Clinician's Pocket Drug Reference 2008

52 BumetanideBumetanide (Bumex) Uses: *Edema from CHF, hepatic cirrhosis, &renal Dz* Action: Loop diuretic; ↓ reabsorption of Na + & Cl - , in ascending loop ofHenle & the distal tubule Dose: Adults. 0.5–2 mg/d PO; 0.5–1 mg IV/IM q8–24h(max 10 mg/d) for PO and IV. Peds. 0.015–0.1 mg/kg/d PO, q6h-24h Caution:[D, ?] Contra: Anuria, hepatic coma, severe electrolyte depletion Disp: Tabs 0.5,1, 2 mg; inj 0.25 mg/mL SE: ↓ K + , ↓ Na + , ↑ creatinine, ↑ uric acid, dizziness, ototoxNotes: Monitor fluid & lytesBupivacaine (Marcaine) Uses: *Local, regional, & spinal anesthesia,local & regional analgesia* Action: Local anesthetic Dose: Adults & Peds. Dosedependent on procedure (tissue vascularity, depth of anesthesia, etc) (Table 2)Caution: [C, ?] Contra: Severe bleeding, ↓ BP, shock & arrhythmias, local Infxnsat anesthesia site, septicemia Disp: Inj 0.25, 0.5, 0.75% SE: ↓ BP, bradycardia,dizziness, anxietyBuprenorphine (Buprenex) [C-V] Uses: *Moderate/severe pain* Action:Opiate agonist-antagonist Dose: 0.3–0.6 mg IM or slow IV push q6h PRNCaution: [C, ?/–] Disp: 0.3 mg/mL SE: Sedation, ↓ BP, resp depression Notes:Withdrawal if opioid-dependentBupropion (Wellbutrin, Wellbutrin SR, Wellbutrin XL, Zyban)WARNING: Closely monitor for worsening depression or emergence of suicidality,increased suicidal behavior in young adults Uses: *Depression, adjunct tosmoking cessation* ADHD Action: Weak inhibitor of neuronal uptake of serotonin& norepinephrine; ↓ neuronal dopamine reuptake Dose: Depression: 100–450mg/d ÷ bid-tid; SR 150–200 mg bid; XL 150–450 mg daily. Smoking cessation(Zyban, Wellbutrin XR): 150 mg/d × 3 d, then 150 mg bid × 8–12 wk, last dose notafter 6 PM; ↓ renal/hepatic impair Caution: [C, ?/–] Contra: Sz disorder, Hxanorexia nervosa or bulimia, MAOI, w/in 14 d, abrupt D/C of EtOH or sedativesDisp: Tabs 75, 100 mg; SR tabs 50, 100, 150, 200 mg; XL tabs 150, 300 mg;Zyban 150 mg tabs SE: Szs, agitation, insomnia, HA, tachycardia Notes: AvoidEtOH & other CNS depressants, SR and XR do not cut/chew/crushBuspirone (BuSpar) WARNING: Closely monitor for worsening depressionor emergence of suicidality Uses: Short-term relief of *anxiety* Action:Antianxiety; antagonizes CNS serotonin receptors Dose: Initial: 7.5 mg PO bid; ↑by 5 mg q 2–3 days to effect; usual 20–30 mg/d; max 60 mg/d Contra: w/ MAOICaution: [B, ?/–] avoid w/severe hepatic/renal insuff Disp: Tabs dividose 5, 10,15, 30 mg SE: Drowsiness, dizziness, HA, N, EPS, serotonin synd, hostility, depressionNotes: No abuse potential or physical/psychologic dependenceBusulfan (Myleran, Busulfex) Uses: *CML,* preparative regimens forallogeneic & ABMT in high doses Action: Alkylating agent Dose: (per protocol)Caution: [D, ?] Disp: Tabs 2 mg, inj 60 mg/10 mL SE: ↓ BM, pulm fibrosis, N(w/high-dose), gynecomastia, adrenal insuff, & skin hyperpigmentationButorphanol (Stadol) [C-IV] Uses: *Anesthesia adjunct, pain* & migraineHA Action: Opiate agonist-antagonist w/ central analgesic actions Dose: