By X. Pyran. Tennessee State University.
Gynecomastia generic clindamycin 150mg free shipping, tration buy generic clindamycin 150mg online, but unlike ﬂuconazole, it undergoes extensive impotence, reduced sperm counts, and diminished li- hepatic metabolism and is highly protein bound. No sig- bido can occur in men, and prolonged drug use can re- niﬁcant amount of bioactive drug is excreted into the sult in irregular menses in women. Because Drug Interactions of its low toxicity proﬁle, this drug may gain importance Both rifampin and isoniazid lower plasma ketoconazole in the chronic treatment of infections with invasive di- levels, and concomitant administration should be avoided. When it is used as monotherapy, resistance and (Femstat) is an effective topical agent for vaginal can- clinical failure are common. Potential mechanisms for didiasis; terconazole (Terazol) is effective in the treat- drug resistance include decreased fungal cell mem- ment of vaginal candidiasis; and econazole (Spectazole) brane permeability and reduced levels of fungal is useful in the treatment of superﬁcial fungal infections cytosine deaminase. Combination therapy with am- of the skin, achieving high tissue levels in the stratum photericin B and flucytosine in the treatment of corneum. Oxiconazole nitrate (Oxistat) and sulconazole cryptococcal meningitis and deep-seated Candida in- nitrate (Exelderm) are topical imidazole derivatives fections, such as septic arthritis and meningitis, permits available for the treatment of dermatophyte infections reduced dosing of amphotericin B and prevents the and pityriasis (tinea versicolor). When higher doses of is available without a prescription for the treatment of amphotericin B are used, combination therapy with dermatophyte infections and candidiasis. Adverse Effects FLUCYTOSINE When 5-FC is prescribed alone to patients with normal renal function, skin rash, epigastric distress, diarrhea, Chemistry and Mechanism of Action and liver enzyme elevations can occur. When it is pre- scribed to patients with renal insufﬁciency or to patients Flucytosine (5-ﬂucytosine, 5-FC; Ancoban) is a ﬂuori- receiving concurrent amphotericin B therapy, blood lev- nated pyrimidine analogue of cytosine that was origi- els of 5-FC may rise, and bone marrow toxicity leading nally synthesized for possible use as an antineoplastic to leukopenia and thrombocytopenia is common. Because of baseline leukope- quently, 5-FC metabolites interfere with fungal DNA nia, 5-FC is often not tolerated by end-stage HIV- synthesis by inhibiting thymidylate synthetase. Absorption, Distribution, Metabolism, CAPSOFUNGIN and Excretion Capsofungin (Cancidas) is a semisynthetic lipopeptide 5-FC is well absorbed orally, with greater than 90% known as an echinocandin, the ﬁrst representative of a bioavailability. The serum half-life is 3 to 5 hours, with new class of antifungal agents that inhibit the synthesis of serum levels peaking 4 to 6 hours after a single dose.
Tocolysis Magnesium sulfate prevents convulsions in preeclamp- also allows for the transport of the mother to a tertiary sia and directly uncouples excitation–contraction in center where delivery of the preterm infant often re- myometrial cells through inhibition of cellular action sults in its improved survival discount clindamycin 150 mg without a prescription. Furthermore purchase 150mg clindamycin visa, magnesium sulfate decreases These drugs act by binding to 2-adrenoceptors on calcium uptake by competing for its binding sites, acti- myometrial cell membranes and activating adenylyl cy- vating adenylyl cyclase (thereby reducing intracellular clase. This in turn increases levels of cAMP in the cell calcium), and stimulating calcium-dependent adenosine (Fig. The fetal ductus is more adrenergic agents in patients with heart disease, dia- sensitive to indomethacin beyond 32 weeks of gesta- betes, hypertension, or hyperthyroidism. Indomethacin use also can decrease amniotic ﬂuid There is much debate as to the efﬁcacy of magne- volume and cause oligohydramnios through its ability sium sulfate. Long-term use of ma- enough must be given to maintain a blood plasma level ternal indomethacin is associated with primary pul- of at least 5. Even at this level, tocolysis may monary hypertension and an increased incidence of in- be hard to achieve. Patients The calcium channel blocking agent nifedipine given magnesium lose patellar reﬂexes at plasma levels (Procardia; see Chapter 19), is one of the more recent greater than 8 to 10 mEq/L. It acts by impairing occur at levels greater than 10 to 12 mEq/L, with respi- the entry of Ca into myometrial cells via voltage- ratory paralysis and arrest soon after (e. Toxicity can be avoided by following urine out- studies are needed before its usefulness can be fully as- put and checking patellar reﬂexes in patients receiving sessed. Other side effects include sweating, Hydroxyprogesterone has been used prophylacti- warmth, ﬂushing, dry mouth, nausea, vomiting, dizzi- cally for the 12th to 37th week of pregnancy, particularly ness, nystagmus, headache, palpitations, pulmonary in women who are in the high-risk category for prema- edema, maternal tetany, profound muscular paralysis, ture delivery (e. Hydroxy- progesterone as a tocolytic agent requires further eval- Other Agents uation before its routine prophylactic administration Since certain prostaglandins are known to play a role in can be recommended. Atosiban is an analogue of oxytocin that is modiﬁed at Indomethacin is given orally or rectally for 24 or 48 positions 1, 2, 4, and 8. Early studies have demonstrated that cerning the use of indomethacin is premature closure of this drug does decrease and stop uterine contractions. Adverse reactions to the prostaglandin analogue sulfate that may be related to its ability to relax carboprost tromethamine include all of the follow- uterine smooth muscle EXCEPT ing EXCEPT (A) Uncoupling excitation–contraction in myome- (A) Diarrhea trial cells through inhibition of cellular action po- (B) Fever tentials (C) Water intoxication (B) Decreasing calcium uptake by competing for (D) Nausea binding sites (E) Dyspnea (C) Activating adenylate cyclase 722 VII DRUGS AFFECTING THE ENDOCRINE SYSTEM (D) Stimulating calcium-dependent ATPase rather than inhibit premature labor. The mechanism of action by which (B) Fetal gastrointestinal bleeding magnesium sulfate causes smooth muscle contrac- (C) Fetal hematuria tion is complex and poorly understood.