Ileus

USP (Oncovin) vindesine sulfate [59917-39 ] C43H55N5O7 -H2S0 852.01 (50) chil-dren lymphocytic leukemia Hodgkin s disease non-Hodg-kin s lymphomas Wilm s tumor neuroblastoma rhabdomyosarcoma, investigational dmg (paresthesias, foot drop, double vision, etc) constipation ileus alopecia leu-kopenia (occasional) ... 

Paralytic ileus 4. Increased AEA levels participate in inhibition of small intestine motility 4. CB antagonists... 

Some patients with parkinsonism communicate poorly and do not tell the primary health care provider or nurse that problems are occurring. The nurse observes the patient with parkinsonism for outward changes that may indicate one or more adverse reactions. For example a sudden change in the facial expression or changes in posture may indicate abdominal pain or discomfort, which may be caused by urinary retention, paralytic ileus, or constipation. Sudden changes in behavior may indicate hallucinations, depression, or other psychotic episodes. 

Helicobader pylori hydrochloric acid hypersecretory paralytic ileus photophobia proton pump inhibitor... 

Anorexia, nausea, vomiting, mental depression, confusion, delayed or impaired thought processes, drowsiness, abdominal distention, decreased bowel sounds, paralytic ileus, muscle weakness or fatigue, flaccid paralysis, absent or diminished deep tendon reflexes, weak irregular pulse, paresthesias, leg cramps, ECG changes Hyperkalemia... 

Gastrointestinal involvement may present initially as small bowel obstruction shortly after birth (known as meconium ileus) due to abnormally thick meconium that cannot be passed. Older CF patients may develop distal intestinal obstruction syndrome (DIOS), formerly called meconium ileus equivalent, which occurs due to fecal impaction in the terminal ileum and cecum. 

Other complications may include gastroesophageal reflux, dysmotility, intussusception, volvulus, atresia, rectal prolapse, and complications related to corrective surgery for meconium ileus.6... 

Intestinal obstruction may be manifested as meconium ileus, distal intestinal obstruction syndrome, or intussusception on abdominal x-ray or computed tomography scan. Rectal prolapse may be noted on physical exam. 

Treatment of distal intestinal obstruction syndrome (DIOS) consists of oral or nasogastric administration of polyethylene glycol electrolyte (PEG) solutions. Enemas may also be used to facilitate stool clearance. IV fluids are often required to correct dehydration due to vomiting or decreased oral intake. Re-evaluation of enzyme compliance and dosing is essential to prevent further episodes. Patients with recurrent symptoms may require daily PEG administration (Miralax ).5 Severe presentations of DIOS or initial meconium ileus may require surgical resection. 

Pentobarbital (Nembutal) 1 0-1 5 mg/kg Up to 50 mg/minute 10-20 mcg/mL (typically titrated to EEG) Hypotension, respiratory depression, cardiac depression, infection, ileus Requires mechanical intubation, pressors, hemodynamic monitoring... 

Liver Fever, lethargy, change in color or quantity of bile in patients w/ biliary T-tube, graft tenderness and swelling, back pain, anorexia, ileus, tachycardia, jaundice, ascites, encephalopathy Abnormal LFTs, increased bilirubin, alkaline phosphatase, transaminases, biopsy positive for mononuclear cell infiltrate with evidence of tissue damage... 

Pancreas Fever, graft tenderness and swelling, abdominal pain, ileus, malaise Increased FBS, leukocytosis, decreased human C-peptide and urinary amylase levels... 

Fulminant colitis Acute abdomen and systemic symptoms such as fever, tachycardia, dehydration, and hypotension. Some patients have marked leukocytosis (up to 40,000 white blood cells/mm3). Diarrhea is usually prominent but may not occur in patients with paralytic ileus and toxic megacolon. 

Severe disease is defined as the presence of complications of colitis, such as sepsis, volume depletion, electrolyte imbalance, hypotension, paralytic ileus, and toxic megacolon. Patients with signs of severe disease should receive oral vancomycin as initial therapy. Surgical intervention may be indicated and lifesaving, particularly in cases complicated by toxic megacolon or colonic perforation. 

An additional important component of therapy is nutrition. Intraabdominal infections often involve the GI tract directly or disrupt its function (paralytic ileus). The return of GI motility may take days, weeks, and occasionally, months. In the interim, enteral or parenteral nutrition as indicated facilitates improved immune function and wound healing to ensure recovery. 

Each category of chemotherapy drugs has similar side effects. Anthracyclines cause cardiac toxicity, which is related to the cumulative dose. Tubulin interactive agents are associated with neuropathy and ileus. Alkylating agents are associated with secondary malignancies. 

The vesicant vinorelbine is structurally similar to vincristine and may cause many of the same side effects as vincristine. While this vesicant is administered intravenously over 6 to 10 minutes, patients should be counseled about neuropathy, ileus, and myelosuppression. The pharmacokinetics of vinorelbine are best described by a three-compartment model, with an a half-life of 2 to 6 minutes, a 3 half-life of 1.9 hours, and a y half-life of 40 hours. Vinorelbine has shown efficacy in the treatment of breast cancer and non-small cell lung cancer. Additional side effects include myelosuppression, paresthesias, and mild nausea and vomiting. 

Peripheral neuropathy primary dose-limiting toxicity motor sensory, autonomic, and cranial nerves may all be affected (paresthesias, ileus, urinary retention, facial palsies) may be irreversible mild emetogen SIADH vesicant extravasation injury... 

Physical/mechanical (e.g., tumor compressing intestinal lumen) Functional (e.g., postoperative ileus)... 

Severe hemorrhagic pancreatitis Severe necrotizing pancreatitis Necrotizing enterocolitis Diffuse peritonitis Small bowel obstruction Paralytic ileus... 

Tsukamoto, K., Mizutani, M., Yamano, M., Suzuki, T., The relationship between gastrointestinal transit and motility in dogs with postoperative ileus, Biol. Pharm. Bull. 1999, 22, 1366-1371. 

Vinblastine -vinca alkaloid inhibits tubulin polymerization G2 phase specific -bone marrow suppression -vesicant if extravasated -nausea and vomiting -constipation (often secondary to neuropathy induced ileus) -neuropathy (jaw pain, peripheral neuropathy, autonomic neuropathy) -SIADH -tumor pain... 

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