Clinical therapeutics
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Clinical therapeutics · Sep 1995
ReviewA review of the causes and treatment of bacterial and allergic conjunctivitis.
The most common causes of ocular inflammation are allergic or infectious in origin. A presumptive diagnosis can often be made through a comprehensive patient history and evaluation of presenting signs and symptoms, although the constellation and intensity of clinical findings may vary. Patients with allergic conjunctivitis often have itchy, red eyes, whereas patients with bacterial conjunctivitis often give a history of morning crusting and difficulty opening the eyelids. ⋯ Staphylococcus species is the predominant organism in adults. Therefore, the treatment of patients with bacterial conjunctivitis consists of an antimicrobial agent with a broad spectrum of activity against most susceptible pathogens. Other causes of inflammation need to be considered in patients with atypical clinical signs and symptoms and in patients who do not respond to presumptive therapy.
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Pain is the most common symptom experienced in patients with advanced cancer. This pain may be acute, chronic, or intermittent, and often has a definable origin, usually related to tumor recurrence and treatment. The goal of therapy is to provide patients with enough pain relief to enable them to tolerate diagnostic and therapeutic manipulations and allow them freedom of movement and choice, while limiting medication-induced adverse effects. ⋯ Morphine can also be administered subcutaneously, intravenously, and rectally, which provides enhanced flexibility for dosing patients unable to take oral medications. The transdermal fentanyl patch may provide a convenient dosage-form alternative if oral morphine preparations are not tolerated. Some patients with advanced cancer may require other adjunctive medications such as nonsteroidal anti-inflammatory agents, tricyclic antidepressants, steroids, or benzodiazepines, as well as psychologic techniques, to assist in pain management.
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The literature on the pharmacologic treatment of schizophrenia and schizoaffective disorders is reviewed (116 references). All clinically active antipsychotic drugs share the ability to block postsynaptic dopamine receptors in the central nervous system. Their potencies vary, chlorpromazine and thioridazine being the least potent and fluphenazine and haloperidol the most potent. ⋯ Their effects are more pronounced on the positive symptoms of schizophrenia, such as hallucinations, delusions, disordered thinking, and paranoia, than on the negative symptoms, such as deficits in social interaction, emotional expression, and motivation. Strategies for acute and maintenance treatment and for the management of treatment-resistant patients are reviewed. The pharmacology and clinical use of the newer atypical neuroleptics, particularly clozapine, and their adverse effects are discussed.
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Clinical therapeutics · Jan 1983
ReviewManagement of the pregnant patient with chronic hypertension.
Once the diagnosis of chronic hypertension in pregnancy has been made, many centers in the United States treat moderate to severe cases of chronic hypertension pharmacologically, hoping to delay or obviate the onset of superimposed preeclampsia and to improve perinatal outcome. Methyldopa, which is most often used, is the only antihypertensive drug for which there is no evidence of adverse effects in long-term follow-up studies of fetuses exposed to it. ⋯ These newer drugs have fewer maternal side effects and, as yet, no adverse effects on fetuses have been seen. Clinical trials of labetalol will soon start in the United States.