Clinician's Pocket Drug Reference 2008

122 Influenza Virus Vaccine Live, Intranasalacute resp or febrile illness, Hx Guillain–Barré, immunocompromised, children5–17 y on aspirin Disp: Based on manufacturer, 0.25- & 0.5-mL prefilled syringesSE: Inj site soreness, fever, myalgia, malaise, Guillain–Barré synd (controversial)Notes: Fluvarix not labelled for Peds; Optimal in US Oct–Nov, protection begins1–2 wk after, lasts up to 6 mo; each yr, vaccines based on predictions of flu active influ season (December–spring in US); whole or split virus for adults; Peds 6 wk apart in 1st vaccination year Peds >9 y: see adultdose Caution: [C,?/–] Contra: Egg allergy, PRG, Hx Guillain–Barré synd,known/suspected immune deficiency, asthma or reactive airway Dz, acute febrileillness, 5–17 YO on ASA Disp: Prefilled, single-use, intranasal sprayer; shippedfrozen, store 35–46 F; new refrigerated shipping form for 2008 SE: Runny nose,nasal congestion, HA, cough Notes: Do not give w/ other vaccines; avoid contactw/immunocompromised individuals for 21 daysInsulin, Injectable (See Table 5) Uses: *Type 1 or type 2 DM refractory todiet or PO hypoglycemic agents; acute life-threatening ↑K + *Action: Insulin suplDose: Based on serum glucose; usually SQ; can give IV (only regular)/IM; type Itypical start dose 0.5–1 units/kg/d; type 2 0.3–0.4 units/kg/d; renal failure ↓insulinneeds Caution: [B, +] Contra: Hypoglycemia Disp: Table 5 SE: Highly purifiedinsulins↑free insulin; monitor for several wks when changing doses/agentsInsulin Human Inhalation Powder (Exubera) Uses: *Type-1DM in adults combo w/LA insulin; Type-2 DM monotherapy or w/other agentsAction: Regulates glucose metabolism Dose: Premeal (mg) = BW(kg) × 0.05mg/kg; round down to nearest whole mg; give w/in 10 min pc; titrate based on glucose;1 mg blister = 3 IU of SC regular human insulin; 3 mg blister = 8 IU of SCregular human insulin. Caution: [C, M] Contra: Smoker/or D/C smoking < 6 mobefore start; D/C if smoking resumes; unstable or poorly controlled lung diseaseDisp: Unit dose blisters: 1, 3 mg w/Exubera Inhaler SE: Hypoglycemia, drymouth, chest pain, otitis media, cough, dyspnea, pharyngitis, rhinitis, sinusitis,epistaxis, ↑sputum Notes: pulm fxn before Tx and 6–12 mo; store blisters atroom temperatureInterferon Alfa (Roferon-A, Intron-A) WARNING: Can cause oraggravate fatal or life-threatening neuropsychiatric, autoimmune, ischemic, and infectiousdisorders. Monitor patients closely Uses: *Hairy cell leukemia, Kaposisarcoma, melanoma, CML, chronic Hep B & C, follicular NHL, condylomataacuminata* Action: Antiproliferative; modulates host immune response; ↓viralreplication in infected cells Dose: Per protocols. Adults. Hairy cell leukemia:Alfa-2a (Roferon-A): 3 M units/d for 16–24 wk SQ/IM then 3 M units 3 ×/wk X 6–24mo; Alfa-2b (Intron A): 2 M units/m 2 IM/ SQ 3 ×/wk for 2–6 mo Chronic Hep B: