In au aparut semnele de recidiva, iar in am fost reoperata, de aceasta data tumoarea a avut dimensiuni mai reduse. In anul am suferit si un infarct miocardic, in urma cauia s-a efectuat bypass aorto-coronarian, pentru care a fost nevoie de cerclaj. Dupa cerclaj din pacate nu am mai efectua RMN, doar CT, pe care il fac regulat, pentru urmarirea evetualelor recidive.
Recidive clare, deocamdata nu s-au evidentiat. Intrebarea mea ar fi urmatoarea: M-ar ajuta pentru prevenirea recidivelor? Seful Curtii de Conturi Nicolae Vacaroiu, care a fost operat pe 25 martie pe cord deschis, se va putea intoarce la serviciu dupa Paste, a adaugat medicul serban Bradisteanu, seful echipei medicale de la Spitalul Floreasca care a facut operatia.
INR este util numai pentru pacientii cu terapie anticoagulanta orala stabila si nu are nici o valoare pentru diagnosticul sau tratamentul celor cu PT prelungit din alte motive8. Tratament anticoagulant-control de laborator Efectul anticoagulant se stabilizeaza la zile de la initierea tratamentului.
Cand este necesar un efect anticoagulant rapid, heparina sau heparina cu greutate moleculara mica trebuie administrate concomitent, iar suprapunerea cu ACO dureaza pana cand INR a fost in intervalul terapeutic 2 zile consecutiv. Frecventa determinarilor ulterioare este stabilita de catre medic in functie de complianta pacientului si raspunsul la tratament. Dupa obtinerea unei doze stabile se recomanda monitorizarea la un interval nu mai mare de 4 saptamani.
Monitor for proarrhythmic effects especially with digoxin toxicity Disease-related concerns: Use with caution in patients with an acute MI; may increase myocardial oxygen demand and lead to ischemia.
When used for rate control in patients with atrial fibrillation, monitor serum concentrations closely; may be associated with an increased risk of mortality especially when serum concentrations are not properly controlled Vamos Patients with beri beri heart disease may fail to adequately respond to digoxin therapy; treat underlying thiamine deficiency concomitantly.
Hypercalcemia may increase the risk of digoxin toxicity and hypocalcemia can nullify the effects of digoxin; maintain normocalcemia. Digoxin should be considered for use only in heart failure HF with reduced ejection fraction HFrEF when symptoms remain despite guideline-directed medical therapy.
Withdrawal of digoxin in clinically stable patients with HF may lead to recurrence of HF symptoms Packer Monitor serum concentrations closely; may be associated with an increased risk of mortality especially when serum concentrations are not properly controlled Vamos Atrial arrhythmias associated with hypermetabolic eg, hyperthyroidism or hyperdynamic hypoxia, arteriovenous shunt states are very difficult to treat; treat underlying condition first.
If digoxin is used, ensure digoxin toxicity does not occur. Outflow obstruction may worsen due to the positive inotropic effects of digoxin; avoid use unless used to control ventricular response with atrial fibrillation. Digoxin is potentially harmful in the treatment of dyspnea in patients with HCM in the absence of atrial fibrillation Gersh In a murine model of viral myocarditis, digoxin in high doses was shown to be detrimental Matsumori If used in humans, therefore, digoxin should be used with caution and only at low doses Frishman The manufacturer recommends avoiding the use of digoxin in patients with myocarditis.
Decreased cardiac output may occur in patients with preserved left ventricular systolic function, including restrictive or hypertrophic cardiomyopathy, constrictive pericarditis, amyloid heart disease, and acute cor pulmonale; in general, the manufacturer recommends to avoid use unless used to control ventricular response with atrial fibrillation.
Use with caution in patients with renal impairment; dosage adjustment needed. Because digoxin slows sinoatrial and AV conduction, the drug commonly prolongs the PR interval. Digoxin may cause severe sinus bradycardia or sinoatrial block particularly in patients with preexisting sinus node disease.
Avoid use in patients with second- or third-degree heart block except in patients with a functioning artificial pacemaker Yancy ; incomplete AV block eg, Stokes-Adams attacks may progress to complete block with digoxin administration.
In such patients, if treatment with digoxin is necessary, consider the insertion of a pacemaker before treatment. Use with caution in patients with hypothyroidism, higher digoxin concentrations may result due to significant reduction in digoxin clearance Burk In patients with hyperthyroidism, lower digoxin concentrations may result due to an increase in renal clearance of digoxin.
No significant differences in absorption were seen in either thyroid condition compared with those with normal thyroid function Burk New-onset atrial fibrillation or exacerbation of ventricular arrhythmias should prompt evaluation of thyroid status. Concurrent drug therapy issues: Consult drug interactions database for more detailed information. Newborn infants display considerable variability to their tolerance to digoxin; premature and immature infants are particularly sensitive to the effects of digoxin.
Patients with decreased body weight are at an increased risk of drug-related toxicity. Dosage form specific issues: Some dosage forms may contain propylene glycol; large amounts are potentially toxic and have been associated hyperosmolality, lactic acidosis, seizures, and respiratory depression; use caution AAP ; Zar It is not necessary to routinely reduce or hold digoxin therapy prior to elective electrical cardioversion for atrial fibrillation; however, exclusion of digoxin toxicity eg, clinical and ECG signs is necessary prior to cardioversion.
Monitoring Parameters Heart rate and rhythm should be monitored along with periodic ECGs to assess desired effects and signs of toxicity; baseline and periodic serum creatinine. Periodically monitor serum potassium, magnesium, and calcium especially if on medications where these electrolyte disturbances can occur eg, diuretics , or if patient has a history of hypokalemia or hypomagnesemia.
Observe patients for noncardiac signs of toxicity, confusion, and depression. When to draw serum digoxin concentrations: Digoxin serum concentrations are monitored because digoxin possesses a narrow therapeutic serum range; the therapeutic endpoint is difficult to quantify and digoxin toxicity may be life-threatening. Therefore, warfarin therapy should be monitored closely.
The response to diabetes drugs may be reduced because prednisone increases blood glucose. Prednisone may increase the risk of tendon rupture in patients treated with fluoroquinolone type antibiotics. Examples of fluoroquinolones include ciprofloxacin Cipro and levofloxacin Levaquin. The elderly are especially at risk and tendon rupture may occur during or after treatment with fluoroquinolones. Combining aspirin , ibuprofen Motrin or other nonsteroidal anti-inflammatory agents NSAIDS with corticosteroids increases the risk of stomach related side effects like ulcers.
Barbiturates , carbamazepine , rifampin and other drugs that increase the activity of liver enzymes that breakdown prednisone may reduce blood levels of prednisone.
Conversely, ketoconazole , itraconazole Sporanox , ritonavir Norvir , indinavir Crixivan , macrolide antibiotics such as erythromycin , and other drugs that reduce the activity of liver enzymes that breakdown prednisone may increase blood levels of prednisone. Is it safe to take prednisone over a long period of time? No, prolonged therapy with prednisone causes the adrenal glands to atrophy and stop producing cortisol.
Is this drug safe to take if I'm pregnant or breastfeeding? Corticosteroids cross the placenta into the fetus. Contraindicatii Hipersensibilitate la unul din constituenti. Ca alti vasoconstrictori, fenilefrina este contraindicata in rinite atrofice cu sau fara ozena, la pacientii sub tratament cu IMAO sau care au intrerupt aceasta terapie cu mai putin de 2 saptamani in urma.
Efecte Adverse In rare cazuri s-a constatat o reactie tranzitorie de uscare a mucoasei nazale Precautii Vibrocil nu trebuie utilizat pe o perioada mai mare de saptamani. Prelungirea duratei de tratament poate induce tahifilaxie, congestie reflexa sau rinita iatrogena.
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