FAMCICLOVIR (FAMVIR, GENERIC)
USES: *Acute herpes zoster (shingles) & genital herpes.*
ACTIONS: ↓ Viral DNA synth.
DOSE: Zoster: 500 mg PO q8h × 7 days. Simplex: 125–250 mg PO BID; ↓ w/ renal impairment.
W/P: [B, −].
CI: Component sensitivity.
DISP: Tabs 125, 250, 500 mg.
SE: Fatigue, dizziness, headache, pruritus, N/diarrhea.
NOTES: Best w/in 72 hr of initial lesion.
FEBUXOSTAT (ULORIC)
USES: *Hyperuricemia and gout.*
ACTIONS: Xanthine oxidase inhibitor (enzyme that converts hypoxanthine to xanthine to uric acid).
DOSE: 40 mg PO 1 × day, ↑ 80 mg if uric acid not <6 mg/dL after 2 wk.
W/P: [C, ?/−].
CI: Use w/ azathioprine, mercaptopurine, theophylline.
SUPPLIED: Tabs 40, 80 mg.
SE: ↑ LFTs, rash, myalgia.
NOTES: OK to continue w/ gouty flare or use w/ NSAIDs.
FENTANYL, INJECTION (SUBLIMAZE, GENERIC) [C-II]
USES: *Short-acting analgesic in anesthesia* & patient controlled analgesia.
ACTIONS: Narcotic analgesic.
DOSE:
Adults: 1–2 μg/kg or 25–100 μg/dose IV/IM titrated; Anesthesia: 5–15 μg/kg; Pain: 200 μg over 15 min, titrate to effect.
Peds: 1–2 μg/kg IV/IM q1–4h titrate; ↓ in renal impairment, elderly.
W/P: [B,+] To be used only by those experienced with medication; hypotension possible w/ tranquilizer use.
CI: Opioid intolerance.
DISP: Inj 0.05 mg/mL.
SE: Sedation, ↓ BP, ↓ HR, constipation, N, resp depression, miosis.
NOTES: 50 μg = 0.05 mg = 1 mL; 0.1 mg fentanyl = 10 mg morphine IM.
FENTANYL, TRANSDERMAL (DURAGESIC, GENERIC) [C-II]
WARNING: Potential for abuse and fatal OD; resp depression possible; accidental exposure can be fatal; initiation of CYP 3A4 inhibitors (or discontinuation of CYP 3A4 inducers) can result in a fatal OD; avoid heat to application site, can cause OD.
USES: *Persistent mod–severe chronic pain in pts already tolerant to opioids.*
ACTIONS: Narcotic.
DOSE: Apply patch to upper torso q72h; dose based on narcotic requirements in previous 24 hr; start 25 μg/h patch q72h; ↓ in renal impairment.
W/P: [B, +] w/ CYP3A4 inhibitor or D/C CYP3A4 inducer may ↑ fentanyl effect, w/ Hx substance abuse.
CI: Not opioid tolerant, short-term pain management, postop outpatient pain in outpatient surgery, mild pain, PRN use, ↑ ICP, resp depression, severe renal/hepatic impairment, peds <2 yr.
DISP: Patches 12.5, 25, 50, 75, 100 μg/h.
SE: Resp depression (can be fatal), sedation, ↓ BP, ↓ HR, constipation, N, miosis.
NOTES: 0.1 mg fentanyl = 10 mg morphine IM; do not cut patch; peak level in PREGNANCY 24–72 hr.
FENTANYL, TRANSMUCOSAL (ABSTRAL, ACTIQ, FENTORA, LAZANDA, ONSOLIS, GENERIC) [C-II]
WARNING: Potential for abuse and fatal OD; use only in pts w/ chronic pain who are opioid tolerant; CI in acute/postop pain; do not substitute for other fentanyl products; fentanyl can be fatal to children, keep away; use w/ strong CYP3A4 inhibitor may ↑ fentanyl levels. Abstral, Onsolis restricted distribution.
USES: *Breakthrough cancer pain w/ tolerance to opioids.*
ACTIONS: Narcotic analgesic, transmucosal absorption.
DOSE: Titrate to effect.
• Abstral: Start 100 μg SL, 2 doses max. per pain breakthrough episode; wait 2 hr for next breakthrough dose; limit to <4 breakthrough doses w/ successful baseline dosing.
• Actiq: Start 200 μg PO × 1, may repeat × 1 after 30 min.
• Fentora: Start 100 μg buccal tab × 1, may repeat in 30 min, 4 tabs/dose max.
• Lazanda: Through TIRF REMS Access Program; initial 1 × 100 μg spray; if no relief, titrate for breakthrough pain as follows: 2 × 100 μg spray (1 in each nostril); 1 × 400 μg; 2 × 400 μg (1 in each nostril); wait 2 hr before another dose; max. 4 doses/24 h.
• Onsolis: Start 200 μg film, ↑ 200 μg increments to max. four 200-μg films or single 1,200-μg film.
W/P: [B, +] resp/CNS depression possible; CNS depressants/CYP3A4 inhibitor may ↑ effect; may impair tasks (driving, machinery); w/ severe renal/hepatic impairment.
CI: Opioid intolerant pt, acute/postop pain.
DISP:
• Abstral: SL tabs 100, 200, 300, 400, 600, 800 μg
• Actiq: Lozenges on stick 200, 400, 600, 800, 1,200, 1,600 μg
• Fentora: Buccal tabs 100, 200, 400, 600, 800 μg
• Lazanda: Nasal spray metered dose audible and visual counter, 8 doses/bottle, 100/400 μg/spray
• Onsolis: Buccal soluble film 200, 400, 600, 800, 1,200 μg
SE: Sedation, ↓ BP, ↓ HR, constipation, N/V, ↓ resp, dyspnea, headache, miosis, anxiety, confusion, depression, rash dizziness.
NOTES: 0.1 mg fentanyl = 10 mg IM morphine.
FERRIC CARBOXYMALTOSE (INJECTAFER)
USES: *Iron-deficiency anemia.*
ACTIONS: Fe Supl.
DOSE:
Adults: ≥50 kg: 2 doses 750 mg IV separated by 7 days; <50 kg: 2 doses of 15 mg/kg IV separated by 7 days.
W/P: [C, M] Hypersens rxn (monitor during & 30 min after inf).
CI: Component hypersens.
DISP: Inj 750 mg iron/15 mL single-use vial.
SE: N, HTN, flushing, hypophosphatemia, dizziness, HTN.
FERROUS GLUCONATE (FERGON [OTC], OTHERS)
WARNING: Accidental OD of iron-containing products is a leading cause of fatal poisoning in children <6 yr. Keep out of reach of children.
USES: *Iron-deficiency anemia* & Fe supl.
ACTIONS: Dietary supl.
DOSE:
Adults: 100–200 mg of elemental Fe/d ÷ doses.
Peds: 4–6 mg/kg/d ÷ doses; on empty stomach (OK w/ meals if GI upset occurs); avoid antacids.
W/P: [A,?].
CI: Hemochromatosis, hemolytic anemia.
DISP: Tabs Fergon 240 (27 mg Fe), 246 (28 mg Fe), 300 (34 mg Fe), 324 mg (38 mg Fe).
SE: GI upset, constipation, dark stools, discoloration of urine, may stain teeth.
NOTES: 12% elemental Fe; false (+) stool guaiac; keep away from children; severe tox in OD.
FERROUS GLUCONATE COMPLEX (FERRLECIT)
USES: *Iron-deficiency anemia or supl to erythropoietin Treat therapy.*
ACTIONS: Fe supl.
DOSE: Test dose: 2 mL (25 mg Fe) IV over 1 hr, if OK, 125 mg (10 mL) IV over 1 hr. Usual cumulative dose: 1 g Fe over 8 sessions (until favorable Hct).
W/P: [B, ?].
CI: Non–Fe-deficiency anemia; CHF; Fe overload.
DISP: Inj 12.5 mg/mL Fe.
SE: ↓ BP, serious allergic reactions, GI disturbance, Inj site reaction.
NOTES: Dose expressed as mg Fe; may infuse during dialysis.
FERROUS SULFATE (OTC)
USES: *Fe-deficiency anemia & Fe supl.*
ACTIONS: Dietary supl.
DOSE:
Adults: 100–200 mg elemental Fe/d in ÷ doses.
Peds: 1–6 mg/kg/d ÷ daily–TID; on empty stomach (OK w/ meals if GI upset occurs); avoid antacids.
W/P: [A, ?] ↑ Absorption w/ vit C; ↓ absorption w/ tetracycline, fluoroquinolones, antacids, H2 blockers, proton pump inhibitor.
CI: Hemochromatosis, hemolytic anemia.
DISP: Tabs 187 (60 mg Fe), 200 (65 mg Fe), 324 (65 mg Fe), 325 mg (65 mg Fe); SR caplets & tabs 160 (50 mg Fe), 200 mg (65 mg Fe); gtt 75 mg/0.6 mL (15 mg Fe/0.6 mL); elixir 220 mg/5 mL (44 mg Fe/5 mL); syrup 90 mg/5 mL (18 mg Fe/5 mL).
SE: GI upset, constipation, dark stools, discolored urine.
FERUMOXYTOL (FERAHEME)
USES: *Iron-deficiency anemia in chronic kidney disease.*
ACTIONS: Fe replacement.
DOSE:
Adults: 510 mg IV × 1, then 510 mg IV × 1 3–8 days later; give 1 mL/s.
W/P: [C, ?/−] Monitor for hypersens & ↓ BP for 30 min after dose, may alter MRI studies.
CI: Iron overload; hypersens to ferumoxytol.
DISP: IV soln 30 mg/mL (510 mg elemental Fe/17 mL).
SE: N/diarrhea, constipation, dizziness, hypotension, peripheral edema, hypersens reaction.
NOTES: Check hematologic response 1 mo after 2nd dose.
FESOTERODINE (TOVIAZ)
USES: * Overactive bladder w/ urge urinary incontinence, urgency, frequency.*
ACTIONS: Competitive muscarinic receptor antagonist, ↓ bladder muscle contractions.
DOSE: 4 mg PO qd, ↑ to 8 mg PO daily PRN.
W/P: [C, /?] Avoid >4 mg w/ severe renal insufficiency or w/ CYP3A4 inhibitor (eg, ketoconazole, clarithromycin); w/ bladder outlet obstruction, ↓ GI motility/constipation, narrow-angle glaucoma, myasthenia gravis.
CI: Urinary/gastric retention, or uncontrolled narrow-angle glaucoma, hypersens to class.
DISP: Tabs 4, 8 mg.
SE: Dry mouth, constipation, ↓ sweating can cause heat prostration.
FIDAXOMICIN (DIFICID)
USES: *Clostridium difficile-associated diarrhea.*
ACTIONS: Macrolide antibiotic.
DOSE: 200 mg PO BID × 10 days.
W/P: [B, +/−] Not for systemic infection or <18 yr; to ↓ resistance, use only when diagnosis suspected/ proven.
DISP: Tabs 200 mg.
SE: N/V, abdominal pain, GI bleed, anemia, neutropenia.
FINASTERIDE (PROSCAR [GENERIC], PROPECIA)
USES: *BPH & androgenetic alopecia.*
ACTIONS: ↓ 5-α-reductase.
DOSE: BPH: 5 mg/d PO. Alopecia: 1 mg/d PO; food ↓ absorption.
W/P: [X, −] Hepatic impairment.
CI: Pregnant women should avoid handling pills, teratogen to male fetus.
DISP: Tabs 1 mg (Propecia), 5 mg (Proscar).
SE: ↓ Libido, vol ejaculate, erectile dysfunction, gynecomastia; may slightly ↑ risk of high-grade prostate cancer.
NOTES: Both ↓ PSA by ∼50%; reestablish PSA baseline 6 mo (double PSA for “true” reading); 3–6 mo for effect on urinary Sxs; continue to maintain new hair, not for use in women.
FLAVOXATE (GENERIC)
USES: *Relief of Sx of dysuria, urgency, nocturia, suprapubic pain, urinary frequency, incontinence.*
ACTIONS: Antispasmodic.
DOSE: 100–200 mg PO TID–QID.
W/P: [B, ?].
CI: GI obst, GI hemorrhage, ileus, achalasia, BPH.
DISP: Tabs 100 mg.
SE: Drowsiness, blurred vision, xerostomia.
NOTE: Urispas brand discontinued.
FLUCONAZOLE (DIFLUCAN, GENERIC)
USES: *Candidiasis (esophageal, oropharyngeal, urinary tract, Vag, prophylaxis); cryptococcal meningitis, prophylaxis w/ BMT.*
ACTIONS: Antifungal; ↓ cytochrome P-450 sterol demethylation. Spectrum: All Candida sp except C. krusei.
DOSE:
Adults: 100–400 mg/d PO or IV. Vaginitis: 150 mg PO daily.
Peds: 3–6 mg/kg/d PO or IV; 12 mg/kg/d/systemic infection; ↓ in renal impairment.
W/P: [C, Vag candidiasis (D high or prolonged dose), −] Do not use w/ clopidogrel (↓ effect).
CI: Hypersensitivity, terfenadine with high dose fluconazole; w/ drugs that ↑ QT interval and are metabolized via CYP3A4 (cisapride, astemizole, erythromycin, pimozide, quinidine).
DISP: Tabs 50, 100, 150, 200 mg; susp 10, 40 mg/mL; Inj 2 mg/mL.
SE: Headache, rash, GI upset, ↓ K+, ↑ LFTs.
NOTES: PO (preferred) = IV levels; cong anomalies w/ high dose 1st tri.
FLUDROCORTISONE ACETATE (GENERIC)
USES: *Adrenocortical insufficiency, Addison disease, salt-wasting adrenogenital syndrome.*
ACTIONS: Mineralocorticoid.
DOSE:
Adults: 0.1–0.2 mg/d PO.
Peds: 0.05–0.1 mg/d PO.
W/P: [C, ?].
CI: Systemic fungal infections; known hypersensitivity.
DISP: Tabs 0.1 mg.
SE: HTN, edema, CHF, headache, dizziness, convulsions, acne, rash, bruising, hyperglycemia, hypothalamic—pituitary–adrenal suppression, cataracts.
NOTES: For adrenal insufficiency, use w/ glucocorticoid; dose adjustments based on plasma renin activity.
FLUOROURACIL, INJECTION [5-FU] (GENERIC)
WARNING: Administration by experienced chemotherapy physician only; pts should be hospitalized for 1st course d/t risk for severe reaction.
USES: *Palliative management of carcinoma of the colon, rectum, breast, stomach and pancreas*, head, neck, bladder cancers.
ACTIONS: Inhibits thymidylate synthetase (↓ DNA synth, S-phase specific).
DOSE: 370–1,000 mg/m2/d × 1–5 days IV push to 24-hr cont Inf; protracted venous Inf of 200–300 mg/m2/d (per protocol); 800 mg/d max.
W/P: [D, ?] ↑ Tox w/ allopurinol; do not give live vaccine before 5-FU.
CI: Poor nutritional status, depressed BM function, thrombocytopenia, major surgery w/in past mo, G6PD enzyme deficiency, pregnancy, serious infection, bili >5 mg/dL.
DISP: Inj 50 mg/mL.
SE: Stomatitis, esophagopharyngitis, N/V/diarrhea, anorexia, ↓ BM, rash/dry skin/photosensitivity, tingling in hands/feet w/ pain (palmar-plantar erythrodysesthesia), phlebitis/discoloration at Inj sites.
NOTES: ↑ Thiamine intake; contraception OK.
FLUOROURACIL, TOPICAL [5-FU] (CARAC, EFUDEX, FLUOROPLEX, GENERIC)
USES: *Basal cell carcinoma (when standard therapy impractical); actinic/solar keratosis* carcinoma in situ (CIS) of the penis,
ACTIONS: Inhibits thymidylate synthetase (↓ DNA synth, S-phase specific),
DOSE: 5% cream BID × 2–6 wk,
W/P: [D, ?] Irritant chemotherapy,
CI: Component sensitivity,
DISP: Cream 0.5, 1, 5%; soln 1%, 2%, 5%.
SE: Rash, dry skin, photosensitivity.
NOTES: Healing may not be evident for 1–2 mo; wash hands thoroughly; avoid occlusive dressings; do not overuse; typical penile regimen described: apply 12 hr every 48 hr for 28 days.
FLUOXETINE (GABOXETINE, PROZAC, PROZAC WEEKLY, SARAFEM, GENERIC)
WARNING: Closely monitor for worsening depression or emergence of suicidality, particularly in ped pt.
USES: *Depression, OCD, panic disorder, bulimia (Prozac)* premature ejaculation* PMDD (Sarafem).*
ACTIONS: SSRI.
DOSE: 20 mg/d PO (max. 80 mg/d ÷ dose); weekly 90 mg/wk after 1–2 wk of standard dose. Bulimia: 60 mg q a.m. Panic disorder: 20 mg/d. OCD: 20–80 mg/d. PMDD: 20 mg/d or 20 mg intermittently, start 14 days prior to menses, repeat w/ each cycle; ↓ in hepatic failure.
W/P: [C, ?/−] Serotonin syndrome w/ MAOI, SSRI, serotonin agonists, linezolid; QT prolongation w/ phenothiazines; do not use w/ clopidogrel (↓ effect).
CI: w/ MAOI/thioridazine (wait 5 wk after D/C before MAOI).
DISP: Prozac: Caps 10, 20, 40 mg; scored tabs 10, 20 mg; Prozac Weekly: SR weekly caps 90 mg; soln 20 mg/5 mL. Sarafem: Caps 10, 15, 20 mg.
SE: N, nervousness, Wt loss, headache, insomnia.
FLUOXYMESTERONE (GENERIC) [C-III]
USES: *Hypogonadism (primary, hypogonadotropic), delayed puberty in males; postmenopausal metastatic breast cancer.*
ACTIONS: Synthetic androgen; ↓ secretion of LH & FSH (feedback inhibition).
DOSE: Breast cancer: 10–40 mg/d ÷ × 1–3 mo. Hypogonadism: 5–20 mg/d.
W/P: [X, ?/−] ↑ Effect w/ anticoagulants, cyclosporine, insulin, lithium, narcotics.
CI: Men with carcinomas of the breast or with known/suspected prostate cancer; women who are/may become pregnant.
DISP: Tabs 10 mg.
SE: Priapism, edema, virilization, amenorrhea & menstrual irregularities, hirsutism, alopecia, acne, N, cholestasis; suppression of factors II, V, VII, & X, & polycythemia; ↑ libido, headache, anxiety,
NOTES: Radiographic exam of hand/wrist q6mo in prepubertal children; ↓ total T4 levels.
FLUTAMIDE (GENERIC)
WARNING: Liver failure & death reported. Measure LFTs before, monthly, & periodically after; D/C immediately if ALT 2 × ULN or jaundice develops.
USES: Advanced *PCa* (w/ LHRH agonists); w/ radiation & LHRH agonists for localized CaP.
ACTIONS: Nonsteroidal antiandrogen.
DOSE: 250 mg PO TID (750 mg total).
W/P: [D, ?].
CI: Severe hepatic impairment.
DISP: Caps 125 mg.
SE: Hot flashes, loss of libido, impotence, N/V/diarrhea, gynecomastia, hepatic failure, aniline-like toxicity (methemoglobinemia, hemolytic anemia, cholestatic jaundice).
NOTES: Check LFTs, avoid EtOH.
FONDAPARINUX (ARIXTRA)
WARNING: When epidural/spinal anesthesia or spinal puncture is used, pts anticoagulated or scheduled to be anticoagulated w/ LMW heparins, heparinoids, or fondaparinux are at risk for epidural or spinal hematoma, which can result in long-term or permanent paralysis.
USES: *DVT prophylaxis* w/ hip fracture, hip or knee replacement, abdominal surgery; w/ DVT or PE in combo w/ warfarin.
ACTIONS: Synth inhibitor of activated factor X; a pentasaccharide.
DOSE: Prophylaxis 2.5 mg SQ daily, up to 5–9 days; start >6 hr postop; Tx: 7.5 mg SQ daily (<50 kg: 5 mg SQ daily; >100 kg: 10 mg SQ daily); ↓ w/ renal impairment.
W/P: [B, ?] ↑ Bleeding risk w/ anticoagulants, anti-plts, drotrecogin alfa, NSAIDs.
CI: Wt <50 kg, CrCl <30 mL/min, active bleeding, SBE ↓ plt w/ anti-plt Ab.
DISP: Prefilled syringes w/ 27G needle: 2.5/0.5, 5/0.4, 7.5 /0.6, 10/0.8 mg/mL.
SE: Thrombocytopenia, anemia, fever, N.
NOTES: D/C if plts <100,000 cells/μL; only give SQ; may monitor antifactor Xa levels.
FORMALIN (40% FORMALDEHYDE)
(Note: This medication is not FDA approved for this use. Medication usually prepared by hospital pharmacy.)
USES: Intractable hemorrhagic cystitis refractory to conservative management.
ACTIONS: Fixation of bladder wall mucosa through protein cross-linking.
DOSE: Fill bladder to capacity with 1–2% formalin initially under gravity (<15 cm water) for up to 10–15 min; must be under general or spinal anesthesia with patient in reverse Trendelenburg (minimize reflux); if needed can repeat with higher concentration (4–10%).
W/P: [C, ?].
DISP: Formalin solution 1–10%.
SE: Bladder fibrosis, skin irritation with contact, reflux resulting in acidosis, ureteral fibrosis and obstruction or papillary necrosis; extravasation causes peritonitis and/or fistulas.
NOTES: Cystogram required to rule out reflux and bladder perforation; coat perineum petroleum jelly and vaginal vault packed with petroleum gauze to protect shin from formalin contact.
FOSFOMYCIN (MONUROL, GENERIC)
USES: *Uncomplicated UTI in women.*
ACTIONS: ↓ Cell wall synth. Spectrum: gram(+) Enterococcus, staphylococci, pneumococci; gram(−) (E. coli, Salmonella, Shigella, H. influenzae, Neisseria, indole(−) Proteus, Providencia); B. fragilis & anaerobic gram(−) cocci are resistant.
DOSE: 3 g PO in 90–120 mL of H2O single dose; ↓ in renal impairment.
W/P: [B, ?] Not for pyelo;↓ absorption w/ antacids/Ca salts.
CI: Component sensitivity.
DISP: Granule packets 3 g.
SE: Headache, GI upset.
NOTES: May take 2–3 days for Sxs to improve.
FOSINOPRIL (GENERIC)
USES: *HTN, CHF*, diabetic nephropathy.
ACTIONS: ACE inhibitor.
DOSE: 10 mg/d PO initial; max. 40 mg/d PO; ↓ in elderly; ↓ in renal impairment.
W/P: [D, +] ↑ K+ w/ K+ supls, ARBs, K+-sparing diuretics; ↑ renal after effects w/ NSAIDs, diuretics, hypovolemia.
CI: Hereditary/idiopathic angioedema or angioedema w/ ACE inhibitor, bilateral RAS.
DISP: Tabs 10, 20, 40 mg.
SE: Cough, dizziness, angioedema, ↑ K+.
FUROSEMIDE (LASIX [ORAL], GENERIC)
USES: *CHF, HTN, edema*, ascites.
ACTIONS: Loop diuretic; ↓ Na & Cl reabsorption in ascending loop of Henle & distal tubule.
DOSE:
Adults: 20–80 mg PO or IV BID.
Peds: 1 mg/kg/dose IV q6–12h; 2 mg/kg/ dose PO q12–24h (max. 6 mg/kg/dose); ↑ doses w/ renal impairment.
W/P: [C, +] ↓ K+, ↑ risk digoxin tox & ototox w/ aminoglycosides, cisplatin (especially in renal dysfunction).
CI: Sulfonylurea allergy; anuria; hepatic coma; electrolyte depletion.
DISP: Tabs 20, 40, 80 mg; soln 10 mg/mL, 40 mg/5 mL; Inj 10 mg/mL.
SE: ↓ BP, hyperglycemia, ↓ K+.
NOTES: Check lytes, renal function; high doses IV may cause ototox.