PubMed · 14256455
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F W TURNBULL. 1965-01-01. PULMONARY TUBERCULOSIS.. https://pubmed.ncbi.nlm.nih.gov/14256455/
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Care is required when applying the findings from randomised controlled trials, systematic reviews of RCTs or national 'evidence-based' guidelines to the broad groups of patients in primary care. N-of-1 trials offer a useful approach to tailor medication and improve the quality of a treatment decision in an individual patient. The length of the relationship with patients makes follow-up important.
Lower urinary tract disorders include disorders affecting continence (stress urinary incontinence, urge urinary incontinence, and benign prostatic hyperplasia) and male erectile dysfunction. Although none of these conditions are fatal, they affect overall quality of life. Throughout modern medicine the treatment of these conditions was limited to psychological counseling or surgical intervention. In recent years, research defining the physiological mechanisms of continence and male sexual function has aided in the pharmacologic design of approaches to these conditions. These agents can act both centrally or on the peripheral genitourinary smooth muscle to alleviate disease symptoms. Incontinence is primarily treated with agents that act directly on the bladder smooth muscle such as muscarinic antagonists. However, afferent blockade to attenuate the spinalbulbospinal reflex pathway including mixed norepinephrine/serotonin reuptake inhibitors may provide a key breakthrough. Erectile dysfunction treatment has been revolutionized via the discovery of the nitric oxide pathway and phosphodiesterase 5 inhibitors. New peripheral targets as well as centrally acting agents represent potential emerging therapies. In this review, the pharmacologic basis of treatment of these disorders is discussed with special emphasis on emerging new therapeutics.
Genetic factors play a major role in the differential responses to treatment or the incidence of adverse drug effects in psychopharmacotherapy. The aim of pharmacogenetics is to elucidate this variability caused by hereditary differences. From hypotheses on the mechanisms of drug action, several mutations in genes coding for neurotransmitter receptors, neurotransmitter-degrading enzymes, transport proteins or enzymes of the drug metabolizing system have been identified and investigated. Although there exists some controversy among the results, many studies are supportive of the hypothesis that psychopharmacogenetics will be helpful in predicting an individual's drug response while minimizing the rate of side effects. The inclusion of functional genomics, which investigates the complex gene and/or protein expression in response to a given drug, could help lead to the development of novel and safer drugs.