Biomedical subjects

Pamela A Foral

Publications and source records attributed to Pamela A Foral.

4 recordsLinked to original sources

PubMed2004

Nebulized opioids use in COPD.

OBJECTIVE: To evaluate the role of nebulized opioids in COPD. METHODS: A MEDLINE search was completed to obtain pertinent clinical literature. Key search terms included the following: nebulizer, opioids, COPD, dyspnea, morphine, and hydromorphone. RESULTS: Currently, the evidence in the literature is lacking regarding placebo-controlled studies to support nebulized morphine for the relief of dyspnea in patients with COPD. The studies reviewed varied considerably in the dose, opioid used, administration schedule, and methodology. One study found improved exercise capacity in 11 patients not reproducible in a larger sample, and another study found benefit in 54 terminal patients. All other studies found no benefit. CONCLUSIONS: The recently published Global Initiative for Lung Disease guidelines have specifically stated that opioids are contraindicated in COPD management due to the potential respiratory depression and worsening hypercapnia. Nebulized opioids should be discouraged, as current data do not support their use.

Administration, Inhalation↗

PubMed2004

Impact of nesiritide on health care resource utilization and complications in patients with decompensated heart failure.

STUDY OBJECTIVE: To determine the impact of nesiritide on health care resource utilization and complications in patients hospitalized with decompensated heart failure. DESIGN: Retrospective case-control study. SETTING: United States hospitals. PATIENTS: Two hundred sixteen patients hospitalized for decompensated heart failure. MEASUREMENTS AND MAIN RESULTS: One hundred eight patients who received a nesiritide infusion for a minimum of 12 hours during the first 48 hours after hospital admission were matched with 108 patients not receiving nesiritide. Health care resource utilization, consisting of hospital length of stay (LOS), rate of rehospitalization within 90 days, concomitant drugs administered, and laboratory and diagnostic tests, was determined for each hospital admission. Rates of adverse events also were recorded. Patients receiving nesiritide had a significantly shorter LOS in a critical care unit (p=0.03). General medical ward or step-down unit LOS was not different between the treatment groups. A favorable trend toward a lower rate of rehospitalization over the 90-day follow-up period was observed with nesiritide (p=0.07). The number of patients who developed life-threatening ventricular arrhythmias and hypotension was similar for both treatment groups. However, in patients receiving nesiritide, significantly less atrial fibrillation (p=0.03) and renal dysfunction (p=0.04) occurred compared with patients not receiving nesiritide. CONCLUSION: Nesiritide therapy is associated with significant reductions in both health care resource utilization and complications in patients with decompensated heart failure.

Aged↗

PubMed2003

Gastrointestinal-related adverse effects of COX-2 inhibitors.

Selective cyclooxygenase-2 (COX-2) inhibitors are used for the treatment of inflammation and pain while having the reported advantage of fewer upper gastrointestinal adverse effects compared to traditional nonsteroidal anti-inflammatory drugs. Although fewer adverse effects occur, there is still a risk for developing upper gastrointestinal adverse effects. Clinical practitioners have increased concern regarding this risk. The belief that COX-2 inhibitors are safe for the gastrointestinal tract has been questioned. This has encouraged the proposal of several explanations on the mechanism of gastromucosal injury and healing relative to COX isoenzymes. These mechanisms are delineated in the following review, along with the gastrointestinal safety, risk factors, clinical and case studies, and cost effectiveness of the COX-2 inhibitors.

Cyclooxygenase Inhibitors↗

PubMed2002

Gastrointestinal bleeds associated with rofecoxib.

Data suggest that cyclooxygenase (COX)-2 inhibitors are safer for the gastrointestinal tract than traditional nonsteroidal antiinflammatory drugs (NSAIDs). Rofecoxib, a COX-2-specific NSAID, does not inhibit the COX-1 enzyme, thereby decreasing the potential for gastrointestinal-related adverse effects. Patients who are at an increased risk for NSAID-related gastrointestinal bleeding are therefore appropriate candidates for COX-2 inhibitors. Although the agents provide benefits for many patients, gastrointestinal-related side effects may occur, and caution should be practiced when prescribing COX-2 inhibitors. We report two patients who were admitted to the hospital with diagnoses of gastrointestinal bleeds while they were taking rofecoxib.

Aged↗