Professor, Florida Atlantic University Charles E. Schmidt College of Medicine
In large doses erectile dysfunction treatment devices generic sildigra 100 mg, riboflavin may produce yellowgreen fluorescence in urine impotence medical definition buy 100mg sildigra fast delivery, which can cause false elevations in certain fluorometric determinations of urinary catecholamines erectile dysfunction dx code discount sildigra 120 mg without a prescription. Patient and Family Education: To prevent deficiency goal of erectile dysfunction treatment buy generic sildigra from india, consume dietary sources rich in thiamine such as yeast, pork, beef, liver, wheat, and other whole grains, nutrient-added breakfast cereals, and fresh vegetables, especially peas and dried beans. Patient and Family Education: To prevent deficiency, consume dietary sources rich in riboflavin such as organ meats (liver, kidney, heart), beef, pork, eggs, milk and milk products, yeast, whole-grain cereals and breads, vitamin-enriched breakfast cereals, dark leafy green vegetables, and mushrooms. As with thiamine, a deficiency of riboflavin is most commonly observed in people with chronic alcoholism. Clinical symptoms of deficiency include digestive disturbances, headache, burning sensation of the skin (especially "burning" feet), cracking at the corners of the mouth (cheilosis), glossitis, seborrheic dermatitis (and other skin lesions), mental depression, corneal vascularization (with photophobia, burning and itchy eyes, lacrimation, roughness of eyelids), anemia, and neuropathy. Riboflavin therapy is used to prevent riboflavin deficiency and microcytic anemia and to supplement other B vitamins in the treatment of pellagra and beriberi. Niacin: Vitamin B3 the primary use for niacin is for the medical management of elevated cholesterol levels in patients at risk for atherosclerotic disease. It may be used as monotherapy or in combination with other antihyperlipidemic drugs. Pyridoxine: Vitamin B6 Therapeutic Effects and Uses: Pyridoxine deficiency occurs with inadequate dietary intake due to alcoholism, drug-induced deficiency. Pyridoxine is used to improve symptoms of vitamin deficiency such as nausea, vomiting, and skin lesions. Notify the health care provider if planning a pregnancy or of any known or suspected pregnancy because supplementation may be started early to reduce the chance of birth defects. Mechanism of Action: Pyridoxine is usually available as part of a water-soluble complex of three closely related compounds with vitamin B6 activity. Pyridoxine is essential to human nutrition, although a deficiency syndrome is not well defined. It is converted in the body to pyridoxal, a coenzyme that functions in protein, fat, and carbohydrate metabolism and in facilitating the release of glycogen from the liver and muscle. In protein metabolism, pyridoxine participates in many enzymatic transformations of amino acids and in the conversion of tryptophan to niacin and serotonin. It aids in energy transformation in the brain and nerve cells and is thought to stimulate heme production. Adverse Effects: Adverse events are few but the patient could experience paresthesias, slight flushing or feeling of warmth, temporary burning or stinging pain at the injection site, somnolence seizures (particularly following large parenteral doses), low folic acid levels, insomnia, or anxiety. Folic Acid: Vitamin B9 Therapeutic Effects and Uses: Folic acid is used to treat folate deficiency, macrocytic anemia, and megaloblastic anemias, which are associated with inadequate dietary intake, alcoholism, primary liver disease, malabsorption syndromes, pregnancy, infancy, and childhood. Studies have shown that up to 80% of neural tube defects in newborns can be prevented with supplementation of folic acid prior to pregnancy. Folic acid is readily absorbed in the proximal small intestine, is distributed to all body tissues, crosses the placenta in pregnancy, and is secreted in breast milk in lactating women. Contraindications/Precautions: Pyridoxine should be used with caution in patients with renal impairment, neonatal prematurity with renal impairment, or cardiac disease. Although rare, the possible adverse effects include irritability, depression, loss of appetite, rash, itching, nausea, shortness of breath, or tightness in the chest. Drug Interactions: Use of isoniazid, cycloserine, penicillamine, hydralazine, and oral contraceptives may increase pyridoxine requirements. This vitamin may reverse or antagonize the therapeutic effects of the antiparkinsonism drug levodopa because it reduces the amount of dopamine entering the brain by facilitating the breakdown of levodopa in peripheral circulation. Contraindications/Precautions: Folic acid should not be used in patients with allergic sensitivity to B vitamins. It should be administered with caution if using folic acid alone to correct pernicious anemia or other vitamin B12 deficiency states as well as normocytic, refractory, aplastic, or undiagnosed anemia. Folic acid can cause false low serum folate levels in patients who are receiving antibiotics such as tetracyclines. Patient and Family Education: To prevent deficiency, consume dietary sources rich in vitamin B6 such as yeast, wheat germ, whole-grain cereals, Drug Interactions: Folic acid inhibitors such as methotrexate can antagonize the effects of folate therapy. Folic acid therapy increases the metabolism of phenytoin (Dilantin), possibly causing increased seizure activity. Vitamin deficiency may occur as a result of normal physiological changes related to aging and nutrient absorption, alcohol use, or medication interactions. Patient and Family Education: To prevent deficiency consume dietary sources rich in folic acid such as whole-grain cereals and breads, organ meats such as liver and kidney, yeast, fruits, beans, potatoes, and leafy green vegetables. This drug is also used in vitamin B12 deficiency caused by increased physiological requirements or inadequate dietary intake, and in the vitamin B12 absorption (Schilling) test. It may be used to prevent and treat toxicity associated with sodium nitroprusside, to treat asthma, and possibly to aid in healing following surgery. Intestinal absorption requires the presence of intrinsic factor in the terminal ileum. It is widely distributed and is principally stored in the liver, kidneys, and adrenals.
Antipyretics such as ibuprofen are usually not appropriate because they can mask the symptoms of a significant infection erectile dysfunction doctors in brooklyn trusted sildigra 25mg. However erectile dysfunction protocol free buy sildigra 120mg, they should be taught measures to reduce the exposure risk to infections erectile dysfunction yoga order 25 mg sildigra amex, and should always receive appropriate instruction for fever management before they begin to take the medication erectile dysfunction for young adults order 50mg sildigra with mastercard. Aldesleukin is a very toxic drug that should only be administered by personnel familiar with its use. Aldesleukin should not be administered to patients with developing moderate to severe lethargy because the drug may induce coma. Aldesleukin may cause seizures and should be used with caution in patients with epilepsy. Drug Interactions: Aldesleukin has the potential to interact with nearly any other drug. Given concurrently with aldesleukin, drugs that affect mental status such as many antianxiety agents, opioids, sedatives, or antipsychotic agents may cause mood disturbances and drowsiness. Concurrent administration with drugs that are hepatotoxic or nephrotoxic may cause additive organ damage. Treatment of Overdose: Dexamethasone may be used to reverse some of the toxicities observed from an overdose of aldesleukin. Adverse Effects: Aldesleukin is a toxic drug that has the potential to cause serious adverse effects in virtually any organ system. Many of the adverse effects are caused by capillary leak syndrome, a serious condition in which plasma proteins and other substances leave the blood and enter the interstitial spaces because of porous capillaries. Over 70% of patients taking aldesleukin will experience hypotension, which can sometimes be severe enough to cause tissues and organs to receive an insufficient blood supply to function properly. Diarrhea, nausea, or vomiting may occur in as many as half the patients taking the drug. Other common adverse effects include confusion, drowsiness, oliguria, stomatitis, anorexia, hyperbilirubinemia, hypothyroidism, elevated hepatic enzymes, weight gain, dyspnea, and pulmonary congestion. Black Box Warning: Aldesleukin can cause capillary leak syndrome, which can be severe. Death may result from infection that can spread throughout the body because of impaired neutrophil function. Contraindications/Precautions: There are many contraindications to using aldesleukin, and a thorough baseline assessment of health status is required. Lifespan and Diversity Considerations: Monitor hepatic and renal function laboratory values and cardiac function more frequently in the older adult because normal age-related physiological changes may greatly increase the risk of adverse effects. Patient and Family Education: Avoid vaccinations while receiving treatment with this drug and for 3 months after completion of treatment. An additional immunostimulant, levamisole (Ergamisol), has been discontinued in the United States. TheraCys: TheraCys is approved for the prophylaxis and treatment of patients with superficial bladder cancer. This drug is instilled into the urinary bladder for 2 hours, after which the patient voids the medication. Adverse effects include local reactions such as bladder irritability, hematuria, dysuria, cystitis, incontinence, and nocturia. This drug is used to prevent tuberculosis and is not given to treat active infections. Used to inhibit the immune response, immunosuppressants are prescribed for patients who are receiving transplanted tissues or organs and to treat autoimmune disorders. Transplantation: Transplants may include specific cells, parts of tissues, or complete organs. This response, called transplant rejection, is often acute; antibodies sometimes destroy the transplanted tissue within 48 hours after a transplant. The cell-mediated branch of the immune system responds more slowly to the transplant, attacking it about 2 weeks following surgery. Transplantation would be impossible without the use of effective immunosuppressant drugs. Although immunosuppressant therapies have proven very successful at preventing acute transplant rejection, they have been far less successful at preventing chronic rejection. Prior to the initiation of immunosuppressant therapy, it is critical that the patient be carefully assessed to rule out active infections. If an active infection is discovered, it should be treated prior to transplantation. In addition, patients should be screened for the presence of cancer prior to surgery because immunosuppressant drugs will allow preexisting cancers to grow rapidly. During immunosuppressant therapy the patient is susceptible to infection from all types of pathogens: viral, bacterial, fungal, or protozoan. Opportunistic pulmonary infections are the leading cause of morbidity and mortality in patients receiving a transplant. Many patients receive antibiotics for the prophylaxis of opportunistic infections for 4 to 12 months following surgery. Six months following the transplant, 80% of patients will return to their baseline risk of infection, but the remainder will remain at high risk indefinitely.
Most packages contain enough drug for one treatment although a second package may be required if the hair is long psychological erectile dysfunction drugs discount sildigra 25 mg. Comb through using a small-toothed comb to remove any dead lice erectile dysfunction treatment with exercise purchase sildigra 100mg free shipping, nits erectile dysfunction killing me order sildigra 50 mg mastercard, or nit casings impotence or erectile dysfunction sildigra 50 mg line. Acne vulgaris and rosacea are two disorders that produce similar appearing lesions on the face. Although the two conditions have some visual similarities and share a few common treatments, the pharmacotherapy of the disorders is very different. Acne Vulgaris Acne vulgaris, a disorder of the hair follicles and sebaceous glands, is a common condition that affects 80% of adolescents. Although acne occurs most often in teenagers, it is not unusual to find patients with acne who are older than 30 years, which is a condition referred to as mature acne or acne tardive. Acne affects approximately 17 million persons in the United States, making it one of the most common skin conditions encountered by the nurse. Although the precise cause of acne is unknown, several factors that are associated with acne vulgaris include abnormal formation of keratin that blocks oil glands and seborrhea, the overproduction of sebum by oil glands. The bacterium Propionibacterium acnes grows within oil gland openings and changes sebum to an acidic and irritating substance. Other factors associated with acne include androgens, which stimulate the sebaceous glands to produce more sebum. This is clearly evident in teenage boys and in patients who are administered testosterone. Blackheads, or open comedones, occur when sebum has plugged the oil gland, causing it to become black because of the presence of melanin granules. Whiteheads, or closed comedones, develop just beneath the surface of the skin and appear white rather than black. Acne is graded as mild, moderate, or severe, depending on the number and type of lesions present. The goals of acne therapy are to treat existing lesions and to prevent or lessen the severity of future recurrences. Treatment for acne is directed toward the pathogenesis of the lesion and there is no single effective treatment. Mechanisms of action of antiacne medications include the following: Inhibit sebaceous gland overactivity. Mild acne is treated by topical therapy with agents such as benzoyl peroxide, topical antibiotics, and salicylic acid. Moderate to severe acne is treated with increasing strengths of tretinoin and the use of systemic antibiotics. Because of their increased toxicity, prescription agents are reserved for more severe, persistent cases. Benzoyl peroxide has a keratolytic effect, which helps to treat acne by loosening dry skin and causing an increased shedding of the outer layer of the epidermis. In addition, this drug suppresses sebum production and exhibits antibacterial effects against P. Benzoyl peroxide is available as a topical lotion, cream, or gel in various percentage concentrations. Typically the patient applies benzoyl peroxide once daily and, in many instances, this is the only treatment needed. The drug is very safe, with local redness, irritation, and drying being the most common adverse effects. Although the symptoms might worsen during the early weeks of therapy, the skin usually adjusts quickly to its use. Other keratolytic agents that are available by prescription are used for severe acne and include benzoyl peroxide with erythromycin (Benzamycin) and benzoyl peroxide with sulfur (Sulfoxyl). They are used in the treatment of inflammatory skin conditions, dermatologic malignancies, and acne. The topical formulations are often the drugs of choice for patients with mild to moderate acne, particularly those with the presence of inflammatory cysts. Tretinoin (Avita, Retin-A, Others) is an older drug with an irritant action that decreases comedone formation and increases extrusion of comedones from the skin. Tretinoin also has the ability to improve photodamaged skin and is used for wrinkle removal. Therapy with retinoids may require 8 to 12 weeks to achieve maximum effectiveness. Common reactions to retinoids include burning, stinging, and sensitivity to sunlight. Adapalene (Differin) is a third-generation retinoid that causes less irritation than the older agents. Additional retinoid-like agents and the related compounds that are used to treat acne are listed in Table 76. Antibiotics are sometimes used in combination with acne medications to lessen the severe redness and inflammation associated with moderate to severe acne, especially when the acne is inflammatory and results in cysts and pustules. Oral doxycycline (Vibramycin, Others), minocycline, and tetracycline, which are administered in small doses over a long period, have been the traditional antibiotics used in acne therapy. Erythromycin and clindamycin are frequently used topically and have a low incidence of adverse effects. Oral contraceptives that contain ethinyl estradiol and norgestimate are also used to help clear the skin of acne by suppressing sebum production and reducing skin oiliness. They are most effective for young women when the acne begins somewhat later than usual and tends to flare up at certain times in the menstrual cycle. Estrogen is not administered to male patients because of undesirable adverse effects, such as breast enlargement and decrease in body hair. Rosacea Rosacea is an inflammatory skin disorder of unknown etiol- ogy with lesions affecting mainly the face.
Cognitive Level: Analyzing; Client Need: Health Promotion and Maintenance; Nursing Process: Evaluation 6 Answer: 1 Rationale: the therapeutic effect of succinylcholine is to paralyze skeletal muscles erectile dysfunction protocol book download sildigra 50mg on-line. Cognitive Level: Applying; Client Need: Physiological Integrity; Nursing Process: Implementation Chapter 20 1 Answer: 1 Rationale: With beta-adrenergic blockers such as propranolol zyprexa impotence discount sildigra 100mg otc, the most important action is to monitor the client for adverse effects associated with the cardiovascular system such as changes in pulse and blood pressure erectile dysfunction rap beat order 25 mg sildigra. Elevation of the head of the bed is not specifically required for this drug regimen impotence purchase discount sildigra on line. Inderal can be taken anytime regardless of meals, and the therapeutic action of Inderal is not contingent on serum K levels. Cognitive Level: Applying; Client Need: Physiological Integrity; Nursing Process: Planning 2 Answer: 4 Rationale: Beta-adrenergic antagonists may cause hypoglycemic episodes in clients with diabetes. The client should be instructed to monitor blood glucose levels frequently initially, and to notify the prescriber of a decrease. Insulin dosages are never arbitrarily increased without checking with a health care provider. Clients with diabetes should remain on their normal diabetic diets even though they may be taking antihypertensive medications. Elevation of the extremities is not related to a client with diabetes taking beta-adrenergic blocker drugs. Cognitive Level: Applying; Client Need: Health Promotion and Maintenance; Nursing Process: Implementation 3 Answer: 1 Rationale: Initial doses of drugs that cause a "first-dose phenomenon" should be very low doses and administered at bedtime. The decline in blood pressure due to prazosin is often marked when beginning pharmacotherapy and when increasing the dose. This "first-dose phenomenon" can lead to syncope due to reduced blood flow to the brain. Doses of antihypertensive medications should never be doubled, but should be gradually increased to avoid hypotension, and the best time to give prazosin in the initial phases of therapy is at bedtime. Cognitive Level: Applying; Client Need: Physiological Integrity; Nursing Process: Implementation Chapter 19 1 Answer: 1 Rationale: Phenylephrine causes vasoconstriction, reducing the swelling in the nasal passages. While some drugs may be swallowed via the nasopharynx, localized action is predominant, and excessive drug use and swallowing may result in adverse effects. Cognitive Level: Applying; Client Need: Physiological Integrity; Nursing Process: Implementation 2 Answer: 1, 2, 4 Rationale: Adrenergic agonist nasal sprays should not be shared among individuals due to the risk of spreading any infection. Individuals should be taught the dangers of using adrenergic nasal sprays for longer than 3 days. These medications can cause increased blood pressure, increased heart rate, and insomnia. Habitual use of nasal adrenergic agents can also cause rebound congestion, as well as necrosis of the nasal Appendix A 1405 4 Answer: 1 Rationale: the nurse should suspect that the client is describing orthostatic hypotension induced by the medication. Most clients find it helpful to move slowly from a recumbent position to avoid dizziness and syncope. Although drinking a full glass of water with the medication is a health promotion activity that the nurse might suggest, this action does not eliminate orthostatic hypotension. Cognitive Level: Applying; Client Need: Physiological Integrity; Nursing Process: Implementation larger dose of a benzodiazepine to get the same effect as that of a nonsmoker. Cognitive Level: Applying; Client Need: Physiological Integrity; Nursing Process: Implementation Chapter 23 1 Answer: 1 Rationale: Imipramine should not be used by clients with seizure disorders because it lowers the seizure threshold. Imipramine is a drug that is effective in treating depression, and is one of only two drugs approved for enuresis (bedwetting) in children. Cognitive Level: Applying; Client Need: Physiological Integrity; Nursing Process: Implementation 2 Answer: 3 Rationale: Full therapeutic effects of fluoxetine may take up to 1 month. Polyuria is an adverse effect that may occur in early therapy, but is not associated with early toxicity. Cognitive Level: Analyzing; Client Need: Physiological Integrity; Nursing Process: Evaluation 4 Answer: 1 Rationale: the client taking lithium must be conscious of maintaining normal sodium intake. Because lithium is a salt, if sodium intake is low the body will replace the sodium with lithium, leading to lithium toxicity. The client taking lithium must have regular blood studies and toxicity is a very real concern; hence the necessity for routine blood studies. Cognitive Level: Analyzing; Client Need: Physiological Integrity; Nursing Process: Evaluation 5 Answer: 3 Rationale: A typical antidepressant such as venlafaxine may take up to 3 weeks or longer to reach full therapeutic effect, so the client must continue taking the medication as ordered so that therapeutic drug levels can be reached and maintained. Cognitive Level: Analyzing; Client Need: Health Promotion and Maintenance; Nursing Process: Evaluation 6 Answer: 2, 3 Rationale: Fluoxetine causes weight loss in some clients, while other clients experience weight gain or fluctuations in weight. A healthy diet and adequate exercise will help maintain normal weight while on this drug. While rare, an increased risk of suicide has been noted in clients up to age 24, and the client should be carefully monitored, especially during the early initiation of therapy. Cognitive Level: Analyzing; Client Need: Physiological Integrity; Nursing Process: Evaluation 5 Answer: 4 Rationale: One adverse effect of alpha1-adrenergic antagonists is tachycardia. Clients experiencing tachycardia should not receive alpha1-adrenergic antagonists. A pheochromocytoma is a benign tumor of the adrenal medulla that secretes catecholamines. Cognitive Level: Applying; Client Need: Physiological Integrity; Nursing Process: Implementation 6 Answer: 2, 3, 4 Rationale: Beta-adrenergic blockers can have dramatic metabolic effects that produce an increase in serum triglycerides and hypoglycemia. Additionally, these drugs can affect the sexual function of men by producing a decreased libido. Anorexia and thrombocytopenia are not adverse effects associated with beta-adrenergic antagonists. Cognitive Level: Analyzing; Client Need: Physiological Integrity; Nursing Process: Evaluation Chapter 22 1 Answer: 3 Rationale: Ataxia, weakness, restlessness, dizziness, and other motor problems can occur with lorazepam. Cognitive Level: Applying; Client Need: Physiological Integrity; Nursing Process: Implementation 2 Answer: 4 Rationale: Sleeping for 7 h is the desired effect of temazepam. The client will be taking temazepam to assist with insomnia, not to treat anxiety related to everyday stress or to help control panic attacks.
Immediately report any excessive diarrhea erectile dysfunction exam video cheapest generic sildigra uk, especially if it contains mucus or blood erectile dysfunction drugs in homeopathy discount sildigra 120mg mastercard. Because reactions may not always be predictable erectile dysfunction causes emotional order sildigra overnight, caution and frequent monitoring are essential to ensure prompt treatment erectile dysfunction treatment penile injections generic sildigra 120mg without prescription. Protection of the nurse, pharmacy personnel, and others involved in the preparation and administration of chemotherapy is essential. Specific instructions should be obtained from the oncology provider or pharmacist if a spill occurs at home. Encourage the use of calendars for recording drugs and doses used; provide information on handling a liquid spill, and on proper disposal of any unused drug. Chemotherapy should never be flushed down the toilet, poured in a drain, or thrown away in the trash. These drugs enhance the ability of the immune system to respond and reduce some of the myelosuppression caused by antineoplastic medications. Hematopoietic growth factors include epoetin alfa (Epogen, Procrit), filgrastim (Neupogen), and sargramostim (Leukine). Research into the mechanisms of cancer formation has allowed scientists to identify specific proteins (antigens) on the surface of cancer cells that are not present in normal cells. For example, cells in a brain tumor would have different antigens than those of a pancreatic tumor. Indeed, a single type of tumor in a patient may contain cancer cells with varied surface antigens. A targeted therapy is an antineoplastic drug that has been specially engineered to attack these cancer antigens. For example, gemtuzumab ozogamicin (Mylotarg) carries a cytotoxic antitumor antibiotic. Tositumomab (Bexxar) carries radioactive iodine, 131I, to its specific antigen, whereby the tumor cell receives a dose of ionizing radiation. Approved in 2009, everolimus (Afinitor, Zortress) inhibits a different type of kinase and is approved as an antineoplastic agent as well as for the prophylaxis of transplant rejection (see Chapter 45). Approved in 2011, vemurafenib (Zelboraf) was designed to specifically inhibit multiple types of kinases and is indicated for malignant melanoma. Thalidomide (Thalomid) and lenalidomide (Revlimid) are miscellaneous drugs, shown in Table 60. Severe myelosuppression is observed in 15% of patients with a nadir at 3 to 4 weeks and recovery at 6 weeks. Altretamine causes mild to moderate neurotoxicity, including peripheral neuropathy, mood disorders, disorders of consciousness, ataxia, dizziness, and vertigo. Arsenic trioxide (Trisenox): Approved in 2000, arsenic trioxide is a toxic metal that has only one indication: acute promyelocytic leukemia. Leukocytosis, thrombocytopenia, anemia, nausea, vomiting, abdominal pain, diarrhea, constipation, and anorexia are common adverse effects. Neurotoxicity is relatively common and manifests as headache, insomnia, paresthesias, anxiety, dizziness, and tremors. It is only approved to treat acute lymphocytic leukemia in combination with other antineoplastics. Hypersensitivity reactions occur in 40% of patients with symptoms ranging from urticaria to anaphylactic shock. Pretreatment with corticosteroids reduces the incidence of hypersensitivity reactions. This drug is hepatotoxic and may cause hypoalbuminemia and decreased synthesis of coagulation factors. Lethargy, confusion, impaired cognition, and drowsiness are common neurotoxic effects. Pegylation increases the half-life of the drug and allows for less frequent dosing: 3 injections of pegaspargase versus 21 injections of asparaginase. Bexarotene (Targretin): Approved in 1999, bexarotene is a retinoid, a group of agents related to vitamin A that are usually used for skin conditions such as psoriasis and acne (see Chapter 76). Adverse effects of the oral formulation include hyperlipidemia, hypothyroidism, acute pancreatitis, leukopenia, headache, asthenia, anemia, anorexia, and photosensitivity. Hydroxyurea (Droxia, Hydrea, Mylocel): Hydroxyurea is an oral antineoplastic approved in 1967 for chemotherapy of chronic myelogenous leukemia, head and neck cancers, malignant melanoma, and ovarian cancer. It may be used off-label for acute myelogenous leukemia, astrocytoma, lung cancer, and malignant glioma. Some antineoplastics are classified as miscellaneous because they are structurally dissimilar to any of the previously discussed groups. Altretamine (Hexalen): Altretamine is an oral antineoplastic that has effects similar to those of alkylating agents. When metabolized it forms toxic metabolites that bind to cellular macromolecules, resulting in a cytotoxic effect. This drug carries a black box warning that longterm use may cause secondary leukemias. Ixabepilone (Ixempra): Approved in 2007, ixabepilone acts by the same mechanism as the taxanes but it has different pharmacokinetic properties. It is used in combination with capecitabine to treat metastatic or advanced breast cancer resistant to treatment with first-line medications such as the taxanes. At least 20% of patients experience alopecia, diarrhea, fatigue, asthenia, musculoskeletal pain, peripheral sensory neuropathy, stomatitis, mucositis, nausea, and vomiting. Because the drug is cytotoxic to the adrenal gland, symptoms of acute adrenal insufficiency may emerge. Romidepsin (Istodax) and vorinostat (Zolinza): these two drugs induce apoptosis in cancer cells by inhibiting the activity of the enzyme histone deacetylase.
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