Page 174 - 2022 Ranger Medic Handbook

LEVOFLOXACIN (LEVOQUIN)
Class: Antimicrobial – antibiotic; fluoroquinolone. All fluoroquinolones now have a US Black Box Warning due to
serious adverse reactions including tendonitis and tendon rupture, peripheral neuropathy and CNS effects.
However, in some rare cases, benefits may outweigh the risks of fluoroquinolone use. Fluoroquinolones re-
quire prior approval from unit physician or physician assistant.
Action: Broad-spectrum antibiotic that inhibits DNA bacterial topoisomerase II, an enzyme required for DNA replica-
tion, transcription, repair, and recombination; prevents replication of certain bacteria resistant to β-lactam antibiotic
Dose: Community-acquired pneumonia – 750mg/d PO/IV × 7 days; skin infection – 750mg/d × 5–14 days; rhinosinus-
itis (bacterial) – 500mg/d × 5–7 days; for chronic bacterial prostatitis: 500mg PO qd × 28 days; for UTIs: 500–750mg
PO qd × 7 days
Indications: For treatment of maxillary sinusitis, acute exacerbations of bacterial bronchitis, community-acquired
pneumonia, uncomplicated skin/skin structure infections, UTI, acute pyelonephritis; chronic bacterial prostatitis; bac-
terial conjunctivitis
Contraindications: Quinolone hypersensitivity; hypokalemia; tendon pain; syphilis; viral infections; phototoxicity;
pregnancy category consider alternative during pregnancy and avoid while breastfeeding
SECTION 4 Adverse/Side-effects: Prolonged QT syndrome, tendon rupture, headache, insomnia, dizziness; nausea, diarrhea,
constipation, vomiting, abdominal pain, dyspepsia; rash, pruritus; decreased vision, foreign body sensation, transient
ocular burning, ocular pain, photophobia; chest or back pain, fever, pharyngitis
Interactions: Magnesium- or aluminum-containing antacids, sucralfate, iron, and zinc may decrease absorption;
NSAIDs may increase risk of CNS reactions including seizures; may cause hyper- or hypoglycemia in patients on
oral hypoglycemic agents; may cause false positives on opiate screening tests; avoid exposure to excess sunlight or
artificial UV light; avoid NSAIDs while taking levofloxacin
Mission Impact: GROUNDING medication for personnel on flight status

LIDOCAINE (XYLOCAINE)
Class: Amide-type local anesthetic; cardiovascular agent; class IB antiarrhythmic
Action: Anesthetic effect similar to that of procaine; class IB antiarrhythmic action by suppressing automaticity in the
His-Purkinje system and by elevating the electrical stimulation threshold of ventricles during diastole
Dose: For local anesthesia, infiltrate 0.5–2% injection with and without epinephrine; max dose – 4.5mg/kg/dose
(without epinephrine); 7mg/kg (with epinephrine)
Onset/Peak/Duration: Procedural local injection – Onset 1–3 minutes/Duration 10 minutes; dosing with epinephrine –
Onset 1–3 minutes/Duration infiltration ~2 hours, nerve block ~3–3.5 hours
Indications: For surface, infiltration, and nerve block anesthesia; also used for rapid control of ventricular arrhythmias
Contraindications: Amide-type local anesthetic hypersensitivity; systemic injection in presence of severe trauma or
sepsis, blood dyscrasias, supraventricular arrhythmias, untreated sinus bradycardia, severe degrees of sinoatrial, atrio-
ventricular, and intraventricular heart block; pregnancy category may use during pregnancy and while breastfeeding
Adverse/Side-effects: Drowsiness, dizziness, light–headedness, restlessness, confusion, disorientation, irritability,
apprehension, euphoria, wild excitement, numbness of lips or tongue, hot and cold paresthesia, chest heaviness,
difficulty speaking, difficulty breathing or swallowing, muscular twitching, tremors, psychosis; convulsions, respiratory
depression and arrest, hypotension, bradycardia, conduction disorders, heart block, cardiovascular collapse, and
cardiac arrest in high doses; tinnitus, decreased hearing; blurred or double vision, impaired color perception; local
erythema and edema; anorexia, nausea, vomiting; excessive perspiration, thrombophlebitis; urticaria, rash, edema,
anaphylactoid reaction
Interactions: Barbiturates decrease activity; cimetidine, β-blockers, quinidine increases effects; phenytoin increases
cardiac depressant effects; procainamide compounds neurologic and cardiac effects
Mission Impact: GROUNDING medication for personnel on flight status

160 SECTION 4 RANGER MEDIC PHARMACOLOGY & FORMULARY