Clinician's Pocket Drug Reference 2008

Efavirenz, emtricitabine, tenofovir 87Eculizumab (Soliris) WARNING: ↑ risk of meningococcal infections (givemeningococcal vaccine 2 weeks prior to first dose and revaccinate per guidelines)Uses: *Rx paroxysmal nocturnal hemoglobinuria* Action: Complement inhibitorDose: 600 mg IV q 7 days x 4 wks, then 900 mg IV fifth dose 7 days later, then 900mg IV q 14 days Caution: [C; ?] Contra: Active N. meningitides infection; if notvaccinated against N. meningitides Disp: 300-mg vial SE: Meningococcal infxn,HA, nasopharyngitis, N, back pain, infxns, fatigue, severe hemolysis on D/C Notes:IV over 35 min (2-hr max inf time); monitor for 1 hr for s/sx of infusion rxnEdrophonium (Tensilon, Enlon, Reversol) Uses: *Diagnosis ofMyG; acute MyG crisis; curare antagonist, reverse of nondepolarizing neuromuscularblockers* Action: Anticholinesterase Dose: Adults. Test for MyG: 2 mg IVin 1 min; if tolerated, give 8 mg IV; (+) test is brief ↑ in strength. Peds. Test forMyG: Total dose 0.2 mg/kg; 0.04 mg/kg test dose; if no Rxn, give remainder in1-mg increments to 10 mg max; ↓ in renal impair Caution: [C, ?] Contra: GI orGU obst; allergy to sulfite Disp: Inj 10 mg/mL SE: N/V/D, excessive salivation,stomach cramps, ↑ aminotransferases Notes: Can cause severe cholinergic effects;keep atropine availableEfalizumab (Raptiva) WARNING: Associated w/ serious Infxns, malignancy,thrombocytopenia Uses: Chronic moderate–severe plaque psoriasis Action:MoAb Dose: Adults. 0.7 mg/kg SQ conditioning dose, followed by 1 mg/kg/wk;single doses should not exceed 200 mg Caution: [C, +/–], chronic infection, elderlyContra: Admin of most vaccines Disp: 150-mg vial SE: First-dose Rxn,HA, worsening psoriasis, ↑ LFT, hemolytic anemia immunosuppressive-relatedRxns (see Warning) Notes: Minimize 1st-dose Rxn by conditioning dose; pltsmonthly, then every 3 mo & w/ dose ↑; pts may be trained in self-adminEfavirenz (Sustiva) Uses: *HIV Infxns* Action: Antiretroviral; nonnucleosideRTI Dose: Adults. 600 mg/d PO q hs. Peds. See insert; avoid high-fat mealsCaution: [D,?] CDC recommends HIV-infected mothers not breast-feed Contra:Component sensitivity Disp: Caps 50, 100, 200; 600 mg tab SE: Somnolence,vivid dreams, dizziness, rash, N/V/D Notes: LFT, cholesterolEfavirenz, emtricitabine, tenofovir (Atripla) WARNING: Lacticacidosis and severe hepatomegaly with steatosis, including fatal cases, have beenreported with the use of nucleoside analogs alone or in combination with other antiretroviralsUses: *HIV Infxns* Action: Triple fixed-dose combination antiretroviralDose: Adults. 1 tab daily on empty stomach; HS dose may ↓ CNS effectsCaution: [D, ?] CDC recommends HIV-infected mothers not breast-feed Contra:< 18 yrs, component sensitivity, w/ astemizole, midazolam, triazolam or ergot derivatives(competition for CYP3A4 by efavirenz could result in serious and/or lifethreateningSE) Disp: Tab containing efavirenz 600 mg/emtricitabine 200mg/tenofovir/300 mg SE: Somnolence, vivid dreams, HA, dizziness, rash, N/V/D,↓ bone mineral density Notes: Monitor LFT, cholesterol; see individual agents foradditional info, do not use in HIV and HepB coinfection