Allergies sulfa

Allergies Sulfa (patient states she breaks out in a rash that in some areas is "red and raised" and "red and flat")... 

Patients often develop rashes due to HIV infection or drug allergy. Sulfa desensitization is well documented, but desensitization to other medications is not as well studied. One patient taking nelfinavir developed a severe, pruritic rash management included nelfinavir desensitization over 12 days (10). 

PE Vital signs BP 160/99 mm Hg, HR 55 beats/min. Allergies Sulfa-based drugs. Medications Albuterol inhaler, fluticasone inhaler, and nitroglycerin sublingual tablets. 

Diazoxide Up to 24 hour <5 minute 1-3 mg/kg up to 150 mg Hypernatremia, dizziness, vomiting Avoid in patients with sulfa allergies also used in patients with hypoglycemia... 

Pneumocystis jiroveci prophylaxis See Table 52-7 Sulfa allergy... 

Starting sulfasalazine at low doses and titrating slowly will minimize the nausea and abdominal discomfort caused by the drug. Patients receiving sulfasalazine must undergo routine blood work to monitor for leukopenia.1 Patients with a sulfa allergy should not receive sulfasalazine. 

This combination is highly effective against most aerobic enteric bacteria except P. aeruginosa. High urinary tract tissue levels and urine levels are achieved, which may be important in complicated infection treatment. Also effective as prophylaxis for recurrent infections. Well tolerated, low cost. Palienls with sulfa allergies may preclude its use. 

Both solid and liquid dosage forms may contain saccharin. Saccharin is a nonnutritive sweetening agent, which is 300 times as sweet as sucrose. In a survey of sweetener content of pediatric medications, seven out of nine chewable tablets contained saccharin (0.45-8.0 mg/tablet) and sucrose or mannitol. Seventy-four of the 150 liquid preparations investigated contained saccharin (1.25-33 mg/5 mL) [62], Saccharin is a sulfanamide derivative that should be avoided in children with sulfa allergies [54],... 

Loop diuretics 40-80 mg IV every 1-4 hours N/A Allergy to sulfas (use ethacrynic acid) Electrolyte abnormalities... 

Sulfa drug allergy Probenecid is a sulfonamide patients with a history of allergy to sulfa drugs may react to probenecid. 

Sulfa allergy Use tipranavir with caution in patients with a known sulfonamide allergy. Tipranavir contains a sulfonamide moiety. 

WARNING Renal impair is the major tox foUow administration instructions Uses CMV retinitis w/ HIV Action Selective inhibition of viral DNA synth Dose Rx 5 mg/kg IV over 1 h once/wk for 2 wk w/ probenecid Maint 5 mg/kg IV once/2 wk w/ probenecid (2 g PO 3 h prior to cidofovir, then 1 g PO at 2 h 8 h after cidofovir) X in renal impair Caution [C, -] Contra Probenecid or sulfa allergy Disp Inj SE Renal tox, chills, fever, HA, NA /D, thrombocytopenia, neutropenia Interactions t Nephrotox W/ aminoglycosides, amphot icin B, foscar-net, IV pentamidine, NSAIDs, vancomycin t effects W/zidovudine EMS Monitor ECG for hypocalcemia (t QT int val) and hypokalemia (flattened T waves) OD May cause renal failure hydration may be effective in reducing drug levels/effects Cilostazol (Pletal) TAntiplatelet, Arterial Vasodilator/ Phosphodiesterase Inhibitor] Uses Reduce Sxs of intermittent claudication Action Phosphodiesterase in inhibitor t s cAMP in pits blood vessels, vasodilation inhibit pit aggregation Dose 100 mg PO bid, 1/2 h before or 2 h after breakfast dinner Caution [C, +/-] Contra CHE, hemostatic disorders. 

A 17-year-old boy with a history of sulfa allergy is diagnosed with left-side ulcerative colitis after a 3-week history of bloody diarrhea and tenesmus. On examination he is afebrile and has no abdominal tenderness. The appropriate drug therapy to institute initially is which of the following ... 

C. The information provided suggests the patient has mild to moderate disease. Initial therapy should be a 5-ASA containing product, which includes sulfasalazine and mesalamine. However, the patient has a sulfa allergy, precluding the use of sulfasalazine. Metronidazole is useful in the treatment of some patients with Crohn s disease. Cyclosporine has been used in patients with fulminant ulcerative colitis. Prednisone may have to be added to this patient s therapy, but only if he fails to respond to the mesalamine. It should not be used initially. 

Use with caution in patients with sulfa allergy. 

Although allergic cross-reactivity with sulfonamide antibiotics and sulfonamide nonantibiotics has not been demonstrated, use with caution in patients with a history of severe sulfa allergies. 

Darunavir PI2 600 mg bid with ritonavir 100 mg bid Take with food Diarrhea, headache, nausea, rash, hyperlipidemia, t liver enzymes, t serum amylase Avoid in patients with sulfa allergy. See footnote 4 for contraindicated medications... 

Tipranavir PI2 Must be taken with ritonavir to achieve effective levels tipranavir 500 mg bid/ritonavir 200 mg bid. Avoid use in hepatic insufficiency. Approved for pediatric usage Take with food. Separate from ddl by at least 2 h. Avoid antacids. Avoid in patients with sulfa allergy. Refrigeration required Diarrhea, nausea, vomiting, abdominal pain, rash, t liver enzymes, hypercholesterolemia, hypertriglyceridemia See footnote 4 for contraindicated medications. Avoid concurrent fosamprenavir, saquinavir. Do not administer to patients at risk for bleeding... 

Tipranavir is a newer PI for treating patients with resistance to other PI agents. Bioavailability is poor but is increased when taken with a high-fat meal. The drug is metabolized by the liver microsomal system. Tipranavir must be taken in combination with ritonavir to achieve effective serum levels. It is contraindicated in patients with hepatic insufficiency. Tipranavir contains a sulfonamide moiety and should not be administered to patients with known sulfa allergy. 

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