Drug usage analysis in pregnant women

BACKGROUND

Drug usage in pregnant women is associated with a problem of possible negative influence on prenatal development. It is always necessary to judge the need for drug administration during pregnancy.

OBJECTIVE

The aim of presented study was to analyse data about pregnant women hospitalized in the postpartum period.

METHODS

The study was designed as a retrospective observational study including 300 women hospitalized at the 2nd Department of Gynaecology and Obstetrics, University Hospital, Bratislava. Data were obtained through questionnaires in form of an interview.

RESULTS

The average age of women was 30.79 ± 4.40 years. Risk pregnancy occured in 20.59 % of women. Chronic disorders before pregnancy required regular pharmacotherapy in 29.24 %. Drug usage analysis: I. trimester, 31 % used at least one drug, 52 % nutritional supplements, 63.3 % drug and/or nutritional supplement; II. trimester, 23 % used at least one drug, 45 % nutritional supplements, 58.3 % drug and/or nutritional supplement; III. trimester, 32 % used at least one drug, 67 % nutritional supplements, 75.3 % drug and/or nutritional supplement.

CONCLUSION

Drug usage during pregnancy requires great precaution at choosing pharmacotherapy. The benefit of pharmacotherapy should always outweight the potential risk of administered drug (Tab. 3, Fig. 3, Ref. 37).

Risk perception of NSAIDs in hospitalized patients in Greece

BACKGROUND

Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used analgesics worldwide in different syndromes. There is a relevant evidence about NSAIDs various adverse effects (AEs) on gastrointestinal, cardiovascular, renal, pulmonary, nervous systems. Many of these problems are preventable with respects to appropriate patient´s risk perception.

OBJECTIVES

The main goal of our study was to examine drug risk perception with relation to participation factors as comorbidities in patients.

METHODS

A structured questionnaire was delivered to 124 patients hospitalized at Department of Internal Medicine in a selected General Hospital in Greece. Data were evaluated using a descriptive statistics.

RESULTS

Low awareness of NSAID risk was recorded, with 45.16 % of respondents unaware of any particular AEs. Lack of this knowledge appears to be attributed to low communication of physicians and pharmacists with patients about possible risk from comorbidity, over half of respondents (55.8 %) had history of hypertension, and 25.9 % were diabetics, which would increase the risk of NSAID therapy.

CONCLUSION

Our study revealed a restricted knowledge about risk of NSAIDs in the studied population and showed some important data related to the presence of comorbidity in patients, which could potentiate the risk of cardiovascular AEs (Fig. 5, Ref. 22).

Comments to regional problems of analgesic risk perception

OBJECTIVES

The aim of our study was to analyse analgesic risk perception and then to compare analgesic drug choice among general practitioners.

METHOD

The structured questionnaire was used and completed during continuous medical education lectures. Series of targeted open or close questions and visual analog scale (VAS) to determine drug risk perception were used. Slovak general practitioners attending continuous medical education lectures during 2004-2005 were invited to participate in the study. Group 1 consisted of respodents from Bratislava (capital city of Slovakia, n = 245) and group 2 consisted of general practitioners from 3 other cities (middle and eastern Slovakia, n = 325). Data were compared to reported adverse drug reactions.

RESULTS

Quarter of doctors 25.3% (n = 62), (25.2% (n = 82) respectively), considered non-steroidal anti-inflammatory drugs to be the safest group of analgesics. Gastrointestinal damage in general was perceived as most common adverse drug reaction. 72.41% (75.94% respectively) of respondents considered analgesics as exactly or probably danger. Perceived drug risk labeled on VAS was 4.23 (SD 1.52), (3.22 (SD 2.19) respectively) (p < 0.05). Total number of reported adverse drug reactions in years 1998-2002 was 3249, 412 were related to analgesic use. Specific organotoxic adverse drug reactions (nephrotoxicity, etc.) were reported rarely.

CONCLUSION

The actual perception of analgesic risk in Slovakia seems to be generally inadequate. We found only a low support of spontaneous adverse drug reactions reporting to the national monitoring system (Tab. 1, Fig. 2, Ref. 11).

5 most consumpted opioid analgesics in Slovakia in the year 2006--comparison to five other countries (Finland, Norway, Denmark, Spain, Australia)

INTRODUCTION

Opioid analgesics are drugs of choice in the treatment of moderate and severe malignant or noncancer pain. Consumption data helps us to evaluate the status of country's public health.

METHODS

We analysed the consumption of opioid analgesics from ATC class N02A in Slovakia in the year 2006 and compared it with five other countries -- Finland, Norway, Denmark, Spain and Australia. We then calculated drugs that accounted for 90% of the total volume of DDDs in the year 2006.

RESULTS

Slovakia showed a dominance of tramadol consumption that constituted three quarters of the total group consumption. Tramadol is the commonest consumed opioid analgesic in all observed countries (in Norway it constituted only 35% of total group consumption, whereas in Slovakia it was 72%).

DISCUSSION

Opioid consumption in Slovakia is increasing, but comparison with the Nordic countries, Spain and Australia showed a significantly lower consumption. Exception is tramadol with the highest consumption in Slovakia.

CONCLUSION

Observed trends in consumption indicate a well known accent of the Nordic countries on treatment of pain. Opiod consumption in Slovakia continues to stay low (Tab. 1, Fig. 1, Ref. 10). Full Text (Free, PDF) www.bmj.sk.

Modified problem-based learning in pharmacology

OBJECTIVE

The aim of this study was to determine differences between PBL as compared to modified PBL with special focus on acquiring EBM principles.

METHODS

Two groups consisted of total 152 students (139 respectively). The use of EBM principles means integrating individual expertise with the best available external clinical evidence by using available data sources and national guidelines.

CONCLUSION

Our findings suggest that modified PBL with extended EBM approach could be superior to "classical" PBL (Fig. 3, Ref. 29). Full Text (Free, PDF) www.bmj.sk.

A comparison of the opinion of general practitioners and their patients on compliance with pharmacotherapy

OBJECTIVES

The aim of the study was to identify and confront the opinions of both patients and general practitioners on their relationship.

METHODS

Our questionnaire was designed according to the target of our study--to analyse the communication between the GP and the patient as well as the adherence to the treatment procedures--in the group of 100 GPs and 500 patients.

RESULTS

The response rate was 95% in GPs and 86.6% in patients. Totally, 88% of patients and 52% of GPs were convinced that the compliance with the treatment and the trust to the GP are related.

CONCLUSIONS

Non-compliance is a frequent reason for the patient's unsatisfying response to the therapy. A professional approach to this problem is an essential precondition of an increased quality of health care and an increased patient's satisfaction without requirements of health care system for additional financial resources (Tab. 1, Fig. 1, Ref. 12).

Comparison of NSAID consumption in Slovakia, Finland and Norway

BACKGROUND

Non-steroidal anti-inflammatory drugs (NSAIDs) belong to most frequently used drugs worldwide. NSAIDs belong to the family of drugs that represent the biggest drug risk as to the number of adverse drug reactions (ADRs), as well as to the number of deregistered drugs.

METHODS

We analysed the whole consumption of NSAIDs from ATC class M01 in Slovakia during 1996-2007.

RESULTS

Most frequently used NSAIDs in Slovakia were ibuprofen and diclofenac. There was a marked increasing trend in piroxicam, meloxicam, ibuprofen and especially nimesulide medicines.

CONCLUSION

Prescription habits of doctors in Slovakia reflect the drug risk only partially, nevertheless the total consumption of dangerous medicines is decreasing and substances with safer profile remain being more used. In the prescribing process the patients' risk factors together with the differences in drug characteristics should be considered. Nevertheless some of these drugs are OTC, and their consumption is strongly influenced by pharmacists and advertisement (Tab. 2, Fig. 1, Ref. 18). Full Text (Free, PDF) www.bmj.sk.

Biochemical evaluation of the antiplatelet effect of aspirin in patients at different levels of cardiovascular risk

BACKGROUND

The phenomenon called aspirin resistance is being intensively discussed.

METHODS

To evaluate the biochemical aspirin response, the method of urinary 11-dehydro TXB2 levels measurement was used. Quantitative detection of TXB2 in urine was determined by competitive enzyme immunoassay, using human Thromboxane B2 ELISA-kit. We investigated the urine samples from 69 patients.

RESULTS

The mean urinary levels of 11-dehydro TXB2 were significantly lower in patients in the primary and secondary types of aspirin prevention comparing with the control group of patients not taking aspirin. The difference in thromboxane concentrations between the two groups of patients taking aspirin did not reach statistical significance. Our results did not show significant differences in the biochemically measured aspirin response when comparing diabetics with non-diabetics. Similarly, the observed tendency to higher thromboxane levels in women did not show to be significantly different from men.

CONCLUSION

Our pilot study did not show any significant differences among patients at different cardiovascular risk. Since there is currently no standard laboratory method to detect aspirin non-responders available, the term aspirin resistance remains controversial and requires further research. Every effort should be done to improve patients' compliance and to prevent clinically relevant interactions of aspirin with ibuprofen. The elimination of these two factors as was the case in our study may provide better efficacy of the antithrombotic prevention by aspirin (Fig. 2, Tab. 4, Ref. 19). Full Text (Free, PDF) www.bmj.sk.

Endothelaemia--a marker of vascular damage

OBJECTIVES

The aim of the study was to determine the amount of circulating endothelial cells (CECs) in patients with an advanced cardiovascular (CV) disease, compare the values with a control group and finally to ascertain if there are statistically significant differences within the studied patient groups.

BACKGROUND

Endothelaemia has been intensively studied as a marker of vascular injury. Clinical studies have demonstrated an increased endothelaemia in patients at high CV risk but also in certain non-cardiovascular disorders. Its possible usage in the diagnostics of the acute coronary syndrome and for CV risk assessment needs further investigations.

METHODS

Thirty six hospitalized patients were studied. Quantitative measurement of endothelaemia was performed by the method developed by J. Hladovec. It is based on ECs counting in Bürker's chamber after their isolation with platelets and the removal of the latter by an addition of adenosine-diphosphate.

RESULTS

The mean baseline endothelaemia was significantly higher in patients with increased cardiovascular risk when compared with the control group (1.38 +/- 0.899): ACS (4.9 +/- 1.59, p < 0.05) and PAOD (3.74 +/- 0.61, p < 0.05). When comparing the mean endothelaemia values in patients with PAOD before (2.67 +/- 0.86) and after (3.88 +/- 0.77) surgery, a significant increase of endothelaemia was observed (p < 0.05).

CONCLUSION

Our pilot study, though limited by a relatively small number of patients, proved a significant increase of endothelaemia in patients at high CV risk, which is consistent with other available data. The introduction of newer specific methods based on immunomagnetic principles may provide a wider use of endothelaemia measurement in clinical settings (Fig. 3, Ref. 17). Full Text (Free, PDF) www.bmj.sk.

Perception of drug risk in the database of Drug Information Centre in Bratislava

OBJECTIVE

The aim of the presented study was to analyse the types and quantity of inquiries received at Drug Information Centre in Bratislava during the period from May 1997 to May 2006. The study analyses also the profile of the users of the latter centre with focus on the perception of drug risk, adverse drug reactions, and drug interactions.

BACKGROUND

The Drug Information Centre (Druginfo) was established in Slovak Republic as part of the Department of Pharmacology in May 1997. In 2002 Druginfo became a member of International Register of Drug Information Services of the Society of Hospital Pharmacists of Australia. Druginfo provides voluntary free of charge drug information for healthcare professionals.

METHODS

Statistical processing of all inquiries received at Druginfo during a 10-year period focused on the aspect of drug risk perception.

RESULTS

867 inquiries were received in total. The most frequent inquiries came from hospital teaching clinics in Bratislava. Questions concerning pregnancy/lactation (25 %), adverse drug reactions (16 %), basic information about drugs (14 %) and interactions (13 %) were asked most frequently.

CONCLUSION

The types of inquiries and inquirers using the service are generally similar to those recorded at many others Druginfos within Europe and USA. The number of questions is lower than in other centres. Druginfo in Bratislava has a very important role in providing independent drug information (Tab. 1, Fig. 8, Ref. 9). Full Text (Free, PDF) www.bmj.sk.

Current opinions on the role of inhaled corticosteroids in the treatment of chronic obstructive pulmonary disease

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is one of the main cases of mortality and morbidity of population worlwide. In spite of enormous efforts there are not pharmacological agents evidently influencing natural course of disease available. Besides looking for new drugs influencing the long term outcome of patients with COPD, there is also running the process of reevaluation of the role of several already established drug groups.

METHODS

Through the use of recent knowledge and results from large-scale clinical studies as well as metaanalyses we give a view on action of inhaled corticosteroids in the pathophysiological mechanisms of COPD and complex summary of their role in the therapeutic management of the disease.

CONCLUSION

Contrary to systemic corticosteroids, agreement regarding usage of inhaled corticosteroids necessary by acute exacerbations of disease has not been reached yet. Recent meta-analyses of the long-term clinical studies have clearly demonstrated that inhaled corticosteroids could pose with ability of slowing down the progressive deterioration of lung functions and lead to the prolongation of life in broad population of patients with COPD. Benefit of treatment insists in decrease of frequency and severity of exacerbations, mildering symptoms, improving overall health state as well as exercise tolerance in patients with COPD. Clinical relevant is also reduction of the number of hospitalizations and mortality related to progression of COPD (Tab. 2, Ref 45) Full Text (Free, PDF) www.bmj.sk.

[Gastroduodenal complications associated with non-steroidal anti-inflammatory drugs in Slovak Republic: results of one-year prospective study]

The aim of the one-year prospective study was to estimate the prevalence of non-steroidal anti-inflammatory drugs using in patients with symptomatic gastroduodenal ulcers, the upper gastrointestinal bleeding and perforation (PUB--perforation, ulcer, bleeding). Among of 326 patients with PUB, prevalence of non-steroidal anti-inflammatory drugs using was 60%. In the group of 194 patients with non-steroidal antiinflammatory drugs induced PUB, 49% patients took aspirin, 38% non-aspirin non-steroidal anti-inflammatory drugs and 13% their combination. Low dosing aspirin (daily dosis < or =200 mg) was associated with PUB in 21% of patients. Age higher than 60 years and women had statisticaly signiticant higher prevalence of non-steroidal anti-inflammatory drugs induced PUB.

Effect of pentoxifylline on endothelaemia and hypothalamic-pituitary-adrenocortical axis activation in female rats under stress exposure

Endothelial dysfunction may belong to negative consequences of stress exposure accompanied by activation of several stress systems including the hypothalamic-pituitary-adrenocortical (HPA) axis. The present experiments were aimed at testing the hypotheses that i) immobilization (IMO) stress results in sustained increase in endothelaemia for 24 h and that ii) pentoxifylline, a drug with endothelium protective properties, attenuates the rise in endothelaemia and HPA axis activation in female rats as shown previously in males. Circulating endothelial cells increased immediately after the IMO for 2 h, returned back to control levels at 12 h and increased again at 24 h. Stress-induced rise in adrenocorticotropic hormone (ACTH) and corticosterone levels was particularly high immediately after the IMO. Pretreatment with pentoxifylline (20 mg/kg subcutaneously for 7 days) attenuated the rise in endothelaemia and adrenal corticosterone measured at 24 h following IMO. Plasma levels of ACTH and proopiomelanocortin gene expression in the anterior pituitary were not affected by pentoxifylline treatment. The present results indicate that IMO stress in female rats induces a biphasic rise in endothelaemia early at the time of stress exposure and than 24 h thereafter. Based on these data and our previous study we can conclude that intensive stress has a negative influence on endothelial cells in both sexes and no gender differences seem to be present in the protective action of pentoxifylline.

Perception of potentially inappropriate medication in elderly patients by Slovak physicians

PURPOSE

The aim of the present study was to determine the risk perception of potentially inappropriate drug treatment of elderly patients by Slovak physicians. In Slovakia, a list of such drugs is not available.

METHODS

The study sample consisted of 600 patients aged > or =65 years hospitalized at the Department of Internal Medicine in a Slovak general hospital between 1 December 2003 and 31 March 2005. The use of potentially inappropriate drugs at the time of hospital admission and discharge was compared. Potentially inappropriate drug use was defined by Beers 2003 criteria. In addition, 206 physicians were asked to mark the drugs that they considered potentially inappropriate for elderly patients out of a list provided in a questionnaire analysis.

RESULTS

Out of 600 patients 20.2% and 20% were treated with at least one potentially inappropriate drug at the time of hospital admission and discharge, respectively. Hospitalization had no significant influence on the number of potentially inappropriate medicines used. The most frequently prescribed potentially inappropriate drugs were digoxin >0.125 mg/day and ticlopidine. Out of 206 responding physicians only 4.9% considered ticlopidine as potentially inappropriate for elderly patient. On the other hand, more than 20% of respondents were aware of the potential inappropriateness of amitriptyline, diazepam and chlordiazepoxide. Mentioned drugs were observed in less than 2% of study population (n = 600).

CONCLUSIONS

The results of the questionnaire analysis in physicians as well as the prevalence of potentially inappropriate medication demonstrate that Slovak clinicians are aware of the risk of certain treatments in elderly patients.

[Consultation activity of two Slovak centres for pharmacotherapy during pregnancy and lactation]

BACKGROUND

In our paper we present analysis based on number and structure of consultations concerning drug used in pregnancy and lactation in the Drug Information Centre in Bratislava and at the Department of Clinical Pharmacology in Nitra during period 2000 to 2003.

METHODS AND RESULTS

In both centres the questions related to pregnancy and lactation represented the significant part of total sum of the requested information. Vast majority of consulted drugs belonged to C category concerning FDA pregnancy drug risk classification. In these drugs animal studies have revealed a risk, but studies in pregnant women were not available and thus the drugs had limited applicability from view point of safety. Decisions of consultants regarding drug use were based on the availability of information sources. A serious problem is the evaluation of retrospective drug risks in cases of drugs administered before pregnancy was confirmed.

CONCLUSIONS

The evaluation of drug risk in fertile age, especially in early pregnancy, long-term drug administration during pregnancy and lactation becomes indispensable within professional field of clinical pharmacy and pharmacology in developing local teratogen surveillance system.

[Pharmacoeconomic profile of antibiotics used in the treatment of lower respiratory tract infections in geriatric patients]

The paper aims to evaluate the pharmacoeconomic profile of antibiotics (ATB) used in the treatment of lower respiratory tract (LRT) infections and thus contribute to rationalization of therapeutic procedures. Of 2870 patients hospitalized at the Geriatric Clinic of the Medical Faculty of Comenius University from 1 January 1999 to 31 December 2001, 189 patients with acute infections of the LRT were included in the retrospective study. For pharmacoeconomic evaluation, cost effectiveness analysis was employed, the principal parameter of which, cost effectiveness coefficient, was the ratio of the price of ATB treatment in Slovak crowns (SK) and the criterion of effectiveness (E), the number of asymptomatic days in a month. The authors separately evaluated ATBs administered perorally (p.o.); intravenously (i.v.), and sequentially, and they also compared i.v. and the corresponding sequentially administered ATBs. Statistical comparison revealed significant differences in the prices and cost effectiveness coefficients of individual alternatives of ATB treatment. Employed ATBs did not significantly differ in the criteria of effectiveness. According to the cost effectiveness coefficient (SK/asymptomatic day), fluoroquinolones were less expensive (median price/E: pefloxacin: p.o. 19.3; i.v. 29.1; sequentially administered 26.0, and ciprofloxacin: p.o., 14.7, i.v., 54.1, sequentially administered, 31.7). Sequential administration of ATBs (ampicillin-sulbactam, cefuroxime, amoxicillin-klavulanate, ciprofloxacin) was significantly cheaper in comparison with i.v. administration. With therapeutic equivalence, the total pharmacoeconomic profile of ATB treatment depended on the price parameter. In the selection of ATB it is also necessary to consider the price of the drug.

Assessing skills in pharmacology in medical students

The results of this pilot survey have shown the importance of evaluation of medical student knowledge in pharmacology using three independent parts of the examination. The final mark includes the results of a written test, oral examination and evaluation of seminar essay. We evaluated students with final grade A (n=76) and F (n=61) in relation to the results of tests and seminar essays. Most of the students with grade A (88.2 %) wrote the test in the upper range (90-99 %) and their seminar essay evaluations were grade A in 82.9 %. A significant correlation between the results in the test and the mark obtained in the seminar essay was found (r=0.22, p<0.05). Another group of students with grade F obtained low scores in the test (57.4 %), and a relatively large part of students got satisfactory results in test (42.6 %). In this group the quality of seminar essays was variable ranged from A to E. The evaluation showed that in students with final grade A were all three independent part of exam in agreement with final classification. The differences occurred in group of unsuccessful students who performed much better in written part than in the oral examination. The experience with the final assessment of medical student knowledge in pharmacology showed that the most important essay evaluation seems to be the oral form of exam. The results of seminar evaluations correspond satisfactory with the performance of students during the final exam and their effort may continue in diploma work, which is mandatory for all medical students (Tab. 2, Fig. 1, Ref. 2).

Experience with problem oriented teaching in pharmacology

Pharmacology is one of the core subjects for further graduation in both preclinical and clinical area. Medical education is being performed either in the "classical" way (lecture based learning--LBL) or in a more advanced form, such as problem based learning (PBL). According to the Medline database, the interest in PBL is still increasing. At our department, the PBL has been introduced using the knowledge obtained at the the Mac Master University and University of Groningen. PBL in pharmacology requires well-qualified staff with clinical experience. A common character of PBL is the use of selected clinical cases as models and starting points to study certain topics with a student centred approach. In an interview we made on a sample of 88 students of our medical faculty in the last study year, 65.5% of them found the amount of information concerning pharmacotherapy not sufficient for their future clinical practice and 83.3% did not feel able to use the knowledge obtained. More than 90% of students did not see enough opportunities for pharmacotherapy training during clinical subject courses. These results are in support of our orientation of teaching towards the PBL. This type of teaching forces students to be active, trains their skills in communication and selection of knowledge, which is believed to enhance the long-term knowledge retention. By using the hybrid PBL-LBL model at our department we respect the principal proposal of medical education and attempt to improve skills in decision making in training of future medical doctors. (Tab. 3, Fig. 2, Ref. 13.)

The Slovak Drug Information (Druginfo) Centre during the period 1997-2004

OBJECTIVES

The aim of the presented study was to evaluate the profile of users, the number and character of questions which were received during the period May 1997-December 2004.

BACKGROUND

The drug information centre (Druginfo) has been established in Slovak Republic at the Department of Pharmacology in May 1997. Since 2002 Druginfo is a member of International Register of Drug Information Services of the Society of Hospital Pharmacists of Australia. Druginfo provides voluntarily free of charge drug information for healthcare professionals.

METHOD

Druginfo receives questions addressed via phone, fax and e-mail. The questions were replied by consulting pharmacologists on duty. The data for this study were obtained from records which include list the received questions and the basic information about the questioners.

RESULTS

The Druginfo received 495 questions during the period May 1997-December 2004. Questions were mostly from hospital physicians, followed by outpatient physicians and employees of the Faculty of Medicine. The most frequent specializations of the asking physicians were internal medicine, gynaecology-obstetrics, clinical pharmacology and general medicine. The most common topic was basic information about drugs, followed by questions concerning the use of drugs in pregnancy and lactation. According to the ATC classification the questions were most often related to antiinfective drugs, cardiovascular drugs and psychiatric drugs.

CONCLUSION

The existence of Druginfo in Slovak Republic represents a possibility of an open access to independent drug information. (Fig. 3, Ref. 11.)

Factors influencing the spontaneous reporting of adverse drug reactions--the experience of the Slovak Republic

The system of adverse drug reaction (ADR) monitoring in the Slovak Republic is greatly influenced by changes taking place in the current health care delivery system. Under-reporting and reporting biases due to selective ADR reporting provide very serious problems in pharmacovigilance. In the year 2001, the number of reported ADRs increased due to reports of angiotensin converting enzyme (ACE) inhibitor-induced cough; this coincided with limits being imposed on the use of angiotensin-II receptor antagonists. These factors provide an example of selective ADR reporting, deforming the quality of drug safety monitoring. They also indicate that administrative strategies can significantly affect spontaneous reporting activities.

Drug utilisation in outpatient children. A comparison among Tenerife, Valencia, and Barcelona (Spain), Toulouse (France), Sofia (Bulgaria), Bratislava (Slovakia) and Smolensk (Russia)

INTRODUCTION

Scarce information about comparative diagnostic and therapeutic patterns in paediatric outpatients of different countries is found in the literature.

OBJECTIVE

To describe the similarities and differences observed in diagnosis and therapeutic patterns of paediatric patients of seven locations in different countries.

DESIGN

Cross-sectional, prospective, international comparative, descriptive study.

PATIENTS AND METHODS

A randomly selected sample of 12,264 paediatric outpatients seen in consultation rooms of urban and rural areas and attended by paediatricians or general practitioners of the participating locations. Data on patient demographic information, diagnosis and pharmacological treatment were collected using pre-designed forms. Diagnoses were coded using the ICD-9 and drugs according to the ATC classification.

RESULTS

Among the ten most common diagnoses, upper respiratory tract infections are in the first position in all locations; asthma prevalence is highest in Tenerife (8.4%). Tonsillitis, otitis, bronchitis and dermatological affections are the most common diagnoses in all locations. Pneumonia is only reported in Sofia (3.8%) and Smolensk (2.3%). The average number of drugs prescribed per child varied from 1.3 in Barcelona to 2.9 in Smolensk. There are no great differences in the profile of pharmacological groups prescribed, but a considerable range of variations in antibiotic therapy is observed: prescription of cephalosporins is low in Smolensk (0.7%) and higher in the other locations, from 16.5% (Bratislava) to 28% (Tenerife). Macrolides prescriptions range from 12.6% (Toulouse) to 24.7% (Smolensk), except in Sofia where they drop to 5.6%. Trimethoprim and its combinations are used in Smolensk (23.3%), Sofia (11.8%) and Bratislava (8.7%). Check-up consultations are not recorded in Smolensk and Bratislava, whereas in Toulouse these visits account for 16.2% of all consultations and in the other locations the percentage varies from 6.1% (Tenerife) to 1.9% (Sofia). Homeopathic treatments are registered only in Toulouse.

CONCLUSION

Except in asthma prevalence, there are no great differences in diagnostic maps among locations. Significant variations in the number of drugs prescribed per child and antibiotic therapies are observed. Areas for improvement have been identified.

Pharmacological treatment of acute otitis media in children. A comparison among seven locations: Tenerife, Barcelona and Valencia (Spain), Toulouse (France), Smolensk (Russia), Bratislava (Slovakia) and Sofia (Bulgaria)

OBJECTIVE

To describe patterns observed in the treatment of acute otitis media (AOM) in several locations of five countries.

PATIENTS AND METHODS

Cross-sectional, descriptive study. Random sample of 12,264 paediatric outpatients seen by paediatricians or general practitioners (GPs). Data on patient demographics, diagnoses and treatment were collected. Diagnoses were coded by ICD-9 and drugs by ATC classification. Patients diagnosed with AOM (ICD-9 codes: 381 and 382) were selected for analysis.

RESULTS

Cases of AOM (873) accounted for 7.1% of the sample. There is a clear variation in the percentage of children diagnosed with AOM and treated with antibiotics in the different locations, antibiotic prescriptions being higher in Barcelona (93% of children), and lowest in Smolensk (56.4 % of children were treated without antibiotics). The antibiotics used varied widely: ampicillin use is almost limited to Smolensk (26.7%) and Bratislava (13.8%), whereas amoxicillin plus clavulanic acid is the choice in Toulouse (33.8%), Valencia (30.2%) and Barcelona (28.9%), and cephalosporins are more frequently prescribed in Tenerife (51.7%). Finally, macrolides are used in Barcelona (18.3%), Valencia (17.5%) and Tenerife (13.6%), but not prescribed in Toulouse or Sofia. Prescriptions of anti-inflammatory drugs were only relevant in Valencia (31.7%), Tenerife (27.2%) and Toulouse (17.4%) and of otological preparations in Sofia, where almost each child received ear drops (91.9%). Nasal preparations are commonly used only in Sofia (41.9%), Bratislava (65.5%) and Smolensk (68.6%).

CONCLUSION

Despite the general agreement of most guidelines, wide differences in the treatment of uncomplicated AOM in children are observed. Non-antibiotic therapy for AOM and the use of first-choice antibiotics should be more actively encouraged in the primary care centres. Studies to measure prevailing rates of antibiotic resistance in these populations are needed.

Cost-effectiveness analysis of switching from intravenous to oral administration of antibiotics in elderly patients

OBJECTIVE

The aim of the introduced work was to evaluate pharmacoeconomic advantages of timely switching from intravenous to oral administration of antibiotics (ATB).

METHODS

The evaluated group was selected out of 2870 patients, who were hospitalised at the Clinic of Geriatric Medicine of the Faculty of Medicine of Comenius University in Bratislava from January 1st 1999 to December 31st 2001. In our retrospective study we analysed 96 patients with community-acquired pneumonia successfully treated by ATB. In 43 of them ATB were given intravenously and in 53 the therapy was switched, i.e. the intravenous administration was used at the beginning and oral administration when the condition improved. We applied a cost-effectiveness analysis to the pharmacoeconomic evaluation. The cost-effectiveness coefficient was calculated as the ratio of ATB price (Slovak Crowns) to the effectiveness criterion (number of asymptomatic days in month).

RESULTS

According to the cost-effectiveness coefficient, the switch therapy was significantly less expensive in all evaluated ATB (except for pefloxacin) in comparison with intravenous administration: ampicillin-sulbactam 93.9 vs 168.1; cefuroxime 90.0 vs 123.3; amoxicillin-clavulanate 74.0 vs 116.3; ciprofloxacin 31.7 vs 54.1.

CONCLUSIONS

A timely switching from intravenous to oral administration of ATB in a suitable patient is an effective way to save financial resources. (Tab. 5, Ref: 21.)

[Polypharmacotherapy in clinical gerontology]

Multimorbidity frequently develops in old age and it is usually accompanied with pharmacotherapy of elderly patients. The growing number of seniors and comparatively low attention given to this reality among the medical community makes the problem highly significant for the practical medicine. Solution requires in the broad medical community a deeper knowledge of gerontopharmacotherapy and of its specific features, including the pharmacodynamics and pharmacokinetics in elderly organism. Non-geriatric physicians will face in their daily clinical praxis the questions of drug interactions and undesirable general and local side effects. Moreover, some foods, beverages or preservatives can influence the pharmacological effect. Due to multimorbidity in the senescence, such problems can be linked to large geriatric syndromes (instability with downfalls, immobility, decubitus, incontinency, intellectual and sensory defects of vision and hearing).

Stress-induced rise in endothelaemia, von Willebrand factor and hypothalamic-pituitary-adrenocortical axis activation is reduced by pretreatment with pentoxifylline

Stress is considered to be a risk factor of several diseases. The following hypotheses were tested: (1) single exposure to an intensive stressor is followed by endothelial stimulation and/or damage to endothelial cells, (2) potential stress-induced endothelial cell damage is reduced by repeated pretreatment with pentoxifylline and (3) pentoxifylline treatment modifies neuroendocrine activation during stress reflected by changes in hypothalamic-pituitary-adrenocortical (HPA) axis function. Rats were treated with saline or pentoxifylline (20 mg/kg, s.c.) once daily for 7 days and then exposed to single immobilization stress for 20 or 120 min. In saline pretreated rats, stress exposure was followed by a rise in endothelaemia, von Willebrand factor concentrations, adrenocorticotropic hormone (ACTH) and corticosterone release, as well as by enhanced gene expression of hypothalamic corticotropin releasing factor (CRH). Stress-induced changes were reduced by pretreatment with pentoxifylline. Significant inhibition was observed in endothelaemia, plasma ACTH and corticosterone concentration in the adrenals. Thus, signs of endothelial injury as well as stress-induced hormone levels were reduced by pretreatment with pentoxifylline, although there is no evidence for a causal relationship. This protective action of pentoxifylline might be of benefit in the prevention and therapy of some stress-related disorders.

[Antibiotics in ambulatory practice in Slovakia 1999-2001]

Evaluation of the consumption of antimicrobial drugs is an important component of antibiotic policy and provides a picture of rationality of treatment. In the present paper, the authors analyzed the consumption of antibacterial agents of the ATC group J01 for systemic use in out-patient practice in Slovakia in 1999-2001. The data were taken from materials of all Slovak insurance companies provided by the Ministry of Health of the Slovak Republic. The paper evaluated the total out-patient consumption of antimicrobial agents and the financial costs of antibiotic therapy, analyzed the consumption of the individual groups of antibiotics and the consumption of individual agents, and compared the found out-patient consumption with that of Finland. The DDD values in the period under study gave evidence of a high but stable consumption of antibiotics. The analysis according to the groups of antibiotics revealed the dominance of penicillins with wider spectra, penicillins sensitive to beta-lactamases, and macrolides. The evaluation of individual antimicrobial agents showed a positive tendency of the growth of amoxicillin consumption, compensated by a decrease in the consumption of less advantageous ampicillin. The comparison of the Slovak and Finnish consumptions of macrolide antibiotics showed a prevailing consumption of roxitromycin and klaritromycin in Slovakia, and azitromycin in Finland. As far as cephalosporins are concerned, the preparations of the first generation dominated in Finland, and those of the second generation in Slovakia.

Risks of antibiotic treatment

Adverse effects of antibiotics can cause a failure of antibiotic treatment. The authors give a survey of antibiotic toxicity manifestations, according to the target organ systems, with emphasis on identification of at-risk patients and on possible prevention of particular adverse effects. Although antibiotics belong to relatively safe pharmaceuticals, many of them can be a cause of a serious damage to the human organism. Beta-lactam antibiotics are considered the least dangerous. A considerable number of adverse effects, especially the dose-dependent ones, are preventable on condition that the risk factors, as the patient's age, functional capacity of eliminating organs (kidney, liver), associated diseases and simultaneous administration of drugs, are considered. In conclusion, the clinically significant drug interactions of antibiotics are pointed out, being of increasing importance especially in patients with multiple diseases and polypragmatic manner of treatment. (Tab. 2, Ref. 48.)

Temporal situation of NSAID-related adverse drug reaction reports in Slovak Republic

To make the drug therapy safer and more rational, it is substantial to gain sufficient amount of information concerning the perception of ADRs, especially those related to most "risky" groups such as NSAID. By viewing ADR reporting as a professional responsibility, and recognizing that the quality of submitted information, health professionals can play a major role in improving the public health. (Fig. 2, Ref. 5.)

Reduction of rise in blood pressure and cortisol release during stress by Ginkgo biloba extract (EGb 761) in healthy volunteers

The standardized extract of Ginkgo biloba (EGb 761) was found not only to improve memory and aging associated cognitive deficits but also to exert beneficial effects on mood. An antistress action of the extract has been suggested but not directly proven. The present study was aimed to evaluate the effects of EGb 761 on salivary cortisol and blood pressure responses during stress in healthy young volunteers (n = 70) in a double blind placebo controlled design. A stress model involving a combination of static exercise (handgrip) and mental stimuli was used. Single treatment with EGb 761 (120 mg) reduced stress-induced rise in blood pressure without affecting the heart rate. Salivary cortisol responses showed differences with respect to the gender and the time of day of the stress exposure, with the activation only in male subjects in the afternoon. This activation was absent if they were treated with EGb 761. The performance in a short memory test with higher scores achieved by women remained unaffected by EGb 761 treatment. Thus, this study provides evidence that EGb 761 has an inhibitory action on blood pressure and it may influence cortisol release in response to some stress stimuli.

Comparison of vasoconstrictor responses to selected NSAIDs in rabbit renal and femoral arteries

BACKGROUND

Nonsteroidal anti-inflammatory drugs (NSAIDs) have been shown to induce adverse renal effects, which are closely related to physiological inhibition of renal prostaglandin synthesis.

AIM

This study was aimed to evaluate the effect of drugs inhibiting both cyclooxygenase (COX) isoforms COX-1 and COX-2 on vasoconstrictor responses to noradrenaline in the rabbit renal artery and to compare these responses with femoral artery as a systemic vessel.

METHODS

Rabbit femoral and renal arteries were perfused with a constant flow. Vascular responses to drugs were measured and registered as changes in perfusion pressure.

RESULTS

It was found that the vasoconstrictor responses to noradrenaline were significantly enhanced after administration of all NSAIDs in both the renal and femoral arteries. The effect of indomethacin on renal vasoconstrictor responses was more pronounced compared to ibuprofen or phenacetin. Comparison of NSAIDs effects on renal and femoral arteries did not show significant differences.

CONCLUSIONS

These results demonstrate an increase of vasoconstrictor activity after NSAIDs administration without significant differences between the renal and femoral arteries. The strongest potentiation of the vasoconstrictor responses in the renal artery was found with indomethacin. (Tab. 1, Fig. 4, Ref. 20.)

[Are we underestimating the nephrotoxicity of drugs?]

In the submitted review the authors discuss the nephrotoxicity of drugs which is a serious danger of pharmacotherapy. Clinically it may be manifested in different ways from acute deterioration of renal functions to the picture of chronic renal insufficiency. It is particularly important to know the nephrotoxic potential of different drug groups and to ensure a careful stratification of patients. The most frequent drug groups which lead to affection of the kidneys are radiocontrasting substances, aminoglycoside antibiotics, non-steroid analgesics-antiphlogistics and ACE inhibitors. With the increasing number of transplantations the problem of nephrotoxicity of immunosuppressives is becoming important. The authors analyze in each group risk factors, the pathogenesis, clinical picture and prognosis of damage. Special emphasis is laid on adherence to preventive measures and careful monitoring of the laboratory and clinical picture, in particular in risk groups of patients as treatment of already developed nephrotoxic sequelae of pharmacotherapy is frequently difficult.

Eradicative effect of cotrimoxazole and quinolones on non-typhoid salmonellae

Opinions on antibiotic treatment of salmonella gastroenteritis are still different. Many authors support an opinion that antimicrobial treatment has no effect on salmonella elimination. The authors of the study have tried to prove that fluoroquinolones shorten the elimination of salmonellae and therefore they are useful not only for the treatment of salmonella gastroenteritis in immunocompromised patients to prevent sepsis and extraintestinal manifestations of the infection, but also for eradication of salmonellae in food industry workers, whose carrier state might exclude them from their work. (Tab. 3, Ref. 10.)

Drug information center

One of the most important prerequisities concerning the process of selecting drugs for rational pharmacotherapy is the availability of independent information about them. The first self-existent Drug Information Center (DIC) in Slovakia was established in May 1997 at the Department of Pharmacology, School of Medicine, Comenius University in Bratislava. The organization of DIC and its activities are similar to other analogous centers in other countries. DIC provides free drugs information to all medical professionals. The majority of inquiries are from hospital physicians followed by general practitioners and staff of the University. The most frequent questions involve basic information about drugs, pharmacotherapy during pregnancy and lactation, adverse drug reactions, registration of new drugs, drug action etc.

[Acebutolol in the treatment of arterial hypertension in pregnancy--comparison with commonly used hypertensive agents]

OBJECTIVE

The main purpose of our study was to analyse efficacy and safety of acebutolol (Sectral) in the treatment of hypertension in pregnancy.

DESIGN

Cohort clinical study comparing efficacy and safety of acebutolol with other antihypertensive drugs by 77 patients and their 81 newborns. The number of 48 patients were treated by acebutolol.

SETTING

Internal Medicine and Clinical Pharmacology Department, Regional Hospital, Nitra and The Faculty of Health Service and Social Work, University of Trnava; Department of Gynaecology and Obstetrics, Regional Hospital Nitra and The Faculty of Health Service and Social Work, University of Trnava; Institute of Pharmacology, The Faculty of Medicine, Komenského University, Bratislava; Environment, a.s. Nitra.

METHODS

During the period of 6 years our patients were divided into subgroups according to the type of hypertension in pregnancy and the severity of the illness which was the basis for used antihypertensive drugs. One of the topics of the study was to provide monitoring of adverse events by mother and possible drug influence on their new-born has been evaluated by investigating the week of birth, weight and length of the new-born and evaluating of Apgar score.

RESULTS

In the subgroup of 48 women treated by acebutolol we have confirmed the efficacy and safety of this antihypertensive drug without any clinically significant effect on the quality of life of their new-born and evaluating of Apgar score.

CONCLUSION

With regard to the results of our clinical study we can consider acebutolol to be effective and safe antihypertensive drug in the treatment of hypertension in pregnancy.

Renal damage induced by the treatment with non-opioid analgesics--theoretical assumption or clinical significance

Non-opioid analgesics are some of the most widely used therapeutic agents in clinical practice today. The number of patients at risk for adverse events related to the use of these agents is rapidly expanding. While the gastrointestinal toxicity of these medications is well known, it has become increasingly apparent that the kidney is also an important target for untoward clinical events. Evidence of the nephrotoxicity of analgesic preparations is not sufficiently completed and available in our region. Analgesic-related renal injury has been classified based on mechanism of action into "classic" analgesic nephropathy and NSAID-related renal toxicity. From clinical point of view the renal side effects induced by analgesics can be classified into hemodynamic (functional) side effects and idiosyncratic side effects. The common link in both types of side effects seems to be renal ischemia related to prostaglandin synthesis inhibition. Key enzyme in this process is cyclooxygenase occurring in two isoforms: COX-1 and COX-2. Antiinflammatory effect of NSAIDs is mediated by COX-2 inhibition, while the side effects (gastrotoxicity, nephrotoxicity) by inhibition of COX-1. COX-1 was more inhibited by indomethacin and piroxicam and COX-2 by 6-MNA (active metabolite of nabumetone), diclofenac and ibuprofen. Nimesulide and meloxicam selectively block COX-2 and are recommended to patients at risk or treated with diuretics. (Tab. 2, Fig. 2, Ref. 38.)

Evaluation of endothelium-protective effects of drugs in experimental models of endothelial damage

Endothelium-protective properties of pharmacological agents may be assessed by using different experimental models of endothelial dysfunction or injury. The model of endothelial dysfunction induced by vessel perfusion with polymorphonuclear leukocytes (PMN) was used for evaluation of pentoxifylline (PTX) effects on vasoconstrictor responses to noradrenaline (NA) in the rabbit renal artery. Addition of PMN into the perfusion solution significantly increased the responses to NA at all doses. PTX administration (10(-5) mol x l(-1)) significantly diminished the constrictor responses to NA in vessels perfused with PMN+PTX when compared to the responses in PMN-perfused vessels (at dose 0.1 microg: 32.25 vs. 14.25, at dose 1 microg: 51 vs. 27.75 (p<0.01), at dose 10 microg 74.25 vs. 39.75 (p<0.05), all values expressed as median of perfusion pressure in mm Hg). The model of endothelial damage induced by repeated NA administration in 5 doses (10-50 microg of NA) was used for evaluation of the endothelium-protective effect of sulodexide (SLX). It was found that SLX (120 U/l) significantly decreased the number of desquamated endothelial cells (EC) compared to the control group (controls: 131.4+/-20.1 EC, +SLX: 83.3+/-13.8 EC, p<0.01). These results confirmed the favorable endothelium-protective effects of pentoxifylline and sulodexide in the two experimental models.

Effect of indomethacin and deendothelisation on vascular responses in the renal artery

Vasodilator prostaglandins (PGE2, PGI2) play an important role in the regulation of renal blood flow. Hence, inhibition of their production with nonsteroidal anti-inflammatory drugs increases renal vascular resistance and exerts adverse renal effects. It has been reported that besides endothelium-derived prostaglandin products, nitric oxide (NO) may be mainly involved in regulation of renal functions. The aim of our study was to evaluate the effect of cyclooxygenase inhibition with indomethacin and endothelium removal on vascular responses of the renal artery as a model vessel. Isolated segments of rabbit renal arteries were perfused at constant flow. Indomethacin administration (10(-5) mol x l(-1)) significantly increased the responses to single doses (0.1, 1, 10 microg) of noradrenaline (NA) as compared with the controls. In indomethacin-pretreated vessels, subsequent deendothelisation by air bubbles enhanced the constrictor responses to NA. In reversed order, when deendothelisation was followed by indomethacin administration, the responses to NA were similar in character. A comparison of renal artery responses to NA in both experimental situations did not reveal any significant differences. It can be supposed that endothelial and non-endothelial factors may be involved in local regulation of renal vascular tone.

[Treatment and prevention of gastrointestinal complications caused by non-steroidal antiphlogistic agents]

The aim of our study is to give a survey of the most efficient methods for treatment and prevention of non-steroidal anti-inflammatory drug (NSAID)-induced gastrointestinal adverse in cases when antiphlogistic treatment cannot be discontinued due to active and progressive joint disease. Analysis of published studies shows that, the proton pump inhibitors (omeprazole) are the most efficient agents in treatment of gastric and duodenal ulcers induced by NSAIDs. The analysis shows a reliable effect of prostaglandin analogues (misoprostol) as well. Prostaglandin analogues (misoprostol) proved the most effective in treatment of gastric erosions. Prophylaxis of adverse gastrointestinal mucosal abnormalities can be primary or secondary. Secondary prevention is intended for patients with gastrointestinal symptoms or those treated for mucosal defects (ulcer, erosions). The standard prevention using H2-antagonists or sucralphate does not provide sufficient protection against NSAID in these patients, but omeprazole reduces the chance of a peptic lesion relapse. Primary prevention is intended for patients with a higher risk of gastrointestinal complications (age above 60, history of peptic ulcer, a higher dose of NSAID, simultaneous treatment with glucocorticoids or anticoagulants). Diclofenac with misoprostol and nabumetone reduce the incidence of gastroduodenal ulcers and their complications in short-term as well long-term studies. Meloxicam reduces the incidence of gastroduodenal mucosal abnormalities is short-term studies. Nimesulide is associated with a lower incidence of adverse gastrointestinal events, but the fact is that, reliable data on gastroduodenal ulcer incidence reduction or their complications are not available.

[General principles of drug evaluation within the framework of drug policy]

This paper reviews the problems connected with drug evaluation in particular periods of its development. Requirements for drug registration, which represents the entrance of the drug on the market, are created by legislation. Drug application in the therapeutic process is determined by several factors and state regulations. The amount of evidence, reliability and validity of the facts should be the key factors of drug selection within the ambit of drug politics. Categorization of drugs means drug selection with regard to state reimbursement by means of health-insurance companies. Methods of drug categorization together with further regulations by means of positive letters, hospital blanks, should respect the criteria of professionality, transparency and sociopharmacology. Effective prognostication of drug use should ensure well-proportioned accessibility of effective safe drugs within the ambit of rational pharmacotherapy.

[Endothelial diseases and endothelium-protective agents]

Endothelial dysfunction plays the key role in the development of cardiovascular system disorders. Using certain markers it is possible to evaluate the endothelial function alterations and in this way to propose the disease prognosis. Recently the number of information concerning possible reversibility of these changes and the pharmacological intervention increases. Partial data about endothelium protective properties of ACE inhibitors, hypolipidemics, pentoxifyllin, Ca2+ channel blockers, lazaroids, glycosaminoglycanes exist. In experimental conditions it is possible to evoke endothelial dysfunction and evaluate the effects of these substances. Glycosaminoglycan sulodexide reduced endothelial losses at in vitro conditions of vessel perfusion on the model of endothelium damage by vasoconstrictive stimuli. Further evidence of these substances efficacy is required for the clinical evaluation of their endothelium protective properties. The research direction in this field will certainly provide such information concerning the endothelial function moderation which may be able to change the strategy of vascular diseases pharmacotherapy. (Tab. 5, Ref. 66.)

Treatment of neonatal rats with monosodium glutamate attenuates the cardiovascular reactivity to phenylephrine and angiotensin II

In rats, neonatal administration of monosodium glutamate (MSG) causes serious damage in some hypothalamic and circumventricular areas. The resulting loss of appropriate neurons important for the regulation of blood pressure (BP) may modulate cardiovascular system receptivity in these animals. In the present study, the reactivity of the cardiovascular system to intravenous injection of alpha1-adrenergic receptor agonist phenylephrine (200 microg/kg/ml) and angiotensin II (500 ng/kg in 0.6 ml for 2 min) was investigated in adult rats which had been neonatally treated with MSG or vehicle. BP parameters measured directly in conscious cannulated rats were continuously registered using a computerized system. Under basal conditions, MSG-treated rats had slightly lower systolic, diastolic and mean BP with significant differences in pulse pressure (systolic - diastolic BP). In MSG-treated animals, the maximal increase of mean arterial BP after phenylephrine and the duration of BP elevation after both agents were significantly reduced. Slopes of the linear portion of baroreceptor function curves in control and MSG-treated rats did not differ significantly, indicating that baroreflex efficacy was unchanged. The results obtained by perfusion of the hindlimb vascular bed in situ showed that the pressure responses to increasing doses of noradrenaline in MSG-treated rats were reduced. These findings demonstrate that neonatal treatment of rats with MSG lowers the responsiveness of the cardiovascular system, particularly in response to alpha-adrenergic stimulation. It is suggested that the attenuation of cardiovascular reactivity in MSG-treated rats is, at least partly, caused by diminished vascular responsiveness.

The effect of ambroxol on the vascular reactivity in the rabbit

Experiments were designed to determine whether ambroxol, a drug used for the treatment of respiratory disorders, affects the basal tension and/or contractions due to adrenergic stimuli in the isolated rabbit portal vein and pulmonary artery. Ambroxol in concentrations of 10(-6)-10(-4) mol/l produced a concentration-dependent increase in basal tension, but a decrease in spontaneous mechanical activity of portal vein. The same concentrations of ambroxol failed to influence basal tension of pulmonary artery. However, when the vessel tone was increased by exogenous noradrenaline, ambroxol elicited concentration-dependent contractions also in this vessel. Moreover, ambroxol in the concentration of 10(-5) mol/l significantly enhanced vascular contractions due to both exo- and endogenous noradrenaline. The results suggest that ambroxol, in biologically relevant concentrations, may influence or even induce vascular contractions to adrenergic stimuli. Their expression, however, depend on the type of vascular smooth muscle. (Fig. 7, Ref. 25.)

Neuroendocrine response during stress with relation to gender differences

Neuroendocrine activation belongs to the main characteristics of the stress response. This response is not uniform but depends on the stress stimulus involved and on many other factors including the gender of the individual. In rats, corticosterone and ACTH levels as well as functional activity of the hypothalamo-pituitary-adrenocortical axis are higher in females compared to males under both basal and stress conditions. Marked sex differences were observed in stress-induced changes posterior pituitary hormone release. In male rats, release of vasopressin is not stimulated during stress conditions without an osmotic component while in female rats a rise in plasma vasopressin levels was observed even after short immobilization. Oxytocin release is enhanced in response to the majority of stress stimuli and it was found to be greater in females than in males. Mentioned gender differences are attributed to the effect of sex steroids, particularly those of estrogens. Not enough information is available on gender differences in the neuroendocrine response during stress in humans. We observed a greater neuroendocrine activation in women than in men in response to heat exposure in sauna with pronounced differences in ACTH and prolactin release and partly also after a cold-pressor test. Understanding of gender differences in neuroendocrine response during stress might contribute to the explanation of the development of some emotional and other disorders with higher incidence in women.

[The importance of stereoselectivity for the effectiveness and safety of drugs]

Forty per cent of synthetic drugs are chiral, most of them being used in the form of a racemate. Though the existence of optical isomerism has been known since the last century, an increased attention to pharmacological and toxicological differences in the individual enantiomers of chiral drugs is being paid as late as the recent two decades. The present review paper discusses the importance of stereoselectivity and on the examples of the individual drugs it lists the advantages and/or disadvantages of the individual isomers with regard to the racemic mixture from the standpoint of efficacy and safety.

Automatic solid-phase extraction and high-performance liquid chromatographic determination of quinidine in plasma

High-performance liquid chromatography (HPLC) was used for the therapeutic drug monitoring of quinidine in clinical samples. Solid-phase extraction (SPE) was studied in both off-line and on-line modes. SPE was performed in an automatic on-line mode using a fully automated Prospekt system. Extraction recoveries were in the range 97.1-99.4% for 1-2 micrograms/ml quinidine concentrations. For HPLC separation an Ultrasep RP-8 reversed-phase column was applied with acetonitrile-water (9:1) containing 0.3% triethylamine (pH 2.5) as the mobile phase. The Prospekt system is recommended for the routine monitoring of quinidine in plasma samples. Concentrations were in therapeutic range (1.2-3.6 micrograms/ml).

[Development of a withdrawal syndrome in a neonate after long-term therapy of the mother with metipranolol during pregnancy]

The authors describe the withdrawal syndrome of a beta-adrenolytic in neonates manifested above all 10-16 hours after delivery by alternating bradycardia and marked tachycardia independently on the infant's activity. The withdrawal syndromes correlate with the increased heart rate of the mother after delivery. The authors draw attention to the fact that the withdrawal syndrome in the neonate may develop after delivery if the mother used during pregnancy not only addictive drugs affecting the central nervous system but also drugs affecting the cardiovascular system such as the beta-adrenolytic metipranolol.