Clinician's Pocket Drug Reference 2008

Famciclovir 99plant subdermally q3y Caution: [X, +] exclude pregnancy before implant Contra:PRG, hormonally responsive tumors, Breast Ca, AUB, hepatic tumor, active liverDz, hx thromboembolic Dz Disp: 68 mg implant SE: spotting, irregular periods,amenorrhea, dysmenorrhea, HA, tender breasts, N, wgt gain, acne, ectopic pregnancy,PE, ovarian cysts, stroke, ↑ BP, Notes: 99% effective; remove implant andreplace; restricted distribution; physician must register and train; does not protectagainst STDsEtoposide [VP-16] (VePesid, Toposar) Uses: *Testicular, non-smallcelllung CA, Hodgkin Dz & NHLs, peds ALL, & allogeneic/autologous BMT inhigh doses* Action: Topoisomerase II inhibitor Dose: 50 mg/m 2 /d IV for 3–5 d; 50mg/m 2 /d PO for 21 d (PO availability = 50% of IV); 2–6 g/m 2 or 25–70 mg/kg inBMT (Per protocols); ↓ in renal/hepatic impair Caution: [D, –] Contra: IT administrationDisp: Caps 50 mg; inj 20 mg/mL SE: N/V (Emesis in 10–30%), ↓ BM,alopecia, ↓ BP w/rapid IV, anorexia, anemia, leukopenia, ↑ risk secondary leukemiasExemestane (Aromasin) Uses: *Advanced breast CA in postmenopausalwomen w/progression after tamoxifen* Action: Irreversible, steroidal aromatase inhibitor;↓ estrogens Dose: 25 mg PO daily after a meal Caution: [D, ?/–] Contra:PRG, Component sensitivity Disp: Tabs 25 mg SE: Hot flashes, N, fatigueExenatide (Byetta) Uses: Type 2 DM combined w/ metformin &/or sulfonylureaAction: An incretin mimetic: ↑ insulin release, ↓ glucagon secretion,↓ gastric emptying, promotes satiety Dose: 5 mcg SQ bid w/in 60 min before AM& PM meals; ↑ to 10 mcg SQ bid after 1 mo PRN; do not give pc Caution:[C, ?/–] may ↓ absorption of other drugs (take antibiotics/contraceptives 1 h before)Contra: CrCl < 30 mL/min Disp: Soln 5, 10 mcg/dose in prefilled pen SE:Hypoglycemia, N/V/D, dizziness, HA, dyspepsia, ↓ appetite, jittery Notes: Consider↓ sulfonylurea to ↓ risk of hypoglycemia; discard pen 30 d after 1st useEzetimibe (Zetia) Uses: *Hypercholesterolemia alone or w/a HMG-CoAreductase inhibitor* Action: ↓ cholesterol & phytosterols absorption Dose: Adults& Peds >10 y. 10 mg/d PO Caution: [C, +/–] Bile acid sequestrants ↓ bioavailabilityContra: Hepatic impair Disp: Tabs 10 mg SE: HA, D, abd pain, ↑ transaminasesw/ HMG-CoA reductase inhibitorEzetimibe/Simvastatin (Vytorin) Uses: *Hypercholesterolemia* Action:↓ absorption of cholesterol & phytosterols w/HMG-CoA-reductase inhibitorDose: 10/10–10/80 mg/d PO; w/cyclosporine or danazol:10/10 mg/d max; w/amiodarone or verapamil: 10/20 mg/d max; ↓ w/severe renal insuff Caution:[X, –]; w/ CYP3A4 inhibitors (Table 11), gemfibrozil, niacin >1 g/d, danazol,amiodarone, verapamil Contra: PRG/lactation; liver Dz, ↑ LFTs Disp: Tabs (ezetimibe/simvastatin)10/10, 10/20, 10/40, 10/80 mg SE: HA, GI upset, myalgia, myopathy(muscle pain, weakness, or tenderness w/ creatine kinase 10 × ULN,rhabdomyolysis), hepatitis, Infxn Notes: Monitor LFTsFamciclovir (Famvir) Uses: *Acute herpes zoster (shingles) & genital herpes*Action: ↓ viral DNA synth Dose: Zoster: 500 mg PO q8h × 7 d. Simplex: