Expert opinion on pharmacotherapy
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Prostate cancer is a common cancer and the role of adjuvant medical therapy continues to be investigated. An understanding of the use of adjuvant medical therapy is essential for the appropriate care of prostate cancer patients, especially for those with locally advanced or high-risk disease. ⋯ There is a complex literature describing the role of adjuvant medical therapy in prostate cancer, which is reviewed here. Continuing and future clinical trials will define the utility of adjuvant therapy in this setting and require the support of the clinical community.
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Expert Opin Pharmacother · Jan 2011
CommentDefining the optimal dose of aspirin and clopidogrel in acute coronary syndromes. Evaluation of ‘Dose comparisons of clopidogrel and aspirin in acute coronary syndromes’, N Engl J Med 2010;363:930-42.
Platelet inhibition is integral to the contemporary management of acute coronary syndromes. While aspirin and clopidogrel are used almost universally in patients treated with an early invasive strategy, the optimal dosing strategy for these drugs remains unknown. In a large randomized trial, the OASIS-CURRENT 7, investigators demonstrated no benefit of a higher dose of aspirin. There was no overall benefit of a higher dose of clopidogrel, although in patients treated with percutaneous coronary intervention a double-dose strategy was associated with a reduction in stent thrombosis and other ischemic events at the cost of an increased risk of bleeding events.
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Expert Opin Pharmacother · Jan 2011
Review Comparative StudyIntravenous acetylcysteine for the treatment of acetaminophen overdose.
Acetaminophen is a leading cause of overdose-related hepatotoxicity. Although acetylcysteine prevents or minimizes acetaminophen-induced hepatotoxicity and reduces mortality, some patients presenting with complicated overdose scenarios (massive ingestions or combination or modified-release formulations) may develop toxicity despite administration of recommended dosage regimen. ⋯ The standard intravenous regimen will effectively treat most early-presenting uncomplicated overdoses. Acetylcysteine dosing should be individualized in patients with complicated presentations and in particular situations in which plasma acetaminophen concentrations may be persistently elevated at the end of the infusion or in late presenters. More studies are needed to evaluate the optimal intravenous dosage regimen and the role of oral acetylcysteine in these high-risk patients. Treatment decisions may be aided by consultation with a poison center and/or clinical toxicologist.