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Respiratory Changes During Sleep
Published in Alan D. Miller, Armand L. Bianchi, Beverly P. Bishop, Neural Control of the Respiratory Muscles, 2019
Sandra J. England, Richard J. Strobel
Protriptyline, a tricyclic antidepressant, reduces REM sleep time and has modest effects to decrease apneas in patients with OSA,9 probably through increased neural activation of upper airway muscles.8 Fluoxetine, a selective serotonin reuptake inhibitor, has similar efficacy and is better tolerated than protriptyline in the treatment of OSA.35 Increased serotonergic input to upper airway motor nuclei is a possible explanation for fluoxetine’s beneficial effect in OSA.48 Nicotine, which increases both overall ventilatory output and upper airway muscle activity,37 improves sleep-disordered breathing transiently; however its short half-life and side effects limit its usefulness.67 Almitrine, a carotid body stimulant, improves oxygenation during wakefulness and sleep in patients with COPD16 but is not useful in the treatment of sleep apnea.67 Theophylline is similarly ineffective in the treatment of OSA33 although reductions in central apneas may be seen with this drug and it is the drug of choice in the treatment of central apneas in infants.67
Transition to extrauterine life
Published in Prem Puri, Newborn Surgery, 2017
Carlos E. Blanco, Eduardo Villamor
The nature (and indeed the location) of the inhibitory processes is not known. Because the inhibition occurs even in chemodenervated fetuses,65 it is clear that the neurons involved do not receive an excitatory input from the chemoreceptors. They may therefore be chemoreceptors themselves or receive input from other cells thought to be sensitive to hypoxia, e.g., in the rostral ventrolateral medulla.66 The neural activity as a whole behaves as a chemoreceptor, because the chemoreceptor stimulant drug almitrine mimics the effects of hypoxia in inhibiting FBM, irrespective of the integrity of the peripheral chemoreceptors.67 As expected from the discussion above, the stimulatory effect of the drug on the peripheral chemoreceptors only becomes manifest when lesions were placed in the lateral pons,68 unmasking its peripheral actions.
Respiratory Failure after Surgery or Trauma
Published in Stephen M. Cohn, Matthew O. Dolich, Complications in Surgery and Trauma, 2014
Joseph J. DuBose, James V. O’Connor
Patients most likely to benefit from iNO include those with a high baseline pulmonary vascular tone, a high degree of initial venous admixture, and increased cardiac output. Efforts aimed at improving outcomes have focused on combination therapies involving iNO. Its use in combination with pulmonary vasoconstrictors such as almitrine [27] or norepinephrine [28] increases the PF ratio more than does the use of either agent alone. This outcome is probably the effect of a reduction in the shunt fraction that is the result of generalized pulmonary vasoconstriction with vasodilatation in the well-ventilated areas. Other combination therapies include the use of phosphodiesterase inhibitors [29], prone positioning, high-frequency ventilation, and partial liquid ventilation.
Ongoing non-industry-sponsored COVID-19 clinical trials in the first trimester of the pandemic: significant differences between the European and the USA approaches
Published in Expert Review of Clinical Pharmacology, 2020
On March 31, 32% (20/62) of European trials and 15% (7/46) of American trials were already registered. The first study to be registered in February 2020 was BEST-CP, a China-sponsored non-RCT assessing bevacizumab in hospitalized patients in Italy. In the USA, ACTT, an adaptive, double-blind RCT assessing remdesivir vs placebo in hospitalized patients, was also registered in February 2020. Evolution over time (February 15-April 25) of the registered trials showed that (Supplementary online material-2): a) up to March 31, hydroxychloroquine (7 trials), lopinavir/ritonavir (4), tocilizumab (4), remdesivir (3), losartan (3) and systemic corticosteroids (3) were the most frequently assessed medicines, that were being evaluated in 15 of 24 trials; b) on April 1–14, hydroxychloroquine (16 trials), azithromycin (11), tocilizumab (7), systemic corticosteroids (6), sarilumab (3), comprised 34 of 56 trials; and c) new approaches such as almitrine (1 trial), anticoagulants (antithrombin, enoxaparin; 3), dapagliflozin (1), estradiol patch (1), fluvoxamine (1), imatinib (2), were first registered on April 14–25.
A description of medicines-related safety issues evaluated through a referral procedure at the EU level after 2012
Published in Expert Opinion on Drug Safety, 2020
Andreea Farcas, Teodora Balcescu, Laura Anghel, Camelia Bucsa, Cristina Mogoșan
The majority of the medicinal products evaluated through referral procedures remained on the market after PRAC benefit-risk assessments, with only seven being completely withdrawn: almitrine, daclizumab, fenspiride, flupirtine, fusafungine, tetrazepam, and the combination containing nicotinic acid and laropiprant. Other recommendations were: i) to withdraw certain medicines/combinations from a class (e.g. quinolones, some gadolinium contrast agents, combination products containing domperidone and cinnarizine); ii) certain concentrations (e.g. oral formulations of domperidone 20 mg); or iii) certain pharmaceutical forms (e.g. rectal formulations containing short-acting beta-agonists and domperidone, oral formulation of methadone containing povidone K90) (Figure 2).