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Class: nucleoside analog also called nucleoside reverse transcriptase inhibitor, NRTI or nuke ; Standard dose: One 300 mg tablet twice-a-day two 100 mg capsules three times a day also available ; , no food restrictions may be taken with or without food ; . Clear, strawberryflavored liquid available for pediatric use. Take missed dose as soon as possible, but do not double up on your next dose. AWP: $387.38 month Manufacturer contact: GlaxoSmithKline, treathiv , 1 800 ; 7229294 AIDS Treatment Information Service: 1 800 ; HIV0440 4480440 ; Potential side effects and toxicity: Most common side effects include headaches, fever, chills, muscle soreness, fatigue, nausea, and fingernail discoloration. AZT has been associated with alteration of various cells in the blood through bone marrow suppression resulting in anemia low red blood cells ; and or neutropenia low white blood counts ; , particularly in people with advanced HIV during the first three months. Potential for severe anemia requiring blood transfusion or hospitalization when used on its own or in combination with hydroxyurea. Prolonged use of high doses of AZT has been associated with symptomatic myopathy muscle damage ; . Rare but potentially fatal toxicity with all NRTIs is pancreatitis inflammation of the pancreas ; , hepatomegaly enlarged liver ; with steatosis and lactic acidosis accumulation of lactate in the blood and abnormal acid-base balance ; . Lactic acidosis has been seen in patients taking NRTIs but is more common and more severe in women, people who are obese and people who have been taking nukes for a long time; and more common in people with liver disease, but can occur in people without a history of liver damage. People with lactic acidosis may experience persistent fatigue, abdominal pain or distension, nausea vomiting, and difficulty breathing or shortness of breath; and enlarged, fatty liver called hepatomegaly with steatosis ; . Pancreatitis can be life-threatening and may cause pain in the stomach and back, along with nausea, vomiting and blood in the urine. Your physician will check for pancreatitis by checking for increased levels of amylase and lipase in the blood. Risks for pancreatitis include: higher than recommended doses of NRTIs, advanced HIV, and alcohol use. The risk for pancreatitis with AZT is low compared to didanosine. Potential drug interactions: Biaxin, Dilantin, Mycobutin, and rifampin under various brand names ; may decrease AZT blood levels. Benemid and Depakote may increase AZT blood levels and decrease AZT clearance. Cytovene, Vitrasert and Valcyte increase AZT blood levels, and perhaps AZT-related anemia. Prescriber may need to adjust doses accordingly. AZT and Zerit should not be used together due to evidence that one limits the other's effectiveness. Also, bone marrow supression should be monitored with use of ganciclovir, amphotericin B, pentamidine, dapsone, flucytosine, sulfadiazine, interferonalpha, ribavirin Rebetol ; , and with other antineoplastics anti-tumor treatment ; such as hydroxyurea and doxorubicin. Ribavirin and AZT may cancel each other out and may increase the risk of lactic acidosis, therefore combination use should be avoided. Tips: Outstanding news for AZT this year: it came to the rescue of triple nuke therapy. After the bad news that the two most potent nukes, Viread and Ziagen, failed badly in the triplenuke combination with Epivir, came the good news that the three drugs worked well in the nuke-only regimen of Trizivir Viread. AZT found in Trizivir ; helps fight off the drug resistance problems that plague triple nukes that don't include it. These results are still preliminary. A nuke-only regimen should only be tried by people with low viral loads below 50, 000 ; --see aidsinfo.nih.gov for a full discussion. The notso-good news for people adding AZT: the fatigue and the potential anemia. You can start taking Procrit for some anemias, but that's adding an expensive weekly injectible. Some doctors would prefer switching out the AZT for another drug. Also, some clinicians are avoiding the "T" drugs, or thymidine analogs AZT and Zerit ; because of implication in lipoatrophy. Taking with food may minimize upset stomach. Studies show that AZT crosses the blood-brain barrier to a useful degree, which may be beneficial for patients at risk for neurological damage such as dementia ; from HIV. Proven to significantly reduce mother-to-infant transmission. Also available in Combivir with Epivir ; and in a triple combination in Trizivir with both Epivir and Ziagen.
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These therapies are based on the premise of decreased cholinergic activity in the brain resulting in cognitive decline; therefore, medications are targeted at increases in or prolonging acetylcholine ach ; activity in cortical cholinergic synapses.
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60 Johnson and Kaplan 1987; Kaplan 1990; Fisher 1992; Tuomela 2000; Vaivio 1995, 2001 ; . Productivity measurement has also a long tradition of nonfinancial measures see e.g. Maskell 1989; Armitage and Atkinson 1990; Hannula 1999 ; . But even the pioneering ideas of non-financial measurement promoted the strategic monitoring dimension of performance measurement e.g. Rockart and Treacy 1982; Rockart 1984; see also Schneiderman 2001 ; and even the seemingly operative theme of measuring continuous improvement has a strong strategic undertone e.g. Turney and Anderson 1989; Grundy 1997 ; . Thus the emergent non-financial performance measurement and control systems have had a close linkage to the evolving strategic management accounting concept. Kaplan's intentionally provocative start to an over a decade-long debate of relevance in management accounting Kaplan, 1983, 1984; Johnson and Kaplan, 1987 ; was a critique of the lack of support to new manufacturing technologies and management systems, its subordination to financial accounting, especially to financial reporting, its new theory being too distant from actual management accounting practice, and its relevance being gradually lost since 1925 when the theory was fully mature. This debate boosted many performance measurement systems. The most well-known normative responses to the alleged loss of relevance were The Balanced Scorecard Kaplan and Norton 1992, 1993, 1996a, ; , Performance Pyramid Lynch and Cross 1993 ; , Dynamic Performance Measurement System DPMS ; Laitinen 1998 ; and Tableau de Bord see Epstein and Manzoni 1997 ; . The balanced scorecard and performance pyramid are explicitly strategy driven performance measurement systems. Tableau de bord was developed originally by process engineers who wanted to improve their production processes. Later the promoters of tableau de bord have emphasised the role of business units mission and vision in performance measurement. Epstein and Manzoni 1997; see also Bromwich and Bhimani 1994. ; Kaplan and Norton 2001, 3 ; claim that they introduced the balanced scorecard as a measurement system, but it evolved through successive implementations into a tool for managing strategy. Very often strategic performance measurement systems are associated with the upper levels of the organisational hierarchy but all these management models emphasise the role of SBUs as crucial see e.g. Kaplan and Norton 1996b, 297 ; . An elementary part of strategy monitoring and prerequisite for strategy formulation is competitor-focused accounting CFA ; which is vaguely defined but practices such as competitor cost assessment, competitive position monitoring, competitor appraisal based on published financial statements, strategic costing and strategic pricing are identified in literature Guilding and cefzil.
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