Drug therapies safer

The numerous clinical trials that have been widely published and that are summarized in other chapters of this textbook attest to the need for combination drug therapy in the ACS, It is to be expected that results obtained in clinical practice will vary somewhat from those found in clinical trials but on balance it is important to treat patients in accordance with guidelines derived from clinical trials unless there are contraindications or relative risks, It is not possible to state that a given drug is more effective or safer than another drug without a head-to-head clinical trial of the drug in question. 

Pharmacogenomics is here to stay and provides a useful contribution to the development of new drugs in diseases for which we have no medicines, and, for other diseases, new, safer, and more efficacious drugs. This, hopefully, will justify the already made large financial investments and will also justify the enormous efforts needed by many players in society to limit its potentially harmful uses outside of the narrower, well-regulated area of drug therapy. 

Although -blockers and calcium chaimel blockers have taken a more prominent role in acutely controlling rate in patients with rapid atrial fibrillation or flutter, a cautionary note must be made. That is, most patients with these tachycardias also have concomitant symptoms of heart failure, and these two forms of drug therapy may worsen the situation initially. Usually, a prompt decline in rate and increase in stroke volume balances the decrease in contractility seen with p blockers or calcium chaimel blockers such that heart failure symptoms remain unchanged. However, occasionally, severe reactions and hypotension may occur one study implies that diltiazem may be safer than verapamil. ... 

Ingelman-Sundberg M, Rodriguez-Antona C (2005). Pharmacogenetics of drug-metabolizing enzymes implications for a safer and more effective drug therapy. Phil Trans R Soc Lond B Biol Sci 360 1563-1570. 

Pentylenetetrazol (188) is a drug with profound stimulatory activity on the central nervous system. As such, the agent was at one time used in shock therapy for treatment of mental disease. Although it has since been supplanted by safer methods, the agents still occupy an important role in various experimental animal models in pharmacology. Addition of hydrazine to the imino ether (186) obtained from caprolactam affords 187. Treat-... 

Sequential therapy involves rapid clearing of psoriasis with aggressive therapy (e.g., cyclosporine), followed by a transitional period in which a safer drug such as acitretin is started at maximal dosing. Subsequently, a maintenance period using acitretin in lower doses or in combination with UVB or PUVA can be continued. 

Some newer drugs are listed in Table 37-5. Clinical trials and phase 4 reports suggest that these agents are effective for the duration of therapy (up to 1 year) and are probably safer than the amphetamine mimics. However, they do not produce more than a 5-10% loss of weight. 

Studies and reviews sponsored by the manufacturer of tibolone have over many decades argued that, as one reviewer puts it, tibolone may provide a safer alternative to traditional hormone replacement therapy , but even this review adds that the impact of tibolone on the risk of breast cancer or cardiovascular and thromboembolic events is not well defined (2). Bearing in mind that these are precisely the questions that have cast a shadow over other forms of hormone replacement therapy, this is a serious defect in the evidence about the drug s safety it is possible that the extent of use of tibolone has been insufficient to provide well-documented answers. 

Metoprolol, atenolol, and several other drugs (see Table 10-2) are members of the Di-selective group. These agents may be safer in patients who experience bronchoconstriction in response to propranolol. Since their Bi selectivity is rather modest, they should be used with great caution, if at all, in patients with a history of asthma. However, in selected patients with chronic obstructive lung disease the benefits may exceed the risks, eg, in patients with myocardial infarction. Betai-selective antagonists may be preferable in patients with diabetes or peripheral vascular disease when therapy with a 6-blocker is required since B2 receptors are probably important in liver (recovery from hypoglycemia) and blood vessels (vasodilation). 

N. Bodor, The application of soft drug approaches to the design of safer corticosteroids, Topical Corticosteroid Therapy A Novel Approach to Safer Drugs (E. Christophers, A. M. Kligman, E. Schopf, and R. B. Stoughton, eds.) Raven Press Ltd, New York, 1988, p. 13. 

Corticosteroids have a range of activity. They have potent antiinflammatory and immunosuppressive activity. Many synthetic drugs are available as corticosteroids. In appropriate doses, these are used as replacement therapy in adrenal insufficiency. The topical application of corticosteroids is safer when compared with systemic use. Corticosteroids should be used in smaller doses for the shortest duration of time. A high dose may be used for life-threatening syndromes or diseases. A tapering pattern of withdrawal should be followed to avoid complications of sudden withdrawal. Systemic therapy is indicated in a variety of conditions. These are administered by intraarticular injections with aseptic conditions for rheumatoid arthritis and osteoarthritis. In skin diseases, such as eczema, contact dermatitis, and psoriasis, corticosteroids are used topically. In some cases, steroids are combined with antimicrobial substances such as neomycin. 

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