Pharmacotherapy
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Conditions in which antidepressants have been used include diabetic neuropathy, postherpetic neuralgia, headaches, arthritis, chronic back pain, cancer, thalamic pain, facial pain, and phantom limb pain. Although much of the available information is derived from inadequately controlled trials, it seems that antidepressants provide analgesia in many of these disorders. The analgesic effects tend to be independent of antidepressant effects, and doses of heterocyclic antidepressants used for analgesia seem to be lower than those considered effective in the treatment of depression. ⋯ Onset of analgesia is variable, ranging from 1 day to 10 weeks. Common side effects include dry mouth, drowsiness, urinary retention, orthostatic hypotension, and constipation. Optimum dosages and schedules have not been established.
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Review Multicenter Study Clinical Trial
Acylated plasminogen-streptokinase activator complex: a new approach to thrombolytic therapy.
Acylated plasminogen-streptokinase activator complex (APSAC; antistreplase) is an inactive complex of human plasminogen and streptokinase. When it is injected, a controlled deacylation of the catalytic center occurs, activating the complex so that thrombolysis may begin. This process extends the half-life of streptokinase, allowing for 4-6 hours of fibrinolytic activity. ⋯ Serious bleeding reactions are uncommon, with the frequency of cerebrovascular accident reported at 0.4-0.6%. The special advantage of anistreplase is its administration as a 30-U intravenous bolus injected over 5 minutes, eliminating the need for long infusions and increasing the ease of administration. Based on its efficacy and ease of administration, anistreplase may become the drug of choice in the emergency treatment of acute myocardial infarction.
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Cancer chemotherapy is associated with numerous toxicities such as nausea and vomiting (emesis). The frequency, onset, and duration of emesis depend largely on the emetogenic potential of specific agents. An exact mechanism for chemotherapy-induced emesis (CIE) is not known but is thought to occur through several noxious actions and numerous neuronal pathways. ⋯ Investigational agents such as serotonin antagonists may prove to be effective with few toxic effects. Despite the minimal information available on delayed and anticipatory nausea and vomiting, attempts should be made to treat them. Suggested guidelines for the management of CIE have been developed.