Expert opinion on pharmacotherapy
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Expert Opin Pharmacother · Jun 2008
ReviewPharmacological interventions and concepts of fast-track perioperative medical care for enhanced recovery programs.
Improving perioperative efficiency and tightly maintaining the patient's homeostasis in order to improve rehabilitation and well-being are key factors in the increasing popularity of fast-track recovery programs. Although the pharmacological contribution should not be overestimated, the use of up-to-date pharmacological agents with predictable duration of action and minimal side effects is mandatory to allow for a fast and gentle recovery process. ⋯ The pivotal role played by the anesthesiologist in facilitating the recovery process following surgical procedures has assumed increased importance in the concept of enhanced recovery programs. Although the interdisciplinary approach common to all parties involved (surgeons, anesthesiologists, nurses, physiotherapists) is the true enabler of fast-track surgery, the choice of anesthetic drugs and concomitant medication can all influence the ability to fast-track patients after surgery and should therefore considered mandatory in fast-track programs.
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Ziconotide is the only N-type calcium channel blocker approved by the US FDA for the treatment of chronic pain. The approved indication is for the management of severe chronic pain in patients for whom intrathecal therapy is warranted and who are intolerant of or refractory to other treatments such as systemic analgesics, adjunctive therapies or intrathecal morphine. ⋯ Ziconotide is administered intrathecally by infusion pump to block nociceptive signal transmission in the spinal cord. It is a synthetic neuroactive peptide equivalent to the omega conotoxin MVIIA, a constituent of the venom of the fish-hunting marine snail Conus magus. It is highly potent, has a steep dose-response curve, a slow onset of action and a narrow margin of safety and responses to dose adjustments are slow. Patients receiving ziconotide should be under the care of physicians experienced in the management of intrathecal infusion therapy for pain control and should have convenient access to medical facilities.
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Expert Opin Pharmacother · Jun 2008
ReviewTreprostinil for the treatment of pulmonary hypertension.
Pulmonary hypertension (PH) is a severely disabling disorder characterized by sustained elevations of pulmonary arterial pressure, ultimately leading to right-heart failure and death. Pulmonary arterial hypertension (PAH) usually occurs in the absence of an evident cause (idiopathic PAH) or may be associated with connective tissue disease, HIV infection, congenital heart disease, chronic liver disease or result from the use of toxic agents and anorexigens. ⋯ Treprostinil sodium is a stable prostacyclin analogue, sharing pharmacologic actions similar to epoprostenol with comparable haemodynamic effects. Treprostinil is chemically stable at room temperature and has a long half-life (2 - 4 h), making this drug suitable for subcutaneous administration, with practical benefits in avoiding the risk of line infection and thrombosis, and cardiovascular reactions due to abrupt drug discontinuation.
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Expert Opin Pharmacother · Jun 2008
ReviewSugammadex: a cyclodextrin to reverse neuromuscular blockade in anaesthesia.
Neuromuscular blocking agents are used to provide relaxation and immobility during surgery. To avoid residual paralysis after anaesthesia, reversal of blockade is commonly accomplished with anticholinesterase agents but these drugs have cardiovascular side effects and incomplete effectiveness. Sugammadex is a cyclodextrin that binds rocuronium and chemically similar neuromuscular blocking drugs. ⋯ More data are needed, especially in patients with renal failure and those who require neuromuscular blockade again soon after receiving sugammadex.
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Expert Opin Pharmacother · Jun 2008
Morphine sulfate extended-release capsules for the treatment of chronic, moderate-to-severe pain.
Morphine sulfate extended-release capsules (KADIAN) contain polymer-coated morphine sulfate pellets that are formulated to deliver sustained plasma morphine levels with minimal fluctuation. Morphine sulfate extended-release capsules, the only opioid formulation indicated in the US for both once- and twice-daily (every 12 and every 24 h) dosing, is approved in eight dosage strengths and is effective against pain from diverse sources in a variety of patient types. The formulation of morphine sulfate extended-release capsules allows flexible dosing options: capsules can be taken whole or the contents can be sprinkled on apple sauce or delivered via a gastrostomy tube. Morphine sulfate extended-release capsules have no immediate-release component and no components that would limit high doses. ⋯ The bioavailability of morphine sulfate extended-release capsules is not compromised when taken with food and dose dumping (immediate elevations in dose) does not occur when morphine sulfate extended-release capsules are taken concomitantly with alcohol. Nearly all patients taking morphine sulfate extended-release capsules for pain relief adhere to the recommended dosing frequency. The flexibility available with morphine sulfate extended-release capsules may offer clinical advantages for pain management.