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Iveth Yamaguchi Whitaker - One of the best experts on this subject based on the ideXlab platform.
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Acta Paulista de Enfermagem Factors associated with phlebitis in elderly patients with Amiodarone intravenous infusion Fatores relacionados à flebite em idosos com infusão intravenosa de amiodarona Corresponding author
2020Co-Authors: Brasil Loureiro Buzatto, Maria Angelica, Iveth Yamaguchi Whitaker, Leandro Loureiro Buzatto, Gabriella Pinna Massa, Maria Angelica Sorgini PeterliniAbstract:Abstract Objective: To verify the incidence of phlebitis and identify factors associated with the development of phlebitis due to peripheral intravenous infusion of Amiodarone in elderly patients. Methods: Prospective and observational cohort study on risk factors for the development of phlebitis in patients aged over 60 years, who received peripheral intravenous infusion of Amiodarone, hospitalized in 2012 in the coronary care (22 beds) and general semi-intensive units (43 beds) of a large private hospital in São Paulo, Brazil. Results: Of the total 102 elderly people, 34 (33.3%) had phlebitis. It was more frequent in women (43.6%), in the dominant punctured member (36.2%), in the forearm basilica or cephalic veins (41.2%), in caliber 20G devices (40.0%), in IV Fix® sterile dressings (39.3%), in Intima® catheters (34.3%) and when there was device repositioning (33.3%). However, these variables were not statistically associated with phlebitis. Phlebitis absence in the exclusive bolus infusion was marginally significant (p = 0.051) compared to different types of infusion. Conclusion: One-third of the studied elderly patients presented phlebitis. There was absence of phlebitis only in exclusive bolus infusions. Resumo Objetivo: Identificar fatores associados à ocorrência de flebite decorrente da infusão intravenosa periférica de amiodarona em idosos. Métodos: Coorte prospectiva, observacional sobre fatores de risco para ocorrência de flebite em pacientes com idade acima de 60 anos que receberam infusão intravenosa periférica de amiodarona, internados, no ano de 2012, nas unidades Coronarianas (22 leitos) e Semi Intensivas Gerais (43 leitos) de um hospital privado de grande porte, localizado na cidade de São Paulo, Brasil. Resultados: Do total de 102 idosos, 34 (33,3%) apresentaram flebite. A flebite foi mais frequente em mulheres (43,6%), em membro dominante puncionado (36,2%), em veias basílica ou cefálica do antebraço (41,2%), nos dispositivos de calibre 20G (40,0%), em curativo estéril IV Fix® (39,3%), em cateter Intima® (34,3%) e quando houve reposicionamento do dispositivo (33,3%); mas essas variáveis não se associaram estatisticamente à flebite. Ausência de flebite na infusão rápida exclusiva foi marginalmente significante (p= 0,051) comparada aos diferentes tipos de infusão. Conclusão: Um terço dos idosos estudados apresentou flebite, verificou-se ausência de flebite somente nas infusões rápidas exclusivas
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Factors associated with phlebitis in elderly patients with Amiodarone intravenous infusion Fatores relacionados à flebite em idosos com infusão intravenosa de amiodarona Corresponding author
2020Co-Authors: Leandro Loureiro Buzatto, Iveth Yamaguchi Whitaker, Gabriella Pinna Massa, Maria Angelica Sorgini PeterliniAbstract:Abstract Objective: To verify the incidence of phlebitis and identify factors associated with the development of phlebitis due to peripheral intravenous infusion of Amiodarone in elderly patients. Methods: Prospective and observational cohort study on risk factors for the development of phlebitis in patients aged over 60 years, who received peripheral intravenous infusion of Amiodarone, hospitalized in 2012 in the coronary care (22 beds) and general semi-intensive units (43 beds) of a large private hospital in São Paulo, Brazil. Results: Of the total 102 elderly people, 34 (33.3%) had phlebitis. It was more frequent in women (43.6%), in the dominant punctured member (36.2%), in the forearm basilica or cephalic veins (41.2%), in caliber 20G devices (40.0%), in IV Fix® sterile dressings (39.3%), in Intima® catheters (34.3%) and when there was device repositioning (33.3%). However, these variables were not statistically associated with phlebitis. Phlebitis absence in the exclusive bolus infusion was marginally significant (p = 0.051) compared to different types of infusion. Conclusion: One-third of the studied elderly patients presented phlebitis. There was absence of phlebitis only in exclusive bolus infusions. Resumo Objetivo: Identificar fatores associados à ocorrência de flebite decorrente da infusão intravenosa periférica de amiodarona em idosos. Métodos: Coorte prospectiva, observacional sobre fatores de risco para ocorrência de flebite em pacientes com idade acima de 60 anos que receberam infusão intravenosa periférica de amiodarona, internados, no ano de 2012, nas unidades Coronarianas (22 leitos) e Semi Intensivas Gerais (43 leitos) de um hospital privado de grande porte, localizado na cidade de São Paulo, Brasil. Resultados: Do total de 102 idosos, 34 (33,3%) apresentaram flebite. A flebite foi mais frequente em mulheres (43,6%), em membro dominante puncionado (36,2%), em veias basílica ou cefálica do antebraço (41,2%), nos dispositivos de calibre 20G (40,0%), em curativo estéril IV Fix® (39,3%), em cateter Intima® (34,3%) e quando houve reposicionamento do dispositivo (33,3%); mas essas variáveis não se associaram estatisticamente à flebite. Ausência de flebite na infusão rápida exclusiva foi marginalmente significante (p= 0,051) comparada aos diferentes tipos de infusão. Conclusão: Um terço dos idosos estudados apresentou flebite, verificou-se ausência de flebite somente nas infusões rápidas exclusivas
G Frangin - One of the best experts on this subject based on the ideXlab platform.
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Amiodarone interaction with β blockers analysis of the merged emiat european myocardial infarct Amiodarone trial and camiat canadian Amiodarone myocardial infarction trial databases
Circulation, 1999Co-Authors: Florent Boutitie, Jeanpierre Boissel, Stuart J Connolly, John A Camm, John A Cairns, Desmond G Julian, Michael Gent, Michiel J Janse, Paul Dorian, G FranginAbstract:Background —Investigations with in vitro and animal models suggest an interaction between Amiodarone and β-blockers. The objective of this work was to explore if an interaction with β-blocker treatment plays a role in the decrease of cardiac arrhythmic deaths with Amiodarone in patients recovered from an acute myocardial infarction. Methods and Results —A pooled database from 2 similar randomized clinical trials, the European Amiodarone Myocardial Infarction Trial (EMIAT) and the Canadian Amiodarone Myocardial Infarction Trial (CAMIAT), was used. Four groups of post–myocardial infarction patients were defined: β-blockers and Amiodarone used, β-blockers used alone, Amiodarone used alone, and neither used. All analyses were done on an intention-to-treat basis. Unadjusted and adjusted relative risks for all-cause mortality, cardiac death, arrhythmic cardiac death, nonarrhythmic cardiac death, arrhythmic death, or resuscitated cardiac arrest were lower for patients receiving β-blockers and Amiodarone than for those without β-blockers, with or without Amiodarone. The interaction was statistically significant for cardiac death and arrhythmic death or resuscitated cardiac arrest ( P =0.05 and 0.03, respectively). Findings were consistent across subgroups. Conclusions —These findings are based on a post hoc analysis. However, they confirm prior results from in vitro and animal experiments suggesting an interaction between β-blockers and Amiodarone. In practice, not only is the adjunct of Amiodarone to β-blockers not hazardous, but β-blocker therapy should be continued if possible in patients in whom Amiodarone is indicated.
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Amiodarone interaction with beta blockers analysis of the merged emiat european myocardial infarct Amiodarone trial and camiat canadian Amiodarone myocardial infarction trial databases the emiat and camiat investigators
Circulation, 1999Co-Authors: Florent Boutitie, Jeanpierre Boissel, Stuart J Connolly, John A Cairns, Desmond G Julian, Michael Gent, Michiel J Janse, Paul Dorian, A J Camm, G FranginAbstract:Background—Investigations with in vitro and animal models suggest an interaction between Amiodarone and β-blockers. The objective of this work was to explore if an interaction with β-blocker treatment plays a role in the decrease of cardiac arrhythmic deaths with Amiodarone in patients recovered from an acute myocardial infarction. Methods and Results—A pooled database from 2 similar randomized clinical trials, the European Amiodarone Myocardial Infarction Trial (EMIAT) and the Canadian Amiodarone Myocardial Infarction Trial (CAMIAT), was used. Four groups of post–myocardial infarction patients were defined: β-blockers and Amiodarone used, β-blockers used alone, Amiodarone used alone, and neither used. All analyses were done on an intention-to-treat basis. Unadjusted and adjusted relative risks for all-cause mortality, cardiac death, arrhythmic cardiac death, nonarrhythmic cardiac death, arrhythmic death, or resuscitated cardiac arrest were lower for patients receiving β-blockers and Amiodarone than for t...
Stuart J Connolly - One of the best experts on this subject based on the ideXlab platform.
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evidence based analysis of Amiodarone efficacy and safety
Circulation, 1999Co-Authors: Stuart J ConnollyAbstract:Amiodarone was initially developed 3 decades ago for angina. On the basis of the number of prescriptions filled in retail pharmacies, Amiodarone was the most-often-prescribed antiarrhythmic agent, accounting for 24.1% of the total antiarrhythmic prescriptions in 1998. Amiodarone accounted for 34.5% of prescriptions in Europe, 32.8% in North America, 73.8% in Latin America, and 0.3% in Japan and the Philippines. Amiodarone use has increased globally in 1998 at a rate greater than that of the whole antiarrhythmic market, with striking growth in North America, a 20.0% increase from 1997 to 1998 (according to International Medical Statistics, Medical Data Index, and Scott Levin drug and diagnosis audit, obtained with the assistance of J. Jones, Sanofi Pharma Inc, Paris, France). Amiodarone is used to manage virtually all forms of supraventricular and ventricular tachycardia. This review focuses on the arrhythmias most commonly requiring antiarrhythmic therapy—sustained ventricular tachycardia (VT), ventricular fibrillation (VF), and atrial fibrillation (AF)—because they are the most clinically significant and have been the focus of most studies published. This review will analyze the evidence that Amiodarone is a safe and effective antiarrhythmic drug. To exploit the antiarrhythmic properties of Amiodarone fully, the clinician needs to be familiar with its pharmacokinetics, because they differ markedly from those of other cardiac drugs. Amiodarone is markedly lipophilic, which may account for some of its unusual pharmacokinetic features.1 It is incompletely absorbed (35% to 65%) after oral administration.2 3 4 It is taken up very extensively by tissue, with marked interindividual variation.5 Estimates of the elimination half-life of Amiodarone vary, depending on how it has been measured. The relatively short half-life for disappearance of Amiodarone from plasma after intravenous administration is likely a measure of drug redistribution from vascular space into tissue and not true body elimination.6 After long-term oral therapy, …
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Amiodarone interaction with β blockers analysis of the merged emiat european myocardial infarct Amiodarone trial and camiat canadian Amiodarone myocardial infarction trial databases
Circulation, 1999Co-Authors: Florent Boutitie, Jeanpierre Boissel, Stuart J Connolly, John A Camm, John A Cairns, Desmond G Julian, Michael Gent, Michiel J Janse, Paul Dorian, G FranginAbstract:Background —Investigations with in vitro and animal models suggest an interaction between Amiodarone and β-blockers. The objective of this work was to explore if an interaction with β-blocker treatment plays a role in the decrease of cardiac arrhythmic deaths with Amiodarone in patients recovered from an acute myocardial infarction. Methods and Results —A pooled database from 2 similar randomized clinical trials, the European Amiodarone Myocardial Infarction Trial (EMIAT) and the Canadian Amiodarone Myocardial Infarction Trial (CAMIAT), was used. Four groups of post–myocardial infarction patients were defined: β-blockers and Amiodarone used, β-blockers used alone, Amiodarone used alone, and neither used. All analyses were done on an intention-to-treat basis. Unadjusted and adjusted relative risks for all-cause mortality, cardiac death, arrhythmic cardiac death, nonarrhythmic cardiac death, arrhythmic death, or resuscitated cardiac arrest were lower for patients receiving β-blockers and Amiodarone than for those without β-blockers, with or without Amiodarone. The interaction was statistically significant for cardiac death and arrhythmic death or resuscitated cardiac arrest ( P =0.05 and 0.03, respectively). Findings were consistent across subgroups. Conclusions —These findings are based on a post hoc analysis. However, they confirm prior results from in vitro and animal experiments suggesting an interaction between β-blockers and Amiodarone. In practice, not only is the adjunct of Amiodarone to β-blockers not hazardous, but β-blocker therapy should be continued if possible in patients in whom Amiodarone is indicated.
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Amiodarone interaction with beta blockers analysis of the merged emiat european myocardial infarct Amiodarone trial and camiat canadian Amiodarone myocardial infarction trial databases the emiat and camiat investigators
Circulation, 1999Co-Authors: Florent Boutitie, Jeanpierre Boissel, Stuart J Connolly, John A Cairns, Desmond G Julian, Michael Gent, Michiel J Janse, Paul Dorian, A J Camm, G FranginAbstract:Background—Investigations with in vitro and animal models suggest an interaction between Amiodarone and β-blockers. The objective of this work was to explore if an interaction with β-blocker treatment plays a role in the decrease of cardiac arrhythmic deaths with Amiodarone in patients recovered from an acute myocardial infarction. Methods and Results—A pooled database from 2 similar randomized clinical trials, the European Amiodarone Myocardial Infarction Trial (EMIAT) and the Canadian Amiodarone Myocardial Infarction Trial (CAMIAT), was used. Four groups of post–myocardial infarction patients were defined: β-blockers and Amiodarone used, β-blockers used alone, Amiodarone used alone, and neither used. All analyses were done on an intention-to-treat basis. Unadjusted and adjusted relative risks for all-cause mortality, cardiac death, arrhythmic cardiac death, nonarrhythmic cardiac death, arrhythmic death, or resuscitated cardiac arrest were lower for patients receiving β-blockers and Amiodarone than for t...
Florent Boutitie - One of the best experts on this subject based on the ideXlab platform.
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Amiodarone interaction with β blockers analysis of the merged emiat european myocardial infarct Amiodarone trial and camiat canadian Amiodarone myocardial infarction trial databases
Circulation, 1999Co-Authors: Florent Boutitie, Jeanpierre Boissel, Stuart J Connolly, John A Camm, John A Cairns, Desmond G Julian, Michael Gent, Michiel J Janse, Paul Dorian, G FranginAbstract:Background —Investigations with in vitro and animal models suggest an interaction between Amiodarone and β-blockers. The objective of this work was to explore if an interaction with β-blocker treatment plays a role in the decrease of cardiac arrhythmic deaths with Amiodarone in patients recovered from an acute myocardial infarction. Methods and Results —A pooled database from 2 similar randomized clinical trials, the European Amiodarone Myocardial Infarction Trial (EMIAT) and the Canadian Amiodarone Myocardial Infarction Trial (CAMIAT), was used. Four groups of post–myocardial infarction patients were defined: β-blockers and Amiodarone used, β-blockers used alone, Amiodarone used alone, and neither used. All analyses were done on an intention-to-treat basis. Unadjusted and adjusted relative risks for all-cause mortality, cardiac death, arrhythmic cardiac death, nonarrhythmic cardiac death, arrhythmic death, or resuscitated cardiac arrest were lower for patients receiving β-blockers and Amiodarone than for those without β-blockers, with or without Amiodarone. The interaction was statistically significant for cardiac death and arrhythmic death or resuscitated cardiac arrest ( P =0.05 and 0.03, respectively). Findings were consistent across subgroups. Conclusions —These findings are based on a post hoc analysis. However, they confirm prior results from in vitro and animal experiments suggesting an interaction between β-blockers and Amiodarone. In practice, not only is the adjunct of Amiodarone to β-blockers not hazardous, but β-blocker therapy should be continued if possible in patients in whom Amiodarone is indicated.
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Amiodarone interaction with beta blockers analysis of the merged emiat european myocardial infarct Amiodarone trial and camiat canadian Amiodarone myocardial infarction trial databases the emiat and camiat investigators
Circulation, 1999Co-Authors: Florent Boutitie, Jeanpierre Boissel, Stuart J Connolly, John A Cairns, Desmond G Julian, Michael Gent, Michiel J Janse, Paul Dorian, A J Camm, G FranginAbstract:Background—Investigations with in vitro and animal models suggest an interaction between Amiodarone and β-blockers. The objective of this work was to explore if an interaction with β-blocker treatment plays a role in the decrease of cardiac arrhythmic deaths with Amiodarone in patients recovered from an acute myocardial infarction. Methods and Results—A pooled database from 2 similar randomized clinical trials, the European Amiodarone Myocardial Infarction Trial (EMIAT) and the Canadian Amiodarone Myocardial Infarction Trial (CAMIAT), was used. Four groups of post–myocardial infarction patients were defined: β-blockers and Amiodarone used, β-blockers used alone, Amiodarone used alone, and neither used. All analyses were done on an intention-to-treat basis. Unadjusted and adjusted relative risks for all-cause mortality, cardiac death, arrhythmic cardiac death, nonarrhythmic cardiac death, arrhythmic death, or resuscitated cardiac arrest were lower for patients receiving β-blockers and Amiodarone than for t...
Tsuyoshi Yokoi - One of the best experts on this subject based on the ideXlab platform.
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a significant role of human cytochrome p450 2c8 in Amiodarone n deethylation an approach to predict the contribution with relative activity factor
Drug Metabolism and Disposition, 2000Co-Authors: Katsuhiro Ohyama, Miki Nakajima, Sumika Nakamura, Noriaki Shimada, Tsuyoshi YokoiAbstract:Human cytochrome P450 (CYP) isoforms involved in Amiodarone N-deethylation were identified, and the relative contributions of these CYP isoforms were evaluated in different human liver microsomes. The mean K(M) and V(max) values of Amiodarone N-deethylation in microsomes from six human livers were 31.6 +/- 7.5 microM and 1.2 +/- 0.7 pmol/min/pmol of CYP, respectively. Ketoconazole and anti-CYP3A antibodies strongly inhibited Amiodarone N-deethylase activity in human liver microsomes at a substrate concentration of 50 microM. Of 15 recombinant human CYP enzymes (19 preparations), CYP1A1, CYP3A4, CYP1A2, CYP2D6, CYP2C8, and CYP2C19 catalyzed Amiodarone N-deethylation. The Amiodarone N-deethylase activity at a substrate concentration of 5 microM was significantly correlated with the paclitaxel 6alpha-hydroxylase activity (r = 0.84, P <.05) in the human liver microsomes, whereas the Amiodarone N-deethylase activity at 100 microM was significantly correlated with the testosterone 6beta-hydroxylase activity (r = 0.94, P <.005). According to the concept of relative activity factor, it was clarified that CYP2C8 as well as CYP3A4 were significantly involved in Amiodarone N-deethylation in human livers at clinically significant concentrations and that the contributions of CYP1A2, CYP2C19, and CYP2D6 were relatively minor. However, there was a large interindividual variability in the contribution of each CYP isoform to Amiodarone N-deethylase activity in human liver; the relevance of these enzymes would be dependent on the content of the respective isoforms and on the Amiodarone concentration in the liver.
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inhibitory effects of Amiodarone and its n deethylated metabolite on human cytochrome p450 activities prediction of in vivo drug interactions
British Journal of Clinical Pharmacology, 2000Co-Authors: Katsuhiro Ohyama, Hiroshi Yamazaki, Miki Nakajima, Noriaki Shimada, M Suzuki, Tsuyoshi YokoiAbstract:Aims To predict the drug interactions of Amiodarone and other drugs, the inhibitory effects and inactivation potential for human cytochrome P450 (CYP) enzymes by Amiodarone and its N-dealkylated metabolite, desethylAmiodarone were examined. Methods The inhibition or inactivation potency of Amiodarone and desethylAmiodarone for human CYP activities were investigated using microsomes from B-lymphoblastoid cell lines expressing CYP1A1, CYP1A2, CYP2A6, CYP2B6, CYP2C9, CYP2C19, CYP2D6, CYP2E1, and CYP3A4. The in vivo drug interactions of Amiodarone and desethylAmiodarone were predicted in vitro using the 1+Iu/Ki values. Results Amiodarone weakly inhibited CYP2C9, CYP2D6, and CYP3A4-mediated activities with Ki values of 45.1–271.6 μm. DesethylAmiodarone competitively inhibited the catalytic activities of CYP2D6 (Ki=4.5 μm ) and noncompetitively inhibited CYP2A6 (Ki=13.5 μm ), CYP2B6 (Ki=5.4 μm ), and CYP3A4 (Ki=12.1 μm ). The catalytic activities of CYP1A1 (Ki=1.5 μm, α=5.7), CYP1A2 (Ki=18.8 μm, α=2.6), CYP2C9 (Ki=2.3 μm, α=5.9), and CYP2C19 (Ki=15.7 μm, α=4.5) were inhibited by desethylAmiodarone with mixed type. The 1+Iu/Ki values of desethylAmiodarone were higher than those of Amiodarone. Amiodarone inactivated CYP3A4, while desethylAmiodarone inactivated CYP1A1, CYP1A2, CYP2B6, and CYP2D6. Conclusions The interactions between Amiodarone and other drugs might occur via the inhibition of CYP activities by its N-dealkylated metabolite, desethylAmiodarone, rather than by Amiodarone itself. In addition, the inactivation of CYPs by desethylAmiodarone as well as by Amiodarone would also contribute to the drug interactions.