Biomedical subjects
Publications and source records attributed to E Gysling.
Many reliable drug information resources are now available free via the internet. The websites selected for this synopsis are apt to help the busy practitioner in his or her decision on an individualised drug therapy.
Generics are pharmaceutical products containing the same active substance as an original branded medication. Generics are used in order to reduce the cost of pharmacotherapy. They have to be bioequivalent to the original drug-their mean "area under the curve" (AUC) should not deviate from the AUC of the original by more than 20 per cent. One generic is not necessarily bioequivalent to another generic. It is therefore highly questionable whether an original drug should be replaced by a no-name generic. From a medical point of view only branded generics should be prescribed. "Generics-related" conflicts can be minimized through tight cooperation between hospitals, physicians in ambulatory practice and pharmacies. Generic drugs should never be used if a better but non-generic medication is available.
Because of their high morbidity and mortality, elderly people benefit most from drugs with a proven effect on disease complications and premature death. Thiazides, beta adrenergic blocking drugs, oral anticoagulants and aspirin are drugs that satisfy such criteria. These medications are comparatively well tolerated and cheap. They should not be neglected in favour of newer drugs with a less complete performance record.
A 48-year-old man with accelerated hypertension developed right-sided ischemic colitis. There was no evidence of another cause of vascular inadequacy. Microscopically, the bowel showed ischemic alterations of different stages. The arterial alterations of different stages. The arterial vessels showed minimal changes. In older lesions, fibrosis was prominent and the mucosa was atrophic. In more recent lesions, some vessels of the submucosa were plugged with fibrin and the overlying mucosa was infiltrated by nonorganized hemorrhage and cellular elements.
Plasma renin activity (PRA) was studied before and during long-term treatment with moderate oral doses (0.2 or 0.3 mg/d) of clonidine. Nine outpatients with essential hypertension received clonidine for 12 weeks; a significant decrease in blood pressure was evident in all patients. Except for a nonsignificant increase after 12 weeks of treatment, PRA values were not notably changed by clonidine therapy. No correlation was found between individual blood pressure changes and PRA variation during the study. The absence of a net effect on PRA in this study does not exclude more complex interactions of clonidine with the renin-angiotensin system. Nonetheless, clonidine cannot generally be classified as a "renin-inhibiting" drug.
During the first phase of a drug study, 33 hypertensive patients received 2 placebo tablets daily for 2 weeks as the sole treatment. Analysis of the blood pressure readings during this placebo phase shows that the study in itself creates a psychological climate which tends to decrease blood pressure. This effect should be taken into account when analyzing results of drug studies; only in studies with a double blind design is drug effect adequately judged.
In Switzerland the relative therapeutic value of various drugs (e.g. pyrazolone analgesics, phenacetin, clindamycine, clioquinol) is placed demonstrably higher than in Canada. In Canada, rare but possibly dangerous complications of drug therapy are considered to be of greater importance. Two factors might be responsible for these differences: 1. Compared with similar publications in Canada, drug advertisements in Swiss medical journals contain fewer warnings of untoward effects. This can be interpreted as an "information lag". 2. Since the link between an untoward effect and a drug is very difficult to establish with absolute certainty, it may be concluded that the drug is relatively inoffensive. This conclusion is drawn more often in Switzerland than in Canada. Uniformization of the way in which the physician is presented with information concerning untoward drug effects would be an important step towards the establishment of internationally accepted standards of drug therapeutic value.
All drug effects can be explained as results of complex interactions between the drug, the patient and his condition, and additional extrinsic factors. On the basis of these three "determinants", a practical classification of untoward drug effects (UDE) is suggested. UDE lists using this classification would fulfill the physician's informational needs better than the material with which he is presently provided.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.