Clinician's Pocket Drug Reference 2008

Ropinirole 183or ergot alkaloids due to inhibited drug metabolism Uses: *HIV* Actions: Proteaseinhibitor; ↓ maturation of immature noninfectious virions to mature infectiousvirus Dose: Adults. Initial 300 mg PO bid, titrate over 1 wk to 600 mg PO bid(titration will ↓ GI SE). Peds > 1 mo. 250 mg/m 2 titrate to 400 mg bid (adjust w/amprenavir, indinavir, nelfinavir, & saquinavir); w/ food Caution: [B, +] w/ ergotamine,amiodarone, bepridil, flecainide, propafenone, quinidine, pimozide, midazolam,triazolam Contra: Component Allergy Disp: Caps 100 mg; soln 80 mg/mLSE: ↑ triglycerides, ↑ LFTs, N/V/D/C, abd pain, taste perversion, anemia, weakness,HA, fever, malaise, rash, paresthesias Notes: RefrigerateRivastigmine (Exelon) Uses: *Mild–moderate dementia in AlzheimerDz* Action: Enhances cholinergic activity Dose: 1.5 mg bid; ↑ to 6 mg bid, w/ ↑at 2-wk intervals (w/ food) Caution: [B, ?] w/ β-Blockers, CCBs, smoking, neuromuscularblockade, digoxin Contra: Rivastigmine or carbamate allergy Disp:Caps 1.5, 3, 4.5, 6 mg; soln 2 mg/mL SE: Dose-related GI effects, N/V/D, dizziness,insomnia, fatigue, tremor, diaphoresis, HA, wgt loss (in 18–26%) Notes:Swallow capsules whole, do not break/chew/crush; avoid EtOHRivastigmine transdermal (Excelon) Uses: * Mild/moderateAlzheimer’s and Parkinson’s disease dementia* Action: Acetylcholinesterase inhibitorDose: Initial 4.6-mg patch/day applied to back, chest, upper arm, ↑ 9.5 mgafter 4 wks if tolerated Caution: [?; ?]sick sinus synd, conduction defects, asthma,COPD, urinary obst, seizures Contra: Hypersensitivity to rivastigmine, other carbamatesDisp: Transdermal patch 5 cm 2 (4.6 mg/24 hr), 10 cm 2 (9.5 mg/24 hr)SE:N/V/DRizatriptan (Maxalt, Maxalt MLT) Uses: *Rx acute migraine* Action:Vascular serotonin receptor agonist Dose: 5–10 mg PO, repeat in 2 h, PRN,30 mg/d max Caution: [C, M] Contra: Angina, ischemic heart Dz, ischemicbowel Dz, hemiplegic/basilar migraine, uncontrolled HTN, ergot or serotonin 5HT-1 agonist use w/in 24 hr, MAOI use w/in 14 d Disp: Tab 5, 10 mg; MLT: OD tabs5, 10 mg. SE: Chest pain, palpitations, nausea, vomiting, asthenia, dizziness, somnolence,fatigueRocuronium (Zemuron) Uses: *Skeletal muscle relaxation during rapidsequenceintubation, surgery, or mechanical ventilation* Action: Nondepolarizingneuromuscular blocker Dose: Rapid sequence intubation: 0.6–1.2 mg/kg IV. Continuousinf: 5–12.5 mcg/kg/min IV; adjust/titrate based on monitoring; ↓ in hepaticimpair Caution: [C, ?] Aminoglycosides, vancomycin, tetracycline, polymyxinsenhance blockade Contra: Component or pancuronium allergy Disp: Inj preservativefree 10 mg/mL SE: BP changes, tachycardiaRopinirole (Requip) Uses: *Rx of Parkinson Dz, restless leg synd* Action:Dopamine agonist Dose: Initial 0.25 mg PO tid, weekly ↑ 0.25 mg/dose, to 3mg max, max 4 mg for RLS Caution: [C, ?/–] Severe CV, renal, or hepatic impairContra: Component allergy Disp: Tabs 0.25, 0.5, 1, 2, 3, 4, 5 mg SE: Syncope,