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Long-Term Care Updates
Long-Term Care Updates October 2017 By Alyson Lozicki, PharmD The treatment of migraine symptoms in elderly patients is similar to treatment in younger adults. For all patients, the selection of a pharmacological agent should be based on patient- specific factors and migraine severity, and greater caution should be exercised for older adults due to an increased prevalence of comorbid conditions and risk of adverse effects. Because of this, options for drug therapy in the elderly are limited, but this population tends to have a better response to acute treatment in comparison to a younger cohort.1-3 Of the drugs that have established efficacy in the treatment of migraine, acetaminophen, triptans, ergotamine, opioids, and antiemetics can be appropriate options for elderly patients. Acetaminophen is the safest option and is the drug of choice for most patients with non- debilitating symptoms of migraine.2-4 The choice of therapy for patients with moderate- severe symptoms should be based on comorbid conditions, potential drug-drug interactions, and the risk of serious adverse effects. However, the adverse effect profile of a medication does not preclude its use.3 General recommendations and safety considerations are outlined in Table 1; some of these medications do appear on the Beers List with a strong recommendation to avoid due to increased risk of falls and fracture. Additionally, certain medications used to treat migraine in younger patients should be avoided in older adults due to the increased risk of serious adverse events. These include acetylsalicylic acid, nonsteroidal anti-inflammatory drugs (NSAIDs), barbiturate-containing drugs, flunarizine, www.creighton.edu/ 1-5 and tricyclic antidepressants (Table 2). -
A Comparative Effectiveness Meta-Analysis of Drugs for the Prophylaxis of Migraine Headache
University of South Florida Masthead Logo Scholar Commons School of Information Faculty Publications School of Information 7-2015 A Comparative Effectiveness Meta-Analysis of Drugs for the Prophylaxis of Migraine Headache Authors: Jeffrey L. Jackson, Elizabeth Cogbill, Rafael Santana-Davila, Christina Eldredge, William Collier, Andrew Gradall, Neha Sehgal, and Jessica Kuester OBJECTIVE: To compare the effectiveness and side effects of migraine prophylactic medications. DESIGN: We performed a network meta-analysis. Data were extracted independently in duplicate and quality was assessed using both the JADAD and Cochrane Risk of Bias instruments. Data were pooled and network meta-analysis performed using random effects models. DATA SOURCES: PUBMED, EMBASE, Cochrane Trial Registry, bibliography of retrieved articles through 18 May 2014. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: We included randomized controlled trials of adults with migraine headaches of at least 4 weeks in duration. RESULTS: Placebo controlled trials included alpha blockers (n = 9), angiotensin converting enzyme inhibitors (n = 3), angiotensin receptor blockers (n = 3), anticonvulsants (n = 32), beta-blockers (n = 39), calcium channel blockers (n = 12), flunarizine (n = 7), serotonin reuptake inhibitors (n = 6), serotonin norepinephrine reuptake inhibitors (n = 1) serotonin agonists (n = 9) and tricyclic antidepressants (n = 11). In addition there were 53 trials comparing different drugs. Drugs with at least 3 trials that were more effective than placebo for episodic migraines -
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 -
A Unitary Mechanism of Calcium Antagonist Drug Action '(Dihydropyridine/Nifedipine/Verapamil/Neuroleptic/Diltiazem) KENNETH M
Proc. Nati Acad. Sci. USA Vol. 80, pp. 860-864, February 1983 Medical Sciences A unitary mechanism of calcium antagonist drug action '(dihydropyridine/nifedipine/verapamil/neuroleptic/diltiazem) KENNETH M. M. MURPHY, ROBERT J. GOULD, BRIAN L. LARGENT, AND SOLOMON H. SNYDER* Departments of Neuroscience, Pharmacology and Experimental Therapeutics, and Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 72S North Wolfe Street, Baltimore, Maryland 21205 Contributed by Solomon H. Snyder, October 21, 1982 ABSTRACT [3H]Nitrendipine binding to drug receptor sites liquid scintillation counting were carried out as described (7). associated with calcium channels is allosterically regulated by a All experiments, performed in triplicate, were replicated at diverse group of calcium channel antagonists. Verapamil, D-600 least three times with similar results. (methoxyverapamit), tiapamil, lidoflazine, flunarizine, cinnari- Guinea pig ileum longitudinal muscles were prepared for zine, and prenylamine all reduce P3H]nitrendipine binding affin- recording as described by Rosenberger et aL (13) and incubated ity. By contrast, diltiazem, a benzothiazepine calcium channel an- in a modified Tyrode's buffer (14) at 370C with continuous aer- tagonist, enhances [3H]nitrendipine binding. All these drugeffects ation with 95% '02/5% CO2. Ileum longitudinal muscles were involve a single site allosterically linked to the [3H]nitrendipine incubated in this buffer for 30 min before Ca2"-dependent con- binding site. Inhibition of t3H]nitrendipine binding by prenyl- were as described Jim et aL amine, lidoflazine, or tiapamil is reversed by D-600and diltiazem, tractions recorded by (15). which alone respectively slightlyreduceorenhance H]mnitrendipine RESULTS binding. Diltiazem reverses the inhibition of [3H]nitrendipine binding by D-600. -
Antipsychotics for Migraines, Cluster Headaches, and Nausea
Web extra Antipsychotics for migraines, cluster headaches, and nausea Evidence of efficacy for these conditions is limited, and risk of side effects may inhibit use ost evidence supporting antipsychotics as a treat- ment for migraine headaches and cluster head- Maches is based on small studies and chart reviews. Some research suggests antipsychotics may effectively treat nausea but side effects such as akathisia may limit their use. Migraine headaches Antipsychotic treatment of migraines is supported by the theory that dopaminergic hyperactivity leads to migraine headaches (Table 1, page E2). Antipsychotics have been used off-label in migraine patients who do not tolerate triptans or have status migrainosus—intense, debilitating migraine JON KRAUSE FOR CURRENT PSYCHIATRY lasting >72 hours.1 Primarily a result of D2 receptor block- ade, the serotonergic effects of some second-generation anti- Aveekshit Tripathi, MD psychotics (SGAs) may prevent migraine recurrence. The Senior Resident Psychiatry and Behavioral Sciences first-generation antipsychotics (FGAs) prochlorperazine, droperidol, haloperidol, and chlorpromazine have been Matthew Macaluso, DO Assistant Professor, Psychiatry and Behavioral Sciences 1-27 used for migraine headaches (Table 2, page E3). Associate Director, Residency Training Prochlorperazine may be an effective treatment of acute • • • • headaches9 and refractory chronic daily headache.10 Studies show that buccal prochlorperazine is more effective than oral University of Kansas School of Medicine-Wichita Wichita, KS ergotamine tartrate11 and IV prochlorperazine is more effective than IV ketorolac12 or valproate28 for treating acute headache. Evidence suggests that chlorpromazine administered IM2 or IV3 is better than placebo for managing migraine pain. In a study comparing IV chlorpromazine, lidocaine, and dihydroergotamine, patients treated with chlorproma- zine showed more persistent headache relief 12 to 24 hours post-dose.4 In another study, IV chlorpromazine, 25 mg, Current Psychiatry was as effective as IM ketorolac, 60 mg.5 Vol. -
Drug-Induced Parkinsonism
InformationInformation Sheet Sheet Drug-induced Parkinsonism Terms highlighted in bold italic are defined in increases with age, hypertension, diabetes, the glossary at the end of this information sheet. atrial fibrillation, smoking and high cholesterol), because of an increased risk of stroke and What is drug-induced parkinsonism? other cerebrovascular problems. It is unclear About 7% of people with parkinsonism whether there is an increased risk of stroke with have developed their symptoms following quetiapine and clozapine. See the Parkinson’s treatment with particular medications. This UK information sheet Hallucinations and form of parkinsonism is called ‘drug-induced Parkinson’s. parkinsonism’. While these drugs are used primarily as People with idiopathic Parkinson’s disease antipsychotic agents, it is important to note and other causes of parkinsonism may also that they can be used for other non-psychiatric develop worsening symptoms if treated with uses, such as control of nausea and vomiting. such medication inadvertently. For people with Parkinson’s, other anti-sickness drugs such as domperidone (Motilium) or What drugs cause drug-induced ondansetron (Zofran) would be preferable. parkinsonism? Any drug that blocks the action of dopamine As well as neuroleptics, some other drugs (referred to as a dopamine antagonist) is likely can cause drug-induced parkinsonism. to cause parkinsonism. Drugs used to treat These include some older drugs used to treat schizophrenia and other psychotic disorders high blood pressure such as methyldopa such as behaviour disturbances in people (Aldomet); medications for dizziness and with dementia (known as neuroleptic drugs) nausea such as prochlorperazine (Stemetil); are possibly the major cause of drug-induced and metoclopromide (Maxolon), which is parkinsonism worldwide. -
Us 2019 / 0262353 A1
US 20190262353A1 ( 19) United States (12 ) Patent Application Publication (10 ) Pub. No. : US 2019 /0262353 A1 YONG et al. (43 ) Pub . Date : Aug . 29 , 2019 ( 54 ) TREATMENT FOR PROGRESSIVE Publication Classification MULTIPLE SCLEROSIS (51 ) Int. Cl. (71 ) Applicant : UTI LIMITED PARTNERSHIP , A61K 31 / 55 ( 2006 . 01 ) Calgary (CA ) A61K 31 / 404 ( 2006 .01 ) (72 ) Inventors : Voon Wee YONG , Calgary (CA ) ; A61P 25 / 28 (2006 .01 ) Simon FAISSNER , Bochum (DE ) ; ( 52 ) U .S . CI. Marcus KOCH , Calgary (CA ); Nathan CPC . .. .. .. A61K 31/ 55 ( 2013. 01 ) ; A61P 25 / 28 James MICHAELS, Kamloops (CA ) ( 2018 .01 ) ; A61K 31 /404 ( 2013 .01 ) (21 ) Appl. No. : 16 / 343, 818 (22 ) PCT Filed : Oct. 24 , 2017 (57 ) ABSTRACT ( 86 ) PCT No. : PCT/ CA2017 /051269 In one aspect , there is provided a method of treating , $ 371 ( C ) ( 1 ) , prophylaxis , or amelioration of a neurological disease by ( 2 ) Date : Apr. 22 , 2019 administering to a subject in need thereof one or more Related U . S . Application Data compounds described herein . In a specific example , the ( 60 ) Provisional application No . 62 /412 ,534 , filed on Oct . neurological disease is multiple sclerosis (also referred to as 25 , 2016 . “ MS ” ) . Patent Application Publication Aug. 29, 2019 Sheet 1 of 23 US 2019 / 0262353 A1 3000 Iron mediated neurotoxicity * * * * * * * * * * * Neurons 1000 fitini TTTTTTTToitain | 1 | ControlFeSO4DMSO 50 WMAtenolol PimozideFosfomycinKetoprofen MefloquineQuinapril Liothyronine'5-Chloroindole Ranitidine Bumetanide TolfenamicTranexamic acid acid ketoprofenDequaliniumPyridostigmineCyclosporine Paromomycin Labetalol Tenoxicam Mitoxanthrone Trazodone FeSO450 PM Control Fes0 , 50 PM FeSO , 50 UM + Indapam Control Feso , 50 UM FeSO , 50 UM + Indapam SA FIGURE 1 Patent Application Publication Aug. 29, 2019 Sheet 2 of 23 US 2019 / 0262353 A1 ??? - iron Antiaggregation Antihypertensive Antipsychotic Tricyclic . -
Parkinsonism, Tremor, and Depression Induced by Cinnarizine and Flunarizine
Age at diagnosis ofAIDS at this transbronchial biopsy did not show any pathogen. He patients will die without AIDS being diagnosed. In the hospital to October 1987 was treated with co-trimoxazole and hydrocortisone. United States 10% of patients with AIDS are over 50, After 14 days of co-trimoxazole he had improved 2-5% over 60, and 0 4% over 70. The table shows the Age (years) No of patients clinically and radiographically and was discharged age distribution of our patients with AIDS up to 0-19 2 receiving maintenance treatment. October 1987. Six of 235 (2 5%) patients were over 60. 20-24 19 P carinii pneumonia should be considered in all 25-29 26 30-34 48 patients with atypical chest infections, even when there 35-39 57 Comment are no apparent risk factors. 40-44 33 positive for HIV antibody 45-49 3 1 Both these patients were 50-54 7 and had a clinical and radiological presentation We thank Miss Linda Stannard for preparing the 55-59 6 suggestive of P carinni pneumonia that responded to manuscript and Dr D J R Morgan for his helpful comments. 60-64 2 65 4 treatment; thus the criteria fbr a diagnosis of AIDS were satisfied.' In case 2 the diagnosis was complicated I Anonymous. Revision of the CDC surveillance case definition for acquired imrmlunodeficiency syndrome. .7AMA 1987;258:1143-54. by the previous amiodarone treatment, though 2 Marchinski FE, Lansten TS, Waxman HL, Josephson ME. Amiodarone pneumonitis induced by amiodarone is unusual at a pulmonary toxicity. Ann Intern Med 1982;97:839-45. -
Summary of Product Characteristics
Health Products Regulatory Authority Summary of Product Characteristics 1 NAME OF THE MEDICINAL PRODUCT Sibelium 5 mg Tablets 2 QUALITATIVE AND QUANTITATIVE COMPOSITION Each tablet contains 5 mg of flunarizine as flunarizine dihydrochloride. Excipients with known effect: Each tablet also contains 57.42 mg lactose monohydrate For the full list of excipients see section 6.1 3 PHARMACEUTICAL FORM Tablet. White, oblong tablet inscribed 'J -C' on one side and 'F1 5' on the other side. 4 CLINICAL PARTICULARS 4.1 Therapeutic Indications In the prophylaxis of migraine. The limited information available for periods longer than 12 months has shown flunarizine to continue to be effective. Patients should be regularly reviewed to assess their response to treatment, and if a sustained attack -free period is established, interrupted flunarizine treatment should be considered. 4.2 Posology and method of administration Adults and elderly (18 years of age and older): Starting Dose Treatment is started at 10 mg daily (at night) for adult patients aged 18 to 64 years and at 5 mg daily (at night) for elderly patients aged 65 years and older. If, during this treatment, depressive, extrapyramidal or other unacceptable adverse experiences occur, administration should be discontinued (see Sections 4.4 and 4.8). If, after 2 months of this initial treatment, no significant improvement is observed, the patient should be considered a non -responder and administration should be discontinued. Maintenance Treatment If the patient is responding satisfactorily and a maintenance treatment is needed, the same daily dose should be used, but this time interrupted by two successive drug -free days every week, eg Saturday and Sunday. -
Refractory Migraine with Patent Foramen Ovale Yichen Guo , Yujie Shi, Dan Zhu, Rui Liu, Yi Qi , Guogang Luo
Original research J Investig Med: first published as 10.1136/jim-2020-001342 on 26 August 2020. Downloaded from Clopidogrel can be an effective complementary prophylactic for drug- refractory migraine with patent foramen ovale Yichen Guo , Yujie Shi, Dan Zhu, Rui Liu, Yi Qi , Guogang Luo Department of Neurology, ABSTRACT The First Affiliated Hospital The present study aims to determine the potential Significance of this study of Xi’an Jiaotong University, Xi’an, Shaanxi, China prophylactic effect of clopidogrel for migraine with patent foramen ovale (PFO) in patients who What is already known about this subject? ► The incidence of patent foramen ovale Correspondence to are poor responders to two or more common Professor Guogang Luo, preventive medications. Migraineurs underwent (PFO) is higher in patients with migraine Department of Neurology, contrast- enhanced transcranial doppler examination than in those without migraine; migraine The First Affiliated Hospital to confirm the presence of PFO and determine the is alleviated after PFO closure; clopidogrel of Xi’an Jiaotong University, right-to- left shunt degree. Clopidogrel 75 mg/day could improve new- onset migraine after Xi’an, Shaanxi 710061, device implantation. China; lguogang@ 163. com was added to the existing prophylactic regimen for 3 months and 6 months. The presence of PFO What are the new findings? Accepted 28 July 2020 was found in 56.8% (151/266) of all patients with ► PFO was closely correlated with migraine, Published Online First migraine and 70.2% (59/84) of migraine with aura 26 August 2020 especially in migraine with aura(MHA); a (MHA), and among MHA a large shunt was observed large right- to- left shunt is very common in in 36 patients. -
Paediatrica Indonesiana Effectiveness of Cyproheptadine in The
Paediatrica Indonesiana VOLUME 49 September NUMBER 5 Original Article Effectiveness of cyproheptadine in the prevention of childhood migraine Zulkarnain, Johannes Saing, Yazid Dimyati, Bistok Saing Abstract Background Migraine is one of the causes of recurrent headache eadache, more particularly migraine, is a LQFKLOGKRRG&\SURKHSWDGLQHLVZHOONQRZQDVDQDQWLKLVWDPLQH frequent health problem in children and but there are few studies revealing the drug’s effect in pediatric migraine. DGROHVFHQWV+HDGDFKHVDUHHVWLPDWHGWR Objective To determine the effectiveness of cyproheptadine in the EHRFFXUUHGLQXSWRRIDGROHVFHQWV prophylactic treatment of childhood migraine. +DQGRI\RXQJHUFKLOGUHQ0LJUDLQHKDVWKHJUHDWHVW Methods$UDQGRPL]HGSODFHERFRQWUROOHGFOLQLFDOWULDOVWXG\ impact on children and parents. It occurs in up to was performed at Medan. One hundred children with migraine DFFRUGLQJWRWKH,QWHUQDWLRQDO+HDGDFKH6RFLHW\FULWHULDZHUH FKLOGUHQZLWKDJHEHWZHHQDQG\HDUVDQG 1 LQFOXGHGLQWKHVWXG\6XEMHFWVZHUHGLYLGHGLQWRWZRJURXSVDQG LQFKLOGUHQDJHGWR\HDUV Although the HDFKJURXSZDVJLYHQHLWKHUPJF\SURKHSWDGLQHRUSODFHERIRU DWWDFNVRIPLJUDLQHPD\VWDUWDWDQ\DJHWKHLQFLGHQFH ZHHNV+HDGDFKHIUHTXHQF\ZDVPHDVXUHGLQKHDGDFKHGD\VSHU SHDNVLQHDUO\WRPLGDGROHVFHQFHMigraine, as month, duration was measured in hours and functional disability defined by the research group on headache of the ZDVPHDVXUHGE\3HGLDWULF0LJUDLQH'LVDELOLW\$VVHVVPHQW 3HG0,'$6 7KHHIILFDF\ZDVPHDVXUHGEHIRUHLQWHUYHQWLRQ World Federation of Neurology, is a familial disorder DOVRDQGPRQWKVDIWHULQWHUYHQWLRQ FKDUDFWHUL]HGE\UHFXUUHQWDWWDFNVRIKHDGDFKH -
Changes in Body Weight and Psychotropic Drugs: a Systematic Synthesis of the Literature
Review Changes in Body Weight and Psychotropic Drugs: A Systematic Synthesis of the Literature Robert Dent1,3*, Angelique Blackmore1, Joan Peterson2, Rami Habib3, Gary Peter Kay3, Alan Gervais1, Valerie Taylor4, George Wells5 1 Weight Management Clinic, Ottawa Hospital, Ontario, Canada, 2 Ottawa Health Research Institute, Ottawa, Ontario, Canada, 3 Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada, 4 University of Toronto, Toronto, Ontario, Canada, 5 Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada [9–14], for antipsychotic medications [15–22] and for lithium Abstract: Introduction: Psychotropic medication use is [23,24] and has been cited by an expert consensus panel on associated with weight gain. While there are studies and adherence problems in serious and persistent mental illness reviews comparing weight gain for psychotropics within [25,26]. Non-adherence to prescribed medications places patients some classes, clinicians frequently use drugs from at a greatly increased risk of illness exacerbation and re- different classes to treat psychiatric disorders. hospitalization. These costs are high [27], and were estimated to Objective: To undertake a systematic review of all classes range from $1392 million to $1826 million in 2005 in the US for of psychotropics to provide an all encompassing evi- antipsychotics alone [28]. These issues are balanced by the dence-based tool that would allow clinicians to determine therapeutic benefit of the psychiatric medication. The CATIE trial the risks of weight gain in making both intra-class and concluded that the superior efficacy of olanzapine might prevent interclass choices of psychotropics. discontinuation due to weight gain [29,30].