Clinician's Pocket Drug Reference 2008

Pentobarbital 167synth. Spectrum: PCN G-sensitive organisms that respond to low, persistent serumlevels Dose: Adults. 0.6–4.8 million units/d in ÷ doses q12–24h; give probenecidat least 30 min prior to PCN to prolong action. Peds. 25,000–50,000 units/kg/d IM÷ daily–bid Caution: [B, M] Contra: Allergy Disp: Inj 300,000, 500,000,600,000 units/mL SE: Pain at inj site, interstitial nephritis, anaphylaxis Notes: LAparenteral PCN; levels up to 15 hPenicillin V (Pen-Vee K, Veetids, others) Uses: Susceptible streptococciInfxns, otitis media, URIs, skin/soft tissue Infxns (PCN-sensitive staph)Action: Bactericidal; ↓ cell wall synth. Spectrum: Most gram (+), including strepDose: Adults. 250–500 mg PO q6h, q8h, q12h. Peds. 25–50 mg/kg/25h PO in 4doses; ↓ in renal impair; on empty stomach Caution: [B, M] Contra: AllergyDisp: Tabs 125, 250, 500 mg; susp 125, 250 mg/5 mL SE: GI upset, interstitialnephritis, anaphylaxis, convulsions Notes: Well-tolerated PO PCN; 250 mg =400,000 units of PCN GPentamidine (Pentam 300, NebuPent) Uses: *Rx & prevention ofPCP* Action: ↓ DNA, RNA, phospholipid, & protein synth Dose: Rx: Adults &Peds. 4 mg/kg/24 h IV daily for 14–21 d. Prevention: Adults & Peds >5 y. 300 mgonce q4wk, give via Respirgard II neb; ↓ w/IV in renal impair Caution: [C, ?]Contra: Component allergy, use w/ didanosine Disp: Inj 300 mg/vial; aerosol300 mg SE: Pancreatic cell necrosis w/ hyperglycemia; pancreatitis, CP, fatigue,dizziness, rash, GI upset, renal impair, blood dyscrasias (leukopenia & thrombocytopenia)Notes: Follow CBC, glucose, pancreatic Fxn monthly for 1st 3 mo; monitorfor ↓ BP following IV dosePentazocine (Talwin, Talwin Compound, Talwin NX) [C-IV]Uses: *Moderate–severe pain* Action: Partial narcotic agonist–antagonist Dose:Adults. 30 mg IM or IV; 50–100 mg PO q3–4h PRN. Peds. 5–8 y: 15 mg IM q4hPRN. 8–14 y: 30 mg IM q4h PRN; ↓ in renal/hepatic impair Caution: [C (1st tri,D w/ prolonged use/high dose near term), +/–] Contra: Allergy, ↑ ICP (unlessventilated) Disp: Talwin Compound tab 12.5 mg + 325 mg ASA; Talwin NX 50mg + 0.5 mg naloxone; inj 30 mg/mL SE: Considerable dysphoria; drowsiness, GIupset, xerostomia, Szs Notes: 30–60 mg IM = 10 mg of morphine IM; Talwin NXhas naloxone to curb abuse by nonoral routePentobarbital (Nembutal, others) [C-II] Uses: *Insomnia, convulsions,*induce coma following severe head injury Action: Barbiturate Dose: Adults.Sedative: 20–40 mg PO or PR q6–12h. Hypnotic: 100–200 mg PO or PR hs PRN.Induced coma: Load 5–10 mg/kg IV, then maint 1–3 mg/kg/h IV inf to maint burstsuppression on EEG. Peds. Hypnotic: 2–6 mg/kg/dose PO hs PRN. Induced coma:As adult Caution: [D, +/–] Severe hepatic impair Contra: Allergy Disp: Caps 50,100 mg; elixir 18.2 mg/5 mL (= 20 mg pentobarbital); supp 30, 60, 120, 200 mg; inj50 mg/mL SE: Resp depression, ↓ BP w/ aggressive IV use for cerebral edema;bradycardia, ↓ BP, sedation, lethargy, resp ↓, hangover, rash, Stevens–Johnsonsynd, blood dyscrasias Notes: Tolerance to sedative–hypnotic effect w/in 1–2 wk