Clinician's Pocket Drug Reference 2008

Pirbuterol 171Pimecrolimus (Elidel) WARNING: Associated with rare skin malignanciesand lymphoma, limit to area, not for age < 2 yr Uses: *Atopic dermatitis*refractory, severe perianal itching Action: Inhibits T-lymphocytes Dose: Adult andPeds > 2 yr: Apply bid; use at least 1 wk following resoln Caution: [C, ?/–] w/local Infxn, lymphadenopathy; immunocompromise; avoid < 2 yrs of age Contra:Allergy component, < 2 yr Disp: Cream 1% SE: Phototox, local irritation/burning,flulike Sxs, may ↑ malignancy Notes: Use on dry skin only; wash hands after; second-line/short-termuse onlyPindolol (Visken) Uses: *HTN* Action: β-adrenergic receptor blocker, β 1 ,β 2 , ISA Dose: 5–10 mg bid, 60 mg/d max; ↓ in hepatic/renal failure Caution: [B(1st tri; D if 2nd or 3rd tri), +/–] Contra: Uncompensated CHF, cardiogenic shock,bradycardia, heart block, asthma, COPD Disp: Tabs 5, 10 mg SE: Insomnia, dizziness,fatigue, edema, GI upset, dyspnea; fluid retention may exacerbate CHFPioglitazone/Metformin (ActoPlus Met) WARNING: Can causelactic acidosis, which is fatal in 50% of cases Uses: *Type 2 DM as adjunct todiet and exercise* Action: Combined ↑ insulin sensitivity w/ ↓ hepatic glucose releaseDose: Initial 1 tab PO daily or bid, titrate; max daily pioglitazone 45 mg &metformin 2550 mg Caution: [C, –] Stop w/ radiologic contrast agents Contra:Renal impair, acidosis Disp: Tabs pioglitazone mg/metformin mg: 15/500, 15/850SE: Lactic acidosis, hypoglycemia, edema, wgt gain, URI, HA, GI upset, liverdamage Notes: Follow LFTs; ↑ fracture risk in women receiving pioglitazonePioglitazone (Actos) Uses: *Type 2 DM* Action: ↑ Insulin sensitivityDose: 15–45 mg/d PO Caution: [C, –] Contra: Hepatic impair Disp: Tabs 15, 30,45 mg SE: Wgt gain, URI, HA, hypoglycemia, edema,↑ fracture risk in womenPiperacillin (Pipracil) Uses: *Infxns of skin, bone, resp &, urinary tract, abdomen,sepsis* Action: 4th-gen PCN; bactericidal; ↓ cell wall synth. Spectrum: Primarilygram (+), better Enterococcus, H. influenza, not staph; gram(–) E. coli, Proteus,Shigella, Pseudomonas, not β-lactamase-producing Dose: Adults. 2-4 g IV q4–6h.Peds. 200–300 mg/kg/d IV ÷ q4–6h; ↓ in renal failure Caution: [B, M] Contra: PCNsensitivity Disp: Powder for inj: 2, 3, 4, 40-g SE: ↓ Plt aggregation, interstitial nephritis,renal failure, anaphylaxis, hemolytic anemia Notes: Often used w/ aminoglycosidePiperacillin–Tazobactam (Zosyn) Uses: *Infxns of skin, bone, resp &urinary tract, abdomen, sepsis * Action: PCN plus β-lactamase inhibitor; bactericidal;↓ cell wall synth. Spectrum: Good gram (+), excellent gram (–);anaerobes &β-lactamase producers Dose: Adults. 3.375–4.5 g IV q6h; ↓ in renal insuff Caution:[B, M] Contra: PCN or β-lactam sensitivity Disp: Powder for inj: frozen,premix inj 3.25, 3.375, 4.5 g SE: D, HA, insomnia, GI upset, serum sickness-likerxn, pseudomembranous colitis Notes: Often used in combo w/ aminoglycosidePirbuterol (Maxair) Uses: *Prevention & Rx reversible bronchospasm*Action: β2-adrenergic agonist Dose: 2 inhal q4–6h; max 12 inhal/d Caution:[C, ?/–] Disp: Aerosol 0.2 mg/actuation SE: Nervousness, restlessness, trembling,HA, taste changes, tachycardia Note: Teach patient proper inhaler technique