Adverse Effects of Antipsychotic AgentsCunningham Owens, Dr
doi: 10.2165/00003495-199651060-00001pmid: 8736614
Although antipsychotic drugs are effective in treating the so-called positive features of schizophrenia, between one-quarter and one-third of patients respond poorly. Furthermore, the incidence of adverse effects is high, especially those reflecting disruption of extrapyramidal function, and is a major source of non-compliance. There is a clear need for new compounds that are more efficacious and/or better tolerated. Until recently, the classical dopamine hypothesis, with its emphasis on D2 blockade as the key mechanism of antipsychotic action, dominated drug development, though the emphasis is now shifting. Three ‘new’ antipsychotics have reached the international market in the past 5 years — the newly rehabilitated Clozapine and the genuinely new remoxipride and risperidone. Claims of enhanced tolerability have been made for each of these, but as none is free from adverse effects, their place in treatment can only be meaningfully established in relation to the efficacy of each in different clinical situations.
Drug Therapy of Non-Insulin-Dependent Diabetes Mellitus in the ElderlyMooradian, Arshag
doi: 10.2165/00003495-199651060-00002pmid: 8736615
Non-insulin-dependent diabetes (NIDDM) is a common problem in the elderly. The discovery of several classes of oral antidiabetic agents has increased the prospects of achieving better control of hyperglycaemia with reduced risk of severe adverse events. Some of these agents, such as acarbose or miglitol, do not cause hypoglycaemia and act locally in the gut. As such they are safer agents. On the other hand, the low cost of some sulphonylurea agents and a once or twice daily administration schedule make them an attractive option. Metformin appears to be especially useful in obese insulin-resistant patients with NIDDM. However, obesity is not as much of a problem in the elderly as it is in middle-aged patients, and contraindications to the use of metformin are common in the elderly. The use of a combination of 2 or 3 oral antidiabetic agents to delay the need for insulin therapy is now possible. The long term effects of this approach are not known and the cost of polypharmacy is of concern.
The Thrombocytopenic PurpurasGillis, Shmuel
doi: 10.2165/00003495-199651060-00003pmid: 8736616
Idiopathic thrombocytopenic purpura (ITP) and thrombotic thrombocytopenic purpura (TTP), are distinct entities. ITP is a relatively common autoimmune disorder typically manifesting with isolated thrombocytopenia. The acute form, more common in children, is a self-limiting, often post-viral disease. Therapy, if indicated, usually consists of a brief course of steroids or intravenous IgG. Chronic ITP, more common in adults, rarely remits spontaneously. Most patients respond initially to steroids, j but generally the disease relapses when steroids are tapered. Splenectomy offers a 70% chance of cure. A variety of treatment options exist for patients not responding to splenectomy. The treating physician must choose the most effective and least toxic treatment for the individual patient.
Diagnosis and Drug Therapy of ProlactinomaCiccarelli, Enrica; Camanni, Franco
doi: 10.2165/00003495-199651060-00004pmid: 8736617
A prolactin-secreting pituitary tumour is the most frequent cause of hyperprolactinaemia that commonly occurs in clinical practice. Prolactinomas occur more frequently in women than in men and may differ in size, invasive growth and secretory activity. At presentation, macroadenomas are more frequently diagnosed in men. Specific immunohistochemical stains are necessary to prove the presence of prolactin in the tumour cells. The main investigations in the diagnosis of a prolactin-secreting adenoma are hormonal and radiological. As prolactin is a pulsatile hormone, it is a general rule to obtain several blood samples by taking a single sample on 3 separate days or 3 sequential samples (every 30 minutes) in restful conditions. Prolactin levels of 100 to 200 μg/L are commonly considered diagnostic for the presence of a prolactinoma; however, prolactinoma cannot be excluded in the presence of lower levels, and prolactin levels >100 μg/L are present in some patients with idiopathic hyperprolactinaemia.
Practical Guidelines for the Treatment of CholeraSeas, Carlos; DuPont, Herbert; Valdez, Luis; Gotuzzo, Eduardo
doi: 10.2165/00003495-199651060-00005pmid: 8736618
Cholera is a dramatic clinical illness that requires rapid diagnosis and aggressive therapy. Clinical signs and symptoms of mild, moderate and severe dehydration must be determined, before beginning fluid therapy. Fluid therapy has 2 phases: rehydration (first 3 to 4 hours to correct deficits) and maintenance (to match continuing losses). The route and speed of fluid administration will depend on the degree of dehydration. Patients with severe dehydration should be treated intravenously, as should thpse patients who do not tolerate oral rehydration solution (ORS). Ringer’s lactatje is the preferred intravenous solution, although normal saline may be used alohg with ORS. For most patients with cholera, an ORS using one of the higher sodium-containing solutions and plain water optimally provide the fluid and salt needed. Close monitoring of intake, outputs and hydration status should be performed for all patients. Antimicrobial therapy should be given to moderately and severely ill patients in order to decrease the volume of fluids lost and to shorten the period of excretion of vibrios.