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Orthostatic Sodium Retention

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141. Assistive Devices to Improve Independence (Treatment)

mobility, orthostatic hypotension (systolic blood pressure [SBP] < 20 mm Hg), balance disorders, and vasovagal syncope. Depression, confusion, dementia, and other cognitive deficits also contribute to falls. Cognitive impairment, depressive symptoms, and orthostatic hypotension most contribute to gait dysfunction. Slower performance on the Timed Up-and-Go Test (TUG), a mobility task, is independently associated with poorer performance on measures of global cognition, executive function, memory (...) , female sex, cognitive impairment, poor self-rated health, low BMD, osteoporosis, inactivity, sedative use, alcohol use, and orthostatic hypotension. Extrinsic risk factors include adverse effects of medications, polypharmacy, and environmental hazards. Psychotropics, neuroleptics, tricyclic antidepressants, benzodiazepines, analgesics, sedatives, skeletal muscle relaxants, cardiac drugs (diuretics, antiarrhythmics), vasodilators, and antihistamines may contribute to falls. Results of studies suggest

2014 eMedicine.com

142. Altitude-Related Disorders (Treatment)

to displace the CSF. Conversely, those with lesser CSF to brain volume ratio have limited space for compensation of brain swelling and are prone to AMS. The role of fluid retention in the pathogenesis of AMS remains uncertain. Secretion of antidiuretic hormone and atrial natriuretic factor is altered in AMS and may contribute to vasogenic edema. More recently, hypoxia-induced alterations in oxidative stress and free radical metabolism have been implicated in the pathophysiology of AMS. [ ] Treatment (...) of the pathogenesis of HAPE is shown below. This image shows the pathophysiology of high-altitude pulmonary edema (HAPE) following ascent to high altitude. Factors leading to a low partial pressure of oxygen (PO2), such as exercise, sleep, or a low ventilatory response to hypoxia, increase the likelihood of developing HAPE. Alterations in the sympathetic nervous system are also believed to contribute to the development of HAPE. Recent evidence suggests that a defect in sodium transport across the alveolar

2014 eMedicine.com

144. Mirabegron (Myrbetriq)

Low risk, may be done along with behavioral therapy Usually not effective as stand alone therapy Antimuscarinic Agents Daily dose of agents either by patch, topical gel application or oral dosing Mainstay of current OAB therapy. Modest efficacy. Chronic use A/Es: dry mouth, constipation, blurred vision: glaucoma contraindication: 27% of OAB patients fail on medication: drug costs: Urinary retention Neuromodulation Surgical implantation (sacral nerves) of an electrical stimulator Used in refractory (...) of efficacy Botulinum Toxin Single intravesical injection session using approximately 200 units of botulinum toxin. May need to repeat at 6+ months Can be used in lieu of neuromodulation. Treatment effect may persist for 6+ mos. Not an FDA approved therapy for regular OAB. Death and paralysis possible though unlikely. Allergic reactions. Increase of PVR, retention, possible need for intermittent Reference ID: 3139101Clinical Review {Insert Reviewer Name} {Insert Application Type and Number} {Insert

2012 FDA - Drug Approval Package

146. Administration of medicinal products by non - medical personnel as part of Clinical Nuclear Medicine Procedures

PET Dobutamine * Myocardial perfusion imaging Furosemide * Renogram Glyceryl Trinitrate Cardiac imaging Intrinsic factor Schillings Test Laxative + dexamethasone Adrenal Laxatives Octreoscan Laxatives Gallium scan Lugols iodine Iodine-labelled RPx Methylphenidate F-18 Fallypride Morphine * Hepato-cholescintigraphy Omeprazole * Meckels Diverticulum Potasium iodate Iodine-labelled RPx Ranitidine * Meckels Diverticulum Sodium Perchlorate Iodine-labelled RPx Where adverse reactions are classified (...) : of the central nervous system such as hypnotics, anxiolytics, tricyclic antidepressants and sedating antihistamines. possible enhanced sedative and hypotensive effect. (such as loperamide and kaolin): concurrent use may increase the risk of severe constipation. agents such as atropine antagonise morphine-induced respiratory depression and can partially reverse biliary spasm but are additive to the gastrointestinal and urinary tract effects. Consequently, severe constipation and urinary retention may occur

2010 British Nuclear Medicine Society

147. Ezogabine (Potiga)

Potiga / ezogabine 17 5.2 Review Strategy Studies 303 & 304 1. Determine the number of patients remaining in each study 2. Determine the additional patient exposure in each study 3. Examine Key safety measures, Death, SAE, and Withdrawal. 4. Examine the new datasets in each of these studies for events of special interest in this submission- (7.3.5) Draw conclusions if there is a change in signal: a. increased frequency or severity b. greater or lesser predictability, urinary : urinary retention (...) , Nephrolithiasis c. greater or lesser predictability, hallucinations / psychotic symptoms. 5. Re-examine the new dataset for additional items of interest for change in signal intensity: a. hypokalemia b. orthostatic hypotension c. syncope d. atrial fibrillation e. hepatic dysfunction f. blood dyscrasias Clinical Pharmacology Studies RTG114137, RTG113214, RTG113215. 1. Determine the number of patients remaining in each study 2. Determine patient exposure in each study 3. Examine Key safety measures, Death, SAE

2011 FDA - Drug Approval Package

148. Plenadren - hydrocortisone

after intravenous, intramuscularly, sublingual and gastric administration. It was concluded that the varying Assessment report EMA/CHMP/424438/2011 Page 15/69 route of administrations of 14 C -hydrocortisone to rats caused different excretion rates of the radiolabelled metabolites, but the amounts excreted were independent of the route of administration (Hyde et al 1957). This indicates that the absorption is complete from all administrations sites. The transdermal penetration and skin retention

2011 European Medicines Agency - EPARs

149. Renal Denervation in Patients With Heart Failure and Severe Left Ventricular Dysfunction.

pathophysiological basis of this finding is probably excessive sodium retention due to direct activation of sympathetic fibers innervating renal tubules (7). Recent experimental work on animals have shown that surgical renal denervation inhibits an increase in renal vascular resistance, prevents a decrease in renal blood flow (8), and also prevents changes in expression of angiotensin receptors in the kidney (8). Surgical sympathectomy began to be used for the treatment of severe and malignant hypertension more (...) than 50 years ago. But this was a rather complicated procedure, which was accompanied by a number of adverse effects (orthostatic hypotension and tachycardia, shortness of breath, bowel and sexual disorders]. Moreover it required a long hospitalization of 2-4 weeks and then required a recovery period of 1-2 months. However this intervention led to a rapid decrease in pressure and a higher survival rate after surgery in a large observational study(9). In recent years a method has been developed

2013 Clinical Trials

150. Study of Renal Denervation in Patients With Heart Failure

of breath or ankle swelling. Recent studies suggest that reducing the nerve activity to a kidney could reduce sodium retention and blood pressure. An improvement in the way the kidneys handle sodium may reduce disease progression and decrease symptoms for heart failure patients. Condition or disease Intervention/treatment Phase Heart Failure Device: Symplicity Renal Denervation Phase 2 Detailed Description: Over the past decades, clinical trials in HF have been unable to alter the natural history (...) , 2016 Sponsor: Adrian Hernandez Collaborators: National Heart, Lung, and Blood Institute (NHLBI) Medtronic Information provided by (Responsible Party): Adrian Hernandez, Duke University Study Details Study Description Go to Brief Summary: Congestive heart failure is a common disorder in which the heart cannot pump enough blood to meet the needs of the rest of the body. Poor sodium handling by the kidneys is a damaging effect of heart failure, and it leads to symptoms of congestion such as shortness

2013 Clinical Trials

151. The Effect of Renal Denervation on Biological Variables

of modulating elevated SNS activity - both by reducing the sympathetic modulation of renal function (renin release, sodium excretion and renal blood flow) and by removing the renal afferent sympathetic contribution to central blood pressure elevation. This current study is an observational exploratory study. The main objective of this study is to learn more on the effects of RD. We wish to do that by quantifying the effects of RD on various biological variables. Those variables are studied in four sets (...) % confirmed by angiogram. laboratorial endpoint [ Time Frame: t=0 and t=12 months ] Absolute changes of: eGFR, plasma renin activity (PRA), aldosterone, ACE, lipid spectrum, proteinuria, insulin, C-peptide, glucose, VMA, metanephrines and catecholamines, 12 months after renal denervation compared to baseline measurements blood pressure related endpoint [ Time Frame: t=0 t=6 and t=12 months ] The effect of renal denervation on the development of orthostatic hypotension - The change in the existing

2011 Clinical Trials

153. Ceftaroline fosamil for injection (Teflaro)

Table 89. PCS Postbaseline Vital Sign Values in Pooled Phase 3 Trials 195 Table 90. PCS Changes in Systolic and Diastolic BP Meeting Orthostatic Criteria 196 Table 91. IRT Analysis of Point Estimate and 90% CI of QTcIB Changes in Thorough QT Study 198 Table 92. Incidence of TEAEs representing Potential Renal Impairment 199 Table 93. Incidence of Treatment-Emergent Adverse Events Indicating Potential Renal Impairment for Phase 3 Trials 200 Table 94. PCS Postbaseline Renal Chemistry Values for Pooled (...) of Water for Injection, USP and the entire constituted solution should be diluted within 2 minutes in = 250 mL of 0.9% Sodium Chloride Injection, USP (normal saline), 0.45% Sodium Chloride Injection, USP, 5% Dextrose Injection, USP, 2.5% Dextrose Injection USP, or Lactated Ringer’s Injection, USP before infusion. Compatibility evaluation includes evaluation of appearance, turbidity, stability, and examination for particulate matter. The resulting solution should be administered over 1 hour

2010 FDA - Drug Approval Package

154. Urorec - silodosin

of life (QOL) and to prevent complications, such as urinary retention or upper urinary tract dilatation. Initial management of men with LUTS can be categorised into 1) watchful waiting, 2) medical therapy, and 3) surgical treatment. Medical therapy may consist of the use of 5 a-reductase inhibitors (finasteride, dutasteride) or a- adrenoreceptor antagonists (terazosin, doxazosin, tamsulosin, prazosin, alfuzosin). The active substance of Urorec is silodosin. Silodosin is an a1-adrenoreceptor antagonist (...) starch, purified water, sodium lauril sulfate and magnesium stearate. Other ingredients of the capsule shell are gelatine, titanium dioxide and colourants. The hard capsules are marketed in polyvinylchloride (PVC)/polyvinylidenchloride (PVDC)/aluminium foil blisters, packed in carton packs. Active Substance The drug substance is silodosin its chemical name is (-)-1-(3-hydroxypropyl)-5-[(2R)-2-({2-[2-(2,2,2- trifluoroethoxy)phenoxy]ethyl}amino)propyl]-2,3-dihydro-1H-indole-7-carboxamide according

2010 European Medicines Agency - EPARs

155. Silodyx - silodosin

contribute to the symptoms and impairment of outflow. The obstructive component relates primarily to the increased size of the prostate, and the storage component relates to the tone of the smooth muscle in the prostatic capsule and stroma. The aim of therapy is to improve LUTS and quality of life (QOL) and to prevent complications, such as urinary retention or upper urinary tract dilatation. Initial management of men with LUTS can be categorised into 1) watchful waiting, 2) medical therapy, and 3 (...) on conditions, granted for products intended to treat benign prostatic hyperplasia has been issued by the EMEA. 2.2 Quality aspects Introduction Silodyx is presented in the form of hard capsules containing 4 mg and 8 mg of silodosin as active substance. The other ingredients are mannitol, pregelatinised starch, purified water, sodium lauril sulfate and magnesium stearate. Other ingredients of the capsule shell are gelatine, titanium dioxide and colourants. The hard capsules are marketed in polyvinylchloride

2010 European Medicines Agency - EPARs

156. Chronic Venous Insufficiency and Postphlebitic Syndrome

/ / / / IN THIS TOPIC OTHER TOPICS IN THIS CHAPTER Test your knowledge Orthostatic Hypotension In patients with orthostatic hypotension, which of the following red flag findings suggests a more serious etiology? Bloody stool Heat intolerance Incontinence Urinary retention NEWS & VIDEOS Becoming Active in Middle Age Still Offers Health Benefits FRIDAY, March 8, 2019 (HealthDay News) -- Becoming physically active in middle age may provide comparable health benefits to long-term participation in leisure-time physical (...) infection, when present Treatment depends on the disorder's severity and involves Leg elevation Compression using bandages, stockings, and pneumatic devices Topical wound care Surgery Some experts also believe that weight loss, regular exercise, and reduction of dietary sodium may benefit patients with bilateral chronic venous insufficiency. However, all interventions may be difficult to implement. Elevating the leg above the level of the right atrium decreases venous hypertension and edema

2013 Merck Manual (19th Edition)

157. Overview of Hypertension

Orthostatic Hypotension In patients with orthostatic hypotension, which of the following red flag findings suggests a more serious etiology? Bloody stool Heat intolerance Incontinence Urinary retention NEWS & VIDEOS Water Pipe Tobacco Smoking Addictive, Harmful to the Heart FRIDAY, March 8, 2019 (HealthDay News) -- Smoking a water pipe is addictive and can increase the risk for initiating cigarette smoking, according to a scientific statement from the American... 3D Model Cardiac Conduction System Video (...) in the brain to increase sympathetic discharge and stimulates release of aldosterone and vasopressin . Aldosterone and vasopressin cause sodium and water retention, elevating BP. Aldosterone also enhances potassium excretion; low plasma potassium ( < 3.5 mEq/L) increases vasoconstriction through closure of potassium channels. Angiotensin III, present in the circulation, stimulates aldosterone release as actively as angiotensin II but has much less pressor activity. Because chymase enzymes also convert

2013 Merck Manual (19th Edition)

158. Drugs for Hypertension

Hypotension In patients with orthostatic hypotension, which of the following red flag findings suggests a more serious etiology? Bloody stool Heat intolerance Incontinence Urinary retention NEWS & VIDEOS History of Cycling Weight May Up Risk for Heart Disease in Women FRIDAY, March 8, 2019 (HealthDay News) -- A history of weight cycling (HWC), or yo-yo dieting, is associated with poorer cardiovascular health in women, according to a study presented at the... 3D Model Cardiac Conduction System Video (...) antinuclear antibody test, drug-induced lupus (rare at recommended doses) Augments vasodilating effects of other vasodilating drugs Minoxidil 1.25–40 mg bid Sodium and water retention, hypertrichosis; possibly new or worsening pleural and pericardial effusions Reserved for severe, refractory hypertension *Both drugs may cause headache, tachycardia, and fluid retention and may precipitate angina in patients with coronary artery disease. Last full review/revision February 2018 by George L. Bakris, MD NOTE

2013 Merck Manual (19th Edition)

159. Renovascular Hypertension

Orthostatic Hypotension In patients with orthostatic hypotension, which of the following red flag findings suggests a more serious etiology? Bloody stool Heat intolerance Incontinence Urinary retention NEWS & VIDEOS ACC: Long-Term Outcomes for MI Similar at ≤40, 40 to 50 THURSDAY, March 7, 2019 (HealthDay News) -- Patients with myocardial infarction (MI) at age 40 years or younger have similar long-term all-cause and cardiovascular death rates as patients aged... 3D Model Cardiac Conduction System (...) Subtraction Angiography) Image provided by Jan N. Basile, MD. Measurements of renal vein renin activity are sometimes misleading and, unless surgery is being considered, are not necessary. However, in unilateral disease, a renal vein renin activity ratio of > 1.5 (affected to unaffected side) usually predicts a good outcome with revascularization. The test is done when patients are depleted of sodium, stimulating the release of renin. Treatment Aggressive medical management of hypertension

2013 Merck Manual (19th Edition)

160. Angina Pectoris

In patients with orthostatic hypotension, which of the following red flag findings suggests a more serious etiology? Bloody stool Heat intolerance Incontinence Urinary retention NEWS & VIDEOS Becoming Active in Middle Age Still Offers Health Benefits FRIDAY, March 8, 2019 (HealthDay News) -- Becoming physically active in middle age may provide comparable health benefits to long-term participation in leisure-time physical activity (LTPA)... 3D Model Cardiac Conduction System Video Overview of Aneurysms (...) Angina Pectoris Angina Pectoris - Cardiovascular Disorders - MSD Manual Professional Edition Brought to you by The trusted provider of medical information since 1899 SEARCH SEARCH MEDICAL TOPICS Common Health Topics Resources QUIZZES & CASES Quizzes Cases The trusted provider of medical information since 1899 SEARCH SEARCH MEDICAL TOPICS Common Health Topics Resources QUIZZES & CASES Quizzes Cases / / / / IN THIS TOPIC OTHER TOPICS IN THIS CHAPTER Test your knowledge Orthostatic Hypotension

2013 Merck Manual (19th Edition)

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