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Immunologically mediated skin disorders
Published in Ronald Marks, Richard Motley, Common Skin Diseases, 2019
Drug treatment with antihistamines of the H1 receptor blocker type is most effective at relieving symptoms in this disorder. It is better to become familiar with just a few of these than to try to memorize the whole range available. The ‘older’ antihistamines such as promethazine and diphenhydramine are quite effective, but have a hypnotic effect precluding driving or using machinery. Newer antihistamines such as fexofenadine, cetirizine, levocetirizine, loratadine, and desloratadine are very effective, with little or no hypnotic effect. A few patients obtain increased benefit by adding an H2 antagonist such as cimetidine to the H1 antagonist already being administered. In some cases it may be necessary to give higher than the normal recommended doses of the antihistamine, but this should only be considered when a conventional dose has failed and with full knowledge of possible side effects and drug interactions. The normal daily dose of desloratadine is 5 mg but this may be increased to 20 mg if necessary.
Dermatology
Published in John D Firth, Professor Ian Gilmore, MRCP Part 1 Self-Assessment, 2017
John D Firth, Professor Ian Gilmore
A precipitant is identified in about 50% of patients with chronic urticaria, but IgE-mediated chronic urticaria is a relatively minor cause. It is not associated with internal malignancy, but can rarely be associated with systemic vasculitides although in the vast majority of cases there are no vasculitic changes on biopsy. H1-antagonists can be very helpful and H2-antagonists can help some patients. Most patients with chronic urticaria will have improved within a year, but relapses are not infrequent. For uncomplicated chronic urticaria with no clear clues from the history or examination of systemic disease or an exogenous precipitant, the current UK guidelines (2003) recommend full blood count, ESR and antinuclear antibodies as reasonable screening investigations for those with moderate-severe disease. Non-steroidals are a common cause of exacerbation of urticaria.
Children with feeding difficulties: medical and nursing perspectives
Published in Southall Angela, Feeding Problems in Children, 2017
Essex. Charles, Southall. Angela, Southall. Angela, Woolliscroft. Kim
Drugs to reduce gastric acid secretion are used in more severe cases. These include H2 antagonists such as cimetidine. Gastric acid secretion can also be reduced by drugs such as omeprazole, which is a proton pump inhibitor that blocks the final step in the pathway of gastric acid production. Many children whose feeding problems are related to severe neurological impairment or to significant neurological immaturity have significant drooling. Although this is not usually distressing for the child, it can be embarrassing for parents and siblings and can also create a lot of washing for the parents as the child may require a change of clothes several times a day. Hyoscine patches can be very effective at reducing drooling. These are slow-release patches that are stuck on the skin, rather like plasters. They are impregnated with hyoscine, which is then absorbed transdermally, and are effective for up to three days.
Update on diagnosis and treatment of immune thrombocytopenia
Published in Expert Review of Clinical Pharmacology, 2021
Rajeev Sandal, Kundan Mishra, Aditya Jandial, Kamal Kant Sahu, Ahmad Daniyal Siddiqui
Initial response to corticosteroids takes 2 to 14 days, with peak response usually between 1 and 4 weeks (Figure 2). Although two-thirds of ITP patients achieve an initial response to glucocorticoids, the sustained response is seen in only 30%-50% of patients. Steroid-refractory ITP patients are candidates for second-line treatment options [7,8,12,52–54].Glucocorticoid-based therapy needs supervision as they are associated with various adverse effects (Table 2). Intolerance to corticosteroids due to side effects is one of the indications to change therapy [55,56]. Calcium and vitamin D supplementation are recommended to reduce the risk of osteoporosis. Bone mineral density (BMD) should be monitored with DEXA-scan in patients on steroids for a prolonged duration [57]. Patients with dyspeptic symptoms can be treated with proton-pump inhibitors or H2 antagonists [58].
Soluplus® based solid dispersion as fast disintegrating tablets: a combined experimental approach for enhancing the dissolution and antiulcer efficacy of famotidine
Published in Drug Development and Industrial Pharmacy, 2020
Mona Basha, Abeer Salama, Shereen H. Noshi
The main strategy adopted for management of peptic ulcer depends upon the reduction of gastric acid secretion provided by proton pump inhibitors, antimuscarinics, and histamine H2- antagonists in addition to acid-independent therapy using sucralfate and bismuth cholinergic [19]. Famotidine (FM) is type-2 receptor antagonist widely indicated for treatment of different types of ulcers, gastroesophageal reflux disease, and hypersecretory conditions [20]. Compared to the other H2-receptor antagonists; ranitidine and cimetidine, FM is reported to be more potent (7.5 and 20 times, respectively) in inhibiting gastric acid secretion. Despite the high potency and the promising pharmacological effect of FM, the poor aqueous solubility resulting in low and variable bioavailability (40–50%) is the primary obstacle against its effective treatment of ulcers [21].
Individual long-term variation of platelet reactivity in patients with dual antiplatelet therapy after myocardial infarction
Published in Platelets, 2019
Joakim Alfredsson, Eva Swahn, Kerstin M Gustafsson, Magnus Janzon, Lena Jonasson, Elisabeth Logander, Lennart Nilsson, Tomas L. Lindahl
We included 77 patients; median age was 66 years, 74% were male, 29% were smokers, 12% had diabetes, 17% had a history of myocardial infarction (MI) and 16% had a history of revascularization with PCI or coronary artery by-pass grafting (9% and 7%, respectively). A majority of the patients were admitted with STEMI, (60%), all but one were catheterized, 90% underwent PCI and 82% had a stent implanted (Table I). During PCI, 58% were treated with a GP IIb/IIIa-inhibitor (abciximab). There were no significant differences in pharmacological treatment from discharge to 6-month follow-up. Importantly, all patients were discharged with DAPT (clopidogrel and aspirin) and continued on DAPT at least 6 months. (Table II) A total of 15 patients were discharged with a proton pump inhibitor (PPI) or H2 antagonist. Nine received pantoprazole (recommended PPI with clopidogrel treatment), three ranitidin, two omeprazol and one lanzoprazol. The majority of the patients remained on the same treatment over 6-month follow-up. Of the two patients discharged with omeprazole, one was on omeprazole for the duration of the follow-up with no change in platelet aggregation category (LPR at both time-points) and one stopped treatment before 6-month follow-up (LPR at 8 days and optimal response at 6 months). In addition, one patient discharged with ranitidine changed to omeprazole during follow-up, with no change in aggregation category (optimal response both at 8 days and 6 months).