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1/18. calcium-channel blocker withdrawal in a pregnant woman.

    We present a case report of a woman for whom a topical mucosal ulcer drug was prescribed and the pharmacist erroneously dispensed a calcium channel blocker (CCB), resulting in toxicities from the drug and withdrawal symptoms when attempts were made to stop the CCB. The pharmacology and toxicology of CCBs are discussed, particularly in relation to the adverse experiences of the case.
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ranking = 1
keywords = pharmacology
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2/18. Zipeprol (Zinolta) abuse among American adolescents in korea: a discussion of the problem, clinical presentation, and treatment.

    Zipeprol dihydrochloride (Zinolta) is a Korean medication that is abused by American dependent teenagers in korea. The adolescents usually present for medical care after a seizure. Since this medication is not available in the united states, many physicians are unfamiliar with zipeprol-induced seizures. The extent of the problem, the pharmacology and mechanism of action of zipeprol, the clinical presentation, and suggestions for treatment are discussed. Military physicians should consider zipeprol overdose when a teenager presents with a seizure.
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ranking = 1
keywords = pharmacology
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3/18. Management of the difficult patient with complex partial seizures.

    Successful treatment of partial complex seizures (and the epilepsies in general) is a process of management over time and involves several factors. It starts with accurate and adequate diagnostic formulations. To this end the physician must be thoroughly familiar with the ictal manifestations of partial complex and other epilepsies as well as the clinical features of other transient but reversible episodes that might present difficulties in differential diagnosis. The diagnosis is based upon the history of a patient experiencing partial complex seizures, and the most important resource is a careful and detailed history of the ictal events and the circumstances under which they occur. Clinical observation and electrophysiologic monitoring of the patient during attacks, either spontaneous or induced, is the most powerful technique available in cases which present difficult diagnostic problems. In addition to recognition and proper classification of the seizures themselves, diagnosis and treatment of the cause of the seizures, particularly when it is an active disease, is of prime importance. Even after accurate diagnosis, the heterogenous nature of the population of patients with partial complex seizures is such that marked variation in response to treatment with antiepileptic drugs is to be anticipated. The use of these drugs must be individualized and based upon a thorough and working knowledge of their clinical pharmacology. The most frequent mistakes in our experience have been prescribing the drugs in too little doses or for too short a time. Less often the problem is overmedication. The best indicator of the effectiveness of the drugs is the clinical response of the individual patient, and in general each drug should be prescribed in increasing doses until either the seizures are controlled or unacceptable degrees of toxicity develop. The use of serum level determinations can be very helpful if not invaluable, particularly in identifying and understanding potential adverse effects of the drugs. Patient noncompliance in adhering to drug schedules is widespread, but usually can be detected by measuring serum levels. Even with the most efficient use of the drugs, however, some patients will be intractable, and elective surgical treatment should be considered. Finally, control of seizure occurrence alone is not necessarily adequate treatment, as many patients will have difficult psychosocial problems associated with their epilepsy. Treatment of such associated problems is necessary on its own merits, but occasionally can result in significant improvement in seizure control.
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ranking = 1
keywords = pharmacology
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4/18. Tailoring adult psychiatric practices to the field of geriatrics.

    The united states' population is aging. Epidemiological surveys suggest significant rates of mental illness amongst the rapidly growing over-65 cohort. A burgeoning experience and data base related to the developing sub-discipline of geriatric psychiatry is now available. This article synthesizes key issues and concepts as an introduction to geropsychiatric practice-in particular, a) the interface between medical illness and psychiatric expression in the elderly, b) delirium, c) dementia, and d) depression-and considers their interactions. Finally, there is a brief overview of geriatric psychopharmacology, followed by clinically-oriented discussions of each of the major classes of psychotropics as applied to a geriatric population.
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ranking = 1
keywords = pharmacology
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5/18. Asphyxial deaths from the recreational use of nitrous oxide.

    The recreational use of nitrous oxide is widespread. nitrous oxide for recreational use is usually obtained from anesthesia tanks or whipped-cream machine chargers or cans. Twenty previously described deaths associated with recreational nitrous-oxide use describe anesthesia tanks and whipped-cream machine dispensors as a source. Five deaths associated with nitrous oxide use are presented; two involving whipped-cream cannisters as the source, two involving anesthesia tanks, and one involving a racing fuel tank as a source of nitrous oxide. autopsy findings in our cases were subtle or negative, but usually suggestive of asphyxia. Through a laboratory simulation, we have confirmed that nitrous oxide displaces oxygen in a closed space, which probably leads to asphyxia. A review of the literature, neuropharmacology, and pathophysiology of nitrous oxide use is also presented.
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ranking = 1
keywords = pharmacology
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6/18. Use and abuse of khat (catha edulis): a review of the distribution, pharmacology, side effects and a description of psychosis attributed to khat chewing.

    There have been relatively few reported cases of psychosis due to khat usage despite its heavy consumption in certain East African and Arabian countries. Four cases have been reported in the UK. We report here on three further cases of psychotic reactions to this substance in Somalian males, and emphasize the need to be aware of khat as a potential substance of abuse, with both medical and psychiatric complications. The features of khat psychoses are described and the relationship to amphetamine and ephedrine psychoses is discussed. The forensic aspects of two of the cases which involved homicide and combined homicide and suicide are highlighted, as is the possible role of social dislocation from the culture of origin.
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ranking = 4
keywords = pharmacology
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7/18. pseudoephedrine-induced hypertensive emergency: treatment with labetalol.

    The case of a young man in hypertensive emergency following the ingestion of 840 mg of pseudoephedrine is reported. The hypertension, which peaked at 200/160 mm Hg and was associated with severe headache and diaphoresis, responded expeditiously to two initial intravenous doses of labetalol. No rebound was observed following the administration of an additional dose in the intensive care unit, after which an uneventful one-day hospitalization ensued. The toxicity of pseudoephedrine is briefly reviewed along with the pharmacology and use of labetalol. On the basis of previous experimental studies and the present report, labetalol is suggested as a promising agent in the treatment of hyperadrenergic-induced hypertensive emergencies.
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ranking = 1
keywords = pharmacology
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8/18. Fatal intracranial hemorrhage associated with phenylpropanolamine, pentazocine, and tripelennamine overdose.

    Hemorrhagic cerebrovascular accident is an uncommon but serious complication of drug overdose. A case of fatal intracranial hemorrhage following overdose with phenylpropanolamine, pentazocine, and tripelennamine is presented. The pharmacology, pathophysiology, clinical presentation, and management of poisoning by these agents are discussed.
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ranking = 1
keywords = pharmacology
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9/18. Clinical psychiatry and cardiovascular disease in the aged.

    The geriatric patient has a high incidence of cardiovascular and psychiatric illness; treatment of either may lead to emergence or aggravation of the other. Toxic side effects can frequently be managed by a reduction in dose or a change in medication. In general, the psychiatric problems of elderly patients, including patients with cardiovascular disease, can be managed despite the cardiovascular toxicity of most psychotropic drugs. Psychiatrists who treat geriatric patients need an understanding of psychopharmacology and clinical manifestations of the cardiovascular system in order to provide well-rounded care.
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ranking = 1
keywords = pharmacology
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10/18. lithium toxicity with rarely reported ECG manifestations.

    A case of severe lithium intoxication treated successfully with hemodialysis is presented. In addition to the common neurological manifestations of toxicity the patient demonstrated three rarely reported cardiotoxic manifestations: reversible first degree A-V block, intraventricular conduction delay, and prolonged Q-T interval. These findings demonstrate the need to include lithium intoxication in the differential diagnosis of drug overdose with prominent ECG changes. The pharmacology, presenting signs and symptoms, and current treatment modalities of lithium intoxication are reviewed.
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ranking = 1
keywords = pharmacology
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