Clinical therapeutics
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Clinical therapeutics · Jan 2007
ReviewAchieving better outcomes in pregnancies complicated by type 1 and type 2 diabetes mellitus.
Pregnancy in type 1 and type 2 diabetes mellitus (DM) is associated with an increased rate of adverse outcomes for both mother and fetus. ⋯ Women with DM who are of reproductive age should be identified as members of a high-risk group. Access to specialized prepregnancy clinics should be made available where their DM can be intensively managed throughout pregnancy by a combined obstetrical/endocrine multidisciplinary team. Use of multiple insulin injection regimens, including use of insulin aspart during pregnancy, is both well tolerated and effective and may offer some benefits with respect to postprandial glycemic control.
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Clinical therapeutics · Jan 2007
ReviewAdverse drug interactions involving common prescription and over-the-counter analgesic agents.
Eight analgesic preparations with approved indications for acute pain were among the top 200 drugs prescribed in the United States in 2006. In addition, an estimated 36 million Americans use over-the-counter (OTC) analgesics daily. Given this volume of use, it is not surprising that a number of drug interactions involving analgesic drugs have been reported. ⋯ Considering the widespread use of analgesic agents, the overall incidence of serious drug-drug interactions involving these agents has been relatively low. The most serious interactions usually involved other interacting drugs with low therapeutic indices or chronic and/or high-dose use of an analgesic and the interacting drug.
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Clinical therapeutics · Jan 2007
Randomized Controlled Trial Comparative StudyA randomized, open-label, two-period, crossover bioavailability study of two oral formulations of tacrolimus in healthy Korean adults.
Tacrolimus is a macrolide immunosuppressant used in transplantation. It has been shown to have a comparable therapeutic effect and a low adverse drug reaction profile relative to cyclosporme. ⋯ In these healthy Korean adults, there were no statistically significant differences between the pharmacokinetic parameters of the more recently developed oral formulation of tacrolimus and the conventional formulation.
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Clinical therapeutics · Jan 2007
Influences of attitudes on family physicians' willingness to prescribe long-acting opioid analgesics for patients with chronic nonmalignant pain.
The treatment of moderate to severe chronic nonmalignant pain (CNMP) is a challenge for both the patient and health care provider. Conflicting information exists regarding the appropriate use of long-acting (ie, controlled-release [CR]) opioid analgesics for CNMP, and physicians may be reluctant to prescribe them even when medically appropriate. ⋯ About two thirds of physician respondents were willing to prescribe long-acting opioids for patients with CNMP, and physician attitudes were marginally favorable. Further study should investigate how physicians' attitudes and willingness translate into actual prescribing behavior.
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Clinical therapeutics · Jan 2007
Randomized Controlled Trial Multicenter StudyPsychometric testing and validation of the Chronic Pain Sleep Inventory.
Patients with chronic pain often experience significant disruptions in sleep. A potential benefit of treatment aimed at pain relief is improved quality of sleep in patients with chronic pain. ⋯ CPSI items showed good construct validity, and the results support the scoring of a reliable single index from 3 of the 5 CPSI items that all attributed sleep problems to pain.