Home Medication Packet - National Registry Test Preparation



Home Medication Packet

Paramedic Pharmacology

Table of Contents

Nortriptyline………………………………………………..………………………………………………...4

Diltiazem………………………………….……….………………………….……………………………5-6

HCTZ………………………………………..….…………………………………………………………..6-7

Azmacort……………………………….…….…………………………………………………………….7-8

Elavil………………………………….……………….…………………………………………………...8-9

Cartrol…………………………………..……………….………………………………………..……….9-10

Reglan…………………………………………………………………………………………………....10-11

Celexa………………………………..……….………….……………………………………………….…12

Dipyridamole……………………..………………………….……………………………………..……12-13

Neurontin……………………………..………………….………………………………………………13-14

Adalat………………………………..……………….………………………….…………………....…14-15

Fexofenadine………………………….……..………………….…………………………………………...15

Labetalol……………………………………………..…….…………………………………………..……16

Isordil……………………………………………….…………………………………………………....16-17

Carbamazipine……………………………………………….………………………………...……...…17-18

Metolazone……………………………………………….……………………………...………………18-19

Phenelzine……………………………………………….……………………………............…………19-20

Lipitor……………………………………………….……………………………...…………....………20-21

Zovirax……………………………………………….……………………………...……………..……21-22

Digoxin……………………………………………….……………………………...……………...………23

Temazepam……………………………………………….…………………………….………...…………24

Atenolol……………………………………………….……………………………...……………..………25

Feldene……………………………………………….…………………………………………...…………26

Levodopa……………………………………………….……………………………...……………………27

Benztropine……………………………………………….……………………………...……………...27-28

Dilaudid……………………………………………….……………………………...………….………28-29

Glucophage……………………………………………….…………………………………...…………29-30

Captopril……………………………………………….……………………………...…………………30-31

Metaxalone……………………………………………….……………………………...………………31-32

Timolol……………………………………………….……………………………...……………………...32

Reference Page……………………………………………………………………………………………...33

Nortriptyline

Generic and Trade Names: Aventyl, Pamelor

Classifications:

-Therapeutic: Antidepressants

-Pharmacologic: Tricyclic Antidepressant

Pharmacodynamics:

-Potentiates the effect of serotonin and norepinephrine. This drug also has significant anticholinergic properties. Antidepressant action develops slowly over several weeks.

Pharmacokinetics:

-Absorption: Well absorbed after oral administration.

-Distribution: Widely distributed. Enters the breast milk in small doses. It probably crosses the placental barrier

-Protein Binding: 92%

-Metabolism and Excretion: Extensively metabolized by the liver much on its first pass. Some of the drug is converted to active compounds. This drug undergoes enterohepatic recirculation and secretion into gastric juices.

-Half-life: 18-28 hrs.

Indications:

-Used in the treatment of various forms of depression with psychotherapy incorporated in. -Another use is in the treatment of neurogenic pain.

Contraindications:

-Hypersensitivity.

-Pregnant and lactating females.

-Narrow angle glaucoma.

-Alcohol intolerance

Adverse Reactions and Side Effects:

-CNS: Drowsiness-fatigue-lethargy-agitation-confusion-EPE-headache-insomnia-hallucinations

-EENT: Blurred vision-dry eyes-dry mouth

-Cardiovascular: Arrythmias-hypotension-ECG changes

-Gastrointestinal: Constipation-nausea-unpleasant taste-paralytic ileus

-Urinary: urinary retention

-Integumentary: photosensitivity

-Endocrine: gynecomastia

-Hematology: blood dyscrasias

-Metabolism: weight gain

Average Dosages:

-PO: Children (6-12y/o) 10-20mg/day or 1-3mg/kg/day in divided doses.

-PO: Children (>12y/o) 25-50mg/day or 1-3 mg/kg/day in divided doses initially.

-PO: Adult 25mg 3-4 times daily to max of 150 mg/day.

-PO: Geriatrics 30-50 mg/day in divided doses.

Diltiazem

Generic and Trade Names: Cardizem-Cardizem LA-CartiaXT-Dilacor XR-Diltia XT-Tiamate-Tiazac.

Classifications:

-Therapeutic: Antianginals-antihypertensives-class IV antiarrythmics

-Pharmacologic: Calcium channel blockers

Pharmacodynamics:

-Inhibits the transport of calcium into myocardial and vascular smooth cells, resulting in inhibition of excitation-contraction coupling and each other contraction. Provides systemic vasodilation resulting in a decrease in blood pressure. Coronary vasodilation results in less frequency and severity of angina.

Pharmacokinetics:

-Absorption: Well absorbed, but rapidly metabolized after oral administration.

-Distribution: This is unknown in this drug.

-Protein Binding: 70-80%

-Metabolism and Excretion: Mostly metabolized by the liver.

-Half-life: 3.5-9 hrs.

Indications:

-Hypertension

-Chest pain and Prinzmetals angina

-Supraventricular tachyarrythmias and rapid ventricular rates in Afib anf flutter.

-Management of Raynaud’s syndrome (unlabeled use)

Contraindications:

-Hypersensitivity

-Sick sinus syndrome

-2nd or 3rd degree heart block (unless pacemaker is implanted)

-Blood pressure 6 yr): 2 inhalations twice daily (250 mcg/ inhalation; not to exceed 8 inhalations/day in adults or 4 inhalations/day in children).

Fluticasone (Aerosol Inhaler)

-Inhaln (Adults and Adolescents): Previous control on bronchodilators alone —88 mcg twice daily initially, may be increased up to 440 mcg twice daily; previous control on other inhaled corticosteroids 88–220 mcg twice daily initially, up to 440 mcg twice daily; previous control included systemic corticosteroids 880 mcg twice daily.

Fluticasone (Dry Powder Inhaler)

-Inhaln (Adults and Adolescents): Previous control on bronchodilators alone 100 mcg twice daily initially, may be increased up to 500 mcg twice daily; previous control on other inhaled corticosteroids 100–250 mcg twice daily initially, up to 500 mcg twice daily; previous control on systemic corticosteroids 1000 mcg twice daily.

-Inhaln (Children 4–11 yr): 50 mcg twice daily initially, may be increased up to 100 mcg twice daily.

Elavil

Generic and Trade Names: Amitriptyline-Endep

Classifications:

-Therapeutic: Antidepressants

-Pharmacologic: Tricyclic antidepressants

Pharmacodynamics:

-Potentiates the effect of serotonin and norepinephrine in the CNS.

-Has significant anticholinergic properties

-Antidepressant action.

Pharmacokinetics:

-Absorption: Well absorbed from the GI tract.

-Distribution: Widely distributed.

-Protein Binding: 95% bound to plasma proteins.

-Metabolism and Excretion: Extensively metabolized by the liver. Some metabolites have antidepressant activity. Undergoes enterohepatic recirculation and secretion into gastric juices. Probably crosses the placental barrier and enters breast milk.

-Half-life: 10-50hrs.

Indications:

-Treatment of depression usually in conjunction with psychotherapy.

-Used in chronic pain syndromes. (unlabeled use)

Contraindications:

-Narrow angle glaucoma

-Pregnant and lactating females.

Adverse Reactions and Side Effects:

-CNS: Lethargy-sedation

-EENT: Blurred vision-dry eyes-dry mouth.

-Cardiovascular: Arrythmias-hypotension-ECG changes.

-Gastrointestinal: Constipation-hepatitus-paralytic ileus.

-Urinary: Urinary retention.

-Integumentary: Photosensitivity.

-Endocrine: Changes in blood glucose-gynecomastia.

-Hematology: Blood dyscrasias.

-Misc.: Increased appetite-weight gain

Average Doses:

-IM: Adults 20-30mg four times daily.

-PO: Adults 75mg/day in divided doses. May be increased up to 150mg/day or 50-100mg at bedtime, may increase by 25-50mg up to 150mg. (hospitalized patients may initiate with 100mg/day, increasing total dose up to 300mg.)

-PO: Geriatric and adolescents 10mg 3 times per day and 20mg at bedtime or 25mg at bedtime initially, slowly increased to 100mg/day as a single bedtime dose or divided doses.

Cartrol

Generic and Trade Names: Carteolol

Classifications:

-Therapeutic: Antianginals, antihypertensives

-Pharmacologic: Beta blockers

Pharmacodynamics:

-Blocks stimulation of Beta 1 (myocardial)- and Beta 2 (pulmonary, vascular, and uterine)- drenergic receptor sites

-Also has intrinsic symathomimetic activity (ISA), which may reduce Bradycardia

-Therapeutic Effects: decreased heart rate and blood pressure

Pharmacokinetics:

-Absorbtion: 85% absorbed following oral administration

-Distribution: Unknown

-Metabolism and Excretion: Some metabolism by the liver, with conversion two at least one active compound; 50-70% excreted unchanged by the kidneys

-Half-life: 6-8 hrs

Indications:

-Management of hypertension

-Management of angina pectoris

Contraindications:

-Uncompensated CHF

-Pulmonary edema

-Cardiogenic shock

-Bradycardia or heart block

Adverse Reactions and Side Effects:

-CNS: fatigue, weakness, anxiety, depression, dizziness, drowsiness, insomnia, memory loss

-EENT: blurred vision, dry eyes, nasal stuffiness

-Respiratory: bronchospasm, wheezing

-Cardiovascular: bradycardia, CHF, pulmonary edema, orthostatic hypotension, peripheral vasoconstriction

-Gastrointestinal: constipation, diarrhea, nausea

Average Doses:

-PO: Adults 2.5 mg once daily, may increase up to 10 mg/day

-Renal Impairment

-PO: Adults CCr 20-60 ml/min-increase dosing interval to q 48 hr; CCr 12yrs 60mg BID or 180mg once daily

-PO: Children 6-11 yrs 30mg BID

Labetalol

Generic and Trade Names: Normodyne, trandate

Classification:

-Therapeutic: Antianginals, antihypertensives

-Pharmacologic: Beta blockers

Pharmacodynamics:

-Blocks stimulation of beta 1 and beta 2 adrenergic receptor sites.

-Also has alpha 1 adrenergic blocking activity, which may result in more orthostatic hypotension.

Pharmacokinetics:

-Absorption: Well absorbed but rapidly undergoes extensive first-pass hepatic metabolism, resulting in 25% bioavailability.

-Distribution: Some CNS penetration; crosses the placenta.

-Metabolism and Excretion: Undergoes extensive hepatic metabolism.

-Half-life: 3-8 hrs

Indications:

-Management of hypertension.

Contraindications:

-Uncompensated CHF.

-Pulmonary edema.

-Cardiogenic shock.

-Bradycardia or heart block.

Adverse Reactions and Side Effects:

-CNS: fatigue, weakness, anxiety, depression, dizziness, drowsiness, insomnia, memory loss

-EENT: Blurred vision, dry eyes, nasal stuffiness

-Respiratory: Bronchospasm, wheezing

-Cardiovascular: Arrhythmias, bradycardia, CHF, pulmonary edema

-Gastrointestinal: Constipation, diarrhea, nausea

Average Dose:

-PO: Adults 100mg twice a daily initially, may be increased by 100mg twice daily q 2-3 days as needed.

-IV: Adults 20mg initially, additional doses of 40-80mg may be given q 10 min as needed.

Isordil

Generic and Trade Names: Dilatrate SR-ISDN-Iso bid-Isonate-Isorbid-Isotrate-Sorbitrate.

Classification:

-Therapeutic: Antianginals

-Pharmacologic: Nitrates

Pharmacodynamics:

-Produces vasodilation

-Decreases left ventricular end diastolic pressure and left ventricular end diastolic volume.

-Increases coronary blood flow by dilating coronary arteries improving collateral flow to ischemic region.

-Relief of chest pain and increase cardiac output.

Pharmacokinetics:

-Absorption: Well absorbed after PO and SL administration.

-Distribution: Unknown.

-Metabolism and Excretion: Mostly metabolized by the liver.

-Half-life: 50min.

Indications:

-Acute treatment of anginal attacks. (SL only)

-Prophylactic management of angina pectoris.

-Treatment of chronic CHF.

Contraindications:

-Hypersensitivity

-Severe anemia.

-Concurrent use of Sildenafil.

Adverse Reactions and Side Effects:

-CNS: Dizziness-headache-apprehension-weakness.

-Cardiovascular: Hypotension-tachycardia-paradoxic bradycardia-syncope.

-Gastrointestinal: ABD pain-nausea-vomiting.

-Misc: Cross tolerance-flushing-tolerance.

Average Dose:

-SL, Buccal: Adults (acute attack of chest pain) 2.5-5mg every 5-10min to max of 3 doses.(prophylaxis of chest pain) 2.5-10mg every 2-3hrs or 15min prior to activities known to produce angina.

-PO: Adults (prophylaxis of angina pectoris) 5-20mg initially. Maintenance dose is usually 10- 40mg every 6 hrs. or 40-80mg every 8-12hrs as sustained release.

Carbamazipine

Generic and Trade Names: Atretol-Carbatrol-Epitol-Tegretol-Tegretol XR-Teril

Classifications:

-Therapeutic: Anticonvulsant.

Pharmacodynamics:

-Decreases synaptic transmission in the CNS by affecting sodium channels in neurons.

-Prevention of seizures.

-Relief of pain in trigeminal neuralgia.

Pharmacokinetics:

-Absorption: Slow but complete. Suspension produces earlier higher peak and lower trough levels.

-Distribution: Widely distributed. Crosses the blood brain barrier. Crosses the placenta barrier and rapidly enters the breast milk in large doses.

-Metabolism and Excretion: Extensively metabolized by the liver

-Half-life: 25-65 hrs. single dose. 8-29hrs chronic dose. 5-8hrs epoxide.

Indications:

-Prophylaxis of tonic-clonic, mixed, and complex partial seizures.

-Management of pain in trigeminal neuralgia.

-Management of other forms of neurogenic pain. (unlabeled)

-Prophylaxis and treatment of bipolar disorder. (unlabeled

Contraindications:

-Hypersensitivity.

-Bone marrow depression.

-Pregnancy (unless benefits outweigh risk to fetus)

-Lactation.

Adverse Reactions and Side Effects:

-CNS: Ataxia-drowsiness-fatigue-psychosis-vertigo.

-EENT: Blurred vision-corneal opacities.

-Respiratory: Pneumonitis

-Cardiovascular: CHF-HTN-hypotension-syncope.

-Gastrointestinal: Hepatitus.

-Urinary: Hesitancy-urinary retention.

-Integumentary: Photosensitivity-rashes-urticaria.

-Endocrine: syndrome of inappropriate antidiuretic hormone.

-Hematology: Agranulocytosis-aplastic anemia-thrombocytopenia-eosinophillia-leukopenia.

-Misc: Chills-fever-lymphadenopathy.

Average Dose:

-PO (Adults): Anticonvulsant— 200 mg twice daily (tablets) or 100 mg 4 times daily (suspension); increase by 200 mg/day q 7 days until therapeutic levels are achieved (range is 600– 1200 mg/day in divided doses q 6–8 hr; not to exceed 1 g/day in 12–15-yr-olds. Extended-release products are given twice daily (XR, CR). Antineuralgic— 100 mg twice daily or 50 mg 4 times daily (suspension); increase by up to 200 mg/day until pain is relieved, then maintenance dose of 200–1200 mg/day in divided doses (usual range, 400–800 mg/day).

-PO (Children 6–12 yr): 100 mg twice daily (tablets) or 50 mg 4 times daily (suspension) increased by 100 mg weekly until therapeutic levels are obtained (usual range 400–800 mg/day; not to exceed 1 g/day). Extended-release products (XR, CR) are given twice.

-PO (Children 45%); may be increased q 2–4 wk up to 80 mg/day.

Zovirax

Generic and Trade Names: Acyclovir

Classification:

-Therapeutic: Antivirals.

-Pharmacologic: Purine analogues.

Pharmacodynamics:

-Interferes with viral DNA synthesis

-Inhibition of viral replication, decreased viral shedding, and reduced time for healing lesions.

Pharmacokinetics:

-Absorption: Despite poor absorption, therapeutic blood levels are achieved.

-Distribution: Widely distributed. CSF concentrations are 50% of plasma. Crosses placental barrier and enters breast milk.

-Metabolism and Excretion: >90% eliminated unchanged by the kidneys. The remainder is metabolized by the liver.

-Half-life: 2.1-3.5 hrs. Increased in renal failure.

Indications:

-PO: Recurrent genital herpes infections. Localized cutaneous herpes zoster infections (shingles) and chickenpox (varicella)

-IV: Severe initial episodes of genital herpes in nonimmunosuppressed patients. Mucosal or cutaneous herpes simplex infections or herpes zoster infections (shingles) in immunosuppressed patients. Herpes simplex encephalitis

-Topical: Cream— Recurrent herpes labialis (cold sores). Ointment— Treatment of limited non– life-threatening herpes simplex infections in immunocompromised patients (systemic treatment is preferred).

Contraindications:

-Hypersensitivity to acyclovir and valacyclovir.

Adverse Reactions and Side Effects:

-CNS: Seizures-dizziness-headache-hallucinations-trembling.

-Gastrointestinal: Diarrhea-nausea-vomiting-ABD pain-anorexia.

-Urinary: Renal failure-crystalluria-hematuria.

-Integumentary: Acne-hives-skin rashe-unusual sweating.

-Endocrine: Changes in menstrual cycle.

-Hematology: Thrombotic thrombocytopenic purpura/Hemolytic uremic syndrome.

-Local: Pain phlebitis-local irritation.

-Muscaloskeletal: Joint pain.

-Misc.: Polydipsia.

Average Dose:

Initial Genital Herpes

-PO (Adults): 200 mg q 4 hr while awake (5 times/day) for 7–10 days.

-IV (Adults): 5 mg/kg q 8 hr for 5 days.

Chronic Suppressive Therapy for Recurrent Genital Herpes

-PO (Adults): 400 mg twice daily or 200 mg 3–5 times/day for up to 12 mo.

Intermittent Therapy for Recurrent Genital Herpes

-PO (Adults): 200 mg q 4 hr while awake (5 times/day) for 5 days, start at first sign of symptoms.

Acute Treatment of Herpes Zoster

-PO (Adults): 800 mg q 4 hr while awake (5 times/day) for 7–10 days.

Chickenpox

-PO (Adults and Children): 20 mg/kg (not to exceed 800 mg/dose) qid for 5 days.

Mucosal and Cutaneous Herpes Simplex Infections in Immunosuppressed Patients

-IV (Adults and Children >12 yr): 5 mg/kg q 8 hr for 7 days.

-IV (Children 17 yr): 500 mg twice daily; may increase by 500 mg up at weekly intervals to 2000 mg/day. If doses >2000 mg/day are required, give in 3 divided doses (not to exceed 2500 mg/day) or 850 mg once daily; may increase by 850 mg at 2-wk intervals (in divided doses) up to 2550 mg/day in divided doses (up to 850 mg 3 times daily); Extended-release tablets 500 mg once daily with evening meal, may increase by 500 mg at weekly intervals up to 2000 mg once daily. If 2000 mg once daily is inadequate, 1000 mg twice daily may be used.

-PO (Children >10 yr): 500 mg twice daily, may be increased by 500 mg/day at 1–wk intervals, up to 2000 mg/day in 2 divided doses.

Captopril

Generic and Trade Names: Capoten.

Classification:

-Therapeutic: antihypertensives.

-Pharmacologic: ACE inhibitors.

Pharmacodynamics:

-ACE inhibitors block the conversion of angiotensin I to the vasoconstrictor angiotensin II. ACE also inactivates the vasodilator bradykinin and other vasodilatory prostaglandins. ACE inhibitors also increase plasma renin levels and reduce aldosterone levels. Net result is systemic vasodilation.

-Lowering of blood pressure in hypertensive patients

-Decreased afterload in patients with CHF

-Decreased development of overt heart failure

-Increased survival after MI (selected agents only)

-Decreased progression of diabetic nephropathy (captopril only).

Pharmacokinetics:

-Absorption: At least 75% following oral administration. (decreased to 30-55% with food.)

-Distribution: Crosses the placenta. Enters the breast milk in small amounts.

-Metabolism and Excretion: 50% metabolized by the liver and 50% excreted unchanged by the kidneys.

-Half-life: ................
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