Clinician's Pocket Drug Reference 2008

Esterified Estrogens + Methyltestosterone 93Esmolol (Brevibloc) Uses: *SVT & noncompensatory sinus tachycardia,AF/flutter* Action: β 1 -adrenergic blocker; class II antiarrhythmic Dose: Adults &Peds. Initial 500 mcg/kg load over 1 min, then 50 mcg/kg/min × 4 min; if inadequateresponse, repeat load & maint inf of 100 mcg/kg/min × 4 min; titrate by repeatingload, then incremental ↑ in the maint dose of 50 mcg/kg/min for 4 minuntil desired HR reached or ↓ BP; average dose 100 mcg/kg/min; 0.5 mg/kg over1 min, then 0.05 mg/kg/min (ECC 2005) Caution: [C (1st tri; D 2nd or 3rd tri), ?]Contra: Sinus bradycardia, heart block, uncompensated CHF, cardiogenic shock,↓ BP Disp: Inj 10, 20, 250 mg/mL; premix inf 10 mg/mL SE: ↓ BP; bradycardia,diaphoresis, dizziness, pain on inj Notes: Hemodynamic effects back to baselinew/in 30 mins after D/C infEsomeprazole (Nexium) Uses: *Short-term (4–8 wk) for erosiveesophagitis/GERD; H. pylori Infxn in combo with antibiotics* Action: Protonpump inhibitor, ↓ gastric acid Dose: Adults. GERD/erosive gastritis: 20–40 mg/dPO × 4–8 wk; 20–40 mg IV 10–30 min inf or > 3 min IV push, 10 d max; Maint:20 mg/d PO. H. pylori Infxn: 40 mg/d PO, plus clarithromycin 500 mg PO bid &amoxicillin 1000 mg/bid for 10 d; Caution: [B, ?/–] Contra: Component sensitivityDisp: Caps 20, 40 mg; IV 20, 40 mg SE: HA, D, abd pain Notes: Do not chew;may open capsule & sprinkle on applesauceEstazolam (Prosom) [C-IV] Uses: *Short-term management ofinsomnia* Action: Benzodiazepine Dose: 1–2 mg PO qhs PRN; ↓ in hepatic impair/elderly/debilitatedCaution: [X, –] ↑ effects w/ CNS depressants Contra:PRG Disp: Tabs 1, 2 mg SE: Somnolence, weakness, palpitations, anaphylaxis,angioedema, amnesia Notes: May cause psychological/physical dependence; avoidabrupt D/C after prolonged useEsterified Estrogens (Estratab, Menest) WARNING: Do not use inthe prevention of CV Dz or dementia; ↑ risk of endometrial cancer Uses: *VasomotorSxs or vulvar/vaginal atrophy w/ menopause*; female hypogonadism, Pca,prevent osteoporosis Action: Estrogen supl Dose: Menopausal vasomotor sx:0.3–1.25 mg/d, cyclically 3 wk on, 1 wk off; add progestin 10–14 d w/ 28-daycycle w/uterus intact; Vulvovaginal atrophy: same regimen except use 0.3–1.25mg; Hypogonadism: 2.5–7.5 mg/d PO × 20 d, off × 10 d; add progestin 10–14d w/28-day cycle w/uterus intact Caution: [X, –] Contra: Undiagnosed genital bleeding,breast CA, estrogen-dependent tumors, thromboembolic disorders, thrombophlebitis,recent MI, PRG, severe hepatic Dz Disp: Tabs 0.3, 0.625, 1.25, 2.5 mgSE: N, HA, bloating, breast enlargement/tenderness, edema, venous thromboembolism,hypertriglyceridemia, gallbladder Dz Notes: Use lowest dose for shortesttime (see Women’s Health Initiatives (WHI) data www.whi.org)Esterified Estrogens + Methyltestosterone (Estratest, EstratestHS, Syntest DS, HS) WARNING: ↑ risk of dementia in postmenopausalwomen, unopposed estrogens may ↑ risk of endometrial carcinoma inpostmenopausal women. Uses: *Vasomotor Sxs*; postpartum breast engorge-