Clinician's Pocket Drug Reference 2008

106 Fluticasone, OralFluticasone, Oral (Flovent, Flovent Rotadisk) Uses: Chronic*asthma* Action: Topical steroid Dose: Adults & Adolescents. 2–4 puffs bid. Peds4–11 y. 50 mcg bid Caution: [C, M] Contra: Primary Rx of status asthmaticusDisp: Rotadisk dry powder: 50, 100, 250 mcg/activation SE: HA, dysphonia, oralcandidiasis Notes: Risk of thrush, rinse mouth after; counsel on use of deviceFluticasone Propionate & Salmeterol Xinafoate (AdvairDiskus, Advair HFA, 45/21, 115/21, 230/21 inhaledaerosol) WARNING: Increased risk of worsening wheezing or asthmarelateddeath with long acting β-2 adrenergic agonists Uses: *Maint therapy forasthma* Action: Corticosteroid w/ LA bronchodilator β-2 agonist Dose: Adults &Peds >12 y. 1 inhal bid q 12 h; titrate to lowest effective dose (4 inhal or 920/84mcg/day max) Caution: [C, M] Contra: Acute asthma attack; conversion from POsteroids; w/ phenothiazines Disp: Diskus = met-dose inhal powder (fluticasone/salmeterolin mcg) 100/50, 250/50, 500/50; HFA = aerosol 45/21, 115/21, 230/21 mgSE: Upper resp Infxn, pharyngitis, HA Notes: Combo of Flovent & Serevent; donot wash mouthpiece, do not exhale into device; ADVAIR HFA for patients notcontrolled on other medications (eg, low-medium dose inhal steroids) or whosedisease severity warrants 2 maintenance therapiesFluvastatin (Lescol) Uses: *Atherosclerosis, primary hypercholesterolemia,heterozygous familial hypercholesterolemia hypertriglyceridemia* Action:HMG-CoA reductase inhibitor Dose: 20–40 mg BID PO or XL 80 day ↓ w/hepatic impair Caution: [X, –] Contra: Active liver Dz, ↑ LFTs, PRG, breastfeedingDisp: Caps 20, 40 mg; XL 80 mg SE: HA, dyspepsia, N/D, abd painNotes: Dose no longer limited to HS LFT’sFluvoxamine (Luvox) WARNING: Closely monitor for worsening depressionor emergence of suicidality, particularly in ped pts Uses: *OCD* Action:SSRI Dose: Initial 50-mg single qhs dose, ↑ to 300 mg/d in ÷ doses; ↓ inelderly/hepatic impair, titrate slowly; ÷ doses > 100 mg Caution: [C, ?/–] Interactions(MAOIs, phenothiazines, SSRIs, serotonin agonists, others) Contra: MAOIw/in 14 days Disp: Tabs 25, 50, 100 mg SE: HA, N/D, somnolence, insomniaFolic Acid Uses: *Megaloblastic anemia; folate deficiency* Action: Dietarysupl Dose: Adults. Supl: 0.4 mg/d PO. PRG: 0.8 mg/d PO. Folate deficiency: 1 mgPO daily–tid. Peds. Supl: 0.04–0.4 mg/24 h PO, IM, IV, or SQ. Folate deficiency:0.5–1 mg/24 h PO, IM, IV, or SQ Caution: [A, +] Contra: Pernicious, aplastic,normocytic anemias Disp: Tabs 0.4, 0.8, 1 mg; inj 5 mg/mL SE: Well toleratedNotes: OK for all women of child-bearing age; ↓ fetal neural tube defects by 50%;no effect on normocytic anemiasFondaparinux (Arixtra) WARNING: When epidural/spinal anesthesiaor spinal puncture is used, pts anticoagulated or scheduled to be anticoagulatedwith LMW heparins, heparinoids, or fondaparinux are at risk for epidural or spinalhematoma, which can result in long-term or permanent paralysis Uses: *DVTprophylaxis* w/hip fracture or replacement, knee replacement, abd surgery; w/