Venous drug therapy

Totally implantable venous devices are being increasingly used in patients who require long-term continuous parenteral drug therapy, especially in cancer chemotherapy. Inevitably there have been complications, including catheter fracture, as a consequence of pinched-off syndrome (6). 

Many women with pregnancy-inflnenced gastrointestinal issues can be treated safely with lifestyle modification or medications, many of them nonprescription. Gestational diabetes, hypertension, and thyrotoxicosis may or may not require drug therapy venous thromboembolism usually will require therapy with a low-molecular-weight heparin and compression stockings. 

Intra-arterial catheters have been used for different objectives, such as the placement of other devices like stents, the delivery of drugs to various targets in the cardiovascular system and the delivery of embolic materials to close arterial-venous fistulas. Drug therapy has also been combined with catheter ablation, pacemakers and cardioverter defibrillators in order to treat arrhythmias. On the other hand, implants for the reconstruction or functional replacement of cardiovascular components have been combined with drugs to prevent thrombosis. Finally, drugs to avoid restenosis have been widely employed in different devices such as drug-eluting stents. 

The ACCP Conference on Antithrombotic Therapy recommended against the use of aspirin as the primary method of VTE prophylaxis.2 Antiplatelet drugs clearly reduce the risk of coronary artery and cerebrovascular events in patients with arterial disease, but aspirin produces a very modest reduction in VTE following orthopedic surgeries of the lower extremities. The relative contribution of venous stasis in the pathogenesis of venous thrombosis compared with that of platelets in arterial thrombosis likely explains the reason for this difference. 

Amphotericin B is the mainstay of treatment of patients with severe endemic fungal infections. The conventional deoxycholate formulation of the drug can be associated with substantial infusion-related adverse effects (e.g., chills, fever, nausea, rigors, and in rare cases hypotension, flushing, respiratory difficulty, and arrhythmias). Pre-medication with low doses of hydrocortisone, acetaminophen, nonsteroidal anti-inflammatory agents, and meperidine is common to reduce acute infusion-related reactions. Venous irritation associated with the drug can also lead to thrombophlebitis, hence central venous catheters are the preferred route of administration in patients receiving more than a week of therapy. 

Drugs Use streptomycin at 15 mg/kg lean body mass intra-muscular every twenty-four hours for ten to fourteen days or use gentamicin at 5 mg/kg lean body mass intra-venous every twenty-four hours for ten to fourteen days or use gentamicin at 1.75 mg/kg lean body mass intra-venous every eight hours for ten to fourteen days or use ciprofloxacin at 400 mg intra-venous every twelve hours (oral therapy may be given at 750 mg orally every twelve hours after the patient is clinically improved, for completion of a ten to fourteen-day course of therapy) or use doxycycline at 200 mg intra-venous loading dose followed by 100 mg intra-venous every twelve hours (oral therapy may be given at 100 mg orally every twelve hours after the patient is clinically improved, for completion of a ten to fourteen-day course of therapy. 

Therapy of congestive heart failure. By lowering peripheral resistance, diuretics aid the heart in ejecting blood (reduction in afterload, pp. 132, 306) cardiac output and exercise tolerance are increased. Due to the increased excretion of fluid, EEV and venous return decrease (reduction in preload, p. 306). Symptoms of venous congestion, such as ankle edema and hepatic enlargement, subside. The drugs principally used are thiazides (possibly combined with K+-sparing diuretics) and loop diuretics. 

I11 the therapy of deep venous thrombosis, heparin is commonly administered. This drug takes effect immediately to prevent further thrombus formation. However, heparin is regarded as a hazardous drug and possibly may be tlie leading cause of drug-related deaths 111 hospitalized patients who are relatively well. Usually administered intravenously, preferably by pump-dnven infusion at a constant rate rather than by intermittent injections, it sometimes may cause major bleeding, which is particularly hazardous if it is intracranial. The action of heparin can be terminated almost immediately by intravenous injection of protamine sulfate, but where there may be less urgency, vitamin Ki may be used. The vitamin preparation may be administered intravenously, intramuscularly, or subcutaneously. 

Finally, thrombolytic drugs are gaining acceptance in treating other types of arterial and venous occlusion. For example, thrombolytic therapy can help dissolve clots in peripheral arteries (femoral, popliteal, and so forth)56 these drugs can help resolve thrombus formation in the large veins (DVT).68 This treatment... 

Once ACES providers arrive, further definitive therapy is given (Fig. 7-1). If the rhythm is not shockable, it is likely to be either asystole or PEA. Central venous catheter access results in faster and higher peak drug concentrations than peripheral venous administration, but central line access is not needed in most resuscitation attempts. However, if a central line is already present, it should be the access site of choice. If IV access (either central or peripheral) has not been established, a large peripheral venous catheter should be inserted. Intraosseous (lO) administration is the preferred alternative if IV administration cannot be achieved. 

Topical dorzolamide does not appear to cause a change in retinal circulatory variables, including venous diameter and volumetric blood flow rate, after a single dose in normal subjects. The drug also does not have any apparent effect on retrobulbar hemodynamics as determined by color Doppler imaging. In some studies, however, improvements in retinal, choroidal, and retrobulbar blood flow as determined by various assessment methods and hemodynamic markers demonstrate that dorzolamide alone or in combination therapy may improve ocular blood flow in patients with glaucoma and ocular... 

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