Page 172 - 2022 Ranger Medic Handbook

KETACONAZOLE
Class: Antimicrobial – antifungal agent, imidazole derivative
Action: Alters the permeability of the cell wall by blocking fungal cytochrome P450; inhibits biosynthesis of triglyc-
erides and phospholipids by fungi; inhibits several fungal enzymes that results in a build-up of toxic concentrations
of hydrogen peroxide
Dose: Oral: 200mg once daily; may increase to 400mg once daily if response is insufficient. Continue until active
fungal infection is resolved; some infections may require a treatment duration of up to 6 months; tinea cruris, tinea
pedis: topical cream: apply to the affected and immediate surrounding area once daily for tinea corporis, cruris: 2
weeks; tinea pedis: 6 weeks; seborrheic dermatitis: topical cream: apply to the affected area twice daily for 4 weeks
or until clinical response is noted. Foam: apply to affected area twice daily for 4 weeks. Gel: apply to the affected
area once daily for 2 weeks. Shampoo 2%: Apply 5–10mL to wet scalp, lather, leave on 3–5 minutes, and rinse; apply
twice weekly for 2–4 weeks
Indications: Topical – Treatment of tinea corporis (ringworm), tinea cruris (jock itch), and tinea pedis (athlete’s foot)
caused by Trichophyton rubrum, treatment of seborrheic dermatitis. Systemic – Treatment of susceptible fungal infec-
tions in patients who have failed or who are intolerant to other antifungal therapies
Contraindications: Not indicated for the treatment of onychomycosis, cutaneous dermatophyte infections, or Can-
dida infections; ketoconazole hypersensitivity; alcoholism, fungal meningitis; ocular administration; administration
of the following drugs with ketoconazole is contraindicated: dofetilide, quinidine, pimozide, cisapride, methadone,
SECTION 4 disopyramide, dronedarone, and ranolazine. Ketoconazole can cause elevated plasma concentrations of these drugs
and may prolong QT intervals, sometimes resulting in life-threatening ventricular dysrhythmias, such as torsades de
pointes; administration with benzodiazepines; pregnancy category caution advised during pregnancy and may use
while breastfeeding
Adverse/Side-effects: Orthostatic hypotension, peripheral edema, fatigue, insomnia, malaise, nervousness, pares-
thesia, erythema, urticarial, anaphylactoid reaction.
Interactions: Topical treatment has no known drug interactions. Systemic treatment coadministration with mid-
azolam, triazolam, and alprazolam may result in elevated plasma concentrations of the benzodiazepines, leading to
prolonged hypnotic and sedative effects. There are many other drug interactions that require you to consult with a
provider and pharmacology resources prior to administration
Notes: Systemic – Hepatic function tests (baseline), including weekly ALT for the duration of treatment; calcium and
phosphorous (periodically with long-term use); adrenal function as clinically necessary. Use ketoconazole only when
other effective antifungal therapy is not available or tolerated and the potential benefits are considered to outweigh
the potential risks
KETAMINE * – CONTROLLED SUBSTANCE III
Class: Dissociative
Action: Produces a cataleptic-like state causing dissociation from the surrounding environment by direct action on
the cortex and limbic system. Ketamine is a noncompetitive NMDA receptor antagonist that blocks glutamate. Smaller
doses produce analgesia, and modulate central sensitization, hyperalgesia and opioid tolerance. Reduces polysy-
naptic spinal reflexes.
Dose: Sedation: 1–1.5mg/kg slow IV push titrate to effect, followed by half induction dose PRN q10–20min. 4–5mg/kgIM,
repeat doses q30min prn for maintenance. Do not administer faster as this may result in respiratory depression/apnea
Pain: 0.1–0.3mg/kg slow IV push over 30 seconds–1 minute. IM/IN = 0.2–0.6mg/kg
Avoid: 0.3–0.8mg/kg IV due to adverse effects
Onset/Peak/Duration:
IV – Onset in 30 seconds/Duration 5–10 minutes
IM – Onset in 3–4 minutes/Duration 12–25 minutes
IN – Onset in 5–10 minutes/Duration 12–25 minutes
Indications: General sedative and analgesic; anesthetic agent for procedures
Contraindications: Hypersensitivity to ketamine, cardiovascular disease category consider alternative during preg-
nancy and caution advised while breastfeeding
Adverse/Side-effects: Hypertension, respiratory depression, emergence reactions (delirium, hallucinations, confusion)
Interactions: Effects of ketamine are increased when combined with other analgesics or muscle relaxants
Mission Impact: GROUNDING medication for personnel on flight status
K9 Dosage: 100–150mg (5mg/kg) IV/IM (best given in conjunction with midazolam 2–10mg for profound sedation)

158 SECTION 4 RANGER MEDIC PHARMACOLOGY & FORMULARY