Clearance Monitoring

BETA-BLOCKERS LITHIUM Report of episode of t lithium levels in elderly patient after starting low-dose propanolol. However, propanolol is often used to treat lithium-induced tremor without problems Mechanism uncertain at present, but propanolol seems to 1 lithium clearance Monitor lithium levels when starting propanolol therapy in elderly people... 

STATINS PROTON PUMP INHIBITORS Possible T efficacy and adverse effects of atorvastatin Inhibition of P-gp, reducing first-pass clearance Monitor closely... 

BLEOMYCIN ANTICANCER AND IMMUNOMODULATING DRUGS-CISPLATIN t bleomycin levels, with risk of pulmonary toxicity Elimination of bleomycin is delayed by cisplatin due to 1 glomerular filtration. This is most likely with accumulated doses of cisplatin in excess of 300 mg/m2 Monitor renal function and adjust dose of bleomycin as per creatinine clearance. Monitor clinically, radiologically and with lung function tests for pulmonaiy toxicity... 

Kuhlmann U, Goldau R, Samadi N, Graf T, Gross M, Orlandmi G, et al. Accuracy and safety of online clearance monitoring based on conductivity variation. Nephrol Dial Transplant 2001 16 1053-8. 

A) Where the TSI or surfacing material to be removed is 25 linear or 10 square feet or less, the evaluation required in paragraph (g)(6) of this section may be performed by a competent person , and may omit consideration of perimeter or clearance monitoring otherwise required. 

A recently developed on-line clearance monitor (Gotch et al., 2004) has been demonstrated to be effective at predicting future mortality (Lowrie et al., 2005), indicating that it is a valid tool for assessing dialysis adequacy. 

For those dmgs that are administered as the racemate, each enantiomer needs to be monitored separately yet simultaneously, since metaboHsm, excretion or clearance maybe radically different for the two enantiomers. Further complicating dmg profiles for chiral dmgs is that often the pharmacodynamics and pharmacokinetics of the racemic dmg is not just the sum of the profiles of the individual enantiomers. 

Monitoring or providing clearance for employee pubHcations, lectures, and other pubHc activities related to the business of the organisation. 

Maintenance doses widely vary among patients (e.g., from 1 to 20 mg/day for warfarin), and are influenced by diet (variable vitamin K intake) and medications that affect coumarin metabolism (decreased drug clearance e.g., cotrimoxazole, amiodarone, erythromycin increased clearance e.g., barbiturates, carbamaze-pine, rifampin). Thus, regular monitoring is needed... 

Older adults are at increased risk for adverse reactions from the antineoplastic drugs because of the increased incidence of chronic disease, particularly renal impairment or cardiovascular disease. When renal impairment is present, a lower dosage of the antineoplastic may be indicated. Creatinine clearance isused to monitor renal function in the older adult. Blood creatinine levels are likely to be inaccurate because of a decreased muscle mass in the older adult. 

Worldwide, 15 million HBsAg carriers are also infected with hepatitis D/delta virus (HDV) (Gaeta et al. 2000). This situation represents a major therapentic challenge, as most of these patients have advanced liver disease, inclnding cirrhosis in 60-70% of cases, and hepatocellular carcinoma (Fattovich et al. 2000 Saracco et al. 1987). No specific HDV inhibitors have been developed, and IFN-a-based treatment is more difficnlt in HBV-HDV infection than in HBV monoinfection. HDV RNA levels in sernm can be nsed to monitor treatment efficacy. The endpoint of therapy is HDV RNA clearance and ALT normalization, and this is sometimes achieved after the end of treatment. A snstained response can lead to HBsAg clearance from serum. 

With this focus on CYP and fiver metabolism, most companies have established high throughput assays to measure compound stability in the presence of human (or preclinical species) fiver microsomes [49]. Disappearance of starting compound from an incubation with microsomes is monitored. Measurement at a single time point enables a rank-ordering of compounds for stability based on percent of parent compound remaining acquisition of data at multiple time points allows determination of half-life, intrinsic clearance, and extrapolation to a predicted in vivo clearance [50]. 

Monitor for adequate perfusion of vital organs through assessment of mental status, creatinine clearance, liver function tests, and a stable HR between 50 and 100 beats per minute. Additionally, adequate skin and muscle blood perfusion and normal pH is desirable. 

Prior to initiating treatment with a LMWH, baseline laboratory tests should include PT (prothrombin time)/INR, aPTT, complete blood cell count (CBC), and serum creatinine. Monitor the CBC every 3 to 4 days during the first 2 weeks of therapy, and every 2 to 4 weeks with extended use.5 Use LMWHs cautiously in patients with renal impairment. Specific dosing recommendations for patients with a creatinine clearance (CrCl) less than 30 mL/minute are currently available for enoxaparin but lacking for other agents of the class (Table 7-3). Current guidelines recommend the use of UFH over LMWH in patients with severe renal dysfunction (CrCl less than 30 mL/minute).8... 

Use of zileuton is uncommon due to the need for dosing four times a day, potential drug interactions, and the potential for hepatotoxicity with the resulting need for frequent monitoring of liver enzymes. In patients started on zileuton, serum alanine aminotransferase concentrations should be monitored before treatment begins, monthly for the first 3 months, every 2 to 3 months for the remainder of the first year, and then periodically thereafter for as long as the patient continues to receive the medication. Zileuton also inhibits the cytochrome P-450 (CYP) mixed function enzyme system and has been shown to decrease the clearance of theophylline, R-warfarin and propranolol.34... 

Monitor for changes in pulmonary symptoms such as cough, sputum production, respiratory rate, and oxygen saturation. Symptoms of an acute exacerbation should improve with antibiotics and aggressive airway clearance therapy. Pulmonary function tests should be markedly increased after 1 week and trend back to pre-exacerbation levels after 2 weeks of therapy, ft improvement lags, 3 weeks of therapy may be needed. 

Saline laxatives containing magnesium, potassium, or phosphates should be used cautiously in persons with reduced kidney function. Monitor appropriate serum electrolyte concentrations in patients with unstable renal function evidenced by changing serum creatinine or creatinine clearance. 

CYP3A4 and 2D6 are the major enzymes involved in the metabolism of galantamine. Pharmacokinetic studies with inhibitors of this system have resulted in increased galantamine concentrations or reductions in clearance. Similarly to donepezil, if inhibitors are given concurrently with galantamine, monitoring for increased cholinergic side effects should be done. Studies with inducers of these enzymes have not been completed.37... 

Monitor the patient for clearance of skin lesions. Depending on the agent(s) used and site of lesions it may take 2 to 6 weeks or longer to see a response. Complete clearance may not be achieved for all patients. 

The only current treatment of EHEC infection is supportive, including fluid and electrolyte replacement, often in the form of ORT. Most illnesses resolve in 5 to 7 days. Patients should be monitored for the development of HUS. Antibiotics are currently contraindicated because they can induce the expression and release of toxin. Antimotility agents should be avoided because they may delay clearance of the pathogen and toxin. This, in turn, may increase the risk of systemic complications. 

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