Pharmacotherapy
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Randomized Controlled Trial
Effect of food and ranitidine on saquinavir pharmacokinetics and gastric pH in healthy volunteers.
To assess the relative bioavailability of saquinavir after administration with ranitidine alone, ranitidine and food, and food alone; and to investigate the mechanism underlying the effects of pH and food on saquinavir absorption. ⋯ Plasma concentrations of saquinavir were significantly higher when the drug was administered with food and ranitidine than when it was given with food alone. However, these increases were not related to changes in gastric pH caused by ranitidine. It can be postulated that food does not increase the bioavailability of saquinavir through its effect on gastric pH.
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To assess the effectiveness of using low-dose recombinant activated factor VII (rFVIIa) to reverse the effects of warfarin in critically ill patients with major bleeding events. ⋯ Low-dose rFVIIa appears to be an effective, rapid reversal modality for major bleeding events in the presence of warfarin and an elevated INR. The agent's response is quicker than that expected with fresh frozen plasma combined with vitamin K. In emergency situations, rFVIIa 1.2 mg can be used to reverse the anticoagulant effect of warfarin and other vitamin K antagonists without inducing a hypercoagulable state; the product, however, is expensive.
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To identify the factors affecting tacrolimus apparent total body clearance (Cl/F [F = bioavailability]) in adult liver transplant recipients. ⋯ These findings could be useful to the health care provider for adjustment of tacrolimus dosage in adult liver transplant recipients with various clinical factors.
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To determine the risk factors for venous thromboembolism (VTE) and the rates of prophylactic measures used in acutely ill medical patients. ⋯ Rates of VTE prophylaxis were higher than previously reported rates, although no formalized guidelines, standardized order sets, alerting programs, training, or risk-stratification tools were used during the study period. Rates of adverse events were low.
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ST-segment-elevation myocardial infarction: guidelines and the challenge of real-world patient care.
ST-segment-elevation myocardial infarction (STEMI) is a serious condition that requires early, aggressive management to reduce infarction damage and the risk of mortality. Although evidence-based guidelines recognize the clear benefits of early, effective reperfusion in STEMI, a number of barriers interfere with prompt delivery of care. Delays in treatment that exceed current evidence-based recommendations often plague reperfusion with either fibrinolytic therapy or percutaneous coronary intervention (PCI). ⋯ Under investigation are new therapeutic strategies that take advantage of improved coordination of care, such as the administration of bolus fibrinolytic therapy in the prehospital environment followed by immediate transfer of the patient for PCI. This approach may shorten the time to effective reperfusion and improve outcomes. Ongoing studies will help in determining the role this facilitated-PCI strategy may play in effective management of STEMI.