A Lange Medical Book Pediatrics on call - part 10 pot

Notes: Give maintenance dose 12 hours after loading dose. Tolerance develops to sedation. Long half-life allows single daily dosing. Follow levels as needed; therapeutic range 15–40 mcg/mL. PHENYLEPHRINE (NEO-SYNEPHRINE) Indications: Vascular failure in shock, hypersensitivity, or drug-induced hypotension; nasal congestion; mydriatic. Actions: α-Adrenergic agonist. Dosage: Mild to moderate hypotension: 2–5 mg IM or SQ elevates BP for 2 hours; 0.1–0.5 mg IV elevates BP for 15 minutes. Severe hypotension or shock: Children: 5–20 mcg/kg per dose IV q10–15min prn or 0.1–0.5 mcg/kg/min continuous IV infusion; Adults: 0.1–0.5 mg per dose q10–15min prn or continuous IV infusion at 100–180 mcg/min; once stabilized, lower to maintenance rate of 40–60 mcg/min. Nasal congestion: Infants > 6 months: 1–2 drops of 0.16% q3h; Children 1–6 years: 2–3 drops of 0.125% q4h prn; Children 6–12 years: 2–3 drops of 0.25% q4h prn; Children > 12 years and adults: 2–3 drops or 1–2 sprays of 0.25–0.5% solution q4h into each nostril prn. Ophthalmologic: Infants < 1 year: 1 drop of 2.5% 15–30 minutes before exam; Children and adults: 1 drop of 2.5% or 10% solution, may repeat in 10–60 minutes as needed. Supplied: Injection 10 mg/mL; nasal solution* 0.125%, 0.16%, 0.25%, 0.5%, 1%; ophthalmic solution* 0.12%, 2.5%, 10%. Notes: Promptly restore blood volume if loss has occurred. Use with extreme caution in patients with hyperthyroidism, bradycardia, partial heart block, myocardial disease, or severe arteriosclerosis. Use large veins for infusion to avoid extravasation; phentolamine 10 mg in 10–15 mL of NS may be injected locally as antidote for extravasation. Activity of drug is potentiated by oxytocin, MAO inhibitors, and tricyclic antidepressants. PHENYTOIN (DILANTIN) Indications: Seizure disorders. Actions: Inhibits seizure spread in motor cortex. Dosage: Neonates: Load 15–20 mg/kg IV in single or divided dose fol- lowed by maintenance dose of 5–8 mg/kg/day divided q8–12h. Infants, children, and adults: Load 15–20 mg/kg IV at max infusion rate of 25 mg/min in single or divided dose followed by age-dependent main- tenance dose: • 0.5–3 years: 8-10 mg/kg/day. • 4–6 years: 7.5–9 mg/kg/day. 2. GENERIC DRUGS 709 710 VIII: COMMONLY USED MEDICATIONS • 7–9 years: 7–8 mg/kg/day. • 10–16 years: 6–7 mg/kg/day. • Adolescents > 15 years and adults: 300 mg/day or 4–6 mg/kg/day in 2–3 divided doses; Oral dosing same as IV. Supplied: Capsules 30 mg, 100 mg; chewable tablet 50 mg; oral suspen- sion 125 mg/5 mL; injection 50 mg/mL. Notes: Be alert for cardiac depressant side effects, especially with IV administration; follow levels as needed. Nystagmus and ataxia are early signs of toxicity. Gum hyperplasia occurs with long-term use. Avoid use of oral suspension if possible because of erratic absorption. Some patients may require q8h dosing. PHOSPHATE SUPPLEMENTS Indications: Treatment and prevention of hypophosphatemia; short-term treatment of constipation; urinary acidifier for reduction in formation of cal- cium stones. Actions: Participates in bone deposition and calcium metabolism; acts as buffer in acid-base equilibrium; acts as laxative by exerting osmotic effect in small intestine. Dosage: Hypophosphatemia: Children: 0.08–0.36 mmol/kg IV over 6 hours; Adults: 0.16–0.64 mmol/kg IV over 6–12 hours; Maintenance: Children: 0.5–1.5 mmol/kg/day IV or 2–3 mmol/kg/day PO in divided doses; Adults: 50—70 mmol/day IV or 50–150 mmol/day PO in divided dose. Laxative: Children < 4 years: 250 mg (8 mmol) PO 4 times daily; Children ≥ 4 years and adults: 250–500 mg (8–16 mmol) PO 4 times daily; Oral solution: Children 5–9 years: 5 mL PO 1 time; Children 10–12 years: 10 mL PO 1 time; Children > 12 years and adults: 20–30 mL PO 1 time. Enema: Children 2–11 years: One 2.25-oz pediatric enema 1 time; Children > 12 years and adults: One 4.5-oz adult enema 1 time. Urinary acidification: Adults: 2 tablets PO 4 times daily. Supplied: Tablet phosphorous 114 mg (3.7 mmol), 125.6 mg (4 mmol), 250 mg (8 mmol); enema pediatric (66 mL) or adult (133 mL); injection as potassium or sodium phosphate 3 mmol phosphate per mL; powder phos- phorous 250 mg (8 mmol) per packet; oral solution phosphate 4 mmol and sodium 4.82 mEq per mL. Notes: Give with food to reduce risk of diarrhea. Dilute each packet in 75 mL of water. Maintain adequate fluid intake. Max rate of IV infusion is 0.06 mmol/kg/h. PHYSOSTIGMINE (ANTILIRIUM, ISOPTO ESERINE) Indications: Antidote for tricyclic antidepressant, atropine, and scopo- lamine overdose. Actions: Reversible cholinesterase inhibitor. Dosage: Reversal of toxic anticholinergic effects: Children: 0.01–0.03 mg/kg per dose IV, may repeat after 15–20 min to max total dose of 2 mg; Adults: 2 mg IV, IM, or SQ q20min until response occurs. Preanesthetic reversal: Children and adults: Twice the dose, on a weight basis, of the anticholinergic drug (atropine, scopolamine). Supplied: Injection 1 mg/mL. Notes: Rapid IV administration is associated with convulsions. Max rate of infusion is 0.5–1 mg/min. Has cholinergic side effects; may cause asystole. PHYTONADIONE (VITAMIN K) (AQUAMEPHYTON, OTHERS) Indications: Coagulation disorders caused by faulty formation of factors II, VII, IX, and X; hemorrhagic disease of newborn; oral anticoagulant overdose. Actions: Supplementation; needed for production of factors II, VII, IX, and X. Dosage: Hemorrhagic disease of newborn: Prophylaxis: 0.5–1 mg SQ or IM within 1 hour of birth; Treatment: 1–2 mg/day SQ or IM. Oral anticoagulant overdose: Infants and children: 0.5–5 mg SQ or IV; Adults: 2.5–10 mg PO or IV. Vitamin K deficiency: Infants and children: 2.5–5 mg PO daily or 1–2 mg SQ, IM, or IV; Adults: 2.5–25 mg PO daily or 10 mg SQ, IM, or IV. Supplied: Tablet 5 mg; injection 2 mg/mL, 10 mg/mL. Notes: With parenteral treatment, first change in prothrombin is usually seen in 12–24 hours. SQ route is preferred. Anaphylaxis can result from IV dosage; drug should therefore be administered slowly if IV route is used. PILOCARPINE (ISOPTO CARPINE, PILOCAR, PILOPINE HS GEL) (SEE TABLE VIII–6, P. 748) PIPERACILLIN (PIPRACIL) Indications: Serious infections caused by susceptible strains of gram- positive, gram-negative (including Pseudomonas aeruginosa), and anaer- obic bacilli. 2. GENERIC DRUGS 711 712 VIII: COMMONLY USED MEDICATIONS Actions: Inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins. Dosage: Infants and children: 200–300 mg/kg/day IV divided q4–6h, max 24 g/day; Adults: 2–4 g IV q4–8h, max 24 g/day. Supplied: Powder for reconstitution 2 g, 3 g, 4 g. Notes: Reduce dose in patients with renal dysfunction. Use with caution in patients allergic to cephalosporins. PIPERACILLIN AND TAZOBACTAM (ZOSYN) Indications: Sepsis; gynecologic, intra-abdominal, skin and skin structure, and lower respiratory infections; and UTIs caused by piperacillin- resistant, β-lactamase–producing strains that are piperacillin-tazobactam susceptible. Actions: Inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins; tazobactam prevents degradation of piperacillin by binding to β-lactamases. Dosage: Infants and children: 240–400 mg/kg/day of piperacillin IV divided q6–8h, max 18 g/day; Adults: 3.375 g (3 g piperacillin/0.375 g tazobactam) IV q6h, max 18 g/day. Supplied: Injection 2.25 g, 3.375 g, 4.5 g. Notes: Reduce dose in patients with renal dysfunction. Use with caution in patients who are allergic to cephalosporins. 8:1 ratio of piperacillin to tazobactam. PNEUMOCOCCAL CONJUGATE VACCINE, 7 VALENT (PREVNAR) (SEE APPENDIX D, P. 759) PNEUMOCOCCAL VACCINE, POLYVALENT (PNEUMOVAX-23) (SEE APPENDIX D, P. 759) POLIOVIRUS VACCINE, INACTIVATED (SEE APPENDIX D, P. 759) POLYETHYLENE GLYCOL [PEG]-ELECTROLYTE SOLUTION (GOLYTELY, MIRALAX) Indications: Bowel cleansing prior to examination or surgery. Actions: Osmotic cathartic. Dosage: Bowel cleansing: Children: 25–40 mL/kg/h PO or NG until rectal effluent is clear; Adults: 240 mL PO q10min until 4 L consumed or rectal effluent is clear. Constipation (MiraLax): 17 g PO daily. Supplied: Powder for reconstitution in 4 L container; MiraLax 17 g/tbsp. Notes: No solid foods 2 hours prior to administration. First bowel move- ment should occur in approximately 1 hour. Solution may cause some cramping or nausea. POLYMYXIN B AND HYDROCORTISONE (OTOBIOTIC OTIC) Indications: Superficial bacterial infections of external ear canal. Actions: Antibiotic anti-inflammatory combination. DOSAGE: 4 drops in ear(s) 3–4 times daily. Supplied: Solution: Polymyxin B 10,000 units/hydrocortisone 0.5%/mL. Notes: Useful in neomycin allergy. POTASSIUM CITRATE AND CITRIC ACID (POLYCITRA-K) Indications: Alkalinization of urine; prevention of urinary stones (uric acid, calcium stones if hypocitraturic). Actions: Urinary alkalinizer. Dosage: Infants and children: 2–3 mEq/kg/day PO divided 3–4 times daily; Adults: 10–20 mEq PO 3 times daily with meals, max 100 mEq/day. Supplied: Solution 2 mEq/mL potassium and 2 mEq/mL bicarbonate. POTASSIUM IODIDE (LUGOL’S SOLUTION, SSKI) Indications: Thyroid crisis; reduction of vascularity before thyroid surgery; blocking thyroid uptake of radioactive isotopes of iodine; thinning of bronchial secretions; sporotrichosis. Actions: Iodine supplement. Dosage: Preoperative thyroidectomy: Children and adults: 50–250 mg (1–5 drops SSKI; or 2–6 drops Lugol’s solution) PO 3 times daily for 10 days prior to surgery. Thyroid crisis: Infants < 1 year: 150–250 mg (3–5 drops SSKI) PO 3 times daily; Children and adults: 300–500 mg (6–10 drops SSKI) PO 3 times daily. Expectorant: Children: 60–250 mg PO 4 times daily; Adults: 300–650 mg PO 3–4 times daily. Sporotrichosis: Children and adults: 250–500 mg PO 3 times daily. 2. GENERIC DRUGS 713 714 VIII: COMMONLY USED MEDICATIONS Supplied: Tablets 60 mg, 130 mg; solution SSKI 1 g/mL; Lugol’s solution, strong iodine: potassium iodide 100 mg and iodine 50 mg per mL; syrup 325 mg/5 mL. Notes: 10 drops SSKI = 500 mg potassium iodide. POTASSIUM SUPPLEMENTS (KAON, KAOCHLOR, K-LOR, SLOW-K, MICRO-K, KLORVESS, OTHERS) Indications: Prevention or treatment of hypokalemia (often related to diuretic use). Actions: Supplementation of potassium. Dosage: Treatment of hypokalemia: • Oral: Infants and children: 2–5 mEq/kg/day in divided doses; Adults: 40–100 mEq/day in divided doses. • IV intermittent infusion: Infants and children: 0.5–1 mEq/kg per dose IV over 30–60 minutes; Adults: 10–20 mEq IV over 2–3 hours, max 40 mEq per dose. Supplied: As potassium chloride: Sustained-release tablets 8 mEq, 10 mEq, 20 mEq; sustained-release capsules 8 mEq, 10 mEq; liquid 10 mEq/15 mL, 20 mEq/15 mL, 30 mEq/mL, 40 mEq/15 mL; powder packets 20 mEq, 25 mEq; effervescent tablets as potassium bicarbonate 25 mEq. Notes: Must dilute prior to use. Maximum concentration via peripheral line is 80 mEq/mL; via central line, 200 mEq/mL. Maximum infusion rate is 1 mEq/kg/h. Oral supplements can cause GI irritation. Powder and liquids must be mixed with water or juice. Use with caution in patients with renal insufficiency, and along with NSAIDs, potassium-sparing diuretics, and ACE inhibitors. Chloride salt is recommended in patients with coexisting alkalosis; for coexisting acidosis use acetate, bicarbonate, citrate, or glu- conate salt. PRAMOXINE (ANUSOL OINTMENT, PROCTOFOAM-NS, OTHERS)* Indications: Pain and itching from external and internal hemorrhoids and anorectal surgery; topical for burns and dermatosis. Actions: Topical anesthetic. Dosage: Apply cream, ointment, gel, or spray freely to anal area q3–4h. Supplied: Foam (Proctofoam NS) 1%; cream 1%; ointment 1%; lotion 1%; gel 1%; pads 1%; spray 1%. PRAMOXINE AND HYDROCORTISONE (ENZONE, PROCTOFOAM-HC) Indications: Pain and itching from hemorrhoids. Actions: Topical anesthetic. Dosage: Apply freely to anal area 3–4 times daily. Supplied: Cream: Pramoxine hydrochloride 1% hydrocortisone acetate 0.5/1%; Foam: Pramoxine 1% hydrocortisone 1%; Lotion: Pramoxine 1% hydrocortisone 0.25/1/2.5%; pramoxine 2.5% and hydrocortisone 1%. Prazosin (Minipress) Indications: Hypertension; congestive heart failure. Actions: Peripherally acting α-adrenergic blocker. Dosage: Children: Initial 5 mcg/kg per dose, increase gradually up to 25 mcg/kg per dose PO q6h, max dose 15 mg/day; Adults: 1 mg PO 3 times daily, may increase to total daily dose of up to 20 mg/day. Supplied: Capsules 1 mg, 2 mg, 5 mg. Notes: May cause orthostatic hypotension; therefore, patient should take first dose at bedtime. Tolerance develops to this effect. Tachyphylaxis may result. PREDNISOLONE (PEDIAPRED, PRELONE, ORAPRED) Indications: Endocrine disorders; rheumatic disorders; collagen diseases; der- matologic diseases; allergic states;ophthalmic diseases; respiratory diseases; hematologic disorders; neoplastic diseases; edematous states; GI diseases. Actions: Anti-inflammatory. Dosage: Children: 0.1–2 mg/kg/day PO in divided doses; Adults: 5–60 mg/day PO. Supplied: Tablet 5 mg; syrup 5 mg/5 mL, 15 mg/5 mL. Notes: Administer after meals or with food to decrease GI upset. PREDNISOLONE (AK-PRED, PRED FORTE) (SEE TABLE VIII–6, p. 754) PREDNISONE (DELTASONE) Indications: Management of adrenocortical insufficiency, used for anti- inflammatory or immunosuppressant effects. 2. GENERIC DRUGS 715 716 VIII: COMMONLY USED MEDICATIONS Actions: Anti-inflammatory. Dosage: Anti-inflammatory or immunosuppressive: Children: 0.1–2 mg/kg/day PO in divided doses; Adults: 5–60 mg/day PO. Supplied: Tablets 1 mg, 2.5 mg, 5 mg, 10 mg, 20 mg, 50 mg; oral solution 1 mg/1 mL, 5 mg/mL. Notes: Dose depends on condition being treated and patient response. Administer after meals or with food to decrease GI upset. PRIMIDONE (MYSOLINE) Indications: General tonic-clonic, complex partial, and simple partial seizures. Actions: Decreases neuron excitability; raises seizure threshold. Dosage: Children < 8 years: Initial 50–125 mg/day PO at bedtime; increase by 50–125 mg/day increments every 3–7 days; usual dose 10–25 mg/kg/day divided 3–4 times daily. Children ≥ 8 years and adults: Initial 125–250 mg/day PO at bedtime; increase by 125–250 mg/day every 3–7 days; usual dose 750–1500 mg/day divided 3–4 times daily, max 2 g/day. Supplied: Tablets 50 mg, 250 mg. Notes: Metabolized in liver to phenobarbital. Monitor both primidone and phenobarbital concentrations. Therapeutic level is 5–12 mcg/mL. PROCAINAMIDE (PRONESTYL, PROCAN) Indications: Supraventricular and ventricular arrhythmias. Actions: Class 1a antiarrhythmic. Dosage: Children: 15–50 mg/kg/day PO in divided doses q3–6h, max 4 g/day; Adults: Immediate release: 250–500 mg PO q3–6h; Sustained- release: 500 mg to 1 g PO q6h. Intravenous loading dose: Children: 3–6 mg/kg per dose over 5 minutes, max 100 mg per dose, followed by continuous IV infusion of 20–80 mcg/kg/min; Adults: 50–100 mg IV load followed by infusion of 1–6 mg/min. Supplied: Tablets 250 mg, 375 mg, 500 mg; capsules 250 mg, 500 mg; sustained-release tablets 500 mg, 750 mg, 1000 mg; injection 100 mg/mL, 500 mg/mL. Notes: Titrate to patient’s response. Can cause hypotension and lupus- like syndrome. Adjust dose in patients with renal or hepatic impairment. PROCHLORPERAZINE (COMPAZINE) Indications: Nausea and vomiting; agitation; psychotic disorders. Actions: Phenothiazine; blocks postsynaptic mesolimbic dopaminergic receptors in brain. Dosage: Antiemetic: Children > 10 kg: 0.4 mg/kg/day PO or PR divided 3–4 times daily; Adults: 5–10 mg PO 3–4 times daily; or 25 mg PR twice daily; or 5–10 mg deep IM q4–6h, max 40 mg/day. Antipsychotic: Children 2–12 years: 2.5 mg PO or PR 2–3 times daily, increase to max dose prn of 20 mg for 2–5 years or 25 mg for 6–12 years; Adults: 10–20 mg IM in acute situations; or 5–10 mg PO 3–4 times daily for maintenance. Supplied: Tablets 5 mg, 10 mg; sustained-release capsules 10 mg, 15 mg; syrup 5 mg/5 mL; suppositories: 2.5 mg, 5 mg, 25 mg; injection 5 mg/mL. Notes: Much larger dose may be required for antipsychotic effect. Extrapyramidal side effects are common. Treat acute extrapyramidal reac- tions with diphenhydramine. Not recommended for IV use. PROMETHAZINE (PHENERGAN) Indications: Management of nausea and vomiting and motion sickness; symptomatic treatment of various allergic conditions; sedative. Actions: Phenothiazine; blocks postsynaptic mesolimbic dopaminergic receptors in brain. Dosage: Antihistamine: Children: 0.1 mg/kg per dose (max 12.5 mg per dose) PO q6h during the day and 0.5 mg/kg per dose (max 25 mg per dose) at bedtime prn; Adults: 6.25–12.5 mg PO 3 times daily and 25 mg at bedtime. Antiemetic: Children: 0.25 mg to 1 mg/kg PO, PR, IM, or IV (max 25 mg per dose) 4–6 times daily prn; Adults: 12.5–25 mg PO, PR, or IM q4h prn. Motion sickness: Children: 0.5 mg/kg (max 25 mg per dose) PO or PR 30 minutes to 1 hour prior to departure, then q12h prn; Adults: 25 mg PO twice daily with first dose 30 minutes to 1 hour prior to departure, then q8–12h prn. Sedation: Children: 0.5–1 mg/kg per dose PO, PR, IM, IV (max 50 mg per dose) q6h prn; Adults: 25–50 mg PO, PR, IM, or IV q4–6h prn. Supplied: Tablets 25 mg, 50 mg; syrup 6.25 mg/5 mL; suppositories 25 mg, 50 mg; injection 25 mg/mL, 50 mg/mL. Notes: High incidence of drowsiness. 2. GENERIC DRUGS 717 [...]... of patients have stone recurrence after dissolution Effect of drug is decreased in combination with aluminum-containing antacids and cholestyramine VALPROIC ACID AND DIVALPROEX (DEPAKENE, DEPAKOTE) Indications: Epilepsy; prophylaxis of migraines Actions: Anticonvulsant; increases availability of gamma-aminobutyric acid (GABA) Dosage: Seizures: Children and adults: • Oral: Initial 10 15 mg/kg/day in... cardiac effects than pancuronium Reduce in patients with hepatic dysfunction Concomitant analgesia or sedation is required VERAPAMIL (CALAN, ISOPTIN) Indications: Angina; essential hypertension; arrhythmias (paroxysmal supraventricular tachycardia [PSVT], atrial fibrillation, atrial flutter) Actions: Calcium channel blocker Dosage: Arrhythmias (SVT): Children 1–16 years: 0.1–0.3 mg/kg per dose IV, max... TRIAMCINOLONE (AZMACORT, NASACORT) Indications: Chronic treatment of asthma Actions: Topical steroid Dosage: Intranasal: Children 6–12 years: 2 sprays each nostril once daily, titrate to response; Children > 12 years and adults: 2 sprays each nostril once daily, may increase to 4 sprays each nostril in 4–7 days, maintenance dose may be given in 1–4 divided doses Oral inhalation: Children 6–12 years:... bladder cancer; preparative for allogeneic and autologous bone marrow transplantation Actions: Antineoplastic alkylating agent Dosage: Refer to individual protocols Supplied: Powder for injection 15 mg Notes: Toxicity includes myelosuppression, nausea, vomiting, dizziness, headache, allergy, and paresthesias TIAGABINE (GABITRIL) Indications: Adjunctive therapy in treatment of partial seizures Actions:... mg/kg/day IV divided q4–6h, max 24 g/day; Adults: 1–4 g IV q4–6h, max 24 g/day Supplied: Powder for injection 3 g Notes: Adjust dose in patients with renal impairment 2 GENERIC DRUGS 731 TICARCILLIN AND POTASSIUM CLAVULANATE (TIMENTIN) Indications: Serious gram-negative infections caused by Pseudomonas, Proteus, E coli, and Enterobacter Actions: Antipseudomonal penicillin and beta-lactamase combination antibiotic... Supplied: Capsule 100 mg; solution 80 mg/mL Notes: Titrate dose over 1 week to avoid GI complications; should be taken with food Has many drug interactions; may cause perioral and peripheral paresthesias Store in refrigerator ROCURONIUM (ZEMURON) Indications: Skeletal muscle relaxation during rapid-sequence intubation, surgery, or mechanical ventilation Actions: Nondepolarizing neuromuscular blockade Dosage:... sticks, 10% ointment, 10% , 25%, 50% solution Notes: May stain tissue black; usually resolves SILVER SULFADIAZINE (SILVADENE) Indications: Prevention of sepsis in second- and third-degree burns Actions: Bactericidal Dosage: Aseptically cover affected area with 1/16-inch coating twice daily Supplied: Cream 1% Notes: Can have systemic absorption with extensive application SIMETHICONE (MYLICON)* Indications:... Notes: Adverse reactions are rate related; anaphylactic medications should be available Live virus vaccines should be deferred until 9 months after last dose RIBAVIRIN (VIRAZOLE) Indications: Respiratory syncytial virus; influenza A and B; hepatitis C; adenovirus Actions: Inhibits DNA and RNA virus replication Dosage: Aerosolization: 6 g diluted in 300 mL sterile water or NS for 12–18 h/day for 3–7 days... use vitamin K or fresh-frozen plasma, or both Drug is highly teratogenic; do not use in pregnancy Caution patients who take warfarin with other medications, especially aspirin Common warfarin drug interactions: Potentiated by: Acetaminophen, alcohol (with liver disease), amiodarone, cimetidine, ciprofloxacin, co-trimoxazole, erythromycin, fluconazole, isoniazid, itraconazole, metronidazole, omeprazole,... shell, and bone meal as they may contain heavy metal contamination (lead, arsenic) Caffeine and cigarette smoking may reduce calcium absorption Hyperthyroidism, diabetes mellitus, use of corticosteroids, and use of loop diuretics all either reduce calcium absorption or increase excretion Calcium supplementation should be strongly considered in these cases Vitamin D plus calcium combination decreases fracture . impairment. SODIUM BICARBONATE Indications: Alkalinization of urine; renal tubular acidosis (RTA); treatment of metabolic acidosis; hyperkalemia. Dosage: Emergency cardiac care: Initiate adequate ventilation,. Solution may cause some cramping or nausea. POLYMYXIN B AND HYDROCORTISONE (OTOBIOTIC OTIC) Indications: Superficial bacterial infections of external ear canal. Actions: Antibiotic anti-inflammatory. bowel. SPIRONOLACTONE (ALDACTONE) Indications: Hyperaldosteronism; essential hypertension; edematous states (congestive heart failure, cirrhosis, nephrotic syndrome). Actions: Aldosterone antagonist; potassium-sparing