ANALYSIS OF DRUG THERAPY FOR ACUTE CEREBRAL INFARCTION AT HUE CENTRAL HOSPITAL FROM AUGUST 2010 TO JUNE 2011

2011 ◽  
pp. 43-52
Author(s):  
Thi Ha Vo ◽  
Thi Kim Huyen Hoang ◽  
Khanh Hoang
Keyword(s):  
Drug Interaction ◽  
Drug Therapy ◽  
Cerebral Infarction ◽  
Acute Cerebral Infarction ◽  
Central Hospital ◽  
Neuroprotective Drugs ◽  
History Of ◽  
The Mean ◽  
Drug Drug Interaction ◽  
Ulcer Prophylaxis

Objectives: The cerebral infarction is a complex clinical emergency and the application of guidelines of treatment in each health establishment varies. The study was conducted with two main objectives: (1) Identify the profile of patients and (2) Analyze the drug therapy in patients with acute cerebral infarction. Materials and Methods: A prospective, descriptive study of 94 in patients with acute cerebral infarction treated at the Hue Central Hospital from 08/2010 to 06/2011 was conducted; Results: the mean age was 68.6 ± 15.5 years (range 16-101), 73.4% had hypertension at admission, the most commonly risk factors included pre-existing hypertensions (59.6%), cardiovascular diseases (28.7%) and a history of cerebral vascular accident or TIA (26.6%). Four groups of drugs used the most frequently were: neuroprotective drugs (95.8%), antibiotics (85.1%), vitamins - minerals (84.0%), drugs for peptic ulcer prophylaxis (74.5%). A total of three cases of ADR were reported. 86.2% of patients received potential drug-drug interaction pairs and the mean number of drug-drug interaction pairs per patient was 4.9 ± 2.4. Conclusions: The treatment of patients with cerebral infarction was complex, often has to combine many different classes of drugs, some have narrow therapeutic ranges, which were indicated in patients with multiple pathologies that increased the risk of drug-related problems. It is necessary to monitor closely the drug therapeutics.

Pseudo-Parkinson Disease Secondary to Ritonavir–Buspirone Interaction

2003 ◽  
Vol 37 (2) ◽  
pp. 202-205 ◽  
Author(s):  
Patrick G Clay ◽  
Molly M Adams
Keyword(s):  
Drug Interaction ◽  
Inhibitory Effect ◽  
Hiv Positive ◽  
High Dose ◽  
Resting Tremor ◽  
Case Summary ◽  
History Of ◽  
Drug Drug Interaction ◽  
To Receive

OBJECTIVE: To report a case of Parkinson-like symptoms appearing in a patient after introduction of ritonavir to buspirone therapy. CASE SUMMARY: A 54-year-old HIV-positive white man presented to the clinic with a 2-week history of ataxia, shuffling gait, cogwheel rigidity, resting tremor, and sad affect with masked features. This patient had been receiving high-dose buspirone (40 mg every morning and 30 mg every evening) for 2 years prior to the introduction of ritonavir/indinavir combination therapy (400 mg/400 mg twice daily) 6 weeks prior to initiation of the above symptoms. Buspirone was decreased to 15 mg 3 times daily, ritonavir/indinavir was discontinued, and amprenavir 1200 mg twice daily was added. The patient's symptoms began to subside after 1 week, with complete resolution after about 2 weeks. The patient continued to receive buspirone for an additional 12 months without recurrence of symptoms. DISCUSSION: This is the first reported interaction of buspirone and antiretrovirals. Buspirone, extensively metabolized by CYP3A4, was likely at supratherapeutic levels due to the inhibitory effect of ritonavir and, secondarily, indinavir. The Parkinson-like symptoms developed rapidly and severely, impacted this patient's quality of life, and necessitated significant clinic expenditures to identify this drug–drug interaction. CONCLUSIONS: This case demonstrates a severe drug–drug interaction between buspirone and ritonavir and further demonstrates the need for awareness of the metabolic profile for all agents an HIV-infected patient is receiving.

scholarly journals Headache as a Predictive Factor of Severe Systolic Hypertension in Acute Ischemic Stroke

2003 ◽  
Vol 30 (3) ◽  
pp. 210-214 ◽  
Author(s):  
Yoon-Ho Hong ◽  
Yong-Seok Lee ◽  
Seong-Ho Park
Keyword(s):  
Logistic Regression ◽  
Ischemic Stroke ◽  
Cerebral Infarction ◽  
Acute Ischemic Stroke ◽  
Acute Cerebral Infarction ◽  
Stroke Severity ◽  
Plasma Catecholamine ◽  
Catecholamine Level ◽  
Stroke Subtypes ◽  
The Mean

ABSTRACT:Background:Elevation of blood pressure (BP) is common in acute cerebral infarction, with several studies reporting a high plasma catecholamine level or previous hypertension as a contributory factor. However, more comprehensive studies on associated clinical parameters are lacking. Our main aim in undertaking this study was to correlate clinical variables associated with a BPelevation in acute ischemic stroke.Methods:Consecutive patients who were admitted to the emergency room and diagnosed with an acute cerebral infarction within 24 hours after the onset of symptoms were investigated. A BP elevation was defined as a high systolic (³200mmHg) or diastolic (³110 mmHg) pressure. The mean systolic and diastolic BP were compared between the different stroke subtypes, lesion locations (carotid vs. vertebrobasilar), and hemispheric sides. The frequency of symptoms, risk factors, location of the infarct, stroke severity, vascular status and laboratory abnormalities were analyzed in order to build a regression model.Results:One hundred thirty-one patients were recruited (M:F=60:71, mean age 66±12 years) and an elevated BP was identified in 33 patients (25.2%). The mean systolic and diastolic BP did not differ significantly between the stroke subtypes, lesion locations, and hemispheric sides. According to univariate logistic regression, an elevated systolic BP correlated with headache (p=0.01) and underlying hypertension (p=0.02) while an elevated diastolic BP correlated with underlying hypertension (p=0.01). Multivariate logistic regression analysis revealed previous hypertension (OR 5.21, 95% CI 1.40-19.37) and headache (OR 4.09, 95% CI 1.44-11.66) to be independent predictors of an elevated systolic BP.Conclusions:Headache itself is closely associated with severe systolic BP elevation in acute ischemic stroke. Whether treatment of elevated BP improves headache and clinical outcome is not yet known, necessitating future controlled studies.

Carbohydrate metabolism in patients with Cushing disease: a glance at the incretin system

2016 ◽  
Vol 62 (5) ◽  
pp. 67-68
Author(s):  
Lubov V. Matchekhina ◽  
Ekaterina A. Shestakova ◽  
Zhanna E. Belaya ◽  
Marina V. Shestakova
Keyword(s):  
Drug Therapy ◽  
Carbohydrate Metabolism ◽  
Previous History ◽  
Pituitary Surgery ◽  
Underlying Disease ◽  
Control Group ◽  
Cushing Disease ◽  
Free Cortisol ◽  
History Of ◽  
The Mean

Introduction. The relevance of carbohydrate metabolism studying in patients with Cushing disease can be explained by frequent occurrence of glucose metabolism disturbances on the one hand, and difficulties in glucose-lowering therapy in these patients on the other. The effectiveness of hyperglycaemia treatment may be reduced due to difficulties in remission / cure of the underlying disease, as well as to the use of specific drug-therapy, leading to the hyperglycaemia. There is a growing interest in research aimed at studying the role of incretin system in the pathogenesis of secondary hyperglycemia associated with neuroendocrine diseases recently.Methods. A total of 20 patients with Cushing disease were included, (19 female and 1 male), the mean age was 37.5 years (18-69). All of the patients were diagnosed with Cushing disease for the first time (using urinary free cortisol levels and MRI-data); none of them had a history of previous drug therapy, radiotherapy or pituitary surgery. The mean HbA1c level was 5,8% (5,3-6,2). All patients underwent OGTT, during which glucose, glucagon, GLP1, GLP2, GIP, ghrelin were measured at 0, 30 and 120 min respectively. The control group included 21 patients without previous history of carbohydrate metabolism disturbances. After OGTT 57% were presented without any carbohydrate metabolism disturbances, 28,57% presented with prediabetes and 14,43% were diagnosed with diabetes.Results. After glucose levels analyzing 40% of patients were diagnosed with early carbohydrate metabolism disturbances ,15% were diagnosed with diabetes. After glucose intake a slight inrease in glucagon levels with a peak by 30’ (p=0,001) compared to gradually decreasing levels in controls was observed . The levels of GIP during OGTT were not significantly different compared to control group. GLP-1 and GLP-2 levels were significantly higher compared to controls (p=0,017 and p<0,001 respectively) with peak levels at 30’. Ghrelin levels were also significantly higher compared to controls (p=0,013)Conclusion. Incretins levels can be possible markers of specific carbohydrate metabolism disturbances in patients with Cushing disease and presumably will help to differentiate steroid diabetes from T2DM. Further investigations needed to prove these speculations.

scholarly journals Toxicological Findings in a Possible Drug-drug Interaction Death: A Case Report

2021 ◽  
Vol 3 (1) ◽  
pp. 128-133
Author(s):  
Mohammed Y. Albeishy ◽  
Magbool E. Oraiby ◽  
Ahmad M. Alamir ◽  
Ibrahim A. Khardali ◽  
Farid M. Abualsail ◽  
...  
Keyword(s):  
Drug Interaction ◽  
Case Report ◽  
Solid Phase ◽  
Synergistic Effects ◽  
Post Mortem ◽  
Migraine Headaches ◽  
History Of ◽  
Drug Drug Interaction ◽  
Serotonergic Drugs ◽  
Identification And Quantification

Synergistic effects are the most encountered types of drug-drug interaction in post-mortem toxicology. Concomitant use of fentanyl, tramadol and carbamazepine may increase the risk of severe serotonin toxicity. The decedent was a 32-year-old black man, with a history of severe migraine headaches. He died after being administered several drugs to treat the migraine. For fentanyl identification and quantification, samples were extracted using solid phase extraction and analyzed by GC-MS. For carbamazepine and tramadol identification and quantification, samples were extracted by liquid-liquid extraction and analyzed by LC-QTOF. Toxicology showed post-mortem concentrations of fentanyl 0.033, 0.025, 0.005, 0.0127, and 0.005 mg/L; tramadol 0.143, 0.093, 0.043, 0.09, and 0.08 mg/L; carbamazepine 1.6, 1.04, 0.3, 0.83, and 0.18 mg/L in the blood, brain, liver, kidney and stomach, respectively. In this case report, the combination of serotonergic drugs can contribute to synergistic serotonergic effects. Therefore, drug-drug interaction is expected, and the cause of death may be attributed to toxic synergistic drug-drug interaction including fentanyl, tramadol and carbamazepine.

Familial Hypercholesterolemia and Cerebral Infarction - A Case Report

2021 ◽  
Author(s):  
Huajun Jiang ◽  
Qu Wei ◽  
Liang Zhanhua ◽  
Yang Jingjing
Keyword(s):  
Family History ◽  
Carotid Artery ◽  
Cerebral Infarction ◽  
Carotid Stenosis ◽  
Familial Hypercholesterolemia ◽  
Acute Cerebral Infarction ◽  
Ldlr Gene ◽  
History Of ◽  
The Right ◽  
Arterial Plaques

Abstract Background: Familial hypercholesterolemia has various presentations mostly including early-onset cardiovascular diseases, remarkable skin and tendon xanthomas. By comparison, Cerebral Infarction due to familial hypercholesterolemia is extremely rare. Case presentation: We present a 41-year-old man who was admitted to our hospital with dizziness, vertigo, slurred speech, weakness in his left limbs. He had family history of Hyperlipidemia in older sister . Head CT scan demonstrated multiple acute cerebral infarction in the right frontal and parietal lobes, and arterial plaques was found in the bifurcation of common carotid artery. The severe carotid stenosis was located in the initial segment of the right internal carotid artery. Histopathologic findings were consistent with xanthoma. Especially, molecular analysis of the LDLR gene was made, which identified heterozygous missense mutation in exon 12 of the LDLR gene. The final diagnosis of cerebral infarction associated with familial hypercholesterolemia was made. The patient was referred to a nutritionist for dietary advice, and was treated with Tab. Finally, the patient recovered well. The symptoms of brain infarct vanished and no recurrence occurred during follow-up.Conclusions: In the present case, the acute cerebral infarction is most likely due to hypercholesterolemia, as his family history of hypercholesterolemia, and arterial plaques and severe carotid stenosis was found by CTA. This case highlights the importance of the early diagnosis and treatment of hypercholesterolemia, which may help in preventing the development of cardiovascular and cerebrovascular diseases.

scholarly journals A STUDY ON DRUG-DRUG INTERACTION BETWEEN GLIPIZIDE AND CIMETIDINE IN RABBITS

2021 ◽  
pp. 17-18
Author(s):  
RANJEETA GHOLVE ◽  
DHANESHWAR SHEP ◽  
PRAKASHCHANDRA GADE ◽  
MANISH RAMAVAT
Keyword(s):  
Drug Interaction ◽  
Drug Therapy ◽  
Receptor Antagonist ◽  
Blood Sugar ◽  
Blood Sugar Level ◽  
H2 Receptor Antagonist ◽  
Single Drug ◽  
Single Drug Therapy ◽  
The Mean ◽  
Sugar Levels

Objective: To study the effect of Cimetidine (H2 receptor antagonist) in combination with Glipizide (Sulfonylurea) on the blood sugar level in rabbits. Methods: Six albino rabbits were taken for the study. Glipizide was administrated to each rabbit as a single drug therapy on day 1 and it was co-administrated with Cimetidine to each rabbit as a combinational drug therapy on day 7. Cimetidine was administrated to each rabbit from day 2 to day 6 as single drug therapy. Blood sugar levels were estimated on day 1 and on day 7 at 0, 1, 2, 4, and 6 h. Results: The mean blood sugar level readings at 0, 1, 2, 4 and 6 h on day 1 were 90.4, 69.4, 62.9 and 65.7 mg% and on day 7 were 89.4, 74.8, 65.5, 56.4 and 61.2 mg % respectively. When mean blood sugar level on day 1 and day 7 was considered, there was a significant reduction in blood sugar level at 1, 2, 4 and 6 h and there was no significant fall in blood sugar level at 0 hour after co-administration of Glipizide and Cimetidine. Conclusion: Cimetidine, when co-administered with Glipizide, significantly increases the hypoglycaemic action of Glipizide.

scholarly journals Aortic Valve Papillary Fibroelastoma Associated with Acute Cerebral Infarction: A Case Report

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Nobuhiro Takeuchi ◽  
Masanori Takada ◽  
Koichi Fujita ◽  
Yoshiharu Nishibori ◽  
Takao Maruyama ◽  
...  
Keyword(s):  
Cerebral Infarction ◽  
Cardiac Tumor ◽  
Drug Regimen ◽  
Acute Cerebral Infarction ◽  
Papillary Fibroelastoma ◽  
Pathological Examination ◽  
Thromboembolic Events ◽  
Resected Tumor ◽  
History Of ◽  
Warfarin Potassium

An 80-year-old woman with a history of congestive heart failure, atrial fibrillation, and hypertension was transferred to our institution with hematemesis. Her drug regimen included 2 mg warfarin potassium/day to prevent thromboembolic events. Transthoracic echocardiography (TTE) performed at 78 years of age revealed a mass attached to the noncoronary cusp and a cardiac tumor was suspected. The patient declined surgery and was meticulously followed up with periodic TTE. Upper gastroendoscopy revealed a gastric ulcer with an exposed blood vessel; anticoagulant therapy was ceased. On day 15 of admission, acute cerebral infarction occurred. Heparin sodium and warfarin potassium were administered rapidly, and her symptoms improved. TTE revealed no alteration of the mobile, string-like mass attached to the noncoronary cusp. Cardiac tumor was considered the cause of cerebral infarction, and the patient consented to surgical therapy. Pathological examination of the resected tumor suggested papillary fibroelastoma (PFE). Although no guidelines exist for PFE management, a mobile, cardiac tumor necessitates surgical resection to prevent thromboembolic events, even when small in size.

scholarly journals A Study on Design, Development, Implementation, and Evaluation of Severe Drug-Drug Interaction Alert System in ICU

2021 ◽  
Author(s):  
mehrdad Karajizadeh ◽  
Farid Zand ◽  
Roxana Sharifian ◽  
Afsaneh Vazin ◽  
Najmeh Bayati
Keyword(s):  
Drug Interaction ◽  
Cross Sectional Study ◽  
Teaching Hospitals ◽  
Design Development ◽  
Alert System ◽  
Cross Sectional ◽  
Computerized Provider Order Entry ◽  
System Usability Scale ◽  
The Mean ◽  
Drug Drug Interaction

Abstract Background and objective: The overridden rate of Drug-Drug Interaction Alerts (DDIAs) in the Intensive Care Unit (ICU) is very high. Therefore, this study aimed to design, develop, implement, and evaluate a severe Drug-Drug Alert System (DDIAS) in ICU and measure the override rate of DDIAs. Methods This is a cross-sectional study for the design, development, implementation, and evaluation of severe DDIAs into a Computerized Provider Order Entry(CPOE) system in the ICUs of Nemazee general teaching hospitals in 2021. The patients exposed to the volume of DDIAs, acceptance and overridden of DDIAs, and usability of DDIAS have been collected. Results The knowledge base of DDIAS contains 9,809 severe DDIs. A total of 2672 medications were prescribed in the population study. The volume and acceptance rate for severe DDIAs were 81 and 97.5%, respectively. However, the override rate was 2.5%. The mean System Usability Scale (SUS) score of the DDIAS was 75. Conclusion This study demonstrated that the implementation of high-risk DDIAs at point of prescribing in ICU improved adherence to alerts. In addition, the usability of DDIAS was reasonable. Further studies are need to investigate the establishment of severe DDIAS and measure the physician's response to DDIAS on a larger scale.

scholarly journals Direct antiviral agents for hepatitis C and drug interaction risk: A retrospective cohort study with real and simulated data on medication interaction, prevalence of comorbidities and comedications

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0245767
Author(s):  
Raquel Boff da Costa ◽  
Marisa Boff Costa ◽  
Larisse Longo ◽  
Daniela Elisa Miotto ◽  
Gustavo Hirata Dellavia ◽  
...  
Keyword(s):  
Drug Interaction ◽  
Hepatitis C ◽  
Drug Interactions ◽  
Retrospective Cohort ◽  
Significant Risk ◽  
Simulated Data ◽  
Direct Acting Antivirals ◽  
The Mean ◽  
Drug Drug Interaction ◽  
Direct Acting

Introduction and aim Comorbidities and comedication are common in patients with hepatitis C, which could result in a risk of drug-drug interaction. The objective of this study was to evaluate the prevalence of comorbidities, comedication and drug-drug interactions involving direct-acting antivirals in this population. Methods Comorbidities and comedications were evaluated in a retrospective cohort of hepatitis C patients. Drug-drug interactions were estimated in real life and with simulated data on comedications following drug regimens: telaprevir; elbasvir/grazoprevir, ombitasvir/paritaprevir/r/ritonavir (2D regimen), and sofosbuvir/simeprevir, sofosbuvir/daclatasvir, sofosbuvir/ledipasvir; 2D/dasabuvir (3D regimen); glecaprevir/pibrentasvir and sofosbuvir/velpatasvir/voxilaprevir. The interactions were evaluated according to the University of Liverpool database. Statistical analysis was performed by SPSS® 18.0. Results Data from 1433 patients with hepatitis C were evaluated. The mean patient age was 51.7 years (SD ± 10.7), and 50.6% were female. Direct-acting antivirals were prescribed for 345 (24.1%) patients, and a sustained virological response occurred in 264 (76.5%). The main comorbidities were systemic arterial hypertension [436 (30.4%)], diabetes mellitus [352 (24.6%)] and depression [130 (9.1%)]. The mean number of comorbidities was 1.52 (median [IQR] of 1.00 [1.00–2.00]). The mean number of comedications was 3.16 (median [IQR] of 3.00 [1.00–5.00]). A total of 12916 drug-drug interactions were found, of which 1.859 (14.4%) were high risk, with a mean of 1.29 ± 3.13 per patient. The 3D regimen, as well as glecaprevir/pibrentasvir and sofosbuvir/velpatasvir/voxilaprevir, presented the highest drug-drug interaction indexes. Conclusion Comorbidities and comedications are common in patients with hepatitis C, as are drug-drug interactions. Even when second generation drugs are used, the occurrence of drug-drug interactions still presents a significant risk.

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