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ABSTRACT Objectives: to verify sociodemographic, academic and health risk factors for Central Nervous System drug use among nursing students. Methods: a cross-sectional study with 199 public undergraduate students from Ceará, using Characterization Instrument, Antonovsky's Sense of Coherence Questionnaire, Beck Depression Inventory and Beck Anxiety Inventory. Fischer's exact test and Pearson's chi-square test were performed, verifying an association between variables. Prevalence ratio was used. Results: a total of 34 used such drugs, with predominance of use of anxiolytics, associated with age (p=0.026), dissatisfaction with the relationship between classmates (p=0.003), insomnia (p=0.009), chronic disease (p=0.001), depression (p=0.035), and severe anxiety (p=0.023). Conclusions: using Central Nervous System drugs among students was associated with sociodemographic, academic and health factors, evidencing the need for actions promoting undergraduate students' mental health.
RESUMEN Objetivos: verificar los factores de riesgo sociodemográficos, académicos y de salud por el uso de drogas en el Sistema Nervioso Central en estudiantes de enfermería. Métodos: estudio transversal, con 199 estudiantes de una universidad pública de Ceará, utilizando el Instrumento de Caracterización, Cuestionario de Sentido de Coherencia de Antonovsky, Inventario de depresión de Beck y Inventario de ansiedad de Beck. Se realizó la prueba exacta de Fischer y la prueba de chi-cuadrado de Pearson, verificando la asociación entre variables. Se utilizó la razón de prevalencia. Resultados: 34 utilizaron este tipo de fármacos, predominantemente ansiolíticos, asociados a la edad (p=0,026), insatisfacción con la relación entre compañeros de curso (p=0,003), insomnio (p=0,009), enfermedad crónica (p=0,001), depresión (p=0,035) y ansiedad severa (p=0,023). Conclusiones: el uso de drogas del Sistema Nervioso Central en estudiantes se asoció con factores sociodemográficos, académicos y de salud, destacando la necesidad de acciones para promover la salud mental de los estudiantes universitarios.
RESUMO Objetivos: verificar fatores de risco sociodemográficos, acadêmicos e de saúde para o uso de fármacos do Sistema Nervoso Central entre estudantes de enfermagem. Métodos: estudo transversal, com 199 estudantes de universidade pública do Ceará, utilizando Instrumento de Caracterização, Questionário de Senso de Coerência de Antonovsky, Inventário de Depressão de Beck e o Inventário de Ansiedade de Beck. Realizou-se Teste exato de Fischer e Teste Qui-Quadrado de Pearson, verificando associação entre variáveis. Utilizou-se Razão de Prevalência. Resultados: 34 utilizavam tais fármacos, predominando o uso dos ansiolíticos, associado à idade (p=0,026), à insatisfação com o relacionamento entre colegas de curso (p=0,003), à insônia (p=0,009), à doença crônica (p=0,001), à depressão (p=0,035) e à ansiedade grave (p=0,023). Conclusões: o uso de fármacos do Sistema Nervoso Central entre os estudantes esteve associado a fatores sociodemográficos, acadêmicos e de saúde, evidenciando a necessidade de ações promotoras da saúde mental dos universitários.
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Resumo Medicamentos neuropsiquiátricos são utilizados para variadas condições neurológicas e psiquiátricas. O objetivo deste artigo é analisar evolução e determinantes dos gastos públicos com esses medicamentos em Minas Gerais de 2010 a 2017. Dados do Sistema Integrado de Administração de Materiais e Serviços (SIAD) foram usados para estimar volumes de aquisição e gastos. Realizou-se análise de decomposição e, para os medicamentos antiparkinsonianos foi avaliado o elenco adquirido, aplicando-se, ainda, a técnica de Drug Utilization (DU90%). O gasto anual diminuiu 36%, passando de R$ 111,7 milhões em 2010 para R$ 40,9 milhões em 2017, tendo como fatores determinantes a queda de preços e de volume, associada às mudanças do drugmix, optando-se pela aquisição de produtos, em média, mais caros. Destaca-se o aumento dos gastos para a classe dos antiparkinsonianos, porém, com significativa mudança no elenco adquirido. Esse estudo contribuiu para um melhor entendimento dos gastos públicos com medicamentos neuropsiquiátricos. A redução do volume pode elevar o risco de desabastecimento. Com relação aos antiparkinsonianos, não há evidências que sugiram aumento da oferta para a população.
Abstract Neuropsychiatric drugs are used for a wide variety of neurological and psychiatric conditions. This article aims to analyze the trend and determinants of public expenditure of these medicines in Minas Gerais, from 2010 to 2017. Data from the Integrated Materials and Services Administration System (SIAD) database were used to estimate volumes of acquisition and expenditure. A breakdown analysis was performed, and the list of purchased drugs was reviewed, and the Drug Utilization technique (DU90%) applied concerning anti-Parkinson drugs. Annual expenditure dropped by 36%, from R$ 111.7 million in 2010 to R$ 40.9 million in 2017, and the determinant factors were the falling prices and volume, associated with changes in the drug mix, which favored the acquisition, on average, of more expensive products. Higher levels of expenditure for anti-Parkinson drugs stand out, however, with a significant change in the list purchased. This study contributed to a better understanding of public spending on neuropsychiatric drugs. A reduced volume can increase the risk of shortages. Regarding anti-Parkinson drugs, there is no evidence to suggest an increased supply to the population.
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Humans , Pharmaceutical Preparations , Brazil , Health ExpendituresABSTRACT
Benzodiazepine receptor agonists (BZs) are medications to be used with caution, not only for long-time users, but also for first-time users. This study aimed to compare the use of BZs or central nervous system (CNS) agents in first-time BZs users (FU) and continuing BZs users (CU). Using a large health insurance claims database in Japan, BZs users aged ≥40 years in 2013 who were opioid non-users without hospitalization were classified into FU or CU, by use of BZs in the first half-year. BZs or CNS agent use at the index date (the first date BZs were dispensed in the latter year) was investigated as follows: (1) proportion of patients with prescriptions of BZs for use as needed (BZs-AN), (2) daily number of BZs or CNS agents, and (3) daily standardized dose of BZs or CNS agents. More individuals in the FU group (3,162/16,576; 19%) than in the CU group (7,627/46,088; 17%) received BZs-AN (p＜0.001); 87% of the FU group vs 62% of the CU group used single BZs (p＜0.001), and 53% vs 24% used less than 5 mg/day of equivalent diazepam (p＜0.001). A similar trend was found for CNS agents. Numbers or doses of BZs or CNS agents decreased with increasing age in both groups. However, some first-time users aged 70-74years started with ≥2 types of BZs or ≥10 mg/day of equivalent diazepam. Overall, BZs for outpatients without opioids were started carefully, but a prescription review was necessary for some patients, requiring more effort from healthcare providers.
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El uso de psicofármacos es cada vez más frecuente por problemas emergentes como la depresión. Se presenta el caso de una mujer de 47 años que recibía tratamiento antidepresivo (fluoxetina y levomepromazina) y fue llevada a emergencia por presentar en su domicilio trastorno de conciencia súbito, evidenciándose durante su estancia hospitalaria dos episodios de taquicardia ventricular sin pulso que respondieron satisfactoriamente a desfibrilación y reanimación cardiopulmonar avanzada. Se comenta la prolongación del intervalo QT asociada a uso de antidepresivos y antipsicóticos, así como sus factores de riesgo. Finalmente se destaca la importancia de tener presente la relación entre psicofármacos y arritmias ventriculares potencialmente fatales, siendo necesario realizar un electrocardiograma a estos pacientes que consulten al servicio de emergencia.
The use of psychotropic drugs is increasingly frequent due to emerging problems such as depression. We present the case of a 47-year-old woman who received antidepressant treatment (fluoxetine and levomepromazine) and arrived at the emergency room because lost consciousness in her home, evidencing two episodes of pulseless ventricular tachycardia during her hospital stay that responded satisfactorily to defibrillation and advanced cardiopulmonary resuscitation. The prolongation of the QT interval associated with the use of antidepressants and antipsychotics, as well as their risk factors, is discussed. Finally, it is important to have on mind the relationship between psychotropic drugs and potentially fatal ventricular arrhythmias, making it necessary to perform an electrocardiogram to these patients who consult the emergency room.
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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.
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Accidental Falls/prevention & control , Central Nervous System Agents/pharmacology , Inpatients/classification , Wounds and Injuries/classification , Risk Assessment , Health Services/statistics & numerical dataABSTRACT
ABSTRACTObjective Our aim was to investigate and compare the neuromodulatory effects of bromazepam (6 mg) and modafinil (200 mg) during a sensorimotor task analyzing the changes produced in the absolute alpha power.Method The sample was composed of 15 healthy individuals exposed to three experimental conditions: placebo, modafinil and bromazepam. EEG data were recorded before, during and after the execution of the task. A three-way ANOVA was applied, in order to compare the absolute alpha power among the factors: Group (control, bromazepam and modafinil) Condition (Pre and Post-drug ingestion) and Moment (pre and post-stimulus).Results Interaction was found between the group and condition factors for Fp1, F4 and F3. We observed a main effect of moment and condition for the Fp2, F8 and Fz electrodes.Conclusion We concluded that drugs may interfere in sensorimotor processes, such as in the performance of tasks carried out in an unpredictable scenario.
RESUMOObjetivo Investigar e comparar os efeitos neuromoduladores do bromazepam (6mg) e modafinil (200mg), durante a prática de uma tarefa sensoriomotora, analisando as modificações produzidas na potência absoluta de alfa.Método A amostra foi composta por 15 indivíduos saudáveis, expostos a três condições experimentais: Placebo, modafinil e bromazepam. Dados eletroencefalográficos foram registrados antes, durante e após a execução da tarefa motora. Um ANOVA three-way foi aplicado para comparar a potência absoluta de alfa nos fatores Grupo (controle, bromazepam e modafinil), Condição (Pré e Pós ingestão da droga) e Momento (Pré e Pós estimulo).Resultados Verificou-se interação entre os fatores grupo e condição para os eletrodos Fp1, F4 e F3. Observamos um efeito principal para momento e condição nos eletrodos Fp2, F8 e Fz.Conclusão Concluímos que as drogas, podem interferir em processos sensoriomotores, como no desempenho de tarefas executadas em um cenário imprevisível.
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Adult , Female , Humans , Male , Young Adult , Benzhydryl Compounds/pharmacology , Bromazepam/pharmacology , Frontal Lobe/drug effects , GABA Modulators/pharmacology , Psychomotor Performance/drug effects , Somatosensory Cortex/drug effects , Brain Waves/drug effects , Epidemiologic Methods , Electroencephalography/drug effects , Frontal Lobe/physiology , Reference Values , Somatosensory Cortex/physiology , Time FactorsABSTRACT
The blood-brain barrier(BBB) is the basic structure to maintain homoestasis of the central nervous system, which has protective effect on brain tissue, but prevents many drugs into the brain, resulting in the limited clinical application of these drugs. How to effectively deliver the drugs through BBB has become a key step. As a novel drug-loaded carrier, nanoparticle can carry drugs through the BBB and increase the drug concentration in the brain, so as to achieve brain targeted drug delivery. This article briefly reviews recent research advances in drug-loaded nanoparticle and the mechanism of penetrating through BBB into brain tissue.
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Objective To investigate the effects of modafinil,a new wake-promoting agent,on simulated flight performance during 48 h sleep deprivation(SD).Method Six male healthy young volunteers were exposed to two periods of 48 h continuous wakefulness during the crossover experiment.In one period,three 200 mg doses of modafinil were given and in the other,separated by two weeks,matching placebos were administered.The SD time started from 8:00 of the first day to 8:00 of the third day.Drug was given at 0:00,16:00 of the second day and 0:00 of the third day.Flight performance in J7-E flight simulator was tested at 21:00 of the first day and 1,3,5,7 h after each drug administration.Result The scores of simulated flight performance in the placebo group decreased with time during SD and became significant at 1:00～7:00 of the third day.Numbers of errors increased with time during SD,especially in the left ascending turn stage and the descending & landing stages.Compared with the placebo,flight performance was significantly increased after the third administration of modafinil.Numbers of errors during 48 h SD and at 1:00～7:00 of the third day in modafinil group was 19% and 40% lower than those in placebo group respectively.Conclusion Simulated flight performance during 48 h SD is significantly improved after repeated administration of modafinil,especially when the impacts of SD and the circadian trough are combined.
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Objective To investigate the effects of modafinil,a new wake-promoting agent, on vestibular function during 24 h sleep deprivation(SD). Method Eight male healthy young volunteers were exposed to two 24 h periods of continuous wakefulness during the crossover experiment. In one period, 200 mg doses of modafinil were given and in the other, separated by one week, matching placebos were administered. The SD time started from 8:00 of the first day to 8:00 of the second day. Drugs was given at 0:00 of the second day. Vestibular function was tested at 21:00 of the first day and 1 ,3,5,7 h after drug administration. Result The accuracy of saccade tracking and the gains of VVOR(visual-vestibular optokinetic reflex)and OKN(optokinetic nystagmus)in the placebo group decreased during 24 h SD, especially at 1: 00～5:00 of the second day, while OKN gains in the modafinil group was increased significantly. There were no significant differences of other vestibular function between modafinil group and placebo group. Conclusion Twenty four SD can influence vestibular function in certain degree,but optokinetic nystagmus can be improved by modafinil.
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Objective: To establish an in vitro model of brain blood barrier (BBB) using cultured mouse brain microvascular endothelial cells (BMVEC). Methods: Mouse BMVEC were seeded on micro pore membrane of gelatin coated cell culture insert and cultured to confluence. The establishment of BBB was preliminary judged by a 4 h water leaking test. The tight junctions between BMVEC were demonstrated by scanning and transmission electron microscope. The transendothelial electrical resistance(TEER) over BMVEC was measured. The permeability of Horseradish peroxidase (HRP) through the BBB was analyzed and the effect of RMP 7 on permeability of the BBB was investigated. Results: The 4 h water leaking test became positive when BMVEC were cultured to confluence. By scanning and transmission electron microscope, the tight junctions were demonstrated on confluent BMVEC. The TEER over BMVEC monolayer increased 3.2 and 7.68 times and the permeability rates for HRP were 13.4% and 6.7% respectively, as compared with sub confluent BMVEC and human umbilical vein endothelial cell monolayer(HUVEC). The HRP permeability rate in the model of BBB increased 2.7 times after treatment with RMP 7. Conclusion: The established in vitro model of BBB has basic characteristics of BBB in vivo , and is suitable for central nervous system (CNS) drug research over BBB.
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The formalin test is a model of injury-produced inflammatory pain. Anesthetics, in clinically relevant concentrations, affect neutrophils and immune suppression. This study was to determine whether halothane reliably inhibits inflammatory reaction and formalin induced pain behavior or does not. Rats were exposed to 100% oxygen (control) or halothane, respectively for 30 min and then 24 hr later five percent formalin test was assessed. The base values of the paw's diameter were obtained earlier, and then formalin induced edema was assessed by measuring diameters of the injected paws at 5 min, 1 hr, 4 hr and 24 hr after the injection. Nociceptive behavior was quantified by counting the number of times with the paw flinched at 5 min intervals for 60 min. The diameters of edema in the halothane group lessened more than those in the oxygen group at 1 and 24 hr in each following of the injection (p<0.05). The rats pre-administered with oxygen or halothane were similar appearances in nociceptive behaviors. It suggests that halothane anesthesia might inhibit slightly the inflammatory reaction with the formalin-induced edema but might not inhibit the formalin-induced pain behavior in the event of pre-administration halothane 24 hr earlier before the formalin test of rat.