Expert opinion on pharmacotherapy
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Many advances have been made in the understanding and management of burn injury, dramatically increasing pharmacological decision options for burn care professionals. Since burn injury is so multi-faceted, these advances cross many injury processes, both acute and chronic. ⋯ Many advances over the past decade in multiple fields have made pharmacological options plentiful in burn care. That said, there are many problems for the burn patient which persist, making burn injury still the most severe form of trauma. These issues range from management of a catabolic state with involuntary weight loss in the critical burn to severe itching in the rehabilitating patient. There are also many more treatment options available today. Two key reasons stand out as the most prominent. One reason is the fact that burn care has become much more proactive, by searching out new approaches to solve old problems. Now the treatment approach is altering its focus on manipulating the course of a burn. Examples include the use of temporary skin substitutes in partial thickness or second degree burns, decreasing pain and increasing the healing rate. Another is the use of slow release silver dressing as the topical burn wound antimicrobial of choice, markedly reducing discomfort, the need for dressing changes and an overall decrease in infection. In larger, deeper burns, the approach has changed from the chronic management of an open burn wound to rapid excision and wound closure, eliminating the burn as a source of complications. In addition, there has been a very aggressive approach to controlling the profound hypermetabolic, catabolic response to burns, rather than simply treating the outcome of this predictable post-burn complication. Approaching psychosocial stress again by prevention rather than treatment of established problems is another example. The second reason for increased options and differences in management involves the mindset of those individuals taking care of burns. Tremendous differences in experience are involved in decision-making. Different opinions are based on the expertise and also the personal preferences of those managing the burn.
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Expert Opin Pharmacother · Aug 2008
Review Comparative StudyMorphine-6-glucuronide: potency and safety compared with morphine.
In contemporary medicine, morphine remains the drug of choice in the treatment of severe postoperative pain. Nevertheless, morphine has several side effects, which can seriously compromise its analgesic effectiveness and the patient safety/compliance. The search for opioid analgesics with a better side-effect profile than morphine has led to a morphine metabolites, morphine-6-glucuronide (M6G). ⋯ M6G > 0.2 mg/kg is an effective analgesic with a slower onset but longer duration of action (> 12 h) compared with morphine. Side effects, most importantly postoperative nausea and vomiting, occur less frequent after M6G treatment. M6G is an attractive alternative to morphine in the treatment of severe postoperative pain.
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Expert Opin Pharmacother · Aug 2008
ReviewNeoadjuvant chemotherapy preceding cystectomy for bladder cancer.
Occult micrometastasis at the time of radical cystectomy leads predominantly to distant failures in patients with locally advanced, muscle-invasive transitional cell carcinoma of the bladder. ⋯ Neoadjuvant chemotherapy is a standard for the therapy of locally advanced bladder cancer, and the neoadjuvant paradigm may assist in accelerating novel agent development.
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Expert Opin Pharmacother · Aug 2008
Randomized Controlled TrialEffects of extended-release tramadol on pain-related sleep parameters in patients with osteoarthritis.
To examine the effects of extended release tramadol (tramadol ER) on reducing pain-related sleep disturbances (PRSDs) in patients (20-80 years) with moderate to moderately severe pain with radiographically confirmed osteoarthritis (OA) of the knee or hip. ⋯ In this post hoc analysis, a reduction in pain was associated with a significant reduction in PRSDs due to OA.
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Heparin-induced thrombocytopenia (HIT) is a serious, life-threatening complication which occurs in 1-3% of patients receiving heparin. Patients with untreated HIT have an up to 50% risk of developing life- and limb-threatening thromboembolic complications. Treatment is based upon clinical suspicion, stopping heparin therapy and initiation of anticoagulation with a rapidly acting alternative non-heparin anticoagulant, such as argatroban-a hepatically excreted direct thrombin inhibitor which is effective in the treatment of HIT. ⋯ Argatroban is a safe and effective treatment for HIT. In patients taking other hepatically cleared medications, lower initial doses may have to be used to avoid over-anticoagulation.