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Biomedical subjects

Mark A Munger

Publications and source records attributed to Mark A Munger.

7 recordsLinked to original sources
PubMed2006

Management of acute decompensated heart failure: treatment, controversy, and future directions.

Acute decompensated heart failure is a growing public health care problem worldwide. The goals of treatment are immediate hemodynamic and symptomatic improvement followed by persistent follow-up with adherence to chronic heart failure guidelines. Controversies have centered around the best treatment options and avoidance of serious adverse events. This article highlights our current understanding of acute decompensated heart failure, discusses the controversy surrounding currently available new vasoactive treatments, and details future potential therapies.

Acute Disease↗
PubMed2004

High-impact articles related to the pharmacotherapeutic management of systolic heart failure.

This compilation is part of a series of five articles identifying important literature in cardiovascular pharmacotherapy. This list focuses on pharmacotherapeutic management of acute decompensated and chronic heart failure. Most of the cited works present the results of landmark clinical studies that have shaped the management of patients with left ventricular systolic dysfunction. Limited primary literature is available for some topics; thus, pertinent review articles also are listed. In addition, consensus documents formed by expert panels in the United States and Europe are reviewed. This compilation may serve as a teaching tool, reference resource, or update of the literature for pharmacy clinicians, physicians, and students.

Heart Failure↗
PubMed2003

Epidemiology and practice patterns of acute decompensated heart failure.

The epidemiology and clinical characteristics of acute decompensated heart failure (ADHF) and the management of patients with ADHF are discussed. ADHF has become a significant health care problem in the United States. In an effort to fully understand the current epidemiology, clinical characteristics, and management of patients hospitalized with ADHF, a national registry was started in 2002 as a joint collaboration between academic heart failure specialists and the bio-pharmaceutical industry. The largest compilation of ADHF data has been collected in the Acute Decompensated Heart Failure National Registry (ADHERE). This article describes ADHERE, which suggests that the health care industry needs to conduct root-cause analysis of outpatient and inpatient practices toward these patients and make adjustments in these treatment patterns if we are going to reduce the morbidity, mortality, and health care costs in these patients.

Acute Disease↗
PubMed2003

Faculty turnover within academic pharmacy departments.

BACKGROUND: Pharmacy faculty manpower has been debated within the academic pharmacy community over the last several decades. Previous investigations studied job satisfaction among faculty members, but have not evaluated faculty retention and turnover among academic pharmacy departments. OBJECTIVE: To evaluate retention and turnover rates in the departments of Pharmacy Practice and Basic Science (Pharmacology/Toxicology, Pharmaceutics, Medicinal Chemistry) over the last 5 years. METHODS: Individual instructors and assistant, associate, and full professors across 80 colleges of pharmacy in the US were tracked between the years 1996 and 2001 using the American Association of Colleges of Pharmacy published rosters. Differences between departments were analyzed by year-stratified cross-tabulation table analysis. RESULTS: A greater percentage of Pharmacy Practice faculty resigned (10.6%) compared with Basic Science faculty (6.0%; percent ratio 1.76; 95% CI 1.58 to 1.95; p < 0.001), which remained constant across each academic year. Approximately 2.7 faculty members left their academic institutions per year in Pharmacy Practice compared with 1.1 faculty members in the aggregate of Basic Science departments. A higher percentage of women resigned in Pharmacy Practice (13.2%) than did men (8.7%; percent ratio 1.5; 95% CI 1.34 to 1.68; p < 0.001), despite a 1.3-fold male to female ratio. Likewise, regardless of a 4.1-fold male to female ratio in the Basic Science group, a higher percentage of women resigned (8.0%) than men (5.5%; percent ratio 1.45; 95% CI 1.18 to 1.78; p < 0.001). CONCLUSIONS: Over a 5-year period, Pharmacy Practice exhibited a higher turnover compared with Basic Science. Women displayed significantly higher turnover than men across all pharmacy academic departments. New retention approaches, especially for female faculty members, should be explored.

Education, Pharmacy↗
PubMed2002

Chronically inhaled salmeterol improves pulmonary function in heart failure.

Inhaled beta-agonists are commonly prescribed for the symptoms of exercise intolerance in heart failure despite a paucity of data regarding their safety and efficacy. This was a prospective, randomized, double-blind, double-dummy, placebo-controlled 14-day cross-over study to determine if chronic inhaled salmeterol therapy 84 microg every 12 hours improved pulmonary function without augmentation of neurohormonal systems or ventricular ectopy in 8 symptomatic heart failure subjects with left ventricular ejection fraction (LVEF) <40% and FEV1 <or=80%. The primary endpoint was FEV1, and the secondary endpoints were forced vital capacity (FVC), forced expiratory flow (FEF25-75), peak expiratory flow rate (PEFR), blood pressure, heart rate, rate-pressure product, plasma norepinephrine, plasma epinephrine, plasma renin activity, percent ventricular ectopy, and salmeterol pharmacokinetics. Salmeterol was associated with a significant 6% improvement in FEV1 compared with placebo (salmeterol 2.46 +/- 0.73 vs. placebo 2.33 +/- 0.73 L, p = 0.01). There was no significant difference in FVC, FEF25-75, and PEFR. Salmeterol increased mean rate-pressure product by 5% (salmeterol 8878 +/- 1560 vs. placebo 8414 +/- 1440 bpm x mm Hg, p = 0.04), although no increase in plasma norepinephrine, epinephrine, plasma renin activity or ventricular ectopy was detected. The Tmax, Cmax, and half-life of salmeterol at steady-state were 5 min, 715 pg/ml and 11.4 hours, respectively. Inhaled salmeterol significantly improves FEV1 without producing measurable effects on neuroactivation or ventricular ectopy. Inhaled salmeterol causes minor increases in rate-pressure product, whose clinical significance remains to be determined. The plasma half-life of salmeterol may be prolonged in heart failure patients, thus leading to accumulation at steady-state.

Administration, Inhalation↗
PubMedDate not supplied

Atherothrombosis: epidemiology, pathophysiology, and prevention.

OBJECTIVES: To review the pathophysiology of atherothrombosis (atherosclerosis with superimposed platelet-rich thrombus formation) and the measures that can be taken to prevent its clinical sequelae through lifestyle modifications and pharmacotherapy, with emphasis on the role of antiplatelet agents. DATA SOURCES: Recent (1995-2003) published scientific literature, as identified by the authors through Medline searches using the terms atherothrombosis, pathophysiology, risk factors, prevention, and reviews on treatment. STUDY SELECTION: Recent systematic English-language review articles were screened for relevant material. DATA SYNTHESIS: Atherothrombosis is a generalized and diffuse progressive process affecting multiple vascular beds; its clinical consequences, including acute coronary syndromes (unstable angina, acute myocardial infarction, and sudden cardiac death), ischemic stroke, and peripheral arterial disease, are unpredictable in their time course and potentially life-threatening. Atherothrombosis rather than arterial stenosis appears to account for most of the acute ischemic manifestations of the atherosclerotic process. Interventions that can favorably influence atherosclerotic progression include lifestyle modifications (dietary control, exercise, and smoking cessation) and pharmacotherapy (lipid-lowering, antihypertensive, antiglycemic, and antiplatelet drugs). The pivotal role played by the platelet in thrombus formation provides the rationale for employing antiplatelet drugs with complementary modes of action (e.g., aspirin, clopidogrel) to prevent atherothrombosis. CONCLUSION: Ischemic cerebrovascular, coronary, and peripheral arterial disease can be regarded as diverse manifestations of a common underlying systemic pathology, namely atherothrombosis. Secondary prevention of an ischemic event in an affected arterial bed confers the added benefit of primary prevention against potential ischemic events in other arterial beds.

Angiotensin-Converting Enzyme Inhibitors↗