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Julienne K. Kirk PharmD BCPS CDE Charley Hepfinger PharmD BCPS 《Clinical reviews in bone and mineral metabolism》2005,3(1):39-49
Calcitonin is a 32-amino acid polypeptide secreted by the parafollicular cells of the thyroid. Effects on bone include inhibition
of osteoclasts, thus preventing bone resorption, as well as increased renal calcium excretion. Salmon calcitonin is often
used therapeutically because it is more potent and has a longer duration of action compared with human calcitonin. Calcitonin
also possesses analgesic properties. The mechanism of its analgesic effect is unknown but is thought to involve inhibition
of prostaglandins and stimulation of β-endorphins.
Most of the clinical data in postmenopausal osteoporosis involves the use of salmon calciton in nasal spray. Clinical trials
have demonstrated a reduction in the risk of vertebral fractures and increased bone mineral density. Studies examining nonvertebral
fractures have shown mixed results, some indicating a nonsignificant risk In general, calcitonin is inferior to bisphosphonates
(BPs) in reducing fracture risk. Calcitonin is effective in the treatment of osteopathic pain. It has also been used in glucocorticoid-induced
osteoporosis.
Parenteral calcitonin is generally associated with more frequent side effects compared with intranasal calcitonin. Injectable
administration can cause flushing, tingling, nausea, and injection site and allergic reactions. Side effects with intranasal
use are usually limited to local effects (nasal congestion and irritation). Recent phase I trials with a new oral dosage form
show promise in terms of efficacy and tolerability for treating patients who prefer this route of administration.
This review of pertinent literature on calcitonin indicates that this remains a viable, though second-or third-line, agent
for osteoporotic patients who refuse or cannot tolerate other treatments (e.g., BPs, raloxifene, and estrogen). 相似文献
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S. L. Dahl PharmD BCPS 《Journal of clinical pharmacy and therapeutics》1995,20(3):131-147
Rheumatoid arthritis (RA) is an unremitting and progressive disease despite the use of second–line drugs in the majority of patients. In addition, a shortened life–span directly attributable to RA is now recognized. The additions of methotrexate and sulfasalazine to the therapeutic armamentarium represent important treatment advances during the past decade. To improve the effectiveness of second–line drug therapy, earlier intervention and use of these newer drugs in combination with older second–line drugs is being advocated. Several proposed strategies for intervening earlier, combining second–line drugs, and/or improving patient selection for second–line drug therapy are reviewed. Systematic evaluation of these strategies is needed. Controlled studies to date have not demonstrated combining secondline drugs is superior to using individual secondline agents. Future advances in optimizing patient outcomes with these drugs will require systematic screening for potentially superior treatment strategies followed by supportive proof of effectiveness in the form of large–scale studies. 相似文献
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Glargine Insulin Use Versus Continuous Regular Insulin in Diabetic Surgical Noncritically Ill Patients Receiving Parenteral Nutrition: Randomized Controlled Study
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Hakeam A. Hakeam MS Pharm BCPS Hamdy A. Mulia PharmD Ayman Azzam MD Tarek Amin MD 《JPEN. Journal of parenteral and enteral nutrition》2017,41(7):1110-1118
Background: Hyperglycemia is a major complication of parenteral nutrition (PN). Guidelines for hyperglycemia management in noncritically ill patients cite basal insulin administration but do not recommend a regimen. The GLUCOSE‐in‐PN study aimed to compare the efficacy of glargine insulin versus continuously infused regular insulin in PN (RI‐in‐PN) to achieve glycemic control in noncritically ill surgical patients with diabetes who were receiving PN. Methods: This prospective randomized open‐label study was conducted at King Faisal Specialist Hospital and Research Centre. Noncritically ill surgical patients with diabetes who were receiving PN were randomized to receive basal glargine insulin or RI‐in‐PN on day 4 of PN support. Mean blood glucose levels were compared on study days 5–9. The percentages of blood glucose measurements at goal were compared between groups. Results: Sixty‐seven PN treatment episodes were analyzed. There were no statistically significant differences in mean glucose levels between groups on any study day (P > .1). Overall glycemic control rates were 52.24% (glargine insulin) and 47.76% (RI‐in‐PN; P = .06). A significantly higher percentage of hyperglycemia was observed on day 5 for glargine insulin versus RI‐in‐PN (22.39% vs 5.97%, P = .0059). Blood glucose measurements indicated 6 hypoglycemic events: 2 for glargine insulin (5.7%) and 4 for RI‐in‐PN (11.4%; P > .1). Conclusion: Both glargine insulin and RI‐in‐PN are effective basal insulin modalities for blood glucose control in noncritically ill surgical patients with diabetes who are receiving PN. Uncontrolled hyperglycemic events occurred more frequently with glargine insulin, and the rate of hypoglycemia was acceptable for both regimens. 相似文献
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Interdisciplinary Discrepancies Between Parenteral Nutrition Macronutrient Prescribing and Recommendations: Is Body Mass Index a Factor?
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Katie L. Elliott MS RD CDE Jay Kandiah PhD RD CD Todd A. Walroth PharmD BCPS 《JPEN. Journal of parenteral and enteral nutrition》2017,41(5):759-765
Background: Formal nutrition training in medical schools and residencies is lacking and needed. Registered dietitians (RDs) are formally trained in nutrition support and considered experts in the nutrition field. Our purpose was to examine prescribing and recommending discrepancies of parenteral nutrition macronutrients between medical residents (MRs) and RDs and compare results with the ASPEN clinical care guidelines. We also looked at discrepancies among obese patients, due to their increased risk of mortality. Materials and Methods: The primary end point of this retrospective review was discrepancies in nonprotein calories (NPCs) and grams of protein (PRO) between MRs and RDs. The secondary end point was discrepancies in NPCs and PRO between MRs and RDs among patients stratified by body mass index category. Results: MRs prescribed 300 NPCs more versus RDs (P < .001). When compared with RDs, MRs prescribed fewer NPCs for underweight patients and more for obese patients (P < .001). The same analysis found that the PRO discrepancies significantly varied by body mass index classification as well (P = .022). When these results were compared with the ASPEN clinical care guidelines, RDs adhered closer to the guidelines than did MRs in terms of permissive underfeeding of obese patients. Conclusion: It is widely accepted that MRs are in need of increased formal training, and the results of our study confirm this need and suggest a short‐term solution of increasing order‐writing privileges for the RD. RDs with this privilege may adhere more closely to clinical care guidelines and therefore increase patient safety. 相似文献
57.
Persistence of metabolic monitoring for psychiatry inpatients treated with second‐generation antipsychotics utilizing a computer‐based intervention
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