Treatment of skeletal muscle spasticity in multiple sclerosis, spinal cord injury, children with cerebral palsy; intrathecal dose form for severe spasticity in spinal cord injury or those not responsive to oral dose form; unapproved: trigeminal neuralgia
PO: Drug reaches colon intact; bacterial azoreductases release 5-aminobenzyl-B-analine and mesalamine (active metabolite); low, variable systemic absorption; peak concentration 1–2 hr, protein binding ≈99%; less than 1% renal excretion; most excreted in feces (65%).
• Patients with advanced diabetes should be questioned about any limitations in activities or stress tolerance. Some will also be receiving dialysis treatment if renal function is compromised. Dental treatment usually can be performed the day after dialysis.
Glucocorticoids have multiple actions that include antiinflammatory and immunosuppressant effects. They inhibit phospholipase A2, interfering with or reducing the synthesis of prostaglandins and leukotrienes. They also bind to cytoplasmic glucocorticoid receptors (GRs) and enter the cell nucleus to bind with DNA. This results in the synthesis of various enzymes such as collagenase, elastase, and cytokines that play important roles in inflammation control and immunosuppression. They also suppress the production of lymphocytes, monocytes, and eosinophils.
Partially absorbed from the GI tract. Protein binding: 97%. Metabolized in the liver to active metabolite. Primarily excreted in urine. Minimal removal by hemodialysis. Half-life: 35 min; metabolite 10–11 hr.
The exact mechanism of action of bendamustine is unknown. Bendamustine is an alkylating drug and (PARP) modulator. Dissociates into electrophilic alkyl groups, forms covalent bonds with electron-rich nucleophilic moieties, which results in tumor cell death through different pathways.
A benzothiadiazine derivative that acts as a thiazide diuretic and antihypertensive. As a diuretic blocks reabsorption of water, sodium, and potassium at cortical diluting segment of distal tubule. As an antihypertensive reduces plasma, extracellular fluid volume, peripheral vascular resistance by direct effect on blood vessels.
• Patient on chronic drug therapy may rarely present with symptoms of blood dyscrasias, which can include infection, bleeding, and poor healing. If dyscrasia is present, caution patient to prevent oral tissue trauma when using oral hygiene aids.