British journal of clinical pharmacology
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Br J Clin Pharmacol · Mar 2011
ReviewClinical pharmacology of analgesic medicines in older people: impact of frailty and cognitive impairment.
Pain is highly prevalent in frail older people who often have multiple co-morbidities and multiple medicines. Rational prescribing of analgesics in frail older people is complex due to heterogeneity in drug disposition, comorbid medical conditions, polypharmacy and variability in analgesic response in this population. ⋯ People living with dementia and cognitive impairment have suboptimal pain relief which in part may be related to altered pharmacodynamics of analgesics and challenges in the systematic assessment of pain intensity in this patient group. In the absence of rigorously controlled trials in frail older people and those with cognitive impairment a pharmacologically-guided approach can be used to optimize pain management which requires a systematic understanding of the pharmacokinetics and pharmacodynamics of analgesics in frail older people with or without changes in cognition.
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Br J Clin Pharmacol · Mar 2011
Randomized Controlled TrialTranscutaneous nicotine does not prevent postoperative nausea and vomiting: a randomized controlled trial.
There is empirical evidence that smokers are less likely to suffer from postoperative nausea and vomiting (PONV). We sought to investigate whether transcutaneus nicotine prevents PONV. ⋯ Non-smokers receiving a prophylactic nicotine patch had a similar incidence of PONV during the first 24h and tended to develop PONV symptoms earlier compared with controls. They had a significantly increased risk of insomnia during the first postoperative night.
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Br J Clin Pharmacol · Feb 2011
Overdose pattern and outcome in paracetamol-induced acute severe hepatotoxicity.
Paracetamol (acetaminophen) hepatotoxicity is the commonest cause of acute liver failure (ALF) in the UK. Conflicting data regarding the outcomes of paracetamol-induced ALF resulting from different overdose patterns are reported. ⋯ Unintentional paracetamol overdose is associated with increased mortality compared with intentional paracetamol overdose, despite lower admission paracetamol concentrations. Alternative prognostic criteria may be required for unintentional paracetamol overdoses.
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Br J Clin Pharmacol · Jan 2011
Randomized Controlled Trial Comparative StudyComparative evaluation of atracurium dosed on ideal body weight vs. total body weight in morbidly obese patients.
Different conflicting reports have been published for the use of atracurium in morbidly obese patients. Dosing of atracurium based on lean body mass, total body weight, and total body weight with a dose reduction for every 10 kg more than 70 kg have been proposed. ⋯ In morbid obesity (112-260 kg), atracurium 0.5 mg kg(-1) ideal body weight results in a predictable profile of muscle relaxation allowing for adequate intubation conditions and recovery of muscle strength to a TOF ratio >90% within 60 min with lack of need for antagonism. A dose-dependent prolongation of action is shown when dosing is based on total body weight.
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Br J Clin Pharmacol · Jan 2011
Randomized Controlled TrialImpact of a focussed teaching programme on practical prescribing skills among final year medical students.
Medication errors, and particularly prescribing errors, are common in UK hospitals. Junior doctors make the majority of prescribing errors. Deficiencies in prescribing education and training have been closely linked to the high frequency of medication errors. ⋯ Medical students make significant errors in prescribing. Teaching improves ability and confidence but is insufficient alone in eradicating errors.