Medical Inspection – Health Blog

OVERVIEW

In November 2002, the Food and Drug Administration (FDA) approved atomoxetine (Strattera generic, Eli Lilly) for the treatment of Attention-Deficit/Hyper-activity Disorder (ADHD), previously called Attention-Deficit Disorder. Atomoxetine is a potent inhibitor of the pre-synaptic norepinephrine transporter, with minimal affinity for other nor-adrenergic receptors or for other neu-rotransmitter transporters or receptors. Atomoxetine is thought to work by blocking norepinephrine, a neuro-transmitter that is important in modulating the brain systems that control attention and activity.

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In terms of antiviral activity, PIs inhibit the HIV protease enzyme, which is required for the proteolytic cleavage of viral polyprotein precursors. PIs bind to the active site on the HIV-1 protease enzyme and prevent the processing of viral GaG and GaG-pol polyprotein precursors. This results in the formation of immature, noninfectious viral particles.

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Nevirapine, Delavirdine, and Efavirenz drug

The first NNRTI, nevirapine (NVP) (Viramune®, Boehringer Ingelheim), was approved in June 1996. Delavirdine (DLV) (Rescriptor®, Pharmacia & Upjohn) received approval in April 1997, and EFV was approved in September 1998. Studies with NNRTIs, in particular with EFV, have received considerable attention. NVP has been extensively studied in resource-poor countries as an affordable alternative to short-course ZDV in the prevention of perinatal HIV transmission.

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Tenofovir

On October 26, 2001, tenofovir (Viread®, Gilead Sciences) became the first FDA-approved agent in the NtRTI class. The drug was the second of two agents in this class to be developed by Gilead. Adefovir dipivoxil, the other agent in this class then under investigation, is no longer under consideration as an anti-HIV agent following disappointing virologic and immunologic results and a high incidence of proximal renal tubular dysfunction in a comparison with placebo (17% vs. 0.4%, P < .0001). This class of drugs is similar to the NRTIs except for a structural difference relating to phosphorylation.

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The history of antiretroviral agents that have been approved by the Food and Drug Administration (FDA) dates from March 19, 1987, when generic zidovudine (ZDV), also known as AZT (Retrovir canadian, GlaxoSmithKline), became the first drug to be used to treat patients with acquired immunodeficiency syndrome (AIDS). Since that time, the therapy for patients with human immunodeficiency virus (HIV) has grown increasingly complex. A total of 17 new agents, many with more than one formulation, have been added to the anti-HIV arsenal.
Part 1 of this two-part series (P&T, August 2003) detailed the fundamental aspects of HIV therapy, namely goals, resistance, and patient adherence to treatment. Part 2 focuses on selected agents approved within each drug class.

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The concept of receiving additional resources or privileges, on the basis of better-than-expected results, is the bedrock of the American business model. Whether it’s bonuses, promotions, or congratulations from the boss, rewards are meant to motivate individuals and teams to strive for excellence. And these rewards do work! However, the design of an incentive program can get tricky, because the goals must be meaningful and clearly understood, not vulnerable to negative unplanned consequences.

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In the U.S., a number of educational programs have recently been developed to meet the emerging need for experts and professionals who are capable of conducting, interpreting, and using health economic evaluations for health care decision-making. Among the diverse types of educational offerings, pharmacoeconomic and outcomes research (PE/OR) fellowship programs have become one of the most prominent types of training curricula.

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