Page 166 - 2022 Ranger Medic Handbook

DOCUSATE (COLACE)
Class: GI agent – stool softener
Action: Anionic surface-active agent with emulsifying and wetting properties; detergent action lowers surface tension,
permitting water and fats to penetrate and soften stools for easier passage
Dose: 50–500mg/d PO divided qd–qid
Indications: For treatment of constipation associated with hard and dry stools, also used prophylactically in patients
taking narcotics or patients who should avoid straining during defecation
Contraindications: Atonic constipation, nausea, vomiting, abdominal pain, fecal impaction, structural anomalies of
colon and rectum, intestinal obstruction or perforation; patients on sodium restriction or with renal dysfunction; con-
comitant use of mineral oil; pregnancy category may use during pregnancy and while breastfeeding
Adverse/Side-effects: Mild abdominal cramps, diarrhea, nausea, bitter taste; rash
Interactions: Increases systemic absorption of mineral oil
SECTION 4 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
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.

152 SECTION 4 RANGER MEDIC PHARMACOLOGY & FORMULARY