Clinician's Pocket Drug Reference 2008

Trandolapril 205Topiramate (Topamax) Uses: *Adjunctive Rx for complex partial Szs &tonic–clonic Szs,* bipolar disorder, neuropathic pain, migraine prophylaxis Action:Anticonvulsant Dose: Adults. Seizures: Total dose 400 mg/d; see insert for 8-wk titration schedule. Migraine prophylaxis: titrate 100 m/d total Peds 2–16 y:Initial, 1–3 mg/kg/d PO qhs; titrate per insert to 5–9 mg/kg/d; ↓ w/ renal impairCaution: [C, ?/–] Contra: Component allergy Disp: Tabs 25, 50, 100, 200 mg;caps sprinkles 15, 25, 50 mg SE: Wgt loss, memory impair, metabolic acidosis,kidney stones, fatigue, dizziness, psychomotor slowing, paresthesias, GI upset,tremor, nystagmus, acute glaucoma requiring D/C Notes: Metabolic acidosis responsiveto ↓ dose or D/C; D/C w/taperTopotecan (Hycamtin) WARNING: Chemo precautions, for use byphysicians familiar with chemotherapeutic agents, BM suppression possibleUses: *Ovarian CA (cisplatin-refractory), cervical Ca, NSCLC*, sarcoma, pednon-small-cell lung CA Action: Topoisomerase I inhibitor; ↓ DNA synth Dose:1.5 mg/m 2 /d as a 1-h IV inf × 5 days, repeat q3wk; ↓ w/renal impair Caution:[D, –] Contra: PRG, breast-feeding Disp: Inj 4-mg vials SE: ↓ BM, N/V/D, drugfever, skin rashTorsemide (Demadex) Uses: *Edema, HTN, CHF, & hepatic cirrhosis*Action: Loop diuretic; ↓ reabsorption of Na + & Cl – in ascending loop of Henle &distal tubule Dose: 5–20 mg/d PO or IV; 200 mg/day max Caution: [B, ?] Contra:Sulfonylurea sensitivity Disp: Tabs 5, 10, 20, 100 mg; inj 10 mg/mL SE: Orthostatic↓ BP, HA, dizziness, photosens, electrolyte imbalance, blurred vision, renal impairNotes: 20 mg torsemide = 40 mg furosemideTramadol (Ultram, Ultram ER) Uses: *Moderate–severe pain* Action:Centrally acting analgesic Dose: Adults. 50–100 mg PO q4–6h PRN, start 25 mgPO qam, ↑ Q3d to 25 mg PO QID; ↑ 50 mg Q3D, 400 mg/d max (300 mg if > 75yr); ER 100–300 mg PO daily Peds. 0.5–1 mg/kg PO q 4–6h PRN; ↓ w/ renal insuffCaution: [C, ?/–] Contra: Opioid dependency; w/MAOIs; sensitivity tocodeine Disp: Tabs 50 mg; ER 10, 20, 30 mg SE: Dizziness, HA, somnolence, GIupset, resp depression, anaphylaxis Notes: ↓ Sz threshold; tolerance/dependencemay developTramadol/Acetaminophen (Ultracet) Uses: *Short-term Rx acutepain (< 5 d)* Action: Centrally acting analgesic; nonnarcotic analgesic Dose:2 tabs PO q4–6h PRN; 8 tabs/d max. Elderly/renal impair: Lowest possible dose;2 tabs q12h max if CrCl < 30 Caution: [C, –] Szs, hepatic/renal impair, or Hx addictivetendencies Contra: Acute intox Disp: Tab 37.5 mg tramadol/325 mg APAPSE: SSRIs, TCAs, opioids, MAOIs ↑ risk of Szs; dizziness, somnolence, tremor,HA, N/V/D, constipation, xerostomia, liver tox, rash, pruritus, ↑ sweating, physicaldependence Notes: Avoid EtOHTrandolapril (Mavik) WARNING: Use in PRG in 2nd/3rd tri can resultin fetal death Uses: *HTN,* CHF, LVD, post-AMI Action: ACE inhibitor Dose:HTN: 2–4 mg/d; CHF/LVD: 4 mg/d; ↓ w/severe renal/hepatic impair Caution: