ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1990.tb02552.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

This study assessed the relative efficacy and toxicity of second‐line antirheumatic drugs in patients 65 years of age or older compared to younger counterparts. The results of three prospective, double‐blind, parallel, randomized, multicenter trials were reanalyzed, stratifying outcomes by intervention and patient age. Efficacy was assessed by categorizing patient responses as follows: important improvement, no meaningful change, or progressive disease. Toxicity was analyzed by comparing withdrawal rates due to adverse effects. The three trials compared the following treatments: (1) d‐penicillamine 10–12 mg/day versus azathioprine 1.25‐1.5 mg/kg/day; (2) gold sodium thiomalate 50 mg intramuscularly weekly versus auranofin 6 mg/day versus placebo; and (3) pulse oral methotrexate 7.5–15.0 mg weekly versus placebo. At baseline, 103 patients age 65 or older were similar to 485 patients less than 65 years of age, with the exception of disease duration in all studies and erythrocyte sedimentation rate in one study. For patients completing each study, efficacy outcomes based on age were not significantly different. Withdrawal rates due to adverse drug reactions were also not significantl

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1990.tb02553.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

We studied the effect of phenylpropanolamine on blood pressures in seven patients whose hypertension was controlled with β blockers. Rapid‐release phenylpropanolamine 25 mg and placebo were given on separate days according to a double‐blind, randomized, two‐period crossover design. The crossover analyses detected significant drug effects without carryover or period effects for both systolic and diastolic pressures. The peak systolic blood pressures after phenylpropanolamine averaged 8 mm Hg higher than those measured after placebo. Similarly, the peak diastolic pressures after phenylpropanolamine averaged 4.9 mm Hg higher than those with placebo. Baseline weights, blood pressures, and pulses did not significantly differ between patient groups or change significantly across study periods. Usual single and therapeutic doses of phenylpropanolamine caused small but statistically significant increases in blood pressure. If such changes are not considered when antihypertensive therapy is altered or initiated, patients may receive excessive or unnecessary

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1990.tb02554.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Several physiologic changes accompany the aging process and may alter the pharmacokinetics and pharmacodynamics of drugs given to elderly patients. The primary purpose of the present investigation was to compare the pharmacokinetics of labetalol in young and elderly hypertensive patients. Limited data regarding the pharmacodynamics of labetalol in each of these age groups were also evaluated. Ten young (age 32–48 yrs) and nine elderly (age 60–68 yrs) patients with essential hypertension were evaluated after the first and last doses of a 15‐day regimen of labetalol. The young group received 200 mg orally at 9:00 P.M. and 9:00 A.M.; the elderly group received 200 mg once daily at 9:00 P.M. No significant differences in the mean (SD) apparent oral clearance of the drug existed between groups after the first [4.8(1.9) and 4.3 (1.2) L/hr/kg] and final [4.4 (2.2) and 3.4(1.0) L/hr/kg]doses of labetalol. No changes in any pharmacokinetic values for labetalol were detected as a function of age. Changes in standing blood pressure and heart rate after the first and last doses were generally similar between the young and elderly hypertensives. Labetalol was effective and well tolerated in both g

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1990.tb02555.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

We compared the efficacy of diltiazem and propranolol in a randomized, prospective, double‐blind, crossover study in six patients with untreated thyrotoxicosis (mean age 31 yrs). The patients received either diltiazem 60 mg orally four times a day or propranolol 40 mg orally four times a day, each for 1 week, separated by a 3‐day drug‐free period. Blood pressure, heart rate, thyroid hormone levels (free T4, T3), electrocardiogram, two‐dimensional and M‐mode echocardiograms, and Doppler studies were performed. In addition, 8 clinical signs and 18 symptoms of thyrotoxicosis were graded. All subjects felt better with drug therapy, with three preferring diltiazem to propranolol. No significant difference in clinical response or in hemodynamic effects was noted between the agents. These data suggest that diltiazem may serve as an alternative therapy for β blockers in controlling thyrotoxic symptoms in patients in whom β blockade may be cont

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1990.tb02556.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

The effects on the hypothalamic‐pituitary‐adrenal axis of the ultra‐high potency corticosteroid halobetasol in the treatment of psoriasis were evaluated in seven patients with extensive, long‐standing plaque psoriasis. Each patient applied 3.5 g halobetasol 0.05% ointment in the morning and evening for 7 days. Morning plasma Cortisol levels and 24‐hour urinary excretion of 17‐hydroxycorticosteroid were determined before and on the last 2 days of treatment; plasma Cortisol levels were also determined 4 and 5 days after completion of therapy. Morning plasma Cortisol concentrations did not decrease significantly during treatment, and no values were below the normal range. Mean 24‐hour urinary 17‐hydroxycorticosteroid excretion fell from 6.6 ± 1.4 mg to 5.1 ± 1.4 mg. Two patients had mild, localized pruritus and stinging with the initial ointment application. No other adverse cutaneous effects were observed. Halobetasol was also clinically efficacious over the 7 days of treatment, based on evaluation of pruritus, erythema, scaling, and plaque elevation. These results demonstrate no adverse effects of the drug on the hypothalamic‐pituitary‐adrenal axis at doses that are clinically effective in the managemen

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1990.tb02557.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

A follow‐up study of 35,909 outpatients who filled more than 220,000 prescriptions for theophylline over 9 years revealed 30 hospitalizations for xanthine toxicity. The overall estimated incidence rate of 7.8/10,000 person‐years at risk indicates that in this population, hospitalization for xanthine toxicity is a relatively rare ev

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1990.tb02558.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Acylated plasminogen‐streptokinase activator complex (APSAC; anistreplase) is an inactive complex of human plasminogen and streptokinase. When it is injected, a controlled deacylation of the catalytic center occurs, activating the complex so that thrombolysis may begin. This process extends the half‐life of streptokinase, allowing for 4–6 hours of fibrinolytic activity. Anistreplase has demonstrated equivalent efficacy to intracoronary streptokinase with regard to reperfusion rates in acute myocardial infarction. In addition, patients have shown a 56% reduction in mortality at 28 days with anistreplase compared to heparin. The adverse effect profile of anistreplase includes minor bleeding and hematoma formation at the site of venipuncture, hypotensive and bradycardic episodes, arrhythmias, facial flushing, fever, and rarely, allergic reactions. Serious bleeding reactions are uncommon, with the frequency of cerebrovascular accident reported at 0.4‐0.6%. The special advantage of anistreplase is its administration as a 30‐U intravenous bolus injected over 5 minutes, eliminating the need for long infusions and increasing the ease of administration. Based on its efficacy and ease of administration, anistreplase may become the drug of choice in the emergency treatment of acute myocardial i

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1990.tb02559.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Cancer chemotherapy is associated with numerous toxicities such as nausea and vomiting (emesis). The frequency, onset, and duration of emesis depend largely on the emetogenic potential of specific agents. An exact mechanism for chemotherapy‐induced emesis (CIE) is not known but is thought to occur through several noxious actions and numerous neuronal pathways. The three types of CIE are acute, delayed, and anticipatory. Nonchemotherapy causes of emesis should be considered before diagnosing CIE. Once the diagnosis is established, antiemetic regimens should be recommended based on characteristics of the patients and the agents. Phenothiazines, butyrophenones, cannabinoids, metoclopramide, corticosteroids, and benzodiazepines have been successful in preventing and treating CIE. Combinations of these drugs have also been successful and are still being investigated for improved emetic protection with fewer adverse reactions. Investigational agents such as serotonin antagonists may prove to be effective with few toxic effects. Despite the minimal information available on delayed and anticipatory nausea and vomiting, attempts should be made to treat them. Suggested guidelines for the management of CIE have been develope

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1990.tb02560.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Fluconazole and itraconazole are two investigational triazole antifungal agents that are currently undergoing clinical trials in the United States. Both are active orally, have favorable pharmacokinetics (i.e., good bioavailability, long half‐life, low plasma protein binding), and possess activity against several systemic fungal pathogens. In addition, preliminary information suggests that these agents are substantially less toxic than currently available azole compounds. Fluconazole and, to a lesser degree, itraconazole have been shown to be highly effective for the treatment of cryptococcal meningitis. The potential for drug interactions is much lower with these agents compared to drugs such as ketoconazol

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1990.tb02561.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY