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TIME/ACTION PROFILE
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famotidine (fa-moe-ti-deen)
Acid Control, Pepcid, Pepcid AC, Peptic Guard,
Classification
Therapeutic: antiulcer agents
Pharmacologic: histamine H2 antagonists
Pregnancy Category B
Ulcidine
ROUTE
ONSET
PEAK
DURATION
PO
IV
within 60 min
within 60 min
1–4 hr
0.5–3 hr
6–12 hr
8–15 hr
Contraindications/Precautions
Contraindicated in: Hypersensitivity; Phenylketonuria (chewable tablets only);
Indications
Short-term treatment of active duodenal ulcers and benign gastric ulcers. Maintenance therapy for duodenal ulcers after healing of active ulcer(s). Management of
gastroesophageal reflux disease (GERD). Treatment of heartburn, acid indigestion,
and sour stomach (OTC use). Management of gastric hypersecretory states (Zollinger-Ellison syndrome). Prevention and treatment of stress-induced upper GI bleeding in critically ill patients. Unlabeled Use: Management of GI symptoms associated with the use of NSAIDs. Prevention of stress ulceration or aspiration
pneumonitis. Prevention of acid inactivation of supplemental pancreatic enzymes in
patients with pancreatic insufficiency. Management of urticaria.
OB: Crosses placenta; no adequate human studies; Lactation: Discontinue breast
feeding to avoid exposure of infant to serious side effects.
Use Cautiously in: Renal impairment (more susceptible to adverse CNS reactions;qdosage interval recommended if CCr ⬍10 mL/min); Pedi: Injection contains
benzyl alcohol which has been associated with gasping syndrome in neonates; Geri:
More susceptible to adverse CNS reactions; doseprecommended.
Adverse Reactions/Side Effects
CNS: confusion, dizziness, drowsiness, hallucinations, headache. CV: ARRHYTHMIAS.
GI: constipation, diarrhea, nausea. GU:psperm count, erectile dysfunction. Endo:
gynecomastia. Hemat: AGRANULOCYTOSIS, APLASTIC ANEMIA, anemia, neutropenia,
thrombocytopenia. Local: pain at IM site. Misc: hypersensivity reactions.
Interactions
Drug-Drug: Maypabsorption of ketoconazole, itraconazole, atazanavir, delavirdine, and gefitinib.
Action
Inhibits the action of histamine at the H2-receptor site located primarily in gastric parietal cells, resulting in inhibition of gastric acid secretion. Therapeutic Effects:
Healing and prevention of ulcers. Decreased symptoms of gastroesophageal reflux.
Decreased secretion of gastric acid.
Pharmacokinetics
Absorption: 40– 45% absorbed following oral administration.
Distribution: Enters breast milk and cerebrospinal fluid.
Protein Binding: 15– 20%.
Metabolism and Excretion: Up to 70% excreted unchanged by the kidneys,
30– 35% metabolized by the liver.
Half-life: Infants: 4.5– 15 hr; Children: 3.3– 5.7 hr; Adults: 2.5– 3.5 hr.
⫽ Canadian drug name.
⫽ Genetic Implication.
Route/Dosage
PO (Adults): Short-term treatment of active ulcers— 40 mg/day at bedtime or 20
mg twice daily for up to 8 wk. Duodenal ulcer prophylaxis— 20 mg once daily at
bedtime. GERD— 20 mg twice daily for up to 6 wk; up to 40 mg twice daily for up to
12 wk for esophagitis with erosions, ulcerations, and continuing symptoms. Gastric
hypersecretory conditions— 20 mg q 6 hr initially, up to 160 mg q 6 hr. OTC use—
10 mg for relief of symptoms; for prevention— 10 mg 60 min before eating or take
10 mg as chewable tablet 15 minutes before heartburn-inducing foods or beverages
(not to exceed 20 mg/24 hr for up to 2 wk).
PO, IV (Children 1– 12 yr): Peptic ulcer— 0.5 mg/kg/day as a single bedtime
dose or in divided doses twice daily (maximum: 40 mg daily); GERD— 1 mg/kg/day
in divided doses twice daily (maximum: 80 mg daily).
PO (Infants ⬎ 3 mo— 1 yr): GERD— 0.5 mg/kg/dose twice daily.
CAPITALS indicate life-threatening, underlines indicate most frequent.
Strikethrough ⫽ Discontinued.
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IV Administration
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PO (Infants and neonates ⬍ 3 mo): GERD— 0.5 mg/kg/dose once daily.
IV (Adults): 20 mg q 12 hr.
Renal Impairment
PO (Adults): CCr 10– 50 mL/min-administer normal dose q 24 hr or 50% dose at
normal dosing interval CCr ⬍10 mL/min— 20 mg at bedtime; interval may need to
beqto every 36– 48 hr.
NURSING IMPLICATIONS
Assessment
● Assess for epigastric or abdominal pain and frank or occult blood in the stool, em-
esis, or gastric aspirate.
● Geri: Assess elderly and debilitated patients routinely for confusion. Report
promptly.
● Lab Test Considerations: Monitor CBC with differential periodically
during therapy.
● Antagonize effects of pentagastrin and histamine during gastric acid secretion test-
ing. Avoid administration for 24 hr preceding the test.
● May cause false-negative results in skin tests using allergenic extracts. Histamine
antagonists should be discontinued 24 hr prior to the test.
● May cause anqin serum transaminases and serum creatinine.
● May cause false-positive results for urine protein; test with sulfosalicylic acid.
Potential Nursing Diagnoses
Acute pain (Indications)
Implementation
● PO: Administer with meals or immediately afterward and at bedtime to prolong ef-
fect.
● Doses administered once daily should be administered at bedtime to prolong ef-
fect.
● Shake oral suspension prior to administration. Discard unused suspension after
30 days.
● Open blister for oral disintegrating tablets with dry hands, place tablet on tongue
to disintegrate and swallow with saliva; no water is needed.
● pH: 5.0– 6.4.
● Direct IV: Diluent: 0.9% NaCl for injection. Concentration: not ⬎4 m g/mL.
Rate: Administer at a rate of 10 mg/min over at least 2 min. Rapid administration
may cause hypotension.
● Intermittent Infusion: Diluent: Dilute each 20 mg in 100 mL of 0.9% NaCl,
D5W, D10W, or lactated Ringer’s solution. Concentration: 0.2 mg/mL. Diluted
solution is stable for 48 hr at room temperature. Do not use solution that is discolored or contains a precipitate. Rate: Administer over 15– 30 min.
● Y-Site Compatibility: acyclovir, alemtuzumab, alfentanil, allopurinol, amifostine, amikacin, aminocaproic acid, aminophylline, amiodarone, amphotericin B
lipid complex, amphotericin B liposome, amsacrine, anakinra, anidulafungin, argatroban, ascorbic acid, atracurium, atropine, aztreonam, benztropine, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium chloride, calcium gluconate, carboplatin, carmustine, caspofungin, cefotaxime, ceftaroline,
cefotetan, cefoxitin, ceftazidime, cefuroxime, chlorpromazine, cisatracurium, cisplatin, cladribine, clindamycin, cyanocobalamin, cyclophosphamide, cyclosporine, cytarabine, dactinomycin, daptomycin, dexamethasone, dexmedetomidine,
dextran 40, digoxin, diltiazem, diphenhydramine, dobutamine, docetaxel, dopamine, doripenem, doxacurium, doxorubicin, doxorubicin liposome, doxycycline,
droperidol, enalaprilat, ephedrine, epinephrine, epirubicin, epoetin alfa, eptifibitide, ertapenem, erythromycin lactobionate, esmolol, etoposide, etoposide
phosphate, fenoldopam, fentanyl, filgrastim, fluconazole, fludarabine, fluorouracil, folic acid, gemcitabine, gentamicin, glycopyrrolate, granisetron, heparin,
hetastarch, hydrocortisone, hydromorphone, idarubicin, ifosfamide, imipenem/
cilastatin, irinotecan, isoproterenol, ketorolac, labetalol, levofloxacin, lidocaine,
linezolid, lorazepam, magnesium sulfate, mannitol, mechlorethamine, melphalan, meperidine, metaraminol, methotrexate, methoxamine, methyldopate,
methylprednisolone, metoclopramide, metoprolol, metronidazole, midazolam,
milrinone, mitoxantrone, morphine, multivitamins, mycophenolate, nafcillin, nalbuphine, naloxone, nesiritide, nicardipine, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxacillin, oxaliplatin, oxytocin, paclitaxel, palonosetron, pamidronate, pancuronium, papaverine, pemetrexed, penicillin G,
pentamidine, pentazocine, pentobarbital, perphenazine, phenobarbital, phentolamine, phenylephrine, phytonadione, potassium acetate, potassium chloride, potassium phosphates, procainamide, prochlorperazine, promethazine, propofol,
propranolol, protamine, pyridoxime, ranitidine, remifentanil, rituximab, sargra䉷 2015 F.A. Davis Company
CONTINUED
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Evaluation/Desired Outcomes
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● Decrease in abdominal pain, heartburn, acid indigestion, and sour stomach.
● Prevention of gastric irritation and bleeding. Healing of duodenal ulcers can be
CONTINUED
famotidine
mostim, sodium acetate, sodium bicarbonate, streptokinase, succinylcholine, sufentanil, tacrolimus, telavancin, teniposide, theophylline, thiamine, thiotepa, ticarcillin/clavulanate, tigecycline, tirofiban, tobramycin, tolazoline, trastuzumab,
trimetaphan, vancomycin, vasopressin, vecuronium, verapamil, vincristine, vinorelbine, voriconazole, zoledronic acid.
● Y-Site Incompatibility: amphotericin B cholesteryl, amphotericin B colloidal,
azathioprine, azithromycin, cefepime, chloramphenicol, dantrolene, diazepam,
diazoxide, ganciclovir, indomethacin, pantoprazole, piperacillin/tazobactam, trimethoprim/sulfamethoxazole.
seen by endoscopy. Therapy is continued for at least 6 wk in treatment of ulcers
but not usually longer than 8 wk.
● Decreased symptoms of gastroesophageal reflux.
Why was this drug prescribed for your patient?
Patient/Family Teaching
● Instruct patient to take medication as directed for the full course of therapy, even if
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feeling better. Take missed doses as soon as remembered but not if almost time for
next dose. Do not double doses.
Advise patients taking OTC preparations not to take the maximum dose continuously for more than 2 wk without consulting health care professional. Notify health
care professional if difficulty swallowing occurs or abdominal pain persists.
Inform patient that smoking interferes with the action of histamine antagonists.
Encourage patient to quit smoking or at least not to smoke after last dose of the
day.
May cause drowsiness or dizziness. Caution patient to avoid driving or other activities requiring alertness until response to the drug is known.
Advise patient to avoid alcohol, products containing aspirin or NSAIDs, and foods
that may cause an increase in GI irritation.
Inform patient that increased fluid and fiber intake and exercise may minimize
constipation.
Advise patient to report onset of black, tarry stools; fever; sore throat; diarrhea;
dizziness; rash; confusion; or hallucinations to health care professional promptly.
⫽ Canadian drug name.
⫽ Genetic Implication.
CAPITALS indicate life-threatening, underlines indicate most frequent.
Strikethrough ⫽ Discontinued.
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