otc คือ

Apr 07

Otc คือ

Interest Rate Swap Explained otc คือ.

วิดีโอ otc คือ

Clonidine and Propranolol The combination may produce a mysteriou

Heat exchange: legs of birds, body heating of fish such as Tuna and Mako shark; Salt and waste excretion in kidneys; O2 and CO2 exchange in gills of many invertebrates and fish, in lungs of birds (but not those of mammals).

If you are using nitroglycerin ointment to treat anal fissure pain, ask your pharmacist or doctor for a copy of the manufacturer's information for the patient.

อ่านเพิ่มเติมเกี่ยวกับ otc คือ

A recent study in Washington found that only 67% of serious drug interactions resulted in a correct warning from a pharmacy computer system designed to warn of significant drug interactions.(1) Causes contributing to harmful drug?drug interactions include narrow therapeutic dosage ranges associated with certain drugs and a patient?s disease state (Tables 1 and 2). For example, patients with epilepsy have increased chances of drug interaction, compared with those with other disease states.(2)Several antiepileptic agents?such as phenytoin, carbamazepine, and valproic acid?have narrow therapeutic indexes. Thus, there is little room for error when using these drugs. Compromised renal function or changes in the cytochrome P-450 enzymes also can increase the risk of experiencing a severe adverse drug event. Clearly, it is important for pharmacists to recognize and understand which drug interactions can result in significant patient harm. Understanding the pharmacokinetics and pharmacodynamics responsible for these significant interactions strengthens the pharmacist?s chances of identifying dangers and preventing patient harm. This article focuses on 10 prevalent and potentially fatal drug interactions, listed in Table 3.

Fluoxetine and Phenelzine The interaction can result in a central serotonin syndrome.(3)This condition is characterized by mental status changes, agitation, diaphoresis, tachycardia, and death. These symptoms can develop quickly with only 1 or 2 doses of fluoxetine when combined with phenelzine. Serotonin syndrome is possible with any monoamine oxidase inhibitor (MAOI), such as phenelzine or tranylcypromine sulfate, in combination with any drug that increases serotonin levels, such as dextromethorphan, meperidine, and other selective serotonin reuptake inhibitors (SSRIs).(3)It is recommended that fluoxetine be stopped for at least 5 weeks before an MAOI is prescribed because of the long half-life of fluoxetine and its primary metabolite, norfluoxetine. Also, 2 weeks should be allowed after discontinuation of an MAOI before starting SSRI treatment.(3)

Digoxin and Quinidine This significant drug interaction has been known for a long time, yet it continues to be a problem, often with devastating results. The interaction can lead to a marked increase in plasma concentration levels of digoxin in more than 90% of patients.(4)Significant changes in serum digoxin are noticed within 24 hours. The average increase is roughly 2-fold.(5)The effects from this interaction range from nausea and vomiting to death. The primary mechanism for this interaction is a decreased volume of distribution of digoxin, secondary to its displacement from binding sites in body tissues.(4)Quinidine also decreases renal and nonrenal excretion rates of digoxin, which leads to increased steady-state concentrations of the cardiac glycoside.(4)Ideally, patients taking digoxin should avoid the use of quinidine; however, if the combination is necessary, the patient should be closely watched. Pharmacists should anticipate the need to reduce the digoxin dose by one half.(4)

Sildenafil and Isosorbide Mononitrate  Sildenafil may markedly increase the hypotensive effects of isosorbide mononitrate.(6)More than 123 deaths have been reported since 1998, when sildenafil was made available in the United States.(6)Most deaths were among patients with 1 or more risk factors, including obesity, hypertension, and cigarette smoking. Sildenafil was developed as a phosphodiesterase-5 (PDE5) inhibitor. In the presence of PDE5 inhibitors, nitrates can cause intense increases in cyclic guanosine monophosphate and dramatic drops in blood pressure.(7)Patients taking isosorbide mono-nitrate or any nitrate, including nitroglycerin, should be advised not to take sildenafil.

Potassium Chloride and Spironolactone This is another significant drug interaction that has been known for a long time. The combination may result in hyperkalemia.(8)The resulting hyperkalemia can be serious and may lead to cardiac failure and death. Patients with renal impairment are especially prone to this effect. Spironolactone is a competitive antagonist of mineral corticoids, of which aldosterone is a potent example.(9)This mechanism occurs in the kidney at the distal portion of the nephron and leads to the excretion of sodium ions while saving potassium ions.(9)Patients receiving potassium-depleting diuretics, such as amiloride or triamterene, may also experience this interaction. These diuretics can interact with all absorbable forms of potassium?bicarbonate, citrate, acetate, gluconite, and iodide salts.(9)Severe hyperkalemia is dangerous, and thus patients who are prescribed spironolactone must undergo an evaluation of serum potassium levels.(9)

Clonidine and Propranolol The combination may produce a mysteriou

Source: http://www.pharmacytimes.com/publications/issue/2002/2002-11/2002-11-7010

otc คือ