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Pharmskills Online - Clinical Report - Reports Database

ReportCodeAgent
AA0001LOOK FOR C & S RESULTS
BB0001STEROID THERAPY
STEROID THERAPY
BB0002TPN THERAPY
TPN HAS STARTED. MONITOR NUTRITIONAL STATUS
BB0003PPN
PPN HAS STARTED. MONITOR NUTRITIONAL STATUS
CC0001WARFARIN (COUMADIN)
MONITOR INR, PT OR PTT
CC0002PHYTONEDIONE 10MG (VIT K)
MONITOR INR, PT OR PTT
CC0003ASPIRIN
MONITOR INR, PT OR PTT
CC0004CLOPIDOGREL (PLAVIX)
MONITOR INR, PT OR PTT
CC0005ENOXAPARIN (LOVENOX)
MONITOR INR, PT OR PTT
CC0006HEPARIN SQ
MONITOR INR, PT OR PTT
CC0007CILOSTAZOL (PLETAL)
MONITOR INR, PT OR PTT
CC0008DIPYRIDAMOLE (PERSANTINE)
MONITOR INR, PT
CC0009AGGRENOX (ASA,DIPYRIDAMOLE)
MONITOR INR,PT
CC0010AGGRASTAT AND TIROFIBAN
MONITOR PLATELETS. IF WITH HEPARIN, MONITOR PTT. PLATELETS <90 MAY REQUIRE INTERRUPTION/DC. CHECK HGB/HCT 6 HOURS AFTER STARTING
DD0001DIABETIC MEDICATION
DD0002ATYPICAL ANTIPSYCHOTIC
MONITOR FOR HYPERGLYCEMIA
DD0099SLIDING SCALE INSULIN
TOTAL DOSES GIVEN IN PAST 24 HOURS
FF0001VITAMIN K FOODS
AVOID FOODS WITH HIGH LEVELS OF VITAMIN K.
FF0003FOOD DELAYS RESPONSE
TAKE ON AN EMPTY STOMACH FOR RAPID RESPONSE
FF0004EMPTY STOMACH
TAKE ON AN EMPTY STOMACH 1 HOUR BEFORE MEALS OR 2 HOURS AFTER MEALS
FF0005AVOID HIGH PROTEIN MEALS
PROTEIN SHOULD BE DISTRUBUTED THROUGHOUT THE DAY.
FF0007CAFFEINE
CAFFEINE MAY DECREASE EFFECTIVENESS. AVOID CAFFEINE USE.
FF0008ADMIN. CONSISTENTLY
FOOD MAY INCREASE CONCENTRATIONS. TAKE CONSISTENTLY WITH FOOD OR ON EMPTY STOMACH.
FF0009DAIRY FOODS
DAIRY FOODS REDUCE ABSORPTION. TAKE 1 HR BEFORE OR 2HR AFTER DAIRY FOODS.
FF0010POTASSIUM FOODS
USE WITH POTASSIUM RICH FOODS MAY RESULT IN HYPERKALEMIA
FF0011GRAPEFRUIT JUICE
DESCRIPTION WHILE ON THIS DRUG AVOID GRAPEFRUIT AND GRAPEFRUIT JUICE.
FF0013OXALIC ACID FOODS
OXALIC ACID FOODS MAY RESULT IN DECREASED EFFECTIVENESS. AVOID OXALIC ACID FOODS.
FF0015AVOID CAFFEINE
CAFFEINE CONCENTRATIONS MAY BE INCREASED RESULTING IN INCREASED CNS STIMULATION. AVOID USE.
FF0016TYRAMINE FOODS
TYRAMINE FOODS MAY RESULT IN INCREASED BLOOD PRESSURE. AVOID TYRAMINE FOODS.
FF0017ENTERAL NUTRITION
ENTERAL NUTRITION MAY RESULT IN DECREASED CONCN.
FF0018AVOID HIGH LIPID MEALS
HIGH FAT FOODS MAY RESULT IN INCREASED DRUG CONCENTRATIONS OR DECREASED DRUG ABSORPTION. AVOID HIGH FAT MEALS.
FF0019DOPAMINE FOODS
DOPAMINE FOODS MAY RESULT IN INCREASED BLOOD PRESSURE. AVOID DOPAMINE FOODS.
FF0020CRANBERRY JUICE
AVOID ALL CRANBERRY JUICE PRODUCTS WHILE ON THIS MEDICATION
FF0021HIGH ALKALINE FOODS A ABSORP
HIGH ALKALINE FOODS INCREASE SERUM CONCHS.
FF0022INSULIN RELEASE DELAY
WHEN TAKEN WITH FOOD INSULIN RELEASE MAY BE DELAYED. TAKE MEDICATION ON AN EMPTY STOMACH BEFORE MEALS.
FF0023>30MIN P SAME MEAL QD
TAKE 30MIN AFTER SAME MEAL EACH DAY
FF0024ALUMINUM-CONTAINING ANTACIDS
DO NOT TAKE WITHIN 3-4 HOURS OF ALUMINUM CONTAINING ANTACIDS
FF0025ZINC
AVOID FOODS HIGH IN CALCIUM,PHOSPHOROUS OR PHYTATE
FF0026ALCOHOL (ETHANOL)
AVOID ALCOHOLIC BEVERAGES WHILE ON THIS DRUG.
FF0027TAKE WITH FOOD
TAKE THIS DRUG WITH FOOD.
FF0028MAY TAKE WITH FOOD IF GI UPSET
MAY TAKE THIS DRUG WITH FOOD IF GI SIDE EFFECTS OCCUR
FF0029TAKE 30 MIN BEFORE MEALS
TAKE THIS DRUG 30 MINUTES BEFORE MEALS
FF0030CARAFATE
TAKE CALCIUM OR MAGNESIUM 30 MINUTES BEFORE CARAFATE
FF0031ALENDRONATE ON EMPTY STOM
TAKE FOSAMAX 30MIN BEFORE FIRST BITE OF FOOD, BEVERAGE, OR DRUG OF THE DAY. SIT UP FOR 30 MINUTES AFTER TAKING FOSAMAX
FF0032FIRST BITE
TAKE THIS DRUG WITH THE FIRST BITE OF EACH MEAL
FF0033TAKE WITH WATER ONLY
TAKE THIS DRUG WITH WATER ONLY. NO GRAPEFRUIT, ORANGE OR APPLE JUICE.
FF0034GIVE PACKAGE INSERT WHEN COUNS
FF0035PED TAKE WITH FOOD
PEDIATRIC PATIENTS TAKE WITH FOOD
FF0036HIGH FIBER
AVOID ADMINISTRATION WITH HIGH FIBER MEALS
HH001ATORVASTATIN (LIPITOR)
BASELINE LFT, REPEAT , 6, 12 WEEKS P INITIATION OR ADOSE, THEN Q6MONTHS.IF LFT>3 TIMES ULN, DECREASE DOSE OR STOP. ABNORMALITIES USUALLY OCCUR IN FIRST 3 MONTHS OF TX.
HH0002FLUVASTATIN (LESCOL,LESCOL XL)
BASELINE LFT AT 12 WEEKS AFTER INITIATION OR DOSE INCREASE. IF LFT INCREASE, REPEAT TESTS UNTIL RETURN TO NORMAL. IF >3 TIMES ULN OCCURS AND PERSISTS, STOP DRUG. ABNORMALITIES USUALLY OCCUR IN FIRST 3 MONTHS.
HH0003LOVASTATIN (MEVACOR,ALTOCOR)
BASELINE LFT AT 6, 12 WEEKS AFTER INITIATION OR DOSE INCREASE. IF LFT INCREASE, REPEAT TESTS UNTIL RETURN TO NORMAL. IF >3 TIMES ULN OCCURS AND PERSISTS, STOP DRUG. ABNORMALITIES USUALLY OCCUR IN FIRST 3-12 MONTHS.
HH0004PRAVASTATIN (PRAVACHOL)
BASELINE LFT AT 6, 12 WEEKS AFTER INITIATION OR DOSE INCREASE & AT 6 MONTHS. IF LFT INCREASE, REPEAT TESTS UNTIL RETURN TO NORMAL. IF >3 TIMES ULN OCCURS AND PERSISTS, STOP DRUG.
HH0005ROSUVASTATION (CRESTOR)
BASELINE LFT AT 2, 12 WEEKS AFTER INITIATION OR DOSE INCREASE & Q6 MONTHS. IF LFT INCREASE, REPEAT TESTS UNTIL RETURN TO NORMAL. IF >3 TIMES ULN OCCURS AND PERSISTS, STOP DRUG. ABNORMALITIES USUALLY OCCUR IN FIRST 3 MONTHS.
HH0006SIMVASTATIN (ZOCOR)
BASELINE LFTS.REPEAT AT 6,12 WEEKS AFTER INITIATION OR DOSE INCREASE & THEN Q6 MONTHS UNTIL 1 YEAR AFTER LAST DOSE. INCREASE FOR PT ON 80MG DAILY, CHECK LFTS AFTER FIRST 3 MONTHS. IF LFTS INCREASED, SECOND TEST SHOULD BE OBTAINED. REPEAT LFTS UNTIL RETURN TO NORMAL. IF >3 TIMES ULN, STOP DRUG
HH0007GEMFIBROZIL (LOPID)
BASELINE LFTS,Q3MONTHS FOR 1 YEAR, THEN PERIODICALLY. IF ABNORMALITIES EXIST, STOP DRUG.
HH0008FENOFIBRATE (TRICOR)
REGULAR PERIODIC MONITORING FOR DURATION OF THERAPY. IF LFTS ARE >3 TIMES ULN, STOP DRUG.
II0001IV TO PO CONVERSION
DRUGS TARGETED FOR IV-TO-PO CONVERSION
LL0002RT MEDS INTERACTION REPORT
PHARMACY AND RT VERIFY FOR ANY DUPLICATIONS FOR INHALERS AND NEBULIZER TREATMENTS. INTERVENE AS NECESSARY
PP0001PAIN MED CLINICAL MONITORING
MONITOR PAIN MED USAGE
PP0002MUSCLE RELAXANT
MONITOR PAIN MED USE. INTERVENE PRN
PP0003PAIN MANAGEMENT ADJDNCT MED
MONITOR PAIN MED USAGE
RR0001ACETAMINOPHEN (TYLENOL)
NORMAL DOSE: 325-650MG Q4-6H PRN MAX DOSE=4GM DAILY. IF CRCL=50-10, DOSE Q6H. IF CRCL<10, DOSE QSH (METABOLITES ACCUMULATE)
RR0002ALLOPURINOL (ZYLOPRIM)
NORMAL DOSE:200-300MG DAILY X2-3 DOSES. INCREASE FOR CANCER,SEVERE GOUT. CRCL=140, 400MG DAILY. CRCL=120, 350MG DAILY. CRCL=100,300MG DAILY. CRCL=80, 250MG DAILY. CRC=60, 200MG DAILY. CRCL=40, 150MG DAILY. CRCL=20,100MG DAILY. CRCL=10,100MG EVERY 2DAYS. CRCL=O, 100MG EVERY 3DAYS. BASED ON 300MG DAILY IF CRCL=100.
RR0003ASPIRIN
NORMAL DOSE:325-650MG Q4-6H CRCL<10, AVOID USE.
RR0004ATENOLOL (TENORMIN)
NORMAL DOSE:50-100MG DAILY IF CRCL=15-35, 50MG DAILY MAX IF CRCL<15, 50MG EVERY 2 DAYS MAX OR-CRCL=10-50, 50% OR Q48H CRCL <10, 30-50% OR Q 96H
RR0005BENAZEPRIL (LOTENSIN)
NORMAL DOSE:20-40MG DAILY. IF CRCL<30: 5MG DAILY. MAY INCREASE TO CONTROLLED BP OR 40MG MAX. OR CRCL = 10-50, 50-75% OF DOSE <10 CRCL = 25-50% OF DOSE
RR0006BISOPROLOL (ZEBETA)
NORMAL DOSE:5-20MG DAILY IF CRCL<40, INITIAL 2.5MG OR, CRCL= 10-50, 75%; CRCL= <10, 50% ALSO DECREASE DOSE IN HEPATIC IMPAIRMENT
RR0007BUSPIRONE (BUSPAR)
NORMAL DOSE:15-60MG DAILY IF ANURIC, REDUCE DOSE 25-50%
RR0008CAPTOPRIL (CAPOTEN)
NORMAL DOSE:25-150MG TID. MAX=450MG DAILY IF CRCL<50M REDUCE DOSE 50-75% OR, CRCL = 10-50, 75% OF DOSE CRCL = <10, 50% OF DOSE
RR0009CARBAMAZEPINE (TEGRETOL)
NORMAL DOSE:200MG BID INIT. 800-1200MG DAILY HAINT. IF CRCL<10, 75% OF NORMAL DOSE.
RR0010CELECOXIB (CELEBREX)
NORMAL DOSE:100MG BID IF ADVANCED RENAL DISEASE, MONITOR RENAL FUNCTN.
RR0011CHLORDIAZEPOXIDE (LIBRIUM)
NORMAL DOSE:15-100MG DIVIDED 3-4TIMES /DAY. IF CRCL< 10M GIVE 50% OF DOSE.
RR0012CIMETIDINE (TAGAMET)
NORMAL DOSE:400MG PO BID IF CRCL 20-40: Q8H OR 75% IF CRCL<20: Q12H OR 50% OR, CRCL = 10-50%, 50% CRCL = <10, 25%
RR0013CITALOPRAM (CELEXA)
NORMAL DOSE: 20-40MG DAILY IF CRCL <20: AVOID
RR0014CLONIDINE (CATAPRES)
NORMAL DOSE:0.2-1.2MG DAILY IN 2-4 DIVIDED DOSES. MAX 2.4MG DAILY IF CRCL<10: 50-75%
RR0015DIFLUNISAL (DOLOBID)
NORMAL DOSE:250-500MG BID IF CRCL<50: GIVE 50% OF NORMAL DOSE OR, CRCL =10-50%, 50% OF NORMAL DOSE CRCL < 10, GIVE 50% OR LESS
RR0016DIGOXIN (LANOXIN)
NORMAL DOSE: 0.125-2.5MG DAILY IF CRCL 50-10:25-75% OR Q36H. IF CRCL<10:10-25% OR Q48H
RR0017DILTIAZEM (CARDIZEM,DILACOR)
USE CAUTION:MET BY LIVER, EXCRETED BY KIDNEYS
RR0018DISOPYRAMIDE (NORPACE)
NORMAL DOSE: 100MG Q6H OR 200MG CR Q12H IF CRCL 30-40:Q8H IF CRCL 15-30:Q12H IF CRCL <15: Q24H
RR0019ENALAPRIL(VASOTEC)
NORMAL DOSE: 5-40MG DAILY PO, 1.25MG Q6H OVER 5 MIN IF CRCL 30-80: START 5MG DAILY, MAX 40MG DAILY IF CRCL <30: START 2.5MG DAILY, OR, CRCL = 10-50, 75% OF DOSE CRCL < 10, 50% OF DOSE
RR0020ENOXAPARIN (LOVENOX)
NORMAL DOSE: BY INDICATION, SEE DRUG INFO IF CRCL<30:PROPH ABD SURG,HIP/KNEE,MED.ILL:30MG DAILY TX UA/MI,INPT DVT/PE, OP DVT:IMG/KG DAILY
RR0021FAMOTIDINE (PEPCID)
NORMAL DOSE:20-40MG BID-QID IF CRCL <50 DECREASE DOSE BY 50% OR INCREASE INTERVAL TO Q 36-48 HOURS
RR0022FENOFIBRATE (TRICOR)
NORMAL DOSE: 67-201MG DAILY IF RENAL FAILURE, AINTERVAL OR DECREASE DOSE
RR0023FEXOFENADINE (ALLEGRA)
NORMAL DOSE: 60MG BID IF CRCL<50, START AT 60MG DAILY, THEN TITRATE TO EFFECT. OR, CRCL =10-50, Q12-24H CRCL = <10, Q 24 HRS
RR0024GABAPENTIN (NEURONTIN)
NORMAL DOSE: 300-600MG Q8H IF CRCL>60, 1200MG DAILY MAX, IF CRCL 30-60, 600MG DAILY IF CRCL 15-30, 300MG DAILY,IF CRCL < 15, 150MG DAILY OR, CRCL 10-50, 300MG Q 12-24 HRS CRCL < 10, 300MG EVERY OTHER DAY
RR0025GLYBURIDE (GLYNASE, DIABETA)
NORMAL DOSE:2.5-6MG Q24H MAY DIVIDE DOSES MAX 20MG DAILY IF CRCL<50: NOT RECOMMENDED
RR0026HCTZ (HYDRODIURIL)
NORMAL DOSE:25-100MG DAILY IF CRCR<50, AVOID USE
RR0027HYDRALAZINE (APRESALINE)
NORMAL DOSE:12.5-50MG QID. IF CRCL 10-50: Q8H. IF CRCL<10: Q8-16H FAST ACETYLATORS, Q12-24H SLOW ACETYLATOR OR, CRCL<10, GIVE Q 8-16 HRS
RR0028LISINOPRIL (ZESTRIL, PRINIVIL)
NORMAL DOSE:10-40MG DAILY. IF CRCL 10-50: 50-75% OF NORMAL DOSE. IF CRCL<10: 25-50% OF NORMAL DOSE
RR0029MAGNESIUM
CRCL<25: MONITOR SERUM MAG LEVELS
RR0030METFORMIN (GLUCOPHAGE)
NORMAL DOSE:500-850MG TID(MEALS) UP TO 2500MG DAILY. IF SCR>1.5 (MALES) OR 1.4 (FEMALES) DO NOT USE. TEMP DC WHEN GETTING IODINATED CONTRAST FOR RADIOLOGIC PROC. AVOID IN PTS OVER 80 UNLESS CrCl NORMAL
RR0031LEVOFLOXACIN (LEVAQUIN)
NORMAL DOSE:500MG IV OR PO DAILY. IF CRCL 20-49: 250MG Q24H. IF CRCL 10-19: 250MG Q48H OR, CRCL 10-50, 500MG INITIAL, THEN 250MG Q 24-48H. CRCL<10, 500MG INITIAL, THEN 250MG Q 48HRS
RR0032METOCLOPRAMIDE (REGLAN)
NORMAL DOSE:10MG AC &HS. IF CRCL 10-40: GIVE 50% OF DOSE. IF CRCL <10: GIVE 25% OF DOSE OR, CRCL =10-50, 75% OF DOSE CRCL < 10, GIVE 50% OF DOSE
RR0033METRONIDAZOLE (FLAGYL)
NORMAL DOSE:500-750MG TID-QID IV/PO. IF CRCL <10: GIVE Q12H
RR0034MORPHINE SULFATE
IF CRCL 10-50: GIVE 75% OF USUAL DOSE. IF CRCL <10: GIVE 50% OF USUAL DOSE
RR0035PENTAZOCINE (TALWIN)
USUAL DOSE:IM/SC:30-60MG Q3-4H 360MG/DAY MAX. IV:30MG Q3-4H. PO:50-100MG Q3-4H MAX:600MG QD. IF CRCL 10-50:GlVE 75% USUAL DOSE. IF CRCL <10: GIVE 50% USUAL DOSE
RR0036PRIMIDONE (MYSOLINE)
USUAL DOSE:INIT:125-250MG HS. A TO 750-1500MG TID-QID. MAX DOSE:2GM DAILY. IF CRCL 50-80: GIVE Q8H. IF CRCL 10-50: GIVE Q8-12H. IF CRCL <10: GIVE Q12-24H
RR0037PROPOXYPHENE (DARVON,DCN-100)
USUAL DOSE: HCL SALT:65MG Q3-4H PIN MAX 390MG DAILY. NAPS. SALT: 100MG Q4H PRN MAX:600MG DAILY. IF CRCL<10: AVOID USE
RR0038PROPRANOLOL (INDERAL)
USUAL DOSE BASED ON INDICATION SEE DIH. IF CRCL 31-40: GIVE 50% OR Q24-36H. IF CRCL 10-30: GIVE 50% OR Q24-48H. IF CRCL <10: GIVE 25% OR Q40-60H *NOTE , RENAL BOOK LISTS 100% AT ALL PHASES EXCEPT ESRD*
RR0039QUINIPRIL (ACCUPRIL)
USUAL DOSE:INIT:10-20MG DAILY MAINT:20-80MG DAILY IF CRCL >60, INIT AT 10MG DAILY IF CRCL 30-60: INIT 5MG DAILY IF CRCL 10-30: INT 2.5MG DAILY IF CRCL <10 INSUFF DATA TITRATE ALL DOSES TO RESPONSE
RR0040QUININE
USUAL DOSE: 260-650MG Q8H OR 325MG BID OR 650MG Q6-8H OR 200-300MG HS IF CRCL 10-50: Q8-12H OR 75% IF CRCL <10: Q24H OR 30-50%
RR0041RAMIPRIL (ALTACE)
USUAL DOSE: 2.5-5MG PO DAILY IF CRCL <40: 25% OF USUAL DOSE OR, CRCL =10-50, 50-75% OF DOSE CRCL<10, 25-50% OF DOSE
RR0042RANITIDINE (ZANTAC)
USUAL DOSE: IV: 50MG Q6-8H PO:150MG BID OR 300MG HS MAX: 600MG DAILY IF CRCL 10-50; 75% OR Q18-24H, CRCL<10;50% OR Q18-24H RENAL BOOK; CRCL 10-50, 50%; CRCL <10, 25% OF DOSE
RR0043RISPERIDONE (RISPERDAL)
USUAL DOSE: INIT:1MG BID MAINT:4-6MG DAILY IF RENAL IMPAIRED: INIT:0.5MG BID TITRATE
RR0044SPIRONOLACTONE (ALDACTONE)
USUAL DOSE: VARIES BY INDICATION IF CRCL 10-50: GIVE Q12-24H IF CRCL<10: AVOID USE
RR0045TERBUTALINE (BRETHINE)
USUAL DOSE: 5MG Q6H FOR 3X DAILY MAX DAILY DOSE:15MG IF CRCL 10-50: GIVE 50% IF CRCL <10: AVOID USE
RR0046CEFUROXIME AXETIL (CEFTIN)
USUAL DOSE: 250-500MG BID UNCOMPLICATED UTI:125-250MG Q12H IF CRCL 10-20: Q12H IF CRCL<10: Q24H OR, CRCL =10-50, Q 8-12H CRCL<10, Q 12HRS
RR0047VERAPAMIL (CALAN, COVERA-HS)
USUAL DOSE:80-120MG TID OR 240MG SR IF CRCL<10: GIVE 50-75%
RR0048SMZ/TMP (BACTRIM DS,CO-TRIMOXA
USUAL DOSE: PO: 1 TAB BID IV:20MG TMP/KG/DAY IN 3-4DOSES IF CRCL 15-30: PO: 1 TAB Q24H IV: 2.5-5MG TMP/KG Q12H IF CRCL <15: PO: AVOID IV: 2.5-5MG TMP/KG Q24H
RR0049SOTALOL (BETAPACE)
USUAL DOSE:80MG BID IF CRCL >60: GIVE Q12H IF CRCL 30-60: GIVE Q24H IF CRCL 10-30: GIVE Q36-48H IF CRCL<10: INDIVIDUALIZE DOSE
RR0050SIMVASTATIN (ZOCOR)
USUAL DOSE:5-80MG HS IF CRCL<10: 5MG HS; CLOSE MONITORING
RR0051AMANTADINE (SYMMETREL)
USUAL DOSE: 100-200MG BID. IF CRCL 50-60: GIVE 200MG QD ALTERNATING WITH 100MG QD. IF CRCL 30-50: 100MG QD IF CRCL 20-30: 200MG BIW. IF CRCL 10-20: 100MG TIW. IF CRCL <10: GIVE 200MG QW ALTERNATING WITH 100MG QW.
RR0052DEMECLOCYCLINE (DECLOMYCIN)
AVOID IF RENAL/HEPATIC DYSFUNCTION
RR0053ALENDRONATE (FOSAMAX)
USUAL DOSE:5-10MG QAM. PAGETS:40MG QAM X6MO. IF CRCL <35: AVOID (LACK OF EXPERIENCE)
RR0054VENLAFAXINE (EFFEXOR)
USUAL DOSE: ID. RELEASE:75MG QD IN 2-3DOSES.MAY INCREASE TO 375MG QD SUS. RELEASE:75MG QD. MAY INCREASE TO 225MG QD IF CRCL 10-70: DECREASE DOSE BY 25%
RR0055SULFASALAZINE (AZULFIDINE)
USUAL DOSE: 2GM QD IN 3-4 DOSES. IF CRCL 10-30: GIVE BID. IF CRCL <10: GIVE QD
RR0056NADOLAL (CORGARD)
USUAL DOSE:INIT:40MG QDABY 40-80MG Q3-7D TO RESPONSE.MAY NEED 160-240MG QD IN ANGINA,240-320MG QD IN HTN IF CRCL 31-40: 50% OR Q24-36H IF CRCL 10-30: 50% OR Q24-48H IF CRCL <10: 25% OR Q40-60H
RR0057FLUOXETINE (PROZAC)
USUAL DOSE: 20MG QD MAY INCREASE TO 80MG QD. IF >20MG, GIVE DIVIDED INTO MORNING AND NOON DOSES. IF SEVERELY RENALLY IMPAIRED, MAY ACCUMULATE
RR0058AMIKACIN (AMIKIN)
USUAL DOSE: 7.5MG/KG Q12H. IF CRCL 50-90: 60-90% Q12H. IF CRCL 10-50: 30-70% Q12-18H. IF CRCL <10: 20-30% Q24-48H
RR0059NETILMICIN (NETROMYCIN)
USUAL DOSE: 2MG/KG Q8H. IF CRCL 50-90: 50-90% Q8-12H. IF CRCL 10-50: 20-60% Q12H. IF CRCL <10: 10-20% Q24-48H
RR0060STREPTOMYCIN
USUAL DOSE: 15MG/KG (MAX 1GM) Q24H. IF CRCL 50-90: 50% Q24H. IF CRCL 10-50: Q24-72H. IF CRCL <10: Q72-96H
RR0061IMIPENEM (PRIMAXIN)
USUAL DOSE: 500MG Q6H. IF CRCL 50-90: 250-500MG Q6-8H. IF CRCL 10-50: 250MG Q6-12H. IF CRCL <10: 125-250MG Q12H
RR0062MEROPENEM (MERONEM)
USUAL DOSE: 1GM Q8H. IF CRCL 26-50: 1GM Q12H. IF CRCL 10-25: 500MG Q12H. IF CRCL <10: 500MG Q24H
RR0063CEFAZOLIN (KEFZOL, ANCEF)
USUAL DOSE: 1-2GM Q8H IF CRCL 10-30: Q12H IF CRCL <10, Q24-48H
RR0064CEFEPIME (MAXIPIME)
USUAL DOSE: 2GM Q12H IF CRCL 30-60: 1 GM Q12H IF CRCL 11-29: 1 GM Q24H IF CRCL <10, 500MG Q 24-48 HRS
RR0065CEFOTAXIME (CLAFORAN)
USUAL DOSE: 1-2GM Q8H IF CRCL 10-50: Q8-12H IF CRCL <10: Q24H
RR0066CEFOTETAN (CEFOTAN)
USUAL DOSE: 1-2GM Q12H IF CRCL 10-30: Q24H IF CRCL <10: Q48H
RR0067CEFTAZIDIME (TAZIDIME,FORTAZ)
USUAL DOSE: 2GM Q8H IF CRCL 30-50: Q12H IF CRCL 10-30: Q24H IF CRCL <10: Q48-72H
RR0068CEFUROXIME (ZINACEF, KEFUROX)
USUAL DOSE: 750-1500MG Q8H IF CRCL 10-20: Q12H IF CRCL <10: Q24H
RR0069CIPROFLOXACIN (CIPRO)
USUAL DOSE: PO: 500-750MG Q12H IV: 400MG Q12H IF CRCL 10-30: 50% OR Q24H IF CRCL <10: 25-50% Q24H
RR0070OFLOXACIN (FLOXIN)
USUAL DOSE: 400MG Q12H IF CRCL 10-50: 200-400MG Q24H IF CRCL <10: 100-200MG Q24H
RR0071CLARITHROMYCIN (BIAXIN)
USUAL DOSE: 500MG -1 GM Q12H IF CRCL <30: 500MG LOAD, THE 250MG QD OR BID OR, CRCL =10-50, 75% OF DOSE CRCL>10, 50% OF DOSE
RR0072ERYTHROMYCIN (EMYCIN,ERY-PED)
USUAL DOSE: 250-500MG Q6H IF CRCL <10: 50-75%
RR0073AMOXICILLIN (AMOXIL,AUGMENTIN)
USUAL DOSE: 250-500 Q8H OR 875MG Q12H IF CRCL 10-50: Q12H IF CRCL <10: Q24H AUGMENTIN 875MG OR ANY ER TAB NOT RECOMMENDED IF CRCL<30
RR0074AMPICILLIN (OMNIPEN,PRINCIPEN)
USUAL DOSE: 250MG-2GM Q6H IF CRCL 30-50: Q6-8H IF CRCL 10-30: Q8-12H IF CRCL <10: Q12H
RR0075AZTREONAM (AZACTAM)
USUAL DOSE: 2GM Q8H. IF CRCL 10-30: 50% OF DOSE-USUAL INTERVAL. IF CRCL <10: 25% OF DOSE-USUAL INTERVAL
RR0076MEZLOCILLIN (MEZLIN)
USUAL DOSE: 3-4GM Q4-6H. IF CRCL 10-30: Q6-8H. IF CRCL <10: Q8H
RR0077PENICILLIN G
USUAL DOSE: 2-24MILLION UNITS QD IN DIVIDED DOSES Q4H IF CRCL 30-50; Q6H IF CRCL 10-30: Q8H IF CRCL <10: Q12H OR CRCL>10, GIVE 20-50% OF DOSE
RR0078PIPERACILLIN (PIPRACIL)
USUAL DOSE: 2-4GM Q4-6H MAX:24GM QD. IF CRCL 20-40: 3-4GM Q8H. IF CRCL <20: 3-4GM Q12H
RR0079PIP/TAZO (ZOSYN)
USUAL DOSE: 3.375GM Q6H. IF CRCL 20-40: 2.25GM Q6H. IF CRCL <20: 2.25GM Q8H
RR0080TICARCILLIN (TICAR)
USUAL DOSE: 3GM IV Q4-6H. IF CRCL 30-60: 2GM Q4H OR 3GM Q8H. IF CRCL 10-30: 2GM Q8H OR 3GM Q12H. IF CRCL <10: 2GM Q12H
RR0081TICAR/CLAV (TIMENTIN)
USUAL DOSE: 3.1GM Q4-6H MAX:24GM QD. IF CRCL 30-60: 2GM Q4H OR 3.1GM Q8H. IF CRCL 10-30: 2GM Q8H OR 3.1GM Q12H. IF CRCL <10: 2GM Q12H
RR0082TETRACYCLINE (SUMYCIN)
USUAL DOSE: 250-500MG Q6H. IF CRCL 50-80: Q8-12H. IF CRCL 10-50: Q12-24H. IF CRCL <10: Q24H
RR0083FLUCONAZOLE (DIFLUCAN)
USUAL DOSE: 200-400MG FIRST DAY, THEN 100-400MG QD IF CRCL 11-50: 50% OR Q48H IF CRCL <10: Q48-72H
RR0084FLUCYTOSINE (ANCOBON)
USUAL DOSE: 50-150MG/KG/DAY IN DIVIDED DOSES Q6H. IF CRCL 50-90: Q12H. IF CRCL 10-50: Q16H. IF CRCL <10: Q24H
RR0085ITRACONAZOLE (SPORINOX)
USUAL DOSE: 100-200MG Q12H. IF CRCL <30: IV NOT RECOMMENDED
RR0086TERBINAFINE (LAMISIL)
USUAL DOSE: 250-500MG PO QD. IF CRCL <50: AVOID. NO DATA
RR0087DOXYCYCLINE
USUAL DOSE: 100-300MG QD. MAY DIVIDE DOSES. IF CRCL <10: 100MG QD.
RR0088ETHAMBUTOL (MYAMBUTOL)
USUAL DOSE: 15-25MG/KG/DAY OR SOMG/KG TWICE WEEKLY. MAX 2. 5G IF CRCL 10-50: Q24-36H IF CRCL <10: Q48H
RR0089ETHIONAMIDE (TRECATOR-SC)
USUAL DOSE: 500-1000MG QD IN 1-3 DIVIDED DOSES. IF CRCL <50: 50%
RR0090ISONIAZID (LANIAZID,NYDRAZID)
USUAL DOSE: 5MG/KG/DAY MAX:300MG. IF CRCL <10: 50%
RR0091PYRAZINAMIDE (TEBRAZID)
USUAL DOSE: 25MG/KG Q24H MAX 2.5GM QD. IF CRCL <50: 10-20MG/KG/DAY OR 40-50NG/KG 3X/WEEK
RR0092RIFAMPIN (RIFADIN)
USUAL DOSE: 600MG QD. IF CRCL 10-50: Q24-48H. IF CRCL <10: Q48H
RR0093ACYCLOVIR (ZOVIRAX)
DOSED PER INDICATION. FOR OTHER INDICATIONS, SEE DIH SHINGLES:IV:10MG/KG/DOSE Q8H PO:250-600MG/M2/DOSE 4-5X QD IF CRCL 25-50:IV 5-10MG/KG/DOSE Q12H IF CRCL 10-25:IV 5-10MG/KG/DOSE Q24H PO:Q8H IF CRCL<10:IV:2.5-5MG/KG/DOSE Q24H PO:Q12H
RR0094CEPHALEXIN (KEFLEX)
USUAL DOSE: 250-1000MG Q6H MAX 4GM QD. IF CRCL 10-40: 250-500MG Q8-12H. IF CRCL <10: 250MG Q12-24H
RR0095ROFECOXIB (VIOXX)
USUAL DOSE:OA:12.5-25MG QD DYSMEN:50MG QD OTHER:50MG QD RENAL ADVERSE EFFECTS INCREASE IF DOSE>25MG QD. AVOID IF SEVERE RENAL DX.
RR0096OSELTAMIVIR (TAMIFLU)
USUAL DOSE: 75MG PO BID X5D. IF CRCL 10-30: 75MG PO QD X5D. IF CRCL <10: AVOID. NO DATA AVAIL ON RENAL FAILURE.
RR0097TOCAINIDE (TONOCARD)
USUAL DOSE:1200-1800MG/DAY IN 3 DIVIDED DOSES.MAX 2400MG QD. IF CRCL <30: 50% OR 600MG QD
RR0098MIDODRINE (PROAMATINE)
USUAL DOSE: 10MG TID DURING DAYTIME HOURS (Q3-4H). IF RENAL IMPAIRMENT: 2.5MF TID, GRADUALLY INCREASED AS TOLERATED.
RR0099ALUMINUM SALTS
IF SEVERE RENAL FAILURE OR ACUTE RENAL FAILURE, MONITOR ALUMINUM SALT USE
RR0100HYDROXYUREA (HYDREA)
NORMAL DOSE:10-30MG/KG/DAY=500-3000MG/DAY. CHK WBC TO ADJUST IF CRCL 10-50: GIVE 50% OF NORMAL DOSE IF CRCL <10: GIVE 20% OF NORMAL DOSE SEE DRUG INFO HANDBOOK FOR DOSE PER INDICATION
RR0101TOLTERODINE (DETROL)
USUAL DOSE: IR:1-2MG BID LA:2-4MG QD. IF CRCL 10-30: IR:1MG BID LA:2M QD
RR0102COLCHICINE
ACUTE GOUT ATTACK:0.5-1.2MG, THEN 0.5-0.6MG Q1-2H TIL GI UPSET OR RELIEF. MAX TOTAL DOSE OF 8MG PER COURSE. PROPHYLAXIX: 0.5-0.6MG QD OR QOD. IF CRCL <50, MAX 0.6MG PO, 2MG IV DAILY TO Q48H IF CRCL <10, CONTRAINDICATED
RR0103COLCHICINE IV
USUAL:1-3MG THEN 0.5MG TIL RELIEF. NOT TO EXCEED 4MG QD. MAY GIVE 1-2MG FOR SEVERAL DAYS, BUT THEN DO NOT GIVE MORE COLCHICINE BY ANY RT FOR 7 DAYS. IF CRCL <50, AVOID CHRONIC USE. IF CRCL <10, DECREASE DOSE BY 50% FOR ACUTE ATTACKS
RR0104GENTAMICIN
DOSE PER PHARMACOKINETICS
RR0105VANCOMYCIN
DOSED PHARMACOKlNETlCALLY
RR0106ACARBOSE (PRECOSE)
NORMAL DOSE:50-200MG TID. IF CRCL <50 AVOID USE
RR0107ACEBUTOLOL (SECTRAL)
USUAL DOSE:400-600MG QD OR BID. MAX DAILY DOSE:1200MG. IF CRCL 10-50: USE 50%. IF CRCL <10: USE 30-50%
RR0108ACETAZOLAMIDE (DIAMOX)
USUAL DOSE: 250MG Q6-12H. MANY SIGS/DOSES, SEE DIH. IF CRCL >50: Q6H. IF CRCL 10-50: Q12H. IF CRCL <10: AVOID
RR0109ALBUTEROL (VENTOLIN)
USUAL DOSE: 2-4MG TID-QID. MAX QD:32MG. IF CRCL 10-50: USE 75%. IF CRCL <10: USE 50%
RR0110AGGRENOX (ASPIRIN/DIPYRIDAMOLE)
USUAL DOSE = 1 CAP BID IF CRCL < 10, NO NOT USE.
RR0111AMPHOTERICIN B (FUNGIZONE)
USUAL DOSE:0.25-1.5MG/KG/DAY. MAX DOSE:1.5MG/KG/DAY IF RENAL IMPAIR FROM AMPHO: CRCL<10: Q24-36H OR 50% OF DOSE
RR0112INAMRINONE(AMRINONE OR INOCOR)
USUAL DOSE BASED UPON CLINICAL RESPONSE:5-10MCG/KG/MIN **DO NOT EXCEED 10MG/KG/24HR** IF CRCL<10:50-75% OF DOSE
RR0113FAMCICLOVIR (FANVIR)
USUAL DOSE: ACUTE HZ: 500MG TID X7D, RECURR HZ IN IMMUNO: 125MG BID X5D, GENITAL HZ:125MG BID X5D. IF CRCL 40-59: 500 Q12H. IF CRCL 20-39: 500 Q24H. IF CRCL<20: UNKN
RR0114RISEDRONATE (ACTONEL)
USUAL DOSE:5MG QD (OA) OR PAGETS:30MG QD X2 MONTHS. MAY REPEAT. IF CRCL < 30: NOT RECOMMENDED FOR USE
RR0115CEFIXIME (SUPRAX SUSPENSION)
USUAL DOSE:CHILDREN -8MG/KG/D DIVIDED Q12-24H. ADULT -400MG QD DIVIDED Q12-24H IF CRCL 21-60:GIVE 75% OF STD DOSE IF CRCL <20 OR WITH CAPD:GIVE 50% OF STD DOSE.
RR0116BRETYLIUM
NORMAL DOSE: 5-30MG/KG LOAD, THEN 5-10MG IV Q 6HR. IF CRCL =10-50, 25-50%. IF CRCL = < 10, GIVE 25%
RR0117BLEOMYCIN
NORMAL DOSE VARIES BY PROTOCOL. IF CRCL = 10-50; GIVE 75% OF DOSE. IF CRCL < 10; GIVE 50% OF DOSE
RR0118CARBOPLATIN
NORMAL DOSE VARIES BY PROTOCOL. IF CRCL = 10-50; GIVE 50% OF DOSE. IF CRCL < 10; GIVE 25% OF DOSE
RR0119CEFACLOR (CECLOR)
NORMAL DOSE; 250-500MG TID. IF CRCL =10-50, GIVE 50-100%. IF CRCL < 10, GIVE 50%
RR0120CEFADROXIL
NORMAL DOSE; 500-1000MG Q 12HR. IF CRCL = 10-50, GIVE Q 12-24HR. IF CRCL < 10, GIVE Q 24-48HR
RR0121CEFAMANDOLE
NORMAL DOSE; 500-1000MG Q 4-8 HR. IF CRCL =10-50, GIVE Q 6-8HR. IF CRCL < 10, GIVE Q 12HR
RR0122CEFIXIME (SUPRAX)
NORMAL DOSE IS 200MG Q 12 HR. IF CRCL = 10-50, GIVE 75% OF DOSE. IF CRCL < 10, GIVE 50% OF DOSE
RR0123TRAMADOL (ULTRAM)
NORMAL DOSE:50-100MG Q4-6H PRN.MAX 400MG QD. IF CRCL <30:Q12H. MAX 200MG/DAY
RR0124CEFOTETAN (CEFOTAN)
NORMAL DOSE; 1-2 GMS Q 12 HRS IV. IF CRCL =10-50, GIVE 50% OF DOSE. IF CRCL < 10, GIVE 25% OF DOSE
RR0125CLOFIBRATE
NORMAL DOSE; 500-1000MG Q 12 HRS. IF CRCL = 10-50, GIVE Q 12-18HRS. IF CRCL < 10 AVOID USE
RR0126DICLOFENAC
NORMAL DOSE; 25-75MG BID. IF CRCL; =10-50, GIVE 25-50% or DOSE. IF CRCL < 10, GIVE 25% OF DOSE
RR0127DISOPYRAMIDE
NORMAL DOSE; 100-200MG Q 6 HRS. IF CRCL =10-50, GIVE Q 12-24HRS. IF CRCL < 10, GIVE Q 24-48 HRS
RR0129FEXOFENADINE (ALLEGRA)
NORMAL DOSE; 60MG BID IF CRCL = 10-50, GIVE Q 12-24 HRS IF CRCL < 10 GIVE Q24 HRS
RR0130FOSINOPRIL (MONOPRIL)
NORMAL DOSE; 10-40MG Q 24 HR IF CRCL < 10, GIVE 75% OF DOSE
RR0131ROSUVASTATIN (CRESTOR)
NORMAL DOSE:10-40MG DAILY IF CRCL<30, START AT 5MG DAILY, MAX 10MG DAILY
RR0132LEVAQUIN 750MG
CRCL >50 750MG IV DAILY CRCL 20-49 7S0MG FIRST DOSE THEN 7S0MG Q 48HR CRCL 10-19 7S0MG FIRST DOSE THEN 500MG Q 48RR
RR0133PREGABALIN (LYRICA)
CRCL 30-60: TOTAL DAILY DOSE 75-300MG IN 2-3 DIVIDED DOSES CRCL 15-30: TOTAL DAILY DOSE 25-150MG IN 2-3 DIVIDED DOSES CRCL<15: TOTAL DAILY DOSE 25-75MG IN 2-3 DIVIDED DOSES
RR0135ALDACTONE (SPIRONOLACTONE)
INCREASED RISK HYPERKALEMIA. CONTRAINDICATED WITH ACE/ARB IF CRCL<30. DO NOT COMBINE WITH ACE/ARB IF K+>5 OR SCR>2.5 IN MALES, 2.0 IN FEMALES. MONITOR K+ ROUTINELY.
RR0136ERTAPENEM (INVANZ)
NORMAL DOSE: 1GM DAILY IF CRCL<30, GIVE 500MG DAILY
RR0137COLCHICINE DRUG CONTRAINDICATI
COLCHICINE CONTRAINDICATED WITH: AMIODARONE,BIAXIN,CYCLOSPORINE,DILTIAZEM,EES,INDINAVIR,ITRACONAZOLE,KETOCONAZOLE,NICARDIPINE,PROPAFENONE,QUINIDINE, TAMOXIFEN,VERAPAMIL
RR0138CEFOXITIN (MEFOXIN)
NORMAL DOSE:1-2GM Q8-12H IF CRCL<30, 1-2GM Q12-24H IF CRCL<10, 500-1000MG Q12-24H IF CRCL<5, 500-1000MG Q24-48H
RR0139LISINOPRIL
CRCL = 10-30 INITIAL DOSE IS 5MG MONITOR POTASSIUM LEVELS
RR0140FENOFIBRATE (TRICOR)
CRCL =31-80 DOSE=48MG/DAY CRCL<31 DOSE=CONTRAINDICATED
SS0002PATIENT SAFETY GOALS:SOMNOLENC
SEDATIVES/HYPNOTICS/ANXIOLYTICS--PATIENT MAY BE AT INCREASED RISK FOR FALLS. SCORE=5
SS0004PATIENT SAFETY GOALS:TCA
TRICYCLIC ANTIDEPRESSANTS/MISC ANTIDEPRESSANTS INCREASE RISK OF FALL SCORE=2
SS0006PATIENT SAFETY GOALS:SSRI
PATIENT ON SSRI/MISC UPTAKE REINHIBITORS HAVE AN INCREASED RISK FOR FALLS. SCORE = 2
SS0007PATIENT SAFETY GOALS:NEUROLEPT
PATIENT ON NEUROLEPTIC MEDICATIONS HAVE AN INCREASED RISK FOR FALLS. SCORE = 5
SS0008PATIENT SAFETY GOALS:BENZODIAZ
PATIENT ON BENZODIAZEPINES HAVE AN INCREASED RISK FOR FALLS. SCORE =5
SS0009PATIENT SAFETY GOALS:ANTI-CONV
ANTI-CONVULSANTS MAY CAUSE ATAXIA AND BONE LOSS. PATIENT MAY BE AT AN INCREASE RISK FOR FALLS. SCORE = 1
SS0012PATIENT SAFETY GOALS:NARCOTIC
PATIENT ON ANARCOTIC/ANALGESIC IF NARC/ANALGESIC CAUSES SOMNOLENCE--PT MAY BE AT INCREASED RISK FOR FALLS SCORE = 1
SS0014PT SAFETY GOALS:MAJOR TRANQUIL
PT ON MAJOR TRANQUILIZER MAY BE AT INCREASED RISK FOR FALLS. INCLUDES PHENOTHIAZINES, BUTYROPHENONES SCORE = 5
SS0015PT SAFETY GOALS:ATYP. ANTIPSYC
PT ON ATYPICAL ANTIPSYCHOTIC MAY BE AT INCREASED RISK FOR FALL. SCORE = 3
SS0016PT SAFETY GOALS:ANTI-PARKINSON
PT ON ANTI-PARKINSON MED MAY BE AT INCREASED RISK FOR FALL SCORE =1