Drug toxicity, minimizing

Frequently monitor the patient for signs of drug toxicity and seizures until the patient s drug concentrations have stabilized. Drug interactions are likely when patients are on more than one AED therefore, closely evaluate the patient s entire medication profile, and change medications or doses to minimize the interaction, if possible. 

Blood urea nitrogen (BUN) and serum creatinine are needed to dose antibiotics appropriately and to minimize or prevent drug toxicity (especially in the elderly patient). 

Pharmacogenetics provides a rational framework to minimize the uncertainty in outcome of drug therapy and clinical trials and thereby should significantly reduce the risk of drug toxicity. The reader is referred to the Internet sources in Table 20.1 for more details on pharmacogenetics and drug development. Potential improvements in patient inclusion criteria will be addressed later in this chapter. 

These tests are of minimal value in determining ocular toxicity and are not recommended for routine use in ophthalmological examination to detect drug toxicities. 

Single agents are seldom used to treat HIV infection. Instead, multidrug therapy is used to counteract the rapid mutation rate of HIV and to minimize drug toxicity. Highly active antiretroviral therapy (HAART) uses combinations of reverse transcriptase inhibitors and protease inhibitors (Table 51.1). In this system, drugs working by different mechanisms produce a sequential blockade of steps required for viral reproduction. It is... 

The remote release of encapsulated materials is desired for bioapplications in order to minimize drug toxicity, to control the properties of biosurfaces and interfaces, and to study intracellular processes [132], Remote release can be more convenient for a patient because external stimuli like a magnetic field, light, and ultrasound are... 

MINIMIZING DRUG TOXICITY AND OTHER ADVERSE REACTIONS ... 

Intensive supportive therapy is all that is required for most patients suffering from dose-related drug toxicity/ and drug removal by extracorporeal methods generally is indicated only for those patients whose condition deteriorates despite institution of these more conservative measures (49). However/ a decision to intervene with extracorporeal therapy may be prompted by other clinical and pharmacologic considerations that are listed in Table 6.6. For example/ most intoxications with phenobarbital can be managed by a combination of supportive care and minimization... 

The drug toxicity to healthy tissues and the cell resistance to treatments described earher pose a twofold challenge for drug delivery technology—to improve the dehvery selectivity and to overcome the cell resistance— to simultaneously maximize the therapeutic efficacy and minimize the side effects. 

Electroretinographic toxicity criteria have also been employed but concurrent controls in which a placebo is injected in the fellow eye simultaneously are important since surgical invasion of the eye alone can reduce the electroretinographic response (33). The antimicrobial itself, the vehicle, or the preservatives may all be sources of intraocular toxicity. Osmolality or pH have been suggested by Marmor as potential causes for iatrogenic tissue damage to the retina (34). Injection of low volumes of drug probably minimizes this risk. 

Dactinomycin is administered by intravenous injection. The drug is excreted both in bile and in the urine and disappears from plasma with a terminal t j of 36 hours. Metabolism of the drug is minimal. Dactinomycin does not cross the blood—brain barrier. The usual daily dose of dactinomycin (actinomycin D cosmegen) is 10-15 pg/kg this is given intravenously for 5 days. If no manifestations of toxicity are encountered, additional courses may be given at intervals of 2—4 weeks. 

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