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Pharmacological Approaches To Behavioral Symptoms In Alzheimer’s Disease
Published in Zaven S. Khachaturian, Teresa S. Radebaugh, Alzheimer’s Disease, 2019
Cyclic antidepressants have been a mainstay in the treatment of depression. They have a wide range of potential side effects in the elderly. Antihistamine actions may cause sedation, although this sometimes is beneficial for patients with depression and insomnia. Antiadrenergic effects may lead to orthostasis; anticholinergic actions may result in confusion, urinary retention, constipation, or tachycardia. Tricyclic agents slow cardiac conduction and should be avoided if the EKG shows bundle branch block because of the risk of causing high-grade heart block. For these reasons, when treating elderly patients, clinicians prefer to prescribe nortriptyline or desipramine, which are secondary amines with less-pronounced side effects than tertiary amines such as imipramine or amitriptyline.
Post-traumatic stress disorder
Published in Laeth Sari Nasir, Arwa K Abdul-Haq, Caring for Arab Patients, 2018
Eyad El-Sarraj, Taysir Diab, Abdel Aziz Thabet
Anti-depressant drugs — selective serotonin re-uptake inhibitors (SSRIs) such as sertraline (Zoloft) or paroxetine (Paxil) — are considered first-line treatments for PTSD owing to their efficacy, tolerability and safety. Other medications such as imipramine (Tofranil) and amitriptyline (Elatrol), two tricyclic drugs, may also be used in the treatment of PTSD. Dosages of imipramine and amitriptyline should be the same as those used to treat depressive disorders, and an adequate trial should last at least six to eight weeks. Patients who respond well should probably continue the pharmacotherapy for at least one year before an attempt is made to withdraw the medication. Some studies indicate that pharmacotherapy is more effective in treating the depression, anxiety and hyperarousal than in treating the avoidance, denial and emotional numbing.22 Other drugs that may be useful in the treatment of PTSD include buspirone (BuSpar) and trazodone (Desyrel), which are predominantly serotonergic in action, monoamine oxidase inhibitors such as phenelzine (Nardil), and some anticonvulsants such as carbamazipine (Tegretol) or valproate (Depakene). Use of clonidine (Catapres) and propranolol (Inderal), which are anti-adrenergic agents, might theoretically be effective given the noradrenergic hyperactivity in the disorder. There is little evidence that antipsychotic drugs are effective in this disorder. Therefore the use of medications such as haloperidol (Haldol) should be reserved for the short-term control of severe aggression and agitation.
100 MCQs from Dr. Guy Molyneaux and Colleagues
Published in David Browne, Selena Morgan Pillay, Guy Molyneaux, Brenda Wright, Bangaru Raju, Ijaz Hussein, Mohamed Ali Ahmed, Michael Reilly, MCQs for the New MRCPsych Paper A, 2017
Dr Pauline Devitt, Dr Angela Noonan, Dr Klaus Oliver Schubert, Prof Finian O’Brien
Monoamine oxidase inhibitors are antidepressants most strongly associated with anti-adrenergic side effects such as dry mouth, bradycardia, dizziness and drowsiness. The tricyclic antidepressant class of medications are the next most likely. Tetracyclic antidepressants (e.g., mianserin) may cause some anti-adrenergic effects. SSRIs and St. John’s wort are not considered to be associated with anti-adrenergic side effects. (1, p 162, 8)
Association between hypertensive medication during pregnancy and risk of several maternal and neonatal outcomes in women with chronic hypertension: a population-based study
Published in Expert Review of Clinical Pharmacology, 2022
Anna Cantarutti, Gloria Porcu, Anna Locatelli, Giovanni Corrao
Most of the pregnancies (72%) were exposed to recommended drugs compared to the 14% exposed to not recommended, and 14% of pregnancies were exposed to both recommended and not recommended drugs during the first 20 weeks of gestation. The most common antihypertensive drugs used were calcium channel blockers, followed by beta-adrenergic blocking agents, ACE inhibitors, and ARBs (Supplementary material Table S7, Table S8, and Table S9). Table 3 shows the adjusted relative risk of maternal and neonatal outcomes according to the recommended class of antihypertensive medication (i.e. antiadrenergic agents, beta-blocking agents, and calcium channel blockers) used during the first 20 weeks of gestation. It seems that the beta-blocking agents have a less negative impact on both maternal and neonatal outcomes (Table 3). Differently, among antiadrenergic agents and calcium channel blockers classes were confirmed the main results (Table 3).
Dopamine β hydroxylase as a potential drug target to combat hypertension
Published in Expert Opinion on Investigational Drugs, 2020
Sanjay Kumar Dey, Manisha Saini, Pankaj Prabhakar, Suman Kundu
From the 1990s, drugs targeting the RAAS, gradually replaced antiadrenergic drugs as the primary line of treatment for hypertension because of their high efficacies and better tolerance in diverse patient populations [61]. Later on, anti-renin drugs, calcium channel blockers, and diuretics became the preferred antihypertensive therapy in use. Albeit, target BP could not be achieved in at least 10% hypertensive patients and they developed drug-resistant hypertension. Drug-resistant hypertensive patients were treated either with the surgically implanted baro-stimulator device or with catheter-based renal denervation which off course failed too initially due to low success rate in three clinical trials of renal denervation including the Symplicity HTN-3 trial [10,11,56,57,62–65]. However, three recent sham-controlled trials, namely, SPYRAL HTN-OFF MED and RADIANCE SOLO (in which patients were not on concurrent medication), and SPYRAL HTN-ON MED (in which 29% of individuals were using one medicine, 18% were taking two drugs, and 53% were using three types of antihypertensive medications), demonstrated a significant baseline-adjusted fall in ambulatory BP suggesting increase in the success rate of renal denervation [12,13]. These three trials also indicated that transcatheter renal denervation for treating hypertension is an emerging clinical procedure.
Focussing on the fundaments – assessing and treating Clozapine Induced Gastrointestinal Hypomotility
Published in International Journal of Psychiatry in Clinical Practice, 2020
Graham Blackman, Adisha Kapila, Charlotte Maria Grosskopf, Luiz Dratcu
Clozapine has been demonstrated to be the most effective antipsychotic in treatment-resistant schizophrenia (Meltzer 1992); however, it is also recognised as having several serious and potentially fatal side-effects. These include haematological and cardiac complications, such as agranulocytosis (Alvir et al. 1993) and myocarditis (Haas et al. 2007) necessitating close monitoring with blood tests and electrocardiograms. Relative to these, Clozapine Induced Gastrointestinal Hypomotility (CIGH) has gained little attention despite affecting an estimated 80% of patients (Citrome et al. 2016; Every-Palmer et al. 2016) and being identified as the commonest cause of clozapine-related death (Ellis et al. 2006). Early clinical features of CIGH include constipation, vomiting, nausea and paradoxical diarrhoea (Flanagan and Ball 2011), with progression to paralytic ileus, obstruction and, in severe cases, bowel perforation (Levin et al. 2002; Hibbard et al. 2009). The cause of CIGH remains to be fully elicited, yet anticholinergic, antiadrenergic and antiserotonergic effects of clozapine are thought to play an important role, with risk factors including older age, male gender and higher daily dose of clozapine (West et al. 2017). Inpatients are at particularly high risk due to their limited mobility and severity of mental illness.