Postoperative nausea and vomiting in patients undergoing colorectal surgery within an institutional enhanced recovery after surgery protocol: comparison of two prophylactic antiemetic regimens / 대한마취과학회지

BACKGROUND: Enhanced recovery protocols (ERP) provide optimal perioperative care for surgical patients. Postoperative nausea and vomiting (PONV) is common after colorectal surgery (CRS). We aim to compare the efficacy of aprepitant to a cost-effective alternative, perphenazine, as components of triple antiemetic prophylaxis in ERP patients. METHODS: Patients who underwent ERP CRS at a single institution from July 2015 to July 2017 were evaluated retrospectively. Only subjects who received aprepitant (Group 1) or perphenazine (Group 2) preoperatively for PONV prophylaxis were included. Patient characteristics, simplified Apfel PONV scores, perioperative medications, and PONV incidence were compared between the groups. PONV was defined as the need for rescue antiemetics on postoperative days (POD) 0–5. RESULTS: Five hundred ninety-seven patients underwent CRS of which 498 met the inclusion criteria. Two hundred thirty-one (46.4%) received aprepitant and 267 (53.6%) received perphenazine. The incidence of early PONV (POD 0–1) was comparable between the two groups: 44.2% in Group 1 and 44.6% in Group 2 (P = 0.926). Late PONV (POD 2–5) occurred less often in Group 1 than Group 2, respectively (35.9% vs. 45.7%, P = 0.027). After matching the groups for preoperative, procedural, and anesthesia characteristics (164 pairs), no difference in early or late PONV could be demonstrated between the groups. CONCLUSIONS: The incidence of PONV remains high despite most patients receiving three prophylactic antiemetic medications. Perphenazine can be considered a cost-effective alternative to oral aprepitant for prophylaxis of PONV in patients undergoing CRS within an ERP.

Prolonged Drug-Drug Interaction between Terbinafine and Perphenazine

I report here an elderly woman receiving perphenazine together with terbinafine. After 1 week of terbinafine treatment she experienced extrapyramidal symptoms and, in particular, akathisia. Her symptoms did not disappear for 6 weeks, and so at 2 weeks prior to this most recent admission she had stopped taking terbinafine. However, these symptoms persisted for 3 weeks after discontinuing terbinafine. It is well known that terbinafine inhibits CYP2D6 and that perphenazine is metabolized mainly by CYP2D6. Thus, when terbinafine and perphenazine are coadministrated, the subsequent increase in the concentration of perphenazine may induce extrapyramidal symptoms. Thus, terbinafine therapy may be associated with the induction and persistence of extrapyramidal symptoms, including akathisia. This case report emphasizes the importance of monitoring drug-drug interactions in patients undergoing terbinafine and perphenazine therapy.

Factors That Influence the Prescription of Antipsychotics for Patients with Schizophrenia in China

OBJECTIVE: To investigate the patterns of antipsychotic use in China and to analyze the factors that influence antipsychotic prescriptions. METHODS: A standardized survey was conducted from May 20 to 24 2002 in five different regions of China with varying economic levels. The patterns of antipsychotic medication use were analyzed in a sample of 4,779 patients with schizophrenia. The survey gathered information on demographic characteristics, clinical profiles, and antipsychotic medications prescribed. Multiple logistic regression was used to analyze factors related to patterns of antipsychotic medication use. RESULTS: A plurality of patients with schizophrenia was treated with clozapine (39%); this was followed by risperidone, sulpride, chlorpromazine, perphenazine, and haloperidol. More than 56.3% of patients were treated with only one atypical antipsychotic. The mean daily dose of chlorpromazine was 365+/-253 mg (mean+/-standard deviation), and 6.5% of patients were treated with depot injections of typical antipsychotic medications. A total of 73.7% (n=3,523) of patients with schizophrenia received monotherapy, 24.8% (n=1,183) received two antipsychotics, 1.1% (n=52) received three antipsychotics, and one received four different antipsychotics. Patients often simultaneously received other classes of medications including anticholinergic agents, benzodiazepines, beta-blockers, antidepressants, and mood stabilizers. Economic status and clinical symptoms were the main factors that contributed to the patterns of antipsychotic prescription. CONCLUSION: The present study suggests that atypical antipsychotic medications, especially clozapine, are the primary psychiatric treatments of choice in the management of schizophrenia in China. Moreover, the economic status and clinical profile of the patient are the major factors affecting the prescription of antipsychotic medication.

[Neuroleptic malignant syndrome: predisposing factors, symptomatoly, treatments and complications]

Neuroleptic Malignant Syndrome [NMS] is an acute and dangerous syndrome which usually arise as a side-effect of Neuroleptic drugs. Its high mortality rate, acute course and the current controversies about the best treatment method indicates the necessity of further investigation on its clinical features, predisposing factors and effective therapeutic methods. Retrospectively in a 4-year period, we studied patients hospitalized with NMS applying a 7-section questionnaire assessing: drug historys, the underlying psychiatric disorder, clinical signs and symptoms, laboratory findings, treatment methods and their outcomes, and duration of hospital stay. Rigidity and impaired consciousness were the most common clinical findings. Haloperidol, perphenazine and risperidone were the most common antisychotics used before the NMS onset. Mood disorders, schizophrenia, and mental retardation were the most frequent underlying disorders. The most common prescriptions for treatment of NMS were bromocriptine, fluid and electrolytes therapy, and amantadine. In diagnosing the NMS, impaired consciousness, especially when being accompanied by rigidity and fever, may be a more sensitive criteria than it is currently believed. Bromocriptin and fluid and electrolyte replacement therapy among many other treatment methods, and also interventions for prevention of NMS complications may play important roles in reducing its mortality rate

Differentiation-inducing effects of perphenazine on K562 leukemia cells / 中南大学学报(医学版)

OBJECTIVE@#To determine the differentiation-inducing effects of perphenazine on K562 leukemia cells.@*METHODS@#Differentiation-Inducing effects of a phenothiazine perphenazine were evaluated by proliferation, morphology and function of K562 cells. We evaluated the effects of perphenazine on K562 cells proliferation by cellular enumeration in liquid culture assay, MTT assay and clony formation assay, the morphology by Wight-Gimesa staining, and the function by detecting CD71 through flow cytometry.@*RESULTS@#Perphenazine enhanced the expression of CD71 on K562 cells and increased Hb content in K562 cells, while inhibited the proliferation of K562 cells. K562 cells showed differentiation morphology after the drug treatment.@*CONCLUSION@#Perphenazine possessed differentiation-inducing effects on K562 cells.

Role of adenosine in drug-induced catatonia in mice.

Parkinson's disease is one of the most common neurodegenerative disorders affecting large majority of population who are older than age of 65. Apart from dopamine, acetylcholine and glutamate, adenosinc has also been identified in the basal ganglia. Adenosine modulates the release of a variety of neurotransmitters including dopamine. In order to establish adenosine-dopamine interactions in drug-induced catatonia we studied the effect of adenosine in drug-induced catatonia in mice. In the present study adenosine dose dependently produced catatonia when assessed on rota-rod and bar tests in mice. Adenosine also potentiated the catatonic effect of perphenazine. L-dopa plus carbidopa or OR-486 (a potent centrally acting COMT inhibitor) completely reversed adenosine-induced catatonia. Since reversal by scopolamine of adenosine-induced catatonia was not to the same extent as with l-dopa and OR-486 it appears that catecholamines particularly dopamine rather than cholinergic modulation is more important in adenosine induced catatonia. The motor dysfunction (catatonia) could be easily assessed using rota-rod test apparatus in mice.

Cinqüenta anos de medicamentos antipsicóticos em psiquiatria: II - fenotiazinas piperazínicas / Fifty yearts of antipsychotic drugs in psychiatry: II - piperazine phenothiazines

Na iminência de uma nova era na terapêutica psiquiátrica, com a redescoberta da clozapina e a introduçäo de novos antipsicóticos atípicos, é feito um balanço sistemático das substância desenvolvidas nos últimos 50 anos. As substâncias introduzidas até o presente säo reunidas nos grupos-tioxantênicos com estrutura aparentada às fenotiazinas), tioxantenos, butirofenonas, difenilbutilpiperidinas, benzamidas, indóis, dibenzoxazepinas - e nos grupos químicos mais recentes - dibenzodiazepinas, benzisoxazólicos, tienobenzodiazepinas, dibenzotiazepinas, benzisotiazólicos, didroindolonas, imidazolidinonas -, além de compostos ainda em desenvolvimento. Neste artigo, o segundo da série concebida com esta finalidade, säo examinados os derivados fenotiazínicos com cadeia lateral piperazínica, carfenazina, clorimpifenina, dixirazina, flufenazina, metofenazina, oxaflumazina, perazina, perfenazina, proclorperazina, tietilperazina, tiopropazato, tioproperazina e trifluperazina. Com base em bibliografia básica específica, säo discutidos aspectos técnicos e revisado o conhecimento cientíco acumulado através da experimentaçäo e da utilizaçäo clínica destes compostos, desde seu lançamento até a presente data, com informaçöes sistemáticas sobre fórmula estrutural, fórmula molecular, nomes químicos, nomes fantasia e códigos de cada composto, além de dados sobre sua eventual comercializaçäo no país

Hypersexuality and Obsessive-Compulsive Behaviors in a Stroke Patient with the Left Mesial Frontal Cortex and Both Basal Ganglia Lesion

Hyposexuality after stroke has been frequently observed, but hypersexuality as a sequela of stroke has not been commonly documented. We report a patient who exhibited hypersexuality and obsessive-compulsive behaviors after stroke in the region of the left mesial frontal cortex and both basal ganglia. At 2 months after stroke, he visited psychiatric unit due to these symptoms. His motor function was almost full recovered. He was treated with fluvoxamine and perphenazine, With two-month medication, his hypersexuality and obsessive-compulsive behavior disappeared. This case may indicate that basal ganglia-thalamocortical circuit plays an important role in the mediation of sexual behavior and obsessive-compulsive behavior. Since changes in sexual activity may not be spontaneously reported, a systemic inquiry into patient's sexual functioning after infarction in frontal lobe or basal ganglia is warranted.

Oxidative reaction between perphenazine and peroxyacetic acid [Part 1. Kinetic study]

The oxidation of perphenazine to perphenazine sulphoxide by peroxyacetic acid was kinetically studied utilizing first derivative UV-spectrophotometry and a simple iodometric procedure. The first-derivative UV-spectrophotometric procedure indicates that the reaction with respect to perphenazine is most probably zero-orer at the initial stage with a rate constant [k0] of magnitude 5.62x10-8 mol L-1S-1. Based on the titrimetric procedure in which 0.01 N Na2S2O3 was employed the reaction with respect to peroxyacetic acid is most probably second order initially having a rate constant [k2] equal to 0.05805 L mol-1 S-1. the disparity between the orders with respect to concentration [i.e.nc] and time [i.e.n1] for peroxyacetic acid was highlighted

Neurolépticos: os legítimos e verdadeiros antimanicomiais / Neuroleptic: the real antimanicomial drug

O autor analisa o advento dos neurolépticos e suas conseqüências. Faz ampla revisão do tema abordando a farmacologia destas substâncias, os aspectos clínicos, principais indicações e efeitos colaterais. Conclui mostrando o verdadeiro alcance antimanicomial dos neurolépticos

Candida albicans test for the screening of phototoxicity in anthistamines / 대한피부과학회지

BACKGROUND: Antihistamine drugs are used widely in many conditions. Although some antihistamines may cause a photosensitive reaction,many physicians are not awae of it. OBJECTIVE: For examination of the phototoxic potential of antihistamines, we performed the Candida albiecrns test which is simple, cheap, and good for the screening of many drugs. MEHTODS: Thirty microliters of each solute of various antihistamines were applied to the Sabraud dextrose agar plate in which Candida albicans were applied diffusly. Four hours after the application, 60J/cm fo UVA was irradiated for two days. The irradiated. plates and nonirradiated control ones were incubated in a dark room for 48 hours, and examined for lear zones arround the drug, which means a positive results for the phototoxic potential of the drugs. RESULTS: Mequitazine, thiethylperazine, perphenazine and cllorromazine showed positive results, whereas others did not. An additional Candida albicans test using 0.1%, 0.01%, and 0.001% of the positive drugs revealed tht chlorpromazine, thiethylperazine aderphenazine showed positive results at 0.1%, but negative at 0.01 and 0.001%. Mequitazine was niegative at 0.1, 0.01, and 0,001%, Additional studies of the Candida albicans test using 5% and 10% of the diphenhydramine and dimenhydrinate, those were known photosensitizers but they slowed negative results at this study and revealed very weak posit,ive result in 10% diphenhydramine. CONCLUSION: A photosensitive reaction such as photoallergy and persistent light react,ion may be triggered by the phenothiazine antihistamines. Negative result in 1%, and very weak positive results in 10% diphenhydramine may be due to different mechanism of phototoxicity, or the low phototoxic potential of diphenhydrainine.

Death following intentional overdose of psychotropic drugs.

A case of successful suicide from overdose of amitriptyline, perphenazine, and midazolam is described. Postmortem findings were inadequate to explain the death. Sudden cardiac arrest suggested that the death from overdose probably resulted from drug cardiotoxicity. The physicians should be aware of this serious complication when prescribing a combination of these potential lethal drugs. A limited supply should be given to depressed patients.

Niveles sanguíneos de los neurolépticos / Serum levels of neuroleptics

La determinación de los niveles sanguíneos de la drogas antipsicóticas podría, eventualmente, proporcionar: una guía para determinar las dosis terapéuticas óptimas y un margen de seguridad dentro de un rango de dosis, una manera de discriminar a los pacientes refractarios, la información farmacocinética necesaria para ajustar adecuadamente las dosificaciones, la posibilidad de predecir los efectos terapéuticos y una ayuda en la selección de la droga para cada caso en particular. Evidentemente, estos puntos son de una gran trascendencia para la clínica, lo que ha dado lugar a un creciente interés en la investigación de las relaciones entre los niveles sanguíneos de los neurolépticos y diversas respuestas: la antipsicótica, la extrapiramidal y la endócrina. En el presente documento se revisan, en primer término, las técnicas de laboratorio que se han utilizado con mayor frecuencia para la cuantificación de las concentraciones de los neurolépticos en las muestras biológicas: cromatografía, radio-inmunoanálisis y ensayo de radio-receptor. En segundo lugar se analiza la información disponible acerca de los antipsicóticos de uso más frecuente en nuestro medio, abordándose aspectos farmacocinéticos, estudios referentes a las relaciones entre los niveles sanguíneos de la droga y los tres tipos de respuestas mencionadas, así como la influencia de otras drogas en las concentraciones sanguíneas de los antipsicóticos. Finalmente, se comenta la información presentada y se señala su relevancia para la práctica clínica

The Clinical Study of Nausea and Vomiting after General Anesthesia / 대한마취과학회지

There are many reports about post-anesthetic nausea and vomiting. Pst-anesthetic nausea and vomiting can cause not only severe discomfort but also many complications. McKie (1970) said that the incidence varies from 23% 82%. But nowadays, the incidence seems greatly decreased due to the development of anesthetic techniques and anesthetic agents. We studied the incidence and factors affecting nausea and vomiting in 564 patients under general anesthesia from July 1, 1975. to September 30, 1975. at Severance Hospital, The conclusions are as follows; (1) The over all incidence is 34%. (2) It is more common in women. (3) It is less common below 10 years of age. (4) It is more common after prolonged anesthesia. (5) It is most common with ether. (6) It is more common when parasympatholytic agents are used for premedication. (7) It is most common in abdominal operations. We also studied post-anesthetic headache, and the incidence was 15%. Post-anesthetic headache was most common with halothane. There are many different opinions about the effect of the prophylactic use of antiemetics for post-anesthetic nausea and vomiting. So we studied the prophylactic antiemetic effect in ether anesthesia with the use of perphenazine HCI (Trimin). The antiemetic reduced the incidence from 42% to 3% in cases using ether.