DOCSLIB.ORG

Problems Encountered When Testing for LSD in a Regional Medium Secure Unit 17

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Problems Encountered When Testing for LSD in a Regional Medium Secure Unit 17 Acosta-Armas Te sting for LSD Psychiatric Bulletin (2003), 27,17^19 A. J. ACOSTA-ARMAS original Problems encountered when testing for LSD in a regional papers medium secure unit AIMS AND METHOD same day, to two different labora- without adequate confirmatory Between1998 and 2000, a surpris- tories. At the first laboratory, only analysis, many psychiatric and non- ingly high number of positive results one test method was used and at the psychiatric prescribed drugs can give was noticed in our regional medium second one test plus two confirma- false positives. secure unit when testing for D- tory tests were carried out. lysergic acid diethylamide (LSD).This CLINICAL IMPLICATIONS led to an investigation of possible RESULTS Positive LSD results should be con- factorsinvolved.Itwasfeltthatthe Outofatotalof23patientstestedon firmed by at least one, preferably testing protocol, particularly the use two separate occasions, the first chromatographic, alternative of a single, non-isotopic homoge- laboratory gave three positive results method. A protocol for testing and neous immunoassay without routine the first time and three positive reporting LSD in psychiatric patients further confirmatory testing, was results the second, while the second should be considered in order to largely to blame for what seemed to laboratory gave only one positive minimise the risk of obtaining false- be a high incidence of false positives. result on the second occasion that positive results which have negative On two different occasions, samples samples were sent and none on the clinical, legal and psychological from each patient were sent, on the first.This reinforces the belief that, repercussions. Introduction immunoassays (enzyme-linked immunosorbent assay (ELISA) and enzyme-multiplied immunoassay technique The use of D-lysergic acid diethylamide (LSD), a strong (EMIT)), high performance thin-layer chromatography and hallucinogenic drug, continues to cause concern within gas or liquid chromatography linked to mass spectro- the medical profession and particularly in the field of metry. Recently, homogeneous immunoassays have mental health, because of its association with different become more popular because they are easier to perform psychiatric conditions, especially panic reactions, and they produce results more quickly. Unfortunately, prolonged schizoaffective psychoses and post-halluci- they are associated with lack of sensitivity and, in nogen perceptual disorder (Abraham & Aldridge, 1993). particular, lack of specificity (Liu, 1995). There is evidence to suggest that its use has increased in A very high incidence of positive LSD results past years, particularly by young people (Sankar, 1997; (between 4.5% and 9%) were being found in our patient Schwartz, 1995). The use of illicit drugs, including LSD, has population, sometimes in cases where it was very unlikely a particular relevance in forensic psychiatry because that any illicit drugs had been taken. The interference of substance misuse has been shown consistently to be a other prescribed and non-prescribed drugs in testing for significant risk factor for violence and disturbed beha- LSD has been documented (Ritter et al, 1997; Rohrich et viour (Soyka, 2000). LSD was the first synthetic halluci- al, 1998), although little research has been done and the nogenic compound, accidentally discovered by a Swiss information available is sparse. chemist, Albert Hoffman, in 1943. The first systematic This small piece of research is important because study of the clinical effects of LSD was carried out in 1947 there seems to be little understanding and knowledge of at the University Psychiatric Clinic in Zurich. Its medical drug-testing, particularly about possible interference by use became popular in the USA in the 1950s, when it was drugs commonly prescribed in psychiatry, and our work used to assist psychotherapy sessions by releasing shows how easy it can be to give a false-positive result forgotten memories from childhood. Its abuse first unless these potential problems are taken into consid- appeared in the 1960s when it became an essential part eration. The repercussions of a false-positive result on any of the drug scene. In the UK, LSD was proscribed under patient, particularly within our type of service, could be the 1971 Misuse of Drugs Act. The LSD that is used on the quite detrimental for future decision-making and, hence, streets appears in different forms, usually adsorbed onto their future clinical management, so it is even more microdots or paper with colourful designs. important to ensure that the risks of false-positive results The detection of LSD use is a challenge for toxi- are minimised. cology laboratories because of the very low concentra- tions of LSD and its metabolites found in body fluids. LSD is also relatively unstable and sensitive to ultraviolet light Background and heat. Several methods have been developed for detection of LSD in body fluids, particularly in urine. Such Around February 1998, there was increasing concern in methods include: radioimmunoassays, non-isotopic our regional medium-secure psychiatric unit about the 17 Acosta-Armas Te s ting for LSD use of LSD by in-patients and its effect on their mental toxicologists on LSD testing. Discussions with a senior state, particularly when a positive result was obtained toxicologist at the toxicology department of another UK original after a significant deterioration in a patient’s condition. hospital (Laboratory B), which is experienced in LSD papers Towards the end of that year, over a period of almost 2 testing, confirmed our initial suspicion that certain drugs months, there were six positive results involving five which are commonly prescribed in psychiatry can inter- patients from a total population of approximately 22, fere with LSD testing. It appeared that confirmatory tests although not everybody on the wards was tested at the are essential to rule out the high incidence of false posi- same time. During the following 3 months, 10 more tives that occur in such cases, particularly when immu- positive results were obtained, involving 7 patients in the noassay is the only test used. We also contacted the unit. This led to great concern among members of the manufacturers of the EMIT test and they provided a list of medical, nursing and managerial staff who decided to commonly prescribed drugs that were known by them to introduce random blanket-testing for all patients in the cause interference in LSD testing using EMIT. unit from April 1999. Five blanket-testing sessions were The initial literature search identified numerous conducted between April and May 1999 with two posi- papers on different methods of LSD testing, but only two tive results out of a total of 22 patients (9%) in the first on interference with testing for LSD. One paper, by Ritter session, and one positive result (4.5%) in the second. The et al (1997), was particularly useful. The other paper, by three following blanket-testing sessions gave only nega- Rohrich et al (1998), was also useful although their work tive results in all the patients tested. Following these was done with intensive care patients only. No systematic negative findings, systematic testing was suspended in reviews had been conducted on this matter, possibly June 1999. In February 2000, there was another signifi- because of the paucity of previous research work. cant change in a patient’s mental state and the use of Because of the surprisingly high rate of positive illicit drugs was suspected. One urine sample was sent for results, we decided to collect two urine samples from testing and it showed a positive result for LSD. The each patient in the unit on two separate occasions and concerns from the previous year returned and random send one sample to the original reference laboratory blanket-testing was reintroduced in the unit in February, (Laboratory A) and the other to Laboratory B in order to producing two positive results out of a total of 22 compare the results from each. Each sample was split, patients (9%). with one aliquot going to Laboratory A and one to By this time, there was a strong suspicion that the Laboratory B. We knew that Laboratory A would only incidence of positive results was too high and that there perform a simple immunoassay (EMIT II LSD) and that had to be an explanation for those findings. We consid- Laboratory B would perform two initial screening tests (a ered various explanations, including the possibility of radioimmunoassay, manufactured by Cozart Biosciences, false-positives because of interference from other and an enzyme-immunoassay, produced by Diagnostic substances or prescribed drugs in the test method used. We also questioned the methodology used by the Products Corporation) plus a confirmatory test (high laboratory when carrying out the tests. performance liquid chromatographic method using The samples taken from our patients were tested in fluorometric detection). On two separate occasions, 46 a designated laboratory (Laboratory A) in another city urine samples were taken from 23 patients. because there are few laboratories around the country which perform LSD tests. The original samples were collected in specific containers and kept refrigerated as Results and discussion required. They were then sent to our local hospital and On the first occasion, three positive results were given by from there to Laboratory A where the tests were carried Laboratory A and no positive results by Laboratory B. On out using EMIT, a non-isotopic immunoassay from Dade the second occasion, there were three positive results Behring Diagnostics (2000). The laboratory does not again from the samples sent to Laboratory A and only one normally perform confirmatory tests when it has a posi- positive result in those sent to Laboratory B. tive result unless this is specifically requested and results Two patients tested positive in the samples sent to are considered to be positive when they are above a cut- Laboratory A on both occasions. The other two positive off point of drug concentration.
Load more

Recommended publications
  • Appendix A: Potentially Inappropriate Prescriptions (Pips) for Older People (Modified from ‘STOPP/START 2’ O’Mahony Et Al 2014)
    Appendix A: Potentially Inappropriate Prescriptions (PIPs) for older people (modified from ‘STOPP/START 2’ O’Mahony et al 2014) Consider holding (or deprescribing - consult with patient): 1. Any drug prescribed without an evidence-based clinical indication 2. Any drug prescribed beyond the recommended duration, where well-defined 3. Any duplicate drug class (optimise monotherapy) Avoid hazardous combinations e.g.: 1. The Triple Whammy: NSAID + ACE/ARB + diuretic in all ≥ 65 year olds (NHS Scotland 2015) 2. Sick Day Rules drugs: Metformin or ACEi/ARB or a diuretic or NSAID in ≥ 65 year olds presenting with dehydration and/or acute kidney injury (AKI) (NHS Scotland 2015) 3. Anticholinergic Burden (ACB): Any additional medicine with anticholinergic properties when already on an Anticholinergic/antimuscarinic (listed overleaf) in > 65 year olds (risk of falls, increased anticholinergic toxicity: confusion, agitation, acute glaucoma, urinary retention, constipation). The following are known to contribute to the ACB: Amantadine Antidepressants, tricyclic: Amitriptyline, Clomipramine, Dosulepin, Doxepin, Imipramine, Nortriptyline, Trimipramine and SSRIs: Fluoxetine, Paroxetine Antihistamines, first generation (sedating): Clemastine, Chlorphenamine, Cyproheptadine, Diphenhydramine/-hydrinate, Hydroxyzine, Promethazine; also Cetirizine, Loratidine Antipsychotics: especially Clozapine, Fluphenazine, Haloperidol, Olanzepine, and phenothiazines e.g. Prochlorperazine, Trifluoperazine Baclofen Carbamazepine Disopyramide Loperamide Oxcarbazepine Pethidine
    [Show full text]
  • The Use and Potential Abuse of Anticholinergic
    British Journal of Clinical DOI:10.1111/j.1365-2125.2008.03342.x Pharmacology Correspondence Dr Pål Gjerden, Department of Psychiatry, The use and potential abuse Telemark Hospital, N-3710 Skien, Norway. Tel: + 47 3500 3476 Fax: + 47 3500 3187 of anticholinergic E-mail: [email protected] ---------------------------------------------------------------------- antiparkinson drugs in Keywords adverse effects, anticholinergic agents, antiparkinson agents, antipsychotic Norway: a agents, drug abuse ---------------------------------------------------------------------- Received pharmacoepidemiological 9 June 2008 Accepted 18 October 2008 study Published Early View 16 December 2008 Pål Gjerden, Jørgen G. Bramness1 & Lars Slørdal2 Department of Psychiatry,Telemark Hospital, Skien, 1Department of Pharmacoepidemiology, Norwegian Institute of Public Health, Oslo and 2Department of Laboratory Medicine, Children’s and Women’s Health, Norwegian University of Science and Technology,Trondheim, Norway WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • Anticholinergic antiparkinson drugs are used to ameliorate extrapyramidal AIMS symptoms caused by either Parkinson’s The use of anticholinergic antiparkinson drugs is assumed to have disease or antipsychotic drugs, but their use shifted from the therapy of Parkinson’s disease to the amelioration in the treatment of Parkinson’s disease is of extrapyramidal adverse effects induced by antipsychotic drugs. There is a considerable body of data suggesting that anticholinergic assumed to be in decline. antiparkinson drugs have a potential for abuse.The aim was to • Patients with psychotic conditions have a investigate the use and potential abuse of this class of drugs in Norway. high prevalence of abuse of drugs, including anticholinergic antiparkinson drugs. METHODS Data were drawn from the Norwegian Prescription Database on sales to a total of 73 964 patients in 2004 of biperiden and orphenadrine, and use in patients with Parkinson’s disease or in patients who were WHAT THIS STUDY ADDS also prescribed antipsychotic agents.
    [Show full text]
  • CENTRAL NERVOUS SYSTEM DEPRESSANTS Opioid Pain Relievers Anxiolytics (Also Belong to Psychiatric Medication Category) • Codeine (In 222® Tablets, Tylenol® No
    CENTRAL NERVOUS SYSTEM DEPRESSANTS Opioid Pain Relievers Anxiolytics (also belong to psychiatric medication category) • codeine (in 222® Tablets, Tylenol® No. 1/2/3/4, Fiorinal® C, Benzodiazepines Codeine Contin, etc.) • heroin • alprazolam (Xanax®) • hydrocodone (Hycodan®, etc.) • chlordiazepoxide (Librium®) • hydromorphone (Dilaudid®) • clonazepam (Rivotril®) • methadone • diazepam (Valium®) • morphine (MS Contin®, M-Eslon®, Kadian®, Statex®, etc.) • flurazepam (Dalmane®) • oxycodone (in Oxycocet®, Percocet®, Percodan®, OxyContin®, etc.) • lorazepam (Ativan®) • pentazocine (Talwin®) • nitrazepam (Mogadon®) • oxazepam ( Serax®) Alcohol • temazepam (Restoril®) Inhalants Barbiturates • gases (e.g. nitrous oxide, “laughing gas”, chloroform, halothane, • butalbital (in Fiorinal®) ether) • secobarbital (Seconal®) • volatile solvents (benzene, toluene, xylene, acetone, naptha and hexane) Buspirone (Buspar®) • nitrites (amyl nitrite, butyl nitrite and cyclohexyl nitrite – also known as “poppers”) Non-Benzodiazepine Hypnotics (also belong to psychiatric medication category) • chloral hydrate • zopiclone (Imovane®) Other • GHB (gamma-hydroxybutyrate) • Rohypnol (flunitrazepam) CENTRAL NERVOUS SYSTEM STIMULANTS Amphetamines Caffeine • dextroamphetamine (Dexadrine®) Methelynedioxyamphetamine (MDA) • methamphetamine (“Crystal meth”) (also has hallucinogenic actions) • methylphenidate (Biphentin®, Concerta®, Ritalin®) • mixed amphetamine salts (Adderall XR®) 3,4-Methelynedioxymethamphetamine (MDMA, Ecstasy) (also has hallucinogenic actions) Cocaine/Crack
    [Show full text]
  • Georgia State Forensic Drugs
    Comprehensive Forensic FT-IR Collection Library Listing – 4,286 spectra This extensive library contains materials not only of forensic interest but also for general problem solving and identification of unknown substances in industry and academia. The wide range of items include drugs, clandestine lab chemicals, explosives, paints, fabrics, dyes, polymers, inorganic compounds, pigments, adhesives, and other common materials. The library consists of 4,286 spectra that were acquired from a wide range of laboratories involved in forensic investigations. The collection includes the following classes of compounds: • Drugs of abuse, scheduled materials • Pharmaceuticals, vitamins and excipients • Clandestine lab materials and intermediates • Solvents, organic chemicals and hazardous chemicals • Accelerants • Lubricants and natural oils • Explosives, pyrotechnics, primers, powders and boosters • Herbal and plant material and fibers • Automobile paint vehicles, pigments, primers and clear coats • Textiles, natural and man-made fibers, carpet materials • Paints, coatings, varnishes, oils • Dyes and stains • Polymers, monomers, copolymers, plasticizers and rubbers • Inorganics, pigments, minerals and clays • Tape, adhesives, sealants, glues, caulks and putties • Crystal test derivatives and intermediates • Household chemicals, cleaning agents, surfactants and pesticide All spectra were measured using micro or macro Diamond ATR, thin films on salt windows or KBr pellets at 4 cm-1 spectral resolution. Comprehensive Forensic FT-IR Collection Index
    [Show full text]
  • DRUG TREATMENTS for Parkinson's
    DRUG TREATMENTS FOR Parkinson’s 1 There is no cure yet for Parkinson’s but there are The content in this booklet is designed to be dipped in and out many different drugs that can of – don’t feel like you need to help manage the symptoms. read everything in one go. This is particularly true because what This booklet is for people works for you when starting with Parkinson’s and their treatment for Parkinson’s may family, friends and carers. change later on. It provides information Reading the bits of this about the drugs most information that you need will commonly used to help also make this booklet more manage the condition. manageable and relevant for you. This booklet starts with some key practical points about the drugs used for treating Parkinson’s, then gives further details about categories of drugs and individual drugs. There is also a summary that gives an overview list of Parkinson’s drugs. Choosing the right medication is always a decision you should make with your specialist or Parkinson’s nurse. You can show this booklet to your specialist or Parkinson’s nurse and ask them questions about the information here. You may also find it a useful starting point when you are talking about the next steps in your treatment. Contents Section 1 This gives an overview of Parkinson’s medication and is recommended for anyone with the condition. Parkinson’s drugs: an introduction .........................................................6 This includes how drugs work, their names and what treatment to take. Other ways to manage your Parkinson’s .............................................9 This includes exercise and therapies.
    [Show full text]
  • Briefing Note on Restriction to Use of Orphenadrine
    MEDICINES MANAGEMENT BRIEFING NOTE No 3 Restriction to the use of orphenadrine NOVEMBER 2013 (UPDATED MARCH 2016) In September 2013 the Drugs and Therapeutics Committee (DTC) discussed the issues around increased risk of toxicity with orphenadrine compared to other anticholinergic drugs, particularly in overdose. Current available evidence suggests that orphenadrine has the highest mortality among anticholinergics in overdose and its potential for abuse is likely to be similar to other anticholinergics. As there are other drugs with much lower toxicity, and no clear advantages of orphenadrine, routine use of orphenadrine should be discouraged. The DTC has therefore decided to restrict the use of orphenadrine to a third-line choice, in patients who are not at risk of overdose. Orphenadrine 50mg tablets have since then been discontinued (Dec 2015), however orphenadrine oral solution 50mg in 5ml sugar free remains available as a third line option. Formulary choices for management of antipsychotic induced extra-pyramidal side- effects: First choice procyclidine 5mg tablets, 2.5mg/5ml oral solution (sugar free) Second choice trihexyphenidyl 2mg tablets, 5mg tablets, 5mg/5ml oral solution (benzhexol) Third choice Orphenadrine 50mg in 5ml oral solution (sugar free) (only in those who are not at risk of overdose) Background and Evidence Mental health disorders tend to carry a substantial risk of self-poisoning and suicide. One strategy to reduce deaths from self-poisoning is to identify the drugs which are more toxic in overdose than other drugs used for the same indication. N Buckley et. al. examined the fatal toxicity of antipsychotic drugs and anticholinergic drugs for the years 1983-1992.
    [Show full text]
  • KEMADRIN Tablets Are Supplied in Bottles of 100 Tablets
    NEW ZEALAND DATA SHEET 1. KEMADRIN Tablets (procyclidine hydrochloride 5 mg tablets) 2. QUALITATIVE AND QUANTITATIVE COMPOSITION Active ingredient: procyclidine hydrochloride 5mg White, round, biconvex tablets, one face with a break line and coded KT above the break line and 05 below the break line, with a score line on the other face. For the full list of excipients, see section 6.1. 3. PHARMACEUTICAL FORM Tablets. 4. CLINICAL PARTICULARS 4.1 Therapeutic Indications KEMADRIN is indicated for the treatment of all forms of Parkinson's disease: idiopathic (paralysis agitans), postencephalitic and arteriosclerotic. KEMADRIN is efficacious in the relief of parkinsonian symptoms. It is particularly effective in the alleviation of rigidity. Tremor, akinesia, speech and writing difficulties, gait, sialorrhoea and drooling, sweating, oculogyric crises and depressed mood are also beneficially influenced. KEMADRIN is also indicated for the control of extrapyramidal symptoms induced by neuroleptic drugs including pseudo-parkinsonism, acute dystonic reactions and akathisia. 4.2 Dose and method of administration The variation in optimum dosage from one patient to another should be taken into consideration by the physician. Dosage in adults Parkinson's disease Treatment is usually started at 2.5mg procyclidine three times per day, increasing by 2.5 to 5mg per day at intervals of two or three days until the optimum clinical response is achieved. The usual maintenance dose to achieve optimal response is 15 to 30mg procyclidine per day. Addition of a fourth dose before retiring has been seen to be beneficial in some patients. Doses up to 60mg procyclidine have been well tolerated, and at the discretion of the attending physician dosing to this level may be appropriate.
    [Show full text]
  • Pharmacological Therapies Against Soman-Induced Seizures in Rats 30 Min
    (Review) Choice of approaches in developing novel medical countermeasures for nerve agent poisoning Trond Myhrer, Pål Aas Norwegian Defence Research Establishment (FFI), Protection and Societal Security Division, P. O. Box 25, NO-2027 Kjeller, Norway Running title: Nerve agent poisoning and countermeasures Correspondence: Pål Aas Norwegian Defence Research Establishment (FFI) Protection and Societal Security Division P O Box 25 NO-2027 Kjeller, Norway Phone: +47 63 80 78 43 Fax: +47 63 80 75 09 E-mail: [email protected] Dette er en postprint-versjon / This is a postprint version. DOI til publisert versjon / DOI to published version: 10.1016/j.neuro.2014.04.011 2 Abstract During the establishment of a research branch, all relevant matters encountered will be of interest to study. After having acquired a body of basal knowledge, it becomes possible to derive ideas or hypotheses for further elaboration of information. The purpose of the present study was to show that therapies for nerve agent poisoning based on specific neuropharmacological approaches can have greater probability for being successful than treatment regimens based on fragmental research or serendipitous discoveries. By following the guidelines for research in experimental epilepsy, neuronal target areas for nerve agents have been identified through lesion studies, and critical receptors for pharmacological treatment have been specified through microinfusion studies of rats. Subsequent experimentations have shown that the results achieved from microinfusion studies are transferable to systemic administration. It is demonstrated that a treatment regimen developed through the novel approach is more efficacious than regimens derived from conventional research on countermeasures. A therapy consisting of HI-6, levetiracetam, and procyclidine that has been worked out along the new lines, exerts powerful anticonvulsant capacity and appears to have universal utility as a stand-alone therapy against soman intoxication in rats.
    [Show full text]
  • Anticholinergic Drugs / Burden
    Community Interest Company Anticholinergic drugs This project reviews appropriate treatment with anticholinergic drugs. An increasing number of systematic reviews and meta-analyses report that drugs with anticholinergic effects are associated with an increased risk of cognitive impairment and all cause mortality in older people. This project identifies the risk and examines tools and actions that health care professionals can take to minimise the use of drugs that may adversely affect cognitive function. A briefing, MUR community pharmacy sheet and power point presentation are available at www.prescqipp.info Recommendations • Prescribe anticholinergic drugs with caution in older or frail people or people with complex multi- morbidities.1 Older/frail patients are more likely to experience adverse effects with anticholinergics such as constipation, urinary retention, dry mouth/eyes, sedation, confusion, delirium, photophobia, falls and reduced cognition. • Research suggests a link to increased mortality with the number and potency of anticholinergic agents prescribed.1-3 Use toolkits to review anticholinergic burden (ACB) (see attachment 1 and attachment 2 for examples). • Minimise the use of anticholinergic drugs where possible.1,2 • Review at regular intervals. Discontinue medication if there is no absolute need or switch to medication with a lower ACB score or from a different class.2 • Review medication in older people that have had a fall or are at increased risk of falling as part of a multifactorial risk assessment.4 • In patients with dementia, perform a medication review to identify and minimize use of drugs that may adversely affect cognitive function. Avoid prescribing anticholinergics with acetylcholinesterase inhibitors.5 Background Anticholinergic drugs are prescribed for a wide range of conditions, including Parkinson’s disease, overactive bladder, chronic obstructive pulmonary disease, nausea and vomiting, depression and psychosis.
    [Show full text]
  • Management of Acute Dental Problems Guidance for Healthcare Professionals
    Management of Acute Dental Problems Guidance for healthcare professionals March 2013 © Scottish Dental Clinical Effectiveness Programme SDCEP operates within NHS Education for Scotland. You may copy or reproduce the information in this document for use within NHS Scotland and for non-commercial educational purposes. Use of this document for commercial purpose is permitted only with written permission. First published March 2013 Scottish Dental Clinical Effectiveness Programme Dundee Dental Education Centre, Frankland Building, Small’s Wynd, Dundee DD1 4HN Email [email protected] Tel 01382 425751 / 425771 Website www.sdcep.org.uk Management of Acute Dental Problems 1 Introduction 1 1.1 Why this guidance has been developed 1 1.2 Scope of the guidance 1 1.3 How the guidance is presented 2 1.4 Who should use this guidance 2 1.5 Statement of Intent 3 2 Overarching Principles 4 2.1 Critically Unwell Patients 4 2.2 Timescales for Treatment 4 2.3 Management of Spreading or Systemic Infection 4 2.4 Drug Interactions 5 2.5 Adverse Drug Reactions 5 2.6 Patient Assessment and Record Keeping 6 3 Pathways to Providers of Care – Decision Support 7 3.1 Patient with Pain 8 3.2 Patient with Swelling 10 3.3 Patient with Bleeding 11 3.4 Patient with Trauma 12 3.5 Patient with Ulceration 14 3.6 Patient with Altered Sensation or Abnormal Appearance in the Head and Neck 16 3.7 Decision Support Pathway Endpoints 17 4 Management of Oral Conditions 20 Common Conditions 4.1 Acute Apical Abscess 20 4.2 Acute Pericoronitis (including Erupting Teeth
    [Show full text]
  • Interaction of Atropine-Like Drugs with Dopamine-Containing Neurones in Rat Brain M
    Br. J. Pharmac. (1972), 44% 301-306. Interaction of atropine-like drugs with dopamine-containing neurones in rat brain M. B. BOWERS, JUN. AND R. H. ROTH Departments of Psychiatry and Pharmacology, Yale University School of Medicine, and Connecticut Mental Health Center, New Haven, Connecticut, USA Summary 1. A variety of atropine-like drugs effective in the treatment of drug-induced extrapyramidal syndromes have been investigated with regard to their inter- action with dopamine-containing neurones in rat brain. 2. Under some conditions benztropine, trihexyphenidyl, atropine and ethopro- pazine significantly antagonized the chlorpromazine-induced increase in sub- cortical concentrations of homovanillic acid. 3. Most of the atropine-like drugs investigated also decreased the turnover of dopamine in the subcortex as measured by following the disappearance of dopamine after administration of a-methyl-p-tyrosine. 4. These findings are suggestive that an imbalance between a dopaminergic and cholinergic system might be closely linked to the pathogenesis of extra- pyramidal movement disorders. Introduction An increased synthesis and turnover of dopamine is routinely observed in animal brain after the administration of various antipsychotc drugs which produce extra- pyramidal symptoms in man. Thus, one common feature of all the neuroleptic drugs which have extrapyramidal side effects is their ability to produce large in- creases in the homovanillic acid content of mammalian brain. However, the ability of certain antipsychotic drugs to produce extrapyramidal disorders is thought not to be due to their ability to stimulate dopamine synthesis and turnover directly, but rather related to the ability of these agents to block dopamine receptors (Anden, Carlsson & Haggendal, 1969).
    [Show full text]
  • BBBA7086 Procyclidine 5 Mg-Ml Solution for Injection
    PATIENT INFORMATION LEAFLET PROCYCLIDINE HYDROCHLORIDE 5 mg/ml Solution for Injection • K • If you have any further questions, ask your doctor or pharmacist. • This medicine has been prescribed for you. Do not pass it on to others. It may harm them, even if their symptoms are the same as yours. • If an please tell your doctor or pharmacist. 1. What is PROCYCLIDINE Injection and what is it used for? 2. Before you are given PROCYCLIDINE Injection 3. How you will be given PROCYCLIDINE Injection 4. Possible side effects 5. Storing PROCYCLIDINE Injection 6. Further information 1. What is PROCYCLIDINE Injection and what Are you taking any of the following drugs? is it used for? • T ranquillisers (e.g. thioridazine) • T ricyclic and related antidepressants What is PROCYCLIDINE Injection? (e.g. amitriptyline) PROCYCLIDINE Injection belongs to a group of • Monoamine oxidase inhibitors, otherwise known medicines called anticholinergics. Anticholinergics as MAOIs (used for depressive illness) block the effects of a substance called acetylcholine • Amantadine (used for parkinsonism and viral in your body. infections) What is PROCYCLIDINE Injection used for? • Antihistamines (used to treat allergies) PROCYCLIDINE Injection is used to treat and relieve • K etoconazole (used as antifungals) the symptoms of Parkinson’s disease such as stiff • T acrine, memantine, phenothiazines and neuroleptics (medicines used to treat mental writing and walking, overproduction of saliva and health problems including Alzheimer’s disease dribbling, sweating, uncontrolled eye movements and dementia) and depression. • Clozapine (used for schizophrenia) Some tranquillisers have side-effects like the • Quinidine and disopyramide (used for arrhythmias symptoms of Parkinson’s disease and they can also – too fast, too slow or irregular heart beat) cause restlessness and abnormal head and body • Nef opam (used for moderate pain) movements.
    [Show full text]