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http://cs.gmu.edu/~xzhou10/semester/thesis-ideas-for-religion.html thesis ideas for religion Other adverse effects included abnormal liver function tests, fatigue, nausea, headache, and hypokalemia. Cardiac toxicity was not a reason for study withdrawal. »» pertuzumab the fda approved the new her-2-targeted pertuzumab in june 2012. When compared to trastuzumab, pertuzumab recognizes different extracellular epitopes, binds uniquely which causes structural changes and therefore interrupts receptor dimerization. These differences were thought to be able to provide greater inhibition of her-2 when compared to trastuzumab. This has not been proven to be the case, but based on clinical studies is indicated for first-line treatment in combination with trastuzumab and docetaxel for her-2-positive metastatic breast cancer. Adverse effects seen in clinical trials were diarrhea and a similar incidence of cardiac toxicity as trastuzumab. When used in combination with trastuzumab, it does not appear to increase the incidence of cardiac toxicity. Tyrosine kinase inhibitors there are more than 100 different types of tyrosine kinases present in the body. Tyrosine kinase inhibitors (tkis) are also referred to as small-molecule inhibitors. Each of the following drugs was developed to block either several or a specific tyrosine kinase. »» imatinib imatinib was the first fda-approved tki and is considered to be first-generation. Imatinib inhibits phosphorylation during cell proliferation. The drug was designed to block the breakpoint cluster region tyrosine kinase (bcr-abl) produced by the philadelphia chromosome associated with cml and all. Imatinib also has shown activity against gastrointestinal stromal tumors (gist) that are positive for c-kit (cd117). Imatinib is usually well tolerated, but common adverse effects include myelosuppression, rash, gi upset, edema, fatigue, arthalgias, myalgias, and headaches. A cumulative cardiotoxicty is a serious but rare adverse effect therefore it is recommended to closely monitor patients with preexisting cardiac conditions. Numerous drug interactions have been reported for imatinib. Cyp3a4 inducers, such as rifampicin and st. John’s wort, increase the clearance of imatinib. 35,36 ketoconazole, a cyp3a4 inhibitor, has been shown to decrease imatinib clearance by almost 30%. 37 imatinib also may increase the exposure of simvastatin, a cyp3a4 substrate. 38 these are various examples of how drug–drug interactions can occur and how important monitoring for these reactions is for the health professionals. »» advanced-generation bcr-abl tkis advanced generation bcr-abl tkis were developed in an effort to overcome the resistance or intolerance to imatinib. These agents are more potent than imatinib and can overcome most bcr-abl mutations that lead to imatinib resistance. Dasatinib and nilotinib are second-generation tki that share the same binding site on the bcr-abl cluster region as imatinib but maintains activity despite imatinib resistance, with higher potency than imatinib. Dasatinib also inhibits src kinases, which are tyrosine kinases that mediate cellular differentiation, proliferation, and survival. Dasatinib and nilotinib are used front line in the treatment of cml and in cml with resistance or intolerance to imatinib. Side effects of dasatinib and nilotinib are similar to imatinib and include myelosuppression, nausea and vomiting, headache, fluid retention, and hypocalcemia. Pleural effusions have been reported with dasatinib and imatinib but not with nilotinib. Qt prolongation can occur with dasatinib and nilotinib.

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gilded age essay Clinical practice guidelines for the management of cryptococcal disease. 2010 update by the infectious diseases society of america. Clin infect dis. 2010;50(3):291–322. 32.

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hp pagewriter 200i paper Many practitioners opt to initiate therapy with nonprescription clotrimazole, tolnaftate, miconazole, or terbinafine, reserving prescription topical agents, such as naftifine, ciclopirox, and butenafine, for second-line therapy or viagra in drug screen refractory cases and systemic therapy for refractory cases. When recommending topical therapy, the selection of vehicle is based on the type of lesion and location of the infection. Solutions and lotions are recommended for hairy areas and oozing lesions, whereas creams and ointments should be avoided in these areas. Creams are better for moderately scaling and nonoozing lesions. For hyperkeratotic lesions, ointments can be considered. The selected formulation should be applied to the affected area after it is cleaned and dried. The medication should be rubbed into the infected area for improved penetration. Because most patients do not rub in sprays and powders, penetration of the epidermis is minimal, making them less effective than other formulations. Sprays and powders should 1226  section 15  |  diseases of infectious origin table 83–6  available topical antifungal agents medication rx/otc cream/ointment butenafine ciclopirox clotrimazole econazole efinaconazole haloprogin ketoconazole miconazole naftifine nystatin oxiconazole sertaconazole sulconazole tavaborole terbinafine tolnaftate otc rx otc rx rx rx rx/otc otc rx rx rx rx rx rx otc otc x x x x   x x x x x x x x   x x be considered as adjuvant therapy with a cream or lotion or as prophylactic therapy to prevent recurrence. 7 due to the severity of infection and inflammation, tinea capitis does not adequately respond to topical agents. Therefore, oral agents for 6 to 8 weeks are recommended. Griseofulvin has long been considered the treatment of choice due to its ability to achieve high levels within the stratum corneum. Itraconazole has also demonstrated effectiveness. Due to its lipophilicity, itraconazole achieves high dermal concentrations that are maintained for 4 weeks after discontinuation of therapy. Treatment of onychomycosis for onychomycosis, a chronic infection that rarely remits spontaneously, adequate treatment is essential to prevent spread to other sites, secondary bacterial infections, cellulitis, or gangrene. Due to the chronic nature and impenetrability of nails, topical agents have low efficacy rates for treating onychomycosis. Oral agents that can penetrate the nail matrix and nail base, table 83–7  dosing of topical agents for tinea infections and onychomycosis agents topical dosing frequency butenafine ciclopirox clotrimazole econazole efinaconazole haloprogin ketoconazole miconazole naftifine oxiconazole sertaconazole sulconazole tavaborole terbinafine tolnaftate once daily twice daily. At bedtime (lacquer) twice daily once daily once daily (nail solution) twice daily once daily twice daily once daily (cream). Twice daily (gel) twice daily twice daily twice daily once daily (nail solution) twice daily two to three times daily gel lotion spray/solution                 x           x       lacquer and shampoo x   x x shampoo x           x x x x x         x   x x         x powder     x         x   x             such as itraconazole and terbinafine, are more effective than ciclopirox lacquer, efinaconazole solution, or tavaborole solution. Itraconazole (200 mg twice daily for 1 week per month or 200 mg daily for 12 weeks) and terbinafine (250 mg daily for 12 weeks) demonstrate mycological cure rates of 71% and 77%, respectively, whereas the cure rate range from 29% to 36% for ciclopirox, approximately 55% for efinaconazole, and 35% for tavaborole. 23 for patients with liver disease or who are unable to use oral agents, ciclopirox lacquer, efinaconazole solution, and tavaborole solution remain reasonable alternatives, despite requiring 48 weeks of therapy. Due to low efficacy, griseofulvin should only be considered as second-line therapy with therapy continued for 4 months for fingernail infections or 6 months for toenail infections. The fda has released warnings pertaining to itraconazole and terbinafine as there is a small but real risk of developing congestive heart failure with itraconazole therapy due to its negative inotropic effects. Itraconazole should not be administered to patients with ventricular dysfunction such as congestive heart failure. The fda also released warnings that itraconazole and terbinafine are associated with serious hepatic toxicity, including liver failure and death. Liver failure associated with these medications has occurred in patients with no preexisting living disease or serious underlying medical conditions. Treatment with itraconazole or terbinafine for prolonged periods requires laboratory monitoring of liver function tests before initiation of therapy and at monthly intervals. Table 83–8  dosing of systemic therapy for tinea infections medication adult dosing pediatric dosing fluconazole griseofulvin itraconazole ketoconazole terbinafine 150 mg/week 0. 5–1 g/day 200 mg twice daily 200–400 mg/day 250 mg/day 6 mg/kg/week 10–20 mg/kg/day not studied 3. 3–6. 6 mg/kg/day < 25 kg.

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