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Biomedical subjects

P Cushman

Publications and source records attributed to P Cushman.

At least 37 records · Page 2Linked to original sources
PubMed1987

Clonidine and alcohol withdrawal.

Clonidine attenuates opiate withdrawal syndrome, via reduction in catecholamine activity in the brain, most probably at the locus ceruleus. Clonidine and locus ceruleus lesions, in animals with alcohol dependency as with the opiates, modify alcohol withdrawal. Both alcohol loading and withdrawal from steady alcohol use alter catecholamines in man and animals. Clonidine's potential to treat alcoholics in withdrawal is reviewed. Several double blind studies showed clonidine, or similar analogues, to be somewhat superior to placebo in acute alcohol withdrawal. Major improvements were in pulse, blood pressure and composite alcohol withdrawal scores. Side effects were minor and mainly included mild sedation, or postural hypotension. In the only available published study clonidine compared reasonably well to a standard sedative in alcohol withdrawal, and greatly influential in plasma catecholamine levels. Other components of alcohol withdrawal, as seizures and hallucinations-delirium tremens have not been documented to change with clonidine. The alpha-2-adrenergic agonists in alcohol treatment seemed modestly effective for treatment of some parts of alcohol withdrawal. They represent a promising, novel, but still investigational approach. Additional data, particularly comparing them to the benzodiazepines, are needed before their potential in therapeutics can be assessed.

Alcohol Withdrawal Delirium↗
PubMed1986

Sedative drug interactions of clinical importance.

In an age of widespread availability of psychoactive drugs, use of multiple sedatives is very common. Why such multiple drug use prevails is poorly understood. Sequential drug use may leave sequential problems. Concomitant use of several drugs can produce a host of interactions. Increasingly, the metabolic basis of sedative interactions are becoming known. Cross-tolerance between sedatives permit substitution of one for another and reduced sedation when combined. Metabolic interactions at the hepatic oxidation enzyme level may greatly affect drug disposal rates. Recognition of polysubstance abuse can assist in management. Treatment ranges from urgent life support to abrupt or slow withdrawal, to substitution long-term treatment usually requiring specialized care, with abstinence the preferred goal. However, polysubstance abusers seem to have low probabilities of achieving lasting abstinence.

Alcohol Drinking↗
PubMed1982

Association between plasma high density lipoprotein cholesterol and antipyrine metabolism in alcoholics.

Seven patients entering an alcoholic detoxification and treatment unit exhibited elevated levels of plasma high density lipoprotein cholesterol (HDLC) and enhanced metabolic disposal of antipyrine. Following a 2-week abstinence treatment, the HDLC levels were reduced by 28% (from 64 to 47 mg/100 ml) and the t 1/2 of antipyrine was extended from 12.4 to 13.7 hours. The extent of the HDLC reduction correlated with the antipyrine t 1/2 changes (r = -0.753, P = 0.05).

Adult↗
PubMed1981

Abstinence-induced changes in plasma apolipoprotein levels of alcoholics.

Plasma lipids, including total cholesterol, plasma triglycerides, high density lipoprotein cholesterol and several apolipoproteins were measured in eight otherwise healthy male alcoholics at the beginning and during a 4-week inpatient abstinence treatment program. The initial triglyceride and apolipoprotein A-11 levels were higher and apolipoprotein B was lower in alcoholics than in 12 nondrinking control subjects. During the alcohol abstinence there was a parallel fall in the levels of high density lipoprotein cholesterol, and apolipoproteins A-I and A-II and a rise in apolipoprotein B. The changes in apolipoproteins C-III and E were less consistent. These findings suggest that, even in otherwise healthy alcoholics, elevated levels of apolipoproteins A-I and A-II on admission are ameliorated during abstinence of several weeks.

Adult↗
PubMed1980

Benzodiazepines and drug abuse: clinical observations in chemically dependent persons before and during abstinence.

Sixty-nine (9.2%) of 750 consecutive persons entering a chemical-dependence treatment hospital had urinary evidence of benzodiazepines, a somewhat higher proportion than in the general adult American population. The 54 subjects in whose urine benzodiazepines, but not the other commonly abused psychoactive drugs, were detected, had varied clinical findings. One had used benzodiazepines only, 38 others were alcoholic benzodiazepine users, and 15 were multiple-drug (including benzodiazepines) users. Of these 54 only 6 (11%) developed major withdrawal symptoms. All 6 had used high doses of benzodiazepines (larger than or equal to 30 mg of diazepam or equivalent) daily. The risk of major withdrawal symptoms was about 50% for the high benzodiazepines--heavy alcohol group and zero for all other benzodiazepine-consuming patients. While clinical vigilance regarding withdrawal is urged for all benzodiazepine consumers, it is especially important amongst alcoholics, consuming high doses of benzodiazepines.

Adult↗
PubMed1980

Alcohol and benzodiazepines: withdrawal syndromes.

A mixed alcohol-benzodiazepine (BD) addiction was recognized in 25 alcoholics who were admitted for detoxification. They experienced a withdrawal syndrome, atypical for alcoholics, starting 2--10 days after abrupt discontinuation of drugs and characterized by more psychomotor and less autonomic nervous system signs than is usual in alcohol withdrawal. The timing and nature of the specific symptoms in the mixed sedative addiction resembled BD withdrawal. Treatment with tapering oral barbiturates after sedative tolerance tests was effective. Awareness of the mixed alcohol--BD addiction should result in improved recognition and treatment.

Adult↗
PubMed1980

Chronic alcohol abuse and high density lipoprotein cholesterol.

The possible use of high density lipoprotein cholesterol (HDLC) as a marker of alcohol abuse was studied in 92 alcoholic patients entering an inpatient treatment program. The average HDLC levels of 68 male patients (66 +/- 23 mg/dl) and 24 female patients (83 +/- 18 mg/dl) were significantly higher than the values for the corresponding control groups of similar ages. Approximately 20% of the male patients had HDLC levels over the mean +/- 2 SD over the control groups. Following 2 wk of alcohol abstinence, the HDLC levels decreased to the control range. HDLC, as a measure of alcohol abuse, may be especially useful in combination with determination of gamma glutamyl transpeptidase (GGT), since these two tests singly or in combination were elevated in 65% of the male and 85% of the female patients.

Adult↗