ABSTRACT
Proposed mechanisms, clinical features, prevalence, and treatment of phenothiazine-induced cholestatic jaundice are reviewed, and interactions between phenothiazines and other drugs that could theoretically alter the risk of cholestasis are described. Phenothiazine-induced jaundice is classified as a form of cholestatic hepatocanalicular hepatotoxicity and as an acute liver disease. Occasionally cholestatic jaundice may progress to chronic liver disease. The mechanism of hepatotoxicity is not completely understood but may involve a combination of physiochemical, immune, and direct toxic effects. Based on proposed mechanisms, concomitant use of drugs that alter microsomal hepatic enzyme function or have metabolic pathways that interfere with or overlap with those of the phenothiazines could be expected to potentiate or reduce the risk of cholestasis. The estimated prevalence of jaundice with chlorpromazine is 1-2%. The prevalence of jaundice with other phenothiazines is probably similar. The onset of jaundice usually occurs during the first one to four weeks of therapy. In most cases, discontinuation of the offending drug is the only treatment required. Jaundice usually resolves without sequelae two to eight weeks later. Pruritus can be relieved by topical corticosteroid or analgesic therapies or by oral antihistamines or bile acid sequestrants if topical therapy is ineffective. Whenever possible, reinstitution of neuroleptic therapy should be delayed until the reaction has resolved. Selection of a nonphenothiazine neuroleptic agent may be preferred. Phenothiazine-induced cholestatic jaundice occurs relatively infrequently and is usually self-limited; topical agents and oral antihistamines can alleviate the discomfort associated with the reaction.
Subject(s)
Antipsychotic Agents/adverse effects , Cholestasis/chemically induced , Cholestasis/drug therapy , Cholestasis/physiopathology , Humans , Phenothiazines , Risk FactorsABSTRACT
Because of the existence of multiple medical diseases and the concurrent use of multiple medications, many elderly patients present a therapeutically complex picture to clinicians. This pilot study evaluates a systematic approach to identifying and reducing medication-related problems in a population averaging five chronic medical problems and taking an average of eleven medications. The approach is unique in its use of an in-depth home medication history and a comprehensive review of therapy. In spite of close medical supervision, an average of ten potentially medication-related problems were identified among seventeen therapeutically complex patients. Recommendations to eliminate these problems were developed by pharmacists who reviewed the patient information. These recommendations were presented to the patient's physician who accepted 67% of the suggestions.
Subject(s)
Drug-Related Side Effects and Adverse Reactions , Family Practice , Aged , Aged, 80 and over , Drug Therapy , Female , Humans , Middle Aged , Patient Education as Topic , Referral and ConsultationABSTRACT
The extent of potential medication-related problems was examined using a thorough review of drug therapy for 53 elderly patients who averaged five chronic illnesses and who used a mean of 11 drugs. An average of 11 specific potential medication-related problems was identified for each patient. These problems fell into three broad categories: drug toxicity, physician prescribing, and patient medication behaviors. The strongest predictor of the total number of potential problems was the number of prescription medications. The type of drug therapy review used in this study can help health professionals identify and prevent the types of medication-related problems occurring in multiple medication users.
Subject(s)
Aged , Drug-Related Side Effects and Adverse Reactions , Drug Interactions , Drug Prescriptions , Female , Humans , Judgment , Male , Middle Aged , Patient Compliance , Patient Education as Topic , Pharmaceutical Preparations/administration & dosage , Pharmacists , Physicians/psychology , Regression Analysis , Self Administration/adverse effects , Sick RoleABSTRACT
A computer-administered interview on life events (CAI-LEV) was developed for use by patients in the waiting room of the model family practice unit at the Medical University of South Carolina, Charleston, South Carolina. Computer printouts of CAI-LEV are immediately available for doctor/patient communication, so that CAI-LEV fits into ongoing patient flow and care. Throughout a three-month study, confidentiality of information was protected by the use of numbers for patient responses to questions in 16 areas covering a wide range of possible life events. The adept physician can utilize the printout to assess stress in the patient's current situation, to focus quickly on any particular area of concern, or to initiate a counseling session. Of some 250 completed interview, 93 have been reviewed by residents and faculty after in-depth utilization during patient care. Of these 93 physician-evaluated interviews, 40 percent yielded important new information, while in 22 percent of the cases, doctor/patient communication was improved.
