Expert opinion on pharmacotherapy
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Expert Opin Pharmacother · Sep 2007
Review Comparative StudyEffect of buccal dwell time on the pharmacokinetic profile of fentanyl buccal tablet.
The time fentanyl buccal tablet (FBT) takes to completely dissolve after placement on the buccal mucosa (i.e., 'dwell time') could exceed the time to onset of analgesia. ⋯ The pharmacokinetic parameters of FBT did not appear to be related to its buccal dwell time.
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Traditional anti-anginal agents such as beta-blockers and nitrates improve symptoms of cardiac ischemia by affecting either blood pressure or heart rates. Despite aggressive therapy, many patients suffer persistent angina, and optimal therapy is limited by intolerance to traditional agents. ⋯ In the largest evaluation of ranolazine, the MERLIN-TIMI 36 trial (Metabolic Efficiency with Ranolazine for Less Ischemia in non ST elevation acute coronary syndrome), ranolazine did not reduce the risk of death or recurrent myocardial infarction in patients with non-ST-elevation acute coronary syndromes, but it did improve ischemic symptoms over the subsequent year of therapy. Thus, ranolazine offers clinicians a new therapy in the long-term treatment of patients with chronic angina.
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Expert Opin Pharmacother · Sep 2007
ReviewCombined use of ultra-short acting beta-blocker esmolol and intravenous phosphodiesterase 3 inhibitor enoximone.
In patients with impaired myocardial contractility associated with downregulation of the beta-receptors, compounds inhibiting phosphodiesterase (PDE) 3 may be useful to increase contractility. The PDE3 inhibitor enoximone has been shown to improve pump-function independent from the beta-receptor pathway. A simultaneous decrease in ventricular preload and afterload by vasodilation has led to the term 'inodilator'. ⋯ As with all other beta-blockers, it has dose-dependent negative inotropic effects, and this limits its use in patients with severe heart failure showing low cardiac output. It seems reasonable that an intravenous combination of both approaches, enoximone-induced positive inotropy and esmolol-associated protection from myocardial ischemia, might offer advantages by producing beneficial hemodynamic effects and by compensating each other's limitations in a complementary way. In spite of some promising results, the place of a combination of enoximone and esmolol in the process of treating patients with (acute) heart failure showing low output is still not entirely clear, and needs further confirmation.
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Expert Opin Pharmacother · Sep 2007
Comparative StudyImmediate removal of femoral-sheath following protamine administration in patients undergoing intracoronary paclitaxel-eluting-stent implantation.
Immediate sheath-removal using post-procedural reversal of heparin with protamine reduces groin complications, shortens bed rest and hospital stay after percutaneous coronary intervention (PCI) with bare-metal stents. No data are available with newer and possibly more thrombogenic paclitaxel-eluting stents (PES). ⋯ Immediate heparin neutralisation by protamine after successful PES implantation appears to be safe and feasible, also in patients with ACS. Use of protamine and early sheath removal after PCI confers early deambulation and may significantly limit healthcare cost, reduce vascular complications, bedrest, delayed discharge and patient discomfort.