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Biomedical subjects

J Camí

Publications and source records attributed to J Camí.

At least 55 records · Page 3Linked to original sources
PubMed1993

[Clinical effectiveness of naloxone in acute ethanol intoxication].

The first articles trying to link the effects of ethyl alcohol with those of opiates appeared in 1970. The first case of reversion from ethylic coma due to naloxone was described in 1978. Since then, many authors have reported different results related to the effectiveness of opiate antagonists in this clinical situation, without any of the studies showing a beneficial effect from its use. The purpose of the present study is to perform a double-blinded clinical trial with placebo to evaluate naloxone's clinical effectiveness in severe ethylic intoxication, using the Glasgow test (GT) to measure the level of consciousness. Treatment was randomly assigned to 38 patients of whom 18 received 2 mg of naloxone and 20 a placebo. Among the results, it was found that the best approximation of the level of alcoholemia responsible for ethylic coma, without the involvement of other toxic psychotropes, was made using the Glasgow test, especially in patients who are occasional drinkers. It was shown that naloxone indeed lacks effectiveness in ethylic coma, raising the level of consciousness only one or two points in the Glasgow test for the 15 to 45 minutes after its administration and primarily in the group of patients with the lowest levels of consciousness.

Adolescent↗
PubMed1993

Alcohol and cocaine interactions in humans.

The effects of 100 mg of intranasal cocaine (COC) in acute alcohol intoxication (1 g/kg) was assessed in nine experienced and non-dependent healthy volunteers in a double-blind, controlled, randomized, cross-over clinical trial. Alcohol alone impaired psychomotor performance, whereas COC alone produced subjective effects related to euphoria and well-being, improved the reaction time and increased heart rate and blood pressure. The combination of COC and alcohol induced a nonsignificant decrease in the subjective feelings of drunkeness, an increase in COC-induced euphoria, a significant improvement in alcohol-related changes in psychomotor performance and a marked increase in heart rate. Subjects experienced subjective and performance effects that could be self-interpreted as more pleasant compared to the effects of alcohol alone. When alcohol was given simultaneously, COC plasma levels were higher (possibly as a result of an inhibition of hepatic metabolism of COC produced by alcohol), norcocaine plasma levels almost doubled and cocaethylene was detected in plasma, so that its basic pharmacokinetic profile could be described. The simultaneous use of both drugs produced changes in heart rate and blood pressure that could increase the risk of cardiovascular toxicity associated with the use of COC.

Adult↗
PubMed1992

Assessment and management of opioid withdrawal symptoms in buprenorphine-dependent subjects.

The spontaneous physical dependence of buprenorphine was assessed in opioid addicts who switched from heroin to sublingual or intravenous buprenorphine. Twenty-two patients were randomly assigned to double-blind administration of methadone (n = 11) or placebo (n = 11) for 13 days after abrupt withdrawal of buprenorphine. Methadone was administered according to four pre-established dosing schedules depending on the previous amount of daily consumed buprenorphine. No methadone-treated patient required modification of the therapeutic regimen, whereas eight of eleven placebo-treated patients needed treatment with methadone. Buprenorphine withdrawal syndrome was of opioid type, began somewhat more slowly, and showed a peak until day 5. The occurrence, time-course and characteristics of buprenorphine withdrawal syndrome make it necessary to reconsider the abuse potential of this analgesic.

Adult↗
PubMed1992

Hypercortisolism after opioid discontinuation in rapid detoxification of heroin addicts.

Long-term opioid consumption can induce hypoadrenalism through impairment of the hypothalamic-pituitary-adrenal axis. Results of the present study showed that, in heroin addicts, saliva cortisol concentrations varied according to the amount of recently consumed heroin and the time elapsed since the last self-administration. Hypercortisolism was observed either after abrupt withdrawal of heroin or the last dose of methadone. Post-detoxification hypercortisolism was still present on day 16 after the last opioid consumption, whereas it was not observed in abstinent addicts for a mean period of 4 months. During detoxification treatment, mean AUC8-24 cortisol in saliva of clonidine or guanfacine-treated patients was significantly higher than that in methadone-treated patients. It may be hypothesized that elevated cortisol levels may account for untoward effects of adrenergic agonist therapy which, in turn, may represent an added risk factor for relapse during detoxification. Further studies are necessary to correlate the severity of withdrawal symptoms to cortisol levels in opioid addicts detoxified with alpha 2-adrenergic agonist substitution.

Adult↗
PubMed1992

[Treatment of acute pain in a general hospital: opinions of physicians and nurses].

A survey was carried amongst physicians and nurses of a general hospital, in order to know their opinion about acute pain treatment. Out of 106 physicians and 153 nurses questioned, 72 and 105 respectively answered the questionnaire. Two thirds of them though that analgesic treatment was currently good, although, it could be improved if they increased their knowledge about it. Twenty nine per cent of physicians thought that their patients were receiving lower doses than what they had prescribed and that this fact could be responsible for the treatment failure. Those questioned believed that approximately 30% of patients treated with opium derivatives for over a week could develop addiction problems. Our study confirmed the existence of inadequate attitudes towards the need for analgesics in patients with acute pain.

Acute Disease↗
PubMed1991

Effect of subject expectancy on the THC intoxication and disposition from smoked hashish cigarettes.

Subject expectancy on cannabis effects was assessed in a balanced-placebo study in experienced consumers who smoked cigarettes containing hashish (200 mg hashish with 11.5% THC per 1 g tobacco cigarette) (n = 24) or placebo (n = 24). Although statistically significant differences were not found between subjects who received the drug with positive or negative expectancy, a tendency toward more marked subjective effects was shown in subjects who expected and received the drug. This trend was supported by the significant difference observed in the mean AUC0-25 of the heart rate between subjects who smoked hashish with positive or negative expectancies. In subjects who received hashish, the sum AUC0-205 of THC and COOH-THC of those who expected the drug was greater than in those who did not expect it (p less than 0.05). The ratio THC/COOH-THC AUC0-205 was lower in those with positive expectancy than in those with negative expectancy (p less than 0.02). An increased metabolism of THC was shown in subjects with positive expectancy. Positive expectancy induced powerful subjective effects in the absence of active THC. Expectancy appeared to influence smoking behavior, as seen in higher plasma levels of cannabinoids for the group who received the drug.

Adult↗
PubMed1991

Perspectives and future on testing for abuse liability in humans.

Testing of drugs for abuse liability can benefit public health. By encouraging proper therapeutic use, appropriate regulation, and development of safer and more effective drugs, such testing can benefit both consumers and pharmaceutical manufacturers. Many factors influence actual abuse; animal and human drug abuse liability testing procedures are useful, though imperfect, predictors of abuse. Three suggestions are made concerning human drug abuse liability testing: (1) that more research is needed on differences between individuals and between different subpopulations tested with these procedures (2) that actual epidemiological experience concerning abuse should be the 'gold standard' for assessing the validity and utility of drug abuse liability testing methods; and (3) that methods for drug abuse liability testing in humans should be introduced and used systematically to guide appropriate development, regulation, and marketing of drugs.

Drug and Narcotic Control↗
PubMed1991

Pharmacokinetic considerations in abuse liability evaluation.

The behavioral effects of a drug are related to three factors: its intrinsic pharmacological activity, its physicochemical properties, and its pharmacokinetic parameters. In many cases differences in absorption, distribution, metabolism, and elimination may explain the different abuse liability profiles of drugs from within the same pharmacological class. Rapid absorption rate and high lipid solubility are the most important factors contributing to early drug concentrations in the brain. Differences in drug metabolism may be related to dose-dependent kinetics, first-pass metabolism, and variations in genetic traits (e.g. poor or extensive metabolizers). Metabolic pathways may produce active metabolites with similar or greater pharmacological activity than the parent substance. Drugs with a rapid elimination rate have been associated with greater self-administration and with early emergence of withdrawal symptoms. More pharmacokinetic studies are needed in human drug abuse liability evaluations. Knowledge of the plasma concentrations of drugs and their pharmacokinetic parameters can be essential to interpret differences among similar drugs in human abuse liability assessments.

Drug Evaluation↗
PubMed1990

Simultaneous detection in urine of cocaine and its main metabolites.

The simultaneous detection in urine of cocaine (CO), and the main biotransformation products, benzoylecgonine (BE) and ecgonine methyl ester (EME), is difficult due to their different physicochemical properties. The method presented involves a bonded silica solid-phase extraction procedure that allows mixed ionic and apolar interactions with the analyte. After extraction the compounds are derivatized sequentially with ethyliodide to obtain the BE ethyl ester derivative, and with N-methyl-N-trimethylsilyl trifluoroacetamide (MSTFA) to obtain the O-TMS derivatives. The derivatized compounds are then analysed by a capillary (methylphenylsilicone) gas chromatographic system equipped with a specific nitrogen-phosphorus detector. The method is suitable for the confirmation and quantitation of CO and its main metabolites in urine. BE levels in urine samples (n = 20) measured by the described method and by an immunological technique were in close agreement (r = 0.999).

Chemical Phenomena↗
PubMed1990

Efficacy of clonidine, guanfacine and methadone in the rapid detoxification of heroin addicts: a controlled clinical trial.

The efficacy of clonidine, methadone, and guanfacine in rapid detoxification of heroin inpatients was assessed in a randomized controlled clinical trial. Signs and symptoms of abstinence and of side effects were analysed in 90 heroin addicts successfully completing a 12-day inpatient trial. All patients fit DSM-III criteria for opioid dependence, the age range being 18 to 36 years. All three drugs were effective in controlling abstinence; however, the course of abstinence was different in the methadone group as compared to the adrenergic agonists, the latter showing limitations in their ability to suppress withdrawal manifestations. While mean number of withdrawal signs and symptoms was significantly lower during days 2 to 5 in the methadone group (p less than 0.01), adrenergic agonists were slightly more effective at the end of the trial. Incidence of side effects was closely related to the dose administered. Hypotensive action of adrenergic agonists was more marked in orthostatic position. The present results suggest that methadone is superior to adrenergic agonists. Between these drugs clonidine appears to be less effective than guanfacine in controlling some withdrawal manifestations, and causes more side effects, mainly of cardiovascular nature.

Adrenergic alpha-Agonists↗
PubMed1989

[Outcome of a sample of heroin addicts 2 years after the beginning of treatment (project EMETHYST)].

The Multicentric Study for the Evaluation of Treatment and Follow-up of Narcotic Addicts (EMETYST project) recruited 311 heroin addicts who asked for treatment between March and July, 1985, and who have been followed for two years. The sample was obtained from 16 specialized outpatient drug-free clinics. 78% of patients were males, their mean age was 24 years, and 73% lived with their parents or relatives. During the last year, 53% had been working and 17% had been in jail, 61% had started treatment for the first time. Throughout the follow up a reduction in the use of heroin, cannabis and tranquilizers was observed, as well as an improved psychological status and a reduction in illegal activities. By contrast, the use of cocaine, alcohol and tobacco did not change. There was no increase, either, in the proportion of persons who either studied or worked, and their judicial status, as measured by the number of police arrests, trials and imprisonments, showed a deterioration. The improvements found after 6 months persisted throughout the follow up. After 2 years, 54% abstained from heroin use. The patients that remained more than 90 days on therapy and those without previous judicial procedures had a better overall outcome.

Adult↗
PubMed1989

Effect of quinolones on caffeine disposition.

Six healthy volunteers received a single caffeine dose after pretreatment with norfloxacin, pipemidic acid, or placebo in a crossover, randomized, single-blind clinical trial. Quinolones altered the pharmacokinetics of caffeine, with a significant increase in the AUCs and a decrease in plasma clearance. The elimination half-life increased significantly with pipemidic acid. The apparent volume of distribution, mean renal clearance, and time to reach maximum caffeine concentrations remained unaltered. There was a decline in caffeine metabolite levels in the 24-hour urine samples for both quinolone treatments, suggesting that pipemidic acid and, to a lesser degree, norfloxacin inhibit metabolism of the N-demethylation pathways of caffeine. The practical consequence of this observation could be caffeine accumulation during repeated intake of coffee. In two additional healthy volunteers under a controlled multiple-dose regimen of caffeine ingestion, administration of pipemidic acid for 2 days caused a fourfold increase in the plasma concentrations of caffeine.

Adult↗
PubMed1989

Success and failure at inpatient heroin detoxification.

Predictors of either detoxification success or failure were evaluated during an inpatient trial that compared the efficacy of methadone, clonidine and guanfacine for rapid heroin detoxification. The analysis of such predictors was stimulated by the fact that in order to achieve 90 patients who completed the study (30 in each group), a total of 170 patients had to be included. Of 80 detoxification failures, 10 occurred in the methadone group, 32 in the guanfacine group, and 38 in the clonidine group. Voluntary request for discontinuation of the detoxification schedule was the first cause of failure. There were not statistically significant differences with regard to sociodemographic characteristics and pattern of drug consumption among patients in the three groups who completed detoxification with success or failure. The treatment drug, the type of schedule and the score obtained from the Symptom Checklist-90/Revised (SCL-90/R) were the only predictors of either detoxification success or failure. Inpatient opioid detoxification would be a useful strategy for patients with more severe psychological symptoms.

Adult↗