Medication therapy

Artificial Hearts. Congestive heart failure (CHF) is a common cause of disabiHty and death. It is estimated that three to four million Americans suffer from this condition. Medical therapy in the form of inotropic agents, diuretics (qv), and vasofilators is commonly used to treat this disorder (see Cardiovascularagents). Cardiac transplantation has become the treatment of choice for medically intractable CHF. Although the results of heart transplantation are impressive, the number of patients who might benefit far exceeds the number of potential donors. Long-term circulatory support systems may become an alternative to transplantation (5). 

As pharmacogenetics and pharmacogenomics are not mutually exclusive, but even sometimes display overlapping features, both disciplines are aimed at better tailoring medical therapy for a given complex disease such as essential hypertension or other CVD. In the wake of new technologies to identify candidate region for whatever phenotype, more robust and complex bioinformatic analyses are necessary to... 

Review Questions—several questions, reviewing important information covered in the chapter, can be found at the end of each chapter. The questions are written in PN-NCLEX format and provide the student an opportunity to answer questions specifically about the drug s covered in the chapter. Space does not permit more questions of this type, but provides the student practice in answering questions concerning medication therapy and administration of drug s. 

Gilchrest BA (1996) A review of skin aging and its medical therapy. Br J Dermatol 135 867-875... 

In the emergency situation, we beheve this technique can be successfully employed in selected patients with symptomatic ischemia due to dissection or atherosclerotic disease despite being on maximal medical therapy. We have also seen patients with carotid occlusion and an isolated cerebral hemisphere (poor collateral flow) benefit from EC-IC bypass. Any potential benefit, however, must... 

Once BE s symptoms are improved, how would you optimize her oral medication therapy for heart failure ... 

In general, early pharmacotherapy of NSTE ACS (Fig. 5-3) is similar to that of STE ACS with three exceptions (1) fibrinolytic therapy is not administered (2) glycoprotein Ilb/IIIa receptor blockers are administered to high-risk patients for medical therapy as well as to PCI patients and (3) at this time, there are no standard quality indicators for patients with NSTE ACS who are not diagnosed with MI. 

In patients with NSTE ACS scheduled for early PCI, administration of either abciximab or eptifibatide (double bolus) is recommended. The use of tirofiban in these patients is not recommended, because it has been shown to be inferior to abciximab.2 Medical therapy with glycoprotein Ilb/IIIa receptor inhibitors in patients not undergoing PCI is reserved for higher-risk patients, such as those with positive troponin or ST-segment depression, and patients who have continued or recurrent ischemia despite other antithrombotic therapy.2... 

Carotid angioplasty with or without stenting is typically restricted to patients who are refractory to medical therapy and are not surgical candidates. Clinical trials are currently ongoing to further define the role of carotid angioplasty in both symptomatic and asymptomatic patients. 

Parathyroidectomy is a treatment of last resort for sHPT, but should be considered in patients with persistently elevated iPTH levels above 800 pg/mL (800 ng/L) that is refractory to medical therapy to lower serum calcium and/or phosphorus levels.39 A portion or all of the parathyroid tissue may be removed, and in some cases a portion of the parathyroid tissue may be transplanted into another site, usually the forearm. Bone turnover can be disrupted in patients undergoing parathyroidectomy whereby bone production outweighs bone resorption. The syndrome, known as hungry bone syndrome, is characterized by excessive uptake of calcium, phosphorus, and magnesium for bone production, leading to hypocalcemia, hypophosphatemia, and hypomagnesemia. Serum ionized calcium levels should be monitored frequently (every 4 to 6 hours for the first 48 to 72 hours) in patients receiving a parathyroidectomy. Calcium supplementation is usually necessary, administered IV initially, then orally (with vitamin D supplementation) once normal calcium levels are attained for several weeks to months after the procedure. 

The initial therapeutic modality selected depends in part on the patient s age, risk of psychiatric adverse effects, and degree of physical impairment. The current approach to treatment is to delay medication therapy until the symptoms begin to interfere with the patient s ability to function or impact their QOL. 

Educate patient and/or caretaker about the disease state, lifestyle modifications, and medication therapy. 

Morgenthaler TI, Kapen S, Lee-Chiong T, et al. Practice parameters for the medical therapy of obstructive sleep apnea. Sleep 2006 29 1031-1035. 

Surgery generally is reserved for patients who fail to respond to medical therapy and have progressive limitations in activities of daily living (ADL). These patients should be referred to an orthopedic surgeon for evaluation. Most patients achieve... 

Laser trabeculoplasty uses laser energy aimed at the trabecular meshwork to improve the outflow of aqueous humor and can be used as first-line therapy, especially in patients unable or unwilling to adhere to medical therapy. Laser trabeculoplasty may be used as bridge therapy between medical and surgical intervention, and approximately 50% of laser trabeculoplasty procedures will fail at 10 years. Trabeculectomy is the removal of a portion of the trabecular meshwork to improve aqueous... 

The treatment of choice for PACG is laser iridotomy. Medical therapy is used to lower IOP, reduce pain, and reverse corneal edema prior to the iridotomy. IOP should first be lowered... 

Potential adverse drug reactions of medical therapy. 

Which drugs may interact with the medication therapy... 

Eventually, HIV becomes resistant to current medication therapy. To prolong this time to resistance, strict adherence to the drug regimen is critical. 

Practitioners who design, implement, monitor, and evaluate medication therapy bear an important responsibility to their patients and society. Development of these abilities requires an integration of knowledge, skills, attitudes, and values that can be acquired only through a structured learning process that includes classroom work, independent study, hands-on practice, and, ultimately, involvement with actual patients. 

---