Drug intelligence & clinical pharmacy
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Drug Intell Clin Pharm · Sep 1984
Atracurium and vecuronium: two unique neuromuscular blocking agents.
Atracurium and vecuronium are two new nondepolarizing skeletal muscle relaxants that were developed to overcome the deficiencies seen with currently available agents (tubocurarine, metocurine, pancuronium, and gallamine). Both compounds have unique metabolic profiles, separating them from other nondepolarizing agents. Neither drug depends on normal renal function for excretion and each can safely be given to patients with renal failure. ⋯ Both agents produce a lower degree of histamine release than other agents, although atracurium appears to produce a higher incidence of histamine-like reactions than vecuronium. Vecuronium appears to be the agent of choice in patients with a history of asthma or allergy. The place in therapy for these new agents is discussed.
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Drug Intell Clin Pharm · Jul 1984
ReviewIntrinsic sympathomimetic activity: physiological reality or marketing phenomenon.
Intrinsic sympathomimetic activity (ISA) describes the partial beta-adrenergic agonist responses elicited by a series of beta-adrenergic antagonists. The dual effect on the beta-adrenergic receptor appears to be related to structural specificity of the drugs allowing competitive binding to the receptor (antagonist activity) and partial interaction at the receptor's activation site (agonist activity). The clinical effects of a beta-adrenergic antagonist with ISA depend on the relative balance of the drug's inherent antagonist and agonist activity and on the degree of underlying sympathetic tone in the patient. ⋯ However, predisposing factors such as acute illness and individual idiosyncrasies may interfere with the manifestations of the agonist effects. Further, maximal response to full beta-adrenergic agonists will be diminished by concurrent therapy with beta-adrenergic antagonists regardless of ISA presence. In summary, ISA does have a physiological basis and increased experience in larger patient populations will help to place it in proper clinical perspective.
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Drug Intell Clin Pharm · Jun 1984
Case ReportsAnaphylactoid reaction caused by intravenous doxycycline during general anesthesia and beta-blockade treatment.
A 71-year-old woman with icterus was treated with doxycycline orally for one week. She then was admitted for an exploratory laparotomy under general anesthesia with barbiturate, pancuronium, fentanyl, and nitrous oxide. ⋯ Soon after the completed infusion, she developed a severe anaphylactoid reaction with bronchospasm, hypotension, and generalized urticaria, which was treated successfully with ephedrine, aminophylline, hydrocortisone, furosemide, metaraminol, ketamine, and epinephrine. The possibility of beta-blockade treatment worsening the reaction is discussed and five other reports of anaphylactoid reactions to intravenous doxycycline are mentioned.
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Two cases of severe beta-blocker overdose are presented that were treated successfully with glucagon therapy. The effects of glucagon in reversing the cardiovascular depression of profound beta-blockade, including its mechanism of action, onset and duration of action, dosage and administration, cost and availability, and side effects are reviewed. Medical complications of beta-blocker overdose include hypotension, bradycardia, heart failure, impaired atrioventricular conduction, bronchospasm and, occasionally, seizures. ⋯ The doses of glucagon required to reverse severe beta-blockade are 50 micrograms/kg iv loading dose, followed by a continuous infusion of 1-15 mg/h, titrated to patient response. Glucagon-treated patients should be monitored for side effects of nausea, vomiting, hypokalemia, and hyperglycemia. The high cost and limited availability of glucagon may be the only factors precluding its future clinical acceptance.
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The crystalloid vs. colloid controversy is based on a disagreement as to the most effective, safest, and most economical method of maintaining an effective plasma volume in shock patients. This review discusses Starling's law of fluid movement, with a definition of each term in the normal physiological state, and presents examples of how each component of Starling's law differs in the two major types of pulmonary edema: (1) cardiogenic and (2) noncardiogenic. ⋯ Each major colloid (albumin, dextran, hetastarch) and a representative crystalloid (lactated Ringer's) are discussed in terms of their chemistry; pharmacology and indications; and precautions, adverse reactions, and side effects. A table is included that summarizes the available products' data regarding composition, volume expansion, duration of expansion, half-life, metabolism, elimination, precautions, adverse reactions, and dose.