Amphotericin hypokalemia

When amphotericin B or diuretics are administered with ACTH, the potential for hypokalemia is increased. There may be an increased need for insulin or oral antidiabetic drag s in the patient with diabetes who is taking ACTH. There is a decreased effect of ACTH when the agent is administered with the barbiturates. Profound muscular depression is possible when ACTH is administered with the anticholinesterase drugp. Live virus vaccines taken while taking ACTH may potentiate virus replication, increase vaccine adverse reaction, and decrease the patient s antibody response to the vaccine... 

L A. Nephrotoxicity is the most common and most serious toxicity associated with amphotericin B administration. This is manifested by azotemia (elevated serum blood urea nitrogen and creatinine), and by renal tubular acidosis, which results in the wasting of potassium and magnesium in the urine (leading to hypokalemia and hypomagnesemia, requiring oral or intravenous replacement therapy). Normochromic normocytic anemia is also seen with long-term amphotericin B administration. Elevation of hver enzymes is not associated with the use of amphotericin B. 

WARNING Renal impair is the major tox follow 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) 1 in renal impair Caution [C, -] Contra Probenecid or sulfa allergy Disp Inj SE Renal tox, chills, fever, HA, N/V/D, thrombocytopenia, neutropenia Interactions T Nephrotox W/ aminoglycosides, amphotericin B, foscar-net, IV pentamidine, NSAEDs, vancomycin T effects W/ zidovudine EMS Monitor ECG for hypocalcemia (T QT interval) and hypokalemia (flattened T waves) OD May cause renal failure hydration may be effective in reducing drug levels/effects Cilostazol (Pletal) [Antiplatelet, Arterial Vasodilator/ Phosphodiesterase Inhibitor] Uses Reduce Sxs of intermittent claudication Action Phosphodiesterase m 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 CHF, hemostatic disorders,... 

T Effects W/ antihypertensives, cliazoxicle, nitrates, EtOH T effects OF ACEIs, Li T risk of hypokalemia W/ amphotericin B, corticosteroids, mezlocillin, piperacillin, ticarcillin effects W/ cholestyramine, colestipol, NSAIDs EMS Monitor ECG for hypokalemia (flattened T waves) T risk of photosensitivity Rxns use caution w/ other diuretics, may T risk of electrolyte imbalances and dehydration may affect glucose (hyperglycemia) OD May cause dehydration, hypotension, drowsiness, headache, and fatigue symptomatic and supportive, do not do anything that would force greater fluid loss (ie, induce V)... 

Amphotericin B is nephrotoxic in most patients and often causes a permanent reduction in the glomerular filtration rate. Furthermore, hypokalemia may occur, requiring the oral administration of potassium chloride. 

One compound that has been associated with distal tubular injury is amphotericin B, a polyene antifungal agent used in the treatment of systemic mycoses caused by opportunistic fungi. Clinical utility of amphotericin B is limited by its nephrotoxicity, characterized functionally by polyuria resistant to antidiuretic hormone administration, hyposthenuria, hypokalemia, and mild renal tubular acidosis. 

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)... 

ADRs can also be classified as mild/ moderate/ or severe. Mild reactions/ such as dysgeusia associated with clarithromycin/ are bothersome but may not require a change in therapy. Moderate reactions/ such as amphotericin B-induced hypokalemia/ often require a change in therapy/ additional treatment/ or continued hospitalization. Reactions that are disabling or life-threatening/ or those that considerably prolong hospitalization/ are classified as severe (18). 

Amphotericin is highly effective in the treatment of visceral leishmaniasis (18). In a prospective study of 938 patients from Bihar, India, who received the drug in a dosage of 1 mg/kg/day infused over 2 hours for 20 days, serum creatinine values over 177 pmol/l were noted in 6.3%, and acute renal insufficiency developed in three patients. Two patients died, possibly related to amphotericin, one with renal insufficiency and one with hypokalemia and cardiac arrest. Infnsion-related chills occurred in 92% and fever in 40% of patients. The parasitological cure rate (no relapse within 6 months) exceeded 99%. 

The safety and efficacy of ABLC 5 mg/kg/day in patients with neutropenia and intolerance or refractoriness to amphotericin deoxycholate have been reported in two smaller series of 25 treatment courses from the UK. In one, the mean serum creatinine at the start of therapy was 139 pmol/l and at the end of therapy 132 pmol/l there were no infusion-related adverse events (27). There was an increase in alanine transaminase activity in 12 of the 22 analysed treatment courses. In the other, there was an increase in serum creatinine in 5 of 18 courses (28%), and hypokalemia (less than 2.5 mmol/1) in two courses (11%) premedication for infusion-associated reactions was required in three courses (17%) (28). There were modest increases in serum alanine transaminase activities in five patients (30%). 

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