SUBSTANCE 1 2 3 DU90% Estradiol Acetylsalicylic acid Lisinopril Amlodipine Diclofenac Ascorbic acid vit C ; Furosemide Diazepam Atenolol Simvastatin Isosorbide mononitrate Levothyroxine Oxazepam Glibenclamide Alpeazolam Verapamil Cilazapril Loratadine Metildigoxin Chlortalidone DDD ; 2 mg 1 tabl 10 mg 5 mg 0.1 g 0.2 g 40 mg 10 mg 75 mg 15 mg 40 mg 0.15 mg 50 mg 7 mg 1 mg 0.24 g 2.5 mg 10 mg 0.2 mg 25 mg Mill. DDD 85 84 45 TOT 7.7% 4.1% Mill Euro 1.1 2.3 12.3 Euro DDD 0.01 0.03 0.27.
This thesis focuses on drug use in the elderly, in particular those residing in Dutch nursing homes: the frail elderly. These elderly are especially prone to drug-related problems because of their age, frequently occurring co-morbidity and polypharmacy. Relatively little is known of drug use and drug-related problems in these frail elderly. The studies described in this thesis aim to increase the knowledge on drug use and drug-related problems in this population. The thesis comprises four main parts. In chapter 1, the introductory chapter, the scope and the objective of this thesis are described and the problems of drug use in elderly people are outlined. Because of co-morbidity, reduced homeostatic mechanisms and the prescription of several drugs simultaneously, elderly people are at an increased risk of drug-related problems such as drug-drug interactions, drugdisease interactions and adverse drug effects. Drugs may also inadvertently be withheld from the elderly, sometimes as a result of underdiagnosing. In view of these considerations, prescribers need a thorough understanding of the risks and benefits of drug therapy in the elderly, especially in the frail elderly, most of whom will be residing in nursing homes. In the Netherlands, relatively few epidemiological studies on drug use in nursing homes have been carried out. The objective of this thesis is to provide insight in the extent, determinants and characteristics of drug use, as well as the outcomes of drug use in frail elderly. Section 1.2 gives an overview of the Dutch health care system for ambulatory and institutionalised elderly. The Dutch nursing home is a healthcare institution for chronically ill persons in need of permanent medical and paramedical attention and complex nursing care. The type of care can be characterised as continuous, long-term, systematic and multidisciplinary. Recently it was concluded that quality aspects should be more incorporated in medication distribution processes and in pharmaceutical care activities in Dutch nursing homes. Hospital pharmacists play a role in drug and therapeutics committees, the evaluation of prescribing practices on patient level, and development and implementation of drug formularies. Chapter 2 describes several studies that investigated drug use in nursing home residents and elderly outpatients. The first part describes the studies performed in nursing home residents. In section 2.1 an introduction is given to the field of drug utilisation studies and studies that describe the quality of drug use in nursing homes. Many studies have investigated the extent of drug use, whereas only few studies used longitudinal prescription data to evaluate drug effects over time. The studies showed an average number of drugs prescribed per resident, because alprazolam for dogs.
TABLE 6 Results from the COPD model Strategy Heat lamp Chest percussion and drainage Active cycle of breathing Autogenic drainage No manual therapy QALYs 0.047134 0.047163 0.047249 Costs 317.90 316.85 315.84 Dominated Dominated Dominated 232, 673.
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Table 2. - Individual variability of musscl plasma cytolytic activity towards HORBC and corresponding total protein content. Results are arithmetic means f SE n Individual variability The seventeen plasma samples collected from individual mussels revealed enormous differences in cytotoxic activity towards HORBC, ranging from 8 to 81% table 2 ; . Most mussels exhibited an activity of between 50 and 70%. Less extended variability was observed with the total protein content of the various plasma samples with values ranging from 550 pglml to 990 pglml.
Therpetic neuralgia. Neurology. 1997; 48: 12121218. Katz NP. MorphiDex MS: DM ; , double-blind, multiple-dose studies in chronic pain patients. J Pain Symptom Manage. 2000; 19 1 suppl ; : S37-S41. 51. Wadhwa A, Clarke D, Goodchild CS, Young D. Large-dose oral dextromethorphan as an adjunct to patient-controlled analgesia with morphine after knee surgery. Anesth Analg. 2001; 92: 448454. Dalal S, Melzack R. Potentiation of opioid analgesia by psychostimulant drugs: a review. J Pain Symptom Manage. 1998; 16: 245-253. Lauretti GR, Lima ICPR. The effects of intrathecal neostigmine on somatic and visceral pain: improvement by association with a peripheral anticholinergic. Anesth Analg. 1996; 82: 617620. Gordon NC, Gear RW, Heller PH, Paul S, Miaskowski C, Levine JD. Enhancement of morphine analgesia by the GABAB agonist baclofen. Neuroscience. 1995; 69: 345-349. Gillings DB. Pentoxifylline and intermittent claudication: Review of clincial trials and costeffectvieness analyses. J Cardiovasc Pharmacol. 1995; 25 suppl 2 ; : S44-S50. 56. Kotani N, Kushikata T, Hashimoto H, Kimura F, Muraoka M, Yodono M, et al. Intrathecal methylprednisolone for intractable post-herpetic neuralgia. N Engl J Med. 2000; 343: 1514-1519. Taguchi H, Shingu K, Okuda H, Matsumoto H. Analgesia for pelvic and perineal cancer pain by intrathecal steroid injection. Acta Anaesthesiol Scand. 2002; 46: 190-193. Patt RB, Proper G, Reddy S. The neurolpetics as adjuvant analgesics. J Pain Symptom Manage. 1994; 9: 446-453. Stiell IG, Dufour DG, Moher D, Yen M, Beilby WJ, Smith NA. Methotrimeprazine versus meperidine and dimenhydrinate in the treatment of severe migraine: a randomized, controlled trial. Ann Emerg Med. 1991; 20: 1201-1205. Fernandez F, Adams F, Holmes VE. Analgesic effect of alprazolam with chronic, organic pain of malignant origin. J Psychopharmacol. 1987; 7: 167-169. Janssen SA, Arntz A. No interactive effects of naltrexone and benzodiazepines on pain during phobic fear. Behav Res Ther. 1999; 37: 77-86. Dunlop TJ, Deen C, Lind S, Voyle RJ, Prichard JG. Use of combined oral narcotic and benzodiazepine for control of pain associated with bone marrow examination. South Med J. 1999; 92: 477480. Nishiyama T, Matsukawa T, Hanaoka K. Continuous epidural administration of midzolam and bupivacaine for postoperative analgesia. Acta Anaesthesiol Scand. 1999; 43: 568-572. Cox RF, Collins MA. The effects of benzodiazepines on human opioid receptor binding and function. Anesth Analg. 2001; 93: 354-358. Goldstein FJ. Inadequate pain management: a suicidogen Dr. Jack Kevorkian: Friend or Foe? ; J Clin Pharmacol. 1997; 37: 1-3 and
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The length of maternity leaves among employed mothers varies among DIALOG countries between 14 Germany ; and 26 weeks Poland ; . The average length was 20.2 weeks, not including Switzerland. Some countries reported that the length was longer in case of multiple births. It should be noted that there was no real maternity leave at that time in Switzerland. In case of employed mothers, the coverage of the maternity allowance varies between countries from 25 % up to 100 % of monthly earnings. For example, in Lithuania, `during the period of pregnancy and maternity leave the allowance is paid at the full amount 100 % ; of salary'. In Belgium Flanders ; , the size of the allowance is related to the length of the leave: during the first 30 days the maternity allowance is 82 % of the wage with no ceiling ; then 75 % or 60 % wages up to a ceiling respectively. Six countries reported about the allowance practice in cases where the mother is not in the labour market not employed ; . German women without an employment contract insured as a family member via their husband ; receive a maternity grant, which is 77 and benefits in kind such as medical care and midwife care, domestic care, medicine and appliances etc. ; . In the Netherlands unemployed workers receive 100 % of earnings with the minimum wage 1, 066 a month ; as a maximum. Irrespective of employment status, the minimum daily allowance in Finland is 11.45 per weekday. This is roughly 50 % of the minimum public unemployment benefit.
Son of lithium carbonate, chlorpromazine, and haloperidol. Arch Gen Psychiatry. 1975; 32: 34-42. Amsterdam JD, Hornig-Rohan M, Maislin G. Efficacy of alprazolam in reducing fluoxetine-induced jitteriness in patients with major depression. J Clin Psychiatry. 1994; 55: 394-400. Arana GW, Hyman SE. Handbook of Psychiatric Drug Therapy. 2nd ed. Boston, Mass: Little Brown & Co Inc; 1991. 29. American Psychiatric Association. Practice guideline for the treatment of patients with bipolar disorder. J Psychiatry. 1994; 151 suppl ; : 1-36. 30. American Psychiatric Association. Practice guideline for the treatment of patients with schizophrenia. J Psychiatry. 1997; 154 suppl ; : 1-63. 31. Pincus HA. Assessing the effects of physician payment on treatment of mental disorders in primary care. Gen Hosp Psychiatry. 1990; 12: 23-29. Rogers WH, Wells KB, Meredith LS, Strum R, Burnham MA. Outcomes for adult patients under pre-paid or fee-for-service financing. Arch Gen Psychiatry. 1993; 50: 517-525. Regier DA, Hirschfeld RM, Goodwin FK, Burke JD, Lazar JB, Judd LL. The NIMH Depression Awareness, Recognition, and Treatment Program: structure, aims, and scientific basis. J Psychiatry. 1988; 145: 1351-1357. Hirschfeld RM, Keller MB, Panico S, et al. The National Depressive and Manic-Depressive Association Consensus Statement on the Undertreatment of Depression. JAMA. 1997; 277: 333-340. Kessler RC, McGonagle KA, Zhao S, et al. Lifetime and 12 month prevalence of DSM-III-R psychiatric disorders in the United States: results from the National Comorbidity Survey. Arch Gen Psychiatry. 1994; 51: 8-19. Kramer PD. Listening to Prozac. New York, NY: Viking Penguin; 1993. 37. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, DC: American Psychiatric Association; 1994 and
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Recent reports have provided increasing evidence for the existence of one or more populations of resident stem or progenitor cells in adult hearts. Bromodeoxyuridine BrdU ; -label retention has been used to identify stem cells based on their characteristic of being slow cycling in various tissues such as skin and colon, but not in the heart. We investigated whether adult mouse hearts contain BrdU label-retaining cells LRC ; . Using a BrdU pulse and chase-protocol, adult mouse hearts were analyzed immunohistochemically at different time points of chase 0-12 months ; . The number of LRC decreased from 12% at baseline i.e., immediately after the BrdU pulse ; to ~0, 25% at 4 months of chase, but then remained stable plateau ; for up to 12 months. LRC were widely distributed across the heart; however, they showed a predominant localization at the ventricular tip and in the atria. LRC were mostly negative for differentiation markers of cardiac cell myocytes, endothelial and smooth muscle cells, fibroblasts ; . A FACS-based method was set up to sort viable LRC that are currently kept in cell culture to investigate their in vitro proliferation and differentiation potential. Cardiac cells expressing stem cell antigen-1 Sca-1 ; , which accounted for 9, 24, 5% of non-myocytic cells in adult mouse hearts, showed a 2.5-fold enrichment in LRC, as compared to Sca-1-negative cells. In conclusion, the adult mouse heart contains LRC that retain the BrdU label for more than 1 year, a typical feature of stem cells. Enrichment of Sca-1-positive cardiac cells for the LRC subset also support the hypothesis that LRC are candidate cardiac-resident stem cells. This remains to be established by clonogenic analysis of the LRCs, because alpazolam without prescription.
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Ozdemir V, Naranjo CA, Herrmann N, Shulman RW, Sellers EM, Reed K, Kalow W The extent and determinants of changes in CYP2D6 and CYP1A2 activities with therapeutic doses of sertraline J Clin Psychopharmacol 1998 Feb; 18 1 ; : 55-61 von Moltke LL, Greenblatt DJ, Cotreau-Bibbo MM, Harmatz JS, Shader RI. Inhibitors of alprazolam metabolism in vitro: effect of serotonin-reuptake-inhibitor antidepressants, ketoconazole and quinidine. Br J Clin Pharmacol 1994 Jul; 38 1 ; : 23-31 Kobayashi K, Yamamoto T, Chiba K, Tani M, Ishizaki T, Kuroiwa Y The effects of selective serotonin reuptake inhibitors and their metabolites on S-mephenytoin 4'-hydroxylase activity in human liver microsomes Br J Clin Pharmacol 1995 Nov; 40 5 ; : 481-5 von Moltke LL, Greenblatt DJ, Duan SX, Schmider J, Kudchadker L, Fogelman SM, Harmatz JS, Shader RI. Phenacetin O-deethylation by human liver microsomes in vitro: inhibition by chemical probes, SSRI antidepressants, nefazodone and venlafaxine. Psychopharmacology Berl ; 1996 Dec; 128 4 ; : 398-407 and atenolol and alprazolam.
Assistant Professor of Psychiatry, Mount Sinai School of Medicine, New York, NY. The following authors are also affiliated with MIRECC: Dr. Robert S. Kern, Dr. Jim Mintz, Dr. William C. Wirshing, Dr. Donna Wirshing.
Trimipramine, Cont. ; 5 Mestranol, 1259 2 Metaraminol, 1143 2 Methoxamine, 1143 5 Methyldopa, 855 5 Methylphenidate, 1268 2 Norepinephrine, 1143 3 Pentobarbital, 1252 5 Perphenazine, 1270 1 Phenelzine, 1267 3 Phenobarbital, 1252 5 Phenothiazines, 1270 2 Phenylephrine, 1143 3 Primidone, 1252 5 Prochlorperazine, 1270 5 Promazine, 1270 4 Propafenone, 1271 5 Quinestrol, 1259 1 Quinolones, 1274 2 Rifabutin, 1275 2 Rifampin, 1275 2 Rifamycins, 1275 3 Secobarbital, 1252 2 Sertraline, 1276 1 Sparfloxacin, 1274 2 Sympathomimetics, 1143 5 Thioridazine, 1270 5 Thyroid, 1278 5 Thyroid Hormones, 1278 1 Tranylcypromine, 1267 5 Trifluoperazine, 1270 5 Triflupromazine, 1270 2 Valproate Sodium, 1279 2 Valproic Acid, 1279 Trimox, see Amoxicillin Trimpex, see Trimethoprim Triostat, see Liothyronine Triphasil, see Contraceptives, Oral Triptone, see Scopolamine Trofan, see L-Tryptophan Troglitazone, 4 Anisindione, 143 4 Anticoagulants, 143 2 Bile Acid Sequestrants, 1281 2 Cholestyramine, 1281 2 Contraceptives, Oral, 364 1 Cyclosporine, 426 4 Dicumarol, 143 4 Warfarin, 143 Troleandomycin, 2 Alprazolam, 196 2 Aminophylline, 1204 1 Anticoagulants, 109 1 Antihistamines, Nonsedating, 154 1 Astemizole, 154 2 Benzodiazepines, 196 2 Buspirone, 262 1 Carbamazepine, 284 1 Cisapride, 316 2 Contraceptives, Oral, 365 2 Corticosteroids, 375 2 Cyclosporine, 405 2 Diazepam, 196 1 Dihydroergotamine, 531 1 Ergot Alkaloids, 531 1 Ergotamine, 531 4 Fluoxetine, 1057 2 Methylprednisolone, 375 2 Midazolam, 196 2 Oxtriphylline, 1204 4 Paroxetine, 1057 1 Pimozide, 956 2 Rifabutin, 804 2 Rifampin, 804 2 Rifamycins, 804 and atrovent.
Interpreting Empirical Evidence Although we are not yet at this stage with our current research project in Tibet, issues of translation across cultures also pertain to the ways in which data will be analyzed and empirical results interpreted. Previous research by members of our Research Committee, and other scholars of Tibetan medicine serve as useful examples of how different cultural and medical traditions.
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1. George, B. K.; Goodman, L. S. The Pharmacological Basis of Therapeutics, 3rd ed., The Macmillan Company: New York, 1965, p. 427. 2. Brandsteterova, E.; Kubalec, P.; Krajnak, K.; Skacani, I.; Neoplasma 1996, 43, 107. Hollenbach, E.; Schulz, C.; Lehnert, H.; Life Sci. 1998, 63, 737. Lakshmana, M. K.; Raju, T. R.; Anal. Biochem. 1997, 246, 166. Sharma, C.; Mohanty, S.; Kumar, S.; Rao, N. G.; Analyst 1996, 121, 19631. Chang, H. T.; Yeung, E. S.; Anal. Chem. 1995, 67, 1079. Ragab, G. H.; Nohta, H.; Kai, M.; Ohkura, Y.; Zaitsu, K.; J. Pharm. Biomed. Anal. 1995, 13, 645. Unceta, N.; Rodriguez, E.; de Balugera, Z. G.; Sampedro, C.; Goicolea, M. A.; Barrondo, S.; Salles, J.; Barrio, R. J.; Anal. Chim. Acta 2001, 441, 211. Ricebery, L. J.; Vanuis, H. V.; Levin, L.; Anal. Biochem. 1974, 60, 551. Hu, S.; Li, P.B.; Cheng, J. K.; Fenxi. Shiyanshi. 1996, 15, 1. Aman, T.; Khan, I. U.; Aslam, N.; Ahmed, I.; Anal. Lett. 1998, 31, 1007. Kothari, Y. K.; Srinivasalu, K.; Asian J. Chem. 1989, 1, 42. Biryuk, A.; Petrenko, V. V.; Zorya, B. P.; Farm. Zh. Kiev ; 1992, 2, 57. Mohamed, W. I.; Salem, F. B.; Anal. Lett. 1984, 17, 191 and altace.
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