Management of clozapine-induced sialorrhoea

SUMMARYSialorrhoea (hypersalivation) is a common adverse effect of clozapine. If severe, it can affect patients' quality of life and adherence to the treatment. Clinicians therefore need to proactively manage this effect. At present, no drugs are licensed to manage clozapine-induced sialorrhoea, although there are many off-label treatment options, with variable effectiveness. Anticholinergic medications are commonly prescribed for it, but they have limited effect and can worsen constipation. This article gives a brief overview of other practical and pharmacological management options.

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Physical approach for prevention and treatment of osteoporosis

Arquivos Brasileiros de Endocrinologia & Metabologia ◽

10.1590/s0004-27302010000200013 ◽

2010 ◽

Vol 54 (2) ◽

pp. 171-178 ◽

Cited By ~ 17

Author(s):

Ana Paula Rebucci Lirani-Galvão ◽

Marise Lazaretti-Castro

Keyword(s):

Pharmacological Treatment ◽

Treatment Options ◽

Mineral Density ◽

Management Options ◽

Pharmacological Management ◽

Treatment Of Osteoporosis ◽

Specific Strength ◽

Positive Effects ◽

Coordination Training

Osteoporosis and its consequent fractures are a major problem in public health. To complement the conventional pharmacological treatment for this metabolic disease, non-pharmacological treatment options have been developed in the last decades. Several studies demonstrate that physical exercise programs including impact exercises, specific strength training, balance and coordination training may maintain or increase spine and hip bone mineral density as well as decrease the frequency of falls among osteoporotic and osteopenic patients. Furthermore, some physical agents such as vibratory platforms, low intensity electrical stimulation, laser therapy and ultrasound show positive effects on osteoporotic tissue as well. Consequently, while planning treatment for an osteoporotic patient, non-pharmacological management options should be considered and integrated to the conventional treatment in order to maximize its effects and improve the quality of life of these patients.

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Genitourinary Issues in Palliative Care

10.1093/med/9780190059996.003.0013 ◽

2021 ◽

pp. 198-213

Author(s):

Min Ji Kim ◽

Kimberson Tanco

Keyword(s):

Quality Of Life ◽

Palliative Care ◽

Symptom Management ◽

Urinary Tract Obstruction ◽

Performance Status ◽

Treatment Options ◽

Symptom Control ◽

Kidney Injury ◽

Management Options

Genitourinary problems in palliative care can be very distressing to patients and require prompt management and alleviation of symptoms. Examples include urinary tract obstruction, which can lead to pain and kidney injury, as well as infection, hematuria, renal colic, and bladder spasm-related pain. This chapter addresses relevant aspects of palliative care in patients with genitourinary issues, including consideration for context of symptoms and subsequent practical management. Options for symptom management may range from medications to procedural interventions. In deciding between treatment options, factors such as the patient’s preexisting comorbidities, performance status, goals of care, and anticipated benefit in symptom control and in quality of life versus potential burden of treatment must be considered.

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Gastroesophageal Reflux Disease and Foregut Dysmotility in Children with Intestinal Failure

Nutrients ◽

10.3390/nu12113536 ◽

2020 ◽

Vol 12 (11) ◽

pp. 3536

Author(s):

Anna Rybak ◽

Aruna Sethuraman ◽

Kornilia Nikaki ◽

Jutta Koeglmeier ◽

Keith Lindley ◽

...

Keyword(s):

Quality Of Life ◽

Gastroesophageal Reflux ◽

Treatment Options ◽

Hormone Secretion ◽

Intestinal Failure ◽

Pharmacological Management ◽

Gastrointestinal Dysmotility ◽

Critical Reduction ◽

Intestinal Pseudo Obstruction

Gastrointestinal dysmotility is a common problem in a subgroup of children with intestinal failure (IF), including short bowel syndrome (SBS) and pediatric intestinal pseudo-obstruction (PIPO). It contributes significantly to the increased morbidity and decreased quality of life in this patient population. Impaired gastrointestinal (GI) motility in IF arises from either loss of GI function due to the primary disorder (e.g., neuropathic or myopathic disorder in the PIPO syndrome) and/or a critical reduction in gut mass. Abnormalities of the anatomy, enteric hormone secretion and neural supply in IF can result in rapid transit, ineffective antegrade peristalsis, delayed gastric emptying or gastroesophageal reflux. Understanding the underlying pathophysiologic mechanism(s) of the enteric dysmotility in IF helps us to plan an appropriate diagnostic workup and apply individually tailored nutritional and pharmacological management, which might ultimately lead to an overall improvement in the quality of life and increase in enteral tolerance. In this review, we have focused on the pathogenesis of GI dysmotility in children with IF, as well as the management and treatment options.

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Raynaud’s phenomenon and digital ischaemia - pharmacologic approach and alternative treatment options

VASA ◽

10.1024/0301-1526/a000526 ◽

2016 ◽

Vol 45 (3) ◽

pp. 201-212 ◽

Cited By ~ 13

Author(s):

Birgit Linnemann ◽

Matthias Erbe

Keyword(s):

Quality Of Life ◽

Angiotensin Receptor Blockers ◽

Raynaud’S Phenomenon ◽

Treatment Options ◽

Raynaud's Phenomenon ◽

Tissue Loss ◽

Receptor Antagonists ◽

Skin Ulcers ◽

Digital Ischaemia

Abstract. The primary goal of therapy is to reduce the frequency and intensity of Raynaud’s attacks and to minimize the related morbidity rather than to cure the underlying condition. Treatment strategies depend on whether Raynaud’s phenomenon (RP) is primary or secondary. All patients should be instructed about general measures to maintain body warmth and to avoid triggers of RP attacks. Pharmacologic intervention can be useful for patients with severe and frequent RP episodes that impair the patient’s quality of life. Calcium channel blockers are currently the most prescribed and studied medications for this purpose. There has been limited evidence for the efficacy of alpha-1-adrenergic receptor antagonists, angiotensin receptor blockers, topical nitrates or fluoxetine to treat RP. The intravenously administered prostacyclin analogue iloprost can reduce the frequency and severity of RP attacks and is considered a second-line therapy in patients with markedly impaired quality of life, critical digital ischaemia and skin ulcers who are at risk for substantial tissue loss and amputation. Phosphodiesterase inhibitors (e.g., sildenafil) can also improve RP symptoms and ulcer healing whereas endothelin-1 receptor antagonists (e.g., bosentan) are mainly considered treatment options in secondary prevention for patients with digital skin ulcers related to systemic sclerosis. However, their use in clinical practice has been limited by their high cost. Antiplatelet therapy with low-dose aspirin is recommended for all patients who suffer from secondary RP due to ischaemia caused by structural vessel damage. Anticoagulant therapy can be considered during the acute phase of digital ischaemia in patients with suspected vascular occlusive disease attributed to the occurrence of new thromboses. In patients with critical digital ischaemia, consideration should be given to hospitalisation, optimisation of medical treatment in accordance with the underlying disease and evaluation for a secondary, possibly reversible process that is causing or aggravating the clinical symptoms.

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Preventing Premature Weaning: Management Options for Common Lactation Conditions, Including OMT

Osteopathic Family Physician ◽

10.33181/12012 ◽

2020 ◽

pp. 20-25

Author(s):

Denise Sackett ◽

Tala Dajani ◽

David Shoup ◽

Uzoma Ikonne

Keyword(s):

Postpartum Depression ◽

Family Physician ◽

Treatment Options ◽

World Health ◽

Management Options ◽

Pharmacological Management ◽

Control And Prevention ◽

Lactational Mastitis ◽

One Year ◽

Health Organization

The benefits of breastfeeding are well established. The World Health Organization and the Centers for Disease Control and Prevention recommend that mothers breastfeed infants for at least one year, but most children are not breastfed that long because of many factors. Breastfeeding mothers face many challenges to continued breastfeeding, including medical conditions that arise during this period, such as postpartum depression and lactational mastitis. Because of a perceived lack of consistent guidance on medication safety, it can be difficult for the family physician to treat these conditions while encouraging mothers to continue breastfeeding. The purpose of the current review is to summarize and clarify treatment options for the osteopathic family physician treating lactating mothers. We specifically focus on the pharmacological management of contraception, postpartum depression, and lactational mastitis.

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MP-AzeFlu in Moderate-to-Severe Allergic Rhinitis: A Literature Review

International Archives of Allergy and Immunology ◽

10.1159/000516417 ◽

2021 ◽

pp. 1-10

Author(s):

Ludger Klimek ◽

William E. Berger ◽

Jean Bousquet ◽

Paul K. Keith ◽

Peter Smith ◽

...

Keyword(s):

Quality Of Life ◽

Allergic Rhinitis ◽

Fluticasone Propionate ◽

Treatment Options ◽

Symptomatic Disease ◽

Intranasal Corticosteroids ◽

Need For Treatment ◽

Ocular Symptoms ◽

Symptom Complex

Allergic rhinitis (AR) is prevalent, and many patients present with moderate-to-severe symptomatic disease. The majority of patients are not satisfied with their AR treatment, despite the use of concurrent medications. These gaps underscore the need for treatment with more effective options for moderate-to-severe AR. The authors’ objective was to review systematically the efficacy and safety of MP-AzeFlu for the treatment of AR. The primary outcomes studied were nasal, ocular, and total symptoms. Other outcomes included time to onset and of AR control, quality of life, and safety. Searches of PubMed and Cochrane databases were conducted on May 14, 2020, with no date restrictions, to identify publications reporting data on MP-AzeFlu. Clinical studies of any phase were included. Studies were excluded if they were not in English, were review articles, did not discuss the safety and efficacy of MP-AzeFlu for AR symptoms. Treatment of AR with MP-AzeFlu results in effective, sustained relief of nasal and ocular symptoms, and faster onset and time to control compared with intranasal azelastine or fluticasone propionate. Long-term use of MP-AzeFlu was safe, with benefits in children, adults, and adults aged ≥65 years. Other treatment options, including fluticasone propionate and azelastine alone or the combination of intranasal corticosteroids and oral antihistamine, do not provide the same level of efficacy as MP-AzeFlu in terms of rapid and sustained relief of the entire AR symptom complex. Furthermore, MP-AzeFlu significantly improves patient quality of life. MP-AzeFlu is a currently available combination that may satisfy all these patient needs and expectations.

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Quality of Life in Opioid Replacement Therapy: A Naturalistic Cross-Sectional Comparison of Methadone/Levomethadone, Buprenorphine, and Diamorphine Patients

European Addiction Research ◽

10.1159/000514192 ◽

2021 ◽

pp. 1-10

Author(s):

Stephanie Paula Elisabeth Guillery ◽

Rainer Hellweg ◽

Golo Kronenberg ◽

Ulrich Bohr ◽

Hagen Kunte ◽

...

Keyword(s):

Quality Of Life ◽

Replacement Therapy ◽

Psychological Functioning ◽

Treatment Options ◽

Chronically Ill ◽

Cross Sectional ◽

Life Improvement ◽

Methadone Patients ◽

Opioid Replacement Therapy

Background: Research on quality of life (QoL) of chronically ill patients provides an opportunity to evaluate the efficacy of long-term treatments. Although it is established that opioid replacement therapy is an effective treatment for opioid-dependent patients, there is little knowledge about physical and psychological functioning of QoL for different treatment options. Objectives: Altogether, 248 opioid-dependent patients receiving substitution treatment with either methadone/levomethadone (n = 126), diamorphine (n = 85), or buprenorphine (n = 37) were recruited in 6 German therapy centers. Methods: Sociodemographic data were collected. QoL – physical and psychological functioning – for different substitutes was assessed using the Profile of the Quality of Life in the Chronically Ill (PLC) questionnaire. Results: Patient groups were similar regarding age and duration of opioid dependence. Employment rate was significantly higher (p < 0.005, φ = 0.22) in the buprenorphine group (46%) compared to methadone (18%). Dosage adjustments were more frequent (p < 0.001, φ = 0.29) in diamorphine (55%) than in methadone (30%) or buprenorphine (19%) patients. Buprenorphine and diamorphine patients rated their physical functioning substantially higher than methadone patients (p < 0.001, η2 = 0.141). Diamorphine patients reported a higher psychological functioning (p < 0.001, η2 = 0.078) and overall life improvement (p < 0.001, η2 = 0.060) compared to methadone, but not compared to buprenorphine patients (both p > 0.25). Conclusion: Measurement of important QoL aspects indicates significant differences for physical and psychological functioning in patients receiving the substitutes methadone/levomethadone, diamorphine, and buprenorphine. This could be relevant for the differential therapy of opioid addiction.

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Health-Related Quality of Life in Adrenocortical Carcinoma

Cancers ◽

10.3390/cancers11101500 ◽

2019 ◽

Vol 11 (10) ◽

pp. 1500 ◽

Cited By ~ 1

Author(s):

Rebecca V. Steenaard ◽

Laura A. Michon ◽

Harm R. Haak

Keyword(s):

Quality Of Life ◽

General Population ◽

Adrenocortical Carcinoma ◽

Treatment Options ◽

Clinical Aspects ◽

Health Related Quality ◽

Related Quality ◽

Health Related ◽

The Impact

Insight into the health-related quality of life (HRQoL) impact of adrenocortical carcinoma (ACC) is important. The disease and its treatment options potentially have an impact on HRQoL. For patients with limited survival, HRQoL research is of utmost importance. We will therefore provide an overview of HRQoL studies in patients with ACC. We found six studies that measured HRQoL in 323 patients with ACC (3 cross-sectional, 1 cohort, 2 trials), all indicating a reduced HRQoL compared to the general population. The FIRMACT trial found that HRQoL of patients with ACC was reduced compared to the general population, and that chemotherapy-mitotane further reduced HRQoL even though survival improved. Clinical aspects of the disease, including cortisol and aldosterone production and adrenal insufficiency have shown great impact on HRQoL in benign disease, even after the recovery of hormonal status. However, the impact of malignant adrenal disease and treatment options on HRQoL including adrenalectomy, radiotherapy, mitotane therapy, and chemotherapy have not been sufficiently studied in patients with ACC. Although the number of HRQoL studies in patients with ACC is limited, the existing literature does indicate that ACC has a large impact on patients’ HRQoL, with disease specific aspects. Further HRQoL research in patients with ACC is essential to improve patient-centered care, preferably by using an ACC-specific HRQoL questionnaire.

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Impact of Voice and Swallowing Problems in the Elderly

Otolaryngology ◽

10.1016/j.otohns.2008.05.162 ◽

2008 ◽

Vol 139 (2_suppl) ◽

pp. P50-P50

Author(s):

Richard Turley ◽

Seth M Cohen

Keyword(s):

Quality Of Life ◽

Treatment Options ◽

The Elderly ◽

T Test ◽

Barriers To Treatment ◽

Continuous Variables ◽

Spearman Correlation ◽

Cross Sectional ◽

Swallowing Problems

Objective 1) Evaluate the prevalence of and quality of life impact of voice and swallowing problems in the elderly. 2) Determine treatment trends and barriers to treatment. Methods Cross-sectional study of independent living residents in 2 retirement communities. Main outcome measures include prevalence of dysphonia and dysphagia, Voice Related Quality of Life (VRQOL), 7-point Likert scale of dysphagia severity, Center for Epidemiologic Studies Depression (CES-D) scale, and barriers to treatment. Relationship between continuous variables were analyzed with Spearman correlation and between categorical and continuous variables with a t-test. Results 248 residents responded, with a mean age of 82.4 years. 19.8% had dysphonia, 13.7% dysphagia, and 6% both. Respondents with more severe swallowing difficulty had greater impairment on the VRQOL (p = 0.04, Spearman correlation = −0.4). Respondents with both dysphonia and dysphagia had greater depression scores than those with neither symptom (mean CES-D score 15.5 versus 9.9, p = 0.008, t-test). While 75% of respondents with dysphonia were interested in treatment, only 20.4% and 2.1% had sought treatment for dysphonia and dysphagia, respectively. Being unaware of treatment options, and viewing voice and swallowing trouble as a normal part of aging, were the two most common reasons for not seeking treatment. Conclusions Voice and swallowing problems are common in the elderly but they are not realizing potential treatment benefits. Improved health care services for voice and swallowing problems in the elderly are essential.

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Treatment Given Near the End of Life in Castration-Resistant Prostate Cancer

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909111433128 ◽

2012 ◽

Vol 29 (7) ◽

pp. 536-540 ◽

Cited By ~ 3

Author(s):

Hanna A. Zaghloul ◽

Jose R. Murillo

Keyword(s):

Quality Of Life ◽

Prostate Cancer ◽

End Of Life ◽

Treatment Options ◽

Castration Resistant Prostate Cancer ◽

Castration Resistant ◽

Related Quality ◽

Impact On Survival ◽

New Treatments

Chemotherapy treatment options are limited for patients with castration-resistant prostate cancer (CRPC). The purpose of this study is to report treatment use and adverse effects (AEs) within the last three months of life in patients with CRPC. Of the 88 patients identified, 32% received treatment within 3 months of death, and documented AEs occurred in 25% of patients. Of those, neutropenia (18.3%), nausea/vomiting (18.3%), and febrile neutropenia (13.6%) were the most frequent. Results of this study show high treatment utility towards the end-of-life in patients with CRPC, with one fourth of patients experiencing AEs. Attention to health-related quality of life becomes increasingly important as new treatments appear to have small impact on survival, and AEs of those treatments may significantly impact patient quality of life.

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