Medication individual response

SSRIs are theorized to reduce the frequency of hot flashes by increasing serotonin in the central nervous system and by decreasing LH. Of the SSRIs, citalopram, paroxetine, and sertraline all have been studied and have demonstrated a reduction in hot flashes while treating other symptomatic complaints such as depression and anxiety.33 Venlafaxine, which blocks the reuptake of serotonin and norepinephrine, has demonstrated a reduction in hot flashes primarily in the oncology population.34 Overall, these antidepressant medications offer a reasonable option for women who are unwilling or cannot take hormonal therapies, particularly those who suffer from depression or anxiety. These agents should be prescribed at the lowest effective dose to treat symptoms and may be titrated based on individual response. 

Asthma is the most serious of the atopic diseases and has become epidemic, affecting more than 155 million individuals in the developed world. It is the most common chronic childhood disease in developed nations [1], and carries a very substantial direct and indirect economic cost worldwide [2]. A number of pharmacological treatments have been developed for asthma. These treatments have a modest efficacy overall, due in part to widely variable individual responses to asthma drugs. Because of such variability, it is clear that some of the substantial resources expended on asthma medication, estimated to exceed U.S. 3 billion per annum in the U.S. alone [3], would be better spent targeting those patients who... 

Common, non-prescription substances such as caffeine, nicotine, and alcohol often cause sleeping difficulties [41]. In addition, a number of prescribed medications and illegal substances can cause insomnia, depending on factors such as amount used, time of usage, and individual response. Types of drugs that can cause insomnia include energizing antidepressants, anti-hypertensives, bronchodilators, diuretics, beta-blockers, and corticosteroids. 

An emergency response incident that involves the release of any chemicals or toxic materials will typically be referred to as a HAZMAT incident. The response to a HAZMAT incident is somewhat standardized across the country, and specialized HAZMAT teams are called in to address these situations. HAZMAT teams are typically affiliated with the fire services and will possess a majority of the locality s chemical detection equipment. Emergency medical responders arriving on the scene must first be capable of determining that a HAZMAT incident has occurred. These first responders are the individuals responsible for determining whether the HAZMAT team should be called for assistance. Responders may have different levels of training and preparedness for HAZMAT response (see Table 25.2). 

The topic of preclinical assessment of a clinical candidate has been reviewed in Chapter 29. The topic is mentioned here because the decision as to whether it is safe to take a candidate drug into humans is ultimately a medical judgment that can only be made by individuals responsible for clinical drug development. Preclinical safety assessments are designed to provide the knowledge needed to decide whether it is reasonably safe to study a drug candidate in humans. The term reasonably safe is used in this context because that is what an FDA reviewer must answer when reviewing an IND application. 

An increasing number of infectious diseases pharmacists practice in outpatient settings. These individuals usually practice in one of two areas. One area is in outpatient clinics, where they are directly involved in patient care. This is particularly true for pharmacists who specialize in treatment of patients infected with human immunodeficiency virus (HIV) or other chronic infectious diseases (e.g., leprosy). Pharmacists take medication histories, counsel patients about their medications, assess response to antimicrobial therapy, and make adjustments in therapy, as necessary. 

Relapsed CMV retinitis while undergoing HAART may be a sign of progressive immune dysfunction and requires reassessment of HAART and other medications. Individuals treated with HAART may experience reactivation of CMV retinitis when their CD4 count decreases (108). The threshold CD4 count below which reactivation of CMV retinitis occurred in patients for whom HAART was not successful is approximately 50cells/mm3. Thus, despite an initial response to HAART, there is a risk for CMV retinitis reactivation when the CD4 count decreases below 50cells/mm3. The HIV viral load does not appear to predict CMV reactivation. 

Senn SJ (2004b) Individual response to treatment is it a valid assumption. British Medical Journal 329 966-968. 

In the hospital, management organization has evolved into a diffuse authority structure that is commonly referred to as the triad model. The three primary components are the governing board (trustees), hospital administration (CEO and administrative staff), and the medical staff organization. The role of the governing board and the chief executive officer are briefly discussed below to provide some insight regarding their individual responsibilities and their interrelationship. 

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