Clinician's Pocket Drug Reference 2008

Tamoxifen 195Sunitinib (Sutent) Uses: *Advanced GI stromal tumor refractory/intolerant ofimatinib; advanced RCC* Action: Kinase inhibitor Dose: Adults. 50 mg PO daily × 4wks, followed by 2 wk holiday = 1 cycle; ↓ to 37.5 mg w/CYP3A4 inhibitors (Table11), to ↑ 87.5 mg w/CYP3A4 inducers Contra: w/atazanavir Caution: [D,–] Multipleinteractions require dose modification (eg, St. John’s wort) Disp: Caps 12.5, 25, 50 mgSE: ↓ WBC & plt, bleeding, ↑ BP, ↓ ejection fraction, ↑ QT interval, pancreatitis, DVT,seizures, adrenal insufficiency, N/V/D, skin discoloration, oral ulcers, taste perversion,hypothyroidism Notes: Monitor CBC, platelets, chemistries, cardiac funct at baseline ↓dose in 12.5-mg increments if not toleratedTacrine (Cognex) Uses: *Mild–moderate Alzheimer dementia* Action:Cholinesterase inhibitor Dose: 10–40 mg PO qid to 160 mg/d; separate doses fromfood Caution: [C, ?] Contra: Previous tacrine-induced jaundice Disp: Caps 10,20, 30, 40 mg SE: ↑ LFT, HA, dizziness, GI upset, flushing, confusion, ataxia,myalgia, bradycardia Notes: Serum conc > 20 ng/mL have more SE; monitor LFTsTacrolimus [FK 506] (Prograf, Protopic) WARNING: ↑ risk of infectionand lymphoma Uses: *Prevent organ rejection,* eczema Action:Macrolide immunosuppressant Dose: Adults. IV: 0.05–0.1 mg/kg/d cont inf. PO:0.15–0.3 mg/kg/d ÷ 2 doses. Peds. IV: 0.03–0.05 mg/kg/d as cont inf. PO:0.15–0.2 mg/kg/d PO ÷ q 12 h. Adults & Peds. Eczema: Apply bid, continue 1 wkafter clearing; ↓ in hepatic/renal impair Caution: [C, –] w/ cyclosporine; avoidtopical if < 2 yrs of age Contra: Component allergy, castor oil allergy w/ IV formDisp: Caps 0.5, 1, 5 mg; inj 5 mg/mL; oint 0.03, 0.1% SE: Neuro & nephrotox,HTN, edema, HA, insomnia, fever, pruritus, ↓/↑ K + , hyperglycemia, GI upset, anemia,leukocytosis, tremors, paresthesias, pleural effusion, Szs, lymphoma Notes:Monitor levels; reports of ↑cancer risk; topical use for short term/second lineTadalafil (Cialis) Uses: *Erectile dysfunction* Action: PDE5 inhibitor, increasescGMP and NO levels; relaxes smooth muscles, dilates cavernosal arteriesDose: Adults. 10 mg PO before sexual activity w/o regard to meals (range 5–20 mgmax) 1 dose/72 h; ↓ 5 mg (10 mg max) w/ renal/ & hepatic insuff Caution: [B, –]w/CYP3A4 inhibitor (Table 11) Contra: Nitrates, α-blockers (except tamsulosin),severe hepatic impair Disp: 5-, 10-, 20-mg tabs SE: HA, flushing, dyspepsia, rhinitis,back pain, myalgia hearing loss Notes: Longest acting of class (36 h)Talc (Sterile Talc Powder) Uses: *↓ recurrence of malignant pleural effusions(pleurodesis)* Action: Sclerosing agent Dose: Mix slurry: 50 mL NS w/5-g vial, mix, distribute 25 mL into two 60-mL syringes, volume to 50 mL/syringew/ NS. Infuse each into chest tube, flush w/ 25 mL NS. Keep tube clamped; havept change positions q15min for 2 h, unclamp tube Caution: [X, –] Contra:Planned further surgery on site Disp: 5 g powder SE: Pain, Infxn Notes: May add10–20 mL 1% lidocaine/syringe; must have chest tube placed, monitor closelywhile tube clamped (tension pneumothorax), not antineoplasticTamoxifen WARNING: Cancer of the uterus, stroke, and blood clots can occurUses: *Breast CA [postmenopausal, estrogen receptor(+)], ↓ reduction of breast CA