Clinician's Pocket Drug Reference 2008

Metronidazole 1436–12 yrs* Action: CNS stimulant Dose: Peds. Apply to hip in AM (2 h before desiredeffect), remove 9 h later Caution: [C,+/–] sensitization may preclude subsequentuse of oral forms; abuse and diversion concerns Disp: Patches 10, 15, 20, 30mg SE: Local rxns, stimulation Notes: Titrate dose in weekly increments; effectslast several hours following removal; eval BP, HR at baseline and periodicallyMethylprednisolone (Solu-Medrol) [See Steroids page 191and Table 3]Metoclopramide (Reglan, Clopra, Octamide) Uses: *Diabeticgastroparesis, symptomatic GERD; chemo N/V, facilitate small-bowel intubation& UGI radiologic evaluation* stimulate gut in prolonged postop ileus Action:↑ UGI motility; blocks dopamine in chemoreceptor trigger zone Dose: Adults.Gastroparesis: 10 mg PO 30 min ac & hs for 2–8 wk PRN, or same dose IV for 10d, then PO. Reflux: 10–15 mg PO 30 min ac & hs. Antiemetic: 1–3 mg/kg/dose IV30 min before chemo, then q2h × 2 doses, then q3h X3 doses. Peds. Reflux: 0.1mg/kg/dose PO qid. Antiemetic: 1–2 mg/kg/dose IV as adults Caution: [B, –]Drugs w/ extrapyramidal ADRs Contra: Sz disorders, GI obst Disp: Tabs 5, 10mg; syrup 5 mg/5 mL; inj 5 mg/mL SE: Dystonic Rxns common w/ high doses,(Rx w/IV diphenhydramine); restlessness, D, drowsinessMetolazone (Mykrox, Zaroxolyn) Uses: *Mild–moderate essentialHTN & edema of renal Dz or cardiac failure* Action: Thiazide-like diuretic;↓ distal tubule Na reabsorption Dose: Adult. HTN: 2.5–5 mg/d PO (Zaroxolyn),0.5–1 mg/day PO (Mykrox) Edema: 2.5–20 mg/d PO. Peds. 0.2–0.4 mg/kg/d PO ÷q12h–daily Caution: [D, +] Contra: Thiazide/sulfonamide sensitivity, anuriaDisp: Tabs: Mykrox (rapid acting) 0.5 mg, Zaroxolyn 2.5, 5, 10 mg SE: Monitorfluid/lytes; dizziness, ↓ BP, tachycardia, CP, photosens Notes: Mykrox & Zaroxolynnot bioequivalentMetoprolol (Lopressor, Toprol XL) WARNING: Do not acutely stoptherapy as marked worsening of angina can result Uses: *HTN, angina, AMI,CHF* Action: β-adrenergic receptor blocker Dose: Adult. Angina: 50–200 mg PObid max 400mg/d HTN: 50–200 mg PO BID max 450 mg/d. AMI: 5 mg IV q2 min× 3 doses, then 50 mg PO q6h × 48 h, then 100 mg PO bid. CHF: 12–25 mg/d PO× 2 wk, ↑ at 2-wk intervals to 200 mg/max, use low dose in pts w/ greatest severity;5 mg slow IV q 5 min, total 15 mg (ECC 2005); ↓ in hepatic failure; takew/meals Caution: [C, +] Uncompensated CHF, bradycardia, heart block Contra:Arrhythmia w/ tachycardia Disp: Tabs 25, 50, 100 mg; ER tabs 25, 50, 100, 200mg; inj 1 mg/mL SE: Drowsiness, insomnia, ED, bradycardia, bronchospasmMetronidazole (Flagyl, MetroGel) WARNING: Carcinogenic inrats Uses: *Bone/joint, endocarditis, intraabd, meningitis, & skin Infxns; amebiasis;trichomoniasis; bacterial vaginosis; PID; giardiasis; pseudomembranous colitis(C. diff)* Action: Interferes w/ DNA synth. Spectrum: Excellent anaerobic C. difficile,also H. pylori in combo therapy Dose: Adults. Anaerobic Infxns: 500 mg IVq6–8h. Amebic dysentery: 750 mg/d PO for 5–10 d. Trichomoniasis: 250 mg PO