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1.
Liver Transpl ; 19(4): 457-61, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23526600

RESUMO

Latent tuberculosis infection is an important problem for solid organ transplant recipients because of the frequency of its occurrence and its potential for reactivation. Because of the high mortality rate associated with active tuberculosis infections in transplant recipients, guidelines from the American Thoracic Society recommend treatment for latent tuberculosis in this population. However, the choice of treatments is often difficult because liver transplant recipients may be more sensitive to isoniazid hepatotoxicity, and rifampin has significant drug interactions with the calcineurin inhibitors used for immunosuppression. Two prior case reports described success with the use of rifabutin, a rifampin alternative, as part of a multidrug treatment regimen for active tuberculosis in posttransplant patients; however, there is no prior literature describing any experience with rifabutin for the treatment of latent tuberculosis in the posttransplant setting. We present a summary of tacrolimus drug levels and corresponding dose requirements for a single posttransplant patient during the administration of 3 different latent tuberculosis drug regimens: rifampin alone, rifampin plus ketoconazole, and rifabutin. In this patient's case, rifabutin allowed the maintenance of adequate tacrolimus levels, although an approximate 2.5-fold increase in the dose was required. Rifampin alone was associated with inadequate immunosuppressant levels, and rifampin plus ketoconazole was associated with a problematically prolonged QT interval and concerns about inadequate tuberculosis treatment.


Assuntos
Antibióticos Antituberculose/uso terapêutico , Imunossupressores/uso terapêutico , Transplante de Rim/efeitos adversos , Tuberculose Latente/tratamento farmacológico , Transplante de Fígado/efeitos adversos , Rifabutina/uso terapêutico , Tacrolimo/uso terapêutico , Adolescente , Antibióticos Antituberculose/efeitos adversos , Interações Medicamentosas , Monitoramento de Medicamentos , Substituição de Medicamentos , Quimioterapia Combinada , Humanos , Imunossupressores/efeitos adversos , Imunossupressores/sangue , Imunossupressores/farmacocinética , Cetoconazol/uso terapêutico , Transplante de Rim/imunologia , Tuberculose Latente/diagnóstico , Tuberculose Latente/imunologia , Tuberculose Latente/microbiologia , Transplante de Fígado/imunologia , Síndrome do QT Longo/induzido quimicamente , Masculino , Rifabutina/efeitos adversos , Rifampina/uso terapêutico , Tacrolimo/efeitos adversos , Tacrolimo/sangue , Tacrolimo/farmacocinética , Resultado do Tratamento
2.
Nephrol Nurs J ; 37(3): 304-8, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20629469

RESUMO

Chronic kidney disease affects millions of Americans. Many drugs are eliminated from the body by the kidneys. As renal function declines due to the disease, drugs that are normally eliminated by the kidneys can accumulate, potentially leading to toxicity. Assessing kidney function in patients is essential in determining the appropriate dose of medications to achieve the desired clinical outcome while minimizing the potential for toxicity.


Assuntos
Creatinina/sangue , Monitoramento de Medicamentos/métodos , Taxa de Filtração Glomerular , Falência Renal Crônica , Testes de Função Renal/métodos , Fatores Etários , Peso Corporal , Dieta com Restrição de Proteínas/métodos , Relação Dose-Resposta a Droga , Feminino , Taxa de Filtração Glomerular/efeitos dos fármacos , Taxa de Filtração Glomerular/fisiologia , Humanos , Falência Renal Crônica/tratamento farmacológico , Falência Renal Crônica/metabolismo , Masculino , Matemática , Taxa de Depuração Metabólica , Guias de Prática Clínica como Assunto , Índice de Gravidade de Doença , Caracteres Sexuais , Estados Unidos , United States Food and Drug Administration
3.
Nephrol Nurs J ; 36(2): 223-7, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19397179

RESUMO

Advances in drug therapy for patients with kidney disease have contributed to increased exercise capacity, reduced cardiovascular disease, decreased renal bone disease, improved quality of life, and most importantly, reduced morbidity and mortality. New insights into the pathophysiology of chronic kidney disease (CKD) have helped lead to the development of many novel drugs and treatments. The purpose of this article is to highlight some of the developments in nephrology pharmacotherapy that occurred during the first 40 years of the American Nephrology Nurses' Association.


Assuntos
Tratamento Farmacológico/história , Falência Renal Crônica/história , Nefrologia/história , Especialidades de Enfermagem/história , Anemia Ferropriva/história , Quelantes/história , Distúrbio Mineral e Ósseo na Doença Renal Crônica/história , Hematínicos/história , História do Século XX , História do Século XXI , Humanos , Imunossupressores/história , Transplante de Rim/história
4.
Nephrol Nurs J ; 36(3): 333-7, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19588704

RESUMO

Infection with the hepatitis C virus is a major public health problem and is the leading cause of liver disease in the United States. Chronic infection with hepatitis C virus can lead to liver disease, cirrhosis, and hepatocellular carcinoma. Treatment options include interferon or peginterferon, and ribavirin. The objective of treatment is to eradicate the infection in an effort to prevent complications of hepatitis C virus infection.


Assuntos
Antivirais/uso terapêutico , Hepatite C/tratamento farmacológico , Hepatite C/complicações , Humanos , Falência Renal Crônica/complicações
5.
Nephrol Nurs J ; 35(2): 213-5, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18472692

RESUMO

Pharmacokinetics describes the time course of the drug concentration following administration of a specific dosage regimen. An understanding of pharmacokinetic principles will assist the clinician in designing an individualized dosage regimen that achieves the desired drug concentration.


Assuntos
Monitoramento de Medicamentos/métodos , Farmacocinética , Administração Oral , Disponibilidade Biológica , Débito Cardíaco , Relação Dose-Resposta a Droga , Esquema de Medicação , Interações Medicamentosas , Meia-Vida , Humanos , Rim/fisiologia , Fígado/fisiologia , Taxa de Depuração Metabólica , Diálise Renal , Distribuição Tecidual
6.
Nephrol Nurs J ; 35(5): 507-10, 534, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18856082

RESUMO

Chronic infection with hepatitis B virus can lead to liver disease, cirrhosis, and hepatocellular carcinoma. Treatment options include interferons and antiviral drugs. The interferons have immunomodulatory, antiproliferative, and antiviral effects. Nucleoside analogs, such as entecavir, lamivudine and telbivudine, and neucleotide analogs, such as adefovir and tenofovir, exhibit antiviral effects by inhibiting viral replication. Treatment is directed at suppressing viral replication and halting the progression of disease.


Assuntos
Antivirais/uso terapêutico , Hepatite B Crônica/tratamento farmacológico , Adenina/administração & dosagem , Adenina/efeitos adversos , Adenina/análogos & derivados , Adenina/uso terapêutico , Antivirais/administração & dosagem , Antivirais/efeitos adversos , Guanina/administração & dosagem , Guanina/efeitos adversos , Guanina/análogos & derivados , Guanina/uso terapêutico , Humanos , Interferons/administração & dosagem , Interferons/efeitos adversos , Interferons/uso terapêutico , Lamivudina/administração & dosagem , Lamivudina/efeitos adversos , Lamivudina/uso terapêutico , Nucleosídeos/administração & dosagem , Nucleosídeos/efeitos adversos , Nucleosídeos/uso terapêutico , Organofosfonatos/administração & dosagem , Organofosfonatos/efeitos adversos , Organofosfonatos/uso terapêutico , Pirimidinonas/administração & dosagem , Pirimidinonas/efeitos adversos , Pirimidinonas/uso terapêutico , Telbivudina , Tenofovir , Timidina/análogos & derivados
7.
Transplantation ; 101(9): 2079-2082, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28880197

RESUMO

BACKGROUND: Hepatitis B immune globulin (HBIG) has been an integral component of prophylaxis against hepatitis B virus (HBV) recurrence in liver transplantation (LT) recipients, but HBIG is costly and inconvenient to administer, prompting consideration of alternative regimens. METHODS: In this retrospective cohort, we report on the success of antiviral therapy combined with a short course (in hospital only) HBIG in liver transplant recipients with HBV DNA less than 100 IU/mL pre-LT. RESULTS: A total of 42 hepatitis B surface antigen (HBsAg) positive, human immunodeficiency virus and hepatitis D virus-negative patients with pretransplant HBV DNA undetectable to 100 IU/mL who received HBIG 5000 IU in anhepatic phase and daily for 5 days together with nucleos(t)ide analogues indefinitely yielded 1- and 3-year cumulative incidences of recurrence, defined by positive serum HBsAg, of 2.9% (upper 95% confidence interval, 19%). One patient had HBV viremia 16 months post-LT without detectable HBsAg. Both patients with either HBsAg positivity or viremia had recurrent hepatocellular carcinoma diagnosed within a month of detection. Post-LT survival was 98% and 94% at 1 and 5 years, respectively. CONCLUSIONS: We conclude that a very short course of HBIG combined with long-term antiviral therapy is highly effective in preventing HBV recurrence and should be the preferred strategy for LT recipients with undetectable or low-level viremia at time of LT.


Assuntos
Antivirais/administração & dosagem , Doença Hepática Terminal/cirurgia , Vacinas contra Hepatite B/administração & dosagem , Vírus da Hepatite B/efeitos dos fármacos , Hepatite B/tratamento farmacológico , Imunoglobulinas/administração & dosagem , Transplante de Fígado , Ativação Viral/efeitos dos fármacos , Adulto , Idoso , Antivirais/efeitos adversos , Biomarcadores/sangue , DNA Viral/sangue , DNA Viral/genética , Esquema de Medicação , Doença Hepática Terminal/diagnóstico , Doença Hepática Terminal/virologia , Feminino , Hepatite B/complicações , Hepatite B/diagnóstico , Hepatite B/virologia , Antígenos de Superfície da Hepatite B/sangue , Vacinas contra Hepatite B/efeitos adversos , Vírus da Hepatite B/genética , Vírus da Hepatite B/imunologia , Humanos , Imunoglobulinas/efeitos adversos , Transplante de Fígado/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Carga Viral
8.
Clin Liver Dis ; 8(2): 371-85, 2004 May.
Artigo em Inglês | MEDLINE | ID: mdl-15481345

RESUMO

For the management of HBV infection, an increasing number of nucleotide and nucleoside analogs are active against wild-type HBV and some against HBV with YMDD and other compensatory mutations. Table 2 depicts the IC50 and susceptibilities of HBV to various antiviral agents. The dichotomy between in vitro and in vivo susceptibilities to YMDD mutants is due to a change in IC50 between wild-type and mutant virus. Thus a drug may have less activity in vitro but at doses used in vivo show activity against YMDD and other compensatory mutations. Some HBV drugs share activity against HIV, which may be useful in the co-infected patient. Other nucleoside analogs are in various stages of development, including MCC-478 and DAPD. In the future, clinicians will have a plethora of reagents to chose from, and combination therapies may be invoked.


Assuntos
Antivirais/farmacologia , Vírus da Hepatite B , Hepatite B/tratamento farmacológico , Inibidores da Transcriptase Reversa/farmacologia , Antivirais/uso terapêutico , Dioxolanos/farmacologia , Dioxolanos/uso terapêutico , Humanos , Concentração Inibidora 50 , Mutação Puntual , Nucleosídeos de Purina/farmacologia , Nucleosídeos de Purina/uso terapêutico , Purinas/farmacologia , Purinas/uso terapêutico , Inibidores da Transcriptase Reversa/uso terapêutico , Replicação Viral/efeitos dos fármacos
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