RESUMO
A patient is described with an unusual presentation of ulcerating skin lesions in Philadelphia chromosome-positive chronic granulocytic leukaemia. Treatment with topical mustine ointment (nitrogen mustard, mechlorethamine) achieved a good palliative result.
Assuntos
Leucemia Mieloide/patologia , Mecloretamina/uso terapêutico , Neoplasias Cutâneas/patologia , Administração Tópica , Idoso , Feminino , Humanos , Leucemia Mieloide/tratamento farmacológico , Mecloretamina/administração & dosagem , Neoplasias Cutâneas/tratamento farmacológicoRESUMO
Clinical pharmacokinetics is an expanding scientific discipline which can make an impact on treatment in coronary care, intensive care, paediatrics, general medicine and surgery, and general practice. The aim of this study was to establish a rapid system of drug assay, to report the result, to assess the influence of pathological and clinical factors on the pharmacokinetics of certain drugs, and to use a computer to determine the optimum dosage of drugs. The clinical pharmacokinetics laboratory in Stobhill is available to all clinical departments and to general practitioners in the area. Digoxin, theophylline, and phenytoin have been assessed. Initial samples of these drugs showed that only about a third were in the therapeutic range; samples obtained after the issue of the laboratory report showed an improvement. The predictive performance of the computer program improved with feedback of one or two drug concentrations. Dosages of drugs chosen on an empirical basis may not lead to optimum treatment, and by testing samples early the dosage of the drug can be adjusted. It is hoped that the results achieved will encourage other clinical, pharmaceutical, and scientific colleagues to develop laboratories along similar lines.
Assuntos
Preparações Farmacêuticas/sangue , Farmacologia Clínica/métodos , Digoxina/sangue , Esquema de Medicação , Humanos , Cinética , Microcomputadores , Preparações Farmacêuticas/administração & dosagem , Fenitoína/sangue , Valores de Referência , Teofilina/sangueRESUMO
The serum concentration/time profiles resulting from two oral disopyramide dosage regimes were studied in ten patients with ischaemic heart disease. Conventional dosing on a 6 r 8 hourly basis consistently achieved disopyramide concentrations within the accepted therapeutic range of 2-7 micrograms/ml. In contrast, a twice daily regime was associated in some patients with trough levels below the minimum effective concentration. The mean elimination half-life was 5.8 h; this does not substantiate previous reports of significantly prolonged disopyramide half-lives in patients with ischaemic heart disease. Unless significant renal impairment or cardiac failure is present, or a sustained release preparation is used, the dosage interval for oral disopyramide should not exceed 8 h.
