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Thrombophlebitis Analog information on medical topics, symptoms, Thrombophlebitis Analog, drugs, procedures, news and more, written for the health care professional. See also Thrombophlebitis Analog of Fungal Infections.
Drugs for systemic antifungal treatment include the following see Table: Some Drugs for Systemic Fungal Infections:. Amphotericin B, an effective but relatively toxic drug, Thrombophlebitis Analog, has long been the mainstay of antifungal therapy for invasive and serious mycoses.
However, Thrombophlebitis Analog, newer potent and less toxic triazoles and echinocandins are now often recommended as first-line drugs for many invasive fungal infections. These drugs have markedly changed the approach to antifungal therapy, Thrombophlebitis Analog, sometimes even allowing oral treatment of chronic mycoses.
Acute Thrombophlebitis Analog reactions, neuropathy, GI upset, renal failure, anemia, thrombophlebitis, hearing loss, rash, hypokalemia, hypomagnesemia, Thrombophlebitis Analog.
CandidiasisThrombophlebitis Analog, including candidemia. Mucosal and systemic candidiasis. Pancytopenia due to bone marrow toxicity, neuropathy, Thrombophlebitis Analog, nausea, vomiting, hepatic and renal injury, colitis. Histoplasmosisblastomycosiscoccidioidomycosissporotrichosis. Hepatitis, GI upset, rash, headache, dizziness, hypokalemia, hypertension, edema, QT prolongation, heart failure.
Amphotericin B has been the mainstay of antifungal therapy for invasive and serious mycoses, but other antifungals eg, fluconazolevoriconazoleposaconazolethe echinocandins are now considered first-line drugs for many of these infections. Although amphotericin B does not have good CSF penetration, it is still effective for certain mycoses such as cryptococcal meningitis.
For acute, life-threatening mycosesamphotericin B deoxycholate may be started at 0. It is usually given over 2 to 3 h, although more rapid infusions over 20 to 60 min can be used in selected patients. However, more rapid infusions usually have no advantage. Many patients experience chills, fever, nausea, vomiting, anorexia, headache, and, occasionally, hypotension during and for several hours after an infusion.
Amphotericin B may also cause chemical thrombophlebitis when given via peripheral veins; a central venous catheter may be preferable. Pretreatment with acetaminophen or NSAIDs is often used; if these drugs are ineffective, hydrocortisone 25 to 50 mg or diphenhydramine 25 mg is sometimes added to the infusion or given as a separate IV bolus. Often, hydrocortisone can be tapered and omitted during extended therapy.
Severe chills and rigors can be relieved or prevented by meperidine 50 to 75 mg IV. Several lipid vehicles reduce the toxicity of amphotericin B particularly nephrotoxicity and infusion-related symptoms.
Two preparations are available:. Lipid formulations are preferred over conventional amphotericin B because they cause fewer infusion-related symptoms and less nephrotoxicity. Renal impairment is the major toxic risk of amphotericin B therapy, Thrombophlebitis Analog. Serum creatinine and BUN should be monitored before treatment Thrombophlebitis Analog at regular intervals during treatment: Amphotericin B is unique Thrombophlebitis Analog nephrotoxic antimicrobial drugs because it is not eliminated appreciably via the kidneys and does not accumulate as renal failure worsens.
Acute nephrotoxicity can be reduced by aggressive IV hydration with saline before amphotericin B infusion; at least 1 L of normal saline should be given before amphotericin infusion. Mild Thrombophlebitis Analog moderate renal function abnormalities induced by amphotericin B usually resolve gradually after therapy is completed.
Amphotericin B also frequently suppresses bone marrow function, manifested primarily Thrombophlebitis Analog anemia. Hepatotoxicity or other untoward effects are unusual. Azoles block the synthesis of ergosterol, Thrombophlebitis Analog, an important component of the fungal cell membrane. They can be given orally to treat chronic mycoses.
The first such Thrombophlebitis Analog drug, ketoconazolehas been supplanted by more effective, less toxic triazole derivatives, such as fluconazoleisavuconazole, itraconazoleposaconazoleand voriconazole. Drug interactions can occur with all azoles but are less likely with fluconazole. The drug interactions mentioned below are not intended as a complete listing; clinicians should refer to a specific drug interaction reference before using azole antifungal drugs, Thrombophlebitis Analog.
Drug and food interactions are common with azole antifungals; review all concurrent drug use before prescribing them.
This water-soluble drug is absorbed almost completely after an oral dose. It is also one of the first-line drugs for treatment of candidemia in nonneutropenic patients. Adverse effects that occur most commonly with fluconazole are GI discomfort and rash. More severe toxicity is unusual, but the following have occurred: Drug interactions occur less often with fluconazole than with other azoles, Thrombophlebitis Analog.
However, fluconazole sometimes elevates serum levels of calcium channel blockers, cyclosporinerifabutinphenytointacrolimuswarfarin -type oral anticoagulants, sulfonylurea drugs eg, tolbutamideand zidovudine. Rifampin may lower fluconazole blood levels. Isavuconazole is a broad-spectrum triazole for the treatment of aspergillosis and mucormycosis.
It is available as an IV Thrombophlebitis Analog as well as an oral capsule. No drug level monitoring is required. Adverse Thrombophlebitis Analog of isavuconazole include GI upset and hepatitis; the QT interval may decrease. Itraconazole has become the standard treatment for lymphocutaneous sporotrichosis as well as for mild or moderately severe histoplasmosisblastomycosisand paracoccidioidomycosis.
It is also effective in mild cases of invasive aspergillosis, some cases of coccidioidomycosisand certain types of chromoblastomycosis, Thrombophlebitis Analog. Despite poor CSF penetration, itraconazole can be used to treat some types of fungal meningitis, but it is not the drug of choice, Thrombophlebitis Analog.
Because of its high lipid solubility and protein binding, Thrombophlebitis Analog, itraconazole blood levels tend to be low, Thrombophlebitis Analog, but tissue levels are typically high. Drug levels Thrombophlebitis Analog negligible in urine and CSF. Use of itraconazole has declined as use of voriconazole and posaconazole has increased. Other reported adverse effects include allergic rash, hepatitis, Thrombophlebitis Analog, and hallucinations, Thrombophlebitis Analog.
An FDA black box warning for heart failure has been issued, particularly with a total daily dose of mg. Drug and food interactions can be significant. When the capsule form is used, Thrombophlebitis Analog, acidic drinks eg, Thrombophlebitis Analog, cola, acidic fruit juices or foods especially high-fat foods improve absorption of itraconazole from the GI tract, Thrombophlebitis Analog. However, absorption may be reduced if itraconazole is taken with prescription or OTC drugs used to lower gastric acidity.
Several drugs, including rifampinrifabutindidanosinephenytoinand carbamazepinemay decrease serum itraconazole levels. Itraconazole also inhibits metabolic degradation of other drugs, elevating blood levels with potentially serious consequences, Thrombophlebitis Analog.
Serious, even fatal cardiac arrhythmias may occur if itraconazole is used with cisapride not available in the US or some antihistamines eg, terfenadine, astemizole, perhaps loratadine. Rhabdomyolysis has been associated with itraconazole -induced elevations in blood levels of cyclosporine or statins, Thrombophlebitis Analog. Blood levels of some drugs eg, digoxinThrombophlebitis Analog, tacrolimusoral anticoagulants, sulfonylureas may increase when these drugs are used with itraconazole.
The triazole Verletzung des Waffenströmungs is available as an oral suspension, a tablet, and an IV formulation.
This drug is highly active against yeasts and molds and effectively treats various opportunistic mold infections, such as those due to dematiaceous dark-walled fungi eg, Cladophialophora sp. It is effective against many of the species that cause mucormycosis. Posaconazole can also be used as fungal prophylaxis in neutropenic patients with various cancers and in bone marrow transplant recipients.
Adverse effects of posaconazole Thrombophlebitis Analog, as for other triazoles, include a prolonged QT interval and hepatitis. Drug interactions occur with many drugs, including rifabutinrifampinstatins, various immunosuppressants, and barbiturates. This broad-spectrum triazole is available as a tablet and an IV formulation.
It is considered the treatment of choice for Aspergillus infections aspergillosis in immunocompetent and immunocompromised hosts. Voriconazole can also be used to treat Scedosporium apiospermum and Fusarium infections, Thrombophlebitis Analog. Additionally, the drug is effective in candidal esophagitis and invasive candidiasisalthough it is not usually considered a first-line treatment; it has activity against a broader spectrum of Candida sp than does fluconazole.
Adverse effects that must be monitored for include hepatotoxicity, visual disturbances commonhallucinations, and dermatologic reactions. Voriconazole can prolong the QT interval, Thrombophlebitis Analog. Drug interactions are numerous, notably with certain immunosuppressants used after organ transplantation. Echinocandins are water-soluble lipopeptides that inhibit glucan synthase.
They are available only for IV administration. Their mechanism of action is unique among antifungal drugs; echinocandins target the fungal cell wall, making them attractive because they lack cross-resistance with other drugs and their target is fungal and has no mammalian counterpart. Drug levels in urine and CSF are not significant.
Echinocandins available in the US are anidulafungincaspofunginand micafungin. There is little evidence to suggest that one is better than the other, but anidulafungin appears to interact with fewer Thrombophlebitis Analog than the other two. These drugs are potently fungicidal against most clinically important Candida Thrombophlebitis Analog see Candidiasis Invasive: Treatment but are considered fungistatic against Aspergillus.
FlucytosineThrombophlebitis Analog, a nucleic acid analog, is water soluble and well-absorbed after oral administration. Preexisting or emerging resistance is common, so Thrombophlebitis Analog is almost always used with another antifungal, usually amphotericin B. Flucytosine plus amphotericin B is used primarily to treat cryptococcosis but is Thrombophlebitis Analog valuable for some cases of disseminated candidiasis including endocarditisother yeast infections, and severe invasive aspergillosis.
Flucytosine plus antifungal azoles may be beneficial in treating cryptococcal meningitis and some other mycoses. Major adverse effects of flucytosine are bone marrow suppression thrombocytopenia and leukopeniahepatotoxicity, and enterocolitis; the degree of bone marrow suppression is proportional to serum levels. Which of the following is the most common adverse effect of Thrombophlebitis Analog B? Throughout my life, I have always had a job.
Since I was 16, I was working somewhere part-time and earning my own money even if it was minimum wage Tap to Thrombophlebitis Analog to the Consumer Version.
Antifungal Drugs By Sanjay G. This is the Professional Version. Click here for the Consumer Version.
Antifungal Drugs - Infectious Diseases - Merck Manuals Professional Edition
Jul 06, Author: The mainstay of medical therapy has been anticoagulation since the introduction of heparin in the s. More recently, mechanical thrombolysis has become increasingly used as endovascular therapies have increased, Thrombophlebitis Analog. Absolute contraindications to anticoagulation treatment include intracranial bleeding, Thrombophlebitis Analog, severe Thrombophlebitis Analog bleeding, recent brain, eye, or spinal cord surgery, pregnancy, and malignant hypertension, Thrombophlebitis Analog.
Relative contraindications include recent major surgery, recent Thrombophlebitis Analog accident, and severe thrombocytopenia. Systemic IV thrombolysis once improved the rate of thrombosed vein recanalization; however, it is no longer recommended because of an elevated incidence of bleeding complications, slightly increased risk of death, and insignificant improvement in PTS.
Thrombolytic therapy is recommended systemic preferred Thrombophlebitis Analog catheter directed in hypotensive individuals with an acute PE. The bleeding risk of systemic thrombolysis is similar to that of catheter-directed thrombolysis, Thrombophlebitis Analog, and the risk of PTS may further decrease risk, Thrombophlebitis Analog.
However, whether catheter-directed thrombolysis is preferred to anticoagulation has not been examined. The addition of percutaneous mechanical thrombectomy to the interventional options may facilitate decision-making, because recanalization may be achieved faster than before and with a decreased dose Thrombophlebitis Analog lytic; therefore, the bleeding risk may be decreased. Anticoagulant therapy is recommended for months depending on site of thrombosis and on the ongoing presence of risk factors.
If DVT recurs, if a chronic hypercoagulability is identified, Thrombophlebitis Analog, or if PE is Thrombophlebitis Analog threatening, lifetime anticoagulation therapy may be recommended. Most patients with confirmed proximal vein DVT may be safely treated on an outpatient basis. Exclusion criteria for outpatient management are as follows:. For admitted patients treated with UFH, the activated partial thromboplastin time aPTT or heparin activity level must be monitored every 6 hours while the patient is taking intravenous IV heparin until the dose is stabilized in the therapeutic range.
Platelets should be monitored. Heparin or LMWH should be discontinued if the platelet count falls below 75, Fondaparinux is not associated with hepatin-induced thrombocytopenia HIT, Thrombophlebitis Analog. Long-term anticoagulation is necessary to prevent the high frequency of recurrent venous thrombosis or thromboembolic events, Thrombophlebitis Analog. Anticoagulation does have problems. Although it inhibits propagation, Thrombophlebitis Analog does not remove the thrombus, and a variable risk of clinically significant bleeding is observed.
First-line therapy for non-high risk venous thromboembolism VTE or pulmonary embolism PE consists of direct oral anticoagulants dabigatran, rivaroxaban, apixaban, or edoxaban over vitamin K antagonists VKAs. Inferior vena cava filters are not recommended in patients with acute VTE on Marl Lieferung Varikosette therapy. Barring contraindications to aspirin therapy, aspirin is recommended to prevent recurrent VTE in patients with an unprovoked proximal DVT or Menovazin und Krampfadern following anticoagulation cessation.
Park and Byun indicate Thrombophlebitis Analog possibilities for advances in anticoagulant delivery systems include expansion of new oral agents and their antidotes, reducing the size of heparins, developing oral or topical heparins, and modifying physical or chemical formulations.
Heparin products used in the treatment of deep venous thrombosis DVT include unfractionated heparin and low molecular weight heparin LMWH The efficacy and safety of low-molecular-weight heparin LMWH for the initial treatment of DVT have been well established in several trials. Traditionally, heparin has been used only for admitted patients with DVT. Regular unfractionated heparin was the standard of care until the Thrombophlebitis Analog of LMWH products.
Heparin prevents extension of the thrombus and has been shown to significantly reduce but not eliminate the incidence of fatal and nonfatal pulmonary embolism and recurrent thrombosis. Heparin is a heterogeneous mixture of polysaccharide fragments with varying molecular weights but with similar biological activity, Thrombophlebitis Analog.
The low-molecular-weight fragments exert their anticoagulant effect by inhibiting the activity of activated factor X.
The hemorrhagic complications attributed to heparin are thought to arise from the larger higher-molecular-weight fragments. Fondaparinux, a direct selective inhibitor of factor Xa, overcomes many of the aforementioned disadvantages of low-molecular-weight heparins LMWHs. Pharmacokinetic studies of fondaparinux reveal that only a single-daily Thrombophlebitis Analog dose is required. Furthermore, a single dose of 7.
Daily doses of 5 mg or 10 Thrombophlebitis Analog are appropriate for patients who weigh less or more than that weight range. Heparin-induced thrombocytopenia HIT has not been reported. Therapeutic monitoring of laboratory parameters such as the prothrombin time or activated partial thromboplastin time aPTT is also not required, Thrombophlebitis Analog.
In some regions, the cost of therapy with fondaparinux is less than enoxaparin when it is being used to bridge therapy to a vitamin K antagonist VKA.
The combination of two factor Xa inhibitors may be an effective treatment strategy for acute venous thromboembolism VTE. Both Thrombophlebitis Analog levels and quantitative ultrasound thrombosis QUT scores were improved with the use of fondaparinux, and further reductions were achieved using rivaroxaban. Buller and his coauthors on behalf of the Matisse Investigators conducted a randomized, double-blind, international study of fondaparinux versus enoxaparin on 2, patients with objectively confirmed acute deep venous thrombosis DVT and found the two agents to be comparable in safety and efficacy.
Fondaparinux was administered as a single 7. Anticoagulation with a VKA was continued for 3 months. Efficacy was measured by the rate of recurrent VTE in the 3-month follow-up period after enrollment.
Safety was Thrombophlebitis Analog by the incidence of major bleeding and mortality over the same interval. The recurrence rate showed a nonsignificant trend in favor of fondaparinux 3. Major bleeding rates were essentially identical, and mortality rates were also comparable. In general, the safety and efficacy of fondaparinux were independent of body weight. However, Thrombophlebitis Analog, patients with mild renal insufficiency and a low creatinine clearance had the same risk of bleeding in both the LMWH and fondaparinux groups.
Overall, Thrombophlebitis Analog, the authors concluded that once-daily fondaparinux was as effective and as safe as twice-daily, weight-adjusted enoxaparin. Only one fixed-dosage regimen for fondaparinux is required for patients who weigh between 50 kg and kg, and only one subcutaneous dose per day is required, Thrombophlebitis Analog. This greatly simplifies the treatment of DVT and facilitates outpatient therapy. In the original study, about one third of the patients were treated partially or entirely as outpatients without any increased risk when compared with those treated as inpatients.
In the event of a major bleed, protamine sulfate partially reverses the anticoagulant effect of enoxaparin. However, no specific antidote to fondaparinux is available. Participants were randomly assigned to receive rivaroxaban, a combination of enoxaparin and a VKA eg, warfarinor a placebo, Thrombophlebitis Analog.
Study endpoints were designed to measure the number of patients who experienced recurrent symptoms of DVT, PE, or death after receiving treatment. Dabigatran Pradaxa inhibits free and clot-bound thrombin and thrombin-induced platelet aggregation. This agent was FDA approved in to reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation, Thrombophlebitis Analog.
In Aprilit was approved for the treatment of DVT and PE in patients who have been treated with a parenteral anticoagulant for days. Additionally, it was approved to reduce the risk of DVT and PE recurrence in patients who have been previously treated.
Approval was based on results from 4 global phase III trials that showed dabigatran was noninferior to warfarin and had a lower risk of major or clinically relevant Thrombophlebitis Analog compared with warfarin, Thrombophlebitis Analog.
Results showed dabigatran was noninferior to warfarin in reducing DVT and PE after a median of days of treatment with a lower risk of bleeding compared with warfarin, Thrombophlebitis Analog. Results from this trial showed dabigatran was noninferior to warfarin in the extended treatment of VTE and carried a lower risk of major or clinically relevant bleeding than warfarin.
Among patients with PE, had right ventricular dysfunction, as assessed by measurement of N-terminal pro-brain natriuretic peptide NT-proBNP levels, Thrombophlebitis Analog. The investigators concluded that edoxaban was not only noninferior to high-quality standard warfarin therapy but also caused significantly Varizen behandelt Öl bleeding in a broad spectrum of patients with VTE, including those with severe PE.
Approval of betrixaban was based on Krampfadern Hoden Unfruchtbarkeit from the phase 3 APEX studies. Patients in the enoxaparin group received 40 mg subcutaneously once daily for days and took an oral placebo once daily for days, Thrombophlebitis Analog.
Efficacy was measured in 7, Thrombophlebitis Analog, patients using a composite outcome score composed of the occurrence of asymptomatic or symptomatic Thrombophlebitis Analog DVT, nonfatal PE, stroke, or VTE-related death. For the first episode of deep venous thrombosis DVTpatients should be treated for months. Recurrent episodes should be treated for at least 1 year.
Prandoni et al found that the use of ultrasonography to determine the duration of anticoagulation can reduce recurrences of venous thromboembolism after a first episode of acute proximal DVT. Recurrent venous thromboembolism developed in Patients with cancer have a particularly higher rate of DVT recurrence than noncancer patients. Long-term therapy for DVT is strongly recommended. Studies have shown a lower rate of venous thromboembolism VTE recurrence without increasing the risk of bleeding with low-molecular-weight heparin LMWH therapy.
Reports also describe that the LMWH compounds may decrease the all-cause mortality rate. Indefinite therapy is recommended for patients with recurrent episodes of venous thrombosis regardless of the cause. Long-term therapy with LMWH has been shown to be as effective as warfarin in the treatment of venous thrombosis, except in those patients with a concurrent malignancy. In this subgroup, LMWH was shown to be more effective than oral therapy. Hemorrhagic complications are the most common adverse Thrombophlebitis Analog of anticoagulant Behandlung von venösen Ulcera der unteren Extremitäten bei der Atherosklerose. Patients who require yearlong or indefinite anticoagulation because of chronic risk factors have double the risk of hemorrhage, Thrombophlebitis Analog.
Significant bleeding ie, hematemesis, hematuria, GI hemorrhage should be thoroughly investigated because anticoagulant therapy may unmask a preexisting disease eg, Thrombophlebitis Analog, cancer, peptic ulcer disease, arteriovenous malformation. The treatment of hemorrhage while taking heparin depends on the severity of the bleeding and the extent to which the Thrombophlebitis Analog partial thromboplastin time aPTT is elevated above the therapeutic range.
Patients who hemorrhage while receiving heparin are best treated by discontinuing the drug. The half-life is relatively short, and Thrombophlebitis Analog aPTT usually returns to the reference range within a few hours. Treatment with fresh frozen plasma or platelet infusions is ineffective. For severe hemorrhage, Thrombophlebitis Analog, such as intracranial or massive gastrointestinal bleeding, heparin may be neutralized by protamine at a dose of 1 mg for every units.
Protamine should be administered at the same time that the infusion is stopped. The treatment of major hemorrhage associated with low-molecular-weight heparin LMWH is similar to heparin. However, the half-life of these agents is longer h. As with heparin, fresh frozen plasma or platelet Thrombophlebitis Analog are ineffective, Thrombophlebitis Analog. The risk of bleeding on warfarin is not linearly related to the elevation of the international normalized ratio INR.
The risk is conditioned by other factors, including poor follow-up, Thrombophlebitis Analog, drug interactions, Thrombophlebitis Analog, age, and preexisting disorders that predispose to bleeding. Patients who hemorrhage while receiving oral warfarin are treated by withholding the drug and administering vitamin K. Severe life-threatening hemorrhage is managed with fresh frozen plasma in addition to vitamin K.
Recombinant factor VIIa is another option especially for central nervous system hemorrhage. The qualities desired in the ideal anticoagulant are ease of administration, Thrombophlebitis Analog, efficacy and safety with minimal complications or adverse effectsrapid onset, a therapeutic half-life, and minimal or no Creme Bestandteil Krampf.
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