Addiction Rehab: The Older Patient With Hypertension: Care and Cure.
The older patient with hypertension: care and cure.
Filed under: Addiction Rehab
Ther Adv Chronic Dis. 2012 Sep; 3(5): 231-6
Borghi C, Tartagni E
Hypertension is one of the most important clinical conditions affecting older people. Its prevalence in this group of subjects is above 60% and continues to grow. Isolated systolic hypertension accounts for the majority of cases as systolic blood pressure increases with advancing age, while diastolic blood pressure remains unchanged or even decreases. Nowadays hypertension is a well established risk factor for stroke and cardiovascular disease among older people and its treatment is considered mandatory. The general recommended blood pressure goal in uncomplicated hypertension is less than 140/90 mmHg, even if this target in older people is based mainly on expert opinion. All patients should receive nonpharmacological treatment, in particular reduction in excess body weight when body mass index is greater than 26 kg/m(2) and dietary salt restriction. Older patients with hypertension may also benefit from smoking cessation, physical activity and alcohol restriction. In relation to drug therapy, a low-dose thiazide diuretic could be a good first step. Other first-line drugs are long-acting calcium channel blockers, generally dihydropyridines, and angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers. The HYVET study showed a specific protective effect of indapamide with or without perindopril in people older than 80 years. Since monotherapy normalizes blood pressure in only 40-50% of cases, a combination of two or more drugs is often required. Moreover the addiction of a second drug may reduce the dose-related adverse effects of the first one. Finally, compliance with treatment should always be achieved by giving complete information to patients and simplifying the drug regimen as much as possible.
HubMed – addiction
Effects of acute and sub-chronic nicotine on impulsive choice in rats in a probabilistic delay-discounting task.
Filed under: Addiction Rehab
Psychopharmacology (Berl). 2013 Jan 23;
Kelsey JE, Niraula A
RATIONALE: Cigarette smokers typically display impulsivity by preferring immediate rewards over larger, delayed rewards at shorter delays than do non-smokers. Suggesting causality, nicotine injections in rats increase the choice for an immediate reward over a larger, delayed reward. OBJECTIVES: To examine the generality of this latter effect, the present study employed a delay-discounting task to determine if acute and sub-chronic nicotine will also increase impulsive choice when subjective reward value is manipulated by changes in the probability, rather than magnitude, of reward. MATERIALS AND METHODS: Rats were presented with two levers, one of which delivered an immediate water reward on half of the trials, while the other lever delivered the same reward on every trial, but only after one of five increasing delays. RESULTS: Acute injections of 1.2 mg/kg, but not 0.8 mg/kg, of nicotine increased the preference for the immediate (but less certain) reward lever at intermediate delays. Moreover, twice-daily injections of 0.8 mg/kg of nicotine for 6 days progressively increased the preference for the immediate reward. Latency to make the first response on each trial was not affected by nicotine. CONCLUSIONS: The similar increases in impulsive choice produced by both acute and sub-chronic nicotine in delay-discounting paradigms whether subjective reward value is manipulated by changes in reward magnitude or probability suggests that nicotine may be increasing what is common to these paradigms, namely delay discounting. Whatever the mechanism, these data indicate that both acute and sub-chronic nicotine may help develop and maintain an addiction by increasing impulsivity.
HubMed – addiction
Tramadol induced paradoxical hyperalgesia.
Filed under: Addiction Rehab
Pain Physician. 2013 Jan; 16(1): 41-4
Lee SH, Cho SY, Lee HG, Choi JI, Yoon MH, Kim WM
Opioids have been the mainstay analgesics for postoperative, cancerous, and chronic noncancerous pain. Common concerns regarding the use of opioids include the development of physical dependence and addiction. However, as a potential complication of opioid therapy, opioid-induced hyperalgesia (OIH) is often overlooked. That is, patients receiving opioids to control their pain may paradoxically become more sensitive to pain as a consequence of opioid therapy. OIH is a very important issue because it may complicate the clinical course of pain treatment and even worsen the suffering of patients receiving opioids because of the development of excruciating pain. Three OIH types were defined: 1) in the context of maintenance dosing and withdrawal, 2) at very high or escalating doses, and 3) at ultra-low doses. In the literature, most attention has been paid to the first 2 forms, and almost all cases of reported OIH have been ascribed to morphine administration. The third form of OIH has not been documented in humans, although it has been observed in animals. We present 2 cases of OIH resulting from administration of tramadol, which is a synthetic analogue of codeine and exhibits 10-fold less affinity for mu-opioid receptors, in patients suffering from chronic pain. The 2 cases presented herein imply the importance of recognizing OIH in patients medicated with tramadol if analgesic effects are lost in the context of dose titration, when generalized pain is reported without any evidence of disease exacerbation. While OIH associated with ultra-low dose opiates seems to be quite rare, if it is suspected, switching to other drugs and an appropriate treatment should be considered.
HubMed – addiction
No evidence for an effect of testosterone administration on delay discounting in male university students.
Filed under: Addiction Rehab
Psychoneuroendocrinology. 2013 Jan 19;
Ortner GR, Wibral M, Becker A, Dohmen T, Klingmüller D, Falk A, Weber B
Intertemporal choices between a smaller sooner and a larger delayed reward are one of the most important types of decisions humans face in their everyday life. The degree to which individuals discount delayed rewards correlates with impulsiveness. Steep delay discounting has been associated with negative outcomes over a wide range of behaviors such as addiction. However, little is known about the biological foundations of delay discounting. Here, we examine a potential causal link between delay discounting and testosterone, a hormone which has been associated with other types of impulsive behavior. In our double-blind placebo-controlled study 91 healthy young men either received a topical gel containing 50mg of testosterone (N=46) or a placebo (N=45) before participating in a delay discounting task with real incentives. Our main finding is that a single dose administration of testosterone did not lead to significant differences in discount rates between the placebo and the testosterone group. Within groups and in the pooled sample, no significant relationship between testosterone and discount rates was observed. At the same time, we do replicate standard findings from the delay discounting literature such as a magnitude-of-rewards effect on discount rates. In sum, our findings suggest that circulating testosterone does not have a significant effect on delay discounting in young men.
HubMed – addiction
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