Number Of Different Medications Research Articles

Treatment and Prevention of Depression.

Depression is one of the most common and debilitating psychiatric disorders and is a leading cause of suicide. Most people who become depressed will have multiple episodes, and some depressions are chronic. Persons with bipolar disorder will also have manic or hypomanic episodes. Given the recurrent nature of the disorder, it is important not just to treat the acute episode, but also to protect against its return and the onset of subsequent episodes. Several types of interventions have been shown to be efficacious in treating depression. The antidepressant medications are relatively safe and work for many patients, but there is no evidence that they reduce risk of recurrence once their use is terminated. The different medication classes are roughly comparable in efficacy, although some are easier to tolerate than are others. About half of all patients will respond to a given medication, and many of those who do not will respond to some other agent or to a combination of medications. Electro-convulsive therapy is particularly effective for the most severe and resistant depressions, but raises concerns about possible deleterious effects on memory and cognition. It is rarely used until a number of different medications have been tried. Although it is still unclear whether traditional psychodynamic approaches are effective in treating depression, interpersonal psychotherapy (IPT) has fared well in controlled comparisons with medications and other types of psychotherapies. It also appears to have a delayed effect that improves the quality of social relationships and interpersonal skills. It has been shown to reduce acute distress and to prevent relapse and recurrence so long as it is continued or maintained. Treatment combining IPT with medication retains the quick results of pharmacotherapy and the greater interpersonal breadth of IPT, as well as boosting response in patients who are otherwise more difficult to treat. The main problem is that IPT has only recently entered clinical practice and is not widely available to those in need. Cognitive behavior therapy (CBT) also appears to be efficacious in treating depression, and recent studies suggest that it can work for even severe depressions in the hands of experienced therapists. Not only can CBT relieve acute distress, but it also appears to reduce risk for the return of symptoms as long as it is continued or maintained. Moreover, it appears to have an enduring effect that reduces risk for relapse or recurrence long after treatment is over. Combined treatment with medication and CBT appears to be as efficacious as treatment with medication alone and to retain the enduring effects of CBT. There also are indications that the same strategies used to reduce risk in psychiatric patients following successful treatment can be used to prevent the initial onset of depression in persons at risk. More purely behavioral interventions have been studied less than the cognitive therapies, but have performed well in recent trials and exhibit many of the benefits of cognitive therapy. Mood stabilizers like lithium or the anticonvulsants form the core treatment for bipolar disorder, but there is a growing recognition that the outcomes produced by modern pharmacology are not sufficient. Both IPT and CBT show promise as adjuncts to medication with such patients. The same is true for family-focused therapy, which is designed to reduce interpersonal conflict in the family. Clearly, more needs to be done with respect to treatment of the bipolar disorders. Good medical management of depression can be hard to find, and the empirically supported psychotherapies are still not widely practiced. As a consequence, many patients do not have access to adequate treatment. Moreover, not everyone responds to the existing interventions, and not enough is known about what to do for people who are not helped by treatment. Although great strides have been made over the past few decades, much remains to be done with respect to the treatment of depression and the bipolar disorders.

Depressogenic medication as an aetiological factor in major depression: an analysis in a clinical population of depressed elderly people

To study the role of depressogenic medication in the aetiology of major depression in the elderly. Depression can be caused, provoked or sustained by drugs prescribed for other reasons. The evidence for this statement is based on case-reports, not on investigations in relevant populations. In the geriatric wards of three Dutch psychiatric hospitals, 195 patients with a DSM-III-R diagnosis of major depression (MDD) were studied. In the first week after admission the following data were recorded: age, gender, personal psychiatric history, family psychiatric history, Montgomery-Asberg Depression Rating Scale, Mini-Mental State Examination, history of stroke, use of medication and number of different medications used. Subjects using depressogenic medication were contrasted with subjects not using depressogenic medication on all variables. There was a significant negative relationship, adjusted for the other variables, between the use of depressogenic medication and a previous admission for depression. No other significant relationships between the use of depressogenic medication and aetiological variables were found. Patients with a first-time admission for MDD use depressogenic medication 2.44 times more often than patients with previous admissions for depression. The use of depressogenic medication is an independent and clinically relevant aetiological factor in MDD.

Prescribing for seniors: neither too much nor too little.

OVER THE PAST FEW YEARS THE pendulum has swung from concern about the risks of excessive prescribing of inappropriate or unnecessary drug therapy to concerns about the consequences of underprescribing of potentially beneficial therapies to seniors (65 years and older). Concerns about excess drug use are for good reason. Use of greater numbers of drug therapies, rather than age alone, has been associated with an increased risk of developing adverse drug reactions. Furthermore, prescribing additional drugs to treat drug-induced symptoms can lead to prescribing cascades that develop when an adverse drug reaction is misinterpreted as a new medical problem. However, prescribing strategies that seek to limit the number of drugs prescribed to elderly patients in the name of improving quality of care may be seriously misdirected. A broader view of prescribing for seniors recognizes that problems occur from both the overprescribing and underprescribing of drug therapies. The past few years have seen a number of studies, a handful of which are cited in this article, illustrating the adverse consequences associated with underprescribing of beneficial drug therapies. These studies point to a more complex model for assessing the quality of prescribing for seniors than simply counting the number of different medications that an elderly patient is receiving.

Gastroesophageal reflux disease.

Gastroesophageal reflux disease is a common disorder in which irritant gastric contents enter the esophagus, most commonly via transient lower esophageal sphincter relaxation. The diagnosis of gastroesophageal reflux disease may be made on clinical grounds alone or may be confirmed with studies including esophagogastroduodenoscopy or ambulatory pH monitoring. There are a number of different medications to treat reflux disease, including histamine-2 receptor antagonists, promotility agents and the proton pump inhibitors. Reflux disease often requires chronic maintenance therapy.

Oral side-effects of the most frequently prescribed drugs.

Oral side-effects and their respective prevalence rates for the 200 most frequently prescribed drugs for 1992, as measured by IMS America's National Prescription Audit is reviewed. Accounting for duplication due to brand and generic name listings, the actual number of different medications covered was 131. The results of this review are presented in a table and include the oral side-effects and prevalences as reported in the literature. The three most frequent side-effects encountered with these medications were xerostomia (80.5%), dysgeusia (47.5%), and stomatitis (33.9%). The included table should fill the need for a ready reference for dentists in monitoring and counseling patients regarding the potential oral side-effects of the medications.

Comparing Sources of Drug Data about the Elderly

This project assessed the extent of agreement between drug-taking data obtained from an in-home assessment and that obtained from an automated outpatient pharmacy system and from a mail questionnaire. The underlying assumption is that an in-home assessment provides the most complete information (criterion standard) about the prescription medications being taken. The drug data from the mail questionnaire and automated outpatient pharmacies were compared with that from the in-home assessment by use of t tests and measures of sensitivity, specificity, and positive predictive value. Kaiser Permanente, Northwest Region, a prepaid group practice HMO. All elderly HMO members enrolled in the Social HMO demonstration project who had a comprehensive assessment within 30 days of returning a mail questionnaire between March 1986 and March 1988 (n = 83 frail elderly). The number of medications currently being taken and the number of different therapeutic classes of drugs being taken per elderly HMO member. The in-home assessment and the automated prescription system closely agreed on the number of different medications and the different therapeutic classes of prescription drugs being taken. The in-home assessment and mail questionnaire were in less agreement. Agreement was less for non-prescription drugs. An automated prescription system is an adequate source of information about the prescription drugs currently being taken by frail elderly HMO enrollees with a prepaid prescription drug benefit.

Drug interactions in surgical patients

Drug interactions, defined as when the administration of a single substance (drug, nutrient, or tobacco) modifies the response to a drug, occur relatively frequently in surgical patients and may result in increased morbidity and lengthened hospital stay. Drug interactions also account for some instances of drug ineffectiveness or exaggerated pharmacologic response. There are many types of drug interactions. However, most of them are related to altered drug pharmacokinetic properties, where there are alterations in drug absorption, distribution, metabolism, or elimination; or altered drug pharmacodynamic actions, where two agents may have synergistic, additive, or antagonistic pharmacologic effects. The term, drug interaction, usually refers to pairs of drug substances administered concurrently, but more than two agents may be involved. When patients are taking a large number of different medications, there may be multiple drug interactions with additive or antagonistic effects, the overall effects of which are difficult to predict. There are hundreds of reported drug interactions, and some may be of important clinical consequence. In surgical patients, the majority of drug interactions involve histamine-2 blockers (particularly cimetidine), digoxin, warfarin, or a variety of agents that may be administered during anesthesia. Recognition of the potential for adverse drug interactions is of primary importance in minimizing their effects. Usually, potentially interacting drugs may be administered concurrently as long as appropriate patient or laboratory assessments are performed. For some agents, such as digoxin or theophylline, serum drug concentrations may aid in the avoidance of adverse drug interactions.

How mothers treat their children's physical symptoms.

An important area of concern in community health is the widespread practice of individuals undertaking courses of treatment in the absence of medical advice or direction. This is especially a problem when it involves the administration of medicines to children. This study examines the extent, determinants, and quality of the independent use by mothers of medications for treating their children's symptoms. Data on mother-initiated medication behavior (MIMB) were obtained from a random sample of 500 mothers of children at two pediatric ambulatory care sites. Six expert pediatric judges rated every reported medication use (N = 3,908) along three dimensions (usefulness, correctness, and harmfulness/helpfulness) and also evaluated the overall appropriateness of each mother's MIMB. Results indicate that: 1) mothers keep available and use for their children a considerable number of different medications; 2) clear relationships exist between mothers' socioeconomic status and the different categories of medications they employ; 3) mothers' perceptions of their children's vulnerability to specific illnesses, and of the efficacy of over-the-counter medications for treating those illnesses, were related to the possession and use of relevant medications; and 4) judges' ratings indicated little enthusiasm for the mothers' therapeutic actions. These findings suggest the need for pediatricians to become aware of the medications their patients may be ingesting as a result of MIMB, and to educate mothers concerning use and misuse of over-the-counter (and other) treatments.

Neonatal medication surveillance by the pharmacist

Data on prenatal, labor and delivery, and postnatal medication exposure to neonates were collected. During an 11-week period, 100 neonates consecutively admitted to a hospital were studied. The pharmacist obtained a social and medication history from the mothers and reviewed maternal anesthesia records and the charts of the neonates. Fifteen definite and possible adverse medication reactions were detected in 13 neonates. The median number of different medications ingested prenatally was 4.7. The four most commonly ingested prenatal medications were vitamins (97%), iron preparations (90%), headache/pain/arthritis medications (68%) and antinausea/vomiting medications (40%). The most commonly used medications during labor and delivery were oxytocin (73%), meperidine (33%) and promazine (25%). The use of strong narcotics during this period produced neonatal respiratory depression in some cases. The four most commonly prescribed postnatal medications were vitamin K1 (100%), gentamicin (10%), ampicillin (8%) and Poly-Vi-Sol (6%). The maternal interview indicated that most mothers were unaware of the influence that many medications can play upon the fetus. It is recommended that the pharmacist conduct a maternal medication interview prior to labor and delivery.

Drugs In Pregnancy

In 1991 WHO International Survey of Drug Utilization in Pregnancy is 86% of women took medication during pregnancy, Average of 2.9 prescriptions and despite this high rate of medication intake, most drugs are not labeled for use during pregnancy. Most women use a number of different medications during pregnancy, many of which are self-administered. It is essential to consider the following factors before prescription of drugs during pregnancy. A) Dose and duration of drug exposure is important. The larger the dose is more likely the effects. The longer the duration of drug exposure is greater chance of susceptible periods of organogenesis and developmental problem. B) Timing of exposure is very crucial. Certain organ systems may have only limited period of susceptibility for damage. C) Pathogenetic mechanism, teratogens produce their adverse effect by specific mechanism. D) Host susceptibility, variability in the genetic factors related to mechanism of certain drugs. All drugs can affects the health of the mother and fetus, therefore any drugs should be administer with care during pregnancy. Key words: Drug; pregnancy; congenital malformation; fetus DOI: 10.3329/fmcj.v5i1.6811Faridpur Med. Coll. J. 2010;5(1):29-31

Not Allowed to Die

<h3>Objectives</h3> To study the association between polypharmacy and the risk of hospitalisation and death in cases of COVID-19 in the population over the age of 65. <h3>Design</h3> Population-based cohort study. <h3>Setting</h3> Quebec Integrated Chronic Disease Surveillance System, composed of five medico-administrative databases, in the province of Quebec, Canada. <h3>Participants</h3> 32 476 COVID-19 cases aged over 65 whose diagnosis was made between 23 February 2020 and 15 March 2021, and who were covered by the public drug insurance plan (thus excluding those living in long-term care). We counted the number of different medications they claimed between 1 April 2019 and 31 March 2020. <h3>Outcome measures</h3> Robust Poisson regression was used to calculate relative risk of hospitalisation and death associated with the use of multiple medications, adjusting for age, sex, chronic conditions, material and social deprivation and living environment. <h3>Results</h3> Of the 32 476 COVID-19 cases included, 10 350 (32%) were hospitalised and 4146 (13%) died. Compared with 0–4 medications, polypharmacy exposure was associated with increased hospitalisations, with relative risks ranging from 1.11 (95% CI 1.04 to 1.19) for those using 5–9 medications to 1.62 (95% CI 1.51 to 1.75) for those using 20+. Similarly, the risk of death increased with the number of medications, from 1.13 (95% CI 0.99 to 1.30) for those using (5–9 medications to 1.97 (95% CI 1.70 to 2.27) (20+). Increased risk was mainly observed in younger groups. <h3>Conclusions</h3> Polypharmacy was significantly associated with the risk of hospitalisations and deaths related to COVID-19 in this cohort of older adults. Polypharmacy may represent a marker of vulnerability, especially for younger groups of older adults.