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Peri-operative medicine
Published in Henry J. Woodford, Essential Geriatrics, 2022
Regional anaesthesia may be more difficult to implement in people with advanced cognitive impairment without resorting to sedation, but may reduce post-operative opioid analgesia requirements. There is no strong evidence that the incidence of post-operative delirium or mortality differs between general and regional anaesthesia techniques.17 The lowest effective dose of medications should be used for the shortest possible time. Propofol is preferred to benzodiazepines for sedation due to lower risk of adverse effects.
Medicines in neonates
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
Drug toxicity is dose-related. Severe side effects were noted in infants with doxapram plus ketodoxapram concentrations over 9 mg/1 [39]. Mild adverse effects have been observed with plasma concentrations as low as 0.39, 0.47 and 1.0 mg/1 [36,38]. As for the methylxanthines, an extensive study of the follow-up of neonates treated with doxapram is needed to assess the safety on neurological development.
The Protocol and Case Report Form
Published in Gary M. Matoren, The Clinical Research Process in the Pharmaceutical Industry, 2020
(1) Data elements. The following are data elements involved in test drugs and dosages: (a) test agent name; (b) time units (days, hours, minutes; days and hours; days or date alone); (e) time ranges of the above; (d) frequency of dosing or dosage number; (e) route of administration—oral, intravenous (rapid or bolus), infusion (prolonged or continuous), intramuscular, subcutaneous, rectal, or topical; (f) dosage form (tablets, capsules,ointments, salves, creams, solutions, suspensions); (g) unit of measurement (expressed as milligrams, milliliters, drops, tablespoons, grams, milligrams/kilograms or volume); (h) unit dose—quantity of drug administered to a patient at one time; (i) drug containers (bottles, vials, ampules, envelopes, tubes, jars).
Dosimetry and uncertainty approaches for the million person study of low-dose radiation health effects: overview of the recommendations in NCRP Report No. 178
Published in International Journal of Radiation Biology, 2022
Lawrence T. Dauer, André Bouville, Richard E. Toohey, John D. Boice, Harold L. Beck, Keith F. Eckerman, Derek Hagemeyer, Richard W. Leggett, Michael T. Mumma, Bruce Napier, Kathy H. Pryor, Marvin Rosenstein, David A. Schauer, Sami Sherbini, Daniel O. Stram, James L. Thompson, John E. Till, R. Craig Yoder, Cary Zeitlin
Other considerations are undetected dose (commonly referred to as missed dose) and unmonitored dose. Undetected dose is defined as the dose received that was not measured by the dosimeter, because it fell below the minimum detectable response of the dosimeter. Since the undetected dose may in reality range from zero to the minimum detectable, it is customary to assign some fraction of the minimum detectable dose (or some other clearly stated value) for each monitoring period in which the dosimeter reads zero (i.e. less than the minimum detectable). Unmonitored dose is that assumed to be received when a personal dosimeter was not worn, and often may be reconstructed from knowledge of workplace activities or from coworker data when others in the same location did wear dosimeters. This latter approach is typically applied to atomic veterans, when one or two dosimeters were issued to a unit that may have totaled 40 or more individuals.
Long-term physico-chemical stability of 5-fluorouracile at standardised rounded doses (SRD) in MyFuser® portable infusion pump
Published in Journal of Chemotherapy, 2021
Mélanie Closset, Sabrina Onorati, Marie-Lise Colsoul, Nicolas Goderniaux, Benoît Bihin, Jacques Jamart, Laura Soumoy, Jean-Daniel Hecq, Pascal Odou, Laurence Galanti
The constant increase of the number of cancer1 leads hospitals to wonder about their therapeutic management of this pathology. A main concern in oncology remains the cytotoxic drug dosing. As far as we know, “the recommended dose for a specific patient is the highest dose associated with an acceptable toxicity”2. The historical calculation of chemotherapy doses is based on Body Surface Area (BSA) but the concept of dose-banding gradually arises as another option because of the weak correlation between BSA doses and the efficacy and toxicity of the drugs. As Plumridge et al. described, dose-banding must be understood as a “system whereby through agreement between prescribers and pharmacists, doses of intravenous cytotoxic drugs, calculated on an individualized basis that are within defined ranges or bands are rounded up or down to predetermined standard doses. The maximum variation of the adjustment between the standard dose and the doses constituting each band is 5% or less”3. The usage of dose-banding remains restricted in Belgium so that stability studies are needed on the horizon of implementation.
Patient initiation and maintenance of GLP-1 RAs for treatment of obesity
Published in Expert Review of Clinical Pharmacology, 2021
The dose-escalation period for GLP-1 RAs is intended to make treatment more tolerable. GI side effects, such as nausea, are commonly reported upon initiation of GLP-1 RAs [39]. To minimize these, it is recommended that the dose of liraglutide is escalated over a 4-week period, starting with 0.6 mg for the first week and escalating by 0.6 mg per week for each of the following 3 weeks, to a maintenance dose of 3.0 mg [52,54]. If patients do not tolerate an increased dose, it is recommended to delay escalation for 1 additional week. The prescribing information recommends discontinuing liraglutide if the 3.0 mg dose cannot be tolerated [54]. If a dose is missed, the once-daily regimen should be resumed as prescribed with the next scheduled dose, without taking an extra dose or increase in dose to make up for the missed dose. If more than 3 days have passed since the last liraglutide dose, patients should reinitiate treatment at 0.6 mg daily and follow the dose-escalation schedule as used for treatment initiation [54]. It is important to note that dose escalation does not fully mitigate GI side effects, as these AEs were still commonly observed across the SCALE trials despite patients following a dose-escalation schedule [55,58,60].