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1
Asadi-Pooya, Ali A., and Michael R. Sperling. Antiseizure Medications. 3rd ed. Oxford University Press, 2022. http://dx.doi.org/10.1093/med/9780197541210.001.0001.
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Abstract The prevalence of epilepsy ranges between 0.6% and 1%, and perhaps 70 million worldwide suffer from this condition. The mainstay of treatment is drug therapy. In the past decade, many new antiseizure medications (ASMs) have been introduced, so that there are now approximately 30 medications available to treat epilepsy. The healthcare provider therefore has many choices. However, having many alternatives also allows for the possibility of choosing an inappropriate or a suboptimal agent. For most seizures, there is little difference in efficacy between the different agents, and other factors chiefly influence drug selection. These include the potential adverse effects, comorbid conditions, concomitant medications, age, and gender, among others. The choice of medication should be guided by knowledge and familiarity with the ASMs. This book is designed as a practical tool for physicians and other healthcare providers. While the authors include a brief formal discussion of the basic pharmacology of each ASM, this text emphasizes how to select and use ASMs in a variety of clinical contexts. The authors discuss choosing drugs when faced with various medical comorbidities; how to correctly prescribe, titrate, and taper drugs; how to monitor drug efficacy and side effects; how to diagnose and manage toxicity; interactions with other drugs; and other relevant issues. The text is designed to fill an unmet need and should lead to improved patient care.
2
Castle, David J., Peter F. Buckley, and Fiona P. Gaughran. Effects of antipsychotic medications on physical health. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198811688.003.0006.
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Antipsychotic medications are a crucial part of the core platform upon which effective treatments for schizophrenia are built. While the marketed agents have established efficacy for reduction in the symptoms of schizophrenia, they all carry some side effects. Such effects differ across medications and between individuals. Prescribers need to be aware of the side effect profile of the medications they use, and ensure patients are also aware, so that a true shared decision-making model can be followed in terms of medication choice. Appreciation of long-term risk is required, with treatment choice in the short term having a view to the long term.
3
Lynch, Tara A., and J. Christopher Glantz. Seizure Medications Effects on Fetus, Neonate, and Lactation. Edited by Emma Ciafaloni, Cheryl Bushnell, and Loralei L. Thornburg. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190667351.003.0021.
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Medication use in pregnancy requires a careful balance between the risks of fetal teratogenicity and the maternal benefits of disease treatment. For women with epilepsy, there are many antiepileptic medications available for use in pregnancy. Each varies in their safety profile, risk for fetal anomalies, and effectiveness of seizure control. In most scenarios, the benefits of maternal treatment outweigh the risk of fetal effects, especially in cases of refractory epilepsy or severe disease. Many of the newer anti-epileptic drugs appear to have less teratogenic risk than the older medications. The ideal AED is one that is effective from the woman, is least teratogenic, and used at the lowest possible dose. Overall, a detailed understanding of antiepileptic efficacy, the pharmacologic differences in pregnancy, and the potential adverse fetal effects are required for optimal treatment of pregnant patients with epilepsy.
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Mecca, Adam P., and Rajesh R. Tampi. Risk of Death with Atypical Antipsychotic Medications for Dementia. Edited by Ish P. Bhalla, Rajesh R. Tampi, Vinod H. Srihari, and Michael E. Hochman. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190625085.003.0016.
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This chapter provides a summary of a landmark meta-analysis that investigated the risks of atypical antipsychotic use to treat psychosis, aggression, or agitation in patients with dementia. The chapter briefly reviews the study design, as well as implications and limitations. A relevant clinical case concludes the chapter. In summary, atypical antipsychotic use for 6 to 26 weeks was associated with increased risk of death (Odds Ratio of 1.54 for antipsychotic vs placebo). There were no differences in risk between individual medications, disease severity, indication for antipsychotic, or treatment setting. In patients with psychosis, agitation, or aggression due to dementia, the efficacy of atypical antipsychotics is questionable and their use comes with considerable risks of side effects and adverse events.
5
Yarnell, Eric, Kathy Abascal, and G. M. D. Hooper Carol. Botanical Medicine: Efficacy, Quality Assurance and Regulation. Mary Ann Liebert, 1999.
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6
Lam, Raymond W. Pharmacotherapy. Oxford University Press, 2012. http://dx.doi.org/10.1093/med/9780199692736.003.0007.
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• The newer antidepressants (SSRIs, SNRIs, other receptor agents) are first-line medications due to improved safety and tolerability over first-generation medications (TCAs, MAOIs).• Selection of an antidepressant must take into account efficacy, depression subtype, safety, side effect profile, simplicity of use, comorbid conditions, concurrent medications, and cost....
7
McKay, James R., Henry R. Kranzler, Kyle M. Kampman, Rebecca L. Ashare, and Robert A. Schnoll. Psychopharmacological Treatments for Substance Use Disorders. Oxford University Press, 2015. http://dx.doi.org/10.1093/med:psych/9780199342211.003.0024.
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The treatment of substance use disorders with medications is well established, although most experts agree that pharmacological interventions must be combined with psychosocial therapies. Many type 1 and type 2 controlled trials have shown that the use of nicotine replacement therapy significantly increases abstinence rates. Non-nicotine treatments, such as bupropion and varenicline, have been found in controlled trials to significantly increase abstinence rates. The treatment of alcohol use disorder can be enhanced by three approved medications with different mechanisms of action: disulfiram, naltrexone, and acamprosate. Methadone maintenance treatment has consistently shown efficacy in the treatment of opioid dependence, and buprenorphine has substantially expanded the options for treating the disorder. Although double-blind, placebo-controlled clinical trials of several medications have provided initial evidence of efficacy for cocaine use disorder, efficacy has not yet been shown in multisite trials.
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Guastella, Adam J., Alice Norton, Gail A. Alvares, and Yun Ju Christine Song. Current and Experimental Treatments for Anxiety Disorders. Edited by Dennis S. Charney, Eric J. Nestler, Pamela Sklar, and Joseph D. Buxbaum. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190681425.003.0040.
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There are currently a range of treatments available for anxiety disorders, including pharmacological and behavior-based therapies. The most widely used medications, for which there is considerable evidence of efficacy across a range of anxiety disorders, are the serotonin-selective reuptake inhibitor antidepressants. Benzodiazepines are also widely prescribed and show efficacy for acute anxiety, but their use in the treatment of chronic anxiety syndromes is more problematic. Many patients are not adequately covered by the available range of medications, which is driving interest in potentially new pharmacological approaches. The best established non-pharmacological treatment of anxiety is cognitive behavioral therapy and several related behavioral approaches, which have been shown to be efficacious in a range of anxiety disorders. One of these related approaches is called cognitive bias modification, which aims to alter an individual’s responses to anxiety-provoking stimuli.
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Dittmann, Ralf W., Alexander Häge, Juan D. Pedraza, and Jeffrey H. Newcorn. Non-stimulants in the treatment of ADHD. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198739258.003.0042.
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The psychostimulants methylphenidate and amphetamine are the most effective and frequently prescribed medications for ADHD. But these agents also have certain limitations; for example, they are controlled substances, and a proportion of patients do not achieve optimal symptom response, or they do not tolerate treatment well. There are two classes of regulatory-approved non-stimulant medications for ADHD, the selective norepinephrine reuptake inhibitors (atomoxetine) and the long-acting alpha-2 adrenergic agonists (guanfacine and clonidine). In addition, several other medication classes have been used off-line with reported efficacy, while others are in clinical development. While the non-stimulant medications are, on average, not as effective as the psychostimulants, they can be very helpful in treating certain patients with ADHD (and respective comorbidities)—either as monotherapy or as adjunctive agents. This chapter reviews a selection of current non-stimulant medications that are clinically used or studied for ADHD.
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Nasrallah, Henry A., and Priyanka Sarihan. The Use of Antipsychotics in PTSD. Edited by Charles B. Nemeroff and Charles R. Marmar. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190259440.003.0036.
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Psychosis is one of the manifestations of the post-traumatic stress Disorder (PTSD) syndrome. Several controlled and uncontrolled trials have been published about the efficacy and safety of second-generation antipsychotic drugs in PTSD. In this chapter, we review the various studies and provide data related to the management of psychotic symptoms in the context of PTSD. Most second-generation antipsychotic agents exert efficacy in PTSD, with varying degrees of tolerability and safety. In many cases, they may be used in combination with other medications targeting depression and anxiety, the most common symptom clusters in PTSD.
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Johnson, Kevin, and Srinivas Muvvala. Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence. Edited by Ish P. Bhalla, Rajesh R. Tampi, Vinod H. Srihari, and Michael E. Hochman. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190625085.003.0049.
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This chapter provides a summary of the Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence Study. This landmark study researches the efficacy of medications, behavioral therapies, and their combinations in the treatment of alcohol use disorder. Starting with the research question, this review describes the basics of the study, including funding, study location, who was studied, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. One key finding is the efficacy of naltrexone at lowering the number of heavy alcohol consumption days. The chapter briefly reviews other relevant studies and information, discusses implications, provides clinical guidelines, and concludes with a relevant clinical case.
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Castle, David J., Peter F. Buckley, and Fiona P. Gaughran. Interventions for metabolic problems in people with schizophrenia. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198811688.003.0008.
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To address the risk factors associated with early death in people with schizophrenia, a comprehensive framework is required. This is required to address individuals, systems, and the community. A number of specific frameworks are available to provide better physical health treatments for people with schizophrenia. The most effective of these embrace elements of self-management and self-efficacy. The engagement of patients, carers, and clinicians requires concerted work and effective communication. Peer workers can play a particular role. Various medications can also be used to address specific aspects of the metabolic syndrome in particular, and care should be taken to try to choose (where feasible) antipsychotic medications with the lowest possible risk of metabolic syndrome.
13
Chan, Jonathan, and Nigil Haroon. Treatment: NSAIDs. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198734444.003.0020.
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Non-steroidal anti-inflammatory drugs (NSAIDs) constitute a diverse group of medications that inhibit prostaglandin synthesis. NSAIDs form the first-line pharmacological therapy in ankylosing spondylitis (AS). A number of randomized controlled trials (RCTs) support the efficacy of NSAIDs in reducing pain and improving patient function. Head-to-head comparisons have demonstrated equivalent effect of different NSAIDs in symptom control. The proposed disease-modifying potential of regular NSAID therapy is debatable and recent literature provides evidence to the contrary. Several safety concerns have been raised regarding long-term use of NSAIDs, especially an increase in cardiovascular risk. This chapter discusses the pharmacology, efficacy in treatment of AS, disease-modifying potential, and safety concerns of NSAIDs.
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Dougherty, Darin D., Scott L. Rauch, and Michael A. Jenike. Pharmacological Treatments for Obsessive Compulsive Disorder. Edited by Gail Steketee. Oxford University Press, 2012. http://dx.doi.org/10.1093/oxfordhb/9780195376210.013.0061.
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Progress in treating OCD has accelerated in recent years. Effective first-line treatments include behavior therapy and medications, with overwhelming evidence supporting the efficacy of serotonergic reuptake inhibitors (SRIs). Second-line medication treatments for OCD include augmentation of SRIs with neuroleptics, clonazepam, or buspirone, with limited support for other strategies at present. Alternative monotherapies (e.g., buspirone, clonazepam, phenelzine) have more limited supporting data and require further study. Behavior therapy, and perhaps cognitive therapy, is as effective as medication and may be superior in risks, costs, and enduring benefits. Future rigorous research is needed to determine which patients respond preferentially to which medications, at what dose, and after what duration. Emerging treatments include new compounds acting via serotonergic, dopaminergic, glutamatergic, and opioid systems.
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Sayal, Puneet, and Jianren Mao. Opioids in Spine Pain: Indications, Challenges, and Controversies. Edited by Mehul J. Desai. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199350940.003.0029.
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Opioid medications are commonly used in the treatment of spine-mediated pain. They are used on a chronic, long-term basis, and their use is on the rise. The available evidence supports their use for short periods if much effort is put into patient and opioid selection, and with close monitoring. Challenges include numerous adverse effects, aberrant behaviors, and the comfort and skill set of providers. Controversies surrounding the chronic use of opioids center on the inconclusive evidence regarding long-term efficacy and safety. More research is necessary to determine whether these medications are appropriate, efficacious, and safe over the long term, and also to aid providers in managing patients on chronic opioids in terms of patient and opioid selection, risk stratification, monitoring, and discontinuation/weaning.
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Wiffen, Philip, Marc Mitchell, Melanie Snelling, and Nicola Stoner. Herbal medicines. Oxford University Press, 2012. http://dx.doi.org/10.1093/med/9780199603640.003.0008.
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Herbal drugs 150General information about commonly used herbal medications 154Chinese herbal medicine 157Herbal interactions 158Perioperative considerations for herbal drugs 160The efficacy and safety of herbal drugs present a number of issues to pharmacists. Herbal drugs are more often complex mixtures of active constituents that vary in quality for a number of reasons, such as environmental and genetic factors. Furthermore, the constituents responsible for the claimed therapeutic effects are frequently unknown or only partly explained....
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Howlett, Jonathon R., and Murray B. Stein. Novel Prevention and Treatment Approaches to PTSD. Edited by Israel Liberzon and Kerry J. Ressler. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780190215422.003.0021.
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Current therapeutic and preventive interventions for post-traumatic stress disorder (PTSD) have important limitations in terms of efficacy and tolerability. Translational research based on animal models of fear extinction and the stress response has yielded a number of new targets for investigation in clinical studies. Novel treatment approaches include new medications, psychotherapies, and the combination of exposure-based therapies with medications to enhance fear extinction. PTSD prevention represents a major opportunity, and preventive interventions can also be informed by basic neurobiology. Despite potentially useful new therapeutic and prevention approaches, the pace of clinical studies has been slow, and the evidence for most novel interventions is sparse. Given the urgent clinical need, more resources should be directed to clinical trials to fulfill the promise of translational research for this disorder.
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Wenzel, Amy, and Deborah Kim. Psychopharmacology in Pregnancy and the Postpartum Period. Edited by Amy Wenzel. Oxford University Press, 2015. http://dx.doi.org/10.1093/oxfordhb/9780199778072.013.21.
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A substantial minority of pregnant and lactating women meet criteria for one or more mental health disorders and, in many of these cases, treatment with psychotropic medication is indicated. Data from empirical studies on psychopharmacology using antidepressant medications for perinatal women suggest that the risk-benefit ratio is favorable, although their usage during pregnancy is associated with a slight increase in risk of spontaneous abortion, cardiac malformations (specifically with paroxetine), preterm birth, and poor neonatal adaptation syndrome. However, these risks should be contrasted with the fact that women with moderate to severe depression who have had multiple lifetime episodes have a substantial relapse rate if they stop taking their antidepressant during pregnancy. There is more limited research on the use of other classes of psychotropic medications during pregnancy and the postpartum period. Future research should establish the efficacy and risk-benefit profile of psychotropic medications for the broad array of mental health disorders during pregnancy and lactation, as well as for postpartum mental health disorders other than depression.
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Serpell, Mick G. Antineuropathic medication combination therapy. Edited by Paul Farquhar-Smith, Pierre Beaulieu, and Sian Jagger. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198834359.003.0068.
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The landmark paper discussed in this chapter is ‘Morphine, gabapentin, or their combination for neuropathic pain’, published by Gilron et al. in 2005. Although combination drug therapies for neuropathic pain had long been suggested, this seminal paper provided the first evidence for efficacy of combination therapy of mechanistically distinct medications in analgesia, using morphine in combination with gabapentin in post-herpetic neuralgia or diabetic neuropathy. Combination therapy had greater efficacy than gabapentin alone and was equally effective as morphine alone but with a lower dose of morphine; however, this did not seem to translate into reduced side effects. To this day, precious little is known about what are the most effective combinations for neuropathic pain, and the need for large randomized controlled trials in this area is still as pressing it was back in 2005.
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Faraone, Stephen V., Pradeep G. Bhide, and Joseph Biederman. Neurobiology of Attention Deficit Hyperactivity Disorder. Edited by Dennis S. Charney, Eric J. Nestler, Pamela Sklar, and Joseph D. Buxbaum. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190681425.003.0064.
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Attention deficit hyperactivity disorder (ADHD) is a prevalent, early-onset and persistent disorder of inattention, hyperactivity, and impulsivity. The mechanisms of action of ADHD medications, neuroimaging studies, and studies of monoamine systems and animal models suggest that dysregulation of catecholaminergic neurotransmission in cerebellar-corticostriatal circuits plays a key role in the pathophysiology of ADHD. The efficacy of ADHD medications likely arises from their differing profile of effects on (a) dopaminergic and noradrenergic systems and (b) the localization of these effects in prefrontal cortex and striatum. ADHD has a very high heritability, and although molecular genetic studies have found no causal common DNA variants yet, they have found strong evidence that rare duplications and deletions are risk factors for ADHD. Environmental risk factors, especially those that impact early neurodevelopment (i.e., exposure to cigarette smoking and alcohol during pregnancy), also influence susceptibility to ADHD.
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Geracioti, Thomas D., Jeffrey R. Strawn, and Matthew D. Wortman. Mechanisms of Action in the Pharmacology of PTSD. Edited by Israel Liberzon and Kerry J. Ressler. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780190215422.003.0020.
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This chapter reviews medications currently available for PTSD in the context of their mechanisms of action, pathophysiological relevance, and clinical efficacy data. It systematically reviews aminergic mechanisms in PTSD pharmacology, including commonly used serotonin and norepinephrine agents, selective reuptake inhibitors and receptors drugs, as well as dopaminergic agents and psychostimulants. It also discusses the use of anticonvusants and antianxiety agents that modulate GABAergic and glutamatergic signaling, such as carbamazepine, VPA, benzodiazepines, gabapentine, and others. It also reviews other clinically available agents as well as HPA axis-modulating compounds, both for treatment and secondary prevention of PTSD. It concludes with the suggestion that clinical selection of one or more of these medications for PTSD should be based on individual patient considerations, including target symptoms, PTSD subtype, post-traumatic interval, comorbidities, genotypes for CYP450 enzymes, and genetic polymorphisms of clinical relevance.
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Zuddas, Alessandro, Tobias Banaschewski, David Coghill, and Mark A. Stein. ADHD treatment. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198739258.003.0041.
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Stimulants are effective medications and should be used as one of the main pharmacological options for the management of ADHD in children, adolescents, and adults. They all inhibit catecholamine uptake, but they differ for specific aspects of the mechanism of action, pharmacokinetics, as well as on efficacy for specific patients. Short-term efficacy in reducing ADHD symptoms is well established, as is the safety profile for these agents. There is increasing evidence that ADHD symptom improvement generally translates or corresponds to improved functioning and quality of life. Stimulant treatment should be based on a comprehensive assessment and diagnosis, including full medical history and physical examination, and it should always be part of a comprehensive treatment plan that includes psychological, behavioural, and educational advice and interventions. Medication treatment should be closely monitored for both common and unusual (but potentially serious) adverse events.
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Nutt, David J., and Liam J. Nestor. The GABA system and addiction. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198797746.003.0008.
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Research points to the potential role of gamma-aminobutyric acid (GABA) in substance addiction. GABA is the major inhibitory neurotransmitter in the brain. Disturbances in the GABA system may predate substance abuse and addiction, whereby its efficacy to modulate other neurotransmitter systems (e.g. dopamine) strongly implicated in substance addiction behaviours is impaired. There are a number of addictive substances that boost GABA functioning, however, such as alcohol and benzodiazepines. Medications that boost the availability of GABA or mimic its effects at receptors may possess some clinical potential in treating addiction, but also have abuse liability.
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Gourlay, Douglas L., and Howard A. Heit. The Use of Drug Testing in Promoting Treatment Adherence in Pain Medicine. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190600075.003.0004.
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Drug testing has become an important component of a comprehensive risk assessment and mitigation program when prescribing controlled substances to patients with chronic pain. State and federal opioid prescribing guidelines strongly recommend the use of drug testing, although there is lack of evidence in the literature supporting the efficacy of drug testing in reducing prescription opioid abuse. Drug testing can be useful in facilitating adherence to prescribed medications. This chapter provides an overview of the strengths and weaknesses of drug testing in pain medicine, insights into laboratory and test selection, test interpretation, and communicating results to patients within a patient-centered model.
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Sano, Mary, and Judith Neugroschil. Current Treatments for Alzheimer’s Disease. Edited by Dennis S. Charney, Eric J. Nestler, Pamela Sklar, and Joseph D. Buxbaum. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190681425.003.0057.
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Five medications representing two classes of drugs have been approved by the US Food and Drug Administration for the treatment of Alzheimer’s disease since 1994. There have been no new approved agents since 2003, although hundreds of clinical trials are in progress. This chapter reviews the pharmacology underlying the currently approved treatments, acetylcholinesterase inhibitors and the NMDA receptor antagonist memantine, and the data supporting their efficacy. Other approaches currently in use or being developed are also reviewed, including the use of hormones, agents that modify cardiovascular and metabolic risk, as well as a number of vitamin supplements and nutritional approaches.
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Willment, Kim, and David Loring. Practical and Diagnostic Challenges for the Neuropsychologist. Edited by Barbara A. Dworetzky and Gaston C. Baslet. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190265045.003.0009.
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The objective of this chapter is to outline practical and diagnostic challenges in the clinical neuropsychological evaluation of patients with psychogenic nonepileptic seizures (PNES) and to aid neuropsychologists in developing a consistent decision-making protocol. Challenges outlined include responding to performance validity test (PVT) failures, testing in different clinical environments, medications effects, acute psychological distress, and length of evaluations. Diagnostic challenges related to the neuropsychological evaluation in PNES, including the lack of specificity of cognitive profiles and psychopathological heterogeneity, are discussed. The final focus of the chapter is therapeutic goals of the neuropsychological evaluation, particularly the integration of the neuropsychological findings during the delivery of the PNES diagnosis and promoting cognitive self-efficacy.
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Nutt, David J., and Liam J. Nestor. The glutamate system and addiction. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198797746.003.0009.
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Glutamate is the primary excitatory neurotransmitter in the brain. Glutamate is involved in synaptic plasticity, particularly within dopamine systems of the brain that are involved in reward. Glutamate-dependent plasticity is involved in the development of substance addiction through its actions at NMDA receptors during long-term potentiation (LTP) related learning and memory processes. This plasticity within brain circuitry involved in learning and memory is sustained during substance abstinence and may provide a neural substrate for a vulnerability to addiction relapse. Medications that possess the efficacy to reduce glutamate tone in certain brain circuits may reduce craving, and ultimately, relapse in substance dependence. Further research is required, however, to show that the modulation of glutamate transmission in the brain confers clinical benefits in substance addiction.
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Ross, Lisa. Electroconvulsive Therapy. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190495756.003.0029.
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The anesthetic management of patients who receive electroconvulsive therapy (ECT) for various psychiatric conditions in both the inpatient and the outpatient settings must take into account a number factors, such as its associated physiologic responses, existing comorbidities, medication management, monitoring, complications, and contraindications in order for it to remain a safe procedure. This chapter reviews the indications for ECT, the preprocedure anesthetic evaluation; theories regarding the therapeutic mechanism of action leading to the efficacy of ECT; cerebrovascular, cardiovascular, and neuroendocrine responses and monitoring standards. Furthermore, it discusses the selection of medications for induction, inhalational agents, and muscle relaxants as well as common drug interactions and premedication practices. The chapter culminates with an assessment of the morbidity and mortality associated with ECT both anesthetic and nonanesthetic related.
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Fleischmann, Roy. Signalling pathway inhibitors. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199642489.003.0081.
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Oral, small-molecule signalling pathway inhibitors, including ones that inhibit the JAK and SyK pathways, are currently in development for the treatment of rheumatoid arthritis (RA). Tofacitinib is an orally administered small-molecule inhibitor that targets the intracellular Janus kinase 3 and 1 (JAK1/3) molecules to a greater extent than JAK2 while baricitinib (formerly INCB028050) predominantly inhibits JAK1/2. Many of the proinflammatory cytokines implicated in the pathogenesis of RA utilize cell signalling that involves the JAK-STAT pathways and therefore inhibition of JAK-STAT signalling, by targeting multiple RA-associated cytokine pathways, has the potential to simultaneously reduce inflammation, cellular activation, and proliferation of key immune cells. Fostamatinib disodium is an orally available inhibitor of spleen tyrosine kinase (SyK), which is a cytoplasmic tyrosine kinase that is an important mediator of immunoreceptor signalling in mast cells, macrophages, neutrophils, and B cells. Interruption of SyK signalling may interrupt production of tumour necrosis factor (TNF) and metalloproteinase and therefore affect RA disease activity. Tofacitinib has been investigated in multiple phase 2 and phase 3 trials which have investigated its efficacy (clinical, functional, and radiographic) and safety in patients who have failed disease-modifying anti-inflammatory drugs (DMARDs) as monotherapy or in combination with DMARDs, compared to an inhibitor of tumour necrosis factor alpha (TNFα) and in patients who have failed TNFα inhibitors. The efficacy of fostamatinib and baricitinib has been investigated in phase 2 trials; both are in large phase 3 clinical programmes. Each of these medications has demonstrated efficacy; their safety profile has been shown to be different from each other and from currently approved biological agents. This chapter discusses what is currently known and understood about their efficacy and safety.
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Fozdar, Manish A., and Jacob C. Holzer. Psychopharmacological Agents, Side Effects, and Black Box Warnings. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199374656.003.0015.
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From a medical-legal viewpoint, psychopharmacological management in the elderly population requires a multifaceted, comprehensive approach, involving a detailed clinical diagnostic assessment, an awareness of a patient’s current medical status, risk factors, and an understanding of the risks and benefits of various treatment options. Several risk management strategies can be employed as part of the treatment process, which are reviewed in this chapter. Special attention is needed in the pharmacological management of the elderly population with respect to efficacy and risk as well as polypharmacy. It is important that clinicians have a broad understanding of the different medication classes, including antidepressants, antipsychotics, mood stabilizers, cognitive-enhancing medications, benzodiazepines, sedative-hypnotics, and stimulants; specific agents; indications; kinetics; and side effects in both the clinical management of elderly patients and in medical-legal consultation.
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Nutt, David J., and Liam J. Nestor. The opioid system and addiction. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198797746.003.0010.
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The opioid system of the brain is the major target for opiate drugs such as morphine and heroin, and has been implicated in processes such as pain, stress and reward. Many of these effects take place at the mu opioid receptor (mOR), which is distributed throughout the brain. Significantly, genetic polymorphisms at the mOR may confer a greater dopamine response to the reinforcing effects of alcohol, and it has been suggested that addiction per se may be associated with alterations to the opioid system. There is evidence for the potential efficacy of mOR antagonists (e.g. naltrexone) in reducing drug and alcohol relapse, increasing treatment retention and attenuating the subjective effects of substances of abuse. Medications with partial agonist activity at the kappa opioid receptor (e.g. nalmefene) may also confer an additional clinical advantage by reducing binging following relapse.
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Abramowitz, Jonathan S., Steven Taylor, and Dean McKay. Exposure-Based Treatment for Obsessive Compulsive Disorder. Edited by Gail Steketee. Oxford University Press, 2012. http://dx.doi.org/10.1093/oxfordhb/9780195376210.013.0071.
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Exposure and response prevention (ERP) is one of the oldest and most effective treatments for obsessive compulsive disorder. The present chapter describes the empirical foundations, development, delivery, and latest research on ERP. Commonly used methods and procedural variants of ERP are described, along with findings concerning the underlying mechanisms of action. The efficacy of ERP in relation to other treatments is discussed, in addition to research on the long-term effects of ERP and its effects in non-research settings. Pretreatment predictors of the outcome of treatments using ERP are also considered. Efforts to improve treatment outcome are discussed, including research into the benefits of combining ERP with other psychosocial interventions such as cognitive therapy, or with particular medications. The chapter concludes by considering important future research directions for improving the outcome of treatment packages that include ERP.
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Tolin, David F., and Blaise L. Worden. Combining Pharmacotherapy and Psychological Treatments for OCD. Edited by Gail Steketee. Oxford University Press, 2012. http://dx.doi.org/10.1093/oxfordhb/9780195376210.013.0081.
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This chapter reviews the outcome literature on the efficacy of combined pharmacotherapy and cognitive-behavioral therapy (CBT) for obsessive compulsive disorder (OCD). By far, most research on combinations of CBT and pharmacotherapy for OCD has examined antidepressant medications, particularly those in the serotonin reuptake inhibitor (SRI) class. Quantitative review of randomized studies in which treatments were combined simultaneously indicated that combined therapy shows a small but significant advantage over exposure and response prevention (ERP) monotherapy, and a moderate advantage over pharmacologic (antidepressant) monotherapy. Studies of sequential treatment combination, in which CBT was added after a trial of antidepressant medication, suggest a significant incremental benefit of CBT, including for patients who show minimal response to antidepressant medication alone. The chapter concludes by discussing new pharmacologic possibilities for combined therapy, such as the use of D-cycloserine (DCS).
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Tolin, David F., and Blaise L. Worden. Combining Pharmacotherapy and Psychological Treatments for OCD. Edited by Gail Steketee. Oxford University Press, 2012. http://dx.doi.org/10.1093/oxfordhb/9780195376210.013.019_update_001.
Full textAbstract:
This chapter reviews the outcome literature on the efficacy of combined pharmacotherapy and cognitive-behavioral therapy (CBT) for obsessive compulsive disorder (OCD). By far, most research on combinations of CBT and pharmacotherapy for OCD has examined antidepressant medications, particularly those in the serotonin reuptake inhibitor (SRI) class. Quantitative review of randomized studies in which treatments were combined simultaneously indicated that combined therapy shows a small but significant advantage over exposure and response prevention (ERP) monotherapy, and a moderate advantage over pharmacologic (antidepressant) monotherapy. Studies of sequential treatment combination, in which CBT was added after a trial of antidepressant medication, suggest a significant incremental benefit of CBT, including for patients who show minimal response to antidepressant medication alone. The chapter concludes by discussing new pharmacologic possibilities for combined therapy, such as the use of D-cycloserine (DCS).
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Schatman, Michael E. The Demise of Interdisciplinary Chronic Pain Management and Its Relationship to the Scourge of Prescription Opioid Diversion and Abuse. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199981830.003.0010.
Full textAbstract:
Even though the efficacy of interdisciplinary pain management programs is supported, their numbers have decreased and the vast majority of Americans with chronic pain do not have access to them. Insurance companies do not want to pay for these services, hospitals believe they are financial losers, and the opioid crisis has placed a pall over the practice of pain medicine. The demise of these programs has left pain medicine in a fragmented state. Few healthcare providers who treat chronic pain patients have the time to coordinate care by multiple professionals The opioid crisis seen in certain areas, such as Appalachia, may be related to the lack of these interdisciplinary programs. There should be concerted efforts to increase access to and funding of these programs. Although they are not a panacea for all types of chronic pain, they can improve patients’ well-being and function and reduce their need for opioid medications.
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Asherson, Philip, and Josep Antoni Ramos-Quiroga. Treatment in adult ADHD. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198739258.003.0046.
Full textAbstract:
The treatment of ADHD in adults is very similar to that recommended for children and adolescents. There have been many more clinical trials evaluating the efficacy and safety of the drugs used in ADHD treatment on children than adults. Pharmacotherapy for adults with ADHD has been shown to be effective. The National Institute of Health and Care Excellence (NICE) guidelines recommend pharmacotherapy as first-line treatment for adult ADHD. The NICE guidelines consider stimulants (methylphenidate and dexamfetamine) as the first choice for treatment of adult ADHD, and the non-stimulant atomoxetine as a second-line treatment option, followed by other non-stimulant medications such as bupropion and tricyclic antidepressants. This recommendation is in line with European Consensus as determined by the European Network of Adult ADHD. Psychological treatment programmes have been developed implementing psychoeducation, cognitive–behavioural therapy, dialectical behaviour therapy, and mindfulness. Typically, psychological treatments have been added to drug treatment.
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Li, Madeline, Joshua Rosenblat, and Gary Rodin. Psychopharmacologic Management of Anxiety and Depression. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190491857.003.0005.
Full textAbstract:
Depression and anxiety are highly prevalent in patients with cancer. Defining the quality and severity of these symptoms, along with ruling out other causes for them, is required before treatment is initiated. The continuum of symptoms of depression or anxiety ranges from a normative response to more severe symptoms. Pharmacological management of depression and anxiety should be reserved for the latter, often in conjunction with psychotherapeutic interventions. Relative efficacy, adverse effects, and potential drug–drug interactions should be considered in the selection of medications. Antidepressants are first line in the treatment of both major depression and anxiety disorders. Antipsychotics may also be considered if antidepressant monotherapy yields only a partial response. Psychostimulants may be considered when time is short and when there are associated symptoms of fatigue or anergia. The short-term judicious use of benzodiazepines may also be considered for situational or severe anxiety, until an antidepressant takes effect.
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Majid, Adrian, and Bruce L. Gilliam. Future Antiretrovirals, Immune-Based Strategies, and Therapeutic Vaccines. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190493097.003.0023.
Full textAbstract:
Highly active antiretroviral therapy remains the mainstay of treatment for patients chronically infected with HIV. Novel drugs, both within existing classes and new ones, are in various stages of development and testing. New medications within existing classes of antiretroviral agents are in clinical trials and will likely offer activity against resistant HIV-1 strains and provide alternatives for combination pill therapy. Novel therapeutics including oral attachment inhibitors and monoclonal antibody treatments continue to show efficacy against HIV-1 and progress in clinical trials. Tenofovir alafenamide is a prodrug that produces higher intracellular levels of tenofovir diphosphate with likely less renal and bone toxicity. Among traditional classes of HIV treatment, both doravirine (a non-nucleoside reverse transcriptase inhibitor) and cabotegravir (an integrase strand inhibitor) are newer agents with activity against resistant virus. Maturation inhibitors are a new class of treatment that block protease cleavage, leading to the release of an immature virion.
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Nestler, Eric J. New Approaches for Treating Depression. Edited by Dennis S. Charney, Eric J. Nestler, Pamela Sklar, and Joseph D. Buxbaum. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190681425.003.0030.
Full textAbstract:
Several obstacles have impeded the introduction of new antidepressant medications over the past six decades. These obstacles include our still rudimentary knowledge of the biological basis of depression, as well as difficulties in evaluating the therapeutic efficacy of new putative antidepressant mechanisms in pathophysiologically distinct subtypes of the syndrome. Despite these obstacles, several tangible steps can be taken to advance depression treatment moving forward. The field needs to continue to take advantage of serendipitous discoveries in humans, such as the demonstration of rapid antidepressant effects of ketamine. Re-establishing experimental pharmacology in humans, to make it possible to establish the actions of new mechanisms in people, is essential, combined with the judicious use of a growing range of chronic stress models in animals. We anticipate that, with these approaches, the field can at long last breakthrough the logjam of discovery and introduce new treatments for depression over the next decade.
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Huntoon, Elizabeth. Complementary and Alternative Medicine. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190217518.003.0014.
Full textAbstract:
Complementary and alternative medicine (CAM) is a broad area that has become popular with both patients and physicians alike. Most of the CAM practices are used together with conventional therapies and therefore have been called complementary to distinguish them from alternative practices. Most of the therapies under the heading of CAM are considered safe as adjuncts or alternative treatments by the medical profession for a variety of pain problems; however, one area deserves special consideration: herbal and vitamin preparations. Herbal supplement use has risen in the past few years and patients may fail to mention that they are taking these substances. This lack of disclosure (or our lack of inquiry about supplements) may put them at risk for herb–drug interaction. The popularity of CAM therapies may be due largely to their presumed safety, efficacy, cultural acceptability, and lesser side effects compared with prescription medications.
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Wakeman, Sarah E., and Josiah D. Rich. Pharmacotherapy for substance use disorders within correctional facilities. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199360574.003.0046.
Full textAbstract:
Drug addiction treatment is increasingly complex. Only 5% of prisons and 34% of jails offer any detoxification services, and only 1% of jails offer methadone for opioid withdrawal. Even fewer facilities offer medication assisted therapy (MAT) for alcohol or substance use disorders despite the tremendous evidence base supporting the use of medications to treat addiction. Untreated opioid dependence both within corrections and in the community is associated with HIV, Hepatitis C, crime, and death by overdose. Substantial evidence argues that these risks are reduced through long-term treatment with agonist medications such as methadone and buprenorphine. Only a minority of prisoners receive any addiction treatment while incarcerated. Those that do are usually offered behavioral interventions, which when used alone have extremely poor outcomes. Although there are limited studies on the outcomes of drug treatment during incarceration, there are nearly 50 years of evidence documenting the efficacy of methadone given in the community in reducing opioid use, drug-related health complications, overdose, death, criminal activity, and recidivism. Buprenorphine is similarly an effective, safe, and cost-effective long-term treatment for opioid dependence that reduces other opioid use and improves health and quality of life outcomes. There is a growing role for MAT in jails, and to a lesser degree in prisons for the treatment of alcohol and opiate dependence. This chapter presents the current state of evidence based practice in correctional MAT models.
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Wakeman, Sarah E., and Josiah D. Rich. Pharmacotherapy for substance use disorders within correctional facilities. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199360574.003.0046_update_001.
Full textAbstract:
Drug addiction treatment is increasingly complex. Only 5% of prisons and 34% of jails offer any detoxification services, and only 1% of jails offer methadone for opioid withdrawal. Even fewer facilities offer medication assisted therapy (MAT) for alcohol or substance use disorders despite the tremendous evidence base supporting the use of medications to treat addiction. Untreated opioid dependence both within corrections and in the community is associated with HIV, Hepatitis C, crime, and death by overdose. Substantial evidence argues that these risks are reduced through long-term treatment with agonist medications such as methadone and buprenorphine. Only a minority of prisoners receive any addiction treatment while incarcerated. Those that do are usually offered behavioral interventions, which when used alone have extremely poor outcomes. Although there are limited studies on the outcomes of drug treatment during incarceration, there are nearly 50 years of evidence documenting the efficacy of methadone given in the community in reducing opioid use, drug-related health complications, overdose, death, criminal activity, and recidivism. Buprenorphine is similarly an effective, safe, and cost-effective long-term treatment for opioid dependence that reduces other opioid use and improves health and quality of life outcomes. There is a growing role for MAT in jails, and to a lesser degree in prisons for the treatment of alcohol and opiate dependence. This chapter presents the current state of evidence based practice in correctional MAT models.
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Kimmel, Ryan J., Peter P. Roy-Byrne, and Deborah S. Cowley. Pharmacological Treatments for Panic Disorder, Generalized Anxiety Disorder, Specific Phobia, and Social Anxiety Disorder. Oxford University Press, 2015. http://dx.doi.org/10.1093/med:psych/9780199342211.003.0015.
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Selective serotonin reuptake inhibitors (SSRIs) are the first-line pharmacological treatment for panic disorder based on their low rate of side effects, lack of dietary restrictions, and absence of tolerance. SSRIs and venlafaxine are attractive first-line treatments for social anxiety disorder. Pharmacological treatments of choice for generalized anxiety disorder are buspirone and antidepressants, including SSRIs and venlafaxine. Benzodiazepines, although effective for all these disorders, lack efficacy for comorbid depression and carry the risk of physiological dependence and withdrawal symptoms. Their greatest utility seems to be as an initial or adjunctive medication for patients with disabling symptoms requiring rapid relief and for those unable to tolerate other medications. Chronic treatment with benzodiazepines is generally safe and effective but should probably be reserved for patients nonresponsive or intolerant to other agents. Larger trials are necessary to determine whether pharmacological agents might be useful as monotherapies, or adjuncts to exposure psychotherapy, for specific phobia.
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Ferini-Strambi, Luigi, and Sara Marelli. Restless legs syndrome/Willis–Ekbom disease. Edited by Sudhansu Chokroverty, Luigi Ferini-Strambi, and Christopher Kennard. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199682003.003.0024.
Full textAbstract:
Restless legs syndrome (RLS)/Willis–Ekbom disease (WED), is a common neurological disorder characterized by uncomfortable and unpleasant sensations in the legs, with an urge to move. The general population prevalence has been estimated at approximately 5%. In 1995, the International RLS/WED Study Group established four clinical criteria for RLS/WED diagnosis, and in 2012 introduced a fifth (that symptoms are not due to another medical or behavioral condition) to improve differential diagnosis. Periodic leg movements causing sleep fragmentation may be observed in almost 80% of RLS/WED patients. Genetics, central nervous system dopamine dysregulation, and brain iron deficiency seem to be the primary involved factors, but peripheral phenomena may also contribute to the pathophysiology. Several medications have demonstrated efficacy in treating RLS/WED, including dopaminergic agents, alpha-2-delta ligands, and opioids. Pharmacological therapy should be limited to those patients who suffer from clinically relevant symptoms with impaired sleep quality or quality of life.
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Vincent, Nicole A., Thomas Nadelhoffer, and Allan McCay, eds. Neurointerventions and the Law. Oxford University Press, 2020. http://dx.doi.org/10.1093/oso/9780190651145.001.0001.
Full textAbstract:
This volume makes a contribution to the field of neurolaw by investigating issues raised by the development, use, and regulation of neurointerventions. The broad range of topics covered in these chapters reflects neurolaw’s growing social import, and its rapid expansion as an academic field of inquiry. Some authors investigate the criminal justice system’s use of neurointerventions to make accused defendants fit for trial, to help reform convicted offenders, or to make condemned inmates sane enough for execution, while others interrogate the use, regulation, and social impact of cognitive enhancement medications and devices. Issues raised by neurointervention-based gay conversion “therapy”, the efficacy and safety of specific neurointervention methods, the legitimacy of their use and regulation, and their implications for authenticity, identity, and responsibility are among the other topics investigated. The focus on neurointerventions also highlights tacit assumptions about human nature that have important implications for jurisprudence. For all we know, at present such things as people’s capacity to feel pain, their sexuality, and the dictates of their conscience, are unalterable. But neurointerventions could hypothetically turn such constants into variables. The increasing malleability of human nature means that analytic jurisprudential claims (true in virtue of meanings of jurisprudential concepts) must be distinguished from synthetic jurisprudential claims (contingent on what humans are actually like). Looking at the law through the lens of neurointerventions thus also highlights the growing need for a new distinction—between analytic jurisprudence and synthetic jurisprudence—to tackle issues that increasingly malleable humans will face when they encounter novel opportunities and challenges.