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Gestational hypertension and pre-eclampsia
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Hydralazine is given in sequential intravenous boluses of 5, 5, and 10 mg at intervals of 15 to 20 minutes until a satisfactory response is achieved. Hydralazine causes a direct relaxation of arterial smooth muscle, resulting in stimulation of the sympathetic nervous system and causing an increased reflex heart rate and contractility. Maternal side effects include flushing, headache, palpitations, nausea, and vomiting. Uteroplacental perfusion may decrease following parenteral administration leading to fetal heart rate decelerations. The onset of drug effect may be 20 to 30 minutes, reaching a peak at 60 minutes from administration. Therefore, the drug may accumulate after continuous intravenous infusion, resulting in overshoot hypotension.
Liver Diseases
Published in George Feuer, Felix A. de la Iglesia, Molecular Biochemistry of Human Disease, 2020
George Feuer, Felix A. de la Iglesia
The ability of the liver to metabolize foreign compounds is used to measure hepatic function in man in a noninvasive fashion.44,63,64,384,471 In normal circumstances, the metabolism and disposition of drugs are adequate, and thus therapeutic doses have no harmful effects on hepatic function. The efficiency and duration of the drug effect depend on the rate at which drugs are activated or inactivated. Under certain conditions, however, adverse reactions occur related either to hepatic dysfunction or to the toxic nature of the foreign compound.517 These reactions result in hepatic disorders which may be reversible, like drug-induced jaundice, or irreversible causing long-term damage, like cirrhosis.
Psychodynamics
Published in Albert A. Kurland, S. Joseph Mulé, Psychiatric Aspects of Opiate Dependence, 2019
Albert A. Kurland, S. Joseph Mulé
The nosological preoccupation with the addictive disorders and the differences expressed by the pioneering analysts are reflected in the attempt by Fenichel72 to classify drug addictions as “impulse neuroses,” as distinguished from “compulsion neuroses” on the basis of their seemingly ego-syntonic character. What distinguishes the drug addict from those who confine their temporary drug-taking to these states is that the drug effect is used to satisfy archaic oral (sexual) longing, the need for security, and the need to maintain self-esteem. In essence, the premorbid personality is decisive. The need to fulfill a deep and primitive desire is more imperative than genital sexuality, which is given up. Regression reactivates various fixation points until, in the end, the libido becomes an “amorphous erotic tension energy” without organized differentiation. Addicts, therefore, are people who are fixated to a passive-narcissistic aim and who have never set much store on object relations. Addicts are intolerant of tension and cannot stand pain or frustration. The drug reproduces the earliest narcissistic state but, because self-esteem is so remarkably elevated (with erotic and narcissistic satisfactions coinciding with Feniche’s views on the ultimate stage of addiction) that when the drug begins to fail there occurs only the alleviation of hunger and satiation in a primary narcissistic state.
Investigating differences of medications in hospitalized schizophrenia and schizoaffective disorder patients: impact of substance use
Published in Journal of Substance Use, 2023
Onur Durmaz, Aslı Büyükçapar, Berçem Arinci, Can Inceman, Neslihan Akkişi Kumsar
The number of APs in the patients’ last medications showed that a prominent proportion of patients enrolled in the study were being treated with a combination of antipsychotic medications, which implies that they likely had a treatment-resistant clinical condition. In patients who had no substance use history, the prevalence of LAI APs used in their medical recordings was relatively higher than among SUs. These data might support the notion that patients with no substance use profile could be more adherent to follow-up, thus clinicians could have an opportunity to arrange medications in accordance with clinical outcomes. This finding may also be related with the assumption that patients with substance use might be reluctant to accept parenteral medications and prefer to use oral medications; likewise, they may respond to treatment more quickly, and the drug effect may wear off sooner, compared to chronic schizophrenia patients without substance use. On the other hand, higher numbers of LAI AP medication interventions could be related with clinical symptoms severity and inadequate response to treatment for those without substance use.
Clinical pearls in hospital nephrology
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Abdurrahman Hamadah, Tibor Fulop, Kamel Gharaibeh
The diuretic response in this patient is clearly suboptimal and further adjustment of dose is needed. Loop diuretics exhibit threshold pharmacokinetics [7]. This means that the full drug effect will only be seen when the concentration of the drug at the site of action reaches a certain threshold. If the dose of the loop diuretic is less than the needed threshold, then the effect of the drug will be small and clinically insignificant. Once the threshold is reached, diuretic full response will be in effect. One approach would be to double the current dose and reassess response. In the case at hand, increasing the dose to 80 mg would be the best next step. A common mistake is to increase frequency of the dosing despite not reaching the threshold which often delays clinical improvement. The threshold for the same individual may be different for different levels of kidney function [7]. Adding a thiazide diuretic or restriction of salt intake is important, but effective early management of loop diuretics in this setting takes precedence.
Potential Psychotropic Drug Interactions among Drug-dependent People
Published in Journal of Psychoactive Drugs, 2021
Diego Zapelini do Nascimento, Gabriela Moreno Marques, Fabiana Schuelter-Trevisol
As for the mechanism of action, they were classified into pharmacokinetic and pharmacodynamic interactions. When alterations occur because of the interference with drug absorption, distribution, metabolism, and/or excretion, it is said to be a pharmacokinetic interaction. When changes occur in the drug effect because of increased activity (synergism) or decreased activity and/or activity cancellation (antagonism), it is said to be a pharmacodynamic interaction (Cedraz and Junior 2014). If there was more than one drug interaction with different mechanisms of action in the same medical record of the participant, this, as a whole, was determined by the mechanism of action that was most frequent among all interactions found in the most recent prescribed drugs. If there were only two interactions, it was considered the interaction action mechanism that had the highest clinical risk for the patient. Thus, clinical risks and mechanisms of action were analyzed for each psychotropic drug by reviewing the patient’s medical record to identify drug interactions. All study procedures were approved by the Research Ethics Committee of the University of Southern Santa Catarina on October 24, 2018 (Opinion No. 2 979 024).