Dosing to remember for Naplex

12.5-25 mg daily - for HTN

12.5-25 mg daily - for HTN

Chlorthalidone dosing

12.5-50 mg daily - for HTN

* means discontinued

Hydrochlorothiazide (Microzide*) dosing

75-162 mg daily

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

75 mg daily - MD for ACS prevention

Clopidogrel (Plavix) - dosing for ACS and Stroke prevention

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?

SL tablets

0.3 mg

0.4 mg

0.6 mg

Nitroglycerin (Nitrostat) - dosing (formulation)

0.4 mg/spray

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

0.4 mg/packet

Nitroglycerin SL powder (GoNitro) - dosing

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

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

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)

1. Dosing: 0.625-5 mg Q6H

Note: IV version only for HTN

Enalapril (Vasotec IV)

1. for HTN Dosing:

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:

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

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:

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:

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:

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

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:

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:

3.125 mg BID

Carvedilol (Coreg IR) - starting dose: for CHF

25 mg BID

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

50 mg BID

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

10 mg daily

Carvedilol (Coreg CR) - starting dose:

80 mg daily

Carvedilol (Coreg CR) - target dose:

0.125-0.25 mg daily

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

0.5-0.9 ng/ml

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

0.8-2ng/mL

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

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

0.9 mg/kg (max dose 90 mg)

Atleplase (activase) - dosing for stroke.

Max: 10 mg/day.

dronedarone, verapamil, or diltiazem.

Max dose of simvastatin with: DVD (3 drugs)

Max: 20 mg/day.

Lomitapide, amiodarone, ranolazine, amlodipine.

Max dose of simvastatin with: LARA (4 drugs)

Max: 20-40 mg/day.

Danazol, amlodipine, amiodarone. plus,

dronedarone, verapamil, or diltiazem.

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

PO: 250-500 mg Q6-12H

Cephalexin (Keflex) dosing

1-2.5 mg/kg/dose

Gentamicin / Tobramycin - Traditional IV dosing

4-7 mg/kg/dose

commonly 7 mg/kg

Gentamicin / Tobramycin - Extended interval IV dosing

< 2 mcg/mL

gentamicin (G+) < 1 mcg/mL

Gentamicin (G-) infxn / Tobramycin TROUGH levels dosing

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?

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

Azithromycin (Zithromax, Z-pak) dosing

500 mg daily for 3 days

Azithromycin (Tri-Pak) dosing

400 mg SMX/80 mg TMP

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

800 mg SMX/160 mg TMP

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

1 DS tablet PO BID x 3 days

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

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.

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

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

Goal trough: 15-20 mcg/mL

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

PO: 100 mg BID x 5 days

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

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

Amoxicillin dosing for Acute Otitis Media

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

2 grams 30-60 min before dental procedure

Amoxicillin - dosing for Infective Endocarditis (IE)

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?

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

Azithromycin dosing for Traveler's Diarrhea treatment

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

Ciprofloxacin dosing for Traveler's Diarrhea treatment

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

Levofloxacin dosing for Traveler's Diarrhea treatment

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

Ofloxacin dosing for Traveler's Diarrhea treatment

200 mg PO TID x 3 days

Rifaximin dosing for Traveler's Diarrhea treatment

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)

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

100 mg PO BID x 14 days

Doxycycline dosing for syphilis

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

100 mg PO BID x 28 days

Doxycycline dosing for syphilis

late latent (> 1 year duration) or tertiary syphilis

250 mg IM x 1

Ceftriaxone - dosing for Gonorrhea

1 gram PO x 1

Azithromycin dosing for Chlamydia

2 grams PO x 1

Metronidazole - dosing for Trichomoniasis

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?

150 mg PO x 1

Fluconazole (Diflucan) dosing for Vaginal candidiasis

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)

500 mg BID or 1 gram ER daily x 7 days

Clarithromycin dosing for Acute Bronchitis (not COPD exacerbation)

1 tablet BID x 14 days

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

Acute Bacterial Exacerbation of Chronic Bronchitis

5-7 days

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

- Amoxicillin/Clavulanate or

- Azithromycin or

- Doxycycline.

Tx: 75 mg BID x 5 days

must be symptomatic < 2 days for best results
renal adjustment

Oseltamivir (Tamiflu) dosing

- treatment, age > 12 years

PPX: 75 mg daily x 10 days

community outbreaks - can be given for 6 weeks
renal adjustment

Oseltamivir (Tamiflu) dosing

- prophylaxis, age > 12 years

apply 5x daily at first sign of outbreak

Docosanol

Abreva (OTC) cream - dosing for Herpes Labialis

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

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

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

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

1 gram PO TID for 7 days

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

Cap: 200 mg daily

Emtricitabine (FTC, Emtriva) dosing

300 mg daily

Tenofovir disproxil fumarate (TDF) (Viread) dosing

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

Lopinavir + ritonavir, LPV/r (Kaletra) dosing

1 tablet daily

Genvoya dosing

1 tablet daily

Stribild dosing

1 tablet daily

Bictegravir (Biktarvy) dosing

1,200 mg daily (two 600 mg tablets)

Raltegravir (Isentress HD) dosing

325 (65 mg elemental iron) PO daily to TID

Ferrous sulfate dosing for anemia

160 mg (50 mg elemental Iron) PO daily to TID

Ferrous sulfate, dried (SlowFe, Slow Iron)

Adult: 25-50 mg PO Q4-6H (max 300 mg/day)

Diphenhydramine HCL (Benadryl) dosing

1 drop daily or BID

Timolol 0.25% and 0.5% dosing - for glaucoma

1 drop BID

Dorzolamide + timolol

Cosopt, Cosopt PF dosing - for glaucoma

1 mg daily, at least 3 months duration to begin to see effect

Finasteride (Propecia) - for alopecia

MDI/DPI: 1-2 inhalations Q4-6H PRN

Albuterol (ProAir HFA, Proventil HFA, Ventolin HFA) dosing for asthma

therapeutic range: 5-15 mcg/mL

Theophylline - therapeutic range for asthma

1-2 inhalations daily or BID

1-4 inhalations BID

General dosing of Dry Powders Inhaler (DPI) - for asthma

1-2 or 1-4 inhalations BID

2 inhalations BID

General dosing of Meter Dose Inhalers (MDI) - for asthma

MDI: 2 inhalations QID

Ipratromium Bromide (Atrovent) - dosing

MDI: 1 inhalations QID

Combivent Respimat (ipratropium/albuterol) dosing - for COPD

DPI: 1 capsule via HandiHaler device daily (requires 2 puffs)

Tiotripium (Spiriva) HandiHaler capsule dosing - for COPD

MDI: 2 inhalations daily

Tiotropium Respimat dosing COPD

>10 cig/day --> start w/ 21mg patch.

- for 8-10 weeks.

Nicotine patch (NicoDerm)

>10 cig/day --> start w/ ____________mg patch.

- for _________________________weeks

1st cigarette > 30 min upon awaking: 2 mgs.

1st cigarette < or = to 30 mins upon awaking: 4 mgs.

Nub (both): 9 pieces/day during first 6 weeks.

Nicotine polacrilex gum (Nicorette) - dosing smoking cessation.

1st cigarette > 30 min upon awaking: ___________ mgs.

1st cigarette < or = to 30 min upon awaking: ______ mgs.

Nub (both): _________pieces/day during first _______ weeks.