First-line therapy

Corticosteroids are the most efficacious treatment available for the long-term treatment of asthma, and inhaled corticosteroids are considered to be a first-line therapy for asthma (247). In the early 1950s, cortisone (31) and cortisol (29) were used to treat asthma. However, dmgs with fewer side effects and with... 

Obesity is a difficult condition to treat. Dietary restriction of caloric intake is the first line therapy and is optimally combined with an exercise program to promote loss of fat relative to lean body mass (17). For the grossly obese (BMI > 40), invasive mechanical measures such as jaw wiring, gastric banding, and gastric by-pass have been attempted with at least limited success (18). 

Thiazide diuretics have a venerable history as antihypertensive agents until the advent of the angiotensin-converting enzyme (ACE) inhibitors this class of drugs completely dominated first line therapy for hypertension. The size of thi.s market led until surprisingly recently to the syntheses of new sulfonamides related to the thiazides. Preparation of one of the last of these compounds starts by exhaustive reduction of the Diels-Alder adduct from cyclopentadiene and malei-mide (207). Nitrosation of the product (208), followed by reduction of the nitroso group of 209,... 

For example, PGF201 agonists such as latanaprost have been developed as eyedrops to reduce intraocular pressure for the treatment of glaucoma. Topical instillation of these agonists is effective in lowering intraocular pressure and may be used as a first-line therapy for the treatment of glaucoma. 

The clinical trial that resulted in FDA approval of bevacizumab (February 2004) was a randomized, double-blind, phase III study in which bevacizumab was administered in combination with bolus-IFL (irinotecan, 5FU, leucovorin) chemotherapy as first-line therapy for previously untreated metastatic colorectal cancer [3]. Median survival was increased from 15.6 months in the bolus-IFL + placebo arm to 20.3 months in the bolus-IFL + bevacizumab arm. 

Methyldopa Preferred first-line therapy on the basis of long-term follow-up studies supporting safety after exposure in utero. Surveillance data do not support an association between drug and congenital defects when the mother took the drug early in the first trimester. 

The addition of ipratropium bromide to inhaled p2-agonist therapy in acute severe asthma improves pulmonary function and decreases hospitalization rates in both adult and pediatric patients.31 The benefit of combining ipratropium and albuterol appears to be greatest in moderate to severe exacerbations, and the combination should be considered first-line therapy in severe exacerbations. 

Treatment of acute episodes of ulcerative colitis is dictated by the severity and extent of disease, and first-line therapy of mild to moderate disease involves oral or topical aminosalicylate derivatives. 

Treatment of acute episodes of ulcerative colitis is dictated by the severity and extent of disease, and first-line therapy of mild to moderate disease involves oral or topical aminosalicylate derivatives. Topical suppositories and enemas are preferred for active distal UC (left-sided disease and proctitis), as they deliver mesalamine directly to the site of inflammation. Topical mesalamine is superior to both topical corticosteroids and oral aminosalicylates for inducing remission in active mild to moderate UC.1,33,34 Enemas are appropriate for patients with... 

For patients with more extensive disease extending proximal to the splenic flexure, oral sulfasalazine or any of the newer oral mesalamine products is considered first-line therapy.1 Doses should provide 4 to 6 g of sulfasalazine or 4.8 g of mesalamine. While little differences in efficacy exist between... 

Metronidazole or ciprofloxacin can be used in patients who do not respond to oral aminosalicylates. Response rates of up to 50% are reported, but the data are conflicting and these agents should generally not be considered first-line therapy.2,36... 

The NKF suggests that CKD should be classified as a coronary heart disease (CHD) risk equivalent and the goal LDL-C level should be below 100 mg/dL in all patients with CKD.22 The most frequently used agents for the treatment of dyslipidemias in patients with CKD are the 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors ( statins ) and the fibric acid derivatives. However, other treatments have been studied in patients with CKD and should be considered if first-line therapies are contraindicated. 

Once the first dose of benzodiazepine is given, an antiepileptic drug must be started to prevent further seizures from occurring. AEDs must not be given as first-line therapy since they must be infused relatively slowly to avoid adverse effects, delaying their onset of action. 

Explain the use of drugs as first-line therapy in bipolar disorder, including appropriate dosing, expected therapeutic effects, potential adverse effects, and important drug-drug interactions. 

Treatment of depressive episodes in bipolar disorder patients presents a particular challenge because of the risk of a pharmacologic mood switch to mania, although there is not complete agreement about such risk. Treatment guidelines suggest lithium or lamotrigine as first-line therapy.17,41 Olanzapine has also demonstrated efficacy in treatment of bipolar depression, and quetiapine is under review for approval of treatment of bipolar depression.42 When these fail, efficacy data support use of antidepressants. 

A recent consensus panel recommends calcium- or magnesium-containing antacids as first-line therapies for heartburn in pregnancy.21 This recommendation was based on the added benefit of calcium and magnesium supplementation. Avoid antacids containing aluminum hydroxide owing to associations with fetal neurotoxicity.22... 

Hormone-replacement therapy is also indicated for the prevention of osteoporosis but is not recommended for longterm use. Alternatives such as bisphosphonates or raloxifene should be considered as first-line therapy for the prevention of osteoporosis, in addition to appropriate doses of calcium and vitamin D. 

BMD will increase and the risk of fractures will decrease in women taking HRT. However, when therapy is discontinued, a decline in BMD will resume at the same rate as in women not on HRT. Therefore, therapy for osteoporosis prevention should be considered long term. Since HRT should be maintained only for the short term, alternative therapies such as bisphosphonates or raloxifene should be considered as first-line therapy for the prevention of postmenopausal osteoporosis, in addition to appropriate doses of calcium and vitamin D. Because of the risks associated with HRT, it should not be prescribed solely for the prevention of osteoporosis. 

Describe current nonpharmacologic and pharmacologic options for treating ED and determine an appropriate first-line therapy for a specific patient. 

Vacuum erection devices and intracavernosal injections are highly effective for many patients, but side effects, lack of spontaneity, and fear of needles limit their widespread use as first-line therapy. 

P-Blockers and thiazide diuretics have proven benefits in reducing cardiovascular disease-associated morbidity and mortality.55 Tolerability permitting, these agents are to be considered first-line therapies in most transplant recipients. The... 

---