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At least 883 records · Page 49Linked to original sources
PubMed1996

The effect of oophorectomy and hormone replacement on neurohypophyseal hormone secretion in women.

OBJECTIVE: There is evidence to suggest that the release of neurohypophyseal hormones may be influenced by the circulating concentrations of gonadal steroids. We therefore monitored this relationship in women undergoing prophylactic bilateral oophorectomy at the time of hysterectomy with subsequent hormone replacement therapy and compared it with that in women undergoing hysterectomy with conservation of ovaries. DESIGN: Patients were randomly allocated to receive either transdermal oestradiol patches, 0.05 mg/day, or subdermal implants containing either 50 mg oestradiol or 50 mg oestradiol with 100 mg testosterone. Blood samples for determination of plasma hormone concentrations, electrolytes and osmolality were obtained immediately before and after surgery and then at two-monthly intervals for 8 months and finally at 12 months. MEASUREMENTS: Free oestradiol, vasopressin and oxytocin were measured by radioimmunoassay. RESULTS: Vasopressin concentrations were found to fall after surgery in oophorectomized women, but not in those with ovaries. There were no changes in fluid balance to account for the reduced plasma vasopressin concentrations. During treatment oestradiol appeared to enhance and testosterone to suppress vasopressin release. Oophorectomy had no significant effect on plasma oxytocin concentrations, but in the groups receiving oestradiol implants concentrations fell significantly at 8 and 12 months compared with the value at 6 days. CONCLUSION: The observed changes in plasma vasopressin concentrations were consistent with the observations in experimental animals and provide evidence that vasopressin release in the human is influenced by gonadal steroids.

Adult↗
PubMed2001

The use of ultrasound for drug delivery.

Ultrasound has been in use for the last three decades as a modality for diagnostic imaging in medicine. Recent studies have shown that nonthermal ultrasound energy could be applied for targeting or controlling drug release. This new concept of therapeutic ultrasound combined with drugs has induced interest in various medical fields. Enhanced effects of thrombolytic agents such as urokinase and TPA with acoustic energy have been demonstrated. Ultrasound transducer-tipped catheters are being developed for treatment of cardiovascular diseases. Other devices with ultrasound transducers implanted in transdermal drug patches are also being evaluated for possible delivery of insulin through the skin. Echo contrast microbubbles could also be used to carry and release genes to various tissues and lesions. Chemical activation of drugs by ultrasound energy for treatment of cancers is another new field recently termed "sonodynamic therapy." Various examples of ultrasound application are under investigation that could lead to revolutionary drug delivery systems of the future.

Drug Delivery Systems↗
PubMed2006

Nicotine and cognitive efficiency in alcoholics and illicit stimulant abusers: implications of smoking cessation for substance users in treatment.

Cigarette smoking is prevalent among alcoholics and illicit substance abusers. However, the potentially confounding effect of nicotine on studies of cognition in detoxified substance users has rarely been addressed. In the current study of 87 participants, behavioral and electrophysiological indices of cognitive efficiency were measured in tobacco smokers from four groups: alcoholics, illicit stimulant abusers, concurrent abusers, and control subjects. Data were collected from 2001 to 2003. We hypothesized that acute nicotine administration would modify cognitive deficits in alcoholics and illicit stimulant abusing groups. An adaptation of the Rapid Visual Information Processing task was administered after stabilization of nicotine levels via a high- or low-dose transdermal nicotine patch. Across groups, increased nicotine dose was associated with decreased reaction time (p = .03). A group x nicotine dose interaction trend was noted in which increased nicotine was associated with increased correct responding within the alcoholic group (p = .02). No significant differences in electrophysiology were observed. These results suggest that nicotine may modify cognitive efficiency in alcoholics and illicit stimulant abusers, a concept with relevance to both the design of experimental work and the treatment of alcohol and illicit stimulant dependence. Further work is needed to determine whether this effect predominantly reflects facilitation of cognition function or alleviation of nicotine withdrawal.

Administration, Cutaneous↗
PubMed2004

Rate of nicotine onset from nicotine replacement therapy and acute responses in smokers.

The subjective and reinforcing effects of drugs of abuse may depend partly on their rate of onset, with faster acting formulations typically producing stronger effects than slower ones. In this within-subjects study, we examined the acute effects of nicotine replacement therapy via nicotine nasal spray (fast delivery) vs. transdermal nicotine patch (slow delivery) on craving, withdrawal, cardiovascular responses, subjective ratings, and reinforcing effects of smoking. Smokers (N=30) not seeking treatment participated in three sessions, each after overnight smoking abstinence, involving 14-mg nicotine (Nicoderm) or placebo patch, followed 4 hr later by intermittent administration of nicotine (Nicotrol) or placebo nasal spray. Specifically, the three group comparisons were nicotine patch condition (with placebo spray), nicotine spray condition (with placebo patch), and placebo condition (placebo spray and patch). Nicotine patch and nicotine spray were never administered in the same session. Blood nicotine levels were similar between nicotine patch and nicotine spray conditions, by design. Heart rate and systolic blood pressure were higher following nicotine spray vs. the other conditions, as hypothesized. However, other than reductions in craving related to nicotine spray and patch at some points, no differences between conditions were observed in withdrawal, subjective effects of sprays and smoking, or smoking reinforcement assessed by a computer task. Thus, under these acute conditions, the speed of nicotine delivery from nasal spray vs. patch differentially affected cardiovascular responses and perhaps craving but did not influence withdrawal, subjective ratings, and smoking reinforcement.

Administration, Cutaneous↗
PubMed2002

Nicotine intervention during detoxification and treatment for other substance use.

This preliminary study evaluated the efficacy of a brief smoking cessation intervention (30 controls, 34 intervention groups) on a smoke-free inpatient unit for substance use detoxification. Controls received usual care, including the transdermal nicotine patch and referral to an outpatient smoking program. The intervention group additionally received a structured motivational enhancement program. Biochemically confirmed smoking cessation rate and abstinence/reduction of alcohol or other drug use were the main outcome measures taken 6 months after treatment initiation. The smoking cessation intervention did not result in greater participation in formal outpatient smoking cessation treatment and was not associated with either enhanced smoking cessation (6 vs. 0%) or greater smoking reduction at follow-up. Both groups significantly reduced the number of cigarettes smoked per day (cpd) from about 24 at baseline to 10cpd. The groups did not differ on abstinence from nonnicotine addictive substances. Smoking cessation treatment in substance users undergoing detoxification resulted in little or no smoking cessation advantage.

Adult↗
PubMed2005

Postoperative pain management with a patient-controlled transdermal delivery system for fentanyl.

PURPOSE: The efficacy and safety of fentanyl hydrochloride patient-controlled trans-dermal system (PCTS) for management of acute postoperative pain are discussed. SUMMARY: Fentanyl hydrochloride PCTS is a self-contained, needle-free, credit-card-sized fentanyl-delivery system that is worn on the patient's arm or chest. The system uses iontophoretic technology to actively deliver preprogrammed doses of fentanyl into the systemic circulation when activated by the patient on demand. PCTS is as safe and effective as i.v. morphine patient-controlled analgesia and superior to placebo for managing acute postoperative pain. Fentanyl absorption from PCTS is clinically insignificant when the device is not activated. This contrasts with the transdermal fentanyl patch, which delivers fentanyl continuously for 72 hours via passive absorption and is indicated only for use in the management of chronic pain. CONCLUSION: Fentanyl hydrochloride PCTS is a self-contained iontophoretic fentanyl-delivery system that provides patients control over pain management and consistent management of pain without analgesic peaks and troughs.

Administration, Cutaneous↗
PubMed1998

Perioperative pharmacokinetics of transdermal fentanyl in elderly and young adult patients.

The perioperative pharmacokinetics of transdermally-delivered fentanyl were compared in 10 young adult (mean [range] age 32.7, [25-38] yr) and eight elderly (mean [range] age 73.7 [64-82] yr) patients following abdominal surgery. Transdermal fentanyl patches designed to release 50 micrograms h-1 were applied 2 h preoperatively and left in place for 72 h. Plasma fentanyl concentrations were measured by radioimmunoassay during patch application and for 30 h after patch removal. The mean half-time (time for plasma concentrations to double after patch application) was 4.2 h in the younger group and 11.1 h in the elderly group (P < 0.005). Mean maximum plasma concentrations were 1.9 ng ml-1 and 1.5 ng ml-1 in the younger and elderly groups respectively (ns). There were no differences in the time at which maximum plasma concentrations occurred (tmax), elimination half-life after patch removal, or AUC(0-infinity).

Abdomen↗
PubMed1997

Transfer of cryopreserved-thawed pre-embryos in a cycle using exogenous steroids without prior gonadotrophin-releasing hormone agonist suppression yields favourable pregnancy results.

We have analysed the use of a programmed cycle of administration of exogenous steroids without prior suppression with a gonadotrophin-releasing hormone agonist (GnRHa) for the transfer of cryopreserved-thawed pre-embryos. From July 1992 to June 1994, 199 cycles (162 patients) were studied. Pre-embryos had been previously cryopreserved at the pronuclear stage using 1.5 M 1,2-propanediol as a cryoprotectant. Preparation of the endometrium was achieved in a step-up regime with transdermal oestradiol patches (0.1 to 0.4 mg). Progesterone in oil (50 mg i.m.) was started on cycle day 13. Pre-embryos were thawed on day 14 and transferred on day 15 after evidence of survival and cleavage. The mean (+/- SD) age of patients undergoing transfer was 35.4 +/- 4.3 years. The mean number of pre-embryos thawed was 4.7 +/- 1.8 with a mean of 3.3 +/- 1.4 pre-embryos being transferred. Eight of the cycles demonstrated follicular development >16 mm prior to thaw and transfer; however, these patients did not demonstrate a luteinizing hormone surge. Mean endometrial thickness on day 13 was 10.8 +/- 2.1 mm. Overall pregnancy rate was 29.2% (57/195). The ongoing or delivery rate was 16.1% (32/195). The rate of preclinical losses per transfer was 6.2% (12/195). Overall, the implantation rate was 6.2% (47/757). Thus, the use of a programmed cycle for cryopreserved embryo transfer yields favourable pregnancy outcome and offers practical advantages to patients. Prior suppression with a GnRHa is not necessary for endometrial preparation.

Adult↗
PubMedDate not supplied

Postmortem distribution of nicotine and cotinine from a case involving the simultaneous administration of multiple nicotine transdermal systems.

A 31-year-old female was found dead with 18 nicotine transdermal system patches taped to her upper body and a plastic bag taped over her nose and mouth (the cause of death was ruled asphyxiation). Nicotine concentrations in biological fluids and tissues were analyzed using a liquid-liquid extraction followed by injection onto and HP-5890 gas chromatograph (GC) equipped with a nitrogen-phosphorus detector. Cotinine was separated from the biological matrices using solid-phase extraction followed by analysis on an HP-5890 GC with flame ionization detection. A variety of specimens were analyzed, including blood, urine, vitreous, brain, liver, and gastric contents. Heart and femoral blood concentrations (1.4 and 0.46 micrograms/mL, respectively) were 175 and 57 times, respectively, the mean C(max) value reported following the proper administration of a single 7-mg/day patch.

Administration, Cutaneous↗
PubMed1992

HRT: developments in therapy.

Various forms of oestrogen have been available for use as Hormone Replacement Therapy (HRT) for approximately 50 years. However, there has been little change in the mode of administration until the last 10-15 years. Although the oral route has remained the mainstay of therapy, non-oral routes of administration have been developed. During the 1970s it became clear that use of unopposed oestrogens in women with an intact uterus resulted in an increase in risk of endometrial carcinoma and thus the current practice of adding a sequential progestogen each month, to prevent endometrial hyperplasia, was introduced. However, certain progestogens can cause side-effects and some of the metabolic changes which they induce are potentially undesirable. Thus the search continues for new oral progestogens which are more 'metabolically friendly' than those in current use. Additionally, non-oral delivery systems for progestogens have been studied, such as the transdermal route (patches) and local administration within the uterine cavity (progestogen-containing intra-uterine devices). Both these strategies may minimise their symptomatic, psychological and metabolic effects. Continuous (every day) administration of progestogens in combination with the oestrogen, or the use of new compounds (e.g. tibolone) may overcome the problem of regular withdrawal bleeding which some women find unacceptable. However, it remains to be determined whether such therapies are as efficacious as conventional oestrogen/sequential progesterone regimens.

Administration, Cutaneous↗
PubMed1995

Acute effect of oestrogen replacement therapy on treadmill performance in postmenopausal women with coronary artery disease.

The significant reduction in cardiovascular morbidity and mortality following oestrogen replacement therapy in postmenopausal women is only partly explained by an improved lipid profile. Given acutely, oestradiol causes vasodilatation and increases coronary blood flow and, in large doses, improves treadmill performance in postmenopausal women with coronary artery disease. However, the significance of oestrogen-mediated vasodilatation is unknown since the acute effects of oestradiol in doses and preparations commonly used clinically have not been tested. The aim of this study was to evaluate the acute effects of conventional replacement therapy with 17 beta-oestradiol on treadmill performance in 16 postmenopausal women with angina in a randomized, double-blind, placebo-controlled cross-over trial. Following baseline treadmill testing a transdermal oestrogen patch releasing 50 micrograms oestradiol. 24 h-1 or matching placebo was applied and the exercise test repeated 24 h later. The patch was then removed. Seven to 14 days later the sequence was repeated using the alternative patch. The changes in time to angina, time to 1 mm ST segment depression and total exercise time for each treatment compared with the corresponding baseline test were calculated. Plasma 17 beta-oestradiol increased with active therapy from 56 +/- 30 pmol.l-1 to 204 +/- 90 pmol.l-1, indicating adequate replacement. Compared with their respective baseline exercise tests there were no differences between active and placebo patches for time to angina (active: 13 +/- 55 s vs placebo: 10 +/- 47 s), time to 1 mm ST segment depression (active: -30 +/- 52 s vs placebo: 24 +/- 71 s) or total exercise time (active: 14 +/- 45 s vs placebo: 13 +/- 35 s). Despite the recognized acute vasodilator action of larger doses of oestrogen, doses conventionally used in hormone replacement therapy had no acute effect on treadmill performance in this group of postmenopausal women with coronary artery disease.

Administration, Cutaneous↗
PubMed1996

Case study: long-term potentiation of neuroleptics with transdermal nicotine in Tourette's syndrome.

Sixteen Tourette's syndrome patients, aged 9 to 15 years, whose symptoms were not controlled with neuroleptics, were followed for various lengths of time after the application of a transdermal nicotine patch (TNP) (7 mg/24 hours) as part of an ongoing case study. While there was a broad range in individual response, application on the TNP produced significant reductions (p < .001) in Yale Global Tic Severity Scale scores relative to baseline, with an average duration of effect lasting between 1 and 2 weeks. Side effects, for the most part, were transient. Clinical implications for the use of TNP as an adjunct to neuroleptic treatment of Tourette's syndrome are discussed.

Administration, Cutaneous↗
PubMed2006

ADHD: new pharmacological treatments on the horizon.

Attention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral disorder affecting school-age children. In many cases, symptoms persist into adolescence and adulthood, causing significant lifelong impairments in academic, career, and social functioning. The stimulants methylphenidate and amphetamines have been used for decades as first-line therapy for the treatment of ADHD. Short-acting stimulant formulations control symptoms only for a few hours, creating the need for multiple daily doses of the medication. For school-age children, this necessitates administering medication during school hours, creating the potential for embarrassment and noncompliance. To offset these problems, longer acting stimulant formulations have been developed. Long-acting medications often control symptoms for up to 8 hours with only one daily dose of the medication, eliminating the need for in-school administration. Some long-acting stimulants are designed to control symptoms for up to 10 to 12 hours. Although stimulants are effective in most cases, some children are unable to tolerate these medications. Nonstimulant options are available for the treatment of ADHD and include atomoxetine, alpha-adrenergic agents, and antidepressants. Of these, atomoxetine is the only medication approved to treat ADHD. In spite of the number of medications available for the management of ADHD, treatment options with greater flexibility and reduced side effects are still desirable. A transdermal methylphenidate patch has recently been approved, and advances to existing stimulants currently under development include an amphetamine prodrug and a longer acting formulation of amphetamine. In addition, a number of nonstimulant entities, including guanfacine and modafinil, are under development for the treatment of ADHD.

Adrenergic Uptake Inhibitors↗
PubMedDate not supplied

Smoking status and nicotine administration differentially modify hemodynamic stress reactivity in men and women.

OBJECTIVES: To investigate the impact of cigarette smoking and oral contraceptive (OC) use on hemodynamic stress responses of women. Also, to examine gender differences in stress reactivity as a function of smoking status and acute nicotine administration. METHODS: Thirty men and 46 women, differing in smoking status and OC use, were tested for cardiovascular stress responses to a variety of behavioral and physical stressors. Each was tested twice, once under a transdermal nicotine patch condition and once under a placebo patch condition. Impedance cardiography was used to estimate hemodynamic reactivity noninvasively. RESULTS: In response to behavioral stressors, women smokers, irrespective of OC use or nicotine vs placebo, demonstrated significantly blunted cardiac output and heart rate reactivity to stressors, and showed significantly greater estimated total peripheral resistance (TPR) under stress relative to women nonsmokers. There were no differences in hemodynamic stress reactivity between men smokers and nonsmokers. The only significant effect involving nicotine administration on stress reactivity was seen in men where, regardless of smoking status, nicotine increased heart rate reactivity to all stressors relative to placebo responses. CONCLUSIONS: Results suggest that cigarette smoking may act differently in men and women to increase risk for cardiovascular disease (CVD). For men, nicotine may exert pathogenic influences via increasing the magnitude of heart rate reactivity to stressors. For women, however, smoking seems to have deleterious effects on hemodynamic stress reactivity patterns, reducing myocardial but increasing TPR contributions to blood pressure responses.

Administration, Cutaneous↗
PubMed2006

Assessing risk factors for postoperative nausea and vomiting: a retrospective study in patients undergoing retromastoid craniectomy with microvascular decompression of cranial nerves.

We have observed that patients, after retromastoid craniectomy (RMC) with microvascular decompression (MVD) of cranial nerves, frequently experienced postoperative nausea and vomiting (PONV). The authors conducted this study to track the incidence of PONV and to identify potential factors for PONV after RMC with MVD. Medical records from 185 adults, who underwent elective RMC with MVD, were identified and reviewed from January 2000 to December 2004. Extracted data included patient, anesthesia, and surgery related variables that were considered to have a possible effect on the patients experiencing PONV after RMC with MVD. Despite the use of intraoperative prophylactic ondansetron in 99% of patients, the overall incidence of PONV (nausea or emesis or both) was 60% during the first 24 hours postoperatively. It was higher for the patients after RMC with MVD of cranial nerve V [69%, 82/119, P=0.005, odds ratio (OR)=2.8]. Regression modeling demonstrated that female sex (OR=3.0, P=0.005) and use of desflurane (OR=2.8, P=0.003) were significant independent predictors of PONV. Prophylactic transdermal scopolamine patch administered preoperatively was associated with less PONV (OR=0.3, P=0.001). We concluded that PONV occurs frequently in adults recovering from RMC with MVD. The results of this study suggest that it may be necessary to administer a combination of antiemetics to decrease the incidence of PONV after RMC.

Adolescent↗
PubMed2006

Acute pain management for opioid dependent patients.

Patients requiring acute pain management may be opioid dependent as a result of either recreational or therapeutic opioid use, including those in opioid addiction programmes. Pain in these patients is often under-estimated and under-treated. In addiction, drug-seeking behaviour differentiates it from simple dependence. With few randomised controlled trials, current evidence predominantly consists of guidelines based on case reports, retrospective studies and expert opinion. Consensus recommendations include maintaining regular provision of the patient's pre-existing opioid requirement, with additional analgesia, ideally multimodal, in appropriate combinations of short-acting opioid (as required), local anaesthesia, and adjuvant anti-inflammatory analgesics and paracetamol. Patient controlled analgesia with higher bolus doses and shorter lock-out intervals is a recommended strategy. Transdermal opioid patches and implantable pumps will continue to deliver opioid, to which non-opioid and short-acting opioids may be added. Re-exposure to opioid is ideally avoided in previously addicted patients, but if not feasible, opioid therapy should be prescribed.

Acute Disease↗
PubMed2006

Pharmacokinetics of fentanyl delivered transdermally in healthy adult horses--variability among horses and its clinical implications.

The safety and pharmacokinetics of fentanyl, delivered transdermally at a dosage of 60-67 microg/kg, were investigated in six healthy adult horses. Three transdermal fentanyl patches (Duragesic), each containing 10 mg of fentanyl citrate, were applied to the mid-dorsal thorax of each horse and left in place for 72 h. Plasma fentanyl concentrations were periodically measured throughout this period and for 12 h after patch removal. After an initial delay of approximately 2 h, the plasma fentanyl concentration rose rapidly in a fairly linear fashion, reaching a peak at around 12 h; thereafter, it gradually declined in a roughly linear manner over the next 72 h. There was much individual variation, however. The initial delay ranged from 0 to 5.1 h (mean, 1.91+/-2.0 h), Tcmax ranged from 8.5 to 14.5 h (mean, 11.4+/-2.7 h) and Cmax ranged from 0.67 to 5.12 ng/mL (mean, 2.77+/-1.92 ng/mL). In two horses, the plasma fentanyl concentration failed to reach even 1 ng/mL, whereas in the other four horses it was >1 ng/mL for at least 40 h and for at least 72 h in two of these horses. No adverse effects attributable to fentanyl were observed in any of the horses, indicating that this dosage is safe in systemically healthy adult horses. However, it failed to achieve plasma fentanyl concentrations generally considered to be analgesic (>or=1 ng/mL) in about one-third of horses.

Administration, Cutaneous↗
PubMed2005

Sclerotherapy for gastric fundal variceal bleeding: is complete obliteration possible without cyanoacrylate?

BACKGROUND: Many studies have suggested that endoscopic obliteration using cyanoacrylate for bleeding gastric fundal varices is effective. However, serious complications by injection of cyanoacrylate into varices have also been reported. METHODS: Thirty patients with bleeding gastric fundal varices underwent endoscopic injection sclerotherapy using 5% ethanolamine oleate under fluoroscopic guidance plus infusion of vasopressin and a transdermal nitroglycerin patch. The injection of 5% ethanolamine oleate was continued until it filled the varices and their feeder veins under fluoroscopic guidance. The injection needle was removed while thrombin glue was sprayed at the puncture site through the side hole of the injector needle to prevent bleeding from the puncture site. RESULTS: Complete hemostasis was achieved in 28/30 patients (93.3%). The cumulative rebleeding rate after 1, 3 and 5 years was 13%, 19% and 19%, respectively. The 1-, 3-, and 5-year cumulative mortality rates were 31%, 54% and 59%, respectively. There was no complication related to infusion of vasopressin and sclerotherapy procedure. CONCLUSION: The sclerotherapy method carried out using 5% ethanolamine oleate combined with infusion of vasopressin under fluoroscopic guidance might be a feasible method for obliteration of gastric fundal varices as an alternative to cyanoacrylate.

Adult↗