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By New Intern 2015 Srinagarind Hospital


: ( ), , , , , , , Edit: RKing
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Content
Antihypertensive Drug 2
CVS Drug 3
Anti Lipid Drug 3
ATB IV 4
PO 5
Anti TB Drug 6
Analgesic Drug 6
Supplement 7
Antiparasite 8
Antifungal 9
Antiviral 11
EYE/ENT 12
Steroid 13
Endocrine 14
GI drug 15
Antivertigo&Migraine drug 18
Emergency Drug 19
Neuropsychiatric drug 25
Sedative, Antihistamine 26
GYN 27
OB 33
Respiratory drug 42
Electrolyte correction 48
Ventilator setting 54
2

Antihypertensive drug
- Nicardipine (1:5) iv drip 25 ml/hr (5-15 mg/hr)
- NTG (1:5) iv drip 5 ml/hr (5-20 mcg/min)
- Hydralazine
5-20 ml/mg+NSS10ml slowly iv drip or IM
- Hydralazine (25,50) 50-200 mg bid-qid
- Captopril (25) 25-100 mg bid-tid
- Amlodipine (10) 2.5-10 mg OD
- Enalapril (5,10) 5-20 mg OD-bid
- Losartan (50,100) 50-100 mg OD
- Propranolol (10,40) 20-180 mg bid-qid
- Atenolol (50,100) 25-100 mg bid-qid
- Carvedilol (6.25) 12.5-25 mg bid
- Bisoprolol (2.5) 2.5-10 mg OD
- Metoprolol (25) 25-200 mg OD
- Verapamil SR240 1 tab OD
- HCTZ (50) 12.5-50 mg OD
0.5-1 mkd qid <3 mkd
- Furosemide (40) po,iv 40-1000 mg OD-bid
2-6 mkdose OD-bid
- Spironolactone (25) 25-100 mg OD-tid
- Doxasocin (2) 1-16 mg OD-bid
- Methyldopa (250) 250-2000 mg bid-qid
- Nifedipine(10) 1 tab q 15 min max 50 mg
3

CVS drug
- ASA (81,325) 1tab od,stat
- Clopidogrel (75,300) 1tab od,stat
- Warfarin (2,3,5)
- Enoxaparin 1mg/kg SC bid, OD if GFR<30
- Digoxin (250mcg) 500mcg/d
- ISDN (5 mg SL prn for 3 tabs, 10 mg 1 tab po
tid pc HTN)

Antilipid drug
- Simvastatin (10,20,40) max 40 mg OD hs
- Gemfibrozil (300-600mg), Fibrate (100-300mg) OD
- Cholestyramine (4g/sach) 1x2-3 sachet ac
- Atorvastatin (10,20,40) 10-80 mg OD hs
4

ATB
***IV ATB (Normal GFR)
- Cloxacillin 1-2 g iv q 6 hr / severe 2 g iv q 4 hr
- Cefazolin 1 g iv q 6 hr
- Cefotazime 2 g iv q 8 hr
- Ceftriaxone 2 g iv OD / 2 g iv q 12 hr( )
- Ceftazidime 2 g iv q 8 hr
- Ampicilllin 1 g iv q 4 hr / 2 g iv q 6 hr
- Clindamycin 600 mg iv q 8 hr / 900 mg iv q 8 hr
- Metronidazole 500 mg iv q 8 hr
- Fosfomycin 2 g iv q 12 hr
- Tazocin 4.5 g iv q 8 hr
- Meropenam 1-2 g iv q 8 hr
- Ciprofloxacin 400 mg iv q 8-12 hr
- Levofloxacin 750 mg iv q 24 hr
- Azithromycin 500 mg iv q 24 hr
- Clarithromycin 600 mg iv q 8 hr
- Gentamycin 240 mg iv q 24 hr
- Amikacin 15 mg/kg iv q 24 hr
5

***ORAL ATB 1
- Dicloxacilllin(250) 1x4 o ac
- Cephalexine/Keflex(500) 1x3/ 1x4 o ac
- Cefspan/cefixime(100) 2x2
- Cefdinir/omicef(150) 1x2 / (100) 2x2
- PenicillinV(500) 1x2 / (250) 2x2
- Amoxycillin(500) 2x2
- Augmentin(1000) 1x2
- Clarithromycin(500) 1x2 / (250) 2x2
- Levofloxacin(500) 1x1
- Roxithromycin(150) 1x2
- Doxycycline(100) 1x2
- Ofloxacin(200) 1x2
- Ciprofloxacin(250) 2x2 / (500) 1x2
- Norfloxacin(400) 1x2
- Metronidazole(200) 2x3
- Clindamycin(300) 1x3
*** ANTI-TB
- Isoniazid 5 mkd(100,300)
- Rifampicin 10 mkd(150,300)
- Ethambuthal 15 mkd(250,400)
- Pyrazinamide 25 mkd(500)
6

Analgesics
- Paracetamol(325,500) 1-2 tab prn 4-6hr
/ drop 60mg/0.6ml
/ syr120,250/5ml 10-15 mkdose

- Norgesic(para+orphen) 1-2x3 pc

- Mydocalm(tolperisone)(50) 1x3 pc (M.relax)

- Ibuprofen(400) 1x3 pc
/ susp100mg/5ml 6-10mkdose

- Diclofenac(25, 1 mkdose) 1-2x3 pc

- Ponstan(500) 1x3 pc : dysmen

- Indomethacin(25) 1x2 pc

- Naproxen(250, 5 mkdose) 1x2 pc

- Gabapentin (400) 1x1 hs, Pregabalin (25) 1x1 hs


- Celecoxib(200,400) 1x1 pc

- Paracoxib (Dynastat) 40mg IV q12hr

- Tramadol(50, max400mkday)1 cap prn q6hr


7

- Pethidine 20 mg IV / 50mg IM
/ 0.3-0.5mg/kg IV prn q2-3hr

- Morphine 0.5-2 mg IV stat/ drip 0.5 mg/hr cont.


/ 0.03-0.05mg/kg IV prn q 2-4hr (>1 yr)
=dose IVx3 syr 2mg/ml

- Colchicine(0.6) 1x1( ) / 1x3(acute attack)

- Allopurinol(100,300) 100-600mg/day bid-qid

Supplyment
- Ferrous sulfate (325=Fe65) (syr Fe25mg/1ml)
/ iron def: 3-6mgFe/kg/d, OD-tid or
adult 1x3 pc / prophy 1-2MKD
- Vit B 1-2-6-12
tx:100,10mg,20mg,100mcg/d 1-2 tab OD-bid

- Thiamine 100 mg IV then 100 mg IM x 3 d


- VitK 2.5-10mg + NSS50ml IV drip in 1 hr
8

Antiparasite
- Albendazole (200mg)
2 x 1 for 21 day (Gnatho)
2 x 2 for 5 day (Strongyloides , creeping eruption)
2 x 2 for 8-30 day (neurocysticercosis)
2 x 1 Once (Trichuris / Ascaris / Hookworm
/enterobius repeat 2 wk)
1 x 2 for 10 day (Capillaria)

- Ivermectin (6mg/tab) 200 mcg/kg 2 d


/ If dissem 5-7 day Strongyloides

- Praziquantel (600) 10 mg/kg once


Tapeworm 2x3 for 2 day (Opisthorchis)

- Metronidazole (750) 1x3 for 5 day (Giardia,


Entamoeba histolytica)

- 1% Gamma benzene hexachloride (Lindane)


Jacutin 12 hr 3 days (Scabies)
neurotoxic
9

Antifungal

- Fluconazole(200) 1 x 1 2-3 wks (Esophageal


candidiasis)

- Pyrimethamine(25) 200mg stat then 1 x 2 o pc ,


Sulfadiazine(500) 2 x 4 oral pc hs , Folinic acid(5) 1 x
3 for 6wk (CNS toxoplasmosis)

- Clotrimazole Cream apply lesion bid 3-4 wk (


Tinea, dermatophyte)
Vag. Tab(100) 2 tabs vg hs 6 day (Vulvovaginal
Candidiasis) / 1 tab OD 7 day (Oral candidiasis)

- Nystatin susp/lozenge
100000 unit qid for
2 wk (Oral candidiasis)

- Ketoconazole (200) 1 x 1 for 10-14 day P. versicolor


( ) / 1 x 2 2 wk (Candidiasis)

- Itraconazole (100) 1 x 2 for 2 wk T. pedis / 2 x 2


for 7day/month = 1 cycle T. ungium (3 cycle ,
4 cycle )
10

- Griseofluvin (500) 1 x 2 for 5 wk T. capitis , T.pedis /


1 x 1 for 4wk T.corporis ()
- Cryptococcus meningitis
Induction Ampho B 0.7-1 MKD iv + Fluconazole(200)
800mg/day ; 14 day CPM , para , iv
Consolidation Fluconazole 400 mg/day ; 8wk
Maintenance Fluconazole 200 mg/day

- PCP Bactrim ( 15 MKD of TMP + 75 MKD of SMZ)


Bactrim 3 amp +5%DW250ml iv drip in 2 hr
every 8 hrs oral 4 x 3 oral pc sat
drop , A-a gra Prednisolone(5mg) 4x2
5d then 4x15d then 2x111d
11

Antiviral

- Acyclovir (200,400,800)
4000 mg = (800) 1x5 for 7 day Herpes Zoster ()
> 50,eye,dissem, immune compromised
1000mg = (200) 1x5 for 5 day immune com
lesion Herpes simplex
(800) 1 x 5 for 5-7 day severe

- Imiquimod(Aldara) Apply 3 times/wk (Wart , genital


wart , molluscum contagiosum)

- Oseltamivir (75) 1 x 2 5 days (Flu)

- Gancyclovir 5 MKdose iv q 12 hr 2-3 wk (CMV)


12

EYE/ENT

- Hista-oph,Dex-oph 1-2 drop 4-6

- Poly-oph 1-2 drop qid

- Chloroph 1-2 drop qid

- Chloram eye ointment hs,qid

-1%atropine 1 drop od bid qid

- Acetazolamide(250) 1x4

-0.5%timolol 1 drop bid


13

Steroid

- methyprednisolone 1g iv OD ( RPGN, LE, Neuro)


/ 1 mkd IV ( other condition)

-dexamethasone 5 mg iv q 6-12 hr

-hydrocortisone 200 mg iv q 6-24 hr

-prednisolone(5) indication

-cream:
0.02-0.1 % TA cream / 0.5% prednisolone cream /
0.1% betamethasone cream / 0.05% clobetasol
cream
14

Endocrine

- MMI(5) 10-30 mg/d Then maintenance 5-15 mg/d


q 8hr

- L-thyroxine(100mcg) -healthy with age <60 year:1.6


micrograms/kg/day orally adjust dose in increments
of 12.5 to 25 micrograms to normalize TSHs
pre-existing CAD or age >60 years: 25-50 mcg od,
adjust dose 12.5 to 25 micrograms every 6-8 weeks
sub-clinical hypothyroidism with TSH over 10 milli-
international units/L: 1 mcg/kg/d adjust dose 25 to
50 micrograms to normalise TSH

- PTU(50) 150-400 mg/d initially given in 3 divided


doses, adjust according to response; usual
maintenance dose: 50-150 mg/day given in 2-3
divided doses

- Metformin(500) 500-2500 mg/day 1-3 pc

- Glipizide(5) 5-20 mg/d


15

Gastrointestinal Drugs

Antacids
Drugs Dose Note
Alum milk (0.5-1 ml/kg/dose) 30
(AlOH3+Mg )
2+
ml PO tid-qid pc hs
M.carminative Children 5-15ml PO tid
Adults 30ml PO tid pc
Simethicone 1x3 opc 80mg/
(Air-x) tab

Antidiarrheal drugs

Drugs Dose Note


Loperamide (0.08-0.24MKD) 1mg/5ml syr
(Imodium) 2tabs then 1 tab if 2 mg/tab
each stool(Max 16
mg/day)
Lomotil 2x3 opc 2x1
16

Antiemetic, Antispasmodics
Drugs Dose Note
Metoclopamid (0.1-0.2MKdose, 10 mg/tab
e Max 0.8 MKD) 10mg/amp
(Plasil) 1x3 oac
or IV/IM q 8 hr
Domperidone (0.2-0.4 MKdose) 10mg/tab
(Motilium) 1x3 oac 5mg/5ml susp
Hyoscine 1 amp IV stat 20 mg/amp
(Buscopan) 1x3 opc 10mg/tab
Ondansetron 1 tab bef CMT 30 8mg/tab
(Onsia) min then 1tab 12hr 8mg/vial/4ml
later Use in CMT
8mg IV q 12 hr
Ulcer healing drugs
Drugs Dose Note
Omeprazole (0.2-3.5 MKD)
(Losec) 1x2 oac 20 mg/tab
40mg IV q12hrOD 40mg/vial
Pantoprazole 80 mg IV stat then *
(Controloc) 80mg+NSS100ml IV 80drip8mg
drip 10 ml/hr (Active bleed)
Sucralfate (40-80 MKD) 500mg/tab
(Ulsanic) 1gm x4 oac 1gm/tab
Ranitidine 1x2 opc 150mg/tab
50mg(amp) IV q 8 hr 25mg/ml
(amp=2ml)
17

Laxative drugs
Drugs Dose Note
Senna 2x1 ohs 7.5 mg/tab
(Senokot)
Lactulose Infants 5 ml/dose 10gm/15ml
(Dulphalac) Children 10-15 ml/dose
Adults 15-30 ml/dose
HE 1-2 ml/kg/day
MOM <2yrs 0.5 ml/kg/dose *
2-5yrs 5-15 ml/dose Renal failure
6-12yrs 15-30 ml/dose
Adults 30-60 ml/dose
400mg/5ml
OD hs
Bisacodyl <2yrs 5mg rect suppo prn 5mg/tab
>2yrs 5-10mg rect sup prn 10mg/tab
(Dulcolax) >6yrs 5-10mg PO hs
Adults 5-30mg PO hs (2x1
ohs)
Unison rectal suppo stat 10 ml
enema
Proctosedyl 1 tab rectal suppo Use in
hemorrhoid
Variceal bleeding
- Octreotide(Sandostatin) 50 mcg IV stat then 500
mcg+NSS100ml IV drip 10 ml/hr (** 50 drip 50mcg)
18

Antivertigo&Dizziness
Drugs Dose Note
Dimenhydrinate 50 mg PO or IV 5omg/tab
q 4-6 hr 50mg/amp
Cinnarizine 1x3 opc 25mg/tab
Flunarizine 1x1 or 2x1 ohs 5mg/tab
Betahistine 1x3 or 2x3 opc 8,16 mg/tab
Migraine
Drugs Dose Note
Excedrin migraine 1-2 tab PO q 6 hr Combination
(Acetaminophen, (Max 8tabs /day) analgelsics
250 mg/aspirin, 250
mg/caffeine, 65
mg )
Ibuprofen 1x3 opc 400mg/tab
Naproxen 1x2 opc 250mg/tab
Cafergot 2 tab then 1 tab in * Preg,
(Caffeine 30 min later If not on PI(ARV),
100mg/Ergotamine relieved (Max 6 azole ,use
1mg) tabs/day, 10/wks) triptan in past
24 hrs ,heart
dz.
Sumatriptan 1x1 opc (.
50mg/tab)
19

Emergency drugs
ACLS
Drugs Dose Note
Adrenaline 1mg IV bolus q3-5 min (1:1000)
Neonate0.1-0.3 ml/kg q3-5 min (1:10000)
Children 0.1 ml/kg IV q3-5 min (1:10000)
Vasopressin 40u IV/IO
Amiodarone 300mg IV (1stdose)
150mg(2nddose)
Post arrest care
Drugs Dose preparation
Adrenaline 0.1-0.5 Adrenaline
mcg/kg/min 10mg+5%DW100ml IV
drip 10 ml/hr
Dopamine 5-10 Dopamine(1:1)
mcg/kg/min 250mg(1amp)+5%DW2
50ml IV drip 10 ml/hr
Dopamine(2:1)
500mg(2amp)+5%DW2
50ml IV drip 5 ml/hr
Levophed 0.1-0.5 Levophed(4:125)
(NE) mcg/kg/min 4mg+5%DW125ml IV
* add NSS drip 10 ml/hr
20

Bradycardia
Drugs Dose preparation
Atropine 0.5 or 0.6mg -
IV bolus
(Max 3mg)
Dopamine 2-10 Dopamine(1:1)
mcg/kg/min 250mg(1amp)+5%DW2
50ml IV drip 10 ml/hr
Dopamine(2:1)
500mg(2amp)+5%DW2
50ml IV drip 5 ml/hr
Adrenaline 2-10 Adrenaline
mcg/min 10mg+5%DW100ml IV
drip 5 ml/hr
21

Tachycardia
Drugs Dose Note
Adenosine 6mg then 12 mg IV Double syringe
Neonate0.05 then 0.1 technique
mg/kg IV ** 2nd ,3rd
Children 0.1 then 0.2 AV block, SSS
mg/kg IV
Amiodarone 150 mg IV drip in 10 min ** Severe
then 360mg+5%DW100ml SA node dysfn ,
IV drip in 6 hr(1mg/min) 2nd,3rd AV block,
then 540 mg+5%DW cardiogenic shock,
100ml IV drip in 18 hr bradycardia
(0.5mg/min) induced syncope
OR ** Add NSS
150 mg IV drip in 10 min
then 900mg+5%DW100ml
IV drip in 24 hr
Cardioversion/Defribillation
Mode Pattern Energy(J)
Synchronized SVT 50-100
Cardioversion AF 120-200
VT with Pulse 100
Defribillation VF 120-200
Pulseless VT 120-200
22

Inotropes
Drugs Dose preparation
Adrenaline 0.01-0.1 Adrenaline
mcg/kg/min 10mg+5%DW100ml IV
drip 10 ml/hr
Dopamine Max50 Dopamine(1:1)250mg
(immediate mcg/kg/min (1amp)+5%DW250ml
precursor
Dopamine(2:1) 500mg
of NE) 30mcg/kg/min
(2amp)+5%DW250ml

Levophed 0.1-3 Levophed(4:125)


(NE) mcg/kg/min 4mg(1vial)+5%DW125ml
* add NSS Levophed(4:250)
4mg(1vial)+5%DW250ml
Dobutamine <15mcg/kg/min Dobutamine(1:1)250mg
Contractility (1vial)+5%DW250ml
dose 15-20 Dobutamine (2:1) 500mg
mcg/kg/min (2vial)+5%DW250ml
SVR
Alpha1
**Dose FB : 1412cardiology**
23

Anaphylaxis
Drugs Dose Note
Adrenaline (0.01 ml/kg) IM at lat (1mg/ml)
thigh(Max 0.5 ml)
0.5ml IM repeat q 5min
Dexamethasone 5mg IV stat then q 6 WAO2011
hr Hydro
Hydrocortisone Children 100mg IV stat cortisone
Adult 200 mg IV stat
CPM (0.25MKdose) 10mg/amp
Children 2.5-5mg IV
Adults 10mg IV stat
then 1x3 opc
Ranitidine (1 MKdose)
50 mg IV stat
Supportive tx. : IV fluid, O2therapy,Bronchodilators
24

Status epilepticus
25

Neuropsychiatric drug

# Alcohol withdrawal syndrome


- Diazepam 10 mg + NSS 100 ml iv free flow stat dose
- Lorazepam(Ativan) 6-8 mg/day x 2days
Ex : Ativan(0.5) 2x3 po or Ativan(0.5) 2x4 po pc ---2x4 -> 2x3
-> 1x3 -> 1x2
- Low dose antipsychotics
If Hallucination / severe agitation Hadol 6-10 mg/day
- Valium 10 mg iv prn q 6 hr
- Thiamine 100 mg iv OD / q 12 hr X 5 days then PO tid x 3-4
wks
- Folate 1 mg PO OD
- B complex 1 tab PO bid
# Delirium
- Low dose antipsychotics
Haloperidol 0.5-2mg PO q 8-12 hr
Ex:Haloperidol(0.5) 1 tab , 1 tab , 2 tab hs
-Haloperidol 5 mg IM prn for acute agitation (max10mg)
*Haloperidol lactate form IV (max10mg)
# Schizophrenia
IPD Case :
- Haloperidol 5 mg im prn for agitation
- Haloperidol 5 mg im hs if NPO
26

Antihistamine
-Chlorpheniramine(4) 1x1-4 pc
syr 2mg/5ml, inj 10mg/ml 0.35mkday bid-qid
-Hydroxyzine(10) 1x3 pc
syr 10mg/5ml 2 mkday, tid
-Loratadine&Cetirizine(10) 1 tab ac
syr 5mg/5ml:2-5yr 5 mg qid, >6yr 10mg qid

Sedation

-Diazepam(Valium) (2,5) 2-10 mg PO q 6-12 hr for anxiolytic


Valium 5-20 mg IV stat to sedate
-Midazolam(Dormicum)
Loading : 0.5-4 mg(10-50mcg/kg) IV stat repeat q 10-15
min
Maintenance: 20-100mch/kg/hr infusion titrate 25-
50% prn
-Lorazepam(Ativan) (0.5,1,2) 2-4 mg PO hs
-Fentanyl 25-50 mcg IV purge or drip 25-50 mcg/hr
-Morphine 1-2 mg IV post op, 0.01-0.04 mkdose q 2-4hr
-Amitriptyline (10,25) 1x1 PO hs (10-80mg/d)
27

Gynecology
Septic abortion
- Ampicillin 1 g v q 6 hr + Gentamicin 240 mg v OD +
metronidazole 500 mg v q 8 hr
- TT 0.5 ml IM
- Remove content : MVA ATB 4-6 hr bleed

Management for Incomplete abortion 1st day


-NPO(plan D&C) NPO -+/-Regular diet
(plan cytotec) -Record V/S
-5%DN/2 1,000 ml v drip rate 80- -Medication
100 ml/hr Para(500) 2 tabs po prn
-CBC c plt,PT,PTT,INR,+/- AntiHIV q 6 hr
-+/- UPT ( conceptus )
-Misoprostal(cytotec) 2 tab
vaginal suppo stat then q 8 hr
28

Pre-op order for Dilated & curretage


-NPO
-5%DN/2 1,000 ml v drip rate 80-100 ml/hr Or LRS 1,000 ml v
drip rate 80-100 ml/hr
-Set OR for D&C
-Void OR

Post-op order for Dilated & curretage

-Record V/S q 15 min X4 Then -Regular diet


q 30 min X2 Then q 1 hr until -Record V/S
stable -Med
-5%DN/2 1,000 ml v drip rate -Amoxycillin (500) 2x2 o pc
80-100 ml/hr Or LRS 1,000 ml -Paracetamol(500) 2 tabs o
v drip rate 80-100 ml/hr prn
- -Fermate 1x2 o pc(obimin)
- observe vaginal bleeding &
abdominal sign
- D/C
-F/U OPD GYN 3 wk patho
family planning D/C
-HM Amoxycillin(500) 2x2 o
pc#20,para,fermate
29

Pre-op order for Tubal Sterilization

-NPOAMN
-5%DN/2 1,000 ml v drip rate 80-100 ml/hr Or LRS 1,000 ml v
drip rate 80-100 ml/hr
-Set OR for TS
-Void OR
-+/- Unison enema

Post-op order for Tubal Sterilization

-Record V/S q 15 min X4 Then q 30 min X2 Then q 1 hr until


stable
-IV off
-
30

Pre-op for Explore lab+ Surgical staging


-Admit
-NPOAMN
-LRS 1,000 ml v drip 100-120 ml/hr
-Vg dough hs,
-Prep skin abd&perinium
- cefazolin 2 g
urine bag
foley cath No.16
G/M for PRC 4 u
-CBC c plt,UA,CxR(age>40),FBS,BUN,Cr,Elyte,LFT,Anti-HIV
-Ba unima,IVP indication

bowel
-2 low residual diet + dulcolax 1 tab hs
- liquid diet 3 swiff 45 ml + 500
ml in 30 min 7.00,19.00 Neomycin 1 g po at
13.00,14.00,23.00(0,1,9 hr) Erythromycin 1 g po at 0,1,9 hr
NPO
- 5% DN/2(1,000) + KCl 20 mEq v drip 100 ml/hr
31

Post-op for Explore lab+ Surgical staging


-Record V/S q 15 min X4 Then q -NPO
30 min X2 Then q 1 hr until stable -Record V/S,I/O
-Retain foley cath -MED
-CBC c -cefazolin 1 gm v q 6 hr x
plt,BUN,Cr,Elyte,PT,PTT,INR at IV
ward
-LRS 1,000 ml v drip 100-120
ml/hr
-5 % DN/2 1,000 ml v drip rate
100 ml/hr 2
-If Urine output <100 ml/4hr
please notify
32

LEUCORIA
1. Tricomoniasis 4. GC
- tricomonas vaginalis - gram neg. Intracellular
- Rx. -Metronidazole(400) diplococci
sig. 5 tabs. po single dose - Rx.- Cef-3 125 mg IM
-Metronidazole(400/500) single
sig. 1x2--7 days dose
-Metronidazole(200) -Cefixime 400 mg po single
sig. 2x2--7 days dose
2. Bacterial vaginosis 5. Chlamydia
- Gardnerela vaginalis - Chlamydia trachomatis
- Rx. -Metronidazole(400/500) - Rx. Doxycycline(100) 1x2-
sig. 1x2--7 days -7
-Metronidazole(200) days
sig. 2x2--7 days *** combine drug
3. Candidiasis Gynecon 1 tab Vg suppo
- Candida spp. hs x 7
- Rx. - Fluconazole(50) [ candida,BV,TV]
sig. 3 tabs .po single dose
- Cotrimazole(100/200/500)
Sig. 200 mg Vg suppo x 3
days
- Ketoconazole 1x2 --7 day
33

Obstetrics
34

Inhibit labour
- CBC, UA, cervical swab culture Elyte, blood sugar
- Dexamethasone (6mg) IM q12hr x 4doses
- Bricanyl 20 amp+5%D/W 1,000ml IV drip 20drops/min (
5 drop)
(keep PR <120/min)
(Beware hyperglycemia, hypokalemia)

- Nifedipine (adalat) 10 mg po q 15 min x 3dose
then 10 mg q 6 hr ( 10mg q 4hr then 20mg q 6 hr
then 20 mg q 4 hr)
- Keep BP > 90/60 mmHg dose

GBS prophylaxis
4
Recommend PenG 5 u IV then 2.5 u IV q4hr
Alternative Ampicillin 2g IV then 1g IV q4hr
penicillin
- Cafazolin 2g IV then 1g IV q8hr (non-anaphylaxis)
- Clindamycin 900mg IV q8hr (anaphylaxis)
- Erythromycin 500mg IV q6hr
- Vancomycin 1g IV q12hr
35

Sedation
Sedation(Latent) Sedation(Active)
- Morphine 10mg IM stat ( - Pethidine 50mg IM stat (
N/V ) PIH)
- Plasil 10mg IM stat - Plasil 10mg IM stat
- cervical
dilatation >5cm
2 hr (peak
onset)
- morphine

PROM
- CBC, UA, cervical swab culture
- observe progression of labor, FHS
- observe S&S of chorioamnionitis
- No PV,PR
- PV go on labor

Augmentation
- 5%DN/2 1,000ml + syntocinon 10 unit IV drip 8drops/min
( 4 drops/min)
( 40drops/min)
36

Postpartum Hemorrhage
- G/M PRC 2unit
- Hct stat
- Retain foley's cath
- + cold pack
- 0.9%NSS 1,000 ml IV loading
- 5%DN/2 1,000 ml + syntocinon 20 unit IV 120 ml/hr
- Methergin 0.2 mg IV repeat q 15 min ( 5 doses)
- Nalador 500 mcg + NSS 100 ml IV drip in - 1 hr
- Cytotec (200mg) 4 tab rectal suppository
- PPH Duratocin 100 mcg IV slowly
push

Post-op order for NL, F/E, V/E


One day Continue
- admit ______ - Regular Diet
- IV off - Record V/S as usual
- intermittent cath if not void - Perineal light&care bid
q 6 hr x 2 Medication
- Paracetamol (500) 1 tab po
- observe vaginal bleeding
prn for pain q 4-6 hr #20
- (HIV infection)
- Amoxycillin /Augmentin
breast binding +
(case tear 3rd, 4th)
breastfeeding - Mucillin 1 hs (case
Home medication
tear 3rd, 4th)
- FeSO4 1x3 po pc #100 ()
- Obimin AZ 1x1 po pc #30
()
37

Basic Symptomatic treatment after delivery


- 48 hr Senokot 2 tab po stat hs
- rectum MOM 30 ml po stat hs
- M carminative 15-30 ml po tid pc
Air-x 1 tab po tid pc
- Ativan(0.5) 1 tab po hs
stat prn for insomnia
- Bromhexine(8)
- 1 tab po tid pc
Ibuprofen(400) 1 tab po tid pc()
para

Arcoxia(120) 1 tab po OD pc
para Cereblex(400)1 tab po OD
()

Post-op order for LT C/S


Day 0
- 12 - NPO
- Record V/S - Record V/S , I/O
q 15 min x4 - Retain foley cath
q 30 min x2 Medication
q 1 hr until stable then as - cefazolin 1g V q6hr
usual -
- 5% DN/2 1,000ml+synto - General anesthesia
38

20unit -MO 30mg + 5%D/W


IV drip120ml/hr x I 500ml IV 20-40 ml/hr
then 5% DN/2 1,000ml IV -Plasil 10mg IV prn for
drip 120ml/hr x II N/V q 6hr
- observe vaginal & wound
bleeding

Day 1 - Paracetamol(500) 2tab


- IV off foley po prn for pain q4-6hr
( on HL ) #20
-
- liquid diet
-
- early ambulation
Home medication
- FeSO4 1x3 po pc #100(
)
- Obimin AZ 1x1 po pc#30
()
Day 2
- Soft diet 3
Day 3 Regular diet
- Dressing wound
- Senokot 2tab po hs prn for
constipation # 6
-
tegaderm
7
39

Chorioamnionitis
Ampicillin 2g IV q6hr +Gentamycin 240mg IV OD
C/S add
- Clindamycin 900mg IV q8hr
- Metronidazole 500mg IV q8hr
Post C/S endometritis
24-48

Pregnancy Induced Hypertension

Mild Preeclampsia
- Admit
- Hx + PE + Observe clinical sign of preeclampsia
- Bed rest
- CBC, UA, BUN/Cr, PT, PTT, INR, uric acid,
SGOT, SGPT, ALP, LDH
- BW, urine albumin, UPCI
- Urine protein 24hr ( )
- Regular diet
- U/S, NST, BPP
** methergin
40

Severe Preeclampsia
- NPO
- IV fluid
( dehydration pulmonary edema)
- G/M
- CBC, UA, BUN/Cr, PT, PTT, INR, uric acid, SGOT,SGPT, ALP,
LDH
- 24hr urine protein
- 10% MgSO4 5g (5amp) + 5%D/W 100ml IV slowlypush in
5min [1g/min]
then 50% MgSO4 10g (10amp) + 5%D/W 1,000ml IV drip
100ml/hr [2g/hr]
- Retain foley
( MgSO4 0.5g/hr monitor )
- Record BP, RR, DTR, urine output q1hr
If BP>160/110mmHg,
RR<12/min, Please notify
urine output<30ml/hr,
absent DTR

MgSO4
- Loading Dose
10% MgSO4 5g (5amp) + 5%D/W 100ml IV slowly push in
5min [1g/min]
- Maintenance Dose 1 loading dose
Zuspan Method
50% MgSO4 10g (10amp) + 5%D/W 1,000ml IV drip 100ml/hr
[1-2g/hr] drip until 24hr PP
41

Parkland Method** (Prichard Method)


50% MgSO4 10g (10amp) IM 2
50% MgSO4 5g IM q4hr until 24hr PP ()
( 2% xylocaine 1ml )
( 20 3 )
Monitoring
- N/V, headache, ,
- Urine output > 30ml/hr (100ml/4hr)
- DTR esp patella reflex
- RR>12/min
- f/u Mg level q6hr
- Cr>1 : 1g/hr
- Cr>2.5 : off MgSO4

MgSO4
- Antidote 10% Calcium gluconate/chloride 10ml(1g) IV
slowly push
**( intubation)
- MgSO4 level
- 10% MgSO4 2g (2amp) + 5%D/W 100ml IV slowly push in 5-
10min
- Dilantin/Phenytoin control
42

Respiratory Drug
Anti histamine
Drugs Dose Note
Chlopheniramine 2-11 yr
maleate (CPM) 0.35 mg/kg/dose 2
PO, IV tid-qid 2mg/5ml(syr)
max 6 mg/day (2-6 yr)
max 12 mg/day(6-11yr) 4mg/tab
12 yr-adult
4 mg/dose PO,IV q 6 hr 10mg/ml/a
mp
max 24 mg/day
Hydroxyzine 2mg/kg/day 10mg/5ml
(syr)
HCL (Atarax) PO prn q 4-6hr
10mg/tab
max 600 mg/day 25mg/tab
Cetirizine < 2yr 5mg/5ml(syr)
0.25 mg/kg/day
PO OD, max 2.5 mg/day 10mg/tab
2-5yr
initial 2.5 mg/dose PO
OD,bid max 5mg/day
> 6 yr,adult
5-10 mg/day PO OD,bid
Loratadine mg PO OD ac 10mg/tab
BW< 30kg 5
>30kg 10 mg PO OD ac 5mg/5ml(syr)
43

Nasal Decongestant
Drugs Dose Note
Pseudoephedrine Children 30mg/5ml
4 mg/kg/day (syr)
PO tid-qid
max 120 mg/day 60mg/tab
Adult
30-60 mg/kg/dose
PO qid
max 240 mg/day

Expectorants
Drugs Dose Note
Guaifenesin < 2 yr 100mg/5ml
0.125-0.25 ml/kg/dose
2-6 yr
2.5 ml/dose PO qid
6-12 yr
5 ml/dose PO qid
> 12 yr
10ml/dosr PO qid
44

Cough suppressants
Drugs Dose Note
Codeine 1-1.5 mg/kg/day 5mg/5ml
phosphate PO qid (syr)
maxdose
- < 6 yr 30mg/day
- 6-12 yr 60 mg/day 30mg/tab
- > 12 yr 120 mg/day
Dextromethophan 2-6 yr
2.5 7.5 mg/dose PO
tid-qid max 30 mg/day
6-12 yr
10 15 mg/dose PO
tid-qid, max 60 mg/day
> 12 yr and adult
10 - 30mg/dose PO
tid-qid, max 120 mg/day
45

Mucolytic
Drugs Dose Note
Acetylcysteine Children 100mg/
50-100 mg/dose PO tid-qid
Adult
100 mg/dose PO tid-qid
Bromhexine Children 4 mg/5ml
2-6 yr 2mg/dose PO tid
6-12 yr 4 mg/dose PO tid 8 mg/tab
Adult
8 mg/dose PO tid
Bronchodilator
Drugs Dose Note
Salbutamol 0.1 mg/kg/dose, 2mg/5ml
(Ventolin) max 2 mg PO q 6 hr 2mg/tab
0.01 mg/kg/dose, 0.5mg/ml/amp
max 0.5mg IM, SC q 6 hr
Salbutamol Adult 1mg/ml
RS solution 1 Nebule NB q 4-6 hr 2.5ml/nebule
Ped
0.03-0.05 ml/kg/dose
dilute c NSS up to 4 ml
NB q 4 6 hr, max 0.5
ml/dose
46

Compound bronchodilators
Drugs Dose Note
Fenoterol + 1-2 puff inhale Fenoterol 0.05 mg
Ipratopium q 4 6 hr Ipratopium 0.02 mg
bromide / puff
(Berodual)
Fenoterol + Ped Fenoterol 0.5 mg
Ipratopium 0.5 ml dilute c NSS Ipratopium 0.25 mg
bromide up to 4ml NB q 4-6 hr / ml vial 4ml
(Berodual Adult
forte) 4ml NB q 4-6 hr
RS solution
Oral Prophylactic drug for asthma
Drugs Dose Note
Montelukast 1-5 yr 4mg/tab
(singulair) 4mg/day PO OD 10mg/tab
6-14 yr
5mg/day PO OD
>14yr
10mg/day PO OD
47

Inhaler Prophylactic drug for asthma


Drugs Dose Note
Budesonide 100-800 mcg/dose 100mcg/puff
MDI
(Budecort)
Budesonide 100-800 mcg/day 100mcg/puff
DPI inhale bid
(Pulmicort)
Combination Inhaler
Drugs Dose Note
Fluticasone + 100-800 Salmeterol :
salmeterol MDI mcg/dose of fluticasone
(seretide evohaler) Fluticasone bid 25:50 mcg
25:125 mcg
25:250 mcg
Fluticasone + 100-800 Salmeterol :
salmeterol DPI mcg/dose of fluticasone
(seretide accuhaler) Fluticasone bid 50 : 100 mcg
50 : 250 mcg
Budesonide + 100-800 Budesonide :
Formoterol DPI mcg/day Formoterol
(Symbicort) 80:4.5 mcg
160:4.5 mcg
48

Imbalance of sodium
Total body water Safety in sodium correction
Newborn = 0.8 BW < 1-2 mEq/L/hr (Acute)
Infant = 0.7 BW < 0.5 mEq/L/hr (Chronic)
Male = 0.6 BW < 12 mEq/L/24 hr (total)
Female = 0.5 BW
Hypernatremia (>145)
hypo or euvolumia free water
1 1 = 2 2 Free water 2 1
50 kg Na 150 140
150(0.550) = 140(2 )
2 = 26.79 lit
26.79 25 = 1.79 lit
feed 5%DW 1000 rate 75 ml/hr
hypervolumia Na
Furosemide with 5%DW , if renal failure HD
Hyponatremia (<135)
volume status mEq = TBW(Na)
-Hypovolumia : NaCl solution
-Euvolumia : cause SIADH, AI, Hypothyroid
resirtct water, Salt tab, 3%NaCl( neuro)
-Hypervolumia : Furosemide
49

Imbalance of Potassium
Hyperkalemia (> 5)
-Mild hyperkalemia 5 - 6 mEq/L
furosemide 1 mg/kg IV
Kalimate 30 gm + 50 ml po q 2-3 hr
30 gm + 100 ml rectal suppo
Ped dose 1 gm / Kg / Dose
-Moderate hyperkalemia 6 - 6.5 mEq/L
+ 7.5% NaHCO3 50 ml IV in 15-30 min
Ped dose : 1-2 mEq/Kg (50ml 44 mEq)
+ 50 % Glucose 50- 100 ml + RI 10 u IV in 15-30 min
Ped dose RI 0.2 u/kg + Glucose 1g/kg
+ Ventolin
-Severe hyperkalemia 6.5-7 mEq/L or EKG change
+10% Calcium Gluconate 10 ml IV over510 min
Ped dose 0.5-1 mL/kg
or CalciumChloride same dose
HD if intractable
50

Hypokalemia (<3.5)
- Mild hypokalemia 3-3.5 mEq/L po replace
- Moderate hypokalemia 2.5-3 mEq/L po replace
- Severe hypokalemia < 2.5 mEq/L IV replace
Adult replacement
Oral replacement
3.3 3.5 20 mEq
3 3.2 40 mEq Elixir KCl 30 ml = K 20 mEq
<3 60 mEq po q 2 3 hr (. )
IV replacement
mild - 0.9% NaCl 1000 ml + KCl 20-40 mEq
- rate < 10 mEq/hr
- total < 200 mEq in 24hr
severe with - life threatened cardiac arrhythmia
- muscle weakness
- 0.9% NaCl 100 ml + KCl 10 mEq over 30 min
Drip in central line when
add KCL > 60-80 mEq/L or rate > 10 mEq/hr
Monitor EKG when
rate of replacement > 10 mEq/hr
Ped replacement
mEq = 0.3 x Wt x (4.5-serumK) max 3mEq/kg/days
Oral 0.5-1mEq/kg/dose
IV rate < 0.3 mEq/Kg/hr
51

Imbalance of other electrolyte


Hypomagnesemia (<1.5)
50 % MgSO4 4 ml + 5%DW 100 ml (2 gm)
IV drip in 4 hr 3 days
if severe (< 1) add 8 12 ml (4-6 gm)
Hypermagnesemia (>2.4) furosemide
if symptomatic 10% Calcium gluconate 10 ml IV
Hypophosphatemia (<2.7)
Oral
Phosphate mixture 3o ml po q 4 hr 4 dose
IV replacement in severe (<1.5) or npo
- 0.9% NaCl 1000 ml + KCl 20-40 mEq
PO4 Replacing dose *K2PO4 20ml
2-2.5 0.08-0.16 mEQ/Kg K PO4 20 mEq
1.5-2 0.16-0.24 mEQ/Kg
1-1.5 0.24-0.32 mEQ/Kg * line
<1 0.32-0.64 mEQ/Kg drip KCL
Hyperphosphatemia (>4.5)
PO4 Ca > 55 mg/dl add PO4 binder
CaCO3 (1gm) 1 tab po tid c meal
52

CorrectedCa = 0.8(4-Alb) + SerumCa


HypoCalcemia (<8.6)
Dose f/u 2 hr

Calcium IV 10% Calcium Gluconate Dose


8-8.6 10ml in 5%DW 100ml iv drip over 30 min
7-7.9 20ml in 5%DW 100ml iv drip over 60 min
6.5-6.9 30ml in 5%DW 100ml iv drip over 60 min
<6.4 40ml in 5%DW 100ml iv drip over 90 min
IV infusion tetany

Hypocalcemia tetany
(maxdose /day)
Infant 2-8 ml/kg/day 1-2 ml/kg/dose slowly push 6hr
Ped 2-5 ml/kg/day iv infusion 5 ml/kg/day
Adult 20-150ml/day 10 30 ml/dose
I.V. infusion
- Conc < 50 ml(5gm) / 100 mL
- Rate < 12-14ml(120-140 mg)/kg/hour
Hypercalcemia(>10.5)
1. IV hydration at least 1-2 L per day
2. When adequate hydration furosemide
3. Bisphosphonate C/I in renal failure
: Pamidronate 60-90mg in 100ml NSS iv in 4hr
4. Prednisolone 20-40 mg/day
5. Dialysis if volume over load
53

NaHCO3 Metabolic acidosis


ABG pH < 7.2 ( DKA < 6.8)
HCO3 < 7
0.2 BW (24- HCO3) = mEq
0.3 BW BE = mEq
7.5% NaHCO3 50 ml 44 mEq
max dose : Adult 100 ml / dose
Ped 2ml/kg/dose

Chronic Metabolic acidosis (RTA, inbornerror,CKD)


HCO3 20 22 mEq/L
Shohls solution 1 ml HCO3- = 1mEq,
Modified Shohls solution 1 ml HCO3- = 2 mEq
Sodamint 1 tab HCO3- = 3.5 mEq
54

Ventilator setting
Default Setting
Parameter V-CMV P-CMV PSV
P-Trigger -2 to -3 (cmH2O) -
Flow-Trigger 2 to 3 (L/min) -
TV (ml/Kg) 8-10 -
IP (cmH2O) - 10-15
Ramp DC
Flow pattern Square
- -
Flow rate Ramp 40-60
Square 20-30
- -
(L/min)
RR 8 - 35 -
Ti (sec) - 0.8-1.5 -
I : E ratio 1 : 1.2-1.5 -
ETS - 25%
PEEP (cmH2O) 3-5
FiO2 Use minimum as required
* V-CMV Ppeak 35 cmH2O
Pplateau 30 cmH2O
* P-CMV volume
Ppeak = IP+PEEP
Ppeak > 35
55

* TV Actual BW -

* Flow pattern
Square : Ppeak airtrapping
Decerelate : Oxygenation Square
* Toxicity High FiO2 (manifest ALI, ARDS)
FiO2 1.0 toxic in 2-3 hr
0.8 toxic in 24-48 hr
0.5-0.6 Last longer
* I : E Flow rate, RR, Ti

* Ti PSV ETS Ti
* COPD Asthma PEEP
56

Basic Dyssynchony on pressure time curve



V-CMV mode flow rate


Trigger trigger

P-CMV mode Ti , I:E


RR

trigger , Trigger
circuit trigger

Auto triggering
P-CMV mode IP
compliance lung
Double triggering P TV
trigger
ABG Correcting
PaCO2 (35-45) PaO2(80-100)
*Mean airway pressure
cause fever, pain, stress, PIP, PEEP Ti
seizure , High cal Diet * FiO2
57

Basic Alarming
1. Pressure : V-CMV
High PeakIP
Airway resistance : Ppeak PPlateau
: secretion, bronchospasm, tube
Lung Compliance : Ppeak PPlateau
: Pulmonary edema, Pneumonia, Pneumothorax
Low PeakIP Air leak
2. Respiratory rate
High RR inadequate Ventilation support
Circuit leak
Patient related : fever, pain, anxiety
Low RR Apnea, CNS depression, Sedation
3. Low exhale volume alarm / Low tidal volume
Circuit leak
Rapid swallow breathing
-spontaneous tidal volume
-respiratory rate
ICD c air leak
Airway resistance High Ppeak
Lung Compliance