ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1985.tb03415.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

The stepped‐care approach to the treatment of hypertension suggests the use of a diuretic or, in some cases, a beta blocker as intitial monotherapy. If either of these agents proves to be ineffective, the other can be tried as monotherapy. Stepped‐care suggests the use of different classes of drugs that affect different mechanisms related to hypertension at various stages of treatment. Although empiric, the concept makes good physiologic sense. Results of its use in major clinical trials, as well as an extensive private practice experience, suggest that in a large majority of patients, hypertension can be controlled with relatively little expense, few titration problems and a high rate of adherence. Advocates of individualization of care, or sequential monotherapy, base their suggestion on theory, but widespread use of this approach would make management more complex and more expensive, and would probably decrease adherence to long‐term treatment. Stepped‐care treatment allows for adequate individualization and a wide choice of drugs, and should continue to be employed unless data are obtained that demonstrate a better outcome with sequential monotherapy or other more complex app

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1985.tb03416.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

The choice of initial therapy of hypertensive patients may be critical in the long‐term efforts to reduce premature cardiovascular morbidity and mortality. In the 1984 report of the third Joint National Committee (JNC), significant changes in the usual approach to initial therapy were suggested, including a more conservative approach toward the institution of drug therapy, more liberal use of nondrug therapies and broader choices for the initial drug. I support these changes and believe that even a greater number of choices for initial therapy should be considered. I am increasingly concerned about the hazards of diuretic therapy and believe that for most patients, an adrenergic inhibitor is preferable for first drug. Rather than limit the type of adrenergic inhibitor to a beta blocker as suggested in the JNC report, either an alpha blocker or a centrally acting drug may be preferable. In the near future, calcium antagonists will likely also become logical choice

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1985.tb03417.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

Terfenadine is the first of a new class of non‐sedating H1antihistamines. It differs from chlorpheniramine in its lower anticholinergic activity in rabbit salivation tests. In animal model distribution studies, the drug is not found in the brain. In most clinical studies sedation attributed to terfenadine was on the order of that observed with placebo. Clinical trials of efficacy show that at best terfenadine is slightly less effective than or as effective as chlorpheniramin

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1985.tb03418.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

Flecainide acetate is the first class IC antiarrhythmic agent marketed in the United States. In vitro, animal and human studies have shown that the drug markedly prolongs conduction and has minimal effect on repolarization. Efficacy trials have shown flecainide to be effective in a wide range of ventricular and selected atrial arrhythmias. The drug is generally well tolerated, although minor adverse effects are common. These generally are related to the central nervous system and respond to a reduction in dosage. Like other antiarrhythmic agents, flecainide may demonstrate proarrhythmic effects. It is excreted in the urine as the parent compound and inactive metabolites. The elimination half‐life ranges from 12–27 hours in patients with normal renal function, allowing convenient dosing regimens of 100–200 mg twice daily in most patients. Flecainide has the potential for widesprea

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1985.tb03419.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

Although the medical literature describes the perioperative use of antibiotic irrigations in abdominal, pelvic, orthopedic and vascular surgery, the lack of well‐designed and executed, controlled clinical studies often precludes a definitive assessment of the value of this technique. Future randomized, double‐blind, controlled clinical trials are required to establish its merit. In this age of cost consciousness, lavages with antibiotic solutions cannot at present be regarded as conventional medical ther

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1985.tb03420.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

Book reviewed in this article:Evaluations of Drug Interactions, third edition. Edited by Arthur F. Shinn and Robert P. Shrewsbury. Published by C.V. Mosby Company, 11830 Westline Industrial Drive, St.Drug Interactions, fifth edition. By Philip D. Hansten. Published by Lea&Febiger, 600 Washington Square, Philadelphia, PA 19106, 1985.

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1985.tb03421.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY