Morphine High Alert Medication opioid analgesics- Pregnancy

Category C Schedule II
Indications: Severe Pain, Mgmt of moderate to severe chronic pain requiring use of a
continuous around-the-clock opioid analgesic for an extended period of time
(extended/sustained-release)
Action: Binds to opiate receptors in the CNS. Alters the perception of and response to painful
stimuli while producing generalized CNS depression.
Contraindicated in: hypersensitivity, significant respiratory depression, acute or severe
bronichal asthma, paralytic ileus
Use cautiously in: Neonates and infants <3 mo (more susceptible to respiratory
depression); Neonates (oral solution contains sodium benzoate which can cause potentially
fatal gasping syndrome).
Adverse Reactions/Side Effects: confusion, sedation, hypotension, constipation,
RESPIRATORY DEPRESSION
Drug Drug Interactions: Use with extreme caution in patients receiving MAO inhibitors
within 14 days prior (may result in unpredictable, severe reactions initial dose of morphine
to 25% of usual dose), CNS depression with alcohol, sedative/hypnotics, clomipramine,
barbiturates, tricyclic antidepressants, and antihistamines. Administration of partialantagonist opioid analgesics may precipitate opioid withdrawal in physically dependent

patients. Buprenorphine, nalbuphine, butorphanol, or pentazocine may analgesia, May

the anticoagulant effect of warfarin, Cimetidine metabolism and may effects

Morphine Route/Dosage:
PO: Rect: (Adults and Children <50 kg): Usual starting dose for moderate to severe
pain in opioid-naive patients0.3 mg/kg q 34 hr initially.
PO: (Children >1 mo): Prompt-release tablets and solution0.20.5 mg/kg/dose q 46 hr
as needed. Controlled-release tablet0.30.6 mg/kg/dose q 12 hr.
IM: IV: SC: (Adults and Children <50 kg): Usual starting dose for moderate to severe
pain in opioid-naive patients0.050.2 mg/kg q 34 hr, maximum: 15 mg/dose.
IM: IV: SC: Neonates 0.05 mg/kg q 48 hr, maximum dose: 0.1 mg/kg. Use preservativefree formulation.
IV: SC: (Children >1 mo): Continuous infusion, postoperative pain0.010.04 mg/kg/hr.
Continuous infusion, sickle cell or cancer pain0.022.6 mg/kg/hr.
IV: Neonates Continuous infusion0.010.03 mg/kg/hr.
Epidural: (Children >1 mo): 0.030.05 mg/kg, maximum dose: 0.1 mg/kg or 5 mg/24
hr. Use preservative-free formulation.

Toxicity Overdose:naloxone, For children and adults weighing <40 kg, dilute
0.1 mg of naloxone in 10 mL of 0.9% NaCl for a concentration of 10 mcg/mL and
administer 0.5 mcg/kg every 2 min.

Acetaminophen antipyretics/nonopioid analgesics - Pregnancy

Cat. B & C
Indications: PO: Rect: Mild pain, fever IV: Mild to Mod. Pain, Mild to Mod. Pain with
Opioids, Fever
Action: Inhibits the synthesis of prostaglandins that may serve as mediators of pain and
fever, primarily in the CNS, Has no significant anti-inflammatory properties or GI toxicity
Contraindicated in: Previous hypersensitivity; Products containing alcohol, aspartame,
saccharin, sugar, or tartrazine (FDC yellow dye #5) should be avoided in patients who
have hypersensitivity or intolerance to these compounds; Severe hepatic
impairment/active liver disease.
Use Cautiously in: Hepatic disease, Renal disease, malnutrition, Neonates (safety and
effectiveness not established) (for IV).
Adverse Reactions Side Effects: agitation ( in children) (IV),atelectasis ( in children)
(IV), constipation ( in children) (IV), HEPATOTOXICITY ( DOSES), ACUTE GENERALIZED

EXANTHEMATOUS PUSTULOSIS, STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL

NECROLYSIS
Drug Drug Interactions: Chronic high-dose acetaminophen (>2 g/day) may risk of
bleeding with warfarin (INR should not exceed 4), Hepatotoxicity is additive with other
hepatotoxic substances, Concurrent use of isoniazid, rifampin, rifabutin, phenytoin,
barbiturates, and carbamazepine may the risk of acetaminophen-induced liver damage
(limit self-medication); these agents will also therapeutic effects of acetaminophen,
Concurrent use of NSAIDs may the risk of adverse renal effects (avoid chronic
concurrent use), Propranolol metabolism and may effects, May effects of
lamotrigine and zidovudine.

Acetaminophen Route/Dosage:

Children 12 yr should not receive >5 PO

or rectal doses/24 hr without notifying physician or other health care professional. No
dosage adjustment needed when converting between IV and PO acetaminophen in adults
and children 50 kg

PO: (Adults and Children >12 yr): 325650 mg q 6 hr or 1 g 34 times daily

or 1300 mg q 8 hr (not to exceed 3 g or 2 g/24 hr in patients with hepatic/renal
impairment).
PO: (Children 112 yr): 1015 mg/kg/dose q 6 hr as needed (not to exceed 5
doses/24 hr).
PO: Infants 1015 mg/kg/dose q 6 hr as needed (not to exceed 5 doses/24 hr).
PO: Neonates 1015 mg/kg/dose q 68 hr as needed.

IV: (Adults and Children 13 yr and 50 kg): 1000 mg q 6 hr or 650 mg q

4 hr (not to exceed 1000 mg/dose, 4 g/day, and less than 4 hr dosing interval).
IV: (Adults and Children 13 yr and <50 kg): 15 mg/kg q 6 hr or 12.5
mg/kg q 4 hr (not to exceed 15 mg/kg/dose, 75 mg/kg/day, and less than 4 hr
dosing interval).
IV: (Children 212 yr): 15 mg/kg q 6 hr or 12.5 mg/kg q 4 hr (not to exceed 15
mg/kg/dose, 75 mg/kg/day, and less than 4 hr dosing interval).
IV: (Infants and Children <2yr): 7.515 mg/kg/dose q 6 hr (not to exceed 60
mg/kg/day).
Rect: (Adults and Children >12 yr): 325650 mg q 46 hr as needed or 1 g
34 times/day (not to exceed 4 g/24 hr).
Rect: (Children 112 yr): 1020 mg/kg/dose q 46 hr as needed.
Rect: Infants 1020 mg/kg/dose q 46 hr as needed.
Rect: Neonates 1015 mg/kg/dose q 68 hr as needed.
Toxicity Overdose: If overdose occurs, acetylcysteine (Acetadote) is the
antidote.

Ibuprofen antipyretics/nonopioid analgesics/NSAID -Pregnancy Cat.

C&D
Indications: PO, IV: Mild to Mod. Pain, Fever, PO:Treatment of inflammatory disorders
(incl. Juvenile RA), dysmenorrhea, IV: Moderate to severe pain with opioid analgesics.

Closure of a clinically significant PDA in neonates weighing 5001500 g and 32 weeks

gestational age (ibuprofen lysine only)
Action: Inhibits prostaglandin synthesis.
Contraindicated In: Hypersensitivity, Active GI/ulcer bleed, Chewable tablets contain
aspartame and should not be used in patients with phenylketonuria, Preterm neonates
with untreated infection, congenital heart disease where patency of PDA is necessary for
pulmonary or systemic blood flow, bleeding, thrombocytopenia, coagulation defects,
necrotizing enterocolitis, significant renal dysfunction
Use Cautiously in: Renal or hepatic disease, dehydration, or patients on nephrotoxic
drugs (may risk of renal toxicity), Aspirin triad patients (asthma, nasal polyps, and
aspirin intolerance); can cause fatal anaphylactoid reactions, Coagulation disorders,
Safety not established for infants <6 mo (oral) and children <17 yr (IV Caldolor);
Ibuprofen lysine: Hyperbilirubinemia in neonates (may displace bilirubin from albuminbinding sites)
Adverse Reactions/Side Effects: Headache, dyspepsia, nausea, constipation, vomiting,
GI BLEEDING, HEPATITIS, EXFOLIATIVE DERMATITIS, STEVENS-JOHNSON SYNDROME, TOXIC
EPIDERMAL NECROLYSIS, ANAPHYLAXIS
Drug Drug Interactions: risk of nephrotoxicity with cyclosporine, risk of adverse
hematologic reactions with antineoplastics or radiation therapy, risk of bleeding with
cefotetan, cefoperazone, corticosteroids, valproic acid, thrombolytics, warfarin, and drugs

affecting platelet function including clopidogrel, ticlopidine, abciximab, eptifibatide, or

tirofiban.

Ibuprofen Route/Dosage:
PO: (Children 6 mo12 yr): Anti-inflammatory3050
mg/kg/day in 34 divided doses (maximum dose: 2.4 g/day).
Antipyretic5 mg/kg for temperature <102.5F (39.17C) or 10
mg/kg for higher temperatures (not to exceed 40 mg/kg/day);
may be repeated q 46 hr. Cystic fibrosis (unlabeled)2030
mg/kg/day divided twice daily.
PO:
hr.
PO:
PO:
PO:
PO:
PO:
PO:
PO:

(Infants and Children): Analgesic410 mg/kg/dose q 68

(Children 11 yr/7295 lb): 300 mg q 68 hr.
(Children 910 yr/6071 lb): 250 mg q 68 hr.
(Children 68 yr/4859 lb): 200 mg q 68 hr.
(Children 45 yr/3647 lb): 150 mg q 68 hr.
(Children 23 yr/2435 lb): 100 mg q 68 hr.
(Children 1223 mo/1823 lb): 75 mg q 68 hr.
(Infants 611 mo/1217 lb): 50 mg q 68 hr.

IV: (Neonates Gestational age 32 weeks, 5001500 g): 10

mg/kg followed by two doses of 5 mg/kg at 24 and 48 hr after initial
dose

Albuterol bronchodilator/andrenergic - Pregnancy Category C

Indications: Used as a bronchodilator to control and prevent reversible airway
obstruction caused by asthma or COPD, Inhaln: Used as a quick-relief agent for acute
bronchospasm and for prevention of exercise-induced bronchospasm, PO: Used as a longterm control agent in patients with chronic/persistent bronchospasm.
Action: Binds to beta2-adrenergic receptors in airway smooth muscle, Relaxation of
airway smooth muscle with subsequent bronchodilation.
Contraindicated In: Hypersensitivity to adrenergic amines.
Use Cautiously In: Cardiac disease, Hypertension, Hyperthyroidism, Diabetes, Seizure
disorders, Safety not established for children <2 yr.
Adverse Reactions/Side Effects: nervousness, restlessness, tremor, insomnia (Pedi:
occurs more frequently in young children than adults), hyperactivity in children, chest
pain, palpitations

Drug Drug Interactions: Concurrent use with other adrenergic agents will have
adrenergic side effects, use with MAO inhibitors may lead to hypertensive crisis,
Cardiovascular effects are potentiated in patients receiving tricyclic antidepressants
Use spacer for children < 8 yr of age, Caution adolescents and their parents about
overuse of inhalers, which can cause heart damage and life-threatening arrhythmias.

Albuterol Route/Dosage:
PO: (Adults and Children 12 yr): 24 mg 34 times daily (not to exceed 32 mg/day)
or 48 mg of extended-release tablets twice daily.
PO: (Children 612 yr): 2 mg 34 times daily or 0.30.6 mg/kg/day as extended-release
tablets divided twice daily; may be carefully as needed (not to exceed 8 mg/day).
PO: (Children 26 yr): 0.1 mg/kg 3 times daily (not to exceed 2 mg 3 times daily
initially); may be carefully to 0.2 mg/kg 3 times daily (not to exceed 4 mg 3 times
daily).
Inhaln: (Adults and Children 4 yr): Via metered-dose inhaler2 inhalations q 46 hr
or 2 inhalations 15 min before exercise (90 mcg/spray); some patients may respond to 1
inhalation. NIH Guidelines for acute asthma exacerbation: Children48 puffs q 20 min for
3 doses then q 14 hr; Adults48 puffs q 20 min for up to 4 hr then q 14 hr prn.

Inhaln: (Adults and Children >12 yr): NIH Guidelines for acute asthma exacerbation
via nebulization or IPPB2.55 mg q 20 min for 3 doses then 2.510 mg q 14 hr prn;
Continuous nebulization1015 mg/hr.
Inhaln: (Children 212 yr): NIH Guidelines for acute asthma exacerbation via
nebulization or IPPB0.15 mg/kg/dose (minimum dose 2.5 mg) q 20 min for 3 doses then
0.150.3 mg/kg (not to exceed 10 mg) q 14 hr prn or 1.25 mg 34 times daily for children
1015 kg or 2.5 mg 34 times daily for children >15 kg; Continuous nebulization0.53
mg/kg/hr.
Inhaln: Neonates 1.25 mg/dose q 8 hr via nebulization or 12 puffs via MDI into the
ventilator circuit q 6 hrs.

Prelone/Orapred/prednisolone - anti-inflammatories
(steroidal) (intermediate-acting)- Pregnancy Category C
Indications: Used systemically and locally in a wide variety of chronic diseases
including: Inflammatory, Allergic, Hematologic, Neoplastic, Autoimmune
disorders; Suitable for alternate-day dosing in the management of chronic
illness; Replacement therapy in adrenal insufficiency
Action: In pharmacologic doses, suppresses inflammation and the normal
immune response, has numerous intense metabolic effects, Suppresses adrenal
function at chronic doses of 5 mg/day, Has minimal mineralocorticoid activity.

Contraindicated In: Active untreated infections (may be used in patients

being treated for tuberculous meningitis)
Use Cautiously In: Chronic use will result in growth; use lowest possible
dose for shortest period of time, Neonates (oral solution and syrup contains
benzoic acid, a metabolite of benzyl alcohol, which can cause potentially fatal
gasping syndrome)
Adverse Reactions/Side Effects: depression, euphoria, intracranial
pressure (children only), hypertension, acne, wound healing, ecchymoses,
fragility, hirsutism, petechiae, adrenal suppression, muscle wasting,
osteoporosis,cushingoid appearance, THROMBOEMBOLISM

Prelone/Orapred/prednisolone
Drug Drug Interactions: Additive hypokalemia with thiazide and loop
diuretics, amphotericin B, piperacillin, or ticarcillin, May requirement for
insulin or oral hypoglycemic agents, Phenytoin, phenobarbital, and rifampin
stimulate metabolism; may effectiveness, Oral contraceptives may
metabolism, risk of adverse GI effects with NSAIDs (including aspirin ), At
chronic doses that suppress adrenal function, may antibody response to and
risk of adverse reactions from live-virus vaccines, May risk of tendon
rupture from fluoroquinolones.

Route/Dosage:
PO: Children Antiinflammatory/Immunosuppressive0.12
mg/kg/day in 14 divided doses. Nephrotic syndrome2
mg/kg/day (60 mg/m2/day) in 13 divided doses daily (maximum
dose: 80 mg/day) until urine is protein free for 46 weeks,
followed by 2 mg/kg/dose (40 mg/m2/dose) every other day in
the morning, gradually taper off over 46 weeks. Asthma
exacerbations1 mg/kg q 6 hr for 48 hr, then 12 mg/kg/day
(maximum: 60 mg/day) divided twice daily.
Children should have periodic evaluations of growth.
Atrovent/ipratropium Bronchodilator Pregnancy Category C
Indications:Inhaln: Maintenance therapy of reversible airway obstruction due
to COPD, including chronic bronchitis and emphysema; Intranasal: Rhinorrhea
associated with allergic and nonallergic perennial rhinitis (0.03% solution) or the
common cold (0.06% solution).

Action: Inhaln: Inhibits cholinergic receptors in bronchial smooth muscle,

resulting in decreased concentrations of cyclic guanosine monophosphate
(cGMP). Decreased levels of cGMP produce local bronchodilation; Intranasal:
Local application inhibits secretions from glands lining the nasal mucosa.
Contraindicated In: Hypersensitivity to ipratropium, atropine, belladonna
alkaloids, or bromide; Avoid use during acute bronchospasm;
Use Cautiously In: Patients with bladder neck obstruction, prostatic
hyperplasia, glaucoma, or urinary retention
Adverse Reactions/Side Effects: dizziness, cough, GI irritation, nausea
Drug Drug Interactions: anticholinergic effects with other drugs having
anticholinergic properties (antihistamines, phenothiazines, disopyramide)

Atrovent/ipratropium Route/Dosage:
Inhaln: (Adults and Children >12 yr): Metered-dose inhaler (nonacute)2
inhalations 4 times daily (not to exceed 12 inhalations/24 hr or more frequently
than q 4 hr). Acute exacerbations48 puffs using a spacer device as needed.
Via nebulization (nonacute)500 mcg 34 times daily. Via nebulization (acute
exacerbations)500 mcg q 30 min for 3 doses then q 24 hr as needed.

Inhaln: (Children 512 yr): Metered-dose inhaler (nonacute)12 inhalations

q 6 hr as needed (not to exceed 12 inhalations/24 hr). Acute exacerbations48
puffs as needed Via nebulization (nonacute)250500 mcg 4 times daily given q
6 hr. Acute exacerbations250 mcg q 20 min for 3 doses then q 24 hr as
needed.
Inhaln: Infants Nebulization125250 mcg 3 times a day.
Inhaln: Neonates Nebulization25 mcg/kg/dose 3 times a day.
Intranasal: (Adults and Children > 6 yr): 0.03% solution2 sprays in each
nostril 23 times daily (21 mcg/spray).
Inhaln: (Adults and Children > 5 yr): 0.06% solution2 sprays in each nostril
34 times daily (42 mcg/spray).

Solumedrol/methylprednisolone - anti-inflammatories
(steroidal), immunosuppressants Pregnancy Category C
Indications: Used systemically and locally in a wide variety of chronic diseases including:
Inflammatory, Allergic, Hematologic, Neoplastic, Autoimmune disorders,
Immunosuppresant; May be suitable for alternate-day dosing in the management of
chronic illness; Replacement therapy in adrenal insufficiency

Action: Suppresses inflammation and the normal immune response, has numerous
intense metabolic effects; Suppresses adrenal function at chronic doses of 4 mg/day; Has
negligible mineralocorticoid activity.
Contraindicated In: Active untreated infections (may be used in patients being treated
for tuberculous meningitis); Known alcohol, bisulfite, or tartrazine hypersensitivity or
intolerance (some products contain these and should be avoided in susceptible patients),
Administration of live virus vaccines
Use Cautiously In: Chronic use will result in growth; use lowest possible dose for
shortest period of time; Neonates (avoid use of benzyl alcohol containing injectable
preparations, use preservative-free formulations).
Adverse Reactions/Side Effects: depression, euphoria, intracranial pressure
(children only), hypertension, anorexia, nausea, acne, wound healing, ecchymoses,
fragility, hirsutism, petechiae, adrenal suppression, muscle wasting, osteoporosis,
cushingoid appearance, THROMBOEMBOLISM

Solumedrol/methylprednisolone
Drug Drug Interactions: Additive hypokalemia with thiazide and loop
diuretics, amphotericin B, piperacillin, or ticarcillin, May requirement

for insulin or oral hypoglycemic agents, Phenytoin, phenobarbital, and

rifampin stimulate metabolism; may effectiveness, Oral
contraceptives may metabolism, risk of adverse GI effects with
NSAIDs (including aspirin ), At chronic doses that suppress adrenal
function, may antibody response to and risk of adverse reactions
from live-virus vaccines, May risk of tendon rupture from
fluoroquinolones.
Route/Dosage:Children should have periodic evaluations of growth.
PO: Children Anti-inflammatory/Immunosuppressive 0.51.7 mg/kg/day
or 525 mg/m2/day in divided doses q 612 hr. Asthma exacerbations1
mg/kg q 6 hr for 48 hr, then 12 mg/kg/day (maximum: 60 mg/day) divided
twice daily.
IM: IV: Children Anti-inflammatory/Immunosuppressive 0.51.7
mg/kg/day or 525 mg/m2/day in divided doses q 612 hrAcute spinal cord
injury: methylprednisolone sodium succinate30 mg/kg over 15 min initially,
then 45 min later initiate continuous infusion of 5.4 mg/kg/hr for 23 hr
(unlabeled). Stausasthmaticus2 mg/kg/dose, then 0.51 mg/kg/dose q 6 hr.
Lupus nephritis30 mg/kg IV every other day for 6 doses.

ranitidine/Zantac antiulcer agent Pregnancy Cat. B

Indications: Treatment of/maintenance therapy for erosive esophagitis;
Treatment of (GERD); Heartburn, acid indigestion, and sour stomach
(OTC use); IV: Prevention and treatment of stress-induced upper GI
bleeding in critically ill patients
Action: Inhibits the action of histamine at the H2-receptor site located
primarily in gastric parietal cells, resulting in inhibition of gastric acid
secretion.
Contraindicated In: Hypersensitivity; syrup contains alcohol and
should be avoided in patients with known intolerance
Use Cautiously In:Phenylketonuric patients; renal & hepatic
impairment; Acute porphyria
Adverse Reactions/Side Effects: confusion, ARRHYTHMIAS,
AGRANULOCYTOSIS, APLASTIC ANEMIA

Drug Drug Interactions: May absorption of ketoconazole,

itraconazole, atazanavir, delavirdine, and geftinib; May absorption of
triazolam and glipizide; May procainamide levels; May the effects of
warfarin.

rantidine/Zantac - Route/Dosage:
PO: (Children 1 mo-16 yr): Treatment of active ulcers24
mg/kg/day divided twice daily, maximum 300 mg/day. GERD and
Erosive esophagitis410 mg/kg/day divided twice daily, maximum
300 mg/day for GERD, 600 mg/day for erosive esophagitis.
PO: Neonates 2 mg/kg/day divided q 12 hr.

IV: IM: (Children 1 mo16 yr): Treatment of active ulcers

24 mg/kg/day divided q 68 hr, maximum 200 mg/day.
Continuous infusion1 mg/kg/dose followed by 0.080.17
mg/kg/hr.

IV: Neonates 1.5 mg/kg/dose load, then in 12 hr start

maintenance of 1.52 mg/kg/day divided q 12 hrContinuous IV
infusion1.5 mg/kg/dose load followed by 0.040.08 mg/kg/hr
infusion.

Prostaglandin E1/alprostadil - ductusarteriosus patency adjuncts

Pregnancy Category: UNK

Indications:IV: Temporary maintenance of patent

ductusarteriosus in neonates who depend on patency until
surgery can be performed.
Action:IV: Directly relaxes smooth muscle of the
ductusarteriosus.
Contraindicated In:Respiratory distress syndrome.

Use Cautiously In:Neonates with bleeding tendencies.

Adverse Reactions/Side Effects: flushing, fever, SEIZURES,
APNEA
Drug Drug Interactions: Risk of bleeding may be by
concurrent use of anticoagulants, some cephalosporins, or
antiplatelet agents. Concurrent use of epinephrine, or
phenylephrine may effectiveness of alprostadil. Concurrent
use with other vasodilators risk of hypotension.

Prostaglandin E1/alprostadil Route/Dosage:

IV: IA: Neonates 0.050.1 mcg/kg/min initially; may be
increased up to 0.4 mcg/kg/min until satisfactory response, then
decrease to maintenance dose by halving infusion rate. In some
patients lower doses (0.01 mcg/kg/min) may be sufficient.

Toxicity Overdose:
Symptoms of overdose include flushing, hypotension, bradycardia,
fever,

and decreased respiratory rate or apnea. Infusion should be

discontinued ifapnea or bradycardia occurs.

Digoxin antiarrhythmics, inotropics / digitalis glycosides Pregnancy

Cat. C
Indications: Heart failure, Atrial fibrillation and atrial flutter (slows ventricular rate),
Paroxysmal atrial tachycardia.
Action: Increases the force of myocardial contraction, Prolongs refractory period of the AV
node, Decreases conduction through the SA and AV nodes.
Contraindicated In: Hypersensitivity; Uncontrolled ventricular arrhythmias; AV block
(in absence of pacemaker); Idiopathic hypertrophic subaortic stenosis; Constrictive
pericarditis; Known alcohol intolerance (elixir only).

Use Cautiously In: Hypokalemia ( risk of digoxin toxicity); Hypercalcemia ( risk of

toxicity, especially with mild hypokalemia); Hypomagnesemia ( risk of digoxin toxicity);
Diuretic use (may cause electrolyte abnormalities including hypokalemia and
hypomagnesemia); Hypothyroidism; MI; Renal impairment (dose required); Obesity
(dose should be based on ideal body weight)
Adverse Reactions/Side Effects: Fatigue, bradycardia, anorexia, nausea, vomiting,
ARRHYTHMIAS
Drug Drug Interactions: Thiazide and loop diuretics, piperacillin, ticarcillin,
amphotericin B, corticosteroids, and excessive use of laxatives may cause hypokalemia
which may risk of toxicity; Amiodarone, some benzodiazepines, cyclosporine,
diphenoxylate, indomethacin, itraconazole, propafenone, quinidine, quinine,
spironolactone, and verapamil may levels and lead to toxicity (serum level
monitoring/dose may be required); Levels may be by some antineoplastics
(bleomycin, carmustine, cyclophosphamide, cytarabine, doxorubicin, methotrexate,
procarbazine, vincristine), activated charcoal, cholestyramine, colestipol, kaolin/pectin,
metoclopramide, penicillamine, rifampin, or sulfasalazine.
Route/Dosage:
IV: (Children >10 yr): Digitalizing dose812 mcg/kg given as 50% of the dose initially
and one quarter of the initial dose in each of 2 subsequent doses at 6-12 hr intervals.
IV: (Children 510 yr): Digitalizing dose1530 mcg/kg given as 50% of the dose initially
and one quarter of the initial dose in each of 2 subsequent doses at 6-12 hr intervals.
Digoxin
IV: (Children 25 yr): Digitalizing dose2535 mcg/kg given as 50% of the dose initially
and one quarter of the initial dose in each of 2 subsequent doses at 6-12 hr intervals.
IV: (Children 124 mo): Digitalizing dose3050 mcg/kg given as 50% of the dose
initially and one quarter of the initial dose in each of 2 subsequent doses at 6-12 hr
intervals.

IV: (Infants full term): 2030 mcg/kg given as 50% of the dose initially and one
quarter of the initial dose in each of 2 subsequent doses at 6-12 hr intervals.
IV: (Infants premature): Digitalizing dose1525 mcg/kg given as 50% of the dose
initially and one quarter of the initial dose in each of 2 subsequent doses at 6-12 hr
intervals.
PO: (Children >10 yr): Digitalizing dose1015 mcg/kg given as 50% of the dose
initially and one quarter of the initial dose in each of 2 subsequent doses at 6-12 hr
intervals. Maintenance dose2.55 mcg/kg given daily as a single dose.
PO: (Children 510 yr): Digitalizing dose2035 mcg/kg given as 50% of the dose
initially and one quarter of the initial dose in each of 2 subsequent doses at 6-12 hr
intervals. Maintenance dose510 mcg/kg given daily in 2 divided doses.
PO: (Children 25 yr): Digitalizing dose3040 mcg/kg given as 50% of the dose initially
and one quarter of the initial dose in each of 2 subsequent doses at 6-12 hr intervals.
Maintenance dose7.510 mcg/kg given daily in 2 divided doses.
PO: (Children 124 mo): Digitalizing dose3560 mcg/kg given as 50% of the dose
initially and one quarter of the initial dose in each of 2 subsequent doses at 6-12 hr
intervals. Maintenance dose1015 mcg/kg given daily in 2 divided doses.
PO: (Infants full term): Digitalizing dose2535 mcg/kg given as 50% of the dose
initially and one quarter of the initial dose in each of 2 subsequent doses at 6-12 hr
intervals. Maintenance dose610 mcg/kg given daily in 2 divided doses.
PO: (Infants premature): Digitalizing dose2030 mcg/kg given as 50% of the dose
initially and one quarter of the initial dose in each of 2 subsequent doses at 6-12 hr
intervals. Maintenance dose57.5 mcg/kg given daily in 2 divided doses.

Regular Insulin/HumuLIN R, NovoLIN Rantidiabetic, hormone

Pregnancy Cat. B

Indications:Control of hyperglycemia in patients with diabetes

mellitus, Concentrated regular insulin U-500: Only for use in
patients with insulin requirements >200 units/day
Action: Lowers blood glucose by: stimulating glucose uptake in
skeletal muscle and fat, inhibiting hepatic glucose production. Other
actions of insulin:inhibition of lipolysis and proteolysis, enhanced
protein synthesis.
Contraindicated In: Hypoglycemia; Allergy or hypersensitivity to a
particular type of insulin, preservatives, or other additives.
Use Cautiously In:Stress or infectionmay temporarily insulin
requirements; Renal/hepatic impairmentmay insulin requirements;
Concomitant use with pioglitazone or rosiglitazone ( risk of fluid
retention and worsening HF)
Adverse Reactions/Side Effects:HYPOGLYCEMIA, ANAPHYLAXIS
Drug Drug Interactions: Beta blockers, clonidine, and reserpine may mask some of the
signs and symptoms of hypoglycemia; Corticosteroids, thyroid supplements, estrogens,
isoniazid, niacin, phenothiazines, and rifampin may insulin requirements; Alcohol, ACE
inhibitors, MAO inhibitors, octreotide, oral hypoglycemic agents, and salicylates, may

insulin requirements; Concurrent use with pioglitazone or rosiglitazone may risk of fluid
retention and worsening HF

Regular Insulin/HumuLIN R, NovoLIN R Route/Dosage:

Dose depends on blood glucose, response, and many other factors
IV: Children Loading dose-0.1 unit/kg, then maintenance continuous
infusion 0.050.2 unit/kg/hr, titrate to optimal rate of decrease of serum
glucose of 80100 mg/dL/hr.
Maintenance Therapy
SC: (Adults and Children) 0.51 unit/kg/day in divided doses.
Adolescents during rapid growth0.81.2 unit/kg/day in divided doses.
Treatment of Hyperkalemia
SC: IV: (Adults and Children) dextrose 0.51 g/kg combined with
insulin 1 unit for every 45 g dextrose given.

Furosemide/Lasix diuretic/loop diuretic Pregnancy Category C

Indications: Edema due to heart failure, hepatic impairment or renal
disease; Hypertension.
Action: Inhibits the reabsorption of sodium and chloride from the loop
of Henle and distal renal tubule; Increases renal excretion of water,
sodium, chloride, magnesium, potassium, and calcium; Effectiveness
persists in impaired renal function.
Contraindicated In: Hypersensitivity; Cross-sensitivity with thiazides
and sulfonamides may occur; Hepatic coma or anuria; Some liquid
products may contain alcohol, avoid in patients with alcohol intolerance.
Use Cautiously In: Severe liver disease (may precipitate hepatic
coma; concurrent use with potassium-sparing diuretics may be
necessary); Electrolyte depletion; Diabetes mellitus; Hypoproteinemia
( risk of ototoxicity); Severe renal impairment ( risk of ototoxicity);
risk for renal calculi and patent ductusarteriosis in premature neonates;

Adverse Reactions/Side Effects: dehydration, hypocalcemia,

hypochloremia, hypokalemia, hypomagnesemia, hyponatremia,
hypovolemia, metabolic alkalosis, ERYTHEMA MULTIFORME, STEVENSJOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS, APLASTIC
ANEMIA, AGRANULOCYTOSIS
Furosemide/Lasix
Drug Drug Interactions: risk of hypotension with
antihypertensives, nitrates, or acute ingestion of alcohol; risk of
hypokalemia with other diuretics, amphotericin B, stimulant laxatives,
and corticosteroids; Hypokalemia may risk of digoxin toxicity and
risk of arrhythmia in patients taking drugs that prolong the QT interval,
lithium excretion, may cause lithium toxicity, risk of ototoxicity with
aminoglycosides or cisplatin, risk of nephrotoxicity with cisplatin,
NSAIDS effects of furosemide.
Route/Dosage:
PO: (Children > 1 mo): 2 mg/kg as a single dose; may be by 12
mg/kg q 68 hr
(maximum dose = 6 mg/kg).
PO: Neonates 14 mg/kg/dose 12 times/day.

IM: IV: Children 12 mg/kg/dose q 612 hr Continuous infusion0.05

mg/kg/hr, titrate to clinical effect.
IM: IV: Neonates 12 mg/kg/dose q 1224 hr.

Dilantin/phenytoin antiarrhythmics/anticonvulsants
Pregnancy Category D
Indications: Treatment/prevention of tonic-clonic (grand mal) seizures and
complex partial seizures.
Action: Limits seizure propagation by altering ion transport; May also decrease
synaptic transmission; Antiarrhythmic properties as a result of shortening the
action potential and decreasing automaticity.
Contraindicated In: Hypersensitivity; Hypersensitivity to propylene glycol
(phenytoin injection only); Alcohol intolerance (phenytoin injection and liquid
only); Sinus bradycardia, sinoatrial block, 2nd- or 3rd-degree heart block, or
Stokes-Adams syndrome (phenytoin injection only); Concurrent use of
delavirdine
Use Cautiously In: All patients (may risk of suicidal thoughts/behaviors);

Hepatic or renal disease ( risk of adverse reactions; dose reduction

recommended for hepatic impairment); Patients with severe cardiac or
respiratory disease (use of IV phenytoin may result in an risk of serious
adverse reactions); Suspension contains sodium benzoate, a metabolite of
benzyl alcohol that can cause potentially fatal gasping syndrome in neonates;
Adverse Reactions/Side Effects: ataxia, diplopia, nystagmus, hypotension,
gingival hyperplasia, nausea, rash, SUICIDAL THOUGHTS, STEVENS-JOHNSON
SYNDROME, TOXIC EPIDERMAL NECROLYSIS, AGRANULOCYTOSIS, APLASTIC
ANEMIA

Dilantin/phenytoin
Drug Drug Interactions: May the effects of amiodarone, atorvastatin,
benzodiazepines, carbamazepine, corticosteroids, cyclosporine, digoxin,
doxycycline, efavirenz, estrogens, fluvastatin, indinavir, lopinavir/ritonavir,
methadone, mexiletine, nelfinavir, nisoldipine, oral contraceptives, paroxetine,
quinidine, rifampin, ritonavir, saquinavir, simvastatin, tacrolimus, theophylline,
topiramate, and warfarin; IV phenytoin and dopamine may cause additive
hypotension; Additive CNS depression with other CNS depressants, including
alcohol, antihistamines, antidepressants, opioids, and sedative/hypnotics.
Route/Dosage:
PO: (Children 1016 yr): 67 mg/kg/day in 23 divided doses.
PO: (Children 79 yr): 78 mg/kg/day in 23 divided doses.

PO: (Children 46 yr): 7.59 mg/kg/day in 23 divided doses.

PO: (Children 0.53 yr): 810 mg/kg/day in 23 divided doses.
PO: (Neonates up to 6 mo): 58 mg/kg/day in 2 divided doses, may require q
8 hr dosing.
IV: Children Status epilepticus loading dose1520 mg/kg at 13
mg/kg/min. Maintenance dosesame as PO dosing above.
Antiarrhythmic
IV: Children 1.25 mg/kg q 5 min, may repeat up to total loading dose of 15
mg/kg. Maintenance dose510 mg/kg/day in 23 divided doses IV or PO.

DDAVP/desmopressin hormones Pregnancy Category B

Indications:PO: SC: IV: Intranasal: Treatment of central diabetes
insipidus caused by a deficiency of vasopressin.IV: Intranasal:
Controls bleeding in certain types of hemophilia and von Willebrand's
disease.PO: Primary nocturnal enuresis.
Action:An analogue of naturally occurring vasopressin (antidiuretic
hormone). Primary action is enhanced reabsorption of water in the
kidneys.

Contraindicated In: Hypersensitivity; Hypersensitivity to

chlorobutanol; Patients with severe type I, type IIB or platelet-type
(pseudo) von Willebrand's disease, hemophilia A with factor VIII levels
<5% or hemophilia B; Renal impairment (CCr< 50 mL/min);
Hyponatremia.
Use Cautiously In: Angina pectoris; Hypertension; Patients at risk for
hyponatremia
Adverse Reactions/Side Effects: drowsiness, headache, SEIZURES
Drug Drug Interactions:Chlorpropamide, clofibrate, chlorpromazine,
lamotrigine, SSRIs or carbamazepine may enhance the antidiuretic
response to desmopressin; Demeclocycline, lithium, or norepinephrine
may diminish the antidiuretic response to desmopressin; Large doses
may enhance the effects of vasopressors.
DDAVP/desmopressin Route/Dosage:
Primary Nocturnal Enuresis
PO: (Adults and Children 6 yr): 0.2 mg at bedtime; may be titrated
up to 0.6 mg at bedtime to achieve desired response.
Diabetes Insipidus

PO: (Adults and Children) 0.05 mg twice daily; adjusted as needed

(usual range: 0.11.2 mg/day for adults or 0.10.8 mg/day for children
in 23 divided doses).
Intranasal: (Adults and Children 12 yr): DDAVP540 mcg
(0.0.050.4 mL)in 13 divided doses.
Intranasal: (Children 3 mo12 yr): DDAVP530 mcg (0.050.3 mL)
in 12 divided doses.
SC: IV: (Adults and Children12 yr):24 mcg/day in 2 divided doses.
SC: IV: (Children < 12 yr): 0.11 mcg/day in 12 divided doses.
Hemophilia A/von Willebrand's disease
Intranasal: (Adults and Children >50 kg):Stimate1 spray (150
mcg) in each nostril.
Intranasal: (Adults and Children 50 kg):Stimate1 spray (150
mcg) in one nostril.
IV: (Adults and Children >3 mo): 0.3 mcg/kg, repeated as needed.

Somatotropin hormones (growth) Pregnancy Category B & C

Indications: Growth failure in children due to deficiency of growth hormone;

Children with growth failure associated with Prader-Willi syndrome or Turner

syndrome; Children with short stature born small for gestational age with no
catch-up growth by age 2 yr.; Children with idiopathic short stature.
Action: Produce growth (skeletal and cellular); Metabolic actions include:
Increased protein synthesis, Increased carbohydrate metabolism, Lipid
mobilization, Retention of sodium, phosphorus, and potassium; Growth hormone
enhances GI tract mucosal transport of water, electrolytes and nutrients.
Contraindicated In: Closure of epiphyses; Active malignancy; Hypersensitivity
to growth hormone or any of the excipients; Acute critical illness (therapy
should not be initiated) or respiratory failure; Diabetic retinopathy; Prader-Willi
syndrome with severe obesity, upper airway obstruction, sleep apnea, or severe
respiratory impairment ( risk of fatal complications).
Use Cautiously In: Growth hormone deficiency due to intracranial lesion;
Coexisting adrenocorticotropic hormone (ACTH) deficiency; Diabetes (may
cause insulin resistance); Scoliosis (may cause progression); Turner syndrome
with otitis media or cardiovascular disorders (may cause progression)
Adverse Reactions/Side Effects: hypothyroidism, eosinophilia, PANCREATITIS

Somatotropin

Drug Drug Interactions:In patients requiring

glucocorticoid/corticosteroid replacement or supplementation careful
titration is required as some metabolic pathways are inhibited by
somatropin; May alter clearance of compounds known to be
metabolized by CYP450 liver enzymes including corticosteroids,
steroidal hormones, anticonvulsants and cyclosporine; Estrogen may
requirements for somatropin; May alter response to insulin and/or oral
hypoglycemic agents, dose adjustment may be necessary.
Route/Dosage:

Pediatric Growth Hormone Deficiency

SC: Children 0.160.24 mg/kg/wk divided into equal doses given 67 times per
wk.
Growth Failure Associated with Prader-Willi or Turner Syndrome
SC: Children Prader-Willi syndrome0.24 mg/kg/wk divided into equal doses
given 67 times per wk; Turner syndrome0.33 mg/kg/wk divided into equal
doses given 67 times per wk.
Short Stature Born Small for Gestational Age
SC: Children up to 0.48 mg/kg/wk divided into equal doses given 67 times per
wk.
Idiopathic Short Stature

SC: Children Up to 0.47 mg/kg/wk divided into equal doses given 67 times per
wk.

succimer/Chemet antidote/chelating agent Pregnancy

Category C
Indications: Treatment of lead poisoning in children with blood
lead levels >45 mcg/dL.
Action: Forms a water-soluble compound with lead, allowing
urinary elimination of excessive amounts of lead.
Contraindicated In: Hypersensitivity or allergy to succimer;
Lactation (should be discouraged during succimer therapy).
Use Cautiously In: Renal failure (chelates are not dialyzable);
Children (increased risk of bradyarrhythmias); Children with
skeletal muscle myopathy (more prone to rare, but serious,
adverse reactions); Pregnancy or children <1 yr (safety not
established).

Adverse Reactions/Side Effects: nausea, vomiting

Drug Drug Interactions: Not recommended for use with other
chelating agents.
succimer/Chemet
Route/Dosage:
PO: (Adults and Children) 10 mg/kg (350 mg/m2) q 8 hr for 5 days,
then reduce to 10 mg/kg (350 mg/m2) q 12 hr for 2 more wk. Repeated
courses should follow a 2-wk rest period.
If patient is unable to swallow the capsule, open capsule and sprinkle
medicated beads on a small amount of soft food or place in a spoon and
follow with a fruit drink.

diazepam Rectal Gel/Valiumantianxiety

agents/anticonvulsants/sedative/hypnotics/skeletal muscle relaxants
(centrally acting) benzodiazepine Pregnancy Category D
Indications for Rectal Gel: Adjunct in the management of: Treatment of
status epilepticus/uncontrolled seizures (injection); Skeletal muscle relaxant
Action: Depresses the CNS, probably by potentiating GABA, an inhibitory
neurotransmitter; Produces skeletal muscle relaxation by inhibiting spinal
polysynaptic afferent pathways; Has anticonvulsant properties due to enhanced
presynaptic inhibition. Absorption: Well absorbed (90%) from rectal mucosa.
Contraindicated In: Hypersensitivity; Cross-sensitivity with other
benzodiazepines may occur; Comatose patients; Myasthenia gravis; Severe
pulmonary impairment; Sleep apnea; Severe hepatic dysfunction; Uncontrolled
severe pain; Children <6 mo (for oral; safety not established)

Use Cautiously In: Severe renal impairment; History of suicide attempt or

drug dependence; Debilitated patients (dose required); Patients with low
albumin;
Metabolites can accumulate in neonates. Injection contains benzyl alcohol which
can cause potentially fatal gasping syndrome in neonates;
Adverse Reactions/Side Effects: dizziness, drowsiness, lethargy,
RESPIRATORY DEPRESSION

diazepam Rectal Gel/Valium

Drug Drug Interactions: Alcohol, antidepressants, antihistamines, and opioid

analgesicsconcurrent use results in additive CNS depression; Cimetidine,
hormonal contraceptives, disulfiram, fluoxetine, isoniazid, ketoconazole,
metoprolol, propranolol, or valproic acid may the metabolism of diazepam,
enhancing its actions; May the efficacy of levodopa; Rifampin or barbiturates
may the metabolism and effectiveness of diazepam; Sedative effects may
be by theophylline; Concurrent use of ritonavir is not recommended.
Route/Dosage:
Status Epilepticus/Acute Seizure Activity
Rect: (Adults and Children >12 yr): 0.2 mg/kg; may repeat 412 hr later.
Rect: (Children 611 yr): 0.3 mg/kg; may repeat 412 hr later.

Rect: (Children 25 yr): 0.5 mg/kg; may repeat 412 hr later.

Rect: Do not repeat Diastat rectal dose more than 5 times/mo or 1 episode
every 5 days. Round dose up to next available dose unit.
Diazepam injection has been used for rectal administration. Instill via catheter
or cannula fitted to the syringe or directly from a 1-mL syringe inserted 45 cm
into the rectum. A dilution of diazepam injection with propylene glycol
containing 1 mg/mL has also been used.
Do not dilute with other solutions, IV fluids, or medications.

hydroxyurea/Droxia/Hydrea antineoplastic Pregnancy Category D

Indications: Head and neck carcinoma; Ovarian carcinoma; Resistant
chronic myelogenous leukemia; Melanoma; Reduction of painful
crises in sickle cell anemia and decreased need for transfusions in
adult patients with a history of recurrent moderate to severe crises (at
least 3 in the preceding yr).
Action:Interferes with DNA synthesis (cell-cycle S-phasespecific); May
alter characteristics of RBCs.

Contraindicated In: Hypersensitivity; Some products contain

tartrazine (FDC yellow dye #5) and should be avoided in patients with
known hypersensitivity.
Use Cautiously In:Renal impairment; Hepatic impairment;
Myeloproliferative disorders; Active infections; bone marrow reserve;
Other chronic debilitating illness; HIV patients receiving didanosine and
stavudine ( risk of pancreatitis and hepatotoxicity)
Adverse Reactions/Side Effects:anorexia, diarrhea, nausea,
vomiting, leukopenia

hydroxyurea/Droxia/Hydrea
Drug Drug Interactions:Additive bone marrow depression with agents
that depress bone marrow, including radiation therapy; May the
antibody response to and increase the risk of adverse reactions to livevirus vaccines; risk of pancreatitis and hepatotoxicity when used with
didanosine and stavudine; avoid concurrent use.

Route/Dosage:
Sickle Cell Anemia
PO: (Adults and Children) 15 mg/kg/day as a single dose, may by
5 mg/kg/day q 12 wk up to 35 mg/kg/day.
PO: Capsules may be opened and contents mixed into a glass of water
and taken immediately if patient has difficulty swallowing. Some inert
powder may float on the surface. If powder from capsule is spilled, wipe
with a damp, disposable cloth immediately.

deferoxamine/Desferal antidote Pregnancy Category C

Indications: Acute toxic iron ingestion; Secondary iron overload
syndromes associated with multiple transfusion therapy.
Action: Chelates unbound iron, forming a water-soluble complex
(ferrioxamine) in plasma that is easily excreted by the kidneys.

Contraindicated In: Severe renal disease; Anuria

Use Cautiously In: Children <3 yr (safety not established)
Adverse Reactions/Side Effects: red urine
Drug Drug Interactions: Ascorbic acid may effectiveness of
deferoxamine but may also cardiac iron toxicity.

deferoxamine/Desferal Route/Dosage:
Acute Iron Ingestion
IM: IV: (Adults and Children 3 yr): 1 g, then 500 mg q 4 hr
for 2 doses. Additional doses of 500 mg q 412 hr may be needed
(not to exceed 6 g/24 hr).

Chronic Iron Overload

IM: IV: (Adults and Children 3 yr): 500 mg1 g daily IM;
additional doses of 2 g should be given IV for each unit of blood
transfused (not to exceed 1 g/day in absence of transfusions; 6
g/day if patient receives transfusions).
SC: (Adults and Children 3 yr): 12 g/day (2040 mg/kg/day)
infused over 824 hr.