Biomedical subjects
Publications and source records attributed to P T Rodgers.
Nonadherence is a significant medical problem in the United States, leading to excessive morbidity, mortality, and medical costs. In this first installment of a two-part article, the authors review the literature and discuss the effects of the problem, with particular reference to patients with congestive heart failure.
Nonadherence is a significant medical problem in the United States, leading to excessive morbidity, mortality, and medical costs. In the conclusion to this two-part article, the authors describe a pilot study involving 311 patients taking an angiotensin-converting enzyme inhibitor that evaluates the principal factors for nonadherence to pharmaceutical therapy in patients with congestive heart failure.
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OBJECTIVE: To review the use of combination therapy versus monotherapy in hypertension, and to review seven major antihypertensive combinations in regard to their pharmacologic actions and appropriateness. DATA SOURCES: Literature was identified through a MEDLINE search from January 1985 to December 1997. Search terms included hypertension, blood pressure, combination therapy, diuretics, beta-receptor antagonists, calcium channel antagonists, angiotensin-converting enzyme inhibitors (ACEIs). Major hypertension texts were also reviewed for information on combination therapy. STUDY SELECTION: Clinical studies focusing primarily on blood pressure control with combinations of antihypertensive medications. DATA EXTRACTION: Data were evaluated with respect to study design, clinical outcomes, and use of antihypertensive classes commonly seen in practice. DATA SYNTHESIS: Combination therapy in hypertension is often required because many patients cannot be controlled on one drug alone. Available data demonstrate that ACEIs plus diuretics or calcium channel blockers (CCBs) produce synergistic effects on blood pressure. Beta-blockers plus diuretics or CCBs produce additive effects, as does the rarer combination of diltiazem plus a dihydropyridine CCB. Ineffective combinations include beta-blockers plus ACEIs and dihydropyridine CCBs plus diuretics, although there are specific clinical circumstances where these combinations may be used. CONCLUSION: When used appropriately, certain combinations of antihypertensives can effectively control blood pressure and minimize side effects. The pharmacist who understands and applies the pharmacology of these antihypertensives can help prescribers make rational decisions in selecting combination therapy.
A 77-year-old man who had taken ranitidine for several years for dyspepsia was prescribed alternative therapy with famotidine 20 mg twice/day. He subsequently developed mental status changes, with confusion, disorientation, and nightmares. The symptoms dissipated after he discontinued famotidine for 2 days. He rechallenged himself and experienced return of the symptoms shortly thereafter, with additional visual hallucinations. His therapy was changed to lansoprazole, and his symptoms again disappeared and have not recurred. Case reports of central nervous system effects with other histamine2 antagonists have been published. Eight cases occurred with famotidine, all of which were in hospitalized patients receiving intravenous famotidine. We believe this is the first report of mental status changes in an ambulatory patient taking oral famotidine. The elderly may be particularly susceptible to such changes.