HEPARIN (GENERIC)
USES: *Treat & prevention of DVT & PE*, unstable angina, AF w/ emboli, & acute arterial occlusion.
ACTIONS: Acts w/ antithrombin III to inactivate thrombin & ↓ thromboplastin formation.
DOSE:
Adults: Prophylaxis: 3,000–5,000 U SQ q8–12h. DVT/PE Treat: Load 50–80 U/kg IV (max. 10,000 U), then 10–20 U/kg IV qh (adjust based on PTT).
Peds/Infants: Load 50 U/kg IV bolus, then 20 U/kg/h IV by cont Inf. Children: Load 50 U/kg IV, then 15–25 U/kg cont Inf or 100 U/kg/dose q4h IV intermittent bolus (adjust based on PTT).
W/P: [C, +] ↑ Risk of hemorrhage w/ anticoagulants, ASA, anti-plt, cephalosporins w/ MTT side chain.
CI: Uncontrolled bleeding, severe thrombocytopenia, suspected ICH.
DISP: Unfractionated Inj 10, 100, 1,000, 2,000, 2,500, 5,000, 7,500, 10,000, 20,000, 40,000 U/mL.
SE: Bruising, bleeding, thrombocytopenia.
NOTES: Follow PTT, thrombin time, or activated clotting time; little PT effect; therapeutic PTT 1.5–2 control for most conditions; monitor for heparin-induced thrombocytopenia w/ plt counts; new “USP” formulation heparin is ∼10% less effective than older formulations.
HEXAMINOLEVULINATE (CYSVIEW)
USES: *An optical imaging agent used in the cystoscopic detection of nonmuscle invasive papillary cancer of the bladder in patients suspected or known to have lesion(s) on the basis of a prior cystoscopy. Used with the Karl Storz D-Light C photodynamic diagnostic (PDD) system to perform cystoscopy with blue (360–450 nm) and white light.
ACTIONS: An ester of the heme precursor, aminolevulinic acid; concentrates in abnormal cells and fluoresces red under blue light.
DOSE: 50 mL instilled intravesically; cysto 30 min after evacuation of Cysview, but no less than 1 or more than 3 hr after instillation.
W/P: [C, −] Not a replacement for random bladder biopsies; not for repetitive use; false positive fluorescence: inflammation, cystoscopic trauma, scar tissue or previous bladder biopsy.
CI: Porphyria, gross hematuria, BCG or intravesical chemo w/in 90 days; hypersensitivity product.
DISP: Kit w/ 100 mg Cysview and 50 mL diluent.
SE: Bladder spasm, dysuria, hematuria, bladder pain, procedural pain, urinary retention, headache, anaphylaxis.
NOTES: Perform a complete cysto under white light and then under blue light. Document information about location and appearance of suspicious lesions and areas seen under both white and blue lights. Abnormalities of the bladder mucosa during blue light cystoscopy are characterized by the detection of red, homogenous and intense fluorescence. Necrotic cells generally do not fluoresce. (Product is Hexvix in Europe)
HISTRELIN ACETATE (SUPPRELIN LA, VANTAS)
USES: *Advanced PCa [Vantas], central precocious puberty [Supprelin LA].*
ACTIONS: GNRH agonist; paradoxically ↑ release of GnRH w/ ↓ LH from anterior pituitary; in men ↓ testosterone.
DOSE: Vantas: 50 mg SQ implant q12mo inner aspect of the upper arm; Supprelin LA: 1 implant q12mo.
W/P: [X, −] Transient “flare reaction” at 7–14 days after 1st dose [LH/testosterone surge before suppression]); w/ impending cord compression or urinary tract obstruction; ↑ risk DM, CV disease, MI.
CI: GNRH sensitivity, pregnancy.
DISP: 50 mg 12-mo SQ implant.
SE: Hot flashes, fatigue, implant site reaction, testis atrophy, gynecomastia.
NOTES: Nonsteroidal antiandrogen (eg, bicalutamide) may block flare in men w/ PCa.
HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE (CERVARIX [TYPES 16, 18], GARDASIL [TYPES 6, 11, 16, 18])
USES: *Prevent cervical cancer, precancerous genital lesions (Cervarix and Gardasil), genital warts, anal cancer and oral cancer (Gardasil) d/t to HPV types 16, 18 (Cervarix) and types 6, 11, 16, 18 (Gardasil) in females 9–26 yr*; prevent genital warts, anal cancer, and anal intraepithelial neoplasia in males 9–26 yr (Gardasil).*
ACTIONS: Recombinant vaccine, passive immunity.
DOSE: 0.5 mL IM, then 1 and 6 mo (Cervarix), or 2 and 6 mo (Gardasil) (upper thigh or deltoid).
W/P: [B, ?/−].
DISP: Single-dose vial & prefilled syringe: 0.5 mL.
SE: Erythema, pain at Inj site, fever, syncope, venous thromboembolism.
NOTES: 1st cancer prevention vaccine, 90% effective in preventing CIN 2 or more severe disease in HPV naive populations; report adverse events to Vaccine Adverse Events Reporting System (VAERS: 1-800-822-7967); continue cervical cancer screening. Hx of genital warts, abn Pap smear, or + HPV DNA test is not contraindication to vaccination.
HYDROCHLOROTHIAZIDE (MICROZIDE, GENERIC)
USES: *Edema, HTN,* prevent stones in hypercalciuria.
ACTIONS: Thiazide diuretic; ↓ distal tubule Na+ reabsorption; Thiazides urine calcium ↓ possibly by an increase in calcium absorption in the proximal tubule, induced by volume contraction.
DOSE:
Adults: 25–100 mg/d PO single or ÷ doses; 200 mg/d max.
Peds: <6 mo: 2–3 mg/kg/d in 2 ÷ doses. >6 mo: 2 mg/kg/d in 2 ÷ doses.
W/P: [D, +] Idiosyncratic reaction, resulting in acute transient myopia and acute angle-closure glaucoma; latent DM may become manifest.
CI: Anuria, sulfonamide allergy, renal insufficiency.
DISP: Tabs 25, 50, mg; caps 12.5 mg; PO soln 50 mg/5 mL.
SE: ↓ K+, hyperglycemia, hyperuricemia, ↓ Na+; sun sensitivity.
NOTES: Follow K+, may need supplementation.
HYDROCHLOROTHIAZIDE/AMILORIDE (MODURETIC, GENERIC)
USES: *HTN.*
ACTIONS: Combined thiazide & K+-sparing diuretic.
DOSE: 1–2 tabs/d PO.
W/P: [D, ?].
CI: Renal failure, sulfonamide allergy.
DISP: Tabs (amiloride/HCTZ) 5 mg/50 mg.
SE: ↓ BP, photosensitivity, ↑ K+/ ↓ K+, hyperglycemia, ↓ Na+, hyperlipidemia, hyperuricemia.
HYDROCHLOROTHIAZIDE/SPIRONOLACTONE (ALDACTAZIDE, GENERIC)
USES: *Edema, HTN.*
ACTIONS: Thiazide & K+-sparing diuretic.
DOSE: 25–200 mg each component/d, ÷ doses.
W/P: [D, +].
CI: Sulfonamide allergy.
DISP: Tabs (HCTZ/spironolactone) 25/25, 50/50 mg.
SE: Photosensitivity, ↓ BP, ↑ or ↓ K+, ↓ Na+, hyperglycemia, hyperlipidemia, hyperuricemia.
HYDROCHLOROTHIAZIDE/TRIAMTERENE (DYAZIDE, MAXZIDE, GENERIC)
USES: *Edema & HTN.*
ACTIONS: Combo thiazide & K+-sparing diuretic.
DOSE: Dyazide: 1–2 caps PO daily–BID. Maxzide: 1 tab/d PO.
W/P: [D, +/−].
CI: Sulfonamide allergy.
DISP: (Triamterene/HCTZ) 37.5/25, 75/50 mg.
SE: Photosensitivity, ↓ BP, ↑ or ↓ K+, ↓ Na+, hyperglycemia, hyperlipidemia, hyperuricemia.
NOTES: HCTZ component in Maxzide more bioavailable than in Dyazide.
HYDROCODONE (ZOHYDRO ER)
WARNING: Addiction, abuse, misuse, overdose and death risk. Fatal respiratory depression; overdose especially in children can be fatal. With pregnancy neonatal opioid withdrawal syndrome possible. Do not consume alcohol.
USES: *Pain severe enough to require daily, around-the-clock, long-term opioid.*
ACTIONS: Opioid analgesic.
DOSE: 1st Opioid Analgesic: 10 mg cap Q 12 hr. Not Opiod tolerant: 10 mg cap Q 12 hr (Opioid tolerant: Receiving, for >1 wk, at least 60 mg oral morphine/d, 25 μg transdermal fentanyl/h, 30 mg oral oxycodone/d, 8 mg oral hydromorphone/d, 25 mg oral oxymorphone/d, or an equianalgesic dose of another opioid) increase in increments of 10 mg every 12 hr every 3–7 days to effect; Conversion from other oral opioids see package insert.
W/P: [D, +/−] see “Warning"; w/ other CNS depressants, monitor elderly, debilitated for resp depression; CYP3A4 inhibitors may ↑ effect.
CI: Significant respiratory depression; severe bronchial asthma or hypercarbia; paralytic ileus; hypersensitivity to ingredients.
DISP: ER caps 10/15/20/30/40/50 mg.
SE: Constipation, nausea, somnolence, fatigue, headache, dizziness, dry mouth, vomiting, pruritus, others.
NOTES: Swallow capsules whole; do not crush/chew; not a PRN use drug.
HYDROCODONE/ACETAMINOPHEN (HYCET, LORCET, GENERIC) [C-III]
WARNING: Acetaminophen has been associated with acute liver failure (liver transplant and death possible). Most cases associated with doses >4,000 mg/d and often involve more than 1 acetaminophen-containing product.
USES: *Mod–severe pain.*
ACTIONS: Narcotic analgesic w/ nonnarcotic analgesic.
DOSE:
Adults: 1–2 caps or tabs PO q4–6h PRN; soln 15 mL q4–6h.
Peds: Soln (Hycet) 0.27 mL/kg q4–6h.
W/P: [C, M].
CI: CNS depression, severe resp depression.
DISP: Many formulations; specify hydrocodone/acetaminophen dose; caps 5/500 mg; tabs 2.5/500, 5/300, 5/325, 5/500, 7.5/300, 7.5/325, 7.5/500, 7.5/650, 7.5/750,10/300, 10/325, 10/500, 10/650, 10/660, 10/750 mg; soln Hycet (fruit punch) 7.5 mg hydrocodone/325 mg acetaminophen/15 mL.
SE: GI upset, sedation, fatigue.
NOTES: Do not exceed >4 g acetaminophen/d; see Acetaminophen note.
HYDROCODONE/IBUPROFEN (REPREXAIN, VICOPROFEN, GENERIC) [C-III]
USES: *Mod–severe pain (<10 days).*
ACTIONS: Narcotic w/ NSAID.
DOSE: 1–2 tabs q4–6h PRN.
W/P: [C, M] Renal insufficiency; ↓ effect w/ ACE inhibitor & diuretics; ↑ effect w/ CNS depressants, EtOH, MAOI, ASA, tricyclic antidepressants, anticoagulants.
CI: Component sensitivity.
DISP: Tabs 2.5/5/7.5/10 mg hydrocodone/200 mg ibuprofen.
SE: Sedation, fatigue, GI upset.
NOTES: Not for arthritis.
HYDROCORTISONE, RECTAL (ANUSOL-HC SUPPOSITORY, CORTIFOAM RECTAL, PROCTOCORT, OTHERS, GENERIC)
USES: *Painful anorectal conditions*, radiation proctitis, ulcerative colitis.
ACTIONS: Anti-inflammatory steroid.
DOSE:
Adults: Ulcerative colitis: 10–100 mg PR daily–BID for 2–3 wk.
W/P: [B, ?/−].
CI: Component sensitivity.
DISP: Hydrocortisone acetate: Rectal aerosol 90 mg/applicator; supp 25 mg. Hydrocortisone base: Rectal 0.5%, 1%, 2.5%; rectal susp 100 mg/60 mL.
SE: Minimal systemic effect.
HYDROCORTISONE, SYSTEMIC (CORTEF, SOLU-CORTEF, GENERIC)
See also Steroids Systemic and Topical.
USE: Adrenal insufficiency.
ACTION: Glucocorticoid.
DOSE: 2 mg/kg IV/IO bolus; max. dose 100 mg.
W/P: [B, −].
CI: Viral, fungal, or tubercular skin lesions; serious infections (except septic shock or TB meningitis).
SE: Systemic: ↑ Appetite, insomnia, hyperglycemia, bruising.
NOTES: May cause hypothalamic–pituitary–adrenal axis suppression.
HYDROMORPHONE (DILAUDID, DILAUDID HP, GENERIC) [C–II]
WARNING: A potent Schedule II opioid agonist; highest potential for abuse and risk of resp depression. HP formula is highly concentrated; do not confuse w/ standard formulations, OD and death could result. Alcohol, other opioids, CNS depressants ↑ resp depressant effects.
USES: *Mod–severe pain.*
ACTIONS: Narcotic analgesic.
DOSE: 1–4 mg PO, IM, IV, or PR q4–6h PRN; 3 mg PR q6–8h PRN; ↓ w/ hepatic failure.
W/P: [B (D if prolonged use or high doses near term), ?] ↑ Resp depression and CNS effects, CNS depressants, phenothiazines, tricyclic antidepressants.
CI: CNS lesion w/ ↑ ICP, COPD, cor pulmonale, emphysema, kyphoscoliosis, status asthmaticus; HP-Inj form in OB analgesia.
DISP: Tabs 2, 4, 8 mg scored; liq 5 mg/5 mL or 1 mg/mL; Inj 1, 2, 4 mg, Dilaudid HP is 10 mg/mL; supp 3 mg.
SE: Sedation, dizziness, GI upset.
NOTES: Morphine 10 mg IM = hydromorphone 1.5 mg IM.
HYDROXYZINE (ATARAX, VISTARIL, GENERIC)
USES: *Anxiety, sedation, itching.*
ACTIONS: Antihistamine, antianxiety.
DOSE:
Adults: Anxiety/sedation: 50–100 mg PO or IM QID or PRN (max. 600 mg/d). Itching: 25–50 mg PO or IM TID–QID.
Peds: 0.5–1.0 mg/kg/24 h PO or IM q6h; ↓ w/ hepatic impairment.
W/P: [C, +/−] ↑ Effects w/ CNS depressants, anticholinergics, EtOH.
CI: Component sensitivity.
DISP: Tabs 10, 25, 50 mg; caps 25, 50 mg; syrup 10 mg/5 mL; susp 25 mg/5 mL; Inj 25, 50 mg/mL.
SE: Drowsiness, anticholinergic effects.
NOTES: Used to potentiate narcotic effects; not for IV/SQ (thrombosis & digital gangrene possible).
HYOSCYAMINE (ANASPAZ, CYSTOSPAZ, LEVSIN, OTHERS, GENERIC)
USES: *Spasm w/ GI & bladder disorders.*
ACTIONS: Anticholinergic.
DOSE:
Adults: 0.125–0.25 mg (1–2 tabs) SL/PO TID–QID, ac & hs; 1 SR caps q12h.
W/P: [C, +] ↑ Effects w/ amantadine, antihistamines, antimuscarinics, haloperidol, phenothiazines, tricyclic antidepressants, MAOI.
CI: Bladder outlet obstruction, GI obst, narrow-angle glaucoma, myasthenia gravis, paralytic ileus, ulcerative colitis, MI.
DISP: (Cystospaz-M, Levsinex) time-release caps 0.375 mg; elixir (EtOH); soln 0.125 mg/5 mL; Inj 0.5 mg/mL; tab 0.125 mg; tab (Cystospaz) 0.15 mg; XR tab (Levbid) 0.375 mg; SL (Levsin SL) 0.125 mg.
SE: Dry skin, xerostomia, constipation, anticholinergic SE, heat prostration w/ hot weather.
NOTES: Administer tabs ac.
HYOSCYAMINE, ATROPINE, SCOPOLAMINE, & PHENOBARBITAL (DONNATAL, OTHERS, GENERIC)
USES: *Irritable bowel, spastic colitis, peptic ulcer*, spastic bladder.
ACTIONS: Anticholinergic, antispasmodic.
DOSE: 0.125–0.25 mg (1–2 tabs) TID–QID, 1 caps q12h (SR), 5–10 mL elixir TID–QID or q8h.
W/P: [D, M].
CI: Glaucoma, obstructive uropathy, GI obstruction, unstable patient with hemorrhage, severe ulcerative colitis.
DISP: Many combos/manufacturers. Caps (Donnatal, others): Hyoscyamine 0.1037 mg/atropine 0.0194 mg/scopolamine .0065 mg/phenobarbital 16.2 mg. Tabs (Donnatal, others): Hyoscyamine 0.1037 mg/atropine .0194 mg/scopolamine 0.0065 mg/phenobarbital 16.2 mg. LA (Donnatal): Hyoscyamine 0.311 mg/ atropine 0.0582 mg/scopolamine 0.0195 mg/phenobarbital .6 mg. Elixirs (Donnatal, others):Hyoscyamine 0.1037 mg/atropine .0194 mg/scopolamine 0.0065 mg/phenobarbital 16.2 mg/5 mL.
SE: Sedation, xerostomia, constipation.
NOTE: FDA has classified the indications as “possibly” effective.