Biomedical subjects

G E Pakes

Publications and source records attributed to G E Pakes.

At least 37 records · Page 2Linked to original sources

PubMed1980

Nefopam: a review of its pharmacological properties and therapeutic efficacy.

Nefopam is a non-narcotic analgesic not structurally related to other analgesic drugs. It is effective by the oral and parenteral routes, and when appropriate dose ratios were compared in short term studies it was shown to produce analgesia comparable to that with the oral analgesics aspirin, dextropropoxyphene and pentazocine, as well as that with 'moderate' doses of parenteral morphine, pethidine and pentazocine. However, when 'higher' dose ratios were compared, morphine and pethidine were usually more effective than nefopam, possibly due to a 'ceiling effect' for analgesia which may occur with higher doses of nefopam, as with other simple analgesics. Although a few patients with chronic pain have received nefopam for several weeks, further studies are needed to clarify its continued effectiveness and safety when used over long periods. In most patients nefopam has been relatively well tolerated, the most frequent side effects being sweating, nausea and in some studies sedation.

Administration, Oral↗

PubMed1980

Flunisolide: a review of its pharmacological properties and therapeutic efficacy in rhinitis.

Flunisolide, a derivative of fluocinolone acetonide, is advocated for intranasal inhalation for the treatment of perennial and seasonal allergic rhinitis. It is rapidly absorbed by all routes of administration, but it quickly undergoes extensive first-pass metabolism to a 6 beta-hydroxylated metabolite, which possesses only weak corticosteroid effects. Intranasal flunisolide relieves nasal symptoms (but not eye symptoms) in both perennial and seasonal allergic rhinitis, being most effective in patients who have an allergic component to their rhinitis; and like other corticosteroids it may reduce the need for systemic antihistamines in such patients, expecially during peak pollen periods. A few well designed comparative studies have shown flunisolide to be as effective as intranasal beclomethasone, and (in a single study) more effective than intranasal sodium cromoglycate solution. Only transient side effects have occurred, including nasal stinging and throat irritation. No Candida infections have been clinically apparent in short or longer term trials. Resting morning plasma cortisol levels have not been suppressed by usual therapeutic doses of intranasal flunisolide, but the drug's effects on hypothalamo-pituitary-adrenal (HPA) axis integrity during conditions of stress have not been evaluated.

Beclomethasone↗

PubMed1980

Nadolol: a review of its pharmacological properties and therapeutic efficacy in hypertension and angina pectoris.

Nadolol is a nonselective beta-adrenoceptor blocking drug without intrinsic sympathomimetic or membrane stabilising activity. Its inherently long duration of activity makes it suitable for once daily administration in both hypertension and angina pectoris, and in these conditions it has been as effective as propranolol given in a traditional regimen 4 times daily. However, other beta-blocking drugs can also be given with reduced frequency, especially in hypertension; and some, such as atenolol (a longer acting 'cardioselective' agent) or long-acting preparations of other beta-blockers, have also been given once daily in angina prophylaxis. Nevertheless, nadolol is one of a few beta-blocking drugs which have clearly been shown to be effective in both hypertension and angina with once daily administration. Other specific properties of nadolol, such as its excretion entirely in unmetabolised form, may offer advantages over other existing beta-blocking drugs in specific patients, while some properties (such as lack of 'cardioselectivity') may be disadvantageous in others. The choice of a beta-blocking drug should thus be based on a knowledge of the pharmacodynamic and pharmacokinetic properties of the different beta-blocking drugs, and a careful consideration of how such properties can best be applied to benefit the individual patient.

Adrenergic beta-Antagonists↗

PubMed1980

Diclofenac sodium: a review of its pharmacological properties and therapeutic use in rheumatic diseases and pain of varying origin.

Diclofenac sodium, a phenylacetic acid derivative, is a non-steroidal, anti-inflammatory, analgesic agent advocated for use in rheumatoid arthritis, degenerative joint disease, ankylosing spondylitis and allied conditions, and in the treatment of pain resulting from minor surgery, trauma and dysmenorrhoea. Published data indicate that diclofenac 75 to 150mg daily (25 to 50mg 3 times daily) is comparable in efficacy with ordinary aspirin 3 to 5g daily and indomethacin 75 to 150mg daily in rheumatoid arthritis and with indomethacin in osteoarthritis. Available data suggest that in patients with osteoarthritis diclofenac sodium is comparable in efficacy and tolerability with naproxen, ibuprofen, sulindac and diflunisal. As oral diclofenac is generally given in 3 divided daily doses it may be at a disadvantage relative to less frequent administration with naproxen, diflunisal and sulindac in rheumatoid arthritis, although there is some evidence of diclofenac's efficacy when administered twice daily, or once daily as a slow release tablet. The drug is also available as suppositories and ampoules for intramuscular injection. No one of the non-steroidal anti-inflammatory agents is the most suitable drug for all patients requiring such therapy, and diclofenac should be considered along with other drugs of its type in the arthritic patient.

Adult↗

PubMed1980

Ipratropium bromide: a review of its pharmacological properties and therapeutic efficacy in asthma and chronic bronchitis.

Ipratropium bromide is an anticholinergc bronchodilator administered by inhalation. Although producing bronchodilation in most patients with obstructive airways disease, it is somewhat less effective than beta 2-adrenoceptor agonist drugs such as salbutamol or fenoterol in patients with asthma, but is at least as effective as these agents in bronchitis. As with the beta 2-adrenoceptor agonists, the onset of maximum effect with ipratropium (about 1.5 to 2 hours) is slower than with isoprenaline (although significant bronchodilation usually occurs within seconds or minutes of ipratropium inhalation), and the duration of effect (about 4 to 6 hours) is longer. Studies of concomitant use of ipratropium and other agents such as beta 2-adrenoceptor agonists, theophylline, or sodium cromoglycate, have usually shown a greater response in many patients than with single drug therapy, as might be expected from the different mechanisms of action of these groups of drugs. Usual inhaled doses of ipratropium were well tolerated in all studies. Ipratropium thus appears to be a suitable alternative to beta 2-adrenoceptor agonist drugs in patients not fully responding to these agents, and combined therapy with ipratropium and other bronchodilating drugs may prove to be an important area of use in patients failing to respond adequately to a single drug regimen. (nevertheless, in asthma patients in whom a 'non-responsive' state is developing, initiation of corticosteroid therapy should not be delayed). Ipratropium may also be useful in the occasional patient in whom side effects such as palpitations or tremor are troublesome with usual inhaled doses of beta 2-adrenoceptor agonists.

Asthma↗

PubMed1980