Drug of Choice

Dec 4, 2019 admin DƯỢC KHOA 0

OPTHALMOLOGY
••  open-angle glaucoma – Prostaglandins analogs ••  closed-angle glaucoma – Acetazolamide ••  secondary glaucoma – Beta blocker ••  inclusion conjunctivitis – Ceftriaxone ••  trachoma – Azithromycin ••  primary open angle glaucoma (POAG) – Timolol ••  Xerostomia – Cevimeline ••  corneal ulcer – Cyclopentolate ••  hypertension with glaucoma – Timolol ••  iridocyclitis – Atropine • Which beta blocker is the drug of choice in open-angle glaucoma – Timolol ••  hepatic keratitis – Idoxuridine ••  fungal corneal ulcer – Natamycin ••  uveal herpetic keratitis – Acyclovir ••  preventing meiosis during cataract surgery – Flurbiprofrn ••  mild allergic conjunctivitis – Topical antihistaminics ••  decreasing intra ocular pressure before surgery – Osmotic diuretics ( Eg: Manitol) ••  decreasing high intra ocular pressure – Osmotic diuretics ••  recurrent anterior uveitis – NSAID’s ••  reducing intra ocular pressure in diabetes – Osmotic diuretics

HEMATOLOLGY I7
••  preventing bleeding due to thrombolytic therapy – Epsilon-aminocaproic acid ••  treatment of deep vein thrombosis – Low molecular weight heparin ••  pulmonary embolism – Low molecular weight heparin ••  anemia in chronic renal failure – Erythropoietin

HEMATOLOGY
••  microcytic anemia – Ferrous Sulfate ••  iron deficiency anemia in pregnancy – Ferrous sulfate ••  warfarin overdose – Vitamin K ••  heparin overdose – Protaminc sulfate ••  hairy cell leukemia – Cladribine ••  chronic lymphocytic leukemia – Fludarabine ••  chronic myeloid leukemia (CML) – Imatinib ••  chemotherapy-induced anemia – Erythropoietin ••  anemia due to chronic kidney disease (CKD) – Erythropoietin • drug of choive for autoimmune hemolytic anemia – Prednisolone • transient ischemic attack (TIA) – Aspirin ••  multiple myeloma – Melphalan ••  heparin-induced thrombocytopenia – Argatroban ••  chemotherapy-induced leukopenia – Sargramostim ••  chemotherapy-induced thrombocytopenia – Oprelvekin • 1ST line drugs for multiple myeloma – Prednisolone. Prednisolone, Cyclophosphamide ••  heparin-induced thrombocytopenia – Argatroban ••  bleeding due to heparin – Hirudin ••  warfarin overdose – Vitamin K ••  heparin overdose – Protamine • Thrombolytic agent of choice in acute myocardial infarction – Streptokinase • arterial fibrillation induced clotting – Warfarin • prevention of stroke – Aspirin • prevention of deep vein thrombosis – Low molecular weight heparin

DRUG OF CHOICE FOR POISONING
••  paracetamol poisoning – N-Acetyl cysteine ••  organophosphate poisoning – Atropine ••  methotrexate toxicity – Folinic Acid ••  ethylene glycol poisoning – Fomepizole ••  warfarin poisoning – Vitamin k ••  heparin poisoning – Potassium sulfate ••  acute mercury – Dimercaprol ••  theophylline poisoning – Beta blockers ••  iron poisoning – Deferoxamine ••  copper poisoning – D- Penicillamine or Zinc acetate ••  acute arsenic poisoning – Dimercaprol ••  carbamate poisoning – Atropine ••  calcium channel blocker poisoning – Calcium with Glucagon ••  lead poisoning – DMSA ••  anticholinergic drug poisoning – Physostigmine ••  methylxanthines poisoning – Beta blocker ••  ergot alkaloid poisoning – Sodium nitroprusside ••  alpha I agonist poisoning – Phentolamine ••  beta 2 agonist poisoning – Propranolol ••  carbon dioxide poisoning – Hyperbaric oxygen ••  chronic mercury poisoning – N-acetyl- penicillamine ••  beta blocker poisoning – Glucagon ••  antipsychotic poisoning – Sodium bicarbonate with lidocaine ••  INH poisoning – Vitamine B6 ••  cyanide poisoning – Amyl Nitrate ••  opiod overdose – Naloxone

CENTRAL NERVOUS SYSTEM 10
••  reducing hyper excitement in acute mania – Haloperidol ••  reducing excitement in chorea – Haloperidol ••  reducing hyper excitement in acute schizophrenia – Haloperidol ••  reducing excitment in delerium – Haloperidol ••  post traumatic stress disorder – SSRI’s ••  somatic pain – NSAID’s ••  bipolar depression – Lithium ••  depression with hypotension – SSRI’s ••  depression with heart disease – SSRI’s ••  depression with insomnia – Amytriptyline ••  pain in asprin allergic patients – Paracetamol

CENTRAL NERVOUS SYSTEM
••  cerebral edema – Mannitol ••  increased intracranial pressure – Mannitol ••  psychomotor seizures – Carbamazepine ••  mania – Lithium Carbonate ••  Huntington chorea – Tetrabenazine ••  Parkinsonism – Ropinirole and Pramipexole ••  morning sickness – Hyoscine ••  multiple sclerosis – Amitriptyline ••  acute attack of migraine – Sumatriptan /Ergotamine ••  night terrors – Benzodiazepines ••  atypical depression – MAO inhibitors ••  hydrocephalus – Glycerol or Acetazolamide ••  cluster headache – Sumatriptan • Treatment of choice for cluster headache – High flow 02 ••  infantile spasm – ACTH ••  Huntington chorea – Tetra benzene ••  multiple sclerosis – Interferon B ••  pulmonary edema – Morphine •  generalized anxiety disorders – Diazepam (Benzodiazepines) ••  pain in terminal illness – Morphine ••  pain of acute myocardial infarction – Morphine ••  chronic cancer pain – Morphine ••  borderline personality disorder – Buspirone (5 HT partial agonist) ••  neonate with respiratory depression due to use of morphine to control severe labour pain – Naloxone ••  sedation in liver failure patients – Lorazepam ••  decreasing anxiety in children preoperatively – Antihistaminics ••  sedation in patients with porphyries – Benzodiazepines ••  trigeminal neuralgia – Carbamazepine ••  status absence – Benzodiazepines ••  convulsion in lidocaine treated patients – Diazepam ••  tardive dyskinesia – Diazepam ••  convulsion in tetanus patients – Diazepam ••  delirium caused by ketamine – Diazepam

CENTRAL NERVOUS SYSTEM
••  febrile seizures – Diazepam ••  endoscopic and colonscopy – Midazolam ••  hypnosis in elderly – Zolpidcm ••  diabetic neuropathy – Topiramate ••  neuropathic pain – Lamotrigine or Topiramate or Gahapentin ••  reducing alcohol craving – Naltrexone • Drug for decreasing relapse of alcoholism – Acamprosate (NMDA receptor antagonist) or Naltrexone ••  alcohol detoxification – Disulfiram ••  smoking cessation – Bupropion ••  depression in parkinson disease – SSRI’s ••  parkinson disease – Levodopa ••  psycosis in parkinson disease – Clozapine ••  depression – SSRI’s ••  restless leg syndrome – Ropinirolc ••  violent behaviour – Haloperidol ••  psychotic depression – Loxapine ••  neutropenia in felty’s syndrome – Lithium ••  patients with extra pyramidal symptoms (EPS) – Clozapine ••  negative symptoms – Clozapine ••  treatment resistant schizophrenia – Clozapine ••  elderly with schizophrenia – Clozapine ••  peripheral neuropathy – Lamotrigine ••  bulimia – SSRI’s (Eg: Fluoxetine) ••  acute mania – Lithium ••  serotonin syndrome – Cyproheptadine ••  nocturnal enuresis – Desmopressin ••  major depression – SSRI’s ••  heat stroke – Chlorpromazine ••  OCD – SSRI’s or Clomipramine ••  sleep walking – Carbamazepine ••  cluster headache – Lithium ••  cyclical vomiting – Lithium ••  bipolar mood disorder – Lithium

ANTIMICROBIAL DRUGS 21

scabies – Permethrin • Oral scabies – Ivermectin ••  filariasis – Diethyl Carbamazine (DEC) ••  listeria monocytogenes – Ampicillin ••  enterococcus fecalis – Ampicillin ••  toxoplasmosis – Cotrimoxazole ••  toxoplasmosis in pregnancy – Spiramycin ••  schistosomiasis – Praziquantel ••  leishmania.sis – Amphotericin B ••  Aspergillosis – Amphotericin B ••  roundworm (Ascaris) – Albendazole (Anti helminthic agent ) ••  pinworm (Enterobius vermicularis) – Albendazole (Anti helminthic agent ) ••  hookworm – Albendazole (Anti helminthic agent ) ••  whip worm – Albendazole (Anti helminthic agent ) ••  trichinae worm ( Trichinella spiralis) – Albendazole (Anti helminthic agent ) ••  guinea worm (Dracunculus medinensis) – Albendazole (Anti helminthic agent) ••  hydatid disease – Albendazole ••  filarial worm – Ivermectin (Anti helminthic agent ) ••  threadworm (Strongyloides stercoralis) – Ivermectin (Anti helminthic agent ) ••  pork tapeworm (Taenia solium ) – Praziquantel ••  beef tapeworm (Taenia saginata) – Praziquantel ••  fish tapeworm (Diphyllobothrium Tatum ) – Praziquantel ••  dog tapeworm (Echinococcus granulosus) – Praziquantel ••  dwarf tapeworm (Hymenolepis nana) – Praziquantel ••  liver fluke (Fasciola hepatica) – Triclabendazole ••  blood fluke – Praziquantel ••  lung fluke – Praziquantel ••  community acquired pneumonia – Clarithromycin ••  surgical prophylaxis – Cefazolin ••  pneumocystis carnii – Cotrimoxazole ••  cholera in children – Cotrimoxazole

ANTIMICROBIAL DRUGS 22

Second line filariasis – Ivermectin ••  tapeworm infestation – Praziquantel ••  suongyloidiasis (Threadworm) – Iverniectin ••  onchocerciasis (River Blindness) – Ivermectin ••  tetanus – Metronidazole ••  listeria – Ampicillin • Second line listeria – SMZ -TMP (Sulphamethoxazole Trimethoprim) ••  MRSA – Vancomycin ••  vancomycin-resistant staph aureus (VRSA) – Linezolid ••  neonatal meningitis – Ampicillin + 3rd generation Cephalosporin ••  bacteriosides fragialis – Clindamycin ••  pseudomembranous colitis – Metronidazole ••  amebiasis – Metronidazole ••  trench mouth – Metronidazole ••  bacterial vaginosis – Metronidazole ••  amoebic liver disease – Metronidazole ••  trichomoniasis – Metronidazole ••  giardiasis – Metronidazole ••  extraluminal amebiasis – Metronidazole ••  antibiotic-induced colitis – Metronidazole ••  anaerobic infections – Metronidazole ••  gonorrhea – Ceftriaxone ••  H.pylori eadication – Metronidazole ••  whooping cough – Erythromycin ••  cat scratch disease – Erythromycin ••  campylobacter infections – Erythromycin ••  gonococcal urethritis – Azithromycin ••  chancroid – Azithromycin ••  legionellosis – Azithromycin ••  trachoma – Azithromycin ••  intlammed acne – Minocycline ••  cystic acne – Isotretinoin ••  urinary tract infection – Norfloxacin

ANTIMICROBIAL DRUGS 23

Plasmodium vivax – Chloroquine ••  Plasmodium falciparum – Artemisinin combination therapy Artesunate + Pyrimethamine + Sulfadoxine ) ••  cerebral malaria – Artesunate ••  malaria – Chloroquine ••  chloroquine-resistant malaria – Artemisinin combination therapy ( Artesunate + Pyrimethamine + Sulfadoxine ) ••  brucella – Streptomycin with doxycycline ••  candida – Fluconazole ••  aspergillosis – Voriconazole ••  dermatophytosis – Topically (Azole), Systemic (Griseofulvin) ••  Chagas disease – Nifurtimox, Benznidazole ••  dysuria – Phenazopyridine ••  gonorrhea – Procaine Penicillin ••  syphilis – Procaine penicillin ••  rickettsia! infection – Tetracycline ••  plague – Tetracycline ••  anthrax – Doxycycline ••  toxoplasmosis – Trimethoprim Sulphamethoxazole ••  Haemophilus influenza type B – Rifampicin ••  prophylaxis of tuberculosis – Isoniazid ••  diarrhea in HIV patient – Octreotide ••  acyclovir-resistant herpes – Foscarnet ••  hepatitis B – Limuvidine ••  hepatitis C – Ribavarine & Interferon 2 alpha ••  lava migrans – Albendazole ••  inflammatory – Sulphasalazine ••  prophylaxis of newborn to TB mother – INH ••  accidental exposure of HIV to health care workers – Zidovudine with Latnivudine ••  salmonella – Ceftriaxone ••  meningitis – Ceftriaxone ••  gonorrhea – Ceftriaxone ••  resistant pneumococcal infections – Ceftriaxone

DRUG OF CHOICE IN PREGNANCY
••  preventing neural tube defect – Folic acid ••  anticoagulation in pregnancy – Heparin ••  mania – Lithium ••  mysthenia gravis – Neostigmine ••  thromboflebitis – Aspirin ••  urinary tract infection during pregnancy – Ampicillin ••  HIV in pregnancy – Zidovudine and Nevirapine ••  resistant typhoid – Ceftriaxone ••  tuberculosis – INH with rifampicin ••  vitamin B12 deficiency – Cynacobalamin ••  iron deficiency – Ferrous sulfate ••  antiplatelet action – Aspirin ••  anxiety – Benzodiazepines ••  pain – Aspirin / Paracetamol ••  depression in pregnancy – Tricyclic antidepressant ••  superficial thrombophlebitis – Asprin • Drug choice for bacterial vaginosis in 1st trimester in pregnancy – Clindamycin • Drug choice for rosacea – NSAIDS • Drug choice for seizures – Benzodiazepines • Drug choice for seizure maintenance – Phenobarbitone • Drug choice for rheumatoid arthritis – Aspirin • Drug choice for schizophrenia – Phenothiazines (Eg: Haloperidol) • Drug choice for seborrhic dermatitis – Salicylic acid • Drug choice for psoriasis – Topical corticosteroids / salicyclic acid • Drug choice for shigella dysentry – Ampicillin ••  ectopic pregnancy – Methotrexate ••  Induction of labor – Oxytocin ••  postpartum hemorrhage – Oxytocin ••  hypertension in pregnancy – Alpha-Methyldopa ••  endometriosis – Danazol ••  asthma – Beta 2 agonises ••  postpartum breast engorgement – Oxytocin •• . eizures in eclampsia – Magnesium. sulphate •  in seizures during pregnancy – Phenobarbitone ••  the hypertensive emergency in pregnancy – Labetalol ••  postpartum hemorrhage – Oxytocin ••  falciparum malaria in pregnancy – Quinine ••  cerebral malaria – Quinine ••  gonorrhea – Penicillin or Ceftlitutone ••  toxoplasmosts in pregnancy – Spiramycin ••  malaria in pregnancy – Chloroquine ••  acne – Erythromycin (oral) ) / Benzylbenzoate (Topical) ••  epilepsy in pregnancy – Phenobarbitone ••  mania In pregnancy – Olanzapine ••  hyperthyroidism – Propylthiouracil ••  hypothyroidism – Levothyroxine ••  bacterial vaginosis in 1st trimester – Clindamycin •  cholera in pregnancy – Furazolidone ••  typhoid fever in pregnancy – Ceitrizone or Amplcillin ••  amoebiasis Meironidazole ( Contraindicated in 1st trimester ) ••  amoebiasis In 1st trimester Purazolldone •  deep vein thrombosis – Heparin

ANTIMICROBIAL DRUGS 24
••  filarial worm – Di Ethyl Carbamazepine ••  Platyhelminthes – Praziquantel ••  trichomoniasis – Metronidazole ••  extended spectrum bacterial lactamase – Carbapenem ••  otitis media – Atnoxicillin ••  Nocardia – Sulfonamides ••  neurosyphilis – Aqueous penicillin ••  donovanosis – Azithromycin or Doxycycline ••  Neisseria – Ceftriaxone ••  Cryptococcus – For induction( Amphotericin) , for maintenance (Fluconazole) ••  Neurocysticercosis – Albendazole ••  typhoid (Enteric fever) – I.V Ceftriaxone • First line drugs for tuberculosis – Rifampicin. lsoniazid, Pyrazinamide, Ethambutol. Streptomycin ••  tuberculosis in renal failure – Rifampicin ••  prevention of tuberculosis in susceptible individuals – INH ••  treatment of tuberculosis in HIV positive patients taking protease inhibitor – Rifabutin ••  MDR strains of tuberculosis – Amikacin ••  latent tuberculosis – INH ••  INH resistant patients of latent tuberculosis – Rifampin ••  leprosy – Rifampin ••  lepra 1 reaction – Glucocorticoids ••  lepra 2 reaction – Glucocorticoids • Treatment of choice for multibacillary leprosy – Rifampin with Dapsone & Clofazamine ••  hot water born tuberculosis in hospital (M.xenopi) – Clarithromycin ••  cutaneous TB caused by atypical mycobacteria – Clarithromv.. ••  meningococcal prophylaxis – Ciprofloxacin ••  meningococcemia – Ceftriaxone ••  post spleenectomy sepsis – Ceftriaxone

ANTIMICROBIAL DRUGS 25

gram negative sepsis – Piperacillin with Toberamycin ••  gram positive sepsis – Vancomycin with Gentamicin ••  toxic shock syndrome (Group A strep.) – Penicillin with Clindamycin ••  necrotizing fasciitis (Group A streptococcus) – Penicillin ••  prophylaxis of cardiac lesions in infective endocarditis Amoxicillin ••  impetigo – Penicillin G ••  meningococcal meningitis – Penicillin G ••  severe falciparum and chlorquinine resistant malaria – Quinine ••  enterococcus faecium – Linezolid ••  animal bite – Amoxicillin ••  otitis media – Amoxicillin ••  dirty wound prophylaxis – Cefazolin ••  pneumococcal pneumonia in adults – Amoxicillin ••  typhus fever – Chloramphenicol ••  lice infection – 1% permethrin ••  dental prophylaxis in infective endocarditis – Clarithromycin ••  cellulitis – Oxacillin ••  severe infection in penicillin allergic patient – Vancomycin ••  microspora – Albendazole ••  serious upper urinary tract infections – Aminoglycosides • Dnig of choice for serious upper respiratory infections by atypical pathogens – Doxycycline ••  endoctirdial prophylaxis in patients allergic to penicillin -Vancomycin ••  histoplasmosis – Amphotericin B ••  invasive streptococcal infection – Clindamycin • Din of choice for dermatitis herpetiformis – Aspirin ••  cryptoccocus – Fluconazole ••  vulvovaginal candidiasis – Fluconazole ••  pyrazinamide induced hyperuricemia – Aspirin ••  systemic fungal infection – Amphotericin B ••  CMV retinitis – Gancyclovir ••  condyloma accuminata – Podophyline

GASTROINTESTIONAL SYSTEM

stool softening – Dioctyl sodium sulfosuccinate ••  irritable bowel syndrome – Tegaserod (5-HT4 agonist) ••  increasing motility – Mosapride (Gastroprokinetic) ••  diabetic gastroparesis – Mosapride ••  spasmodic abdominal pain – Drotaverine ( Phospho- diesterase inhibitor) ••  pain relief in ulcer – Antacids ••  diabetic diarrhea – Clonidine (Alpha – 2 adrenergic agonist) ••  non infectious diarrhea – Loperamide ••  secretory diarrhea – Cholestyramine ••  carcinoid syndrome – Cyprohepatadine ••  inducing vomiting – Apomorphine ( via parenteral route) •  shortening gastric emptying time before surgery – Metoclopramide ••  Mendelson’s syndrome – Metoclopramide ••  vomiting in children – Metoclopramide ••  inducing vomiting – Ipecacuhana ••  laxative effect in patients with hepatic encephalopathy – Lactulose

ENDOCRINE SYSTEM
••  acute & chronic adrenal insufficiency – Hydrocortisone (Shortest acting glucocorticoid) ••  congenital adrenal hyperplasia – Hydrocortisone ••  tumor induced brain edema – Dexamethasone ( Long acting glucocorticoid ) • Drug used for mineralocorticoid replacement – Fludrocortisone ••  Premenstrual syndrome – SSRI’s (Eg: Fluxetine) ••  dysfunctional uterine bleeding – NSAIDS ••  androgenic alopecia – Finasteride (5 Alpha reductase inhibitor) ••  hypothyroidism – Levothyroxine ••  hypothyroidism in children ( cretinism) – Thyroxine ••  myxedema coma – Levothyroxine ••  reducing thyroid gland vascularity – Potassium iodide ••  hyperprolactinemia – Bromocriptine ••  acute gout – NSAID (Indomethacin) ••  chronic gout – Allopurinol (Xanthine oxidase inhibitor ) ••  thyroid storm – Propylthiouracil ••  making patient euthyroid before surgery – Potassium iodide ••  thyroid cancer – Levothyroxine ••  grave’s disease – Methimazole (Antithyroid drug) ••  thyroid ablation – 1131 ••  thyroid storm in India – Potassium iodide ••  reducing somatic manifestations of hyperthyroidism – Propranolol ••  diabetic ketoacidosis (DKA) – Regular Insulin ••  pheochromocytoma – Phenoxybenzamine (Alpha blocker) ••  acute hypercalcemia – Furosemide (Loop diuretic) ••  hypercalcemia due to malignancy – Bisphosphonate ••  vaginal atrophy – Topical estrogen or HRT

ENDOCRINE SYSTEM 15

lithium-induced diabetes mellitus – Amiloride ••  steroid-induced osteoporosis – Zolindrate (Bisphosphonates ) ••  osteoporosis – Reloxifen (SERM- selective estrogen recptor modulator) ••  prostate cancer – GnRH Analogues (Eg: buserelin ) ••  neurogenic diabetes insipidus – Desmopressin ••  nephrogenic diabetes insipidus – Thiazides ••  acute adrenal insufficiency – Hydrocortisone (I.V) ••  postprandial hyperglycemia – Nateglinide (Maglitinide derivative) ••  type 2 diabetes mellitus (DM) – Metformin (Bigunides ) ••  type 1 diabetes mellitus (DM) – Regular Insulin ••  diabetes mellitus in pregnancy – Regular Insulin ••  uncontrolled diabetes mellitus – Regular Insulin ••  diabetic ketoacidosis – Regular Insulin ••  diabetes in renal and hepatic failure – Regular Insulin ••  controlling glucose level during infections in diabetes – Regular Insulin ••  diabetes in renal failure – Repaglinide ( Maglitinide derivative) ••  prevention of breast cancer – Tamoxifen ••  prevention of diabetes – Metformin ••  severe hypoglycemia in case of insulinoma – Diazoxide (Potassium channel opener) ••  emergency contraception – Mifepristone ••  polycystic ovarian disease – Clomiphene citrate ••  oligospermia – Clomiphene citrate ••  corpus luteum insufficiency – Clomiphene citrate ••  anovulatory infertility – Clomiphene citrate ••  post coital contraception – Mifepristone ••  hirsutism – Cyproterone acetate (Androgen receptor antagonist ) ••  large prostate – Finasteride ( 5 alpha reductase inhibitor ) ••  inducing labour – Oxytocin ••  BPH – Tamsulosin ••  postmenopausal osteoporosis – Raloxifene or Bisphosphonates ••  prevention of postmenopausal osteoporosis – Vitamin D & Calcium

RESPIRATORY SYSTEM

COPD – Anticholinergics (Eg:Tiotropium) • First line drugs for tuberculosis – Rifampicin, Isoniazid, Pyrazinamide, Ethambutol Streptomycin ••  testing bronchial hyperactivity – Methacholine (Non- selective muscarinic receptor agonist) ••  pulmonary edema with Congestive heart failure (CHF) – Furosemide (Diuretic) ••  a va.sodilatory shock – Norepinephrine ••  persistent hiccups – Carbon Dioxide ••  apnea in premature infants – Theophylline ••  exercise induced asthma – Mast cell stabilizers (Eg: Sodium Cromoglycate) ••  asprin induced asthma – Leukotriene antagonist (Eg: Montelukast) ••  starting treatment of asthma – Inhaled beta 2 agonist (Eg: salmeterol) ••  bronchospasm with COPD – Ipratropium Bromide ••  smoking cessation – Nicotine ••  liquefying plaques of sputum in patients with cystic fibrosis – Acetylcysteine ••  temporal arteritis – Corticosteroid ••  prophylaxis of exercise induced asthma – Sodium chromoglycate ••  pulmonary edema – Furosemide ••  dry itchy cough – Codeine ••  acute asthma attack – Salbutamol (Short acting selective beta2- adrenergic receptor agonist) ••  persistent asthma – Inhaled corticosteroid

ANTICANCER DRUGS

breast cancer – Tamoxifen ••  glioma – Nitrosourea ••  colorectal cancer – 5 Fluorouracil ••  choriocarcinoma – Methotrexate ••  pancreatic carcinoma – Gemcitabine • First line chemotherapy for cervix carcinoma – Cisplatin ••  the brain tumor – Lomustine ••  prostate carcinoma – Flutamide ••  insulinoma – Streptozotocin ••  polycythemia vera – Busulphan or Chlorambucil ••  carcinoma of endometrium – Progestins ••  kaposi sarcome – IF2 alpha ••  CLL – Chlorambucil or Fludarabine ••  acute myelocytic leukemia – Cytarabine with Mitoxantrone ••  wilm’s tumor – Vincristine with Danctinomycin ••  acute promyeloblastic leukemia – Retinoic acid ••  hairy cell leukemia – Cladarabine ••  thyroid carcinoma – 1131 with Doxarubicin and cisplatin ••  stomach cancer – Fluorouracil with Cisplatin ••  CML – Imatinib or Busulfan ••  acute lymphocytic leukemia(ALL) – Vincristine Prcdnisolone + Mercaptopurine + Cyclophosphamide +Methotrexate ••  ovarian cancer – Cisplatin with Paclitaxel ••  lung cancer – Cisplatin with Taxane ••  malignant melanoma – Dacarbazine ••  testicular cancer – Bleomycin+ Etoposide + Cisplatin

DERMATOLOGY

tacnia – Topical azoles (Eg: clotriamazole ) ••  erythrodermic psoriasis – Methotrexate ••  psoriatic arthropathy – Methotrexate ••  severe psoriasis – Methotrexate ••  severe erythrodermic psoriasis – Cyclosporine ••  pustular psoriasis – Retinoid ••  impetigo herpetiformis – Systemic Steroids ••  dermatitis herpetiformis – Dapsone • Treatment of choice for acute eczema – Moist compresses • Treatment of choice for subacute eczema – Creams & Moisturizers • Treatment of choice for chronic eczema – Ointment ••  impetigo – Mupirocin ••  solar lentigenes – Tretinoin ••  chancroid – Ceftriaxone ••  pemphigus vulgaris – Prednisolone ••  vitiligo – Corticosteroids ••  atopic dermatitis – Topical corticosteroids ••  severe excerebation of atopic dermatitis – Systemic corticosteroids ••  reducing recurrence of melanoma – Alpha interferon with vaccine ••  lichen simplex chronicus – Corticosteroids ••  seborrhic dermatitis in scalp – Selenium shampoo ••  acne rosacea – Oral tetracycline ••  Linea capitis – Griseofulvin ••  the scleroderma induced hypertensive crisis – Ace inhibitors (Eg:Captopril, Enapril etc) • Treatment of choice for lichen planus – Topical glucocorticoids ••  systemic dermatophytosis – Griseofulvin ••  steven johnson syndrome – IV Immunoglobulins

CARDIOVASCULAR SYSTEM
••  torsades de pointes – Magnesium Sulfate ••  dyslipidemia – HMG -COA Reductase inhibitors ••  hypertriglyceridemia – Fibric acid ••  myocardial infarction pain – Morphine ••  mild hypertension – Diuretics ••  the hypertensive crisis – Nitroprusside ••  hypertension with BPH – Prazosin ••  hypertension with ischemic heart disease – Beta-blockers ••  hypertension with diabetes mellitus – ACE Inhibitors ••  hypertension with diabetic nephropathy – ACE inhibitors ••  hypertension in young patients – ACE inhibitors (Eg: Captopril) ••  unilateral artery stenosis – ACE inhibitors ••  hypertension with mnal disease – ACE inhibitors ••  hypertension in CHF – ACE inhibitors ••  hypertension in non-diabetic protein urea – ACE inhibitors ••  hypertension in asthma – ACE inhibitors ••  hypertension in patients with Ischemie heart disease – Beta blockers ••  isolated systolic hypertension – Calcium channel blockers ••  low renin hypertension – Calcium channel blockers ••  hypertension with bronchial asthma – ACE inhibiors or CCB’s ••  hypertension with chronic kidney disease (CKD) – ACE Inhibitors ••  hypertension preferred in older patients – Thiazides ••  digoxin overdose – Digifab or Digibind ••  group B streptococcal infection – Ampicillin ••  endocarditis – Amoxicillin

CARDIOVASCULAR SYSTEM
••  digoxin toxicity – Potassium • 1st line CHF – ACE inhibitors (Eg Captopril ,Enalapril) ••  rapid fast diuresis – Loop diuretics (Eg: Furosemide) ••  multi-focal atrial tachycardia – Verapamil (Calcium channel blocker) ••  paroxysmal supra-ventricular tachycardia (PSVT) – Adenosine (Anti-arrhythmic agent ) ••  supra-ventricular tachycardia (SVT) – Verapamil ••  digitalis-induced ventricular arrhythmia – Lignocaine ( Anti-arrhythmic agent) ••  ventricular arrhythmias – Lidocaine ••  ventricular tachycardia and fibrillation – Lidocainc ••  ventricular extra-systole – Beta blocker (Eg: Atenolol) ••  atrial fibrillation – Digitalis ••  maintaining sinus rhythm – Amiodarone (Anti- arrhythmic agent ) ••  Wolff- Parkinson-white syndrome – Procainamide or Amiodarone ••  digitalis-induced arrhythmia – Lignocainc ••  acute left ventricular failure – I.V Furosemide ••  the scleroderma induced hypertensive crisis – ACE inhibitors ••  acute long QT syndrome – MgSo4 ••  congenital long QT syndrome – Beta blocker ••  hypertension with peripheral vascular disease – Calcium channel blockers ••  the hypertensive emergency – Sodium nitroprusside (Vasodilator) ••  malignant hypertension – Nitroprusside (Vasodilator) ••  producing controlled hypotension – Sodium nitroprusside ••  pulmonary hypertension – Bosentan ••  atrial flutter and fibrillation – lbutilide ••  paradoxical tachycardia – Digoxin (Digitalis glycosides) ••  angina – Nitrates ( Vasodilator) ••  prophylaxis of stable angina – Beta blockers ••  variant angina – Calcium channel blockers (Eg: Verapamil) ••  diabetic dyslipedemia – Statins (Eg: Atorvastatin, Rosuvastatin)

 

Cardiology           Treatment of Choice Second-line Treatment
Atrial Fib/Flutter
  • Antithrombotic therapy1
 CHA2DS2-VASc score > 2:
Warfarin (INR 2.0-3.0, target 2.5)
CHA2DS2-VASc score 1: Aspirin
or Warfarin (INR 2.0-3.0, target 2.5) or consider no treatment
CHA2DS2-VASc score 0: No treatment
  • Rate control
 Atenolol 25-100 mg daily Metoprolol 25-100 mg bid Diltiazem ER 180-360 mg daily
Verapamil ER 240-320 mg daily
Digoxin 125-250 mcg daily2
Heart Failure
  • Systolic dysfunction (LVEF <35-40%)
 Lisinopril 5-40 mg daily
Furosemide 20-200 mg daily-bid
Carvedilol 3.125-25 mg bid or 50 mg bid in patients >85 kg
Bisoprolol 2.5-20 mg daily
Spironolactone 25 mg daily
(class III and IV after ACEI titration)In African Americans, or if ACEI intolerance due to rising SCr, use Hydralazine 25 mg tid PLUS Isosorbide Dinitrate 20-40 mg tid4 OR Isosorbide Mononitrate 30-60 mg qam4.		 Digoxin 125-250 mcg daily2
Metoprolol Succinate 12.5-200 mg daily (titrate slowly)
Torsemide 10-200 mg daily
Metolazone 2.5-20 mg daily
If ACEI intolerance due to cough, rash, or angioedema3 use Losartan 25-100 mg daily
  • Diastolic dysfunction
 Furosemide 20-200 mg daily-bid
Torsemide 10-200 mg daily Metolazone 2.5-20 mg daily
  • Hypertension
 Initial therapy: Lisinopril/HCTZ 20/25 mg5 (Advance as needed) Start with ½ tablet J 1 tablet J 2 tablets daily
If ACEI intolerant, replace w/ARB: Losartan 25 mg daily J 25 mg bid J 50 mg bid If BP still above goal: add Amlodipine 2.5 mg J 5 mg J 10 mg daily
If BP still above goal: replace HCTZ with Chlorthalidone 25 mg daily If BP still above goal: add beta-blocker or Spironolactone.
Atenolol 25 mg daily J 50 mg daily (keep HR 55-70 bpm) OR
Spironolactone 12.5 mg daily J 25 mg daily (if on thiazide therapy & eGFR ≥60 mL/min & K+<4.5)
  • w/ CAD
 Initial therapy: Atenolol 25 mg + Lisinopril 5-40 mg daily4 If ACEI intolerant, replace w/ ARB: Losartan 25 mg daily
If BP still above goal: optimize beta-blocker dose and ACEI dose
If BP still above goal: add Amlodipine 2.5-10 mg daily or switch to lisinopril/HCTZ 20/25 mg If BP still above goal: replace HCTZ with Chlorthalidone 25 mg daily
If BP still above goal: advance beta-blocker or use Spironolactone
Spironolactone 12.5 mg daily J 25 mg daily (if on thiazide therapy & eGFR ≥60 mL/min & K+<4.5)
  1. High risk factors: prior CVA, TIA, or embolism; prosthetic heart Moderate risk factors: Age ≥75, HTN, CHF, diabetes, ejection fraction <30%. Weaker risk factors: female, age 65-74, CAD, thyrotoxicosis. ACC/AHA/ESC 2006 Atrial Fibrillation Guidelines.
  2. Avoid doses >125 mcg/day in those ≥65 years
  3. If ACEI-induced angioedema is severe, use caution with
  4. A daily nitrate-free interval of at least 14 hours is advisable to minimize
  5. Verify effective contraception in women of child-bearing potential: use chlorthalidone or Use caution with ACEI if eGFR <30 ml/min or K+>5.5. Use ARBs if ACEI intolerant and HTN not controlled on thiazide alone.

 

 

 

Dermatology
Acne
Mild inflammatory and/or comedonal acne          Benzoyl peroxide/Erythromycin 5-3% gel daily-bid PLUS Tretinoin 0.025% cream qhs OTC Benzoyl peroxide 5% daily-bid +/-             Clindamycin 1% topical soln daily-bid PLUS
Tretinoin 0.025% cream qhs
Moderate-severe acne

or truncal involvement

 Continue other treatments listed above and change from topical to oral antibiotic: Doxycycline 100 mg bid1 EES 400 mg bid NF
Dermatitis Low potency (face and folds): Hydrocortisone 1%, 2.5%
Medium potency: Triamcinolone 0.1%		 Medium to High potency: Triamcinolone 0.5%
High Potency: Augmented betamethasone dip 0.05%
Fungal Infection OTC Terbinafine cream OTC Clotrimazole cream OTC Miconazole cream
Pediculosis (lice) OTC Permethrin 1% rinse (Nix)2—leave on for 10 min, rinse well Permethrin 5% cream (Elimite)2 — apply to hair, cover w/ shower cap, leave on overnight, rinse well
Warts OTC salicylic acid 40% plasters—change daily and scrape off dead skin before reapplying
1. Use of tetracyclines should be avoided during tooth development (i.e., last half of pregnancy and children <8 years old) because it may cause permanent tooth discoloration.
2. Repeat in 7 days if nits are still present.

 

Endocrinology
Diabetes (DM) Type 2 Metformin IR 500-1000 mg bid
(max recommended is 2550 mg/day)
Metformin ER 500-2000 mg once daily
(max recommended 2000 mg/day)
Glipizide 2.5-10 mg bid
(max recommended is 20 mg/day) (max recommended is 8 mg/d)
Insulin NPH (Humulin N) qhs Insulin regular (Humuiln R) bid ac
Insulin NPH/insulin regular (Humulin 70/30) bid ac		 Insulin glargine (Lantus B, NF) daily
(NF Long acting insulins: Equivalent to NPH in blood sugar control. Consider if nocturnal hypoglycemia or new onset Type I DM)
Hypercholesterolemia Encourage added dietary changes
Moderate-intensity statin:
Simvastatin 20-40 mg daily1-3
Atorvastatin 10- 20 mg daily (consider for
patients that require LDL-C reduction >41%)
If intolerant to above:
Lovastatin 40-80 mg daily
Pravastatin 40-80 mg daily		 High-intensity statin:
Atorvastatin 40-80 mg dailyAdditional options include:
Switch to a more potent statin
Encourage added dietary changes & stop advancing therapy
Hypertriglyceridemia
TG = >200 mg/dL Initiate statin therapy if indicated
TG = >500 mg/dL OTC omega-3 fish oil supplement 2-4 gm/day (EPA+DHA)
If on statin, consider switching to atorvastatin.
If patient not at TG goal: Consider adding OTC Slo-Niacin 250-1000 mg4 + Fenofibrate 160 mg daily5 (If eGFR <50 mL min, reduce dose to 54 mg daily) Gemfibrozil 600 mg bid5 (If eGFR <50 mL/ min reduce dose to 300 mg bid)
  1. Simvastatin 80 mg or Vytorin 10/80 mg should not be initiated in any patients including those that are already taking lower
  2. A reduced initial simvastatin dose (5-10 mg) is suggested in patients with eGFR <30 mL/min.
  3. Simvastatin should not be used with itraconazole, ketoconazole, posaconaozle, erythromycin, clarithromycin, telithromycin, HIV protease inhibitors, nefazodone, cyclosporine, gemfibrozil, or Do not use: >10 mg of simvastatin with dronedarone, verapamil, or diltiazem; or >20 mg simvas- tatin with amlodipine, amiodarone or ranolazine.
  4. A maximum OTC Slo-Niacin dose of 1000 mg daily is recommended when used in combination with simvastatin 80
  5. Fenofibrate preferred when used in combination with a Gemfibrozil is the preferred fibrate if eGFR ≤30 mL/min and patient is not on statin therapy. Avoid combining gemfibrozil with statins due to increased risk of myopathy and rhabdomyolysis.
Hypogonadism1 Testosterone cypionate 200-300 mg
IM every 2 weeksTestosterone 1% gel pump (12.5 mg/actuation)
50 mg (4 pump actuations) topically daily2		 Testosterone 1% gel packet NF apply 25-50 mg qAM2
  1. A possible increase in cardiovascular risk has been identified in men who use testosterone replacement therapy (TRT). TRT is FDA-approved only for men who have low testosterone levels due to disorders of the testicles, pituitary gland, or brain that cause
  2. Application sites should be allowed to dry completely prior to dressing, wash hands thoroughly with soap and water after application, avoid swim- ming or showering or washing the administration site for a minimum of 2 hours after application

NF = Non-Formulary
B = Brand name drug – higher copay for tiered plans

 

 

Gastroenterology
Diverticulitis Ciprofloxacin 500 mg bid +
Metronidazole 500 mg tid x 10-14 days
TMP-SMX DS bid +
Metronidazole 500 mg tid x 10-14 days		 Amoxicillin/clavulante 875/125 mg BID x 10-14 days
GERD Famotidine 20-40 mg bid EXCLUDED2
Ranitidine 150-300 mg bid EXCLUDED2		 Pantoprazole 20-40 mg daily1 EXCLUDED2
Omeprazole 20-60 mg daily1 EXCLUDED2
(Use if fails double dose H2RA, or if esophageal
ulcer/stricture)
PUD or Barrett’s Esophagus Pantoprazole 20-40 mg daily1 EXCLUDED2 Omeprazole 20-60 mg daily1 EXCLUDED2
H.Pylori Eradication Pantoprazole 40 mg bid1 EXCLUDED2 +
Amoxicillin 500 mg 2 caps bid +
Clarithromycin 500 mg bid +		 Pylera 140- 125-125 B,NF mg 3 caps qid +
Pantoprazole 40 mg bid1 x 10 days EXCLUDED2
IBS Dicyclomine 20 mg qid prn§
Hyoscyamine 0.125-0.25 mg SL tid-qid prn
For constipation, options include:
OTC psyllium (Konsyl or Metamucil) 1 tsp or
1 Tbsp (depending on product) up to tid
(goal of stool large and soft)
OTC Polyethylene glycol 17 g dissolved in
4-8 oz beverage daily
For diarrhea: OTC Loperamide 4-8 mg/day		 Nortriptyline§ 10-50 mg qhs,§
1. Very low cost Rx and OTC Omperazole 20 mg capsules and Rx Pantoprazole 20-40 mg tablets are available for purchase at KP internal pharmacies.
2. Proton-pump inhibitors (i.e., Omeprazole) and H2-antagonists (i.e., Famotidine) are excluded from coverage under the Commercial prescription drug benefit and are only available to members for the cash price.
§ Avoid in adults ≥65 years old.

 

 

Infectious Diseases
Bronchitis NO ANTIBIOTIC INDICATED
OTC APAP 325 mg 1-2 tabs q6h prn
OTC Robitussin DM 2 tsp q4h prn
K fluid intake		 If antibiotic indicated (acute bacterial
exacerbation of chronic bronchitis)1:
Amoxicillin/Clavulanate 875/125 mg bid x 7 days
Doxycycline 100 mg bid x 7 days
Levofloxacin 500 mg daily x 7 days
Skin and Soft Tissues Infections Dicloxacillin 500 mg qid
Cephalexin 500 mg qid		 Clindamycin 300 mg q6h
Nonpurulent
Purulent TMP-SMX DS 1-2 tabs bid +/-
Rifampin 300 mg bid		 Doxycycline 100 mg bid in patients with PCN allergies
Diabetic Skin Infection
With acute cellulitis Dicloxacillin 500 mg qid
Cephalexin 500 mg qid
Suspect MRSA Add TMP/SMX DS 1-2 tabs bid
Deep ulcer (w/cellulitis) Consider referral to wound care clinic or Infectious Diseases to determine if antibiotics are appropriate.
Clostridium Difficile Discontinue other antibiotics ASAP
Mild- moderate Metronidazole 500 mg q8h x 14 days 1st reoccurrence: treat same as initial episode
Severe (Leukocytes
> 15,000 and Scr
>1.5x baseline)		 Vancomycin 125 mg PO q6h x 14 days (Vancomycin 50 mg/ml soln is preferred) 2nd reoccurrence: vancomycin taper2
Community-Acquired Pneumonia
Previously healthy
no comorbidities		 Doxycycline 100 mg bid x 5 days Azithromycin 500 mg x 1 days, then
250 mg x 4 more days
Comorbidities
antibiotic use in last
3 months or high rate
of resistance		 Cefuroxime 500 mg bid x 5-7 days +
Azithromycin 500 mg x 1 days, then
250 mg x 4 more days OR
Doxycycline 100 mg bid x 5-7 days		 Levofloxacin 750 mg daily x 5 days
Herpes Zoster Acyclovir 800 mg 5 times daily x 7-10 days Valacyclovir NF 1 gm tid x 7 days
Famciclovir NF 500 mg tid x 7 days
Otitis Media Amoxicillin 500 mg tid or 875 mg bid x 5 days Cefuroxime 500 mg bid x 7 days
Azithromycin 500 mg x 1 day, then 250 mg daily
x 4 more days
Pertussis Azithromycin 500 mg x 1 day then,
250 mg daily x 4 more days		 Clarithromycin 500 mg bid x 7 days
If macrolide-intolerant: TMP-SMX DS bid x 14 days
Pharyngitis
Streptococcal Patient to fill prescription only after postive Strep. probe confirmed.
 

PCN VK 500 mg bid x 10 days
PCN G Benzathine 1.2 million units IM x 1 dose

 If PCN-allergic: Cephalexin 500 mg bid x 10 days
Clindamycin 300 mg tid x 10 days
Azithromycin 500 mg x 1 day, then 250 mg daily x 4 more days
Viral OTC throat spray or lozenge
Sexually Transmitted Diseases: The Centers for Disease Control (CDC) recommends presumptive therapy for both gonococcal and Chlamydia infection when mak- ing one of these diagnoses.
Gonorrhea and
Chlamydia		 Ceftriaxone 250 mg IM x 1 dose PLUS
Azithromycin 1 gm x 1 dose (DOT)		 f patient has severe penicillin or cephalosporin
allergy: Azithromycin 2 gm x 1 dose (DOT) PLUS
gentamicin 240 mg IM x 1 dose
Herpes Simplex (Genital Herpes)
First clinical episode Acyclovir 400 mg tid x 7-10 days or until clinical resolution
Recurrent episodes Acyclovir 400 mg tid x 5 days Acyclovir 800 mg bid x 5 days
Suppressive therapy Acyclovir 400 mg bid
Sinusitis NO ANTIBIOTIC INDICATED
OTC saline nasal spray
OTC decongestant
If antibiotic indicated: Amoxicillin/Clavulanate 875/125 mg bid x 5-7 d		 If antibiotic indicated:
Doxycycline 100 mg bid x 5-7 days
1. Antibiotics should be given if have (a) 3 cardinal symptoms (increased dyspnea, increased sputum volume and purulence) (b) increased sputum purulence and 1 other cardinal symptom (c) require mechanical ventilation.
2. Suggested vancomycin taper dosing: 125mg qid x 14D then 125mg bid x 7D then 125mg qd x 7d then 125mg every other day x 7d then 125mg every 3 days x 14D

 

 

 

Insomnia Identify and treat the etiology of insomnia
Non-pharmacological practices
Overcoming™ Insomnia CBT program
Sleep hygiene (.piinsomnia)		 If medication indicated, use short-term (<30 days)
Trazodone 25-100 mg qhs prn
Zolpidem 5 mg qhs prn1
Zaleplon 5-20 mg qhs prn1
Temazepam 15 mg qhs prn§
Mirtazapine 7.5 mg -15 mg qhs prn
Melatonin 3 mg -5 mg qhs prn
1. Avoid chronic use (>90 days per year) in adults ≥65 years old.
§ Avoid in adults ≥65 years old.

 

 

 

 

Neurology
Fibromyalgia Amitriptyline 10-150 mg qhs§
Tramadol 50-100 mg q4-6h prn
Cyclobenzaprine 5-10 mg tid§		 Nortriptyline 10-75 mg qhs§
Migraine Sumatriptan 25-100 mg; may repeat after
2 hrs, max 200 mg/day		 Naratriptan 2.5 mg; may repeat after 4 hrs,
max 5 mg/day
Rizatriptan 5 mg; may repeat after 2 hrs,
max 30 mg/day
Migraine prevention Propranolol 20 mg bid, K up to 240 mg/day
Valproic Acid 250 mg bid,K to max 500 mg bid
Divalproex delayed release (Depakote DR)
250 mg bid, K to max 500 mg bid
Nortriptyline 25-75 mg qhs§		 Topiramate 25-100 mg daily
Neuropathic Pain Amitriptyline 25-150 mg qhs§
Tramadol 50-100 mg q4-6h prn
Cyclobenzaprine 5-10 mg tid§		 Nortriptyline 10-75 mg qhs§
Venlafaxine ER 37.5 mg daily x 7 d, K to 75 mg/d
x 7 days, then K by 37.5 mg/d up to 150 mg/d2
Restless Legs Syndrome Ropinirole 0.25 mg once daily 1-3 hours before bedtime
If needed, after 2 days, can K dose to 0.5 mg; K to 1 mg after first week; then K by 0.5 mg weekly (up to 4 mg)
Pramipexole 0.125 mg [½ of 0.25 mg] once daily 2-3 hours before bedtime
If needed, double the dose every 4-7 days (up to 0.5 mg)
1. Successful pain relief is defined as a 30-50% reduction in frequency and intensity from baseline on scale of 0-10
2. If pain is not relieved after 1 month of therapy at 150 mg/day, increase Venlafaxine dose to 225 mg/day. Venlafaxine should be taken with food. Daily doses can be divided bid or tid (if using Venlafaxine IR tablets) or one time daily (if using Venlafaxine ER capsules)
§ Avoid in adults ≥65 years old.

 

 

 

 

OB/GYN – Women’s Health
Dysmenorrhea Ibuprofen 600 mg q6h or 800 mg q8h
Naproxen 500 mg initially, then 250 mg q6-8h
(max 1250 mg/day)		 Oral contraceptive (i.e., Levora, Microgestin 1/20)
Menopausal Symptoms1
Non-Hormonal Therapy for Hot Flashes2: Venlafaxine 37.5-150 mg/day
Sertraline 25-50 mg daily3,§
Citalopram 10-20 mg daily4
Gabapentin up to 300 mg tid x 4 weeks
For Hot Flashes With or Without Vaginal Dryness:
Uterus absent Estradiol 0.5-1 mg daily§ Estradiol (Climara) transdermal patch 0.025-0.1 mg/24 hrs; Apply topically weekly§
Uterus present Estradiol (oral or transdermal) +
Medroxyprogesterone 2.5 mg daily, or
5 mg for 12 consecutive days monthly		 Estradiol (oral or transdermal) +
Norethindrone 0.35 mg daily, or
0.7 mg for 12 consecutive days monthly
For Isolated Vaginal Dryness: Conjugated Estrogen (Premarin B) vaginal
cream 0.5 g 2x/week		 Estradiol (Estring B) vaginal ring 2 mg;
one ring vaginally every 90 days
Vagifem 10 mcg; 1 tab vaginally daily x 2 weeks,
then 1 tab vaginally 2x/week
Oral Contraceptive5 Monophasic
Apri
Aviane
Cryselle 28
Kelnor 1/35
Levora6
Microgestin Fe 1/20, 1.5/30
Necon 0.5/35, 1/35, 1/50
Nora-BE
Sprintec (35 mcg EE + 0.25 mg Norgestimate)
Zovia 1/50		 Biphasic
Necon10/11 NFTriphasic
Aranelle
Necon 7/7/7
Tri-Sprintec
Trivora
Osteoporosis7,8 Alendronate 70 mg once weekly Ibandronate (generic Boniva, NF) 150 mg monthly
Yeast Infection OTC vaginal antifungal Fluconazole 150 mg x 1 dose
1. HRT should be discontinued while patient is hospitalized or at extended bed rest and restarted based on noncardiac benefits/risks. Do not start HRT in patients who have a recent history of CVD. HRT should be discontinued if ASCVD score > 10%.
2. Off label use. There are no FDA-approved non-hormonal therapies for treatment of hot flashes. Data for the agents listed are some what limited.
3. Avoid if patient on concomitant tamoxifen. Drug interaction may reduce the effects of tamoxifen.
4. The maximum recommended dose of Citalopram is 20 mg per day for patients with hepatic impairment, >60 years of age, CYP2C19 poor metabo- lizers or taking concomitant CYP2C19 inhibitors.
5. Not listed as first and second line therapy, but listed alphabetically by phases.
6. Preferred formulary alternative for extended cycle regimen.
7. For osteopenia, refer to Fracture Risk Assessment (FRAX) tool to estimate individual fracture risk (www.shef.ac.uk/FRAX).
8. Total daily intake (from diet and supplements) of calcium 1,200 mg/day and vitamin D3 1,000 units/day is recommended for postmenopausal women and for men 50 years and older.
§ Avoid in adults ≥65 years old

 

 

Ophthalmology
Conjunctivitis Allergic OTC Ketotifen (Zaditor) 0.025% soln 1 gtt bid
OTC Naphazoline/Pheniramine (Opcon-A) 1 gtt qid		 Fluorometholone 0.1% 1-2 gtt bid-qid
Cromolyn 4% 1-2 drops q4-6 h NF
Epinastine 0.05% 1 gtt bid NF
Infectious Tobramycin soln 1 gtt qid
Polymyxin B/TMP (Polytrim) soln 1 gtt qid		 Gentamicin soln 1 gtt tid
Ofloxacin soln 1 gtt qid

 

 

 

Pain
Inflammatory Ibuprofen 400-800 mg tid§
Naproxen 375-500 mg bid§ Meloxicam 7.5-15 mg daily§		 Nabumetone 500-1000 mg bid§
Non-inflammatory OTC APAP 325-650 mg q6h1
Hydrocodone/APAP 5/325 mg 1 tab q4-6h prn1 (C-II)*		 Tramadol 50 mg 1-2 tabs q4-6h prn
Severe pain Hydrocodone/APAP 5/325 mg 1 tab q4-6h prn1 (C-II)*
Oxycodone/APAP 5/325 mg 1 tab q4-6h prn1 (C-II)*		 Morphine IR 7.5–15 mg q3-4h prn pain (C-II)*
Hydromorphone 2-4 mg q3-4h prn severe pain(C-II)*
Chronic3 Morphine SR 15 mg qhs x 1 week, then 15 mg q12h (C-II)*
Fentanyl patch 12.5, 25, 50, 75, 100 mcg/hr q72h (C-II)*		 Methadone 2.5-10 mg q8-12h (C-II)2*
1. Limit APAP dose to ≤3 gm/day; ≤2 gm/day for adults with liver dysfunction or history of alcohol use.
2. Use with caution. Avoid in opioid-naive patients & in those where long-term use may be required for non-cancer and non-post surgical conditions.
3. Fentanyl is reserved for patients with chronic pain who are opioid-tolerant and/or unable to take oral medications. Methadone is associated with cardiac complications (i.e., QTc prolongation) and one must be familiar with the appropriate monitoring guidelines before initiating its use. Treat underlying causes of pain. Consider adjunctive therapies before initiating chronic opioid therapy. Chronic opioid therapy should be considered cautiously.
§ Avoid in adults ≥65 years old. * Should be used short-term.

 

Hydrocodone to Morphine SR
Start with short-acting opioid to determine appropriate dose and can substitute with equivalent dose of long-acting formulation
(i.e., Morphine SR) if opioid is effective & well-tolerated.
1 to 1.5 mg hydrocodone = 1 mg morphine sulfate

 

Total Daily dose of HYDROCODONE Approximate Daily Dose of Morphine Equianalgesic dose of MORPHINE SR
20-30 mg 15-30 mg 15 mg daily-BID
40-60 mg 30-60 mg 15-30 mg BID
80-120 mg 60-120 mg 30-60 mg

 

 

 

Psychiatry
Anxiety
  • Acute*
 Clonazepam 0.25-0.5 mg bid prn§ Lorazepam 0.5-1 mg bid prn§
  • Chronic
 Fluoxetine 10-40 mg daily§
Citalopram 10-40 mg daily1
Paroxetine10-20 mg daily		 Buspirone 5-10 mg bid-tid (max 60 mg/day)
Sertraline 25-100 mg daily
Venlafaxine 37.5-75 mg daily2
Depression Fluoxetine 10-60 mg daily (max 80 mg/day)§
Citalopram 10-40 mg daily (max 40 mg/day)1
Sertraline 50-100 mg daily (max 200 mg/day)
Escitalopram 5-20 mg daily (max 20 mg/day)1
Paroxetine 20-40 mg daily (max 50mg/day)		 Venlafaxine 37.5 mg/day x 7 days, K to 75 mg/day
x 7 days, then K to 150 mg/day (max 375 mg/day)2
Bupropion SR 150 mg qam x 3 days, K to 150 mg bid x several weeks (max 400 mg/day)
Mirtazapine 15-45 mg qhs (max 45 mg/day)
Psychosis Risperidone 0.25-8 mg/day (dosed qhs or bid)
Quetiapine 25 mg bid, titrate up to maintenance dose of 200-800 mg/day
Ziprasidone 40-80 mg bid		 Olanzapine 2.5-20 mg daily
Aripiprazole 10-30 mg day (½ tab dosing)
1. The maximum recommended dose of Citalopram is 20 mg per day and Escitalopram is 10 mg per day for patients with hepatic impairment,
>60 years of age, CYP2C19 poor metabolizers or taking concomitant CYP2C19 inhibitors.
2. Venlafaxine should be taken with food. Daily doses can be divided to bid or tid (if using Venlafaxine IR tablets) or once daily (if using Venlafaxine ER capsules).
§ Avoid in adults ≥65 years old, short term only.
* No evidence for greater efficacy for alprazolam versus other benzodiazepines in panic disorders. There are more adverse events associated with alprazolam than other benzodiazepines.

 

 

 

Respiratory
Allergic Rhinitis OTC Triamcinolone (Nasacort Allergy 24 hr)
1-2 sprays each nostril daily
Fluticasone EXCLUDED2 1-2 sprays each		 OTC Loratadine 10 mg daily1
OTC Cetirizine 5-10 mg daily1
OTC Fexofenadine 60 mg bid or 180 mg daily1
Asthma (persistent)3 Albuterol prn for acute symptoms4 + long acting controller
Inhaled Corticosteroids (ICSs):
Beclomethasone HFA (QVAR B)
80 mcg 1-2 puffs bid
Mometasone furoate (Asmanex B)
220 mcg 1 inh in the evening – 2 inh bid		 Combination ICS/LABA:
Mometasone furoate/formoterol (Dulera B, NF)
100/5 mcg or 200/5 mcg – 2 inh bid
COPD (fewer symptoms,
low risk)		 Albuterol 1-2 puffs q4-6h prn AND/OR
Tiotropium (Spiriva Respimat B) 2.5 mcg 2 inh daily		 Olodaterol (Striverdi Respimat B) 2.5 mcg 2 inh daily
Ipratropium HFA (Atrovent HFA B) 2 puffs qid
Smoking Cessation5 0-5 cigarettes/day: OTC Nicotine gum or lozenge 2 mg x 12 wks
6-10 cigarettes/day: OTC Nicotine patch taper 14 mg/d x 2 wks, then 7 mg/d x 2 wks
11-20 cigarettes/day: OTC Nicotine patch taper 21 mg/d x 4 wks, 14 mg /d x 2 wks, then 7 mg/d x 2 wks PLUS OTC Nicotine gum or lozenge prn for breakthrough cravings
21-30 cigarettes/day:
– OTC Nicotine patch taper PLUS OTC Nicotine gum or lozenge prn for breakthrough cravings OR
– OTC Nicotine patch taper PLUS Bupropion SR 150 mg BID x 8 wks6 OR
– Triple therapy (option for refractory patients who have history of severe withdrawal symptoms): OTC Nicotine patch taper PLUS OTC Nicotine gum or lozenge PLUS Bupropion SR6
31-40 cigarettes/day: OTC Nicotine patch (high dose) 35 mg/day [21 mg + 14 mg] x 4 wks, 21 mg/d x 2 wks, 14 mg/d x 2 wks, 7 mg/d x 2 wks + OTC Nicotine gum or lozenge + Bupropion SR6
>40 cigarettes/day: OTC Nicotine patch (high dose) 42 mg/day [2 x 21 mg] x 4 wks, 21 mg/d x 2 wks, 14 mg/d x 2 wks, 7 mg/d x 2 wks + OTC Nicotine gum or lozenge + Bupropion SR6
1. Antihistamines can be used for mild or breakthrough symptoms or in combination with an intranasal steroid.
2. Intranasal steroids (i.e., fluticasone) are excluded from coverage under the Commercial prescription drug benefit and are only available to members for the cash price.
3. Stepwise approach to therapy is recommended. The goal of therapy is to maintain long-term control with the least amount of medication, thereby exposing the patient to the least risk for medication adverse effects. For more information on therapy options, please refer to the Adult Asthma guidelines on cl.kp.org.
4. Use of albuterol more than 2 days per week for symptom relief (not prevention of exercise induced bronchospasm) generally indicates inadequate control and the need to step-up treatment.
5. Final selection and dosage of medication may depend on patient preference, contraindications, potential for ADEs, and previous experience.
6. Bupropion therapy should begin one week prior to quit date.

 

 

 

Rheumatology
Gout (Acute) Naproxen 750 mg, then
250 mg q8h until resolved§
buprofen 800 mg tid x 2 days, then
400 mg tid for 4-7 days (or until resolved)§		 Prednisone 40 mg daily x 3 days, 30 mg daily x 3 days
20 mg daily x 3 days, 10 mg x 3 days, then 5 mg
x 3 days (or until resolved)
IM or intra-articular corticosteroid injection
(i.e., methylprednisolone, triamcinolone)
Gout (Prevention)1
Urate-lowering therapy		 Allopurinol 100 mg2, K by 100 mg/day every 2-4
weeks until serum uric acid level <6 mg/dl4
(max 800 mg/day)		 Probenecid 250 mg bid x 1 week, K to 500 mg bid3
Gout (Prophylaxis)5 Naproxen§ 250 mg bid PLUS a
proton pump inhibitor		 Colchicine NF 0.6 mg daily-bid5
1. Urate lowering therapy is indicated for patients with recurrent gout attacks, chronic gouty arthropathy, tophi, and uric acid stones.
2. Start with allopurinol 50 mg daily in patients with CKD stage 4 or 5.
3. Probenecid is an option for patients who are under-excretors of uric acid and in those resistant to, or intolerant of allopurinol. It should not be used in patients with renal impairment (GFR <50 mL/min) or a history of nephrolithiasis.
4. Alternate goal also < 5 mg/dl in patients with tophi.
5. Prophylaxis therapy should be initiated with urate lowering therapy and continued for 4-6 months after uric acid target (<6 mg/dL) is achieved. Col- chicine dose should be adjusted in those with eGFR <50 mL/min and avoided in patients with eGFR <10 mL/min. § Avoid in adults ≥65 years old

 

 

 

Urology
BPH Terazosin 2 mg qhs; if ineffective may increase
by 2 mg every week to a max of 10 mg/day		 Tamsulosin 0.4 mg daily 30 min after the same meal1
Hyperactive Bladder
(Urge incontinence)		 Behavioral modifications (i.e., kegels, timed
voiding, bladder training)
Oxybutynin 2.5-5 mg bid-tid§
Oxybutynin ER 5-15 mg/day2,§		 Trospium IR 20 mg bid3
(20 mg daily in those >75 years)
Tolterodine IR 2 mg bid§ NF
Prostatitis, Acute4
Young sexually active men Ceftriaxone 250 mg IM x 1 dose PLUS Azithromycin 1000 mg x 1 dose
Older patients TMP-SMX DS bid up to 6 weeks
Ciprofloxacin 500 mg bid up to 6 weeks
Urinary Tract Infection5 No antibiotic indicated for asymptomatic bacteriuria
Uncomplicated cystitis in non-pregnant women Nitrofurantoin 100 mg bid x 5 days6
Cephalexin 500 mg bid x 3-7 days7		 Ciprofloxacin 250 mg bid x 3 days8
Pyelonephritis Ciprofloxacin 500 mg bid x 7 days TMP/SMX DS bid x 5 days9 (if organisim susceptible)
Cystitis in pregnancy Cephalexin 500 mg bid x 3-7 days Nitrofurantoin 100 mg bid x 5 days
1. Tamsulosin is associated with increased complications during cataract surgery (Intraoperative Floppy Iris Syndrome [IFIS]). Consider non-selective alpha-blockers (i.e., Terazosin, Doxazosin) for patients diagnosed with cataracts and who have not undergone cataract surgery.
2. May be preferred in adults ≥65 years because of improved side effect profile.
3. May be preferred for elderly patients with dementia.
4. If duration of symptoms >3 weeks, treat for 21-28 days.
5. Therapeutic options for UTI maybe limited and should be based on known or local patterns of susceptibility for the causative pathogen(s).
6. Nitrofurantoin is contraindicated in patients with significant renal impairment (eGFR <60 mL/min). Avoid chronic use in adults >65 years old.
7. Consider Cephalexin therapy in areas with high rates (>20%) of E. coli resistant to TMP/SMX.
8. Caution should be used when using Ciprofloxacin in the elderly due to the risk of tendonitis and tendon rupture.
9. Avoid use in 1st and 3rd trimester of pregnancy.
§ Avoid in adults >65 years old.

 

 

 

Pediatrics
Allergic Rhinitis OTC Triamcinolone (Nasacort Allergy 24 hr)
2-6 yrs: 1 spray each nostril daily
™6 `YZ! 1-2 sprays each nostril daily
™4 `YZ: Fluticasone EXCLUDED1 1-2 sprays
each nostril daily		 OTC Loratadine 5 mg/5 mL liquid
OTC Cetirizine 5 mg/5 mL liquid
OTC Fexofenadine 30 mg/5 mL liquid
OTC Brompheniramine + PE (Dimetapp)2
Chlorpheniramine 2 mg/5 mL syrup
Asthma (persistent)3 Albuterol prn for acute symptoms4 + long acting controller
<5 yrs:
Beclomethasone HFA (QVAR B)
40 mcg 1 puff bid
5-11 years:
Beclomethasone HFA (QVAR B)
80 mcg 1 puff bid
™12 `LHYZ!
Beclomethasone HFA (QVAR B)
80 mcg 1-2 puffs bid		 If unable to use inhaler, consider budesonide
nebulizer suspension
4-11 yrs:
Mometasone (Asmanex B) 110 mcg 1 inh qpmMometasone (Asmanex B) 220 mcg 1 inh qpm –
2 inh bid
Conjunctivitis
Allergic OTC Ketotifen (Zaditor) 0.025% soln 1 gtt bid
OTC Naphazoline/Pheniramine (Opcon-A) 1 gtt qid		 ≥ 2 years: Ketorolac 0.5% 1 gtt qid
Bacterial Tobramycin soln 1 gtt qid
Polymyxin B/TMP (Polytrim) soln
1 gtt q3h x 7-10 days (max 6 doses/day)		 >1 year: Ofloxacin ophthalmic drops 1-2 gtts
q2-4h x 2 days. then 1-2 gtts qid for 5 more days
Gentamicin soln 1 gtt tid
Otitis Media Antibiotics are not indicated for otitis media with effusion only (OME).
Amoxicillin 80-90 mg/kg/day ÷ bid x 10 days If PCN Allergic:
Non-Type 1 hypersensitivity: Cefdinir susp
14 mg/kg/day daily or ÷ bid x 10 days
Type 1 hypersensitivity:
Azithromycin 10 mg/kg/day daily (max 500 mg)
x 1 day then, 5 mg/kg/day daily (max 250 mg)
x 4 more days
Clarithromycin 15 mg/kg/day ÷ bid x 7-10 days		 Failure of treatment after 48-72 hrs or recurrence:
Amoxicillin/Clavulanate ES 90 mg/kg/d ÷
bid x 10 days
Cefdinir susp 14 mg/kg/day daily or ÷ bid x 10 days
Clindamycin 30-40 mg/kg/day ÷ tid x 10 days
Ceftriaxone 50 mg/kg/d IM daily x 1-3 days
Pertussis Azithromycin:
1-5 months: 10 mg/kg/dose daily x 5 day
≥ 6 months: 10 mg/kg X 1 day, then
5 mg/kg/day daily x 4 more days		 Clarithromycin 15 mg/kg/day ÷ bid x 7 days
(max 500 mg/dose)
If macrolide-intolerant:
TMP-SMX 8 mg/kg/day ÷ bid x 14 days
Pharyngitis Patient to fill prescription only after positive strep. probe confirmed.
Streptococcal PCN VK
<27 kg 250 mg bid x 10 days
≥27 kg 500 mg bid x 10 days
Amoxicillin: 3-18 yrs: 50 mg/kg/day or 25 mg/kg
bid x 10 days (max 1,000 mg/day)		 PCN G benzathine
<27 kg 600,000 units IM x 1 dose
≥27 kg 1.2 million units IM x 1 dose
If PCN-allergic:
Cephalexin
<15 yrs: 25-50 mg/kg/day ÷ q12h x 10 days
≥15 yrs: 500 mg ÷ q12h x 10 days
Clindamycin 21 mg/kg/day ÷ q8h x 10 days
(max 300 mg/dose)
Azithromycin 12 mg/kg x 1 day, then 6 mg/kg/dose
daily x 4 more days
1. Intranasal steroids (i.e., fluticasone) are excluded from coverage under the Commercial prescription drug benefit and are only available to members for the cash price.
2. FDA cautions against the use of cough and cold medicines in children under 4 years of age.
3. For asthma not controlled on ICS therapy alone, addition of montelukast (generic Singulair) is a potential option. For asthma not controlled on low- to-medium dose ICS in older kids, consider change to combination ICS/LABA therapy. For more information on therapy options, please refer to the Asthma guidelines on cl.kp.org.
4. Use of albuterol more than 2 days per week for symptom relief (not prevention of exercise induced bronchospasm) generally indicates inadequate
control and the need to Step-Up therapy.
Sinusitis – Acute bacterial Amoxicillin/Clavulanate:
<40 kg: 45 mg/kg/day ÷ q12h x 10-14 days
≥40 kg: 500 mg q8h or 875 mg q12hx 5-7 days
Adolescents:
Doxycycline 100 mg bid x 10-14 days
If PCN allergic:
Non-Type 1 hypersensitivity (use combination therapy):
Cefdinir susp 14 mg/kg/day daily or ÷ bid -PLUS-
Clindamycin 30-40 mg/kg/day ÷ tid x 10-14 days
Type 1 hypersensitivity:
Levofloxacin 10-20 mg/kg/day daily or ÷ bid x 10-14 days
URI Treat symptoms
OTC PSE, APAP, or Chlorpheniramine

 

 

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