) (92/10/1) Gastrointestinal drugs (1) (3) (4) (5) (1) (91/2/1) Grade B

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1 T P N 10 ADR Statins : ( ) (92/10/1) Gastrointestinal drugs Gastrointestinal drugs (1) (1) (2) (2) (3) (3) (4) (4) gefarnatecetraxatecarbenoxolone Dibismuth trioxide, sucralfate, (5) Dibismuth trioxide, sucralfate, pirenzepine HCl, Gaspin, Caved-S, misoprostol, proglumide pirenzepine HCl, Gaspin, Caved-S, misoprostol, proglumide (5) gefarnatecetraxatecarbenoxolone (1) active healing (1) active healing (2) scar stage (2) scar stage (3) The (3) (91/2/1) Los Angeles Classification of EsophagitisGrade A (4) (91/2/1) Grade B (5) (87/7/1)(91/2/1) (4) (6) The Los Angeles Classification of (91/2/1) esophagitisgrade C Grade D (7) The Los Angeles Classification of Esophagitis Grade C Grade D Zollinger-Ellision Zollinger-Ellison

2 (91/2/1) (5) NSAIDs (8) NSAIDs (9) (6) 24 ph (7) (10) (11) (12) (8) (13) (9) (14) NSAID ( misoprostol) (10) (11) NSAID misoprostol The Los Angeles Classification of Esophagitis. Grade A: One or more mucosal break,each <=5mm long,confined to. the mucosal folds Grade B: One or more mucosal break > 5mm long,confined to the mucosal folds but not continuous between the tops of two 1.The Los Angeles Classification of Esophagitis mucosal folds Grade A: One or more mucosal break, each <=5mm long, Grade C: One or more mucosal break continuous between the tops of confined to the mucosal folds two or more mucosal folds but which involve less than 75% Grade B: One or more mucosal break > 5mm long, confined to the of the esophageal circumference mucosal folds but not continuous between the tops of two Grade D: Mucosal breaks which involve less than 75% of the mucosal folds esophageal circumference Grade C: One or more mucosal break continuous between the tops of two or more mucosal folds but which involve less than 75% of the esophageal circumference Grade D: Mucosal breaks which involve less than 75% of the esophageal circumference 2. () ADR Statins statins 1,2 CK <

3 ADR statins 41 ADR ( N=41 ) ( N=41 ) ( %) ( %) Atorvastatin Fluvastatin Lovastatin Pravastatin 2 Simvastatin ADR 1.Drug facts and Comparisons AHFS Drug information 3. ADR vs Acetazolamide (Diamox) Acyclovir (Zovirax) Adenosine (Adenocor) Albumin Amikacin (Amikin) Diltiazem Dobutamine, dopamine, aztreonam, cefepime, morphine, ondansetron, piperacillin sod.-tazobactam sod. NaCl 0.45 &, R, RL, D5W, D10W D5W, NaCl D5RL, D5W, RL, NaCl Midazolam, vancomycin Amphotericin B, ampicillin, cefazolin, heparin, hetastarch, phenytoin, propofol, vitamin B complex with C NaCl 0.45 &, R, RL, D5W, D10W D5W, D10W, D5NaCl 0.2, &, NaCl 0.45 &, D5R, D5RL, R, RL

4 Aminophylline Amiodarone (Cordarone) Amphotericin B (Fungizone) Ampicillin Ampicillin sod. Sulbactam sod. Ascorbic acid Atracurium (Tracrium) Aztreonam (Azactam) Calcium gluconate (Calglon) Cefazolin (Veterin) Cefepime HCl (Maxipime) Cefoperazone (Shinfomycin) Cefoxitin (Mefoxin) Ceftazidime (Kefadim) Ascorbic acid, atracurium, amiodarone, cefepime, ceftazidime, ceftriaxone, ciprofloxacin, clindamycin, dobutamine, epinephrine, hydralazine, isoproterenol, meperidine, morphine, norepinephrine, ondansetron, prochlorperazine, RI Aminophylline, heparin, NaHCO 3 - Amikacin, aztreonam, Ca. gluconate, cefepime, cefpirome, cimetidine, diphenhydramine, dopamine, filgrastim, gentamicin, lidocaine, MgSO 4, meropenem, penicillin G sodium, piperacillin sodtazobactam sod., KCl, prochlorperazine, propofol, ranitidine Amikacin, dopamine, epinephrine,erythromycin lactobionate, fluconazole, gentamicin, hydralazine, metoclopramide, midazolam, ondansetron, prochlorperazine D5W, D5NaCl 0.2 &, NaCl 0.45 &, R, RL,D5RL D5W D5W, D10W, D5NaCl 0.2%, NaCl Ciproxin, ondansetron NaCl Sod. bicarbonate, theophylline, cefazolin, D5NaCl 0.45%, D5W, D10W, R, RL, NaCl 0.45 & Aminophylline, cefazolin, diazepam, D5W, D5NaCl, NaCl heparin, nitroprusside, propofol, ranitidine Acyclovir, amphotericin B, ganciclovir, D5W, NaCl lorazepam, metronidazole, prochlorperazine Amphotericin B, dobutamine, fluconazole, D5RL, D5NaCl, D5W, indomethacin, methylprednisolone, D10W, RL, NaCl metoclopramide Amikacin,ascorbic acid, atracurium, cimetidine, lidocaine, ranitidine, vitamin B complex with C Acyclovir, aminophylline, amphotericin B, cimetidine, ciprofloxacin, diazepam, diphenhydramine, dobutamine, dopamine, famotidine, filgrastim, ganciclovir, gentamicin, haloperidol, MgSO 4, mannitol, meperidine, metoclopramide, morphine, netilmicin,ondansetron, prochlorperazine, tobramycin Filgrastim, gentamicin, hetastarch, labetalol, meperidine,ondansetron, tobramycin Filgrastim, hetastarch, ranitidine Aminophylline, fluconazole, midazolam, ranitidine, warfarin D5RL, D5NaCl0.2, 0.45 &, D5W, R, RL, NaCl D5RL,D5NaCl, D5W, D10W, NaCl D5NaCl0.2 &, D5W, D10W, RL, NaCl D5W, D10W, D5NaCl 0.2, 0.45 &, NaCl, R, RL, D5RL D5NaCl 0.2, 0.45 &, D5W, D10W, R, RL, NaCl

5 Ceftriaxone (Sintrix, Rocephin) Cimetidine (Tagamet) Ciprofloxacin (Ciproxin) Clindamycin Aminophylline, clindamycin, filgrastim, fluconazole, labetalol, vancomycin Amphotericin B, cefazolin, cefepime, indomethacin, warfarin Aminophylline, ampicillin-sulbactam, amoxicillin, cefepime, clindamycin, dexamethasone, furosemide, heparin, hydrocortisone, methylprednisolone, phenytoin, propofol, warfarin Aminophylline, barbiturates, calcium gluconate, ceftriaxone, ciprofloxacin, filgrastim, phenytoin D5W, D10W, RL, NaCl D5RL, D5NaCl 0.2, 0.45 &, D5W, D10W, R, RL, NaCl D5NaCl 0.2 & 0.45%, D5W, D10W, NaCl, R, RL D5R, D5W, D10W, D5NaCl 0.45 &, NaCl, RL Corticotropin D5NaCl, D5W, RL, NaCl Sod. bicarbonate (ACTH) Cyanocobalamin D5W, D10W, R, RL, NaCl 0.45 & Cyclosporine Magnesium sulfate D5W, NaCl Dexamethasone (Methason) Ciprofloxacin, midazolam, vancomycin D5W, NaCl Diazepam (Dupin) Digoxin (Digosin) Diltiazem (Herbesser) Diphenhydramine (Venalin) Dobutamine (Dobuject) Dopamine (Dopavate) Enoxaparin (Clexane) Epinephrine (Adrenalin) Erythromycin lactobionate Esmolol (Brevibloc) Atracurium, cefepime, diltiazem, furosemide, fluconazole, heparin, meropenem, pancuronium bromide, KCl, propofol, vecuronium bromide, vitamin B complex with C D5W, R, RL, NaCl Dobutamine, fluconazole, propofol D5W, RL, NaCl 0.45 & Diazepam, furosemide, phenytoin, rifampin D5NaCl 0.45%, D5W, NaCl Amphotericin B, cefepime, haloperidol, phenobarbital, phenytoin Acyclovir, aminophylline, cefepime, calcium gluconate, diazepam, digoxin, furosemide, MgSO 4, phenytoin, phytonadione, piperacillin sod. tazobactam sod., potassium phosphates, RI, Sod. Bicarbonate, warfarin Acyclovir, amphotericin B, ampicillin, cefepime, RI NaCl Aminophylline, ampicillin, lidocaine, sod. bicarbonate Furosemide, heparin, metoclopramide, Vitamin B complex with C, ampicillin, fluconazole Diazepam, furosemide, warfarin, NaCl 0.45 &, D5W, D10W, R, RL D5RL, D5NaCl 0.45 &, D5W, RL, NaCl 0.45 & D5RL, D5NaCl 0.45 &, D5W, D10W, RL, NaCl D5R, D5RL, D5NaCl, D5W, R, RL, NaCl NaCl D5NaCl 0.45 &, D5W, NaCl 0.45 &, D5RL, RL

6 Famotidime Cefepime, piperacillin sod. tazobactam (Gaster) sod. D5W, D10W, RL, NaCl Fentanyl D5W, NaCl Filgrastim (G-CSF) Amphotericin B, cefepime, cefoperazone, cefoxitin, ceftriaxone, clindamycin, furosemide, heparin, mannitol, methylprednisolone, metronidazole, piperacillin, prochlorperazine D5W Fluconazole (Diflucan) Furosemide (Lasix) Ganciclovir (Cymevene) Gentamicin (V-Genta) Haloperidol (Haldol, Pandol) Heparin Hydrocortisone sod. succinate (Solu-cortef) Hydralazine (Apresoline) Imipenem- cilastatin (Tienam) Insulin Isoproterenol (Isuprel) Amphotericin B, ampicillin, Ca. gluconate, ceftriaxone, clindamycin, diazepam, digoxin, dobutamine, erythromycin lactobionate, furosemide, gentamicin, haloperidol lactate, imipenem-cilastatin sod., meperidine, netilmicin, piperacillin, ticarcillin, trimethoprim + sulfamethoxazole Ciprofloxacin, diazepam, diltiazem, esmolol, filgrastim, fluconazole, hydralazine, isoproterenol, metoclopramide, midazolam, netilmicin, nicardipine, ondansetron, prochlorperazine, vecuronium Aztreonam, cefepime, ondansetron, piperacillin sod.- tazobactam sod. Amphotericin B, ampicillin, cefepime, furosemide, heparin, hetastarch, indomethacin, propofol, ticarcillin, warfarin Cefepime, diphenhydramine, NS, fluconazole, heparin, ketorolac, morphine, piperacillin- tazobactam, Sod. nitroprusside Amiodarone, amikacin, atracurium, ciprofloxacin, diazepam, erythromycin lactobinate, filgrastim, gentamicin, haloperidol, meperidine, morphine, netilmicin, nicardipine, phenytoin, tobramycin, vancomycin, warfarin Ciprofloxacin, diazepam, midazolam, phenobarbital, phenytoin, prochlorperazine Aminophylline, ampicillin, hydrocortisone, nitroglycerin, phenobarbital, verapamil, furosemide Fluconazole, lorazepam, meperidine, midazolam, Sod. Bicarbonate Aminophylline, dopamine, dobutamine, norepinephrine, phenobarbital, phenytoin, ranitidine Aminophylline, barbiturates, furosemide, lidocaine, Sod. Bicarbonate D5W, D10W, RL D5RL, D5NaCl, D5W, RL, NaCl D5W, NaCl D5W, D10W, R, RL, NaCl D5W D5NaCl 0.45 &, D5W, NaCl0.45 &, D5RL, R, R, RL, NaCl 0.45 & D5RL, R, RL, NaCl 0.45 & D5NaCl 0.2, 0.45 &, RL, D5W, NaCl NaCl D5RL, D5NaCl, D5W, RL, NaCl 0.45 &

7 Ketorolac (Keto) Labetalol (Trandate) Lidocaine (xylocaine) Lorazepam (Anxicam) Magnesium sulfate Mannitol Meperidine (Demerol) Meropenem (Mepem) Methylprednisolo ne (Solu-metrol) Metoclopramide (Primperan) Metronidazole (Anegyn,Medazole) Midazolam (Dormicum) Morphine Multivitamins Netilmicin (Netromycin) Nicardipine (Perdipine) Nitroglycerin (Millisrol) Haloperidol, prochlorperazine D5NaCl, D5W, R, RL, NaCl Cefoperazone, ceftriaxone, warfarin D5R, D5RL, D5NaCl 0.2, 0.33 &, D5W, R, RL, NaCl Cefazolin, epinephrine, isoproterenol, D5RL, D5NaCl 0.45 &, norepinephrine, phenytoin D5W, RL, NaCl 0.45 & Aztreonam, imipenem-cilastatin, omeprazole, ondansetron D5W Amphotericin B, cefepime, cyclosporine, Sod. bicarbonate D5W, RL, NaCl Imipenem-cilastatin, cefepime, meropenem Aminophylline, cefepime, cefoperazone, furosemide, imipenem-cilastatin, heparin,, D5W, R, RL, NaCl 0.45 & morphine, phenytoin, phenobarbital Amphotericin B, diazepam, metronidazole, NaCl, R, RL, D5W multivitamins Ca. Gluconate, ciprofloxacin, filgrastim, RI, ondansetron, penicillin G Na, propofol Ampicillin, Ca. Gluconate, cefepime,erythromycin lactobionate, furosemide, propofol, Sod. bicaronate Aztreonam, dopamine, filgrastim, meropenem, warfarin Albumin, ampicillin, ceftazidime, dexamethasone, furosemide,hydrocortisone, imipenem-cilastatin, omeprazole, prochlorperazine, ranitidine, sod. Bicarbonate, trimethoprimsulfamethoxazole Aminophylline, cefepime, haloperidol, heparin, meperidine, phenobarbital, phenytoin, sod. bicarbonate Meropenem Cefepime, furosemide, heparin, piperacillin, propofol, ticarcillin Furosemide, heparin Hydralazine, phenytoin Nitroprusside Atracurium D5W, RL Norepinephrine Aminophylline, RI, lidocaine, Phenobarbital, phenytoin, sod. Bicarbonate, (Levophed) whole blood D5NaCl,D5W, NaCl D5NaCl 0.45%, D5W, R, RL, NaCl D5W, RL, NaCl Nitroprusside Atracurium D5W Octreotide (Sandostatin) NaCl D5NaCl, D5W, NaCl, D5W, R, RL, NaCl 0.45 & D5RL, D5NaCl, D5W, D10W, RL, NaCl D5RL, D5NaCl, D5W, D10W, R, RL, NaCl D5NaCl 0.45 &, D5W, NaCl 0.45 & D5RL, D5NaCl 0.45 &, D5W, RL, NaCl 0.45 & D5NaCl, D5W, RL, NaCl

8 Ondansetron (Zofran) Oxacillin (Prostaphlin) Pancuronium (Pavulon) Penicillin G sod. Phenobarbital (Phebital) Phenytoin (Dilantin) Phytonadione (Vitamin K1) Piperacillin (Pitamycin) Acyclovir, aminophylline, amphotericin B, ampicillin, ampicillin sod.-sulbactam sod., cefepime, cefoperazone, furosemide, ganciclovir, lorazepam, methylprdnisolone, piperacillin, sod. bicarbonate Sodium bicarbonate Diazepam Amphotericin B, methylprednisolone, prochlorperazine, vancomycin Atracurium, cimetidine, clindamycin, diphenhydramine, ephedrine, hydralazine, hydrocortisone, RI, isoproterenol, meperidine, morphine, norepinephrine, pancuronium, prochlorperazine, ranitidine, succinylcholine, vancomycin Amikacin, aminophylline, ciprofloxacin, diltiazem, dobutamine, gentamicin, heparin, RI, lidocaine, meperidine, morphine, nitroglycerin, norepinephrine, KCl, prochlorperazine, propofol, theophylline, vancomycin, vitamin B complex with C Dobutamine, ranitidine Aminoglycosides, filgrastim,fluconazole, ondansetron, vancomycin Piperacillin sod. - Acyclovir, amphotericin B, dobutamine, tazobactam sod. famotidine, ganciclovir, haloperidol, (Tazocin) prochlorperazine, vancomycin Potassium chloride Potassium phosphate Prochlorperazine (Novamin) Propofol (Diprivan, Recofol) Amphotericin B, diazepam, phenytoin D5NaCl 0.45 &, D5W, R, NaCl, RL D5NaCl, D5W, RL, NaCl, D5RL D5NaCl, D5W, RL, NaCl NaCl, D5W, R, RL, NaCl 0.45 & NaCl D5W, D10W, R, RL, NaCl 0.45 & D5NaCl, D5W, RL, NaCl D5W, NaCl, D5W, D10W, R, RL, NaCl 0.45 & Dobutamine D5W, D10W, NaCl 0.45 & Aminophylline, amphotericin B, ampicillin, aztreonam, cefepime, filgrastim, furosemide, hydrocortisone, ketorolac, midazolam, penicillin G sodium, Phenobarbital, piperacillin sod.-tazobactam sod Amikacin, amphotericin B, atracurium, ciprofloxacin, diazepam, digoxin, gentamicin, methotrexate, methylprdnisolone, metoclopramide, netilmicin, phenytoin, tobramycin, D5W, R, RL, NaCl 0.45 & D5RL, D5NaCl 0.2 & 0.45%, D5W, RL

9 Ranitidine (Zantac) Sod. Bicarbonate Ticarcillin disod.- clavulanate pot. (Timentin) Amphotericin B, atracuonrium, cefazolin, cefoxitin, ceftazidime, clindamycin, hetastarch, midazolam, Phenobarbital, phytonadione Amiodarone, Vit C, dobutamine, dopamine, epinephrine, imipenem-cilastatin, isoproterenol, labetalol, midazolam, MgSO 4, morphine, metoclopramide, meropenem, norepinephrine, ondansetron, succinylcholine, ticarcillin disod.- clavulanate pot. Amikacin, gentamicin, netilmicin, sod. bicarbonate, tobramycin, vancomycin Trimethoprim sulfamethoxazole Fluconazole, midazolam (Septrin) Vasopressin (Pitressin) Vancomycin (Vancocin) Vecuronium (Norcuron) D5NaCl 0.45%, D5W, D10W, RL, NaCl D5R, D5NaCl 0.2, 0.45 &, D5W, NaCl 0.45 & D5W, RL, NaCl D5NaCl 0.45%, D5W, RL, NaCl 0.45 & D5W, NaCl Albumin, cefepime, ceftazidime, dexamethasone, heparin, omeprazole, phenobarbital, phenytoin, piperacillin sod.- tazobactam sod., ticarcillin disod. clavulanate pot., vitamin B complex with C Diazepam, furosemide D5RL, D5NaCl, D5W, RL, NaCl D5NaCl, D5W, RL, NaCl 1D5R:Dextrose 5% in Ringer s injection; D5RL: Dextrose 5% in Ringer s injection, lactated; D5NaCl 0.2, 0.45 & : Dextrose 5% in sodium chloride 0.2, 0.45 & ; D5(10)W: Dextrose 5(10)% in water, R: Ringer s injection, RL: Ringer s injection,lactated; NaCl 0.45 & : Sodium chloride 0.45 &. 2 Incompatible ( additive compatibility, drugs in syringe compatibility, Y-site injection compatibility) 3 Reference: Lawrence A, Trisseal Handbook of Injectable drugs, 11 th ed, ASHP