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At least 1,117 records · Page 62Linked to original sources
PubMed1992

The first lithium clinic in Hong Kong: a Chinese profile.

A study of 50 Chinese patients referred to the first lithium clinic in Hong Kong revealed a high prevalence of recurrent mania and rarely unipolar depression. A history of delusions and hallucinations, and re-diagnosis from schizophrenia to manic depressive psychosis, were common. Lithium was prescribed after 3.9 episodes of illness, and at a dosage of 1,191 mg despite a moderate serum level of 0.63 mmol/l. Laboratory monitoring was haphazard, and polypharmacy was common. This might pose unnecessary risks to some patients.

Adolescent↗
PubMed1991

Drug-related admissions to a department of medical gastroenterology. The role of self-medicated and prescribed drugs.

Three hundred and twenty-eight consecutive patients admitted to a department of medical gastroenterology were evaluated in a high-intensity study of drug-related hospitalizations (DRH). The drug events considered were adverse drug reaction and dose-related therapeutic failures (DTF). With regards to the 'definite' and 'probable' drug events, DRHs accounted for 26 admissions (7.9%; 95% confidence interval (CI), 5.2-11.4%), and with the additional inclusion of 'possible' drug events DRHs accounted for 39 admissions (11.9%; CI, 8.6-15.9%). Of these, five and seven admissions, respectively, were caused by DTF. Patients admitted because of drug events took significantly more drugs than others. An evaluation of the circumstances of the 26 'definite' or 'probable' DRH showed none to be 'definitely avoidable', 6 to be 'possibly avoidable', and 20 to be 'not avoidable' by efforts from the prescribing physicians. Gastroduodenal lesions causally related to non-steroidal anti-inflammatory drug (NSAID) or aspirin use accounted for 17 of the definite, probable, or possible DRHs (44%). Only 1 of the 11 cases related to NSAID use was rated as possibly avoidable by efforts from the health service personnel. In 13 cases self-medication with aspirin played a substantial role in the DRH. Self-medication was largely characterized by poor indication, uncontrolled use, polypharmacy, treatment of epigastric pain with aspirin, and the patient's unawareness of potential adverse reactions. This suggests the need for intensified information to the public concerning the adverse effects of aspirin and NSAID.

Adult↗
PubMed1988

Future trends in the treatment of rheumatoid arthritis in the light of current etiopathogenetic theories.

The current treatment of rheumatoid arthritis is based on the use of synthetic chemical compounds, the mechanism and action of which have been more or less unknown. Usually this therapeutic effectiveness was discovered accidentally. Often the initial use of such compounds was motivated on the basis of generally diffuse ideas about the eventual pathogenesis of rheumatoid arthritis. The main site of action of most of these drugs has recently been elucidated. Depending on their multiple sites of action the polypharmacy frequency relied upon at present seems also to be theoretically motivated. Many new possibilities for treatment which have appeared recently have resulted from the amission of page limitation. These include various thymic (46), steroid and other hormones (67) and various vehicles or new modes of application, e.g. percutaneous, for directing the effects of drugs selectively to the target tissue, organ and cells. The use of specific T cell clones in therapy (68) has been only briefly dealt with in this article, and the development of operative techniques, endoprosthesis technology and orthopedic devices have not been dealth with at all. Chemical synovectomies with 165Dy-FHMA and other agents (69) will be developed further etc. This overview mainly deals with future trends in the treatment of rheumatoid arthritis based on advances made in the evaluation of the etiopathogenesis. Due to advances in basic sciences and medicine, the pathogenetic mechanisms effective in rheumatoid arthritis are better known today than ever before. The same progress in science has for the first time in history provided us with a potential means of producing bioactive mediators and reagents in sufficient amounts to enable their use also for therapeutic trials and treatment. In addition to the need to develop better methods of treatment for the patients crippled by this chronic disease, studies on the pathogenesis will also be of great benefit to our ideas about exactly what is involved in the complex process clinically known as rheumatoid arthritis.

Arthritis, Rheumatoid↗
PubMed1995

Autonomic measures associated with chemotherapy-related nausea: techniques and issues.

Advances in antiemetic therapy for cancer patients have been hindered by a lack of understanding of the physiological mechanisms associated with nausea and their corresponding measurement techniques. Here we review conceptual and methodological issues involved in developing an autonomic frame of reference for nausea and outline two strategies for assessing autonomic function. A primarily research-oriented strategy uses heart rate, blood volume pulse, pallor, and skin temperature to assess autonomic activity and reactivity over 24 hr. Peak values of these measures relative to time of emesis, heart rate spectral analyses of autonomic activity, and analyses of the standard deviation of successive differences of beat-to-beat intervals were all associated with subsequent nausea. A primarily clinically oriented strategy assesses normal and abnormal results on eight common bedside clinical tests of autonomic function. The total number of abnormal tests was associated with subsequent nausea. A better understanding of chemotherapy side effect mechanisms is likely to result in less polypharmacy and more effective individualized treatment for cancer patients.

Arrhythmia, Sinus↗
PubMed1994

Bupropion/nortriptyline combination for refractory depression.

Many patients fail to respond to one or more trials with a single antidepressant. In such cases polypharmacy is often necessary and beneficial, although there may be an increased risk of complications. Four case reports are presented of patients with refractory depression treated successfully with the combination of the tricyclic antidepressant nortriptyline and the newer agent bupropion.

Bupropion↗
PubMedDate not supplied

Evaluating the clinical significance of drug interactions: a systematic approach.

Remembering the myriad of psychotropic drug interactions is extremely difficult. Nevertheless, by applying a systematic approach, the clinician can often predict the occurrence and time course of such interactions. Several factors must be considered when assessing the potential consequences. Drug-related factors that increase the risk for clinically significant interactions include a low therapeutic index or narrow therapeutic window, a multiplicity of pharmacological actions, and inhibition or inducement of cytochrome P450 enzymes. Next, patient-related factors that can increase the risk for significant drug interactions should be considered. These include genetically based variations in drug-metabolizing capacity, as well as advanced age, underlying medical illness, and comorbid substance abuse. Finally, the literature should be carefully reviewed to as-certain the potential clinical relevance of available data. If a clinically significant drug interaction appears likely to occur, the patient's clinical status should be followed closely; therapeutic drug monitoring should be used if applicable and dosage adjustments made accordingly. Rational polypharmacy requires an understanding of the pharmacological principles governing drug interactions and a knowledge of the factors that increase the likelihood of clinically significant variations in drug action. This will allow the clinician to maximize beneficial effects while minimizing the risk of adverse events.

Drug Interactions↗
PubMed1977

Drugs and children: methods for therapeutic monitoring.

In this era of polypharmacy, the incidence of adverse reactions due to drug therapy has increased alarmingly since the precise effects on the metabolism of a drug given in combination with other drugs can never be predicted with certainty. Inadequate therapy due to insufficient medication or to factors which diminish absorption or enhance metabolism may be equally undesirable. The consequences to patients in terms of increased morbidity and financial cost of prolonged hospitalization may be considerable. For pediatric patients, particularly in the newborn period, these hazards may be much more dangerous. There is a need for more investigation into the validity of procedures in current use for the determination of drug levels in biologic fluids and into the interpretation of the values they produce. In addition clinical chemists and clinical pharmacologists are faced with the challenge of defining those drugs for which blood level information would be advantageous and developing rapid, sensitive, and accurate assays which can be performed by the routine clinical laboratory. The day may be not too far away when a major proportion of the workload of the clinical laboratory consists of assays primarily designed as an aid to therapy rather than diagnosis.

Carbamazepine↗
PubMed1998

Pediatric benzodiazepine ingestion resulting in hospitalization.

OBJECTIVE: To characterize the clinical findings in children hospitalized for benzodiazepine ingestion. METHOD: Retrospective case series in two urban children's hospitals, with no intervention. Suicide attempts and polypharmacy ingestions were excluded. RESULTS: Forty-six children (67% male) with a mean age of 36 months (range 14-127 months) were hospitalized from January 1987 through September 1994. Lorazepam was most frequently ingested (13/41 identified drugs, 32%). The most prevalent symptoms were ataxia (87%), lethargy (57%), coma (Glasgow coma score < 15, 35%; Reed coma score > 0, 22%), and respiratory depression (9%). Duration of symptoms was less than 24 hours in 88% of patients. Isolated ataxia occurred in eight patients; in five of these patients, benzodiazepine ingestion was unsuspected by the physicians. Three parents intentionally administered the benzodiazepine to their child. Only 50% of 32 toxicology screens were positive for benzodiazepines. One child required endotracheal intubation. Flumazenil administration preceded clinical improvement in two other children. The remaining patients received activated charcoal administration and supportive care. CONCLUSION: Children hospitalized for benzodiazepine overdose occasionally had life-threatening symptoms. Ataxia was the most common clinical finding following benzodiazepine ingestion in this series. Flumazenil appeared beneficial for the treatment of severe benzodiazepine toxicity in only two patients. Most children recovered from their overdose uneventfully after receiving activated charcoal and supportive care.

Anti-Anxiety Agents↗
PubMed1993

[Present status of elderly patients at geriatric outpatient clinics in terms of number of clinics consulted and number of drugs taken].

It has been said that elderly patients generally have many diseases (polypathology) for which they consult multiple doctors and are given a wide variety of drugs by their attending doctors (polypharmacy). There is a tendency for elderly patients to buy various kinds of drugs from drug stores without medical prescriptions. However, little is known about the actual status of the numbers and kinds of drugs they take. To answer these questions, we studied 192 elderly patients who were regularly consulting the outpatient clinic of geriatric medicine at Kyoto University Hospital. Seventy nine patients (41%) were consulting other clinics of the same hospital in parallel with ours. Of these patients 81% were given some drugs at other clinics. Forty of 192 patients took a variety of OTC drugs, concerning which they did not inform their attending doctors. Among these, 24 patients took some kinds of traditional Chinese medicine. Thus, a considerable percentage of elderly patients were consulting more than one clinic and in most of these patients were given some drugs. Some of them also take, without permission, drugs other than those prescribed by attending doctors. These results led us to conclude that elderly patients should be under the strict control of a single attending doctor to avoid unexpected adverse effects.

Aged↗
PubMed2004

[Incidence of adverse drug reactions in geriatric wards of university hospitals].

Adverse drug reactions (ADR) in elderly people, which have been shown to increase with age, are often attributed to functional decline and polypharmacy. A multi-institutional retrospective survey was undertaken to investigate the current status of ADR in geriatric wards of university hospitals. The inpatient database from 2000 to 2002 in 5 university hospitals was studied, and a total of 1,289 patients were analyzed. The incidence of ADR, as determined by attending physicians, was 9.2% on the whole but varied from 6.3% to 15.8% among the institutions. The factors significantly related to ADR were number of diagnoses, number of geriatric syndromes, number of prescribed drugs, increase of more than two drugs during admission, longer hospital stay, emergency admission, depression and apathy. These results are mostly consistent with previous reports and will provide important information on pharmacotherapy in elderly people.

Aged↗
PubMed2026

Digital twins in precision pharmacotherapy: emerging applications, challenges, and future directions.

Digital twin technology, defined as dynamic digital models that represent individual patients, is emerging as a promising paradigm in precision pharmacotherapy. The integration of pharmacokinetic and pharmacodynamic (PK/PD) modeling, clinical data, genomic information, and real-time patient monitoring enables digital twins to shift drug therapy away from population-based averages toward individualized, adaptive decisions. This narrative review explores conceptual frameworks, emerging applications, methodological approaches, clinical value, limitations, and future directions of digital twins in pharmacotherapy, with particular emphasis on the role of clinical pharmacists. Unlike broader digital twin reviews that primarily emphasize technical architectures, disease-specific applications, or pharmaceutical research and development, this review focuses on the clinical-pharmacy translation layer: how digital twin outputs can be interpreted, validated, communicated, and converted into actionable medication decisions at the bedside and across ambulatory care settings. Key applications include precision dosing, polypharmacy management, antimicrobial stewardship, and the optimization of complex therapies, alongside important ethical, regulatory, and implementation challenges.

clinical pharmacy↗
PubMed1996

Noncardiac chest pain: where does it start?

The pathogenesis of recurrent noncardiac chest pain remains an enigma. The literature suggests that it may be caused by a heightened state of visceral nociperception. Coronary atherosclerosis must first be excluded with a reasonable degree of certainty. The physician can then focus on reassuring the patient and continuing management, bearing in mind the caveat, first do no harm. Polypharmacy and hazardous procedures should be avoided. Aggressive acid suppression is helpful in patients with gastroesophageal reflux disease, and antidepressants have shown promise in otherwise unexplained cases of chest pain. Despite significant morbidity in patients with the disorder, the long-term prognosis is excellent.

Chest Pain↗
PubMed1989

LTC in the Third World.

1. More than half the world's elderly, 370 million people, live in Third World Nations. As this population increases, the growth rate is fastest for the oldest of the old, those most likely in need of health services. Provision of long-term care is a vital issue in future development planning. 2. A major threat to the elderly's health was communicable disease, a societal dilemma that will require further economic development and advances in the country's community health system. 3. The aged in this setting in India experienced multiple chronic diseases and degenerative conditions, potential problems with polypharmacy, and major functional losses. Some also expressed feelings of uselessness and dependency. These issues can be compared to those of institutionalized elderly in the West.

Aged↗
PubMed1991

Iatrogenesis in the elderly. Drug-related problems.

Drug reactions are generally related to the influence of age, toxicity, side effects, immunologic reactions, idiosyncratic reactions, drug-drug interactions, and drug-disease interactions. In addition to age-related changes, the elderly are susceptible to the incidence of adverse drug reactions because of polypharmacy, incorrect self-administration of drugs, omission of drugs, taking another's prescriptions, use of over-the-counter drugs, and medication errors by health-care personnel. To prevent or predict adverse drug reactions, the gerontologic nurse can obtain thorough drug histories, educate clients and health-care providers, use nursing measures to alleviate symptoms, and be astute for the potential for problems through drug review.

Aged↗
PubMed1996

Neuroleptic therapy. How much do nurses know?

1. Nursing home nurses play an integral and crucial role in neuroleptic therapeutic regimens as they are responsible for administering medications and monitoring for potential side effects. 2. The geriatric population residing in nursing homes is particularly vulnerable to side effects associated with neuroleptics for a variety of reasons including decreased drug distribution/metabolism/excretion, concomitant polypharmacy, and increased prevalence of tardive dyskinesia. 3. Nursing home nurses need to be better informed regarding neuroleptic use; education should be specifically targeted to include changes in pharmacokinetics and pharmacodynamics associated with aging, drug-drug interactions, and ongoing evaluation of side effects. 4. There is a pressing need to continue to examine the judicious use of neuroleptics in nursing home residents.

Adult↗
PubMed2005

Preventing falls in acute care: an innovative approach.

Falls among elderly individuals have been significant sources of disability and death. Falls have affected as many as 10% of older adults during an acute care inpatient stay. The acute care environment has contributed to elderly patient falls. Additionally, manifestations of acute illness, polypharmacy, and medication side effects have been risk factors for falls in the acute care setting. Individualized fall prevention strategies, initial patient assessments, and ongoing patient reassessments have been linked to a decrease in falls in the acute care setting. Approaches to fall prevention have included identification of high-risk patients, communication among staff and family members about an individual's risk of falls, and both case-specific and universal interventions for fall prevention. The purpose of this article is to describe a fall prevention program instituted in an acute care setting in southern Arizona that has produced encouraging results. Moreover, this article addresses individualizing interventions through a continuous clinical feedback loop, which provides patient care areas with relevant information about their patients who fell and recommendations for improving fall prevention.

Accident Prevention↗
PubMed1992

Medication management, antidepressant drugs, and the elderly: an overview.

1. Several factors may affect an elderly client's use of medications: polypharmacy, potentially leading to interactions; over-the-counter drugs taken without a physician's knowledge; noncompliance or poor compliance with medication regimens; and ageist beliefs. 2. Psychiatric nurses must be aware that the signs and symptoms they observe may be the result of normal physical or biological aging, psychosocial changes, disease-related changes, medication side effects, or a drug interaction. 3. Nurses must ask two questions when psychotropic drugs are used with elderly clients: What will be the onset, duration, magnitude, and characteristic action of a specific drug in an individual; and What are the characteristics of an "ideal" medication?

Aged↗
PubMed2004

Serotonin syndrome and the use of SSRIs.

Nurses need to become more aware of serotonin syndrome to avoid its development and to ensure a therapeutic response when early symptoms emerge. While polypharmacy tends to put individuals at greatest risk for the syndrome, use of a single serotonergic agent may also provoke an adverse response. Because the onset and progression of serotonin syndrome are rapid, prompt action may be needed to avoid potentially life-threatening consequences.

Adult↗