Driving performance, effect

The ultimate outcome goal for any patient with epilepsy is elimination of all seizures without any adverse effects of the treatment. An effective treatment plan would allow the patient to pursue a normal lifestyle with complete control of seizures. Specifically, the treatment should enable the patient to drive, perform well in school, hold a reasonable job, and function effectively in the family and community. However, due to the intractability of the seizures or sensitivity to antiepileptic drugs (AEDs), many patients are not able to achieve these outcomes. In these cases, the goal of therapy is to provide a tolerable balance between reduced seizure severity and/or frequency and medication adverse effects that optimizes the individual s ability to have a lifestyle as nearly normal as possible. 

About fifteen years after our LSD research at Edgewood, Leo Hollister and I collaborated on a study for the California Department of Justice, comparing the effects of alcohol and marijuana on driving performance. In the process, I interviewed more than 200 young male volunteers. One of them, a prime specimen of physical fitness and lucid intellect, told me he had taken LSD virtually every day while he was in high school, simply for fun and stimulation (a surprisingly large number of individuals still use LSD frequently for recreational purposes.)... 

Ketchum JS, Reeve V, Hollister L Effects in volunteers of alcohol and marijuana on driving performance. Department of Justice, State of California, Sacramento, CA Unpublished data, 1982. 

Brookhuis, K.A., Volkerts, E.R., and O Hanlon, J.F., Repeated dose effects of lormetazepam and flurazepam upon driving performance, Eur. J. Clin. Pharmacol., 39, 83, 1990. 

Tom os, J. and Laurell, H., Acute and hangover effects of alcohol on simulated driving performance,... 

Brookhuis KA, de Vries G, de Waard D. The effects of mobile telephoning on driving performance. Accid Anal Prev 1991 23 309-316. 

Ramaekers JG, van Veggel LM, O Hanlon JF. A cross-study comparison of the effects of moclobemide and brofaromine on actual driving performance and estimated sleep. Clin Neuropharmacol 1994 17 (suppl 1) S9—18. 

Brookhuis KA, De Vries G, De Waard D. Acute and subchronic effects of the Hl-histamine receptor antagonist ebastine in 10, 20 and 30 mg dose, and triprolidine 10 mg on car driving performance. Br J Clin Pharmacol 1993 36 67-70. 

Ridout F, Meadows R, Johnsen S, Hindmarch I (2003) A placebo controlled investigation into the effects of paroxetine and mirtazapine on measures related to car driving performance. Hum Psychopharmacol 18 261-269... 

Drive performance and health processes with the right rhythm to allow the organization to be directed and operated effectively and efficiently. A chemical company can have in place the appropriate review processes, value-drivers, and targets, but not the proper sequence, timing, and pace of performance management events for its particular businesses. 

Alcohol and Car Driving The effects of alcohol and driving are a subject of great importance, as many countries have made laws designed to prevent car accidents. Accidents involving alcohol number as many as 50% of total accidents (Fig. 14-1). Hence, it is necessary to perform breath or blood tests to determine a driver s alcohol content. In the United Kingdom, a blood-alcohol level exceeding 80 mg/100 mL is an offense other countries such as the United States and Australia have lower limits. 

J.G. Ramaekers, et al., A comparative study of acute and subchronic effects of doth-iepin, fluoxetine and placebo on psychomotor and actual driving performance. Br. J. Clin. Pharmacol. 39 397-404, 1995. 

Bhatti JZ, Hindmarch I. The effects of terfenadine with and without alcohol on an aspect of car driving performance. Clin Exp Allergy 1989 19(6) 609-11. 

The effect of levocetirizine 5 mg/day on actual driving performance during normal traffic has been compared with the effect of the first-generation antihistamine diphenhydramine 50 mg/day in 48 healthy volunteers in a double-blind, placebo-controlled, randomized trial (73). Treatments were given on days 1, 2, 3, and 4, at 90 minutes before the start of a standardized driving test on days 1 and 4. In contrast to diphenhydramine, driving performance was not significantly affected by levocetirizine 5 mg/day. 

Automated control schemes employ one or more sets of controls, which will fit into three categories U) control loops which are used to regulate the addition of flocculant, (2) control loops to regulate the withdrawal of underflow, and (3) rake drive controls. Usually, the feed to a thickener is not controlled and most control systems nave been designed with some flexibility to deal with changes in feed characteristics, such as an increase in volume or alteration in the nature of the solids themselves. In severe cases, some equalization of the feed is required in order to allow the control system to perform effectively. 

In a comparison of the effects of acrivastine, terfenadine, and diphenhydramine on driving performance, there was a dose-dependent effect of acrivastine, with severely affected driving in doses of 16 and 24 mg (SEDA-19,170). Terfenadine in doses of 60-180 mg did not affect driving performance. 

In a comparison of cetirizine and loratadine, cetirizine 10 mg had acute sedative effects and impaired driving performance (65), whereas loratadine had no sedating potential furthermore, there was an additive effect of alcohol and cetirizine but not alcohol and loratadine. However, in a study using a driving simulator cetirizine 10 mg did not affect driving ability (66). In other studies cetirizine 20 mg caused significant sedation, while in one study there was a dose-dependent sedative effect with 10 mg and 20 mg but not 5 mg (67). Pooling the available data (SEDA-16, 163) shows that cetirizine is little more sedative than loratadine and terfenadine. 

Weiler JM, Bloomfield JR, Woodworth GG, Grant AR, Layton TA, Brown TL, McKenzie DR, Baker TW, Watson GS. Effects of fexofenadine, diphenhydramine, and alcohol on driving performance. A randomized, placebo-controlled trial in the Iowa driving simulator. Ann Intern Med 2000 132(5) 354-63. 

Cetirizine did not potentiate the effects of ethanol on psychomotor and driving performance (SEDA-20, 163), but did affect tracking speed and performance in divided attention tests. 

O Hanlon JF, Ramaekers JG. Antihistamine effects on actual driving performance in a standard test a summary of Dutch experience, 1989-94. Allergy 1995 50(3) 234-42. 

In a study conducted by the National Highway Traffic Safety Administration, a moderate dose of marijuana alone was shown to impair driving performance however, the effects of even a low dose of marijuana combined with alcohol were markedly greater than for either drug alone. Driving indices measured included reaction time, visual search frequency (driver checking of side streets), and the ability to perceive and/or respond to changes in the relative velocity of other vehicles. ... 

Van Laar MW, Volkerts ER, van Willgenburg AP. Therapeutic effects and effects on actual driving performance of chronically administered buspirone and diazepam in anxious outpatients, j Clin Psychopharmacol 1992 12 86-95. 

---