Archived Message board responses
(Categorized by date - most recent listed first)

Does anyone have experience with Nafcillin for Intra-
peritoneal use??

Personally, I have seen vanco used much more frequently for staph. However, if the cultured organism is methicillin-sensitive it is more clinically sound to use a cephalosporin or anti-staphylococcal penicillin and reserve vancomycin for resistant strains. Studies have used 125mg of Nafcillin per liter at each exchange. Here is a link to the 2000 treatment guidelines.....

Another Link to the 1996 guidelines: (if using internet explorer hit ctrl F once you open the document and search for nafcillin).
1996 recommendations

• ADULT PERITONEAL DIALYSIS-RELATED PERITONITIS TREATMENT RECOMMENDATIONS: 2000 Update

is there any information on how to prevent cellulitis in adults or any self help if contracted the disease

Many of the common preventive measures focus on basic skin care. I will provide you with a couple of links that have published guidelines for cellulitis:

Here is an excerpt from druginfonet: Causes of cellulitis are quite diverse. Essentially, any break in the skin's defense can become infected. This includes burns, swelling and stretching of the skin, lacerations, bruises, abrasions, animal bites, scratches, or even insect bites (although insect bites get infected less commonly). The specific appearance, behavior, and treatment of a given cellulitis varies with the infecting organism, and the immune defense of the individual patient. In severe cases, untreated cellulitis can progress to skin death (necrosis).

Here is some preventive measures from RXmed: * Avoid skin damage. Use protective clothing if you participate in strenuous work or contact sports.
* Keep the skin clean.
* Avoid swimming if you have a skin lesion.
* In diabetes, strive to attain good blood sugar control

Are there precautions or contraindications to admin. fluoroquinolones in pt. with Crohn's disease.

The presence of other medical problems may affect the use of fluoroquinolones, however crohn's disease is not one of them.
Conditions which may have an impact include: (Source: National Institutes fo Health: Medlineplus)

Brain or spinal cord disease, including hardening of the arteries in the brain or epilepsy or other seizures--Fluoroquinolones may cause nervous system side effects.

Diabetes mellitus--Levofloxacin may cause changes in blood sugar, which could lead to problems in controlling blood sugar.

Heart disease-- Gatifloxacin, moxifloxacin or sparfloxacin may exacerbate this condition.

Kidney disease or
Liver disease--Patients with kidney disease or liver disease may have an increased chance of side effects with any of the fluoroquinolones.

Sensitivity of the skin to sunlight (previous)--Patients taking sparfloxacin or any of the other fluoroquinolones may have an increased risk of severe reactions to sunlight.

Tendinitis (previous)--Fluoroquinolones may increase the risk of tendon injury.

------------
If you want to search the literature for medications that should be used with caution or not at all in patient's with crohn's disease, use the following link to search Medline. Enter something like crohn's precautions, or crohn's contraindications. Finally, just to make sure there hasn't been any reported cases of adverse effects--search for crohn's fluoroquinolones. The program does not require the word "and". It will submit your request and will search for the presence of both words...

QUESTION:
pt is s/p knee arthroplasty
and also has a systolic heart mumur and questionable
mitral regurgitation. Has a history of hematuria with
anticoagulation. Was not on any anticoagulants prior to
surgery.
Post-op he was started on warfarin prophylaxis.
Trying to figure out if this is the best choice for
this patient. Any thoughts?

Warfarin is still commonly used at various medical centers across the country following hip and knee arthroplasty. One of the main concerns with this drug is obviously followup. The patient will have to maintain a consistent diet, and have appropriate laboratory monitoring. There is usually a greater success rate (shorter time to therapeutic levels: INR 2-3) if the patient is followed by an anticoagulation clinic. Some medical centers have switched to low molecular weight heparins such as Lovenox. Studies have shown an increase in efficacy--sometime significant compared to warfarin. Here is a quick excerpt from Aventis:
A double-blind, randomized, multicenter trial
of 417 evaluable knee-replacement patients
treated up to 14 days postop

All patients were followed for 6 months

Patients received either LOVENOX 30 mg
q12h SC or warfarin (INR:2.0 to 3.0)

Those receiving LOVENOX experienced a
relative risk reduction of 28.6% compared
with warfarin (P=0.003)

There was no statistical difference in the
incidence of major hemorrhage‡ between
the two groups (1.8% and 2.1% for warfarin
and LOVENOX, respectively)

------

In sum, the physician's choice to use warfarin is an appropriate intervention based on the current literature

I am currently on 3 patches of Duragesic 100 ug/hourly every 48 hourss change. My doctor has changed me to Dilaudid oral. The patches were no longer providing pain relief. He put me on 4mg of Dilaudid 4 times daily. However, when I calculate the amount it does not jive and seems that I am taking much less. I am worried that I will go into withdrawl. please help before I start.

The fentanyl patch calculator is based on the table found here. Duragesic is a very potent narcotic analgesic. I would suggest printing out the page that contains the table and schedule a follow-up visit with your presciber. By the way, how long have you been on the Duragesic patches, and what is your current diagnosis. Further, you are correct in your analysis of comparable potencies.

Hope this helps...

Does anyone have experience with Thymoglobulin in the home?

Here are some guidelines from the National Institutes of Health: (standard operating procedure) 
Background Information

Currently there are two ATG products .
Thymoglobulin is produced from serum of rabbits and is 10X more potent than Atgam.
Atgam is produced from serum of horses.
These 2 products are not interchangeable. Desensitization Infusion is delivered as a continuous infusion X 4 days.
Intermittent Infusion is delivered as an intermittent infusion on 4 consecutive days.
II. General

Assessment
Patients may undergo ATG intradermal skin test to determine ATG 24-hour infusion delivery mode, i.e., desensitization infusion or intermittent daily infusions. 72 hours prior to intradermal skin test, patients should avoid use of H1 receptor antagonists (antihistamines)
Prior to initiation of ATG, RN will:
Assess recent use (within 72 hours) of beta blockers, steroids, and H1 receptor antagonists ...... (the rest of the document can be found here) Let me know if this helps..

How low does is take for a bruise to appear after some kind of trauma?

Bruising can occur rapidly depending on the inciting condition. A bruise is a hemorrhage under the skin that occurs as a result of trauma to the skin itself or the underlying tissue. Small capillaries burst and blood seeps beneath the skin or layers of tissue and cause discoloration. Most bruises are not serious and look much worse than the actual injury but there can be complications from some. A bruise that is deep, swells or feels hot might be something more than just a minor black and blue spot. Heavy bruising can leave clots that can cause some very serious health risks. If there is swelling, fever or pain, you need to consult a physician. (Notice I said PAIN and not just minor discomfort.)

There are several things that can raise the potential for bruises. Certain medications cause the body to bruise much easier, among them are blood thinners, medications for hypertension, certain antidepressants or aspirins, to name just a few. There are some medical ways to help prevent or reduce bruises. One way is to be sure that you are eating a well balanced diet.

Is anyone familiar with a drug called Poly MVA? Can you direct me to detailed information?

Poly MVA is a compound comprised of the element paladium and a potent anti-oxidant (alpha lipoic acid). Poly-MVA is undergoing advance trials in the United States for otherwise untreatable brain tumors. Some clinical studies have shown that higher concentrations of alpha lipoic acid exhibit antiproliferative effects.
Here is an example of one of these studies:

Mantovani G, Maccio A, Melis G, Mura L, Massa E, Mudu MC. Restoration of functional defects in peripheral blood mononuclear cells isolated from cancer patients by thiol antioxidants alpha-lipoic acid and N-acetyl cysteine.
Int J Cancer. 2000 Jun 15;86(6):842-7.

Some alternative medicine related sites are really jumping on these new studies. Many of these sites advise against traditional chemotherapeutic regimens for the treatment of malignancies and push non-traditional therapies.

Here is an except from one of these sites:
Seventy years of study have demonstrated that cancer cells have a highly altered energy metabolism, including increased glycolysis and a shift to the use of glutamine to drive the TCA cycle. The primary source of this tumor specific energy metabolism is the pyruvate dehydrogenase (PDH) complex. The PDH complex is the likely target for the cancer cell killing observed by Poly-MVA. It has been found that cells are substantially sensitized to killing by Poly-MVA by partial deprivation for either glucose or glutamine. Also, it has been observed that the capacity of mitochondrial membranes to maintain characteristic transmembrane potential is strongly and specifically reduced in cancer cells in the presence of Poly-MVA.

Other studies strongly suggest that the tumor-specific alteration of energy patterns represent the activation of a wound healing cellular program. Moreover, the functioning of this program likely involves a process in which tumor cells both provoke deposition of a highly charged wound extracellular matrix (ECM) and, in turn, react to the presence of this specialized ECM. In the laboratory, the Poly-MVA produces specific killing of transformed cells that are adherent to highly charged surfaces but not cells that are adherent to relatively uncharged surfaces. This is highly provocative in light of the properties of tumor ECM. (Source: http://www.naturalbiologics.com/Therapies/nontoxic.html)

Finally, here is a website that contains some pertinent links on this subject: Poly MVA Survivors

-------
Please keep me posted on your progress..

____________________________________

Posted by Tim Matson-Administrator of www.polymvasurvivors.com site on June 12, 2001 at 13:20:54:
Call toll free 888-547-8020 or go online to www.polymvasurvivors.com for info. and Testimonials

______________________________________

Posted by John C. Batulis on August 30, 2001 at 21:54:36:

An interesting read is FIRST PULSE, A Personal Journey in Cancer Research by Dr. Merrill Garnett

Can this drug (Ibutilide) be used for SVT refractory to adenocard or is it indicated for atrial fibrillation only?

In Reply to: ibutilide posted by William Dicindio, D.O. on April 13, 2001 at 11:50:10:

As you know, there have been some significant changes in the ACLS guidelines in the past year. Some of the new algorithms do not even resemble protocols we have used for years. The 2000 ACLS guidelines place a new emphasis on ejection fraction to guide continued therapy. In the treatment of SVT, therapy can be initialized with adenosine, however, subsequent therapy must be based on the patients estimated ejection fraction. If the patient’s ejection fraction is > 40 (absence of CHF), the trial of medications listed in order of relevance are: (1) calcium channel blockers (2) Beta blocker (3)Digoxin (4) DC cardioversion. // Consider amiodarone, procainamide, or sotalol. For patients with an ejection fraction of < 40, or CHF: Attempt control with amiodarone, digoxin, or diltiazem.

Now on to ibutilide: The new ACLS guidelines put additional restrictions on this drug. The drug should only be used in the treatment of Atrial Fibrillation/Flutter of recent onset (<48 hours) and only in those patients who have an estimated ejection fraction of > 40%.

Hope this helps. Currently, I have only the previous guidelines listed on this site: http://www.globalrph.com/acls.htm

Conclusion: your initial assumption was obviously correct...