Clinician's Pocket Drug Reference 2008

112 Glyburide/Metformin1.25–10 mg daily–bid, max 20 mg/d. Micronized: 0.75–6 mg daily–bid, max 12mg/d Caution: [C, ?] Renal impair Contra: DKA, Type I DM Disp: Tabs 1.25,2.5, 5 mg; micronized tabs 1.5, 3, 6 mg SE: HA, hypoglycemia Notes: Not OK forCrCl < 50 mL/min; hold dose if NPOGlyburide/Metformin (Glucovance) Uses: *Type 2 DM* Action:Sulfonylurea: ↑ Pancreatic insulin release. Metformin: Peripheral insulin sensitivity;↓ hepatic glucose output/production; ↓ intestinal glucose absorption Dose: 1stline (naive pts), 1.25/250 mg PO daily–bid; 2nd line, 2.5/500 mg or 5/500 mg bid(max 20/2000 mg); take w/ meals, slowly ↑ dose; hold before & 48 h after ioniccontrast media Caution: [C, –] Contra: SCr > 1.4 in females or > 1.5 in males;hypoxemic conditions (sepsis, recent MI); alcoholism; metabolic acidosis; liverDz; Disp: Tabs 1.25/250 mg, 2.5/500 mg, 5/500 mg SE: HA, hypoglycemia, lacticacidosis, anorexia, N/V, rash Notes: Avoid EtOH; hold dose if NPO; monitor folatelevels (megaloblastic anemia)Glycerin Suppository Uses: *Constipation* Action: Hyperosmolar laxativeDose: Adults. 1 adult supp PR PRN. Peds. 1 infant supp PR daily–bid PRNCaution: [C, ?] Disp: Supp (adult, infant); liq 4 mL/applicatorful SE: DGonadorelin (Factrel) Uses: *Primary hypothalamic amenorrhea* Action:Stimulates pituitary release of LH & FSH Dose: 5 mcg IV q 90 min × 21 dusing pump kit Caution: [B, M] ↑ levels w/ androgens, estrogens, progestins, glucocorticoids,spironolactone, levodopa; ↓ levels with OCP, digoxin, dopamine antagonistsContra: Condition exacerbated by PRG or reproductive hormones,ovarian cysts, causes of anovulation other than hypothalamic, hormonally dependenttumor Disp: Inj 100 mcg SE: Multiple pregnancy risk; inj site pain Notes:Monitor LH, FSHGoserelin (Zoladex) Uses: Advanced *CA Prostate* & w/ radiation forlocalized high-risk Dz, *endometriosis, breast CA* Action: LHRH agonist, transient↑ then ↓ in LH, w/ ↓ testosterone Dose: 3.6 mg SQ (implant) q 28d or 10.8mg SQ q3mo; usually lower abd wall Caution: [X, –] Contra: PRG, breast-feeding,10.8-mg implant not for women Disp: SQ implant 3.6 (1 mo), 10.8 mg (3 mo)SE: Hot flashes, ↓ libido, gynecomastia, & transient exacerbation of CA-relatedbone pain (“flare rxn” 7–10 d after 1st dose) Notes: Inject SQ into fat in abd wall;do not aspirate; females must use contraceptionGranisetron (Kytril) Uses: *Prevention of N/V* Action: Serotonin receptorantagonist Dose: Adults & Peds. 10 mcg/kg/dose IV 30 min prior to chemoAdults. Inj 0.1, 1 mg/mL 2 mg PO 1 h prior to chemo, then 12 h later. Postop N/V:1 mg IV before end of OR case Caution: [B, +/–] St. John’s wort ↓ levels Contra:Liver Dz, children