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Ovid: Oxford Handbook of Clinical Medicine

Editors: Longmore, Murray; Wilkinson, Ian B; Turmezei, Tom; Cheung, Chee Kay Title: Oxford Handbook of Clinical Medicine, 7th Edition Copyright ©2007 Oxford University Press > Back of Book > Useful Doses for the New House Officer Useful Doses for the New House Officer ▶These pages outline typical adult doses, and the commoner side-effects, of medications that a new house officer will be called upon to prescribe. If in any doubt, consult a drug fomulary (eg British National Fomulary, BNF, www.bnf.org).

Drug

Dose and frequency

Notes

Analgesics

(see p454 for more details on analgesia)

Aspirin

300-900mg/4-6h PO, max. 4g/24h

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SE of NSAIDs: gastritis; bronchospasm; hypersensitivity. CI: GI ulcer/bleeding; NSAID-induced asthma; coagulopathy. Avoid aspirin in children (risks Reye’s syndrome).

Diclofenac

50mg/8h PO/PR

Ibuprofen

400mg/6h PO, max. 2.4g/24h

Paracetamol

0.5-1g/4-6h PO, max 4g/24h

Avoid if hepatic impairment.

Codeine phosphate

30-60mg/4h PO/IM max. 240mg/24h

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Patients with chronic pain (eg malignancy) may require higher doses. SE of opioids: nausea and vomiting; constipation; drowsiness; hypotension; respiratory depression, dependence. CI: Acute respiratory depression, acute alcoholism. Use carefully in head injury, as may hinder neurological assessment.

Dihydrocodeine tartrate

30mg/4-6h PO, OR 50mg/4-6h IM/SC

Meptazinol

200mg/3-6h PO, OR 50-100mg/2-4h IM/IV

Oxycodone

5mg/6h PO

Pethidine

50-100mg/4h PO/IM/SC

Tramadol

50-100mg/4h PO/IM/IV

Morphine

5-10mg/4h PO/IM/SC

Antibiotics

(see p366-374)

Antiemetics

Cyclizine

50mg/8h PO/IM/IV

Metaclopramide

10mg/8h PO/IM/IV

May cause extrapyramidal SE, especially in young adults.

Ondansetron

8mg/8h PO, or 4mg IM/IV

Antihistamines

Chlorphenamine

10-20mg IM/IV, maximum 40mg/24h OR 4mg/6h PO

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SE of antihistamines: Drowsiness; urinary retention; dry mouth; blurred vision; GI disturbance; arrhythmias. Drowsiness is less commoner with newer drugs, eg cetirizine, fexofenadine.

Cetirizine

5-10mg/24h PO

Levocetirizine

5mg/24h PO

Fexofenadine

120-180mg/24h PO

Loratadine

10mg/24h PO

Desloratadine

5mg/24h PO

Gastric acid reducing drugs

Cimetidine

400mg/6-12h PO

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SE of H2-blockers: GI disturbance; ↑LFT.

Ranitidine

150mg/12h PO

Omeprazole

20-40mg/24h PO

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SE of PPIs: GI disturbance; hypersensitivity.

▶ Acid-reducing drugs may mask symptoms of gastric cancer; use with care in middle-aged patients.

Esomperazole

20-40mg/24h PO

Lansoprazole

15-30mg/24h PO

Pantoprazole

20-40mg/24h PO

Heparins

(see p334 for more details on anticoagulation)

Unfractionated heparin

DVT prophylaxis: 5000u/12h sc

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SE of heparins: bleeding; thrombocytopenia; hypersensitivity; hyperkalaemia; osteoporosis after prolonged use. CI: coagulopathy; peptic ulcer; recent cerebral bleed; recent trauma or surgery; active bleeding.

Enoxaparin

DVT prophylaxis: 20-40mg/24h SC. DVT/PE treatment: 1.5mg/kg/24h SC until warfarinized. Unstable angina: 1mg/kg/12h sc for 2-8d

Tinzaparin

DVT prophylaxis: 3500U/24h SC (eg starting 2h pre-op). DVT/PE treatment: 175U/kg per 24h SC till warfarinized.

Dalteparin

DVT prophylaxis: 2500-5000U/24h SC. DVT/PE treatment: 200U/kg/d SC (18,000U/24h maximum). Unstable angina: 120U/kg/12h SC (up to 10,000U/12h maximum) for 5-8d.

Hypnotics

Temazepam

10-20mg PO at night

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SE: Drowsiness; dependence. Zopicolone also causes bitter taste and GI disturbances. CI: Respiratory depression; myasthenia.

Zopiclone

3.75-7.5mg PO at night

Tranquilizers

Haloperidol

2-5mg IM/IV initially, then every 4-8h till response, maximum 18mg in total.

SE: Extrapyramidal effects, sedation, hypotension, antimuscarinic effects, neuroleptic malignant syndrome.

Others

Naloxone

In opiate overdose: 0.8-2mg IV repeated every 2-3min to a maximum of 10mg if respiratory function does not improve. To reverse opiate-induced respiratory depression: 100-200µg IV every 2min.

SE: tachycardia; fibrillation. Can precipitate opiate withdrawl.

Flumazenil

To reverse benzodiazepines: 200µg IV over 15s, then 100µg every 60s if required, up to 1mg maximum.

SE: convulsions (esp. in epileptics); nausea and vomiting; flushing. Avoid if patient has a life-threatening illness con-trolled by benzodiazepines (eg status epilepticus).

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