ISSN:0091-2700    

DOI:10.1002/j.1552-4604.1991.tb03759.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

ISSN:0091-2700    

DOI:10.1002/j.1552-4604.1991.tb03760.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

ISSN:0091-2700    

DOI:10.1002/j.1552-4604.1991.tb03761.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

ISSN:0091-2700    

DOI:10.1002/j.1552-4604.1991.tb03762.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Enoximone is a phosphodiesterase inhibitor, which has been studied extensively for use in the management of patients with moderate‐to‐severe heart failure. The authors have studied the absorption and disposition kinetics of enoximone and its primary metabolite, enoximone sulfoxide, after both single oral doses of enoximone and at steady‐state after short‐term chronic oral therapy. A total of ten patients (two female, eight male) with moderate‐to‐severe heart failure (NYHA class II—IV) were enrolled into the study after giving written informed consent. The plasma levels of enoximone sulfoxide were greater than those of enoximone at all sampling times. The peak enoximone sulfoxide plasma concentrations ranged from 3.5 to 17.3 times the peak enoximone plasma levels for individual patients. The average steady‐state plasma concentrations for enoximone were 115 ± 40 ng/mL and 190 ± 78 ng/mL for 50 mg every 8 hours and 100 mg every 8 hours dosage regimens, respectively. The absorption and disposition kinetics of enoximone were found to be significantly variable between patients. The authors also evaluated the relationship between dose administered and steady‐state plasma levels as well as the relationship between the observed and predicted steady‐state plasma levels. The authors found a linear relationship between the dose that was administered and the accrued plasma levels, as well as a good correlation between the predicted and observed steady‐state levels. Although these data confirm previous reports that the sulfide metabolite of enoximone accumulates extensively in the plasma during oral therapy, reaching levels much higher than those of enoximone, these data do not support previous suggestions that the disposition of

ISSN:0091-2700    

DOI:10.1002/j.1552-4604.1991.tb03763.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Five chronic hemodialysis patients (1 woman and 4 men, aged, 46–68 yr) were given an oral dose of 10 mg felodipine followed by 0.057 mg[3H]felodipine IV. After 5 hours, a hemodialysis treatment lasting 4 hours was performed. Blood and dialysate flows were 200 mL/min and 500 mL/min, respectively. Capillary dialyzers with 1.3 m2cellulose acetate membrane were used. The pharmacokinetic characteristics and reduction in diastolic BP were similar to those in hypertensive patients with normal renal function and in uremic patients who were not treated with dialysis. There was no measurable removal of felodipine by hemodialysis. Dialyzer clearance of radioactive metabolites was about 10 mL/min, and only 8.9% of the dose was eliminated by the treatment. The half‐life of radioactive metabolites was 10 days (6–14 days) in three patients dialyzed thrice weekly. Since the metabolites are biologically inactive, no adjustment of dose is required in hemodialysis pat

ISSN:0091-2700    

DOI:10.1002/j.1552-4604.1991.tb03764.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

The efficacy of intravenously administered metoprolol, a cardioselective beta‐adrenergic blocking agent, was evaluated in the treatment of supraventricular tachyarrhythmias in 16 patients. The arrhythmias that were treated were atrial fibrillation (11 patients), atrial flutter (2 patients), supraventricular tachycardia (2 patients), and multifocal atrial tachycardia (1 patient). Mean dose of metoprolol was 9.5 mg (range: 2–15 mg) administered in one or two separate infusions of up to 7.5 mg each over a cumulative maximum interval of 25 minutes. In the 13 responders (81%), mean ventricular rate decreased from 134 ± 6 to 106 ± 7 beats/min 10 minutes after metoprolol administration and was controlled for 40 to 320 minutes without further therapy. Minimum ventricular rate (98 ± 6 beats/min) was reached 48 minutes after initiation of metoprolol. Metoprolol reduced ventricular rate by>15% (decrease of 26–60 beats/min) in 11 (69%) of 16 patients, including 9 (82%) of 11 patients with atrial fibrillation. In two other patients, one with atrial fibrillation and one with supraventricular tachycardia, ventricular rate was reduced by>12%. Hypotension, occurring in jive patients, was the most frequent side effect but was transient and readily managed. Cardioselective beta‐adrenergic blockade by metoprolol was rapidly effective in controlling ventricular rate in a majority of patients with supraventricular tachyarrhythmias and may be of particular use in selected patients with chronic obstructive pulmonary disease in whom intravenous beta‐adrenergic blockade is indicated. Hypotension is an important potential

ISSN:0091-2700    

DOI:10.1002/j.1552-4604.1991.tb03765.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Enterococcal endocarditis is the third most common presentation in native valves, and it is the most refractory. Unique among the streptococci, enterococci are relatively resistant to beta‐lactam antibiotics requiring a combination aminoglycoside regimen for cure. Relapse is common even after apparently adequate therapy and may be seen in up to 25% of cases that involve streptomycin‐resistant strains. This problem is magnified by the recent appearance of beta—lactamase‐producing strains ofS. faecalisresistant to both ampicillin and gentamicin. Ciprofloxacin is being investigated with a number of antimicrobials in the attempt to identify superior protocols against troublesome pathogens. However, little published data is available concerning the clinical efficacy of this drug in enterococcal endocarditis. In vitrostudies and preliminary trials with animal models have generally been disappointing with broth macrodilution time‐kill or agar dilution proving the most reliablein vitromethods for predictingin vivooutcomes. The urgent need to identify new combination drug regimens is underscored not only by the development of new resistance patterns, but by the well‐documented toxicities of conventional therapies. The authors present a case of relapsing enterococcal endocarditis caused by a non—beta—lactamase‐producing strain ofS. faecalis,which demonstrated high‐level resistance to streptomycin but not to gentamicin. Relapses occurred despite favorable laboratory data and aggressive beta—lactam‐gentamicin therapies. Cure was achieved using oral ciprofloxacin in a combination drug regimen, which is reported

ISSN:0091-2700    

DOI:10.1002/j.1552-4604.1991.tb03766.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

The disposition of ceftriaxone was studied after a single 2 g intravenous dose in seven patients 3 to 5 days after liver transplantation. Ceftriaxone concentrations in plasma, urine, and bile were measured by HPLC, and plasma protein binding was determined by equilibrium dialysis. Plasma protein binding was nonlinear, and the unbound fraction varied between 0.05 and 0.56. Both capacity and affinity were markedly different from reported values for normal subjects. The pharmacokinetic parameters obtained were: total body clearance (TBC), 11.2 ± 7.8 mL/hr/kg total and 44.8 ± 29.1 mL/hr/kg unbound; volume of distribution (Varea), 224 ± 76 mh/kg total and 767 ± 432 mL/kg unbound; steady‐state volume of distribution (Vss), 212 ± 68 mh/kg total and 651 ± 368 mL/kg unbound; terminal disposition half‐life (t1/2), 21.6 ± 14.3 hour total and 16.3 ±11.1 hour unbound. TBC for both total and free drug was considerably lower than literature values for normal subjects. Vareafor total drug was greater than normal whereas the corresponding value for free drug was smaller than normal. The plasma ceftriaxone concentrations at 12 and 24 hours were above the reported minimum inhibitory concentration (MIC). The fraction of the administered dose excreted in urine over 24 hours was 38 ± 29% and did not differ markedly from that reported for normal subjects. Less than 2% of the administered dose was excreted in 24‐hour bile; however, biliary concentrations were always above MIC. Ceftriaxone can be administered once or twice daily at a dose of 2 g/day for prophylaxis in liver transpl

ISSN:0091-2700    

DOI:10.1002/j.1552-4604.1991.tb03767.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

A prospective, randomized, open‐label, triple crossover comparison of the effects of indomethacin, misoprostol, or the combination, on renal function was performed to assess the ability of an oral prostaglandin E analogue, misoprostol, to minimize indomethacin‐induced decline in renal function in middle‐aged women. Twelve healthy women (mean age: 60.5 ±1.6 yr) with normal renal function (serum creatinine: 81 ± 9 umol/L) were studied; six women were normotensive, and six women were hypertensive with their blood pressure controlled with 50‐mg hydrochlorothiazide daily. All patients were placed on a 2‐g sodium daily diet for 2 weeks before initiation of the study. The subjects were prospectively randomized to receive each of three 4‐day treatments of indomethacin (25 mg q 6hr), misoprostol (200 mcg q 6hr), or the combination of drugs with a 4‐day washout between each treatment period. Measurements of GFR (urine accumulation of99mTc‐DTPA) and RPF (serum disappearance131I‐Hippuran), and urine collections for electrolytes were obtained before the first treatment period and on the fourth day of each treatment period. Three of the six hypertensive patients and three of the six normotensive patients had a decrease (>10%) in GFR associated with indomethacin therapy. When misoprostol was given with the indomethacin, four of these six patients did not experience a decline in GFR (baseline GFR for six patients: 75.4 ± 6.6 mL/min/1.73m2, GFR after indomethacin: 57.8 ± 9.5 mL/min/1.73m2, GFR with combination of indomethacin and misoprostol: 69.7 ± 3.5 mL/min/1.73m2. RPF was not consistently altered by subacute/chronic dosing of indomethacin, misoprostol, or the combination of the drugs. The authors conclude that misoprostol ameliorates indomethacin‐induced renal dysfunction in salt‐restricted and diuretic‐treated middle‐aged wome

ISSN:0091-2700    

DOI:10.1002/j.1552-4604.1991.tb03768.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY