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  • 1
    ISSN: 1573-739X
    Keywords: Administration, epidural ; Adverse effects ; Analgesia ; Clinical trials ; Fentanyl ; Pain, postoperative ; Sufentanil
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology
    Notes: Abstract In a double-blind, randomized study the efficacies of concentrated fentanyl and sufentanil injections as intraoperative epidural analgesics were compared. Also, the equivalent dose of fentanyl and sufentanil administered by continuous infusion during the first. 24 h postoperatively, expressed in analgesia and also considering the side-effects was determined. 53 Patients undergoing elective thoracotomy, aortic surgery and bowel surgery were randomized and treated double-blind with fentanyl 0.250 mg/ml or sufentanil 0.05 mg/ml. Preoperatively, 0.5–1 ml study medication was administered, followed by increments of 0.2–0.5 ml during surgery guided by heart rate and systolic: blood pressure. Postoperatively, study medication diluted in 1.25 mg/l bupivacaine was administered by continuous epidural infusion. The infusion rate was adjusted to optimize analgesia. Dose, heart rate and systolic: blood pressure were measured infra- and postoperatively. Pain, sedation, nausea and pruritus were assessed on a 10 cm visual analogue scale. There were no differences in required volume of study medication, heart rate and systolic blood pressure nor in the parameters assessed postoperatively. Administered doses were 27.5μg/h fenlanyl and 5.5μg/h sufentanil. It was concluded that 0.250 mg/ml (0.74μmol/ml) fentanyl is clinically equivalent to 0.050 mg/ml (0.13 μmol/ml) sufentanil.
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  • 2
    Electronic Resource
    Electronic Resource
    Springer
    Pharmacy world & science 16 (1994), S. 27-29 
    ISSN: 1573-739X
    Keywords: Adverse effects ; Azathioprine ; Clinical trials ; Methotrexate ; Rheumatic diseases
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1573-739X
    Keywords: Adverse effects ; Liver diseases ; Prosthesis ; Streptokinase ; Thrombosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology
    Notes: Abstract We report the case of a 47-year-old woman with a history of mitral valve replacement with a mechanical prosthesis who was admitted to the hospital with a 3-month history of progressive exertional dyspnoea and was diagnosed as suffering from prosthetic valve thrombosis. Two consecutive courses of streptokinase were given as an intravenous infusion over 90 min at a dose of 1,500,000 IU each. Twenty minutes after the start of the second infusion (3 h and 20 min after the first one) she developed chills, fever, tachycardia and hypotension; symptomatic treatment was given and the infusion was completed. Two days later jaundice and choluria appeared with laboratory findings of hepatic cytolysis and cholestasis and renal insufficiency. The results of extensive microbiological and immunological investigations were not revealing. All the laboratory values spontaneously returned to baseline levels over the next 4 weeks. These abnormalities were attributed to an allergic reaction to streptokinase, although the exact pathogenic mechanisms involved are not known. We believe that further studies to elucidate the mechanisms involved in the production of these effects are warranted in view of their potential clinical severity.
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    Pharmacy world & science 17 (1995), S. 177-177 
    ISSN: 1573-739X
    Keywords: Adverse effects ; Angiotensin-converting enzyme inhibitors ; Drug design
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    Pharmacy world & science 18 (1996), S. 1-15 
    ISSN: 1573-739X
    Keywords: Administration, transdermal ; Adverse effects ; Analgesia, epidural ; Analgesics, opioid ; Drug development ; Pharmacology ; Receptors, opioid
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology
    Notes: Abstract The clinically available opiolds have different physicochemical properties, resulting in differences in clinical profile with regard to potency, onset, and duration of activity. However, they all have comparable side-effects after acute systemic application. Several approaches can be used to overcome these side-effects. The following approaches, with special emphasis on the perioperative use of the opioids, are discussed: (1) the use of alternative routes of administration, such as via the spine (epidurally and intrathecally); (2) optimization of opioid delivery by means of slow-release preparations, chronic infusions with indwelling catheters, and transdermal delivery systems; (3) use of additional agents to potentiate the analgesic properties of the oploids so that the dose of oploid can be reduced; and (4) searching for new analgesics on the basis of knowledge of the pain-transmission system and the different opioid receptors with their functional interactions.
    Type of Medium: Electronic Resource
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  • 6
    ISSN: 1573-739X
    Keywords: Acquired immunodeficiency syndrome ; Adverse effects ; AIDS-related complex ; CD4-positive T-lymphocytes ; Clinical trials ; Human immunodeficiency virus ; 9-(2-Phosphonylmethoxyethyl)adenine
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology
    Notes: Abstract The compound 9-(2-phosphonylmethoxyethyl)adenine (PMEA) is a potent inhibitor of a number of viruses in vitro, such as human immunodeficiency virus types 1 and 2, herpes simplex virus types 1 and 2, hepatitis B virus, cytomegalovirus, and Epstein-Barr virus. PMEA also proved to be effective in vivo against feline immunodeficiency virus in cats and simian immunodeficiency virus in rhesus monkeys. In an open, non-placebo-controlled trial, the safety of weekly doses of PMEA in 10 patients with acquired immunodeficiency syndrome (AIDS) or AIDS-related complex was studied for a period of 11 weeks. CD4+ T-Cell counts at baseline were between 10 and 450/mm3. The drug was administered intravenously at a dose of 1000 mg. No serious side-effects were seen. On one occasion one patient showed alanine aminotransferase and aspartate aminotransferase levels 5 times higher than the upper limit of normal and another patient showed on one occasion aspartate aminotransferase levels 5 times higher than the upper limit of normal. In another patient serum amalyse levels increased, on one occasion 1.5 times above the upper limit of normal. An improvement in general well-being was reported by all patients. For patients with a CD4+ T-cell count 〉 100/mm3 at baseline, the CD4+ T-cell count increased from a mean of 283/mm3 at baseline to a mean of 448/mm3 at the end of the study. Repeat infusions of PMEA at a dose of 1000 mg were safe and well tolerated. Our results suggest that PMEA, administrated according to this treatment schedule, may be effective in treating patients with human immunodeficiency virus infection.
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  • 7
    ISSN: 1573-739X
    Keywords: Adverse effects ; Dementia ; Drug utilization ; Nursing homes ; Pharmacoepidemiology ; Psychotropic drugs
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology
    Notes: Abstract The aim of this study was to describe the use of psychotropic drugs in a psychogeriatric nursing home, “Joachim en Anna”, in Nijmegen, the Netherlands. To this end the medical records of 890 nursing home patients with dementia, admitted between 1980 and 1989, were analysed retrospectively. Each time pattern of psychotropic drug use was registered. Drugs were coded by means of the Anatomical Therapeutic Chemical classification system. The daily dose was expressed as the ratio of the mean prescribed daily dose and the defined daily dose. Side-effects and changes in prescription patterns throughout the years patients were admitted were analysed. A total of 3,090 time patterns of exposure to psychotropics were registered. Neuroleptics, benzodiazepines, and antidepressants accounted for 58, 32, and 9% of the time patterns, respectively. For almost every drug prescription the prescribed daily dose was lower than the defined daily dose. More than 75% of these nursing home patients had at least one prescription for a psychotropic drug during institutionalization. One or more side-effects were observed in 50% of the patients who used a neuroleptic. The total number of patients receiving psychotropics did not change throughout the study. Psychotropics were prescribed for long-term use, but in a low dose. Side-effects were frequently observed while the correct individual dose was being determined.
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  • 8
    ISSN: 1573-739X
    Keywords: Adverse effects ; Critical illness neuromyopathy ; Elderly ; Intensive care unit ; Muscle relaxants ; Obstetrics ; Paediatrics
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology
    Notes: Abstract The pharmacodynamic and pharmacokinetic characteristics of the non-depolarizing muscle relaxants are dependent on age. Thus differences are found between paediatric patients, adults, and elderly patients. Muscle relaxants cross the placenta and thus may cause problems in the fetus. Many of the potential adverse effects of relaxant administration are seen more pronounced in intensive care patients. Prolonged effects and problems in weaning patients from the ventilator are observed when muscle relaxants are used in such patients. Critical illness neuropathy is a syndrome different from relaxant induced neuromyopathy, but may be enhanced by relaxant administration.
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  • 9
    ISSN: 1573-739X
    Keywords: Adverse effects ; Calcium channels ; Histamine H1 receptor blockaders ; Metabolism ; Receptors, histamine H1 ; Resolution ; Stereoisomers ; Synthesis ; Terfenadine
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology
    Notes: Abstract Terfenadine was the first non-sedating histamine H1 receptor antagonist and one of the most frequently prescribed H1 antihistamines. Terfenadine has one asymmetric centre in the molecule and is currently used as a racemate. Different methods and approaches for obtaining pure enantiomers of terfenadine are summarized and discussed in the present paper. Studies on antihistamine activity of the enantiomers, their side-effects on the central nervous system, calcium channel affinity and metabolism are also reviewed and analysed.
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  • 10
    ISSN: 1573-739X
    Keywords: Adverse effects ; Astemizole ; Drug interactions ; Overdose ; Probability ; Product surveillance, postmarketing ; Terfenadine ; Torsades de pointes
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology
    Notes: Abstract Recently, the use of astemizole and terfenadine, both non-sedating H1-antihistamines, caused considerable concern. Several case reports suggested an association of both drugs with an increased risk of torsades de pointes, a special form of ventricular tachycardia. The increased risk of both H1-antihistamines was associated with exposure to supratherapeutic doses; for terfenadine the risk was also associated with concomitant exposure to the cytochrome P-450 inhibitors ketoconazole, erythromycin and cimetidine. To predict the size of the population that runs the risk of developing this potentially fatal adverse reaction in the Netherlands, the prevalence of prescribing supratherapeutic doses and the concomitant exposure to terfenadine and cytochrome P-450 inhibitors was studied. Data were obtained from the PHARMO data base in 1990, a pharmacy-based record linkage system encompassing a catchment population of 300,000 individuals. The results of the study showed that the prescribing of supratherapeutic doses and the concomitant exposure to terfenadine and cytochrome P-450 inhibitors was low. Furthermore, the results of a sensitivity analysis showed that the risk of fatal torsades de pointes has to be as high as 1 in 10,000 to cause one death in the Netherlands in one year.
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