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Progress in Palliative Care Apr 2014Despite being a common admitting diagnosis, there is very little published literature on medication management in hospice patients admitted with a diagnosis of failure...
OBJECTIVES
Despite being a common admitting diagnosis, there is very little published literature on medication management in hospice patients admitted with a diagnosis of failure to thrive or debility. The purpose of this study was to describe medication prescribing practices in hospice patients with either of these primary diagnoses by characterizing prescribed medications by name and by pharmaceutical class, and determining whether the patient or the hospice organization provided each medication.
METHODS
A retrospective review of a patient information database compiled by a national hospice organization was conducted. Patients were included in this retrospective study if they were admitted to hospice care with a primary diagnosis of failure to thrive or debility, and if they were admitted on or after 1 January 2010, and discharged by death on or before 31 December 2010.
RESULTS
Overall 293 patients and 6181 medication entries were evaluated. The most commonly prescribed drugs were acetaminophen, lorazepam, morphine, atropine, prochlorperazine, haloperidol, docusate, aspirin, and bisacodyl. The most commonly prescribed pharmacological classes were opioid and non-opioid analgesics, anxiolytics, anticholinergics, antihypertensives, laxatives, antidepressants, and supplements. The hospice organization provided over 90% of prescriptions for analgesics, antipsychotics, anticholinergics, and anxiolytics, and these medications were discontinued before death in less than 5% of patients.
CONCLUSION
Recognized clinical components of failure to thrive syndrome include cognitive impairment, malnutrition, and depression. The hospice organization provided 80% of antidepressants, but infrequently provided appetite stimulants and drugs treating dementia. The most commonly provided drugs were those used for symptoms associated with most end-stage diseases.
PubMed: 24904199
DOI: 10.1179/1743291X13Y.0000000068 -
American Family Physician May 2014
Review
Topics: Acute Disease; Adult; Anti-Inflammatory Agents, Non-Steroidal; Antipsychotic Agents; Dexamethasone; Dopamine Antagonists; Droperidol; Emergency Service, Hospital; Glucocorticoids; Humans; Metoclopramide; Migraine Disorders; Practice Guidelines as Topic; Prochlorperazine
PubMed: 24784338
DOI: No ID Found -
BMJ Clinical Evidence Mar 2014More than half of pregnant women suffer from nausea and vomiting, which typically begins by the fourth week and disappears by the 16th week of pregnancy. The cause of... (Review)
Review
INTRODUCTION
More than half of pregnant women suffer from nausea and vomiting, which typically begins by the fourth week and disappears by the 16th week of pregnancy. The cause of nausea and vomiting in pregnancy is unknown, but may be due to the rise in human chorionic gonadotrophin concentration. In 1 in 200 women, the condition progresses to hyperemesis gravidarum, which is characterised by prolonged and severe nausea and vomiting, dehydration, and weight loss.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatment for nausea and vomiting in early pregnancy? What are the effects of treatments for hyperemesis gravidarum? We searched: Medline, Embase, The Cochrane Library, and other important databases up to September 2013 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 32 studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions: acupressure; acupuncture; corticosteroids; ginger; metoclopramide; ondansetron; prochlorperazine; promethazine; and pyridoxine (vitamin B6).
Topics: Acupressure; Acupuncture Therapy; Adrenal Cortex Hormones; Antiemetics; Female; Zingiber officinale; Humans; Nausea; Pregnancy; Pyridoxine; Vomiting
PubMed: 24646807
DOI: No ID Found -
Audiology & Neuro-otology 2014The present study investigated whether prochlorperazine affects vestibulo-ocular reflex (VOR) and vestibulo-perceptual function. (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The present study investigated whether prochlorperazine affects vestibulo-ocular reflex (VOR) and vestibulo-perceptual function.
METHODS
We studied 12 healthy naïve subjects 3 h after a single dose of oral prochlorperazine 5 mg in a randomised, placebo-controlled, double-blind, crossover study in healthy young subjects. Two rotational tests in yaw were used: (1) a threshold task investigating perceptual motion detection and nystagmic thresholds (acceleration steps of 0.5°/s(2)) and (2) suprathreshold responses to velocity steps of 90°/s in which vestibulo-ocular and vestibuloperceptual time constants of decay, as well as VOR gain, were measured.
RESULTS
Prochlorperazine had no effect upon any measure of nystagmic or perceptual vestibular function compared to placebo. This lack of effects on vestibular-mediated motion perception suggests that the drug is likely to act more as an anti-emetic than as an antivertiginous agent.
Topics: Adult; Cross-Over Studies; Dopamine Antagonists; Double-Blind Method; Eye Movements; Female; Healthy Volunteers; Humans; Male; Motion Perception; Prochlorperazine; Reflex, Vestibulo-Ocular; Vestibular Function Tests; Young Adult
PubMed: 24401765
DOI: 10.1159/000357028 -
Anaesthesia Jul 2013
Topics: Anti-Inflammatory Agents, Non-Steroidal; Antiemetics; Diclofenac; Drug Incompatibility; Prochlorperazine; Syringes
PubMed: 24044397
DOI: 10.1111/anae.12307 -
Clinical and Experimental... Sep 2013Gastroparesis is a motility disorder of the stomach causing delay in food emptying from the stomach without any evidence of mechanical obstruction. The majority of cases... (Review)
Review
Gastroparesis is a motility disorder of the stomach causing delay in food emptying from the stomach without any evidence of mechanical obstruction. The majority of cases are idiopathic. Patients need to be diagnosed properly by formal testing, and the evaluation of the severity of the gastroparesis may assist in guiding therapy. Initially, dietary modifications are encouraged, which include frequent and small semisolid-based meals. Promotility medications, like erythromycin, and antiemetics, like prochlorperazine, are offered for symptom relief. In patients who are refractory to pharmacologic treatment, more invasive options, such as intrapyloric botulinum toxin injections, placement of a jejunostomy tube, or implantation of a gastric stimulator, can be considered. Hemin therapy and gastric electric stimulation are emerging treatment options that are still at different stages of research. Regenerative medicine and stem cell-based therapies also hold promise for gastroparesis in the near future.
PubMed: 24039443
DOI: 10.2147/CEG.S50236 -
BMC Pregnancy and Childbirth Jun 2013Nausea and vomiting of pregnancy (NVP) is a common condition. The objective of this study was to evaluate the association between response to antiemetics in the...
BACKGROUND
Nausea and vomiting of pregnancy (NVP) is a common condition. The objective of this study was to evaluate the association between response to antiemetics in the treatment of NVP and genetic polymorphisms in the serotonin receptor subunit genes HTR3A and HTR3B.
METHODS
Pregnant women ≥18 years of age with NVP starting antiemetic therapy with promethazine, prochlorperazine, metoclopramide, or ondansetron at ≤ 16 weeks gestational age were eligible. The study recruited 29 women with complete data and sampling who returned for their one week follow-up and were genotyped for HTR3A and HTR3B polymorphisms. Severity of NVP was captured (using Pregnancy Unique Quantification of Emesis (PUQE) and Quality of Life (QOL) tools) upon enrollment and after one week of antiemetic therapy. These measures were correlated with pharmacogenetic variability.
RESULTS
Subjects with genotype associated with high serotonin affinity of the 5-HT3B receptor (rs1176744, CC) required more antiemetic medications (p < 0.001) than other subjects. Those with genotypes associated with increased expression of the 5-HT3A receptor subunit (rs1062613, CT or TT) had worse final PUQE scores (p = 0.01) than other subjects while rs3782025 variants carriers had significantly better initial (p = 0.02) and final (p = 0.02) PUQE scores than other subjects.
CONCLUSIONS
HTR3B and HTR3A gene variants may contribute to variability in response to antiemetic therapy for NVP.
Topics: Adult; Antiemetics; Female; Humans; Metoclopramide; Morning Sickness; Ondansetron; Pilot Projects; Polymorphism, Single Nucleotide; Pregnancy; Pregnancy Trimester, First; Pregnancy Trimester, Second; Prochlorperazine; Promethazine; Receptors, Serotonin, 5-HT3; Severity of Illness Index; Treatment Outcome; Young Adult
PubMed: 23786674
DOI: 10.1186/1471-2393-13-132 -
Indian Journal of Psychological Medicine Oct 2012All kinds of drugs are available over the counter in Bangladesh.
Investigation into self-medication of drugs for primary and adjunct therapy in psychiatric diseases among students in chittagong city of bangladesh: a comparison between medical and nonmedical students.
BACKGROUND
All kinds of drugs are available over the counter in Bangladesh.
AIM
The objective of this study was to investigate the over the counter use of self medicated drugs for primary and adjunct therapy in psychiatric diseases among medical and nonmedical students.
MATERIALS AND METHODS
101 medical students and 186 nonmedical students were found, who used at least one of the nine drugs (believed as antipsychotics among nonmedical people) under survey within 6 months prior to survey date. The nine drugs used for survey were domperidone, sertraline, amitriptyline, midazolam, diazepam, prochlorperazine bromazepam, flupentixol-melitracen, and clonazepam.
STATISTICAL ANALYSIS
Snowball sampling method was used. The symptoms, diseases, etc. of the students and the length of therapies they had followed for the respective drugs were noted.
RESULTS
Among nonmedical students, several cases were found where drugs were being self medicated in wrong indications, for example, use of flupentixol melitracen and domperidone to treat headache.
CONCLUSION
The nonmedical students chose the fast acting drugs having the strongest effects for self medication.
PubMed: 23723537
DOI: 10.4103/0253-7176.108195 -
Antimicrobial Agents and Chemotherapy Aug 2013The effects of clinically available drugs targeting muscarinic cholinergic, adrenergic, dopaminergic, and serotonergic receptors; intracellular calcium levels and/or the...
The effects of clinically available drugs targeting muscarinic cholinergic, adrenergic, dopaminergic, and serotonergic receptors; intracellular calcium levels and/or the function of calcium-dependent biochemical pathways; ion channels; and cellular pumps were tested against a keratitis isolate of Acanthamoeba castellanii belonging to the T4 genotype. In vitro growth inhibition (amoebistatic) assays were performed by incubating A. castellanii with various concentrations of drugs in the growth medium for 48 h at 30°C. To determine amoebicidal effects, amoebae were incubated with drugs in phosphate-buffered saline for 24 h, and viability was determined using trypan blue exclusion staining. For controls, amoebae were incubated with the solvent alone. Of the eight drugs tested, amlodipine, prochlorperazine, and loperamide showed potent amoebicidal effects, as no viable trophozoites were observed (>95% kill rate), while amiodarone, procyclidine, digoxin, and apomorphine exhibited up to 50% amoebicidal effects. In contrast, haloperidol did not affect viability, but all the drugs tested inhibited A. castellanii growth. Importantly, amlodipine, prochlorperazine, and loperamide showed compelling cysticidal effects. The cysticidal effects were irreversible, as cysts treated with the aforementioned drugs did not reemerge as viable amoebae upon inoculation in the growth medium. Except for apomorphine and haloperidol, all the tested drugs blocked trophozoite differentiation into cysts in encystation assays. Given the limited availability of effective drugs to treat amoebal infections, the clinically available drugs tested in this study represent potential agents for managing keratitis and granulomatous amoebic encephalitis caused by Acanthamoeba spp. and possibly against other meningoencephalitis-causing amoebae, such as Balamuthia mandrillaris and Naegleria fowleri.
Topics: Acanthamoeba castellanii; Amlodipine; Antiprotozoal Agents; Culture Media; Digoxin; Drug Evaluation, Preclinical; Genotype; Haloperidol; Loperamide; Parasitic Sensitivity Tests; Prochlorperazine; Trophozoites
PubMed: 23669391
DOI: 10.1128/AAC.00299-13 -
Neurology Mar 2013A 44-year-old woman with a history of migraines and idiopathic intracranial hypertension presented to the emergency room with 1 day of headache and nausea. She had been...
A 44-year-old woman with a history of migraines and idiopathic intracranial hypertension presented to the emergency room with 1 day of headache and nausea. She had been otherwise healthy with no sick contacts. She was afebrile without nuchal rigidity, rash, or cardiac murmur, and her neurologic examination was normal. Migraine therapy was initiated with IV prochlorperazine, ketorolac, and magnesium. Two hours later, she developed fever (101.4°F) and confusion, continually stating, “It hurts,” but unable to answer questions or follow commands despite an otherwise unremarkable examination. Noncontrast head CT demonstrated mastoid sinus opacification, but no abnormalities of her brain parenchyma or ventricular system.
Topics: Acute Disease; Adult; Anti-Bacterial Agents; Brain; Diagnosis, Differential; Female; Headache; Humans; Intracranial Hypertension; Nervous System Diseases; Neurologic Examination
PubMed: 23530156
DOI: 10.1212/WNL.0b013e318289704c