K
kanamycin sulfate
Brand Name(s): Kantrex
Clinical Pharmacology:Mechanism of Action: An aminoglycoside antibacterial that irreversibly binds to protein on bacterial ribosomes. Therapeutic Effect: Interferes with protein synthesis of susceptible microorganisms.
Pharmacokinetics: Negligible amounts are absorbed through intact intestinal mucosa. Protein binding: 0%-3%. Minimally metabolized in liver. Partially excreted in feces; small amounts eliminated in urine. Removed by hemodialysis. Half-life: approximately 2 hr.
Available Forms:
Indications and Dosages:Short-term treatment of serious infections: IV 15 mg/kg/day. IM 15 mg/kg/day in 2 divided dosages administered at equally divided intervals (75 mg/kg q12h). If continuously high blood levels are desired, the daily dose of 15 mg/kg may be given in equally divided doses q6-8h.
Dosage in renal impairment: GFR > ml/min. 60%-90% of normal dose q8-12h. GFR 10-50 ml/min. 30%-70% of normal dose q12h. GFR, 10 ml/min. 20%-30% of normal dose q24-48h.
Contraindications: Hypersensitivity to other aminoglycosides (cross-sensitivity), or their components, long-term therapy
Side Effects
Serious Reactions
• Serious reactions may include nephrotoxicity (as evidenced by increased thirst, decreased appetite, nausea, vomiting, increased BUN and serum creatinine levels, and decreased creatinine clearance), neurotoxicity (manifested as muscle twitching, visual disturbances, seizures, and tingling), and ototoxicity (as evidenced by tinnitus, dizziness, and loss of hearing).
Patient/Family Education
Monitoring Parameters
• Serum peak drawn at 30-60 min after IV INF or 60 min after IM inj, trough level drawn just before next dose; adjust dosage per levels, especially in renal function impairment (usual therapeutic plasma levels; peak 15-30 mg/L, trough ≤10 mg/L)
Geriatric side effects at a glance:
U.S. Regulatory Considerations
ketoconazole
Brand Name(s): Nizoral, Nizoral Topical
Clinical Pharmacology:Mechanism of Action: A fungistatic antifungal that inhibits the synthesis of ergosterol, a vital component of fungal cell formation. Therapeutic Effect: Damages the fungal cell membrane, altering its function.
Pharmacokinetics: Well absorbed from GI tract following PO administration. Protein binding: 91%-99%. Metabolized in liver. Primarily excreted in bile with minimal elimination in urine. Negligible systemic absorption following topical absorption. Ketoconazole is not detected in plasma after shampooing or topical administration. Half-life: 2-12 hr.
Available Forms:
Indications and Dosages:Histoplasmosis, blastomycosis, systemic candidiasis, chronic mucocutaneous candidiasis, coccidioidomycosis, paracoccidioidomycosis, chromomycosis, seborrheic dermatitis, tinea corporis, tinea capitis, tinea manus, tinea cruris, tinea pedis, tinea unguium (onychomycosis), oral thrush, candiduria: PO 200-400 mg/day. Topical Apply to affected area 1-2 times a day for 2-4 wk. Shampoo Use twice weekly for 4 wk, allowing at least 3 days between shampooing. Use intermittently to maintain control.
Unlabeled Uses: Systemic: Treatment of fungal pneumonia, prostate cancer, septicemia
Contraindications: None known.
Side Effects
Serious Reactions
• Hematologic toxicity (as evidenced by thrombocytopenia, hemolytic anemia, and leukopenia) occurs occasionally.
Patient/Family Education
