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Prescribed Medicines (prescribed + medicine)
Selected AbstractsCatatonia in childhood and adolescencePSYCHIATRY AND CLINICAL NEUROSCIENCES, Issue 2 2003Ken Takaoka Abstract Child and adolescent catatonia has been poorly investigated. A literature review was undertaken to clarify phenomenology, diagnosis, etiology, and treatment as well as ethical problems of catatonia in childhood and adolescence. Although there are no accepted standardized criteria for catatonia in childhood and adolescence, catatonic features described by child psychiatrists are similar to Diagnostic and Statistical Manual of Mental Disorders (4th edn; DSM-IV) criteria for catatonia. With respect to etiology, the motor and behavioral symptoms that are part of catatonia bear some similarities with those seen in autism. Several case reports suggest an association between catatonia and general medical conditions. Certain drugs abused by youngsters as well as prescribed medicine can induce catatonia. Regarding catatonic cases originally diagnosed as schizophrenia, it is unclear whether all of these cases should be identified as schizophrenia or whether some of them are pervasive developmental disorders that develop psychic features in adolescence. Environmental changes preceding the onset of catatonia in patients with mood disorder play a possibly important role. Examples that suggest stress-induced catatonia, although rare, also exist. A few patients exhibit features of malignant catatonia, some without taking neuroleptics and others having taken them. Benzodiazepines and electroconvulsive therapy are considered to be effective treatments for catatonic youngsters. [source] Non-prescription medicine use by outpatients of a hospital in north-central Trinidad living with hypertension, and the potential clinical risksINTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 5 2008Miss Rian Extavour Assistant Lecturer, principal investigator Objective To describe the reported use of non-prescription medicines (NPMs) and the reported frequency of use by outpatients living with hypertension; to identify potential drug-drug and drug-disease interactions between reported NPMs and either antihypertensives prescribed or hypertension. Setting Adult outpatient clinics of the Eric Williams Medical Sciences Complex Adult Hospital in Trinidad. Method Outpatients were interviewed about their use of NPMs using a structured instrument. Chi-squared test or Fisher's exact test was used to test for associations between NPM use and selected variables: age group, gender, education level, number of prescribed medicines, use of prescribed medicines and the presence of comorbidities. Combinations of NPMs and antihypertensive drugs or hypertension itself that may lead to undesirable interactions were identified. Key findings One hundred and fifty-five clients were interviewed (mean age 61 years; 46% men; 56% of East Indian descent). Of these, 82% were living with a cardiac condition and 60% with diabetes mellitus. In addition, 92% reported using NPMs to treat minor illnesses. Analgesic use was reported by 81%. Some 66% reported using paracetamol, 54% reported antitussives, 48% antacids, 47% antihistamines and 39% said they used sympathomimetic drugs. The majority (98%) of NPMs were used only when needed. Sixty per cent had at least one combination a with risk of interaction with NPMs and hypertension or antihypertensive medicines: 16% had risk of interactions between enalapril (or captopril) and antacids, 13% between angiotensin-converting enzyme (ACE) inhibitors and non-steroidal anti-inflammatory drugs (NSAIDs), 12% between beta-blockers and NSAIDs and 12% between thiazide diuretics and NSAIDs. Thirty-nine per cent had a drug-disease interaction risk due to sympathomimetic drugs and 26% had one due to NSAID use. Conclusion Based on self-reports, outpatients living with hypertension in north-central Trinidad use NPMs when needed to treat minor illnesses, mainly paracetamol for pain. Non-prescription-antihypertensive interactions may arise due to ACE inhibitor/antacid combinations and NPM-hypertension interactions may result from use of sympathomimetics. Interactions may also arise as a result of the use of NPMs containing NSAIDs and sodium. [source] An evaluation of a Diabetes Specialist Nurse prescriber on the system of delivering medicines to patients with diabetesJOURNAL OF CLINICAL NURSING, Issue 12 2008Nicola Carey BSc Aim., To evaluate the impact of a Diabetes Specialist Nurse prescriber on insulin and oral hypoglycaemic agent medication errors and length of stay. Background., The National Health Service has committed to a 40% reduction in the number of drug errors in the use of prescribed medicines. Drug errors in diabetes care are a common cause of significant morbidity and complications. Nurse prescribing creates an opportunity for nurses to improve care for these patients. Design., A quasi-experiment using six wards in a single hospital trust. Methods., Inpatient care of a convenience sample of patients with diabetes was evaluated before (n = 27) and after (n = 29) the intervention of a Diabetes Specialist Nurse prescriber. Prospective data were collected to measure insulin and oral hypoglycaemic medication errors and length of stay. Results., There was a significant reduction in the total number of errors between the pre-intervention and intervention group (mean reduction 21 errors) (p = 0·016). The median length of stay was reduced by three days. The total number of errors and length of stay were affected by admission category (p = 0·0004). Conclusions., A medicines management intervention, provided by a Diabetes Specialist Nurse prescriber, had a positive effect on the system of delivering medicines to patients with diabetes and significantly reduced the number of errors. This reduction had some effect on length of stay. The cost saving was sufficient to finance a Diabetes Specialist Nurse prescriber post. Relevance to clinical practice., (i) Errors frequently occur in the prescription and administration of medicines to patients with diabetes. (ii) The education of healthcare professionals is a factor contributing to these errors. (iii) Nurse prescribing provides a new system by which to educate patients and staff about their medicines. (iv) A Diabetes Specialist Nurse prescriber can reduce insulin and OHA MEs. This reduction had some effect on LOS. [source] Sample trial to assess the level of understanding of the mechanisms of drug actionNURSING & HEALTH SCIENCES, Issue 3 2004Tadahiro Shikimi phd Abstract The object of the present paper was to investigate whether or not the level of understanding of the mechanisms of drug action in nursing students is reflected in their descriptions of the factors in ineffective cases or adverse effects of prescribed medicines. The number of subcategories identified in the descriptions was closely connected with the test scores from the multiple-choice and short-answer written examination on ,Pharmacology and Pharmaceutics', and those from questions about the mechanisms of drug action. These results suggest that the number is useful for an estimated assessment of the level of understanding of the mechanisms of drug action. [source] Latest news and product developmentsPRESCRIBER, Issue 6 2008Article first published online: 24 APR 200 Government responds to NICE report The Government has published its response to the Health Select Committee's report into NICE, broadly arguing that the Committee's recommendations are either already being dealt with or are not appropriate. The Committee recommended appraisals for all new drugs, shorter, rapid appraisals to coincide with their launch, and improved mechanisms for setting drug prices. The Government says its negotiations on the PPRS preclude a detailed response but suggests a rapid system may not be transparent or legally robust. It is exploring how high-cost drugs can be brought within the payment-by-results tariff. While defending NICE's reliance on QALYs, the Government accepts the need to explore how wider economic factors can be considered. As for the threshold cost per QALY by which NICE defines cost effectiveness, it says this is being validated scientifically and NICE will continue to determine the threshold. More topically, the Committee criticised the quality of clinical trial data available to NICE. The Government sees no need to compel pharmaceutical companies to disclose information and says NICE is already becoming more involved with research programmes. All clinical trials must be registered (confidentially) with the EU and the Government believes mandatory registration in the UK would be ineffective and illegal. Prescription charge up again from April The Government has raised the prescription charge by 25p to £7.10 per item with effect from 1 April. Prescription prepayment certificates will cost £27.85 for three months and £102.50 for 12 months. The increase, below the annual rate of inflation for the 10th successive year, will be levied on the 12 per cent of prescriptions that are liable for the charge: 5 per cent via prepayment certificates and 7 per cent from other prescriptions. The charge will generate £435 million in England in 2008/09; this excludes money from prescriptions written by dispensing doctors, which is retained by the PCT. Following criticism of the charge by the Health Select Committee, the Government says it has reviewed the charge and is now consulting on ,cost-neutral' options. MHRA safety update The MHRA warns of possible dose errors associated with Boots Medisure Domiciliary Dosage System in its latest issue of Drug Safety Update (2008;1:issue 8). One case has been reported in which incomplete sealing allowed tablets to mix between compartments. No other cases are known and the MHRA says no harm was reported but the risk is serious. The system should be carefully sealed and inspected visually and physically. The MHRA reaffirms its plans to reclassify all pseudoephedrine and ephedrine products to prescription-only status in 2009 if the new restrictions on sales do not reduce misuse. Other topics in this month's Update include revised indications for oral ketoconazole (Nizoral), restricting its use to selected conditions unresponsive to topical therapy; reformulation of the injectable antibiotic Tazocin (piperacillin plus tazobactum); the risk of peripheral neuropathy associated with pegylated interferon and telbivudine (Sebivo) in the treatment of hepatitis B; and serious adverse events associated with modafinil (Provigil). First oral anticoagulant since warfarin In January this year the EMEA issued a positive opinion to recommend marketing authorisation of the oral, fixed-dose, direct thrombin inhibitor dabigatran etexilate (Pradaxa) for the primary prevention of venous thromboembolism (VTE) in adult patients that have undergone elective knee or hip replacement surgery. Marketing authorisation for the EU (including the UK) is expected from the European Commission in the next few weeks, making dabigatran the first oral anticoagulant since warfarin was introduced in 1954. Dabigatran etexilate has been shown to be as safe and effective as enoxaparin (Clexane) with a similar adverse event profile in the noninferiority phase III RENOVATE (Lancet 2007;370: 949-56) and RE-MODEL (J Throm Haemost 2007;5:217885) trials, which investigated the efficacy and safety of dabigatran compared to enoxaparin in reducing the risk of VTE after total hip and knee surgery respectively. Dabigatran has the practical advantage over low-molecular-weight heparin of oral postoperative administration and no risk of heparin-induced thrombocytopenia and, unlike warfarin, does not require monitoring or dose titration. Risk scale predicts anticholinergic effects US investigators have developed a scale for predicting the risk of anticholinergic side-effects from older patients' medicines (Arch Intern Med 2008;168: 508-13). The scale assigns a score from 1 (low) to 3 (high) for the risk of anticholinergic effects such as dry mouth, constipation and dizziness associated with commonly prescribed medicines. Checking the scale retrospectively in older patients in residential care, a higher score was associated with a 30 per cent increased risk of side-effects after adjustment for age and number of medicines. When this was repeated prospectively in a primary-care cohort, the increased risk was 90 per cent. HRT cancer risk persists The latest analysis of the Women's Health Initiative (WHI) trial of HRT shows that the small increase in the risk of cancer persists for up to three years after stopping treatment (J Am Med Assoc 2008;299:1036-45). WHI was stopped after 5.6 years' follow-up when it became clear the risks of HRT outweighed its benefits. This follow-up after a further three years (mean 2.4) involved 15 730 women. The annual risk of cardiovascular events was similar for HRT (1.97 per cent) and placebo (1.91 per cent). Cancers were more common among women who had taken HRT (1.56 vs 1.26 per cent), in particular breast cancer (0.42 vs 0.33 per cent). All-cause mortality was higher, but not statistically significantly so, with HRT (1.20 vs 1.06 per cent). Tight glycaemic control may increase falls Maintaining HbA1C at or below 6 per cent with insulin is associated with an increased risk of falls, a US study suggests (Diabetes Care 2008;31:391-6). The Health, Aging and Composition study involved 446 older people with type 2 diabetes (mean age 74) followed up for approximately five years. The incidence of falls ranged from 22 to 30 per cent annually. Comparing subgroups with HbA1C of ,6 per cent and >8 per cent, an increased risk of falls was associated with insulin use (odds ratio 4.4) but not oral hypoglycaemic drugs. Copyright © 2008 Wiley Interface Ltd [source] | ||||||||||