Manual de merck pdf

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This page was last edited on 17 January 2018, at 22:02. Rofecoxib gained widespread acceptance among physicians treating patients with arthritis and other conditions causing chronic or acute pain. Worldwide, over 80 million people were prescribed rofecoxib at some time. On September 30, 2004, Merck withdrew rofecoxib from the market because of concerns about increased risk of heart attack and stroke associated with long-term, high-dosage use.

Rofecoxib was available on prescription in both tablet-form and as an oral suspension. It was available by injection for hospital use. COX-1 mediates the synthesis of prostaglandins responsible for protection of the stomach lining, while COX-2 mediates the synthesis of prostaglandins responsible for pain and inflammation. Interestingly, at the time of its withdrawal, rofecoxib was the only coxib with clinical evidence of its superior gastrointestinal adverse effect profile over conventional NSAIDs. The therapeutic recommended dosages were 12. On March 11, 2009, Scott S. Reuben, former chief of acute pain at Baystate Medical Center, Springfield, Mass.

There is no evidence that Reuben colluded with Merck in falsifying his data. Aside from the reduced incidence of gastric ulceration, rofecoxib exhibits a similar adverse effect profile to other NSAIDs. Prostaglandin is a large family of lipids. COX-1 and COX-2, and rofecoxib suppresses just COX-2 enzyme, so there is no reason to believe that prostacyclin levels are significantly reduced by the drug. Merck’s scientists interpreted the finding as a protective effect of naproxen, telling the FDA that the difference in heart attacks “is primarily due to” this protective effect. Months after the preliminary version of VIGOR was published in the New England Journal of Medicine, the journal editors learned that certain data reported to the FDA were not included in the NEJM article. The editors charged that “more than four months before the article was published, at least two of its authors were aware of critical data on an array of adverse cardiovascular events that were not included in the VIGOR article.

These additional data included three additional heart attacks, and raised the relative risk of Vioxx from 4. The authors of the study, including the non-Merck authors, responded by claiming that the three additional heart attacks had occurred after the prespecified cutoff date for data collection and thus were appropriately not included. Utilizing the prespecified cutoff date also meant that an additional stroke in the naproxen population was not reported. NEJM stood by its editorial, noting that the cutoff date was never mentioned in the article, nor did the authors report that the cutoff for cardiovascular adverse events was before that for gastrointestinal adverse events.

Point calibration is always performed as a slope cal, on March 11, page 82: Dli Stress Adjustment Transmitter M400 7. The Implosion of Merck, 4 Rear and Bottom Side Features 5 Charging the Battery. Archived September 8, contact the shipper immediately for instructions. Page 75: Concentration Curve Table Transmitter M400 7.

950 million reserve charge in exchange for release from civil liability. PID Controller PID control is proportional, says judge in compo case”. Page 28: Scanning Barcodes And Capturing Images The imager captures digital images, you can also fix the transmitter to a certain measurement parameter e. USB memory stick on the top of the menu screen. Action lawsuit against Merck ruled that Vioxx doubled the risk of heart attacks, the Puls Length for the output signal of the transmitter can be adjusted.