Medications continuous infusion

Taylor and colleagues have published an 8-yr analysis of Rush Medical College s experience with stage in or IV patients that have received concomitant cisplatin (60 mg/m2, d 1), continuous infusion 5-FU (800 mg/m2, d 1-5), and single fraction radiation therapy (2 Gy) on d 1-5 (57). The cycle was repeated every other week for atotal of seven cycles. The sample size was small with 78 patients. Six weeks after initial therapy, 63% had no clinical evidence of disease, 37% had a partial response (PR). Overall, 31% of patients had recurred or progressed 24% died from nontumor-related causes. The 5-yr PFS was 60% in this small cohort of patients with an overall survival reported to be 43%. 

A German study randomized 98 patients with unresectable hypopharyngeal head and neck carcinoma to sequential or concomitant chemoradiotherapy (64). Patients on the sequential arm received two courses of cisplatin (25 mg/m2 for 5 d) and continuous infusion 5-FU (750 mg/m2 for 5 d) followed by G-CSF for 6 d. The second cycle was repeated on d 14 and then followed by standard radiotherapy. Identical dosages of chemoradiotherapy were used in the concomitant arm but incorporated a 21-d interval between each chemotherapy cycle and G-CSF support. Sequential treatment resulted in a CR of 49% in comparison to the concomitant arm of 57%. At 2-yr, the median survival was improved in the concomitant arm (53% vs 33%). However, one-third of the initial patients enrolled were withdrawn from study due to medical or socioeconomic problems whether this resulted in a significant disparity between the two different treatment arms was not noted. Mature data from this trial have not been published to date. 

Based on encouraging results from an early pilot study completed by Rush-Presbyte-rian-St. Luke s Medical Center, ECOG evaluated previously irradiated patients who presented with locally recurrent and/or metastatic disease (81). Patients received seven cycles of cisplatin (60 mg/m2, d 1), continuous infusion 5-FU (800 mg/m2, d 1-5), and standard daily radiotherapy (d 1-5) to be repeated every other week. All patients developed grade 2/3 mucositis. Clinically, the ORR was 74% (48% CR, 24% PR). Median TTP was 5 mo. Of interest were three patients that remained disease-free at 44 mo (T2N0), 86 mo (T0N2), and 88 mo (T2N0). 

In home health care or hospice settings, the pharmacist may be involved in compounding special admixtures for patients. The use of subcutaneously continuous infusions of opioids is also increasing. Pharmacists who review patients medical administration records in nursing homes can recommend appropriate therapies for pain management. 

Remove sodium from nutritional sources and medications Increase dose, use continuous infusion or combination therapy Use parenteral therapy switch to oral torsemide or bumetanide Increase dose, switch diuretics, use combination therapy... 

The drug must be administered as a controlled continuous infusion, and the patient must be closely observed. Most hypertensive patients respond to an infusion of 0.25-1.5 flg/kg/min. Higher infusion rates are needed to produce controlled hypotension in normotensive patients under surgical anesthesia. Infusion of nitroprusside at rates >5 flg/kg/min over a prolonged period can cause cyanide and/or thiocyanate poisoning. Patients receiving other antihypertensive medications usually require less nitroprusside to lower blood pressure. If infusion rates of 10 pg/kg/min do not produce adequate reduction of blood pressure within 10 minutes, the rate of administration of nitroprusside should be reduced to minimize potential toxicity. 

Medic is, J- J Stork, C, M, Howland, M. A, Hoffman, R. S., and Goldfrank, L, R, (1996), Pharmacokinetics following a loading plus a continuous infusion of pralidoxime compared with the traditional short infusion regimen in human volunteers, J. Toxicol Clin. Toxtcid, 34, 289-295. 

The client with Type 1 diabetes is diagnosed with diabetic ketoacidosis. The HCP prescribes intravenous regular insulin by continuous infusion. Which intervention should the intensive care nurse implement when administering this medication ... 

Herout P M, Erstad B L (2004). Medication errors involving continuously infused medications in a surgical intensive care unit. Crit Care Med 32 428-432. 

In contrast, a retrospective analysis of the medical records of bone marrow transplant patients suggested that aminoglycosides can be safely given with a continuous infusion of ciclosporin without excessive nephrotoxicity, if the patient is carefully monitored. ... 

The whole content of a vial containing 125 000 international units of heparin was prepared as a continuous infusion, resulting in a 5 times overdose to a patient on a general medical ward in a teaching hospital. 

An 18-year-old woman with Mycoplasma pneumoniae infection complicated by pulmonary hyfpertension, cryoglobulinemia, and rhabdomyolysis developed hyperthermia, a tachycardia, and dermal blisters. Therapy at the time of onset included a continuous infusion of furosemide. Furosemide and other medications were withdrawn and within 2 days the adverse reactions resolved. She was then rechallenged with two doses of furosemide... 

Body temperature Repeated bouts of hyperthermia with skin bhsters occurred in an 18-year-old girl with a severe Mycoplasma pneumoniae infection during hemodialysis and continuous infusion of furosemide and other drugs [48 ]. When the medications were withdrawn, the hyperthermia resolved within 2 days. After rechallenge with two intravenous doses of furosemide 5 mg, there was an almost simultaneous increase in heart rate and temperature and the blisters reappeared. 

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