1. Primary hyper-cholesterolemia & mixed dyslipidemia (Fredrickson types IIa & IIb): After 3-6 wks cholesterol-lowering diet, start 10-20 mg HS. Adjust q4wks up to max 40 mg QD

2. MI, coronary death, & myocardial revascularization procedures: Start 10-20 mg HS. Adjust q4wks up to max 40 mg QD

3. 8-18 y/o w/ heterozygous familial hypercholesterolemia: <13 y/o-20 mg QPM. 14-18 y/o 40 mg QPM

1. Warn about myopathy

2.  Avoid sunlight

3.  If pregnant, DC

4. Limit OH

Oral dosage

1. Vasomotor sxs associated w/ menopause

2. Female hypogonadism

3. Female castration & primary ovarian failure

4. Breast cancer

5. prostatic carcinoma

6. Prevention of postmenopausal osteoporosis after other non-estrogen txs have been considered

IV

1. Abnormal uterine bleeding due to hormonal imbalance in the absence of organic pathology

Cream

1. Atrophic vaginitis & krauosis vulvae

2.  Tx of moderate to severe dyspareunia due to menopause

1. suspected breast cancer

2. suspected estrogen-dependent neoplasia

3. pregnancy

4. undx abnormal genital bleeding

5. thrombophlebitis, thrombosis, or thromboembolic disorders except when used in tx of breast or prostatic malignancy

6. nursing mothers

1.  May be taken w/ food or milk if GI upset occurs

2.  Read pt info sheet carefully

3.  DC if suspected pregnancy

4.  Report to MD if pains in the legs, coughing blood, abnormal vaginal bleeding, skin yellowing, and abdominal pain

1. Hypersensitive to nitrates

2. during the acute phase of MI

3. CHF

Triamterene inhibits the reabsorption of Na in exchange for K at the DCT

HCTZ inhibits the reabsorption of Na & Cl at the DCT

dementia of Alzheimer's type:

Starting dose 5 mg QD x 1 wk

Increase 5 mg BID x 1 wk

Increase 5 mg in AM & 10 mg in PM x 1 wk

Increase dose to 10 mg BID

Target dose: 20 mg QD

1. Symptomatic relief of anxiety & tension associated w/ psychoneurosis & as an adjunct in organic disease states in which anxiety is manifested:

Adults: 50-100 mg QID

>6 y/o: 50-100 mg in divided doses

<6 y/o:  50 mg in divided doses

2. Managementof pruritus due to allergic conditions such as chronic urticaria, atopic dermatoses, & contact dermatoses and in histamine-mediated pruritus

Adults: 25 mg TID-QID

>6 y/o: 50-100 mg in divided doses

<6 y/o: 50 mg daily in divided doses

3. sedative when used as a premedication and following general anesthesia

50-100 mg for adults

0.6 mg/kg for children

selective inhibitor of neuronal 5HT

weak inhibitor of NE & DA

1. MAO-Is

2. drug may be increased or decreased when used w/ phenytoin, phenobarbital, or cimetidine

3.  displace Warfarin

4.  increase levels of procyclidine

5. Variables effects w/ 2D6

6. ASA or NSAID - increase upper GI bleeding

1. CNS depressants

2. MAO-Is

3. ASA or NSAID

1. MAOI in 14 days

2.  sore throat, fever, stomatitis, or other signs of infection, along w/ a low WBC count

1.  May be taken w/ or w/o food, although it may be best to administer Diovan w/o food for consistent plasma level

2.  If pregnant, DC

3.  Dizziness may occur the 1st few days

1. decrease the effects of ACEIs

2. increase Li levels

3. Fluconazole increases plasma levels

4. inhibitor of 2C9

5. increase effects of warfarin

1. asthma, urticaria, or allergic-type rxs after taking sulfonamides, ASA, or NSAIDs

2.  peri-operative pain in the setting of coronary artery bypass graft surgery

Nitroglycerin (SL & injectable)

FDA indications/Dosages

1.  Prophylaxis, tx, & management of angina pectoris (SL):

Dissolve 1 TA under the tongue or in the buccal pouch at first sign of an acute anginal attack Use no more >3 tablets in 15 minutes

2. Tx of angina pectoris, perioperative HTN, CHF associated w/ MI, & for production of controlled hypotension during surgery:

Must be individualized Diluted prior to use. Start w/ 5 mcg/min & titrate to the optimum response using 5 mcg/min increments w/ q 3-5 min until some response is seen.

Increments of 10-20 mcg/min may be used if no response is seen at 20 mcg/min

1. Dihydroergotamine may be increased

2. Heparin may be decreased

3. Hypotensive effects may be increased by sildenafil citrate

1. intoleratnt to organic nitrates 

2.  severe anemias

3.  closed-angle glaucoma

4.  postural hypotension

5. increased intracranial pressure

6. early MI

7.   injection in pts w/ hypotension or uncorrected hypovolemia

8.  injection in pts w/ constrictive pericarditis or pericardial tamponade

Tablets: 100 mg

Capsules: 50 and 100 mg

Syrup: 50 mg/5 mL (Ca salt) raspberry/apple-flavored suspension

Powder for Oral suspension: 25 mg as monohydrate/5 mL after reconstitution, raspberry flavor

Powder for injection: 100 and 200 mg/vial

1. Narcolepsy:  5-60 mg/day in divided doses

2. ADD w/ hyperactivity

3-5 y/o:  2.5 mg QD & increase by 2.5 mg at weekly intervals until optimum effects

>5 y/o:  5-10 mg QD & increase by 5 mg weekly intervals until optimum effect

Adults (XR):  20 mg/day

1. MAO-I and furazolidone increase the effects

2. Urine alkalinizing agents (Na bicarbonate) increase reabsorption while GI alkalinizing agents increase absorption

3. Decrease effects anti-HTN

1. familial or nonfamilial hypercholesterolemia

2. combo w/ HMG-CoA reductase inhibitor w/ familial or nonfamilial hypercholesterolemia

3. combo w/ Lipitor or Zocor w/ homozygous familial hypercholesterolemia as an adjunct to othe rlipid-lowering txs apheresis or if such txs are unavailable

4. adjunctive therapy to diet for the reduction of elevated sitosterol & campesterol levels w/ homozygous familial sitosterolemia

5. combo w/ fenofibrate for mixed hyperlipidemia

10 mg

Tablets (Cystitis Pak): 100, 250, 500, and 750 mg

Tablets ER (Cipro XR): 500 and 1000 mg

Oral suspension: 100 mL containing either 5% or 10%

Injection:

200 mg in 20 mL vials (1%) and 100 mL in 5% dextrose (0.2%).

400 mg in 40 mL vials (1%) and 200 mL in 5% dextrose (0.2%)

1. Antacaids and Fe salts decrease bioavailability

2. Probenecid increases serum levels by decreasing excretion

3. NSAIDs lower seizure thresholds

4.  predispose pts to convulsive seizures when taking w/ levofloxacin

5. increase theophylline

Tablets: 12.5, 25, and 50 mg

Syrup plain: 6.25 mg/5 mL

Suppositories: 12.5, 25, and 50 mg

Injection: 25 mg/mL and 50 mg/mL

1. Management of perennial & seasonal allergic rhinitis, vasomotor rhinitis, allergic conjunctivitis, uncomplciated allergic skin manifestation of urticaria & angioedema, amelioration of allergic rxns to blood or plasma, demographism & combo therapy in anaphylactic rxns

2. control of motion sickness

3. control of N & V

4. sedation

1. AC may decrease effects

2. OH and CNS depressants

3. Metrizamide decrease seizure threshold

4. Barbiturates decrease actions

Promethazine HCl

CIs/Precautions

1. Hypersensitivity to phenothiazines

2.  pts w/ lower respiratory tract sxs

3. pediatric pts <2 y/o due to the potential for fatal respiratory depression

4. injection in comatose states & pts who have taken lg amts of CNS depressants & should not be given by the SQ or intraarterial route