NAFCILLIN (GENERIC)
USES: *Infections d/t susceptible strains of Staphylococcus & Streptococcus.*
ACTIONS: Bactericidal; antistaphylococcal PCN; ↓ cell wall synth. Spectrum: Good gram(+) except MRSA & enterococcus, no gram(−), poor anaerobe.
DOSE:
Adults: 1–2 g IV q4–6h.
Peds: 50–200 mg/kg/d ÷ q4–6h.
W/P: [B, ?].
CI: PCN allergy, allergy to corn-related products.
DISP: Inj powder l, 2 g.
SE: Interstitial nephritis, N/diarrhea, fever, rash, allergic reaction.
NOTES: In setting of both hepatic & renal impairment, modification of dose may be necessary.
NALOXONE (GENERIC, EVZIO)
USES: *Opioid addiction (diagnosis) & OD.*
ACTIONS: Competitive opioid antagonist.
DOSE:
Adults: 0.4–2 mg IV, IM, or SQ q2–3 min; via endotracheal tube, dilute in 1–2 mL NS; may be given intranasal; total dose 10 mg max.; Evzio: 0.4 mg IM or sub-Q.
Peds: 0.01–0.1 mg/kg/dose IV, IM, or SQ; repeat IV q3min × 3 doses PRN; Reverse narcotic effects: 0.1 mg/kg q2min PRN; max. dose 2 mg; smaller doses (1–5 μg/kg may be used); cont Inf 2–160 μg/kg/h.
W/P: [C, ?], Evzio [B, ?/-], may precipitate withdrawal in addicts.
CI: Component hypersensitivity.
DISP: Inj 0.4, 1 mg/mL; Evzio 0.4 mg/0.4mL prefilled auto-injector, w/ electronic voice instructions.
SE: ↓ BP, ↑ BP, fever, tachycardia, VT, VF, irritability, agitation, coma, GI upset, pulm edema, tremor, piloerection, sweating.
NOTES: If no response after 10 mg, suspect nonnarcotic cause; w/ Evzio use in the field, seek emergent care immediately; duration of action less than most opioids, may need repeat dosing; for by-stander use, administer in anterolateral thigh.
NAPROXEN (ALEVE [OTC], ANAPROX, ANAPROX DS, EC-NAPROSYN, NAPRELAN, NAPROSYN, GENERIC)
WARNING: May ↑ risk of CV events & GI bleeding.
USES: *Arthritis & pain.*
ACTIONS: NSAID; ↓ prostaglandins.
DOSE:
Adults & Peds: >12 yr: 200–500 mg BID–TID to 1,500 mg/d max. >2 yr: JRA 5 mg/kg/dose BID; ↓ in hepatic impairment.
W/P: [C, (D 3rd tri), −].
CI: NSAID or ASA triad sensitivity, peptic ulcer, post-CABG pain, 3rd-tri pregnancy.
DISP: Tabs: 250, 375, 500 mg; DR: 375, 500, 750 mg; CR: 375, 550 mg; susp 25 mg/5 mL (Aleve) 200 mg multiple OTC forms.
SE: Dizziness, pruritus, GI upset, peptic ulcer, edema.
NOTES: Take w/ food to ↓ GI upset; 220 mg naproxen sodium = 200 mg naproxen base.
NEOMYCIN (NEO-FRADIN, GENERIC)
WARNING: Systemic absorption of oral route may cause neuro/oto/nephrotoxic; resp paralysis possible w/ any route of administration.
USES: *Hepatic coma, bowel prep.*
ACTIONS: Aminoglycoside, poorly absorbed PO; ↓ GI bacterial flora
DOSE:
Adults: 3–12 g/24 h PO in 3–4 ÷ doses; 12 g/d max.
Peds: 50–100 mg/kg/24 h PO in 3–4 ÷ doses.
W/P: [C, ?/−] Renal failure, neuromuscular disorders, hearing impairment.
CI: Intestinal obst.
DISP: Tabs 500 mg; Neo-Fradin PO soln 125 mg/5 mL.
SE: Hearing loss w/ long-term use; rash, N/V.
NOTES: Do not use parenterally (↑ tox); also topical forms.
NEOMYCIN-POLYMYXIN BLADDER IRRIGANT [NEOSPORIN GU IRRIGANT]
USES: *Short-term use (up to 10 days) as a continuous irrigant in the urinary bladder of abacteriuric patients to help prevent bacteriuria and gram-negative rod septicemia associated with the use of indwelling catheters.*
ACTIONS: Bactericidal; not for Serratia sp or streptococci.
DOSE: 1 mL irrigant in 1 L of 0.9% NaCl; cont bladder irrigation w/ 1 L of soln/24 h 10 days max.
W/P: [D].
CI: Component allergy; aminoglycoside allergy.
DISP: Soln neomycin sulfate 40 mg & polymyxin B 200,000 U/mL; amp 1, 20 mL.
SE: Rash, neomycin oto/nephrotoxic (rare).
NOTES: Potential for bacterial/fungal super-infection; not for Inj; use only 3-way catheter for irrigation.
NIFEDIPINE (ADALAT CC, AFEDITAB CR, PROCARDIA, PROCARDIA XL, GENERIC)
USES: *HTN*; tocolytic.
ACTIONS: Calcium channel blocker.
DOSE:
Adults: SR tabs 30–90 mg/d.
Peds: 0.25–0.5 mg/kg/24 h ÷ 3–4×/d.
W/P: [C, +] Heart block, aortic stenosis, cirrhosis.
CI: Component hypersensitivity.
DISP: Caps 10, 20 mg; SR/XL tabs 30, 60, 90 mg.
SE: Headache common on initial Treat; reflex tachycardia may occur w/ regular-release dosage forms; peripheral edema, ↓ BP, flushing, dizziness.
NOTES: Adalat CC & Procardia XL not interchangeable; used for medical expulsive therapy for ureterolithiasis; considered to be inferior to α-1 blockers such as tamsulosin.
NILUTAMIDE (NILANDRON)
WARNING: Interstitial pneumonitis possible; most cases in 1st 3 mo; check CXR before and during Treat.
USES: *Combo w/ surgical castration for metastatic PCa.*
ACTIONS: Nonsteroidal antiandrogen.
DOSE: 300 mg/d PO × 30 days, then 150 mg/d.
W/P: [Not used in females].
CI: Severe hepatic impairment, resp insufficiency.
DISP: Tabs 150 mg.
SE: Interstitial pneumonitis, hot flashes, ↓ libido, impotence, N/V/diarrhea, gynecomastia, hepatic dysfunction.
NOTES: May cause reaction when taken w/ EtOH, follow LFTs/CXR.
NITROFURANTOIN (FURADANTIN, MACROBID, MACRODANTIN, GENERIC)
USES: *Prophylaxis & Treat UTI.*
ACTIONS: Interferes w/ metabolism & cell wall synthesis. Spectrum: Some gram(+) & (−) bacteria; Pseudomonas, Serratia, & most Proteus resistant.
DOSE:
Adults: Prophylaxis: 50–100 mg/d PO. Treat: 50–100 mg PO QID × 7 days; Macrobid 100 mg PO BID × 7 days.
Peds: Prophylaxis: 1–2 mg/kg/d ÷ in 1–2 doses, max. 100 mg/d. Treat: 5–7 mg/kg/24 h in 4 ÷ doses (w/ food/milk/antacid).
W/P: [B, +/not OK if child < 1 mo] Avoid w/ CrCl <60 mL/min.
CI: Anuria, oliguria, or significant impairment of renal function (CrCl <60 mL/min), infants <1 mo, pregnancy at term; history of cholestatic jaundice/hepatic dysfunction associated with nitrofurantoin.
DISP: Caps 25, 50, 100 mg; (Furadantin) susp 25 mg/5 mL.
SE: GI effects, dyspnea, various acute/chronic pulm reactions, peripheral neuropathy, hemolytic anemia w/ G6PD deficiency, rare aplastic anemia.
NOTES: Macrocrystals (eg, Macrodantin)<="" p="">
NORFLOXACIN (NOROXIN)
WARNING: ↑ Risk Achilles tendon rupture and tendonitis, ↑ in pts >60 yr, on steroids or with organ transplant; avoid w/ myasthenia gravis, may ↑ muscle weakness.
USES: *Comp & uncomp UTI, prostatitis due to E. Coli, gonorrhea*, infectious diarrhea, conjunctivitis.
ACTIONS: Quinolone, ↓ DNA gyrase, bactericidal. Spectrum: Broad gram(+) and (–) E. faecalis, E. coli, K. pneumoniae, P. mirabilis, P. aeruginosa, S. epidermidis, S. saprophyticus.
DOSE: Uncomp UTI (E. coli, K. pneumoniae, P. mirabilis): 400 mg PO BID × 3 days; other uncomp UTI Treat × 7–10 days. Comp UTI: 400 mg PO q12h for 10–21 days. Gonorrhea: 800 mg × 1 dose. Prostatitis: 400 mg PO BID × 28 days. Gastroenteritis, traveler’s diarrhea: 400 mg PO BID × 1–3 days; take 1 hr ac or 2 hr pc.
Adults & Peds: >1 yr: Ophthal: 1 gtt each eye QID for 7 days; CrCl < 0 mL/min use 400 mg qd.
W/P: [C, −] Quinolone sensitivity, w/ some antiarrhythmics ↑ QT.
CI: Hx allergy or tendon problems due to quinolones.
DISP: Tabs 400 mg; ophthal 3 mg/mL.
SE: Photosensitivity, headache, dizziness, asthenia, GI upset, pseudomembranous colitis; ocular burning w/ ophthal, peripheral neuropathy risk w/ PO only.
NOTES: Interactions w/ antacids, theophylline, caffeine; good conc in the kidney & urine, poor blood levels; not for urosepsis; CDC suggests do not use for GC.
NYSTATIN (GENERIC)
USES: *Mucocutaneous Candida infections (oral, skin, vaginal).*
ACTIONS: Alters membrane permeability. Spectrum: Susceptible Candida sp.
DOSE:
Adults & Peds: PO: 400,000–600,000 U PO “swish & swallow” QID. Vag: 1 tab Vag hs × 2 wk. Topical: Apply BID–TID to area.
Peds Infants: 200,000 U PO q6h.
W/P: [B (C PO), +].
DISP: PO susp 100,000 U/ mL; PO tabs 500,000 U; troches 200,000 U; Vag tabs 100,000 U; topical cream/oint 100,000 U/g, powder 100,000 U/g.
SE: GI upset, SJS.
NOTES: Not absorbed through mucus membranes/intact skin, poorly absorbed through GI; not for systemic infections; see also triamcinolone/nystatin.