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Methylphenidate Hydrochloride
Application for Inclusion to the 22nd Expert Committee on the Selection and Use of Essential Medicines: METHYLPHENIDATE HYDROCHLORIDE December 7, 2018 Submitted by: Patricia Moscibrodzki, M.P.H., and Craig L. Katz, M.D. The Icahn School of Medicine at Mount Sinai Graduate Program in Public Health New York NY, United States Contact: [email protected] TABLE OF CONTENTS Page 3 Summary Statement Page 4 Focal Point Person in WHO Page 5 Name of Organizations Consulted Page 6 International Nonproprietary Name Page 7 Formulations Proposed for Inclusion Page 8 International Availability Page 10 Listing Requested Page 11 Public Health Relevance Page 13 Treatment Details Page 19 Comparative Effectiveness Page 29 Comparative Safety Page 41 Comparative Cost and Cost-Effectiveness Page 45 Regulatory Status Page 48 Pharmacoepial Standards Page 49 Text for the WHO Model Formulary Page 52 References Page 61 Appendix – Letters of Support 2 1. Summary Statement of the Proposal for Inclusion of Methylphenidate Methylphenidate (MPH), a central nervous system (CNS) stimulant, of the phenethylamine class, is proposed for inclusion in the WHO Model List of Essential Medications (EML) & the Model List of Essential Medications for Children (EMLc) for treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) under ICD-11, 6C9Z mental, behavioral or neurodevelopmental disorder, disruptive behavior or dissocial disorders. To date, the list of essential medications does not include stimulants, which play a critical role in the treatment of psychotic disorders. Methylphenidate is proposed for inclusion on the complimentary list for both children and adults. This application provides a systematic review of the use, efficacy, safety, availability, and cost-effectiveness of methylphenidate compared with other stimulant (first-line) and non-stimulant (second-line) medications. -
Metabolic-Hydroxy and Carboxy Functionalization of Alkyl Moieties in Drug Molecules: Prediction of Structure Influence and Pharmacologic Activity
molecules Review Metabolic-Hydroxy and Carboxy Functionalization of Alkyl Moieties in Drug Molecules: Prediction of Structure Influence and Pharmacologic Activity Babiker M. El-Haj 1,* and Samrein B.M. Ahmed 2 1 Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, University of Science and Technology of Fujairah, Fufairah 00971, UAE 2 College of Medicine, Sharjah Institute for Medical Research, University of Sharjah, Sharjah 00971, UAE; [email protected] * Correspondence: [email protected] Received: 6 February 2020; Accepted: 7 April 2020; Published: 22 April 2020 Abstract: Alkyl moieties—open chain or cyclic, linear, or branched—are common in drug molecules. The hydrophobicity of alkyl moieties in drug molecules is modified by metabolic hydroxy functionalization via free-radical intermediates to give primary, secondary, or tertiary alcohols depending on the class of the substrate carbon. The hydroxymethyl groups resulting from the functionalization of methyl groups are mostly oxidized further to carboxyl groups to give carboxy metabolites. As observed from the surveyed cases in this review, hydroxy functionalization leads to loss, attenuation, or retention of pharmacologic activity with respect to the parent drug. On the other hand, carboxy functionalization leads to a loss of activity with the exception of only a few cases in which activity is retained. The exceptions are those groups in which the carboxy functionalization occurs at a position distant from a well-defined primary pharmacophore. Some hydroxy metabolites, which are equiactive with their parent drugs, have been developed into ester prodrugs while carboxy metabolites, which are equiactive to their parent drugs, have been developed into drugs as per se. -
Substance Abuse and Dependence
9 Substance Abuse and Dependence CHAPTER CHAPTER OUTLINE CLASSIFICATION OF SUBSTANCE-RELATED THEORETICAL PERSPECTIVES 310–316 Residential Approaches DISORDERS 291–296 Biological Perspectives Psychodynamic Approaches Substance Abuse and Dependence Learning Perspectives Behavioral Approaches Addiction and Other Forms of Compulsive Cognitive Perspectives Relapse-Prevention Training Behavior Psychodynamic Perspectives SUMMING UP 325–326 Racial and Ethnic Differences in Substance Sociocultural Perspectives Use Disorders TREATMENT OF SUBSTANCE ABUSE Pathways to Drug Dependence AND DEPENDENCE 316–325 DRUGS OF ABUSE 296–310 Biological Approaches Depressants Culturally Sensitive Treatment Stimulants of Alcoholism Hallucinogens Nonprofessional Support Groups TRUTH or FICTION T❑ F❑ Heroin accounts for more deaths “Nothing and Nobody Comes Before than any other drug. (p. 291) T❑ F❑ You cannot be psychologically My Coke” dependent on a drug without also being She had just caught me with cocaine again after I had managed to convince her that physically dependent on it. (p. 295) I hadn’t used in over a month. Of course I had been tooting (snorting) almost every T❑ F❑ More teenagers and young adults die day, but I had managed to cover my tracks a little better than usual. So she said to from alcohol-related motor vehicle accidents me that I was going to have to make a choice—either cocaine or her. Before she than from any other cause. (p. 297) finished the sentence, I knew what was coming, so I told her to think carefully about what she was going to say. It was clear to me that there wasn’t a choice. I love my T❑ F❑ It is safe to let someone who has wife, but I’m not going to choose anything over cocaine. -
Date Rape and Steroid Panels, Updated Feb 1 2010
DRUG-FACILITATED SEXUAL ASSAULT (aka “DATE RAPE”) AND STEROID PANELS (Effective January 26, 2010) Basic Date Rape Panel Comprehensive Date Rape Panel • GHB (Hair Only) • Ketamine • GHB • Benzodiazepines, including Rohypnol • Benzodiazepines Alprazolam Clonazepam Alprazolam Clonazepam Diazepam Flunitrazepam (Rohypnol) Diazepam Flunitrazepam Lorazepam Oxazepam Lorazepam Oxazepam Temazepam Nitrazepam Temazepam Nitrazepam • Opioids Codeine Hydrocodone Comprehensive Date Rape Panel Meperidine Tramadol (Urine Only) Methadone Fentanyl • GHB • Sedatives/Hypnotics Ketamine Methaqualone • Barbiturates Zolpidem Zopiclone Amobarbital Butalbital Pentobarbital Phenobarbital • Over-The-Counter Drugs Secobarbital Diphenhydramine Dextromethorphan Doxylamine Chlorpheniramine • Benzodiazepines Brompheniramine Promethazine Alprazolam Clonazepam Pheniramine Diazepam Flunitrazepam Lorazepam Oxazepam • Muscle Relaxants Temazepam Nitrazepam Carisoprodol Meprobamate • Opioids Cyclobenzaprine Methocarbamol Codeine Morphine • Hallucinogens (PCP) Hydrocodone Hydromorphone Oxycodone Oxymorphone Meperidine Tramadol ANABOLIC STEROID PANEL Methadone Fentanyl (Urine or Blood) Propoxyphene Buprenorphine Androstenedione Boldenone • Sedatives/Hypnotics Fluoxymesterolone Mesterolone Ketamine Methaqualone 17-a-Methyltestosterone Methenolone Zolpidem Zopiclone Methandrostenolone Nandrolone • Over-The-Counter Drugs Norethandrolone Oxandrolone Diphenhydramine Dextromethorphan Stanozolol Trenbolone Doxylamine Chlorpheniramine Brompheniramine Promethazine Pheniramine For additional steroids, • Muscle Relaxants call for details and pricing Carisoprodol Meprobamate EXPERTOX, INC. Cyclobenzaprine Methocarbamol Blood should only be 1803 CENTER STREET, SUITE A submitted for date rape • Hallucinogens DEER PARK, TX 77536 PCP MDMA panels if within five (5) hours of 281.476.4600 MDA MDEA ingestion. FAX 281.930.8856 Cannabinoids (Carboxy-THC) • WWW.EXPERTOX.COM Turaround Time: Ten (10) Urine must be collected within five (5) days business days from specimen of drug exposure receipt at the lab . -
Emergency Medical Services Program Policies – Procedures – Protocols
Emergency Medical Services Program Policies – Procedures – Protocols Protocols Table of Contents GENERAL PROVISIONS ................................................................................................ 3 DESTINATION DECISION SUMMARY-METRO BAKERSFIELD AREA ........................ 5 DETERMINATION OF DEATH ..................................................................................... 12 101 AIRWAY OBSTRUCTION ...................................................................................... 16 102 ALTERED LEVEL OF CONSCIOUSNESS ............................................................ 18 103 ALLERGIC REACTION/ANAPHYLAXIS ................................................................ 20 104 ASYSTOLE/ PULSELESS ELECTRICAL ACTIVITY ............................................. 22 105 BITES STINGS ENVENOMATION ......................................................................... 24 106 BRADYCARDIA ..................................................................................................... 26 107 BRIEF RESOLVED UNEXPLAINED EVENT ......................................................... 29 108 BURNS ................................................................................................................... 32 109 CHEMPACK ........................................................................................................... 35 110 CHEST PAIN OR ACUTE CORONARY SYNDROME ........................................... 37 111 CHEST TRAUMA .................................................................................................. -
XANAX® Alprazolam Tablets, USP
XANAX® alprazolam tablets, USP CIV WARNING: RISKS FROM CONCOMITANT USE WITH OPIOIDS Concomitant use of benzodiazepines and opioids may result in profound sedation, respiratory depression, coma, and death [see Warnings, Drug Interactions]. Reserve concomitant prescribing of these drugs for use in patients for whom alternative treatment options are inadequate. Limit dosages and durations to the minimum required. Follow patients for signs and symptoms of respiratory depression and sedation. DESCRIPTION XANAX Tablets contain alprazolam which is a triazolo analog of the 1,4 benzodiazepine class of central nervous system-active compounds. The chemical name of alprazolam is 8-Chloro-1-methyl-6-phenyl-4H-s-triazolo [4,3-α] [1,4] benzodiazepine. The structural formula is represented to the right: Alprazolam is a white crystalline powder, which is soluble in methanol or ethanol but which has no appreciable solubility in water at physiological pH. Each XANAX Tablet, for oral administration, contains 0.25, 0.5, 1 or 2 mg of alprazolam. XANAX Tablets, 2 mg, are multi-scored and may be divided as shown below: 1 Reference ID: 4029640 Inactive ingredients: Cellulose, corn starch, docusate sodium, lactose, magnesium stearate, silicon dioxide and sodium benzoate. In addition, the 0.5 mg tablet contains FD&C Yellow No. 6 and the 1 mg tablet contains FD&C Blue No. 2. CLINICAL PHARMACOLOGY Pharmacodynamics CNS agents of the 1,4 benzodiazepine class presumably exert their effects by binding at stereo specific receptors at several sites within the central nervous system. Their exact mechanism of action is unknown. Clinically, all benzodiazepines cause a dose-related central nervous system depressant activity varying from mild impairment of task performance to hypnosis. -
Critical Care Nursing of Infants and Children Martha A
University of Pennsylvania ScholarlyCommons Miscellaneous Papers Miscellaneous Papers 1-1-2001 Critical Care Nursing of Infants and Children Martha A. Q. Curley University of Pennsylvania, [email protected] Patricia A. Moloney-Harmon The Children's Hospital at Sinai Copyright by the author. Reprinted from Critical Care Nursing of Infants and Children, Martha A.Q. Curley and Patricia A. Moloney-Harmon (Editors), (Philadelphia: W.B. Saunders Co., 2001), 1,128 pages. NOTE: At the time of publication, the author, Martha Curley was affiliated with the Children's Hospital of Boston. Currently, she is a faculty member in the School of Nursing at the University of Pennsylvania. This paper is posted at ScholarlyCommons. http://repository.upenn.edu/miscellaneous_papers/4 For more information, please contact [email protected]. Please Note: The full version of this book and all of its chapters (below) can be found on ScholarlyCommons (from the University of Pennsylvania) at http://repository.upenn.edu/miscellaneous_papers/4/ Information page in ScholarlyCommons Full book front.pdf - Front Matter, Contributors, Forward, Preface, Acknowledgements, and Contents Chapter 1.pdf - The Essence of Pediatric Critical Care Nursing Chapter 2.pdf - Caring Practices: Providing Developmentally Supportive Care Chapter_3.pdf - Caring Practices: The Impact of the Critical Care Experience on the Family Chapter_4.pdf - Leadership in Pediatric Critical Care Chapter 5.pdf - Facilitation of Learning Chapter_6.pdf - Advocacy and Moral Agency: A Road Map for -
National Clearinghouse for Drug Abuse Information Selected Reference Series, Series 1, No
DOCUMENT RESOHE ED 090 455 CG 008 832 TITLE National Clearinghouse For Drug Abuse Information Selected Reference Series, Series 1, No. 1. INSTITUTION National Inst. of Mental Health (DHEW), Rockville, Hd. National Clearinghouse for Drug Abuse Information.; Student Association for the Study of Hallucinogens, Biloit, His. PDB DATE Nov 73 NOTE 13p. AVAILABLE FROM National Clearinghouse for Drug Abuse Information, p. 0. Box 1908, Rockville, Maryland 20850 EDRS PRICE MF-10.75 HC-S1.50 PLUS POSTAGE DESCRIPTORS ^Bibliographies; *Drug Abuse; *Drug Education; *Drug Therapy; Government Publications; ^Narcotics ABSTRACT One of a series of bibliographies published by the National Clearinghouse for Drug Abuse Information, this reference focuses on the drug, methagualone. Literature is selected for inclusion on the basis of its currency, significance in the field, and its availability to the public. Materials are directed toward researchers, educators, lawyers, physicians, and members of the public with more than a general need for information. Citations are not annotated. (Author/CJ) SERIES 7, No.l NOVEMBER 1973 Each bibliography of the National Clearinghouse for Drug Abuse 3- Information Selected Reference Series is a representative listing of citations on subjects of topical interest. The selection of o literature is based on its currency, its significance in the field, and its availability in local bookstores or research libraries. The scope of the material is directed toward students writing research papers, special interest groups, such as educators, lawyers and phy sicians, and the general public requiring more resources than public information materials can provide. Each reference series is meant to present an overview of the existing literature, but is not meant to be comprehensive or definitive in scope. -
Chemistry Information Sheet Methaqualone © 2014 Beckman Coulter, Inc
SYNCHRON System(s) METQ Chemistry Information Sheet Methaqualone © 2014 Beckman Coulter, Inc. All rights reserved. 475021 For In Vitro Diagnostic Use Rx Only ANNUAL REVIEW Reviewed by Date Reviewed by Date PRINCIPLE INTENDED USE METQ reagent, in conjunction with UniCel® DxC 600/800 System(s) and SYNCHRON® Systems Drugs of Abuse Testing (DAT) Urine Calibrators, is intended for the qualitative determination of methaqualone in human urine at a cutoff value of 300 ng/mL. The METQ assay provides a rapid screening procedure for determining the presence of methaqualone (METQ) and its metabolites in urine. This test provides only a preliminary analytical result; a positive result by this assay should be conrmed by another generally accepted non-immunological method such as thin layer chromatography (TLC), gas chromatography (GC), or gas chromatography/mass spectrometry (GC/MS). GC/MS is the preferred conrmatory method.1,2 Clinical consideration and professional judgement should be applied to any drug of abuse test result, particularly when preliminary positive results are used. CLINICAL SIGNIFICANCE Measurements of methaqualone are used as an aid in the diagnosis and treatment of methaqualone use or overdose. METHODOLOGY The Methaqualone assay utilizes a homogenous enzyme immunoassay method.3 The METQ reagent is comprised of specic antibodies which can detect methaqualone and its metabolites in urine. A drug-labeled glucose-6-phosphate dehydrogenase (G6PDH) conjugate competes with any free drug from the urine sample for a xed amount of antibody binding sites. In the absence of free drug from the sample, the drug-labeled G6PDH conjugate is bound by the specic antibody and the enzyme activity is inhibited. -
HS 172 R5/13 Briefly Review the Objectives, Content and Activities of This Session
HS 172 R5/13 Briefly review the objectives, content and activities of this session. Upon successfully completing this session the participant will be able to: • Explain a brief history of the CNS Depressant category of drugs. • Identify common drug names and terms associated with this category. • Identify common methods of administration for this category. • Describe the symptoms, observable signs and other effects associated with this category. CONTENT SEGMENTS LEARNING ACTIVITIES A. Overview of the Category Instructor-Led Presentations B. Possible Effects Instructor Led Demonstrations C. OtdDtifEfftOnset and Duration of Effects RdiAiReading Assignmen ts D. Overdose Signs and Symptoms Video Presentations E. Expected Results of the Evaluation Slide Presentations F. Classification Exemplar HS 172 R5/13 9-2 • Explain the typical time parameters, i.e. onset and duration of effects, associated with this category. • List the clues that are likely to emerge when the drug influence evaluation is conducted for a person under the influence of this category of drugs. • Correctly answer the “topics for study” questions at the end of this session. HS 172 R5/13 9-3 A. Overview of the Category CNS Depressants Central Nervous System Depressants slow down the operations of the brain. Point out that other common names for CNS Depressants are “downers” and “sedative-hypnotics.” • Depressants first affect those arareaseas of the brain that control a person’ s conscious, voluntary actions. • Judgment, inhibitions and reaction time are some of the things that CNS Depressants affect first. • As the dose is increased, depressants begin to affect the parts of the brain that control the body’s automatic processes, heartbeat, respiration, etc. -
First Reported Case of Lorazepam-Assisted Interview in A
Hindawi Publishing Corporation Case Reports in Psychiatry Volume 2014, Article ID 346939, 4 pages http://dx.doi.org/10.1155/2014/346939 Case Report First Reported Case of Lorazepam-Assisted Interview in a Young Indian Female Presenting with Dissociative Identity Disorder and Improvement in Symptoms after the Interview Raheel Mushtaq,1,2 Sheikh Shoib,1,2 Tasleem Arif,3 Tabindah Shah,4 and Sahil Mushtaq5 1 ECT Clinic, Postgraduate Department of Psychiatry, Government Medical College, Srinagar, Jammu and Kashmir 190010, India 2 Memory Clinic, Postgraduate Department of Psychiatry, Government Medical College, Srinagar 190010, India 3 Post Graduate Department of Dermatology, Government Medical College, Srinagar 190010, India 4 Government Medical College, Srinagar, Jammu and Kashmir 190010, India 5 Acharya Shri Chander College of Medical Sciences, Jammu, India Correspondence should be addressed to Raheel Mushtaq; [email protected] Received 30 May 2014; Revised 17 July 2014; Accepted 18 July 2014; Published 5 August 2014 Academic Editor: Toshiya Inada Copyright © 2014 Raheel Mushtaq et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Dissociative identity disorder (DID) is one of the most fascinating disorders in psychiatry. The arduous search to reveal the obscurity of this disorder has led to colossal research in this area over the years. Although drug-assisted interviews are not widely used, they may be beneficial for some patients that do not respond to conventional treatments such as supportive psychotherapy or psychopharmacotherapy. Drug-assisted interviews facilitate recall of memories in promoting integration of dissociative information. -
Prescription Medications: Misuse, Abuse, Dependence, and Addiction
Substance Abuse Treatment May 2006 Volume 5 Issue 2 ADVISORYNews for the Treatment Field Prescription Medications: Misuse, Abuse, Dependence, and Addiction How serious are prescription Older adults are particularly vulnerable to misuse and medication use problems? abuse of prescription medications. Persons ages 65 and older make up only 13 percent of the population but Development and increased availability of prescription account for one-third of all medications prescribed,3 drugs have significantly improved treatment of pain, and many of these prescriptions are for psychoactive mental disorders, anxiety, and other conditions. Millions medications with high abuse and addiction liability.4 of Americans use prescription medications safely and Data from the National Survey on Drug Use and Health responsibly. However, increased availability and vari- indicate that nonmedical use of prescription medications ety of medications with psychoactive effects (see Table was the second most common form of substance abuse 1) have contributed to prescription misuse, abuse, among adults older than 55.5 dependence, and addiction. In 2004,1 the number of Americans reporting abuse2 of prescription medications Use of prescription medications in ways other than was higher than the combined total of those reporting prescribed can have a variety of adverse health conse- abuse of cocaine, hallucinogens, inhalants, and heroin. quences, including overdose, toxic reactions, and serious More than 14.5 million persons reported having used drug interactions leading to life-threatening conditions, prescription medications nonmedically within the past such as respiratory depression, hypertension or hypoten- year. Of this 14.5 million, more than 2 million were sion, seizures, cardiovascular collapse, and death.6 between ages 12 and 17.