Cardiology: Drug Dose

A-Z
DRUG DOSE
CARDIOLOGY
1
A-Z Cardiovascular Drug Doses
Contents
ACS 1
Table 1 Doses Of Fibrinolytic Agents 1
Table 2 Comparison Of Approved Fibrinolytic Agents* 1
Table 3 Contraindications And Cautions For Fibrinolytic
Use In Stemi* 3
Table 4 Doses Of Antiplatelet And Antithrombin Co-
Therapies 4
Table 5 Dosages Of Inhibitors Of The Renin–Angiotensin–
Aldosterone System
In Trials After Myocardial Infarction 6
Table 6 -- Recommended Dosing Regimens For Long-
Term Nitrate Therapy 7
Normogram Heparine 8
Table A.1 -- Intravenous Unfractionated Heparin
“Raschke Nomogram” 8
Table A.2 -- Recommended Dose Adjustment Of
Conventional Antithrombotics Used For Acute Coronary
Syndromes* 9
Table B -- Biomarkers For Evaluation Of Patients With
St-Segment Elevation Myocardial Infarction 12
AF - ATRIAL FIBRILASI
Table 7 Drugs And Doses For Pharmacological Conversion

Of (Recent-Onset) Af 13
Table 8 Drugs For Rate Control 15
2
HEART FAILURE
Table 9 -- Diuretics For Treating Fluid Retention In
Chronic Heart Failure 16
Table 10 Drugs For The Prevention And Treatment Of
Chronic Heart Failure 18
Table 11 Intravenous Vasodilators Used To Treat Acute
Heart Failure 19
Table 12 Drugs Used To Treat Acute Heart Failure That
Are Positive Inotropes Or Vasopressors Or Both 20
HIPERTENSI
Table 13 -- Representative Diuretics And Potassium-
Sparing Agents 21
Table 14 -- Parenteral Drugs For Treatment Of
Hypertensive Emergency 22
DYSLIPIDEMIA
Table 15 -- Current Lipid-Lowering Medications 24
ANTIARRHYTHMIA
Table 16. Clinical Usage Information For Antiarrhythmic
Agents 26
PULMONARY EMBOLISM OR DVT

Table 17 -- Low-Molecular-Weight Heparins 29
3
Table 18-- Fondaparinux Dosing For Patients With Acute
Pulmonary Embolism Or Dvt 31
Table 19 Use Of Heparin Before And
After Thrombolysis 31
Table 20 Approved Thrombolytic Regimens For Pulmonary
Embolism 32
Table 21 Adjustment Of Intravenous Unfractionated
Heparin Dosage Based On The Activated Partial
Thromboplastin Time 32
Table 22 Subcutaneous Regimens Of Low
Molecularweight Heparins And Fondaparinux Approved
For The Treatment Of Pulmonary Embolism 33
RHEUMATIC FEVER
Table 23 Antibiotic Therapy For Acute Rheumatic Fever
And Long-Term Prophylaxis 34
ENDOCARDITIS
Table 25 Treatment Of Native Valve Endocarditis Caused
By Penicillin-Susceptible Viridans Streptococci And
Streptococcus Gallolyticus (Bovis) (Mic <0.1 ?G/Ml)* 37
Table 26 Treatment Of Native Valve Endocarditis Caused
By Strains Of Viridans Streptococci And Streptococcus
Gallolyticus (Bovis) Relatively Resistant To Penicillin G
(Mic >0.1 ?G/Ml And <0.5 ?G/Ml)* 38
Table 27 Treatment Of Staphylococcal Endocarditis In

The Absence Of Prosthetic Material 39
Table 29 Treatment Of Endocarditis Caused By Hacek
Microorganisms* 41
4
5
6
ACS
Table 1 Doses of Fibrinolytic agents
Initial treatment Spesific contra-
indications
Streptokinase (SK) 1.5 million units over 30- Prior SK or anis-
60 min i.v treptase
Alteplase (tPA) 15 mg i.v bolus 0,75 mg/
kg over 30 min ( up to 50
mg) then 0,5 mg/kg over
60 min i.v. ( up to 35 mg)
Reteplase (r-PA) 10 units + 10 units i.v.
bolus given 30 min apart
Tenecteplase ( TNK- Single i.v bolus :
tPA) 30 mg if < 60 kg
35 mg if 60-<70 kg
40 mg if 70-<80 kg
45 mg if 80-<90 kg
50 mg if > 90 kg
TABLE 2 -- Comparison of Approved Fibrinolytic Agents*

PA- STREPTO- ALTEPLASE RE- TNK
RA-ME- KINASE TEPLASE t-PA
TER
30-
10 U ? 2
Up to 100 mg in 50 mg
1.5 MU in (30 min
Dose 90 min (based based
30-60 min apart) each
on weight) on
over 2 min
weight
1
PARAME- STREPTO- ALTEPLASE RE- TNK
TER KINASE TEPLASE t-PA
Bolus
administra- No No Yes Yes
tion
Antigenic
Allergic
reactions
(hypoten- Yes No No No
sion most
common)
Systemic
Mini-
fibrinogen Marked Mild Moderate
mal
depletion
90-min
patency ≈50 ≈75 ≈75 ≈75[†]
rates (%)
TIMI grade
32 54 60 63
3 flow (%)
Cost per 2750
dose (U.S. 568 2750 2750 for
$)[‡] 50 mg
From Antman EM, Anbe DT, Armstrong PW, et al: ACC/AHA guidelines for the management of patients
with ST-elevation myocardial infarction: A report of the American College of Cardiology/American Heart
Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Manage-
ment of Patients with Acute Myocardial Infarction). Circulation 110:e82, 2004.
TIMI = Thrombolysis in Myocardial Infarction; TNK = tenecteplase.
* Data from Armstrong PW, Collen D: Fibrinolysis for acute myocardial infarction: Current status
and new horizons for pharmacological reperfusion, part 1. Circulation 103:2862, 2001.
† Data from Cannon CP, Gibson CM, McCabe CH, et al: TNK-tissue plasminogen activator com-
pared with front-loaded alteplase in acute myocardial infarction: results of the TIMI 10B trial.
Thrombolysis in Myocardial Infarction (TIMI) 10B Investigators. Circulation 98:2805, 1998.
‡ Data from Medical Economics Staff: 2001 Drug Topics Red Book. 105th ed. Montvale, NJ, Medi-
cal Economics Company, 2001.
2
TABLE 3 -- Contraindications and Cautions for
Fibrinolytic Use in STEMI*
Absolute Contraindications
Any prior intracranial hemorrhage
Known structural cerebral vascular lesion (e.g., arteriovenous
malformation)
Known malignant intracranial neoplasm (primary or metastatic)
Ischemic stroke within 3 mo except acute ischemic stroke within
3 hr
Suspected aortic dissection
Active bleeding or bleeding diathesis (excluding menses)
Significant closed head or facial trauma within 3 mo
Relative Contraindications
History of chronic severe poorly controlled hypertension
Severe uncontrolled hypertension on presentation (SBP
>180 mm Hg or DBP >110 mm Hg)[†]
History of prior ischemic stroke > 3 mo, dementia, or known
intracranial pathology not covered in contraindications
Traumatic or prolonged (>10 min) CPR or major surgery (<3 wk)
Recent (within 2-4 wk) internal bleeding
Noncompressible vascular punctures
For streptokinase, anistreplase: Prior exposure (>5 days ago) or

prior allergic reaction to these agents
Pregnancy
Active peptic ulcer
Current use of anticoagulants: the higher the INR, the higher
the risk of bleeding
3
Table 4 Doses of antiplatelet and antithrombin co-
therapies
Doses of antiplatelet co-therapies
With primary PCI
Aspirin Loading dose of 150–300 mg orally or of 80–150
mg i.v. if oral ingestion is not possible, followed by
a maintenance dose of 75–100
mg/day.
Clopidogrel Loading dose of 600 mg orally, followed by a
maintenance dose of 75 mg/day.
Prasugrel Loading dose of 60 mg orally, followed by a main-
tenance dose of 10 mg/day.
In patients with body weight <60 kg, a mainte-
nance dose of 5 mg is recommended.
In patients >75 years, prasugrel is generally not
recommended, but a dose of 5 mg should be
used if treatment is deemed necessary.
Ticagrelor Loading dose of 180 mg orally, followed by a
maintenance dose of 90 mg b.i.d.
Abciximab Bolus of 0.25 mg/kg i.v. and 0.125 μg/kg/min in-
fusion (maximum 10 μg/min) for 12 h.
Eptifibatide Double bolus of 180 μg/kg i.v. (given at a 10-min
interval) followed by an infusion of 2.0 μg/kg/min
for 18 h.
Tirofiban 25 μg/kg over 3 min i.v., followed by a mainte-
nance infusion of 0.15 μg/kg/min for 18 h.
With fibrinolytic therapy

Aspirin Starting dose 150–500 mg orally or i.v. dose of
250 mg if oral ingestion is not possible.
Clopidogrel Loading dose of 300 mg orally if aged ≤75 years,
followed by a maintenance dose of 75 mg/day.
4
Without reperfusion therapy
Aspirin Starting dose 150–500 mg orally.
Clopidogrel 75 mg/day orally.
Doses of antithrombin co-therapies
With primary PCI
Unfractionated 70–100 U/kg i.v. bolus when no GP IIb/IIIa inhibi-
heparin tor is planned.
50–60 U/kg i.v. bolus with GP IIb/IIIa inhibitors.
Enoxaparin 0.5 mg/kg i.v. bolus.
Bivalirudin 0.75 mg/kg i.v. bolus followed by i.v infusion of
1.75 mg/kg/h for up to 4 h after the procedure as
clinically warranted. After cessation
of the 1.75 mg/kg/h infusion, a reduced infusion
dose of 0.25 mg/kg/h may be continued for 4–12
h as clinically necessary.
With fibrinolytic therapy
Unfractionated 60 U/kg i.v. bolus with a maximum of 4000 U
heparin followed by an i.v. infusion of 12 U/kg with a max-
imum of 1000 U/h for 24–48 h.Target
aPTT: 50–70 s or 1.5 to 2.0 times that of control
to be monitored at 3, 6, 12 and 24 h.
Enoxaparin In patients <75 years of age:
30 mg i.v. bolus followed 15 min later by 1 mg/kg
s.c. every 12 h until hospital discharge for a maxi-
mum of 8 days The first two
doses should not exceed 100 mg.
In patients >75 years of age:
no i.v. bolus; start with first s.c. dose of 0.75 mg/

kg with a maximum of 75 mg for the first two s.c.
doses.
In patients with creatinine clearance of <30 mL/
min, regardless of age, the s.c. doses are given
once every 24 h.
5
Fondaparinux 2.5 mg i.v. bolus followed by a s.c. dose of 2.5 mg
once daily up to 8 days or hospital discharge.
Without reperfusion therapy
Unfractionated Same dose as with fibrinolytic therapy.
heparin
Enoxaparin Same dose as with fibrinolytic therapy.
Fondaparinux Same dose as with fibrinolytic therapy.
aPTT ¼ activated partial thromboplastin time; b.i.d.¼ twice a day; GP ¼ glycoprotein; i.v. ¼ intravenous;
PCI ¼ percutaneous coronary intervention; s.c. ¼ subcutaneous; UFH ¼ unfractionated heparin
Table 5 Dosages of inhibitors of the renin–angiotensin–

aldosterone system in trials after myocardial infarction
Initial dosage Target dosage
GISSI- lisinopril 5 mg initially Up to 10 mg daily
ISIS captopril 6.25 mg initially, 12.5 mg Up to 50 mg b.i.d.
in 2 h, 25 mg at 10–12 h
CHINESE captopril 6.25 mg initially, 12.5 mg 2 Up to 12.5 mg t.i.d.
h later if tolerated
SMILE zofenopril 7.5 mg initially, repeat- Up to30 mg b.i.d.
ed after 12 h and repeated-
lydoubled if tolerated
AIRE ramipril 2.5 mg b.i.d. increased to 5 Up to 5 mg b.i.d.
mg b.i.d. if tolerated
SAVE captopril Test of 6.25 mg, in- Up to 50 mg t.i.d.
creased if tolerated to 25
TRACE trandolapril mg t.i.d. Up to 4 mg daily
VALIANT valsartan Test of 0.5 mg Up to 160 mg b.i.d.
20 mg initially uptitrated in
OPTIMAAL losar- four steps Up to 50 mg daily
tan 12.5 mg
EPHESUS eplerone 25 mg intially Up to 50 mg daily
b.i.d : twice daily; t.i.d : three times daily.

6
TABLE 6 -- Recommended Dosing Regimens for Long-
Term Nitrate Therapy
PREPARATION DOSE SCHEDULE
OF AGENT
Nitroglycerin*
Ointment 0.5-2 inches Two or three times daily
q 24 hr; remove at bed-
Transdermal patch 0.2-0.8 mg/hr
time for 12-14 hr
As needed, up to three
Sublingual tablet 0.3-0.6 mg
doses 5 min apart
One or two As needed, up to three
Spray
sprays doses 5 min apart
Isosorbide dinitrate*
Oral 10-40 mg Two or three times daily
Oral sustained Once or twice daily (ec-
80-120 mg
release centric schedule)
Isosorbide 5-mono-

nitrate
Twice daily (given 7-8 hr
Oral 20 mg
apart)
Oral sustained
30-240 mg Once daily
release
* A 10- to 12-hour nitrate-free interval is recommended.

7
Normogram heparine
TABLE A.1 -- Intravenous Unfractionated Heparin
“Raschke Nomogram”
VARIABLE ACTION
Initial heparin bolus 80 units/kg bolus, then 18 units/kg/hr
aPTT <35 seconds (<1.2 80 units/kg bolus, then increase by 4
times control) units/kg/hr
aPTT 35 to 45 seconds
40 units/kg bolus, then increase by 2
(1.2 to 1.5 times con-
units/kg/hr
trol)
(1.5 to 2.3 times con- No change
trol)
Decrease infusion rate by 2 units/kg/hr
(2.3 to 3 times control)
aPTT >90 seconds (>3 Hold infusion 1 hr, then decrease infusion
times control) rate by 3 units/kg/hr
From Raschke RA, Reilly BM, Guidry JR, et al: The weight-based heparin dosing nomogram compared with
a “standard care” nomogram: A randomized controlled trial. Ann Intern Med 119:874, 1993.
8
TABLE A.2 -- Recommended Dose Adjustment of
Conventional Antithrombotics Used for Acute Coronary
Syndromes*
eGFR (mL/min/1.73 m2) (CrCl in mL/min)
ANTI-
THROM- DIALY-
BOTIC SIS-DE-
60-90 30-60 <30
AGENT PEN-
DENT
No ad- No adjust- No ad-
No adjustment
Aspirin justment ment need- justment
needed
needed ed needed
No adjustment
Clopidogrel justment ment need- justment
needed
needed ed needed
No adjustment
Ticlopidine justment ment need- justment
needed
needed ed needed
No
No guide- No guide-
Heparin guide- No guidelines
lines lines
lines
Reduce dose
No
No guide- by 30%; factor No guide-
LMWH guide-
lines Xa monitoring lines
lines
advocated A-Z Cardiovascular Drug Doses
9
ANTI-
THROM- DIALY-
BOTIC SIS-DE-
60-90 30-60 <30
AGENT PEN-
DENT
CrCl = 45-
60 mL/min
or SrCr =
1.6-2 mg/
dL—reduce CrCl = 15-
bolus to 29 mL/min
0.2 mg/kg IV or SrCr = 3.1-
+ decrease 6 mg/dL—re-
infusion duce bolus
rate by 50% to 0.2 mg/
(0.075 mg/ kg IV + de- Reduce
No kg/hr IV) crease infusion bolus dose
Lepirudin guide- CrCl = 30- rate by 85% to 0.2 mg/
lines 44 mL/min (0.0225 mg/ kg IV; no
or SrCr = kg/hr IV) infusion
2.1-3 mg/ CrCl < 15 mL/
dL—reduce min or SrCr >
bolus to 6 mg/dL—re-
0.2 mg/kg IV duce bolus to
+ decrease 0.2 mg/kg IV;
standard ini- no infusion
tial infusion
rate by 70%
(0.045 mg/
kg/hr IV)
No Reduce infu- Reduce infu- Reduce in-

Bivalirudin guide- sion dose by sion dose by fusion dose
lines 20% 60% by 90%
No dose
No dose ad- No dose ad-
Argatroban adjust-
justment justment
ment
10
ANTI-
THROM- DIALY-
BOTIC SIS-DE-
60-90 30-60 <30
AGENT PEN-
DENT
No
guide- No guide- No guide-
No guidelines
lines lines lines;
Abciximab Monitoring
Monitor- Monitoring monitoring
advocated
ing advo- advocated advocated
cated
SrCr =
No clinical
2-4 mg/
data; in
No dL—135 mg/ SrCr > 4.0 mg/
vitro data
Eptifibatide guide- kg IV bolus + dL; contraindi-
demon-
lines 0.5 mg/kg/ cated
strate
min IV infu-
clearance
sion
No clinical
0.2 mg/kg/min
data; in
No dose IV for 30 min,
No dose ad- vitro data
Tirofiban adjust- followed by
justment demon-
ment 0.05 mg/kg/
strate
min IV
clearance
Modified from Sica D: The implications of renal impairment among patients undergoing percutaneous
coronary intervention. J Invasive Cardiol 14(Suppl B):30B, 2002.
LMWH = low-molecular-weight heparin; SrCr = serum creatinine.
* In patients with CKD and ESRD.

11
TABLE B -- Biomarkers for Evaluation of Patients with
ST-Segment Elevation Myocardial Infarction
BIOMARK- MOLEC- RANGE MEAN TIME TO
ER ULAR OF TIME TIME RETURN TO
WEIGHT TO INI- TO PEAK NORMAL
(DA) TIAL EL- ELEVA- RANGE
EVATION TIONS
(HR) (NON-
REPER-
FUSED)
Frequently Used in Clinical Practice
MB-CK[*] 86,000 3-12 24 hr 48-72 hr
cTnI[†] 23,500 3-12 24 hr 5-10 days
12 hr-2
cTnT 33,000 3-12 5-14 days
days
Infrequently Used in Clinical Practice
Myoglobin 17,800 1-4 6-7 hr 24 hr
MB-CK tis-
86,000 2-6 18 hr Unknown
sue isoform
MM-CK tis-
86,000 1-6 12 hr 38 hr
sue isoform
Modified from Antman EM, Anbe DT, Armstrong PW, et al: ACC/AHA guidelines for the management of
patients with ST-elevation myocardial infarction: A report of the American College of Cardiology/American
Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the
Management of Patients with Acute Myocardial Infarction). Circulation 110:e82, 2004.
* Increased sensitivity can be achieved with sampling every 6 or 8 hr.

† Multiple assays available for clinical use; clinicians should be familiar with the cutoff value used
in their institution.
12
AF - Atrial Fibrilasi
Table 7 Drugs and doses for pharmacological conversion of
(recent-onset) AF
Drug Dose Follow up Risk
dose
Amiodarone 5 mg/kg i.v. over 50 mg/h Phlebitis, hypotension.
1h Will slow the ventricu-
lar rate. Delayed
AF conversion to sinus
rhythm.
Flecainide 2 mg/kg i.v. over N/A Not suitable for pa-
10 min, tients with marked
or structural heart
200–300 mg p.o. disease; may prolong
QRS duration, and
hence the QT
interval; and may inad-
vertently increase the
ventricular rate
due to conversion to
atrial flutter and 1:1
conduction to the
ventricles.
Ibutilide 1 mg i.v. over 1 mg i.v. Can cause prolongation
10 min over 10 of the QT interval and
min after torsades de
waiting for pointes; watch for
10 min abnormal T-U waves or

QT prolongation.
Will slow the ventricu-
lar rate.
13
Propafenone 2 mg/kg i.v. over Not suitable for pa-
10 min, tients with marked
or structural heart
450–600 mg p.o. disease; may prolong
QRS duration; will
slightly slow
the ventricular rate,
but may inadvertently
increase the
ventricular rate due
to conversion to atrial
flutter and 1:1
conduction to the ven-
tricles.
Vernakalant 3 mg/kg i.v. over Second So far only evaluated in
10 min infusion clinical trials; recently
of 2 mg/ approved.
kg i.v.
over 10
min af-
ter15 min
rest
14
Table 8 Drugs for rate control
Intravenous Usual oral maintenance dose
administration
Beta-Blockers
Metoprolol
2.5–5 mg 100–200 mg o.d. (ER)
CR/XL
Bisoprolol N/A 2.5–10 mg o.d.
Atenolol N/A 25–100 mg o.d.
Esmolol 10 mg N/A
Propranolol 1 mg 10–40 mg t.i.d.
Carvedilol N/A 3.125–25 mg b.i.d.
Non-dihydropyridine calcium channel antagonists

40 mg b.d. to 360 mg (ER)
Verapamil 5 mg
o.d.
60 mg t.d.s. to 360 mg (ER)
Diltiazem N/A
o.d.
Digitalis glyco-
sides
Digoxin 0.5–1 mg 0.125 mg–0.5 mg o.d.
Digitoxin 0.4–0.6 mg 0.05 mg–0.1 mg o.d.
Others
5 mg/kg in 1
h, and
Amiodarone 100 mg–200 mg o.d.
50 mg/h main-
tenance
Dronedaronea N/A 400 mg b.i.d.
ER : extended release formulations; N/A : not applicable.
aOnly in patients with non-permanent atrial fibrillation.
15
Heart Failure
TABLE 9 -- Diuretics for Treating Fluid Retention in
Chronic Heart Failure
DRUG INITIAL DAILY MAX- DURA-
DOSAGE IMUM TION OF
TOTAL ACTION
DAILY (hr)
DOSAGE
Loop diuretics*
Bumetanide 0.5-1.0 mg qd or bid 10 mg 4-6
Furosemide 20-40 mg qd or bid 600 mg 6-8
Torsemide 10-20 mg qd 200 mg 12-16
Ethacrynic acid 25-50 mg qd or bid 200 mg 6
Thiazide diuretics[†]
250-500 mg qd or
Chlorothiazide 1000 mg 6-12
bid
Chlorthalidone 12.5-25 mg qd 100 mg 24-72
Hydrochlorothi-
25 mg qd or bid 200 mg 6-12
azide
Indapamide 2.5 mg qd 5 mg 36
Metolazone 2.5-5 mg qd 20 mg 12-24
Potassium-sparing diuretics
Amiloride 12.5-25 mg qd 20 mg 24
Triamterene 50-75 mg bid 200 mg 7-9
16
DRUG INITIAL DAILY MAX- DURA-
DOSAGE IMUM TION OF
TOTAL ACTION
DAILY (hr)
DOSAGE
AVP antagonists
Satavaptan 25 mg qd 50 mg qd NS
Tolvaptan 15 mg qd 60 mg qd NS
Lixivaptan 125 mg qd 250 mg bid NS
20-mg IV loading
40-mg IV
dose, followed by
Conivaptan (IV) infusion/ 7-9
20-mg continuous IV
day
infusion/day
Sequential nephron blockade
2.5 to 10 mg qd plus
Metolazone
loop diuretic
Hydrochlorothi- 25 to 100 mg qd or

azide bid plus loop diuretic
Chlorothiazide 500 to 1000 mg qd

(IV) plus loop diuretic
Modified from Hunt SA, Abraham WT, Chin MH, et al: ACC/AHA 2005 Guideline Update for the Diagnosis and
Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American
Heart Association Task Force on Practice Guidelines. Circulation 112:e154, 2005.
Note: Unless indicated, all doses are for oral diuretics.
NS = not specified.
* Equivalent doses: 40 mg furosemide = 1 mg bumetanide = 20 mg torsemide = 50 mg of ethacrynic acid.

† Do not use if estimated glomerular filtration is <30 mL/min or with cytochrome 3A4 inhibitors.
17
TABLE 10 -- Drugs for the Prevention and Treatment of
Chronic Heart Failure
AGENTS INITIATING MAXIMAL DOS-
DOSAGE AGE
Angiotensin-Converting Enzyme Inhibitors
Captopril 6.25 mg tid 50 mg tid
Enalapril 2.5 mg bid 10 mg bid
Lisinopril 2.5-5.0 mg qd 20 mg qd
Ramipril 1.25-2.5 mg qd 10 mg qd
Fosinopril 5-10 mg qd 40 mg qd
Quinapril 5 bid 40 mg bid
Trandolapril 0.5 mg qd 4 mg qd
Angiotensin Receptor Blockers
Valsartan 40 mg bid 160 mg bid
Candesartan 4-8 mg qd 32 mg qd
Losartan 12.5-25 mg qd 50 mg qd
Beta Receptor Blockers
25 mg bid (50 mg
Carvedilol 3.125 mg bid bid if body weight >
85 kg)
Carvedilol-CR 10 mg qd 80 mg qd
Bisoprolol 1.25 mg bid 10 mg qd
Metoprolol succinate CR 12.5-25 mg qd 200 mg qd

Aldosterone Antagonists
Spironolactone 12.5-25 mg qd 25-50 mg qd
Eplerenone 25 mg qd 50 mg qd
18
AGENTS INITIATING MAXIMAL DOS-
DOSAGE AGE
Other Agents
Combination of hydrala- 10-25 mg/10 mg
75 mg/40 mg tid
zine/isosorbide dinitrate tid
Fixed dose of hydrala- 37.5 mg/20 mg 75 mg/40 mg (two
zine/isosorbide dinitrate (one tablet) tid tablets) tid
Digoxin* 0.125 mg qd ≤0.375 mg/day[†]
Modified from Mann DL: Heart failure and cor pulmonale. In Kasper DL, Braunwald E, Fauci AS, Hauser SL,
et al (eds): Harrison›s Principles of Internal Medicine. 17th ed. New York, McGraw-Hill, 2007, p 1449.
* Dosing should be based on ideal body weight, age and renal function
† Trough level should be 0.5-1 ng/mL, although absolute levels have not been established
Table 11 Intravenous vasodilators used to treat acute heart

failure
Vasodilator Dosing Main side Other
effects
Nitroglycerine Start with10–20 μg/ Hypotension, Tolerance
min, headache on
increase up to continuous
200 μg/min use
Isosorbide Start with 1 mg/h, Hypotension, Tolerance
dinitrate increase up to 10 headache on
mg/h continuous
use
Nitroprusside Start with 0.3 μg/ Hypotension, Light
kg/min isocyanate sensitive

and increase up to toxicity
5 μg/kg/min
Nesiritidea Bolus 2 μg/kg + Hypotension
infusion 0.01 μg/
kg/min
19
Table 12 drugs used to treat acute heart failure that are
positive inotropes or vasopressors or both
Bolus Infusion Rate
Dobutamine No 2–20 μg/kg/min (β+)
Dopamine No <3 μg/kg/min: renal
effect (δ+)
3–5 μg/kg/min;
inotropic (β+)
>5 μg/kg/min: (β+),
vasopressor (α+)
Milrinone 25–75 μg/kg over 0.375–0.75 μg/kg/min
10–20 min
Enoximone 0.5–1.0 mg/kg 5–20 μg/kg/min
over 5–10 min
Levosimedana 12 μg/kg over 10 0.1 μg/kg/min, which
min can be decreased to
(optional)b 0.05 or increased to
0.2 μg/kg/min
Norepinephrine NO 0.2–1.0 μg/kg/min
Norepinephrine Bolus: 1 mg can be 0.05–0.5 μg/kg/min
given
i.v. during resusci-
tation,
repeated every
3–5 min
aAlso a vasodilator.
bBolus not recommended in hypotensive patients (systolic blood pressure
,90 mmHg).
a ¼ alpha adrenoceptor; b ¼ beta adrenoceptor; d ¼ dopamine receptor.
20
Hipertensi
TABLE 13 -- Representative Diuretics and Potassium-
Sparing Agents
AGENT DAILY DOSE DURATION OF
(MG) ACTION (HR)
Thiazides
Bendroflumethiazide 1.25-5.0 >18
Hydrochlorothiazide 6.25-50 12-18
Methyclothiazide 2.5-5.0 >24
Trichlormethiazide 1-4 >34
Related Sulfonamide Compounds
Chlorthalidone 12.5-50 24-72
Indapamide 1.25-2.5 24
Metolazone 0.5-10 24
Loop Diuretics
Bumetanide 0.5-5 4-6
Ethacrynic acid 25-100 12
Furosemide 40-480 4-6
Torsemide 5-40 12
Potassium-Sparing Agents
Amiloride 5-10 24
Eplerenone 50-200 24
Spironolactone 25-100 8-12
Triamterene 50-100 12
21
TABLE 14 -- Parenteral Drugs for Treatment of
Hypertensive Emergency
DRUG* DOSE ONSET DUR- ADVERSE SPECIAL
OF AC- ATION EFFECTS INDICA-
TION OF AC- TIONS
TION
Vasodilators
Nausea, vom-
Not pre-
iting, muscle
0.25- ferred for
Nitroprus- Immedi- twitching,
10.00 ?g/ 1-2 min most hy-
side ate thiocyanate
kg/min IV pertensive
and cyanide
emergencies
toxicity
Headache,
vomiting, Not pre-
methe- ferred but
Nitroglyc- 5-100 ?g/ moglobin- may be
2-5 min 5-10 min
erin min emia, toler- useful for
ance with coronary
prolonged ischemia
use
Tachycardia, May be in-
Fenoldo-
0.1-0.6 ?g/ 10- increased dicated for
pam (Cor- 4-5 min
kg/min IV 15 min intraocular renal insuffi-
lopam)
pressure ciency
Nicardipine Most hy-
(Cardene 5-15 mg/h 5-10 min 1-4 hr pertensive
IV) Headache, emergencies
1-2 mg nausea, flush-
IV, rapidly ing, tachycar- Most hy-
Clevidipine
increasing 2-4 min 5-15 min dia pertensive
(Cleviprex)
dose to emergencies
16 mg max
10- Tachycardia,
5-20 mg IV 1-4 hr
20 min flushing,
Eclampsia;
Hydrala- headache,
not for aortic
zine 10-40 mg 20- vomiting,
4-6 hr dissection
IM 30 min aggravation
of angina
22
DRUG* DOSE ONSET DUR- ADVERSE SPECIAL
OF AC- ATION EFFECTS INDICA-
TION OF AC- TIONS
TION
Adrenergic Inhibitors

Tachycardia,
Phentol- Catechol-
5-15 mg IV 1-2 min 3-10 min flushing,
amine amine excess
headache
250-
500 ?g/
Aortic dis-
Esmolol kg/min for Hypotension,
1-2 min 1-20 min section after
(Brevibloc) 4 min, then nausea
surgery
50-300 ?g/
kg/min IV
Vomiting,
20-80 mg scalp tingling,
Most hy-
Labetalol IV bolus burning in
pertensive
(Normo- every throat, dizzi-
5-10 min 3-6 hr emergencies,
dyne, Tran- 10 min, ness, nausea,
except acute
date) 2-mg/min heart block,
heart failure
IV infusion orthostatic
hypotension
* In order of rapidity of action.
† Hypotension may occur with any of these.
‡ Intravenous formulations of other calcium channel
blockers are also available
23
Dyslipidemia
TABLE 15 -- Current Lipid-Lowering Medications
GENERIC NAME BRAND NAME RECOMMEND-
ED DOSAGE
RANGE
Statins
Atorvastatin Lipitor 10-80 mg
Fluvastatin Lescol 20-80 mg
Lovastatin Mevacor 20-80 mg
Pravastatin Pravachol 10-40 mg
Rosuvastatin Crestor 15-40 mg
Simvastatin Zocor 10-80 mg
Pitavastatin Levacol 2-4 mg
Bile Acid Absorption Inhibitors
Cholestyramine Questran 2-24 g
Colestipol Colestid 5-30 g
Colesevelam WelChol 3.8-4.5 g
Cholesterol Absorption Inhibitor
Ezetimibe Zetia (Ezetrol) 10 mg
Fibrates*
24
GENERIC NAME BRAND NAME RECOMMEND-
ED DOSAGE
RANGE
Bezafibrate Bezalip 400 mg
Tricor, Trilipix, Lipi-
Fenofibrate 40-200 mg
dil Micro, Lipidil EZ
Gemfibrozil[†] Lopid 600-1200 mg
Niacin‡ Niacin 1-3 g
Nicotinic acid Niaspan 1-2 g
* Avoid in patients with renal insufficiency.
† Not recommended in combination with statins.
‡ Use with caution in patients with diabetes or glucose intolerance.
25
26
Antiarrhythmia
Table 16. Clinical Usage information for antiarrhythmic agents
USUAL DOSAGE RANGES TIME TO PEAK MAJOR
PREG-
INTRAVENOUS (MG) ORAL (MG) PLASMA CON ROUTE
DRUG NANCY
CENTRATION OF ELIMI-
MAINTE- LOAD- MAINTE- CLASS
LOADING (ORAL) (hr) NATION
NANCE ING NANCE
6 to 10 mg/ 300 to
800 to
Quinidine kg at 0.3 to — 600 q 1.5 to 3.0 Liver C
1000
0.5 mg/kg/min 6 hr
6 to 13 mg/ 2 to 250 to
Procain- 500 to
kg at 0.2 to 6 mg/ 1000 q 1 Kidneys C
amide 1000
0.5 mg/kg/min min 4-6 hr
1 to 2 mg/ 100 to
Disopyra- 1 mg/kg/
kg over 15 to 300 q 1 to 2 Kidneys C
mide hr
45 min* 6-8 hr
1 to 3 mg/kg at 1 to
Lidocaine 20 to 50 mg/ 4 mg/ N/A N/A N/A Liver B
min min
0.5 to 150 to
400 to
Mexiletine 500 mg* 1.0 g / 300 q 2 to 4 Liver C
600
24 hr 8 -12 hr
100 to
100 mg q 5 min
Phenytoin 1000 400 q12- 8 to 12 Liver D
for ≤1000 mg
24 hr
100 to 50 to
Flecainide 2 mg/kg* 200 q 200 q 3 to 4 Kidneys C
12 hr 12 hr
150 to
600 to
Propafenone 1 to 2 mg/kg 300 q 1 to 3 Liver C
900
8-12 hr
0.25 to 0.5 mg 10 to
Propranolol q 5 min to 200 q 4 Liver C
≤0.20 mg/kg 6-8 hr
15 mg/min for
10 min
800 to
1 mg/min for
1600 qd 200 to
Amiodarone 3 hr 1 mg/min Kidneys D
for 7-14 600 qd
5 mg/min
days
thereafter
400 mg
Dronedarone N/A N/A N/A 3 to 4 Liver X
q 12hr
80 to
10 mg over 1 to
Sotalol 320 q 2.5 to 4 Kidneys B
2 min*
12 hr
27
28
1 mg over
Ibutilide N/A N/A N/A N/A Kidneys C
10 min
0.125
2 to 5 ?g/kg
Dofetilide N/A N/A to 0.5 q Kidneys C
infusion*
12 hr
80 to
5 to 10 mg over 0.005 mg
Verapamil 120 q 1 to 2 Liver C
1 to 2 min /kg /min
6-8 hr
6 to 18 mg (rap-
Adenosine N/A N/A N/A N/A C
idly)
0.125 to 0.5 to 0.125 to
Digoxin 0.5 to 1.0 mg 2 to 6 Kidneys C
0.25 qd 1.0 0.25 qd
N/A: not applicable.
Results presented may vary according to doses, disease state, and intravenous or oral administration.
Pregnancy class: A—controlled studies show no fetal risk; B—no controlled studies, but no evidence of fetal
risk; fetal harm unlikely; C—fetal risk cannot be excluded; drug should be used only if potential benefits
outweigh potential risk; D—definite fetal risk; drug should be avoided unless in a life-threatening situation
or safer alternatives do not exist ; X—contraindicated in pregnancy.
* Intravenous use investigational.
Pulmonary Embolism or
DVT
TABLE 17 -- Low-Molecular-Weight Heparins
NAME STATUS MOLEC- AN- TREATMENT
ULAR TI-Xa/ DOSE
WEIGHT ANTI-IIa
RATIO
1 mg/kg twice
daily (approved
FDA ap-
as an inpatient or
Enoxapa- proved for
4800 3.9 outpatient dose),
rin DVT treat-
or 1.5 mg/kg once
ment
daily (inpatient
dose only)
FDA ap-
proved for 100 units/kg twice
Dalteparin cancer-as- 5000 2.2 daily, or 200 units/
sociated kg once daily
DVT
4100 units twice
daily for patients
Not avail- weighing <50 kg,
Nadropa- able in the 6150 units twice
4500 3.5
rin United daily for 50-70 kg,
States and 9200 units
twice daily for

>70 kg
29
NAME STATUS MOLEC- AN- TREATMENT
ULAR TI-Xa/ DOSE
WEIGHT AN-
TI-IIa
RATIO
3500 units twice
daily for patients
weighing 35-45 kg,
Not available
4200 units twice
Reviparin in the United 3900 3.3
daily for 46-60 kg,
States
and 6300 units
twice daily for
>60 kg
FDA approved
175 units/kg once
Tinzaparin for DVT treat- 4500 1.5
daily
ment
In 2007, the Food and Drug Administration (FDA) approved the LMWH dalteparin as
monotherapy without warfarin in cancer patients with acute VTE. In a trial of 672 pa-
tients with VTE and cancer, those randomized to dalteparin monotherapy had a much
lower VTE recurrence rate than did patients receiving dalteparin as a “bridge” to warfa-
rin: 8.8% versus 17.4%.[86] At times, LMWH is used off label as monotherapy without
warfarin to treat VTE patients without cancer who cannot tolerate warfarin or who suffer
recurrent VTE despite warfarin.[87]
30
TABLE 18-- Fondaparinux Dosing for Patients with
Acute Pulmonary Embolism or DVT
Patient weight <50 kg 50-100 kg >100 kg
Daily dose of 5 mg 7.5 mg 10 mg
fondaparinux*
* Assumes normal renal function.
TABLE 19 -- Use of Heparin Before and After

Thrombolysis
1 Discontinue the continuous infusion of intravenous UFH as

soon as the decision has been made to administer thrombol-
ysis.
2 Proceed to order thrombolysis. Use the U.S. Food and Drug
Administration–approved regimen of alteplase 100 mg as a
continuous infusion during 2 hours.
3 Do not delay the thrombolysis infusion by obtaining an acti-

vated partial thromboplastin time (aPTT).
4 Infuse thrombolysis as soon as it becomes available.
5 At the conclusion of the 2-hour infusion, obtain a stat aPTT.
6 If the aPTT is 80 seconds or less (which is almost always the

case), resume UFH as a continuous infusion without a bolus.
7 If the aPTT exceeds 80 seconds, hold off from resuming hepa-
rin for 4 hours and repeat the aPTT. At this time, the aPTT has
virtually always declined to <80 seconds. If this is the case, re-
sume continuous infusion of intravenous UFH without a bolus.
31
Table 20 Approved thrombolytic regimens for pulmonary
embolism
Streptokinase 250 000 IU as a loading dose over 30 min, fol-
lowed by 100 000 IU/h over 12–24 h
Accelerated regimen: 1.5 million IU over 2 h
Urokinase 4400 IU/kg as a loading dose over 10 min, fol-
lowed by 4400 IU/kg/h over 12–24 h
Accelerated regimen: 3 million IU over 2 h
rtPA 100 mg over 2 h or 0.6 mg/kg over 15 min (max-
imum dose 50 mg)
rtPA = recombinant tissue plasminogen activator.
Table 21 Adjustment of intravenous unfractionated

heparin dosage based on the activated partial
thromboplastin time
Activated partial thromboplastin Change of dosage
time
<35 s ( <1.2 times control) 80 U/kg bolus; increase infu-
sion rate by 4 U/kg/h
35–45 s (1.2–1.5 times control) 40 U/kg bolus; increase infu-
sion rate by 2 U/kg/h
46–70 s (1.5–2.3 times control) No change
71–90 s (2.3–3.0 times control) Reduce infusion rate by 2 U/
kg/h
> 90 s (>3.0 times control) Stop infusion for 1 h, then

reduce infusion rate by 3 U/
kg/h
32
Table 22 Subcutaneous regimens of low molecularweight
heparins and fondaparinux approved for the treatment of
pulmonary embolism
Dose Interval
Enoxaparin 1.0 mg/kg Every 12 h
or 1.5 mg/kg (a) Once daily (a)
Tinzaparin 175 U/kg Once daily
Fondaparinux 5 mg (body weight < 50 kg) Once daily
7.5 mg (body weight 50–
100 kg)
10 mg (body weight .100
kg)
In patients with cancer, Dalteparin is approved for extended treatment of symptomatic VTE (proximal DVT
and/or PE), at an initial dose of 200 U/kg s.c. once daily (see drug labelling for details).
Once-daily injection of enoxaparin at the dose of 1.5 mg/kg is approved for inpatient (hospital) treatment
of PE in the United States and in some, but not all, European countries.
33
Rheumatic Fever
TABLE 23 -- Antibiotic Therapy for Acute Rheumatic
Fever and Long-Term Prophylaxis
Initial Treatment of Group A Beta-Hemolytic Streptococcal Pharyngitis
(Adult Dosages)
ANTI- DOSE FRE- DURA- COM- CLASS
BIOTIC QUENCY TION MENTS
↓ Compli-
Benzathine 1.2 million Acutely
One time ance issues I
penicillin G units IM only
↑ Pain
Penicillin V 500 mg PO Twice daily 10 days I
1000 mg
Amoxicillin Daily 10 days I
PO
Penicillin

Allergic
Avoid if
Nar- history of
row-spec- Varies by Varies by anaphy-
10 days I
trum ceph- drug drug laxis sec-
alosporins* ondary to
penicillin
Clindamy-
300 mg PO Twice daily 10 days IIa
cin*,[†]
500 mg PO
Azithromy- day 1
Daily 5 days IIa
cin*,[‡] 250 mg PO
days 2-5
Clarithro-
250 mg PO Twice daily 10 days IIa
mycin*,[‡]
34
Secondary Prophylaxis Regimen for Patients with Documented RF
(Adult Dosages)[?]
FRE- COM-
ANTIBIOTIC DOSE CLASS
QUENCY MENTS
↓ Com-
Benzathine peni- 1.2 million Every 3 to pliance
I
cillin G units IM 4 weeks[?] issues
↑ Pain
Penicillin V 250 mg PO Twice daily I
Erythromycin*,[‡] 250 mg PO Twice daily I
Sulfadiazine* 1 g PO Daily I
Sulfisoxazole* 1 g PO Daily IIa
Modified from Gerber MA, Baltimore RS, Eaton CB, et al: Prevention of rheumatic fever and diagnosis and
treatment of acute streptococcal pharyngitis. A scientific statement from the American Heart Association
Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee. Circulation 119:1541, 2009; and Rheu-
matic fever and rheumatic heart disease. World Health Organ Tech Rep Ser 923:1, 2004.
* Alternative for penicillin-allergic patients. Erythromycin for secondary prophylaxis is an alterna-

tive for patients allergic to both penicillin and sulfa.
† Dosage is empiric. For severe pharyngitis, doses up to 1.2 g daily in two to four divided doses.
‡ Some areas have a high rate of macrolide-resistant group A streptococci. In addition, erythro-
mycin toxicity, including gastrointestinal intolerance and long-QT syndrome, limits its use.
? Duration of therapy ranges from 5 years to life-long (see text). For patients with poststrepto-
coccal reactive arthritis, recommended duration is 1 year in nonendemic areas, 5 years where
RF is prevalent if no evidence of carditis appears.
? In endemic areas, benzathine penicillin every 3 weeks should be considered to maintain opti-
mal drug levels (Class I indication). In nonendemic areas, benzathine penicillin is given every 3
weeks if RF recurs on the regimen of every 4 weeks (Class I).
35
36
Endocarditis
TABLE 25 -- Treatment of Native Valve Endocarditis
Caused by Penicillin-Susceptible Viridans Streptococci
and Streptococcus gallolyticus (bovis) (MIC <0.1 ?g/mL)*
ANTIBIOT- DOSAGE AND ROUTE[†] DURATION
IC
12-18 million units/24 hr IV either
Aqueous peni-
continuously or every 4 hr in six 4 weeks
cillin G
equally divided doses
or
Ceftriaxone 2 g once daily IV or IM 4 weeks
12-18 million units/24 hr IV either
Aqueous peni-
cillin G
or
Ceftriaxone 2 g once daily IV or IM 2 weeks
plus
3 mg/kg/day IM or IV as a single
Gentamicin daily dose or divided in equal doses 2 weeks
every 8 hr
30 mg/kg/24 hr IV in two equal-
ly divided doses, not to exceed
Vancomycin 4 weeks
2 g/24 hr unless serum levels are
monitored
Modified from Baddour LM, Wilson WR, Bayer AS, et al: Infective endocarditis: Diagnosis, antimicrobial
therapy, and management of complications. Circulation 111:3167, 2005.
Three treatment options are recommended.
† Dosages given are for patients with normal renal function. Vancomycin and gentamicin doses
must be reduced for treatment of patients with renal dysfunction. Gentamicin doses are
calculated by ideal body weight (men = 50 kg + 2.3 kg per inch over 5 feet; women = 45.5 kg +
2.3 kg per inch over 5 feet). Vancomycin doses are based on actual body weight. Vancomycin
doses are adjusted to yield 1-hour postinfusion serum concentration of 30 to 45 ?g/mL and
trough of 15 ?g/mL. Gentamicin administered every 8 hours should be adjusted to achieve
a 1-hour peak concentration of 3 to 3.5 ?g/mL and a trough of <1.0 ?g/mL. Lengthening of
the dose-to-dose interval may be required to achieve these parameters in patients with renal
dysfunction.
37
TABLE 26 -- Treatment of Native Valve Endocarditis
Caused by Strains of Viridans Streptococci and
Streptococcus gallolyticus (bovis) Relatively Resistant to
Penicillin G (MIC >0.1 ?g/mL and <0.5 ?g/mL)*
IC
24 million units/24 hr IV either
Aqueous peni-
cillin G
or
Ceftriaxone 2 g once daily IV or IM
plus
3 mg/kg/day IM or IV as a single
Gentamicin daily dose or divided in equal 2 weeks
doses every 8 hr
30 mg/kg/24 hr IV in two equal-
ly divided doses, not to exceed
Vancomycin 4 weeks
2 g/24 hr unless serum levels
are monitored
Two treatment options are recommended.
* For streptococci with penicillin MIC > 0.5 ?g/mL, see text and Table 67-8.
† Dosages are for patients with normal renal function; see Table 67-6 footnote.
38
TABLE 27 -- Treatment of Staphylococcal Endocarditis
in the Absence of Prosthetic Material
DURA-
ANTIBIOTIC DOSAGE AND ROUTE* TION
Methicillin-susceptible staphylococci†
Nafcillin or oxacillin 2 g IV every 4 hr 4-6 weeks
or
Cefazolin 2 g IV every 8 hr 4-6 weeks
or
15 to 20 mg/kg actual body
Vancomycin 4-6 weeks
weight, IV every 8 to 12 hr
Methicillin-resistant staphylococci‡
Vancomycin[?] 4-6 weeks
Modified from Baddour LM, Wilson WR, Bayer AS, et al: Infective endocarditis: Diagnosis, antimicrobial t
herapy, and management of complications. Circulation 111:3167, 2005.
* Dosages are for patients with normal renal function; see Table 67-6 footnote.
† For treatment of endocarditis caused by penicillin-susceptible staphylococci (MIC ≤ 0.1 ?g/mL),

aqueous penicillin G 18-24 million units/24 hr) can be used for 4 to 6 weeks instead of nafcillin
or oxacillin. Cefazolin or vancomycin may be used in selected penicillin-allergic patients contin-
gent on degree of allergic response.
‡ For staphylococcal infection, vancomycin target trough serum concentration is 15 to 20 ?g/mL.
? If vancomycin MIC > 1.5 ?g/mL, see text for daptomycin use.

39
TABLE 28 -- Treatment of Staphylococcal Endocarditis
in the Presence of a Prosthetic Valve or Other Prosthetic
Material
ANTIBIOTIC DOSAGE AND ROUTE* DURATION
Regimen for methicillin-resistant staphylococci†
Vancomycin[‡] ≥6 weeks
plus
Rifampin 300 mg PO every 8 hr ≥6 weeks
and
Gentamicin[?] 1.0 mg/kg IM or IV every 8 hr 2 weeks
Regimen for methicillin-susceptible staphylococci
Nafcillin or oxacil-
2 g IV every 4 hr ≥6 weeks
lin[?]
plus
Rifampin 300 mg PO every 8 hr ≥6 6weeks
and
Gentamicin[?] 1.0 mg/kg IM or IV every 8 hr 2 weeks
* Dosages are for patients with normal renal function. See Table 67-6 footnote for gentamicin
dosing.
40
TABLE 29 -- Treatment of Endocarditis Caused by
HACEK Microorganisms*
IC
Ceftriaxone[‡] 2 g once daily IV or IM 4 weeks
or
Ampicillin-sul- 12 g/24 hr IV given every 4 hr in
4 weeks
bactam six equally divided doses
* HACEK microorganisms are Haemophilus species, Aggregatibacter aphrophilus or actinomyce-

temcomitans, Cardiobacterium hominis, Eikenella corrodens, and Kingella species.
† Dosages are for those with normal renal function; see Table 67-6 footnote.
‡ Cefotaxime or another third- or fourth-generation cephalosporin in comparable doses may

be substituted for ceftriaxone. See text for treatment of patients unable to take beta-lactam
antibiotics.
41
Hyperthyroidism
TABLE 30 -- Beta-Adrenergic Receptor Blockade in the
Treatment of Hyperthyroidism*
DRUG DOSAGE FREQUENCY CONSIDER-
ATIONS
Nonselective β-AR
Propranolol 10-40 mg tid or qid blockade; longest
experience
Relative beta1
selectivity; in-
Atenolol 25-100 mg bid
creased patient
compliance
Relative beta1
Metoprolol 25-50 mg qid
selectivity
Nonselective β-AR
blockade; once
Nadolol 40-160 mg qd
daily; least experi-
ence to date
IV pump, In ICU setting of
Esmolol 50-100 ?g/ severe hyperthy-
kg/min roidism or storm
β-AR = beta-adrenergic receptor; ICU = intensive care unit.
* Each of these drugs has been approved for the treatment of cardiovascular diseases, but to
date none has been approved for the treatment of hyperthyroidism.
42
Dosis PIAT
43
44
45
46
47
48
49
50

Cardiology: Drug Dose

Загружено:

Сведения о документе

Оригинальное название

Авторское право

Доступные форматы

Поделиться этим документом

Поделиться или встроить документ

Параметры публикации

Этот документ был вам полезен?

Это неприемлемый материал?

Авторское право:

Доступные форматы

Cardiology: Drug Dose

Загружено:

Авторское право:

Доступные форматы

A-Z

Table 7 Drugs And Doses For Pharmacological Conversion

PULMONARY EMBOLISM OR DVT

Table 27 Treatment Of Staphylococcal Endocarditis In

TABLE 2 -- Comparison of Approved Fibrinolytic Agents*

For streptokinase, anistreplase: Prior exposure (>5 days ago) or

With fibrinolytic therapy

no i.v. bolus; start with first s.c. dose of 0.75 mg/

Table 5 Dosages of inhibitors of the renin–angiotensin–

b.i.d : twice daily; t.i.d : three times daily.

* A 10- to 12-hour nitrate-free interval is recommended.

No Reduce infu- Reduce infu- Reduce in-

LMWH = low-molecular-weight heparin; SrCr = serum creatinine.

* In patients with CKD and ESRD.

* Increased sensitivity can be achieved with sampling every 6 or 8 hr.

10 min abnormal T-U waves or

Atenolol N/A 25–100 mg o.d.

Propranolol 1 mg 10–40 mg t.i.d.

Carvedilol N/A 3.125–25 mg b.i.d.

Non-dihydropyridine calcium channel antagonists

Digitoxin 0.4–0.6 mg 0.05 mg–0.1 mg o.d.

* Equivalent doses: 40 mg furosemide = 1 mg bumetanide = 20 mg torsemide = 50 mg of ethacrynic acid.

Metoprolol succinate CR 12.5-25 mg qd 200 mg qd

Table 11 Intravenous vasodilators used to treat acute heart

kg/min isocyanate sensitive

A-Z Cardiovascular Drug Doses

* Avoid in patients with renal insufficiency.

† Not recommended in combination with statins.

‡ Use with caution in patients with diabetes or glucose intolerance.

A-Z Cardiovascular Drug Doses

twice daily for

TABLE 19 -- Use of Heparin Before and After

1 Discontinue the continuous infusion of intravenous UFH as

3 Do not delay the thrombolysis infusion by obtaining an acti-

6 If the aPTT is 80 seconds or less (which is almost always the

Table 21 Adjustment of intravenous unfractionated

> 90 s (>3.0 times control) Stop infusion for 1 h, then

A-Z Cardiovascular Drug Doses

* Alternative for penicillin-allergic patients. Erythromycin for secondary prophylaxis is an alterna-

Three treatment options are recommended.

Two treatment options are recommended.

† For treatment of endocarditis caused by penicillin-susceptible staphylococci (MIC ≤ 0.1 ?g/mL),

‡ For staphylococcal infection, vancomycin target trough serum concentration is 15 to 20 ?g/mL.

? If vancomycin MIC > 1.5 ?g/mL, see text for daptomycin use.

* HACEK microorganisms are Haemophilus species, Aggregatibacter aphrophilus or actinomyce-

‡ Cefotaxime or another third- or fourth-generation cephalosporin in comparable doses may

A-Z Cardiovascular Drug Doses

β-AR = beta-adrenergic receptor; ICU = intensive care unit.

date none has been approved for the treatment of hyperthyroidism.

Вам также может понравиться