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1.
East Asian Arch Psychiatry ; 31(4): 87-96, 2021 Dec.
Article in English | MEDLINE | ID: mdl-34987119

ABSTRACT

OBJECTIVES: To investigate the association between alcohol use and depression among university students in Hong Kong, their stress-coping methods, and their knowledge and perception of the effects of alcohol on health. METHODS: 345 full-time undergraduate students from The University of Hong Kong were invited to complete a questionnaire to assess their alcohol consumption (Alcohol Use Disorders Identification Test, CAGE questionnaire), depressive symptoms (Patient Health Questionnaire-9), and stress-coping methods (Coping Orientation to Problems Experienced Inventory), as well as knowledge and perception of alcohol consumption on health. Multiple linear regression was used to determine significant variables associated with depressive symptoms. Multinominal logistic regression was used to determine the effect of such variables on depressive symptom caseness and AUDIT drinking risk groups. RESULTS: 43.2% of respondents were moderate- to high-risk drinkers, but only 23.2% were self-reported as moderate- to high-level drinkers. 57.9% of respondents had mild to severe depressive symptoms. Probable depression was more likely to occur in female students, those with higher general stress, those who do not use social support for stress-coping, and those who smoke. High-risk drinkers were more likely to occur in older students, smokers, those with higher household income, and those with higher general stress levels. Students with higher levels of depressive symptoms and higher risk of alcohol consumption were more likely to use avoidance for stress-coping. 89.5% of students considered alcohol consumption moderately to very harmful to health, but students demonstrated only moderate knowledge levels of alcohol consumption on health. CONCLUSION: Alcohol consumption and depressive symptoms are prevalent among university students in Hong Kong. The use of avoidance for stress-coping is common in those with higher levels of depressive symptoms and higher-risk drinkers. Students tend to avoid seeking help for depressive symptoms and potentially take up drinking as a coping strategy. Context-specific approaches should be used when providing counselling services for student wellbeing in university settings. Further education of university students on knowledge and perception of alcohol consumption on health should be provided.


Subject(s)
Alcoholism , Universities , Adaptation, Psychological , Aged , Alcohol Drinking/epidemiology , Alcoholism/epidemiology , Depression/epidemiology , Female , Humans , Perception , Students , Surveys and Questionnaires
2.
Life Sci ; 75(7): 797-808, 2004 Jul 02.
Article in English | MEDLINE | ID: mdl-15183073

ABSTRACT

Coriolus versicolor (CV), also known as Yunzhi, is one of the commonly used Chinese medicinal herbs. Although recent studies have demonstrated its antitumour activities on cancer cells in vitro and in vivo, the exact mechanism is not fully elucidated. Hence, the objective of this study was to examine the in vitro cytotoxic activities of a standardized aqueous ethanol extract prepared from Coriolus versicolor on a B-cell lymphoma (Raji) and two human promyelocytic leukemia (HL-60, NB-4) cell lines using a MTT cytotoxicity assay, and to test whether the mechanism involves induction of apoptosis. Cell death ELISA was employed to quantify the nucleosome production resulting from nuclear DNA fragmentation during apoptosis. The present results demonstrated that CV extract at 50 to 800 microg/ml dose-dependently suppressed the proliferation of Raji, NB-4, and HL-60 cells by more than 90% (p < 0.01), with ascending order of IC50 values: HL-60 (147.3 +/- 15.2 microg/ml), Raji (253.8 +/- 60.7 microg/ml) and NB-4 (269.3 +/- 12.4 microg/ml). The extract however did not exert any significant cytotoxic effect on normal liver cell line WRL (IC50 > 800 microg/ml) when compared with a chemotherapeutic anticancer drug, mitomycin C (MMC), confirming the tumour-selective cytotoxicity. Nucleosome productions in HL-60, NB-4 and Raji cells were significantly increased by 3.6-, 3.6- and 5.6-fold respectively upon the treatment of CV extract, while no significant nucleosome production was detected in extract-treated WRL cells. The CV extract was found to selectively and dose-dependently inhibit the proliferation of lymphoma and leukemic cells possibly via an apoptosis-dependent pathway.


Subject(s)
Antineoplastic Agents/pharmacology , Apoptosis/drug effects , Drugs, Chinese Herbal/pharmacology , Leukemia, Promyelocytic, Acute/drug therapy , Lymphoma, B-Cell/drug therapy , Plants, Medicinal/chemistry , Cell Division/drug effects , Cell Line, Tumor , Cell Survival/drug effects , DNA Fragmentation , Dose-Response Relationship, Drug , Drug Screening Assays, Antitumor , Formazans/metabolism , Humans , Leukemia, Promyelocytic, Acute/metabolism , Leukemia, Promyelocytic, Acute/pathology , Liver/drug effects , Liver/pathology , Lymphoma, B-Cell/metabolism , Lymphoma, B-Cell/pathology , Medicine, Chinese Traditional , Mitomycin/pharmacology , Nucleosomes/drug effects , Tetrazolium Salts/metabolism
3.
Pharmazie ; 59(4): 282-5, 2004 Apr.
Article in English | MEDLINE | ID: mdl-15125573

ABSTRACT

The Potts and Guy's model for skin permeability, log P = alpha log K - beta MV + delta where P is the permeability coefficient of a compound from aqueous solution through human skin in vitro, K and MV are octanol-water partition coefficient and molecular volume of the compound respectively, and alpha, beta, delta are constants, is examined for a data set of 53 miscellaneous compounds. The model will result in over-estimation for penetrants having higher hydrogen-bond donor activity and underestimation for penetrants having no hydrogen-bond donor. A predictive algorithm for skin permeability including the effects of hydrogen-bond on diffusivity is proposed: log P = alpha log K - beta MV - gamma Hb + delta where Hb is the descriptor of hydrogen-bonding capacity of penetrants and gamma is a constant. The calculated log P values from the latter model are in good accordance with respective experimental ones for the data set.


Subject(s)
Algorithms , Skin Absorption , Chemical Phenomena , Chemistry, Physical , Diffusion , Humans , Hydrogen Bonding , Models, Biological , Octanols/chemistry , Permeability , Predictive Value of Tests , Solubility , Water/chemistry
4.
J Control Release ; 95(2): 209-16, 2004 Mar 05.
Article in English | MEDLINE | ID: mdl-14980769

ABSTRACT

A working equation to predict drug release from hydroxypropyl methylcellulose (HPMC) matrices was derived using a training set of HPMC matrices having different HPMC concentration (w/w, 16.5-55%) and different drugs (solubilities of 1.126-125.5 g/100 ml in water and molecular volumes of 0.1569-0.4996 nm(3)). The equation was log(M(t)/M( infinity ))=-0.6747+1.027 log t -0.1759 (log C(s)) log t +0.4027 (log V) log t -1.041C(H) +0.3213 (log C(s)) C(H) -0.4101 (log V) C(H) -0.3521 (log V) log C(s) (n=263, r=0.9831), where M(t) is the amount of drug released at time t, M( infinity ) the amount of drug released over a very long time, which corresponds in principle to the initial loading, t the release time (h), C(s) the drug solubility in water (g/100 ml), V the volume of drug molecule (nm(3)), and C(H) is HPMC concentration (w/w). The benefit of the novel model is to predict M(t)/M( infinity ) values of a drug from formulation and its physicochemical properties, so applicable to the HPMC matrices of different polymer levels and different drugs including soluble drugs and slightly soluble drugs.


Subject(s)
Lactose/analogs & derivatives , Lactose/chemistry , Methylcellulose/analogs & derivatives , Methylcellulose/chemistry , Algorithms , Chemical Phenomena , Chemistry, Physical , Delayed-Action Preparations , Drug Compounding , Excipients/chemistry , Oxazines , Pharmaceutical Preparations/administration & dosage , Polymers , Regression Analysis , Solubility , Tablets
5.
Pharmacotherapy ; 21(10): 1187-91, 2001 Oct.
Article in English | MEDLINE | ID: mdl-11601664

ABSTRACT

STUDY OBJECTIVE: To evaluate the effect of cardiac arrest and cardiopulmonary resuscitation (CPR) on blood chemistry in a canine model. DESIGN: Evaluative canine animal study. SETTING: Animal laboratory accredited by the Association for Assessment and Accreditation of Laboratory Animals. SUBJECTS: Twenty-six adult mongrel dogs. INTERVENTION: The dogs underwent an episode of induced fibrillatory cardiac arrest for 3 minutes followed by 10 minutes of standard CPR. Blood samples were taken at baseline (before cardiac arrest), after 10 minutes of ventricular fibrillation, and 10 minutes after successful resuscitation for determination of blood chemistries and hematologic parameters. MEASUREMENTS AND MAIN RESULTS: Glucose, blood urea nitrogen, serum creatinine, sodium, potassium, chloride, calcium, phosphorus, uric acid, alkaline phosphatase, lactate dehydrogenase, aspartate aminotransferase, alanine aminotransferase, protein, albumin, cholesterol, triglycerides, iron, white blood cell count, red blood cell count, and hematocrit were measured. Significant changes (p<0.05) in values obtained during CPR versus baseline values were noted for all laboratory parameters except blood urea nitrogen, chloride, and alkaline phosphatase. Eighteen dogs achieved return of spontaneous circulation (ROSC); their laboratory values were obtained after CPR. Significant changes (p<0.05) after ROSC compared with baseline were noted for all laboratory values except chloride, blood urea nitrogen, uric acid, alkaline phosphatase, glucose, potassium, calcium, triglycerides, iron, red blood cell count, and hematocrit. CONCLUSION: Results indicate that significant changes in blood chemistries and hematologic parameters occur during and after CPR. Clinicians should note these normal laboratory parameter changes when interpreting laboratory data in patients who experience cardiac arrest.


Subject(s)
Heart Arrest/blood , Heart Arrest/metabolism , Animals , Blood Chemical Analysis , Blood Pressure/physiology , Cardiopulmonary Resuscitation , Dogs , Electrocardiography , Pilot Projects
6.
Int J Pharm ; 222(2): 305-8, 2001 Jul 17.
Article in English | MEDLINE | ID: mdl-11427360

ABSTRACT

The pharmacokinetics of acetaminophen have been well studied in different populations, especially in Caucasians. However, limited studies on acetaminophen pharmacokinetics have been conducted in the native Chinese and few such data have been reported in the English language literature. Previous published studies suggested that environmental and genetic factors may cause inter-individual difference in acetaminophen disposition, thus we investigated the pharmacokinetics of acetaminophen in Hong Kong Chinese subjects. A single 500 mg oral dose of acetaminophen was administered to 12 healthy male Chinese subjects under fasting conditions. Multiple blood samples were obtained after drug administration. Plasma acetaminophen concentrations were determined using HPLC, and its main pharmacokinetic parameters were generated. In comparison to other published data, acetaminophen half-life was considerably longer (15-62%), and oral clearance was lower (16-56%) in Hong Kong Chinese as compared to Australian Chinese, Caucasians (USA, UK, Australia), and subjects from Pakistan, Denmark, Spain and South Africa. Similarities however were found in the pharmacokinetic parameters between Hong Kong Chinese and Mainland Chinese subjects. The observed pharmacokinetic parameters of acetaminophen in Hong Kong Chinese subjects may be different from other ethnic populations. Further studies are needed to verify this hypothesis.


Subject(s)
Acetaminophen/pharmacokinetics , Analgesics, Non-Narcotic/pharmacokinetics , Acetaminophen/blood , Administration, Oral , Adult , Analgesics, Non-Narcotic/blood , Area Under Curve , Chromatography, High Pressure Liquid , Half-Life , Hong Kong , Humans , Male , Metabolic Clearance Rate , Racial Groups
7.
Ann Noninvasive Electrocardiol ; 6(2): 129-33, 2001 Apr.
Article in English | MEDLINE | ID: mdl-11333170

ABSTRACT

OBJECTIVES: To determine if gender, age, and gender per age category, have an impact on QT and QTc dispersion in healthy volunteers. METHODS: This study was undertaken in 150 patients (50 per age group, 75 males, 75 females). The age groups included young (20-40 years), middle-aged (41-69 years) and elderly (> 70 years) subjects. The QT intervals on a 12 lead ECG were determined and Bazett's formula was used to derive the QTc intervals. The QT and QTc dispersion were determined by subtracting the shortest QTc interval from the longest on each 12-lead recording. RESULTS: Males had higher QT dispersion than females (50 +/- 22 vs 42 +/- 18 ms, P = 0.017) but QTc dispersion was not significantly changed. No significant differences were seen among the different age categories for QT or QTc dispersion. In elderly subjects, males had higher QT and QTc dispersion than females (54 +/- 23 vs 42 +/-15 ms, P = 0.039 and 63 +/- 23.7 vs 48 +/- 21 ms, P = 0.032, respectively). CONCLUSIONS: When evaluating the effect of gender in different age categories, elderly males have significantly greater QT and QTc dispersion than elderly female subjects. No other gender differences were noted for QT or QTc dispersion in the other two age categories. When evaluating a population of healthy volunteers, regardless of age, gender has an impact on QT dispersion but no significant interaction with QTc dispersion. Evaluating age without dividing the data by gender yields no significant differences in QT or QTc dispersion.


Subject(s)
Aging/physiology , Electrocardiography/methods , Heart Conduction System/physiology , Heart Rate/physiology , Sex Characteristics , Adult , Age Factors , Aged , Death, Sudden, Cardiac/epidemiology , Death, Sudden, Cardiac/etiology , Female , Humans , Long QT Syndrome/epidemiology , Long QT Syndrome/etiology , Male , Middle Aged , Reference Values , Sex Distribution , Single-Blind Method , Torsades de Pointes/epidemiology , Torsades de Pointes/etiology , Ventricular Fibrillation/epidemiology , Ventricular Fibrillation/etiology
8.
J Pharmacol Exp Ther ; 297(1): 224-9, 2001 Apr.
Article in English | MEDLINE | ID: mdl-11259548

ABSTRACT

The purpose of the study was to test the hypothesis that diaspirin cross-linked hemoglobin (DCLHb) can produce improved resuscitation during cardiac arrest. DCLHb, a derivative of human hemoglobin, has previously been demonstrated to produce a vasopressor response that is associated with increased blood flow to vital organs. In addition, it is an oxygen carrier. These effects may be beneficial to extreme low flow states, such as that during cardiac arrest and cardiopulmonary resuscitation (CPR). Experimental cardiac arrest and CPR were carried out in 32 anesthetized immature pigs. In each animal, ventricular fibrillation was induced for 5 min, followed by 10 min of standard CPR with a pneumatic device and room air ventilation. High (15 ml/kg) and low (5 ml/kg) doses of DCLHb or equivalent volume of normal saline were infused at the beginning of CPR in a random and blind manner. Cardiac output, organ blood flow, aortic pressure, coronary perfusion pressure, blood gases, and lactate concentrations were obtained before and during CPR. Following the 10-min CPR, the animals were defibrillated and the return of spontaneous circulation (ROSC) determined. DCLHb treatment achieved 75% ROSC compared with 25% in the saline group (p < 0.05). In addition, a better (p < 0.05) myocardial O(2) delivery, venous blood O(2) content, and myocardial and cerebral perfusion pressure were observed in the DCLHb group. DCLHb treatment during cardiac arrest and CPR significantly improves ROSC. This is most likely related to its improvement in coronary perfusion and myocardial oxygen delivery.


Subject(s)
Aspirin/analogs & derivatives , Aspirin/pharmacology , Blood Substitutes/pharmacology , Cardiopulmonary Resuscitation , Hemoglobins/pharmacology , Animals , Blood Pressure , Female , Male , Oxygen/blood , Swine
9.
J Electrocardiol ; 34(1): 25-30, 2001 Jan.
Article in English | MEDLINE | ID: mdl-11239367

ABSTRACT

This article evaluates the antifibrillatory effects of carvedilol 5 mg/kg and vehicle (dimethyl-formamide) over time. Sprague-Dawley rats were anesthetized and intubated. They underwent baseline ventricular fibrillation threshold (VFT) determination and then received 1 of the 2 treatments (n = 10/group) over 8 minutes. VFT and determinations were performed at 2, 7, 15, 30, 45, and 60 minutes postinfusion. Carvedilol significantly increased the VFT at 2, 7, 15, 30 minutes versus baseline and the vehicle control group. Carvedilol significantly reduced the heart rate and the mean arterial pressure at every evaluable time point versus baseline and vehicle control. Carvedilol showed significant antifibrillatory effects versus baseline and vehicle for the first 30 minutes but not thereafter, even though the heart rate and mean arterial pressure remain significantly reduced.


Subject(s)
Adrenergic beta-Antagonists/therapeutic use , Carbazoles/therapeutic use , Propanolamines/therapeutic use , Ventricular Fibrillation/drug therapy , Ventricular Fibrillation/physiopathology , Ventricular Function/drug effects , Ventricular Function/physiology , Animals , Blood Pressure/drug effects , Carvedilol , Heart Rate/drug effects , Rats , Rats, Sprague-Dawley
10.
J Clin Pharmacol ; 41(1): 92-6, 2001 Jan.
Article in English | MEDLINE | ID: mdl-11144999

ABSTRACT

The objective of this study was to determine the percentage of patients with paroxysmal atrial fibrillation who were poor metabolizers of CYP2D6 in a Chinese population from Hong Kong and to assess the relationship between the dextromethorphan/dextrorphan ratio and the propafenone/5-hydroxypropafenone ratio or the steady-state propafenone concentration. Patients (n = 60) were recruited from the Arrhythmia Clinic at the University of Hong Kong and given dextromethorphan 30 mg. The dextromethorphan and dextrorphan concentrations in urine over the next 8 hours were used to determine metabolizer status. If the metabolic ratio was greater than 0.3, the patient was determined to be a poor metabolizer. In phase 2, patients (n = 38) were given propafenone 150 mg twice daily, and at steady state, the propafenone and 5-OH propafenone plasma concentrations were determined. It was found that 15% of the patients were poor metabolizers of dextromethorphan. There was a significant correlation between the metabolic ratios of dextromethorphan/dextrorphan and propafenone/5-OH propafenone (r = 0.49, p = 0.0019) and between the dextromethorphan/dextrorphan ratio and the concentration of propafenone (r = 0.32, p = 0.05). No correlations were found in the extensive or poor metabolizer subgroups. It was concluded that the percentage of poor metabolizers in atrial fibrillation patients from Hong Kong was much larger than in previous studies of Chinese patients who were not from Hong Kong. The ability to metabolize dextromethorphan to dextrorphan is related to the ability to metabolize propafenone to 5-hydroxypropafenone.


Subject(s)
Anti-Arrhythmia Agents/blood , Atrial Fibrillation/enzymology , Cytochrome P-450 CYP2D6/metabolism , Dextromethorphan/urine , Excitatory Amino Acid Antagonists/urine , Propafenone/analogs & derivatives , Propafenone/blood , Atrial Fibrillation/blood , Atrial Fibrillation/urine , China/ethnology , Dextrorphan/urine , Female , Hong Kong , Humans , Male , Middle Aged , Oxidation-Reduction
11.
Am J Cardiol ; 86(12): 1327-32, 2000 Dec 15.
Article in English | MEDLINE | ID: mdl-11113407

ABSTRACT

The frequent recurrence of paroxysmal atrial fibrillation (PAF) despite the use of standard antiarrhythmic agents prompted the use of new therapeutic approaches. There are few data on systematic assessment of PAF control with stepwise dose escalation and the use of a drug combination. Low-dose quinidine may promote the efficacy of propafenone by inhibiting its degradation through the cytochrome P450 pathway (CYP2D6). We prescribed propafenone 300 to 450 mg/day to 60 patients with PAF for 8 weeks, and 62% were symptomatically controlled. The 19 refractory patients were randomized in a double-blinded fashion to receive either a higher dose of propafenone (450 to 675 mg/day) or the standard dose of propafenone with low-dose quinidine 150 mg/day, each for an 8-week study period, and subsequently crossed over to the alternative treatment. The resulting serum propafenone concentrations were 259 +/- 208 and 336 +/- 237 mg/day (p >0.5), respectively. Both treatment arms prolonged the time to the first symptomatic atrial fibrillation (AF) recurrence and the interval between attacks, and AF was controlled in 37% of patients. However, the higher dose of propafenone was associated with gastrointestinal side effects not present with the low-dose quinidine combination. Of the 10 refractory patients, 7 were further controlled with a standard dose of propafenone plus quinidine (600 mg/day). Overall, control of PAF was achieved in 85% of patients at the end of 8 months; adverse effects necessitating withdrawal were observed in 6%, and uncontrolled AF in 5% of patients. There was no difference in the mean AF rate during recurrences in all phases, and ventricular proarrhythmia was not seen. This study documents the role of stepwise antiarrhythmic treatment of PAF. The use of a standard dose of propafenone, followed by low-dose quinidine combination to reduce propafenone degradation, and the combined standard dose of propafenone and quinidine may be used to maximize efficacy and tolerability.


Subject(s)
Anti-Arrhythmia Agents/therapeutic use , Atrial Fibrillation/prevention & control , Propafenone/therapeutic use , Quinidine/therapeutic use , Adolescent , Adult , Aged , Analysis of Variance , Anti-Arrhythmia Agents/administration & dosage , Anti-Arrhythmia Agents/adverse effects , Anti-Arrhythmia Agents/blood , Cross-Over Studies , Dose-Response Relationship, Drug , Double-Blind Method , Drug Combinations , Female , Humans , Male , Middle Aged , Propafenone/administration & dosage , Propafenone/adverse effects , Propafenone/blood , Prospective Studies , Quinidine/administration & dosage , Quinidine/adverse effects , Quinidine/blood , Recurrence , Safety , Treatment Outcome
12.
Ann Pharmacother ; 34(11): 1233-7, 2000 Nov.
Article in English | MEDLINE | ID: mdl-11098333

ABSTRACT

OBJECTIVE: To determine the efficacy and safety of ibutilide in atrial fibrillation (AF) and atrial flutter (AFl) in a clinical setting and to compare the cost of first-line ibutilide with that of projected first-line electrical cardioversion (EC) from a hospital and third-party payer perspective. METHODS: Medical records of all patients (n = 60) who received ibutilide from August 1996 to March 1998 were reviewed. Efficacy was defined as successful conversion to sinus rhythm within 60 minutes of the end of the infusion, and the maintenance of sinus rhythm until hospital discharge. Safety was evaluated by determining the incidence of torsade de pointes. Charges for EC and drug administration were obtained from the hospital database and converted to costs using cost/charge ratios. Hospital costs included drug, drug administration, cardiac intensive care laboratory fee, and the cost of managing torsade de pointes. The third-party payer calculation included all of the above plus the cardiologist and anesthesiologist fees. RESULTS: Fifty percent of patients with AF or AFl were successfully converted with ibutilide; 67% of these remained in sinus rhythm at hospital discharge. Three patients experienced nonsustained torsade de pointes; all resolved with pharmacologic management. From a hospital perspective, the cost of first-line ibutilide was greater than the cost of first-line EC ($280 vs. $138 per patient). However, from a third-party payer perspective, the use of ibutilide saved approximately $324 per patient ($718 vs. $1042). CONCLUSIONS: The efficacy and safety of ibutilide in the clinical setting are consistent with data reported in clinical trials. In contrast to a previous decision analysis, ibutilide was not associated with cost savings from a hospital perspective, but was from a payer perspective.


Subject(s)
Anti-Arrhythmia Agents/therapeutic use , Atrial Fibrillation/drug therapy , Sulfonamides/therapeutic use , Aged , Anti-Arrhythmia Agents/adverse effects , Anti-Arrhythmia Agents/economics , Costs and Cost Analysis , Electric Countershock/economics , Female , Humans , Male , Medical Records , Sulfonamides/adverse effects , Sulfonamides/economics , Torsades de Pointes/chemically induced
13.
Am J Health Syst Pharm ; 57(14): 1315-22; quiz 1323-5, 2000 Jul 15.
Article in English | MEDLINE | ID: mdl-10918921

ABSTRACT

The rationale for clinical trials of antiestrogens for prevention of breast cancer, potential concerns with antiestrogens, and clinical trials of antiestrogens for breast cancer prevention are discussed. Extensive preclinical evidence supports clinical investigation and use of tamoxifen for preventing breast cancer. The efficacy of tamoxifen in the treatment of advanced breast cancer and as adjuvant therapy has further strengthened the rationale for use in prevention. Tamoxifen is well tolerated and, like raloxifene, has been associated with non-cancer-related benefits. The major concerns with tamoxifen are an increased risk of thromboembolic events and endometrial cancer and an association with ocular disorders. Little is known about the long-term safety of raloxifene. Three randomized, double-blind, placebo-controlled clinical trials of tamoxifen 20 mg (as the citrate) daily for the prevention of breast cancer and one post hoc analysis and a literature review examining the effect of raloxifene on breast cancer risk (as a secondary endpoint) have been published. In one of the three trials of tamoxifen, the rate of invasive breast cancer was reduced 49%; in the other two trials, no reduction in breast cancer was found. Raloxifene apparently reduced the frequency of breast cancer. On the basis of the positive tamoxifen trial, tamoxifen can be offered to women with a five-year projected risk of breast cancer of > or = 1.67%, as determined by the Gail model. Risks and benefits should be evaluated for each patient. Tamoxifen may offer some women protection against breast cancer. Raloxifene may also have a preventive role, but more study is needed.


Subject(s)
Breast Neoplasms/prevention & control , Estrogen Antagonists/therapeutic use , Raloxifene Hydrochloride/therapeutic use , Tamoxifen/therapeutic use , Estrogen Antagonists/adverse effects , Female , Humans
15.
Pharmacotherapy ; 20(4): 380-2, 2000 Apr.
Article in English | MEDLINE | ID: mdl-10772366

ABSTRACT

Alteplase is the most commonly administered thrombolytic agent in the United States. However, concurrent therapy with nitroglycerin reduces plasma alteplase concentrations and its clinical efficacy. We sought to determine if this interaction is concentration and pH dependent. Seventy plasma samples were prepared and divided into three groups: alteplase 500 IU/ml alone (group 1), alteplase 500 IU/ml plus nitroglycerin 5 ng/ml (group 2), and alteplase 500 IU/ml plus nitroglycerin 200 ng/ml (group 3). The samples were analyzed at time zero and 3 hours (incubated at 37 degrees C). Group 1 had significantly higher plasma alteplase concentrations than group 3 (p<0.001). When alteplase and nitroglycerin are combined, the degradation of alteplase in plasma is enhanced.


Subject(s)
Fibrinolytic Agents/pharmacology , Nitroglycerin/pharmacology , Tissue Plasminogen Activator/pharmacology , Data Interpretation, Statistical , Dose-Response Relationship, Drug , Drug Interactions , Fibrinolytic Agents/blood , Humans , Hydrogen-Ion Concentration , Time Factors , Tissue Plasminogen Activator/blood , Tissue Plasminogen Activator/drug effects
17.
Am J Health Syst Pharm ; 56(21): 2211-7, 1999 Nov 01.
Article in English | MEDLINE | ID: mdl-10565700

ABSTRACT

The cost-effectiveness of amiodarone prophylaxis of atrial fibrillation (AF) in patients undergoing coronary artery bypass grafting (CABG) was determined. A decision analysis using current hospital data and values from the literature was conducted. Under the base-case scenario, CABG patients received usual care (no prophylaxis) or 2 g of oral amiodarone hydrochloride over one to three days before surgery and 400 mg daily for seven days after surgery. Costs of hospitalization in the intensive care unit (ICU) and the cardiac step-down unit (SDU), cardioversion costs, electrocardiogram costs, drug costs, nursing administration charges, and pharmacy i.v. admixture charges were included. A sensitivity analysis using a Monte Carlo simulation and a one-way sensitivity analysis were performed. The mean cost per AF event avoided was lower in the amiodarone group ($15,750, 95% confidence interval [CI]: $15,591-$15,999) than the control group ($17,426,95% CI: $17,252-$17,600). A majority of the cost difference was due to the cost of hospitalization for patients without AF, the frequency of AF, and the cost of hospitalization in the SDU for patients with AF. For patients treated with amiodarone who did not develop AF, the cost difference was sensitive to changes in the cost of hospitalization and the efficacy of amiodarone. For patients who did develop AF, the cost difference was robust. Prophylaxis of AF with amiodarone in CABG patients was more cost-effective than usual care in the short term from a hospital perspective; the results were sensitive to changes in the cost of hospitalization of patients who did not develop AF and the efficacy of amiodarone.


Subject(s)
Amiodarone/therapeutic use , Anti-Arrhythmia Agents/therapeutic use , Atrial Fibrillation/prevention & control , Coronary Artery Bypass/adverse effects , Cost-Benefit Analysis , Decision Support Techniques , Health Care Costs , Hospital Costs , Humans
18.
J Cardiovasc Pharmacol ; 34(3): 440-5, 1999 Sep.
Article in English | MEDLINE | ID: mdl-10471005

ABSTRACT

We evaluated the effect of two different doses of desethylamiodarone (DEA) and amiodarone on the ventricular fibrillation threshold (VFT). We ascertained the VFT in 24 pigs randomized to intravenous DEA, amiodarone, or vehicle. Ventricular fibrillation was induced by pacing the right ventricle by using a primary drive train at a cycle length of 270 ms for eight beats of 2-ms duration each. A secondary train of 20 pulses of 4-ms duration (100 Hz) immediately followed this over a total duration of 200 ms synchronized to the primary drive train. The intensity of the secondary train stimuli current was initially 2 mA and was increased by 2-mA increments until sustained VF with hemodynamic collapse was induced. The minimal current strength needed to induce sustained VF was defined as the VFT measured in mA. DEA (10 mg/kg) increased the VFT significantly over baseline from 13.5+/-4.9 to 23.2+/-8.8 mA (p = 0.0076). Amiodarone, 10 mg/kg, increased the VFT significantly over baseline (mean +/- SD) from 14.4+/-3.6 to 23.8+/-6.1 mA (p = 0.0016). An additional dose of amiodarone (15 mg/kg) increased the VFT to 38.5+/-15.9 mA, which is significantly greater than the VFT derived from lower-dose amiodarone (p = 0.046). We showed that DEA (10 mg/kg) has a similar antifibrillatory effect as 10 mg/kg of amiodarone. We also demonstrated a dose-dependent effect on VFT for amiodarone.


Subject(s)
Amiodarone/analogs & derivatives , Amiodarone/pharmacology , Anti-Arrhythmia Agents/pharmacology , Ventricular Fibrillation/prevention & control , Amiodarone/blood , Amiodarone/therapeutic use , Animals , Anti-Arrhythmia Agents/blood , Anti-Arrhythmia Agents/therapeutic use , Disease Models, Animal , Dose-Response Relationship, Drug , Electrophysiology , Injections, Intravenous , Swine , Ventricular Fibrillation/blood
19.
Pharmacotherapy ; 19(7): 832-7, 1999 Jul.
Article in English | MEDLINE | ID: mdl-10417031

ABSTRACT

We evaluated the antifibrillatory effect of two different doses of amiodarone after cardiac arrest with a cardiopulmonary resuscitation (CPR) model in 19 pigs. Ventricular fibrillation was induced by pacing the right ventricle using a primary drive train at a cycle length of 270 msec for 8 beats. The minimum current strength necessary to induce sustained ventricular fibrillation was defined as the ventricular fibrillation threshold (VFT) measured in mA. Three VFT determinations were made at baseline, followed by 9 minutes of continuous CPR with two determinations of VFT, and three after stabilization. The pigs were placed into one of three groups: amiodarone 2 or 5 mg/kg, or placebo. The average poststabilization VFT in each group was compared with the average baseline VFT. Pigs receiving amiodarone 2 mg/kg had significantly higher VFT after stabilization than at baseline (22.88+/-12.76 to 27.10+/-10.18 mA, p=0.048), as did those receiving 5 mg/kg (17.03+/-7.01 to 28.08+/-11.58 mA, p=0.002). The deltaVFT was significantly greater with amiodarone 5 mg/kg than with vehicle (placebo), but not with 2 mg/kg. There were no changes in VFT in any group during CPR versus baseline. When active treatments were combined, the trend was toward better survival in the amiodarone groups (13/13) compared with the placebo group (4/6, p=0.076).


Subject(s)
Amiodarone/pharmacology , Vasodilator Agents/pharmacology , Ventricular Fibrillation/physiopathology , Animals , Blood Circulation/drug effects , Blood Gas Analysis , Cardiopulmonary Resuscitation , Dose-Response Relationship, Drug , Hemodynamics/drug effects , Hydrogen-Ion Concentration , Reference Values , Swine , Ventricular Fibrillation/drug therapy , Ventricular Function/drug effects
20.
Pharmacotherapy ; 19(5): 635-40, 1999 May.
Article in English | MEDLINE | ID: mdl-10331827

ABSTRACT

We assessed the prophylactic effect of intravenous magnesium sulfate on the occurrence of torsades de pointes and early after-depolarizations, and on the QT interval (QTc) in an established rabbit model. Ten rabbits were given intravenous methoxamine to slow their heart rates. After 12 minutes five animals received a 60-mg/kg bolus and continuous infusion of magnesium 0.6 mg/kg/minute, and five received equivolume normal saline concurrently with the class III antiarrhythmic agent clofilium 5 mg/kg over 30 minutes. Electrocardiogram lead II and the monophasic action potential were recorded continuously throughout the experiment. The magnesium group experienced significantly less torsades de pointes and early after-depolarizations than the normal saline group (1/5 and 5/5 both parameters, respectively, p=0.048). There were no differences between groups in QT or QTc interval at baseline or at maximum QT or QTc prolongation. Magnesium decreases the occurrence of torsades de pointes without affecting the QT or QTc interval but does decrease the occurrence of early after-depolarizations. These findings must be validated in human studies.


Subject(s)
Anti-Arrhythmia Agents/adverse effects , Arrhythmias, Cardiac/prevention & control , Electrocardiography/drug effects , Magnesium/pharmacology , Quaternary Ammonium Compounds/adverse effects , Torsades de Pointes/prevention & control , Anesthesia , Animals , Arrhythmias, Cardiac/chemically induced , Methoxamine/pharmacology , Rabbits , Sympathomimetics/pharmacology
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