Clinician's Pocket Drug Reference 2008

Alprostadil, Intracavernosal 33somnolence, paresthesias, HA, dry mouth, weakness, numbness, coronary vasospasm,HTNAlosetron (Lotronex) WARNING: Serious GI side effects, some fatal, includingischemic colitis reported. May be prescribed only through participation in theprescribing program for Lotronex Uses: *Severe D-predominant IBS in women whofail conventional therapy* Action: Selective 5-HT 3 receptor antagonist Dose: Adults.0.5 mg po bid; titrate to 1 mg bid max; D/C after 4 wk at max dose if Sxs not controlledCaution: [B, ?/–] Contra: Hx chronic/severe constipation, GI obst, strictures,toxic megacolon, GI perforation, adhesions, ischemic/ulcerative colitis, Crohn Dz, diverticulitis,thrombophlebitis, hypercoagulability Disp: Tabs 0.5, 1 mg SE: Constipation,abd pain, N Notes: D/C immediately if constipation or Sxs of ischemic colitisdevelop; pt must sign informed consent prior to use “patient-physician agreement”Alpha 1 -Protease Inhibitor (Prolastin) Uses: *α 1 -Antitrypsin deficiency*;pancinar emphysema Action: Replace human α 1 -protease inhibitor Dose:60 mg/kg IV once/wk Caution: [C, ?] Contra: Selective IgA deficiencies w/known IgA antibodies Disp: Inj 500 mg/20 mL, 1000 mg/40 mL powder for injSE: Fever, dizziness, flulike Sxs, allergic Rxns, ↑AST/ALTAlprazolam (Xanax, Niravam) [C-IV] Uses: *Anxiety & panic disorders,*anxiety w/ depression Action: Benzodiazepine; antianxiety agent Dose:Anxiety: Initial, 0.25–0.5 mg tid; ↑ to 4 mg/d max ÷ doses. Panic: Initial, 0.5 mgtid; may gradually ↑ to response; ↓ in elderly, debilitated, & hepatic impair Caution:[D, –] Contra: NAG, concomitant itra/ketoconazole Disp: Tabs 0.25, 0.5, 1,2 mg; Xanax XR 0.5, 1, 2, 3 mg; Niravam (orally disintegrating tabs) 0.25, 0.5, 1, 2mg; soln 1 mg/mL SE: Drowsiness, fatigue, irritability, memory impair, sexualdysfunction, paradoxical rxns Notes: Avoid abrupt D/C after prolonged useAlprostadil [Prostaglandin E 1 ] (Prostin VR) WARNING: Apneain up to 12% of neonates especially < 2 kg at birth Uses: *Conditions ductus arteriosusblood flow must be maintained* sustain pulm/systemic circulation until OR(eg, pulm atresia/stenosis, transposition, etc.) Action: Vasodilator (ductus arteriosusvery sensitive), plt inhibitor Dose: 0.05 mcg/kg/min IV; ↓ to lowest that maintainsresponse Caution: [X, –] Contra: Neonatal resp distress synd Disp: Inj 500mcg/mL SE: Cutaneous vasodilation, Sz-like activity, jitteriness, ↑ temp, ↓ Ca 2+ ,thrombocytopenia, ↓ BP; may cause apnea Notes: Keep intubation kit at bedsideAlprostadil, Intracavernosal (Caverject, Edex) Uses: *Erectiledysfunction* Action: Relaxes smooth muscles, dilates cavernosal arteries, ↑ lacunarspaces and blood entrapment Dose: 2.5–60 mcg intracavernosal; titrate in officeCaution: [X, –] Contra: ↑ risk of priapism (eg, sickle cell); peniledeformities/implants; men in whom sexual activity inadvisable Disp: Caverject: 5,10, 20, 40 mcg powder for injection vials ± diluent syringes 10, 20, 40 mcg amp.Caverject Impulse: Self-contained syringe (29 gauge) 10 & 20 mcg. Edex: 10, 20,40 mcg cartridges SE: Local pain w/ injection Notes: Counsel about priapism, penilefibrosis, & hematoma risks, titrate dose in office