Clinician's Pocket Drug Reference 2008

164 PancrelipaseN/V, constipation, UTI, bone pain, ↓ K + , ↓ Ca 2+ , ↓ Mg 2+ , hypophosphatemia; jawosteonecrosis, perform dental exam pretherapyPancrelipase (Pancrease, Cotazym, Creon, Ultrase) Uses:*Exocrine pancreatic secretion deficiency (eg, CF, chronic pancreatitis, pancreaticinsuff), steatorrhea of malabsorption* Action: Pancreatic enzyme supl Dose: 1–3caps (tabs) w/ meals & snacks; ↑ to 8 caps (tabs); do not crush or chew EC products;dose-dependent on digestive requirements of pt; avoid antacids Caution:[C, ?/–] Contra: Pork product allergy, acute pancreatitis Disp: Caps, tabs SE:N/V, abd cramps Notes: Individualize therapyPancuronium (Pavulon) Uses: *Paralysis w/ mechanical ventilation*Action: Nondepolarizing neuromuscular blocker Dose: Adults. 2–4 mg IV q2–4hPRN. Peds. 0.02–0.1 mg/kg/dose q2–4h PRN; ↓ in renal/hepatic impair; intubatept & keep on controlled ventilation; use adequate sedation or analgesia Caution:[C, ?/–] Contra: Component or bromide sensitivity Disp: Inj 1, 2 mg/mL SE:Tachycardia, HTN, pruritus, other histamine rxnsPanitumumab (Vectibix) WARNING: Derm toxicity common (89%)and severe in 12%; can be associated w/ infection (sepsis, abscesses requiringI&D); w/ severe derm toxicity, hold or D/C and monitor for infections; severe infusionrxns (anaphylactic rxn, bronchospasm, fever, chills, hypotension) in 1%; w/severe rxns, immediately D/C infusion and possibly permanent discontinuationUses:* Rx EGFR-expressing metastatic colon CA* Action: Anti-EGFR MoABDose: 6 mg/kg IV inf over 60 min q 14 days; doses > 1000 mg over 90 min. ↓ infrate by 50% w/ grade 1–2 inf rxn, D/C permanently w/ grade 3–4 rxn. For derm toxicity,hold until < grade 2 toxicity. If improves < 1 mo, restart 50% original dose. Iftoxicity recurs or resoln > 1 month permanently D/C. If ↓ dose tolerated, ↑ dose by25% Caution: [C; –] D/C nursing during, 2 mo after Disp: Vial 20 mg/ml SE:Rash, acneiform dermatitis, pruritus, paronychia, ↓ Mg +2 , abd pain, N/V/D, constipation,fatigue, dehydration, photosens, conjunctivitis, ocular hyperemia, ↑lacrimation, stomatitis, mucositis, pulm fibrosis, severe derm toxicity, infusion rxnsNotes: May impair female fertility; lytes; wear sunscreen/hats, limit sun exposurePantoprazole (Protonix) Uses: *GERD, erosive gastritis,* ZE synd,PUD Action: Proton-pump inhibitor Dose: 40 mg/d PO; do not crush/chew tabs;40 mg IV/d (not >3 mg/min, use Protonix filter) Caution: [B, ?/–] Disp: Tabs, delayedrelease 20, 40 mg; powder for inj 40 mg SE: Chest pain, anxiety, GI upset,↑ LFTsParegoric [Camphorated Tincture of Opium] [C-III] Uses:*D,* Pain & neonatal opiate withdrawal synd Action: Narcotic Dose: Adults. 5–10mL PO daily–qid PRN. Peds. 0.25–0.5 mL/kg daily–qid. Neonatal withdrawal:3–6 gtt PO q3–6 h PRN to relieve Sxs X 3–5 d, then taper over 2–4 wk Caution:[B (D w/ prolonged use/high dose near term, +] Contra: Toxic Diarrhea; convulsivedisorder Disp: Liq 2 mg morphine = 20 mg opium/5 mL SE: ↓ BP, sedation,