Dosing to remember for Naplex

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12.5-25 mg daily - for HTN

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12.5-25 mg daily - for HTN

Chlorthalidone dosing

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12.5-50 mg daily - for HTN

* means discontinued

Hydrochlorothiazide (Microzide*) dosing

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75-162 mg daily

Aspirin (Bayer, Bufferin, Ecotrin) - dosing for Angina

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75 mg daily - MD for ACS prevention

Clopidogrel (Plavix) - dosing for ACS and Stroke prevention

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Clopidogrel (Plavix) 75 mg daily + Aspirin 81 mg daily

Dual Antiplatelet Therapy (DAPT) used in Stable Ischemic Heart Disease (SIHD)

- clue: what is the only P2Y12 inhibitor recommended for this?

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SL tablets

0.3 mg

0.4 mg

0.6 mg

Nitroglycerin (Nitrostat) - dosing (formulation)

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0.4 mg/spray

Nitroglycerin translingual spray (NitroMist, Nitrolingual Pump Spray) - dosing

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0.4 mg/packet

Nitroglycerin SL powder (GoNitro) - dosing

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Maintaince Dose

- 90 mg PO BID for 1 year, then 60 mg bid

Ticagrelor (Brilinta) dosing

- for the first year, then after the first year

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a. 100

b. avoided

c. 100

With Ticagrelor (Brilinta) - Maintenance doses of Aspirin above _______a________ mg reduce the effectiveness of Ticagrelor and should be _________b___________; after any initial aspirin dose, maintenance aspirin dose should not exceed _____c________ mg daily

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a. 60

b. 600

Transition to oral P2Y12 inhibitor after PCI: ticagrelor 180 mg given during or immediately after stopping cangrelor infusion; prasugrel_______a________ mg or clopidogrel ____________b___________ mg immediately after stopping cangrelor infusion (do not give prior to stopping cangrelor)

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  1. Dosing: 0.625-5 mg Q6H

Note: IV version only for HTN

Enalapril (Vasotec IV)

  1. for HTN Dosing:

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  1. for CHF:

    1. Target: 200 mg BID

    2. Start: 50-100 mg BID

    3. CrCl < 30: 50 mg BID

  2. for HTN: Do not use for HTN

Sacubitril/Valsartan (Entresto) - tablet

  1. for CHF:

    1. Target:

    2. Start:

    3. CrCl < 30:

  2. for HTN:

    1. Dosing:

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  1. Sacubitril 24 mg/Valsartan 26 mg

  2. Sacubitril 49 mg/Valsartan 51mg

  3. Sacubitril 97 mg/Valsartan 103 mg

How is the split of Sacubitril/Valsartan (Entresto) - tablets

  1. 50 mg

  2. 100 mg

  3. 200 mg

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  1. for CHF:

    1. Target: 20-40 mg PO daily

    2. Start: 2.5 mg PO daily

  2. for HTN:

    1. Dosing: 5-40 mg daily

Lisinopril (Prinivil, Zestril)

  1. for CHF:

    1. Target:

    2. Start:

  2. for HTN:

    1. Dosing:

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  1. for CHF:

    1. Target: 20 mg BID

    2. Start: 5 mg BID

  2. for HTN:

    1. Dosing: 5-40 mg daily

Quinapril (Accupril)

  1. for CHF:

    1. Target:

    2. Start:

  2. for HTN:

    1. Dosing:

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10 mg daily

  1. for CHF:

    1. Target: 10 mg PO daily

    2. Start: 1.25-2.5 mg PO daily

  2. for HTN:

    1. Dosing: 2.5-20 mg daily

Ramipril (Altace)

  1. for CHF:

    1. Target:

    2. Start:

  2. for HTN:

    1. Dosing:

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  1. for CHF

    1. Start: 25-50 mg daily.

    2. Target: 50-150 mg daily

  2. for HTN: 25-100 mg daily in 1 - 2 divided doses

Losartan (Cozaar)

  1. for CHF

    1. Start:

    2. Target:

  2. for HTN

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160 mg BID

  1. for CHF:

    1. Target: 160 mg BID

    2. Start: 40 mg BID

  2. for HTN:

    1. Dosing: 80-320 mg daily

Valsartan (Diovan)

  1. for CHF:

    1. Target:

    2. Start:

  2. for HTN:

    1. Dosing:

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  1. 200 mg daily

  2. 25-100 mg daily; max dose is 400 mg daily

  1. for CHF:

    1. Target: 200 mg PO daily

    2. Start: 12.5-25 mg PO daily

  2. for HTN:

    1. Dosing: 25-100 mg daily

    2. Max: 400 mg daily

Metoprolol Succinate (Toprol XL)

  1. for CHF:

    1. Target:

    2. Start:

  2. for HTN:

    1. Dosing & Max:

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3.125 mg BID

Carvedilol (Coreg IR) - starting dose: for CHF

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25 mg BID

Carvedilol (Coreg IR) - target dose: ≤ 85 kg: for CHF

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50 mg BID

Carvedilol (Coreg IR) - target dose: > 85 kg: for CHF

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10 mg daily

Carvedilol (Coreg CR) - starting dose:

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80 mg daily

Carvedilol (Coreg CR) - target dose:

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0.125-0.25 mg daily

Digoxin (Digitek, Digox, Lanoxin) - Typical dose:

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0.5-0.9 ng/ml

Digoxin (Digitek, Digox, Lanoxin) - Dosing Therapeutic range for HF: =

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0.8-2ng/mL

Digoxin (Digitek, Digox, Lanoxin) - Dosing Therapeutic range for Afib: =

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range for before stroke: 50-325 mg daily.

after stroke: 162-325 mg PO within 24 - 48 hours after stroke onset..

Aspirin (Bayer, Bufferin, Ecotrin) - dosing for range for before stroke vs after Stroke

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0.9 mg/kg (max dose 90 mg)

Atleplase (activase) - dosing for stroke.

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Max: 10 mg/day.

dronedarone, verapamil, or diltiazem.

Max dose of simvastatin with: DVD (3 drugs)

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Max: 20 mg/day.

Lomitapide, amiodarone, ranolazine, amlodipine.

Max dose of simvastatin with: LARA (4 drugs)

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Max: 20-40 mg/day.

Danazol, amlodipine, amiodarone. plus,

dronedarone, verapamil, or diltiazem.

Max dose of lovavastatin with: DAA + DVD (6 drugs)

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PO: 250-500 mg Q6-12H

Cephalexin (Keflex) dosing

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1-2.5 mg/kg/dose

Gentamicin / Tobramycin - Traditional IV dosing

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4-7 mg/kg/dose

commonly 7 mg/kg

Gentamicin / Tobramycin - Extended interval IV dosing

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< 2 mcg/mL

gentamicin (G+) < 1 mcg/mL

Gentamicin (G-) infxn / Tobramycin TROUGH levels dosing

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  1. 60 mL/min: Q8H

  2. 40-60 mL/mi: Q12H

  3. 20-40 mL/min: Q24H

  4. < 20 mL/min: 1x dose:, then dose per levels

when to Renal Dose adjust for traditional dosing of Aminoglycosides when CrCl is:

  1. ≥ 60 mL/min:?

  2. 40-60 mL/min?

  3. 20-40 mL/min?

  4. < 20 mL/min?

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500 mg on day 1, then 250 mg on days 2-5

Azithromycin (Zithromax, Z-pak) dosing

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500 mg daily for 3 days

Azithromycin (Tri-Pak) dosing

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400 mg SMX/80 mg TMP

Sulfamethoxazole/Trimethoprim (Bactrim, Bactrim Single Strength) - dosing

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800 mg SMX/160 mg TMP

Sulfamethoxazole/Trimethoprim (Bactrim, Bactrim Double Strength) - dosing

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1 DS tablet PO BID x 3 days

Sulfamethoxazole/Trimethoprim (Bactrim, Bactrim DS) - dosing for Uncomplicated UTI

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IV: 15-20 mg/kg Q8-12H.

dosed based on TBW.

CrCl 20-49 ml/min: Q24H.

Vancomycin (Vancocin).

- dosing (based on ABW, TBW, or IBW).

- also if CrCl - 20-49 ml/min frequency.

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125-500 mg QID x 10 days (upper end used for severe, complicated disease)

Vancomycin (vancocin) dosing for C. difficile infections (PO only)

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Goal trough: 15-20 mcg/mL

Vancomycin (Vancocin) dosing to tx pneumonia, endocarditis, osteomyelitis

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PO: 100 mg BID x 5 days

Nitrofurantoin (MacroBID) dosing for uncomplicated UTI (cystitis only)

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80-90 mg/kg/day in 2 divided doses (e.g. Q12H)

Amoxicillin dosing for Acute Otitis Media

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90 mg/kg/day * in 2 divided doses (e.g. Q12H)

  • take at start of a meal.

Amoxicillin/Clavulanate (Augmentin) dosing for Acute Otitis Media

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2 grams 30-60 min before dental procedure

Amoxicillin - dosing for Infective Endocarditis (IE)

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clindamycin 600 mg or

azithromycin or clarithromycin both 500 mg.

If a patient is allergic to PCN medications for infective Endocarditis, what two alternative drugs with dosing can they take?

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1,000 mg PO x 1 or 500 mg PO daily x 1-3 days

Azithromycin dosing for Traveler's Diarrhea treatment

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750mg PO x 1 or 500 mg PO daily x 1-3 days

Ciprofloxacin dosing for Traveler's Diarrhea treatment

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500 mg PO x 1 or 500 mg PO daily x 1-3 days

Levofloxacin dosing for Traveler's Diarrhea treatment

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400 mg PO x 1 or 400 mg PO BID x 3 days

Ofloxacin dosing for Traveler's Diarrhea treatment

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200 mg PO TID x 3 days

Rifaximin dosing for Traveler's Diarrhea treatment

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2.4 million units IM x 1 dosing

Penicillin G benzathine (Bicillin L-A) dosing for Syphilis

Primary, secondary or early latent (< 1 year duration)

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2.4 million units IM x 1 weekly x 3 weeks (7.2 million units total)

Penicillin G benzathine (Bicillin L-A) dosing for Syphilis

late latent (> 1 year duration) or tertiary syphilis

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100 mg PO BID x 14 days

Doxycycline dosing for syphilis

Primary, secondary or early latent (< 1 year duration)

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100 mg PO BID x 28 days

Doxycycline dosing for syphilis

late latent (> 1 year duration) or tertiary syphilis

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250 mg IM x 1

Ceftriaxone - dosing for Gonorrhea

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1 gram PO x 1

Azithromycin dosing for Chlamydia

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2 grams PO x 1

Metronidazole - dosing for Trichomoniasis

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Ceftriaxone 150 mg IM

+ Azithromycin 1 gram or doxycycline 100 mg BID x 7 days

Drug(s) Name and dosing for the treatment of Gonorrhea & Chlamydia combo that often goes together?

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150 mg PO x 1

Fluconazole (Diflucan) dosing for Vaginal candidiasis

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500 mg x 1 dose on day 1, then 250 mg x 1 dose daily on days 2-5

Azithromycin (Zithromax) dosing for Acute Bronchitis (not COPD exacerbation)

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500 mg BID or 1 gram ER daily x 7 days

Clarithromycin dosing for Acute Bronchitis (not COPD exacerbation)

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1 tablet BID x 14 days

SMX/TMP DS (Bactrim) dosing for Acute Bronchitis (not COPD exacerbation)

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Acute Bacterial Exacerbation of Chronic Bronchitis

5-7 days

Duration for COPD patients with (ABECB) with these antibitoics:

- Amoxicillin/Clavulanate or

- Azithromycin or

- Doxycycline.

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Tx: 75 mg BID x 5 days

must be symptomatic < 2 days for best results
renal adjustment

Oseltamivir (Tamiflu) dosing

- treatment, age > 12 years

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PPX: 75 mg daily x 10 days

community outbreaks - can be given for 6 weeks
renal adjustment

Oseltamivir (Tamiflu) dosing

- prophylaxis, age > 12 years

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apply 5x daily at first sign of outbreak

Docosanol

Abreva (OTC) cream - dosing for Herpes Labialis

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Apply 5x daily for 4 days (can be used on genital sores)

Acyclovir (Zovirax) (Rx) topical cream - dosing for Herpes Labialis

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800 mg PO 5x daily for 7 days (or 10 days)

Acyclovir (Zovirax) - dosing for Herpes Zoster (Shingles) treatment

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1 gram PO TID for 7 days

Valacyclovir (Valtrex) - dosing for Herpes Zoster (Shingles) treatment

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Cap: 200 mg daily

Emtricitabine (FTC, Emtriva) dosing

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300 mg daily

Tenofovir disproxil fumarate (TDF) (Viread) dosing

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Treatment naive: 800 mg lopinavir/200 mg ritonavir daily or 400/100 mg BID.

Lopinavir + ritonavir, LPV/r (Kaletra) dosing

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1 tablet daily

Genvoya dosing

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1 tablet daily

Stribild dosing

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1 tablet daily

Bictegravir (Biktarvy) dosing

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1,200 mg daily (two 600 mg tablets)

Raltegravir (Isentress HD) dosing

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