摘要:

Quazepam is a benzodiazepine hypnotic that can be useful in the adjunctive pharmacologic treatment of insomnia. It is slowly eliminated due to the long elimination half‐lives of the parent compound and its two active metabolites, 2‐oxoqua‐zepam andN‐desalkyl‐2‐oxoquazepam. This drug is recommended in doses of 15 mg for adults and 7.5 mg for geriatric patients. Sleep laboratory studies and clinical trials have shown that the 15 mg dose is quite efficacious for inducing and maintaining sleep not only with initial and short‐term use but also with continued use. The 7.5 mg dose which has been studied less extensively has also been shown to be effective for inducing and maintaining sleep. There is considerable evidence of carryover effectiveness both during drug administration and after withdrawal. Thus, rebound phenomena are not observed during administration (early morning insomnia and daytime anxiety) and after withdrawal (rebound insomnia). Furthermore, certain behavioral side effects that have occurred with certain benzodiazepines (triazolam) have not been reported with quazepam. The only notable side effect seen with quazepam is a variable degree of daytime sedation, which can be minimized by intermittent use of the 15 mg dose when necessary and use of the 7.5 mg dose in the elderly. In comparison to triazolam and temazepam, quazepam is more effective with short‐term use, and with continued use it maintains its efficacy in contrast to both of these drugs which show rapid development of tolerance. Most important, quazepam lacks the frequent and severe side effects increasingly reported with triazolam use or following

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1990.tb02545.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Dilevalol is a novel antihypertensive drug that combines nonselective ß blockade with selective ß2‐receptor agonist activity. Its antihypertensive effect is mediated through arterial vasodilation and a decrease in systemic vascular resistance. At rest, dilevalol has little effect on heart rate or cardiac output. The drug is rapidly and completely absorbed but undergoes significant first‐pass hepatic extraction. Its elimination half‐life of approximately 12 hours allows for once‐daily administration. In controlled clinical trials, dilevalol was at least as effective as angiotensin‐converting enzyme inhibitors and comparable to ß blockers in antihypertensive efficacy. Preliminary data indicate that dilevalol reverses left ventricular hypertrophy in some patients. It does not adversely affect renal function and may have a favorable effect on plasma lipids, especially high‐density lipoprotein cholesterol. The agent is usually well tolerated and may prove to be a useful addition to our antihype

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1990.tb02546.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

The pharmacokinetics of methylprednisolone sodium succinate (MPHS) and methylprednisolone (MP) were determined in six patients undergoing open heart surgery with cardiopulmonary bypass. Plasma concentrations of both compounds were measured by high‐performance liquid chromatography after doses of MPHS of 1.7‐2.4 g. The prodrug ester MPHS yields MP with an average formation rate constant of 0.70 + 0.29 hr−1. Peak concentrations of MP occur around 1–2 hours after loading and additional administration of MPHS. The pharmacokinetic values of the two drugs in patients having cardiopulmonary bypass were compared to those in younger, healthy subjects. The volume of distribution of MPHS was lower in the patients, and that of MP was similar to the value in controls. Total clearances of both agents were reduced by about 5 and 2 times. The elimination half‐life of MPHS was increased slightly, whereas that of MP increased more than twice in the patients. Significant alterations in clearances occurred in patients, but concentrations of MP were appreciable and prolonged MP due to the extensive formation of MP from MPHS and reduced cleara

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1990.tb02547.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

In November 1988, 164 hospitals enrolled in the Drug Surveillance Network participated in a nationwide survey of prescribing patterns for thrombolytic drugs for patients with an acute myocardial infarction. The results indicated that alteplase has made dramatic inroads, being used exclusively in 14.6% of the hospitals; in 64% of the hospitals both alteplase and streptokinase were on the formulary. Overall, however, only 17% of patients admitted with an acute myocardial infarction were treated with a thrombolytic, and use of these agents varied markedly across institutions. One of the reasons for this low figure may be the current maximum allowable time from onset of symptoms to administration of a thrombolytic. This time limit was less than 6 hours in the majority of hospitals in spite of recent evidence suggesting that these drugs may be effective up to 24 hours after onset of symptoms. The low and variable use of the agents for acute myocardial infarction suggests the need to identify patient‐ and physician‐related obstacles so that overall attitudes and professional practice can be modified to reverse this trend. Given large number of institutions reporting the presence of formal, prospective, pharmacy‐initiated monitoring programs, we suggest that clinical pharmacists will play a major role in implementing the necessary ch

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1990.tb02548.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

This investigation was conducted to determine if measurements of bioelectrical impedance in conjunction with serum creatinine concentrations are useful in predicting creatinine clearance. Twenty‐eight healthy volunteers between 23 and 50 years of age followed an individualized protein diet to provide 1.2 g protein/kg/day for 3 consecutive days. At the beginning of day 3, a 24‐hour urine collection was initiated. At the midpoint of urine collection, bioelectrical impedance measurements of resistance and reactance were taken, together with a single blood sample for assessment of serum creatinine concentration. Multiple linear regression techniques were used to identify significant values for predicting creatinine clearance. Resistance and serum creatinine concentration were identified as significant predictors. The measured creatinine clearance was compared to that predicted by the impedance‐derived model that we developed, as well as other established estimation methods. Mean absolute prediction errors in creatinine clearance using this model were significantly lower than those obtained using four empiric methods. Bioelectrical impedance may provide a noninvasive, quick, and accurate method for predicting creatinine clearance from serum creatinine concentration v

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1990.tb02549.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Widespread use and abuse of cocaine have increased the frequency with which health professionals must manage acute and chronic intoxication and the complications stemming from drug ingestion. Acute intoxication from catecholamine excess progresses through three stages, affecting the cardiovascular, respiratory, and central nervous systems. Management is to support or return these systems to normal with sedation, ß blockade, and antiarrhythmics. Casual cocaine use is no longer considered benign, and numerous related medical complications are now recognized. Dopaminergic systems are the principal sites of reward and participate in abstinence symptomatology, putatively through depletion of dopamine and changes in receptor sensitivity and responsiveness. Long‐term treatment approaches have focused on psychologic strategies of behavior modification and supportive psychotherapy. Pharmacotherapy with desipramine, amantadine, and bromocriptine was shown in preliminary studies to minimize the symptoms of cocaine withdrawal when used adjunctively with psychotherapy. The response to treatment may depend on the patient's premorbid psychiatric stat

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1990.tb02550.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Imipramine, a widely used antidepressant, has rarely been associated with hepatic abnormalities. In the majority of reported cases, hepatic effects have been transient and readily reversible on discontinuation of the drug. We cared for an 11‐year‐old boy with hepatic failure and massive cell necrosis which followed treatment with imipramine for enuresis. This therapy led to fulminant hepatic failure and subsequent liver transplantat

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1990.tb02551.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY