Amlodipine see calcium-channel blockers. Amoxicillin beta-lactam Dose 500mg \200\2231g PO/IV 8h Indication infection CI penicillin a llergy Caution glandular fever, CMV infection, ALL/CLL SE N+V, diarrhea, rash BNF 5.1.1.3. Ampicillin beta-lactam Dose 500mg \200\2231g PO/IV 6h Indication infection CI penicillin al lergy Caution glandular fever, CMV infection, ALL/CLL SE N+V, diarrhea, rash BNF 5.1.1.3. Antacids/Alginates Dose see Table 5.3 Indications acid refl ux disease Caution hepatic and renal impairment; if symptoms are severe or persist seek expert opinion SE depends upon pre paration used, see Table 5.3 Info the sodium load in these preparations can be signifi cant and they should be used with caution in patients with hepatic impair- ment. The alginates increase the viscosity of the stomach contents and can protect the oesophageal mucosa from acid attack; the raft-forming alginates fl oat on the surface of the stomach contents and m ay further reduce the symptoms of refl ux BNF 1.1.1/1.1.2. Table 5.3 Antacids BNF 1.1.1; alginates BNF 1.1.2 Classi \201 cation eg Alu-Cap Dose 1 capsule 4 times daily and at bedtime CI hypophosphataemia, neonates SE constipation Dose 10ml 3 times daily in water CI hypophosphataemia SE diarrhea, belching (d ue to CO2 liberation) Aluminum hydroxide Magnesium carbonate Magnesium trisilicate Dose depends upon preparation, see BNF 1.1.1 CI and SE see magnesium carbonate eg Peptac Dose 10 \200\22320ml after meals and at bedtime SE u sually none eg Gastrocote Dose 5 \200\22315ml 4 times daily (after meals and at bedtime) SE usually none Alginate raft-forming suspensions Other alginate preparations OHFP.indb 184 OHFP.indb 184 30/05/2014 16:18 30/05/2014 16:18 185 pharmacopeia Antiemetics Dose see Table 5.5 Indications N+V see Table 5.4; not all antiemetics are eff e ctive for all causes of N+V Caution and SE see Table 5.5 Info it is important to establish the cause of N+V BNF 4.6. Table 5.4 Causes of N+V and suggested antiemetic BNF 4.6 Likely cause Suggested antiemetics Pregnancy Post-operative Promethazine, prochlorperazine, metoclopramide In no particular order: 5HT3 antagonists, an tihistamines (eg cyclizine), dexamethasone, phenothiazines (eg prochlorperazine), metoclopr amide. Bowel obstruction Treat the cause. Avoid metoclopramide Motion sickness Hyoscine hydrobromide, promethazine, cyclizine Vestibular disorders Cytotoxic chemotherapy Betahistine (see BNF 4.6), antihistamine (eg cinnarizine, see BNF 4.6), phenothiazine (eg p rochlorperazine) Pre- and post-treatment with domperidone or metoclopramide; add in dexamet hasone, 5HT3 antagonists. See BNF 8.1 Depends upon cause. See b p91 Palliative care Table 5.5 Antiemetic classi \201 cation BNF 4.6 Antihistamines Cinnarizine, cyclizine, promethazine Cyclizine Dose 50mg/8h PO/IV/IM CI heart failure SE drowsiness, pain on injection, urinary retention, dry mouth, blurred vision Phenothiazines Chlorpromazine, droperidol, perphenazine, prochlorperazine, trifl uoperazine Prochlorperazine Dose consult BNF; 10mg/8h PO, 12.5mg/24h IM, 3 \200\2236mg/12h BUCCAL CI P arkinson \200\231s, epilepsy SE extrapyramidal eff ects, hypotension, drowsiness, agitation Dopamine antagonists Domperidone, metoclopramide Metoclopramide Dose 10mg/8h PO/IV/IM CI avoid in patients <21y (especially 5) and in bowel obstruction SE extrapyramidal eff ects Granisetron, ondansetron, palonosetron 5HT3 antagonists Ondansetron Dose 4 \200\2238mg/8h PO/IV/IM CI QT prolongation SE constipation, headache, fl ushing, bra dycardia, hypotension Dexamethasone, benzodiazepines, hyoscine hydrobromide, nabilone, neur okinin receptor antagonists Miscellaneous _OHFP.indb 185 _OHFP.indb 185 30/05/2014 16:18 30/05/2014 16:18 186 CHAPTER 5 Pharmacopeia Antihistamines H1 receptor antagonists Dose see Table 5.6 Indications symptomatic relief of allergy (eg hayfever, allergic rhinitis, urticaria) Caution avoid if possible in pregnancy and breastfeeding; consult BNF if renal or hepatic impairment; all antihistamines have the potential to cause sedation, some more so than others (see Table 5.6); the sedating antihi stamines also possess signifi cant antimuscarinic activity and should be used with caution in prostatic hypertrophy, urinary retention, and in patients with angle-closure glaucoma SE drowsiness, headache, antimuscarinic eff ects Info the drugs in this section are all antag onists at H1 receptor; cimetidine and ranitidine antagonists at the H2 receptor and are use ful for gastric acid suppression (see ranitidine) BNF 3.4.1. Table 5.6 Antihistamines BNF 3.4.1 Non-sedating antihistamines; acrivastine, cetirizine, desloratadine, fexofenadine, levoceti rizine, loratadine, mizolastine, rupatadine Dose 10mg/24h PO Cetirizine Caution halve dose if eGFR <30ml/min Dose 5mg/24h PO Dose 10mg/24h PO Desloratadine Loratadine Sedating antihistamines; alimemazine, chlorphenamine, clemastine, cyproheptadine, hydroxyzi ne, ketotifen, promethazine Chlorphenamine (chlorpheniramine) Dose 4mg/4 \200\2236h PO (max 24mg/24h); 10mg/8h IV/IM (over 1min if given IV) Arthrotec NSAID see diclofenac. Asacol aminosalicylate see mesalazine. Aspirin; antipla telet NSAID Dose anti-platelet 75mg/24h PO; ACS/MI 300mg/STAT PO; non-haemorrhagic stroke 3 00mg/24h PO for 14d then 75mg/24h PO Indication secondary prevention of thrombotic cerebrov ascular and cardiovascular events CI active bleeding, children under 16 (Reye \200\231s syn drome) Caution pregnancy, breastfeeding, asthma, peptic ulceration, concomitant use of othe r anticoagulants SE bronchos- pasm, GI irritation/hemorrhage BNF 2.9. Aspirin; analgesic/antipyretic NSAID Dose 300 \200\223900mg/4 \200\2236h PO; max 4g/24h Ind ication pain, pyrexia CI as above Caution as above SE as above BNF 4.7.1. OHFP.indb 186 OHFP.indb 186 30/05/2014 16:18 30/05/2014 16:18 187 pharmacopeia AT II receptor antagonists Dose see Table 5.7; commence therapy in the same way as starting an ACEi (see b p182) Indications patients intolerant of ACEi; heart failure, hypertension, diabetic nephropathy, prophylaxis of cardiovascular events Caution pregnancy and breast- f eeding, renal artery stenosis/renal impairment, aortic stenosis, hyperkalaemia, known aller gy to ACEi. May not be eff ective in African- Caribbean patients SE postural hypotension, r enal impairment and hyperkalaemia, taste disturbance, urticaria and angioneurotic oedema; c ough can occur but is less common than with ACEi BNF 2.5.5.2. Table 5.7 AT II receptor antagonists BNF 2.5.5.2 Dose initially 4-8mg/24h PO up to max 32mg/24h PO Dose initially 75 \200\223150mg/24h PO up to max 300mg/24h PO Dose initially 25 \200\22350mg/24h PO up to max 100mg/24h PO Dose init ially 80mg/24h PO up to max 320mg/24h PO Candesartan Irbesartan Losartan Valsartan Atenolol see beta-blockers. Atorvastatin HMG CoA reductase inhibitor see statins. Atropine; bradycardia anticholinergic Dose 500micrograms/ STAT IV every 3 \200\2235min; max 3mg/24h Indication bradycardia CI glau- coma, myasthenia gravis, pyloric stenosis, prostatic enlarg ement Caution Down s syndrome, GORD SE transient bradycardia, antimuscarinic eff ects (cons tipation, urinary urgency and retention, pupil dilatation/loss of accommodation, dry mouth) BNF 15.1.3. Atropine; cardiac arrest anticholinergic Dose 3mg/STAT IV Indication non-shock able cardiopulmonary arrest Caution none in the arrest situation SE as above Info atropine is no longer recommended for routine use in non-shockable cardiopulmonary arrest (see 2010 Resuscitation Guidelines) BNF 2.7.3. Bactroban antibacterial see mupirocin. Beclometasone corticosteroid Dose 200 \200\223400micrograms/12h INH Indication chronic asthma (step 2 BT S guidelines) Caution TB SE oral candidiasis, hoarse voice, paradoxical bronchospasm (rare) Info dif- ferent preparations/devices are not interchangeable and should be pre- scribed b y brand name BNF 3.2. Bendro \202 umethiazide thiazide diuretic Dose Oedema; 5 \200\22310m g/alternate days PO Hypertension; 2.5mg/24h PO Indication oedema, hypertension Caution DM, gout, SLE SE dehydration, hypo- tension, electrolyte imbalance (especially dK+) Interaction ilithium levels and NSAIDs decrease eff ect BNF 2.2.1. _OHFP.indb 187 _OHFP.indb 187 30/05/2014 16:18 30/05/2014 16:18 188 CHAPTER 5 Pharmacopeia Benzylpenicillin (penicillin G) beta-lactam Dose 0.6 \200\2231.2g/6h IV (max 4.8g/24h in di vided doses) Indication infection; skin, throat, endocarditis CI penicillin allergy Caution history of allergy SE diar- rhoea Interaction decrease eff ects of oral contraceptive pill , allopurinol increases risk of rash BNF 5.1.1.1. Beta-blockers Dose see Table 5.8 Indications generic indications include: hypertension, ang ina, myocardial infarction, arrhythmias, heart failure, thyrotoxicosis, anxiety, migraine p rophylaxis, benign essential tremor; topically for glaucoma Caution pregnancy, breastfeedin g, avoid abrupt withdrawal especially in patients with IHD (risk of rebound iHR/iBP), 1st-d egree AV block, DM (may mask symptoms dglucose), COPD CI asthma, uncontrolled heart failure , marked bradycardia, dBP, 2nd/3rd-degree AV block, severe peripheral arterial disease SE b rady- cardia, hypotension (especially postural), heart failure, bronchospasm, conduction di sorders, peripheral vasoconstriction, headache, fatigue, sleep disturbance (often nightmare s, insomnia), impotence Info the cardioselective B-blockers (below) have less eff ect on B2 receptors but are not cardiospecifi c and bronchoconstriction can still occur in suscep- t ible patients. Water-soluble B-blockers (atenolol, nadolol, sotalol) are excreted by the ki dneys and a dose reduction is often necessary in renal impairment; these also are less like ly to cause sleep disturbance and nightmares. Table 5.8 B-blockers BNF 2.4 Doses below show initial dose range for treatment of hypertens ion, doses vary with indication; consult BNF Cardioselective Atenolol Bisoprolol Metoprolol Dose 25 \200\22350mg/24h PO (100mg/24h max); also available IV Dose 5 \200\22310mg/24h PO ( 20mg/24h max) Dose 50 \200\223100mg/24h PO (400mg/24h max); also available IV Non-cardioselective Carvedilol Labetalol Dose 12.5mg/24h PO (max 50mg/24h in divided doses) Dose 100mg/12h PO (max 2.4g/24h in divid ed doses); also available IV Dose 40 \200\22380mg/12h PO, increase weekly (max 320mg/24h in divided doses) Used only to treat arrhythmias. Only commence after seeking expert advice D ose 40mg/12h PO (usual maintenance dose 80 \200\223160mg/12h PO); also available IV Used pr edominantly as eye drops for the treatment of glaucoma; case reports exist of this resultin g in systemic eff ects Propranolol Sotalol Timolol OHFP.indb 188 OHFP.indb 188 30/05/2014 16:18 30/05/2014 16:18