Expert opinion on drug metabolism & toxicology
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Expert Opin Drug Metab Toxicol · Jan 2015
ReviewDosing of rivaroxaban by indication: getting the right dose for the patient.
Vitamin K antagonists were the only oral anticoagulants available for several decades, but they require frequent coagulation monitoring and dose adjustment. The direct oral anticoagulants rivaroxaban , dabigatran, apixaban, and, most recently, edoxaban have been approved for the management of specific thromboembolic indications. ⋯ Education on pharmacokinetic/pharmacodynamic characteristics, as well as how to manage adverse events, is needed to increase physician knowledge and confidence in using direct oral anticoagulants, as specifically discussed for rivaroxaban in this article. The continued uptake of direct oral anticoagulants in clinical practice depends on understanding of the clinical evidence and reassurance provided by emerging real-world data.
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Expert Opin Drug Metab Toxicol · Jan 2015
ReviewManagement of pulmonary toxicity associated with targeted anticancer therapies.
Targeted anticancer therapies act by interfering with defined molecular entities and/or biologic pathways. Because of their more specific mechanism of action, adverse events (AEs) on healthy tissues are intended to be minimal, resulting in a different toxicity profile from that observed with conventional cytotoxic chemotherapy. Pulmonary AEs are rare but potentially life-threatening and it is, therefore, critical to recognize early on and manage appropriately. ⋯ Novel agents used in the treatment of cancer have specific side-effects, the result of allergic reactions, on-target and off-target effects. Clinical syndromes associated with pulmonary toxicity vary from bronchospasms, hypersensitivity reactions, pneumonitis, acute respiratory distress, lung bleeding, pleural effusion to pneumothorax. Knowledge of risk factors, a high index of suspicion and a complete diagnostic work-up are essential for limiting the risk of these events becoming life threatening. The development of treatment algorithms is extremely helpful in managing these events. It is probable that these toxicities will be even more frequent with the introduction of combination therapies with the obvious challenge of discerning the responsible agent.
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Expert Opin Drug Metab Toxicol · Jan 2015
Review Comparative StudyPharmacodynamics and clinical efficacy of fentanyl iontophoretic transdermal system for post-operative pain in hospitalized patients.
The fentanyl iontophoretic transdermal system (ITS) is a patient-controlled transdermal system allowing needle-free administration of on-demand doses of Fentanyl of 40 µg over a 10-min period up to 80 doses or over a 24-h period. It is indicated in opioid naïve patients for the treatment of acute postoperative pain in the hospitalized patients for up to 72 h. ⋯ Fentanyl ITS has shown high patient satisfaction rates, and was described by patients and investigators as easy and convenient to use. These properties make this technology interesting when considering perioperative pain management. In the present health care environment additional data are required to establish the cost-benefit ratio of this technology in optimizing patient's recovery from surgery.
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Clinicians use antiemetic drugs in a multitude of scenarios. Despite the differences in subspecialty and etiology of the nausea, practitioners of all subspecialties use the same drugs in similar ways to provide relief for their patients. ⋯ The key to providing relief for patients suffering from nausea and vomiting is to consider multiple drugs to approach the nausea in a systematic way. Anesthesiologists identify patients who are at high risk of nausea and vomiting based on physical characteristics and surgical procedures. Oncologists treat nausea based on the prescribed chemotherapeutics regimen and known risk of emesis while palliative care physicians and others balance the etiology of the nausea while optimizing patients other co morbid conditions.
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Expert Opin Drug Metab Toxicol · Jan 2015
Unique pharmacology of tapentadol for treating acute and chronic pain.
Even though pain is a complex process involving many different mediators, enzymes, receptors and ion channels, pain medications usually address only individual targets. Nucynta, which addresses multiple pain targets, was the first new centrally acting analgesic to be approved by the FDA in 2008. ⋯ Although future improved, well-designed prospective, randomized double-blind controlled studies are needed to determine both the relative efficacy of tapentadol and its safety, we believe that tapentadol has the potential to become a uniquely suited opioid medication in the multi-modal management of moderate-to-severe acute and chronic pain conditions.