Pharmacotherapy
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Comparative Study Clinical Trial
Patient self-reporting of compliance does not correspond with electronic monitoring: an evaluation using isosorbide dinitrate as a model drug.
To assess the accuracy of patient-kept diaries relative to electronic monitoring of compliance with isosorbide dinitrate prescribed 3 times/day for ischemic heart disease. ⋯ Patient-kept diaries statistically overestimate actual compliance relative to that determined by MEMS devices. Given the prevalence of the use of diaries as the predominant tool on which researchers depend to document compliance with study drugs, our findings suggest that this practice should be reevaluated specifically when the time of the dose and documentation of administration are critical to qualifying the outcome of drug therapy. Such is the case with isosorbide dinitrate use in patients with ischemic heart disease. Furthermore, the overall poor compliance documented in this study suggests that the utility of isosorbide dinitrate prescribed 3 times/day be reevaluated as a clinically effective antianginal drug.
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Fluoxetine and its metabolite norfluoxetine are eliminated by oxidative metabolism via the CYP450 system and may inhibit the oxidative metabolism of other drugs to various degrees. A fluoxetine-warfarin interaction has been postulated, but is not well documented in the literature. The elimination of diazepam may also be inhibited by fluoxetine. ⋯ He also manifested drug delirium secondary to inhibited diazepam metabolism. In elderly patients receiving fluoxetine, lorazepam or oxazepam would be safer alternatives to diazepam since they are conjugated in the liver. Patients stabilized on warfarin should be monitored closely for changes in INR if fluoxetine is added or deleted.
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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.