RESUMO
The role of certain treatments in the development of bone fragility is well known. Since the 2000s, several studies, conducted in patients on long-term anticoagulants have suggested the involvement of vitamin K antagonist (VKA) in the occurrence of osteoporotic fractures. Since their launch in 2008, the new oral anticoagulants (NOACs) have been widely used. Compared to VKA, this drugs' class is associated with a lower fracture risk. Therefore, the presence of risk factors for fracture should be considered when prescribing long-term anticoagulants. In this line, the NOACs seem to be an interesting alternative for patients at risk of fracture requiring a long-term anticoagulation. Nevertheless, certain aspects remain to be clarified.
Le rôle joué par certains traitements pour favoriser une fragilité osseuse est bien connu. Depuis les années 2000, plusieurs études, menées chez des patients anticoagulés au long cours, évoquent l'implication des antivitamines K (AVK) dans la survenue de fractures ostéoporotiques. Depuis leur mise sur le marché en 2008, les nouveaux anticoagulants oraux (NACO) sont largement utilisés. Comparée aux AVK, cette classe médicamenteuse semble associée à un risque fracturaire moindre, menant à considérer la présence de facteurs de risque osseux lors de la prescription d'une anticoagulation au long cours. En ce sens, et bien que certains aspects restent à éclaircir, les NACO semblent être une alternative intéressante chez les patients présentant un risque fracturaire accru et la nécessité d'une anticoagulation au long cours.
Assuntos
Fibrilação Atrial , Fraturas por Osteoporose , Acidente Vascular Cerebral , Administração Oral , Anticoagulantes/efeitos adversos , Fibrilação Atrial/tratamento farmacológico , Humanos , Fraturas por Osteoporose/epidemiologia , Fraturas por Osteoporose/prevenção & controle , Fatores de Risco , Vitamina K/uso terapêuticoRESUMO
OBJECTIVE: To determine methadone plasma trough and peak concentrations in patients presenting opiate withdrawal symptoms after introduction of nevirapine or efavirenz. To describe the disappearance of these symptoms after methadone titration based on plasma concentrations rather than on the symptoms. METHODS: Nine patients undergoing highly active antiretroviral therapy (HAART) and either nevirapine or efavirenz treatment were monitored daily for opiate withdrawal in a specialized drug addiction center. Methadone dose was titrated daily, and plasma concentrations were measured. The data are retrospective (case series). RESULTS: Several patients complained of symptoms such as nausea, vomiting, accelerated intestinal transit, or insomnia. Even after methadone titration based on clinical symptoms, patients and health-care providers trained in infectious disease did not classify these as withdrawal symptoms and considered them as the side effects of HAART or anxiety. Methadone plasma trough concentration showed low levels of (R)- and (R,S)-methadone. Further methadone dose adjustment according to plasma level resulted in the disappearance of these withdrawal symptoms. The daily methadone dose was split when the peak/trough (R)-methadone ratio was more than 2. CONCLUSIONS: When introducing efavirenz or nevirapine to patients undergoing methadone treatment, withdrawal symptoms should be monitored, especially those such as insomnia, vomiting, or nausea. Methadone plasma trough and peak measurements can be of value in preventing unnecessary side effects of HAART.
Assuntos
Benzoxazinas/efeitos adversos , Relação Dose-Resposta a Droga , Interações Medicamentosas , Metadona/sangue , Metadona/uso terapêutico , Nevirapina/efeitos adversos , Síndrome de Abstinência a Substâncias/tratamento farmacológico , Alcinos , Terapia Antirretroviral de Alta Atividade/efeitos adversos , Benzoxazinas/administração & dosagem , Ciclopropanos , Humanos , Metadona/efeitos adversos , Nevirapina/administração & dosagem , Inibidores da Transcriptase Reversa/administração & dosagem , Inibidores da Transcriptase Reversa/efeitos adversos , Síndrome de Abstinência a Substâncias/sangueRESUMO
The 2009 news in medicine regarding dependence confirm the bio-psycho-social field of addiction medicine and psychiatry. First a statement is made about the risk of cardiac arythmy in opioid substitution treatments. Then a review of the treatment of C hepatitis shows its importance in an addicted population. In the field of cognitive neuroscience, progress has been made in the knowledge of "craving" and of its endophenotypical components. Electronic medias related disorders are on the border of addiction: a case study is exploring this new domain. At last, recent datas are presented on the relationship between cannabis and psychosis.
Assuntos
Transtornos Relacionados ao Uso de Substâncias/terapia , Humanos , Transtornos Relacionados ao Uso de Substâncias/complicaçõesRESUMO
BACKGROUND: In Switzerland, general practitioners (GPs) manage most of the patients receiving methadone maintenance treatment (MMT). METHODS: Using a cross-sectional postal survey of GPs who treat MMT patients and GPs who do not, we studied the difficulties encountered in the out-patient management of drug-addicted patients. We sent a questionnaire to every GP with MMT patients (556) in the French-speaking part of Switzerland (1,757,000 inhabitants). We sent another shorter questionnaire to primary care physicians without MMT patients living in the Swiss Canton of Vaud. RESULTS: The response rate was 63.3%. The highest methadone dose given by GPs to MMT patients averaged 120.4 mg/day. When asked about help they would like to be given, GPs with MMT patients primarily mentioned the importance of receiving adequate fees for the care they provide. Secondly, they mentioned the importance of better training, better knowledge of psychiatric pathologies, and discussion groups on practical cases. GPs without MMT patients refuse to treat these patients mostly for emotional and relational reasons. CONCLUSION: GPs encounter financial, relational and emotional difficulties with MMT patients. They desire better fees for services and better training.
Assuntos
Assistência Ambulatorial , Atitude do Pessoal de Saúde , Serviços de Saúde Mental/provisão & distribuição , Médicos de Família/psicologia , Atenção Primária à Saúde , Transtornos Relacionados ao Uso de Substâncias/terapia , Assistência Ambulatorial/economia , Competência Clínica , Estudos Transversais , Feminino , Humanos , Masculino , Serviços de Saúde Mental/economia , Metadona/administração & dosagem , Relações Médico-Paciente , Médicos de Família/estatística & dados numéricos , Atenção Primária à Saúde/economia , Recusa em Tratar/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Inquéritos e Questionários , SuíçaRESUMO
We studied profile of patients (n=1782) treated in specialized centers and general practice (GP) enrolled in methadone maintenance treatment (MMT) programs during 2001 in the Swiss Canton of Vaud. We found that GPs treated the majority of patients (76%). Specialized centers treated a higher proportion of patients with uncontrolled intravenous use of cocaine and heroin, and prescribed neuroleptics as concomitant medication three times more frequently than GPs. Patients treated in specialized centers were more likely to undergo screening for HIV, HBV, HCV, and receive complete HBV immunization. In conclusion, specialized centers are more likely to treat severely addicted patients and patients with a poor global assessment (physical, psychiatric, and social).
Assuntos
Medicina de Família e Comunidade/estatística & dados numéricos , Metadona/uso terapêutico , Entorpecentes/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/reabilitação , Centros de Tratamento de Abuso de Substâncias/estatística & dados numéricos , Sorodiagnóstico da AIDS , Adulto , Antipsicóticos/uso terapêutico , Transtornos Relacionados ao Uso de Cocaína/tratamento farmacológico , Transtornos Relacionados ao Uso de Cocaína/reabilitação , Estudos Transversais , Quimioterapia Combinada , Medicina de Família e Comunidade/métodos , Feminino , Seguimentos , Hepatite B/diagnóstico , Hepatite C/diagnóstico , Dependência de Heroína/tratamento farmacológico , Dependência de Heroína/reabilitação , Humanos , Masculino , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Pacientes Desistentes do Tratamento , Centros de Tratamento de Abuso de Substâncias/métodos , Abuso de Substâncias por Via Intravenosa/tratamento farmacológico , Abuso de Substâncias por Via Intravenosa/reabilitação , Inquéritos e Questionários , SuíçaRESUMO
Using data from the Public Health Service, we studied the demographic and clinical characteristics of 1,782 patients enrolled in methadone maintenance treatment (MMT) during 2001 in the Swiss Canton of Vaud, comparing our findings with the results of a previous study from 1976 to 1986. In 2001, most patients (76.9%) were treated in general practice. Mortality is low in this MMT population (1%/year). While patient age and sex profiles were similar to those found in the earlier study, we did observe a substantial increase in the number of patients and the number of practitioners treating MMT patients, probably reflecting the low-threshold governmental policies and the creation of specialized centers. In conclusion, easier access to MMT enhances the number of patients, but new concerns about the quality of management emerge: benzodiazepine as a concomitant prescription; low rates of screening for hepatitis B, C and HIV, and social and psychiatric preoccupations.