Audit of psychoactive drug prescriptions in group homes.
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Biomedical subjects
Publications and source records attributed to C W Gowdey.
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Several studies have shown that there are differential levels of salsolinol excretion between consumers of varying levels of alcohol. The excreted salsolinol may arise during metabolism of alcohol, reflect endogenous biosynthesis of the compound, or result from ingestion of exogenous salsolinol. A previous study identified that salsolinol excretion in urine distinguished light and heavy social drinkers, who had consumed chocolate (containing salsolinol) in combination with a test dose of alcohol. The present study was designed to examine the relationship between social drinking level and the excretion of salsolinol after ingesting dietary salsolinol alone. Participants were 120 volunteers, balanced for gender, social drinking level (abstainers, light, moderate and heavy), and dose of salsolinol. Urine samples were taken on entry, and at 90 minutes and 3 hours after consumption of chocolate. Analysis revealed a dose effect on salsolinol excretion. There were no main or interactive effects of gender or social drinking on salsolinol excretion. The results indicate that the appearance of salsolinol in urine following dietary consumption alone is insufficient to distinguish alcohol consumption levels in social drinkers.
This paper describes the Adverse Drug Reaction Reporting Program developed and operated by the Committee on Drugs and Pharmaco-therapy of the Ontario Medical Association. Analyses were done to demonstrate some of the trends derived from the reports. Some of the clinical observations based on the reports, which are published quarterly and circulated to physicians and to pharmacy, nursing and hospital organizations, are also reviewed.
Salsolinol, a substance that may participate in the development of alcoholism, has been identified in urine and other biological samples from alcoholics. Differentials have been observed between alcoholics and controls. Salsolinol forms when dopamine reacts with acetaldehyde, which may exist in higher concentrations in the blood of alcoholics after alcohol ingestion. Hence, it was postulated that there is a relationship between level of social drinking and the elaboration of salsolinol. Salsolinol is also found in certain food and beverage products. Eighty volunteers, balanced for gender, social drinking level, ethanol dose administered and experimental diet provided urine samples 90 minutes and three hours after ethanol was consumed. Salsolinol levels were analysed in urine using high performance liquid chromatography. A 24 hour carryover effect was observed. Diet, ethanol dose and social drinking level had main and interactive effects on excreted quantities of salsolinol. Gender, situational stress and cigarette smoking had minor if any influence on salsolinol excretion. While there was no evident difference in amounts of salsolinol excreted by light and heavy drinkers in the absence of external sources of salsolinol, heavy social drinkers excreted less salsolinol than did light drinkers after consuming a "salsolinol-enriched" diet, suggesting that they differ in some aspect of absorption, distribution, or metabolism of salsolinol after drinking ethanol. Accordingly, studies that attempt to determine whether salsolinol has any relationship to drinking behaviour in humans should be particularly concerned with salsolinol that occurs in exogenous sources.
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The placebo effect is capable of relieving pain in a substantial proportion of patients; affective disorders also respond to the administration of inert medication. Changes in objective measures, such as blood pressure and blood glucose levels, demonstrate the action of placebos. The underlying mechanisms are not yet known, but because the nature and strength of the placebo response are governed by the patient's perceptions, both positive and negative results may be obtained. The complexity of human perception has made it extremely difficult to characterize the people who react. In clinical situations the placebo may be underused as a therapeutic agent, while in clinical trials the effect may be inadequately evaluated; the power and nature of the placebo effect truly warrant greater recognition.
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When morphine is instilled directly into the ventromedial hypothalamus of rats there is a latent period followed by a prolonged bout of feeding. This enhanced activity may be mediated by the release of norepinephrine; for morphine-induced feeding was depressed by the alpha-adrenergic receptor blocker phentolamine. Several neurotransmitter agonists and antagonists failed to duplicate this action: propranolol, serotonin, methysergide, apomorphine and haloperidol were ineffective in modifying ingestion elicited after morphine. Unlike apomorphine, dopamine augmented morphine's feeding effect. This difference may exist because dopamine acts as a precursor for norepinephrine formation in local ventromedial hypothalamic neurons.
The effects of long-acting narcotic agonist preparations on the severe withdrawal syndrome following abrupt cessation of daily injections of codeine phosphate were studied in rats. Twelve hours after the last codeine injections, one injection of either a high or low dose of the zinc tannate salt of heroin, levo-alpha-acetylmethadol (LAAM) or hydromorphone in slow-release vehicle (SRV) was administered. Body weight, core temperature and hyperirritability scores (Teiger, 1974) were recorded every 6 h for the next 3 days. With the exception of the group that received the lower dose of heroin zinc tannate, all drug-treated groups lost significantly less weight than the SRV controls. All rats injected with either LAAM or hydromorphone zinc tannate exhibited prolonged marked hyperthermia, but the low, the high dose heroin groups and the SRV groups showed no significant differences in diurnal temperature patterns. Rats treated with the narcotic agonists were generally less irritable, as indicated by lower Teiger scores. These results indicate that a single injection of heroin, LAAM or hydromorphone zinc tannate can ameliorate the characteristic and intense signs of abstinence following withdrawal from codeine.
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The licking behavior of male Sprague-Dawley rats individually housed in a controlled environment with a 12-h lighting schedule and food and water available ad libitum was recorded every 30 min. Body weight and 24-h fluid intake were measured daily at 0800 hours, after which subcutaneous injection was given. When saline (0.3 mL/100 g) was injected as a control for 5 days, only a small percentage of total daily licking behavior occurred during the light hours. Heroin hydrochloride (5 or 20 mg/kg) was then injected for the next 10 days. The first injection of heroin caused a cessation of licking behavior followed by a bout of daytime drinking so that the percentage occurring during the light hours increased. This "stimulated" licking occurred progressively earlier as heroin injections were repeated. Total daily fluid intake and rate of weight gain during heroin treatment were not significantly different from those in the control period, although they tended to be less with the higher dose. Withdrawal from this dose led to mild transient hyperirritability (Teiger scores) during the first 36 h and another change of licking behavior. The results suggest that the diurnal licking pattern of rats drinking ad libitum is especially vulnerable to disruption by heroin.
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Complex zinc tannate salts of heroin, hydromorphone and l-alpha-acetylmethadol were synthesized and injected in a slow-release vehicle, into rats. One, 3, 7, 10 and 14 days after the drug was administered rats were injected with naloxone hydrochloride (10 mg/kg) and during the following 4 hours body weights, core temperature and behavioral signs such as diarrhea, writhing, teeth chattering and wet dog shakes were recorded. On every naloxone testing day the narcotic-treated groups presented behavioral signs of abstinence, but weight loss and temperature changes were much less consistent. Reduction of core temperature following naloxone administration seems to be an earlier indicator of physical dependence than weight loss. According to the parameters tested a level of physical dependence can persist for at least two weeks after a single injection of these narcotic salts.
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Core temperatures, measured by telemetry, and acquisition of food pellets on a continuous reinforcement schedule were recorded every 30 min in unrestrained male rats given saline for 5 days before and 5 days after 10 daily SC injections of codeine phosphate (200 mg/kg) at 08:00 hr. After the first codeine injection rats were immobile, slightly catatonic, breathed shallowly and had elevated core temperatures, loss of body weight and inhibition of feeding activity. As injections of codeine were repeated, the initial depressant signs decreased and the period of inhibited feeding was replaced by prolonged (greater than 8 hr) post-injection bouts of feeding activity (stimulated feeding) during daylight hours. Core temperatures remained elevated during this phase of drug-induced feeding activity. Mean body weight and 24-hr food intake remained below control levels over the 10-day codeine period as diurnal feeding patterns became reversed. On the first withdrawal day core temperatures declined and feeding patterns changed from those responses on the last codeine day as the rats lost body weight and were hyperirritable. As withdrawal continued core temperature and feeding patterns began to resemble those of the saline control period, body weights increased and hyperirritability subsided. In this study, tolerance and evidence of physical dependence to daily injections of codeine could be demonstrated in rats by continuous monitoring of their diurnal feeding and temperature responses.
Core temperatures of unrestrained male rats were measured by rectal probe over a 4-h period following seven daily subcutaneous injections of morphine sulphate in doses of 5, 20, or 80 mg/kg. With the smaller doses, rapid hyperthermia occurred and was maximal after 20 mg/kg; with 80 mg/kg, two of eight rats had immediate hypothermia, with the group response being a small, delayed hyperthermia. The results with repeated administration of morphine give statistical validity to earlier findings suggesting that peak hyperthermia increased and occurred progressively sooner after each injection of morphine. In groups of naive rats a single injection was given of saline or of 1, 10, or 40 mg naloxone hydrochloride per kilogram in saline. In these rats saline led to a slight increase in core temperature; when the first injection was one of the three doses of naloxone, no transient increase was seen. In nine other groups each of the three doses of naloxone was given 15 min before each of the morphine doses. All three doses of naloxone significantly reduced the hyperthermia induced by 5 and 20 mg morphine sulphate per kilogram, but this was less apparent in the group treated with 80 mg/kg, although naloxone at 40 mg/kg prevented any increase in temperature for over 3 h. The results obtained in this study demonstrate that morphine-induced temperature changes and perhaps stress-induced changes can be suppressed by naloxone.