Clinical pharmacy最新文献_第9页

New antiepilepsy drug, felbamate, marketed. 新型抗癫痫药物非苯乙酸酯上市。

Clinical pharmacy Pub Date : 1993-10-01

引用次数: 0

Dosage of transdermal fentanyl. 透皮芬太尼的剂量。

Clinical pharmacy Pub Date : 1993-10-01

D Côté

引用次数: 0

Pharmacologic prophylaxis of acute graft-versus-host disease after allogeneic marrow transplantation. 同种异体骨髓移植后急性移植物抗宿主病的药理学预防。

Clinical pharmacy Pub Date : 1993-10-01

T L Schwinghammer, E J Bloom

{"title":"Pharmacologic prophylaxis of acute graft-versus-host disease after allogeneic marrow transplantation.","authors":"T L Schwinghammer, E J Bloom","doi":"","DOIUrl":"","url":null,"abstract":"The immunology, pathophysiology, incidence, clinical manifestations, grading, and prevention of acute graft-versus-host disease (GVHD) are reviewed. GVHD occurs after allogeneic marrow transplantation when immunologically competent T lymphocytes in the donor marrow identify the host's antigens as foreign and attempt to reject host tissues. Acute GVHD occurs within three months after marrow transplantation and may affect the skin, gastrointestinal tract, liver, and immune system. Even with prophylactic immunosuppression, acute GVHD occurs in 20% to 80% of patients. Moderate to severe GVHD (grades II-IV) is a major cause of morbidity and mortality after allogeneic bone marrow transplantation. Conventional GVHD prophylaxis consists of immunosuppressives such as corticosteroids, methotrexate, and cyclosporine. Methotrexate and cyclosporine are equally effective in preventing GVHD. A combination of both drugs is better than either drug alone and results in an improved survival rate. The addition of corticosteroids to methotrexate, cyclosporine, or antithymocyte globulin is also more effective than single-drug therapy. Serial administration of intravenous immune globulin may contribute additional protection against acute GVHD. There is conflicting evidence concerning the prophylactic efficacy of pentoxifylline. Elimination of T lymphocytes from the donor marrow before transplantation has been associated with less GVHD but a higher incidence of graft failure. Total elimination of GVHD in patients with leukemia may cause loss of a graft-versus-leukemia effect, resulting in increased relapse rates and decreased long-term survival. Promising experimental prophylactic agents include thalidomide, zolimomab aritox, tacrolimus, antibodies to cytokines involved in the pathogenesis of GVHD, and monoclonal antibodies against cytokine receptors on T lymphocytes. Current research efforts are also directed toward eliminating GVHD without compromising the graft-versus-leukemia effect.","PeriodicalId":10498,"journal":{"name":"Clinical pharmacy","volume":"12 10","pages":"736-61"},"PeriodicalIF":0.0,"publicationDate":"1993-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19246943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Atrial fibrillation and atrial flutter. 心房颤动和心房扑动。

Clinical pharmacy Pub Date : 1993-10-01

D R Geraets, M G Kienzle

{"title":"Atrial fibrillation and atrial flutter.","authors":"D R Geraets, M G Kienzle","doi":"","DOIUrl":"","url":null,"abstract":"The epidemiology, pathophysiology, diagnosis, evaluation, and treatment of atrial fibrillation (AF) and atrial flutter (AFl) are reviewed, and recent developments and controversies in the approach to these arrhythmias are addressed. AF and AFl are the arrhythmias most frequently encountered in clinical practice. Although occasionally unaware of their arrhythmia, patients usually complain of palpitations, weakness, dyspnea, and decreased exercise tolerance. The initial goal of therapy is control of the ventricular rate. Rate control is accomplished with atrioventricular node-blocking agents such as digoxin, calcium-channel blockers, or beta-adrenergic blockers. Along with a rapid, irregular ventricular response, other detrimental outcomes of AF and AFl include compromised hemodynamics and increased vulnerability to thromboembolism. After the cause of the patient's arrhythmia has been evaluated, pharmacologic treatment is directed at converting the rhythm to normal sinus rhythm and maintaining it. Antiarrhythmic drugs have proved effective in about 50% of cases but may be associated with increased mortality. More effective and safer forms of drug therapy for AF and AFl are needed. Nonpharmacologic alternatives to antiarrhythmic medications for refractory AF and AFl include radio-frequency catheter ablation of the bundle of His with pacemaker placement and surgery. Patients who remain in AF despite therapy should receive long-term warfarin treatment. Drugs may be used to control the ventricular response in patients with AF and AFl, terminate and prevent the arrhythmias, and prevent thromboembolism. Nonpharmacologic treatments are reserved for patients whose arrhythmias are poorly controlled by drugs.","PeriodicalId":10498,"journal":{"name":"Clinical pharmacy","volume":"12 10","pages":"721-35; quiz 783-4"},"PeriodicalIF":0.0,"publicationDate":"1993-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"18900107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Methotrexate for the treatment of chronic corticosteroid-dependent asthma. 甲氨蝶呤治疗慢性皮质类固醇依赖性哮喘。

Clinical pharmacy Pub Date : 1993-10-01

D J Reid, L W Segars

引用次数: 0

Amiodarone-induced thyroid dysfunction. 胺碘酮引起的甲状腺功能障碍。

Clinical pharmacy Pub Date : 1993-10-01

U Khanderia, C A Jaffe, V Theisen

{"title":"Amiodarone-induced thyroid dysfunction.","authors":"U Khanderia, C A Jaffe, V Theisen","doi":"","DOIUrl":"","url":null,"abstract":"Cases of hypothyroidism and hyperthyroidism associated with amiodarone therapy are described, and the mechanisms, clinical appearance, and management of amiodarone-induced thyroid dysfunction are discussed. A 72-year-old man with a history of recurrent ventricular tachycardia unresponsive to conventional antiarrhythmic drugs was started on amiodarone therapy. Initially he responded well, but after three months he began to have fatigue, dry skin, and intolerance of cold. His serum thyroid-stimulating hormone (TSH) concentration had risen from 4.4 microU/mL before amiodarone therapy began to 20 microU/mL, consistent with hypothyroidism. He was started on sodium levothyroxine for thyroid hormone replacement; the dosage was adjusted in accordance with subsequent TSH measurements. His hospital course was complicated by congestive heart failure. The second patient was a 43-year-old man with a history of atrial fibrillation who developed hyperthyroidism when placed on amiodarone therapy. He had persistent sweating, intolerance of heat, restlessness, and tachycardia. Thyroid function tests confirmed the presence of hyperthyroidism. The patient was treated with propylthiouracil and propranolol, and amiodarone was discontinued. He remained unresponsive to the propylthiouracil, which was discontinued, and was scheduled for radioactive iodine treatment. The mechanism of amiodarone-induced thyroid dysfunction may involve the large iodine content of the drug. Amiodarone-induced hypothyroidism may range in severity from mild symptoms to severe myxedema; the skin, hair, and nails are particularly affected. Persons with clinical hyperthyroidism secondary to amiodarone treatment show the signs and symptoms of a hypermetabolic state resulting from thyroid hormone excess. Amiodarone-induced hypothyroidism is treated with levothyroxine and hyperthyroidism with antithyroid drugs. Amiodarone can cause thyroid dysfunction, which can have serious consequences.","PeriodicalId":10498,"journal":{"name":"Clinical pharmacy","volume":"12 10","pages":"774-9"},"PeriodicalIF":0.0,"publicationDate":"1993-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19246947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Pleurodesis with solution prepared from quinacrine hydrochloride tablets. 盐酸阿奎那片配制的胸膜固定术。

Clinical pharmacy Pub Date : 1993-09-01

B M Lomaestro, T S Lesar, R A Kaslovsky

引用次数: 0

Criteria for use of cyclosporine in adult transplant recipients. 成人移植受者环孢素使用标准。

Clinical pharmacy Pub Date : 1993-09-01

M A Ninno, S K Davis

引用次数: 0

FDA reiterates personal-use importation policy to buyers' clubs. FDA向买家俱乐部重申个人使用进口政策。

Clinical pharmacy Pub Date : 1993-09-01

引用次数: 0