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The Patient with Non-Group 2 Pulmonary Hypertension
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Sophia Anastasia Mouratoglou, George Giannakoulas
Epoprostenol is a synthetic analogue of the naturally occurring prostacyclin and is a potent pulmonary vasodilator. However, its short half-life (3 to 6 min) necessitates continuous IV infusion by a portable pump through a permanent catheter. The drug should be initiated and carefully up-titrated in the hospital in experienced centers. Infusion rates vary, determined by patient tolerance of side effects (e.g., jaw pain, headache, diarrhea, pain in extremities, nausea, and vomiting). The usual starting dose is 2 ng/kg/min. Various up-titration schemes have been proposed.58 Epoprostenol was the first drug used for the treatment of PAH. In randomized, controlled trials, epoprostenol improved exercise capacity and hemodynamics and reduced mortality (over a period of 12 weeks and 3 years), compared with placebo.59–61 To date, this is the only approved treatment for PAH that reduces mortality. These results were confirmed by observational studies62,63 and by the French registry,64,65 in which survival benefit was greatest in treatment-naïve patients who received upfront combination therapy with epoprostenol and oral medications. Epoprostenol use is limited by the need for strict adherence to protocols for sterile drug preparation and IV administration, as serious complications (e.g., catheter-related infection, cellulitis, pneumothorax, and thrombosis) have been observed. Caution should be paid to avoid abruptly stopping the continuous infusion, as this may lead to rebound PH with grave consequences, which may even lead to death.
Medicines management
Published in Nicola Neale, Joanne Sale, Developing Practical Nursing Skills, 2022
Kirsty Andrews, Martina O’Brien
Student nurses, healthcare assistants and nursing associates are not allowed to administer intravenous fluids or blood. This means you cannot connect up a bag of infusion fluid, or alter the flow rate, as both actions mean you are administering the intravenous fluid. However, you may well be caring for people receiving infusions, so you need to know how to care for them safely and general precautions and signs to look for if the infusion is causing problems.
Antibody-Based Therapies
Published in David E. Thurston, Ilona Pysz, Chemistry and Pharmacology of Anticancer Drugs, 2021
As a class, other infusion-related side effects are commonly reported with these agents, and tend to occur predominantly during the first infusion. They include fever and chills, nausea and vomiting, general pain, allergic reactions (such as rash, pruritus, angioedema, bronchospasm, and dyspnea), and flushing. Analgesics and antihistamines can be provided before each dose of antibody to help reduce these symptoms, and premedication with a corticosteroid is sometimes helpful. If the ADRs are severe, the infusion may be stopped temporarily in order to treat the infusion-related effects. The six most prominent CD-targeted antibodies at the time of writing are described in more detail below. These are rituximab, ofatumumab, and obinutuzumab that target CD20, alemtuzumab that targets CD52, and daratumumab targeting CD38.
HI-6-loaded PEGylated liposomes: an on-site first-aid strategy for acute organophosphorus agent poisoning
Published in Drug Delivery, 2023
Liao Shen, Yadan Zhang, Qimei Cai, Jun Yang, Yongan Wang, Dongqin Quan
The current treatment strategy is to relieve acute symptoms by administration of a muscarinic acetylcholine (ACh) receptor antagonist and an anticonvulsant drug, as well as oxime antidotes to restore AChE function (Hulse et al., 2019). Oxime AChE reactivators have been widely studied and proven to be effective in reactivating phosphorylated AChE (Kuca et al., 2010; Acharya et al., 2011; Gupta & Ghosh, 2013; Kovarik et al., 2013). Among these antidotes, HI-6 is one of the most promising reactivators against OP poisoning. HI-6 has good effects on reactivating AChE that inhibited by many nerve agents, in terms of soman, sarin and cyclosarin (Koplovitz & Stewart, 1994; Cassel & Fosbraey, 1996; Lundy et al., 2005; Myhrer et al., 2018; Reymond et al., 2018). Although HI-6 exerts a powerful effect in in vitro experiments, the treatment effect of HI-6 is still unsatisfactory due to its very fast clearance rate in plasma (Ligtenstein & Kossen, 1983; Myhrer et al., 2018). Furthermore, poor stability in plasma inevitably leads to low-level drug distribution in the CNS, leaving serious brain damage unsettled (Myhrer et al., 2018). Intravenous infusion is an effective way to achieve stable drug concentration in blood, but this method requires the support of professional medical personnel and medical equipment which are not easy to approach during wars or other emergency situations.
Device profile of the Orchid safety release valve for the prevention of accidental catheter dislodgement
Published in Expert Review of Medical Devices, 2023
Infusion therapy for patients is predominately performed through the connection of a fluid medication bag and administration tubing, all attached to a patient’s indwelling IV catheter. Continuous infusions of medications or solutions require the patient to maintain a constant connection to the IV. The normal patient activity of bed transfers, transportation to different departments, movements in bed, frequent trips to the bathroom, and even patient confusion can all result in excessive pulling on IV tubing. As the tubing becomes stretched, the tension is transferred to the catheter and dressing with subsequent loosening of securement and accidental removal of the IV catheter. Forceful removal of the catheter and dressing can cause injury to the patient, skin damage, and loss of venous access. Prevention of accidental catheter dislodgement through the insertion of a safety releasing valve can relieve the tension on the tubing and catheter to protect the patient and facilitate uninterrupted treatment. The Infusion Nurses Society (INS) Standards recommend using catheter protection devices for specific patient populations, including pediatric, elderly, and those with cognitive dysfunction at risk for the catheter being accidentally dislodged or removed [5]. A responsibility to patients exists to provide safety devices, when available, to prevent these types of complications.
Newly approved agents for relapsing remitting multiple sclerosis: how real-world evidence compares with randomized clinical trials?
Published in Expert Review of Neurotherapeutics, 2021
Giancarlo Comi, Gloria Dalla Costa, Lucia Moiola
Possible side effects include infusion reactions and increased risk of infections. Infusion reactions are common, reported by 34.3% of patients in OPERA I and II, are the result of B cell lysis with massive cytokine release, present most often with the initial dose, tend to decrease with subsequent doses, and can be mitigated by pretreatment with steroids, antihistaminics and acetaminophen [171]. Infections were reported in 57%-60% of OCR-treated RRMS patients compared with 53%-54% of IFNβ-1a patients, with no difference in serious infections [171]. Most of the infections reported were of respiratory and urinary origin. No cases of PML were reported in pivotal trials; however, six potential serious opportunistic infections have been observed, three cases due to herpes zoster, one to systemic pasteurella, one to candida sepsis and one to enterovirus [174]. Neoplasms occurred in 0.48% of OCR-treated patients, compared with 0.24% of IFN and placebo patients in the OPERA [171]. Increased malignancy risk, including breast cancer, has fallen in open-label extension studies, and OCR-treated patients showed no higher incidence of malignancies compared with large cohorts and registries of MS patients [174].