Use Of Sympathomimetic Amines Research Articles

Use, Abuse, and Misuse of Nasal Medications: Real-Life Survey on Community Pharmacist's Perceptions.

Medication overuse is an increasing global problem, especially for those rhinology diseases whose management requires over-the-counter drugs. This observational community pharmacy-based study aimed to investigate the actual use of the best-selling topical nasal medications and to characterize the clinical issues underlying their query through the pharmacist's perception. In the pilot phase, a preliminary survey was developed by a team of researchers and tested on a small sample of practitioners to assess usability and intelligibility. Eventual amendments were made according to the feedback obtained, and the final version was submitted to practitioners working in 376 pharmacies evenly distributed over the Italian territory. Two groups of customers (18-30 years old and 60-75 years old) were the ones who most frequently purchased topical decongestants. The dosage applied for sympathomimetic amines was higher than recommended in up to 44.4% and the duration of use longer than 5 days in up to 31.9% of the cases. Patients' queries of alpha agonists and topical corticosteroids resulted in significantly higher numbers than practitioners' prescriptions. Allergic rhinitis was the most common disease affecting patients seeking sympathomimetic amines. The prolonged use of sympathomimetic amines in patients suffering from rhinology diseases is a significant problem that requires greater attention in terms of social education and surveillance.

Use of sympathomimetic amines to correct premenstrual urticaria and anaphylaxis

Purpose: To see if the use of sympathomimetic amines, which have been shown to treat cases of hives, can help prevent cyclical urticaria and anaphylaxis associated with the late luteal phase that was resistant to standard treatment. Materials and Methods: Treatment with low dose dextroamphetamine sulfate to gain relief of symptoms was given to one young woman whose urticaria only occurred premenstrually, but was also associated with life threatening anaphylaxis. Patient 2 had chronic daily urticaria which was exacerbated premenstrually. Results: Both patients showed prompt 100% improvement in the urticaria. Patient 2 after 20 years of therapy ran out of medication for one month. Her severe urticaria quickly returned only to dissipate when dextroamphetamine sulfate was restarted. Conclusion: Use of dextroamphetamine sulfate was successful in treating the anaphylaxis and extensive luteal phase hives in patient 1 as well as treating chronic hives with a premenstrual exacerbation in patient 2. These cases are both consistent with the proposed mechanism of the sympathetic neural hyperalgesia edema syndrome, i.e., increased cellular permeability related to sympathetic nervous system hypofunction of specific permeability defects of certain tissues. In these cases, the hypothesis is that the increased permeability manifests as leakage from the vesicles that contain the histamines.

The use of sympathomimetic amines for severe pelvic pain may help defer potentially oocyte damaging laparoscopic surgery

To determine if treatment with sympathomimetic amines could provide sufficient pelvic pain relief to preclude laparoscopic surgery which has been shown to further diminish oocyte reserve in women with endometriosis.

Sympathomimetic amines as a novel treatment for refractory chronic idiopathic urticaria

Rationale To corroborate or refute a previous case report showing marked improvement in severe chronic idiopathic urticaria (CIU) by the use of sympathomimetic amines. Methods Retrospective review of all patients who were refractory to conventional medication such as various anti-histamines and corticosteroids that were treated with dextroamphetamine sulfate spansules 20-30mg/day. The patients were evaluated for degree and persistence of improvement. Results Four reviewed cases with chronic idiopathic urticaria of a mean 9 years duration (range 4-17 years) showed either moderate to significant improvement following dextroamphetamine sulfate therapy. One patient also had angioedema which also improved considerably following therapy. No cases had to stop using dextroamphetamine sulfate because of side effects. All cases remain improved for treatment duration of 4 years minimum and a maximum of 8 years. Conclusions These data corroborate previous findings of 2 previous reported cases that sympathomimetic amines can effectively control chronic idiopathic urticaria that was refractory to conventional therapy. Furthermore, these additional 4 cases show that the effectiveness of therapy does not wane over time. The duration of effectiveness was not evaluated in the 2 previous cases. Also, the therapy was well tolerated. Thus, to date, in a small series of 6 cases, sympathomimetic amine treatment caused significant improvement in 100% of studied cases. A search of the English literature failed to find any publications pro or con about this therapy for CIU in the 20 years since the original publications. Hopefully these data will prompt interest in performing a larger prospective study.

Pharmacology Review

During the past 2 decades, dopamine has become the most frequently used sympathomimetic amine in the treatment of neonatal shock. The observations that severe and prolonged hypotension may result in the development of irreversible shock, which is associated with increased mortality and central nervous system morbidity, form the rationale behind the early use of dopamine and other sympathomimetic amines in neonates if volume administration fails. However, although cautious volume administration and the early use of dopamine are effective in improving the cardiovascular status and renal function in most neonates who have hypotension, there is only indirect evidence that the use of dopamine (and the other sympathomimetic amines) in the management of neonatal shock improves mortality and morbidity. Recent advances in understanding of the pathophysiology of neonatal shock and the developmentally regulated mechanisms of dopamine action have led to more sophisticated use of this drug. Yet, limitations in the ability to assess accurately tissue perfusion at the bedside present challenges to management of neonatal shock, especially in the very preterm neonate during the immediate postnatal period. Furthermore, although recent studies have shed light on the effects of dopamine on regional organ blood flow in the neonate, there is very little evidence on the effects of dopamine (and the other sympathomimetic amines) on tissue oxygen delivery and consumption. Bearing these limitations in mind, we review the mechanisms of action and pharmacokinetics of dopamine and discuss the cardiovascular, renal, and neuroendocrine effects of the drug. Additionally, we examine the clinical evidence supporting and challenging the use of this sympathomimetic amine in the treatment of neonatal cardiovascular compromise. Dopamine, an endogenous catecholamine and the precursor of epinephrine and norepinephrine, plays an important physiologic role in the regulation of cardiovascular, renal, neuroendocrine, and central nervous system functions. Therefore, when used for its cardiovascular and renal …

Complications and mortality of percutaneous balloon mitral commissurotomy. A report from the National Heart, Lung, and Blood Institute Balloon Valvuloplasty Registry.

In response to the increasing use of percutaneous balloon mitral commissurotomy, the National Heart, Lung, and Blood Institute established the Balloon Valvuloplasty Registry in November 1987. Between November 1, 1987, and October 31, 1989, 738 patients aged 18 or older underwent percutaneous balloon mitral commissurotomy at the clinical sites. Data were prospectively entered into the registry at the time consent was obtained. Serious complications occurred in 87 procedures, or 12%. Death in the laboratory occurred in eight patients, or 1%. Within 30 days there were 24 cumulative deaths, 18 cardiac and six noncardiac. Univariate analysis revealed that older age, a history of cardiac arrest, cerebrovascular disease, dementia, renal insufficiency, cachexia, class IV congestive heart failure, use of an intra-aortic balloon pump, use of sympathomimetic amines, and a high echo score (greater than or equal to 13) were associated with early death (p less than 0.01). Additional univariate predictors included a precommissurotomy mitral valve area of less than 0.7 cm2. Left atrial pressure greater than 12 mm Hg and a mitral valve area of less than 1.5 cm2 after the procedure were also associated with higher 30-day mortality (p less than 0.05). Multivariate analysis identified higher echo score and smaller valve area before the procedure as the strongest predictors of early death (p less than 0.001). Centers that performed more than 25 procedures also had lower complication rates. Although percutaneous balloon mitral commissurotomy appears to be effective at relieving the hemodynamic effects of rheumatic mitral stenosis, it does have risks. In properly selected patients, however, it appears to have low morbidity and 30-day mortality. Individual center experience with the procedure also appears to have great impact on complications.

Dopamine in the treatment of hypotension and shock.

ALTHOUGH sympathomimetic amines with vasoconstrictor (alpha-adrenergic) activity are commonly given to elevate the systemic blood pressure in hypotensive states, their use has been questioned on the basis that vasoconstriction may result in reduced blood flow to visceral organs.1 Most clinically useful sympathomimetic amines, however, also possess potentially beneficial beta-adrenergic activity, which results in increased myocardial contractility.2 Attempts to achieve myocardial stimulation without vasoconstriction have centered on the use of sympathomimetic amines with predominant beta-adrenergic activity (isoproterenol,3 or epinephrine4) or on the conjoint use of alpha-adrenergic blocking agents with amines possessing both alpha and beta activity (norepinephrine5 or metaraminol). Although . . .

Anesthesia for cardiac surgery: The immediate postoperative period ∗

The problems that arise in the immediate postoperative period following cardiac surgery are primarily related to events in the preoperative preparation and the anesthetic and surgical manipulation in the operating room. The difficulty may be increased by failure to provide adequate support for an inefficient respiratory mechanism and a precariously balanced circulation with little reserve. Emphasis should be placed on complete preoperative preparation including adequate digitalization and a baseline neurologic examination. The use of minimal doses of preanesthetic drugs, anesthetic agents and muscle relaxants is essential. The sternal-splitting incision and minimal handling of heart and lungs is recommended. Early use of a mechanical respiratory assistor through a cuffed tracheostomy tube should be considered the conservative approach when indicated. The need for sufficient replacement of blood to provide an effective circulating volume and the judicious use of sympathomimetic amines are outlined.

Ischemic necrosis due to administration of metaraminol. Report of a case.

The use of sympathomimetic amines, such as arterenol (Levophed) bitartrate and metaraminol (Aramine) bitartrate, as vasopressor agents in the treatment of clinical hypotension has received widespread acceptance. The occurrence of ischemic necrosis secondary to the administration of arterenol has been well documented. 1 Due to the physiological similarity of these drugs it could be expected that such a complication would arise with extensive use of metaraminol. One such case was reported recently. 2 The following is a report of a similar case. A 62-year-old man was admitted to the Latter-day Saints Hospital on April 17, 1959, with the type of electrocardiographic changes found in patients with acute, posterior myocardial infarction, a white blood cell count of 11,200 per cubic millimeter, and a serum transaminase level of 56 Todd units. At the time of admission the patient's blood pressure was 130/100 mm. Hg in both arms, and his pulse rate was

The use of sympathomimetic amines in the treatment of shock

1. The salient features of the various conditions grouped under the heading of “shock” have been briefly considered. Broadly speaking, the principal feature which these conditions share in common is a persistent hypotension the proximate cause of which may be either cardiac or peripheral. 2. The action of the sympathomimetic amines on the cardiac and peripheral vascular mechanisms has been discussed, with particular reference to epinephrine and nor-epinephrine. 3. On the basis of the present experimental evidence we cannot as yet be sure that the use of sympathomimetic amines in the treatment of shock may not be actually harmful rather than beneficial to some patients. It is suggested, therefore, that its use be reserved for clinical investigation, or for patients who are in profound shock, who fail to respond to extensive fluid replacement or other therapeutic procedures, and whose prognosis therefore is very grave under any circumstances.