hospital drugs clinical pearls

Bumex

Clinical pearls

Dose Conversions: furosemide 40 mg = bumetanide 1 mg

bumetanide

clinical pearls

Dose Conversions: furosemide 40 mg = bumetanide 1 mg

Lasix

clinical pearls

Furosemide IV:PO ratio 1:2 (furosemide 20mg IV = furosemide 40mg PO)

furosemide

clinical pearls

Furosemide IV:PO ratio 1:2 (furosemide 20mg IV = furosemide 40mg PO)

Diuril

clinical pearls

Only thiazide available IV

chlorothiazide

clinical pearls

Only thiazide available IV

Cardene

clinical pearls

Warning(s): Hypotension(especially with severe aortic stenosis), nicardipine should not be used in advanced aortic stenosis

nicardipine

Warning(s): Hypotension(especially with severe aortic stenosis), nicardipine should not be used in advanced aortic stenosis

verapamil

Indication(s): IV: atrial fibrillation/other arrhythmias (rate control)

Warning(s): May worsen symptoms of HF, bradycardia, increased LFTs

Vasotec IV

BBW: Fetal toxicity - Avoid in pregnancy

Do not use within 36 hours of sacubitril/valsartan (Entresto)

Side effect(s): cough, hyperkalemia

Warning(s): Angioedema,

enalaprilat

BBW: Fetal toxicity - Avoid in pregnancy

Do not use within 36 hours of sacubitril/valsartan (Entresto)

Side effect(s): cough, hyperkalemia

Warning(s): Angioedema,

Brevibloc

Warning(s): Caution in pts with diabetes; can worsen hyperglycemia or hypoglycemia and mask hypoglycemic conditions

esmolol

Warning(s): Caution in pts with diabetes; can worsen hyperglycemia or hypoglycemia and mask hypoglycemic conditions

Lopressor

BBW: Do not discontinue abruptly, taper dose

Metoprolol tartrate IV is not equivalent to PO (IV:PO ratio is 1:2.5)

metoprolol

BBW: Do not discontinue abruptly, taper dose

Metoprolol tartrate IV is not equivalent to PO (IV:PO ratio is 1:2.5)

Inderal

Warning(s): Caution in pts with diabetes; can worsen hyperglycemia or hypoglycemia and mask hypoglycemic conditions

High lipid solubility, crosses BBB, associated with more CNS side effects, but makes it useful for other conditions (migraine prophylaxis)

Non-selective BBs are used in portal HTN

propanolol

Warning(s): Caution in pts with diabetes; can worsen hyperglycemia or hypoglycemia and mask hypoglycemic conditions

High lipid solubility, crosses BBB, associated with more CNS side effects, but makes it useful for other conditions (migraine prophylaxis)

Non-selective BBs are used in portal HTN

labetalol

BBW: Do not discontinue abruptly, taper dose

Drug of choice in pregnancy

hydralazine

Indication(s): Chronic hypertension, hypertensive emergency (off-label), HFrEF (off-label)

nitroglycerin

Low doses: venous vasodilator, High doses: arterial vasodilator

Notes: Requires non-PVC container (e.g. glass bottle)

Nipride

BBW: Metabolism produces cyanide

Warning(s): Increased intracranial pressure

Requires light protection during administration;

nitroprusside

BBW: Metabolism produces cyanide

Warning(s): Increased intracranial pressure

Requires light protection during administration;

dobutamine

may turn slightly pink due to oxidation but potency is not lost

Lanoxin

Narrow therapeutic index (monitor digoxin level)

Toxicity: s/sx blurred/double vision, greenish-yellow halos signs of toxicity

Antidote: DigiFab

digoxin

Narrow therapeutic index (monitor digoxin level)

Toxicity: s/sx blurred/double vision, greenish-yellow halos signs of toxicity

Antidote: DigiFab

Nexterone

BBW: Pulmonary toxicity (tablet), hepatotoxicity. Amiodarone is used for life-threatening arrhythmias only.

Antiarrhythmic drug of choice in heart failure

amiodarone

BBW: Pulmonary toxicity (tablet), hepatotoxicity. Amiodarone is used for life-threatening arrhythmias only.

Antiarrhythmic drug of choice in heart failure

procainamide

BBW: Potentially fatal blood dyscrasias (agranulocytosis)

Xylocaine

Indication(s): Ventricular arrhythmias (refractory VT/ cardiac arrest)

lidocaine

Indication(s): Ventricular arrhythmias (refractory VT/ cardiac arrest)

AtroPen

Indication(s): Bradycardia, inhibition of salivation and secretions, organophosphate poisoning

atropine

Indication(s): Bradycardia, inhibition of salivation and secretions, organophosphate poisoning

Dopamine

BBW: All vasopressors are vesicants when administered IV - extravasation risk; treat extravasation with phentolamine

MOA is dose dependent

All vasopressors should be administered via central IV line

Adrenalin

BBW: Vesicants when administered IV; treat extravasation with phentolamine

Epi for IV push is 0.1 mg/mL, Epi for IM injection and compounding IV products is 1 mg/mL

epinephrine

BBW: Vesicants when administered IV; treat extravasation with phentolamine

Epi for IV push is 0.1 mg/mL, Epi for IM injection and compounding IV products is 1 mg/mL

Levophed

BBW: All vasopressors are vesicants when administered IV - extravasation risk; treat extravasation with phentolamine

All vasopressors should be administered via central IV line

norepinephrine

BBW: All vasopressors are vesicants when administered IV - extravasation risk; treat extravasation with phentolamine

All vasopressors should be administered via central IV line

Neosynephrine

Indication(s): hypotension/shock, hypotension during anesthesia

phenylephrine

Indication(s): hypotension/shock, hypotension during anesthesia

Vasocstrict

BBW: Vesicant when administered IV; treat extravasation with phentolamine

Known as arginine vasopressin (AVP) and antidiuretic hormone (ADH)

vasopressin

BBW: Vesicant when administered IV; treat extravasation with phentolamine

Known as arginine vasopressin (AVP) and antidiuretic hormone (ADH)

Flolan, Veletri

Continuous IV infusion, avoid interruptions and sudden large dose reductions

Indication(s): Pulmonary arterial hypertension

epoprostenol

Continuous IV infusion, avoid interruptions and sudden large dose reductions

Indication(s): Pulmonary arterial hypertension

Remodulin

Indication(s): Pulmonary arterial hypertension

Continuous IV infusion, avoid interruptions and sudden large dose reductions

treprostinil

Indication(s): Pulmonary arterial hypertension

Continuous IV infusion, avoid interruptions and sudden large dose reductions

Reopro

Side effect(s): Bleeding, thrombocytopenia

abciximab

Side effect(s): Bleeding, thrombocytopenia

integrilin

Side effect(s): Bleeding, thrombocytopenia

eptifbatide

Side effect(s): Bleeding, thrombocytopenia

aggrastat

Side effect(s): Bleeding, thrombocytopenia

tirofiban

Side effect(s): Bleeding, thrombocytopenia

activase, cathflo activase

Indication(s):

Activase- Acute ischemic stroke, pulmonary embolism, ST-elevation myocardial infarction (STEMI)

Cathflo Activase- IV line clearance

Contraindication(s): active internal bleed, history of recent stroke, severe uncontrolled hypertension

alteplase

Indication(s):

Activase- Acute ischemic stroke, pulmonary embolism, ST-elevation myocardial infarction (STEMI)

Cathflo Activase- IV line clearance

Contraindication(s): active internal bleed, history of recent stroke, severe uncontrolled hypertension

TNKase

Indication(s): ST-elevation myocardial infarction (STEMI)

Contraindication(s): active internal bleed, history of recent stroke, severe uncontrolled hypertension

tenecteplase

Indication(s): ST-elevation myocardial infarction (STEMI)

Contraindication(s): active internal bleed, history of recent stroke, severe uncontrolled hypertension

heparin

Clinical Pearl(s): Warning(s): Fatal medication error; verify correct concentration is chosen
High Alert Medication
Note: Heparin lock flush solution is intended only to maintain patency of IV devices and is not to be used for systemic anticoagulant therapy.
Contraindication(s): Uncontrolled active bleed, history of HIT
Antidote: protamine

heparin sodium

Clinical Pearl(s): Warning(s): Fatal medication error; verify correct concentration is chosen
High Alert Medication
Note: Heparin lock flush solution is intended only to maintain patency of IV devices and is not to be used for systemic anticoagulant therapy.
Contraindication(s): Uncontrolled active bleed, history of HIT
Antidote: protamine

lovenox 

Clinical Pearl(s): BBW: Risk of hematomas and subsequent paralysis in patients receiving neuraxial anesthesia

Contraindication(s): History of HIT (heparin-induced thrombocytopenia), active major bleed

Antidote: protamine

Common Adult Dosing:

Prophylaxis of VTE- 40 mg SC daily

Treatment of VTE- 1 mg/kg SC Q12H

enoxaparin sodium

Clinical Pearl(s): BBW: Risk of hematomas and subsequent paralysis in patients receiving neuraxial anesthesia

Contraindication(s): History of HIT (heparin-induced thrombocytopenia), active major bleed

Antidote: protamine

Common Adult Dosing:

Prophylaxis of VTE- 40 mg SC daily

Treatment of VTE- 1 mg/kg SC Q12H

argatroban

Clinical Pearl(s): Notes: Safe for use with active HIT or history of HIT; no antidote

Angiomax 

Clinical Pearl(s): Notes: Safe for use with active HIT or history of HIT; no antidote

bivalirudin

Clinical Pearl(s): Notes: Safe for use with active HIT or history of HIT; no antidote

Arixtra

Clinical Pearl(s): Contraindication(s): Severe renal impairment (CrCl <30mL/min)

fondaparinux 

Clinical Pearl(s): Contraindication(s): Severe renal impairment (CrCl <30mL/min)

Kcentra

Clinical Pearl(s): Indication(s): Bleeding (treatment and prophylaxis)
Contains factors II, VII, IX and X and Protein C and Protein S
Administer with vitamin K

promthrombin complex concentrate

Clinical Pearl(s): Indication(s): Bleeding (treatment and prophylaxis)
Contains factors II, VII, IX and X and Protein C and Protein S
Administer with vitamin K

Mephyton 

Clinical Pearl(s): Indication(s): Warfarin reversal, vitamin K deficiency
Protect from light

vitamin K or phytonadione

Clinical Pearl(s): Indication(s): Warfarin reversal, vitamin K deficiency
Protect from light

protamine

Clinical Pearl(s): Indication(s): UFH/LMWH reversal

Heparin neutralization: 1 mg of protamine will reverse 100 units of heparin

Low-molecular-weight heparin neutralization: 1 mg protamine per 1 mg of enoxaparin

Amicar 

Clinical Pearl(s): Indication(s): Approved for excessive bleeding associated with cardiac surgerya

aminocaproic acid

Clinical Pearl(s): Indication(s): Approved for excessive bleeding associated with cardiac surgery

Cyklokapron

Clinical Pearl(s): Indication(s): Approved for bleeding with hemophilia and used off-label to control surgical bleeding and trauma-associated hemorrhage

tranexamic acid 

Clinical Pearl(s): Indication(s): Approved for bleeding with hemophilia and used off-label to control surgical bleeding and trauma-associated hemorrhage

DDVAP

Clinical Pearl(s): BBW: Life threatening hyponatremia

desmopressin

Clinical Pearl(s): BBW: Life threatening hyponatremia

Sandostatin

Clinical Pearl(s): Use(s): Vasoconstricting medication to minimize variceal bleeding

octreotide

Clinical Pearl(s): Use(s): Vasoconstricting medication to minimize variceal bleeding

Diprivan

propofol-related infusion syndrome (PRIS)

Monitor: Triglycerides (serum triglyceride concentration ≥ 400 mg/dL)

Oil-in-water lipid emulsion (opaque white solution)

propofol

propofol-related infusion syndrome (PRIS)

Monitor: Triglycerides (serum triglyceride concentration ≥ 400 mg/dL)

Oil-in-water lipid emulsion (opaque white solution)

Ketalar

Indication(s): Induction agent for anesthesia and/or intubation

ketamine

Indication(s): Induction agent for anesthesia and/or intubation

Amidate

Indication(s): Induction of general anesthesia and/or intubation

etomidate 

Indication(s): Induction of general anesthesia and/or intubation

Precedex

Used for sedation in intubated and non-intubated patients

Duration of infusion should not exceed 24 hours per FDA labeling

dexmedolomidine

Used for sedation in intubated and non-intubated patients

Duration of infusion should not exceed 24 hours per FDA labeling

xylcocaine

Used for local procedures, such as inserting and IV line.

Epinephrine is added for vasoconstriction, which keeps the lidocaine localized.

lidocaine

Used for local procedures, such as inserting and IV line.

Epinephrine is added for vasoconstriction, which keeps the lidocaine localized.

Toradol

Short-term use only- ***Max duration 5 days***

ketorolac

Short-term use only- ***Max duration 5 days***

ofimev 

Maximum dose of 4g/day from all sources

BBW: Risk of hepatotoxicity

acteminophen

Maximum dose of 4g/day from all sources

BBW: Risk of hepatotoxicity

fentanyl

BBW: Risk for abuse, misuse, and addiction; use with strong or moderate 3A4 inhibitors can increase effects and risk for potentially fatal respiratory depression

Not used in opioid-naive patients

Dilaudid

BBW: Risk of medication error with high potency (use in opioid-tolerant patients only)

hydromoprhone 

BBW: Risk of medication error with high potency (use in opioid-tolerant patients only)

demerol

Warning(s): Use caution in renal impairment/ elderly at risk for CNS toxicity

Can cause seizures when the toxic metabolite, normeperidine accumulates

meperidine

Warning(s): Use caution in renal impairment/ elderly at risk for CNS toxicity

Can cause seizures when the toxic metabolite, normeperidine accumulates

duramorph

BBW: Respiratory depression; risk for abuse, misuse, and addiction

Side effect(s): pruritus, constipation

morphine sulfate

BBW: Respiratory depression; risk for abuse, misuse, and addiction

Side effect(s): pruritus, constipation

nubain

BBW: Life-threatening respiratory depression

Used for obstetrical analgesia during labor and delivery

nalbuphine

BBW: Life-threatening respiratory depression

Used for obstetrical analgesia during labor and delivery