-
Experimental Biology and Medicine... May 2021Assessment of respiratory mechanics extends from basic research and animal modeling to clinical applications in humans. However, to employ the applications in human... (Review)
Review
Assessment of respiratory mechanics extends from basic research and animal modeling to clinical applications in humans. However, to employ the applications in human models, it is desirable and sometimes mandatory to study non-human animals first. To acquire further precise and controlled signals and parameters, the animals studied must be further distant from their spontaneous ventilation. The majority of respiratory mechanics studies use positive pressure ventilation to model the respiratory system. In this scenario, a few drug categories become relevant: anesthetics, muscle blockers, bronchoconstrictors, and bronchodilators. Hence, the main objective of this study is to briefly review and discuss each drug category, and the impact of a drug on the assessment of respiratory mechanics. Before and during the positive pressure ventilation, the experimental animal must be appropriately sedated and anesthetized. The sedation will lower the pain and distress of the studied animal and the plane of anesthesia will prevent the pain. With those drugs, a more controlled procedure is carried out; further, because many anesthetics depress the respiratory system activity, a minimum interference of the animal's respiration efforts are achieved. The latter phenomenon is related to muscle blockers, which aim to minimize respiratory artifacts that may interfere with forced oscillation techniques. Generally, the respiratory mechanics are studied under appropriate anesthesia and muscle blockage. The application of bronchoconstrictors is prevalent in respiratory mechanics studies. To verify the differences among studied groups, it is often necessary to challenge the respiratory system, for example, by pharmacologically inducing bronchoconstriction. However, the selected bronchoconstrictor, doses, and administration can affect the evaluation of respiratory mechanics. Although not prevalent, studies have applied bronchodilators to return (airway resistance) to the basal state after bronchoconstriction. The drug categories can influence the mathematical modeling of the respiratory system, systemic conditions, and respiratory mechanics outcomes.
Topics: Anesthetics; Animals; Bronchoconstrictor Agents; Bronchodilator Agents; Models, Animal; Neuromuscular Blocking Agents; Respiratory Mechanics
PubMed: 33601911
DOI: 10.1177/1535370221993095 -
Oncology (Williston Park, N.Y.) Apr 2005Approximately 70% to 80% of all patients who receive chemotherapy experience nausea and vomiting, which can disrupt their lives in numerous ways. Chemotherapy-induced... (Review)
Review
Approximately 70% to 80% of all patients who receive chemotherapy experience nausea and vomiting, which can disrupt their lives in numerous ways. Chemotherapy-induced nausea and vomiting (CINV) has traditionally been classified according to three patterns: acute, delayed, and anticipatory. Additional classifications include refractory and breakthrough nausea and vomiting. The mechanisms by which chemotherapy causes nausea and vomiting are complex, but the most common is thought to be activation of the chemoreceptor trigger zone. An appreciation of the risk factors for developing CINV is important when matching antiemetic treatment to risk. The emetogenicity of the chemotherapy regimen--generally categorized as high, moderate, low, or minimal--greatly affects a patient's risk for developing CINV In addition to established and emerging pharmacologic approaches to managing CINV, many complementary and integrated modalities may be options. Progress in CINV management must include a better understanding of its etiology and a focus on prevention. This review will consider the etiology, assessment, and treatment of patients with CINV.
Topics: Antiemetics; Antineoplastic Agents; Humans; Nausea; Neoplasms; Practice Guidelines as Topic; Risk Factors; Vomiting
PubMed: 15945344
DOI: No ID Found -
Cleveland Clinic Journal of Medicine Jul 2015Although marijuana is sometimes used to treat chemotherapy-induced nausea and vomiting, when used long-term it can have a paradoxical hyperemetic effect known as... (Review)
Review
Although marijuana is sometimes used to treat chemotherapy-induced nausea and vomiting, when used long-term it can have a paradoxical hyperemetic effect known as cannabinoid hyperemesis syndrome. Knowledge of this phenomenon may reduce the ordering of unnecessary and expensive investigations, as well as inappropriate medical and surgical treatment in patients presenting with recurrent vomiting of unknown cause. This article reviews the pathophysiology, clinical presentation, diagnosis, and management of this emerging condition.
Topics: Antiemetics; Cannabinoids; Emetics; Humans; Syndrome; Vomiting
PubMed: 26185942
DOI: 10.3949/ccjm.82a.14023 -
Acta Medica Portuguesa Dec 2018Chronic obstructive pulmonary disease is a chronic condition that requires the engagement of our patients in lifestyle changes and pharmacological treatment. Although...
Chronic obstructive pulmonary disease is a chronic condition that requires the engagement of our patients in lifestyle changes and pharmacological treatment. Although there are guidelines on many aspects of chronic obstructive pulmonary disease management, the challenge of engaging our patients persists. We propose a simple mnemonic that we hope will make it easier for patients and clinicians to achieve this goal together.
Topics: Abbreviations as Topic; Air; Bronchodilator Agents; Chronic Disease; Disease Progression; Dyspnea; Healthy Lifestyle; Humans; Nebulizers and Vaporizers; Pulmonary Disease, Chronic Obstructive
PubMed: 30684366
DOI: 10.20344/amp.11010 -
Respiratory Medicine Feb 1994
Topics: Adrenal Cortex Hormones; Asthma; Bronchodilator Agents; Drug Interactions; Humans; Sympathomimetics; Theophylline
PubMed: 8146419
DOI: 10.1016/0954-6111(94)90019-1 -
Pediatric Pulmonology Nov 2023Mechanisms underlying lung dysfunction after preterm birth are poorly understood. Studying phenotypes of prematurity-associated lung disease may aid understanding of...
INTRODUCTION
Mechanisms underlying lung dysfunction after preterm birth are poorly understood. Studying phenotypes of prematurity-associated lung disease may aid understanding of underlying mechanisms. Preterm-born children with and without lung dysfunction and term controls were assessed using oscillometry before and after exercise, and after postexercise bronchodilation.
METHODS
Preterm-born children, born at gestation of 34 weeks or less, were classified into those with prematurity-associated obstructive lung disease (POLD; FEV < LLN, FEV /FVC < LLN), prematurity-associated preserved ratio of impaired spirometry (pPRISm; FEV < LLN, FEV /FVC ≥ LLN) and compared to preterm (FEV ≥ LLN) and term controls (%predicted FEV > 90%). All children underwent cardiopulmonary exercise, and oscillometry assessment at baseline, postexercise, and after postexercise bronchodilator administration.
RESULTS
From 241 participants aged 7-12 years, complete data were available from 179: 15 children with POLD and 11 with pPRISm were compared with 93 preterm and 60 term controls. POLD group, when compared to both control groups, had impaired impedance, greater resistance, more negative (greater magnitude) reactance at low frequencies, and also had decreased compliance. pPRISm group demonstrated impaired reactance and compliance compared to term controls. No differences were noted between the preterm and term controls. Exercise had little impact on oscillometry values, but children with POLD had greatest improvements after postexercise bronchodilator administration, with decreased resistance and decreased magnitude of reactance, particularly at low frequencies.
CONCLUSION
Preterm-born children with obstructive airway disease had the greatest oscillometry impairments and the largest improvements after postexercise bronchodilator compared to control groups. Oscillometry can potentially be used to identify preterm-born children with lung disease to institute treatment.
Topics: Child; Female; Humans; Infant, Newborn; Bronchodilator Agents; Oscillometry; Forced Expiratory Volume; Premature Birth; Lung; Lung Diseases; Lung Diseases, Obstructive; Spirometry; Infant, Newborn, Diseases
PubMed: 37701982
DOI: 10.1002/ppul.26658 -
Thorax Aug 2017
Topics: Bronchodilator Agents; Disease Progression; Empathy; Pulmonary Disease, Chronic Obstructive
PubMed: 28465408
DOI: 10.1136/thoraxjnl-2017-210065 -
Thorax Apr 1997
Review
Topics: Administration, Inhalation; Aerosols; Asthma; Bronchodilator Agents; Drug Delivery Systems; Equipment Design; Humans; Nebulizers and Vaporizers; Ultrasonics
PubMed: 9155849
DOI: 10.1136/thx.52.2008.s31 -
The European Respiratory Journal Mar 1996Metered-dose inhalers (MDIs) provide several advantages over nebulizers, including ease of administration, decreased cost, reliability of dosing, and freedom from... (Review)
Review
Metered-dose inhalers (MDIs) provide several advantages over nebulizers, including ease of administration, decreased cost, reliability of dosing, and freedom from contamination. However, this method of aerosol delivery has been considered ineffective in mechanically-ventilated patients because most of the aerosol deposits in the endotracheal tube and ventilator circuit. A smaller amount of aerosol from a MDI is deposited in the lower respiratory tract of mechanically-ventilated patients than in ambulatory patients, although recent studies show that a significant bronchodilator effect can still be achieved. When employed optimally, significant bronchodilation occurs with as little as 4 puffs of a sympathomimetic aerosol. Multiple factors influence the efficacy of MDIs in mechanically-ventilated patients. The method of connecting the MDI canister to the ventilator circuit has a marked effect on aerosol delivery, and other factors include the timing of MDI actuation, ventilator mode, tidal volume, circuit humidity, and duty cycle. With a proper technique of administration, a MDI serves as an effective, convenient, and safe method for delivering bronchodilator aerosols in mechanically-ventilated patients.
Topics: Administration, Inhalation; Bronchodilator Agents; Combined Modality Therapy; Humans; Lung Diseases; Nebulizers and Vaporizers; Particle Size; Respiration, Artificial; Treatment Outcome
PubMed: 8730023
DOI: 10.1183/09031936.96.09030585 -
Daru : Journal of Faculty of Pharmacy,... Dec 2023Chemotherapy-induced nausea and vomiting are commonly experienced side effects in breast cancer (BCa) patients. Antiemetic drugs used in BCa treatment are either...
BACKGROUND
Chemotherapy-induced nausea and vomiting are commonly experienced side effects in breast cancer (BCa) patients. Antiemetic drugs used in BCa treatment are either inhibitors or inducers of cytochrome P450 (CYP) enzymes, while anticancer drugs are metabolized by CYPs.
OBJECTIVES
The purpose of the present work was to evaluate in silico drug-drug interaction (DDI) potential between BCa chemotherapeutic drugs and antiemetic agents.
METHODS
The Drug-Drug Interaction™ module of GastroPlus™ was employed to assess CYP-related interactions between antiemetic and anticancer therapy combinations. The CYP inhibitory or inducing parameters (IC, K, EC) used in simulations were obtained from the literature.
RESULTS
Analyses of twenty-three BCa drugs indicated that 22% of the chemotherapeutic drugs do not need an antiemetic agent due to their low emetogenicity, whereas 30% of the anticancer drugs are not metabolized by CYPs. The remaining eleven anticancer drugs metabolized by CYPs generated ninety-nine combinations with nine antiemetics. Simulation of DDIs suggest that about half of the pairs did not demonstrate any potential for DDI, whereas 30%, 10%, and 9% of the pairs showed weak, moderate, and strong interaction potential, respectively. In the present study, netupitant was the only antiemetic that showed strong inhibitory interactions (predicted AUC ratio > 5) with CYP3A4-metabolzied anticancer therapies (e.g., docetaxel, ribociclib, olaparib). Moderate to no interactions were observed with ondansetron, aprepitant, rolapitant, and dexamethasone in combination with anticancer agents.
CONCLUSION
It is critical to recognize that these interactions can get amplified in cancer patients because of the severity of the disease and chemotherapy toxicities. Clinicians need to be aware of the DDI likelihood of the drug combinations used in BCa treatment.
Topics: Humans; Female; Antiemetics; Breast Neoplasms; Antineoplastic Agents; Aprepitant; Drug Interactions
PubMed: 37223851
DOI: 10.1007/s40199-023-00463-1