Clinician's Pocket Drug Reference 2008

206 Trastuzumab[D, +] ACE inhibitor sensitivity, angioedema w/ ACE inhibitors Disp: Tabs 1, 2, 4mg SE: ↓ BP, bradycardia, dizziness, ↑ K + , GI upset, renal impair, cough, angioedemaNotes: Afro-Americans, min. dose is 2 mg vs 1 mg in CaucasiansTrastuzumab (Herceptin) WARNING: Can cause cardiomyopathy andventricular dysfunction; infusion rxns and pulm toxicity reported Uses: *Metbreast CA that overexpress the HER2/neu protein* breast Ca adjuvant, w/ doxorubicin,cyclophosphamide, and paclitaxel if pt HER2/neu (+) Action: MoAb; bindshuman EGF receptor 2 protein (HER2); mediates cellular cytotox Dose: Per protocol,typical 2 mg/kg/IV/week Caution: [B, ?] CV dysfunction, allergy/inf RxnsContra: Live vaccines Disp: Inj form 21 mg/mL SE: Anemia, cardiomyopathy,nephrotic synd, pneumonitis Notes: Inf related Rxns minimized w/ acetaminophen,diphenhydramine & meperidineTrazodone (Desyrel) WARNING: Closely monitor for worsening depressionor emergence of suicidality, particularly in pts < 24 yr Uses: *Depression,*hypnotic, augment other antidepressants Action: Antidepressant; ↓ reuptake ofserotonin & norepinephrine Dose: Adults & Adolescents. 50–150 mg POdaily–qid; max 600 mg/d. Sleep: 50 mg PO, qhs, PRN Caution: [C, ?/–] Contra:Component allergy Disp: Tabs 50, 100, 150, 300 mg SE: Dizziness, HA, sedation,N, xerostomia, syncope, confusion, tremor, hepatitis, EPS Notes: Takes 1–2 wk forsymptom improvement; may interact with CYP3A4 inhibitors to ↑trazodone concentrations,carbamazepine to ↓ trazodone concentrationsTreprostinil Sodium (Remodulin) Uses: *NYHA class II–IV pulm arterialHTN* Action: Vasodilation, inhibits plt aggregation Dose: 0.625–1.25ng/kg/min inj cont inf Caution: [B, ?/–] Contra: Component allergy Disp: 1, 2.5,5, 10 mg/mL inj SE: Additive effects w/ anticoagulants, antihypertensives; inf siteRxns; D (25%), N (22%), HA (27%) Notes: Initiate in monitored setting; do notD/C or ↓ dose abruptlyTretinoin, Topical [Retinoic Acid] (Retin-A, Avita, Renova,Retin- A Micro) Uses: *Acne vulgaris, sun-damaged skin, wrinkles* (photoaging), some skin CAs Action: Exfoliant retinoic acid derivative Dose: Adults & Peds> 12 y. Apply daily hs (w/ irritation, ↓ frequency). Photoaging: Start w/ 0.025%, ↑ to0.1% over several mo (apply only q3d if on neck area; dark skin may require bid use)Caution: [C, ?] Contra: Retinoid sensitivity Disp: Cream 0.02, 0.025, 0.05, 0.1%;gel 0.01, 0.025, microformulation gel 0.1, 0.04%; liq 0.05% SE: Avoid sunlight;edema; skin dryness, erythema, scaling, changes in pigmentation, stinging, photosensTriamcinolone (Azmacort) Uses: *Chronic asthma* Actions: Topicalsteroid Dose: Two inhalations tid–qid or 4 inhal bid Caution: [C, ?] Contra:Component allergy Disp: Aerosol, metered inhaler 100 mcg spray SE: Cough, oralcandidiasis Notes: Instruct pts to rinse mouth after use; not for acute asthmaTriamcinolone & Nystatin (Mycolog-II) Uses: *Cutaneous candidiasis*Action: Antifungal & antiinflammatory Dose: Apply lightly to area bid; max25 mg/d Caution: [C, ?] Contra: Varicella; systemic fungal Infxns Disp: Cream