Clinician's Pocket Drug Reference 2008

Ziconotide 213Warfarin (Coumadin) Uses: *Prophylaxis & Rx of PE & DVT, AF w/ embolization,*other postop indications Action: ↓ Vitamin K-dependent clotting factorsin order: VII-IX-X-II Dose: Adults. Titrate, INR 2.0–3.0 for most; mechanical valvesINR is 2.5–3.5. ACCP guidelines: 5 mg initial (unless rapid therapeutic INR needed),may use 7.5–10 mg; ↓ if pt elderly or w/has other bleeding risk factors. Alternative:10–15 mg PO, or IV daily for 1–3 d; maint 2–10 mg/d PO, IV, or follow daily INRinitial to adjust dosage (Table 9). Peds 0.05–0.34 mg/kg/24 h PO, or IV; followPT/INR to adjust dosage; monitor vitamin K intake; ↓ w/hepatic impair/elderly Caution:[X, +] Contra: Severe hepatic/renal Dz, bleeding, peptic ulcer, PRG Disp:Tabs 1, 2, 2.5, 3, 4, 5, 6, 7.5, 10 mg; inj SE: Bleeding due to overanticoagulation (PT> 3 × control, INR > 5.0–6.0) or injury & therapeutic INR; bleeding, alopecia, skinnecrosis, purple toe synd Notes: Monitor vitamin K intake (↓ effect); INR preferredtest; to rapidly correct overanticoagulation: vitamin K, FFP or both; highly teratogenic.Caution pt on taking w/ other meds, especially ASA. Common warfarin interactions:Potentiated by: APAP, EtOH (w/ liver Dz), amiodarone, cimetidine,ciprofloxacin, cotrimoxazole, erythromycin, fluconazole, flu vaccine, isoniazid, itraconazole,metronidazole, omeprazole, phenytoin, propranolol, quinidine, tetracycline.Inhibited by: barbiturates, carbamazepine, chlordiazepoxide, cholestyramine,dicloxacillin, nafcillin, rifampin, sucralfate, high–vitamin K foodsZafirlukast (Accolate) Uses: *Adjunctive Rx of asthma* Action: Selective& competitive inhibitor of leukotrienes Dose: Adults & Peds ≥ 12 y. 20 mgbid. Peds 5–11 y. 10 mg PO bid (empty stomach) Caution: [B, –] Interacts w/ warfarin,↑ INR Contra: Component allergy Disp: Tabs 10, 20 mg SE: Hepatic dysfunction,usually reversible on D/C; HA, dizziness, GI upset; Churg–Strauss syndNotes: Not for acute asthmaZaleplon (Sonata) [C-IV] Uses: *Insomnia* Action: A nonbenzodiazepinesedative/hypnotic, a pyrazolopyrimidine Dose: 5–20 mg hs PRN; ↓ w/renal/hepatic insuff, elderly Caution: [C, ?/–] w/ mental/psychological conditionsContra: Component allergy Disp: Caps 5, 10 mg SE: HA, edema, amnesia, somnolence,photosens Notes: Take immediately before desired onsetZanamivir (Relenza) Uses: *Influenza A & B* Action: ↓ viral neuraminidaseDose: Adults & Peds > 7 y. 2 inhal (10 mg) bid for 5 d; initiate w/in48 h of Sxs Caution: [C, M] Contra: Pulm Dz Disp: Powder for inhal 5 mg SE:Bronchospasm, HA, GI upset Notes: Uses a Diskhaler for administrationZiconotide (Prialt) WARNING: Psychiatric, cognitive, neurologic impairmay develop over several weeks; monitor frequently; may necessitate D/C Uses:*IT Rx of severe, refractory, chronic pain* Action: N-type CCB in spinal cordDose: 2.6 mcg/d IT at 0.1 mcg/h; may ↑ 0.8 mcg/h to total 19.2 mcg/d by day 21Caution: [C, ?/–] Reversible psychiatric/neurologic impair Contra: PsychosisDisp: Inj 25, 100 mg/mL SE: Dizziness, N/V, confusion, abnormal vision; may requiredosage adjustment Notes: May D/C abruptly; uses specific pumps; do not ↑more frequently than 2–3 ×/wk