Clinician's Pocket Drug Reference 2008

Cytarabine 71phosphoramide mustard, the active alkylating moieties Dose: (per protocol)500–1500 mg/m 2 ; single dose at 2- to 4-wk intervals; 1.8 g/m 2 to 160 mg/kg (or @12 g/m 2 in 75-kg individual) in the BMT setting (per protrocols); ↓ renal impairCaution: [D, ?] w/ BM suppression, hepatic insuff Contra: Component sensitivityDisp: Tabs 25, 50 mg; inj 500 mg, 1g, 2g SE: ↓ BM; hemorrhagic cystitis,SIADH, alopecia, anorexia; N/V; hepatotox; rare interstitial pneumonitis; irreversibletesticular atrophy possible; cardiotox rare; 2nd malignancies (bladder,ALL), risk 3.5% at 8 y, 10.7% at 12 y Notes: Hemorrhagic cystitis prophylaxis:continuous bladder irrigation & mesna uroprotection; encourage hydration, longtermbladder Ca screeningCyclosporine (Sandimmune, NeOral, Gengraf) WARNING: ↑risk neoplasm, ↑ risk skin malignancies, ↑ risk HTN and nephrotoxicity. Uses:*Organ rejection in kidney, liver, heart, & BMT w/ steroids; RA; psoriasis* Action:Immunosuppressant; reversible inhibition of immunocompetent lymphocytesDose: Adults & Peds. PO: 15 mg/kg/d 12 h pretransplant; after 2 wk, taper by 5mg/wk to 5–10 mg/kg/d. IV: If NPO, give 1/3 PO dose IV; ↓ in renal/hepatic impairCaution: [C, ?] Dose-related risk of nephrotox/hepatotox; live, attenuatedvaccines may be less effective Contra: Renal impair; uncontrolled HTN Disp:Caps 25, 50, 100 mg; PO soln 100 mg/mL; inj 50 mg/mL SE: May ↑ BUN & Cr &mimic transplant rejection; HTN; HA; hirsutism Notes: Administer in glass container;many drug interactions; NeOral & Sandimmune not interchangeable; monitorBP, Cr, CBC, LFTs, interaction w/ St. John’s wort; Levels: Trough: Just beforenext dose: Therapeutic: Variable 150–300 ng/mL (RIA)Cyclosporine ophthalmic (Restasis) Uses: * ↑ Tear production suppresseddue to ocular inflammation* Action: Immune modulator, anti-inflammatoryDose: 1 gtt bid each eye 12 h apart; OK w/ artificial tears, allow 15 minbetween Caution: [C, –] Contra: Ocular Infxn, component allergy Disp: Singleusevial 0.05% SE: Ocular burning/hyperemia Notes: Mix vial wellCyproheptadine (Periactin) Uses: *Allergic Rxns; itching* Action:Phenothiazine antihistamine; serotonin antagonist Dose: Adults. 4–20 mg PO ÷q8h; max 0.5 mg/kg/d. Peds. 2–6 y: 2 mg bid-tid (max 12 mg/24 h). 7–14 y: 4 mgbid-tid; ↓ in hepatic impair Caution: [B, ?] BPH Contra: Neonates or