Imuran

By X. Giacomo. University of Wisconsin-Parkside.

Among 34 infants born to women who were treated with mercaptopurine early in pregnancy generic imuran 50 mg online, one infant had a birth defect (1/34 imuran 50 mg online, 2. In addition, the one birth defect was probably not related to the drug as the neonate had a chromosomal aberration. Infants of eight women treated with mercaptopurine and other antineoplastic agents during preg- nancy had no congenital anomalies (Aviles et al. Mercaptopurine is often a com- ponent of polydrug regimens, making it impossible to assess the teratogenic potential of an individual agent. This agent was associated with neonatal pancytopenia in several case reports (McConnell and Bhoola, 1973; Okun et al. Congenital anomalies (limb, facial, and central nervous system) were increased in frequency among rodents whose mothers were given up to several times the usual human dose of mercaptopurine during gestation (Mercier-Parot and Tuchmann-Duplessis, 1967; Puget et al. It was part of a multiple drug regimen to which a fetus Alkylating agents 135 was exposed in the first trimester and it had multiple abnormalities similar to Baller–Gerald syndrome (Artlich et al. An increased frequency of malformations was found in offspring of pregnant rats that were given thioguanine during embryogen- esis (Thiersch, 1957). A few reports of monotherapy with this agent during early pregnancy have been published. Wagner and associates (1980) reported a newborn with limb and ear anomalies whose mother received this agent alone. In a review of leukemia treatment during pregnancy, 46 infants (summarized from 24 case reports) were born to mothers who received cytosine arabi- noside (Ara-C) at some point during pregnancy, and several had received it during the first trimester (Caliguri and Mayer, 1989). Among exposed pregnancies, there were two spontaneous and six therapeutic abortions. Of the remaining 38 pregnancies, there were four intrauterine deaths (apparently grossly normal), one infant with polydactyly and one with adherence of the iris to the cornea; one newborn presented with neonatal pan- cytopenia (Caliguri and Mayer, 1989). Anecdotal reports seem to indicate an increased risk of birth defects following first trimester exposure to cytarabine, this kind of infor- mation cannot be used to attribute risk. However, this suspicion is bolstered by findings in experimental animal studies parallel to those in humans. In addition, it seems that treatment of leukemia during pregnancy given after the first trimester is not associated with a high frequency of congenital abnormalities. It is important to note that the folate antagonist methotrexate was a component of the polydrug therapy in several of these gravidas. When given during embryogenesis, cytarabine was associated with an increased fre- quency of congenital anomalies in two rodent teratology studies (Chaube and Murphy, 1965; Percy, 1975). Other uses include bladder, cervix, endometrium, esophagus, head and neck, liver, lung, ovary, prostate, and skin cancers. Among 24 infants whose mothers were treated with intravenous fluorouracil in com- bination with doxorubicin and cyclophosphamide for breast cancer during the second and third trimesters of pregnancy, no congenital anomalies occurred (Berry et al. However, it must be noted that these exposures occurred outside the period of embryo- genesis, and do not indicate anything about the risk of birth defects that may be related to first trimester exposure to the drug. However, the patient had also undergone bowel resec- tion and multiple diagnostic X-ray procedures during late embryogenesis. Malformations included bilateral radial aplasia, absent thumbs, abnormal fingers, a sin- gle umbilical artery, hypoplastic aorta, and esophageal atresia, imperforate anus, and renal dysplasia. These anomalies were probably not related to fluorouracil because of the gestational timing of the exposure (i. Two normal infants were born following first-trimester maternal treatment with intravaginal 5-fluorouracil (Odom et al. Skeletal and other major anomalies (cleft palate, central nervous system) were increased in frequency among offspring of several species of pregnant nonprimate animals born to mothers exposed to this antineoplastic during pregnancy (Chaube and Murphy, 1968; Dagg, 1960; Shah and Mackay, 1978; Wilson et al. No reports regarding the use of bleomycin monotherapy during organogenesis have been published. One newborn infant had profound but transient neonatal leukopenia (resolved by day of life 13) following maternal therapy for metastatic adenocarcinoma that was initiated very early in the third trimester with bleomycin in combination with etoposide and cisplatin (Raffles et al. Limb and tail anomalies were reported in nine rat teratology studies involving bleomycin (Nishimura and Tanimura, 1976). Antibiotics 137 Dactinomycin Dactinomycin (Cosmegen), also known as actinomycin-D, is one of a group of antibi- otics produced by various species of streptomyces called the actinomycins. Primary indication for dactinomycin in obstetrics is to treat gestational trophoblastic tumors. Four normal infants (one set of twins) were born to mothers who received dactinomycin in the second and/or third trimesters of pregnancy as part of com- bination therapy in two pregnancies (Gililland and Weinstein, 1983), but there was no exposure during embryogenesis. The manufacturer of dactinomycin reported that mal- formations were increased in frequency in various animals whose mothers were given doses of the drug several times those normally used in humans, but the information is unpublished and no details were provided. It is isolated from the broth of Streptomyces caespitosus, similar to dactinomycin. No reports have been published regarding the use of mitomycin during pregnancy and infant outcome.

Spinal irritation is most effectively treated by the use of a succession of Ellingwood’s American Materia Medica buy imuran 50mg without a prescription, Therapeutics and Pharmacognosy - Page 405 these poultices imuran 50mg amex. On the first day of the treatment one is applied on the back, across the upper third of the spine; on the second day across the middle third, and on the third day across the lower third, producing thorough sharp counter-irritation but no blistering. On the fourth day it is applied at the top of the spine again and the same course followed as before. This may be continued for two weeks or more if the skin is sufficiently restored in the interim, between the poultices. This course will most materially assist other measures adopted in the treatment of this condition. A hot mustard foot bath is of great service in congestive chill, also in the chill at the onset of acute fever, or acute inflammation of any character. It produces immediate derivation, assists in equalizing the circulation, acts as a diaphoretic and perceptibly checks the progress of the disease. In the recession of the rash of eruptive fevers no measure is more prompt than a general hot mustard bath, which should be continued until a mild redness covers the entire body. At the onset of acute cerebro-spinal meningitis the disease has been completely aborted by the prompt use of a hot mustard bath. In some cases the patient may be wrapped in a blanket wrung out of hot mustard water, until the skin is reddened. In conditions where there is a constant tendency for the skin of the legs to become cold, and the muscles to cramp during the night, a hot mustard foot bath at bedtime is of direct benefit. In arrest of the menses from cold, a sitz bath strong with mustard will sometimes produce an immediate restoration of the flow. It is sometimes necessary to take this bath each night for a week preceding the time the menses should appear and continue it until that result is obtained. Extractum Sarsaparillae Fluidum Compositum, Compound Fluid Extract of Sarsaparilla. Therapy—This agent is an active eliminant, possessing diuretic and alterative properties to a marked degree. It has long been a popular remedy for the treatment of blood dyscrasias, but is nearly always given in combination with other well known specific alteratives. In combination with potassium iodide, stillingia, corydalis, phytolacca, podophyllum, or other alteratives, it has been given in scrofula and secondary syphilis, and especially in cutaneous diseases depending upon blood dyscrasia, and in rheumatic and gouty conditions, with inactive kidneys irritated from the presence of large quantities of uric acid and the urates. It was used in an Eastern hospital for epileptics experimentally, with a reduction in the number of paroxysms of twenty- five per cent. It may be given in all forms of epilepsy in sufficient frequent doses to produce a sensation of dullness or drowsiness. It has been used in the treatment of puerperal convulsions with satisfactory results, in a few cases. Potatoes and tomatoes belong to this family, and although the fruit is edible, the vines are usually poisonous. Injected into the veins it causes dyspnea, thrombosis in the vessels and arrest of respiration. Toxic doses produce tremors, muscular contractions, central paralysis, collapse, coma, a violent fall of the temperature and death. It is a narcotic, and in toxic doses causes nausea, vomiting, faintness, pain in the joints, numbness of the limbs, dryness of the mouth, convulsive movements, a small hard pulse, paralysis of the tongue, a purplish color of the face and hands, twitching of the eyelids and lips, trembling of the limbs, erythematous eruption, suppression of venereal desire, though recov. Clarus administered six grains of solanine, which produced general cephalic distress, with occipital pain, increase of the frequency and loss of the force of the pulse, followed after some hours by sudden vomiting, diarrhea, great weakness, and marked dyspnea. Therapy—Dulcamara is a remedy for all conditions resulting from suppression of secretion, from exposure to cold and dampness. Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 408 In acute coryza, in bronchial and nasal catarrh, in lung congestion and bronchial cough, with pain in the chest, all from cold, in bronchial asthma, and in acute bronchitis it is an excellent auxiliary remedy. In eruptive fevers it assists in determining the eruption to the surface, especially if there is retrocession. It has a direct action upon the skin also, being given in pustular eczemas and vesicular disorders quite freely. It has produced good results in psoriasis, pityriasis, lepra, and other scaly skin disorders. It acts as an alterative in such cases, and will influence the skin derangements of scrofula and syphilis to a certain extent. It is available in the various skin disorders of childhood from disordered blood and deranged stomach. It is an excellent alterative, if administered with care, and is therefore valuable in syphilis, scrofula, and other blood disorders. In acute and chronic rheumatism from exposure to dampness and cold, and in gout, it has been advantageously used. Nervous irritation with depression, with hyperesthesia of the organs, and pruritus pudendi are relieved by it. It may be used in spermatorrhea with undue excitement, priapism, nymphomania, and satyriasis.

This has been shown to be effective in treating dermal necrosis and sloughing if given within 12 hours of extravasation buy 50mg imuran visa. Prevention of dermal necrosis during infusion of noradrenaline (unlicensed): 10mg (1mL) phentolamine has been added to each 1L of noradrenaline infusion discount imuran 50mg overnight delivery. Technical information Incompatible with No information Compatible with Flush: NaCl 0. Additional information Common and serious Immediate: Bronchospasm or shock especially in asthma due to sulfite undesirable effects content. Injection-related: Local: Pain on injection into the corpus cavernosum; induration and fibrosis may occur with repeated use. Significant interactions * The following may "hypotensive effect of phentolamine: adrenaline (severe "pulse), anaesthetics-general, beta-blockers, calcium channel blockers, diuretics, moxisylyte, sildenafil. Antidote: The drug has a short duration of action; the patient should remain recumbent and fluids and electrolytes may be required. Noradrenaline may be used cautiously to overcome alpha blockade but adrenaline must be avoided. This assessment is based on the full range of preparation and administration options described in the monograph. Phenylephrine hydrochloride | 679 Phenylephrine hydrochloride 10mg/mL solution in 1-mL ampoules * Phenylephrine hydrochloride is a sympathomimetic with mainly alpha-adrenergic activity. Intravenous injection Preparation and administration The initial dilution of this injection produces more than the required dose. Cap the syringe and mix well to give a solution containing 1mg/mL (1000 micrograms/mL). Inspect visually for particulate matter or discolor- ation prior to administration and discard if present. Inspect visually for particulate matter or discolor- ation prior to administration and discard if present. Adjust the rate to clinical response: usually 30--60 micrograms/minute (90-- 180mL/hour). Stability after From a microbiological point of view, prepared infusions should be used preparation immediately; however, they are known to be stable at room temperature for up to 24 hours. The hypertensive effects may be treated with an alpha-adrenoceptor blocking drug, e. This assessment is based on the full range of preparation and administration options described in the monograph. Phenytoin sodium 50mg/mL solution in 5-mL ampoules * Phenytoin sodium is a hydantoin antiepileptic agent believed to act by preventing the spread of seizure activity, rather than by raising seizure threshold. Blood levels may be checked 2 hours after giving the loading dose to ensure that they are in the correct range. Dose in hepatic impairment: a reduced maintenance dose may be adequate to control seizures. Inspect visually for particulate matter or discoloration prior to administration and discard if present. The rate of administration may be further reduced in higher-risk patientsto5--10mg/minute (e. Phenytoin sodium | 683 Intermittent intravenous infusion Phenytoin sodium is incompatible with Gluc 5%, Gluc-NaCl, Hartmann’s, Ringer’s. Dosesmay begivenas undilutedinjection via syringepump becausethis reduces thelikelihood of precipitation that is seen when using dilutions in NaCl 0. Inspect visually for particulate matter or discoloration prior to administration and discard if present. The rate of administration may be further reduced in higher-risk patients to 5--10mg/ minute (e. Technical information Incompatible with Phenytoin sodium is incompatible with Gluc 5%, Gluc-NaCl, Hartmann’s, Ringer’s. Flushlineswell before and after administration of phenytoin to avoid contact with other drugs. Propylene glycol (adverse effects seen in #renal function, may interact with disulfiram and metronidazole). If albumin is low, free phenytoin levels will be high even if total plasma-phenytoin levels are in range. Pregnancy test If pregnancy suspected * May cause blood clotting abnormalities and congenital malformations in the neonate. Other: Nausea, vomiting, constipation, anorexia, insomnia, transient nervousness, tremor, paraesthesia, dizziness, headache, peripheral neuropathy, dyskinesia, rash, megaloblastic anaemia, leucopenia, thrombocytopenia, aplastic anaemia, hepatotoxicity, lymphadenopathy, polyarteritis nodosa, lupus erythematosus, Stevens-Johnson syndrome, toxic epidermal necrolysis, pneumonitis, interstitial nephritis.