The Annals of pharmacotherapy
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Review
Intranasal fentanyl spray: a novel dosage form for the treatment of breakthrough cancer pain.
To review the pharmacology, pharmacokinetics, clinical efficacy, adverse events, dosing, and administration of intranasal fentanyl spray in the treatment of breakthrough cancer pain (BTCP) in adults. ⋯ For the treatment of BTCP, intranasal fentanyl spray offers improved onset of analgesia compared to other oral therapies; this improved onset of analgesia may closely mimic the typical time course of a BTCP episode. Nasal administration may overcome problems such as nausea, vomiting, or xerostomia that may complicate oral administration of analgesics. Potential disadvantages include uncertainty in treating more than 4 BTCP episodes per 24 hours and a higher cost compared to generically available oral opioid analgesics.
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To report a paradoxical reaction of Raynaud phenomenon following the repeated administration of iloprost in a patient with diffuse cutaneous systemic sclerosis with vascular involvement. ⋯ This case demonstrates a probable relationship between the rate of infusion of iloprost and the paradoxical reaction of Raynaud phenomenon.
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In 2003, a retrospective trial comparing linezolid versus vancomycin in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) showed improved survival in the linezolid group. This led to the ZEPHyR (Linezolid in the Treatment of Subjects with Nosocomial Pneumonia Proven to Be Due to Methicillin-Resistant Staphylococcus aureus) trial comparing linezolid versus vancomycin for MRSA pneumonia, which showed a benefit for linezolid with respect to clinical response but without a survival advantage. Limitations of the study included unbalanced treatment groups at baseline and number of patients excluded to reach the per-protocol group. Results of the ZEPHyR trial do not support routine use of linezolid for the treatment of MRSA pneumonia.
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To review the primary literature evaluating the effect preoperative use of angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) has on the risk of postoperative atrial fibrillation following coronary artery bypass grafting (CABG). ⋯ The studies reviewed here had conflicting results. Randomized placebo-controlled trials are necessary to determine the risk for atrial fibrillation after CABG associated with preoperative use of ACE inhibitors and ARBs. The decision to continue or withhold the drugs is not evidence-based and should be based on a patient's other clinical characteristics.