Echothiophate Iodide
Trade Name(s): Phospholine Iodide
Chemically Related To: Irreversible cholinesterase inhibitors
Pregnancy Category: C
Medical Category: Antiglaucoma agent, cyclostimulant, diagnostic aid
Accepted Indications: Glaucoma, esotropia (diagnosis and treatment)
Mechanism of Action: Cholinesterase inhibitor
Peak activity: Miosis: 2 h
Research Notes: Onset of miosis: less than 1 h; duration of miosis: up to 1 m
Adult Dosage: Antiglaucoma: to conjunctiva, 1 drop of 0.03%–{endash}0.25% solution 1–{endash}2 times daily
Elderly Dosage: Decreased concentration
Child Dosage: 2 y and over: same as adult dosage
Dosage Forms: For ophthalmic solution: 0.03%, 0.06%, 0.125%, and 0.25%
By System: Ocular
Warnings: For the eye only–{endash}decreases night vision
Precautions: Carry medical identification
Frequent Side Effects: Frequencies not given for stinging of eyes, headache, miosis
Rare Side Effects: Retinal detachment
Overdosage: Bradycardia, bronchospasm, hypotension, increased sweating, nausea/vomiting, diarrhea
Antidotal Therapy: May include atropine sulfate injection, IV pralidoxime CL, diazepam
Disease States: Glaucoma, peptic ulcer, myasthenia gravis, epilepsy, bronchial asthma, Down syndrome, hypertension
Other Drugs: Cholinesterase inhibitors, cocaine, succinylcholine, ophthalmic belladonna alkaloids, anticholinergics
Administrative Notes: Reconstituted solution is stable for 3–{endash}4 w at room temperature
Econazole Nitrate
Trade Name(s): Spectazole
Chemically Related To: Miconazole
Pregnancy Category: C
Medical Category: Topical antifungal
Accepted Indications: Cutaneous candidiasis, tinea corporis, tinea cruris, tinea pedis, tinea versicolor, paronychia, tinea barbae, tinea capitis
Mechanism of Action: Fungistatic
Absorption/Distribution: Minimal systemic absorption
Elimination: Renal, fecal
Adult Dosage: Topical, b.i.d., morning and evening
Elderly Dosage: Same as adult dose
Child Dosage: Same as adult dose
Infant Dosage: Same as adult dose
Dosage Forms: Cream: 1%
Warnings: Avoid tight-fitting underwear for tinea cruris
Precautions: Follow for full course
Occasional Side Effects: Hypersensitivity
Edetate Calcium Disodium
Trade Name(s): Calcium Disodium Verserate
Pregnancy Category: B
Medical Category: Chelating agent, diagnostic aid, lead mobilization
Accepted Indications: Lead toxicity
Unaccepted Indications: Arsenic, gold, or mercury poisoning; prevention or retardation of atherosclerosis
Mechanism of Action: Reduces lead stores
Absorption/Distribution: Well absorbed after parenteral administration
Half life: IV: 20–{endash}60 min. IM: 1.5 h.
Metabolism: Not metabolized
Elimination: Renal
Adult Dosage: 30–{endash}50 mg/kg/d in 2 divided doses; 2 g/d maximum
Child Dosage: IV or IM: 1500 mg/m2/d, administered on 4 h schedule for 5 d
Dosage Forms: Injection: 200 mg/mL
Frequent Side Effects: Systemic febrile reaction, histamine-like reaction, nausea, vomiting, hypotension, renal damage, thrombophlebitis
Occasional Side Effects: Transient anemia, bone marrow depression, dermatitis, hypercalcemia
Rare Side Effects: Secondary gout, frequent urge to urinate
Contraindications: Anuria, oliguria
Disease States: Dehydration, hypercalcemia, renal function impairment
Other Drugs: Insulin, zinc supplements
Lab Tests: BUN, calcium concentrations
Edrophonium Chloride
Trade Name(s): Enlon, Reversol, Tensilon
Pregnancy Category: C
Medical Category: Cholinergic, diagnostic aid, antidote
Accepted Indications: Myasthenia gravis diagnosis, nondepolarizing neuromuscular blockade, curare toxicity
Unaccepted Indications: Supraventricular tachycardia
Mechanism of Action: Inhibits destruction of acetylcholine
Half life: 7–{endash}12 min (distribution), 33–{endash}110 min (elimination)
Elimination: Renal
Adult Dosage: IV, 1–{endash}10 mg; IM, 10 mg as diagnostic aid
Elderly Dosage: Same as adult dose
Child Dosage: Under 34 kg: IM, 2 mg; IV, 1 mg initially, may be repeated to a total dose of 5 mg. 34 kg and over: IM, 5 mg; IV, 2 mg initially, may be repeated to a total dose of 10 mg.
Infant Dosage: IM or SQ: 50 m{mu}g–{endash}1 mg. IV: 500 m{mu}g.
Dosage Forms: Injection: 10 mg/mL
Warnings: Protect from freezing
Occasional Side Effects: Muscarinic effects (blurred vision, diarrhea, sweating, bronchial secretion)
Rare Side Effects: Nicotinic effects (weakness, cramps, twitching)
Contraindications: Asthma, intestinal obstruction
Antidotal Therapy: May include atropine sulfate, 0.4–{endash}0.5 mg
Disease States: AV block
Other Drugs: Cholinesterase inhibitors, digitalis glycosides, neuromuscular blocking agents
Enalapril Maleate
Trade Name(s): Vasotec
Chemically Related To: Captopril
Pregnancy Category: C (D 2nd and 3rd trimesters)
Medical Category: Antihypertensive
Accepted Indications: Hypertension, CHF
Mechanism of Action: Blocks ACE producing vasodilation
Absorption/Distribution: Partially absorbed
Half life: 11 h
Peak activity: 1 h
Metabolism: Hepatic
Elimination: Renal and fecal
Adult Dosage: 5–{endash}40 mg/d
Elderly Dosage: Based on clinical response
Child Dosage: Not recommended
Infant Dosage: Not recommended
Dosage Forms: Tablets: 5 mg, 10 mg, and 20 mg
By System: ACE inhibitor; vascular
Warnings: Proteinuria and neutropenia may occur
Precautions: Dizziness and lightheadedness may occur after first dose
Occasional Side Effects: Dizziness, lightheadedness, fainting, cough
Rare Side Effects: Chest pain, sudden trouble in swallowing or breathing, swelling, (angioedema), hyperkalemia
Overdosage: Dizziness, syncope
Antidotal Therapy: May include supportive measures
Disease States: Autoimmune disease; bone marrow depression; diabetes; renal function impairment
Other Drugs: Alcohol, diuretics, NSAIDs, estrogens, sympathomimetics
Lab Tests: BUN, serum potassium and sodium ion concentration
Enalapril/Hydrochlorothiazide
Trade Name(s): Vaseretic
Pregnancy Category: C (D 2nd and 3rd trimesters)
Medical Category: Antihypertensive
Accepted Indications: Hypertension
Mechanism of Action: Reduces peripheral arterial resistance by decreasing the rate of production for angiotensin II
Absorption/Distribution: Approximately 60% absorption for enalapril
Half life: 11 h
Peak activity: 4-6 h
Metabolism: Hepatic
Elimination: Renal 60% and 33% fecal
Adult Dosage: 1 tablet/d
Elderly Dosage: See adult
Child Dosage: 100 m{mu}g/kg/d to a max of 500 m{mu}g/kg/d (enalapril); 1-2 mg/kg or 30-60 mg/sq meter/d
Dosage Forms: Tablets: 10 mg/25 mg
By System: CNS
Frequent Side Effects: Dry cough
Occasional Side Effects: Hypotension, diarrhea, increased sensitivity to light, loss of taste, unusual tiredness, nausea
Rare Side Effects: Angioedema, chest pain, cholecystitis, pancreatitis, hepatic function impairment, hyperuricemia, gout, neutropenia, agranulocytosis, thrombocytopenia
Overdosage: Dryness of mouth, irregular heartbeat, weak pulse
Disease States: Angioedema, anuria, hyperkalemia, renal artery stenosis, renal transplant, renal function impairment
Other Drugs: Adrenocorticoids, ACTH, alcohol, diuretics, potassium containing medications or supplements, salt substitutes, digitalis glycosides, lithium, methenamine, sympathomimetics, norepinephrine, phenylephrine
Lab Tests: Serum calcium, sodium, potassium, uric acid or cholesterol
Administrative Notes: Avoid too much sun or use of sunlamp
Enalaprilat
Trade Name(s): Vasotec-IV
Pregnancy Category: C (D second and third trimesters)
Medical Category: Antihypertensive, vasodilator
Accepted Indications: Hypertension, CHF
Mechanism of Action: Inhibits ACE
Half life: 11 h
IV: 1–{endash}4 h
Elimination: Renal
Adult Dosage: IV (over a period of 5 min) 1.25 mg/6 h
Elderly Dosage: Same as adult dose
Child Dosage: Safety and efficacy not established
Infant Dosage: Safety and efficacy not established
Dosage Forms: Injection: 1.25 mg
By System: Cardiovascular, respiratory
Warnings: May cause dizziness; prevent dehydration
Frequent Side Effects: Dry cough, headache
Occasional Side Effects: Diarrhea, fatigue, nausea, hypotension, rash, fever, pain in joints
Rare Side Effects: Angioedema of extremities, chest pain, hyperkalemia, pancreatitis, neutropenia
Antidotal Therapy: May include volume expansion; hemodialysis for removal
Disease States: Angioedema, autoimmune disease, bone marrow depression, diabetes mellitus, kidney problems
Other Drugs: Alcohol, diuretics, NSAIDs, potassium supplements, bone marrow depressants, estrogens, lithium, sympathomimetics
Lab Tests: Iodohippurate sodium I 123 or 131, BUN, hematocrit, hemoglobin, serum potassium and sodium, serum creatinine
Enoxacin
Trade Name(s): Penetrex
Chemically Related To: Fluoroquinolone
Pregnancy Category: C
Medical Category: Anti-infective
Accepted Indications: Mild to moderately severe urinary tract infections, gonorrhea
Unaccepted Indications: Syphilis
Absorption/Distribution: 90% bioavailability
Half life: 3–{endash}6 h
Metabolism: Hepatic
Elimination: Renal
Research Notes: 5 metabolites have been identified
Adult Dosage: 200 mg b.i.d. for 5 d
Elderly Dosage: Usually normal dose
Child Dosage: Not recommended
Infant Dosage: Not recommended
Dosage Forms: Film-coated tablets: 200 mg and 400 mg
Warnings: May cause dizziness
Precautions: Avoid sunlight; drink plenty of fluids
Occasional Side Effects: Nausea and vomiting, dizziness
Rare Side Effects: Headache, rash, diarrhea, dyspepsia
Contraindications: Pregnancy
Antidotal Therapy: May include supportive treatment: gastric lavage, emesis
Disease States: Epilepsy, cerebral arteriosclerosis
Other Drugs: Antacids, NSAIDs, theophylline, caffeine, bismuth, cyclosporine, digoxin, warfarin
Lab Tests: Hemoglobin, hematocrit, bilirubin, urinary protein
Administrative Notes: Dosage should be adjusted in patients with a creatinine clearance value of 30 mL/min/1.73 m2 or less
Enoxaparin
Trade Name(s): Lovenox
Pregnancy Category: B
Medical Category: Antithrombotic
Accepted Indications: Pulmonary thromboembolism, deep venous thrombosis prophylaxis after hip surgery
Mechanism of Action: Increased antithrombin III-mediated inhibition of the formation and activity of factor XA
Absorption/Distribution: Absorbed rapidly and almost completely
Half life: 3–{endash}6 h (elimination)
Peak activity: 3–{endash}5 h (SQ)
Metabolism: Hepatic
Elimination: Renal
Research Notes: Duration of action up to 24 h
Adult Dosage: SQ: 30 mg b.i.d. for 7–{endash}10 d
Elderly Dosage: Same as adult dose
Child Dosage: Not established
Infant Dosage: Not established
Dosage Forms: Injection: 30 mg/0.3 mL
By System: Vascular
Occasional Side Effects: Bleeding complications, confusion, fever, peripheral edema, thrombocytopenia, increased menstrual bleeding, irritation at injection site, nausea, vomiting
Rare Side Effects: Angioedema, cardiovascular toxicity, rash, hives
Overdosage: Bleeding complications
Antidotal Therapy: May include protamine sulfate
Disease States: Threatened abortion, aneurysm, cerebrovascular hemorrhage, uncontrollable hemorrhage, hypertension, thrombocytopenia, regional or lumbar block anesthesia, blood dyscrasias, recent childbirth, endocarditis, neurosurgery, ophthalmic surgery, pericarditis, renal function impairment, retinopathy, spinal puncture, severe trauma, ulcerations or lesions, vasculitis, wounds with large open surfaces
Other Drugs: Platelet aggregation inhibitors, aspirin, sulfinpyrazone, ticlopidine, plicamycin, valproic acid, thrombolytics, alteplase, anistreplase, streptokinase, urokinase
Lab Tests: Blood coagulation, platelet aggregation, platelet count
Ephedrine Hydrochloride/Guaifenesin
Trade Name(s): Broncholate (Capsules, Syrup)
Medical Category: Antitussive, Mucolytic
Accepted Indications: Cough and cold
Adult Dosage: Capsules: 1–{endash}2 capsules every 4 h; syrup: 10–{endash}20 mL every 4 h
Child Dosage: Syrup: 2–{endash}6 y: 2.5–{endash}5 mL; 6–{endash}12 y: 5–{endash}10 mL every 4 h
Dosage Forms: Capsules: 12.5 mg/200 mg; syrup: 6.25 mg/100 mg
Ephedrine Hydrochloride/Guaifenesin/Phenobarbital/Theophylline
Trade Name(s): Bronkolixir, Bronkotabs, Guaiphed, Mudrane GG
Pregnancy Category: C
Medical Category: Bronchodilator, mucolytic
Accepted Indications: Asthma
Adult Dosage: Varies by strength
Elderly Dosage: Varies by strength
Child Dosage: Varies by strength
Dosage Forms: Varies by preparation
Ephedrine Hydrochloride/Phenobarbital/Theophylline Anhydrous
Trade Name(s): Tedrigen, Theodrine, Theofedral, Theophedrital
Pregnancy Category: C
Medical Category: Antiasthmatic, bronchodilator
Accepted Indications: Asthma
Dosage Forms: Varies by preparation
Ephedrine Hydrochloride/Potassium Iodide
Trade Name(s): KIE
Pregnancy Category: C
Medical Category: Bronchodilator, expectorant
Accepted Indications: Asthma
Adult Dosage: 10–{endash}15 mL every 4–{endash}6 h
Child Dosage: 3–{endash}6 y: 2.5–{endash}5 mL; 6–{endash}12 y: 5–{endash}10 mL every 4–{endash}6 h
Dosage Forms: Syrup: 8 mg/150 mg
Ephedrine Hydrochloride/Potassium Iodide/Phenobarbital/Theophylline Salicylate
Trade Name(s): Quadrinal
Pregnancy Category: C
Medical Category: Antiasthmatic, mucolytic
Accepted Indications: Asthma, bronchodilator
Dosage Forms: Tablet: 24 mg/320 mg/24 mg/130 mg
Ephedrine Sulfate
Trade Name(s): Generic only
Chemically Related To: Amphetamine
Pregnancy Category: C
Medical Category: Bronchodilator, nasal decongestant, CNS stimulant, urticaria therapy adjunct
Accepted Indications: Asthma, bronchitis, bronchospasm, bronchiectasis, emphysema, nasal congestion, sinus congestion, mental depression, narcolepsy, urticaria
Unaccepted Indications: Enuresis, myasthenia gravis
Mechanism of Action: Relaxes bronchial smooth muscle
Absorption/Distribution: Rapidly absorbed
Half life: 3-6 h
Metabolism: Hepatic
Elimination: Mostly excreted unchanged in the urine
Research Notes: Oral onset of action 15-60 min, IM onset of action 10-20 min, oral duration of action 3-5 h, IM duration of action 0.5-1 h
Adult Dosage: Capsules: 25-50 mg q 3 h; IV, IM or SQ: 12.5-25 mg, up to 150 mg/d
Elderly Dosage: Use with caution
Child Dosage: Capsules or injection: 3 mg/kg/d in 4-6 divided doses
Infant Dosage: Use with caution
Dosage Forms: Capsules: 25 and 50 mg; syrup: 20 mg/5 mL; injection: 25 mg/mL and 50 mg/mL
Frequent Side Effects: Trouble sleeping, nervousness, restlessness
Occasional Side Effects: Difficult urination, dizziness, dry mouth, fast heartbeat, headache, increased sweating, increase in blood pressure, loss of appetite, nausea, pounding heartbeat, trembling, unusual paleness, vomiting, weakness
Rare Side Effects: Chest pain, irregular heartbeat, hallucinations, mood changes, paradoxical bronchospasm, chills, convulsions, blurred vision, unusual weakness
Contraindications: Cardiovascular disease, angle-closure glaucoma, prostatic hypertrophy
Antidotal Therapy: May include IV fluids, diazepam
Disease States: Diabetes mellitus, hyperthyroidism, pheochromocytoma, prostatic hypertrophy
Other Drugs: Levodopa, nitrates, doxapram, glucocorticoid adrenocorticoids, corticotropin, urinary alkalizers, alpha-adrenergic beta blockers, diatrizoates, iothalamate, ioxaglate, ergot alkaloids, methysergide, oxytocin, guanadrel, guanethidine, mazindol, mecamylamine, methyldopa, trimethaphan, methylphenidate, rauwolfia alkaloids, rapidly acting vasodilators, hydrocarbon inhalation anesthetics, antihypertensives, CNS stimulation–{endash}producing medications, cocaine, digitalis glycosides, dihydroergotamine, ergotamine, MAO inhibitors, ritodrine, sympathomimetics, thyroid hormones, xanthines
Ephedrine Sulfate/Hydroxyzine Hydrochloride/Theophylline
Trade Name(s): Ami-Rax, Hydrophed, Marax, T.E.H., Theomax DF, Therax
Pregnancy Category: C
Medical Category: Antiasthmatic, antianxiety
Accepted Indications: Asthma, bronchodilator
Dosage Forms: Syrup: 6.25 mg/2.5 mg/32.5 mg; tablet: 25 mg/10 mg/130 mg
Epinephryl Borate
Trade Name(s): Epinal
Chemically Related To: Epinephrine
Pregnancy Category: C
Medical Category: Antiglaucoma agent, surgical aid
Accepted Indications: Glaucoma
Mechanism of Action: Decrease in production of aqueous humor
Absorption/Distribution: Limited absorption
Peak activity: 4–{endash}8 h
Research Notes: Duration of action in reducing intraocular pressure: up to 24 h
Adult Dosage: Topical to conjunctiva, 1 drop once daily or b.i.d.
Child Dosage: Safety not established
Infant Dosage: Safety not established
Dosage Forms: Ophthalmic solution: USP 0.5%, 1%, and 2%
By System: Ocular
Warnings: Avoid contamination of applicator; do not use solution if discolored
Precautions: Check eye pressure regularly
Frequent Side Effects: Headache; stinging or watering of eyes
Occasional Side Effects: Blurred vision, eye pain
Rare Side Effects: Tachycardia
Antidotal Therapy: May include symptomatic treatment such as a beta-adrenergic blocker
Disease States: Bronchial asthma, heart problems, diabetes mellitus, glaucoma, hypertension, hyperthyroidism
Other Drugs: Hydrocarbon anesthetics, tricyclic antidepressants, digitalis glycosides, MAO inhibitors, systemic sympathomimetics
Administrative Notes: Do not use unless solution is colorless or amber-colored; Do not use if there is a precipitate
Epoetin Alfa
Trade Name(s): Epogen, Procrit
Chemically Related To: Human erythropoietin
Pregnancy Category: C
Medical Category: Antianemic
Accepted Indications: Anemia associated with renal failure, anemia associated with AIDS, anemia associated with frequent blood donation
Unaccepted Indications: Blood transfusion substitute
Mechanism of Action: Stimulates division and differentiation of erythroid progenitor cells
Absorption/Distribution: Destroyed in GI tract; delayed and incomplete absorption
Half life: 4–{endash}13 h
Peak activity: SQ 5–{endash}24 h
IV: 15 min
Metabolism: Hepatic
Elimination: Renal
Research Notes: Increase in red blood cell count in 2–{endash}6 w
Adult Dosage: Initial dose: IV or SQ, 50–{endash}100 units/kg 3 times/w
Dosage Forms: Recombinant injection 2000 units/mL, 3000 units/mL, 4000 units/mL, and 10,000 units/mL
By System: Hematopoietic
Warnings: Discard unused portions; do not shake vial
Precautions: Take iron supplements
Frequent Side Effects: Chest pain, tachycardia, hypertension, swelling of face and extremities, weight gain, diarrhea, nausea/vomiting, shortness of breath
Occasional Side Effects: Seizures
Rare Side Effects: Rash, hives
Contraindications: Hypersensitivity to human albumin; uncontrolled hypertension
Antidotal Therapy: For clotting, follow dialysis center policy; also administer antihypertensives
Disease States: Hypertension, vascular disease, convulsions, vitamin B12 deficiency, infection
Nutrition: Special diet often needed; possible need for iron supplements
Other Drugs: Heparin, antihypertensives
Lab Tests: Iron concentration, blood pressure, BUN, bleeding time, serum uric acid concentration
Administrative Notes: Do not administer with other medications
Ergocalciferol
Trade Name(s): Calciferol, Deltalin, Drisdol, Ostoforte
Chemically Related To: Vitamin D
Pregnancy Category: C
Medical Category: Antihypocalcemic, nutritional supplement, antihypoparathyroid
Accepted Indications: Hypocalcemia, rickets, tetany, hypophosphatemia, osteodystrophy, vitamin D deficiency
Unaccepted Indications: Lupus vulgaris, psoriasis, rheumatoid arthritis
Mechanism of Action: Promotes absorption and utilization of calcium and phosphate
Absorption/Distribution: Readily absorbed from small intestine
Half life: 19–{endash}48 h
Metabolism: Hepatic, renal
Elimination: Biliary, renal
Adult Dosage:
Elderly Dosage: May require higher dose
Child Dosage:
Infant Dosage: Must be individualized
Dosage Forms: Capsules: 50,000 units; tablets: 50,000 units; oral solution: 8,000 units; injection: 500,000 units. Lower dose units available in over the counter preparations
Contraindications: Hypercalcemia, cardiac impairment
Overdosage: Constipation, headache, metallic taste, bone pain, diarrhea, dry mouth, increased thirst, frequent urination, appetite loss, nausea, vomiting, cloudy urine, high blood pressure, irregular heartbeat, pancreatitis, itching
Antidotal Therapy: May include withdrawal of vitamin, low-calcium diet, increased fluid intake, prednisone
Disease States: Hypervitaminosis D, renal osteodystrophy with hyperphosphatemia, arteriosclerosis, hyperphosphatemia, renal function impairment
Other Drugs: Antacids, thiazide diuretics, colestipol, calcium–{endash}containing preparations, vitamin D analogs
Lab Tests: BUN, serum creatinine
Ergoloid Mesylates
Trade Name(s): Gerimal, Hydergine, Hydergine LC
Chemically Related To: Ergot alkaloids; natural alkaloid
Pregnancy Category: X
Medical Category: Dementia symptoms treatment adjunct
Accepted Indications: Early dementia, efficacy debatable
Mechanism of Action: Decreases vascular tone; blocks peripheral alpha receptors
Absorption/Distribution: Rapidly but incompletely absorbed
Half life: 2–{endash}5 h
Metabolism: Hepatic
Research Notes: Onset of action: may take 3–{endash}4 w
Adult Dosage: 1–{endash}2 mg t.i.d.
Dosage Forms: Capsules: 1 mg; oral solution: 1 mg/mL; tablets: 0.5 mg, 1 mg; sublingual tablets: 0.5 mg, 1 mg
By System: Vascular
Warnings: Do not use more or less than prescribed dose
Precautions: Monitor blood pressure and pulse
Occasional Side Effects: Bradycardia, orthostatic hypotension, rash
Overdosage: Blurred vision, dizziness, fainting, flushing, headache, nausea/vomiting, nasal congestion
Disease States: Bradycardia, liver function disorders, hypotension, psychosis
Ergonovine Maleate
Trade Name(s): Ergotrate
Chemically Related To: Ergotamine
Medical Category: Uterine stimulant, diagnostic aid (coronary vasospasm)
Accepted Indications: Uterine hemorrhage, postpartum and postabortal
Unaccepted Indications: Migraine, labor (induction), abortion (induction)
Mechanism of Action: Directly stimulates the uterine muscle to increase force and frequency of contraction; causes vasoconstriction of coronary arteries
Absorption/Distribution: Rapid and complete
Metabolism: Hepatic
Elimination: Renal
Research Notes: Antiemetic medications such as prochlorperazine may be administered before ergonovine
Adult Dosage: Uterine stimulant: Tablets: 200–{endash}400 m{mu}g b.i.d. to q.i.d.; IV or IM, 200 m{mu}g, repeated in 2–{endash}4 h, not to exceed 5 doses. Diagnostic aid: IV, 50 m{mu}g every 5 min not to exceed 400 m{mu}g
Dosage Forms: Tablets: 200 m{mu}g; IV and IM: 200 m{mu}g/mL and 250 m{mu}g/mL
By System: Uterine or smooth muscle
Frequent Side Effects: Nausea, uterine cramping
Occasional Side Effects: Bradycardia, coronary vasospasm, abdominal or stomach pain, diarrhea, dizziness, headache, nasal congestion, sweating
Rare Side Effects: Cardiac arrest or ventricular arrhythmias, including fibrillation and tachycardia
Contraindications: Unstable angina pectoris, recent myocardial infarction, history of cerebrovascular accident, transient ischemic attack, severe hypertension
Overdosage: Angina, bradycardia, confusion, drowsiness, weak pulse, miosis, severe peripheral vasoconstriction, depressed respiration, seizures, tachycardia
Antidotal Therapy: May include supportive and symptomatic treatment
Disease States: Cardiovascular disease, coronary artery disease, mitral valve stenosis, hepatic and renal function impairment, sepsis
Other Drugs: General anesthetics, antianginal agents, nitroglycerin, nicotine, vasoconstrictors, vasopressors
Administrative Notes: For patients who do not respond to ergonovine, calcium gluconate may restore the oxytocic action
Ergotamine Tartrate
Trade Name(s): Ergostat, Gynergen
Chemically Related To: Ergot alkaloid
Pregnancy Category: X
Medical Category: Vascular headache suppressant
Accepted Indications: Vascular headaches, cluster headaches
Unaccepted Indications: Migraine (long-term prophylaxis), production of oxytocic effect
Mechanism of Action: Adrenergic blocking; vasoconstriction
Absorption/Distribution: Slow and incomplete absorption
Half life: Alpha phase, 2 h; beta phase, 21 h
Metabolism: Hepatic
Elimination: Hepatic, fecal
Research Notes: Ergotamine is a semisynthetic alkaloid
Adult Dosage: 1–{endash}2 mg at start of attack, followed by 1 tablet at intervals of at least 30 min up to a total of 6 tablets/d
Child Dosage: Not established
Infant Dosage: Not established
Dosage Forms: Tablets: 1 mg; sublingual tablets: 2 mg
By System: Sympathetic nervous system
Warnings: May cause dizziness, avoid excessive cold, increased risk of hypothermia in elderly patients
Frequent Side Effects: Edema, CNS effects, dry mouth, GI distress
Occasional Side Effects: Cardiovascular problems, ocular changes
Contraindications: Vascular insufficiency, angioplasty, severe hypertension, vascular surgery
Overdosage: CNS toxicity, diarrhea, vomiting, respiratory depression
Antidotal Therapy: May include monitoring of vital signs; administration of oxygen, volume expanders, benzodiazepines
Disease States: Malnutrition, hyperthyroidism, hypertension, diarrhea, angina pectoris, liver problems, peripheral vascular disease
Other Drugs: Macrolide antibiotics, beta-adrenergic blockers, vasoconstrictors, nitroglycerin
Lab Tests: Gastric acid secretion
Administrative Notes: Recommended use not more than 2 times/w, 5 d apart
Erythrityl Tetranitrate
Trade Name(s): Generic only
Chemically Related To: Nitroglycerin
Pregnancy Category: C
Medical Category: Antianginal, vasodilator
Accepted Indications: Acute angina pectoris (prophylaxis), CHF
Mechanism of Action: Reduction of myocardial oxygen demand, attributed to a reduction in left ventricular preload and afterload
Absorption/Distribution: Readily absorbed
Metabolism: Hepatic, blood
Elimination: Renal
Research Notes: Duration of action, oral tablets: up to 6 h; sublingual tablets: 2–{endash}3 h. Onset of action, oral tablets: 15–{endash}30 min; sublingual tablets: 5 min.
Adult Dosage: 5–{endash}10 mg t.i.d. or q.i.d. up to 100 mg/d
Elderly Dosage: May be more sensitive to hypotensive effect
Child Dosage: Not established
Infant Dosage: Not established
Dosage Forms: Tablets: 10 mg
By System: Cardiovascular
Warnings: Caution with alcoholic use; keep container tightly closed, and store in a cool, dry place
Precautions: Buccal dosage not recommended at bedtime because of possibility of aspiration
Frequent Side Effects: Tachycardia, flushing of face and neck, headache, nausea and vomiting, orthostatic hypotension, restlessness
Occasional Side Effects: Sore, reddened skin
Rare Side Effects: Blurred vision, dry mouth, headache, severe or prolonged rash
Overdosage: Bluish lips, fingernails, or palms of hands; dizziness (extreme); fainting, feeling of extreme pressure in head; shortness of breath; extreme tiredness or weakness; weak pulse or tachycardia; fever; convulsions
Antidotal Therapy: May include removal of any remaining nitroglycerin; elevate legs to aid venous return; administer phenylephrine if necessary
Disease States: Severe anemia; recent head trauma; cerebral hemorrhage; recent myocardial infarction; severe hepatic and renal function impairment; hypotension; hyperthyroidism
Nutrition: Take with a glass of water on an empty stomach 1 h before or 2 h after meals
Other Drugs: Norepinephrine, antihypertensives, hypotensives, narcotic analgesics, other vasodilators, heparin, sympathomimetics
Lab Tests: Serum cholesterol, methemoglobin concentrations, urine catecholamine concentrations
Administrative Notes: Loss of drug potency is accelerated by exposure to heat and moisture. The tablets may be utilized for oral, sublingual, or buccal dosage. Take with a glass of water on an empty stomach 1 h before or 2 h after meals.
Erythromycin (Ophthalmic)
Trade Name(s): Ilotycin
Chemically Related To: Macrolide antibiotics
Pregnancy Category: B
Medical Category: Ophthalmic antibacterial
Accepted Indications: Conjunctivitis, ocular infections, ophthalmia neonatorum
Mechanism of Action: Interferes with messenger RNA
Absorption/Distribution: May be absorbed into the cornea and aqueous humor
Adult Dosage: Topical to the conjunctiva, 1 cm once daily
Elderly Dosage: Same as adult dose
Child Dosage: Same as adult dose
Infant Dosage: Neonatal conjunctivitis or ophthalmia neonatorum: topical to the conjunctiva, 0.5–{endash}1 cm as a single dose; ocular infections: same as adult dose
Dosage Forms: Ophthalmic ointment: 0.5%
Precautions: Protect from freezing
Frequent Side Effects: Blurred vision
Rare Side Effects: Eye irritation
Administrative Notes: Complete full course of treatment
Erythromycin Base
Trade Name(s): E-Mycin, ERYC, Ery-Tab
Chemically Related To: Erythromycin
Pregnancy Category: Use not recommended
Medical Category: Systemic antibacterial, antiacne agent, bowel preparative adjunct (preoperative)
Accepted Indications: Preoperative bowel preparation, conjunctivitis, chlamydial infections, pneumonia, diphtheria, bacterial endocarditis, gonorrhea, skin and soft tissue infections, bronchitis, acute otitis media, sinusitis, erythrasma, legionnaires' disease, listeriosis, pertussis, pharyngitis, rheumatic fever prophylaxis, syphilis, urethritis
Mechanism of Action: Inhibits bacterial protein synthesis
Absorption/Distribution: Well absorbed; widely distributed to most tissues and fluids
Half life: 1.4–{endash}2 h
Metabolism: Hepatic
Elimination: Hepatic, renal, fecal
Research Notes: Not removed by hemodialysis
Adult Dosage: 250 mg q.i.d. up to 4 g/d
Elderly Dosage: May require decreased dose
Child Dosage: 7.5-12.5 mg/kg q.i.d.
Infant Dosage: 7.5 to 12.5 mg/kg q.i.d.
Dosage Forms: Delayed-release capsules: 250 mg; tablets: 250 mg and 500 mg; delayed-release tablets: 250 mg, 333 mg, and 500 mg
Frequent Side Effects: GI upset
Occasional Side Effects: Hypersensitivity, oral candidiasis, hepatotoxicity, vaginal candidiasis
Rare Side Effects: Hearing loss, cardiac toxicity, pancreatitis
Antidotal Therapy: May include epinephrine, adrenocorticoids and antihistamines, gastric lavage
Disease States: Liver problems, cardiac arrhythmias, hearing loss
Other Drugs: Lincomycins, chloramphenicol, warfarin, xanthines, hepatotoxic medications, alfentanil, astemizole, terfenadine, midazolam, carbamazepine, valproic acid, cyclosporine
Lab Tests: Urinary catecholamines, alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase
Administrative Notes: Delayed-release medications must be swallowed whole; may be taken with food
Erythromycin Estolate
Trade Name(s): Erythrozone, Ilosone
Chemically Related To: Erythromycin
Pregnancy Category: B
Medical Category: Antiacne agent, adjunct bowel preparation
Accepted Indications: Chlamydial conjunctivitis, GI tract infections, chlamydial pneumonia, diphtheria, bacterial endocarditis, erythrasma, gonorrhea, legionnaires' disease, sinusitis, acute otitis media
Mechanism of Action: Blocks protein formation; bacteriostatic
Absorption/Distribution: Absorbed in duodenum, unaffected by food; widely distributed
Half life: 1.4–{endash}2 hours
IV: 30 min
Metabolism: Hepatic
Elimination: Renal, fecal
Research Notes: Has been associated with an increased risk of reversible, subclinical hepatotoxicity in approximately 10% of pregnant women
Adult Dosage: Antibacterial: 1–{endash}4 g/d
Child Dosage: 30–{endash}50 mg/kg/d
Infant Dosage: Same as child dose
Dosage Forms: Capsules: 250 mg; oral suspension: 125 mg/5 mL and 250 mg/5 mL; tablets: 250 mg and 500 mg; chewable tablets: 125 mg; injectable: 500 mg
Precautions: Do not miss doses; take at evenly spaced times
Frequent Side Effects: GI disturbances
Occasional Side Effects: Hypersensitivity, cholestatic jaundice, inflammation or phlebitis at injection site, sore mouth or tongue
Rare Side Effects: Hearing loss (reversible), cardiac arrhythmias
Antidotal Therapy: May include supportive measures
Disease States: Cardiac arrhythmias, hepatic impairment, hearing loss
Other Drugs: Lincomycins, digoxin, hepatotoxic medications, ototoxic medications, penicillins, xanthines, warfarin, terfenadine, astemizole, midazolam
Lab Tests: Urinary catecholamines, serum bilirubin, serum alkaline phosphatase
Erythromycin Ethylsuccinate
Trade Name(s): EES, E-Mycin, Erythro
Chemically Related To: Macrolides
Pregnancy Category: B
Medical Category: Antibacterial, antiacne agent, preoperative bowel preparation
Accepted Indications: Skin and soft tissue infections, legionnaires' disease, gonorrhea, otitis media, sinusitis
Unaccepted Indications: Viral infections
Mechanism of Action: Prevents protein synthesis
Absorption/Distribution: Absorbed mostly in duodenum; variable distribution
Half life: 1.4–{endash}2 h
Metabolism: Hepatic
Elimination: Renal
Research Notes: Hydrolyzed to free drug in GI tract and in blood
Adult Dosage: 500 mg q.i.d.
Elderly Dosage: Same as adult dose
Child Dosage: 7.5–{endash}12.5 mg/kg q.i.d.
Infant Dosage: 5 mg/kg q.i.d.
Dosage Forms: Oral suspension: 200 mg/5 mL and 400 mg/5 mL; for oral suspension: 200 mg/ 5mL and 400 mg/5 mL; tablets: 400 mg; chewable tablets: 200 mg
Warnings: Finish even if symptoms subside
Precautions: Check with the physician if there is no improvement after several days of therapy
Occasional Side Effects: Rash, itching, GI disturbances
Rare Side Effects: Hearing loss
Antidotal Therapy: May include gastric lavage, supportive measures, epinephrine, adrenocorticoids, antihistamines
Disease States: Hearing problems, history of cardiac problems, hepatic impairment
Other Drugs: Carbamazepine, cyclosporine, warfarin, xanthines, terfenadine, astemizole, theophylline, midazolam
Lab Tests: Alanine aminotransferase, asparate aminotransferase, serum bilirubin
Administrative Notes: Pediatric drops technique should be explained and a calibrated liquid–{endash}measuring device dispensed. Suspension will retain taste for 10 d after reconstitution. Dose should be taken with food to lessen GI discomfort.
Erythromycin Stearate
Trade Name(s): Erythrocin Stearate, Wintrocin
Chemically Related To: Erythromycin
Pregnancy Category: Use not recommended
Medical Category: Antibacterial, antiacne agent, bowel preparation adjunct
Accepted Indications: Diphtheria, preoperative bowel preparation, genitourinary tract infections, legionnaires' disease, skin and soft tissue infections
Mechanism of Action: Inhibits protein synthesis
Absorption/Distribution: Well absorbed
Half life: 1.4–{endash}2 h
Metabolism: Hepatic
Elimination: Hepatic, renal, fecal
Research Notes: Effective only against actively dividing organism; not all species or strains may be susceptible.
Adult Dosage: 250 mg q.i.d. up to 4 g/d
Child Dosage: 7.5–{endash}12.5 mg/kg q.i.d.
Infant Dosage: 7.5–{endash}12.5 mg/kg q.i.d.
Dosage Forms: Tablets: 250 mg and 500 mg
By System: Bacterial
Frequent Side Effects: GI upset
Occasional Side Effects: Inflammation at injection site, oral candidiasis
Rare Side Effects: Cholestatic jaundice, hearing loss
Antidotal Therapy: May include epinephrine, adrenocorticoids, antihistamines, gastric lavage
Disease States: Cardiac arrhythmias, hearing loss, liver problems
Other Drugs: Xanthines, warfarin, hepatotoxic medications, lincomycin, digoxin, ergotamine, astemizole, theophylline, terfenadine, midazolam
Lab Tests: Bilirubin, alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase
Esmolol
Trade Name(s): Brevibloc
Chemically Related To: Beta-blockers
Pregnancy Category: C
Medical Category: Antiadrenergic, antiarrhythmic
Accepted Indications: Rapid cardiac arrhythmias (short-term control), intraoperative and postoperative tachycardia, intraoperative and postoperative hypertension
Mechanism of Action: Blocks beta1 receptors in cardiac tissue
Half life: 9 min (elimination), 2 min (distribution)
Peak activity: 10–{endash}20 min
Metabolism: Esterases in red blood cells
Elimination: Renal
Adult Dosage: Antiarrhythmic: loading, IV, 0.5 mg/kg for 1 min; maintenance, 0.05 mg/kg/min for 4 min, sequence may be repeated with an increment of 0.05 mg/kg/min; tachycardia or hypertension: initial, IV, 0.25–{endash}0.5 mg/kg for 1 min; maintenance, IV, 0.05 mg/kg/min for 4 min, sequence may be repeated with an increment of 0.05 mg/kg/min
Elderly Dosage: May require adjusted dose
Child Dosage: IV: 0.05 mg/kg/min, dosage may be titrated upward every 10 min to 0.3 mg/kg/min
Dosage Forms: Injection: 10 mg/mL and 250 mg/mL
By System: Vascular
Precautions: 250 mg/mL solution must be diluted before use
Frequent Side Effects: Hypotension
Occasional Side Effects: Confusion, anxiety, flushing, swelling at site of injection, reduced peripheral circulation, drowsiness, tiredness, pale skin, headache, nausea, vomiting
Rare Side Effects: Bradycardia, chest pain, breathing difficulty, fainting, fever, mental depression
Contraindications: Cardiac failure, cardiac shock, AV block, sinus bradycardia
Overdosage: Bradycardia, dizziness, fainting, drowsiness, difficulty breathing, seizures, bluish fingernails
Antidotal Therapy: May include atropine, IV lidocaine or phenytoin, IV fluids, oxygen, vasopressor, glucagon
Disease States: Allergy, asthma, emphysema, CHF, diabetes mellitus
Other Drugs: MAO inhibitors, insulin, xanthines, sympathomimetics, antidiabetics, digoxin, verapamil, propranolol and other beta blockers
Lab Tests: Blood pressure, EKG, heart rate
Estazolam
Trade Name(s): ProSom
Chemically Related To: Benzodiazepines
Scheduled Class: IV
Pregnancy Category: X
Medical Category: Sedative-hypnotic
Accepted Indications: Insomnia
Mechanism of Action: Mediates GABA firing
Absorption/Distribution: 93% protein binding
Half life: 10–{endash}24 h
Peak activity: 0.5–{endash}6 h
Elimination: Renal
Adult Dosage: 1 mg; maximum 2 mg in some patients
Elderly Dosage: 1 mg; small or debilitated older patients may start with 0.5 mg
Child Dosage: Up to 18 y: safety and efficacy not established
Infant Dosage: Safety and efficacy not established
Dosage Forms: Tablets: 1 mg, 2 mg
Warnings: Avoid alcohol; may cause daytime drowsiness
Frequent Side Effects: Ataxia, drowsiness, slurred speech
Occasional Side Effects: Mental depression; confusion; abdominal cramps; blurred vision; other vision changes; changes in libido; constipation; diarrhea; dry mouth; euphoria; headache; increased bronchial secretions; watering of mouth; muscle spasm; nausea; vomiting; urination problems; tachycardia; palpations; trembling; extreme tiredness or weakness
Rare Side Effects: Allergic reaction, behavior problems, leukopenia, thrombocytopenia, extrapyramidal effects, hepatic dysfunction, muscle weakness, paradoxical reactions, phlebitis, venous thrombosis, seizures, anemia, neutropenia, blood dyscrasias, memory impairment
Contraindications: Glaucoma, myasthenia, pulmonary disease
Overdosage: Confusion, bradycardia, decreased reflexes, staggering, severe weakness, drowsiness, trembling, shortness of breath, slurred speech
Antidotal Therapy: May include emesis/gastric lavage, IV fluids, flumazenil
Disease States: Intoxication, coma, hyperkinesis, psychoses, history of drug abuse
Other Drugs: Alcohol, CNS depressants, antacids, cimetidine
Lab Tests: Sodium iodide I 123, sodium iodide I 131, metyrapone
Estradiol
Trade Name(s): Estrace, Estraderm
Chemically Related To: Estrogens
Pregnancy Category: X
Medical Category: Estrogen, oncology drug, prophylactic for osteoporosis
Accepted Indications: Estrogen deficiency; uterine bleeding; carcinomas of the breast and prostate; osteoporosis (prophylaxis)
Unaccepted Indications: Breast engorgement, contraception
Mechanism of Action: Estrogen replacement and reduces release of gonadotropin–{endash}releasing hormone from the hypothalamus
Absorption/Distribution: Moderate to high protein binding; well absorbed; distributed to most body tissues
Metabolism: Hepatic
Elimination: Renal
Research Notes: High affinity for fat tissue
Adult Dosage: 0.5–{endash}2 mg/d
Elderly Dosage: No dose reduction required
Child Dosage: Not recommended
Infant Dosage: Not recommended
Dosage Forms: Tablets: 1 mg and 2 mg; cypionate salt injection: 1 mg/mL and 5 mg/mL; valerate salt injection: 10 mg/mL, 30 mg/mL, and 40 mg/mL; transdermal system: 50 m{mu}g and 100 m{mu}g
By System: Endocrine
Warnings: Possibility of relationship to endometrial and breast cancer; breast-feeding mothers should avoid this drug; possible need for extra calcium
Precautions: Can hasten the premature closing of ends of bones in maturing children
Frequent Side Effects: Abdominal cramping, breast tenderness, nausea
Occasional Side Effects: Mild diarrhea, lightheadedness, amenorrhea, hepatitis
Rare Side Effects: Breast tumors, unopposed estrogen replacement therapy increases risk of uterine cancer in postmenopausal females
Contraindications: Breast cancer, bleeding from vaginal area
Disease States: Hepatic function impairment, hypercalcemia, hepatitis, jaundice, thrombophlebitis
Other Drugs: Hepatotoxic medications, corticotropin, cyclosporine, bromocriptine
Lab Tests: Thyroid function, glucose tolerance, fasting blood glucose, LDL concentration
Administrative Notes: Mandatory patient package insert
Estramustine Phosphate Sodium
Trade Name(s): Emcyt
Chemically Related To: Estradiol and nitrogen mustard
Scheduled Class: Unique compound
Pregnancy Category: D
Medical Category: Antineoplastic
Accepted Indications: Prostatic carcinoma
Absorption/Distribution: Well absorbed
Half life: Multiphasic 20 h
Metabolism: Hepatic
Elimination: Biliary/fecal, renal
Research Notes: Highly localized in prostatic tissue
Adult Dosage: 600 mg/m2 in 3 divided daily doses
Elderly Dosage: Decrease dose
Dosage Forms: Capsules: 140 mg
By System: Rapidly growing cells
Precautions: Avoid immunizations
Frequent Side Effects: Swelling of lower extremities, breast tenderness, decreased libido, diarrhea, nausea
Occasional Side Effects: Insomnia, vomiting
Rare Side Effects: Anemia, leukemia, thrombocytopenia, thrombosis
Contraindications: Thromboembolic disorders, active thrombophlebitis
Antidotal Therapy: May include gastric lavage, monitoring of liver and blood for 6 w
Disease States: Asthma, heart problems, mental depression, epilepsy
Other Drugs: Hepatotoxic medications, vaccines, calcium–{endash}containing products, calcium products, estrogens
Lab Tests: Metyrapone, induced platelet aggregability, sulfobromophthalein test, thyroid function, pyridoxine, serum folate concentrations
Estrogens, Conjugated
Trade Name(s): Premarin
Chemically Related To: Steroids
Pregnancy Category: X
Medical Category: Systemic estrogen, antineoplastic, osteoporosis prophylactic
Accepted Indications: Estrogen deficiency, atrophic vaginitis, female hypogonadism, vulvar squamous hyperplasia, primary ovarian failure, symptoms of menopause, breast carcinoma, prostatic carcinoma, osteoporosis
Unaccepted Indications: Postpartum breast engorgement
Mechanism of Action: Estrogen replacement. Increases DNA and RNA synthesis; reduces release of gonadotropin-releasing hormone
Absorption/Distribution: High distribution, especially to adipose tissue; moderate protein binding
Metabolism: Hepatic, muscle, kidneys, gonads
Elimination: Renal, fecal
Research Notes: Has a direct effect on testes, resulting in reduced concentrations of testosterone
Adult Dosage: 300 m{mu}g/d to 1.25 mg/d cyclically or continuously
Child Dosage: Use with caution
Dosage Forms: Tablets: 300 m{mu}g, 625 m{mu}g, 900 m{mu}g, 1.25 mg, and 2.5 mg; for injection: 25 mg; vaginal cream: 625 m{mu}g/g
By System: Hormonal
Warnings: May cause dental problems; stop taking drug if pregnancy suspected
Precautions: Visit physician regularly
Frequent Side Effects: Breast pain, edema in lower extremities, breast enlargement, cramping, skin irritation, anorexia, nausea
Occasional Side Effects: Amenorrhea, breast tumor, hepatitis, diarrhea, breakthrough bleeding, menorrhagia, gallbladder obstruction, increased or decreased libido, headache, vomiting, hepatitis
Rare Side Effects: Chorea, menorrhagia, unopposed estrogen replacement therapy increases risk of uterine cancer
Contraindications: Breast cancer, vaginal bleeding
Disease States: Endometriosis, gallbladder and liver problems, porphyria, thrombophlebitis, jaundice, hypercalcemia, uterine fibroids, coronary artery disease
Other Drugs: Calcium supplements, corticosteroids, cyclosporine, hepatotoxic medications, bromocriptine, somatropin, tamoxifen, corticotropin, tobacco, somatrem
Lab Tests: Metyrapone, clotting factors, glucose tolerance, triglycerides
Administrative Notes: Injection not compatible with acid pH; take with food
Estrogens, Conjugated/Meprobamate
Trade Name(s): PMB 200, PMB 400
Pregnancy Category: C
Medical Category: Estrogen replacement
Accepted Indications: Menopause with anxiety
Adult Dosage: 1 tablet t.i.d. for 21 d courses, followed by 1 w rest periods
Dosage Forms: Tablets: 0.45 mg/200 mg and 0.45 mg/400 mg
Estrogens, Conjugated/Methyltestosterone
Trade Name(s): Premarin with Methyltestosterone
Pregnancy Category: Not recommended
Medical Category: Androgen/estrogen
Accepted Indications: Menopause vasomotor symptoms
Adult Dosage: 1.25 mg/10 mg/d for 21 d, followed by 7 d of no medication, then 21 d of medication, etc.
Dosage Forms: Tablets: 0.625 mg/5 mg and 1.25 mg/10 mg
Estrogens, Esterified
Trade Name(s): Estratab, Menest
Chemically Related To: Estradiol; mixed compounds
Pregnancy Category: X
Medical Category: Estrogen, antineoplastic, prophylactic for osteoporosis
Accepted Indications: Estrogen deficiency, ovarian failure, menopause, hormonal imbalance-induced uterine bleeding, breast cancer, postmenopausal osteoporosis
Unaccepted Indications: Postpartum breast engorgement
Mechanism of Action: Increases synthesis of DNA and gonadotropin–{endash}releasing hormone, leading to reduction of FSH and LH
Absorption/Distribution: Distributed to most tissues
Peak activity: Within 2 h
Metabolism: Hepatic
Elimination: Renal
Research Notes: Elimination is prolonged in obese patients
Adult Dosage: 300 m{mu}g–{endash}10 mg/d. Dose varies by indication
Elderly Dosage: Same as adult dose
Child Dosage: Not recommended
Infant Dosage: Not recommended
Dosage Forms: Tablets: 300 m{mu}g, 625 m{mu}g, 1.25 mg, and 2.5 mg
By System: Endocrine
Warnings: Stop medication immediately and check with physician if pregnancy is suspected
Precautions: Dental problems possible
Frequent Side Effects: Breast pain or tenderness, peripheral edema, abdominal cramping, anorexia, nausea
Occasional Side Effects: Diarrhea, dizziness, headache, migraine headache, vomiting
Rare Side Effects: Amenorrhea, breakthrough bleeding, breast tumors, chorea, gallbladder obstruction, hepatitis, unopposed estrogen therapy increases risk of uterine cancer
Contraindications: Breast cancer, vaginal bleeding
Disease States: Endometriosis, gallbladder disease, hepatic dysfunction, jaundice, thrombophlebitis, uterine fibroids, hepatic porphyria
Other Drugs: Adrenocorticoids, bromocriptine, calcium supplements, hepatotoxic medications, cyclosporine, somatropin, tamoxifen
Lab Tests: Total serum cholesterol, calcium, clotting factors, sodium and triglycerides, phospholipids, glucose
Administrative Notes: Withdrawal bleeding occurs in many postmenopausal patients with an intact uterus who receive cyclic estrogen therapy with a progestin
Estrogens, Esterified/Methyltestosterone
Trade Name(s): Estratest, Estratest H.S., Premarin with Methyltestosterone
Pregnancy Category: C
Medical Category: Androgen-estrogen
Accepted Indications: Moderate to severe vasomotor symptoms associated with menopause
Unaccepted Indications: Postpartum breast engorgement
Adult Dosage: 625 m{mu}g–{endash}2.5 mg/1.25–{endash}5 mg/d for 21 d courses, followed by 1 w rest periods
Dosage Forms: Tablets: 0.625 mg/1.25 mg, 0.625 mg/5 mg, 1.25 mg/2.5 mg and 1.25 mg/10 mg
Estrone
Trade Name(s): Aquest, Estragyn 5, Estro-A, Estrone `5', Kestrone-5, Wehgen
Chemically Related To: Estrogen
Pregnancy Category: X
Medical Category: Systemic estrogen; antineoplastic
Accepted Indications: Estrogen deficiency, vaginitis, ovarian failure, uterine bleeding, female hypogonadism, vulvar squamous hyperplasia, menopause, prostatic carcinoma
Unaccepted Indications: Postpartum breast engorgement reduction
Absorption/Distribution: Distributed to most tissues, especially adipose tissue
Metabolism: Hepatic, muscle, renal, gonads
Elimination: Renal, fecal
Adult Dosage: Varies by indication
Elderly Dosage: Same as adult dose
Child Dosage: Use with caution
Infant Dosage: Not established
Dosage Forms: Sterile suspension: 2 mg/mL and 5 mg/mL
Warnings: Protect from freezing
Frequent Side Effects: Breast pain, enlargement of breasts, gynecomastia (males), peripheral edema, abdominal cramping, anorexia, nausea, skin irritation
Occasional Side Effects: Amenorrhea, breakthrough bleeding, menorrhagia, spotting, breast tumors, gall bladder obstruction, hepatitis, diarrhea, headache, contact lens intolerance, decreased libido (males), increased libido (females), migraines, vomiting
Contraindications: Breast cancer, vaginal bleeding
Disease States: Endometriosis, jaundice, uterine fibroids, gall bladder disease, hepatic dysfunction, hypercalcemia, porphyria, thrombophlebitis, cerebrovascular disease, coronary artery disease
Other Drugs: Bromocriptine, corticosteroids, calcium supplements, corticotropin, cyclosporine, hepatotoxic medications, tobacco, somatrem, somatropin, tamoxifen
Lab Tests: Glucose tolerance, metyrapone
Estropipate
Trade Name(s): Ogen
Chemically Related To: Ethinyl estradiol
Pregnancy Category: X
Medical Category: Estrogen, prophylactic for osteoporosis
Accepted Indications: Estrogen deficiency, atrophic vaginitis, vulvar squamous hyperplasia, primary ovarian failure, breast cancer, prostatic cancer, prostatic carcinoma
Unaccepted Indications: Postpartum breast engorgement
Mechanism of Action: Reduces release of gonadotropin-releasing hormone from the hypothalamus
Absorption/Distribution: Widely distributed; settles in adipose tissue; moderate protein binding
Metabolism: Hepatic, muscular, renal
Elimination: Renal/fecal
Research Notes: Semisynthetic compound
Adult Dosage: 750 m{mu}g–{endash}6 mg/d cyclically or continuously. Dose varies by indication
Child Dosage: Decrease dosage
Dosage Forms: Tablets: 750 m{mu}g, 1.5 mg, 3 mg, 6 mg
By System: Hormonal
Warnings: Stop medication if pregnancy suspected
Precautions: Dental hygiene should be practiced meticulously
Frequent Side Effects: Breast pain, peripheral edema, nausea, loss of appetite
Occasional Side Effects: Diarrhea, dizziness, headache, decreased libido
Rare Side Effects: Amenorrhea, breast tumors, chorea, hepatitis, unopposed estrogen replacement therapy increases risk of uterine cancer
Contraindications: Breast cancer, abnormal vaginal bleeding
Disease States: Hypercalcemia, thrombophlebitis, endometriosis, gallbladder problems, jaundice
Other Drugs: Cyclosporine, hepatotoxic medications, tamoxifen, somatropin, calcium supplements, bromocriptine
Lab Tests: Fasting blood glucose, glucose tolerance, metyrapone, thyroid function, platelet aggregability
Ethacrynic Acid
Trade Name(s): Edecrin
Chemically Related To: Thiazide diuretics
Pregnancy Category: B
Medical Category: Diuretic, antihypertensive, antihypercalcemic
Accepted Indications: Edema, hypertension, hypercalcemia
Mechanism of Action: Inhibits reabsorption of Na and Cl in loop of Henle
Absorption/Distribution: High protein binding; rapidly absorbed from GI tract
IV: 15–{endash}30 min
Metabolism: Hepatic
Elimination: Renal, biliary/fecal
Research Notes: Oral dosage form: onset of action, 0.5 h; duration of action, 6–{endash}8 h
Adult Dosage: 50–{endash}200 mg/d up to 400 mg/d
Elderly Dosage: Greater risk of circulatory collapse and thromboembolic episodes
Child Dosage: 25 mg/d
Infant Dosage: Not recommended
Dosage Forms: Tablets: 25 mg and 50 mg; injection USP 50 mg
By System: Cardiovascular
Warnings: May increase blood glucose level
Precautions: Use with caution if surgery required and in use of alcohol
Frequent Side Effects: Diarrhea, loss of appetite, orthostatic hypotension
Occasional Side Effects: Electrolyte imbalance (hyponatremia, hypokalemia), ototoxicity, blurred vision, confusion, headache, nervousness
Rare Side Effects: Blood in urine, rash, gout, thrombocytopenia, pain at site of injection
Disease States: Anuria, diabetes mellitus, gout, pancreatitis, myocardial infarction, hearing problems
Other Drugs: Anticoagulants, lithium, hypokalemia–{endash}causing medications, NSAIDs, alcohol, digitalis
Lab Tests: BUN, serum uric acid, blood and urine glucose concentrations, magnesium and potassium concentrations, calcium and chloride levels
Administrative Notes: Injection solution is physically incompatible with whole blood and its derivatives; drug should be taken with meals; additional potassium may be needed
Ethambutol Hydrochloride
Trade Name(s): Myambutol
Pregnancy Category: B
Medical Category: Antimycobacterial
Accepted Indications: Tuberculosis
Mechanism of Action: Suppresses multiplication of mycobacteria by interfering with RNA synthesis
Absorption/Distribution: Rapid absorption (75–{endash}80%) from GI tract; distributed everywhere except CSF; low protein binding
Half life: 3–{endash}4 h
Metabolism: Hepatic
Elimination: Renal, fecal
Research Notes: Therapy may be required for up to several y or indefinitely
Adult Dosage: Initial treatment 500 mg–{endash}2.5 g/d
Elderly Dosage: Age-related decrease in renal function may necessitate adjustment in dosage
Child Dosage: Not established
Infant Dosage: Not established
Dosage Forms: Tablets: 100 mg and 400 mg
Warnings: May cause optic neuritis
Precautions: Continue medicine for full course of treatment
Occasional Side Effects: Acute gout or hyperuricemia, GI disturbances, headache, confusion, and disorientation
Rare Side Effects: Hypersensitivity, peripheral neuritis, retrobulbar optic neuritis
Disease States: Gout, optic neuritis, renal function impairment
Other Drugs: Neurotoxic medications
Lab Tests: Uric acid
Ethchlorvynol
Trade Name(s): Placidyl
Chemically Related To: Non-barbiturate depressants
Scheduled Class: IV
Abuse Potential: Mild
Pregnancy Category: C
Medical Category: Sedative-hypnotic
Accepted Indications: Insomnia (has generally been replaced by other sedative-hypnotic agents)
Absorption/Distribution: Rapidly absorbed from GI tract
Half life: 10–{endash}20 h
Metabolism: Hepatic
Elimination: Renal
Adult Dosage: 500 mg–{endash}1 g
Elderly Dosage: Dosage should be decreased
Dosage Forms: Capsules: 200 mg, 500 mg, and 750 mg
By System: CNS subcortical nuclei
Warnings: Medication should not be used for periods exceeding 1 w
Frequent Side Effects: Blurred vision, dizziness or lightheadedness, indigestion, nausea or vomiting, numbness of face, stomach pain, unpleasant aftertaste, extreme tiredness or weakness
Occasional Side Effects: Paradoxical excitation reaction, thrombocytopenia
Rare Side Effects: Cholestatic jaundice, withdrawal symptoms
Overdosage: Continuing confusion, severe weakness, shortness of breath or slow and troubled breathing, slurred speech, staggering, bradycardia
Antidotal Therapy: May include supportive measures
Disease States: Alcoholism, drug abuse, hepatic or renal function impairment, mental depression, uncontrolled pain, porphyria
Other Drugs: Alcohol, CNS antidepressants, anticoagulants, tricyclic antidepressants
Ethinamate
Trade Name(s): Valmid
Scheduled Class: IV
Pregnancy Category: C
Medical Category: Sedative-hypnotic
Accepted Indications: Short-term insomnia (has generally been replaced by other sedative-hypnotic agents)
Mechanism of Action: Unknown
Absorption/Distribution: Rapidly absorbed
Half life: 2.5 h
Elimination: Renal
Adult Dosage: 500 mg–{endash}1 g 20 min before bedtime
Child Dosage: Up to 15 y: not established
Infant Dosage: Not established
Dosage Forms: Capsules: 500 mg
Frequent Side Effects: Allergic reaction
Occasional Side Effects: Indigestion, abdominal pain
Rare Side Effects: Daytime drowsiness, thrombocytopenia
Overdosage: Bradycardia, slurred speech, confusion
Antidotal Therapy: May include IV fluids, charcoal, dialysis
Disease States: Alcoholism, drug abuse, depression, intractable pain
Other Drugs: Alcohol, CNS depressants
Lab Tests: Phentolamine, urinary steroid
Ethinyl Estradiol
Trade Name(s): Estinyl
Chemically Related To: Diethylstilbestrol
Pregnancy Category: X
Medical Category: Systemic estrogen, antineoplastic, prophylactic for osteoporosis
Accepted Indications: Estrogen deficiency, atrophic vaginitis, female hypogonadism, symptoms of menopause, breast and prostatic carcinoma, osteoporosis (prophylaxis)
Unaccepted Indications: Postpartum breast engorgement, postcoital contraceptive
Mechanism of Action: Estrogen replacement. Reduces the release of gonadotropin–{endash}releasing hormone leading to a reduction in release of FSH and LH
Absorption/Distribution: Distributed to most tissues; higher affinity for adipose tissue; moderate to high protein binding
Metabolism: Hepatic
Elimination: 65% renal; some percentage fecal
Research Notes: May predispose patient to bleeding of gingival tissue
Adult Dosage: 50 m{mu}g–{endash}3 mg/d. Dose varies by indication
Elderly Dosage: No demonstration of specific problems
Child Dosage: May accelerate epiphyseal closure; should be used with caution in children and adolescents in whom bone growth is not complete
Infant Dosage: Not recommended
Dosage Forms: Tablets: 20 m{mu}g, 50 m{mu}g, and 500 m{mu}g
By System: Endocrine
Warnings: Stop medication immediately and check with physician if pregnancy is suspected
Frequent Side Effects: Breast pain or tenderness, peripheral edema, gynecomastia, abdominal cramping, anorexia, nausea
Occasional Side Effects: Diarrhea, dizziness, headache, intolerance to contact lenses, migraine headache
Rare Side Effects: Amenorrhea, gallbladder obstruction, hepatitis, chorea, increased risk of uterine cancer if unopposed estrogen replacement therapy is used
Contraindications: Breast cancer, abnormal and unexplained vaginal bleeding, thrombophlebitis
Disease States: Endometriosis, gallbladder disease, hepatic dysfunction, jaundice, thrombophlebitis, uterine fibroids
Other Drugs: Adrenocorticoids, bromocriptine, calcium supplements, hepatotoxic medications, somatropin, tamoxifen
Lab Tests: Fasting blood glucose, glucose tolerance, thyroid function, calcium
Administrative Notes: Administer lowest effective dose
Ethinyl Estradiol/Ethynodiol Diacetate
Trade Name(s): Demulen 1/35-21, 1/35-28, 1/50-21, 1/50-28
Pregnancy Category: C
Medical Category: Systemic contraceptive, estrogen-progestin
Accepted Indications: Pregnancy prophylaxis, endometriosis, female hypogonadism, polycystic ovary syndrome
Unaccepted Indications: Pregnancy test, treatment of threatened or habitual abortion
Adult Dosage: 21 d cycle: 1 tablet/d for 21 d; 28 d cycle: 1 tablet/d for 28 d
Dosage Forms: Tablets: 35 m{mu}g/1 mg and 50 m{mu}g/1 mg
Ethinyl Estradiol/Levonorgestrel
Trade Name(s): Levlen 21, 28; Nordette-21, -28; Tri-Levlen 21, 28; Triphasil 21, 28
Pregnancy Category: C
Medical Category: Systemic contraceptive, estrogen-progestin
Accepted Indications: Pregnancy prophylaxis, endometriosis, female hypogonadism, polycystic ovary syndrome
Unaccepted Indications: Pregnancy test, treatment of threatened or habitual abortion
Adult Dosage: 21 d cycle: 1 tablet/d for 21 d; 28 d cycle: 1 tablet/d for 28 d
Dosage Forms: Tablets: monophasic formula: 30 m{mu}g/150 m{mu}g; triphasic formula also available
Ethinyl Estradiol/Norethindrone
Trade Name(s): Brevicon, Genora, Jenest, Loestrin, ModiCon, Nelova, Norethin, Norinyl, Ortho-Novum, Ovcon, Synphasic, Tri-Norinyl
Pregnancy Category: X
Medical Category: Oral contraceptive
Accepted Indications: Pregnancy prophylaxis, hypermenorrhea
Adult Dosage: 21 day cycle: 1 tablet/d for 21 d; 28 day cycle: 1 tablet/d for 28 d
Dosage Forms: Monophasic 21 d cycle formula: 35 m{mu}g/400 m{mu}g; 35 m{mu}g/500 m{mu}g; 35 m{mu}g/1 mg and 50 m{mu}g/1 mg; biphasic and triphasic formulas also available
Ethinyl Estradiol/Norgestrel
Trade Name(s): Lo/Ovral, Ovral
Pregnancy Category: X
Medical Category: Systemic contraceptive, estrogen-progestin, postcoital contraceptive
Accepted Indications: Pregnany prophylaxis, endometriosis, female hypogonadism, polycystic ovary syndrome
Unaccepted Indications: Pregnancy test, treatment of threatened or habitual abortion
Adult Dosage: 21 d cycle: 1 tablet/d for 21 d; 28 d cycle: 1 tablet for 28 d
Dosage Forms: Tablets: 30 m{mu}g/300 m{mu}g and 50 m{mu}g/500 m{mu}g
Ethionamide
Trade Name(s): Trecator-SC
Chemically Related To: Unique compound
Pregnancy Category: Not recommended
Medical Category: Antimycobacterial
Accepted Indications: Tuberculosis
Mechanism of Action: Inhibits peptide synthesis
Absorption/Distribution: Rapidly absorbed; widely distributed in most tissues and fluids
Half life: 3 h
Metabolism: Hepatic
Elimination: Renal
Research Notes: Not all species or strains of a particular organism may be susceptible to ethionamide
Adult Dosage: 250 mg–{endash}1 g/d
Child Dosage: Up to 750 mg
Infant Dosage: Same as child dose
Dosage Forms: Tablets: 250 mg
Warnings: Finish entire prescription even if symptoms subside; should be administered concurrently with other antitubercular drugs
Precautions: Use caution if blurred vision or loss of vision occurs; take pyridoxine concurrently to prevent or minimize signs of peripheral neuritis
Frequent Side Effects: GI disturbances, orthostatic hypotension
Occasional Side Effects: Gynecomastia, hepatitis or jaundice, peripheral neuritis, psychiatric disturbances
Rare Side Effects: Goiter or hypothyroidism, hypoglycemia, optic neuritis, rash
Disease States: Diabetes mellitus, severe hepatic function impairment
Other Drugs: Cycloserine, neurotoxic medications, pyridoxine
Lab Tests: Serum alanine aminotransferase, serum aspartate aminotransferase
Administrative Notes: Take with food if GI irritation occurs
Ethopropazine Hydrochloride
Trade Name(s): Parsidol
Chemically Related To: Phenothiazines
Pregnancy Category: C
Medical Category: Antidyskinetic
Accepted Indications: Parkinsonism, extrapyramidal reactions, athetosis
Mechanism of Action: Blocks central cholinergic receptors to balance cholinergic and dopaminergic receptor activity
Absorption/Distribution: Well absorbed from GI tract
Adult Dosage: 50–{endash}600 mg/d
Elderly Dosage: May predispose elderly patients to glaucoma; memory may become severely impaired
Child Dosage: Not established
Infant Dosage: Not established
Dosage Forms: Tablets: 10 mg and 50 mg
By System: CNS, subcortical nuclei
Warnings: Avoid alcohol and CNS depressants; avoid use of antacids or antidiarrheal medication within 1 h of taking medication
Precautions: May increase eye sensitivity to bright light; use caution during exercise and hot weather
Frequent Side Effects: Mild anticholinergic effects (blurred vision, constipation, decreased sweating, painful urination, nausea or vomiting, dry mouth)
Occasional Side Effects: Headache, memory loss, muscle cramps, hypotension, sore tongue
Rare Side Effects: Confusion, increased intraocular pressure
Overdosage: Anticholinergic effects, CNS depression or stimulation, psychosis
Antidotal Therapy: May include emesis/gastric lavage; physostigmine; diazepam and pilocarpine
Disease States: Cardiac arrhythmias, tardive dyskinesia, extrapyramidal reactions, hypertension, myasthenia gravis, urinary retention
Other Drugs: Alcohol, CNS depressants, anticholinergics, MAO inhibitors, antacids, chlorpromazine, adsorbent antidiarrheals
Administrative Notes: When drug is to be discontinued, dose should be reduced gradually to prevent sudden increase in adverse symptoms
Ethosuximide
Trade Name(s): Zarontin
Pregnancy Category: Problems in humans not documented
Medical Category: Anticonvulsant
Accepted Indications: Absence seizure pattern, epilepsy
Mechanism of Action: May increase seizure threshold
Absorption/Distribution: Rapid and complete, distributed to all body tissues except fat
Half life: 56–{endash}60 h
Metabolism: Hepatic
Elimination: Renal
Adult Dosage: 15–{endash}30 mg/kg/d up to 1.5 g/d
Elderly Dosage: Same as adult dose
Child Dosage: Under 6 y: 15–{endash}40 mg/kg/d; 6 y and over: same as adult dose
Infant Dosage: 15–{endash}40 mg/kg/d
Dosage Forms: Capsules: 250 mg; syrup: 250 mg/5 mL
Frequent Side Effects: Anorexia, ataxia, hiccups, Stevens-Johnson syndrome, systemic lupus erythematosus, dizziness, headache, stomach cramps
Occasional Side Effects: Irritability, mental depression, difficult concentration, nightmares, unusual tiredness
Rare Side Effects: Blood dyscrasias, leukopenia, aplastic anemia, eosinophilia, tonic-clonic convulsions, mood changes, rash
Overdosage: CNS depression, severe nausea and vomiting, respiratory depression
Antidotal Therapy: May include emesis, gastric lavage, activated charcoal, cathartics
Disease States: Blood dyscrasias, hepatic function impairment, renal function impairment, porphyria
Other Drugs: CNS depressants, haloperidol
Lab Tests: Blood cell counts
Ethynodiol Diacetate
Trade Name(s): Not available as a single agent
Chemically Related To: Progesterones
Medical Category: Progestin
Accepted Indications: When used in combination with estrogens: pregnancy prophylaxis, endometriosis, polycystic ovary syndrome
Mechanism of Action: Suppresses ovulation by inhibiting secretion of FSH and LH
Absorption/Distribution: Readily absorbed from GI tract
Metabolism: Hepatic
Elimination: Renal
Etodolac
Trade Name(s): Lodine
Chemically Related To: Aspirin
Pregnancy Category: C
Medical Category: NSAID, analgesic, anti-inflammatory, antipyretic
Accepted Indications: Pain and osteoarthritis
Unaccepted Indications: Rheumatoid arthritis
Mechanism of Action: Inhibits the synthesis of prostaglandins
Absorption/Distribution: Rapidly absorbed; extensively distributed; very high protein binding
Half life: Approximately 1 h
Metabolism: Hepatic
Elimination: Renal
Research Notes: Duration of action 4–{endash}5 h; onset of action within 30 min
Adult Dosage: 400 mg b.i.d. or t.i.d.
Elderly Dosage: NSAID-induced side effects more dangerous to the elderly
Child Dosage: Not established
Infant Dosage: Not established
Dosage Forms: Capsules: 200 mg and 300 mg
By System: CNS
Warnings: Alcohol use can increase GI irritation
Precautions: Sensitivity to light possible; increased chance of bleeding if surgery is required
Occasional Side Effects: Lightheadedness, headache, tinnitus, constipation, vomiting, gastric irritation
Rare Side Effects: Hypertension, edema, GI bleeding
Contraindications: Nasal polyps
Overdosage: Lethargy, drowsiness, abdominal pain, nausea, vomiting, GI hemorrhage, acute renal failure, convulsions, coma
Antidotal Therapy: Do not use ipecac but induce vomiting with activated charcoal; monitor vital signs
Disease States: Asthma; peptic ulcer; diabetes; systemic lupus erythematosus; renal or hepatic impairment
Other Drugs: Anticoagulants, thrombolytic agents, additional NSAIDs
Lab Tests: Bleeding times, liver function tests
Administrative Notes: Concurrent use with a narcotic allows less narcotic to be used and increases control of pain; food slows absorption of the drug, but peak activity is not affected
Etoposide
Trade Name(s): VePesid
Chemically Related To: Unique compound
Pregnancy Category: D
Medical Category: Antineoplastic
Accepted Indications: Testicular, lung and bladder carcinomas; Hodgkin's and non-Hodgkin's lymphomas; acute myelocytic leukemia;
Mechanism of Action: Inhibits DNA synthesis
Absorption/Distribution: Variable bioavailability; high protein binding
Half life: 7 h
Metabolism: Hepatic
Elimination: Renal, fecal, biliary
Research Notes: Cell cycle-dependent; phase-specific
Adult Dosage: Lung cancer small cell: oral: 70 mg/m2/d for 4 d to 100 mg/m2 for 5 d; repeat every 3–{endash}4 w
Elderly Dosage: Same as adult dose
Dosage Forms: Capsules: 50 mg; for injection: 20 mg/mL
By System: Rapidly growing tissues
Warnings: Avoid immunizations; in combination therapy, take each medication at right time
Precautions: Take medication even with GI distress
Frequent Side Effects: Anemia, leukopenia, thrombocytopenia, nausea and vomiting, hair loss
Occasional Side Effects: Stomatitis, tiredness, diarrhea
Rare Side Effects: Anaphylaxis, chemical phlebitis, neurotoxicity
Disease States: Bone marrow depression, chickenpox, infection, liver/kidney problems, herpes zoster
Other Drugs: Blood dyscrasia–{endash}causing medications, live virus vaccines, bone marrow depressants, radiation therapy
Administrative Notes: Dilute injection with 5% dextrose or 0.9% sodium chloride
Etretinate
Trade Name(s): Tegison
Chemically Related To: Unique compound
Pregnancy Category: X, major teratogenic risk
Medical Category: Antipsoriatic
Accepted Indications: Psoriasis, keratinization disorders, oral lichen planus
Mechanism of Action: Normalization of epidermis
Absorption/Distribution: Absorbed in small intestine; distributed especially to adipose tissue; high protein binding
Half life: 120 d
Metabolism: Hepatic
Elimination: Biliary, renal
Research Notes: To treat relapses, give same dosage as used in first treatment
Adult Dosage: 750 m{mu}g–{endash}1 mg/kg/d up to 1.5 mg/kg/d
Child Dosage: Do not use unless all other therapies have failed
Infant Dosage: Do not use unless all other therapies have failed
Dosage Forms: Capsules: 10 mg and 25 mg
By System: Dermatologic
Warnings: May cause dizziness and blurred vision; do not take if pregnant
Precautions: Avoid sun/sun lamp
Frequent Side Effects: Joint pain, muscle cramps, chapped lips, headache, nosebleed, tiredness
Occasional Side Effects: Double vision, hepatitis, earache, dizziness, nausea, sore tongue
Rare Side Effects: Amnesia, anxiety, confusion, bleeding gums, ear infection, photophobia
Disease States: Heart or liver problems, diabetes mellitus, obesity, hypertriglyceridemia
Other Drugs: Alcohol, medicated soaps and cleansers, acne preparations with peeling agent, vitamin A, tetracyclines, photosensitizing medications
Lab Tests: White blood cell counts, fasting blood glucose, BUN, platelet counts, serum cholesterol, HDLs, red blood cell counts
Administrative Notes: Take with milk or fatty foods. Avoid pregnancy and do not donate blood for 2 years or longer after discontinuing drug. Rule out pregnancy before use. Ensure reliable contraception.
Famotidine
Trade Name(s): Pepcid
Chemically Related To: Cimetidine
Pregnancy Category: B
Medical Category: Histamine H2 receptor antagonist, antiulcer agent, gastric acid secretion inhibitor
Accepted Indications: Duodenal ulcer, gastric ulcer, hypersecretory conditions, Zollinger-Ellison syndrome, mastocytosis, adenoma
Unaccepted Indications: Minor digestive complaints
Mechanism of Action: Competitive inhibition of histamine
Absorption/Distribution: Rapid, incomplete absorption; low protein binding
Half life: 2.5–{endash}3.5 h
IV: 0.5 h
Metabolism: Hepatic
Elimination: Renal
Research Notes: Onset of action, 1 h
Adult Dosage: 40–{endash}80 mg/d
Child Dosage: Tablets and oral suspension: more than 10 kg: 1–{endash}2 mg/kg/d in 2 divided doses; less than 10 kg: 1–{endash}2 mg/kg/d in 3 divided doses; Injection: not established
Dosage Forms: Tablets: 20 mg and 40 mg; injection: 10 mg/mL; for oral suspension, 40 mg/5 mL
By System: GI
Warnings: Avoid alcohol; discontinue smoking
Precautions: Consult physician if condition continues
Occasional Side Effects: Constipation, diarrhea, headache
Rare Side Effects: Bradycardia, tightness in chest, fever, thrombocytopenia
Antidotal Therapy: No specific antidote; supportive treatment may include emesis/gastric lavage, IV diazepam, atropine, lidocaine
Disease States: Cirrhosis, kidney/liver problems
Other Drugs: Bone marrow depressants, ketoconazole, sucralfate
Lab Tests: Gastric acid secretion test; skin tests with allergen extracts; transaminase
Administrative Notes: Treatment rarely continues beyond 8 w; avoid food that causes gastric irritation
Felodipine
Trade Name(s): Plendil, Renedil
Chemically Related To: Calcium channel blockers
Pregnancy Category: C
Medical Category: Antianginal, antihypertensive
Accepted Indications: Angina, hypertension, Raynaud's phenomenon
Mechanism of Action: Inhibits calcium ion entry
Absorption/Distribution: Almost completely absorbed
Half life: Polyphasic 11–{endash}16 h (terminal)
Metabolism: Hepatic
Elimination: Renal, biliary/fecal
Research Notes: Onset of action, 2–{endash}5 h; duration of action, 24 h
Adult Dosage: Antihypertensive, initial: 5 mg once daily, dosage adjusted as needed; maintenance: 5–{endash}10 mg once daily. Antianginal, 10 mg once daily
Elderly Dosage: Lower dosage may be required
Child Dosage: Safety and efficacy not established
Infant Dosage: Safety and efficacy not established
Dosage Forms: Extended-release tablets: 5 mg and 10 mg
By System: Vascular
Frequent Side Effects: Peripheral edema, headache
Occasional Side Effects: Rash, angina, tachycardia, constipation, diarrhea, dizziness, flushing, feeling of warmth, nausea, extreme tiredness
Rare Side Effects: Hypotension, gingival hyperplasia, mental depression, dry mouth
Contraindications: Hypotension, heart failure, liver impairment, acute myocardial infarction
Disease States: Bradycardia
Other Drugs: Hydrocarbon inhalation anesthetics, NSAIDs, cimetidine, estrogens, hypotension–{endash}producing medications, lithium, prazosin, procainamide, quinidine, medications prolonging QT interval, sympathomimetics
Lab Tests: EKG, QT interval, T-wave, prolactin
Fenoprofen Calcium
Trade Name(s): Nalfon
Chemically Related To: Aspirin
Pregnancy Category: B
Medical Category: Antirheumatic, analgesic, antigout
Accepted Indications: Rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, psoriatic arthritis, pain, acute attacks of gout or calcium pyrophosphate deposition disease
Mechanism of Action: Inhibits the activity of the enzyme cyclo-oxygenase, which prevents the formation of prostaglandins
Absorption/Distribution: Rapid absorption
Half life: 3 h (elimination)
Peak activity: 1–{endash}2 h
Metabolism: Hepatic
Elimination: Renal
Adult Dosage: 800–{endash}2400 mg/d
Elderly Dosage: Same as adult dosage
Child Dosage: Safety and efficacy not established
Infant Dosage: Safety and efficacy not established
Dosage Forms: Capsules: 200 mg and 300 mg; tablets: 600 mg
By System: Pain receptor mediation in peripheral nervous system and CNS
Frequent Side Effects: Dermatitis
Occasional Side Effects: Confusion, GI irritation
Rare Side Effects: Edema, arrhythmia, convulsions, mental depression, dermatitis, necrolysis, Stevens-Johnson syndrome, peptic ulcer
Contraindications: Anemia or asthma
Disease States: Nasal polyps, asthma, peptic ulcer, hypertension, sepsis, hemophilia, renal function impairment, stomatitis, bronchospasm, systemic lupus erythematosus
Other Drugs: Acetaminophen, potassium supplements, antacids, insulin, triamterene, aspirin, radiation therapy, colchicine, gold compounds, methotrexate, nephrotoxic medications, verapamil, phenobarbital, platelet aggregation inhibitors, probenecid
Lab Tests: Bleeding time, serum potassium concentrations, liver function
Administrative Notes: Fenoprofen excreted in breast milk in very small quantities; use caution in patients with genitourinary tract problems
Fentanyl (Transdermal)
Trade Name(s): Duragesic, Sublimaze
Chemically Related To: Meperidine
Scheduled Class: II
Abuse Potential: High
Pregnancy Category: C
Medical Category: Analgesic
Accepted Indications: Chronic pain
Unaccepted Indications: Acute, mild, or intermittent pain
Mechanism of Action: Binds with stereospecific receptors at many sites within the CNS, alters processes affecting perception and emotional response to pain
Absorption/Distribution: Some fentanyl released relatively rapidly, most located in reservoir layer
Half life: 17 h (single application), 13–{endash}31 h (multiple applications)
Peak activity: 24–{endash}72 h
Metabolism: Hepatic
Elimination: Renal, fecal
Research Notes: Onset of action, 12–{endash}24 h; duration of action, 72 h
Adult Dosage: Topical to skin of torso q72h
Elderly Dosage: Lower dosage may be required
Child Dosage: Up to 18 y: safety and efficacy not established
Infant Dosage: Safety and efficacy not established
Dosage Forms: Transdermal system: 2.5 mg, 5 mg, 7.5 mg, and 10 mg
By System: CNS
Warnings: Do not operate dangerous machinery
Frequent Side Effects: Apnea, CNS depression, difficulty in breathing, hypoventilation, hallucinations, urinary retention, anxiety, confusion, GI effects, headache, itching, nausea, sweating, vomiting
Occasional Side Effects: Chest pain; CNS effects; arrhythmia; localized skin reaction; spitting of blood; agitation; hypotension; bloated feeling; burning, tingling, or crawling sensation in the skin; memory loss; unusual dreams
Rare Side Effects: Abdominal distention, amblyopia, bladder pain, bradycardia, urination cessation, CNS toxicity, exfoliative dermatitis, fluid-filled blisters, urge to urinate, respiratory problems, asthma
Overdosage: Cold, clammy skin; confusion; convulsions; dizziness; drowsiness; nervousness; restlessness; weakness; hypotension; pinpoint pupils; bradycardia; troubled breathing; unconsciousness
Antidotal Therapy: May include removal of transdermal system; administration of naloxone, atropine, IV fluids
Disease States: Diarrhea associated with pseudomembranous colitis; diarrhea caused by poisoning; acute respiratory depression; acute asthma; respiratory impairment; inflammatory bowel disease, head injury, arrhythmias
Other Drugs: Alcohol, CNS depressants, naltrexone, opioid analgesics, monoamine oxidase inhibitors
Administrative Notes: Short-acting opioid may be applied during first 24 h
Fentanyl Citrate
Trade Name(s): Sublimaze
Scheduled Class: II
Pregnancy Category: C
Medical Category: Anesthesia adjunct, analgesic
Accepted Indications: General anesthesia adjunct, postoperative pain
Mechanism of Action: Affects perception and emotional response to pain
Half life: Triphasic, 1.7 min–{endash}3.6 h
IM: 20–{endash}30 min
IV: 3–{endash}5 min
Metabolism: Hepatic
Elimination: Hepatic
Research Notes: Onset of action, 1–{endash}2 min IV, 7–{endash}15 min IM; duration of action, 0.5–{endash}1 h IV; 1–{endash}2 h IM
Adult Dosage: Up to 150 m{mu}g/kg as primary anesthetic in major surgery; 2–{endash}50 m{mu}g as anesthesia adjunct
Elderly Dosage: Lower dosage required
Child Dosage: 2–{endash}12 y: IV, 2–{endash}3 m{mu}g/kg
Infant Dosage: Up to 2 y: not established
Dosage Forms: Injection: 50 m{mu}g/mL
Frequent Side Effects: Bradycardia, hypotension, respiratory depression, drowsiness, nausea, vomiting
Occasional Side Effects: Arrhythmia, confusion, biliary spasm, blurred vision, constipation, ureteral spasm
Rare Side Effects: Bronchospasm, circulatory depression, convulsions, dermatitis, dysesthesia, laryngospasm, mental depression, paradoxical CNS excitation
Overdosage: Cold, clammy skin; dizziness; drowsiness; restlessness; pinpoint pupils; weakness
Antidotal Therapy: May include atropine, naloxone, IV fluids, vasopressors
Disease States: Bradyarrhythmias, compromised cardiac reserve, head injury, hepatic function impairment, cirrhosis, renal function impairment, respiratory impairment, hypothyroidism
Other Drugs: Benzodiazepines, buprenorphine, CNS depressants, hepatic enzyme inhibitors, naltrexone, MAO inhibitors
Ferrous Fumarate
Trade Name(s): Feostat Drops, Feostat, Fumerin, Hemocyte, Ircon, Span-FF
Chemically Related To: Iron
Pregnancy Category: A
Medical Category: Antianemia
Accepted Indications: Iron deficiency anemia
Mechanism of Action: Provides elemental iron
Absorption/Distribution: Absorption increased when stores depleted; high protein binding
Metabolism: Stored in blood and liver
Research Notes: Contains 33% elemental ferrous iron
Adult Dosage: 600–{endash}800 mg/d
Child Dosage: Extended-release capsules not recommended; oral solution, oral suspension, tablets: 3–{endash}9 mg/kg/d
Dosage Forms: Extended-release capsules: 325 mg; oral solution: 45 mg/0.6 mL; oral suspension: 100 mg/5 mL; tablets: 63 mg, 195 mg, 200 mg, 300 mg and 325 mg; chewable tablets: 100 mg
Warnings: Keep out of reach of children; elderly may require increased dosage
Precautions: Post number of poison control center and emergency room; infants are sensitive to iron accumulation
Frequent Side Effects: Abdominal pain, cramping, constipation, diarrhea, nausea/vomiting, allergic reaction, backache or muscle pain, dizziness, chills, fever, headache
Occasional Side Effects: Dark urine, stained teeth, heartburn
Rare Side Effects: Contact irritation
Contraindications: Hemochromatosis, hemosiderosis, anemic conditions
Overdosage: Diarrhea, fever, nausea/vomiting, bluish lips, fingernails, drowsiness, convulsions, tachycardia
Antidotal Therapy: May include syrup of ipecac/emesis, IV sodium bicarbonate, deferoxamine administered slowly IM or IV, exchange transfusion, maintain fluid-electrolyte balance
Disease States: Alcoholism, asthma, liver or kidney problems, peptic ulcer, rheumatoid arthritis
Other Drugs: Acetohydroxamine acid, etidronate, dimercaprol, tetracyclines, zinc supplements, cimetidine
Lab Tests: Bilirubin, calcium, iron concentrations, skeletal imaging, occult blood in stools
Administrative Notes: Warn patients or caregivers of toxic effects of overdose, especially in children; patients should eat lean red meat for additional iron
Ferrous Fumarate/Folic Acid
Trade Name(s): Fumatinic, Hemocyte-F, Ircon-FA
Pregnancy Category: C
Medical Category: Hematinic
Accepted Indications: Anemia
Adult Dosage: 100–{endash}200 mg/d in 3 divided doses
Elderly Dosage: Same as adult dose
Child Dosage: 6 m–{endash}2 y: up to 6 mg/kg/d in 3–{endash}4 divided doses; 2–{endash}12 y: 3 mg/kg/d in 3–{endash}4 divided doses
Infant Dosage: 10–{endash}25 mg/d in 3–{endash}4 divided doses
Dosage Forms: Tablet: 82 mg/0.8 mg; 90 mg/1 mg; and 106.9 mg/1 mg
Ferrous Fumarate/Folic Acid/Multivitamins
Trade Name(s): Hemocyte Plus, Nephro-Vite Rx and FE, Parulex, Theragenerix-H, Theragran Hematinic, Vitafol, Zodeac-100
Pregnancy Category: C
Medical Category: Hematinic
Accepted Indications: Anemia
Adult Dosage: 100–{endash}200 mg/d in 3 divided doses
Elderly Dosage: Same as adult dose
Child Dosage: 6 m–{endash}2y: up to 6 mg/kg/d in 3–{endash}4 divided doses; 2–{endash}12 y: 3 mg/kg/d in 3-4 divided doses
Infant Dosage: 10–{endash}25 mg/d in 3–{endash}4 divided doses
Dosage Forms: Tablets: 60 mg/1 mg, 65 mg/1 mg, 66.7 mg/0.33 mg, 100 mg/ 0.1 mg, 100 mg/1 mg, 106 mg/1 mg
Ferrous Gluconate
Trade Name(s): Fergon, Ferralet, Simron
Chemically Related To: Iron
Pregnancy Category: C
Medical Category: Antianemic
Accepted Indications: Iron deficiency anemia
Mechanism of Action: Iron transported to bone marrow for red blood cell production
Half life: 6 h
Elimination: No elimination system exists
Adult Dosage: Capsules: 325 mg q.i.d. to a maximum of 650 mg q.i.d.; elixir: 300 mg q.i.d. to a maximum of 650 mg q.i.d.; syrup: 300–{endash}600 mg q.i.d.; tablets: 325–{endash}650 mg q.i.d.
Elderly Dosage: May require larger dose
Child Dosage: 8 mg/kg/d
Dosage Forms: Capsules: 86 mg and 325 mg; elixir: 300 mg/5 mL; tablets: 300 mg, 320 mg, and 325 mg
By System: Hemic
Frequent Side Effects: Cramping, soreness, nausea, diarrhea
Occasional Side Effects: Constipation
Contraindications: Hemochromatosis, hemosiderosis
Overdosage: Bluish-colored fingertips, clammy skin, tachycardia, diarrhea
Antidotal Therapy: May include transfer to emergency room, ipecac, deferoxamine
Disease States: Alcoholism, asthma, peptic ulcer, rheumatoid arthritis
Other Drugs: Acetohydroxamic acid, dimercaprol, etidronate, tetracyclines
Lab Tests: Bilirubin, skeletal imaging
Ferrous Sulfate
Trade Name(s): Feosol, Fer-In-Sol, Fero-Gradumet
Chemically Related To: Iron
Pregnancy Category: C
Medical Category: Antianemic
Accepted Indications: Iron deficiency anemia
Mechanism of Action: Increases oxygen transport in the blood
Absorption/Distribution: Absorption increases when iron in body depleted
Half life: 6 h
Elimination: No physiologic system of elimination; recycles itself
Research Notes: Contains 20% elemental ferrous iron
Adult Dosage: 300 mg once or twice daily
Child Dosage: Extended release and enteric-coated forms not recommended; other forms: 5–{endash}30 mg/kg/d 1–{endash}3 times daily
Dosage Forms: Dried capsules: 159 mg and 190 mg; extended-release capsules: 150 mg and 250 mg; elixir: 220 mg/5 mL; oral solution: 75 mg/0.6 mL, 90 mg/5 mL, and 125 mg/mL; tablets: 195 mg, 300 mg and 325 mg; dried tablets: 200 mg; enteric-coated tablets: 300 mg and 325 mg; extended-release tablets: 525 mg; dried extended-release tablets: 160 mg
By System: Systemic
Warnings: Overdose may be very toxic, especially in children; extreme caution in neonates; elderly may require increased dose
Precautions: Post numbers of emergency and poison control centers
Frequent Side Effects: Stomach cramps, constipation, diarrhea, nausea/vomiting
Occasional Side Effects: Dark urine, stained teeth, heartburn
Rare Side Effects: Contact irritation
Contraindications: Hemochromatosis, hemosiderosis, anemia conditions
Overdosage: Diarrhea, fever, nausea/vomiting, bluish lips and fingernails, convulsions, tachycardia, cramping
Antidotal Therapy: Immediate medical treatment, may include syrup of ipecac/gastric lavage, IV sodium bicarbonate, deferoxamine
Disease States: Alcoholism, asthma, hepatitis, peptic ulcer, rheumatoid arthritis
Other Drugs: Acetohydroxamic acid, oral tetracyclines, dimercaprol, etidronate, alcohol
Lab Tests: Glucose oxidase, occult blood in serum, bilirubin, calcium concentrations, skeletal imaging
Administrative Notes: Ferrous sulfate dried extended-release tablets can leave a wax matrix, which is detectable in stool; take iron supplements on an empty stomach if possible
Ferrous Sulfate/Fluoride/Multivitamins
Trade Name(s): Florvite +{plus} Iron; Poly-Vi-Flor with Iron; Vi-Daylin/F +{plus} Iron
Pregnancy Category: C
Medical Category: Hematinic
Accepted Indications: Anemia
Child Dosage: Varies by fluoride content of drinking water
Infant Dosage: Varies by fluoride content of drinking water
Dosage Forms: Chewable tablets: 12 mg/1 mg; tablets: 12 mg/1 mg; drops: 10 mg/1 mg
Ferrous Sulfate/Folic Acid/Multivitamins
Trade Name(s): Fero-Folic-500, Iberet-Folic-500
Pregnancy Category: C
Medical Category: Hematinic
Accepted Indications: Anemia
Adult Dosage: 100–{endash}200 mg in 3 divided doses
Elderly Dosage: Same as adult dose
Child Dosage: 6 m–{endash}2 y: up to 6 mg/kg/d in 3–{endash}4 divided doses; 2–{endash}12 y: 3 mg/kg/d in 3–{endash}4 divided doses
Infant Dosage: 10–{endash}25 mg/d in 3–{endash}4 divided doses
Dosage Forms: Tablets: 105 mg/0.8 mg and 105 mg/0.2 mg
Fibrinolysin
Trade Name(s): Not available as a single agent
Chemically Related To: Protein enzymes; derived from bovine plasma lytic enzyme
Medical Category: Thrombolytic enzyme
Mechanism of Action: Attacks fibrin of blood clots and fibrinous exudates
Research Notes: Acts mainly against denatured protein found in devitalized tissue; ignores healthy protein
Filgrastim
Trade Name(s): Neupogen
Chemically Related To: Biogenic product
Pregnancy Category: C
Medical Category: Hematopoietic stimulant, antineutropenic
Accepted Indications: Chemotherapy-related, AIDS-associated, drug-induced neutropenia; myeloid engraftment; enhancing of progenitor cells
Mechanism of Action: Acts on hematopoietic cells to stimulate proliferation
Absorption/Distribution: Rapidly absorbed
Half life: Elimination 3.5 h
Peak activity: SQ 2–{endash}8 h
Research Notes: Action begins within 5 min of IV administration
Adult Dosage: IV or SQ 5 m{mu}g/kg once daily increased if necessary
Elderly Dosage: Same as adult dose
Child Dosage: Not established
Dosage Forms: Injection: 300 m{mu}g/mL
By System: Hematopoietic stimulant
Warnings: Do not shake medication
Precautions: Call physician at first sign of infection
Frequent Side Effects: Pain in muscles, headache, itching
Occasional Side Effects: Leukocytosis, pain at injection site
Rare Side Effects: Sweet's syndrome, vasculitis
Disease States: Auto-immune disease, inflammatory conditions, sensitivity to Escherichia coli–{endash}derived proteins, sepsis, heart problems
Lab Tests: Blood pressure, uric acid serum concentrations, lactic dehydrogenase
Administrative Notes: Contains no preservatives; should be discarded 6 h after thawing
Finasteride
Trade Name(s): Proscar
Chemically Related To: 4-Azasteroid
Pregnancy Category: X
Medical Category: Antiprostate enlargement
Accepted Indications: Benign prostatic hyperplasia with associated urinary obstruction
Mechanism of Action: Competitive inhibitor of steroid 5a{alpha}-reductase
Absorption/Distribution: High protein binding; crosses blood-brain barrier
Metabolism: Hepatic
Elimination: Renal/fecal
Research Notes: Potential risk to male fetus
Adult Dosage: 5 mg once daily
Dosage Forms: Film-coated tablets: 5 mg
By System: Prostate tissue
Warnings: Not intended for use by women or children
Precautions: Digital rectal examinations should be done; elimination rate decreased in elderly patients
Occasional Side Effects: Impotence, decreased libido
Disease States: Liver problems
Lab Tests: Serum prostate-specific antigen
Administrative Notes: 6–{endash}12 m of therapy may be necessary to see whether response beneficial
Flavoxate Hydrochloride
Trade Name(s): Urispas
Chemically Related To: Unique compound
Pregnancy Category: B
Medical Category: Antispasmodic (urinary tract)
Accepted Indications: Urologic disorders or symptoms, irritative voiding
Mechanism of Action: Relaxant effect on smooth muscle
Absorption/Distribution: Well absorbed
Elimination: Renal
Research Notes: If urinary tract infection is present, antibacterial drugs should be initiated
Adult Dosage: 100–{endash}200 mg t.i.d or q.i.d.
Dosage Forms: Tablets 100 mg
By System: Genitourinary system
Warnings: Drowsiness, blurred vision; confusion more likely to occur in elderly
Precautions: Overheating could cause heat stroke; dry mouth possible
Frequent Side Effects: Drowsiness, dry mouth and throat
Occasional Side Effects: Constipation, difficulty voiding, tachycardia, nausea/vomiting, nervousness, increased sweating
Rare Side Effects: Confusion, hypersensitivity, leukopenia, increased intraocular pressure
Overdosage: Anticholinergic effects (clumsiness, dizziness, fever, flushing, respiratory distress)
Antidotal Therapy: May include emesis or gastric lavage, slurry of activated charcoal, short-acting barbiturates, phenathiazines
Disease States: GI tract obstruction, glaucoma, obstructive uropathy, paralytic ileus
Nutrition: If GI upset, take with food
Administrative Notes: Reduce dosage as symptoms improve; if GI upset occurs, take with food
Flecainide Acetate
Trade Name(s): Tambocor
Chemically Related To: Lidocaine
Pregnancy Category: C
Medical Category: Antiarrhythmic
Accepted Indications: Supraventricular arrhythmia, prophylaxis; ventricular arrhythmias
Unaccepted Indications: Less severe arrhythmias, chronic atrial fibrillation
Mechanism of Action: Membrane stabilizing effect; decreases rate of rise of the action potential
Absorption/Distribution: Almost completely absorbed
Half life: 20 h
Metabolism: Hepatic
Elimination: Renal, fecal
Research Notes: Has local anesthetic activity
Adult Dosage: 50 mg q12h increased to a maximum of 400 mg/d
Child Dosage: Safety not established
Infant Dosage: Safety not established
Dosage Forms: Tablets: 50 mg, 100 mg, and 150 mg
By System: Cardiovascular
Warnings: Dizziness
Frequent Side Effects: Blurred vision, dizziness
Occasional Side Effects: Arrhythmias, anxiety, depression, constipation, headache, nausea/vomiting, weakness, chest pain, CHF
Rare Side Effects: Hepatic disorder
Contraindications: AV block, bifascicular block without a pacemaker
Antidotal Therapy: May include oxygen, mechanical respiration, circulatory assistance, dopamine, cardiovascular defibrillation
Disease States: Renal impairment, cardiogenic shock, CHF, liver problems, sick sinus syndrome, hyperkalemia, hypokalemia, myocardial infarction
Other Drugs: Digoxin, bone marrow depressants, antiarrhythmics, beta-adrenergic blockers
Lab Tests: EKG changes
Floxuridine
Trade Name(s): FUDR
Pregnancy Category: D
Medical Category: Antineoplastic
Accepted Indications: Regional intra-arterial infusion to treat carcinomas, including breast, hepatic, GI, ovarian, cervical, bladder, renal, and prostatic
Mechanism of Action: Inhibits DNA, RNA synthesis
Absorption/Distribution: Some crossing of blood-brain barrier
Metabolism: Hepatic
Elimination: Respiratory, renal
Adult Dosage: Intra-arterial: 100–{endash}600 m{mu}g/kg/d for 14–{endash}21 d, rest period of 2 w between courses
Elderly Dosage: May require lower dose
Child Dosage: Safety and efficacy not established
Infant Dosage: Safety and efficacy not established
Dosage Forms: Sterile injection: 500 mg
Warnings: Protect from light
Frequent Side Effects: Aphthous stomatitis, enteritis
Occasional Side Effects: GI ulceration, esophagopharyngitis, glossitis, nausea, vomiting, scaling of hands and feet, loss of appetite, rash, itching, thinning of hair
Rare Side Effects: Leukopenia, infection, hepatotoxicity, thrombocytopenia, anemia, difficulty in walking
Contraindications: Chickenpox, herpes zoster, hepatitis, infection
Disease States: Bone marrow depression, hepatic function impairment, renal function impairment
Other Drugs: Bone marrow depressants, live virus vaccines
Lab Tests: Platelet count, hematocrit
Fluconazole
Trade Name(s): Diflucan
Chemically Related To: Ketoconazole
Pregnancy Category: C
Medical Category: Antifungal
Accepted Indications: Cryptococcal meningitis, candidiasis
Mechanism of Action: Fungistatic, interferes with cytochrome P450 activity
Absorption/Distribution: Well absorbed; widely distributed throughout body and in CSF
Half life: 20–{endash}50 h
IV: 1–{endash}2 h (intraperitoneal)
Metabolism: Hepatic
Elimination: Renal
Research Notes: Oral fluconazole is almost completely bioavailable; the daily
Adult Dosage: 200–{endash}400 mg/d
Elderly Dosage: Same as adult dose
Child Dosage: 3–{endash}6 mg/kg/d
Infant Dosage: Not established
Dosage Forms: Tablets: 50 mg, 100 mg, and 200 mg; injection: 200 mg and 400 mg
Warnings: Reduce dose in patients with renal dysfunction
Occasional Side Effects: GI disturbances (diarrhea, nausea, and vomiting), headache
Rare Side Effects: Exfoliative skin disorders, hepatotoxicity, thrombocytopenia
Disease States: Hepatic and renal function impairment
Other Drugs: Oral antidiabetic agents, cyclosporine, phenytoin, rifampin, warfarin, theophylline
Lab Tests: Bilirubin
Flucytosine
Trade Name(s): Ancobon
Pregnancy Category: C
Medical Category: Systemic antifungal
Accepted Indications: Fungal endocarditis, fungal meningitis, fungal pneumonia, fungal septicemia, fungal urinary tract infections
Mechanism of Action: Interferes with protein synthesis
Absorption/Distribution: Well absorbed from GI tract
Half life: 2.5–{endash}6 h
Metabolism: Metabolism not significant
Elimination: Renal
Adult Dosage: 12.5–{endash}37.5 mg/kg q.i.d.
Elderly Dosage: May require lower dose
Child Dosage: Same as adult dose or 375–{endash}562.5 mg/m2 q.i.d.
Infant Dosage: Same as child dose
Dosage Forms: Capsules: 250 mg and 500 mg
Frequent Side Effects: Anemia, hepatitis, thrombocytopenia, leukopenia, hypersensitivity, GI disturbances, nausea, diarrhea
Occasional Side Effects: Confusion, photosensitivity, hallucinations, CNS effects
Contraindications: Bone-marrow depression
Antidotal Therapy: May include gastric lavage, diuresis, hemodialysis
Disease States: Hematologic disease, renal impairment, liver impairment
Other Drugs: Radiation therapy, bone marrow depressants, amphotericin B, cytarabine, blood dyscrasia–{endash}causing medications
Lab Tests: BUN, serum bilirubin, creatinine
Fludarabine
Trade Name(s): Fludara
Pregnancy Category: D
Medical Category: Antineoplastic
Accepted Indications: Chronic lymphocytic leukemia, non-Hodgkin's lymphoma (orphan drug)
Mechanism of Action: Inhibits DNA synthesis
Half life: 10 h (terminal)
Elimination: Renal
Adult Dosage: IV: 25 mg/m2 for 5 d, treatments every 28 d
Elderly Dosage: May require lower dose
Child Dosage: Safety and efficacy not established
Infant Dosage: Safety and efficacy not established
Dosage Forms: Injection: 50 mg
Warnings: Should be used within 8 h of reconstitution
Frequent Side Effects: Anemia, leukopenia, infection, pain, pneumonia, thrombocytopenia, diarrhea, nausea, vomiting, rash, tiredness
Occasional Side Effects: Edema, neurologic effects, stomatitis, headache, muscle aches, loss of appetite, malaise
Rare Side Effects: Loss of hair, delayed severe neurologic effects, blood in urine, pulmonary edema, pneumonitis, tumor lysis syndrome
Contraindications: Bone marrow depression, chickenpox
Disease States: Gout, herpes zoster, kidney stones, infection
Other Drugs: Probenecid, bone marrow depressants, sulfinpyrazone, pentostatin, live virus vaccines
Lab Tests: Alkaline phosphate, uric acid
Fludrocortisone Acetate
Trade Name(s): Florinef
Chemically Related To: Corticosteroids
Pregnancy Category: C
Medical Category: Corticosteroid, antihypotensive, diagnostic aid (renal tubular acidosis)
Accepted Indications: Chronic or secondary adrenocorticoid insufficiency, congenital adrenogenital syndrome, idiopathic orthostatic hypotension, acidosis in renal tubular disorders
Mechanism of Action: Acts on distal tubule to increase excretion of potassium and hydrogen ions, increase sodium reabsorption, increase protein synthesis
Absorption/Distribution: Well distributed
Half life: 3.5 h
Metabolism: Hepatic, renal
Elimination: Renal
Research Notes: Duration of action is 1–{endash}2 d
Adult Dosage: 100 m{mu}g/d
Elderly Dosage: 50–{endash}100 m{mu}g/d
Child Dosage: 50–{endash}100 m{mu}g/d
Dosage Forms: Tablets: 100 m{mu}g
Precautions: In children, could cause growth suppression
Occasional Side Effects: CHF, dizziness, headache, hypokalemia
Disease States: Heart problems, hypertension, kidney or liver problems, hyperthyroidism, chronic nephritis, osteoporosis
Other Drugs: Digitalis glycosides, lithium, hepatic enzyme inducers, hypokalemia–{endash}causing medications
Lab Tests: Blood pressure, hematocrit, potassium, sodium
Administrative Notes: May need concurrent use of a diuretic
Flunisolide
Trade Name(s): AeroBID (oral inhaler), Nasalide (nasal inhaler)
Chemically Related To: Steroids
Pregnancy Category: C
Medical Category: Adrenocorticoid, antiasthmatic, anti-inflammatory
Accepted Indications: Bronchial asthma (oral inhalation), rhinitis, nasal allergic disorders, nasal polyps
Unaccepted Indications: Acute bronchospasm, nonasthmatic bronchitis
Mechanism of Action: Prevents recruitment and activation of inflammatory cells
Absorption/Distribution: About 0.5 of dose absorbed
Half life: 1.5–{endash}2 h
Peak activity: 1.5–{endash}2 h
Metabolism: Hepatic, pulmonary
Elimination: Renal, fecal
Research Notes: Onset of action, 1–{endash}4 w
Adult Dosage: Oral inhalation: 500 m{mu}g up to 2 mg/d; nasal inhalation: 50 m{mu}g in each nostril b.i.d., maximum daily dose 200 m{mu}g in each nostril
Child Dosage: 4 y and over: same as adult dose
Dosage Forms: Oral inhalation aerosol: 250 m{mu}g per metered spray; nasal inhalation: 25 m{mu}g per metered spray
By System: Respiratory
Warnings: Use caution if surgery is required; rinse mouth after each dose
Frequent Side Effects: Rash, bronchitis, endocrine imbalance, tachycardia, GI upset, dizziness, headache
Occasional Side Effects: Acne, cataracts, edema, depression, mood changes, trouble sleeping, nasal or oral candidiasis
Rare Side Effects: Bronchospasm
Contraindications: Bronchiectasis
Overdosage: Acneiform lesions, Cushing's syndrome, menstrual changes
Antidotal Therapy: May include supportive treatment
Disease States: Heart problems, diabetes mellitus, myasthenia gravis, systemic fungal infections, peptic ulcer, glaucoma
Other Drugs: Antidiabetic agents
Lab Tests: Blood or urine glucose, potassium, cholesterol, uric acid, spermatozoa concentrations, sodium
Fluocinolone Acetonide
Trade Name(s): Bio-Syn, Fluocet, Fluonid, Flurosyn, Synalar, Synemol
Chemically Related To: Dexamethasone
Pregnancy Category: C
Medical Category: Topical steroidal anti-inflammatory, topical corticosteroid
Accepted Indications: Atopic or exfoliative skin disorders, dermatitis, severe eczema, keloids, psoriasis, sarcoidosis, sunburn
Unaccepted Indications: Acne, routine gingivitis
Mechanism of Action: Anti-inflammatory through cytosolic glucocorticoid receptor-mediated action
Absorption/Distribution: Absorbed systemically across stratum corneum
Metabolism: Dermal, hepatic
Research Notes: Medium to high potency corticosteroid
Adult Dosage: Topical, to the skin, b.i.d. to q.i.d.
Elderly Dosage: May require lower dose
Child Dosage: Topical, to the skin, once daily or b.i.d.
Infant Dosage: Same as child dose. In children up to 2 y, 2% strength not recommended.
Dosage Forms: Cream: 0.01%, 0.025%, and 0.2%; ointment: 0.025%; topical solution: 0.01%
By System: Dermal
Warnings: For external use only; do not use in eyes
Precautions: Avoid tight-fitting diapers or plastic pants in area being treated
Occasional Side Effects: Burning sensation, dryness, irritation, scaling, contact dermatitis, purpura, numbness in fingers, skin atrophy
Rare Side Effects: Acne, cataracts, Cushing's syndrome, glaucoma, hypopigmentation, skin maceration, hirsutism
Antidotal Therapy: No specific antidote; may include dilution with fluids
Disease States: Infection at treatment site; pre-existing skin atrophy
Lab Tests: Glucose, eosinophil count, adrenal function as assessed by corticotropin, hypothalamic-pituitary-adrenal axis function
Administrative Notes: Occlusive dressings greatly increase absorption.
Fluocinolone Acetonide/Neomycin Sulfate
Trade Name(s): Neo-Synalar
Medical Category: Topical anti-inflammatory
Accepted Indications: Dermatitis
Adult Dosage: Topical, to the skin, b.i.d. to q.i.d.
Dosage Forms: Cream: 0.25 mg/5 mg/g
Fluocinonide
Trade Name(s): Fluocin, Licon, Lidex
Chemically Related To: Steroids
Pregnancy Category: C
Medical Category: Topical adrenocorticoid, topical steroidal anti-inflammatory
Accepted Indications: Severe inflammatory dermatoses, psoriasis, lichen simplex dermatosis, chronic eczematous dermatoses
Unaccepted Indications: Acne, routine gingivitis
Mechanism of Action: Complexes with cytoplasmic glucocorticoid receptors
Absorption/Distribution: Can be absorbed systemically; absorbed across stratum corneum
Metabolism: Dermal, hepatic
Research Notes: High potency
Adult Dosage: Topically to skin b.i.d. to q.i.d.
Elderly Dosage: Pre-existing skin atrophy may cause problems
Child Dosage: Topically to skin once daily
Infant Dosage: Same as child dose
Dosage Forms: Cream: 0.05%; gel: 0.05%; ointment: 0.05%; topical solution: 0.05%
By System: Dermal
Warnings: For external use only; do not use in or around the eyes
Precautions: Avoid tight-fitting diapers or plastic pants on affected area
Occasional Side Effects: Contact dermatitis, purpura, numbness in fingers, burning, irritation
Rare Side Effects: Acne, cataracts, Cushing's syndrome, gastric ulcer, glaucoma, hirsutism
Antidotal Therapy: No specific antidote; may include dilution with fluids
Disease States: Infection at treatment site; pre-existing skin atrophy
Lab Tests: Glucose tolerance, total eosinophil count, hypothalmic-pituitary-adrenal axis function, ACTH stimulation
Fluorescein Sodium
Trade Name(s): Ak-Fluor, Fluorescite, Fluorets, Fluor-I-Strip, Ful-Glo, Funduscein-10, Funduscein-25, Ophthifluor
Pregnancy Category: C
Medical Category: Ophthalmic diagnostic aid
Accepted Indications: Contact lens fitting; applanation tonometry; detection of corneal stippling, abrasions, lesions, foreign bodies, and contact lens pressure points; lacrimal drainage testing; wound leakage tests; diagnostic aid in ophthalmic angiography; evaluation of iris vasculature; distinction between viable and nonviable tissue; observation of aqueous flow; diagnosis of malignant vs. nonmalignant tumors
Mechanism of Action: Demonstrates defects of corneal epithelium
Adult Dosage: Injection: 500–{endash}750 mg injected rapidly into antecubital vein; ophthalmic solution: 1–{endash}2 drops to detect foreign bodies or corneal abrasions; strips: place moistened strip at fornix close to punctum
Child Dosage: Safety and efficacy not established
Infant Dosage: Safety and efficacy not established
Dosage Forms: Injection: 10% and 25%; solution: 2%; strips: 0.6 mg, 1 mg, and 9 mg
Warnings: Drops may stain soft contact lenses; discontinue drops if hypersensitivity develops; avoid extravasation with injection
Side/Adverse Effects: Nausea, GI distress, headache, syncope, vomiting, hypotension, cardiac arrest, basilar artery ischemia, hives, itching, bronchospasm, thrombophlebitis, shock, seizures, jaundice, anaphylaxis, dyspnea, pyrexia, dizziness, angioneurotic edema, strong taste, bright yellow urine
Disease States: Allergies, asthma
Administrative Notes: Do not use if solution contains a precipitate
Fluorescein Sodium/Proparacaine
Trade Name(s): Flucaine, Fluoracaine, Fluress, Spectro-Fluorocaine
Medical Category: Diagnostic agent
Accepted Indications: Eye examination
Dosage Forms: Ophthalmic solution: 0.5 %/0.25 %
Fluoride/Polyvitamin
Trade Name(s): Bio-Poly-Flor; Mulvidren-F; Polytabs-F; Poly-Vi-Flor; Soluvite-F; Vi-Daylin/F
Pregnancy Category: C
Medical Category: Vitamin supplement
Accepted Indications: Hypovitaminosis
Dosage Forms: Liquid: 0.25 mg; solution: 0.25 mg/mL, various other strengths; tablet: 0.5 mg
Fluoride/Vitamin A/Vitamin C/Vitamin D
Trade Name(s): ADC with Fluoride; Florvite; Tri-Vi-Flor; Vi-Daylin/F ADC
Pregnancy Category: C
Medical Category: Vitamin supplement
Accepted Indications: Hypovitaminosis
Dosage Forms: Liquid: 0.25 mg; solution: 0.25 mg/1500 IU/35 mg/400 IU; tablet: 1 mg/2500 IU/60 mg/400 IU; other strengths
Fluorometholone
Trade Name(s): Fluor-Op, FML
Chemically Related To: Corticosteroids
Pregnancy Category: C
Medical Category: Ophthalmic adrenocorticoid, ophthalmic anti-inflammatory
Accepted Indications: Ophthalmic non-infective, inflammatory disorders
Unaccepted Indications: Degenerative ocular disorders
Mechanism of Action: Stimulates protein synthesis responsible for anti-inflammatory action
Absorption/Distribution: Absorbed into aqueous humor, cornea, iris, and retina; some systemic absorption
Research Notes: Monitor patient with tonometry and slit-lamp examination
Adult Dosage: Topically to conjunctiva 1–{endash}4 times/d
Dosage Forms: Ointment: 0.1%; suspension: 0.1% and 0.25 %
By System: Ocular
Warnings: If no improvement, see physician
Precautions: Eye examinations should be performed routinely during long-term therapy; protect applicator from contamination
Frequent Side Effects: Blurred vision
Occasional Side Effects: Burning sensation, stinging, or redness of eyes
Rare Side Effects: Secondary eye infections, optic nerve damage, ocular hypertension
Contraindications: Ocular fungal infections, ocular tuberculosis, viral disease, herpes simplex
Overdosage: No serious side effects
Antidotal Therapy: May include dilution with fluids
Disease States: Cataracts, diabetes mellitus, glaucoma, corneal infections
Other Drugs: Antiglaucoma agents, anticholinergics, contact lenses
Administrative Notes: Shake suspension before using
Fluorouracil
Trade Name(s): Adrucil, Efudex, Fluoroplex
Pregnancy Category: D for systemic; X for topical
Medical Category: Antineoplastic; topical antineoplastic
Accepted Indications: Various carcinomas, including breast, prostatic, lung, ovarian, colorectal, hepatic, head and neck, gastric, pancreatic, bladder, cervical, endometrial; pericardial malignant effusions; topical-actinic keratoses
Mechanism of Action: Inhibits DNA, RNA synthesis
Absorption/Distribution: Crosses blood-brain barrier
Half life: Biphasic: 10–{endash}20 min and 20 h
Metabolism: Hepatic
Elimination: Respiratory, renal
Adult Dosage: Varies by indication. Representative doses: injection: IV, 7–{endash}12 mg/kg/d for 4 d, then 7–{endash}10 mg/kg every 3–{endash}4 d; total course of therapy of 2 w. Topical solution or cream: topical once daily or b.i.d. to lesions.
Elderly Dosage: Lower dosage may be required
Child Dosage: Injection: same as adult dose. Topical solution or cream: safety and efficacy not established.
Infant Dosage: Same as child dose
Dosage Forms: Injection: 50 mg/mL. Cream: 1% and 5%. Topical solution: 1%, 2%, and 5%.
Frequent Side Effects: Systemic: diarrhea, leukopenia, esophagopharyngitis, infection, ulcerative stomatitis, dermatitis, loss of appetite, nausea, vomiting, weakness, loss of hair; topical: allergic reaction, inflammatory response, burning at application site, contact dermatitis, photosensitivity, oozing, itching
Occasional Side Effects: GI ulceration, thrombocytopenia, dry skin
Rare Side Effects: Acute cerebellar syndrome, pneumopathy, myocardial ischemia, palmar-plantar erythrodysesthesia syndrome, skin darkening, scaling, watering eyes
Contraindications: Chickenpox, herpes zoster, infection
Disease States: Bone marrow depression, liver impairment, renal function impairment, hemorrhagic ulcerated tissues, pre-existing dermatoses
Other Drugs: Radiation therapy, leucovorin, bone marrow depressants, live virus vaccines
Lab Tests: Hematocrit, leukocyte, platelet
Fluoxetine Hydrochloride
Trade Name(s): Prozac
Chemically Related To: Unique compound
Pregnancy Category: B
Medical Category: Antidepressant, antiobsessional agent
Accepted Indications: Mental depression, obsessive-compulsive disorders
Mechanism of Action: Inhibitor of serotonin
Absorption/Distribution: Well absorbed
Half life: 2–{endash}3 d
Metabolism: Hepatic
Elimination: Renal/biliary
Research Notes: Onset of action, 1-4 weeks
Adult Dosage: Up to 80 mg/d
Dosage Forms: Capsules: 20 mg; oral solution: 20 mg/5 mL
By System: CNS subcortical nuclei
Warnings: May cause drowsiness; avoid alcohol
Precautions: Use caution when getting up from a prone position
Frequent Side Effects: Anxiety, diarrhea, drowsiness, headache, insomnia, increased sweating
Occasional Side Effects: Chills, joint pain, hives, respiratory problems, abnormal dreams, chest pain, constipation
Rare Side Effects: Allergic reactions, hypoglycemia, convulsions, swollen glands
Overdosage: Agitation, excitement, nausea/vomiting, convulsions
Antidotal Therapy: May include supportive treatment; maintain body temperature, respiration, and cardiac function; give anticonvulsants
Disease States: Diabetes mellitus, liver and kidney problems, convulsions
Other Drugs: Alcohol, MAO inhibitors, phenothiazines, tricyclic antidepressants, digitalis, diazepam
Fluoxymesterone
Trade Name(s): Halotestin
Chemically Related To: Steroids
Scheduled Class: III
Abuse Potential: High
Pregnancy Category: X
Medical Category: Androgen, antineoplastic, antianemic
Accepted Indications: Androgen deficiency, delayed male puberty, breast carcinoma, anemia
Unaccepted Indications: Enhancement of athletic performance, prevention of postpartum breast engorgement
Mechanism of Action: Stimulates spermatogenesis, male secondary sex characteristics, and sexual maturation at puberty
Absorption/Distribution: Well absorbed; distributed to all body tissues
Half life: 9.2 h
Metabolism: Hepatic
Elimination: Renal
Research Notes: Fluoxymesterone is a synthetic androgen
Adult Dosage: 20–{endash}50 mg/d
Elderly Dosage: Use with caution because prostate enlargement may occur
Child Dosage: May delay puberty in males if doses exceed 2.5–{endash}10 mg/d; limit duration of therapy to 4–{endash}6 m
Dosage Forms: Tablets: 2 mg, 5 mg, and 10 mg
By System: Endocrine and testicular
Warnings: In women with metastatic breast cancer, androgen therapy occasionally accelerates the course of the disease
Frequent Side Effects: Menstrual irregularities, amenorrhea, bladder irritability, breast soreness, priapism
Occasional Side Effects: Edema, GI irritation, hepatic dysfunction, hypercalcemia, prostatic carcinoma, prostatic hypertrophy, impotence
Rare Side Effects: Hepatic necrosis, leukopenia
Contraindications: Breast cancer in males, prostate cancer
Overdosage: Priapism
Disease States: Cardiac function impairment, edema, nephritis, diabetes mellitus, renal or hepatic function impairment, hypercalcemia, prostatic hypertrophy
Other Drugs: Anticoagulants, antidiabetic agents, hepatotoxic medications, human growth hormone, cyclosporine, insulin
Lab Tests: Glucose tolerance; fasting blood glucose; clotting factors II, V, VII, and X; hematocrit; hemoglobin
Administrative Notes: Women should be checked for signs of virilization during androgen therapy
Fluphenazine
Trade Name(s): Permitil, Prolixin
Chemically Related To: Piperazine
Pregnancy Category: Not recommended
Medical Category: Antipsychotic, antineuralgia adjunct
Accepted Indications: Psychotic disorders, neurogenic pain
Mechanism of Action: Blocks dopaminergic receptors
Metabolism: Hepatic
Elimination: Renal, biliary
Adult Dosage:
Elderly Dosage: Lower dosage may be required
Child Dosage:
Infant Dosage: Not established
Dosage Forms: Elixir: 2.5 mg/mL. Tablets: 1 mg, 2.5 mg, 5 mg, and 10 mg. Oral solution: 5 mg/mL. Injection: 2.5 mg/mL. Decanoate injection: 25 mg/mL. Enanthate injection: 25 mg/mL
Warnings: Do not use if discolored
Precautions: Avoid alcohol
Frequent Side Effects: Akathisia, hypotension, tardive dyskinesia, parkinsonian effects, anticholinergic effects, nasal congestion, dizziness, trembling, vomiting, nausea, blurred vision, dystonic effects
Occasional Side Effects: Contact dermatitis, difficult urination, photosensitivity, changes in menstrual period, galactorrhea, weight gain, swelling of breasts, decreased sexual ability
Rare Side Effects: Agranulocytosis, priapism, cholestatic jaundice, neuroleptic malignant syndrome, heat stroke, melanosis
Contraindications: CNS depression, cardiovascular disease
Disease States: Angina pectoris, breast cancer, Reye's syndrome, Parkinson's disease, comatose state, alcoholism, blood dyscrasias, hepatic function impairment
Other Drugs: Epinephrine, levodopa, lithium, alcohol, CNS depression–{endash}producing medications, tricyclic antidepressants, antithyroid agents, hypotension–{endash}causing medications, extrapyramidal reaction–{endash}causing medications, metrizamide
Lab Tests: Blood cell counts, bilirubin, bile
Flurandrenolide
Trade Name(s): Cordran
Chemically Related To: Hydrocortisone
Pregnancy Category: C
Medical Category: Adrenocorticoid (topical), anti-inflammatory
Accepted Indications: Skin disorders, mild dermatitis, psoriasis, pruritus, mild eczema
Unaccepted Indications: Acne, routine gingivitis
Mechanism of Action: Anti-inflammatory through effects mediated by cytosolic glucocorticoid receptors
Absorption/Distribution: Partially absorbed systemically
Metabolism: Dermal, hepatic
Research Notes: Medium-potency topical corticosteroid
Adult Dosage: Topically to skin b.i.d. or t.i.d.
Elderly Dosage: Pre-existing skin atrophy may cause problems
Child Dosage: Topically to skin 0.025% once daily or b.i.d.; 0.05% once daily
Infant Dosage: Same as child dose
Dosage Forms: Cream: 0.025% and 0.05%; lotion: 0.05%; ointment: 0.025% and 0.05%; tape: 4 m{mu}g/cm2
By System: Dermal
Warnings: For external use only; do not use in eye
Precautions: Do not use plastic pants if diaper area being treated
Occasional Side Effects: Burning sensation, dryness, itching, contact dermatitis, numbness in fingers
Rare Side Effects: Acne, Cushing's syndrome, glaucoma, hypopigmentation, skin maceration
Contraindications: Skin infections
Antidotal Therapy: No specific antidote; may include dilution with fluids
Disease States: Infection at treatment site, pre-existing skin atrophy
Lab Tests: Glucose, total eosinophil count, adrenal function
Administrative Notes: Tape dosage form should not be applied to serum-leaking wounds
Flurazepam Hydrochloride
Trade Name(s): Dalmane
Chemically Related To: Benzodiazepines
Scheduled Class: IV
Abuse Potential: Mild
Pregnancy Category: Not given
Medical Category: Sedative-hypnotic
Accepted Indications: Insomnia
Unaccepted Indications: Antianxiety
Mechanism of Action: CNS depressant of subcortical nuclei
Absorption/Distribution: Well absorbed
Half life: Phase 1, 2.3 h; phase 2, up to 100 h
Peak activity: 0.5–{endash}2 h
PO: 0.5–{endash}2 h
Metabolism: Hepatic
Elimination: Renal
Adult Dosage: 15–{endash}30 mg at bedtime
Elderly Dosage: 15 mg at bedtime
Child Dosage: Not recommended
Infant Dosage: Not recommended
Dosage Forms: Capsules: 15 mg and 30 mg
By System: CNS subcortical nuclei
Warnings: Avoid alcohol
Precautions: Do not operate machinery
Frequent Side Effects: Dizziness, lightheadedness, tiredness
Occasional Side Effects: Palpitations, nausea and vomiting, headache, increased thirst, diarrhea
Rare Side Effects: Constipation, clumsiness, blurred vision, false sense of well-being, withdrawal symptoms
Overdosage: Confusion, decreased reflexes, muscle weakness, shakiness, slurred speech
Antidotal Therapy: May include supportive measures, flumazenil
Disease States: Intoxication, coma, shock, epilepsy, glaucoma, pulmonary disease
Other Drugs: Alcohol, CNS depressants, antidepressants, antacids, erythromycin
Lab Tests: NaI uptake, metyrapone
Administrative Notes: Extremely effective on second or third d of use
Flurbiprofen
Trade Name(s): Ansaid
Chemically Related To: Aspirin
Pregnancy Category: B (first trimester); not recommended in second half of pregnancy
Medical Category: Antirheumatic; nonsteroidal anti-inflammatory, antidysmenorrheal
Accepted Indications: Rheumatoid arthritis, osteoarthritis, anklylosing spondylitis, nonrheumatic inflammation, dysmenorrhea
Unaccepted Indications: Reduction of edema after eye surgery
Mechanism of Action: Interferes with prostaglandin synthesis
Absorption/Distribution: Rapid absorption
Half life: 3 h (distribution); 5.7 h (elimination)
Peak activity: 5.2 h
PO: 1.5 h
Elimination: Renal
Research Notes: Drug is toxic to fetus but not teratogenic
Adult Dosage: 200–{endash}300 mg/d in 2–{endash}4 divided doses
Elderly Dosage: Use with caution
Child Dosage: Safety and efficacy not established
Infant Dosage: Safety and efficacy not established
Dosage Forms: Tablets: 50 mg and 100 mg
By System: CNS
Warnings: Excreted in breast milk
Precautions: Avoid alcohol; sensitivity to the sun possible
Frequent Side Effects: Headache, fluid retention, abdominal cramps, diarrhea, indigestion, nausea
Occasional Side Effects: Forgetfulness, mental depression, hematemesis, allergic rhinitis, blurred vision, tinnitus, tachycardia, flushing, anxiety, dizziness, drowsiness, irritability, trembling, insomnia, extreme weakness, gas, constipation, decreased appetite, vomiting
Rare Side Effects: Chest pain, nosebleed, arrhythmia, CHF, increased blood pressure, confusion, meningitis, dermatitis, bitter taste, muscle weakness, Stevens-Johnson syndrome, toxic epidermal necrolysis, esophagitis, gastritis, GI ulceration, vaginal bleeding, blood in urine, cystitis, incontinence, anemia, bruising, eosinophilia, leukopenia, thrombocytopenia, jaundice, anaphylaxis, angioedema, troubled breathing, fever, lymphadenopathy, corneal opacity, conjunctivitis, dry eyes, retinal hemorrhage, stomatitis, decreased hearing, hyperkalemia, interstitial nephritis, renal impairment, increased sweating, pounding heartbeat, photosensitivity
Contraindications: Blood disorders, bone marrow depression, cardiac disease, peptic ulcer
Overdosage: Listlessness, GI distress, convulsions, acute renal failure, coma
Antidotal Therapy: May include emesis/gastric lavage; no syrup of ipecac; activated charcoal, antacids
Disease States: Bleeding disorders, sensitivity to aspirin or NSAIDs, nasal polyps, GI inflammatory disease, renal function impairment, stomatitis, hypertension
Other Drugs: Anticoagulants, heparin, platelet-aggregation inhibitors, epinephrine, acetaminophen, alcohol, corticosteroids, corticotropin, potassium supplements, thrombolytic agents, triamterene, aspirin, cefamandole, cefoperazone, cefotetan, plicamycin, valproic acid, cyclosporine
Administrative Notes: Take with full glass of water. Maximal listed dose is for short-term therapy only and not meant to be an indication of maintenance dose
Flurbiprofen Sodium (Ophthalmic)
Trade Name(s): Ocufen
Chemically Related To: Aspirin
Pregnancy Category: C
Medical Category: Prostaglandin synthesis inhibitor, anti-inflammatory, miosis inhibitor
Accepted Indications: Ocular inflammation, miosis, cystoid macular edema
Mechanism of Action: Interferes with prostaglandin synthesis
Absorption/Distribution: Penetrates the cornea, significant systemic absorption may occur
Metabolism: Hepatic
Elimination: Renal
Adult Dosage: Topical to the conjunctiva, miosis inhibitor: 1 drop every 30 min beginning 2 h prior to surgery for a total of 4 drops; anti-inflammatory: 1 drop q4h
Child Dosage: Safety not established
Infant Dosage: Safety not established
Dosage Forms: Ophthalmic solution 0.03%
By System: Ocular
Frequent Side Effects: Ocular irritation
Rare Side Effects: Bleeding in eye, redness in eye
Disease States: Epithelia herpes simplex keratitis, bleeding disorders, sensitivity to aspirin or NSAIDs
Other Drugs: Acetylcholine chloride, carbachol, anticoagulants, heparin, platelet aggregation inhibitors, epinephrine
Flutamide
Trade Name(s): Eulexin
Chemically Related To: Androgens
Pregnancy Category: D
Medical Category: Antineoplastic
Accepted Indications: Prostatic carcinoma
Mechanism of Action: Inhibition of androgen uptake; interference with testosterone activity
Absorption/Distribution: Rapidly and completely absorbed
Half life: 6 h
PO: 2 h
Metabolism: Hepatic
Elimination: Renal/fecal
Research Notes: Used in combination with LH releasing hormone analogues such as leuprolide
Adult Dosage: 125–{endash}750 mg/d in 3 divided doses
Elderly Dosage: Half-life increased
Dosage Forms: Capsules: 125 mg
Warnings: Reduces sperm count
Precautions: Continue with medication despite side effects; check with physician if vomiting occurs shortly after dose is taken
Frequent Side Effects: Impotence or decrease in libido; diarrhea; hot flashes; nausea or vomiting
Occasional Side Effects: Gynecomastia, loss of appetite, numbness or tingling of hands or feet, swelling of feet or lower legs
Rare Side Effects: Hepatitis
Antidotal Therapy: May include supportive treatment
Lab Tests: Plasma estradiol and testosterone, serum bilirubin, serum creatinine
Administrative Notes: Therapy should begin simultaneously with LH releasing hormone analogue therapy
Fluticasone Propionate
Trade Name(s): Cutivate
Pregnancy Category: C
Medical Category: Topical corticosteroid, topical steroidal anti-inflammatory
Accepted Indications: Skin disorders (dermatitis, pruritus)
Unaccepted Indications: Acne, rosacea
Metabolism: Skin, hepatic
Adult Dosage: Topical, to the skin, b.i.d.
Elderly Dosage: Lower dose may be required
Child Dosage: Not established
Infant Dosage: Not established
Dosage Forms: Cream: 0.05%. Ointment: 0.005%.
Warnings: Do not use in or around eyes
Occasional Side Effects: Contact dermatitis, folliculitis, furunculosis, hyperesthesia, numbness in fingers, skin atrophy, secondary skin infection
Rare Side Effects: Acneiform eruptions, Cushing's syndrome, perioral dermatitis, edema, gastric ulcer, glaucoma, hirsutism, hypopigmentation, skin maceration, unusual loss of hair
Disease States: Diabetes, skin atrophy, glaucoma, tuberculosis, infection at treatment site
Lab Tests: Eosinophil count, glucose
Folic Acid
Trade Name(s): Folvite
Pregnancy Category: A
Medical Category: Nutritional supplement; diagnostic aid (folate deficiency)
Accepted Indications: Folic acid deficiency (treatment and diagnosis)
Unaccepted Indications: Mental disorders, aplastic anemia
Mechanism of Action: Synthesis of purine, metabolism of amino acids, and histidine
PO: 0.5–{endash}1 h
Metabolism: Hepatic
Elimination: Renal
Research Notes: Large proportion stored in liver
Adult Dosage: 100 m{mu}g/d up to 500 m{mu}g; 3–{endash}15 mg when used in tropical sprue
Child Dosage: Supplement 100 m{mu}g/d up to 500 m{mu}g/d
Infant Dosage: Folic acid injection that contains benzyl alcohol as a preservative should not be used
Dosage Forms: Tablets: 100 m{mu}g, 400 m{mu}g, 800 m{mu}g, and 1 mg; injection: 5 mg/mL
Warnings: Megadoses not recommended without physician's approval
Precautions: Use parenteral administration only when oral administration not acceptable
Rare Side Effects: Erythema, fever, itching
Disease States: Pernicious anemia
Other Drugs: Antibiotics, zinc supplements, estrogens, analgesics, methotrexate, sulfonamides, anticonvulsants
Lab Tests: Vitamin B12 concentrations in blood
Administrative Notes: Follow proper diet, obtaining folic acid from appropriate food sources.
Formaldehyde
Trade Name(s): Formalin, Formalyde-10, Forma-Ray, LazerFormalyde
Chemically Related To: Aldehydes
Medical Category: Drying agent, dermatologic agent, anti-infective, skin/mucous membrane agent
Accepted Indications: Pre- and postsurgical removal of warts drying agent; hyperhidrosis and bromidrosis
Mechanism of Action: Destroys microorganisms, drying agent
Research Notes: Perform skin sensitivity test
Adult Dosage: Apply to affected area once daily
Dosage Forms: Aerosol spray: 10%; solution: 7.4%, 8%, and 10%
By System: Dermal
Warnings: For external use only; check skin for sensitivity
Precautions: Keep out of reach of children; avoid contact with eyes and mucous membranes
Side/Adverse Effects: Some redness or irritation
Foscarnet Sodium
Trade Name(s): Foscavir
Pregnancy Category: C
Medical Category: Systemic antiviral
Accepted Indications: Cytomegalovirus retinitis, herpes simplex, varicella-zoster
Unaccepted Indications: Bacteria, mycoplasma
Mechanism of Action: Inhibits viral replication by blocking DNA polymerase
Absorption/Distribution: Poorly absorbed after oral administration
Half life: 0.4–{endash}1.4 h (distribution), 3.3–{endash}6.8 h (elimination)
IV: End of infusion
Metabolism: Not metabolized
Elimination: Renal
Adult Dosage: IV: 60 mg/kg t.i.d. for 14–{endash}21 d initially; maintenance, IV, 90–{endash}120 mg/kg once daily
Elderly Dosage: May require lower dose
Child Dosage: Same as adult dose
Dosage Forms: Injection: 6000 mg/250 mL and 12,000 mg/500 mL
Frequent Side Effects: Nephrotoxicity, GI disturbances, neurotoxicity
Occasional Side Effects: Anemia, granulocytopenia, phlebitis
Rare Side Effects: Penile ulcerations, mouth sores
Contraindications: Dehydration
Disease States: Anemia, kidney impairment
Other Drugs: Pentamidine, zidovudine, nephrotoxic medications
Lab Tests: Serum phosphate, serum calcium
Fosinopril Sodium
Trade Name(s): Monopril
Chemically Related To: ACE inhibitors
Pregnancy Category: C in first trimester, D in second and third
Medical Category: Antihypertensive
Accepted Indications: Hypertension
Unaccepted Indications: CHF
Mechanism of Action: Inhibition of ACE enzyme
Absorption/Distribution: 36% absorbed slowly from GI tract
Half life: 11.5 h (fosinoprilat, active metabolite)
Peak activity: 2–{endash}6 h
Metabolism: Hepatic
Elimination: Renal, fecal
Research Notes: Onset of action, 1 h; duration of action, 24 h
Adult Dosage: Initial: 10 mg once daily; maintenance: 20–{endash}40 mg once daily up to 80 mg maximum/d
Elderly Dosage: May require lower dose
Child Dosage: Safety and efficacy not established
Infant Dosage: Safety and efficacy not established
Dosage Forms: Tablets: 10 mg and 20 mg
Warnings: Excreted in breast milk
Frequent Side Effects: Dry cough, headache
Occasional Side Effects: Hypotension, rash, fever, joint pain, itching, diarrhea, dysgeusia, fatigue, nausea
Rare Side Effects: Angioedema, chest pain, hyperkalemia, neutropenia, agranulocytosis, pancreatitis
Contraindications: Angioedema, hyperkalemia, renal artery stenosis, renal transplantation
Overdosage: Severe hypotension
Antidotal Therapy: May include volume expansion
Other Drugs: Alcohol, potassium sparing diuretics, potassium supplements, low-salt milk, potassium–{endash}containing medications, salt substitutes
Lab Tests: Blood pressure, leukocyte count, urinary protein, BUN, digoxin levels
Furosemide
Trade Name(s): Lasix, Myrosemide
Chemically Related To: Sulfonamides
Pregnancy Category: C
Medical Category: Diuretic, antihypertensive, antihypercalcemic
Accepted Indications: Edema, hypertension
Mechanism of Action: Inhibits reabsorption of Cl- and water in ascending loop of Henle
Half life: 0.5–{endash}1 h
PO: 2.5 h
IV: 0.5 h
Metabolism: Hepatic
Elimination: 88% renal; 12% biliary/fecal
Adult Dosage: 20–{endash}600 mg/d
Child Dosage: 2–{endash}6 mg/kg/d
Infant Dosage: Same as child, but the dosing interval should be extended because of prolonged half–{endash}life in neonates
Dosage Forms: Oral solution: 8 mg/mL and 10 mg/mL; tablets: 20 mg, 40 mg, and 80 mg: injection: 10 mg/mL
By System: Cardiovascular and renal
Warnings: May increase blood glucose levels in diabetic patients; use caution if any kind of surgery, including dental surgery, is required; elderly patients may be more sensitive to the drug's effects
Precautions: Skin photosensitivity possible
Frequent Side Effects: Orthostatic hypotension
Occasional Side Effects: Electrolyte imbalance, blurred vision, diarrhea, headache, pain at site of injection, stomach cramps
Rare Side Effects: Rashes, gout, hepatic dysfunction, leukopenia, ototoxicity, pancreatitis, thrombocytopenia, hyperglycemia
Disease States: Severe renal function impairment, diabetes mellitus, hyperuricemia, acute myocardial infarction, pancreatitis, hearing impairment
Other Drugs: Hypotensive medication, anticoagulants, oral antidiabetic agents, chloral hydrate, probenecid, ototoxic medications
Lab Tests: Blood glucose concentrations, BUN, calcium chloride, magnesium, potassium and sodium serum concentrations
Administrative Notes: IV infusion should not exceed 4 mg/min
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