I Alphabetical Listing of Drugs Acetazolamide Brand Name Diamox. Class of Drug Carbonic anhydrase inhibitor (CAI) (sulfonamide). Indications Benign intracranial hypertension, ocular hypertension, open- angle glaucoma (OAG), secondary glaucoma, preoperatively in acute angle-closure glaucoma (ACG), some forms of cysto- id macular edema, acute mountain sickness. Dosage Form Oral: 125 mg, 250 mg. IV: 500 mg/vial. Dose Glaucoma: should be used as adjunct to usual therapy; 250 mg to 1 g/24 h in adults. Secondary glaucoma, or preope- ratively in acute ACG to delay surgery: 250 mg every 4 h (some reported cases of short-term efficacy with 250 mg b.i.d.). Acu- te cases: Initial 500 mg dose followed by 125–250 mg every 4 h. In benign intracranial hypertension, initial dose should not be less than 1 g/day. IV therapy may be used for rapid re- lief of ocular hypertension. Contraindications In patients with decreased serum sodium and/or potassium, marked renal or hepatic disease/dysfunction, suprarenal gland failure, hyperchloremic acidosis, liver cirrhosis, or for long-term use for ACG. Warnings Discontinue use if hypersensitivity develops. Rare fatalities have occurred due to severe sulfonamide reactions (Stevens– Johnson syndrome, toxic epidermal necrolysis, fulminant he- patic necrosis, agranulocytosis, aplastic anemias, and other blood dyscrasias). In patients with pulmonary obstruction or emphysema where alveolar ventilation may be impaired, it may aggravate acidosis and should be used with caution. Adverse Reactions May occur: (common to all sulfonamide derivatives): anaphy- laxis, fever, rash (including erythema multiforme, Stevens- Johnson syndrome, toxic epidermal necrolysis), crystalluria, renal calculus, bone-marrow depression, thrombocytopenic purpura, hemolytic anemia, leukopenia, pancytopenia, agra- nulocytosis, (precaution is advised for early detection of such reactions, and the drug should be discontinued and appro- priate therapy instituted), paresthesias, tinnitus, decreased appetite, taste alteration, gastrointestinal (GI) symptoms (nausea, vomiting, diarrhea), polyuria, drowsiness, confusion, metabolic acidosis, electrolyte imbalance, increased or decre- ased blood glucose levels, transient myopia (subsides after discontinuation), Occasional: urticaria, melena, hematuria, glycosuria, hepatic insufficiency, flaccid paralysis, photosen- sitivity, convulsions. Periodic monitoring for hematologic reactions and electro- lyte imbalance with a baseline complete blood count (CBC) and platelet count and serum electrolytes are recommended prior to initiating therapy and at regular intervals during the- rapy. If significant changes occur, early discontinuance and institution of appropriate therapy are important. Pregnancy Category C. 4 Acetylcholine Chloride Drug Interactions Safety and effectiveness in pediatric patients have not been A established. Growth retardation has been reported in child- ren receiving long-term therapy believed secondary to chro- nic acidosis. Caution advised for patients on concomitant high-dose aspirin (reported cases of anorexia, tachypnea, lethargy, coma, death). Modifies phenytoin metabolism with increased serum levels of phenytoin. May decrease serum concentrations of primidone and its metabolites by decrea- sing the absorption of primidone. May increase the effects of other folic acid antagonists. May reduce urinary excretion of amphetamine and quinidine and prevent the urinary anti- septic effect of methenamine. May increase lithium excreti- on. May elevate cyclosporine level. Brand Name Diamox Sequels. Class of Drug Sustained release. Indications See »Diamox.« Dosage Form Sustained-release capsules 500 mg. Dose Glaucoma: 500 mg capsule two times per day (A.M., P.M.). Contraindications See »Diamox.« Warnings See »Diamox.« Adverse Reactions See »Diamox.« Pregnancy Category C. Drug Interactions See »Diamox.« Acetylcholine Chloride Brand Name Miochol-E. Class of Drug Miotic cholinergic. Indications Immediate miosis after lens placement in cataract surge- ry, penetrating keratoplasty, iridectomy, other anterior segment surgery where rapid miosis is desired.Off-label: acetylcholine has been used without approval in cases of acute retinal vascular occlusion as a retrobulbar injection to relieve vasodilation of the retinal and choroidal blood vessels. Dosage Form Ophthalmic injection.Intraocular upper chamber: 20 mg ace- tylcholine and 56 mg mannitol. Lower chamber: 2 ml modi- fied diluent. Dose 0.5–2 ml intraocularly. Contraindications None known. Warnings Do not gas sterilize. Aqueous solutions are unstable. Prepa- re solution immediately before use and discard any solution that has not been used. Do not use solution that is not clear and colorless. Acyclovir Sodium 5 Adverse Reactions Infrequent: corneal edema/clouding/decompensations. Rare: bradycardia, hypotension, flushing, breathing difficulties, sweating (all indicative of systemic absorption). Pregnancy Category C. Drug Interactions A few reports of interference in efficacy with use of topical nonsteroidal anti-inflammatory drugs (NSAIDs). Acetylcysteine Brand Name Mucomyst; Mucosil 10% and 20%. Class of Drug Collagenase inhibitor. Mucolytic agent. Indications Off-label: alkali burns, corneal melts, and keratoconjunctivitis sicca, filamentary keratopathy, zoster mucous plaque kerati- tis. Dosage Form Ophthalmic solution 10% or 20%. Off-label: dilute the com- mercial preparation to 2–5% by adding artificial tears or phy- siologic saline. Dose 1–2 drops to affected eye(s) up to four times per day in maintenance therapy and up to hourly in acute cases. (Com- mercially available solution is not approved for ophthalmic use.) Pregnancy Category B. Acyclovir Sodium Brand Name Zovirax. Class of Drug Antiviral. Indications Injection: initial and recurrent mucosal and cutaneous her- pes simplex virus (HSV-1 and HSV-2) in immunocompro- mised patients, severe initial clinical episodes of herpes genitalis in immunocompetent patients, herpes simplex encephalitis, neonatal herpes infections, varicella-zoster (shingles) infections in immunocompromised patients. Capsules, tablets, suspension: acute treatment of herpes zoster (shingles), initial episodes and management of re- current episodes of genital herpes, varicella (chickenpox). Ointment 5%: initial genital herpes, limited non-life-threa- tening mucocutaneous, HSV infections in immunocompro- mised patients. Dosage Form See »Antivirals.« 6 Acyclovir Sodium Dose HSV-1 and HSV-2 infections in immunocompromised patients: A Adults and adolescents (12 years of age and older)—5 mg/kg infused at a constant rate over 1 h every 8 h for 7 days. Pe- diatrics (younger than 12 years of age)—10 mg/kg infused at a constant rate over 1 h every 8 h for 7 days. Severe initial clinical episodes of herpes genitalis: Adults and adolescents (12 years of age and older)—5 mg/kg infused at a constant rate over 1 h every 8 h for 5 days. Herpes simplex encephalitis: Adults and adolescents (12 years of age and older)—10 mg/ kg infused at a constant rate over 1 h every 8 h for 10 days. Pediatrics (3 months to 12 years of age)—20 mg/kg infused at a constant rate over 1 h every 8 h for 10 days. Neonatal HSV infections (birth to 3 months): 10 mg/kg infused at a constant rate over 1 h every 8 h for 10 days. In neonatal herpes simplex infections, doses of 15 mg/kg or 20 mg/kg (infused at a con- stant rate over 1 h every 8 h) have been used; safety and effi- cacy of these doses are not known. Varicella-zoster infections in immunocompromised patients: Adults and adolescents (12 years of age and older)—10 mg/kg infused at a constant rate over 1 h every 8 h for 7 days. Pediatrics (younger than 12 ye- ars of age)—20 mg/kg infused at a constant rate over 1 h eve- ry 8 h for 7 days. Obese patients: dose at the recommended adult dose using ideal body weight; dosage adjustments re- quired for patients with renal impairment or undergoing he- modialysis. Peritoneal dialysis: no supplemental dose appears to be necessary after adjustment of the dosing interval. Contraindications In patients who develop hypersensitivity to the product or any of its components.Cream: intended for cutaneous use only and should not be used in the eye or inside the mouth or nose; should only be used on herpes labialis on the affected external aspects of the lips and face. Ointment: no data to sup- port the use of Zovirax ointment 5% to prevent transmission of infection to other persons or prevent recurrent infections when applied in the absence of signs and symptoms; should not be used for the prevention of recurrent HSV infections. Warnings Renal failure, in some cases resulting in death, has been ob- served. Thrombotic thrombocytopenic purpura/hemolytic uremic syndrome (TTP/HUS), which has resulted in death, has occurred in immunocompromised patients. Abnormal renal function [decreased creatinine clearance (CrCl)] can occur as a result of administration and depends on the state of the patient‘s hydration, other treatments, and the rate of drug administration. Concomitant use of other nephrotoxic drugs and in patients with preexisting renal disease and dehydra- tion make further renal impairment more likely. IV infusions must be given over a period of at least 1 h to reduce the risk of renal tubular damage. Approximately 1% of patients recei- ving i.v. acyclovir have manifested encephalopathic changes characterized by either lethargy, obtundation, tremors, con- fusion, hallucinations, agitation, seizures, or coma. Should Adalimumab 7 be used with caution in those