General questions

Generally, yes. That is why patients are advised not to break sustained released tablets. However, there are certain sustained release forms that may not be as prone to this such as novel solid forms of the active pharmaceutical ingredient that dissolve more slowly. If the “sustained release” effect is achieved at the molecular level, crushing would have little effect. Hope this helps.

Within the contraindications there are different types . Depending on what you look for you can find information in one way or another: Contraindications for side effects: that refer to an unintended consequence that is part of the pharmacological action of a medication; for example, dry mouth in the course of a treatment with anticholinergics. Think of, a patient with s. Sjogren, who sees his symptoms worsened by taking anticholinergics. It could also be a non-selective beta-blocker and an asthmatic patient. The physiological mechanism of bronchial relaxation is through beta2 agonism, if you block it you can trigger asthma attacks. You can usually find the cause by looking at the physiology of the mechanism of action and physiology of the side effect.Also books of clinical pharmacolgy usually explain this.
Secondary effect, on the other hand, is an unintended manifestation that arises as a consequence of the fundamental action of a medicine, but that is not an inherent part of it. By way of example, hypokalemia may occur that occurs in the course of treatment with thiazide diuretics. You can also evaluate it depending on the mechanism of action of the drugAdverse reaction or undesirable effect, finally, refer to the unwanted effects that, in addition, are harmful. In these the cause of the adverse reaction is not usually known . You know the frequency of appearance, the characteristics of the population that it affects … in these cases the information can be found in pivotal trials, or in safety drug monitoring agenciesand drug technical data sheets. Physiologically justify why they appear is difficult, if a patient taking ibuprofen suffers a syndrome of Steve Johnson, you may say that it is a very rare adverse reaction, but not why this patient, its idiosyncrasic.

Other questions

The elimination average half-life of cefepime is about 2 hours, and is independent of the dose for the range of 250 mg to 2 g. There is no evidence of accumulation in the healthy individuals receiving doses up to 2 g IV every 8 hours for 9 days. The total body clearance is 120 ml/min. The average renal clearance of cefepime is 110 ml/min, suggesting an elimination almost exclusively via the kidneys, mainly by glomerular filtration.
 
According to the PK theory and guidelines, the five times of a drug half-life (i.e. 5 x 2 hours = 10 hours) is a general rule of complete drug elimination. However, in this case your med is cefepime, which is an antibiotic indicated for UTI. You thus need to consider the high drug distribution in the urine, patient’s age and renal clearance, spectrum and sensitivity. Usually a 10-day treatment of UTI can eradicate gram- bacilli up to 70 – 90% depending on the patient’s condition. For your case, probably complicated UTI, it is suggested in practice to continue the drug with 1 g i.m. ASAP to complete the 14-day treatment course even though the missed dose of one day. Do not worry too much about the drug resistance, which is minimal.
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