Clinician's Pocket Drug Reference 2008

192 Streptokinase• Septic shock (controversial): Adults. Hydrocortisone 500 mg–1 g IM/IV q2–6h.Peds. Hydrocortisone 50 mg/kg IM/IV, repeat q4–24 h PRN.• Status asthmaticus: Adults & Peds. Hydrocortisone 1–2 mg/kg/dose IV q6h; then ↓by 0.5–1 mg/kg q6h.• Rheumatic Dz: Adults. Intraarticular: Hydrocortisone acetate 25–37.5 mg largejoint, 10–25 mg small joint; methylprednisolone acetate 20–80 mg large joint,4–10 mg small joint. Intrabursal: Hydrocortisone acetate 25–37.5 mg. Intraganglial:Hydrocortisone acetate 25–37.5 mg. Tendon sheath: Hydrocortisone acetate5–12.5 mg.• Periop steroid coverage: Hydrocortisone 100 mg IV night before surgery, 1 hpreop, intraop, & 4, 8, & 12 h postop; postop d #1 100 mg IV q6h; postop d #2100 mg IV q8h; postop d #3 100 mg IV q12h; postop d #4 50 mg IV q12h;postop d #5 25 mg IV q12h; resume prior PO dosing if chronic use or D/C ifonly periop coverage required.• Cerebral edema: Dexamethasone 10 mg IV; then 4 mg IV q4–6hCaution: [C, ?/–] Contra: Active varicella Infxn, serious Infxn except TB, fungalInfxns Disp: Table 3 SE: ↑ appetite, hyperglycemia, ↓ K + , osteoporosis, nervousness,insomnia, “steroid psychosis,” adrenal suppression Notes: Hydrocortisone succinatefor systemic, acetate for intraarticular; never abruptly D/C steroids, taper doseStreptokinase (Streptase, Kabikinase) Uses: *Coronary arterythrombosis, acute massive PE, DVT, & some occluded vascular grafts* Action:Activates plasminogen to plasmin that degrades fibrin Dose: Adults. PE: Load250,000 units peripheral IV over 30 min, then 100,000 units/h IV for 24–72 h.Coronary artery thrombosis: 1.5 million units IV over 60 min. DVT or arterial embolism:Load as w/ PE, then 100,000 units/h for 72 h; 1.5 million IU in a 1 h inf(ECC 2005) Peds. 3500–4000 units/kg over 30 min, then 1000–1500 units/kg/h.Occluded catheter (controversial): 10,000–25,000 units in NS to final volume ofcatheter (leave in for 1 h, aspirate & flush w/ NS) Caution: [C, +] Contra: StreptococcalInfxn or streptokinase in last 6 mo, active bleeding, CVA, TIA, spinalsurgery/trauma in last month, vascular anomalies, severe hepatic/renal Dz, endocarditis,pericarditis, severe uncontrolled HTN Disp: Powder for inj 250,000,750,000, 1,500,000 Units SE: Bleeding, ↓ BP, fever, bruising, rash, GI upset, hemorrhage,anaphylaxis Notes: If inf inadequate to keep clotting time 2–5X control,see package for adjustments; antibodies remain 3–6 mo following doseStreptomycin WARNING: Neuro/oto/renal toxicity possible; neuromuscularblockage w/resp paralysis possible Uses: *TB,* streptococcal or enterococcalendocarditis Action: Aminoglycoside; ↓ protein synth Dose: Adults. Endocarditis:1 g q12h 1–2 wk, then 500 mg q12h 1–4 wk; TB: 15 mg/kg/d (up to 1 g), directlyobserved therapy (DOT) 2 × wk 20–30 mg/kg/dose (max 1.5 gm), DOT 3 × wk25–30 mg/kg/dose (max 1 g). Peds. 15 mg/kg/d; DOT 2 × wk 20–40 mg/kg/dose(max 1 g); DOT 3 × wk 25–30 mg/kg/dose (max 1 g); ↓ w/in renal failure insuff,either IM or IV over 30–60 min Caution: [D, +] Contra: PRG Disp: Inj 400