Subject(s)
Angioedema/chemically induced , Angiotensin-Converting Enzyme Inhibitors/adverse effects , Enalapril/adverse effects , Aged, 80 and over , Clopidogrel , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/drug therapy , Enalapril/administration & dosage , Enalapril/therapeutic use , Female , Humans , Hydrochlorothiazide/administration & dosage , Hydrochlorothiazide/adverse effects , Hydrochlorothiazide/therapeutic use , Hypertension/complications , Hypertension/drug therapy , Metformin/administration & dosage , Metformin/therapeutic use , Ticlopidine/administration & dosage , Ticlopidine/analogs & derivatives , Ticlopidine/therapeutic useABSTRACT
No disponible
Subject(s)
Female , Aged , Humans , Angioedema/chemically induced , Enalapril/adverse effects , Enalapril/therapeutic use , Hypertension/drug therapyABSTRACT
ST segment elevation acute coronary syndrome is a clinical condition that is rarely observed in pregnant women. However, its manifestation is a situation of high maternal-fetal risk. Pharmacotherapeutical management of these patients is difficult and requires individualized care by a multidisciplinary team since many of the standard treatments are included within the categories of teratogencity C or D of the Food and Drug Administration and experience with techniques such as coronary angioplasty with stent placement is scarce. The case of a 32-year woman who was 11 weeks pregnant and diagnosed of acute coronary syndrome with ST segment and its therapeutic approach are described. Furthermore, the information available on epidemiology, etiology and pathophysiology of acute coronary syndrome with ST segment during pregnancy and the specific role of the currently available treatment options are reviewed.
Subject(s)
Angina, Unstable/drug therapy , Myocardial Infarction/drug therapy , Pregnancy Complications, Cardiovascular/drug therapy , Acute Disease , Adult , Angina, Unstable/physiopathology , Electrocardiography , Female , Humans , Myocardial Infarction/physiopathology , Pregnancy , Pregnancy Complications, Cardiovascular/physiopathology , SyndromeABSTRACT
El síndrome coronario agudo con elevación de ST (SCACEST) es una entidad clínica que rara vez se observa en mujeres embarazadas, pero cuya manifestación constituye una situación de alto riesgo materno-fetal. El manejo farmacoterapéutico de estas pacientes es difícil y requiere una atención individualizada por parte de un equipo multidisciplinar, puesto que muchos de los tratamientos estándar se incluyen dentro de las categorías de teratogenicidad C o D de la Food and Drug Administration, y es escasa la experiencia con técnicas como la angioplastia coronaria con colocación de stent. Se describe el caso de una mujer de 32 años, gestante de 11 semanas y diagnosticada de SCACEST, así como el abordaje terapéutico de la misma. Además se revisa la información disponible sobre la epidemiología, etiología y fisiopatología del SCACEST durante el embarazo y el papel específico de las opciones de tratamiento disponibles actualmente
ST segment elevation acute coronary syndrome is a clinical condition that is rarely observed in pregnant women. However, its manifestation is a situation of high maternal-fetal risk. Pharmacotherapeutical management of these patients is difficult and requires individualized care by a multidisciplinary team since many of the standard treatments are included within the categories of teratogencity C or D of the Food and Drug Administration and experience with techniques such as coronary angioplasty with stent placement is scarce. The case of a 32-year woman who was 11 weeks pregnant and diagnosed of acute coronary syndrome with ST segment and its therapeutic approach are described. Furthermore, the information available on epidemiology, etiology and pathophysiology of acute coronary syndrome with ST segment during pregnancy and the specific role of the currently available treatment options are reviewed
Subject(s)
Humans , Female , Pregnancy , Coronary Disease/drug therapy , Pregnancy Complications, Cardiovascular/drug therapy , Pregnancy, High-Risk , Coronary Angiography , 35526 , Fibrinolysis , Thrombolytic Therapy , Arrhythmias, Cardiac/complications , Risk FactorsABSTRACT
No disponible
Subject(s)
Male , Female , Child , Child, Preschool , Humans , Tumor Lysis Syndrome/drug therapy , Urate Oxidase/therapeutic use , Single DoseSubject(s)
Analgesics, Non-Narcotic/adverse effects , Carbamazepine/adverse effects , Inappropriate ADH Syndrome/chemically induced , Inappropriate ADH Syndrome/physiopathology , Pulmonary Disease, Chronic Obstructive/drug therapy , Aged , Analgesics, Non-Narcotic/therapeutic use , Carbamazepine/therapeutic use , Humans , Male , SyndromeABSTRACT
No disponible
Subject(s)
Humans , Male , Aged , Inappropriate ADH Syndrome/chemically induced , Carbamazepine/adverse effects , Respiratory Tract Infections/complicationsABSTRACT
Disseminated intravascular coagulation as associated to sepsis contributes to the development of clinical multiple organ failure by extensive thrombosis in microcirculation vessels. This condition commonly manifests itself in severe meningococcal sepsis. On the skin, its clinical manifestation is extensive purpura with necrotic lesions that usually progress to serious distal ischemia and may call for amputation. A common denominator in these events regarding hemostasis is a depletion of so-called natural anticoagulant proteins, particularly protein C. According to clinical observations replacement therapy with human plasma-derived protein C concentrates has been associated with significantly improved clinical outcome in patients with meningococcal sepsis and fulminant purpura. This paper reports a case of acquired protein C deficiency in a girl with meningococcal sepsis, fulminant purpura, disseminated intravascular coagulation, and septic shock. Fresh plasma therapy was intended to increase consumption coagulopathy-depleted coagulation factors and to provide small amounts of protein C. The inability to restore protein C concentrations above 30%, and the presence of severe thrombopenia in the setting of disseminated intravascular coagulation led to the onset of replacement therapy using a human protein C concentrate (Ceprotin), which increased plasma protein C concentrations and contributed to revert the existing hypercoagulability status. Finally, evidence available in the literature regarding fulminant meningococcal sepsis management using human protein C concentrates and recombinant activated protein C is discussed.
Subject(s)
Fibrinolytic Agents/therapeutic use , IgA Vasculitis/drug therapy , Meningococcal Infections/drug therapy , Protein C Deficiency/drug therapy , Protein C/therapeutic use , Child , Fatal Outcome , Female , Hematologic Tests , Humans , IgA Vasculitis/etiology , Meningococcal Infections/complications , Protein C Deficiency/etiologyABSTRACT
BACKGROUND: Mycophenolate mofetil (MMF) has been used successfully in patients with various forms of uveitis not responsive to other immunosuppressants. Nevertheless, for these patients neither recommendations for optimal dosage of MMF nor data concerning drug exposure of MMF are available. OBJECTIVE: To describe the results of the therapeutic drug monitoring (TDM) of MMF trough concentrations in a cohort of patients with uveitis, with the aim of optimizing the dosage of this drug, by maintaining a target concentration to achieve adequate immunosuppression with a minimal risk of therapeutic failure or toxicity. PATIENTS AND METHODS: This study describes the results of monitoring trough plasma concentrations of MMF in 12 patients with uveitis during a mean period of 21.4 months. Patients included one with Stevens-Johnson syndrome, one with Graves-Basedow's disease, one with Behcet's disease, one with idiopathic thrombocytopenic purpura and the rest with idiopathic uveitis. All patients were treated with steroids and additional therapy prior to treatment with MMF. RESULTS: Pharmacokinetic monitoring of mycophenolic acid (MPA) was performed with 108 trough plasma samples using an EMIT assay. Mean daily MMF dose was 24.5 +/- 6.3 mg/kg and mean trough MPA concentration was 2.9 +/- 1.9 microg/mL. Therapy was effective in 10 patients (83%). There were few side-effects: diarrhoea, excitement, agitation and cough that disappeared with daily dose reduction of MMF. CONCLUSIONS: MMF was effective in the majority of patients with uveitis with an acceptable profile of side-effects. TDM of MMF in patients with uveitis is clinically practicable and may help to optimize individual immunosuppressive therapy. We estimated that MMF dosages in the range of 0.5-1.5 g/day might be sufficient for treating uveitis and we recommend an initial target range of 2-4 microg/mL, which included 50% of our results. Randomized controlled trials are essential to confirm the efficacy of MMF in uveitis.
Subject(s)
Immunosuppressive Agents/blood , Mycophenolic Acid/analogs & derivatives , Mycophenolic Acid/blood , Uveitis/drug therapy , Adult , Aged , Child , Drug Monitoring/methods , Enzyme Multiplied Immunoassay Technique , Female , Humans , Immunosuppressive Agents/administration & dosage , Immunosuppressive Agents/adverse effects , Male , Middle Aged , Mycophenolic Acid/administration & dosage , Mycophenolic Acid/adverse effectsABSTRACT
A number of literature references suggest that carbapenem-like antibiotics decrease plasma concentrations of valproic acid in epileptic patients. This interaction may result in a recurrence of epileptic seizures in these patients. To clarify the possible mechanism of such carbapenem-valproic acid interaction several experimental studies have been carried out in animals. However, the mechanism of this drug-drug interaction is as yet uncertain. in this article we report three new cases that were observed in our hospital within three months. One of these patients developed seizures. We also review the different mechanisms proposed, as well as cases published to this day. All these data demonstrate that care should be taken in using these potent antibiotics in patients receiving valproic acid.
Subject(s)
Anticonvulsants/pharmacokinetics , Carbapenems/pharmacokinetics , Valproic Acid/pharmacokinetics , Adult , Aged , Drug Interactions , Female , Humans , MaleABSTRACT
Existen referencias en la literatura que indican que los antibióticos carbapenémicos disminuyen las concentraciones plasmáticas de ácido valproico en pacientes epilépticos. El resultado de esta interacción podría traducirse en la aparición de crisis epilépticas en estos pacientes. Con el fin de clarificar el posible mecanismo implicado en la interacción entre carbapenemes y ácido valproico se han desarrollado diversos estudios en animales de experimentación. Sin embargo, el mecanismo concreto sigue sin determinarse. En este trabajo se describen tres casos detectados en nuestro hospital durante un periodo de tiempo de tres meses, coincidiendo uno de ellos con la aparición de convulsiones. Además, se recogen los distintos mecanismos de interacción propuestos, así como los casos publicados hasta la fecha. De todo ello se desprende la necesidad de proceder con precaución a la hora de emplear estos potentes antibióticos en asociación con ácido valproico (AU)
