Specific Therapy

In certain disorders, such as AD and PD, neurodegeneration leads to deficiencies in specific neurotransmitters. Therapy has been targeted at replacing or increasing levels of the deficient neurotransmitter in patients. Disease specific therapy of this 

Individually, the cholinesterase inhibitors improve memory in patients with AD. There have been no head-to-head comparisons made of the drugs to determine w hether one is more effective than the others and no trials of agents in combination. The main know n differences are the side effect profiles, titration schedules and the dosing regimens (Table 39.1). The most common side effects of treatment with cholinesterase inhibitors are gastrointestinal and include nausea, vomiting and diarrhea. A meta-analysis of the efficacy and safety of these agents revealed that despite many clinical studies show ing 

As in AD, knowdedge of the neurotransmitter deficiency underlying PD, in this case dopamine, has been the basis for the development of therapy. Early studies show ed that cerebral dopamine was concentrated in the shiatum and that levodopa, the precursor to dopamine, could reverse the akinetic effects of the dopamine-depleting agent reserpine in experimental animals (Carlsson et al., 1957, 1958). Eventually, the identification of shiatal dopamine depletion as a key neurochemical finding in parkinsonian brains lead to heatment wdth levodopa in humans and to the subsequent advent of compounds that mimic the effects of dopamine or prolong its action (Table 39.2). 

Carbidopa/levod opa 25mg/300mg - 200mg/2,000mg per day 

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In order to effectively treat respiratory acidosis, the causative process must be identified and treated. If a cause is identified, specific therapy should be started. This may include naloxone for opiate-induced hypoventilation or bronchodilator therapy for acute bronchospasm. Because respiratory acidosis represents ventilatory failure, an increase in... 

It is imperative to identify serious causes of respiratory alkalosis and institute effective treatment. In spontaneously breathing patients, respiratory alkalosis is typically only mild or moderate in severity and no specific therapy is indicated. Severe alkalosis generally represents respiratory acidosis imposed on metabolic alkalosis and may improve with sedation. Patients receiving mechanical ventilation are treated with reduced minute ventilation achieved by decreasing the respiratory rate and/or tidal volume. If the alkalosis persists in the ventilated patient, high-level sedation or paralysis is effective. 

The triptans are considered specific therapies in that they target the pathophysiology underlying migraine.33 They abort headache through beneficial effects on neuronal imbalances.11 Triptans inhibit neurotransmission in the trigeminal complex and activate serotonin lb/Id pathways that modulate nociception in the brain stem. They also decrease the release of vasoactive peptides leading to vascular reactivity and pain.34 Triptans are a welcome addition to the therapeutic armamentarium in that they are available in intranasal, subcutaneous, and oral... 

After a diagnosis is made, institute specific therapy. 

Hereditary triose phosphate isomerase (TPI) deficiency is an autosomal recessive disorder that has the most severe clinical manifestations of the erythroenzy-mopathies, including hemolytic anemia, neurological dysfunction, sudden cardiac death, and increased susceptibility to infection. Since the first description by Schneider et al. (S10), more than 25 unrelated families have been reported (Fll). Cases of decreased TPI activities associated with cat cry syndrome and pancytopenia were reported, whereas the correlation between TPI deficiency and these disorders was not clear. Although the degree of anemia is variable, most patients require blood transfusions. Neurological involvement, such as paraparesis, weakness, and hypotonia, is progressive in most cases. No specific therapy is available for the neuropathic manifestations of the disease, and most severely affected children fail to survive beyond the age of 5 years. 

A deeper understanding of the molecular mechanisms underlying tobacco addiction will lead to the identification of different types of smokers. Classifying smokers according to the underlying biological processes involved in their addiction will lead to new treatments for tobacco dependence. Patient-specific therapy with both choice of treatment and dose of drug informed by DNA analysis seems likely to be more effective than conventional therapy with fewer unwanted effects. 

When AAD is mild, the best first step is to discontinue the inciting antibiotics. Most cases will resolve spontaneously. Some advocate restriction of dietary carbohydrate as well [60], More serious cases require specific therapy against the pathogen. Antidiarrheals and opiates should be avoided. 

Treatment for nonketotic hyperglycinemia is less effective than that available for other aminoacidurias. There is no specific therapy. Exchange transfusion and dialysis usually do not alter the progressive neurological deterioration. Sodium benzoate has been administered in the hope that glycine would react with it to form hippuric acid, but this approach is not helpful. It may be that a combination of benzoate and carnitine therapy is more effective [28]. Similarly, the restriction of dietary protein... 

Clinical findings include mental retardation, severe metabolic acidosis, and evidence of a spastic quadripare-sis and cerebellar disease. Some patients develop normally until late childhood, when a progressive loss of intellectual function became appreciated. Patients also may manifest a mild hemolysis. Pathological changes have included atrophy of the cerebellum and lesions in the cortex and thalamus. There is no specific therapy. 

Treatment. Treatment for dystonia is for the most part symptomatic, except in rare instances where known mechanisms are present and specific therapies are available. The available treatments include support and rehabilitation, pharmacotherapy and, in some cases, functional neurosurgery. Sensory retraining in humans with focal dystonias has resulted in a substantial recovery of function in some patients. 

No specific therapy is available for the management of acute HBV infection. Some patients with chronic HBV infection should be treated. A suggested treatment algorithm for chronic HBV is as shown for patients without (Fig. 25-1) and with cirrhosis (Fig. 25-2). 

Treatment of hemolytic anemia should focus on correcting the underlying cause. There is no specific therapy for glucose-6-phosphate dehydrogenase deficiency, so treatment consists of avoiding oxidant medications and chemicals. Steroids, other immunosuppressants, and even splenectomy can be indicated to reduce RBC destruction. 

Mechanism of 2,3,7,8-TCDD was not established so far means of specific therapy as to this compound poisoning are not available. Experiments with animals have shown that activated carbon, zeolite (subject to introduction of sorbents immediately after poison), unithiol, Liv-52, carsil, festal, guaranteed survival of 20-50% laboratory rats [6],... 

The specific therapy consists in concurrent use of two antidotes differing by mechanism of action cholinolytics eliminating anticholinesterase effects on CNS, and cholinesterase reactivators (ChR) ensuring the restoration of inhibited enzymatic activity. 

Treatment (See Inhalational Anthrax Treatment Protocol at http //www.cdc.gov/ mmwr/preview/mmwrhtinl/m in5042al.htm for specific therapy)... 

Chronic diarrhea is likely to result in a disturbance of water and salt balance. This has been shown to be so in the malabsorption syndrome (C9, F5). These changes, especially potassium deficiency, may cause some aggravation of the intestinal situation and increase of abdominal distension. Some improvement in absorption may consequently occur on appropriate rehabilitation. However, a residual defect of absorption will remain until more specific therapy is instituted. 

A Standard Template dynamic model incorporates aspects of Patient Flow dynamics. Doctor Adoption of newly-release pharmaceuticals, and Treatment Attractiveness metrics of indication-specific therapies. 

Hypotension If hypotension/hypoperfusion occurs, place the patient in shock position (head lowered, feet elevated) specific therapy may include ... 

Results with Surgery and Radiation Therapy Trials of Chemotherapeutic Agents Recursive Partitioning Analysis Specific Therapy Considerations in non-GBM Malignant Gliomas Radiation Therapy Strategies Novel Chemotherapeutic Agents Future Directions References... 

Also when the cytokine interleukin 2 (IL-2) was used for cancer treatment, serious adverse effects were noted resulting in the so-called vascular leak syndrome (VLS) [98, 99]. VLS is a life-threatening toxicity marked by vasopermeability with hypotension induced during high dose IL-2 treatment of cancer patients [100]. VLS is caused by endothelial activation and can be induced in lungs and liver of mice by IL2 administration [99]. The mechanism of IL-2-induced VLS is still poorly understood and at present there is no specific therapy for VLS. For the investigation of these... 

Why are cancer cells attractive candidates for gene-specific therapies ... 

Still, we believe that widespread use of monoclonal antibodies in CSF immuno-cytology in tumor disease as part of the arsenal of routine techniques of examination will markedly improve the prognosis of patients because it offers the possibility of establishing the diagnosis early and prompt initiation of specific therapy. 

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