Impairment hepatic

The sulfonamides are used with caution in patients with renal or hepatic impairment and bronchial asthma. These drugs are given with caution to patients with allergies. Safety for use during pregnancy has not been established (Pregnancy Category C, except at term). 

The nurse should use cephalosporins cautiously in patients with renal or hepatic impairment and in patients with bleeding disorders. Safety of cephalosporin administration has not been established in pregnancy or lactation these drugs are assigned to Pregnancy Category B. 

Ketoconazole is contraindicated in patients with known hypersensitivity to the drug. Ketoconazole is used cautiously in patients with hepatic impairment, those who are pregnant (Category C), and during lactation. The absorption of ketoconazole is impaired when the drug... 

Metronidazole is contraindicated in patients with known hypersensitivity. Metronidazole is contraindicated during the first trimester of pregnancy (Category B). Metronidazole is given during the second and third trimesters of pregnancy. Metronidazole is used cautiously in patients with blood dyscrasias, seizure disorders, and severe hepatic impairment. The patient must avoid alcohol while taking metronidazole... 

When the hydantoins are used with odier CNS depressants (eg, alcohol, narcotic analgesics, and antidepressants), an additive CNS depressant effect may occur. The hydantoins are used cautiously in patients widi liver or kidney disease and neurologic disorders. Phenytoin is used cautiously in patients widi hypotension, severe myocardial insufficiency, and hepatic impairment. 

C) and lactation and in patients witii congestive heart failure (CHF), hypotension, or renal or hepatic impairment. 

The antidiarrheal drugs are used cautiously in patients with severe hepatic impairment or inflammatory bowel disease Antidiarrheals are classified as Pregnancy Category B drugs and should be used cautiously during pregnancy and lactation. 

The proton pump inhibitors are contraindicated in patients who have hypersensitivity to any of the drags. Omeprazole (Pregnancy Category C) and lansoprazole, rabeprazole, and pantoprazole (Pregnancy Category B) are contraindicated during pregnancy and lactation. The proton pump inhibitors are used cautiously in older adults and in patients with hepatic impairment. 

Insulin is used cautiously in patients with renal and hepatic impairment and during pregnancy (Pregnancy Category B and Category C, insulin glargine and insulin... 

Antineoplastic drug s are used cautiously in patients with renal or hepatic impairment, active infection, or other debilitating illnesses, or in those who have recently completed treatment with other antineoplastic drug > or radiation tiierapy. 

Note Critically ill patients (e.g., elderly, organic mental syndrome, pulmonary, cardiac, renal, and/or hepatic impairment) may be at increased risk for adverse drug events. Start with the lowest dose and titrate very carefully. 

Check a level if therapy is continued beyond 24 h or if a patient has LV dysfunction or hepatic impairment... 

Decrease dose in patients with hepatic impairment. 

Medication use must be monitored carefully for potential hepatotoxicity. Hepatically metabolized medications have the potential to accumulate in patients with liver disease. Little guidance is available on drug dosing in hepatic impairment because these patients are often excluded from drug trials. Daily acetaminophen use should not exceed 2 g. Dietary supplements have not been well studied in hepatic impairment and cannot be recommended. 

Entacapone (Comtan ) Peripherally blocks COMT metabolism of DA Take a 200-mg tab with each Sinemet dose up to 8 tabs daily usual MD is 200 mg 3-4 times daily decrease dose by 50% with hepatic impairment... 

The use of duloxetine in stress urinary incontinence is complicated by (1) the potential for multiple clinically relevant drug-drug interactions with cytochrome P-450 2D6 and 1A2 inhibitors, (2) withdrawal reactions if abruptly discontinued, (3) high rates of nausea and other side effects, (4) the hepa-totoxicity that contraindicates its use in patients with any degree of hepatic impairment, and (5) its mild hypertensive effect. 

Primarily renal elimination of unchanged drug Would not expect hepatic impairment to have an effect (no data) Expect sign, effect of renal impairment and no effect of advanced age (beyond decreased CrCI with age) (no data)... 

Not altered in advanced age, mild to moderate renal impairment, mild hepatic impairment (Child-Pugh A). Sign, altered in severe renal disease and moderate hepatic impairment (Child-Pugh B) Systemic exposure to duloxetine decreased by V3 in smokers (dose change not recommended) Multiple drug-drug interactions possible with CYP4502D6 and 1A2 substrates/ inhibitors... 

The dose of basiliximab is 20 mg intravenously (IV) given within 2 hours prior to the transplant, followed by a second 20 mg dose on postoperative day 4.7,9,11 This dosing schedule can be used for both children weighing 35 kg (77 lb) or more and adults. Two 10 mg doses with the same dosing schedule should be used for children weighing less than 35 kg (77 lb). No specific dosage adjustments is needed in renal or hepatic impairment.7,9,11... 

Rescriptor tabs mg tabs can be dispersed in greater than or equal to 3 oz of water to produce slurry) 200 mg tabs should be administered whole separate dosing from buffered DDI or antacids by 1 hour with hepatic impairment LFTs, headaches cytochrome P-450 (CYP) CYP3A inhibitor 51% excreted in urine (less than 5% unchanged) 44% in feces... 

Use with caution in patients No food restrictions with hepatic impairment... 

Prezista RTV 1 00 mg twice daily patients with hepatic impairment with food moiety, Stevens Johnson erythema multiforum have been reported) diarrhea, nausea headache hyperlipidemia transaminase elevation hyperglycemia fat maldistribution possible increased bleeding episodes in patients with hemophilia substrate... 

Fosamprenavir (fAPV) Lexiva 700-mg tabs ARV-na ive pts fAPV 1,400 mg bid or fAPV 700 mg + RTV 1 00 mg bid PS-experienced pts fAPV 700 mg + RTV 1 00 mg bid Co-admin is tra tion w/EFV fAPV 700 mg + RTV 1 00 mg bid or fAPV 1400 mg + RTV 300 mg qday Child-Pugh Dose Class 5-8 700 mg bid 9-12 Not recommended Ritonavir should not be used in patients with hepatic impairment None Skin rash diarrhea, nausea and vomiting headache hyperlipidemia LFT elevation hyperglycemia fat maldistribution increased bleeding episodes in patients with hemophilia CYP3A4 inhibitor, inducer, and substrate... 

LPV/r) Kaletra RTV 50 mg tablet, LPV 400 mg + RTV 1 00 mg/5 mL oral solution (contains 42% alcohol) bid 4 tablets qday With EFV or NVP 3 tablets or 6.7 mL bid with hepatic impairment T 48-80%) asthenia hyperlipidemia LFT elevation hyperglycemia fat maldistribution increased bleeding episodes in hemophiliacs and susbstrate... 

Viracept tabs, 50 mg/g oral powder 750 mg tid with hepatic impairment snack hyperglycemia fat maldistribution increased bleeding in hemophiliacs LFT elevation and substrate... 

Norvir 600 mg/7.5 mL (when ritonavir mild hepatic impairment to improve paresthesias hyperlipidemia 2D6 potent... 

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