A Lange Medical Book Pediatrics on call - part 9 docx

Notes: Has little activity against streptococci. Drug interactions occur with theophylline, caffeine, sucralfate, warfarin, didanosine, and antacids. Should be taken on empty stomach. Adjust dose in patients with renal impairment. CIPROFLOXACIN, OPHTHALMIC (CILOXAN) (SEE TABLE VIII–6, P. 754) CIPROFLOXACIN, OTIC (CIPRO HC OTIC) Indications: Otitis externa. Actions: Quinolone antibiotic; inhibits DNA gyrase. Dosage: 3 drops in affected ear(s) twice daily for 7 days. Supplied: Suspension ciprofloxacin 0.2% and hydrocortisone 1%. Cisatracurium (Nimbex) Indications: Adjunct to anesthesia to facilitate endotracheal intubation. Actions: Nondepolarizing neuromuscular blocker. Dosage: Initial 0.1 mg/kg IV, followed by 0.03 mg/kg prn; Continuous infusion: 1–4 mcg/kg/min IV or 6–20 mcg/kg/min. Supplied: Injection 2 mg/mL, 10 mg/mL. Notes: Patient must be intubated and on controlled ventilation. Intermediate onset; not recommended for rapid sequence intubation. Undergoes rapid nonenzymatic degradation (Hofmann elimination), making dosage adjustment in patients with renal or hepatic impairment unnecessary. CISPLATIN (PLATINOL-AQ) Indications: Treatment of Hodgkin and non-Hodgkin lymphoma; head or neck cancer; cervical, testicular, ovarian, and breast cancer; lung cancer; brain tumors; neuroblastoma; osteosarcoma. Actions: Antineoplastic alkylating agent. Dosage: Refer to individual protocols. Verify doses > 120 mg/m 2 per course to prevent overdose. Supplied: Injection 1 mg/mL. Notes: Adjust dose in patients with renal impairment. Maintain adequate hydration and urine output to prevent nephrotoxicity. Toxicities include 2. GENERIC DRUGS 627 628 VIII: COMMONLY USED MEDICATIONS allergic reactions, high-frequency hearing loss, peripheral “stocking-glove” type neuropathy, cardiotoxicity, hypomagnesemia, mild myelosuppression, and hepatotoxicity. CITRATE AND CITRIC ACID (BICITRA) Indications: Metabolic acidosis. Actions: Alkalinizing agent. Dosage: 2–3 mEq/kg/day PO divided 3–4 times daily or 5–15 mL after meals and at bedtime. Supplied: Oral solution 1 mEq/mL sodium and 1 mEq/mL bicarbonate. Notes: Dilute in water or juice. Contraindicated in patients with severe renal impairment or sodium-restricted diets. CLARITHROMYCIN (BIAXIN) Indications: Upper and lower respiratory tract infections; acute otitis media; skin and skin structure infections; Helicobacter pylori infections caused by susceptible strains of Staphylococcus aureus, Streptococcus pyogenes, S pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Mycoplasma pneumoniae, Chlamydia trachomatis, and Legionella spp; prevention and treatment of Mycobacterium avium–complex (MAC) infec- tions in HIV-infected individuals; prophylaxis of bacterial endocarditis in penicillin-allergic patients. Actions: Macrolide antibiotic; inhibits protein synthesis. Dosage: Infants and children: 15 mg/kg/day PO twice daily; Bacterial endocarditis prophylaxis: 15 mg/kg PO 1 hour before procedure; MAC prophylaxis: 15 mg/kg/day PO twice daily, max 1 g/day. Adolescents and adults: 250–500 mg PO twice daily or 1000 mg (2 × 500 mg extended-release tablets) PO daily; Bacterial endocarditis pro- phylaxis: 500 mg PO 1 hour before procedure; MAC prophylaxis: 500 mg PO twice daily; H pylori: 250 mg PO twice daily up to 500 mg PO 3 times daily. Supplied: Tablets 250 mg, 500 mg; suspension 125 mg/5 mL, 250 mg/ 5 mL; extended-release tablet 500 mg. Notes: Increases theophylline and carbamazepine levels. Avoid concur- rent use with cisapride. Causes metallic taste. Reduce dose in patients with renal impairment. CLINDAMYCIN (CLEOCIN, CLEOCIN-T) Indications: Susceptible strains of streptococci, pneumococci, staphylo- cocci, and gram-positive and gram-negative anaerobes (no activity against gram-negative aerobes); bacterial vaginosis; topical therapy for severe acne and vaginal infections. Actions: Bacteriostatic; interferes with protein synthesis. Dosage: Oral: 10–30 mg/kg/day PO divided 3–4 times daily, max 1.8 g/day. Intravenous: 25–40 mg/kg/day IV divided q6–8h, max 4.8 g/day. Vaginal: 1 applicatorful at bedtime for 7 days. Topical: Apply 1% gel, lotion, or solution twice daily. Supplied: Capsules 75 mg, 150 mg, 300 mg; suspension 75 mg/5 mL; injection 300 mg/2 mL; vaginal cream 2%; topical gel, lotion, or solution 1%. Notes: Beware of diarrhea that may represent pseudomembranous colitis caused by Clostridium difficile. CLONAZEPAM (KLONOPIN) [C] Indications: Lennox-Gastaut syndrome; akinetic and myoclonic seizures; absence seizures. Actions: Benzodiazepine anticonvulsant. Dosage: Infants and children < 10 years ( < 30 kg): Initial dose 0.01–0.03 mg/kg/day (max initial dose 0.05 mg/kg/day) PO divided 2–3 times daily, increase by no more than 0.5 mg every 3 days prn up to 0.2 mg/day; Children ≥ 10 years ( > 30 kg): 0.5 mg PO 3 times daily, increase by 0.5–1 mg every 3 days prn up to 20 mg/day. Supplied: Tablets 0.5 mg, 1 mg, 2 mg. Notes: CNS side effects, including sedation. CLONIDINE (CATAPRES) Indications: Hypertension; alternative treatment of attention-deficit/hyper- activity disorder (ADHD); adjunct in treatment of neuropathic pain; epidural form used in combination with opiates for analgesia in cancer patients; opioid, alcohol, and tobacco withdrawal in adults. Actions: Centrally acting α 2 -adrenergic stimulant. Dosage: Hypertension: Children: 5–10 mcg/kg/day PO divided q8–12h, increase gradually prn to 5–25 mcg/kg/day divided q6h, max 0.9 mg/day; 2. GENERIC DRUGS 629 630 VIII: COMMONLY USED MEDICATIONS Adults: 0.1 mg PO twice daily adjusted daily by 0.1–0.2-mg increments, max 2.4 mg/day. ADHD: Children: 0.05 mg/day PO, increase every 3–7 days by 0.05 mg/day to 3–5 mcg/kg/day divided 3–4 times daily, max 0.5 mg/day. Epidural: Children: 0.5 mcg/kg/h continuous infusion, increase up to 2 mcg/kg/h prn; Adults: 30–40 mcg/h. Transdermal: Children may switch to transdermal from an equivalent, stable PO dose; Adults: 0.1 mg/day patch every 7 days, titrate to response. Supplied: Tablets 0.1 mg, 0.2 mg, 0.3 mg; transdermal patch TTS-1, TTS-2, TTS-3 deliver 0.1, 0.2, 0.3 mg/day respectively; epidural injection 100 mcg/mL, 500 mcg/mL. Notes: Dry mouth, drowsiness, and sedation occur frequently. Adjust dose in patients with renal impairment. Rebound hypertension can occur with abrupt cessation. Hypotensive action may not begin until 2–3 days after transder- mal application. Apply patch at bedtime to hairless area (arm; chest). CLORAZEPATE (TRANXENE) [C] Indications: Acute anxiety disorders; adjunctive therapy for partial seizures. Actions: Benzodiazepine; antianxiety agent. Dosage: Initial dose 0.3 mg/kg/day PO 2–3 times daily up to 0.5–3 mg/kg/day. Supplied: Tablets 3.75 mg, 7.5 mg, 15 mg; extended-release tablets 11.25 mg, 22.5 mg. Notes: Monitor patients with renal or hepatic impairment. Has CNS depressant effects. CLOTRIMAZOLE (LOTRIMIN, MYCELEX)* Indications: Candidiasis and tinea infections; troches may be effective for pro- phylaxis against oropharyngeal candidiasis in immunosuppressed patients. Actions: Antifungal agent; alters cell wall permeability. Dosage: Oral: 1 troche dissolved slowly in mouth 5 times per day for 14 days. Vaginal: • Cream: 1 applicatorful at bedtime for 7–14 days. • Tablets: 100 mg vaginally at bedtime for 7 days; or 200 mg (2 tablets) vagi- nally at bedtime for 3 days; or 500-mg tablet vaginally at bedtime one time. Topical: Apply twice daily for 10–14 days. Supplied: Cream 1%; solution 1%; lotion 1%; troche 10 mg; vaginal tablets 100 mg, 500 mg; vaginal cream 1%. Notes: Dissolve troche in mouth over 15–30 minutes; troches should not be used for treatment of systemic fungal infections. COCAINE [C] Indications: Topical anesthetic for mucous membranes. Actions: Narcotic analgesic; local vasoconstrictor. Dosage: Apply lowest amount of topical solution that provides relief; max 1 mg/kg. Supplied: Topical solution 4%, 10%; powder 5 g, 125 g. Notes: Do not use on extensive areas of broken skin. Solutions > 4% are not recommended due to increased risk of systemic toxicities. CODEINE [C] Indications: Mild to moderate pain; symptomatic relief of cough. Actions: Narcotic analgesic; depresses cough reflex. Dosage: Analgesic: 0.5–1 mg/kg per dose PO, IM, SQ divided q4–6h prn, max 60 mg per dose. Antitussive: Children ≥ 2 years: 1–1.5 mg/kg/day PO divided q4–6 hours prn; max 30–60 mg/day. Supplied: Tablets 15 mg, 30 mg, 60 mg; solution 15 mg/5 mL; injection 15 mg/mL, 30 mg/mL. Notes: Most often used in combination with acetaminophen for pain or with agents such as guaifenesin as an antitussive; 120 mg IM is equivalent to 10 mg morphine IM. COLFOSCERIL (EXOSURF) Indications: Prevention and treatment of acute respiratory distress syn- drome in premature neonates. Actions: Surfactant replacement. 2. GENERIC DRUGS 631 632 VIII: COMMONLY USED MEDICATIONS Dosage: Prophylactic treatment: 5 mL/kg as soon after birth as possible, may give 1–2 more doses q12h to infants who remain on ventilators. Rescue treatment: 5 mL/kg as soon as diagnosis is made, may repeat in 12 hours for 1 more dose. Supplied: Powder for intratracheal suspension 108 mg. Notes: Suction infant prior to administration. Administer via sideport on special endotracheal tube adapter without interrupting mechanical venti- lation. Administer dose in two 2.5 mL/kg aliquots. Each aliquot should be given with infant in different position. CORTICOTROPIN (H.P. ACTHAR GEL) Indications: Infantile spasms. Actions: Stimulates adrenal cortex to secrete adrenal steroids, andro- genic substances, and small amount of aldosterone. Dosage: Infantile spasms: Various regimens have been used. Low dose/short term: 5–40 units IM daily for 1–6 weeks; or High dose/long term: 40–160 units IM daily for 3–12 months. Supplied: Injection, repository 80 units/mL. Notes: Do not give IV; do not abruptly discontinue. CROMOLYN SODIUM (INTAL, NASALCROM, OPTICROM) Indications: Adjunct to prophylaxis of asthma; prevention of exercise- induced asthma; allergic rhinitis; ophthalmic allergic manifestations; systemic treatment of inflammatory bowel disease. Actions: Antiasthmatic; mast cell stabilizer. Dosage: Nebulization: Children > 2 years and adults: 20 mg inhaled 4 times daily. Metered-dose inhaler (MDI): Children ≤ 12 years: 1–2 puffs 3–4 times daily; Children > 12 years and adults: 2–4 puffs 3–4 times daily. Inflammatory bowel disease: Children > 2 years: 100 mg PO 4 times daily, may double dose if needed up to 40 mg/kg/day; Children > 12 years and adults: 200 mg PO 4 times daily, may double dose if needed up to 400 mg 4 times daily. Nasal instillation: Children > 2 years and adults: Spray once in each nostril 2–6 times daily. Ophthalmic: Children > 4 years and adults: 1–2 drops in each eye 4–6 times daily. Prevention of allergen- or exercise-induced bronchospasm: Children > 2 years and adults: 20 mg nebulization or 2 puffs from MDI 10–15 min- utes prior exposure or exercise. Supplied: Oral concentrate 100 mg/5 mL; solution for nebulization 10 mg/mL; MDI 800 mcg/inhalation; nasal spray 40 mg/mL; ophthalmic solution 4%. Notes: Has no benefit in acute situations. May require 2–4 weeks for maximal effect in patients with perennial allergic disorders. CYANOCOBALAMIN (VITAMIN B 12 ) (SEE VITAMINS, P. 745) CYCLOPENTOLATE OPHTHALMIC (AK-PENTOLATE, CYCLOGYL) Indications: Mydriasis and cycloplegia. Actions: Prevents ocular muscles from responding to cholinergic stimulation. Dosage: Neonates and infants: 1 drop in eye q5–10min, up to 3 doses, 40–50 minutes before procedure of cyclopentolate 0.2% and phenyle- phrine 1% combination (recommended in this age group due to lower cyclopentolate concentration); Children: 1 drop of 0.5% or 1% solution in eye, may repeat if necessary in 5 minutes, approximately 40–50 minutes before procedure; Adults: 1 drop of 1% solution followed by another drop in 5 minutes, approximately 40–50 minutes before procedure. Supplied: Ophthalmic solution 0.5%, 1%, 2%. Notes: Pilocarpine ophthalmic drops applied after the exam may reduce recovery time to 3–6 hours. CYCLOPHOSPHAMIDE (CYTOXAN, NEOSAR) Indications: Hodgkin disease; malignant lymphomas; multiple myeloma; leukemias; sarcomas; mycosis fungoides; neuroblastoma; ovarian and breast cancer; conditioning regimen for bone marrow transplantation; nephrotic syndrome; lupus erythematosus; severe rheumatoid arthritis and vasculitis. Actions: Antineoplastic alkylating agent (nitrogen mustard). Dosage: Refer to individual protocols. Supplied: Tablets 25 mg, 50 mg; Powder for injection 100 mg, 200 mg, 500 mg, 1 g, 2 g. Notes: Toxicity includes myelosuppression (leukopenia and thrombocy- topenia), hemorrhagic cystitis, SIADH, alopecia, anorexia, nausea, and vomiting. Second malignancies (bladder cancer and leukemias) have 2. GENERIC DRUGS 633 634 VIII: COMMONLY USED MEDICATIONS been reported. Continuous bladder irrigation and mesna uroprotection are used in high-dose regimens to prevent hemorrhagic cystitis. Reduce dose if creatinine clearance ≤ 10 mL/min. CYCLOSPORINE (SANDIMMUNE, NEORAL) Indications: Prophylaxis of organ rejection in kidney, liver, heart, and bone marrow transplantation in conjunction with adrenal corticosteroids; treat- ment of nephrotic syndrome in patients with focal glomerulosclerosis; severe psoriasis; severe rheumatoid arthritis; severe autoimmune disease; prevention of graft-versus-host disease in bone marrow transplant patients. Actions: Immunosuppressant; reversible inhibition of immunocompetent lymphocytes. Dosage: Transplantation: Oral: 14–18 mg/kg per dose beginning 4–12 hours prior to transplantation followed postoperatively by 5–15 mg/kg/day divided q12–24h; after 2 weeks, taper dose to 3–10 mg/kg/day. Intravenous: If patient is unable to take drug orally, give 1 / 3 of oral dose IV. Rheumatoid arthritis and psoriasis: 2.5 mg/kg/day PO divided q12h, may increase by 0.5–0.75 mg/kg/day if insufficient response is seen after 4–8 weeks of treatment to max of 4 mg/kg/day. Focal glomerulosclerosis: 3 mg/kg/day PO divided q12h. Autoimmune diseases: 1–3 mg/kg/day PO divided q12h. Supplied: Capsules 25 mg, 100 mg; oral solution 100 mg/mL; injection 50 mg/mL. Notes: May elevate BUN and creatinine, which may be confused with renal transplant rejection. Should be administered in glass containers. Has many drug interactions. Neoral and Sandimmune are not inter- changeable. Therapeutic levels depend on organ transplanted and time after transplantation; range 100–400 ng/mL. CYPROHEPTADINE (PERIACTIN) Indications: Allergic reactions, including urticaria; appetite stimulant for anorexia nervosa. Actions: Phenothiazine antihistamine. Dosage: Allergic conditions: 0.25 mg/kg/day PO divided q8–12h; max 0.5 mg/kg/day. Appetite stimulation: Adolescents > 13 years: 2 mg PO 4 times daily, may increase gradually over 3 weeks up to 8 mg PO 4 times daily. Supplied: Tablet 4 mg; syrup 2 mg/5 mL. Notes: Anticholinergic side effects and drowsiness are common. CYTARABINE (CYTOSAR-U, ARA-C) Indications: Leukemias; Hodgkin lymphoma; non-Hodgkin lymphoma. Actions: Antineoplastic antimetabolite agent. Dosage: Refer to individual protocols. Supplied: Powder for injection 100 mg, 500 mg, 1 g, 2 g. Notes: Toxicity includes myelosuppression, nausea, vomiting, and diar- rhea, stomatitis, flulike syndrome, rash of palms and soles of feet, and hepatic dysfunction. High-dose toxicities include conjunctivitis, cerebellar dysfunction, and noncardiogenic pulmonary edema. CYTOMEGALOVIRUS IMMUNE GLOBULIN [CMV-IVIG] (CYTOGAM) Indications: Prophylaxis against cytomegalovirus (CMV) disease associ- ated with transplantation. Actions: Provides exogenous IgG antibodies to CMV. Dosage: Administer for 16 weeks post-transplantation; see product infor- mation for dosing schedule. Supplied: Injection 50 mg/mL. Daclizumab (Zenapax) Indications: Prevention of acute organ rejection. Actions: Interleukin-2 receptor antagonists. Dosage: 1 mg/kg IV per dose; first dose prior to transplantation followed by 4 doses 14 days apart post-transplantation. Supplied: Injection 5 mg/mL. Dactinomycin (Cosmegen) Indications: Wilms tumor; rhabdomyosarcoma; neuroblastoma; retinoblas- toma; Ewing sarcoma; testicular tumors; uterine sarcomas. Actions: Antineoplastic antibiotic. 2. GENERIC DRUGS 635 [...]... dysfunction FLUTICASONE NASAL (FLONASE) Indications: Seasonal allergic rhinitis Actions: Topical steroid Dosage: Children ≥ 4 years and adults: 1–2 sprays (50–100 mcg) in each nostril once daily Supplied: Nasal spray 50 mcg per actuation FLUTICASONE ORAL (FLOVENT, FLOVENT ROTADISK) Indications: Chronic treatment of asthma Actions: Topical steroid Dosage: Oral inhalation, divided twice daily: Children: Low... Notes: Reconstitute powder with water; do not mix powder with fruit juice or other acidic beverages Side effects include pancreatitis, peripheral neuropathy, diarrhea, and headache Give 2 tablets for each administration Adjust dose in patients with renal impairment DIGOXIN (LANOXIN, LANOXICAPS) Indications: Congestive heart failure; atrial fibrillation and flutter; paroxysmal atrial tachycardia Actions: Positive... VIII: COMMONLY USED MEDICATIONS Supplied: Tablets 0.1 mg, 0.2 mg; injection 4 mcg/mL; nasal solution 100 mcg/mL with rhinal tube; nasal spray 100 mcg/mL (10 mcg/spray), 1.5 mg/mL (150 mcg/spray) Notes: Adjust fluid intake to avoid water intoxication and hyponatremia DEXAMETHASONE (DECADRON) Indications: Chronic inflammation; airway edema prior to extubation; chemotherapy-induced emesis; bacterial meningitis;... injection [1:200]; aerosol for oral inhalation 0.2 mg per inhalation; solution for oral inhalation 2.25% Notes: Sus-Phrine offers sustained action Dilute intratracheal doses with 3–5 mL saline and follow with several positive pressure ventilations Tissue irritant EPOETIN ALFA [ERYTHROPOIETIN, EPO] (EPOGEN, PROCRIT) Indications: Treatment of anemia associated with chronic renal failure, anemia of prematurity,... patients; treatment of chronic neutropenia Actions: Recombinant granulocyte colony-stimulating factor Dosage: 5–10 mcg/kg/day SQ or IV as single daily dose Supplied: Injection 300 mcg/mL Notes: May cause bone pain Discontinue therapy when ANC > 10,000/mm3 FLUCONAZOLE (DIFLUCAN) Indications: Oropharyngeal and esophageal candidiasis; cryptococcal meningitis; Candida infections of lungs, peritoneum, and... DNA Dosage: Children > 5 years and adults: 2.5 mg inhaled once daily Supplied: Solution for inhalation 1 mg/mL Notes: To be used with recommended nebulizer DOXORUBICIN (ADRIAMYCIN) Indications: Ovarian, breast, and bladder tumors; various lymphomas and leukemias (ALL, AML); soft tissue sarcomas; neuroblastoma; osteosarcoma Actions: Antineoplastic anthracycline antibiotic Dosage: Refer to individual... meningitis; cerebral edema; facilitates ventilator weaning in neonates with bronchopulmonary dysplasia (BPD) Actions: Anti-inflammatory corticosteroid Dosage: Neonatal BPD: 0.5–0.6 mg/kg/day PO or IV q12h for 3–7 days, taper over 1–6 weeks Airway edema or extubation: 0.5–2 mg/kg/day PO or IV q6h, begin 24 hours prior to extubation and continue for 4–6 doses after extubation Antiemetic: Initial 10 mg/m2 per...636 VIII: COMMONLY USED MEDICATIONS Dosage: Refer to individual protocols Supplied: Injection 0.5 mg Notes: Toxicity includes myelosuppression, nausea, vomiting, alopecia, acneiform skin changes and hyperpigmentation, radiation recall phenomenon, phlebitis, and tissue damage with extravascular extravasation and hepatic dysfunction DANTROLENE (DANTRIUM) Indications: Clinical spasticity resulting... hemophilia A; type I von Willebrand disease; primary nocturnal enuresis Actions: Synthetic analogue of vasopressin, a naturally occurring human antidiuretic hormone; increases factor VIII Dosage: Diabetes insipidus: • Intranasal: 5 mcg/day in 1–2 divided doses, titrate to response (range 5–30 mcg/day) • Oral: Initial 0.05 mg PO twice daily, titrate to response (range 0.1–0.8 mg/day) • Parenteral: 2–4 mcg/day... holidays” are recommended for ADHD patients DEXTROAMPHETAMINE AND AMPHETAMINE (ADDERALL, ADDERALL XR) Indications: Attention-deficit/hyperactivity disorder; narcolepsy Actions: CNS stimulant; amphetamine Dosage: ADHD: Children 3–5 years: Initial dose 2.5 mg/day PO q AM, increase by 2.5 mg/day every 7 days until response obtained, max 40 mg/day given in 1–3 divided doses; Children ≥ 6 years: 5 mg once . staphylo- cocci, and gram-positive and gram-negative anaerobes (no activity against gram-negative aerobes); bacterial vaginosis; topical therapy for severe acne and vaginal infections. Actions:. myelosuppression, nausea, vomiting, alopecia, acneiform skin changes and hyperpigmentation, radiation recall phenom- enon, phlebitis, and tissue damage with extravascular extravasation and hepatic dysfunction. DANTROLENE. pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Mycoplasma pneumoniae, Chlamydia trachomatis, and Legionella spp; prevention and treatment of Mycobacterium avium–complex (MAC) infec- tions