Clinician's Pocket Drug Reference 2008

Naltrexone 149Caution: [C,?/- ] Elderly, HTN, heart failure, underlying psychiatric illness, substanceabuse; high protein binding w/first-pass metabolism may lead to drug interactionsDisp: Caps 1 mg SE: Drowsiness, vertigo, xerostomia, euphoria, ataxia,HA, difficulty concentrating, tachycardia, ↓ BP Notes: May require initial doseevening before chemo; Rx only quantity for single cycleNabumetone (Relafen) WARNING: May ↑risk of cardiovascular events& GI bleeding Uses: *Arthritis & pain* Action: NSAID; ↓ prostaglandins Dose:1000–2000 mg/d ÷ daily–bid w/ food Caution: [C (D 3rd tri), +] severe hepatic dzContra: Peptic ulcer, NSAID sensitivity, after CABG surgery Disp: Tabs 500, 750mg SE: Dizziness, rash, GI upset, edema, peptic ulcerNadolol (Corgard) Uses: *HTN & angina* migraine prophylaxis Action:Competitively blocks β-adrenergic receptors (β 1 , β 2 ) Dose: 40–80 mg/d; ↑ to 240mg/d (angina) or 320 mg/d (HTN) at 3–7 day intervals; ↓ in renal insuff & elderlyCaution: [C (1st tri; D if 2nd or 3rd tri), +] Contra: Uncompensated CHF, shock,heart block, asthma Disp: Tabs 20, 40, 80, 120, 160 mg SE: Nightmares, paresthesias,↓ BP, bradycardia, fatigueNafcillin (Nallpen) Uses: *Infxns due to susceptible strains of Staphylococcus& Streptococcus* Action: Bactericidal β-lactamase-resistant penicillin;↓ cell wall synth Spectrum: Good gram (+) except MRSA and enterococcus, nogram (–), poor anaerobe Dose: Adults. 1–2 g IV q4–6h. Peds. 50–200 mg/kg/d ÷q4–6h Caution: [B, ?] PCN allergy Disp: Inj powder l, 2 gm SE: Interstitialnephritis, D, fever, N Notes: No adjustments for renal FxnNaftifine (Naftin) Uses: *Tinea pedis, cruris, & corporis* Action: Allylamineantifungal, ↓ cell membrane ergosterol synth Dose: Apply daily (cream) orBID (gel) Caution: [B, ?] Contra: Component sensitivity Disp: 1% cream; gelSE: Local irritationNalbuphine (Nubain) Uses: *Moderate–severe pain; preop & obstetricanalgesia* Action: Narcotic agonist–antagonist; ↓ ascending pain pathways Dose:Adults. 10–20 mg IM or IV q3–6h PRN; max of 160 mg/d; 20 mg max 1 × dosePeds. 0.2 mg/kg IV or IM, 20 mg max; ↓ in hepatic insuff Caution: [B (D w/prolonged/highdoses at term), ?] Contra: Sulfite sensitivity Disp: Inj 10, 20 mg/mLSE: CNS depression, drowsiness; caution w/ opiate use, ↓ BPNaloxone Uses: *Opioid addiction (diagnosis) & OD* Action: Competitivenarcotic antagonist Dose: Adults. 0.4–2 mg IV, IM, or SQ q2-3 min; total dose 10mg max Peds. 0.01–0.1 mg/kg/dose IV, IM, or SQ; repeat IV q3min × 3 doses PRNCaution: [B, ?] May precipitate acute withdrawal in addicts Disp: Inj 0.4,1 mg/mL; neonatal inj 0.02 mg/mL SE: ↓ BP, tachycardia, irritability, GI upset,pulm edema Notes: If no response after 10 mg, suspect nonnarcotic causeNaltrexone (Depade, ReVia, Vivitrol) WARNING: Can cause hepaticinjury, contraindicated with active liver disease Uses: *EtOH & narcoticaddiction* Action: Antagonizes opioid receptors Dose: ETOH and narcotic addiction:50 mg/d PO; do not give until opioid-free for 7–10 d; ETOH dependence: 380