Expert opinion on drug safety
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Expert Opin Drug Saf · Sep 2009
ReviewConsiderations on the use of oxymorphone in geriatric patients.
Pain among the elderly is pervasive, under-treated and can be properly managed by judiciously using analgesics in the armamentarium. For severe pain, opioids generally provide the most effective pain relief, but concerns about safety and tolerability have limited, often unnecessarily, their utilization in the geriatric population. ⋯ Based on the results from nine published clinical studies, oxymorphone is an effective opioid analgesic with a safety profile at least comparable to other opioid drugs. At low starting doses and individual titration, oxymorphone should be considered for appropriate geriatric patients, particularly in whom there is concern about interaction with drugs that are metabolized by CYPP450 enzymes.
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Expert Opin Drug Saf · Sep 2009
ReviewStatins and coronary artery bypass graft surgery: preoperative and postoperative efficacy and safety.
In patients with native coronary artery disease, strong evidence supports the use of statins to reduce the risk of recurrent cardiovascular events and improve survival. However, for patients undergoing coronary artery bypass graft surgery (CABG), statins appear to be underutilized, and concerns have been raised regarding their perioperative safety. ⋯ Numerous studies have demonstrated that statins improve the outcomes of patients undergoing CABG. The benefits seem to outweigh the risks associated with their use, both in the preoperative and postoperative period. In the absence of contraindications, essentially all CABG patients are candidates for life-long statin therapy that ideally should be started before surgery. The optimal postoperative statin regimen remains unknown and should be the subject of future study.
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Expert Opin Drug Saf · Sep 2009
ReviewSodium-nitroprusside-induced cyanide toxicity in pediatric patients.
Sodium nitroprusside (SNP) is often used as a continuous infusion intravenous vasodilator in pediatric patients. However, cyanide toxicity can occur with SNP therapy. Scant literature is available determining the safety of SNP therapy, the incidence of cyanide toxicity or the risk factors for cyanide toxicity in pediatric patients. ⋯ Sodium nitroprusside seems to be safe when used in critically ill pediatric patients. Cyanide toxicity may occur in patients with specific risk factors. Routine monitoring of cyanide levels may not be warranted.
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Expert Opin Drug Saf · Sep 2009
ReviewErythropoiesis-stimulating agents in patients with cancer: update on safety issues.
Chemotherapy-induced anemia in patients with cancer can effectively be treated with erythropoiesis-stimulating agents. These drugs, which are currently indicated only in patients without curative treatment intent, increase hemoglobin (Hb) levels, reduce the risk for transfusions and improve the quality of life. ⋯ Hypertension and thromboembolic events are the main side effects. The association between erythropoietic proteins and clinical outcome including survival warrants further studies.
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Expert Opin Drug Saf · Jul 2009
Review Comparative StudyOccupational exposure to anaesthetic gases: a role for TIVA.
Modern anaesthesia is still mostly administered by the inhalational route and there is increasing concern over its potential for pollution. One of the first gaseous anaesthetic agents was nitrous oxide and this is still widely used today despite being associated with adverse effects caused by depression of vitamin B(12) function and diminished reproductive health. The use of halothane is associated with hepatitis but the adverse effects of newer halogenated hydrocarbons are less well recognised. ⋯ Levels of inhalational anaesthetics in the ambient air of operating theatres and recovery rooms often exceed those stated in national guidelines. Anaesthetic procedures can be modified and air-conditioning and air scavenging systems should be used to minimise the risks from occupational exposure and threats to the environment. Such contamination could be avoided with the use of total intravenous anaesthesia.