Clinician's Pocket Drug Reference 2008

70 Cyclobenzaprinemcg/kg x 2 days test dose; if OK 30–50 mcg/day/M for 2 or more wks (total 10mcg) then maint: 100 mg/month. Caution: [A (C if dose exceeds RDA), +] Contra:Allergy to cobalt; hereditary optic nerve atrophy; Leber Dz Disp: Tabs 50,100, 250, 500, 1000, 2500, 5000 mcg; inj 100, 1000 mcg/mL; intranasal (Nasocobal)gel 500 mcg/0.1 mL SE: Itching, D, HA, anxiety Notes: PO absorption erraticand not recommended; OK for use w/hyperalimentationCyclobenzaprine (Flexeril) Uses: *Relief of muscle spasm* Action:Centrally acting skeletal muscle relaxant; reduces tonic somatic motor activityDose: 5–10 mg PO bid-qid (2–3 wk max) Caution: [B, ?] Shares the toxic potentialof the TCAs; urinary hesitancy, NAG Contra: Do not use concomitantly orw/in 14 d of MAOIs; hyperthyroidism; heart failure; arrhythmias Disp: Tabs 5, 7.5,10 mg SE: Sedation & anticholinergic effects Notes: May inhibit mental alertnessor physical coordinationCyclobenzaprine, extended release (Amrix) Uses: *Musclespasm* Action: ? Centrally acting long-term muscle relaxant Dose: 15–30 mg POdaily 2–3 wks; 30 mg/day max Caution: [B, ?/–]w/urinary retention, NAG,w/ETOH/CNS depressant Contra: MAOI w/in 14 d, elderly, arrhythmias, heartblock, CHF, MI recovery phase, ↑thyroid Disp: Caps 15, 30 ER SE: Dry mouth,drowsiness, dizziness, HA, N, blurred vision, dysgeusia Notes: Avoid abrupt D/Cw/ long-term useCyclopentolate ophthalmic (Cyclogyl,Cylate) Uses: *Cycloplegia,mydriasis* Action: Cycloplegic mydriatic, anticholinergic inhibits iris sphincterand ciliary body Dose: Adults. 1 gtt in eye 40–50 min preprocedure, may repeat× 1 in 5–10 min Peds. As adult, children 0.5–1.0%; infants use 0.5% Caution: (C[may cause late-term fetal anoxia/bradycardia, +/–], premature infants HTN, Downsynd, elderly, Contra: NAG Disp: Ophth soln 0.5, 1, 2% SE: Tearing, HA, irritation,eye pain, photophobia, arrhythmia, tremor, ↑ IOP, confusion Notes: Compresslacrimal sac for several min after dose; heavily pigmented irises may require↑ strength; peak 25–75 min, cycloplegia 6–24 h, mydriasis up to 24 h; 2% solnmay result in psychotic rxns and behavioral disturbances in pedsCyclopentolate with Phenylephrine (Cyclomydril) Uses: * Action:Cycloplegic mydriatic, α-adrenergic agonist w/ anticholinergic to inhibit irissphincter Dose: 1 gtt in eye q 5–10 min (max 3 doses) 40–50 min preprocedureCaution: (C [may cause late-term fetal anoxia/bradycardia, +/–] HTN, w/elderlyw/CAD, Contra: NAG Disp: Ophth soln cyclopentolate 0.2%/phenlephrine 1%(2, 5 mL) SE: Tearing, HA, irritation, eye pain, photophobia, arrhythmia, tremorNotes: Compress lacrimal sac for several min after dose; heavily pigmented irisesmay require ↑ strength; peak 25–75 min, cycloplegia 6–24 h, mydriasis up to 24 hCyclophosphamide (Cytoxan, Neosar) Uses: *Hodgkin Dz &NHLs; multiple myeloma; small-cell lung, breast, & ovarian CAs; mycosis fungoides;neuroblastoma; retinoblastoma; acute leukemias; allogeneic & ABMT inhigh doses; severe rheumatologic disorders* Action: Converted to acrolein &