Clinician's Pocket Drug Reference 2008

Fludrocortisone Acetate 103seen in atrial arrhythmias Uses: Prevent AF/flutter & PSVT, *prevent/suppresslife-threatening ventricular arrhythmias* Action: Class 1C antiarrhythmic Dose:Adults. 100 mg PO q12h; ↑ by 50 mg q12h q4d to max 400 mg/d. Peds. 3–6mg/kg/d in 3 ÷ doses; ↓ w/renal impair, Caution: [C, +] monitor w/hepatic impair,↑ conc with amiodarone, digoxin, quinidine, ritonavir/amprenavir, BB, verapamil;may worsen arrhythmias Contra: 2nd-/3rd-degree AV block, RBBB w/ bifascicularor trifascicular block, cardiogenic shock, CAD, ritonavir/amprenavir, alkalinizingagents Disp: Tabs 50, 100, 150 mg SE: Dizziness, visual disturbances,dyspnea, palpitations, edema, chest pain, tachycardia, CHF, HA, fatigue, rash, NNotes: Initiate Rx in hospital; dose q8h if pt is intolerant/uncontrolled at q12h;Levels: Trough: just before next dose: Therapeutic: 0.2–1 mcg/mL; Toxic >1mcg/mL; 1 ⁄2 life: 11–14 hFloxuridine (FUDR) WARNING: Administration by experienced physicianonly; patients should be hospitalized for first course due to risk for severe rxnUses: *GI adenoma, liver, renal cancers*; colon & pancreatic CAs Action: Convertedto 5 FU; inhibits thymidylate synthase; ↓ DNA synth (S-phase specific)Dose: 0.1–0.6 mg/kg/d for 1–6 wk (per protocols) usually intra arterial for livermets Caution: [D, –] Interaction w/ vaccines Contra: BM suppression, poor nutritionalstatus, potentially serious Infxn Disp: Inj 500 mg SE: ↓ BM, anorexia, abdcramps, N/V/D, mucositis, alopecia, skin rash, & hyperpigmentation; rare neurotox(blurred vision, depression, nystagmus, vertigo, & lethargy); intra-arterial catheterrelatedproblems (ischemia, thrombosis, bleeding, & Infxn) Notes: Need effectivebirth control; palliative Rx for inoperable/incurable ptsFluconazole (Diflucan) Uses: *Candidiasis (esophageal, oropharyngeal,urinary tract, vaginal, prophylaxis); cryptococcal meningitis* Action: Antifungal;↓ cytochrome P-450 sterol demethylation. Spectrum: All Candida sp exceptC. krusei Dose: Adults. 100–400 mg/d PO or IV. Vaginitis: 150 mg PO daily.Crypto: doses up to 800 mg/day reported: 400 mg day 1, then 200 mg × 10–12wkafter CSF (–). Peds. 3–6 mg/kg/d PO or IV; 12 mg/kg/d/systemic Infxn; ↓ in renalimpair Caution: [C, –] Contra: none Disp: Tabs 50, 100, 150, 200 mg; susp 10,40 mg/mL; inj 2 mg/mL SE: HA, rash, GI upset, ↓ K + , ↑ LFTs Notes: PO (preferred)= IV levelsFludarabine Phosphate (Flamp, Fludara) Uses: *Autoimmune hemolyticanemia, CLL, cold agglutinin hemolysis,* low-grade lymphoma, mycosisfungoides Action: ↓ Ribonucleotide reductase; blocks DNA polymerase-inducedDNA repair Dose: 18–30 mg/m 2 /d for 5 d, as a 30-min inf (per protocols) Caution:[D, –] Give cytarabine before fludarabine (↓ its metabolism) Contra: w/pentostatin,severe Infxns, CrCl