confusion

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confusion

 [kon-fu´zhun]
disturbed orientation in regard to time, place, or person, sometimes accompanied by disordered consciousness.

cyclosporine ophthalmic emulsion

Restasis, Sandimmun (UK)CNS: tremor, headache, confusion, paresthesia, insomnia, anxiety, depression, lethargy, weakness

Pharmacologic class: Polypeptide antibiotic

Therapeutic class: Immunosuppressant

Pregnancy risk category C

Respiratory: cough, dyspnea, Pneumocystis jiroveci pneumonia, bronchospasm

FDA Box Warning

• Drug should be prescribed only by physicians experienced in managing systemic immunosuppressive therapy for indicated disease. At doses used for solid-organ transplantation, it should be prescribed only by physicians experienced in immunosuppressive therapy and management of organ transplant recipients. Patient should be managed in facility with adequate laboratory and medical resources. Physician responsible for maintenance therapy should have complete information needed for patient follow-up.

• Neoral may increase susceptibility to infection and neoplasia. In kidney, liver, and heart transplant patients, drug may be given with other immunosuppressants.

• Sandimmune should be given with adrenal corticosteroids but not other immunosuppressants. In transplant patients, increased susceptibility to infection and development of lymphoma and other neoplasms may result from increased immunosuppression.

• Sandimmune and Neoral aren't bioequivalent. Don't use interchangeably without physician supervision.

• In patients receiving Sandimmune soft-gelatin capsules and oral solution, monitor at repeated intervals (due to erratic absorption).

Action

Unclear. Thought to act by specific, reversible inhibition of immunocompetent lymphocytes in G0-G1 phase of cell cycle. Preferentially inhibits T lymphocytes; also inhibits lymphokine production. Ophthalmic action is unknown.

Availability

Capsules: 25 mg, 100 mg

Injection: 50 mg/ml

Oral solution: 100 mg/ml

Solution (ophthalmic): 0.05% (0.4 ml in 0.9 ml single-use vial)

Indications and dosages

Psoriasis

Adults:Neoral only-1.25 mg/kg P.O. b.i.d. for 4 weeks. Based on patient response, may increase by 0.5 mg/kg/day once q 2 weeks, to a maximum dosage of 4 mg/kg/day.

Severe active rheumatoid arthritis

Adults:Neoral only-1.25 mg/kg P.O. b.i.d. May adjust dosage by 0.5 to 0.75 mg/kg/day after 8 weeks and again after 12 weeks, to a maximum dosage of 4 mg/kg/day. If no response occurs after 16 weeks, discontinue therapy. Gengraf only-2.5 mg/kg P.O. daily given in two divided doses; after 8 weeks, may increase to a maximum dosage of 4 mg/kg/day.

To prevent organ rejection in kidney, liver, or heart transplantation

Adults and children:Sandimmune only-Initially, 15 mg/kg P.O. 4 to 12 hours before transplantation, then daily for 1 to 2 weeks postoperatively. Reduce dosage by 5% weekly to a maintenance level of 5 to 10 mg/kg/day. Or 5 to 6 mg/kg I.V. as a continuous infusion 4 to 12 hours before transplantation.

To increase tear production in patients whose tear production is presumed to be suppressed due to ocular inflammation associated with keratoconjunctivitis sicca

Adults: 1 drop in each eye b.i.d. given 12 hours apart

Off-label uses

• Aplastic anemia
• Atopic dermatitis

Contraindications

• Hypersensitivity to drug and any ophthalmic components
• Rheumatoid arthritis, psoriasis in patients with abnormal renal function, uncontrolled hypertension, cancer (Gengraf, Neoral)
• Active ocular infections (ophthalmic use)

Precautions

Use cautiously in:
• hepatic impairment, renal dysfunction, active infection, hypertension
• herpes keratitis (ophthalmic use)
• pregnant or breastfeeding patients
• children younger than age 16 (safety and efficacy not established for ophthalmic use).

Administration

• For I.V. infusion, dilute as ordered with dextrose 5% in water or 0.9% normal saline solution. Administer over 2 to 6 hours.
• Mix Neoral solution with orange juice or apple juice to improve its taste.
• Dilute Sandimmune oral solution with milk, chocolate milk, or orange juice. Be aware that grapefruit and grapefruit juice affect drug metabolism.
• In postoperative patients, switch to P.O. dosage as tolerance allows.
• Be aware that Sandimmune and Neoral aren't bioequivalent. Don't use interchangeably.
• Before administering eyedrops, invert unit-dose vial a few times to obtain a uniform, white, opaque emulsion.
• Know that eyedrops can be used concomitantly with artificial tears, allowing a 15-minute interval between products.

Adverse reactions

CNS: tremor, headache, confusion, paresthesia, insomnia, anxiety, depression, lethargy, weakness

CV: hypertension, chest pain, myocardial infarction

EENT: visual disturbances, hearing loss, tinnitus, rhinitis; (with ophthalmic use) ocular burning, conjunctival hyperemia, discharge, epiphora, eye pain, foreign body sensation, itching, stinging, blurring

GI: nausea, vomiting, diarrhea, constipation, abdominal discomfort, gastritis, peptic ulcer, mouth sores, difficulty swallowing, anorexia, upper GI bleeding, pancreatitis

GU: gynecomastia, hematuria, nephrotoxicity, renal dysfunction, glomerular capillary thrombosis Hematologic: anemia, leukopenia, thrombocytopenia

Metabolic: hyperglycemia, hypomagnesemia, hyperuricemia, hyperkalemia, metabolic acidosis

Musculoskeletal: muscle and joint pain

Respiratory: cough, dyspnea, Pneumocystis jiroveci pneumonia, bronchospasm

Skin: acne, hirsutism, brittle fingernails, hair breakage, night sweats

Other: gum hyperplasia, flulike symptoms, edema, fever, weight loss, hiccups, anaphylaxis

Interactions

The following interactions pertain to oral and I.V. routes only.

Drug-drug.Acyclovir, aminoglycosides, amphotericin B, cimetidine, diclofenac, gentamicin, ketoconazole, melphalan, naproxen, ranitidine, sulindac, sulfamethoxazole, tacrolimus, tobramycin, trimethoprim, vancomycin: increased risk of nephrotoxicity

Allopurinol, amiodarone, bromocriptine, clarithromycin, colchicine, danazol, diltiazem, erythromycin, fluconazole, imipenem and cilastatin, itraconazole, ketoconazole, methylprednisolone, nicardipine, prednisolone, quinupristin/dalfopristin, verapamil: increased cyclosporine blood level

Azathioprine, corticosteroids, cyclophosphamide: increased immunosuppression Carbamazepine, isoniazid, nafcillin, octreotide, orlistat, phenobarbital, phenytoin, rifabutin, rifampin, ticlopidine: decreased cyclosporine blood level

Digoxin: decreased digoxin clearance

Live-virus vaccines: decreased antibody response to vaccine

Lovastatin: decreased lovastatin clearance, increased risk of myopathy and rhabdomyolysis

Potassium-sparing diuretics: increased risk of hyperkalemia

Drug-diagnostic tests.Alanine aminotransferase, aspartate aminotransferase, bilirubin, blood urea nitrogen, creatinine, glucose, low-density lipoproteins: increased levels

Hemoglobin, platelets, white blood cells: decreased values

Drug-food.Grapefruit, grapefruit juice: decreased cyclosporine metabolism, increased cyclosporine blood level

High-fat diet: decreased drug absorption (Neoral)

Drug-herbs.Alfalfa sprouts, astragalus, echinacea, licorice: interference with immunosuppressant action St. John's wort: reduced cyclosporine blood level, possibly leading to organ rejection

Patient monitoring

• Observe patient for first 30 to 60 minutes of infusion. Monitor frequently thereafter.
• Monitor cyclosporine blood level, electrolyte levels, and liver and kidney function test results.
• Assess for signs and symptoms of hyperkalemia in patients receiving concurrent potassium-sparing diuretic.

Patient teaching

• Advise patient to dilute Neoral oral solution with orange or apple juice (preferably at room temperature) to improve its flavor.
• Instruct patient to use glass container when taking oral solution. Tell him not to let solution stand before drinking, to stir solution well and then drink all at once, and to rinse glass with same liquid and then drink again to ensure that he takes entire dose.
• Tell patient taking Neoral to avoid high-fat meals, grapefruit, and grapefruit juice.
• Advise patient to dilute Sandimmune oral solution with milk, chocolate milk, or orange juice to improve its flavor.
• Instruct patient to invert vial a few times to obtain a uniform, white, opaque emulsion before using eyedrops and to discard vial immediately after use.
• Inform patient that eyedrops can be used with artificial tears but to allow 15-minute interval between products.
• Caution patient not to wear contact lenses because of decreased tear production; however, if contact lenses are used, advise patient to remove them before administering eyedrops and to reinsert 15 minutes after administration.
• Inform patient that he's at increased risk for infection. Caution him to avoid crowds and exposure to illness.
• Instruct patient not to take potassium supplements, herbal products, or dietary supplements without consulting prescriber.
• Tell patient he'll need to undergo repeated laboratory testing during therapy.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, and herbs mentioned above.

con·fu·sion

(kon-fyū'zhŭn),
A mental state in which reactions to environmental stimuli are inappropriate because the person is bewildered, perplexed, or unable to orientate herself or himself.
[L. confusio, a confounding]

confusion

/con·fu·sion/ (kon-fu´zhun) disturbed orientation in regard to time, place, or person, sometimes accompanied by disordered consciousness.

confusion

(kən-fyo͞o′zhən)
n.
Psychology A mental state involving impaired orientation with respect to time, place, or person.

con·fu′sion·al adj.

confusion

[kənfyo̅o̅′shən]
Etymology: L, confundere, to mingle
a mental state characterized by disorientation regarding time, place, person, or situation. It causes bewilderment, perplexity, lack of orderly thought, and inability to choose or act decisively and perform the activities of daily living. It is usually symptomatic of an organic mental disorder, but it may accompany severe emotional stress and various psychological disorders. confusional, adj.

confusion

Neurology Disorientation with respect to time, space–place, or person, which may be accompanied by disordered consciousness. See Nocturnal confusion.

con·fu·sion

(kŏn-fyū'zhŭn)
A mental state in which reactions to environmental stimuli are inappropriate because the subject is bewildered, perplexed, or disoriented.
[L. confusio, a confounding]

confusion

A state of DISORIENTATION from disturbance of memory, loss of contact with reality, HALLUCINATION or DEMENTIA. Confusion is often temporary and the result of brain disorder from toxic influences, EPILEPSY or head injury.

con·fu·sion

(kŏn-fyū'zhŭn)
A mental state in which reactions to environmental stimuli are inappropriate.
[L. confusio, a confounding]

confusion,

n a mental state characterized by disorientation regarding time, place, or person that causes bewilderment, perplexity, lack of orderly thought, and inability to act decisively or perform the activities associated with daily living.

Patient discussion about confusion

Q. I am confused. I am overweight and my age is 39. When I checked with my weight/age chart I have found myself in the normal range. But I feel bulky and my doctor says I am overweight. I don’t understand why according to the chart I am not obese but when the doctor takes my weight and finds me as an obese. I am confused.

A. Obesity is based on the persons Basal Metabolic Rate i.e. BMI calculation. This is calculated by using the data such as your present height and weight. A simple weight/age chart is not wrong but it’s not a complete calculation to indicate a person obese. BMI is important to be known as it gives an indication that the overweight may have future chances of heart disease, diabetes and high blood pressure.

http://www.youtube.com/watch?v=JNTuzExFowo&eurl=http://www.imedix.com/health_community/vJNTuzExFowo_nutrition?q=nuetrition&feature=player_embedded

Q. I was confused, is he really sticking to diet? My friend is following Fixed-menu diet which I didn’t hear before. He told that he is in diet but he is taking some of the food which he likes. I was confused, is he really sticking to diet?

A. Of course, your friend may be under diet control. I will tell you what fixed menu diet means? A fixed-menu diet provides a list of all the foods you will eat. The merits of this kind of diet are that it can be easy to follow because the foods are selected for you. However the demerit of this type of diet is that you get only few varieties of food which will make the diet boring and it will be hard to follow. If you start with a fixed-menu diet, it is easy to follow.

Q. Many diagnosis confusing me! So many people say so many diagnosis for bipolar. I am confused. I want to know what is the proper diagnosis for bipolar1?

A. bipolar/depression are both mental illnesses chemical impalance in the brain--every person is biochemically unique possessing or lacking some enzymes systems which differ subtly from those of others,these systema are inherited(genetic).the only diagnosis that they give so that you can understand is;depression,a swing between two states,episodes of overactivity,elation,or irritabillity,increased appetite for food,sex,alcohol,outbust of inappropiate anger,laugther,delusions,attacks can last for montha or days.I have about 7pdrs an none of them can give you an answer that the every day person can understand.---mrfoot56

More discussions about confusion
References in classic literature ?
To heighten the excitement and confuse the guessers, a number of dry poles are laid before each platoon, upon which the members of the party "in hand" beat furiously with short staves, keeping time to the choral chant already mentioned, which waxes fast and furious as the game proceeds.
Vain der School favored the jury with an abridgment of the testimony, recounted in such a manner as utterly to confuse the faculties of his worthy listeners.
Do justice to his meaning, however I may confuse it.
When you know your own Regiment a trifle better you won't confuse the line of march with line of battle, Kim.
We must be careful not to confuse the physical and the moral.
Their prodigious bounds and the shrill, screeching purr of their uncanny mouths were well calculated to confuse and terrorize their prey, so that as two of them leaped simultaneously from either side, the mighty sweep of those awful tails met with no resistance and two more green Martians went down to an ignoble death.
Well, perhaps such invitations were not so common as they have grown in my memory; nor must you confuse my then feelings on all these matters with those which I entertain as I write.
He cursed himself for his stupidity, and yet he knew that the fiendish power which the Lotharian had invoked to confuse him might have deceived any.
Fred was keen enough to foresee that anger would confuse distinctions, and that his denial of having borrowed expressly on the strength of his uncle's will would be taken as a falsehood.