Clinician's Pocket Drug Reference 2008

150 Naphazolinemg IM q4 wks (Vivitrol) Caution: [C, M] Contra: Acute hepatitis, liver failure,opioid use Disp: Tabs 50 mg; inj 380 mg (Vivitrol) SE: May cause hepatotox; insomnia,GI upset, joint pain, HA, fatigueNaphazoline (Albalon, AK-Con, Naphcon, others), Naphazoline& Pheniramine Acetate (Naphcon A) Uses: *Relieve ocularredness & itching caused by allergy* Action: Sympathomimetic(alpha-adrenergic vasoconstrictor) & antihistamine (pheniramine) Dose: 1–2 gtt upto qid, 3-day max Caution: [C, +] Contra: NAG, in children, w/ contact lensesSE: CV stimulation, dizziness, local irritation Disp: Ophthalmic 0.012, 0.025,0.1%/15 mL; naphazoline & pheniramine 0.025%/0.3% solnNaproxen (Aleve [OTC], Naprosyn, Anaprox) WARNING:May ↑ risk of cardiovascular events & GI bleeding Uses: *Arthritis & pain* Action:NSAID; ↓ prostaglandins Dose: Adults & Peds >12 y. 200–500 mg bid–tid to1500 mg/d max; ↓ in hepatic impair Caution: [B (D 3rd tri), +] Contra: NSAIDor ASA triad sensitivity, peptic ulcer, post CABG for pain, 3rd tri PRG Disp: Tabs:220, 250, 375, 500 mg; delayed release: 375 mg, 500 mg; controlled release: 375mg, 550 mg; susp 125 mL/5 mL. SE: Dizziness, pruritus, GI upset, peptic ulcer,edema Note: w/ food to ↓ GI upset.Naratriptan (Amerge) Uses: *Acute migraine* Action: Serotonin 5-HT 1receptor antagonist Dose: 1–2.5 mg PO once; repeat PRN in 4 h; 5 mg/24 hrs max;↓ in mild renal/hepatic insuff, take w/ fluids Caution: [C, M] Contra: Severerenal/hepatic impair, avoid w/ angina, ischemic heart Dz, uncontrolled HTN, cerebrovascularsynds, & ergot use Disp: Tabs 1, 2.5 mg SE: Dizziness, sedation, GIupset, paresthesias, ECG changes, coronary vasospasm, arrhythmiasNatalizumab (Tysabri) WARNING: Cases of progressive multifocalleukoencephalopathy (PML) reported Uses: *Relapsing MS to delay disabilityand ↓ recurrences* Action: Adhesion molecule inhibitor Dose: Adults. 300 mg IVq4 wk; second-line Tx only Contra: PML; immune compromise or w/immunosuppressantCaution: [C,?/–] baseline MRI to rule out PML Disp: Vial 300 mg SE:Infxn, immunosuppression; infusion rxn precluding subsequent use; HA, fatigue,arthralgia Notes: Give slowly to ↓ Rxns; limited distribution (TOUCH risk program);D/C immediately w/signs of PML (weakness, paralysis, vision loss, impairedspeech, cognitive ↓); evaluate at 3 and 6 mos, then q 6 mos thereafterNateglinide (Starlix) Uses: *Type 2 DM* Action: ↑ Pancreatic insulinrelease Dose: 120 mg PO tid 1–30 min ac; ↓ to 60 mg tid if near target HbA 1cCaution: [C, –] w/CYP2C9/3A4 metabolized drug (Table 11) Contra: DKA, type1 DM Disp: Tabs 60, 120 mg SE: Hypoglycemia, URI; salicylates, nonselectiveβ-blockers may enhance hypoglycemiaNedocromil (Tilade) Uses: *Mild–moderate asthma* Action: Antiinflammatoryagent Dose: Inhal: 2 inhal qid Caution: [B, ?/–] Contra: Componentallergy Disp: Met-dose inhal 1.75 mg/spray SE: Chest pain, dizziness,dysphonia, rash, GI upset, Infxn Notes: Not for acute asthma