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Ouanounou A, Ng K, Chaban P. Adverse drug reactions in dentistry. Int Dent J 2020; 70:79-84. [PMID: 31944297 DOI: 10.1111/idj.12540] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 10/10/2019] [Accepted: 10/15/2019] [Indexed: 11/26/2022] Open
Abstract
An adverse drug reaction (ADR) is an undesirable effect of a drug. ADRs are possible with any medication that is prescribed or administered in the dental office. While most pharmacological agents in use today have favourable drug profiles and are relatively safe, the prudent clinician must be aware of the potential ADRs that can occur and be prepared to manage any complications. Here we review the most commonly used agents in dentistry, namely local anaesthetics, sedatives, analgesics and antibiotics, and their ADRs and management.
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Affiliation(s)
- Aviv Ouanounou
- Department of Clinical Sciences, Pharmacology & Preventive Dentistry, Faculty of Dentistry, University of Toronto, Toronto, ON, Canada
| | - Kester Ng
- Faculty of Dentistry, University of Toronto, Toronto, ON, Canada
| | - Peter Chaban
- Faculty of Dentistry, University of Toronto, Toronto, ON, Canada
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2
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Jacob TF, Singh V, Dixit M, Ginsburg-Shmuel T, Fonseca B, Pintor J, Youdim MBH, Major DT, Weinreb O, Fischer B. A promising drug candidate for the treatment of glaucoma based on a P2Y6-receptor agonist. Purinergic Signal 2018; 14:271-284. [PMID: 30019187 DOI: 10.1007/s11302-018-9614-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 05/31/2018] [Indexed: 11/28/2022] Open
Abstract
Extracellular nucleotides can regulate the production/drainage of the aqueous humor via activation of P2 receptors, thus affecting the intraocular pressure (IOP). We evaluated 5-OMe-UDP(α-B), 1A, a potent P2Y6-receptor agonist, for reducing IOP and treating glaucoma. Cell viability in the presence of 1A was measured using [3-(4, 5-dimethyl-thiazol-2-yl) 2, 5-diphenyl-tetrazolium bromide] (MTT) assay in rabbit NPE ciliary non-pigmented and corneal epithelial cells, human retinoblastoma, and liver Huh7 cells. The effect of 1A on IOP was determined in acute glaucomatous rabbit hyaluronate model and phenol-induced chronic glaucomatous rabbit model. The origin of activity of 1A was investigated by generation of a homology model of hP2Y6-R and docking studies. 1A did not exert cytotoxic effects up to 100 mM vs. trusopt and timolol in MTT assay in ocular and liver cells. In normotensive rabbits, 100 μM 1A vs. xalatan, trusopt, and pilocarpine reduced IOP by 45 vs. 20-30%, respectively. In the phenol animal model, 1A (100 μM) showed reduction of IOP by 40 and 20%, following early and late administration, respectively. Docking results suggest that the high activity and selectivity of 1A is due to intramolecular interaction between Pα-BH3 and C5-OMe which positions 1A in a most favorable site inside the receptor. P2Y6-receptor agonist 1A effectively and safely reduces IOP in normotense, acute, and chronic glaucomatous rabbits, and hence may be suggested as a novel approach for the treatment of glaucoma.
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Affiliation(s)
- Tali Fishman Jacob
- GlaucoPharm Ltd, P.O.Box 620, New Industrial Park, 20692, Yokneam, Israel
| | - Vijay Singh
- Department of Chemistry, Gonda-Goldschmied Medical Research Center, Bar-Ilan University, 52900, Ramat Gan, Israel
| | - Mudit Dixit
- Department of Chemistry, Gonda-Goldschmied Medical Research Center, Bar-Ilan University, 52900, Ramat Gan, Israel
| | - Tamar Ginsburg-Shmuel
- Department of Chemistry, Gonda-Goldschmied Medical Research Center, Bar-Ilan University, 52900, Ramat Gan, Israel
| | - Begoña Fonseca
- Escuela Universitaria De Optica, Universidad Complutense De Madrid, C/Arcos De Jalon 118, 28037, Madrid, Spain
| | - Jesus Pintor
- Escuela Universitaria De Optica, Universidad Complutense De Madrid, C/Arcos De Jalon 118, 28037, Madrid, Spain
| | - Moussa B H Youdim
- GlaucoPharm Ltd, P.O.Box 620, New Industrial Park, 20692, Yokneam, Israel
| | - Dan T Major
- Department of Chemistry, Gonda-Goldschmied Medical Research Center, Bar-Ilan University, 52900, Ramat Gan, Israel.
| | - Orly Weinreb
- GlaucoPharm Ltd, P.O.Box 620, New Industrial Park, 20692, Yokneam, Israel.
| | - Bilha Fischer
- Department of Chemistry, Gonda-Goldschmied Medical Research Center, Bar-Ilan University, 52900, Ramat Gan, Israel.
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Gautier C, Charpin D. Environmental triggers and avoidance in the management of asthma. J Asthma Allergy 2017; 10:47-56. [PMID: 28331347 PMCID: PMC5349698 DOI: 10.2147/jaa.s121276] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Identifying asthma triggers forms the basis of environmental secondary prevention. These triggers may be allergenic or nonallergenic. Allergenic triggers include indoor allergens, such as house dust mites (HDMs), molds, pets, cockroaches, and rodents, and outdoor allergens, such as pollens and molds. Clinical observations provide support for the role of HDM exposure as a trigger, although avoidance studies provide conflicting results. Molds and their metabolic products are now considered to be triggers of asthma attacks. Pets, dogs, and especially cats can undoubtedly trigger asthmatic symptoms in sensitized subjects. Avoidance is difficult and rarely adhered to by families. Cockroach allergens contribute to asthma morbidity, and avoidance strategies can lead to clinical benefit. Mouse allergens are mostly found in inner-city dwellings, but their implication in asthma morbidity is debated. In the outdoors, pollens can induce seasonal asthma in sensitized individuals. Avoidance relies on preventing pollens from getting into the house and on minimizing seasonal outdoor exposure. Outdoor molds may lead to severe asthma exacerbations. Nonallergenic triggers include viral infections, active and passive smoking, meteorological changes, occupational exposures, and other triggers that are less commonly involved. Viral infection is the main asthma trigger in children. Active smoking is associated with higher asthma morbidity, and smoking cessation interventions should be personalized. Passive smoking is also a risk factor for asthma exacerbation. The implementation of public smoking bans has led to a reduction in the hospitalization of asthmatic children. Air pollution levels have been linked with asthmatic symptoms, a decrease in lung function, and increased emergency room visits and hospitalizations. Since avoidance is not easy to achieve, clean air policies remain the most effective strategy. Indoor air is also affected by air pollutants, such as cigarette smoke and volatile organic compounds generated by building and cleaning materials. Occupational exposures include work-exacerbated asthma and work-related asthma.
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Affiliation(s)
| | - Denis Charpin
- Department of Pulmonology and Allergy, North Hospital; Faculty of Medicine, Aix-Marseille University, Marseille, France
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Brent J, Burkhart K, Dargan P, Hatten B, Megarbane B, Palmer R, White J. Adverse Drug Reactions in the Intensive Care Unit. CRITICAL CARE TOXICOLOGY 2017. [PMCID: PMC7153447 DOI: 10.1007/978-3-319-17900-1_33] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Adverse drug reactions (ADRs) are undesirable effects of medications used in normal doses [1]. ADRs can occur during treatment in an intensive care unit (ICU) or result in ICU admissions. A meta-analysis of 4139 studies suggests the incidence of ADRs among hospitalized patients is 17% [2]. Because of underreporting and misdiagnosis, the incidence of ADRs may be much higher and has been reported to be as high as 36% [3]. Critically ill patients are at especially high risk because of medical complexity, numerous high-alert medications, complex and often challenging drug dosing and medication regimens, and opportunity for error related to the distractions of the ICU environment [4]. Table 1 summarizes the ADRs included in this chapter.
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Affiliation(s)
- Jeffrey Brent
- Department of Medicine, Division of Clinical Pharmacology and Toxicology, University of Colorado, School of Medicine, Aurora, Colorado USA
| | - Keith Burkhart
- FDA, Office of New Drugs/Immediate Office, Center for Drug Evaluation and Research, Silver Spring, Maryland USA
| | - Paul Dargan
- Clinical Toxicology, St Thomas’ Hospital, Silver Spring, Maryland USA
| | - Benjamin Hatten
- Toxicology Associates, University of Colorado, School of Medicine, Denver, Colorado USA
| | - Bruno Megarbane
- Medical Toxicological Intensive Care Unit, Lariboisiere Hospital, Paris-Diderot University, Paris, France
| | - Robert Palmer
- Toxicology Associates, University of Colorado, School of Medicine, Denver, Colorado USA
| | - Julian White
- Toxinology Department, Women’s and Children’s Hospital, North Adelaide, South Australia Australia
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Gomes ER, Brockow K, Kuyucu S, Saretta F, Mori F, Blanca-Lopez N, Ott H, Atanaskovic-Markovic M, Kidon M, Caubet JC, Terreehorst I. Drug hypersensitivity in children: report from the pediatric task force of the EAACI Drug Allergy Interest Group. Allergy 2016; 71:149-61. [PMID: 26416157 DOI: 10.1111/all.12774] [Citation(s) in RCA: 173] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2015] [Indexed: 12/22/2022]
Abstract
When questioned, about 10% of the parents report suspected hypersensitivity to at least one drug in their children. However, only a few of these reactions can be confirmed as allergic after a diagnostic workup. There is still a lack of knowledge on drug hypersensitivity (DH) epidemiology, clinical spectrum, and appropriate diagnostic methods particularly in children. Meanwhile, the tools used for DH management in adults are applied also for children. Whereas this appears generally acceptable, some aspects of DH and management differ with age. Most reactions in children are still attributed to betalactams. Some manifestations, such as nonsteroidal anti-inflammatory drug-associated angioedema and serum sickness-like reactions, are more frequent among young patients as compared to adults. Risk factors such as viral infections are particularly frequent in children, making the diagnosis challenging. The practicability and validity of skin test and other diagnostic procedures need further assessment in children. This study presents an up-to-date review on epidemiology, clinical spectrum, diagnostic tools, and current management of DH in children. A new general algorithm for the study of these reactions in children is proposed. Data are presented focusing on reported differences between pediatric and adult patients, also identifying unmet needs to be addressed in further research.
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Affiliation(s)
- E. R. Gomes
- Allergology Department; Centro Hospitalar do Porto; Porto Portugal
| | - K. Brockow
- Division Environmental Dermatology and Allergology Helmholtz Zentrum München/TUM; Department of Dermatology und AllergologyBiederstein; Technical University Munich; Munich Germany
| | - S. Kuyucu
- Department of Pediatric Allergy and Clinical Immunology; Faculty of Medicine; Mersin University; Mersin Turkey
| | - F. Saretta
- Pediatric Department; Hospital of Palmanova; A.S.S.5 ‘Bassa Friulana’; Palmanova UD Italy
| | - F. Mori
- Allergy Unit; Department of Pediatric; Anna Meyer Children's Hospital; University of Florence; Florence Italy
| | - N. Blanca-Lopez
- Allergy Department; Infanta Leonor University Hospital; Madrid Spain
| | - H. Ott
- Division of Pediatric Dermatology; Children's Hospital Auf der Bult; Hannover Germany
| | - M. Atanaskovic-Markovic
- University Children's Hospital of Belgrade; Medical Faculty University of Belgrade; Belgrade Serbia
| | - M. Kidon
- Allergy and Clinical Immunology Unit and Institute for Pediatric Pulmonology and National CF Center; Safra Children's Hospital; Tel Hashomer Israel
| | - J.-C. Caubet
- Division of Pediatric Allergy; University Hospital of Geneva; Geneva Switzerland
| | - I. Terreehorst
- Department of ENT and Pediatrics; AMC; Amsterdam The Netherlands
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Abstract
SUMMARY Chronic pain in children is a poorly recognized entity that is challenging to treat and leaves many families frustrated. Often, lack of an identifiable etiology along with the complex biopsychosocial nature of this condition leads to a lengthy diagnostic odyssey and delayed treatment that exacerbates the existing problem. Effective treatment of chronic pain requires a team approach in order to deal with the various aspects of this condition. Combinations of medication along with nonpharmacologic treatments, such as physical therapy, psychological interventions and complementary therapies, are often the most effective ways of treating chronic pain rather than medication alone. Further research is needed to understand the complex biobehavioral processes involved in the development and maintenance of chronic pain. Development of targeted novel therapies as well as comparative studies of existing treatments will help to improve treatment for chronic pain in children.
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Affiliation(s)
- Shahram Yazdani
- Pediatric Pain Program & Division of General Pediatrics, David Geffen School of Medicine at University of California, Los Angeles (UCLA), 10833 Le Conte Ave, Los Angeles, CA 90095-1752, USA
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Shah S, Prematta T, Adkinson NF, Ishmael FT. Hypersensitivity to polyethylene glycols. J Clin Pharmacol 2013; 53:352-5. [PMID: 23444288 DOI: 10.1177/0091270012447122] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2012] [Accepted: 03/09/2012] [Indexed: 01/29/2023]
Affiliation(s)
- Sapna Shah
- Department of Pediatrics, The Pennsylvania State University College of Medicine, PA, USA
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Pergolizzi JV, van de Laar M, Langford R, Mellinghoff HU, Merchante IM, Nalamachu S, O'Brien J, Perrot S, Raffa RB. Tramadol/paracetamol fixed-dose combination in the treatment of moderate to severe pain. J Pain Res 2012; 5:327-46. [PMID: 23055775 PMCID: PMC3442743 DOI: 10.2147/jpr.s33112] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Pain is the most common reason patients seek medical attention and pain relief has been put forward as an ethical obligation of clinicians and a fundamental human right. However, pain management is challenging because the pathophysiology of pain is complex and not completely understood. Widely used analgesics such as nonsteroidal anti-inflammatory drugs (NSAIDs) and paracetamol (acetaminophen) have been associated with adverse events. Adverse event rates are of concern, especially in long-term treatment or at high doses. Paracetamol and NSAIDs are available by prescription, over the counter, and in combination preparations. Patients may be unaware of the risk associated with high dosages or long-term use of paracetamol and NSAIDs. Clinicians should encourage patients to disclose all medications they take in a “do ask, do tell” approach that includes patient education about the risks and benefits of common pain relievers. The ideal pain reliever would have few risks and enhanced analgesic efficacy. Fixed-dose combination analgesics with two or more agents may offer additive or synergistic benefits to treat the multiple mechanisms of pain. Therefore, pain may be effectively treated while toxicity is reduced due to lower doses. One recent fixed-dose combination analgesic product combines tramadol, a centrally acting weak opioid analgesic, with low-dose paracetamol. Evidence-based guidelines recognize the potential value of combination analgesics in specific situations. The current guideline-based paradigm for pain treatment recommends NSAIDs for ongoing use with analgesics such as opioids to manage flares. However, the treatment model should evolve how to use low-dose combination products to manage pain with occasional use of NSAIDs for flares to avoid long-term and high-dose treatment with these analgesics. A next step in pain management guidelines should be targeted therapy when possible, or low-dose combination therapy or both, to achieve maximal efficacy with minimal toxicity.
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Affiliation(s)
- Joseph V Pergolizzi
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA ; Association of Chronic Pain Patients, Houston, TX, USA
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9
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Immediate-type drug hypersensitivity and associated factors in a general population. Allergol Immunopathol (Madr) 2011; 39:27-31. [PMID: 20675031 DOI: 10.1016/j.aller.2010.02.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2009] [Revised: 02/02/2010] [Accepted: 02/08/2010] [Indexed: 11/23/2022]
Abstract
BACKGROUND Our aim was to assess the prevalence and associated risk factors of common hypersensitivity reactions to drugs in the adult population, for which limited data are available. METHODS The data consisted of 1052 questionnaires obtained from adults. The questionnaires consisted of questions on immediate-type hypersensitivity reactions induced by drugs (itching, skin rash/hives, angio-oedema, shortness of breath, hypotension, and loss of consciousness). The questionnaire added knowledge on physician's diagnosis of asthma, allergic rhinitis, eczema, and other chronic systemic diseases. RESULTS The prevalence of self-reported drug hypersensitivity reactions was 11.8% for all reactions. Hypersensitivity reactions to analgesics were the most common (37.2%) followed by antibiotics (24.2%). Multivariate analysis showed that female gender (Odds Ratio (OR) 95% Confidence Interval (CI) (2.00 (1.25-3.21)), physician-diagnosed allergic rhinitis (3.03 (1.64-5.59)), and eczema (3.22 (1.87-5.53)) were associated with any type of drug hypersensitivity reactions. Itching was associated with allergic rhinitis (4.50 (2.06-9.81)) and eczema diagnosis (4.24 (2.14-8.64)). Skin rash/hives were associated with female gender (2.67 (1.24-5.74)), allergic rhinitis (4.57 (1.99-10.05)), and eczema (5.36 (2.65-10.84)). Angio-oedema was higher in females (5.74 (1.69-18.5)). In addition, eczema (2.87 (1.12-7.32)) and systemic hypertension (2.60(1.03-6.10)) were associated with angio-oedema. Shortness of breath was only associated with ever asthma diagnosis (6.59 (2.09-20.83)). Factors associated with loss of consciousness were female gender (5.56 (1.27-24.30)), allergic rhinitis diagnosis (4.76 (1.73-13.14)), and systemic hypertension (2.74 (1.02-7.41)). CONCLUSION The study showed that females and subjects with allergic diseases and hypertension were more susceptible to drug hypersensitivity reactions.
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Chen TL. Bronchospasms after infusion of a cephalosporin in anesthetized patients: what is the culprit? J Chin Med Assoc 2010; 73:181-2. [PMID: 20457436 DOI: 10.1016/s1726-4901(10)70036-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Revised: 03/11/2010] [Indexed: 10/19/2022] Open
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Kuo YM, Ting CK, Wang YC, Chang WK, Wu HL, Chan KH, Chen PT. Prophylactic antibiotic administration induced bronchospasm as increased airway pressure during general anesthesia. J Chin Med Assoc 2010; 73:72-7. [PMID: 20171586 DOI: 10.1016/s1726-4901(10)70005-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2009] [Accepted: 12/28/2009] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Anaphylactic reaction induced bronchospasm as wheezing and severe elevation of airway pressure was observed in a succession of patients during general anesthesia at our institute in November 2007. The aim of this survey was to investigate the suspected causes and risk factors of these anaphylactic reactions and the degree of correlation. METHODS All patients who received general anesthesia between November 1 and November 10, 2007 were enrolled. Underlying diseases, substances including intravenous and inhalational anesthetics, antibiotics, and the degree of increase in airway pressure were recorded. Enrolled patients were divided into a significant-airway-pressure-elevation group (Group P) and a no-airway-pressure-elevation group (Group N). RESULTS A new brand of cephalexin (Roles) used as a prophylactic antibiotic was identified as the most likely causative substance of this succession of suspected anaphylactic reactions (28 in 185 patients, 15.14%), and rapid administration was a contributor to these anaphylactic reactions. CONCLUSION In this study, we found that rapid administration of Roles was the main cause of suspected anaphylactic reaction presenting as bronchospasm with severe elevated airway pressure. Using Roles as the prophylactic antibiotic is not recommended in patients receiving general anesthesia.
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Affiliation(s)
- Yi-Min Kuo
- Department of Anesthesiology, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C
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Kaiserman I, Fendyur A, Vinker S. Topical beta blockers in asthmatic patients-is it safe? Curr Eye Res 2009; 34:517-22. [PMID: 19899964 DOI: 10.1080/02713680902989337] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To investigate the use of topical ocular anti-glaucoma medications by glaucomatous patients with obstructive pulmonary disease and their effect on related hospitalizations and emergency room visits. PARTICIPANTS We followed the electronic medical records of all the members in a district of the largest health maintenance organization in Israel (the "central district" of Clalit Health Services) older than 20 years (317,469 members); 6597 of them were on chronic topical anti-glaucoma treatment of which 693 (10.5%) suffered from obstructive pulmonary disease (OPD). METHODS In a historical cohort study, we documented all anti-glaucoma prescriptions filled in the district between January 1, 2001, and December 31, 2003, and all emergency room (ER) visits and hospitalizations in internal medicine, geriatric, or pulmonology departments. MAIN OUTCOME MEASURES The rate of hospitalization and emergency room visits during treatment with each anti-glaucoma medication. RESULTS Five hundred forty-four glaucomatous OPD patients (78.5%) were treated with topical beta-blockers, but only 169 (31.1%) of them received a cardio-selective beta-blocker (betaxolol). Patients treated with betaxolol each received more prescriptions per year than patients treated with timolol (p < 0.0001). Patients on topical betaxolol or timolol had 23.1 and 20.7 hospitalization days as well as 7.3 and 6.1 emergency room visits per 100 treatments per year, respectively, compared to a mean of 10 hospitalization days (p < 0.0001) and 5.0 ER visits for patients on non-beta-blocker anti-glaucoma medications. CONCLUSIONS A majority of glaucomatous patients with obstructive pulmonary disease were treated with topical beta-blockers, mostly non-cardioselective (timolol). Those patients were more prone to be hospitalized or visit the emergency room while on the medication.
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Affiliation(s)
- Igor Kaiserman
- Department of Ophthalmology, Barzilai Medical Center, Ashkelon, Israel.
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13
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Affiliation(s)
- M Ben-Shoshan
- McGill University Health Center, Division of Pediatric Allergy and Clinical Immunology, 2300 Tupper C-510 Montreal, Quebec H3H 1P3, Canada.
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Boita F, Couderc LJ, Crestani B, de Wazieres B, Devillier P, Ferron C, Franco A, Guenard H, Hayot M, Housset B, Jeandel C, Kuentz Rousseau M, Orlando JP, Orvoen-Frija E, Parent B, Partouche H, Piette F, Pinganaud G, Pison C, Puisieux F, Boucot I, Ruault G. [Evaluation of pulmonary function in the elderly. Intergroupe Pneumo Gériatrie SPLF-SFGG]. Rev Mal Respir 2007; 23:619-28. [PMID: 17202967 DOI: 10.1016/s0761-8425(06)72077-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Aging is associated with a progressive decrease in lung function. As a consequence of aging, individual's reserve is diminished, but this decrease is heterogeneous between individual subjects. Many factors are involved in the overall decline in lung function. The prevalence of asthma in the elderly is estimated between 6 and 10%. Mortality due to COPD is increasing, especially among older subjects. Older subjects are at an increased risk of developing chronic diseases such as Parkinson's disease, which can have consequences for lung function. Under-nutrition is also common in the elderly and can produce sarcopenia and skeletal muscle dysfunction. The presentation of respiratory disorders may differ in the elderly, especially because of a lack of perception of symptoms such as dyspnea. The impact of bronchodilatators or corticosteroids on respiratory function has not been studied in the elderly. Drugs usually used for the treatment of hypertension or arrhythmias, which are often observed with aging, can have pulmonary toxicity. There is no difference between functional evaluation in younger and older subjects but it is more difficult to find predicted values for older patients. Performing pulmonary function tests in older patients is often difficult because of a higher prevalence of cognitive impairment and/or poor coordination. When assessing pulmonary function in the elderly, the choice of tests will be depend on the circumstances, with the use of voluntary manoeuvres dependent on the condition of the patient.
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Affiliation(s)
- F Boita
- Service de Pneumologie, Hôpital Bichat, Paris
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15
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Kaiserman I, Kaiserman N, Elhayany A, Vinker S. Topical beta-blockers are not associated with an increased risk of treatment for depression. Ophthalmology 2006; 113:1077-80. [PMID: 16815397 DOI: 10.1016/j.ophtha.2006.02.056] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2005] [Revised: 01/01/2006] [Accepted: 02/24/2006] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To investigate the effect of topical beta-blockers on the prevalence of depression among glaucoma patients. DESIGN Retrospective observational population-based cohort study. PARTICIPANTS We reviewed the electronic medical records of all the members in a district of the largest health maintenance organization in Israel (Central District of Clalit Health Services) who were older than 20 years (317,469 members). METHODS We documented all antiglaucoma prescriptions (n = 274,023) and all antidepressant prescriptions (n = 16,948) filled by glaucoma patients in the district between January 1, 2001 and December 31, 2003. We included only those patients who filled at least 6 consecutive antiglaucoma prescriptions at least once every 2 months (n = 6597; 5846 [88.6%] were treated with topical beta-blockers). Depressed patients were defined as patients that filled at least four prescriptions for antidepressants during the study period (n= 810, 12.3% of all glaucoma patients). MAIN OUTCOME MEASURE Relationship of topical beta-blocker use and prevalence of depression among glaucoma patients. RESULTS No significant demographic differences were noted between glaucoma patients treated and not treated with topical beta-blockers. Of those treated and not treated with beta-blockers, 12.2% (12.7% after age-adjustment) and 12.7%, respectively, were also receiving drug therapy for depression (P = 0.7, chi-square test). With stratification by age, treatment with topical beta-blockers did not influence the prevalence of depression in any age group. Logistic regression analysis revealed a significant effect of age, place of birth, and gender on the prevalence of depression, but the prevalence of use of topical beta-blockers had no significant effect. CONCLUSIONS Use of topical beta-blockers by glaucoma patients does not appear to increase the risk of depression in this population.
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Affiliation(s)
- Igor Kaiserman
- Department of Ophthalmology, Barzilai Medical Center, Ashkelon, Israel.
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Vinker S, Kaiserman I, Waitman DA, Blackman S, Kitai E. Prescription of Ocular ??-Blockers in??Patients with Obstructive Pulmonary Disease. Clin Drug Investig 2006; 26:495-500. [PMID: 17163282 DOI: 10.2165/00044011-200626090-00002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVES Topical beta-blockers are contraindicated in obstructive pulmonary diseases (OPDs). In this study we aimed to evaluate through central or local electronic medical records (EMRs) the prescription patterns for topical ocular beta-blockers for patients with glaucoma and OPD treated by ophthalmologists. METHODS The study was carried out at the Leumit Health Maintenance Organisation (HMO) in Israel. The physicians at the HMO all work with an EMR, either a central EMR incorporating data from primary-care physicians and consultants, or a local one. The study population included all HMO members who filled at least one prescription for antiglaucoma medications in 2004. The patients were divided into two groups: those with a previous diagnosis of OPD (ICD-9 codes 493) and those with no known diagnosis of OPD. RESULTS 7481 patients consumed topical antiglaucoma medications during the study period, and 14.5% had a diagnosis of OPD. 798 OPD patients were treated by ophthalmologists, and of the 61.8% who were treated with topical beta-blockers, only 38 received betaxolol. In comparison with glaucoma patients without OPD, OPD patients received fewer beta-blockers (p < 0.001), more selective beta-blockers (p < 0.0001) and less timolol (p < 0.001). Of the OPD patients treated by ophthalmologists with a central EMR, 59.5% received beta-blockers in comparison with 66.4% treated by ophthalmologists with a local EMR (p = 0.06). OPD patients treated by ophthalmologists with a central EMR received more non-beta-blockers in comparison with patients treated by ophthalmologists with a local EMR (p = 0.02). CONCLUSION Most patients with OPD and glaucoma continued to receive topical beta-blockers, mostly noncardioselective beta-blockers. A central EMR with a comprehensive and highly available medical history reduced the prescription of beta-blockers to OPD patients, but rates remained unacceptably high.
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Affiliation(s)
- Shlomo Vinker
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Abstract
Drug-induced airway disease is a significant problem and must be considered in the differential diagnosis. A history of drug intake with a temporal association should raise the physician's suspicion toward a drug-induced cause. Because most of the conditions are amenable to withdrawal of the offending agent, an early diagnosis is essential. Conditions like obliterative bronchiolitis, are usually irreversible, but timely stoppage of the provoking agent can prevent further progression of the disease. Most of the drug reactions are nonallergic and the physician and the patient should be aware of this fact. In view of the constantly-evolving therapies, an active policy to identify and report adverse effects is essential to develop management strategies and treatment recommendations.
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Affiliation(s)
- K Suresh Babu
- Mail Point 810, Level D, Centre Block, Southampton General Hospital, Southampton SO16 6YD, UK.
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18
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Brack A, Rittner HL, Schäfer M. [Non-opioid analgesics for perioperative pain therapy. Risks and rational basis for use]. Anaesthesist 2004; 53:263-80. [PMID: 15021958 DOI: 10.1007/s00101-003-0641-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Non-opioid analgesics play a central role in the management of postoperative pain. In this review, the pharmacology, the analgesic efficacy and the side-effects of non-opioid analgesics are summarized. First, the pharmacology of diclofenac, acetyl salicylic acid, dipyrone, acetaminophen and the COX-2 inhibitors is described. Second, the analgesic efficacy of non-opioid analgesics is analyzed for moderate pain (e.g. ambulatory surgery) and for moderate to severe pain (e.g. abdominal surgery-in combination with opioids). There is limited evidence for an additive analgesic effect of two non-opioid analgesics. Third, the major side-effects of non-opioid analgesics are discussed in relation to the pathophysiology, the frequency and the clinical relevance of these effects. In particular, side-effects on the gastrointestinal tract (ulcus formation), on coagulation (bleeding and thrombosis), on the renal (renal insufficiency), the pulmonary (bronchospasm) and the hematopoetic systems (agranulocytosis) are described. Recommendations for the clinical use of non-opioid analgesics for perioperative pain therapy are given.
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Affiliation(s)
- A Brack
- Klinik für Anaesthesiologie und operative Intensivmedizin, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin.
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Courtney P, Doherty M. Key questions concerning paracetamol and NSAIDs for osteoarthritis. Ann Rheum Dis 2002; 61:767-73. [PMID: 12176799 PMCID: PMC1754226 DOI: 10.1136/ard.61.9.767] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- P Courtney
- Academic Rheumatology, Clinical Sciences Building, City Hospital, Nottingham NG5 1PB, UK
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Current literature in. Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2002; 11:79-94. [PMID: 11998557 DOI: 10.1002/pds.657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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