Anemia depression with

Adverse reactions may include bone marrow depression with aplastic anemia agranulocytosis or thrombocytopenia (long-term therapy) peripheral neuritis purpura myopathy loss of hair reversible azoospermia dermatoses hypersensitivity vomiting diarrhea abdominal pain nausea elevated alkaline phosphatase and AST. 

The most publicized adverse affects are those involving the hematopoietic system they are manifested by toxic bone marrow depression or idiosyncratic aplastic anemia. The bone marrow depression is dose related and is seen most frequently when daily doses exceed 4 g and plasma concentrations exceed 25 jig/mL. The bone marrow depression is characterized by anemia, sometimes with leukopenia or thrombocytopenia, but it is reversible on discontinuation of chloramphenicol. 

Anyone taking diuretics for longer than six months may experience a folate, or folic acid, deficiency. Folic acid plays a part in the health and reproduction of virtually every cell in the body. It is responsible for protein metabolism, the prevention of neural tube defects in pregnancy, blood cell production, and the synthesis of neurotransmitters. Individuals with folate deficiencies may suffer from anemia, depression and other mood disorders, and may give birth to babies with neural tube defects. Supplementation with folic acid may be useful in reversing these effects. 

Most common adverse effects include nausea, vomiting, diarrhea, abdominal pain, bone marrow depression with agranulocytosis, thrombocytopenia, and aplastic anemia. Cumulative toxicity is possible in elderly patients, hence it should be used cautiously. Care also should be exercised in patients with cardiac, hepatic, and renal dysfunctions. Colchicine causes teratogenicity in animals, and there are evidences of the risk of fetal chromosomal damage in humans. Colchicine should not be administered by the parenteral route as it causes severe local irritation. 

A second, more serious, type of bone marrow depression consists of aplastic anemia. Considered an idiosyncratic reaction rather than a toxic reaction, aplastic anemia occurs most commonly weeks to months after completion of therapy and is not dose related. In the most severe form of aplastic anemia, pancytopenia with an aplastic marrow is present. Prognosis is very poor because the anemia is usually irreversible. 

Adverse effects of thiacetazone include bone marrow depression, with anemia, leukopenia, agranulocytosis, and thrombocytopenia (2-4). Hemolytic anemia has also been described (5). 

Effects Acute exposure leads to CNS depression with ataxia and coma. Long-term exposure to benzene is associated with hematotoxicity (thrombocytopenia, leukopenia, aplastic anemia), and the compound may be leukemogenic. Toluene is not a myelosuppressant. 

Chronic toxicosis in poultry and dogs. Bone marrow depression with granulocytopenia, anemia, and hypoprothrombinemia suggest sulfaquinoxaline toxicosis in poultry or dogs. Analysis of musde, kidney, or liver tissue teveais sulfonamide concentrations above 20 ppm. d. Treatment... 

Toxicity of zinc is characterized by anemia, depressed growth, stiffness, hemorrhages in bone joints, bone resorption, depraved appetite, and in severe cases, death. The anemia appears to result from an interference with iron and copper utilization because addition of these two elements can overcome the anemia caused by excessive zinc. 

Other agents are also used for the treatment of manic-depressive disorders based on preliminary clinical results (177). The antiepileptic carbamazepine [298-46-4] has been reported in some clinical studies to be therapeutically beneficial in mild-to-moderate manic depression. Carbamazepine treatment is used especially in bipolar patients intolerant to lithium or nonresponders. A majority of Hthium-resistant, rapidly cycling manic-depressive patients were reported in one study to improve on carbamazepine (178). Carbamazepine blocks noradrenaline reuptake and inhibits noradrenaline exocytosis. The main adverse events are those found commonly with antiepileptics, ie, vigilance problems, nystagmus, ataxia, and anemia, in addition to nausea, diarrhea, or constipation. Carbamazepine can be used in combination with lithium. Several clinical studies report that the calcium channel blocker verapamil [52-53-9] registered for angina pectoris and supraventricular arrhythmias, may also be effective in the treatment of acute mania. Its use as a mood stabilizer may be unrelated to its calcium-blocking properties. Verapamil also decreases the activity of several neurotransmitters. Severe manic depression is often treated with antipsychotics or benzodiazepine anxiolytics. 

As regards toxicity, pyrazole itself induced hyperplasia of the thyroid, hepatomegaly, atrophy of the testis, anemia and bone marrow depression in rats and mice (72E1198). The 4-methyl derivative is well tolerated and may be more useful than pyrazole for pharmacological and metabolic studies of inhibition of ethanol metabolism. It has been shown (79MI40404) that administration of pyrazole or ethanol to rats had only moderate effects on the liver, but combined treatment resulted in severe hepatotoxic effects with liver necrosis. The fact that pyrazole strongly intensified the toxic effects of ethanol is due to inhibition of the enzymes involved in alcohol oxidation (Section 4.04.4.1.1). 

Other adverse reactions associated with penicillin are hematopoietic changes such as anemia, thrombocytopenia (low platelet count), leukopenia (low white blood cell count), and bone marrow depression. When penicillin is given orally, glossitis (inflammation of the tongue), stomatitis (inflammation of die mouth), dry mouth, gastritis, nausea, vomiting, and abdominal pain occur. When penicillin is given intramuscularly (IM), there may be pain at die injection site Irritation of the vein and phlebitis (inflammation of a vein) may occur witii intravenous (IV) administration. 

Administration of trimethadione (Tridione) may result in hematologic changes, such as pancytopenia (decrease in all the cellular components of the blood), leukopenia, aplastic anemia, and thrombocytopenia Also reported are various types of skin rashes, diplopia (double vision), vomiting, changes in blood pressure, CNS depression, photosensitivity, and fatal nephrosis. Because these dm have been associated with serious adverse reactions and fetal malformations, they should be used only when other less toxic dm are not effective in controlling seizures. The oxazolidinediones may precipitate a tonic-clonic seizure... 

The answer is c. (Hardman, pp 1134-1135.) Hematologic toxicity is by far the most important adverse effect of chloramphenicol The toxicity consists of two types (1) bone marrow depression (common) and (2) aplastic anemia (rare) Chloramphenicol can produce a potentially fatal toxic reaction, the gray baby syndrome, caused by diminished ability of neonates to conjugate chloramphenicol with resultant high serum concentrations. Tetracyclines produce staining of the teeth and phototoxicity... 

However, the use of CAP was soon restricted after its association with bone marrow depression and aplastic anemia. The underlying biochemical lesion is still obscure, and adequate animal models are lacking. Since thiamphenicol, a CAP analogue where the nitro function has been replaced by a MeSC>2 -group, has never been associated with aplastic anemia, Yunis and coworkers suggested that the p-n il.ro group of CAP may be involved in the development of aplastic anemia129,130. 

Toxicology. Acute benzene exposure causes central nervous system depression chronic exposure causes bone marrow depression leading to aplastic anemia and is also associated with an increased incidence of leukemia. 

Until recent times, the only toxicological hazards attributable to nitrous oxide were those common to asphyxiants, with death or permanent brain injury occurring only under conditions of hypoxia. A number of untoward and toxic effects have now been associated with exposure. One of the earliest findings was that patients given 50% nitrous oxide and 50% oxygen for prolonged periods, to induce continuous sedation, developed bone marrow depression and granuloqn openia. The bone marrow usually returned to normal within a matter of days once the nitrous oxide was removed, but several deaths from aplastic anemia have been recorded. ... 

In livestock, selenium has been found to be the cause of blind staggers and alkali disease. Blind staggers occurs as a result of acute ingestion of seleniferous plants and is characterized by impaired vision, depressed appetite, a tendency to wander in circles, paralysis, and death from respiratory failure. A more chronic syndrome described in horses and livestock is alkali disease, which also is associated with consumption of grains or plants containing selenium. The disease is characterized by lack of vitality, loss of appetite, emaciation, deformed hoofs, loss of hair, erosion of the joints of long bones, anemia, cirrhosis, and cardiac atrophy ... 

Other effects reported in tetryl workers are irritability, fatigue, malaise, headache, lassitude, insomnia, nausea, and vomiting. Anemia, of either the marrow depression or deficiency type, has been observed among tetryl workers. Conjunctivitis may be caused by rubbing the eyes with contaminated hands or by airborne dust keratitis and iridocyclitis have occurred. Tetryl has been reported to cause irreversible liver damage and death after chronic heavy exposure." However, complicat-... 

Biood dyscrasias Agranulocytosis, bone marrow depression, neutropenia, hypoplastic anemia and thrombocytopenia in patients receiving procainamide have been reported at a rate of approximately 0.5%. Fatalities have occurred (with approximately 20% to 25% mortality in reported cases of agranulocytosis). Perform complete blood counts including white cell, differential, and platelet counts at weekly intervals for the first 3 months of therapy, and periodically thereafter. Perform complete blood counts promptly if the patient develops any signs of infection (eg. 

Aplastic anemia and agranulocytosis have been reported in association with carbamazepine therapy. The risk of developing these reactions is 5 to 8 times greater than in the general population. Consider discontinuation of the drug if any evidence of significant bone marrow depression develops. 

Hematologic/Lymphatic Anemia hemolytic anemia thrombocytopenia thrombocytopenic purpura eosinophilia leukopenia granulocytopenia neutropenia bone marrow depression agranulocytosis reduction of hemoglobin or hematocrit prolongation of bleeding and prothrombin time decrease in WBC and lymphocyte counts increase in lymphocytes, monocytes, basophils, and platelets. Hypersensitivity Adverse reactions (estimated incidence, 1% to 10%) are more likely to occur in individuals with previously demonstrated hypersensitivity. In penicillin-sensitive individuals with a history of allergy, asthma, or hay fever, the reactions may be immediate and severe. 

Blood dyscrasias An irreversible type of marrow depression leading to aplastic anemia with a high rate of mortality is characterized by appearance of bone marrow aplasia or hypoplasia weeks or months after therapy. Peripherally, pancytopenia is most often observed, but only 1 or 2 of the 3 major cell types may be depressed. 

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