scholarly journals First-generation antipsychotics: not gone but forgotten

2016 ◽  
Vol 40 (2) ◽  
pp. 93-96 ◽  
Author(s):  
Claire R. M. Dibben ◽  
Golam M. Khandaker ◽  
Benjamin R. Underwood ◽  
Christopher O'Loughlin ◽  
Catherine Keep ◽  
...  
Keyword(s):  
Side Effects ◽  
First Generation ◽  
Similar Efficacy ◽  
Dose Titration ◽  
Similar Proportion ◽  
High Dose ◽  
Training Experience ◽  
East Anglia ◽  
Regular Medication ◽  
First And Second Generation

Aims and methodTo identify training needs of the next generation of psychiatrists and barriers in prescribing first-generation antipsychotics (FGAs). We have surveyed psychiatry trainees in East Anglia with regard to their training experience, knowledge and attitudes to the use of oral FGAs as regular medication.ResultsTwo-thirds of trainees were aware that first- and second-generation antipsychotics (SGAs) have similar efficacy, and a similar proportion perceived the older drugs to have more or ‘stronger’ side-effects. Lack of training experience was noted as the second leading concern for prescribing FGAs. A quarter of trainees received no training exposure to the older drugs and two-thirds had never initiated these drugs themselves. Although nearly 90% of trainees felt confident about initiating an oral SGA as a regular medication, only about 40% felt confident with FGAs (P<0.001).Clinical implicationsThe survey highlights worrying gaps in training. FGAs can be used effectively, minimising side-effects, by careful dose titration, avoiding antipsychotic polypharmacy, high-dose, and high-potency drugs, thus ensuring they are not lost to future generations of psychiatrists.

Attitudes to antipsychotics: a multi-site survey of Canadian psychiatry residents

2018 ◽  
Vol 13 (6) ◽  
pp. 318-338
Author(s):  
Anees Bahji ◽  
Neeraj Bajaj
Keyword(s):  
First Generation ◽  
Treatment Options ◽  
Similar Efficacy ◽  
Psychiatry Residents ◽  
Training Experience ◽  
Content Type ◽  
Electronic Survey ◽  
Site Survey ◽  
Long Acting ◽  
The University

Purpose The purpose of this paper is to identify the training needs of the next generation of psychiatrists, and barriers in prescribing first-generation antipsychotics (FGAs), long-acting injectable (LAIs) antipsychotics and clozapine. Design/methodology/approach An electronic survey was sent to psychiatry residents (N= 75/288, 26 percent) at four Canadian residency programs in late December 2017. The survey was based on an instrument originally developed at the University of Cambridge and consisted of 31 questions in 10 content domains. Findings Nearly 80 percent of residents were aware that FGAs and second-generation antipsychotics (SGAs) have similar efficacy. However, extra-pyramidal symptoms and lack of training experience were the leading concerns associated with the prescribing of FGAs. Although over 90 percent of residents felt confident about initiating an oral SGA as a regular medication, only 40 percent did so with FGAs. Confidence with initiating LAIs and clozapine was 60 and 61 percent, respectively. Practical implications The survey highlights the need for better training in the use of FGAs, clozapine and LAIs. These medications can be effectively used in providing patients with the most appropriate evidence-based treatment options to improve treatment outcomes, while ensuring that these resources are not lost to the future generations of psychiatrists. Originality/value The survey may be the first of its kind to assess antipsychotic prescribing attitudes in Canadian psychiatry residents in multiple sites.

Quality-by-Design Enabled Chitosan Nanoparticles for Antitubercular Therapy: Formulation, Statistical Optimization, and In vitro Characterization

2020 ◽  
Vol 15 ◽  
Author(s):  
Manasi M. Chogale ◽  
Sujay S. Gaikwad ◽  
Savita P. Kulkarni ◽  
Vandana B. Patravale
Keyword(s):  
Side Effects ◽  
Treatment Regimen ◽  
Research Work ◽  
Chitosan Nanoparticles ◽  
In Vitro Release ◽  
Antitubercular Therapy ◽  
Prolonged Treatment ◽  
High Dose ◽  
Average Size

Background: Tuberculosis (TB) continues to be among the leading causes for high mortality among developing countries. Though a seemingly effective treatment regimen against TB is in place, there has been no significant improvement in the therapeutic rates. This is primarily owing to the high drug doses, their associated sideeffects, and prolonged treatment regimen. Discontinuation of therapy due to the severe side effects of the drugs results in the progression of the infection to the more severe drug-resistant TB. Objectives: Reformulation of the current existing anti TB drugs into more efficient dosage forms could be an ideal way out. Nanoformulations have been known to mitigate the side effects of toxic, high-dose drugs. Hence, the current research work involves the formulation of Isoniazid (INH; a first-line anti TB molecule) loaded chitosan nanoparticles for pulmonary administration. Methods: INH loaded chitosan nanoparticles were prepared by ionic gelation method using an anionic crosslinker. Drugexcipient compatibility was evaluated using DSC and FT-IR. The formulation was optimized on the principles of Qualityby-Design using a full factorial design. Results: The obtained nanoparticles were spherical in shape having an average size of 620±10.97 nm and zeta potential +16.87±0.79 mV. Solid state characterization revealed partial encapsulation and amorphization of INH into the nanoparticulate system. In vitro release study confirmed an extended release of INH from the system. In vitro cell line based safety and efficacy studies revealed satisfactory results. Conclusion: The developed nanosystem is thus an efficient approach for antitubercular therapy.

scholarly journals TNF-Alpha Inhibitors for Chronic Urticaria: Experience in 20 Patients

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Freja Lærke Sand ◽  
Simon Francis Thomsen
Keyword(s):  
Side Effects ◽  
Chronic Urticaria ◽  
Treatment Options ◽  
Significant Proportion ◽  
Response Duration ◽  
Immunosuppressive Drugs ◽  
Tnf Alpha ◽  
High Dose ◽  
Duration Of Treatment ◽  
Durable Response

Patients with severe chronic urticaria may not respond to antihistamines, and other systemic treatment options may either be ineffective or associated with unacceptable side effects. We present data on efficacy and safety of adalimumab and etanercept in 20 adult patients with chronic urticaria. Twelve (60%) patients obtained complete or almost complete resolution of urticaria after onset of therapy with either adalimumab or etanercept. Further three patients (15%) experienced partial response. Duration of treatment ranged between 2 and 39 months. Those responding completely or almost completely had a durable response with a mean of 11 months. Six patients (30%) experienced side effects and five patients had mild recurrent upper respiratory infections, whereas one patient experienced severe CNS toxicity that could be related to treatment with TNF-alpha inhibitor. Adalimumab and etanercept may be effective and relatively safe treatment options in a significant proportion of patients with chronic urticaria who do not respond sufficiently to high-dose antihistamines or in whom standard immunosuppressive drugs are ineffective or associated with unacceptable side effects.

scholarly journals Dose-dependent response to infection with SARS-CoV-2 in the ferret model and evidence of protective immunity

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Kathryn A. Ryan ◽  
Kevin R. Bewley ◽  
Susan A. Fotheringham ◽  
Gillian S. Slack ◽  
Phillip Brown ◽  
...  
Keyword(s):  
Protective Immunity ◽  
Viral Rna ◽  
Dose Titration ◽  
High Dose ◽  
Lung Pathology ◽  
Upper Respiratory Tract ◽  
Virus Shedding ◽  
Upper Respiratory ◽  
Dose Dependent ◽  
Titration Study

AbstractThere is a vital need for authentic COVID-19 animal models to enable the pre-clinical evaluation of candidate vaccines and therapeutics. Here we report a dose titration study of SARS-CoV-2 in the ferret model. After a high (5 × 106 pfu) and medium (5 × 104 pfu) dose of virus is delivered, intranasally, viral RNA shedding in the upper respiratory tract (URT) is observed in 6/6 animals, however, only 1/6 ferrets show similar signs after low dose (5 × 102 pfu) challenge. Following sequential culls pathological signs of mild multifocal bronchopneumonia in approximately 5–15% of the lung is seen on day 3, in high and medium dosed groups. Ferrets re-challenged, after virus shedding ceased, are fully protected from acute lung pathology. The endpoints of URT viral RNA replication & distinct lung pathology are observed most consistently in the high dose group. This ferret model of SARS-CoV-2 infection presents a mild clinical disease.

Bilateral dysthyroid compressive optic neuropathy responsive to teprotumumab

2021 ◽  
pp. 112067212199104
Author(s):  
Catherine J Hwang ◽  
Erin E Nichols ◽  
Brian H Chon ◽  
Julian D Perry
Keyword(s):  
Side Effects ◽  
Optic Neuropathy ◽  
Surgical Decompression ◽  
Thyroid Eye Disease ◽  
Eye Disease ◽  
High Dose ◽  
Compressive Optic Neuropathy ◽  
Traditional Management ◽  
Immune Mediated ◽  
Orbital Radiation

Thyroid eye disease is an auto-immune mediated orbitopathy which can cause dysthyroid compressive optic neuropathy. Traditional management of active thyroid eye disease includes temporizing high-dose steroids, orbital radiation and surgical decompression, which each possess significant limitations and/or side effects. Teprotumumab is an IGF-IR inhibitor recently FDA-approved for active thyroid eye disease. The authors report reversal of bilateral dysthyroid compressive optic neuropathy managed medically utilizing teprotumumab.

scholarly journals Current Nanocarrier Strategies Improve Vitamin B12 Pharmacokinetics, Ameliorate Patients’ Lives, and Reduce Costs

Nanomaterials ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 743
Author(s):  
Marco Fidaleo ◽  
Stefano Tacconi ◽  
Carolina Sbarigia ◽  
Daniele Passeri ◽  
Marco Rossi ◽  
...  
Keyword(s):  
Side Effects ◽  
Vitamin B12 ◽  
Memory Performance ◽  
Oral Route ◽  
High Dose ◽  
Human Beings ◽  
Inborn Errors ◽  
Essential Nutrient

Vitamin B12 (VitB12) is a naturally occurring compound produced by microorganisms and an essential nutrient for humans. Several papers highlight the role of VitB12 deficiency in bone and heart health, depression, memory performance, fertility, embryo development, and cancer, while VitB12 treatment is crucial for survival in inborn errors of VitB12 metabolism. VitB12 is administrated through intramuscular injection, thus impacting the patients’ lifestyle, although it is known that oral administration may meet the specific requirement even in the case of malabsorption. Furthermore, the high-dose injection of VitB12 does not ensure a constant dosage, while the oral route allows only 1.2% of the vitamin to be absorbed in human beings. Nanocarriers are promising nanotechnology that can enable therapies to be improved, reducing side effects. Today, nanocarrier strategies applied at VitB12 delivery are at the initial phase and aim to simplify administration, reduce costs, improve pharmacokinetics, and ameliorate the quality of patients’ lives. The safety of nanotechnologies is still under investigation and few treatments involving nanocarriers have been approved, so far. Here, we highlight the role of VitB12 in human metabolism and diseases, and the issues linked to its molecule properties, and discuss how nanocarriers can improve the therapy and supplementation of the vitamin and reduce possible side effects and limits.

scholarly journals High dose antipsychotic polypharmacy and dopamine partial agonists - time to rethink guidelines?

2021 ◽  
pp. 026988112110264
Author(s):  
Gavin P Reynolds
Keyword(s):  
Side Effects ◽  
Dopamine D2 Receptor ◽  
D2 Receptor ◽  
Receptor Site ◽  
Receptor Occupancy ◽  
Antipsychotic Agents ◽  
High Dose ◽  
Partial Agonists ◽  
Favourable Side Effect Profile ◽  
Different Characteristics

Guidelines for the treatment of schizophrenia limit the use of antipsychotic agents to clinically-established maximum doses. This acknowledges both the absence of additional efficacy of dopamine D2 receptor antagonists above a receptor occupancy threshold, and the increases in side effects that can occur at higher doses. These limits restrict the dosing of combinations of antipsychotics as they do single agents; drugs sharing the major antipsychotic mechanism of D2 receptor antagonism will act additively in blocking these receptors. Several newer antipsychotic drugs, including aripiprazole and cariprazine, act as partial agonists at the D2 receptor site and avoid action at several other receptors, effects at which are responsible for some non-dopaminergic adverse effects. This pharmacology imparts different characteristics to the drugs resulting often in a more favourable side effect profile. Their partial agonism, along with high affinities for the D2 receptor, also means that these drugs given adjunctively may in part replace, rather than enhance, the D2 antagonism of other antipsychotic agents. This can result in an improvement in certain side effects without loss of antipsychotic efficacy. This article makes the case for distinguishing the D2 partial agonists from antagonists in defining maximum doses of combined treatments, which would increase the options available to the prescriber, emphasising that pharmacological mechanisms need to be understood in identifying optimal treatments for psychotic illness.

Ampicillin-Associated Diarrhea: Effect of Dosage and Route of Administration

PEDIATRICS ◽  
1976 ◽  
Vol 58 (6) ◽  
pp. 869-872
Author(s):  
John A. Phillips ◽  
Frederick H. Lovejoy ◽  
Yoichi Matsumiya
Keyword(s):  
Urinary Tract ◽  
Side Effects ◽  
High Dose ◽  
Total Dosage ◽  
Pediatric Practice ◽  
Severe Diarrhea ◽  
Bowel Movements ◽  
Gastrointestinal Side Effects ◽  
Tract Infections ◽  
Mild Diarrhea

Ampicillin is one of the most frequently used antibiotics in pediatric practice.1 Its clinical efficacy has been widely studied, but its gastrointestinal side effects are poorly documented. In adults with urinary tract infections, 11% taking 1 gm/day of ampicillin orally had bowel movements which were at least twice as frequent as normal.2 Another series in adults receiving ampicillin reported an increase in stools with 16% having ≤5 and 5% having ≥5 stools per day. The change in stools increased with total dosage and was equal after oral or intravenous administration.3 In children, ampicillin ranging from 50 to the unusually high dose of 200 mg/kg/day resulted in mild diarrhea (≤5 stools per day) in 18% to 30%, moderate diarrhea (5 to 10 stools per day) in 2% to 11%, and severe diarrhea (≥10 stools per day) in 1% or less of cases.

Assimilation of the Puerto Ricans on the Mainland

1968 ◽  
Vol 2 (2) ◽  
pp. 21-39
Author(s):  
John J. Macisco
Keyword(s):  
United States ◽  
First Generation ◽  
Second Generation ◽  
Puerto Ricans ◽  
The United States ◽  
Social Scientists ◽  
First Marriage ◽  
Labor Force Status ◽  
Age At First Marriage ◽  
First And Second Generation

Social scientists have repeatedly tried to specify the process whereby assimilation takes place. This article points out the value of socio-demographic analysis in the study of assimilation, by describing the characteristics of Puerto Ricans on the United States mainland. In order to assess the direction of change between the first and second generation Puerto Ricans, data for the total United States population are also presented. Most of the data are drawn from the 1960 Census. First generation Puerto Ricans are compared with the second generation along the following dimensions: age, education, labor force status, income, occupation, age at first marriage, percent outgroup marriage and fertility. The Author concludes that second generation Puerto Ricans are moving in the direction of total United States averages.

scholarly journals Alfentanil anesthetic augmentation lengthens seizure duration in electroconvulsive therapy with older people

2016 ◽  
Vol 28 (6) ◽  
pp. 1051-1052
Author(s):  
Craig D'Cunha ◽  
Christos Plakiotis ◽  
Daniel W. O'Connor
Keyword(s):  
Side Effects ◽  
Older People ◽  
Electroconvulsive Therapy ◽  
Electrode Placement ◽  
Seizure Threshold ◽  
Dose Titration ◽  
Seizure Duration ◽  
New Learning ◽  
Prescription Rates ◽  
Cognitive Side Effects

Electroconvulsive therapy (ECT) prescription rates rise with age, making it important that treatments be made as effective and safe as possible (Plakiotis et al., 2012). Older people are vulnerable to post-treatment confusion and to subsequent deficits in attention, new learning, and autobiographical memory (Gardner and O'Connor, 2008). Strategies to minimize cognitive side-effects include unilateral electrode placement and stimulus dose titration whereby electrical charge is individually calibrated to seizure threshold (Sackeim et al., 2000). It remains the case, however, that threshold levels typically rise over the treatment course, leading to an increase both in delivered charge and the risk of adverse sequelae.

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