Clinician's Pocket Drug Reference 2008

132 Levorphanol1st tri ab; wait 6 wk if postpartum; replace any time during menstrual cycle Caution:[C, ?] Contra: Disp: 52 mg IUD SE: Failed insertion, ectopic pregnancy,sepsis, PID, infertility, PRG comps w/IUD left in place, abortion, embedment,ovarian cysts, perforation uterus/cervix, intestinal obstruct/perf, peritonitis, Notes:Counsel patient does not protect against STD/HIV; see insert for instructionsLevorphanol (Levo-Dromoran) [C-II] Uses: *Moderate–severe pain;chronic pain* Action: Narcotic analgesic Dose: 2–4 mg PO PRN q6–8h; 1–2 mgIM/SQ PRN q6–8h; ↓ in hepatic impair Caution: [B/D (prolonged use/high dosesat term), ?] Contra: Component allergy Disp: Tabs 2 mg; inj 2 mg/mL SE: Tachycardia,↓ BP, drowsiness, GI upset, constipation, resp depression, pruritusLevothyroxine (Synthroid, Levoxyl, others) Uses: *Hypothyroidism,myxedema coma* Action: Supplement L-thyroxine Dose: Adults. HypothyroidInitial, 12.5–50 mcg/d PO; ↑ by 25–50 mcg/d every mo; usual 100–200mcg/d. Myxedema: 200–500 mcg IV, then 100–300 mcg/d Peds. Hypothyroid: 0–3mo: 10–15 mcg/kg/24 h PO. 3–6 mo: 8–10 mcg/kg/d PO; 6–12 mo: 6–8 mcg/kg/dPO; 1–5 yr: 5–6 mcg/kg/d PO; 6–12 yr: 4–5 mcg/kd/d PO; > 12 yr: 2–3 mcg/kd/dPO. Reduce dose by 50% if IV; titrate based on response & thyroid tests; dose can↑ rapidly in young/middle-aged Caution: [A, +] Contra: Recent MI, uncorrectedadrenal insuff Disp: Tabs 25, 50, 75, 88, 100, 112, 125, 137, 150, 175, 200, 300mcg; inj 200, 500 mcg SE: Insomnia, wgt loss, alopecia, arrhythmia Notes: Takew/ full glass of water (prevents choking)Lidocaine (Anestacon Topical, Xylocaine, others) Uses: *Localanesthetic; Rx cardiac arrhythmias* Action: Anesthetic; class IB antiarrhythmicDose: Adults. Antiarrhythmic, ET: 5 mg/kg; follow w/ 0.5 mg/kg in 10 min if effective.IV load: 1 mg/kg/dose bolus over 2–3 min; repeat in 5–10 min; 200–300 mg/hmax; cont inf 20–50 mcg/kg/min or 1–4 mg/min; Cardiac arrest from VF/VT: Initial:1.0–1.5 mg/kg IV. Refractory VF: Additional 0.5–0.75 mg/kg IV push, repeat in 5–10min, max total 3 mg/kg. ET: 2–4 mg/kg. Perfusing stable VT, wide complex tachycardiaor ectopy: 1.0–1.5 mg/kg IV push; repeat 0.5–0.75 mg/kg q 5–10 min; max total 3mg/kg; Maint 1–4 mg/min (30–50 µg/min) (ECC 2005) Peds. Antiarrhythmic, ET,load: 1 mg/kg; repeat in 10–15 min 5 mg/kg max total, then IV inf 20–50mcg/kg/min. Topical: Apply max 3 mg/kg/dose. Local inj anesthetic: Max 4.5 mg/kg(Table 2) Caution: [C, +] Contra: Do not use lidocaine w/ epi on digits, ears, or nose(risk of vasoconstriction & necrosis); heart block Disp: Inj local: 0.5, 1, 1.5, 2, 4, 10,20%. Inj IV: 1% (10 mg/mL), 2% (20 mg/mL); admixture 4, 10, 20%. IV inf: 0.2%,0.4%; cream 2%; gel 2, 2.5%; oint 2.5, 5%; liq 2.5%; soln 2, 4%; viscous 2% SE:Dizziness, paresthesias, & convulsions associated w/ tox Notes: 2nd line to amiodaronein ECC; dilute ET dose 1–2 mL w/ NS; epi may be added for local anesthesiato ↑ effect & ↓ bleeding; for IV forms, ↓ w/ liver Dz or CHF; systemic levels: steadystate 6–12h: Therapeutic: 1.2–5 mcg/mL; Toxic >6 mcg/mL; 1 ⁄2 life: 1.5 hLidocaine/Prilocaine (EMLA, LMX) Uses: *Topical anesthetic*; adjunctto phlebotomy or dermal procedures Action: Topical anesthetic Dose: