Medicines and heatwaves – RGH Pharmacy E-Bulletin

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Global climate change continues to be the subject of international debate, which has included concern about the health impacts of climate change. Attention has also focused on the impact of ‘heat waves’ on morbidity and mortality.

Over 70,000 additional deaths were recorded in 12 European countries over the summer of 2003 during a prolonged heatwave – after this, a number of related papers were published in medical literature, including some that specifically looked at the potential for increased harm from medicine use during the heatwaves.

A number of countries including Australia have since operationalised ‘National Heat Wave Plans.’ In Australia individual states having developed specific information for to help people to manage in heatwaves, including SA Health’s “Extreme Heat – guide to coping and staying healthy in the heat.”

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A joint initiative of the Patient Services Section and the Drug and Therapeutics Information Service of the Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia. The RGH Pharmacy E-Bulletin is distributed in electronic format on a weekly basis, and aims to present concise, factual information on issues of current interest in therapeutics, drug safety and cost-effective use of medications.
Editor: Assoc. Prof. Chris Alderman, University of South Australia – Director of Pharmacy, RGH © Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia 5041.

Farnesyltransferase inhibitors in Hutchinson-Gilford progeria – RGH Pharmacy E-Bulletin

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Farnesyltransferase inhibitors (FTIs) are a new class of biologically active agents originally developed as potential anticancer drugs, and are currently unavailable in Australia.

FTIs inhibit the enzyme farnesyltransferase, preventing the farnesylation and hence activation of a wide range of target proteins, including Ras (which is mutated in 30 % of all human cancers), ultimately resulting in cell growth arrest. In preclinical models, farnesyl transferase inhibitors showed great potency as a novel anti-cancer agent; yet in clinical studies, the early potential of FTIs were not realised.

This was attributed to several reasons: the molecular pharmacology and biology of FTIs had not yet been fully elucidated, an escape mechanism for the inhibition by FTIs was discovered (known as geranylgeranylation) and a well-defined proof of the concept of clinical studies was lacking.

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A joint initiative of the Patient Services Section and the Drug and Therapeutics Information Service of the Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia. The RGH Pharmacy E-Bulletin is distributed in electronic format on a weekly basis, and aims to present concise, factual information on issues of current interest in therapeutics, drug safety and cost-effective use of medications.
Editor: Assoc. Prof. Chris Alderman, University of South Australia – Director of Pharmacy, RGH © Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia 5041.

Factors influencing clozapine plasma concentrations – RGH Pharmacy E-Bulletin

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The use of therapeutic drug monitoring for clozapine is indicated in various situations, including poor compliance, inadequate response to treatment, presence of significant adverse effects, the presence of specific disease states (especially hepatic disease) and where there may be drug interactions.

In clinical practice, the dose of clozapine is usually adjusted to provide plasma concentrations of 350 – 600micrograms per litre. However some patients may respond to lower concentrations, or conversely may experience limiting adverse effects despite concentrations in the recommended range.

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A joint initiative of the Patient Services Section and the Drug and Therapeutics Information Service of the Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia. The RGH Pharmacy E-Bulletin is distributed in electronic format on a weekly basis, and aims to present concise, factual information on issues of current interest in therapeutics, drug safety and cost-effective use of medications.
Editor: Assoc. Prof. Chris Alderman, University of South Australia – Director of Pharmacy, RGH © Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia 5041.

Rasagiline – RGH Pharmacy E-Bulletin

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The treatment of Parkinson’s disease often requires the use of multiple agents to achieve optimal symptom control with minimal side effects.

The mainstay of treatment is levodopa, however the development of movement disorders occurs with long term treatment. In younger patients, therefore, it may be preferable to reserve levodopa for use later in the course of disease progression. Also, in patients taking long term levodopa, additional therapies may help to reduce motor fluctuations.

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