naloxone

(Narcan)

Classification: Narcotic antagonist; Antidote

Action: Displaces opioids at opioid-occupied receptor sites in CNS. Therapeutic Effect: Reverses opioid-induced sleep/sedation, increases respiratory rate, raises BP to normal range.

Uses: Complete or partial reversal of opioid depression including respiratory depression. Diagnosis of suspected opioid tolerance or acute opioid overdose. Neonatal opiate depression. Coma of unknown origin.

Contraindications: Respiratory depression due to nonopioid drugs.

Cautions: Chronic cardiac/pulmonary disease, coronary artery disease. Those suspected of being opioid dependent, postop pts.

Considerations: Pregnancy/Lactation: Unknown if drug crosses placenta or is distributed in breast milk. Pregnancy Category B. Children/Elderly: No age-related precautions noted.

Dosage: IV, IM, Subq.: Adults, Elderly: 0.4-2 mg q2-3min prn. May repeat doses q20-60min. Children 5 yrs and older, weighing 20kg and more: 2 mg/dose; if no response, may repeat q2-3min. May need to repeat doses q20-60min. Children younger than 5 yrs, weighing less than 20 kg: 0.1 mg/kg; if no response, repeat q2-3min. May need to repeat doses q20-60 min.

Side effects: None known; little or no pharmacologic effect in absence of narcotics.

Adverse effects: Too-rapid reversal of narcotic-induced respiratory depression may result in nausea, vomiting, tremors, increased BP, tachycardia.Hypotension or hypertension, ventricular tachycardia/fibrilation, pulmonary edema may occur in those with CVD.

docusate

(Colace)

Classification: Bulk-producing laxative; stool softener

Action: Decreases surface film tension by mixing liquid with bowel contents.

Therapeutic Effect: Increases infiltration of liquid to form a softer stool.

Uses: Stool softener for those who need to avoid straining during defecation; constipation associated with hard, dry stools.

Contraindications: Acute abdominal pain, concomitant use of mineral oil, intestinal obstruction, nausea, vomiting.

Cautions: Do not use for longer than 1 wk.

Considerations: Pregnancy/Lactation: Unknown if drug is distributed in breast milk. Pregnancy category C. Children: Not recommended in those younger than 6 yrs.

Dosage: PO: Adults, Elderly, Children in 12 yrs and older: 50-500 mg/day in 1-4 divided doses. Children 6-11 yrs: 40-150 mg/day in 1-4 divided doses. Children 3-5 yrs: 20-60 mg/day in 1-4 divided doses. Children younger than 3 yrs: 10-40 mg in 1-4 divided doses.

Side effects: Occasional: Mild GI cramping, throat irritation (with liquid preparation). Rare: Rash.

Adverse Effects: None.

bisacodyl

(Dulcolax)

Classification: GI stimulant; laxative

Action: Direct effect on colonic smooth musculature by stimulating intramural nerve plexi.

Therapeutic Effect: Promotes fluid and ion accumulation in colon increasing peristalsis, producing laxative effect.

Uses: Treatment of constipation, colonic evacuation before examinations or procedures.

Contraindications: Abdominal pain, appendicitis, intestinal obstruction, nausea, undiagnosed rectal bleeding, vomiting.

Cautions: Excessive use may lead to fluid, electrolyte imbalance.

Considerations: Pregnancy/Lactationm: Unknown if drug crosses placenta or is distributed in brease milk. Pregnancy Category C. Children: Use with caution in those younger than 6 yrs.

Dosage: PO: Adults, children older than 12 yrs: 5-15 mg prn. Maximum: 30 mg. Powder: Mix a capful with 4-8 oz water or favorite beverage. Children 3-12 yrs: 5-10 mg or 0.3 mg/kg at bedtime or after breakfast. Elderly: Initially, 5 mg/day. Rectal, enema: Adults, children older than 12 yrs: One 1.25 oz bottle in a single daily dose. Rectal, Suppository: Adults, children older than 12 yrs: 10 mg to induce bowel movement. Children 2-12 yrs: 5-10 mg as a single dose. Children younger than 2 yrs: 5 mg.  Elderly: 5-10 mg/day.

Side effects: Frequent: Some degree of abdominal discomfort, nausea, mild cramps, faintness. Occasional: Rectal administration: burning of rectal mucosa, mild proctitis.

Adverse Effects: Long-term use may result in laxative dependence, chronic constipation, loss of normal bowel function. Chronic use or overdose may result in electrolyte or metabolic disturbances (hypokalemia, hypocalcemia, metabolic acidosis, alkalosis), persistent diarrhea, vomiting, muscle weakness, malabsorption, weight loss.

Classification: Enzymatic mineral; iron preparation

Action: Essential component in formation of Hgb, myoglobin, enzymes. Promotes effective erythropoiesis and transport, utilization of oxygen.

Therapeutic Effect: Prevents iron deficiency.

Uses: Prevention, treatment of iron deficiency anemia due to inadequate diet, malabsorption, pregnacy, blood loss.

Contraindications: Hemochromatosis, hemosiderosis, hemolytic anemias, peptic ulcer disease, regional enteritis, ulcerative colitis.

Cautions: Bronchial asthma, iron hypersensitivity, GI tract inflammation.

Considerations: Pregnancy/Lactation: Crosses placenta; distributed in breast milk. Pregnancy Category A. children/elderly: No age-related precautions noted.

Dosage: Iron deficiency anemia: PO: Adults, elderly: 65 mg 2-4 times a day. Children: 3-6 mg/kg/day in 2-3 divided doses. Prevention of iron deficiency: PO: Adults, elderly: 65 mg/day. Children: 1-2 mg/kg/day.

Side effects: Occasional: Mild, transient nausea. Rare: Heartburn, anorexia, constipation, diarrhea.

Adverse effects: Large doses may aggravate existing Gi tract disease. Severe iron poisoning occurs most often in children, manifested as vomiting, severe abdominal pain, diarrhea, dehydration, followed by hyperventilation, pallor, cyanosis, CV collapse.

methylergonovine maleate

(Methergine)

Classification: Ergot alkaloid; uterine stimulant

Action: Stimulates alpha-adrenergic, serotonin receptors, producing arterial vasoconstriction. Causes vasospasm of coronary arteries. Directly stimulates uterine muscle.

Therapeutic effect: Increases strength, frequency of uterine contractions, decreases uterine bleeding.

Uses: Prevention/treatment of postpartum, postabortion hemorrhage due to atony, involution (not for induction, augmentation of labor).

Contraindications: Hypertension, pregnancy , toxemia, untreated hypocalcemia.

Cautions: Renal/hepatic impairment, CAD, occulsive PAD, sepsis.

Considerations: Pregnancy/Lactation: Contraindicated during pregnancy. Small amounts distributed in breast milk. Pregnancy Category C. children/elderly; No information available.

Dosage: PO: Adults: 0.2 mg 3-4 times a day. Continue for up to 7 days. IV,, IM: Adults: Initially, 0.2 mg after delivery of anterior shoulder, after delivery of placenta, or during puerperium. May repeat q2-4h prn.

Side effects: Frequent: Nausea, uterine cramping, vomiting. Occasional: Abdominal pain, diarrhea, dizziness, diaphoresis, tinnitus, bradycardia, chest pain. Rare: Allergic reaction (rash, pruritus), dyspnea; severe or sudden hypertension.

Adverse effects: Severe hypertensive episodes may result in CVA, serious arrhythmias, seizures. Hypertensive effects are more frequent with pt susceptibility, rapid IV adminstration, concurrent use of regional anesthesia, vasoconstrictors. Peripheral ischemia may lead to gangrene.

oxytocin

(Pitocin)

Classification: Uterine smooth muscle stimulant; oxytocic

Action: Affects uterine myofibril activity, stimulates mammary smooth muscle.

Therapeutic effect: Contracts uterine smooth muscle. Enhances lactation.

Uses: Induction of labor at term, control postpartum bleeding, Adjunct in management of abortion.

Contraindications: Adequate uterine activity that fails to progress, cephalopelvic disproportion, fetal distress without imminent delivery, grand multiparity, hyperactive or hypertonic uterus, obstetric emergencies that favor surgical intervention, prematurity, unengaged fetal head, unfavorable fetal position/presentation, when vaginal delivery is contraindicated.

Cautions: Induction of labor should be for medical, not elective, reasons.

Considerations: Pregnancy/Lactation: Used as indicated, not expected to present risk of fetal abnormalities. Small amounts in breast milk. Breast-feeding not recommended. Pregnancy Category X. children/elderly: Not used in these pt populations.

Dosage: Induction or stimulation of labor: IV: adults: 0.5-1 milliunit/min. May gradually increase in increments of 1-2 milliunits/min. Rates of 9-10 milliunits/min are rarely required. Abortion: IV: adults: 10-20 milliunits/min. Maximum: 30 units/12-hr dose. Control of postpartum bleeding: IV infusion: Adults: 10-40 units in 1000 ml IV fluid at rate sufficient to control uterine atony. IM: adults: 10 units after delivery.

Side effects: Occasional: Tachycardia, premature ventricular contractions, hypotension, nausea, vomiting. Rare: Nasal: Lacrimation/tearing, nasal irritation, rhinorrhea, unexpected uterine bleeding/contractions.

Adverse effects: Hypertonicity may occur with tearing of uterus, increased bleeding, abruptio placentae, cervical/vaginal lacerations. Fetal: Bradycardia, CNS/brain damage, trauma due to rapid propulsion, low Apgar score at 5 min, retinal hemorrhage occur rarely. Prolonged IV infusion of oxytocin with excessive fluid volume has caused severe water intoxication with seizures, coma, death.

simethicone

(Mylicone)

Classification: Antiflatulent

Action: Changes surface tension of gas bubbles, allowing easier elimination of gas.

Therapeutic effect: Disperses, prevents formation of gas pockets in GI tract.

Uses: Treatment of flatulence, gastric bloating, postop gas pain, when gas retention may be problem.

Contraindications & Cautions: None

Considerations: Pregnancy/Lactation: Unknown if drug crosses placenta or is distributed in breast milk. Pregnancy category C. children/elderly: No age-related precautions noted.

Dosage: PO: Adults, Elderly, Children 12 yrs and older: 40-125 mg after meals and at bedtime. Maximum: 500 mg/day. Children 2-11 yrs: 40 mg 4 times a day. Children younger than 2 yrs: 20 mg 4 times a day.

Side effects & adverse effects: None

diphenhydramine

(Benadryl)

Classification: Ethanolamine; antihistamine, anticholinergic, antipruritic, antitussive, antiemetic, antidyskinetic

Action: Competitively blocks effects of histamine at peripheral H1 receptor sites.

Therapeutic effect: Produces anticholinergic, antipruritic, antitussive, antiemetic, antidyskinetic, sedative effects.

Uses: Treatment of allergic reactions, parkinsonism; prevention/treatment of nausea, vomiting, vertigo due to motion sickness; antitussive; short-term management of insomnia. Topical form used for relief of pruritus, insect bites, skin irritations.

Contraindications: Acute exacerbation of asthma, use of MAOIs within 14 days.

Cautions: Narrow-angle glaucoma, peptic ulcer, prostatic hypertrophy, pyloroduodenal/bladder neck obstruction, asthma, COPD, increased IOP, CVD, hyperthyroidism, hypertension, seizure disorders.

Considerations: Pregnancy/Lactation: Crosses placenta. Detected in breast milk. Increased rish of seizures n neonates, premature infants if used during third trimester of pregnancy. May prohibit lactation. Pregnancy Category B. Children: Not recommended in newborns, premature infants.

Dosage: Moderate to severe allergic reaction: PO, IV, IM: Adults, elderly: 25-50 mg 16-8h. Maximum: 400 mg/day. Children: 5 mg/kg/day in divided doses 16-8h. Maximum: 300 mg/day.

Motion Sickness: PO: Adults, elderly, children 12 yrs and older: 25-50 mg q4-6h. Maximum: 300 mg/day. Children 6-11 yrs: 12.5-25 mg q4-6h. Maximum: 150 mg/day. Children 2-5 yrs: 6.25 mg q4-6h. Maximum: 37.5 mg/day.

Parkinson's Disease: PO: Adults, elderly: 25-50 mg 3-4 times a day.

Antitussive: PO: Adults, elderly, children 12 yrs and older: 25 mg q4h. Maximum: 150 mg/day. Children 6-11 yrs: 12.5 mg q4h. Maximum 75 mg/day. Children 2-5 yrs: 6.25 mg q4h. Maximum: 37.5 mg/day.

Pruritus: Topical: Adults, elderly, children 12 yrs and older: Apply 1% or 2% cream or spray 3-4 times a day. Children 2-11 yrs: Apply 1% cream or spray 304 times a day.

Side effects: Frequent: Drowsiness, dizziness, muscle weakness, hypotension, urinary retention, thickening of bronchial secretions, dry mouth, nose, throat, lips; in elderly: sedation, dizziness, hypotension. Occasional: Epigastric distress, flushing, visual/hearing disturbances, paresthesia, diaphoresis, chills.

Adverse effects: Hypersensitivity reactions may occur. Overdose symptoms may vary from CNS depression to severe paradoxical reactions. Children, infants, neonates may experience paradoxical reactions. Overdosage in children may result in hallucinations, seizures, death.

cefazolin

(Ancef)

Classification: First-generation cephalosporin; antibiotic

Action: Binds to bacterial cell membranes, inhibits cell wall synthesis.

Therapeutic effect: Bactericidal

Uses: Treatment of susceptible infections due to S. aureus, S.epidermidis, Group A beta-hemolytic streptococci, S. pneumoniae, E. coli, P. mirabilis, Klebsiella spp., H. influenzae including biliary tract, bone and joint, genital, resp. tract, skin/skin structur and UTIs, endocarditis, perioperative prophylaxis, septicemia.

Contraindications: History of anaphylactic reaction to penicillins, hypersensitivity to cephalosporins.

Cautions: Renal impairment, history of GI disease, concurrent use of nephrotoxic medications.

Considerations: Pregnancy/Lactation: Readily crosses placenta; distributed in breast milk. Pregnancy category B. children: None.

Dosage: Usual dosage range: IV, IM: Adults: 250 mg to 2g q6-12 h. Children older than 1 mo: 25-100 mg/kg/day divided q6-8h. Maximum: 6 g/day.

Mild to moderate infections: IV, IM:Adults, elderly: 500 mg-1 g q6-8h.

Severe infections: IV, IM: Adults, elderly: 1-2 g q6-8h.

Life-threatening infections: IV, IM: Adults, elderly: 1-2 g q4-6h. Maximum: 12 g/day.

Side effects: Frequent: Discomfort with IM adminstration, oral candidiasis, mild diarrhea, mild abdominal cramping, vaginal candidiasis. Occasional: Nausea, serum sickness-like reaction. Rare: Allergic reaction, thrombophlebitis.

Adverse effects: Antibiotic-associated colitis, other super-infections may result from altered bacterial balance. Nephrotoxicity may occur esp. in pts with preexisting renal disease. Pts with a history of allergies, esp. to penicillin, are at increased risk for developing a severe hypersensitivity reaction.