Clinician's Pocket Drug Reference 2008

Ferrous Gluconate 101Fentanyl iontophoretic transdermal system (Ionsys) WARN-ING: May only be used for the treatment of hospitalized patients, D/C on discharge;fentanyl may result in potentially life-threatening respiratory depressionand death Uses: *Short term in hospital analgesia* Action: Opioid narcotic, transdermaladministration Dose: 40 mcg/activation by patient; dose given over 10 min;max over 24 h 3.2 mg (80 doses) Caution: [C,–] Contra: See fentanyl Disp: Battery-operatedself-contained iontophoretic transdermal system, 40 mcg/activation,80 doses SE: See fentanyl, site Rxn Notes: Choose normal skin site chest or upperouter arm; titrate to comfort, patients must have access to supplemental analgesia;instruct in device use; dispose properly at dischargeFentanyl, Transdermal (Duragesic) [C-II] WARNING: Potentialfor abuse and fatal overdose Uses: *Persistent moderate–severe chronic pain inpatients already tolerant to opioids* Action: Narcotic Dose: Apply patch to uppertorso q72h; dose based on narcotic requirements in previous 24 h; start 25 mcg/hpatch q 72h; ↓ in renal impair Caution: [B, +] w/CYP3A4 inhibitors (Table 11)may ↑ fentanyl effect, w/ Hx substance abuse Contra: Not opioid tolerant, shorttermpain management, postop pain in outpatient surgery, mild pain, PRN use ↑ICP, resp depression, severe renal/hepatic impair, peds < 2 y Disp: Patches 12.5,25, 50, 75, 100 mcg/h SE: Resp depression (fatal), sedation, ↓ BP, bradycardia,constipation, N, miosis Notes: 0.1 mg fentanyl = 10 mg morphine IM; do not cutpatch; peak level 24–72 hFentanyl, Transmucosal System (Actiq, Fentora) [C-II]WARNING: Potential for abuse and fatal overdose; use only in cancer patientswith chronic pain who are opioid tolerant; buccal formulation ↑ bioavailabilityover trans mucosal; do not substitute on a mcg per mcg basis; use w/ strongCYP3A4 inhibitors may ↑ fentanyl levels Uses: *Breakthrough CA pain* Action:Narcotic analgesic, trans mucosal absorption Dose: Start 100 mcg buccal(Fentora) X1, may repeat in 30 min, 4 tabs/dose max; titrate; start 200 mcg PO(Actiq) ×1, may repeat ×1 after 30 min; titrate Caution: [B, +] Contra: ↑ ICP,resp depression, severe renal/hepatic impair, management of postop or awake painDisp: (Actiq) Lozenges on stick 200, 400, 600, 800, 1200, 1600 mcg; (Fentora)Buccal Tabs 100, 200, 300, 400, 600, 800 mcg SE: Sedation, ↓ BP, bradycardia,constipation, N, resp depression, miosis Notes: 0.1 mg fentanyl = 10 mg IM morphine;for use in patients already tolerant to opioid therapyFerrous Gluconate (Fergon) Uses: *Iron deficiency anemia* & Fe suplAction: Dietary supl Dose: Adults. 100–200 mg of elemental Fe/d ÷ doses. Peds.4–6 mg/kg/d ÷ doses; on empty stomach (OK w/ meals if GI upset occurs); avoidantacids Caution: [A, ?] Contra: Hemochromatosis, hemolytic anemia Disp: Tabs246 mg (2.8 mg elem), 240 mg (27 mg elm), 300 (34 mg Fe), 325 mg (36 mg Fe)SE: GI upset, constipation, dark stools, discoloration of urine, may stain teethNotes: 12% elemental Fe; false + stool guaiac; keep away from children; severetoxicity in overdose