Adverse Medication Side Effects Research Articles

A Qualitative Study Exploring the Perceived Barriers Among Patients After Percutaneous Coronary Intervention

Introduction: Cardiovascular diseases, particularly coronary heart disease (CHD), are the third biggest cause of mortality worldwide, and percutaneous coronary intervention (PCI) is one of the available treatments. The patient’s self-efficacy in performing self-care decreases as a result of several post-PCI hurdles, which has an effect on their quality of life. The purpose of this investigation was to explore the barriers that patients experience following PCI. Methods: The study design used was descriptive qualitative in 15 patients after PCI. Purposive sampling was used to conduct the participant recruitment process. Between June 2021 and January 2022, data were collected using a semi-structured interviewing method. The data were analysed through the use of thematic content analysis. Results: The thematic content analysis found four themes: 1) Perceived physical barriers; 2) Perceived psychological barriers; 3) Low adherence; 4) The adverse side effects of medications. Conclusion: The results of this study highlight the value of empowering patients to take care of themselves at home following PCI and assisting in the creation of holistic and continuity nurse intervention models.

Patterns of use, knowledge, and perceived effects of sedating medication on driving: A questionnaire survey of Japanese drivers who use sedating medication

ObjectiveThis study was designed to investigate patterns of medication use among drivers using pharmaceutical drugs, the subjective impact of medication use on driving, and knowledge about the effects of medication use on driving. MethodsAn online survey was administered to a sample of Japanese drivers (n = 1424, age range 21–79 years) to investigate the use pattern of major sedating medications such as cold/sinus drugs, anxiolytics, hypnotics, and antidepressants. The strength of association between variables pertaining to the use of sedating medications and self-reported at-fault crash involvement was explored using a series of multivariate logistic regression models. ResultsOn average, respondents reported using 2.7 sedating medications over the past two years (standard deviation = 1.8; range = 0–11). The pattern of psychotropic medication use was diverse, and the use of multiple psychotropic medications was common. Respondents could be grouped into four subgroups in terms of multiple medication use. Irrespective of the type of medication taken, respondents noticed few adverse side effects of medication on driving and generally did not adhere to driving-related product warnings; some respondents were unaware of important facts such as the exacerbation of the effects of medication effects when combining medications. Multivariate logistic regression analyses showed that the presence of a higher number of sedating agents in the medication taken was positively associated with reporting an at-fault crash in the last two years, having longer driving distance, being a commercial driver, receiving more traffic tickets, and having a higher tendency for rules violations. ConclusionsThe present study showed that medication use by drivers is diverse and complex, that most drivers are not sufficiently informed of the potentially impairing effects of medication, and that poly-medication use appeared prevalent among those who use psychotropic medications. In line with previous studies, the current study reveals a need for better communication between health experts and patients and for education of all stakeholders. The results also highlighted the need for systematic investigation into cause of crash in light of potential contribution of sedating medication used by the driver, given the low autopsy rate for fatally injured drivers in Japan.

Early Combination Therapy for Type 2 Diabetes Mellitus and Common Comorbid Mental Disorders.

The relationship between type 2 diabetes mellitus and antipsychotic use by schizophrenia patients is recognized but not well understood. This article reviews the literature regarding metabolic interactions, pathological pathways, and protocols for screening, monitoring, and using combination therapy for individuals with type 2 diabetes mellitus and common comorbid mental health conditions. Because primary care physicians manage patients with both mental and general medical illnesses, such as diabetes, understanding their perspectives on the challenges and facilitators of the care of these patients is critical to improving clinical outcomes. Although the relationship between type 2 diabetes mellitus and antipsychotic use by schizophrenia patients has been recognized, clinical guidelines for their treatment are not recent. Individuals with mental disorders present a vulnerable population with high medical needs that are often mistreated or missed. Given the significant contribution of metabolic syndrome and comorbid diabetes mellitus to morbidity and mortality of such patients, ongoing primary care should be coordinated between general practitioners and mental health professionals to prevent serious complications and adverse medication side effects.

Perceptions of Health Status, Medication Side effects and Depression after Successful Renal Transplantation

Objective: To investigate the perceptions of health status and depression among Renal Transplant Recipients (RTRs). Stydy Design: A longitudinal research design was used. Methods: Recipients’ perceived health status (PHS) was measured by a self-developed questionnaire that reflected the symptom severity and frequency of common immunosuppressant side effects. Depression levels were assessed using Beck Depression Inventory B.D.I II) .The sample population comprised of RTRs with a successful and healthy renal transplant recruited from private and government sector renal units in Lahore, Pakistan. Results: Recipients with poorer perceptions of health status tend to be more depressed as indicated by significant negative correlations between PHS and depression. However, further regression analysis found both constructs as significant predictors of each other, raising a question of causal direction. A cross lagged correlation analysis indicated that PHS appears to be a stronger predictor of depression comparatively. Most recipients tend to have positive perceptions of their health status (M = 30.84, S.D = 3.64) with minimum to moderate level of depression (M = 9.50, S.D = 4.00), It is found that a positive perception of health status is associated with lowered depression. Conclusion: Most recipients’ with a healthy kidney transplant tend to report a positive perception of their health status despite adverse medication side effects. However, the perceived health status is significantly associated with consequent feeling of depression. The study confirms the efficacy and positive health outcomes of renal transplantation in Pakistan.

Marijuana and Cannabinoids in ESRD and Earlier Stages of CKD

Marijuana is the most commonly used recreational drug in the United States, and legal recreational and medicinal use has gained public acceptance during the last decade. Twenty-nine US states have established medical marijuana programs, 8 of which have also legalized recreational marijuana, and Canada is expected to legalize recreational marijuana in 2018. Advanced chronic kidney disease (CKD) and end-stage renal disease (ESRD) are chronic conditions with significant associated morbidity and mortality. Patients experience substantial symptom burden that is frequently undertreated due to adverse medication side effects. This article reviews the available evidence for the use of medical marijuana to manage chronic pain, nausea/vomiting, anorexia/cachexia, and pruritus, all of which are frequently reported by patients with advanced CKD or ESRD. Potential adverse health effects of medical and recreational marijuana use are also discussed. Regardless of personal, social, and political beliefs, marijuana use is becoming mainstream, and nephrologists should be aware of the potential impact on our patient population. Further research is warranted to investigate the renal endocannabinoid system, the impact of marijuana use on kidney disease outcomes, and the risks and benefits of medical marijuana use on symptoms of advanced CKD and ESRD.

Pharmacokinetic evaluation of fixed-ratio combination of insulin degludec and liraglutide in the treatment of type 2 diabetes

ABSTRACTIntroduction: Type 2 diabetes is a complex disease requiring individualized and often multi-faceted treatment plans. Balancing glycemic control with adverse medication side effects can be challenging. Combination therapy of basal insulin and GLP-1 receptor agonist therapy appears to provide a balance between glycemic efficacy, hypoglycemia and weight gain.Areas covered: Available pharmacokinetic data, clinical trials and abstracts regarding fixed-ratio combination of insulin degludec and liraglutide were reviewed. Literature was searched from PubMed and available abstracts using the search term IDegLira up to June 2016.Expert opinion: Fixed-ratio combination of insulin degludec and liraglutide is associated with sustained glucose-lowering effects as assessed by HbA1c reduction. Overall, hypoglycemia is reduced and weight loss is observed compared to basal insulin alone. There is no significant increase in gastrointestinal side-effects, including nausea compared to non-glucagon-like peptide-1 receptor agonists. Pen injector delivery and dose-step titration allow for individualized therapy intensification. Combined treatment for type 2 diabetes with degludec and liraglutide therapy provides complementary therapeutic efficacy in the treatment of individuals with type 2 diabetes.

Management of Psychological Effects through Counselling During HCV (Hepatitis) Treatment

Hepatitis (HCV) is a serious virus that can cause significant damage to the liver. Many individuals, who contact HCV, do so through blood transfusions or intravenous drug use. Additionally, the treatments available for HCV can cause negative side effects and decrease a client’s quality of life. Psychiatric disorders or drug addiction are often regarding as contraindications against the use of interferon (IFN-α), ribavirin and sofosovior in patients with chronic hepatitis C. Our aim was to find out role of counseling on mental side effect of treatment with IFN- α, ribavirin and sofobuvior in different psychological risk groups. Individuals with HCV also experience psychological problems as a result. For instance, many people who are diagnosed with HCV are of low socioeconomic status and have limited access to adequate health care. Other psychological conditions that are common among individuals with HCV include discrimination, depression, and substance misuse. We suggested that Psychologists may be able to not only help with co morbid conditions but also help clients deal with the adverse side effects of medication and the psychological stigma and discrimination surrounding HCV.

Topiramate and motivational enhancement therapy for cannabis use among youth: a randomized placebo-controlled pilot study.

Cannabis misuse accounts for nearly all of the substance abuse treatment admissions among youth in the United States. Most youth do not experience sustained benefit from existing psychosocial treatments; however, medication development research for treating adolescent cannabis misuse is almost nonexistent. We conducted a double-blind, placebo-controlled, pilot study to test the potential efficacy of topiramate plus motivational enhancement therapy (MET) for treating cannabis use among adolescents. Sixty-six heavy cannabis users, ages 15 to 24 years, were randomized to one of two 6-week treatment conditions: topiramate plus MET or placebo plus MET. Topiramate was titrated over 4 weeks then stabilized at 200 mg/day for 2 weeks. MET was delivered biweekly for a total of three sessions. Only 48 percent of youths randomized to topiramate completed the 6-week trial (n = 19), compared with 77 percent of youths in the placebo condition (n = 20). Adverse medication side effects were the most common reason for withdrawal among participants in the topiramate group. Latent growth models showed that topiramate was superior to placebo for reducing the number of grams smoked per use day, but it did not improve abstinence rates. The same pattern of results was found when values for missing outcomes were imputed. We show that topiramate combined with MET demonstrated efficacy for reducing how much cannabis adolescents smoked when they used but did not affect abstinence rates. The magnitude of this effect was modest, however, and topiramate was poorly tolerated by youths, which calls into question the clinical importance of these findings.

Bladder Cancer and Genetic Mutations.

The most common type of urinary bladder cancer is called as transitional cell carcinoma. The major risk factors for bladder cancer are environmental, tobacco smoking, exposure to toxic industrial chemicals and gases, bladder inflammation due to microbial and parasitic infections, as well as some adverse side-effects of medications. The genetic mutations in some chromosomal genes, such as FGFR3, RB1, HRAS, TP53, TSC1, and others, occur which form tumors in the urinary bladder. These genes play an important role in the regulation of cell division which prevents cells from dividing too quickly. The changes in the genes of human chromosome 9 are usually responsible for tumor in bladder cancer, but the genetic mutation of chromosome 22 can also result in bladder cancer. The identification of p53 gene mutation has been studied at NIH, Washington, DC, USA, in urine samples of bladder cancer patients. The invasive bladder cancers were determined for the presence of gene mutations on p53 suppressor gene. The 18 different bladder tumors were evaluated, and 11 (61%) had genetic mutations of p53 gene. The bladder cancer studies have suggested that 70% of bladder cancers involve a specific mutation in a particular gene, namely telomerase reverse transcriptase (TERT) gene. The TERT gene is involved in DNA protection, cellular aging processes, and cancer. The Urothelial carcinomas of the bladder have been described in Atlas of genetics and cytogenetics in oncology and hematology. HRAS is a proto-oncogene and has potential to cause cancer in several organs including the bladder. The TSC1 c. 1907 1908 del (E636fs) mutation in bladder cancer suggests that the location of the mutation is Exon 15 with frequency of TSC1 mutation of 11.7%. The recent findings of BAP1 mutations have shown that it contributes to BRCA pathway alterations in bladder cancer. The discoveries of more gene mutations and new biomarkers and polymerase chain reaction bioassays for gene mutations in bladder cancer need further research.

Anesthesia for outpatient spine surgery: a commentary

In the current medical climate aimed at reducing unnecessary hospitalization, hospital costs, and resource utilization, ambulatory care centers and outpatient surgical popularity are on the rise [1]. Technological advancements have allowed a shift in the surgical paradigm towards minimally invasive surgery with evidence demonstrating smaller incisions, reduced soft tissue injury, operative time, estimated blood loss, and postoperative pain, lower rates of complications, and improved postoperative patient function compared to their open counterparts [2-4]. Successful efforts to minimize soft tissue injury have resulted in faster recovery times, time to rehabilitation, and shorter length of hospital stay [5]. In effort to meet the growing demand of ambulatory surgery, anesthetic techniques have evolved to reduce perioperative morbidity and adverse medication side effects associated with general anesthesia as well as reduce postoperative pain in order to prevent overconsumption of narcotic medications.

Review of State Medication Policies/Guidelines Regarding Psychotropic Medications in Public Schools

It is currently estimated that up to 6 million children take psychotropic medications for the treatment of mental health problems. The highest prevalence rates (50–76 %) are typically found among students with special needs, especially among those with ADHD and emotional disturbance. The Individuals with Disabilities Education Act (IDEA) and Section 504 of the Rehabilitation Act of 1973 require medications be administered by schools whenever it is deemed necessary for the child to have access to educational services. However, these requirements do not extend to all students, nor do they provide guidance regarding the safest and most efficacious manner in which psychotropic medications should be administered. The authors reviewed existing state medication policies and guidelines to assess the level of guidance currently provided to school staff. Results showed the vast majority of states (48) provided guidance related to the administration of medications to students, with slightly fewer (44) states discussing required documentation procedures. Surprisingly, only 15 states addressed monitoring students for adverse side effects of medications, and even fewer (11) states specifically discussed psychotropic medication in their policies/guidelines. The vast majority (42) of states also addressed requirements for the safe and proper storage of medications, while slightly more than half of all states (31) provided any guidance regarding training of unlicensed personnel (e.g., secretaries) who frequently administer medications to students. The authors highlight several model guidelines/policies and review recommendations for best practice.

Aging with HIV and disability: The role of uncertainty

Due to advances in treatment, people with HIV are living longer and developing disabilities related to the virus, adverse side effects of medications, and aging. Illness-related uncertainty has been shown to contribute to disablement; however, there is little understanding of the uncertainties related to aging with HIV. The purpose of this research was to describe the contribution of uncertainty to the disability experienced by older adults living with HIV. Forty-nine men and women living with HIV and 50 years or older participated in in-depth qualitative interviews exploring various aspects of social participation and disability. Transcriptions of the interviews were analyzed using a grounded theory approach. Age-related uncertainties were described in the following themes: source of health challenge; health providers' age-related knowledge and skills; financial uncertainty; transition to retirement; appropriate long-term housing, and uncertainty over who would care for them. While not directly attributable to aging, the episodic nature of HIV left many with uncertainties related to when their next episode of illness would occur and often resulted in an inability to plan in advance. Results highlight the need to focus on the notion of successful and positive aging with the view to identifying effective interventions that reduce disability and enhance the overall health of older adults with HIV. This work builds on previous studies highlighting the role of uncertainty in the disability experience by identifying age-related components specific to older adults aging with HIV.

Cognitive functioning and behaviour of epileptic children in parents' assessment

Background and purposeCognitive functioning and behaviour of chronically ill children are affected by many factors, including anxiety due to hospitalization, persistent symptoms of sickness and adverse side effects of medications. The aim of this work was to seek out parents' opinion concerning cognitive functioning and behaviour of children with epilepsy. Material and methodsThe study comprised 156 children with epilepsy aged 7–18 and treated in the Department of Developmental Neurology at Karol Marcinkowski Poznan University of Medical Sciences and in an outpatient clinic. The research tool used was the questionnaire Quality of Life in Childhood Epilepsy (QOLCE) completed by parents. Assessment of cognitive functioning and behaviour was based on the analysis of the areas V (cognitive processes) and VII (behaviour). ResultsParents assessed children's functioning in the areas of cognitive processes and behaviour at a similar level – 55 points. In the area of cognitive processes, concentration while performing some tasks and reading was assessed as the worst. A significant difference in caregivers' assessment was found according to age, frequency of seizures and duration of disease. In the area analysing the child's behaviour, parents indicated getting angry easily and not being upset by other people's opinions. The display of aggression towards others got the lowest number of comments. ConclusionsThe children's functioning was assessed by parents as rather poor in both analysed areas. Parents of children treated with polytherapy noticed more difficulties in cognitive functioning and behaviour than parents of children treated with one medication.

Depression

The aim of this article is to provide an overview on depression as a risk factor for the onset and follow-up of cardiovascular disease (CVD). In brief, the current state of psychobiological mechanisms bridging the gap between affective states and somatic consequences are presented. Four meta-analyses dealing with depression as a CVD risk factor in apparently healthy populations with >100,000 participants included, extracted an adjusted effect estimator of 1.60-1.90. Depressed subjects present with an unhealthier lifestyle (nutrition, smoking, physical activity). Three major psychobiological pathways directly acting on the circulatory system are under discussion: (1) hyperregulation of the autonomic nervous system (e.g., increased mean heart rate, increased heart rate responses, impaired heart rate variability), (2) overshooting stress responses of the endocrine system with impaired feedback mechanisms (e.g., for cortisol release), and (3) the immune system with dysregulated release of acute phase proteins and proinflammatory cytokines, all involved in a bidirectional crosstalk with the patient's affective state and leading to platelet activation and flow mediated endothelial (dys-)function. Nonadherence and adverse side effects of medications also contribute to the lethal properties of depression in CVD.

Treatment of Epilepsy in Postmenopausal Women

Menopausal women represent a rapidly growing proportion of the population. Epidemiologic evidence for the increased incidence of epilepsy in elderly patients suggests that with global aging of the population, there is likely to be a growing need for healthcare workers to manage seizures in older women. Unfortunately, there has been relatively little scientific investigation into the unique concerns of postmenopausal woman with epilepsy. There is some evidence that women may experience increased seizure activity during the menopausal transition owing to the effects of estrogen and progesterone on neuronal excitability. During perimenopause and menopause, use of hormone-replacement therapy can also worsen seizure control. Menopausal women are particularly vulnerable to osteoporosis and fragility fractures, both of which demonstrate increased risk following exposure to antiepileptic drugs. Optimization of epilepsy therapy to avoid both seizures and falls caused by antiepileptic drug-induced imbalance is crucial in order to minimize fracture risk in this group of women. Elderly patients are more susceptible to adverse medication side effects owing to drug interactions and the physiologic changes of aging that result in altered drug pharmacokinetics.

The Effects of Medications on Bone

Medications taken for the treatment of arthritis and psychotropic and epileptic disorders, as well as anticoagulants, antacids, bisphosphonates, corticosteroids, and antineoplastic drugs, can profoundly affect bone metabolism. In some scenarios (eg, osteoporosis), these effects are intended; in others (eg, rickets, osteomalacia secondary to antiepileptic drugs), potentially adverse side effects of medications on bone may occur. Nonsteroidal anti-inflammatory drugs appear to delay fracture healing and bone ingrowth, although these effects are reversible. Disease-modifying antirheumatic drugs do not appear to affect bone metabolism adversely when taken in the low dosages currently prescribed. Bisphosphonates are useful in restoring bone mass in cases of postmenopausal osteoporosis, glucocorticoid-induced osteoporosis, Paget's disease, and neoplastic conditions with bone loss and hypercalcemia. Corticosteroids and cancer chemotherapeutic agents generally affect bone adversely and increase fracture risk.

Psychiatrische und psychosoziale Notfallsituationen

Psychiatric emergencies and crises are unforseeable by nature and can have devastating consequences. They can arise both in the course of chronic mental illness and in people who had not shown any previous signs of mental illness. Conditions that are so similar that they might be confused with one another can be caused by a wide range of internal illnesses, adverse side-effects of medications or intoxication. This is the reason why establishing a psychiatric diagnosis in emergency situations must be primarily driven by the question as to whether the differential diagnosis is an internal illness or rather intoxication. The most prevalent psychiatric emergencies in clinical practice are nervous breakdowns, psychomotor agitation and violence, suicidal tendencies, delirium, psychoses as well as addictions.

Clinical correlates of early medication adherence: West London first episode schizophrenia study.

Little is known about factors that mediate adherence with medication during the early stages of antipsychotic treatment in schizophrenia. This study sought to identify factors that may be associated with medication adherence in first-episode schizophrenia. In 101 patients, adherence was assessed along with potentially relevant variables, including attitudes toward medication, insight, substance misuse, side effects and psychopathology. In a linear regression analysis, negative attitudes toward medication and a relative lack of insight contributed significantly towards poor adherence. Although poorly adherent patients had significantly higher scores on negative and disorganization syndromes, these did not contribute significantly towards adherence. Adverse medication side effects, subjective well-being and substance misuse showed no significant association with adherence. At the initiation of drug treatment, attitudes toward medication and insight appear more relevant to medication adherence than side effects. Adherence appears to reflect a complex interaction of influences, which may change over time.

EXPLORING THE COMPLEXITY OF COMPLIANCE IN SCHIZOPHRENIA

A large body of literature indicates that people diagnosed with schizophrenia are highly likely to not comply with their prescribed treatment regime at some stage during the illness process. Factors that indicate the risk of noncompliance have been the subject of considerable research over a number of years. This paper presents an extensive review of the research literature on the subject of compliance in schizophrenia. A number of factors have constituted the focus of research into this area. These include: socio-demographic characteristics, including age, gender and socioeconomic status; illness factors including insight, psychiatric symptomatology, duration of illness, substance abuse, and adverse side-effects of medication; psychosocial factors such as health beliefs and social supports; and treatment factors including the nature of the therapeutic relationship between patients and health care professionals. While the results of relevant research do not provide a clear and conclusive picture of compliance, they provide important information to guide the pivotal role of the mental health nurse in facilitating patient compliance.

A follow-up of medical treatment of persons with psychiatric health problems and mental retardation

One hundred and thirty patients with psychiatric problems in combination with mental retardation have been treated at a psychiatric ward for patients with mental retardation. A follow-up has been made of those patients who have been treated with clozapine and/or citalopram/paroxetine for some time. Data have been collected from their medical charts. Fifty-one patients have been treated with clozapine, and 25 of these have also been given a diagnosis of autism. A positive effect was achieved in 35 (69%) of the patients and in 15 (60%) of those with autism. Citalopram/paroxetine have been given to 37 patients, and 7 of these have been diagnosed as having autism. These drugs had a positive effect in 26 (70%) patients, and in 4 (56%) cases among those with autism. The group as a whole seems more sensitive to adverse side effects of medication and more prone to respond negatively when medication is not administered with great care.