Page 168 - 2025 Ranger Medic Handbook

DOXYCYCLINE
Class: Antimicrobial – antibiotic; tetracycline
Action: Semisynthetic broad-spectrum antibiotic derived from oxytetracycline, but more completely absorbed with
effective blood levels maintained for longer periods and excreted more slowly than most other tetracyclines, thus it
requires smaller and less frequent dosing; primarily bacteriostatic in effect
Dose: As antimalarial, 100mg PO qd starting 1–2 days prior to 4 weeks after exposure; as antimicrobial, 100mg PO
q12hr on day 1, then 100mg qd; for travelers’ diarrhea, 100mg PO QD during risk period; for gonorrhea, 200mg PO
immediately, followed by 100mg bid × 3 days; for syphilis 100mg PO tid × 10 days; for acne, 100mg PO qd–bid
Indications: For suppression and chemoprophylaxis of chloroquine-resistant malaria, short-term prophylaxis and
treatment of travelers’ diarrhea caused by enterotoxigenic strains of Escherichia coli, chlamydial and mycoplasmal
infections, gonorrhea, syphilis in penicillin-allergic patients, rickettsial diseases, acute exacerbations of chronic bron-
chitis, and treatment of acne
Contraindications: Tetracycline hypersensitivity; use during period of tooth development including last half of preg-
nancy causes permanent yellow discoloration of teeth, enamel hypoplasia, and retardation of bone growth, pregnancy
SECTION 4 category may use for anthrax infection and otherwise consider alternative during pregnancy and avoid use while
breastfeeding
Adverse/Side-effects: Interference with color vision; anorexia, nausea, vomiting, diarrhea, enterocolitis; esophageal
irritation; rashes, photosensitivity reaction; superinfections
Interactions: Antacids, iron preparation, calcium, magnesium, zinc, kaolin-pectin, sodium bicarbonate can signifi-
cantly decrease absorption; effects of both doxycycline and desmopressin antagonized; increases digoxin absorption
and risk of toxicity; methoxyflurane increases risk of renal failure. Antacids (Pepto-Bismol, Kaopectate, Mylanta)
can significantly decrease the absorption effects of doxycycline.

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EPINEPHRINE (INCLUDING EPI-PEN)
Class: Autonomic nervous system agent – natural and synthetic catecholamine; α- and β-adrenergic agonist;
bronchodilator
Action: Sympathomimetic that acts directly on both alpha and beta receptors; the most potent activator of alpha re-
ceptors; strengthens myocardial contraction; increases systolic but may decrease diastolic blood pressure; increases
cardiac rate and output; constricts bronchial arterioles and inhibits histamine release, thus reducing congestion and
edema and increasing tidal volume and vital capacity
Dose: Anaphylaxis: 0.3–0.5mg IM q10–15min (1:1,000 soln = 1mg/1mL) ACLS: 1mg IV/IO q3–5min for cardiac arrest
Onset/Peak/Duration: IV/IM – Onset Rapid/Duration 1–2 minutes
Indications: For hypersensitivity and anaphylactic reactions, acute asthma attack, bronchospasm, mucosal conges-
tion, syncope due to heart block or carotid sinus hypersensitivity, and to restore cardiac rhythm in cardiac arrest;
prolong action and delay absorption of anesthetics; control superficial bleeding
Contraindications: Sympathomimetic amine hypersensitivity; narrow-angle glaucoma; hemorrhagic, traumatic, or
cardiogenic shock; cardiac dilatation, cerebral arteriosclerosis, coronary insufficiency, arrhythmias, organic heart or
brain disease; (use with local anesthesia of fingers, toes, ears, nose, genitalia has been demonstrated safe); pregnancy
category caution advised during pregnancy and consider alternative while breastfeeding
Adverse/Side-effects: Nervousness, restlessness, sleeplessness, fear, anxiety, tremors, headache, CVA, weak-
ness, dizziness, syncope, pallor, sweating, dyspnea; nausea, vomiting; precordial pain, palpitations, hypertension,
MI, tachyarrhythmias; bronchial and pulmonary edema; urinary retention; tissue necrosis; metabolic acidosis; altered
state of perception and thought, psychosis
Interactions: May increase hypotension in circulatory collapse; additive toxicities with other medications
Mission Impact: GROUNDING medication for personnel on flight status

154 SECTION 4 RANGER MEDIC PHARMACOLOGY & FORMULARY