Adverse drug events reduction

Monitoring parameters for pharmacotherapy of narcolepsy include reduction in daytime sleepiness, cataplexy, hypnagogic and hypnopompic hallucinations, and sleep paralysis. Patients should be evaluated regularly during medication titration, then every 6 to 12 months to assess adverse drug events (e.g., mood changes, sleep disturbances, and cardiovascular abnormalities). If symptoms increase during therapy, PSG should be done. 

Women s Hospital conducted a study designed to measure the effect of a single pharmacist s participation on medical rounds on the rate of preventable adverse drug events in an intensive care unitJ The participation of an experienced BCPS was associated with a 66% reduction in preventable adverse drug events and approximately 270,000 in annual cost savings to the hospital. The BCPS was accepted as a member of the multidisciplinary team, and the researchers noted that mutual cooperation and positive interpersonal relationships between the pharmacy and medical staff were vital criteria for successful pharmacist interventions. 

Goals of therapy for OCD include reduction in the frequency of obsessive thoughts and in the time spent performing compulsive acts and reduction in the degree of anxiety. Treatment for OCD may not completely eliminate obsessions or compulsions, but patients may feel remarkably improved with partial resolution of their symptoms. Treatment should provide the patient with an optimal level of psychosocial and occupational functioning and an overall improved QOL. Efforts should be made to minimize adverse drug events and prevent drug interactions. 

THERAPEUTIC USES The CNS effects prevent this class of drugs from being a leading option for monotherapy of hypertension. These drugs effectively lower blood pressure in some patients who have not responded adequately to combinations of other agents. Enthusiasm for these drugs is further diminished by the paucity of evidence demonstrating reduction in risk of adverse cardiovascular events. 

In 342 children with Plasmodium falciparum malaria who were randomly assigned to artesunatemefloquine or mefloquine alone all the children recovered clinically with similar fever clearance times [13. Parasite clearance was significantly faster in those who took the combination. Gameto-cyte carriage rates and drug-attributable reductions in hematocrit were significantly lower with the combination. Most of the adverse events were attributable to malaria. 

A statin combined with a resin results in similar reductions in LDL cholesterol as those seen with ezetimibe. However, the magnitude of triglyceride reduction is less with a resin compared to ezetimibe, and this should be considered in patients with higher baseline triglyceride levels. In addition, gastrointestinal adverse events and potential drug interactions limit the utility of this combination. 

Phase 1 dose-escalating and PK studies of Vatalanib were performed on a wide spectrum of tumors including colorectal, RCC, NSCLC, AML, ghoblas-toma, and prostate cancer. Dose ranged up to 2000 mg once daily or 1000 mg twice daily by oral administration. In most studies, results in patients with advanced solid tumors indicated that treatment was well tolerated with no drug-related serious adverse events. Tumor volume reduction was observed in some patients. The MTD was not reached with doses up to 1500 mg/day. The optimal dose was determined as 1250 mg/day. Measurable responses of tumor volume reduction were observed in 19% and 4% of the patients with RCC and ghoblastoma, respectively. Over 50% of patients achieved stable disease [282]. 

UK phase I studies in solid tumor and AML patients were initiated by January and October 2004, respectively. Patients received single oral doses of CF1IR258, ranging between 50 and 400 mg for 7 days, followed by a 7-day rest period. The drug was well tolerated. Adverse events were generally mild to moderate, but there was one incidence of grade IV fatigue. All patients exhibited reductions or stabilization of peripheral blasts, and reduction or... 

Dose reduction and discontinuation If paradoxical aggravation of symptoms or other adverse events occur, reduce the dosage, or, if necessary, discontinue the drug. 

Antimalarials Mefloquine is a major drug for malaria, in particular, for chloroquine-resistant malaria." However, some cases of neuropsychiatric adverse events and the apparition of resistance tend to limit its use. Metabolism into inactive and phototoxic 1 -7/-2-oxoquinoline is blocked by the presence of the CF3 group." Instead of performing the resolution of enantiomers at the end of the synthesis," the asymmetric reduction of the carbonyl group in the presence of ruthenium catalyst and a chiral diphosphine provided mefloquine with an excellent enantiomeric excess (Figure 8.25). °... 

If a botanical is shown to reverse an abnormal test result, modify another drug s adverse event, or act synergistically with another modality, it will usually be best developed as a drug. This is especially true if the botanical provides a distinct benefit for a patient population, but would pose safety concerns if used by the general public. In contrast to prevention, risk-reduction, or health-maintenance trials, therapeutic studies are often able to demonstrate clinical benefit with smaller numbers of subjects and with more tangible measures of outcome. 

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