The Renal Drug Handbook.

1 12 The following references were used in compiling these monographs:Fink, Mitchell et al. of Critical Care. 5th edition 2005 Ashley, Caroline and Currie, Aileen. The Renal Drug Handbook. 2nd ed. United Kingdom: Radcliffe Medical Press Ltd, 2004 Shann, Frank. Drug Doses. 14th ed. Intensive Care Unit. Royal Children s Hospital, Parkville, Victoria 3052, Australia, 2008 McClintock, Alan et al. Notes on Injectable Drugs. 5th ed. New Zealand. New Zealand Healthcare Pharmacists Association, 2004 Medsafe Drug Data sheets (New Zealand Medicine and Medical Devices Safety Authority): Gateway: online version of this drug manual, optimised for smartphone & tablet viewing, is available at: An offline version is available for download (as a PDF) from: The most up-to-date version of this drug manual will always be available online.

2 Should any discrepancies exist between the printed & online versions, the latter should always take The first edition of the Intensive Care Drug Manual was developed by Dr. Paul Young for use in the Intensive Care Unit in Wellington Regional Hospital in 2011. This third edition has been updated for 2020 with revisions reflecting changes in our unit s Intensive Care practice and the ever-evolving critical care literature. On occasion, doses, methods of administration and indications differ from those available given in the product information. In such cases, recommendations reflect common ICU practice both here and elsewhere.

3 All doses have been checked independently by two Intensive Care Specialists. However if you suspect an error, please check data with alternative sources and notify the editor. Clinical responsibility for the choice, dose, route & frequency of any medication always remains with the prescribing doctor. This manual is for use in a monitored critical care environment only. Specific changes for this third edition include: New entries for levetiracetam, mannitol & tranexamic acid. Updated & expanded appendices providing more information on common drug-related queries. New appendices on drug cost by administration route, intravenous to oral antibiotic SWITCH, and local anaesthetic toxicity.

4 Vancomycin dosage & monitoring has been changed extensively. All drug prices have been updated as of August 2017 and are quoted are in New Zealand dollars. Prices have been included to inform prescribing choices where intravenous or enteral routes of administration are equivocal. For example, the intravenous preparation of Acetazolamide costs 250 times that of a single tablet (bioavailability >90%). 3 Alex Psirides Wellington, New Zealand August 2020 e: w: t: @psiridesThis document (c) 2020 Wellington ICU. It cannot be sold or altered without permission of the author. It is made freely available in keeping with the principles of Free Open Access to Medical Education (FOAMEd)A Acetazolamide 7 Acetylcysteine 9 Acyclovir 11 Adenosine 14 Adrenaline 17 Allopurinol 20 Aminophylline 23 Amiodarone 26 Amitriptylline 29 Amlodipine 31 Amoxicillin /Amoxycillin 33 Amoxicillin-Clavulanic Acid 36 Amophtericin B (Liposomal)

5 39 Aspirin 42 Atenolol 44 Atorvastatin 46 Atracurium 48 Atropine 50 Azathioprine 52 B Bendrofluazide 55 Benzylpenicillin / Penicillin G 57 C Caffeine 60 Calcitriol 62 Calcium Carbonate 64 Calcium Chloride 66 Calcium Gluconate 68 Candesartan 70 Captopril 72 Carbamazepine 75 Carvedilol 79 Caspofungin 82 Cefaclor 85 Cefazolin / Cephazolin 88 Cefotaxime 91 Ceftazidime 94 Ceftriaxone 97 Cefuroxime 100 Celiprolol 104 Charcoal (Activated) 106 Chloral Hydrate 108 Chlorpromazine 110 Cilazapril 113 Ciprofloxacin 116 Citalopram 120 Clarithromycin 122 Clindamycin 125 Clonazepam 128 Clonidine 131 Clopidogrel 133 Clozapine 135 Codeine Phosphate 138 Colchicine 140 Coloxyl with Senna 142 Co-trimoxazole 143 Cyclizine 147 Cyclosporin 149 D Dantrolene 154 Desmopressin / DDAVP 156 Dexamethasone 158 dexmedetomidine 161 Diazepam 164 Diclofenac Sodium 167 Digoxin 171 Diltiazem 175 Dipyridamole 178 Dobutamine 180 Dopamine 182 Doxazosin 185 E Enalapril

6 187 Enoxaparin 190 Ephedrine 194 Erythromycin 196 Esmolol 199 Etomidate 201 4T A B L E O F C O N T E N T SF Felodipine 203 Fentanyl 205 Flucloxacillin 207 Fluconazole 210 Flumazenil 213 Fluoxetine 215 Frusemide 217 G Gabapentin 220 Ganciclovir 222 Gentamicin 224 Glucagon 227 Glyceryl Trinitrate 229 Glycopyrrolate 231 H Haloperidol 233 Heparin 236 Hydralazine 239 Hydrocortisone 241 Hyoscine Butylbromide 244 Hyoscine Hydrobromide 246 I Ibuprofen 248 Iloprost 251 Imipenem 254 Ipratropium Bromide 257 Isoprenaline 259 K Ketamine 261 L Labetalol 263 Lactulose 266 Levetiracetam 268 Levosimendan 271 Lithium 274 Loperamide 277 Losartan 279 M Magnesium Sulphate 281 Mannitol 284 Meropenem 287 Metaraminol 290 Metformin 292 Methylene Blue 294 Methylprednisolone 296 Metoclopramide 299 Metoprolol 302 Metronidazole 304 Midazolam 307 Milrinone 310 Morphine Sulphate & Morphine Tartrate 312 Moxifloxacin 315 N Naloxone 318 Neostigmine 320 Nicotine 322 Nimodipine 324 Noradrenaline 326 O Octreotide 328

7 Olanzapine 330 Omeprazole 332 Ondansetron 334 Oxycodone 336 5T A B L E O F C O N T E N T SP Paracetamol 339 Paracoxib 341 Paroxetine 343 Pethidine hydrochloride 345 Phenobarbitone 348 Phenylephrine 351 Phenytoin 353 Potassium Chloride 356 Phosphate 358 Prednisone 360 Propofol 362 Propranolol 364 Protamine Sulphate 366 Q Quinapril 368 R Ranitidine 371 Remifentanil 373 Risperidone 375 Rocuronium 377 Roxithromycin 380 S Salbutamol 381 Sildenafil 384 Simvastatin 386 Sodium Bicarbonate 388 Sodium Nitroprusside 391 Sodium Valproate 393 Sotalol 396 Spironolactone 399 Suxamethonium 401 T Tazocin (Piperacillin & Tazobactam) 403 Terlipressin 406 Thiamine 408 Tobramycin 410 Tranexamic Acid 413 Tramadol 415 Thyroxine 417 Thiopentone 422 V Vancomycin 423 Vasopressin 429 Vitamin K 431 Verapamil 433 W Warfarin Sodium 436 Z Zopiclone 4396 APPENDICES (page 441 onwards)

8 Of Medicines Via Enteral Feeding Tubes Reversal Guidelines Poisoning Treatment Nomogram Drug Level Monitoring Susceptibility Overview Dose Equivalence vs Enteral Medication Costs To Enteral Antibiotic Conversion Anaesthetic Toxicity 10. Drug CalculationsT A B L E O F C O N T E N T SWellington ICU Drug Manual v3a 2020 Acetazolamide [1 vial $ , 1 tablet 17 cents] ADMINISTRATION ROUTES: PO, NG, IV ALTERNATIVE NAMES: Diamox (Tab), Glaumox (Vial) ICU INDICATIONS: (particularly in the presence of metabolic alkalosis) of severe metabolic alkalosis PRESENTATION AND ADMINISTRATION: PO / NG: Diamox 250 mg tablets (white); for NG use, crush prior to administration.

9 IV: Glaumox is supplied as a sterile powder requiring reconstitution. Each vial contains an amount of acetazolamide sodium equivalent to 500 mg of acetazolamide. Each 500 mg vial containing acetazolamide should be reconstituted with at least 5 ml of sterile water for injection prior to use. Reconstituted solutions retain their physical and chemical properties for 24 hours under refrigeration at 2-8 C or 12 hours at room temperature DOSAGE: For diuresis, the dose is usually 250-375 mg stat. If, after an initial response, the patient fails to continue to diurese, do not increase the dose but allow for kidney recovery by skipping medication for a day.

10 Acetazolamide yields best diuretic results when given on alternate days, or for 2 days alternating with a day of rest. DOSAGE IN PAEDIATRICS: The safety and effectiveness of acetazolamide in paediatric patients below the age of 12 years have not been established. DOSAGE IN Renal FAILURE AND Renal REPLACEMENT THERAPY: No dose adjustment is required when administered for ICU indications (beware that acetazolamide is contraindicated in the presence of metabolic acidosis). This drug is not indicated in patients on Renal replacement therapy. CLINICAL PHARMACOLOGY: Acetazolamide is an enzyme inhibitor that acts on carbonic anhydrase, the enzyme that catalyzes the reversible reaction involving the hydration of carbon dioxide and the dehydration of carbonic acid.