Allopurinol

Therapeutic class: Antigout drug

Pregnancy risk category C
Action: Inhibits conversion of xanthine to uric acid and increases reutilization of hypoxanthine
and xanthine for nucleic acid synthesis, thereby decreasing uric acid levels in both serum and
urine
Availability
 Powder for injection: 500-mg vial Tablets: 100 mg,300 mg 1
Indications and dosages
 Gout in patients with frequent disabling attacks; gout resulting from hyperuricemia, acute
or chronic leukemia, psoriasis, or multiple myeloma Adults:200 to 300 mg P.O.daily in
mild cases or 400 to 600 mg P.O.daily in severe cases, to a maximum dosage of 800
mg/day; or 200 to 400 mg/m2/day I.V.as a single infusion or in equally divided doses q
6,8,or 12 hours to a maximum dosage of 600 mg/day Children ages 6 to 10:300 mg
P.O.daily Children younger than age 6:150 mg P.O.daily
 To prevent acute gout attacks Adults:100 mg P.O.daily;increase by 100 mg at weekly
intervals without exceeding maximum dosage of 800 mg,until uric acid level falls to 6
mg/dl or less
 Recurrent calcium oxalate calculi Adults:200 to 300 mg P.O.daily in single dose or
divided doses
 To prevent uric acid nephropathy during cancer chemotherapy Adults:600 to 800 mg
P.O.daily for 2 to 3 days, accompanied by high fluid intake Dosage adjustment
 Renal impairment
Off-label uses
 Hematemesis caused by gastritis  Seizures refractory to standard
induced by nonsteroidal anti- therapy Contraindications
inflammatory drugs  Hypersensitivity to drug
 Pain from acute pancreatitis

Precautions
Use cautiously in:
 Acute gout attack, renal insufficiency, dehydration
 Pregnant or breastfeeding patients.
Adverse reactions
 CNS: drowsiness, dizziness, headache, peripheral neuropathy ,neuritis, paresthesia
 CV: hypersensitivity vasculitis, necrotizing vasculitis
 EENT: retinopathy ,cataract, epistaxis
 GI: nausea, vomiting, diarrhea, abdominal pain ,dyspepsia ,gastritis
 GU: exacerbation of gout and renal calculi, uremia, renal failure
 Hematologic: eosinophilia, anemia, thrombocytopenia, bone marrow depression,
agranulocytosis, leukocytosis, aplastic anemia, leukopenia
 Hepatic: cholesteric jaundice, hepatomegaly, hepatitis, hepatic necrosis
 Musculoskeletal: myopathy, joint pain
 Skin: rash; alopecia; maculopapular, urticarial, or purpuric lesions; severe furunculosis of
nose chthyosis; bruising; scaly or exfoliative erythema multiforme ;toxic epidermal
necrolysis
 Other: abnormal taste ,loss of taste, fever, chills
Patient teaching
 Instruct patient to promptly report painful urination, bloody urine, rash, eye irritation, or
swelling of lips and mouth.
 Tell patient to take drug with food or milk, exactly as prescribed.
 Explain that gout attacks may not ease significantly until 2 to 6 weeks of therapy.
 Caution patient to avoid driving and other hazardous tasks until he knows how drug
affects concentration and alertness.
 Advise patient to avoid alcohol, caffeine-containing beverages and foods, mineral water,
and orange juice during therapy.
 As appropriate, review all other significant and life-threatening adverse reactions and
interactions, especially those related to the drugs, tests, foods, and behaviors mentioned
above.

Mefloquine Hydrochloride
Therapeutic class: Antimalarial
Pregnancy risk category C
Action: Unknown. Thought to increase intravesicular pH in parasite acid vesicles and form
complexes with hemin, inhibiting parasite development.
Availability: Tablets- 250 mg
Indications and dosages
 Acute malarial infection Adults: 1,250 mg P.O.as a single dose Children: 20 to 25 mg/kg
P.O.in two divided doses given 6 to 8 hours apart
 Malaria prophylaxis Adults and children weighing more than 45 kg (99 lb): 250 mg
P.O.once weekly on same day each week, starting 1 week before entering endemic area
and continuing for 4 weeks after leaving area Children weighing 30 to 45 kg (66 to 99
lb): 187.5 mg P.O.q week Children weighing 20 to 30 kg (44 to 66 lb): 125 mg P.O.q
week
 Children weighing 10 to 20 kg (22 to 44 lb): 62.5 mg P.O.q week Children weighing 5 to
10 kg (11 to 22 lb): 31.25 mg P.O.q week
Contraindications
 Hypersensitivity to drug, related agents (quinine, quinidine), or excipients
 Prophylactic use in patients with active depression, recent history of depression,
generalized anxiety disorder, psychosis, schizophrenia, other psychiatric disorders, or
history of seizures
Precautions
Use cautiously in:
 cardiac disorders, seizure disorders
 pregnant or breastfeeding patients
 Children.
Adverse reactions
 CNS: dizziness, syncope headache, psychotic changes, depression, hallucinations,
confusion, anxiety, fatigue, vertigo, seizures
 EENT: blurred vision, tinnitus
 GI: nausea, vomiting, diarrhea, loose stools, abdominal discomfort, anorexia
Hematologic: leukopenia, thrombocytopenia
 Musculoskeletal: myalgia
 Skin: rash
 Other: fever, chills
Patient teaching
 Tell patient to take with full glass of water and not on empty stomach.
 In prophylactic use, instruct patient to take first dose 1 week before departure and to
continue therapy as prescribed upon return. Tell him to take drug on same day each week.
 Advise patient to report fever after returning from malarious area.
 Inform patient that malaria prophylaxis should include protective clothing, insect
repellent, and bed netting. 2Tell patient to immediately report psychiatric symptoms
(such as acute anxiety, depression, restlessness, or confusion) and to stop taking drug.
 Caution patient to avoid driving and other hazardous activities because drug may cause
dizziness.
 Instruct patient to have periodic ophthalmic exams, because drug may cause eye damage.
 Tell female patient to inform prescriber if she is pregnant.
 Advise female patient not to breastfeed while taking drug.
 As appropriate, review all other significant and life-threatening adverse reactions and
interactions, especially those related to the drugs and tests mentioned above

Loxapine Succinate
Therapeutic class: Antipsychotic
Pregnancy risk category C
Action: Unknown.Thought to block neurotransmission of postsynaptic dopamine receptors in
brain, alleviating psychotic symptoms.
Availability: Capsules: 5 mg, 10 mg, 25 mg,50 mg
Indications and dosages
 Schizophrenia Adults: 10 mg P.O.b.i.d. Dosage may be increased over first 7 to 10
days,up to 100 mg/day P.O.in two to four divided doses. Maximum dosage is 250
mg/day.
Contraindications
 Hypersensitivity to drug or other dibenzoxazepines
 Coma or severe drug-induced CNS depression
Precautions
Use cautiously in:
 Seizures  Parkinson’s disease
 Cerebral arteriosclerosis  Blood dyscrasias
 Severe hypotension  Urinary retention
 Hypertension  Concurrent use of other CNS active
 Glaucoma drugs or anticholinergics
 Breast cancer  Pregnant or breastfeeding patients
 Hepatic disease  Children younger than age 16
 Bone marrow depression

Adverse reactions
 CNS: drowsiness, insomnia, vertigo, headache, dizziness, weakness, akinesia ,staggering
or shuffling gait, slurred speech, agitation, extrapyramidal reactions, sedation, syncope,
tardive dyskinesia, numbness, confusion, pseudoparkinsonism,
 EEG changes, seizures, neuroleptic malignant syndrome
 CV: orthostatic hypotension, hypertension, ECG changes
 EENT: blurred vision, ptosis, nasal congestion
 GI: nausea, vomiting, constipation, dry mouth, paralytic ileus
 GU: urinary retention
 Hematologic: leukopenia, agranulocytosis, thrombocytopenia
 Hepatic: hepatocellular injury with hepatic enzyme elevations
 Metabolic: polydipsia
 Musculoskeletal: muscle twitching
 Skin: rash, pruritus, seborrhea, photosensitivity, alopecia
 Other: weight gain or loss, hyperpyrexia, facial edema, hypersensitivity reactions
Patient teaching
 Tell patient to take with or without food.
 Inform patient that drug may cause tardive dyskinesia. Describe symptoms.
 Caution patient to avoid activities requiring mental concentration until drug’s effects are
known. Teach patient to immediately report sore throat, fever ,rash, Impaired vision,
tremors, involuntary muscle twitching, muscle stiffness, or yellowing of eyes or skin.
 Instruct patient to move slowly when sitting up or standing, to avoid dizziness from
sudden blood pressure decrease.
 Caution patient to avoid alcohol use.
 As appropriate, review all other significant and life-threatening adverse reactions and
interactions, especially those related to the drugs, tests, and behaviors mentioned above.
Fluconazole
Therapeutic class: Systemic antifungal
Pregnancy risk category C
Action: Alters cellular membrane, increasing permeability and leakage of essential elements
needed for fungal growth. At higher concentrations , may be fungicidal.
Availability:
 Injection: 2 mg/ml in 100- or 200-ml bottles or containers
 Powder for oral suspension: 50 mg/ 5 ml in 35-ml bottle,200 mg/5 ml in 35-ml bottle
 Tablets: 50 mg,100 mg,150 mg, 200 mg
Indications and dosages
 Oropharyngeal candidiasis Adults: 200 mg P.O.or I.V.on first day, followed by 100
mg/day for at least 2 weeks Children: 6 mg/kg P.O.or I.V.on first day, followed by 3
mg/kg/day for at least 2 weeks
 Esophageal candidiasis Adults:200 mg P.O.or I.V.on first day, followed by 100 mg/day
for 3 weeks and then for 2 weeks after symptom resolution. Up to 400 mg/day may be
used in severe cases. Children: 6 mg/kg P.O.or I.V.on first day, followed by 3 mg/kg/day
for 3 weeks and for at least 2 weeks after symptom resolution
 Candidal urinary tract infection; peritonitis Adults: 50 to 200 mg P.O.or I.V.daily
 Systemic candidiasis Adults:400 mg P.O.or I.V.on first day, followed by 200 mg/day for 4
weeks and for at least 2 weeks after symptom resolution Children:6 to 12 mg/kg/day
P.O.or I.V.
 Vaginal candidiasis Adults:150 mg P.O.as a single dose
 Cryptococcal meningitis Adults:400 mg P.O.or I.V.on first day, followed by 200 or 400
mg/day for 10 to 12 weeks after cerebrospinal fluid (CSF) is negative Children: 12 mg/kg
P.O.or I.V.on first day, followed by 6 mg/kg/day for 10 to 12 weeks after CSF is negative
 Suppression of cryptococcal meningitis in patients with AIDS Adults: 200 mg/day P.O.or
I.V.
 To prevent candidiasis after bone marrow transplantation
Contraindications
 Hypersensitivity to drug or its components
 Concurrent use of terfenadine (not available in U.S.) in patients receiving fluconazole at
multiple doses of 400 mg or higher and other drugs known to prolong QT interval and
that are metabolized via CYP3A4,such as cisapride,astemizole (not available in
U.S.),pimozide, and quinidine
Precautions
Use cautiously in:
 Hypersensitivity to other azole  prolonged QT interval, torsades de
antifungals pointes, and consequently sudden
 Renal impairment or hepatic disease death (avoid use)
 Potentially proarrhythmic conditions  Pregnant or breastfeeding patients
 Concurrent use of erythromycin  Children younger than 6 months.
because of potential for increased risk
of
Adverse reactions
 CNS: headache, dizziness
 CV:QT interval prolongation, torsades de pointes
 GI: nausea, vomiting, diarrhea, dyspepsia, abdominal discomfort
 Hematologic: leukopenia, thrombocytopenia
 Hepatic: hepatotoxicity
 Skin: rash, pruritus, exfoliative skin disorders (including Stevens-Johnson syndrome)
 Other: altered taste, anaphylaxis
Patient teaching
 Teach patient how to recognize and immediately report signs and symptoms of allergic
response.
 Urge patient to contact prescriber if rash occurs, to determine whether Stevens-Johnson
syndrome is developing.
 Caution patient to avoid driving and other hazardous activities until he knows how drug
affects concentration and alertness.
 Advise patient to minimize GI upset by eating frequent, small servings of food and
drinking adequate fluids.
 Tell female patient to inform prescriber if she is pregnant or breastfeeding.
 As appropriate, review all other significant and life-threatening adverse reactions and
interactions, especially those related to the drugs and tests mentioned above.

Carvedilol
Therapeutic class: Antihypertensive
Pregnancy risk category C
Action: Blocks stimulation of cardiac beta1adrenergic receptor sites and pulmonary beta2-
adrenergic receptor sites. Shows intrinsic sympathomimetic activity, causing slowing of heart
rate, decreased myocardial excitability, reduced cardiac output, and decreased renin release from
kidney.
Availability:
 Capsules (extended-release): 10 mg, 20 mg,40 mg,80 mg
 Tablets: 3.125 mg,6.25 mg,12.5 mg, 25 mg
Indications and dosages
 Hypertension: Adults: Initially,6.25 mg P.O.b.i.d. (Coreg).May be increased q 7 to 14
days to a maximum dosage of 25 mg b.i.d.Or,20 mg P.O.daily (Coreg CR).If tolerated,
using standing systolic pressure about 1 hour after dosing, maintain dosage of Coreg CR
for 7 to 14 days; then increase to 40 mg once daily if needed based on trough systolic
standing blood pressure. Maintain this dosage for 7 to 14 days and adjust to 80 mg once
daily if tolerated and needed. Total daily dose of Coreg CR shouldn’t exceed 80 mg.
 Heart failure caused by ischemia or cardiomyopathy Adults: Initially,3.125 mg P.O.b.i.d.
(Coreg) for 2 weeks. May increase to 6.25 mg b.i.d. Dosage may be doubled q 2 weeks as
tolerated ,not to exceed 25 mg b.i.d.in patients weighing less than 85 kg (187 lb) or 50
mg b.i.d.in patients weighing more than 85 kg.Or,10 mg P.O.daily (Coreg CR) for 2
weeks. If tolerated, increase dosage to 20 mg,40 mg, and 80 mg over successive intervals
of at least 2 weeks.
 Left ventricular dysfunction following myocardial infarction Adults:Initially,6.25 mg
P.O.b.i.d. (Coreg);increase after 3 to 10 days to 12.5 mg b.i.d.(based on tolerability), then
increase to target dosage of 25 mg b.i.d.A lower starting dose (3.125 mg b.i.d.) or slower
titration may be used if clinically indicated.Or,20 mg P.O. once daily (Coreg
CR);increase after 3 to 10 days to 40 mg daily (based on tolerability),then increase to
target dose of 80 mg daily. A lower starting dose may be used (10 mg daily) or the rate of
up titration may be slowed if clinically indicated.
Off-label uses
 Angina pectoris
 Idiopathic cardiomyopathy
Contraindications
 Hypersensitivity to drug  Bradycardia or heart block
 Uncompensated heart failure  Severe hepatic impairment
 Pulmonary edema  Bronchial asthma
 Cardiogenic shock  bronchospasm
Precautions
Use cautiously in:
 Renal or hepatic impairment  Hypotension
 Pulmonary disease  Respiratory depression
 Diabetes mellitus  Elderly patients
 hypoglycemia  Pregnant or breastfeeding patients
 Thyrotoxicosis  Children
 Peripheral vascular disease
Adverse reactions
 CNS: dizziness, fatigue, anxiety, depression, insomnia, memory loss, nightmares,
headache, pain
 CV: orthostatic hypotension, peripheral vasoconstriction, angina pectoris, chest pain,
hypertension, bradycardia, heart failure, atrioventricular block
 EENT: blurred or abnormal vision, dry eyes, stuffy nose, rhinitis, sinusitis, pharyngitis
 GI: nausea, diarrhea, constipation
 GU: urinary tract infection, hematuria, albuminuria, decreased libido, erectile
dysfunction, renal dysfunction
 Hematologic: bleeding, purpura, thrombocytopenia
 Metabolic: hypovolemia, hypervolemia, hyperglycemia, hyponatremia, hyperuricemia,
glycosuria, gout, hypoglycemia
 Musculoskeletal: arthralgia, back pain, muscle cramps
 Respiratory: wheezing, upper respiratory tract infection, dyspnea, bronchitis,
bronchospasm, pulmonary edema S
 Skin: pruritus, rash
 Other: weight gain, lupus like syndrome, viral infection, and anaphylaxis
Patient teaching
 Instruct patient to take drug with food exactly as prescribed.
 Tell patient to take extended-release capsule in the morning with food, to swallow
capsule whole, and not to chew, crush, or divide its contents.
 Instruct patient who can’t swallow capsule whole to carefully open capsules sprinkle
contents on cool or cold applesauce, and swallow contents immediately without chewing.
Tell patient not to store mixture for future use. Caution patient not to stop taking drug
abruptly, because serious reactions may result.
 Advise patient to move slowly when sitting up or standing, to avoid dizziness or light-
headedness from sudden blood pressure drop.
 Caution patient to avoid driving and other hazardous activities until he knows how drug
affects concentration and alertness.
 Inform male patient that drug may cause erectile dysfunction. Advise him to discuss this
issue with prescriber.
 Advise patient to use soft-bristled toothbrush and electric razor to avoid gum and skin
injury.
 As appropriate, review all other significant and life-threatening adverse reactions and
interactions, especially those related to the drugs, tests, foods, and behaviors mentioned
above.