Clinician's Pocket Drug Reference 2008

86 Drotrecogin Alfatachycardia & extrapyramidal Rxns, ↑ QT interval, arrhythmias Notes: Give IVPslowly over 2–5 minDrotrecogin Alfa (Xigris) Uses: *↓ Mortality in adults w/ severe sepsis(w/ acute organ dysfunction) at high risk of death (eg, determined by APACHE IIWWW.NCEMI.ORG)* Action: Recombinant human-activated protein C; antithromboticand anti-inflammatory, unclear mechanism Dose: 24 mcg/kg/h, total of96 h Caution: [C, ?] Contra: Active bleeding, recent stroke/CNS surgery, headtrauma/CNS lesion w/ herniation risk, trauma w/ ↑ bleeding risk, epidural catheter,mifepristone Disp: 5, 20-mg vials SE: Bleeding Notes: Single organ dysfunction& recent surgery may not be at high risk of death irrespective of APACHE II score& therefore not indicated. Percutaneous procedures: Stop inf 2 h before & resume1 h after; major surgery: stop inf 2 h before & resume 12 h after in absence ofbleedingDuloxetine (Cymbalta) WARNING: Antidepressants may ↑ risk of suicidality;consider risks/benefits of use. Closely monitor for clinical worsening, suicidality,or behavior changes Uses: *Depression, DM peripheral neuropathic pain,GAD* Action: Selective serotonin & norepinephrine reuptake inhibitor (SSNRI)Dose: Depression: 40–60 mg/d PO ÷ bid. DM neuropathy: 60 mg/d PO; GAD:30–60 mg/d max 120mg/d Caution: [C, ?/–]; use in 3rd tri; avoid if CrCl < 30mL/min, NAG, w/fluvoxamine, inhibitors of CYP2D6 (Table 11), TCAs, phenothiazines,type 1C antiarrhythmics (Table 10) Contra: MAOI use w/in 14 d, w/ thioridazine,NAG, hepatic insuff Disp: Caps delayed-release 20, 30, 60 mg SE:N, dizziness, somnolence, fatigue, sweating, xerostomia, constipation, ↓ appetite,sexual dysfunction, urinary hesitancy, ↑ LFTs, HTN Notes: Swallow whole; monitorBP; avoid abrupt D/CDutasteride (Avodart) Uses: *Symptomatic BPH* Action: 5α-Reductaseinhibitor; ↓ intracellular DHT Dose: 0.5 mg PO/day Caution: [X, –] Hepatic impair;pregnant women should not handle pills Contra: Women & children Disp:Caps 0.5 mg SE: ↑ testosterone, TSH ↑, ↓ PSA levels, impotence, ↓ libido, gynecomastiaNotes: No blood donation until 6 mo after D/C, new baseline PSA @6 mo; corrected PSA × 2Echothiophate Iodine (Phospholine Ophthalmic) Uses: *Glaucoma*Action: Cholinesterase inhibitor Dose: 1 gtt eye(s) bid w/ 1 dose hs Caution:[C, ?] Contra: Active uveal inflammation, inflammatory Dz of iris/ciliarybody, glaucoma iridocyclitis Disp: Powder, reconstitute 1.5 mg/0.03%; 3 mg/0.06%; 6.25 mg/0.125%; 12.5 mg/0.25% SE: Local irritation, myopia, blurred vision,↓ BP, bradycardiaEconazole (Spectazole) Uses: *Tinea, cutaneous Candida, & tinea versicolorInfxns* Action: Topical antifungal Dose: Apply to areas bid (daily for tineaversicolor) for 2–4 wk Caution: [C, ?] Contra: Component sensitivity Disp: Topicalcream 1% SE: Local irritation, pruritus, erythema Notes: Early symptom/clinicalimprovement; complete course to avoid recurrence