藥典note

[C]: 末梢神經系統-抗組織胺 & 其他

第一代
學名	商品名	Dose	副作用/小心	肝腎差調整
diphenhydramine	Vena (10mg/#) Panacal (30mg/1ml/amp)	1-5# b-qid 30mg-100mg b-tid, iv, im Sleep aid: 1-5# hs	泌尿道阻塞
	Rehistacal B6=Vena-cal-B6 Diphen.-Calcium bromide-B6 (20mg-200mg-5mg)	Slow iv
Cyproheptadine	Cypromin (0.4mg/ml, 120ml/bt)	10-20ml t-qid
Homochlorcyclizine	Homoclomin (10mg/#)	1-2# tid
Buclizine	Bucofene (25mg/#)	過敏: 1-2# b-tid 暈動症: 1-2# (30min前), 4-6h prn
第二代
Loratadine	Finska (10mg/#)	1-4# qd or 1-2# qd-bid
	loraPseudo (5mg-120mg) (lora-pseudoephedrine)	1# bid
Cetirizine	Cetirizine (1mg/ml, 60ml/bt)	> 6y/o: 5-10mg (ml) qd-bid	Mild sedation
Levo-cetirizine	Xyzal (5mg/#)	5-20mg (1-4#) qd-bid (晚上)
其他
Hokuphagen	Hokuphagen: Glycirrhizine-25mg DI-Methionine-25mg Aminoacetic acid-25mg	過敏dz: 1-3# tid

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[D]: 循環系統用藥-

(a) cardiotonics

			副作用
Digoxin	Lanoxin (0.25mg/#) Lanoxin (0.5mg/2ml/amp) Cardiacin (0.05mg/ml, 60ml/bt)	CHF: PO 0.125-0.25mg/d   (0.5-1# qd) Af: 初:PO/iv 0.5mg, then 0.25mg q6h x2 ds; 維:0.125-0.375mg/d	C/I: WPW synd, 3AVB, HOCM	腎差: 減量 Af with ffg無效:  -甲亢, fever, hypoxia, 急性出血, 交感亢進者
Milrinone   PDE III inhibitor	Primacor (10mg/10ml/vial)	短期用於CHF: 初:50u/kg over 10min 維:0.375-0.75u/kg/min	[副]: PVCs, VT, Vf, PSVT, 低血壓

(b) Coronary dilator

Nitrate
Nitroglycerine (NTG)   稀釋:NS,D5W   50mg/250ml=200u/ml 10u/min=3ml/h 20u/min=6ml/h	Nitrostat SL (NTG) (0.6mg/#) (25#/bt) Glyceryl trinitrate (NTG) (50mg/10ml/amp)	Iv: 初: 5-10u/min (1.5-3ml/h), 每5-10min上調5-20ug/min   Max: angina:200u/min     HTN: 400u/min	C/I: RV MI, BP<90, 並用PDEi
Isosorbide 5-mononitrate	Isormol (20mg/#) Imdur (60mg/#)	Isormol: 0.5-1-2# bid Imdur: 0.5-1# qd (max 4#/d)
Nitrate with鉀通道活化劑
Nicorandil	Sigmart (5mg/#)	1# tid (1-4# b-tid) (max: 16#/d)	[副]: ALT上升
CCB
Diltiazem	Herbesser (30mg/#) Diltelan (90mg/cap) Herbesser (50mg/vial)	Angina, Raynaud’s synd, PSVT, Af, HTN 30mg (1#) tid (max: 360mg/d) Af: iv 0.25-0.35mg/kg x2min, + 5-15mg/h	[副]: 低血壓, 心跳變慢, 水腫, 惡化CHF, 便秘 [C/I]: AMI with 肺充血, SSS, 2-3°AVB
Verapamil	Vetrimil (40mg/#) Verelan SR (120mg/cap) Verapamil (5mg/2ml/amp)	Angina, migraine預防:  40-120mg q8h  SR: 1-4# qd (-qid) PSVT, Af, AF:  Iv (1-2min) 5-10mg (1-2amp)  (0.1-0.2mg/kg), q15-30min prn (~total 20-30mg)	[C/I]: sinus bradycardia, advanced heart block, Af with WPW -勿iv倂用BB

(c) 抗心律不整藥

Class IA
Quinidine	Quinidine (200mg/cap)	Af, AF
Class IB
Lidocaine	Xylocaine (2%, 5ml/amp=100mg) (20支in NS 400ml)	心室心律不整(VT, Vf):  Iv 1-1.5mg/kg + 1-4mg/min		稀釋: NS, D5W Conc: 2g/500ml=4mg/ml Ivd: 1mg/min=15ml/h    2mg/min=30ml/h
Phenytoin	Dilantin (100mg/cap) Aleviatin (250mg/5ml/amp)	心室心律不整, prolonged QT  Iv:   1) 3.5-5mg/kg(≦50mg/min), repeat after 10min prn   2) 10-15mg/kg over 1h  PO: 1# t-qid or 3# hs	[C/I]: heart block, sinus bradycardia
Mexiletine	Mexitil (100mg/cap)	心室心律不整, 神經痛  1-4# tid	[副]: 胸痛, 心跳太慢, ALT上升
Class IC
Propafenone	Rytmonorm (150mg/#)	危及生命之心室心律不整, Af (無結構性心臟病)   1-2# b-tid	-QRS變寬需減量
Class II
Propranolol	Inderal (10mg/#) Propranolol (40mg/#)	心律不整, MI, essential tremor, angina, 嗜鉻細胞瘤, 偏頭痛預防, 焦慮, 預防食道靜脈區張出血:  10-40mg t-qid or 20-80mg bid Max: 320mg/d	C/I: uncompensated CHF, 心因性休克, Heart block, Raynaud’s synd	在低血糖狀態, inderal 會mask低血糖症狀, selective BB較適宜用在糖尿病
Class III
Dronedarone	Multaq (400mg/#)	Af, AF: 1# q12h	C/I: CHF III/IV, 嚴重肝失能
Amiodarone	Cordarone (200mg/#) Cordarone (150mg/3ml/amp)	VF/pVT: ivp/IO 300mg, then 150mg prn VT:  PO: 400-800mg bid x7-14d ->taper 200-300mg bid x7-14d ->taper 200-400mg qd  IV: 150mg iv x10min, iv prn     900mg ivd x 24h Af:  PO: 300-400mg bid x 1-2wk, then 200mg bid x 1-2wk, then 100-200mg qd  IV: 150mg x 10min + 500-1000mg x24h
Class IV
Verapamil	Vetrimil, verelan
Diltiazem	Herbesser, diltelan
其他
Adenosine	Adenozer (6mg/2ml/vial)	PSVT: iv 6mg-12-12 (q1-2min) (20ml NS flush if via週邊) 3mg if give via CVC
Mag sulfate	Mag sulfate (10%, 20ml/amp, 2g/amp, 0.8mEq/mL)	Torsades de pointes: -iv 2g (1amp) over 1-15min, 低血鎂: iv 2-4g, over 30min Acute severe asthma: iv 1.2-2g over 20min	[副]: 低血壓,↓心跳, C/I: 嚴重腎衰竭, complete AVB

[d] 抗高血壓藥

ACEi					In most pt, GFR↓<30%可被接受
		HTN	CHF	AMI
Captopril	Cabudan (25)	1-2# b-tid	0.25-0.5# tid, may to 2# tid	初: 0.25#, 24-48h titrate to 1-2# tid	C/I: 雙側腎動脈狹窄	使用前2m需f/u K, Cr
Ramipril	Tritace (10)	0.25-2# qd	0.25-0.5# qd-bid
Fosinopril	Fonosil (10)	1#qd (4#/d)	1#qd (4#/d)
Quinapril	Accupril (10)	1-2# qd	0.5-2# qd
Lisinopril	Zestril (10)	1-4# qd	0.5-2# qd
Imidapril	Tanatril (10)	0.5-2# qd	0.5-1# qd
Perindopril
ARB (AT1 antagonist)
Valsartan	Diovan (160)	0.5-2# qd	0.25-1# bid			CCr >30不調ds
Irbesartan	Aprovel (150)	1-2# qd				DM腎病變
Candesartan	Blopress (8)	1-4# qd
Olmesartan	Olmetec (20)	1-2# qd
Telmisartan	Micardis (40)	1-2# qd

		用途	副作用
CCB (Dihydropyridine)		HTN, angina
Nifedioine	Adalat OROS (30)	1-2# qd-tid
Nicardipine	Component (20) Perdipine (10mg/10ml/amp)	1-2# tid 初:5mg/h->15mg/h 維:1-3mg/h
Felodipine	Plendil (5,10)	5-20mg qd (or div)	[副]: 頭暈,水腫,心悸	合併ACEi may↓水腫
Amlodipine	Norvasc (5)	1-2# qd (or div)	腳踝水腫(19%)	腎差不調
Lercanidipine	Zanidip (10)	1-3# qd (or div)	腳踝水腫(9.3%)

Diuretics
Thiazide & related
Trichlormethiazide	Fluitrain (2)	0.5-2#/d			CCr <30: 無效, 但併用Loop may保有益處
Indapamide	Natrilix SR (1.5)	HTN: 1# qd 利尿: 2-3# qd			CCr<30: 無效
Loop
Furosemide	Rasitol (40) Fumide (10mg/ml, 120ml/bt) Rasitol (20mg/2ml/amp)
Aldosterone antagonist
Spironolactone	Aldactin (25)	HTN: 1-2#qd	CHF(II,III,IV): 0.5-1#qd

BB
Propranolol	Inderal (10) Propranolol (40)	HTN: 10-20mg t-qid, or 20-40mg bid (通常ds: 40-160mg/d)	HTN, Af, angina, anxiety, akathisia
Carteolol	Mikelan (5)	5-30mg qd
Atenolol (β1)	Mirobect (50) Tenormin (100)	50-100mg qd-bid	HTN, Af, angina, MI	[副]: 低血壓, 徐脈, 夜尿/dysuria [C/I]: 肺水腫,心因性休克, AVB, 嚴重CHF
Bisoprolol (β1)	Concor (1.25, 5)	5-10mg/d (max 20)	HTN: (5) 1# QD-BID Stable CHF: 1.25 bid (q2wk)->2.5 bid (q2w) -> 3.75 bid
Carvedilol (αβ)	Dilatrend (6.25, 25)	12.5mg qd-bid or 25mg qd	HTN, angina Stable CHF: 3.125 bid (2wk), then 6.25 bid, then 12.5 bid
Labetalol (αβ)	Labtal (200) Trandate (25/5ml/amp)		HTN	[C/I]: 肺水腫,心因性休克, AVB, 嚴重CHF

αB
Terazosin	Hytrin (2)	初: 0.5# hs 維: 0.5-2.5# hs (10#)	HTN, BPH	[副]:姿態性低血壓, 心悸
Doxazosin	Doxaben (1) Doxaben XL (4)	AM or PM 1-16mg	HTN, BPH	同上

Vasodilator		HTN/ CHF
Hydralazine	Apresoline (10), (50) Apresoline (20/amp)	PO: 10-50mg t-qid IV, im: 10-40mg prn q4-6h	[副]: 高血鉀,咳, angioedema

Direct renin inhibitor
Aliskiren	Rasilez (150)	0.5-2# qd		[副]: 高血鉀,咳, angioedema

Combo:

C+ statin
Amlodipine (5)-atorvastatin (10)	Caduet	1-2# qd
A+C
Benazepril (10)-amlodipine (5)	Amtrel	1-2# qd
Olmesartan (20)-amlodipine (5)	Sevikar
Valsartan (80)-amlodipine (5)	Exforge
A+D
Perindopril (5)- indapamide (1.25)	Acertil-PLUS	1-2# qd
Valsartan (80)- HCT (12.5)	Co-Diovan
Irbesartan (150)-HCT (12.5)	Co-Aprovel
Losartan (100)- HCT (12.5)	Hyzaar	1# qd
A+C+D
Valsartan (160)-amlodipine (5)-HCT(12.5)	Exforge HCT	1-2# qd

高血脂症治療藥

藥物	↓LDL	↑HDL	↓TG	TC	忍受性	副作用
Statins	20-60%	5-10%	10-25%	15-30%	Good	↑ALT (0.5-3%) (dose-dependent) Myalgia <10%, myositis 0.5%, rhabdo < 0.1%
Ezetimibe	15-20%	-	-	?	Good
Fibrate	5-15% (↑LDL ?)	5-15%	35-50%	15%	Good	Myopathy risk↑with statin. Dyspepsia, 膽結石
Niacin*	10-25%	~30%	40%	25%	Poor – reasonable	NO clinical benefit (NEJM 2011;365:2255; THRIVE)
Resin	20%	3-5%	? ↑	20%	Poor	Bloating, 結合他藥
Ω-3 FA	↑5%	3%	25-30%			Dyspepsia, 腹瀉

Statins	HMG-CoA Reductase inhibitors	DOSE	標準劑量 QD	↓LDL
Rosuvastatin	Crestor (10)	0.5-2#	0.5-2# (max 40/d) CCr <30: 0.5-1#qd	39-55%	ALT (0.5-2%), 週邊神經炎, myopathy
Atorvastatin	Lipitor (10, 40)		10-20-40 (max 80/d)	39-50%	同上
Pitavastatin	Livalo (2)		0.5-2#	38-49%	C/I: 急性肝衰竭, 末期LC
Simvastatin	Vytorin (simva (20)-ezetimibe (10)		20-40mg (0.5-1-2#)	35-40%	ALT, myopathy, GI
Fluvastatin	Lescol XL (80)		0.5-1#	25-35%	C/I: 同上 TG: ↓19%
Lovastatin			40mg /d	31%

Combo
Ezetinibe (10)-simvastatin (20)	Vytorin

Fibrate	PPARα activator
Fenofibrate	Fenolip (200/cap)	1# qd		[副]:週邊神經炎, myopathy, rhabdo -與TZD併用, may↓HDL -may↑LDL, esp., in TG很高pt (due to improve VLDL to LDL轉化)

循環障礙疾病用藥

Dihydro-ergotoxin	Headgen (1.5)	Age-related mental capacity decline  1-2# b-tid	[副]: GI upset, flush/rash, 鼻塞,頭暈, cramps
Nicergoline	Sermion (10)	腦循環障礙引起的智能衰退 1-2# tid	GI, flush, 頭暈, 失眠
Piracetam	Syntam (2.4g/pk) Nootropil (200mg/ml, 60ml/bt)	Cognative促進劑in 腦循環障礙  PO: 1.2-2.4g/d (max 2 pk)  Iv: 1.2-2.4g (1-2 bt) x20-60min
Pentoxifylline	Fylin (400) Trental (100/5ml/amp)	PAD/PAOD, asthenospermia (精蟲活力減弱) PO 400 b-tid Iv 200-300mg x2h BID Critical limb ischemia :  Ivd 600mg x4-6h bid  Ivd 1200mg x24h ~21day	GI upset	腎差: 減少ds
Alprostadil (PG E1)	Promostan (20ug/vial) Prostin VR (500ug/ml/amp)	PAD  Ivd 40-60ug in N/S x2h qd-bid  IAD 10-15 ug in N/S x24h	[副]: phlebitis
Flunarizine (neuronal Ca blocker)	Sibelium (5/cap)	PAD, central vascular d/o, vertigo, 暈動症, 預防偏頭痛 1-2 cap HS (max 4#)	[副]: 想睡, 變胖, GI, 頭痛, 憂鬱, EPS
Nicametate	Songora (50)	PAD: 1-2# tid	Flush, 發癢, 發熱
Diphenidol	Diphenidol (25)	Vertigo, Meniere’s dz  1-2# tid	GI, 想睡	具弱抗膽鹼effect
Ginkgo biloba extract	Gintec (40)	循環障礙疾病: 1# tid	GI, 頭暈, 頭痛
Nimodipine (CCB)	Nimotop (10mg/50ml/bt)	創傷或腦血管瘤破裂後之血管痙攣   1mg/5ml/h (15ug/kg/h) x2h  ->may 增量到 10ml/h for 5-14d   < 70kg, or BP不穩: 2.5ml/h

呼吸系統疾病用藥

(a) antitussives & expectorants

止咳				副作用
Morphine	Compound glycyrrhiza mixture (120ml/bt)	Tincture opium camphor (morphine 0.06mg/ml) Extract glycyrrhiza K antimony tartrate Spirit ethylnitrite	10ml t-qid
Dextromethorphan	Medicon A (1# tid)  Dextrometho. 20mg  K cresol sulfate 90mg  Lysozyme 20mg	Medicon syrup (6ml t-qid) Dextrometho. 2.5mg/ml  K cresol sulfate 15mg/ml	Medicon A (1# tid) Medicon syrup  (6ml t-qid)	GI, 想睡
祛痰
Acetylcysteine	Flutafin (200/cap) Encore (300/3ml/amp)	化痰 (fluidify)
Ambroxol	Mubroxol (30)	使黏液fluidified 對喉嚨痛具抗發炎作用	1-2# b-tid
Bromhexine	Bisolvon (100mg/50ml/bt)	4-6ml PO tid 4ml bid 蒸氣吸入
KI powder	碘化鉀粉劑 (1gm/pk)	祛痰, erythema nodosum (x3-4wk)	1/3 pk tid (泡果汁或牛奶增加風味)	長期服用->goiter

氣喘藥

支氣管擴張劑
Xanthines	1) PDE4i, adenosine antagonist	2)↑HDAC histone deacetylase (低劑量)
Theophylline	Phyllocontin (225) Asiphylline (250/10ml/支)	Asthma, COPD, SSS  PO:225 (1#) qd-bid  Iv: 6mg/kg x20’, +   0.1-0.7mg/kg/h	C/I: uncontrol arrhythmia [副]: 心跳快, tremor, SZ
Dyphylline	Prophyllin (100)	1-2# t-qid	不需監測血中濃度 [副]: 心跳快, tremor,
β2 agonist
Procaterol	Meptin (25ug) Meptin liquid (5ug/ml, 60ml/bt)	2# (10ml) qd (hs)-bid	[副]: 心跳快, tremor, 口乾
Bambuterol	Lungtec (10)	1-2# qd	[副]: 心跳快, tremor,
Leukotriene receptor antagonist
Montelukast	Singulair (10mg, 5(咀嚼錠), 4/pk))	成人:1# qd 6-14y: 0.5# qd 6m-5y: 1 pk (4mg) qd
Mastocyte degranulation inhibitor (mast cell stabilizer, H1 blocker)
Ketotifen	Zaditen (1mg/#)	1-2# bid
Inhaler
Salbutamol (albuterol)	Ventolin MDI (100ug/puff, 200puff/bt)	急性氣喘:1 puff q20’ x3 ds, then q20’-4h 運動引發氣喘(EIB):  5-10’前吸2puff
Indacaterol	Onbrez (150ug/cap, 30 cap + breezhaler)	COPD: 1 puff qd
Tiotropium	Spiriva respimat (2.5ug/puff, 60 puff/Bt)	2 puff qd
Ciclesonide (steroid)	Alvesco MDI(160ug/ds, 60ds/bt)	中度dz: 1-2 ds qd 嚴重dz: 2-4 ds qd-bid
Fluticasone	Flixotide evolaher (乾粉吸入劑) (50ug/ds, 120ds/bt) Flixotide accuhaler (乾粉吸入劑) (250ug/ds, 60ds/bt)	50-500ug bid Stable-mild dz:  -100ug qd	多個嚴重adrenal crisis
Salmeterol / Fluticasone	Seretide evohaler 25/ 50ug per ds, 120ds/bt 成人:  Seretide evohaler 25/ 250ug per ds, 120/bt  Seretide accuhaler 50/250ug per ds, 60ds/bt	小孩(<12y): 25/50 1-2 puff bid >12y:  25-250ug 1-2 puff bid  50/250ug 1 puff bid
Formoterol (長效)/ Budesonide	Symbicort turbuhaler(乾粉吸入劑) 160ug/4.5ug, 120ds/bt	維持治療:  2 puff qd or 1-2 puff bid   (max 8-12 puff/d)
Nebulizer solution
Terbutaline	Bricanyl (5mg/2ml/UDV (unit ds vial)	5-10mg (1-2 vial) b-qid
Salbutamol/ ipratropium	Combivent (2.5/ 0.5/ 2.5ml/ UDV)	1 UDV t-qid
Budesonide	Pulmicort (1mg/2ml/unit ds)	1-2 unit qd-bid
Anti-IgE
Omalizumab	Xolair (150mg/vial)	1-2.5 vial SC q2-4wk, base on BW, IgE

	Evohaler (加壓噴霧劑型)	Accuhaler (胖胖魚); turbuhaler	Nebulizer霧化吸入劑
	劑量低	劑量高
	MDI劑型 -每壓1 puff產生一個定量噴霧藥劑	DPI劑型	-藥本身作成液體
	-壓下噴霧器	轉動device, 深吸氣	需使用高壓氧氣加壓使藥液霧化或機械霧化器完成給藥
	-慢速深吸然後閉氣	-快速深吸 -吸氣流量達30L/分以上	利用氣體加壓霧化,靠呼吸深入肺部
	-此噴霧藥劑經口鼻吸入到達氣管深部要注意憋氣五到十秒,有點類似局部加壓到氣管讓藥劑推進去肺部完成治療 -不會憋氣的患者要借重輔助器 -輔助吸入器可以使噴霧懸浮其中經過小朋友口鼻呼吸十數次送進去肺部	-是一個一個藥包~轉圈以後算是撕開藥包~接著靠自己的吸力把藥劑吸入氣管深部到達肺部~ -不會自動推出藥劑~所以沒辦法用輔助吸入器給藥	-無法有效使用前兩者劑型或是欲使藥效快速作用
輔助吸入器	有	無法用
	定量噴霧方式	靠自己深吸氣的力量, 將藥帶到肺
	6歲以下, 會憋氣10秒才可不用吸藥輔助器	6-12歲以上(有足夠深吸力) (年紀太小不會吸藥的小朋友沒辦法有效的使用)

肺Surfactant

Beractant (牛surfactant)	Survanta (200mg/ 8ml/vial)	嬰兒RDS 預防/治療

[F]: 消化系統藥物

Drugs for peptic ulcer

制酸劑
Polymerized Al(OH)3 hexitol complex
Ulcerin P (233mg) Al(OH)3		1-2# t-qid
Strocain	Oxethazine (5) Polymigel Al(OH)3, CaCO3, MgCO3 (244)	1-2# t-qid
Ulstal (10ml/pk)
Kolantyl