Pharmacotherapy
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Review Comparative Study
Assessing the treatment of congestive heart failure: diuretics, vasodilators, and angiotensin-converting enzyme inhibitors.
Congestive heart failure (CHF) causes disabling symptoms and increases the likelihood of decreased survival. Diuretics, direct vasodilators, and angiotensin-converting enzyme (ACE) inhibitors can be used to reduce symptoms, prolong life, or both, in these individuals. Diuretics induce sodium and water excretion, leading to decreased cardiac preload and wall tension, and an effective decrease of symptomatic pulmonary and systemic congestion. ⋯ The drug has recently been withdrawn from the market. The ACE inhibitors can cause hemodynamic and neurohormonal changes that lead to a reduction of preload and afterload, decreasing symptoms of heart failure. They significantly decrease CHF mortality, and might also deter the development of overt heart failure in some asymptomatic patients with left ventricular dysfunction.
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Fluconazole is a triazole antifungal agent reported to have a low affinity for human cytochrome P-450, and thus would not be expected to interact with drugs metabolized through the cytochrome P-450 system, including phenytoin, cyclosporine, and warfarin. A potential interaction between warfarin and fluconazole occurred in a 39-year-old man with chronic renal insufficiency. ⋯ There were no changes in the patient's other medications, and the INR decreased to 1.5 on discontinuation of fluconazole. The possible mechanism of an interaction may be dose-related inhibition of warfarin metabolism, and may be more pronounced in patients with decreased renal clearance of fluconazole.
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To examine the relationship among postoperative pain severity, serum beta-endorphin level, and serum morphine level in pediatric patients after posterior spinal fusion with instrumentation. ⋯ The clinical usefulness of serum beta-endorphin as a measure of pain severity was not established under the experimental conditions of this study.
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The accuracy of 2- and 8- hour urine collections for estimating creatinine clearance was compared with that of the standard 24-hour procedure in 45 hospitalized elderly patients (age > or = 65 yrs) with indwelling urethral catheters. Urine was collected at blocked intervals from 0-2, 2-8, and 8-24 hours and then added together to determine the 8- and 24-hour clearances. ⋯ Regardless of age, renal function, serum creatinine level, or diuretic use, the 8-hour value was less biased, usually more precise, and clinically more accurate. Thus it can be used in stable, hospitalized, elderly patients with indwelling catheters to determine degrees of renal impairment and provide optimum drug dosing.
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Infection is responsible for a large percentage of morbidity and mortality in intensive care unit (ICU) patients. Conventional infection-control measures are directed at decreasing infection by exogenous sources and have had variable success in significantly reducing nosocomial infection rates. Selective gastrointestinal decontamination with topical nonabsorbable antibiotics attempts to reduce infection by eliminating intestinal mucosal colonization by pathogenic microorganisms. ⋯ In the majority of clinical trials, selective decontamination effectively reduced colonization and infection among ICU patients, with the most significant reductions observed in gram-negative respiratory infections. Resistance to the antimicrobials was not documented in the majority of trials; however, follow-up periods were minimal and may not have been adequate to detect selection of resistant strains. Reductions in infection do not alter mortality; however, patients without significant underlying disease appear to be the subgroup that will most likely benefit.