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Critical study of the use of long acting neuroleptics (depot neuroleptics) in France.

Long acting neuroleptics (L.A.N.) represent 11% of the medical prescription of neuroleptics in France (about 40,000 patients in 1974). Some psychiatrists remain reluctant to prescribe long acting-neuroleptics and many problems related to their use are still solved empirically:1) relation between the posology of the standard Neuroleptic and the corresponding L.A.N. 2)the problem of dose-interval. 3) the necessary prescription of an parkinsonian. The superiority of N.A.P. over the Neuroleptic Standard has received no experimental confirmation in France, but the L.A.N. appear to us as an original therapy, the "pivot chemotherapy" around which psychotherapy and sociotherapy can be arranged without anarchical and ceaseless changes of neuroleptic compounds and of posology.

Antipsychotic Agents↗

Inhibition by naloxone of tolerance and dependence in mice treated acutely and chronically with morphine.

The inhibition by naloxone of tolerance and dependence in morphinized mice is dose- and time-dependent. In animals receiving a single, large dose of morphine, partial inhibition by naloxone of the analgesic effect results in partial development of tolerance and dependence. This relationship appears to be true for animals which have been treated with morphine chronically. Complete and sustained blockage of morphine receptors by naloxone is required for complete inhibition of the development of tolerance and dependence.

Analgesics, Opioid↗

The medical management of angina pectoris.

The availability of excellent short-acting and long-acting drugs for the treatment of angina pectoris needs to be emphasized. Properly used in conjunction with other measures such as the treatment of hypertension and a graded exercise routine, they provide, for most patients with angina, a tested therapeutic program that is remarkably effective, well-tolerated, appropriate for long-term outpatient use, and quite inexpensive.

Adrenergic beta-Antagonists↗

[Zollinger-Ellison syndrome treated medically by an inhibitor of H2 histamine receptors].

Metiamide an histamine H2-receptors antagonist has been used to treat a case of Zollinger-Ellison syndrome characterized by a long standing diarrhea, an important gastric hypersecretion and a moderatly elevated plasma gastrin but without digestive ulceration. At the dose of 600 mg per day, Metiamide induced a complete suppression of acid secretion, an effect which lasted for 15 days after stopping the drug. Accordingly and since the only finding at time of laparotomy was a small lymph node enlarged with endocrine metastatic tissue, the stomach was left intact and Metiamide pursued. During the first 4 months of chronic administration of Metiamide, acid secretion was maintained at levels below 25 p.cent of initial values. Ulteriorly however, although dosages of Metiamide were increased, acid hypersecretion resumed and a duodenal ulcer developed. Total gastrectomy was then performed 11 months after the beginning of Metiamide. In spite of the failure of Metiamide treatment, the long term follow up of this case of Zollinger-Ellison Syndrome, allowed us to get theoretical and practical informations.

Adult↗

[Drug-drug interactions (author's transl)].

This short outline of drug-drug interactions does not claim to cover the entire field. The task of this paper is to illustrate the most important principles of drug-drug interactions by paradigms taken from the experience of the practitioner. One consequence of drug-drug interactions is the change in pharmacolinetic parameters important for the therapeutical effect of drugs in the organism. Very often the elucidation of the mechanisms of drug-drug interactions in man is impossible; therefore, for clinical pharmacologists experiments on animals remain the tool in order to gain more knowledge in this field.

Age Factors↗

[Galenical possibilities and problems in protraction of drug effects (author's transl)].

In recent years, dosage forms with sustained release have obtained a significant importance. The technological possibilities for manufacturing are described as coating, embedding and matrix procedures. The range of auxiliary substances, which are responsible for the retardation of drug activity, reaches from lipophilic compounds as lipoids, fatty alcohols and compounds which are forming hydrogels as cellulose derivatives and natural polysaccharides to synthetic polymers derived from acrylic acid. The formulation of the dosage forms requires particular care in respect to the amount of initial and maintenance doses. On account of technological processes, for example during manufacturing of tablets, under certain circumstances the liberation rate is altered. In vitro test methods allow comparisons only then when the results can be counter-checked by in vitro experiments. The release of drug follows different mechanisms, which are described, entirely or in part, to be reactions following the time law of zero or first order. In special cases, a linear correlation is observed as a function of square root of time. The calculation of given special equations for events within the dosage form is feasible from blood-level values.

Biological Availability↗

[The influence of neuroleptic drugs on urinary excretion of non-protein nitrogen (author's transl)].

During treatment with thioxanthenes or phenothiazines of schizophrenic patients non-protein nitrogen in urine was measured. The values were calculated in relation to the excretion of creatinine. a) Flupentixol or fluphenazine applied in optimal dosage, increased the excretion of urea and the amino acids asp, glu + gln, and gly. b) Moreover, if the drug induced a parkinsonoid (thioridazine) the excretion of ser and thr was increased, too. The usual desalting procedure by ion-exchanging resins before chromatography increases the contents of several amino acids, e.g. asp, asn, ala, gly, cys, ser, thr, indicating a breakdown of some instable products.

Amino Acids↗