FORMULARY

These medications may be supplied as listed or they may be substituted by their generic equivalent.

NON-PRESCRIPTION / USUAL DIRECTIONS
Actifed (Pseudoephedrine Hcl/Trirolidine HCL) / 1 tab q 4 h, 6 max. (do not use in hypertensives)
Ambusol/Hurricane Gel / PRN-sore gums or toothache
Aspirin 325 mg / 1-3 tablets, 12 max.
* Avoid use in patients less than 20 years old.
Benadryl 25 mg (Diphenhydramine HCL) / 1-2 tablets q 4-6 hrs. 12 max.
Caladryl 2 1/2 fl. oz. / tid or qid to clean dry skin
Cepastat (generic) / 1-2 q 2 hr 18 max.
Colace 50 mg (Docustate Sodium) generic / 1-4 caps HS
Coricidin 2mg (Chlorpheniramine Maleate) / 2 q 4 hrs prn
Dramamine 25mg / 1 tablet qid prn for vomiting
Emetrol 250mg / 2 tablets tid or qid
Folic Acid 1mg tablets / 1 tablet PO OD
Glycerine Suppository / Apply rectally prn for constipation
Hydrocortisone Cream 1-2.5% / Apply 4-6 times/day
Ibuprofen (Motrin) (Advil) 200mg / 1 or 2 tabs q 4-6 hrs.
8 tabs max/24 hr.
Immodium / For Diarrhea
2 capsules to start then 1 capsule
After each loose stool. Maxium 8 capsules daily
Kaopectate / 30 – 60 cc after each loose or watery stool
Maalox / 30 cc 1-2 hrs pc and HS
MOM (Magnesia Magna) / Laxative 30cc followed by 8 oz. of warm water
Monagel / prn insulin reaction
Mycitracin 1 oz. (Triple Antibiotic Oint) / as needed
Naldacon SR Ex
Naldacon SR Dx
Nupercainol Oint. 1 oz. (Dibucaine Oint 1%) / as needed for hemorrhoids
Pepto Bismol (Bismuth Subsalicylate) / Per container
Pericolace (Casanthranol 30mg/Docusate 100mg) / 1-2 caps HS stool softener/laxative
Sudafed 30 mg (Pseudoephedrine HCL) / 1-2 tabs q 4-6 h 8 max. 3 days max.
(do not use in hypertensives)
Thiamine 100mg (Vitamin B1) / 1 daily x 5 days alcoholic
Tinactin 15 gm (Tolnaftate 1%) / apply bid for athletes foot
TUMS / Antacid
Tylenol 500 mg (Acetaminophen) / 1-2 tabs qid prn
Maximum 8 tabs daily
Visine (Tetrahydrozoline) / For minor eye irritation
PRESCRIPTION
Analgesics
Darvocet N 100 (Propoxyphene Napsylate 100mg / 1 tab q 4 hrs prn pain, maximum 6 per day,
/Acetaminophen 650mg) / 15 day limit
Antibiotics
Amoxicillin 50 mg / respiratory tract, pharyngitis, sinusitis, dental
abcess
1 tid x 10 days
Augmentum 875 mg / Otitis media, sinusitis, lower respiratory tract, UTI
(Amoxacillin 875/Clavulanate 125 mg / 1 bid x 10 days
Azithromax 250mg / Acute exaccerbation of COPD, mild pneumonia
Skin and Skin structure infection by staph or strept
Second line for pharyngitis tonsillitis
Day 1 500mg PO single dose
Day 2-5 250mg PO daily
Bactrim Tablets DS / U.T.I. 1 tab every 12 hrs for 5 days
Colymycin-S Otic with Neomycin and / 4-5 gtts quid x 2 dyas, then 4-5 gtts tid x 8 days
Hydrocortisone
Dicloxacillin 500 mg / Cellulitis
500 mg po q6h for 10 days
Erythromycin base 250 mg / Penicillin sensitivity
Pharyngitis/Dental abcess 1 tab q 6 h x 7 days
Keflex 500 mg / Pharyngitis and cellulitis
1 tab q 6 hr x 10 days
Mupirocin 2% Ointment / Apply TID to rash for 7 days.
Neosporin Ophthalmic Solution / 1-2 gtts q 2 hrs x 8 hrs,
Then 1-2 gtts quid x 7-10 days
Tetracycline 250 mg / Acne 1 tab daily
Anti-Hypertensive
Atenolol 50mg / 1 tab po qd
Clonidine Patch (0.1mg/week) / 1 patch applied weekly
Clonidine (0.1mg tab) / 1 Tablet PO BID-TID
Dyazide (Triamterene 37.5mg/Hydrodiuril 25mg) / 1 tab po q am
Bronchodilator
Albuterol Metered Dose Inhaler / Two puffs, q 2 hours prn for SOB or wheezing

Antiscabicide

Kwell (Lindane) lotion or cream / Per package insert
Cardiac
Nitroglycerine Tabs / 1 SL q 5 min, prn for angina, MR x 3
Gastrointestinal
Tagamet 400mg / 1 tab tid x 4-6 weeks for acute gastritis/ulcer
1-2 tabs qhs for history of ulcer
Avoid use in patients on Dilantin
Zantac 150mg / 1 tab bid
Muscle Relaxant
Flexeril 10 mg (Cyclobenzapine) / for muscle spasm-pain: 10 mg tid may be increased to 30 or 40 mg daily.
Tranquilizer
Librium 250mg Tabs / For alcohol detox standing orders
Valium 2 mg (Diazepam) / for anxiety
2 mg - 10 mg tid or qid 10 day limit
For alcohol detox see standing orders

BIOLOGICS

Chemstrip

Prurified protein derivative (PPD)

Tetanus Diphteria Toxoid adult (Td)

Rev. 1/28/2008

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I:\Admin\R JOHANSEN\OPPM\VBCHD\Manuals\Jail\Manual\Current\FORMULAR.DOC Rev: 1/28/08