Symptomatic agents

At this writing anticholinergic agents are not widely used for the symptomatic treatment of asthma, although compounds such as atropine [51 -55-8] C17H23NO3, (18) have been used for centuries (111). Inhalation of the smoke produced by burning herbal mixtures, such as Datura Stramonium provided bronchodilation and rehef from some of the symptoms of asthma. The major active component in these preparations was atropine or other closely related alkaloids (qv). 

Magnesium sahcylate, an analgesic and antiinflammatory agent, appears to have exceptional abihty to reheve backaches. It is also used for the symptomatic rehef of arthritis. Magnesium sahcylate is prepared in a similar manner as sodium sahcylate, using the appropriate magnesium carbonate salt. 

Treatment for chronic benzene poisoning is supportive and symptomatic, with chemotherapy and bone marrow transplants as therapeutic agents for leukemia and aplastic anemia (127). 

Vesicant agents, such as mustard, require no special treatment once the bums have occurred. Copious washing is quite effective when used early for Hquid contamination of the eyes, and soap and water removes the Hquid agent from the skin. Bums resulting from mustard agent are treated like any other severe bum. The pulmonary injuries are treated symptomatically antibiotics are used only if indicated for the control of infection. 

Antacids are neutralizing agents. Examples are magnesium hydroxide, magnesium trisylicate and aluminium hydroxide. Prior to the introduction of histamine-H2 receptor antagonists and proton pump inhibitors, they were the standard drugs for the treatment of duodenal/ peptic ulcers. Today their clinical use is limited to the treatment of dyspepsia and the symptomatic relieve for patients with peptic ulcers. 

Treatment with 3-blockers, verapamil, or diltiazem can usually be continued in patients with asymptomatic bradycardia. However, reduce or discontinue treatment with these agents in patients who develop symptomatic bradycardia or serious conduction abnormalities. 

A number of non-hormonal therapies have been studied for symptomatic management of vasomotor symptoms, including antidepressants [e.g., selective serotonin reuptake inhibitors (SSRIs) and venlafaxine], herbal products (e.g., soy, black cohosh, and dong quai), and a group of miscellaneous agents (e.g., gabapentin, clonidine, and megestrol). The choice of therapy depends on the patient s concomitant disease states, such as depression and hypertension, and the risk for potential adverse effects. 

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. 

The National Comprehensive Cancer Network (NCCN) recommends an anemia work-up for patients with hemoglobin of less than 11 g/dL (110 g/L or 6.8 mmol/L). Patients who are symptomatic or asymptomatic with significant risk factors (e.g., extensive transfusion history, myelosuppressive chemotherapy, etc) may qualify for treatment with erythropoietic agents such as epoetin-alfa or darbepoetin. Data do not support the use of one agent over another they are both equally effective in treating this type of anemia.12 Table 63-4 provides dosing recommendations for chemotherapy-related anemia. 

D/C offending agents symptomatic management of pancreatits—bowel rest, IV hydration, pain control, gradual resumption of oral intake... 

Mild to moderate rash symptomatic treatment with antihistamine and continuation of offending agent ... 

Patients who present with symptomatic disease will be started on therapy. Two regimens used are VAD and melphalan and prednisone (MP). VAD like chemotherapy regimens are used most often in transplant candidates because it avoids the alkylating agent melphalan, thus minimizing damage to the stem cell compartment. These two regimens produce equivalent response rates of approximately 50% to 70% in previously untreated patients with myeloma (see Table 93-4).35>36... 

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