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PubMed1989

Prescribing patterns of neuroactive drugs in 98 schizophrenic patients.

Ninety-eight schizophrenic outpatients receiving pharmacotherapy were surveyed on two census days, 18 months apart. From this study sample it was found that, as recently as 1987, 18% of the patients were prescribed three classes of neuroactive drugs--16% two antipsychotic drugs simultaneously. Of antipsychotics receivers, 44% were prescribed anticholinergics, 3% antidepressants, and 4% benzodiazepines. Between census days, a significant shift from use of oral antipsychotics to the depot form of administration occurred, while polypharmacy frequency remained unchanged. An analysis of the data will provide guidelines for rendering a more rational pharmacological treatment.

Adolescent↗

PubMed1989

Antirheumatic agents: CNS toxicity and its avoidance.

Altered drug metabolism, polypharmacy, multiple diseases, and errors in self-medication are all factors seen in the elderly which increase the risk for side effects from antirheumatic drug therapy. The geriatric presentation of central nervous system (CNS) toxicity, which is common yet frequently overlooked, is reviewed as it pertains to various drugs commonly used to treat rheumatic disease. Practical advice on avoiding common pitfalls in antirheumatic prescribing is offered.

Aged↗

PubMedDate not supplied

[Lennox-Gestaut syndrome: therapeutic aspects].

The Lennox-Gastaut Syndrome is one of the most refractory form of epilepsy and a variety of compounds, such as traditional antiepileptics, "new anticonvulsants" and non-anticonvulsant drugs has been tested. ACTH and, among the traditional antiepileptics. Clonazepam and Sodium Valproate showed the most favorable effects. The immediate (within 6 months) therapeutic response to ACTH and Clonazepam is satisfactory, with a more than 50% reduction of seizures in about one half of patients; after one year, however, only a small percentage of cases (7-10%), rather close to that with spontaneous remission, shows some therapeutic benefit. Valproate, when used as a single drug, produces a decrease in seizures (greater than 50%) in 25-30% of pts. A list of compounds, such as amphetamine, taurine, amantadine, allopurinol and, among the new putative antiepileptics, cinromide and gamma-vinyl-GABA, has been tested with some occasionally observed improvement in seizure control. None of these compounds, however, is of really proven efficacy. An acquired general rule of treatment is to avoid complex polypharmacy and overdose; there is in fact good evidence that making the child drowsy will greatly increase the number of fits.

Anticonvulsants↗

PubMed1989

Review of states' practices on the use of psychotropic medication.

Concerns involved with prescription of psychotropic medication to persons with developmental disabilities to ameliorate maladaptive behavior were described. Responses to a national survey of state agencies regarding statutes, regulations, and operating procedures for initiating and monitoring psychotropic drug regimens were examined. The survey showed that most states had more rules and regulations for persons in institutions than in community settings. It also showed that some states have initiated rules similar to court-ordered guidelines for assessing tardive dyskinesia, restricting the use of antiparkinson drugs and polypharmacy, and implementing periodic drug interruptions. Recommendations were made based on these findings.

Drug Therapy, Combination↗

PubMed1989

GI problems in the elderly, Part I: Aging-related considerations.

Gastrointestinal problems are very common in the elderly; they account for 20% of all geriatric deaths. The evaluation of gastrointestinal ailments is difficult in the aged due to variation in signs and symptoms, coexisting nutritional problems, lack of patient cooperation, presence of comorbidity, and effects of polypharmacy. Poor clinical histories are common and gastrointestinal ailments may be atypical. Non-compliance with therapy and testing is a common problem and unrealistic expectations from interventions are the rule rather than the exception. Iatrogenic disorders must be ruled out in all patients with gastrointestinal symptoms; an accurate drug and nutritional history is critical for achieving success in the management of the elderly.

Aged↗

PubMedDate not supplied

Drug interactions.

Any patient taking two or more drugs is at risk for an adverse drug interaction. However, drug interactions are not always dangerous; some can be beneficial (i.e., protamine to neutralize a heparin overdose). The development and release of many new drugs in recent years makes it difficult to stay abreast of all possible drug interactions. Nurses can help polypharmacy to be safe and effective in their patients by understanding the important mechanisms and sites by which drugs interact.

Drug Interactions↗

PubMed1987

Angiotensin converting enzyme inhibitors in the clinic: first-dose hypotension.

A fall in blood pressure occurs, in most patients, within a few hours of a single dose of an angiotensin converting enzyme (ACE) inhibitor. While a serious fall in pressure is unusual in previously untreated essential hypertension, some patients are at risk of severe first-dose hypotension. These include those with treated heart failure, severe hypertension on polypharmacy, 'renin-dependent' renovascular hypertension and the occasional elderly patient. In such groups of patients the incidence of severe, symptomatic first-dose hypotension approaches 10%. This effect is not specific for ACE inhibitor therapy and may well occur as frequently with other drugs in such patients. First-dose hypotension may not be accompanied by tachycardia, possibly as a result of a parasympathomimetic action that may contribute to the first-dose effect. It is generally not possible to predict patients at risk, although plasma renin and angiotensin II concentrations show a modest positive correlation with the initial fall in blood pressure. The maximum initial hypotensive effect of ACE inhibitors is not clearly dose related but the duration of effect may be. Therefore such drugs should be started at minimum effective dosage. High-risk patients should be observed closely for at least 6 h. Symptomatic hypotension usually responds to supine rest although infusion of angiotensin II, atropine and occasionally saline may be required.

Atenolol↗

PubMed1985

Antipsychotic medication: clinical guidelines for maintenance therapy.

In neuroleptic maintenance therapy, first-illness schizophrenic patients should be prescribed continuing medication for at least one year. In the management of chronic schizophrenic patients following relapse, neuroleptic medication in standard oral doses or depot injections is recommended for periods in excess of 5 years to reduce the risk of relapse. Results are summarized from studies regarding drug therapy in conjunction with psychotherapeutic factors and family environment, the efficacy of lower dosage, benefit/risk ratios, and the advantages of long-term neuroleptic maintenance. The relationships of neuroleptic dose to plasma level and to therapeutic response are considered, as well as the implications of polypharmacy (e.g., use of anticholinergic drugs with neuroleptics).

Administration, Oral↗

PubMed1986

Drug-induced hyperkalemia.

This is the era of polypharmacy. Treatment with multiple therapeutic agents for multiple underlying medical conditions leads to greater vulnerability to such metabolic imbalances as hyperkalemia. The physician must know which underlying medical conditions and drugs predispose to abnormal intracellular-extracellular potassium balance and abnormal regulation of potassium excretion.

Adrenergic beta-Antagonists↗

PubMed1989

Rational pharmacotherapy for the elderly.

Aging is accompanied by normal physiologic changes. Paralleling these changes, disease further contributes to a decline in optimal organ-system function. Many of these changes produce significant alterations in pharmacodynamics and pharmacokinetics that are relevant to safe and effective pharmacotherapy in the elderly. As aging is accompanied by disease, chronic disease states lead to polypharmacy and drug-drug interactions. Drug therapy may cause further decline in organ-system functions, precipitate or exacerbate preexisting disease, and produce drug-induced illness. Consequently, pharamcotherapy in the elderly should only be instituted following comprehensive dentomedical assessment. Use as few drugs as possible. Prescribe the lowest therapeutic dose. Assess the patient's response frequently for compliance, drug effects, and toxicity. Discontinue unnecessary medications.

Aged↗

PubMed1988

Essential factors in the care of elderly patients.

With the increase in life expectancy since the turn of the century, all optometrists must have a good understanding of essential factors in the care of elderly patients. Some of the most important aspects of the clinical approach to and understanding of the elderly patient are considered here. Characteristic differences in symptomatology, the altered doctor-patient relationship, polypharmacy and compliance issues, and altered environmental needs are also described.

Aged↗

PubMed1978

Psychologists and psychoactive drugs.

Research on psychoactive drugs: antianxiety, antidepressant, and antipsychotic was reviewed. The drug families and their usual side effects were described. Proliferation of drug use, polypharmacy, and tardive dyskinesia were seen as areas of concern; advances in biological explanations of schizophrenia and manic-depressive disorders, and increasing knowledge about the brain's neurotransmitters brightened the investigative efforts.

Anti-Anxiety Agents↗

PubMed1987

A comparative study of the relative effects of anticonvulsant drugs and dietary folate on the red cell folate status of patients with epilepsy.

In a survey of the red cell folate status of 200 patients with epilepsy, compared to 72 controls, we found that median red cell folate levels were reduced significantly in patients treated with phenytoin (p less than 0.01) or carbamazepine (p less than 0.001) alone. Patients taking more than one drug had reduced levels also (p less than 0.001), but in patients treated with sodium valproate alone there was no significant decrease in red cell folate levels compared to controls. Twenty-two per cent of patients in the group taking more than one drug had reduced levels of red cell folate compared with 17 per cent of those taking carbamazepine alone, 13 per cent of those taking phenytoin only, and 9 per cent of those taking sodium valproate only. Dietary folate intake was significantly reduced in all the patient groups compared with controls (p less than 0.001 for the carbamazepine and phenytoin groups, p less than 0.01 for the polypharmacy and sodium valproate groups); a significant correlation between red cell folate levels and dietary folate was not established. Significant negative relationships were established between carbamazepine dose (r = -0.35, p less than 0.01) or serum level (r = -0.27, p less than 0.05) and red cell folate level in patients on one drug only. The correlation between dose or serum level of phenytoin and red cell folate level was also negative but did not reach significance. Our findings show that all anticonvulsant drugs interfere with folate metabolism.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1988

Accidental salicylate intoxication in a hemodialysis patient.

A 61-year-old woman receiving long-term hemodialysis presented with symptoms of tinnitus, insomnia, malaise, and disequilibrium. On close questioning, it was discovered that she had received a prescription for salsalate (Disalcid) from a consulting physician who had evaluated her for joint pain. This tablet was similar in appearance to a dried aluminum hydroxide gel preparation (Alu-tab) that the patient was taking as a phosphate binder. She had mistakenly been taking six Disalcid tablets with each meal. Her salicylate level was 5.86 mmol/L, but she had no change in her serum electrolyte levels or acid-base status. When the salsalate treatment was stopped and regular dialysis treatments were continued, the symptoms of salicylism resolved. This case illustrates one of the potential dangers of polypharmacy in patients with chronic disease. The midl course was probably due to ongoing hemodialysis, which prevented the appearance of the usual acid-base abnormalities of salicylate intoxication.

Aluminum Hydroxide↗

PubMed1988

[Use of psychotropic drugs in mentally handicapped adults].

Type and frequency of psychotropic drug treatment have been analysed in the case of 1154 institutionalized and non-institutionalized mentally retarded adults. The psychotropic drug prevalence amounts to 21.7%, only about one half of corresponding rates in other studies; possible causes of this result are discussed. Neuroleptics are prescribed most frequently by far, succeeded by anxiolytics. The psychotropic drug prevalence is significantly related to age, sex, and setting. A comparison of the psychotropic drug treatment of 1980 with that of 1986 above all shows a distinctly rarer prescription of anxiolytics and hypnotics as well as a decrease of polypharmacy in 1986.

Adult↗

PubMed1988

Geriatric rheumatology: safe use of potentially toxic antirheumatics.

Despite what is known about pharmacokinetics in the elderly, there is little information regarding the relationship between age and disease-modifying antirheumatic agents or immunosuppressive drugs. Musculoskeletal diseases are common in the aging population, and the therapeutic use of potentially toxic pharmacologic agents, including immunosuppressives, is prevalent. A number of factors influence the potential for toxicity in this age group, including polypharmacy and age-related physiologic change. An overview of clinical pharmacologic factors in the elderly is presented, and available information on efficacy and toxicity of disease-modifying antirheumatics and immunosuppressives is reviewed.

Aged↗

PubMed1979

A survey of psychotropic medication in mental retardation facilities.

A survey of psychotropic drug usage by questionnaires was conducted at 5 regional residential centers for the mentally subnormal in Eastern Ontario, Canada. Of the 2238 residents studied, 42% were given psychotropics, 27% anticonvulsants, and 11% a combination of both. Prolonged medication and polypharmacy were observed in all facilities. The therapeutic responses to psychotropic medication were generally poor, especially among the disturbed epileptics who had received psychotropic and anticonvulsant simultaneously. It is estimated that between one-half to two-thirds of those on psychotropics were given the agents too liberally.

Adolescent↗

PubMed1979

Antipsychotic drugs: can education change prescribing practices?

Forty-two VA Hospitals participated in an evaluation of educational techniques for physicians on the use of psychotherapeutic drugs. The purpose of the study was to determine whether educational techniques, such as articles and videotapes can be instrumental in changing physician prescribing practices so that they are more in conformity with current recommendations. The 2 major findings of the study were that there was less polypharmacy--less use of antiparkinson drugs and less use of antiparkinson drugs for longer than 6 months--and that there were no statistically significant differences among educational groups.

Antiparkinson Agents↗