ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1990.tb02572.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Adenosine is a purine nucleoside present in every cell of the human body. It is released into the extracellular space under physiologic and pathophysiologic conditions characterized by increased oxygen demand: supply ratio. Adenosine can exert a wide spectrum of effects in various organs and tissues. Exogenous adenosine has a wide spectrum of effects in experimental animal models as well as humans. The pharmacokinetics, pharmacodynamics, and the interaction of adenosine with other drugs are reviewed.

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1990.tb02573.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Obsessive‐compulsive disorder (OCD) is a potentially devastating illness, both to the patient and family members. Its etiology is unclear, but some evidence points toward dysfunction in an orbitofrontal striatal‐limbic neuronal loop. Although many agents have been used, clomipramine, a tricyclic antidepressant, appears to be the most promising therapy. Clomipramine was approved by the Food and Drug Administration and released for general use in early 1990 under the brand name Anafranil. Clomipramine's adverse effect profile is similar to that of currently marketed tricyclic antidepressants; however, it is associated with a higher frequency of seizures, estimated to be 0.7%. Although other serotonergic agents such as fluoxetine have shown promise in OCD, they have been studied only in a limited number of patients. Other agents, with the possible exception of monoamine oxidase inhibitors, either have resulted in inconsistent improvement or have been reported in an anecdotal fash

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1990.tb02574.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Before 1982, annual retrospective drug‐use audits clearly established the pattern of increased antibiotic use and expenditures at the University of Minnesota Hospital. At that point, a concurrent trend analysis system was developed to track this use by individual drug and therapeutic class, to identify trends in use for qualitative evaluation, and to provide an assessment of any intervention intended to alter use. Monthly use of all injectable antibiotics and antifungal agents, and selected oral antifungals has been tracked since 1982 as both defined daily doses and dollars. Use patterns in 1981 served as baseline. The defined daily dose index, which captures changes associated with intensity of antibiotic use per patient, increased 62% from baseline through 1988. This increase, however, resulted in a disproportionate 228% rise from baseline in antibiotic expenditures to nearly $3 million/year for 1988. The defined daily dose index peaked in 1985, declined in 1986, and remained stable for 1987 and 1988. Qualitative drug‐use review programs were associated with this positive change. These results demonstrate the utility of concurrent trend analysis as a resource‐management tool and as a measure of effectiveness for collaborative physician‐pharmacist programs to foster safe, appropriate, and economical use of antiinfective

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1990.tb02575.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

We evaluated the economic and clinical effects of two immunosuppressive drug regimens used to treat recipients of human leukocyte antigen (HLA)‐identical sibling donor renal transplants during the first posttransplant year. We compared consecutive patients in two groups of 30 who were given either antilymphoblast globulin (ALG), azathioprine, plus prednisone or cyclosporine, azathioprine, and prednisone for immunosuppression. We standardized all dollar values, costs and charges, to the 1986 level using our hospital's health care charge inflation rate. There were no significant differences between the two treatment groups for actual patient (100% vs 93%; p = 0.51) and graft survival rates (100% vs 93%; p = 0.51), average serum creatinine level (1.0 ± 0.3 vs 1.0 ± 0.2 mg%; p = 0.46), and most recent creatinine level (1.4 ± 0.3 vs 1.4 ± 0.7 mg%; p = 0.45). The average cyclosporine‐azathioprine‐prednisone costs were $3987/patient more for the first year of therapy than for ALG‐azathioprine‐prednisone. However, the former regimen produced an average of $9543/patient less in total hospitalization charges. This was due to both a shorter initial hospital stay and a decreased rate of rehospitalization, with a lower frequency of acute rejection episodes (p = 0.001) and infectious complications (p = 0.05). We conclude that, although this cyclosporine‐containing protocol was associated with increased drug costs, it is justified by decreased hospitalization charges that resulted from improved effi

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1990.tb02576.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Seventy‐five patients with moderate to severe cancer pain were randomly assigned in a double‐blind fashion to receive first‐dose ketorolac tromethamine 10 mg orally, acetaminophen 600 mg plus codeine 60 mg orally, or placebo, followed by subsequent doses of ketorolac or acetaminophen plus codeine four times daily for 7 days. Patient characteristics were similar among the treatment groups. The first‐dose observation documented that both ketorolac and acetaminophen plus codeine produced an equivalent reduction in cancer pain and were superior to placebo as measured by pain intensity differences and pain relief. Multidose comparison documented a small but statistically significant advantage in mean daily pain relief favoring acetaminophen plus codeine, although there were no differences in mean daily ratings of overall effects for either study medication. Adverse symptoms were acceptable with both ketorolac and acetaminophen plus codeine. We conclude that ketorolac has significant analgesic activity in patients with cancer pain, although its precise role in the treatment regimen of these patients remains undefined. (Pharmacotherapy 1990;10(3):

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1990.tb02577.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1990.tb02578.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

During the last 5 years we believe that the prescribing of dobutamine has increased over that of the older agent dopamine. The literature reports advantages such as less tachycardia, less peripheral vasoconstriction, and fewer increases in intracardiac pressures with dobutamine as opposed to dopamine. After a thorough review of the literature, we were unable to find conclusive evidence of these initial findings, and present several studies to show potential flaws in their interpretation that may help explain the increased use of dobutamine over dopamine. The overuse of dobutamine, if it does exist, must be dealt with by pharmacy departments in an informed, yet unbiased fashion, to aid in preventing the continued escalation of health care costs.

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1990.tb02579.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1990.tb02580.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY