ABSTRACT
Cytomegalovirus (CMV) is a serious complication of immunosuppressed patients receiving bone marrow transplantation. Foscarnet, a pyrophosphate analog, has been used in the treatment of CMV infections. Renal impairment and electrolyte abnormalities are potential adverse reactions associated with the use of foscarnet. We report a case of significant electrolyte changes after initiation of foscarnet in a bone marrow transplant patient receiving parenteral nutrition.
Subject(s)
Antiviral Agents/adverse effects , Bone Marrow Transplantation , Cytomegalovirus Infections/drug therapy , Electrolytes/blood , Foscarnet/adverse effects , Parenteral Nutrition, Total/adverse effects , Adult , Antiviral Agents/administration & dosage , Antiviral Agents/pharmacology , Cytomegalovirus/drug effects , Cytomegalovirus Infections/prevention & control , Foscarnet/administration & dosage , Foscarnet/pharmacology , Humans , MaleABSTRACT
To eliminate and reduce medication errors, health care organizations must develop a consistent approach that allows examination of errors in a supportive atmosphere with a bias toward preventing future errors rather than punishing past ones. Until improved systems are in place, physicians can help prevent many of the most serious medication errors by observing some basic safety practices, such as writing orders whenever possible and limiting verbal orders to urgent or emergency situations, writing clearly and neatly, and avoiding abbreviations.
Subject(s)
Drug-Related Side Effects and Adverse Reactions , Medication Errors , Practice Patterns, Physicians' , Handwriting , Humans , Medication Systems, Hospital/standards , Nurses , Risk ManagementABSTRACT
Troglitazone is the first of a new family of antihyperglycemic drugs. We review its use in clinical practice.
Subject(s)
Chromans/therapeutic use , Diabetes Mellitus, Type 2/drug therapy , Hypoglycemic Agents/therapeutic use , Thiazoles/therapeutic use , Thiazolidinediones , Diabetes Mellitus, Type 2/metabolism , Gluconeogenesis/drug effects , Humans , Insulin Resistance , TroglitazoneABSTRACT
In general, patients who are malnourished tend to have prolonged effects from drugs metabolized by the MFOS. On the other hand, in obese patients, drugs that undergo phase II metabolism tend to be metabolized more rapidly, thus shortening their duration of action. Therefore, clinicians must remember that, in protein-calorie malnutrition, drugs metabolized in the liver may be more likely to cause toxic effects due to the decreased rate of hepatic metabolism. Dose reduction could eliminate these adverse effects. Alternatively, drugs that undergo phase II metabolism may need to be administered at higher doses in obese patients, since the desired clinical effect may not be seen at a normal dose due to the obesity-related increase in hepatic metabolism. This should be considered before discontinuing the drug as a result of its lack of effect.
