Drugs
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Opioids remain the drugs of choice for the treatment of severe pain. In recent years several new potent opioids have become available for clinical use. These newer drugs are generally safer than the older morphine-like compounds and their differing pharmacological and pharmacokinetic properties allow the physician to choose an appropriate drug according to the clinical situation and need of an individual patient. ⋯ The risk of dependence is also less, so that these drugs are safer for the treatment of chronic pain. Additionally, it is particularly worth noting that buprenorphine and nalbuphine cause minimal cardiovascular changes, and are safe and effective drugs for treatment of pain associated with myocardial infarction. Buprenorphine, which is effective parenterally, orally and sublingually, has a prolonged duration of action (up to 12 hours after a single dose).
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of intravenous anisoylated plasminogen streptokinase activator complex with intracoronary streptokinase in acute myocardial infarction.
In a randomised trial the efficacy and safety of anisoylated plasminogen streptokinase activator complex (APSAC) administered intravenously and streptokinase administered by intracoronary infusion were compared in patients with proven acute myocardial infarction. Occlusion of the infarct-related vessel, reperfusion and reocclusion were all assessed angiographically. ⋯ These results indicate that APSAC (30U intravenously) is as effective as intracoronary streptokinase (250,000U). The major advantages of APSAC in acute myocardial infarction are its rapid, convenient administration and its low rate of arterial reocclusion.
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Randomized Controlled Trial Clinical Trial
Electrocardiographic and enzymatic infarct size in a randomised study of intracoronary streptokinase and intravenous anisoylated plasminogen streptokinase activator complex in acute myocardial infarction.
The effect of thrombolytic therapy on ECG and enzymatic indices, including estimates of relative infarct size, was studied in 93 patients with acute myocardial infarction randomised to intracoronary streptokinase or intravenous anisoylated plasminogen streptokinase activator complex (APSAC) therapy within 6 hours of the onset of symptoms. 90 minutes after treatment, 49% (19/39) of the evaluable streptokinase patients and 44% (19/43) of the APSAC patients had reperfused (p = NS). The time from treatment to reperfusion was less in the streptokinase patients (30 +/- 18 minutes for streptokinase and 42 +/- 22 minutes for APSAC, p less than or equal to 0.02). Resolution of ST segment elevation, 90 minutes after treatment, was greater in the streptokinase patients (residual ST segment elevation 47 +/- 36% of initial value for streptokinase and 70 +/- 49% for APSAC, p less than or equal to 0.06) and in the patients reperfused by either agent (residual ST segment elevation 46 +/- 34% for reperfused and 68 +/- 52% for non-reperfused, p less than or equal to 0.10). ⋯ However, the time to peak enzyme levels was significantly shorter in the reperfused patients. Early intracoronary streptokinase and intravenous APSAC therapy have similar effects on ECG and enzymatic infarct size. Reperfusion by either agent, given at a mean of 3 hours 25 minutes, may reduce estimates of infarct size modestly.
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Review
Preclinical pharmacological evaluation of anisoylated plasminogen streptokinase activator complex.
An ideal thrombolytic (or fibrinolytic) agent is one which would generate the formation of plasmin only where it is required, i.e. bound to fibrin within the thrombus. However, the capacity of even the newer thrombolytic agents to achieve localised plasmin generation within the thrombus is relative and depends on the concentration of the agent administered. For all available activators, the concentration required for effective clinical thrombolysis is also capable of converting plasminogen to plasmin within the circulation (plasminaemia). ⋯ The intrinsic efficiency of the plasminogen activators is a second important property. In vitro, under conditions pertaining to the circulation, urokinase is about 10 times more efficient than t-PA at converting glu-plasminogen to plasmin (on the basis of the Vmax to Km ratio), while streptokinase-plasmin is 20 times more efficient. The efficiency of these activators is increased in the presence of fibrin and lys-plasminogen, 1800-fold for t-PA, 8-fold for urokinase and 180-fold for streptokinase-plasmin.(ABSTRACT TRUNCATED AT 400 WORDS)
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Clinical Trial Controlled Clinical Trial
A placebo-controlled patency study of intravenous anisoylated plasminogen streptokinase activator complex 30U in acute myocardial infarction.