Drug Name	
Classification / Action	
Route /
Dosage
	
Contraindication	
Medication interaction	
Side Effects	
Indication for use	
Bactrim	Anti-infective, antiprotozoals

Folate antagonist, sulfonamides

Combination inhibits the metabolism of folic acid in bacteria at two different points	PO & IV – Mild to moderate infections: 6-12mg TMP/kg/day divided q12h
Serious infection/pneumocystitis:15-20mg TMP/kg/day
Divided q 6-8h	Hypersensitivity to sulfonamides or trimethoprim
Megaloblastic anemia secondary to folate deficiency
Severe renal impairment

Pregnancy, lactation, or children under 2 months of age	May increase half life, decrease clearance, and exaggerate folic acid deficiency caused by phenytoin.
May increase effects of sulfonylurea oral antidiabetics, phenytoin, digoxin, thiopental, and warfarin.
May increase toxicity of methotrexate	Hypotension, fatigue, hallucinations, headache, insomnia, mental depression, hyperkalemia, pseudomembranous colitis, hepatic necrosis, nausea, vomiting, diarrhea, stomatitis, hepatitis, cholestatic jaundice, pancreatitis, crystalluria, toxic epidermal necrosis, rashes, photosensitivity	Bacterial infections, urinary tract infection, traveller’s diarrhea, bronchitis, shigella enteritis, otitis media	
Cipro (Ciprofloxacin)	Anti-infective
Fluoroquinolones

Inhibits bacterial DNA synthesis by inhibiting DNA gyrase enzyme 	PO: 500-750mg q12h

IV: 400mg q12h

Gonorrhea: 250mg single dose	Hypersensitivity
OB – do not use unless potential benefit outweighs risk to fetus	Administration with antacids, iron salts, bismuth subsalicylate, sucralfate, and zinc salts decrease absorption.
May alter effects of warfarin.
Serum levels may be decreased by antineoplastics
Cimetidine may interfere with elimination
May increase risk of nephrotoxicity from cyclosporine
Concurrent use with foscarnet may increase risk of seizures
Concurrent therapy with corticosteroids may increase risk of tendon rupture	Dizziness, seizures, drowsiness, headache, insomnia, agitation, confusion, abdominal pain, pseudomembranous colitis, abdominal pain, diarrhea, abnormal liver enzymes, nausea, vaginitis, rash, hyperglycemia, hypoglycemia, eosinophilia, tendinitis, peripheral neuropathy, anaphylaxis	Urinary tract infections, gonorrhea, prostatitis, respiratory tract infections, skin and skin structure infections, bone and joint infections, infectious diarrhea, typhoid fever	
Macrobid (Nitrofurantoin)	Anti-infective

Interferes with bacterial synthesis	PO – Treatment of active infection: 50-100mg q6-8h or 100mg q12h as extended release product 
Treatment of chronic infection: 50-100mg single evening dose.

	Hypersensitivity, hypersensitivity to parabens, oliguria, anuria, or significant renal impairment, history of cholestatic jaundice or hepatic impariemtn with previous use of nitrofuranotin, pregnancy near term and infants under 1 month of age	Probenicid and sulfinpyrazone prevent high urinary concentrations; may decrease effectiveness.
Antacids may decrease absorption.
Increased risk of neurotoxicity with neurotoxic drugs.
Increased risk of hepatotoxicity with hepatotoxic drugs.
Increased risk of pneumonitis with drugs having pulmonary toxicity.	Dizziness, drowsiness, headache, nystagmus, pneumonitis, pulmonary fibrosis, chest pain, hepatotoxicity, pseudomembranous colitis, anorexia, nausea, vomiting, abdominal pain, diarrhea, rust/brown discoloration of urine, photosensitivity, blood dyscrasias, hemolytic anemia, peripheral neuropathy, hypersensitivity reactions.	Prevention and treatment of urinary tract infections caused by susceptible organisms; not effective in systemic bacterial infections.	
Pyridium (Phenazopyridine)	Nonopoid analgesic

Acts locally on the urinary tract mucosa to produce analgesic or local anesthetic effects

Has no antimicrobial activity	PO – 200mg 3 times daily for 2 days	Hypersensitivity, glomerulonephritis, severe hepatitis, uremia, or renal failure, renal insufficiency, glucose-6-phosphate dehydrogenase deficiency	No significant interactions	Headache, vertigo, hepatotoxicity, nausea, bright-orange urine, renal failure, rash, hemolytic anemia, methemoglobinemia	Provides relief from the following urinary tract symptoms:
Pain
Itching
Burning
Urgency
Frequency
	
Unasyn (Ampicillin/
Sulbactam)	Anti-infective

Binds to bacterial cell wall, resulting in cell wall death – broader spectrum than penicillin.	IM & IV – 1-2g ampicillin q6-8h 
(not to exceed 12mg ampicillin/day)	Hypersensitivity to penicillins or sulbactum	Probenicid decreases renal excretion and increases blood levels of ampicillin – therapy may be combined for this purpose.
May potentiate the effect of warfarin.
Concurrent allopurinol therapy (increased incidence of rash).
May decrease effectiveness of hormonal contraceptives.	Seizures (with high doses), pseudomembranous colitis, diarrhea, nausea, vomiting, rashes, urticaria, blood dyscrasias, pain at IM or IV site, allergic reactions 	Treatment of the following infections:
Skin and skin structure infections
Otitis media
Intra-abdominal infections
Sinusitis
Respiratory infections
Genitourinary infections
Meningitis
Septicemia	
Diflucan (Fluconazole)	Systemic antifungal

Inhibits synthesis of fungal sterols, a necessary component of the cell membrane	PO, IV – Oropharyngeal Candidiasis 200mg initially, then 100mg daily for at least 2 weeks
Esophageal Candidiasis: 200mg initially, then 100mg daily for at least three weeks – up to 400mg/day
Vaginal candidiasis: 150mg single dose	Hypersensitivity to fluconazole or other azole antifungals

Concurrent use with pimozide	Increase activity of warfarin.
Decreased levels with rifampin, rifabutin, and isoniazid.
Increased hypoglycemic effects of tolbutamide, glyburide, or glipizide.
Increase levels and risk of toxicity from cyclosporine, rifabutin, theophylline, phenytoin, alfentanil, zidovudine.
Increases levels and effects of benzodiazepines, tricyclic antidepressants, losartan, zolpidem, nisoldipine, tacrolimus.
May increase risk of bleeding with warfarin.
May antagonize effects of amphotericin B.	Headache, dizziness, seizures, hepatotoxicity, abdominal discomfort, diarrhea, nausea, vomiting, exfoliative skin disorders (stevens-johnson syndrome), hypokalemia, hypertriglyceridemia, allergic reactions	PO or IV – for fungal infections caused by susceptible organisms.
Candidiasis
Urinary tract infections
Peritonitis
Cryptococcal meningitis
Prevention of candidiasis in bone marrow transplant recipients

Treatment (single oral dose) for vaginal candidiasis
	
Flagyl (Metronidazole)	Anti-infective, antiprotozoals, antiulcer agents

Disrupts DNA and protein synthesis in susceptible organisms	PO – 7.5mg/kg q6h (anaerobic infections); 250mg q8h for 7 days or single 2g dose or 2 1g doses each day for 7 days (trichomoniasis); 250mg qid for 1-2 weeks (H. pylori)

IV – Initial dose 15mg/kg, then 7.5mg/kg q 6-8h or 500mg q6-8h

Do NOT exceed 4g/day

VAG (5g bid for 5 days)	Hypersensitivity	Cimitidine – may decrease metabolism
Phenobarbitol and rifampin – increase metabolism and may decrease effectiveness
Increased effects with phenytoin, lithium, and warfarin
May cause acute psychosis and confusion with disulfiram	CNS- Seizures, dizziness. GI- abdominal pain. NEURO- peripheral neuropathy. LOCAL- phlebitis at IV site.	Treats intra-abdominal infections, gynecologic infections, skin and skin structure infections, lower respiratory tract infections, bone/ joint infections, CNS infection, septicemia, and endocarditis. Also used to treat peptic ulcers and pseudomembranous colitis.	
O & B suppositories

Belladonna/ Opium Suppository	Opoid analgesic

Antispasmodic

This product is used to treat moderate to severe pain from spasms of the urinary tract.	1 suppository per rectum bid prn	Allergy to belladonna or opium, narcotic pain medications, or to atropine or scopolamine

Other allergies	Do not take with naltrexone.

Use caution with narrow angle glaucoma, myasthenia gravis, paralytic ileus, blockage
	Nausea, vomiting, constipation, blurred vision, increased eye discomfort in bright light, lightheadedness, dizziness, drowsiness, increased/decreased sweating, or dry mouth	Treatment of bladder spasms, diarrhea, intestinal cramps, tenesmus, rectal spasms.	
Demerol (Meperidine)	Opioid analgesic

Binds to opiate receptors in the CNS.  Alters the perception and response to painful stimulus and produces generalized CNS depression.	PO, SC, IM – General analgesia: 50mg q3-4h, may be increased as needed 

Not to exceed 600mg/24 hr

Continuous infusion: 35mg/hr as a continuous infusion 

PCA: 10mg initially, 1-5mg incremental dose (recommended lockout interval of 6-10min)	Hypersensitivity, hypersensitivity to bisulfites, recent MAO inhibitor therapy	Do not use in patients taking MAO therapy or procarbazine – FATAL REACTION POSSIBLE

Increased CNS depression with alcohol, antihistamines, and sedative or hypnotics.
Nalbuphine or pentazocine may decrease analgesia.
Protease inhibitors may increase metabolism and decrease effects.
Taking with kava-kava, valerian, or chamomile can reduce CNS depression.
Taking with St. John’s Wort may increase serious side effects, not recommended.
Chlorpromazine and thioridazine may increase risk of adverse reactions.	Seizures, confusion, sedation, dysphoria, euphoria, floating feeling, hallucinations, headache, unusual dreams, blurred vision, diplopia, miosis, respiratory depression, hypotension, bradycardia, constipation, nausea, vomiting, urinary retention, flushing, sweating, physical dependence, tolerance, and allergic reactions.	Moderate or severe pain, anesthesia adjunct, analgesic during labor, preoperative sedation	
Dilaudid (Hydromorphone)	Allergy, cough, and cold remedy (antitussive)

Opioid analgesic

Binds to opiate receptors in the CNS.
Alters perception and response to pain, producing generalized CNS depression.

Suppresses cough reflex via a direct central action.	PO: 4-8mg q3-4h (patients may respond to doses as low as 2mg initially)

IM, IV, SC: 1.5mg q3-4h PRN, may be increased

If under 50kg, 5mg/day maximum dose

Antitussive: 
PO – 1mg q3-4h	Exercise extreme caution with MAO inhibitors – use 25% of usual dose initially

Increased risk of CNS depression with alcohol, antidepressants, antihistamines, benzodiazepines, and phenothiazines.

Nalbuphine or pentazocine may decrease analgesia effects.

Concurrent use with kava-kava, valerian, chamomile or hops can increase CNS depression. 	Hypersensitivity
Hypersensitivity to bisulfites
Avoid chronic use during pregnancy and lactation	Confusion, sedation, dizziness, dysphoria, euphoria, floating feeling, hallucinations, headache, unusual dreams, blurred vision, diplopia, miosis, respiratory depression, hypotension, bradycardia, constipation, dry mouth, nausea, vomiting, urinary retention, flushing, sweating, physical and psychological dependence, tolerance	Moderate to severe pain

Antitussive (lower dose)	
Vicodin (hydrocodone)	Allergy, cough, and cold remedy (antitussive)

Opioid analgesic

Bind to opiate receptors in the CNS.  Alter response and perception to painful stimulus and produce generalized CNS depression.

Suppress cough reflex via direct central action.	PO: Analgesic: 2.5-10mg q 3-6h as needed

Do not exceed 4g acetaminophen per day with combination products

Do not exceed 5 tablets per day with ibuprofen combination products.

Antitussive:
5mg q4-6h	Exercise extreme caution with MAO inhibitors

Additive CNS depression with alcohol, antihistamines, and sedative/hypnotic.

Nalbuphine or pentazocine may decrease analgesia effects.

Concurrent use with kava-kava, valerian, chamomile or hops can increase CNS depression.	Hypersensitivity to hydrocodone
Hypersensitivity to acetaminophen or ibuprofen

Avoid chronic use in pregnant and lactation patients

Avoid ibuprofen containing products for patients with thrombocytopenia or bleeding disorders.

Avoid acetaminophen products for patients with severe hepatic or renal impairment.	Confusion, dizziness, sedation, euphoria, hallucinations, headache, unusual dreams, blurred vision, diplopia, miosis, respiratory depression, hypotension, bradycardia, constipation, dyspepsia, nausea, vomiting, urinary retention, sweating, physical or psychological dependence, tolerance	Used mainly in combination with nonopioid analgesics in the management of moderate to severe pain

Antitussive (in combination with decongestant products)