Side effects and compliance

For those RR MS patients whose flu-like symptoms, fatigue or significant muscle and joint pain persist while on IFN(3 therapies, use of low dose oral corticosteroids is another option (Rio, 1998 Martinez-Cacenes, 1998). 

Brain ahophy is recognized as a reproducible outcome measure of deshuctive change in MS. Significant atrophy 

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Efficacy, side-effects, and compliance with AGIs strongly depend on rational indication, education of patients on how to use the drug, and good dietary advice. Even with good clinical practice, a considerable variation in response and side-effects is seen. Side-effects depend, among other things, on the... 

Electrotransport technology offers a number of benefits for therapeutic appHcations, including systemic or local adininistration of a wide variety of therapeutic agents with the potential adininistration of peptides and proteins long-term noninvasive administration, improving convenience and compliance controlled release, providing a desired deflvery profile over an extended period with rapid onset of efficacious plasma dmg levels and in some cases reduced side effects and a transport rate relatively independent of skin type or site. Additional benefits include easy inception and discontinuation of treatment, patterned and feedback-controlled deflvery, and avoidance of first-pass hepatic metaboHsm. 

Compared with monotherapy, combination therapy is relatively unstudied in terms of the effects on CHD event reduction and may reduce patient compliance through increased side effects and increased costs. When used appropriately and with proper precautions, however, they are effective in normalizing lipid abnormalities, particularly in patients who cannot tolerate adequate doses of statin therapy for more severe forms of dyslipidemia. 

Inadequate discussion about potential side effects, and duration of treatment Lacking in flexibility to change regimen in response to side effects Lack of contingency planning in case of non-compliance... 

The goal of treatment is to control or reduce the frequency of seizures, minimize side effects, and ensure compliance, allowing the patient to live... 

Strategies to improve compliance are shown in Table 8. Pharmacists should be encouraged to monitor the use of drugs, to advise on potential side effects and to prevent adverse drug interactions. Nurse-managed clinics improve adherence and outcomes. The other members of the health care team can provide guidance in nutrition or exercise. 

The question of compliance with medication regimens is a complicated one for sure teens told me that they feared being labeled mentally ill, experiencing unpleasant side effects, and losing important parts of their personalities. Nonetheless, several young people said that the most difficult aspect of being on medication was remembering to take the pills ... 

Key elements to be covered in the medication followup visit include (2) a change in target symptoms from baseline, (2) a review of side effects, (3) compliance and resistance, and (4) discussion of the concerns of the child and the parents (see Table 31.1). The medication follow-up visit also includes dosage adjustment and laboratory monitoring. Guidelines for specific disorders and medications are contained in the relevant chapters in this text. 

In children or adolescents managed as outpatients, where compliance is less enforcible, medications are ideally introduced gradually and one at a time. This approach permits gradual achievement of therapeutic levels while minimizing side effects and enhances treat-... 

Treatment should begin in the least restrictive setting that ensures personal safety, as it is important to maximize family involvement from the onset. In youth with SUD, family involvement increases compliance with treatment and leads to higher rates of sustained abstinence (Bergmann et ah, 1995). It is important to review with the patient and family that medication is one aspect of the treatment plan and is more likely to be effective when used in conjunction with other treatments. In addition, the clinician should also review how the medication will work, the possible side effects, and the time frame in which benefit may be expected. An informed and involved family is more likely to encourage compliance from an adolescent than one that has never met their child s treatment team. An adult caretaker and not the patient should store, administer, and monitor all prescription medications to maximize compliance and minimize the potential for abuse. 

Clonidine is a potent antihypertensive agent which is well absorbed from the GI tract (95%). The dmg has a relatively long half-life (6-20 h) and a modest clearance (13 L h ). The rationale for the development of transdermal clonidine was to reduce side-effects and to improve patient compliance. Catapres-TTS, a reservoir-type patch, reached the market in 1985 in a form designed to remain in place and to deliver dmg for 7 days. Dose titration was possible via the use of systems of different active areas (3.5, 7.0, and 10.5 cm2). The control of dmg delivery over 7 days is impressive, and avoids the peaks and valleys of conventional (twice-a-day) oral administration (Figure 8.7). However, this system has not achieved as wide a success as first seemed likely because of skin sensitization. Clonidine itself, when administered transdermally on a chronic, repetitive basis, induces in a significant fraction of patients a classic immunologic skin reaction, and this has severely attenuated its use. 

In general, users should be prescribed the lowest total hormone dose that suits them (good cycle control and minimal side-effects) and should make a start with the first preparation given above, recognising that compliance is particularly important with the 20 microgram dose. 

In addition, quantitative bioanalysis is involved in therapeutic dmg monitoring in cases, where the dmg administered has a low therapeutic index and/or due side effects and/or toxic metabolites, a narrow safe plasma concentration, or when patient compliance with a certain dmg must be evaluated (Ch. 12.2). 

Sometimes schizophrenics feel better not taking antipsychotic medications because they are able to entertain more grandiose notions about themselves and thereby lift their mood. Even more commonly, premature discontinuation occurs because patients are plagued by very unpleasant medication side effects. Like other people, they understandably don t like to suffer, and they respond by discontinuing. Appropriate education of patients regarding side effects and medical intervention (many side effects can be controlled with other medications) can improve the quality of life and greatly enhance compliance. It may be helpful to present medications as a tool for the person to use to help them control their illness, as a diabetic uses insulin. 

As might be expected, the presence of food in the gastrointestinal tract has been shown to affect lithium absorption and a diurnal variation in renal lithium clearance has been reported 183, 184). In our experiments, diurnal and other factors appeared to influence lithium pharmacokinetics to a greater degree than did formulation differences 182). We conclude that the practice of administering an early evening dose after a meal may delay the lithium peak sufficiently to reduce the possible discomfort of any transient side effects and may improve patient compliance. This is more important than the choice of preparation to be given. 

In the fourth chapter, Drs. Edmond H. Pi and Gregory E. Gray review the pharmacokinetics, pharmacodynamics, and sociocultural influences on the psychotropic responses among Asian American populations. Particular consideration is given to anti-psychotics, antidepressants, benzodiazepines, and lithium. The authors stress the importance of prescribing the lowest possible effective dose, to minimize untoward side effects and thus ensure treatment compliance. 

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