1530 Drugs

Antiarrhythmic

• Restores normal sinus rhythm
• Slows conduction time through the AV node
• Produces coronary artery vasodilation

Dosage: 6 mg by rapid IV (injection) bolus; if no results are seen repeat 1-2 minutes later as 12 mg rapid bolus

Contraindication: Patients with 2nd or 3rd degree AV block

Concurrent use with digoxin may increase risk of ventricular fibrillation

S/E: SOB, facial flushing, transient arrhythmia

Mucolytic/ Antidote
Mucolytic: Degrades pulmonary mucus for easier expectoration by lowering mucal viscosity

Dosage: 6-10 mL of 10% nebulizer solution or 3-5 mL of 20% nebulizer solution inhaled Q 6-8 H PRN

Antidote: Decreases buildup of hepatic metabolite in acetaminophen overdose preventing or limiting liver damage

Dosage:
• 140 mg PO followed by 70 mg PO Q4H for 17 additional doses
• 150 mg PO over 60 min followed by 50 mg over 4 H followed by 100 mg over 16 H

S/E: bronchospasm, nausea, vomiting, and rash

Blood Volume Expanders/ Colloids
• Provides increase in intravascular fluid volume
• Expands plasma volume and maintenance of cardiac output in situations associated with fluid volume deficit, including shock, hemorrhage, and burns
• Moves fluid from extravascular tissues back into the intravascular space
Dosage:
• Hypovolemic Shock (5% Albumin) 25 g IV (may be repeated within 30 min)
• Hypoproteinemia (25% Albumin) 50–75 g IV
• Nephrotic Syndrome (25% Albumin) 12.5–50 g/day in 3–4 divided doses

S/E: Fever, nausea, tachycardia, hypotension, rash, pulmonary edema

Potassium Sparing Diuretic
• Used for management of HTN, edema associated with CHF, hyperaldosteronism, and hypokalemia
• Causes loss of sodium bicarbonate and calcium while saving potassium and hydrogen ions by antagonizing aldosterone
• Conservation of potassium

Dosage: 25–400 mg/day PO as a single dose or 2 divided doses. Congestive heart failure—25–50 mg/day PO.

Contraindications: Renal impairments and insufficiency, hyperkalemia

S/E: Hyperkalemia, gastritis, nausea, gynecomastia, amenorrhea, fever, uticaria, headache, ataxia, lethargy, agranulocytosis

Anti-anxiety Agents- Benzodiazepines
• Relief of anxiety
• Treatment of GAD, panic disorder, and for management of anxiety associated with depression
• Acts on the CNS to trigger anxiolytic affect
• Effects mediated by GABA (inhibitory transmitter)
Dosage:
• Anxiety: 0.25–0.5 mg PO 2–3 times daily (not >4 mg/day; begin with 0.25 mg 2–3 times daily in geriatric/debilitated patients)
• Panic: 0.5 mg 3 times PO daily; may be increased by 1 mg or less every 3–4 days as needed (not >10 mg/day)

Contraindications: Alcohol, contraceptives, cigarettes, grapefruit juice

S/E: Dizziness, drowsiness, lethargy

Sedative/Hypnotic
• Used for insomnia
• Produces CNS depression by binding with GABA receptors resulting in sedations and induction of sleep

Dosage:
• Tablets, spray, or SL tablets: 10 mg PO HS
• Extended-release tablets: 12.5 mg PO HS

Contraindications: Sleep apnea, substance abuse history, psychiatric history, hepatic impairment, pulmonary disease

S/E: Daytime drowsiness, dizziness, diarrhea, nausea, vomiting

Antiarrhythmics Class III
• Used for suppression of arrhythmias
• Prolongs action potential and refractory period
• Inhibits adrenergic stimulation
• Slows the sinus rate, increases PR and QT intervals, and decreases peripheral vascular resistance (vasodilation)
Dosage:
Ventricular:
• 800–1600 mg/day PO in 1–2 doses for 1–3 wk, then 600–800 mg/day PO in 1–2 doses for 1 mo, then 400 mg/day PO maintenance dose
• 150 mg IV over 10 min, followed by 360 mg IV over the next 6 hr and then 540 mg IV over the next 18 hr; continue infusion at 0.5 mg/min IV until oral therapy is initiated
Supraventricular:
• 600–800 mg/day PO for 1 wk or until desired response occurs or side effects develop, then ↓ to 400 mg/day PO for 3 wk, then maintenance dose of 200–400 mg/day PO

S/E: Dizziness, fatigue, malaise, corneal microdeposits, bradycardia, hypotension, anorexia, constipation, nausea, vomiting, photosensitivity, hypothyroidism, ataxia, involuntary movement, paresthesia, peripheral neuropathy, poor coordination, tremor

Antihypertensive/ Calcium Channel Blocker
• Used for management of HTN and angina
• Inhibits the transport of calcium into myocardial and vascular smooth muscle cells, lowering excitation-contraction coupling and subsequent contraction
• Systemic vasodilation resulting in decreased blood pressure
• Coronary vasodilation resulting in decreased frequency and severity of attacks of angina

Dosage: 5–10 mg PO once daily

Contraindication: Systolic blood pressure <90 mm Hg

S/E: Headache, peripheral edema

Anti-infective/ Aminopenicillins Beta Lactamase Inhibitors
• Bactericidal action active against streptococci, pneumococci, and enterococci
• Binds to bacterial cell wall, resulting in cell death; spectrum is broader than that of penicillin. Addition of sulbactam increases resistance to beta-lactamases, enzymes produced by bacteria that may inactivate ampicillin

Dosage: IM/IV- 1–2 g ampicillin q 6–8 hr (not to exceed 12 g ampicillin/day)

Contraindication: Penicillin or sulbactam allergy

S/E: Diarrhea, rash, pain at IM/IV site

Anti-infective/ First Generation Cephalosporins
• Bactericidal action against susceptible bacteria such as many gram-positive cocci, and some gram-negative rods
• Binds to bacterial cell wall membrane, causing cell death
• Not effective against MRSA
Dosage:
• Moderate-to-severe infections: 500 mg-2 g IM/IV every 6–8 hr; maximum 12 g/day
• Mild infections with Gram-positive cocci: 250–500 mg IM/IV every 8 hr
• Uncomplicated urinary tract infection: 1 g PO every 12 hr
• Pneumococcal pneumonia: 500 mg IM/IV every 12 hr
• Infective endocarditis or septicemia: 1–1.5 g IM/IV every 6 hr
• Perioperative prophylaxis: 1 g IM/IV within 30–60 min prior to incision (an additional 500 mg-1 g should be given for surgeries ≥ 2 hr) 500 mg-1 g should then be given for all surgeries every 6–8 hr for 24 hr following the surgery

Contraindications: Allergy to penicillins or cephalosporins

S/E: Diarrhea, nausea, vomiting, rash, pain at IM site, phlebitis at IV site

Anti-Anginals/Anti-Hypertensives/Beta Blockers
• Used for management of HTN, angina pectoris, and prevention of MI
• Blocks stimulation of Beta 1 (adrenergic) receptors
• Decreases BP and HR and incidence of angina
Dosage:
• Antianginal: 50 mg PO once daily; may be increased after 1 wk to 100 mg/day PO (up to 200 mg/day)
• Antihypertensive: 25–50 mg PO once daily; may be increased after 2 wk to 50–100 mg PO once daily
• MI: 50 mg PO, then 50 mg PO 12 hr later, then 100 mg/day PO as a single dose or in 2 divided doses for 6–9 days or until hospital discharge
Contraindications: Uncompensated CHF, pulmonary edema, cardogenic shock, bradycardia or heartblock
S/E: Fatigue, weakness, ED

Anti-Arrhythmics/ Anti-Cholinergics
• Treatment of sinus bradycardia and heart block
• Increases HR
• Inhibits the action of acetylcholine at postganglionic sites located in smooth muscle and CNS

Doses: 0.5–1 mg IV; may repeat as needed q 5 min, not to exceed a total of 2 mg (q 3–5 min in Advanced Cardiac Life Support guidelines) or 0.04 mg/kg (total vagolytic dose)

Contraindications: Tachycardia secondary to cardiac insufficiency or thyrotoxicosis

S/E: Drowsiness, blurred vision, tachycardia, dry mouth, urinary hesitancy

Loop Diuretic
• Treats edema due to heart failure, hepatic disease, or renal impairment
• Induces diuresis and subsequent mobilization of excess fluid (edema, pleural effusions)
• Inhibits the reabsorption of sodium and chloride from the loop of Henle and distal renal tubule
• Increases renal excretion of water, sodium chloride, magnesium, potassium, and calcium

Dosage:
• PO: 0.5–2 mg/day given in 1–2 doses; titrate to desired response (maximum daily dose = 10 mg/day)
• IV/IM: 0.5–1 mg/dose, may repeat q 2–3 hr as needed (up to 10 mg/day)

S/E: dehydration, hypochloremia, hypokalemia, hypomagnesemia, hyponatremia, hypovolemia, metabolic alkalosis

Fat Soluble Vitamins
• Used for treatment and prevention of deficiency states, particularly bone manifestations
• Management of hypocalcemia in patients undergoing chronic renal dialysis
• Treatment of hypocalcemia in patients with hypoparathyroidism or pseudohypoparathyroidism
• Active form of vitamin D that promotes the absorption of calcium and decreases parathyroid hormone concentrations

Dosage:
• Hypocalcemia during dialysis: PO: 0.25 mcg/day or every other day; if needed, may ↑ by 0.25 mcg/day at 4–8 wk intervals (typical dosage = 0.5–1 mcg/day)
• IV: 0.5 mcg (0.01 mcg/kg) 3 times weekly during dialysis. May be increased by 0.25–0.5 mcg/dose at 2- to 4-wk intervals (typical maintenance dose = 0.5–3 mcg 3 times weekly (0.01–0.05 mcg/kg 3 times weekly)
• Hypoparathyroidism: 0.25 mcg/day PO initially; if needed, may ↑ dose by 0.25 mcg/day at 2–4 wk intervals (typical dosage = 0.5–2 mcg/day)
• Pre-dialysis: 0.25 mcg/day PO; if needed, may ↑ dosage up to 0.5 mcg/day

Anti-Anginal/Anti-Arrhythmic/Anti-HTN /CC Blockers

• Used to treat HTN, angina, and supraventricular tachyarrhythmias and rapid ventricular rates in atrial flutter or fibrillation
• Inhibits transport of calcium into myocardial and vascular smooth muscle cells, resulting in inhibition of excitation-contraction coupling and subsequent contraction
• Systemic vasodilation resulting in decreased blood pressure
• Coronary vasodilation resulting in decreased frequency and severity of attacks of angina
Dosage:
• PO: 30–120 mg 3–4 times daily or 60–120 mg twice daily as SR capsules or 180–240 mg once daily as CD or XR capsules or LA tablets (up to 360 mg/day)
• IV: 0.25 mg/kg; may repeat in 15 min with a dose of 0.35 mg/kg. May follow with continuous infusion at 10 mg/hr (range 5–15 mg/hr) for up to 24 hr

Contraindication: Systolic blood pressure <90 mm Hg, recent MI or pulmonary congestion
S/E: Peripheral edema