Medikamentöse Frequenzkontrolle bei Vorhofflimmern

Atrial fibrillation is the most common form of persistent arrhythmia. Atrial fibrillation frequently causes rapid ventricular response with severe clinical symptoms requiring acute control of the ventricular rate. This leads to hemodynamic stabilization and improvement of symptoms. The long-term treatment target is to minimize patient symptoms and prevention of complications. As a rhythm control strategy does not provide a survival benefit compared to a rate control strategy, decisions on the best long-term treatment have to be individualized. Important factors affecting this decision are age of the patient, chances to re-establish and maintain sinus rhythm, tolerance of antiarrhythmic medication and accompanying diseases of the heart. For younger patients a rhythm control strategy will usually be the preferred option. For rate control beta blockers are considered first line therapy, alternative drugs include calcium antagonists and digoxin. Occasionally, amiodarone may also be used for rate control. If pharmacological rate management fails ablation of the atrioventricular (AV) node may be an option to control the ventricular rate.     

Medikamentöse Therapie von Vorhofflimmern

Atrial fibrillation is one of the most common long-lasting arrhythmias of the heart. It leads to an increase in morbidity and a substantial reduction in quality of life in most patients. Therefore, an early and adequate therapy strategy and prevention of comorbidities of atrial fibrillation are demanding. There is no controversy about the pharmaceutical treatment as the first choice and gold standard in atrial fibrillation patients. As there is no evidence that frequency control is superior to rhythm control or vice versa, therapy strategies should depend on the clinical status and comorbidities of the individual patient. However, adequate anticoagulation for prevention of thromboembolism should be performed in every patient, even after conversion of atrial fibrillation into sinus rhythm.     

Medikamentöse Therapie bei Patienten mit Leberzirrhose

Die Gastroenterologie - Die Leberzirrhose ist das Endstadium chronischer Lebererkrankungen und insbesondere im fortgeschrittenen Stadium mit einer hohen Morbidität und Mortalität...     

Medikamentöse Nephroprotektion

Die Inzidenz und Pr?valenz der terminalen Niereninsuffizienz in Deutschland stieg in den letzten Jahren kontinuierlich an, zuletzt auf eine Pr?valenz von 600–700 Patienten/Mio. Einwohner. Das chronische Nierenversagen stellt durch die enormen Kosten der Nierenersatztherapie, die j?hrlich ca. 80.000 DM pro H?modialysepatient betragen, eine ?konomische und medizinische Herausforderung dar. Der Fokus muss daher darauf liegen, das Fortschreiten einer Nierenerkrankung zu verhindern.     

Medikamentöse vasoaktive Therapien von Mikrozirkulationsstörungen bei rheumatischen Erkrankungen

Ohne Zusammenfassung     

Medikamentöse Therapie von Hypophysenerkrankungen

Zusammenfassung Eine erfolgreiche medikamentöse Pharmakotherapie von hypophysären Hormonexzessen ist lediglich für die Behandlung der Akromegalie (Dopaminagonisten, Somatostatinanaloga und Wachstumshormonrezeptorantagonisten) und des Prolaktinoms (Dopaminagonisten) etabliert. Allerdings ist bei der Akromegalie die transsphenoidale Hypophysenoperation die Therapie der ersten Wahl, während beim Prolaktinom nur in Ausnahmefällen eine Operationsindikation besteht.Bei einer endokrinen Insuffizienz der Hypophyse ermöglicht eine Substitutionstherapie dem Patienten eine normale Belastbarkeit und Lebensqualität. Die Substitution der kortikotropen und thyreotropen Achse mit Hydrocortison und L-Thyroxin ist lebensnotwendig. Die gonadotrope Achse sollte bei der Frau zumindest bis zum Zeitpunkt des natürlichen Klimakteriums mittels Östrogen/Gestagenpräparaten ersetzt werden. Beim Mann sollte, solange keine Kontraindikationen bestehen, die Substitutionstherapie lebenslang erfolgen (transdermales Testosteronpflaster, Testosterongele und Testosteronundecanoat bzw. -enantat). Bei Kinderwunsch bestehen bzgl. der Fertilität sehr gute Aussichten mit einer Gonadotropinbehandlung bzw. pulsatilen GnRH-Therapie. Insbesondere bei jüngeren Patienten scheint auch eine Wachstumshormonsubstitution (Somatropin) sinnvoll.     

Medikamentöse Therapie nach Herzinfarkt

Zum Thema Die medikament?se Therapie nach akutem Herzinfarkt hat zun?chst die Antagonisierung der neurohumoralen Aktivierung als wesentlicher Determinante des Remodeling zum Ziel. Das zweite Hauptziel besteht danach in der Sekund?rpr?vention, um die Inzidenz weiterer atherothrombotischer Ereignisse zu vermindern. Der vorliegende Beitrag beschreibt die Hauptangriffspunkte der medikament?sen Postinfarkttherapie. Die Ergebnisse der relevanten Studien zu den eingesetzten Substanzen (Antithrombotika, Antikoagulantien, ACE-Hemmer, Angiotensin-I- und Aldosteronantagonisten, β-Blocker und Statine) werden ausführlich beschrieben, sodass auf ihrer Basis Empfehlungen für die Sekund?rpr?vention gegeben werden k?nnen.     

Medikamentöse Behandlung gastrointestinaler Tumoren

Background

In gastrointestinal cancer, early diagnosis, multidisciplinary treatment and new therapeutic options result in increased cure rates or survival times. After treatment of gastrointestinal cancer, many patients suffer from treatment-related sequelae that affect the quality of life.

Objectives

This article provides an overview of the most common long-term sequelae after pharmacological therapy of gastrointestinal tumors.

Materials and methods

The results of a literature review, current basic research, and expert recommendations are discussed.

Results

Common sequelae after pharmacological therapy of gastrointestinal tumors are polyneuropathy, fatigue, bone marrow toxicity, and sexual dysfunction/reduced fertility.

Conclusions

With more intensive therapeutic approaches, long-term side effects will increase after treatment of gastrointestinal tumors. Because the quality of life can be significantly affected, the development of long-term side effects should be closely monitored in the follow-up of patients.

     

Medikamentöse Therapie der Arthrose

The pharmacological management of osteoarthritis includes pure analgesia, anti-inflammatory drugs and substances supporting tissue maintenance in osteoarthritic joints. The decision for the treatment modality is made depending on the affected joint, the stage of the disease, the extent and frequency of inflammatory flares and the patient risk profile. This article gives an overview of the current treatment modalities including the advantages and disadvantages.     

Medikamentöse Therapie von Harnwegsinfekten

Urinary tract infections (UTI) are the most common bacterial infectious diseases seen in the community, in most cases caused by E. coli. The treatment strategy differs depending on localization (lower vs. upper UT), acute uncomplicated vs. complicated infection, as well as for chronic disease and asymptomatic bacteriuria, the known or susceptible causative uropathogen with the (local) resistance pattern and the morbidity of the patient. There is a considerable worrying increase in the resistance rate of E. coli to TMP/SMX, quinolones and others. Most patients with uncomplicated, in the community acquired UTI are treated safely and effectively as out-patients. The available data support a short-course therapy with 3 days as the current standard therapy for lower UTI, but with a 7-14 days treatment for upper and complicated UTI. Recurrent UTI is best managed by low-dose antimicrobial prophylaxis for 3-6 (12 ore more) months. Besides that, new approaches to preventive strategies must prove their value in specific patient groups.     

Medikamentöse Therapie der Harninkontinenz

Urinary incontinence has a high prevalence in both men and women. Women suffer predominantly from stress urinary incontinence and men from urge incontinence. Other types of incontinence are less frequent. Stress urinary incontinence is caused by an insufficient urethral closure mechanism and urge incontinence by uninhibited detrusor contractions. Medical treatment is beside other conservative options and operations only one part of the treatment strategy in incontinence. Duloxetine, a serotonine-norepinephrine reuptake inhibitor, is used to treat stress urinary incontinence, can increase activity of the external urethral sphincter and is able to reduce incontinence episodes in up to 64%. Antagonists of muscarinic receptors can reduce urgency, frequency and urge incontinence as well as increase bladder capacity significantly. In Germany, trospium chloride, tolterodine, solifenacin, oxybutynin and propiverine are available to treat urge incontinence. Efficacy of these agents are comparable. However, tolerability is different and side effects, especially dry mouth, often limit their use. None of the agents show ideal efficacy or tolerability in all patients and, therefore, new agents and formulations are currently under clinical investigation.     

Medikamentöse Arthrosetherapie im Alter

Osteoarthritis (OA) is the most common cause of functional disability in the elderly. Pain and loss of motion induce a vicious circle, leading to instability, frailty and ultimately invalidity. Currently, there is no treatment to reverse or slow the disease progression to a clinically meaningful extent. Thus, the primary goal of OA treatment in the elderly is pain relief and preservation of joint function. For this, pharmacological, non-pharmacological and if necessary surgical treatment regimes must form an integrated concept. However, the real challenge is polymorbidity and other age-related or age-associated factors, which influence the course of disease and its therapy unfavorably. The changes in pharmacokinetics and -dynamics in the elderly can be compensated for the nonopioid and opioid-analgesics by the well known "start low, go slow" approach. More problematic are non-steroidal anti-inflammatory drugs (NSAIDs), which are most often used for symptomatic treatment of OA: Patients over 65 have an enhanced susceptibility to the gastrointestinal and renal side effects of NSAIDs; all NSAIDs, not only coxibs, increase the cardiovascular risk in patients with such a disease; number and severity of drug interactions is elevated due to age-associated polypharmacy. Thus, NSAIDs, including coxibs, should be used with great caution for treatment of OA in the elderly.     

Medikamentöse Therapie bei akuten und chronischen lumbalen Rückenschmerzen

Low back pain is common. In the acute (duration <6 weeks) and subacute pain phases (6–12 weeks) the main goal of pharmacological pain treatment is to enable patients to move and to stay as active as possible. In the chronic phase, pain medications can support non-pharmacological measures and improve physical function. Although almost every person will experience low back pain at least once in a lifetime, for many pain medications no clinical studies on their efficacy exist. Most data are available on the efficacy of non-steroidal anti-inflammatory drugs (NSAIDs) in acute and chronic low back pain; however, potential adverse effects and contraindications for NSAIDs need to be taken into account when the medication is prescribed. For other non-opioid medications (e.?g. paracetamol, metamizole) the efficacy is not well studied. Weak and strong opioids have been shown to be effective compared to placebo in the short term; however, there is increasing evidence that opioids are no more effective than non-opioid medications in the treatment of acute and chronic low back pain. Furthermore, gastrointestinal and central nervous system adverse effects of opioids should be considered. Conclusion: in low back pain, the choice of a specific pain medications is based on the individual patient preferences, contraindications, and potential adverse effects. The main goal of pain medications is to enable patients to stay active. In persisting pain, non-pharmacological measures are important and should complement pharmacological pain treatment.