Drugs of today
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Platelets play a pivotal role in maintaining hemostatic competence. Thrombocytopenia, irrespective of its etiology, is associated with a risk for bleeding. Treatment modalities for chronic idiopathic thrombocytopenic purpura (ITP) are numerous, but the response is variable, often disappointing and associated with high risks. ⋯ The success of this treatment further paved the way for evaluating its efficacy in raising platelet counts in hepatitis C virus (HCV)-related infection and myelodysplastic syndrome. Although there is less experience in hepatitis C than in chronic ITP, preliminary data are highly promising. This review will focus on the experience gained with eltrombopag in chronic ITP and HCV-related thrombocytopenia.
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Despite technological advances in surgery and anesthesia during the last few decades, the incidence of postoperative cognitive dysfunction remains a relatively common complication in surgical patients. After surgery, elderly patients in particular often exhibit a transient reversible state of cerebral cognitive alterations. ⋯ The available literature does not allow definitive conclusions to be drawn on the possible differences between anesthetics in relation to the subsequent occurrence of cognitive dysfunction. However, such information is crucial to improve anesthesia performance and patient safety, as well as outcomes.
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Tramadol hydrochloride is a widely prescribed, centrally acting analgesic marketed in over 90 countries. Before being released in the U. S. in 1995, the drug had been available in Europe for almost two decades. ⋯ Therefore, tramadol may be of particular value in patients with chronic pain who also suffer from depression. This drug has been shown to be beneficial in the treatment of a wide range of acute and chronic pain syndromes, including neuropathic pain. While abuse of tramadol may occur, several large studies have demonstrated that the incidence of abuse is rather low, about one case per 100,000 patients.
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The undertreatment of acute and chronic pain continues to be a significant health concern in the U. S. Opioids are recommended for the treatment of acute or chronic pain of moderate to severe intensity that is not responsive to other pharmacologic agents, such as nonsteroidal antiinflammatory drugs. ⋯ S. Food and Drug Administration and may provide new options for patients who have not achieved adequate and well-tolerated analgesia with their current opioid. This review provides an overview of the basic pharmacology (including pharmacokinetic and pharmacodynamic profiles), clinical efficacy and tolerability of both oral oxymorphone formulations.
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Treating acute and chronic musculoskeletal pain is essential for improving healing of traumatic injuries and surgical procedures, and for improving patient quality of life. Physicians are limited primarily to treating musculoskeletal pain with nonsteroidal antiinflammatory drugs (NSAIDs), cyclooxygenase type 2 (COX-2)-selective NSAIDs such as celecoxib, or narcotics. Patients often treat their pain with over-the-counter NSAIDs. ⋯ Differences in pharmacology between NSAIDs, treatment regimens, experimental models and potential off-target effects also may confuse many of these issues. It is clear, however, that cyclooxygenase activity is involved in the healing of many skeletal tissues, either directly or indirectly through modulation of the inflammatory response. Consequently, pharmacological manipulation of cyclooxygenase using NSAIDs or celecoxib can profoundly affect skeletal health.