-
Amoxycillin
250-500mg TDS or 1g BD
- (MIMS)
- Adult, children >20kg: 250-500 mg q8h
- children <20kg: 20-40mg/kg/day in 3 divided doses
- (AMH)
- Adult: orally: 250-500mg tds OR 1g BD
- 1g TDS (severe infections)
- IM/IV: 1g q6h (max 12g d (severe infections))
- Child: orally: 7.5-25 mg/kg q8h (80-90mg/kg in severe infections)
- IM/IV: 10-25mg/kg q8h (max 50mg/kg q4h)
-
Amoxycillin with Clavulanic acid
1 BD for 5-10 days
- AMH:
- Adult: 500-875mg q12h for 5-10 days or longer depending on infection
- Children: 7.5-15mg/kg q8h for 5-10 days, max 22.5mg/kg q8h in severe infections
- Duo product: 12.5-22.5mg/kg q12h
- acute bacterial sinusitis: tds for 7-14 days
- UTI: bd for 5 days
- max 14 days without r/v
-
Cephalexin
- 250-500mg QID or 500mg-1g QID-BD
- UTI Px: 250mg n
- UTI Tx: 500mg BD
-
-
Doxycycline
- 2 stat then 1 d (100) (max 200mg d)
- Acne: 50mg d
- Malaria: 1d (100) for 2d before, during and 2-4 weeks after
-
Cefaclor
1 BD (375mg CD)
- AMH:
- Adult: CD: 375-750mg BD (max 4g d) OR 250-500mg q8h
- Child: 10-15mg/kg q8h OR 20mg/kg q12h (max 1g/dose)
With food
-
Di/Flucloxacillin
250-500mg q6h (max 4g d)
- AMH:
- po: 250-500mg q6h (max 4g d)
- IV: 1-2g q6h, max 12g d
empty stomach
-
Metronidazole
200-400mg TDS (max 4g d)
- child: 7.5mg/kg q8h
- tabs with food, liquid 1hr before food
- EtOH (during + 24 hrs after)
-
Atorvastatin
1 d (10/20/40/80)
-
Simvastatin
1 n (10/20/40/80)
-
Irbesartan
- 1 D
- usually 150mg d; 300mg if req
- start at 75mg
-
Candesartan
1 d (4/8/16/32 - usu 8; 16 if req)
-
telmisartan
1d (usu 20-40; 80 if req)
-
Nicorandil
- 10-20mg BD
- initially 5mg BD
painful ulcers (any region of GI tract - mouth, perianal region most common)
-
perhexiline
- 100mg d
- Load: 200-300mg for 5-7d
- TDM drug - slow metabolisers = very low doses, test after 3-5 days, MM kinetics
- diabetes - hypos risk
- P neuropathy
- monitoring: weight, BSLs, hepatotoxicity, p neuropathy, levels
-
Perindopril
5-10mg d
- reduce dose in elderly/renal imp - 2.5mg
- 30-60mL/min = 1d
- 15-30mL/min = alt days
-
Ramipril
1 d (2.5-10) in 1-2 doses (BD for HF)
-
Amlodipine
2.5-5mg d (max 10)
-
diltiazem
- IR: 180-240mg d (3-4 divided doses)
- CR: 180-360 d
-
-
nifedipine
- IR: 20-40mg BD
- CR: 20-30 D, max 90 D (angina) OR 120mg d (HTN)
- Med box:
- IR: 1 D (10/20)
- CR: 1 BD (20/30/60)
-
verapamil
- IR: 160 BD-TDS
- CR: 120-240 D-BD
-
Atenolol (Noten, Tenormin, Tensig)
25-100mg d
-
bisoprolol
10mg d (initially 1.25mg d and gradually titrate up)
-
carvedilol
1 D (3.125/6.25/12.5/25)
- Maintenance:
- 25mg bd (max if <85 kg)
- 50mg bd (max if >85kg)
- initially 3.125mg BD and titrating up at intervals of at least 2 weeks
-
Metoprolol (Betaloc, Minax)
- 50-100mg D-BD (HTN, migraine)
- 50-100mg BD-TDS (Angina)
- CR: 23.75mg-190mg D (maintenance)
-
propranolol
- 120-320mg d (in 3 divided doses) (HTN, angina, tremor)
- initially 20-40mg bd - tds
-
Prazosin (Minipress)
- 3-20mg D (in 2-3 divided doses)
- initially 0.5mg BD
-
Clonidine (Catapres)
- po: 150-300mg BD (MD) (HTN)
- 25mg BD, max 75mg BD (menopausal flushing)
- withdrawal syndrome - risk of rebound hypertension, withdraw gradually over at least 7 days
- withdrawal may worsen wtih BB. Stop BB days before removing clonidine
- depression - may exacerbate, avoid
- Common: sedation, depression, constipation, othostatin
-
Hydralazine (Alphapress)
- 50-200mg D
- initially 25mg BD, caution with doses > 100mg D
- arterial vasodilator
- give 300mg D in 4 divided doses with ISDN (HF)
- usually add BBS and thiazides to prevent tachycardia and fluid retention
- Common sfx: oedema, flushing, tachycardia
-
Amiodarone
- 100-400mg D
- use lowest MD to control arrhythmia
- Loading required: po schedule: 200-400mg tds for 1 week, then 200-400 BD for 1 week
- iodine allergy = C/I
- monitor q6m: Thyroid fn, Lung fn (CXR), EUC (hypo/hyperK, hypoMg)
- eye exam anually
- counselling: sun exposure, regular tests, tell dr if dyspnoea, dry cough, problems with vision, wt loss, muscle weakness, worsening of heart symptoms
-
digoxin
- 62.5-250mcg D
- tailor dose according to renal fn, clinical resp, and levels
- SS after 5 days
- Rnage: 0.6-2.6nmol/L
- toxicity: a --> n --> v
- Common sfx: a, n, v, d, blurred VISION, confusion,
-
flecainide
50-100mg po BD, max 400mg D
-
-
rosuvastatin
5-20mg D
max 40mg D (specialist supervision)
-
Simvastatin
10-80mg D (usually 40mg - existing/risk CAD)
-
Fenofibrate
- lower dose in renal imp:
- 20-60mL/min = 96 mg D
- TRIGLYCERIDES
- MOA: PPAR-g activators - lower TG, inc HDL ( mod), variable LDL effects
- Common ADR: GI (dyspepsia, abdo pain)
- infrequent: photosensitivity
- monitor LFTs
-
Ezetemibe
10mg D
- Reduces absorption of cholesterol (dietary and biliary) by inhibiting its transport across the intestinal wall = inc. LDL uptake
- Tell GP if muscle pain, tenderness or weakness
- Fibrate tx - increase risk of GALL BLADDER disease
- Common ADR: headache, diarrhoea
-
-
Enalapril
1 D (mane) (2.5/5/10/20)
- AMH:
- usu 10-40mg D (HTN) as 1-2 doses
- 10-20mg D (HF) as 1-2 doses
Renitec
-
Captopril
25-50mg TWICE daily
Capoten
-
Lisinopril
1 D (mane) (5/10/20)
Prinivil
-
Fosinopril + HCT
1 D (F: 10/20, HCT: 12.5)
Monoplus, Fosetic
-
Quinapril
1 D (5/10/20)
- Maintenance:
- 10-40 D (mane) (in 1-2 doses) (HTN)
- 5-10 D (HF)
- 2.5-5 D (elderly/renal imp/taking diruretic)
Accuretic, Accupril, Acquin
-
Indapamide
- IR: 1.25-2.5 D (mane)
- CR: 1.5 D
Risk of hypoK lower with CR tablet
-
Trandolapril
1 D (usu 1-2mg D, max 4mg D)
Gopten
-
Aspirin
100-150mg D (anti-platelet)
300-900mg D (analgesic)
-
Rivaroxaban
10mg D (2 weeks TKR, 5 weeks THR)
- Factor Xa inhibitor (selective) - blocks thrombin production, conversion of fibrinogen to fibrin, and thrombus development
- No antidote
- Common ADR: bleeding, signs of bleeding (e.g. anaemia)
- Oral (fondaparinux = sc)
-
Dabigatran
- 110mg BD
- 150mg D (CrCl 30-50mL/min)
- Direct thrombin inhibitor
- 10 days after TKR, 4-5 weeks (28-35 days) after THR
- lower dose (150mg) with amiodarone and conventional verapamil (or 2 hrs before Verapamil to avoid interaction)
-
Iron tablets
- 1mg elemental iron =
- ferrous fumarate 3mg
- ferrous sulphate (dried) = 3mg
- ferrous sulphate (non-dried, heptahydrate) = 5mg
- EMPTY STOMACH (1 hr b4/2 hrs after)
- Shortly after food if upset stomach
- Minimise GI sfx by: slowly inc dose, use CR (may have lower F)
- accidental overdose serious - v, d, hypotension, tacchycardia, acidosis, CNS depression.
-
Systemic photosensitisers
- amiodarone
- griseofulvin
- NSAIDs
- phenothiazines (chlorpromazine, pimozide, clozapine, promethazine, etc. - 'z-drugs')
- methoxsalen (for psoriasis)
- quinolones (ciprofloxacin, moxifloxacin, norfloxacin, ofloxacin)
- retinoids (acitretin, adapalene, isotretinoin, tazarotene, tretinoin)
- SJW
- tetracyclines (doxycycline, minocycline, tetracycline)
- thiazides (rare)
-
Topical sensitisers
- triclosan
- coal tar derivatives
- fragrances
- methoxsalen
- retinoids (adalaplene, isotretinoin, tazarotene, tretinoin)
- sulfonamides
-
topical corticosteroids
- BD except for mometasone and methylprednisolone, which are applied ONCE a day
- no benefit from more frequent application, some cases less may be adequate (e.g. eczema)
- Dose = finger tip unit; tip of index to first crease: area twice size of adult hand with fingers together
- Apply enough to cover affected areas. Smooth gently into skin, preferably after bathing
-
hydrocortisone
- 0.5-1%
- mild
- DermAid, Cortic-DS, Cortef, Sigmacort
-
betamethasone valerate
- 0.02%, 0.05%
- moderate
- 0.02% Betnovate 1/5, Cortival 1/5, Celestone-M
-
-
triamcinolone
- 0.02%
- moderate
- Aristocort, Tricortone
-
betamethasone dipropionate
- 0.05%
- potent
- Diprosone, Eleuphrat
very potent = diprosone OV
-
betamethasone valerate 0.1%
- 0.1%
- potent (vs. 0.05% and less = moderate)
- Betnovate, Cortival
-
mometasone
- 0.1%
- potent
- Elocon, Novasone
-
-
Isotretinoin
- 0.5mg/kg d (as 1-2 doses)
- treatment continued until total cumulative dose is 120-150mg/kg (usually 4-5 months)
- Roaccutane, Oratane
- PPs:
- with food
- promptly report n, headaches, visual changes (poor night vision or blurring)
- dry lips, mouth, eyes - vaseline, lubricating eye drops. tell dr if not mgeable
- avoid vit A supplements
- photosensitivity - physical barrier sunscreen
- Cat X - contraception during and for 1 month after
- monitor BSLs in pts predisposed to diabetes
ADRs: hyperlipidaemia, tetracyclines - inc risk of benign intracranial HTN, photosensitising meds, topical retinoids
-
Permethrin
- 1% - head lice
- 5% - scabies: adult - 1 tube/application, 5-12 yrs - 0.5 tube, 1-5 yrs - 0.25 tube
- scabies - apply chin-down and wash off with warm soapy water 8-14 hours later. rinse thoroughly. rpt after 7 days.
- also apply to neck, face, scalp and ears in children <2 yrs, elderly or immunocompromised ppl, tx failure
head lice: apply to damp hair after washing with usual shampoo, leave in for 10 mins, rinse with warm water, rpt after 7/7. Use fine tooth comb to remove dead lice/nits.
-
Intranasal corticosteroids
- 2 sprays D - acute phase
- 1 spray D - MD
- Beclomethasone 50mcg/dose - Beconase Allergy & Hayfever (use BD)
- Budesonide 32mcg/dose - Rhinocort Hayfever; 64mcg/dose - Budamax, Rhinocort
- Fluticasone 27.5mcg/dose - Avamys, 50mcg/dose - Beconase Allergy & Hayfever 24 hour
- Mometasone 50mcg/dose - Nasonex
- Triamcinolone 55mcg/dose - Telnase
-
Glibenclamide
2.5-20mg D (1-2 divided doses)
Daonil, Glimel
-
Gliclazide
- IR: 40-320mg D (1-2 divided doses, max 160mg/dose)
- CR: 30-120mg D
NB: 30mg CR = 80mg IR
Diamicron, Glyade
-
Glimepiride
1-4mg D
Amaryl, Aylide
-
Glipizide
2.5-40mg D (1-2 doses - divide doses > 15mg)
Minidiab
-
Pioglitazone
15-30mg D (max 45mg D)
Actos
-
Rosiglitazone
4mg D (max 8mg D in 1-2 doses)
Avandia
-
Sitagliptin
- 100mg D
- reduce dose in renal imp
- 25mg, 50mg, 100mg tabs av
Januvia
DPP-1 inhibitor (gliptin)
-
Acarbose
50mg D-TDS swallowed whole with liquid immeidately before a meal or chew with first few mouthfuls of food
Glucobay
-
Exanitide
5mcg BD (10mcg BD if tolerated) - 60 mins before breakfast and dinner
-
Metformin
- IR: 500-850mg D-TDS according to response (Max 3g D)
- CR: 500mg-2g D (with evening meal)
- Reduce dose in renal imp:
- 60-90mL/min - 2g D
- 30-60mL/min - 1g D
-
Thyroxine
- usual: 100-200mcg D
- start at 25-50mcg, increase according to TSH
-
Carbimazole
- initially 20-40mg D (up to 60mg in severe cases) for 3-4 weeks
- MD: 5-15 mg D
- Neo-Mercazole
- common: itching & mild rash --> antihistamines
- rare: agranulocytosis - rapid onset in 1st 3 months -->tell dr stat: fever, mouth ulcers, sore throat, rash, severe fatigue, abdominal pain, jaundice
-
Calcium
1200-1300mg (including diet)
- Dietary intake (Australian recommendations):
- 1300mg - men >70, post-menopausal women, adolescents 12-18 yrs
- 1000mg for all other adults
-
Fosamax combinations
- Fosamax Plus Once weekly 70/70 OR 140: alendronate 70mg, cholecalciferol 70mcg OR 140mcg
- Fosamax Plus D-Cal: alendronate 70mg, cholecalciferol 140mcg (4), calcium 500mg (48)
-
alendronate
- 70mg once weekly OR
- 10mg D
- avoid use if CrCl <35mL/min
- combination pack with:
- cholecalciferol 70mcg OR 140mcg - 1/week (Fosamax plus 70/70 OR 70/140)
- cholecalciferol 140mcg (w/ alendronate) & calcium 500mg (Fosamax plus D Cal)
-
Actonel combinations
- Actonel Combi: risedronate 35mg (4), calcium 500mg (24)
- Actonel Combi D: risedronate 35mg (4), calcium 1000mg, cholecalciferol 22mcg (24)
-
risedronate
- 5mg D OR
- 35mg weekly OR
- 150mg monthly
- not recommended if CrCl < 30mL/min
- Actonel
-
calcitriol
0.25mcg BD
(0.75mcg D when for OP prev'n w/ oral pred dose >10mg D)
Rocaltrol
-
Cholecalciferol
- 25mcg D
- 75-125 (3-5) daily for 6-12 weeks as loading dose
-
raloxifene
60mg D
- Evista
- SERM - oestrogen agonist effects on bone, antagonistic effects at other oestrogen-responsive tissue (e.g. breast, endometrium)
-
Strontium
2g D (bedtime, at least 2 hrs after food) - sachet, mix with water
Rare ADR: VTE, DRESS (drug rash with eosinophilia) --> rash = seek advice promptly
Protos
-
chloramphenicol
- Bacterial conjunctivitis:
- 0.5% eye drop: 1 drp q2-4h for 2 days, then if there is improvement, 1 drop qid for 5 days
- 1% ointment: use n as adjunct to eye drop, or as single agent TDS, e.g. in children
- Prevention of infection after sx/superficial trauma:
- 0.5% drop: 1 drop qid until epithelium healed (rarely > 4 days)
- do not supply OTC if eye is red and painful (esp. if contact lens wearer) - further investigation req'd
-
drug classes for chronic open-angle glaucoma - usual doses/day
- BB (e.g. timolol) --> 1-2
- PG analogue (e.g. latanoprost) --> 1
- Carbonic anhydrase inhibitor --> 2 (except dorzolamide when single agent --> 3)
- A2 agonist (e.g. brimonidine) --> 2
- cholinergic (e.g. pilocarpine) --> 2-4
-
MOA of glaucoma eye drops
- BBs - dec aqueous humor formation
- PG analogues - inc UV scleral outflow
- A2 agonist - dec aq humor formation and inc UV scleral outflow
- CA-i - dec aq humor formation
- ie. dec aq humor formation - all classes except PG analogues, A2 agonists - do both (2 for both!)
-
Preferred H. Pylori eradication regimen
- PPI - standard dose BD
- clarithromycin 500mg BD
- amoxycillin - 1g BD
- duration: 7 days
-
H. Pylori eradication regimen if amoxycillin unsuitable
- PPI - standard dose BD
- clarithromycin - 500mg BD
- metronidazole - 400mg BD
- duration: 7 days
-
H. Pylori eradication regimen if clarithromycin unsuitable
- PPI - standard dose BD
- amoxycillin - 500mg TDS metronidazole - 400mg TDS
duration: 14 days
-
ranitidine
300mg daily (1-2 divided doses)
-
esomeprazole
Usually 20mg D-BD (range: 20-40mg D-BD)
- tablet - swallow whole or dispserse in water and drink within 30 mins
- oral liquid/sachet av
Nexium
-
lansoprazole
15-30mg D
- capsule - open and mix with juice/yogurt
- tablet - suck, swallow whole with water, disperse and drink stat
Zoton
-
omeprazole
MD: 10-20mg D
Losec, Acimax
-
pantoprazole
20-40mg D
somac
-
rabeprazole
10-20mg D
Pariet
-
Hyoscine butylbromide
- 10-20mg TDS-QID
- doses can be repeated after 30 mins prn
- MOA - SM relaxant, dec GI motility
- Indications: GI spasm, aid in endoscopy, IBS
buscopan, setacol
-
mebeverine
135mg TDS
- MOA: SM relaxant, reduces GI motility and spasm
- indications: IBS
Colese, Colofac
-
domperidone
10-20mg TDS -QID
10-20mg q6-8h (TDS-QID) (max 80mg D) (12 weeks - n+v, 6 months - gastroparesis) - stimulation of lactation: 10mg TDS for 5 days, then taper down
- prolongs QT interval - C/I with ketoconazole, erythromycin and other potent inhibitors of CYP3A4 (e.g. fluconazole, clarithromycin)
- ADRs: dry mouth (common), hyperprolactinaemia --> boobs, leaking (infrequent), EPSE (rare)
Motilium
-
metoclopramide
10mg TDS
- n+v, gastric stimulation, lactation stimulation
- caution - PD (prefer domperidone) - EPSE, depression + elderly - avoid LT use
dopamine ANTagonist
-
Prochlorperazine
- n+v: initially 20mg, then 10mg 2 hrs later
- if still needed, 5-10mg TDS PRN
potentiates CNS dep - C/I
- ADR: common: constipation, dry mouth, drowsiness, parkinsonism, EPSE (esp children), hyperprolactinaemia
- rare: prolong QT
counselling - L1: drowsy, EtOH
- Nausetil, Stemetil, Stemzine
- 5mg tabs, 25mg suppositories
-
hyoscine butylbromide
1-2 tabs, max 4/24 hrs (halve dose in children)
- 1 tab = 0.3mg = 300mcg
- take 1st dose 30 mins before travel, repeat in 4-6 hrs prn
- indication: motion sickness
- Kwells, Travacalm HO
- combination: Travacalm original (hyoscine butylBr 0.2mg. dimenhydrinate 50mg, caffeine 20mg)
-
docusate
100-150mg D-BD (max 480mg D)
onset 1-3 days (po)
-
lomotil, lofenoxal
2 TDS-QID PRN
diphenoxylate 2.5mg (+ atropine 25mcg)
L1 - drowsiness, alcohol
-
Imodium, Gastro-Stop
acute diarrhoea, SHORT TERM: initially 4mg, then 2mg after each loose bowel motion (max 16 mg D)
loperamide 2mg
-
Imodium advanced
loperamide 2mg, simethicone 125mg
diarrhoea associated with gas-related abdominal discomfort, SHORT TERM
-
Oral rehydration salts
- 2 tabs or 1 sachet into 200mL fresh drinking water/freshly boiled and cooled water
- Age determines dose:
- 6-24 months: 1 sachet/q3-4h
- 2-5 yrs: 1-2 sachet/q3-4h
- 5-8 yrs: 2 sachet/q3-4h
- 8-10 yrs: 1 sachet/q1-2h
- 10-12 yrs: 1 sachet/q1h (up to 6-12 sachets in 24h)
- adults, children >12y: 1-2 sachets after every loose bowel motion (up to 8-12 sachets in 24 hrs)
- seek medical advice if diarrhoea persists:
- <6 months: >6 hrs
- <3 yrs: >12 hrs
- 3-6 yrs: > 24 hrs
- 6+ yrs: >48 hrs
- Reconstituted soln can be stored for up to 24 hrs in FRIDGE, otherwise d/c w/in 1 hr
- If vomitting - drink in small amounts at first
-
colifoam
1 applicatorful D-BD for 2-3 weeks, then every second day until remission achieved
- indications: UC, CD; mild rectal/rectosigmoidal disease
- hydrocortisone 10% - rectal foam
-
5-ASAs - agents
- balsalazide - Colazide
- mesalazine - mesasal, salofalk, pentasa
- olsalazine
- sulfasalazine - salazopyrin (contains sulfonamide moiety)
- monitoring: renal and liver fn - baseline, q3m for 1 yr, then q6m
-
sulfasalazine
- Acute: 2-4g D in 3-4 doses (UC), 3-6g D (CD)
- MD: 500mg QID
- RA: initially 500mg D (max 3g), MD: 2-3g D
- C/I - allergy to sulphonamides, blood dyscrasias
- common sfx: reversible male infertility, haemolysis (usu not severe)
- take WITH FOOD
- STAINS - urine - dark orange, skin & tears - yellow, soft contacts - stained
- impairs absorption of FOLIC ACID (NB: sulfonamide moiety)- consider supplements
-
xenical
- 120mg TDS with main meals
- Do not take dose if you miss a meal/meal dose not contain fat
- likely to cause fatty or oily stools, esp when diet too high in fat
- efficacy for up to 4 yrs
- mean wt loss of approx 2-4 kg in 1st yr
- may decrease abs of fat-sol vitamins (ADEK) - supplement if necessary at least 2 hrs from orlistat dose
- orlistat
-
oxybutinin
- oral: 2.5-5mg BD-TDS (max 20mg D) (Ditropan)
- patch: 1 patch TWICE weekly (q3-4 days) - apply to abdomen, hip or buttock; patch = 3.9mg/24hrs (Oxytrol)
- anticholinergic
- urinary urge incontince
-
solifenacin
- 5-10mg D
- anticholinergic
- urinary urge incontinence
- Vesicare
-
selective alpha-blockers - agents + MOA
- alfuzosin
- prazosin
- tamsulosin
- terazosin
MOA: block A1 receptors, relaxing SM in bladder neck, decreasing resistance to urinary flow
- tamsulosin most selective
- less effect on BP: tamsulosin, alfuzosin - better tol
- prazosin - short duration of action - BD
- precautions:
- intra-operative floppy iris syndrome during cataract sx (esp tamsulosin)
- first dose hypotension
-
Prazosin in BPH
0.5-2mg BD
Minipress
-
tamsulosin
400mcg D
flomaxtra
-
finasteride
5mg D
indications: BPH, alopecia in men
Proscar
-
celecoxib
- 100mg D-BD, max 400mg D
- Do not use >200mg D LT - risk of CV ADR dose-related
Celebrex
-
Diclofenac
- 75-150mg D in 2-3 divided doses (max 200mg D) (po)
- 1-2 TDS PRN (25)
1% gel - rub into affected area BD - TDS PRN
-
Ibuprofen
200-400mg TDS-QID PRN (max 2400mg D)
Nurofen, Panafen, brufen, advil
NB: ibuprofen can reduce the antiplatelet activity of low-dose aspirin, possibly reducing or negating its cardioprotective effect - consider if using LT
-
Indomethacin
- po: 25-50mg BD-QID
- pr: 100mg D-BD
Indocid, Arthrexin
-
Meloxicam
7.5-15mg 1 D PRN
Mobic, Movalis
-
Naproxen
- IR: 250-500mg BD
- CR: 750-1000mg D
- max, 1250mg D
period pain: 500mg initially, then 250mg q6-8h prn
NB: naproxen may reduce/negate cardioprotective effects of low-dose aspirin
CR products - take nocte to reduce nocturnal and morning sx
Inza, Naprosyn, Naproxyn SR
-
azathioprine
- 1mg/kg D (usually 50-100mg D in 1-2 doses)
- MD: 50-150mg D (1-2 doses)
Allopurinol reduces AZA metabolism = inc risk of severe BM toxicity. Redue AZA dose to a QUARTER or a THIRD of normal dose.
Referal: persistent fever, sore throat, bruising, bleeding, paleness
Imuran
-
Methotrexate
5-25mg once weekly, depending on response
referal: cough, difficulty breathing, signs of infection
photosensitivity
- monitor: FBC, Hep B + C serology, pulmonary fn tests + CXR
- GI ADRs:
- folic acid supplements - 1mg D to reduce GI ADRs (stomatitis, nausea, diarrhoea)
- divide oral dose into 3 - take at 0, 12, 24 hrs
- may be 1-2 months before effect seen
-
Hydroxychloroquine
- RA: 2-3 (200mg) D for 1-3 months
- MD: 1-2 D (if desired/responsive)
malaria p'laxis: 400mg once weekly (start 1 week before leaving and 4 weeks after leaving endemic area)
- MOA: anti-inflammatory + immunosuppressive effects
- Indications: mild RA, malaria prophylaxis of chloroquine not available (reasonable 1st choice in mild disease)
ADRs: retinopathy (rare) - tell dr if any changes in sight, wear sunglasses - VISION!
-
sulfasalazine (RA)
- 500mg D (inc to max of 3g D)
- MD: 2-3 g D
- with food
- monitor: FBC, renal and liver fn tests
- 1-3 months for effect
-
allopurinol
- 100-300mg D
- prevention of hyperuricaemia due to tumour lysis syndrome: 600-800mg D
- MOA: inhibits xanthine oxidase = dec uric acid production
- after food
- stop + see Dr: rash, swollen lips or mouth, persistent fever, sore throat
- drink lots of fluids - prevent kidney stones
- L1 - drowsy
- interaction with azathioprine/mercaptopurine - reduce their dose to a QUARTER to a THIRD normal dose
- consider low-dose NSAID/low-dose colchicine to prevent gout during 1st 3 months of tx
-
colchicine
- tx: 1mg ASAP, then 500mcg 1hr later (max 1.5mg/course)
- prophylaxis: 500mcg D-BD
MOA: inhibits neutrophil activity - reduces inflammatory reaction to urate crystals (no effect on uric acid)
common ADR: GI (n, v, d, abdominalk discomfort)
Dr: severe v/d, myalgia, peripheral neuropathy, unusual bleeding, infection
accumulation and toxicity if used with CYP3A4 inhibitor (e.g. clarithromycin), or course repeated too quickly
Colgout, Lengout (500mcg tabs)
-
topical muscoloskeletal agents
- Apply BD - QID PRN for up to 14 days, r/v use afterwards
- may stain skin and discolour skin - rub in properly
- photosensitivity
- rice for days 1-2
-
carbamazepine
- Epilepsy:
- usual range = 400-1.2g D (in 2 + doses) (max 3g D)
- initially 100mg BD and titrate up
- neuropathic pain: 200-600mg BD
- mania/bipolar: 400mg D (divided doses), titrate up to effect
th range: 4-12mg/L
- MOA: prevents repetitive neuronal discharge by blocking
- voltage and use-dependent Na channels
- Indications:
- - partial seizures (simple and complex), generalised tonic-clonic
- - bipolar - acute mania and prevention
- - neuropathic pain
- Increase dose slowly - auto-induces own metabolism monitor for life-threatening skin reactions
- risk of osteomalacia - vit D + cal supp's
Tegretol
-
CBZ (in epilepsy)
400mg - 1.2g D (in 2-4 divided doses) (max 2g D)
Tegretol
-
CBZ
- In 2-4 doses:
- 400mg - 1.2g D, max 2g (epilepsy)
- 400-800mg D, max 1.6g (trigeminal neuralgia)
- 200-600mg D, max 1.2g (neuropathic)
- 400mg D, max 1.6g (mania/bipolar)
- Tegretol
-
Gabapentin
- partial seizures: usually 0.9-1.8g D (in 3 divided doses)
- neuropathic pain: 1.8-3.6g D (in 3 divided doses), but initially 100-300mg nocte
- L1 - drowsiness, EtOH
- L9 - do not stop abruptly
Neurontin
-
Lamotrigine
- 100-200mg D (in 1-2 doses)
- (OR 200-400mg D (in 2 doses, up to 500-700mg D) in pts taking enzyme inducers and not taking valproate)
ADR: common: VISION (diplopia, blurred vision), dizziness, somnolescence; SEVERE SKIN REACTIONS - occur with rapid dose inc/valproate tx
Lamictal, Seaze
-
Levetiracetam
500mg BD, up to 1.5g BD (adults, children > 50kg)
Keppra
-
Phenytoin
usually 200-500mg D (in 1-2 doses)
not effective in absence and myoclonic seizures
- ADRs: VISION (diplopia, blurriness), gingival hypertrophy - visit dentist regularly
- TDM - total PHY = 40-80mmol/L
- saturable metabolism/MM kinetics
Dilantin
-
pregabalin
75-150mg BD (max 300mg BD) (partial seizures + neuropathic pain)
Lyrica
-
Valproate
epilepsy: 600mg D (in 2 doses) titrate to response, max 2.5g D
- common ADR: increased appetite, wt gain, elevated ALT/AST, blood dyscrasias --> fever, rash, abdo pain, bruising, bleeding (inc INR/thrombocytopaenia)
- BMD - monitor/supplement vit D/Ca
indications: epilepsy, migraine, bipolar
Epilim (100, 200, 500mg)
-
Drug classes for PD + common examples
- LevodopaDOPA-decarboxylase - carbidopa, benserazide (given with levo) - decreases peripheral metabolism of levo (= less n, v, hypotension)
- MAO-B inhibitor - selegeline (levo adjunct)
- COMT-i - entecapone (levo adjunct)
- dopamine agonists - pramipexole (non-ergot), carbergoline
- apomorphine - stimulates dopa Rs, use with domperidone (highly emetogenic)
- Amantadine - dopaminergic and anticholinergic activity
- anticholinergics - benzhexol, benztropine, etc. - used infrequently
-
Entacapone
200mg with each levodopa/carbidopa or benserazide dose (max 2 g D)
- COMT-I
- indications: adjunct to levo with motor fluctuation
Comtan (200mg)
-
levodopa with benserazide or carbidopa
dosage expressed as levo: 50-100mg TDS, titrate to response (max 2g D)
levodopa : benserazide/carbidopa = 4:1, 10:1 ratio also av with carbidopa
do not stop suddenly, take at same time daily and same way (with/without food - food reduces abs of levo, but minimised GI fx)
- w/ Benserazide
- Madopar (50-200mg levo) rapid (tab)
- Madopar (50-200mg levo) (cap)
- w/ Carbidopa
- Sinemet, Kinson (100-250mg levo)
- Sinemet CR (200mg levo)
- w/ Carbidopa + Entecapone
- Stalevo (50-200mg levo) + 200mg entecapone
-
Sumatriptan
- 50-100mg ASAP after headache onset
- MOA: constrict cranial vessels (selective 5HT1B/D) - C/I in IHD, TIA
- indications: acute relief of migraine
- take as headache beginning to develop; if no improvement with first dose, do not repeat; repeat after at least 2 hrs if migraine recurs
- Imigran, Sumagran
-
Donepezil
- 5-10mg D (bedtime)
- Anticholinesterase
- Aricept
-
Galantamine
- 8-16mg D (mane, max 24mg)
- anticholinesterase
- Reminyl, Galantyl
-
levonorgestrel + ethinyloestradiol
- 100mcg levo, 20mcg ED - microgynon, loette, microlevlen
- 150mcg levo, 30mcg - microgynon, levlen, monofeme, nordette
-
Oestradiol
monorest, femtran, estraderm, climara
-
standard doses of SSRIs
- 10mg escitalopram
- 20mg citalopram, fluoxetine, paroxetine
- 50mg sertraline
- 50-100mg fluvoxamine
dose may be higher in OCD or eating disorders (vs. for depression or anxiety)
-
citalopram
20mg D (max 60mg)
Cipramil
-
Escitalopram
10mg D (max 20mg D)
Lexapro
-
Fluoxetine
20mg D (max 60mg D)
longer t1/2
Lovan, Prozac
-
Fluvoxamine
50mg D, titrate to effect (max 100-300mg D)
nocte of somnolence exp'd
Luvox, Movox
-
Paroxetine
20mg D (max 50mg D)
short t1/2 - more likely to exp withdrawal fx
Aropax
-
Sertraline
50mg D (max 200mg D)
Zoloft, Eleva
-
amitriptyline
- depression: 75-150mg D (max 300mg D)
- pain mgt, migraine p'laxis: 10-25mg N (max 75 in migraine, 150mg pain)
- Urge incontinence: 10-25mg D-TDS
- Endep
-
TCAs - dose in major depression
75-150mg D (max 300mg D, except nortriptyline - max 150mg D)
-
TCAs indicated in things other than depression
- amitriptyline, nortriptyline, imipramine - nocturnal enuresis, urge incontinence
- (amitriptyline also indicated for pain mgt, migraine p'laxis)
-
Dothiepin
75-150mg D (max 300mg)
Prothiaden, Dothep
-
Nortriptyline
- maj depression: 75-150mg D (max 150mg)
- nocturnal enuresis: 10-20mg nocte
- urge incontinence: 10-25mg D-TDS
- Allegron
-
Desvenlefaxine
50mg D (max 200mg D)
- major metabolite of venlefaxine
- SNRI
Pristiq
-
duloxetine
30-60mg D
- SNRI
- indications: major depression, GAD, painful diabetic peripheral neuropathy
Cymbalta
-
Mirtazapine
15-45mg nocte (max 60mg)
- tetracyclic antidepressant
- post-synaptic blockade of 5HT2 & 3 Rs, presynaptic blockade of central A2 autoRs
Axit, avanza, mirtazon
-
moclobemide
450-600mg D (in 1-2 doses, usual max 600mg D)
- indications: depression and anxiety
- selective MAO-A-i - inc presynaptic conc's of 5HT, dopamine, NA - take doses no later than early afternoon
- low tyramine diet not required
aurorix
-
venlefaxine
75-150mg D, sometimes 225mg (max 300mg)
hypertension - may be exacerbated, monitor BP when starting
Efexor
-
monitoring for antipsychotics
- weight
- blood gluclose
- BP
- lipids
- FBCs
- LFTs
-
chlorpromazine
- AP: 25-100mg TDS - QID (max 1000mg D)
- acute beh dist: 50-100mg q2h PRN (max 500mg D)
indications: antipsychotic, ST mgt of anxiety/agitation/disturbed beh, intractable hiccup
ADR: photosensitivity, contact dermatitis on contact with soln
largactil
-
clozapine
usually 200-600mg D (max 900mg)
monitoring: neutrophils, WBCs
caffeine and smoking - affect dose
Clopine
-
Haloperidol
- chronic psychoses: 1-5mg BD-TDS (max 30mg D); 0.5-10mg D in elderly (EPSE)
- acute psychoses and mania: 5-10mg q2h PRN
indications: acute and chronic psychoses. acute mania, severe anxiety/agitation/beh disturbance
Serenace
-
Olanzapine
- schizophrenia: 10-20mg D
- acute mania and MD in bipolar: 2-20mg D
indications: schizophrenia, bipolar (adjunct to Li/valproate)
- common ADR: hyperglycaemia, T2DM, wt gain, p oedema, constipation
- EPSE infrequent
Smoking - affect levels
Zyprexa
-
Quetiapine
300-800mg D, lower doses generally required for bipolar than schizophrenia
- schizophrenia:
- IR: 150-800mg BD, usual effective dose 400-800mg BD
- CR: 400-800mg D
- bipolar:
- IR: 300-800mg D (in 2 doses)
- CR: 300-800mg D
indications: schizophrenia, monotherapy/adjunct in bipolar (to lithium/valproate), adjunct in major depression
- common: tachycardia, constipation, somnolescence
- infrequent: inc ALT/ALP, wt gain, neutropenia
Seroquel
-
Risperidone
- schizoprenia, bipolar (acute mania): usual range = 4-6mg D (po), 25-50mg q2weeks (im)
- behaviour dist in demetia: 0.25-1mg BD
Risperdal, Risperdal Consta (im)
-
Lithium
250-1000mg D (in divided doses - BD if CR product) (max 2500mg D)
hyponatraemia (e.g. dehydration, low Na diet) - inc risk of toxicity
toxicity = blurred vision, extreme thirst, frequent urination, n/v/d - tell pt!, esp during illness/excessive sweating/low fluid intake
avoid urinary alkalinisers- decreases potency
TDM: 0.4-1mmol (prophylaxis)
monitoring: TSH, ECG, electrolytes, LFT, FBC
- Lithicarb (250mg IR)
- Quilonum (450mg CR)
-
Alprazolam
0.5-4mg D (max 10mg D - panic disorder)
Kalma, Xanax
-
Diazepam
- depends on indication
- anxiety, agitation, parasomnia: 1-10mg TDS PRN
Valium, Antenex
indications: ST mgt of anxiety, agiation, acute EtOH withdrawaal, muscle spasm, benzo withdrawal
-
flunitrazepam
0.5-2mg nocte
Hypnodorm
-
-
nitrazepam
5-10mg nocte
Alodorm, Mogadon
-
oxazepam
7.5-30mg nocte (3-4 times daily for anxiety)
Serepax, Murelax
-
temazepam
5-20mg nocte
normison
-
zolpidem
5-12.5mg nocte
- Stilnox
- 6.25mg, 12.5mg CR
- 10mg IR
-
zopiclone
3.75-7.5mg nocte
Imovane
-
atomoxetine
- approx 1mg/kg/day (1.2mg/kg) - give as a single dose mane, or m and late afternoon (max 100mg D)
- MOA: inhibits presynaptic NA reuptake
- ADHD
- common: GI fx, inc BP, somnolescence, aggression
- rare: suicidal thoughts/behaviours, hepatic dysfn
- couselling: L1 + GP for signs of hepatotoxicity (yellowing of skin/eyes, dark urine, tiredness, pale faeces)
- Strattera
-
dexamphetamine
- child: 2.5-10mg D
- adult: 10mg m, titrate up to 60mg D (divided doses)
- MOA: enhances dopaminergic and NA NT
- indications: ADHD, narcolepsy
- avoid taking doses after early afternoon
- no brand
-
methylphenidate
- 5-40mg D in divided doses (unless LA prep) (max 60mg in adults)
- 5-10mg daily, titrate to effect (max 40mg D) (<10mg D in 1-2 doses. >10mg D in 2-3 doses)
- MOA: enhance NA and dopaminergic neurotransmission
- indications: ADHD, narcolepsy
- avoid taking doses after early afternoon
- IR: ritalin
- LA: Concerta, Ritalin LA
-
acamprosate
- adult >60kg: 2 tabs TDS
- adult <60kg: 2 tabs m, 1 midi, 1 n
- tablet = 333mg
- MOA: reduces cravings, GABA analogue
- indications: maintain abstinence in alcohol dependence
- preferred when opiods used for pain
- Campral
-
disulfuram
- MD: 200mg D (max 300mg D)
- deters EtOH use - blocks acetylaledhyde - prevents usual metabolism of alcohol --> unpleasant effects if EtOH consumed (flushing, sweatgin , n+v, palpitations, dyspnoea, etc.)
- indications: maintenance of abstinence
- precautions: IHD (C/I), isoniazid and metronidazole inc's risk of toxic reactions
- referral: jaundice sx, AVOID ETOH (inc. alcohol containing aftershaves, body lotions, vinegar, etc.) during tx and 7 days after
- Antabuse
-
naltrexone
- 50mg once D
- MOA: opiod antagonist - reduces cravings and pleasurable fx
- adjust in tx and maintenance of abstinence
- precautions: opiod tx, imp liver fn
- monitor: LFTs (esp. bilirubin)
-
bupropion
- 150mg m (3 days), then 150mg BD for 7-9 weeks
- 150mg m in elderly
- take medication for at least a week before you stop smoking - takes this long for it to be effective
- inhibits dopamine and NA reuptake
- may exacerbate schizophrenia, dep, bipolar, seizure
- ADRs: INSOMNIA, agitation, tremor, fever, rash, dry mouth, constipation, tachy (infreq.)
- stop taking if not markedly helpful
- Zyban
-
nicotine - dose form choice
- MI/unstable angina/IHD - do not use
- GORD - avoid gum/lozenge
- denture work - avoid gum
- asthma - avoid use of inhaler
- skin cond - avoid patch
- pregnancy - short acting products preferred, remove patch at night if using
- breastfeeding - short acting product after feed
- ADRs: nicotine - sleep disturbance, vivid dreams (esp 24 hr patch), dizziness, wt gain, headache; lozenge/gum - irritation of throat, mouth, sinusitis; patch - redness, itch, rash
-
nicotine - doses (high dependence)
- Tx duration - 12 weeks (6-8 wks most ppl)
- gum: 6-10 pieces of 4mg gum D, avoid >1 piece/hr; taper o/ 3months; each piece lasts about 30 mins, can be cut if too bulky/tapering dose, excessive chewing = salivation = indigestion
- inhaler - 6-12 cartridges D (10mg)
- lozenge: 1 q1-2h (max 15/24h for 2 and 4mg, 20/24h for 1.5mg) - dissolve in mouth, do not chew/swallow, try not to eat or drink with lozenge
- patch: 1 D (stop w/in 12 wks)
- s/l tab: 1-2 q1-2h (max 40 tabs/d) - apply to upper body
-
varenicline
- initially 0.5mg D for 3 dya, then 0.5mg BD for 4 days, then 1mg BD for 11 weeks (i.e. 12 week tx)
- start 7-14 days before stopping
- if successful in stopping smoking by the last week, consider reducing to 1mg m for the last 2 weeks, then stopping - (insomnia, craving by some after sudden stopping)
- NO NRT!! - worsen n + headache
- MOA: partial agonist at nicotinic Rs - reduces pleasurable fx of smoking and prevents withdrawal
- precaution: psychiatric condition may be worsened; use w/ NRT - may inc. risk of NAUSEA, headache, dizziness, dyspepsia
- Common: NAUSEA, sleep disorder, constipation
- Champix
-
buprenorphine
- usu 12-24 mg D (start with 4mg s/l m; max 32 mg D)
- MOA: partial opioid R agonist - reduces cravings and withdrawal symptoms
- contraindicated if currently intoxicated - delay dose until resolved (will further depress respiration)
- use non-opioid analgesics if possible/consider methadone
- common: constipation, hypotension
- opioids, methadone >30mg, alcohol, benzos (esp during start) - risk ppting withdrawal; give at least 6 hrs after last use (ideally when some sx of withdrawal present - usu 1-4hrs)
- may be possible to admin double dose on alternate days
- subutex (0.5, 2, 8mg tabs)
- suboxone (2/0.5, 8/2mg) - ie: 4:1 ratio
-
methadone
- MD: 60-80mg D (12-16mL) (start at 20-30mg D)
- C/I if currently intoxicated - further resp dep
- ADR: prolong QT (rare, pot from high dose), drowsiness (start, dose inc.)
- may take days to feel effects - don't use
- higher than standard opioid doses for analgesia
- Biodone
-
eformoterol
- 6-12mcg BD (max 48mcg D)
- w/ Budesonide (symbicort)
- MD: 1-2 BD
- sx relief: 1 PRN (max 6), if sx recur (max 12)
- Oxis
-
salbutamol
- 1-2 PRN or 5-15 mins before exercise
- repeat TDS-QID as necessary, higher in exacerbations
- 100mcg/dose MDI
- 2.5mg, 5mg nebs
Asmol, ventolin, airomir
-
salmeterol
50mcg BD (max 100mcg BD in severe disease)
- combination with fluticasone (Seretide)
- MDI (25mcg S) - 2 puffs BD (50, 125, 250mcg F)
- DPI (50mcg S) - 1 puff BD (100, 250, 500mcg F)
COPD: 50mcg BD
- Serevent accuhaler (50mcg/dose)
- Seretide (w/ F)
-
Terbutaline
- 500mcg PRN or 5-15 mins before exercise
- rpt TDS-QID PRN
acute: 4 puffs (repeat after 4 mins until ambulance arrives)
Bricanyl (DPI, inj)
-
ipratropium
- MDI: 2 puffs (40mcg) TDS-QID PRN
- neb: 250-500mcg TDS-QID PRN
acute: MDI with spacer - 6 puffs (120mcg) OR 500mcg neb q2h WITH SALBUTAMOL
- admin: dilute solution for nebulisation with 2-3mL saline
- refer: eye pain/discomfort/halos
- MDI: 20mcg/dose
- neb: 250mcg, 500mcg
Atrovent
-
tiotropium
18mcg via HandiHaler mane
spiriva
-
theophylline
- MD: max 900mg D - dose deps on response and level
- indications: maintenance in SEVERE asthma and COPD
- TDM 10-20mg/L
- with food
- Nuelin SR (200, 250, 300mg tabs), syrup (50% sugar)
-
prednisolone (for asthma)
1mg/kg 1 D, then taper
-
Budesonide
- 100-400mcg BD (adult)
- Pulmicort (DPI 100, 200, 400mcg/dose); neb 0.5mg, 1mg
-
Fluticasone
100-200mcg BD (refer when >800mcg D req'd)
- Flixotide
- Jr = 50mcg/dose
- MDI = 125, 250mcg
- DPI = 100, 250, 500mcg
- neb = 0.5, 2mg
-
codeine (for cough)
15-30mg 3-4 times D
-
dextromethorphan (for cough)
- 10-20mg q4h OR 30mg TDS-QID (max 120mg D)
- NB: Serotonin toxicity
-
-
pholcodeine
- 10-15mg 3-4 times D
- Duro-Tuss Dry (reg 1mg/mL; forte 3mg/mL)
-
ADT booster
diptheria and tetanus
-
Dukoral
cholera vaccine (oral)
-
Boostrix
diptheria, tetanus, pertussis vaccine
-
Hiberix
H influenzae type B vaccine
-
-
Priorix
measles, mumps, rubella
|
|