Severe degrees of SA, AV or intraventricular heart block

High alert only as antiarrhythmic

Magnesium sulfate

Indication: IV: torsades de pointes, PO: magnesium deficiency

Class: Essential mineral

Safety/warning 1: Heart block

Safety/warning 2: IV use for pre-eclampsia

High alert IV

Morphine (MS contin) (MS IR)

Indication: Pain

Class: Opioid agonist

Safety/warning 1: Severe respiratory depression, risk of addiction, misuse, abuse

Safety/warning 2: CNS depression

High alert

Naloxone (narcan)

Indication: Opioid overdose

Class: Opioid antagonist

DOSE: Initial = 0.4-2 mg, Max = 10 mg total

Potassium chloride

Indication: Hypokalemia

Class: Essential mineral

Safety/warning 1: Hyperkalemia

Safety/warning 2: Severe renal impairment

High alert IV

Thiamine (vitamin B1)

Indication: Alcoholism, dietary supplement

Class: Vitamin

Trastuzumab (herceptin)

Indication: Breast cancer

Class: Human epidermal growth factor receptor (HER2) inhibitor

Safety/warning 1: Embryo-fetal toxicity, cardiomyopathy, pulmonary toxicity, chemo-induced neutropenia

Adalimumab (Humira)

Indication: Rheumatoid arthritis, psoriasis, Crohns, ulcerative colitis

Class: TNF Blocker

Safety/warning 1: Serious Infection

Safety/warning 2: Cancer

Dexmethasone (Decadron)

Indication: Inflammation

Class: Corticosteroid

Safety/warning 1: Infection

Epoetin Alfa (Epogen) (Procrit)

Indication: Anemia secondary to chronic kidney disease

Class: Erythropoiesis stimulated agent

Safety/warning 1: Serious + life-threatening side effects and/or death when raising Hgb target of 12 g/dl or higher

Famotidine (pepcid)

Indication: Duodenal Ulcer

Class: H2 receptor antagonist

Safety/warning 1: CNS (Confusion, delirium, hallucination, disorientation) in elderly

Dose: 20 mg BID or 40 mg QD

Fosphenytoin (Cerebyx)

Indication: Epilepsy

Class: Anticonvulsant

Safety/warning 1: Severe hypotension, Cardiac arrhythmia w/ rapid IV administration

Haloperidol (Haldol)

Indication: Schizophrenia

Class: Antipsychotic

Safety/warning 1: Increased mortality in elderly w/ dementia-related psychosis

Dose: 2-5 mg IM

Hydrocortisone (Solu-Cortef)

Indication: Inflammation, Rash

Class: Corticosteroid

Safety/warning 1: Infections

Infliximab (remicade)

Indication: Rheumatoid arthritis, Crohns, ulcerative colitis

Class: TNF blocker

Safety/warning 1: Serious infection

Safety/warning 2: Cancer

Iron Dextran (infed) (venofer (ferrous surcrose))

Indication: Anemia, dietary supplement

Class: Essential mineral

Lactulose (enulose) (generlac)

Indication: Laxative - osmotic

Class: Prevention and treatment of hepatic encephalopathy

Safety/warning 1: Avoid galactosemia

Lorazepam (ativan)

Indication: Anxiety

Class: Benzodiazepines

Methocarbamol (robaxin)

Indication: Musculoskeletal discomfort

Class: Muscle relaxant

Methotrexate (trexall) (rheumatrex)

Indication: Rheumatoid arthritis, Crohn’s, ulcerative colitis, cancer

Class: Antimetabolite

Methylprednisolone (solu-medrol)

Indication: Inflammation

Class: Corticosteroid

Safety/warning 1: Fungal infections

Safety/warning 2: Live vaccination

Metoclopramide (reglan)

Indication: N/V, gastroparesis

Class: Dopamine-2 receptor antagonist

Safety/warning 1: Tardive dyskinesia

Midazolam (versed)

Indication: Sedation

Class: Benzodiazepine

Ondansetron (zofran)

Indication: N/V

Class: Serotonin 5-HT3 receptor antagonist

Safety/warning 1: Markedly prolonged QT interval leading to torsades de pointes

Safety/warning 2: Hypersensitivity to 5-HT3 receptor antagonist or any component of the formulation

Pantoprazole (protonix)

Indication: Heartburn, GERD, PUD

Class: PPI

Safety/warning 1: C. Diff, bone fractures, vitamin B12 deficiency w/ prolonged use

Phenytoin sodium (dilantin)

Indication: Epilepsy

Class: Hydrantoin

Safety/warning 1: Severe hypotension, cardiac arrhythmia w/ rapid IV administration

Prochlorperazine (compazine)

Indication: N/V, schizophrenia

Class: Phenothiazines

Propofol (diprivan)

Indication: Sedation

Class: Sedative — hypnotic

Sumatriptan (imitrex)

Indication: Migraine

Class: Selective serotonin receptor agonist

Safety/warning 1: ischemic heart disease or uncontrolled hypertension

Safety/warning 2: Pregnancy, peripheral vascular disease, MAO-I inhibitors w/in 2 wks

Amphotericin B (ambisome) (abelcet)

Indication: Fungal infection - systemic

Class: Antifungal

Safety/warning 1: should not exceed daily dose of greater than 1.5 mg/kg (fatal cardiac or cardiopulmonary arrest)

Dose: CNS fungal infections — 0.25-0.3 mg/kg IV daily w/ doses increased by 5-10 mg/day to reach a full dose of 0.5-0.7 mg/kg/dose IV QD

Ampicillin/sulbactam (unasyn)

Indication: Bacterial infection

Class: Antibiotic — penicillin + beta-lactamase inhibitor

Dose: 1.5-3 g IV/IM Q6H

Azithromycin (zithromax)

Indication: Bacterial infection

Class: Antibiotic — Macrolide

Dose: 250-500 mg IV or PO QD x 7-10 days

Cefazolin (ancef)

Indication: Bacterial infection

Class: Antibiotic — cephalosporin

Safety/warning 1: allergy to B-lactams

Dose: 1-1.5 g IV q6-12h (depending on infection)

Cefepime (maxipime)

Indication: Bacterial infection

Class: Antibiotic — cephalosporin

Safety/warning 1: B-lactams

Ceftriaxone (rocephin)

Indication: Bacterial infection

Class: Antibiotic — cephalosporin

Safety/warning 1: Allergy to B-lactams

Dose: 1-2 g IV daily or BID, Max 4g/day

Ciprofloxacin (Cipro)

Indication: Bacterial infection

Class: Antibiotic — quinolone

Safety/warning 1: Tendinitis and tendon rapture

Safety/warning 2: Myasthenia gravis

Dose: IV = 200-400 mg IV Q8-12h, PO = 250-750 mg PO q12h x 3-14 days

Clindamycin (cleocin)

Indication: Bacterial infection

Class: Antibiotic

Safety/warning 1:C. Diff infections

Ertapenem (invanz)

Indication: Bacterial infection

Class: Carbapenem

Safety/warning 1: Seizures (in patients w/ CNS disorders)

Fluconazole (diflucan)

Indication: Candidasis

Class: Antifungal

Safety/warning 1: CYP450 metabolized drugs

Safety/warning 2: QT prolongation

Dose: 150 mg IV/PO daily; loading dose 200-800 mg daily

Gentamicin (garamycin)

Indication: Bacterial infection

Class: Antibiotic — aminoglycoside

Safety/warning 1: Serious or life threatening infections and normal renal function: 3-5 mg/kg/day divided into 3 to 4 doses; needs renal dosage adjustment

Levofloxacin (levaquin)

Indication: Bacterial infection

Class: Antibiotic — quinolone

Safety/warning 1: Hypersensitivity to levofloxacin, any component of formulation, or other quinolones

Safety/warning 2: Tendinitis and tendon rapture; myasthenia gravis

Dose: 250-750 mg IV/PO QD (duration depends on infection)

Linezolid (Zyvox)

Indication: Bacterial infection

Class: Antibiotic — oxazolidinone

Safety/warning 1: Serotonin syndrome when Co-administration w/ SSRI, SNRI, bupropion, triptans, opioids

Dose: 600 mg IV/PO Q12h

Meropenem (merrem)

Indication: Bacterial infection

Class: Carbapenem

Safety/warning 1: Co-admin w/ valproic or divalproex inc risk of breakthrough seizures

Dose: 0.5-1g IV q8h (not to exceed 2g IV q8h)

Metronidazole (flagyl)

Indication: bacterial infection

Class: Antibiotic — nitroimidazole

Piperacillin/tazobactam (zosyn)

Indication: bacterial infection

Class: Antibiotic — penicillin + beta-lactamase inhibitor

Safety/warning 1: Allergies to PCN

Dose: 3.375 g q6h or 4.5 g q6-8h

Trimethoprim/sulfamethoxazole (bactrim)

Indication: Bacterial infection

Class: Antibiotic — Sulfonamide + folic acid inhibitor

Vancomycin (vancocin)

Indication: Bacterial infection

Class: Antibiotic

Safety/warning 1: Infusion related pruritis, erythematous rash