Amphotericin Vancomycin

TDF -tFTC Truvada 200 mg and 300 mg tablet IV aminoglycosides, acyclovir, famciclovir, ganciclovir, valacyclovir, amphotericins, vancomycin... 

An additive nephrotoxicity develops when pentamidine isethionate is administered with other nephrotoxic drugs (eg, aminoglycosides, vancomycin, or amphotericin B). An additive bone marrow depression occurs when the drug is administered with antineoplastic drugs or when the patient lias received radiation therapy recently. 

Amphotericin B, cephalosporins, penicillins, minocycline, nitrofurantoin, sulfonamide antimicrobials, and vancomycin... 

Nephrotoxins (N) orototoxins (0) (eg., amphotericin B (N), cisplatin (N/0), cyclosporine (N), furosemide (0), NSAIDs (N), radio contrast (N), vancomycin (N) Additive adverse effects Monitor aminoglycoside SDC and renal function... 

The severity of aminoglycoside nephrotoxicity is additive with that of vancomycin, polymixin, gallium, furosemide, enflurane, cisplatin, and cephalosporins. Aminoglycoside nephrotoxicity is synergistic with that of amphotericin B and cyclosporine. 

Direct tubular damage, e.g. aminoglycoside, vancomycin, tetracycline, amphotericin... 

Vancomycin, fusidic acid, macrolides and amphotericin all cause irritation to veins when administered intravenously... 

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,... 

A final example of metabolic pathway engineering is based on polyketide and nonribosomal peptide biosynthesis. Polyketides and nonribosomal peptides are complex natural products with numerous chiral centers, which are of substantial economic benefit as pharmaceuticals. These natural products function as antibiotics [erythromycin A (65), vancomycin (66)], antifungals (rapamycin, amphotericin B), antiparasitics [avermectin Ala (67)], antitumor agents [epothiolone A (68), calicheamicin yj, and immunosuppressants [FK506 (69), cyclosporin A], Because this exponentially growing and intensely researched field has developed, the reader is directed to review articles for additional details.347-359 Also with the potential economic benefit to develop the next blockbuster pharmaceutical, a number of patents and patent applications have been published.360-366... 

Benzylpenicillin is incompatible with rubber products and metal ions. Stability is affected by alcohols, surfactants, oxidizing and reducing agents, macrogols and other hydroxy compounds, glycerol, glycols, some paraffins and ointment bases, preservatives such as chlorocresol or thiomersal, blood and blood products, and antibacterials such as amphotericin, cephalosporins, and vancomycin. Injections of benzylpenicillins and aminoglycosides should be administered separately. 

VANCOMYCIN ANTIFUNGALS -AMPHOTERICIN Risk of renal failure Additive effect Monitor renal function closely... 

ADEFOVIR DIPIVOXIL 1. ANTIBIOTICS -aminoglycosides, vancomycin 2. ANTICANCER AND IMMUNOMODULATING DRUGS - cidosporin, tacrolimus 3. ANTIFUNGALS-amphotericin, 4. ANTIPROTOZOALS-pentamidine 5. ANTIVIRALS - cidofovir, foscarnet sodium, tenofovir Possible t efficacy and side-effects Competition for renal excretion Monitor renal function weekly... 

In a prospective study 56 patients with suspected or proven severe Gram-positive infections were randomized to receive vancomycin (1 g 12-hourly intravenously) or teicoplanin (200-400 mg/day intravenously or intramuscularly) (5). Clinical and bacteriological cure rates were similar, but vancomycin was associated with significantly greater toxicity (16 vancomycin, 7 teicoplanin), predominantly histamine-associated reactions (15, including two cases of red man syndrome) (SEDA-17, 312), and nephrotoxicity (five with vancomycin compared with one with teicoplanin). Four of the five vancomycin patients who developed nephrotoxicity were receiving netilmicin at the time, some with amphotericin as well. 

Antibiotics aminogiycosides, cephaioridine, cephaiothin, amphotericin B, rifampicin, vancomycin, foscarnet, pentamidine. 

Beta-lactam induced renal toxicity can results from their use in monotherapy or when used in combination with other nephrotoxic drugs such as aminoglycosides, amphotericin B, cisplatin, cyclosporine, furosemide, ifosfamide, vancomycin and nephrotoxic p-lactams. While the risk of nephrotoxic injury from monotherapy with p-lactams is relatively low, this risk is substantially increased when multiple drug combinations are required. 

A more widely used approach is to divide agents into those approved for unrestricted use and those for restricted use. Agents on the unrestricted list are appropriate for the majority of common clinical situations. The restricted list may include agents where microbiological sensitivity information is essential, such as for vancomycin and certain aminoglycosides. In addition, agents that are used infrequently but for specific indications, such as parenteral amphotericin B, are also restricted in use. Other compounds that may be expensive and... 

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