The Use and Abuse of Beta-Blockers in the Performing Arts
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22 Psychiatric Medications for Monitoring in Primary Care
22 Psychiatric Medications for Monitoring in Primary Care Medication Warnings, Precautions, and Adverse Events Comments Class: SSRI Fluvoxamine Boxed Warnings: Suicidality Used much less than SSRIs in the group of eight Indications: Warnings and Precautions: Similar to other SSRIs medications for prescribing, probably because it has no Adult: OCD Adverse Events: Similar to other SSRIs FDA indication for MDD or any anxiety disorder. Still Child/Adolescent: OCD (10-17 years) somewhat popular as a medication for OCD. Uses: Anxiety, OCD Monitoring: Same as other SSRIs Citalopram Boxed Warning: Suicidality. Escitalopram, one of the SSRIs in the group of Indications: Warnings and Precautions: Similar to other SSRIs medications for prescribing, is an active metabolite of Adult: MDD Adverse Events: Similar to other SSRIs citalopram. Escitalopram reportedly has fewer AEs and Child/Adolescent: None less interaction with hepatic metabolic enzymes than Uses: Anxiety, MDD, OCD citalopram but is otherwise essentially identical. Citalopram offers no advantage other than price, as Monitoring: Same as other SSRIs escitalopram is branded until 2012. Paroxetine Boxed Warnings: Suicidality. Paroxetine used much less than the SSRIs for Indications: Warnings and Precautions: Similar to other SSRIs prescribing, probably because of its nonlinear kinetics. Adult: MDD, OCD, Panic Disorder, Generalized Anxiety Adverse Events: Similar to other SSRIs A study of children and adolescents showed doubling Disorder, Social Anxiety Disorder, Posttraumatic Stress Disorder the dose of paroxetine from 10 mg/day to 20 mg/day Child/Adolescent: None resulted in a 7-fold increase in blood levels (Findling et Uses: Anxiety, MDD, OCD al, 1999). Thus, once metabolic enzymes are saturated, paroxetine levels can increase dramatically with dose Monitoring: Same as other SSRIs increases and decrease dramatically with dose decreases, sometimes leading to adverse events. -
Benzodiazepine Anti-Anxiety Agents: Prevalence and Correlates of Use in a Southern Community
Benzodiazepine Anti-anxiety Agents: Prevalence and Correlates of Use in a Southern Community rn- rn Marvin Swartz, MD, Richard Landerman, PhD, Linda K George, PhD, Mary Lou Melville, MD, Dan Blazer, MD, PhD, and Karen Smith, PhD Introduction alence and patterns of benzodiazepine antianxiolytic drug use in the Piedmont re- Benzodiazepine anti-anxiety agents gion of North Carolina during 1982-83, uti- are the most widely prescribed psycho- lizing logistic regression analysis, which al- therapeutic drugs in the United States to- lows prediction of benzodiazepine use day.' First introduced in 1960, these drugs while introducing controls for potential rapidly achieved a lead position in the pre- confounding and mediating variables. scription drug market,2 stimulating public and professional debate over appropriate Method psychotropic drug use.3 Recent evidence, however, suggests that the prevalence and The present paper reports results patterns of psychotropic use, especially from Wave 1 of the Piedmont Health Sur- those of benzodiazepine anxiolytics, may vey, one site of the five-site National In- be changing and resulting in decreased stitute of Mental Health Epidemiologic use.4,5 The first detailed population survey Catchment Area program (NIMH- of psychotropic drug use, the National ECA).'1 The sampling frame for the Pied- Household Sample in 1970-71,6-9 found mont Health Survey (PHS) was a five- that 22 percent of American adults had county area in north central North used prescription psychotropic medica- Carolina, consisting of one urban county tion during the year 1969-70, with higher and four contiguous rural counties. The use among women and the elderly. -
Advantages and Disadvantages of Beta- Adrenergic Blocking Drugs in Hypertension
Reprinted from ANCIOLOCY Vol. 29, No. -I April 1978 Copyright 0 1978 Prinred in U.S.A. All Rights Rewrced Advantages and Disadvantages of Beta- Adrenergic Blocking Drugs in Hypertension Eoin T. O'Brien DUBLIN, IRELAND General Measures Elevation of blood pressure should be regarded as one of a number of potential risk factors for cardiovascular disease-albeit a major risk factor- rather than a disease per se.' It is important to identify additional risk factors in the hypertensive patient, not only because collectively these factors may greatly magnify the cardiovascular risk, but also because modification of them may, of itself, lower the blood pressure and thus alleviate the risk and save the patient the inconvenience, expense, and potential harm that may result from even the simplest of drug regimes. Careful consideration should be given to the patient's diet (particularly in relation to the calorie intake in the case of obesity, the cholesterol and saturated fat content in the case of hyperlipidemia and patients at high risk, and the salt content) and to smoking habits, physical activity. stress. personality, and drug therapy, especially anovulant preparations. Other diseases, such as diabetes mellitus, which are associated with a high incidence of hypertension and pri- mary causes of hypertension must be excluded. Although there is still no statistical evidence to show that modification of these risk factors-with the exception of tobacco and anovulant preparations-will actually reduce mortal- ity, it does seem prudent on the basis of the evidence available to encourage the hypertensive patient to adjust his or her life-style not only to reduce the cardiovascular risk,2 but also because in many instances the mildly hypertensive patient will respond to this approach alone. -
Drug Class Review Antianginal Agents
Drug Class Review Antianginal Agents 24:12.08 Nitrates and Nitrites 24:04.92 Cardiac Drugs, Miscellaneous Amyl Nitrite Isosorbide Dinitrate (IsoDitrate ER®, others) Isosorbide Mononitrate (Imdur®) Nitroglycerin (Minitran®, Nitrostat®, others) Ranolazine (Ranexa®) Final Report May 2015 Review prepared by: Melissa Archer, PharmD, Clinical Pharmacist Carin Steinvoort, PharmD, Clinical Pharmacist Gary Oderda, PharmD, MPH, Professor University of Utah College of Pharmacy Copyright © 2015 by University of Utah College of Pharmacy Salt Lake City, Utah. All rights reserved. Table of Contents Executive Summary ......................................................................................................................... 3 Introduction .................................................................................................................................... 4 Table 1. Antianginal Therapies .............................................................................................. 4 Table 2. Summary of Agents .................................................................................................. 5 Disease Overview ........................................................................................................................ 8 Table 3. Summary of Current Clinical Practice Guidelines .................................................... 9 Pharmacology ............................................................................................................................... 10 Table 4. Pharmacokinetic Properties -
(Orion) 5 Mg Tablets Buspirone (Orion) 10 Mg Tablets
NEW ZEALAND DATA SHEET 1. PRODUCT NAME Buspirone (Orion) 5 mg tablets Buspirone (Orion) 10 mg tablets 2. QUALITATIVE AND QUANTITATIVE COMPOSITION Each tablet contains 5 mg buspirone hydrochloride. Each tablet contains 10 mg buspirone hydrochloride. Excipient with known effect: 5 mg tablet: Each tablet contains 59.5 mg lactose (as monohydrate) 10 mg tablet: Each tablet contains 118.9 mg lactose (as monohydrate). For the full list of excipients, see section 6.1. 3. PHARMACEUTICAL FORM Tablet. 5 mg tablet: White or almost white, oval tablets debossed with ‘ORN 30’ on one side and a score on the other side. The tablet can be divided into equal doses. 10 mg tablet: White or almost white, oval tablets debossed with ‘ORN 31’ on one side and a score on the other side. The tablet can be divided into equal doses. 4. CLINICAL PARTICULARS 4.1 Therapeutic indications Buspirone hydrochloride is indicated for the management of anxiety with or without accompanying depression in adults. Buspirone hydrochloride is indicated for the management of anxiety disorders or the short- term relief of symptoms of anxiety with or without accompanying depression. 4.2 Posology and method of administration The usual starting dose is 5 mg given three times daily. This may be titrated according to the needs of the patient and the daily dose increased by 5 mg increments every two or three days depending upon the therapeutic response to a maximum daily dose of 60 mg. After dosage titration the usual daily dose will be 20 to 30 mg per day in divided doses. -
Calcium Channel Blockers in Mental Health and Neuro Sciences
Article NIMHANS Journal Editorial : Calcium Channel Blockers in Mental Health and Neuro Sciences Volume: 15 Issue: 01 January 1997 Page: 3-5 S M Channabasavanna, - Vice-Chancellor, NIMHANS, (Deemed University), Bangalore Calcium is a familiar ion; first year medical students learn of its physiological importance in a host of situations, such as in nutrition, in enzymatic reactions, in muscle contraction, and in the structure of bone. Calcium has long been known to also play an important role in the physiology of the nervous system, for example, it is well recognised that calcium is a co-factor in several enzymatic processes in the central nervous system (CNS), that release of neurotransmitters from synaptic vesicles is calcium-dependent, that the stability of the neuronal membrane is partly regulated by calcium, that calcium is involved in neurotoxic processes etc. [1]. Several cognitive functions have been associated with calcium mechanisms. For example, the involvement of calcium is learning and memory processes is widely documented [2], [3]; most of the work to-date concerns calcium influx through receptors for excitatory amino acids [4]; compounds that block inonotropic glutamate receptors and inhibit calcium inflow, such as MK 801, are reported to impair memory [5], [6]. Voltage-dependent calcium channels, of which the best characterized are those that contain dihydropyridine binding sites, form a second mechanism controlling calcium inflow into the cells [7]. In recent years, these calcium channels in the neuron have assumed substantial importance; treatments affecting these channels have been shown to affect a number of functions related to the CNS. For example, repeated electroconvulsive shocks upregulate voltage dependent calcium channels, which effect appears to increase sensitivity to pain, enhance responsiveness to dopaminergic agonists etc [8], [9], [10]. -
COPD Agents Review – October 2020 Page 2 | Proprietary Information
COPD Agents Therapeutic Class Review (TCR) October 1, 2020 No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, digital scanning, or via any information storage or retrieval system without the express written consent of Magellan Rx Management. All requests for permission should be mailed to: Magellan Rx Management Attention: Legal Department 6950 Columbia Gateway Drive Columbia, Maryland 21046 The materials contained herein represent the opinions of the collective authors and editors and should not be construed to be the official representation of any professional organization or group, any state Pharmacy and Therapeutics committee, any state Medicaid Agency, or any other clinical committee. This material is not intended to be relied upon as medical advice for specific medical cases and nothing contained herein should be relied upon by any patient, medical professional or layperson seeking information about a specific course of treatment for a specific medical condition. All readers of this material are responsible for independently obtaining medical advice and guidance from their own physician and/or other medical professional in regard to the best course of treatment for their specific medical condition. This publication, inclusive of all forms contained herein, is intended to be educational in nature and is intended to be used for informational purposes only. Send comments and suggestions to [email protected]. October 2020 -
CORGARD® TABLETS Nadolol Tablets USP
CORGARD® TABLETS Nadolol Tablets USP Rx Only DESCRIPTION CORGARD (nadolol) is a synthetic nonselective beta-adrenergic receptor blocking agent designated chemically as 1-(tert-butylamino)-3-[(5,6,7,8-tetrahydro-cis-6,7-dihydroxy-1- naphthyl)oxy]-2-propanol. Structural formula: C17H27NO4 MW 309.40 Nadolol is a white crystalline powder. It is freely soluble in ethanol, soluble in hydrochloric acid, slightly soluble in water and in chloroform, and very slightly soluble in sodium hydroxide. CORGARD (nadolol) is available for oral administration as 20 mg, 40 mg, and 80 mg tablets. Inactive ingredients: microcrystalline cellulose, colorant (FD&C Blue No. 2), corn starch, magnesium stearate, povidone (except 20 mg and 40 mg), and other ingredients. CLINICAL PHARMACOLOGY CORGARD (nadolol) is a nonselective beta-adrenergic receptor blocking agent. Clinical pharmacology studies have demonstrated beta-blocking activity by showing (1) reduction in heart rate and cardiac output at rest and on exercise, (2) reduction of systolic and diastolic blood pressure at rest and on exercise, (3) inhibition of isoproterenol-induced tachycardia, and (4) reduction of reflex orthostatic tachycardia. CORGARD (nadolol) specifically competes with beta-adrenergic receptor agonists for available beta receptor sites; it inhibits both the beta1 receptors located chiefly in cardiac muscle and the beta2 receptors located chiefly in the bronchial and vascular musculature, inhibiting the chronotropic, inotropic, and vasodilator responses to beta-adrenergic stimulation proportionately. CORGARD has no intrinsic sympathomimetic activity and, unlike some other beta-adrenergic blocking agents, nadolol has little direct myocardial depressant activity and does not have an anesthetic-like membrane- stabilizing action. Animal and human studies show that CORGARD slows the sinus rate and depresses AV conduction. -
Drugs Used to Treat Joint and Muscle Disease
PHARMACOLOGY Drugs used to treat joint and Learning objectives muscle disease After reading this article, you should be able to: David G Lambert C list the main joint and muscle diseases and their treatments C describe the treatment options for arthritic disease, myasthenia gravis and muscle spasticity Abstract Joint disease: Arthritis can be simply broken into osteoarthritis and rheumatoid arthritis (RA). Osteoarthritis is treated with symptomatic pain relief and surgery. RA is a chronic autoimmune disease that causes 1. Osteoarthritis: this is the most common joint disease and is inflammation of joints (leading to their destruction), tissues around joints often described as a disease of wear and tear. This disease affects and other organ systems. Treatment (for pain) of RA in the first instance is around 8.5 million people in the UK alone, is more common in with non-steroidal anti-inflammatory drugs, with second-line treatment women and those who are overweight and affects a range of using disease-modifying antirheumatic drugs (DMARDs). DMARDs are a joints (knees, hips, hands and neck). There are important disparate group and include methotrexate, D-penicillamine, sulphasala- anaesthetic consequences relating to a reduced range of move- zine, gold salts, antimalarial drugs and immunosuppressant drugs. The ment when the neck is affected. Typical degenerative changes newer class of ‘biological’ DMARDs includes etanercept (tumour necrosis include a thinning of joint cartilage, growth of osteophytes and factor a (TNF-a) receptoreimmunoglobulin G chimera), infliximab (mono- increased synovial fluid production. Typical presenting symp- clonal anti-TNF-a antibody), anakinra (interleukin 1 receptor antagonist) toms are pain, joint stiffness, swelling and a reduced range of and rituximab (an anti-CD20 antibody that depletes B cells). -
Psychedelics in Psychiatry: Neuroplastic, Immunomodulatory, and Neurotransmitter Mechanismss
Supplemental Material can be found at: /content/suppl/2020/12/18/73.1.202.DC1.html 1521-0081/73/1/202–277$35.00 https://doi.org/10.1124/pharmrev.120.000056 PHARMACOLOGICAL REVIEWS Pharmacol Rev 73:202–277, January 2021 Copyright © 2020 by The Author(s) This is an open access article distributed under the CC BY-NC Attribution 4.0 International license. ASSOCIATE EDITOR: MICHAEL NADER Psychedelics in Psychiatry: Neuroplastic, Immunomodulatory, and Neurotransmitter Mechanismss Antonio Inserra, Danilo De Gregorio, and Gabriella Gobbi Neurobiological Psychiatry Unit, Department of Psychiatry, McGill University, Montreal, Quebec, Canada Abstract ...................................................................................205 Significance Statement. ..................................................................205 I. Introduction . ..............................................................................205 A. Review Outline ........................................................................205 B. Psychiatric Disorders and the Need for Novel Pharmacotherapies .......................206 C. Psychedelic Compounds as Novel Therapeutics in Psychiatry: Overview and Comparison with Current Available Treatments . .....................................206 D. Classical or Serotonergic Psychedelics versus Nonclassical Psychedelics: Definition ......208 Downloaded from E. Dissociative Anesthetics................................................................209 F. Empathogens-Entactogens . ............................................................209 -
0Bcore Safety Profile
Core Safety Profile Active substance: Levobunolol Pharmaceutical form(s)/strength: Eye drops solution/ 0,1%; 0,25%; 0,5%; 0,5% UD P-RMS: CZ/H/PSUR/0006/001 Date of FAR: 26.05.2009 4.2 Posology and method of administration Adults (including the elderly) Country specific posology and method of administration to be included. Children /.../ is not recommended for use in children due to lack of safety and efficacy data. If required, /.../ may be used with other agents to lower intra-ocular pressure. The use of two topical beta-adrenergic blocking agents is not recommended (see section 4.4). Intraocular pressure should be measured approximately four weeks after starting treatment with /.../ as a return to normal ocular pressure can take a few weeks. As with any eye drops, to reduce possible systemic absorption, it is recommended that the lachrymal sac is compressed at the medial canthus (punctual occlusion) for one minute. This should be performed immediately following the instillation of each drop. Transfer from other beta-blocking treatment When another beta blocking agent is being used treatment must be discontinued after a full day of therapy. Start treatment with /.../ the next day with X drop of /.../ topically applied into the conjunctival sac in the affected eye(s). If /.../ is to replace a combination of anti-glaucoma products, only a single product should be removed at a time. Use in renal and hepatic impairment Levobunolol hydrochloride has not been studied in patients with hepatic or renal impairment. Therefore, caution should be used in treating such patients (see section 4.4). -
Metered-Dose Inhalers (Mdis): Anti-Cholinergic Drugs
Texas Vendor Drug Program Drug Use Criteria: Aerosolized Agents - Metered-Dose Inhalers (MDIs): Anti-Cholinergic Drugs Publication History 1. Developed January 1995. 2. Revised April 2021; March 2019; March 2017; November 2015; March 2014; August 2012; June 2012; October 2010; January 2008; January 2003; January 2002; January 2001; March 2000; January 2000; February 1999; February 1998; February 1997; August 1995. Notes: All criteria may be applied retrospectively. The information contained is for the convenience of the public. The Texas Health and Human Services Commission is not responsible for any errors in transmission or any errors or omissions in the document. Medications listed in the tables and non-FDA approved indications included in these retrospective criteria are not indicative of Vendor Drug Program formulary coverage. Prepared by: • Drug Information Service, UT Health San Antonio. • The College of Pharmacy, The University of Texas at Austin 1 1 Dosage 1.1 Adults Ipratropium (Atrovent®), a short-acting, inhalational anticholinergic agent, is FDA- approved to manage bronchospasm associated with chronic bronchitis and emphysema, collectively known as chronic obstructive pulmonary disease (COPD). Ipratropium is considered a second-line agent in the treatment of asthma as the bronchodilatory effects seen with ipratropium are less than those seen with beta- adrenergic drugs. While not FDA approved, the Expert Panel 3 guidelines from the National Heart Lung and Blood Institute document benefit when multiple ipratropium doses are administered adjunctively with beta2-agonists in the emergency department to manage more severe acute asthma exacerbations, and the Global Initiative for Asthma (GINA) guidelines state that ipratropium may be considered an alternative bronchodilator in patients who experience adverse effects to short-acting beta2-agonists (e.g., tachycardia, arrhythmia, tremor).