Drug therapies therapeutic outcomes

Each of the collagen-vascular diseases has its own recommended form of therapy. For most of these diseases, there are few well-controlled clinical trials evaluating pharmacotherapy. Treatment of most of these diseases requires anti-inflammatory or immunosuppressive drugs. Monitoring therapeutic outcomes is essential because drugs and drug doses may need to be modified frequently. 

The expected outcomes of the patient may include an optimal response to drug therapy, identification of adverse reactions, reduction in anxiety, and an understanding of the therapeutic regimen. 

Develop a plan for monitoring therapeutic outcomes, focusing on the individual symptom profile and level of function of each patient. Include a plan for dosage adjustments or alternate therapy if the patient fails to respond adequately. Include serum drug concentration monitoring as appropriate. 

This conclusion stands in contrast to the statements made in an earlier review (Kauffmann and Hallahan, 1979) that behavioral therapeutic techniques have an important role to play in ADHD, and partly contradicts the results of some more recent studies. As summarized in Chapter 7 (p. 250 f.), the US MTA study did not detect any significant difference between combined treatments and treatment with methylphenidate alone with regard to their effects on ADHD symptoms however combined treatments had some advantage over drug alone on features such as anxiety disorders, social skills, consumer (mainly parent) satisfaction and possibly academic achievement (Pelham et al., 2000). Additional statistical analysis of the MTA study by responders and in terms of composite outcome measures also revealed additional benefit of combined treatments over drug therapy alone (Jensen et al., 2001). 

ECT is the only clearly established bimodal therapy in that it is equally effective for both the depressed and manic phases of the disorder. Although the primary indication for ECT is a severe, unremitting, or drug-nonresponsive depressive episode, data from as early as the 1940 s support its use for the treatment of acute mania, particularly manic delirium (242, 243 and 244). Based on clinical experience, we would expect mania to remit rapidly with ECT, whereas lithium can take weeks. Hence, there may be a superiority for E(3T over lithium in the early phases of treatment. What the final outcome would be is more problematic, but clearly, there is a need to further explore the efficacy of ECT in mania. In this light, Schnur and colleagues ( 245) reported on the relationship between various pretreatment symptoms and therapeutic outcome to ECT in 18 manic patients. They found that although severity of mania was not predictive, anger, irritability, and suspiciousness were more characteristic of nonresponders to ECT. 

With concerns growing about the rising cost of drug therapies it is not surprising that a new academic discipline has arisen—pharmacoecononics. Not entirely new, the study of therapeutic outcomes from an academic perspective has remained somewhat intuitive up to now but obviously is of considerable interest to developing... 

The type of research described under this heading aims at correlating therapeutic outcome and pre-therapy sleep as well as therapy-induced sleep alterations. This section is voluntarily limited to the two therapies whose relationships to sleep are the most documented, i.e., antidepressant drugs and sleep deprivation therapy. The effects of these two therapies are examined in the light of the three theories. According to these theories, effective therapies have either to decrease the arousal level, to increase process S, or to restore the aminergic/cholinergic balance. 

Mission statement. The pharmacy department needs a concise mission statement that reflects how the staff will provide patient-specific services designed to achieve (1) optimal therapeutic outcomes by ensuring safe and effective drug therapy and (2) quality... 

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