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At least 1,261 records · Page 70Linked to original sources
PubMed1977

Patterns of antipsychotic drug use in four Southeastern state hospitals.

The drug prescriptions of patients in the four mental hospitals of a state were obtained as of a specific date and subjected to various analyses. The results disclose a high frequency of antiparkinson drug orders (41.5% of the patients), their relationship to polypharmacy (30% of the antipsychotic drug prescriptions were for two or more to be administered simultaneously), the direct relationship between the antipsychotic dose level and antiparkinson drug and PRN orders and the incidence of multiple dose schedules (75%). Also other prescription practices which have received little or no attention are described and discussed.

Antiparkinson Agents↗
PubMedDate not supplied

[Practice guideline for the administration of drugs with parenteral nutrition].

The "Y" administering of drugs or administering them during parenteral nutrition should not be a normal practice in daily clinical operations, due to the problems of the possible lack of physio-chemical stability in the lipid emulsion forming the mixture of aminoacids, glucose, lipids, electrolytes, vitamins and oligoelements or the chemistry of the drug itself with these components. Also, the "Y" administration of drugs in parenteral nutrition increases the risk of infection in the catheter, since it is handled much more often. Despite these problems, there are clinical situations (such as preoedema of the lung, inadequate syndrome of the antidiuretic hormone in bone marrow transplants), in which it is necessary to restrict to a minimum the fluids to be perfused. As an example, we could mention Ranitidine in TPN or the elimination of second line peripheric maintenance serum and the administering of other drugs in "Y" using a syringe or microdrop system. The same case as in patients subjected to bone marrow transplants, where due to polypharmacy and transfusions, drugs should be administered in "Y". This study is an updated review of the chemical stability of drugs administered in "Y" or in parenteral nutrition, and the physio-chemical stability of the lipid emulsion.

Clinical Protocols↗
PubMed1991

[Interactions of cytostatic agents with other drugs].

With the degree of polypharmacy currently practiced in the field of oncology, there are undoubtedly many drug interactions. In the present study the influence of "non-cytotoxic" drugs on anticancer drugs is discussed, but not the reverse. Not only is the augmentation (reversal of multidrug resistance) or the reduction of antitumor properties of cytotoxic drugs observed, but also cytostatic activities of "non-cytotoxic" drugs themselves. Examples are calmodulin inhibitors such as phenothiazines and tricyclic antidepressants. Interactions may also increase side effects of cytostatic drugs or even neutralize the antitumoral activity. To ensure that interactions are not overlooked, all medicaments being administered should be listed. It is, however, not feasible yet to determine serum concentrations of all the drugs given to the patient. The antitumor activity of supportive care could be evaluated in randomized studies (e.g. cytostatic drugs +/- antidepressants).

Antineoplastic Agents↗
PubMed1991

[Surgical treatment of epilepsy resistant to drug therapy. A review].

The prevalence of epilepsy is 7-9 cases per 1,000 population, corresponding to 440,000 individuals in Denmark. Approximately 1/4 of these individuals have seizures refractory to anticonvulsant medications and most of them have an epileptic focus in the temporal lobe. Epilepsy refractory to anticonvulsant medication is an incapacitating disease with high costs for the person and the society. The main problems are polypharmacy with side effects, suspicion of neurodegenerative consequences and a higher mortality. The modern era of epilepsy surgery began more than 100 years ago and since then, the developments in neurophysiology and neuroimaging have made it possible to demonstrate the epileptic focus with relatively high precision. As a consequence of this, the volume of the resected tissue has diminished and the operative complications become less frequent. The somatic and neuropsychological effects of a cortical resection are discrete and compensated by a general improvement in performance. Surgical treatment of epilepsy should no longer be considered as a last resort, but as a realistic treatment in cases of medication failure.

Anticonvulsants↗
PubMed1990

Goals of treatment and current management strategies.

"Many of us were taught in medical school that monotherapy is better than polypharmacy. But congestive heart failure (CHF) is a prototypical disease in which combination therapy including digoxin appears to surpass any of the agents used alone. In CHF we treat different aspects of the pathophysiology."

Adrenergic beta-Antagonists↗
PubMed1990

Psychotropic medication in the elderly. A survey of prescribing and clinical outcome.

Due to the increasing elderly population, an increased number of elderly patients requires treatment for mental and behavioural disorders. There are relatively few clinical studies of the prescribing of psychotropic drugs in patients over 65 years of age. A prospective study was undertaken at three centres caring for the elderly, encompassing patients from general nursing homes and a psychiatric department. Entry of patients into the survey was determined by the clinical decision to prescribe psychotropic medication and an age of 65 years or older. Included in the study were 160 patients. The main reasons for initiating psychotropic medication were indicated, and anamnestic data were collected. Initial and continuing dosages of psychotropic medication were recorded. The clinical condition was assessed at the start of treatment and after four and eight weeks, utilising the Clinical Global Impressions (CGI) scale. The patient's daily activity using an abbreviated Stockton Geriatric Rating Scale (SGRS) was assessed. Side effects were recorded using the UKU Scale. Clinical improvement was seen in about half of the patients with the best effect in patients with mainly psychotic symptoms. Patients with chronic dementia-related problems responded less well. Side effects were few and generally mild. This situation may relate to cautious introduction of the medication and adoption of low-dose regimens. All centres avoided, if possible, psychotropic polypharmacy.

Adjustment Disorders↗
PubMed1991

Assessment of elderly people in general practice. 2. Functional abilities and medical problems.

A random sample of 239 patients aged 75 years and over registered with general practitioners in north and north west London was selected for home assessment to determine the functional abilities and medical problems of this group of patients. Nearly one in five of the patients were incontinent of urine (18.4%), although this was on a daily basis for only 4.1%. Around one in 20 patients were incontinent of faeces (5.9%), yet only one patient had laundry service support. Unassisted mobility outdoors was reported as possible by 81.2% of the patients. Fourteen different types of aids were present in the participants' homes, the commonest being walking sticks, bath aids and stair rails. Only a small proportion of aids seemed to be currently unused. The major functional problems were bathing, housework, shopping, washing and ironing, and cooking main meals, but the level of demand for extra help was low. One in five patients had a hearing aid (19.8%) but for only 30% of these patients was it in continuous use. Polypharmacy was common, with 29.7% of patients taking three or more prescribed medicines. The workload implications of this approach to anticipatory care of elderly people are considerable. In an average practice of 2000 patients with 130 patients aged 75 years and over the primary care team would need over 150 hours of face-to-face contact per year with these patients to fulfil the new contractual obligation and the yield of new information leading to effective medical or social intervention is limited.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMedDate not supplied

[Difficulties and errors in ambulatory therapy of Parkinson disease].

The clinical findings as well as the follow-up of 52 patients with progressive Parkinsonism were analyzed and the following results obtained: The reasons for the clinical progression of the disease were most often acute secondary illnesses not involving the CNS, Parkinsonism-independent CNS lesions ("Parkinson plus"), the absolute as well as relative L-DOPA overdose and, lastly but significantly, the effects and side-effects of too many prescribed drugs. Our findings resulted in the following therapeutic recommendations: A monotherapy should be used for as long as possible with slowly increasing doses up to the threshold of tolerance. Only if necessary should alternative drugs or a combination of not more than two drugs be used. Parkinsonism progresses even with the present best therapy. So far, it was only been possible to mitigate this progress, but not to prevent it. In the late stage of the disease it is more appropriate to accept some remaining symptoms than to risk an overdose or polypharmacy with its attendant problems.

Amantadine↗
PubMed1991

Recognition and treatment of depression in the elderly.

The author reviews clinical issues related to recognition of depression in elderly patients and provides a practical, systematic approach to diagnostic and treatment decision making. Factors complicating accurate diagnosis of geriatric depression include the presence of medical illness, dementia syndromes, cohort effects, ageism, and heterogeneity of patient populations. Age-related pharmacokinetic changes and polypharmacy need to be considered because they will increase an elderly person's sensitivity to medications. A variety of antidepressant drugs has been found to be safe and effective in elderly depressed patients, but some modification in their use is suggested. A systematic approach is provided to assist the clinician when confronted with this often complex and challenging patient population.

Age Factors↗
PubMedDate not supplied

In-vitro susceptibility patterns of some major respiratory tract pathogens in Nigeria to eleven selected antibiotics.

A study of the antibiotic sensitivity patterns of nine pathogens isolated from bronchopulmonary infections was made using the disc diffusion method. Erythromycin, carbenicillin and chloramphenicol were in that sequence the drugs most effective against the Gram-positive cocci, followed by ampicillin to which however, 56% of the strains of staphylococcus aureus tested showed resistance. More than 95% of the strains of Haemophilus influenza were very susceptible to carbenicillin and chloramphenicol while over 70% were sensitive to ampicillin, penicillin G, and erythromycin. All strains of Pseudomonas aeruginosa tested were sensitive to carbenicillin and gentamicin. Klebsiella pneumoniae was moderately sensitive to tetracycline, carbenicillin, streptomycin, gentamicin and septrin (co-trimoxazole). Sixty-seven percent of Escherichia coli were sensitive to septrin while 50% were susceptible to chloramphenicol, erythromycin and ampicillin. In general there was evidence that tetracycline, septrin, penicillin G, streptomycin and orbenin had become less effective against most of the respiratory tract pathogens. The study shows the necessity for the early identification of the aetiologic agents and their antibiotic sensitivity patterns so as to reduce the degree of wasteful polypharmacy or the development of high resistance rates in hospitals and their environments.

Anti-Bacterial Agents↗
PubMed1990

The prescription of psychotropic medication in general practice--a descriptive study.

The prescriptions of all patients who attended an urban general practice from September 1987 to December 1987 were studied. Of the 111 patients (60 females and 51 males) who received a psychotropic prescription the commonest presenting complaint was insomnia (56 patients or 50.5%). This was followed by tension, headache and unexplained aches and pains (19 patients or 17.1%), and anxiety (nine patients or 8.1%). Consistent with these presentations a vast majority (92.8%) received a benzodiazepine. The commonest drugs prescribed were Lorazepam and Bromazepam whereas the longer acting benzodiazepines were rarely used. Polypharmacy was rare.

Drug Prescriptions↗
PubMed1990

Hepatic diseases in the elderly.

The clinical manifestations of liver disease in the geriatric population reflect both the cumulative effects of longevity on the liver and the generalized senescence of the body's ability to adjust to metabolic, infectious, and immunologic insults. Although liver tests are not significantly affected by age, the presentation of liver diseases such as viral hepatitis may be more subtle in the geriatric population than that of younger patients. Alcoholic liver disease and primary biliary cirrhosis usually are advanced in the elderly. Geriatric patients are at risk for untoward drug side effects because of polypharmacy, alterations in the rate of first pass and phase I metabolism, and decreased capacity of carrier proteins such as albumin.

Age Factors↗
PubMed1990

[Epilepsy and pregnancy].

Epilepsy affects almost 1% of all pregnant women. The effect of pregnancy upon epilepsy is unpredictable for the individual patient. In one third to one half of the patients epilepsy had no effect on seizure frequency, in one fourth to one third of the patients seizure frequency increased, and in one third to one fourth it improved. Several reasons are discussed for a frequently observed tendency to a drop in plasma concentration of antiepileptic drugs during pregnancy where the daily dose was kept unchanged. For unknown reasons, perinatal lethality is up to twice as high as in controls. The risk of bearing children with malformations is approximately 1.5-3 times higher for mothers with epilepsy than in non-epileptic mothers. Apart from antiepileptic drugs the role of genetic factors, the type and severity of epilepsy and the possible influence of grand-mal seizures during pregnancy must be considered to be involved in congenital anomalies. Polypharmacy produces more frequent anomalies than monotherapy. Valproate should be avoided in the pregnant women due to the increased incidence of neural tube defects. At this time there is no reason to discourage a mother on antiepileptic drug therapy from breast feeding.

Abnormalities, Drug-Induced↗
PubMed1990

Benzodiazepine use in a small community hospital. Appropriate prescribing or not?

Benzodiazepine (BDZ)-prescribing patterns in relation to indications and to drug characteristics in a small short-stay hospital were examined. In a sample of 800 patients, 183 were prescribed BDZs during their stay. Female patients received more BDZs (BDZ:female patients 1.31:1.0) than males (BDZs:male patients 1.02:1.0), particularly in the 21-40-year age group in which polypharmacy was highest. BDZs were classified according to their elimination half-lives. Our data showed that the majority fell into the long-acting (half-life greater than 24 h) (55%) and intermediate-acting (half-life 12-24 h) (20.7%) categories, despite the fact that most indications (pre-anaesthetic and night-time sedation; total 71.6%) called for the shorter-acting drugs. The merits or otherwise of this situation are discussed, and a number of questions put regarding the validity of this approach. Overall, BDZs accounted for 5.8% of the calculated medications given to the 800-patient sample.

Adolescent↗
PubMed1990

[Reducing and stopping treatment].

It is nowadays well-established that a large number of patients with epilepsy can experience a full remission of their condition. In some cases, seizures that were resistant at the onset of the disease may become responsive to therapy over the years. A good knowledge of the classification of epilepsies and epileptic syndromes may give important clues to the overall prognosis of particular epilepsy case. In subjects controlled by therapy, a slow and careful discontinuance of drugs may be initiated after a 2-year seizure-free period. If seizures recur, it will most probably be possible to return to full control with a lesser treatment. Even if seizures fail to be totally controlled and therapy cannot be discontinued, it is often possible to reduce polypharmacy and thus lessen unwanted side-effects.

Anticonvulsants↗
PubMed1989

[A case of primary right ureteral squamous cell carcinoma with intraperitoneal invasion].

A case of primary right ureteral squamous cell carcinoma with intraperitoneal invasion was studied. The patient was a 38-year-old male with chief complaints of right lumbago and gross hematuria. He was admitted to our clinic suspected of having calculi. However, the radiogram was negative. As the patient was suffering from severe hypogastric pain, indicating acute abdomen, an investigative celiotomy was performed. The tumor that was subsequently revealed formed a mass engulfing the furcation of the right internal and external iliac arteries, ureter, ileum and sigmoid colon. As a radical resection was considered impossible, as much of the tumor as possible was excised and a colostomy was performed. After the operation, a regimen of polypharmacy, including bleomycin, was administered against the residual tumor. This therapy has proved to be remarkably effective. At present, the patient is under regular medical observation, and the postoperative course has been favorable.

Adult↗
PubMedDate not supplied

Prescriber performance in a paediatric general practice clinic of a university teaching hospital.

In order to assess prescriber performance at a general practice clinic of a University Teaching Hospital, the medical records on and the prescription given to patients less than 16 years of age were studied. Performance was assessed on the basis of the diagnosis, suitability of the drugs prescribed, their dosage, duration, combination and cost. Prescription was inappropriate in 74.3% of cases and the prescribers indulged in polypharmacy, unnecessary and extravagant prescribing of drugs in suboptimal dosage. Establishment of drug prescription/utilization committee, and hospital drug formulary, coupled with frequent evaluation of the prescribers are suggested means of enhancing prescriber performance.

Adolescent↗
PubMed1989

[A study of prescriptions for psychotropic drugs at a French psychiatric hospital].

The prescribing habits were studied in a psychiatric hospital which provides services for one district of Paris. The sample consisted of 175 inpatients. A mean of 2.1 psychotropic drugs was prescribed per patient, and more than two-thirds received two psychotropic drugs or more. Almost one-half had a PRN order. Major tranquilizers were frequently used in patients not having a psychotic disorder and were associated to anticholinergic drugs in 55% of the cases. Factors associated with drug prescriptions were diagnosis, age and unit of treatment. Our results are similar to those of previous studies on excessive polypharmacy. The discussion draws attention on the need to obtain data on the rationale for prescribing and the response to treatment. Emphasis is placed on the potential usefulness of studying drug prescriptions for psychiatric practice.

Adolescent↗