American journal of hospital pharmacy
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The chemistry, pharmacokinetics, pharmacology, clinical efficacy, adverse effects, physical dependence and tolerance, drug interactions, dosing, and cost of zomepirac sodium (Zomax, McNeil) are reviewed. Zomepirac is a new nonsteroidal anti-inflammatory agent (NSAIA) approved for the treatment of mild to moderately severe pain. The drug is well absorbed when given orally. ⋯ The drug has not demonstrated any potential for physical dependence, withdrawal, or tolerance. Zomepirac may provide a suitable alternative to aspirin, narcotic/NSAIA combinations, and narcotics in the treatment of mild to moderately severe pain. It is unlikely that zomepirac will replace narcotics in more severe types of pain.
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Sarcoidosis, the possibility of its spontaneous remission, and its responsiveness to corticosteroid and other drug therapies are discussed. Sarcoidosis is a disease of unknown etiology characterized histologicaly by a granulomatous process with cellular infiltration. The granulomatous changes may remit spontaneously or may develop into fibrosis that, at times, is severe; factors that influence these progressions of the disease are not known. ⋯ Corticosteroids only temporarily influence the natural progression of sarcoidosis; however, corticosteroid therapy can preserve the function of vital organs. Other forms of treatment, such as chloroquine, methotrexate, oxyphenbutazone, allopurinol and levamisole hydrochloride, also produce remissions of the granulomatous infiltrate of sarcoidosis but offer no therapeutic advantages over corticosteroids. The decision to treat is often a difficult one, since corticosteroids and these other therapies have potentially hazardous side effects.
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Drug treatment of status epilepticus is reviewed. Tonic-clonic, focal motor, complex partial and absence status epilepticus are discussed. In managing tonic-clonic status epilepticus one should: (1) maintain vital functions at all times, (2) identify and treat precipitating factors and (3) administer an intravenous loading dose of phenytoin sodium or phenobarbital sodium. ⋯ Treatment of focal motor and complex partial status epilepticus is similar to that of tonic-clonic status epilepticus, but i.v. diazepam is required less frequently and loading doses of phenytoin and phenobarbital sometimes can be given more slowly. Status epilepticus of the absence type is managed with i.v. acetazolamide sodium or diazepam. Paraldehyde, muscle relaxants, general anesthesia and lidocaine may be tried when conventional therapies fail.