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  • [::..archive..::]
    07/20/2003 - 07/27/2003 07/27/2003 - 08/03/2003 08/03/2003 - 08/10/2003 08/10/2003 - 08/17/2003 08/24/2003 - 08/31/2003 08/31/2003 - 09/07/2003 09/07/2003 - 09/14/2003 09/14/2003 - 09/21/2003 09/21/2003 - 09/28/2003 11/09/2003 - 11/16/2003 03/21/2004 - 03/28/2004
    Sindhu's News: 2,636
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    :: Saturday, September 27, 2003 ::

    preventing organ rejection continued

    mycophenolate motefil (cellcept) http://www.rocheusa.com/products/cellcept/pi.pdf

    used in combination with cyclosporine and glucocorticoids.

    major adverse effects include diarrhea, severe neutropenia, vomiting and sepsis.

    associated with an increased risk of infection and malignancies.
    absorption is decreased by the use of magnesium and aluminum antacids and by cholestyramine (questran, prevalite)
    contraindicated in pregnancy.

    muromonab-CD3 (orthoclone OKT3) http://www.orthobiotech.com/pdfs/okt3.pdf

    used to prevent acute allograft rejection of kidney transplants
    adverse reactions include fever, chills, dyspnea, chest pain and nausea and

    antithymocyte globulin (atgam) http://www.pfizer.com/download/uspi_atgam.pdf

    used to prevent rejection of renal transplants
    usually administered with glucocorticoidss and azathioprine
    adverse reactions include chills, fever, leukopenia, and skin reactions.

    :: Sindhu's Medical News @ 2:31 PM [+]

    :: Friday, September 26, 2003 ::
    preventing organ rejection continued

    dacliximab (zenapax) http://www.rocheusa.com/products/zenapax/pi.pdf

    basiliximab (simulect) http://www.pharma.us.novartis.com/product/pi/pdf/simulect.pdf

    used to prevent acute rejection of transplanted kidneys
    used in combination iwth other immunosuppressants such as cyclosporine and glucocorticoids
    administered by the IV route
    contraindicated in the client with an allergy to protein

    dacliximab (zenapax)

    initial dose administered within 24 hours before transplanation

    side effects include chest pain, GI distress, edema, shortness of breath, pain in the joints, and slow wound healing.

    basiliximab (simulect)

    initial dose administered within 2 hours before transplantation

    side effects are similar to those of zenapax; additionally, headache, insomnia, dizziness can occur.

    :: Sindhu's Medical News @ 6:56 PM [+]


    oral anticoagulants

    anisinidione (miradon) http://www.rxlist.com/cgi/generic/miradon.htm

    warfarin sodium (coumadin) http://www.rxlist.com/cgi/generic/warfarin.htm

    parenteral anticoagulants

    ardeparin (normiflo) http://www.drugdigest.org/DD/DVH/Uses/0,3915,46%7CNormiflo+%252D+No+longer+available,00.html

    dalteparin (fragmin) http://www.rxlist.com/cgi/generic2/daltep_cp.htm

    danaproid (orgaran) http://www.orgaran.com/

    enoxaparin (lovenox) http://www.lovenox.com/


    prevent the extension and formation of clots by inhibiting factors in the clotting cascade and decreasing blood coaguability

    used for thrombosis, pulmonary embolism, and myocardial infarction (MI)

    contraindicated with active bleeding, except for disseminated intravascular coagulation (DIC), bleeding disorders or blood dsycrasias, ulcers, liver, and kidney disease and spinal cord or brain injuries

    side effects

    bleeding gums

    :: Sindhu's Medical News @ 6:16 PM [+]

    heparin sodium (liquaemin sodium)


    prevents thrombin from converting fibrinogen to fibrin
    prevents thromboembolism
    the therapeutic dose does not dissolve clots, but prevents new thrombus formation

    blood levels

    normal activated partial thromboplastin time (APTT) is 20 to 36 seconds
    maintain APTT at 1.5 to 2.5 times normal
    at therapeutic levels, heparin will increase the APTT by a factor of 1.5 to 2
    APTT therapy shuld be measured every 4 to 6 hours during initial therapy, then on a daily basis
    if the APTT is too long -- more than 80 seconds--the dosage should be lowered
    if aPTT is too short-- less than 60 seconds-- the dosage should be increased
    normal clotting time is 8 to 15 minutes; maintain the clotting time at 15 to 20 minutes


    monitor clotting time and APTT
    monitor platelet count
    observe for bleeding gums, bruises, nosebleeds, hematuria, hematemesis, occult blood in the stool and petechiea
    when administering heparin subcutaneously, inject into the abdomen using a small needle (25 to 28 gauage) at a 90 degree angle and do not aspirate or rub the injection site
    instruct the client regarding measures to prevent bleeding
    antidote:protamine sulfate

    :: Sindhu's Medical News @ 5:58 PM [+]


    decreases prothrombin activity and prevents the use of vitamin K by the liver
    used for long term anticoagulation
    prolongs clotting time and is monitored by prothrombin time
    used mainly to prevent thromboembolytic conditions such as thrombophlebitis, pulmonary embolism, and embolism formation caused by atrial fibrillation, thrombosis, myocardial infarction, or heart valve damage.
    usually given for 2 to 3 months after an MI to decrease the incidence of deep vein thrombosisi and thromboembolism.

    blood levels

    average PT is 9.6 to 11.8 seconds
    warfarin sodium prolongs the PT

    international normalized ratio (INR)

    the normal INR is 1.3 to 2.0
    the INR is determined by multiplying the observed PT ratio (the ratio of the client's PT to a control PT) by a correction factor specific to a particular thromboplstin preparation used in the testing.
    the treatment goal is to raise the INR to an appropriate value
    an INR of 2 to 3 is appropriate fo rmost clients, although for some clients, the target INR is 3.0 to 4.5
    if the INR is below the recommended level, warfarin sodium dose should be increased.
    if the INR is above the recommended range, warfarin sodium dose should be reduced.


    monitor PT and INR
    observe for a bleeding gums, bruises, nosebleeds, hematuria, hematemesis, occult blood in the stool in the petechiae
    instruct the client regarding measures to prevent bleeding
    antidote: vitamin K phytonadione (aquamephyton)

    :: Sindhu's Medical News @ 5:46 PM [+]

    thromboembolytic medications

    alteplase (activase, TPA, tissue plasminogen activator) http://www.gene.com/gene/products/information/cardiovascular/activase/index.jsp

    anistrepteplase (eminase) http://www.drugdigest.org/DD/DVH/Uses/0,3915,6027%7CEminase,00.html

    reteplase (retavase) http://www.retavase.com/retavase_pi.pdf

    streptokinase (kabikinase, streptase) http://www.drugdigest.org/DD/DVH/Uses/0,3915,6238%7CKABIKINASE,00.html

    urokinase (abbokinase) http://www.abbotthosp.com/prod/pdf/abbo.pdf


    activate plasminogen; plasminogen generates plasmin (the enzyme that dissolves clots)
    used early in the course of myocardial infarct (within 4 to 6 hours of the onset of the infarct) to restore blood flow, limit myocardial damage, preserve left ventricular function and prevent death.


    active internal bleeding
    history of cerebrovascular accidents
    intracranial problesm
    intracranial surgery or trauma within the two previous months
    history of thoracic, pelvic or abdominal surgery in the previous ten days.
    history of hepatic or renal disease.
    uncontrolled hypertension
    recently required, prolonged cardiopulmonary resuscitation

    side effects

    allergic reactions


    obtain APTT, PT, fibrinogen level, hematocrit, and platelet count.
    monitor vital signs
    assess pulses
    monitor for bleeding
    monitor all excretions for occult blood.
    monitor for neurological changes usch as slurred speech, lethargy, confusion and hemiparesis.
    monitor for hypotension and tachycardia
    avoid injections if possible
    apply direct pressure over a puncture site for 20 to 30 minutes
    handle teh client as little as possible when moving
    instruct teh client to use an electric razor for shaving and to brush teeth gently.

    :: Sindhu's Medical News @ 2:00 AM [+]

    :: Monday, September 22, 2003 ::
    antiplatelet medications

    abciximab (ReoPro) http://pi.lilly.com/reopro.pdf

    aspirin (acetylsalicylic acid, ASA) http://www.nursespdr.com/members/database/ndrhtml/acetylsalicylicacid.html

    clopidrogel bisulfate (plavix) http://www.sanofi-synthelabous.com/products/pi_plavix/pi_plavix.html

    eptifibatide (integrilin) http://www.millennium.com/images/INTEGRILIN(r)insert.pdf

    ticlopidine Hydrochloride (ticlid) http://www.rocheusa.com/products/ticlid/pi.pdf


    inhibits the aggregation of platelets in teh clotting process, thereby prolonging the bleeding time.
    may be used in conjunction with anticoagulants
    used in the prophylaxis of long term complications after MI, coronary revascularization and CVAs.
    contraindicated in bleeding disorders and known sensitivity.

    side effects

    gastrointestinal bleeding
    tarry stools


    determine sensitivity before administration
    monitor vital signs
    instruct teh client to take medication with food if GI upset occurs
    monitor bleeding time
    monitor for side effects related to bleeding
    instruct the client in the use of the medication
    instruct the client to monitor for side effects related to bleeding and in the measures to prevent bleeding.

    :: Sindhu's Medical News @ 6:17 PM [+]

    positive inotropic/cardiotonic medications

    amrinone (inocor):- used for short term managment of congestive heart failure in those who have not responded adequately to cardiac glycosides, diuretics, and vasodilators


    milrinone (primacor):- used for short term management of congestive heart failure or may be given before heart transplantation.



    stimulates myocardial contractility and produces a positive inotropic effect

    the increase in myocardial contractility increases cardiac, peripheral and kidney functions by increasing cardiac output, decreasing preload, improving blood flow to the periphery and kidneys, decreasing edema, and increasing fluid excretion; as a result, fluid retention in the lungs and extremities is decreased.

    side effects


    adverse reactions

    hepatoxicity manifested by elavated liver enzyme levels
    hypersensitivity manifested by wheezing, shortness of breath, pruritis, urticaria, clammy skin, and flushing.


    monitor apical pulse and blood pressure
    monitor for hypersensitivity
    check lung sounds for wheezing and rales
    monitor for edema
    monitor for relief of congestive heart failure as noted by reduction in edema, lessening of dyspnea, orthopnea and fatigue
    monitor electrolytes, liver enzymes, platelet count, and renal function studies, may decrease potassium and increase liver enzymes.

    :: Sindhu's Medical News @ 4:54 PM [+]

    cardiac glycosides

    digoxin (lanoxin, lanoxicaps) http://www.rxlist.com/cgi/generic/dig.htm
    digitoxin (crystodigin) http://www.usadrug.com/IMCAccess/ConsDrugs/Digitoxincd.shtml


    inhibit sodium potassium pump, thereby increasing intracellular calcium, which causes the heart muscle fibers to contract more efficiently.

    produces a positive inotropic action, which increases teh force of myocardial contractions

    produces a negative chronotropic action which depresses the sinoatrial node (SA), reduces conduction of the impulse through the atrioventricular (AV) node, and slows the heart rate.

    produces a negative dromotropic action that decreases the condution of the heart cells.

    the increase in myocardial contractility increases cardiac, peripheral, and kidney functions by increasing cardiac output, decreasing preload, and improving blood flow to the periphery and kidneys, decreasing edema, and increasing fluid excretion, as a result; fluid retention in the lungs and extremities is decreased.

    used for CHF, atrial tachycardia, atrial fibrillation, and atrial flutter

    contraindicated in ventricular dysrhythmias and second or third degree heart block

    used with caution in clients with renal disease, hypothyroidism, and hypokalemia

    side effects

    anorexia, nausea vomiting,
    visual disturbances:-diplopia, blurred vision, yellow-green halos
    fatigue, and weakness


    monitor for toxicity as evidenced by anorexia, nausea, vomiting, visual disturbances, confusion, bradycardia, heart block, premature ventricular contractions (PVCs), and tachydysrhythmias

    monitor serum digoxin level, electrolyte balances and renal function tests
    therapeutic digoxin range is 0.5 to 2.0 mg/ml and levels above 2.0 are toxic.

    :: Sindhu's Medical News @ 4:13 PM [+]


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