Expert opinion on pharmacotherapy
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Expert Opin Pharmacother · Mar 2003
ReviewCurrent pharmacotherapy for the treatment of severe burns.
The pharmacotherapy of burn care has evolved from the first topical antibiotics instituted > 30 years ago. These have helped greatly to reduce the incidence of burn wound sepsis, but a better understanding of the principles of burn care has resulted in earlier burn wound excision and complete coverage with autograft, cadaver skin, synthetic dressings, and amnion. This has markedly reduced septic complications and ameliorated the hypermetabolic response to burn injury. ⋯ Current therapy of frequently encountered problems, such as post-burn pruritus, prophylaxis of deep venous thrombosis and peptic ulceration, and pharmacological manipulation of inhalation injury in the burned patient is described. Current pharmacotherapy to ameliorate psychosocial problems associated with burns such as acute stress disorder, depression and post traumatic stress disorder are discussed. Better analgesics, newer antibiotics and immune stimulating drugs are required to reduce mortality and morbidity in large burns.
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The burden of asthma is increasing in terms of prevalence, severity of symptoms and other markers of asthma control. Poor control of symptoms is a major issue that can result in adverse clinical and economic outcomes. Prescribing costs are the most obvious and visible expense in asthma care but these are but the tip of the iceberg. ⋯ Drug-related costs need to take into account savings made by decreased costs of other prescribed medication and patient factors must be taken into account. We need information that is applicable to the types of patients we see in the real world to make proper cost analyses. Such information can come from 'pragmatic' randomised trials, from retrospective claims analysis from observational studies or using primary care clinical and prescribing databases.
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Expert Opin Pharmacother · Feb 2003
ReviewClinical pharmacology of etoricoxib: a novel selective COX2 inhibitor.
The development of COX2 inhibitors with improved biochemical selectivity (such as etoricoxib and valdecoxib) over that of commercially available coxibs has been driven by the potential advantage of safety using higher coxib doses for increased efficacy. Etoricoxib has been approved in the UK as a once-daily medicine for symptomatic relief in the treatment of osteoarthritis (OA), rheumatoid arthritis (RA) and acute gouty arthritis. It is currently approved with additional indications (i.e., for relief of acute pain associated with dental surgery, for primary dysmenorrhoea and for chronic musculo-skeletal pain, including chronic lower-back pain) in Mexico, Brazil and Peru. ⋯ Combined analysis of efficacy trials with etoricoxib versus non-selective NSAIDs has shown that the drug halves both investigator-reported upper gastrointestinal perforation, ulcers and bleeds (PUBs) and confirmed PUBs, and reduces the need for gastroprotective agents and gastrointestinal comedications by approximately 40%. The risk of lower extremity oedema and hypertension adverse experiences with etoricoxib was low and generally similar to comparator NSAIDs in a combined analysis of eight Phase III studies in OA, RA, chronic low-back pain and surveillance endoscopy. Large, randomised clinical trials have been planned to confirm the renal, gastrointestinal and cardiovascular safety of etoricoxib.
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Cholera, caused by Vibrio cholerae O1 and O139, is characterised by profuse purging of watery stools, and vomiting and dehydration. The mainstay of therapy of cholera patients is rehydration with oral rehydration salt solution or intravenous Ringer's lactate depending upon the degree of dehydration. Antibiotics such as tetracycline, doxycycline, norfloxacin, ciprofloxacin and furazolidone may be used as an adjunct to rehydration therapy for severely purging cholera patients to reduce the rate of stool output. ⋯ Other antidiarrhoeals are not recommended. Many antisecretory drugs have been tried as an adjunct therapy, unfortunately, until today, none has been found useful in the treatment of cholera. Feeding during and after cholera is emphasised.
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The pain that accompanies surgical procedures remains prevalent and is an aspect of the perioperative experience that generates the greatest concern for patients about to undergo surgery. There is also a growing recognition of the extent that acute painful experiences can lead to longer-term painful consequences, even when tissue healing appears to be complete. The neurobiologic basis of this has been partially elucidated. ⋯ Acute perioperative pain is an ideal setting for the use of pre-emptive analgesic techniques because the timing of noxious stimuli is known in advance and surgical sensitisation of the nervous system is ongoing despite adequate levels of general anaesthesia with volatile anaesthetics. The relevant neurobiology of pain, reviewed in this article, is the basis for advocating an aggressive, multimodal, pre-emptive approach to acute pain therapy throughout the entire perioperative period. A growing body of outcome studies demonstrates the long-term efficacy of this approach.