RESUMO
Although recent advances in drug therapy for low back and neck pain may seem slight, some consolidation of knowledge has taken place. Opiates, NSAIDs, and acetaminophen remain the drugs of choice. New NSAIDs, especially ketorolac, have some advantages. Injections of steroids and other agents into the lumbar area do not offer any distinct advantages. The use of adjunctive drugs such as muscle relaxants and antidepressants has not materially changed in the last few years.
Assuntos
Analgésicos/uso terapêutico , Dor Lombar/tratamento farmacológico , Pescoço , Dor/tratamento farmacológico , Anti-Inflamatórios não Esteroides/uso terapêutico , HumanosRESUMO
We conducted urine screening for cocaine metabolite in 500 consecutive women admitted to a labor and delivery unit. The pregnancy outcome of 411 of the women was determined at that admission. The prevalence of cocaine-positive urines was 15.3% (95% confidence interval 11.8-18.8%). A subset of this population that had not received prenatal care had a prevalence of 62% (95% confidence interval 47.2-76.6%). Women with positive urines were almost four times more likely to have preterm labor and over twice as likely to deliver a premature infant or one with a 1-minute Apgar score of 6 or lower. Our findings support the concept that urine drug screening for cocaine and/or other drugs of abuse should be considered in patients who present with no prenatal care, premature labor, premature delivery, and delivery of an infant with a 1-minute Apgar score of 6 or less. This strategy may enable us to identify and bring to therapy a population of women that could potentially go unrecognized.
Assuntos
Cocaína , Trabalho de Parto Prematuro/epidemiologia , Resultado da Gravidez/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/complicações , Adulto , Índice de Apgar , Cocaína/urina , Feminino , Humanos , Recém-Nascido , Philadelphia/epidemiologia , Gravidez , Cuidado Pré-Natal , Prevalência , Fatores de Risco , Detecção do Abuso de SubstânciasRESUMO
It is now customary practice to couple separately metered infusions via a manifold to a common catheter that enters the patient. Nitroprusside, however, is considered incompatible with all other medications. Critically ill patients who require multiple infusions of vasoactive and inotropic medications would benefit if physicians had additional information regarding compatibility of nitroprusside with other commonly used infusions. Utilizing high-performance liquid chromatography, the authors investigated the physical and chemical compatibility of nitroprusside, dobutamine, and nitroglycerin in solutions of 5% dextrose or 0.9% NaCl at clinically relevant concentrations. All drugs were present within the guidelines of the U.S. Pharmacopeia (+/- 10%) over 24 h in NaCl, but nitroglycerin degraded over 24 h when the three drugs were mixed in dextrose. We recommend diluting these medicines in NaCl when mixtures of them would exist for greater than 4 h.