Steroid sparing agents definition

The potassium-sparing diuretics are competitive antagonists that either compete with aldosterone for intracellular cytoplasmic receptor sites, or directly block sodium channels (specifically epithelial sodium channels (ENaC) by amiloride ). The former prevents the production of proteins that are normally synthesized in reaction to aldosterone. These mediator proteins are not produced, and so stimulation of sodium-potassium exchange sites in the collection tubule does not occur. This prevents sodium re-absorption and potassium and hydrogen ion secretion. [3]

On January 8, 2010, the FDA approved tocilizumab (Actemra) for the treatment of adults with moderate-to-severe RA who have not adequately responded to or can not tolerate other approved drug classes for RA.  Actemra can be used alone or with methotrexate and DMARDs and after the use and failure of at least one TNF antagonist.  Actemra recommended use is limited to patients who have failed other approved therapies because of serious safety concerns that were noted in clinical studies.  These safety concerns include elevated liver enzymes, elevated low-density lipoprotein (LDL), hypertension, and gastrointestinal perforations.  The FDA is requiring the manufacturer to perform a post-marketing clinical trial to further assess the long-term safety of Actemra.  Specifically, the FDA wants to evaluate the impact of elevated LDL cholesterol and blood pressure observed in some patients in shorter-term trials on the cardiovascular health of patients treated with Actemra.  Furthermore, a Risk Evaluation and Mitigation Strategy (REMS) will require the drug sponsor to implement a communication plan for physicians informing them how to appropriately monitor their patients for liver and/or gastrointestinal side effects. The REMS will include a medication guide to ensure that patients are informed of the benefits and risks of Actemra.

Safety and efficacy have not been established. However, pediatric patients commonly receive dosing as in product labels: 1 to 2 drops in the affected eye(s) 2 to 4 times daily or 2 drops in the affected eye(s) 4 times per day. During the initial 24 to 48 hours, may increase dose frequency if necessary. If signs and symptoms fail to improve after 2 days, re-evaluate. Once the condition is responding, lower dosage may be used, but care should be taken not to discontinue therapy prematurely. In chronic conditions, withdrawal of treatment should be carried out by gradually decreasing the frequency of applications.

The caudal approach to the epidural space involves the use of a Tuohy needle, an intravenous catheter, or a hypodermic needle to puncture the sacrococcygeal membrane . Injecting local anaesthetic at this level can result in analgesia and/or anaesthesia of the perineum and groin areas. The caudal epidural technique is often used in infants and children undergoing surgery involving the groin, pelvis or lower extremities. In this population, caudal epidural analgesia is usually combined with general anaesthesia since most children do not tolerate surgery when regional anaesthesia is employed as the sole modality.

Steroid sparing agents definition

steroid sparing agents definition

The caudal approach to the epidural space involves the use of a Tuohy needle, an intravenous catheter, or a hypodermic needle to puncture the sacrococcygeal membrane . Injecting local anaesthetic at this level can result in analgesia and/or anaesthesia of the perineum and groin areas. The caudal epidural technique is often used in infants and children undergoing surgery involving the groin, pelvis or lower extremities. In this population, caudal epidural analgesia is usually combined with general anaesthesia since most children do not tolerate surgery when regional anaesthesia is employed as the sole modality.

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