Primary therapy

Primary therapy for acute pancreatitis is supportive, with fluid repletion, discontinuation of oral intake, and analgesia. 

Antithyroid drugs are used as primary therapy for Graves disease or as preparative therapy before surgery or radioactive iodine administration. The decision to use antithyroid drugs as... 

Primary therapy is based on disease severity and type of hemorrhage.7 Most patients with mild to moderate disease and a minor bleeding episode can be treated with l-desamino-8-D-arginine vasopressin [desmopressin acetate (DDAVP)], a synthetic analog of the antidiuretic hormone vasopressin. DDAVP causes release of von Willebrand factor (vWF) and factor VIII from endogenous storage sites. This formulation increases plasma factor VIII levels by three- to fivefold within 30 minutes. The recommended dose is 0.3 mcg/kg intravenously (in 50 mL normal saline infused over 15 to 30 minutes) or subcutaneously or 300 meg intranasally via concentrated nasal spray every 12 hours. Peak effect with intranasal administration occurs 60 to 90 minutes after administration, which is somewhat later than with intravenous administration. Desmopressin infusion may be administered daily for up to 2 to 3 days. Tachyphylaxis, an attenuated response with repeated administration, may occur after several doses.8... 

Herbrecht R, Denning DW, Patterson TF, et al. Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. N Engl J Med 2002 347 408M15. 

Endocrine therapy is primary therapy for endocrine-responsive disease, with chemotherapy being added for some intermediate- and all high-risk patients... 

Goldhirsch A, Click JH, Gelber RD, et al. Meeting highlights International Expert Consensus on the Primary Therapy of Early Breast Cancer 2005. Ann Oncol 2005 16 1569-1583. 

FIGURE 93-1. Algorithm for primary therapy in newly diagnosed CML patients. DU, donor lymphocyte infusion IFN, interferon. 

Adjuvant therapy Therapy that supplements or follows primary therapy to prevent the risk of disease recurrence or manage associated symptoms. 

Blockers are usually used as adjunctive therapy with antithyroid drugs, RAI, or iodides when treating Graves disease or toxic nodules in preparation for surgery or in thyroid storm. /3-Blockers are primary therapy only for thyroiditis and iodine-induced hyperthyroidism. 

Due to the high relapse rate following acute therapy for C. neoformans, AIDS patients require lifelong maintenance or suppressive therapy. The standard of care for AIDS-associated cryptococcal meningitis is primary therapy, generally using amphotericin B with or without flucytosine followed by maintenance therapy with fluconazole for the fife of the patient. 

Relapse of C. neoformans meningitis occurs in approximately 50% of AIDS patients after completion of primary therapy. Fluconazole (200 mg daily)... 

Voriconazole is the drug of choice for primary therapy of most patients with aspergillosis since it provided improved survival and fewer side effects. 

Breast-conserving therapy (BCT) is appropriate primary therapy for most women with stage I and II disease it is preferable to modified radical mastectomy because it produces equivalent survival rates with cosmetically superior results. BCT consists of lumpectomy (i.e., excision of the primary tumor and adjacent breast tissue) followed by radiation therapy (RT) to prevent local recurrence. 

Radiation therapy is used as primary therapy in stages I and II if the patient refuses surgery, the tumor is unresectable, or the patient is not a good surgical candidate. 

Leishmaniasis For treatment of visceral leishmaniasis (liposomal only) treatment of American mucocutaneous leishmaniasis but not as primary therapy (deoxycholate). Unlabeled uses Prophylaxis for fungal infection in patients with bone marrow transplantation (0.1 mg/kg/day). 

Amphotericin B deoxycholate (eg, Fungizone) - 0.5 mg/kg/day administered on alternate days for 14 doses has been effective but is not recommended as primary therapy. 

Lactation Because no information is available on the excretion of ethionamide in breast milk, administer to nursing mothers only if the benefits outweigh the risks. Children Investigations have been limited do not use in pediatric patients younger than 12 years of age except when the organisms are definitely resistant to primary therapy and systemic dissemination of the disease, or other life-threatening complications of tuberculosis, is judged to be imminent. 

The feasibility of concomitant chemoradiotherapy has been evaluated in numerous studies in esophageal cancer, given either as preoperative treatment or as primary therapy. In most of these studies, fluorouracil was an integral part of the chemotherapy regimen. Byfield et al. (74) evaluated the efficacy of 5-FU infusion (for 5 d) and 10 Gy of radiation... 

Vokes EE, Kies MS, Haraf DJ, et al. Concomitant chemoradiotherapy as primary therapy for locoregionally advanced head and neck cancer. J Clin Oncol 2000 18 1652-1661. 

Based on these presumptions, during the past decade we have tested in two prospective Phase I-II clinical trials the role of concurrent chemo-RT as the primary therapy in LABC. In both trials pretreatment biopsies of the tumor were included in the study design to explore correlations between original molecular markers and the extent of pathological response achieved at surgery, after chemo-RT. 

The first implantable cardioverter-defibrillator (ICD) was placed in 1982. Since that time, their use has expanded exponentially. Several large clinical trials have demonstrated the superiority of ICDs compared with pharmacological therapy for the secondary prevention of arrhythmic death and possibly as primary therapy for patients at risk for ventricular arrhythmias. 

Powders generally used as adjunctive therapy, but may be acceptable as primary therapy in very mild cases... 

Colorectal cancer (CRC) is the third most common cause of cancer-related death in women and men in the United States (4). Although surgical resection is the primary therapy for CRC, prognosis remains poor and not all patients are candidates for surgery. The current therapeutic options for patients with metastatic CRC (mCRC) are 5-fluorouracil (5-FU) based therapy regimens in combination with irinotecan (CPT-11) or oxaliplatin (5,6). 

Therapists who are treating patients with Parkinson disease usually wish to coordinate the therapy session with the peak effects of drug therapy. In patients receiving levodopa, this usually occurs approximately 1 hour after a dose of the medication has been taken. If possible, scheduling the primary therapy session in elderly patients after the breakfast dose of levodopa often yields optimal effects from the standpoint of both maximal drug efficacy and low fatigue levels. 

Goldhirsch A et al (2007) Progress and promise highlights of the international expert consensus on the primary therapy of early breast cancer 2007. Ann Oncol 18 1133-1144... 

Which of the following patients is most suited for primary therapy with hydrochlorothiazide ... 

Bacterial enterocolitis, caused by invasive organisms, including Salmonella, Shigella, and Campylobacter do not use as primary therapy... 

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