Simultaneous Use Of Drugs Research Articles

Evaluation Of Polypharmacy And Excessive Polypharmacy In Geriatric Inpatients In General Hospital

Polypharmacy is the simultaneous use of drugs with 5-9 drugs. Excessive polypharmacy is the simultaneous use of drugs with ≥ 10 drugs. Chronic diseases that are commonly suffered by geriatric patients are prone to causing a person to receive polypharmacy or excessive polypharmacy. This study aims to eval_uate polypharmacy and excessive polypharmacy in inpatient geriatric patients, by knowing the factors that may trigger a person to receive polypharmacy. The research uses a cross-sectional study method, using medical record data for the period January to December 2023. The part studied was in the form of sociodemographics, disease history and treatment of patients, as well as length of stay. From the research conducted, the results were obtained from 295 patient data samples with 141 patients (47.8%) and 154 patients (52.5%) were female. The age of patients consisted of 60-74 years old 192 patients (65.1%), 75-90 years old 100 patients (33.9%), and ≥ 90 years 3 patients (1%). The last education of the highest patient with a high school background was 101 patients (34.2%), the highest marital status was married as many as 245 patients (83.1%). The diagnosis of the third disease has the most patients, namely diabetes mellitus as many as 95 patients (15.5%), anemia as many as 70 patients (11.5%), and hypertension as many as 56 patients (9.2%). The preval_ence of polypharmacy in geriatric patients was 115 patients (39%) and excessive polypharmacy was 180 patients (61%). Broadly speaking, the sociodemographics of patients do not have a relationship with the occurrence of polypharmacy and excessive polypharmacy. The patient's clinical condition has a relationship with the occurrence of polypharmacy and excessive polypharmacy, this is evidenced by a p value of 0.000 (<0.05). The length of hospitalization and diagnosis of the patient's disease is a predictor of polypharmacy and excessive polypharmacy.

Adequate antiemetic treatment in patients receiving antitumor drug therapy

Despite the widespread use of immuno-oncological and targeted therapy in the treatment of malignant tumors, in real clinical practice the role of chemotherapy is still significant, used both in mono regimen and in combination with other antitumor drugs. Cytostatics cause a wide range of adverse events, which are often the cause of dose reduction, cyclical disorders, or even discontinuation of therapy. One of the most common symptoms is chemotherapy-induced nausea and vomiting which affect not only the quality of life, but also the results of treatment. It is important to address these issues from prevention and treatment perspectives so that patients remain committed to their treatment regimens. Since nausea and vomiting induced by chemotherapy are classified into 5 different types, the main medications for prevention and treatment include 5-hydroxytryptamine type 3 (5-HT3) and neurokinin-1 (NK1) receptor antagonists and corticosteroids. Simultaneous use of drugs from the groups of second-generation NK1 receptor blockers and 5-HT3 receptor blockers, for example: netupitant + palonosetron in combination with corticosteroids, makes it possible to achieve maximum antiemetic effect, even with the most emetogenic antitumor treatment regimens.

Treating Chronic Pain and Anxiety – a Modest Proposal

Introduction: the CDC guidelines of 2016 and 2022 strongly proscribed the co-prescription of opioids and benzodiazepines, implicitly suggesting that the combination was associated with high risk. This position now strongly influences health provider organizations, clinicians, pharmacies, health insurance companies, and boards of medicine. We have previously comprehensively reviewed the generally high-quality published studies, all employing a retrospective cohort design. These studies suggest that, to the extent that the combination increases mortality risk, the magnitude of the increase is small and it likely reflects a conflation of mortality risk related to the underlying conditions and the risks associated with simultaneous use of drugs of both classes. We here recapitulate the results of our prior analyses, contrast them with CDC positions, and introduce the results of additional studies, some only recently published and some of which we had previously been unaware.

Polypharmacy and cognition in older women: less is more?

At present, two-thirds of all community-dwelling adults develop multiple non-communicable diseases in their lifetime, with women at nearly double the risk of multimorbidity involving psychiatric conditions than men. This high burden of somatic-psychiatric multimorbidity among women necessitates frequent and simultaneous use of drugs according to various disease-specific guidelines. This do not necessarily imply overtreatment as co-occurring diseases may warrant treatment by multiple drugs, yet when inappropriate, polypharmacy turns to be particularly detrimental to cognitive health among older women.

Inhibition effect of choline and parecoxib sodium on chronic constriction nerve injury-induced neuropathic pain in rats

PurposeThe simultaneous use of drugs with different mechanisms of analgesic action is a strategy for achieving effective pain control while minimizing dose-related side effects. Choline was described to potentiate the analgesic action of parecoxib sodium at small doses in several inflammatory pain models. However, these findings are still very limited, and more associated data are required to confirm the effectiveness of the combined choline and parecoxib sodium therapy against inflammatory pain.MethodsAdult rats were randomly divided into 9 groups (N = 6/group). The sham surgery group received an intraperitoneal (i.p.) injection of saline. Rats with chronic constriction injury (CCI) of the sciatic nerve received saline, choline (cho, 6, 12 and 24 mg/kg), parecoxib sodium (pare, 3, 6, and 12 mg/kg), or a combination of choline 6 mg/kg and parecoxib sodium 3 mg/kg. Mechanical and heat pain thresholds were measured at 30 min after drug treatment at Days 3, 5, 7, 10, and 14 after CCI. Another 30 rats were divided into 5 groups (N = 6/group): the sham, CCI + saline, CCI + cho-6 mg/kg, CCI + pare-3 mg/kg, and CCI + cho-6 mg/kg + pare-3 mg/kg groups. After repeated drug treatment for 7 days, five rats were randomly selected from each group, and the lumbar dorsal root ganglia (DRGs) (L4–6) were harvested for western blot analysis.ResultsCholine significantly attenuated mechanical and heat hypersensitivity in CCI rats at 12 and 24 mg/kg doses (P < 0.05) but was not effective at the 6 mg/kg dose. Parecoxib sodium exerted significant pain inhibitory effects at the 6 and 12 mg/kg doses (P < 0.05) but not at the 3 mg/kg dose. Combining a low dose of choline (6 mg/kg) and parecoxib sodium (3 mg/kg) produced significant pain inhibition in CCI rats and reduced the expression of high mobility group protein 1 (HMGB1) and nuclear factor-kappa Bp65 (NF-κBp65) in L4–6 DRGs.Conclusion1. In a rat model of chronic neuropathic pain (CCI), at a certain dose, choline or parecoxib sodium can alleviate mechanical pain and thermal hyperalgesia caused by CCI. 2. The combination of choline and parecoxib sodium in nonanalgesic doses can effectively relieve neuropathic pain, and its mechanism may be related to the inhibition of the high mobility group protein 1 (HMGB1)/Toll-like receptor 4 (TLR4)/nuclear factor kappa-B (NF-κB) pathway.

Musculoskeletal pain: pharmacological treatment

Abstract&#x0D; Pain has the aim of identifying a harmful stimulus and avoiding tissue damage. Acute pain has recent onset and limited duration, while chronic pain is caused by continuous tissue damage or alteration in the pathways of transmission. Musculoskeletal pain is defined as acute and/or chronic pain affecting bones, muscles, ligaments, tendons and nerves. Medical literature about clinical aspects of pain, with particular focus on musculoskeletal pain, was reviewed and combined with expert opinion of the authors. The simultaneous use of drugs with different mechanisms of action (multimodal approach) allows a more effective analgesia with better tolerability. Paracetamol is a known molecule with analgesic and antipyretic activity, better tolerated than NSAIDs. Codeine is a natural opioid that inhibits transmission at the level of the spinal synapse and enhances the action of inhibitory descending pathways. The two drugs have a similar half-life, and the same time of onset and duration of analgesic activity. Many randomized studies have shown that this combination is more effective and better tolerated than NSAIDs and the combination of paracetamol/tramadol in different types of pain, i.e. postoperative, musculoskeletal, dental, headache, osteoarthritis, polytrauma. The Italian Intersociety group recommends the use of paracetamol and the combination paracetamol/codeine 500/30 mg, repeatable every 6 hours, for the management of moderate pain in the emergency setting.&#x0D; Due to its safety and tolerability, paracetamol alone or in combination with codeine remains a first-choice treatment of mild-moderate pain, and its lack of cardiovascular and gastric toxicity represents a valid alternative to NSAIDs.

Pathogenetic Therapy in Patients with Recurrent Herpetic Infection

When treating patients with recurrent herpesvirus infection, it is necessary to use combination therapy, which involves the use of both chemotherapy and immunotropic drugs. Simultaneous use of drugs with different mechanisms of action allows to achieve greater efficiency than the use of monotherapy. The effectiveness of Cycloferon, an interferon inducer, which has an anti-inflammatory and immunomodulatory effect in combination therapy in patients with labial herpes, has been established. An accelerated elevation of rashes was observed against the background of the use of Cycloferon in combination therapy with acyclic nucleosides (Acyclovir); the severity of general intoxication syndrome, subjective symptoms (pain, itching, burning), and signs of inflammation (edema, hyperemia) decreased by half compared with the control group. Also, an increase in the duration of remission by 2–2.5 times was observed in patients taking Cycloferon. High efficiency, good tolerance by patients, as well as the possibility of using it with the main antiviral chemotherapy drugs indicate the advisability of including Cycloferon in the combination therapy in patients with recurrent herpes infection.

Potential drug interactions with garlic

Every drug may cause central nervous system, gastrointestinal tract or cardiovascular system adverse drugs reactions (ADRs). At the same time, doctors often do not have sufficient information about possible food-drug interactions, in particular, garlic. But this spice is shown to increase the risks of developing ADRs. From the beginning of the 20th century to the present, garlic has been the subject of many chemical studies, which have revealed some differences in the chemical composition of the studied preparation (fresh or stored garlic). The most important chemical ingredients found in garlic are divided into two groups: sulfur-containing (allicin [diallyl thiosulfinate], allyl methanesulfinate, alliin [S-allyl-L-cysteine sulfoxide, diallyl disulfide, DADS], S-allylmethyl cysteine, diallyl trisulfide [diallyl trisulfide, DATS], allyl methyl trisulfide, allyl methyl disulfide, diallyl tetrasulfide, allyl methyl tetrasulfide, dimethyl trisulfide, diallyl sulfide, 2-vinyl-4-H1,3-dithiine, 3-vinyl-4.-H1,2-dithiin) and sulfur-free compounds. Most of the pharmacological effects of garlic are due to sulfur compounds, in particular allicin. In animal, in vitro and clinical studies, it has been shown that garlic can interact with various drug througt pharmacokinetic or pharmacodynamic way. For example, garlic extract has shown to inhibit the metabolic activity of CYP2C9*1, 2C19, 3A4, 3A5, 3A7, but not CYP2D6. It has also been shown that garlic can affect the function thrombocyte and blood clotting, which leads to an increased risk of bleeding, which is especially important in the case of its simultaneous use with antiplatelet agents and/or anticoagulants. This article provides an overview of the open literature on the risks and benefits of the simultaneous use of drugs and products containing garlic.

Population-wide impacts of aspirin, statins, and metformin use on prostate cancer incidence and mortality

We evaluated the association between aspirin, statins, and metformin use and prostate cancer (PC) incidence and mortality using a large population-based dataset. 388,760 men who participated in national health screening program in Korea during 2002–2003 were observed from 2004 to 2013. Hazard ratios of aspirin, statins, and metformin use for PC incidence and PC mortality were calculated with adjustment for simultaneous drug use. Cumulative use of each drug was inserted as time-dependent variable with 2-year time windows. Aspirin use ≥ 1.5 year (per 2-year) was associated with borderline decrease in PC mortality when compared to non-users (adjusted hazard ratio [aHR] 0.71, 95% confidence interval [CI] 0.50–1.02). Statins use was not associated with either PC incidence or PC mortality. Metformin ever-use was associated with decreased PC incidence compared with non-diabetics (aHR 0.86, 95% CI 0.77–0.96). Diabetics who were not using metformin or using low cumulative doses had higher PC mortality than non-diabetics (aHR 2.01, 95% CI 1.44–2.81, and aHR 1.70, 95% CI 1.07–2.69, respectively). However, subjects with higher cumulative doses of metformin did not show increased PC mortality. In conclusion, metformin use was associated with lower PC incidence. Use of aspirin and that of metformin among diabetic patients were associated with lower PC mortality.

Influence of Dietary Supplement Assortment on the Population's Quality of Life

Since the appearance of the skin is an important attribute of the modern person, various methods can be used to achieve the desired. The most effective is often the simultaneous use of drugs “inside and outside”. The object of this research is dietary supplements, one of the methods for improving the appearance of the skin. The market situation for functional dietary supplements has been studied. The assortment of dietary supplements according to their purpose has been systematized (“cleansing”, “nutrition”, “protection”, “improvement of skin functions”). The results will help to make timely decisions about the need to develop products of this type.

RESULTS OF MONITORING OF PRESCRIPTION OF POTENTIALLY DANGEROUS COMBINATIONS OF DRUGS IN PHARMACOTHERAPY UNDER INPATIENT TREATMENT

In case of combined pharmacotherapy, between drugs can occur interactions, which can be dangerous to the life and health of patients. Such combinations of drugs are considered to be one of the serious clinical problems, and are considered as errors that can be prevented. Therefore, it is relevant to determine the frequency of such appointments for further work on their prevention. Aim of the research. Determine the structure and prevalence of the appointments of potentially dangerous combinations of drugs in the treatment of patients under inpatient treatment for further optimization of pharmacotherapy. Materials and methods. In the automated mode, the lists of medical appointments of patients who were under inpatient treatment of 30 health facilities of Zhytomyr region in 2017 were monitored for the purpose of the simultaneous use of drugs, the interaction of which is dangerous. For further analysis by the levels of clinical significance using the Drug Interaction Checker system, the "Major" (hazardous) and "Moderate" (significant) combinations were selected on the Internet resource www.drugs.com. The frequency of the appointments of dangerous combinations, their prevalence by the nosological classes and the profiles of the offices of medical institutions was determined. Results. As a result of the monitoring of 69405 cases, it was found that the average number of prescriptions per patient was 5.6±1.2 titles. In 1390 cases of treatment (2.0 % of 69405) simultaneously prescribed medicines, the interaction of which could be dangerous. In the structure of dangerous combinations, 81.5 % is taken with the simultaneous administration of drugs containing active substances ketorolac and pentoxifylline. The frequency of potentially dangerous appointments was greatest in the treatment of patients with diseases of the blood and blood-forming organs (D50-D89) – 11.6 %, in diseases of the musculoskeletal system and connective tissue (M00-M99) – 7.7 %, in diseases of the nervous system – 5.0 % of all cases of treatment.

Screening of furanocoumarin derivatives as cytochrome P450 3A4 inhibitors in citrus.

Furanocoumarins, such as bergamottin (BG) and 6',7'-dihydroxybergamottin (DHB), isolated from grapefruit juice are clinically active constituents capable of inhibiting cytochrome P450 3A4. Furanocoumarins are also found in hassaku, pummelo and daidai. Several types of hybrid citrus fruits have recently been developed, and these may also contain furanocoumarins because they were produced by cross-breeding pummelo, daidai and other citrus fruits. In this study, we quantified BG and DHB levels in the flesh and peel of hybrid citrus fruits. Extracts from flesh and peel were diluted with acetonitrile and analysed using high-performance liquid chromatography. For flesh extracts, lime juice (24.13μg/mL) contained a greater amount of BG than grapefruit juice (13.61μg/mL). Lime (13.21μg/mL) and sour orange (8.08μg/mL) juices also contained greater amounts of DHB than grapefruit juice (7.54μg/mL). For peel extracts, lime (1749.15μg/g), Citrus kawachibankan (308.13μg/g), lemon (203.44μg/g) and sour orange (161.95μg/g) contained greater amounts of BG than grapefruit (white) (78.80μg/g). The hybrid sweetie (Citrus maxima × Citrus paradise; 173.32μg/g) contained a greater amount of DHB than grapefruit (white) (85.27μg/g). The lime flesh and the sweetie peel contained the greatest amounts of furanocoumarins. Thus, caution is required during the simultaneous use of drugs metabolized by cytochrome P450 3A4 and consumption of these citrus fruits.

Prevalence and Geographic Variations of Polypharmacy Among West Virginia Medicaid Beneficiaries.

West Virginia (WV) residents are at high risk for polypharmacy given its considerable chronic disease burdens. To evaluate the prevalence, correlates, outcomes, and geographic variations of polypharmacy among WV Medicaid beneficiaries. In this cross-sectional study, we analyzed 2009-2010 WV Medicaid fee-for-service (FFS) claims data for adults aged 18-64 (N=37,570). We defined polypharmacy as simultaneous use of drugs from five or more different drug classes on a daily basis for at least 60 consecutive days in one year. Multilevel logistic regression was used to explore the individual- and county-level factors associated with polypharmacy. Its relationship with healthcare utilization was assessed using negative binomial regression and logistic regression. The univariate local indicators of spatial association method was applied to explore spatial patterns of polypharmacy in WV. The prevalence of polypharmacy among WV Medicaid beneficiaries was 44.6%. High-high clusters of polypharmacy were identified in southern WV, indicating counties with above-average prevalence surrounded by counties with above-average prevalence. Polypharmacy was associated with being older, female, eligible for Medicaid due to cash assistance or medical eligibility, having any chronic conditions or more chronic conditions, and living in a county with lower levels of education. Polypharmacy was associated with more hospitalizations, emergency department visits, and outpatient visits, as well as higher non-drug medical expenditures. Polypharmacy was prevalent among WV Medicaid beneficiaries and was associated with substantial healthcare utilization and expenditures. The clustering of high prevalence of polypharmacy in southern WV may suggest targeted strategies to reduce polypharmacy burden in these areas.

Potential Drug Interactions and Drug Risk during Pregnancy and Breastfeeding: An Observational Study in a Women's Health Intensive Care Unit

Introduction In the pregnancy-puerperal cycle, women may develop complications that require admission to the Intensive Care Unit (ICU). Thus, special attention to pharmacotherapy is necessary, particularly to potential drug interactions (PDIs) and to the effect of the drugs on the fetus and newborn. Objective The aim of this study was to determine the profile of PDIs and the potential risk of drugs used during pregnancy and breastfeeding among patients admitted to the ICU. Methods We conducted an observational, cross-sectional and prospective study, including pregnant and breastfeeding women admitted to the ICU at the Women's Hospital of a university in the city of Campinas, Brazil, for one year. Online databases were used to identify and classify the PDIs and the potential risk of the drugs used during pregnancy and breastfeeding. Results We evaluated 305 prescriptions of 58 women, 31 pregnant and 27 breastfeeding, and 284 (91%) prescriptions presented PDIs. A total of 175 different combinations of PDIs were identified in the prescriptions, and adverse effects caused by the simultaneous use of drugs were not actually observed in the clinical practice. A total of 26 (1.4%) PDIs were classified as contraindicated. We identified 15 (13.8%) drugs prescribed with risk D, and 2 (1.8%) with risk X for pregnant women, as well as 4 (4.9%) drugs prescribed with high risk for breastfeeding women. Conclusions This study demonstrates that there is a high incidence of PDIs in prescriptions. Most drugs used by pregnant and breastfeeding women at the ICU did not present serious risks to their fetus and newborns, but sometimes drugs with risk D or X are necessary in the course of the treatment.

Atropinic burden of drugs during pregnancy and psychological development of children: a cohort study in the EFEMERIS database.

The aim of this study was to evaluate the potential effect of in utero exposure to drugs with atropinic properties on infant psychological development using atropinic burden (AB) scales. Women from the EFEMERIS cohort, a French database including prescribed and dispensed reimbursed drugs during pregnancy and pregnancy outcomes, delivering between 2004 and 2010 were included (n = 43 740). Each drug was classified as having no (score=0), few (score=1) or strong (score=3) atropinic properties. AB per woman was calculated by adding the atropinic scores of drugs prescribed during pregnancy. AB was categorized as exposure or no exposure. Secondary analyses were performed by dividing the exposure into four scores = [0], [1-8], [9-17] and [≥18]. Data for psychological development were extracted from children's medical certificates completed at 9 and 24months. Thirty-four% (n = 14 925) of women received at least one atropinic drug during pregnancy. Women with AB ≥1 were older and received more drugs during pregnancy than unexposed women. At 24months, more infants of mothers with AB ≥1 had difficulties to 'name a picture' (ORa , 1.18, 95% CI 1.03, 1.36) and to 'understand instructions' (ORa , 1.61, 95% CI 1.13, , 2.30]) compared with infants of unexposed women. Analyses of four groups of exposure and analyses excluding women receiving psychotropics led to similar results. The study showed significant association between in utero exposure to drugs with atropinic properties and fewer infant cognitive acquisitions at 24months. Further exploring the potential effect of simultaneous use of drugs with atropinic effects among pregnant women will bring into consideration whether such prescriptions could be inappropriate for the child.

Cigarette smoking in patients newly diagnosed with pulmonary tuberculosis in Iran.

The association between pulmonary tuberculosis (PTB) and tobacco smoke has been verified by most studies on the subject; figures from different countries for the prevalence of smoking among PTB patients vary. To assess the prevalence of and factors associated with smoking among TB patients in Iran. In this cross-sectional study, subjects were included on a first-come, first-served basis from among newly diagnosed PTB patients using a multistage cluster sampling method during 2012-2014. Data were collected during face-to-face interviews and a questionnaire was used to gather information on smoking habits. Of 1127 newly diagnosed PTB patients included in the study (mean age 50.0 ± 19.8 years), 228 (20.2%) were daily smokers, 20 (1.8%) were occasional smokers and 93 (8.9%) had quit before diagnosis. Simultaneous drug use (P < 0.001, OR 75.21), increasing age (P = 0.001), being single (P < 0.001, OR 16.95), being an Iranian national (P < 0.001, OR 6.26) and living in a rural area (P < 0.001, OR 5.85) were found to be independent risk factors for smoking in study patients. The prevalence of smoking among PTB patients in Iran is relatively high. It is therefore necessary to include smoking cessation interventions in the National TB Programme.

'Weekend on the town': discrete sessions of drug use for a sample of young psychostimulant users.

Few epidemiological studies have examined the behaviours and experiences of young adults during discrete drug-use events. This study was designed to capture a rich, detailed description of discrete occasions or 'sessions' of psychostimulant use. Participants were 220 young psychostimulant users living in Melbourne, Australia, recruited through targeted advertising in entertainment street press, on websites, at events/dance parties and through peer referral between September 2007 and March 2008. The research identified the timing, sequence, frequencies, quantities and modes of alcohol and other drug administration during the participants' most recent session of psychostimulant use and explored the contexts and settings in which drug use took place. Participants were well-educated young people who used a variety of different drugs. Their most recent session of psychostimulant use was reported as highly enjoyable and typical of their other sessions of psychostimulant use. The session lasted a median of 20 h, and in most cases, simultaneous drug use was the norm, and large quantities of alcohol, psychostimulants and other drugs were consumed. Acquisition of illicit drugs commonly occurred through social networks during the course of the session and significant sums of money were reportedly spent. Findings point to a range of priorities for future research and public health interventions aimed at young psychostimulant users, focused primarily on reducing the prevalence and consequences of simultaneous and heavy/binge drug use.

Synergistic interaction between choline and aspirin against acute inflammation induced by carrageenan and lipopolysaccharide

The simultaneous use of drugs with different mechanisms of anti-inflammatory action is a strategy for achieving effective control of inflammation while minimizing dose-related side effects. Choline was described to potentiate the antinociceptive action of aspirin at small doses in several inflammatory pain models. However, these findings are only limited to alleviating pain, more associated data are required to confirm the effectiveness of the combined choline and aspirin therapy against inflammatory disorders. Moreover, no report is available regarding the mechanism responsible for their synergism. Here, we first investigated the anti-inflammatory activity and pharmacological mechanisms of co-administration of choline and aspirin in 2 commonly studied inflammation models, carrageenan-induced paw edema and lipopolysaccharide (LPS)-induced sepsis in mice. Isobolographic analysis revealed that combined choline and aspirin administration exhibited a strong synergistic interaction in reducing carrageenan-mediated edema, and the estimated combination index values at 50%, 75%, and 90% effective dose (ED50, ED75, and ED90) were 0.25, 0.32, and 0.44. Drug co-administration also afforded synergistic protection against LPS-induced sepsis and mortality, since aspirin or choline alone was inadequate to improve survival. The effects of choline-aspirin co-administration were blocked by methyllycaconitine, suggesting that activation of alpha 7 nicotinic acetylcholine receptor participates in the interaction between choline and aspirin. Furthermore, co-administration of choline and aspirin was more likely to inhibit the production of pro-inflammatory mediators induced by LPS. Our results indicated that combined choline and aspirin therapy represented a significant synergistic interaction in attenuating acute inflammatory response. This preclinical relevant evidence provides a promising approach to treat inflammation-based diseases such as arthritis and sepsis.

Pharmaceutical Point of View on Parenteral Nutrition

Parenteral nutrition—a form of administering nutrients, electrolytes, trace elements, vitamins, and water—is a widely used mode of therapy applied in many diseases, in patients of different ages both at home and in hospital. The success of nutritional therapy depends chiefly on proper determination of the patient's energetic and electrolytic needs as well as preparation and administration of a safe nutritional mixture. As a parenterally administered drug, it is expected to be microbiologically and physicochemically stable, with all of the components compatible with each other. It is very difficult to obtain a stable nutritional mixture due to the fact that it is a complex, two-phase drug. Also, the risk of incompatibility between mixture components and packaging should be taken into consideration and possibly eliminated. Since parenteral nutrition is a part of therapy, simultaneous use of drugs may cause pharmacokinetic and pharmacodynamic interactions as well as those with the pharmaceutical phase. The aim of this paper is to discuss such aspects of parenteral nutrition as mixture stability, methodology, and methods for determining the stability of nutritional mixtures and drugs added to them.

Simultaneous use of Mephedrone and Alcohol: A Qualitative Study of Users’ Experiences

Mephedrone (4-methylmethcathinone) gained popularity across “recreational” drug scenes in the United Kingdom and Ireland during 2009. Although mephedrone was banned in both jurisdictions in 2010, the drug was subsequently sourced through street dealers. This qualitative study explores the simultaneous use of mephedrone and alcohol, among study participants who used mephedrone following legislative controls. Data were collected through semi-structured interviews with male and female respondents. The results suggest a three-tier classification system that describes users’ experiences with simultaneous use of mephedrone and alcohol. Most participants engaged in “heavy” alcohol use immediately prior to consuming mephedrone, and then reduced alcohol consumption as the effects of mephedrone were experienced during the drug episode. Spontaneous use of mephedrone often was associated with larger amounts of alcohol being consumed just prior to the mephedrone episode. The findings have the potential for informing socioepidemiological surveys as well as peer interventions to reduce harm associated with simultaneous drug use.