Amphotericin dependence

Clotrimazole and other azole derivatives have a different mode of action than the polyenes, eg, amphotericin B. The latter biad to the ergosterol present ia the membranes of yeasts and fungi, but azole derivatives inhibit the cytochrome P-450 dependent biosynthesis of ergosterol (8—11). This inhibition not only results in a reduction of ergosterol, but also in an accumulation of C-14 methyl sterols. They disturb membrane permeabiUty, inhibit cell rephcation, and are basically responsible, in combination with the reduction of ergosterol levels, for the antifungal action. 

AMPHOTERICIN B. Fever (sometimes with shaking chills) may occur within 15 to 20 minutes of initiation of the treatment regimen. It is important to monitor the patient s temperature, pulse, respirations, and blood pressure carefully during the first 30 minutes to 1 hour of treatment. The nurse should monitor vital signs every 2 to 4 hours during therapy, depending on the patient s condition. 

Prolonged presence of the drug at the site of injection is the aim of liposome encapsulation of drugs, which are injected in the vitreous body. Both amphotericin and gentamicin in liposome formulations were cleared from the injection site significantly more slowly than the free drug residence times depended on liposome size and, in some cases, on bilayer composition (Tremblay et al., 1985 Barza et al., 1985, 1987 Fishman et al., 1986). 

A special field of application of CD to oligoenes is that of some antibiotics, like filipin51 and amphotericin B52. These molecules are characterized by a strong tendency to autoaggregation, which causes the CD spectra to be strongly solvent, temperature and concentration dependent. In fact, in the presence of dimers, the CD is dominated by the appearance of a strong exciton couplet between the polyenic chains of neighbouring molecules. 

Bolard J, Seigneuret M, Boudet G. Interaction between phospholipid bilayer membranes and the polyene antibiotic amphotericin B lipid state and cholesterol content dependence. Biochim Biophys Acta 1980 599 280. 

DHAP-dependent aldolases have also been used in the synthesis of the C3-C9 fragment of aspicilin [46] and of the C12-C20 fragment of amphotericin [47]. 

Amphotericin B IV Infusion Initially 1 mg (base) as a test dose, administered in 20 mL of 5% dextrose injection over a period of 20 to 30 minutes, with 5 mg to 10 mg incremental increases depending on patient tolerance and severity of the infection, up to a maximum of 0.5 to 0.7 mg/kg Should be infused over a period of 2 to 6 hours... 

The primary adverse effect of intravenous cidofovir is a dose-dependent nephrotoxicity. Concurrent administration of other potentially nephrotoxic agents (eg, amphotericin B, aminoglycosides, nonsteroidal anti-inflammatory drugs, pentamidine, foscarnet) should be avoided. Prior administration of foscarnet may increase the risk of nephrotoxicity. Other potential side effects include uveitis, decreased intraocular pressure, and probenecid-related hypersensitivity reactions. Neutropenia and metabolic acidosis are rare. The drug caused mammary adenocarcinomas in rats and is embryotoxic. 

Zalcitabine therapy is associated with a dose-dependent peripheral neuropathy that can be treatment-limiting in 10-20% of patients but appears to be slowly reversible if treatment is stopped promptly. The potential for causing peripheral neuropathy constitutes a relative contraindication to use with other drugs that may cause neuropathy, including stavudine, didanosine, and isoniazid. Decreased renal clearance caused by amphotericin B, foscamet, and aminoglycosides may increase the risk of zalcitabine neuropathy. The other major reported toxicity is oral and esophageal... 

Amphotericin B Voltage-dependent channel maker in cell membrane... 

Amphotericin B (AmB) is a polyene macrolide used in the treatment of systemic fungal infections. The clinical use of amphotericin, however, is limited by its dose-dependent nephrotoxicity. A number of studies have shown that AmB is... 

Although sedative antihistamines do not potentiate the effect of alcohol, they should be avoided in excess quantity. Overdose of astemizole can be treated with gastric lavage and supportive measures.86 Coadministration of astemizole and ter-fenadine with antiarrhythmics, antipsychotics, cisapride, and diuretics should be avoided. Chlorpheniramine maleate has been found to be incompatible with phe-nobarbitone sodium, kanamycin sulfate, and calcium chloride. Cyclizines have been used alone or with opioids in tablets or in injectable form for euphoric effects. Cyproheptadine has shown dependence in long-term use. Diphenhydramine is reported to be incompatible with amphotericin, cephalothin sodium, and hydrocortisone sodium succinate. Diphenhydramine and pheniramine maleate are sometimes used as drugs of abuse. Studies have shown that promethazine is adsorbed onto glass, plastic containers, and infusion systems.87... 

Because amisulpride may dose-dependently prolong QTc interval, use with caution in patients who have hypokalemia and/or hypomagnesemia or who are taking drugs that can induce hypokalemia and/or magnesemia (e.g., diuretics, stimulant laxatives. Intravenous amphotericin B, glucocorticoids, tetracosactide)... 

Ocular penetration of IV amphotericin B is inflammation dependent and the liposomal formulation (L-AMB). May reach the highest aqueous and vitreous concentrations. 

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