Use Of Such Medications Research Articles

Morphine-induced cognitive impairment is attenuated by induced pain in rats.

Opioid medications are frequently used in the effective treatment of intractable pain, but prolonged use of such medications can be complicated by a host of adverse effects. Among these adverse effects, tolerance and mental clouding can be especially disabling and can lead to both a reduced effectiveness of treatment and a reduced quality of life for many requiring treatment with these medications. Here we examined the relative contributions of complete Freund's adjuvant (CFA)-induced inflammatory pain and opioid medication on spatial memory for a well-learned task in male Sprague-Dawley rats. Although CFA, by itself, had little effect on spatial memory, morphine administered to pain-free animals produced profound detrimental effects on spatial memory that persisted longer than the analgesic effectiveness of the drug. However, no significant cognitive deficits were observed in animals receiving morphine in the presence of CFA-induced pain. Taken together, these results are evidence that the pain state of the organism can alter some of the negative effects of morphine.

Knowledge of elderly women about the use of psychotropics

The process of aging can result in diseases and the need for psychotropic medication. This exploratory and descriptive research with qualitative approach aimed to describe the knowledge of the elderly women about the use of such medication. We interviewed 18 elderly subjects, from July to August 2009, registered in the Family Health Strategy that had been using benzodiazepine and / or antidepressants. The data were organized through Bardin’s technique of content analysis. This research showed that the elderly knew the therapeutic indication of the psychotropic medication, how to distinguish the adverse reactions and reported addiction, mainly to benzodiazepine. We concluded that elderly people assisted by the Family Health Strategy acquired knowledge about psychotropic drugs in their everyday experience and that it is necessary to extend discussions on the topic, as well as the formulation of guidelines aimed at the use of psychotropic drugs by the elderly.

Should prophylactic antibiotics be used routinely in epistaxis patients with nasal packs?

IntroductionThe current mainstream practice in otolaryngology departments relating to the use of prophylactic antibiotics in epistaxis patients requiring nasal packing is highly variable. This is due primarily to the lack of any validated guidelines. As such, we introduced a new treatment algorithm resulting in significant reduction of use in the systemic antibiotics, with emphasis instead on the use of topical antibiotics. The results were validated through a complete audit cycle.MethodsA total of 57 patients undergoing nasal packing for spontaneous epistaxis were studied. Reaudit occurred after the implementation of new guidelines. Telephone surveys were conducted six weeks after hospital discharge, assessing infective nasal symptoms as well as rebleeding and readmission rates.ResultsSystemic antibiotic prescribing in anterior nasal packing fell by 58.2% between audit cycles with no statistically significant associated increase in infective nasal symptoms, rebleeding or readmission rates six weeks following hospital discharge.ConclusionsSystemic prophylactic antibiotics are unnecessary in the majority of epistaxis patients with nasal packs. The use of topical antibiotics such as Naseptin® may be more appropriate, cheaper and as effective. Implementation of this treatment algorithm will help standardise systemic antibiotic usage in epistaxis patients with nasal packing and should reduce costs associated with unnecessary use of such medication.

Prevalence and predictors of prescription psychoactive medication use in adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study

Childhood cancer survivors are at risk for late effects which may be managed pharmacologically. The purposes of this study were to estimate and compare the prevalence of psychoactive medication use of adult survivors of childhood cancer and sibling controls, identify predictors of medication use in survivors, and investigate associations between psychoactive medications and health-related quality of life (HRQOL). Psychoactive medication use from 1994 to 2010 was evaluated in 10,378 adult survivors from the Childhood Cancer Survivor Study. A randomly selected subset of 3,206 siblings served as a comparison group. Multivariable logistic regression models were used to calculate odds ratios (OR) for baseline and new onset of self-reported psychoactive medication use and HRQOL. Survivors were significantly more likely to report baseline (22 vs. 15 %, p < 0.001) and new onset (31 vs. 25 %, p < 0.001) psychoactive medication use compared to siblings, as well as use of multiple medications (p < 0.001). In multivariable models, controlling for pain and psychological distress, female survivors were significantly more likely to report baseline and new onset use of antidepressants (OR = 2.66, 95 % CI = 2.01-3.52; OR = 2.02, 95 % CI = 1.72-2.38, respectively) and multiple medications (OR = 1.80, 95 % CI = 1.48-2.19; OR = 1.77, 95 % CI = 1.48-2.13, respectively). Non-cranial radiation and amputation predicted incident use of analgesics >15 years following diagnosis. Antidepressants were associated with impairment across all domains of HRQOL, with the exception of physical function. Prevalence of psychoactive medication use was higher among survivors for most medication classes, as was the use of multiple medications. Clinicians should be aware of the possible contribution of psychoactive medications to HRQOL. Survivors of childhood cancer are more likely to be prescribed psychoactive medication than their sibling counterparts, though use of such medication does not appear to normalize quality of life. Survivors are encouraged to consider additional interventions, including psychosocial support and physical exercise.

The Pediatric Cardiology Pharmacopeia: 2013 Update

The use of medications plays a pivotal role in the management of children with heart diseases. Most children with increased pulmonary blood flow require chronic use of anticongestive heart failure medications until more definitive interventional or surgical procedures are performed. The use of such medications, particularly inotropic agents and diuretics, is even more amplified during the postoperative period. Currently, children are undergoing surgical intervention at an ever younger age with excellent results aided by advanced anesthetic and postoperative care. The most significant of these advanced measures includes invasive and noninvasive monitoring as well as a wide array of pharmacologic agents. This review update provides a medication guide for medical practitioners involved in care of children with heart diseases.

Abstract 201: Trends In Preventive Care Among High Risk Diabetics Prior To Acute Coronary Syndromes; Is There Room For Improvement?

Background: Effective heart disease prevention for patients with diabetes (DM) includes pharmacotherapy such as aspirin, ace-inhibitors and statins. Thus use of such medications among diabetics is an important quality measure. We examined trends in such therapies over time, comparing mediations utilization at time for acute coronary syndrome (ACS) admission for DM and non-DM patients Methods: Data on home medications prior to index ACS event, demographics, and co-morbidities was collected as part of a registry of ACS patients from January 1999 to January 2007. Results: A total of 3,240 ACS patients were included, of which 951(29%) had a diagnosis of DM on admission. Compared to non-DM patients, those with a history of DM were older, and more likely to be obese and have a prior diagnosis of hypertension, hyperlipidemia, and heart disease including angina, myocardial infarction, and coronary revascularization. On admission, DM patients were significantly more likely to be on aspirin 3.51 [1.79, 6.88, p=0.0003], beta blockers 1.71 [1.46, 1.99, p &lt;0.001]; ACE inhibitors 2.79 [2.39, 3.27, p&lt;0.001] and Lipid Lowering Agents 1.95 [1.67, 2.28, p&lt;0.001] compared to non-DM patients. However the overall rates of preventive medications among DM patients was low. Among DM patients with no contraindication, medication prevalence prior to admission was 58.3% for aspirin, 52.9% for ace-inhibitors, and 52.5% for lipid lowering medications including statin therapy. Rates of these medications did increase significantly from 1999 to 2007 (Figure1.) After adjusting for a DM status, age, gender, and six month GRACE 6-month mortality risk score, use of preventive medications prior to admission were associated with a reduced risk of major adverse cardiac events at six months. Conclusions: Despite being at high risk for cardiac events, patients with a history of DM are often not receiving preventive medications such as aspirin, ace-inhibitors and statins. Such medications are independently associated with outcomes at six-month post ACS; suggesting improvements in receipt of these medications may reduce risk pre and post ACS among patients with DM.

The Prevalence of Fibromyalgia in Other Chronic Pain Conditions

Central sensitivity syndromes (CSS) include fibromyalgia syndrome (FMS), irritable bowel syndrome, temporomandibular disorder, restless legs syndrome, chronic fatigue syndrome, and other similar chronic painful conditions that are based on central sensitization (CS). CSS are mutually associated. In this paper, prevalence of FMS among other members of CSS has been described. An important recent recognition is an increased prevalence of FMS in other chronic pain conditions with structural pathology, for example, rheumatoid arthritis, systemic lupus, ankylosing spondylitis, osteoarthritis, diabetes mellitus, and inflammatory bowel disease. Diagnosis and proper management of FMS among these diseases are of crucial importance so that unwarranted use of such medications as corticosteroids can be avoided, since FMS often occurs when RA or SLE is relatively mild.

Improving Adherence — Money Isn't the Only Thing

Interventions that both improve outcomes and save costs are unusual, but the provision of lifesaving medications to survivors of myocardial infarction is one such example.1 In the past, physicians' poor compliance with evidence-based guidelines was a major reason for suboptimal use of such medications. Now, with help from the dissemination of quality metrics, cost-saving medications such as beta-blockers, aspirin, and angiotensin-converting–enzyme (ACE) inhibitors are nearly universally prescribed to eligible patients after myocardial infarction,2,3 so the focus has switched from physician prescribing to patient adherence. The concept of value-based insurance design,4 which is encouraged by the Patient Protection and Affordable . . .

Piodermatite-pioestomatite vegetante: relato de caso e revisão de literatura

Pyodermatitis-pyostomatitis vegetans is a rare inflammatory dermatosis of unknown etiology, with a typical mucocutaneous involvement. We report the case of a woman with pustular and vesicular lesions in the axillae, evolving with vegetating plaques and pustules with annular grouping. The disease progressed with vulvar and inguinal involvement as well as involvement of the oral, nasal and ocular mucous membranes. She started the treatment with prednisone (40 mg/day), with remission of the lesions after one month of use of such medication. Association with inflammatory bowel disease occurs in 70% of the cases. Immunofluorescence, which is typically negative, helps to characterize the disease. A rapid response to systemic steroids is expected.

A case of hepatic injury suspected to be caused by Canephron N, a Centaurium Hill containing phytotherapeutics

Drug induced liver impairment causes 2–5% of hospitalizations in patients with jaundice and 10–20% of cases of fulminant hepatic failure [1]. Herbal medicines are the cause of drug induced liver impairment in only 2% of patients [2]. But due to wide use of such medications, especially for self-treatment, they may be a clinically significant cause of hepatotoxicity [3]. In this article, we describe a case of drug induced hepatic injury presumably caused by use of a medication containing extracts of Centaurium Hill herb, Lovage root, and Rosmarinus leaves (other ingredients: Corn starch, colloid silicon dioxide, lactose monohydrate, poly(1-vinyl-2-pyrrolidone), magnesium stearate, red ferric oxide (E172), riboflavin E101, calcium carbonate, dextrose, modified corn starch, glycol mineral wax, castor oil, sucrose, shellac, talc, titanium dioxide). A 66-years-old woman, employed as a research officer, is admitted to internal medicine unit with jaundice of skin, mucosa, and sclera. The patient was diagnosed with schizophrenia after a psychotic episode in 2007 and is since taking risperidone and clomipramine. She is under a surveillance of a psychiatrist and her physician observed no relapse of psychosis. She has not had viral hepatitis, she also denies having any alcohol or illicit drug abuse. Otherwise her medical history is unremarkable. Two weeks before hospitalization she noticed baggy skin below the eyes, her urination became more frequent, but remained painless and without hematuria. For this she attended her primary care physician who after having diagnosed cystitis prescribed Canephron N (Bionorica AG, Germany, http:// www.bionorica.de/cda/produkte auf einen blick/canephron n/content-128906.html) containing extracts from Centaurium (Centaurium umbellatum), Lovage (Levisticum officinale) and Rosmarinus (Rosmarinus officinale) at a dose of 2 dragee three times a day for two weeks. After 1 week of treatment the patient noticed jaundice on sclera, then on skin. Jaundice was increasing in intensity, but the patient did not experience any other symptoms. Two days before admission she has a biochemistry panel made which revealed high bilirubine 369,2 mcmol/l (reference range 9–25 mcmol/l), direct bilirubine – 284,5 mcmol/l, ALT (SGPT) 302 EU/L (reference range 0–40), AST (SGOT) 89 EU/L (reference range 0–40), GGT 456

Photoacoustic technique: a new method for measuring the rheologic properties of human bronchial mucus

Patients affected by obstructive pulmonary diseases exhibit typical characteristics of airway mucus hypersecretion, including sputum production, increased luminal mucus, goblet cell hyperplasia and submucosal gland hypertrophy. The mucociliary system is a sophisticated defense mechanism to maintain the homeostasis of the respiratory tract by means of the bronchial mucus transport, the process in which airway mucus together with substances trapped within are moved out of the lungs. In the end, the mucus together with the substances trapped within are swallowed or coughed up. It is an important defense mechanism of the human body [1]. Mucociliary clearance is influenced by viscosity and elasticity, that are the fundamental rheologic properties of the respiratory mucus and important determinants of its transportability in the mucociliary system [2]. It has been observed that the rheologic properties of mucus are often abnormal in patients with airways disease [3]. A retardation in mucociliary transport may lead to mucus retention, a condition which predisposes to bacterial colonization and may eventually lead to pneumonia. Drugs may alter the process of mucociliary transport, such that it is necessary to know the effect of the drugs on the rheologic properties of human bronchial mucus. Understanding the interaction of a specific drug with human bronchial mucus may lead to a better therapeutic use of such medication. The photoacoustic technique (PAT) is a new method that permits to monitor indirectly the rheologic properties of any mucus sample [3,4]. PAT enables to study the interaction between therapeutic aerosols and bronchial mucus, making it possible to determine the typical time of interaction between the aerosol and the mucus (T0) and the solubilization period (Δt). According to our knowledge it is important to have an experimental technique that permits the monitoring of the rheologic properties of mucus during the interaction with the specific drug.

Prevalence and Predictors of Anticholinergic Medication Use in Elderly Nursing Home Residents with Dementia

Medications with anticholinergic properties are frequently used in the elderly population. However, evidence suggests that these medications are associated with significant adverse effects and may lead to worsening of cognitive impairment, particularly in elderly patients with dementia. To examine the utilization of anticholinergic medications and factors associated with anticholinergic medication use in elderly nursing home patients with dementia. The study examined anticholinergic medication utilization for patients aged ≥65 years with dementia, using the 2004 US National Nursing Home Survey (NNHS) data. Anticholinergic drugs were identified using the Anticholinergic Drug Scale (ADS), which classifies anticholinergic drugs into four levels in increasing order of their anticholinergic activity. Descriptive analysis was conducted using sampling weights to determine the prevalence of anticholinergic medication use. Multiple logistic regression within the conceptual framework of the Andersen Behavioral Model was used to examine the factors associated with anticholinergic medication use in the study population. Use of medications with marked anticholinergic activities (ADS level 2 or 3) was the dependent variable, and independent variables were the various predisposing, enabling and need factors. According to the 2004 NNHS, 509,931 (95% CI 490,160, 529,702) or 73.62% (95% CI 72.23, 75.00) of elderly patients with dementia used anticholinergic medications. The highest prevalence of anticholinergic medication use among elderly patients with dementia was seen for level-1 medications (67.96%; 95% CI 66.51, 69.41), and 21.27% (95% CI 19.93, 22.60) used ADS level-2 or level-3 medications. Multivariate regression analysis showed that the predisposing factor of age was negatively associated with the use of medications with marked anticholinergic activities (ADS level 2 or 3) and the enabling factor of Medicaid as the source of payment increased the likelihood of receiving these higher-level anticholinergics. Among the need factors, dependence in decision-making ability and behavioural symptoms decreased the likelihood of receiving higher-level anticholinergics, whereas factors such as total number of medications, depressed mood indicators and diagnoses of schizophrenia, anxiety and Parkinson's disease increased the likelihood of use of such medications. Over one in five elderly nursing home residents with dementia used medications with marked anticholinergic activities. The study findings suggest the need to optimize the use of anticholinergic medications in vulnerable patients with dementia given the potentially severe adverse cognitive effects of these agents.

Minireview: New Roles for Peripheral Dopamine on Metabolic Control and Tumor Growth: Let’s Seek the Balance

In peripheral tissues, dopamine is released from neuronal cells and is synthesized within specific parenchyma. Dopamine released from sympathetic nerves predominantly contributes to plasma dopamine levels. Despite growing evidence for peripheral source and action of dopamine and the widespread expression of dopamine receptors in peripheral tissues, most studies have focused on functions of dopamine in the central nervous system. Symptoms of several brain disorders, including schizophrenia, Parkinson's disease, attention-deficit hyperactivity disorder, and depression, are alleviated by pharmacological modulation of dopamine transmission. Regarding systemic disorders, the role of dopamine is still poorly understood. Here we describe the pioneering and recent evidence for functional roles of peripheral dopamine. Peripheral and central dopamine systems are sensitive to environmental stress, such as a high-fat diet, suggesting a basis of covariance of peripheral and central actions of dopaminergic agents. Given the extended use of such medications, it is crucial to better understand the integrated effects of dopamine in the whole organism. Delineation of peripheral and central dopaminergic mechanisms would facilitate targeted and safer use of drugs modulating dopamine action. We discuss the increasing evidence for a link between peripheral dopamine and obesity. This review also describes the recently uncovered protective actions of dopamine on energy metabolism and proliferation in tumoral cells.

Delirium among children and adolescents in an urban sub-Saharan African setting

Objectives The purpose of this study is to describe the demographic and clinical profile, mortality rates, and effectiveness of a multifaceted treatment approach in hospitalized children and adolescents with delirium referred to psychiatry. Methods We report a series of 23 children and adolescents prospectively diagnosed with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, delirium after referral to a consultation–liaison psychiatry service based in a large, regional, dedicated children's hospital in South Africa. Results Children and adolescents with delirium referred to psychiatrists appear to represent a subgroup of delirious patients with a high risk of mortality, an underrepresentation of hypoactive cases, and complex, multifactorial, and often uncertain etiologies. A significant minority of these cases may be managed without the use of psychotropic medications. Uncontrolled data provide supportive evidence for the moderate effectiveness of both haloperidol and risperidone in childhood delirium when explicit criteria guiding the use of antipsychotic medications are utilized. Conclusions Delirium is an important and underresearched disorder in children and adolescents. Although the evidence base for the use of antipsychotic medications in childhood delirium remains relatively slim, tentative threshold criteria for the use of such medications are suggested by this study. Controlled studies comparing different antipsychotic medications with each other and with nonpharmacological strategies are urgently required.

Contraindicated Medication Use in Dialysis Patients Undergoing Percutaneous Coronary Intervention

The US Food and Drug Administration guides clinicians through drug labeling of medications that are contraindicated or not recommended for use in specific patient groups. Little is known about the use of such medications and their effects on outcomes in clinical practice. To investigate the use of the contraindicated/not-recommended agents enoxaparin and eptifibatide among dialysis patients undergoing percutaneous coronary intervention (PCI) and their association with outcomes. Data from 829 US hospitals on 22 778 dialysis patients who underwent PCI between January 1, 2004, and August 31, 2008. In-hospital bleeding and death. Five thousand eighty-four patients (22.3%) received a contraindicated antithrombotic; of these patients, 2375 (46.7%) received enoxaparin, 3261 (64.1%) received eptifibatide, and 552 (10.9%) received both. Compared with patients who did not receive a contraindicated antithrombotic, patients who did had higher rates of in-hospital bleeding (5.6% vs 2.9%; odds ratio [OR], 1.93; 95% confidence interval [CI],1.66-2.23) and death (6.5% vs 3.9%; OR, 1.68; 95% CI, 1.46-1.95). After multivariable adjustment, patients receiving contraindicated antithrombotics had significantly higher risks of in-hospital bleeding (OR, 1.66; 95% CI, 1.43-1.92) and death (OR, 1.24; 95% CI, 1.04-1.48). In 10 158 patients matched by propensity scores, receipt of contraindicated antithrombotics remained significantly associated with in-hospital bleeding (OR, 1.63; 95% CI, 1.35-1.98) but not in-hospital death (OR, 1.15; 95% CI, 0.97-1.36). In a sample of dialysis patients undergoing PCI, 22.3% received a contraindicated antithrombotic medication. In propensity-matched analysis, receipt of these medications was significantly associated with an increased risk of in-hospital major bleeding.

Identifying Clinically Questionable Psychotropic Prescribing Practices for Medicaid Recipients in New York State

This study sought to identify and characterize rates of clinically questionable prescribing in New York State. As part of a quality improvement initiative, 34 national psychopharmacology experts identified a set of questionable prescribing practices recognizable from pharmacy claims data. Indicators of such practices were applied to Medicaid claims data for 217,216 beneficiaries in New York State who had an active psychotropic prescription on April 1, 2008. A total of 156,103 (72%) of these beneficiaries had one or more continuing (>90 days) prescriptions for a psychotropic. About 10% of adults were prescribed four or more psychotropics concurrently, and 13% of children and 2% of older adults were prescribed three or more concurrently. Prescribing an antipsychotic with a moderate-to-high risk of causing metabolic abnormalities approached 50% (46%) among individuals who had existing cardiometabolic conditions. Among beneficiaries prescribed second-generation antipsychotics with a moderate-to-high risk of causing metabolic abnormalities, over half (60%) had not received a metabolic screening test in the past year. Among women of reproductive age prescribed mood stabilizers, over one-quarter (30%) were prescribed a valproic acid-based formulation despite its potential for teratogenicity. Only 2% of youths under age 18 were prescribed benzodiazepines; however, about half (48%) had trials over 90 days' duration. Examination of pharmacy claims from Medicaid beneficiaries in New York State indicated that prescribing practices deemed clinically questionable by pharmacology experts are common. Aggregated pharmacy claims data can identify such practices, and reviews of these data can be a core component of efforts to improve prescribing practices.

Identifying Clinically Questionable Psychotropic Prescribing Practices for Medicaid Recipients in New York State

Identifying Clinically Questionable Psychotropic Prescribing Practices for Medicaid Recipients in New York State

Diagnostic Manual–Intellectual Disability: A Textbook of Diagnosis of Mental Disorders in Persons With Intellectual Disability, by R. Fletcher, E. Loschen, C. Stavrakaki, and M. First

Diagnostic Manual–Intellectual Disability: A Textbook of Diagnosis of Mental Disorders in Persons With Intellectual Disability, by R. Fletcher, E. Loschen, C. Stavrakaki, and M. First

Moving Health Information Technology Forward

Moving Health Information Technology Forward

Whether Kids With ADHD Get Treated May Depend on Parents' Income

Whether Kids With ADHD Get Treated May Depend on Parents' Income