scholarly journals Knowledge of modern principles of rational cardiovascular therapy in Moscow primary care physicians: survey-based assessment

2012 ◽  
Vol 11 (5) ◽  
pp. 61-66 ◽  
Author(s):  
T. G. Kheliya ◽  
S. Yu. Martsevich ◽  
G. B. Selivanova ◽  
Yu. V. Lukina ◽  
L. Yu. Drozdova ◽  
...  
Keyword(s):  
Primary Care ◽  
Adverse Effects ◽  
Primary Care Physicians ◽  
Term Treatment ◽  
Pharmacological Therapy ◽  
Assessment System ◽  
Angiotensin Ii Receptor ◽  
Registration System ◽  
Long Term Treatment ◽  
Therapy Effectiveness

Aim. To assess the knowledge of primary care physicians on the choice of medications for the long-term treatment of cardiovascular disease (CVD); on the control of pharmacological therapy effectiveness and safety; and on the selection of optimal medications for specific clinical situations. Material and methods. In 2010, a voluntary survey of Moscow physicians working at specialised and municipal out-patient clinics was conducted. The number of participants was 281 (response rate 70%). Results. Thirty percent of the physicians correctly identified a selective β-adrenoblocker (β-AB) from the list of various medications. Typical adverse effects of statins, β-ABs, and calcium antagonists were known to 33%, 66,4%, and 38%, respectively. Every fifth respondent (22,6%) would recommend ACE inhibitors or angiotensin II receptor antagonists (captopril or losartan) to pregnant women. Sixty six percent of the participants identified the patients’ unwillingness to simultaneously take many medications and the fear of adverse effects (AE) as the major barriers to prescribing modern complex pharmacological therapy. Conclusion. Specialised questionnaires, used for interactive voting, and point-based assessment system provided an opportunity to identify the inadequate physicians’ knowledge of pharmacological therapyrelated AE and of the AE registration system. Poor knowledge of clinical recommendations affects the physicians’ ability to make correct decisions in specific clinical situations.

Landscape of Combination Therapy – Which Way Forward? Proceedings of the Satellite Symposium Held at the ESH European Meeting on Hypertension and Cardiovascular Protection, 27 April 2012, London

2012 ◽  
Vol 8 (3) ◽  
pp. 192
Author(s):  
Patricia Fonseca ◽  
Anna F Dominiczak ◽  
Stephen Harrap ◽  
◽  
◽  
...  
Keyword(s):  
Blood Pressure ◽  
High Risk ◽  
Combination Therapy ◽  
Enzyme Inhibitor ◽  
Synergistic Effects ◽  
Term Treatment ◽  
Angiotensin Ii Receptor Blocker ◽  
Angiotensin Ii Receptor ◽  
Hypertensive Patients ◽  
Long Term Treatment

Early combination therapy is more effective for hypertension control in high-risk patients than monotherapy, and current guidelines recommend the use of either an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) for first-line therapy in patients younger than 55 years. Recent evidence shows that ACEIs reduce mortality, whereas ARBs show no apparent benefit despite their blood pressure lowering action. However, it is important to consider which blood pressure parameters should be targeted given that different drugs have distinct effects on key parameters. Remarkably, a high percentage of hypertensive patients whose treatment has brought these parameters within target ranges still remain at high risk of cardiovascular disease due to additional risk factors. Combination therapy with synergistic effects on blood pressure and metabolic control should thus be considered for the long-term treatment of hypertensive patients with co-morbid conditions.

scholarly journals What Differs between Patients under Methadone and under Buprenorphine for Opioid Use Disorder (OUD) in Daily Clinical Practice in France? A Short Report

2021 ◽  
Vol 18 (4) ◽  
pp. 1425
Author(s):  
Morgane Guillou-Landreat ◽  
Antoine Dany ◽  
Gaëlle Challet-Bouju ◽  
Edouard Laforgue ◽  
Juliette Leboucher ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Opioid Use Disorder ◽  
Term Treatment ◽  
Pharmacological Therapy ◽  
Daily Clinical Practice ◽  
Short Report ◽  
Opioid Use ◽  
Cross Sectional ◽  
Long Term Treatment ◽  
Social Profiles

(1) Background: Opioid use disorder (OUD) is a complex condition that can require long-term treatment. Pharmacological therapy for OUD involves treatment with opioid agonists (OMT) tailored to individual profiles. The aim of our study in daily clinical practice was to compare the profiles of patients treated with methadone (MTD) and those using buprenorphine (BHD or BHD-naloxone-NX). (2) Methods: A cross-sectional multicentre study explored the psychological, somatic and social profiles of patients with Opioid Use Disorder (OUD) following Opioid Maintenance Treatment (BHD, BHD/NX, or MTD). Descriptive and comparative analyses were performed (3) Results: 257 patients were included, a majority were men using heroin. 68% (178) were on MTD, 32% (79) were on BHD. Patients with MTD were significantly more likely to report socio-affective damage, and more likely to be younger and not to report oral or sublingual use as the main route for heroin or non-medical opioids (4) Conclusions: In daily clinical practice, regarding OUD damage, only socio-affective damage was significantly more prevalent among patients on MTD than among those on BHD in the multivariate model. Age and route of administration also differed, and our results could raise the issue of the type of OMT prescribed in case of non-medical use of prescribed opioids. These hypothesis should be confirmed in larger studies.

Management of congestive heart failure: is the role of positive inotropic therapy fading?

1996 ◽  
Vol 5 (6) ◽  
pp. 455-460
Author(s):  
LG Futterman ◽  
L Lemberg
Keyword(s):  
Term Treatment ◽  
Pharmacological Therapy ◽  
Control Treatment ◽  
Inotropic Therapy ◽  
Digitalis Glycoside ◽  
Inotropic Drugs ◽  
Long Term Treatment ◽  
Clinical Benefits ◽  
Current Concerns ◽  
Digoxin Therapy

Significant strides have been made in the medical therapy of chronic CHF in the past two decades. Treatment has evolved from therapy based on the older concepts of the pathophysiology of CHF to evidence-guided therapy supported by results of major landmark studies that expand the understanding of the pathophysiology. Attenuation of neurohumoral activation is now a goal of pharmacological therapy, and we know that agents that offer hemodynamic and early clinical improvement may not necessarily prolong survival-unless they also modulate these neurohormonal systems. Positive inotropic therapy (e.g., use of a digitalis glycoside) is no longer considered essential in patients with CHF in sinus rhythm. Although impressive hemodynamic benefits can be observed with the use of positive inotropic agents, long-term treatment with these drugs has not produced clinical benefits and may increase mortality. Long before the current concerns about the use of positive inotropic therapy for CHF, cardiovascular physiologists had advised that contractility does not equate with overall cardiac performance. Stimulation of myocardial contractility is a property of digoxin therapy. However, cardiac function is governed by four determinants: preload, afterload, rhythm, and contractility. All four require control. Treatment aimed at reducing preload and afterload and improving arrhythmias can achieve cardiac compensation by reducing cardiac work without the need for digoxin therapy or other inotropic drugs.

scholarly journals P709 Is azathioprine safe as long-term treatment in paediatric patients with inflammatory bowel disease?

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S573-S573
Author(s):  
M A Martínez Ibeas ◽  
I Bacelo Ruano ◽  
S Rodríguez Manchón ◽  
M Velasco Rodríguez-Belvís ◽  
J F Viada Bris ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Side Effects ◽  
Adverse Effects ◽  
Term Treatment ◽  
Tpmt Activity ◽  
Duration Of Treatment ◽  
Median Dosage ◽  
Long Term Treatment ◽  
Inflammatory Bowel

Abstract Background The toxicity of azathioprine (AZA) includes myelosuppression, infections, pancreatitis, photosensitivity, and hepatotoxicity. The aim of this study was to describe the adverse effects profile of azathioprine as long-term treatment in paediatric inflammatory bowel disease (IBD). Methods An observational, descriptive and retrospective study was performed in the paediatric IBD Unit of a tertiary care hospital from September 2008 to December 2018. It was included patients under 18 diagnosed with IBD who were treated with AZA during their follow-up. We recorded epidemiological data, thiopurine methyltransferase (TPMT) enzyme activity, AZA side effects, and the dosage the patients were receiving when these effects took place. Bone marrow suppression (BMS) was defined as leukopenia, thrombocytopenia and/or anaemia. Acute pancreatitis (AP) induced by azathioprine was considered when two of these criteria (Atlanta 2012) were met: lipase increase (> 3 times normal value), congruent signs and symptoms and/or echographic findings, without other possible aetiology and with complete recovery after AZA withdrawal. Results We included 52 patients, being 31 men (59.6%). They were diagnosed with Crohn′s disease (CD) (73%), ulcerative colitis (UC) (21%) and IBD-unclassified (6%). The median TPMT activity was 17 U/ml (14.2–19.2). Up to 63.5% developed adverse effects by AZA with a median time from the beginning of treatment of 11.4 months (2.6–26.4) and a median dosage of 2 mg/kg/day (1.7–2.3). The most frequent side effect was BMS (52%). These patients had a median TPMT activity of 16.9 U/ml (14.2–18.9), the median duration of treatment was 14 months (3.9–27.7), and the median dosage was 2 mg/kg/d (1.8–2.5). BMS was more frequent in patients with UC (p 0.04) and longer treatment (p 0.08). No differences were found according to age, sex or TPMT activity. Up to 11.5% developed AP, the median duration of treatment until its appearance was 1.5 months (0.7–43.3) and the median dosage was 2 mg/kg/d (1.5–2.5). No differences were found related to age, sex, diagnosis or dosage. Other side effects were: 3 flu-like symptoms, 3 opportunistic infections, 2 hypertransaminasemia, and 1 patient with elevated pancreatic enzymes and hyperbilirubinemia. AZA was discontinued in 14 patients (43.8%): in 6 due to AP, in 4 due to severe lymphopenia, in 2 because of Epstein-Barr virus infection, in 1 due to flu-like symptoms and in 1 with several adverse effects. Conclusion More than half of the patients treated with AZA presented side effects, mainly BMS, although most of them were mild and temporary, and the withdrawal of the drug was not necessary. It seems that TPMT activity is not useful to predict BMS, but this adverse effect could be related to a longer treatment.

Orlistat in the Long-term Treatment of Obesity in Primary Care Settings.

2001 ◽  
Vol 21 (1) ◽  
pp. 53
Author(s):  
J Hauptman ◽  
C Lucas ◽  
M N Boldrin ◽  
H Collins ◽  
K R Segal
Keyword(s):  
Primary Care ◽  
Term Treatment ◽  
Primary Care Settings ◽  
Long Term Treatment ◽  
Treatment Of Obesity

Galantamine in long-term treatment formild cognitive impairment: Efficacy and safety

2011 ◽  
Vol 26 (S2) ◽  
pp. 1296-1296
Author(s):  
J. Zarra ◽  
L. Schmidt ◽  
B. Grecco
Keyword(s):  
Cognitive Impairment ◽  
Adverse Effects ◽  
Acetylcholine Receptors ◽  
Well Being ◽  
Cognitive Disorder ◽  
Term Treatment ◽  
Open Label ◽  
Global Deterioration Scale ◽  
Long Term Treatment

IntroductionTo evaluate the efficacy of galantamine in patients with Mild Cognitive Impairment. So there is a possible benefit in the deficit in executive and cognitive cerebral function (cholinergic system) with treatment with Galantamine.PurposeGalantamine is a reversible, competitive cholinesterasa inhibitor that also allosterically modulates nicotine acetylcholine receptors. Inhibition of acetylcholinesterase, the enzyme responsible for hydrolisis of acetylcholine at the cholinergic cognitive impairment. To evaluate the efficacy, safety and tolerability of galantamine in long-term in Mild Cognitive Disorder.MethodsA multicenter, open label, prospective, observational study enrolled 1028 patients, more 55 years old with Mild Neurocognitive Disorder (DSM IV criteria), during 30 months of treatment with galantamine 16 mg./day. Assessments included the MMSE, CDR, ADAS-GOG, FAQ, GCI, Trail making test, Global Deterioration Scale, and UKU scale of Adverse Effects.ResultsA total 1028 outpatients were treated with 16 mg./day galantamine during 30 months, the therapeutic response evaluated with CDR, MMSE and the tests and scales of function cognitive measuring, GCI and UKU scale of adverse effects, comparing the baseline to final scores.ConclusionMild Cognitive Disorder is being examined, so there aren’t enought treatment for this. A long-term treatment (30 months) galantamine improves cognition and global function, behavioural symptoms and the general state well being of patients with MCD. With incidence of adverse effects not significant and a very good profile of safety, the final results of the study suggest that galantamine may be particularly appropiate in the Mild Cognitive Disorder.

scholarly journals Attention deficit and hyperactivity disorder in people with epilepsy: diagnosis and implications to the treatment

2010 ◽  
Vol 68 (1) ◽  
pp. 107-114 ◽  
Author(s):  
Julio A.S. Koneski ◽  
Erasmo B. Casella
Keyword(s):  
Adverse Effects ◽  
Attention Deficit ◽  
Clinical Studies ◽  
Social Life ◽  
Term Treatment ◽  
Hyperactivity Disorder ◽  
The Social ◽  
Long Term Treatment ◽  
Epilepsy Diagnosis

The association between attention deficit and hyperactivity disorder (ADHD) and epilepsy can cause significant impact on the social life of affected individuals and their families. Clinical studies suggest that 30-40% of people with epilepsy also have ADHD. There are no studies which demonstrate that short or long-term treatment with methylphenidate increases the risk of seizures. Some studies attempt to relate drug interactions between methylphenidate and antiepileptic drugs, but adverse effects of methylphenidate have not been shown clearly. This review presents some neurobiological and physiopathogenic aspects, common to ADHD and epilepsy, from recent research studies, related to pharmacology, neuroimaging and electroencephalography. Possible risk of occurrence of seizures associated with the use of methylphenidate are also discussed.

scholarly journals Targeting exertional breathlessness to improve physical activity: the role of primary care

2021 ◽  
Vol 31 (1) ◽  
Author(s):  
Miguel Román-Rodríguez ◽  
Janwillem W. H. Kocks
Keyword(s):  
Physical Activity ◽  
Primary Care ◽  
Primary Care Physicians ◽  
Holistic Approach ◽  
Pharmacological Therapy ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Downward Spiral

AbstractPrimary care physicians (PCPs) play a crucial role in the diagnosis and management of chronic obstructive pulmonary disease (COPD). By working together with patients to target exertional breathlessness and increase physical activity, PCPs have an important role to play, early in the disease course, in improving patient outcomes in both the short and long term. In this article, we consider how physical activity affects disease progression from the PCP perspective. We discuss the role of pharmacological therapy, the importance of an holistic approach and the role of PCPs in assessing and promoting physical activity. The complexity and heterogeneity of COPD make it a challenging disease to treat. Patients’ avoidance of activity, and subsequent decline in capacity to perform it, further impacts the management of the disease. Improving patient tolerance of physical activity, increasing participation in daily activities and helping patients to remain active are clear goals of COPD management. These may require an holistic approach to management, including pulmonary rehabilitation and psychological programmes in parallel with bronchodilation therapy, in order to address both physiological and behavioural factors. PCPs have an important role to optimise therapy, set goals and communicate the importance of maintaining physical activity to their patients. In addition, optimal treatment that addresses activity-related breathlessness can help prevent the downward spiral of inactivity and get patients moving again, to improve their overall health and long-term prognosis.

Adverse effects of dopamine potentiation by long-term treatment with selegiline

2003 ◽  
Vol 19 (1) ◽  
pp. 107-109 ◽  
Author(s):  
Susan Hollán ◽  
László Vécsei ◽  
Kálmán Magyar
Keyword(s):  
Adverse Effects ◽  
Term Treatment ◽  
Long Term Treatment
Sign in / Sign up

Export Citation Format

Share Document