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