Pharmacotherapy
-
To study the frequency, duration, severity, and treatment of agitation in patients in the intensive care unit (ICU) to determine if the elderly represent a distinct population. ⋯ In the ICU, the elderly are not a distinct population for agitation.
-
Comparative Study
Comparison of five beta-lactam antibiotics against common nosocomial pathogens using the time above MIC at different creatinine clearances.
To compare the time above the minimum inhibitory concentration (T>MIC) for five parenteral beta-lactam antibiotics against common nosocomial bacterial pathogens at different creatinine clearances (Clcr). ⋯ At every Clcr, cefepime achieved a desirable T>MIC for more nosocomial pathogens than any other beta-lactam evaluated. Based on pharmacodynamic data, cefepime is an appropriate empiric choice for treatment of nosocomial infections. However, when P. aeruginosa is a potential pathogen, empiric combination therapy should be considered.
-
Physicians and pharmacists routinely advise patients receiving warfarin to take acetaminophen for pain or fever because of its relative safety; however, a recent study questioned the safety of such practice. A comprehensive search of MEDLINE and IPA for human studies and case reports from 1966-1999 revealed evidence that acetaminophen may potentiate the effect of warfarin by a mechanism that has yet to be elucidated. Due to lack of a safer alternative, acetaminophen still should be the analgesic and antipyretic of choice in patients taking warfarin, as long as excessive amounts and prolonged administration (> 1.3 g acetaminophen/day for > 2 wks) are avoided. With the high degree of interpatient variability and the unpredictability of various drug-drug interactions with warfarin, close and frequent monitoring of international normalized ratios is the key for safe oral anticoagulation therapy.
-
Crohn's disease is a chronic inflammatory disorder that can present with symptoms throughout the gastrointestinal system. Though the etiology of Crohn's disease is unknown, genetic and environmental factors seem to play a role. ⋯ Several treatment modalities for Crohn's disease exist, recently including antitumor necrosis factor chimeric monoclonal antibody (cA2). Treatment for Crohn's disease, including data on the safety and efficacy of cA2, will be reviewed.
-
Review
Clinical pharmacology of rapacuronium bromide, a new short-acting neuromuscular blocking agent.
Rapacuronium is a new steroidal, nondepolarizing, neuromuscular blocking agent. It appears to be the least potent of all available nondepolarizing muscle relaxants. ⋯ The clinical duration of rapacuronium can be shortened significantly with early (2 min) administration of neostigmine, which may be beneficial in patients with difficult airway or failed intubation. Rapacuronium appears to be free of significant cardiovascular complications.