cpje top 400 drugs (wheel version)

Acetaminophen
I: fever/pain
D: 325-650mg, max < 4000mg/day from all sources
*OD = liver damage, use NAC for antidote

Pediatric (<12)
D: 10-15 mg/kg/dose
Max: 5 doses/day

Gabapentin/Gralise/Horizant
MOA: antiepileptic
I: Neuropathic pain, PHN, RLS
Max: 3,600 mg/day

Pregabalin [C-V]
MOA: Antiepileptic
I: Fibromyalgia, PHN, neuropathic pain
Max: 450 mg/day

Acetaminophen
I: fever/pain
D: < 4000mg/day from all sources
*Can treat more severe pain
*OD = liver damage, use NAC for antidote

N-acetylcysteine
I: APAP overdose

Aspirin
I: fever/pain/inflammation
D: 75-162 mg qday (antiplatelet)
Stroke: 162-325 mg within 24H after stroke onset nad 50-325mg for 2nd stroke prevention
CI: pregnancy (esp 3rd trimester), OD = tinnitis
*BBW: COX-1 selectivity NSAID = GI bleed

Ibuprofen
I: fever/pain/inflammation
Dose
-OTC: 200-400mg q 4-6 hrs
-Rx: 600-800 mg tid, max 3200mg/d
*BBW: COX-1 selectivity NSAID = GI bleed

Naproxen, Aleve
I: fever/pain/inflammation
D:
-OTC: 220mg qd
-Rx: 250-550mg bid
*Higher GI side effects
*BBW: COX-1 selectivity NSAID = GI bleed

Oxaprozin
I: fever/pain/inflammation
*Similar caution to piroxicam: high risk for GI tox and severe SJS
*BBW: COX-1 selectivity NSAID = GI bleed

Diclofenac (gel)
I: pain/inflammation
Dose: AAA 2-4g QID

Ketorolac
I: analgesia
D:
-IV/IM 30mg x 1, or 30mg QID (max 120mg/d)
-PO: 20mg once after IV or IM, then 10mg q4-6hr (max: 40mg/d)
*Max = 5 days of treatment
*Most GI toxic w/ piroxicam
*BBW: COX-1 selectivity NSAID = GI bleed

Indomethacin
-I: fever/pain/inflammation, gout
-D: 25-50mg IR, 75mg BID CR
*High risk for CNS SE and GI toxicity
*BBW: COX-1 selectivity NSAID = GI bleed

Sulindac
*less common NSAID that may be better w/ reduced renal function
*BBW: COX-1 selectivity NSAID = GI bleed

Nabumetone
I: fever/pain/inflammation
D: 1000-200mg qd or bid

Piroxicam
I: fever/pain/inflammation
D: 10-20mg qd
*High risk for GI tox and severe SJS
*Most GI toxic w/ ketorolac
*BBW: COX-1 selectivity NSAID = GI bleed

Meloxicam
I: fever/pain/inflammation
D: 7.5-15mg po (Max: 15mg/d)
*COX-2 selectivity NSAID: CV event (MI, stroke)

Celecoxib
I: fever/pain/inflammation
D: 200mg qd or BID
*lowest GI bleed risk but highest CV risk
*COX-2 selectivity NSAID: CV event (MI, stroke)

Adalimumab
I: arthritis, psoriasis, Crohn's, UC, etc
D: 40mg SC every other week
*BBW: fatal infections, malignancy, TB

Infliximab
I: arthritis, psoriasis, Crohn's, UC, etc
D: 3 mg/kg IV on weeks 0, 2 and 6, then q8w
*Delayed hypersensitivity reactions
*BBW: fatal infections, malignancy, TB

Etanercept
I: arthritis, psoriasis, Crohn's, UC, etc
D: 50mg SC weekly
*BBW: fatal infections, malignancy, TB

Abatacept
I: arthritis
D: 500-1000mg IV at 0, 2 and 4 weeks, then qm, 125mg SC weekly
*NS only
*Warnings: malignancies, serious infections, may worsen COPD sx

Anakinra
I: RA
D: 100mg SC qd
*Warnings: malignancies, serious infections

Leflunomide
I: DMARD
D: 100mg PO x 3d, then 20mg PO qd
*BBW: embryo-fetal toxicity, hepatotoxicity
*CI: pregnancy (must have negative preg test and 2 forms of birth control & wait 2 yrs after DC to have kids)

Sulfasalazine
I: DMARD
D: 500-1000mg qd, then 1000mg BID
*CI: sulfa allergy

Methotrexate
I: DMARD
D: 7.5-20mg once weekly (never daily for RA)
*BBW: hepatotoxicty, myelosuppression, mucosititis/stomatitis

Hydroxychloroquine
I: DMARD
D: 400mg qd, then 300mg qd
*Warnings: irreversible retinopathy

Azathioprine
I: RA, transplant
D: 1.5-3mg/kg/d IV or PO
*BBW: increased risk of malignancy in IBD
*Warning: hematologic toxicity, increased risk of myelosuppression in TPMT pts

Penicillin VK
I: infection
D: hella
*Renal toxicity

Dicloxacillin
I: staph infection
D: 125-500mg q6h PO

Ampicillin/sulbactam
D: 1.5-3 g q6h
*NS only

Ampicillin
D: 250-500mg po q6h, 1-2g IV q4-6h
*Empty stomach
*NS only

Amoxicillin
D: 250-500mg q8-12h,
500-875 q12h
*Take w/ food

Amoxicillin/clavulanic
D: 875/125mg po q12hr
*Take w/ food

Piperacillin/tazobactam
D:
-3.375 g QID IV
-4.5 TID-QID
-3.375-4.5g IV TID (each dose infused over 4 hrs)

Cefazolin
1-2g q8hr IV/IM
*1st gen

Cefazolin
1-2g q8hr IV/IM
*1st gen

Cephalexin
250-500mg po qid
*1st gen

Cefprozil
250-500mg po qd or bid
*2nd gen

Cefoxitin
1-2g q4-6hr IV/IM
*2nd gen

Cefaclor
250-500mg po tid
*2nd gen

Cefuroxime
0.25-1.5g IV/IM/PO q8-12hr
*2nd gen

Ceftriaxone
1-2g qd or bid IV/IM
*3rd gen
*hepatotox

Cefixime
200-400mg po qd or bid
*3rd gen

Cefotaxime
1-2g IV/IM q6-8hr
*3rd gen

Ceftazidime
1-2g IV/IM tid
*3rd gen

Cefdinir
300-600mg po qd or bid
*3rd gen
*don't need to refrigerate

Cefepime
0.5-2g IV/IM tid
*4th gen

Ceftaroline
400-600mg IV bid
*5th gen
*covers MRSA

Levofloxacin
500-750mg IV/PO qd
*BBW: tendon rupture, peripheral neuropathy, CNS effect
*Warnings: photosensitivity, hypoglycemia, seizures
*don't refrigerate

Ciprofloxacin
-250-750mg po qd or bid
-200-400mg IV tid
*BBW: tendon rupture, peripheral neuropathy, CNS effect
*Warnings: photosensitivity, hypoglycemia, seizures
*don't refrigerate

Ofloxacin (otic)
400mg bid
*don't refrigerate

Moxifloxacin
400mg qd IV/PO
*BBW: tendon rupture, peripheral neuropathy, CNS effect
*Warnings: photosensitivity, hypoglycemia, seizures
*No renal adj

Metronidazole
500mg q6h PO/IV
*Take with food
*Avoid alcohol
*don't refrigerate!

Nitrofurantoin monohydrate
100mg po BID
*less SEs bc of slower absorption
*serious lung problems, C. diff

Nitrofurantoin macrocrystal
100mg po QID
*serious lung problems, C. diff

Vancomycin
-15mg/kg
-500mg to 2g/d q6-12h
*nephro/ototoxicity, RMS

Clindamycin
-450mg po tid or qid
-600-900 mg IV q6-8h
*BBW: C. diff!

Azithromycin
-500mg po on Day 1, then 250mg Days 2-5
*empty stomach
*QT prolongation

Erythromycin
400mg PO QID
*QT prolongation

Clarithromycin
1 g po qd
*metallic taste
*QT prolongation

Trimethoprim/sulfamethoxazole
-SS: 400mg SMX/80mg TMP
-DS: 800mg SMX/160 mg TMP
*CI: sulfa allergy
*Take with food
*SJS, crystalluria, photosensitivity

Linezolid
600mg BID po/iv
*Myelosuppression

Minocycline
100mg po bid
*CI: </= 8 yoa, pregnancy
*Warnings: photosensitivity

Doxycycline
100mg po bid
*take with food
*CI: </= 8 yoa, pregnancy
*Warnings: photosensitivity

Tigecycline
100mg IV x 1, then 50mg bid IV
*CI: </= 8 yoa, pregnancy
*Warnings: photosensitivity

Fluconazole
-500mg qd
-150mg po x 1
*hepatotoxicity, SJS

Terbinafine
250mg po qd
*hepatotoxicity

Nystatin
-Suspension for oral yeast infection (swish and swallow 4-5 times daily)
-Vaginal insert: 100,000 unit x 2 weeks

Voriconazole
-300mg po bid
-4-6mg/kg IV
*DOC for Aspergillus
*SEs: visual changes, photosensitivity, hepatotoxicity
*take on empty stomach

Meperidine
100mg IV/SC/IM
*short DOA (3hrs)
*SE: serotoninergic, CNS toxicity

Morphine ER
-15-200mg po bid-tid
-10mg q4h IV

Morphine IR
-30mg po q4h prn
-10mg q4h IV

Hydrocodone/acetaminophen
2.5-10/325mg po q4h prn

Hydrocodone/ibuprofen
2.5-10/325mg po q4h prn

Oxycodone IR
10-30mg po q4-6hr

Oxycodone CR
10-80mg po bid

Oxycodone/acetaminophen
2.5-10/325mg po q6hr

Oxycodone/aspirin
4.83/325mg po q6h prn (max 12 tabs/hr)

Methadone
2.5-10mg q8-12hr
*BBW: QT prolongation
*used for treating opioid addiction

Hydromorphone
-PO: 7.5mg q4h
-IV/SC: 1.5 mg q6h

Fentanyl injection
-50-100mcg IM or IV 30-60min pre-op
-25-100mcg IV over 1-2 min peri-op

Fentanyl patch
1 patch q72h

Fentanyl lozenge
200mcg x 4

Nalbuphine
I: pain in labor/anesthesia
max 160mg/day

Tramadol
25-50mg po q4h prn
*CIV
*CI: <12 yoa
*Seizure, serotonin syndrome risks

Tapentadol
50-100mg q4-6 hr prn
*CII
*less GI effects than opioids

Naloxone
0.4-2mg q2-3 min or IV infusion

Nalmefene
*for opioid OD

Naltrexone
-25mg po x 1, then 50mg po qd on Day 2
*for alcohol and opioid dependence

Isoniazid
300mg po qd x 9 months
*BBW: severe/fatal hepatitis
*monotherapy for latent TB
*Warning: neurotoxic (take w/ pyridoxine aka Vit B6), lupus

Rifampin
600mg po qd
*Warning: orange urine / body fluid, flu-like syndrome, hepatotoxicity

Peginterferon alfa 2a & 2b
-2a: Pegasys 180 mcg SC qw
-2b: PegIntron 1.5mcg/kg SC qw
*BBW: worsening autoimmune system, infection, psych problems, ischemic problems, blood problems

Ribavirin
200mg po bid
*BBW: hemolytic anemia
*must be taken w/ PEG-IFN bc monotherapy isn't effective
*CI: pregnancy
*Combo SEs: anemia, birth defects, eye problems

Simeprevir
I: Hep C genotype 1 & 4
D: 150mg po qd x 12 weeks + PEG-IFN/RBV or sofosbuvir
*Take w/ food
*SEs: anemia, requiring ESA, photosensitivity

Acyclovir
I: HSV, shingles
-200mg po 2-5 times daily
-Apply cream 6 times/day x 7 days
*Take w/ water to prevent kidney stones

Valacyclovir
I: HSV, shingles
2g po BID x 1 day
*Prodrug of acyclovir

Famciclovir
I: HSV, shingles
-Shingles: 500mg po tid x 7 days w/in 72 hrs onset

Amantadine
I: Parkinson's disease
D: 100mg po bid or tid
*For initial tremor tx

Oseltamivir
I: flu tx and ppx
D:
-Tx: 75mg po BID x 5 d
-Ppx: 75mg po QD x 10 d
*Must be started w/in 48 hrs
*SEs: N/V
*For >/= 1 yoa

Zanamivir
I: flu tx and ppx
D:
-Tx: 10mg po BID x 5 d
-Ppx: 10mg po QD x 10 d
*oral inhalation
*for >/= 7 yoa

Foscarnet
*BBW: only for immunocompromised pts w/ CMV retinitis and acyclovir-resistant HSV, renal impairment, seizures

Dornase alfa
I: cystic fibrosis
D: 2.5mg nebulizer qd or bid if needed

Zidovudine/lamivudine
*NRTI
*SE: lactic acidosis

Lamivudine/abacavir
*NRTI
*SE: lactic acidosis
*Requires HLA-B*5701 testing for hypersensitivity

Zidovudine/lamivudine/abacavir
*NRTI
*SE: lactic acidosis

Tenofovir/emtricitabine
*NRTI
*SE: lactic acidosis
NOF
*N = nephrotoxicity
*O = osteomalacia/osteoporosis
*F = Fanconi syndrome (kidney issues)

Tenofovir/emtricitabine/efavirenz
*NRTI + NNRTI
*Efavirenz: CNS effects
*TAKE WITHOUT FOOD
NOF
*N = nephrotoxicity
*O = osteomalacia/osteoporosis
*F = Fanconi syndrome (kidney issues)

Saquinavir
*PI
*Increase in lipids, BG, weight/fat redistribution
*TAKE WITH FOOD
*Take with booster

Lopinavir / ritonavir
*PI
*Take without food

Atenolol
Max dose: 100mg qd
*Cardioselective
*BBW: Do not stop abruptly to avoid acute tachycardia, HTN and/or ischemia
*CI: diabetes, asthma/COPD, bradycardia, heart block
*SE: dyslipidemia, weight gain, fluid retention, fatigue, dizziness

Metoprolol tartrate
*IR
*Cardioselective
*Max: 450mg/d (doses are bid)
*BBW: Do not stop abruptly to avoid acute tachycardia, HTN and/or ischemia
*CI: diabetes, asthma/COPD, bradycardia, heart block
*SE: dyslipidemia, weight gain, fluid retention, fatigue, dizziness

Metoprolol succinate
*Cardioselective
*Max doses
-HTN: 400mg/d (doses are qd)
-HF: 200mg/d
*BBW: Do not stop abruptly to avoid acute tachycardia, HTN and/or ischemia
*CI: diabetes, asthma/COPD, bradycardia, heart block
*SE: dyslipidemia, weight gain, fluid retention, fatigue, dizziness
*preferred BB in HF

Esmolol
*IV only for HTN emergency
*Cardioselective
*BBW: Do not stop abruptly to avoid acute tachycardia, HTN and/or ischemia
*CI: diabetes, asthma/COPD, bradycardia, heart block
*SE: dyslipidemia, weight gain, fluid retention, fatigue, dizziness

Propranolol
*IR: 80mg BID, ER: 80mg QD (Max for both: 640mg/d)
*Nonselective
*Take with food
*BBW: Do not stop abruptly to avoid acute tachycardia, HTN and/or ischemia
*CI: diabetes, asthma/COPD, bradycardia, heart block
*SE: dyslipidemia, weight gain, fluid retention, fatigue, dizziness

Timolol
40mg po BID
*Nonselective
*BBW: Do not stop abruptly to avoid acute tachycardia, HTN and/or ischemia
*CI: diabetes, asthma/COPD, bradycardia, heart block
*SE: dyslipidemia, weight gain, fluid retention, fatigue, dizziness

Timolol
I: Glaucoma
*CI: asthma/COPD, bradycardia, CHF, depression or MG
*SE: bronchospasm, bradycardia, low BP and libido, CNS depression

Timolol/dorzolamide
I: Glaucoma
*CI: sulfa allergy, kidney disease
*SE: metallic taste, HA, hypokalemia

Labetalol
800mg po BID (Max: 2400mg/d)
*Nonselective
*Take with food
*Also has alpha-1 blockage (vasodilation)
*BBW: Do not stop abruptly to avoid acute tachycardia, HTN and/or ischemia
*CI: diabetes, asthma/COPD, bradycardia, heart block
*SE: dyslipidemia, weight gain, fluid retention, fatigue, dizziness

Carvedilol
*Nonselective
HF Target Dose:
IR: >85kg: 50 mg BID, =/<85kg: 25 mg BID
ER: 80 mg qday
*preferred in HF
*Take with food
*BBW: Do not stop abruptly to avoid acute tachycardia, HTN and/or ischemia
*CI: diabetes, asthma/COPD, bradycardia, heart block
*SE: dyslipidemia, weight gain, fluid retention, fatigue, dizziness

Carteolol
I: glaucoma
*CI: asthma/COPD, bradycardia, CHF, depression or MG
*SE: bronchospasm, bradycardia, low BP and libido, CNS depression

Betaxolol
I: glaucoma
*CI: asthma/COPD, bradycardia, CHF, depression or MG
*SE: bronchospasm, bradycardia, low BP and libido, CNS depression

Diltiazem
I: HTN, angina
Max dose: 120mg/day qd, bid or tid
*non-DHP (more cardioselective)
*Preferred if CKD and nephropathy
*SE: bradycardia, gingival hyperplasia, constipation
*Ok to give in HF if EF is normal

Verapamil
I: HTN, angina
Max dose: 120mg/day qd, bid or tid
*non-DHP (more cardioselective)
*Preferred if CKD and nephropathy
*SE: bradycardia, gingival hyperplasia, constipation
*Ok to give in HF if EF is normal

Amlodipine
I: HTN, angina
Max dose: 10mg/d
*CI: CHF and do not give w/ BB if acute MI
*SE: reflex tachycardia, HA, flushing, edema

Felodipine ER
I: HTN, angina
Max dose: 10mg/d
*CI: CHF and do not give w/ BB if acute MI
*SE: reflex tachycardia, HA, flushing, edema

Isradipine CR
I: HTN, angina
Max dose: 10mg/d
*CI: CHF and do not give w/ BB if acute MI
*SE: reflex tachycardia, HA, flushing, edema

Nicardipine
I: HTN, angina
D: 60mg BID or TID
*CI: CHF and do not give w/ BB if acute MI
*SE: reflex tachycardia, HA, flushing, edema

Nifedipine ER
I: HTN, angina
Max dose: 90mg/d
*CI: CHF and do not give w/ BB if acute MI
*SE: reflex tachycardia, HA, flushing, edema

Doxazosin
I: HTN (2nd or 3rd line), BPH
D:
-HTN: 16mg po qhs
-BPH: 8mg po qhs
*Caution: syncope, dizziness, fatigue --> Titrate
*must taper off

Prazosin
I: HTN (2nd or 3rd line), BPH
D: 5mg po bid or tid (for both indications)
*Caution: syncope, dizziness, fatigue --> Titrate
*must taper off

Terazosin
I: HTN (2nd or 3rd line), BPH
D:
-HTN: max 20mg po qhs
-BPH: 10mg po qhs
*Caution: syncope, dizziness, fatigue --> Titrate
*must taper off

Clonidine
I: resistant HTN or pts who can't swallow
*off-label: opioid withdrawal, anxiety and sleep
D:
-0.1-0.3 mg po BID
-0.1, 0.2, 0.3 mg/24 hr/wk *Apply to upper outer arm or chest and rotate site weekly
*Caution: bradycardia, dry mouth, fatigue, depression, psych rxns, impotence, rebound HTN
*must taper off

Methyldopa
D: 500mg BID (max 3000mg/d)
*SE: lupus sx, hepatitis, myocarditis, hemolytic anemia
*Caution: bradycardia, dry mouth, fatigue, depression, psych rxns, impotence, rebound HTN
*preferred in pregnancy
*must taper off

Reserpine
I: HTN
D: 0.05-0.25mg qd
*Caution: bradycardia, depression
*must taper

Hydralazine
I: HTN
D: 75mg po qid
*SE: lupus
*Caution: reflex tachycardia

Minoxidil
I: HTN
D: 40mg po qd
*SE: hair growth
*Caution: reflex tachycardia

Chlorothiazide
I: HTN, edema
D: 500-1000mg qd or bid
*CI: Sulfa allergy
*SE: metabolic alkalosis, decreases K+, Na+ and Mg2+, increases BG, TG, Chol, uric acid and Ca2+
*Diuretic of choice if no renal impairment

Hydrochlorothiazide (HCTZ)
I: HTN, edema
D: 12.5-50mg po qd
*CI: Sulfa allergy
*SE: metabolic alkalosis, decreases K+, Na+ and Mg2+, increases BG, TG, Chol, uric acid and Ca2+
*Diuretic of choice if no renal impairment

HCTZ/triamterene
I: HTN, edema
D: 1-2 tabs po qd
*CI: Sulfa allergy
*SE: metabolic alkalosis, decreases K+, Na+ and Mg2+, increases BG, TG, Chol, uric acid and Ca2+
*Diuretic of choice if no renal impairment

Chlorthalidone
I: HTN
Target: 12.5-25 mg qd
*CI: Sulfa allergy
*SE: metabolic alkalosis, decreases K+, Na+ and Mg2+, increases BG, TG, Chol, uric acid and Ca2+
*Diuretic of choice if no renal impairment

Metolazone
I: HTN, edema
D: target dose 20mg/d
*CI: Sulfa allergy
*SE: metabolic alkalosis, decreases K+, Na+ and Mg2+, increases BG, TG, Chol, uric acid and Ca2+
*Ok if there's renal dysfunction

Indapamide
I: HTN, edema
D: Target dose 2.5mg/d
*CI: Sulfa allergy
*SE: metabolic alkalosis, decreases K+, Na+ and Mg2+, increases BG, TG, Chol, uric acid and Ca2+
*Diuretic of choice if no renal impairment

Furosemide
I: HTN, HF, edema
D: Target dose 40mg po BID (max: 600mg/d)
*CI: sulfa allergy
*SE: metabolic alkalosis, Decreases K+, Na+, Mg2+, Ca2+ and bone density, increases BG, TG, Chol, and uric acid
*Requires K+ supp
*Diuretic of choice for renal disease
*IV: Ototoxicity and avoid use w/ aminoglycosides
*Equivalency: BTFE = 1:20:40:50

Torsemide
I: HTN, HF, edema
D: Target dose 10mg qd
*CI: sulfa allergy
*SE: metabolic alkalosis, Decreases K+, Na+, Mg2+, Ca2+ and bone density, increases BG, TG, Chol, and uric acid
*Requires K+ supp
*Diuretic of choice for renal disease
*IV: Ototoxicity and avoid use w/ aminoglycosides
*Equivalency: BTFE = 1:20:40:50

Bumetanide
I: HTN, HF, edema
D: Target dose: 1mg po bid
*CI: sulfa allergy
*SE: metabolic alkalosis, Decreases K+, Na+, Mg2+, Ca2+ and bone density, increases BG, TG, Chol, and uric acid
*Requires K+ supp
*Diuretic of choice for renal disease
*IV: Ototoxicity and avoid use w/ aminoglycosides
*Equivalency: BTFE = 1:20:40:50

Ethacrynic acid
I: HTN, HF, edema
D: 25-50mg po qd
*only loop ok if sulfa allergy
*SE: metabolic alkalosis, decreases K+, Na+, Mg2+, Ca2+ and bone density, increases BG, TG, Chol, and uric acid
*Requires K+ supp
*Diuretic of choice for renal disease
*IV: Ototoxicity and avoid use w/ aminoglycosides
*Equivalency: BTFE = 1:20:40:50

Triamterene
I: HTN, glaucoma, edema
D: 300mg po qd
*K+-sparing diuretic
*SE: metabolic acidosis, Increase K+, decrease Ca2+, gout
*CI if CrCl <30

Amiloride
I: HTN, glaucoma, edema
D: 20mg po qd
*K+-sparing diuretic
*SE: metabolic acidosis, Increase K+, decrease Ca2+, gout
*CI if CrCl <30

Spironolactone
I: HF (decreases morbidity), HTN
D: 25-50mg po qd or BID
*K+-sparing diuretic
*SE: gynecomastia, metabolic acidosis, Increase K+, decrease Ca2+, gout
*CI: pregnancy, CrCl <30

Eplerenone
I: HF (decreases morbidity), HTN
D: 25-50mg po qd
*K+-sparing diuretic
*SE: metabolic acidosis, Increase K+, decrease Ca2+, gout
*CI: pregnancy, CrCl <30

Benazepril
I: HTN, HF
Target dose: 40mg po qd
*BBW: pregnancy, bilateral renal artery stenosis
*SE: metabolic acidosis, increase K+, dry cough, angioedema
*Avoid w/ NSAIDs bc of renal damage

Captopril
I: HTN, HF
Target dose: 50mg po tid
*BBW: pregnancy, bilateral renal artery stenosis
*SE: metabolic acidosis, increase K+, dry cough, angioedema
*Avoid w/ NSAIDs bc of renal damage

Enalapril
I: HTN, HF
Target Dose: 10-20 mg BID
*BBW: pregnancy, bilateral renal artery stenosis
*SE: metabolic acidosis, increase K+, dry cough, angioedema
*Avoid w/ NSAIDs bc of renal damage

Fosinopril
I: HTN, HF
Target dose: 40mg po qd
*BBW: pregnancy, bilateral renal artery stenosis
*SE: metabolic acidosis, increase K+, dry cough, angioedema
*Avoid w/ NSAIDs bc of renal damage

Lisinopril
I: HTN, HF
Target dose: 20-40mg po qd
*BBW: pregnancy, bilateral renal artery stenosis
*SE: metabolic acidosis, increase K+, dry cough, angioedema
*Avoid w/ NSAIDs bc of renal damage

Moexipril
I: HTN, HF
Target dose: 15mg po qd
*BBW: pregnancy, bilateral renal artery stenosis
*SE: metabolic acidosis, increase K+, dry cough, angioedema
*Avoid w/ NSAIDs bc of renal damage

Quinapril
I: HTN, HF
Target Dose: 20 mg BID
*BBW: pregnancy, bilateral renal artery stenosis
*SE: metabolic acidosis, increase K+, dry cough, angioedema
*Avoid w/ NSAIDs bc of renal damage

Ramipril
I: HTN, HF
Target dose: 10mg po qd
*BBW: pregnancy, bilateral renal artery stenosis
*SE: metabolic acidosis, increase K+, dry cough, angioedema
*Avoid w/ NSAIDs bc of renal damage

Candesartan
I: HTN, HF
Target dose: 32mg po qd
*BBW: pregnancy, bilateral renal artery stenosis
*SE: metabolic acidosis, increase K+, angioedema
*Avoid w/ NSAIDs bc of renal damage

Irbesartan
I: HTN, HF
Target dose: 300mg po qd
*BBW: pregnancy, bilateral renal artery stenosis
*SE: metabolic acidosis, increase K+, angioedema
*Avoid w/ NSAIDs bc of renal damage

Losartan
I: HTN, HF
Target dose: 50-150 mg po qd
*BBW: pregnancy, bilateral renal artery stenosis
*SE: metabolic acidosis, increase K+, angioedema
*Avoid w/ NSAIDs bc of renal damage

Valsartan
I: HTN, HF
Target: 160 mg BID
*BBW: pregnancy, bilateral renal artery stenosis
*SE: metabolic acidosis, increase K+, angioedema
*Avoid w/ NSAIDs bc of renal damage

Olmesartan
I: HTN, HF
Target dose: 40mg po qd
*BBW: pregnancy, bilateral renal artery stenosis
*SE: metabolic acidosis, increase K+, angioedema
*Avoid w/ NSAIDs bc of renal damage

Telmisartan
I: HTN, HF
Target dose: 80mg po qd
*BBW: pregnancy, bilateral renal artery stenosis
*SE: metabolic acidosis, increase K+, angioedema
*Avoid w/ NSAIDs bc of renal damage

Aliskiren
I: HTN
Target dose: 300mg po qd
*BBW: pregnancy, bilateral renal artery stenosis
*SE: metabolic acidosis, increase K+, dry cough, angioedema
*Avoid w/ NSAIDs bc of renal damage
*High fat meals decreases absorption

Lovastatin IR
I: high cholesterol
D: 20 po qd or bid (Max: 80mg/d)
*CI: Pregnancy
*Caution: rhabdomyolysis, myopathy
*low-medium intensity
*Take with food

Atorvastatin
I: high cholesterol
D: 10-80mg po qd
*CI: Pregnancy
*Caution: rhabdomyolysis, myopathy
*medium-high intensity

Fluvastatin IR
I: high cholesterol
D: 20-80mg po qd
*CI: Pregnancy
*Caution: rhabdomyolysis, myopathy
*low-medium intensity
*Take at bedtime

Rosuvastatin
I: high cholesterol
D: 5-20mg po qd
*CI: Pregnancy
*Caution: rhabdomyolysis, myopathy
*medium-high intensity

Pravastatin
I: high cholesterol
D: 10-80mg po qd
*CI: Pregnancy
*Caution: rhabdomyolysis, myopathy
*low-medium intensity

Simvastatin
I: high cholesterol
D: 10-40mg po qd
*CI: Pregnancy
*Caution: rhabdomyolysis, myopathy
*low-medium intensity
*Take at bedtime

Ezetimibe
I: high cholesterol
D: 10mg po qd
*Caution: myopathy
*Can be used w/ statin

Niacin (B3)
I: high TG
D: men 16mg/d, women 14mg/d, pregnancy 18mg/d, breastfeeding 17mg/d
*only for >18 yoa
*CI: peptic ulcer, bleeding
*Caution: flushing/itching, gout, diabetes, myopathy / rhabdomyolysis if used w/ statin
*Take ER at qhs after low-fat snack
*Take IR w/ food

Colesevelam
I: high cholesterol
D: 6 tabs po qd + w/ meal and liquid
*CI: bowel obstruction and TG > 500
*SE: constipation, gas, bloating (Welcol has less GI SEs)
*OK w/ statins and hepatic disease

Colestipol
I: high cholesterol
D: max 16g tab/d or 30g powder/d
*CI: bowel obstruction
*SE: constipation, gas, bloating
*OK w/ statins and hepatic disease

BAS: all drugs take either 1-4H before or 4-6H after BAS

Cholestyramine
I: high cholesterol
*CI: bowel obstruction
*SE: constipation, gas, bloating
*OK w/ statins and hepatic disease

BAS: all drugs take either 1-4H before or 4-6H after BAS

Gemfibrozil
I: high TG
D: 600mg po bid
*CI: liver / renal / gallbladder disease
*SE: rhabdomyolysis, myopathy
*Avoid w/ statin or zetia
*Take 30 min before breakfast and dinner

Fenofibrate
I: high TG
D: 145mg po qd
*CI: liver / renal / gallbladder disease
*SE: rhabdomyolysis, myopathy
*Avoid w/ statin
*Take w/ food: Lopfen and Fenoglide

Nitroglycerin SL
I: angina attack and prevention
D: 0.3-0.6 mg q5m, max 3 doses in 15 minutes
*CI: PDE-5 inhibitors (sildenafil, tadalafil)
*SE: HA, flushing, burning, stinging in mouth, hypotension, dizziness
*Avoid alcohol

Nitroglycerin spray
I: angina attack and prevention
D: 1-2 (0.4mg) sprays onto or under tongue q5m for max 3 doses in 15 min
*CI: PDE-5 inhibitors (sildenafil, tadalafil)
*SE: HA, flushing, burning, stinging in mouth, hypotension, dizziness
*Avoid alcohol
*Don't shake
*Pump must be primed
*Close mouth after spraying

Nitroglycerin patch
I: angina prevention
D: Titrate to 0.4-0.8mg/hr
*CI: PDE-5 inhibitors (sildenafil, tadalafil)
*SE: HA, flushing, burning, stinging in mouth, hypotension, dizziness
*Avoid alcohol
*Tolerance is minimized by using patch 12 hrs on/12 hrs off
*Rotate patch sites

Nitroglycerin ointment 2%
I: angina prevention
D: Apply 1/2-2 in to chest or back (max 2 doses/d) by placing applicator on skin and taping it into place
*CI: PDE-5 inhibitors (sildenafil, tadalafil)
*SE: HA, flushing, burning, stinging in mouth, hypotension, dizziness
*Avoid alcohol
*Allow for nitrate-free interval of 12hr/d

Nitroglycerin infusion D5W
I: HTN/ischemic emergency
D: 5mcg/min q5min (Max 400mcg/min)
*CI: PDE-5 inhibitors (sildenafil, tadalafil)
*SE: HA, flushing, burning, stinging in mouth, hypotension, dizziness
*Avoid alcohol
*Absorption occurs w/ soft plastic (PVC)

Isosorbide dinitrate
I: angina prevention, HF to decrease mortality w/ hydralazine (BiDil)
D:
-IR: 5-40mg bid-tid
-SR: 40mg po qd-bid
*CI: PDE-5 inhibitors (sildenafil, tadalafil)
*SE: HA, flushing, burning, stinging in mouth, hypotension, dizziness
*Avoid alcohol

Clopidogrel
I: ACS, recent MI/stroke, PAD
LD: 300-600mg (ASC)
MD: 75mg po qd
*SE: bleeding, bruising, TTP
*Caution: may need to test for CYP2C19 poor metabolizers
*Avoid w/ omeprazole and cimetidine

Ticlopidine
I: ACS, recent MI/stroke, PAD
D: 250mg BID
*SE: bleeding, bruising, risk of neutropenia and hematopoietic disorders

Abciximab
I: PCI only (NOT medically managed ACS)
D: 0.25mg/kg bolus pre-PCI, then 0.125mcg/kg/min x 12hr
*IV only
*SE: thrombocytopenia, bleeding, hypotension
*refrigerate
*filter

Eptifibatide
I: ACS + PCI
D: 180mcg/kg bolus, then 2mcg/kg/min x 25h
*IV only
*SE: thrombocytopenia, bleeding, hypotension
*refrigerate
*protect from light

Dipyridamole
I: TIA/stroke prevention
D: 75-100mg po QID
*SE: CP, HA, dizziness, angina exacerbation, abnormal ECG

Aspirin/dipyridamole
I: TIA/2nd stroke prevention
D: 25mg/200mg po BID
*SE: HA, dyspepsia, N/D, bleeding

Cilostazol
I: intermittent claudication
D: 100mg po bid 30 min before or 2 hrs after meals x 3 months

Pentoxifylline
I: intermittent claudication
D: 400mg po TID

Disopyramide
I: arrhythmia
*SE: increase QT interval, HF, anticholingeric
*Avoid: urinary retention, BPH, glaucoma, MG
*Class 1a
*Take on empty stomach

Quinidine
I: arrhythmia
*BBW: increase mortality, thrombocytopenia
*SE: increase QT interval, diarrhea, strong anticholinergic (cinchonism)
*Class 1a
*Take w/ food to decrease GI upset
*DDI w/ digoxin (decrease digoxin by 50%), warfarin, grapefruit and non-DHP CCBs

Procainamide
I: arrhythmia
*BBW: agranulocytosis
*SE: increase QT interval, lupus w/ long-term use
*Take on empty stomach
*Class 1a

Lidocaine
I: arrhythmia
*Monitor LFTs
*Class Ib
*DDI that increases lidocaine: amiodarone, BB, non-DHP CCBs, grapefruit, macrolides, etc

Amiodarone
I: arrhythmia
D: 10mg LD, 100-400mg qd maintenance
CI: Iodine sensitivity
t1/2: 40-60 days **
*SE: QT prolongation, vision changes, photosensitivity, hypotension, blue skin, bradycardia, dizziness, tremor
*Monitor: thyroid, liver and lungs

*Safe in HFrEF
*Take w/ food and plenty of water
* use 0.22 filter

Sotalol
I: arrhythmia
D: 160mg po bid
*SE: QT prolongation, bradycardia, hypotension, torsades, HF, dizziness

Digoxin
MOA: Na-K-ATPase Pump
I: add-on for HF, AF
D: 0.125-0.25 mg po qd
*Decrease by 20-25% for PO to IV conversion
*(+) inotrope, (-) chronotrope
*Toxicity: N/V, appetite loss, blurred/yellow vision, abdominal pain, confusion, delirium
*Antidote: Digibind or DigiFab
*Range
-HF: 0.5-0.9 ng/ml
-AF: 0.8-2 ng/ml
*HypoK, HypoMg, HyperCa = toxicity

An ADD ON drug after BB +/- non-DHP CCB for rate control

Isotrentinoin
I: severe acne
*BBW: pregnancy (need 2 forms of BC and informed consent)
*Pharmacy must be registered w/ iPLEDGE
*Full effect in 3-5 months
*SE: dryness

Permethrin 5%
I: head lice
*Rx required
*May repeat in 7 days after initial application

Permethrin 1%
I: head lice
*OTC for >1 yoa
*May repeat in 7 days after initial application

Calcium acetate
I: control of hyperphosphatemia (ESRD on dialysis)
D: 1334mg w/ meal
SE: GI effects, hypercal

Sevelamer
I: control serum phosphorus

Lanthanum
MedGuide
I: reduction of serum phosphorus
D: 1500 mg QD (upto 4500mg)
SE: GI obstruction

Cinacalcet
CI: serum Ca less than lower limit of normal
I: hyperparathyroidism, parathyroid carcinoma
D: 30mg BID (upto 60mg BID, 90mg BID, 90mg TID-QID)
SE: hypocalcemia, GI effects, QT risk

Aluminum hydroxide
I: antacid, skin protectant

Calcium carbonate
I: antacid

Calcitriol (Vit D3)
I: hypocalcemia in hypoparathyroidisim, 2ndary hyperparathyroism in CKD
SE: excessive vit D, hypercal

Ergocalciferol (Vit D2)
I: hypoparathyroidism

Levothyroxine
I: hypothyroidism, myxedema coma
D: initial 1.6 mcg/kg/d; if CHD = 25-50mcg QD

Thyroid desiccated

Liothyronine
BW: weight reduction
I: hypothyroidism, myxedema coma
D: PO 25mcg QD (25-75 mcg QD maintenance)

Methimazole
I: hyperthyroidism
D: PO 15-60mg/d

Propylthiouracil
MedGuide
BW: hepatotoxcity, pregnancy
I: hyperthyroidism
D: PO 300mg daily in 3 divided doses

Mesalamine (cap, enema)
I: CR, distal UC

Loperamide

Diphenoxylate/atropine

Bismuth subsalicylate

Bismuth subsalicylate

Psyllium

Mineral oil

Magnesium hydroxide
I: antacid, laxative

Polyethylene glycol
I: constipation

Polyethylene glycol

Pramlintide (SQ)
MedGuide
BW: hypoglycemia
I: T1DM, T2DM

Lactulose
I: constipation, portal systemic encephalopathy, overt heapatic encephalopathy
D: 16.7g (25mL) Q1-2h until at least 2 loose stools, titrate to 2-3 bowel movements

Bisacodyl
I: Bowel cleansing (enema only), constipation
D: PO 5-15mg QD; rectal 1 enema QD

Senna
I: constipation

Docusate sodium (PO / rectal)
I: stool softener
D: PO 240mg QD; rectal 1 enema QD-TID

Metformin
DW: lactic acidosis
I: T2DM
D: 500mg QD or BID; or 850 QD (max 2.55g/d)
SE: lactic acidosis, VitB12 deficiency

Glipizide (PO)
I: T2DM
D: 2.5mg QD (max 20mg/d)
SE: hypogly, sulfa allergy

Glyburide (PO)
I: T2DM
D: 2.5-5mg/d (max 20mg/d)
SE: hypogly, sulfa allergy

Glimepiride (PO)
I: T2DM
D: 1-2mg QD (max 8mg/d)
SE: hypogly, sulfa allergy

Nateglinide (PO)
I: T2DM
D: 120mg TID before meals

Repaglinide (PO)
I: T2DM
D: max 4mg/dose or 16mg/d

Pioglitazone
Med Guide
BW: HF
I: T2DM
D: 15-30mg QD
SE: bladder cancer, edema, fractures, HF, wt gain

Rosiglitazone (PO)
BW: HF, MI
I: T2DM
D: 4mg/d QD or BID (max 8mg/d)
SE: bladder cancer, edema, fractures, HF, wt gain

Acarbose (PO)
I: T2DM
D: 25mg TID (upto 50-100mg TID)

Miglitol (PO)
I: T2DM
D: 25mg TID (max 100mg TID)

Lispro (rapid acting)
I: T1DM, T2DM (SQ)
SE: Hypogly, hypokal

Aspart (rapid acting)
I: T1DM, T2DM (SQ)
SE: Hypogly, hypokal

Glulisine (rapid acting)
I: T1DM, T2DM (SQ)
SE: Hypogly, hypokal

Regular (short-acting)
I: T1DM, T2DM (SQ)
SE: Hypogly, hypokal

regular (short-acting)
I: T1DM, T2DM (SQ)
SE: Hypogly, hypokal

NPH (intermediate acting)
I: T1DM, T2DM (SQ)
SE: Hypokal, hypogly

NPH (intermediate acting)
I: T1DM, T2DM (SQ)
SE: hypokal, hypogly

Glargine-long acting
I: T1DM, T2DM (SQ)
SE: hypocal, hypogly

Detemir (SQ)-long acting
I: T1DM, T2DM
D: initial TDD 0.4-0.5 units/kg/d
SE: hypokal, hypogly

Colchicine (PO)
MedGuide
I: Gout
D: PPX=0.6mg QD-BID (max 1.2mg/d); TX= day 1=1.2mg at first sign of flare, in 1 hour 0.6mg (max 1.8mg on day 1), day 2- 0.6mg QD-BID until flare resolves

Allopurinol
*HLA-B*5801 testing
I: Gout
D: PO 100mg QD (max 800mg/d)
SE: bone marrow suppression, hepatoxic, acute gout attacks

Probenecid
I: hyperuricemia w/ gout
D: PO 250mg BID x1wk (max 2g/d)
I: gout, G6PD deficiency

Alendronate
MedGuide
I: osteoporosis
D: PO 70mg Qwkly or 10mg Qd (TX); PO 35mg Qwkly or 5mg QD (prevention)
Bone fractures, bone/joint/muscle pain, GI irritation, hypocal, ocular effects, ONJ

Ibandronate (PO/IV)
MedGuide
*take in an upright position with full glass water and avoid lying down for 60 min (dec GI effects)
I: osteoporosis in postmenopausal females
D: PO 150mg Qmo; IV 3mg Q3mo
SE: bone fractures, bone/joint/muscle pain, GI irritation, hypocal, ONJ

Zolendronic acid
MedGuide
I: Bone metastases, Hypercal/MM osteolytic lesions (Zometa); osteoporosis (Reclast)
D: IV 4mg Q3-4wks (zometa); IV 5mg Qyr
SE: bone fractures, hypocal, musculoskeletal pain, ocular infection, ONJ

Risendronate
I: osteoporosis
D: IR= 5mg QD or 35mg Qwkly or 150mg Qmo; DR=35mg Qwkly

Raloxifene
MedGuide
BW: inc. risk of VTE, CV disease
I: osteoporosis
D: 60mg QD

Calcitonin
I: hypercal, postmenopausal osteoporosis

Estrogen/progestin
BW: smoking+ CV events

Levonorgestrel
I: emergency contraception
D: 2 dose regimen= 0.75mg ASAP within 72H, then 0.75mg 12H after 1st dose; 1 dose regimen= 1.5mg ASAP within 72H

Ulipristal
I: emergency contraception
D: 30mg ASAP, but within 120H (5 days)

Conjugated estrogens
BW: endometrial cancer, CV disease, breast cancer, dementia

Conjugated estrogens
BW: endometrial cancer, CV disease, breast cancer, dementia

Estradiol
BW: endometrial cancer, CV disease, breast cancer, dementia

Medroxyprogesterone
BW: CV disorders (DVT/PE, stroke, MI), breast cancer, dementia, bone loss)

Cetirizine
I: allergic rhinitis/conjunctivitis, uritcaria
D: 10mg QD

Levocetirizine
I: chronic idiopathic uritcaria, allergic rhinitis
D: 5mg QD (PM) (upto 10mg BID)

Loratadine
I: allergic rhinitis, uritcaria
D: 10mg QD or 5mg BID

Desloratadine
I: chronic itiopathic urticaria, allergic rhinitis
D: 5mg QD

Fexofenadine
I: upper resp. allergy
D: 60mg BID (max 120mg/d) or 180mg QD

Diphenhydramine (PO/IM/IV)
I: allergy, cold, motion sickness, uritcaria
D: 25mg Q4-6H or 50mg Q6-8H

Chlorpheniramine
I: allergy
D: IR 4mg Q4-6H (max 24mg/24H); ER 12mg Q12H (max 24mg/24H)
SE: CNS depression

Hydroxyzine pamoate (PO/IM)
I: antiemetic, anxiety,
D: IM 25-100mg/d
SE: CNS depression, QT risk

Hydroxyzine HCl (IM/PO)
I: antiemetic
D: Im 25-100mg/d
SE: CNS depression, QT risk

Promethazine (PO/IM/IV)
BW: resp depression, severe tissue injury (inj)
I: allergies, motion sickness, N/V, sedation
D: 25mg QHS or 12.5mg before meals and at bedtime

Pseudoephedrine (PO)
I: nasal congestion
D: IR 60mg Q4-6H; ER 120mg Q12H or 240mg Q24H (max)
3.6g/d limit or 9g/month limit

Famotidine
I: GERD
D: 10mg BID prn (up to 20mg BID for 2 weeks)
SE: QT risk, vitB12 deficiency

Ranitidine
I:GERD
D: 75mg BID prn (upto 150mg BID for 2 weeks)

Nizatidine
I: Duodenal ulcer, gastric ulcer, GERD
D: 300mg QHS or 150mg BID (up to 8wks for DU, upto 12wks for GERD)

Cimetidine
I: duodenal ulcer, gastric ulcer, GERD, heartburn
D: 300mg QID or 800mg QHS or 400mg BID (up to 8wks)
SE: confusion, VItB12 deficiency

Omeprazole (cap/tab)
I: GERD, H. Pylori, PUD
D: 10-40mg QD; H. pylori 20-40mg BID
SE: C. Diff, fractures, hypomag, VitB12

Esomeprazole (cap, IV)
MedGuide
I: erosive esophagitis, H. Pylori, GERD
D: 20-40mg QD fo 4-8wks, then 20mg QD
SE: C. Diff, fractures, hypomag, VitB12

Lansoprazole (tab/cap)
MedGuide
I: GERD, PUD, H. Pylori
D: 15mg QD X8wks (up to 30mg QD); OTC 15mg QD X14ds (max 15mg/d);
SE: C. Diff, fractures, hypomag, VitB12

Pantoprazole (IV, tab)
MedGuide
I: GERD
D: 20mg QD (up to 40mg QD)
SE: C. diff, fractures, GI infection, hypomag, VitB12 deficiency

Rabeprazole (tab, sprinkle)
MedGuide
I: duodenal ulcer, GERD, H. Pylori
D: 20 mg QD <4-8 weeks
SE: C. Diff, fractures, GI infection, hypomag, VitB12 deficiency

Sucralfate
I: duodenal ulcer
D: susp./tab 1 g QID for 4-8wks, then 1 g BID

Misoprostol
BW: women of child bearing potential (birth defects, abortion)
I: NSAID-induced gastric ulcers
D: 200mcg QID PO
SE: abortifacient

Prochlorperazine (tab/IM/IV / rectal)
BW: dementia
I: N/V
D: PO 5-10mg TID-QID (max 40mg/d)
SE: ocular effects, NMS, hypotension, hyperprolactin, falls, EPS

Metoclopramide (inj, tab)
MedGuide
BW: Tardive dys.
I: chemo induced N/V
D: 10mg
SE: CNS depression, EPS, Hyperprolactin, HTN, TD

Ondansetron (PO/IM/IV)
*IV doses >16mg not recommended (QT risk)
I: chemo-induced N/V
D: 8mg BID PO;8mg or 0.15mg/kg (max 16mg/dose)
SE: QT risk, SS

Filgrastim
I: AML, bone marrow transplant, chemo induced myelosuppression, hematopoietic radiation (Neupogen)
D: SQ 10mcg/kg QD

Pegfilgrastim
I:prevention of chem induced neutropenia; hematopoietic radiation (neulasta)
D: SQ 6mg

Epoetin alfa (SQ/IV)
MedGuide
BW: cardio events, CKD, cancer
*check TSAT, ferritin lvl's before initiating
I: anemia due to CKD

Darbepoetin
(IV/SQ)
MedGuide
BW: cardio events, CKD, cancer
I: anemia due to CKD
*check TSAT, ferritin lvl's before initiating

Warfarin
MedGuide
INR 2-3
INR 2.5-3.5 (mech. valve)
INR1.5-2.5 (PAH)
BW: bleed risk
D: initial 5mg QD x3 days; 2.5mg QD for 3 days (sensitive pts); 1mg (P),2mg(L),2.5mg(G),3mg(B),4mg(B),5mg(P),6mg(T),7.5(Y),10mg(W)
SE: bleeding, calciphylaxis, skin necrosis / gangrene
Antidote: Vit K, Kcentra

Dalteparin
BW: spinal/epidural hematoma
I: NTEMI, VTE
D: NSTEMI- 120 units/kg SQ
SE: bleeding, hyperkal, thrombocytopenia

Enoxaparin
BW: spinal/epidural hematomas
I: ACS, VTE
D: 1 mg/kg Q12H, total hip surgery: 40 mg QD or 30 mg BID
SE: bleeding, thrombocytopenia, hyperkalemia

Fondaparinux (SQ/IV)
BW: spinal/epidural hematomas
I: acute DVT/PE, VTE ppx
D: <50kg - 5mg QD; 50-100kg - 7.5mg QD; > 100kg - 10mg QD
SE: bleeding, thrombocytopenia

Benztropine (PO,IM,IV)
I: drug induced EPS, PD
D: 1-2mg bid-tid

Trihexyphenidyl
I: drug induced EPS, PD
D: 1mg/d (upto 5-15mg/d 3-4 divided doses)