Medication-related inpatient falls: a critical review

Abstract Falls are the second leading cause of accidental and unintentional injury deaths worldwide. Inpatient falls in hospital settings are likely to prolong the length of stay of patients in nearly 6.3 days, leading to increased hospitalization costs. The causes of fall incidents in healthcare facilities are multifactorial in nature and certain medications use could be associated with these incidents. This review seeks to critically evaluate the available literature regarding the relationship between inpatient falls and medication use. A comprehensive search was performed on MEDLINE, EMBASE and Lilacs with no time restriction. The search was filtered using English, Spanish or Portuguese languages. Our study evaluated medication use and inpatients falls that effectively happen, considering all ages and populations. An assessment of bias and quality of the studies was carried out using an adapted tool from the literature. The drugs were classified according to the Anatomic Therapeutics Chemical Code. The search strategy retrieved 563 records, among which 23 met the eligibility criteria; ninety three different pharmacological subgroups were associated with fall incidents. Our critical review suggests that the use of central nervous system drugs (including anxiolytics; hypnotics and sedatives; antipsychotics; opioids; antiepileptics and antidepressants) has a greater likelihood of causing inpatient falls. A weak relationship was found between other pharmacological subgroups, such as diuretics, cardiovascular system-related medications, and inpatient fall. Remarkably, several problems of quality were encountered with regard to the eligible studies. Among such quality problems included retrospective design, the grouping of more than one medication in the same statistical analysis, limited external validity, problems related to medication classifications and description of potential confounders.

Neuromodulatory effects of caffeine and bromazepam on visual event-related potential (P300): a comparative study

O componente P300 do potencial evocado relacionado a evento é uma medida geral de "eficiência cognitiva" e um índice da qualidade do processamento e armazenamento de informações pelo sistema nervoso central (SNC). OBJETIVO: Comparar os efeitos neuromoduladores da cafeína e do bromazepam a partir do banco normativo do potencial evocado visual (P300). MÉTODO: 15 sujeitos destros (7 homens e 8 mulheres), entre 20 e 30 anos de idade, sadios, livres de qualquer déficit cognitivo e sem uso de substâncias psicotrópicas ou psicoativas foram estudados. Os sujeitos foram submetidos a uma tarefa de discriminação visual utilizando o paradigma "oddball", após a administração de uma cápsula de cafeína ou de bromazepam, em um desenho duplo-cego randomizado. RESULTADOS: Foram observadas diferenças estatisticamente significativas quando as condições cafeína e bromazepam foram comparadas com o banco normativo. CONCLUSÃO: Os resultados sugerem que a cafeína e o bromazepam têm efeitos moduladores específicos no SNC.

Effect of undernutrition on morphine analgesia, haloperidol catalepsy and pentobarbitone sodium hypnosis in developing new born rats.

In the present study, half of the pups of a litter were undernourished by 12 h daily maternal deprivation from day 5 to day 18 postnatal and were subsequently nutritionally rehabilitated. Responses of CNS-acting drugs (morphine analgesia, pentobarbitone sodium hypnosis, haloperidol catalepsy) were studied at the age of day 9, 12 and 18 in maternally deprived and of day 25 in nutritionally rehabilitated new born rats as compared to that of their nourished littermates. The results showed that the response of these CNS-acting drugs was maximum at the age of day 9 postnatal and progressively decreased thereafter as the age of the animal advanced. The responses of these drugs in maternally deprived animals varied on different days of undernourishment as compared to that of their nourished littermates. The responses were significantly less in first half and were significantly more in second half period of undernourishment. The changes observed in the responses of these CNS-acting drugs were directly related to the changes observed in brain serotonin level in maternally deprived and nutritionally rehabilitated new born rats. The present findings suggest that the nature and degree of undernutrition imposed in suckling rats might only produce temporary effects on the response of CNS-actin drugs and on brain serotonin levels which is reversible if undernourished new born rats were nutritionally rehabilitated on an appropriate time of brain development.

Pharmacodynamic interactions of cypermethrin and centrally acting drugs in mice.

Cypermethrin a widely used insecticide of Pyrethroids (type II) group, was administered in mice at two dose levels (1/10 of LD50 i.e. 2.5 mg/kg and 1/5 of LD50 i.e. 5.0 mg/kg) and pharmacodynamic interactions of insecticide were studied with centrally acting drugs viz. pentobarbital sodium, amphetamine, pentylenetetrazole, acepromazine and analgin. Cypermethrin pretreatment potentiated the actions of pentobarbital and pentylene-tetrazole as evidenced by an increase in pentobarbital induced hypnosis and duration of pentylene-tetrazole induced chemoshock seizures. Tranquilizing action of acepromazine was potentiated but there was decrease in amphetamine influenced locomotor activity at both the dose levels. Cypermethrin pretreatment, however, did not have any pharmacodynamic interaction with analgin.

Synthesis of certain novel coumarins as possible CNS active agents

A number of new compounds derived from 4-methyl-6-hydroxycoumarin were synthesized and evaluated for their pharmacological activity. Some of the tested compounds exhibited CNS depressant and hypotensive action in the experimental animals

Development of natural products as drugs acting on central nervous system

We have recenty studied several natural product constituents which have effects on the CNS. (1) Tetrahydropalmatine (THP) and its analogues were isolated from Corydalis ambigua and various species of Stephania. (+)-THP and (-_-THP posses not only analgesic activity, but also exert sedative-tranquillizing and hypnotic actions. Results of receptor binding assay and their pre-and post-synaptic effects on dopaminergic system indicate that (-)-THP and (-)-stepholidine are dopamine receptor antagonists while (+)-THP is a selective dopamine depletor. (2) 3-Acetylaconitine (AAC) is an alkaloid isolated from Aconitum flavum. The relative potency of analgesic action of AAC was 5.1-35.6 and 1250-3912 times that of morphine and aspirin, respectively. The analgesic effect of AAC was antagonized by naloxone, but was eliminated by reserpine. In monkeys, after AAC was injected for 92 days, no abstinence syndrome was seen after sudden AAC withdrawal or when challenged with nalorphine. (3) Huperzine A (Hup-A) is an alkaloid isolated from Huperzia serrata which was found to be a selective ChE inhibitor and could improve learning and retrieval process. Preliminary clinical studies showed that Hup-A improve short-and long-term memory in patients of cerebral arteriosclerosis with memory impairment. (4) Ranamargarin is a new tetradecapeptide isolated from the skin of the Chines frog Rana margaratae. This peptide may mainly act on NK-1 receptor

Development of natural products as drugs acting on central nervous system

We have recenty studied several natural product constituents which have effects on the CNS. (1) Tetrahydropalmatine (THP) and its analogues were isolated from Corydalis ambigua and various species of Stephania. (+)-THP and (-)-THP posses not only analgesic activity, but also exert sedative-tranquillizing and hypnotic actions. Results of receptor binding assay and their pre-and post-synaptic effects on dopaminergic system indicate that (-)-THP and (-)-stepholidine are dopamine receptor antagonists while (+)-THP is a selective dopamine depletor. (2) 3-Acetylaconitine (AAC) is an alkaloid isolated from Aconitum flavum. The relative potency of analgesic action of AAC was 5.1-35.6 and 1250-3912 times that of morphine and aspirin, respectively. The analgesic effect of AAC was antagonized by naloxone, but was eliminated by reserpine. In monkeys, after AAC was injected for 92 days, no abstinence syndrome was seen after sudden AAC withdrawal or when challenged with nalorphine. (3) Huperzine A (Hup-A) is an alkaloid isolated from Huperzia serrata which was found to be a selective ChE inhibitor and could improve learning and retrieval process. Preliminary clinical studies showed that Hup-A improve short-and long-term memory in patients of cerebral arteriosclerosis with memory impairment. (4) Ranamargarin is a new tetradecapeptide isolated from the skin of the Chines frog Rana margaratae. This peptide may mainly act on NK-1 receptor.