Hepatic functions

A marked improvement is generally noted after 4—8 weeks of treatment. Treatment is often continued until a total dose of 3 g is reached. In the case of coccidioidomycosis, for example, treatment with 0.4—0.8 mg/kg/d may last months. The polyene is adrninistered intrathecaHy to treat Coccidioides meningitis. However, the results are only moderate. It is very important to check renal and hepatic function during treatment with amphotericin B. 

Mexifitene is well absorbed from the GI tract and less than 10% undergoes first-pass hepatic metabolism. In plasma, 60—70% of the dmg is protein bound and peak plasma concentrations are achieved in 2—3 h. Therapeutic plasma concentrations are 0.5—2.0 lg/mL. The plasma half-life of mexifitene is 10—12 h in patients having normal renal and hepatic function. Toxic effects are noted at plasma concentrations of 1.5—3.0 lg/mL, although side effects have been noted at therapeutic concentrations. The metabolite, /V-methy1mexi1itene, has some antiarrhythmic activity. About 85% of the dmg is metabolized to inactive metabolites. The kidneys excrete about 10% of the dmg unchanged, the rest as metabolites. Excretion can also occur in the bile and in breast milk (1,2). 

Dacarbazine is the most active compound used for treating metastatic melanoma. It is also combined with anthracyclines and other cytostatics in the treatment of different sarcomas and Hodgkin s disease. Dacarbazine may cause severe nausea and vomiting. Myelosuppres-sion results in leukopenia and thrombocytopenia. Alopecia and transient abnormalities in renal and hepatic function also occur. 

Additional culture and sensitivity tests may be performed during therapy because microorganisms causing the infection may become resistant to penicillin, or a superinfection may have occurred. A urinalysis, complete blood count, and renal and hepatic function tests also may be performed at intervals during therapy. 

It also is important to take and record vital signs before the first dose of die antibiotic is given. The primary health care provider may order culture and sensitivity tests, and tiiese should also be performed before die first dose of die drug is given. Odier laboratory tests such as renal and hepatic function tests, complete blood count, and urinalysis may also be ordered by the primary health care provider. 

Hepatotoxicily is the principal adverse reaction seen witii pyrazinamide use Symptoms of hepatotoxicily may range from none (except for slightly abnormal hepatic function tests) to a more severe reaction such as jaundice Nausea, vomiting, diarrhea, myalgia, and rashes also may be seen. 

PYRAZINAMIDE Patients should have baseline liver functions tests to use as a comparison when monitoring liver function during pyrazinamide therapy. The nurse should monitor the patient closely for symptoms of a decline in hepatic functioning (ie, yellowing of the skin, malaise, liver tenderness, anorexia, or nausea). The primary health care provider may order periodic liver function tests. Hepatotoxicity appears to be dose related and may appear at any time during therapy. 

This drug is usually well tolerated, but nausea, vomiting, headache, dizziness, abdominal pain, and pruritus may be seen. Most adverse reactions are mild and transient. On rare occasions, hepatic toxicity may be seen, and use of the drug must be discontinued immediately. Periodic hepatic function tests are recommended to monitor for hepatic toxicity. 

It is important to use the mast cell stabilizers cautiously in patients witii impaired renal or hepatic function and during pregnancy (Pregnancy Category B) and lactation. No significant drug interactions have been reported. 

Continual cardiac monitoring assists the nurse in assessing the patient for adverse drug reactions. If the patient is acutely ill or is receiving one of these drugs par-enterally, the nurse measures and records the fluid intake and output. The primary health care provider may order subsequent laboratory tests to monitor the patient s progress for comparison with tests performed in the preadministration assessment, such as an ECG, renal and hepatic function tests, complete blood count, serum enzymes, and serum electrolytes. The nurse reports to the primary care provider any abnormalities or significant... 

When these drugs are given to the female patient with inoperable breast carcinoma, tire nurse evaluates the patient s current status (physical, emotional, and nutritional) carefully and records tire finding in tire patient s chart. Problem areas, such as pain, any limitation of motion, and the ability to participate in tire activities of daily living, are carefully evaluated and recorded in tiie patient s record. The nurse takes and records vital signs and weight. Baseline laboratory tests may include a complete blood count, hepatic function tests, serum electrolytes, and serum and urinary calcium levels. The nurse reviews these tests and notes any abnormalities. 

Achilefu S, Dorshow RB (2002) Dynamic and Continuous Monitoring of Renal and Hepatic Functions with Exogenous Markers. 222 31-72 Albert M, see Dax K (2001) 215 193-275... 

In the ED setting, the diagnosis of ketamine intoxication is a clinical one. Ketamine is not routinely detected by urine toxicology tests, although it can be detected with high-performance liquid chromatography (Koesters et al. 2002). As with MDMA, the initial assessment for ketamine intoxication includes the use of routine laboratory tests to detect electrolyte abnormalities and to evaluate renal and hepatic functioning (Koesters et al. 2002). 

Laboratory tests can help in assessing the effects of inhalant use. Laboratory tests that measure hepatic function, renal function, and hematopoietic... 

The ammonia produced by enteric bacteria and absorbed into portal venous blood and the ammonia produced by tissues are rapidly removed from circulation by the liver and converted to urea. Only traces (10—20 Ig/dL) thus normally are present in peripheral blood. This is essential, since ammonia is toxic to the central nervous system. Should portal blood bypass the liver, systemic blood ammonia levels may rise to toxic levels. This occurs in severely impaired hepatic function or the development of collateral links between the portal and systemic veins in cirrhosis. Symptoms of ammonia intoxication include tremor, slurred speech, blurred vision, coma, and ultimately death. Ammonia may be toxic to the brain in part because it reacts with a-ketoglutarate to form glutamate. The resulting depleted levels of a-ketoglutarate then impair function of the tricarboxylic acid (TCA) cycle in neurons. 

Stark, M.E. and Szurszewski, J.H. (1992). Role of nitric oxide in gastrointestinal and hepatic function and disease. Gastroen-terolt 103, 1928-1949. 

Clarify the consequences associated with decreased hepatic function. 

Antimicrobial history Drug allergy history Renal and hepatic function Concomitant medications Pregnancy or lactation Compliance potential... 

Host factors can help to ensure selection of the most appropriate antimicrobial agent. Age is an important factor in antimicrobial selection. With regard to dose and interval, renal and hepatic function varies with age. Populations with diminished renal function include neonates and the elderly. Hepatic function in the neonate is not fully developed, and drugs that are metabolized or eliminated by this route may produce adverse effects. For example, sulfonamides and ceftriaxone may compete with bilirubin for binding sites and may result in hyperbilirubinemia and kernicterus. Gastric acidity also depends on... 

Renal and/or hepatic function should be considered in every patient prior to initiation of antimicrobial therapy. In general, most antimicrobials undergo renal elimination and... 

Monitor and assess laboratory data WBC count with differential (goal is a reduction in WBC count if elevated initially and resolution of left shift), renal and/or hepatic function (consider need for dosage adjustments), other labs as indicated (e.g., ESR, CRP). 

Every patient receiving antimicrobial therapy for skin and soft tissue infections must be monitored for efficacy and safety. Efficacy typically is manifested by reductions in temperature, white blood cell count, erythema, edema, and pain that begin within 48 to 72 hours. To ensure safety, dose antibiotics according to renal and hepatic function as appropriate, and monitor for and minimize adverse drug reactions, allergic reactions, and drug interactions. 

Current laboratory analyses to determine renal and hepatic function... 

Abnormal renal and hepatic function will increase drug concentration and predispose the patient to toxicity. 

The success of the treatment of febrile neutropenia depends on the adequate recovery of the ANC and either optimal antimicrobial coverage of identified organisms or empirical coverage of unidentified organbms. Monitor the CBC with differential and 7 rnax (maximum temperature during previous 24 hours) daily. Assess renal and hepatic function at least twice weekly,... 

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