Underlying Diseases

On the other hand, some diseases are associated with a very high incidence of drug-induced reactions. This seems to be the case for systemic lupus erythematosus (SLE) (Brown and Kanwar 1967) although penicillin allergy does not seem to be more frequent in such patients (Von Maur et al. 1975). Individuals with hyperuricemia on allopurinol treatment, infectious mononucleosis, or lymphatic leukemia 

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Cortisone is a hormone produced by the cortex of the adrenal glands. As with other adrenal corticoid steroids, administration of cortisone leads to an increased deposition of liver glycogen. Tt can remove features of rheumatoid arthritis, but does not check the underlying disease it is used in various diseases of the eye, and is an antiallergic and anlifibroplastic agent. 

In rare cases of a systemic release, kinins have the potential to cause severe hypotension. Uncontrolled activation of the contact system (Fig. 3) is thought to trigger a massive formation of kinins under certain pathological conditions [3]. For instance, this situation is seen in patients with underlying diseases such as systemic inflammatory response syndrome (SIRS) due to sepsis or trauma. SIRS progression is accompanied by depletion of contact system factors and low levels of H-kininogen and plasma kallikrein are indicative of a... 

Study and control groups. Investigators need to consider whether the adverse events that occur are due to abnormalities in the distribution, metabolism, and excretion of drugs as a result of underlying disease. These analyses could be systematically facilitated by having standardized ways of measuring blood (and in some cases, tissue) levels of drugs and their metabolites. 

A knowledge of normal metabohsm is essential for an understanding of abnormalities underlying disease. Normal metabolism includes adaptation to periods of starvation, exercise, pregnancy, and lactation. Abnormal metabolism may result from nutritional deficiency, enzyme deficiency, abnormal secretion of hormones, or the actions of drugs and toxins. An important example of a metabolic disease is diabetes mellitus. 

Several pharmacologic classes are available for the treatment and maintenance of IBD. Because there may be differences in the underlying disease process, distribution, and severity between CD and UC, response rates to drugs in the same pharmacologic class may differ between these two diseases. Therefore, initial selection of an appropriate agent for patients with active IBD should be designed to deliver maximum efficacy while minimizing toxicity. Response rates to individual classes of medications for both UC and CD will be discussed within the specific treatment section for each disease. 

The goals of treating ascites are to minimize acute discomfort, re-equilibrate ascitic fluid, and prevent SBP. Treatment should modify the underlying disease pathology without directed therapy, fluid will rapidly reaccumulate. 

It is critical to treat the underlying causative process to effectively resolve most observed acid-base disorders. However, supportive treatment of the pH and electrolytes is often needed until the underlying disease state is improved. 

Acid-base disturbances are always manifestations of underlying clinical disorders. It is useful to specifically define the primary acid-base abnormality, as each disorder is caused by a limited number of disease processes. Establishing the specific disease process responsible for the observed acid-base disorder is clinically important because treatment of a given acid-base disorder will only be accomplished by correcting the underlying disease process. 

The goals of therapy in patients with chronic respiratory acidosis are to maintain oxygenation and to improve alveolar ventilation if possible. Because of the presence of renal compensation it is usually not necessary to treat the pH, even in patients with severe hypercapnia. Although the specific treatment varies with the underlying disease, excessive oxygen and sedatives should be avoided, as they can worsen C02 retention. 

All acid-base abnormalities result from underlying disease processes. Definitive therapy for these disturbances requires treatment of the illness that has disrupted the pH equilibrium. 

There are an estimated 150,000 cases of SE each year in the United States, with approximately 55,000 associated deaths, and an estimated annual direct cost for inpatient admissions of 4 billion.4,5 Status epilepticus occurs more frequently in African-Americans, children, and the elderly. Additional attention should be given to elderly individuals with SE, as other underlying disease states may complicate therapy and worsen prognosis.6... 

Investigate for underlying diseases of nonallergic origin (i.e., anatomic abnormalities, chronic sinusitis, or nasal polyps) if combination therapy does not provide sufficient relief. 

Besides anemia associated with cancer and CKD, anemia of chronic disease can result from inflammatory processes and occurs commonly in autoimmune disorders such as rheumatoid arthritis and systemic lupus erythematosus. In treating these types of anemia of chronic disease, the most important principle is treating the underlying disease. These patients also may have iron deficiency and should be treated in the manner already discussed. Erythropoietin therapy such as epoetin-alfa therapy at a dose of 150 units/kg three times a week also may be used in these patients. 

Empirical therapy should be directed at the most likely pathogen (s) for a specific patient, taking into account age, risk factors for infection (including underlying disease and immune dysfunction, vaccine history, and recent exposures), CSF Gram stain results, CSF antibiotic penetration, and local antimicrobial resistance patterns. 

I NF can affect any age group. Although the risk of NF is higher in patients with underlying diseases (specifically diabetes, alcoholism, cardiac disease, and peripheral vascular disease), healthy hosts can become infected as well.20... 

Intraabdominal infection presents in many different ways and with a wide spectrum of severity. The antibiotic regimen employed and duration of treatment depend on the specific clinical circumstances (i.e., the nature of the underlying disease process and the condition of the patient). 

Patient history (underlying disease, previous cultures or infections, and drug intolerance)... 

To monitor for the effectiveness of the HCT, monitor for symptoms and signs of the disease that is being treated by HCT. For example, the monitoring plan for a patient with CML would be to monitor disease response by PCR of the BCR-ABL transcript. The actual clinical outcome monitored, along with the frequency of monitoring, is based on the underlying disease. 

Efficacy results tables, where you want to see which of the therapies treats the underlying disease state better. 

Diarrheal conditions may decrease drug absorption as a result of reduced intestinal residence time. The absorption of several drugs was decreased in response to lactose- and saline-induced diarrhea [145]. Digoxin absorption from tablets was impaired in one subject who developed chronic diarrhea as a result of x-ray treatment [146]. Abdominal radiation or the underlying disease has been shown to reduce digoxin and clorazepate absorption [147]. A dosage form that provides rapid drug dissolution (e.g., solution) may partially resolve this problem. 

Failure of intestinal motility can be severe leading to frank intestinal pseudoobstruction [122, 132] or mild to moderate depending on the underlying disease, its severity, and the degree of intestinal involvement. 

Adverse events include those that may be attributable to the underlying disease. Figures in parentheses represent percentage. MedDRA = Medical Dictionary for Regulatory Activities (http // www.meddramsso.com/NewWeb2003/medra overview/index. htm) NOS = not otherwise specified. 

An evaluation of the rifaximin tolerability profile observed in almost 1,000 patients from 30 clinical trials was unable to identify a definite pattern of intolerance [33]. Very few adverse events have been reported during short-tem treatment with the drug, the most frequently reported being gastrointestinal in nature (e.g. flatulence, nausea, abdominal pain and vomiting). It is worthwhile to emphasize that the detection of GI adverse reactions could have been difficult in rifaximin trials since the symptoms of the underlying diseases were often similar to the GI complaints observed after drug treatment. 

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