Clinician's Pocket Drug Reference 2008

188 Sitagliptin/metforminpair Caution: [B; ?] Contra: DKA, Type 1 DM Disp: Tabs 25, 50, 100 SE: URI,HA, D, abd pain, arthralgiaSitagliptin/metformin (Janumet) WARNING: Associated w/ lacticacidosis Uses: *Adjunct to diet and exercise in type 2 DM * Action: See individualagents Dose:1 tab PO bid, titrate; 100 mg sitaglipin & 2000 mg metformin/daymax; w/ meals Caution: [B, ?/–] Contra: Type 1 DM, DKA Disp: Tabs 50/500,50 mg/1000 mg SE: Nasopharyngitis, N/V/D, flatulence, abd discomfort, dyspepsia,asthenia, HA Notes: Hold w/contrast study; Cr, CBCSmallpox Vaccine (Dryvax) WARNING: Acute myocarditis and otherinfectious complications possible; contra in immunocompromised, eczema orexfoliative skin conditions, infants < 1 Yr Uses: Immunization against smallpox(Variola virus) Action: Active immunization (live attenuated cowpox virus)Dose: Adults (routine nonemergency) or all ages (emergency): 2–3 punctures w/bifurcated needle dipped in vaccine into deltoid, posterior triceps muscle; sitefor Rxn in 6–8 d; if major Rxn, site scabs, & heals, leaving scar; if mild/equivocalRxn, repeat w/ 15 punctures Caution: [X, N/A] Contra: Nonemergency use,febrile illness, immunosuppression, Hx eczema & their household contacts. Emergency:No absolute contraindications Disp: Vial for recons: 100 million pockformingunits/mL SE: Malaise, fever, regional lymphadenopathy, encephalopathy,rashes, spread of inoculation to other sites administered; Stevens–Johnson synd,eczema vaccinatum w/ severe disability Notes: Avoid infant contact for 14 d; intradermaluse onlySodium Bicarbonate [NaHCO 3 ] Uses: *Alkalinization of urine,* RTA,*metabolic acidosis, ↑ K + , TCA OD* Action: Alkalinizing agent Dose: Adults.Cardiac arrest: Initiate ventilation, 1 mEq/kg IV bolus; repeat 1 ⁄2 dose q 10 min PRN(ECC 2005); Metabolic acidosis: 2–5 mEq/kg IV over 8 h & PRN based onacid–base status. Alkalinize urine: 4 g (48 mEq) PO, then 1–2 g q4h; adjust basedon urine pH; 2 amp/1 L D 5 W at 100–250 mL/h IV, monitor urine pH & serum bicarbonate.Chronic renal failure: 1–3 mEq/kg/d. Distal RTA: 1 mEq/kg/d PO. Peds > 1y: Cardiac arrest: See Adult dosage. Peds < 1 y: ECC: Initiate ventilation, 1:1 dilution1 mEq/mL dosed 1 mEq/kg IV; can repeat w/ 0.5 mEq/kg in 10 min × 1 orbased on acid–base status. Chronic renal failure: See Adult dosage. Distal RTA: 2–3mEq/kg/d PO. Proximal RTA: 5–10 mEq/kg/d; titrate based on serum bicarbonate.Urine alkalinization: 84–840 mg/kg/d (1–10 mEq/kg/d) in ÷ doses; adjust based onurine pH Caution: [C, ?] Contra: Alkalosis, ↑ Na + , severe pulm edema, ↓ Ca 2+Disp: Powder, tabs; 300 mg = 3.6 mEq; 325 mg = 3.8 mEq; 520 mg = 6.3 mEq; 600mg = 7.3 mEq; 650 mg = 7.6 mEq; inj 1 mEq/1 mL, 4.2% (5 mEq/10 mL), 7.5%(8.92 mEq/mL), 8.4% (10 mEq/10 mL) vial or amp SE: Belching, edema, flatulence,↑ Na+, metabolic alkalosis Notes: 1 g neutralizes 12 mEq of acid; 50 mEqbicarb = 50 mEq Na; can make 3 amps in 1 L D 5 W to = D 5 NS w/ 150 mEq bicarbSodium Citrate/Citric Acid (Bicitra) Uses: *Chronic metabolic acidosis,alkalinize urine; dissolve uric acid & cysteine stones* Action: Urinary alkalin-