Pharmacotherapy
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Randomized Controlled Trial Comparative Study Clinical Trial
Parenteral ketorolac: opiate-sparing effect and lack of cardiorespiratory depression in the perioperative patient.
Two studies evaluated the intraoperative and postoperative use of ketorolac, a nonopioid analgesic. Compared with the opioid analgesic alfentanil, ketorolac administered intraoperatively exerted no adverse effects on cardirespiratory functions (i.e., no changes in heart rate, arterial partial pressure of carbon dioxide, or mean arterial pressure, and no associated apnea). Analgesic efficacy of both agents was judged to be equal. ⋯ The lack of respiratory depression with ketorolac, which would be anticipated from its inability to bind to central opioid receptors, was also demonstrated. In the placebo group, arterial partial pressure of carbon dioxide was significantly increased postoperatively, whereas a similar increase was not found in the ketorolac group. Results of the two investigations demonstrate the absence of opioid effects with ketorolac, and support its use for intraoperative and postoperative analgesia in patients undergoing major surgery.
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Review Multicenter Study Clinical Trial
Acylated plasminogen-streptokinase activator complex: a new approach to thrombolytic therapy.
Acylated plasminogen-streptokinase activator complex (APSAC; antistreplase) is an inactive complex of human plasminogen and streptokinase. When it is injected, a controlled deacylation of the catalytic center occurs, activating the complex so that thrombolysis may begin. This process extends the half-life of streptokinase, allowing for 4-6 hours of fibrinolytic activity. ⋯ Serious bleeding reactions are uncommon, with the frequency of cerebrovascular accident reported at 0.4-0.6%. The special advantage of anistreplase is its administration as a 30-U intravenous bolus injected over 5 minutes, eliminating the need for long infusions and increasing the ease of administration. Based on its efficacy and ease of administration, anistreplase may become the drug of choice in the emergency treatment of acute myocardial infarction.
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Conditions in which antidepressants have been used include diabetic neuropathy, postherpetic neuralgia, headaches, arthritis, chronic back pain, cancer, thalamic pain, facial pain, and phantom limb pain. Although much of the available information is derived from inadequately controlled trials, it seems that antidepressants provide analgesia in many of these disorders. The analgesic effects tend to be independent of antidepressant effects, and doses of heterocyclic antidepressants used for analgesia seem to be lower than those considered effective in the treatment of depression. ⋯ Onset of analgesia is variable, ranging from 1 day to 10 weeks. Common side effects include dry mouth, drowsiness, urinary retention, orthostatic hypotension, and constipation. Optimum dosages and schedules have not been established.
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Randomized Controlled Trial Clinical Trial
The effect of theophylline on respiratory muscle contractility and fatigue.
The traditional role of theophylline as a bronchodilator has been expanded by recent findings that suggest this drug has more than smooth muscle relaxant properties. Several investigators indicate that theophylline has an inotropic effect on respiratory muscle, causing enhanced muscular contraction and prevention of muscle fatigue. In animal studies, the drug enhanced respiratory muscle contraction by 15-20%, with levels in the upper end of the therapeutic range (15-20 mg/L). ⋯ Disparity in outcomes may be attributed to differences in patient populations, study designs, and techniques used to determine diaphragmatic contractility. Few long-term trials exist that document significant clinical benefit. Theophylline may prove to be of value in selected populations, such as adults with hypercapnic obstructive lung disease.