Hepatic dysfunction

The drug is contraindicated in die presence of an allergy to die drug, pregnancy (Category C), lactation, and phenylketonuria (oral form only). Linezolid is used cautiously in patients with bone marrow depression, hepatic dysfunction, renal impairment, hypertension, and hyperthyroidism. 

This drug is contraindicated in patients with known hypersensitivity to die drug and during die first trimester of pregnancy (Category B). This drug is used cautiously in patients widi blood dyscrasias, seizure disorders, and hepatic dysfunction. Safety in children (odier dian orally for amebiasis) lias not been established. 

Antiemetics and antivertigo drag s are used cautiously in patients with glaucoma or obstructive disease of the gastrointestinal or genitourinary system, those with renal or hepatic dysfunction, and in older men with possible prostatic hypertrophy. Piromethazine is used cautiously in patients with hypertension, sleep apnea, or epilepsy. Trimethobenzamide is used cautiously in children with a viral illness because it may increase the risk of Reye s syndrome... 

All antiarrhythmic dra are used cautiously in patients with renal or hepatic disease. When renal or hepatic dysfunction is present, a dosage reduction may be necessary. All patients should be observed for renal and hepatic dysfunction. Quinidine and procainamide are used cautiously in patients with CHF. Disopyramide is used cautiously in patients with CHF, myasthenia gravis, or glaucoma, and in men with prostate enlargement. Bretylium is used cautiously in patients with digitalis toxicity because the initial release of norepinephrine with digitalis toxicity may exacerbate arrhythmias and symptoms of toxicity. Verapamil is used cautiously in patients with a history of serious ventricular arrhythmias or CHF. Electrolyte disturbances such as hypokalemia, hyperkalemia, or hypomagnesemia may alter the effects of the antiarrhythmic dru . Electrolytes are monitored frequently and imbalances corrected as soon as possible... 

Niacin is contraindicated in patients with known hypersensitivity to niacin, active peptic ulcer, hepatic dysfunction, and arterial bleeding. The drug is used cautiously in patients with renal dysfunction, high alcohol consumption, unstable angina, gout, and pregnancy (Category C). 

Cisatracurium or atracurium in the presence of renal and/or hepatic dysfunction... 

The Food and Drug Administration (FDA) approved dose of daclizumab is 1 mg/kg within 24 hours of transplant surgery and then 1 mg/kg administered every 2 weeks after surgery for a total of five doses.7,9,11 No dose adjustment is necessary in renal impairment, but no data are available for dose adjustments in hepatic dysfunction. Several trials have shown that a shorter dosing regimen of daclizumab, two doses given in a similar manner as basiliximab, may be as safe and effective as the full five-dose course.12,13... 

Dosage adjustment necessary in patients with concomitant renal and hepatic dysfunction. 

Dosage adjustment necessary in severe hepatic dysfunction. 

Estrogens Diethylstilbestrol Ethinyl estradiol Conjugated estrogens 5 mg orally three times daily 1 mg orally three times daily 2.5 mg orally three times daily Nausea/vomiting, fluid retention, anorexia, thromboembolism, hepatic dysfunction... 

Verify chemotherapy regimen dosages with a standardized reference, and assess for dose adjustment for renal or hepatic dysfunction. 

Caspofungin 70 mg/kg IV loading dose on day 1 followed by 50 mg/kg IV daily Dosage adjustment in hepatic dysfunction. 

Assess the patient daily for any new signs or symptoms of infection. Evaluate the patient for adverse drug reactions, drug allergies, and drug interactions. Have all antibiotics been dose adjusted for renal or hepatic dysfunction ... 

Nonabsorbable antibiotics are appealing because they have fewer systemic side effects and may be safer for children and pregnant women as well as in patients with renal and hepatic dysfunction. One such antibiotic, aztreonam, showed little effect on anaerobic flora in human volunteers, producing most of its effect on the aerobic flora [49, 50], A trial showed efficacy of aztreonam for traveler s diarrhea, where most pathogens are aerobes [51]. While there are no data on rates of AAD for nonabsorbable antibiotics and C. difficile, these would likely be decreased. Given the preservation of the anaerobic flora, another poorly absorbed antibiotic, bicozamycin, has efficacy in traveler s diarrhea with its major effect being on fecal aerobes [52],... 

The answer is b. (Hardman, pp 1268-1269J Asparaginase is an enzyme that catalyzes the hydrolysis of serum asparagine to aspartic acid and ammonia. Major toxicities are related to antigenicity and pancreatitis. In addition, more than 50% of those treated present biochemical evidence of hepatic dysfunction. 

The answer is c. (Katzung, p 729.) Hepatic dysfunction has occurred particularly with the use of troglitazone, necessitating its removal from the market Patients treated with other thiazolidinediones should be monitored for this possibility... 

Colchicine given in low oral doses (0.5 to 0.6 mg twice daily) may be effective in preventing recurrent arthritis in patients with no evidence of visible tophi and a normal or slightly elevated serum urate concentration. The oral dose should be reduced to no more than 0.6 mg daily or every other day in patients with renal or hepatic dysfunction. Treated patients who sense the onset of an acute attack should increase the dose to 1 mg every 2 hours in most instances, the attack aborts after 1 or 2 mg. Discontinuation of prophylaxis may be attempted if the serum urate concentration remains normal and the patient is symptom-free for 1 year. 

The major side effects of allopurinol are skin rash, urticaria, leukopenia, GI problems, headache, and increased frequency of acute gouty attacks with the initiation of therapy. An allopurinol hypersensitivity syndrome characterized by fever, eosinophilia, dermatitis, vasculitis, and renal and hepatic dysfunction occurs rarely but is associated with a 20% mortality rate. 

Eradication of the offending organism and complete clinical cure are the primary objectives. Associated morbidity should be minimized (e.g., renal, pulmonary, or hepatic dysfunction). 

Factors reported to influence TCA plasma concentrations include disease states (e.g., renal or hepatic dysfunction), genetics, age, cigarette smoking, and concurrent drug administration. Similarly, hepatic impairment, renal impairment, and age have been reported to influence the pharmacokinetics of SSRIs. 

Dosage adjustment may be needed in renal/hepatic dysfunction. Refer to manufacturers prescribing information. Available in liquid form. 

Mehendale HM. 1981a. Chlordecone-induced hepatic dysfunction. J Toxicol Environ Health 8 743-755. 

Decreased BUN level is usually indicative of acute hepatic dysfunction and excessive dehydration,... 

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