ISSN:0012-6667    

出版商:ADIS    

年代:1976

数据来源: ADIS

摘要:

While immunosuppressive drugs are principally used in the treatment of malignant disease, their use in non-malignant disease and transplantation has become commonplace.The mechanisms of action of immunosuppressive agents differ. Alkylating agents react with nucleophilic centres of DNA, RNA and proteins. Purine analogues interfere with nucleic acid synthesis by feed back inhibition of purines, while pyrimidine analogues inhibit enzymes involved in the synthesis of DNA and RNA. Folic acid antagonists prevent the conversion of dihydrofolic acid to tetrahydrofolic acid. Antibiotics act in a variety of different ways; the alkaloids cause metaphase arrest.Cytarabine (cytosine arabinoside), methotrexate, hydroxyurea and thioguanine act in the S phase of the cell cycle; daunorubicin acts in G2. Vincristine and vinblastine act during mitosis and the latter also acts during interphase. Other agents are either not cell cycle specific or their particular time of action during replication is not known.Immunosuppressive therapy has been used in a variety of diseases. It has been used most frequently in inflammatory diseases of all organ systems and those in which an immunological component has been demonstrated, and in transplantation.In uncontrolled studies in rheumatological diseases, azathioprine and methotrexate have been shown to produce some improvement in patients with dermatomyositis and polymyositis. Methotrexate has proved beneficial in a few patients with Reiter's syndrome, especially in treating skin manifestations, and cyclophosphamide has prolonged life in patients with the diffuse form of Wegener's granulomatosis. In other studies, azathioprine, cyclophosphamide and chlorambucil have been associated with improvement in patients with systemic lupus erythematosus (not all of whom had major organ involvement), and high-dose cyclophosphamide and azathioprine have proved beneficial to patients with rheumatoid arthritis. However, no therapy has been effective in treating patients with systemic involvement in progressive systemic sclerosis or in treating patients with Sjögren's syndrome.In controlled trials in patients with lupus nephritis, two studies have shown some benefit to patients receiving a combination of azathioprine and prednisone in comparison with prednisone alone, although no advantage with the combination therapy was demonstrated in another study. High-dose cyclophosphamide also seems to be of some benefit.In patients with rheumatoid arthritis, high-dose cyclophosphamide and azathioprine have been shown to be clearly beneficial when compared with placebo.In uncontrolled studies in dermatological diseases, azathioprine, 6-mercaptopurine, hydroxyurea, methotrexate, and azaribine have proven effective in treating psoriasis. Similarly, azathioprine, cyclophosphamide and methotrexate have all been used with success in treating pemphigus and pemphigoid, although none is effective in controlling acute pemphigus. In controlled studies in patients with psoriasis and psoriatic arthritis, azathioprine and methotrexate have been shown to be better than placebo.

ISSN:0012-6667    

出版商:ADIS    

年代:1976

数据来源: ADIS

摘要:

The effects of aspirin, salicylate formulations and substitutes, smoking (nicotine), indomethacin, corticosteroids, phenylbutazone, ethanol, caffeine and reserpine on the gastric mucosa are discussed. The damaging effects of the drugs are considered in terms of the gastric mucosal barrier, gastric erosions, microbleeding and haematemesis and melaena and finally whether they cause peptic ulcer. There is suggestive evidence that unbuffered aspirin is a cause of haematemesis and melaena and of gastric ulcer but the incidence rates for hospital admission are low, being 10 to 15 per 100,000 heavy users per year. Aspirin in solution as acetylsalicylate buffered to maintain a neutral pH protects against gastric damage. Newer aspirin substitutes (mefenamic acid, fenoprofen, naproxen, tolmetin and ibuprofen) appear to cause less faecal blood loss than aspirin but their long-term effects have not been fully evaluated. Smoking is definitely associated with peptic ulcer but the mechanism is unknown. Corticosteroids are probably not ulcerogenic despite clinical bias that they are. Indomethacin and phenylbutazone may be ulcerogenic but there is insufficient evidence to make firm judgements. Ethanol, caffeine and reserpine, on available evidence, are probably not ulcerogenic.

ISSN:0012-6667    

出版商:ADIS    

年代:1976

数据来源: ADIS

摘要:

All tetracycline derivatives are bacteriostatics and their concentration in serum should not fall during the therapy below the generally accepted minimum therapeutic concentration of 0.5 to 1.5μg/ml.Tetracyclines have a high affinity to form chelates with polyvalent metallic cations such as Fe+++, Fe++, Al+++, Mg++and Ca++. Many of these tetracycline-metal complexes are either insoluble or otherwise poorly absorbable from the gastro-intestinal tract. Milk and other dairy products, antacids containing polyvalent cations, as well as various iron salts ingested simultaneously with tetracycline derivatives, might interfere with their absorption by 50 to 90% or even more. The severity of interaction depends both on the nature of the tetracycline derivative and of the cation, on the doses used, on pharmaceutical factors, and on time schedules in dosing. An interval of 3 hours between the ingestion of tetracyclines and cations prevents the interaction.The pharmacokinetic interactions in absorption of tetracyclines are likely to be clinically significant in cases where the infecting pathogens are moderately resistant to tetracyclines and relatively high serum concentrations are needed for proper bacteriostasis.

ISSN:0012-6667    

出版商:ADIS    

年代:1976

数据来源: ADIS

摘要:

With the wide range of medications available today it should be possible to obtain satisfactory control in the majority of hypertensive patients. However, there are various categories of patients who may present particular problems in management, as for example patients with cerebro-vascular and coronary disease, or with renal failure. A particularly important group is those presenting with severe resistant hypertension, and these patients may constitute about 5 to 10% of the hypertensive population. Considerations relevant to the management of patients presenting with such problems are discussed. Combined drug regimens employing clonidine or &bgr;-blockers with peripheral vasodilators appear to be particularly useful.

ISSN:0012-6667    

出版商:ADIS    

年代:1976

数据来源: ADIS

摘要:

Although the mortality of Parkinsonism is negligible, it is one of the major causes of progressive and often pitiful disability in the elderly. Treatment of the condition, whether medical or surgical, is still only palliative. The successes and limitations of the various forms of treatment are discussed. Despite the spectacular gains which have been achieved during the past 25 years by stereotactic thalamotomy and treatment with levodopa, the patient's disabilities tend to progress slowly and the fundamental enigma of Parkinson's disease and of its cure still awaits solution.

ISSN:0012-6667    

出版商:ADIS    

年代:1976

数据来源: ADIS

ISSN:0012-6667    

出版商:ADIS    

年代:1976

数据来源: ADIS