Overactive Bladder
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The Effects of Oral Administration of the Novel Muscarinic Receptor
Choi et al. BMC Urology (2020) 20:41 https://doi.org/10.1186/s12894-020-00611-8 RESEARCH ARTICLE Open Access The effects of oral administration of the novel muscarinic receptor antagonist DA- 8010 on overactive bladder in rat with bladder outlet obstruction Jin Bong Choi1, Seung Hwan Jeon2, Eun Bi Kwon3, Woong Jin Bae4, Hyuk Jin Cho2, U-Syn Ha2, Sung-Hoo Hong2, Ji Youl Lee2 and Sae Woong Kim4* Abstract Background: DA-8010 is a novel compound developed for the treatment of overactive bladder (OAB) and urinary incontinence. The aims of this study were to investigate the effects of DA-8010 on OAB in a rat model. Methods: Study animals were divided into the following five groups of seven animals each: a sham-operated control group, a control group with partial bladder outlet obstruction (BOO) (OAB group), and three DA-8010 (doses of 0.3 mg/kg/day, 1 mg/kg/day, and 3 mg/kg/day, respectively) with partial BOO groups. Oral administration of the drugs was continued for 14 days after 2 weeks of partial BOO. After 4 weeks of partial BOO, cystometrography was performed in all groups. Additionally, pro-inflammatory cytokines, Rho-kinases, and histology of the bladder were analyzed. Results: There was a significant increase in the contraction interval and a decrease in contraction pressure in the 3 mg/kg/day DA-8010 group versus those in the OAB group. Rho kinase was also significantly decreased in the DA- 8010 3 mg/kg/day dosage treatment group. The increased ratio of collagen to smooth muscle after partial BOO was significantly attenuated in the DA-8010 3 mg/kg/day dosage group. -
Anticholinergic Drugs Improve Symptoms but Increase Dry Mouth in Adults with Overactive Bladder Syndrome
Source of funding: Evid Based Nurs: first published as 10.1136/ebn.6.2.49 on 1 April 2003. Downloaded from Review: anticholinergic drugs improve symptoms but Health Research Council of Aotearoa increase dry mouth in adults with overactive bladder New Zealand. syndrome For correspondence: Jean Hay-Smith, Hay-Smith J, Herbison P,Ellis G, et al. Anticholinergic drugs versus placebo for overactive bladder syndrome in adults. Dunedin School of Cochrane Database Syst Rev 2002;(3):CD003781 (latest version May 29 2002). Medicine, University of Otago, Dunedin, New QUESTION: What are the effects of anticholinergic drugs in adults with overactive Zealand. jean.hay-smith@ bladder syndrome? otago.ac.nz Data sources Parallel arm studies of anticholinergic drugs v placebo for overactive bladder syndrome in Studies were identified by searching the Cochrane adults at 12 days to 12 weeks* Incontinence Group trials register (to January 2002) Weighted event rates and reference lists of relevant papers. Anticholinergic Study selection Outcomes drugs Placebo RBI (95% CI) NNT (CI) Randomised or quasi-randomised controlled trials in Self reported cure or adults with symptomatic diagnosis of overactive bladder improvement (8 studies) 63% 45% 41% (29 to 54) 6 (5 to 8) syndrome, urodynamic diagnosis of detrusor overactiv- RRI (CI) NNH (CI) ity, or both, that compared an anticholinergic drug Dry mouth (20 studies) 36% 15% 138 (70 to 232) 5 (4 to 7) (given to decrease symptoms of overactive bladder) with Outcomes Weighted mean difference (CI) placebo or no treatment. Studies of darifenacin, emepronium bromide or carrageenate, dicyclomine Number of leakage episodes in 24 hours (9 − chloride, oxybutynin chloride, propiverine, propanthe- studies) 0.56 (–0.73 to –0.39) Number of micturitions in 24 hours (8 studies) −0.59 (–0.83 to –0.36) line bromide, tolterodine, and trospium chloride were Maximum cystometric volume (ml) (12 studies) 54.3 (43.0 to 65.7) included. -
Pharmacy and Poisons (Third and Fourth Schedule Amendment) Order 2017
Q UO N T FA R U T A F E BERMUDA PHARMACY AND POISONS (THIRD AND FOURTH SCHEDULE AMENDMENT) ORDER 2017 BR 111 / 2017 The Minister responsible for health, in exercise of the power conferred by section 48A(1) of the Pharmacy and Poisons Act 1979, makes the following Order: Citation 1 This Order may be cited as the Pharmacy and Poisons (Third and Fourth Schedule Amendment) Order 2017. Repeals and replaces the Third and Fourth Schedule of the Pharmacy and Poisons Act 1979 2 The Third and Fourth Schedules to the Pharmacy and Poisons Act 1979 are repealed and replaced with— “THIRD SCHEDULE (Sections 25(6); 27(1))) DRUGS OBTAINABLE ONLY ON PRESCRIPTION EXCEPT WHERE SPECIFIED IN THE FOURTH SCHEDULE (PART I AND PART II) Note: The following annotations used in this Schedule have the following meanings: md (maximum dose) i.e. the maximum quantity of the substance contained in the amount of a medicinal product which is recommended to be taken or administered at any one time. 1 PHARMACY AND POISONS (THIRD AND FOURTH SCHEDULE AMENDMENT) ORDER 2017 mdd (maximum daily dose) i.e. the maximum quantity of the substance that is contained in the amount of a medicinal product which is recommended to be taken or administered in any period of 24 hours. mg milligram ms (maximum strength) i.e. either or, if so specified, both of the following: (a) the maximum quantity of the substance by weight or volume that is contained in the dosage unit of a medicinal product; or (b) the maximum percentage of the substance contained in a medicinal product calculated in terms of w/w, w/v, v/w, or v/v, as appropriate. -
Title 16. Crimes and Offenses Chapter 13. Controlled Substances Article 1
TITLE 16. CRIMES AND OFFENSES CHAPTER 13. CONTROLLED SUBSTANCES ARTICLE 1. GENERAL PROVISIONS § 16-13-1. Drug related objects (a) As used in this Code section, the term: (1) "Controlled substance" shall have the same meaning as defined in Article 2 of this chapter, relating to controlled substances. For the purposes of this Code section, the term "controlled substance" shall include marijuana as defined by paragraph (16) of Code Section 16-13-21. (2) "Dangerous drug" shall have the same meaning as defined in Article 3 of this chapter, relating to dangerous drugs. (3) "Drug related object" means any machine, instrument, tool, equipment, contrivance, or device which an average person would reasonably conclude is intended to be used for one or more of the following purposes: (A) To introduce into the human body any dangerous drug or controlled substance under circumstances in violation of the laws of this state; (B) To enhance the effect on the human body of any dangerous drug or controlled substance under circumstances in violation of the laws of this state; (C) To conceal any quantity of any dangerous drug or controlled substance under circumstances in violation of the laws of this state; or (D) To test the strength, effectiveness, or purity of any dangerous drug or controlled substance under circumstances in violation of the laws of this state. (4) "Knowingly" means having general knowledge that a machine, instrument, tool, item of equipment, contrivance, or device is a drug related object or having reasonable grounds to believe that any such object is or may, to an average person, appear to be a drug related object. -
Solifenacin-Induced Delirium and Hallucinations☆
General Hospital Psychiatry 35 (2013) 682.e3–682.e4 Contents lists available at ScienceDirect General Hospital Psychiatry journal homepage: http://www.ghpjournal.com Case Report Solifenacin-induced delirium and hallucinations☆ Matej Štuhec, Pharm.D. ⁎ Ormoz Psychiatric Hospital, Department for Clinical Pharmacy, Slovenia, Ptujska Cesta 33, Ormoz, Slovenia article info abstract Article history: Solifenacin-induced cognitive adverse effects have not been reported frequently, but solifenacin-induced Received 11 April 2013 delirium and hallucinations with successful switching to darifenacin, without additional drug, have not been Revised 5 June 2013 reported in the literature. In this case report, we present an 80-year-old Caucasian male with insomnia and Accepted 5 June 2013 anxiety symptoms and overactive bladder who developed delirium and hallucinations when treated with Keywords: solifenacin and trazodone. After solifenacin discontinuation and switching to darifenacin, symptoms significantly improved immediately. Such a case has not yet been described in literature; however, an Solifenacin Delirium adverse effect associated with solifenacin can occur, as this report clearly demonstrates. Hallucinations © 2013 Elsevier Inc. All rights reserved. Darifenacin Antimuscarinic adverse effect Case report 1. Introduction tion of Diseases, 10th Revision (ICD-10)], and depression with psychotic features was ruled out with differential diagnosis. Patient reported Solifenacin is a competitive muscarinic receptor antagonist, which insomnia, fear, fatigue, nausea, chest pain, shortness of breath and is used for overactive bladder (OAB) treatment. It acts as an headache. Solifenacin (Vesicare) 5 mg daily in morning dose was antimuscarinic agent, showing the highest affinity for the muscarinic prescribed to him 1 week earlier by his physicians because of OAB. M(3) receptor, which mediates urinary bladder contraction. -
1: Gastro-Intestinal System
1 1: GASTRO-INTESTINAL SYSTEM Antacids .......................................................... 1 Stimulant laxatives ...................................46 Compound alginate products .................. 3 Docuate sodium .......................................49 Simeticone ................................................... 4 Lactulose ....................................................50 Antimuscarinics .......................................... 5 Macrogols (polyethylene glycols) ..........51 Glycopyrronium .......................................13 Magnesium salts ........................................53 Hyoscine butylbromide ...........................16 Rectal products for constipation ..........55 Hyoscine hydrobromide .........................19 Products for haemorrhoids .................56 Propantheline ............................................21 Pancreatin ...................................................58 Orphenadrine ...........................................23 Prokinetics ..................................................24 Quick Clinical Guides: H2-receptor antagonists .......................27 Death rattle (noisy rattling breathing) 12 Proton pump inhibitors ........................30 Opioid-induced constipation .................42 Loperamide ................................................35 Bowel management in paraplegia Laxatives ......................................................38 and tetraplegia .....................................44 Ispaghula (Psyllium husk) ........................45 ANTACIDS Indications: -
Pharmacy and Poisons Act 1979
Q UO N T FA R U T A F E BERMUDA PHARMACY AND POISONS ACT 1979 1979 : 26 TABLE OF CONTENTS PART I PRELIMINARY 1 Short title 2 Interpretation PART II THE PHARMACY COUNCIL 3 The Pharmacy Council 4 Membership of the Council 4A Functions of the Council 4B Protection from personal liability 4C Annual Report 5 Proceedings of the Council, etc PART III REGISTRATION OF PHARMACISTS 6 Offence to practise pharmacy if not registered 7 Registration as a pharmacist 7A Re-registration as non-practising member 7AA Period of validity of registration 8 Code of Conduct 9 Pharmacy Profession Complaints Committee 10 Investigation of complaint by Committee 10A Inquiry into complaint by Council 10B Inquiry by Council of its own initiative 11 Surrender of registration 12 Restoration of name to register 1 PHARMACY AND POISONS ACT 1979 13 Proof of registration 14 Appeals 14A Fees 14B Amendment of Seventh Schedule 15 Regulations for this part PART IV REGISTRATION OF PHARMACIES 16 Register of pharmacies 17 Registration of premises as registered pharmacies 18 Unfit premises: new applications 19 Unfit premises: registered pharmacies 20 Appeals 21 When certificates of unfitness take effect 22 Regulations for this Part PART V CONTROL OF PRESCRIPTIONS AND IMPORTATION 23 Prescriptions to be in a certain form 23A Validity of a prescription 24 Supply by registered pharmacist of equivalent medicines 25 Restrictions on the importation of medicines 26 Declaration relating to imported medicines [repealed] PART VI CONTROL OF DRUGS 27 Certain substances to be sold on prescription -
170 Limited Use of Anticholinergic Drugs For
170 Penning-van Beest F1, Sukel M1, Reilly K2, Kopp Z2, Erkens J1, Herings R1 1. PHARMO Institute, 2. Pfizer Inc LIMITED USE OF ANTICHOLINERGIC DRUGS FOR OVERACTIVE BLADDER: A PHARMO STUDY Hypothesis / aims of study The aim of the study was to determine the prevalence of use of anticholinergic drugs for overactive bladder (OAB) in men and women in the Netherlands in the period 1998-2003. Study design, materials and methods Data were obtained from the PHARMO Record Linkage System, which includes patient centric data of drug-dispensing records and hospital records of more than one million patients in the Netherlands. Currently four anticholinergic drugs are available on the Dutch market for the treatment of OAB: tolterodine immediate release (IR), since 1998, tolterodine extended release (ER), since 2001, oxybutynin, since 1986, and flavoxate, since 1979. All patients who were ever prescribed these OAB drugs in the period January 1998 until December 2003 were included in the study cohort. The prevalence of use of tolterodine ER, tolterodine IR, oxybutynin and flavoxate was determined per calendar year, stratified by gender, by counting the number of patients having a dispensing with a duration of use including a single fixed day a year. Results The number of OAB drug users included in the study cohort increased from about 3,800 in 1998 to 5,000 in 2003. About 60% of the OAB drug users in the study cohort were women and about 42% of the OAB drug users were 70 years or older. The use of OAB drugs increased from 100 users per 100,000 men in 1998 to 140 users per 100,000 men in 2003 (table). -
3 Drugs That May Cause Delirium Or Problem Behaviors CARD 03 19 12 JUSTIFIED.Pub
Drugs that May Cause Delirium or Problem Behaviors Drugs that May Cause Delirium or Problem Behaviors This reference card lists common and especially problemac drugs that may Ancholinergics—all drugs on this side of the card. May impair cognion cause delirium or contribute to problem behaviors in people with demena. and cause psychosis. Drugs available over‐the‐counter marked with * This does not always mean the drugs should not be used, and not all such drugs are listed. If a paent develops delirium or has new problem Tricyclic Andepressants Bladder Anspasmodics behaviors, a careful review of all medicaons is recommended. Amitriptyline – Elavil Darifenacin – Enablex Be especially mindful of new medicaons. Clomipramine – Anafranil Flavoxate – Urispas Desipramine – Norpramin Anconvulsants Psychiatric Oxybutynin – Ditropan Doxepin – Sinequan Solifenacin – VESIcare All can cause delirium, e.g. All psychiatric medicaons should be Imipramine – Tofranil Tolterodine – Detrol Carbamazepine – Tegretol reviewed as possible causes, as Nortriptyline – Aventyl, Pamelor Gabapenn – Neuronn effects are unpredictable. Trospium – Sanctura Anhistamines / Allergy / Leveracetam – Keppra Notable offenders include: Insomnia / Sleep Valproic acid – Depakote Benzodiazepines e.g. Cough & Cold Medicines *Diphenhydramine – Sominex, ‐Alprazolam – Xanax *Azelasne – Astepro Pain Tylenol‐PM, others ‐Clonazepam – Klonopin *Brompheniramine – Bromax, All opiates can cause delirium if dose *Doxylamine – Unisom, Medi‐Sleep ‐Lorazepam – Avan Bromfed, Lodrane is too high or -
Anticholinergic Drugs and Dementia
DEMENTIA Q&A 24 Anticholinergic drugs and dementia Anticholinergics are a class of drug used to treat a wide variety of medical conditions. As with any medication, anticholinergics can have many beneficial effects, but these need to be balanced against a number of potential risks. This sheet provides information about how these drugs work as well as the impact that they may have in respect to dementia risk and cognitive functioning. What are anticholinergics? in time.4 It has been estimated that in Australia, 33% of people over the age of 65 years take enough Anticholinergics are generally used to inhibit the medications with anticholinergic effects to potentially involuntary movements of muscles or balance the increase their risk of harm.5 The use of anticholinergics production of various chemicals within the body. They is more common in older people because these drugs have been used in treating a wide variety of medical are prescribed for the symptomatic management of conditions including symptoms of psychosis (which medical conditions that often occur in later life. can be caused by bipolar disorder and schizophrenia), depression, urinary incontinence (e.g. overactive How do anticholinergic drugs work? bladder), gastrointestinal spasms, allergies, respiratory Anticholinergics are a class of drug that block the conditions (such as asthma and chronic obstructive action of acetylcholine in the nervous system, a pulmonary disease), Parkinson’s disease, conditions chemical (neurotransmitter) that is used to control concerning muscles in the eye and pupil dilation, messages travelling from one cell to another. They do nausea, sleep disorders and cardiovascular complaints this by blocking the binding of acetylcholine to its (slow heart rhythms) (Table 1).1,2 Some cold and flu receptor in the nerve cells. -
121 Comparative Evaluation of Human Mucosa And
121 Oki T1, Luvsandorj O1, Suzuki K1, Kageyama A1, Otsuka A2, Shinbo H2, Ozono S2, Yamada S1 1. Department of Pharmacokinetics and Pharmacodynamics, Sch of Pharm Sci, University of Shizuoka, 2. Department of Urology, Hamamatsu University School of Medicine COMPARATIVE EVALUATION OF HUMAN MUCOSA AND DETRUSOR MUSCARINIC RECEPTOR BINDING BY ANTICHOLINERGIC AGENTS IN THE TREATMENT OF OVERACTIVE BLADDER Hypothesis / aims of study The urothelium is the epithelial lining of the urinary tract. Our traditional understanding of the function of this region was simply that of passive barrier between the urinary tract and its contents. In recent years, the urothelium exhibits neuron-like properties that contribute to sensory function. Although the function of such an innervation may be unclear, recent studies in humans and animals have indicated that muscarinic receptors (mAChRs) are present on both mucosa and detrusor of the urinary bladder [1, 2]. The mucosal mAChRs may represent a novel site of action of agents for the treatment of bladder disorders. Anticholinergic agents such as oxybutynin and propiverine are widely used for the treatment of overactive bladder. Tolterodine and darifenacin have been currently developed as novel anticholinergic agents that may exhibit pharmacological selectivity in the bladder. Furthermore, oxybutynin, propiverine and tolterodine are metabolized in the intestine and liver to form active metabolites, N-desethyl-oxybutynin (DEOB), 1- methyl-4-piperidyl benzilate N-oxide (DPr-P-4(N→O)) and 5-hydroxymethyl metabolite (5-HM), respectively. Although these metabolites are assumed to contribute to the mAChR blockade of parent compounds, their mAChR binding characteristics in the mucosa have not been examined. -
Guideline for Preoperative Medication Management
Guideline: Preoperative Medication Management Guideline for Preoperative Medication Management Purpose of Guideline: To provide guidance to physicians, advanced practice providers (APPs), pharmacists, and nurses regarding medication management in the preoperative setting. Background: Appropriate perioperative medication management is essential to ensure positive surgical outcomes and prevent medication misadventures.1 Results from a prospective analysis of 1,025 patients admitted to a general surgical unit concluded that patients on at least one medication for a chronic disease are 2.7 times more likely to experience surgical complications compared with those not taking any medications. As the aging population requires more medication use and the availability of various nonprescription medications continues to increase, so does the risk of polypharmacy and the need for perioperative medication guidance.2 There are no well-designed trials to support evidence-based recommendations for perioperative medication management; however, general principles and best practice approaches are available. General considerations for perioperative medication management include a thorough medication history, understanding of the medication pharmacokinetics and potential for withdrawal symptoms, understanding the risks associated with the surgical procedure and the risks of medication discontinuation based on the intended indication. Clinical judgement must be exercised, especially if medication pharmacokinetics are not predictable or there are significant risks associated with inappropriate medication withdrawal (eg, tolerance) or continuation (eg, postsurgical infection).2 Clinical Assessment: Prior to instructing the patient on preoperative medication management, completion of a thorough medication history is recommended – including all information on prescription medications, over-the-counter medications, “as needed” medications, vitamins, supplements, and herbal medications. Allergies should also be verified and documented.