RESUMO
OBJECTIVE: Lenalidomide (LDM) is an immunomodulatory and anti-angiogenic drug which has been shown to be effective in several haematological disorders (multiple myeloma [MM], myeloid metaplasia with myelofibrosis [MF] and myelodysplastic syndrome [MDS]). The objective of this study is to evaluate the effectiveness and tolerability of LDM in our patients. METHOD: Retrospective observational study which included patients at our hospital who were monitored by the haematology unit, diagnosed with MM, MF and MDS and candidates for LDM treatment. Treatment effectiveness was assessed after approximately 4 cycles of treatment. RESULTS: Between February 2007 and March 2008, 16 patients were listed as candidates for receiving treatment with LDM (50% female/50% male, with a mean age of 69.6 years); of these candidates, 3 never initiated treatment. Five of the six patients with MM treated at our hospital obtained some sort of response (83.3%). Of the 4 patients with MF, 2 (66.6%) experienced some sort of response to treatment. Of the 6 patients diagnosed with MDS, treatment was initiated in 3, and it had to be suspended in 2 cases due to different reasons. Treatment only had to be suspended in two of the 13 patients who began it (15.4%) due to adverse effects (AE). CONCLUSION: LDM is well-tolerated and produces sustained clinical benefits, especially in MM and MF. More studies are needed for in-depth examination of treatment duration, new indications and the use of treatments combined with other drugs.
Assuntos
Antineoplásicos/uso terapêutico , Mieloma Múltiplo/tratamento farmacológico , Síndromes Mielodisplásicas/tratamento farmacológico , Mielofibrose Primária/tratamento farmacológico , Talidomida/análogos & derivados , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Lenalidomida , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Talidomida/uso terapêuticoRESUMO
A number of literature references suggest that carbapenem-like antibiotics decrease plasma concentrations of valproic acid in epileptic patients. This interaction may result in a recurrence of epileptic seizures in these patients. To clarify the possible mechanism of such carbapenem-valproic acid interaction several experimental studies have been carried out in animals. However, the mechanism of this drug-drug interaction is as yet uncertain. in this article we report three new cases that were observed in our hospital within three months. One of these patients developed seizures. We also review the different mechanisms proposed, as well as cases published to this day. All these data demonstrate that care should be taken in using these potent antibiotics in patients receiving valproic acid.
Assuntos
Anticonvulsivantes/farmacocinética , Carbapenêmicos/farmacocinética , Ácido Valproico/farmacocinética , Adulto , Idoso , Interações Medicamentosas , Feminino , Humanos , MasculinoRESUMO
Disseminated intravascular coagulation as associated to sepsis contributes to the development of clinical multiple organ failure by extensive thrombosis in microcirculation vessels. This condition commonly manifests itself in severe meningococcal sepsis. On the skin, its clinical manifestation is extensive purpura with necrotic lesions that usually progress to serious distal ischemia and may call for amputation. A common denominator in these events regarding hemostasis is a depletion of so-called natural anticoagulant proteins, particularly protein C. According to clinical observations replacement therapy with human plasma-derived protein C concentrates has been associated with significantly improved clinical outcome in patients with meningococcal sepsis and fulminant purpura. This paper reports a case of acquired protein C deficiency in a girl with meningococcal sepsis, fulminant purpura, disseminated intravascular coagulation, and septic shock. Fresh plasma therapy was intended to increase consumption coagulopathy-depleted coagulation factors and to provide small amounts of protein C. The inability to restore protein C concentrations above 30%, and the presence of severe thrombopenia in the setting of disseminated intravascular coagulation led to the onset of replacement therapy using a human protein C concentrate (Ceprotin), which increased plasma protein C concentrations and contributed to revert the existing hypercoagulability status. Finally, evidence available in the literature regarding fulminant meningococcal sepsis management using human protein C concentrates and recombinant activated protein C is discussed.
Assuntos
Fibrinolíticos/uso terapêutico , Vasculite por IgA/tratamento farmacológico , Infecções Meningocócicas/tratamento farmacológico , Deficiência de Proteína C/tratamento farmacológico , Proteína C/uso terapêutico , Criança , Evolução Fatal , Feminino , Testes Hematológicos , Humanos , Vasculite por IgA/etiologia , Infecções Meningocócicas/complicações , Deficiência de Proteína C/etiologiaAssuntos
Angioedema/induzido quimicamente , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Enalapril/efeitos adversos , Idoso de 80 Anos ou mais , Clopidogrel , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Enalapril/administração & dosagem , Enalapril/uso terapêutico , Feminino , Humanos , Hidroclorotiazida/administração & dosagem , Hidroclorotiazida/efeitos adversos , Hidroclorotiazida/uso terapêutico , Hipertensão/complicações , Hipertensão/tratamento farmacológico , Metformina/administração & dosagem , Metformina/uso terapêutico , Ticlopidina/administração & dosagem , Ticlopidina/análogos & derivados , Ticlopidina/uso terapêuticoRESUMO
The preparation of paediatric parenteral nutrition admixtures varies greatly. There is still a clear lack of consensus on many points. These points include the use of organic or inorganic phosphate or calcium salts, preparing binary or ternary mixtures, the type of lipid used, and the addition or suppression of heparin or carnitine, etc. The process must be standardised in order to guarantee that prepared mixtures will be stable. However, there is still no information on how to predict their stability with any degree of precision, particularly for ternary mixtures. For that reason, any change applied may trigger a destabilisation process that places patient safety at risk. We describe a case of a ternary paediatric parenteral nutrition admixture in which creaming was observed. We indicate the factors that gave rise to this phenomenon and the measures taken to avoid it.
Assuntos
Heparina/farmacologia , Doenças do Prematuro/terapia , Soluções de Nutrição Parenteral/química , Nutrição Parenteral , Fosfolipídeos/química , Óleo de Soja/química , Cálcio/química , Físico-Química , Composição de Medicamentos/métodos , Estabilidade de Medicamentos , Emulsões/química , Feminino , Heparina/química , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Fosfatos/química , SolubilidadeAssuntos
Analgésicos não Narcóticos/efeitos adversos , Carbamazepina/efeitos adversos , Síndrome de Secreção Inadequada de HAD/induzido quimicamente , Síndrome de Secreção Inadequada de HAD/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Idoso , Analgésicos não Narcóticos/uso terapêutico , Carbamazepina/uso terapêutico , Humanos , Masculino , SíndromeRESUMO
ST segment elevation acute coronary syndrome is a clinical condition that is rarely observed in pregnant women. However, its manifestation is a situation of high maternal-fetal risk. Pharmacotherapeutical management of these patients is difficult and requires individualized care by a multidisciplinary team since many of the standard treatments are included within the categories of teratogencity C or D of the Food and Drug Administration and experience with techniques such as coronary angioplasty with stent placement is scarce. The case of a 32-year woman who was 11 weeks pregnant and diagnosed of acute coronary syndrome with ST segment and its therapeutic approach are described. Furthermore, the information available on epidemiology, etiology and pathophysiology of acute coronary syndrome with ST segment during pregnancy and the specific role of the currently available treatment options are reviewed.
Assuntos
Angina Instável/tratamento farmacológico , Infarto do Miocárdio/tratamento farmacológico , Complicações Cardiovasculares na Gravidez/tratamento farmacológico , Doença Aguda , Adulto , Angina Instável/fisiopatologia , Eletrocardiografia , Feminino , Humanos , Infarto do Miocárdio/fisiopatologia , Gravidez , Complicações Cardiovasculares na Gravidez/fisiopatologia , SíndromeRESUMO
BACKGROUND: Mycophenolate mofetil (MMF) has been used successfully in patients with various forms of uveitis not responsive to other immunosuppressants. Nevertheless, for these patients neither recommendations for optimal dosage of MMF nor data concerning drug exposure of MMF are available. OBJECTIVE: To describe the results of the therapeutic drug monitoring (TDM) of MMF trough concentrations in a cohort of patients with uveitis, with the aim of optimizing the dosage of this drug, by maintaining a target concentration to achieve adequate immunosuppression with a minimal risk of therapeutic failure or toxicity. PATIENTS AND METHODS: This study describes the results of monitoring trough plasma concentrations of MMF in 12 patients with uveitis during a mean period of 21.4 months. Patients included one with Stevens-Johnson syndrome, one with Graves-Basedow's disease, one with Behcet's disease, one with idiopathic thrombocytopenic purpura and the rest with idiopathic uveitis. All patients were treated with steroids and additional therapy prior to treatment with MMF. RESULTS: Pharmacokinetic monitoring of mycophenolic acid (MPA) was performed with 108 trough plasma samples using an EMIT assay. Mean daily MMF dose was 24.5 +/- 6.3 mg/kg and mean trough MPA concentration was 2.9 +/- 1.9 microg/mL. Therapy was effective in 10 patients (83%). There were few side-effects: diarrhoea, excitement, agitation and cough that disappeared with daily dose reduction of MMF. CONCLUSIONS: MMF was effective in the majority of patients with uveitis with an acceptable profile of side-effects. TDM of MMF in patients with uveitis is clinically practicable and may help to optimize individual immunosuppressive therapy. We estimated that MMF dosages in the range of 0.5-1.5 g/day might be sufficient for treating uveitis and we recommend an initial target range of 2-4 microg/mL, which included 50% of our results. Randomized controlled trials are essential to confirm the efficacy of MMF in uveitis.