The Potential Benefit of Beta-Blockers for the Management Of
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Drug Class Review Beta Adrenergic Blockers
Drug Class Review Beta Adrenergic Blockers Final Report Update 4 July 2009 Update 3: September 2007 Update 2: May 2005 Update 1: September 2004 Original Report: September 2003 The literature on this topic is scanned periodically. The purpose of this report is to make available information regarding the comparative effectiveness and safety profiles of different drugs within pharmaceutical classes. Reports are not usage guidelines, nor should they be read as an endorsement of, or recommendation for, any particular drug, use, or approach. Oregon Health & Science University does not recommend or endorse any guideline or recommendation developed by users of these reports. Mark Helfand, MD, MPH Kim Peterson, MS Vivian Christensen, PhD Tracy Dana, MLS Sujata Thakurta, MPA:HA Drug Effectiveness Review Project Marian McDonagh, PharmD, Principal Investigator Oregon Evidence-based Practice Center Mark Helfand, MD, MPH, Director Oregon Health & Science University Copyright © 2009 by Oregon Health & Science University Portland, Oregon 97239. All rights reserved. Final Report Update 4 Drug Effectiveness Review Project TABLE OF CONTENTS INTRODUCTION .......................................................................................................................... 6 Purpose and Limitations of Evidence Reports........................................................................................ 8 Scope and Key Questions .................................................................................................................... 10 METHODS................................................................................................................................. -
Advice for Primary Care Regarding Beta Blockers in Heart Failure and Qof
Advice for Primary Care Regarding Beta-Blockers in Heart Failure and QOF ADVICE FOR PRIMARY CARE REGARDING BETA BLOCKERS IN HEART FAILURE AND QOF Author(s): Trudi Phillips, Lead Nurse, SEWCN / Heart Failure Specialist Nurse, Cwm Taf HB Date: 20 th May 2010 Version: 4: Status Final Pathway: Heart Failure Intended Audience: Cardiac Network, GPs and Primary Care Staff Purpose and Summary of Document: To advise GPs and primary care on the initiation of Beta Blockers for patients with heart failure and changing Beta Blocker medication. Publication / Distribution: • Cardiac Network primary care distribution list • Cardiac Network GPs via email • Network website ( http://www.sewcn.wales.nhs.uk ; http://nww.sewcn.wales.nhs.uk ) • Highlight in next e-Newsletter and Heart Matters Date of Issue: 21 st May 2010 Review Date: May 2011 Date published on Network Website: 10 th May 2010 South East Wales Cardiac Network Advice for Primary Care Regarding Beta-Blockers in Heart Failure and QOF Author: Trudi Phillips. SEWCN and Cwm Taf Date: 7th May 2010 Status: Final HB Intended Audience: Page: 1 of 3 Cardiac Network GPs Primary Care Staff Advice for primary care regarding Beta-blockers in Heart Failure and QOF Carvedilol, Bisoprolol and Nebivolol (in the elderly) are the only three beta-blockers currently licensed for use in heart failure in the UK. Beta-blockade therapy for heart failure should be introduced in a ‘ start low, go slow ’ manner, with assessment of heart rate, blood pressure, and clinical status after each titration. Beta blocker Starting dose Maximum target dose Bisoprolol 1.25 mg od 10 mg od Carvedilol 3.125 mg bd 25mg bd Nebivolol (in the elderly) 1.25 mg od 10 mg od For patients with mild to moderate heart failure maximum dose of Carvedilol is 50 mg twice daily if weight more than 85 kg How to use: • Start with a low dose (see above). -
M2021: Pharmacogenetic Testing
Pharmacogenetic Testing Policy Number: AHS – M2021 – Pharmacogenetic Prior Policy Name and Number, as applicable: Testing • M2021 – Cytochrome P450 Initial Presentation Date: 06/16/2021 Revision Date: N/A I. Policy Description Pharmacogenetics is defined as the study of variability in drug response due to heredity (Nebert, 1999). Cytochrome (CYP) P450 enzymes are a class of enzymes essential in the synthesis and breakdown metabolism of various molecules and chemicals. Found primarily in the liver, these enzymes are also essential for the metabolism of many medications. CYP P450 are essential to produce many biochemical building blocks, such as cholesterol, fatty acids, and bile acids. Additional cytochrome P450 are involved in the metabolism of drugs, carcinogens, and internal substances, such as toxins formed within cells. Mutations in CYP P450 genes can result in the inability to properly metabolize medications and other substances, leading to increased levels of toxic substances in the body. Approximately 58 CYP genes are in humans (Bains, 2013; Tantisira & Weiss, 2019). Thiopurine methyltransferase (TPMT) is an enzyme that methylates azathioprine, mercaptopurine and thioguanine into active thioguanine nucleotide metabolites. Azathioprine and mercaptopurine are used for treatment of nonmalignant immunologic disorders; mercaptopurine is used for treatment of lymphoid malignancies; and thioguanine is used for treatment of myeloid leukemias (Relling et al., 2011). Dihydropyrimidine dehydrogenase (DPD), encoded by the gene DPYD, is a rate-limiting enzyme responsible for fluoropyrimidine catabolism. The fluoropyrimidines (5-fluorouracil and capecitabine) are drugs used in the treatment of solid tumors, such as colorectal, breast, and aerodigestive tract tumors (Amstutz et al., 2018). A variety of cell surface proteins, such as antigen-presenting molecules and other proteins, are encoded by the human leukocyte antigen genes (HLAs). -
Different Beta-Blocking Effects of Carvedilol and Bisoprolol in Humans
Journal of Clinical and Basic Cardiology An Independent International Scientific Journal Journal of Clinical and Basic Cardiology 2001; 4 (1), 53-56 Different beta-blocking effects of carvedilol and bisoprolol in humans Koshucharova G, Klein W, Lercher P, Maier R, Stepan V Stoschitzky K, Zweiker R Homepage: www.kup.at/jcbc Online Data Base Search for Authors and Keywords Indexed in Chemical Abstracts EMBASE/Excerpta Medica Krause & Pachernegg GmbH · VERLAG für MEDIZIN und WIRTSCHAFT · A-3003 Gablitz/Austria ORIGINAL PAPERS, CLINICAL CARDIOLOGY Different Beta-Blocking Effects of Carvedilol and Bisoprolol J Clin Basic Cardiol 2001; 4: 53 Different Beta-Blocking Effects of Carvedilol and Bisoprolol in Humans G. Koshucharova, R. Zweiker, R. Maier, P. Lercher, V. Stepan, W. Klein, K. Stoschitzky Bisoprolol is a beta1-selective beta-adrenergic antagonist while carvedilol is a non-selective beta-blocker with additional blockade of alpha1-adrenoceptors. Administration of bisoprolol has been shown to cause up-regulation of β-adrenoceptor density and to decrease nocturnal melatonin release, whereas carvedilol lacks these typical effects of beta-blocking drugs. The objective of the present study was to investigate beta-blocking effects of bisoprolol and carvedilol in healthy subjects. We compared the effects of single oral doses of clinically recommended amounts of bisoprolol (2.5, 5 and 10 mg) and carvedilol (25, 50 and 100 mg) to those of placebo in a randomised, double-blind, cross-over study in 12 healthy male volun- teers. Three hours after oral administration of the drugs heart rate and blood pressure were measured at rest, after 10 min. of exercise, and after 15 min. -
TRANDATE® (Labetalol Hydrochloride) Tablets
NDA 18716/S-026 Page 2 PRODUCT INFORMATION TRANDATE® (labetalol hydrochloride) Tablets DESCRIPTION: Trandate Tablets are adrenergic receptor blocking agents that have both selective alpha1-adrenergic and nonselective beta-adrenergic receptor blocking actions in a single substance. Labetalol hydrochloride (HCl) is a racemate chemically designated as 2-hydroxy-5-[1-hydroxy-2-[(1 methyl-3-phenylpropyl)amino]ethyl]benzamide monohydrochloride, and it has the following structure: Labetalol HCl has the empirical formula C19H24N2O3•HCl and a molecular weight of 364.9. It has two asymmetric centers and therefore exists as a molecular complex of two diastereoisomeric pairs. Dilevalol, the R,R′ stereoisomer, makes up 25% of racemic labetalol. Labetalol HCl is a white or off-white crystalline powder, soluble in water. Trandate Tablets contain 100, 200, or 300 mg of labetalol HCl and are taken orally. The tablets also contain the inactive ingredients corn starch, FD&C Yellow No. 6 (100- and 300-mg tablets only), hydroxypropyl methylcellulose, lactose, magnesium stearate, pregelatinized corn starch, sodium benzoate (200-mg tablet only), talc (100-mg tablet only), and titanium dioxide. CLINICAL PHARMACOLOGY: Labetalol HCl combines both selective, competitive, alpha1-adrenergic blocking and nonselective, competitive, beta-adrenergic blocking activity in a single substance. In man, the ratios of alpha- to beta-blockade have been estimated to be approximately 1:3 and 1:7 following oral and intravenous (IV) administration, respectively. Beta2-agonist activity has been demonstrated in animals with minimal beta1-agonist (ISA) activity detected. In animals, at doses greater than those required for alpha- or beta-adrenergic blockade, a membrane stabilizing effect has been demonstrated. -
Supporting Information a Analysed Substances
Electronic Supplementary Material (ESI) for Analyst. This journal is © The Royal Society of Chemistry 2020 List of contents: Tab. A1 Detailed list and classification of analysed substances. Tab. A2 List of selected MS/MS parameters for the analytes. Tab. A1 Detailed list and classification of analysed substances. drug of therapeutic doping agent analytical standard substance abuse drug (WADA class)* supplier (+\-)-amphetamine ✓ ✓ S6 stimulants LGC (+\-)-methamphetamine ✓ S6 stimulants LGC (+\-)-3,4-methylenedioxymethamphetamine (MDMA) ✓ S6 stimulants LGC methylhexanamine (4-methylhexan-2-amine, DMAA) S6 stimulants Sigma cocaine ✓ ✓ S6 stimulants LGC methylphenidate ✓ ✓ S6 stimulants LGC nikethamide (N,N-diethylnicotinamide) ✓ S6 stimulants Aldrich strychnine S6 stimulants Sigma (-)-Δ9-tetrahydrocannabinol (THC) ✓ ✓ S8 cannabinoids LGC (-)-11-nor-9-carboxy-Δ9-tetrahydrocannabinol (THC-COOH) S8 cannabinoids LGC morphine ✓ ✓ S7 narcotics LGC heroin (diacetylmorphine) ✓ ✓ S7 narcotics LGC hydrocodone ✓ ✓ Cerillant® oxycodone ✓ ✓ S7 narcotics LGC (+\-)-methadone ✓ ✓ S7 narcotics Cerillant® buprenorphine ✓ ✓ S7 narcotics Cerillant® fentanyl ✓ ✓ S7 narcotics LGC ketamine ✓ ✓ LGC phencyclidine (PCP) ✓ S0 non-approved substances LGC lysergic acid diethylamide (LSD) ✓ S0 non-approved substances LGC psilocybin ✓ S0 non-approved substances Cerillant® alprazolam ✓ ✓ LGC clonazepam ✓ ✓ Cerillant® flunitrazepam ✓ ✓ LGC zolpidem ✓ ✓ LGC VETRANAL™ boldenone (Δ1-testosterone / 1-dehydrotestosterone) ✓ S1 anabolic agents (Sigma-Aldrich) -
Pain Management Opioid Safety a Quick Reference Guide (2014)
Pain Management Opioid Safety A Quick Reference Guide (2014) VA Academic Detailing Service Real Provider Resources Real Patient Results Your Partner in Enhancing Veteran Health Outcomes VA Academic Detailing Service Email Group: [email protected] VA Academic Detailing Service SharePoint Site: https://vaww.portal2.va.gov/sites/ad Opioids: A Practical Guide for Clinicians Example Risk Assessment Tool: Opioid Risk Tool (ORT)1 Item Score if Female Item Score if Male Alcohol 1 3 1. Family history of substance abuse Illegal drugs 2 3 Prescription drugs 4 4 Alcohol 3 3 2. Personal history of substance abuse Illegal drugs 4 4 Prescription drugs 5 5 3. Age (mark box if 16–45) 1 1 4. History of preadolescent sexual abuse 3 0 Attention deficit disorder obsessive compulsive disorder 2 2 5. Psychological disease Bipolar Schizophrenia Depression 1 1 Total Risk Category: 0–3 Low Risk of aberrant behaviors; 4–7 Moderate Risk of aberrant behaviors; ≥8 High Risk of aberrant behaviors Assess risk of aberrant behaviors before initiating opioid medications; the ORT or other rating tools can assist with this process but can overestimate risk thus should not be used as only reason to decline opioid prescription. 1 Opioids Risk Classification10-11 Risk Condition/Situation • Diagnosis with concordant physical exam, medical imaging, laboratory findings • High levels of pain acceptance and active coping strategies Low • Well motivated patient willing to participate in multimodal treatment plan (no moderate to high risk • Attempting to function -
Tetracaine and Oxymetazoline
PATIENT & CAREGIVER EDUCATION Tetracaine and Oxymetazoline This information from Lexicomp® explains what you need to know about this medication, including what it’s used for, how to take it, its side effects, and when to call your healthcare provider. What is this drug used for? It is used before dental care to numb the area. What do I need to tell the doctor BEFORE my child takes this drug? If your child is allergic to this drug; any part of this drug; or any other drugs, foods, or substances. Tell the doctor about the allergy and what signs your child had. If your child has thyroid disease, talk with the doctor. If your child has high blood pressure. If your child has methemoglobinemia. If your child is taking certain drugs used for depression like isocarboxazid, phenelzine, or tranylcypromine, or drugs used for certain other health problems like selegiline or rasagiline. If your child is taking or has recently taken any drugs for mental or mood problems like depression. There are many drugs that Tetracaine and Oxymetazoline 1/7 must not be taken with this drug. Talk with your child’s doctor if you are not sure. If your child is taking any of these drugs: Nadolol, penbutolol, pindolol, propranolol, sotalol, or timolol. If your child has used another drug in the last 24 hours that has the same drug in it. If your child is using another drug in the nose. If your child weighs less than 88 pounds (40 kilograms). This drug is not for use in children who weigh less than 88 pounds (40 kilograms). -
New Drug Evaluation Monograph Template
Drug Use Research & Management Program Oregon State University, 500 Summer Street NE, E35, Salem, Oregon 97301-1079 Phone 503-947-5220 | Fax 503-947-1119 © Copyright 2012 Oregon State University. All Rights Reserved Month/Year of Review: January 2014 Date of Last Review: January 2012 PDL Classes: Beta Blockers Source Document: OSU College of Pharmacy Current Status of PDL Class: Preferred Agents: ACEBUTOLOL HCL, ATENOLOL, CARVEDILOL, LABETALOL HCL, METOPROLOL TARTRATE, NADOLOL, PROPRANOLOL HCL Non-Preferred Agents: BETAXOLOL, BISOPROLOL, METOPROLOL SUCCINATE, NEBIVOLOL (BYSTOLIC®), PENBUTOLOL (LEVABUTOL®), PINDOLOL, TIMOLOL Previous Conclusions and Recommendation: In patients with mild-moderate HF, bisoprolol, carvedilol or metoprolol succinate (ER) reduce mortality. In patients with severe HF, carvedilol or metoprolol succinate (ER) reduce mortality. In patients with recent MI, acebutolol, carvedilol, metoprolol tartrate (IR), propranolol, or timolol reduce mortality. It is important that at least one of these drugs be included in the PDL. All of the β-Blockers reviewed are effective in the treatment of hypertension, but there is no evidence of differences between β-blockers for blood pressure control, survival, or quality of life. All of the β-Blockers reviewed except carteolol reduced anginal attacks in patients in short-term studies that did not allow mortality evaluation. Because of their effectiveness in rate control for atrial fibrillation at least one of either atenolol, bisoprolol, carvedilol, metoprolol succinate (ER), nadolol, pindolol, or propranolol should be included in the PDL. The current evidence does not distinguish a difference among these beneficial β−Blockers that were tested for preventing recurrence and diminishing the severity of migraine headaches: atenolol, bisoprolol, metoprolol tartrate (IR), metoprolol succinate (ER), propranolol, propranolol LA nadolol, or timolol. -
New Zealand Data Sheet 1. Product Name
NEW ZEALAND DATA SHEET 1. PRODUCT NAME Norvir 100 mg tablets. 2. QUALITATIVE AND QUANTITATIVE COMPOSITION Each film-coated tablet contains 100 mg ritonavir. For the full list of excipients, see section 6.1. 3. PHARMACEUTICAL FORM White film-coated oval tablets debossed with the corporate Abbott "A" logo and the Abbott-Code “NK”. 4. CLINICAL PARTICULARS 4.1 Therapeutic indications NORVIR is indicated for use in combination with appropriate antiretroviral agents or as monotherapy if combination therapy is inappropriate, for the treatment of HIV-1 infection in adults and children aged 12 years and older. For persons with advanced HIV disease, the indication for ritonavir is based on the results for one study that showed a reduction in both mortality and AIDS defining clinical events for patients who received ritonavir. Median duration of follow-up in this study was 6 months. The clinical benefit from ritonavir for longer periods of treatment is unknown. For persons with less advanced disease, the indication is based on changes in surrogate markers in controlled trials of up to 16 weeks duration (see section 5.1 Pharmacodynamic properties). 4.2 Dose and method of administration General Dosing Guidelines Prescribers should consult the full product information and clinical study information of protease inhibitors if they are co-administered with a reduced dose of ritonavir. The recommended dose of NORVIR is 600 mg (six tablets) twice daily by mouth, and should be given with food. NORVIR tablets should be swallowed whole and not chewed, broken or crushed. NORVIR DS 29 April 2020 Page 1 of 37 Version 35 Paediatric population Ritonavir has not been studied in patients below the age of 12 years; hence the safety and efficacy of ritonavir in children below the age of 12 have not been established. -
Adrenoceptors Regulating Cholinergic Activity in the Guinea-Pig Ileum 1978) G.M
- + ! ,' Br. J. Pharmac. (1978), 64, 293-300. F'(O t.,," e reab- ,ellular PHARMACOLOGICAL CHARACTERIZATION OF THE PRESYNAPTIC _-ADRENOCEPTORS REGULATING CHOLINERGIC ACTIVITY IN THE GUINEA-PIG ILEUM 1978) G.M. Departmentof Pharmacology,Allen and HzmburysResearchLimited, Ware, Hertfordshire,SG12 ODJ I The presynaptic ct-adrenoceptors located on the terminals of the cholinergic nerves of the guinea- pig myenteric plexus have been characterized according to their sensitivities to at-adrenoceptor agonists and antagonists. 2 Electrical stimulation of the cholinergic nerves supplying the longitudinal muscle of the guinea-pig ! ileum caused a twitch response. Clonidine caused a concentration-dependent inhibition of the twitch i response; the maximum inhibition obtained was 80 to 95_o of the twitch response. Oxymetazoline and xylazine were qualitatively similar to clonidine but were about 5 times less potent. Phenylephrine and methoxamine also inhibited the twitch response but were at least 10,000 times less potent than clonidine. 3 The twitch-inhibitory effects of clonidine, oxymetazoline and xylazine, but not those of phenyl- ephrine or methoxamine, were reversed by piperoxan (0.3 to 1.0 lag/ml). 4 Lysergic acid diethylamide (LSD) inhibited the twitch response, but also increased the basal tone of the ileum. Mepyramine prevented the increase in tone but did not affect the inhibitory action of LSD. Piperoxan or phentolamine only partially antagonized the inhibitory effect of LSD. 5 Phentolamine, yohimbine, piperoxan and tolazoline were potent, competitive antagonists of the inhibitory effect of clonidine with pA2 values of 8.51, 7.78, 7.64 and 6.57 respectively. 6 Thymoxamine was a weak antagonist of clonidine; it also antagonized the twitch-inhibitory effect of morphine. -
Drugs-Biologicals FORMULARY for INTERNET PAGE 12 26 18
AVG ITEM Average Patient Item Charge Code Description BIL AWP /pkg COST Price 25000041 SODIUM and POTASSIUM BICARBONATE TBEF UD $3.61 $0.12 $1.00 25000054 GLIMEPIRIDE TAB 1 MG UD $8.25 $0.11 $1.30 25000086 amLODIPine TAB 5 MG UD $8.65 $0.06 $1.00 25000087 AMMONIA AROMATIC SOLN 15 % (W/V) UD $3.53 $0.17 $1.00 25000090 AMOXICILLIN CAP 500 MG UD $20.12 $0.19 $1.00 25000102 ABACAVIR TAB 300 MG UD $507.10 $8.45 $16.90 25000103 ACAMPROSATE TBEC 333 MG UD $182.38 $0.80 $1.76 25000104 ACARBOSE TAB 25 MG UD $16.70 $0.27 $1.00 25000106 ACETAMINOPHEN SUPP 120 MG UD $5.09 $0.42 $1.00 25000108 ACETAMINOPHEN SUPP 325 MG UD $4.91 $0.44 $1.00 25000109 ACETAMINOPHEN TAB 325 MG UD $12.39 $0.02 $1.00 25000111 ACETAMINOPHEN TAB 500 MG UD $2.34 $0.02 $1.00 25000112 ACETAMINOPHEN SUPP 650 MG UD $3.83 $0.17 $1.00 25000113 ACETAMINOPHEN SOLN 650 MG/20.3 ML UD $75.74 $0.48 $1.22 25000117 ACETAMINOPHEN-CODEINE TAB 300-30 MG UD $12.41 $0.09 $1.00 25000121 ACETYLCYSTEINE SOLN 200 MG/ML (20 %) UD $18.18 $7.66 $15.32 25000140 ALBUTEROL SULFATE NEBU 2.5MG/3ML (0.083 %) UD $8.58 $0.29 $1.00 25000147 ALLOPURINOL TAB 100 MG UD $18.45 $0.12 $1.00 25000150 ALPRAZolam TAB 0.25 MG UD $8.87 $0.09 $1.00 25000151 ALPRAZolam TAB 0.5 MG UD $4.16 $0.04 $1.00 25000182 AMIODARONE TAB 200 MG UD $15.70 $0.20 $1.00 25000184 AMITRIPTYLINE TAB 10 MG UD $8.73 $0.06 $1.00 25000186 AMITRIPTYLINE TAB 25 MG UD $17.46 $0.08 $1.00 25000188 AMITRIPTYLINE TAB 50 MG UD $34.90 $0.16 $1.00 25000205 HYDROCORTISONE ACETATE SUPP 25 MG UD $127.30 $5.75 $11.50 25000206 HEMORRHOIDAL SUPPOSITORY SUPP 0.25