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By R. Bogir. Georgian Court College.

As with many other infections buy micardis 20mg low cost, the severe, disseminated persist for years if the disease is not treated effectively. In im- form usually occurs in patients whose immune systems are sup- munocompromised people, sporotrichosis may spread to various pressed by diseases or drugs. The various lipid preparations differ in their charac- (CSF) are low with or without inflammation. After infusion, second elimination phase, with a half-life of approximately the drug is rapidly taken up by the liver and other organs. It 15 days, which represents elimination from tissue storage is then slowly released back into the bloodstream. Most of the drug is thought to be metabolized in the tis- long-term use, little is known about its distribution and meta- sues; about 5% of the active drug is excreted daily in the bolic pathways. After administration is stopped, amphotericin B can be (eg, pleural, peritoneal, synovial, aqueous, and vitreous hu- detected in the urine for several weeks. Topically to skin lesions two to four times daily for 1–4 wk Oral suspension (100 mg/mL), 1 mL swish and swallow 4 times daily Amphotericin B lipid complex Systemic infections in clients who IV 5 mg/kg/d Same as adults (Abelcet) do not tolerate Fungizone Liposomal amphotericin B Systemic infections in clients who IV 3–5 mg/kg/d Same as adults (AmBisome) do not tolerate Fungizone Empiric treatment of presumed fungal infections in febrile, neu- tropenic clients Amphotericin B cholesteryl Systemic infections in clients who IV, 3–4 mg/kg/d Same as adults (Amphotec) do not tolerate Fungizone Butenafine (Mentax) Tinea infections Topically to skin lesions 1–2 times Safety and efficacy not established daily for 1–4 wk for children <12 y Butoconazole (Femstat, Vaginal candidiasis Intravaginally, once daily for 3 d Gynazole) Caspofungin (Cancidas) Invasive aspergillosis IV infusion over 1 h, 70 mg ini- Safety and efficacy not established tially, then 50 mg daily Hepatic impairment, 70 mg ini- tially, then 35 mg daily Ciclopirox (Loprox) Tinea infections, cutaneous Topically to skin lesions, twice candidiasis daily for 2–4 wk Clotrimazole (Lotrimin, Cutaneous dermatophytosis; Orally, 1 troche dissolved in Same as adults Mycelex, Gyne-Lotrimin) oral, cutaneous, and vaginal mouth five times daily candidiasis Topically to skin daily for 2–4 wk Intravaginally, once daily for 3–7 d Econazole (Spectazole) Tinea infections, cutaneous Topically to skin lesions, once or Dosage not established candidiasis twice daily for 2–4 wk Fluconazole (Diflucan) Oropharyngeal, esophageal, vagi- Oropharyngeal candidiasis, PO, IV Oropharyngeal candidiasis, PO, IV nal, and systemic candidiasis 200 mg first day, then 100 mg 6 mg/kg first day, then Prevention of candidiasis after daily for 2 wk 3 mg/kg/d for at least 2 wk bone marrow transplantation Esophageal candidiasis, PO, IV, Esophageal candidiasis, PO, IV, Cryptococcal meningitis 200 mg first day, then 100 mg 6 mg/kg first day, then 3 daily for at least 3 wk mg/kg/d for at least 3 wk CHAPTER 40 ANTIFUNGAL DRUGS 601 Drugs at a Glance: Selected Antifungal Drugs (continued) Routes and Dosage Ranges Generic/Trade Name Clinical Indications Adults Children Vaginal candidiasis, PO 150 mg Systemic candidiasis, PO, IV as a single dose 6–12 mg/kg/d Systemic candidiasis, PO, IV Cryptococcal meningitis, PO, IV 400 mg first day, then 200 mg 12 mg/kg first day, then daily for at least 4 wk 6 mg/kg/d for 10–12 wk Prophylaxis, PO, IV 400 mg once daily Cryptococcal meningitis, PO, IV, 400 mg first day, then 200–400 mg/d for 10–12 wk Flucytosine (Ancobon) Systemic mycoses due to Can- PO 50–150 mg/kg/d in divided Safety and efficacy not established dida species or Cryptococcus doses q6h neoformans Dosage must be decreased with impaired liver function. This reaction does not represent The azoles comprise the largest group of commonly used anti- drug hypersensitivity. Many of these are used topically and some are with acetaminophen, diphenhydramine (an antihistamine), or available without a prescription for dermatologic (see Chap. Nephrotoxicity is the most common and the are used systemically or both topically and systemically. The drug apparently serious, invasive fungal infections, these drugs are often used damages the kidneys by constricting afferent renal arterioles long term following initial treatment with amphotericin B. Several measures may However, their use as initial treatment for some systemic in- decrease nephrotoxicity, such as keeping the client well fections is increasing.

Thus generic micardis 20mg online, nary estimates of the frequency of common side- information is obtained on the extent to which effects, its effectiveness and its acceptability. Time to onset is recommended to previously conduct repeated- of action and to return to normal ovarian func- dose toxicity and reproduction studies in animals. Other pharmacological effects on the repro- into Phase IIA, studies on the pharmacology of ductive system: effects on the endometrium the drug in patients and Phase IIB, definitive and on the cervical mucus. Effects on other endocrine systems: pituitary, Since steroidal contraceptives are used by adrenal, thyroid. Metabolic effects: effects on hemostatic vari- mum effective dose at the initial stages of clinical ables, plasma lipids and carbohydrate metabolism. The direct assess- and suppressing oestrogen secretion, effect on ment of efficacy in small trials is not possible bone mineral density and bone metabolism. There exist surro- Design gate variables for efficacy of a steroid drug for pregnancy prevention. Phase I trials on contra- For contraception in women, recruitment into ceptives, therefore, are often also used to look Phase I trials is conducted among volunteers of at these surrogates of efficacy in addition to reproductive age, not pregnant or lactating, regu- safety issues, so that Phase I and Phase II tri- larly menstruating, identified in family planning als are combined to evaluate both safety and clinics or selected community groups, who are endocrinological endpoints. Examples of surro- IUD users or sterilised, and therefore, not at risk gates of efficacy are hormone levels as indica- of becoming pregnant. Users of other hormonal tors of inhibition of ovulation in contraceptives contraceptives than the one being studied are not for women, sperm concentration in long-acting acceptable because the method might interfere androgen–progestogen formulations for men as with the assessment of clinical and laboratory an indicator of inhibition of spermatogenesis, and parameters. Other selection criteria depend on amount of serum hCG antibodies in immunocon- the contraceptive being studied. Serological and clin- contraceptive vaccines, acute hypersensitivity to ical diagnoses of pregnancies are also conducted. These studies involve doses that activity of a steroid contained in the contra- are two or three times the initial dose. For each ceptive and its principal metabolites should dose level, a study is conducted in 10–20 healthy be described. Pharmacological action on ovarian function: Selection criteria for Phase II trials on women, the mechanism by which the contraceptive different to those mentioned for Phase I trials, are effect is attained should be described. This being currently exposed to the risk of pregnancy involves, in the first place, a description of and have proven fertility.