Chapter 52: Medication and Dosing

ABSTRACT

This chapter is a tabular list of commonly used medications on the neurology wards for quick reference in text and table formats. A working pharmacotherapy knowledge base is essential to dosing and optimizing patient care. This chapter is intended to highlight practical dosing considerations and common problems associated with the pharmacologic management of patients with neurologic disorders. Pain management, cardiac medications including blood pressure management, antiplatelets, and anticoagulants are covered in this chapter. In addition, antidepressants, antipsychotics, antiepileptic drugs, and agents for the treatment of inflammatory and demyelinating diseases are covered in more detail. A complete discussion of the pharmacology and pharmacokinetics of all medications highlighted is beyond the scope of this chapter. Thus, this will not replace available tertiary references or the most valuable medication reference, the clinical pharmacist. The addition of a clinical pharmacist can provide you with further dosing and medication management considerations.

INTRODUCTION

A working pharmacotherapy knowledge base is essential to optimizing patient care. This chapter is intended to highlight practical dosing considerations and common problems associated with the pharmacologic management of patients with neurologic disorders. A complete discussion of the pharmacology and pharmacokinetics of all medications highlighted is beyond the scope of this chapter. Thus, this will not replace available tertiary references or the most valuable medication reference, the clinical pharmacist. The addition of a clinical pharmacist has demonstrated improvement in clinical and cost-savings outcomes in a variety of settings. They are a vital part of interdisciplinary medicine and should routinely participate in clinical activities when available.

MEDICATIONS COMMONLY UTILIZED IN THE MANAGEMENT OF GENERAL MEDICAL DISORDERS

Pain and analgesia

Nonsteroidal anti-inflammatory drugs (NSAIDs)

• Key features

  • NSAIDs provide analgesic, anti-inflammatory, and antipyretic effects.

  • Ibuprofen

    • Dose:

      • IV (Caldolor): 400–800 mg every 6 hours as needed; maximum 3200 mg daily

      • PO: 200–400 mg every 4–6 hours; maximum 2400 mg daily

    • Avoid in patients with moderate-to-severe renal dysfunction, hyperkalemia, history/active peptic ulcer disease/gastrointestinal (GI) bleeding, high risk of bleeding, and perioperative analgesia in the setting of coronary artery bypass graft (CABG)

  • Naproxen

    • Dose:

      • PO: 220 mg every 8 hours; maximum 660 mg/day

    • Avoid use in patients with CrCl <30 mL/min, hyperkalemia, history/active peptic ulcer disease/GI bleeding, high risk of bleeding, and perioperative analgesia in the setting of CABG

  • Ketorolac (Toradol)

    • Intended for short-term use; maximum combined 5 days of treatment (parenteral and oral)

    • Dose:

      • Patients <65 years old: IV, IM: 30 mg every 6 hours; maximum 120 mg daily; PO: 10 mg every 4 hours as needed; maximum 40 mg daily

      • Patients >65 years old and/or <50 kg and/or mild-to-moderate renal dysfunction: IV, IM: 15 mg every 6 hours as needed; maximum 60 mg daily; PO: 10 mg every 4 hours as needed; maximum 40 mg daily

    • Contraindicated in patients with hypersensitivity to NSAIDs (including aspirin), severe renal dysfunction, high risk of bleeding, ...