Pharmacotherapy
1875-9114
0277-0008
Mỹ
Cơ quản chủ quản: WILEY , American College of Clinical Pharmacy
Lĩnh vực:
Pharmacology (medical)
Phân tích ảnh hưởng
Thông tin về tạp chí
Pharmacotherapy is devoted to publication of original research articles on all aspects of human pharmacology and review articles on drugs and drug therapy. The Editors and Editorial Board invite original research reports on pharmacokinetic, bioavailability, and drug interaction studies, clinical trials, investigations of specific pharmacological properties of drugs, and related topics.
Các bài báo tiêu biểu
Successful Treatment of West Nile Virus Infection After Approximately 3 Weeks into the Disease Course West Nile virus can cause a febrile illness that may progress to meningoencephalitis. The only available treatments are ribavirin (although it has had limited success in humans) and interferon α‐2b. A small pilot study showed that starting treatment with interferon α‐2b on days 1–4 of hospital admission may reduce disease severity and complications. We encountered an 83‐year‐old man with West Nile meningoencephalitis who began taking interferon α‐2b 3 weeks after disease presentation. Although studies and reports indicate that treatment is less likely to provide a favorable response if administered after days 1–6 of the disease course, the patient experienced substantial beneficial effects from this treatment. This is the first case report, to our knowledge, that describes successful treatment with interferon α‐2b after several weeks of West Nile virus infection. Further studies are warranted to more fully understand the value of interferon α‐2b in treating West Nile meningoencephalitis.
Tập 27 Số 3 - Trang 455-458 - 2007
Effect of Health Literacy on Drug Adherence in Patients with Heart Failure Study Objective To assess the effect of health literacy on drug adherence in the context of a pharmacist‐based intervention for patients with heart failure. Design Post hoc analysis of a randomized controlled trial. Setting Inner‐city ambulatory care practice affiliated with an academic medical center. Patients The original trial enrolled 314 patients with heart failure who were aged 50 years or older and were taking at least one cardiovascular drug for heart failure; 122 patients received the pharmacist intervention (patient education, therapeutic monitoring, and communication with primary care providers), and 192 patients received usual care (regular follow‐up with primary care providers). We analyzed the results of 281 patients who had available health literacy and adherence data. Measurements and Main Results Drug adherence was assessed over 9 months using electronic prescription container monitors on cardiovascular drugs. Health literacy was assessed using the S hort T est of F unctional H ealth L iteracy in A dults (scores range from 0–36, with an adequate literacy score defined as ≥ 23). Taking adherence, defined as the percentage of prescribed drug doses taken by the patient compared with the number of doses prescribed by the physician, was assessed for each group. Patients were a mean ± SD of 63 ± 9 years old, 51% had less than 12 years of education, 29% had inadequate health literacy, and they received a mean ± SD of 11 ± 4 drugs. In the usual care group, taking adherence was greater among patients with adequate (69.4%) than those with inadequate (54.2%) health literacy (p=0.001). In the intervention group, the difference in taking adherence among patients with adequate (77.3%) and inadequate (65.3%) health literacy was not statistically significant (p=0.06). Among patients with inadequate health literacy, the intervention increased adherence (65%, 95% confidence interval [CI] 54–77%) by an order of magnitude similar to that of the baseline adherence of patients with adequate health literacy (69%, 95% CI 65–74%). Multivariable analysis supported the association between health literacy and adherence. Conclusion In patients with heart failure, those with adequate health literacy have better adherence to cardiovascular drugs than those with inadequate health literacy. The pharmacist intervention improved adherence in patients with adequate and inadequate health literacy. Health literacy may be an important consideration in drug adherence interventions.
Tập 32 Số 9 - Trang 819-826 - 2012
Rivastigmine, a New‐Generation Cholinesterase Inhibitor for the Treatment of Alzheimer's Disease Rivastigmine is a cholinesterase inhibitor (ChEI) with a structural formula different from that of currently available ChEIs. Tacrine and donepezil are classified as short‐acting or reversible agents since binding to acetylcholinesterase enzyme (AChE) is hydrolyzed within minutes. Rivastigmine is classified as an intermediate‐acting or pseudo‐irreversible agent due to its long inhibition on AChE of up to 10 hours. Preclinical biochemical studies indicated that rivastigmine has central nervous system selectivity over peripheral inhibition. It ameliorated memory impairment in rats with forebrain lesions. The drug is rapidly absorbed orally, with a bioavailability of 0.355 and low protein binding (40%). Its elimination half‐life is less than 2 hours, and it is converted to an inactive metabolite at the site of action, bypassing hepatic metabolic pathways. Its disposition essentially is unaltered in patients with renal or hepatic impairment. It also has dose‐dependent effects on AChE inhibition. In the two large multicenter clinical trials (total 1324 patients) that used a forced‐dosage titration scheme, rivastigmine 6–12 mg/day was superior to placebo on three cognitive and functioning scales (p<0.001). Gastrointestinal symptoms are the most frequently reported adverse events. They occurred mostly during the dosage titration phase and decreased during the maintenance phase. Rivastigmine offers clinicians another therapeutic agent to treat Alzheimer's disease.
Tập 20 Số 1 - Trang 1-12 - 2000
Acute Psychosis Associated with Dissociated Sleep‐Wakefulness State After Mirtazapine Treatment Tricyclic antidepressants decrease rapid eye movement (REM) sleep and may suppress sleep atonia. Reports indicate that these agents can induce visual hallucinations, sometimes characterized as hypnopompic or associated with a dissociated sleep‐wakefulness state. In addition, disturbing dreams and confusional states were reported during clinical trials and in subsequent studies. To our knowledge, only two cases of nightmares associated with mirtazapine, a tetracyclic antidepressant, have been previously reported. We describe a 43–year‐old Caucasian man with major depressive disorder who started mirtazapine 15 mg at bedtime because he had poor symptom control with other antidepressant drugs. Three days later, vivid dream activity was noted, evolving into realistic nightmares that the patient was not able to distinguish from reality on awakening. Acute paranoia was suspected, and haloperidol was started. The dream activity then ended, and within 3 days the patient was able to identify the dreams as unreality. Haloperidol was discontinued, but mirtazapine was continued, and the vivid dream activity persisted; however, reality testing when awake was intact. A short course of haloperidol restored the patient's reality testing, and mirtazapine was eventually replaced with bupropion. The unusual nocturnal activity resolved as a result. Clinicians should be aware of the possible transition from exceptionally vivid dreams to REM sleep behavior disorder and psychosis based on dream content as an adverse effect of mirtazapine.
Tập 30 Số 4 - Trang 423-423 - 2010
Pentoxifylline: A New Drug for the Treatment of Intermittent Claudication; Mechanism of Action, Pharmacokinetics, Clinical Efficacy and Adverse Effects During the past decade, the effectiveness of peripheral vasodilator drugs in the treatment of chronic occlusive arterial disease has been questioned. Pentoxifylline is a hemorheologic agent with primary actions that include increasing erythrocyte flexibility, reducing blood viscosity and increasing microcirculatory flow and tissue perfusion. The result is improved supply of oxygen to ischemic muscles of the limbs. In several double‐blind studies, pentoxifylline increased walking distance of patients with intermittent claudication in comparison to placebo or vasodilators. Like other methylxanthines, pentoxifylline is well absorbed in the gastrointestinal tract, almost completely metabolized in the body and excreted in the urine. The most significant difference in its pharmacokinetics is that, unlike other methylxanthines, it is bound to the erythrocytic membrane where it is initially metabolized. Although pentoxifylline has been shown to be effective in the treatment of intermittent claudication, additional research is needed to determine its use as adjunctive therapy in patients with concurrent coronary or cerebrovascular disease.
Tập 4 Số 6 - Trang 297-306 - 1984
Angiotensin‐Converting Enzyme Inhibitors and Type 2 Diabetic Nephropathy: A Meta‐Analysis Objective. To perform a meta‐analysis on studies evaluating the effect of angiotensin‐converting enzyme (ACE) inhibitors on diabetic nephropathy in patients with type 2 diabetes mellitus.Methods. A computerized literature search was conducted for articles of studies comparing ACE inhibitors with a control in patients with diabetes, in which measurement of albuminuria or proteinuria was an outcome. Each article was abstracted by two of the authors. Data from the articles were presented as geometric or arithmetic means. The data were summarized separately by using standard techniques for meta‐analysis.Main Results. Statistically significant reductions in albuminuria were observed regardless of whether data were described with geometric or arithmetic means. Both were associated with significant heterogeneity. When studies reporting geometric means were stratified and analyzed, the heterogeneity was lost and statistically significant reductions in albuminuria were observed. The same procedure was repeated for studies reporting arithmetic means, but heterogeneity remained.Conclusion. The ACE inhibitors produce statistically significant reductions in albuminuria associated with significant heterogeneity of effect. Stratification reduces the heterogeneity and supports treatment with ACE inhibitors to reduce the progression of nephropathy in patients with type 2 diabetes mellitus.
Tập 23 Số 7 - Trang 909-915 - 2003
Implications of Vancomycin Degradation Products on Therapeutic Drug Monitoring in Patients with End‐Stage Renal Disease In renally impaired patients, vancomycin concentrations typically are maintained at body temperature for extended periods of time due to the drug's prolonged half‐life. Both time and increased temperature potentiate production of vancomycin crystalline degradation products (CDP‐1). Commercially available vancomycin assays, such as fluorescence polarization immunoassay (FPI) and radioimmunoassay, cross‐react with CDP‐1 isomers. Overestimation of vancomycin concentrations by 40–53% due to cross‐reactivity of CDP‐1 with active factor B vancomycin occurs with FPI. As FPI is the most common method of analyzing serum vancomycin, clinicians must be aware of its potential shortcomings and be prepared to alter vancomycin dosages in renally impaired patients. The possibility of adverse affects due to elevated concentrations of CDP‐1 or therapeutic failures due to subtherapeutic levels of factor B vancomycin cannot be excluded.
Tập 19 Số 6 - Trang 702-707 - 1999
Evaluation of Carvedilol for the Treatment of Portal Hypertension Development of bleeding gastroesophageal varices is a serious consequence of portal hypertension secondary to cirrhosis. Nonselective β‐blockers have been used to reduce portal pressures and prevent primary and secondary bleeding episodes. However, up to two thirds of patients may not respond appropriately to these agents. Nonselective β‐blockers combined with vasodilatory drugs result in enhanced lowering of portal pressures by targeting several mechanisms involved in this process. Unfortunately, this practice is associated with increased adverse effects, such as hypotension, and minimal reductions in mortality. Carvedilol possesses both nonselective β‐antagonist and α1 ‐receptor antagonist activity. Given its combined mechanism of action, carvedilol presents a potential option for lowering portal pressures. Its effects on lowering portal pressures and its role in therapy are undefined. Using MEDLINE (1966–2003) and International Pharmaceutical Abstracts (1970–2003), the English‐language literature was searched to identify human studies assessing carvedilol's effects on lowering portal pressure. In general, carvedilol therapy was associated with mean reductions of 16–43% in portal pressure, assessed by the hepatic venous pressure gradient (HVPG) after single and multiple doses. Studies comparing carvedilol with propranolol revealed equal or enhanced efficacy in lowering HVPG. Large percentages of patients had significant HVPG reductions to levels that prevent variceal bleeding. Carvedilol also was associated with substantial symptomatic hypotension, especially in patients with ascites or Child‐Pugh class B or C cirrhosis. Efficacy and adverse effects generally seem to be dose related. Carvedilol appears to be a potentially viable option for treating portal hypertension. Further multiple‐dose trials comparing carvedilol with standard therapy are needed to assess the agent's long‐term safety and effectiveness in preventing variceal bleeding.
Tập 24 Số 1 - Trang 94-104 - 2004
Clinical Pharmacology of Recombinant Human Erythropoietin (r‐HuEPO) Recombinant human erythropoietin reverses the severe anemia associated with end‐stage renal disease. Mean half‐life values after a single intravenous bolus dose range from 4–13 hours. Renal clearance is not a significant route of elimination. Dosing schedules in chronic renal failure involve a single intravenous bolus dose administered three times weekly after hemodialysis. Subcutaneous dosing has been approved and may be used in patients without intravenous access. Reticulocyte counts and hematocrit levels exhibit dose‐dependent increases; improved hematocrit levels can be sustained with maintenance doses.
Tập 10 Số 2P2 - 1990