Side effects following medication evaluation

Following initial assessment, including evaluation of potential suicidality, support systems, and need for inpatient versus outpatient treatment, MW was hospitalized briefly, then followed in the community on medication along with psychotherapy. She has abstained from illicit substances and has returned to her job. She has responded well to treatment with sustained-release lithium carbonate 900 mg once daily at bedtime with a snack. Steady-state 12-hour serum lithium concentrations have stabilized at 0.9 mEq/L (0.9 mmol/L). She now returns to clinic for routine followup. She has tolerated the lithium except for a mild tremor and a gain of 7 pounds (3.2 kg). She is willing to accept these side effects for now, but asks about how long she must take medication since she is now feeling well. 

To determine the success of treatment, evaluate whether the treatment plan restored normal sleep patterns, reduced daytime sequelae, and improved quality of life without causing adverse effects. Schedule patients for follow-up within 3 weeks for insomnia and within 3 months for other sleep disorders. Perform a detailed clinical history to determine the patient s perception of treatment progress and symptoms along with medication effectiveness and side effects. 

Before use of topical P-adrenergic antagonists and following a careful history to assess the potential risk to the patient, it is advisable to evaluate the patient s blood pressure and pulse. Patients with concurrent use of oral P-adrenergic antagonists should typically avoid topical agents in the same class. Patients should be informed of the potential side effects of these medications and should discontinue their use if warranted. 

In another study conducted to evaluate different buccal misoprostol doses following mifepristone in women requesting medical termination of early pregnancy (n = 1122), Chong et al. demonstrated that 400 ng of buccal misoprostol taken 36-48h after 200 mg mifepristone is as effective as the standard 800-ng dose in terminating pregnancies up to 63 days last menstrual period and reduced the appearance of side effects [79 ]. 

The principal cause of graft loss after the first year is chronic allograft nephropathy (CAN), followed by patient death, late acute rejections, nephropathy recurrence and polyomavirus infection (Hariharan 2001). However, prolongation of graft survival also means extended exposure of the patient to side-effects associated with immunosuppressive therapies, mainly infections and cancers, and other late-onset cardiovascular, bone and/or metabolic complications. The first year after transplantation is special, as it is characterized by the highest rates of acute rejection and opportunistic infections, such as cytomegalovirus. In this review, we successively address the presurgical evaluation of the patient, the operation itself and its possible complications, then the early (first year) and late (after the first year) medical complications. 

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