Long-term effects drug tolerance

Other long-term effects of amyl nitrite use are unclear. Mood swings and personality changes have been reported but have not been studied. Tolerance to poppers develops on repeated exposure. Chemical dependence does not occur, and the drugs have a low potential for psychological dependence. 

The patient s priority is relief of joint pain, swelling and stiffness. In addition to providing symptomatic relief, the doctor must avoid the long-term effects of inadequately treated joint inflanunation, which leads to joint failure requiring multiple orthopaedic operations. There is no cure for arthritis (except septic arthritis), and the available drugs are sometimes poorly tolerated. Many patients with arthritis turn to complementary therapies which may interact with conventional drugs. Successful treatment of arthritis usually requires a multidisciplinary approach with physiotherapy, occupational therapy and adjustment on the part of the patient all being important. 

Caffeine is an extremely important drug because of its widespread use. Overall it also seems to be a relatively safe drug. Despite the many years of research that have been devoted to caffeine, however, we still have a lot to learn about it. Probably the most essential research concerns tfcveloping better ways to obtain accurate measures of caffeine consumption. Such advances would help us answer important research questions. F or example, we need to know more about the long-term effects of caffeine use in children, the development of tolerance to caffeine, and the prevalence of more minor symptoms of higher, but not extreme, levels of caffeine use. Another question is how caffeine affects people in special populations, such as those who arc medically or psychiatrically ill. 

Several modem, better-tolerated antipsychotic agents (olanzapine, quetiapine, and risperidone) have recently received FDA approval for use in acute mania. There is also evidence of antimanic efficacy for aripiprazole and ziprasidone. Olanzapine is FDA-approved for its long-term effectiveness in bipolar disorder 1. Other atypical antipsychotic drugs are under investigation for long-term prophylactic treatment of bipolar disorder. 

Tolerance can limit the long-term effectiveness of nitrates in the treatment of CHF. Blood levels of these drugs should be permitted to fall to negligible levels for at least 6-8 hours each day, which can be adjusted to the patient s symptoms. Patients with recurrent orthopnea or paroxysmal nocturnal dyspnea, for example, would likely benefit most by using nitrates at night. N-acetylcysteine (mucomyst) may diminish tolerance to the hemodynamic effects of nitrates in heart failure. Likewise, hydralazine may decrease nitrate tolerance by an antioxidant effect that attenuates superoxide formation, thereby increasing NO bioavailability. 

Bisphosphonates have been shown to be highly effective in osteoporosis, cancer bone metastasis, multiple myeloma, and Paget s disease of bone. While generally very well tolerated, these drugs do have potential adverse effects. Recently, the association of long-term high dose bisphosphonate treatment with osteonecrosis of the jaw has been described. This is a potentially serious side effect seen mostly in patients with multiple myeloma or... 

Since 3 agonists have few of the long-term side effects of ft agonists, 3 agonists that could overcome tolerance development may be useful drugs in the treatment of chronic pain. In fact, the non-peptide 3 selective agonist SIOM [100] did not de-... 

There is some evidence that long-term cyclic administration of rifaximin combined with fiber supplementation is effective for inducing symptomatic relief in patients with uncomplicated diverticular disease of the colon. A therapeutic gain of approximately 30% compared to fiber supplementation only can be expected. The drug is well tolerated and no relevant side effects have been reported. Symptoms attributed to diverticula (abdominal pain or discomfort, bloating, disturbance of bowel habits) are nonspecific symptoms and are also features of irritable bowel syndrome. It has been suggested that irritable bowel syndrome and diverticular disease of the colon may coexist in many people and when bowel symptoms occur with diverticulosis coli, they may be due to a coexistent irritable bowel rather to the diverticula themselves [47, 48]. This hypothesis is supported by the fact that many patients with symptomatic diverticular disease show co-... 

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