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Biomedical subjects

G M Levin

Publications and source records attributed to G M Levin.

31 records · Page 2Linked to original sources
PubMed1995

Attention-deficit hyperactivity disorder: the pharmacist's role.

Included in the variety of options for treating ADHD are several classes of pharmacologic agents with various side effects and monitoring parameters. The pharmacist must understand the issues involved with the use of the agents in each class. The pharmacist is often the most accessible health care professional and can take advantage of this fact to counsel and support both patients and family members. Table 5 offers counseling tips and additional information for the pharmacist. Of the medications discussed here, the stimulants are recognized as the most effective for treating ADHD, with the amphetamines and methylphenidate providing equal benefit. In some instances, pemoline has also been shown to be as effective as the other stimulants. Second-line agents are the TCAs, of which imipramine is the most commonly prescribed. However, the other TCAs are probably just as effective; some may have a less burdensome profile of side effects and may result in better compliance. Next in line is bupropion or clonidine, both of which show promise for ADHD treatment. Nevertheless, these agents need to be tested in more rigorous trials. Agents of last resort include the MAOIs, of which tranylcypromine has been the most studied. The ideal agent for treating ADHD would have an immediate onset, provide benefit throughout the day, have few or no side effects, lack the potential for abuse, be effective for most patients, and be relatively inexpensive. This ideal agent has yet to be discovered. Clinicians and researchers are still looking for a medication to come as close to the ideal therapy as possible. Therefore, it is not uncommon for a pharmacist to see a patient with ADHD try several different medications. In addition, children in whom ADHD is refractory to currently available options or who cannot tolerate these options may also be given other psychotropic medications not mentioned in this review.

Antidepressive Agents, Tricyclic↗
PubMed1993

Treatment of aggressive children with clonidine: results of an open pilot study.

Seventeen aggressive children (14 boys and 3 girls) aged 5 to 15 years, who were characterized by cruel behavior to others and destruction of property, entered an open pilot study using clonidine to evaluate its efficacy and safety and drug-induced changes in plasma gamma aminobutyric acid (GABA). Aggression decreased in 15 children with minimal side effects. In five cases, GABA increased from 105.4 +/- 15.2 ng/mL at baseline to 125.2 +/- 10.8 ng/mL at follow-up (p < 0.01). A sixth patient was noncompliant. These findings suggest that GABA may be correlated with childhood aggressiveness and may be a useful marker of drug compliance. Pharmacotherapy with clonidine should be further assessed for the control of aggression.

Adolescent↗
PubMed1993

Prescribing attitudes of different physician groups regarding fluoxetine.

OBJECTIVE: To determine the attitudes and prescribing patterns of family medicine and psychiatric physicians regarding fluoxetine. DESIGN: A three-part questionnaire was distributed to the Departments of Family Medicine and Psychiatry. The survey included topics associated with fluoxetine use that have received broad professional attention, such as drug-induced suicidal and aggressive behavior. SETTING: The Family Practice Medical Group and the Department of Psychiatry at the University of Florida. PARTICIPANTS: Mailing lists from both above departments were used to distribute surveys to residents, fellows, and attending/faculty members of each department. Eighty-seven surveys were mailed. MAIN OUTCOME MEASURES: Survey questions were divided into three sections to help determine current attitudes of prescribing fluoxetine: eight short cases, 16 statements, and demographic data. RESULTS: The return rate was 69 percent following a mailing and a hand-delivered copy. Responses were dichotomized to agree or disagree and were analyzed by Fisher's exact test. Psychiatrists were much more likely than family practitioners to prescribe fluoxetine for obsessive-compulsive disorder (OCD), and more likely to prescribe for a patient with a history of substance abuse or seizure disorder. Psychiatrists were more aware of safety issues; however, drug-interaction knowledge was weak in both groups. CONCLUSIONS: Family practitioners, being the most predominant of medical specialists, appeared equally comfortable with prescribing fluoxetine in most circumstances compared with psychiatrists. However, there is a need for pharmacists to provide up-to-date drug information on fluoxetine to all healthcare professionals.

Depressive Disorder↗
PubMed1992

A review of cyclic antidepressant-induced blood dyscrasias.

OBJECTIVE: To review the literature for cases of blood dyscrasias associated with cyclic antidepressants. Several types of blood dyscrasias are discussed. DATA SOURCES: All references were selected through the use of MEDLINE. Indexing terms were blood, abnormalities, dyscrasias, antidepressants, agranulocytosis, and eosinophilia. The only constraints were English language and human subjects. STUDY SELECTION: All cases were included except for letters to the editor of various journals when pertinent data such as doses and additional medications were omitted. DATA SYNTHESIS: The review provides a table listing the different blood dyscrasias and the drug the patient was receiving. The table also includes time of onset, time to recovery, and several symptoms for each patient. CONCLUSIONS: Common symptoms of various blood dyscrasias are discussed. The chemical structures of the antidepressants are related to phenothiazines, which are also implicated in causing blood dyscrasias. Recommendations for treatment of both the dyscrasia and depression are discussed.

Adult↗
PubMed1986

Free and conjugated plasma catecholamines in pheochromocytoma patients with and without sustained hypertension.

Ten pheochromocytoma patients, five with paroxysmal hypertension (Group 1), five with sustained hypertension (Group 2) and 15 normals were studied to determine the relationship between differential secretion of the catecholamines (CA) or differences in their sulphoconjugation and the hypertension patterns in these patients. Group 1 patients were studied in the normotensive period. A consistent finding in this study is that permanent hypertensive patients showed the highest free and conjugated norepinephrine (NE) levels while paroxysmal patients studied during the normotensive period showed the highest conjugated epinephrine (E) levels. Although no significant difference was found in levels of free plasma epinephrine in the Group 1 patients, in the ratio of total plasma E/NE, E was clearly predominant. No significant differences could be found in the degree of the per cent conjugation of individual catecholamines between both groups of patients. Group 1 showed a higher (P less than 0.05) E and a lower dopamine (DA) per cent conjugation than controls. In conclusion, although the dominant type of CA secreted seems to be the main factor in determining the hypertension pattern, sulphoconjugation ability may also play an important role.

Adolescent↗
PubMedDate not supplied

Engineering challenges to the long term operation of the International Space Station.

The U.S. Congress has maintained an intense interest in the ISS program since its inception. In the Appropriations Act of 1997, the Senate of the United States included language directing National Aeronautics and Space Administration (NASA) to have the National Research Council (NRC) under take a study that evaluates the engineering challenges posed by extravehicular activity (EVA) requirements, United States and non-United States space launch requirements, the potential need to upgrade or replace equipment and components after Assembly Complete, and the requirement to decommission and disassemble the facility. NASA and the NRC decided the focus should be on the anticipated challenges in the continuous operation and maintenance of the ISS after assembly of the on-orbit facility has been completed. This would encompass the operational years, from late 2004 (if the current schedule holds) to 2020-2025. This executive summary overviews the results of this NRC study. It focuses on the U.S. operation of the ISS after Assembly Complete, including cooperative efforts by the United States and Russia. The paper summarizes the primary findings and recommendations in each of the areas considered during this two-year NRC study.

Astronauts↗
PubMedDate not supplied

Sympathetic nervous system response to graded exercise: effect of beta-blockade.

This study compares the sympathetic nervous system response to graded exercise in normotensive and essential hypertensive subjects with and without beta-adrenergic blockade. Blood pressure (BP), heart rate, and plasma norepinephrine (NE), epinephrine (E), and dopamine (DA) were measured just before starting the exercise (Pre-Ex), in the submaximal exercise (Sub-max),and after 8 minutes rest (Post-Ex). On placebo, Sub-max induced in both normotensives and hypertensives a similar increase in NE and E plasma levels. Plasma DA remained unchanged. Propranolol in controls and propranolol or mepindolol in hypertensives didn't modify significantly: 1) Pre-Ex plasma levels of E, NE, and DA; 2) response at Sub-max in controls; 3) plasma E and DA in hypertensive patients. In hypertensives on beta-blockade, submaximal exercise elicited a greater increase in plasma NE. Values for plasma NE in patients on propranolol were 1135 +/- 229 pg/ml higher than those obtained in the same patients on placebo (p less than 0.001). On mepindolol, the plasma NE increment was higher than that on placebo (p less than 0.05), but lower than that on propranolol (p less than 0.01). In controls, propranolol did not significantly modify BP at Pre-Ex or its response to exercise, whereas systolic and diastolic BP were significantly lower at Pre-Ex, Sub-max, and Post-Ex in hypertensives. On beta-blockade, heart rate decrease in Pre-Ex, Sub-max, and Post-Ex were not different in controls and hypertensives. The differences found on beta blockade would indicate that the effects of beta blockers are not identical in normotensive and hypertensive subjects.

Adrenergic beta-Antagonists↗
PubMedDate not supplied

Sertindole, a new atypical antipsychotic for the treatment of schizophrenia.

The introduction of antipsychotics for the management of schizophrenia greatly improved the quality of life of many patients suffering from this debilitating disease. Although typical antipsychotic drugs represent a significant advancement in psychopharmacology, they carry a heavy side effect burden, have little efficacy in the management of negative symptoms, and are ineffective in about one-third of patients with schizophrenia. Atypical antipsychotic agents characterized the next major advancement in pharmacotherapy. They differ from typical antipsychotics in their mechanism of action, side effect profiles, and clinical efficacy. Sertindole is a new atypical antipsychotic.

Antipsychotic Agents↗
PubMedDate not supplied

Quetiapine, an atypical antipsychotic.

The discovery of antipsychotic agents in the 1950s revolutionized the treatment of schizophrenia. A large body of evidence supports the dopamine D2 receptor antagonist's efficacy in the treatment of psychotic symptoms. However, the advent of newer agents seems to point to a more complex interaction of neurotransmission in the pathophysiology of schizophrenia. In fact, a defining characteristic of atypical agents is a higher ratio of serotonin (5HT2) receptor blockade to D2 receptor blockade. Clozapine was the first atypical agent to be introduced; it was followed by risperidone, olanzapine, and now quetiapine, which is a dibenzothiazepine derivative structurally related to clozapine and olanzapine.

Antipsychotic Agents↗