[Advances of drug therapy. 3. Drug therapy of virus infections].
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Guanidines↗
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Results for “DRUG THERAPY”
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Practical considerations in emergency drug therapy.
Drug therapy is integral to emergency and critical care medicine but can also be the source of serious medical errors. There are important considerations with regard to drug, route, and interactions that require close attention in critical patients. The continuous development of new therapeutics and new information concerning current therapies requires practitioners to continually review drug therapies. This article addresses general guidelines, routes of administration, dosage calculations, interactions, monitoring recommendations, and resources available to help clinicians improve their drug therapy practices.
Animals↗
Prevention of hip fractures: drug therapy.
Drug therapy to prevent hip fractures may be considered for postmenopausal women with low bone mass and elderly people with risk factors for hip fracture. As most hip fractures occur 25 years or more after menopause, drug therapy may have to be prescribed for many years to be effective. A preventative drug should be effective, safe, and without side effects. Estrogen therapy decreases bone loss and hip fracture incident, but the effect wears off when treatment is stopped. The positive effect of estrogens on cardiovascular disease should be balanced against the increased risk of breast cancer with long-term use. The newer bisphosphonates are potent inhibitors of bone resorption and decrease bone loss substantially. Again, the effect may wear off after the drug is stopped. The bisphosphonates appear to be safe, but long-term data are lacking. Calcium and/or vitamin D may prevent bone loss in late postmenopausal women and elderly people. The combination was shown to prevent hip fractures and other peripheral fractures in elderly nursing home residents. No single drug will be used more than 10-15 years. Therefore, a public health strategy should be developed with a logical sequence of drug and nondrug interventions for the successful prevention of hip fractures.
Aged↗
Principles of irrational drug therapy.
Drugs are extensively used in medicine when they are unlikely to produce a benefit to the patient. In most instances this does no apparent harm to the patient but sometimes (for example, the extensive use of thorotrast) the results are tragic. Even when the patient is not injured, overuse of medicines is an undesirable and money-wasting behavioral pattern. Several factors relating to the social process of drug use which encourage overprescribing are discussed and the Principles of Irrational Drug Therapy are derived. These principles are presented as negative role models for the use of medicines in developing countries.
Attitude of Health Personnel↗
Drug therapy.
Drug therapy for individuals of any age is difficult but prescribing for older patients offers special challenges. Older people take about three times as many prescription medications as younger individuals do, mainly because of their increased prevalence of chronic medical conditions. However, taking several drugs together substantially increases the risk of drug interactions, unwanted effects, and adverse reactions. Many medications need to be used with special caution because of age-related changes in pharmacokinetics and pharmacodynamics. For some drugs, an increase in the volume of distribution (eg, diazepam) or a reduction in drug clearance (eg, digoxin) may lead to higher plasma concentrations in older than in younger patients. Pharmacodynamic changes with ageing may result in an increased sensitivity to the effects of certain drugs (eg, opioids) for any given plasma concentration. While a physician can usually do little to alter the characteristics of individual older patients to affect the kinetics or dynamics of drugs, the decision whether to prescribe anything at all, the choice of drug, and the manner in which it is to be used (eg, dose and duration of therapy) are all factors that are under control of the prescriber. Patient adherence to the regimen prescribed is important, and there should be a partnership between physician and patient in therapeutic decision making. We will discuss here ways of improving prescribing for older patients. Specifically, we will examine the scarcity of information to guide prescribing decisions, the general principles of prudent prescribing, and the opportunities to clarify and expand knowledge about drug therapy in the elderly.
Aged↗
In utero drug therapy.
Drug therapy directed toward the fetus would be intended for either treating a fetal disorder or improving the capacity for later intrauterine or postnatal adaptation. Most reported trials involve single cases or small numbers of fetuses receiving the drug transplacentally after the first trimester, but before attaining maturity. Studies usually involve a single drug administered shortly before delivery. Treatments that are more direct or begun earlier in gestation are being attempted, but our limited understanding of fetal pharmacokinetics forces us to proceed cautiously. Studies to date have shown no risks to the mother and newborn infant, but long-term follow-up is necessary.
Animals↗
Drug-metabolism research challenges in the new millennium: individual variability in drug therapy and drug safety.
One of the most challenging research areas in pharmacology in the new millennium is to understand why individuals respond differently to drug therapy and to what extent that individual variability in disposition is responsible for the observed differences in therapeutic efficacy and adverse reactions. To answer these complex questions, drug-metabolism research will rely on multidisciplinary approaches more than ever to investigate the many components involved in drug metabolism and disposition. Major research challenges include the following: (1) the genetic variation of drug targets (receptors, enzymes, etc.), drug transporters (multispecific organic anion transporter, P-glycoprotein, alpha-1-acid glycoprotein, etc.), and drug-metabolizing enzymes (cytochrome P450s and other enzymes); (2) the structure and function of all genetic variants of drug receptors, transporters, and metabolizing enzymes; (3) the induction, repression, and inhibition of all components involved in drug disposition; (4) the development of noninvasive in vivo methods to determine the physiological significance of various components in the handling of specific therapeutic agents in humans; (5) the mechanism of idiosyncratic adverse drug reactions; and (6) the pharmacokinetic and pharmacodynamic relationships to explain the individual differences in therapeutic efficacy and drug safety. Thus successful drug-metabolism research in the new millennium must integrate receptor biology, enzymology, recombinant DNA technology, biochemical toxicology, and drug disposition into study design and conduct balanced in vitro and in vivo experiments to allow a full understanding of the mechanisms of individual variability in drug therapy and drug safety.
Animals↗
[Renal cancer study activities in Germany. Drug therapy].
Drug therapy of advanced renal cell carcinoma underwent rapid changes. Monotherapeutic, placebo-controlled protocols -- and more recently combinations of different targeted drugs -- dominated the global clinical studies in the past 2 years. The preliminary results are almost encouraging and international investigators, supported by the pharmaceutical industry, were most successful in enrolling patients quickly. The present article reviews the recent German drug study activities and indicates potential future projects.
Antineoplastic Agents↗
Population pharmacokinetics/pharmacodynamics and individualized drug therapy.
Drug concentration and effect vary among patients for any given dose. A goal of population pharmacokinetics (PK) and pharmacodynamics (PD) is to identify patient-specific factors such as weight, creatinine clearance, and age, and associate them with the observed PK/PD differences. Once associated with differences in concentration or response, these distinguishing factors may then be used to better individualize drug therapy. Studies of the population PK of teicoplanin and the population PK and PD of felodipine are summarized as examples of this approach.
Algorithms↗
Modeling, adaptive control, and optimal drug therapy.
Drug therapy, its clearly development, and the advent of pharmacokinetic models are described, from the original work of Teorell, through that of Augsberger and Kruger-Thiemer, to the present. Adaptive control of such models, long known in engineering, began in therapeutics with methods for linear and nonlinear least-squares regression, and has progressed to the Maximum Aposteriori Probability (MAP) Bayesian method. Strategies for optimal monitoring of serum concentrations are described and their clinical results briefly evaluated. Lastly, the new method of Approximate Optimal Closed-Loop (AOCL) control is described, in which the therapeutic regimen is used at the same time to probe (learn about) the patient's model approximately optimally. The new method considers the expected values of planned future serum concentrations (or other responses), in addition to the traditional measurement of past serum concentrations. This should optimize the process of learning about a patient's model while treating him at the same time.
Bayes Theorem↗
[Vertigo drug therapy--merely drug vertigo? Vertigo from the pharmacologic viewpoint].
Vertigo drug therapy is indicated only in few types of vertigo. A causal therapy is possible for infections of the inner ear by antibiotics or antiviral drugs. A symptomatic therapy of severe attacks of vertigo consists in the administration of sedative drugs like antihistaminics, benzodiazepines or neuroleptics. These drugs, however have to be used no longer than one week to avoid an inhibition of beneficial compensatory processes in the central nervous system. Furthermore, the use of non specifically acting blood flow increasing drugs like pentoxifylline in combination with prednisolone can be recommended. For the prophylaxis of Menière's disease, betahistine is the drug of choice because of its two modes of action (beneficial effect on the blood flow in the inner ear, inhibitory effect in vestibular nuclei). For prevention of vomiting as a consequence of vertigo, scopolamine is unsurpassed. In cases of psycogenicly caused vertigo, antivertiginosa from plant origin and homoeopathic drugs can be recommended, especially in the elderly patient, despite the fact that the effect of these drugs can not be fully explained as jet. Beside vertigo drug therapy, vertigo as a side effect of many drugs has to be taken into consideration in clinical routine. The variety of drugs responsible for vertigo consists in relatively harmless substances like aspirin up to substances used in vertigo drug therapy!
Humans↗
Cost effectiveness of implantable cardioverter defibrillator therapy versus drug therapy for patients at high risk of sudden cardiac death.
The implantable cardioverter defibrillator (ICD) is a therapy for patients at risk of sudden cardiac death due to ventricular tachycardia (VT) or ventricular fibrillation (VF). But the apparent high cost of ICD therapy relative to antiarrhythmic drugs such as amiodarone has raised questions about the cost effectiveness of ICD therapy versus drug therapy. To inform this debate we reviewed the literature on ICD cost effectiveness. An electronic and manual search was conducted for articles published since 1980 reporting original data on the cost effectiveness of ICD versus drug therapy for patients at risk of VT/VF. Data on costs and life-years gained were abstracted and studies were grouped into those that used decision-analysis models and those that were trial-based analyses. Cost-effectiveness ratios were inflated to 2001 US dollars. Nine studies were included in the review; five studies were modelling studies and four were part of randomised trials of ICD therapy. Studies varied in time horizon, but all except one indicated that ICD therapy was more costly than drug therapy. Early decision models assumed larger survival benefits than those observed in subsequent trials and therefore had attractive incremental cost-effectiveness ratios in the range of dollars US 27000 to dollars US 60000 per life-year gained. Trial-based studies, with the exception of one small trial, indicated cost per life-year gained in the range dollars US 44000 to dollars US 144000. Stratified analysis shows clearly that patients with a greater risk of mortality due to structural heart disease (e.g. left ventricular ejection fraction < or =35%) benefit more from ICD therapy and therefore have a more attractive cost effectiveness ratio than patients at lower risk. ICD therapy is still evolving over time with implant costs declining and device technology improving. Current evidence is that, in selected patients who are at high risk of VT/VF, ICD therapy can be a cost-effective option. Future research should focus on (i) patient selection to optimise benefits for available resources; and (ii) more comprehensive outcome measures to include health-related quality of life.
Anti-Arrhythmia Agents↗
[Therapy recommendations of the Drug Committee of the German Medical Association--an instrument for quality assurance in drug therapy. Drug Committee of the German Medical Association, Cologne].
The growing flood of information on drug therapy, which is increasingly overwhelming the individual physician, and the simultaneous demand for high-quality, individual therapy, call for guidelines recommending appropriate therapeutic measures for a given indication. The Drug Commission of the German Medical Profession, a scientific committee of the German Medical Association, has set itself the task of providing assistance in this context by elaborating scientifically-based, practice-oriented therapeutic guidelines. These guidelines were drawn up in accordance with a defined procedure and represent the consensus reached between the appropriate independent experts, the general practitioners and the members of the executive committee of the Drug Commission. This review presents the background, aims, procedures and criteria for assessment involved in the elaboration of the guidelines and attempts to define the position of the therapeutic guidelines in comparison to similar activities of other institutions in Germany.
Drug Therapy↗
ABC of monitoring drug therapy. Why monitor drug therapy?
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Drug Monitoring↗
Drug therapy. Serum drug concentrations as therapeutic guides.
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Binding Sites↗
Paediatric drug therapy. II--Drug administration errors.
The incidence of drug administration errors was prospectively evaluated from 1098 drug administrations in 97 paediatric patients. The total incidence of errors was 12.9% in a previous study. An educational programme (lectures and a book on guidelines for drug administration) was offered to nurses in an attempt to decrease this error rate. In this follow-up study, the total incidence of errors declined from 12.9% to 5.1% (P less than 0.05). All types of drug administration errors decreased during this follow-up study. These results suggest that such efforts can maximize therapeutic benefit and minimize any potential adverse consequences of drug therapy in paediatric patients.
Adolescent↗
NOTES on pulmonary tuberculosis. Modern therapy including drug therapy methods.
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Drug Therapy↗
[The treatment of atherosclerosis--drug therapy].
Drug treatment against atherosclerosis has been evaluated recently in many epidemiological studies. Lipid Research Clinics Group convincingly reported in a large scale design that anion exchange resin effectively reduced blood cholesterol level and concomitantly decreased the events of coronary heart disease. Subsequently, anion exchange resin with or without combined administration of niacin or statin was found to inhibit the progression of coronary atherosclerotic lesions in FATS, SCOR, CLAS and STARS. Fenofibrate also successfully reduced the coronary artery narrowings. Based on these intervention studies, several hypocholesterolemic agents are definitely effective in the treatment of coronary atherosclerosis.
Adult↗