Common Medications: Quick Reference

A practical guide to frequently used inpatient medications organized by therapeutic category. All dosing reflects standard adult hospital practice; always verify with institutional protocols and patient-specific factors (renal function, hepatic disease, drug interactions).

Bowel Regimen

Constipation is preventable. Start bowel medications proactively in all patients on opioids.

Drug	Starting Dose	Onset	Indication	Notes
Docusate	100mg PO BID	24–72h	Stool softener for mild constipation	Often combined with other agents; minimal efficacy alone
Miralax (polyethylene glycol)	17g PO daily–BID	1–4 days	First-line osmotic laxative	Very safe, well-tolerated; increase as needed
Magnesium hydroxide (Milk of Magnesia)	30–60mL PO	6–12h	Rapid osmotic laxative	Avoid in renal failure; faster than Miralax
Magnesium citrate	150mL PO	30min–2h	Rapid bowel evacuation	Very fast; use when urgent
Lactulose	10–30cc PO q4–6h	1–2h	Osmotic laxative	Causes bloating/flatulence; less tolerated
Senna	2–4 tablets PO daily–BID	6–12h	Stimulant laxative	Natural alternative; safe for chronic use
Bisacodyl	10–30mg PO or PR	6–10h	Stimulant (oral or rectal)	Rectal suppository faster onset
GoLytely (PEG solution)	4L PO or NG tube	1–2h	Aggressive bowel prep	For severe impaction; very potent
Methylnaltrexone (Relistor)	8–12mg SC every other day	30–60min	Refractory opioid-induced constipation	Peripheral antagonist; preserves analgesia

Opioid-Induced Constipation Protocol

Always initiate bowel regimen when starting opioids. Standard approach: Miralax + Senna. Escalate to stronger agents if ineffective after 48–72h. Add methylnaltrexone if refractory to standard therapy.

Antiemetics

Choose antiemetic based on etiology. Always investigate the cause before masking nausea.

Drug	Starting Dose	Frequency	Mechanism	Notes
Ondansetron	4–8mg	PO/IV q8h	5-HT3 antagonist	Check QTc; avoid if QTc >500; good for post-op nausea
Promethazine	25mg IV or 50mg PO	q4–6h	H1 antagonist + anticholinergic	Sedating; risk of extrapyramidal effects; IV push risk of necrosis
Metoclopramide	10mg	PO/IV q6h	Dopamine antagonist + prokinetic	Check QTc; avoid in mechanical obstruction
Prochlorperazine	5–10mg	IV q4–6h	Dopamine antagonist	Risk of dystonia, QTc prolongation
Scopolamine patch	1 patch	Q72h (behind ear)	Anticholinergic	Effective for motion sickness; risk of urinary retention

Assess Before Treating

Do not reflexively prescribe antiemetics. Nausea from obstruction, perforation, or intracranial pathology masked by antiemetics delays diagnosis. Always obtain focused exam and consider imaging.

Pain Management: Non-Opioid Analgesics

Start with non-opioid options. Opioids should be last resort.

Drug	Starting Dose	Frequency	Indication	Cautions
Acetaminophen	650mg	PO/PR q6h (max 4g/day)	Mild-moderate pain, fever	Avoid in active liver disease; monitor total daily dose
Ibuprofen	200–800mg	PO q6h	Mild-moderate pain, inflammation	Avoid GI bleed, GERD, ACS, CHF, AKI
Naproxen	500mg	PO q12h	Mild-moderate pain	Avoid GI bleed, GERD, ACS, CHF, AKI; longer duration
Ketorolac	30mg	IV/PO q6h (max 5 days)	Moderate acute pain	Short-acting only; avoid GI bleed, GERD, renal disease
Lidocaine patch	1–3 patches	Apply q12h	Localized neuropathic pain	Maximum 3 patches simultaneously; safe, low systemic absorption
Topical diclofenac gel	Apply liberally	TID–QID	Joint/muscle pain	Minimal systemic absorption; good for localized pain

Multimodal Analgesia

Combine non-opioid agents (acetaminophen + NSAID + topical) with non-pharmacologic strategies (positioning, ice/heat, elevation) before resorting to opioids.

Pain Management: Opioid Analgesics

Use lowest effective dose for shortest duration. Prefer PO when possible. Always obtain baseline pain assessment.

Drug	Starting Dose	Duration	Route	Notes
Tramadol	50mg	q4–6h	PO	Lower seizure threshold; avoid in seizure disorder
Hydrocodone/APAP	5–10mg/325mg	q4–6h	PO	Monitor total acetaminophen dose; max 4g/day
Oxycodone	5mg	q4–6h	PO	Short-acting; good for acute pain; more euphoria than other agents
Morphine (immediate-release)	15–30mg	q4h	PO	Standard opioid; caution in renal failure (accumulation)
Morphine	2–4mg	q4h	IV	Slower onset than IV; monitor respiratory depression
Hydromorphone (Dilaudid)	1–2mg	q4–6h	PO	Potent; 1mg PO = ~2mg oxycodone
Hydromorphone (Dilaudid)	1mg (0.5mg if elderly)	q4–6h	IV	Shorter duration than morphine; use low doses in frail
Fentanyl	0.1mg	q1–2h	IV	Very potent; rapid onset; reserved for severe acute pain

Opioid Conversion Table

When switching formulations, convert to morphine equivalents (MEQ) first, then calculate new agent dose.

Drug	Route	Conversion to MEQ	Duration
Morphine	IV (10mg)	1 MEQ	4h
Morphine	PO (30mg)	1 MEQ	4h
Hydrocodone	PO (30mg)	1 MEQ	4h
Oxycodone	PO (20mg)	1 MEQ	4h
Oxycodone	IV (10mg)	1 MEQ	4h
Tramadol	IV (100mg)	1 MEQ	4h
Tramadol	PO (120mg)	1 MEQ	4h
Hydromorphone	IV (1.5mg)	1 MEQ	4h
Hydromorphone	PO (7.5mg)	1 MEQ	4h
Fentanyl	IV (0.1mg)	1 MEQ	1–2h

Example conversion: Patient on Hydromorphone 1mg IV q4h = 0.67 MEQ per dose. If switching to PO Oxycodone, equivalent dose = 0.67 MEQ × 20mg/MEQ = 13.4mg q4h (round to 10–15mg).

Opioid Prescribing Safety

Write one-time orders rather than standing schedules. Reassess need at each patient interaction. Keep naloxone at bedside for all opioid patients. Monitor for respiratory depression, oversedation, and constipation.

Opioid Reversal

Drug	Dose	Route	Duration	Notes
Naloxone (Narcan)	0.4–0.8mg	IV push	30–90min	Repeat q2–3min if needed; short duration (may need repeat dosing); watch for withdrawal

Opioid Withdrawal

Naloxone precipitates acute withdrawal (agitation, diaphoresis, pain). Consider half-doses in opioid-dependent patients. Have benzodiazepines at bedside.

Antibiotics: Common Inpatient Agents

Always use local antibiogram and culture results to guide therapy. Listed here are empiric first-line agents.

Drug	Starting Dose	Frequency	Spectrum	Common Indications	Cautions
Ceftriaxone	1g	IV q12h	3rd-gen cephalosporin (gram-neg, some gram-pos)	Community-acquired pneumonia, UTI, meningitis	Avoid if cephalosporin allergy; diarrhea risk
Cefepime	1–2g	IV q8–12h	4th-gen cephalosporin (broader gram-neg)	Hospital-acquired pneumonia, Pseudomonas concern	Better gram-neg than ceftriaxone; risk of encephalopathy with high doses
Piperacillin-tazobactam	3.375–4.5g	IV q6h	Broad-spectrum (anaerobes, Pseudomonas)	Complicated intra-abdominal, polymicrobial	Monitor for rash, phlebitis; need renal dosing
Vancomycin	15–20mg/kg	IV q8–12h	Gram-positive (MRSA coverage)	MRSA pneumonia/bacteremia, endocarditis	Monitor trough levels (goal 15–20); nephrotoxic; ototoxic
Azithromycin	500mg loading	PO/IV daily	Macrolide (atypical organisms)	Atypical pneumonia (Chlamydia, Mycoplasma)	GI side effects; QTc prolongation
Fluoroquinolone (levofloxacin)	750mg	PO/IV daily	Broad-spectrum (gram-neg + some gram-pos)	Community-acquired pneumonia, UTI	Tendon rupture, peripheral neuropathy, QTc prolongation risk
Trimethoprim-sulfamethoxazole	1–2DS tablets or 5mg/kg TMP	PO/IV BID	Gram-pos + gram-neg + anaerobes	UTI, PCP prophylaxis	Rash, hyperkalemia, Stevens-Johnson syndrome risk
Metronidazole	500mg	PO/IV q8h	Anaerobes, parasites	Anaerobic infections, C. difficile, trichomoniasis	Metallic taste, disulfiram reaction with alcohol
Clindamycin	300–600mg	PO/IV q6–8h	Gram-pos + anaerobes	Streptococcal infections, aspiration pneumonia	C. difficile diarrhea risk; rash

Empiric Sepsis Coverage

Standard empiric regimen: Ceftriaxone or cefepime + vancomycin (add gentamicin if Pseudomonas high risk). De-escalate once sensitivities available.

Antihypertensives: Acute and Chronic Control

Oral Agents (for hypertensive urgency, chronic control)

Drug	Starting Dose	Frequency	Class	Mechanism	Cautions
Metoprolol	25–50mg	PO BID	Beta-blocker	AV nodal blockade, decreased cardiac output	Avoid in hypotension, bradycardia, asthma/COPD
Carvedilol	3.125–6.25mg	PO BID	Alpha/beta-blocker	Combined alpha and beta effects	Avoid if HR <55; may worsen CHF acutely
Diltiazem	30–120mg	PO TID–QID	Calcium channel blocker	AV nodal blockade	Avoid in hypotension, bradycardia, acute CHF
Amlodipine	2.5–5mg	PO daily	Calcium channel blocker (dihydropyridine)	Peripheral vasodilation	Slower onset; good for chronic control; ankle edema
Lisinopril	5–10mg	PO daily	ACE inhibitor	Renin-angiotensin blockade	Avoid in hyperkalemia, AKI; dry cough common
Captopril	12.5–25mg	PO TID	ACE inhibitor	Renin-angiotensin blockade	Fastest onset of ACE inhibitors; caution in AKI
Clonidine	0.1–0.3mg	PO BID	Central alpha-2 agonist	Sympathetic inhibition	Reflex tachycardia; rebound HTN if discontinued abruptly
Hydralazine	10–25mg	PO QID	Vasodilator	Direct vasodilation	Reflex tachycardia; lupus-like syndrome with chronic use

Intravenous Agents (for more rapid control)

Drug	Dosing	Route	Onset	Mechanism	Cautions
Labetalol	10–20mg IV bolus; repeat q4–6h	IV push	5–10min	Alpha/beta-blocker	Avoid in acute CHF, bradycardia; reflex tachycardia rare
Hydralazine	10–20mg IV q6h	IV push	10–20min	Direct vasodilation	Reflex tachycardia; caution in CAD, MI
Nicardipine	5–15mcg/kg/min	IV infusion (titrate)	5–10min	Calcium channel blocker	Titrable; good for gradual control; risk of reflex tachycardia
Esmolol	50–300mcg/kg/min	IV infusion (titrate)	1–5min	Ultra-short-acting beta-blocker	Very rapid titration and reversal; useful if trial needed
Nitroglycerin	5–400mcg/min	IV infusion (titrate)	1–3min	Nitrate (vasodilation + preload reduction)	Use for ACS + HTN; causes tachyphylaxis; avoid in RV MI
Nitroprusside	0.5–10mcg/kg/min	IV infusion (titrate)	Immediate	Dual vasodilation (arterial + venous)	Risk of cyanide/thiocyanate toxicity; avoid prolonged use

HTN Management Goals

Avoid aggressive reduction in asymptomatic patients. Target gradual reduction (10–15mmHg per hour). Do not drop mean arterial pressure >30% or SBP >40mmHg in first hour (stroke/AKI risk).

Cardiac Medications

Beta-Blockers and Rate-Control Agents

Drug	Starting Dose	Frequency	Route	Indication	Notes
Metoprolol	5–10mg	q4–6h	IV (acute); 25–50mg	AF-RVR, ACS, HTN	Cardioselective; caution in asthma/COPD
Diltiazem	10mg bolus; 5–10mg/h drip	q4–6h (bolus) or continuous	IV/PO	AF-RVR (rate control), HTN	Negative inotrope; caution in CHF
Esmolol	50–300mcg/kg/min drip	Continuous (titrate)	IV	Acute AF-RVR, intraoperative tachycardia	Ultra-short-acting; rapid reversal
Digoxin	0.5–1mg loading	Single or divided	PO/IV	AF-RVR in CHF, narrow therapeutic window	Narrow therapeutic window; monitor levels (goal 0.8–2.0ng/mL)

Antiarrhythmics

Drug	Starting Dose	Frequency	Route	Mechanism	Cautions
Amiodarone	150mg bolus over 10min, then 360mg over 6h	Variable drip	IV infusion	Class III antiarrhythmic (multiple mechanisms)	Decreases rate + converts rhythm; risk of QTc prolongation, bradycardia
Flecainide	100–200mg	BID	PO	Class IC antiarrhythmic	Avoid in structural heart disease (risk of proarrhythmia); requires cardiology
Sotalol	80–160mg	BID	PO	Class III antiarrhythmic + beta-blocker	Risk of torsades; monitor QTc, K, Mg; requires cardiology

ACE Inhibitors and Other Cardiac Agents

Drug	Starting Dose	Frequency	Indication	Notes
Lisinopril	5–10mg	PO daily	CHF, post-MI, HTN	Vasodilation + reduced afterload; hyperkalemia risk
Enalapril	2.5–5mg	PO BID	CHF, post-MI, HTN	Longer-acting than captopril; oral option
Carvedilol	3.125–6.25mg	PO BID	CHF (evidence-based)	Improves EF in systolic CHF; start low in CHF
Furosemide	20–80mg	PO/IV daily–BID	CHF, pulmonary edema, fluid overload	Monitor K, Cr; can cause hypokalemia
Nitroglycerin SL	0.3–0.6mg	q5min PRN	Acute angina, ACS, pulmonary edema	Avoid in RV MI (preload-dependent); tachyphylaxis

Pulmonary Medications

Bronchodilators

Drug	Starting Dose	Frequency	Route	Indication	Notes
Albuterol	2.5–5mg	q4–6h PRN	Nebulized or inhaler	Asthma/COPD exacerbation, bronchospasm	Beta-2 agonist; risk of tremor, tachycardia
Ipratropium	0.5mg	q6h	Nebulized (combo with albuterol)	COPD exacerbation (synergistic with albuterol)	Anticholinergic; longer duration than albuterol
Levalbuterol	0.63–1.25mg	q8h	Nebulized	Asthma/COPD exacerbation (alternative to albuterol)	R-isomer of albuterol; less tremor/tachycardia
Theophylline	300mg	BID	PO (sustained-release)	Chronic COPD (rarely used now)	Narrow therapeutic window; monitor levels

Inhaled Corticosteroids

Drug	Dosing	Frequency	Indication	Notes
Fluticasone/Salmeterol (Advair)	1–2 puffs	BID	Chronic asthma/COPD maintenance	Combination ICS + LABA; do not use for acute exacerbation
Budesonide/Formoterol (Symbicort)	1–2 puffs	BID	Chronic asthma maintenance	ICS + LABA; can use as maintenance + reliever

Systemic Corticosteroids (for acute exacerbation)

Drug	Starting Dose	Frequency	Route	Indication	Notes
Methylprednisolone	40–125mg	q4–6h	IV	Acute asthma/COPD exacerbation	Rapid onset; reserve IV for severe exacerbation
Prednisone	40–60mg	daily	PO	Mild-moderate exacerbation (outpatient)	Slower onset; adequate for less severe exacerbations

Sedation and Agitation: Psychiatric Medications

Antipsychotics (for acute agitation/delirium)

Drug	Starting Dose	Frequency	Route	Notes	Cautions
Haloperidol	2–5mg (1mg elderly)	q4–6h	PO/IM/IV	Typical antipsychotic; rapid onset	QTc prolongation; monitor EKG; extrapyramidal side effects; max 20mg/day
Olanzapine	2.5–5mg	q6h	PO/IM	Atypical; lower dystonia risk	Metabolic syndrome risk; monitor QTc
Quetiapine	12.5–25mg	q6h	PO	Atypical; minimal movement disorder	Lower antipsychotic potency; often used at low doses
Risperidone	0.5–1mg	BID	PO	Atypical; effective antipsychotic	Risk of prolactin elevation; orthostasis
Ziprasidone	10mg	IM q4–6h	IM (IV not available in US)	Atypical; short-acting IM option	Monitor QTc; lower weight gain than others
Aripiprazole	2–5mg	daily–BID	PO/IM	Atypical; D2 partial agonist	Use if QTc >500; lower metabolic effects

Benzodiazepines (Use Cautiously—Delirium Risk)

Drug	Starting Dose	Frequency	Route	Indication	Cautions
Lorazepam	1–2mg	q4–6h	PO/IV	Anxiety, alcohol withdrawal, seizure	Short-acting; risk of dependence, delirium in elderly
Alprazolam	0.25–0.5mg	q8h	PO	Anxiety (avoid—no better than others)	Long-acting; accumulates in elderly and renal failure
Midazolam	0.15mg/kg	Single or repeated	IV/IM	Acute seizure, severe anxiety	Ultra-short-acting; risk of respiratory depression

Alternatives to Benzodiazepines

Drug	Starting Dose	Frequency	Route	Indication	Notes
Hydroxyzine	50–100mg	q4–6h	PO/IV	Anxiety, agitation	Non-controlled alternative to benzos; antihistamine
Buspirone	7.5–15mg	BID	PO	Chronic anxiety (not acute)	Slow onset; takes days to weeks; no sedation

Anticoagulation and DVT Prophylaxis

DVT Prophylaxis (Mechanical + Pharmacologic)

Drug	Starting Dose	Frequency	Indication	Cautions
Enoxaparin	40mg	SC daily	DVT prophylaxis (hospitalized patients)	Adjust dose if CrCl <30; monitor for HIT
Fondaparinux	5–10mg (weight-based)	SC daily	DVT prophylaxis (alternative to heparin)	Adjust for CrCl; avoid if CrCl <20
Unfractionated heparin	5,000 units	SC BID–TID	DVT prophylaxis (renal failure preference)	Monitor aPTT if higher doses; requires baseline platelet count

Therapeutic Anticoagulation (for VTE, AF, mechanical valve)

Drug	Loading Dose	Maintenance	Route	Cautions
Unfractionated heparin	80 units/kg bolus	18 units/kg/h infusion (titrate to aPTT 60–85)	IV	Monitor aPTT q6h initially; HIT risk; reversal with protamine
Enoxaparin	1mg/kg x1	1mg/kg q12h or 1.5mg/kg daily	SC	Adjust for CrCl; monitor anti-Xa levels if needed
Apixaban	10mg x1	5mg BID	PO	Direct Factor Xa inhibitor; no monitoring; renal adjustment
Rivaroxaban	15–20mg x1 (with food)	20mg daily (with food)	PO	Direct Factor Xa inhibitor; no monitoring
Dabigatran	150mg x1	150mg BID	PO	Direct thrombin inhibitor; no monitoring; renal adjustment
Warfarin	5–10mg	Titrate to INR 2–3 (goal varies by indication)	PO	Monitor INR; many interactions; slow onset/offset; baseline PT/INR

Reversal Agents

Agent	Bleeding Type	Anticoagulant	Dose	Notes
Fresh frozen plasma (FFP)	Major	Warfarin, UFH	10–15mL/kg	Non-specific; volume risk; slower reversal
Prothrombin complex (PCC)	Major GI/CNS	Warfarin	25–50 units/kg	Faster warfarin reversal than FFP; preferred
Vitamin K1	Major	Warfarin	2.5–5mg IV	Slow onset (12–24h); use with PCC for rapid reversal
Idarucizumab	Major	Dabigatran	5g IV (two 2.5g infusions)	Specific reversal; rapid; expensive
Andexanet alpha	Major	Apixaban, rivaroxaban	Weight/age-based bolus + infusion	Specific Factor Xa reversal; consider cost/access
Protamine sulfate	Major	UFH	1mg per 100 units UFH (max 50mg)	For heparin reversal; rapid onset

Anticoagulation Reversal

Major bleeding on anticoagulation requires immediate reversal. Have reversal agents in mind for each agent. Contact pharmacy/hematology if unsure. Do not delay reversal in life-threatening bleeding.

Electrolyte Replacement

Electrolyte	Deficiency	Starting Dose	Route	Target	Monitoring
Potassium	Hypokalemia (K <3.5)	10–20 mEq	PO/IV (slow if IV)	K 3.5–5.0	Daily K, EKG if <3.0
Magnesium	Hypomagnesemia (Mg <1.7)	1–2g	PO/IV	Mg 1.7–2.2	Daily Mg; adjust for renal function
Calcium	Hypocalcemia (Ca <8.5)	500–1000mg	PO/IV (calcium gluconate for IV)	Ca 8.5–10.5	Daily Ca; ionized Ca if critical
Sodium	Hyponatremia (Na <130)	Varies by acuity/severity	IV hypertonic saline (3%)	Na >130 (slowly to avoid osmotic demyelination)	Frequent Na checks; max correction 4–6 mEq/L per 24h
Phosphate	Hypophosphatemia (P <2.5)	10–20 mmol	PO/IV	P 2.5–4.5	Monitor with K, Ca replacement

Hyponatremia Correction

Overcorrection of sodium (>8–10 mEq/24h) risks osmotic demyelination syndrome (ODS). Correct slowly; target 4–6 mEq/24h increase unless acute symptomatic hyponatremia (<48h, seizures, LOC).

Immunizations (Inpatient)

Vaccine	Indication	Timing	Route	Notes
Influenza (inactivated)	Annual; all patients	Once per season	IM	Exclude egg allergy
Pneumococcal (PPSV23, PCV20)	Age ≥65 or chronic disease	Single or sequenced per guidelines	IM	Guidelines change; check current CDC recommendations
Tetanus/diphtheria/pertussis (Tdap)	If ≥10y since last	Single dose	IM	Repeat q10y
Meningococcal	College students, asplenic patients	Per risk	IM	Various formulations; check indication

Summary: Medication Safety Principles

Always verify renal function before dosing (many drugs renally eliminated; adjust if CrCl <60)
Check drug interactions (especially with warfarin, statins, ACE inhibitors)
Monitor therapeutic levels when applicable (vancomycin, digoxin, phenytoin, theophylline)
Reassess need at each patient interaction (avoid unnecessary continuation)
Know your patient's allergies (especially beta-lactams, sulfonamides)
Document rationale for high-risk drugs (opioids, benzodiazepines, anticoagulants)
Always de-escalate from broad-spectrum antibiotics once sensitivities available

Last Updated: 2026 Version: 1.0 Disclaimer: This guide is for educational purposes. Always follow institutional protocols, verify doses with primary sources, and consult pharmacy for specific patient scenarios.

Last update: April 12, 2026