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Effects on Bleeding No information available to require special precautions Adverse Reactions >10%: Gastrointestinal: Abdominal pain (14% to 29%) lymphocytic gastritis definition purchase allopurinol 300 mg amex, flatulence (13%) gastritis in chinese discount allopurinol generic, nausea (9% to 12%) 1% to 10%: Central nervous system: Dizziness (7%), headache (4%), anxiety (2%), chills (1%) Dermatologic: Hyperhidrosis (3% to 6%) Endocrine & metabolic: Hot flash (3%) Gastrointestinal: Diarrhea (5% to 6%), abdominal distention (4%), vomiting (2%) Neuromuscular & skeletal: Muscle spasm (2%), tremor (1%) Respiratory: Rhinorrhea (2%) <1%, postmarketing, and/or case reports: Abdominal cramps, diaphoresis, flushing, gastrointestinal perforation, increased body temperature (Thomas 2008), malaise, opioid withdrawal syndrome, pain, syncope (Portenoy 2008) Mechanism of Action An opioid receptor antagonist which blocks opioid binding at the mu receptor, methylnaltrexone is a quaternary derivative of naltrexone with restricted ability to cross the blood-brain barrier. It therefore functions as a peripheral acting opioid antagonist, including actions on the gastrointestinal tract to inhibit opioid-induced decreased gastrointestinal motility and delay in gastrointestinal transit time, thereby decreasing opioid-induced constipation. Local Anesthetic/Vasoconstrictor Precautions No information available to require special precautions Pharmacodynamics/Kinetics Half-life Elimination Terminal: ~15 hours (oral) Time to Peak SubQ: 30 minutes; Oral: ~1. Maternal use of methylnaltrexone during pregnancy may precipitate opioid withdrawal effects in newborn. Effects on Bleeding No information available to require special precautions Mechanism of Action Methylfolate, or L-methylfolate, is the active form of folate in the body, which can be transported into peripheral tissues and across the blood-brain barrier. Opioid-induced constipation with chronic non-cancer pain (tablets and injection): Treatment of opioidinduced constipation in adults with chronic non-cancer pain, including patients with chronic pain related to prior cancer or its treatment who do not require frequent (eg, weekly) opioid dosage escalation. Dermatologic: Bullous dermatitis herpetiformis; contact dermatitis; exfoliative dermatitis; exfoliative erythroderma; mycosis fungoides; pemphigus; erythema multiforme (Stevens-Johnson syndrome); severe psoriasis; severe seborrheic dermatitis. Endocrine: Congenital adrenal hyperplasia; hypercalcemia associated with cancer; nonsuppurative thyroiditis; primary or secondary adrenocortical insufficiency (hydrocortisone or cortisone is the first choice; synthetic analogs may be used in conjunction with mineralocorticoids where applicable). Nervous system: Acute exacerbations of multiple sclerosis; cerebral edema associated with primary or metastatic brain tumor, craniotomy, or head injury (excluding oral). Ophthalmic: Oral: Severe acute and chronic allergic and inflammatory processes involving the eye and its adnexa such as allergic conjunctivitis; allergic corneal marginal ulcers; anterior segment inflammation; chorioretinitis; diffuse posterior uveitis and choroiditis; herpes zoster ophthalmicus; iritis and iridocyclitis; keratitis; optic neuritis; sympathetic ophthalmia; uveitis. Data collection to monitor pregnancy and infant outcomes following exposure to methylphenidate is ongoing. Health care providers are encouraged to enroll females exposed to methylphenidate during pregnancy in the National Pregnancy Registry for Psychostimulants at 1-866-961-2388. Renal: To induce diuresis or remission of proteinuria in nephrotic syndrome, with or without uremia, of the idiopathic type or that due to lupus erythematosus. Respiratory: Aspiration pneumonitis (oral only); asthma; berylliosis; fulminating or disseminated pulmonary tuberculosis when used concurrently with appropriate antituberculous chemotherapy; idiopathic eosinophilic pneumonias; symptomatic sarcoidosis. Rheumatic: As adjunctive therapy for short-term administration in acute rheumatic carditis, acute gout flares, ankylosing spondylitis, dermatomyositis, polymyositis, psoriatic arthritis, rheumatoid arthritis (including juvenile rheumatoid arthritis), systemic lupus erythematosus; as adjunctive therapy for short-term administration in acute and subacute bursitis, acute nonspecific tenosynovitis, epicondylitis, posttraumatic osteoarthritis, relapsing polychondritis, synovitis of osteoarthritis (oral only). Intra-articular or soft tissue administration (methylprednisolone acetate only): As adjunctive therapy for short-term administration in acute gouty arthritis, acute and subacute bursitis, acute nonspecific tenosynovitis, epicondylitis, rheumatoid arthritis, and/or synovitis of osteoarthritis. Intralesional administration (methylprednisolone acetate only): Alopecia areata; discoid lupus erythematosus; keloids; localized hypertrophic; infiltrated, inflammatory lesions of granuloma annulare; lichen planus; lichen simplex chronicus (neurodermatitis); psoriatic plaques; necrobiosis lipoidica diabeticorum. Oral: 4 to 48 mg/day in 1 to 4 divided doses initially, followed by gradual reduction in dosage to the lowest possible level consistent with maintaining an adequate clinical response. Intralesional (acetate): 20 to 60 mg; for large lesions, it may be necessary to distribute doses ranging from 20 to 40 mg by repeated local injections; 1 to 4 injections are usually employed with intervals between injections varying with the type of lesion being treated and clinical response. If continuous infusion insulin is employed, maintain blood glucose 120 to 180 mg/dL (Rosendale 2003a; Rosendale 2003b; Rosengard 2002; Salim 2007; Zaroff 2002). If symptoms improve, complete 3-day course of treatment, then taper dose over 2 weeks. If used in this setting, methylprednisolone should not be initiated >8 hours after the injury; not effective in penetrating trauma (eg, gunshot) (Consortium for Spinal Cord Medicine 2008). Pediatric Note: Adjust dose depending upon condition being treated and response of patient. Pneumocystis pneumonia; moderate or severe infection: Note: Initiate therapy within 72 hours of diagnosis, if possible. Mechanism of Action In a tissue-specific manner, corticosteroids regulate gene expression subsequent to binding specific intracellular receptors and translocation into the nucleus. Corticosteroids exert a wide array of physiologic effects including modulation of carbohydrate, protein, and lipid metabolism and maintenance of fluid and electrolyte homeostasis. Moreover cardiovascular, immunologic, musculoskeletal, endocrine, and neurologic physiology are influenced by corticosteroids. Decreases inflammation by suppression of migration of polymorphonuclear leukocytes and reversal of increased capillary permeability. Serious neurologic events (eg, spinal cord infarction, paraplegia, quadriplegia, cortical blindness, stroke), some resulting in death, have been reported with epidural injection of corticosteroids, with and without use of fluoroscopy. Time to onset can be several weeks or longer; resolution has been observed after discontinuation of therapy. Avoid use of high doses in patients with a history of methylprednisoneinduced toxic hepatitis.

Diseases

• Hereditary pancreatitis
• Verloes Van Maldergem Marneffe syndrome
• Mesomelic dwarfism Reinhardt Pfeiffer type
• Neurofibrillary tangles
• Von Gierke disease
• Ciguatera fish poisoning

Insulin aspart may be 721 Adverse Reactions >10%: Endocrine & metabolic: Hypoglycemia (47% to 75%) diet of gastritis patient order generic allopurinol pills, severe hypoglycemia (4% to 16%) Frequency not defined: Cardiovascular: Peripheral edema Endocrine & metabolic: Hypokalemia gastritis snacks discount allopurinol 300mg otc, weight gain Hypersensitivity: Anaphylaxis, hypersensitivity reaction Immunologic: Antibody development Local: Hypersensitivity at injection site (including edema, erythema, or pruritus), lipoatrophy at injection site, lipotrophy at injection site Mechanism of Action Insulin acts via specific membrane-bound receptors on target tissues to regulate metabolism of carbohydrate, protein, and fats. Insulin aspart differs from human insulin by containing aspartic acid at position B28 in comparison to the proline found in human insulin. Use Diabetes mellitus: To improve glycemic control in patients 1 year of age and older with type 1 or type 2 diabetes mellitus Local Anesthetic/Vasoconstrictor Precautions No information available to require special precautions Effects on Dental Treatment Key adverse event(s) related to dental treatment: In general, morning appointments are advisable in patients with diabetes since endogenous cortisol levels are typically higher at this time; because cortisol increases blood sugar levels, the risk of hypoglycemia is less. It is important to confirm that the patient has eaten normally prior to the appointment and has taken all scheduled medications. Effects on Bleeding No information available to require special precautions Pharmacodynamics/Kinetics Onset of Action 10 to 20 minutes; Peak effect: 1 to 4 hours Duration of Action Novolog Mix 50/50: ~13 hours; Novolog Mix 70/30: 18 to 24 hours Half-life Elimination Novolog Mix 50/50: 5. Most available information for use of insulin aspart in pregnancy is from studies using the rapid action solution. Adverse Reactions 10%: Central nervous system: Headache (9% to 12%) Endocrine & metabolic: Severe hypoglycemia (type 1 diabetics on combination insulin therapy: 10% to 18%; type 2 diabetics on combination therapy: 5%) Immunologic: Antibody development Respiratory: Nasopharyngitis (13% to 24%), upper respiratory tract infection (8% to 12%) 1% to 10%: Cardiovascular: Peripheral edema (type 2 diabetes: 3%; type 1 diabetes: <1%) Gastrointestinal: Diarrhea (type 2 diabetes: 6%), gastroenteritis (type 1 diabetes: 5%) Local: Injection site reaction (4%; including discoloration, erythema, hematoma, hemorrhage, mass, nodules, pain, pruritus) Respiratory: Sinusitis (type 1 diabetes: 5%) Frequency not defined: Endocrine & metabolic: Hypokalemia, weight gain <1%, postmarketing and/or case reports: Hypersensitivity reaction, hypertrophy at injection site (lipohypertrophy), lipoatrophy at injection site, urticaria Mechanism of Action Insulin acts via specific membrane-bound receptors on target tissues to regulate metabolism of carbohydrate, protein, and fats. Insulin degludec differs from human insulin by the omission of the amino acid threonine in position B-30 of the B-chain, and the subsequent addition of a side chain composed of glutamic acid and a C16 fatty acid. Staff should be trained to recognize the signs (eg, unusual behavior or profuse sweating in patients who have diabetes) and treat patients who have hypoglycemia; a glucometer should be used to test patient blood glucose levels. Effects on Bleeding No information available to require special precautions Adverse Reactions >10%: Endocrine & metabolic: Hypoglycemia (type 1 diabetes patients using combination insulin regimen: 93% to 95%; type 2 diabetes patients on a combination regimen: 50% to 74%), severe hypoglycemia (type 1 diabetes patients using combination insulin regimen: 6% to 13%; type 2 diabetes patients on a combination regimen: 3%) Immunologic: Antibody development Respiratory: Nasopharyngitis (type 1 diabetes: 25%; type 2 diabetes: 11%) 1% to 10%: Cardiovascular: Peripheral edema (2%) Central nervous system: Headache (6% to 10%) Infection: Influenza (type 1 diabetes: 7%) Local: Injection site reaction (2%; including erythema at injection site, hematoma at injection site, hemorrhage, injection site nodule, injection site pruritus, mass, pain at injection site, skin discoloration at injection site, swelling at injection site, and warmth) Respiratory: Upper respiratory tract infection (6% to 9%) <1%, postmarketing and/or case reports: Hypersensitivity reaction, hypertrophy at injection site, lipotrophy at injection site, urticaria Pharmacodynamics/Kinetics Onset of Action ~1 hour Half-life Elimination ~25 hours (independent of dose) Time to Peak 9 hours Pregnancy Considerations Adverse events were observed in animal reproduction studies secondary to maternal hypoglycemia. Information specific to insulin degludec use in pregnant women is limited (Milluzzo 2017). Mechanism of Action Insulin acts via specific membrane-bound receptors on target tissues to regulate metabolism of carbohydrate, protein, and fats. Insulin promotes hepatic synthesis of fatty acids, which are released into the circulation as lipoproteins. Endocrine & metabolic: Hypoglycemia Local: Hypertrophy at injection site, lipoatrophy at injection site <1%, postmarketing, and/or case reports: Abdominal distension, abdominal pain, allergic skin reaction, anaphylaxis, constipation, decreased appetite, dyspepsia, eructation, flatulence, gastritis, gastroesophageal reflux disease, hypersensitivity reaction, severe hypoglycemia, urticaria, vomiting Mechanism of Action Refer to individual agents. Pharmacodynamics/Kinetics Onset of Action Insulin aspart: 14 minutes Duration of Action Insulin degludec: >24 hours Half-life Elimination Insulin degludec: ~25 hours Time to Peak Insulin aspart: 72 minutes Pregnancy Considerations Refer to individual monographs. Every dental office should have a protocol for managing hypoglycemia in conscious and unconscious patients. Insulin detemir differs from human insulin by the omission of threonine in position B30 and the addition of a C14 fatty acid chain to the amino acid located at position B29. Women who are stable on insulin detemir prior to conception may continue it during pregnancy. Having snack foods or oral glucose tablets or gels available, especially in practices where a large number of surgical procedures are performed, is also prudent (American Diabetes Association 2017). Effects on Bleeding No information available to require special precautions 725 Pharmacodynamics/Kinetics Onset of Action 3 to 4 hours; Peak effect: 3 to 9 hours (Plank 2005) Duration of Action Dose dependent: 6 to 23 hours; Note: At lower dosages (0. Half-life Elimination 5 to 7 hours (dose-dependent) Time to Peak Plasma: 6 to 8 hours Pregnancy Risk Factor B Pregnancy Considerations Insulin detemir has been detected in cord blood. Skeletal muscle effects of insulin include increased protein synthesis and increased glycogen synthesis. Insulin glargine differs from human insulin by adding two arginines to the C-terminus of the B-chain in addition to containing glycine at position A21 in comparison to the asparagine found in human insulin. Insulins are categorized based on the onset, peak, and duration of effect (eg, rapid-, short-, intermediate-, and 726 long-acting insulin). Pharmacodynamics/Kinetics Onset of Action Basaglar: Peak effect: No pronounced peak Lantus: 3 to 4 hours; Peak effect: No pronounced peak Toujeo: 6 hours; Peak effect: Maximum glucose lowering effect may take up to 5 days with repeat dosing; at steady state, the 24-hour glucose lowering effect is ~27% lower than that of Lantus at equivalent doses. Duration of Action Lantus, Basaglar: Generally 24 hours or longer; reported range (Lantus): 10. Women who are stable on insulin glargine prior to conception may continue it during pregnancy. Theoretical concerns of insulin glargine should be discussed prior to conception (Blumer 2013). Pregnancy Considerations Adverse events were observed in some animal reproduction studies. Effects on Bleeding No information available to require special precautions Adverse Reactions >10%: Endocrine & metabolic: Severe hypoglycemia (1% to 8%; children and adolescents, type 1 diabetes: 16%) Respiratory: Nasopharyngitis (8% to 11%), upper respiratory tract infection (7% to 11%) 1% to 10%: Cardiovascular: Peripheral edema (8%; adults, type 2 diabetes), hypertension (4%; adults, type 2 diabetes) Central nervous system: Headache (7%; children and adolescents, type 1 diabetes), hypoglycemic seizure (6%; children and adolescents, type 1 diabetes) Endocrine & metabolic: Hypoglycemia (7%; adults, type 1 diabetes) Hypersensitivity: Hypersensitivity reaction (4%) Infection: Influenza (4% to 6%) Local: Infusion site reaction (10%) Neuromuscular & skeletal: Arthralgia (6%; adults, type 2 diabetes) Frequency not defined: Dermatologic: Pruritus, skin rash Endocrine & metabolic: Hypokalemia, weight gain Hypersensitivity: Anaphylaxis Immunologic: Antibody development (no effect on drug efficacy) Local: Erythema at injection site, hypertrophy at injection site, itching at injection site, lipoatrophy at injection site, swelling at injection site <1%, postmarketing, and/or case reports: Catheter complication Mechanism of Action Insulin acts via specific membrane-bound receptors on target tissues to regulate metabolism of carbohydrate, protein, and fats. Insulin glulisine differs from human insulin by containing a lysine and glutamic acid at positions B3 and B29, respectively, in comparison to the asparagine and lysine found at B3 and B29 in human insulin.

Pneumonia gastritis symptoms itching generic allopurinol 300mg on line, hospital-acquired (nosocomial): Treatment of moderate to severe hospital-acquired (nosocomial) pneumonia caused by beta-lactamaseproducing strains of Staphylococcus aureus and by piperacillin/tazobactam-susceptible Acinetobacter baumannii gastritis diet 40 quality allopurinol 300mg, H. Skin and skin structure infections: Treatment of skin and skin structure infections, including cellulitis, cutaneous abscesses, and ischemic/diabetic foot infections caused by beta-lactamase-producing strains of S. Local Anesthetic/Vasoconstrictor Precautions No information available to require special precautions Effects on Dental Treatment Pioglitazone-dependent patients with diabetes (noninsulin dependent, type 2) or metformin-dependent patients with diabetes (noninsulin dependent, type 2) should be appointed for dental treatment in morning in order to minimize chance of stress-induced hypoglycemia. Effects on Bleeding No information available to require special precautions Adverse Reactions Percentages of adverse effects as reported with the combination product. The clinical significance may be greater with those penicillins that are combined with a betalactamase inhibitor and/or with agents that have greater activity against specific enteric bacterial species. Metformin decreases hepatic glucose production, decreasing intestinal absorption of glucose, and improves insulin sensitivity (increases peripheral glucose uptake and utilization). Tazobactam inhibits many beta-lactamases, including staphylococcal penicillinase and Richmond-Sykes types 2, 3, 4, and 5, including extended spectrum enzymes; it has only limited activity against class 1 beta-lactamases other than class 1C types. Normal platelet function should occur in ~5 elimination half-lives or in <10 hours after discontinuation of piroxicam. Due to pregnancy-induced physiologic changes, some pharmacokinetic properties of piperacillin/tazobactam may be altered (Bourget 1998). Piperacillin/tazobactam is approved for the treatment of postpartum gynecologic infections, including endometritis or pelvic inflammatory disease, caused by susceptible organisms. Effects on Dental Treatment Key adverse event(s) related to dental treatment: Assess unusual presentations of muscle weakness or myopathy resulting from lipid therapy such as patient having a difficult time brushing teeth or weakness with chewing. Pharmacodynamics/Kinetics Onset of Action Analgesia: Oral: Within 1 hour; Maximum effect: 3 to 5 hours Half-life Elimination Children and Adolescents 7 to 16 years: 32. Pharmacodynamics/Kinetics Half-life Elimination ~12 hours Time to Peak ~1 hour Pregnancy Considerations Pitavastatin is contraindicated in pregnant females or those who may become pregnant. Pitavastatin should be discontinued immediately if an unplanned pregnancy occurs during treatment. Adverse Reactions 1% to 10%: Cardiovascular: Hypertension (2%), hypotension (1%) Central nervous system: Headache (1%) Gastrointestinal: Diarrhea (2%), nausea (1%), vomiting (1%) Genitourinary: Nephrotoxicity (4%) Otic: Ototoxicity (2%) Renal: Increased serum creatinine (4%; CrCl: 30 to 90 mL/minute: 10%), acute renal failure (4%), decreased creatinine clearance (4%), renal disease (4%), renal failure syndrome (4%), renal insufficiency (4%) Frequency not defined: Central nervous system: Dizziness Endocrine & metabolic: Hypokalemia Gastrointestinal: Constipation, gastritis Genitourinary: Hematuria Hepatic: Increased serum alanine aminotransferase Respiratory: Dyspnea <1%, postmarketing, and/or case reports: Hypoacusis (reversible), tinnitus (irreversible), vertigo Mechanism of Action Interferes with bacterial protein synthesis by binding to 30S ribosomal subunit resulting in a defective bacterial cell membrane. Local Anesthetic/Vasoconstrictor Precautions No information available to require special precautions Effects on Dental Treatment Key adverse event(s) related to dental treatment: Oral mucosal ulcers have been reported; prolonged use may result in oral opportunistic fungal infections Effects on Bleeding No information available to require special precautions Adverse Reactions 1% to 10%: Gastrointestinal: Diarrhea, nausea Genitourinary: Vulvovaginal candidiasis <1%, postmarketing, and/or case reports: Abdominal pain, abnormal hepatic function tests, acute porphyria, anaphylaxis, Clostridioides (formerly Clostridium) difficile colitis, decreased plasma carnitine concentrations, dizziness, dyspepsia, erythematous rash, esophageal ulcer, esophagitis, fatigue, headache, hypersensitivity reaction, macular eruption, maculopapular rash, oral mucosa ulcer, pruritus, skin rash, thrombocytopenia, urticaria, vertigo, vomiting Mechanism of Action Pivmecillinam is a 6-aminopenicillanic acid derivative that is metabolized to the active form of the drug, mecillinam. There are several reports of total irreversible bilateral congenital deafness in children whose mothers received another aminoglycoside (streptomycin) during pregnancy. Although serious side effects to the fetus/ infant have not been reported following maternal use of all aminoglycosides, a potential for harm exists. The manufacturer notes pivmecillinam may be used in pregnancy when clinically needed. Product Availability Selexid: Health Canada approved July 2016; anticipated availability is unknown. Pregnancy Considerations Plecanatide and its metabolite are not measurable in plasma when used at recommended doses. Women of reproductive potential should use effective contraceptive measures to avoid becoming pregnant during treatment. Effects on Bleeding No information available to require special precautions Adverse Reactions Adverse reactions reported with filgrastim combination therapy. Limited data related to systemic use in pregnancy are available (Heinonen 1977; Kazy 2005). Based on the relative toxicity compared to other antibiotics, systemic use in pregnancy is not recommended (Knothe 1985). Due to poor tissue diffusion, topical use would be expected to have only minimal risk to the mother or fetus (Leachman 2006). Local Anesthetic/Vasoconstrictor Precautions No information available to require special precautions Effects on Dental Treatment No significant effects or complications reported Effects on Bleeding Chemotherapy may result in significant myelosuppression, neutropenia (50% to 52%; grades 3/4: 43% to 47%), anemia (38%; grades 3/4: 22%), thrombocytopenia (25%; grades 3/4: 22%), leukopenia (11%; grades 3/4: 6%). Pomalidomide is an analogue of thalidomide (a known human teratogen) and may cause severe birth defects or embryo-fetal death if taken during pregnancy. In females of reproductive potential, obtain 2 negative pregnancy tests prior to initiation of treatment; females of reproductive potential must avoid pregnancy and use 2 forms of contraception (or continuously abstain from heterosexual sex) beginning at least 4 weeks prior to , during, and for at least 4 weeks after stopping pomalidomide treatment (and during treatment interruptions). Studies in animals have shown evidence of fetal abnormalities and use is contraindicated in women who are or may become pregnant.

Gabapentin is used off-label for the treatment of restless leg syndrome; however gastritis symptoms and diet order discount allopurinol on line, current guidelines note there is insufficient evidence to recommend its use in pregnant women for this indication (Picchietti 2015) gastritis diet ðñò buy 300mg allopurinol fast delivery. Pharmacological agents should not be used for the treatment of alcohol use disorder in pregnant women unless needed for the treatment of acute alcohol withdrawal or a coexisting disorder. This milk concentration was obtained following maternal administration of oral gabapentin 2,100 mg/day. Gabapentin was detected in the serum of two breastfeeding infants 2 to 3 weeks after delivery and in one infant after 3 months of breastfeeding. Manufacturer recommendations may vary; the decision to breastfeed during therapy should consider the risk of infant exposure, the benefits of breastfeeding to the infant, and benefits of treatment to the mother. Based on limited information, gabapentin is considered relatively compatible with breastfeeding; infants should be monitored for drowsiness, adequate weight gain, and developmental milestones (Davanzo 2013; Veiby 2015). Available guidelines state gabapentin may be considered for the treatment of refractory restless leg syndrome in breastfeeding women (Picchietti 2015). Pharmacological agents should not be used for the treatment of alcohol use disorder in breastfeeding 640 Warnings: Additional Pediatric Considerations Neuropsychiatric adverse events, such as emotional lability (eg, behavioral problems), hostility, aggressive behaviors, thought disorders (eg, problems with concentration and school performance), and hyperkinesia (eg, hyperactivity and restlessness), have been reported in clinical trials of pediatric patients ages 3 to 12 years. Most of these pediatric neuropsychiatric adverse events are mild to moderate in terms of intensity but discontinuation of gabapentin may be required; children with mental retardation and attention-deficit disorders may be at increased risk for behavioral side effects (Lee 1996). This channel appears to be located presynaptically, and may modulate the release of excitatory neurotransmitters. Pharmacodynamics/Kinetics Half-life Elimination 5-6 hours Time to Peak Plasma: With food: 7. Gabapentin enacarbil is the prodrug of gabapentin; bioavailability following gabapentin enacarbil is increased in comparison to gabapentin (Backonja 2011). Current guidelines note there is insufficient evidence to recommend gabapentin encarbil in pregnant women for the treatment of restless leg syndrome (Picchietti 2015). Refer to Gabapentin monograph for information related to gabapentin exposure during pregnancy. Pharmacodynamics/Kinetics Half-life Elimination 27 days Time to Peak 5 days Pregnancy Considerations Adverse events were not observed in animal reproduction studies. Galcanezumab-gnlm is a monoclonal antibody; consider the long half-life prior to use in females who are or may become pregnant until information related to pregnancy is available (Tepper 2018). Local Anesthetic/Vasoconstrictor Precautions No information available to require special precautions Effects on Dental Treatment No significant effects or complications reported Effects on Bleeding Anemia (15% to 25%), thrombocytopenia (57% in bone marrow transplant patients; less common in other populations [8%]), and unusual bleeding are frequently reported. Female patients of reproductive potential should undergo pregnancy testing prior to initiation and use effective contraception during and for at least 30 days after therapy. Male patients should use a barrier contraceptive during and for at least 90 days after therapy. Local Anesthetic/Vasoconstrictor Precautions No information available to require special precautions Effects on Dental Treatment Key adverse event(s) related to dental treatment: Taste disturbance. Pregnancy Considerations Systemic concentrations of gatifloxacin following ophthalmic administration are below the limit of quantification. Effects on Bleeding Bleeding has been reported in <1% of patients, but can be serious. Adverse Reactions >10%: Central nervous system: Insomnia (15%), fatigue (14%) Dermatologic: Dermatological reaction (47% to 58%), skin rash (52%), xeroderma (24%), pruritus (18%), paronychia (14%), acne vulgaris (11%), alopecia (5% to 11%) Gastrointestinal: Diarrhea (29% to 47%; grades 3/4: 3%), anorexia (19% to 20%), nausea (17% to 18%), 643 Pharmacodynamics/Kinetics Half-life Elimination Oral: 48 hours Time to Peak Plasma: Oral: 3 to 7 hours Pregnancy Considerations Adverse events have been observed in animal reproduction studies. Females of reproductive potential should use effective contraception during and for at least 2 weeks following gefitinib treatment. Use Hemostasis (adjunct): Adjunct to provide hemostasis in surgical procedures (except ophthalmic) when control of bleeding by pressure, ligature and other conventional techniques are ineffective; adjunct in neuro, thoracic, or ocular surgeries to promote tissue repair and/or prevent adhesions (Gelfilm). Local Anesthetic/Vasoconstrictor Precautions No information available to require special precautions Effects on Dental Treatment Key adverse event(s) related to dental treatment: Local infection and abscess formation. Adverse Reactions Cardiopulmonary bypass surgery (Gelfoam): >10%: Cardiovascular: Atrial fibrillation (13%) 1% to 10%: Cardiovascular: Cardiac failure (4%), atrial flutter (2%), peripheral vascular disease (2%), ventricular tachycardia (2%), heart block (1%) Infection: Wound infection (6%) Respiratory: Pneumothorax (2%), respiratory failure (2%) Miscellaneous: Fever (1%) Frequency not defined (Gelfoam was used in cited surgical procedures): Central nervous system: Arachnoiditis (laminectomy operations), cauda equina syndrome (laminectomy operations), headache (laminectomy operations), meningitis (laminectomy operations), pain (laminectomy operations), paresthesia (laminectomy operations), spinal cord compression (brain implant surgery) Gastrointestinal: Gastrointestinal disease (laminectomy operations) Genitourinary: Bladder dysfunction (laminectomy operations), impotence (laminectomy operations) Hematologic & oncologic: Hematoma Infection: Abscess, localized infection, toxic shock syndrome (nasal surgery) Local: Injection site granuloma (brain; brain implant surgery), localized edema (includes encapsulation of fluid and fluid accumulation in the brain and spinal cord; brain implant surgery and laminectomy operations) Neuromuscular & skeletal: Tendon disease (prolonged fixation of tendon post severed tendon repair) Otic: Hearing loss (tympanoplasty) Miscellaneous: Fever, fibrosis (tendon repair), foreign body reaction Mechanism of Action Arrests bleeding by forming artificial clot and producing mechanical matrix which facilitates clotting Pregnancy Considerations When administered topically, gelatin is completely absorbed; however, the amount of gelatin available systemically following topical application is unknown. Adverse Reactions Frequency of adverse reactions reported for single-agent use of gemcitabine only. Gemcitabine is phosphorylated intracellularly by deoxycytidine kinase to gemcitabine monophosphate, which is further phosphorylated to active metabolites gemcitabine diphosphate and gemcitabine triphosphate. Verify pregnancy status (with pregnancy test) prior to treatment initiation in females of reproductive potential. Females of reproductive potential should use effective contraception during treatment and for 6 months after the final gemcitabine dose.