摘要:

Clinical Pharmacology and Therapeutics(1988)44,365–368; doi:10.1038/clpt.1988.1

ISSN:0009-9236    

DOI:10.1038/clpt.1988.165

年代:1988

数据来源: WILEY

摘要:

Fourteen patients received 5‐iodo‐21‐deoxyuridine (IdUrd) before surgery for placement of a hepatic arterial catheter. Biopsy specimens were obtained at the time of surgery and incorporation of IdUrd into deoxyribonucleic acid (DNA) in tumor and normal hepatic tissue was measured by HPLC and used as an index of drug selectivity. Over a 3‐day intravenous infusion of IdUrd at 1000 mg/m2/day, substitution for thymidine in tumor DNA averaged 3.1%. Normal hepatic DNA contained<1% substitution by IdUrd. Arterial delivery of IdUrd increased levels in DNA, whereas modulation with fluorodeoxyuridine produced mixed results. In six patients, flow cytometric analysis showed that the tumor contained a median of 32% of tumor cells that had incorporated IdUrd in 3 days, corresponding to a potential doubling time of only 10 days. Thymidylate synthetase activity in tumors was 20‐fold greater than in normal liver tissue, whereas thymidine kinase activity was twofold greater in tumors. These pharmacologie studies encourage further clinical trials of IdUrd as a cytotoxic agent or radiosensitizer.Clinical Pharmacology and Therapeutics(1988)44,369–375; doi:10.1038/c

ISSN:0009-9236    

DOI:10.1038/clpt.1988.166

年代:1988

数据来源: WILEY

摘要:

To better understand the use of narcotic analgesics, the hydromorphone concentration was measured in serum samples from 43 patients with chronic severe pain who were receiving this drug. At the time of blood sampling, pain intensity, mood, and cognitive performance were assessed. There was large individual variation in the dose‐drug level relationship. Seven patients with bone or soft tissue pain and drug levels of ≥4 ng/ml had good pain control, whereas 10 did not. None of 15 patients with levels<4 ng/ml had pain control, despite drug doses similar to those given patients with higher levels. Thus 60% of the patients without control of their pain had hydromorphone levels below the lowest level that produced pain control. No patient with pain from nerve infiltration or compression had good pain control, irrespective of the drug level or dose. Poor mood correlated with high pain intensity and low drug level. Impaired cognitive performance was not related to drug level. Knowing that there is a low concentration of narcotic in the blood of a patient with chronic severe pain who is receiving high drug doses and who shows lack of both efficacy and side effects may reassure health care professionals that further narcotic dosage escalation is appropriate.Clinical Pharmacology and Therapeutics(1988)44,376–382; doi:10.1038/clpt.19

ISSN:0009-9236    

DOI:10.1038/clpt.1988.167

年代:1988

数据来源: WILEY

摘要:

Subjective response data from 55 postoperative pain studies were examined for the residual analgesic effects of morphine. The studies were planned as four‐period crossover designs for four treatments. Each patient received 5 and 10 mg of morphine and two doses of a test preparation. Two measures of analgesia were used: Sum of the Pain Intensity Difference (SPID) and Total Pain Relief (TOTPAR). To facilitate analysis, two two‐period groups were defined. Morphine data for periods 1 and 2 were designated as group A, and morphine data for periods 3 and 4 were designated as group B. Residual analgesic effects were 0.12 for both SPID and TOTPAR in group A and were 0.65 and 0.17 for SPID and TOTPAR, respectively, in group B. In these 55 studies, there was no evidence of significant residual analgesic effects. Thus the crossover design is an appropriate method for the evaluation of selected parenteral analgesics in the postoperative pain model.Clinical Pharmacology and Therapeutics(1988)44,383–388; doi:10.1038/clpt.19

ISSN:0009-9236    

DOI:10.1038/clpt.1988.168

年代:1988

数据来源: WILEY

摘要:

In a controlled crossover trial, 15 patients with frequent ventricular arrhythmias were treated with lidocaine to predict efficacy and safety of oral mexiletine. After an initial control period, patients received intravenous lidocaine (bolus infusion of 200 mg/20 min followed by 3.6 gm/24 hr and for 7 days oral mexiletine (200 mg four times a day). Efficacy was controlled by 24‐hour Holter monitoring (responders = suppression of single premature ventricular beats [PVB]>84% and of complex PVB>90%). After lidocaine, 10 of 15 patients (67%) were responders (mean PVB reduction: 97%). After mexiletine, five of 15 patients (33%) were responders (mean PVB reduction: 81%); efficacy was closely related to the plasma concentration. When efficacy of both agents was compared, lidocaine infusion had a positive predictive value of only 50%; however, the negative predictive value was 100%. Thus in nonresponders to lidocaine, mexiletine is very likely to fail in the suppression of ventricular ectopy.Clinical Pharmacology and Therapeutics(1988)44,389–395; doi:10.1038/clpt.1988

ISSN:0009-9236    

DOI:10.1038/clpt.1988.169

年代:1988

数据来源: WILEY

摘要:

The type and distribution of histamine receptors in the portal circulation were studied in patients with schistosomal hypertension. At laparotomy, the umbilical, left gastric, splenic, and superior mesenteric veins were cannulated. Blood samples were drawn from the systemic circulation and from each vein for histamine assay. Portal pressures were then estimated in each vein. One group of patients received local injections of pheniraminep‐aminosalicylate (H1‐antagonist) in the four cannulated veins simultaneously. A second group received cimetidine (H2‐antagonist), and a third group received a mixture of both drugs. Reestimation of portal pressures indicated that all treatments produced a significant drop in pressure in the four compartments. The highest drop was in the splenic vein after the H1‐antagonist and in the gastric vein after the H2‐antagonist. The histamine level was somewhat higher in the splenic compartment. These results suggest that both H1‐ and H2‐receptors are present in the four portal compartments, but their distribution may not be uniform.Clinical Pharmacology and Therapeutics(1988)44,396–399; doi:10.10

ISSN:0009-9236    

DOI:10.1038/clpt.1988.170

年代:1988

数据来源: WILEY

摘要:

Clinical Pharmacology and Therapeutics(1988)44,399–399; doi:10.1038/clpt.1988.1

ISSN:0009-9236    

DOI:10.1038/clpt.1988.171

年代:1988

数据来源: WILEY

摘要:

The influence of dietary sodium on the antihypertensive effects of verapamil and on components of sodium, water, and calcium metabolism was studied in nine white patients 50 to 65 years old with normal renin hypertension. Diets consisting of 109 and 259 mEq Na were given for 5 days each before the study drug was given. On days 4 and 9, intravenous verapamil (0.075 mg/kg) and oral verapamil (80 mg) were given, followed by 80 mg at 8‐hour intervals for three doses. On days 1,4, 5, 9, and 10, serum and urine electrolytes, osmolality (urine [Uosm], serum [Sosm], and osmolar clearance [Cosm]), calcium plasma renin activity (PRA), and levels of serum aldosterone, 1,25‐hydroxyvitamin D, serum ionized calcium, parathyroid hormone, atrial natriuretic hormone (atriopeptin), and erythrocyte calcium and electrolytes were measured. On days 5 and 10, serial plasma samples for measurement of verapamil and norverapamil levels were drawn immediately after the last oral dose of verapamil. After verapamil, Uosmand Cosmdecreased during both 109 and 259 mEq sodium diets (Uosm,p<0.025; Cosm,p<0.01 andp<0.025, respectively), but free water clearance increased during each diet (p<0.01). Urine volume and sodium excretion increased with the 259 mEq sodium diet (p<0.025 andp<0.01, respectively). There were no significant changes in measured values of components of calcium metabolism with either diet or after verapamil. The pharmacokinetics of verapamil were similar during each diet. Twenty‐four hours after the last oral dose of verapamil, supine mean arterial pressure (MAP) decreased ~5 mm Hg (109 mEq sodium diet;p<0.025), whereas supine MAP declined ~10 mm Hg compared with baseline values during the 259 mEq sodium diet (p<0.01). Standing MAP declined by 8 mm Hg with either diet after verapamil (p<0.025 top<0.01). Thus the antihypertensive effects of verapamil are present regardless of sodium intake and are accompanied by natriuresis and diuresis during a high‐sodium diet.Clinical Pharmacology and Therapeutics(1988)44,400–407; doi:10.1038/clp

ISSN:0009-9236    

DOI:10.1038/clpt.1988.172

年代:1988

数据来源: WILEY

摘要:

Twenty‐two unrelated healthy subjects and 28 unrelated patients with insulin‐dependent diabetes were given 200 mg of caffeine and 10 mg of debrisoquin on two occasions. In healthy subjects, caffeine and debrisoquin metabolism and the oxidation and acetylation phenotypes were stable. In the patients with diabetes, the two tests showed a significant decrease in the glycosylated hemoglobin level and a significant increase in the 24‐hour elimination rate of all caffeine metabolites. Most of the values were lower compared with those of healthy subjects during the first test. Because of these variations, caffeine cannot be used to determine the rapid or slow acetylator status in patients with diabetes. In contrast, neither the oxidation of debrisoquin nor the phenotypic expression was disturbed. These results reiterate the need for defining the administration conditions and surveying the drugs used in the treatment of diabetes mellitus complications.Clinical Pharmacology and Therapeutics(1988)44,408–417; doi:10.1038/clpt.

ISSN:0009-9236    

DOI:10.1038/clpt.1988.173

年代:1988

数据来源: WILEY

摘要:

Perindopril is the ester prodrug of the angiotensin converting enzyme inhibitor S‐9780. The influence of age on the pharmacokinetics and pharmacodynamics of S‐9780 (1 mg administered intravenously) and perindopril (8 mg administered orally) was examined in a double‐blind, crossover, acute study in eight young (29 ± 3 years) and eight elderly (71 ± 3 years) healthy subjects. Mild headache and light‐headedness were the only adverse effects and were more common in the younger subjects. Blood pressure fall was greater in the elderly even after correction for starting blood pressure. Bioavailability of S‐9780 was increased in the elderly (35% ± 17% compared with 19% ± 7%;p<0.025) mainly because of increased conversion rather than absorption. Renal clearance of S‐9780 was lower in the elderly (67 ±31 ml/min compared with 110 ± 39 ml/ min;p<0.03). Dose reduction of approximately 50% is suggested for elderly patients with further adjustment proportional to any preexisting diminished renal function.Clinical Pharmacology and Therapeutics(1988)44,418–425; doi:1

ISSN:0009-9236    

DOI:10.1038/clpt.1988.174

年代:1988

数据来源: WILEY