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[PMID]:29269696
[Au] Autor:Yokoi K; Ando T; Kawakami O
[Ad] Endereço:Department of Neurology, Anjo Kosei Hospital.
[Ti] Título:[Case of posterior reversible encephalopathy syndrome caused by Fisher syndrome].
[So] Source:Rinsho Shinkeigaku;58(1):45-48, 2018 Jan 26.
[Is] ISSN:1882-0654
[Cp] País de publicação:Japan
[La] Idioma:jpn
[Ab] Resumo:This report presents a case of a 71-year-old woman with Fisher syndrome who had posterior reversible encephalopathy syndrome (PRES) before the initiation of intravenous immunoglobulin (IVIg) treatment. She had symptoms of common cold 2 weeks before the onset of PRES. On the day of the onset, she began to stagger while walking. On day 2, she developed hypertension, vision impairment, and limb weakness and was admitted to the hospital. On day 3, she was provided steroid pulse therapy. On day 4, she developed convulsions and right imperfection single paralysis and was transferred to the our hospital. During the transfer, the patient was conscious. Her blood pressure was high at 198/107 mmHg. She had mild weakness in her limbs and face, light perception in both eyes, dilation of both pupils, total external ophthalmoplegia, no tendon reflexes, and limb and trunk ataxia. We diagnosed PRES because of the high signal intensities observed on T -weighted MRI on both sides of the parietal and occipital lobes. We also diagnosed Fisher syndrome because of a positive anti-GQ1b immunoglobulin G antibody test and albuminocytologic dissociation in the cerebrospinal fluid. PRES showed prompt improvement with antihypertensive therapy, whereas Fisher syndrome slowly improved over a course of 2 months. This case is the first report of PRES without IVIg suggesting that Fisher syndrome induces hypertension and causes PRES.
[Mh] Termos MeSH primário: Síndrome de Miller Fisher/complicações
Síndrome da Leucoencefalopatia Posterior/etiologia
[Mh] Termos MeSH secundário: Idoso
Anti-Hipertensivos/administração & dosagem
Biomarcadores/sangue
Biomarcadores/líquido cefalorraquidiano
Proteínas do Líquido Cefalorraquidiano/líquido cefalorraquidiano
Diltiazem/administração & dosagem
Feminino
Gangliosídeos/imunologia
Seres Humanos
Imunoglobulina G/sangue
Imunoglobulinas Intravenosas
Imagem por Ressonância Magnética
Síndrome de Miller Fisher/diagnóstico
Neuroimagem
Síndrome da Leucoencefalopatia Posterior/diagnóstico por imagem
Síndrome da Leucoencefalopatia Posterior/tratamento farmacológico
Resultado do Tratamento
Valsartana/administração & dosagem
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antihypertensive Agents); 0 (Biomarkers); 0 (Cerebrospinal Fluid Proteins); 0 (Gangliosides); 0 (Immunoglobulin G); 0 (Immunoglobulins, Intravenous); 68652-37-9 (GQ1b ganglioside); 80M03YXJ7I (Valsartan); EE92BBP03H (Diltiazem)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180227
[Lr] Data última revisão:
180227
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171223
[St] Status:MEDLINE
[do] DOI:10.5692/clinicalneurol.cn-001089


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[PMID]:27777258
[Au] Autor:Bibas L; Levi M; Essebag V
[Ad] Endereço:Division of Cardiology, McGill University Health Center, Montréal, Que.
[Ti] Título:Diagnosis and management of supraventricular tachycardias.
[So] Source:CMAJ;188(17-18):E466-E473, 2016 Dec 06.
[Is] ISSN:1488-2329
[Cp] País de publicação:Canada
[La] Idioma:eng
[Mh] Termos MeSH primário: Adenosina/uso terapêutico
Antagonistas Adrenérgicos beta/uso terapêutico
Antiarrítmicos/uso terapêutico
Bloqueadores dos Canais de Cálcio/uso terapêutico
Ablação por Cateter
Cardioversão Elétrica
Taquicardia Supraventricular/terapia
[Mh] Termos MeSH secundário: Diltiazem/uso terapêutico
Gerenciamento Clínico
Eletrocardiografia
Seres Humanos
Guias de Prática Clínica como Assunto
Taquicardia Supraventricular/diagnóstico
Verapamil/uso terapêutico
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Adrenergic beta-Antagonists); 0 (Anti-Arrhythmia Agents); 0 (Calcium Channel Blockers); CJ0O37KU29 (Verapamil); EE92BBP03H (Diltiazem); K72T3FS567 (Adenosine)
[Em] Mês de entrada:1704
[Cu] Atualização por classe:171206
[Lr] Data última revisão:
171206
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:161026
[St] Status:MEDLINE


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[PMID]:28766866
[Au] Autor:Athukuri BL; Neerati P
[Ad] Endereço:DMPK and Clinical Pharmacology Division, Department of Pharmacology, University College of Pharmaceutical Sciences, Kakatiya University, Warangal, 506 009, TS, India.
[Ti] Título:Enhanced Oral Bioavailability of Diltiazem by the Influence of Gallic Acid and Ellagic Acid in Male Wistar Rats: Involvement of CYP3A and P-gp Inhibition.
[So] Source:Phytother Res;31(9):1441-1448, 2017 Sep.
[Is] ISSN:1099-1573
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:The oral bioavailability of diltiazem is very low due to rapid first pass metabolism in liver and intestine. The purpose of the study was to investigate the effect of gallic acid and ellagic acid on intestinal transport and oral bioavailability of diltiazem in rats. The intestinal transport and permeability of diltiazem was evaluated by in vitro non-everted sac method and in situ single pass intestinal perfusion study. The oral pharmacokinetics was evaluated by conducting oral bioavailability study. The intestinal transport and apparent permeability of diltiazem were significantly enhanced in duodenum, jejunum, and ileum of gallic and ellagic acid-treated groups. The effective permeability of diltiazem was significantly enhanced in ileum part of gallic and ellagic acid-treated groups. When compared with control group, the presence of these two phytochemicals significantly enhanced the area under plasma concentration-time curve and the peak plasma concentration of diltiazem (C ). Gallic acid and ellagic acid significantly increased the bioavailability of diltiazem due to the inhibition of both CYP3A-mediated metabolism and P-glycoprotein-mediated efflux in the intestine and/or liver. Based on these results, the clinical experiments are warranted for the confirmation to reduce the dose of diltiazem when concomitantly administered with these phytochemicals. Copyright © 2017 John Wiley & Sons, Ltd.
[Mh] Termos MeSH primário: Subfamília B de Transportador de Cassetes de Ligação de ATP/metabolismo
Citocromo P-450 CYP3A/metabolismo
Diltiazem/farmacocinética
Ácido Elágico/farmacologia
Ácido Gálico/farmacologia
[Mh] Termos MeSH secundário: Administração Oral
Animais
Disponibilidade Biológica
Diltiazem/administração & dosagem
Interações Medicamentosas
Absorção Intestinal
Intestinos/metabolismo
Masculino
Ratos
Ratos Sprague-Dawley
Ratos Wistar
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (ATP Binding Cassette Transporter, Sub-Family B); 19YRN3ZS9P (Ellagic Acid); 632XD903SP (Gallic Acid); EC 1.14.14.1 (Cytochrome P-450 CYP3A); EE92BBP03H (Diltiazem)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170803
[St] Status:MEDLINE
[do] DOI:10.1002/ptr.5873


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[PMID]:28705745
[Au] Autor:Chenoweth JA; Colby DK; Sutter ME; Radke JB; Ford JB; Nilas Young J; Richards JR
[Ad] Endereço:Department of Emergency Medicine, Division of Cardiothoracic Surgery, University of California Davis Medical Center, Sacramento, CA, United States; Division of Toxicology, Division of Cardiothoracic Surgery, University of California Davis Medical Center, Sacramento, CA, United States. Electronic add
[Ti] Título:Massive diltiazem and metoprolol overdose rescued with extracorporeal life support.
[So] Source:Am J Emerg Med;35(10):1581.e3-1581.e5, 2017 Oct.
[Is] ISSN:1532-8171
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The management of overdoses of cardioactive medications in the emergency department can be challenging. The reversal of severe toxicity from one or more types of cardioactive medication may fail maximal medical therapies and require extreme invasive measures such as transvenous cardiac pacing and extracorporeal life support. We present a case of massive diltiazem and metoprolol overdose refractory to maximal medical therapy, including intravenous calcium, glucagon, vasopressors, high dose insulin, and lipid emulsion. The patient experienced refractory bradydysrhythmia that responded only to transvenous pacing. Extracorporeal life support was initiated and resulted in successful organ perfusion and complete recovery of the patient. This case highlights the potential utility of extracorporeal life support in cases of severe toxicity due to multiple cardioactive medications.
[Mh] Termos MeSH primário: Diltiazem/envenenamento
Overdose de Drogas/terapia
Metoprolol/envenenamento
[Mh] Termos MeSH secundário: Adulto
Antiarrítmicos/envenenamento
Relação Dose-Resposta a Droga
Oxigenação por Membrana Extracorpórea/métodos
Feminino
Seguimentos
Seres Humanos
Vasodilatadores/envenenamento
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Arrhythmia Agents); 0 (Vasodilator Agents); EE92BBP03H (Diltiazem); GEB06NHM23 (Metoprolol)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171012
[Lr] Data última revisão:
171012
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170715
[St] Status:MEDLINE


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[PMID]:28666765
[Au] Autor:Chen C; Lu W; Wu G; Lv L; Chen W; Huang L; Wu X; Xu N; Wu Y
[Ad] Endereço:Department of Hyperbaric Oxygen, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi 530021, PR China.
[Ti] Título:Cardioprotective effects of combined therapy with diltiazem and superoxide dismutase on myocardial ischemia-reperfusion injury in rats.
[So] Source:Life Sci;183:50-59, 2017 Aug 15.
[Is] ISSN:1879-0631
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:AIMS: Our experiments were designed to study the effect of diltiazem (DIL) combined with superoxide dismutase (SOD) on myocardial ischemia-reperfusion (MIRI) injury in a rat model. MAIN METHODS: Fifty rats were randomly separated into sham, ischemia-reperfusion (IR), DIL (5mg/kg), SOD (10,000U/kg) and combinatorial therapy (DIL plus SOD) groups. MIRI was induced by ligating the left anterior descending coronary artery for 30min and then reperfusing for 60min. The cardioprotective effects of combinatorial therapy were evaluated using hemodynamics, biochemical indices, histopathology and apoptotic-related proteins and gene expression. KEY FINDINGS: Compared with the IR group, combinatorial therapy significantly improved cardiac function and decreased arrhythmia, myocardial infarction area and release of myocardial enzyme. In addition, combinatorial therapy protected the myocardial cell structure as well as markedly alleviated oxidative stress, resulting in upregulation of Bcl-2 and adenine nucleotide transporter-1 expression as well as downregulation of Bax, caspase-3 and cleaved caspase-3 expression. SIGNIFICANCE: Our results indicated that DIL combined with SOD can provide protection against MIRI in rats, and these effects may be attributed to a reduction in oxygen stress damage, attenuation of calcium overload, and inhibition of cell apoptosis.
[Mh] Termos MeSH primário: Cardiotônicos/farmacologia
Diltiazem/farmacologia
Traumatismo por Reperfusão Miocárdica/tratamento farmacológico
Estresse Oxidativo/efeitos dos fármacos
Superóxido Dismutase/farmacologia
[Mh] Termos MeSH secundário: Animais
Apoptose/efeitos dos fármacos
Cálcio/metabolismo
Cardiotônicos/administração & dosagem
Diltiazem/administração & dosagem
Modelos Animais de Doenças
Quimioterapia Combinada
Feminino
Regulação da Expressão Gênica/efeitos dos fármacos
Masculino
Ratos
Ratos Sprague-Dawley
Superóxido Dismutase/administração & dosagem
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Cardiotonic Agents); EC 1.15.1.1 (Superoxide Dismutase); EE92BBP03H (Diltiazem); SY7Q814VUP (Calcium)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170808
[Lr] Data última revisão:
170808
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170702
[St] Status:MEDLINE


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[PMID]:28645473
[Au] Autor:Washam JB; Hellkamp AS; Lokhnygina Y; Piccini JP; Berkowitz SD; Nessel CC; Becker RC; Breithardt G; Fox KAA; Halperin JL; Hankey GJ; Mahaffey KW; Singer DE; Patel MR; ROCKET AF Steering Committee and Investigators
[Ad] Endereço:Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina. Electronic address: jeff.washam@duke.edu.
[Ti] Título:Efficacy and Safety of Rivaroxaban Versus Warfarin in Patients Taking Nondihydropyridine Calcium Channel Blockers for Atrial Fibrillation (from the ROCKET AF Trial).
[So] Source:Am J Cardiol;120(4):588-594, 2017 Aug 15.
[Is] ISSN:1879-1913
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Non-dihydropyridine calcium channel blockers (non-DHP CCBs) possess combined P-glycoprotein and moderate CYP3A4 inhibition, which may lead to increased exposure of medications that are substrates for these metabolic pathways, such as rivaroxaban. We evaluated the use and outcomes of non-DHP CCBs in patients with atrial fibrillation (AF) in Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF). We assessed clinical outcomes in patients who received non-DHP CCBs and the impact on the efficacy and safety of rivaroxaban compared with warfarin. Stroke or noncentral nervous system (CNS) systemic embolism (SE), major or nonmajor clinically relevant (NMCR) bleeding, all-cause death, and major bleeding were compared according to non-DHP CCB use. At randomization, 1,308 patients (9.2%) were taking a non-DHP CCB. They were more likely to be women, have diabetes and COPD, and less likely to have heart failure and had a lower mean CHADS score (3.3 vs 3.5). Non-DHP CCB use was not associated with an increased risk of stroke/non-CNS SE (p = 0.11) or the composite outcome of NMCR or major bleeding (p = 0.087). Non-DHP CCB use was associated with an increased risk of major bleeding (adjusted hazard ratio 1.50, 95% CI 1.11 to 2.04) and intracranial hemorrhage (adjusted hazard ratio 2.84, 95% CI 1.53 to 5.29). No significant difference was observed in the primary efficacy (stroke or non-CNS SE; adjusted interaction p value = 0.38) or safety outcome (NMCR or major bleeding; adjusted interaction p value = 0.14) between rivaroxaban and warfarin with non-DHP CCB use. In conclusion, although the overall use of non-DHP CCBs was associated with an increased risk of major bleeding and intracranial hemorrhage, the use was not associated with a significant change in the safety or efficacy of rivaroxaban compared with warfarin observed in ROCKET AF.
[Mh] Termos MeSH primário: Fibrilação Atrial/tratamento farmacológico
Bloqueadores dos Canais de Cálcio/administração & dosagem
Rivaroxabana/administração & dosagem
Acidente Vascular Cerebral/prevenção & controle
Varfarina/administração & dosagem
[Mh] Termos MeSH secundário: Administração Oral
Idoso
Anticoagulantes/administração & dosagem
Fibrilação Atrial/complicações
Diltiazem/administração & dosagem
Relação Dose-Resposta a Droga
Método Duplo-Cego
Quimioterapia Combinada
Inibidores do Fator Xa/administração & dosagem
Feminino
Seres Humanos
Masculino
Fatores de Risco
Acidente Vascular Cerebral/etiologia
Resultado do Tratamento
Verapamil/administração & dosagem
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Anticoagulants); 0 (Calcium Channel Blockers); 0 (Factor Xa Inhibitors); 5Q7ZVV76EI (Warfarin); 9NDF7JZ4M3 (Rivaroxaban); CJ0O37KU29 (Verapamil); EE92BBP03H (Diltiazem)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170906
[Lr] Data última revisão:
170906
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170625
[St] Status:MEDLINE


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[PMID]:28542215
[Au] Autor:Ismail B; deKemp RA; Croteau E; Hadizad T; Burns KD; Beanlands RS; DaSilva JN
[Ad] Endereço:Cardiac PET Centre, Department of Medicine (Division of Cardiology), University of Ottawa Heart Institute, Ottawa, ON, Canada.
[Ti] Título:Treatment with enalapril and not diltiazem ameliorated progression of chronic kidney disease in rats, and normalized renal AT1 receptor expression as measured with PET imaging.
[So] Source:PLoS One;12(5):e0177451, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:ACE inhibitors are considered first line of treatment in patients with many forms of chronic kidney disease (CKD). Other antihypertensives such as calcium channel blockers achieve similar therapeutic effectiveness in attenuating hypertension-related renal damage progression. Our objective was to explore the value of positron emission tomography (PET) imaging of renal AT1 receptor (AT1R) to guide therapy in the 5/6 subtotal-nephrectomy (Nx) rat model of CKD. Ten weeks after Nx, Sprague-Dawley rats were administered 10mg/kg/d enalapril (NxE), 30mg/kg/d diltiazem (NxD) or left untreated (Nx) for an additional 8-10 weeks. Kidney AT1R expression was assessed using in vivo [18F]fluoropyridine-losartan PET and in vitro autoradiography. Compared to shams, Nx rats exhibited higher systolic blood pressure that was reduced by both enalapril and diltiazem. At 18-20 weeks, plasma creatinine and albuminuria were significantly increased in Nx, reduced to sham levels in NxE, but enhanced in NxD rats. Enalapril treatment decreased kidney angiotensin II whereas diltiazem induced significant elevations in plasma and kidney levels. Reduced PET renal AT1R levels in Nx were normalized by enalapril but not diltiazem, and results were supported by autoradiography. Reduction of renal blood flow in Nx was restored by enalapril, while no difference was observed in myocardial blood flow amongst groups. Enhanced left ventricle mass in Nx was not reversed by enalapril but was augmented with diltiazem. Stroke volume was diminished in untreated Nx compared to shams and restored with both therapies. [18F]Fluoropyridine-Losartan PET allowed in vivo quantification of kidney AT1R changes associated with progression of CKD and with various pharmacotherapies.
[Mh] Termos MeSH primário: Progressão da Doença
Enalapril/farmacologia
Regulação da Expressão Gênica/efeitos dos fármacos
Rim/efeitos dos fármacos
Tomografia por Emissão de Pósitrons
Receptor Tipo 1 de Angiotensina/metabolismo
Insuficiência Renal Crônica/tratamento farmacológico
[Mh] Termos MeSH secundário: Angiotensina II/sangue
Animais
Pressão Sanguínea/efeitos dos fármacos
Peso Corporal/efeitos dos fármacos
Diltiazem/farmacologia
Diltiazem/uso terapêutico
Enalapril/uso terapêutico
Coração/efeitos dos fármacos
Coração/fisiopatologia
Rim/metabolismo
Rim/patologia
Rim/fisiopatologia
Masculino
Tamanho do Órgão/efeitos dos fármacos
Ratos
Ratos Sprague-Dawley
Fluxo Sanguíneo Regional/efeitos dos fármacos
Insuficiência Renal Crônica/diagnóstico por imagem
Insuficiência Renal Crônica/metabolismo
Insuficiência Renal Crônica/fisiopatologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Receptor, Angiotensin, Type 1); 11128-99-7 (Angiotensin II); 69PN84IO1A (Enalapril); EE92BBP03H (Diltiazem)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170919
[Lr] Data última revisão:
170919
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170526
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0177451


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[PMID]:28526593
[Au] Autor:Li W; Frohwein T; Ong K
[Ad] Endereço:Internal Medicine, SUNY Upstate Medical University, United States. Electronic address: liwi@upstate.edu.
[Ti] Título:Cardiac tamponade as an initial presentation for systemic lupus erythematosus.
[So] Source:Am J Emerg Med;35(8):1213.e1-1213.e4, 2017 Aug.
[Is] ISSN:1532-8171
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Systemic lupus erythematosus (SLE) is a chronic autoimmune inflammatory disease which follows a relapsing and remitting course that can manifest in any organ system. While classic manifestations consist of arthralgia, myalgia, frank arthritis, a malar rash and renal failure to name a few, cardiac tamponade, however, is a far less common and far more dangerous presentation. We highlight the case of a 61year-old male with complaints of acute onset shortness of breath and generalized body aches associated with a fever and chills in the ER. A bedside echocardiogram revealed a significant pericardial effusion concerning for pericardial tamponade. An emergent pericardiocentesis performed drained 800mL of serosanguinous fluid. While denying a history of any rash, photosensitivity, oral ulcers, or seizures, his physical examination did reveal metacarpal phalangeal joint swelling along with noted pulsus paradoxus of 15-200mmHg. Subsequent lab work revealed ANA titer of 1:630 and anti-DS DNA antibody level of 256IU/mL consistent with SLE. This case highlights cardiac tamponade as a rare but life-threatening presentation for SLE and raises the need to keep it in the differential when assessing patients presenting with pertinent exam findings.
[Mh] Termos MeSH primário: Tamponamento Cardíaco/diagnóstico
Ecocardiografia
Lúpus Eritematoso Sistêmico/diagnóstico
Derrame Pericárdico/diagnóstico
Pericardiocentese/métodos
[Mh] Termos MeSH secundário: Anti-Hipertensivos/uso terapêutico
Tamponamento Cardíaco/tratamento farmacológico
Tamponamento Cardíaco/imunologia
Fármacos Cardiovasculares/uso terapêutico
Calafrios
Diltiazem/uso terapêutico
Dispneia
Febre
Seres Humanos
Lúpus Eritematoso Sistêmico/complicações
Lúpus Eritematoso Sistêmico/tratamento farmacológico
Masculino
Metoprolol/uso terapêutico
Meia-Idade
Derrame Pericárdico/tratamento farmacológico
Derrame Pericárdico/imunologia
Resultado do Tratamento
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antihypertensive Agents); 0 (Cardiovascular Agents); EE92BBP03H (Diltiazem); GEB06NHM23 (Metoprolol)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171004
[Lr] Data última revisão:
171004
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170521
[St] Status:MEDLINE


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[PMID]:28472575
[Au] Autor:Tachere RO; Modirrousta M
[Ti] Título:Beyond anxiety and agitation: A clinical approach to akathisia.
[So] Source:Aust Fam Physician;46(5):296-298, 2017.
[Is] ISSN:0300-8495
[Cp] País de publicação:Australia
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: When patients suddenly become restless and are unable to sit or stand still, especially in general medical settings, anxiety is often the topmost differential on every clinician's mind. However, the possibility of the very subjectively distressing condition called 'akathisia' should always be considered. OBJECTIVE: The aim of this article is to discuss a clinical approach to the management of akathisia, drawing on the presentation of a patient who was admitted to a general medical ward. DISCUSSION: Akathisia, a subjective and very distressing feeling of restlessness, has been found to be caused by a wide range of medications used in general medical settings, such as azithromycin, antiemetics and antipsychotics. Despite its high incidence and association with an increase in suicidal thoughts, it often goes unrecognised. This paper highlights the need for its early recognition, provides a diagnostic guide and an approach to its management.
[Mh] Termos MeSH primário: Ansiedade/etiologia
Agitação Psicomotora/complicações
Agitação Psicomotora/diagnóstico
[Mh] Termos MeSH secundário: Adulto
Antidepressivos/efeitos adversos
Antidepressivos/uso terapêutico
Antieméticos/efeitos adversos
Antieméticos/uso terapêutico
Antipsicóticos/efeitos adversos
Antipsicóticos/uso terapêutico
Ansiedade/diagnóstico
Buspirona/efeitos adversos
Buspirona/uso terapêutico
Cinarizina/efeitos adversos
Cinarizina/uso terapêutico
Diltiazem/efeitos adversos
Diltiazem/uso terapêutico
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico
Feminino
Seres Humanos
Metildopa/efeitos adversos
Metildopa/uso terapêutico
Agitação Psicomotora/etiologia
Reserpina/efeitos adversos
Reserpina/uso terapêutico
Ideação Suicida
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antidepressive Agents); 0 (Antiemetics); 0 (Antipsychotic Agents); 3DI2E1X18L (Cinnarizine); 56LH93261Y (Methyldopa); 8B1QWR724A (Reserpine); EE92BBP03H (Diltiazem); TK65WKS8HL (Buspirone)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171102
[Lr] Data última revisão:
171102
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170505
[St] Status:MEDLINE


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[PMID]:28165822
[Au] Autor:Ammar HO; Haider M; Ibrahim M; El Hoffy NM
[Ad] Endereço:a Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmaceutical Sciences and Pharmaceutical Industries, Future University in Egypt , Cairo , Egypt.
[Ti] Título:In vitro and in vivo investigation for optimization of niosomal ability for sustainment and bioavailability enhancement of diltiazem after nasal administration.
[So] Source:Drug Deliv;24(1):414-421, 2017 Nov.
[Is] ISSN:1521-0464
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Diltiazem hydrochloride (DTZ) is a calcium channel antagonist depicted by extensive first pass metabolism and low oral bioavailability. The aim of this work was to develop niosomes for potential nasal delivery of DTZ. Niosomes protect hydrophilic drugs inside their core while nasal route offers both rapid onset and evasion of first-pass metabolism. Niosomes were prepared using a combination of Span 60 or Brij-52 with cholesterol (CHOL) in different molar ratios followed by determination of entrapment efficiency, particle size and in vitro drug release. A parallel design was adopted to evaluate the pharmacokinetic performance of DTZ-loaded niosomes in male Wistar rats. Non-compartmental analysis was performed where C , T , t , MRT, area under the release curve (AUC) and K were assessed. The prepared niosomes were spherical with mean particle size 0.82-1.59 µm. Span 60-cholesterol niosomes (1:1 molar ratio) showed the highest entrapment and release efficiencies. In vivo study revealed an increase in MRT, t and AUC with a decrease in K . In conclusion, nasal niosomal formulation of DTZ expressed suitable pharmacokinetic parameters and bioavailability through prolonged duration of action inside the body as well as low rate of elimination depicting a promising alternate to the conventional oral route.
[Mh] Termos MeSH primário: Diltiazem/administração & dosagem
Diltiazem/metabolismo
Lipossomos/administração & dosagem
Lipossomos/metabolismo
[Mh] Termos MeSH secundário: Administração Intranasal
Animais
Disponibilidade Biológica
Preparações de Ação Retardada/administração & dosagem
Preparações de Ação Retardada/metabolismo
Masculino
Ratos
Ratos Wistar
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Delayed-Action Preparations); 0 (Liposomes); EE92BBP03H (Diltiazem)
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170606
[Lr] Data última revisão:
170606
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170207
[St] Status:MEDLINE
[do] DOI:10.1080/10717544.2016.1259371



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