fundamental concepts in clinical pharmacology
CLINICAL PHARMACOLOGY 2003 (PART 25B)
... extensively used in psychiatry but is now obsolete Reserpine depletes adrenergic nerves of noradrenaline primarily by blocking amine storage within vesicles present in the nerve ending, so reducing stores ... Both alteplase and streptokinase bind plasminogen and convert it to plasmin, which lyses fibrin Alteplase has a much higher affinity for plasminogen bound to fibrin than in the circulation This ... after leaving hospital In particular, patients need to reduce saturated fat intake, and there is increasing evidence of the benefit of increased intake of fish and olive oil incidence of reinfarction...
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CLINICAL PHARMACOLOGY 2003 (PART 28)
... of urine • is used as a test for renal tubular acidosis • increases elimination of amphetamine, methylene dioxymethamphetamine (MDMA or 'Ecstasy'), dexfenfluramine, quinine and phencyclidine, ... caused by hydralazine, procainamide, sulfasalazine Drugs may thus induce any of the common clinical syndromes of renal injury, namely: Acute renal failure, e.g aminoglycosides, cisplatin Nephrotic ... frequency, urgency and incontinence Propantheline was formerly widely used in urinary incontinence but had a low response rate and a high incidence of adverse effects; it is now used mainly for adult...
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CLINICAL PHARMACOLOGY 2003 (PART 29)
... (approximately 1000-fold) and inhibition is essentially instantaneous Heparin binding to antithrombin induces a conformational change in antithrombin that locks the heparin in place and is followed ... pharmacokinetics Mode of action Heparin depends for its anticoagulant action on the presence in plasma of a single chain glycoprotein, antithrombin (formerly antithrombin III), a naturally-occurring inhibitor ... the intrinsic and common pathways including thrombin, factor Xa and factor IXa (Fig 28.1) Antithrombin is homologous to members of the a-antitrypsin family of serine protease inhibitors (serpins)...
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Fundamental Concepts
... temperature.) Accordingly, CH increases with decreasing separation between the electrode surface and the counterionic layer, as well as with increasing the dielectric constant in the intervening medium ... [CO(0,t)/CR(0,t)] = 1/10(n = 1) The decrease in CO(0,t) is coupled with an increase in the diffusion-layer thickness, which dominates the 10 FUNDAMENTAL CONCEPTS change in slope after CO(0,t) approaches ... calculating the double-layer capacitance of solid electrodes By recording linear scan voltammograms at different scan rates (using the supporting electrolyte solution), and plotting the charging...
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CLINICAL PHARMACOLOGY 2003 (PART 30)
... probably involving a protein DMT1 though the precise details have not been established Two other proteins, hephaestin and ferroportin 1, appear to be involved in intracellular transport and release into ... given by deep i.m injection, which can be painful It stains the skin (for up to years) but this can be minimised by inserting the needle through the skin and then moving the skin and subcutaneous ... ANAEMIAS ing the stomach, desferrioxamine 10 g in 50-100 ml water should be left in the stomach to chelate any remaining iron in the intestinal lumen; it is not absorbed Subsequently, desferrioxamine...
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CLINICAL PHARMACOLOGY 2003 (PART 31)
... doxorubicin (Adriamycin) + vincristine EP: etoposide + cisplatin MIC: mitomycin + ifosfamide + cisplatin MVP: mitomycin + vinblastine + cisplatin Cisplatin + gemcitabine;vinorelbine MOPP: mustine ... (chlormethine) + vincristine + procarbazine + prednisolone; ABVD: doxorubicin (Adriamycin) + bleomycin + vinblastine + dacarbazine CHOP: cyclophosphamide + doxorubicin* + vincristine (Oncovin) + ... irinotecan may be complicated by an acute cholinergic reaction, reversible by administering atropine s.c SPINDLE POISONS The plant alkaloids (vincristine, vinblastine, vindesine and vinorelbine)...
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The use of hypothesis-testing statistics in clinical trials
... often intuitively more understandable by clinicians Thus, it is typical for a clinical treatment study in psychiatry to be designed mainly 46 Chapter 8: Clinical trials to describe a change in depressive ... analyses in such a large sample The primary outcome of the study was a comparison of aspirin versus streptokinase for prevention of myocardial infarction, with a finding in favor of aspirin In subgroup ... kind of measurement, such as points on a depression rating scale This measurement can be defined in various ways; for example, it can reflect the actual change in points on a depression rating...
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CLINICAL PHARMACOLOGY 2003 (PART 32)
... used in the hope of improving the blood circulation to the inner ear in Meniere's syndrome; also cinnarizine GUIDETO FURTHER READING Agreus L, Talley N 1997 Challenges in managing dyspepsia in ... low therapeutic index that is inactivated by these isoenzymes, e.g warfarin, phenytoin, lidocaine, propranolol, 5-fluorouracil and theophylline Ranitidine, famotidine, nizatidine The modes of ... vitamin B12 and increased susceptibility to gastrointestinal infections as a result of prolonged hypochlorhydria There is as yet no real evidence for these being a clinical problem Proton pump inhibitors...
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CLINICAL PHARMACOLOGY 2003 (PART 33)
... Sulfasalazine (salicylazosulfapyridine, Salazopyrin) consists of two compounds, sulphapyridine and 5-aminosalicylic acid, joined by an azo-bond Sulfasalazine is poorly absorbed from the small intestine ... manifested by a variety of gastrointestinal symptoms including disordered bowel habit (constipation, diarrhoea or both), abdominal pain and bloating Upper gastrointestinal symptoms manifest as nonulcer ... gastrointestinal bleeding Selective COX-2 inhibitors may possess advantage in this situation ANAL FISSURE Anal fissures are often intensely painful due to sphincter spasm Anaesthetic ointments...
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CLINICAL PHARMACOLOGY 2003 (PART 34)
... interval between doses of such drugs may need to be lengthened, and the time to reach steady-state concentration in the plasma (5 x t1/,) is increased 652 PLASMA PROTEIN-BINDING OF DRUG Binding ... drugs eliminated predominantly by the kidney Where facilities exist, dosing should be guided by plasma concentration monitoring, e.g of theophylline, lidocaine and phenytoin These changes in drug ... MANAGEMENT OF DRUG-INDUCED LIVER INJURY • Always bear in mind the possibility Take a careful drug history, including over-the-counter and alternative complementary medicine remedies • In patients with...
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Tài liệu CLINICAL PHARMACOLOGY 2003 (PART 1) docx
... problem of combining practical clinical utility with some account of the principles on which clinical practice rests How much practical technical detail to include is difficult to decide In general, ... enjoyed, reading Clinical Pharmacology The world of clinical pharmacology has greatly changed since 1957 when I took up my pen, and I wish my successors well D R Laurence, Professor Emeritus of Pharmacology ... continuously or intermittently to maintain health without attaining cure (as in hypertension, diabetes mellitus, epilepsy, asthma) or to control symptoms (such as pain and cough) whilst awaiting...
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Tài liệu CLINICAL PHARMACOLOGY 2003 (PART 35) doc
... saltlosing syndrome of renal origin, e.g following an episode of interstitial nephritis Aldosterone (tl/2 20 min), the principal natural saltretaining hormone, has been used i.m in acute adrenal insufficiency ... sodium-retaining activity • For local administration (skin, lung), more potent, fluorinated steroids may be required Uses Corticotropin is used principally in diagnosis and rarely in treatment It is inactive ... measles should be avoided Gastrointestinal Patients taking continuous steroid, especially in combination with a nonsteroidal antiinflammatory drug (NSAID), have an excess incidence of peptic ulcer...
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Tài liệu CLINICAL PHARMACOLOGY 2003 (PART 36) doc
... crystalline Longer duration of action: Insulin Zinc Suspension, crystalline, or Protamine Zinc Insulin (insulin in suspension with both zinc and protamine) A mixture of soluble and isophane insulins, ... Modified Porcine), prb (Proinsulin Recombinant in Bacteria) and pyr (Precursor insulin Yeast Recombinant) Although one of the incentives for introducing human insulin was avoidance of insulin antibody ... Insulin (neutral insulin) The most recent addition to this class of insulin, insulin lispro (Humalog), is a modified human insulin in which the reversing of two amino acids has 682 resulted in...
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Tài liệu CLINICAL PHARMACOLOGY 2003 (PART 38) pptx
... 342 Alfuzosin, 473 Alginic acid, 627 Alimentary tract, see Gastrointestinal tract Alimenzamine, 555 Alkalinisation, urinary, 540 in poisoning, 156 Alkalinity, see pH Alkaloids cholinergic, 434, ... stimulation, 552 Aminoquinolones 4-aminoquinolones, 269 8-aminoquinolones, 269 interactions, 285 5-Aminosalicylic acid, 645-6 alone, see Mesalazine in Crohn's disease, 647 dimer of, see Olsalazine prodrug, ... analgesics anticoagulants interacting with, 572 choice and ranking (mild / moderate / severe / overwhelming pain), 324-5 clinical evaluation, 323-4 combining, 324 definition, 319 mechanisms of...
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Tài liệu CLINICAL PHARMACOLOGY 2003 (PART 2) ppt
... seated in the row behind two doctors He overheard one of the doctors expressing doubt about the long-term safety in children of inhaled corticosteroids He interrupted the conversation, explaining ... Merely providing information (on antimicrobials) did not influence prescribing, but gently asking physicians to justify their prescriptions caused a marked fall in inappropriate prescribing On a ... by the pharmaceutical industry Principal sources of guidance 37 Ian Dodds-Smith A professor of clinical pharmacology who has made special studies of prescribing and patient information writes:...
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Tài liệu CLINICAL PHARMACOLOGY 2003 (PART 3) ppt
... treatment * chloroquine primaquine * quinine COMPLEMENTARY DRUGS * doxycycline (for use only in combination with quinine) mefloquine * sulfadoxine + pyrimethamine RESTRICTED INDICATIONS artemether artesunate ... drugs * amoxicillin ampicillin benzathine benzylpenicillin benzylpenicillin * cloxacillin phenoxymethylpenicillin procaine benzylpenicillin RESTRICTED INDICATIONS * amoxycillin + *clavulanic ... Cytotoxic drugs asparaginase bleomycin calcium folinate chlorambucil chlormethine cisplatin cyclophosphamide cytarabine dacarbazine daunorubicin dactinomycin * doxorubicin etoposide fluorouracil...
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Tài liệu CLINICAL PHARMACOLOGY 2003 (PART 4) pptx
... Science, medicine and clinical pharmacology British Journal of Clinical Pharmacology 40:1-9 Breckenridge A1999 Clinical pharmacology and drug regulation British Journal of Clinical Pharmacology ... Ethics and law in clinical pharmacology British Journal of Clinical Pharmacology 27: 715-722 Reidenberg M M 1999 Clinical pharmacology: the scientific basis of therapeutics Clinical Pharmacology ... and use, i.e clinical pharmacology GUIDETO FURTHER READING Brater D C, Daly W J 2000 Clinical pharmacology in the middle ages: principles that presage the 21st century Clinical Pharmacology and...
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Tài liệu CLINICAL PHARMACOLOGY 2003 (PART 5) pdf
... Medicine 1:15 Di Masi J A1995 Success rates for new drugs entering clinical testing in the United States Clinical Pharmacology and Therapeutics 58:1 14 The cost of treating a patient having the ... potential medicines, and more doctors will become involved in clinical testing; it is expedient that they should have some acquaintance with the events and processes that precede their involvement ... eliminate their undesired, properties to create highly selective targeted compounds In principle all molecular structures capable of binding to a single highaffinity site can be modelled Combinatorial...
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Tài liệu CLINICAL PHARMACOLOGY 2003 (PART 6) doc
... terminated when a predetermined result is attained and not when the investigator looking at the results thinks it appropriate Reviewing results in a continuous or interim basis requires formal interim ... possibility of recruiting subjects from a wide population and of administering the medication in a broad range of clinical settings Multicentre trials can be used at any phase in clinical development, ... usual to analyse these according to the clinicians' initial intention (intention-to-treat analysis), i.e investigators are not allowed to risk introducing bias by exercising their own judgement as...
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Tài liệu CLINICAL PHARMACOLOGY 2003 (PART 7) pdf
... Phocomelia is ordinarily exceedingly rare Most [West] German clinics had no cases during the 10 years up to 1959 In 1959, in 10 clinics, 17 were seen in 1959, 126 in 1960, 477 in 1961 The European ... babies' were born in the USA following indiscriminate premarketing clinical trials Thalidomide has anti-inflammatory and immunosuppressant actions and retains a limited specialist use in, for example, ... has provided incentive for novel drug investigation in humans but a European Union Directive, when in force, will remove this freedom and require that all clinical trials, i.e including Phase 1,...
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