Guidelines for the Management of Nausea and Vomiting in Palliative Care
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Medications and Alcohol Craving
Medications and Alcohol Craving Robert M. Swift, M.D., Ph.D. The use of medications as an adjunct to alcoholism treatment is based on the premise that craving and other manifestations of alcoholism are mediated by neurobiological mechanisms. Three of the four medications approved in the United States or Europe for treating alcoholism are reported to reduce craving; these include naltrexone (ReVia™), acamprosate, and tiapride. The remaining medication, disulfiram (Antabuse®), may also possess some anticraving activity. Additional medications that have been investigated include ritanserin, which has not been shown to decrease craving or drinking levels in humans, and ondansetron, which shows promise for treating early onset alcoholics, who generally respond poorly to psychosocial treatment alone. Use of anticraving medications in combination (e.g., naltrexone plus acamprosate) may enhance their effectiveness. Future studies should address such issues as optimal dosing regimens and the development of strategies to enhance patient compliance. KEY WORDS: AOD (alcohol and other drug) craving; anti alcohol craving agents; alcohol withdrawal agents; drug therapy; neurobiological theory; alcohol cue; disulfiram; naltrexone; calcium acetylhomotaurinate; dopamine; serotonin uptake inhibitors; buspirone; treatment outcome; reinforcement; neurotransmitters; patient assessment; literature review riteria for defining alcoholism Results of craving research are often tions (i.e., pharmacotherapy) to improve vary widely. Most definitions difficult to interpret, -
Safety and Efficacy of a Continuous Infusion, Patient Controlled Anti
Bone Marrow Transplantation, (1999) 24, 561–566 1999 Stockton Press All rights reserved 0268–3369/99 $15.00 http://www.stockton-press.co.uk/bmt Safety and efficacy of a continuous infusion, patient controlled anti- emetic pump to facilitate outpatient administration of high-dose chemotherapy SP Dix, MK Cord, SJ Howard, JL Coon, RJ Belt and RB Geller Blood and Marrow Transplant Program, Oncology and Hematology Associates and Saint Luke’s Hospital of Kansas City, Kansas City, MO, USA Summary: and colleagues1 described an outpatient BMT care model utilizing intensive clinic support following inpatient admin- We evaluated the combination of diphenhydramine, lor- istration of HDC. This approach facilitated early patient azepam, and dexamethasone delivered as a continuous discharge and significantly decreased the total number of i.v. infusion via an ambulatory infusion pump with days of hospitalization associated with BMT. More patient-activated intermittent dosing (BAD pump) for recently, equipped BMT centers have extended the out- prevention of acute and delayed nausea/vomiting in patient care approach to include administration of HDC in patients receiving high-dose chemotherapy (HDC) for the clinic setting. Success of the total outpatient care peripheral blood progenitor cell (PBPC) mobilization approach is dependent upon the availability of experienced (MOB) or prior to autologous PBPC rescue. The BAD staff and necessary resources as well as implementation of pump was titrated to patient response and tolerance, supportive care strategies designed to minimize morbidity and continued until the patient could tolerate oral anti- in the outpatient setting. emetics. Forty-four patients utilized the BAD pump Despite improvements in supportive care strategies, during 66 chemotherapy courses, 34 (52%) for MOB chemotherapy-induced nausea and vomiting continues to be and 32 (48%) for HDC with autologous PBPC rescue. -
Adverse Reactions to Hallucinogenic Drugs. 1Rnstttutton National Test
DOCUMENT RESUME ED 034 696 SE 007 743 AUTROP Meyer, Roger E. , Fd. TITLE Adverse Reactions to Hallucinogenic Drugs. 1rNSTTTUTTON National Test. of Mental Health (DHEW), Bethesda, Md. PUB DATP Sep 67 NOTE 118p.; Conference held at the National Institute of Mental Health, Chevy Chase, Maryland, September 29, 1967 AVATLABLE FROM Superintendent of Documents, Government Printing Office, Washington, D. C. 20402 ($1.25). FDPS PRICE FDPS Price MFc0.50 HC Not Available from EDRS. DESCPTPTOPS Conference Reports, *Drug Abuse, Health Education, *Lysergic Acid Diethylamide, *Medical Research, *Mental Health IDENTIFIEPS Hallucinogenic Drugs ABSTPACT This reports a conference of psychologists, psychiatrists, geneticists and others concerned with the biological and psychological effects of lysergic acid diethylamide and other hallucinogenic drugs. Clinical data are presented on adverse drug reactions. The difficulty of determining the causes of adverse reactions is discussed, as are different methods of therapy. Data are also presented on the psychological and physiolcgical effects of L.S.D. given as a treatment under controlled medical conditions. Possible genetic effects of L.S.D. and other drugs are discussed on the basis of data from laboratory animals and humans. Also discussed are needs for futher research. The necessity to aviod scare techniques in disseminating information about drugs is emphasized. An aprentlix includes seven background papers reprinted from professional journals, and a bibliography of current articles on the possible genetic effects of drugs. (EB) National Clearinghouse for Mental Health Information VA-w. Alb alb !bAm I.S. MOMS Of NAM MON tMAN IONE Of NMI 105 NUNN NU IN WINES UAWAS RCM NIN 01 NUN N ONMININI 01011110 0. -
Yorkshire Palliative Medicine Clinical Guidelines Group Guidelines on the Use of Antiemetics Author(S): Dr Annette Edwards (Chai
Yorkshire Palliative Medicine Clinical Guidelines Group Guidelines on the use of Antiemetics Author(s): Dr Annette Edwards (Chair) and Deborah Royle on behalf of the Yorkshire Palliative Medicine Clinical Guidelines Group Overall objective : To provide guidance on the evidence for the use of antiemetics in specialist palliative care. Search Strategy: Search strategy: Medline, Embase and Cinahl databases were searched using the words nausea, vomit$, emesis, antiemetic and drug name. Review Date: March 2008 Competing interests: None declared Disclaimer: These guidelines are the property of the Yorkshire Palliative Medicine Clinical Guidelines Group. They are intended to be used by qualified, specialist palliative care professionals as an information resource. They should be used in the clinical context of each individual patient’s needs. The clinical guidelines group takes no responsibility for any consequences of any actions taken as a result of using these guidelines. Contact Details: Dr Annette Edwards, Macmillan Consultant in Palliative Medicine, Department of Palliative Medicine, Pinderfields General Hospital, Aberford Road, Wakefield, WF1 4DG Tel: 01924 212290 E-mail: [email protected] 1 Introduction: Nausea and vomiting are common symptoms in patients with advanced cancer. A careful history, examination and appropriate investigations may help to infer the pathophysiological mechanism involved. Where possible and clinically appropriate aetiological factors should be corrected. Antiemetics are chosen based on the likely mechanism and the neurotransmitters involved in the emetic pathway. However, a recent systematic review has highlighted that evidence for the management of nausea and vomiting in advanced cancer is sparse. (Glare 2004) The following drug and non-drug treatments were reviewed to assess the strength of evidence for their use as antiemetics with particular emphasis on their use in the palliative care population. -
The Use of Cyclizine in Patients Receiving Parenteral Nutrition
DRAFT - The use of cyclizine in patients receiving parenteral nutrition Jeremy Nightingale, Uchu Meade, Gavin Leahy and the BIFA committee Cyclizine is a piperazine derivative that was discovered in 1947 while researching new antihistamine drugs (H1 blockers) and was first sold 1965. It is marketed for the treatment or prevention of nausea, vomiting, and labyrinthine disorders including vertigo and motion sickness. This includes nausea after a general anaesthetic and that caused by opioid use. In the United Kingdom the oral formulation is classified as a Pharmacy (P) medicine and can be sold from a registered pharmacy premises by or under the supervision of a pharmacist. The intravenous formulation is classified as a Prescription Only Medicine (POM). There is increasing recognition that the intravenous formulation of cyclizine may cause euphoria and dependence (addiction); these side effects may not be reported by patients and be under recognised by healthcare professionals. It has many associated problems when used by patients receiving long-term parenteral nutrition. This position paper highlights the risks associated with its long-term intravenous use. Actions/pharmacology (1) Cyclizine has both anti-histamine (H1) and anti-cholinergic (anti-muscarinic M1) effects. It is a class 1 drug in the biopharmaceutical classification (high permeability and solubility) with a peak plasma concentration of about 70 ng/ ml reached approximately 2 hours after oral ingestion, as measured in healthy adult patients. Its quoted elimination (biological) half-life is 20 hours when given orally (1) and 13 hours when given intravenously (2). Cyclizine is metabolised to its N-demethylated derivative, norcyclizine, which has little anti-histaminic (H1) activity compared to cyclizine. -
Acute Migraine Treatment
Acute Migraine Treatment Morris Levin, MD Professor of Neurology Director, Headache Center UCSF Department of Neurology San Francisco, CA Mo Levin Disclosures Consulting Royalties Allergan Oxford University Press Supernus Anadem Press Amgen Castle Connolly Med. Publishing Lilly Wiley Blackwell Mo Levin Disclosures Off label uses of medication DHE Antiemetics Zolmitriptan Learning Objectives At the end of the program attendees will be able to 1. List all important options in the acute treatment of migraine 2. Discuss the evidence and guidelines supporting the major migraine acute treatment options 3. Describe potential adverse effects and medication- medication interactions in acute migraine pharmacological treatment Case 27 y/o woman has suffered ever since she can remember from “sick headaches” . Pain is frontal, increases over time and is generally accompanied by nausea and vomiting. She feels depressed. The headache lasts the rest of the day but after sleeping through the night she awakens asymptomatic 1. Diagnosis 2. Severe Headache relief Diagnosis: What do we need to beware of? • Misdiagnosis of primary headache • Secondary causes of headache Red Flags in HA New (recent onset or change in pattern) Effort or Positional Later onset than usual (middle age or later) Meningismus, Febrile AIDS, Cancer or other known Systemic illness - Neurological or psych symptoms or signs Basic principles of Acute Therapy of Headaches • Diagnose properly, including comorbid conditions • Stratify therapy rather than treat in steps • Treat early -
Hydroxyzine Prescribing Information
Hydroxyzine Hydroxyzine Hydrochloride Hydrochloride Injection, USP Injection, USP (For Intramuscular Use Only) (For Intramuscular Use Only) Rx Only Rx Only DESCRIPTION: Hydroxyzine hydrochloride has the chemical name of (±)-2-[2-[4-( p-Chloro- a- phenylbenzyl)-1-piperazinyl]ethoxy]ethanol dihydrochloride and occurs as a white, odorless powder which is very soluble in water. It has the following structural formula: Molecular Formula: C 21 H27 ClN 2O2•2HCl Molecular Weight: 447.83 Hydroxyzine Hydrochloride Injection, USP is a sterile aqueous solution intended for intramuscular administration. Each mL contains: Hydroxyzine HCl 25 mg or 50 mg, Benzyl Alcohol 0.9%, and Water for Injection q.s. pH adjusted with Sodium Hydroxide and/or Hydrochloric Acid. CLINICAL PHARMACOLOGY: Hydroxyzine hydrochloride is unrelated chemically to phenothiazine, reserpine, and meprobamate. Hydroxyzine has demonstrated its clinical effectiveness in the chemotherapeutic aspect of the total management of neuroses and emotional disturbances manifested by anxiety, tension, agitation, apprehension or confusion. Hydroxyzine has been shown clinically to be a rapid-acting true ataraxic with a wide margin of safety. It induces a calming effect in anxious, tense, psychoneurotic adults and also in anxious, hyperkinetic children without impairing mental alertness. It is not a cortical depressant, but its action may be due to a suppression of activity in certain key regions of the subcortical area of the central nervous system. Primary skeletal muscle relaxation has been demonstrated experimentally. Hydroxyzine has been shown experimentally to have antispasmodic properties, apparently mediated through interference with the mechanism that responds to spasmogenic agents such as serotonin, acetylcholine, and histamine. Antihistaminic effects have been demonstrated experimentally and confirmed clinically. -
5-HT3 Receptor Antagonists in Neurologic and Neuropsychiatric Disorders: the Iceberg Still Lies Beneath the Surface
1521-0081/71/3/383–412$35.00 https://doi.org/10.1124/pr.118.015487 PHARMACOLOGICAL REVIEWS Pharmacol Rev 71:383–412, July 2019 Copyright © 2019 by The Author(s) This is an open access article distributed under the CC BY-NC Attribution 4.0 International license. ASSOCIATE EDITOR: JEFFREY M. WITKIN 5-HT3 Receptor Antagonists in Neurologic and Neuropsychiatric Disorders: The Iceberg Still Lies beneath the Surface Gohar Fakhfouri,1 Reza Rahimian,1 Jonas Dyhrfjeld-Johnsen, Mohammad Reza Zirak, and Jean-Martin Beaulieu Department of Psychiatry and Neuroscience, Faculty of Medicine, CERVO Brain Research Centre, Laval University, Quebec, Quebec, Canada (G.F., R.R.); Sensorion SA, Montpellier, France (J.D.-J.); Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran (M.R.Z.); and Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada (J.-M.B.) Abstract. ....................................................................................384 I. Introduction. ..............................................................................384 II. 5-HT3 Receptor Structure, Distribution, and Ligands.........................................384 A. 5-HT3 Receptor Agonists .................................................................385 B. 5-HT3 Receptor Antagonists. ............................................................385 Downloaded from 1. 5-HT3 Receptor Competitive Antagonists..............................................385 2. 5-HT3 Receptor -
Effect of Naltrexone and Ondansetron on Alcohol Cue–Induced Activation of the Ventral Striatum in Alcohol-Dependent People
ORIGINAL ARTICLE Effect of Naltrexone and Ondansetron on Alcohol Cue–Induced Activation of the Ventral Striatum in Alcohol-Dependent People Hugh Myrick, MD; Raymond F. Anton, MD; Xingbao Li, MD; Scott Henderson, BA; Patrick K. Randall, PhD; Konstantin Voronin, MD, PhD Context: Medication for the treatment of alcoholism is double-blind randomly assigned daily dosing with 50 mg currently not particularly robust. Neuroimaging tech- of naltrexone (n=23), 0.50 mg of ondansetron hydro- niques might predict which medications could be use- chloride (n=23), the combination of the 2 medications ful in the treatment of alcohol dependence. (n=20), or matching placebos (n=24). Objective: To explore the effect of naltrexone, ondanse- Main Outcome Measures: Difference in brain blood tron hydrochloride, or the combination of these medi- oxygen level–dependent magnetic resonance when view- cations on cue-induced craving and ventral striatum ac- ing alcohol pictures vs neutral beverage pictures with a tivation. particular focus on ventral striatum activity comparison across medication groups. Self-ratings of alcohol craving. Design: Functional brain imaging was conducted dur- ing alcohol cue presentation. Results: The combination treatment decreased craving for alcohol. Naltrexone with (P=.02) or without (P=.049) Setting: Participants were recruited from the general ondansetron decreased alcohol cue–induced activation community following media advertisement. Experimen- of the ventral striatum. Ondansetron by itself was simi- tal procedures were performed in the magnetic reso- lar to naltrexone and the combination in the overall analy- nance imaging suite of a major training hospital and medi- sis but intermediate in a region-specific analysis. cal research institute. -
Motion Sickness Traveler Summary Key Points Motion Sickness Consists of a Group of Signs and Symptoms That Develop in Response to Real Or Perceived Motion
Motion Sickness Traveler Summary Key Points Motion sickness consists of a group of signs and symptoms that develop in response to real or perceived motion. Symptoms include dizziness, nausea, and vomiting. Prevention includes: Eating light meals Avoiding alcohol Sitting in the front seat of a car, over the wings on an airplane, or mid-deck on ships and facing forward in buses and trains Avoiding tasks requiring a close focus (e.g., reading) Using over-the-counter (OTC) or prescription medication OTC medications include: Dimenhydrinate, diphenhydramine, cyclizine, or meclizine: take 1 hour before departure and continue during the trip. These medications can cause sedation; do not mix with alcohol. Read labels carefully. Check for cautions regarding use in certain conditions. Prescription medications include: Scopolamine patches: place behind the ear; change every 3 days; apply 8 hours before the first incidence of rough weather or rough roads. Dry mouth and dry eyes may result. Patches do not work if cut in half. More than 1 patch should never be applied; hallucinations or psychosis may result. Strong sedatives (such as promethazine or prochlorperazine): take orally or by suppository after onset of severe symptoms, but anticipate sleep for a number of hours. A cruise medical clinic may administer injectable promethazine if absolutely necessary. Introduction The human body has a delicate system of equilibrium that relies on fluids in the inner ear, visual sensors, and other physical input to maintain a sense of balance. When incoming signals are in conflict—for example, when the body is at rest yet the eyes sense movement—this system is disturbed, causing the symptoms of motion sickness. -
Hallucinogens: an Update
National Institute on Drug Abuse RESEARCH MONOGRAPH SERIES Hallucinogens: An Update 146 U.S. Department of Health and Human Services • Public Health Service • National Institutes of Health Hallucinogens: An Update Editors: Geraline C. Lin, Ph.D. National Institute on Drug Abuse Richard A. Glennon, Ph.D. Virginia Commonwealth University NIDA Research Monograph 146 1994 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service National Institutes of Health National Institute on Drug Abuse 5600 Fishers Lane Rockville, MD 20857 ACKNOWLEDGEMENT This monograph is based on the papers from a technical review on “Hallucinogens: An Update” held on July 13-14, 1992. The review meeting was sponsored by the National Institute on Drug Abuse. COPYRIGHT STATUS The National Institute on Drug Abuse has obtained permission from the copyright holders to reproduce certain previously published material as noted in the text. Further reproduction of this copyrighted material is permitted only as part of a reprinting of the entire publication or chapter. For any other use, the copyright holder’s permission is required. All other material in this volume except quoted passages from copyrighted sources is in the public domain and may be used or reproduced without permission from the Institute or the authors. Citation of the source is appreciated. Opinions expressed in this volume are those of the authors and do not necessarily reflect the opinions or official policy of the National Institute on Drug Abuse or any other part of the U.S. Department of Health and Human Services. The U.S. Government does not endorse or favor any specific commercial product or company. -
On the Approximation of the Laws of the Member States Relating to Cosmetic Products (76/768/EEC )
27 . 9 . 76 Official Journal of the European Communities No L 262/169 COUNCIL DIRECTIVE of 27 July 1976 on the approximation of the laws of the Member States relating to cosmetic products (76/768/EEC ) THE COUNCIL OF THE EUROPEAN COMMUNITIES, regards the composition, labelling and packaging of cosmetic products ; Having regard to the Treaty establishing the Euro pean Economic Community, and in particular Whereas this Directive relates only to cosmetic prod Article 100 thereof, ucts and not to pharmaceutical specialities and medicinal products ; whereas for this purpose it is necessary to define the scope of the Directive by Having regard to the proposal from the Commission, delimiting the field of cosmetics from that of phar maceuticals ; whereas this delimitation follows in particular from the detailed definition of cosmetic Having regard to the opinion of the European Parlia products, which refers both to their areas of appli ment ( 1 ), cation and to the purposes of their use; whereas this Directive is not applicable to the products that fall Having regard to the opinion of the Economic and under the definition of cosmetic product but are Social Committee (2 ), exclusively intended to protect from disease; whereas, moreover, it is advisable to specify that certain prod ucts come under this definition, whilst products Whereas the provisions laid down by law, regulation containing substances or preparations intended to be or administrative action in force in the Member ingested, inhaled, injected or implanted in the human States