Clinician's Pocket Drug Reference 2008

Nicotine Gum 153surgery Contra: NSAID/aspirin sensitivity Caution: [C,?/- ] may ↑ bleeding time,delay healing, cause keratitis Disp: Susp 3 mL SE: Capsular opacity, visualchanges, foreign body sensation, inc. IOP Notes: Prolonged use ↑ risk of cornealdamage; shake well before use; separate from other drops by > 5 min.Nesiritide (Natrecor) Uses: *Acutely decompensated CHF* Action:Human B-type natriuretic peptide Dose: 2 mcg/kg IV bolus, then 0.01 mcg/kg/minIV Caution: [C, ?/–] When vasodilators are not appropriate Contra: SBP < 90,cardiogenic shock Disp: Vials 1.5 mg SE: ↓ BP, HA, GI upset, arrhythmias, ↑ CrNotes: Requires continuous BP monitoring; some studies indicate ↑ in mortalityNevirapine (Viramune) WARNING: Reports of fatal hepatotox even aftershort-term use; severe life-threatening skin rxns (Stevens–Johnson, toxic epidermalnecrolysis, & allergic Rxns); monitor closely during 1st 8 wk of Rx Uses: *HIVInfxn* Action: Nonnucleoside RT inhibitor Dose: Adults. Initial 200 mg/d PO × 14 d,then 200 mg bid. Peds. < 8 y: 4 mg/kg/d × 14 d, then 7 mg/kg bid. > 8 y: 4 mg/kg/d ×14 d, then 4 mg/kg bid max 200 mg/dose for peds (w/o regard to food) Caution:[B, +/–] OCP Disp: Tabs 200 mg; susp 50 mg/5 mL SE: Life-threatening rash; HA,fever, D, neutropenia, hepatitis. Notes: HIV resistance when given as monotherapy;always use in combo w/at least 1 additional antiretroviral agent. Not recommended inwomen if CD4 > 250 or men > 400 unless benefit > risk of hepatotoxicityNiacin (Niaspan, Slo-Niacin) Uses: *Adjunct in significant hyperlipidemia*Action: Nicotinic acid, Vit B 3 ; ↓ lipolysis; ↓ esterification of triglycerides;↑ lipoprotein lipase Dose: 1–6 g ÷ doses PO tid; 9 g/d max (w/ food) Caution: [A(C if doses >RDA), +] Contra: Liver Dz, peptic ulcer, arterial hemorrhage Disp:SR caps 125, 250, 400, 500 mg; tabs 50, 100, 250, 500 mg; SR tabs 150, 250, 500,750, 1000 mg; elixir 50 mg/5 mL SE: Upper body/facial flushing & warmth; GIupset, flatulence, exacerbate peptic ulcer; HA, paresthesias, liver damage, gout, oraltered glucose control in DM. Notes: Flushing ↓ by taking aspirin or NSAID30–60 min prior to doseNicardipine (Cardene) Uses: *Chronic stable angina & HTN*; prophylaxisof migraine Action: CCB Dose: Adults. PO: 20–40 mg PO tid. SR: 30–60 mgPO bid. IV: 5 mg/h IV cont inf; ↑ by 2.5 mg/h q15min to max 15 mg/h. Peds. PO:20–30 mg PO q 8h. IV: 0.5–5 mcg/kg/min; ↓ in renal/hepatic impair Caution:[C, ?/–] Heart block, CAD Contra: Cardiogenic shock Disp: Caps 20, 30 mg; SRcaps 30, 45, 60 mg; inj 2.5 mg/mL SE: Flushing, tachycardia, ↓ BP, edema, HANotes: PO-to-IV conversion: 20 mg tid = 0.5 mg/h, 30 mg tid = 1.2 mg/h, 40 mgtid = 2.2 mg/h; take w/ food (not high fat)Nicotine Gum (Nicorette, others) [OTC] Uses: *Aid to smokingcessation, relieve nicotine withdrawal* Action: Systemic delivery of nicotineDose: Chew 9–12 pieces/d PRN; max 24 pieces/d Caution: [C, ?] Contra: Lifethreateningarrhythmias, unstable angina Disp: 2 mg, 4 mg/piece; mint, orange,original flavors SE: Tachycardia, HA, GI upset, hiccups Notes: Must stop smoking& perform behavior modification for max effect