DIAZEPAM(VALIUM) Indications Doses Precautions and Adverse Effects

Indications:

Anxiety, epilepsy, muscle relaxation (tetanus), and acute alcohol with drawal.

Doses & Administrations:
Oral: Adult: Anxiety: 2mg three times daily. maximum 30mg/daily. Acute alcohol with drawl: 5-20mg, repeated 2 to 4 hours if required. Muscle Spasm : 2-15mg daily in divided doses. Muscle Spasm (Tetanus) : 3-10mg/kg/day. Pediatric: 0.1-0.8mg/kg/day every 6 to 8 hours. Parenteral: Adult: Severe Anxiety : 2-10mg I/V or I/M repeated after 4 hours if required. Muscle Spasm : 5-10mg I/V or I/M repeated after 4 hours if needed. Tetanus : 0.1-0.3mg/kg I/V repeated at intervals of 1 to 4 hours or by 1.v infusion of 3- 10mg/kg/day. Status Epilepticus: 10-20mg I/V or I/M repeated 30-60 minutes if necessary. Pediatric: 0.1 to 0.3mg/kg repeated in 2 to 4 hours as required.
Contra Indications:
Hypersensitivity to benzodiazepines, respiratory depression, and chronic psychosis.

Precautions:
Avoid prolong use and abrupt withdrawal, respiratory depression, late pregnancy, lactation, hepatic and renal impairment.

Pregnancy Status:
Category "D"

Renal Failure Doses:
No specific dosage adjustment is necessary in renal insufficiency.

Lactation Status:
Contraversial.

Interactions:
Neuroleptics, tranquilizers, antidepressants, analgesics and anaesthetic.

Adverse Effects:
Drowsiness, sedation, ataxia, hypotension, apnoea, G.I, upset skin, rashes, visual disturbance, changes in libido and urinary retention.

Nursing Considerations:
Concentration available are 5mg/ml in 2ml ampoule. The product should be protected from light and retain potency for 3 months at room temperature. For IM administration it should be given deeply in the muscle. Do not use small veins (dorsum of hand or wrist) for IV injection. Reduce dose of narcotic analgesics with IV diazepam. Carefully monitor PULSE, BP, and RESPIRATION during IV administration. Maintain patients receiving parenteral diazepam in bed for 3 hrs. Monitor liver and kidney function, CBC during long term therapy. Report severe dizziness, weakness, drowsiness that persists, rash or skin lesions, palpitations, swelling of the ankles, visual or hearing disturbances, difficulty voiding.

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Unknown Adverse Effects, DIAZEPAM, doses, indication, Precautions

OCTREOTIDE ACETATE(SANDOSTATIN) Adverse Effects Indications and Precautions

Indications:

Octreotide inhibits growth hormone secretions and glucagon, secretion,useful in the treatment of acromegaly,Zollinger-ellison syndrome,secretory diarrhea,carcinoid syndrome and GI endocrine tumors.

Doses & Administrations:
Adult: subcutaneous Acromegaly: 50 - 100 mcg SC 2 - 3 times daily. Gastrinoma: 200 mcg SC 2 times daily. Pancreatic Tumors: 100 - 600 mcg/ day SC in 2 - 4 divided doses. Small bowl fistula: 225 - 300 mcg/day in 3 divided doses. Intravenous; Zollinger- ellison syndrome as continuous infusion 25 mcg/hour. Maintenance : 100 mcg SC Twice daily.

Contra Indications:
Hypersensitivity to the drug.

Precautions:
Diabetic patient,repeated injection should be avoided, pregnancy,lactation,renal impairement and gall bladder abnormalities.

Pregnancy Status:
Category "B"

Renal Failure Doses:
Dose adjustment may be necessary in patients with severe renal failure requiring dialysis since half life of drug can be increased. Ref:Micromeix

Lactation Status:
Unknown.

Interactions:
Cyclosporin.

Adverse Effects:
Diarrhea, loose stools,nausea,abdominal discomfort, headache,dizziness,fatigue,weakness,sinus bradycardia, arrythmias,pneumonia,cold symptoms,injection site pain, hyperglycemia,hypoglycemia and galactorrhea.

Nursing Considerations:
IV DILUTION-----0 to 200 mcg/ 50 ml (@ 15-30 min) 600 mcg/ 250 ml (@ 25 mcg/hr) 1250 mcg/ 250 ml (@ 50 mcg/hr) Usually 25 to 50 mcg/ hr. Dilute in NS preferably, but acn also dilute in D5W *(Ref:Vancouver Hospital Health Sciences Center, Parenteral Drug Therapy Manual)

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Unknown Adverse Effects, indication, OCTREOTIDE ACETATE, Precautions

Gabapentin Indications Doses Precautions Interactions and Adverse Effects

Indications:

Gabapentin has been effective as add-on therapy in patients with drug-resistant partial seizures in patients over 3 years of age; limited studies also suggest efficacy of the drug in generalized seizures; comparisons of gabapentin with standard antiepileptic agents are required to determine its ultimate place in therapy.

Doses & Administrations:
DOSE: ADULT: Initially a dose of 300mg TID should be used, this should be titrated to acheive response and a usual dose of 400mg TID, dose may be titrated according to the response to a maximum dose of 2400-3600mg/day PEDIATRIC: FOR 01 MONTH - 05 YEARS: 40MG/KG/DAY in three divided doses FOR 5 YEARS TO 12 YEARS: 30MG/KG/DAY in three divided doses FOR OVER 12 YEARS: 300MG TID

Contra Indications:
Hypersensitivity to GABAPENTIN Pancreatitis

Precautions:
Renal insufficiency Abrupt discontinuation may precipitate status epilepticus.

Pregnancy Status:
CATEGORY: 'C' (contraversial)

Renal Failure Doses:
IF creatinine clearance is 30 to 60 milliliters/minute, the recommended GABAPENTIN dose is 300 milligrams twice a day. creatinine clearance 15 to 30 milliliters/minute, the GABAPENTIN dose is 300 milligrams daily. For creatinine clearance less than 15 ml/minutes, the recommended dose is 300 milligrams every other day

Lactation Status:
BREASTFEEDING: Unknown.

Interactions:
ANTACID-GABAPENTIN: ANTACID MAY DECREASE THE BIOAVAILABILITY OF GABAPENTIN TO 20%, THEREFORE, GABAPENTIN SHOULD BE AVOIDED WITH ANTACIDS PHENYTOIN-GABAPENTIN: GABAPENTIN MAY INCREASES THE PHENYTOIN LEVELS IN SERUM, THEREFORE, CARE SHOULD BE TAKEN WHEN BOTH ARE USED SIMULTANEOUSLY OR WHEN ONE OF THEM IS ADDED OR REMOVE FROM THE REGIMEN.

Adverse Effects:
The most frequent adverse effects of gabapentin in studies to date have been somnolence, fatigue, dizziness, blood pressure changes, ataxia, and nystagmus; other adverse effects include abnormal coordination, weight gain, edema, skin rash, purpura, nausea, vomiting, blurred vision, diplopia, mood changes, headache, seizures, tremor, and slurred speech.

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Unknown Adverse Effects, Gabapentin, Interactions, Intrerations, Precautions

Levofloxacin Indications Doses Contra Indications Precautions and Adverse Effects

Indications:

Levofloxacin is the active stereisomere of ofloxacin. Levofloxacin is approved for the treatment of COMMUNITY ACQUIRED PNEUMONIA,and other repiratory tract infections.

Doses & Administrations:
ADULTS: RTI: 500 mg ONCE DAILY TB : 500 mg bid or 750 mg qd May take with or with out meals. Take at least 2 hours apart from antacids, zinc and iron containing preps. PEDIATRIC (IV+PO) : Limited data for dose available. 5-10mg/kg/day, maximum : 500 mg/day

Contra Indications:
Hypersensitivity to levofloxacin,other fluoroquinolones, or to any of its components.

Precautions:
CNS disorders (epilepsy) Renal insufficiency (dose reduction) Liver disease (transamine elevations have occured) Risk factors for tendinitis include pt.>60 years of age,renal failure, dialysis,concomitant therapy,and dyslipidemia. Pregnant and nursing women.

Pregnancy Status:
Category "C"

Renal Failure Doses:
Cr.clear(ml/min) Loading Dose Subsequent dose =======20-49 500 mg 250 mg/24 hr. 10-19 500 mg 250 mg/48 hr. Hemodialysis 500 mg 250 mg/48 hr. (<10ml/min) NOTE: No need to give loading dose if pt. is already on Levofloxacin.

Lactation Status:
Unknown,levofloxacin has not been measured in human milk, however, based upon data from ofloxacin,it can be presumed that it will be excreted.

Interactions:
Minor and moderate interactions with drugs like antacids,calcium , cimetidine are reported with levofloxacin. DRUG FOOD INTERACTIONS: *Take atleast 02hrs before or after antacids,dairy products,sucralfate,iron supplements,calcium,magnesium,aluminium,zinc,minerals & multivitamins. * Limit fat & caffeine intake REF: http://www.mdanderson.org/departments/nutrition/index.cfm

Adverse Effects:
The most common adverse effects are nausea,diarrhea,headache,and constipation. Levofloxacin should be avoided in prepubertal children since animal studies have demonstrated erosion of the cartilage and weight-bearing joints.

Nursing Considerations:
THE VIAL IS FOR SINGLE USE ONLY. The diluted solution in compatible fluids is stable for 14 days in refrigerator and 72 hours at room temperature at the concentration of 5mg/ml in plastic IV containers.

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Unknown Adverse Effects, Contraindicated, doses, indication, Levofloxacin, Precautions

Suxamethonium chloride Indication Side Effect Precautions and Dosage

Pharmacologicalaction
Suxamethonium chloride is a deplorising neuromuscular blocking agent.the initial effect is to depolarize the membrane in the same manner as acetylcholine,but more peristently,ehich results in a brief period of firing manifested by transient muscular fasciculation.This phase is succeeded shortly by neuromuscular paralysis
the mechanism and even the primary site of which are still uncertain and controversial.

Indication
Suxamethonium (Cl) is primarily indicated in conditions like Muscle relaxation (rapid onset, short duration), Muscular spasm, Neuromuscular blockade, and can also be given in adjunctive therapy as an alternative drug of choice in Anesthesia, Insomnia, Surgery.

Side Effect of suxamethonium chloride

• Increased saliva levels or mucous
• production
• Rash
• Muscle twitching or pain
• Flushing
• Itching
• More bowel movements than
• normal
• Change in heart beat or
• palpitations
• Eye pain
• Muscle stiffness
• Fever
• Breathing difficulties, rash or
• Irritation
• Headache
• Feeling faint

Warnings / Precautions
Avoid suxamethazone in patients with burns, massive trauma, renal impairment, severe long lasting sepsis and severe hyperkalaemia, sensitivity to drug, eye injury or glaucoma. It should be used with caution in patients with bone fractures, cardiac or respiratory disease. Dose of neuromuscular blocking agent need to be clearly titrated for individual patients according to their response; monitoring of the degree of block is recommended in order to reduce the risk of overdosage. Patients who have received neuromuscular blocker should always have their respiration assisted or controlled until the drug has been inactivated or antagonized.

Dosage of suxamethonium chloride
Determined by the physician according to patient's needs.
Usual dose: 20 to 80 mg intravenously maximum up to 100mg.2.5mg to 4mg per kg body weight intramuscularly maximum up to 150mg

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Unknown dosage, indication, Precautions, Side Effects, Suxamethonium chloride

Imipenem Precautions Dosage and Administration

Imipenem and cilastatin combination is used to treat infections in many different parts of the body. nfections caused by bacteria. It is sometimes given with other antibiotics.

PRECAUTIONS: Before using imipenem with cilastatin, tell your doctor or pharmacist if you are allergic to either of its ingredients; or to penicillins or cephalosporins; or if you have any other allergies.Before using this medication, tell your doctor or pharmacist your medical history, especially of: brain disorders (e.g., seizures, head injury, tumor), kidney disease, liver disease, stomach/intestinal diseases (e.g., colitis).Kidney function declines as you grow older. This medication is removed by the kidneys. Therefore, elderly people may be at greater risk for side effects while using this drug.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.This medication passes into breast milk. Though there have been no reports of harm to nursing infants, consult your doctor before breast-feeding.


Dosage and Administration
Adults

IV 125, 250, or 500 mg dose over 20 to 30 min. Infuse a 750 mg or 1 g dose over 40 to 60 min. If nausea develops, slow the infusion rate. Max: 50 mg/kg/day or 4 g/day, whichever is lower.
Adults

IM 500 to 750 mg every 12 h. Max: 1,500 mg/day.
Children less than 40 kg

IM 60 mg/kg/day.
Children at least 40 kg

IM Adult dose.
Premature Infants (at least 36 wk Gestational Age)

IM 20 mg/kg every 12 h.
General Advice

    For IV administration, reconstitute with 100 mL of compatible diluent. Shake until suspension is clear; add suspension to 100 mL of appropriate infusion solution. Then add 10 mL of infusion to vial; shake well to ensure that all medication is used and transfer resulting suspension to infusion solution. Color of solution may range from colorless to yellow. Solution is stable for 4 h at room temperature and for 24 h when refrigerated. Do not administer if solution is cloudy.
    Do not mix with or physically add to antibiotics. However, it may be administered concomitantly with other antibiotics (eg, aminoglycosides).
    Do not use IM preparation for IV administration.
    For IM administration, prepare with 1% lidocaine HCl solution (without epinephrine). Prepare 500 mg vial with 2 mL and 750 mg vial with 3 mL of lidocaine. Agitate to form suspension. Color of solution may range from white to light tan. Withdraw and inject entire contents of vial IM. Use within 1 h of preparation.

Storage/Stability

Store unreconstituted powder at or below 77°F.

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Unknown administration, dosage, Imipenem, Precautions

Bronchodilators and Antiasthma Drugs Contraindicationa Precautions and Intreractions

Bronchodilators and Antiasthma Drugs:
Within the past few years a number of new drugs have been introduced to treat respiratory disorders, such as
bronchial asthma and disorders that produce chronic airway obstruction.  bronchodilators, drugs that have been around for a long time but are still effective in specific instances, and the newer antiasthma drugs that have proven to be highly effective in the prophylaxis (prevention) of breathing difficulty.
Asthma is a reversible obstructive disease of the lower airway. With asthma there is increasing airway
obstruction caused by bronchospasm and bronchoconstriction, inflammation and edema of the lining of the bronchioles,and the production of thick mucus that can plug the airway .

There are three types of asthma:
1. Extrinsic (also referred to as allergic asthma and caused in response to an allergen such as pollen, dust, and animal dander)
2. Intrinsic asthma (also called nonallergic asthma and caused by chronic or recurrent respiratory infections, emotional upset, and exercise)
3. Mixed asthma (caused by both intrinsic and extrinsic factors)

Extrinsic or allergic asthma causes the IgE inflammatory response. With exposure, the IgE antibodies
are produced and attach to mast cells in the lung. Reexposure to the antigen causes them to bind to the IgE
antibody, releasing histamine and other mast cell products. The release of these products causes bronchospasm, mucous membrane swelling, and excessive mucous production. Gas exchange is impaired,
causing carbon dioxide to be trapped in the alveoli so that oxygen is unable to enter.identifies the
asthmatic pathway from both intrinsic and extrinsic stimulus.
Other disorders of the lower respiratory tract include emphysema (lung disorder in which the terminal bronchioles or alveoli become enlarged and plugged with mucus) and chronic bronchitis (chronic
inflammation and possibly infection of the bronchi).
Chronic obstructive pulmonary disease (COPD) is the name given collectively to emphysema and chronic
bronchitis because the obstruction to the airflow is present most of the time. Asthma that is persistent and
present for most of the time may also be referred to as COPD.

BRONCHODILATORS

A  bronchodilator is a drug used to relieve bronchospasm associated with respiratory disorders, such as
bronchial asthma, chronic bronchitis, and emphysema.These conditions are progressive disorders characterized by a decrease in the inspiratory and expiratory capacity of the lung. Collectively, they are often referred to as COPD.
The patient with COPD experiences dyspnea (difficulty breathing) with physical exertion, has difficulty inhaling
and exhaling, and may exhibit a chronic cough.The two major types of bronchodilators are the sympathomimetics and the xanthine derivatives. The anti-cholinergic drug ipratropium bromide (Atrovent) is
used for bronchospasm associated with COPD, chronic bronchitis, and emphysema.

Bronchodilators: Sympathomimetic
Examples of sympathomimetic bronchodilators include albuterol (Ventolin), epinephrine (Adrenalin), salmeterol (Serevent), and terbutaline (Brethine). Many of the sympathomimetics used as bronchodilators have the subclassification of beta-2 (2) receptor agonists (eg,albuterol, salmeterol, and terbutaline). Additional information concerning the various sympathomimetic

ACTIONS
When bronchospasm occurs, there is a decrease in the lumen (or inside diameter) of the bronchi, which
decreases the amount of air taken into the lungs with each breath. A decrease in the amount of air taken into
the lungs results in respiratory distress. Use of a bronchodilating drug opens the bronchi and allows more air
to enter the lungs, which in turn, completely or partially relieves respiratory distress.

USES
Sympathomimetics  (drugs that mimic the sympathetic nervous system) are used primarily to treat reversible airway obstruction caused by bronchospasm associated with acute and chronic bronchial asthma,exercise induced bronchospasm, bronchitis, emphysema, bronchiectasis (abnormal condition of the bronchial tree), or other obstructive pulmonary diseases.

ADVERSE REACTIONS
Administration of a sympathomimetic bronchodilator may result in restlessness, anxiety, increase in blood
pressure, palpitations, cardiac arrhythmias, and insomnia. When these drugs are used by inhalation, excessive
use (eg, over the recommended times) may result in paradoxical bronchospasm.

CONTRAINDICATIONS, PRECAUTIONS,
AND INTERACTIONS
The sympathomimetic bronchodilators are contraindicated in patients with known hypersensitivity to the
drug, cardiac arrhythmias associated with tachycardia, organic brain damage, cerebral arteriosclerosis, and narrow angle glaucoma. Salmeterol is contraindicated during acute bronchospasm. The sympathomimetics are used cautiously in patients with hypertension, cardiac dysfunction, hyperthyroidism, glaucoma, diabetes, prostatic hypertrophy, or a history of seizures. The sympathomimetic drugs are used cautiously during pregnancy (all are Pregnancy Category C, except terbutaline, which is Pregnancy Category B), and lactation.
When the sympathomimetics are used concurrently with other sympathomimetic drugs , additive adrenergic effects can occur. When used with the monoamine oxidase inhibitors, the patient is at increased risk for a hypertensive crisis.
When the sympathomimetics are administered with a adrenergic blocker, the drugs may inhibit the cardiac,
bronchodilating, and vasodilating effects of the sympathomimetic. When a  blocker such as propranolol is
administered with a sympathomimetic such as epinephrine, an initial hypertensive episode may occur followed
by bradycardia. Concurrent use of the sympathomimetics with oxytocic drugs may result in severe hypotension. When the sympathomimetics are administered with theophylline there is an increased risk for cardiotoxicity. When epinephrine is administered with insulin or oral hypoglycemic drugs, the patient may require an increased dose of the hypoglycemic drug.

Bronchodilators: Xanthine Derivatives
Examples of the  xanthine derivatives (drugs that stimulate the central nervous system [CNS] resulting in
bronchodilation, also called methylxanthines) are theophylline and aminophylline. 

ACTIONS 
The xanthine derivatives, although a different class of drugs, also have bronchodilating activity by means of their direct relaxation of the smooth muscles of the bronchi.

USES
The xanthine derivatives are used for symptomatic relief or prevention of bronchial asthma and reversible
bronchospasm associated with chronic bronchitis and emphysema.


ADVERSE REACTIONS
Adverse reactions associated with administration of the xanthine derivatives include nausea, vomiting, restlessness, nervousness, tachycardia, tremors, headache, palpitations, increased respirations, fever, hyperglycemia,and electrocardiographic changes.


CONTRAINDICATIONS, PRECAUTIONS,
AND INTERACTIONS

The xanthine derivatives are contraindicated in those with known hypersensitivity, peptic ulcers, seizure disorders (unless well controlled with appropriate anticonvulsant medication), serious uncontrolled rrhythmias,
and hyperthyroidism.
The xanthine derivatives are used cautiously in patients older than 60 years, those with cardiac disease,
hypoxemia, hypertension, congestive heart failure, or liver disease. Aminophylline, dyphylline, oxtriphylline,
and theophylline are Pregnancy Category C drugs and are used cautiously during pregnancy and lactation.
When xanthine bronchodilators are administered with sympathomimetic drugs, additive
CNS and cardiovascular effects may occur. If a patient eats large amounts of charcoal-broiled foods while taking the xanthines, a decrease in the therapeutic effect of the xanthines may occur. Certain foods contain xan
thine (eg, coffee, colas, or chocolate) and may increase the risk of cardiac and CNS adverse reactions.Cigarettes, nicotine gum and patches, barbiturates,phenytoin, loop diuretics, isoniazid, and rifampin may decrease the effectiveness of the xanthines. There is an increased risk of xanthine toxicity when the drugs are administered with influenza vaccination, oral contraceptives, glucocorticoids, -adrenergic blockers, cimetidine, macrolides, thyroid hormones, or allopurinol.

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Unknown Bronchodilators and Antiasthma Drugs, Contraindications, Interactions, Precautions

Antifungal Drugs Contraindications Precautions And Intrerations

Fungal infections range from superficial skin infections to life-threatening systemic infections. Systemic fungal infections are serious infections that occur when fungi gain entrance into the interior of the body.
A fungus is a colorless plant that lacks chlorophyll.
Fungi that cause disease in humans may be yeastlike or moldlike; the resulting infections are called mycotic
infections or fungal infections.Mycotic (fungal) infections may be one of two types:
1. Superficial mycotic infections
2. Deep (systemic) mycotic infections
The superficial mycotic infections occur on the surface of, or just below, the skin or nails. Superficial infections include tinea pedis (athlete’s foot), tinea cruris (jock itch), tinea corporis (ringworm), onychomycosis (nailfungus), and yeast infections, such as those caused by Candida albicans.
Yeast infections or those caused by C. albicans affect women in the vulvovaginal area and can be difficult
to control. Women who are at increased risk for vulvovaginal yeast infections arethose who have diabetes, are pregnant, or are taking oral contraceptives, antibiotics, or corticosteroids. Deep mycotic infections develop inside the body, such as in the lungs. Treatment for deep mycotic infections is often difficult and prolonged.
ACTIONS
Antifungal drugs may be fungicidal (able to destroy fungi) or fungistatic (able to slow or retard the multiplication of fungi). Amphotericin B (Fungizone IV),miconazole (Monistat), nystatin (Mycostatin), and ketoconazole (Nizoral) are thought to have an effect on the cell membrane of the fungus, resulting in a fungicidal or fungistatic effect. The fungicidal or fungistatic effect of these drugs appears to be related to their concentration in body tissues. Fluconazole (Diflucan) has fungistatic activity that appears to result from the depletion of sterols (a group of substances related to fats) in the fungus cells. Griseofulvin (Grisactin) exerts its effect by being deposited in keratin precursor cells, which are then gradually lost (due to the constant shedding of top skin cells), and replaced by new , noninfected cells.The mode of action of flucytosine (Ancobon) is not clearly understood. Clotrimazole (Lotrimin, Mycelex) binds with phospholipids in the fungal cell membrane,increasing permeability of the cell and resulting in loss of intracellular components.

USES
Antifungal drugs are used to treat superficial and deep fun-gal infections. The antifungal drugs specifically discussed in this chapter are: amphotericin B (Fungizone), flucona-zole (Diflucan), flucytosine (Ancobon), griseofulvin (Grisactin), ketoconazole (Nizoral), and miconazole (Monistat).
Miconazole is an antifungal drug used to treat vulvo-vaginal “yeast” infections and is representative of all of the vaginal antifungal agents.Fungal infections of the skin or mucous membranes may be treated with topical or vaginal preparations.

ADVERSE REACTIONS
When topical antifungal drugs, such as clotrimazole, are applied to the skin or mucous mem-branes, few adverse reactions are seen. On occasion, a local reaction, such as irritation or burning, may occur with topical use. The vulvovaginal antifungal drugs may cause local irritation, redness, stinging, or abdominal
pain. Few adverse reactions are seen with the use of the vulvovaginal antifungal drugs.

Amphotericin B
Amphotericin B is the most effective drug available forthe treatment of most systemic fungal infections.Administration often results in serious reactions,including fever, shaking, chills, headache, malaise, anorexia, joint and muscle pain, abnormal renal func-tion, nausea, vomiting, and anemia. This drug is given
parenterally, usually for a period of several months.Its use is reserved for serious and potentially life-threatening fungal infections. Some of these adverse reactions may be lessened by use of aspirin, antihistamines, or antiemetics.

Fluconazole
Administration may result in nausea, vomiting,headache, diarrhea, abdominal pain, and skin rash.Abnormal liver function tests may be seen and may require follow-up tests to determine if liver function has been affected.
Flucytosine
Administration may result in nausea, vomiting, diar-rhea, rash, anemia, leukopenia, and thrombocytopenia.Signs of renal impairment include elevated blood urea nitrogen (BUN) and
serum creatinine levels. Periodic renal function tests are usually performed during therapy.

Griseofulvin
Administration may result in a hypersensitivity-type reaction that includes rash and urticaria. Nausea, vomit-ing, oral thrush, diarrhea, and headache also may be seen.
Itraconazole
The most common adverse reactions are nausea, vomit-ing, and diarrhea. On occasion, severe hypokalemia (low potassium level) has occurred in patients receiving 600 mg or more of the drug on a daily basis. Hepatotoxicity is a possibility with itraconazole administration.

Ketoconazole
This drug is usually well tolerated, but nausea, vomit-ing, headache, dizziness, abdominal pain, and pruritus may be seen. Most adverse reactions are mild and transient. On rare occasions, hepatic toxicity may be seen,and use of the drug must be discontinued immediately.Periodic hepatic function tests are recommended to monitor for hepatic toxicity.
Miconazole
Administration of miconazole for a vulvovaginal fungal infection may cause irritation, sensitization, or vulvo- vaginal burning. Skin irritation may result in redness, itching, burning, or skin fissures. Other adverse reac-tions with miconazole include cramping, nausea, and headache. Adverse reactions associated with topical use are usually not severe.

CONTRAINDICATIONS, PRECAUTIONS,
AND INTERACTIONS

Amphotericin B

Amphotericin B is contraindicated in patients with a his-tory of allergy to the drug and during lactation. It is used cautiously in patients with renal dysfunction, electrolyte imbalances, and in combination with antineoplastic drugs (because it can cause severe bone marrow sup-pression). This drug is a Pregnancy Category B drug and is used during pregnancy only when the situation is life threatening. When given with the corticosteroids, severe hypokalemia may occur. There may be an increased risk of digitalis toxicity if digoxin is administered con-currently with amphotericin B. Administration with nephrotoxic drugs (eg,aminoglycosides or cyclosporine)may increase the risk of nephrotoxicity in patients also taking amphotericin B. Amphotericin B decreases the effects of miconazole. Amphotericin B is given only under close supervision in the hospital setting.
Fluconazole

Fluconazole is contraindicated in patients with known hypersensitivity to the drug. The drug is used cautiously in patients with renal impairment and during pregnancy (Category C) and lactation. The drug is given during pregnancy only if the benefit of the drug clearly outweighs any possible risk to the infant. When fluconazole is administered with oral hypoglycemics, there is an increased effect of the oral hypoglycemics.Fluconazole may decrease the metabolism of phenytoin and warfarin.

Flucytosine

Flucytosine is contraindicated in patients with known hypersensitivity to the drug. Flucytosine is used autiously in patients with bone marrow depression and with extreme caution in those with renal impairment.
The drug is also used cautiously during pregnancy (Category C) and lactation. When flucytosine and
amphotericin B are administered concurrently, the risk of flucytosine toxicity is increased.

Griseofulvin

Griseofulvin is contraindicated in patients with known hypersensitivity to the drug and in those with severe liver disease. This drug is used cautiously during pregnancy (Category C) and lactation. It is impor-tant to use caution when administering concurrently with penicillin because there is a possibility of crosssensitivity. When griseofulvin is administered with warfarin, the anticoagulant effect may be decreased.When administered with the barbiturates the effect of griseofulvin may be decreased. A decrease in the effects of oral contraceptives may occur with griseo-fulvin therapy, causing breakthrough bleeding, preg-nancy, or amenorrhea. Blood salicylate concentrations may be decreased when the salicylates are adminis tered with griseofulvin.


Itraconazole

Itraconazole is contraindicated in patients with a known hypersensitivity to the drug. The drug is used cautiously in patients with hepatitis, those with human immunodeficiency virus, impaired liver function, and in pregnant women (Pregnancy Category C). In patients with hypochlorhydria, the absorption of itraconazole
is decreased. Multiple drug interactions occur with itraconazole. Itraconazole elevates blood concentrations of digoxin and cyclosporine. Phenytoin decreases blood levels of itraconazole and alters the metabolism of phenytoin. Histamine antagonists, isoniazid, and rifampin decrease plasma levels of itraconazole. There is
an increased anticoagulant effect when warfarin is administered concurrently with itraconazole.

Ketoconazole
Ketoconazole is contraindicated in patients with known hypersensitivity to the drug. Ketoconazole is used cau-tiously in patients with hepatic impairment, those who are pregnant (Category C), and during lactation. The absorption of ketoconazole is impaired when the drug is taken with histamine antagonists and antacids.
Ketoconazole enhances the anticoagulant effect of warfarin and causes an additive hepatotoxicity when given with other hepatotoxic drugs and alcohol.
Administration of ketoconazole with rifampin or isoni-azid may decrease the blood levels of ketoconazole.

Miconazole
Miconazole is contraindicated in patients with known hypersensitivity to the drug. The drug is given cau-tiously in cases of chronic or recurrent candidiasis.With recurrent or chronic candidiasis the patient may have underlying diabetes. Recurrent or chronic candidi-asis requires an evaluation for diabetes. The drug is
used cautiously during pregnancy (Category C). If used during pregnancy, a vaginal applicator may be con-traindicated. Manual insertion of the vaginal tablets may be preferred. Because small amounts of these drugs may be absorbed from the vagina, the drug is used dur-ing the first trimester only when essential.

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Unknown Antifungal Drugs, Contraindications, Intrerations, Precautions