Drugs effects, clinical

The file Is used routinely In the laboratory at the National Institutes of Health In an attempt to explain abnormal test results The resident physicians affiliated with the Clinical Chemistry Service discuss the results with the patient-care physicians and determine If the results were due to the patient s clinical state or to a drug effect This close monitoring of test results has led to recognition of deficiencies In what Is believed are specific enzymatic procedures for the measurement of glucose and uric acid Likewise, the gualac procedure for occult blood In feces was found to yield false negative results under certain circumstances This has prompted the development of a more specific procedure (Jaffe et al unpublished) ... 

Young, D.S. Thomas, D.W. Friedman, R.B..and Pestaner, L.C. "Effects of Drugs on Clinical Laboratory Tests". Clin. 

Some AEDs, especially phenytoin and valproate, are highly bound to plasma proteins. When interpreting a reported concentration for these drugs, it is important to remember that the value represents the total (i.e., bound and unbound) concentration in the blood. Because of differences in the metabolism of these drugs, the clinical effects of altered protein binding are different for different drugs. 

Educate the patient on common adverse drug effects and a few of the key signs and symptoms of severe toxicity (i.e., jaundice and abacavir hypersensitivity reaction). Tell them to call their provider immediately if any of those symptoms occur. Make sure they have the correct telephone number for the clinic. 

One thing that occurred to us, when considering how surprisingly small the drug effect was in the clinical trials we had... 

But do the clinical-trial data submitted to the FDA even establish proof of principle Recall that the rather small differences found between drug and placebo in the trials submitted to the FDA could have been due to the breaking of blind on the basis of perceived side effects. It may simply be evidence of an enhanced placebo effect, rather than a true drug effect. As I noted in Chapter i, once side effects are taken into account, the difference between SSRI and placebo is not even statistically significant.30... 

There is yet another possibility. The general assumption is that the effect of a drug adds to the placebo effect, so that the total improvement that patients experience is the drug effect in addition to the placebo effect. This assumption is implicit in the design of placebo-controlled clinical trials, in which the drug effect is assessed as the difference between the response to the drug and the response to the placebo. Anne Harrington, an historian of science at Harvard University and the London School of Economics, calls it the oil-and-water hypothesis. 

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