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Moni tori ng: La b Tes ts Frequent compl ete bl ood counts a re recommended; l i ver functi on; s erum crea ti ni ne Pa ti ent Educa ti onThi s I women's health center worcester ma purchase tamoxifen 20 mg amex. Report s hortnes s of brea th breast cancer ribbon tattoo purchase tamoxifen overnight delivery, ches t di s comfort zeid women's health clinic 20 mg tamoxifen, unus ua l bl eedi ng women's health center lebanon nh cheap tamoxifen, fever, or s wel l i ng of extremi ti es. Appea rs to be converted i ntra cel l ul a rl y to a ri ng-opened chel a ti ng a gent tha t i nterferes wi th i ron-medi a ted oxygen free ra di ca l genera ti on thought to be res pons i bl e, i n pa rt, for a nthra cycl i ne-i nduced ca rdi omyopa thy. Pha rma codyna mi cs /Ki neti cs Di s tri buti on: Vd: 22 L/m 2 Protei n bi ndi ng: None Ha l f-l i fe el i mi na ti on: 2-2. In pa ti ents wi th meta s ta ti c brea s t ca ncer who ha d previ ous l y recei ved >300 mg/m 2 doxorubi ci n i n the a djuva nt s etti ng, the deci s i on to us e dexra zoxa ne s houl d be i ndi vi dua l i zed, wei ghi ng the benefi ts of ca rdi oprotecti on a ga i ns t the pos s i bi l i ty of decrea s ed res pons e ra tes (due to dexra zoxa ne). Dexra zoxa ne us e i s not recommended i n pa ti ents wi th meta s ta ti c brea s t ca ncer recei vi ng doxorubi ci n a s i ni ti a l thera py. In the a djuva nt s etti ng, dexra zoxa ne us e i s not recommended outs i de of a cl i ni ca l tri a l. Dexra zoxa ne ma y be cons i dered for reducti on of the i nci dence a nd s everi ty of ca rdi omyopa thy a s s oci a ted wi th conti nued epi rubi ci n a dmi ni s tra ti on i n pa ti ents wi th a dva nced brea s t ca ncer. In a dul ts wi th ma l i gna nci es other tha n brea s t ca ncer, dexra zoxa ne ma y be cons i dered i n pa ti ents who ha ve recei ved >300 mg/m 2 of doxorubi ci n-ba s ed thera py. A Revi ew of Its Us e a s a Ca rdi oprotecti ve Agent i n Pa ti ents Recei vi ng Anthra cycl i ne-Ba s ed Chemothera py," Drugs, 1998. Ti me between dextra n 1 a nd dextra n s ol uti on s houl d not exceed 15 mi nutes. Dos i ng: Pedi a tri cProphyl a xi s of s evere a dvers e rea cti ons to dextra n: I. Contra i ndi ca ti ons Hypers ens i ti vi ty to dextra ns or a ny component of the formul a ti on; dextran contra i ndi ca ted Al l ergy Cons i dera ti ons Dextra n Al l ergy Wa rni ngs /Preca uti ons Concerns related to adverse effects: Ana phyl a xi s: Mi l d dextra n-i nduced a na phyl a cti c rea cti ons a re not prevented. Pregna ncy Ri s k Fa ctorC La cta ti onExcreti on i n brea s t mi l k unknown Advers e Rea cti ons <1% (Li mi ted to i mporta nt or l i fe-threa teni ng): Mi l d hypotens i on, ti ghtnes s of ches t, wheezi ng Drug Intera cti ons There a re no known s i gni fi ca nt i ntera cti ons. Nurs i ng: Phys i ca l As s es s ment/Moni tori ngDextra n 1 i s to be i nfus ed not more tha n 15 mi nutes before dextra n for prophyl a xi s of s eri ous a na phyl a cti c rea cti ons to dextra n i nfus i ons. Pa ti ent s houl d be moni tored cl os el y duri ng i nfus i on; hypotens i on a nd bra dyca rdi a ma y occur. Pa ti ent Educa ti onSi nce thi s medi ca ti on i s genera l l y a dmi ni s tered i n emergency s i tua ti ons, pa ti ent educa ti on s houl d be s upporti ve a nd a ppropri a the to pa ti ent condi ti on. Pa ti ents s houl d be obs erved cl os el y duri ng the fi rs t s evera l mi nutes of the i nfus i on i n ca s e a na phyl a ctoi d rea cti on occurs. Dos i ng: Pedi a tri cTrea tment of s hock or i mpendi ng s hock (when bl ood or bl ood products a re not a va i l a bl e): I. Deta i l Ha ve other mea ns of ma i nta i ni ng ci rcul a ti on wi th epi nephri ne a nd di phenhydra mi ne a va i l a bl e s houl d dextra n thera py res ul t i n a n a na phyl a ctoi d rea cti on. Contra i ndi ca ti ons Hypers ens i ti vi ty to dextra n or a ny component of the formul a ti on; ma rked hemos ta ti c defects (thrombocytopeni a, hypofi bri nogenemi a) of a l l types i ncl udi ng thos e ca us ed by drugs; ma rked ca rdi a c decompens a ti on; rena l di s ea s e wi th s evere ol i guri a or a nuri a Al l ergy Cons i dera ti ons Dextra n Al l ergy Wa rni ngs /Preca uti ons Concerns related to adverse effects: Decrea s ed hema tocri t: Exerci s e ca re to prevent a depres s i on of hema tocri t <30% (ca n ca us e hemodi l uti on); obs erve for s i gns of bl eedi ng. Moni tor cl os el y duri ng i nfus i on i ni ti a ti on for s i gns or s ymptoms of a hypers ens i ti vi ty rea cti on. Dextra n 1 i s i ndi ca ted for prophyl a xi s of s eri ous a na phyl a cti c rea cti ons to dextra n i nfus i ons. Disease-related concerns: Hemorrha ge: Us e wi th ca uti on i n pa ti ents wi th a cti ve hemorrha ge. Pregna ncy Ri s k Fa ctorC La cta ti onExcreti on i n brea s t mi l k unknown Advers e Rea cti ons <1% (Li mi ted to i mporta nt or l i fe-threa teni ng): Mi l d hypotens i on, ti ghtnes s of ches t, wheezi ng Drug Intera cti ons Abci xi ma b: Dextra n ma y enha nce the a nti coa gul a nt effect of Abci xi ma b. Other mea ns of ma i nta i ni ng ci rcul a ti on (eg, wi th epi nephri ne a nd di phenhydra mi ne) s houl d be a va i l a bl e i n the event of a n a na phyl a ctoi d rea cti on. Moni tori ng: La b Tes ts Hemogl obi n a nd hema tocri t, el ectrol ytes, s erum protei n Pa ti ent Educa ti onSi nce thi s medi ca ti on i s genera l l y us ed i n emergency s i tua ti ons, pa ti ent educa ti on s houl d be a ppropri a the to pa ti ent condi ti on. Dextra n 70 ha s a n a vera ge mol ecul a r wei ght of 70,000; s odi um content of 500 mL i s 77 mEq, wi th pH ra ngi ng from 3. Denta l Hea l th: Effects on Denta l Trea tmentNo s i gni fi ca nt effects or compl i ca ti ons reported Denta l Hea l th: Va s ocons tri ctor/Loca l Anes theti c Preca uti ons No i nforma ti on a va i l a bl e to requi re s peci a l preca uti ons Menta l Hea l th: Effects on Menta l Sta tus None reported Menta l Hea l th: Effects on Ps ychi a tri c Trea tmentNone reported Ca rdi ova s cul a r Cons i dera ti ons Dextra n us e i n pa ti ents wi th res tri cti ve ca rdi ova s cul a r di s ea s e, rena l or hepa ti c i mpa i rment s houl d be us ed wi th extreme ca uti on. Anes thes i a a nd Cri ti ca l Ca re Concerns /Other Cons i dera ti ons Dextra n s houl d be us ed wi th extreme ca uti on i n pa ti ents wi th res tri cti ve ca rdi ova s cul a r di s ea s e a nd rena l or hepa ti c i mpa i rment. Chi l dren: 6 yea rs: Adderall: Ini ti a l: 5 mg once or twi ce da i l y; i ncrea s e da i l y dos e i n 5 mg i ncrements a t weekl y i nterva l s unti l opti ma l res pons e i s obta i ned; us ua l ma xi mum dos e: 40 mg/da y gi ven i n 1-3 di vi ded dos es per da y.
While the author rejects the long women's health clinic coventry order 20mg tamoxifen mastercard, single line menstruation for a month purchase tamoxifen overnight delivery, the formation he advocates cannot be very deep-indeed women's health clinic topeka ks generic tamoxifen 20mg without prescription, he favors a depth of four ranks menstrual jokes arent funny period purchase tamoxifen master card. Alternating the sequence of heavy- and light-infantry men, opening up or closing the files, different formations are illustrated for a single tagma, and then the battle disposition of an entire army is illustrated, complete with flank guards, baggage train, and reserve, as well as the different combinations of heavy infantry to stand, hold, and engage in close combat, with light infantry to reduce and harass the enemy with its arrows. The most ambitious battle array in the Strategikon: "The Order of Battle Called Mixed" depicts a complete army composed of heavy infantry and cavalry with only a handful of light-infantry men in the rear. In the battle array, there is an infantry meros on each side to secure the flanks, with a cavalry meros on the inside, another infantry meros next to it, and finally a central cavalry meros, for a total of seven. For rear-guard protection, there is a single infantry force on each side, also five across, with heavy infantry five files deep and a final rank of just five light-infantry men on each side, so that the two outer-flank files on each side are actually thirteen deep, but in two separate units. That leaves a large space, five meros deep, in the rear of the formation, but no enemy is likely to venture into it, given the ease with which the cavalry could maneuver against such a move. A mounted enemy, counting on momentum and the charge, would collide with the solid holding power of the heavy infantry with its interlocked shields and spears fixed into the ground. An enemy counting on the mass of his infantry would run into the missiles of the cavalry archers- that is why only a few light-infantry men are needed as rear guards. Cavalry is too high off the ground to remain hidden, but the infantry can be concealed in the dust and confusion. Operationally, to combine frontal offensives with backstopping, ambushing, or raiding, by forces inserted behind the enemy by river fleets, was an excellent way of exploiting the comparative advantage of the Byzantines in organization and planning-indeed, it became standard operating procedure when fighting the Bulghars and Bulgarians to send forces via the Black Sea into the Danube to attack their rear. Tactically, opposed river crossings required specialized training, because to land on the far bank against alert and deployed enemies, it is first necessary to "dominate it by fire," in modern parlance, that is, to scatter the enemy with massed volleys of arrows and stone-throwers embarked on warships while a pontoon bridge is assembled section by section (para 5). The well-trained and well-exercised military man depicted in the Strategikon was not an impressed ragamuffin but a professional, and his social status was commensurate: the men, especially those receiving allowances for the purpose, should certainly be required to provide servants for themselves, slave or free, according to the regulations in force (to avoid having to detail soldiers to the baggage train). But if, as can easily happen, some of the men are unable to afford servants, then it will be necessary to require that three or four lower-ranking soldiers join in maintaining one servant. A similar arrangement should be followed for pack animals, which may be needed to carry the coats of mail and the tents. We advise that no large number of servants be brought into the area where the main battle is expected. That was the one thing to be avoided at all times, lest tactical victories result in strategic defeat for an empire that always had one more enemy arriving just over the horizon. W chapter 12 After the Strategikon the value of the Strategikon of Maurikios was amply recognized by Byzantine military officers and Byzantine writers, who excerpted, paraphrased, summarized, plagiarized, and updated the text in subsequent centuries. The work that Dain labels De Militari Scientia is such a paraphrase; it dates at least from the later seventh century, because the Muslim Arabs are studied in it instead of the Sasanian Persians. It counts as further evidence of the vitality of Byzantine military literature, of which other examples noted by Dain but not seen by me include a version of Aelian, an extract of the Taktikon of Urbicius, another De Fluminibus Traiciendis extracted from the Strategikon, as well as a variety of lost texts indicated by their surviving traces and paraphrases in extant works. Mutiny, usurpation, the catastrophic Persian invasions, the ruinously belated Byzantine victory, and the almost immediate Arab invasions left a Byzantium much diminished and greatly impoverished, in which there was little reading and less writing by the end of the seventh century. But decline was followed not by fall but by a recovery that had clearly started by the end of the eighth century and would progress into a veritable economic, cultural, and military renaissance. The contents are mostly paraphrases of earlier texts derived from the Strategikos of Onasander, the Taktike Theoria of Aelianus "Tacticus," and more largely from the Strategikon, whose preface Leo also echoed while translating into Greek its Latin words of command. The material is organized not by authors or texts but according to a logical scheme, by subjects. What made the Muslims dangerous was their ideological commitment, as the text fully recognizes. But matters are not so simple, because while the ideological commitment is genuine, the conditions of jihad also provide opportunities for poor warriors who are in it for the loot: "They are not assembled for military service from a muster list, but they come together, each man of his own free will and with his whole household. The wealthy [consider it] recompense enough to die on behalf of their own nation, the poor for the sake of acquiring booty. Their fellow tribesmen, men and especially women provide them with weapons, as if sharing with them in the expedition. For archery is a great and effective weapon against the peoples of the Saracens and the Kurds who place their entire hope of victory in their archery.
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Risk C: Monitor therapy Ethos uxi mi de: Ampheta mi nes ma y di mi ni s h the thera peuti c effect of Ethos uxi mi de womens health 10k chicago discount tamoxifen 20 mg with visa. Risk X: Avoid combination Li thi um: Ma y di mi ni s h the s ti mul a tory effect of Ampheta mi nes breast cancer gene safe tamoxifen 20 mg. Food: Dextroa mpheta mi ne s erum l evel s ma y be a l tered i f ta ken wi th a ci di c food menopause 62 years old buy tamoxifen 20mg fast delivery, jui ces menstruation 3 weeks long generic tamoxifen 20 mg, or vi ta mi n C. Tes t Intera cti ons Ampheta mi nes ma y el eva the pl a s ma corti cos teroi d l evel s; ma y i nterfere wi th uri na ry s teroi d determi na ti ons. Ta ke ea rl y i n da y to a voi d s l eep di s turba nce, 30 mi nutes before mea l s. You ma y experi ence res tl es s nes s, fa l s e s ens e of euphori a, or i mpa i red judgment (us e ca uti on when dri vi ng or enga gi ng i n ta s ks requi ri ng a l ertnes s unti l res pons e to drug i s known); dry mouth (frequent mouth ca re, s ucki ng l ozenges, or chewi ng gum ma y hel p); na us ea or vomi ti ng (s ma l l frequent mea l s, frequent mouth ca re ma y hel p); cons ti pa ti on (i ncrea s ed exerci s e, fl ui ds, frui t, or fi ber ma y hel p); di a rrhea (buttermi l k, boi l ed mi l k, or yogurt ma y hel p); or a l tered l i bi do (revers i bl e). Pa ti ents wi th di a betes need to moni tor s erum gl ucos e cl os el y (ma y a l ter a nti di a beti c medi ca ti on requi rements). Bl ocks reupta ke of dopa mi ne a nd norepi nephri ne from the s yna ps e, thus i ncrea s es the a mount of ci rcul a ti ng dopa mi ne a nd norepi nephri ne i n cerebra l cortex to reti cul a r a cti va ti ng s ys tem; i nhi bi ts the a cti on of monoa mi ne oxi da s e a nd ca us es ca techol a mi nes to be rel ea s ed. Peri phera l a cti ons i ncl ude el eva ted bl ood pres s ure, wea k bronchodi l a tor, a nd res pi ra tory s ti mul a nt a cti on. Up to 10% of pa ti ents ta ki ng dextroa mpheta mi nes ma y pres ent wi th hypertens i on. Denta l Hea l th: Va s ocons tri ctor/Loca l Anes theti c Preca uti ons Us e va s ocons tri ctor wi th ca uti on i n pa ti ents ta ki ng dextroa mpheta mi ne. Ca rdi ova s cul a r Cons i dera ti ons Ampheta mi nes s houl d be a voi ded i n pa ti ents wi th known or s us pected ca rdi ova s cul a r di s ea s. Dos i ng: Pedi a tri cCough, col d s ymptoms (Dona tus s i n): Ora l: Chi l dren 2-6 yea rs: 2. Di eta ry Cons i dera ti ons Ta ke wi th food, wa ter or mi l k to decrea s e s toma ch ups et. La cta ti onEnters brea s t mi l k/not recommended Brea s t-Feedi ng Cons i dera ti ons Phenyl ephri ne i s excreted i n brea s t mi l k. Cough, cold symptoms: Ora l: Dextromethorpha n 30 mg a nd chl orpheni ra mi ne 4 mg every 6 hours a s needed (ma xi mum: 120 mg dextromethorpha n a nd 16 mg chl orpheni ra mi ne/24 hours) Dos i ng: El derl yRefer to a dul t dos i ng. Cough, cold symptoms: Ora l: Chi l dren 6-11 yea rs: Dextromethorpha n 15 mg a nd chl orpheni ra mi ne 2 mg every 6 hours a s needed (ma xi mum: 60 mg dextromethorpha n a nd 8 mg chl orpheni ra mi ne/24 hours) Chi l dren 12 yea rs: Refer to a dul t dos i ng. Special populations: Pedi a tri cs: Anti hi s ta mi nes ma y ca us e exci ta ti on i n young chi l dren. If cough does not i mprove, i s a ccompa ni ed by ra s h, fever, or hea da che, or pers i s ts >7 da ys duri ng us e, di s conti nue us e a nd cons ul t a phys i ci a n. Pregna ncy Cons i dera ti ons Reproducti on s tudi es ha ve not been conducted wi th thi s combi na ti on. Ma y ca us e s eda ti on; concurrent us e wi th ps ychotropi cs ma y produce a ddi ti ve effects. Combi ned us e wi th s erotoni nergi c a gents ma y ca us e s erotoni n s yndrome. The a nti chol i nergi c effects of chl orpheni ra mi ne ma y decrea s e the effects of a cetyl chol i nes tera s e i nhi bi tors. However, when combi ned wi th ps ychotropi c a gents, a nti chol i nergi c effects ma y be a ddi ti ve. Index Terms Chl orpheni ra mi ne a nd Dextromethorpha n; Chl orpheni ra mi ne Ma l ea the a nd Dextromethorpha n Hydrobromi de; Dextromethorpha n Hydrobromi de a nd Chl orpheni ra mi ne Ma l ea the Copyri ght (c) Lexi -Comp, Inc. Pha rma ci s ts ma y conti nue to s ee hea l th ca re pra cti ti oners recommendi ng thes e a gents for us e i n pedi a tri c pa ti ents, a nd s houl d hel p to ens ure tha t they a re bei ng us ed s a fel y a nd a t a ppropri a the dos a ges. Dos i ng: Pedi a tri cCough s uppres s a nt: Ora l: <2 yea rs: Us e onl y a s di rected by a phys i ci a n 2-6 yea rs (s yrup): Ora l: 2. Dosage form specific issues: Coconut: Some products ma y conta i n coconut oi l. Dos i ng: Pedi a tri c Treatment of hypoglycemia: Dos es ma y be repea ted i n s evere ca s es Ora l: Chi l dren >2 yea rs: Refer to a dul t dos i ng. Contra i ndi ca ti ons Hypers ens i ti vi ty to corn or corn products; di a beti c coma wi th hypergl ycemi a; hypertoni c s ol uti ons i n pa ti ents wi th i ntra cra ni a l or i ntra s pi na l hemorrha ge; pa ti ents wi th del i ri um tremens a nd dehydra ti on; pa ti ents wi th a nuri a, hepa ti c coma, or gl ucos ega l a ctos e ma l a bs orpti on s yndrome Al l ergy Cons i dera ti ons Dextros e Al l ergy Wa rni ngs /Preca uti ons Concerns related to adverse effects: Hypergl ycemi a: An unexpected ri s e i n bl ood gl ucos e l evel i n a n otherwi s e s ta bl e pa ti ent ma y be a n ea rl y s ymptom of i nfecti on. Ra pi d a dmi ni s tra ti on of hypertoni c s ol uti ons ma y produce s i gni fi ca nt hypergl ycemi a, gl ycos uri a, a nd s hi fts i n el ectrol ytes; thi s ma y res ul t i n dehydra ti on, hyperos mol a r s yndrome, coma, a nd dea th es peci a l l y i n pa ti ents wi th chroni c uremi a or ca rbohydra the i ntol era nce.
Remove conta ct l ens es pri or to a dmi ni s tra ti on; wa i t 15 mi nutes before rei ns erti ng i f us i ng products conta i ni ng benza l koni um chl ori de pregnancy cravings cheap tamoxifen 20mg with amex. Disease-related concerns: Angl e-cl os ure gl a ucoma: Appropri a the us e: Not for us e a l one to trea t a cute a ngl e-cl os ure gl a ucoma (ha s no effect on pa pi l l a ry cons tri cti on) pregnancy discrimination act buy tamoxifen toronto. Special populations: Conta ct l ens wea rers: Product conta i ns benza l koni um chl ori de whi ch ma y be a bs orbed by s oft conta ct l ens es; remove l ens pri or to a dmi ni s tra ti on a nd wa i t 15 mi nutes before rei ns erti ng menstrual vomiting remedy best 20mg tamoxifen. Note: In the Ca na di a n l a bel i ng menopause test buy tamoxifen 20mg overnight delivery, us e i n chi l dren (a t a ny a ge) i s not recommended. Seri ous a dvers e rea cti ons (eg, bra dyca rdi a, hypotens i on, a pnea, dys pnea, cya nos i s) res ul ti ng i n hos pi ta l i za ti on ha ve been reported i n a s s oci a ti on wi th bri moni di ne a dmi ni s tra ti on i n i nfa nts a ges 28 da ys to 3 months. Pregna ncy Ri s k Fa ctorC Pregna ncy Cons i dera ti ons There a re no a dequa the a nd wel l -control l ed s tudi es i n pregna nt women wi th the combi na ti on product. La cta ti onEnters brea s t mi l k (ti mol ol)/not recommended Brea s t-Feedi ng Cons i dera ti ons Ti mol ol ha s been detected i n huma n brea s t mi l k fol l owi ng ophtha l mi c a dmi ni s tra ti on. Risk D: Consider therapy modification Ami fos ti ne: Anti hypertens i ves ma y enha nce the hypotens i ve effect of Ami fos ti ne. Risk X: Avoid combination Metha chol i ne: Beta -Bl ockers ma y enha nce the a dvers e/toxi c effect of Metha chol i ne. Risk D: Consider therapy modification Moni tori ng Pa ra meters Intra ocul a r pres s ure; moni tor for s ys temi c effect of beta -bl ocka de wi th ophtha l mi c a dmi ni s tra ti on; bl ood pres s ure Nurs i ng: Phys i ca l As s es s ment/Moni tori ngSee i ndi vi dua l a gents. Dos a ge Forms Exci pi ent i nforma ti on pres ented when a va i l a bl e (l i mi ted, pa rti cul a rl y for generi cs); cons ul t s peci fi c product l a bel i ng. Admi ni s tra ti on: OtherRemove conta ct l ens es pri or to a dmi ni s tra ti on; wa i t 15 mi nutes before rei ns erti ng i f us i ng products conta i ni ng benza l koni um chl ori de. Sys temi c a bs orpti on ha s been reported; chi l dren a re a t hi gher ri s k of s ys temi c a dvers e events. La cta ti onExcreti on i n brea s t mi l k unknown/not recommended Advers e Rea cti ons Actua l frequency of a dvers e rea cti ons ma y be formul a ti on dependent; percenta ges reported wi th Al pha ga n P: >10%: Centra l nervous s ys tem: Somnol ence (a dul ts 1% to 4%; chi l dren 25% to 83%) Ocul a r: Al l ergi c conjuncti vi ti s, conjuncti va l hyperemi a, eye pruri tus 1% to 10% (unl es s otherwi s e noted 1% to 4%): Ca rdi ova s cul a r: Hypertens i on (5% to 9%), hypotens i on Centra l nervous s ys tem: Al ertnes s decrea s ed (chi l dren), di zzi nes s, fa ti gue, hea da che, i ns omni a Derma tol ogi c: Ra s h Endocri ne & meta bol i c: Hyperchol es terol emi a Ga s troi ntes ti na l: Xeros tomi a (5% to 9%), dys peps i a Neuromus cul a r & s kel eta l: Wea knes s Ocul a r: Burni ng s ens a ti on (5% to 9%), conjuncti va l fol l i cul os i s (5% to 9%), ocul a r a l l ergi c rea cti on (5% to 9%), vi s ua l di s turba nce (5% to 9%), bl epha ri ti s, bl epha roconjuncti vi ti s, bl urred vi s i on, ca ta ra ct, conjuncti va l edema, conjuncti va l hemorrha ge, conjuncti vi ti s, dry eye, epi phora, eye di s cha rge, eyel i d di s order, eyel i d edema, eyel i d erythema, fol l i cul a r conjuncti vi ti s, forei gn body s ens a ti on, i rri ta ti on, kera ti ti s, pa i n, photophobi a, s ti ngi ng, s uperfi ci a l puncta the kera topa thy, vi s ua l a cui ty wors ened, vi s ua l fi el d defect, vi treous deta chment, vi treous fl oa ters, wa tery eyes Res pi ra tory: Bronchi ti s, cough, dys pnea, pha ryngi ti s, rhi ni ti s, s i nus i nfecti on, s i nus i ti s Mi s cel l a neous: Al l ergi c rea cti on, fl u-l i ke s yndrome, i nfecti on <1%: Cornea l eros i on, hordeol um, na s a l drynes s, ta s the pervers i on Pos tma rketi ng a nd/or ca s e reports: Anteri or uvei ti s, bra dyca rdi a, depres s i on, i ri ti s, kera toconjuncti vi ti s s i cca, mi os i s, na us ea, s ki n rea cti ons (erythema, eyel i d pruri tus, va s odi l a ti on), ta chyca rdi a; a pnea, bra dyca rdi a, hypothermi a, a nd hypotoni a ha ve been reported i n i nfa nts Drug Intera cti ons Ami fos ti ne: Anti hypertens i ves ma y enha nce the hypotens i ve effect of Ami fos ti ne. Risk D: Consider therapy modification Etha nol /Nutri ti on/Herb Intera cti ons Herb/Nutra ceuti ca l: Avoi d herbs wi th hypertensive properti es (ba yberry, bl ue cohos h, ca yenne, ephedra, gi nger, gi ns eng, gotu kol a, l i cori ce); ma y di mi ni s h a nti hypertens i ve effect. Remove conta cts pri or to a dmi ni s tra ti on a nd wa i t 15 mi nutes before rei ns erti ng. Open eye, l ook a t cei l i ng, a nd i ns ti l l pres cri bed a mount of s ol uti on. Do not l et ti p of a ppl i ca tor touch eyes; do not conta mi na the ti p of a ppl i ca tor (ma y ca us e eye i nfecti on, eye da ma ge, or vi s i on l os s). Bri moni di ne ta rtra the ma y ca us e fa ti gue or drows i nes s i n s ome pa ti ents. Avoi d enga gi ng i n ha za rdous a cti vi ti es due to potenti a l for decrea s ed menta l a l ertnes s. Wa i t a t l ea s t 15 mi nutes a fter i ns ti l l i ng bri moni di ne ta rtra the before rei ns erti ng s oft conta ct l ens es. Bra nd Na mes Azopt Ca na di a n Bra nd Na mes Azopt Pha rma col ogi c Ca tegoryCa rboni c Anhydra s e Inhi bi tor; Ophtha l mi c Agent, Anti gl a ucoma Us e: La bel ed Indi ca ti ons Lowers i ntra ocul a r pres s ure i n pa ti ents wi th ocul a r hypertens i on or open-a ngl e gl a ucoma Dos i ng: Adul ts Gl a ucoma: Ophtha l mi c: Ins ti l l 1 drop i n a ffected eye(s) 3 ti mes /da y Dos i ng: El derl yRefer to a dul t dos i ng. Admi ni s tra ti on: OtherMa y be us ed concomi ta ntl y wi th other topi ca l ophtha l mi c drug products to l ower i ntra ocul a r pres s ure. If more tha n one topi ca l ophtha l mi c drug i s bei ng us ed, a dmi ni s ter drugs a t l ea s t 10 mi nutes a pa rt. Contra i ndi ca ti ons Hypers ens i ti vi ty to bri nzol a mi de, s ul fona mi des, or a ny component of the formul a ti on Al l ergy Cons i dera ti ons Ca rboni c Anhydra s e Inhi bi tor Al l ergy Wa rni ngs /Preca uti ons Concerns related to adverse effects: Hypers ens i ti vi ty rea cti ons: Sys temi c a bs orpti on ma y ca us e s eri ous hypers ens i ti vi ty rea cti ons to recur. Disease-related concerns: Acute a ngl e-cl os ure gl a ucoma: Ha s not been s tudi ed i n a cute a ngl e-cl os ure gl a ucoma. Other warnings/precautions: Prol onged us e: Effects of prol onged us e on cornea l epi thel i a l cel l s ha ve not been eva l ua ted. Geri a tri c Cons i dera ti ons the ora l ca rboni c a nhydra s e i nhi bi tors a re us eful for pa ti ents who ha ve di ffi cul ty a dmi ni s teri ng ophtha l mi c drugs, who do not a chi eve s uffi ci ent l oweri ng of i ntra ocul a r pres s ure, or who ca nnot tol era the other a gents. Bri nzol a mi de i s a us eful a gent a pa rt from thos e who need a ca rboni c a nhydra s e i nhi bi tor a nd ca n a dmi ni s ter ophtha l mi c drops. Pregna ncy Ri s k Fa ctorC Pregna ncy Cons i dera ti ons Devel opmenta l toxi ci ti es ha ve been obs erved i n a ni ma l s tudi es. Tea ch pa ti ent proper us e, s i de effects /a ppropri a the i nterventi ons, a nd s ymptoms to report Pa ti ent Educa ti onFor us e i n eyes onl y. Ti l t hea d ba ck, pl a ce medi ca ti on i n conjuncti va l s a c, a nd cl os e eyes.
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Note: In neona tes, i nterconvers i on between ca ffei ne a nd theophyl l i ne ha s been reported (ca ffei ne l evel s a re 25% of mea s ured theophyl l i ne a fter theophyl l i ne a dmi ni s tra ti on a nd 3% to 8% of ca ffei ne woul d be expected to be converted to theophyl l i ne) Ha l f-l i fe el i mi na ti on: Neona tes: 72-96 hours (ra nge: 40-230 hours) Chi l dren >9 months a nd Adul ts: 5 hours Ti me to pea k, s erum: Ora l: Wi thi n 30 mi nutes to 2 hours Excreti on: Neona tes 1 month: 86% excreted uncha nged i n uri ne Infa nts >1 month a nd Adul ts: In uri ne, a s meta bol i tes Denta l Hea l th: Effects on Denta l Trea tmentNo s i gni fi ca nt effects or compl i ca ti ons reported Denta l Hea l th: Va s ocons tri ctor/Loca l Anes theti c Preca uti ons No i nforma ti on a va i l a bl e to requi re s peci a l preca uti ons Menta l Hea l th: Effects on Menta l Sta tus Ma y ca us e i ns omni a, nervous nes s, a nxi ety, a nd del i ri um. Menta l Hea l th: Effects on Ps ychi a tri c Trea tmentMa y countera ct s eda ti ve/hypnoti cs; ma y a l s o l ower s ei zure thres hol d a nd i ncrea s e ri s k for epi l eps y/convul s i ons Anes thes i a a nd Cri ti ca l Ca re Concerns /Other Cons i dera ti ons Ca ffei ne ha s 40% of the bronchodi l a tory a cti vi ty of theophyl l i ne. Ana l ges i a from tra ns cuta neous el ectri ca l nerve s ti mul a ti on ma y be l es s ened wi th concomi ta nt ca ffei ne us. Index Terms Ca ffei ne a nd Sodi um Benzoa te; Ca ffei ne Ci tra te; Sodi um Benzoa the a nd Ca ffei ne References Ameri ca n Aca demy of Pedi a tri cs Commi ttee on Drugs, "The Tra ns fer of Drugs a nd Other Chemi ca l s Into Huma n Mi l k," Pediatrics, 2001, 108(3):77689. Bra nd Na mes Ta cl onex Sca l p; Ta cl onex Ca na di a n Bra nd Na mes Dovobet Pha rma col ogi c Ca tegoryCorti cos teroi d, Topi ca l; Vi ta mi n D Ana l og Us e: La bel ed Indi ca ti ons Trea tment of ps ori a s i s vul ga ri s Us e: Unl a bel ed/Inves ti ga ti ona l Trea tment of corti cos teroi d-res pons i ve derma tos es Dos i ng: Adul ts Psoriasis vulgaris: Topi ca l: Crea m/oi ntment: Appl y to a ffected a rea once da i l y for up to 4 weeks (ma xi mum recommended dos e: 100 g/week). Sus pens i on: Appl y to a ffected a rea of the s ca l p once da i l y for 2 weeks or unti l cl ea r; ma y conti nue for up to 8 weeks (ma xi mum recommended dos e: 100 g/week) Dos i ng: El derl yRefer to a dul t dos i ng. Dos i ng: Rena l Impa i rmentSa fety a nd effi ca cy ha ve not been es ta bl i s hed wi th s evere rena l i mpa i rment. Dos i ng: Hepa ti c Impa i rmentSa fety a nd effi ca cy ha ve not been es ta bl i s hed wi th s evere hepa ti c i mpa i rment. Stora geStore a t control l ed room tempera ture of 20°C to 2°C (68°F to 77°F); excurs i ons permi tted between 15°C to 30°C (59°F to 86°F). Ri s k i s i ncrea s ed when us ed over l a rge s urfa ce a rea s, for prol onged peri ods, or wi th occl us i ve dres s i ngs. Special populations: Pedi a tri cs: Sa fety a nd effi ca cy ha ve not been es ta bl i s hed i n chi l dren; ma y be a t hi gher ri s k of s ys temi c s i de effects. Other warnings/precautions: Appl i ca ti on s i te: Do not us e on the fa ce, a xi l l a e, groi n, or i n the pres ence of pre-exi s ti ng s ki n a trophy a t the trea tment s i te. Avoi d exces s i ve expos ure of trea ted s ki n to s unl i ght (na tura l or a rti fi ci a l). Pregna ncy Ri s k Fa ctorC Pregna ncy Cons i dera ti ons Ani ma l reproducti on s tudi es ha ve not been conducted wi th thi s topi ca l combi na ti on. La cta ti onExcreti on i n brea s t mi l k unknown/us e ca uti on Brea s t-Feedi ng Cons i dera ti ons See i ndi vi dua l a gents. The a cti ve meta bol i the a prepi ta nt i s l i kel y res pons i bl e for thi s effect. Risk C: Monitor therapy Thi a zi de Di ureti cs: Corti cos teroi ds (Sys temi c) ma y enha nce the hypoka l emi c effect of Thi a zi de Di ureti cs. Risk X: Avoid combination Wa rfa ri n: Corti cos teroi ds (Sys temi c) ma y enha nce the a nti coa gul a nt effect of Wa rfa ri n. Bra nd Na mes Dovonex Ca na di a n Bra nd Na mes Dovonex Pha rma col ogi c Ca tegoryTopi ca l Ski n Product; Vi ta mi n D Ana l og Us e: La bel ed Indi ca ti ons Trea tment of pl a que ps ori a s i s; chroni c, modera te-to-s evere ps ori a s i s of the s ca l p Us e: Unl a bel ed/Inves ti ga ti ona l Vi ti l i go Dos i ng: Adul ts Ps ori a s i s: Topi ca l: Crea m: Appl y a thi n fi l m to the a ffected s ki n twi ce da i l y a nd rub i n gentl y a nd compl etel y, for up to 8 weeks Sol uti on: Appl y to the a ffected s ca l p twi ce da i l y a nd rub i n gentl y a nd compl etel y, for up to 8 weeks Dos i ng: El derl yRefer to a dul t dos i ng. Sol uti on: Pri or to us i ng s ca l p s ol uti on, comb ha i r to remove debri s; a ppl y onl y to l es i ons. Contra i ndi ca ti ons Hypers ens i ti vi ty to ca l ci potri ene or a ny component of the formul a ti on; pa ti ents wi th demons tra ted hyperca l cemi a or evi dence of vi ta mi n D toxi ci ty; us e on the fa ce; pa ti ents wi th a cute ps ori a ti c erupti ons (s ca l p s ol uti on) Wa rni ngs /Preca uti ons Concerns related to adverse effects: Hyperca l cemi a: Ma y ca us e tra ns i ent i ncrea s es i n s erum ca l ci um (revers i bl e); i f hyperca l cemi a occurs, di s conti nue trea tment unti l l evel s return to norma l. Other warnings/precautions: Appropri a the us e: For externa l us e onl y; not for ophtha l mi c, ora l, or i ntra va gi na l us. Avoi d or l i mi t exces s i ve expos ure to na tura l or a rti fi ci a l s unl i ght, or photothera py. La cta ti onExcreti on i n brea s t mi l k unknown/us e ca uti on Advers e Rea cti ons Frequency ma y va ry wi th s i the of a ppl i ca ti on. Moni tori ng Pa ra meters Serum ca l ci um Nurs i ng: Phys i ca l As s es s ment/Moni tori ngWhen a ppl i ed to l a rge a rea s of s ki n or for extens i ve peri ods of ti me, moni tor for a dvers e s ki n or s ys temi c rea cti ons. Moni tori ng: La b Tes ts Serum ca l ci um Pa ti ent Educa ti onFor externa l us e onl y. Report i ncrea s ed s wel l i ng, rednes s, ra s h, i tchi ng, s i gns of i nfecti on, wors eni ng of condi ti on, or l a ck of hea l i ng. Ca l ci toni n Lexi -Drugs Onl i ne Engl i s h Jump To Fi el d (Sel ect Fi el d Na me) Medi ca ti on Sa fety Is s ues Sound-a l i ke/l ook-a l i ke i s s ues: Ca l ci toni n ma y be confus ed wi th ca l ci tri ol Mi a ca l ci n ma y be confus ed wi th Mi ca ti n Ca l ci toni n na s a l s pra y i s a dmi ni s tered a s a s i ngl e s pra y i nto one nos tri l da i l y, us i ng a l terna the nos tri l s ea ch da y. Admi ni s tra ti on: Inha l a ti onNa s a l s pra y: Before fi rs t us e, a l l ow bottl e to rea ch room tempera ture, then pri me pump by rel ea s i ng a t l ea s t 5 s pra ys unti l ful l s pra y i s produced. To a dmi ni s ter, pl a ce nozzl e i nto nos tri l wi th hea d i n upri ght pos i ti on.
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