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WELLINGTON REGIONAL HOSPITAL INTENSIVE CARE UNIT

!1 WELLINGTON REGIONAL HOSPITALINTENSIVE care UNITD R U G M A N U A L second edition 2013 Written by Paul Young second edition edited by Alex Psirides INTENSIVE care Specialists WELLINGTON , New Zealand 2013!2 The following references were used in compiling these monographs:Fink, Mitchell et al. of Critical care . 5th edition , Caroline and Currie, Aileen. The Renal Drug Handbook. 2nd ed. United Kingdom: Radcliffe Medical Press Ltd, , Frank. Drug Doses. 14th ed. INTENSIVE care Unit. Royal Children s HOSPITAL , Parkville, Victoria 3052, Australia, , Alan et al. Notes on Injectable Drugs. 5th ed. New Zealand. New Zealand Healthcare Pharmacists Association, Drug Data sheets (New Zealand Medicine and Medical Devices Safety Authority): Online: 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

!1 WELLINGTON REGIONAL HOSPITAL INTENSIVE CARE UNIT D R U G M A N U A L second edition 2013 Written by Paul Young second edition edited by Alex Psirides

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Transcription of WELLINGTON REGIONAL HOSPITAL INTENSIVE CARE UNIT

1 !1 WELLINGTON REGIONAL HOSPITALINTENSIVE care UNITD R U G M A N U A L second edition 2013 Written by Paul Young second edition edited by Alex Psirides INTENSIVE care Specialists WELLINGTON , New Zealand 2013!2 The following references were used in compiling these monographs:Fink, Mitchell et al. of Critical care . 5th edition , Caroline and Currie, Aileen. The Renal Drug Handbook. 2nd ed. United Kingdom: Radcliffe Medical Press Ltd, , Frank. Drug Doses. 14th ed. INTENSIVE care Unit. Royal Children s HOSPITAL , Parkville, Victoria 3052, Australia, , Alan et al. Notes on Injectable Drugs. 5th ed. New Zealand. New Zealand Healthcare Pharmacists Association, Drug Data sheets (New Zealand Medicine and Medical Devices Safety Authority): Online: 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 Young for use in the INTENSIVE care Unit in WELLINGTON REGIONAL HOSPITAL in 2011. This second edition was updated in 2013 with revisions made reflecting the changes in our unit s INTENSIVE care practice. 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. All doses have been checked independently by two INTENSIVE care Specialists.

3 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. Specific changes for this second edition include: The monograph for recombinant activated protein C (Drotrecogin alfa/Xigris) has been removed Entries for Iloprost, Levosimendan & Tobramycin have been added Appendices have been added to provide more information on common drug-related queries Gentamicin dosage & monitoring has been changed All drug prices quoted are in New Zealand dollars & are up to date as of February 2013 Prices have been included to inform prescribing choices where intravenous or enteral routes of administration are equivocal.

4 For example, the intravenous preparation of Acetazolamide costs 250 times that of a single tablet (bioavailability >90%). !3 Paul Young Alex Psirides February 2013 document (c) 2013 WELLINGTON ICU. It cannot be sold or altered without permission of the 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) 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)

5 106 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 Sodium Phosphate 158 Dexmedetomidine 161 Diazepam 163 Diclofenac Sodium 166 Digoxin 170 Diltiazem 174 Dipyridamole 177 Dobutamine 179 Dopamine 181 Doxazosin 184 E Enalapril 186 Enoxaparin 189 Ephedrine 193 Erythromycin 195 Esmolol 198 Etomidate 200 !

6 4T A B L E O F C O N T E N T SF Felodipine 202 Fentanyl 204 Flucloxacillin 206 Fluconazole 209 Flumazenil 212 Fluoxetine 214 Frusemide 216 G Gabapentin 219 Ganciclovir 221 Gentamicin 223 Glucagon 226 Glyceryl Trinitrate 228 Glycopyrrolate 230 H Haloperidol 232 Heparin 235 Hydralazine 238 Hydrocortisone 240 Hyoscine Butylbromide 243 Hyoscine Hydrobromide 247 I Ibuprofen 247 Iloprost 250 Imipenem with Cilastatin 253 Ipratropium Bromide 256 Isoprenaline Hydrochloride 258 K Ketamine 260 L Labetalol 262 Lactulose 265 Levosimendan 267 Lithium 270 Loperamide 273 Losartan 275 M Magnesium Sulphate 277 Meropenem 280 Metaraminol 283 Metformin 285 Methylene Blue 287 Methylprednisolone Sodium Succinate 289 Metoclopramide 292 Metoprolol 295 Metronidazole 297 Midazolam 300 Milrinone 303 Morphine Sulphate & Morphine Tartrate 305 Moxifloxacin 308 N Naloxone 311 Neostigmine 313 Nicotine 315 Nimodipine 317 Noradrenaline 319 O Octreotide 321 Olanzapine 323 Omeprazole 325 Ondansetron 327 Oxycodone 329 !

7 5T A B L E O F C O N T E N T SP Paracetamol 332 Paracoxib 334 Paroxetine 336 Pethidine Hydrochloride 338 Phenobarbitone 341 Phenylephrine 344 Phenytoin 346 Potassium Chloride 349 Phosphate 351 Prednisone 353 Propofol 355 Propranolol 357 Protamine Sulphate 359 Q Quinapril 361 R Ranitidine 364 Remifentanil 366 Risperidone 368 Rocuronium 370 Roxithromycin 372 S Salbutamol 374 Sildenafil 377 Simvastatin 379 Sodium Bicarbonate 381 Sodium Nitroprusside 384 Sodium Valproate 386 Sotalol 389 Spironolactone 392 Suxamethonium 394 T Tazocin (Piperacillin & Tazobactam) 396 Terlipressin 399 Thiamine 401 Tobramycin 403 Tranexamic Acid 406 Tramadol 408 Thyroxine 410 Thiopentone 414 V Vancomycin 416 Vasopressin 420 Vitamin K 422 Verapamil 424 W Warfarin Sodium 427 Z Zopiclone 430 !

8 6T A B L E O F C O N T E N T SAPPENDICES (page 432 onwards) Of Medicines Via Enteral Feeding Tubes Reversal Guidelines Poisoning Treatment Nomogram Drug Level Monitoring Sensitivity Overview Dose EquivalenceWellington ICU Drug Manual v3 2015 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 250mg tablets (white); for NG use, crush prior to administration. IV: Glaumox is supplied as a sterile powder requiring reconstitution.

9 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. Acetazolamide yields best diuretic results when given on alternate days, or for 2 days alternating with a day of rest.

10 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.


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