Clinician's Pocket Drug Reference 2008

210 ValsartanLevels: Trough: just before next dose; Therapeutic: Peak 50–100 mcg/mL; ToxicTrough > 100 mcg/mL; 1 ⁄2 life: 5–20 h; phenobarbital & phenytoin may alter levelsValsartan (Diovan) WARNING: Use during 2nd/3rd tri of PRG can causefetal harm Uses: HTN, CHF, DN Action: Angiotensin II receptor antagonistDose: 80–160 mg/d, max 320 mg/day Caution: [C (1st tri; D 2nd & 3rd tri), ?/–]w/ K + -sparing diuretics or K + supls Contra: Severe hepatic impair, biliary cirrhosis/obst,primary hyperaldosteronism, bilateral RAS Disp: Tabs 40, 80, 160, 320mg, capsule: 80 mg, 160 mg SE: ↓ BP, dizzinessVancomycin (Vancocin, Vancoled) Uses: *Serious MRSA Infxns;enterococcal Infxns; PO Rx of C. difficile pseudomembranous colitis* Action:↓ Cell wall synth. Spectrum: Gram(+) bacteria & some anaerobes (includesMRSA, Staphylococcus sp, Enterococcus sp, Streptococcus sp, C. difficile) Dose:Adults. 1 g IV q12h; or 15 mg/kg/dose for colitis 125–500 mg PO q6h. Peds.40–60 mg/kg/24 h IV in ÷ doses q6–12 h. Neonates. 10–15 mg/kg/dose q12h; ↓ inrenal insuff Caution: [C, M] Contra: Component allergy; w/ avoid in Hx hearingloss Disp: Caps 125, 250 mg; powder 250 mg/5 mL, 500 mg/6 mL for PO soln;powder for inj 500 mg, 1000 mg, 10 g/vial SE: Ototoxic & nephrotoxic, GI upset(PO), neutropenia Notes: Not absorbed PO, local effect in gut only; give IV doseslowly (over 1–3 h) to prevent “red-man synd” (flushing of head/neck/upper torso);IV product PO for colitis; Levels: Peak: 1 h after inf; Trough < 0.5 h before nextdose; Therapeutic: Peak 30–40 mcg/mL, Trough < 2 mcg/mL; Toxic Peak > 50mcg/mL, Trough > 15 mcg/mL; 1 ⁄2 life: 6–8 hVardenafil (Levitra) WARNING: May prolong QT c interval Uses:*ED* Action: PDE5 inhibitor, increases cGMP and NO levels; Relaxes smoothmuscles, dilates cavernosal arteries Dose: 10 mg PO 60 min before sexual activity;2.5 mg if administered w/ CYP3A4 inhibitors (Table 11); max × 1 ≤20 mg Caution:[B, –] W/ CV, hepatic, or renal Dz Contra: Nitrates, ↑ Qtc interval Disp:Tabs 2.5, 5, 10, 20 mg tabs SE: ↓ BP, HA, dyspepsia, priapism hearing loss Notes:Concomitant α-blockers may cause ↓ BPVarenicline (Chantix) Uses: *Smoking cessation* Action: Nicotine receptorantagonist Dose: Adults. 0.5 mg PO daily × 3 d, 0.5 mg bid × 4 d, then 1 mgPO bid for 12 wks total; after meal w/ glass of water Caution: [C,?/–] ↓ dosew/renal impair Disp: Tabs 0.5, 1 mg SE: N, V, insomnia, flatulence, unusualdreams Notes: Slowly ↑ dose to ↓ N; initiate 1 wk before desired smoking cessationdateVaricella Virus Vaccine (Varivax) Uses: *Prevent varicella (chickenpox)*Action: Active immunization; live attenuated virus Dose: Adults & Peds.0.5 mL SQ, repeat 4–8 wk Caution: [C, M] Contra: Immunocompromise;neomycin-anaphylactoid Rxn, blood dyscrasias; immunosuppressive drugs; avoidPRG for 3 mo after Disp: Powder for inj SE: Mild varicella Infxn; fever, localRxns, irritability, GI upset Notes: OK for all children & adults who have not hadchickenpox