Expert opinion on pharmacotherapy
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Expert Opin Pharmacother · Jun 2009
ReviewFlupirtine: pharmacology and clinical applications of a nonopioid analgesic and potentially neuroprotective compound.
Flupirtine is a nonopioid drug without antipyretic or antiphlogistic properties and with a favorable tolerability. It constitutes a unique class within the group of nonsteroidal analgesics and displays a peculiar pharmacodynamic profile that invites the investigation of applications beyond the pain-relieving effect. ⋯ Although flupirtine has gained a firm place in the treatment of acute and chronic pain in various clinical settings since its introduction, a broader range of applications remains to be explored in clinical trials. Possible neuroprotective effects due to N-methyl-d-aspartate antagonistic properties of flupirtine might be promising in the treatment of Creutzfeld-Jakob disease, Alzheimer's disease, and multiple sclerosis. Trials in these fields are forthcoming.
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Despite aggressive efforts to reduce nosocomial infections, many intubated patients develop ventilator-associated pneumonia (VAP). VAP has been an area of intense research; however, there is still little consensus in the literature on how to accurately diagnose or treat VAP. VAP complicates the course of 8 - 28% of mechanically ventilated patients and mortality varies greatly from 8 to 76%, depending on the specific population being studied. ⋯ When final cultures and sensitivities are available, de-escalation to less broad spectrum antibiotics should be performed. If cultures show no bacterial growth, antibiotics should be discontinued so that patients are not exposed to unnecessary antibiotics. Following these practices will help to decrease multi-resistant strains of bacteria and can improve the morbidity and mortality of VAP.
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Expert Opin Pharmacother · May 2009
ReviewTreatment strategies for cystic fibrosis: what's in the pipeline?
Cystic fibrosis (CF) is an inherited disease, characterised by pancreatic malabsorption (with poor growth) and impaired mucociliary clearance (leading to recurrent pulmonary infection). The prognosis has markedly improved over the last 40 years. ⋯ Currently the greatest therapeutic challenges are to correct the biochemical defect of CF and to identify effective treatments for chronic respiratory infection. This review provides an overview of CF, the treatment strategies currently used, and new drugs undergoing clinical trials.
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Sevoflurane is often presented as a near-perfect anaesthetic. After 10 years in the operating room, new uses are emerging outside. ⋯ Sevoflurane presents many benefits with minimum inconvenience. It allows rapid inhalation induction, maintenance and rapid recovery. It has little toxicity and its haemodynamic and respiratory depressive effects are moderate and well tolerated. It is already widely use for sedation for magnetic resonance imaging in children. Its use in paediatric or adult intensive care could improve the management of pain and sedation.
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Expert Opin Pharmacother · Apr 2009
Meta Analysis Comparative StudyEfficacy of citicoline as an acute stroke treatment.
Citicoline (cytidine-5'-diphosphocholine or CDP-choline) is a precursor essential for the synthesis of phosphatidylcholine, one of the cell membrane components that is degraded during cerebral ischemia to free fatty acids and free radicals. Animal studies suggest that citicoline may protect cell membranes by accelerating resynthesis of phospholipids and suppressing the release of free fatty acids, stabilizing cell membranes, and reducing free radical generation. Numerous experimental stroke studies with citicoline have shown improved outcome and reduced infarct size in both ischemic and hemorrhagic stroke models. ⋯ A meta-analysis of four randomized US clinical citicoline trials concluded that treatment with oral citicoline within the first 24 h after a moderate to severe stroke is safe and increases the probability of complete recovery at 3 months. Citicoline clinical efficacy trials are now continuing outside of the US in both ischemic and hemorrhagic stroke. A citicoline supplement is now available from several sources on the internet.