Drugs of today
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Pregabalin (PGB), like its predecessor gabapentin, is a structural analogue (but not functional) of the gammaaminobutyric acid (GABA). PGB has analgesic, antoconvulsivant, and ansiolytic activities. Neuropathic pain (NP) initial recommended dose is 150 mg per day. ⋯ Based on controlled studies, the main adverse effects observed with PGB are dizziness (23.1%), drowsiness (14.6%), and peripheral aedema (10.4%). As these side effects are dosedependent, they can be easily managed by a simple dose reduction, with no need to discontinue the therapy. Thus, according to efficacy and tolerability data, PGB is an important therapeutic option in NP treatment.
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The practice of procedural sedation is expanding rapidly because minimally invasive surgery and interventional medical specialties are replacing conventional surgery, and increasingly these procedures can appropriately be done under sedation rather than general anesthesia. Patients prefer sedation techniques so the procedures can be accomplished with minimal discomfort and they can recover more rapidly and avoid the potential side effects of general anesthesia. The goals for a sedation technique are to provide sedation, analgesia and, as requested, amnesia. ⋯ S. as a sedative. Fospropofol is formulated in aqueous solution and has some potential advantages over propofol. This review discusses the pharmacology and clinical uses of propofol and fospropofol, as well as the benefits and disadvantages of the two drugs when used for sedation.
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Tapentadol exerts its analgesic effects through micro opioid receptor agonism and noradrenaline reuptake inhibition in the central nervous system. Preclinical studies demonstrated that tapentadol is effective in a broad range of pain models, including nociceptive, inflammatory, visceral, mono- and polyneuropathic models. ⋯ In addition, it was reported to be associated with significantly fewer treatment discontinuations due to a significantly lower incidence of gastrointestinal-related adverse events compared with equivalent doses of oxycodone. The combination of these reduced treatment discontinuation rates and tapentadol efficacy for the relief of moderate to severe nociceptive and neuropathic pain may offer an improvement in pain therapy by increasing patient compliance with their treatment regimen.
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Rilonacept (IL-1 Trap/Arcalyst) is a long-acting interleukin-1 (IL-1) blocker developed by Regeneron Pharmaceuticals. Initially, Regeneron entered into a joint development effort with Novartis to develop rilonacept for the treatment of rheumatoid arthritis (RA) but this was discontinued following the review of phase II clinical data showing that IL-1 blockade appeared to have limited benefit in RA. In February 2008, Regeneron received Orphan Drug approval from the Food and Drug Administration for rilonacept in the treatment of two cryopyrin-associated periodic syndromes (CAPS) disorders, namely, familial cold-induced autoinflammatory syndrome (FCAS) and Muckle-Wells syndrome (MWS), for children and adults 12 years and older. ⋯ The desirable longer half-life of rilonacept offers potential alternatives to patients who do not tolerate daily injections very well or have difficulty with drug compliance. The initial evidence for the beneficial effects of rilonacept for MWS and FCAS suggests that it would also be a suitable treatment for CNICA/NOMID. It is yet to be determined whether rilonacept would be an effective treatment for other chronic inflammatory conditions such as gout, familial Mediterranean fever and systemic juvenile idiopathic arthritis.
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Review
Empiric antibiotic selection for infectious emergencies: bacterial pneumonia, meningitis and sepsis.
Appropriate early management of infectious emergencies is essential to preventing adverse outcomes. Clinicians in acute-care settings must be prepared to provide appropriate empiric antibiotics, as failure to do so has been associated with an increased risk of mortality. Empiric treatment of these infections requires knowledge of the disease state, most common pathogens, and patient-specific risk factors. ⋯ Bacterial infection with pneumonia, meningitis and sepsis severe enough to warrant hospitalization are included in this review. The most common bacterial pathogens and empiric antibiotic recommendations for immunocompetent adults will be discussed. In addition, circumstances that may influence the selection of certain antibiotics are reviewed.