Clinician's Pocket Drug Reference 2008

34 Alprostadil, Urethral SuppositoryAlprostadil, Urethral Suppository (Muse) Uses: *Erectile dysfunction*Action: Urethral absorption; vasodilator, relaxes smooth muscle of corpus cavernosaDose: 125–1000 mcg system 5–10 min prior to sexual activity; may repeat ×1/24 hrs; titrate in office Caution: [X, –] Contra: ↑ priapism risk (eg, sickle cell) peniledeformities/implants; men in whom sexual activity inadvisable Disp: 125, 250,500, 1000 mcg w/transurethral delivery system SE: ↓ BP, dizziness, syncope, penile/testicularpain, urethral burning/bleeding, priapism Notes: Titrate dose in officeAlteplase, Recombinant [tPA] (Activase) Uses: *AMI, PE, acute ischemicstroke, & CV cath occlusion* Action: Thrombolytic; binds fibrin in thrombus,initiates fibrinolysis Dose: AMI: 15 mg IV over 1–2 mins, then 0.75 mg kg(max 50 mg) over 30 min, then 0.5 mg/kg over next 60 minutes (max 35 mg)(ECC2005) Stroke: 0.09 mg/kg IV over one min, then 0.81 mg/kg; max 90 mg) inf over60 min (ECC 2005) Cath occlusion: 10–29 kg 1 mg/mL; ≥ 30 kg 2 mg/mL Caution:[C, ?] Contra: Active internal bleeding; uncontrolled HTN (SBP = >185 mmHg/DBP = >110 mm Hg); recent (w/in 3 mo) CVA, GI bleed, trauma; intracranial orintraspinal surgery or diseases (AVM/aneurysm/subarachnoid hemorrhage), prolongedcardiac massage; intracranial neoplasm, suspected aortic dissection, bleeding/hemostaticdefects, Sz at the time of stroke Disp: Powder for inj 2, 50, 100 mgSE: Bleeding, bruising (eg, venipuncture sites), ↓ BP Notes: Give heparin to preventreocclusion; in AMI, doses of >150 mg associated w/ intracranial bleedingAltretamine (Hexalen) WARNING: Bone marrow suppression, neurotoxicitycommon Uses: *Epithelial ovarian CA* Action: Unknown; cytotoxicagent, unknown alkylating agent; ↓ nucleotide incorporation into DNA/RNADose: 260 mg/m 2 /d in 4 ÷ doses for 14–21 d of a 28-d Rx cycle; dose ↑ to 150mg/m 2 /d for 14 d in multiagent regimens (per protocols); after meals and at bedtimeCaution: [D, ?/–]. Contra: Preexisting BM depression or neurologic toxDisp: Caps 50 mg SE: V/D, cramps; neurologic (peripheral neuropathy, CNS depression);minimally myelosuppressive Notes: CBC, routine neuro examsAluminum Hydroxide (Amphojel, AlternaGEL) [OTC] Uses:*Relief of heartburn, upset or sour stomach, or acid indigestion*; supl to Rx of hyperphosphatemiaAction: Neutralizes gastric acid; binds PO −24 Dose: Adults.10–30 mL or 300–1200 mg PO q4–6h. Peds. 5–15 mL PO q4–6h or 50–150mg/kg/24 h PO ÷ q4–6h (hyperphosphatemia) Caution: [C, ?] Disp: Tabs 300, 600mg; susp 320, 600 mg/5 mL SE: constipation Notes: OK in renal failureAluminum Hydroxide + Magnesium Carbonate (GavisconExtra Strength, Liquid) [OTC] Uses: *Relief of heartburn, acid indigestion*Action: Neutralizes gastric acid Dose: Adults. 15–30 mL PO pc & hs. Peds.5–15 mL PO qid or PRN; avoid in renal impair Caution: ↑ Mg 2+ (w/ renal insuff)[C, ?] Disp: Liq w/ AlOH 95 mg/Mg carbonate 358 mg/15 mL; Extra Strength liqAlOH 254 mg/Mg carbonate 237mg/15mL; chew tabs AlOH 160 mg/Mg carb 105mg SE: Constipation, D Notes: qid doses best given pc & hs; may affect absorptionof some drugs, take 2–3 h apart to ↓ effect