كتيب أدوية الازمات والكوارث

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HANDBOOK
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Cultures
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Empiric
Therapy
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Stop, Narrow,
Change to Oral
Prepared by:
Dr. Rasha Elmeciry
Dr. Shimaa Elfaramawy
Under Supervision Of Pharmacy Director Dr. Mohammed Helmy Hospital Director

Dr. Ibrahim Zidan
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No Drug name
1 Acetaminophen (Abimol®,Paramol®, Cetal®,Perfalgan®) 6
2 Acetyl salicylic acid (Aspirin®) 7
3 Acyclovir (Acyclovir ®) 8
4 Adrenaline (Adrenaline®, Epinephrine®) 11
5 Amiodarone (Cordarone®) 13
6 Amikacin (Amikin®, Amikacin®) 14
7 Amoxicillin + fluxacillin (Flumox®) 15
8 Ampicillin + sulbactam (Unasyn®) 16

9 Atracurium (Tracrium®) 18
10 Atropine (Atropine sulphate®) 19
11 Budenoside (Budecort®,Pulmicort®,Rhinocort®) 21
12 Calicum gluconate 22
13 Captopril ( Capoten®) 24
14 Cefepime (Maxipime®, Wincef®) 26
15 Cefotaxime (Cefaxim®, Cefotax®, Ceforan®) 27
16 Ceftriaxone (Cefaxone®, Cefotrix®) 28

17 Chlorpheniramine maleate (Avil®) 30
18 Clarithromycin (Klacid®) 31
19 Clopidogril (Plavix®) 32
20 Dexamethasone(Apidone®,Fortecortin®, Orazone®) 33
21 Diazepam (Valium®, Neuril®) 35
22 Diclofenac potassium (Cataflam®, Actifast®) 37
Digoxin (Lanoxin®)
23 38
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24 Dobutamine (Dobutamine®, Dobuject®) 41

25 Dopamine (Intropin®,Dopasunny®) 42
26 Doxycycline (vibramycin®) 43
27 Enoxaparin (Clexane®) 44
28 Etamsylate (Dicynone ®) 45
29 Famtodine (Antodine ) 46
30 Flumazenil (Anexate®, Anexnil®) 47
31 Furosemide ( Laxis®) 49
32 Heparin 50
33 Hydrocortisone sodium succinate ( Solu-Cortef®) 51
34 Ibuprofen (Brufen®, Megafen®, Profinal®) 52
35 Imipenem/cilastatin (Tienam®) 54
36 Ipratropium (Atrovent®) 56
37 Isoflurane 57
38 Isosorbid dinitrate ( Dinitra®) 58
39 Ketoprofen (Ketofan®, Ketoprof®) 59
40 Levofloxacin (Tavanic®) 60
41 Linezolid (Averozolid®, Linezomentin®) 62
42 Magnesium sulphate 63
43 Meropenem (Meronem®, Mirage®) 65
44 Methyl prednisolone (Methyl prednisolone MYLAN®) 66
45 Metronidazole ( Flagyl®, Amrizole®) 68
46 Midazolam (Dormicum®, Midathetic®) 69
47 Naloxone ( Rescuerix®, Xeropium®) 71
48 Noradrenaline (Levophrine®) 72
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49 Obidoxime 73

6
50 Ondansetron (Danset®, Zofran®) 74

51 Oxytocin (Oxytocin®, Syntocinon®) 75
52 Pantoprazole (Controloc®, Pantazol®, Zurcal®) 76
53 Phenytoin ( Epanutin®, Phenytin®) 78
54 Piroxicam (Feldene®,lnflacam®) 79
55 Potassium chloride 81
56 Propofol (Diprivan®) 84
57 Propranolol (Inderal®, Mayestrotense®) 86
58 Protamine sulfate (Protam®) 78
610
59 Recombinant human insulin (Insulin H R) 88
60 Rifampicin (Rimactan®) 90
61 Salbutamol ( Salbovent®, Farcolin®, vental®, Bronchoterol®) 92
62 Salbutamol /beclomethasone (Vental Compositum®) 94

63 Sodium bicarbonate 95
64 Streptokinase (Streptolase ®) 96
65 Streptomycin (Streptomycin sulphate®) 97
66 Theophylline (Minophylline- N®) 98

67 Tiemonium Methylsulfate (Spasmofree®,Visceralgine®) 102
68 Tranexamic acid( Kapron®) 102
69 Trimebutine Maleate (Gastreg®) 104
70 Vancomycin (Vancobact®, Vancomix®) 105
71 Verapamil (Isoptin®) 107
72 Vitamin k (Phytomenadione®,Konakion®,Amri-k®) 109

7
No Fluids
1 Glucose 5 % 110
2 Glucose 10 %
111
3 Glucose 25% 111
4 Hydroxyethyl starch ( Voluven®, Heasteril®) 112
5 Lactated Ringer 114
6 Mannitol 115
7 Sodium chloride 0.9%
116

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3\retaminop fien (Paramo f, CetaC, PerfaCgari\ PyraC)

Drug Class: antipyretics, analgesics.
Indications: Analgesia and Fever.
Dosage:
Parenteral:
pediatric:
2 to 12 years: 15 mg/kg IV every 6 hours or 12.5 mg/kg IV every 4 hours; max. single dose not to
exceed 750mg.
Adult: 1 g IV every 6 hours OR 650 mg IV every 4 hours, maximum dose: 4 g/day.
Oral:
Pediatric: 10 to 15 mg/kg orally every 4 to 6 hours as needed not to exceed 5 doses in 24 hours. Adult:
325-650 mg PO q4-6h, maximum dose 4g/day. extra-strength 500-1000mg PO q4-6h, maximum dose 4
g/day.
Rectal:
Infants and Children: 10 to 20 mg/kg rectally every 4 to 6 hours as needed; maximum of 75 mg/kg/day.
Adult: 650 mg rectally every 4 to 6 hours, maximum dose: 4 g/day.
Dosage adjustment
Renal impairment: CrCI <30: consider decrease dose and/or frequency.
Hepatic impairment:
■ Mild-moderate impairment: caution advised, consider decrease dose;
■ Severe impairment: contraindicated.
Administration:
Chewable tablets: Chew tablets before swallowing.
Extended-release: Swallow whole; do not crush, chew, split, or dissolve.
Oral disintegrating tablets: Allow to dissolve in mouth or chew before swallowing. Oral suspension:
Shake well before using.
Injection:
■ 1 g (100 mL) vial For IV infusion only. Administer undiluted over 15 minutes.
■ Do not add other medication(s) to the vial or infusion device.
■ Store at 20 C to 25 C, Do not refrigerate or freeze.
Precautions:
■ Unlike ASA or NSAIDs, acetaminophen does NOT have anti-inflammatory effects.
■ Hepatotoxicity at dosages <4g/day have been reported.
■ Use with caution in patients with febrile neutropenia or severe infections as acetaminophen
may mask the fever, leading to delayed treatment of life-threatening infections. If
symptomatic relief is needed, give single dose only and appropriate actions have been taken
(e.g. blood cultures, antibiotics).
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■ Treat acetaminophen overdose with N-
acetylcysteine: 150 mg/kg (~60ml) in 200 ml D5W over 1 hour, then 50 mg/kg (~20ml) in 500 ml
D5W over 4 hours, then 100 mg/kg (~40 ml) in IL D5W over 16 hours. Alternatively, N-
acetylcysteine 140 mg/kg PO/NG, then 70 mg/kg q4h for 17 doses.
Pregnancy category: B
Lactation: excreted in breast milk, compatible with breastfeeding.
AcetylsaCicyCic acitf (Asjnrin®)
Dosage form & strength: 75,81,100,300,500 mg tablet.

Class: Antiplatelet Agents, NSAIDs.
Indications: Antiplatelet therapy for cardiovascular and cerebrovascular disease.
Dosage:
162 to 325 mg once (chew and swallow) at the time of diagnosis; then 75 to 100 mg once daily.
Dosage adjustment:
Renal impairment:
■ CrCI >10 mL/min: Dose adjustment not necessary.
■ CrCI <10 mL/min: Not recommended.
Hepatic impairment:
■ Severe liver disease: Not recommended.
Dosage in pediatrics:-
■ Analgesia / antipyretic : 10-15 mg/kg 4-6 hr;
■ Kawasaki Febrile phase: 80-100 mg/kg/day PO divided q6hr for up to 14 days (48-72 hours after
fever defervescence).
Maintenance: 3-6 mg/kg/day PO in single dose.
Contraindications:
■ Hypersensitivity to aspirin.
■ Gastrointestinal bleeding.
■ Hemolytic anemia from pyruvate kinase (PK) and glucose-6-phosphate dehydrogenase (G6PD)
deficiency.
■ Hemorrhoids, lactating mother, nasal polyps associated with asthma, sarcoidosis,
thrombocytopenia, ulcerative colitis.
Precautions:
■ Aspirin tablets should be administered with caution to patients with Gl malabsorption, history of
peptic ulcers, gout, hepatic disease, hypochlorhydria, hypoprothrombinemia, renal
impairment,thyrotoxicosis, vitamin K deficiency.
■ NSAIDS have the potential to trigger HF by prostaglandin inhibition that leads to sodium and
water retention, increased systemic vascular resistance, and blunted response to diuretics.
■ High-dose aspirin (greater than 325mg) should be avoided or withdrawn whenever possible.
Important drug interactions:
■ Large doses of salicylates have a hypoglycaemic action and may enhance the effect of the oral
hypoglycaemics.
■ Serum phenytoin levels may be increased by aspirin.
■ Coadministration with ACEIS ( Captopril, enalapril, lisinopril) may result in a significant decrease
in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors.
■ Varicella Virus-Containing Vaccines: Salicylates may enhance the adverse/toxic effect of
Varicella Virus-Containing Vaccines. Specifically, the risk for Reye's syndrome may increase.
Avoid combination.
Pregnancy:
■ Avoid chronic or intermittent high doses during pregnancy; may affect maternal and newborn
hemostasis mechanisms, leading to an increased risk of hemorrhage.
■ High doses may also increase perinatal mortality by intrauterine growth restriction and
teratogenic effects.
■ Near term, aspirin may prolong gestation and labor.
■ Premature closure of the ductus arteriosus may occur if used near term with use of full-dose
aspirin.
Lactation: Drug enters breast milk; discontinue nursing or discontinue drug.
sodium (^AcvcCovir )
Dosage form & strength: 500 mg vial.

Class: Antivirals.
Indications:
■ Herpes simplex encephalitis.
■ Herpes simplex virus, genital infection (severe).
■ Herpes simplex virus, mucocutaneous infection in immunocompromised patients.
■ Herpes simplex virus, neonatal.
■ Herpes zoster (shingles) in immunocompromised patients.
■ Varicella Zoster (Chickenpox).
General dosing
Adult dose
IV: 10-20 mg/kg q8hr for 10 days; up to 14-21 days reported; In obese patients, use IBW Oral: 400-800
mg q8 hr.
Ideal BodyWeight (IBW):
IBW (male) = 50 + 2.3 (H - 60).
IBW (female) = 45.5 + 2.3 (H - 60).
Where: H = height in inches. 1 Inch = 2.54 cm.
Pediatric dose:
30 mg/kg/day IV divided q8hr for 14-21 days; alternatively, 20 mg/kg IV q8hr for 14-21 days.
20 mg/kg orally 4 times a day.
Dose adjustment
Renal dosing:
Percent Dosing
Creatinine clearance
r of
[ interval
(mL/min/1.73 m2)
ec :ommen ▼ (hours)
>50 100% 8
25 to 50 100% 1
2
10 to 25 100% 2
4
2
Oto 10 50%
4
Liver impairment: No adjustment recommended.

Administration:
■ Each 500 mg vial should be reconstituted by 10 ml SWI.
■ The resulting solution contains 50 mg acyclovir per mL (pH approximately 11).
■ Shake the vial well to assure complete dissolution before measuring and transferring each
individual dose.
■ Further dilute by 100-250 ml NS, or D5W (approximately 7 mg/mL or lower are
recommended).
■ Higher concentrations (e.g., 10 mg/mL) may produce phlebitis or inflammation at the injection
site upon inadvertent extravasation.
■ DO NOT USE BACTERIOSTATIC WATER FOR INJECTION CONTAINING BENZYL ALCOHOL OR
PARABENS.
Oral: Administer with or without food.
Stability:
■ Once diluted for administration, each dose should be used within 24 hours.
■ The reconstituted solution should be used within 12 hours.
■ To prevent precipitation, avoid refrigerating reconstituted solutions.
Precautions
■ Avoid rapid infusion because of risk of renal damage.
■ Use with caution in immunocompromised patients (potential risk of thrombotic
thrombocytopenic purpura [TTP]/hemolytic uremic syndrome [HUS]).
■ Use with caution in patients with renal impairment.
■ Treatment should begin within 24 hours of appearance of rash.
■ Use with caution in patients receiving nephrotoxic drugs.
■ Maintain adequate hydration during PO or IV therapy to decrease nephrotoxicity.
■ Thrombocytopenic purpura/hemolytic uremic syndrome reported.
■ Extravasation may occur during administration of acyclovir, If signs or symptoms of
extravasation occur:
* Stop the infusion immediately.
* If possible, withdraw 3 to 5 mL of blood to remove some of the drug.
* Remove the infusion needle.
* Delineate the infiltrated area on the patient's skin with a felt-tip marker.
* Hyaluronidase is an effective antidote for hyperosmolar drug infiltrations; administer
promptly within the first few minutes to 1 hour after extravasation. Higher doses (150
units) have primarily been used in adults while lower doses (15 units) have been used in
children.
* Administer hyaluronidase according to the following steps:
Dilute hyaluronidase to desired concentration, depending on the dose and product
used. (Note: Some products do not require dilution.) For example, if the total dose is
15 units, make 15 units/mL dilution. If the total dose is 150 units, make 150 units/mL
dilution.
Cleanse area with povidone-iodine, Inject hyaluronidase locally, subcutaneously or
intradermally, using a 25-gauge needle or smaller.
The dose is given as five 0.2 mL injections at the leading edge of the extravasation site
(Change needle after each injection).
Elevate for 48 hours above heart level using a sling or stockinette dressing with an
observation window cut in the dressing.
Avoid pressure or friction. Do not rub area. Observe for signs of increased erythema,
pain, or skin necrosis. If increased symptoms occur, consult a plastic surgeon. Ensure
that no medication is given distally to extravasation site. After 48 hours, encourage the
patient to use the extremity normally to promote full range of motion.
■ Precipitation of acyclovir crystals in renal tubules can occur if the maximum solubility of free
acyclovir (2.5 mg/mL at 37°C [98.6°F] in water) is exceeded or if the drug is administered by bolus
injection. Ensuing renal tubular damage can produce acute renal failure.
■ Administration of acyclovir by IV infusion must be accompanied by adequate hydration.
■ Acyclovir for injection is intended for IV infusion only; do not administer topically, IM, orally,
subcutaneously, or in the eye. IV infusions must be given over a period of at least 1 hour to
reduce the risk of renal tubular damage.
Lactating: Compatible with breastfeeding.
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J^renaCine tartar ate (J^renaCine®. Tpiney brine®)
Dosage form & strength: lmg/iml amp.

Class: Alpha/Beta Adrenergic Agonists.
Dosage:
Cardiac Arrest:
Adult:
1 mg IV/10 q3-5min PRN; may administer up to 0.2 mg/kg if no response.
Dose >1 mg not shown to improve survival or neurological outcomes as compare d to standard
dosing; not recommended.
Endotracheal: 2-2.5 mg q3-5min until IV/IO access established or spontaneous circulation restored.
Pediatrics
IV, Intraosseous: 0.01 mg/kg (maximum single dose: 1 mg); every 3 to 5 minutes until return of
spontaneous circulation.
Asthma, Severe/Anaphylaxis:
Adults: 1:1000 (1 mg/mL): 0.2 to 0.5 mL (0.2 - 0.5 mg) IM (preferred) in the anterolateral aspect of the
middle third of the thigh is preferred; repeat every 5 to 15 minutes in the absence of clinical
improvement.
IV infusion: 1 mg (1 ml in 250 ml D5W) 4 mcg/ml solution & infuse IV at rate of 1-10 mcg/min (0.25
ml/min - 2.5ml/min) (15 ml/hr-150 ml/hr).
Pediatrics
IM, SubQ: 0.01 mg/kg (0.01 mL/kg/dose of 1 mg/mL solution) not to exceed: Prepubertal child: 0.3
mg/dose; adolescent: 0.5 mg/dose; administered every 5 to 15 minutes.
Dosage adjustment:
Renal impairment: no dosage adjustments.
Hepatic impairment: no dosage adjustments.
Administration:
Epinephrine solutions for injection can be administered IM, 10, ET, IV, or SC. Diluents: D5W, D10W,
dextrose-Ringer's, dextrose-saline, NS, LR, Ringer's.
IV:
■ Solution: 1 mg in 1000-250 mL D5W or NS (1-4 mcg/mL) to make up concentration of 15-60
mL/hr (1-4 mcg/min).
■ When administering as a continuous infusion, central line administration is preferred.
■ IV infusions require an infusion pump.
■ If central line not available, as a temporary measure, may administer through a large vein.
01093741899
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■ Avoid use of ankle veins (due to potential
for gangrene), leg veins in elderly patients, or leg veins in those suffering from occlusive
vascular diseases (eg, diabetic endarteritis, Buerger disease, arteriosclerosis, atherosclerosis).
IM:
■ Administration in the anterolateral aspect of the middle third of the thigh is preferred in the
setting of anaphylaxis.
■ Do not inject into the buttocks.
■ Do not administer repeated injections at the same site.
■ In overweight or obese children, administration into the lower half of the thigh may be
preferred.
■ In very obese children, injection into the calf will provide an even greater chance of
intramuscular administration.
Stability:
■ Discard after 24 hours or if solution is discolored or contains precipitate.
■ Store in light-resistant container.
■ Do not administer if solution develops a pinkish color or is otherwise discolored.
■ Epinephrine hydrochloride is known to be alkali-labile and should not be mixed with alkaline
drugs such as sodium bicarbonate and aminophylline.
■ Mixing lidocaine hydrochloride with epinephrine hydrochloride may raise the solution pH to
about 6, which will result in epinephrine decomposition within a few hours. Such mixtures
should be used promptly.
Precautions:
■ If extravasation occurs;
* Stop infusion immediately and disconnect (leave cannula/needle in place).
* Gently aspirate extravasated solution (do NOT flush the line).
* Remove needle/cannula; elevate extremity.
* Initiate phentolamine (or alternative antidote).
* Apply dry warm compresses.
■ Use caution in cerebrovascular insufficiency.
■ Correct blood volume depletion before administering any vasopressor.
■ May cause worsening of symptoms in patients with Parkinson disease.
■ Rapid IV administration, although necessary in pulesless arrest, may cause death from
cerebrovascular hemorrhage or cardiac arrhythmias.
■ Decreased urine output may occur as the result of renal blood vessel constriction.
Pregnancy:
* Used only if the potential benefit justifies the potential risk to the fetus.
* First-line medication of choice for treatment of anaphylaxis during pregnancy in humans
Lactation: Unknown if excreted into breast milk; It is generally considered compatible in
breastfeeding.
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Amiodarone (Corddrone®)
Dosage form & strength: 150 mg/3 ml amp.

Adult dose:
ACLS, Pulseless Ventricular Fibrillation/Ventricular Tachycardia (Off-label):
■ 300 mg IV or intraosseous push after dose epinephrine if no initial response to defibrillation.
■ May follow initial dose with 150 mg IV q3-5min.
Ventricular Arrhythmias:
■ 150 mg IV bolus in 10 minutes; may repeat qlOmin as necessary, THEN
■ 360 mg IV over next 6 hours (1 mg/min), THEN
■ 540 mg IV over remaining 18 hours (0.5 mg/min); not to exceed 2.2 g/24hr
■ For breakthrough episodes of VF or hemodynamically unstable VT, repeat the initial load.
■ Maintenance: 0.5 mg/min for a total 720 mg/24hr.
■ Duration of therapy: May continue to administer 0.5 mg/min for 2-3 weeks regardless of
patient's age, renal function or ventricular function.
Pediatric dose:
Pulseless Ventricular Tachycardia or Ventricular Fibrillation (Off-label)
5 mg/kg IV/10 rapid bolus; not to exceed 300 mg/dose; may repeat twice to maximum 15 mg/kg
during acute treatment.
Dose adjustment:
No dosage adjustment necessary in renal or hepatic impairment.
Warnings/Precautions:
■ Hypotension is the most common adverse effect seen. Hypotension should be treated by
vasopressor drugs, positive inotropic agents, and volume expansion. Slowing the rate of
infusion may also be effective.
■ May cause life-threatening or fatal cutaneous reactions, including Stevens-Johnson syndrome
and toxic epidermal necrolysis (TEN). If symptoms or signs occur, immediately discontinue.
■ Fatal toxicities: Fatal toxicities may be caused by pulmonary toxicity, hepatotoxicity, and
proarrhythmic effect.
■ Elevated bilirubin levels have been reported in patients administered IV amiodarone. [US
Boxed Warning (tablet)]: Hepatotoxicity (may be fatal) can occur. Obtain baseline and
periodic liver transaminases; these effects may also be seen with IVadministration, depending
on duration of use.
■ Avoid excessive exposure to sunlight; may cause photosensitivity.
■ Correct hypokalemia, hypomagnesemia or hypocalcemia before initiating treatment as these
disorders can exaggerate the degree of QTc prolongation and increase the potential forTdP.
■ Causes increased INR; use caution when initiating therapy in patients treated with warfarin.
01093741899
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Pregnancy:
cross the placenta; should be used in pregnancy only to treat arrhythmias refractory to other
treatments or when other treatments are contraindicated.
Lactation: present in breast milk. Do not recommend; Hypothyroidism and bradycardia have been
observed in breastfed infants.
Amikacin (Amikin®. Amikacin®)

Class: Aminoglycosides, antibiotics.
Indications:
■ Serious bacterial infectious disease, due to gram-negative organisms, including Pseudomonas
aeruginosa.
■ Bacterial meningitis.
■ Burn - Infectious disease.
■ Cystic fibrosis - Respiratory tract infection.
■ Urinary tract infectious disease (Severe).
General dosing:
Adult: 15-22.5 mg/kg/day divided IV/IM q8-12hr; Max 1.5 g/day, for 7-10 days.
Urinary Tract Infection: 250 mg IV/IM ql2hr
Pediatric:
Neonates: 10-mg/kg loading dose followed with 7.5 mg/kg every 12 hours, for 7 to 10 days. The total
daily dose should not exceed 15 mg/kg/day .
Infants and children:
IM, IV: 15 to 22.5 mg/kg/day divided every 8 hours or 15 to 20 mg/kg/dose every 24 hours.
Dosing considerations:
■ Monitor: peak (15-40 mg/L), trough (5-10 mg/L).
■ Monitor renal & auditory function.
Dose adjustment:
Renal impairement:
■ CrCI >90 mL/min and aged <60 yr: q8hr
■ CrCI 60-90 mL/min OR aged >60 yr: ql2hr
■ CrCI 25-60 mL/min: q24hr
■ CrCI 10-25 mL/min: q48hr
■ CrCI <10 mL/min: q72hr
01093741899
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Administration:
■ Amikacin may be given by IV infusion or IM injection.
■ IV: Dilute 500 mg in 100-200 mL NS or D5W (to a final concentration of 0.25 to 5 mg/mL)
; infuse over 30-60 min in adults and children; infuse over 1-2 hr in infants. ■ For intravenous
administration, other compatible solution D5 1/4NS, D5V2NS, LR.
Precautions:
■ May cause neuromuscular blockade and respiratory paralysis, especially when given soon
after anesthesia or muscle relaxants.
■ Use with caution in patients with preexisting vertigo, tinnitus, or hearing loss.
■ Irreversible deafness, renal failure, and death due to neuromuscular blockade have been
reported following use of aminoglycosides as surgical irrigation; rapid systemic absorption
occurs with topical application (except to the urinary bladder).
■ May contain sulfites, which may cause allergic-type reactions (including anaphylaxis) as well as
life-threatening or less severe asthmatic episodes in certain individuals.
Pregnancy Category: D
Lactation: Not recommended.
y\.ntoxiciCCin/fCucCoxaciCCin (TCumox ®)
Dosage form & strength: 500 mg, 1 g cap & vial.

Class: Penicillins, Aminopenicillins, antibiotic + 0- lactamase resistant penicillin.
Indications:
■ Respiratory Tract Infections.
■ Ear, nose &throat infections.
■ GIT infections.
■ Acute Bacterial Sinusitis.
■ Impetigo.
■ Skin and/or subcutaneous tissue infections.
■ Urinary tract infections.
General dosing:
Adult: 500-1000 mg q 6- 8 h.
Pediatric (2-12 years): 0.5 adult dose.
< 2 years: 0.25 adult dose.
Dose adjustment:
Doses should be reduced in severe renal impairment.
Administration:
Oral: Administer on empty stomach.
IM: Reconstitute 500 mg & 1 g vial with 2ml & 4 ml SWI.
IVP : Reconstitute 500 mg & 1 g vial with 5 ml & 10 ml SWI; slowly over 3-4 min. IV infusion: Dilute
reconstituted solution with 100 ml NS.
Stability:
Solutions containing dextrose infused within 30-40 min; must be changed within 2 h.
Precautions:
■ Previous hypersensitivity reactions to [3-lactam antibiotics.
■ Caution in patients with evidence of hepatic dysfunction.
■ Avoid use in patients with mononucleosis due to increased risk for erythematous skin rash.
Pregnancy & Lactation:
should be used only during pregnancy or lactation if clearly needed.
y\mpiciCCin/suCbactam (Suffiin®/Unasyn®)
Dosage form & Strength: 375 (ampicillin 250 mg/sulbactam 125mg),

750(ampicillin 500 mg/sulbactam 250 mg),
1.5g (ampicillin lg/sulbactam 0.5g) vial.
Class: Penicillins, Aminopenicillins, antibiotic+ 0-lactamase inhibitor.
Indications:
■ Endocarditis & Endocarditis Prophylaxis.
■ Post-operative infections.
■ Skin and skin structure infections.
■ Gastrointestinal Tract Infections.
■ Bacteremia associated with IV line.
■ Typhoid fever.
General dosing:
Adult dose: 1.5-3 g IM/IV q6h.
Max: 12 g/day; dose and duration varies according to infection type and severity.
Pediatric dose: IV 100 to 200 mg ampicillin/kg/dav divided every 6 hours (maximum: 8 g ampicillin
daily or 12 g ampicillin/sulbactam daily).
Dose adjustment:
Renal impairment
■ CrCI > 30: No dose adjustment necessary.
■ CrCI 15-29: give ql2h.
■ CrCI 5-14: give q24h.
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Hepatic Impairment
There is no dosage adjustment required.
Administration:
IM
■ Reconstitute 1.5 g with 3.2 ml; using SWI or 0.5% or 2% lidocaine to obtain a 250 mg ampicillin-
125 mg sulbactam/mL solution.
■ Use within 1 hr after preparation.
IVP
■ Reconstitute 1.5 g vial with 3.2 ml to yield solutions containing 375 mg Ampicillin and
Sulbactam per mL (250 mg ampicillin/125 mg sulbactam per mL).
■ Administer by slow injection over 10 to 15 minutes.
■ Reconstituted solutions should be used within 1 hour after reconstitution.
IV infusion:
■ NS is the diluent of choice for IV infusion use.
■ Reconstituted solution should then be immediately diluted with a suitable parenteral diluent to
yield solutions containing 3-45 mg Ampicillin and Sulbactam per mL (2 to 30 mg ampicillin/1 to
15 mg sulbactam/per mL).
■ Administer over 15 to 30 minutes.
■ Diluted Solutions made in NS are stable up to 48 hours when refrigerated & 8 h at RT.
■ Dextrose solutions are stable for only 4 hours when refrigerated & 2 h at RT.
Precautions:
■ Contraindicated in Patients with previous history of cholestatic jaundice/hepatic dysfunction
associated with ampicillin/ sulbactam.
■ Hepatic dysfunction, including hepatitis and cholestatic jaundice reported; hepatic toxicity is
usually reversible; however, deaths have occurred; monitor hepatic function at regular
intervals in patients with hepatic impairment.
■ With prolonged therapy, monitor hematologic, renal, and hepatic function; monitor for signs of
anaphylaxis during first dose.
Lactation: Excreted in breast milk; use caution.
01093741899
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JAtracurium ('Tracrium®)
Dosage form & strength:50 mg/5 ml amp.
Class: Neuromuscular Blockers, Nondepolarizing
ICU Indications:
■ Skeletal Muscle Relaxant.
■ Endotracheal Intubation, Mechanical Ventilation.
Adult Dose:
Calculate dose based on ideal body weight
■ 0.4 to 0.5 mg/kg over 60 seconds, then 0.08 to 0.1 mg/kg administered 20 to 45 minutes after
initial dose to maintain neuromuscular block; repeat dose at 15- to 25-minute intervals as
needed.
■ Maintenance infusion for continued surgical relaxation during extended surgical procedures: At
initial signs of recovery from bolus dose, a continuous infusion may be initiated at a rate of 9 to
10 mcg/kg/minute (0.54 to 0.6 mg/kg/hour); block usually maintained by a rate of 5 to 9
mcg/kg/minute (0.3 to 0.54 mg/kg/hour) under balanced anesthesia; range: 2 to 15
mcg/kg/minute (0.12 to 0.9 mg/kg/hour).
Pediatric Dose:
1 month - 2 years: 0.3-0.4 mg/kg IVP under halothane anesthesia.
Maintenance dose: Children may need more frequent maintenance doses than adult
>2 years: as adult
Dose adjustment:
Administration:
■ May be administered undiluted as a bolus IV injection; do not administer IM due to tissue
irritation.
■ For continuous IV infusions, further dilute and administer via an infusion pump; use infusion
solutions within 24 hours of preparation.
■ Usual Infusion Concentrations: 20 mg in 100 mL (concentration: 0.2 mg/mL) or 50 mg in 100
mL (concentration: 0.5 mg/mL) of D5W, D5NS, or NS.
■ Dilution in LR not recommended.
Stability & storage:

■ Store intact vials at 2°C to 8°C. Do not freeze.
■ Dilutions of 0.2 mg/mL or 0.5 mg/mL in 0.9% NS, D 5W, or D 5NS are stable
for up to 24 hours at room temperature or under refrigeration.
■ Unstable in alkaline solutions.
01093741899
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■ Severe anaphylactic reactions have been reported.
■ Reduce initial dosage and inject slowly (over 1 to 2 minutes) in patients in whom substantial
histamine release would be potentially hazardous (eg, patients with clinically-important
cardiovascular disease).
■ Additive/synergistic effects if administered with or following an opioid, sedative or anesthetic
agent.
■ Closely monitor patients with bronchogenic carcinoma, dehydration, electrolyte imbalance,
hypotension, hypothermia, myasthenia gravis, pulmonary disease.
Pregnancy category: c
Lactation: excretion in milk unknown; use with caution.
Mr opine. (Mropine sulphate")

Dosage form & strength: lmg/ ml amp.
Class: Anesthetic Premedication Agents; Cholinergic, Toxicity Antidotes.
General closing:
Adult:
Sinus Bradycardia (ACLS): 0.5-1 mg or 0.04 mg/kg IV q5min, no more than 3 mg; Note: Atropine may be
ineffective in heart transplant recipients.
Anesthesia Premedication:
■ 0.4-0.6 mg IV/IM/SC 30-60 minutes before anesthesia; repeat q4-6hr PRN.
■ ET: Some experts suggest 2-3 times IV dose diluted in 3- 5 mL sterile water for injection/NS
(sterile water for injection may facilitate absorption better than NS, but may produce more
negative effect on arterial oxygen pressure).
Bronchospasm:
0.025 mg/kg in 2.5 mL NS q6-8hrvia nebulizer; no more than 2.5 mg/dose. Organophosphate
poisoning:
■ 2 to 3 mg IV/ IM; may repeat every 20 to 30 minutes.
■ Doubling the dose if previous dose did not induce atropinization.
■ Maintain atropinization by administering repeat doses as needed for at least 2-12 hours based
on recurrence of symptoms.
Asystole/Pulseless Electrical Activity (ACLS):
1 mg IV q3-5min PRN if asystole persist up to 0.04 mg/kg.
Note: administration of less than 0.5 mg can produce a paradoxical bradycardia because of the
central or peripheral parasympathomimatic effects of low dose in adults.
01093741899
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Pediatric:
Bradycardia (Infants, children, and adolescents): 0.02 mg/kg administered IV / 10. Anesthesia
Premedication:
Infants < 5 kg:
0.02 mg/kg/dose administered IM, IV, or SC 30 to 60 minutes preoperatively then every 4 to 6 hours
as needed.
Infants > 5 kg:
0.01 to 0.02 mg/kg/dose administered IM, IV, or SC 30 to 60 minutes preoperatively then every 4 to 6
hours as needed; maximum single dose: 0.4 mg; minimum dose: 0.1 mg. Asthma
as an inhalation solution diluted with saline, 0.025 to 0.05 mg/kg, nebulized 3 to 4 times daily (MAX
2.5 mg).
Dosage adjustment:
Renal impairment: no dosage adjustment.
Hepatic impairment: no dosage adjustment.
Administration:
SC, IM, IV
Intratracheal
■ Dilute 1 to 2 mg of atropine in no more than 10 mL of sterile water or NS.
Intravenous
■ IV administration is generally preferred.
■ Give into large vein or IV tubing over 1-2 min.
■ When administered in conjunction with cyclopropane, doses less than 0.4 mg should be used
and should be given slowly to prevent ventricular arrhythmias.
Precautions:
■ Caution in hepatic/renal impairment, BPH, CHF.
■ Tachycardia may occur with recurrent use in patients with coronary artery disease; dose
reduction recommended.
■ May convert partial organic pyloric stenosis into complete obstruction.
■ May lead to complete urinary retention in patients with prostatic hypertrophy.
■ MAOI use is not recommended due to potential for precipitation of hypertensive crisis.
■ Increase risk of inspissation of bronchial secretions and formation of viscid plugs in patients
with chronic lung disease.
■ May precipitate acute glaucoma.
■ In patients with myasthenia gravis, use atropine with extreme caution when used to treat
adverse effects of acetylcholinesterase inhibition or avoid; may precipitate a myasthenic crisis.
■ Use with caution in children with spastic paralysis.
■ Arrhythmias; Avoid relying on atropine for effective treatment of type II second-degree or
third-degree AV block (with or without a new wide QRS complex).
■ Injection side effects may include dry mouth, blurred vision, photophobia, and tachycardia.
Pregnancy Category: C (Human Data Suggest Low Risk).
Lactation: Trace amounts enter breast milk; use with caution (AAP Committee states "compatible
with nursing").
ISucCesonicCe CBudecorlr .
Pufrnicovf. 'Rfiinocorf)
Dosage form & Strength: 0.25 mg/ml 2 ml amp nebulizer susp., 32 mcg, 64 mcg nasal spray.
Class: Corticosteroids.
Indications:
■ Asthma.
■ Chronic obstructive pulmonary disease (acute exacerbation)
Dosage:
Nebulization
Adult
0.5 - 2 mg daily, in very severe cases the dosage may be increased further.
Pediatric
Asthma guidelines: Nebulization solution: Administer once daily or in divided doses twice daily.
Children <4 years:
■ "Low" dose: 0.25 to 0.5 mg/day.
■ "Medium" dose: >0.5 to 1 mg/day.
■ "High" dose: >1 mg/day.
Children 5 to 11 years:
■ "Low" dose: 0.5 mg/day.
■ "Medium" dose: 1 mg/day.
■ "High" dose: 2 mg/day.
Intra nasal
Adult
■ Initial dose: 1 spray/nostril qDay (64 mcg/day).
■ Not to exceed 4 sprays/nostril qDay (256 mcg/day).
Pediatric
■ <6 years: Safety and efficacy not established
■ Initial dose: 1 spray/nostril qDay (64 mcg/day)
■ 6-11 years: Not to exceed 2 sprays/nostril qDay (128 mcg/day)
Administration:
■ Suspension should be administered via jet nebulizer connected to air compressor with
adequate air flow and equipped with mouthpiece or suitable face mask
■ can be mixed with 0.9% saline and with solutions for nebulisation of terbutaline, salbutamol,
fenoterol, acetylcysteine, sodium cromoglycate and ipratropium bromide. The admixture
should be used within 30 minutes.
Precautions:
■ Contraindicated in Status asthmaticus & acute bronchospasm; Budesonide is not a
bronchodilator and is not indicated for rapid relief of bronchospasm.
■ Risk of infections of nose and pharynx, including C albicans, the patient should rinse their
mouth out with water after inhaling to minimize the risk.
■ Risk of more serious or fatal course of chickenpox or measles in susceptible patients (eg,
unvaccinated or immunologically unexposed individuals); care must be taken to avoid
exposure.
■ Excessive use may suppress hypothalamic-
pituitary-adrenal function; monitor closely, especially postoperatively or during periods of
stress.
■ Use with caution in cases of hepatic impairment.
■ As with other inhaled medications, budesonide can produce paradoxical bronchospasm that
may be life-threatening. If occurs, treat it immediately with an inhaled, short-acting, beta-2
bronchodilator.
Pregnancy: Increased risk of abnormalities has not been demonstrated in pregnant women using
intranasal budesonide; ICS are recommended for the treatment of asthma during pregnancy.
Lactation: Drug enters breast milk; use only if benefits greatly outweigh risks
CaCcium aCuconate
Dosage form & Strength: 1 g ampoule (100 mg/ml, 10 ml; 10% solution).
Class: Antidotes. Calcium Salts
lndications& Doses:
■ Hypocalcemia: IV
* Moderate to severe (without seizure or tetany; ionized calcium: <4 mg/dL [<1 mmol/LJ): 4
g over 4 hours.
* Severe symptomatic (eg, seizure, tetany): 1 to 2 g over 10 minutes; repeat every 60
minutes until symptoms resolve.
Note: Repeat ionized calcium measurement 6 to 10 hours after completion of
administration. Check for hypomagnesemia and correct if present. Consider continuous
infusion if hypocalcemia is likely to recur due to ongoing losses.
■ Cardiac arrest or cardiotoxicity in the presence of hyperkalemia, hypocalcemia, or
hypermagnesemia: IV: 1.5 to 3 g over 2 to 5 minutes.
■ Beta-blocker overdose & Calcium channel blocker overdose(off-label dose): 60 mg/kg IV over
5 minutes every 10-20 minutes PRN up to 3-4 doses; not to exceed 3-4 g/dose or 60
120 mg/kg/hr IV titrated to improve hemodynamic response.
■ Hydrofluoric acid burn(off-label dose):
SC: 10% calcium gluconate, no more than 0.5 mL/cm2 of skin; do not use in digits If topical
and/or SC do not work, consider intra-arterial
Intra-arterial calcium infusion for moderate to severe burns: Infuse 10 mL 10% calcium
gluconate mixed with 40-50 mL D5W over 4 hours, repeating as needed.
■ Hypocalcemia induced by citrate-based replacement fluid during continuous renal

replacement therapy (CRRT) (off-label dose)
* If ionized calcium is <3.6 mg/dL (<0.9 mmol/L): Notify nephrology.
* If ionized calcium is 3.6 to 4 mg/dL (0.9 to 1 mmol/L): 1.4 g/hour
* If ionized calcium is 4 to 4.4 mg/dL (1 to 1.1 mmol/L): 1.2 g/hour
* If ionized calcium is 4.4 to 5.2 mg/dL (1.1 to 1.3 mmol/L): 1 g/hour
* If ionized calcium is >5.2 mg/dL (>1.3 mmol/L): Notify nephrology.
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Dose adjustment;
Renal Impairment:
■ Initiate with the lower limit of the dosage range (accumulation may occur with renal impairment
and subsequent doses may require adjustment based on serum calcium concentrations).
Hepatic Impairment:
■ No initial dosage adjustment necessary;
■ Subsequent doses should be guided by serum calcium concentrations. In patients in the
anhepatic stage of liver transplantation, equal rapid increases in ionized concentrations occur
suggesting that calcium gluconate does not require hepatic metabolism for release of ionized
calcium.
Administration;
e
■ May be given diluted or undiluted.

■ For IV bolus or continuous infusion. Administer bolus slowly (not to exceed 200 mg/minute).
■ May administer IV push at rate of 50-100 mg/min (0.5-1 mL/min); rapid IV administration may
produce arrhythmias, hypotension, myocardial infarction, or vasodilation
■ Solution may be diluted in NS, D5W (mix in up to 1000 mL), or 2/3-1/3.
■ For intermittent IV infusion, maximum rate is 200 mg/min (2 mL/min).
■ Do not mix in same bag or line with carbonates, phosphates, sulfates, and tartrates, because of
precipitation
■ Store at room temperature.
Contraindications:
■ Hypersensitivity.
■ IM/SC administration.
■ Ventricular fibrillation during CPR.
■ Hypercalcemia.
■ concomitant use of IV calcium gluconate with ceftriaxone in neonates (<28 days of age).
■ Avoid extravasation; Monitor the IV site closely.
■ Use with caution in patients with severe hypokalemia as acute rises in serum calcium levels
may result in life-threatening cardiac arrhythmias.
■ Rapid IV infusion associated with hypotension, bradycardia, syncope, cardiac arrest, cardiac
arrhythmias, sense of oppression or heat waves, tingling sensation, vasodilation.
Pregnancy category: C, Calcium crosses the placenta.
Lactation: Calcium enters human milk; use with caution
01093741899
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Captopril ( Capoten®)
Dosage form & Strength: 12.5 mg, 25 mg, 50 mg tablet.
Class: ACE Inhibitors.
Dosage & Indications:
Adult:
■ Acute Hypertension (urgency/emergency): Oral, sublingual: 12.5-25 mg PO; may repeat PRN.
■ Hypertension (Alone or with Thiazide):
Initial: 25 mg PO q8-12hr, increase gradually based on response (may start lower in some
patients);
Maintenance: 25-150 mg PO q8-12hr, 450 mg/day maximum.
■ Congestive Heart Failure (With Diuretics and Digitalis):
Initial: 6.25-12.5 mg PO q8hr in conjunction with cardiac glycoside and diuretic therapy. Target
therapy: 50 mg q8hr, 450 mg/day maximum.
■ Left Ventricular Dysfunction After Myocardial Infarction:
6.25 mg PO initially followed by 12.5 mg q8hr. Increase to 25 mg PO q8hr over next few days;
THEN Target dose: 50 mg PO q8hr.
■ Diabetic Nephropathy: 25 mg PO q8hr.
Pediatric:
■ Neonates: 0.05-0.1 mg/kg/dose q8-24hr, titrate dose up to 0.5 mg/kg/dose q6-24hr.
■ Infants: 0.15-0.3 mg/kg/dose; titrate dose upward to maximum 6 mg/kg/day in 1-4 divided
doses; 2.5-6 mg/kg/day usually required.
■ Children: 0.3-0.5 mg/kg/dose; titrate to maximum 6 mg/kg/day divided q6-12hr.
■ Older children: 6.25-12.5 mg/dose ql2-24hr; titrate to no more than 6 mg/kg/day divided q6-
12hr.
Dosage adjustment:
Renal Impairment:
■ CrCI 10 to 50 mL/minute: Administer at 75% of normal dose every 12 to 18 hours.
■ CrCI <10 mL/minute: Administer at 50% of normal dose every 24 hours. Hepatic Impairment:
There are no dosage adjustments.
Administration: Oral
■ It may be taken before, during and after meals.
■ Unstable in aqueous solutions; to prepare solution for oral administration, mix prior to
administration and use within 10 minutes.
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01093741899
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Contraindications:
■ Hypersensitivity to ACE inhibitors.
■ Anuria.
■ History of ACEI-induced angioedema.
■ Hereditary or idiopathic angioedema.
■ Coadministration of neprilysin inhibitors (eg, sacubitril) with ACE inhibitors may increase
angioedema risk; do not administer ACE inhibitors within 36 hr of switching to or from
sacubitril/valsartan.
■ Bilateral renal artery stenosis.
■ Do not coadminister with aliskiren in patients with diabetes mellitus or with renal impairment
(ie, GFR <60 mL/min/1.73 m2).
Warning/ precautions:
■ Aortic stenosis/hypertrophic cardiomyopathy, hypotension, biliary cirrhosis or biliary
obstruction, myelosuppression, electrolyte imbalance, hyperuricemia or gout, SLE, hepatic or
renal impairment.
■ Avoid concomitant use with lithium.
■ Less effective in African-Americans.
■ Excessive hypotension if concomitant diuretics or volume-depleted; start with 6.25 mg q8hr.
■ Risk of hyperkalemia, especially with K+ sparing diuretics.
■ Dual blockade of the renin angiotensin system with ARBs, ACE inhibitors, or aliskiren
associated with increased risk for hypotension, hyperkalemia, and renal function changes
(including acute renal failure) compared to monotherapy.
■ ACE inhibition also causes increased bradykinin levels which putatively mediates angioedema.
■ Coadministration with mTOR inhibitors (eg, temsirolimus, everolimus, sirolimus) may increase
risk for angioedema.
■ Intestinal angioedema, that presented with abdominal pain, reported in patients treated with
ACE inhibitors.
■ Total urinary proteins >1 g per day have been reported (<1%); nephrotic syndrome occurred in
about one-fifth of proteinuric patients.
■ Neutropenia (<1000/mm3 with myeloid hypoplasia reported with captopril; risk is dependent
on clinical status of patient.
■ Causes false positive urine acetone.
Lactation: enters breast milk/not recommended (AAP states compatible with nursing).
01093741899
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Cefgrime. (Maxipime®. 'Wince]®)

Dosage form & strength: 500mg, lg vial.
Class: cephalosporins. 4th generation.
Indications:
■ Empiric therapy in febrile neutropenic patients.
■ Pneumonia.
■ Treatment of uncomplicated and complicated urinary tract infections (UTIs), including
pyelonephritis.
■ Bacteremia associated with IV line.
■ Infective endocarditis.
■ Infections caused by Pseudomonas aeruginosa.
■ Skin/Skin Structure Infections.
■ Intra-abdominal Infections.
General dosing:
■ Adult dose: 1 -2 g q 8-12 hr.
■ Child dose: 50 mg/kg q 8-12 hr.
■ Usual duration is 7 to 14 days; individualize duration depending on source and extent of
infection as well as clinical response.
Dosage adjustment:
Renal dosing
Recommended Maintenance Schedule
Creatinine
Clearance (mL/min)
>60 Normal recommended dosing 500 mg ql2h lgql2h 2gql2h 2 g q8h
schedule
30-60 500 mg q24h 1 g q24h 2 g q24h 2gql2h
11-29 500 mg q24h 500 mg q24h 1 g q24h 2 g q24h

<11 250 mg q24h 250 mg q24h 500 mg q24h 1 g q24h
Hepatic dosing: no adjustment.
Administration:
IM: Reconstitute 500 mg or 1 g vial with 1.3 mL or 2.4 mL, respectively; resulting concentration is
280 mg/mL.
IVP: Reconstitute 500 mg vial with 5 mL and 1 or 2 g vial with 10 mL of a compatible diluent; over 5
minutes (resulting concentration of 100 mg/mL for 500 mg and 1 g vial and 160 mg/mL for 2 g vial). IV
infusion: further dilute with 50 or 100 mL of a compatible IV fluid.
Recommended diluents: SWI, NS, D5W, D10W, R, LR, or (lidocaine 0.5% or 1% for IM). Stability: After
reconstitution, stable for 24 hours at RT and 7 days at refrigerator.
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Precautions:
■ IM recommended only for mild-to-moderate complicated or uncomplicated UTI due to E coli.
■ Neurotoxicity has been reported, including life-threatening or fatal occurrences such as
aphasia, encephalopathy, myoclonus, seizures, and nonconvulsive status epilepticus.
Lactation: Drug enters breast milk; use with caution.
Cefotaxime (Cefaxim®. Cefotax!®. Ceforan®)

Dosage form & strength: 500 mg, 1 g vial.
Class: 3rd generation cephalosporin; antibiotic.
Indications:
■ Bacterial sepsis.
■ Infectious disease of abdomen.
■ Infections of the Skin and Skin Structures.
■ Pelvic Inflammatory Disease.
■ Urinary Tract Infectious disease.
■ Postoperative infectious disease.
■ Gonorrhea.
General dosing:
Adult: 1-2 g IM/IV q8-12h; Max: 12 g/day; dose, duration varies with infection type and severity.
Pediatric: 50 - 200 mg/kg/day divided q6-8h.
Renal dosing
CrCI <20: decrease dose by 50%; HD: give 0.5-2 g after dialysis; PD: 1 g q24h.
Hepatic dosing
No adjustment recommended
Administration:
■ IM: Reconstitute 500 mg, 1 g, 2 g with 2, 3 & 5 mL SWI respectively.
■ IV: Reconstitute 500 mg, 1 g, 2 g with 10 mL SWI.
■ lnfusion:_Reconstituted solution should be further diluted with 50 or 100 mL NS or D5W
■ May be diluted further.
■ Recommended diluents: NS, D5W, D10W, D5NS, R, LR.
■ Inject directly IV as a bolus over at least 3 to 5 minutes. Infuse intermittent infusion over 15 to
30 minutes.
■ Inject deep IM into large muscle mass. Individual doses of 2 g may be given if the dose is
divided and administered in different IM sites.
01093741899
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Stability:
■ Protect from light.
■ Reconstituted solution is stable for 12 to 24 hours at room temperature, 7 to 10 days when
refrigerated, for 13 weeks when frozen. For IV infusion in NS or D5W, solution is stable for 24
hours at room temperature, 5 days when refrigerated.
Precautions:
■ Cefotaxime may potentiate the nephrotoxic effects of nephrotoxic drugs, including
aminoglycosides, NSAIDs, and furosemide.
■ Caution if seizure disorder.
■ Potentially life-threatening arrhythmia reported in patients receiving rapid bolus injection
through central venous catheter.
■ In most cases, perivascular extravasation of cefotaxime responds to changing of the infusion
site. In rare instances, extensive perivascular extravasation of cefotaxime may result in tissue
damage and require surgical treatment.
Lactation: Drug enters breast milk in low concentrations; compatible with breast feeding.
Ceftriaxone. (Cefaxone®. Cefotrix")

Dosage form & strength: 500 mg, 1 g vial.
Class: 3rd generation cephalosporin; antibiotic.
Indications:
■ Upper& Lower respiratory tract infections.
■ Acute bacterial otitis media.
■ Meningitis.
■ Intra-abdominal infections.
■ Typhoid fever.
Dosage:
Usual adult dose: 1-2 g IV/1 M q 24 h, duration varies with infection type, severity. Meningitic dose: 4
g IV divided ql2-24h x7-21 days.
Usual pediatric dose: 50-75 mg/ kg IV/ IM q 24 h, duration varies with infection type, severity.
Meningitic dose: 80-100 mg/kg/day IV divided ql2-24h x7-21 days; Start: 100 mg/kg IV xl; Max: 4
g/24h.
Dose adjustment:
Renal failure: no initial adjustment, monitor serum levels.
hepatic impairment: no dosage adjustments provided in the manufacturer's labeling; however, in
patients with concurrent hepatic dysfunction (impaired biliary excretion) and severe kidney
impairment, use of >2 g/day should be done with caution and close monitoring for toxicity.
Administration: Administered IM or IV;
■ IM: Reconstitute 500 mg & 1 g vial with 1.8 ml & 3.6 ml diluent respectively.
■ I VP: Reconstitute 500 mg , 1 g & 2 g vial with 4.8 ml, 9.6 ml & 19.2 ml; diluent respectively.
■ Do not coadminister with calcium-containing solutions.
■ Infuse as an intermittent infusion over 30 minutes. IV push administration over 1 to 4 minutes
■ IV infusion:
After reconstitution further dilute to cone between 10 mg/ml and 40 mg /ml; Infuse
intermittently over 30 minute.
(i.e. Reconstituted 2 g vial should be diluted in 20 - 50 ml diluent or more).
■ Recommended diluents:
SWI, NS, D5W & D10W; not be diluted by Ringer.
Reconstituted vials are stable for 3 days at 2 to 8° C (refrigerated).
Precautions
■ Concomitant use of ceftriaxone and intravenous calcium-containing products such as Ringer's
solution or Hartmann's solution is contraindicated in neonates (<28 days of age).
■ In patients >28 days of age, ceftriaxone and calcium-containing products may be administered
sequentially, provided the infusion lines are thoroughly flushed between infusions with a
compatible fluid.
■ Sonograhic abnormalities in gallbladder may occur due to ceftriaxone-calcium salt precipitate,
which may be misinterpreted as gallstones.
■ Ceftriaxone is contraindicated in premature neonates: it can displace bilirubin from its binding
to serum albumin (Ceftriaxone has plasma protein binding 85-95%), leading to a risk of bilirubin
encephalopathy.
Lactation: Drug enters breast milk in low concentrations; compatible with breast feeding.
Use with caution in breast-feeding women; drug may displace bilirubin from albumin-binding sites,
increasing risk of kernicterus.
CfiCoryfienirainine. maCeate
CAvif)
Dosage form & Strength: 5 mg /ml amp, 2 mg/5ml syrup.
Class: Antihistamines, 1st Generation.
Indications:
■ Allergic rhinitis & Common cold.
■ Contrast media adverse reaction & Systemic mast cell disease.
Dosage:
Adult:
■ Oral: 4 mg (10 ml) PO q4-6hr; not to exceed 24 mg/day (max 12 mg/day in elderly).
■ Injection: 10 - 20 mg as a single dose SC/IM/IV over 1 min; max. Dose up to 40 mg/day.
■ The only indications for IV chlorpheniramine is as a secondary drug (after epinephrine) in
anaphylaxis since intramuscular or oral may be absorbed too slowly as a result of poor
perfusion of blood secondary to shock.
Pediatric:
Not recommended for children below 2 years old.
2mg/ 5 ml syrup:
■ 6-12 years: 5 ml (2 mg) every 4-6 hours. Maximum daily dose: 12 mg (30ml).
■ 2-6 years: 2.5 ml (1 mg) every 4-6 hours. Maximum daily dose: 6 mg (15ml). Injectable
solution:
■ 2-5 years: 2.5- 5 mg/day (0.2mg/kg/day) in divided doses every 4 to 6 hours as needed.
■ 6-12 years: 5-10 mg/day (0.2mg/kg/day) in divided doses every 4 to 6 hours as needed.
Dosage adjustment:
Renal impairment: No specific dosage adjustment.
Hepatic impairment: Use caution in patients with cirrhosis or other liver disease.
Administration: Administer without regard to meals. Administer with food if Gl upset occurs.
Precautions:
■ The anticholinergic properties of chlorphenramine may cause drowsiness, dizziness, blurred
vision and psychomotor impairment in some patients which may seriously affect ability to drive
and use machinery.
■ Should not be used with other antihistamine containing products, including antihistamine
containing cough and cold medicines.
■ Concurrent use of chlorphenamine and hypnotics or anxiolytics may cause an increase in
sedative effects, therefore medical advice should be sought before taking chlorphenamine
concurrently with these medicines.
■ Chlorphenamine inhibits phenytoin metabolism and can lead to phenytoin toxicity. Monitor for
evidence of phenytoin toxicity (ataxia and nystagmus) .
■ Caution in narrow angle glaucoma, prostatic hypertrophy, stenosing peptic ulcer,
pyloroduodenal obstruction, or bladder neck obstruction.
Pregnancy:
There are no controlled data in human pregnancy; only recommended for use during pregnancy when
benefit outweighs risk.
Lactation: excretion in milk unknown/not recommended.
CCaritfiromvcin (JCfacicf )
Dosage form & Strength: 500 mg powder for solution for IV infusion. Indications:
■ Lower respiratory tract infections; acute and chronic bronchitis, and pneumonia.
■ Upper respiratory tract infections; sinusitis and pharyngitis.
■ Skin and soft tissue infections (e.g. folliculitis, cellulitis, erysipelas).
Usual dosage:
■ 1 gram daily, divided into 500 mg q 12 h.
■ Treatment with intravenous clarithromycin should be between 2 to 5 days, the patient should
then be switched to oral clarithromycin when necessary.
■ The total treatment period should not exceed more than 14 days.
Dose adjustment:
Renal Impairment:
■ CrCI >30 mL/minute: No dosage adjustment necessary.
■ CrCI <30 mL/minute: Decrease clarithromycin dose by 50%
Administration:
■ Clarithromycin should not be given as a bolus or an intramuscular injection.
■ For intravenous infusion only.
■ The method of dilution:
Step 1: Reconstitute with 10 ml Water for Injections.
Step 2: Dilute reconstituted solution to 250 ml with recommended diluents to form a solution
of approximately 2mg/ml.
■ Recommended diluents: NS, D5W, or RL solution.
■ Administer into one of the larger proximal veins as an IV infusion over 60 minutes.
■ Reconstituted/Diluted Solutions are stable for 24 hours at 2 to 8° C (refrigerated).
Warnings:
■ Children under 12 years should not be given Clarithromycin infusion.
■ Use with caution in patients with history of cholestatic jaundice or hepatic dysfunction
associated with previous use of clarithromycin.
■ Use with caution in patients who have: ever suffered from QT-prolongation, arrhythmia,
coronary artery disease, severe cardiac insufficiency hypokalaemia or hypomagnesaemia.
■ Discontinue immediately if symptoms of hepatitis occur.
■ May exacerbate Myasthenia gravis.
Lactation: Drug is excreted in breast milk; use with caution.
01093741899
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CCoyicCogreC ('Ptavix)
Dosage form & strength: 75 mg tablet.
Class: Antiplatelet Agents
Dosage & Indications:
Adult:
► Acute Coronary Syndrome:
■ Unstable angina, non-ST-segment elevation Ml (NSTEMI):
Age <75 years: Oral: Initial loading dose: 300 mg(4 tabs.) once at the time of diagnosis;
followed by 75 mg once daily. Administer in combination with aspirin 75-325 mg q Day with or
without thrombolytics.
Age >75 years: Oral: 75 mg once daily.
■ ST-segment elevation Ml (STEMI): 75 mg/day PO in combination with aspirin 162-325 mg/day
and then 81-162 mg/day.
► Ischemic stroke or transient ischemic attack, noncardioembolic, secondary prevention: Oral: 75
mg once daily.
Pediatric
Antiplatelet effect: Limited data available:
■ Children >2 years and Adolescents: Initial dose: 1 mg/kg once daily; titrate to response; in
general, do not exceed adult dose.
Dosage adjustment:
No dosage adjustment necessary in renal or Hepatic Impairment.
Administration:
■ Administer without regard to meals.
■ Avoid or minimize the consumption of grapefruit juice.
Contraindications:
■ Hypersensitivity to clopidogrel.
■ Active bleeding (eg, peptic ulcer, intracranial hemorrhage).
■ Clopidogrel's antiplatelet activity is dependent on conversion to an active metabolite by the

cytochrome P450 (CYP) system, principally CYP2C19; Tests are available to identify patients
who are CYP2C19 poor metabolizers.
■ Use with caution in patients with bleeding or platelet disorders.
■ Use caution in patients receiving either anticoagulants, including heparin and warfarin, or
other platelet aggregation inhibitors; risk of bleeding increases. 01093741899
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■ Use caution in patients with atrial fibrillation; assess bleeding risk carefully jjl) OLajLi-J)jSjj
4JJ)
■ Premature interruption of therapy may result in stent thrombosis with subsequent fatal and
nonfatal myocardial infarction; duration of therapy is determined by type of stent placed.
■ May increase risk of major hemorrhage in patients with recent lacunar stroke.
01093741899
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Pregnancy:
According to the manufacturer, use should not be withheld if needed for emergent treatment of
stroke or myocardial infarction during pregnancy. Discontinue use 5 to 7 days prior to labor, delivery,
or neuraxial blockade if possible due to increased risk of maternal bleeding and hemorrhage.
Lactation: It is not known if clopidogrel is present in breast milk.
Dexametfiasone. (Jtyiddne®. Tortecortin®. Orazone®)

Dosage form & strength: 8 mg / 2 ml amp.
Class: Corticosteroids; Anti-Inflammatory Agents.
Indications & dosage:
Usual dosage range: Oral, IV, IM: 4 to 20 mg/day given in a single daily dose or in 2 to 4 divided doses;
High dose: 0.4 to 0.8 mg/kg/day (usually not to exceed 40 mg/day).
■ Coronavirus disease 2019 (COVID-19), treatment (severe or critical) (off-label use):
* Adult: IV, Oral: 6 mg once daily for 7 to 10 days (or until discharge if sooner).
■ Multiple Sclerosis (Acute Exacerbation):
* Adult: 30 mg/day PO for 1 week; follow by 4-12 mg/day for 1 mo.
■ Cerebral Edema:
* Adult: Initial, 10 mg IV, followed by 4 mg IM q6hr until symptoms of cerebral edema
subside and gradually discontinue over 5-7 days.
* pediatric: 1-2 mg/kg IV/1 M once; maintenance: 1-1.5 mg/kg/day IV/1 M divided q4-
6hr; not to exceed 16 mg/day.
■ Shock: 1-6 mg/kg IV once or 40 mg IV q2-6hr PRN.
■ Allergic Conditions & asthma:
* Adult & pediatric: 0.5 to 9 mg/day IV/1 M; adjust according to patient response.
* Asthma exacerbation; pediatric: 0.6 mg/kg once daily as a single dose or once daily for
2 days; maximum dose: 16 mg/dose.
■ Meningitis; Adjunct:
* Adult: 0.15 mg/kg/dose or 10 mg every 6 hours for 4 days.
* Pediatric: >6 weeks: 0.15 mg/kg/dose every 6 hours for the first 2 to 4 days of antibiotic
treatment; start dexamethasone 10 to 20 minutes before or with the first dose of
antibiotic.
Dose adjustment:
Renal dosing: no adjustment.
hepatic dosing: Use with caution in patients with hepatic impairment, including cirrhosis; long-term
use has been associated with fluid retention.
01093741899
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Administration:
iv
Administer the 4 mg/mL or 10 mg/mL concentration IV push, continuous or intermittent IV
infusion(after dilution with 50 ml D5W, NS and infuse over 30 min).
IM
Administer the 4 mg/mL or 10 mg/mL concentration deep IM.
Stability
Protect from light, heat, and freezing. Diluted solutions should be used within 24 hours.
■ Prolonged use may result in ocular hypertension and/or glaucoma, with damage to the optic
nerve, defects in visual acuity and fields of vision.
■ Corticosteroids may exacerbate systemic fungal infections; not for use in presence of such
infections unless needed to control life-threatening drug reactions.
■ May lead to inhibition of bone growth in pediatric patients.
■ Osteoporosis may occur; use caution in patients at increased risk (e.g., postmenopausal
women).
■ Has minimal mineralocorticoid activity; can't be used in the management/prevention of
adrenal crisis in patients with known primary adrenal insufficiency.
■ Acute myopathy has been reported with high-dose corticosteroids, usually in patients with
neuromuscular transmission disorders; may involve ocular and/or respiratory muscles; monitor
creatine kinase; recovery may be delayed.
■ Withdraw therapy with gradual tapering dose.
■ Administration of live virus vaccines, including smallpox, is contraindicated in individuals
receiving immunosuppressive doses of corticosteroids, as the expected serum antibody
response may not be obtained.
■ Use with caution following acute myocardial infarction; corticosteroids have been associated
with myocardial rupture.
■ Use with caution in patients with Gl diseases (diverticulitis, intestinal anastomoses, peptic
ulcer, ulcerative colitis) due to perforation risk. Avoid ethanol; may enhance gastric mucosal
irritation.
■ Use with caution in patients with diabetes mellitus; may alter glucose production/regulation,
leading to hyperglycemia.
Pregnancy Category: C
■ Some studies have shown an association between first trimester systemic corticosteroid use
and oral clefts.
■ Systemic corticosteroids may also decrease birth weight.
■ Hypoadrenalism may occur in newborns.
■ When systemic corticosteroids are needed in pregnancy, it is generally recommended to use
the lowest effective dose for the shortest duration of time, avoiding high doses during the first
trimester.
■ However, the injection is often used for antenatal fetal lung maturation in patients with
preterm premature rupture of membranes or preterm labor (membrane rupture or preterm
contractions between 24 0/7 weeks and 34 0/7 weeks of gestation), who are at risk of preterm
delivery.
■ Use may also be considered as early as 23
0/7 weeks in women with membrane rupture at risk of preterm delivery or preterm labor
when delivery is expected within 7 days.
■ Dexamethasone should not be used to treat primary adrenal insufficiency in pregnant
women.
Lactation:
■ Corticosteroids, when administered systemically, appear in human breast milk. In sufficient
quantities, this could result in growth suppression, interfere with endogenous corticosteroid
production, or cause other adverse events for the nursing infant.
■ Caution should be taken when breast-feeding women are taking pharmacologic doses of
corticosteroids.
■ The World Health Organization considers dexamethasone compatible with breastfeeding in a
single dose, while no information is available regarding prolonged use.
Diazepam CVaCium®. Neurit®)
Dosage form & strength: io mg / 2 ml amp.

Class: Anticonvulsants. Skeletal Muscle Relaxants; Antianxiety Agents; Benzodiazepines.
Indications:
■ Anxiety.
■ Seizure; Adjunct in severe recurrent convulsive seizures and status epilepticus.
■ Acute alcohol withdrawal.
■ Sedation in the ICU.
■ Muscle spasm; as an adjunct for the relief of skeletal muscle spasm because of reflex spasm
caused by local pathology.
■ Preoperative Relief of anxiety and tension in patients undergoing surgical procedures.
■ Hydroxychloroquine/chloroquine toxicity.
Dosage:
Anxiety
Adults: 2-10 mg PO q6-12hr, OR 2-10 mg IV/IM q6-12hr; no more than 30 mg/8 hours.
Hydroxychloroquine/chloroquine toxicity
IV: 2 mg/kg once administered over 30 minutes, followed by 1 to 2 mg/kg/day for 2 to 4 days. Alcohol
Withdrawal:
10 mg PO q6-8hr during first 24hr; reduce to 5 mg PO q6-8hr PRN. Or 10 mg IV/IM, may give additional
doses of 5-10 mg IV q6-8hr as needed.
Muscle spasm:
2-10 mg PO q6-8hr PRN, OR 5-10 mg IV/IM initially; THEN q3-4hr if necessary Sedation:
IV: Loading dose: 5 to 10 mg; Maintenance dose: 0.03 to 0.1 mg/kg every 30 minutes to 6 hours.
Seizure Disorder: 2-10 mg PO q6-12hr as adjunct.
Status epilepticus: 5-10 mg IV/IM q5-10min; not to exceed 30 mg.
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Dose adjustment:
Renal impairment:
No dose adjustment recommended unless administered for prolonged period; decrease dose in
prolonged periods.
Hepatic impairment: 50% of maintenance dose.
Administration:
JV:
■ Administer undiluted by slow IV push; do not mix with other solutions or medications.
■ Rapid injection may cause respiratory depression or hypotension.
■ In infants and children, do not exceed 1 to 2 mg/minute IV push; in adults, maximum infusion
rate is 5 mg/minute.
■ Monitor respiration q 5-15min and before each IV dose.
■ Have airway support ready until effects of IV administration are known.
■ Do not administer through small veins (eg, dorsum of hand/wrist). Avoid intra-arterial
administration.
■ Continuous infusion is not recommended because of precipitation in IV fluids and absorption of
drug into infusion bags and tubing.
■ Ensure proper needle or catheter placement prior to and during infusion; avoid extravasation.
Extravasation:
If extravasation occurs:
■ Stop IV administration immediately and disconnect (leave cannula/needle in place).
■ Gently aspirate extravasated solution (do not flush the line).
■ Remove needle/cannula; elevate extremity. Apply dry cold compresses.
Rectal: 0.5 mg/kg
Precautions:
■ Concomitant use of benzodiazepines and opioids may result in profound sedation, respiratory
depression, coma, and death.
■ Use caution in COPD, sleep apnea, renal/hepatic disease, open-angle glaucoma (questionable),
depression, suicide ideation, impaired gag reflex, history of drug abuse, or obese patients
(prolonged action when discontinued).
■ Paradoxical reactions may occur including hallucinations, aggressive behavior, and psychoses;
dinscontinue use if reactions occur.
■ Abrupt withdrawal may result in temporary increase of seizures.
■ Contraindicated in acute narrow angle glaucoma and open angle glaucoma unless patients
receiving appropriate therapy.
Pregnancy category: D
Lactation: present in breast milk.; not recommended.
01093741899
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THcCofenac potassium
(Cataftam®, Acttfasf®)
Dosage form &strength: 75 mg/ 3 ml amp & 25, 50, 75 mg tab/ supp.
Class: NSAIDS
Indications:
■ Pain/Fever/Dysmenorrhea.
■ Inflammatory Disease.
■ Osteoarthritis.
■ Rheumatoid Arthritis.
■ Acute migraine & Ankylosing spondylitis.
General dosing:
Adult:
■ 50 mg PO q8hr or 75 mg PO/IM ql2hr, 100 mg ORALLY once daily,
■ 37.5 mg slow IV bolus injection over 15 seconds every 6 hours as needed; MAX dose 150
mg/day.
■ MAX dose 225 mg/day for Rheumatoid Arthritis.
Pediatric:
Injection: contraindicated
1-12 years with juvenile chronic arthritis: 12.5 mg and 25 mg suppositories only: 1-3 mg/kg /day
divided into 2 or 3 doses maximum 4 days.
Children (aged 6-12 years) with acute post-operative pain: 1-2 mg/kg /day in divided doses. Treatment
of acute post-operative pain should be limited to 4 days treatment (12.5 mg and 25 mg suppositories
only).
Administration:
Oral
■ Take this medicine with food if your stomach gets upset.
■ Do not take other medicines that contain aspirin, ibuprofen or naproxen with this medicine,
Side effects such as stomach upset, nausea, or ulcers may be more likely to occur.
■ Take with food or 240-360 ml of water to avoid Gl effects.
IM: deep gluteal injection.
IV infusion: slow infusion after dilution with NS, or D5W (100 - 500 ml).
■ Declophen must not be given as IV bolus injection.

■ Do not administer injections preserved with benzyl alcohol to neonates.
■ Use caution in patients with known or risk factors for cardiovascular disease due to risk of
serious cardiovascular thrombotic events, myocardial infarction, and stroke, which may be
fatal.
■ NSAIDS are contraindicated in the setting of coronary artery bypass graft (CABG) surgery.
■ NSAIDs also cause an increased risk of serious gastrointestinal adverse events including
bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal. Risk is
especially increased in the elderly and in patients with prior peptic ulcer disease or Gl bleeding.
01093741899
43
■ Avoid chronic use in older adults unless
other alternatives are not effective and patient can take gastroprotective agent (ie, proton
pump inhibitor or misoprostol).
■ Inhibit platelet aggregation; may result in prolonged bleeding time.
■ Heart failure; edema and fluid retention have been reported; increased risk of renal toxicity or
injury.
Pregnancy category: avoid use in late pregnancy (may cause premature closure of ductus
arteriosus); category D if >30 weeks after gestation.
Lactation: Excreted in breast milk; not recommended.
Digoxin (Lanoxin®)
Dosage form & strength: 0.5 mg/2 ml amp.

Class: Antidysrhythmics, V; Inotropic Agents.
Indications:
Atrial fibrillation or atrial flutter:
Total digitalizing dose (TDD): Initial:
IV: 0.25 to 0.5 mg over several minutes, with repeat doses of 0.25 mg every 6 hours to a maximum of
1.5 mg over 24 hours
Heart failure with reduced ejection fraction (HFrEF): 0.125-0.25 mg PO/IV qDay; higher doses
including 0.375-0.5 mg/day rarely needed.
Use lower end of dosing (0.125 mg/day) in patients with impaired renal function or low lean body
mass
Renal Impairment Dosing; Adult:
Adjust maintenance dose by estimating CrCI and measuring serum levels
In heart failure, higher dosages have no additional benefit and may increase toxicity; decreased renal
clearance may lead to increased toxicity
In geriatric patients, use lean body weight to calculate dose
Altered kidney function:

Atrial fibrillation/flutter:
IV, Oral:
Loading dose: Note: Use with caution and only when rapid ventricular rate control is necessary.
■ CrCI <15 mL/minute: Administer 50% of usual dose.
Maintenance dose: Note: Patients with low lean body weight may require lower doses. Doses of
0.0625 mg once daily may be given as 0.125 mg every other day.
■ CrCI 45 to <60 mL/minute: 0.0625 to 0.125 mg once daily.
■ CrCI 30 to <45 mL/minute: 0.0625 mg once daily.
■ CrCI <30 mL/minute: 0.0625 mg every 48 hours or consider alternative agent.
Heart failure:
Oral:
Digoxin Dosing Suggestions When Used for Heart Failure a,b

Ideal body weight (kg) CrCl (mL/minute) Digoxin dose
>60 0.125 mg once daily
45 to 50
15 to 60 0.0625 mg once dailyc
>110 0.1875 mgd to 0.25 mg once daily
>50 to 60 >45 to 110 0.125 mg once daily
>110 0.1875 mgd to 0.25 mg once daily
>80 to 110 0.1875 mgd to 0.25 mg once daily
>100 0.25 mg once daily
>80 >70 to 100 0.1875 mgd to 0.25 mg once daily
15 to 70 0.125 mg once daily
■ a
Derived from a contemporary digoxin dosing nomogram using CrCI and ideal body weight or height
for determining the initial maintenance dose in patients with heart failure to achieve a target digoxin
concentration of 0.7 ng/mL.
■ bNo loading dose necessary.
■ cMay administer as 0.125 mg every other day.
■ dMay administer as 0.125 mg alternating with 0.25 mg every other day.
Hepatic Impairment Dosing; adult: No dosage adjustment necessary.

Administration:
IV
■ May be administered undiluted or diluted. Inject slowly over >5 minutes.
■ Dilute with 4-fold or greater volume of SWI, D5W, or NS.
■ IV Solution Compatibilities: D5/14NS with potassium chloride 20 mEq, D5W, LR, ]4NS, NS.
■ Do not administer if precipitate present.
■ Vesicant; ensure proper needle or catheter placement prior to and during administration;
avoid extravasation.
Storage:
■ Store at controlled room temperature
El 01093741899
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5
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■ Not recommended in patients with acute myocardial infarction.
■ Avoid in patients with myocarditis.
■ Risk of advanced or complete heart block in patients with sinus node disease and AV block.
■ Very narrow margin between effective therapeutic and toxic dosages: Therapeutic range,
0.5-2 ng/mL (target 0.5-1 ng/mL); toxic range, >2.5 ng/mL.
■ Signs and symptoms of digoxin toxicity include anorexia, nausea, vomiting, visual changes, and
cardiac arrhythmias; toxicity is usually associated with digoxin levels >2 ng/mL, although
symptoms may occur at lower levels.
■ Patients at increased risk for digoxin toxicity include those with low body weight, advanced
age, renal impairment, hypokalemia, hypercalcemia, or hypomagnesemia.
■ Maintain adequate amounts of potassium in diet to decrease risk of hypokalemia.
■ May cause false-positive ST-T changes during exercise testing.
■ Do not switch between different PO forms or between brand and generic forms of digoxin;
bioavailability varies.
■ Serum levels drawn within 6-8 hours of dose will be falsely high because of prolonged
distribution phase.
■ Increased risk of estrogen-like effects in geriatric patients.
■ Avoid rapid IV administration in digitalized patients; may produce serious arrhythmias.
Pregnancy category:
■ Digoxin crosses the placenta. Based on available data, an increased risk of adverse pregnancy
outcomes has not been observed. However, untreated maternal heart failure and atrial
fibrillation may increase the risk of preterm birth and low birth weight, respectively.
■ The manufacturer recommends monitoring neonates for signs and symptoms of digoxin
toxicity ( vomiting, and cardiac arrhythmias) following in utero exposure.
Lactating:
■ Digoxin is present in breast milk. The manufacturer reports the relative infant dose (RID) of
digoxin to be 1% to 7% of a weight-adjusted maternal dose or ~ 0.2% to 4% of a neonatal
maintenance dose.
■ In general, breastfeeding is considered acceptable when the RID of a medication is <10%
■ The amount of digoxin available to the infant via breast milk is not likely to be clinically
significant. The World Health Organization considers digoxin to be compatible with
breastfeeding.
01093741899
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Ttofaitamine (Vo (mt amine®,
Dofaiject®)
Dosage form & strength: 250 mg/5 ml amp.
Class: Inotropic Agents
Indications & Dosage:
Adult:
Cardiac decompensation:
■ 0.5-1 mcg/kg/min IV continuous infusion initially, then 2-20 mcg/kg/min; not to exceed 40
mcg/kg/min.
■ Note: In patients with heart failure, lower doses are preferred to minimize adverse effects.
Pediatric:
Hemodynamic support: Infants, Children, and Adolescents: Continuous IV or intraosseous infusion:
Initial: 0.5 to 1 mcg/kg/minute, titrate gradually every few minutes until desired response achieved;
usual range: 2 to 20 mcg/kg/minute.
Dose adjustment:
Administration:
■ Dilute 250 mg in 250 mL of compatible solution to yield final concentration of 1000 mcg/mL(l
mg/mL); not to exceed 5000 mcg/mL (5 mg/mL).
■ Comatible with NS,D5W, D5w/NS 0.9% , D5w/NS 0.045%, LR , D5W/LR and D10W.
Incompatible With: Sodium bicarbonate or other alkaline intravenous solutions, and diluent
that containing sodium bisulfite or ethanol.
■ Infuse into large vein via infusion pump.
■ Diluted solution should be used within 24 hours.
■ Ventricular arrhythmias, including nonsustained ventricular tachycardia and supraventricular
arrhythmias, have been reported.
■ An increase in blood pressure is more common due to augmented cardiac output, but
occasionally a patient may become hypotensive.
■ An increased risk of hospitalization and death has been observed with prolonged.
■ May cause dose-related increases in heart rate.
■ May exacerbate ventricular ectopy (dose-related).
■ Ineffective therapeutically in the presence of mechanical obstruction such as severe aortic
stenosis.
■ If needed, correct hypovolemia first to optimize hemodynamics. Correct electrolyte
disturbances, especially hypokalemia or hypomagnesemia, prior to use and throughout
therapy to minimize the risk of arrhythmias.
■ Use with caution in patients with active myocardial ischemia or recent myocardial infarction;
can increase myocardial oxygen demand.
Lactation: It is not known if dobutamine is present in breast milk ; avoid use.
' '"y^’'i 2t^,^t| ^j_ua
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Dopamine (Intropm . Dopasunny®)

Dosage form & Strength: 40mg/ml (200mg in 5ml) amp.
Class: Inotropic Agents
ICU Indication & dosage:
Adult: Hemodynamic support:
Treatment of hypotension, low cardiac output, poor perfusion of vital organs;
used to increase mean arterial pressure in septic shock patients who remain hypotensive after
adequate volume expansion:
■ (low dose) 1-5 mcg/kg/min IV: May increase urine output and renal blood flow.
■ (medium dose) 5-15 mcg/kg/min IV: May increase renal blood flow, cardiac output, heart rate,
and cardiac contractility.
■ (high dose) 20-50 mcg/kg/min IV: May increase blood pressure and stimulate vasoconstriction;
may not have a beneficial effect in blood pressure; may increase risk of tachyarrhythmias.
■ Titrate to desired response.
Pediatric:
Hemodynamic support: Continuous IV or intraosseous infusion: 2 to 20 mcg/kg/minute, titrate
gradually by 5- to 10-mcg/kg/minute increments until optimal response is obtained.
Administration:
■ Dilute 200-400 mg in 250-500 mL of compatible diluent (eg, D5W, NS, LR, D5/NS, D5/LR);
typical concentration range is 0.8-1.6 mg/mL, though up to 3.2 mg/mL has been used.
■ Administer as a continuous infusion with the use of an infusion pump. Administer into large
vein to prevent the possibility of extravasation (central-line administration).
■ Administration into an umbilical arterial catheter is not recommended.
■ Drug is stable for 24 hours after dilution.
■ Protect from light. Solutions that are darker than slightly yellow should not be used.
■ Hypovolemia should be corrected with suitable volume expanders before treatment with
dopamine.
■ If an increased number of ectopic beats are observed the dose should be reduced if possible.
■ At lower infusion rates, if hypotension occurs, the infusion rate should be rapidly increased
until adequate blood pressure is obtained. If hypotension persists, dopamine should be
discontinued and a more potent vasoconstrictor agent such as noradrenaline should be added.
■ Use caution in angina pectoris, extravasation, hypovolemia, occlusive vascular disease,
ventricular arrhythmias, recent use of monoamine oxidase inhibitors, sensitivity to sulfites.
01093741899
48
i
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4JJ) jjl) '■^'1
■ If extravasation occurs, infiltrate the area with diluted phentolamine (5 to 10 mg in 10 to 15

mL of saline) with a fine hypodermic needle. Phentolamine should be administered as soon as
possible after extravasation is noted to prevent sloughing/necrosis.
■ Drug is inactivated by alkali.
■ Use with caution after myocardial infarction.
■ Monitor blood pressure closely.
It is not known if dopamine crosses the placenta. Medications used for the treatment of cardiac
arrest in pregnancy are the same as in the non-pregnant woman. Appropriate medications should not
be withheld due to concerns of fetal teratogenicity.
Lactation:
It is not known if dopamine is present in breast milk. The manufacturer recommends that caution be
exercised when administering dopamine to breastfeeding women.
T) oxy eye Cine (Viframycin®. TaCocme")

Dosage form & strength: loo mg cap.
Class: Tetracyclines, antibiotics.
Indications:
■ Brucellosis & Bartonellosis.
■ Cellulitis due to community-acquired MRSA.
■ Acne vulgaris & amebic infection.
■ Vibrio Cholera & Q fever.
■ Acute bacterial rhinosinusitis.
■ Malaria, Severe Treatment (Unlabeled) & Malaria prophylaxis.
■ Syphilis in penicillin-allergic patients.
■ Tularemia & gonorrhea.
■ Chlamydial infection & listeriosis.
■ Actinomycotic & Clostridial infections, when penicillin is contraindicated.
■ Rickettsial infections & Gonorrhea.
■ Infections by Mycoplasma pneumonia.
■ Urinary tract infections.
■ Respiratory tract infections.
General dosing:
Adult dose:
Initial: 200 mg/day divided twice daily PO/IV on first day (IV may be given q Day), THEN; Maintenance:
100-200 mg/day q Day or divided ql2hr PO/IV (IV may be given q Day)
01093741899
49
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Pediatric dose:
^8 years: Not recommended; may cause tooth discoloration and enamel hypoplasia during tooth
development.
Dose adjustment
Renal Impairment: No dosage adjustment necessary.
Hepatic impairment: caution advised.
Administration:
■ The immediate/delayed-release capsules should be swallowed whole; do not break, crush or
chew.
■ Take with adequate fluid to prevent esophageal irritation and ulceration.
■ Should be taken on an empty stomach, preferably at least 1 hour prior to or 2 hours after
meals.
Precautions:
■ Give doxycycline 1 h before or 4 h after AI-, Ca-, or Mg-containing antacids; these antacids
decrease doxycycline efficacy (absorption decreased via chelation).
■ Hepatotoxicity may occur; if symptoms occur, measure LFTs and discontinue drug.
■ Photosensitivity may occur with prolonged exposure to sunlight or tanning equipment.
■ use doxycycline in pediatric patients 8 years of age or less only when potential benefits
expected to outweigh risks in severe or life-threatening conditions particularly when there are
no alternative therapies.
■ May induce hyperpigmentation in many organs including skin, eyes, nails, thyroid and bone.
Lactation: Enters breast milk; not recommended.
Znoxaparm(Cfexane)
Dosage form Strength : 40 mg prefilled syringe.
Class: Anticoagulants, Cardiovascular.
Adult Dose:
■ Venous thromboembolism prophylaxis: 40 mg SC once daily; continue until risk of VTE has
■ NOTE: BMI >40 kg/m2: Increase standard prophylaxis dose by 30%.
■ VTE treatment: 1 mg/kg every 12 hours (preferred) or 1.5 mg/kg once every 24 hours.
Pediatric Dose:
Prophylaxis:
■ <2 months: 0.75 mg/kg SC ql2hr
■ >2 months: 0.5 mg/kg SC ql2hr
Treatment:
■ <2 months: 1.5 mg/kg SC ql2hr
■ >2 months: 1 mg/kg SC ql2hr
01093741899
50
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Dose adjustment:
Renal Impairment:
■ CrCI >30 mL/minute no dosage adjustments.
■ CrCI <30 mL/minute:
VTE prophylaxis: 30 mg SC once daily. VTE treatment: 1 mg/kg SC once daily.
Contraindications:
■ History of immune mediated heparin-induced thrombocytopenia (HIT) in the past 100 days.
■ Active major bleeding.
Warnings:
■ Thrombocytopenia can occur.
■ hyperkalemia can occur by suppressing aldosterone production esp. with renal dysfunction,
concomitant use of potassium-sparing diuretics or potassium supplements, hematoma in body
tissues.
Monitoring Parameters:
■ Hemoglobin.
■ Platelet count.
■ PT, aPTT.
■ Serum creatinine.
Pregnancy: does not cross the placenta; increased risks of fetal bleeding or teratogenic effects have
not been reported.
Lactation: Excretion in milk unknown; not recommended.
'EtamsyCate. ( 'Dicynone)
Dosage form & strength: 250 mg/2ml amp.
Uses:
Etamsylate is a haemostatic that appears to maintain the stability of the capillary wall and correct
abnormal platelet adhesion. It is given for the prophylaxis and control of haemorrhages from small
blood vessels.
Dosage & Administration:
■ For the control of haemorrhage after surgery: 250 to 500 mg IV/IM.
A dose may be given 1 hour before surgery, and further doses given after surgery and repeated
every 4 to 6 hours as long as bleeding risk persists. Intravenous doses may be given during
surgery if necessary.
■ Children: half the adult dose.
■ Prophylaxis of neonatal intraventricular haemorrhage: 10 mg/kg IM within 2 hr after birth then
every 6 hr for 4 days.
01093741899
51
j£j-a
Stability:
Protect from light. Discard ampoules if the solution is coloured.
Pregnancy:
It should not be taken during first trimester of pregnancy. Whereas during the second and third
trimester, it should be administered only if the expected therapeutic benefit is superior to the
potential risk for foetus.
Lactation: No data is available; not advisable.
TAMOTlPIIt (Anth0
Dosage forms: 20, 40 mg tablet & 20 mg amp.
Pharmacological action:
■ It is a highly specific and potent competitive histamine- H2 - receptor antagonist. Absorption is
rapid and the onset of action is by one hour after oral administration. The plasma half life is
approx. 3 hrs. but the duration is longer.
■ Famotidine has no cyt. P450 interactions.
Indication and dosage:
Adult dose
■ Duodenal Ulcer; Acute treatment: 20 mg PO/IV ql2hr or 40 mg PO at bedtime for 8 weeks,
Maintenance: 20 mg PO at bedtime.
Reduction of recurrence risk: 20 mg PO qDay for 1 year or as clinically indicated.
■ Benign Gastric Ulcer: 40 mg PO at bedtime up to 8 weeks.
■ Gastroesophageal Reflux Disease: Nonerosive: 20 mg ql2hr; up to 6 weeks. Erosive diagnosed by
endoscopy: 20-40 mg PO ql2hr for up to 12 weeks.
■ Hypersecretory Conditions: 20 mg PO/IV q6hr; may increase up to 160 mg q6hr.
■ Heartburn: 10-20 mg ql2 hr; may take 15-60 min before eating foods that could cause heartburn.
Pediatric Patients 1-17 years: 0.25-0.5 mg/kg/day PO at bedtime or divided b.i.d. up to 8 weeks; not
to exceed 40 mg/day.
Dosing Modifications:
Injection: CrCI <50 mL/min: Give 50% of usual dose, or prolong dosing interval to q36-48hr.
Administration:
■ IV push: Dilute 2 mL (20 mg) with NS or another compatible solution(eg, D5W, D10W, LR) to a
total volume of 5 or 10 mL and inject over at least 2 minutes.
■ IV Infusion: Dilute 2 mL (20 mg) with 100 mL of D5W or another compatible solution and Infuse
over 15 to 30 minutes.
Storage:
■ Solution for injection: store at 2°C to 8°C. If solution freezes, allow to solubilize at room
temperature.
■ IV push: Following preparation, solutions for IV push should be used immediately, or may be
stored in refrigerator and used within 48 hours.
01093741899
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■ Infusion: Following dilution in D5W, D10W, NS or LR, may be stored for up to 48 hours under
refrigeration; however, solutions for infusion have been found to be physically and chemically
stable for 7 days at room temperature (maintains at least 90% of initial potency).
Cautions:
■ Headache , dizziness , constipation and diarrhea are reported adverse reactions.
■ CNS adverse effects, including confusion, delirium, hallucinations, disorientation, agitation,
seizures, and lethargy, reported with moderate-to-severe renal impairment.
Pregnancy Category: B
There are, however, no adequate or well-controlled studies in pregnant women. This drug should be
used during pregnancy only if clearly needed.
Lactation:
Excreted into human milk; A decision should be made to discontinue breastfeeding or discontinue the
drug, taking into account the importance of the drug to the mother.
TCumazeniC (JAnexate®, AnexniC)
Dosage form & strength: 0.5 mg/5 ml amp.

Class: Benzodiazepine Toxicity Antidotes.
Indications& Dosage:
■ Benzodiazepine reversal when used in conscious sedation or general anesthesia: Adult
* 0.2 mg IV over 15 sec
* IF after 45 sec no response, administer 0.2 mg again over 1 min; may repeat at 1 min
intervals; not to exceed 4 doses (1 mg)
* IF resedation occurs, may repeat doses at 20-min intervals; not to exceed 1 mg/dose or
3 mg/hr
Pediatric
IV: Initial dose: 0.01 mg/kg (maximum dose: 0.2 mg) given over 15 seconds; may repeat
0.01 mg/kg (maximum dose: 0.2 mg) after 45 seconds, and then every minute to a maximum
total cumulative dose of 0.05 mg/kg or 1 mg, whichever is lower; usual total dose: 0.08 to 1
mg
■ Benzodiazepine Overdose:
Adult
* 0.2 mg IV over 15-30 sec
* IF no response after 30 sec, administer 0.3 mg over 30 sec 1 min later; IF no response, repeat
dose of 0.5 mg IV over 30 sec at 1-min intervals to max cumulative dose of 3 mg/hr.
* In the event of resedation, may repeat dose at 20-min intervals if needed; not to exceed 1 mg
(administered as 0.5 mg/min) administered at any one time and no more than 3 mg/hr.
* Rarely patient may require titration up to total dose 5 mg; IF no response after 5 min,
sedation unlikely to be secondary to benzodiazepines.
01093741899
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Pediatric
Initial dose: 0.01 mg/kg (maximum dose: 0.2 mg) with repeat doses of 0.01 mg/kg (maximum dose:
0.2 mg) given every minute to a maximum total cumulative dose of 1 mg; as an alternative to repeat
bolus doses, follow up continuous infusions of 0.005-0.01 mg/kg/hour have been used. Renal
Impairment:
No dosage adjustment provided in manufacturer's labeling; however,pharmacokinetics are not
significantly affected by renal failure (CrCI <10 mL/minute) or hemodialysis.
Hepatic Impairment:
Initial reversal: No dosage adjustment necessary. Repeat doses: Reduce dose or frequency.
Administration
■ IV over 15-30 sec.
■ To minimize pain, administer through a freely running IV infusion line into a large vein.
■ Avoid extravasation.
Storage/Stabilitv
■ Store at 20°C to 25°C .
■ Once drawn up in the syringe or mixed with D5W, LR, or NS, use within 24 hours.
■ Discard any unused solution after 24 hours.
Warnings
■ Head trauma & History of seizures.
■ Not for reversal of respiratory depression (need to establish an airway, assist ventilation, and
continue to observe patient)-monitor for return of respiratory depression/sedation.
■ May not reverse amnesia.
■ May cause CNS depression, which may impair physicaI or mental abilities; patients must be
cautioned about performing tasks which require mental alertness (eg, operating machinery or
driving) for 24 hours after discharge.
■ Resedation occurs frequently in patients who have received a large single dose or cumulative
dose of a benzodiazepine administered along with a neuromuscular blocker and multiple
anesthetic agents.
■ Agitation produced in some patients.
■ Patients rarely seize with 0.2 mg dose.
■ If seizure after flumazenil, recommend valium 20-30 mg, then immediately to barbiturates
■ Use caution in patients with hepatic dysfunction & panic disorder.
Pregnancy Category: c
Lactation: It is not known if flumazenil is excreted in breast milk. The manufacturer recommends
that caution be used if administering to breast-feeding women.
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TurosemicCe ( £axis®)
Class: Diuretics, Loop
Adult:
■ Edema (eg, peripheral, pulmonary, generalized): 20 to 40 mg once then titrate as needed to
an effective dose.
■ Acute Pulmonary Edema/Hypertensive Crisis/lncreased Intracranial Pressure
0.5-1 mg/kg (or 40 mg) IV over 1-2 minutes; may be increased to 80 mg if there is no adequate
response within 1 hour;not to exceed 160-200 mg/dose.
■ Hyperkalemia in Advanced Cardiac Life Support (ACLS): 40-80 mg IV.
Pediatric:
Edema (diuresis):
IM, intermittent IV: usual initial adult dose: 20 to 40 mg/dose; if initial dose ineffective after 2 hours,
may increase dose by 1 mg/kg/dose; maximum dose: 6 mg/kg/dose not to exceed maximum adult
dose: 200 mg/dose; adjust to minimal effective dose for maintenance.
Dose adjustment:
Renal impairement:
■ Acute renal failure: Doses up to 1 to 3 g daily may be necessary to initiate desired response;
avoid use in oliguric states.
■ Dialysis: Not removed by hemodialysis or peritoneal dialysis; supplemental dose is not
necessary.
Administration :
■ Injection: Inject directly or into tubing of actively running IV over 1-2 minutes.
■ Administer undiluted IV injections at rate of 20-40 mg/min; not to exceed 4 mg/min for short-
term intermittent infusion; in children, give 0.5 mg/kg/min, titrated to effect.
■ Refrigeration may result in precipitation or crystallization; however, resolubilization at room
temperature or warming may be performed without affecting the drug's stability.
■ Infusion solution in D5W, NS, or LR is stable for 24 hours at room temperature.
■ IV infusion solution may be mixed in NS or D5W solution. May also be diluted for infusion to 1
to 2 mg/mL (maximum: 10 mg/mL).
■ Intact ampoule Store at room temperature. Protect from light. Do not use if solutions have a
yellow colour or contain crystal deposits.
Warnings:
■ If given in excessive amounts, furosemide, similar to other loop diuretics, can lead to
profound diuresis, resulting in fluid and electrolyte depletion.
■ Patients allergic to sulfonamides may also be allergic to frusemide.
■ Cases of tinnitus and reversible or irreversible hearing impairment have been reported.
Usually, reports indicate that frusemide ototoxicity is associated with rapid injection, severe
renal impairment, doses exceeding several times the usual recommended dose,or
concomitant therapy with aminoglycoside antibiotics or other ototoxic drugs.
01093741899
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■ To prevent oliguria, reversible increases in

BUN and creatinine, and azotemia, monitor fluid status and renal function.
■ If increasing azotemia and oliguria occur during treatment of severe progressive renal disease,
LASIX should be discontinued.
Pregnancy category: C; treatment during pregnancy necessitates monitoring of fetal growth

because of risk for higher fetal birth weights.
Lactation: Drug excreted into breast milk; use with caution; may inhibit lactation.
J-Ceyavin sodium
Dosage form & strength: s.ooo i.u./ml
Class: Anticoagulants. Cardiovascular.
Adult Dose:
VTE prophylaxis: 5,000 units SC q8 -12 hours. VTE treatment:
■ 80 units/kg IV bolus followed by a continuous infusion of 18 units/kg/hr or
■ 5,000 unit IV bolus followed by 1,333 units/hour.
Pediatric Dose:
VTE treatment:
■ 1 year: loading dose: 75 units/kg IV over 10 minutes; then 28 units/kg/hour as initial
maintenance dose.
■ > 1 year: loading dose: 75 units/kg over 10 minutes, then 20 units/kg/hour as initial
maintenance dose.
Note: adjust heparin dose according to aPTT (1.5 - 2 times normalior anti-Xa activity (0.3 to 0.7
units/mL).
Dose adjustment:
Renal& Hepatic Impairment:
No dosage adjustment required; adjust therapeutic heparin according to aPTT or anti-Xa activity
IV Administration:
IV injection may be given undiluted or diluted in 50- 100 ml NS or D5W.
Warnings:
■ Hypersensitivity reactions may occur.
■ Use with caution in patients with an increased risk of bleeding.
■ Platelet counts should be measured in patients receiving heparin treatment for longer than
5 days and the treatment should be stopped immediately in those who develop
thrombocytopenia.
■ Monitor for hyperkalemia; can cause hyperkalemia by suppressing aldosterone production.
01093741899
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Monitoring Parameters
■ Hemoglobin.
■ Hematocrit.
■ Platelet count.
■ PT, aPTT.
■ Signs/symptoms of bleeding.
■ Risk factors for bleeding.
■ Level of anticoagulation can be monitored by anti-Factor Xa activity or aPTT .
Lactation: compatible with breast feeding.
^hydrocortisone sodium succinate ( SoCu-Corte f )

Dosage form & strength: 100 mg iv
Class: Corticosteroids
Dose:
Adult:
■ Anti-inflammatory or immunosuppressive: 100 to 500 mg/dose IM/IV at intervals of 2, 4, or
6 hours.
■ Septic shock: 50 mg 6 hourly.
■ Status Asthmaticus: 1-2 mg/kg IV q6hr for 24 hr; not to exceed 250 mg , IV Maintenance: 2
mg/kg/day IV divided q6hr.
Pediatric:
<12 years: 1-5 mg/kg/day IM/IV divided ql2-24hr.
Dose adjustment:
Renal & Hepatic Impairment:
There are no dosage adjustments provided in the manufacturer's labeling; use with caution.
Administration:
IV bolus
■ 100-mg viakReconstitute in <2 mL SWI/BWI
■ Administer undiluted over at least 30 seconds; for large doses (>500 mg), administer over 10
minutes.
IV Infusion
■ Add reconstituted solutions to an appropriate volume of D5W, NS, or D5NS (100 to 1,000 mL
for a 100 mg solution.
■ IV intermittent infusion administer over 20 to 30 minutes.
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Contraindications:
■ Untreated serious infections (except tuberculous meningitis or septic shock).
■ Idiopathic thrombocytopenic purpura (IM administration only).
■ Intrathecal administration (injection).
■ Use in premature infants (formulations containing benzyl alcohol only).
■ Documented hypersensitivity.
■ Systemic fungal infections.
■ Administration of live or live, attenuated vaccines is contraindicated in patients receiving
immunosuppressive doses of corticosteroids.
■ Discontinuation of therapy: Withdraw therapy with gradual tapering of dose.
■ Thromboembolic disorders and myopathy may occur.
■ In general high-dose corticosteroid therapy should be continued only until the patient's
condition has stabilised - usually not beyond 48 to 72 hours. If hydrocortisone therapy must be
continued beyond 48 to 72 hours hypernatraemia may occur, therefore it may be preferable to
replace Hydrocortisone with a corticosteroid such as methylprednisolone sodium succinate as
little or no sodium retention occurs.
Pregnancy: C ; it should not be used during pregnancy.
Breast-Feeding: Corticosteroids are present in breast milk.
Ibuprofen (Unfen, Megafen®, Profinaf)

Dosage form & Strength: 200 mg, 400 mg tab & 200 mg susp.
Class: NSAIDS
Indications:
■ Pain/ Fever/ Dysmenorrhea.
■ Osteoarthritis.
General dosing:
Pediatric:
Fever& pain: 6 months to 12 years: 4-10 mg/kg/dose PO q6-8hr; not to exceed 40 mg/kg/day.
Adult:
Fever& pain: 200-400 mg PO q4-6hr; not to exceed 1.2 g
Inflammatory Disease: 400-800 mg PO q6-8hr; not to exceed 3.2 g/day. Osteoarthritis: 300 mg,
400 mg, 600 mg, or 800 mg PO q6-8hr; not to exceed 3.2 g/day. Renal& hepatic dose adjustment: no
dose adjustment.
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Administration
■ Take with food if your stomach gets upset.
■ Do not take other medicines that contain aspirin, or naproxen with this medicine, Side effects
such as stomach upset, nausea, or ulcers may be more likely to occur.
Precautions:
fatal.
bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal.
Risk is especially increased in the elderly and in patients with prior peptic ulcer disease or Gl
bleeding.
■ Avoid chronic use in older adults unless other alternatives are not effective and patient can
take gastroprotective agent (ie, proton pump inhibitor or misoprostol).
■ Use with caution in case of preexisting asthma; risk of severe and potentially fatal
bronchospasm.
injury.
■ Severe hepatic impairment; avoid use.
Pregnancy: C; D at >30 weeks' gestation; may cause premature closure of ductus arteriosus, avoid
during 1st and 3rd trimesters
Lactation
Drug excreted into breast milk in extremely low level; considered the preferred choice of NSAID for
analgesia, or inflammation use while breastfeeding.
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Imiyenem/ciCastatin (/Tienam®)
Dosage form & strength: 500mg/500mg vial
Class: Carbapenems
Indications:
Usual adult dosage range: IV:
Susceptible bacterial species: 500 mg every 6 hours or 1,000 mg every 8 hours (maximum dose: 4,000
mg/day)
Intermediate susceptibility bacterial species: 1,000 mg every 6 hours (maximum dose: 4,000 mg/day).
Adult Dosage adjustment:
Renal Impairment:
CrCI Usual dosing 1,000 mg Usual dosing 1,000 mg Usual dosing 500 mg
every 6 hours every 8 hours every 6 hour
CrCI >60 to <90 750 mg every 8 hours 500 mg every 6 hours 400 mg every 6 hours
mL/minute
mL/minute:
mL/minute
CrCI <15 mL/minute: Do not administer imipenem and cilastatin unless hemodialysis is instituted within
48 hours.
* ESRD on intermittent hemodialysis: 250 to 500 mg every 12 hours.
* CVVH: Loading dose of 1 g followed by either 250 mg every 6 hours or 500 mg every 8 hours
* CVVHD: Loading dose of 1 g followed by either 250 mg every 6 hours or 500 mg every 6 to 8
hours
* CVVHDF: Loading dose of 1 g followed by either 250 mg every 6 hours or 500 mg every 6 hours
General Pediatric dosing:

susceptible infection; severe infections: IV: 60 to 100 mg/kg/day divided every 6 hours; maximum daily
dose: 4,000 mg/day.
Pediatric dosage adjustment:
Renal Impairment:
■ Manufacturer's labeling: Patient weight <30 kg and impaired renal function (not defined): Use not
recommended.
■ Renally adjusted dose recommendations
are based on doses of 60 to 100 mg/kg/day divided
every 6 hours:
* GFR 30 to 50 mL/minute/1.73 m2: Administer 7 to 13 mg/kg/dose every 8 hours
* GFR 10 to 29 mL/minute/1.73 m2: Administer 7.5 to 12.5 mg/kg/dose every 12 hours
* GFR <10 mL/minute/1.73 m2: Administer 7.5 to 12.5 mg/kg/dose every 24 hours
* Intermittent hemodialysis (IHD): Dialysis: Moderately dialyzable (20% to 50%): 7.5 to
12.5 mg/kg/dose every 24 hours (administer after hemodialysis on dialysis days)
* Peritoneal dialysis (PD): 7.5 to 12.5 mg/kg/dose every 24 hours.
* Continuous renal replacement therapy (CRRT): 7 to 13 mg/kg/dose every 8 hours.
Hepatic Impairment: There are no dosage adjustments provided in the manufacturer's labeling.
Administration:
■ For IV infusion only; do not administer IV push.
■ Reconstitute vials with approximately 10 mL of NS, D5W, D10W, D5NS, D51/2NS, or D51/4NS
and shake well.
■ Vial contents must be transferred to 100 mL of infusion solution.
■ Final concentration should not exceed 5 mg/mL.
■ Infuse doses <500 mg over 20 to 30 minutes; infuse doses >500 mg over 40 to 60 minutes.
■ If nausea and/or vomiting occur during administration, decrease the rate of IV infusion.
■ Reconstituted solutions are stable for 4 hours at room temperature and 24 hours refrigerated
(4 C) in NS.
■ Normal color ranges from clear to yellow; these variations do not affect potency, but
solution should be discarded if brown.
■ Imipenem is inactivated at acidic or alkaline pH.
■ Drug must not be mixed or physically added to other antibiotics; however, it may be
administered concomitantly.
■ Serious hypersensitivity/anaphylactic reactions have been reported, including fatalities; may
be more common in patients with a history of sensitivity to multiple allergens.
■ Use with caution in CNS disorders (eg., history of seizures); adjust dosage in renal impairment
to avoid risk of seizures; carbapenem use has been associated with seizures.
■ Prolonged use may result in fungal or bacterial superinfection.
■ Concurrent use of carbapenem antibiotics with divalproex sodium/valproic acid is generally
not recommended (decrease serum concentration of divalproex sodium/valproic acid
increasing the risk of breakthrough seizures).
■ Not recommended in pediatric CNS infections due to seizure potential. Not recommended in
pediatric patients <30 kg with impaired renal function (no data available).
Pregnancy category:
There are no adequate and well-controlled studies in pregnant women. TIENAM should be used during
pregnancy only if the potential benefit justifies the potential risk to the fetus.
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Lactation: present in breast milk.

According to the manufacturer, the decision to breastfeed during therapy should consider the risk of
infant exposure, the benefits of breastfeeding to the infant, and benefits of treatment to the mother.
Iimatropium bromide. (Mroventf®)
Dosage form & Strength: 0.5 mg/2 ml single dose container nebulizer solution.
Class: Anticholinergics, Respiratory
Indications:
■ Chronic obstructive pulmonary disease; chronic bronchitis and emphysema.
■ Acute asthma (exacerbations).
■ Allergic Rhinitis.
Dosage:
Adults, the elderly and children over 12 years: 0.25 - 0.5 mg (1-2 ml of solution) q6-8h. Children 6 -12
years: 0.25 mg (1ml) 3-4 times a day.
Children up to 5 years:
0.125 - 0.25 mg (0.5-lml of solution), there should be at least 6 hours between doses.
Dosage adjustment:
Renal impairment: no dosage adjustment.
Hepatic impairment: no dosage adjustment.
Administration:
■ Dilute the solution, using ONLY sterile sodium chloride 0.9% solution to make up the total
volume to between 2 mL and 5 mL.
■ When administering ipratropium solution via nebulization with a face mask, avoid leakage
from the mask because direct contact to the eyes may cause blurred vision, precipitation or
worsening of narrow-angle glaucoma, or eye pain.
Precautions:
■ Use for maintenance treatment only; should not be used as rescue therapy.
■ May cause life-threatening paradoxical bronchospasm or hypersensitivity reactions (skin
rash, pruritus, angioedema, urticaria/giant urticaria, laryngospasm); discontinue immediately,
and use alternative treatment.
■ May cause urinary retention; use with caution in patients with benign prostatic hyperplasia
(BPH) or bladder-neck obstruction.
Lactation: Unknown whether the drug is excreted in breast milk.
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IsofCuvane
Dosage form & Strength: 100 % Inhalation Solution.

Class: General Anesthetics, Inhalation.
Indications: Induction and maintenance of general anesthesia.
Dose and administration:
By inhalation using a specially calibrated vaporizer:
■ Induction of anesthesia: 1.5% to 3% isoflurane with oxygen or oxygen
nitrous oxide mixture.
■ Maintenance of anaesthesia: With nitrous oxide: 1% to 2.5%; additional
0.5% to 1% with oxygen alone.
■ Pediatric Use: Safety & efficacy not established.
Renal & Hepatic Impairment:
There are no dosage adjustments provided in the manufacturer's labeling.
Contraindications:
■ Hypersensitivity to isoflurane or other halogenated agents.
■ Patients with know or suspected malignant hyperthermia, unexplained jaundice and/or fever of
unknown origin, hepatic impairment or eosinophilia.
Drug interactions:
Avoid concomitant use of drug with:
■ Drugs which enhance the hypotensive effect: e.g. vasodilators (such as ACE inhibitors, nitrate,
calcium channel blockers), alpha and beta blockers, antipsychotics and diuretics.
■ Drugs which increase the risk of ventricular arrhythmias: e.g. tricyclic antidepressants and
sympathomimetics.
■ Drugs potentiated by isoflurane effect e.g.: Isoniazide: its hepatotoxicity is enhanced by the
drug.
■ Competitive muscle relaxants (use lower doses).
■ Narcotic analgesics.
■ Frequently reported side effects; Nausea, Vomiting & Shivering.
■ May decrease renal and hepatic blood flow.
■ Postoperative hepatic dysfunction and hepatitis reported.
■ Decrease in blood pressure is dose dependent due to peripheral vasodilation; cardiac output is
maintained.
■ Use caution in patients who are hypovolemic, hypotensive, or hemodynamically
compromised; use caution in patients with coronary artery disease to avoid risk of myocardial
ischemia.
■ Should not be used as a sole agent of induction in patients with ventricular dysfunction.
■ Rare risk of perioperative hyperkalemia & malignant hyperthermia.
■ Obstetric anaesthesia: Isoflurane should
be avoided except in caesarean section due to lack of well-controlled studies.
■ In pediatric and neonatal patients <3 years and patients in third trimester of pregnancy, the
repeated or lengthy exposure to sedatives or anesthetics during surgery/procedures may have
detrimental effects on child or fetal brain development and may contribute to various
cognitive and behavioral problems.
Storage:
■ Keep at temperature not exceeding 25°C (15°C to 30°C).
■ Keep in well closed container.
Pregnancy:
Isoflurane crosses the placenta; there are no adequate and well-controlled studies in pregnant
women.
Lactation: it is not known if isoflurane is present in breast milk, Use caution.
Isos or bide (finitrate ( Dinitra®)

Dosage form & Strength: 5 mg sublingual tab.
Class: Nitrates
Indications:
Prevention of angina pectoris due to coronary artery disease.
The onset of action of immediate-release Isonitrate Sublingual Tablets is not sufficiently rapid for this
product to be useful in aborting an acute anginal episode. Dosage and Administration:
■ Usual starting dose: 5 mg to 20 mg, two or three times daily.
■ For maintenance therapy, 10 mg to 40 mg, two or three times daily is recommended. Some
patients may require higher doses.
■ A daily dose-free interval of at least 14 hours is advisable to minimize tolerance.
■ A patient anticipating activity likely to cause angina should take one Isonitrate sublingual
tablet (5 mg) about 15 minutes before the activity is expected to begin.
■ Pediatric Use: Safety and effectiveness in pediatric patients have not been established.
■ Geriatric Use: Start with lowest recommended adult dose.
Dosage adjustment:
Renal Impairment:
■ There are no dosage adjustments provided in the manufacturer's labeling.
■ Hemodialysis & Peritoneal dialysis : Supplemental dose is not necessary.
Hepatic Impairment: There are no dosage adjustments provided in the manufacturer's labeling.
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Contraindications
■ Recent use (within several days) of PDE-5 inhibitors (eg, sildenafil, tadalafil, or vardenafil) may
cause dangerously low hypotension.
■ Severe anemia, shock, markedly low blood pressure.
■ Headache, which may be severe, is the most commonly reported side effect that may be
recurrent with each daily dose, especially at higher doses.
■ Severe hypotension can occur; paradoxical bradycardia and increased angina pectoris can
accompany hypotension. Orthostatic hypotension can also occur.
■ Nitrate therapy may aggravate angina caused by hypertrophic cardiomyopathy.
■ Nitrates may precipitate or aggravate increased intracranial pressure and subsequently may
worsen clinical outcomes in patients with neurologic injury.
■ Not recommended in patients with acute Ml or HF (cannot easily reverse effects if adverse
events develop).
Pregnancy: Category c.
There are no adequate, well-controlled studies in pregnant women. It should be used during
pregnancy only if the potential benefit justifies the potential risk to the fetus. Lactation:
Unknown whether drug is distributed into breast milk, caution should be exercised.
Xetoprofen (Xetofan®, Xetoproj®)

Dosage form & Strength: 100 mg/2 ml amp.& 50 mg cap.
Class: NSAIDS
Indications:
■ Pain/Fever/Dysmenorrhea.
■ Osteoarthritis.
■ Vascular headache & gout.
General dosing:
Adult
Pain Management: 25-50 mg PO q6-8hr as necessary.
Rheumatoid Arthritis or Osteoarthritis: 75 mg PO q8hr or 50 mg PO q6hr. Dysmenorrhea: 25-50 mg
q6-8hr PRN.
Pediatric: (< 12 years) Safety and efficacy not established and the drug is therefore not recommended
in this age group.
01093741899
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4JJ)
Dosage adjustment:
Renal impairment:
■ Mild impairment, maximum dose 150 mg/day.
■ CrCI < 25 mL/min or ESRD, maximum dose 100 mg/day.
Hepatic impairment and serum albumin less than 3.5 g/dL: maximum dose 100 mg/day.
Administration
oral
■ Take this medicine with food if your stomach gets upset.
■ Do not take other medicines that contain aspirin, ibuprofen or naproxen with this medicine,
Side effects such as stomach upset, nausea, or ulcers may be more likely to occur.
IM: deep IM injection
Precautions:
fatal.
bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal. Risk is
especially increased in the elderly and in patients with prior peptic ulcer disease or Gl bleeding.
■ Avoid chronic use in older adults unless other alternatives are not effective and patient can
take gastroprotective agent (ie, proton pump inhibitor or misoprostol).
injury.
Pregnancy category: c.
Lactation: Use is not recommended; Excreted into human milk.
£evof(bxacin('Tavanic®)
Dosage form : 750 mg tab , 500 mg/100 ml vial, 500 mg /20 ml vial .
Dose:75Q mg every 24 hours for 7 days; duration may be individualized based on patient-specific
factors and response to therapy.
Dosage adjustment:
Renal Impairment:
■ CrCI 20 to 49 mL/minute: Administer 750 mg every 48 hours.
■ CrCI 10 to 19 mL/minute or Hemodialysis/chronic ambulatory peritoneal dialysis (CAPD):
Administer 750 mg initial dose, followed by 500 mg every 48 hours.
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Hepatic Impairment:
■ IV, Oral: There are no dosage adjustments provided in the manufacturer's labeling
Administration:
IV infusion:
■ 500 mg/100 ml vial for infusion ready to use.
■ Diluted 20 ml vial (500 mg ) with 80 ml of compatible solution (D5W, NS, D5/NS,
D5/lactated Ringer, D5/NS and potassium chloride).
■ Total volume 100 ml, infused slowly over 60 min(infuse 750 mg IV solution over 90 minutes).
■ The line should be flushed before and after infusion of Levoflox®.
■ Avoid using IV line with solution containing multivalent cations (ie, magnesium, calcium).
■ Compatible with potassium additives.
Oral:
■ Tablets may be administered without regard to meals.
■ Administer at least 2 hours before or 2 hours after antacids containing magnesium or
aluminum, sucralfate, metal cations (eg, iron), multivitamin preparations with zinc.
Precautions:
■ Given by IV infusion only, not bolus; rapid or bolus administration has been associated with
hypotension and must be avoided.
■ Avoid administration through an intravenous line with a solution containing multivalent cations
(eg, magnesium, calcium). Maintain adequate hydration of patient to prevent crystalluria or
cylindruria.
■ Peripheral neuropathy may occur rapidly after initiating and may potentially become
permanent.
■ Commonly seen adverse reactions include tendinitis, tendon rupture, arthralgia, myalgia,
peripheral neuropathy, and CNS effects (hallucinations, anxiety, depression, insomnia, severe
headaches, and confusion), is increased in patients over 60 years of age, in patients taking
corticosteroid drugs, and in patients with kidney, heart or lung transplants.
■ Fatal hypoglycemia reported in elderly patients with or without diabetes.
■ Prolongation of Q.T interval; avoid use in patients with known QT prolongation, those with
hypokalemia, and those taking other QT-prolonging drugs.
■ Hepatotoxicity including acute hepatitis and fatal cases has been reported with higher
incidence in patients 65 years and older; discontinue if signs of hepatitis occur.
Stability:
Reconstituted drug is stable for 72 hours at room temperature, 14 days when refrigerated in plastic
containers.
Pregnancy: Crosses the placenta; fetal risk cannot be ruled out
Lactation: Drug excreted in breast milk; fetal risk cannot be ruled out .
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LinezoCicC (y\.verozoCicC\ Linezomentiv^)

Dosage forms & Strength: 100 mg /5 ml 60 ml SUSP, 600 mg tab, 2 mg/ ml(100 ml, 300 ml
infusion bag).
Class: Antibiotics: Oxazolidinones.
Indications:
■ Vancomycin-Resistant Enterococcal Infection (VRSA).
■ Methicillin-Resistant Staphylococcal Infections.
■ Complicated Skin & Skin Structure Infections.
Dosage:
Adult: 600 mg PO/IV ql2hr for 14-28 days for VRSA ,10-14 for other infections. Pediatric:_10 mg/kg
PO/IV q8hr; maximum dose: 600 mg for 14-28 days for VRSA, 10-14 for other infections.
Dosage adjustment:
■ Renal impairment: no adjustment necessary.
■ Hemodialysis: administer dose after hemodialysis.
■ Hepatic impairment :mild to moderate: no adjustment necessary.
Administration:
Oral: Use reconstituted suspension within 21 days.JVlay be taken with or without food.
IV infusion
■ Supplied as a single-use, ready-to-use infusion bag;
■ Infusion should be administered over 30-120 min.
■ compatible with D5W, NS, and LR.
Store all forms of linezolid at room temperature away from moisture, heat, and light, Do not freeze.
Drug drug interactions:
■ Concomitant use of indirectly or directly acting sympathomimetic agents such as
pseudoephedrine, vasopressive agents such as epinephrine and norepinephrine, or
dopaminergic agents such as dopamine and dobutamine is not recommended unless patients
are monitored for potential blood pressure increases.
Contraindicated. Risk of acute hypertensive episode by pharmacodynamic synergism. Avoid
coadministration with serotonergic psychiatric drugs (eg, SSRIs, SNRIs, TCAs, MAOIs) due to
increased risk of serotonin syndrome. Also triptans, meperidine, bupropion, or buspirone not
recommended unless clinically necessary.
Precautions:
■ Use caution in patients with pheochromocytoma, concurrent apraclonidine, brimonidine,
uncontrolled hypertension, thyrotoxicosis, carcinoid syndrome, diabetes mellitus, or seizure
disorders.
■ Use oral suspension with caution in phenylketonuria (contains phenylalanine).
■ Not approved for gram-negative bacteria or for catheter-related infections.
■ Monitor for myelosuppression.
■ May cause hypoglycemia; monitor blood glucose levels.
Lactation: Unknown; use caution.
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Magnesium suCyfiate
Dosage form & Strength: 100 mg/ml amp = 0.41 m.mol/ml = 0.82 mEq/ml.
Class: Antidysrhythmics, Electrolytes.
Normal Mg level:
0.7-1 mmol/L (1.5-2 mEq/L; 1.7-2.4 mg/dL).
Indications & dosage:
■ Hypomagnesemia:
Adult
* Mild deficiency: 1 g IM q6hr.
* Severe deficiency:
IM: Up to 250 mg/kg within a 4-hour period .
IV: Severe (<1 mg/dL): 4 to 8 g (up to 0.1875 g/kg), administer at <1 g/hour if
asymptomatic; in symptomatic patients, may administer <4 g over 4-5 minutes .
* Maintenance: 30-60 mg/kg/day IV.
Pediatric
* IV/IM: 25-50 mg/kg q4-6hr for 3-4 doses PRN.
■ Tetanus:
* 75 to 80 mg/kg magnesium sulfate loading dose in 30 minutes, followed by maintenance
dose of either 2 g/hr magnesium sulfate if younger than 60 years or 1 g/hr) if older than
60.
* Titrate to a level sufficient to stop spasms and muscle rigidity to provide relief acceptable
to the patient, by increasing the dose by 0.25 g (> 60 years) or 0.5
g (< 60 years) 6-hourly until spasms were controlled; suppression of the patellar reflex or
onset of respiratory inadequacy were accepted.
* as areflexia (absence of patellar reflex) occurs at the upper end of the therapeutic range
(4mmol/L). If areflexia develops, dose should be decreased.
■ Eclampsia/preeclampsia:
* IV: Initial: 4 to 6 g loading dose over 20 to 30 minutes, followed by 1 to 2 g/hour
continuous infusion for at least 24 hours after delivery.
* IM: Initial: 10 g loading dose administered as 5 g IM in each buttock, then 5 g every 4
hours.
Note: Use IM route when unable to establish venous access.
■ Torsades de Pointes:
Adult
* If associated with cardiac arrest: 1 to 2 g diluted in 10 mL of dextrose 5% injection
administered IV bolus or intra-osseous over 15 minutes.
★ If torsades de pointes is intermittent and not associated with cardiac arrest: dilute 1 to
2 g in 50 to 100 mL of dextrose 5% injection and administer over 5-60 minutes, then 0.5-
1 g/hr IV.
Pediatric
25 to 50 mg/kg administered IV or intraosseous over 10 to 20 minutes every 4 to 6 hours for 3
or 4 doses; repeat as needed.
Seizure, Associated with epilepsy, glomerulonephritis or hypothyroidism: 1 g IM or IV.

Dosage adjustment:
■ Severe renal impairment: Do not exceed 20 g/48 hr.
■ Hepatic impairment: no dosage adjustment necessary.
Administration:
IM: Dilute to maximum concentration of 200 mg/mL before injection (25% or 50% concentration).
Eclampsia/preeclampsia: May mix with lidocaine 2% to reduce injection pain IV:
■ Dilute Solutions for IV infusion with D5W or NS to a concentration of 20% or less (10 ml amy
diluted to 50 ml).
■ Infuse over 2-4 hr (hypomagnesemia); Max infusion rate 125 mg/min, except in severe
eclampsia with seizure. In severe cases, half of the dose may be infused over first 15-20
■ Rapid infusions (over 10-20 minutes) may be used for treatment of severe asthma or torsades
de pointes ventricular tachycardia.
■ Cautiously infuse diluted solution through patent IV line.
Diluents: NS, D5W, LR
Stability:
■ After dilution with D5W to be stable for 60 days at 0 °C.
■ After dilution with LR and in NS to be stable for more than 3 months at room temperature.
■ Store intact containers of magnesium sulfate injection at controlled room temperature and
protect from exposure to excessive heat and from freezing.
Precautions:
■ IM administration is painful and should be reserved forthose patients with limited IV access
and severe hypomagnesemia.
■ IV bolus administration may cause flushing, sweating, and warm sensation, and should be
avoided, if possible.
■ Use with caution in digitalized patients.
■ Use with extreme caution in patients with myasthenia gravis or other neuromuscular disease.
■ Hypomagnesemia is usually associated with hypokalemia (potassium levels must be
normalized).
■ Monitor renal function, blood pressure, respiratory rate, and deep tendon reflex when
magnesium sulfate is administered parenterally.
* Continuous maternal use for more than 5 to 7 days (such as for preterm labor, may cause fetal
hypocalcemia and bone abnormalities, as well as fractures in the neonate.
* Magnesium sulfate injection is used for the prevention and treatment of seizures in pregnant
or postpartum women with severe preeclampsia or eclampsia.
* Magnesium sulfate may also be used prior to early preterm delivery for neuro-protection to
reduce the risk of cerebral palsy.
Lactation: Safe.
Meropenem (Meronem®,
Mirage®)
Dosage forms & strength: lgvial.
Class: Antibiotics: Carbapenems.
Antimicrobial Spectrum:
■ Aerobic gram-positive microorganisms: S. aureus including penicillinase-producing strains,
■ Group D streptococcus including Enterococcus spp., Streptococcus pneumoniae, S. pyogenes,
S.viridans group.
■ Aerobic gram-negative microorganisms: Acinetobacter spp., Citrobacter spp., Enterobacter
■ cloacae, E. coli, H. influenzae, K. pneumoniae, P. aeruginosa
■ Anaerobic gram-positive microorganisms: Peptostreptococcus spp.
■ Anaerobic gram-negative microorganisms: Bacteroides spp., Fusobacterium spp.

■ Bacterial meningitis: 2 g IV q 8hr.
■ Pneumonia (HAP/VAP): 1 g IV q 8hr.
■ Febrile neutropenia: 1 g IV q 8hr.
■ Complicated Intra-abdominal Infections: 1 g IV q 8hr; not to exceed 2 g IV q 8hr.
■ Complicated UTIs: 500 mg-1 g IV q 8hr.
■ Complicated Skin/Skin Structure Infections: 500 mg IV q 8hr; not to exceed 2 g IV q 8hr.
Pediatric Dosage:
■ >3 months: 10 - 20 mg/kg IV q 8hr; not to exceed 1 g q 8hr;
meningitic dose: 40 mg/kg IV q 8hr; not to -exceed 2 g IV q 8hr.
Renal Dosage adjustment:
■ CrCI >50 mL/min: 0.5-1 g IV q8hr
■ CrCI 26-50 mL/min: 0.5-1 g IV ql2hr
■ CrCI 10-25 mL/min: 0.25-0.5 g IV ql2hr
■ CrCI <10 mL/min: 0.25-0.5 g IV q24hr
Hepatic impairment: No dose adjustment is necessary.
Administration:
IV bolus
■ Reconstitute 500 mg with 10 ml and 1-g vial with 20 ml of sterile water for injection to a final
concentration of 50 mg/ml; administer over 3 to 5 minutes.
■ After reconstitution: may store for 3 hours at room temperature or for 13 hours refrigerated.
IV infusion
■ Further dilution with NS ranging from 1 to 20 mg/mL; may store for 1 hour at room
temperature or for 15 hours refrigerated.
■ Further dilution with D5W ranging from 1 to 20 mg/mL; use immediately.
■ Infuse over 15 to 30 minutes.
Precautions:
■ Seizures have been reported, most commonly in patients with CNS disorders (eg, brain lesions,
history of seizures), headaches, or paresthesias may occur, potentially interfering with mental
alertness or causing motor impairment.
■ Thrombocytopenia has been reported in patients with renal impairment.
■ To avoid development of drug resistance, drug should be used only in proven or strongly
suspected bacterial infections or a prophylactic indication.
■ Co-administration of meropenem IV with valproic acid or divalproex sodium reduces serum
concentrations of valproic acid potentially increasing risk of breakthrough seizures.
Pregnancy:
There are insufficient human data to establish whether there is a drug-associated risk of major birth
defects or miscarriages.
Lactation:
■ Information is limited. Based on information from one case report, the relative infant dose
(RID) of meropenem is 0.18% compared to a weight-adjusted maternal dose of 3 g/day.
■ In general, breastfeeding is considered acceptable when the RID of a medication is <10%.
MetftyCyYecCnisoCone (MetftyCyredhiso Cone

Dosage form & strength: 500 mg, 1 g IV/IM vial.
Class: Corticosteroids; Anti-Inflammatory Agents.
Dose:
Adult:
■ IV (succinate): 40 to 125 mg/day given in a single daily dose or in divided doses; rarely, for
certain conditions, may go up to 1 to 2 mg/kg/day.
■ Initial high-dose "pulse" therapy for select indications (eg, severe systemic rheumatic
disorders): 7 to 15 mg/kg/dose (or 500 mg to 1 g/dose) given once daily for 3 to 5 days.
Pediatric:
General dosing; anti-inflammatory or immunosuppressive:
■ IM (acetate): 4 to 80 mg every 1 to 2 weeks
Dose adjustment:
Renal impairment: no adjustment.
Hepatic Impairment: not defined. There are no dosage adjustments provided in the manufacturer's
labeling; use with caution.
Administration:
■ Reconstitution: reconstitute with either Water for Injection (IV), or Bacteriostatic Water for
Injection (BWI) with 0.9 % benzyl alcohol (IM/IV).
■ Diluents: NS, D5W, Mannitol, NS/D5W.
■ IVP: inject directly into vein, or in tubing of running IV fluid.
■ Infusion: Infuse over at least 30 to 60 min; after further dilution for the reconstituted mixture
with 100 ml.
N.B. Formulations reconstituted with BWI with 0.9 % benzyl alcohol as a preservative (e.g
Solu-Medrol ) are contraindicated in premature infants, neonates, pregnant women, or breastfeeding
women.
Benzyl alcohol is associated with serious adverse events and death, particularly in pediatric patients
The "gasping syndrome" (characterized by central nervous system depression, metabolic acidosis,
gasping respirations, and high levels of benzyl alcohol and its metabolites found in the blood and urine)
has been associated with benzyl alcohol dosages >99 mg/kg/day in neonates and low-birthweight
neonates.
Stability:
■ Store reconstituted solutions at 20°C to 25°C (use solutions reconstituted with BWI with 0.9 %
benzyl alcohol within 48 hours).
■ Solutions reconstituted with water for injection should be used immediately and any unused
portion should be discarded.
N.B: Rate dependent upon dose. Do not administer large doses IV push; severe adverse effects,
including hypotension, cardiac arrhythmia, and sudden death, have been reported in patients receiving
large doses (more than 250 mg) over <30 minutes. Administer large doses over at least 30 minutes.
Precautions:
■ For discontinuation of therapy: Withdraw therapy with gradual tapering of dose.
■ Not for use in the treatment of traumatic brain injury.
■ Prolonged corticosteroid use may result in elevated IOP, glaucoma, or cataracts.
■ Consider total daily benzyl alcohol load, especially if other medications containing the
preservative are coadministered.
■ High doses of methylprednisolone IV (usually doses of 1 g/day) may induce a toxic form of
acute hepatitis (rare); serious hepatic injury may occur, resulting in acute liver failure and
death.
Time to onset can be several weeks or longer; resolution has been observed after
discontinuation of therapy. Discontinue methylprednisolone if toxic hepatitis occurs. Avoid use
of high doses in patients with a history of methylprednisolone-induced toxic hepatitis.
Lactation: enters milk; use with caution.
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Metronufazofe ( Tfagyt\ JAmrizok®)

Dosage form & Strength: 500 mg tab, 0.5% 100 ml IV infusion vial.
Class: Nitroimidazoles
Indications:
■ Anaerobic Bacterial Infections (diverticulitis, peritonitis, cholangitis, or abscess).
■ Intra-abdominal infection.
■ Clostridium difficile-associated diarrhea (CDAD).
■ Tetanus (Clostridium tetani infection).
■ Amebiasis (amebic liver abscess &intestinal amebiasis).
■ Trichomoniasis & Sexually Transmitted Disease.
■ Bacterial Vaginosis & Colorectal Surgical Infection.
■ Bacterial meningitis and brain abscess & Helicobacter Pylori Infection.
General dosing:
Adult dose: 500 to 750 mg every 8 hours for 5 to 10 days. Abscess, anaerobic infections & bacterial
meningitis: loading dose: 15 mg/kg IV over 1 h; then after 6 h maintenance dose: 7.5 mg/kg q 6-8 h;
Max 4 g/day.
Pediatric dose: 15-30 mg/kg/day divided q 6h; Max: 4 g/day.
Dose adjustment:
Renal impairment:
■ There are no dosage adjustments required.
■ Metabolites may accumulate in End-stage renal disease (ESRD); monitor for adverse events.
Accumulated metabolites may be rapidly removed by dialysis.
Hepatic impairment:
Child-Pugh Class A or B: No dosage adjustment necessary; use with caution and monitor for adverse
events.
Child-Pugh Class C:
Extended-release tablets: Use is not recommended.
Immediate-release capsules:
■ Amebiasis: 375 mg 3 times daily.
■ Trichomoniasis: 375 mg once daily.
■ Immediate-release tablets, injection: Reduce dose by 50%.
Administration:
IV(readv-to- use vial)
■ No dilution or buffering is necessary.
■ Infuse intravenously over 30 to 60 minutes. Avoid contact of drug solution with equipment
containing aluminum.
Oral
Take with food to minimize stomach upset.
Pregnancy: avoid use in the first trimester.
Lactation: Excreted in human milk; not recommended.
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Midazofam (Vormicum®,
Middtfietic®)
Dosage form &strength: 5mg/imlamp

Class: Antianxiety Agents; Anxiolytics, Benzodiazepines.
Indications:
■ Seizures & Subarachnoid hemorrhage (seizure prophylaxis).
■ Anxiety - Induction of amnesia - Preoperative sedation.
■ Induction of general anesthesia & Procedural sedation.
■ Sedation for a mechanically ventilated patient.
Dosage:
Adult dose: The loading dose for obese patients may be calculated using an adjusted body weight
based on the following formula: Dosing weight (kg) = ideal body weight (IBW) + 1.33 x (measured
weight - IBW).
1) Sedation/anxiolysis/amnesia:
Adult:
IM: 0.07 to 0.08 mg/kg IM (usual dose: 5 mg) 30 to 60 minutes prior to surgery/procedure. IV: Initial:
Usually 0.5-1 mg given over 2 minutes (not to exceed 2.5 mg/dose); wait 2-3 minutes to evaluate
sedative effect after each dose adjustment;
Total dose >5 mg usually not necessary to reach desired sedation; use 30% less midazolam if patient
premedicated with narcotics or other CNS depressants.
Pediatric <12y:
IM: 0.1 to 0.15 mg/kg IM 30 to 60 minutes before surgery/procedure (range: 0.05 to 0.15 mg/kg).
Doses up to 0.5 mg/kg have been used in more anxious patients.
6 to 12 years: 0.025 to 0.05 mg/kg IV initially; total dose up to 0.4 mg/kg may be needed. Maximum
total dose: 10 mg.
6 months to 5 years: 0.05 to 0.1 mg/kg IV initially; total dose up to 0.6 mg/kg may be needed.
Maximum total dose: 6 mg.
2) Induction of general anesthesia:

Adult
► <60 v Unpremedicated patients: 0.3 - 0.35 mg/kg IV; administered over 20 to 30 seconds and
allowing 2 minutes for effect.
For complete induction, 25% of the patient's initial dose may be used;
In resistant cases, up to 0.6 mg/kg total dose may be used for induction, but such larger doses
may prolong recovery.
► Unpremedicated patients with severe systemic disease or other debilitation:
0.2 to 0.25 mg/kg IV; in some cases, as little as 0.15 mg/kg is needed.
Maintenance of anesthesia:
0.05 mg/kg IV as needed, or continuous IV infusion 0.015 to 0.06 mg/kg/hour (0.25 to 1
mcg/kg/minute).
3) Status epilepticus:
Usual dosage: 10 mg IM once or 0.2 mg/kg IM once
Adult and pediatric dose:
0.2 mg/kg IV followed by a continuous infusion starting at 2 mcg/kg/min and increasing at 5 min
intervals until seizure control (Max, 10 mcg/kg/min), continue infusion for at least 6 hr after seizure
control, then gradually taper over 12-24hrs.
If patient experiences breakthrough status epileptic u s while on the continuous infus i o n, administer
a bolus of 0.1 to 0.2 mg/kg and increase infusion rate by 0.05 to 0.1 mg/kg/hour (0.83 to 1.66
mcg/kg/minute) every 3 to 4 hours.
Administration:
IV
■ Induction of anesthesia: administer by IV bolus over 20 to 30 seconds; wait at least 2 minutes
between doses to evaluate full effect.
■ Sedation/anxiolysis/amnesia for procedures: administer by IV injection over at least 2
minutes; 1 mg/ml formulation is used to facilitate slower injection; wait at least 2 minutes
between doses to evaluate full effect.
■ Continuous infusion: 5 mg/ml formulation should be diluted to a concent ration of 0.5 mg/ml
with NS or D5W.
■ IVP: Administer through side port of free-flowing IV.
■ Neonatal: should not be administered by rapid IV injection in the neonatal population; severe
hypotension and seizures have been reported, particularly with concomitant use of fentanyl.
■ Administer via infusion pump.
■ May dilute 1 mg/ml or 5 mg/ml in D5W or NS to facilitate slow injection.
■ Wait at least 2 min when adjusting doses to desired effect.
■ Excessive dose or too rapid infusion may cause respiratory arrest.
■ Have resuscitation equipment available and monitor patient closely until effects of IV
administration are known.
Stability: when diluted to 0.5 mg/mL, stable in D5W or NS for up to 24 hours and in LR for up to 4
hours.
Rectal:
For rectal administration of midazolam for sedation and as a Premedication before an Operati o a;
Children over 6 months of age: 0.3-0.5 mg/kg.
■ Dose should be administered 15 to 30 minutes before induction of anaesthesia.
■ Rectal administration of the ampoule solution is performed by means of a plastic applicator
fixed on the end of the syringe.
■ If the volume to be administered is too small, normal saline or water may be added up to a
total volume of 10 mL.
Precautions: As diazepam
Pregnancy:
Teratogenic effects have been observed with some benzodiazepines; however, additional studies are
needed. The incidence of premature birth and low birth weights may be increased following maternal
use of benzodiazepines; hypoglycemia and respiratory problems in the neonate may occur following
exposure late in pregnancy.
Lactation:
Manufacturer recommends that caution be exercised when administering midazolam to breast-feeding
women; However, Milk concentrations were below the limit of detection (less than 5 nmol/L) 4 hours
after a single maternal dose of midazolam.
Nafoxonef 'Rescuerix\Xeropizun)
Dosage forms & strength: o.4mg/mL IM/IV/SC amp.
Class: Opioid Antagonists; Opioid Reversal Agents
Indications:
■ Opioid overdose (IV, IM, SubQ)
o Initial: 0.4 to 2 mg; may need to repeat doses every 2 to 3 minutes.
o A lower initial dose (0.1 to 0.2 mg) should be considered for patients with opioid
dependence to avoid acute withdrawal or if there are concerns regarding concurrent
stimulant overdose.
o After reversal, may need to readminister dose(s) at a later interval (ie, 20 to 60 minutes)
depending on type/duration of opioid. If no response is observed after 10 mg total,
consider other causes of respiratory depression.
■ Reversal of respiratory depression with therapeutic opioid doses:
o IV: Initial: 0.02 to 0.2 mg; titrate to avoid profound withdrawal, seizures,
arrhythmias, or severe pain
■ Postoperative reversal: IV: 0.1 to 0.2 mg every 2 to 3 minutes until desired response (adequate
ventilation and alertness without significant pain). Note: Repeat doses may be needed within 1 to
2 hour intervals depending on type, dose, and timing of the last dose of opioid administered.
Administration:
■ IV push: Dilute naloxone 0.4 mg (1 mL ampul) with 9 mL of NS for a total volume of 10 mL to
achieve a concentration of 0.04 mg/mL .
■ IV infusion: Dilute naloxone 2 mg in 500 mL of NS or D5W to make a final concentration of 4
mcg/mL
Renal & Hepatic impairment:

There are no dosage adjustments provided in the manufacturer's labeling.
Warnings:
■ Caution in patients with cardiovascular disease or patients receiving medications with potential
adverse cardiovascular effects
■ Caution in patients with history of seizures; avoid use in treatment of meperidine-induced seizures
■ Recurrence of respiratory depression may occur if opioid involved is long-acting or a partial
agonist (eg, methadone, buprenorphine); observe patients until there is no further risk of
recurrent respiratory or CNS depression
■ Avoid excessive dosages after use of opioids in surgery; abrupt postoperative reversal may unmask
pain and may cause nausea, vomiting, sweating, seizures, hypertension, and tachycardia; other
cardiovascular events, including pulmonary edema and arrhythmias may occur.
Storase/Stabilitv
• Solution, injection: Store at 20°C to 25°C.
• Protect from light.
• Use IV infusion in NS or D5W within 24 hours of preparation.
• IM/SC Preparation Before using, check to make sure the solution is not discolored, Replace if the
solution is discolored or contains a precipitate.
Pregnancy : C , crosses the placenta.

Breast-Feeding : It is not known if naloxone is present in breast milk, use caution.
Mor-ajfrenaCine (Levopftrine®)
Dosage form & strength: 4mg/4mI amp.
Class: Alpha/Beta Adrenergic Agonists.
Dosage:
IV Preparation
Solution: 4 mg in 1000 ml D5W (4 mcg/ml); 40 ml/hr (~3 mcg/min); dose may be titrated to patient
response.
Cardiac Arrest/ shock:

Adult:
Initial: 8-12 mcg /min (2 ml- 3 ml from prepared solution ). IV infusion; titrate to effect. Maintenance: 2-4
mcg / min (0.5 ml -1 ml from prepared solution). IV infusion. Pediatrics: Safety and effectiveness has not
established.
Dosage adjustment:
Renal impairment: no dosage adjustments.
Hepatic impairment: no dosage adjustments.
IV Administration
■ Administer as a continuous infusion via an infusion pump. Dilute prior to use.
■ Dilute with dextrose containing solutions; D5W, D5NS (dilution in NS is not recommended by the
manufacturer).
■ Central line administration is preferred; extravasation may cause severe ischemic necrosis.
■ Do not administer NaHCO3 through an IV line containing norepinephrine.
■ In pediatric
Rate of infusion (mL/hour) = dose (mcg/kg/minute) x weight (kg) x 60 minutes/hour divided by the
concentration (mcg/mL)
■ If extravasation occurs;
* Stop infusion immediately and disconnect (leave cannula/needle in place).
* Gently aspirate extravasated solution (do NOT flush the line).
01093741899
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Remove needle/cannula; elevate extremity.

Initiate diluted phentolamine (5 to 10 mg in 10 20 ml saline) or alternative antidote.
Apply dry warm compresses.
Contraindications
■ Patients who are hypotensive from blood volume deficits except as an emergency measure to
maintain coronary and cerebral artery perfusion until blood volume replacement therapy can
be completed.
Drug interactions:
■ concurrent monoamine oxidase inhibitor (MAOI) use or antidepressants of the triptyline or
imipramine types; severe, prolonged hypertension may result.
■ Linezolid may enhance the hypertensive effect of Sympathomimetics; closely monitor for
enhanced blood pressure elevations,
■ Caution is required when using Noradrenaline with alpha and beta blockers as severe
hypertension may result.
Pregnancy category: C
crosses the placenta, may impair placental perfusion and induce fetal bradycardia, possible risks
should be weighed against the potential benefit.
Lactation: Not known if excreted into breast milk; avoid use during breastfeeding.
Obidoxime cfiforide.
Class: cholinesterase reactivator
Indications:
It is given with atropine in the treatment of organophosphorus poisoning
Administration in adult
■ usual initial dose of 250 mg (4 mg/kg) by slow intravenous injection or by intramuscular
injection.
■ This may be followed by intravenous infusion of 750 mg over 24 hours, continued until the
concentration of organophosphate is below critical levels; alternatively, repeated doses of 4 to
8 mg/kg by intravenous injection may be given at intervals of 2 to 4 hours.
Administration in children
■ An initial dose of 4 to 8 mg/kg (maximum 250 mg) by slow intravenous injection or by
intramuscular injection is followed by either a continuous intravenous infusion of 10 mg/kg
daily, or repeated doses of 4 to 8 mg/kg by intravenous injection at intervals of 2 to 4 hours.
01093741899
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Ondansetron ('Dansed, Zofran®)

Class: Antiemetics, Selective 5-HT3 Antagonist.
Indications:
■ Postoperative Nausea & Vomiting.
■ Chemotherapy & radiation-induced Nausea & Vomiting.
■ Nausea and vomiting of pregnancy (severe or refractory), (off-label use).
■ Vertigo-associated nausea and vomiting (alternative agent) (off-label use
General dosing: 0.15 mg/kg over 15 min (4- 8 mg/dose). <6 months: Safety and efficacy not
established.
Dosage adjustment:
■ Renal impairment: No dosage adjustment is necessary.
■ Mild to moderate Hepatic impairment: No dosage adjustment is necessary.
■ Severe hepatic impairment (Child-Pugh score >10): Not to exceed 8 mg/day.
Administration:
IM: Should be given undiluted.
IVP: Inject undiluted over at least 30 seconds, preferably over 2-5 minutes.
IV infusion:
■ Infuse over 15 minutes after further dilution with 50 mL NS/D5W.
■ In pediatric patients between 6 months and 1 year of age and/or <10 kg, may dilute in 10 to 50
mL D5W or NS, depending on fluid needs of the patient.
■ Use diluted solutions within 24 hours of preparation.
■ Protect from light, excessive heat, and freezing.
Precautions:
■ Hypersensitivity reactions including anaphylaxis and bronchospasm may occur: discontinue
therapy if suspected.
■ Ondansetron may mask progressive ileus or gastric distention in patients who are undergoing
abdominal surgery or experiencing chemotherapy-induced nausea and vomiting; monitor for
decreased bowel activity, particularly in patients with risk factors for gastrointestinal obstruction.
■ Serotonin syndrome has been reported with 5-HT3 receptor antagonists, predominantly when
used in combination with other serotonergic agents (eg, SSRIs, SNRIs, MAOIs, mirtazapine,
fentanyl, lithium, tramadol, and/or methylene blue).
■ ECG changes, including dose-dependent QT interval prolongation, have been observed with
ondansetron use. Cases of torsade de pointes have also been reported;
avoid in patients with congenital long QT
syndrome; ECG monitoring recommended in patients who have electrolyte abnormalities, CHF, or
bradyarrhythmias or who are also receiving other medications that cause QT prolongation.
Pregnancy: Ondansetron readily crosses the human placenta in the first trimester of pregnancy and
can be detected in fetal tissue, because a dose-dependent QT-interval prolongation occurs with use,
the manufacturer recommends ECG monitoring in patients with electrolyte abnormalities. Lactation:
It is not known whether ondansetron is present in human milk; there are no data on effects of
ondansetron on breastfed infant or effects on milk production.
Oxytocin (Oxytocin®, Syntocinon®)

Dosage form & strength: 5 unit/ml amp.
Class: Oxytocic Agents.
Uses & closing:
■ Postpartum Hemorrhage: 5 unit or 10 unit IM after delivery of placenta; and can be followed by a
maintenance infusion of 10 units/hour. Maximum cumulative dose: 40 units.
The dose may be administered using a standardized infusion containing 30 units in 500 mL NS or
LR or by adding 10 to 40 units to a running infusion solution depending on amount of infusion fluid
remaining (maximum: 40 units in 1,000 mL of IV fluid); adjust infusion rate to sustain uterine
contraction and control uterine atony.
■ Labor Induction: 0.5-1 m Unit/min IV, titrate 1-2 m Unit/min ql5-60min until contraction pattern
reached that is similar to normal labor (usually 6 m Units/min).
■ Adjunctive management of abortion: Add oxytocin 10 units to 500 mL of a physiologic saline

solution or D5W.
Administration: iv infusion or IM
■ Dilute to 10 mll/mL by adding 10 U to 1000 mL of D5W, LR, or NS or 30 units in 500 mL NS or LR.
■ Administer by IV infusion using infusion control device, or by IM injection (not recommended in
most cases).
Storage:
■ Store at room temperature. Do not freeze.
■ Do not use solution if discolored or contains precipitate.
Precautions:
■ If uterine hyperactivity occurs, discontinue immediately.
■ Intravenous preparations should be administered by trained personnel.
■ ORapid IV bolus administration is associated with cardiovascular collapse. Slow IV injections (5 or
10 units over 1 minute) are preferred for women without cardiovascular risk factors; very slow
injections (>5 minutes) are preferred for women with cardiovascular risk factors.
■ Risk of severe water intoxication on prolonged administration due to its antidiuretic effects.
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■ Restricting fluid intake may be

warranted.
■ Uterine hypertonicity, spasm, rupture of the uterus, and tetanic contractions may occur from
high doses.
■ IM not recommended for labor induction/augmentation.
■ Oxytocin should be given with caution to patients with known 'long QT syndrome' or related
symptoms and to patients taking drugs that are known to prolong the QTc interval.
Monitoring Parameters:
■ Fluid intake and output during administration.
■ Uterine activity (tonus, amplitude, and frequency of contractions).
■ Maternal blood pressure.
■ Fetal heart rate in relation to uterine contractions.
Pregnancy Category: X
Lactation: May be distributed milk; commencement of nursing should be delayed for at least 1 day
when discontinued; use caution.
Pantoprazofe. (ControCoc\ ?antazo(\ ZurcaC)

Dosage forms & strength: 40 mg tab, 40 mg vial.
Class: .Proton Pump Inhibitors.
Indications:
■ Erosive Esophagitis Associated With GERD.
■ Short-term Treatment of GERD.
■ Zollinger-Ellison Syndrome(ZES).
■ Gastric hypersecretion, Pathological.
■ Peptic Ulcer Disease (Off-label).
General dosage:
Adult:
■ 40 mg PO qDay; duration vary according to disease type OR 40 mg IV infusion.
■ In ZES; dose may increase up to 240 mg/day administered in some patients,
■ 80 mg IV infusion q8-12hr up to 7 days; switch to PO once patient able to swallow. Pediatric:
> 5 years (Erosive Esophagitis Associated With GERD):
■ 15 kg to <40 kg: 20 mg PO qDay for up to 8 weeks.
■ 40 kg or greater: 40 mg PO qDay for up to 8 weeks.
Dosage adjustment:
No adjustment in hepatic or renal impairment.
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Administration:
Oral: administer 30 to 60 minutes before meals.
IV bolus: Reconstitute with 10 mL NS to final concentration of 4 mg/mL, inject over 2 min. IV infusion:
GERD with a history of erosive esophagitis:
■ Reconstitute with 10 mL NS, THEN further dilute with 100 mL D5W, NS, or LR to final
concentration of 0.4 mg/mL; over 15 min.
Zollinger-Ellison syndrome:
■ Reconstitute each vial with 10 mL NS, THEN Combine 2 vials and further dilute with 80 mL
D5W, NS, or LR to total volume of 100 mL (concentration 0.8 mg/mL) over 15 min.
■ Infuse over 15 min no more than 3 mg/min (7 mL/min) for GERD and 6 mg/min (7 mL/min) for
pathologic hypersecretory conditions.
Stability:
■ Reconstituted solution may be stored for 2 hr at room temperature before further dilution.
■ Admixed solution may be stored for 12 hr at room temperature before administration.
■ Store intact vials at 2-8°C, protect from light.
Precautions:
■ Caution in Severe hepatic impairment.
■ Systemic lupus erythematosus (SLE) reported wit h PPIs; avoid using for longer than medically
indicated.
■ Risk of salmonella and Campylobacter infections increased with use of proton pump
inhibitors.
■ Acute interstitial nephritis reported in patientstaking proton pump inhibitors.
■ Decreased gastric acidity increases serum chromogranin n (CgA ) levels and may cause false-
positive diagnostic results for neuroendocrine tumors.
Pregnancy:
No adequate and well-controlled studies; drug should be used during pregnancy only if potential
benefit justifies potential risk to fetus.
Lactation:
Present in breast milk, the decision to breastfeed during therapy should consider the risk of infant
exposure, the benefits of breastfeeding to the infant, and benefits of treatment to the mother.
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Phenytoin (Pjzanutin®.
Phenytin®)
Dosage form & strength: 250 mg / 5ml amp.

Class: Antidysrhythmics, lb; Anticonvulsants, Hydantoins.
Indications:
■ Seizures: control of status epilepticus of the tonic-clonic type; prevention and treatment of
seizures occurring during neurosurgery.
■ Subarachnoid hemorrhage (seizure prophylaxis).
Dosage:
Loading dose:
10 to 15 mg/kg slow IV at a rate not exceeding 50 mg/minute.
Maintenance dose begin 8 to 12 hours after loading dose.:
100 mg orally or IV every 6 to 8 hours (4 to 7 mg/kg/day);
{Some experts recommend initiating maintenance therapy with 5 mg/kg/day in 2 divided doses};
caution should be used in prescribing maintenance doses >600 mg/day.
Dosage adjustment:
■ For patients with hypoalbuminemia, renal impairment, hepatic impairment, or a critical illness,
monitoring free phenytoin levels should be considered. Interpretation of total phenytoin
plasma concentrations should be made with caution.
■ Alternatively, equations taking into account the patient's serum albumin and renal function
may be used to estimate the serum phenytoin level that would have been observed if serum
albumin and renal function were normal.
■ Total phenytoin levels is adjusted for hypoalbuminemia: Total C nOrmaiized = Total CmeaSured /
[(0.2 x serum albumin [g/dL]) + 0.1].
■ Total phenytoin level adjusted for hypoalbuminemia and end-stage renal disease requiring
hemodialysis: Total CnOrmaiized = Total CmeaSured / [(0.1 x serum albumin [g/dL]) + 0.1].
■ Total phenytoin:
The therapeutic range is 10 to 20 mcg/mL in children and adults; 8 to 15 mcg/mL in neonates.
Levels less than 5 mcg/mL is rarely effective; levels more than 20 mcg/mL produce dose-
related adverse effects.
■ Free phenytoin:
The therapeutic range is 1 to 2 mcg/mL.
Administration:
■ Although phenytoin may be administered by direct IV injection, it is preferable that phenytoin
be administered via infusion pump either undiluted or diluted in NS as an IV piggyback (IVPB)
to prevent exceeding the maximum infusion rate (monitor closely for extravasation during
infusion).
■ May be further diluted in normal saline to a final concentration no less than 5 mg/mL.
■ Infusion must be completed within 4 hours after preparation.
■ Do not refrigerate.
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■ Upon refrigeration or freezing of an

undiluted product, a precipitate might form; this will dissolve again after the solution is
allowed to stand at room temperature. The product is still suitable for use. Only a clear
solution should be used.
Infusion rate: Not to exceed 50 mg /min, intravenously in adults, Highly sensitive patients (eg, elderly
patients, patients with preexisting cardiovascular conditions) should receive phenytoin more slowly
(eg, 20 mg/minute) and not exceeding 1-3 mg/kg/min in neonates.
Precautions:
■ Serum glucose levels may increase in patients with diabetes.
■ Severe hypotension or cardiac arrhythmias may occur with rapid IV administration, with an
increased risk in the critically ill, elderly, and those with hypotension or severe myocardial
insufficiency.
■ Careful cardiac monitoring is needed during and after IV administration.
■ Extensively bound to serum plasma proteins and is prone to competitive displacement
■ Phenytoin is a potent inducer of hepatic drug-metabolizing enzymes.
■ If rash occurs including toxic epiderma necrolysis (TEN) and Stevens-Johnson syndrome;
phenytoin should be discontinued at first sign of a rash.
■ Patients should be evaluated for signs and symptoms of DRESS, also known as multiorgan
hypersensitivity.
■ IV infusion not recommended by many due to poor solubility and risk of crystal formation;
others state it is suitable with right solvent and concentration.
■ Abrupt withdrawal may precipitate status epilepticus in epileptic patients, and dose reduction,
discontinuation, or substitution of anticonvulsant therapy should be done gradually.
Lactating: Infant risk cannot be ruled out.
Piroxicam (feline® Jnflacam® )
Dosage form &Strength: 20 mg amp, 10 & 20 mg cap ,dispersible tab .

Class: NSAIDS
Indications:
Anti-inflammatory and/or analgesic activity for:
■ Osteoarthritis, rheumatoid arthritis & juvenile rheumatoid arthritis.
■ Ankylosing spondylitis, acute musculo-skeletal disorders & acute gout.
■ Post operative & post traumatic pain.
■ Treatment of primary dysmenorrhea in patients 12 years of age or older.
■ Relief of fever and pain associated with acute upper respiratory tract inflammation.
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Dose:
Usual adult dose: 20 mg once daily oral / deep intramuscular injection.
Pediatric: juvenile idiopathic arthritis: Oral: 0.2 to 0.4 mg/kg/day once daily; maximum daily dose: 20
mg/day.
Dosing: Renal Impairment:
Mild to moderate impairment: There are no dosage adjustments provided in the
manufacturer's labeling.
Severe impairment: Use is not recommended (has not been studied); if therapy must be initiated,
close monitoring is recommended.
Hepatic Impairment:
There are no specific dosage adjustments provided in the manufacturer's labeling; however, a dosage
reduction is recommended.
Interactions:
■ Corticosteroids: Increased risk of gastrointestinal ulceration or bleeding.
■ Cyclosporine: Increased risk of nephrotoxicity.
■ Lithium and Other protein-bound agents: piroxicam displace other protein-bound drugs and
increase their levels, closely monitor patients for change in dosage requirements.
■ NSAIDs, including piroxicam, may decrease elimination of methotrexate resulting in increased
plasma levels of methotrexate.
Contraindications:
■ Recent or recurrent history of Gl bleeding.
■ Active gastric/duodenal/peptic ulcer.
■ Active Gl inflammatory disease.
■ Inflammatory bowel disease.
■ Cerebrovascular bleeding or other bleeding disorders.
■ Severe liver impairment or active liver disease.
■ Severe renal impairment (crcl <30 ml/minute) or deteriorating renal disease.
■ Known hyperkalemia.
■ Children and adolescents <16 years of age.
■ Use in the third trimester of pregnancy; breast-feeding.
■ Severe uncontrolled heart failure.
Warnings:
■ NSAIDs cause an increased risk of serious adverse cardiovascular thrombotic events, including
Ml and stroke. Risk may occur early during treatment and may increase with duration of use.
■ May cause drowsiness, dizziness, blurred vision, and other neurologic effects which may
impair physical or mental abilities.
■ NSAIDs cause an increased risk of serious Gl inflammation, ulceration, bleeding, and
perforation; elderly patients and patients with history of peptic ulcer disease and/or Gl
bleeding are at greater risk for serious Gl events.
01093741899
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■ NSAID use may increase the risk of
hyperkalemia, particularly in the elderly, diabetics, renal disease, and with concomitant use of
other agents capable of inducing hyperkalemia (eg, ACE-inhibitors). Monitor potassium closely.
■ Do not administer to patients with aspirin-sensitive asthma; severe bronchospasm may
occur.
Pregnancy Category: C, D during third trimester of pregnancy (may cause premature closure of the
ductus arteriosus).
Lactation: excreted in breast milk; has adverse effect on the nursing infant.
'Potassium CfjCovicfe
Dosage form & Strength: 15% amp = 2 mEq/ml 5 ml amp.
Class: Electrolyte Supplements, Parenteral; Electrolytes.
Indications:
■ Hypokalemia.
■ Hypokalemia prophylaxis.
Normal pot. Level:

* Adults: 3.5-5.1 mEq/L
* Children: 3.4-4.7 mEq/L
Dosage:
Normal daily requirements: Oral, IV: 40 to 80 mEq/day.
Prevention of hypokalemia: Oral: 20 to 40 mEq/day in 1 to 2 divided doses.
Hypokalemia treatment:
Serum potassium less than 2 mEq/L, with ECG changes or muscle paralysis:
■ 400 mEq per 24 hour; Infuse at rate up to 40 mEq/hr IV with continuous cardiac monitoring.
Serum potassium greater than 2.5 mEq/L:

■ 200 mEq per 24 hours. Infuse at rate up to 10 mEq/hr IV in a concentration of up to 40 mEq/L.
Pediatric:
Hypokalemia, treatment; severe: Infants, Children, and Adolescents: Intermittent IV infusion: 0.5 to 1
mEq/kg/dose; maximum dose: 40 mEq/dose; infuse at a rate <0.5 mEq/kg/hour.
Dosage adjustment:
Renal impairment:
■ There are no specific dosage adjustments provided in the manufacturer's labeling. Reduce
initial dose by at least 50% in patients with renal impairment. IV use is contraindicated in
patients with renal failure; may cause potassium intoxication and life-threatening
hyperkalemia.
■ Use caution with oral formulations because of risk of hyperkalemia.
Hepatic impairment:
■ Patients with cirrhosis should usually be started at low end of dosing range, and serum
potassium level should be monitored frequently.
Administration:
■ In critical conditions, potassium may be administered in saline (unless contraindicated) rather
than in dextrose-containing fluids, due to intracellular potassium shift and consequent
lowering of serum potassium levels.
■ Care must be taken to ensure there is complete mixing of the potassium with the large volume
fluid.
■ Do not administer IV push.
■ Concentrated potassium chloride must be diluted prior to parenteral administration.
■ The concentration of infusion may be dependent on patient condition and specific institution
policy;
* Some clinicians recommend that the maximum concentration for peripheral infusion is
10 mEq/100 mL and for central infusion is 20 to 40 mEq/100 mL.
* Pediatric, peripheral IV infusion, concentration 40 mEq/L; MAX 60 to 80 mEq/L.
* Pediatric IV infusion rate, MAX 1 mEq/kg/hr, or 40 mEq/hr.
* Central routes are required with concentrations of 300 and 400 mEq/L.
Stability:
■ When admixed in most common infusion solutions, potassium chloride is stable indefinitely
(ie, until the labeled expiration date of the infusion solution).
■ However, admixing in mannitol 20 or 25% may result in precipitation of the mannitol.
■ Protect from freezing & excessive heat.
Extravasation:
■ Extravasation may occur during administration of potassium chloride.
■ If signs or symptoms of extravasation occur:
* Stop the infusion immediately.
* If possible, withdraw 3 to 5 mL of blood to remove some of the drug.
* Remove the infusion needle.
* Delineate the infiltrated area on the patient's skin with a felt-tip marker.
■ Hyaluronidase is an effective antidote for hyperosmolar drug infiltrations; administer promptly
within the first few minutes to 1 hour after extravasation.
Contraindications:
■ Untreated Addison disease.
■ Hyperkalemia.
■ Concomitant use with triamterene and amiloride.
■ Renal failure.
Precautions:
■ Use solutions containing potassium with caution in the presence of cardiac disease,
particularly in the presence of renal disease. In such instances, cardiac monitoring is
recommended.
■ In acidosis or alkalosis patients, especially cardiac and renal disease; serum potassium levels
may not represent total body potassium.
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■ Concomitant use of angiotensin-

converting enzyme ACE inhibitors; inhibits aldosterone production resulting in potassium
retention.
■ Concomitant use of potassium-sparing diuretics; risk of hyperkalemia.
■ Caution in concomitant use with drugs sensitive to changes in potassium concentration e.g.
digoxin.
■ Metabolic acidosis; hypokalemia should be treated with an aIkalinizing potassium salt.
■ Risk of hyperkalemia in extensive Tissue breakdown; as in severe burns, acute dehydration and
heat cramps.
■ Potassium chloride in sodium chloride may cause hyponatremia; hyponatremia can lead to
acute hyponatremic encephalopathy characterized by headache, nausea, seizures, lethargy,
and vomiting; patients with brain edema are at particular risk of severe, irreversible and life-
threatening brain injury.
■ Digitalis-induced second- or third-degree heart block is the only type of dysrhythmia in which
potassium is contraindicated.
* Potassium supplementation that does not result in hyperkalemia is not likely to adversely
affect the fetus.
Lactation: Compatible
* Potassium is excreted into breast milk. The normal content of potassium in human milk is low,
approximately 13 mEq/L.
* Supplementation (that does not cause maternal hyperkalemia) would not be expected to
affect normal concentrations.
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Troy ofoC ('Diyr tv an®)

Dosage form & Strength: 1% (10 mg/ml) 200mg in 20ml and 500mg in 50ml amp.
Class: General Anesthetics
Indications:
■ Sedation in intubated , mechanically-ventilated ICU patients.
■ Induction of Anaesthesia
Dose:
Adult: Induction of general anesthesia:
■ Induction <55 years :
40 mg IVP qlOsec until onset (2-2.5 mg/kg IV when not premedicated with oral
benzodiazepines or intramuscular opioids).
■ Maintenance <55 years:
6 to 12 mg/kg/hour) for 10 to 15 minutes; usual maintenance infusion rate: 50 to 100
mcg/kg/minute (or 3 to 6 mg/kg/hour) to optimize recovery time.
■ If more an 55 years : doses should be reduced to half.
ICU sedation in intubated mechanically ventilated patients: Avoid rapid bolus injection; individualize
dose and titrate to response.
■ Continuous infusion: Initial: 5 mcg/kg/minute (or 0.3 mg/kg/hour); increase by 5 to 10
mcg/kg/minute (or 0.3 to 0.6 mg/kg/hour) every 5 to 10 minutes until desired sedation level is
achieved;
■ usual maintenance: 5 to 50 mcg/kg/minute (or 0.3 to 3 mg/kg/hour); reduce dose after goal
sedation established and adjust to response.
■ Elderly, debilitated, or ASA-PS 3 or 4 patients: Use 80% of healthy adult dose
Paediatrics:
■ Sedation in ICU: 1 to 2 mg/kg; follow initial dose with 0.5 mg/kg every 3 to 5 minutes as
needed until adequate level of sedation achieved.
■ Short term anaesthesia: child 2.5-3.5 mg/kg stat, then 7.5-18 mg/kg/hr IV.
Dose adjustment:
Renal Impairment & Hepatic Impairment: No dosage adjustment necessary.
Administration:
■ Does not need to be diluted (available form: 10 mg/mL); however, may be further diluted in
D5W to 2 mg/mL
■ To reduce pain associated with injection, use larger veins of forearm or antecubital fossa;
lidocaine IV (1 mL of a 1% solution) may also be used prior to administration.
■ Do not use filter with <5 micron for administration.
■ Do not administer through the same IV catheter with blood or plasma.
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Storage
■ Store at room temp; refrigeration is not recommended.
■ Do not use if there is evidence of separation of phases of emulsion.
■ Drug vehicle (emulsion) is capable of supporting rapid growth of microorganisms; proper
aseptic technique is imperative.
■ Closely monitor patients with anemia, hepatic impairment, myxedema, or renal impairment.
■ Risk of potentially fatal propofol infusion syndrome in ICU patients.
■ May cause hypotension, especialy if patient is hypovolemic or if bolus dosing is used; reduction
in mean arterial pressure may exceed 30%; use caution in patients who arehemodynamically
unstable, hypovelimic, or have abnormally low vascular tone.
■ Use with caution in patients with severe cardiac disease (<50% ejection fraction) or
hypotension; may have more profound adverse cardiovascular responses to propofol.
■ Use caution in patients with respiratory disease and history of epilepsy or seizures; seizures
may occur during recovery phase.
■ Significant hypertriglyceridemia may be observed during infusion of propofol; 0.1 g lipid (1.1
kcal) per 1 mL propofol.
■ Accidental extravasation may result in tissue necrosis.
■ Propofol infusion syndrome may occur; severe metabolic acidosis, hyperkalemia, lipemia,
rhabdomyolysis, hepatomegaly, and cardiac and renal failure (esp with prolonged, high-dose
infusions >5 mg/kg/hr for >48 hr).
■ Anxiety, agitation, and resistance to mechanical ventilation may occur with abrupt withdrawal.
Pregnancy:
■ Propofol crosses the placenta and may be associated with neonatal CNS and respiratory
depression.
■ Evaluate benefits and potential risks of fetal exposure to propofol when duration of surgery is
expected to be >3 hours.
■ Propofol is not recommended by the manufacturer for obstetrical use,
Lactation:
■ Propofol is present in breast milk. In studies where propofol is used prior to cesarean delivery,
exposure to the infant is low due to low concentrations in breast milk and low volume of
breast milk produced within 24 hours' postpartum.
■ Breastfeeding is not recommended by the manufacturer.
■ Milk should be expressed ahead of surgery when possible. In general, when the child is
healthy and full term, breastfeeding may resume, or milk may be expressed once the
mother is awake and in recovery.
■ For children who are at risk for apnea, hypotension, or hypotonia, milk may be saved for
later use when the child is at lower risk.
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TroyranoCoC (InderaC\ Mayesttotens e®)

Dosage form & strength: 1 mg/ml amp.
Class: Antidysrhythmics, II; Beta-Blockers, Nonselective; Antianginal Agents; Antimigraine Agents.
Indications & doses:
Adult:
■ Supraventricular tachycardia & Atrial f i brillation/f I utter:
IV: 1 mg over 1 minute; repeat as needed every 2 minutes up to a maximum of 3 doses.
Pediatric:
■ Tachyarrhythmias:
IV: 0.01 to 0.15 mg/kg/dose slow IV over 10 minutes; may repeat every 6 to 8 hours as
needed; maximum dose is age-dependent: Infants: 1 mg/dose; children a n d a d olescents: 3
mg/dose
Dosage adjustment:
■ Renal impairment & Hepatic impairment: no dosage adjustments provided in the
manufacturer's labeling; however, renal or hepatic impairment increases systemic exposure to
propranolol. Use with caution.
Administration: iv
■ Administer undiluted by slow IV injection/infusion over 10 minutes.
■ Give by direct injection into large vessel or into tubing of free-flowing compatible IV solution.
■ Once diluted, propranolol is stable for 24 hours at room temperature in D5W or NS.
■ Intact amp.: Store at 20°C to 25°C. Protect from freezing or excessive heat. Protect from light.
■ Solution has a maximum stability at pH of 3 and decomposes rapidly in alkaline pH.
■ Beta-blocker therapy should not be withdrawn abruptly (particularly in patients with
coronary artery disease), but gradually tapered to avoid acute tachycardia, hypertension,
and/or ischemia.
■ Use caution with history of severe anaphylaxis to allergens; patients taking beta-blockers may
become more sensitive to repeated challenges.
■ In general, patients with bronchospastic disease should not receive beta-blockers.
■ Use with caution in patients with diabetes mellitus; may potentiate hypoglycemia and/or
mask signs and symptoms.
■ Use with caution in patients with compensated heart failure and monitor for a worsening of
the condition.
■ May worsen bradycardia or hypotension; monitor HR and BP.
■ Can precipitate or aggravate symptoms of arterial insufficiency in patients with peripheral
vascular disease and Raynaud disease. Use with caution and monitor for progression of
arterial obstruction.
■ May induce or exacerbate psoriasis; cause and effect not established.
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Pregnancy:
Propranolol crosses the placenta. According to the manufacturer, congenital abnormalities have been
reported following maternal use of propranolol. Exposure to propranolol during pregnancy may also
increase the risk for other adverse events in the neonate.
Lactation: Use is controversial; an insignificant amount is excreted in breast milk

In general, propranolol may be compatible with breastfeeding when used at usual doses. Mothers
should closely monitor their breastfeeding infants for bradycardia, cyanosis, and hypoglycemia
Protamine suCfate (Protam®)
Dosage form & Strength: 10 mg/ml ( 5 ml & 10 ml) vial. Class: Antidotes.
Indications & Doses:
Adult:
Heparin Neutralization:
■ 1 mg per 100 USP units of heparin; not to exceed 50 mg.
■ if aPTT remains elevated, may repeat 0.5 mg of protamine for every 100 units of heparin.
■ Monitor APTT 5-15 min after dose then in 2-8 hr.
■ In accidental overdoses of heparin, consider tl/2 heparin 60-90 min.
■ In setting without bleeding complications, consider observation, rather than reversal of
anticoagulation with protamine (avoids ADR's).
■ Complex of protamine and heparin may degrade over time requiring further doses. Enoxaparin
neutralization off label):
■ lmg IV for every lmg of Enoxaparin administered in the previous 8 hours.
■ If more than 8 hours has elapsed since the last dose of Enoxaparin , administer 0.5mg for every
lmg of Enoxaparin.
■ If more than 12 hours has elapsed since the last dose of Enoxaparin , protamine sulphate
administration may not be necessary.
Dalteparin, nadroparin, or tinzaparin neutralization ( off label):
■ 1 mg of protamine for every 100 anti-factor Xa units of low-molecular-weight heparin (LMWH)
administered within the past 3 to 5 half-lives; administer by slow IV injection over ~10 minutes;
maximum single dose: 50 mg.
■ If clinically significant bleeding persists or patient has renal impairment, consider repeat dose
of 0.5 mg of protamine for every 100 anti-factor Xa units of LMWH.
Pediatric:
Heparin neutralization:
1 mg protamine neutralizes 100 units of heparin; not to exceed 50 mg/dose.
Time elapsed since heparin dose:
■ <1/2 hr: 1 mg
■ 30-120 min: 0.5-0.75 mg
■ >2 hr: 0.25-0.375 mg
01093741899
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Dose adjustment:
Renal Impairment & Hepatic Impairment: No dosage adjustment necessary.
Administration:
For IV use only.
Reconstitute with 5 mL sterile water, Resulting solution equals 10 mg/mL Administer
slow IVP (50 mg over 10 minutes). Rapid IV infusion causes hypotension. May be
further diluted in D5W or NS.
■ Heparin rebound associated with anticoagulation and bleeding has been reported to occur
occasionally; symptoms typically occur 8-9 hours after protamine administration, but may
occur as long as 18 hours later.
■ May cause hypersensitivity reaction in patients (have epinephrine 1 mg/mL and resuscitation
equipment available). [US Boxed Warning]: Hypotension, cardiovascular collapse,
noncardiogenic pulmonary edema, pulmonary vasoconstriction, and pulmonary hypertension
may occur. Risk factors for such events include use of high doses or overdose, repeated doses,
previous protamine administration (including protamine-containing drugs), fish allergy,
vasectomy, severe left ventricular dysfunction, and abnormal preoperative pulmonary
hemodynamics.
■ May be ineffective in cardiac surgery patients despite adequate dose.
■ Too rapid administration can cause severe hypotensive and anaphylactoid-like reactions.
Pregnancy Risk Factor: C
Lactation: not known if excreted in breast milk; The manufacturer recommends that caution be
exercised.
^com6inant human insuttn (InsuCin H)

Dosage form & strength: 40 or 100 IU / ml.io ml
Pharmacokinetics:
■ After SC injection , act within 30 minutes.
■ Its maximum effect reach within 1-3 hours after injection.
■ Duration of action is 8 hours.
Contraindications:
Hypoglycemia, hypersensitivity to drugs on base of human insulin.
Methods of administration and dosage:

The dosage and route of administration is defined individually in each case:
■ Administered subcutaneously, IM or IV.
■ In case of monotherapy the drug is administered 3 times per day or up to 5 -6 times if
necessary.
■ If the daily dose exceeds 0.6 lU/Kg, insulin H bl° R is injected two or more times /day into
different parts of the body.
01093741899
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Special indications:
■ It is advise to hospitalize the patients receiving more than 100 III insulin/day.
■ In case of substitution of one insulin-containing preparation by another one, the
substitution of insulin-containing drugs should be conducted under the control of glucose
level in blood.
■ In case of the administration of the drug for the first time, special precaution should be
taken for mental stress and ability to operate machinery.
■ The dose should be corrected upon changing the character and the mode of diet, strong
physical stress, infectious diseases, surgical interventions, thyroid dysfunction, Addison
disease, hypo-pituitarism, renal failure and patients over 62 years old.
Drug interactions:
Hypoglycemic effect of insulin H bl° R is enhanced by:
■ MAO inhibitors.
■ Some selective beta-blockers.
■ Sulfunamide preparations.
■ Anabolic steroids.
■ Antibiotics and tetracycline group.
■ Clofibrates.
■ Cyclophosphamide.
■ Phenfluramine.
■ Ethanol-containing drugs.
Hypoglycemic effect of H bl° R insulin is reduced by:

■ Oral contraceptives.
■ Gluccorticoids.
■ Thyroid hormones.
■ Thiazides diuretics.
■ Heparin.
■ Lithium-containing preparations.
■ Tricyclic anti-depressants.
Reserpin & salicylates can also increase or decrease the drug effect.
Side effects:
■ Influence of carbohydrate metabolism: Hypoglycemic state (paleness of dermal
integuments, intensifying of diaphoresis, palpitation, tremor).
■ Allergic responses: very rare dermal eruption.
■ Side reactions: lipo-dystrophy in places of drug administration (Upon long term use).
■ Others: temporal reflection disturbances ( usually at the beginning of the therapy)
01093741899
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Overdose:
In case of overdose, development of hypoglycemic state is possible. Initial symptoms of hypoglycemic
state are as follow:
■ Intensifying of diaphoresis.
■ Palpitation.
■ Tremor.
■ Sense of hunger.
■ Paleness.
■ Headache.
■ In severe case, hypoglycemic coma is possible. 20-40 ml of 40% glucose solutions
intravenously, or lmg of glucagon intramuscularly should be given.
Mild hypoglycemia can be treated by administering sugar or sugar containing products.
Storage:
Store between 2°C - 8°C, avoid freezing.
Rifampicin (‘Ry^tao)
Dosage form & strength: 300 mg cap, 2 % 50 ml syrup.
Class: Antitubercular Agents.
Indications and dosage:
■ Tuberculosis:
Initially, 10 mg/kg/day (in combination with isoniazid and pyrazinamide) ORALLY or IV for 2
months; MAX, 600 mg/day; then 10 mg/kg/day as a single agent for 4 months or (in
combination with isoniazid) for 3 months.
■ Neisseria Meningitidis Carrier(Meningococcal Meningitis Prophylaxis ) :
Adult: 600 mg twice daily for 2 days.
1 month or older: 10 mg/kg ORALLY every 12 hours for 2 days; MAX dose, 600 mg.
< 1 month: 5 mg/kg ORALLY every 12 hours for 2 days.
■ Brucellosis:
♦♦♦ Oral: 600 to 900 mg once daily as part of an appropriate combination regimen. Duration
is 6 weeks for uncomplicated nonfocal infection and at least 12 weeks for spondylitis,
neurobrucellosis, and endocarditis
❖ Postexposure prophylaxis :
Oral: 600 mg once daily in combination with doxycycline for 3 weeks.
■ Leprosy:
Adult: 600 mg ORALLY or IV once daily for 12 months for tuberculoid (paucibacillary) disease
and 24 months for lepromatous (multibacillary) disease, in combination with dapsone, with or
without clofazimine.
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Usual daily dose: less than 50 kg: 450 mg & 50 kg or more: 600 mg.
01093741899
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also may used in:
■ Cutaneous leishmaniasis.
■ Haemophilus influenzae infection; Prophylaxis.
■ Infective endocarditis .
■ Peritoneal dialysis-associated peritonitis.
Dosage adjustment:
Renal impairment: No dosage adjustment necessary.
Hepatic impairment prior to treatment initiation:
There are no dosage adjustments provided in manufacturer's labeling; use with caution.
Hepatotoxicity during treatment:
New or worsening hepatic damage: Discontinue rifampin.
Administration:
■ Give on empty stomach; administer 1 hour before or 2 hours after a meal, with a full glass of
water.
■ For patients in whom capsule swallowing is difficult or when lower doses are needed, a
rifampin suspension can be prepared.
■ Stability of extemporaneously prepared oral suspension is 4 weeks when stored at RT or in a
refrigerator.
Precautions:
■ Rifampin has enzyme-inducing properties.
■ The patient should be told that rifampin may produce a reddish coloration of the urine, sweat,
sputum, and tears.
■ Concomitant antacid administration may reduce the absorption of rifampin. Daily doses of
rifampin should be given at least 1 hour before the ingestion of antacids.
■ Diabetes management may be more difficult.
■ Doses greater than 600 mg once or twice weekly; increased risk of serious adverse effects,
including shortness of breath, shock, anaphylaxis, and renal failure.
■ May decrease the effectiveness of oral contraceptive pills (OCPs).
■ Do not administer parenteral preparation IM or SC.
■ Patients on regimens of >600 mg once or twice weekly may experience adverse reactions,
including flulike syndrome.
■ Advise patient to report signs/symptoms of hepatotoxicity or thrombocytopenia.
■ Rifampin has been reported to cross the placental barrier and appear in cord blood.
■ When administered during the last few weeks of pregnancy, rifampin can cause postnatal
hemorrhages in the mother and infant for which treatment with vitamin K may be indicated.
■ Use during pregnancy only if the potential benefit justifies the potential risk to the fetus.
Lactation:
Because of potential for tumorigenicity shown for rifampin in animal studies, a decision should be
made whether to discontinue nursing or discontinue drug, taking into account importance of drug
to mother.
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SaCButamoC(SaC6avent t TarcoCin®, yentaC)
Dosage form & Strength: 0.121 g/ 20 ml solution, 100 mcg per actuation & 2 mg/ 5 ml syrup.
Class: Beta2 Agonists
Indications:
■ Relief of bronchospasm in patients with reversible obstructive airway disease.
■ Management of asthma.
■ Treatment of moderate to severe hyperkalemia "Inhalation" (off-label).
Dosage and administration:
Adult:
Relief of bronchospasm:
Nebulization solution: 2.5 mg (0.5 ml) 3 to 4 times daily as needed; Quick relief: 1.25 to 5 mg every 4
to 8 hours as needed.
Oral: 2 to 4 mg/dose 3 to 4 times daily; maximum dose not to exceed 32 mg daily. MDI : 2 inhalations
every 4 to 6 hours as needed.
Acute, severe exacerbation of asthma:

Mild to moderate exacerbations
Nebulization solution: 2.5 (0.5 ml) to 5 mg (1 ml) every 20 minutes for 3 doses; if good response, can
lengthen interval to every 3 to 4 hours as needed.
MDI : 2 to 4 inhalations every 20 minutes for 3 doses; if good response, can lengthen interval to every
3 to 4 hours as needed.
Moderate to severe exacerbations

Nebulization solution:
* 2.5 (0.5 ml) to 5 mg (1 ml) every 20 minutes for 3 doses, then taper as tolerated (eg, to 2.5 to 5
mg every 1 to 4 hours as needed).
* For critically ill patients, 10 to 15 mg may be administered by continuous nebulization over 1
hour via special apparatus.
MDI :
* 4 to 8 inhalations every 20 minutes for 3 doses, then taper as tolerated (eg, to 2 to 4
inhalations every 1 to 4 hours as needed).
* For extremely severe exacerbations, some experts suggest up to 10 inhalations for the initial
doses.
Hyperkalemia (off-label use): Nebulization solution: 10 to 20 mg over 10 minutes in combination with
other recommended therapies.
Pediatric:
Relief of bronchospasm:
Nebulization solution:
2 to 12 years: 0.63 to 1.25 mg (0.25 ml) 3 to 4 times daily as needed. >12 years and Adolescents: 2.5
mg (0.5 ml) 3 to 4 times daily as needed.
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Oral:
2 to 6 years: 0.1 to 0.2 mg/kg/dose 3 times daily (maximum: 12 mg daily).
6 to 12 years: 2 mg/dose 3 to 4 times daily (maximum: 24 mg daily).
>12 years and Adolescents: 2 to 4 mg/dose 3 to 4 times daily (maximum: 32 mg daily).
MDI:
Children >4 years and Adolescents: 1 to 2 inhalations every 4 to 6 hours; maximum daily dose: 4
inhalations /day.
Asthma, acute exacerbation

Nebulization: 2.5 mg (0.5 ml) every 20 minutes for the first hour if needed; if there is rapid response
to initial therapy after 1 to 2 hours, therapy can be changed to every 3 to 4 hours as needed.
MDI:
■ <5 years: 2 to 6 inhalations every 20 minutes for 2 to 3 doses; if initial response to 2 doses is
good, administer 2 to 6 inhalations every 3 to 4 hours for 24 to 48 hours.
■ >6 years: 2 to 10 inhalations every 20 minutes for 2 to 3 doses during the first hour; if initial
response to 2 doses is good, administer 2 to 6 inhalations every 3 to 4 hours for 24 to 48
hours.
Dosage adjustment:
Renal Impairment: use with caution.
Hepatic Impairment: no dosage adjustments.
Administration:
Solution for nebulization: To prepare a 2.5 mg dose, dilute 0.5 mL of solution to a total of 3 mL with
normal saline; also compatible with cromolyn or ipratropium nebulizer solutions. Stability:
■ Farcolin respiratory solution should not be used after a period of three months of opening the
bottle.
■ Fresh dilutions should be prepared for each administration and any solution remaining in the
nebulizer after the relief of bronchospasm should be discarded.
Precautions:
■ Salbutamol should be administered cautiously to patients suffering from thyrotoxicosis.
■ Salbutamol and non-selective beta-blockers, such as propranolol, should not usually be
prescribed together.
■ Potentially serious hypokalaemia may result from beta-2 agonist therapy mainly from
parenteral and nebulised administration;
Particular caution is advised in acute severe asthma as this effect may be potentiated by
hypoxia and by concomitant treatment with xanthine derivatives, steroids;
It is recommended that serum potassium levels are monitored in such situations.
■ Cardiovascular effects may be seen with
salbutamol;
Patients with underlying severe heart disease (e.g. ischaemic heart disease, arrhythmia or
severe heart failure) who are receiving salbutamol should be warned to seek medical advice
if they experience chest pain or other symptoms of worsening heart disease;
Attention should be paid to assessment of symptoms such as dyspnoea and chest pain, as they
may be of either respiratory or cardiac origin.
■ Use with caution in patients with diabetes mellitus; beta2-agonists may increase serum
glucose and aggravate preexisting diabetes and ketoacidosis;
Concurrent administration of corticosteroids can exaggerate this effect.
■ Use with caution in patients with glaucoma; may elevate intraocular pressure.
■ Use with caution in patients with seizure disorders; beta-agonists may result in CNS
stimulation/excitation.
■ Use spacer for children <5 years of age and consider adding a face mask for infants and
children <4 years of age.
■ Uncontrolled asthma is associated with adverse events on pregnancy (increased risk of perinatal
mortality, preeclampsia, preterm birth, low birth weight infants), salbutamol is the preferred short
acting beta agonist when treatment for asthma is needed during pregnancy. Lactation: Unknown
whether drug is excreted in milk; not recommended.
SaC6utamoC/ ItecCometfiasone Dwromonate CVentaC

Comyositum®)
Dosage form & Strength: Salbutamol 100 mcg/dose + Beclomethasone Dipropionate 50
mcg/dose.
Class: bronchodilator Salbutamol, with an active corticosteroid for inhalation Beclomethasone
dipropionate.
Indications:
■ Bronchial asthma.
■ Asthmatic bronchitis.
■ Chronic bronchitis.
■ Emphysema with a broncho-spastic component.
Dose:
Adult: 2 puffs every 4 to 6 hours. Children: < 12 years: 1- 2 puffs every 2 to 4 times a day.
No more than two puffs at a time should be employed and the treatment should not be repeated
before 4 hours.
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■ Salbutamol and non-selective beta-blockers, such as propranolol, should not usually be
prescribed together.
■ Use with caution in patients with ischemic cardiopathy, cardiac failure, hyperthyroidism,
serious hypertension and in patients that have previously received large doses of other
sympathomimetic drugs.
Pregnancy:
It should be administered in case of real necessity and under direct control of the physician; in these
cases the interrupted use more than 10 days should be avoided.
Sodium Bicarbonate
Dosage form & Strength: 8.4 % 25 ml ampoule,1 mEq NaHCO3 is equivalent to 84 mg. Class:
Alkalinizing Agents
lndications& Doses:
Cardiac Arrest
■ Initial: 1 mEq/kg/dose (lmEq= 1 ml from: 8.4% 25 ml ampoule) IV xl; base subsequent doses
on results of arterial blood pH and PaCO2 as well as calculation of base deficit.
■ Repeat doses may be considered in the setting of prolonged cardiac arrest only after
adequate alveolar ventilation has been established.
Hyperkalemia: 50 mEq IV over 5 minutes.
Dose adjustment:
Renal Impairment! There is no dosage adjustments provided in the manufacturer's labeling. Use with
caution; can cause sodium retention.
Hepatic Impairment: There is no dosage adjustments provided in the manufacturer's labeling. Use
with caution, especially in clinical states associated with edema and sodium retention.
Administration:
■ Administered IV, either undiluted or diluted in other fluids.
■ For direct IV infusion in emergencies, administer slowly; for infusion, dilute to a maximum
concentration of 0.5 mEq/mL in dextrose solution and infuse over at least 2 hours (maximum
rate of administration: 1 mEq/kg/hour).
■ Store injection at room temperature. Protect from heat and from freezing. Use only clear
solutions.
Monitoring Parameters
■ Serum electrolytes, including calcium, urinary pH, arterial blood gases.
■ If extravasation occurs, stop infusion immediately and disconnect (leave needle/cannula in
place); gently aspirate extravasated solution (do NOT flush the line); initiate hyaluronidase
antidote; remove needle/cannula; apply dry cold compresses.
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■ Not first-line for resuscitation.

■
Edematous or Na-retaining states, history of CHF, renal impairment, cirrhosis, HTN, children
with DKA, concurrent corticosteroid use.
■ May cause hypokalemia.
■ Use caution in patients with cirrhosis, heart failure, renal impairment, peptic ulcer disease, or
edema.
Pregnancy: C, appropriate medications should not be withheld due to concerns of fetal
teratogenicity.
Lactation: Sodium is found in breast milk.
Streptokinase (Sedonase®, Strejrtofase®)

Dosage forms & strength: 1.5 MIU iVvial.
Class: Plasminogen Activator; Antithrombotic.
Indications:
■ Acute myocardial infarction: within 12 hours of onset with persistent ST-segment elevation or
recent left bundle-branch block.
Dosage:
■ Systemic administration: A single dose of 1.5 million IU should be infused intravenously over
one hour.
■ Local intracoronary administration: A bolus of 20,000 IU should be followed by a maintenance
infusion of 2,000 IU to 4,000 IU per minute over 30 to 90 minutes depending on the
achievement of coronary artery patency.
■ Treatment with aspirin (150 mg daily) for at least 4 weeks is recommended for prophylaxis
after streptokinase therapy for acute myocardial infarction. The first dose should be given as
soon as possible after the myocardial infarction.
Administration:
■ Slowly add 5 mL NS or 5% Dextrose.
■ Roll and tilt the vial gently to reconstitute. Avoid shaking. (Shaking may cause foaming.)
■ Withdraw the entire reconstituted contents of the vial; slowly and carefully dilute to a total
volume 50 mL of 5% D5W given IV over 60 minutes.
■ Allergic reactions force the termination of many infusions before a therapeutic dose can be
administered.
Storage
■ Do not store above 25°C and do not freeze.
■ Do not store the reconstituted solution for more than 8 hours in a refrigerator at 2°C to
8°C.
Warnings/precaustions:
■ Severe bleeding complications requiring transfusion are extremely rare (0.3-0.5%), and
combined therapy with low dose aspirin does not appear to increase the risk of major
bleeding.
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■ In the following conditions the risks of
therapy may be increased and should be weighed against the anticipated benefits:
* Recent (within 10 days) major surgery, obstetrical delivery, organ biopsy, previous
puncture of noncompressible vessels.
* Recent (within 10 days) serious gastrointestinal bleeding.
* Recent (within 10 days) trauma including cardiopulmonary resuscitation.
* Hypertension: systolic BP >180 mm Hg and/or diastolic BP >110 mm Hg.
* High likelihood of left heart thrombus, e.g., mitral stenosis with atrial fibrillation
* Subacute bacterial endocarditis.
* Hemostatic defects including those secondary to severe hepatic or renal disease
* Pregnancy.
* Age >75 years.
* Cerebrovascular disease.
* Diabetic hemorrhagic retinopathy.
* Septic thrombophlebitis or occluded AV cannula at seriously infected site.
* Any other condition in which bleeding constitutes a significant hazard or would be
particularly difficult to manage because of its location.
Streptomycin (Streptomycin sulphite®)

Dosage form & strength: lg viaI.
Class: Aminoglycosides, antibiotics.
Indications:
■ Brucellosis.
■ Haemophilus influenzae infection.
■ Infection due to Mycobacterium tuberculosis.
■ Sepsis due to Gram negative bacteria.
■ Urinary tract infectious disease.
General dosing:
Adult: 1-2 g/day IM divided q6-12hr; no more than 2 g/day.
Pediatric: 20-40 mg/kg/day IM divided q6-12 hr.
Dosage adjustment:
Renal impairment Adult (Recommendations are based on doses of 1 to 2 g every 6 to 12 hours)
■ CrCI: 10-50 mL/min: Administer q24-72hr.
■ CrCI <10 mL/min: Administer q72-96hr.
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Renal impairment Pediatric (dose

recommendations are based on doses of 20 to 40 mg/kg/day every 24 hours.) Monitor serum
concentrations.
■ GFR 30 to 50 mL/minute/1.73 m2: Administer 7.5 mg/kg/dose every 24 hours.
■ GFR 10 to 29 mL/minute/1.73 m2: Administer 7.5 mg/kg/dose every 48 hours.
■ GFR <10 mL/minute/1.73 m2: Administer 7.5 mg/kg/dose every 72 to 96 hours.
■ Intermittent hemodialysis (IHD): Administer 7.5 mg/kg/dose every 72 to 96 hours.
■ Peritoneal dialysis (PD): Administer 7.5 mg/kg/dose every 72 to 96 hours.
■ Continuous renal replacement therapy (CRRT): Administer every 24 hours; monitor levels.
Hepatic impairment: no dose adjustment necessary.
Administration:
Intramuscular Route Only
IM: Streptomycin is usually administered daily as a single intramuscular injection, inject deep IM into
large muscle mass.
IV: not recommended.
Warnings
■ May cause nephrotoxicity and neurotoxicity. Avoid concurrent use of nephrotoxic/neurotoxic
drugs such as Ethacrynic acid and furosemide.
■ Nephrotoxicity: The nephrotoxic effect of aminoglycosides is cataionic charge dependent ->
Neomycin > Gentamicin & Tobramycin > Amikacin > Streptomycin.
■ Ototoxicity: Streptomycin > Gentamicin > Amikacin.
■ Common side effects: Black, tarry stools, burning, crawling, itching, numbness, prickling, "pins
and needles", or tingling feelings.
■ May cause neuromuscular blockade and respiratory paralysis, especially when given after
anesthesia or muscle relaxants.
Lactation: enters breast milk (AAP Committee states compatible w/ nursing).
TheopftyCCine. (MinopfiyCCine- M®)
Dosage form &Strength: 25 mg/ml =21.43 mg theophylline anhydrous, 5 ml amp. Class:

Xanthine Derivatives; Phosphodiesterase Enzyme Inhibitors, Nonselective. Aminophylline is a 2:1
complex of theophylline & ethylenediamine.
Indications:
■ Acute Bronchospasm.
■ Asthma.
■ Chronic obstructive pulmonary disease.
General dosage:
Adult:
■ Patients not currently taking theophylline:
LD: 4.6 mg/kg/dose IV (preferred route) or 5 mg/kg orally; not to exceed 25 mg/min IV In a
patient who has received no theophylline in the previous 24 hours.
01093741899
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■ Patients who have received theophylline
in the previous 24 hours:
A loading dose should not be given before obtaining a serum theophylline concentration. The
loading dose should be calculated as follows:
Dose = (desired serum theophylline concentration - measured serum theophylline
concentration) (Vd)
MD:
Adults <60 years: 0.4 mg/kg/hour; maximum: 900 mg/day unless serum levels indicate need
for larger dose.
Adults >60 years: 0.3 mg/kg/hour; maximum: 400 mg/day unless serum levels indicate need
for larger dose.
Smokers: 0.79 mg/kg/hr IV for next 12 hours after loading dose, then 0.63 mg/kg/hr or 5
mg/kg PO (extended release) q 8hr.
■ Co-administration' with drugs that decrease theophylline clearance (eg, cimetidine,
ciprofloxacin, and erythromycin and other macrolides): 0.2-0.3 mg/kg/hr IV or PO (extended
release) q 12-24 hr.
■ Congestive heart failure: 0.39 mg/kg/hr IV for next 12 hours after loading dose, then 0.080.16
mg/kg/hr.
Pediatric:
LD:
■ No theophylline administered in previous 24 hours: IV: 4.6 mg/kg/dose; IV infused over 2030
minutes.
■ Patients currently receiving methylxanthines: calculated as:
Dose = (C desired - C measured) (Vd)
MD:
Continuous IV infusion: Note: Dosing presented is to achieve a target concentration of 10 mcg/mL.
Lower initial doses may be required in patients with reduced theophylline clearance. Dosage
should be adjusted according to serum concentration measurements during the first 12- to 24-
hour period.
■ Infants 4 to 6 weeks: 1.5 mg/kg/dose every 12 hours
■ Infants 6 to 52 weeks: Dose (mg/kg/hour) = (0.008 X age in weeks) + 0.21
■ Children 1 to <9 years: 0.8 mg/kg/hour
■ Children 9 to <12 years: 0.7 mg/kg/hour
Dosage adjustment:
■ 1 mg/kg results in 2 mg/L (34.4 mmol/L) increase in serum theophylline.
■ Therapeutic range: 10-20 mg/l (mcg/ml).
■ Aminophylline is approximately 79-86% theophylline;
To achieve a target concentration of 10 mcg/mL, aminophylline = theophylline divided by 0.8.
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■ Renal impairment: No dosage

adjustment necessary; aminophylline should be stopped if the patient develops significant
renal impairment.
■ Hepatic impairment:
0.2 mg/kg/hour; maximum dose: 400 mg daily unless serum concentrations indicate need for
larger dose. Use with caution and monitor serum theophylline concentrations frequently; risk
of severe and potentially fatal toxicity may occur.
Obesity: dose should be calculated on the basis of ideal body weight;

Ideal BodyWeight (IBW):
* IBW (male) = 50 +2.3 (H-60).
* IBW (female) = 45.5 +2.3 (H-60).
Where: H = height in inches.
1 Inch = 2.54 cm.
■ Don't use standard dosing for IV infusion, if the patient is already on oral theophylline; dosage
should be calculated after determining the serum concentration.
■ LD for patients already on oral theophylline: 3 mg/kg IV.
■ MD: IV infusion= 0.5 mg/kg/hr x factor.
Drug factor: influenza vaccine (0.5), ciprofloxacin (0.7), propranolol (0.6), erythromycin (0.7),
rifampicin (1.3), phenobarbital (1.3)
Disease factor: smoker (1.5), CHF/Liver disease (0.5), COPD (0.8), age > 65 (0.8).
Dosage adjustment based on serum theophylline concentrations: IV, Oral:

■ <9.9 mcg/mL: If symptoms not controlled and current dosage tolerated, increase dose or
infusion rate by ~25%; recheck serum concentration after 24 hours (IV) or 3 days (oral) for
further dosage adjustment.
■ 10 to 14.9 mcg/mL: If symptoms controlled and current dose tolerated, maintain dose and
recheck serum concentrations at 24-hour intervals (IV) or 6- to 12-month intervals (oral); if
symptoms are not controlled and current dose is tolerated, consider adding additional
medications.
■ 15 to 19.9 mcg/mL: Consider 10% decrease in dose or infusion rate even if current dosage is
tolerated.
■ 20 to 24.9 mcg/mL: Decrease dose or infusion rate by 25% even if no adverse effect present;
recheck serum concentrations after 24 hours (IV) or 3 days (oral) to guide further dosage
adjustment.
■ 25 to 30 mcg/mL: Stop infusion for 24 hours or skip next oral dose; decrease subsequent
doses or infusion rate at least 25% even if no adverse effects present; recheck serum
concentrations after 24 hours (IV) or 3 days (oral) to guide further dosage adjustments; if
symptomatic, discontinue infusion and consider if overdose treatment is needed.
■ >30 mcg/mL: Discontinue infusion and treat overdose as indicated; if theophylline is resumed,
decrease dose or infusion rate by at least 50% and recheck serum concentrations after 24
hours (IV) or 3 days (oral) to guide further dosage adjustment.
01093741899
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Administration:
Intravenous:
■ IVP slowly OR IV infusion after dilution with NS or D5W.
■ For IV intermittent therapy, dilute;
o Doses up to 250 mg in 50 mL of compatible diluent and infuse over 30 minutes, o Doses
251-500 mg in 100 ml of compatible diluent and infuse over 30 minutes.
■ Aminophylline can be given by continuous IV infusion, by IV piggyback but not by IV push.
■ Do not mix in a syringe with other drugs.
■ Avoid alkali labile drugs in admixtures with aminophylline (e.g. epinephrine HCI,
norepinephrine bitartrate).
■ Rate of IV infusion should not exceed 7.5 mg/kg/ min over 30 minutes.
Oral: may be taken with or without food.
■ A loading dose should not be given before obtaining a serum theophylline concentration if the
patient has received any theophylline in the previous 24 hours.
■ Extravasation may occur during administration of aminophylline. If signs or symptoms of
extravasation occur, stop the infusion immediately. If possible, withdraw 3 to 5 mL of blood to
remove some of the drug. Remove the infusion needle.
■ Do not make increases in the dose of IV theophylline in response to an acute exacerbation of
symptoms unless the steady-state serum theophylline concentration is less than 10 mcg/mL.
■ Theophylline clearance may decrease in patients with congestive heart failure, acute
pulmonary edema, hepatic disease, cor pulmonale, acute hepatitis, hypothyroidism, cirrhosis,
fever, or sepsis with multiorgan failure and shock.
■ Serious side effects such as ventricular arrhythmias, convulsions or even death, may appear as
the first sign of toxicity without any previous warning.
Lactation:
■ Excreted into breast milk.
■ Maternal use of theophylline is considered compatible with breastfeeding. Infants exposed to
theophylline via breast milk should be monitored for adverse events (irritability, tachycardia,
vomiting).
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Tiemonium MetfiyCsuCfate
(Sj9asmojree®t'Viscerafgine®)
Dosage form & strength: 5 mg/2 mL amp.
Class: Spasmolytic agent, Muscarinic receptor antagonist (anticholinergic, parasympatholytic agent).
Indications:
Treatment of spasm and symptomatic treatment of pain related to functional disorders in the
digestive tract, biliary system, urinary tract and in gynecology.
Dosage& Administration:
1 ampoule by slow I.M. or I.V. injection, up to 3 times daily.
Precautions:
■ IV Injection should be slow to reduce the risk of tachycardia& hypotension.
■ Urethroprostatic disorders involving a risk of urine retention.
■ Risk of angle-Closure glaucoma.
Pregnancy category:
The results of animal studies of tiemonium did not reveal any teratogenic effects. Although these
results do not prejudge the effects in man, no deformities have been reported up till now with
normal use.
Lactation:
Use with caution although no problems have been reported with normal use.
Tranexamic acid(Kapron®)
Dosage form & strength: 500 mg/ 5ml amp.
Class: Antifibrinolytic Agents
Indications:
Local fibrinolysis For short term use in prophylaxis and treatment in patients at high risk of per - and
post-operative haemorrhage following:
■ Prostatectomy.
■ Conisation of the cervix.
■ Surgical procedures and dental extractions in haemophiliacs.
General fibrinolysis:
■ Haemorrhagic complications in association with thrombolytic therapy.
■ Haemorrhage associated with disseminated intravascular coagulation with predominant
activation of the fibrinolytic system.
Dosage:
Adult:
Local fibrinolysis: the recommended standard dose is 5-10ml (500-1000mg) by slow intravenous
injection (1 ml/min), three times daily. Following an initial intravenous injection, subsequent
treatment may proceed by intravenous infusion.
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Children: 20 mg/kg/day. However, data on
efficacy, posology and safety for these indications are limited.
General fibrinolysis:
■ In disseminated intravascular coagulation with predominant activation of the fibrinolytic
system, usually a single dose of 10ml (lg) is sufficient to control bleeding.
■ Neutralisation of thrombolytic therapy; lOmg/kg body wt by slow intravenous injection.
Dosage adjustment:
Renal impairment:
■ SCr 1.36-2.83 mg/dL (120-250 micromoles/L): 10 mg/kg IV ql2hr.
■ SCr 2.83-5.66 mg/dL (250-500 micromoles/L): 10 mg/kg IV qDay.
■ SCr >5.66 mg/dL (>500 micromoles/L): 5 mg/kg IV qDay.
Hepatic impairment: No specific dosage adjustment.
Administration:
■ Intravenous injections should be given very slowly ; should not be administered by IM.
■ May be administered undiluted (100 mg/mL) by direct IV injection;
■ or may further dilute dose in 50 to 250 mL of NS or D5W and infuse over 5 to 30 minutes;
maximum administration rate: 100 mg/minute.
■ Other compatible solutions: 20% fructose; 10% invertose; dextran 40; dextran 70; ringer's
solution.
■ Kapron solution for injection may be mixed with Heparin.
Contraindications:
■ History of venous or arterial thrombosis.
■ History of convulsions.
■ Intrathecal and intraventricular injection, intracerebral application (risk of cerebral oedema
and convulsions)
Warnings:
■ Anaphylaxis reported with intravenous administration.
■ Hypotension, with or without loss of consciousness (generally following a too fast intravenous
injection).
■ Ureteral obstruction resulting from clot formation reported; use caution in patients with
upper urinary tract bleeding.
■ Thromboembolism or venous and arterial thrombosis reported.
Pregnancy: there is no evidence from animal studies of a teratogenic effect, use in caution.
Lactation: Excreted in breast milk, not recommended.
01093741899
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i
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4JJ) '■^'1
jjl) OLajLi-J)jSjj
Trimebutine. Mafeate. (Gastreg ®)

Dosage form &Strength: 50 mg/5 ml amp IV&IM, 100 & 200 mg tab, Oral suspension.
Class: Antimuscarinic, a noncompetitive spasmolytic agent
Indications:
■ Functional digestive disorders accompanied by abdominal pain, spasm, fullness, flatulence,
constipation or diarrhea.
■ Irritable bowel syndrome.
Dose:
■ Tablets 100 mg: 1-2 tablets 3 times daily.
200 mg: one tablet 3 times daily.
■ Oral-suspension for Children >2 years: 1 mg/kg/day in three doses.
Adults: 1-2 tablespoonfuls (10 -20 ml) 3 times daily.
■ Suppositories: 1-2 suppositories daily.
■ Injection:
* Total daily intravenous or intramuscular dose should not exceed 400 mg in the acute
phase.
* The usual dose in adults is 50 - 100 mg, i.e. 1-2 ampoules daily administered as a 3 to 5 minutes
IV injection, as a 60 minutes IV infusion or as an IM injection until resumption of intestinal
motility.
* Infusion, the known incompatibilities are: dihydrostreptomycin, bipenicilline,
pentobarbital sodium injection, gamma-OH, oxyferriscorbine sodium.
Warnings/precautions:
■ Tablets contains lactose. Its use should not be taken in patients with lactose intolerance.
■ Granules for oral suspension contains sucrose. Its use should not be taken in patients with
intolerance to sucrose.
■ it contains sugar, taken with care in case of diabetic patients and who on diet.
■ this medicine contains sun set yellow E 110 and may cause allergic reactions.
■ Injection:
* This product contains benzyl alcohol which is potentially toxic when administered locally to
neural tissue.
* This product is contraindicated for use in premature infants because the formulation
contains benzyl alcohol.
* The injectable form must be administered slowly 3 to 5 minutes.
Storage:
Oral-suspension after reconstitution, store in room temperature not exceeding 25 in dry place to be used
within 4 weeks.
Ampoule: store at temperature 2-8 °c.
Pregnancy:
01093741899
111
■ No teratogenic effects has been evidenced in
animal studies.
■ Clinical experience with trimebutine is insufficient to evaluate its malformative or foetotoxic
effects.
■ Accordingly, as a precaution, it is preferable not to use the trimebutine during the first trimester of
pregnancy. In the absence of adverse effects expected for the mother or the child, the use of
trimebutine over 2 and 3 trimesters of pregnancy should be considered only If needed.
Breastfeeding:
The passage in breast milk is not known; Breastfeeding is possible.
'Vancomycin (VancoBact®, 'Vancomix^)

Class: Glycopeptide, antibiotic.
Indications:
■ Bacterial Meningitis.
■ Pseudomembranous Colitis/Staphylococcal Enterocolitis.
■ Methicillin-resistant Staphylococcus aureus (MRSA) infectious disease.
■ Methicillin-resistant Staphylococcus epidermidis (MRSE) infections.
■ Skin and/or subcutaneous tissue infections.
General dosing:
Adult: 2 g divided either as 500 mg q 6 h, or 1 g q 12 hours (Initial daily dose should be no less than 15
mg/kg).
Meningitic dose: IV: 15 to 20 mg/kg/dose IV (based on actual body weight) q 8-12 h. Pediatric: 10 mg/kg
/dose q 6 hours; Max: 1 g/dose.
Meningitic dose: 15-20 mg/kg/dose every 6 hours.
Renal dosing:
Adult:
Vancomycin Initial Dosage Regimens for Patients With Impaired Renal Function
eGFR Actual Body Weight

(mL/minute per <60 kg 60 to 80 kg 81 to 100 kg >100 kg
1.73 m2)
>90 750 mg every 8 h 1,000 mg every 8h 1,250 mg every 8 h 1,500 mg every 8 h
750 mg every 1,000 mg every 1,250 mg every 1,000 mg every
50 to 90
12 hours 12 hours 12 hours 8 hours
750 mg every 1,000 mg every 1,250 mg every 1,500 mg every
15 to 49
24 hours 24 hours 24 hours 24 hours
<15a 750 mg 1,000 mg 1,250 mg 1,500 mg
a
Check a random vancomycin level in 24 hours after the dose. If random level is <20 mcg/mL, repeat the
dose. If random level is >20 mcg/mL, do not redose; repeat random level in 12 hours.
Pediatric:
■ GFR 30 to 50 mL/minute/1.73 m2:10 mg/kg/dose every 12 hours.
■ GFR 10 to 29 mL/minute/1.73 m2:10 mg/kg/dose every 18 to 24 hours.
■ GFR <10 mL/minute/1.73 m2:10 mg/kg/dose; redose based on serum concentrations.
Dosing Considerations:
■ Peak values 18-26 mg/L; trough values 5-10 mg/L; however, Infectious Diseases Society of
America and other guidelines urge troughs 15-20 mg/L.
Administration:
IV:
■ 1st step: Reconstitute 500-mg vial with 10 mL SWI and 1-g vial with 20 mL SWI to yield 50 mg/mL
solution; further dilution is required.
■ 2nd step: Intermittent infusion; Dilute 500 mg with >100 mL of diluent and 1 g with >200 mL of
diluent (NS or D5W). "final cone, not exceeds 5mg/ml".
■ Diluents: NS, D5W, D5NS, LR.
■ Administer over 60 minutes; not to exceed 10 mg/min to avoid red man syndrome (Red man
syndrome (RMS) is also known as "red neck syndrome" and is the most common of the negative
reactions to vancomycin.) "Rash and hypotension" appear rapidly & resolves within minutes to
hours.
Management of RMS:
* Stopping infusion
* Changing administration site.
* Decreasing rate of infusion and giving antihistaminic.
■ Stable for 24 hrs (RT) and 7 Days (REF).
Oral: May dilute IV formulations in 1 ounce (30 ml) of water to drink or administer via nasogastric tube.
Precautions:
■ Thrombophlebitis may occur with IV administration.
■ Reversible neutropenia has been reported with IV administration (monitoring recommended).
■ Transient or permanent ototoxicity may occur especially with:
* Excessive IV Doses.
* Underlying Hearing Loss.
* Concomitant use with ototoxic agents such as aminoglycosides.
■ Nephrotoxicity may occur; increased risk with:
* Underlying Renal Impairment.
* Advanced Age.
* Dehydration.
* Concomitant use with aminoglycosides.
■ Oral vancomycin is not effective for systemic infections;
It is only indicated for treatment of pseudomembranous colitis due to C. difficile and
enterocolitis due to S. aureus.
01093741899
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i
'
4JJ) jjl) '■^'1
■ M ixtu res of vancomycin and beta-

lactam antibiotics a re physically incompatible;
It is recommended to adequately flush the intravenous lines between the administrations of
these antibiotics.
Pregnancy:
■ Vancomycin crosses the placenta. Adverse fetal effects, including sensorineural hearing loss or
nephrotoxicity, have not been reported following maternal use during the second or third
trimesters.
■ [US Boxed Warning]: The formulation of vancomycin injection containing the excipients
polyethylene glycol (PEG 400) and N-acetyl D-alanine (NADA) is not recommended for use
during pregnancy; fetal malformations in animal reproduction studies.
Lactation: Drug enters breast milk; not recommended.
yerapamiC (Isoptin®)
Dosage form & strength: 5 mg/ 2 ml amp.
Class: : Antidysrhythmics, Non-dihydropyridine Calcium Channel Blockers.
Dosage & ICU Indications:
Adult:
■ Supraventricular Arrhythmia & Atrial Fibrillation/FIutter.
■ Chest pain associated with cocaine ingestion, with or without evidence of acute co ronary
syndrome (off-label use).
2.5-5 mg IV over 2 minutes; 5-10 mg ;dose may be repeated after 15-30 minutes. If 2 bolus doses
do not terminate the arrhythmia, consider alternative therapy.
Pediatric:
Supraventricular Tachycardia:
n
10 mg) may be given after 30 minutes.

Dosage adjustment:
Renal Impairment:
■ Injection: There are no dosage adjustments provided in the manufacturer's labeling; however,
repeated injections in patients with renal failure may lead to accumulation.
■ If repeated injections are essential, monitor BP and PR interval closely and use smaller doses.
Hepatic Impairment:
■ There are no dosage adjustments provided in the manufacturer's labeling; use with caution and
consider additional ECG monitoring in severe impairment.
■ In cirrhosis, reduce dose to 50% of normal and monitor ECG .
■ Repeated injections in patients with hepatic failure may lead to accumulation. If repeated
injections are essential, monitor BP and PR interval closely and use smaller doses.
01093741899
114
i
'
jjl)
4JJ)
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1
Administration:
Direct IV over at least 2 minutes (3 minutes in older patients).
Storage:
Store at room temperature; protect from light
Contraindications
■ Hypersensitivity to verapamil or other calcium channel blockers.
■ Cardiogenic shock.
■ Congestive heart failure.
■ Symptomatic hypotension.
■ Sick sinus syndrome (unless permanent pacemaker in place).
■ 2°/3° AV block (unless permanent pacemaker in place.)
Warning/Precautions:
■ Elevations of hepatic transaminases, alkaline phosphatase, and bilirubin have been reported.
■ Symptomatic hypotension with or without syncope may occur.
■ May cause first-degree atrioventricular (AV) block or sinus bradycardia.
■ IV verapamil has increased intracranial pressure in patients with supratentorial tumors at the
time of anesthesia induction; use with caution in these patients.
■ Use with caution in left ventricular dysfunction; due to negative inotropic effects, may
exacerbate condition.
■ Use with caution in patients with renal impairment; monitor hemodynamics and possibly ECG in
severe impairment.
Pregnancy category: C, Females with preexisting hypertension may continue their medication
during pregnancy unless contraindications exist.
Lactation:
Distributed in milk; (though American Academy of Pediatrics committee states that drug is compatible
with nursing).
01093741899
115
i
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4JJ) '■^'1
jjl) OLajLi-J)jSjj
Vitamin k ('Pfiytomenadione®.JCona^ion®.J{mri-^®)
Dosage form & strength: iv, PO lOmg

Class: Hemostatics; Vitamins, Fat-Soluble.
Indications:
■ Correction of elevated INR due to administration of warfarin or liver impairment.
■ Hypoprothrombinemia Due To Drugs or Factors Limiting Absorption or Synthesis.
Dosage:
2.5-10 mg IV/SC; may be increased PRN to 25 mg or, rarely, to 50 mg; may be repeated in 12-48 hours)
Dose adjustment:
Renal & hepatic impairment: There are no dosage adjustments provided in the manufacturer's
labeling.
Administration:
■ IM route should be avoided due to the risk of hematoma formation(Amri-k used for IM only).
■ Infuse slowly; rate of infusion should not exceed 1 mg/minute, or
■ Dilute dose in a minimum of 50 mL of compatible solution (preservative-free NS, D5W, or
D5NS),administer using an infusion pump over at least 20 minutes.
Cautions:
■ Rapid IV administration may cause potentially fatal anaphylaxis.
■ Protect from light; agent is rapidly degraded.
■ Avoid IM route if patients is bleeding or in 3rd trimester of pregnancy.
■ Administer phtonadione to quickly lower INR into safe range in patients receiving vitamin K
antagonists.
■ If initial doses do not reverse coagulopathy, higher doses are not likely to have any effect;
inefective in hereditary hypoprothrombinemia.
Pregnancy Category:
Lactating: Infant risk cannot be ruled out.
01093741899
116
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4JJ) '■^'1
jjl) OLajLi-J)jSjj
Glucose 5 %
Intravenous Infusionl'D'CW)
Composition:
■ 5 % isotonic glucose (dextrose) solution, each ml contains 50 mg glucose, in 500 ml bottles
(Nutritional value: 400 kcal /litre).
Indications:
■ Treatment of carbohydrate and fluid depletion.
■ A vehicle and diluent for compatible medicinal products for parenteral administration.
Dosage & administration:
■ The recommended dosage when used as a vehicle or diluent ranges from 50 to 250 ml per dose
of medicinal product to be ad ministered.
■ Treatment of carbohydrate and fluid depletion:
• Adults: 500 ml to 3 litres / 24h.
• Babies and children :
0-10 kg 100 ml/kg/24h.
10-20 kg 1000 ml + 50 ml /kg over 10 kg / 24h.
> 20 kg 1500 ml + 20 ml / kg over 20 kg / 24h.
■ The infusion rate depends on the patient's clinical condition.

■ The maximum dose ranges from 5mg/kg/min for adults to 10-18 mg/kg/min for babies and
children depending on the age and the total body mass.
Precautions:
■ Dextrose 5% solution is contraindicated:
* In patients with known allergy to corn or corn products
* In hypokalemia without concomitant electrolyte substitution.
■ The maximum rate at which dextrose can be infused without producing glycosuria is 0.5
g/kg/hour.
■ Dextrose administration may cause vitamin B complex deficiency.
The administration of dextrose without an adequate provision of certain B vitamins, which
form the coenzyme systems in its metabolism, will exhaust tissue stores of these factors,
leading to deficiency states.
01093741899
117
Glucose 10 % ('DicfW)
Composition:
10 % hypertonic glucose solution (100 mg glucose/ ml) for slow IV injection or infusion, in 500 ml
bottles.
Indications: Emergency treatment of severe hypoglycemia.
Dosage & Administration:
■ Severe hypoglycaemia:
Child and adult: 5 ml/kg by very slow IV injection (over 5 minutes) or IV infusion
Check blood glucose level 30 minutes after injection. If blood glucose level is still <
3 mmol/l or < 55 mg/dl, administer a second dose or give oral glucose, according
to the patient clinical condition.
■ Neonatal hypoglycaemia:
5 ml/kg/hour by IV infusion
In the event of loss of consciousness or seizures, give in addition a loading dose of 2.5 ml/kg by
very slow IV infection (over 5 minutes).
Contra-indications, adverse effects, precautions:
Do not administer by IM or SC route.
Remarks:
■ If ready-made 10% glucose solution is not available: add 10 ml of 50% glucose solution per 100
ml of 5% glucose solution to obtain a 10% glucose solution.
■ Nutritional value: 400 kcal/litre.
■ Storage: below 30°.
Glucose 2^%
Composition: 25 % hypertonic glucose solution (250 mg glucose/ ml) for slow IV injection or infusion,
in 500 ml bottles.
Indications:
■ a source of energy incorporated with parenteral nutrition with minimal dilution effect.
■ Acute symptomatic episodes of hypoglycemia in the neonate or older infant to restore depressed
blood glucose levels and control symptoms.
■ For use with an appropriate protein (nitrogen) source in the prevention of nitrogen loss or in the
treatment of negative nitrogen balance in patients where:
i. the alimentary tract cannot or should not be used.
ii. gastrointestinal absorption of protein is impaired.
iii. metabolic requirements for protein are substantially increased, as with
extensive burns.
01093741899
118
Dosage:
Adults: 10 to 25 g (40-100 mL). Repeated doses may be required in severe cases. Neonates: 250 to 500
mg/kg/dose (5 to 10 mL of 25% dextrose in a 5 kg infant)
Precautions:
■ The maximum rate at which dextrose can be infused without producing glycosuria is
0.5 g/kg/hour.
■ Dextrose solutions I.V. can cause fluid or solute overload resulting in dilution of serum
electrolyte concentrations, overhydration, congested states, or pulmonary edema.
■ Monitor changes in fluid balance, electrolyte concentrations, and acid-base balance during
prolonged use.
■ Hypertonic solutions (>10%) may cause thrombosis when infused through peripheral veins;
best to infuse through a central venous cather.
■ Significant hypokalemia may occur from administration of potassium free IV dextrose solutions.
■ Significant hyponatermia or water intoxication may occur from low sodium or sodium- free IV
dextrose solution.
J-fydroxyetfiyC Stared CVoCuverP, S-(eas-steriC)

Dosage form & strength:
■ 6% hydroxyethyl starch(HES) 130/0.4 in 0.9% NaCI, 500 mL.
■ The latest generation of starches.
■ Each 100 mL of the solution contains: 6 g of Hydroxyethyl Starch 130/0.4 and 900 mg of Sodium
Chloride USP in Water for Injection USP.
■ In addition, sodium hydroxide, USP, or Hydrochloric acid, USP, has been added to adjust the
final pH so the final solution pH is 4.0 to 5.5.
Class: Plasma Volume Expander, Colloid.
Indications:
■ Treatment of hypovolaemia (low blood volume) due to acute blood loss when plasma volume
expansion is desired.
Dosage and administration:
■ Administer by intravenous infusion only.
■ Daily dose and rate of infusion depend on the patient's blood loss, hemodynamics and on the
hemodilution effects.
■ Adult: up to 50 mL/kg/day This dose is equivalent to 3500 mL for a 70 kg patient.
■ Pediatric:
* <2 yr: Mean dose of 16 mL/kg IV
* 2-12 years: Mean dose of 36 mL/kg IV
■ Give initial 10-20 mL by slow IV infusion and monitor for anaphylactoid reaction.
■ For single use only. Discard unused portion.
01093741899
119
i CjUti
'
'■^'1
Storage
■ Store at 15° to 25°C. Do not freeze.
Renal Impairment Dosing:

Avoid use in patients with preexisting renal dysfunction. Use is contraindicated in oliguric/anuric renal
failure unrelated to hypovolemia or patients receiving dialysis. Discontinue use at the first sign of renal
injury.
Hepatic Impairment Dosing:
No dosage adjustment provided in manufacturer's labeling; use is contraindicated in severe liver
disease.
Contraindications:
■ In critically ill adult patients, including patients with sepsis, use of hydroxyethyl starch (HES)
products, including Voluven , increases risk of Mortality and Renal replacement therapy.
■ Do not use HES products, including Voluven®, in patients with severe liver disease.
■ Clinical conditions with volume overload.
■ Pre-existing coagulation or bleeding disorders.
■ Severe hypernatremia or hyperchloremia.
■ Intracranial bleeding.
Warnings and precautions:
■ Anaphylactoid reactions (mild influenza-like symptoms, bradycardia, tachycardia,
bronchospasm, noncardiac pulmonary edema) reported.
■ Avoid use with pre-existing renal dysfunction; discontinue at the first sign of renal injury.
■ Monitor renal function for at least 90 days following administration.
■ Monitor coagulation status of patients undergoing open heart surgery in association with
cardiopulmonary bypass as excess bleeding has been reported with HES solutions in this
population; discontinue at the first sign of coagulopathy.
■ Avoid fluid overload; adjust dosage with cardiac or renal dysfunction.
■ In cases of severe dehydration, a crystalloid solution should be given first.
■ Monitor fluid balance, serum electrolytes, renal and hepatic function, acid-base balance, and
coagulation parameters during prolonged parenteral therapy or when warranted.
■ Elevated serum amylase values may occur and interfere with the diagnosis of pancreatitis.
■ High doses may result in dilutional effects (e.g., decreased levels of coagulation factors and
other plasma proteins, decreased hematocrit).
Pregnancy Category: c
Lactation: Unknown if distributed in human breast milk, caution should be exercised.
01093741899
120
'Ringer Cccctate = Hartmanns solution
Isotonic soCutionfor infusion
Composition:
Approx, ionic cone of mmole in litre:
Sodium (Na+): 130.50 mmol (130.50 meq)
Potassium (K+): 4.02 mmol (4.02 meq)
Calcium (Ca++): 0.67 mmol (1.35 meq)
Chloride (CI-): 109.60 mmol (109.60 meq)
Bicarbonate (as lactate): 28.00 mmol (28.00 meq)
Indications:
■ Severe dehydration.
■ Hypovolaemia (trauma, surgery, anaesthesia...)
■ In cases of metabolic alkalosis, diabetes, severe hepatic failure, head injury: isotonic solution of
NaCI 0.9% is preferred.
■ Ringer Lactate provides appropriate amounts of sodium and calcium. It contains lactate which is
converted to bicarbonate for correction of metabolic acidosis when it exists (if
haemodynamic and liver function are normal).
■ It contains 4 mEq of potassium/litre, which is sufficient for short-term use. For prolonged use
(after 2 to 3 days), addition of potassium chloride is necessary: 1 or 2 g per litre = one to two
10 ml ampoules of KCL 10%/litre.
■ Due to the a I ka I inizing action of lactate (formation of bicarbonate), Lactated Ringer's
Irrigation may interfere with the elimination of drugs for which renal elimination is pH
dependent.
■ For moderate and mild dehydration, administer oral rehydration salts (ORS).
■ For correction of hypovolaemia due to haemorrhage; administer 3 times the lost volume only if:
* cardiac and renal function are not impaired,
* blood loss does not exceed 1500 ml in adults.
■ May be used to prevent hypotension induced by spinal anaesthesia.
■ Due to the a I ka I inizing action of lactate (formation of bicarbonate), Renal clearance of acidic
drugs such as salicylates, barbiturates, and lithium may be increased.
■ Storage: below 30°C.
i uLui
' '■^'1
MannitoC
Indications:
■ An osmotic diuretic, Promotion of diuresis in the prevention or treatment of the oliguric phase
of acute renal failure before irreversible renal failure becomes established.
■ Reduction of intracranial pressure and brain mass.
■ Promotion of urinary excretion of toxic materials.
Dosge:
For reducing elevated ICP: 1 g/kg over 30-60 min.( 5ml/kg of 20% mannitol solution).
Precautions:
■ Excessive loss of water and electrolytes may lead to serious imbalances. With continued
administration of mannitol linjection , loss of water in excess of electrolytes can cause
hypernatremia. Electrolyte measurements, including sodium and potassium are therefore of
vital importance in monitoring the infusion of mannitol injection.
■ Osmotic nephrosis, a reversible vacuolization of the tubules of no known clinical significance,
may proceed to severe irreversible nephrosis, so that the renal function must be closely
monitored during mannitol infusion.
■ Mannitol injection may increase cerebral blood flow and the risk of postoperative bleeding in
neurosurgical patients.
■ Mannitol may increase the cerebral blood flow and worsen intracranial hypertension in
children who develop a generalized cerebral hyperemia during the first 24 to 48 hours post
injury.
■ For intravenous use only. Do not administer intramuscularly or subcutaneously. Never add
mannitol in whole blood for transfusion.
Overdose:
Too rapid infusion of large amounts of mannitol injection will cause a shift of intracellular
water into the extracellular compartment resulting in:
■ Cellular dehydration.
■ Repeated doses should not be given to patients with persistent oliguria as this can
produce a hyperosmolar state and precipitate congestive heart failure and pulmonary
edema due to volume overload.
01093741899
122
i uLui
' '■^'1
SocCium cftCovicCe. 0.9%
Composition:
- Isotonic solution of sodium chloride (0.9 g per 100 ml) for infusion.
- Ionic composition: sodium (Na+): 150 mmol per litre (150 mEq).
chloride (Cl-): 150 mmol per litre (150 mEq).
Indications:
■ Vehicle for the administration of parenteral drugs.
■ Fluid replacement.
■ Use with caution in patients with hypertension, heart failure, oedema, ascites due to cirrhosis,
renal impairment and other conditions associated with sodium retention.
■ May cause: pulmonary oedema in the event of too rapid infusion or infusion of excessive
amounts.
■ Do not use as vehicle for the administration of amphotericin B (incompatibility): use only 5%
glucose solution.
Remarks:
■ For correction of hypovolaemia due to haemorrhage, administer 3 times the lost volume only
if:
* blood loss does not exceed 1500 ml in adults,
* cardiac and renal function are not impaired.
■ 0.9% sodium chloride solution may be used to prevent hypotension induced by spinal
anaesthesia.
■ This solution contains neither potassium nor lactate. In case of severe dehydration, use Ringer
Lactate. If Ringer Lactate is not available, add KCI (2 g/l) + NaCI (4 g/l) to 5% glucose.
■ For external use: sterile 0.9% sodium chloride solution is used for cleansing of non-infected
wounds, wound irrigation, eye cleansing (conjunctivitis, eye irrigations), nasal lavage in the
event of obstruction, etc.
■ Storage: below 30°C.
References:
■ https://online.lexi.com
■ https://reference.medscape.com
■ https://www.rxlist.com
■ https://www.medicines.org.uk/emc
■ Drugs information leaflets.
■ https://www.medicinep.com/gast-reg-trimebutine-gastrointestinal-motor-regulator-535.html
■ https://www.eipico.com.eg/PRDSDetails.aspx?id=119
■ https://www.sedico.net/english/Products/WebPages/lsoflurane/lsoflurane_e.htm
■ https://www.amoun.com/leap-portfolio-project/kapron-ampoules/
■ https://sites.google.com/site/adcohaler/vental-compositum-non-cfc-inhaler

كتيب أدوية الازمات والكوارث

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كتيب أدوية الازمات والكوارث

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AJJ)jjl) OLa^Lud) j^J-4

Under Supervision Of Pharmacy Director Dr. Mohammed Helmy Hospital Director

8 Ampicillin + sulbactam (Unasyn®) 16

16 Ceftriaxone (Cefaxone®, Cefotrix®) 28

24 Dobutamine (Dobutamine®, Dobuject®) 41

^jJulljii djliAA OUjkdl >>« Qs^ 01093741899

^jJulljii djliAA OUjkdl >>« Qs^ 01093741899

50 Ondansetron (Danset®, Zofran®) 74

61 Salbutamol ( Salbovent®, Farcolin®, vental®, Bronchoterol®) 92

62 Salbutamol /beclomethasone (Vental Compositum®) 94

66 Theophylline (Minophylline- N®) 98

^jJulljii djliAA OUjkdl >>« Qs^ 01093741899

^jJulljii djliAA OUjkdl >>« Qs^ 01093741899

3\retaminop fien (Paramo f, CetaC, PerfaCgari\ PyraC)

AcetylsaCicyCic acitf (Asjnrin®)

Dosage form & strength: 75,81,100,300,500 mg tablet.

Dosage form & strength: 500 mg vial.

Liver impairment: No adjustment recommended.

J^renaCine tartar ate (J^renaCine®. Tpiney brine®)

Dosage form & strength: lmg/iml amp.

Dosage form & strength: 150 mg/3 ml amp.

Amikacin (Amikin®. Amikacin®)

Dosage form & strength: 500 mg, 1 g cap & vial.

Dosage form & Strength: 375 (ampicillin 250 mg/sulbactam 125mg),

Stability & storage:

Mr opine. (Mropine sulphate")

■ Hypocalcemia induced by citrate-based replacement fluid during continuous renal

■ May be given diluted or undiluted.

Cefgrime. (Maxipime®. 'Wince]®)

30-60 500 mg q24h 1 g q24h 2 g q24h 2gql2h

11-29 500 mg q24h 500 mg q24h 1 g q24h 2 g q24h

Hepatic dosing: no adjustment.

Cefotaxime (Cefaxim®. Cefotax!®. Ceforan®)

Ceftriaxone. (Cefaxone®. Cefotrix")

■ Clopidogrel's antiplatelet activity is dependent on conversion to an active metabolite by the

Dexametfiasone. (Jtyiddne®. Tortecortin®. Orazone®)

Diazepam CVaCium®. Neurit®)

Dosage form & strength: io mg / 2 ml amp.

■ Declophen must not be given as IV bolus injection.

Dosage form & strength: 0.5 mg/2 ml amp.

Altered kidney function:

Digoxin Dosing Suggestions When Used for Heart Failure a,b

Hepatic Impairment Dosing; adult: No dosage adjustment necessary.

Dopamine (Intropm . Dopasunny®)

■ If extravasation occurs, infiltrate the area with diluted phentolamine (5 to 10 mg in 10 to 15

T) oxy eye Cine (Viframycin®. TaCocme")

TCumazeniC (JAnexate®, AnexniC)

Dosage form & strength: 0.5 mg/5 ml amp.

■ To prevent oliguria, reversible increases in

Pregnancy category: C; treatment during pregnancy necessitates monitoring of fetal growth

^hydrocortisone sodium succinate ( SoCu-Corte f )

Ibuprofen (Unfen, Megafen®, Profinaf)

General Pediatric dosing:

Lactation: present in breast milk.

Iimatropium bromide. (Mroventf®)

Dosage form & Strength: 100 % Inhalation Solution.

Isos or bide (finitrate ( Dinitra®)

Xetoprofen (Xetofan®, Xetoproj®)

LinezoCicC (y\.verozoCicC\ Linezomentiv^)

Seizure, Associated with epilepsy, glomerulonephritis or hypothyroidism: 1 g IM or IV.

Indications & Dosage:

MetftyCyYecCnisoCone (MetftyCyredhiso Cone

Metronufazofe ( Tfagyt\ JAmrizok®)

Dosage form &strength: 5mg/imlamp