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PubMed1983

Review articles for continuing education in pharmacology.

The efficacy of educational review articles as alternatives to traditional continuing education courses in pharmacology was evaluated using pre-tests and post-tests and an intrasubject cross-over design. There was a significant improvement (p less than 0.001) from pre-test to post-test in a group of 44 subjects who read an article reviewing the clinical pharmacology of nitrous oxide. This observation suggests that educational review articles may be useful as adjuncts to traditional sources of information for continuing education in pharmacology.

Education, Dental, Continuing↗
PubMed1983

[Ethical problems of clinical pharmacology in pediatrics].

There is no rational and safe treatment without knowledge of clinical pharmacology. Clinical pharmacology is based on data found in the human. Since results of animals trials cannot be used directly Absorption, Distribution, Metabolism and Elimination rates of drugs in children differ from those known in adults. Therefore pharmacological data in children have to be studied specifically. There are always some questions for the pediatrician whether he is allowed to administer a drug prescribed in adult medicine to children, whether he is allowed to obtain data for therapeutical control purposes and whether he may or even must publish these results for the sake of ill infants. Due to the facts that it is difficult to receive these informations, we do not find dosage schemes, for example in the Physicians Desk Reference or Rote Liste for more than 70% of all registered drugs. A new drug without governmental licence must not be employed in pediatric medicine. After its official approval we may use this new pharmaceutical agent in some circumstances this might be even a must. Especially in Pediatrics there is no strict borderline between the clinical trial of a new drug in a group of patients or its application to a single ill child. Whenever a pediatrician is convinced of the high value of a new drug he will certainly get the parent's permission to apply it for the sake of their child as well as to perform a close therapy control. This attitude and produce is medically, ethically and legally correct.

Child↗
PubMedDate not supplied

[Problems and prospects of space pharmacology].

The paper reviews the Soviet and foreign literature on the pharmacological support of manned space flights with emphasis on pharmacological prophylaxis and therapy of adverse effects of the space environment. The paper discusses future development of pharmacological studies as part of space medicine.

Aerospace Medicine↗
PubMedDate not supplied

[Research in the field of clinical pharmacology in the USSR].

The authors analyze the results of research on clinical pharmacology carried out at various institutions in this country. The overwhelming majority of works are concerned with clinical studies on the pharmacodynamics and pharmacokinetics of the drugs, their interaction, and detection of drug side effects. Special attention is paid to the improvement of the methods for determination of the pharmacological agents in biological fluids, and to the design of the maximally adequate parameters of assessing the pharmacodynamics of the main groups of the drugs. Considerable part of investigations is devoted to clinical pharmacogenetics, chronopharmacology, age pharmacology, prediction of the drug effects, approaches to the extrapolation of experimental data to the clinical trials of the drugs. The authors also provide evidence on the system of clinical trials of new drugs and detection of untoward effects of the medicines used.

Clinical Trials as Topic↗
PubMed1980

[The application of modern pharmacology to medical practice].

The medical doctor is increasingly concerned with new and potent drugs. To judge their therapeutic value he should be aware of results of research in pharmacology, toxicology, clinical pharmacology, drug kinetics and drug metabolism. Some basic terms of pharmacological research are briefly outlined and general problems of simple blood kinetics of antibiotics and diuretics are discussed.

Disease Models, Animal↗
PubMed1994

Analysis of pharmacokinetic-dynamic interrelations with special reference to applications in cardiovascular clinical pharmacology.

The relationship between a (detectable) cardiovascular response and plasma concentrations is affected by 1. the temporal delay of the equilibrium between sampling site and effector site(s), 2. the intrinsic relationship between the primary effect(s) and concentration at the effector site(s) and 3. inter-pharmacodynamic processes that link the primary effects to a net response and that might attenuate or amplify the primary effects. Confounding factors (active metabolites, time-variant protein-binding, enantiospecific pharmacological behavior, physiological counter-regulation, etc.) might confuse the issue even more. Models that address kinetic-dynamic interrelations are usually confined to the first two processes listed above and hardly account for the third factor (and often are inadequate if more than one confounding factor is involved). They yield model-driven assimilative solutions that are characterized by a high level of indetermination. The "fit" of the experimental data with an analytical model (in itself usually quite appealing by its mathematical elegance and inductive creativity) should not be mistaken as a "match" between the model and physio-pharmacological "reality". In consequence, these models are cognitive constructions that provide important insight in the complexity of these physio-pharmacological processes without necessarily solving it. Their actual "proof" and ultimate value thus lies in their practical applicability (i.e. their effective instrumental use) to predict, correct and optimize (pharmacotherapeutic) response. Unfortunately most models have failed to be successfully tested in this regard.

Cardiovascular Agents↗
PubMed1994

[Clinical pharmacology in practice].

A university-hospital clinical pharmacology consult service was evaluated for: spontaneous use by clinicians (reflecting the competence conferred to clinical pharmacologists and the information clinicians seek), subject matters of postgraduate teaching to internal medicine trainees (needs perceived by the clinical pharmacologist), and finally, prescription profile of these trainees (clinical reality). Over 14 months, 663 requests were received (86% for a specific patient). Topics included adverse events (AE) (53%), pharmacokinetics (PK) (20%), treatment indications (T) (19%), and product identification (Id) (8%). In the service holding regular teaching sessions in clinical pharmacology, spontaneously requested consults pertained to: T 49% (mainly pain management, a domain of expertise of this particular clinical pharmacology service), AE 34%, PK 12% and Id 5%. In contrast, teaching covered PK 42%, T 39% (half on pain), and AE 16% of the time. The prescription profile included 201, mostly elderly patients, 40% with an estimated creatinine clearance < or = 50 ml/min. Of the renally compromised patients, only 14% were clearly identified as such by the doctor in charge, although 63% received at least one drug requiring dosage adjustment, which was done in 44% of cases. Interactions were present in 9% of treatments, which were appropriately adjusted in two thirds following routine in-hospital monitoring of low therapeutic index drugs, even though the possibility of an interaction was not explicitly charted. In conclusion, despite increasing complexity of therapeutics, reliance on clinical pharmacologists is variable.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1993

Clinical pharmacology in Eastern European countries.

The current status of clinical pharmacology (CP) in the countries of the former Eastern block is presented. The difficulties in obtaining an accurate comparative view are pointed out. CP is unevenly developed in Eastern European countries and the number of hours devoted to basic/clinical pharmacology differs considerably 100/nil to 240/50. The same is true for the orientation of clinical pharmacology, where present. It is mainly basic in only a few countries (Rumania, Turkey, some parts of the former Yugoslavia) and mainly clinical in Czecho-Slovakia, Croatia, Hungary, Poland, Greece. The number of CP units and CP specialists varies greatly as well (from none to more than 10 per country). The awareness that CP, in many countries is still young and the branch of (clinical) medicine is of great importance, not only for rational pharmacotherapy but also for other services as well, education and research is growing. In spite of the fact that the present status of CP in Eastern European countries is generally unsatisfactory, there are realistic chances that in the (near?) future, CP will develop to match the activities now present in the more developed countries.

Bosnia and Herzegovina↗
PubMed1977

[The advantages of multiple choice tests in undergraduate teaching of pharmacology (author's transl)].

Multiple-choice tests in pharmacology were carried out with students who had no previous experience in this kind of examination. The curriculum in pharmacology was divided into four parts. Each part was followed by a test consisting of 90 questions. A special arrangement was made for those students who voluntarily participated in all four tests during academic year. Pass marks in all four completed tests were considered equivalent to a successful outcome in the one oral examination which is, at present, obligatory. In order to encourage a high level of participation amongst the students, failure in one or more of the tests had no adverse consequences. As a result, a markedly increased attendance at lectures, as well as a positive feed back of information for the faculty, were ascertained and assessment of the efficiency of the teaching methods facilitated. Application of multiple choice tests to the teaching of Pharmacology to undergraduate students proved to be recommendable, both as a test procedure and of advantage in the actual learning process.

Austria↗
PubMed1997

The role of clinical pharmacology in molecular genetics.

PROBLEM: Discovering the causes of unusual phenotypes in human subjects is an important aspect of patient-oriented research. MATERIAL: The tools of clinical pharmacology are uniquely useful in addressing these problems. PATIENTS, SUBJECTS, OR CASE HISTORIES: We evaluated a 42-year-old patient with lifelong orthostatic hypotension and ptosis of the eyelids. He underwent a series of biochemical, physiological, and pharmacological tests outlined in this article. RESULTS: These studies indicated that sympathetic innervation was intact but that the sympathetic neurotransmitter was dopamine rather than norepinephrine. These results demonstrated that dopamine-beta-hydroxylase deficiency underlies the clinical abnormalities of this patient. CONCLUSION: In selected individuals with unusual phenotypes, the techniques of clinical chemistry and clinical pharmacology can define the nature of the defect at almost the resolution of the human genome.

Adult↗
PubMedDate not supplied

First year RNs' actual and self-rated pharmacology knowledge.

A questionnaire survey was conducted of first year registered nurses whose postal details were recorded on the Victorian Nursing Council's 1994 mailing list. The nurses were asked to self-rate their knowledge of five categories of pharmacology and to answer questions that tested their knowledge of the same categories. The survey also obtained data related to aspects of the nurses' pharmacology education. The mean test score of the 363 respondents to the survey was 55.8%. The number of months worked as an RN and participation in a graduate year program were significantly correlated with test scores, i.e. longer experience as an RN and participation in a graduate program were associated with higher scores. There was a significant correlation between the groups' overall self-rating of their knowledge and their total test scores but the RNs' self-ratings overestimated their knowledge of drug administration and legal aspects of drug use. The study indicates that many newly registered nurses have an inadequate knowledge of pharmacology. Recommendations for improving the teaching and learning of the subject are drawn from the nurses' evaluation of aspects of their undergraduate and post-registration experience.

Adult↗
PubMed1997

Sir James Black and propranolol. The role of the basic sciences in the history of cardiovascular pharmacology.

The history of cardiology encompasses some of the most revered names in medical history, many belonging to physicians who have advanced knowledge beyond their time. However, there have been countless others whose work in the basic sciences has paid large dividends to clinical cardiology. The original example of such an individual is William Harvey, whose reasoned experimentation led to the understanding of the circulation of blood. Another such man, Sir James Black, has contributed to basic scientific and clinical knowledge in cardiology, both as a physician and as a basic scientist. His invention of propranolol, the beta adrenergic receptor antagonist that revolutionized the medical management of angina pectoris, is considered to be one of the most important contributions to clinical medicine and pharmacology of the 20th century. His method of research, his discoveries about adrenergic pharmacology, and his clarification of the mechanisms of cardiac action are all strengths of his work. In 1988, he was awarded the Nobel Prize in Medicine. Sir James's conclusions and method of research have continued to influence work in clinical pharmacology and cardiovascular medicine. Thus, the development of propranolol runs parallel to most other great achievements in medicine: the genius of a few builds on the accomplishments of many, and the discovery influences thinking long after the breakthrough has occurred.

Adrenergic beta-Antagonists↗
PubMed1984

Comparison of physiologic and pharmacologic assessment of growth hormone secretion.

To determine if pharmacologic and physiologic tests are equally effective in the assessment of growth hormone (GH) secretory status, serum GH levels were measured during sequential tests with intravenous arginine infusion and insulin-induced hypoglycemia (arginine-insulin tolerance test [ AITT ] ) and during sleep in 62 children, aged 2.1 to 17.3 years. Responses during AITT and sleep were concordant in 53 patients and discordant in nine patients. Arginine-insulin tolerance test results were consistent with the subsequent clinical course in 80% of the patients while nocturnal sampling was consistent with the subsequent clinical course in 93% of the patients. Thus, the failure of a normal serum GH response to pharmacologic stimuli is not always a diagnostic indicator of GH deficiency. Additional investigation of discordant GH responses to pharmacologic and physiologic stimuli may lead to a further understanding of the control mechanisms of GH secretion.

Adolescent↗
PubMed1999

Behavioral and pharmacological therapies for late-life insomnia: a randomized controlled trial.

CONTEXT: Insomnia is a prevalent health complaint in older adults. Behavioral and pharmacological treatments have their benefits and limitations, but no placebo-controlled study has compared their separate and combined effects for late-life insomnia. OBJECTIVE: To evaluate the clinical efficacy of behavioral and pharmacological therapies, singly and combined, for late-life insomnia. DESIGN AND SETTING: Randomized, placebo-controlled clinical trial, at a single academic medical center. Outpatient treatment lasted 8 weeks with follow-ups conducted at 3, 12, and 24 months. SUBJECTS: Seventy-eight adults (50 women, 28 men; mean age, 65 years) with chronic and primary insomnia. INTERVENTIONS: Cognitive-behavior therapy (stimulus control, sleep restriction, sleep hygiene, and cognitive therapy) (n = 18), pharmacotherapy (temazepam) (n = 20), or both (n = 20) compared with placebo (n = 20). MAIN OUTCOME MEASURES: Time awake after sleep onset and sleep efficiency as measured by sleep diaries and polysomnography; clinical ratings from subjects, significant others, and clinicians. RESULTS: The 3 active treatments were more effective than placebo at posttreatment assessment; there was a trend for the combined approach to improve sleep more than either of its 2 single components (shorter time awake after sleep onset by sleep diary and polysomnography). For example, the percentage reductions of time awake after sleep onset was highest for the combined condition (63.5%), followed by cognitive-behavior therapy (55%), pharmacotherapy (46.5%), and placebo (16.9%). Subjects treated with behavior therapy sustained their clinical gains at follow-up, whereas those treated with drug therapy alone did not. Long-term outcome of the combined intervention was more variable. Behavioral treatment, singly or combined, was rated by subjects, significant others, and clinicians as more effective than drug therapy alone. Subjects were also more satisfied with the behavioral approach. CONCLUSIONS: Behavioral and pharmacological approaches are effective for the short-term management of insomnia in late life; sleep improvements are better sustained over time with behavioral treatment.

Aged↗
PubMed2005

Pharmacological treatment of neuropsychiatric symptoms of dementia: a review of the evidence.

CONTEXT: Neuropsychiatric symptoms of dementia are common and associated with poor outcomes for patients and caregivers. Although nonpharmacological interventions should be the first line of treatment, a wide variety of pharmacological agents are used in the management of neuropsychiatric symptoms; therefore, concise, current, evidence-based recommendations are needed. OBJECTIVE: To evaluate the efficacy of pharmacological agents used in the treatment of neuropsychiatric symptoms of dementia. EVIDENCE ACQUISITION: A systematic review of English-language articles published from 1966 to July 2004 using MEDLINE, the Cochrane Database of Systematic Reviews, and a manual search of bibliographies was conducted. Inclusion criteria were double-blind, placebo-controlled, randomized controlled trials (RCTs) or meta-analyses of any drug therapy for patients with dementia that included neuropsychiatric outcomes. Trials reporting only depression outcomes were excluded. Data on the inclusion criteria, patients, methods, results, and quality of each study were independently abstracted. Twenty-nine articles met inclusion criteria. EVIDENCE SYNTHESIS: For typical antipsychotics, 2 meta-analyses and 2 RCTs were included. Generally, no difference among specific agents was found, efficacy was small at best, and adverse effects were common. Six RCTs with atypical antipsychotics were included; results showed modest, statistically significant efficacy of olanzapine and risperidone, with minimal adverse effects at lower doses. Atypical antipsychotics are associated with an increased risk of stroke. There have been no RCTs designed to directly compare the efficacy of typical and atypical antipsychotics. Five trials of antidepressants were included; results showed no efficacy for treating neuropsychiatric symptoms other than depression, with the exception of 1 study of citalopram. For mood stabilizers, 3 RCTs investigating valproate showed no efficacy. Two small RCTs of carbamazepine had conflicting results. Two meta-analyses and 6 RCTs of cholinesterase inhibitors generally showed small, although statistically significant, efficacy. Two RCTs of memantine also had conflicting results for treatment of neuropsychiatric symptoms. CONCLUSIONS: Pharmacological therapies are not particularly effective for management of neuropsychiatric symptoms of dementia. Of the agents reviewed, the atypical antipsychotics risperidone and olanzapine currently have the best evidence for efficacy. However, the effects are modest and further complicated by an increased risk of stroke. Additional trials of cholinesterase inhibitors enrolling patients with high levels of neuropsychiatric symptoms may be warranted.

Algorithms↗
PubMed1997

The effect of pharmacologic erection on the dorsal nerve of the penis.

The dorsal nerve of the penis (DNP) is the primary source of afferent somatic input from the penis and is critical in the male sexual functions of erection and ejaculation. Using genitourinary electrodiagnostic techniques, this study was conducted to investigate the effect of pharmacologic erection on the DNP. Three tests were administered, and the changes in the DNP between flaccid, stretched, and erect states were examined. Calculated nerve conduction velocity (cNCV) measurements of the DNP increased with pharmacologic erection because mechanical straightening of the nerve allowed for a more precise measurement of nerve length. The latencies of the cortical evoked response and the bulbocavernosus reflex were not significantly changed with stretch or pharmacologic erection. In the evaluation of impotence, cNCV DNP measurements should be performed on the erect penis.

Adult↗
PubMed1998

Psychosocial modifiers of drug prescription: the hidden face of pharmacology?

Apart from placebo, there is scant medical knowledge regarding the influence of psychosocial effect modifiers in pharmacology. Phenomena such as the nocebo, Hawthorne, Oedipus and complacency effects have been previously described as sources of bias in clinical trials; however, the effects related to prescription patterns have been widely ignored to date. Under certain circumstances, psychosocial effects may even be catalysts for changes in the official regulations on drug prescription--changes often lacking an adequate scientific basis--and, subsequently, induce major changes in drug use worldwide. In spite of this, the study of psychosocial effects in pharmacology has been confined to anecdotal reports. The present overview of this topic is aimed at encouraging the identification of psychosocial effects in pharmacology. It also suggests that commercial case studies of drugs are a suitable method for studying prescription and effect modifiers. Triazolam's commercial history provides a good example of this approach. A better knowledge of these effects may contribute to a better understanding of the prescription habits observed in clinical practice. It may also prevent paradoxical changes in prescription patterns or in drug regulations.

Journal Article↗
PubMed2001

Plug flow cytometry extends analytical capabilities in cell adhesion and receptor pharmacology.

BACKGROUND: Plug flow cytometry is a recently developed system for the automated delivery of multiple small boluses or "plugs" of cells or particles to the flow cytometer for analysis. Important system features are that sample plugs are of precisely defined volume and that the sample vessel need not be pressurized. We describe how these features enable direct cell concentration determinations and novel ways to integrate flow cytometers with other analytical instruments. METHODS: Adhesion assays employed human polymorphonuclear neutrophils (PMNs) loaded with Fura Red and Chinese hamster ovary (CHO) cells cotransfected with genes for green fluorescent protein (GFP) and human P-selectin. U937 cells expressing the human 7-transmembrane formyl peptide receptor were loaded with the fluorescent probe indo-1 for intracellular ionized calcium determinations. A computer-controlled syringe or peristaltic pump loaded the sample into a sample loop of the plug flow coupler, a reciprocating eight-port valve. When the valve position was switched, the plug of sample in the sample loop was transported to the flow cytometer by a pressure-driven fluid line. RESULTS: In stirred mixtures of PMNs and CHO cells, we used plug flow cytometry to directly quantify changes in concentrations of nonadherent singlet PMNs. This approach enabled accurate quantification of adherent PMNs in multicell aggregates. We constructed a novel plug flow interface between the flow cytometer and a cone-plate viscometer to enable real-time flow cytometric analysis of cell-cell adhesion under conditions of uniform shear. The High Throughput Pharmacology System (HTPS) is an instrument used for automated programming of complex pharmacological cell treatment protocols. It was interfaced via the plug flow coupling device to enable rapid (< 5 min) flow cytometric characterization of the intracellular calcium dose-response profile of U937 cells to formyl peptide. CONCLUSIONS: By facilitating the coupling of flow cytometers to other fluidics-based analytical instruments, plug flow cytometry has extended analytical capabilities in cell adhesion and pharmacological characterization of receptor-ligand interactions.

Animals↗