Anticholinergic Burden in Geriatric Patients Attending Clinical Pharmacology Clinic — A Descriptive Cross-sectional Study in Eastern India

Background : Anticholinergic burden in Geriatric population is of great concern throughout the Globe, yet often neglected. There are previous studies to assess the Anticholinergic burden, carried out in specific population, though its prevalence in general population is difficult to interpret. Polypharmacy remains one of the major causes contributing to the increased burden in Anticholinergic score among Geriatrics. Multiple co-morbidities and the prevalence of Multiple Chronic Diseases are the responsible factors which imbibe Multiple Drug Therapy in Geriatric population. Anticholinergic burden in older adults has been associated with Cognitive impairment, Delirium, Dizziness and Confusion, Falls and increased hospitalizations. However, Anticholinergic-acting drugs are often advised in Geriatric population. In this study an attempt was made to understand the Anticholinergic burden score among Geriatric population. Methods : This study is a descriptive cross-sectional study, which was done, in a period of six months among 62 Geriatric patients attending a therapeutics clinic of a private clinical pharmacology OPD for first time. Patients were noted for their comorbidities and anticholinergic burden was calculated, based on the Anticholinergic Cognitive Burden scale. Results were statistically analyzed. Results : Clinically significant anticholinergic burden was observed in 22.58% population. The most frequently prescribed drug was found to be alprazolam followed by amitriptyline and theophylline. Among the comorbidities hypertension and diabetes was commonly seen in majority of the population. Conclusion : Co-professional care at clinical pharmacology OPD with assessment of anticholinergic burden of geriatric prescriptions and advices on rational de-prescribing with suggestions on safer alternatives would be beneficial for treating physicians to optimize therapy.

Underactive bladder and its problems in diagnosis and treatment of lower urinary tract dysfunction / 中华泌尿外科杂志

Underactive bladder (UAB) is a hot research topic in the field of urinary continence.At present,the research on UAB is not in-depth,which brings many serious problems for the diagnosis and treatment of lower urinary tract dysfunction.In this paper,the definition,classification,risk factors,pathogenesis and diagnostic criteria of UAB are described.Some clinical problems related to UAB are discussed in details,such as the indications and surgical expectations of benign prostatic hyperplasia (BPH) and female stress urinary incontinence (SUI) with UAB,strategic issues in detrusor hyperactivity with impaired contractility (DHIC),oral anticholinergic drugs,and bladder wall injection of botulinum toxin A may lead to urinary retention.

Improvement of phencynonate hydrochloride on posterior circulation vertigo in rats and positive vertigo in mice / 中国药理学与毒理学杂志

OBJECTIVE To evaluate the anti-vertigo effect of phencynonate hydrochloride. METHODS To detect the improvement of phencynonate hydrochloride on cerebral blood flow, a rat model wa s es?tablished with bilateral common carotid arteries occlusion. Phencynonate hydrochloride 0.1-4.0 mg·kg-1 was ig given, twice a day for three consecutive days and the alteration of cerebral blood flow was measured with laser Doppler flowmetry. Rotating acceleration equipment was used to provocate mouse vertigo for 30 min, and the spontaneous locomotor activities were tested for occurrence of vertigo in mice. Phencynonate hydrochloride 1.4-5.6 mg·kg-1 was ig given before rotating acceleration. Gastric phenol red emptying rate was used to determine the anti-nausea effect of the test drug in mice 30 min after phencynonate hydrochloride 1.4-8.4 mg·kg-1 was ig given. RESULTS The cerebral blood flow of the rat model with bilateral common carotid arteries occlusion was reduced significantly after 24 h (P<0.01). Compared with the model group, phencynonate hydrochloride (0.5, 2.0 and 4.0 mg · kg-1) increased the cerebral blood flow in a dose-dependent manner in rats with cerebral ischemia (P<0.01). The spontaneous locomotor activities were significantly reduced after vertigo stimulation in mice (P<0.05). Compared with the model group, phencynonate hydrochloride (2.8 and 5.6 mg · kg-1) increased the movement distance and speed of vertigo mice (P<0.05). Phencynonate hydrochloride (2.8, 5.6 and 8.4 mg·kg-1) inhibited the gastric emptying of mice (P<0.05). CONCLUSION Phecynonate hydrochloride can improve the cerebral blood flow and locomotor activities in vertigo rats, while inhibiting gastric emptying, which points to the therapeutic potential of phencynonate hydrochloride for vertigo in clinic.

Drug research and clinical application of organophosphorous poisoning / 中国药理学与毒理学杂志

Acute organophosphorus pesticides poisoning(AOPP)is one of the common critical emergency problems and the fatality is extremely high. Organophosphorus pesticides(OPS)are highly effective acetylcholinesterase(AChE)inhibitors. The AChE inhibition results in accumulation of acetyl?choline and overestimation of acetylcholine receptors in synapses of the autonomic nervous system, central nervous system,and neuromuscular junctions,causing a series of symptoms including musca?rinic,nicotinic,and central nervous system dysfunctions. In the early stage of AOPP,the core treat?ment is the use of anticholinergic drugs coupled with cholinesterase reactivator. Atropine and penehycli?dine hydrochloride(Tuoning)are the most commonly used anticholinergic drugs,which can effectively compete with acetylcholine receptors,block the effect of acetylcholine,and relieve the symptoms of re?spiratory failure,bronchospasm,pulmonary edema caused by AOPP. Oximes are believed to function as AChE reactivators,that can promote enzymatic reactivation and restore the activity of hydrolysis of ace? tylcholine. Recently,new avproaches,such as intravenous lipid emulsion,new detoxification drugs, blood purification,and traditional Chinese medicine,have attracted more attention. Overall,great prog?ress has been made in AOPP treatments. A better understanding of AOPP mechanism,and the support from pharmacology,toxicology,and related fields can contribute to the treatment of AOPP. Improved medical management of AOPP can also result in fewer deaths from poisoning worldwide.

Anti vertigo drugs-revisited.

Vertigo is a sense of whirling and rotation and is frequently associated with nausea and vomiting. Vertigo is a cardinal manifestation of vestibular disorders. Pharmacotherapy is required for symptomatic treatment of vertigo and motion sickness irrespective of the aetiology. Drugs like cinnarizine, betahistine and scopolamine are time honoured drugs. Antihistaminics and phenothiazines are also useful agents. Surprisingly, very few newer agents have shown undisputed efficacy against vertigo. This review describes the neurotransmitters involved in the genesis of vertigo and current status and evolution of appropriate pharmacological options for the treatment.

Characteristics of phase 3-like activity and rebound excitation triggered by hexamethonium and atropine administration in the ovine small bowel.

Administration of hexamethonium (Hx) and atropine inhibits myoelectric and motor activity and then evokes a stimulatory effect called rebound excitation (RE) in the ovine small bowel. RE has not been precisely characterized so far and it is possible that it is composed of different types of motility. This study was thus devoted to characterizing these excitatory changes in the myoelectric and motor activity of the small bowel, particularly in the duodenum in conscious sheep. These alterations occurred in response to different intravenous doses of Hx and atropine administered alone or in combinations during various phases of the migrating myoelectric or motor complex (MMC) in the fasted and non-fasted sheep. Initially two basic types of excitatory response to the cholinergic blockade were found. In the course of chronic experiments different doses of Hx and atropine evoked phase 3-like activity (unorganized phase 3 of the MMC or its fragments) alternating with the less regular RE and the duration of these changes was related to the drug dose. In the non-fasted sheep these changes were less pronounced than in the fasted animals. When the drug was given during phase 1 of the MMC, RE did not occur or was greatly reduced. Administration of Hx and atropine in the course of phase 2a and phase 2b of the MMC produced roughly similar effects. Hx triggered stronger phase 3-like activity and RE than atropine. Combinations of Hx and atropine induced an additive effect, more evident in the fasted animals. These actions of Hx and atropine, thus, appear to involve at least partly the same intramural pathways. It is concluded that Hx and atropine evoke phase 3-like activity alternating with RE as the secondary stimulatory response in conscious sheep and both these types of the intestinal motility represent two distinct motility patterns.

Clinical experiences with oxybutynin chloride in children

Two hundred and forty-five cases are presented, composed of 141 males and 104 females, ranging in ages from 1 month to 11 years and 10 months. Their most common complaint was vomiting followed by abdominal colic, then vomiting and abdominal colic, tenesmus, and lastly, tenesmus and abdominal colic. Of the 245 cases under study a total of 235 or 96% responded to treatment. Only 10 failed to respondIn conclusion, the authors believe that the big success achieved in the treatment of the various conditions mentioned above was due to the dual action of oxybutynin chloride, that is, a musculotropic action (Spasmolytic) and the anticholinergic action (anti-secretory) and also because of the acceptability of the taste of the drugThe dosage schedule was 0.1mg./Kg of body weight, given every 8 hours. (Summary)

Dose - response for Glycopyrrloate and Heart Rate in Children Anesthetized with Halothane and Nitrous Oxide / 대한마취과학회지

The dose-response for glycopyrrolate and heart rate in anesthetized children has not heen defined. We determined the dose-response for glyeopyrrolate and heart rate in 50 children, ASA physical status l and 2, anesthetized with halothane and nitrous oxide. Anesthesia was induced with 60-70% nitrous oxide in oxygen and halothane(1.5-2.0 vo1%). After induction of aneethesia, glycopyrrolate in a dose of 4, 6, 8, 12 or 16ug Xkg(-1) was administered by rapid infusion to each subject. The effects of glycopyrrolate on heart rate, heart rhythm and systolic blood pressure were compared among dosage groups, and dose-response curve for peak heart rate was constructed, Glycopyrrolate increased the heart rate in a dose-related manner upto 12 ug X kg(-1) except 16 ugX kg(-1). Fifty percent maximal response corresponded to 6.1 ug X kg(-1), and 95% maximal response corresponded to 11.1 ug X kg(-1) . None of the patients had nonsinus rhythm after glycopyrrolate injection. Except for glycopyrrolate given at 4 ug x kg(-1), the systolic blood pressure increased significantly after all other doses. Glycopyrrolate in doses greater than or equal to 6 ug X kg(-1) increased the heart rate and systolic blood pressure in children anesthetized with halothane and nitrous oxide.