The Annals of pharmacotherapy
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Comparative Study Clinical Trial
Pain and distress from bone marrow aspirations and lumbar punctures.
To compare the efficacy of 3 different pharmacologic regimens to relieve pain and distress in children with cancer undergoing bone marrow aspirations (BMAs) and lumbar punctures (LPs). ⋯ Children receiving propofol/fentanyl general anesthesia experienced significantly less procedure-related pain and distress than did those receiving either EMLA or oral midazolam/EMLA.
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To compare the relative delivery of 2 methods for providing continuously nebulized albuterol (CNA): a small-volume nebulizer plus infusion pump versus a large-volume nebulizer. ⋯ The large-volume nebulizer evaluated in this study maintains consistent output up to 8 hours and provides an acceptable method for delivering CNA through an infant ventilator circuit.
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Comparative Study
Alteplase versus urokinase for occluded hemodialysis catheters.
The use of central venous catheters as a source of vascular access in patients undergoing hemodialysis may be complicated by thrombosis. Frequently, thrombolytics are used in an attempt to reestablish blood flow through partially or completely occluded catheters. ⋯ Alteplase, administered via the 30-minute push-protocol, is an effective thrombolytic for restoring hemodialysis catheter patency. In our study sample, alteplase was generally more effective than urokinase in restoring blood flow through catheters, especially those that were completely occluded.
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Review Case Reports
Acute pancreatitis associated with angiotensin II receptor antagonists.
To report a case of acute pancreatitis in a patient receiving a combination formulation of irbesartan and hydrochlorothiazide (HCTZ). ⋯ Clinicians should be aware that irbesartan/HCTZ or losartan may cause acute pancreatitis. If abdominal pain develops, the medication should be discontinued and the patient investigated for acute pancreatitis.
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To evaluate the use of proton-pump inhibitors (PPIs) for stress ulcer prophylaxis in critically ill adults. ⋯ Available data indicate that PPIs are safe and efficacious for elevating intragastric pH in critically ill patients. PPIs should be used only as an alternative to H(2)RAs or sucralfate since the superiority of PPIs over these agents for preventing SRMD-associated gastrointestinal bleeding has not been established. Additional comparative studies with adequate patient numbers and pharmacoeconomic analyses are needed before PPIs are considered the agents of choice for stress ulcer prophylaxis.