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PubMed · 2315201

Linking utilization management with quality improvement.

L S Goldstein
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Abstract

The author describes the context for conducting utilization management and quality improvement studies in psychiatry; utilization management and quality improvement are defined and differentiated. Examples of utilization management and drug utilization evaluation studies are given with explanation of how they can be linked to quality improvement efforts.

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Antidepressive Agents, TricyclicDrug UtilizationHospitals, GeneralHumansMental Health ServicesPsychiatric Department, HospitalQuality of Health CareUtilization ReviewJournal Article

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L S Goldstein. 1990. Linking utilization management with quality improvement.. https://pubmed.ncbi.nlm.nih.gov/2315201/

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Inhibition of astroglial inwardly rectifying Kir4.1 channels by a tricyclic antidepressant, nortriptyline.

The inwardly rectifying K(+) (Kir) channel Kir4.1 is responsible for astroglial K(+) buffering. We examined the effects of nortriptyline, a tricyclic antidepressant (TCA), on Kir4.1 channel currents heterologously expressed in HEK293T cells, using a whole-cell patch-clamp technique. Nortriptyline (3-300 microM) reversibly inhibited Kir4.1 currents in a concentration-dependent manner, whereas it marginally affected neuronal Kir2.1 currents. The inhibition of Kir4.1 channels by nortriptyline depended on the voltage difference from the K(+) equilibrium potential (E(K)), with greater potency at more positive potentials. Blocking kinetics of the drug could be described by first-order kinetics, where dissociation of the drug slowed down and association accelerated as the membrane was depolarized. The dissociation constant (K(d)) of nortriptyline for Kir4.1 inhibition was 28.1 microM at E(K). Other TCAs, such as amitriptyline, desipramine, and imipramine, also inhibited Kir4.1 currents in a similar voltage-dependent fashion. This study shows for the first time that nortriptyline and related TCAs cause a concentration-, voltage-, and time-dependent inhibition of astroglial K(+)-buffering Kir4.1 channels, which might be involved in therapeutic and/or adverse actions of the drugs.

Antidepressive Agents, Tricyclic↗