Hospitals initial response

Heller, W. M. (1993). Initial responses to recommendations of the blue-ribbon committee on generic medicines. American Journal of Hospital Pharmacy, 50, 318-321. 

The initial response at hospital to an incident involving contamination... 

Patients with incomplete responses should contact their health care provider immediately for instructions, while those with a poor response should proceed directly to the emergency department.1 In the emergency department, baseline PEF measurements and oxygen saturation should be monitored. PEF should be monitored before and 15 to 20 minutes after bronchodilator administration. Treatment should be initiated as soon as lung function is assessed (Fig. 11-3). Dosages for emergency department and hospital use of quick relief medications are shown in Table 11-5. 

Children Divide daily dosage and administer equal doses every 6 hours or at intervals according to patient needs. Closely monitor plasma levels and therapeutic response. Hospitalize patients during initial treatment and start dose titration at the... 

Slow continuous infusion - Give at a rate of 3 mL/min (2 mg/min). Continue infusion until satisfactory response is obtained then discontinue infusion and start oral labetalol. Effective IV dose range is 50 to 200 mg, up to 300 mg. Transfer to oral dosing (hospitalized patients) Begin oral dosing when supine diastolic BP begins to rise. Recommended initial dose is 200 mg, then 200 or 400... 

Hospitalized patients Initially, 100 orally in divided doses gradually increase to 200 mg/day, as required. If no response occurs after 2 weeks, increase to 250 to 300 mg/day. Administer the total daily dosage once/day at bedtime. 

Adult hospitalized patients - Initially, 100 mg/day in divided doses, increased gradually in a few days to 200 mg/day depending upon individual response and tolerance. If improvement does not occur in 2 to 3 weeks, increase to a maximum dose of 250 to 300 mg/day. 

Isosorbide Dinitrate Hydralazine (BiDil) [Antianginal, Antihypertensive/Vasodilator, Nitrate] Uses HF in African Amer-icans improve survival functional status, prolong time between hospitalizations Action Relaxes vascular smooth muscle peripheral vasodilator Dose Initially 1 tab tid PO (if not tol ated reduce to 1/2 tab tid), titrate >3-5 d as tolerated Max 2 tabs tid Caution [C, /-] recent MI, syncope, hypovolemia, hypotension, hep impair Contra For children, concomitant use w/ PDE5 inhibitors (sildenafil) Disp Tabs SE HA, dizziness, orthostatic hypotension, sinusitis, GI distress, tach, paresthesia, amblyopia Interactions t Risk of severe hypotension W/ antihypertensives, ASA, CCBs, MAOIs, phenothiazides, sildenafil, tadalafil, vardenafil, EtOH X pressor response Wf i -1- effects W7 NSAIDs EMS Use ASA, antihypertensives and CCBs w/ caution, may t hypotension concurrent Viagra-type drug use can lead to profound hypotension concurrent EtOH use can t effects OD May cause N/V, profound hypotension, skin flushing, HA from ICP, bradycardia, confusion, and circulatory collapse activated charcoal may be effective, epi use is contraindicated... 

The duration of treatment required to assess response is longer than for most medications—that is, typically 3-6 months (Meltzer 1994). The patient and tlie family must understand this time frame before clozapine therapy is initiated. If patients are nonresponsive after 6 months of continuous clozapine treatment, the dose may be gradually increased to a maximum of 900 mg/day. Not uncommonly, patients may not have significant reduction in symptoms with clozapine therapy, but review of their course over a 6-month or 1-year period shows a dramatic reduction in rates of relapse and hospitalization. 

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