Routine Pharmacotherapy Research Articles

Therapeutic effect of hyperbaric oxygen treatment combined with pharmacotherapy for sudden deafness: A retrospective study

To compare the therapeutic effect of hyperbaric oxygen (HBO) treatment and pharmacotherapy with that of pharmacotherapy alone in sudden deafness (SD) patients, and to evaluate the impact of therapeutic time window on the therapeutic effect, a total of 264 patients with SD were assigned into HBO group and control group. Patients in the HBO group received routine pharmacotherapy and HBO treatment, and those in the control group were only routinely treated with drugs. Acoustic impedance measurement and pure tone audiometry were performed before and after treatment. The hearing after treatment at different time windows was compared with that before treatment. The overall efficacy in the HBO group was significantly superior to that of the control group (P 0.05). The results demonstrated that the efficacy of HBO combined treatment was superior to that of routine pharmacotherapy for SD patients, and HBO treatment can favorably improve the hearing of these patients. HBO treatment initiated early after symptom onset (<2 weeks) is recommended, and that initiated 2 weeks after symptom onset predicts a poor outcome. Key words: Sudden deafness, hyperbaric oxygen, time window, therapeutic efficacy.

Vasopressin Antagonists: Pharmacotherapy for the Treatment of Heart Failure

To evaluate acute hemodynamic, short-term, and long-term effects of vasopressin antagonists in patients with heart failure (HF). Searches of the PubMed database (1966-February 2010) were conducted. Search terms included AVP receptor antagonist, CHF, tolvaptan, conivaptan, lixivaptan, HF, and hyponatremia. Manufacturers' prescribing information, manufacturer Web site searches, and searches made on www.clinicaltrials.gov were also included. All clinical trials identified from the reference search and data sources were reviewed. Articles were included if they were relevant to short-term and long-term outcomes of patients with HF who were treated with vasopressin antagonists. Trials of conivaptan, tolvaptan, and lixivaptan were evaluated. The evidence indicates that all agents increase urine output >10 mL/h, and conivaptan and tolvaptan decrease pulmonary capillary wedge pressure (-2.6 +/- 0.7, -5.4 +/- 0.7, and -4.6 +/- 0.7 mm Hg for placebo, conivaptan 20 mg, and conivaptan 40 mg, respectively; -5.67 +/- 4.58 to -6.38 +/- 4.12 mmHg for tolvaptan, and -4.16 +/- 4.57 mm Hg for placebo) in patients with HF. Both of these changes occur without inducing electrolyte abnormalities or renal dysfunction. Trials with conivaptan in acute HF have not demonstrated a benefit in cardiac index, mean arterial pressure, or vascular resistance. Data from clinical trials indicate that tolvaptan may decrease dyspnea (p < 0.05) and pedal edema (p < 0.001). To date, no large-scale trials of any agent have demonstrated an improvement in left ventricular systolic function, rehospitalization, worsening HF, or death. Vasopressin antagonists cannot be considered routine pharmacotherapy for HF. Further, conivaptan should not be used for the treatment of acute HF. There is not enough literature to advocate for or against the use of lixivaptan in patients with HF. Tolvaptan may be considered for the treatment of hyponatremia.

Opioidinduzierte Obstipation: Literaturanalyse zu Pathophysiologie und Behandlung

Bowel dysfunction is a frequent and serious side effect of opioid analgetics. In spite of its common occurrence, in the course of clinical routine, it is frequently ignored or underestimated. Authors of the analysed literature widely agree that a prophylactic and routine pharmacotherapy is necessary. For this purpose, laxatives, enemas and suppositories, prokinetic agents and opioid antagonists can be considered. Bulk-forming laxatives did not prove to be effective, since the quantity of fluid intake required for the action usually cannot be provided. Furthermore, the benefit of emollient agents is doubted. As a monotherapy they are not sufficient. By contrast, stimulant and osmotic laxatives proved to be active. Prokinetic drugs are not recommended because of their serious side effects. Effective abatement of opioid-induced obstipation by opioid antagonists has been proven in numerous studies. However, the loss of analgesia and opioid withdrawal symptoms were described as adverse effects. Development of quaternary opioid antagonists such as methylnaltrexone was allowed for mitigating these adverse effects.

Application study of self-care model in nursing of chronic schizophrenic inpatients

Objective To explore the serf-care project of chronic schizophrenic inpatients and its effect. Methods 80 chronic schizophrenic inpatients were divided into the experiment group and the control group according to the grouping method of minimization imbalance index. Then a double-blind comparison was conducted in the two groups. Both the two groups adopted the routine schizophrenic pharmacotherapy and the general nursing, and the experiment group additionally adopted the self-care on the before-mentioned basis. The observation lasted for 6 months. The ADL (Activity of Daily Living Scale) was used to evaluate the curative effect of patients in the two groups before and after the intervention. Results The score of ADL in the experiment group had a statistical meaning compared to that of control group (P < 0. 01). Conclusions On the basis of systematic hospitalization therapy, implementing the self-care among chronic schizophrenic inpatients can obviously improve their self-care ability and the rehabilitation effect, thereby helping the patients return to society early. Key words: Orem self-care model; Schizophrenosis; Self-care

The effects of rehabilitation training on cardiac function in cerebral infarct patients

Objective To study the effects of rehabilitation （RT） on cardiac function in cerebral infarct （CIF） patients with cardiac insufficiency （ CIS）. Methods Fifty-nine CIF patients with CIS were randomly divided into a treatment group （ T group, n = 29 ） and a control group （ n = 30） , and all patients were treated with routine pharmacotherapy for 2 months. In addition, RT was administrated in the T group at the same time. The grading of the New York Heart Association （NYHA） and the changes in cardiac function associated index were observed in both groups before and after treatment. Results Compared with the control group, NYHA grades, left ventricle ejection fraction（LVEF） , the levels of brain natriuretic peptide（BNP） in the blood plasma, and the 6min walking range of the T group patients were all significantly improved after treatment （ P 〈 0.05 ）. Conclusion RT can improve cardiac function in CIF patients with CIS. Key words: Cerebral infarction; Cardiac insufficiency; Rehabilitation training

Anti-inflammatory action of diltiazem in patients with unstable angina

Background and Aims: Plasma concentrations of anti-inflammatory cytokine interleukin 10 (IL10) have been shown to be decreased in patients with unstable angina (UA) suggesting that reduced concentrations of IL10 may...

Association of anticholinergic load with impairment of complex attention and memory in schizophrenia.

The authors' goals were 1) to establish a clinically useful standard index of the relative anticholinergic potency of psychiatric medications; 2) to determine which cognitive functions are most affected by the administration of anticholinergic medications to patients with schizophrenia; and 3) to compare in vitro and clinically derived indexes of anticholinergic load in predicting these cognitive impairments. One hundred six clinically stable patients with schizophrenia were given a brief neuropsychological battery and evaluated on a standard symptom rating scale. The anticholinergic load associated with their psychiatric medications was estimated by using 1) a pharmacological index, calculated from a compilation of published studies reporting in vitro brain muscarinic receptor antagonism, and 2) a clinical index, based on clinician ratings of the anticholinergic side effects of medications. The authors analyzed the correlations of both indexes with the neuropsychological measures and with summary neuropsychological factor scores. The clinical and pharmacological anticholinergic indexes were highly correlated with each other and showed virtually identical associations with neuropsychological measures. Anticholinergic load was associated with lower scores on measures of attention and declarative memory, including several measures of auditory and visual memory and two tests of complex attention, but was unrelated to intelligence, simple attention, working memory, executive functions, conceptual fluency, or motor speed. This pattern of cognitive impairment with central cholinergic antagonism is consistent with emerging models of the functional anatomy of ascending forebrain cholinergic subsystems. Both pharmacological and clinical indexes show utility in predicting the effects of anticholinergic load on cognition in schizophrenia. Doses of psychiatric medication within the range of routine pharmacotherapy practice may have clinically significant effects on memory and complex attention in patients with schizophrenia; these effects may contribute as much as one-third to two-thirds of the memory deficit typically seen in patients with schizophrenia.

Breakthrough pain in cancer patients: new therapeutic approaches to an old challenge.

Breakthrough pain is a well recognized but ill-defined phenomenon that occurs commonly in the presence of otherwise stable, persistent pain. It is defined now as a "transient pain episode that occurs, or breaks through from the otherwise stable background pain." Breakthrough pain is usually associated with moderate to severe pain and may form a predictor of poor response to treatment with routine pharmacotherapy. Breakthrough pain is also associated with functional impairment and psychological distress. The assessment and treatment should be multidimensional. Although primary therapies such as chemotherapy, radiation treatment, and surgical options are explored, the mainstay of treatment is pharmacotherapy. Nonpharmacologic methods, such as orthotic devices and joint stabilizations along with behavioral methods, should be explored. Anesthetic and neurosurgical procedures are performed on a limited number of patients based on the prognosis, intractable nature of pain, and favorable risk/benefit ratio. Newer oral transmucosal fentanyl offers a favorable pharmacokinetic and pharmacodynamic profile and ease of administration.

The presence of lead decreases the availability of meso-2, 3-dimercaptosuccinic acid for analysis in the monobromobimane assay.

meso-2,3-Dimercaptosuccinic acid is a suitable chelating agent for routine pharmacotherapy of lead poisoning in children. Administration of meso-2,3-dimercaptosuccinic acid presumably permits complexation of lead in vivo, allowing excretion through urine or feces. Quantification of the lead is achieved independently from the analysis of meso-2,3-dimercaptosuccinic acid and metabolites from the monobromobimane assay. To date, no direct chemical characterization of the Pb species excreted in urine has been successful. Pharmacokinetic correlation of lead excretion with excretion of meso-2,3-dimercaptosuccinic acid and metabolites has been utilized as an indirect method to draw conclusions regarding the identity of the active chelating agent. In this study, we hypothesized that the Pb-coordinated thiols are not reactive with respect to monobromobimane, and thus, the active chelator contained in the lead complex escapes detection. We performed variations of the assay and found that (1) the fluorescence detector response for the meso-2,3-dimercaptosuccinic acid-monobromobimane adduct was clearly attenuated as a function of added Pb, (2) when meso-2, 3-dimercaptosuccinic acid and monobromobimane were mixed prior to the addition of lead, the lead had no effect on detector response, (3) the addition of dithiothreitol does not affect the ability of Pb to react with meso-2,3-dimercaptosuccinic acid and verifies that oxidation of meso-DMSA had not occurred, and (4) the addition of ethylenediaminetetraacetic acid to the assay reverses the result found in point 1, presumably through trans chelation of the Pb-DMSA complex. Indirect quantification of the Pb-DMSA complexes found in urine might be accomplished through modification of the standard monobromobimane assay for analysis of meso-2,3-dimercaptosuccinic acid.

Significance of Migrainous Features in Cluster Headache: Divalproex Responsiveness

Two patients with cluster headache and prominent migrainous features are described and a shared migraine and cluster headache pathophysiology is discussed. Both patients failed routine cluster headache pharmacotherapy, one failed multiple operative interventions; however, both remitted on divalproex. It is suggested that migrainous features be assessed in cluster headache and divalproex initiated before pursuing invasive procedures.

EPA in the Prevention of Restenosis Post PTCA

The effect of fish oil on restenosis was evaluated in patients undergoing coronary balloon angioplasty. In addition to routine pharmacotherapy, subjects were given 2.8 g of eicosapentanoic acid (EPA) daily. Treatment was started within twenty-four hours after successful percutaneous transluminal coronary angioplasty (PTCA). After six months of therapy, participants were subjected to coronary arteriography, exercise scintigraphy, exercise electrocardiography, or clinical evaluation. Follow-up evaluation involved 97 coronary lesions in 85 patients. Partial or significant restenosis occurred in 36.5% of patients and 33% of vessels. The presence of severe stenosis before PTCA, dissection, thrombus, multilesion PTCA, and template bleeding time values were not correlated with restenosis. Dilation of the left anterior descending (LAD) and a residual stenosis greater than or equal to 35% were associated with restenosis. Approximately 20% of the patients related difficulty in taking the fish oil. Furthermore, these results show no advantage over expected restenosis rates.