台北聯合醫院版火星渦蟲 - 4.10ED - by CMU Vins 2014（含抗生素）

(2014-08)
Penicillin-G Procaine
Penicillin(3MU) [25.4]
cefa
Penicillin-G Benzathine
Bicillin(2.4MU) [800]
Cefazolin
Cefa(1g) [16.1]
Oxacillin
IV=Oxacillin(500mg) [20.6]
Cephalexin
Cephalexin(500mg)[1.85]
PO=Ziefmycin(250mg) [1.5]
Cephradine
PO=Recef(250mg) [2.11]
IV=Lofadine(1g) [28.4]
Ampicillin
Ampolin(500mg) [10.6]
Sulbactam
Maxtam(500mg) [151]
cefa
Amoxicillin
Amoxicillin(500mg) [1.5]
Cefmetazole
Metacin(500mg)[97]
Ampicillin + Sulbactam
PO = Unasyn [14.3]
Cefuroxime
PO = Ceflour(250mg) [7.3]
IV = Unasyn(1.5g)() [108]
Subacillin(1.5g)() [108]
Amoxicillin + Clavulanate
Cefoxitin
Lofatin(1g) [124]Cexitin(1g) [124]
PO = Curam(1g) [10.3]
cefa
IV = Curam(1.2g) [168]
Cefotaxime
Claforan(2g) [571]
Ceftazidime
Tatumcef(0.5g) [37.2], Tatumcef(2g) [469]
Anbicyn (0.6g) [56]

Piperacillin + Tazobactam
IV = Cefuroxime(750mg) [25.3]
Cetazine(1g) [72]
Pip/Taz(2.25g) [298]
Pisutam(2.25) [298]
Ceftriaxone
Chef(1g) [249]
Pisutam(4.5) [520]
Flomoxef
Flumarin(1g) [392]
cefa
Ciprofloxacin
PO = Ciproxin(250mg) [11.2]
Cefepime
Supercef(500mg) [282]Antifect(1g) [487]
IV = Ciproxin(200mg)() [679]
Cefpirome
Cepiro(1g) [339]
Seforce(400mg)() [1124]
Levofloxacin
PO = IV = Cravit [61] [599]
Metronidazole
PO = Flagyl [1.7]IV = SABS(500mg) [92]
Moxifloxacin
PO = IV = Avelox [113] [892]
Clindamycin
PO = LinDacin [2]IV = Clincin [16.2]
Ertapenem
Invanz(1g)() [1144]
Azithromycin
Zithromax(250mg) [39.9]
Meropenem
Mepem(250mg) [400]
Clarithromycin
Klaricid(500mg) [25.1]
Imipenem
Tienam(500mg) [471]
Vancomycin
Vanco(500mg) [115]
Gentamicin
V-Genta(80mg) [15]
Teicoplanin
Targocid(200mg) [773]
Isepamicin
Exacin(200mg) [175]
Amikacin
Aminfec(250mg) [33.7]
Fluconazole
IV=Diflucan(100mg) [394], PO=Flu-D(50mg) [42]
TMP-SMX
PO=Baktar [2]
Acyclovir
IV = Zovirax(250mg)[560]
IV=Sevatrim [18.5]
Oph= Devirus[427], Cream = Deherp [46.6]
Colistin
Colimycin [131]
Linezoid
Zyvox(600mg) [1662]
Daptomycin
Cubicin(500mg)[3644]
Tigecycline
Tygacil(50mg) [1708]
1/68
1/4
Imipenem (see
Comment)
Meropenem
4/>4
Ertapenem
Carbapenem Antibiotics
Doripenem
1/18
ANTIMICROBIAL
1.0 gm q8h
0.5 gm q6h
1.0 gm q24h
500 mg IV q8h
D&I
D&I
D&I
1.0 gm q8h
250500 mg
q68h
250 mg q612h
Dose for CRRT:
0.51 gm bid
(AAC 49:2421, 2005)
1.0 gm q12h
Same dose for CRRT
30 50: 250 mg IV
q8h
>10 <30: 250 mg IV
q12h
1.0 gm q24h 0.5 gm q24h (CrCl <30)
500 mg IV
q8h
0.5 gm q24h
125250 mg
q12h
0.5 gm q24h
No data
187
HEMO: Dose as for CrCl <10; if dosed <6 hrs prior to HD, give 150 mg
supplement AD
HEMO: Dose AD
potential for seizures if recommended
CAPD: Dose for CrCl <10
doses exceeded in pts with CrCl <20 mL
per min. See pkg insert, esp. for pts
<70 kg
HEMO: Dose AD
No data
ADJUSTMENT FOR RENAL FAILURE

HALF-LIFE
DOSE FOR
METHOD
HEMODIALYSIS, CAPD
COMMENTS &
Estimated creatinine clearance (CrCl), mL/min
(NORMAL/
NORMAL RENAL
(see
(see footer)
DOSAGE FOR CRRT
ESRD) hr
FUNCTION
footer)
>5090
1050
<10
ANTIBACTERIAL ANTIBIOTICS
Aminoglycoside Antibiotics: Traditional multiple daily dosesadjustment for renal disease
Amikacin
1.42.3/17150
7.5 mg per kg q12h
I
7.5 mg/kg
7.5 mg/kg q24h
7.5 mg/kg q48h HEMO: of normal
High flux hemodialysis membranes lead to
or 15 mg per kg once
q12h
Same dose for CRRT
renal function dose AD
unpredictable aminoglycoside clearance,
daily (see below)
CAPD: 1520 mg lost per L measure post-dialysis drug levels for effidialysate per day (see
cacy and toxicity. With CAPD, pharmaComment)
cokinetics highly variablecheck serum
levels. Usual method for CAPD: 2 liters of
Gentamicin,
23/2060
1.7 mg per kg q8h.
I
100% of q8h
100% of q12-24h
100% of q48h HEMO: of normal
dialysis fluid placed qid or 8 liters per day
Tobramycin
Once daily dosing
Same dose for CRRT
(give 8Lx20 mg lost per L = 160 mg of
below
CAPD: 34 mg lost per L
amikacin supplement IV per day)
dialysate per day
NUS
Netilmicin
23/3572
2.0 mg per kg q8h.
I
100% of q8h
100% of q12-24h
100% of q48h HEMO: of normal
Adjust dosing weight for obesity: [ideal
Once daily dosing
Same dose for CRRT
body weight + 0.4 (actual body weight
below
ideal body weight)] (CID 25:112, 1997).
dialysate per day
Streptomycin
23/3080
15 mg per kg (max.
I
q24h
q2472h
q7296h
HEMO: of normal
of 1.0 gm) q24h.
Same dose for CRRT
Once daily dosing
below
dialysate per day
ONCE-DAILY AMINOGLYCOSIDE THERAPY: ADJUSTMENT IN RENAL INSUFFICIENCY (see Table 10D for OD dosing/normal renal function)
Creatinine Clearance (mL per min.)
>80
6080
4060
3040
2030
1020
<100
Drug
Dose q24h (mg per kg)
Dose q48h (mg per kg)
Dose q72h and AD
Gentamicin/Tobramycin
5.1
4
3.5
2.5
4
3
2
Amikacin/kanamycin/streptomycin
15
12
7.5
4
7.5
4
3
IsepamicinNUS
8
8
8
8 q48h
8
8 q72h
8 q96h
NetilmicinNUS
6.5
5
4
2
3
2.5
2
TABLE 17A (2)
HALF-LIFE
DOSE FOR
(NORMAL/
NORMAL RENAL
ESRD) hr
FUNCTION
ANTIBACTERIAL ANTIBIOTICS (continued)
METHOD
(see
footer)
3.5/1325
0.8/1323
1.2/1325
2.93.3/21
Cefoxitin
Ceftazidime
Ceftobiprole
68/76
Levofloxacin
Erythromycin
1.4/56
57/22
7/>7
Gemifloxacin
Macrolide Antibiotics
Clarithromycin
714/11-40
GatifloxacinNUS
Cefuroxime
1.2/17
sodium
Fluoroquinolone Antibiotics
Ciprofloxacin
3-6/69
12 gm q12h
1.7/1535
Cefotaxime,
Ceftizoxime
Cefotetan
250500 mg q6h
0.51.0 gm q12h
750 mg q24h IV, PO
320 mg po q24h
D&I
500750 mg po (or
400 mg IV) q12h
400 mg po/IV q24h
D&I
0.751.5 gm q8h
500 mg IV q8-12h
2 gm q8h
2.0 gm q8h
2.0 gm q8h
(max. dose)
2.0 gm q8h
2.2/18
Cefepime
100%
100%
750 mg q24h
320 mg q24h
400 mg q24h
100%
100%
75%
20-49: 750 q48h
400 mg, then 200 mg

q24h
Same dose for CRRT
160 mg q24h
5075% CRRT
400 mg IV q24h
q12h
Same dose for CRRT
2 gm q8h
2 gm q1224h
Same dose for CRRT
q812h
q1224h
Same dose for CRRT
100%
1-2 gm q24h
Same dose for CRRT
q8h
q812h
Same dose for CRRT
q812h
Q1224h
Same dose for CRRT
500 mg IV q8- 30 & 50: 500 mg q12h
12h
over 2 hrs
10 & <30: 250 mg q12h
over 2 hrs
q8h
q812h
Same dose for CRRT
HEMO: Dose AD
HEMO: Extra 0.51 gm AD

CAPD: 0.5 gm q12h
HEMO: Extra 1 gm AD
CAPD: 12 gm q48h
HEMO: Extra 1 gm AD
CAPD: 0.51 gm q24h
HEMO: Extra 1 gm AD
CAPD: 1 gm q24h
HEMO: Extra 1 gm AD
CAPD: 1 gm q24h
HEMO: Extra 1 gm AD
CAPD: 0.5 gm q24h
No data
HEMODIALYSIS, CAPD
(see footer)
5075%
5075%
HEMO: Dose AD
CAPD: None
HEMO/CAPD/CRRT: None
160 mg q24h HEMO: 160 mg q24h AD

CAPD: 160 mg q24h
<20: 750 mg HEMO/CAPD: Dose for
once, then
CrCl <20
500 mg q48h
HEMO: 250 mg po or 200 mg

IV q12h
CAPD: 250 mg po or 200 mg
IV q8h
400 mg, then HEMO: 200 mg q24h AD
200 mg q24h CAPD: 200 mg q24h
50%
q24h
No data
q24-48h
q2448h
1-2 gm q48h
q24h
1 gm q24h
q2448h

>5090
1050
<10
Cephalosporin Antibiotics: DATA ON SELECTED PARENTERAL CEPHALOSPORINS

Cefazolin
1.9/4070
1.02.0 gm q8h
I
q8h
ANTIMICROBIAL
TABLE 17A (3)
Ototoxicity with high doses in ESRD
CRRT as for CrCl 10-50
188
CRRT 750 mg once, then 500 mg q48h
May falsely increase serum creatinine by

interference with assay.
Since 1/2 dose is dialyzed, post-dialysis
dose is max. of 3 gm.
Active metabolite of cefotaxime in ESRD.

dose further for hepatic & renal failure.
CRRT dose: 750 mg q12h
COMMENTS &
DOSAGE FOR CRRT
11/2049
Trimethoprim
(TMP)
100200 mg q12h
10 mg/kg q24h
800 mg q24h
D&I
D
I
None
METHOD
(see
footer)
6/200250
As for TMP
1 tab po q24h or 3
times per week
1 gm q12h
No
change
D&I
1 gm q12h
COMMENTS &
DOSAGE FOR CRRT
>30: q12h
10-30: q18h
Same dose for CRRT
30-50: 7.5 mg/kg q24h
Avoid
q18h
Same dose for CAVH
q48h
Same dose for CRRT
600 mg q24h
(<30 mL per min.)
100%
Same dose for CRRT
600 mg q12h
Same dose for CRRT
<30: 10 mg/kg No data

q48h
q24h
HEMO: Dose AD
CAPD: q24h
600 mg q12h HEMO: As for CrCl <10

AD
CAPD & CRRT: No dose
adjustment
50%
HEMO: Dose as for CrCl
<10 AD
Avoid
Not applicable
q24h
HEMO: Extra 1 gm AD
CAPD: 1 gm q24h
q72h
HEMO: Dose for CrCl <10
600 mg q24h HEMO: 600 mg AD
CAPD: No data
1 gm q2496h
1 gm q47
days
HEMO/CAPD: Dose for

CrCl <10
CAVH.CVVH: 500 mg q2448h. New

hemodialysis membranes clear. of
vanco; check levels
CRRT dose: q18h
189
If CrCl <30, reduce dose to 600 mg once

daily. If both liver and renal failure, dose is
400 mg once daily
No data
Accumulation of 2 metabolitesrisk
unknown (JAC 56:172, 2005)
160 mg q24h
160 mg q36h HEMO: 80 mg AD
LnID 6:589, 2006
Same dose for CRRT
CrCl <30, 46 mg per kg q48h
HEMO & CAPD: 46 mg per kg q48h (after dialysis if possible)
HEMODIALYSIS, CAPD
(see footer)
520 mg/kg/d 3050: 57.5 mg/kg q8h

Not recomNot recommended; but if
divided
(same dose for CRRT)
mended; but if used: 510 mg/kg q24h
q6-12h
1029: 510 mg/kg q12h
used: 5
10 mg/kg per
dose q24h
100%
100%
100%
10 mg/kg
q24h
q12h
800 mg q24h
q24h
100%
q12h
100%
46 mg per
kg per day
600 mg q12h
160 mg q12h

>5090
1050
<10
If renal failure, use EMIT assay to measure levels; levels overestimated by RIA or fluorescent immunoassay.
TMP-SMX
Prophylaxis
Vancomycin1
Trimethoprim-sulfamethoxazole-DS (Doses based on TMP component)

Treatment
As for TMP
520 mg/kg/day
D
(based on TMP
divided q6-12h
component)
7-8/17.9
Telavancin
10/15
6 mg per kg per day
45/62230
Telithromycin
50100 mg
1.0 gm q8h
0.5/1
10/2050
Nitrofurantoin
Sulfamethoxazole
(SMX)
TeicoplaninNUS
7.5 mg per kg q6h
614/721
5-6/6-8
Linezolid
Metronidazole
9.4/30
Daptomycin
46 mg per kg per
day
600 mg po/IV q12h
HALF-LIFE
DOSE FOR
(NORMAL/
NORMAL RENAL
ESRD) hr
FUNCTION
Miscellaneous Antibacterial Antibiotics
Colistin
<6/48
80160 mg q8h
ANTIMICROBIAL
TABLE 17A (4)
1.0/3.35.1
Piperacillin
1.2/13
37/100
250500 mg qid
D&I
3.1 gm q4h
Non-lipid: 0.4
1.0 mg/kg/day
ABLC: 5 mg/kg/day
LAB: 35 mg/kg/day
100400 mg q24h
D&I
D&I
3 gm q4h
3.375 4.5 gm q6-8h
34 gm q46h
0.54 million U q4h
2 gm q8h
100%
q24h
q812h
3.1 gm q4h
12 gm q4h
100%
q46h
100%
100%
50%
q24h
Same dose for CRRT
q1224h
Same dose for CRRT
12 gm q8h
Same dose for CRRT
3.1 gm q8-12h
Same dose for CRRT
2.25 gm q6h
<20: q8h
Same dose for CRRT
q68h
Same dose for CRRT
5075%
Same dose for CRRT
75%
Same dose for CRRT
50%
q24h
q24h
2.0 gm q12h
12 gm q12h
2.25 gm q8h
q8h
2050%
25%
CRRT dose: 1.5 AM/0.75 SB q12h
HEMO: Dose AD
CAPD: 2 gm AM/1 gm SB
q24h
HEMO: Dose AD
HEMO: 100% of
recommended dose AD
HEMO/CAPD/CRRT: No
dose adjustment
HEMO/CAPD/CAVH: None

CAPD: 3.1 gm q12h
190
For ampho B, toxicity lessened by saline

loading; risk amplified by concomitant
cyclosporine A, aminoglycosides, or
pentamidine
CRRT: 200-400 mg q24h
Avoid in ESRD
See footnote 2
5.2 mEq sodium per gm
HEMO: 2 gm q8h plus 1 gm

extra AD
HEMO: Dose for CrCl <10 + 0.75 gm AD
CAPD: 4.5 gm q12h; CRRT: 4.5 gm q48h
1.7 mEq potassium per million units. s

potential of seizure. 10 million units per
day max. dose in ESRD.
1.9 mEq sodium per gm
Technically is a -lactam antibiotic.
IV amoxicillin not available in the U.S.

CRRT: dose for CrCl 10-50
If CrCl 30 per mL, do not use
875/125 or 1000/62.5 AM/CL
COMMENTS &
DOSAGE FOR CRRT
HEMO: Dose AD
CAPD: 250 mg q12h
HEMO: As for CrCl <10;
extra dose after dialysis
HEMODIALYSIS, CAPD
(see footer)
Clavulanate cleared by liver, not kidney. Hence as dose of combination decreased, a deficiency of clavulanate may occur (JAMA 285:386, 2001).
Fluconazole
ANTIFUNGAL ANTIBIOTICS
Amphotericin B
24h-15
& Lipid-based
days//unchanged
ampho B
Ticarcillin/
1.2/11-16
Clavulanate2
Tetracycline Antibiotics
Tetracycline
610/57108
Ticarcillin
0.71-1.2 (both)/2-6
0.5/620
Penicillin G
Pip (P)/Tazo(T)
2.0/68
Aztreonam
ANTIMICROBIAL

HALF-LIFE
DOSE FOR
METHOD
(NORMAL/
NORMAL RENAL
(see
ESRD) hr
FUNCTION
footer)
>5090
1050
<10
Penicillins
Amoxicillin
1.0/520
250500 mg q8h
I
q8h
q812h
q24h
Ampicillin
1.0/720
250 mg2 gm q6h
I
q6h
q612h
q1224h
Amoxicillin/
1.3 AM/1.0
500/125 mg q8h
D&I
500/125 mg
250500 mg AM
250500 mg
Clavulanate2
(see Comments)
q8h
component q12h
AM component
q24h
520/4.0
Amoxicillin ext.
1.5/?
775 mg once daily
Once daily
CrCl <30, no data,
rel. tabs
avoid usage
Ampicillin (AM/
1.0 (AM)/1.0 (SB) 2 gm AM + 1.0 gm
I
q6h
q812h
q24h
Sulbactam(SB)
SB q6h
9.0 (AM)/10.0 (SB)
TABLE 17A (5)
516/516
650 mg q8h
250500 mg q12h
5 mg per kg per day
(max. 300 mg)
25 mg per kg q24h
(max. dose 2.5 gm
q24h)
600 mg per day
D
D
12/500
Amantadine
Ref: Transplantation 80:1086, 2005
7.5/15
Adefovir
100 mg po bid
10 mg po q24h
ANTIVIRAL AGENTS For ANTIRETROVIRALS See CID 40:1559, 2005

Acyclovir, IV
2-4/20
512.4 mg per kg
D&I
q8h
1.55/1.811
9/26
Pyrazinamide
Rifampin
2.1/?
0.74/817
Ethionamide
Isoniazid
HEMODIALYSIS, CAPD
(see footer)
COMMENTS &
DOSAGE FOR CRRT
650 mg q8h
q24h
q12h
10 mg q24h
100% q8h
600 mg q24h
100%
100%
100%
q 7days
10 mg q72h3
10 mg q4872h3
q24-48h
50% q24h
300600 mg
q24h
HEMO/CAPD: Dose for

CrCl<10/
HEMO: 10 mg q week AD
HEMO: Dose AD
HEMO: No adjustment
CAPD/: Dose for CrCl <10
HEMO: Dose AD
CRRT: Dose for CrCl 10-50
CAPD: No data; CRRT: Dose ?
191
Rapid IV infusion can cause Cr. CRRT

dose: 5-10 mg/kg q24h
Biologically active metabolite
25 mg per kg 46 hr prior to 3 times

per wk dialysis. Streptomycin instead of
ethambutol in renal failure.
50%
HEMO/CAPD/CRRT: No dosage adjustment
100%
HEMO: Dose AD
CAPD/: Dose for CrCl <10
1225 mg per HEMO: 40 mg/kg 24 hrs before each 3x/week dialysis
kg q24h
CAPD: No reduction;
q48h
HEMO: As for CrCl <10 plus

0.75 g AD.
CAPD: Dose for CrCl<10
650 mg q24h HEMO: Dose AD
Marked tissue accumulation
q2436h
100% q1224h
300600 mg q24h
Same dose for CRRT
100%
100%
Same dose for CRRT
100%
Same dose for CRRT
q2436h
Same dose for CRRT
650 mg q812h
Same dose for CRRT
q24h
Same dose for CRRT
q1224h
q24h
HEMO: Dose AD
Goal is peak serum level >25 mcg per
Same dose for CRRT
CAPD: 0.51.0 gm q24h
mL and <100 mcg per mL
100%
100%
50%
HEMO/CAPD: oral solution: 100 mg q12-24h
Same dose for CRRT
200 mg IV bid Do not use IV itra if CrCl <30 due to accumulation of carrier: cyclodextrin
q24h
Use has not been studied. Recommend avoidance of drug.
No change If CrCl <50 mL per min., accum. of IV vehicle (cyclodextrin). Switch to po or DC
For CRRT: 4 mg/kg po q12h
q12h

>5090
1050
<10
ANTITUBERCULOUS ANTIBIOTICS (Excellent review: Nephron 64:169, 1993)

Ethambutol
4/715
1525 mg per kg
I
q24h
q24h
Quinine
21/25
200 mg IV q12h
36200/?
250 mg po per day
Non-linear kinetics 6 mg per kg IV q12h
times 2, then 4 mg
per kg q12h
ANTIPARASITIC ANTIBIOTICS
Pentamidine
3-12/73-18
4 mg per kg per day
100200 mg q12h
Itraconazole, po
soln
Itraconazole, IV
Terbinafine
Voriconazole, IV
21/25
HALF-LIFE
DOSE FOR
METHOD
(NORMAL/
NORMAL RENAL
(see
ESRD) hr
FUNCTION
footer)
ANTIFUNGAL ANTIBIOTICS (continued)
Flucytosine
36/75200
37.5 mg per kg q6h
I
ANTIMICROBIAL
TABLE 17A (6)
Ref: for NRTIs and NNRTIs: Kidney International 60:821, 2001
ANTIMICROBIAL

HALF-LIFE
DOSE FOR
METHOD
HEMODIALYSIS, CAPD
(NORMAL/
NORMAL RENAL
(see
(see footer)
ESRD) hr
FUNCTION
footer)
>5090
1050
<10
ANTIVIRAL AGENTS For ANTIRETROVIRALS (continued)
Atripla
I
Do not use if
See each drug 200 mg emtracitabine
+
CrCl <50
300 mg tenofovir
+
600 mg efavirenz
Cidofovir: Complicated dosingsee package insert
Induction
2.5/unknown
5 mg per kg once
5 mg per kg Contraindicated in pts with CrCl 55 ml/min.

per wk for 2 wks
once per wk
Maintenance
2.5/unknown
5 mg per kg q2wks
5 mg per kg Contraindicated in pts with CrCl 55 ml/min.

q2wks
Didanosine
0.61.6/4.5
125200 mg q12h
D
200 mg q12h
200 mg q24h
<60 kg: 150 mg HEMO: Dose AD
tablets4
buffered tabs
q24h
CAPD/CRRT: Dose for CrCl
>60 kg: 100 mg <10
q24h
400 mg q24h entericD
400 mg q24h
125200 mg q24h
Do not use HEMO/CAPD: Dose for CrCl
coated tabs
EC tabs
<10
Emtricitabine
10/>10
200 mg q24h
I
200 mg q24h
3049: 200 mg q48h
200 mg q96h HEMO: Dose for CrCl <10
(CAPS)
1029: 200 mg q72h
Emtricitabine +
See each drug
200-300 mg q24h
I
No change
3050: 1 tab q48h
CrCl <30:
Tenofovir
Do not use
Entecavir
128149/?
0.5 mg q24h
D
0.5 mg q24h
0.150.25 mg q24h
0.05 mg q24h HEMO/CAPD: 0.05 mg q24h
Famciclovir
2.33.0/1022
500 mg q8h
D&I
500 mg q8h
500 mg q1224h
250 mg q24h HEMO: Dose AD
CAPD: No data
Foscarnet (CMV Normal half-life
CrCl (mL/min per kg body weightonly for Foscarnet
dosage). Dosage (T) 3 hrs with
>1.4
>1-1.4
>0.8-1
>0.6-0.8
>0.5-0.6
>0.4-0.5
<0.4
adjustment
terminal T of
Induction: 60 mg/kg
60 q8h
45 q8h
50 q12h
40 q12h
60 q24h
50 q24h
Do not use
based on est.
18-88 hrs.
IV
q8h
x
2-3
wks
CrCl divided by T very long with
Maintenance:
ESRD
wt (kg)
120 q24h
90 q24h
65 q24h
105 q48h
80 q8h
65 q48h
Do not use
90-120 mg/kg/day IV
Ganciclovir
3.6/30
Induction 5 mg per
D&I
5 mg per kg 1.252.5 mg per kg q24h 1.25 mg per HEMO: Dose AD
kg q12h IV
q12h
kg 3 times CAPD: Dose for CrCl <10
per wk
IV:
Maintenance 5 mg
D&I
2.55.0 mg 0.61.25 mg per kg q24h 0.625 mg per HEMO: 0.6 mg per kg AD
per kg q24h IV
per kg q24h
kg 3 times CAPD: Dose for CrCl <10
per wk
po:
1.0 gm tid po
D&I
0.51 gm tid
0.51.0 gm q24h
0.5 gm 3 times HEMO: 0.5 gm AD
per week
TABLE 17A (7)
See package insert for further details
Give after dialysis on dialysis days

CRRT: Not applicable
If <60 kg & CrCl <10 mL per min,

do not use EC tabs
See package insert for oral solution.
Based on incomplete data. Data are

estimates.
192
Major toxicity is renal. No efficacy, safety,

or pharmacokinetic data in pts with
moderate/severe renal disease.
COMMENTS &
DOSAGE FOR CRRT
17/?
2.53.3/14
4/67
2.0/>8
1.11.4/1.43
Tenofovir, po
Valacyclovir
Valganciclovir
Zalcitabine5
Zidovudine5
300 mg q12h
0.75 mg q8h
900 mg po bid
1.0 gm q8h
300 mg q24h
600 mg po daily
Ref. for NRTIs and NNRTIs: Kidney International 60:821, 2001

Acute renal failure and Fanconi syndrome reported.
40-49/No data
Telbivudine
Ribavirin
Rimantadine
Stavudine, po5
600 mg once daily
75 mg po bid
treatment
300 mg po q24h
DOSE FOR
NORMAL RENAL
FUNCTION
300 mg bid
P&I
D&I
METHOD
(see
footer)
600 mg q24h
300 mg po
q24h
75 mg q12h
D&I
D&I
D&I
D&I
300 mg q12h
900 mg po
bid
0.75 mg q8h
1.0 gm q8h
300 mg q24h
600 mg q24h
30-49: 600 mg q48H

<30: 600 mg q72h
30-49: 300 mg q48h
10-29: 300 mg q72-96h
1.0 gm q1224h
Same dose for CRRT
450 mg q24h to 450 mg
every other day
0.75 mg q12h
Same dose for CRRT
300 mg q12h
Same dose for CRRT
100 mg q24hbid
50% q1224h
31-49: 150 mg q24h

10-30: 100 mg q24h
30-50: 75 mg bid
<30: 75 mg once daily
50150 mg q24h
HEMODIALYSIS, CAPD
(see footer)
COMMENTS &
DOSAGE FOR CRRT
0.75 mg q24h HEMO: Dose AD

CRRT dose: As for CrCl 1050
CAPD: No data
100 mg q8h HEMO: Dose for CrCl <10 AD
CAVH dose: As for CrCl 1050
HEMO: 300 mg q7d or after 12 hrs of HEMO.6
HEMO/CAPD: No data
Use with caution, little data
HEMO: Dose as for CrCl <10
AD
CAPD: No data
CRRT: Full dose
HEMO: As for CrCl <10 AD
HEMO: Dose AD
DO NOT USE See package insert
0.5 gm q24h
No data
100 mg q24h
60 kg: 20 mg
per day
<60 kg:15 mg
per day
600 mg q96h
193
Risk of side effects increased if

concomitant CYP3A inhibitor
2550 mg q24h HEMO: Dose AD; CAPD: Dose for CrCl<10. CRRT: 100 mg 1st days,
then 50 mg/day.
No data
HEMO: 30 mg non-dialysis
Dose for prophylaxis if CrCl <30: 75 mg
days; CAPD: 30 mg once per once daily
week
CRRT: 75 mg po bid
100 mg
HEMO: 100 mg (single dose) CRRT:
http://www.cdc.gov/h1n1flu/eva/peramivir.htm
(single dose) then 100 mg 2 hrs AD
then 15 mg (dialysis days only
q24h

>5090
1050
<10
300 mg bid
Use with caution in patients with creatinine clearance <50 mL per min.
1365/Prolonged
100 mg bid po
I
100 mg bid
11.4/5.58
3040 mg q12h
D&I
100%
6-10/>20
Oseltamivir,
therapy
Peramivir
57/1535
HALF-LIFE
(NORMAL/
ESRD) hr
1418/No data
Lamivudine5
Maraviroc
ANTIMICROBIAL
TABLE 17A (8)
TABLE 17B NO DOSAGE ADJUSTMENT WITH RENAL INSUFFICIENCY

BY CATEGORY*
Antibacterials
Azithromycin
Ceftriaxone
Chloramphenicol
Ciprofloxacin XL
Clindamycin
Doxycycline
Linezolid
1
Antifungals
Metronidazole
Minocycline
Moxifloxacin
Nafcillin
Pyrimethamine
Rifaximin
Tigecycline
Andiulafngin
Caspofungin
Itraconazole oral solution
Ketoconazole
Micafungin
Voriconazole, po only
Anti-TBc
Rifabutin
Rifapentine
Enfuvirtide: Not studied in patients with CrCl <35 mL/min. DO NOT USE
Antivirals
Abacavir
Atazanavir
Darunavir
Delavirdine
Efavirenz
Enfuvirtide1
Fosamprenavir
Indinavir
Lopinavir
Nelfinavir
Nevirapine
Raltegravir
Ribavirin
Saquinavir
Tipranavir
TABLE 18 ANTIMICROBIALS AND HEPATIC DISEASE: DOSAGE ADJUSTMENT*

The following alphabetical list indicates antibacterials excreted/metabolized by the liver wherein a dosage adjustment
may be indicated in the presence of hepatic disease. Space precludes details; consult the PDR or package inserts for
details. List is not all-inclusive:
Antibacterials
Antifungals
Antivirals
Ceftriaxone
Nafcillin
Caspofungin
Abacavir
Indinavir
Chloramphenicol
Rifabutin
Itraconazole
Atazanavir
Lopinavir/ritonavir
Clindamycin
Rifampin
Voriconazole
Darunavir
Nelfinavir
Fusidic acid
Synercid**
Delavirdine
Nevirapine
Isoniazid
Telithromycin++
Efavirenz
Rimantadine
Metronidazole
Tigecycline
Enfuvirtide
Ritonavir
Tinidazole
Fosamprenavir
Ref. on antiretrovirals: CID 40:174, 2005
** Quinupristin/dalfopristin
++
Telithro: reduce dose in renal & hepatic failure
TABLE 19 TREATMENT OF CAPD PERITONITIS IN ADULTS*

(Periton Dial Intl 20:396, 2000 & 29:5, 2009)2
EMPIRIC Intraperitoneal Therapy:3 Culture Results Pending
Residual Urine Output
Drug
Cefazolin +
Ceftazidime
Can mix in
same bag
<100 mL per day
>100 mL per day
1 gm per bag, q24h
20 mg per kg BW per bag, q24h
1 gm per bag, q24h
20 mg per kg BW per bag, q24h
Drug Doses for SPECIFIC Intraperitoneal TherapyCulture Results Known. NOTE: Few po drugs indicated
Intermittent Dosing (once per day)
Continuous Dosing (per liter exchange)
Drug
Anuric
Non-Anuric
Anuric
Non-Anuric
Gentamicin
0.6 mg per kg
dose 25%
MD 8 mg
MD by 25%
Cefazolin
15 mg per kg
20 mg per kg
LD 500 mg, MD 125 mg LD 500 mg, MD 25%
Ceftazidime
10001500 mg
ND
LD 250 mg, MD 125 mg ND
Ampicillin
250500 mg po bid
ND
250500 mg po bid
ND
Ciprofloxacin
500 mg po bid
ND
LD 50 mg, MD 25 mg
ND
Vancomycin
1530 mg per kg q57 days dose 25%
MD 3050 mg per L
MD 25%
Metronidazole
250 mg po bid
ND
250 mg po bid
ND
Amphotericin B NA
NA
MD 1.5 mg
NA
Fluconazole
200 mg q24h
ND
200 mg q24h
ND
Itraconazole
100 mg q12h
100 mg q12h
100 mg q12h
100 mg q12h
Amp-sulbactam 2 gm q12h
ND
LD 1 gm, MD 100 mg
ND
LD 320/1600 mg po, MD
TMP-SMX
320/1600 mg po q12 days
ND
ND
80/400 mg po q24h
CAPD = continuous ambulatory peritoneal dialysis
1
2
Ref. for NRTIs and NNRTIs: Kidney International 60:821, 2001

All doses IP unless indicated otherwise.
LD = loading dose, MD = maintenance dose, ND = no data; NA = not applicabledose as normal renal function.
Anuric = <100 mL per day, non-anuric = >100 mL per day
Does not provide treatment for MRSA. If Gram-positive cocci on Gram stain, include vancomycin.
* See page 2 for other abbreviations
194
500mg TID
330
Max=2000mg/day
50mg/kg * q6h
170
60-80mg/kg/day( TID QID) 4.5
100-200/kg/day
800
102
Gentamycin for E.Coli GBS penicillin Ampicillin for Listeria
by Vins 2014/08
Penicillin cover streptococcus

Staphylococcus Oxacillin S Ampicillin Amoxicillin
Ampicillin + Gentamycin for
1Group B streptococcus 2E.Coli3Listeria
Amoxicillin
S + Listeria + Enterococcus
IE2g*q4h
: Cefazolin Clindamycin)
2g * q6h
Cellulitis2g*q6h
Staphylococcus Cellulitis (
Oxacillin
Ampicillin
IM Syphilis240
1 3
Syphilis
Penicillin-G
Benzathine
(<27kg): 60
10 /kg/dose * Q6
300 q6hIEMeningitis240 IM
Group A Streptococcus(pharyngitis)
Pediatric Dosage
Adult Dosage
Penicillin-G
Procaine
MIC
Time dependent
[ Penicillin ]
Name
post-antibiotics effect once daily
AminoglycosideQuinolone
Concentration dependent
GNB: (E.Coli, KP, Proteus, Samonella, Shigella), H.Influenza, H. pylori, Leigionella, Pseudomonas
GNC: Neisseria, Enterococcus
*PECK=Proteus, E.Coli, Klebsiella *HBEN= H.Influenza, Branhamela catarrhalis, Enterobactar, Neisseria
GPB: Listeria, Bacillus, Clostridium, Corynebacterium(), Lactobacillus, Nocardia, Actinomyces
GPC: S
IV
PO
Aspiration pneumonia
pseudomonas
1.2g/Vial(1000/200)
1.2g * Q8H
1# * BID
1.5g * Q6H
1# * BID-QID
Adult Dosage
40mg/kg/dose *Q8
30mg/kg/dose *Q6
0.5mL/kg/dose*BID
25mg/kg/day*BID
Max=1500,g/day
:37.5-75mg/kg/dose*Q6
:75-150mg/kg/dose*Q6
Pediatric Dosage
504
20.6
432
28-57
Carbapenam + Unasyn
Colistin + Rifampin ( Colistin )
Tazocin pseudomonas
by Vins 2014/08
Unasyn AB (Acinetobacter baumannii) Sulbactam MDRAB double3g*q6h

MDRAB combine
Unasyn R Augmentin S Augmentin

Unasyn 1#*QID 1#*BID
Unasyn Augmentin
IV
2.25g/Vial(2000/250) 4.5g * Q8H
90mg/kg/dose*Q8
1788
B-lactamase G(-)
Augmentin Unasyn Augmentin cellulitis Augmentin
Tazocin =
Piperacillin + Tazobactam
PO
Unasyn
1g/Tab(875/125)
1.5g/vial(1000/500)
IV
Augmentin =
Amoxicillin + Clavulanate
375mg/Tab(1:1)
PO
Unasyn =
Ampicillin + Sulbactam
CAP, COPD w/ AE, AOM,

Sinusitis, UTI, /
()
Name
[ Penicillin B-lactamase ]
500mg/Vial
750mg/vial
250mg/tab
Sterp. pneumonia
CAP
Diverticulitis, PID
1g/Vial
G(-) BBB Samonella
SBP,
Cefmetazole
Cefuroxime
Cefoxitin
Cefotaxime(Claforan)
1g/Vial
1g/Vial
100mg/Cap
BBB meningitis
3 ,
Claforan,
G(+)G(-), , MRSA
Amp-C
Ceftriaxone(Rocephin)
Amp-C
Flomoxef(Flumarin)
Ceftibuten
Cefepime
500mg/Vial
1g/Vial
pseudomonas
Ceftazidime(Fortum)
Ceftizoxime(Epocelin)
2g/Vial
7.3
G(-): PECK + HBEN
25.3
25mg/ml 60ml/BT
Cephalexin Susp
282
22.6
392
249
72
571
124
97
36.5
2.11
250mg/Cap
16.1
Cephradine:
1g/Vial
UTI(PECK), Pre-OP
Cefazolin
(Max:4g/day)
25-50mg/kg/day( 2-4 )
2mL/kg/day( QID)
2# * QID
2g * Q8H
2# * BID
1g * Q8H
1g * q12h
()
2g * Q8H
2g * Q8H
2g * Q8
500mg * q12h
750-1500mg * Q8H
1g * Q8
500mg * Q6
3384
90
1176
498
432
1713
by Vins 2014/08
>2 50mg/kg*Q12
>2 50mg/kg*Q8
9mg/kg*QD
400mg*QD
60-80mg/kg/day( Q6)
75mg/kg/day
( QD Q12)
30-50mg/kg/dose*Q8
30
:75-150 mg/kg/day( Q8)
744
152
<1 :50-100 mg/kg/day( Q12)
291
36.5
17
25-50mg/kg/day( QID)
1g*Q8
250-500mg * Q6
48.3
Pediatric Dosage
100mg/kg/day( Q8H)
G(-) 3 (E.coli, KP, Proteus)(=PECK), UTI 3
Dosage
G(+): staphylococcus, streptococcus ( staphy oxacillin , strepyo penicillin )
[ Cephalosporin ]
Name
PO
IV
(1) G(+)
CAP
(2) pseudomonas
45
by Vins 2014/08
TB Quinolone TB Quinolone TB Quinolone TB

TB Quinolone partial treatment
HAP Ciprofloxacin Levofloxacin Levofloxacin 500mg QD pseudomonas

750mg QD 750mg QD 750mg QD
G(+)Mox > Lev >> Cip

Mox >>> Lev = Cip = 0
Levofloxacin CAPHAP CAP Moxifloxacin
892
113
FDA 18 61
1797
E.coli
UTI pyelonephritis 2716
Cystic fibrosis, IE
FDA 18
G(-)Cip > Lev > Mox
400mg * QD
(PO/IV )
750mg * QD
(PO/IV )
400mg Q12H
500mg Q12H
400mg/250ml/BT
400mg/Tab
250mg/BT
IV
Moxifloxacin
4
500mg/Tab
400mg/200ml/BT
( 80%)
250mg/Tab
PO
Levofloxacin
3
Ciprofloxacin (1) KidneyProstate PO

2
(2) Samonella infection

IV
(3) G(+) CAP
Name
Pediatric Dosage
Flomoxef Cephalosporin Cephamycin Cefoxitin

Cefmetazole Flomoxef CefmetazoleCefoxitin bleeding tendency
Ceftriaxone
Dosage
14 Cephalosporin Cephamycin Cephamycin CefmetazoleCefoxitin
[ Quinolone ] DNA gyrase, Mg, Al, Fe, ,
Cephalosporin Enterococciatypical pathogenListeria

BBB pseudomonas Samonella
IV
250mg/Tab
Chlamydia, Legionella
Erythromycin H. Influenza
HP (PPI+Clarithro+Amoxici)
80
15mg/kg/day( QD 12) 50.2
10mg/kg/day QD*3
Meropenem NF
Amp-C ESBL
250mg/Vial
500mg/Vial
G(+)G(-) MRSA
Tienam Seizure
Meropenem
Imipenem(Tienam)
1g/Vial
pseudomonas, AB
Ertapenem
necrotizing fasciitis ?
[ Carbapenem ]
Name
400
471
1144
1g*Q8
500mg*Q6
1g*QD
Dosage
4800
<3
by Vins 2014/08
10-20-40mg/kg*Q8 (--)
1884
1144
<12
15mg/kg/day( Q12)
13y=1g*QD
<3 3m-12y=
Pediatric Dosage
Azithromycin 3
500mg 1 CAP
for atypical pathogen 2 250mg 14
Leginella 5
( QD q12)
0.5-1g/day
500mg*QD*3
344
4.64
25.1
30-50mg/kg/day( Q6)
Pediatric Dosage
15-20mg/kg/day( Q6) (Max=4g/day)
1#Q6 2#Q12
Dosage
Macrolide GI QD
250mg/Tab
40
172
1.16
Clarithromycin
Azithromycin
PO 250mg/Cap
Atypical : Mycoplasma,
Erythromycin
500mg/Vial
Name
[ Macrolide ] 50S, Erythromycin Clarithromycin P450, , Azythromycin ,

$
Quinolone QT prolong EKG QTc

Amiodarone arrythemia QT
prolong LevofloxacinMoxifloxacinGemifloxacin Ciprofloxacin RefUpToDate
Quinolone 80-100%
Quinolone Gemifloxacin(Factive)
12) 15mg
Q12
Amikacin?
Aztreonem
250mg/Cap
Rickettsia(scrub typhus, Q fever), Lyme disease, H. pylori, Chlamydia,
Tetracycline
Tigecycline tetracycline
100 mg/Cap
pleurodesis
Minocycline
100mg/Cap
(1)(2) Malaria
Doxycycline
, 2 (Mg, Al, Fe, Ca)
1-2g*Q8
Dosage
Name
[ Tetracycline ] 30S, , ,
Name
[ Monobactam ] GNB( pseudomonas), Fortum
6.1
1.5
1.5
100mg*Q12
100mg*Q12
250-500mg*Q6
Dosage
by Vins 2014/08
2 mg/kg/dose*Q12
25-50 mg/kg/day
( 4 )
Pediatric Dosage
Pediatric Dosage
Aminoglycoside
UTI B-lactam(Penicillin, Cephlosporin)
G(+)
Amikacin Exacin once daily Gentamycin
30
101
3-7.5mg/kg/day( QD Q8) 5-7.5mg/kg/day (QD )
10-20mg/kg/day ( Q8
Pediatric Dosage
15mg/kg/day( Q8 Q12)
Dosage
G(-)
G(-)Amikacin > Tobramycin > Gentamycin
Amikacin > Tobramycin > Gentamycin
15
33.7
80mg/Vial
250mg/Vial
Amikacin(Amikin)
Gentamicin(Gentamycin) B-lactam , G(+)

pseudomonas
Tobramycin
[ Aminoglycoside ]
Name
UTI=2tab*Q12
PJP=3-4amp*Q6
Dosage
by Vins 2014/08
trough 15-20
Vancomycin resistant Targocid Linezoid vancomycin Linezoid
1546
Vancomycin 0.5-1 1 Trough 30

Trough 5-20 Peak 30-40
Trough Peak Trough Vancomycin 5-6 dose infection trough 5-10
10mg/kg*Q12
460
MRSA Teicoplanin
bonelung Teicoplanin
Vancomycin MRSA IE
Vancomycin 3 Peak Trough through
Peak
Maintain=400mg*QD
Loading=400mg*Q12*3
10mg/kg*Q6
Pediatric Dosage
773
2g/day( Q6 Q12)
Dosage
G(+)
200mg/Vial
Vanco
Teicoplanin
115
500mg/Vial
MRSA, ()
Vancomycin
PJP 15-20mgTMP/kg/day( 3-4 )
[8mgTMP/40mgSMX] /kg/day( 2 )
Pediatric Dosage
PJP(Pneumocystis jiroveci pneumonia) IV form

Stenotrophomonas maltophilia Cravit Bactar
[ Glycopeptide ]
Name
400mg/Tab
Trimethoprim/sulfamethoxazole 80mg : 400mg =Bactar, PABA
Bactar =80mgTMP , , CNS

+ 400mgSMX
PJP(Pneumocystis jiroveci pneumonia)
=Septrin

Name
[ TMP/SMX]
IV
( C. difficile),
(Giardia, Amoeba, Trichomonas vaginalis)
Metronidazole
(66.8 mg/Vial)
500 mg/Vial
pseudomonas AB
G(+)
1822
by Vins 2014/08
MDRAB Colistin 1vial2MUin H/S 2mL, INHL, q12hIV
<18
262
3416
3324
276
13.6
24
4 mg/kg/dose *QD
Pediatric Dosage
<8
<34 >12
2.5-5mg/kg/day( 2-4 )
Loading=100mg
50mg*Q12
600mg*Q12
Pediatric Dosage
7.5mg/kg*Q6H
7-10mg/kg*Q6H
35-50mg/kg( Q6)
Pediatric Dosage
Colistin MDRABDaptomycin VRSAVRE
3644
131
Dosage
1708
1662
500mg*Q8
500mg*Q6
450mg*Q6
Dosage
Dosage
92
1.7
VRSAVRE
2 MU/Vial
G(-)
Colistin(polymyxin E)
Daptomycin (Cubicin)
[ Others ]
Name
Tetracycline , G(+)(-) 50mg/Vial

, MRSAVREMDRAB
pseudomonas Proteus
Tigecycline
pseudomonas Ertapenem, Tigecycline, Moxifloxacin

VREVancomycin-resistant enterococci
600mg/300ml/Bag
MRSA, VRE Vit.B6
Linezolid
Name
500mg/100ml/BT
PO
, G(+)
Clindamycin
[ Oxazolidinones ][Glycylcyclines]
150mg/Cap
250mg/Tab
Name
[ ]
( Unasyn or Augmentin +/- Macrolide) Moxifloxacin

Tazocin Levofloxacin Cefa
Augmentin Moxifloxacin
G(+)+/- Atypical
G(-)
pseudomonas
CAP
HAP/HCAP
Aspiration pneumonia
MRSA
G(-)
pseudomonas
Cefa*
Tazocin Carbapenem
MRSA Carbapenem + (Vancomycin / Teicoplanin)
+/- Macrolide, +/- Fluconazole
G(-)
G(-)G(+)
atypical fungus
Neutropenic fever
Carbapenem Ertapenem pseudomonas

Quinolone Moxifloxacin pseudomonas
by Vins 2014/08
*3 cefa Ceftazidime pseudomonas 3 cefa 3 cefa Ceftazidime
Ampicillin + Gentamycin + Metronidazole

Unasyn /Augmentin /Cefmetazole
( Cefa* + Metronidazole ) Flomoxef
Carbapenem
(34 12 )
Spontaneous Bacterial Peritonitis
Acute cholangitis / Cholecystitis

Liver abscess / PID / TOA
Appendicitits
1.
2.
3.
4.
Ciprofloxacin Ceftazidime
ProstitisCiprofloxacin Levofloxacin
Cefazolin
2 Cefa Unasyn
AminoglycosideQuinolone
G(-) G(+)
UTI
Oxacillin Unasyn / Augmentin
+/-
Cellulitis
Vancomycin Teicoplanin ()
CAP
CAP
AOM, Sinusitis, COPD w /AE
(Ceftazidime + Clindamycin) Tazocin Levofloxacin
[ Vins ]
clerk
Intern complaint
First choice
By vins 2014/08
2014
44
Neutrition & IVF
45
10
46
13
DM neuropathy
50
15
51
()
17
52
18
53
20
54
21
57
Vasopressin
24
63
25
64
27
67
27
PAOD
69
28
71
30
72
31
73
31
74
33
Hormone
76
35
77
36
78
37
80
39
IV pump
85
41
87
42
88
2014
order
ADCVAADIMN
Admit to Dr. OOO on 2011-08-30 ( On Dr.s service since 2011-08-30)

Diagnosis: (1) (2) (3)
Condition: stable/ guarded/ critical
Vital sign: as ward routine/ Q6H/ QID/ TID/ BID GCS SpO2
Allergy:
Activity: as tolerated/ no limitation/ complete bed rest/ physical restriction
Diet: as tolerated/ NPO/ liquid diet/ soft diet/ full diet/ regular diet/ DM diet/ low salt/ low protein
IV fluid:
Mediactions:
Nursing: wound care/ drain/ lines/ record BW / IO / blood sugar
RI sliding scale/ Fever routine/ PRN order/ /
: IV / IV pump
Foley: 2-way
NG: NG with free drain / NG with low pressure
Port-A care(QW)
CVC / A-line / Double lumen / Hickman
Drain: Hemo-Vac / JP / PAD / PTGBD / chest tube .
Stomy: gastrostomy / jejunostomy / ileostomy / colostomy / cyctostomy / nephrostomy(=PCN)
: MV / Nasal cannula / simple / ventri / non-rebreathing / PAP(CPAP / BiPAP) / Endotracheal
tube / Tracheostomy / Steam inhalation(QID) / HHN(Hand hold neubulizer) / sputum suction(Q2/Q4) /
chest care
order
Discharge on 2011-08-30
x1
Dr. OOO on 2011-09-06
OS
OD
OU
[A/ B] A B
A X
A=B
2014
2014
Acetaminophen NSAIDs Ultracet / Tramadol Keto/Nalbuphone Morphine

( Pethidine )
/ Novamin
/ Primperan / Domperidone / Mopride
Ativan
Diphenidol + Euclidan
Novamin

NovaminPrimperanMosapride Domperidone
Baclofen(Befon)
try
(1) Menthal packing
(2) Kascoal
(3) GI Primperan +/- Mosapride
MgO/Gowell/Topaal Strocaine H2 blocker PPI
Senoside + Mopride + Bisacodyl + Normacol / Fiber / Lactulose +

Evac / Fleet / Castor oil
Anti-histamine
Medicon- A / Regrow / Brown mixture Bensau / Becantex Codeine

Medicon-A DM
BZDNon-BZD

/ Ichderm C.B. strong

Steroid
Mycomb / Dr. PI
Anti-histamine
A
(1) 2-agonist Salbutamol
(2) agonist Combivent
B Xanthine AminophyllineTheophyllineCaffeine
.
2014
Nutrition & IVF
Kcal
(1)
a 25-30 kcal/kg/day
b 30-35kcal/kg/day
c Shock 20-25kcal/kg/day ischemic bowel
(2)
a Harris Benedict Equation Basic Energy Expenditure(BEE)
Males66.5 + 13.8 (weight kg) + 5 (height cm) 6.8 (age)
Females655 + 9.6 (weight kg) + 1.7 (height cm) 4.7 (age)
b BEE stress factors REE (Rest Energy Expenditure)REE
ICU
REE
Stress factorsMinor Surgery=1.2, Trauma=1.35, Sepsis=1.6, Major Burns=2.1

(3)
4
Glucose
30-70%
1kcal/mL 1.5kcal/mL
2kcal/mL Osmolality
Protein
1. 0.81g/kg/day 40-50%
2. CKD0.60.8g/kg/day
3.
H/D 1g/kg/day
P/D 1.2g/kg/day
Lipid
12g/kg/day 15-30%
ICU Omega-3 -3 -6 -6
ICU
Na=1-2 mEq/kg/day
K=0.5-1mEq/kg/day
Ca= 10-15 mEq/ day
P= 20-40 mEq/ day
Mg= 8-20 mEq/ day
NPO IVF
IVF
2014
(mEq/L)
Na
Cl
Ca
Mg
Latate
(mM/L)
142
103
25
18
20
40
12
26
75
12
61
110
20
36
Velip
Glucose
(g / L)
(Kcal/L)
(mOsm/L)
280-300
38
129
300
23
33
112
287
20
20
68
285
102
12
25
27
300
18
17
12
100
320
669
40
16
40
50
170
Lactated Ringers
130
109
28
Hatermas
130
111
2.6
27.6
Sorbit-Hartmann
130
109
28
0.9% NaCl
154
1.5
12
100
0
273
200
200
154
300
D5W (5% dextrose)
50
170
250
Aminoplasaml(10%)
400
885
Lipofundin(10%)
110
340
Nutriflex
Glucose=240g, Lipid=0, AA=70g, Na=40, K=26, Ca=4, Mg=10, P=15
1240
>1000
Kabiven
Glucose=75g, Intralipid=51g, AA=34g, Na=32, K=24, Ca=4, Mg=8, P=11
910
750
Oliclinomel-4(N4)
20% Glucose10% Lipid5% AA
610
760
Oliclinomel-7(N7)
40% Glucose20% Lipid10% AA N4
1200
1710
1.
2.
Lactataed ringers Hatermas

dilutional metabolic acidosis Lactated ringers
Hatermas Lactate bicarbonate
glucose D10 Na Na
Line Na
Na Na
Na
Na Na Lactataed
ringers Hatermas [ N/S+D50W ]
3.
(1) 1 NaKCl
(2) 2 1 NaCl K
(3) 3 half saline
(4) 4 NaCl LR NaKCl
2014
(5) 5 Acetate NPO
Lipofundin Kabiven lipid Soybean oil Kabiven

6 3 121N4/N7 3 6 3=21
N4/N7 AminoplasmaLipofundin
4.
N4 N4 lipofundin
Kabiven
N4 1440mL 610*1.44=878kcal 1440*5%=72g
1440*10%=144g
osmolarity 600 serum osmolarity
5.
6.
osmolarity serum osmolarity 5

Aminoplasaml osmolarity 900
N4 line N7
TPN/PPN 710
NPO
TPN/PPN NPO NPO
12 TPN/PPN
50kg
2.
4-2-1 rule 2100mL

< 10kg
100 ml/kg
4 ml/kg/hr
11-20 kg
50 ml/kg
2 ml/kg/hr
>20kg
20 ml/kg
1 ml/kg/hr
30kcal/kg/day 1500kcal
3.
0.8g/kg/day 40g
4.
1g/kg/day 50g
1.

Lipofundin
Aminoplasmal
D50W
11
500
500
800
550
2350
55
200
256
935
1441
50
50
50
50
11 D50W 5-6
N4 1-2 D50W
2014
NPO IVF
NPO 150-200g
50kg
1.
4-2-1 rule 2100mL
2.
500-700kcal
3.
Na 2 mEq/kg/day 100 mEq Na
4.
K 1mEq/kg/day 50 mEq K
Velip
1200
1000
384
Na
K
N/S
Velip
D50W
2200
500
1500
200
2200
170
554
255
340
595
43
40
83
Na
77
60
137
22
16
38
24
24
vs
N/S Na 77mEq
N/S Na
K ok CaPMgK
1 KCl
1.
Albumin 20
2.
Prealbumin 2-3
3.
Transferrin: 7-10
4.
Nitrogen balancenitrogen intake nitrogen outputprotein intake/6.25) (UUN+4)
= 0=
< 0<
> 0>
Colloid
Crystalloid N/SL/R
leak
Crystalloids < Gelofusin < HAES < Hypetonic-hyperosmotic solu
Crystalloids < Albumin < Gelofusin = HAES
Crystalloids < Albumin = HAES < Gelofusin
Crystalloids = Gelofusin < HAES < Albumin
1.
Gelofusin HAES
2.
Colloid
3.
Albumin
(1)
Shock Crystalloid 1000mL 50g Albumin
(2) Albumin<2.5Albumin 3
25g
12hr Albumin 1L 5-10g
acute renal failure
shift 1 20% Albumin 10g 2L
2014
Albumin Albumin FFP1u 30g protein 1u

6L
(3)
4.
pulmonary edema Albumin<3.0Albumin 3
Albumin Albumin
miss
5.
Crystalloid Collid N/S

Crystalloid N/S 1/3
Collid Collid shock overall

survival Collid
XD N/S
6.
FFP/FP
Collid
TBW x mEq(8-12) = 154 x A

A N/S (154 N/S 154 mEq Na)
3% N/S 154 514 ( 3% 514 mEq Na)
Na
TBW x Na = ( TBW + A ) x Na
A
50 Na 160 150
50*0.6*160 = (50*0.6 + A)*150 A= 2L
K 1mg/dl 300mEq K
300
KCl=15mEq Slow-K=8mEq 300 2-3
300
K hydration loop diureticsKalimate
Onset
Insulin + glucose
10-20 mins
0.5mEq
Beta2-agonist (Albuterol)
20-30 mins
0.5mEq
1.2mEq
Sodium bicarbondate
0.6 mEq
Loop or thiazide
fluid status
Kalimate
1-2 hours
24 10-60g 1mEq
Enema 0.8 mEq
Lactulose
25 mEq/hour
TBW=Toal body water x0.6 x0.5

2014
Antipyretic analgesics
1. NSAIDs Prostaglandin
Non-slective
1.
2.
Aspirin (Acetylsalicylic acid)
Aspirin Protect 100mg/Tab [2]

Bokey 100mg/Cap [2]
3.
Indomethacin
1 Aspirin
2
cellulitis
3 PDA PGE2
IV Indocin 1mg/Vial [x / 1324]
EXT Inteban cream10mg/g 40g/Tube [64 /

122]
1.
2.
3.
Ibuprofen
Idofen syrup 20mg/ml 60ml/BT [25]
1/4 8
2ccQ6H
Purfen FC tablet 400mg/Tab [2]
4.
1.
2.
3.
Naproxen
Napton SR tablet 750mg/Tab
U-Ritis tablet 250mg/Tab
4.
Sulindac
Aspirin

TonsillitisPharyngitisLaryngitis
PGE2 Indomethacin
Ibuprofen
2011 British Medical Journal
NSIADs CV risk
ibuprofen 50%
Sulinton 200mg/Tab [2.12] 100-200mg BID, max 400mg/day
Diclofenac Potassium
PO(100-200mg/day)
Cataflam 25mg/Tab [2]
Volna-K 25mg/Tab [2]

Voltaren SR 75mg/Tab [3.35]
Supp(0.5-2mg/kg/day BID-TID, Max 225mg/day)
Voren 12.5 mg/Supp [5]
1.
2.
3.
4.
1.
Ketorolac Tromethamine
Keto EM capsule 10mg/Cap
Keto injection 30mg/ml/Amp [31]
(Max120mg/day)
2.
>65 , , BW<50kg
2014
Aspirin
3.
10
Acetaminophen
GI GI ulcer
NPO
GI ulcer
>
ketorolac
Intern IV
NalbuphineKeto peptic
ulcerNalbuphine
call R Morhpine
Ketoprofen
(Kepinton 200mg) >
Piroxicam
Brexin sachet 191.2mg/sach [12.7] 1pk QD
Flurbiprofen
Lefenine 100mg/tab [4.08] 1# bid
1.
COX inhibitor
1.
COX inhibitor
Partial selective & Selective

(1)60 (2)RAAS NSAIDs (3)
Steroid (4)/(5)
Etodolac
1.
COX-2 COX-2
NSAIDs NSAIDs
1.
COX-2 GI NSAID
Diclofenac Thromboxane-A
PLT
CV
Lonine 200mg/Cap [5.2] BID
Meloxicam
MEL-OD tablet 15mg/Tab [9]
7.5-15mg QD, Max 15mg/day
Mobic injection 10mg/mL, 1.5mL/amp
Nabumetone
Tanleeg
500mg/Tab [4.14] QD~QID
Celecoxib
Celebrex 200mg/Cap [18.5]
OA/RA: 200mg* QD~BID
Etoricoxib
Arcoxia 60mg/Tab [17.8]
2.
3.
1.
2.
COX-2 Preferential inhibitor
6-Methoxy-2-Naphthylacetic Acid(6-MNA)
GI
3.
COX-2 GI
COX-2
NSAID
1.
Diclofenac
2.
Etofenamate
3.
Indomethacin
4.
Voren-G ()40g/Tube [16.6 / 36]
Teiria Gel 20g/Tube [35.6]

Methacin Gel 20g/Tube [39]
Piroxicam
Focus gel 40mg/Tube [43]
2014
11
/
NSAID
Voren-G
NSAID
NSAID
40g()
2. Acetaminophen
Non-narcotic antipyretic analgesics
Acetaminophen
1. Primary care
2. NSAIDs
3.
4.
5. team
Tinten 500mg/Tab
(:Scano , Panadol )
Bubdel 80mg/Tab
Anti-Phen Syrup () 24mg/ml 60ml/BT
:10-15mg/kg/dose*Q4H, max 2.6g/day
2mL
Child Acetaminophen
/TACE
1# QID regular
PRN / 1~2 ok
NSAIDs / NSAIDs
TACE tumor necorsis cytokine tumor
NSAIDs Acetaminophen
PRN Acetaminophen/ NSAIDs
3.
1.
Broen-C 20mg/Tab, 1# tid [5.4]
( = Bromelain + L-Cystein )
2.
3.
4.
Plasminogen Plasmin Plasmin

Fibrin Fribin
Fibrinogen?
etc
1.
2. Acetaminophen Acetaminophen
3. anti-inflammation( arthritis, myalgia, gout..) Acetaminophen
A.
(1) ulcer hx Cataflam / Purfen
(2) ulcer hx Lonine / Tanleeg
B. (60 ) Celebrex / Arcoxia
2014
12
3.
Colchicine
0.5mg/Tab [1.5]
:0.5mg bid
: 0.5-0.6mg/day
1.
2.
3.
4.
5.
6.
7.
Mitotic inhibitors( WBC UA)
8.
1 bid
9. UpToDate
eGFR 30
1
eGFR 30
Allopurinol
1.
2.
3.
Synorid tablet 100mg/Tab [2]

200-300mg/day
600-800mg/day
100-300mg/day
400-600mg/day
4.
Max 800mg/day BID
TID dose 300
5.
6.
Benzbromarone Sulfinpyrazone
Nogout 50mg/tab [3.22]
Eurocin 50mg/tab [2]
1# QD
Febuxostat
1.
2.
3.
1.
2.
Feburic 80mg/tab [25] 1# QD

3.
2014
Xanthine oxidase inhibitors( UA )
(: aspirin)
Tumorlysis syndromeC/T
caner lymphomaleukemia
ADR: Steven-Johnson syndrome
()
UA fluid
Allopurinol
Benzbromarone stone
NaHCO3
Allopurinol xanthine oxidase inhibitor
Benzbromarone
6.0 mg/dL
eGFR45 Cr 1.5

eGFR > 30 Child A-B
13
summery
1. Colchicine + NSAIDsKetorolac IV/IM Diclofenac PO
Acetaminophen
NSAIDs NSAIDs
steroid COX-2 Celebrex
Diclofenac
2. Diuretics dose-dependent
Allopurinol Colchicine
Allopurinol BenzbromaroneBenzbromarone
AllopurinolAllopurinol Allopurinol
(100mg/day)
9
9 + 10
() UA 6 5
UA 3-6
2014
14
Analgesics
Steroid
1. Analgesics
NSAIDsAcetaminophenNarcotics
NSAIDs and Acetaminophen
Tramadol
1 KetoMeperidine Nalbuphine
2
Meperidine GI
Meperidine
Tramadol
3 receptor
4
5
Tramtor 50mg/mL, 2mL/amp [32]
Camadol capsule 50mg/Tab [4.4]

25mg QD , Max
400mg/day
Ultracet Tramadol (37.5mg)

Acetaminophen(325mg) [7.4]
1 Tab Q4-Q6H, Max 8 Tab/day
Nalbuphine
Bain / Nubain
10mg/ml/amp [46.3 / 116.2]
70kg 10mg SC, IM or IV, Q3-Q6H
20mg
160mg
1 Intern
2 5
3
4
1. Intern IV
2. ceiling effect(
ceiling effect Morphine ceiling effect)
3.
4. n/v 50kg
Meperidine
1.
Morphine
2.
cognitive function
Pethidine tablet 50mg/Tab
3.
seizure
Pethidine inj. 50mg/ml/Amp [20]
4.
Demerol
50-150mg Q3-Q4H, Max
1/2 30
600mg/day
5.
Naloxone thiopentone
CCr<15 75%
diazepam
CCr<10 50%
6. Demerol
3
Morphine Oddis sphincter
Demerol
7. Morphine Demerol Morphine
1/10onset
2014
15
Codeine Phosphate
15mg /tab [1.9]
1. Morphine
2.
1/2 1/3
1.
pattern Bowel sound
Laxatives
PO 103060mg Max=1600mg/day
Paralysis ileus
IV/IM/SC 10mg/ml/Amp
2.
20mg/ml/Amp
IV IM/SC 2
*PO IV 1/3
3. < 8/min Pin-point pupil
*PO SC 1/2
Naloxone
*For breakthrough pain Daily dose 1/6
4. Intern
Morphine
Fentanyl patch
IV form=Fentanyl 0.5mg/mL,
10mL/amp
:
12mg/Patch = Durogesic [188]
25mg/Patch = Fentanyl [270]
1. 25mcg/hr=0.6mg/day
2. Narcotics Morphine
100
3. 1
4. Onset 12
12
5. 60mg Morphine 1 Fentanyl
Buprenorphine
Temgesic 0.2mg/tab
, q6-q8h [22.3]
1. Potency morphine 60
2. ceiling effect at 1.6mg/day
FentanylMorphineTramadolCodeine=10011/51/6
WHO by ladder()by mouth(

) by clock()
1.
2. titrate Acetaminophen NSAIDs
3. DemerolMorphine
UltracetTramadolNalbuphine
4.
2014
16
2.

Lidocaine HCL
1.
2.
3. Jelly NG tube
Xylocaine
1%2% injection2% jelly
Baclofen
Befen 5mg/Tab [1.5]
5mg TID 15mg QID
Chlorzoxazone
Solaxin 200mg/Tab [2]

1-2Tab TID-QID
Max 3000mg/day
1.
2. GABA
3.
1.
fibromyalgia, myofascial
pain
2. Trauma //
NSAID
3. (multisynaptic)
4.
Tolperisone
1.
Topee 150mg/Tab [2.14] 1# tid 2. =D ()
Relax [5.2] 1# TID
= Acetaminophen + Carisoprodol
Tengam [1.09] 1# TID
= Acetaminophen+ Caffeine+ Chlorzoxazone
Ergoton [1.5]
= Ergotamine 1mg+ Caffeine 100mg

Mephenoxalone=Mephenoxalone Dorsifex Shuane
Tizanidine=Stidine

Cyclobenzaprine=Musgud
Musolin =Aspirin+ Caffeine+ Orphenadrine citrateOrphenadrine citrate anticholinergic()

Phenprobamate=Extacol
2014
17
3. Steroid
1.
2.
3.
4.
Spinal shock
Secondary immune
response
Dexamethasone
Betamethasone
Intermediate acting
Triamcinolone 10mg/Vial [13.3]

Intermediate acting
Metisone 4mg/Tab [1.4]

Methylprednisolone 40mg/Vial [62]
Medason 125mg/Vial [2.8]
Solu-Medrol 500mg/Vial [270]
Intermediate acting
Compesolon 5mg/Tab [1.5]

Kidsolone 1mg/mL, 60mL/Bot [63]
Hydrocortisone
short acting
Solu-tisone 100mg/2ml/Vial [2.8]
(: Solu-Cortef )
Cortisone acetate
secondary
adrenal gland insufficiency
Solu-medrol > Solu-tisone
Asthma AE / COPD AE
Solu-medrol250mg/( bid~qid )
steroid
5mg 2.5mg
cortisl
40mg/day (
) (24 ) ( 2~3 )

COPD AESpinal shock
lung
1 12
methylprednisolone
septic shock/
100mg* q6h
Asthma AE 1200mg/(
q4h~q6h )
short acting
25mg/Tab [1.4 / 5]
2014
8.
Long acting
Rinderon 4mg/Amp [1.4 / 5] 0.5mg/Tab

Kenacort
Prednisolone
7.
Steroid
Methylprednisolone
6.
Hormone replacement therapy

Adrenal gland insufficiency
secondary adrenal gland

insufficiency
Tapping
Infection sign
Long acting
Methasone 5mg/mL/Amp [18.8]
(:Decadron )
Triamcinolone
5.
18
RAI
ED
NaR
T1/2(hours)
IM/PO(mg/day)
IV (mg/day)
Dexamethasone
25
0.8
36-72
0.75-9
2.5-10
Betamethasone
25
0.8
36-72
0.6-9
0.6-9
Triamcinolone
12-36
40-80
Methylprednisolone
0.5
12-36
4-48
Prednisolone
0.8
12-36
5-60
Hydrocortisone
20
8-12
15-240
0.8
25
0.8
8-12
20-300
Cortisone
10-40
15-240
RAI = Relative anti-inflammatory potency ED = Equivalent dose (=mg) NaR = Sodium retention capacity
steriod ED dose NaR steroid

Na+ retention CHF Mineralocorticoids steroid
Na+ retention
G() Aldosterone MineralocorticoidsAldosterone Mineralocorticoids

F()
Corticosteroid GlucocorticoidsCortisol Glucocorticoids
R() Testosterone
Corticosteroid (cortex) steroid Glucocorticoids Mineralocorticoids
Glucocorticoids
2014
19

Antacids
Antispasmodics
Anti-ulcer
1. AntacidsAntispasmodics

1.
2.
Magnesium OxideMgO
3.
250 mg/Tab [0.18]

1Tab QID
2-4Tab ()
4.
MgO
ESRD Mg
P
AminoglycosideVancomycinCCB
Beta-blocker
Gowell tablet [1.5]

Kowell tablet [1.5]
Strocain 250mg/Tab [2]

1-2Tab TID-QID
( Mucaine )
1 OxethazainePolymigel Oxethazaine
Polymigel
2 15 ()
3 2
Topaal
4
Aluzaine 360mL/Bot [81]

Strocaine
Algitab
[3.44] 1# tid~qid
Topaal
Peptidin 750mg/Tab [x / 4]
1-2Tab TID-QID
1.
2.
3.
4.
1 Oxethazaine
Oxethazaine
2 15 ()
3 Ranitidine
Alginic acid
1. Homatropine methylbromide(
)
2.
Aluminium hydroxide
324mg/Tab [x / 1]
2-5Tab BID-QID
() 1.9-4.8g TID-QID
50-150mg/kg/day 4-6
2014
20
2.
Sucralfate
Sucrate gel suspension 200mg/mL,

5mL/Bag
1pack TID BID
[15]
Ranitidine
Quicran 150mg/Tab [1.96]

Zantac 50mg/2ml/Amp [42 / 74.3]
150mg BID 300mg HS
Famotidine
Fadin tablet 20mg/Tab [2.1]
Quimadine tablet 20mg/Tab [2.1]
Gaster-D tablet 20mg/Tab

1# bid
Fadin injection 20mg/Vial [39.4]
Omeprazole
Losec 40mg/Vial [207 / 227]
stress ulcer40mg*QD
UGI bleeding40mg*Q12H
Esomeprazole
Nexium 40mg/Tab [28.4]
Nexium 40mg/Vial [232]
Rabeprazole
Pariet 20mg/Tab [16]
Lansoprazole
Takepron 30mg/Tab [21.4]
2014
1.
2. (/)
7-14
3. PPI Sucralfate
4.
1. H2 Blocker
2. ESRD 1# QD
3.
(1) Active Healing ulcer GERD

(2) Scaring
(3) A B 4
UGI series
C D 1
(4)
24 PH
(5)
(6) NSAIDs
misoprostolSLERASA
(7) IV form
4. H2 blocker PPI
1. PPI Peptic ulcer GERD H2 blocker
2. PH
3. PPI Ranitidine
4.
PPI
1. Omeprazole
2. IV form N/S 12hr
pump 12
Pump
3. Ranitidine
1. PPI oral
2. Ranitidine
1. PPI
NG feeding
2. Ranitidine
21
Pantoprazole
1. Ranitidine
2. IV form pump Nexium 12hr
Pump
Panho tablet 40mg/Tab [20]

Pantoloc injection 40mg/Vial [222]
Anti-platelet H2-blocker PPI Anti-platelet CV event

H2-blocker
Anti-platelet LosecNexium FDA LosecNexium anti-platelet
Anti-platelet TakepronParietPantoloc
PPI Plavix CYP450 Plavix pro-drug CYP450
1.
2.
3.
Losec Nexium
12 high dose PPI
Pantoloc Nexium
Plavix NexiumIV form
Pantoloc TakepronPariet
HP PPI * bid + Amoxicillin 1g * bid + Clarithromycin 500mg * bid

7 75% HP
Cravit-based therapy Sequential therapy
HP
(1) C13 NT.1160
PPI H2RA 2 4
(2)
Urease Rapid test (CLO test)Bacterial Culture
NG OB Stool OB positive PPI 3 H2-blocker

NPO PPI PPI form
stool OB EIA
sensitivity
30-40% sensitivity 80-92% 20
EIA Hb Hb
EIA LGI bleeding
sensitivity 80%specificity 95%
sensitivity 80
UGI bleeding PPI pump (high dose PPI) ulcer

Forrest type I II high
dose PPI 2B
High dose 8mg/hr 200mg/ IV form PPI 40mg
Pantoloc 5amp in N/S 500mL run 20mL/hr pump
bolus 2amp
H2RA PPI (primary prevention) NSIADs/aspirin peptic ulcer

gastric ulcer end point MgO / Gowell
NSAIDs
GU (%)
Placebo
20
HR2A
PPI
13
paper 2 HR2A
COX-2 inhibitorGU
2014
22
COX-2
GU (%)
Placebo
16
PPI
0.9
Aspirin
GU (%)
Placebo
15
HR2A
PPI
3.4
1.5
1.1
NSAIDs Asprin 1/5 peptic ulcer ulcer history

ulcer history
1/5
peptic ulcer history PPI
H2RA H2RA
GERD H2RA GERD GERD by history H2RA
H2RA
peptic ulcer history
2014
23
3. Vasopressin UGI bleeding

Somatostatin
Stilamin 3mg/Amp [1459]
1.
(1) 5
(2) EV bleeding 3
(3) PPIH2 blocker
3
2. Pump 2amp in N/S 500 run 20
Vasopressin Somatostatin
1. norepinephrine-resistant septic shock
2. Type 1 hepatorenal syndrome (Terlipressin
Terlipressin
hepatorenal syndrome )
Glypressin 1mg/Vial [1215]

Loading: 2mg Maintain 1-2mg*Q4
Octreotide
Sandostatin 0.1mg/Amp [423]
Octide 100mcg/Amp [341 / 375]
3.

4. acute EV bleeding Somatostatin Terlipressin

Hepato-renal syndrome
Terlipressin FDA
Somatostatin FDA
off-label use
1.
(1) R/Tdopamine
(2) 7
(3) EV bleeding 3
2. Pump 50-100mcg bolus + 25-50mcg/hr
(600mg/) = 6 /
EV bleeding TerlipressinPPICefazolin -blocker ( Inderol )

( -blocker )
Acute EV bleeding
1. vital sign
2. Terlipressin / Somatostatin
3. EV ligation
Chronic EV bleeding
1. Inderol(Non-selective B blocker) ()
2. EV ligation
Primary prophylaxis for EV bleeding Inderol ligation end

stage liver disease Inderol hepatic renal syndrome
Inderol keep HR>60 HR 25% 5mg bid
2014
24
1.Antiemetics and anti-hiccup agents

H1-blocker H2-blocker
Chlorpromazine
Coliman 100mg/Tab
Winsumin 50mg/Tab [0.8 / 5]
Prochlorperazine
Novamin 5mg/tab [1.5]

Novamin 5mg/ml/Amp [15.3]
IM
Ondansetron
Zofran 8mg/Tab
Zofran 4mg/2mL/amp [202]
Granisetron
Kytril 1mg/mL, 3mL/Amp [868]
2014
1
2 Dopamin blocker
1
2 Dopamin blocker
Nausea
3
1. 5-HT3
2.
1.
25
2.Laxatives
Metoclopramide
PO
Primperan 5mg/Tab [2]
1-2# TID
IVIM
Chiaowelgen 10mg/Amp
[15]
Mosapride
Mopride 5mg/Tab [2.86]

1# TID
Domperidone
Domtoo 10mg/Tab [2]
1# TID
Domper 10mg, supp [5]
Baclofen
Befon 5mg/Tab [1.5]
1. Ileus
2. Dopamine antagonist EPS Mosapride

Mosapride
3. Post-op n/v C/T-induced n/v
4.
5.
Novamin

Primperan
Bowel sound
6. Novamin
primperan
1. Cisapride QT prolong Mosapride
2. 5-HT4 antagonist(myenteric plexus)
Acetylcholine
GERD
3. MetoclopramideMosapride
4. receptor dopamine receptor
Primperan Mosapride
receptor
5. NG
complain
contraindication
Primperan sennosideMgO
MoprideFunctional GI
Mopride
1. Primperan EPS
2.
3. Primperan Primperan
EPS Domperidone
1. GABAB agonist spinal supraspinal spasticity
2. 0.5# TID 1# TID
2# TID
3. ESRD 5mg CNS baclofen
Wintermin
PrimperanMopride Domperidone
Baclofen
Gabapentin(1200mg/day)
B B6
Primperan( B)Novamin( C)
Aitvan Harrison Nausea/vomiting

2014
26
3.
Lactobacillus Bifidus
Lac-B 1g/Pack [2.61]
Infloran
1# BID [0 / 25]
1. 8108Lactobacillus casei variety rhamonsus

2.
3.
1. Bifidobacterium bifidum 24mg, Lactobacillus acidophilus 24mg
2.
3.
Pancrelipase
Protase EC capsule
280mg/Tab [5]
1-2# TID with meals
Amylase
Enzyme [3.9]
1. LipaseProteaseAmylase
1.
2. AGEfunctional GI
3.
Stazyme [1.9]
= Biodiastase 20mg + Cellulase 10mg + Lipase 15mg + Prozyme

5mg
Dimotil [2.62]
= Pancreatin 212.5mg + Primperan 5mg
4.
Butylscopolamine
Escopan 20mg/Amp [15]

(Bascopan )
Buspan 10mg/Tab [2]
Mepenzolate bromide
Trancolon 7.5mg/Tab [2]
1# TID
1.
2.
3.
4.
peripheral Anti-cholinergic agent
(ileus)/
ilieus
1. Anti-cholinergic agent Bascopan
2.
Pinaverium bromide
Delibs 50mg [7.8] tid

Dicetel 50mg
Otilonium bromide
1. For (IBS)
2.
(BPH)
3. ileus
4. IBS (ICD9=564.1)
Catilon 40mg [4] tid
2014
27
5.LaxativesCathartics
PrimperanMosaprideDomperidone
Magnesium OxideMgO
250mg/Tab [0.2 / 5]
1-2# TID-QID
2-4# HS
1.
2.
3.
4. MgO
Tetracycline(Doxycycline )Fluroquinolone
1.
(1-2 )
Melanosis coli
Lipofusin
polyp cancer risk
Sennapur 12.5mg/Tab [1.16] 2. 12

Through 12mg/Tab [1.16]
3. MgO
Sennoside
Bisacodyl
PO=Bisadyl 5mg/Tab [1.5]

( Ducolax )
Supp=Bisacodyl
10mg/Supp [2.4] 1# PRN
Lactulose
For 30-45ml
TID-QID
Speedon
powder 10g/Pack [8.8]
Normacol 7g/Pack [8]

1-2pack QD-BID
Konsyl 6g/pack [8.9]

Fybogel 3.5g/pack [4.51]
1.
2.
3.
4. Sennoside Bisacodyl
1.
2.
3. Lactulose NH3 + H = NH4

NH3 Ammonia
Hepatoencephalopathy
4. Ammonia
5. Lactolose 100mL in
100mL
1.
NG
2.
3. GI
1. LactuloseCons on NG +/- Lactulose

2.
3. GIBinfectiondehydrationconstipationAcute liver failure
2014
28
Fleet
Fleet soda
90mL/bot [x / 184 ]
enema
Fleet
ESRD colon prepare
GI klean
Niflec
1.
2.
3.
4. Hyperkalemia
5. ESRD CHF
colon prepare Fleet soda
Castor oil
1.
2.
3.
4.
15-60ml colon prepare60ml
Bisacodyl
1. Glycerin Ball 20mL/Ball

2. Evac enema 118mL/Bot ( ESRD )
diet (1.5
2 )
Colon prepare
()
Fleet soda GI klean
6 Fleet soda 300mL (
)
1
2 1000mL
:
12 12 4:30~5:30 Fleet soda

750mL
Niflec
6 :
9 (Niflec) 1
2000mL
1~2
12 12 (
)
2014
29
6.Anti-diarrhea agents
Kaopectin
Pecolin 120ml/BT [20]
30ml QID
Dioctahedral Smectite
Smecta 3g/Pack [6.4]
1.
Imodium
2. AGE
3.
Pecolin
1. Opioid myenteric plexus

receptors
Loperam
2.
opioid BBB CNS
Imodium 2mg/Cap [2]
3.
Ileus
Max 16mg/day
4.
Loperamide HCl
Mepenzolate bromide
Trancolon 7.5mg/Tab [2]
1# TID
3. Anti-cholinergic agent Bascopan
4.
review diet diet diet(

)( Tazocin)
toxin
stool pus cell (WBC) positive (Inflammatory bowel disease)

(salmonella, shigella, campylobacter)
course stool pus cell

7-14
Samonella
pus cell Stool pus cell
1. stool WBCRBC
negative Kaopectin Imodium
positive
2. NPO
NPO Biogen
NPO stool WBCRBC
2014
30
7.(Anti-flatulents)

Simethicone
Gascon
Polygel 15mL/Pack
Dimethicone
1. 12
12
2.
Kascoal tablet [0.48]
Wellpin tablet
Mosapride
Mopride 5mg/Tab [2.86]
1# TID
Simethicone
1. 5-HT4 antagonist
GERD
2.
Metoclopramide
PO
Primperan 5mg/Tab [2] 1-2#
TID
IVIM
Chiaowelgen 10mg/Amp
[15]
1. Ileus
Post-op n/v
C/T-induced n/v
2. Dopamine antagonist EPS Mosapride
Mosapride
8.
Ursodeoxycholic acid
Uliden 100mg/Tab [2.94]

8-10mg/kg/day 2-3
Silymarin
Luckyhepa 150mg/Cap
1# BID-TID [2]
2014
1. VitB1
B2C
2. Cholestasis
3.
1.
2.
3. 3 AST/ALT
(1) HBV/HCV carrier ASTALT 1
(2) ASTALT 2
4. Vit B complex
5. Liverin capsuleSilymarin+Vit.B1, B2, B6,

B12, (B3), (B5)
31
Lamivudine
Zeffix 100mg/Tab [79]

1# QD
TelbivudineSebivo
600mg/tab [107]
EntecavirBaraclude
0.5mg/tab [161]
TenofovirViread
300mg/tab [165]
Combivir [116]
Lamivudine + Zidovudine
Kivexa [375]
Lamivudine + Abacavir
Gastrografin 100mL/BT
1. DNA polymerase YMDD mutation

2. Adefovir(Hepsera )
Entecavir(Baraclude )
1. E
cccDNA (covalently closed circular DNA)
Baraclude
2. YMDD mutation
double 1 1mg
3.
1
2 Animal model
Reverse fibrosis
4. Baraclude/ Viread
1 HBeAg
HBV DNA 2 ALT
ALT DNA
2 HBeAg HBV DNA 2 ALT
3B HBV DNA 2 EV Splenomegaly
4B PT 3 T-bilirubin2
5
1. ionic contrast media ilieus
4 follow KUB
2.
3. ( IVP, RP) ionic contrast media

Urografin 100mL/BT
Megestrol Acetate
Megest suspension
40mg/mL, 120mL/BT [1053]
Sulfasalazine
Salazopyrin
Salazine 500mg/tab [2.53]
Mesalazine
Asacol 800mg/tab [24.6]
2014
1.
2. Tablet Breast/Endometrial ca palliative tx
1. Inflammatory bowel disease
2. Asacol Salazine Colon
UC
Crohns Asacol
3. Steroid
32

Benzodiazepine
1. Sleeping pills=BZD, non-BZD, Anti-histamine
Diazepam
Diapine 2mg/Tab [2] Valium
Dupin inj. 10mg/2ml/Amp [15]

Stesolid rectal tubes 10mg/2ml/Amp
PO 2-10mg BID-QID
IM/IV 2-10mg Q4-Q3H
PO 2-10mg BID-QID
IM/IV 5-10mg, , Max 30mg
Fludiazepam
Flupine 0.25mg/Tab [2.86]
1 Tab TID Era
Flunitrazepam
Modipanol 2mg/tab[2.66]
Lorazepam
Ativan 0.5mg/Tab [2]

Anxican inj. 2mg/Amp [15]
Estazolam
Eszo 2mg/Tab [2]
1-2mg HS
Eurodin
Alprazolam
Xanax () 0.5mg/Tab [2]
Alpraline ()0.5mg/Tab [2]

Gendergin 1mg/Tab [2.41]
0.25-0.5mg TID , Max 4mg/day
2014
1 BZD
2
3 Delirium Seizure
4 seizure Valium ()
5 BZD
FM2
1.
2. IV form 1mg
3. Alcohol withdrawl
(2-4mg * q4-q6h + Thiamine 100mg QD)
//
BZD
1.
2.
0.5#
1.
2.
3.
4.
33
BZD
Midazolam
Domicum inj.15mg/3ml/Amp [44]
Midatin inj. 5mg/ml/Amp [26]
5mg STAT
Zolpidem
Stilnox 6.25mg/Tab [4.7]

*
/
** / 1/2
1. BZD
2.
Delirium
3.
4.
1. non-BZD omega 1
2. sleep walking
3.
4.
(1)
(2) 1 6
(3) 7
( 10mg 6.5mg
10mg
)
1. non-BZD
2. non-BZD 1
3.
Zaleplon
(1)
(2) 65 5mg
(3) Zolpidem
Onsleep 10mg/Tab [4.54]
Zopiclone
Genclone 7.5mg/Tab [3.21]

* Zolpidem
1. non-BZD
2. Duration Zopidem 6
sleep
walking Intern
3. Zolpidem
1.
2.
3. PO IV PO
Summary
1. Ativan Stilnox induction

2. Stilnox Stilnox
3. Eurodin
4. Xanax >
1. 1 6
6 1 6 VS
2. Intern Zopiclone Z
AtivanXanax NPO Vena Ativan
Ativan Eszo Serequel
3. / Vena
4. +/- Ativan
5. /
6. BZD Flumazenil
2014
34
2. Antipsychotic drugs
Primary care
dopamine pathways
Typical antipsychotic
(1) ButyrophenonesHaloperidol, Droperidol

(2) Phenothiazines
Chlorpromazine EPS
Thioridazine EPS
Fluphenazine, Prochlorperazine, Trifluoperazine EPS
(3) ThioxanthenesFlupenthixol, Zuclopenthixol
Atypical antipsychotic
Clozapine, Olanzapine, Risperidone, Quetiapine, Ziprasidone, Amisulpride, Paliperidone,

Zotepine, Sertindole
Aripiprazole Wiki
Droperidol =0.625mg 5mg TdP

Chlorpromazine Hiccup
Prochlorperazine
Trifluoperazine
Chlorpromazine
Winsumin 50mg/Tab
Coliman 100mg/Tab
Wintermin
1.
Schizophrenia
2. Wintermin
Schizophrenia
3. Hiccup Ileus
Hiccup
4.
5. EPS QRS prolong
Haloperidol
1. Delirium
2. Psychosis
Schizophreniamania
3.
Ativan Valium
Haldomin oral soln 2mg/mL[45]
Hadol Hadol
Binin-U
Hadol
PO5mg [2.9]
4. EPSQT prolongtorsades de point
IV 5mg [28.3]
5. NMSNeuroleptic malignant syndrome
(=50%)
2014
35
Prochlorperazine

1. Dopamin(D2) blocker Wintermin

QRS prolong
EPS
2. Wiki Wintermin 10~20
Vertigo
3.
4.
Novamin Ileus
Hypoactive
bowel sound
Projectile
5. Wintermin
Menieres disease Motion sickness
Dopamine receptor EPSParkinsonism

Hadol
Hadol
Quetiapine
Seroquel
25mg [28]
200mg [54]
1. Anti-psychotic
2. 25mg hs
Haldo
3. anti-psychotic BZD
Risperidone
Risperdal 2mg [26.7]

Seridol 1mg/mL, 30mL/bot [727]
Risperdal 25mg/amp [3421] (?)
Risperdal 37.5mg/amp [4559] (?)
1. Quetiapine
3.Affective disorder
Lithium Carbonate
Ligilin 300mg/Cap [1.57]
2014
1.
2.
3.
4.
5.
Mania Mood stabilizer
Na Lithium
36
4.Antiepileptic drugs
BZD
Mood stabilizer
Phenobarbital
Phenobarbital 30mg/Tab [2]
Phenobital 100mg/ml/Amp [10/30]
Carbamazepine
Tegretol 200mg/Tab [3]
Phenytoin
Aleviatin 100mg/Tab [2]

Dilantin
Phenytoin 250mg/5ml/Amp [73]
1.
2. BZD
1.
2. Trigeminal neuralgia
3. Mood
stabilizer
4. HLA-B 1502
Steven-Johnson Syndrome
1.
2. cortex
3. Seizure attack BZD
Phenytoin Valproic acid
4. phenytoin 3 loading (drip>30min) + 1
QD(Maintain) 1
QD(Maintain)
5. Phenytoin
Arrythemia slow drip
Valproic acidValproate sodium 1. 800mg loading 400mg q8h maintain
Depakin
200mg/Tab [3.45]
500mg/Tab [9]
200mg/mL, 40mL/bot [267]
IV: 400mg/4mL/amp [334]
Levetiracetam
Keppra
500mg/tab [31.3]
: 30g/300mL 1mL=100mg,
[1948], 1mL tid
IV: 500mg/mL/amp [437]
2014
2. AV block Phenytoin Valproic acid
3.
Phenytoin Valproic acid

seizure
Keppra
4. Depakin 200mg 500mg 500

200
NG (200mg/mL)
1. Piracetam(Noopol, Nootropic=)
2. FDA
3. Phenytoin Valproic acid
4. 500
3000 24
1000
5. (eGFR 70 ml/min )
37
Clonazepam
Revotril 0.5mg/Tab [1.5]
1. restless leg syndrome
2. T1/2 = 18-50 hrs
Magnesium sulfate
1. ( Torsades de point )
2. Eclampsia
3. Severe Preeclampsia/ Eclampsia
Loading=4g maintain=1-2g/hr 24
Mag.Sulfate
4.
10% 20ml/Amp(16mEq 2g Mg/Amp)

DTR
[21.4]
5. MgSO4
6. Calcium gluconate
2014
38
(anti-vertigo)
(antitussive) (expectorant)
1. (Anti-histamine)

H1-blocker H2-blocker
Diphenhydramine HCl
Diphenhydramine
30mg/1ml/amp [3]
IM/SC (Vena Panacal )
10-50mg
5mg/kg/day()
Cyproheptadine HCl
Cypromin 0.4mg/ml 120ml/BT [25]
Chlorpheniramine
Malenate 4mg/Tab4mg Q6H[0.17]
Peace 1# tid [1]
Triprolidine 2.5mg + Pseudoephedrine 60mg
2014
1
2
Motion sickness
Vertigo
3 (TriadVertigohearing loss
tinnitus)
Peripheral vertigo
5 EPSExtrapyramidal syndrome
(Dysarthria)
Biperiden
Akineton
anticholinergic Maintain
6
1. Serotonin
2.
3.
Pseudoephedrine
Angina
1 Pseudoephedrine
Pseudoephedrine
39
Cetirizine
Cetirizine oral Solu 1mg/ml 60ml/BT

5-10mg QD [41.8]
Levocetirizine
5mg QD
Levozine
Locemine
Xyzal
Xyzine
5mg/Tab [4.7]
5mg/Tab [4.1]
5mg/Tab [5.9]
5mg/Tab [4.1]
1. ESRD
Finska-LP [3.2] (Clarinase )
Loratadine 5mg + Pseudoephedrine 120mg
1# BID
Fexofenadine
1 Pseudoephedrine
Loratadine
2 Pseudoephedrine
Pseudoephedrine
3
Loratadine
4 ESRD
1# QD
ESRD
Fynadin 60mg/Tab [2.78] 1# BID

Allegra 180mg/Tab [8.2] 1# QD
Desloratadine
1.
2.
Denosin 5mg [5.1] 1# QD
Ebastine
Ebastel 10mg/Tab [5.6]
Pseudoephedrine
Angina
Summary
anti-cholinergic BPH

1. Vena Vena
prednisolone steroid
2. +

3. Pseudoephedrine
Peace Finska-LP
2014
40
2. (Anti-vertigo)

Meclizine HCL
Meclizine 25mg/Tab [0.7 / 5]
For motion sickness25-50mg QD
For vertigo25-100mg/day
Flunarizine
Suzin 5mg/Cap [2] 1# hs
Diphenidol
1 Anti-histamine
2 Motion sickness and
Menieres disease
3
Diphenidol 25mg/Tab [2] 1# tid
Betahistine
Nilasen 24mg/Tab [3.78] 1# bid
Prochlorperazine

2014
1.
C/T
2. PCA
3. Menieres disease Motion

sickness
41
3.Anti-tussiveExpectorant
1.
2.
Summary
1.
2. PE
3. ACEI ACEI
4.
I. Opioid Non-opioid
II.
Half-saline Bisolvon Siruta

5. Chest care + postural
drainage
Medicon
Medicon- A [2]
Romicon- A [1.5]
1# tid
Dextromethorphan
Regrow 60mg/Tab [2.8]

1-2# per day
Foning capsule
1-2# Q6-Q8
2014
1.
2.
Regrow Becantex
3. Dextromethorphan
Cresolsulfonate
Lysozyme
Chlorpheniramine 1.25 mg
Methylephedrine 5 mg
Acetaminophen 150 mg
Caffeine 15 mg
Dextromethorphan 7.5 mg
Potassium Guaiacolsulfonate 30 mg
Thiamine 4 mgVitamin B1
Riboflavin 2 mgVitamin B2
42
Opioid
Codeine Phosphate
1. Morphine
2.
1/2 1/3 Intern
3. Codeine Morphine
1.
2. Methylephedrine(ephedrine)
Chlorphenamine
Guaiacol sulfonate
3.
15mg/Tab [1.9]
Intern
Sato syrup 120 ml/BT
Codeine Phosphate 5 mg
Methylephedrine HCl 10 mg
Chlorpheniramine Maleate 2 mg
Potassium Guaiacolsulfonate 30 mg
10 ml TID
Coliso syrup 120 ml/BT

[38.7 / 52.9]
Codeine Phosphate 0.67 mg

Ephedrine HCl 0.67 mg
Chlorpheniramine Maleate 0.17 mg
Potassium Guaiacol sulfonate10 mg
Polygala fluid Extract 0.0067 mg
Ammonium chloride 16.7 mg
Ethanol 0.0013 mg
Menthol 0.067 mg
1. closed angle glaucoma14 MAOI(

Hydralazine, Selegiline)
2. Ephedrine=; Chlorpheniramine=
; Potassium Guaiacol sulfonate=; Polygala fluid
Extract=; Ammonium chloride=
3. Ephedrine
7ml TID
1. 100mL
Glycyrrhiza Extract 12ml
Camphorated Opium Tincture 12ml morphine
0.5mg/mL
Antimony Potassium Tartratee 24mg
Compound Glycyrrhiza
mixture 120ml/BT [29.2]
10mL TID-QID
(: Brown mixture )
N/V BM
Spirit Ethyl Nitrate 3ml

Glycerin 12ml
2.
Liquid Brown mixture

200 ml/BT 5mL TID-QID
2014
1. 100mL Glycyrrhiza Fluid Extract 12ml, Camphorated

Opium Tincture 1.2ml( morphine 10 mg/ml), Antimony
Potassium Tartratee 24mg, Spirit Ethyl Nitrate 3ml
2. BM Morphine 2 Glycerin
43

Sodium dibunate
( Becantex )
Medicon-A
1.
2.
3.
4.
5.
Sodium dibunate
30mg/Tab, 1# tid [1.5]
Benzonatate
Bensau
100mg/Cap [2.18]
1# TID-QID
Secorine 120 ml/BT, contain:
Methylephedrine HCL 10mg

Chlorpheniramine Maleate 1mg
Guaifenesin 5mg
Intern
1. Methylephedrine
Chlorphenamine
Guaifenesin +
2.
10 ml TID-QID [25 / 42]
Guaifenesin
Guaphen Syrup 20 mg/ml 120

ml/BT () 10-20ml Q4H
Max 120ml/day
Colin soln [24]

120 ml/BT 5mL TID-QID
Antica soln [25]
Eufan soln [38.2]
1. Robitussin
2.
> Angle
3.
Asthma
1. 100mL
Chlorpheniramine 40mg
Platycodon Extract 1.2mL
Polygala Extract 1.2mL
Glycyrrhizine 50mg
1.
2. MAOI
1.
Theophylline
Thoin 125mg [1.5] 1# bid

Telin 200mg [2] 1# hs
Centertheo 5.34mg/mL,
60mL/bot [25]
Procaterol
Meptin 50mcg [4.07]

Exdila 5mcg/mL, 60mL/bot [58]
2014
1.
2. NG Thoin NG
3. Theophylline
Digoxin
Meptin
1. selective beta-2agonist
2.
.
44
Acetylcysteine
Flucil 100mg/2.5g/pack [1.8]
Flutafin 200mg/Tab [2.7]
Actein 600mg/Tab [6.9]

Acetaminophen
140 mg/kg Q4H 70mg/kg
100~200mg TID
Ambroxol HCl
1.
2.
3.
4.
Acetaminophen
CT
Contrast-Induced Acute Kidney Injury
hydration Acetylcysteine
(1) IVF1 mL/kg/hr (max=100 ml/hr) 12 and
12 12
hydartion 1000mL IVF
(2) Acetylcysteine600mg q12h x 4
1.
2.
Musco 30mg/Tab [2]
Mucosolvan
1. Plasminogen Plasmin Fibrin
2.
3.
Broen-C [5.4] 1# tid-qid

= Bromelain + L-Cysteine
Bromhexine HCl
Bisolvon 2mg/ml 50ml/BT
2ml + H/S 2mL,
qidAC [54]
Half-saline (H/S)
1.
2.
3.
4.
Half-saline bronchodilator
1. ()
2. Bisolvon Half-saline
bronchodilator
4mL
Mesna
Siruta [41.3]
1 H/S 2ml
Sodium bicarbonate
Sodium bicarbonate [15]
2014
1.
1. For inhalation therapy

2. Jusomine inhalation
3. R/T endo trachea tube ambu
bagging
45
(Anti-diabetic agents)
1.Insulin
First choice
Rapid
Insulin aspart(NovoRapid ) [253]
Onset(hr)
Peak(hr)
Duration(hr)
5-10 min
0.5-1.5
3-4
2-3
3-6
6-10
10-16
peak
12-20
Short
0.5-1
Regular insulin(Humulin-R )
Intermediate NPH(Humulin-N NovoMix Humalog ) 1-4
Insulin detemir(Levemir ) [454]
Basal
1-4
24
Insulin glargine(Lantus ) [454]
NovoMix RI 30%NPH 70%
Humalog 25Mix RI 25%NPH 75% Humalog 50Mix RI 50%NPH 50%

1.
RI 10-15 (Ref: Washington manual)
2.
5% glucose Glucose 25g

5%
4u-6u RI Cover 25 glucose 4u
3.
1u RI 25mg/dL
200 sliding scale
< 200
200-250
251-300
301-350
351-400
> 400
RI
obs
2u
4u
6u
8u
10u 2 recheck
2u 1u 3u
4.
Sliding scale
regular
5.
6.
ICU sliding scale
<150
150-200 201-250
251-300
301-350
351-400
> 400
RI
obs
2u
6u
8u
10u
12u 2 recheck
4u
insulin pump sliding scale DKAHHS ICU DKA

insulin pump HHS basal insulin + sliding scale
insulin pump
q4h q2h basal insulin + sliding scale
RI 100u + N/S 100mL mL RI 1u
7.
8.
<150
150-200
201-250
251-300
301-350
> 350
(mL/hr)
off
0.5
1.5
2.5
Finger blood sugar(F/S)
insulin
F/S F/S 10%
( RI)2
6 2
2014
46
9.
( NPH)2 8 16
DKANKHSor Hyperkalemia Actrapid NPH
10.
insulin 0.5unit/kg/day 60kg 30u
BMI (Ref: Washington manual)

A 4 3 30 1 RI 1 NPH
Total insulin 40%60%
60kg 6u RI 12u NPH
B 2 30 RINPH
Total insulin 2/3 1/3 2/3 NPH1/3 RI
60kg 7u RI + 13u NPH 3u RI + 7u NPH
11.
basal insulin
basal insulin ()
2 OHA basal insulin
12.
Basal insulin Lantus Levemir Lantus basal

insulin onset
Lantus QD
q12h Basal insulin
OHA Sulfonylurea
Biguanide TZD
CV event insulin basal insulin OHA Basal
2-3 Basal = Fasting sugar / 20
13.
(MDII)Novorapid
Basal 60kg
0.8= 48u 21 2/3 = 32u
10u11u11u tidAC 1/3=16u basal basal
14.
Nomomix+
insulin 2 8
cover
15.
HbA1C 7% 6%HbA1C=7%
170 1% 35 HbA1C=10% 170+(10-7)*35=275
16.
HbA1C
HbA1C > 9 % AC sugar
HbA1C < 9 % PC sugar
17.
Exenatide(Byetta ) GLP-1glucagon-like peptide-1

insulin glucagon 5mcg SC bid 60
() 10mcg SC bid
2014
47
2.Oral Anti-DiabeticOAD
First choice
()
Sulfonylurea
Glibenclamide(Diabetin )[2]
HbA1C
1.5
QD
Glipizide(Glutrol ) [1.5]
()
()
Glimepiride(Amaryl )[4.1]
Gliclazide(Mezide )[2.3]
(Kludone ) [4.3]
Insulin
Non-sulfonyurea
1.5
Repaglinide
TID
(Meglitinide)
(Novonorm ) [3.8]
Dipeptidyl peptidase
Sitagliptin (Januvia ) [29]
IV inh.
Saxagliptin (Onglyza ) [28]
0.8
1.5
Cr>1.5
Cr>1.6
Vidagliptin (Galvus ) [14.5]

Biguanide
Phenformin()
Buformin (Bigunal ) [2.68]
Metformin
(Glucomine 250) [2]
(C.T.L 500) [2]
(Glupin 850) [2.5]
TZD
Rosi-glitazone(Avandia )
insulin
Fc
Pio-glitazone(Actos )[27]
III~IV
(Anxotos ) [18.5]
-Glucosidase inh.
Acarbose(Deglu ) [3.61]
Miglitol(Migbose ) [4.1]
0.7
Cr>2.0
Amaryl-M [4.9] Amaryl 2mg Metformin 500mg
ActosMet [16.2] Actos 15mg Metformin 850mg
JanuMet [3.36] Januvia 50mg Metformin 500mg
Kombiglyze [3.36] Onglyza 5mg Metformin 1000mg

1.
Sulfonylurea receptor receptor Sulfonylurea

SU CV risk SU Kludone Amaryl SU
CV risk CP
Metformin
2.
Diabetin 2# tid
V = =b
3.
Kludone Amaryl
2014
48
4.
sulfanyluria
sulfanyluria 1-2
with meal
5.
Biguanide TZD CV event diet control
A Biguanide / Metformin
B TZD
6.
Cr > 1.5 / 1.6 Biguanide Phenformin Buformin

Metformin CKD Cr < 4
AKI Acute on CKD Metformin

1500mg~3000mg 30-40 250mg Metformin
CT(w/ contrast)Kotang QD 2000mg
4 bid-qid
7.
Bigunal Metformin
8.
Metformin GI upset dose dependent complaint
9.
Troglitazone TZD hepatitis risk TZDAvandia Actos

Avandia risk EMA FDA
TZD ActosActos fluid overload
pulmonary edema CHFFc III-IV MI pulmonary edema
ActosActose Actose
10.
contraindication guideline Metformin /

SU / DPP4i / TZD guideline 3 basal insulin
4 guideline support 3
Basal insulin
11.
DPP4 inhibitor sulfonylurea
Sitagliptin(Januvia )
Saxagliptin(Onglyza )
Vildagliptin(Galvus )
CCr 30-50
CCr < 30
100mg QD
50mg QD
25mg QD
5mg QD
2.5mg QD
100mg QD
50mg QD
AST/ALT > 2
ESRD FDA prove
Linagliptin(Tradjenta )
2014
5mg QD
49
4 sulfanyluria insulinAcarboseJanuvia
XD
(1) Type 2 DM contra-indicationcomorbidity Life style modification

Metformin 500mg*BID
(2) 1500~2000mg/day SU
SU DPP4i
(3) DPP4i
(4) Actos
Basal insulin
(5) Basal insulin Metformin +/- DPP4i basal

Novonorm Acarbose
1-2
Novonorm Acarbose
MDII
DM neuropathy
DM nephropathy gene time
course
(1) Vitamin B
(2) TCA Imipramine (Tofranil )
(3) SSRI Duloxetine (Cymbalta )
(4) Anti-convulsant Pregabalin (Lyrica ) Gabapentin (Neurontin )
(5) Alpha-lipoic acid
2014
50
()
1.
Digoxin
2 Atrial fibrillation rate control LVEF <

30% Digoxin CCB CCB
negative inotropic agents
3 Digoxin Amiodarone CYP

450 Digoxin overdose
Amiodarone 2
digoxin
Digoxin 3
Amiodarone
4 GI upset
digoxin
level
5 Hypokalemia Loop
Amphotericin B
Contraindiation
Lanoxin 0.25mg/Tab [1.75]
Lanoxin 0.5mg/Amp [38]

(1) 1# QD 0.5# QOD
(2) Metformin
Aminophylline
100mg/Tab [0.55 / 5]
Aminophyllin
250mg/Amp [15]
Theophylline anhydrous
Thoin 125mg [1.5] 1# bid
Telin 200mg [2] 1# hs
Centertheo 5.34mg/mL, 60mL/bot

[25]
2014
1 PDE Adenosine cAMP

2 CNS
GI
HRCO
CHF
3 Xanthine
Pulmonary hypertensionPulmonary edema
5 COPD
AsthmaEmphysema
Aminophylline
6 1 amp in D5S or D5W or N/S 500ccrun

60cc/hr standard dosage Fluid overload
2 500cc run 30cc/hr IVAC
IV pump
7
Digoxin
Hypokalemia
1.
2.
3.
4.
Aminophylline
600-1000mg QD Q12
for VENTOL [20 / 23]

51
2.
Nitroglycerin
Nitrostat SL 0.6mg/Tab [2.92]

Nitrocontin 2.6mg/Tab [5.1]
Millisrol 5mg/Amp [47]
Isosorbide-5-mononitrate
Isormol 20mg/Tab [2]

Coxine 40mg/Tab [3.4]
Imdur 60mg/Tab [4.47]
1.
2. 2
3.
95
4. Millisrol pump 5 (=25mg) in 200 250mL
D5W N/Srun 3~15mL/hr
5. CAD
pre-load Heart failure pulmonary
edema
acute on CKD
AKI Millisrol pump
6. NO
48
8 NO
8 survival
48
7.
1. Nitrate
NTG
2. bid bid
NO
3.
4. (venous dilatation)
pre-load
Isosorbide Dinitrate
Isobide 10mg/Tab [0.76 / 5.5]
Angidil 10mg/Amp [270 / 315]
Nicorandil
Sigmart 5mg/Tab [4.82]
Dipyridamole
Dipyridamole 25mg/Tab [2]
Sancin 50mg/Tab [2]

Peysan 75mg/Tab [2]
Persantin
IV10mg/Amp [8.5 / 30]
PO75mg/Tab [2.6 / 5.3]
2014
1. IsormolDi
Mono
1. guanylate cyclase c-GMP

Nitrates
2. Isormol
1.
2. adenosine
adenosine
Adenosine A2-receptor
Adenosine
3.
1. steal
phenomenon
52
2013 ACCF/AHA Guideline

CHF ACEI/ARB + BB
ACEI/ARB CHF *
ACEI/ARB
* paper Beta
Blocker Carvidilol Bisoprolol Metoprolol
Harrison 18th Fluid retention
Acute decompensated heart failureADHF

BB
ok BBHypotension
BB inotropic agents
ok Millisrol pump
pre-load wedge pressure
Aldosterone receptor blocker
Spironolactone EplerononeEpleronone
NT 30+ Spiron
Digoxin Af CHF
Glitazone(Actos)CCB (Amlodipine
Felodipine )
NSAIDs fluid retention
2014
53
3.
Af
/// 120-200J
onset > 48 heparin

1.
Af AMIinfectionhypoxiadehydrationCHFpain
CBC/DCCRPcardiac enzymepro-BNPU/AABGEKG CXR
2.
Rate control
onset
Rhythm control
Onset < 48hr
48
criticize
Rate control
II = Beta-blocker
IV = CCB ( non-DHP Verapamil Diltiazem)
Rhythm control
Ic (Na+ channel blocker) = Propafenone
III(K+ channel blocker) = AmidaroneDronedarone
CHADS2( CHADS2-VASc) aspirin anti-coagulant(Warfarin Dabigatran)

HAS-BLED Score 3
Rate control Verapamil HR Verapamil >> Diltiazemnegative inotropic

potency Diltiazem > Verapamil HR
Verapamil Digoxin CCB
BB Digoxin IV bolus
Diltiazem Diltiazem 30mg 30mg PO q8h HR
dosemax dose = 540mg/dayM
HRcontrol 120 120
survivalWPWPRdelta wave CCBBB Digoxin
VT
amiodarone HR HR
Rhythm control(CHFpermanent Af Pradaxa) Dronedarone

rhythm control amiodarone thyroid
dysfunction amiodarone
2014
54

prevent stroke
Anti-coagulant
Amiodarone
Dronedarone
3# QD 2# QD 1# QD ()
3
Dabigatran 110mg*bid
thyroid
sinus bradycardia
2-3 AV block
Lidocaine
Digoxin
rate
10%
400mg*bid
4
Wafarin keep INR 2-3
Permanent Af
4 CHF 2-3
Dabigatran
QT prolong
70
65-70
HTN/DM/CVA or LVEF<40
f/u
Amiodarone + Dabigatran 110mg*bid Dronedarone + Wafarin

prevent stroke Dabigatran f/u INR
thyroid Dabigatran 150mg*bid prevent stroke
Dronedarone + Wafarin
Dabigatran 110mg
Adenosine
Adenocor injection 3mg/mL, 2mL/Amp bronchospasm asthma
Lidocaine
Xylocaine injection 20mg/mL, 5mL/Amp

1.
Amiodarone
Cordarone
200mg/Tab[7.1]
1# QD ~ 1# bid
Cordarone
150mg/3mL/Amp
[70]
2.
3.
4.
5.
10% thyroid dysfunction

eltroxin steroid thyroid
storm amiodarone
=15-60 3-4
Amiodarone Af sinus rhythm convert rate (

30-40%) convert maintain rate
QT prolong K Mg Tdp K
Mg high normalPSVT adenosine
Amiodarone pump6 500mL D5W
6 run 34 mL/hr (360mg)
18 run 17mL/hr (540mg)
Dronedarone
Multaq tablet
400mg/Tab [61]
Propafenone
Rytmonorm
150mg/Tab [11]
CCB
Af AF
170
26570 HTNDMCVALV 50mmLVEF<40
permanent Af
class III amiodarone
class
class II/IV CHF

Amiodarone
CHF amiodarone propafenone
amiodarone
2014
55
Digoxin
Rhythm control Rate control
Affirm study (2002 NEJM)
Athena trial (2009 NEJM)
rhythm control mortality stroke

rhythm control mortality
rhythm control trial

Inclusion criteria75 70 1 risk factor
Exclusion criteriaCHFpermanent Af
Dronedarone CV death stroke rateSE
(GI upset Cr )
Andromeda trial (2008 NEJM)
CHF all cause mortality dronedarone
Pallas trial (2011 NEJM)
permanent Af dronedarone
* rhythm control Dronedarone

Dronedarone Orz phase II phase III
trial rhythm control
* Dronedarone AthenaAndromeda Pallas
2014
56
4.

A = ACE inhibitor ( ACEI ARB)
C = calcium-channel blocker
D = thiazide-type diuretic
step123 Beta-blockers
Beta-blocker
HTN 55
A ()
A
RAA system
Ref: NICE guideline 2007
(contra-indication)
1.
A. <140/90 pre-HTN BMI<25
(<6g NaCl/day)(>30min/day)()
B. DM <130/80
C. >1g/day<125/75
D. 80 BP <150/80 2008 HYVET study
HbA1C 8%
E. 10mmHg
2.
DMESRD
ACEI
ACEI
-blocker(non-ISA)
Isolated systolic HTN
CCB(DHP)
-blocker
-blocer(non-ISA)ThiazideLaxis
ThiazideLaxis
ACEI
HydralazineMethyldopa
ACEI
Pre-eclamsia
TrandateIVNTGCCB
Diuretics
Inderol
-blocker
23 AV block
-blockerCCB(non-DHP)
2014
57
ACEI
Captopril(Apo-capto ) 25mg [1.3]Fosinopril(Fonosil Forsine ) 10mg [6]

*
*
Lisinopril(Genopril ) 20mg [5] Quinapril(Accupril ) 10mg [10.6]
*
Enalapril 20mgRamipril(Tritace )[10.5]Imidapril(Tanatril ) 5mg [8.7]
1. Captopril QD
DCMCHF ACEI/ARB Captopril
2. Captopril CMUH
sBP>220 Captopril Trandate

3. 10~25%Bradykinin
4. ACEI/ARB 2nd 3rd trimester
ARB
Olmesartan(Olmetec 20mg)[15]Irbesartan(Aprovel 300mg)[18.2]

*
Losartan(Cozaar )[18.2] Valsartan(Diovan 160mg)[14.4]

*
Candesartan(Blopress 8mg)[11]Telmisartan(Micardis 80mg)[23.2]
1. ACEI ACEI
2. QD ARB Diovan 80mg
ARB
QD Diovan
3. Olmesartan > Irbesartan > Valsartan > Losartan

4. Losartan
Direct renin AliskirenRasilez ACEI/ARB RAA system
inhibitor
Co-Aprovel [15.1] Irbesartan 300mghydrochlorothiazide 12.5mg
Hysartan [9.6] Losartan 50mghydrochlorothiazide 12.5mg
Hyzaar [13] Losartan 100mghydrochlorothiazide 12.5mg

Exforge [20] Amlodipine 5mgValsartan 80mg
Exforge HCT [25.3] Amlodipine 5mgValsartan 160mghydrochlorothiazide 12.5mg
Sevikar [14.3] Amlodipine 5mgOlmesartan 20mg

Sevikar HCT [14.3] Amlodipine 5mgOlmesartan 20mghydrochlorothiazide 12.5mg
Tripan [12.7] Felodipine 2.5mgRamipril 2.5mg
1. ACEI/ARB CHFDCM
2. ACEI/ARB 7 f/u Cr Cr 3%
3. ACEI/ARB
4. ACEI/ARB /
effective volume
dehydration
5. ACEI/ARB EGF-beta, Insulin-like growth hormone anti-inflammation
P/D (1) (2) anti-inflammation
Aprovel protect prevent ARB
6. CKD ESRD Acute on CKD AKI
Exforge Amlodipine
compliance
7. ACEI/ARB
ACEI + ARB overt proteinuria (> 3g/day)
Direct renin inhibitor + ACEI/ARB
2014
58
Non-ISA (ISA=Intrinsic sympathetic activity)
ISA
Selective 1-blocker
AtenololBisoprololMetoprolol
Acebutolol(Sectral ) [6.7]
Nonselective -blocker
PropranololNadolol(Corgard )
Pindolol
1-blocker +
CarvedilolLabetalol
Nonselective -blocker
Atenolol
(Atinol )50mg/Tab [1.44]

(Ateno )100mg/Tab [1.49]
Bisoprolol
(Bisol )1.25mg/Tab [3.24]

(Biso )5mg/Tab [3.86]
(Concor )5mg/Tab [3.86]
Metoprolol (Betaloc )
1. 1 C.O. Renin
2 bronchodilator insulin
Selective 1-blocker
2. HTN ISA Acebutolol(Gentolol )
MI Non-ISA
100mg/Tab [8.7]
Propranolol
(Inderol ) 10mg/Tab [2]

(Cardolol ) 40mg/Tab [2]
1. partial Alpha blocker Beta blocker
2. Primary prophylaxis for EV bleeding Inderol

ligation keep HR>60 HR
25% 5mg bid end stage liver disease Inderol
hepatic renal syndrome
Carvedilol
(Syntrend ) 6.25mg [4.52]

(Dilatrend ) 6.25mg [4.52]
(Dilatrend ) 25mg [7.5]
(Loncardio ) 25mg [6]
Labetalol (Trandate )
25mg/Amp [85]
200mg/tab [3.4]
Nonselective -blocker + 1-blocker Non-ISA

6.25mg 25mg
1.
1. -blocker ( 1)
HTN -blocker
2. Selective 1-blocker asthma AE -blocker
3. -blocker
mask DM -blocker
CHF -blockerBisoprololMetoprolol(SR)Carvedilol
Trandatewhy?
2014
59
DHP()
NifedipineAmlodipineFelodipine
LercanidipineLacidipineNicardipine
Non-DHP()
DiltilazemVerapamil
Nifedipine
(Atanaal ) 5mg/Cap [1.9]
(Coracten ) 20mg/Tab [4.87]
(Adalat ) 30mg/Tab [8.9]
(Nifecardia SR) 30mg/Tab [8.9]
Amlodipine ( Norvasc )
(Nobar ) 5mg/Tab [7.9]

(Amilo ) 10mg/Tab [6.6]
Felodipine
(Fedil ) 5mg/Tab [3.74]
(Felopine ) 10mg/Tab [5.8]
Lercanidipine
(Zanidip ) 5mg/Tab [9.5]
Lacidipine
(Lacipil ) 4mg/Tab [8.7]

(Lasyn ) 4mg/Tab [8.6]
Nicardipine (Perdipine )
10mL/amp [240]
1.
2. HTN crisis Nifedipine
HTN crisis target organ damage
10% 160/100
3. Adalat
Intern
Intern
Felodipine
1. CCB Norvasc
2. CCB Norvasc
Norvasc
Zanidip Lasyn
1. Perdipine negative
inotropic effect
2. dose-dependent
3.
4.
5. ICU Trandate duration
IV form STAT 1mL
pump
perdipine pump
Diltiazem Herbesser
(Cartil ) 30mg/Tab [2]
(Diltelan SR) 90mg/Cap[6.2]
(Progor SR)180mg/Cap [11.5]
Verapamil
1.
2. 23 AV block
(Cintsu SR) 240mg/Tab [7.5]
(Verpamil ) inj. 5mg/2mL/Amp [65]

1. DHP=Dihydropyridine
2. DHP > Diltilazem >> Verapamil
Verapamil >> Diltilazem > DHP
3. CCB ACEI -blocker isolated systolic HTN
CCB >
2014
60
4 ThiazideLoopCarbonic Anhydrase Inhibitor
Trichlormethiazide
Fluitran 2mg/Tab [2]
Thiazide
Metolazone(Mycros ) [4.83]
onset
loading 2~4#
2014
1. Na-Cl pump Na
2. KNaMg
3. Ca
dose-dependent
4. DM
5. Fluitran Mycros
6. Fluitranduration loop diuretics
loop PRN
7. Loop diuretics
loop Thiazide
8. thiazide loop loop
Thiazide Thiazide
61
1.
2.
3.
4.
Furosemide ( Laxis )
PO= Nadis 40mg/Tab [2]
IV= Rasitol 20mg/Amp[15]

IV PO 2
( =50% )
5.
6.
7.
8.
Bumetanide
PO= Burinex 1mg/Tab [2.44]
IV= Burinex 2mg/amp [47]
Henle Loop Na-K-2Cl pump

thiazide Ca NaKMgCa
thiazide DM
CHF Pulmonary
edema
Laxis
Laxis Albumin Lasix Albumin
Laxis Albumin
Laxis Laxis
1amp*q8h 2amp*q8h
2amp*q8h
pumprate 0.5 1
4mL/hr
1. loop diuretics 100%

2. IV form 20mg Laxis IV form 1mg Burinex
Laxis Burinex NEJM
3. Furosemie
1. loop
Torasemide
1. Lasix
Spironolactone 25mg/Tab
Lasix
Aldactin [1.5]
2. loop
( Aldactone )
1# Nadis 4# Spiron
12 13
Spiron
QD 3. Spiron GI for Ascites

3~4
Ascites RAA system
bid tid
Spiron block RAA system
Ascites
4. Spiron CHF CHF
5. (gynecomastia)
Acetazolamide
Acetazolamide 250mg/Tab[1.5]
1. Carbonic Anhydrase Inhibitor

2.
3.
CXR pulmonary edema
1# bid-tid
1. Acetazolamide 5mg/kg/day 2~3

2
2. Dexamethasone
Acetazolamide Dexamethasone 4mg*q6h

3. Nifedipine10-20mg*q8h
2014
62
Hydralazine
Apresolin 10mg/tab [1.5] Aprelazine 20mg/amp [27.3]

Direct vasodilator
Millisrol
Minoxidil ()
IV NTG
Loniten 10mg/tab [9.5]
hirsutismpericardial effusion
QD
diuretics Ref: Diuretic therapy, NEJM 1998; 339:387-395
5.
Midodrine 2.5mg/Tab [3.43]
1. 1-Agonist
2. / ICU inotropic agent weaning chronic
fatigue syndromehepato-pulmonary syndrome octreotide hepatorenal syndrome
3.
4. indication FDA 2010
paper
5. H/D vessel constricture
CAD PAOD
2014
63
6.
HMG-CoA Reductase Inhibitors
Rosuvastatin(Crestor ) [26]
cholesterol
Simvastatin(Simvahexal ) [7.8]
LDL
LDL
(dose-dependent)
Atorvastatin(Lipitor ) [22]
Fluvastatin(Lescol ) [19]
Lovastatin(Sancos ) [5.3]
Pravastatin(Mevalotin ) [25.7]
Pitavastatin(Livalo ) [34]
Fibric acid
Bezafibrate(Bezalip ) [12.6]
TG
HDL lipoprotein
Fenofibrate(Lipanthyl ) [7.4]
lipase TG
Etofibrate(Lipo-Merz )
Nicotinic acid
Acipimox(Olbetam ) [7.2]
lipoprotein lipase TG
HDL
TGLDL
rash
LDL HDL
LDL
LDL
NPC1L1
statin
(transport protein) cholesterol
statin 3
LDL
Bile acid Sequestrants
Cholestyramine(Choles ) [15.4]
LDL
LDL TG
Cholesterol Absorption Inhibitor
Ezetimibe(Ezetrol ) [37.7]
Vytorin [41.2] = Ezetimibe 10mg + Simvastatin 20mg CKD CV risk
Caduet [26.3] = Norvasc 5mg + Lipitor 10mg

1.
2.
3.
TG LDL
A TG >500mg/dl Fibric acid Nicotinic acid TG
B TG<500mg/dl LDL risk
LDL
Very high risk
ACS CHD DM
< 70
High risk
CHD stable/unstable anginaMI angioplasty
< 100
Moderate risk
2 risk factor
Age(>45>55)
< 130
Low risk
1 risk factor
HTNHDL<40
< 160
ACS=Acute coronary syndromeCHD=coronary heart diseaseMI=myocardial infarction
4.
LDL Non-LDL=T-cholLDL TG + HDL
TG 1000-2000 pancreatitis TG
64
2014
5.
TG Nephrotic syndromeDM(cushing syndrome) estrogenAlcoholism
6.
TG Lipoprotein lipase insulin insulin resistant

TG DM TG TG HDL
TG HDL DM HDL HDL
HDL mortality
TG
7.
TG 90%LDL 10-15% LDL

TG diet control LDL TG
8.
HHS TG TG
9.
LDL Statin TG Fibrate

fibrate Bezafibrate Fenofibrate statin
Gemfibrozil statin
10.
Statin ( HDL) SimvastatinFluvastatinPravastatin

Statin ( HDL) RosuvastatinAtorvastatin
11.
RosuvastatinAtorvastatinSimvastatin statin
insulin resistance new onset DM
12.
Rosuvastatin 35-50% LDL 6% LDL

rule of six
LDL200 QD LDL
Ezetrol statin LDL 10-20%
13.
bind lipoprotein lipase

LDL
14.
Hypothyroidism LDL LDL thyroixin
2014
65
2013-08-01
CAD / CVA
TC160
TC160
3-6
LDL-C100
LDL-C100
TC200
TC200
6-12
LDL-C130
LDL-C130
TC240
TC240
LDL-C160
LDL-C160
LDL-C190
LDL-C190
2
3-6
1
( 1) (1) (2) (3) 45 (4) 55 (5)

( 55 65 ) (6) HDL<40 (7) (
)
( 2)
(1) CAD()
(2) CVA
a
b TIA
c
( 3) 3~6
2013-08-01
CAD / CVA
TG200
3-6 (TC/HDL-C>5 HDL-C<40)
2014
TG500
66
TG200
TG500
(Anti-platelet)
Aspirin
Aspirin 100mg/Tab [2]
Bokey 100mg/Cap [2]
AMI
Aspirin
loading 3# 1# QD
Ticlopidine
Licodine 100mg[5]1# bid
Clopidogrel
(: Plavix )
Clopidogrel 75mg/Tab [36.3]
Thrombifree 75mg/Tab [45.6]
AMI
Plavix
loading 4# 1# QD
Tirofiban
Aggrastat
12.5mg/Vial [7593]
2014
1.
2. TXA2 /
Atherosclerosis
3.
4. RFA 7
Aspirin
1. ADP receptor ADP

2. loading 600mg (=8 )
3. *
Aspirin 3 ACS Aspirin 9
4. PCI
CABG 5~7
1. Glycoprotein IIb/IIIa inhibitor fibrinogen
2. Abciximab
3. High risk UA/NSTEMI PCI
MI
4. *
UA PCI heparin
non-Q wave MI
Q wave MI12 PTCA
67
4.
5. adenosine
adenosine
Adenosine A2-receptor
Adenosine
6.
7. steal phenomenon
Dipyridamole
Dipyridamole 25mg/Tab [2]
Sancin 50mg/Tab [2]

Peysan 75mg/Tab [2]
Persantin
IV10mg/Amp [8.5 / 30]
PO75mg/Tab [2.6 / 5.3]
Pentoxifylline
1.
2. methylxanthine PDE cAMP
SE
3.
4. CMUH routine aspirin
A Pentoxifylline(Trental ) 1 amp Q8H
B Piracetam(Nootropil ) 1BT QD
Ceretal 400mg/Tab [2.3]

(Trental )
High cortical fuction Piracetam
Stroke guideline anti-platelet

1. Aspirin
2. Plavix
3. Licodin Plavix platelet WBC

4. Aggrenox [8.5] ( 25mg Aspirin 200mg Dipyridamole) dipyridamole
200mg 25mg*tid
200mg 200mg 75mg
5. Dipyridamole( Aspirin )
6. Cilostazol (Pletaal )[10.3] PAOD
** Plavix
Aggrenox
Aspirin aspirin ()
PiracetamNootropil Nootropic
1200mg IV
GABA IV

(1) High cortical function
(2) heparin
(3) Anti-platelet bleedingPlatelet (eg )

ThrombusPCI anti-platelet PCI anti-platelet

ACS(NSTEMI / STEMI Bokey + Plavix 9 12
Stent
1. Bare-metal Bokey + Plavix 3 Monotherapy Bokey

Aspirin GI bleeding Plavix ulcer Plavix
2. Drug-elutingBokey + Plavix 3 12
Balloon
1. balloon dual anti-platelet Bokey
2. Drug-eluting balloonBokey + Plavix 1

PCI re-stenosis rateBalloon = 30%Bare-metal stent = 20%Drug-eluting stent < 10%
2014
68
PAODPeripheral arterial occlusion disease
Aspirin
ClopidogrelPlavix
100-325mg QD
75mg QD
CAD Aspirin Plavix
PAOD
TiclopidineLicodin
Dipyridamolepersantin
aspirin
PentoxifyllineTrental 1.2g QD
CilostazolPlestar
CCB
100mg bid
50mg bid
AlprostadilPromostan IV
Prostaglandin E1(PGE1)
[585]
IV
(Anti-coagulant)
Heparin
Heparin
25000 IU/vial
Enoxaparin
Clexane
60mg/amp [156]
SC
Dalteparin
Fragmin 12h
5000iu/0.2mL [156]
2014
1. Antithrombin Factor Iia

2. Embolism
Hyperviscosity
Deep Vein Thrombosis
Varicose vein
3. Onset 24
Wafarin shift
Heparin
4. aPTT 50-70
5. Onset
Wafarin Wafarin onset
overlapping Heparin Wafarin
1.
2.
3.
4.
LMWH(Low Molecular Weight Heparin)

Factor Xa
LMWH Heparin
Heparin PCI
aPTT PCI
5. 75
30mg loading 1mg/kg q12h ()
1mg/kg QD (eGFR < 30 Cr > 2.5)
75
loading 1mg/kg q12h ()
1mg/kg QD (eGFR < 30 Cr > 2.5)
For NSTEMI120 iu/kg (max=1 iu)*q12h
For DVT200 iu/kg*QD or
100 iu/kg*q12h
CCr < 30 UpToDate
69
Warfarin
Cofarin 1mg/Tab [3.6]
Cofarin 5mg/Tab [5]
Coumadin
1. Indication Heparin Outpatient

2. 4872
48
3. PT INR 2.03.0
4. Vit K10mg QD x 3
INR 5( 10)
2mg Vit.K INR
5. Atrial fibrillation Aspirin Wafarin?

CHADS2 0 Aspirin 2 Wafarin (1 )
(CHF, HTN, Age75, DM, Stroke)
Dabigatran
1. thrombin thrombin fibrinogen fibrin

unbound thrombin fibrin-bound thrombin
unbound thrombin LMVH
2. (80%)
150mg bid
CCr 30-50
110mg bid
CCr 15-30
75mg bid ( CCr <30 )
CCr < 15 ESRD
3. /150mg bid > 110mg bid = warfarin

4. 12 17
5. CYP450
Pradaxa 110mg/Tab [51] 6. dronedarone ketocanazole

7.
150mg
8. CCr 50 1-2
CCr <50 3-5

9. SE 1/5 GI upset
10.
Af
1.
1.
2. LVEF < 40%
2. 14
3. CHF NYHA class 2
3. 6
4. 75
4. CCr < 30
5. 65 ~ 74 DMHTN or CAD 5.
2014
70
(Thrombolytic Agents)
tPa
Actilyse
[18559]
Urokinase
[1010]
1. tPA=Tissue Plasminogen Activator

2. 5
A. 2

1
B. 3
sBP >180 dBP >110
Active internal bleeding

3.
A. CPR >10min2
B. INR >2 tPA

1. Plasminogen Plasmin
2. Double lumen
PICCPort-A
2014
71
(Hemostatics)
Vitamin K1 [15]
Estrogens Conjugated
Estromon 0.625mg/Tab [2]
Tranexamic Acid
Transamin 250mg/Cap [1.54]

Transamin 10mL/Amp [37]
1amp*q8h
Max = 2amp*q6h
Epinephrine
Epirenamin 1mg/mL/Amp [10]

Bosmin 0.1% 500ml/BT
2014
1. TPN
2. Prothrombin
Wafarin
1.
2.
3.
4.
5. DVT
1. plasminogen plasmin Fibrinolysis
Fibrin
2. tPA
3. Hemoptysis
colon ulcer bleeding

4. evidence
5. Hematuria
Transamin
Hematuria

Transamin
3-way foley
Normal saline irrigation Full run
500cc
irrigation
Cystoscope
Irrigation
Transamin
Transamin
1.
2. ENT Buccal
ca Tumor bleeding
Bosmin ERCP
3. Bosmin
72

1.Asthma
Quick reliefA+V
1 Short-acting 2-agonist(=SABA)
2
3 cAMP
Salbutamol(Albuterol)
Ventolin [9/10]
( 2)
Ipratropium
1 Anti-cholinergic
Atrovent [10/11]
2
Spiriva [30 1500] 1# QD
1 = Ipratropium 0.5mg + Salbutamol 2.5mg

2
Combivent [21.6]
Long term control

BA BA
BA= SABA
Salbutamol(Ventolin )Terbutaline(Bricanyl )Fenoterol(Berotec )
Budesonide(Pulmicort Duasma )Fluticasone(Flixotide )
BA= LABA
SalmeterolFormoterol(Formorol )
Symbicort = Budesonide + Formoterol (2 puff q12h)
(LABA+)
Foster = Beclomethasone + Formoterol
Seretide = Futicasone + Salmeterol (1puff bid MDV 2puff bid)
A 2-agonist Salbutamol
agonist
EphedrinePseudoephedrine
-agonist
B Xanthine PDE cAMP Aminophylline

TheophyllineCaffeine
.
2.COPD
P D C O
Prevention
65 5
Dilator
Asthma Anti-cholinergic
BA PRN BA
Corticosteroid
Oxygen
Cor pulmonale
AE=Acute exacerbation
1.
systemic glucocorticoid IV PO 7-10
2.
AE CAP
2014
73

1. Emergency
Sodium Bicarbonate
Sodium bicarbonate
Jusomine
7% 20ml/Amp [15]
1
2 ABG HCO3 X Jusomine
24-X/2 HCO3=1224-12
/2=6 3 IV push Slowly drip
3 Bevt (:)
1. 4060mEq
line
Central line
Slow-K
20mEq/L
40mEq/L
Radi-K 595mg/Tab [1.93]
10mEq/hr
20mEq/hr
1 2.54mEq
2. Potassium phosphate [50/ 131]
3. Hypokalemia
Potassium Chloride
Potassium Phosphate
Calcium polystyrene
sulonate
ATP
diet yeast
1. Kalimate 5g/pack [12.2]

Lactulose 5-10mL
enema 5 in N/S 100mL (Uptodate 10 Orz)
2. Hyperkalemia EKGpeak TPR prolongP sine wave
3. Hyperkalemia
A. Calcium gluconate 10mL ( Calcium chloride 5-10mL)
B. RI 4-6U + 2 amp D50Walbuterol 10-20mg in 4mL
N/S, INHLSodium bicarbonate 1-2amp IVP
C. Furosemide 20-40mg IVP
Kayexalate 15-30g*q4-q6h
Calcium Gluconate
1. Glucal black 10% 10ml/Amp [21.4] Ca
Calcium Acetate
1. Caphos 667mg/Tab [2] ESRD

2. Ca
P
Calcium Carbonate [0.5]
Caphos Caphos
Caphos
Caphos Calcium carbonate
(1)
(2) ()
(3) Renagel () ()
(4) Lanthanum()( 150 3 )
iPTH
(1)
(2)
iPTH
Vit-D Vit-D Vit-D iPTH Vit-D iPTH
(3) Vit-D Vit-D iPTH
iPTH 1000 2-3000
2014
74
1. Aredia
2. hydration loop
diuretics
(1) Pamidronate ( 60-90mg) (2-3 )
Pamisol(90mg) NT4000+
Aredia(15mg) NT1461
(2) Zoledronic acid
Zometa NT11871
Pamidronate Disodium
Ferall 2 +VitC+VitB12+[2.19]
Ferich 50mg/Cap [3.55]
Ferric hydroxide sucrose complexSucrofer [77]

1. Ferric hydroxide 3
2.
3. 3 ( Hb Hb) 500~1000 (500-1000
Liver )
50kg Hb=5 3x50x(10-5)+500 = 1250mg
100mg 12 3 4
4. D5W run 4 ( anaphylactic shock)
5. Iron / TIBC > 20% Ferritin > 200
6. (?)
12 2
3
Deferoxamine
Desferal 500mg/amp [268]
Lugols Solution
[x/ 15]
Tetrastarch(TES) Voluven
Hydroxyethyl starch
Gelofusine [240]
Amiparen 400mL/bot [249]

Mannitol 20%, 500ml/Bot [117]
Glycerol 250ml/Bot [93]
2014
1. Iron chelating agent

2. (Fe+3)(Al+3)
hemochromatosis
3. 4amp in D5W 500mL, run 25mh/hr, QD x 7-10 Ferritin
1000
1. Iodine 30mg+ Potassium Iodide 60mg
2. Exophthalmos thyoid goiter
3.
Vasculature
Haes-Steril injection 500mL/Bot [256]

()
(1) Mannitol > Glycerol

I. MCA infarction hemorrhage
Mid-line shift mannitol
II. edmea Glycerol
III. edema craniectomy
stable()
(2) Mannitol 0.5~1g/kg 4~6 0.2~2g/kg
~1 loading 1 q8h~q6h
Mannitol rebound()
(3) Glycerol 1 q8h~q6h
Glyceral RI 4-6u
75
2.
D3
B6
B12
Yu sheng C 200mg/Tab [x/ 1.5]
Vitacicol 100mg/Amp [15]
Alfacalcidol(Onealfa ) 0.5 mcg/Tab [10]
Bio-Cal chewable [0/3.2]
Calcitriol(Macalol ) 0.25mcg/Cap [2.95]
Calcitriol(U-ca ) 0.5mcg/Cap [5.3]
Calcitriol(Cacare ) 1mcg/Amp
Pyridoxine(Vitamin-B6 )[x/ 5]
Pyridoxal-5-phosphate(Hibilox )
Mecobalamin (Methycobal PO/IV )

PO[1.87] IV[15.8]
NPO
Chronic renal failureosteoporosis
Hypoparathyroidism
Alfacalcidol Calcitriol calcium
metabolism
INH Neuropathy
L-dopa
Peripheral neuralgia
Kentamin (B150mg +B650mg +B120.5mcg)PO [2]
Vitamin E [0 / 1]
K1
Vitamin K1 [15]
Folic
Acid
Folic Acid(Folacin ) [2]
Felinamin (B15mg +B610mg+B12100mcg+K) IV [15]
B sudden
hearing loss
Wafarin
Megaloblastic anemia
MTX Folic Acid MTX
5-FU
Bluplex [25.2]Lyo-povigent [67]
3.Hormone
EPO
NESP 20mcg [1030]
NESP 60mcg [3290]
Recormon 5000u [910]
Mircera 100mcg [5241]
Filgrastim
Filgrastim
300mcg/amp[2117]
Lenograstim
Granocyte
100mcg/vial [251/378]
Calcitonin
Miacalcic [107] Calcinin
2014
1. EPO EPO
Cr >6.0 Hct <28
3
2. NESP 20
NESP 60
Recormon 5000 NESP 25
Mircera 100
1.
ANC=Absolute Neutrophil count Seg + Band
500 Neutropenia
2. Indication C/T Neutropenia

Neutropenia
Neutropenia
3. IV=5mcg/kg/day ()
SC=2mcg/kg/day
1. Paget's Disease of bone
76
Medroxyprogesterone Acetate
Provera 5mg/Tab [1.6]
1.
2.
Oxytocin
1.
2.
(: Piton )
Oxytocin 10IU/amp[6.8]
1. T4 Eltroxin
T3
T4T3 ) 1.61.7 mcg / kg / day
60 kg 100mcg ( 1 ) ( 100
2550...)
2. Eltroxin 7 ( 4 ) 1
1
3. TSH 2.0
Eltroxin
4. Eltroxin cortisol
cortisol Eltroxin
Eltroxin cortisol adrenal crisis
Thyroxin sodium
Eltroxin 100mcg [1.43]
Methimazole (:Lica )
Methimazole
5mg [2]
Propylthiouracil (=PTU)
Procil 50mg [1.5]
T4 T3
PTU()Propanolol 1 Logols solnWC effect
1.
2. 1000mg 1500mg
3. D 800~1000
Bisphosphonates
Alendronic acidFosamax plus [238]

30 GERD f/u
zoledronic acid
Zometa [11871]
Aclasta [12117]
Denosumab
Prolia [6344]
RANKL monoclonal antibody
RANKL
SERMs
Selective Estrogen Receptor Modulators ( breast

endometrialuterine cancers )
CAD
Calcitonin
Miacalcic [107] Calcinin UpToDate
Parathyroid hormoneteriparatideForteo [15298] PTH
1. T-score -2.5
2. T-score -1
Fosamax Cr 1.6
2014
77

1. Urine retention 3 (1)
-blocker
(2) 5 -reductase inhibitor ( 5ARI )
(3) Muscarinic receptor
Tamsulosin
Harnalidge 0.2mg/Tab [10.8]

Tamlosin 0.2mg/Cap [9.6]
Urnal 0.2mg/Tab [8.9]
Doxazosin
Kinxaben 2mg/Tab [3.23]
Doxaben 4mg/Tab [16.6]
Finasteride
Propecia (=)1mg/Tab [68]
Proscar 5mg/Tab= [23.3]
Finta 5mg/Tab= [23.3]
Dutasteride
Avodart 0.5mg/tab [40]
Bethanechol
Dampurine 25mg/Tab
[2.23] (:Wecoli )
1 1# hs
2 Alpha 1-blocker BPH
3 prostate 5ARI prostate
BPH complain
Tamsulosin
1 1-8mg QD
2 Tamsulosin Tamsulosin
-blocker
3 SEpostural hypotension
1. 5 -reductase inhibitorBPH
2. For BPH 5mg prostate
3. For 1
5mg(NT.23) 1mg (NT.68)5mg
5mg 4
1/4
impotence
4. 5ARI 25% prostatereduce surgery rate

1.
2.
3.
4.
5.
(Muscarinic receptor) SE/

DM
Atropine reverse
asthmaCADPeptic ulcerHyperthyroidism
1. irritable bowel syndrome anticholinergic(blocks

muscarinic receptors)
CMUH TURPTURBTURS
Dicyclomine
Bentyl 10mg/Tab
2. 1
Anti-cholinergic
Oxybutynin (Oxbu ) 5mg/Tab [8.3]
Solifenacin (Vesicare ) 5mg/Tab [33.7]
1. Urinary retention,
2. GI tract obstruction,
3. GU tract obstruction,
4. Untreated close angle glaucoma
Vesicare
3.Other
Phenazopyridine (Uroprin )100mg/Tab [1.5]
Pipoxolan (Rowapraxin )10mg/tab [4.2]
2014
( Foley )
78
Note
2014
79

1.
Urticaria
+ CB strong
Eczema
+ Topical steroid
Topical steroid
4~6 Elison(4) Rinderon(6)
/1~3 Septon(3) Vimax(1)
/1~2
Topsyn(2) Vimax(1) Esperson(2)
Dr. PI Mycomb
Tinea
Exelderm and/or Irogen( Zalain)
Irogen + Dr. PI ( Dr. PI Neomycin)
Acure()()(A ) +/- Cleocin() +/- Akana()
Cleocin
Conlifu( Neomycin)( Tetracycline) +/ oral abx(Cefa )
10
()
Famir(250mg)[93] Zovirax(250mg)[560]
V1 / S2
Deherp(5g) [46.6]
3
7
10
Famir(250mg)[93] Zovirax(250mg)[560]
V1 / S2
3 5
Neomycin( Conlifu) for
Deherp(5g) [46.6]
()
Oralog
2014
80

Class
1
Clobetasol Propionate (Dermovate Ointment ) 5g [16]
(Vimax Foaming ) 25mL [126]
B. Ointment > Cream > Lotion
C.
Fluocinonide (Topsyn Cream ) 10g/Tube [71]
Desoximetasone(Esperson Ointment ) 5g/Tube [33.4]
A. 1 7
3
4
Betamethasone(Septon Sol.) 10g/bot [114]
()4
Mometasone Furoate (Elisone Cream) 5g [28]
Triamcinolone Acetonide (Encort Cream ) 15g [15/ 32]
Betamethasone(Rinderon VA Cream ) 5g [41.7]
Hydrocortisone Acetate(Tricodex ) 15g/Tube [15/ 31]
D. 10
()
Mycomb [37.4]
1. Triamcinolone acetonideNeomycinGramicidinNystatin
steroid Candida
Candida
Dr. PI [64]
2. Mycomb BetamethasoneClotrimazoleGentamycin
3. Mycomb ( 16g)
Antifungal
Ketoconazole
Kedofu [50/ 66]
1. (tinea)
2. involve Fluconazole
Itraconazole
: Isogen [58] Zalain [106] bid
: SulconazoleExelderm [73] bid
Anti-Scabies
Scabi [100]
Gamma Benzene Hexachloride

8-12
Ulex [30]
steroid Ulex
24-48
Jaline Lotion [180]
Benzyl Benzoate BB lotion

24
2014
81
Other
Bacitracin-Neomycin
34.2g/tube [36.2]
Bacitracin Bacitracin G(+)

Neomycin G(-)
Conlifu oint 5g/tube [44]
: Fucidin
Gentamycin Oph. Oint. [27]
Polytar Liquid [166/260]
1. 2-3 10
2. psorasis
Zinc Oxide Ointment [58]
Sinbaby 120g/BT [34/ 68]
zinc oxide
Menphencala lotion 100mL/Bot [14]
Calamine 80mg Zinc oxide 80mg Calamine = ZnO +

Fe2O3
Silver sulfadiazine
Silva-Sulfa 50g/Bot [44.6]

Canflame 500g/Bot [596]
Fradiomycin
Framycin Gauze [x/ 17]
()
Heparinoid [48 / 84]
C.B. Strong oint. 5g/Tube [11.3]
(1)
(2)
(3)
(4)
(5)
(6)
Doxepin
1.
Ichderm Cream
5% 15g/Tube [85]
2.
Menthol()
Chlorpheniramine Maleate()
Lidocaine()
Methyl Salicylate()
Aspirin
Hexachlorophene()
Camphor()
Doxepine
Ichderm
2.
Chlorhexidine gargle
Parmason
0.2% 200ml/BT [58]
1. Candida(thrush)Candida
Candiasis
2. 10 Nystatin [3.1] 500cc N/S
3. 8 KetoconazoleCotrizine[3.54] 500cc N/S
Oralog [28.4]
Triamcinolone Acetonide
Comfflam 30mL/bot [0/238]
ENT
2014
82
3.
Sulfamethoxazole
Sulmezole [12]
For
Flucon (Fluorometholone)Pred forte(Prednisolone)Rinderon-A
Duratears oint. [88]Tears Naturale [62]
Schirmer test 5mm
()
Tropicamide
Eyehelp ( O.N.S.D. ) [16]
Neostigmin Achese Ach
Quinax [144]
AzapentaceneFor cataract
2014
83
4.
Hemodin
Lidocaine()Phenylephrine()Betamethasone()
10g/Tube [60]
Alcos-anal
20g/Tube [48]
Polidocanol()Chlorcarvacrol()Sodium oletate()
Proctosedyl
15g/Tube [71]
Faktu
100mg/Tab [9.2]
[5.8]
Cinchocaine()Hydrocortisone()
Policresulen()Cinchocaine()
1.
order
2. Menthol packing
Rivanol
1.
2.
3. Rivanol packing Ice Packing
Ice packing
Rivanol packing
1. Adapalene(Acure )[91] Benzoyl Peroxide(Akana )[28]
2. Tetracycline Doxycycline
1# BID-QID
1. Ofloxacin, Tarivid [87] For /
2. Mycomb optic drop [55] For
Flurbi PAP NSAIDs[6.8]

16 1patch QOD
Duofilm
[181] 30gQD For
Urea()
Sinpharderm [37.9]/
Ueraly = Urea + Hydrocortisone 16g [49.7]
2014
84
IV pump
**BWBW BW=50 50
excel
Levophed
2012 sepsis guideline
bradycardia AV block
Dopamine Dopamine
Epinephrine
cyanosis
Dobutamine
Dobutamine
Levophed Dopamine
Gipamine (Dopamine) 2-20 mL/hr
BW
Levophed (Norepinephrine)
BW
4 (=16mg) in 500mL D5W, run 1-56
Gendobu (Dobutamine)
BW
Epinephrine
2 (=500mg) in 250mL D5W, run 3~33
2014
85
BW run 0.12 0.6
Millistrol 5mg/amp
Heparin (keep APTT 50-70)BW
BW
5 (=25mg) in 200 250mL D5W, run 3~15 Loading : 60IU/kg (max=4000)

( off 8 )
Maintain: 12IU/kg /hr (Max=1000/hr)
Loading = 2000-4000 IU
Maintain = 2 5 in IVF 500, run 15-30 mL/hr
Enoxaparin (Clexane 1 60mg)BW

@ 75
30mg loading 1mg/kg SC q12h ()
1mg/kg SC QD
Dormicum
BW
Cr > 2.5)
0.5-2 mL/hr line

, 8amp(=120mg) in N/S
@ 75
loading 1mg/kg SC q12h ()
1mg/kg SC QD
100mL (1mg/mL) run 2-10 mL/hr
Propofol
(eGFR < 30
(eGFR < 30
Cr > 2.5)
BW Apnea
2-25 mL/hr
3 shift Dormicum
Pantoloc (pantoprazole)
Sedation holiday( off 2-3 hrs)
PPI = 2amp bolus
control mode sedation,

muscle relaxant (Esmeron Nimbex),
weaning ,
+ 8mg/hr IVD ( = 200mg/ = 5 / )

2amp bolus + 5amp in 500 run 20
Nexium (esomeprazole)
12
Amiodarone 150mg/3mL/amp
BW
6 500 D5W
* 6 run 34 mL/hr (360mg)
* 18 run 17mL/hr (540mg)
2amp bolus 2amp in 100 run 10
Octreotide (Sandostatin) (100mcg/amp)

50-100mcg bolus + 25-50mcg/hr
(600mg/) = 6 /
Stilamin (Somatostatin) (3mg/amp)

2amp in N/S 500 run 20
2014
86
1. RitodrineYutopar
(1) Beta2-agonistGA >16wks Yutopar
(2) 100mg in N/S 500mLrun 20-25 30 3-5mL/hr(
) 40mL/hr 200mg in N/S 500mL (
Yutopar complication pulmonary edema)
(3) 10 3 HR>120 Max dose (Max dose = 200mg
run 50mL/hr)
2.
(4) 100mg 10mL/hr shift Yutopar Adalat

(5)
MgSO4 Ca
4g, IVD 15-20 mins 2g/hr 10 3
DTR DTR
3.
4.
5.
Adalat (Nifedipine)10mg 15 *4 4 1
cycle(15 *4 )
GA < 12wks progesterone
GA < 32 wks Indomethacin
1. OxytocinSE
2. Methergin (Methyl-ergometrine)SE
3. PGE2(Alprostadil= Promostan )SE
1. Oxytocin 10iu in N/S 500mL, run 3mL/hr 3mL/30mins

> 3times/10mins Max dose = 30mL/hr
2. PGE1(Misoprostol=Cytotec ) C/S
3.
4.
Fucon (Butylscopolamine)
PGE2(Alprostadil= Promostan )
Antibiotics
1. GBS(+) Ampicillin 2g, IVP, ST
2. termination Amocillin 250mg, PO, q6h
BP
1. MgSO4 20g in D5W 300mL, run 300mL in 30mins then keep 25mL/hr seizure
2. Keep sBP <160 dBP <105
Apresolin 0.5amp, IVPLabetalolCCBMethyldopa
ACEI/ARBNTG
2014
87
Acetaminophen
Ibuprofen
by vins 2014-08
Tinten (500mg)
10mg/kg/dose*q6hPRN/QID
Bubdel (80mg)
Idofen syrup (60mL/bt)
(BW/2-4)mL*q6hPRN/QID
Purfen (400mg)
10mg/kg/dose*q6hPRN/QID
12.5kg 1 12.5kg
Diclofenac
Voren (12.5mg)
+++
Antica syrup (120mL/bt)
++
Colin (120mL/bt)
Romicon-A ( medicon-A)
Acetylcysteine
Flucil (100mg/pk)
Cyproheptadine
Cypromin (0.4mg/ml, 120ml) (BW/4)mL *QID
(BW/4)mL *QID
Histapp Gr.
pseudophedrine
Peace
Finska-LP
40 BID rule
Cetirizine
Cetirizine (1mg/mL, 60mL/bt)
Diphenhydramine
Diphenhydramine (30mg/amp)
(BW/4)mL *QD
30kg 1amp ST30kg
Terbutaline
Bricanyl (2.5mg/ml , 2ml/vial)
20kg 1A in N/S 4mL10kg 1/2A5kg
Ipratropium+salbutamol
Combivent
1/4A
Epinephrine
Epirenamin
Croup: 0.3mL+N/S 4mL (20~30 3 )
Exdila (5mcg/ml ,60ml)
(BW/4)mL *BID
Meptin (50mcg/tab)
40 BID rule
Theophylline (
Thoin (125mg) (?)
40 BID rule
Macrolide )
Centertheo liq. (5.34mg/ml ,60ml)
(BW/2)mL *BID
Methylprednisolone
Methylprednisolone
(40mg/vial)
Loading: 2mg/kg/dose *ST

Maintain: 1mg/kg/day q12h-q6h
Compesolon (5mg)
1mg/kg/day BID-QID
Kidsolone (80mg/60ml)
1mL/kg/day BID-QID
Pecolin (120 mL /bt)
(BW/2-3)mL *QID
Procaterol
Prednisolone
(20kg )
(20kg )
Smecta (3g/pk)
double
MgO (250mg)
(50%+50%)
Domperidone
Laitest enema (65mL/bot)
(BW*3-4)mL
Domtoo (10mg)
Domper supp(10mg)
Metoclopramide
Primperan(10mg)
Mosapride
Mopride(5mg)
Dimethicone
Kascoal (40mg)
Lactobacillus biofidus
Lac-B ( NT 2.7)
()
40 QID rule 40kg 1 * QID40kg 40 QID rule

40 BID rule 40kg 1 * BID40kg
IV
Cefazolin
Cefa (1g)
50-100mg/kg/day ( Q8H) (Max=2g/ 1g/)
Ampicillin
Ampolin (500mg)
25-50mg/kg/dose *Q6H
Oxacillin
Oxacillin (500mg)
25-50mg/kg/dose *Q6H
Augmentin
Curam(1.2g)
40-50mg/kg/dose *Q8H#
Unasyn
Unasyn (1.5g)
37.5mg/kg/dose *Q6H (100-300mg/kg/day)
Gentamicin
V-Genta (80mg)
2.5mg/kg/dose *Q8H (Max=80mg*q8h)
( 100mg/kg*q6h)(Max=12g/day)
Taita NO2 ( 100-50-20 rule)

#40*q8h= 120/day Amo 100/day (Amo 200 200 AmoAug Clavu )
PO
Cephlexin(1)
Cephalexin (500mg)
40 QID rule
Cephradine(1) Recef (250mg)

Cefuroxime(2) Ceflour (250mg)
Cefixime(3)
10-25mg/kg/dose*BID
Amolin (25mg/ml ,60ml)
Low dose: (BW/2)mL*QID ( 10kg )

High dose:
Ziefmycin (250mg)
Augmentin syrup (35mL/bot)
Augmentin / Curam (1g)
Azithromycin$
Oseltamivir
Klaricid
(25mg/ml; 70 ml/bt) (NT.303)
15mg/kg/dose
(Max=200mg/dose)
( Staphy.)
Low dose: 40-50mg/kg/day ( TID QID)

High dose: 80-90mg/kg/day ( AOM/)(Max=2g/day)
25-50mg/kg/day ( QID) ( 50-100 cloxacillin )
(BW/4)mL*q12h (20kg )
23mg/kg/dose*q12h ( > 60kg 1# TID )
8-11kg
Clarithromycin
(Max=250mg/dose)
4mg/kg/dose*BID
Amoxicillin (500mg)
Augmentin@
25kg 1# BID< 25kg
Cefspan (100mg)
Amoxicillin
Dicloxacillin
25-50mg/kg/day( QID) (Max=4g/day)
Klaricid Zithromax
2.5ml
*q12h Lab (IgG 4

20-29kg 7.5ml *7 IgM(+))
12-19kg 5 ml
contact hx
30-40kg 10ml
etc ()
Klaricid (500mg)
0.5# /40kg*q12h *7
Zithromax (40mg/ml, 15ml/bt)
(BW/4)mL*QD *3 ( 20kg )
Zithromax (250mg)
10mg/kg/dose*QD *3
Tamiflu (75mg)
15kg
30mg
15-23
45mg
23-40
60mg
>40
75mg
*BID
5
30mL
30mL 3mL
10
$ 10mg/kg/day 20kg ( 20kg NT.298)25kg

@ Augment(/) low dose(40mg) high dose(low dose double )
Amoxicillin=95%Ampicillin=40%
ITAIT2
1~10kg: 100ml/kg + 11~20kg: 50ml/kg + 20kg : 20ml/kg
OIDOF1
OPURF1
OTINT1
OBUBD1
TVORE3
OANTI5
OCOLI1
OROMI1
OFLUC1
OCYPR1
OHIST1
OPEAC1
OMALE1
OFINS1
OCETI3
OXYZA1
IDIPH1
OPECO1
OSMEC1
ODOMT1
TDOMP2
IPRIM1
Idofen syrup (60cc/bt)

[ Ibuprofen ]
BW /3 ~ BW /2 ml, Q4-6H
Purfen (400mg)
[ Ibuprofen ] 1# /40kg, Qid (10mg/kg)
Tinten (500mg)
[ Acetaminophen ] 1# /40kg, Qid (10mg/kg)
Bubdel (80 mg/tab)
[ Acetaminophen ] 10-15 mg/kg/dose, Qid
Voren(12.5mg)
[ Diclofenac ] 1#/12.5kg, supp prn/q6h
Antica syrup (120ml/btl)
BW /4 ml, Qid
BW /4 ml, Qid
Colin (120ml/btl)
Romicon-A
[ Dextromethorphen ] 1# /40kg, Qid (max: 60 mg/BID).
Flucil (100mg/pk)
[ Acetylcysteine ] 1pk /40kg, Qid
Cypromin (0.4mg/ml, 120ml) [Cyproheptadine] BW/ 4 ml, QId
Histapp Gr.
1pk /40kg, Qid
Peace
[ Triprolidine+pseudophedrine ] 1#/40kg, Qid
Malenate (4mg)
[Chlorpheniramine] 1#/40kg, Qid
Finska-LP
[loratadine, pseudoephedrine] 1#/40kg , Bid
Cetirizine (1mg/ml, 60ml)
[Cetirizine] BW/ 4 ml , QD
Xyzal (5mg)
[Levocetirizine] 1# /40kg, QD
Diphenhydramine (30mg)[Diphenhydramine] 1amp /30kg, IM (1mg/kg)
Pecolin (120ml/btl)
[Kaolin+pectin] BW /3 ~ BW /2 ml, Qid
Smecta 3g/PK [Dioctahedral smectite] 1pk /40kg, Qid
Domtoo (10mg)
[Domperidone] 1# /40kg, Qid
Domper Supp. (10mg) [Domperidone] 1# /40kg, Qid
Chiaowelgen Inj.
[Metoclopramide] 0.5amp /40kg, IM
( 0.1mg/kg)
(10mg/2ml/amp)
OBUSP1
OMAGO2
OLACB1
OKASC1
OBISO1
IEPIR1
TBRIC1
TCOMB2
IDUPI1
Buspan (10mg)
[Scopolamine]
Laitest enema 35,65,120cc
MgO (250mg)
[ Magnesium oxide]
Lac-B (10mg/1g) [Lactobacillus biofidus]
Kascoal (40mg)
[Dimethicone]
Bisolvon Soln (2mg/ml , 50ml/btl) [Bromhexine]
Epirenamin (1mg/ml/amp)
[Epinephrine]
Bricanyl Soln (2.5mg/ml , 2ml/vial) [Terbutaline]
Combivent 2.5ml/vial)[ipratropium+salbutamol]
Chloral Hydrate (50mg/ml)
Dupin Inj.
[Diazepam]
(10mg/2ml/amp)
Taita No.2
Dormicum(15mg/3mL), Midatin(5mg/mL)
IMETH6
Methasone (5mg/ml) [Dexamethasone]
OCOMP2
OKIDS1
OMEPT4
OEXDI1
OTHOI1
OSTRO2
OCENT2
Croup: 0.3cc + N/S 3cc, st
2ml/dose, Q20min *3 dose

2.5ml/dose, Q20min *3 dose
0.5-2mL/kg, PO or Enema
0.04ml/kg IVP, Q15min
0.1ml/kg Enema, Q15min
0.1mg/kg/dose
Methylprednisolone (40mg/vial)
Loading: 0.5-2mg/kg/day, st
[Methylprednisolone] Maintain: 0.5-1mg/kg/day,Q6h
IMETH4
3~4ml/kg
1# /40kg, Qid ( 2#)
1pk /40kg, Qid ()
1# /40kg, Qid
2~3ml/dose, Qid
Croup:0.6mg/kg/dose, IM/IV
Cerebral edema:
1.5 mg/kg, For loading
1.5mg/kg/day,Q4h-Q6h * 5days
Compesolon (5mg)
[Prednisolone] 1mg/kg/day divided Qid
Kidsolone (80mg/60ml)
[Prednisolone] BW /4ml, Qid
Meptin (50mcg/tab)
[Procaterol] 1# /40kg, Bid
Exdila Liquid(5mcg/ml ,60ml)[Procaterol] BW /4 ml, Bid
Thoin SRMC (125mg)
[Theophylline] 1# / 40kg, BID
Strolin (0.5mg/ml, 60ml)
[Fenoterol] BW /4 ml , Tid
Centertheo liq.(5.34mg/ml,60ml) [theophylline] BW /1~2 ml, Bid~Qid
[Cefazolin] 50mg/kg/day,Q8H
[Cephradine] 50-100mg/kg/day, Q6H
[Cephalexin] 1# /40kg, Qid
[Cefadroxil] 30mg/kg/day, Q12h~QD
[Cefuroxime] 25mg/kg/dose, IVD, Q8H
[Cefuroxime] 1# /25kg, Bid
Q12H-Qd
ICHEF9 Chef (1g)
[Ceftriaxone] 50-75mg/kg/day,
Meningitis: double dose
Q6h-Q8h
ICLAF1 Claforan(2g)
[Cefotaxime] 50-180mg/kg/day,
Meningitis:300mg
div Q6h
3
ITATU
Tatumcef (500mg), Cetazine(1g),
50mg/kg/dose, Q8H
[Ceftazidime]
ICETA1 Tatumcef(2g)
OCEFS1 Cefspan (100mg)
[Cefixime] 1# /25kg, Bid
5 unit/kg/dose, Q6H
IPENI3
Penicillin G Sodium (3MU)
Q6H
IAMPO1
Ampolin (500mg)
[Ampicillin] 25mg/kg/dose,
Q6H
IOXAC1
Oxacillin (500mg)
[Oxacillin] 25mg/kg/dose,
Severe pt: double dose
IUNAS1
Unasyn (1500mg)
[Amp-1000+Sul-500] 37.5mg/kg/dose, Q6H
Curam (1200mg)
[Amo-1000+Cla-200] 40mg/kg/dose, Q8H
Penicillin ICURA1
OAMOL1
Amolin susp.(25mg/ml ,60ml) [Amoxicillin] BW /2 ml, Qid
OAMOX5
Amoxicillin (500mg)
[Amoxicillin] 1#/50kg, Qid
OUNAS1
Unasyn tab (375mg)
[Sultamicillin] 1#/40kg Q12H
OZIEF1
Ziefmycin (250mg)
[Dicloxacillin] 50-100mg/kg/day, Q6h
OAUGM3
Augmentin susp.(35ml) [Amo 80- + Cla -11-] BW /4 ml, Q12H
OAUGM1
Augmentin tab. (1g)
[Amo-875+Cla-125] 1# /40kg, Q12H
GM IVGEN1
V-Genta (80mg/2ml)
[Gentamicin] 2.5mg/kg/dose, Q8H
8-11kg: 2.5ml, Q12H
Klaricid
(25
mg/ml;
70
ml/bot)
12-19kg:
5 ml, Q12H
OKLAR4
[Clarithromycin] 20-29kg: 7.5ml, Q12H
30-40kg: 10ml, Q12H
Erythro. OKLAR1
Klaricid (500mg)
[Clarithromycin] 0.5# /40kg, Q12H
OZITH1
Zithromax tab.(250mg) [Azithromycin] 10mg/kg/dose ,Qd*3 days
Zithromax susp.
[Azithromycin] BW /4 ml, Qd *3 days
OZITH2
(40mg/1ml, 15ml/btl)
Antifungal OCOTR1
Cotrizine (200mg)
[Ketoconazole] 5mg/kg/day for 10 days
Menphencala
TMENP1 (100ml/btl)
TELID1 Elidel(1%,15g/tube)
[Pimecrolimus]
[Calamine]
TPROT3 Protopic (0.03%, 10g/tube)
Mycomb (16g/tube)
Cefa.
ISTAZ2
ILOFA1
1
OCEPH2
OCEFA2
ICEFU1
2
OCEFL1
TMYCO3
TELIS1
Cefa (1g)
Lofadine (1g)
Cephalexin (500mg)
Cefadroxil (500mg)
Cefuroxime (750mg)
Ceflour (250mg)
TZINC2
Elisone [Mometasone]
DR.PI. Cream (16g)
TDRPI1
[Tacrolimus]
[gramicidin, neomycin
sulfate, nystatin,
triamcinolone acetonide]
ZnO (28.4g/tube)
ETETR1 Tetracycline(5g/tube)
EEYEH1 Eyehelp [Neostigmine]
EGENT1 Gentamycin [Gentamicin]
(4%,15ml/bt)[sulf
ESULM1 Sulmezole
amethoxazole]
EALLE1 Allergopos (+)
TORAL1
[betamethasone 0.64
mg, clotrimazole 10 mg,
gentamicin 1 mg]
Oralog (0.1%, 5g/tube)

[Triamcinolone]
Note
2014
92
Note
2014
93
Note
2014
94

台北聯合醫院版火星渦蟲 - 4.10ED - by CMU Vins 2014（含抗生素）

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台北聯合醫院版火星渦蟲 - 4.10ED - by CMU Vins 2014（含抗生素）

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(2014-08)

Lofatin(1g) [124]Cexitin(1g) [124]

Tatumcef(0.5g) [37.2], Tatumcef(2g) [469]

Anbicyn (0.6g) [56]

Supercef(500mg) [282]Antifect(1g) [487]

PO = IV = Cravit [61] [599]

PO = Flagyl [1.7]IV = SABS(500mg) [92]

PO = IV = Avelox [113] [892]

PO = LinDacin [2]IV = Clincin [16.2]

IV=Diflucan(100mg) [394], PO=Flu-D(50mg) [42]

Oph= Devirus[427], Cream = Deherp [46.6]

ADJUSTMENT FOR RENAL FAILURE

TABLE 17A (2)

750 mg q24h IV, PO

400 mg po/IV q24h

20-49: 750 q48h

400 mg, then 200 mg

HEMO: Extra 0.51 gm AD

160 mg q24h HEMO: 160 mg q24h AD

HEMO: 250 mg po or 200 mg

ADJUSTMENT FOR RENAL FAILURE

Cephalosporin Antibiotics: DATA ON SELECTED PARENTERAL CEPHALOSPORINS

TABLE 17A (3)

Ototoxicity with high doses in ESRD

CRRT as for CrCl 10-50

CRRT 750 mg once, then 500 mg q48h

May falsely increase serum creatinine by

Active metabolite of cefotaxime in ESRD.

30-50: 7.5 mg/kg q24h

<30: 10 mg/kg No data

600 mg q12h HEMO: As for CrCl <10

HEMO/CAPD: Dose for

CAVH.CVVH: 500 mg q2448h. New

CRRT dose: q18h

If CrCl <30, reduce dose to 600 mg once

520 mg/kg/d 3050: 57.5 mg/kg q8h

ADJUSTMENT FOR RENAL FAILURE

Trimethoprim-sulfamethoxazole-DS (Doses based on TMP component)

6 mg per kg per day

7.5 mg per kg q6h

TABLE 17A (4)

3.375 4.5 gm q6-8h

0.54 million U q4h

CRRT dose: 1.5 AM/0.75 SB q12h

HEMO: Extra 3.0 gm AD

For ampho B, toxicity lessened by saline

5.2 mEq sodium per gm

HEMO: 2 gm q8h plus 1 gm

1.7 mEq potassium per million units. s

Technically is a -lactam antibiotic.

IV amoxicillin not available in the U.S.

ADJUSTMENT FOR RENAL FAILURE

TABLE 17A (5)

Ref: Transplantation 80:1086, 2005

ANTIVIRAL AGENTS For ANTIRETROVIRALS See CID 40:1559, 2005

HEMO/CAPD: Dose for

CRRT: Dose for CrCl 10-50

CAPD: No data; CRRT: Dose ?

Rapid IV infusion can cause Cr. CRRT

Biologically active metabolite

25 mg per kg 46 hr prior to 3 times

HEMO: As for CrCl <10 plus

ADJUSTMENT FOR RENAL FAILURE

PECK=Proteus, E.Coli, Klebsiella HBEN= H.Influenza, Branhamela catarrhalis, Enterobactar, Neisseria