Nebulized Morphine for Relief of Dyspnea Due to Chronic Lung Disease

2005 ◽  
Vol 39 (6) ◽  
pp. 1088-1092 ◽  
Author(s):  
Sherrill J Brown ◽  
Samantha F Eichner ◽  
Jennifer R Jones
Keyword(s):  
Lung Disease ◽  
Chronic Lung Disease ◽  
Case Reports ◽  
Data Sources ◽  
Pulmonary Diseases ◽  
Efficacy And Safety ◽  
Data Synthesis ◽  
Disease States ◽  
Search Terms ◽  
Chronic Pulmonary Diseases

OBJECTIVE: To evaluate the efficacy and safety of nebulized morphine for the management of dyspnea in chronic pulmonary diseases. DATA SOURCES: MEDLINE (1966–May 2004), EMBASE (1980–May 2004), and International Pharmaceutical Abstracts (1970–May 2004) searches were performed. Key search terms included morphine, dyspnea, and inhalation. DATA SYNTHESIS: Nine studies have evaluated the efficacy of nebulized morphine in relieving dyspnea. Three trials had positive resuts, but the rest failed to show improvement after treatment with doses ranging from 1 to 40 mg nebulized morphine. The small number of subjects, variety of disease states, and different outcome measures limit interpretation of the studies. CONCLUSIONS: Results from several small studies do not support the use of nebulized morphine for treatment of dyspnea; however, several positive case reports have been published.

Topical Tacrolimus in the Treatment of Atopic Dermatitis

2001 ◽  
Vol 35 (7-8) ◽  
pp. 943-946 ◽  
Author(s):  
Laura M Gianni ◽  
Maria Marzella Sulli
Keyword(s):  
Atopic Dermatitis ◽  
Skin Penetration ◽  
Data Sources ◽  
Cell Mediated Immunity ◽  
Efficacy And Safety ◽  
Data Synthesis ◽  
Topical Tacrolimus ◽  
Duration Of Therapy ◽  
Search Terms ◽  
Optimal Duration

OBJECTIVE: To review the efficacy of topical tacrolimus in the treatment of atopic dermatitis (AD). DATA SOURCES: Searches of MEDLINE (1966–October 2000), International Pharmaceutical Abstracts (1970–October 2000), and ScienceDirect (1994–October 2000) were performed using the key search terms tacrolimus, FK506, and atopic dermatitis. DATA SYNTHESIS: Since patients with AD have defects in cell-mediated immunity, the immunosuppressant properties of the macrolides (cyclosporine and tacrolimus) may prove to be beneficial in the treatment of AD. Topical tacrolimus has been frequently studied in the treatment of AD because it was found to have better skin penetration and higher potentency than topically applied cyclosporine. Studies evaluating the use of topical tacrolimus are presented and provide evidence that topical tacrolimus is effective in the treatment of AD with no evidence thus far of systemic adverse effects. CONCLUSIONS: There is a fair amount of documentation of the efficacy and safety of topical tacrolimus. Further trials are needed to determine the optimal duration of therapy and its efficacy and safety in children less than seven years of age.

Review of Serum Voriconazole Concentrations and Correlations with Adverse Events and Efficacy

2009 ◽  
Vol 25 (3) ◽  
pp. 183-189
Author(s):  
Michael J Latran
Keyword(s):  
Adverse Events ◽  
Fungal Infections ◽  
Case Reports ◽  
Elevated Serum ◽  
Therapeutic Drug ◽  
Serum Concentrations ◽  
Efficacy And Safety ◽  
Data Synthesis ◽  
Additional Information ◽  
Search Terms

Objective: To review the available evidence regarding the monitoring of serum voriconazole concentrations in terms of efficacy and safety. Data Sources: A literature search of MEDLINE was conducted (1950–February 2009), with combinations of the following search terms: voriconazole, therapeutic drug monitoring, voriconazole serum concentrations, voriconazole levels, trough, and adverse events. Data Collection: All studies and case reports that evaluated serum voriconazole concentrations in adults were reviewed and considered for inclusion. Citations in identified articles were searched for additional information. Data Synthesis: Ten studies and case reports that evaluated serum voriconazole concentrations in terms of efficacy and safety in adults were identified and included in this review. Results from efficacy studies show an association between low serum voriconazole concentrations and disease progression. One study found that a lack of response occurred more often in patients with a serum voriconazole trough of 1 μg/mL or less (p = 0.02). Another study found that patients were more likely to fail voriconazole therapy for invasive fungal infections when serum concentrations were less than or equal to 2 μg/mL. In terms of safety, 6 studies showed an association between elevated serum voriconazole concentrations and adverse events. Conclusions: Available data suggest that serum voriconazole concentrations of 1 μg/mL or less are associated with therapeutic failures, whereas serum voriconazole concentrations of 6 μg/mL or more are associated with adverse events. Studies show that monitoring serum voriconazole concentrations may decrease the incidence of adverse events while increasing efficacy.

Levodopa Therapy and the Risk of Malignant Melanoma

2000 ◽  
Vol 34 (3) ◽  
pp. 382-385 ◽  
Author(s):  
Jolene F Siple ◽  
Diana C Schneider ◽  
Wendy A Wanlass ◽  
Burton K Rosenblatt
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Malignant Melanoma ◽  
English Language ◽  
Case Reports ◽  
Levodopa Therapy ◽  
Data Sources ◽  
Data Synthesis ◽  
Medline Search ◽  
Search Terms

OBJECTIVE: To evaluate the use of levodopa therapy in patients with Parkinson's disease and malignant melanoma. DATA SOURCES: A MEDLINE search (January 1966–September 1999) of English-language articles was conducted. Key search terms included levodopa, melanoma, and Parkinson's disease; 34 case reports were identified. DATA SYNTHESIS: Carbidopa/levodopa continues to be a mainstay in the treatment of Parkinson's disease. Since the late 1970s, a warning has appeared in the prescribing literature for levodopa regarding the risk of activating malignant melanoma. An evaluation was conducted of the case reports in which a causal relationship between levodopa and melanoma was suggested. CONCLUSIONS: There is an unlikely association between levodopa and induction or exacerbation of malignant melanoma.

Safety of Selegiline with Cold Medications

2003 ◽  
Vol 37 (3) ◽  
pp. 438-441 ◽  
Author(s):  
Jeena E Jacob ◽  
Mary L Wagner ◽  
Jacob I Sage
Keyword(s):  
Adverse Events ◽  
Drug Interactions ◽  
Interaction Potential ◽  
Data Sources ◽  
Data Synthesis ◽  
Search Terms ◽  
Clinical Literature

OBJECTIVE: To evaluate the safety of the coadministration of selegiline with cold medications. DATA SOURCES: Clinical literature accessed through MEDLINE(1965–September 2002), IPA database, and Drug-Reax System. The following search terms were used: selegiline, pseudoephedrine, dextromethorphan, MAOI, and drug interactions. Somerset Pharmaceuticals, the marketers of Eldepryl (selegiline HCI), were also contacted. DATA SYNTHESIS: Despite a warning against its concomitant use with pseudoephedrine and dextromethorphan, interactions with selegiline have not been reported. However, there have been reports of patients experiencing adverse events with related agents. CONCLUSIONS: Patients taking selegiline should try to avoid pseudoephedrine and dextromethorphan or use drugs without interaction potential. If selegiline is used with these medications, watch for adverse events or replace selegiline with another drug.

Foscarnet-Associated Penile Ulcerations

1994 ◽  
Vol 10 (5) ◽  
pp. 215-217
Author(s):  
Richard M. Cadle ◽  
Richard J. Hamill
Keyword(s):  
Adverse Effect ◽  
Case Reports ◽  
Human Herpesvirus ◽  
Antiviral Agent ◽  
Review Literature ◽  
Data Sources ◽  
Data Synthesis ◽  
Manual Search ◽  
Search Index ◽  
Genital Hygiene

Objective: To report a case of foscarnet-induced penile ulcerations and review literature related to this adverse effect. Data Sources: Case reports and review articles identified by a computerized search (MEDLINE) and manual search (Index Medicus). Data Synthesis: Foscarnet is a pyrophosphate analog antiviral agent that is approved by the Food and Drug Administration for treating cytomegalovirus retinitis in patients with AIDS. It also is used investigationally for other indications and human herpesvirus infections. Adverse effects include nephrotoxicity, anemia, ionized calcium abnormalities, and penile ulcerations. The majority of penile ulcers have developed within two weeks following initiation of foscarnet therapy with dosages of 180–200 mg/kg/d. Most cases required discontinuation of foscarnet to resolve the penile lesions. A postulated mechanism for this effect is inflammatory contact dermatitis from exposure to urine with elevated concentrations of foscarnet. We report a case of foscarnet-induced penile ulcerations that resolved after discontinuing this agent. Conclusions: Foscarnet can induce penile ulcerations. Increased awareness of this phenomenon, along with meticulous genital hygiene and urination practices, are required for its prevention.

Nonthrombocytopenic Purpura Associated Sequentially with Nifedipine and Diltiazem

1992 ◽  
Vol 26 (9) ◽  
pp. 1089-1090 ◽  
Author(s):  
Margaret Kuo ◽  
Nancy Winiarski ◽  
Serafino Garella
Keyword(s):  
Adverse Effect ◽  
Channel Blocker ◽  
Case Reports ◽  
Data Extraction ◽  
Data Sources ◽  
Cutaneous Vasculitis ◽  
Laboratory Studies ◽  
Pertinent Literature ◽  
Data Synthesis ◽  
Purpuric Rash

OBJECTIVE: To report the case of a patient who developed nonthrombocytopenic purpura sequentially following the administration of nifedipine and diltiazem. DATA SOURCES: Case reports, MEDLINE review of pertinent literature, and review of relevant studies. DATA EXTRACTION: Data were extracted from direct patient observation and review of laboratory studies and published reports. DATA SYNTHESIS: Nonthrombocytopenic purpura secondary to cutaneous vasculitis is a known, although rare, adverse effect of nifedipine. It has not been reported in association with diltiazem. We report the case of a 75-year-old woman in whom a purpuric rash demonstrated by biopsy to be attributable to cutaneous vasculitis developed in the course of nifedipine therapy. The rash disappeared after discontinuation of the drug; however, it recurred when diltiazem therapy was initiated. CONCLUSIONS: Nonthrombocytopenic purpura may be associated with diltiazem as well as with nifedipine. When this adverse effect occurs following administration of a calcium-channel blocker, caution is advised in using other agents of the same class.

Isoniazid-Associated Psychosis: Case Report and Review of the Literature

1993 ◽  
Vol 27 (2) ◽  
pp. 167-170 ◽  
Author(s):  
Karen A. Pallone ◽  
Morton P. Goldman ◽  
Matthew A. Fuller
Keyword(s):  
Case Report ◽  
English Language ◽  
Case Reports ◽  
Data Extraction ◽  
Data Sources ◽  
Review Of The Literature ◽  
Data Synthesis ◽  
Medline Search ◽  
Study Selection ◽  
Language Literature

Objective To describe a case of isoniazid-associated psychosis and review the incidence of this adverse effect. Data Sources Information about the patient was obtained from the medical chart. A MEDLINE search of the English-language literature published from 1950 to 1992 was conducted and Index Medicus was manually searched for current information. Study Selection All case reports describing isoniazid-associated psychosis were reviewed. Data Extraction Studies were evaluated for the use of isoniazid, symptoms of psychosis, onset of symptoms, and dosage of isoniazid. Data Synthesis The case report is compared with others reported in the literature. The incidence of isoniazid-associated psychosis is rare. Conclusions The mechanism of isoniazid-associated psychosis is uncertain. It appears that isoniazid was associated with the psychosis evident in our patient and in the cases reviewed.

Clozapine-Induced Hypersalivation

2000 ◽  
Vol 34 (5) ◽  
pp. 662-665 ◽  
Author(s):  
Liya Davydov ◽  
Sheila R Botts
Keyword(s):  
Case Reports ◽  
Treatment Options ◽  
Receptor Activation ◽  
Data Synthesis ◽  
Search Terms ◽  
Primary Literature ◽  
Adrenoceptor Agonists ◽  
Swallowing Reflex ◽  
Pharmacologic Agents ◽  
Underlying Pathophysiology

OBJECTIVE: To review underlying pathophysiology and possible treatments for clozapine-induced hypersalivation. DATA SOURCES: Primary literature was accessed through MEDLINE (1966–May 1999). Key search terms included clozapine, hypersalivation, sialorrhea, and treatment. DATA SYNTHESIS: Hypersalivation occurs in up to 54% of patients receiving clozapine. An evaluation of studies and case reports focusing on management of clozapine-induced hypersalivation was conducted. CONCLUSIONS: It is unclear whether clozapine increases salivation through its muscarinic M4 receptor activation and/or blockade of α2-adrenoceptors, or by causing a distortion in swallowing reflex. Treatment options include chewing gum, reducing the dosage of clozapine, or prescribing pharmacologic agents such as anticholinergics or α2-adrenoceptor agonists.

Drug-Induced Yawning—A Review

2011 ◽  
Vol 45 (10) ◽  
pp. 1297-1301 ◽  
Author(s):  
Edna Patatanian ◽  
Nancy Toedter Williams
Keyword(s):  
Case Reports ◽  
Data Extraction ◽  
Background Information ◽  
Drug Induced ◽  
Data Synthesis ◽  
Search Terms ◽  
Dopaminergic Agents ◽  
Study Selection ◽  
Physiologic Function ◽  
Induction Agents

Objective: To review the current literature on drug-induced yawning. Data Sources: Literature was accessed through MEDLINE/PubMed (1996-July 2011), International Pharmaceutical Abstracts (1997-July 2011), and EMBASE, using the search terms yawning, drug-induced yawning, and adverse drug reactions. Study Selection and Data Extraction: Relevant clinical trials and case reports were selected and included to present background information. Bibliographies of all relevant articles were reviewed for additional citations. Data Synthesis: Yawning is a common stereotype behavior with unknown physiologic function that occurs in most vertebrates and humans as early as 15 weeks of intrauterine life. Yawning Is under the control of several neurotransmitters and neuropeptides, Including dopamine, serotonin, oxytocin, and acetylcholine. Among drugs, antidepressants, opioids, dopaminergic agents, benzodiazepines, and induction agents are the main pharmacologic classes associated with yawning. Conclusions: Yawning is rarely a serious adverse reaction and is not frequently listed in the drug summary. Most available data are based on case reports, small studies, and older literature. Clinicians should be aware of the agents commonly triggering this behavior.

Bismuth Subgallate–Epinephrine Paste in Adenotonsillectomies

2000 ◽  
Vol 34 (4) ◽  
pp. 522-525 ◽  
Author(s):  
Randy C Hatton
Keyword(s):  
Active Ingredient ◽  
Science Citation Index ◽  
Citation Index ◽  
Postoperative Bleeding ◽  
Data Sources ◽  
Data Synthesis ◽  
Search Terms ◽  
Bismuth Subgallate ◽  
Minimal Evidence

OBJECTIVE: To evaluate the role of bismuth subgallate–epinephrine (BSE) paste as a hemostatic in adenotonsillectomies. DATA SOURCES: MEDLINE (January 1966–October 1999) and Current Contents (January 1997–October 1999) were searched, using bismuth subgallate, adenoidectomy, tonsillectomy, and adenotonsillectomy as search terms. A citation search was performed using Science Citation Index (January 1977–October 1999). DATA SYNTHESIS: Adenotonsillectomies are common procedures; although there are few complications, hemorrhage is a concern. Bismuth subgallate has historically been used as an astringent and hemostatic. An evaluation of studies of bismuth subgallate and BSE paste was conducted. CONCLUSIONS: There is minimal evidence to support this practice, but data suggest that epinephrine may be the active ingredient in BSE paste. BSE paste is inexpensive, poses little risk, and may decrease postoperative bleeding; therefore, it may be a reasonable hemostatic agent.

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