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1.
J Clin Psychiatry ; 81(2)2020 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-31995677

RESUMO

OBJECTIVE: A nominal group process followed by a modified Delphi method was used to survey expert opinions on best practices for tardive dyskinesia (TD) screening, diagnosis, and treatment and to identify areas lacking in clinical evidence. PARTICIPANTS: A steering committee of 11 TD experts met in nominal group format to prioritize questions to be addressed and identify core bibliographic materials and criteria for survey panelists. Of 60 invited experts, 29 (23 psychiatrists and 6 neurologists) agreed to participate. EVIDENCE: A targeted literature search of PubMed (search term: tardive dyskinesia) and recommendations of the steering committee were used to generate core bibliographic material. Inclusion criteria were as follows: (1) review articles, meta-analyses, guidelines, or clinical trials; (2) publication in English between 2007 and 2017; (3) > 3 pages in length; and (4) publication in key clinical journals with impact factors ≥ 2.0. Of 29 references that met these criteria, 18 achieved a score ≥ 5 (calculated as the number of steering committee votes multiplied by journal impact factor and number of citations divided by years since publication) and were included. CONSENSUS PROCESS: Two survey rounds were conducted anonymously through electronic media from November 2017 to January 2018; responses were collected, collated, and analyzed. Respondent agreement was defined a priori as unanimous (100%), consensus (75%-99%), or majority (50%-74%). For questions using a 5-point Likert scale, agreement was based on percentage of respondents choosing ≥ 4 ("agree completely" or "agree"). Round 1 survey included questions on TD screening, diagnosis, and treatment. Round 2 questions were refined per panelist feedback and excluded Round 1 questions with < 25% agreement and > 75% agreement (unless feedback suggested further investigation). CONCLUSIONS: Consensus was reached that (1) a brief, clinical assessment for TD should be performed at every clinical encounter in patients taking antipsychotics; (2) even mild movements in 1 body area may represent possible TD; (3) management requires an overall evaluation of treatment, including reassessment of antipsychotics and anticholinergics as well as consideration of vesicular monoamine transporter 2 (VMAT2) inhibitors; and (4) informed discussions with patients/caregivers are essential.


Assuntos
Antipsicóticos , Antagonistas Colinérgicos , Programas de Rastreamento/métodos , Conduta do Tratamento Medicamentoso/normas , Exame Neurológico/métodos , Discinesia Tardia , Antipsicóticos/administração & dosagem , Antipsicóticos/efeitos adversos , Antagonistas Colinérgicos/administração & dosagem , Antagonistas Colinérgicos/efeitos adversos , Consenso , Técnica Delfos , Monitoramento de Medicamentos/métodos , Monitoramento de Medicamentos/normas , Humanos , Guias de Prática Clínica como Assunto , Medição de Risco/métodos , Discinesia Tardia/induzido quimicamente , Discinesia Tardia/diagnóstico , Discinesia Tardia/terapia , Proteínas Vesiculares de Transporte de Monoamina/antagonistas & inibidores
3.
J Evid Based Med ; 12(3): 227-231, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31441236

RESUMO

Anticholinergic drugs are prescribed for a range of conditions including gastrointestinal disorders, overactive bladder, allergies, and depression. While in some circumstances anticholinergic effects are therapeutic, they also pose many undesired or adverse effects. The overall impact from concomitant use of multiple medications with anticholinergic properties is termed anticholinergic burden (ACB). Greater ACB is associated with increased risks of impaired physical and cognitive function, falls, cardiovascular events, and mortality. This has led to the development of interventions aimed at reducing ACB through the deprescribing of anticholinergic drugs. However, little is known about the implementation issues that may influence successful embedding and integration of such interventions into routine clinical practice. In this paper, we present the protocol for our systematic review that aims to identify the qualitative evidence for the barriers and facilitators to reduce ACB from the perspectives of patients, carers, and healthcare professionals. A comprehensive search strategy will be conducted across OVID Medline, EMBASE, PsycInfo, and CINAHL. The review will be conducted in accordance with ENTREQ (Enhancing Transparency in Reporting the Synthesis of Qualitative Research) and has been registered with PROSPERO (Registration CRD42018109084). Normalization process theory (NPT) will be used to explore, understand, and explain qualitative data in relation to factors that act as barriers or facilitators to ACB reduction.


Assuntos
Antagonistas Colinérgicos/efeitos adversos , Antagonistas Colinérgicos/uso terapêutico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Segurança do Paciente , Cuidadores/estatística & dados numéricos , Quimioterapia Combinada , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Medicina Baseada em Evidências , Pessoal de Saúde/estatística & dados numéricos , Humanos , Determinação de Necessidades de Cuidados de Saúde , Pesquisa Qualitativa , Medição de Risco
4.
Artigo em Russo | MEDLINE | ID: mdl-31464299

RESUMO

Drug-induced delirium is an urgent challenge of modern healthcare, especially in elderly patients, due to the widespread prevalence, associated complications, longer hospitalization period, higher mortality rate. The exact pathogenesis of delirium is unknown, however, a number of studies suggest that it is based on neurotransmitter dysfunction. Thus, drugs that affect the metabolism of these neurotransmitters can lead to the onset of delirium. The Delirium Drug Scale (DDS) and the Anticholinergic Burden scale (ACB) are used to assess the risk of delirium. For patients with an increased risk of delirium, it is recommended to avoid prescribing benzodiazepines, use with caution opiates, dihydropyridines and antagonists of H1-histamine receptors. Non-pharmacological methods are recommended as a first-line treatment of delirium (behavioral approaches, placing the patient in specially equipped delirious rooms, etc.). If non-pharmacological methods have shown to be ineffective or the patient's behavior represents a danger to the life and health of himself and / or others, it is possible to administer antipsychotic drugs.


Assuntos
Antipsicóticos , Benzodiazepinas , Antagonistas Colinérgicos , Delírio , Idoso , Antipsicóticos/efeitos adversos , Benzodiazepinas/efeitos adversos , Antagonistas Colinérgicos/efeitos adversos , Delírio/induzido quimicamente , Hospitalização , Humanos
5.
J UOEH ; 41(2): 145-151, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31292358

RESUMO

Constipation is very common and can be caused by adverse drug reactions as a result of many drugs. While the adverse effects of several medications such as opioids and anticholinergic agents are well established and well known, other commonly prescribed drugs, such as hypnotics, are less well understood. This review presents the results of an analysis of the relationship between constipation and drugs.


Assuntos
Antagonistas Colinérgicos/efeitos adversos , Constipação Intestinal/induzido quimicamente , Hipnóticos e Sedativos/efeitos adversos , Anti-Inflamatórios não Esteroides/efeitos adversos , Anticonvulsivantes/efeitos adversos , Antidepressivos Tricíclicos/efeitos adversos , Bloqueadores dos Canais de Cálcio/efeitos adversos , Diuréticos/efeitos adversos , Antagonistas dos Receptores Histamínicos/efeitos adversos , Humanos , Parassimpatolíticos/efeitos adversos
6.
Drugs Aging ; 36(10): 957-967, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31359329

RESUMO

BACKGROUND: Understanding risk factors associated with falls is important for optimizing care and quality of life for older patients. OBJECTIVE: Our objective was to determine the relationship between anticholinergic exposure and falls, fractures, and all-cause mortality. METHODS: An observational retrospective cohort study was conducted using administrative claims data from 1 January 2007 to 30 September 2015. Individuals aged 65-89 years newly diagnosed or treated for overactive bladder (OAB) were identified. Index date was the first OAB diagnosis or OAB medication prescription claim. Follow-up began on the index date and continued until death, disenrollment, or end of study period. The Anticholinergic Cognitive Burden (ACB) scale was used to define and quantify daily anticholinergic exposure and intensity. The primary study outcome was a combined endpoint of falls or fractures. All-cause mortality was a secondary endpoint. RESULTS: There were 113,311 patients with mean age of 74.8 ± standard deviation (SD) 6.2 years included. Current anticholinergic exposure was associated with a 1.28-fold increased hazard of a fall/fracture (95% confidence interval [CI] 1.23-1.32) compared with unexposed person-time, and past exposure was associated with a 1.14-fold increased hazard of a fall/fracture (95% CI 1.12-1.17). Compared with unexposed person-time, low-, moderate-, and high-intensity anticholinergic exposure was associated with a 1.04-fold (95% CI 1.00-1.07), 1.13-fold (95% CI 1.09-1.17), and 1.31-fold (95% CI 1.26-1.36) increased hazard of falls/fractures, respectively. A similar pattern was observed for all-cause mortality. CONCLUSIONS: Anticholinergic exposure is associated with an increased risk of falls or fractures in older patients and is an important consideration when evaluating treatment options for such patients with OAB.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Antagonistas Colinérgicos/administração & dosagem , Fraturas Ósseas/epidemiologia , Bexiga Urinária Hiperativa/tratamento farmacológico , Bexiga Urinária Hiperativa/epidemiologia , Idoso , Antagonistas Colinérgicos/efeitos adversos , Feminino , Fraturas Ósseas/induzido quimicamente , Humanos , Masculino , Medicare/estatística & dados numéricos , Qualidade de Vida , Estudos Retrospectivos , Fatores de Risco , Estados Unidos/epidemiologia
7.
Life Sci ; 233: 116695, 2019 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-31351082

RESUMO

Alzheimer's disease (AD) is neurodegenerative disorder that is associated with memory and cognitive decline in the older adults. Scopolamine is commonly used as a behavioral model in studying cognitive disorders including AD. Many studies have also concurrently examined the neurochemical mechanisms underlying the behavioral modifications by scopolamine treatment. Nonetheless, the scopolamine model has not become a standard tool in the early assessment of drugs. Furthermore, the use of scopolamine as a pharmacological model to study AD remains debatable. This report reviews the scopolamine-induced cellular and molecular changes and discusses how these changes relate to AD pathogenesis.


Assuntos
Doença de Alzheimer/fisiopatologia , Biomarcadores/metabolismo , Antagonistas Colinérgicos/efeitos adversos , Transtornos da Memória/patologia , Redes e Vias Metabólicas/efeitos dos fármacos , Escopolamina/efeitos adversos , Doença de Alzheimer/tratamento farmacológico , Animais , Humanos , Transtornos da Memória/induzido quimicamente , Transtornos da Memória/metabolismo
8.
Int Urol Nephrol ; 51(9): 1459-1471, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31243632

RESUMO

INTRODUCTION AND HYPOTHESIS: Anticholinergics have been established for their efficacy and safety in adults with idiopathic overactive bladder syndrome (OAB-s) but not in children and adolescents. This study was aims to investigate the efficacy and safety of anticholinergics in children and adolescents with idiopathic OAB-s. METHOD: A total of nine studies with 11 trials comprising of 1801 subjects (1116 experimental and 685 controls) were included. Inclusion criteria were idiopathic OAB-s in children or adolescents. Overall SMD of change in diurnal urge incontinence per week, change in mean voiding frequency per 24 h, change in mean voided volume, and incidence of adverse events compared with placebo were investigated. RESULTS: Overall SMD of diurnal urge incontinence per week for the anticholinergic group (experimental group) vs. the placebo group (control group) was - 0.15 (95% CI - 0.31, 0.01). Overall SMD of mean voiding frequency per 24 h was - 0.16 (95% CI - 0.33, 0.02). Overall SMD of mean voided volume was 0.49 (95% CI 0.10, 0.88). The overall incidence of any AEs of anticholinergics compared with placebo was OR = 1.06 (95% CI 0.84-1.34) (p = 0.637). Among each AEs, the only incidence of urinary tract infection showed a higher incidence rate for anticholinergics (OR = 1.92, 95% CI 1.06-3.49) than for placebo. CONCLUSIONS: Apart from oxybutynin, other anticholinergics showed efficacy including an increase in mean voided volume. Moreover, there was no significant difference in the incidence of overall adverse events between anticholinergics and placebo.


Assuntos
Antagonistas Colinérgicos/uso terapêutico , Bexiga Urinária Hiperativa/tratamento farmacológico , Adolescente , Criança , Antagonistas Colinérgicos/efeitos adversos , Humanos , Resultado do Tratamento
9.
Am J Clin Dermatol ; 20(4): 593-604, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31111409

RESUMO

BACKGROUND: Glycopyrronium tosylate is a topical anticholinergic approved in the USA for primary axillary hyperhidrosis in patients aged ≥ 9 years (Qbrexza™ [glycopyrronium] cloth, 2.4%). OBJECTIVE: This 44-week open-label extension study assessed glycopyrronium tosylate safety and descriptive efficacy in patients completing one of two, phase III, double-blind, vehicle-controlled, 4-week trials (NCT02530281; NCT02530294). METHODS: Patients aged ≥ 9 years with primary axillary hyperhidrosis were randomized 2:1 (glycopyrronium tosylate: vehicle, once daily) in the double-blind trials. Completers could receive open-label glycopyrronium tosylate for up to an additional 44 weeks. Treatment-emergent adverse events and local skin reactions were assessed. Descriptive efficacy assessments were gravimetrically measured sweat production, Hyperhidrosis Disease Severity Scale responder rate (≥ 2 grade improvement), and Dermatology Life Quality Index/children's Dermatology Life Quality Index. RESULTS: Of 651 patients completing the double-blind trials, 564 (86.6%) entered the open-label extension; 550 were analyzed. Most patients experiencing treatment-emergent adverse events had mild or moderate events (> 90%). Discontinuation because of treatment-emergent adverse events remained low and relatively stable, with a cumulative rate of 8.0% (44/550) over 44 weeks. Common treatment-emergent adverse events (> 5%) were dry mouth (16.9%), vision blurred (6.7%), application-site pain (6.4%), nasopharyngitis (5.8%), and mydriasis (5.3%). Most patients (67.5%) had no local skin reactions; those occurring were predominantly mild/moderate. Glycopyrronium tosylate efficacy was maintained throughout the trial; at week 44, the Hyperhidrosis Disease Severity Scale responder rate was 63.2%, and improvements from baseline (double blind) in sweat production were - 71.3% and 8.7 ± 6.2/6.2 ± 4.9 for Dermatology Life Quality Index/children's Dermatology Life Quality Index. CONCLUSIONS: Daily long-term application of glycopyrronium tosylate for up to 48 weeks (double blind plus open label) was generally well tolerated and efficacy was maintained. No new safety signals emerged. TRIAL REGISTRY: Clinicaltrials.gov NCT02553798.


Assuntos
Antagonistas Colinérgicos/administração & dosagem , Glicopirrolato/administração & dosagem , Hiperidrose/tratamento farmacológico , Índice de Gravidade de Doença , Administração Cutânea , Adolescente , Adulto , Axila , Criança , Antagonistas Colinérgicos/efeitos adversos , Método Duplo-Cego , Feminino , Seguimentos , Glicopirrolato/efeitos adversos , Humanos , Masculino , Qualidade de Vida , Sudorese/efeitos dos fármacos , Resultado do Tratamento , Adulto Jovem
10.
BMC Geriatr ; 19(1): 121, 2019 04 29.
Artigo em Inglês | MEDLINE | ID: mdl-31035946

RESUMO

BACKGROUND: The Drug Burden Index (DBI) quantifies exposure to medications with anticholinergic and/or sedative effects. A consensus list of DBI medications available in Ireland was recently developed for use as a DBI tool. The aim of this study was to validate this DBI tool by examining the association of DBI score with important health outcomes in Irish community-dwelling older people. METHODS: This was a cohort study using data from The Irish Longitudinal Study on Ageing (TILDA) with linked pharmacy claims data. Individuals aged ≥65 years participating in TILDA and enrolled in the General Medical Services scheme were eligible for inclusion. DBI score was determined by applying the DBI tool to participants' medication dispensing data in the year prior to outcome assessment. DBI score was recoded into a categorical variable [none (0), low (> 0 and < 1), and high (≥1)]. Outcome measures included any Activities of Daily Living (ADL) impairment, any Instrumental Activities of Daily Living (IADL) impairment, any self-reported fall in the previous 12 months, any frailty criterion met (Fried Phenotype measure), quality of life (QoL) score (CASP-19 [Control Autonomy Self-realisation Pleasure] measure), and healthcare utilisation (any hospital admission and any emergency department (ED) visit) in the previous 12 months. Statistical analyses included multivariate logistic and linear regression models controlling for potential confounders. RESULTS: 61.3% (n = 1946) of participants received at least one DBI prescription in the year before their outcome assessment. High DBI exposure (DBI score ≥ 1) vs none was significantly associated with impaired function (ADL impairment adjusted OR 1.89, 95% CI 1.25, 2.88; IADL impairment adjusted OR 2.97, 95% CI 1.91, 4.61), self-reported falls (adjusted OR 1.50, 95%CI 1.03, 2.18), frailty (adjusted OR 1.74, 95% CI 1.14, 2.67), and reduced QoL (ß = - 1.84, 95%CI -3.14, - 0.54). There was no significant association between DBI exposure and healthcare utilisation. CONCLUSIONS: The findings validate the use of the DBI tool for predicting risk of functional impairment, falls, frailty and reduced QoL in older people in Ireland, and may be extended to other European countries. Integration of this tool into routine practice may be an appropriate step forward to improve outcomes in older people.


Assuntos
Envelhecimento/efeitos dos fármacos , Antagonistas Colinérgicos/efeitos adversos , Efeitos Psicossociais da Doença , Hipnóticos e Sedativos/efeitos adversos , Vida Independente/tendências , Acidentes por Quedas/prevenção & controle , Atividades Cotidianas/psicologia , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/psicologia , Estudos de Coortes , Serviço Hospitalar de Emergência/tendências , Feminino , Hospitalização/tendências , Humanos , Vida Independente/psicologia , Irlanda/epidemiologia , Estudos Longitudinais , Masculino , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Qualidade de Vida/psicologia , Resultado do Tratamento
12.
BMC Pulm Med ; 19(1): 88, 2019 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-31072407

RESUMO

BACKGROUND: Inhaled anticholinergics, recommended as first-line maintenance treatment for patients with moderate-to-severe chronic obstructive pulmonary disease (COPD), has been demonstrated to be associated with an increased risk of cardiovascular diseases. Nevertheless, why COPD patients using inhaled anticholinergics have this higher risk remains unknown. One of mechanisms may be an autonomic imbalance because anticholinergics yield reduced vagal nervous activity. To test our hypothesis, we studied heart rate recovery (HRR) after exercise, recognized as a marker of cardiac autonomic function, in COPD patients using and not using inhaled anticholinergics. METHODS: Sixty patients with COPD were involved in this study (mean FEV1 = 1.57 ± 0.42 L), including 24 patients who had received tiotropium for more than 1 year and 36 patients not using tiotropium as a control group. A maximal cardiopulmonary exercise test was performed. HRR was defined as the difference between peak exercise and at 1-min recovery heart rate. RESULTS: HRR was significantly lower in patients using tiotropium than in the controls (16 ± 6 vs 22 ± 8 beats/min, respectively, p < 0.05). Multivariate regression analysis revealed that tiotropium use and peak VCO2 were independent predictors of HRR in these COPD patients. CONCLUSIONS: These findings suggest that anticholinergics bronchodilators reduce HRR after exercise in COPD patients. This has the potential to aggravate autonomic nervous imbalance. Therefore, we recommend that COPD patients taking anticholinergic bronchodilators should be considered for monitoring of cardiac function and prescribers should be alert for cardiovascular events that may arise from autonomic nervous imbalance.


Assuntos
Sistema Nervoso Autônomo/efeitos dos fármacos , Doenças Cardiovasculares/induzido quimicamente , Antagonistas Colinérgicos/efeitos adversos , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Brometo de Tiotrópio/efeitos adversos , Administração por Inalação , Idoso , Broncodilatadores/uso terapêutico , Antagonistas Colinérgicos/administração & dosagem , Teste de Esforço , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Prospectivos , Análise de Regressão , Testes de Função Respiratória , Brometo de Tiotrópio/administração & dosagem
13.
J Urol ; 202(3): 564-573, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31009289

RESUMO

PURPOSE: We evaluated the efficacy and safety of a combination of 2 mg tolterodine and 9 mg pilocarpine, vs tolterodine monotherapy in patients with overactive bladder. MATERIALS AND METHODS: We enrolled patients with overactive bladder symptoms in a multicenter, randomized, double-blind, parallel, active control study. Patients were randomized to the combination or 2 mg tolterodine twice daily for 12 weeks. After the double-blind period finished all patients were started on the combination for 12 weeks. Study co-primary end points were the change from baseline in the mean number of daily micturitions and cumulative incidence of dry mouth at the end of 12 weeks. Secondary end points were other overactive bladder symptoms, the total xerostomia inventory score and results of a visual analogue scale for dry mouth at the end of 12 and 24 weeks. RESULTS: The mean change in the number of daily micturitions from baseline to 12 weeks was -1.49 and -1.74 in the combination and tolterodine monotherapy groups, respectively. The mean difference was -0.26 (95% CI -0.79-0.27), confirming noninferiority. At 12 weeks the incidence of dry mouth was lower in the combination group than in the tolterodine monotherapy group (30.0% vs 42.9%, p = 0.009). All secondary and other efficacy outcomes related to overactive bladder symptoms improved in each group with no significant differences between the groups at 12 weeks. Changes from baseline in the total xerostomia inventory score and the visual analogue scale for dry mouth were significantly lower in the combination group than in the tolterodine monotherapy group. CONCLUSIONS: Tolterodine and pilocarpine alleviated dry mouth in patients with overactive bladder while maintaining anticholinergic efficacy similar to that of tolterodine.


Assuntos
Antagonistas Colinérgicos/administração & dosagem , Agonistas Muscarínicos/administração & dosagem , Pilocarpina/administração & dosagem , Tartarato de Tolterodina/administração & dosagem , Bexiga Urinária Hiperativa/tratamento farmacológico , Xerostomia/epidemiologia , Idoso , Antagonistas Colinérgicos/efeitos adversos , Método Duplo-Cego , Combinação de Medicamentos , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Agonistas Muscarínicos/efeitos adversos , Pilocarpina/efeitos adversos , Tartarato de Tolterodina/efeitos adversos , Resultado do Tratamento , Micção/efeitos dos fármacos , Xerostomia/induzido quimicamente , Xerostomia/prevenção & controle
14.
Clin Neuropharmacol ; 42(3): 108-110, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30920402

RESUMO

The tricyclic antidepressants have long been a tool in the physician's armament for numerous indications, the most prominent of which being depression. Although their efficacy and side effects have been well documented, less known is their abuse. Prior literature has discussed this more for the tertiary amines such as amitriptyline, but currently, there are no documented cases of abuse with the secondary amine nortriptyline. This article reviews the prior literature in regard to tricyclic antidepressants and anticholinergics as substances of abuse, the proposed mechanisms of this, and susceptible populations, as well as a case review of a patient who admitted to using nortriptyline for its "buzz."


Assuntos
Antidepressivos Tricíclicos/efeitos adversos , Nortriptilina/efeitos adversos , Transtornos Relacionados ao Uso de Substâncias , Idoso , Alcoolismo , Antagonistas Colinérgicos/efeitos adversos , Transtorno Depressivo/tratamento farmacológico , Humanos , Masculino
15.
Med. oral patol. oral cir. bucal (Internet) ; 24(2): e204-e210, mar. 2019. tab
Artigo em Inglês | IBECS | ID: ibc-180644

RESUMO

Background: Neuromuscular impairment makes individuals with cerebral palsy (CP) more prone to drooling. Among the treatment options, there are procedures that interfere with saliva production. It is imperative to evaluate the effect of the different modalities since the reduction in salivary flow rate/production may exacerbate the risk of dental caries. Material and Methods: The aim of this study was to compare the effects of different treatments for drooling on caries risk and salivary parameters in children and adolescents with CP. Study design: A total of 142 children and adolescents with CP, aged 6 to 18 years, were assigned to groups based on the different treatments they had received for drooling: G1-anticholinergic drugs (n = 18), G2-botulinum toxin injection (n = 16), G3-salivary glands surgery (n = 16), G4-no treatment (n = 42), and G5-non-drooling subjects (n = 50). All participants were evaluated on the Simplified Oral Hygiene Index, and for the prevalence of dental caries (decayed, missing, and filled teeth index and white spot lesions). Unstimulated whole saliva was collected, and salivary flow rate and osmolality were measured. Chi-square, ANOVA and Poisson regression were calculated. Prevalence ratios and their respective 95 % confidence intervals were obtained. The significance level was fixed at 5%. Results: No differences were found in the decayed, missing, and filled teeth index (p = 0.128) and Simplified Oral Hygiene Index (p = 0.674) among the different groups. G3 presented significantly higher percentages of WSL (p < 0.001), lower values of salivary flow rate (p < 0.001), and higher values of osmolality (p < 0.001). The white spot lesion prevalence ratio was higher only for G3 (Prevalence ratio = 14.36; IC 95% = 4.64-44.40; p < 0.001). Conclusions: Children and adolescents with CP who had received surgical treatment for drooling exhibited higher number of white spot lesions because of the reduced salivary flow rate and higher salivary osmolality


No disponible


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Paralisia Cerebral/complicações , Cárie Dentária/epidemiologia , Sialorreia/tratamento farmacológico , Antagonistas Colinérgicos/efeitos adversos , Saliva/química , Concentração Osmolar , Suscetibilidade à Cárie Dentária , Estudos Transversais , Toxinas Botulínicas/uso terapêutico , Antagonistas Colinérgicos/uso terapêutico
16.
Ther Adv Respir Dis ; 13: 1753466618824010, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30795731

RESUMO

Given the high proportion of patients with asthma who remain uncontrolled despite controller treatment, there remains a need for the development of more effective treatment options with a proven safety and tolerability profile. Recently, asthma guidelines have evolved to incorporate new therapies, including long-acting muscarinic antagonists (LAMAs) and biologics. Here we focus on the safety profile of tiotropium, a LAMA, using data from the large-scale UniTinA-asthma® clinical trial program, which investigated the use of tiotropium in over 6000 patients with asthma who remained symptomatic despite receiving inhaled corticosteroids (ICS) maintenance therapy, with or without other adjunct therapies. The large number of patients included allows robust analysis of safety and tolerability. Overall, a similar incidence of patients reporting any adverse event (AE) was observed in the tiotropium (5 µg and 2.5 µg) and placebo groups. Asthma worsening, decreased peak expiratory flow, and upper respiratory tract infections were the most frequently reported AEs. Serious AEs (SAEs) and investigator-defined drug-related AEs were infrequently reported across all treatment groups, including the placebo group, and there were no deaths in any study. Reports of side effects typically associated with anticholinergic drugs, such as dry mouth and urinary retention, were either infrequent or not reported in children, adolescents or adults. The similar proportions of tiotropium- versus placebo-treated patients reporting AEs and SAEs in African-American and Japanese populations, as well as in elderly patients, contribute to the accumulating evidence of the safety and tolerability of tiotropium across broad ethnic and age populations.


Assuntos
Asma/tratamento farmacológico , Broncodilatadores/administração & dosagem , Brometo de Tiotrópio/administração & dosagem , Administração por Inalação , Adolescente , Adulto , Idoso , Animais , Antiasmáticos/administração & dosagem , Antiasmáticos/efeitos adversos , Asma/fisiopatologia , Broncodilatadores/efeitos adversos , Criança , Antagonistas Colinérgicos/administração & dosagem , Antagonistas Colinérgicos/efeitos adversos , Relação Dose-Resposta a Droga , Glucocorticoides/administração & dosagem , Humanos , Brometo de Tiotrópio/efeitos adversos
17.
Int J Clin Pharm ; 41(1): 167-178, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30659492

RESUMO

Background Prolonged use of anticholinergic and sedative medicines is correlated with worsening cognition and physical function decline. Deprescribing is a proposed intervention that can help to minimise polypharmacy whilst potentially improving several health outcomes in older people. Objective This study aimed to examine the feasibility of implementing a deprescribing intervention that utilises a patient-centred pharmacist-led intervention model; in order to address major deprescribing challenges such as general practitioner time constraints and lack of accessible deprescribing guidelines and processes. Setting Three residential care facilities. Methods The intervention involved a New Zealand registered pharmacist utilising peer-reviewed deprescribing guidelines to recommend targeted deprescribing of anticholinergic and sedative medicines to GPs. Main outcome measure The change in the participants' Drug Burden Index (DBI) total and DBI 'as required' (PRN) was assessed 3 and 6 months after implementing the deprescribing intervention. Results Seventy percent of potential participants were recruited for the study (n = 46), and 72% of deprescribing recommendations suggested by the pharmacist were implemented by General Pratitioners (p = 0.01; Fisher's exact test). Ninety-six percent of the residents agreed to the deprescribing recommendations, emphasising the importance of patient centred approach. Deprescribing resulted in a significant reduction in participants' DBI scores by 0.34, number of falls and adverse drug reactions, 6 months post deprescribing. Moreover, participants reported lower depression scores and scored lower frailty scores 6 months after deprescribing. However, cognition did not improve; nor did participants' reported quality of life. Conclusion This patient-centred deprescribing approach, demonstrated a high uptake of deprescribing recommendations and success rate. After 6 months, significant benefits were noted across a range of important health measures including mood, frailty, falls and reduced adverse reactions. This further supports deprescribing as a possible imperative to improve health outcomes in older adults.


Assuntos
Antagonistas Colinérgicos/administração & dosagem , Desprescrições , Instituição de Longa Permanência para Idosos/normas , Hipnóticos e Sedativos/administração & dosagem , Polimedicação , Instituições Residenciais/normas , Acidentes por Quedas/prevenção & controle , Idoso , Antagonistas Colinérgicos/efeitos adversos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Hipnóticos e Sedativos/efeitos adversos , Masculino , Nova Zelândia/epidemiologia
18.
Drugs Aging ; 36(3): 289-297, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30652263

RESUMO

BACKGROUND: It is not known whether drugs with different anticholinergic ratings contribute proportionately to overall anticholinergic score. OBJECTIVES: Our objective was to assess the risk of falls or fall-related injuries as a function of the overall anticholinergic score resulting from drugs with different anticholinergic ratings among people with impaired cognition. METHODS: This was a retrospective cohort study of adults aged ≥ 65 years with mild cognitive impairment (MCI) or dementia and two or more additional chronic conditions (N = 10,698) in an integrated delivery system. Electronic health record data, including pharmacy fills and diagnosis claims, were used to assess anticholinergic medication use, quantified using the anticholinergic cognitive burden (ACB) scale, falls and fall-related injuries. RESULTS: During a median follow-up of 366 days, 63% of the cohort used one or more ACB drug; 2015 (18.8%) people experienced a fall or fall-related injury. Among patients with a daily ACB score of 5, the greatest increase in risk of falls or fall-related injuries was seen when level 2 and level 3 drugs were used in combination [hazard ratio (HR) 2.06; 95% confidence interval (CI) 1.51-2.83]. Multiple ACB level 1 drugs taken together also increased the hazard of a fall or fall-related injury (HR 1.16; 95% CI 1.03-1.32). The risk of fall or fall-related injury as a function of exposure to ACB level 2 drugs (HR 1.56; 95% CI 1.16-2.10) was higher than that for ACB level 1 or 3 drugs. CONCLUSIONS: The same daily ACB score was associated with a different degree of risk, depending on the ACB ratings of the individual drugs comprising the score. Combinations of level 2 and level 3 drugs had the greatest risk of fall or fall-related injury relative to other individuals with the same daily ACB score. Low-potency anticholinergic drugs taken together modestly increased the hazard of a fall or fall-related injury.


Assuntos
Acidentes por Quedas , Antagonistas Colinérgicos/efeitos adversos , Disfunção Cognitiva/tratamento farmacológico , Disfunção Cognitiva/fisiopatologia , Demência/tratamento farmacológico , Demência/fisiopatologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Antagonistas Colinérgicos/administração & dosagem , Estudos de Coortes , Feminino , Humanos , Masculino , Estudos Retrospectivos
19.
Artigo em Inglês | MEDLINE | ID: mdl-30655665

RESUMO

Rationale: In symptomatic patients with COPD, the decision whether to initiate maintenance treatment with a single agent or a combination of long-acting bronchodilators remains unclear. Objective: To investigate whether baseline symptomatic status influences response to tiotropium/olodaterol treatment. Materials and methods: Post hoc analysis of the randomized OTEMTO® studies (NCT01964352; NCT02006732), in which patients with moderate-to-severe COPD received placebo, tiotropium 5 µg, tiotropium/olodaterol 2.5/5 µg, or tiotropium/olodaterol 5/5 µg once daily for 12 weeks via the Respimat® inhaler (Boehringer Ingelheim, Ingelheim am Rhein, Germany). Impact of baseline symptomatic status (modified Medical Research Council [mMRC] score) on response to treatment with tiotropium/olodaterol 5/5 µg, tiotropium 5 µg, or placebo at Week 12 was assessed by St George's Respiratory Questionnaire (SGRQ) total score and response rate, transition dyspnea index (TDI) focal score and response rate, and trough forced expiratory volume in 1 second response. Results: Tiotropium/olodaterol improved SGRQ total scores and response rates compared with placebo and tiotropium for patients with baseline mMRC scores 0-1 and ≥2. For tiotropium/olodaterol vs tiotropium, greater improvements were observed for patients with mMRC ≥2 (SGRQ score adjusted mean treatment difference -3.44 [95% CI: -5.43, -1.46]; P=0.0007; SGRQ response rate ORs 2.09 [95% CI: 1.41, 3.10]; P=0.0002). Dyspnea, measured by TDI score, was consistently improved with tiotropium/olodaterol vs placebo for patients with mMRC scores 0-1 and ≥2 (adjusted mean treatment difference 1.63 [95% CI: 1.06, 2.20]; P<0.0001 and 1.60 [95% CI: 1.09, 2.10]; P<0.0001, respectively). In patients with mMRC scores 0-1 and ≥2, tiotropium/olodaterol consistently improved TDI response rate and lung function vs placebo and tiotropium. Conclusions: Patients with COPD with more severe baseline dyspnea appear to derive greater health status benefit with tiotropium/olodaterol compared with tiotropium alone.


Assuntos
Agonistas de Receptores Adrenérgicos beta 2/uso terapêutico , Benzoxazinas/uso terapêutico , Broncodilatadores/uso terapêutico , Antagonistas Colinérgicos/uso terapêutico , Pulmão/efeitos dos fármacos , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Brometo de Tiotrópio/uso terapêutico , Agonistas de Receptores Adrenérgicos beta 2/efeitos adversos , Idoso , Benzoxazinas/efeitos adversos , Broncodilatadores/efeitos adversos , Antagonistas Colinérgicos/efeitos adversos , Combinação de Medicamentos , Dispneia/diagnóstico , Dispneia/tratamento farmacológico , Dispneia/fisiopatologia , Feminino , Volume Expiratório Forçado , Nível de Saúde , Humanos , Pulmão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica , Índice de Gravidade de Doença , Fatores de Tempo , Brometo de Tiotrópio/efeitos adversos , Resultado do Tratamento , Capacidade Vital
20.
Med Intensiva ; 43(3): 147-155, 2019 04.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29530328

RESUMO

OBJECTIVE: To evaluate the clinical characteristics, prevalence and factors associated with delirium in critical patients from 5 to 14 years of age. DESIGN: An analytical, cross-sectional observational study was made. Delirium was assessed with the Pediatric-Confusion Assessment Method for the Intensive Care Unit (pCAM-ICU) and motor classification was established with the Delirium Rating Scale Revised-98. SETTING: A pediatric Intensive Care Unit. PATIENTS: All those admitted over a one-year period were assessed during the first 24-72h, or when possible in deeply sedated patients. EXCLUSION CRITERIA: Patients in stupor or coma, with severe communication difficulty, subjected to deep sedation throughout admission, and those with denied consent. RESULTS: Twenty-nine of the 156 assessed patients suffered delirium (18.6%) and 55.2% were hypoactive. The neurocognitive alterations evaluated by the pCAM-ICU were similar in the three motor groups. Intellectual disability (OR=17.54; 95%CI: 3.23-95.19), mechanical ventilation (OR=18.80; 95%CI: 4.29-82.28), liver failure (OR=54.88; 95%CI: 4.27-705.33), neurological disease (OR=4.41; 95%CI: 1.23-15.83), anticholinergic drug use (OR=3.23; 95%CI: 1.02-10.26), different psychotropic agents (OR=4.88; 95%CI: 1.42-16.73) and tachycardia (OR=4.74; 95%CI: 1.21-18.51) were associated to delirium according to the logistic regression analysis. CONCLUSION: The frequency of delirium and hypoactivity was high. It is therefore necessary to routinely evaluate patients with standardized instruments. All patients presented with important neurocognitive alterations. Several factors related with the physiopathology of delirium were associated to the diagnosis; some of them are modifiable through the rationalization of medical care.


Assuntos
Cuidados Críticos , Delírio/epidemiologia , Adolescente , Criança , Pré-Escolar , Antagonistas Colinérgicos/efeitos adversos , Estudos Transversais , Delírio/etiologia , Feminino , Humanos , Deficiência Intelectual/complicações , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Falência Hepática/complicações , Masculino , Doenças do Sistema Nervoso/complicações , Prevalência , Psicotrópicos/efeitos adversos , Respiração Artificial/efeitos adversos , Taquicardia/complicações
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