1/128. A case of gamma-hydroxybutyric acid withdrawal syndrome during alcohol addiction treatment: utility of diazepam administration.Gamma-hydroxybutyric acid (GHB) is an emerging drug for alcoholism therapy. We present a case of GHB withdrawal syndrome secondary to GHB addiction during alcoholism treatment. A complete disappearance of drug withdrawal syndrome was achieved with oral diazepam and the symptoms resolved without sequelae. GHB has been used for alcoholism therapy for only a few years now, but the trend is increasing, and other cases similar to this one are foreseeable. This risk could be higher in some countries in which GHB use is increasing not for alcoholism therapy, but for its euphoric and anabolic effects. The present experience indicates that administration of benzodiazepines would seem to be sufficient to achieve total regression of the withdrawal syndrome in a short time, at least if recognized early.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
2/128. Characteristics and prognosis of alcoholic doctors.Five medically qualified women and 36 men who were being treated for alcoholism at a london postgraduate hospital were studied. Most were middle-aged and at an advanced stage of alcoholism. They had usually started drinking heavily in the wake of well-established drug dependence or other psychiatric disorder; as students or housemen; and in the armed forces. Thirty-six doctors were followed up for a mean of 63 months. Five doctors either killed themselves or died of cirrhosis, and nine persisted in almost continuous dependent drinking, while seven completely overcame their alcohol problem and 10 had only occasional relapses. Their prealcoholic careers had ranged from repeated failure to spectacular success, but of 29 doctors alive at follow-up only eight were practising satisfactorily.- - - - - - - - - - ranking = 0.5keywords = drug (Clic here for more details about this article) |
3/128. Managing addiction in advanced cancer patients: why bother?The management of addiction in patients with advanced cancer can be time-consuming, labor-intensive, and difficult. Some clinicians believe that it is not worth the effort, due in part to a failure to appreciate the deleterious impact of addiction on palliative care efforts and a view of addiction as intractable in any case. Indeed, it is possible that some clinicians perceive addiction not only fatalistically but, because of common misconceptions, believe that managing or attempting to decrease the patient's use of alcohol or illicit substances would be tantamount to depriving a dying patient of a source of pleasure. In this paper, we argue that managing addiction is an essential aspect of palliative care for chemically-dependent and alcoholic patients. The goal of such efforts is not complete abstinence, but exerting enough control over illicit drug and alcohol use to allow palliative care interventions to decrease suffering. To illustrate this view, we describe two patients with chemical-dependency. We highlight the impact of unchecked substance abuse on patients' perpetuation of their own suffering, the complication of symptom management, the diagnosis and treatment of mood/anxiety disorders, and the effect on the patients' family and caregivers.- - - - - - - - - - ranking = 0.5keywords = drug (Clic here for more details about this article) |
4/128. The patient who could not be discharged. How far should patient autonomy extend?A male patient was admitted to the acquired immune deficiency syndrome (AIDS) unit for hemodialysis. His history revealed that he was homeless and that he had tested positive for human immunodeficiency virus (hiv ). He also had a history of alcohol and intravenous drug abuse and tuberculosis. Based on the results of a chest X-ray, he was placed in respiratory isolation. During the next few days of his hospitalization, he exhibited nonadherent behavior toward the treatment regime. Because of previous verbal and physical abuse to staff and patients, all local hemodialysis centers refused to accept him as a patient. Thus, he became a patient who seemingly could never be discharged. A discussion related to the theoretical and practical scope of patient autonomy, institutional altruism vs. institutional self-interest, and the need for social policy to facilitate a just and humane resolution to this ethical situation is presented here.- - - - - - - - - - ranking = 0.5keywords = drug (Clic here for more details about this article) |
5/128. Adverse effects of paclitaxel in patients with alcohol abuse histories.paclitaxel is a taxane antineoplastic agent formulated in polyoxyethylated castor oil (Cremophor El) and dehydrated alcohol. This case report describes the development of central nervous system toxicity and threatened sobriety related to the alcohol content in a paclitaxel infusion. nurses need to be aware of the alcohol contained in paclitaxel and other drugs used in oncology practice and document previous and current alcohol use prior to beginning therapy. Alternative chemotherapy regimens may need to be offered to patients with alcohol abuse histories.- - - - - - - - - - ranking = 0.5keywords = drug (Clic here for more details about this article) |
6/128. Lethal combination of tramadol and multiple drugs affecting serotonin.The death of a 36-year-old alcoholic man who died after developing seizure activity while being treated with tramadol, as well as with venlafaxine, trazodone, and quetiapine, all of which interact with the neurotransmitter serotonin, is reported. The decedent, who had a history of chronic back pain, alcoholism, depression, mild hypertensive cardiovascular disease, and gastritis, had just been discharged from the hospital after 4 days of alcohol detoxification treatment. During the admission, no withdrawal seizures were noted. The morning after discharge, a witness observed the decedent exhibiting seizure activity and then collapsing. An autopsy was performed approximately 6 hours after death, and the anatomic findings were consistent with seizure activity and collapse, which included biting injuries of the tongue and soft-tissue injuries of the face. Toxicologic analysis identified tramadol, venlafaxine, promethazine, and acetaminophen in the urine; tramadol (0.70 mg/L) and venlafaxine (0.30 mg/L) in the heart blood, and 0.10 mg of tramadol in 40 ml of submitted stomach contents. No metabolites, such as acetate, acetone, lactate, and pyruvate, were found in the specimens that would be characteristically found in a person with alcohol withdrawal syndrome. The threshold for seizures is lowered by tramadol. In addition, the risk for seizure is enhanced by the concomitant use of tramadol with selective serotonin reuptake inhibitors or neuroleptics, and its use in patients with a recognized risk for seizures, i.e., alcohol withdrawal. The cause of death in this individual was seizure activity complicating therapy for back pain, depression, and alcohol withdrawal syndrome. The data in Adverse Event Reporting System of the food and Drug Administration from November 1, 1997 to September 8, 1999 was reviewed along with a medline search from 1966 to the present. This case appears to be the first reported death caused by seizure activity in a patient taking tramadol in combination with drugs that affect serotonin.- - - - - - - - - - ranking = 2.5keywords = drug (Clic here for more details about this article) |
7/128. Benefits of linking primary medical care and substance abuse services: patient, provider, and societal perspectives.Individuals with alcohol and drug use problems may receive health care from medical, mental health, and substance abuse providers, or a combination of all three. Systems of care are often distinct and separate, and substantial opportunities for benefit to patient, provider, and payer are missed. In this article, we outline (1) the possible benefits of linking primary care, mental health, and substance abuse services from the perspective of the major stakeholders-medical and mental health providers, addiction clinicians, patients, and society-and (2) reasons for suboptimal linkage and opportunities for improving linkage within the current health care system. We also review published models of linked medical and substance abuse services. Given the potential benefits of creating tangible systems in which primary care, mental health, and substance abuse services are meaningfully linked, efforts to implement, examine, and measure the real impact should be a high priority.- - - - - - - - - - ranking = 0.5keywords = drug (Clic here for more details about this article) |
8/128. Undiagnosed alcoholism & prescription drug misuse among the elderly. Special considerations for home assessment.Elderly patients are living longer than ever. Often, health care providers perceive this longevity as a measure of professional success. These patients don't always share this cheerful perspective. Living to a "ripe old age" can impose tremendous stress. An alarming number of these patients turn to alcohol and prescription drugs to escape the physical, emotional, spiritual, social and financial losses associated with aging.- - - - - - - - - - ranking = 2.5keywords = drug (Clic here for more details about this article) |
9/128. Isolated pulmonic valve endocarditis caused by group B streprococcus (streptococcus agalactiae)--a case report and literature review.The pulmonic valve is the least commonly involved valve in infective endocarditis. Pulmonic valve endocarditis is usually associated with tricuspid valve endocarditis, and isolated pulmonic valve endocarditis is exceedingly rare. The predisposing factors for developing pulmonic valve endocarditis include a congenitally anomalous pulmonic valve, intravenous drug abuse, and the presence of indwelling intravenous or flow-directed pulmonary artery catheters. More cases of group B streptococcus endocarditis are being reported. The risk factors for group B streptococcus endocarditis include diabetes mellitus, cancer, alcoholism, malnutrition, immunocompromised status, intravenous drug abuse, postpartum and postabortion states, and underlying valvular disease. The vegetations of this type of endocarditis are usually large and have a higher tendency to result in embolism. The presentation of group B streptococcus endocarditis is usually acute and may result in rapid valve destruction if not treated promptly. A case of isolated pulmonic valve endocarditis caused by group B streptococcus, streptococcus agalactiae, is presented that was diagnosed with multiplane transesophageal echocardiography in a 40-year old, alcoholic, malnourished man, who was successfully treated with intravenous penicillin g. The literature on the isolated pulmonic valve endocarditis caused by group B streptococcus is reviewed.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
10/128. An "accidental" acute psychosis with ecstasy use.Over the last 10 years, europe has witnessed the development of the ecstasy phenomenon; this term is used to describe several products sharing more or less the same effects. The most widely used and hence the most well known is 3,4 MDMA, but MDA, MDEA, MBDB and even 2CB or nexus are available. The psychopathological consequences of MDMA use in man are relatively poorly understood. The case reported here involves an acute psychotic episode with residual symptoms after six months, with a sudden onset at least 12 hours after taking alcohol and ecstasy without realising it, in an individual with no previous psychopathology other than a moderate anxiety disorder. Twelve cases of acute psychotic episodes after taking ecstasy have been reported in the literature; two after taking the drug on two occasions and one after a single use. No authors have examined the previous mental state or possible previous psychopathology with any precision. The present subject had not displayed any previous psychotic behavior when tested with a proven standardized interview technique; this was confirmed by his peers and his family. He did, however, show signs of social phobia. Although the personality of an individual is a factor in taking a drug, and probably in the quality of the psychotropic effects experienced, a host of arguments favor the appearance of psychotic symptoms de novo, which were probably related to direct toxicity by MDMA and/or its metabolites on the serotoninergic neurons.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
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