Expert opinion on pharmacotherapy
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Duloxetine is a balanced serotonin noradrenaline re-uptake inhibitor that has recently become the first agent to receive regulatory approval for the treatment of painful diabetic neuropathy in the US. This compound has no other significant receptor or channel activities other than the serotonin and noradrenaline re-uptake inhibition mechanisms and works to diminish or control the symptoms of diabetic neuropathy. ⋯ Its effectiveness in diabetic neuropathy confirms the proposed role of serotonin and noradrenaline as key mediators of the descending pain inhibition pathways of the brain stem and spinal cord. Clinical studies have demonstrated the high degree of safety and efficacy for the compound with no adverse effects on glycaemic control due to the action of duloxetine being identified.
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Expert Opin Pharmacother · Feb 2006
ReviewTreatment of heparin-induced thrombocytopenia in cardiovascular patients.
Heparin-induced thrombocytopenia (HIT) is an antibody-mediated syndrome associated with heparin exposure, a falling platelet count and a high risk of thrombosis. Cardiovascular patients are at increased risk of HIT due to wide use of heparin in this population. ⋯ The indirect thrombin inhibitors, danaparoid and fondaparinux, can also be considered at times. These agents and their use in cardiac patients, including patients with acute coronary syndrome, percutaneous coronary interventions, acute ST elevation myocardial infarction or cardiac surgery, will be reviewed.
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Renal, liver, heart and lung transplantation are now considered to be the standard therapeutic interventions in patients with end-stage organ failure. Infectious complications following transplantation are relatively common due to the transplant recipients overall immunosuppressed status. ⋯ Candida and Aspergillus spp. produce most of these infections. This article will review the risk factors, clinical presentation and treatment of invasive fungal infections in solid organ transplant patients, and evaluate the role of prophylactic therapy in this group of patients.
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Ischaemic stroke is a leading cause of death and disability in the US. At present, intravenous administration of tissue plasminogen activator within 3 h of symptom onset is the only proven effective treatment for patients with acute ischaemic stroke. ⋯ The purpose of the present paper is to describe the current state of affairs for intravenous plasminogen activators, and to review recently published research. Agents and strategies under investigation include the intra-arterial delivery of plasminogen activators or antiplatelet agents, as well as combined intravenous/intra-arterial protocols.