Clinician's Pocket Drug Reference 2008

Tobramycin & Dexamethasone Ophthalmic 203N/V, darkens urine Notes: D/C EtOH during & 3 d after Rx; potentiates warfarin &lithium; clearance ↓ w/other drugs; crush & disperse in cherry syrup for peds; removedby HDTinzaparin (Innohep) WARNING: Risk of spinal/epidural hematomasdevelopment w/ spinal anesthesia or lumbar puncture Uses: *Rx of DVT w/ orw/o PE* Action: LMW heparin Dose: 175 units/kg SQ daily at least 6 d until warfarindose stabilized Caution: [B, ?] Pork allergy, active bleeding, mild–moderaterenal dysfunction Contra: Allergy to sulfites, heparin, benzyl alcohol, HIT Disp:Inj 20,000 units/mL SE: Bleeding, bruising, thrombocytopenia, inj site pain, ↑LFTs Notes: Monitor via Anti-Xa levels; no effect on: bleeding time, plt Fxn, PT,aPTTTioconazole (Vagistat) Uses: *Vaginal fungal Infxns* Action: Topicalantifungal Dose: 1 applicatorful intravag hs (single dose) Caution: [C, ?] Contra:Component allergy Disp: Vaginal oint 6.5% SE: Local burning, itching, soreness,polyuria Notes: Insert high into vaginaTiotropium (Spiriva) Uses: Bronchospasm w/ COPD, bronchitis, emphysemaAction: Synthetic anticholinergic like atropine Dose: 1 cap/d inhaled usingHandiHaler, do not use w/ spacer Caution: [C, ?/–] BPH, NAG, MyG, renal impairContra: Acute bronchospasm Disp: Inhalation Caps 18 mcg SE: URI, xerostomiaNotes: Monitor FEV 1 or peak flowTirofiban (Aggrastat) Uses: *Acute coronary synd* Action: GlycoproteinIIB/IIIa inhibitor Dose: Initial 0.4 mcg/kg/min for 30 min, followed by 0.1mcg/kg/min; use in combo w/ heparin; ACS or PCI: 0.4 (g/kg/min IV for 30 min,then 0.1 µg/kg/min (ECC 2005); ↓ in renal insuff Caution: [B, ?/–] Contra:Bleeding, intracranial neoplasm, vascular malformation, stroke/surgery/traumaw/in last 30 d, severe HTN Disp: Inj 50, 250 mcg/mL SE: Bleeding, bradycardia,coronary dissection, pelvic pain, rashTobramycin (Nebcin) Uses: *Serious gram(–) Infxns* Action: Aminoglycoside;↓ protein synth. Spectrum: Gram(–) bacteria (including Pseudomonas)Dose: Adults. 1–2.5 mg/kg/dose IV q8–24h. Peds. 2.5 mg/kg/dose IV q8h; ↓ w/renal insuff Caution: [C, M] Contra: Aminoglycoside sensitivity Disp: Inj 10, 40mg/mL SE: Nephrotox & ototox Notes: Follow CrCl & levels; Levels: Peak: 30min after inf; Trough < 0.5 h before next dose; Therapeutic: Peak 5–8 mcg/mL,Trough < 2 mcg/mL; Toxic Peak > 12 mcg/mL; 1 ⁄2 life: 2 hTobramycin Ophthalmic (AKTob, Tobrex) Uses: *Ocular bacterialInfxns* Action: Aminoglycoside Dose: 1–2 gtt q4h; oint bid–tid; if severe, use ointq3–4h, or 2 gtt q30–60 min, then less frequently Caution: [C, M] Contra: Aminoglycosidesensitivity Disp: Oint & soln tobramycin 0.3% SE: Ocular irritationTobramycin & Dexamethasone Ophthalmic (TobraDex)Uses: *Ocular bacterial Infxns associated w/ significant inflammation* Action:Antibiotic w/ anti-inflammatory Dose: 0.3% oint apply q3–8h or soln 0.3% apply1–2 gtt q1–4h Caution: [C, M] Contra: Aminoglycoside sensitivity Disp: Oint &