Leukotriene Modifiers. This drug class has not been adequately tested in COPD patients and cannot be recommended. Mucolytics. There may be isolated circumstances especially in the presence of copious, thick secretions ; in which an individual with COPD might benefit from a mucolytic or mucoactive agent. In general, however, drugs from this class have not been shown to be effective and are not recommended as treatment for COPD.
Analysis examining total drug costs would be sufficient because no significant differences in outcomes with respect to clinic visits or hospitalizations as a result of the conversion program were expected. Methods Study Design A pre post analysis involving a retrospective cohort study design and primarily using the administrative databases of the VA hospital in Saginaw, Michigan, was conducted to assess the resource utilization implications of a calcium channel blocker therapeutic interchange program. The study was conducted through an institutional perspective and hospital-specific drug acquisition costs in 1997 dollars were used. While 1997 dollars were used for standardization, actual costs of the study drugs varied by less than 3% from these values during the study period. The Saginaw VA Hospital is a 250-bed hospital with associated ambulatory clinics primarily serving veterans. All patients at the Saginaw VA Hospital receiving extendedrelease nifedipine Procardia XL ; were converted to either amlodipine Norvasc ; or felodipine Pldndil ; from September 1994 through February 1995. The study drugs were defined as extended-release nifedipine, amlodipine, and felodipine. The conversion date was defined as the first record of a filled prescription for either amlodipine or felodipine. Patients eligible for study inclusion were defined as all patients continuously serviced by the VA Hospital with at least nine months of complete data prior to and also following the conversion date with respect to drug utilization, clinic visits, and hospitalizations, and a documented diagnosis of hypertension by International Classification of Diseases, 9th Revision ICD-9 ; , code. All eligible patients must have also been receiving Procardia XL throughout the analysis period prior to the conversion date. One hundred and one patients were identified from the database. Patient charts were reviewed for blood pressure readings during the most recent clinic visit prior to the conversion date and also the final clinic visit following the conversion date but prior to the end of the study period. If more than one blood pressure reading was recorded, an average of the readings available was calculated. The patients were assigned classifications of hypertension according to JNC-6. The primary economic endpoint of interest was the change in total drug cost. Secondary health resource utilization endpoints to justify a cost-minimization approach were the number of clinic visits, emergency room visits, and hospitalizations during the pre- and post-conversion periods. Secondary economic endpoints of interest were the study drug costs, cardiovascular drug costs, and noncardiovascular drug costs during the pre- and postconversion periods. Cardiovascular drugs were defined as those drugs belonging to any of the following drug classes: 1.
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Reference Books: 1. 2. 3. Goodman and Gilman's the Pharmacological basis of Therapeutics. Editors: A Goodman Gilman, T.W.Rall, AIS, Nies, P.Taylor, Pergamon Press, 2000. Katzung, B.G.: Basic and Clinical Pharmacology, Prentice Hall, International. M.P.Rang, M.M.Dale, J.M.Riter., Pharmacology, 4th Edition, Churchill, Livingstone, 1995 Modern Pharmacology, C.R.Craig and R.E itzel, Little Brown and Company, 1994. Paul, L. Principles of Pharmacology, Chapman and Hall, 1995. Mycek MJ, Harvey RA and Champe PC, Lipponcott's Illustrated Reviews: Pharmacology. 2nd Edition. Lipponcott Williams & Wilkins, 1997. Barar F.S.K., Test book of Pharmacology, Interprint, New Delhi.
Allergic rhinitis is an increasing global health problem. The ARIA classification distinguishes between intermittent and persistent allergic rhinitis. Allergic rhinitis that is intermittent or mild may be appropriate for management by the pharmacist. Referral to a physician should be considered in cases of symptoms that are moderate to severe-persistent, suggestive of undiagnosed or uncontrolled asthma, suggestive of infection or non-allergic rhinitis, and for symptoms poorly responsive to treatment after 2 to 4 weeks. The management of allergic rhinitis represents a collaboration between pharmacists, physicians, other health care professionals and patients. The costeffectiveness of these approaches should be tested in allergic rhinitis as it has been for asthma 79 ; , reactive airway diseases 80, 81 ; and other chronic diseases 68 and prednisone.
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A 54-year-old male, 157 cm tall, weighing 71 kg, and with an ASA physical status of II, was admitted to our surgical ward for excision of a soft tissue tumor in the posterior area of the right mandibular alveolar ridge. The operation was performed under general anesthesia, which was maintained with nitrous oxide and isoflurane and which lasted for 2 hours 15 min on August 3, 1999 Table 1 ; . He denied having any major systemic disease including hypertension or liver disease, had no histo.
In other markets, CrestorTM sales in the second quarter were $209 million up 58 percent ; on continued strong growth in Europe up 58 percent ; and Canada up 25 percent ; . Volume share of the statin market for CrestorTM is now 15.3 percent in Canada; 10.9 percent in the Netherlands; 17.4 percent in Italy and 9.6 percent in France. CrestorTM sales in other markets increased 52 percent in the first half to $376 million. The interim report of the CrestorTM post-marketing surveillance programme in Japan has been successfully completed. It is anticipated that there may be some reported commercial sales for CrestorTM in Japan in the second half of 2006. On 5 July, AstraZeneca and Abbott announced a US collaboration to co-develop and market a single pill, fixed dose combination of CrestorTM and Abbott's next generation TriCor ABT-335 ; as part of a comprehensive treatment regimen for mixed lipid disorders. AtacandTM sales in the US were down 3 percent in the second quarter and unchanged in the first half. Sales of AtacandTM in other markets were up 16 percent in both the second quarter and the first half. PlendilTM sales in the first half were down 30 percent as a result of generic competition in the US, where sales declined 82 percent and prinivil.
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Risk factors for falls include impairments of vision, sensation, strength and balance, and patient thinness and frailty. In the Dubbo Osteoporosis Epidemiology Study, quadriceps strength and postural sway were of similar importance to BMD in predicting fractures in both men and women.2 Most fractures occur after falls, but not all falls result in fractures. Nevertheless, interventions that reduce falls risk may prevent fractures. Several studies have examined single and multiple risk factors and the use of hip protectors. Of the single risk factor interventions, programs that involve balance training, such as home-based physiotherapy and tai chi, reduce the risk of falls pooled relative risk [RR], 0.80; 95% CI, 0.660.98; and RR, 0.51; 95% CI, 0.360.75, respectively ; .68, 69 Environmental modifications by occupational therapists eg, removing mats, improving lighting ; may reduce falls.70 One study has reported that a reduction in psychoactive medications reduces the risk of falls RR, 0.34; 95% CI, 0.16 0.74 ; , but adoption and compliance rates in the study were low.71 Studies in nursing homes in Denmark and Sweden of the effect of hip protectors have reported reductions in hip fracture rates of 56% and 67%, respectively E2 ; .72, 73 However, hip fractures did occur in the intervention subjects when not wearing their hip protectors, so that compliance remains an issue one reason for non-compliance is that women believe it makes them look "fat" around the hips ; . Systematic reviews74 suggest that hip protectors reduce the risk of hip fracture in high-risk populations E1, for instance, pregnancy.
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