One Step Clinic is a leading outpatient addiction treatment facility in Ireland. For suitable patients Naltrexone implants are administered as part of a sustained treatment option.
Brand name : NAMENDA
US FDA Approval :October 2003
NMDA (N-methyl-D-aspartate) receptor antagonist
Indicated for the treatment of moderate to severe Alzheimer’s Disease
This document discusses the mechanisms of action of benzodiazepines. It notes that benzodiazepines augment the effects of the inhibitory neurotransmitter GABA at GABA-A receptors. They can be selective for different GABA receptor subunits involved in sleep, anxiety, or addiction. The hypnotic and anxiolytic effects of benzodiazepines are explained by their actions on GABA receptors in the amygdala, hippocampus, and hypothalamic regions involved in sleep/wake regulation. Adverse effects and issues with dependence and withdrawal are also covered. Novel approaches to anxiolytic drugs targeting GABA receptors without addiction liability are mentioned.
Clobazam is a benzodiazepine derivative introduced in the 1970s as an anti-anxiety and later anti-epileptic drug. It works by enhancing GABA activity at receptors in the brain. It is rapidly absorbed but has a long half-life due to an active metabolite. While effective against several seizure types and syndromes, it can cause sedation and interacts with other anti-epileptic drugs. Doses of 10-20mg per day are usually effective with tolerance developing more slowly than other benzodiazepines.
This document discusses mood stabilizers used to treat bipolar disorder. It describes the symptoms of mania and depression in bipolar disorder. Lithium, valproic acid, carbamazepine, lamotrigine and various antipsychotics are described as first-line mood stabilizing agents. The mechanisms of action of these drugs involve inhibition of inositol monophosphatase and other enzymes, decreasing intracellular inositol levels. Novel targets for treating bipolar disorder discussed include inhibition of glycogen synthase kinase-3, protein kinase C, modulation of brain-derived neurotrophic factor, enhanced Bcl2 expression, effects on oxidative stress, and modulation of glutamatergic transmission.
This document discusses opioid receptors and opioid analgesics. It begins by introducing opioids and their interaction with opioid receptors in the central nervous system and gastrointestinal tract. It then describes the three main types of opioid receptors - mu, kappa, and delta - and their locations in the brain and spinal cord. The document outlines various classes of opioid analgesics and antagonists based on their receptor interactions. It explains the mechanisms of action of opioids like morphine at opioid receptors, including their analgesic, sedative, and other effects. The pharmacokinetics, uses, and adverse effects of representative opioids like morphine and semi-synthetic derivatives are summarized. Finally, the mechanisms and applications of opioid antagonists such as naloxone and naltrexone
This document provides information about psychosis and schizophrenia. It begins by defining psychosis and describing its main symptoms. It then distinguishes between organic and functional psychosis. Schizophrenia is discussed in more detail, describing its thought disorder features and positive and negative symptoms. The document also discusses the dopamine theory of schizophrenia and evidence for and against it. It provides information on antipsychotic medications, including their mechanisms of action, classifications of typical vs atypical drugs, and their adverse effect profiles.
Brand name : NAMENDA
US FDA Approval :October 2003
NMDA (N-methyl-D-aspartate) receptor antagonist
Indicated for the treatment of moderate to severe Alzheimer’s Disease
This document discusses the mechanisms of action of benzodiazepines. It notes that benzodiazepines augment the effects of the inhibitory neurotransmitter GABA at GABA-A receptors. They can be selective for different GABA receptor subunits involved in sleep, anxiety, or addiction. The hypnotic and anxiolytic effects of benzodiazepines are explained by their actions on GABA receptors in the amygdala, hippocampus, and hypothalamic regions involved in sleep/wake regulation. Adverse effects and issues with dependence and withdrawal are also covered. Novel approaches to anxiolytic drugs targeting GABA receptors without addiction liability are mentioned.
Clobazam is a benzodiazepine derivative introduced in the 1970s as an anti-anxiety and later anti-epileptic drug. It works by enhancing GABA activity at receptors in the brain. It is rapidly absorbed but has a long half-life due to an active metabolite. While effective against several seizure types and syndromes, it can cause sedation and interacts with other anti-epileptic drugs. Doses of 10-20mg per day are usually effective with tolerance developing more slowly than other benzodiazepines.
This document discusses mood stabilizers used to treat bipolar disorder. It describes the symptoms of mania and depression in bipolar disorder. Lithium, valproic acid, carbamazepine, lamotrigine and various antipsychotics are described as first-line mood stabilizing agents. The mechanisms of action of these drugs involve inhibition of inositol monophosphatase and other enzymes, decreasing intracellular inositol levels. Novel targets for treating bipolar disorder discussed include inhibition of glycogen synthase kinase-3, protein kinase C, modulation of brain-derived neurotrophic factor, enhanced Bcl2 expression, effects on oxidative stress, and modulation of glutamatergic transmission.
This document discusses opioid receptors and opioid analgesics. It begins by introducing opioids and their interaction with opioid receptors in the central nervous system and gastrointestinal tract. It then describes the three main types of opioid receptors - mu, kappa, and delta - and their locations in the brain and spinal cord. The document outlines various classes of opioid analgesics and antagonists based on their receptor interactions. It explains the mechanisms of action of opioids like morphine at opioid receptors, including their analgesic, sedative, and other effects. The pharmacokinetics, uses, and adverse effects of representative opioids like morphine and semi-synthetic derivatives are summarized. Finally, the mechanisms and applications of opioid antagonists such as naloxone and naltrexone
This document provides information about psychosis and schizophrenia. It begins by defining psychosis and describing its main symptoms. It then distinguishes between organic and functional psychosis. Schizophrenia is discussed in more detail, describing its thought disorder features and positive and negative symptoms. The document also discusses the dopamine theory of schizophrenia and evidence for and against it. It provides information on antipsychotic medications, including their mechanisms of action, classifications of typical vs atypical drugs, and their adverse effect profiles.
The document summarizes properties and uses of benzodiazepines. It discusses how benzodiazepines act by potentiating GABA, have sedative, anxiolytic and anticonvulsant properties, and replaced barbiturates due to a safer profile. It describes the classification, pharmacokinetics, mechanisms of action, and uses of various benzodiazepines like diazepam, midazolam and lorazepam in conditions like anxiety, insomnia, muscle relaxation and as anticonvulsants. It also notes potential adverse effects with high doses or interactions.
This document provides an overview of the pharmacology of dopamine. It discusses dopamine synthesis, receptors, pathways in the brain, and the role of dopamine in conditions like Parkinson's disease, schizophrenia, and addiction. Dopamine is synthesized from phenylalanine and tyrosine and acts on D1-like and D2-like receptors in the mesolimbic, mesocortical, and nigrostriatal pathways. Imbalances in dopaminergic signaling are implicated in disorders such as Parkinson's, schizophrenia, and ADHD. Drugs that modify dopamine transmission are used to treat these conditions.
Anti depressant and its classificationsNatasha Puri
This document discusses anti-depressant drugs and their classification. It defines depression as a serious mood disorder that can affect people of all ages and backgrounds. The main types of depression are described as uni-polar, bi-polar, and endogenous. Causes include family history, life events, medications, alcohol use, and chemical imbalances in the brain. Common symptoms are loss of interest and sadness/irritability. The document then covers various theories of depression before discussing treatment options like psychotherapy, ECT, natural alternatives, and medications. Anti-depressant drugs are classified as tricyclic antidepressants, selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, atypical antidepressants,
The document discusses psychiatric manifestations that commonly occur in dementia such as Alzheimer's disease and dementia with Lewy bodies. It describes symptoms such as apathy, anxiety, agitation, and depression. Psychotic symptoms like hallucinations and delusions are also addressed. The prevalence of various neuropsychiatric symptoms is provided for mild cognitive impairment and different stages of Alzheimer's disease and dementia with Lewy bodies. Factors that influence the risk of developing certain psychiatric symptoms are also outlined.
David studied neurological disorders like Parkinson's disease and schizophrenia to gain a wider understanding of involved drugs and their targets. He summarized information on major depressive disorder (MDD) and the antidepressant drug Citalopram. MDD is a common mental illness associated with reduced quality of life and increased suicide risk. Citalopram is a selective serotonin reuptake inhibitor used to treat MDD by increasing synaptic serotonin levels. However, some patients do not respond to SSRIs and they have a delayed onset of action leading to discontinuation of treatment for many. Combining SSRIs with 5HT receptor antagonists may improve efficacy and reduce discontinuation.
This document discusses opioid dependence and addiction. It begins with an overview of opioids and their mechanism of action in the body. It then defines addiction, dependence, and tolerance. The mechanisms of dependence and addiction involve both negative reinforcement from withdrawal and positive reinforcement from rewarding effects. Physical dependence theory and positive incentive theory are described as models of addiction. The document outlines treatment options including drug substitution therapy with methadone or buprenorphine, abstinence-based treatment, and psychosocial treatments. It discusses opioid withdrawal and post-acute withdrawal syndrome. The six stages of recovery are defined. Special considerations for treating opioid addicts are noted.
Valproic acid is an anticonvulsant used to treat epilepsy, bipolar disorder, and migraines. It exists in multiple preparations and salt forms. Dosing is initially 10-15 mg/kg/day divided every 8-12 hours, up to a maximum of 60 mg/kg/day. Therapeutic drug monitoring aims for serum concentrations of 50-100 mcg/mL. Valproic acid has nearly complete bioavailability and is highly protein bound. It undergoes hepatic metabolism and renal excretion. Dose adjustments may be necessary in renal or hepatic impairment due to altered protein binding and clearance.
SSRIs are a class of antidepressant drugs that work by inhibiting the reuptake of serotonin in the brain. They are commonly used to treat depression but also anxiety, OCD, and other disorders. While SSRIs take weeks to have an effect due to their mechanism of action beyond just increasing serotonin levels, they have fewer side effects than older antidepressants. Common side effects include nausea, sexual dysfunction, insomnia, and headaches. Drug interactions can occur and serotonin syndrome is a potential risk. SSRIs are generally preferred over older antidepressants due to their safety profile.
Levetiracetam is a white powder that is wholly soluble in water. It is the S-enantiomer form which has anticonvulsant properties, while the R-enantiomer does not. It inhibits calcium channels and prevents the release of calcium from intracellular stores. It is rapidly absorbed after oral administration, has a high bioavailability, and is excreted unchanged in the urine. Common side effects include somnolence, asthenia, and nausea. It is indicated as an adjunctive treatment for partial onset seizures, myoclonus, and primary generalized tonic-clonic seizures in adults and children.
This document discusses various classes of antidepressant drugs, including their mechanisms of action, classifications, and side effects. It describes how tricyclic antidepressants and selective serotonin reuptake inhibitors work by inhibiting the reuptake of neurotransmitters like serotonin and norepinephrine. Monoamine oxidase inhibitors are also covered, noting how they work by inhibiting the enzyme MAO. The summary provides an overview of the major classes of antidepressants and their clinical applications and risks.
This document discusses anti-parkinson agents. It outlines their objectives, indications, contraindications, mechanisms of action, dosages, side effects, and nurses' responsibilities regarding these drugs. Anti-parkinson agents work by increasing dopamine activity or reducing acetylcholine activity in the central nervous system. They are used to treat drug-induced parkinsonism and as an adjunct for parkinsonism. Common side effects include dizziness, drowsiness, weakness, and dry mouth. Nurses should monitor for side effects and educate patients on proper usage.
Sedative, Hypnotic and Anxiolytic Drugs are used to treat anxiety, insomnia and induce sleep. They work by potentiating the action of the inhibitory neurotransmitter GABA in the brain. Benzodiazepines and barbiturates are common classes of these drugs. Benzodiazepines increase the frequency of chloride channel opening, while barbiturates increase the duration. Both classes are used as sedatives, hypnotics and to relieve anxiety. They can cause dependence and tolerance with long term use. Newer non-benzodiazepine drugs like Zolpidem and Zaleplon have fewer side effects.
Opioid receptors are G-protein coupled receptors located in the central nervous system and peripheral tissues that interact with opioid drugs like morphine. There are three main types of opioid receptors: mu, kappa, and delta. Mu receptors have a high affinity for morphine and are responsible for respiratory depression, euphoria, and physical dependence. Kappa receptors are activated by compounds like ethylketocyclazocine and are involved in analgesia and diuresis. Delta receptors have a lower risk of side effects compared to mu receptors and are activated by ligands like levorphanol. Opioid receptors act through G-proteins to inhibit adenyl cyclase, open potassium channels, close calcium channels, and decrease neuronal
Selective serotonin reuptake inhibitors (SSRIs) are a class of antidepressants that work by inhibiting the reuptake of serotonin. SSRIs include fluoxetine, sertraline, paroxetine, fluvoxamine, citalopram, and escitalopram. They are highly selective for serotonin reuptake compared to other neurotransmitters. While SSRIs share the common mechanism of inhibiting serotonin reuptake, they differ in their pharmacokinetic properties such as half-life, metabolic pathways, and drug interaction potential. Adverse effects of SSRIs include nausea, sexual dysfunction, headaches, and weight changes.
This document discusses opioid analgesics, focusing on tramadol and butorphanol. It defines opioids and their receptor types. Tramadol is described as a centrally acting atypical analgesic that is a racemic mixture with both enantiomers contributing to its analgesic effects. Its mechanisms of action and pharmacokinetics are outlined. Butorphanol is introduced as a synthetic agonist-antagonist opioid with greater agonist and antagonist effects than pentazocin. Its proposed mechanisms of analgesia and adverse effects are summarized. Clinical uses of both drugs for various acute and postoperative pain conditions are mentioned.
Haloperidol was the first discovered typical antipsychotic, developed in 1958 and approved by the FDA in 1967 under the brand name Haldol. It works by blocking dopamine D2 receptors in the brain. While effective for treating schizophrenia, bipolar disorder, agitation, and other conditions, it carries risks of extrapyramidal side effects and increased mortality in elderly patients with dementia. Dosing requires consideration of age, weight, renal or hepatic function, and risk/benefit at higher doses above 30 mg per day.
This document discusses anticholinesterase drugs, which inhibit the enzyme acetylcholinesterase and thereby increase cholinergic transmission. It describes the classification, mechanisms of action, pharmacokinetics and uses of specific anticholinesterase drugs including neostigmine, pyridostigmine, edrophonium, and physostigmine. It also covers overdose effects and treatment with atropine and pralidoxime. The document provides detailed information on the pharmacological properties and clinical applications of anticholinesterase drugs.
Certain drugs like reserpine, tetrabenazine, haloperidol, and metoclopramide can deplete dopamine or block dopamine receptors, leading to a parkinsonian syndrome within 3 months. The syndrome is symmetric with mild tremor and usually resolves after withdrawing the causative drug. For treatment, antimuscarinic agents are preferred over levodopa, which may worsen symptoms if the neuroleptic drug is continued. MPTP, through its metabolite MPP+, can selectively damage cells in the substantia nigra by inhibiting mitochondrial complex I, leading to parkinsonism through striatal dopamine depletion. MPTP parkinsonism was discovered in individuals who self-administered M
This document summarizes various central nervous system agents including stimulants, depressants, and anesthetics. CNS stimulants increase mental and physical activity and include substances like caffeine and amphetamines. CNS depressants like barbiturates and benzodiazepines are classified as sedative-hypnotics and can induce sleep. General anesthetics cause unconsciousness during surgery by inhibiting nerve impulses while local anesthetics temporarily disrupt sensory nerve transmission in a specific body area. Nursing responsibilities involve monitoring for side effects and ensuring patient safety.
This document discusses alcohols, including ethanol and methanol. It covers the pharmacology of alcohol including its mechanisms of action in the body, metabolism, effects of acute and chronic consumption, toxicity, and treatment of alcoholism. Specifically, it describes how alcohol is absorbed and distributed in the body, metabolized primarily in the liver, and can cause intoxication, organ damage, and diseases with heavy long-term use such as cirrhosis and fetal alcohol syndrome.
Acp - ce -2016 08 update- smack is wackRobert Cole
This document discusses emerging trends in illicit opioid use, including highly potent fentanyl analogs like carfentanil and acetylfentanil. It notes a rise in overdoses involving these substances, which are often mixed with heroin or cocaine. Two case studies describe patients requiring high doses of naloxone or prolonged infusions to reverse overdoses from acetylfentanil consumed via electronic cigarette or fake pills containing fentanyl. The document provides guidance that standard naloxone doses remain effective for most opioid overdoses but higher doses may be needed for strong suspicions of poly-opioid use involving fentanyl mixes. It emphasizes supporting airway and respiration over waiting for
Consensus guidelines for the management of PONVDr Krunal Bhatt
The document provides guidelines for managing postoperative nausea and vomiting (PONV) based on a review of recent literature. It describes the incidence and causes of PONV, risk factors, and the effectiveness of various pharmacologic and nonpharmacologic therapies both alone and in combination, including 5-HT3 receptor antagonists, neurokinin 1 receptor antagonists, corticosteroids, butyrophenones, antihistamines, scopolamine patches, and acupuncture/acustimulation. Optimal dosing and timing of antiemetic administration is discussed.
The document summarizes properties and uses of benzodiazepines. It discusses how benzodiazepines act by potentiating GABA, have sedative, anxiolytic and anticonvulsant properties, and replaced barbiturates due to a safer profile. It describes the classification, pharmacokinetics, mechanisms of action, and uses of various benzodiazepines like diazepam, midazolam and lorazepam in conditions like anxiety, insomnia, muscle relaxation and as anticonvulsants. It also notes potential adverse effects with high doses or interactions.
This document provides an overview of the pharmacology of dopamine. It discusses dopamine synthesis, receptors, pathways in the brain, and the role of dopamine in conditions like Parkinson's disease, schizophrenia, and addiction. Dopamine is synthesized from phenylalanine and tyrosine and acts on D1-like and D2-like receptors in the mesolimbic, mesocortical, and nigrostriatal pathways. Imbalances in dopaminergic signaling are implicated in disorders such as Parkinson's, schizophrenia, and ADHD. Drugs that modify dopamine transmission are used to treat these conditions.
Anti depressant and its classificationsNatasha Puri
This document discusses anti-depressant drugs and their classification. It defines depression as a serious mood disorder that can affect people of all ages and backgrounds. The main types of depression are described as uni-polar, bi-polar, and endogenous. Causes include family history, life events, medications, alcohol use, and chemical imbalances in the brain. Common symptoms are loss of interest and sadness/irritability. The document then covers various theories of depression before discussing treatment options like psychotherapy, ECT, natural alternatives, and medications. Anti-depressant drugs are classified as tricyclic antidepressants, selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, atypical antidepressants,
The document discusses psychiatric manifestations that commonly occur in dementia such as Alzheimer's disease and dementia with Lewy bodies. It describes symptoms such as apathy, anxiety, agitation, and depression. Psychotic symptoms like hallucinations and delusions are also addressed. The prevalence of various neuropsychiatric symptoms is provided for mild cognitive impairment and different stages of Alzheimer's disease and dementia with Lewy bodies. Factors that influence the risk of developing certain psychiatric symptoms are also outlined.
David studied neurological disorders like Parkinson's disease and schizophrenia to gain a wider understanding of involved drugs and their targets. He summarized information on major depressive disorder (MDD) and the antidepressant drug Citalopram. MDD is a common mental illness associated with reduced quality of life and increased suicide risk. Citalopram is a selective serotonin reuptake inhibitor used to treat MDD by increasing synaptic serotonin levels. However, some patients do not respond to SSRIs and they have a delayed onset of action leading to discontinuation of treatment for many. Combining SSRIs with 5HT receptor antagonists may improve efficacy and reduce discontinuation.
This document discusses opioid dependence and addiction. It begins with an overview of opioids and their mechanism of action in the body. It then defines addiction, dependence, and tolerance. The mechanisms of dependence and addiction involve both negative reinforcement from withdrawal and positive reinforcement from rewarding effects. Physical dependence theory and positive incentive theory are described as models of addiction. The document outlines treatment options including drug substitution therapy with methadone or buprenorphine, abstinence-based treatment, and psychosocial treatments. It discusses opioid withdrawal and post-acute withdrawal syndrome. The six stages of recovery are defined. Special considerations for treating opioid addicts are noted.
Valproic acid is an anticonvulsant used to treat epilepsy, bipolar disorder, and migraines. It exists in multiple preparations and salt forms. Dosing is initially 10-15 mg/kg/day divided every 8-12 hours, up to a maximum of 60 mg/kg/day. Therapeutic drug monitoring aims for serum concentrations of 50-100 mcg/mL. Valproic acid has nearly complete bioavailability and is highly protein bound. It undergoes hepatic metabolism and renal excretion. Dose adjustments may be necessary in renal or hepatic impairment due to altered protein binding and clearance.
SSRIs are a class of antidepressant drugs that work by inhibiting the reuptake of serotonin in the brain. They are commonly used to treat depression but also anxiety, OCD, and other disorders. While SSRIs take weeks to have an effect due to their mechanism of action beyond just increasing serotonin levels, they have fewer side effects than older antidepressants. Common side effects include nausea, sexual dysfunction, insomnia, and headaches. Drug interactions can occur and serotonin syndrome is a potential risk. SSRIs are generally preferred over older antidepressants due to their safety profile.
Levetiracetam is a white powder that is wholly soluble in water. It is the S-enantiomer form which has anticonvulsant properties, while the R-enantiomer does not. It inhibits calcium channels and prevents the release of calcium from intracellular stores. It is rapidly absorbed after oral administration, has a high bioavailability, and is excreted unchanged in the urine. Common side effects include somnolence, asthenia, and nausea. It is indicated as an adjunctive treatment for partial onset seizures, myoclonus, and primary generalized tonic-clonic seizures in adults and children.
This document discusses various classes of antidepressant drugs, including their mechanisms of action, classifications, and side effects. It describes how tricyclic antidepressants and selective serotonin reuptake inhibitors work by inhibiting the reuptake of neurotransmitters like serotonin and norepinephrine. Monoamine oxidase inhibitors are also covered, noting how they work by inhibiting the enzyme MAO. The summary provides an overview of the major classes of antidepressants and their clinical applications and risks.
This document discusses anti-parkinson agents. It outlines their objectives, indications, contraindications, mechanisms of action, dosages, side effects, and nurses' responsibilities regarding these drugs. Anti-parkinson agents work by increasing dopamine activity or reducing acetylcholine activity in the central nervous system. They are used to treat drug-induced parkinsonism and as an adjunct for parkinsonism. Common side effects include dizziness, drowsiness, weakness, and dry mouth. Nurses should monitor for side effects and educate patients on proper usage.
Sedative, Hypnotic and Anxiolytic Drugs are used to treat anxiety, insomnia and induce sleep. They work by potentiating the action of the inhibitory neurotransmitter GABA in the brain. Benzodiazepines and barbiturates are common classes of these drugs. Benzodiazepines increase the frequency of chloride channel opening, while barbiturates increase the duration. Both classes are used as sedatives, hypnotics and to relieve anxiety. They can cause dependence and tolerance with long term use. Newer non-benzodiazepine drugs like Zolpidem and Zaleplon have fewer side effects.
Opioid receptors are G-protein coupled receptors located in the central nervous system and peripheral tissues that interact with opioid drugs like morphine. There are three main types of opioid receptors: mu, kappa, and delta. Mu receptors have a high affinity for morphine and are responsible for respiratory depression, euphoria, and physical dependence. Kappa receptors are activated by compounds like ethylketocyclazocine and are involved in analgesia and diuresis. Delta receptors have a lower risk of side effects compared to mu receptors and are activated by ligands like levorphanol. Opioid receptors act through G-proteins to inhibit adenyl cyclase, open potassium channels, close calcium channels, and decrease neuronal
Selective serotonin reuptake inhibitors (SSRIs) are a class of antidepressants that work by inhibiting the reuptake of serotonin. SSRIs include fluoxetine, sertraline, paroxetine, fluvoxamine, citalopram, and escitalopram. They are highly selective for serotonin reuptake compared to other neurotransmitters. While SSRIs share the common mechanism of inhibiting serotonin reuptake, they differ in their pharmacokinetic properties such as half-life, metabolic pathways, and drug interaction potential. Adverse effects of SSRIs include nausea, sexual dysfunction, headaches, and weight changes.
This document discusses opioid analgesics, focusing on tramadol and butorphanol. It defines opioids and their receptor types. Tramadol is described as a centrally acting atypical analgesic that is a racemic mixture with both enantiomers contributing to its analgesic effects. Its mechanisms of action and pharmacokinetics are outlined. Butorphanol is introduced as a synthetic agonist-antagonist opioid with greater agonist and antagonist effects than pentazocin. Its proposed mechanisms of analgesia and adverse effects are summarized. Clinical uses of both drugs for various acute and postoperative pain conditions are mentioned.
Haloperidol was the first discovered typical antipsychotic, developed in 1958 and approved by the FDA in 1967 under the brand name Haldol. It works by blocking dopamine D2 receptors in the brain. While effective for treating schizophrenia, bipolar disorder, agitation, and other conditions, it carries risks of extrapyramidal side effects and increased mortality in elderly patients with dementia. Dosing requires consideration of age, weight, renal or hepatic function, and risk/benefit at higher doses above 30 mg per day.
This document discusses anticholinesterase drugs, which inhibit the enzyme acetylcholinesterase and thereby increase cholinergic transmission. It describes the classification, mechanisms of action, pharmacokinetics and uses of specific anticholinesterase drugs including neostigmine, pyridostigmine, edrophonium, and physostigmine. It also covers overdose effects and treatment with atropine and pralidoxime. The document provides detailed information on the pharmacological properties and clinical applications of anticholinesterase drugs.
Certain drugs like reserpine, tetrabenazine, haloperidol, and metoclopramide can deplete dopamine or block dopamine receptors, leading to a parkinsonian syndrome within 3 months. The syndrome is symmetric with mild tremor and usually resolves after withdrawing the causative drug. For treatment, antimuscarinic agents are preferred over levodopa, which may worsen symptoms if the neuroleptic drug is continued. MPTP, through its metabolite MPP+, can selectively damage cells in the substantia nigra by inhibiting mitochondrial complex I, leading to parkinsonism through striatal dopamine depletion. MPTP parkinsonism was discovered in individuals who self-administered M
This document summarizes various central nervous system agents including stimulants, depressants, and anesthetics. CNS stimulants increase mental and physical activity and include substances like caffeine and amphetamines. CNS depressants like barbiturates and benzodiazepines are classified as sedative-hypnotics and can induce sleep. General anesthetics cause unconsciousness during surgery by inhibiting nerve impulses while local anesthetics temporarily disrupt sensory nerve transmission in a specific body area. Nursing responsibilities involve monitoring for side effects and ensuring patient safety.
This document discusses alcohols, including ethanol and methanol. It covers the pharmacology of alcohol including its mechanisms of action in the body, metabolism, effects of acute and chronic consumption, toxicity, and treatment of alcoholism. Specifically, it describes how alcohol is absorbed and distributed in the body, metabolized primarily in the liver, and can cause intoxication, organ damage, and diseases with heavy long-term use such as cirrhosis and fetal alcohol syndrome.
Acp - ce -2016 08 update- smack is wackRobert Cole
This document discusses emerging trends in illicit opioid use, including highly potent fentanyl analogs like carfentanil and acetylfentanil. It notes a rise in overdoses involving these substances, which are often mixed with heroin or cocaine. Two case studies describe patients requiring high doses of naloxone or prolonged infusions to reverse overdoses from acetylfentanil consumed via electronic cigarette or fake pills containing fentanyl. The document provides guidance that standard naloxone doses remain effective for most opioid overdoses but higher doses may be needed for strong suspicions of poly-opioid use involving fentanyl mixes. It emphasizes supporting airway and respiration over waiting for
Consensus guidelines for the management of PONVDr Krunal Bhatt
The document provides guidelines for managing postoperative nausea and vomiting (PONV) based on a review of recent literature. It describes the incidence and causes of PONV, risk factors, and the effectiveness of various pharmacologic and nonpharmacologic therapies both alone and in combination, including 5-HT3 receptor antagonists, neurokinin 1 receptor antagonists, corticosteroids, butyrophenones, antihistamines, scopolamine patches, and acupuncture/acustimulation. Optimal dosing and timing of antiemetic administration is discussed.
This document discusses drugs that affect cholinergic function in the autonomic nervous system. It begins by describing the functions of the autonomic nervous system and the roles of acetylcholine as a neurotransmitter. It then discusses different types of cholinergic receptors and drugs that act on them, including direct muscarinic agonists like pilocarpine, direct nicotinic agonists like nicotine, indirect agonists that inhibit acetylcholinesterase like neostigmine, and antagonists that block receptors like atropine. For each drug class, examples of individual drugs are provided along with their mechanisms of action, uses, side effects, and nursing considerations.
Management of epilepsy and sodium valproateNoor Giasuddin
- Epilepsy is one of the most common neurological conditions characterized by recurrent seizures.
- Sodium valproate is recommended as a first-line treatment for many seizure types and epilepsy syndromes according to guidelines due to its broad spectrum of effectiveness shown in clinical studies.
- Multiple randomized controlled trials have found sodium valproate to be an effective and well-tolerated treatment for both children and adults with newly diagnosed focal epilepsy. However, women must be warned about the risks of fetal exposure during pregnancy.
Ondansetron is a selective 5-HT3 receptor antagonist used to prevent chemotherapy-induced nausea and vomiting. It is administered intravenously or intramuscularly. In clinical trials:
- Ondansetron 0.15 mg/kg administered intravenously was more effective than lower or higher doses in preventing nausea and vomiting from cancer chemotherapy.
- Ondansetron was significantly more effective than placebo in preventing nausea and vomiting induced by cisplatin-based chemotherapy in a study of 28 patients. Fewer patients who received ondansetron experienced vomiting or had early onset of vomiting compared to placebo.
- Pediatric cancer patients younger than 18 generally had higher drug clearance
This document discusses various topics in toxicology and prehospital care. It notes that new synthetic opioids like fentanyl and W-18 are much more potent than morphine and their effects may not be reversed by naloxone. It also discusses the risks of opioid-induced hyperalgesia from long-term opioid use. The document recommends techniques to improve cardiac arrest response and outcomes, such as encouraging bystander CPR and measuring quality of CPR. It proposes adding ketamine to the state formulary for treating excited delirium.
The document discusses opiate intoxication and treatment. It covers the history, physical exam findings, differential diagnosis, management, and complications of opiate overdose. Key signs of overdose include depressed consciousness, respiratory depression, miosis, and fresh needle marks. Treatment involves supportive care, naloxone to reverse effects, activated charcoal if ingestion was recent, and monitoring for complications like withdrawal symptoms, infections from needle use, or acute lung injury.
Aspirin is a nonselective COX inhibitor that is rapidly converted to salicylic acid, which is responsible for its analgesic, antipyretic, and anti-inflammatory actions. At analgesic doses, its main adverse effects include nausea, vomiting, and gastric mucosal damage. At higher anti-inflammatory doses, it can cause salicylism, a syndrome with symptoms like dizziness, tinnitus, and electrolyte imbalance. Acute salicylate poisoning is more common in children and can manifest as vomiting, dehydration, breathing issues, and potentially death from respiratory or cardiovascular failure without treatment.
Naltrexone Implants for Treatment of AddictionSCGH ED CME
The document summarizes information about naltrexone implants used for opioid and methamphetamine dependence treatment. It describes a case of severe opioid withdrawal in a patient who received a naltrexone implant that morning. Key points include:
- Naltrexone is an opioid receptor antagonist that blocks the effects of opioids for up to 24 hours after a single dose. Implants release naltrexone over months.
- Patients undergoing rapid detox with naltrexone implants are at risk of severe withdrawal symptoms like agitation and vomiting within hours of the implant.
- Management of withdrawal includes sedation, anti-emetics, clonidine, and monitoring for complications like respiratory depression.
This document provides training for EMTs and EMRs on administering the opioid antagonist naloxone. It aims to reduce deaths from opioid overdose by instructing first responders. The training covers recognizing and treating opioid overdose, indications and contraindications for naloxone use, possible adverse reactions, and how to prepare and administer naloxone via intramuscular autoinjector or intranasal spray. Responders learn to identify overdose, administer naloxone, manage adverse reactions, and ensure transportation to definitive care.
This document discusses clinical toxicology. Some key points:
- Clinical toxicology is the study of toxic or adverse effects of drugs and chemicals in the body. Clinical toxicologists identify, diagnose, and treat conditions resulting from exposure to harmful agents.
- Several factors influence the toxic effect of a substance, including dose, route of exposure, and duration of exposure.
- Initial evaluation of a patient with a suspected toxic exposure focuses on airway, breathing, circulation, and mental status. Vital signs and developing toxic syndromes provide clues to identify toxic agents. Serial monitoring of vital signs is important to assess treatment effectiveness.
Venous thromboembolisms often result from Virchow's triad of altered blood flow, endothelial injury, and hypercoagulability. Lovenox is commonly used to treat and prevent VTEs as it inhibits coagulation factors Xa and IIa. It has high bioavailability, is metabolized in the liver, and has a half-life of 4.5-7 hours. Bleeding is the most common side effect. A multidisciplinary approach including hematology consultation is recommended for oncology patients at high risk of VTEs, as Lovenox is more effective than warfarin for this population.
This document provides an overview and discussion of recent literature on renal replacement therapy (RRT) in intensive care. It summarizes key findings from two important studies from 2008 and 2009 that compared higher vs lower intensity RRT and found no difference in outcomes. It also discusses ongoing questions around optimal timing of RRT initiation and potential roles of biomarkers like NGAL. Modes of RRT like SLED are presented as alternatives to CRRT. While high volume hemofiltration was theorized to help modulate the immune response in sepsis, studies found no clear benefit and it cannot be recommended as standard practice. Ongoing research on biomarkers and optimal dosing and timing is still needed.
Anticraving drugs its efficacy & evidenceHarsh shaH
This document discusses medications used to treat addiction and prevent relapse. It describes three pathways of alcohol craving and medications like naltrexone, acamprosate, and disulfiram that are used to treat alcohol dependence. Naltrexone and acamprosate have different mechanisms of action and combining them may increase treatment effectiveness. Other medications discussed for various addictions include bupropion for nicotine addiction, varenicline for smoking cessation, rimonabant for reducing cravings, and baclofen and disulfiram for cocaine addiction. The document provides details on the mechanisms, efficacy evidence and side effects of these various pharmacological treatments.
- This randomized controlled trial investigated whether prophylactic melatonin reduces delirium prevalence in critically ill patients compared to placebo. Over 800 patients received either 4mg of melatonin or placebo each night for 14 days or until ICU discharge. The trial found no significant differences between the melatonin and placebo groups in the proportion of delirium-free assessments, delirium prevalence, severity or duration, sleep quality, or other clinical outcomes such as mortality and length of stay. Prophylactic melatonin did not demonstrate a benefit for preventing delirium in critically ill patients in the ICU according to this study.
Pharmacology for pediatric anaesthesia [autosaved]DeepakGupta825
This document discusses pharmacology considerations for pediatric anesthesia. It covers several key topics:
1) Developmental pharmacology - Drugs affect infants and children differently due to factors like body composition, organ maturity, and blood-brain barrier development. This impacts drug dosing, distribution, and elimination.
2) Inhalational agents - Sevoflurane and isoflurane are commonly used and have advantages like rapid induction/recovery, but sevoflurane can cause renal damage with prolonged use.
3) Intravenous agents - Propofol, ketamine, midazolam, fentanyl and other opioids are discussed. Propofol requires higher doses in children and should not be used for prolonged sedation in those under 12
Retacrit is a biosimilar of Eprex/Erypo that contains epoetin zeta and is used to treat anemia. It has the same amino acid structure and glycosylation pattern as epoetin alfa. Studies found Retacrit was as effective as correcting and maintaining red blood cell counts in patients with kidney disease and chemotherapy-induced anemia as Eprex/Erypo. Common side effects include increased blood pressure and rare side effects include cerebral hemorrhage. Retacrit was approved for use in Europe in 2007 and its biosimilar application is under review by the FDA in the U.S.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
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• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
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2. Naltrexone
• Naltrexone belongs to a class of drugs known as opiate antagonists. It
works in the brain to prevent opiate effects (e.g., feelings of well-being,
pain relief). It also decreases the desire to take opiates.
• This medication is also used to treat alcohol abuse. It can help people
drink less alcohol or stop drinking altogether. It also decreases the desire
to drink alcohol when used with a treatment program that includes
counselling, support, and lifestyle changes.
www.onestepclinic.ie info@onestepclinic.ie
3. • Naltrexone was synthesised in the 1960s and first used clinically in the early 1970s.
• It is an opiate antagonist that inhibits the µ-opioid receptor in the brain. It blocks the
effects of all opiates including heroin, methadone, morphine, codeine and oxycodone.
• It reduces the ‘pleasure’ or ‘highs’ associated with alcohol consumption.
• It can help patients to remain abstinent in opiate and alcohol dependence.
• Naltrexone itself is not addictive. Although it binds to the opiate receptor, it blocks
rather than stimulates. Even after several months of use, there are no withdrawal
symptoms if a patient stops suddenly.
www.onestepclinic.ie info@onestepclinic.ie
What is Naltrexone?
4. •Naltrexone enters the brain and nervous system, then attaches itself to
small areas called receptor sites. It binds very strongly and is difficult to
displace, blocking receptors completely to opiates.
•These receptors are part of the complex reward mechanisms that motivate
us and lead us to repetitive behaviour. If these receptors are blocked,
craving and dependence-related conduct reduces and new, healthier
behaviours are allowed to re-emerge with time.
www.onestepclinic.ie info@onestepclinic.ie
How does Naltrexone work ?
6. Several research & clinical trials indicates the effectiveness of treating opiate addiction:
Risk factors for craving and relapse in heroin users treated with oral or implant naltrexone (2010)
- Number of Patients: 34-35 Heroin dependent patients - Duration of study: 6 months
- Conclusion: Implant naltrexone was better associated with reduced heroin craving and relapse than oral naltrexone
Improving Clinical Outcomes in Treating Heroin Dependence : Randomised, Controlled Trial of Oral or Implant Naltrexone (2009)
- Number of patients: 129
- Naltrexone blood levels in implant recipients were maintained above 1 and 2 mg/mL for 101 and 56 days, respectively, among men and 124 and 43 days
among women
- The naltrexone implant effectively reduced relapse to regular heroin use compared with oral naltrexone and was not associated with major adverse events.
Naltrexone Implant for the Treatment of Polydrug Dependence : A Randomised Controlled Trial (2012)
- Number of patients: 100 heroin- and amphetamine-dependent outpatients
- Conclusion: Naltrexone implants resulted in higher retention in the study, decreased heroin and amphetamine use, and improved clinical condition for patients
• “Our experience with Naltrexone Implants in opiate addicts is that over 50% of these patients report virtually no cravings.” Dr. Peter Coleman; National
Medical Director; The Coleman Institute, USA
www.onestepclinic.ie info@onestepclinic.ie
Naltrexone implants for opiate addiction?
7. Several research & clinical trials indicates the effectiveness of treating alcohol addiction:
• Naltrexone depot formulations for opioid and alcohol dependence: a systematic review (2011)
- The available naltrexone depot formulations have the potential to significantly improve medication compliance in
opioid and alcohol dependence.
• Naltrexone depot for treatment of alcohol dependence: a multi-centre, randomised, placebo- controlled clinical trial
(2004)
- Number of patients: 315
- Conclusion: Naltrexone depot subjects also had significantly fewer drinking days during treatment and a
significantly greater abstinence rate than the placebo group
• “Our alcoholic patients treated with Naltrexone implants usually report much reduced cravings. A recent newsletter
article of mine reviewed studies that showed that Naltrexone can greatly reduce the memories of getting pleasure
from using drugs and alcohol. (Link)” Dr. Peter Coleman; National Medical Director; The Coleman Institute, USA
www.onestepclinic.ie info@onestepclinic.ie
Naltrexone implants for alcohol addiction?
8. • Opiates
• Patients must have been detoxed from opiates prior to insertion of a Naltrexone implant and
opiate substances must have been entirely excreted from the body
• This usually takes between 5 and 10 days after it was last used, depending on the substance.
• Naltrexone can otherwise induce a precipitated opiate withdrawal that may require hospital
treatment.
• Alcohol
• For patients requiring a Naltrexone implant, a detox is not necessary. It is however important to
prepare a patient properly for a Naltrexone implant, all patients attending the One Step Clinic
will undergo extensive assessment in advance of the insertion of a Naltrexone implant.
www.onestepclinic.ie info@onestepclinic.ie
Preparing a client for a Naltrexone implant
9. • The administration of a Naltrexone implant requires a minor
surgical procedure.
• A small incision is made in the lower abdomen in front of the
hipbone, the implant is inserted, and the wound closed with two -
three stitches.
• The procedure is performed under local anaesthetic and takes about
20 minutes. The patient is ready to leave within 30 minutes of the
procedure.
www.onestepclinic.ie info@onestepclinic.ie
How is it administered?
10. • Implant appear to block receptors for 10-12 weeks. A number of pharmacokinetic studies have been conducted on
implants. Naltrexone blood levels tend to be highly variable between and within patients, accounting for variations
in recorded blood levels in different studies. Blood levels have been shown to need to remain above 2mg/ml for
effective blocking of opiate receptors.
www.onestepclinic.ie info@onestepclinic.ie
Duration
11. • Implants/depot naltrexone helps any motivated person, rather than just highly motivated persons
• Naltrexone acts as a platform for recovery, reduces reinforcement, cravings, relapse & increases self control
• Long-acting formulations overcome issue of poor adherence with oral naltrexone
• Research evidence that beneficial for opiates, alcohol & amphetamines
• Research evidence is accumulating rapidly from several independent sources/countries
www.onestepclinic.ie info@onestepclinic.ie
Conclusions