326
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Thien T, Huysmans FT. [Acute kidney insufficiency and hypertensive encephalopathy following administration of Baralgin]. NEDERLANDS TIJDSCHRIFT VOOR GENEESKUNDE 1988; 132:86-7. [PMID: 3340225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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327
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Rovner BW, David A, Lucas-Blaustein MJ, Conklin B, Filipp L, Tune L. Self-care capacity and anticholinergic drug levels in nursing home patients. Am J Psychiatry 1988; 145:107-9. [PMID: 3337276 DOI: 10.1176/ajp.145.1.107] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The serum anticholinergic levels of 22 demented nursing home patients were related to their cognition and capacity for self-care. The patients with high anticholinergic levels had greater impairment in self-care capacity than patients with low levels.
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328
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Betermiez P, Pedinielli JL, Blondiaux B, Delahousse J, Mizon JP. [Anticholinergic agents. Drug addiction and dangerous withdrawal]. Therapie 1987; 42:559-60. [PMID: 3441899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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329
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Abstract
Despite the widespread use of meperidine as an analgesic, its potential for producing delirium has been overlooked. Six cases demonstrating meperidine-induced behavioral toxicity are reported. Toxicity was more likely when meperidine was combined with cimetidine or drugs having anticholinergic activity. Discontinuation of meperidine and substitution of morphine for analgesia were usually successful in treating the delirium. Physostigmine reversed the delirium in one patient. The authors suggest that the delirium results from the excessive anticholinergic activity of meperidine or its only active metabolite, normeperidine.
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330
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Korsgaard S, Gerlach J, Noring U, Povlsen UJ. [Paradoxal neurological side-effects of neuroleptics. Classification and occurrence]. Ugeskr Laeger 1987; 149:1685-8. [PMID: 2885955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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331
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332
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Lucet V, Do Ngoc D, Cauchemez B, Bizec JL, Guidet F, Cheron G, Toumieux MC. [Treatment of reflex vagal hypertonia in infants. Role of diphemanil (apropos of 50 cases)]. ARCHIVES FRANCAISES DE PEDIATRIE 1987; 44:359-63. [PMID: 3619567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
For a period of 20 months, 50 consecutive infants (mean age: 11 months) were given Diphemanil (atropine like synthetic drug) for reflex symptomatic bradycardia of probable vagal origin. Treatment's results were evaluated with the study of oculo-cardiac reflex (OCR) and Holter monitoring performed before and 3 months after the beginning of Diphemanil. If tolerance was generally good, it was not possible to demonstrate the clinical efficacy of the treatment on the whole group. However, assertive success was seen on individual cases. Holter and OCR data improved statistically. The other therapeutical means aiming at warning possible complications of the hypertonic vagal reflex were reviewed: inserting a cardiac pace-maker does not always prevent sudden death; a nodal sinus surgical selective denervation might be justified in certain exceptional cases, because of the severity of the spontaneous evolution or of the resistance to medical treatment.
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333
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Shashkov VS, Sabaev VV, Il'ina SL, Galle RR. [Problems in the drug prevention of the seasickness syndrome (motion sickness)]. FARMAKOLOGIIA I TOKSIKOLOGIIA 1987; 50:5-20. [PMID: 2886362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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334
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Hannington-Kiff JG. Tetrahydroaminoacridine and the central anticholinergic syndrome. Lancet 1987; 1:862. [PMID: 2882263 DOI: 10.1016/s0140-6736(87)91639-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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335
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336
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Prosser ES, Csernansky JG, Kaplan J, Thiemann S, Becker TJ, Hollister LE. Depression, parkinsonian symptoms, and negative symptoms in schizophrenics treated with neuroleptics. J Nerv Ment Dis 1987; 175:100-5. [PMID: 2879880 DOI: 10.1097/00005053-198702000-00006] [Citation(s) in RCA: 95] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
To determine whether depression and neuroleptic-induced parkinsonism confound the clinical assessment of negative symptoms in schizophrenics, we evaluated 45 outpatient schizophrenics for depression, parkinsonian symptoms, and negative symptoms using standard clinical rating scales. Neuroleptic and anticholinergic dose and plasma activity were also determined. Associations between negative symptoms and these clinical and drug variables were examined using a multivariate statistical model. Negative symptoms were significantly correlated with several parkinsonian symptoms, some vegetative features of depression, and with anticholinergic dose. No significant correlations were found between negative symptoms and cognitive features of depression, or neuroleptic and anticholinergic plasma activity. These findings suggest that assessment criteria for negative symptoms, depression, and drug-induced parkinsonism overlap in treated schizophrenics. Strategies for differentiating these clinical syndromes are discussed.
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337
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Abstract
The administration of homatropine eye-drops precipitated several episodes of delirium in a 69-year-old woman. The unusual susceptibility of this patient to the central anticholinergic effect of homatropine is perhaps related to a preexisting mild cognitive defect possibly related to a cholinergic neurotransmitter deficit.
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338
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Theodore AC, Beer DJ. Pharmacotherapy of chronic obstructive pulmonary disease. Clin Chest Med 1986; 7:657-71. [PMID: 2878760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The pharmacologic treatment of the reversible elements of chronic obstructive pulmonary disease is discussed in this article. Discussion focuses on three classes of bronchodilator drugs--the sympathomimetic agents, the methylxanthines, and the anticholinergic agents. A section on corticosteroid use in patients with chronic airflow limitation is included. An integrated approach to pharmacotherapy is suggested that allows a treatment program to be designed to meet the needs of the individual patient.
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339
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Abstract
Airway mucociliary dysfunction leading to a depression of mucus transport has been demonstrated in patients with acute and chronic bronchitis, cystic fibrosis, and bronchial asthma; use of bronchodilators that might further impair mucociliary function, therefore, generally has been discouraged. Atropine and ipratropium bromide are cholinergic antagonists that are effective bronchodilators in various clinical settings. Atropine has been shown to block the production of respiratory secretions in response to cholinergic stimulation, but to have no effect on baseline secretions. Atropine has also been clearly demonstrated to depress ciliary beat frequency and to slow airway mucociliary clearance, whereas the short-term and long-term administration of ipratropium bromide at higher than clinically recommended doses seems to lack these effects. No satisfactory explanation has thus far been offered for this difference between the two cholinergic antagonists. Nevertheless, with respect to airway mucociliary function, ipratropium bromide appears to be preferable to atropine in the treatment of obstructive airways disease.
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340
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Abstract
Older anticholinergic agents such as stramonium and atropine have significant non-pulmonary effects. The non-pulmonary effects of a new quaternary anticholinergic, ipratropium bromide, have been studied both in the United States and abroad; these effects include inhibition of salivation, interference with micturition, and ocular effects such as pupil size, visual acuity, and intraocular pressure. Hemodynamic effects such as heart rate, blood pressure, and blood gas changes have also been studied. These evaluations have been performed in animals and in healthy and sick human subjects, following administration of ipratropium parenterally and by inhalation in a variety of dosage ranges. Ipratropium, a muscarinic inhibitor, would be expected to have effects similar to those of atropine. The most conspicuous result of these studies has been the low incidence of significant changes, even at high dose levels, when ipratropium bromide is administered by inhalation.
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341
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Abstract
Anticholinergic drugs inhibit a variety of intrapulmonary events related to airflow obstruction. When administered as an inhaled aerosol, approximately 90 percent of ipratropium bromide (as with beta-adrenergic aerosols) can be assumed to be swallowed. Peak pharmacologic effects occur prior to any detectable plasma drug concentrations. Ipratropium does not exhibit the well-known toxic effects of atropine, and doses many times those required for maximum therapeutic benefit do not produce any effects on the eye, urinary bladder, heart rate, or mucociliary function. Ipratropium seems to act primarily on large- and intermediate-size airways; beta-adrenergic agents, on the other hand, appear to act primarily on the smaller airways. The drug is a promising addition to the therapeutic armamentarium, and may be especially useful in certain groups of patients whose condition is less responsive to other agents.
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342
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Tashkin DP, Ashutosh K, Bleecker ER, Britt EJ, Cugell DW, Cummiskey JM, DeLorenzo L, Gilman MJ, Gross GN, Gross NJ. Comparison of the anticholinergic bronchodilator ipratropium bromide with metaproterenol in chronic obstructive pulmonary disease. A 90-day multi-center study. Am J Med 1986; 81:81-90. [PMID: 2947465 DOI: 10.1016/0002-9343(86)90468-7] [Citation(s) in RCA: 112] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The short- and long-term efficacy and safety of an inhaled quaternary ammonium anticholinergic agent, ipratropium bromide, and a beta agonist aerosol, metaproterenol, were compared in 261 nonatopic patients with chronic obstructive pulmonary disease (COPD). The study was a randomized, double-blind, 90-day, parallel-group trial. On three test days-one, 45, and 90-mean peak responses for forced expiratory volume in one second and forced vital capacity and mean area under the time-response curve were higher for ipratropium than for metaproterenol. Clinical improvement was noted in both treatment groups, especially during the first treatment month, with persistence of improvement throughout the remainder of the study. Side effects were relatively infrequent and generally mild; tremor, a complication of beta agonists, was not reported by any subject receiving ipratropium. These results support the effectiveness and safety of long-term treatment with inhaled ipratropium in COPD.
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343
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Lepointe F, Montpellier D, Lephay A, Fournier T, Ossart M. [Post-anesthetic complications in withdrawal of anticholinergics]. CAHIERS D'ANESTHESIOLOGIE 1986; 34:435-6. [PMID: 3779488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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344
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Abstract
The use of aerosolized anticholinergics has not previously been emphasized as a cause of pharmacologic pupillary dilation. The diagnosis can be confirmed by instillation of 1 percent pilocarpine hydrochloride in the affected eye, thereby preventing needless neurologic studies and evaluation. We report one patient who had transient asymmetric pupillary dilation secondary to aerosolized anticholinergic treatment. Also, we looked at the incidence of the above complication in 40 outpatients who were treated for acute asthmatic exacerbation.
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345
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Betermiez P, Delahousse J, Pedinielli JL. [Anticholinergics during neuroleptic treatment. Value and withdrawal]. L'ENCEPHALE 1986; 12:169-74. [PMID: 2878801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
In a study on 144 chronic psychotic patients treated with neuroleptics, the authors tried to define a therapeutic schedule for anti-cholinergic drugs use to control parkinsonism induced by anti-psychotic drugs. Systematic treatment by anti-cholinergic drugs seems to be useless, even dangerous, and, if they have to be employed, the treatment must not exceed six months. The authors emphasize and analyse through the literature, the problems of drug abuse, withdrawal and psychological dependence with anti-parkinsonian drugs and their neurochemical effects.
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346
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Abstract
An extensive amount of research in clinical psychiatry, psychopharmacology, and the neurosciences has led to effective pharmacological treatments for affective disorders. These impressive developments have suffered from several limitations. In the case of antidepressant drugs, the delayed onset of antidepressant effect, troublesome side effects, possible lethality after an overdose, and the 20 to 30 percent of depressed patients not responsive to them have made these drugs less than a panacea. In addition to the limitations of the drugs themselves, there is frequently inattention to pharmacotherapeutic principles by clinicians. There is definitely a need for further research in the field, especially regarding major unresolved issues such as the proper selection of patients for whom antidepressants are indicated, clinical and biological predictors of treatment response, and the development of new antidepressants with superior efficacy and safety as well as an earlier onset of action. Meanwhile, an empathic psychotherapeutic alliance coupled with careful clinical and pharmacological monitoring are the essential prerequisites for successful antidepressant treatment.
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347
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Lannon MC, Thomas CA, Bratton M, Jost MG, Lockhart-Pretti P. Comprehensive care of the patient with Parkinson's disease. J Neurosci Nurs 1986; 18:121-31. [PMID: 2941497 DOI: 10.1097/01376517-198606000-00004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
This article gives an overview of Parkinson's disease, a common neurological disorder. Inpatient care at Boston University Medical Center is discussed, stressing the importance of a comprehensive team approach to the patient with moderate to severe parkinsonism. Management of the patient during a drug holiday is discussed. A case history including a nursing care plan is presented. Guidelines, protocols, and nursing care standards for the care of the patient with parkinsonism are discussed.
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348
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Glenert U, Pindborg JJ, Andreasen JO. Tongue surface conditions of 478 residents of a large Danish rest home. GERODONTICS 1986; 2:82-6. [PMID: 3462072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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349
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Shpilenia LS. [Mental disorders in poisonings by anticholinergic agents]. VOENNO-MEDITSINSKII ZHURNAL 1986:75-6. [PMID: 3523983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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350
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Dilsaver SC. Pharmacologic induction of cholinergic system up-regulation and supersensitivity in affective disorders research. J Clin Psychopharmacol 1986; 6:65-74. [PMID: 3517080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Phenomenological, physiological, biochemical, and receptor binding measures are useful as dependent variables in affective disorders research. Abnormalities of these measures can result from up-regulation and supersensitivity of cholinergic systems and disturbances of cholinergic-monoaminergic interaction. These deviations are safely and inexpensively produced by pharmacologic induction of up-regulation and supersensitivity of central muscarinic cholinergic systems. Techniques for inducing these changes in cholinergic systems are reviewed, and principles governing their application to specific problems are illustrated.
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