Clinician's Pocket Drug Reference 2008

Valproic Acid 209Triptorelin (Trelstar Depot, Trelstar LA) Uses: *Palliation of advancedPCa* Action: LHRH analog; ↓ GNRH w/ continuous dosing; transient ↑in LH, FSH, testosterone, & estradiol 7–10 d after first dose; w/ chronic/continuoususe (usually 2–4 wk), sustained ↓ LH & FSH w/ ↓ testicular & ovariansteroidogenesis similar to surgical castration Dose: 3.75 mg IM monthly or 11.25mg IM q3mo Caution: [X, N/A] Contra: Not indicated in females Disp: Inj depot3.75 mg; LA 11.25 mg SE: Dizziness, emotional lability, fatigue, HA, insomnia,HTN, D, V, ED, retention, UTI, pruritus, anemia, inj site pain, musculoskeletalpain, osteoporosis, allergic RxnsTrospium Chloride (Sanctura) Uses: *OAB* Action: Antimuscarinic,antispasmodic Dose: 20 mg PO bid; ↓ w/ renal impair or > 75 y; on empty stomachor 1 h ac Caution: [C, ?/–] BOO, GI obst, ulcerative colitis, MyG, renal/hepaticimpair Contra: NAG, urinary/gastric retention Disp: Tabs 20 mg SE:Constipation, xerostomiaUrokinase (Abbokinase) Uses: *PE, DVT, restore patency to IVcatheters* Action: Converts plasminogen to plasmin; causes clot lysis Dose:Adults & Peds. Systemic effect: 4,400 units/kg IV over 10 min, then 4,400–6,000units/kg/h for 12 h. Restore catheter patency: Inject 5,000 units into catheter & aspirateup to two doses Caution: [B, +] Contra: Do not use w/in 10 d of surgery,delivery, or organ biopsy; bleeding, CVA, vascular malformation Disp: Powder forinj, 250,000-unit vial SE: Bleeding, ↓ BP, dyspnea, bronchospasm, anaphylaxis,cholesterol embolismValacyclovir (Valtrex) Uses: *Herpes zoster; genital herpes* Action:Prodrug of acyclovir; ↓ viral DNA replication. Spectrum: Herpes simplex I & IIDose: 1 g PO tid. Genital herpes: 500 mg bid × 7–10 d. Herpes prophylaxis:500–1000 mg/d; ↓ w/ renal failure Caution: [B, +] Disp: Caplets 500, 1000 mgSE: HA, GI upset, dizziness, pruritus, photophobiaValganciclovir (Valcyte) Uses: *CMV* Action: Ganciclovir prodrug; ↓viral DNA synth Dose: Induction, 900 mg PO bid w/ food × 21 d, then 900 mg POdaily; ↓ in renal dysfunction Caution: [C, ?/–] Use w/ imipenem/cilastatin,nephrotoxic drugs Contra: Allergy to acyclovir, ganciclovir, valganciclovir; ANCHD < 500/mm 2 ; plt < 25 K; Hgb < 8 g/dL Disp: Tabs 450 mg SE: BM suppression,headache, GI upset Notes: Monitor CBC & CrValproic Acid (Depakene, Depakote) Uses: *Rx epilepsy, mania;prophylaxis of migraines,* Alzheimer behavior disorder Action: Anticonvulsant; ↑availability of GABA Dose: Adults & Peds. Szs: 30–60 mg/kg/24 h PO ÷ tid (afterinitiation of 10–15 mg/kg/24 h). Mania: 750 mg in 3 ÷ doses, ↑ 60 mg/kg/d max.Migraines: 250 mg bid, ↑ 1000 mg/d max; ↓ w/ hepatic impair Caution: [D, +]Contra: Severe hepatic impair Disp: Caps 250 mg; syrup 250 mg/5 mL SE: Somnolence,dizziness, GI upset, diplopia, ataxia, rash, thrombocytopenia, hepatitis,pancreatitis, prolonged bleeding times, alopecia, wgt gain, hyperammonemic encephalopathyreported in pts w/ urea cycle disorders Notes: Monitor LFTs &