Pharmacotherapy
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Randomized Controlled Trial Comparative Study Clinical Trial
A double-blind, placebo-controlled evaluation of intranasal metoclopramide in the prevention of postoperative nausea and vomiting.
Nausea and vomiting are common complaints in the postoperative period and contribute to patient distress and delay of discharge for outpatient surgical procedures. Laparoscopic procedures are associated with a high incidence of postoperative nausea and vomiting (PONV) episodes. Parenteral use of metoclopramide prevents and treats PONV. ⋯ The poor performance of the intranasal metoclopramide formulation in this study cannot be attributed to patient-specific and perioperative factors. It may be due to an inadequate dose or slow absorption of the drug. The small sample size, however, may also have been a factor.
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Randomized Controlled Trial Comparative Study Clinical Trial
A pilot pharmacokinetic-pharmacodynamic study of benzodiazepine antagonism by flumazenil and aminophylline.
To develop a pharmacokinetic-pharmacodynamic model using quantitative electroencephalographic (EEG) analysis to compare two separate benzodiazepine antagonists and generate data concerning response variability. ⋯ Flumazenil was consistently effective in reversing sedation by midazolam at routinely recommended dosing. Further investigation of aminophylline as a reversal agent should use an estimated dose of 6-8 mg/kg aminophylline. To achieve adequate reversal, some patients may require aminophylline dosages that exceed safe clinical administration.
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A MEDLINE search of the National Library of Medicine data base from 1966-1994 was performed to review the anatomy and pathophysiology of intractable hiccups and their nondrug and drug therapies. Pertinent articles were further reviewed for older references and related literature. ⋯ The only approved drug for the disorder, chlorpromazine, may not be acceptable for every patient. Studies have been conducted with metoclopramide, valproic acid, nifedipine, and baclofen as alternative therapies.
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Agitation is a nonspecific constellation of symptoms seen in a variety of psychiatric disorders, ranging from psychotic exacerbations in patients with schizophrenia to behavioral disturbances associated with organic factors. Its treatment must be individualized and based on the etiology of the psychomotor disturbance. Certain categories of drugs are broadly effective. ⋯ Agitation is generally controlled within hours to days, whereas remission of affective or psychotic symptoms often requires weeks to months. Once remission is obtained, sedation is no longer desired and may be a barrier to optimal patient function and compliance. Thus, for long-term treatment, strategies are used to minimize sedation, such as reducing dosages, changing administration to bedtime, or adding antidepressants or stimulants where appropriate.
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Comparative Study Clinical Trial
Comparison of a weight-based heparin nomogram with traditional heparin dosing to achieve therapeutic anticoagulation.
Optimum anticoagulation with heparin within the first 24 hours of a thrombotic event is critical in preventing a recurrence. We believed that traditional nonweight-based heparin dosing at our institution resulted in delayed anticoagulation. A weight-based heparin nomogram was therefore created and compared to traditional heparin dosing in patients with a diagnosis of acute deep vein thrombosis or pulmonary embolism. ⋯ The initial nomogram was revised for patients weighing more than 80 kg owing to a greater frequency of excessive anticoagulation in these patients. Subsequent analysis of 29 patients using the modified nomogram revealed sustained efficacy and a reduced number of supratherapeutic aPTTs. We concluded that a weight-based heparin nomogram is superior to traditional therapy in achieving rapid therapeutic anticoagulation without an increase in adverse outcomes.