Oxycodone

Oxycontin®, Roxicodone®

BBW: High abuse potential; controlled release only for extended chronic pain, not for PRN use; 60-80 mg tab for opioid tolerant pts; do not crush, break, or chew

Uses: Mod-severe pain, usually in combo w/ nonnarcotic analgesics

MOA: Narcotic analgesic

Dose: Adults: 5 mg po q6h prn (IR). Mod-severe chronic pain: 10-160 mg po q12h (ER). Peds 6-12 yrs: 1.25 mg po q6h prn. >12 yrs: 2.5 mg q6h prn; ↓ w/ severe liver/renal dz, elderly; w/food

Caution: B (D if prolonged use/near term), M

CI: Allergy, resp depression, acute asthma, ileus w/ microsomal morphine

Disp: IR Caps (OxyIR) 5 mg; CR Roxicodone tabs 15,30 mg; ER (Oxycontin) 10, 15, 20, 30, 40, 60, 80 mg; liq 5 mg/5 mL; soln conc 20 mg/mL

SE: ↓ BP, sedation, resp depression, dizziness, GI upset, constipation, risk of abuse

Notes: Oxycontin for chronic CA pain; do not crush/chew/cut ER product; sought after as a drug of abuse; reformulated Oxycontin is intended to prevent the opioid medication from being cut, broken, chewed, crushed, or dissolved to release more medication

Schedule: C-II 

Clonidine

Catapres®

Uses: HTN, Opioid, EtOH, & tobacco withdrawal, ADHD

MOA: Centrally acting α-adrenergic stimulant

Dose: Adults: 0.1 mg po bid, adjust daily by 0.1-0.2 mg increments (max 2.4 mg/d). Peds: 5-10 mcg/kg/day ÷ q8-12h (max 0.9 mg/d); ↓ in renal impair

Caution: C, +/-, Avoid w/ Beta Blockers, elderly, severe CV dz, renal impair; use w/ agents that affect sinus node may cause severe ↓ HR

CI: Component sensitivity

Disp: Tabs, Patch 0.1, 0.2, 0.3 mg

SE: Drowsiness, orthostatic hypotension, xerostomia, constipation, ↓ HR, dizziness

Notes: More effective for HTN is combined w/ diuretics; withdraw slowly, rebound HTN w/ abrupt D/C of doses >0.2 mg bid; ADHD use in peds needs CV assessment before starting epidural clonidine (Duraclon) use for chronic CA pain

Amitriptyline

Elavil®

BBW: Antidepressants may ↑ suicide risk; consider risks/benefits of use. Monitor pts closely.

Uses: Depression (not bipolar depression), peripheral neuropathy, chronic pain, tension HAs

MOA:TCA; ↓ reuptake of serotonin & norepinephrine by presynaptic neurons

Dose: Adults: Initial: 30-50 mg po hs; may ↑ to 300 mg hs. Peds: Not OK <12 years unless for chronic pain Initial: 0.1 mg/kg po hs, ↑ over 2-3 weeks to 0.5-2 mg/kg po hs; taper to D/C

Caution: CV dz, Szs, D, +/-, NAG, hepatic impair

CI: w/ MAOIs or w/in 14 d of use, during acute MI recovery

Disp: Tabs 10, 25, 50, 75, 100, 150 mg; Inj 10mg/mL

SE: Strong anticholinergic SEs; OD may be fatal; urine retention, sedation, ECG changes, photosens

Notes: Levels: Therapeutic: 120 to 150 ng/mL Toxic: >500 mg/mL; levels may not correlate w/ effectiveness

Allopurinol

Zyloprim®, Lopurin®, Aloprim®

Uses: Gout, Hyperuricemia of malignancy, uric acid urolithiasis

MOA: Xanthine oxidase inhib; ↓ uric acid production

Dose: Adults: PO: Initial 100 mg/d; usual 300 mg/d; max 800 mg/d; ÷ dose if >300 mg/d IV: 200-400 mg/m2/d (max 600mg/24 h); ↓ in renal impair

Caution: C, M

Disp: Tabs 100, 300 mg; Inj 500 mg/30 mL. (Aloprim)

SE: Rash, N/V, renal impair, angioedema

Notes: Aggravates acute gout; begin after acute attack resolves; IV dose of 6 mg/mL final conc as single daily inj or ÷ 6, 8, or 12 h intervals

Enalapril

Vasotec®

BBW: ACE inhib used during PRG can cause fetal injury& death

Uses: HTN, CHF, LVD, DN

MOA: ACE inhib

Dose: Adults: 2.5-40 mg/d po; 1.25 mg IV q6h. Peds: 0.05-0.08 mg/kg/d po q12-24h; ↓ w/ renal impair

Caution: C (1st trimester; D 2nd & 3rd), +, (D/C immediately w/ PRG, w/ NSAIDs, K+ supplements

CI: Bilateral RAS, angioedema

Disp: Tabs 2.5, 5, 10, 20 mg; IV 1.25 mg/mL (1.2 mL)

SE: ↓ BP w/ initial dose (especially w/ diuretics), ↑ K+, ↑ Cr, nonproductive cough, angioedema

Notes: Monitor Cr; D/C diuretic for 2-3 days prior to start

Carisoprodol

Soma®

Uses: Adjunct to sleep & physical therapy to relieve painful musculoskeletal conditions

MOA: Centrally acting muscle relaxant

Dose: 350 mg

SE: CNS depression, drowsiness, dizziness, HA, tachycardia

Notes: Avoid EtOH & other CNS depressants; available in combo w/ ASA or Codeine

Acetaminophen/Codeine

Tylenol® with Codeine #2, #3, #4

Uses: Mild-mod pain (2,3), Mod-severe pain (4)

MOA: Combined APAP & narcotic analgesic

Dose: Adults: 1-2 tabs q3-4h prn or 30-60 mg/codeine q4-6h based on codeine content (max dose APAP= 4g/d). Peds: APAP 10-15 mg/kg/dose; codeine 0.5-1 mg/kg dose q4-6h (guide: 3-6 yrs, 5 mL/dose; 7-12 yrs, 10 mL/dose) max 2.6 g/d if <12 yrs; ↓ in renal/hepatic impair

Caution: Hypersens

Disp: Tabs 300 mg APAP + codeine (#2=15 mg, #3= 30 mg, #4= 60 mg); Caps 325 mg APAP + codeine; Susp APAP 120 mg + codeine 12 mg/5 mL)

SE: Drowsiness, dizziness, N/V

Schedule: Tabs & Caps: C-III, Susp: C-V

Potassium Chloride

Klor-Con®

Uses: Prevention or treatment of ↓ K+ (e.g. diuretic use)

MOA: K+ supl

Dose: Adults: 20-100 mEq/d po ÷ daily-bid; IV 10-20 mEq/h, max 40 mEq/h & 150 mEq/d (monitor K+ levels frequently and in presence of continuous ECG monitoring w/ high dose IV. Peds: Calculate K+ deficit; 1-43 mEq/kg/d po ÷ daily-qid; IV max dose 0.5-1 mEq/kg/x1-2h

Caution: A, +, renal insuff, use w/ NSAIDs & ACE inhib

CI: ↑ K+

Disp: PO forms 8, 10, 20 mEq, Inj

SE: GI irritation, ↓ HR, ↑K+, heart block

Notes: Mix powder & liq w/ beverage (unsalted tomato juice, etc.), swallow SR tabs whole, monitor K+; Cl- salt OK w/ alkalosis; w/ acidosis use acetate, bicarbonate, citrate, or gluconate salt; Do not administer IV K+ undiluted

Pantoprazole

Protonix®

Uses: GERD, erosive gastritis, ZE synd, PUD

MOA: Proton pump inhib

Dose: 40 mg/d po; do not crush/chew tabs; 40 mg IV/d (not >3mg/min, use Protonix filter)

Caution: B, ?/-, do not use w/ clopidogrel (↓ effect)

Disp: Tabs DR 20,40; 40 mg powder for oral susp (mix in applesauce or juice, give immediately); Inj 40 mg

SE: Chest pain, anxiety, GI upset, ↑ LFTs

Notes: ? ↑ risk of fractures w/ all PPI

Potassium Chloride

Kaon®, Kaochlor®, K-Lor®, Slow-K®, Micro-K®, Klorvess®, others

Uses: Prevention or treatment of ↓ K+ (e.g. diuretic use)

MOA: K+ supl

Dose: Adults: 20-100 mEq/d po ÷ daily-bid; IV 10-20 mEq/h, max 40 mEq/h & 150 mEq/d (monitor K+ levels frequently and in presence of continuous ECG monitoring w/ high dose IV. Peds: Calculate K+ deficit; 1-43 mEq/kg/d po ÷ daily-qid; IV max dose 0.5-1 mEq/kg/x1-2h

Caution: A, +, renal insuff, use w/ NSAIDs & ACE inhib

CI: ↑ K+

Disp: PO forms 8, 10, 20 mEq, Inj

SE: GI irritation, ↓ HR, ↑K+, heart block

Notes: Mix powder & liq w/ beverage (unsalted tomato juice, etc.), swallow SR tabs whole, monitor K+; Cl- salt OK w/ alkalosis; w/ acidosis use acetate, bicarbonate, citrate, or gluconate salt; Do not administer IV K+ undiluted