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Owing to the risk of thrombophlebitis cheap zenegra 100 mg with mastercard, solutions containing >30mmol/L should be given via the largest vein available buy zenegra 100 mg overnight delivery. Inspect visually for particulate matter or discoloration prior to administration and discard if present order zenegra 100 mg without prescription. Owing to the risk of thrombophlebitis 100mg zenegra amex, solutions containing >30mmol/L should be given via the largest vein available. Technical information Incompatible with The following drugs are incompatible with potassium chloride-containing solutions (however this list is not be exhaustive, check individual drug monographs): amoxicillin, amphotericin, dantrolene, diazepam emulsion, enoximone, methylprednisolone sodium succinate, phenytoin sodium. Monitoring Measure Frequency Rationale Serum K Throughout treatment * Measured at regular intervals to avoid the development of "K, especially in patients with renal impairment. Additional information Common and serious Infusion-related: undesirable effects * Too rapid administration: Life threatening "K. Action in case of Symptoms to watchfor: ExtremelyhighserumKconcentrations (8--11mmol/L) overdose may cause death from cardiac depression, arrhythmias or arrest. Give calcium gluconate to stabilise the myocardium and insulin/glucose to lower serum K rapidly. This assessment is based on the full range of preparation and administration options described in the monograph. Pralidoxime | 703 Pralidoxim e 1-g dry powder vial (from designated centres) * Pralidoxime chloride is a cholinesterase reactivator. Pre-treatment checks * Do not use in the treatment of poisoning due to phosphorus, inorganic phosphates or organo- phosphates not having anticholinesterase activity. However, if the poison was ingested, exposure will continue for some time owing to the slow absorption from the lower bowel. Biochemical and other tests (not all are necessary in an emergency situation) Blood pressure and pulse will aid diagnosis and help monitor progress, Bodyweight but do not wait for results before initiating Red blood cell, plasma cholinesterase and uri- treatment. Continue treatment until the patient has not required atropine treatment for at least 12 hours; treatment may be required for several days. Dose in renal impairment: pralidoxime is renally excreted therefore dose reduction is probably required, particularly for prolonged infusions, but little information available. Inspect visually for particulate matter or discolor- ation prior to administration and discard if present. Continuous intravenous infusion (subsequent dosing) Preparation and administration 1. Withdraw 20mL for eachvial to beusedfrom aninfusion bagcontaining the desired final volume of NaCl 0. Withdraw required total dose and add to the prepared infusion bag to give a solution containing 1--2% pralidoxime. Inspect visually for particulate matter or discolor- ation prior to administration and discard if present. Inspect visually for particulate matter or discolor- ation prior to administration and discard if present. Technical information Incompatible with No information Compatible with Flush: NaCl 0. Displacement value Negligible Stability after preparation Use prepared infusions immediately. Additional information Common and serious Injection/infusion-related: undesirable effects * Too rapid administration: "Pulse, laryngospasm and muscle rigidity. Other: Drowsiness, dizziness, visual disturbances, nausea, "pulse, headache, hyperventilation and muscle rigidity. Pharmacokinetics As an adjunct to atropine and it should improve muscle tone within 30 minutes. This assessment is based on the full range of preparation and administration options described in the monograph. Pre-treatment checks * Avoid where systemic infection is present (unless specific therapy given). Dose Intramuscular: 25--100mg once or twice weekly, adjusted according to patient response. Intra-articular or intrasynovial: 5--25mg according to size of joint; not more than three joints should be treated on any one day; where appropriate it may be repeated when relapse occurs. Intramuscular injection Preparation and administration * Withdraw the required dose. Treatment failure after intra-articular injection is most frequently the result of failure to enter the joint space. Technical information Incompatible with Not relevant Compatible with Not relevant pH Not relevant Sodium content Negligible (continued) Prednisolone acetate | 707 Technical information (continued) Excipients Contains benzyl alcohol. Monitoring (dependent on dose and site of injection) Measure Frequency Rationale Serum Na, K, Ca Throughout systemic * May cause fluid and electrolyte disturbances. Signs of infection During systemic * Prolonged courses "susceptibility to infections and treatment severity of infections. Signs of chickenpox * Unless they have had chickenpox, patients receiving corticosteroids for purposes other than replacementshouldberegardedasbeing atriskof severe chickenpox. Exposure to measles * Patients should be advised to take particular care to avoid exposure to measles and to seek immediate medical advice if exposure occurs. Symptoms of septic Following intra- * A marked increase in pain accompanied by local arthritis articular injection swelling, further restriction of joint motion, fever, and malaise are suggestive of septic arthritis. Additional information Common and serious Immediate: Anaphylaxis and other hypersensitivity reactions have been undesirable effects reported. Significant * The following may #corticosteroid levels or effect: interactions barbiturates, carbamazepine, phenytoin, primidone, rifabutin, rifampicin. Following chronic overdose the overdose possibility of adrenal suppression should be considered. Counselling Patients should be specifically warned to avoid over-use of joints in which symptomatic benefit has been obtained. Patients on long-term corticosteroid treatment should read and carry a Steroid Treatment Card. This assessment is based on the full range of preparation and administration options described in the monograph. It is a dopamine inhibitor; it has antiemetic activity; it has muscle relaxant properties; and it inhibitsthe heat-regulating centre. Prochlorperazine | 709 * Caution in renal or hepatic impairment, Parkinson disease, hypothyroidism, cardiac failure, myas- thenia gravis, prostate hypertrophy, history of narrow-angle glaucoma or agranulocytosis. Technical information Incompatible with Not relevant Compatible with Not relevant pH1 5. Special handling Handle solutions with care to avoid risk of contact sensitisation. Counselling Patients on long-term prochlorperazine should avoid exposure to direct sunlight as they may develop photosensitisation. This assessment is based on the full range of preparation and administration options described in the monograph. Procyclidine hydrochloride 5mg/mL solution in 2-mL ampoules * Procyclidine hydrochloride is an antimuscarinic drug. Use the lower end of the dosage range in elderly patients or those of low bodyweight. Inspect visually for particulate matter or discolor- ation prior to administration and discard if present. Technical information Incompatible No information with Compatible with Flush: NaCl 0. Monitoring Measure Frequency Rationale Observe For acute dystonias: the * To ensure that treatment is effective. Additional information Common and serious undesirable effects Common: Constipation, nausea, dry mouth, blurred vision, urinary retention. Action in case of overdose Symptoms to watch for: Agitation, restlessness and severe sleeplessness lasting 24 hours or more. Active measures such as the use of cholinergic agents or haemodialysis are unlikely to be of value. This assessment is based on the full range of preparation and administration options described in the monograph. Progesterone | 713 Progesterone 50mg/mL oily solution in 1-mL and 2-mL ampoules * Progesterone is a natural hormone that acts on the endometrium. Pre-treatment checks * Avoid in undiagnosed vaginal bleeding, missed or incomplete abortion, mammary or genital tract carcinoma, thrombophlebitis, cerebral haemorrhage, severe hepatic dysfunction.
Effectiveness of various barrier preparations in preventing and/or ameliorating experimentally produced Toxicodendron derma- titis generic 100 mg zenegra mastercard. Prevention of poison ivy and poison oak allergic contact dermatitis by quaternium-18 bentonite buy zenegra 100 mg overnight delivery. Training workers at risk for occupational contact dermatitis in the application of protective creams: efﬁcacy of a ﬂuorescence technique generic 100 mg zenegra overnight delivery. The inﬂuence of two barrier creams on the percutaneous absorption of m-xylene in man buy discount zenegra 100mg. A method for the study of the effect of barrier creams and protective gloves on the percutaneous absorption of solvents. Dandruff is the mildest manifestation of seborrheic dermatitis and it cannot be separated from seborrheic dermatitis. Therefore, what is mentioned in the literature for seborrheic dermatitis is also true for dandruff and vice versa. Seborrheic dermatitis is charac- terized by inﬂammation and desquamation in areas with a rich supply of seba- ceous glands, namely, the scalp, face, and upper trunk (1). It is a common disease and the prevalence ranges from 2 to 5% in different studies. The disease usually starts during puberty and is more common around 40 years of age. Seborrheic dermatitis is characterized by red scaly lesions predominantly located on the scalp, face, and upper trunk. The skin lesions are distributed on the scalp, eyebrows, nasolabial folds, cheeks, ears, pre- sternal and interscapular regions, axillae, and groin. Around 90 to 95% of all patients have scalp lesions and lesions on glabrous skin are found in approxi- mately 60% of the patients. Complications include licheniﬁcation, secondary bacterial infection, and otitis externa. A seasonal variation is observed with the majority of patients being better during the summertime. Seborrheic dermatitis is seen more frequently than expected in 197 198 Faergemann patients with pityriasis versicolor, Pityrosporum folliculitis, Parkinson’s disease, major truncal paralysis, mood depression, and acquired immunodeﬁciency syn- drome (1). Many treatment studies de- scribe the effectiveness of antimycotics, which reduces the number of P. The increased inci- dence of seborrheic dermatitis in patients with immunosuppressive disorders sug- gests that the relationship between P. Elevated titers in patients compared to controls as well as no difference in titers have been reported (3,4). In patients with seborrheic dermatitis, a reduced lymphocyte transformation response com- pared to healthy controls has been reported in two studies (5,6). However, in another study an enhanced lymphocyte stimulation response compared to healthy controls was found (7). In two recently published studies, no difference in lym- phocyte stimulation response was found between patients with seborrheic derma- titis and healthy controls (8,9). In an immunological screening of patients with seborrheic dermatitis, we have found low ( 0. In an immunohistochemical study in patients with seborrheic dermatitis deposits of complement C3c and IgG were found in the stratum corneum below Seborrheic Dermatitis 199 clusters of P. The local immune response in the skin may be different from the results obtained from in vitro studies on peripheral blood mononu- clear cells and may better explain the inﬂammatory skin reaction seen in seborrheic dermatitis. In a recently fulﬁlled immunohistochemical study (data are still unpublished), we found an increase in all cellular markers in both le- sional and nonlesional skin from patients with seborrheic dermatitis. It is important that no major differences were seen in the number of interleukin-associated cells between lesional and nonlesional skin in seborrheic dermatitis. The immune response in the skin of pati- ents with seborrheic dermatitis is complex, but showed some similarities with the results obtained with Candida infections (14,15). This is probably one of the important ex- planations why the immune response in the skin is more complex with dis- eases where this organism is involved. A strong stimulation of cells with natural killer function and complement activity may partly be explained by various enzymes (e. Stress and winter climate have a negative effect on the majority of patients and summer and sunshine have a posi- tive effect. In patients with neurological diseases and especially in patients with immunosuppressive disorders, seborrheic dermatitis is more resistant to therapy. Antifungal therapy is effective in the treatment of seborrheic dermatitis and, because it reduces the number of P. In one study, the com- bination of hydrocortisone and miconazole in an alcoholic solution was signiﬁ- cantly more effective than hydrocortisone alone in reducing the number of P. Oral keto- conazole has been effective in a double-blind, placebo-controlled trial in patients with seborrheic dermatitis of the scalp and other areas (18). However, oral ketoco- nazole should be reserved for patients not responding to topical therapy. In an- other double-blind, placebo-controlled study, ketoconazole 2% cream has been effective in the treatment of seborrheic dermatitis of the scalp and face (17), and in a comparative study between ketoconazole and hydrocortisone cream no difference was seen in effectiveness (20). Ketoconazole shampoo used twice weekly is very effective in treating seborrheic dermatitis of the scalp (18). In a double-blind placebo-controlled study of ketoconazole shampoo used twice weekly for 4 weeks, 89% in the ketoconazole group was cured, compared with only 14% in the placebo group (18). Ketoconazole used once weekly has also been effective in preventing re- currence of dandruff in previously treated patients. Ketoconazole shampoo has been compared to ciclopirox olamine shampoo in the treatment of seborrheic dermatitis/dandruff (24). Both shampoos were equally effective and signiﬁcantly more effective than placebo. However, at a follow-up visit 2 weeks after cessation of treatment, the recurrence rate was signiﬁcantly lower in the ketoconazole group compared to the ciclopirox olamine group (24). Other topical antimycotics are effective in the treatment of seborrheic der- matitis (2,16,21–25). Shampoos containing zinc pyrithione (21), selenium sulﬁde (16), or bifonazole (25) are also effective and widely used. In severe inﬂammatory seborrheic dermatitis, topical treatment with anti- fungal therapy alone may not be effective. Another therapy that can be effective is to combine potent topical corticosteroids with topical antifungal therapy. After clearance, many of these patients will remain free of lesions on prophylactic topical antifungal treatment. When lesions are covered with thick adherent scales, keratolytic therapy, especially in the scalp, is necessary. Seborrheic dermatitis especially in the scalp and external ear canal may be secondarily infected with bacteria. Often, in these patients, topical or oral antibacterial therapy in combina- tion with regular treatment is indicated. Seborrhoeic dermatitis and Pityrosporum orbiculare: Treatment of seborrhoeic dermatitis of the scalp with miconazole-hydrocortisone (Dactacort), mi- conazole and hydrocortisone. Seborrhoeic dermatitis and Pityrosporum ovale: cultural, immuno- logical and clinical studies. Cell-mediated deﬁciency to Pity- rosporum orbiculare in patients with seborrhoeic dermatitis. Cell-mediated immune response to Malassezia furfur serovars A, B and C in patients with pityriasis versicolor, sebor- rhoeic dermatitis and controls. Cell-mediated immunity to Pity- rosporum ovale in patients with seborrhoeic dermatitis and pityriasis versicolor. Seborrhoeic dermatitis is not caused by an altered immune response to Malassezia yeast. Bergbrant I-M, Johansson S, Robbins D, Scheynius A, Faergemann J, Soderstrom¨ ¨ T. Immune reactions to Pityrosporum ovale in adult patients with atopic dermatitis and sebor- rhoeic dermatitis. The effects of Malassezia on pro- inﬂammatory cytokine production by human peripheral blood mononuclear cells in vitro. Immunohistochemical aspects of the link between Malassezia ovalis and seborrhoeic dermatitis. Ketoconazole 2% cream versus 1% hydrocortisone cream in the treatment of seborrhoeic dermatitis: A double-blind comparative study.
The first dose should be given a minimum of 24 hours after cytotoxic therapy and is further titrated according to patient response (see product literature) order 100mg zenegra otc. Maintenance dose should be the minimum required to maintain neutrophil count (see product literature) discount zenegra 100mg on-line. Maintenancedoseshouldbe the minimum required to maintain neutrophil count (see product literature) cheap 100mg zenegra otc. Maintenance dose should be the minimum required to maintain neutrophil count (see product literature) zenegra 100 mg without prescription. Subcutaneous infusion Preparation and administration Filgrastim is incompatible with NaCl 0. Withdraw the required dose and add to a suitable volume of Gluc 5%, ensuring that the final concentration is 15 micrograms/mL or more. Inspect visually for particulate matter or discolor- ation prior to administration and discard if present. Intermittent intravenous infusion Preparation and administration Filgrastim is incompatible with NaCl 0. Withdraw the required dose and add to a suitable volume of Gluc 5%, ensuring that the final concentration is 15 micrograms/mL or more. Inspect visually for particulate matter or discolor- ation prior to administration and discard if present. Continuous intravenous infusion Preparation and administration Filgrastim is incompatible with NaCl 0. Withdraw the required dose and add to a suitable volume of Gluc 5%, ensuring that the final concentration is 15 micrograms/mL or more. Inspect visually for particulate matter or discolor- ation prior to administration and discard if present. Amphotericin, cefotaxime, ceftriaxone, cefuroxime, clindamycin phosphate, furosemide, gentamicin, heparin sodium, imipenem with cilastatin, methylprednisolone sodium succinate, metronidazole. Compatible with Flush: Gluc 5% Solutions: Gluc 5% (concentration dependent) Y-site: Aciclovir, amikacin, aminophylline, ampicillin, aztreonam, bumetanide, calcium folinate, calcium gluconate, ceftazidime, co-trimoxazole, dexamethasone sodium phosphate, fluconazole, ganciclovir, granisetron, hydrocortisone sodium succinate, mesna, metoclopramide, ondansetron, potassium chloride, ranitidine, sodium bicarbonate, ticarcillin with clavulanate, tobramycin, vancomycin, zidovudine (continued) 340 | Filgrastim Technical information (continued) pH 4 Sodium content Negligible Storage Store at 2--8 C (accidental freezing does not adversely affect stability). Vials and pre-filled syringe are for single use only: discard any unused solution. Stability after From a microbiological point of view, should be used immediately; however, preparation prepared infusions may be stored at 2--8 C and infused (at room temperature) within 24 hours. Serum lactate * "Levels have been reported (reversible and dose- dehydrogenase and dependent). Physical examination Periodically, and * Splenomegaly is a direct effect of filgrastim of spleen size (and urgently if patient therapy, but splenic rupture may occur. Bone density Consider if treatment * Long-term therapy maypromote osteoporotic bone >6 months disease. Morphological and Regularly every 12 * Accurate diagnosis is required before cytogenetic bone months in long-term commencing treatment with filgrastim. Discontinuation of treatment usually results in a 50% overdose decrease in circulating neutrophils within 1--2 days, returning to normal levels in 1--7 days. Counselling Training in aseptic technique and administration if self-administering. This assessment is based on the full range of preparation and administration options described in the monograph. Flecainide acetate 10mg/mL solution in 15-mL ampoules * Flecainide is a class 1 (membrane-stabilising) antiarrhythmic agent. Pre-treatment checks * Contraindicated in the following: heart failure; abnormal left ventricular function; history of myocardial infarction and either asymptomatic ventricular ectopics or asymptomatic non-sus- tained ventricular tachycardia; long-standing atrial fibrillation where conversion to sinus rhythm is not attempted; haemodynamically significant valvular heart disease. Dose in renal impairment: if CrCl <35mL/minute, reduce each of the above doses by half. Inspect visually for particulate matter or discolor- ation prior to administration and discard if present. Inspect visually for particulate matter or discolor- ation prior to administration and discard if present. Technical information Incompatible with Limited stability in sodium-containing infusion fluids: dose must be diluted to 500mL if using NaCl 0. Stability after There is little information on stability after preparation, therefore it would be preparation prudent to use the infusion immediately after preparation. Plasma flecainide Suggested after 12 * Target trough level is 200--1000 nanograms/mL. Significant * The following may "flecainide levels or effect (or "side-effects): interactions amiodarone (halve flecainide doses), artemether/lumefantrine (avoid combination), quinine, verapamil. Action in case of Life threatening -- no specific antidote; there is no known way of rapidly overdose removing flecainide from the body. This assessment is based on the full range of preparation and administration options described in the monograph. Flucloxacillin (floxacillin) 250-mg, 500-mg, 1-g dry powder vials * Flucloxacillin sodium is apenicillin witha mode of action similar to thatof benzylpenicillin, but it is resistant to staphylococcal penicillinase. Flucloxacillin | 345 Pre-treatment checks * Do not give if there is known hypersensitivity to penicillin. If this is not possible then flush the line with a compatible solution between drugs. Dose in renal impairment: adjusted according to creatinine clearance:1 * CrCl >10mL/minute: dose as in normal renal function. Dose in hepatic impairment: use with caution (risk of cholestatic jaundice and hepatitis). If this is not possible then flush the line with a compatible solution between drugs. Inspect visually for particulate matter or discolor- ation prior to administration and discard if present. Intermittent intravenous infusion Preparation and administration See Special handling below. If this is not possible then flush the line with a compatible solution between drugs. Withdraw the required dose and add to a suitable volume of compatible infusion fluid (usually 100mL NaCl 0. Inspect visually for particulate matter or discolor- ation prior to administration and discard if present. Intramuscular injection (maximum dose 500mg) Preparation and administration See Special handling below. Amikacin, amiodarone, benzylpenicillin, calcium gluconate, ciprofloxacin, clarithromycin, diazepam, dobutamine, erythromycin lactobionate, gentamicin, metoclopramide, midazolam, ofloxacin, tobramycin, verapamil. Renal function * Reduction of dose or extension of dosing interval is required if CrCl <10mL/minute. Neutropenia and thrombocytopenia can also occur but are reversible when treatment is stopped. Additional information Common and serious Immediate: Anaphylaxis and other hypersensitivity reactions have been undesirable effects reported. Other: Urticaria, fever, joint pains, rashes, angioedema, anaphylaxis, serum sickness-like reaction, nausea, vomiting and diarrhoea (pseudomembranous reported rarely). Counselling Women taking the combined contraceptive pill should be should be advised to take additional precautions during and for 7 days after the course. This assessment is based on the full range of preparation and administration options described in the monograph. Fluconazole 2mg/mL solutionin 50-mL, 100-mL,200-mL infusion bags; 25-mL,100-mL infusionvials * Fluconazole is a triazole antifungal drug that in sensitive fungi selectively inhibits cytochrome P450-dependent enzymes resulting in impairment of ergosterol synthesis, an essential component of fungal cell membranes. Commence treatment before the anticipated onset of neutropenia and continue for 7 days after the neutrophil count has reached the desirable range. Dosing in renal impairment (in patients who will receive multiple doses): thenormaldose isgiven according toindicationonday1, thenthe dose isadjusted according tocreatinine clearance, i. Inspect visually for particulate matter or discolor- ation prior to administration and discard if present. Technical information Incompatible with Amphotericin, ampicillin, calcium gluconate, cefotaxime, ceftazidime, ceftriaxone, cefuroxime, chloramphenicol sodium succinate, clindamycin phosphate, co-trimoxazole, diazepam, digoxin, furosemide, imipenem with cilastatin, pantoprazole. Symptoms of Throughout * If a rash develops attributable to fluconazole: exfoliative skin treatment discontinue for a patient with a superficial fungal reactions, e.