Serum toxicity

Table 18 PFOS TRV values for a generic Trophic Level IV predator based on dietary, liver, and serum toxic dosesa...

Electrolytes in frozen human serum Glucose in frozen human serum Toxic elements in blood... 

Recommended formulations employ commercially available components for Eagle s Minimal Essential Medium (MEM). Suggested supplements collectively enhance retention of diploidy, facilitate in vitro adaptation of malignant drivatives, minimize serum toxicity, and stabilize ionic and osmological relationships between cell and medium. These modifications are recommended when single-serum supplemented MEM Eagle s and... 

Most of the adverse events related to lidocaine are associated with sermn toxicity, with various symptoms presenting at different sermn levels. Symptoms such as lightheadedness, perioral numbness, tinnitus, nausea, or metallic taste in the mouth may occur when plasma lidocaine concentrations are 1-5 pg/mL. Dysarthria, local muscle twitches, hallucinations, or nystagmus may present at plasma concentrations from 5 to 8 pg/ mL. Seizmes may occur at 8-12 pg/mL, followed by respiratory depression or coma at levels higher than 20 pg/mL. Hypotension, bradycardia, cardiac arrest, and arrhythmias may also occm at serum levels greater than 20 pg/mL. IntraUpid remains the only available treatment for adverse events related to serum toxicity. 

Oxyphenbutazone (712), y-hydroxyphenylbutazone and kebuzone (715) are metabolites of phenylbutazone in liver. The first cited is an equally potent antiinflammatory agent but slightly less toxic. Compounds (711) and (712) are rarely used as analgesics and antipyretics because of their toxicities. The first one is used in therapy of rheumatoid disorders characterized by a lack of detectable antiglobulin and antinuclear antibodies in the serum. The y-hydroxyphenylbutazone has marked uricosuric activity but little antirheumatic effect. Kebuzone (715) is an antiinflammatory agent still widely used in Europe. 

RISK FOR INEFFECTIVE TISSUE PERFUSION RENAL When the patient is taking a drag tiiat is potentially toxic to die kidneys, die nurse must carefully monitor fluid intake and output. In some instances, die nurse may need to perform hourly measurements of die urinary output. Periodic laboratory tests are usually ordered to monitor the patient s response to therapy and to detect toxic drag reactions. Seram creatinine levels and BUN levels are checked frequentiy during the course of therapy to monitor kidney function. If the BUN exceeds 40 mg dL or if the serum creatinine level exceeds 3 mg cIL, the primary health care provider may discontinue the drug therapy or reduce the dosage until renal function improves. 

When carbamazepine is administered with primidone, decreased primidone levels and higher carbamazepine serum levels may result. Cimetidine administered with carbamazepine may result in an increase in plasma levels of carbamazepine that can lead to toxicity. Blood levels of lamotrigine increase when the agent is administered with valproic acid, requiring a lower dosage of lamotrigine... 

HYDANTOINS Fhenytoin is the most commonly prescribed anticonvulsant because of its effectiveness and relatively low toxicity. However, a genetically linked inability to metabolize phenytoin has been identified. For this reason, it is important to monitor serum concentrations of the drug on a regular basis to detect signs of toxicity Fhenytoin is administered orally and parenterally. If the drug is administered parenterally, the IV route is preferred over the intramuscular route because erratic absorption of phenytoin causes pain and muscle damage at the injection site... 

Buspirone causes less additive CNS depression than do the other antianxiety drugs. However, it is recommended that concurrent use with a CNS depressant be avoided. Buspirone may increase serum digoxin levels, which increases the risk of digitalis toxicity. 

The effects of buspirone are decreased when the drug is administered with fluoxetine Increased serum levels of buspirone occur if the drug is taken with erythromycin or itraconazole Should any of these combinations be required, the dosage of buspirone is decreased to 2.5 mg BID, and the patient is monitored closely. Venlafaxine blood levels increase with a risk of toxicity when administered witii MAOIs or cimetidine There is an increased risk of toxicity when trazodone is administered with the phenothiazines and decreased effectiveness of trazodone when it is administered with carbamazepine Increased serum digoxin levels have occurred when digoxin is administered with trazodone There is a risk for increased phenytoin levels when phenytoin is administered witii trazodone... 

Lithium carbonate is rapidly absorbed after oral administration. The most common adverse reactions include tremors, nausea, vomiting, thirst, and polyuria Toxic reactions may be seen when serum lithium levels are greater than 1.5 mEq/L (Table 32-1). Because some of these toxic reactions are potentially serious, lithium blood levels are usually obtained during therapy, and the dosage of lithium is adjusted according to the results. 

The nurse reports any serum theophylline levels greater than 20 pg/mL or any symptoms associated with toxicity. 

Which of Hie following serum digoxin levels would be most indicative that a patient taking digoxin may be experiencing toxicity ... 

When two antiarrhythmic dragp are administered concurrently the patient may experience additive effects and is at increased risk for drug toxicity. When quinidine and procainamide are administered with digitalis, tiie risk of digitalis toxicity is increased. Hiarmacologic effects of procainamide may be increased when procainamide is administered with quinidine When quinidine is administered with the barbiturates or cimetidine, quinidine serum levels may be increased. When quinidine is administered with verapamil, there is an increased risk of hypotensive effects. When quinidine is administered with disopyramide, there is an increased risk of increased disopyramide blood levels and/or decreased serum quinidine levels. 

There is an increased risk of cyclosporine toxicity when the drug is administered with acetazolamide. Decreased serum and urine concentrations of primidone occur when the drug is administered with acetazolamide. 

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