Rate control therapy

Sjitgren, Rate Control in Drug Therapy ChurchiU Livingstone, Edinburgh, 1985, pp. 38—47. 

Expert opinion is a source, frequently elicited by survey, that is used to obtain information where no or few data are available. For example, in our experience with a multicountry evaluation of health care resource utilization in atrial fibrillation, very few country-specific published data were available on this subject. Thus the decision-analytic model was supplemented with data from a physician expert panel survey to determine initial management approach (rate control vs. cardioversion) first-, second-, and third-line agents doses and durations of therapy type and frequency of studies that would be performed to initiate and monitor therapy type and frequency of adverse events, by body system and the resources used to manage them place of treatment and adverse consequences of lack of atrial fibrillation control and cost of these consequences, for example, stroke, congestive heart failure. This method may also be used in testing the robustness of the analysis [30]. 

Antiarrhythmic drug therapy for maintenance of sinus rhythm/reduction in frequency of episodes of AF should be initiated only in patients in whom symptoms persist despite maximal doses of drugs for ventricular rate control. 

The goals of therapy ofAF are (1) ventricular rate control ... 

FIGURE 6-5. Decision algorithm for ventricular rate control using intravenous drug therapy for patients presenting with the first detected episode or an episode of persistent atrial fibrillation that is hemody-namically stable. 

FIGURE 6-6. Decision algorithm for long-term ventricular rate control with oral drug therapy for patients with paroxysmal or permanent atrial fibrillation, bpm, beats per minute CCB, calcium channel blocker (diltiazem or verapamil) HF, heart failure LV, left ventricular function LVEF, left ventricular ejection fraction. (Algorithm adapted with permission from Tisdale JE, Moser LR. Tachyarrhythmias. In Mueller BA, Bertch KE, Dunsworth TS, et al. (eds.) Pharmacotherapy Self-Assessment Program, 4th ed. Kansas City American College of Clinical Pharmacy 2001 ... 

In recent years, numerous studies have been performed to determine whether drug therapy for maintenance of sinus rhythm is preferred to drug therapy for ventricular rate control.28-31 In these studies, patients have been assigned randomly to receive therapy either with drugs for rate control or with drugs for rhythm control (Table 6-8). These studies have found... 

Monitor and maintain PEF above 80% of personal best PEF variability should be less than 20%. Patients with PEF rates consistently greater than 80% over several months should be evaluated for a step down in long-term control therapy. Patients with a PEF less than 80% of personal best should begin to monitor PEF twice daily and consult their asthma action plan. Patients with a PEF less than 50% of personal best should immediately use their short-acting inhaled 32-agonist and consult their asthma action plan. 

L. Z. Benet and B. Hoener, Pathological limitations in the application of rate control systems, in Proceeding of the 2nd International Conference of Drug Absorption Rate Control in Drug Therapy, (L. Prescott, ed.), Edinburgh, 1983, pp. 155-165. 

AT Florence. Rate Control in Drug Therapy, Edinburgh Churchill Livingston, 1985, p 103. 

Inhaled corticosteroids are the preferred long-term control therapy for persistent asthma in all patients because of their potency and consistent effectiveness they are also the only therapy shown to reduce the risk of death from asthma. Comparative doses are included in Table 80-3. Most patients with moderate disease can be controlled with twice-daily dosing some products have once-daily dosing indications. Patients with more severe disease require multiple daily dosing. Because the inflammatory response of asthma inhibits steroid receptor binding, patients should be started on higher and more frequent doses and then tapered down once control has been achieved. The response to inhaled corticosteroids is delayed symptoms improve in most patients within the first 1 to 2 weeks and reach maximum improvement in 4 to 8 weeks. Maximum improvement in FEVj and PEF rates may require 3 to 6 weeks. 

Breimer, D.D., et al. 1985. Rate controlled rectal drug delivery. In Rate control in drug therapy, eds. L.F. Prescott, and W.S. Nimmo, 54. Edinburgh Churchill Livingstone. 

Mrs GG is over 65 and has persistent or permanent AF so should be considered for rate control of her AF. She is also over 75 but does not have additional risk factors such as hypertension, diabetes or vascular disease so should be considered for aspirin therapy before warfarin therapy. If she is considered for cardioversion then warfarin would be appropriate. 

NICE provides very good treatment algorithms for rhythm control, rate control, management of the various types of AF and assessing stroke risk to determine appropriate antithrombotic therapy that aid treatment decisions. 

The sustained release of artificial tears has been achieved by a hydroxypropylcel-lulose polymer insert [77], However, the best known application of diffusional therapy in the eye, Ocusert-Pilo, as shown in Figure 7, is a relatively simple structure with two rate-controlling membranes surrounding the drug reservoir containing... 

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