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  1. Article: Care of Patients at the End of Life: Management of Nonpain Symptoms.

    Baralatei, Florence T / Ackermann, Richard J

    FP essentials

    2016  Volume 447, Page(s) 18–24

    Abstract: Management of nonpain symptoms can improve quality of life for patients at the end of life and their family members. Constipation is the most common nonpain symptom. It can be related to opioid therapy and/or medical conditions. After abdominal ... ...

    Abstract Management of nonpain symptoms can improve quality of life for patients at the end of life and their family members. Constipation is the most common nonpain symptom. It can be related to opioid therapy and/or medical conditions. After abdominal examination to detect masses or evidence of bowel obstruction and rectal examination to exclude fecal impaction, constipation should be managed with a stimulant laxative (eg, senna) or an osmotic laxative (eg, sorbitol). Dyspnea also is common, and often improves with use of a fan to blow air into the face, as well with breathing and relaxation exercises. However, many patients require titrated doses of opioids to address respiratory depression, and anxiolytics such as haloperidol may be needed to manage dyspnea-related anxiety. Oxygen typically is not effective in dyspnea management in nonhypoxemic patients at the end of life. Cough is managed with antitussives. Nausea and vomiting occur in 70% of patients in palliative care units. If no reversible etiology can be identified, dopamine antagonists and motility-enhancing drugs can be used. There are no clearly effective treatments to manage noisy respiratory secretions, but position change, decrease in fluid intake, and drugs such as scopolamine or glycopyrrolate may be effective.
    MeSH term(s) Analgesics, Opioid/therapeutic use ; Anti-Anxiety Agents/therapeutic use ; Antitussive Agents/therapeutic use ; Breathing Exercises ; Constipation/drug therapy ; Cough/drug therapy ; Dopamine Antagonists/therapeutic use ; Dyspnea/therapy ; Humans ; Laxatives/therapeutic use ; Nausea/drug therapy ; Quality of Life ; Relaxation Therapy ; Terminal Care ; Vomiting/drug therapy
    Chemical Substances Analgesics, Opioid ; Anti-Anxiety Agents ; Antitussive Agents ; Dopamine Antagonists ; Laxatives
    Language English
    Publishing date 2016
    Publishing country United States
    Document type Journal Article
    ISSN 2159-3000
    ISSN 2159-3000
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Switching to duloxetine remits ziprasidone - associated urinary incontinence and improves neuropsychiatric behavior in dementia: possible relationship of incontinence to 5HT2 receptor blockade.

    Lauterbach, Edward C / Baralatei, Florence T

    Psychopharmacology bulletin

    2009  Volume 42, Issue 3, Page(s) 99–105

    Abstract: Objectives: Urinary incontinence arising in dementia lowers patient quality of life, predicts caregiver burden and nursing home placement, and predisposes to adding additional medicines that can further impair cognition, behavior, and function. An ... ...

    Abstract Objectives: Urinary incontinence arising in dementia lowers patient quality of life, predicts caregiver burden and nursing home placement, and predisposes to adding additional medicines that can further impair cognition, behavior, and function. An understanding of incontinence pharmacology can help the clinician predict and manage this adverse event in treating patients with dementia.
    Experimental design: Case report.
    Principal observations: We encountered a patient with Alzheimer's disease and vascular dementia who developed urinary incontinence and parkinsonism when ziprasidone was added to the regimen for behavioral concerns.When he was switched to duloxetine, the incontinence and parkinsonism resolved whereas improvements in perseveration, irritability, paranoia, and agitation persisted.
    Conclusions: While a pharmacokinetic explanation is unlikely, the best evidence suggests that ziprasidone-mediated serotonin 5HT2 receptor blockade may explain the reversible incontinence, with an adrenergic alpha-1 receptor mechanism considered to be less likely. Patients on 5HT2 antagonist drugs, including atypical antipsychotics, should be observed for incontinence. In the event of incontinence developing in the context of these agents, duloxetine may represent a potential pharmacological alternative in some cases. Duloxetine may improve neuropsychiatric symptoms in dementia through its effects on serotonin, norepinephrine, and frontal dopamine.
    MeSH term(s) Aged, 80 and over ; Alzheimer Disease/drug therapy ; Dementia, Vascular/drug therapy ; Duloxetine Hydrochloride ; Humans ; Male ; Parkinsonian Disorders/chemically induced ; Piperazines/adverse effects ; Piperazines/therapeutic use ; Receptors, Serotonin, 5-HT2/drug effects ; Receptors, Serotonin, 5-HT2/metabolism ; Serotonin Antagonists/adverse effects ; Serotonin Antagonists/therapeutic use ; Serotonin Uptake Inhibitors/pharmacology ; Serotonin Uptake Inhibitors/therapeutic use ; Thiazoles/adverse effects ; Thiazoles/therapeutic use ; Thiophenes/pharmacology ; Thiophenes/therapeutic use ; Urinary Incontinence/chemically induced
    Chemical Substances Piperazines ; Receptors, Serotonin, 5-HT2 ; Serotonin Antagonists ; Serotonin Uptake Inhibitors ; Thiazoles ; Thiophenes ; ziprasidone (6UKA5VEJ6X) ; Duloxetine Hydrochloride (9044SC542W)
    Language English
    Publishing date 2009
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 4113-0
    ISSN 0048-5764 ; 0376-0162
    ISSN 0048-5764 ; 0376-0162
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 958: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (1.OG)
    ab Jg. 2022: Lesesaal (EG)

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  3. Article ; Online: Sliding Scale Insulin vs Basal-Bolus Insulin Therapy in Long-Term Care: A 21-Day Randomized Controlled Trial Comparing Efficacy, Safety and Feasibility.

    Dharmarajan, Thiruvinvamalai S / Mahajan, Dheeraj / Zambrano, Annie / Agarwal, Bikash / Fischer, Rachel / Sheikh, Zahra / Skokowska-Lebelt, Anna / Patel, Meenakshi / Wester, Rebecca / Madireddy, Naga P / Pandya, Naushira / Baralatei, Florence T / Vance, Jackie / Norkus, Edward P

    Journal of the American Medical Directors Association

    2016  Volume 17, Issue 3, Page(s) 206–213

    Abstract: Introduction: Sliding scale insulin (SSI) therapy remains a common means of insulin therapy in long-term care (LTC) for the management of type 2 diabetes mellitus, despite current recommendations not supportive of the form of therapy today. Lack of ... ...

    Abstract Introduction: Sliding scale insulin (SSI) therapy remains a common means of insulin therapy in long-term care (LTC) for the management of type 2 diabetes mellitus, despite current recommendations not supportive of the form of therapy today. Lack of randomized trial data on the efficacy and safety of basal-bolus insulin (B-BI) therapy in nursing home residents may have precluded this form of insulin administration in the LTC setting. Our study is a comparison of the efficacy of SSI (control) and B-BI (intervention) therapies during a 21-day intervention trial in older nursing home residents.
    Methods: Fourteen LTC facilities in the US participated; 110 residents with type 2 diabetes volunteered to participate; 35 failed inclusion criteria, 75 signed informed written consent, and 11 were discharged to home/hospital or withdrew consent; data from 64 participants are reported. Recent fasting blood glucose (FBG), hemoglobin A1c, and chemistries were obtained. Four glucose readings (prior to breakfast, lunch, dinner, and bedtime), oral antiglycemic drug, and insulin doses and changes, and all adverse events/serious adverse events, both those related to glucose control [hypoglycemic (<70 mg/dL) and hyperglycemic (>200 mg/dL) episodes] and those unrelated, were recorded daily. Patients were randomized to either remain on SSI or be shifted to the B-BI group.
    Results: Nursing home residents 80 ± 8 (standard deviation) years, 66% female participated; Control and Intervention participants had similar age, gender, race distributions, comorbidity, and 3-day average pretrial FBG levels (all P > .05). At study end, B-BI volunteers had significantly lower 3-day average FBG levels vs pretrial (P = .0231) while SSI participants had no change in 3-day average FBG (P > .05). During the trial, participants from both groups had similar rates of hypoglycemia, hyperglycemia, other adverse events, and hospitalizations (serious adverse events) unrelated to glucose control (all P > .05).
    Conclusions: B-BI therapy produced significantly lower average FBG levels after 21 days compared with SSI therapy; both groups had similar rates of hypo- and hyperglycemia. Switching to B-BI therapy is feasible, safe, and effective in the LTC setting.
    MeSH term(s) Aged ; Aged, 80 and over ; Diabetes Mellitus, Type 2/drug therapy ; Disease Management ; Feasibility Studies ; Female ; Humans ; Hypoglycemia/drug therapy ; Hypoglycemic Agents/administration & dosage ; Insulin, Long-Acting/administration & dosage ; Long-Term Care ; Male ; Patient Safety ; Skilled Nursing Facilities ; Treatment Outcome
    Chemical Substances Hypoglycemic Agents ; Insulin, Long-Acting
    Language English
    Publishing date 2016-03-01
    Publishing country United States
    Document type Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
    ZDB-ID 2171030-2
    ISSN 1538-9375 ; 1525-8610
    ISSN (online) 1538-9375
    ISSN 1525-8610
    DOI 10.1016/j.jamda.2015.08.015
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 5971: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (2.OG)
    ab Jg. 2022: Lesesaal (EG)

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