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=?iso-8859-1?B?UmU6IEluZm9ybWUgc29icmUgb25kYW5zZXRyb24uIEhpcGVyZW1lc2lz? =?iso-8859-1?B?IGdyYXbtZGljYQ==?
From: jaider gomez diaz (dr_jaider@hotmail.com)
Sun Sep 22 20:36:22 2002
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- Previous message: Jorge Renzi: "Informe sobre ondansetron. Hiperemesis gravídica"
Estimado colega, gracias por el aporte, pero el problema es que no contamos con este medicamento y persiste la hiperemesis, a pesar de los tratamientos que tenemos a la mano: metoclopramida, fenergan, esteroides, alimentacion parenteral. Hemos utilizado propofol, droperidol a bajas dosis por recomendación del serv. de anestesiologia, sin resultados. En reunión médica se decidió, mantener la hidratación parenteral por el tiempo que sea necesario. El menejo ha sido multidisciplinario: psiquiatría, gastroenterología, neurología,perinatológia y por nutrición y dietetica. Hasta el momento bienestar fetal conservado. Velocimetria doppler de arteria umbilical, venosa de vena hepática derecha y ducto venoso, arteria cerebral media y anterior, todo dentro de lo normal. Liquido amniótico dentro de lo normal. Determinación de b-HGC, dentro de lo normal, por lo que nos hace dudar si se trata de una mola parcial.... Gastroenterología, sugiere realizar endoscopia gástroduodenal....Primer caso que nos topamos así....bueno gracias por todo...saludos desde venezuela.>From: "Jorge Renzi" <jrenzi@satlink.com>
>Reply-To: obgin-l@obgyn.net
>To: Multiple recipients of list OBGIN-L <obgin-l@mail.medispecialty.com>
>Subject: Informe sobre ondansetron. Hiperemesis gravídica
>Date: Sun, 22 Sep 2002 16:32:31 -0500
>
>Queridos amigos: les envío información sobre el ondansetron y su empleo
>durante la gestación. Como verán es una droga Categoria B que con
>limitaciones y en caso de no responder a la terapéutica corriente se puede
>utilizar durante la gestación.
>
>Siempre en estos casos tenemos que balancear riesgos y beneficios. Pero en
>el caso com hace referencia el colega sería una droga de elección.
>
>Saludos
>
>Dr. Jorge Renzi
>
>Hypersensitivity reactions have been reported in patients who have
>exhibited hypersensitivity to other selective 5-HT3 receptor antagonists.
>
>PRECAUTIONS
>
>Ondansetron is not a drug that stimulates gastric or intestinal
>peristalsis. It should not be used instead of nasogastric suction. The use
>of ondansetron in patients following abdominal surgery or in patients with
>chemotherapy-induced nausea and vomiting may mask a progressive ileus
>and/or gastric distention.
>
>Drug Interactions
>
>Ondansetron does not itself appear to induce or inhibit the cytochrome
>P-450 drug-metabolizing enzyme system of the liver. Because ondansetron is
>metabolized by hepatic cytochrome P-450 drug-metabolizing enzymes, inducers
>or inhibitors of these enzymes may change the clearance and hence, the
>half-life of ondansetron. On the basis of limited available data, no dosage
>adjustment is recommended for patients on these drugs. Tumor response to
>chemotherapy in the P 388 mouse leukemia model is not affected by
>ondansetron. In humans, carmustine, etoposide, and cisplatin do not affect
>the pharmacokinetics of ondansetron.
>
>Carcinogenesis, Mutagenesis, Impairment of Fertility
>
>Carcinogenic effects were not seen in 2-year studies in rats and mice with
>oral ondansetron doses up to 10 and 30 mg/kg per day, respectively.
>Ondansetron was not mutagenic in standard tests for mutagenicity. Oral
>administration of ondansetron up to 15 mg/kg per day did not affect
>fertility or general reproductive performance of male and female rats.
>
>Pregnancy
>
>Teratogenic Effects: Pregnancy Category B. Reproduction studies have been
>performed in pregnant rats and rabbits at I.V. doses up to 4 mg/kg per day
>and have revealed no evidence of impaired fertility or harm to the fetus
>due to ondansetron. There are, however, no adequate and well-controlled
>studies in pregnant women. Because animal reproduction studies are not
>always predictive of human response, this drug should be used during
>pregnancy only if clearly needed.
>
>Nursing Mothers
>
>Ondansetron is excreted in the breast milk of rats. It is not known whether
>ondansetron is excreted in human milk. Because many drugs are excreted in
>human milk, caution should be exercised when ondansetron is administered to
>a nursing woman.
>
>Pediatric Use
>
>Little information is available about dosage in pediatric patients under 2
>years of age (see DOSAGE AND ADMINISTRATION section for use in pediatric
>patients 4 to 18 years of age receiving cancer chemotherapy or for use in
>pediatric patients 2 to 12 years of age receiving general anesthesia).
>
>Use in Elderly Patients
>
>Dosage adjustment is not needed in patients over the age of 65 (see
>CLINICAL PHARMACOLOGY). Prevention of nausea and vomiting in elderly
>patients was no different than in younger age-groups.
>
>TABLETS
>
>Information for Patients
>
>Phenylketonurics: Phenylketonuric patients should be informed that ZOFRAN
>ODT Orally Disintegrating Tablets contain phenylalanine (a component of
>aspartame). Each 4 mg and 8 mg orally disintegrating tablet contains <0.03
>mg phenylalanine. Patients should be instructed not to remove ZOFRAN ODT
>Tablets from the blister until just prior to dosing. The tablet should not
>be pushed through the foil. With dry hands, the blister backing should be
>peeled completely off the blister. The tablet should be gently removed and
>immediately placed on the tongue to dissolve and be swallowed with the
>saliva. Peelable illustrated stickers are affixed to the product carton
>that can be provided with the prescription to ensure proper use and
>handling of the product.
>
>Use in Surgical Patients
>
>The coadministration of ondansetron had no effect on the pharmacokinetics
>and pharmacodynamics of temazepam.
>
>Pediatric Use
>
>Little information is available about dosage in children 4 years of age or
>younger (see CLINICAL PHARMACOLOGY and DOSAGE AND ADMINISTRATION sections
>for use in children 4 to 18 years of age).
>
>Use in Elderly Patients
>
>Dosage adjustment is not needed in patients over the age of 65 (see
>CLINICAL PHARMACOLOGY). Prevention of nausea and vomiting in elderly
>patients was no different than in younger age-groups.
>
>From nobody@medispecialty.com Mon Sep 23 14:41:13 2002
Received: (from nobody@localhost) by mail.medispecialty.com (8.11.6/8.11.6/dsb-1.1) id g8NJfDY28911 for OBGIN-L@OBGYN.NET; Mon, 23 Sep 2002 14:41:13 -0500 Message-Id: <200209231941.g8NJfDY28911@mail.medispecialty.com> Date: Mon, 23 Sep 2002 14:41:13 -0500 (CDT) Errors-To: postmaster@medispecialty.com Reply-To: jdelc@terra.com.pe From: jdelc@terra.com.pe (Jesús Del Carpio) To: OBGIN-L@OBGYN.NET In-Reply-To: <F104dqmMqbET6CLNl9N00003f14@hotmail.com> X-Original-Sender: @ 200.37.99.60 Subject: Re: =?iso-8859-1?B?UmU6IENvcmTzbiB1bWJpbGljYWw= Date: Sun, 22 Sep 2002 13:47:31 -0400La Institución es Privada y el paciente tomó la decisión de no Autopsia y llevarse el cuerpo de su hijo para el entierro. De ser pública, acá en Perú es mandatoria la autopsia si la muerte sucede antes de las 24 hs del ingreso a cualquier Institución de Salud, luego solamente si es autorizado por los familiares, a no ser que existan causas punibles. El Certificado de Defunción mencionó Malformaciones Congénitas como causa probable de fallecimiento, yo tuve que llenarlo así.
Saludos desde la tierra del Ceviche y el Pisco Sour.
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