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4 results

  • Chapter 38 - Drug Hypersensitivities and Contraindications

  • from Part 10 - Interactions, Hypersensitivity and Contraindications
  • Edited by Hugh Montgomery, Robert Shulman, Mayur Murali
  • Book:
    Surviving Prescribing
    Published online:
    08 June 2020
    Print publication:
    25 June 2020, pp 171-174

  • Summary

    First do no harm’ is a fine principle; however, most medicines worth using have side effects, so it’s important that the prescriber can assess the risk/benefit ratio. This chapter provides examples of good advice (e.g. not to use NSAIDs in renal or liver impairment), overly cautious advice that may be flouted (e.g. cephalosporins in pencillin allergic patients) and advice that may appear overly cautious but should still be followed as there is a safer alternative (e.g.metformin in renal failure).

  • Appropriate use of a beta-blocker in paediatric coronary CT angiography

  • Hirofumi Watanabe, Hiroshi Kamiyama, Masataka Kato, Akiko Komori, Yuriko Abe, Mamoru Ayusawa
  • Journal:
    Cardiology in the Young / Volume 28 / Issue 10 / October 2018
    Published online by Cambridge University Press:
    06 August 2018, pp. 1148-1153
  • Background

    There is no standard dose or protocol for beta-blocker administration as preconditioning in children undergoing coronary CT angiography.

    Methods

    A total of 63 consecutive patients, with a mean age of 10.0±3.1 years, who underwent coronary CT angiography to assess possible coronary complications were enrolled in a single-centre, retrospective study. All patients were given an oral beta-blocker 1 hour before coronary CT angiography. Additional oral beta-blocker or intravenous beta-blocker was given to those with a high heart rate. We compared image quality, radiation exposure, and adverse events among the patients without additional beta-blocker, with additional oral beta-blocker, and with additional intravenous beta-blocker.

    Results

    There were no significant differences in image quality or radiation exposure among the groups. The heart rate just before scanning was significantly correlated with image quality (p<0.001, r=−0.533) but was not correlated with radiation exposure (p=0.45, r=0.096). There were no adverse events related to any allergic reaction, thereby showing the effectiveness of the beta-blocker.

    Conclusion

    Initial oral beta-blocker administration (0.8 mg/kg/dose) should be administered to all children undergoing coronary CT angiography. Additional intravenous beta-blocker should be given to those with poor heart rate control to improve image quality without increasing radiation exposure or allowing adverse events.

  • Chapter 18 - Psychiatric aspects of AIDS

  • Edited by James J. Amos, University of Iowa, Robert G. Robinson, University of Iowa
  • Book:
    Psychosomatic Medicine
    Published online:
    04 August 2010
    Print publication:
    27 May 2010, pp 163-173

  • Summary

    The American Heart Association and others have recommended screening for depression among those with cardiovascular disease (CVD). It has been further suggested that this screening should occur at least quarterly. In addition to an appropriate and targeted work-up for CVD, patients should be screened for conditions related to depression and heart disease, such as sleep apnea. Once the diagnosis of depression has been made, a variety of treatment options are available. These include antidepressants, psychotherapy, and exercise. Relaxation and stress management approaches also may be of benefit. Beta-blockers do not cause depression and should not be avoided in patients with depression and CVD. Although case reports have documented a number of psychiatric adverse effects of hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors or statins, such effects have not been reported in systematic studies. Use of statins does not appear to increase risk of suicide.

  • Cardiac chest pain

  • from Chief complaints and diagnoses
  • Edited by Stephen H. Thomas
  • Book:
    Emergency Department Analgesia
    Published online:
    18 December 2009
    Print publication:
    25 September 2008, pp 162-167

  • Summary

    Hemodynamic therapy remains the foundation of aortic dissection (AD) care, and successful control of blood pressure and heart rate improves patient comfort. The first step in AD care, anti-impulse therapy, serves as optimal medical management and also provides pain relief. Ongoing pain after beta-blocker administration usually indicates incomplete blood pressure control. In such cases, pain relief (and optimal medical management) is facilitated by vasodilation. When AD is accompanied by cardiac ischemia, the calcium channel blocker nicardipine is indicated. Citing sedative and anxiolytic properties, expert reviewers recommend morphine for AD pain, but there is no evidence demonstrating its superiority over other opioids. Patients in pain from AD tend to be hypertensive, but in those cases where blood pressure is borderline or low, fentanyl's limited hemodynamic impact is attractive. Anesthesiologists confirm fentanyl's utility for AD, including in cases where there are complicating conditions such as subarachnoid hemorrhage or pregnancy.