Clinician's Pocket Drug Reference 2008

114 Hepatitis A Vaccineqh (adjust based on PTT); Bolus 60 IU/kg (max 4000 IU); then 12 IU/kg/h (max1000 IU/h for patients >70 kg) round to nearest 50 IU; keep PTT 1.5–2.0 (control48 h or until angiography (ECC 2005) Peds. Infants: Load 50 units/kg IV bolus,then 20 units/kg/h IV by cont inf. Children: Load 50 units/kg IV, then 15–25units/kg cont inf or 100 units/kg/dose q4h IV intermittent bolus (adjust based onPTT) Caution: [B, +] ↑ risk of hemorrhage w/ anticoagulants, aspirin, antiplatelets,cephalosporins w/ MTT side chain Contra: Uncontrolled bleeding, severethrombocytopenia, suspected ICH Disp: Inj 10, 100, 1000, 2000, 2500, 5000,7500, 10,000, 20,000, 40,000 units/mL SE: Bruising, bleeding, thrombocytopeniaNotes: Follow PTT, thrombin time, or activated clotting time; little PT effect; therapeuticPTT 1.5–2 × control for most conditions; monitor for HIT w/plt countsHepatitis A Vaccine (Havrix, Vaqta) Uses: *Prevent Hep A* inhigh-risk individuals (eg, travelers, certain professions, or high-risk behaviors) Action:Active immunity Dose: (Expressed as ELISA units [EL.U.]) Havrix: Adults.1440 EL.U. single IM dose. Peds >2 y. 720 EL.U. single IM dose. Vaqta: Adults.50 units single IM dose. Peds. 25 units single IM dose Caution: [C, +] Contra:Component allergy Disp: Inj 720 EL.U./0.5 mL, 1440 EL.U./1 mL; 50 units/mLSE: Fever, fatigue, HA, inj site pain Notes: Booster OK 6–12 mo after primary; reportSAE to VAERS: 1-800-822-7967Hepatitis A (Inactivated) & Hepatitis B (Recombinant) Vaccine(Twinrix) Uses: *Active immunization against Hep A/B* Action: Activeimmunity Dose: l mL IM at 0, 1, & 6 mo Caution: [C, +] Contra: Component sensitivityDisp: Single-dose vials, syringes SE: Fever, fatigue, pain at site, HA Notes:Booster OK 6–12 mo after vaccination; report SAE to VAERS: 1-800-822-7967Hepatitis B Immune Globulin (HyperHep, H-BIG) Uses: *Exposureto HBsAg(+) material* (eg, blood, plasma, or serum, accidental needlestick,mucous membrane contact, PO) Action: Passive immunization Dose: Adults& Peds. 0.06 mL/kg IM 5 mL max; w/in 24 h of exposure; w/in 14 d of sexual contact;repeat 1 mo if nonresponder or refused initial after exposure Caution: [C, ?]Contra: Allergies to g-globulin or anti-immunoglobulin Ab; allergies tothimerosal; IgA deficiency Disp: Inj SE: Inj site pain, dizziness Notes: IM ingluteal or deltoid; w/continued exposure, give Hep B vaccineHepatitis B Vaccine (Engerix-B, Recombivax HB) Uses: *PreventHep B* Action: Active immunization; recombinant DNA Dose: Adults. 3 IMdoses 1 mL each; 1st 2 doses 1 mo apart; the 3rd 6 mo after the 1st. Peds. 0.5 mLIM adult schedule Caution: [C, +] ↓ effect w/ immunosuppressives Contra: Yeastallergy Disp: Engerix-B: Inj 20 mcg/mL; peds inj 10 mcg/0.5 mL. RecombivaxHB: Inj 10 & 40 mcg/mL; peds inj 5 mcg/0.5 mL SE: Fever, inj site pain Notes:Deltoid IM inj adults/older peds; younger peds, use anterolateral thighHetastarch (Hespan) Uses: *Plasma volume expansion* adjunct in shock& leukapheresis Action: Synthetic colloid; acts similar to albumin Dose: Volumeexpansion: 500–1000 mL (1500 mL/d max) IV (20 mL/kg/h max rate). Leuka-