OFLOXACIN (FLOXIN)
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: *Lower resp tract, skin, & skin structure, & UTI, prostatitis, uncomp gonorrhea, & Chlamydia infections.*
ACTIONS: Bactericidal; ↓ DNA gyrase. Broad-spectrum gram(+) & (–): S. pneumoniae, S. aureus, S. pyogenes, H. influenzae, P. mirabilis, N. gonorrhoeae, C. trachomatis, E. coli.
DOSE:
Adults: 200–400 mg PO BID or IV q12h. ↓ in renal impairment, take on empty stomach.
W/P: [C, −] ↓ Absorption w/ antacids, sucralfate, Al2+, Ca2+, Mg2+, Fe2+, Zn+ -containing drugs, Hx seizures.
CI: Quinolone allergy.
DISP: Tabs 200, 300, 400 mg; Inj 20, 40 mg/mL; ophthal & otic 0.3%.
SE: N/V/diarrhea, photosensitivity, insomnia, headache, local irritation, ↑ QTc interval, peripheral neuropathy risk.
NOTES: Floxin brand D/C.
ONDANSETRON (ZOFRAN, ZOFRAN ODT, GENERIC)
USES: *Prevent chemotherapy-associated & postop N/V.*
ACTIONS: Serotonin receptor (5-HT3) antagonist.
DOSE:
Adults & Peds: Chemotherapy: 0.15 mg/kg/dose IV prior to chemotherapy, then 4 & 8 hr after 1st dose or 4–8 mg PO TID; 1st dose 30 min prior to chemotherapy & give on schedule, not PRN.
Adults: Postoperation: 4 mg IV immediately preanesthesia or postoperation.
Peds: Postoperation: <40 kg: 0.1 mg/kg. >40 kg: 4 mg IV; ↓ w/ hepatic impairment.
W/P: [B, +/−] Arrhythmia risk, may ↑ QT interval.
DISP: Tabs 4, 8, 24 mg, soln 4 mg/5 mL, Inj 2 mg/mL; Zofran ODT tabs 4, 8 mg.
SE: Diarrhea, headache, constipation, dizziness.
NOTES: ODT contains phenylalanine. No single IV dose > 6 mg.
ONDANSETRON, ORAL SOLUBLE FILM (ZUPLENZ)
USES: *Prevent chemotherapy/RT-associated & postop N/V.*
ACTIONS: Serotonin receptor (5-HT3) antagonist.
DOSE:
Adults: Highly emetogenic chemo: 24 mg (8 mg film × 3) 30 min prechemo; RT N& V: 8 mg film TID.
Adults & Peds: >12 yr. Mod emetogenic chemo: 8 mg film 30 min prechemo, then 8 mg in 8 hr; 8 mg film BID × 1–2 days after chemo.
Adults: Postop: 16 mg (8 mg film × 2) 1 hr preop; ↓ w/ hepatic impairment.
W/P: [B, +/−].
CI: w/ Apomorphine.
DISP: Oral soluble film 4, 8 mg.
SE: Headache, malaise/ fatigue, constipation, diarrhea.
NOTES: Use w/ dry hands, do not chew/swallow; place on tongue, dissolves in 4–20 s; peppermint flavored.
OSPEMIFENE (OSPHENA)
WARNING: ↑ Risk endometrial Ca; ↑ risk of CVA, DVT/PE.
USES: *Treatment of moderate–severe dyspareunia.*
ACTIONS: Estrogen agonist/antagonist.
DOSE:
Adults: 1 tab daily.
W/P: [X, −] Do not use w/ estrogens and estrogen agonists/antagonists, fluconazole & rifampin ↓ effect, ketoconazole ↑ effect, ↑ side effects w/ drugs that inhibit CYP3A4 and CYP2C9; highly protein bound, may be displaced by other highly bound drugs.
CI: Undiagnosed abnormal genital bleeding; known/suspected estrogen-sensitive cancer; pregnancy.
DISP: Tab 60 mg.
SE: DVT/PE, hemorrhagic or thrombotic stroke, arterial thromboembolic dz, hot flashes; vaginal discharge; hyperhidrosis; muscle cramps; metabolized by CYP3A4, CYP2C9, and CYP2C19.
NOTES: Do not use w/ severe liver disease.
OXACILLIN (GENERIC)
USES: *infections d/t susceptible S. aureus, Streptococcus & other organisms.*
ACTIONS: Bactericidal; ↓ cell wall synth. Spectrum: Excellent gram(+), poor gram(−).
DOSE:
Adults: 250–500 mg (2 g severe) IM/ IV q4–6h.
Peds: 150–200 mg/kg/d IV ÷ q4–6h.
W/P: [B, M].
CI: PCN sensitivity.
DISP: Powder for Inj 500 mg, 1, 2, 10 g.
SE: GI upset, interstitial nephritis, blood dyscrasias, may ↓ OCP effectiveness.
OXYBUTYNIN (DITROPAN, DITROPAN XL, GENERIC)
USES: Relief of symptoms of bladder instability associated with voiding in patients with uninhibited neurogenic or reflex neurogenic bladder (ie, urgency, frequency, urinary leakage, urge incontinence, dysuria). Ditropan XL: Overactive bladder with symptoms of urge urinary incontinence, urgency, and frequency; pediatric patients >6 yr with symptoms of detrusor overactivity associated w/ a neurologic condition (eg, spina bifida).
ACTIONS: Anticholinergic, relaxes bladder smooth muscle, ↑ bladder capacity.
DOSE:
Adults: 5 mg BID–TID, 5 mg 4×/d max. XL 5–10 mg/d, 30 mg/d max.
Peds: >5 yr: 5 mg PO BID–TID; 15 mg/d max.
Peds: 1–5 yr: 0.2 mg/kg/dose 2–4×/d (syrup 5 mg/5 mL); 15 mg/d max.; ↓ in elderly; periodic drug holidays OK.
W/P: [B, ?].
CI: Narrow-angle glaucoma, myasthenia gravis, GI/GU obst, ulcerative colitis, megacolon.
DISP: Tabs 5 mg; XL tabs 5, 10, 15 mg; syrup 5 mg/5 mL.
SE: Anticholinergic (drowsiness, xerostomia, constipation, tachycardia), ↑ QT interval, memory impairment; ER form empty shell expelled in stool.
NOTES: See topical forms of oxybutynin.
OXYBUTYNIN, TOPICAL (GELNIQUE)
USES: *Overactive bladder with symptoms of urge urinary incontinence, urgency, and frequency.*
ACTIONS: Anticholinergic, relaxes bladder smooth muscle, ↑ bladder capacity.
DOSE: 1 g sachet qd to dry skin (abdominal/shoulders/thighs/upper arms).
W/P: [B, ?/−].
CI: Gastric or urinary retention; narrow-angle glaucoma.
DISP: Gel 10%, 1-g sachets (100 mg oxybutynin).
SE: Anticholinergic (lethargy, xerostomia, constipation, blurred vision, ↑ HR); rash, pruritus, redness, pain at site; UTI.
NOTES: Cover w/ clothing, skin-to-skin transfer can occur; gel is flammable; after applying wait 1 hr before showering.
OXYBUTYNIN TRANSDERMAL SYSTEM (OXYTROL, OXYTROL FOR WOMEN [OTC])
USES: *Overactive bladder with symptoms of urge urinary incontinence, urgency, and frequency.*
ACTIONS: Anticholinergic, muscarinic antagonist; relaxes bladder smooth muscle, ↑ bladder capacity.
DOSE: One 3.9 mg/d system apply 2×/wk (q3–4d) to abdomen, hip, or buttock.
W/P: [B, ?/−].
CI: GI/GU obst, untreated narrow-angle glaucoma.
DISP: 3.9 mg/d transdermal patch (Rx and OTC).
SE: Anticholinergic, itching/ redness at site.
NOTES: Do not apply to same site w/in 7 days.
OXYCODONE/ACETAMINOPHEN ER (XARTEMIS XR) [CII]
WARNING: Addiction risk, risk of resp depression. Accidental consumption, esp. peds, can be fatal. Use during PRG can cause neonatal opioid withdrawal. Contains acetaminophen, associated with liver failure, transplant and death.
USES: *Acute pain that requires opioids where alternatives are inadequate.*
ACTIONS: Opioid agonist and acetaminophen.
DOSE: 2 tabs q12h, w/o regard to food; do not crush/chew.
W/P: [C, -] Do not use before delivery; not equivalent to other combo products; caution: w/ other CNS depressants, MAOI, neuromusc blockers, elderly, debilitated, w/ hepatic impair; may ↑ ICP (check pupils); assoc w/ skin reactions; may ↓ BP; acetaminophen hepato tox >4,000 mg, avoid w/ other acetaminophen products; impairs mental/physical abilities; drugs that ↓ CYP3A4 may ↓ oxycodone clearance.
CI: Component hypersens; resp dep, severe asthma/hypercarbia, ileus.
DISP: Tabs oxycodone/acetaminophen: 7.5/325 mg.
SE: ↓ resp, ↓ BP, sedation, coma.
OXYCODONE (OXYCONTIN, ROXICODONE, GENERIC) [C-II]
WARNING: High abuse potential similar to morphine; controlled release only for extended chronic pain, not for PRN use; 60-, 80-, 160-mg tab only for opioid-tolerant pts; or single dose >40 mg or total daily dose of >80 mg can cause fatal respiratory depression if intolerant; do not crush, break, or chew.
USES: *Mod– severe pain, usually in combo w/ nonnarcotic analgesics.*
ACTIONS: Narcotic analgesic.
DOSE:
Adults: 5 mg PO q6h PRN (immediate release). Mod–severe chronic pain: 10–160 mg PO q12h (ER); can give ER q8h if effect does not last 12 hr.
Peds: 6–12 yr: 1.25 mg PO q6h PRN. >12 yr: 2.5 mg q6h PRN; ↓ w/ severe liver/renal disease, elderly; w/ food.
W/P: [B (D if prolonged use/near term), M].
CI: Allergy, resp depression, acute asthma, ileus w/ microsomal morphine.
DISP: CR Roxicodone tabs 15, 30 mg; ER (OxyContin) 10, 15, 20, 30, 40, 60, 80, 160 mg; liq 5 mg/5 mL; soln conc 20 mg/mL.
SE: ↓ BP, sedation, resp depression, dizziness, GI upset, constipation, risk of abuse.
NOTES: OxyContin for chronic cancer pain; do not crush/chew/cut ER product; sought after as drug of abuse; reformulated OxyContin is intended to prevent the opioid medication from being cut, broken, chewed, crushed, or dissolved to release more medication.
OXYCODONE/ACETAMINOPHEN (PERCOCET, TYLOX) [C-II]
WARNING: Acetaminophen has been associated with cases of acute liver failure, at times resulting in liver transplant and death. Most of the cases of liver injury are associated with the use of acetaminophen at doses that exceed 4,000 mg/d, and often involve more than 1 acetaminophen-containing product.
USES: *Mod– severe pain.*
ACTIONS: Narcotic analgesic.
DOSE:
Adults: 1–2 tabs/caps PO q4–6h PRN (acetaminophen max. dose 4 g/d).
Peds: Oxycodone 0.05–0.15 mg/kg/dose q4–6h PRN, 5 mg/dose max.
W/P: [C (D prolonged use or near term), M].
CI: Allergy, paralytic ileus, resp depression.
DISP: Percocet tabs, mg oxycodone/mg acetaminophen: 2.5/325, 5/325, 7.5/325, 10/325, 7.5/500, 10/650; Tylox caps 5 mg oxycodone, 500 mg acetaminophen; soln 5 mg oxycodone & 325 mg acetaminophen/5 mL.
SE: ↓ BP, sedation, dizziness, GI upset, constipation.
NOTES: See Acetaminophen note.
OXYCODONE/ASPIRIN (PERCODAN) [C-II]
USES: *Mod–severe pain.*
ACTIONS: Narcotic analgesic w/ NSAID.
DOSE:
Adults: 1–2 tabs/caps PO q4–6h PRN.
Peds: Oxycodone 0.05–0.15 mg/kg/dose q4–6h PRN, up to 5 mg/dose; ↓ in severe hepatic failure.
W/P: [D, −] w/ Peptic ulcer, CNS depression, elderly, Hx seizures.
CI: Component allergy, children (<16 yr) w/ viral infection (Reyes syndrome), resp depression, ileus, hemophilia.
DISP: Generics: 4.83 mg oxycodone hydrochloride, 0.38 mg oxycodone terephthalate, 325 mg aspirin; Percodan 4.83 mg oxycodone hydrochloride, 325 mg ASA.
SE: Sedation, dizziness, GI upset/ulcer, constipation, allergy.
NOTES: Monitor for possible drug abuse; max. 4 g aspirin/d.
OXYCODONE/IBUPROFEN (COMBUNOX) [C-II]
WARNING: May ↑ risk of serious CV events; CI in perioperative CABG pain; ↑ risk of GI events such as bleeding.
USES: *Short-term (not >7 days) management of acute mod–severe pain.*
ACTIONS: Narcotic w/ NSAID.
DOSE: 1 tab q6h PRN 4 tab max./24 h; 7 days max.
W/P: [C, −] w/ Impaired renal/hepatic function; COPD, CNS depression, avoid in pregnancy.
CI: Paralytic ileus, 3rd-tri pregnancy, allergy to ASA or NSAIDs, where opioids are CI.
DISP: Tabs 5 mg oxycodone/400 mg ibuprofen.
SE: N/V, somnolence, dizziness, sweating, flatulence, ↑ LFTs.
NOTES: Check renal function; abuse potential w/ oxycodone.