Clinical pharmacy
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Review Practice Guideline Comparative Study Guideline
Acute pain management: operative or medical procedures and trauma, Part 1. Agency for Health Care Policy and Research.
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The pathophysiology, assessment, and pharmacologic management of acute pain in infants and children are reviewed, and the mechanism of action, pharmacokinetics, clinical efficacy, adverse effects, and dosages of opioid analgesics, nonopioid analgesics, and local anesthetics used for regional blocks are discussed. The pathophysiology of pain and the physiologic rationale for treatment of pain are similar in children and adults. Severe pain can be controlled by i.v. or epidural administration of opioid analgesics. ⋯ Topical application of local anesthetics is effective for many minor procedures. A variety of pain management techniques are available for the management of acute pain in pediatric patients. The development of drugs having fewer adverse effects and noninvasive administration techniques will be important research priorities in the coming years.
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Randomized Controlled Trial Clinical Trial
Effect of lidocaine-prilocaine cream on pain from subcutaneous injection.
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Review Case Reports
Management of glucose abnormalities in patients receiving total parenteral nutrition.
A patient who developed extreme fluctuations in serum glucose concentrations while receiving total parenteral nutrition (TPN) is described, and etiologies of hyperglycemia and hypoglycemia, as well as a rational approach to preventing and managing these disorders in patients receiving TPN, are presented. A 40-year-old white man with a 29-year history of insulin-dependent diabetes mellitus was hospitalized after he had an episode of rejection related to a cadaveric kidney transplant. During the hospitalization, his right leg was amputated because of cellulitis, and he developed septicemia with respiratory failure. ⋯ Patients receiving parenteral nutrition are subject to widely varying serum glucose concentrations related not only to the nutrition support provided but also to various underlying metabolic and physiologic complications commonly present. Common etiologies of, and ways to prevent and manage, hypoglycemia and hyperglycemia are reviewed. Clinicians should be aware of the risk of hyperglycemia and hypoglycemia in patients receiving TPN and monitor patients appropriately for alterations in glucose homeostasis.
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Three patients who developed torsade de pointes associated with antiarrhythmic or psychotropic drugs are described, and the electrocardiographic characteristics, clinical presentation, predisposing factors, and management of this form of ventricular tachycardia are reviewed. The first patient was a 56-year-old schizophrenic man receiving thioridazine hydrochloride, trifluoperazine hydrochloride, and benztropine mesylate who was admitted to a hospital after a syncopal episode. Subsequently, the patient experienced several episodes of ventricular tachycardia combined with multifocal premature ventricular contractions (PVCs) and torsade de pointes; the arrhythmias were attributed to antipsychotic therapy. ⋯ Potassium and magnesium repletion appear to be essential in abolishing drug-induced torsade de pointes. Drug-induced torsade de pointes is best prevented by avoiding agents known to induce arrhythmias in patients with a pre-existing prolonged QT interval. Periodic serum electrolyte assessment is warranted, and new drugs that prolong the QT interval should be considered potential causative agents of torsade de pointes.