BACITRACIN, TOPICAL (BACIGUENT); BACITRACIN & POLYMYXIN B, TOPICAL (POLYSPORIN); BACITRACIN, NEOMYCIN, & POLYMYXIN B, TOPICAL (NEOSPORIN); BACITRACIN, NEOMYCIN, POLYMYXIN B, & HYDROCORTISONE, TOPICAL (CORTISPORIN)
USES: Prevent/Treat of *minor skin infections.*
ACTIONS: Topical antibiotic w/ added components (anti-inflammatory & analgesic).
DOSE: Apply sparingly BID–QID.
W/P: [C, ?] Not for deep wounds, puncture, or animal bites.
DISP: Bacitracin 500 U/g oint; bacitracin 500 U/polymyxin B sulfate 10,000 U/g oint & powder; bacitracin 400 U/neomycin 3.5 mg/ polymyxin B 5,000 U/g oint; bacitracin 400 U/neomycin 3.5 mg/polymyxin B 5,000 U/hydrocortisone 10 mg/g oint; Bacitracin 500 U/neomycin 3.5 mg/polymyxin B 5,000 U/lidocaine 40 mg/g oint.
NOTES: Ophthal, systemic, & irrigation forms available, not generally used d/t potential tox.
BASILIXIMAB (SIMULECT)
WARNING: Use only under the supervision of a physician experienced in immunosuppression Treat in an appropriate facility.
USES: *Prevent acute transplant rejection.*
ACTIONS: IL-2 receptor antagonists.
DOSE:
Adults & Peds: >35 kg: 20 mg IV 2 hr before transplant, then 20 mg IV 4 days posttransplant.
Peds: <35 kg: 10 mg 2 hr prior to transplant; same dose IV 4 days posttransplant.
W/P: [B, ?/−].
CI: hypersensitivity to murine proteins.
DISP: Inj powder 10, 20 mg.
SE: Edema, ↓ BP, HTN, headache, dizziness, fever, pain, infection, GI effects, electrolyte disturbances.
NOTES: A murine/human MoAb.
BCG [BACILLUS CALMETTE-GUéRIN] (THERACYS, TICE BCG)
WARNING: Contains live, attenuated mycobacteria; transmission risk; handle as biohazard; nosocomial & disseminated infections reported in immunosuppressed.
USES: *Intravesical treatment and prophylaxis of bladder CIS and for the prophylaxis of primary or recurrent stage Ta and/or T1 papillary tumors following TUR; not recommended for Ta low-grade papillary tumors, unless they are judged to be at high risk of recurrence.*
ACTIONS: Attenuated live BCG culture, immunomodulator.
DOSE: Bladder cancer (FDA label), 1 vial prepared & instilled in bladder for 2 hr. Repeat once/wk × 6 wk; then 1 maintenance Tx at 3, 6, 12, 18, & 24 mo after.
W/P: [C, ?] Asthma w/ TB immunization.
CI: Immunosuppression, pregnancy, steroid use, febrile illness, symptomatic UTI, gross hematuria, w/ traumatic catheterization.
DISP: Powder 81 mg (TheraCys), 50 mg (Tice BCG) (both reconstituted to 50 mL volume).
SE: Intravesical: Hematuria, urinary frequency, dysuria, bacterial UTI, rare BCG sepsis malaise, fever, chills, pain, N/V, anorexia, anemia.
NOTES: Do not administer less than 2 wk after resection; do not administer intravesical forms SQ or IM; optimal number of induction instillations and optimal frequency and duration of maintenance instillations remain unknown; SWOG regimen BCG weekly ×6 then 3 weekly doses at 3/6/12/18/24/30 mo; with intravesical use, dispose/void in toilet w/ chlorine bleach; reduced dose administration (1/3, 1/10, 1/100th) used to manage side effects but not widely practiced.
BELATACEPT (NULOJIX)
WARNING: May ↑ risk of posttransplant lymphoproliferative disorder (PTLD) mostly CNS; ↑ risk of infection; for use by physicians experienced in immunosuppressive therapy; ↑ risk of malignancies; not for liver transplant.
USES: *Prevent rejection in EBV positive kidney transplant recipients.*
ACTIONS: T-cell costimulation blocker.
DOSE: Day 1 (transplant day, preop) & day 5 10 mg/kg; end of wk 2, wk 4, wk 8, wk 12 after transplant 10 mg/kg; Maint: End of wk 16 after transplant 4 wk 5 mg/kg.
W/P: [C, −] w/ CYP3A4 inhibitor/inducers, other anticoagulants or plt inhibitor.
CI: EBV seronegative or unknown EBV status.
DISP: 250 mg Inj.
SE: Anemia, N/V/diarrhea, UTI, edema, constipation, ↑ BP, pyrexia, graft dysfunction, cough, headache, ↑/↓ K+, ↓ WBC.
NOTES: REMS; use in combo w/ basiliximab, mycophenolate mofetil (MMF), & steroids; PML w/ excess belatacept dosing.
BELLADONNA & OPIUM SUPPOSITORIES (GENERIC) [C-II]
USES: *Mod–severe pain associated w/ bladder spasms.*
ACTIONS: Antispasmodic, analgesic.
DOSE:
Adult: 1 supp PR 1–2/d (up to 4 doses/d).
Peds: 10–15 kg: 1/4–1/2 suppository PRN.
W/P: [C, ?].
CI: Glaucoma, resp depression, severe renal or hepatic disease, convulsive disorder, acute alcoholism.
DISP: 30 mg opium/16.2 mg belladonna extract; 60 mg opium/16.2 mg belladonna extract.
SE: Anticholinergic (eg, sedation, urinary retention, constipation).
BENAZEPRIL (LOTENSIN)
WARNING: When used in pregnancy during the 2nd and 3rd trimesters, ACE inhibitors can cause injury and even death to the developing fetus.
USES: *HTN.*
ACTIONS: ACE inhibitor.
DOSE: 10–80 mg/d PO.
W/P: [D, −].
CI: Angioedema.
DISP: Tabs 5, 10, 20, 40 mg.
SE: Symptomatic ↓ BP w/ diuretics; dizziness, headache, ↑ K+, nonproductive cough, ↑ SCr.
BENZOCAINE (AMERICAINE, HURRICANE, LANACANE, VARIOUS [OTC])
USES: *Topical anesthetic, lubricant on ET tubes, catheters, etc.; pain relief in external otitis, cerumen removal, skin conditions, sunburn, insect bites, mouth and gum irritation, hemorrhoids.*
ACTIONS: Topical local anesthetic.
DOSE:
Adults & Peds: >1 yr. Anesthetic lubricant: Apply evenly to tube/instrument; other uses per manufacturer instructions.
W/P: [C, −] Do not use on broken skin; see provider if condition does not respond; avoid in infants and those w/ pulmonary diseases.
DISP: Many site-specific OTC forms: creams, gels, liquids, sprays, 2–20%.
SE: Itching, irritation, burning, edema, erythema, pruritus, rash, stinging, tenderness, urticaria; methemoglobinemia (infants or in COPD).
NOTES: Use minimum amount to obtain effect; methemoglobinemia S/Sxs: headache, lightheadedness, SOB, anxiety, fatigue, pale, gray or blue colored skin, and tachycardia.
BETHANECHOL (URECHOLINE, GENERIC)
USES: *Acute postoperative and postpartum nonobstructive (functional) urinary retention and for neurogenic atony of the urinary bladder with retention.*
ACTIONS: Stimulates cholinergic smooth muscle in bladder & GI tract.
DOSE:
Adults: Initial 5–10 mg PO, then repeat qh until response or 50 mg, typical 10–50 mg TID–QID, 200 mg/d max. TID–QID; 2.5–5 mg SQ TID–QID & PRN.
Peds: (Not FDA approved) 0.3–0.6 mg/kg/24 h PO ÷ TID–QID; take on empty stomach.
W/P: [C, −].
CI: Bladder outlet obstruction, PUD, epilepsy, hyperthyroidism, ↓ HR, COPD, AV conduction defects, Parkinsonism, ↓ BP, vasomotor instability.
DISP: Tabs 5, 10, 25, 50 mg.
SE: Abdominal cramps, diarrhea, salivation, ↓ BP.
NOTES: For overdose: SQ atropine 0.6 mg (adult), children 0.01 mg/kg (max. 0.4 mg).
BEVACIZUMAB (AVASTIN)
WARNING: Associated w/ GI perforation, wound dehiscence, & fatal hemoptysis.
USES: *Met colorectal cancer w/5-FU, NSCLC w/ paclitaxel and carboplatin; glioblastoma; metastatic RCC w/ IFN-α.*
ACTIONS: Vascular endothelial GF inhibitor.
DOSE:
Adults: RCC: 10 mg/kg IV q2wk w/ IFN-α.
W/P: [C, −] Do not use w/in 28 days of surgery if time for separation of drug & anticipated surgical procedures is unknown; D/C w/ serious adverse effects.
CI: None.
DISP: 100 mg/4 mL, 400 mg/16 mL vials.
SE: Wound dehiscence, GI perforation, tracheoesophageal fistula, arterial thrombosis, hemoptysis, hemorrhage, HTN, proteinuria, CHF, Inf reactions, diarrhea, leukopenia.
NOTES: Monitor for ↑ BP & proteinuria.
BICALUTAMIDE (CASODEX, GENERIC)
USES: *Stage D2 metastatic prostate cancer with GnRH agonists (eg, leuprolide, goserelin).*
ACTIONS: Nonsteroidal antiandrogen/androgen receptor inhibitor.
DOSE: 50 mg/d.
W/P: [X, ?].
CI: Women.
DISP: Caps 50 mg.
SE: Hot flashes, ↓ loss of libido, impotence, edema, pain, diarrhea/N/V, gynecomastia, ↑ LFTs.
NOTES: 150 mg daily is not FDA approved for use alone or with other treatments.
BISACODYL (DULCOLAX) [OTC]
USES: *Constipation; preop bowel prep.*
ACTIONS: Stimulates peristalsis.
DOSE:
Adults: 5–15 mg PO or 10 mg PR PRN.
Peds: <2 yr: 5 mg PR PRN. >2 yr: 5 mg PO or 10 mg PR PRN (do not chew tabs or give w/in 1 hr of antacids or milk).
W/P: [C, ?].
CI: Abdominal pain or obstruction; N/V.
DISP: EC tabs 5, 10 mg supp 10 mg, enema soln 10 mg/30 mL.
SE: Abdominal cramps, proctitis, & inflammation w/ supps.
BLEOMYCIN SULFATE (GENERIC)
WARNING: Idiopathic reaction (↓ BP, fever, chills, wheezing) in lymphoma pts; pulm fibrosis; should be administered by chemo- experienced physician.
USES: *Testis cancer; Hodgkin disease & NHLs; cutaneous lymphomas; & squamous cell cancer (head & neck, larynx, cervix, skin, penis); malignant pleural effusion sclerosing agent.*
ACTIONS: Induces DNA breakage (scission).
DOSE: (Per protocols) Typical dosing: squamous cell carcinoma, non-Hodgkin’s lymphoma, testicular carcinoma: 0.25–0.50 U/kg (10–20 U/m2) IM/IV/SC weekly or twice weekly; ↓ w/ renal impairment.
W/P: [D, ?].
CI: W/ hypersensitivity, idiosyncratic reaction.
DISP: Powder (Inj) 15, 30 U.
SE: Hyperpigmentation & allergy (rash to anaphylaxis); fever in 50%; lung tox (idiosyncratic & dose related); pneumonitis w/ fibrosis; Raynaud phenomenon, N/V.
NOTES: Test dose 1 U, especially in lymphoma pts; lung tox w/ total dose >400 U or single dose >30 U; avoid high FiO2 in general anesthesia to ↓ tox.
BOTULINUM TOXIN TYPE A [ONABOTULINUMTOXINA] (BOTOX, BOTOX COSMETIC)
WARNING: Effects may spread beyond Tx area leading to swallowing/breathing difficulties (may be fatal); Sxs may occur hours to weeks after injection.
USES: *Overactive bladder with symptoms of urge urinary incontinence, urgency, and frequency, in adults w/ inadequate response or intolerant of an anticholinergic medication; urinary incontinence due to detrusor overactivity associated with a neurologic condition (eg, SCI, MS) in adults who have an inadequate response to or are intolerant of an anticholinergic medication. Glabellar lines (cosmetic) <65 yr, blepharospasm, cervical dystonia, axillary hyperhidrosis, strabismus, chronic migraine, upper limb spasticity. *
ACTIONS: Neurotoxin, ↓ ACH release from nerve endings; denervates sweat glands/muscles.
DOSE:
Adults: Bladder: 100 U of Botox (max. recommended dose). Dilution is 100 U/10 mL. Needle inserted ∼2 mm into the detrusor, and 20 injections of 0.5 mL each (total volume of 10 mL) should be spaced ∼1 cm apart; avoid the trigone. Reinjection: When the clinical effect of the previous injection has diminished (median time in clinical studies was 169 days [∼24 wk]), but no sooner than 12 wk from the prior bladder injection.
W/P: [C, ?] w/ neurologic disease; do not exceed rec doses; sedentary pt to resume activity slowly after Inj; aminoglycosides and nondepolarizing muscle blockers may ↑↑ effects; local or total anesthesia.
CI: Hypersensitivity to components, infection at Inj site.
DISP: Inj powder, single-use vial (dilute w/ NS); (Botox cosmetic) 50, 100 U; (Botox) 100, 200 U vials; store 2–8°C.
SE: Anaphylaxis, erythema multiforme, dysphagia, dyspnea, syncope, headache, narrow-angle glaucoma, Inj site pain.
NOTES: Prophylactic antibiotics, except aminoglycosides, should be administered 1–3 days pretreatment, on the treatment day, and 1–3 days posttreatment; do not exceed total dose of 360 U q12–16wk; Botulinum toxin products not interchangeable; other botulinum toxins are not FDA approved for bladder use: abobotulinumtoxinA (Dysport), incobotulinumtoxinA (Xeomin) [rimabotulinumtoxinB] (Myobloc).
BROMOCRIPTINE (PARLODEL)
USES: *Parkinson disease, hyperprolactinemia, acromegaly, pituitary tumors.*
ACTIONS: Agonist to striatal dopamine receptors; ↓ prolactin secretion.
DOSE: Initial, 1.25 mg PO BID; titrate to effect, w/ food.
W/P: [B, −].
CI: Uncontrolled HTN, pregnancy, severe CAD or CVS disease.
DISP: Tabs 2.5 mg; caps 5 mg.
SE: ↓ BP, Raynaud phenomenon, dizziness, N, GI upset, hallucinations.
BUMETANIDE (BUMEX)
WARNING: Potent diuretic, may result in profound fluid & electrolyte loss.
USES: *Edema from CHF, hepatic cirrhosis, & renal disease.*
ACTIONS: Loop diuretic; ↓ reabsorption of Na+ & Cl−, in ascending loop of Henle & the distal tubule.
DOSE:
Adults: 0.5–2 mg/d PO; 0.5–1 mg IV/IM q8–24h (max. 10 mg/d).
Peds: 0.015–0.1 mg/kg PO q6–24h (max. 10 mg/d).
W/P: [C, ?/−].
CI: Anuria, hepatic coma, severe electrolyte depletion.
DISP: Tabs 0.5, 1, 2 mg; Inj 0.25 mg/mL.
SE: ↓ K+, ↓ Na+, ↑ Cr, ↑ uric acid, dizziness, ototox.
NOTES: Monitor fluid & lytes.
BUPIVACAINE (MARCAINE, SENSORCAINE, GENERIC)
WARNING: Avoid 0.75% for OB anesthesia d/t reports of cardiac arrest and death.
USES: *Local or regional anesthesia or analgesia for surgery, dental and oral surgery procedures, diagnostic and therapeutic procedures, and for obstetrical procedures.*
ACTIONS: Local anesthetic onset 7–30 min; duration 5–7 hr; max.
DOSE:
Adults: 0.25% for infiltration anesthesia; max. dose 3 mg/kg.
Peds: 0.5 ml/kg of 0.25% .
W/P: [C, −] Severe bleeding, ↓ BP, shock & arrhythmias, local infections at site, septicemia.
CI: Obstetrical paracervical block anesthesia.
DISP: Inj 0.25%, 0.5%, 0.75%; with epinephrine 0.25%, 0.5%.
SE: ↓ BP, ↓ HR, dizziness, anxiety.
BUPIVACAINE, LIPOSOME (EXPAREL)
WARNING: Avoid 0.75% for OB anesthesia d/t reports of cardiac arrest and death.
USES: *Single-dose infiltration into the surgical site for postsurgical analgesia.
ACTIONS: Long lasting amide local anesthetic.
DOSE:
Adults & Peds: 0.25% for infiltration anesthesia; max. dose 3 mg/kg (eg, hemorrhoidectomy dose: 266 mg volume: 20 mL.
W/P: [C, −] Monitor of cardiovascular/neurologic status/vital signs; caution with hepatic disease; do not use other bupivacaine forms within 96 hr.
CI: Obstetrical paracervical block anesthesia.
DISP: 20 mL single-use vial, 1.3% (13.3 mg/mL) stored in refrigerator.
SE: N, vomiting, constipation.
NOTES: Do not mix with lidocaine; administer lidocaine and liposomal bupivacaine 20 min apart.
BUPRENORPHINE (BUPRENEX) [C-III]
USES: *Mod–severe pain.*
ACTIONS: Opiate agonist–antagonist.
DOSE: 0.3–0.6 mg IM or slow IV push q6h PRN.
W/P: [C, −].
DISP: 0.3 mg/mL.
SE: Sedation, ↓ BP, resp depression.
NOTES: Withdrawal potential if opioid dependent.
BUTABARBITAL, HYOSCYAMINE HYDROBROMIDE, PHENAZOPYRIDINE (PYRIDIUM PLUS)
USES: *Relieve urinary tract pain w/ UTI, procedures, trauma.*
ACTIONS: Phenazopyridine (topical anesthetic), hyoscyamine (parasympatholytic, ↓ spasm), butabarbital (sedative).
DOSE: 1 PO QID, pc & hs; w/ antibiotic for UTI, 2 days max.
W/P: [C, ?].
DISP: Tab butabarbital/hyoscyamine/phenazopyridine, 15 mg/0.3 mg/150 mg.
SE: headache, rash, itching, GI distress, methemoglobinemia, hemolytic anemia, anaphylactoid-like reactions, dry mouth, dizziness, drowsiness, blurred vision.
NOTES: Colors urine orange, may tint skin, sclera; stains clothing/contacts; see also Phenazopyridine.
BUTORPHANOL (STADOL) [C-IV]
USES: *Anesthesia adjunct, pain & migraine headache.*
ACTIONS: Opiate agonist–antagonist w/ central analgesic actions.
DOSE: 0.5–4 mg IM or IV q3–4h PRN.; ↓ in renal impairment.
W/P: [C, +].
DISP: Inj 1, 2 mg/mL; nasal 1 mg/spray (10 mg/mL).
SE: Drowsiness, dizziness, nasal congestion.
NOTES: May induce withdrawal in opioid dependency.