Potential adverse effects of antihypertensive drugs in the elderly.

Antihypertensive therapy is effective in elderly patients, at least in those under 80 years old. Stepped care may still serve as a therapeutic framework which is modified to fit the individual elderly patient, according to the risk: benefit ratio. However, there are no risk-free drugs and no antihypertensive agent is universally effective.

Antihypertensive therapy for the elderly: an expert system to assist therapeutic decisions.

The prevalence of hypertension among the elderly is high. Recent multicenter studies have shown hypertension, especially isolated systolic hypertension, to be a risk factor and treatment to be effective, if individualized. In addition, the presence of multiple complicating conditions and the need for multiple medications in the elderly increases the required medical knowledge base necessary to appropriately determine antihypertensive therapy.

Medication management.

The elderly receive more drugs than any other patient group, and those in nursing homes receive the most. However, little is known about drug action, particularly in the very old. A host of factors can alter drug action.

Epithelioid hemangioendothelioma of the liver. Diagnostic features and role of liver transplantation.

Five cases of epithelioid hemangioendothelioma of the liver are reported. This unusual type of vascular tumor is often difficult to diagnose; its angiogenic nature is not overt at the radiologic level and may be overlooked by conventional histologic examination. At imaging procedures, epithelioid hemangioendothelioma of the liver presents as multiple focal hypovascular areas, disseminated in both lobes.

Pulmonary complications of hormone treatment in prostate carcinoma.

Fever, dyspnea, dry cough and interstitial fibrosis occurred in a man with prostate carcinoma treated with nilutamide and buserelin for two and one-half months. The diagnosis of drug-induced fibrosis was established on the basis of chronologic and semiologic events. This is the first such case reported.

Age-associated pharmacodynamic changes.

Many pharmacodynamic changes with age have been identified. Quite likely, they, in concert with age-associated pharmacokinetic changes and multiple drug use, are responsible for altered drug action in the elderly and an increasing incidence of adverse drug reactions with age. The pharmacodynamic changes, which can result in altered action of important drugs, can lead to major adverse clinical outcomes if not recognized, particularly in those drugs which affect the heart and the central nervous system.

[Cerebrovascular accidents after endoscopic obturation of esophageal varices with isobutyl-2-cyanoacrylate in 2 patients].

We report 2 cases of cerebral stroke in cirrhotic patients following endoscopic obturation of esophageal varices with Isobutyl-2-Cyanoacrylate. In both cases, hemiplegia appeared several hours after the procedure. A brain CT scan showed radiodense material in the cerebral arteries due to dissemination of Isobutyl-2-Cyanoacrylate.

Generic equivalents: issues and concerns.

Critical questions remain concerning many issues involved in the identification of bioequivalent and therapeutically equivalent drugs. They need to be answered, and scientists and clinicians should address these issues, in concert with the FDA, as soon as possible.

Physicians' knowledge of prescribing for the elderly. A study of primary care physicians in Pennsylvania.

The 143 physicians who returned to Temple University Medical School a questionnaire on knowledge of prescribing for the elderly constituted 25% of a stratified random sample of general practitioners (GPs), family practitioners (FPs), and practitioners in internal medicine (IMs) reimbursed under Medicare in Pennsylvania in 1979. The mean score on the 23-item drug questionnaire was significantly lower (P less than .05) than the score deemed adequate by a panel of six experts in the field.