Stimulants medical uses

Modafinil is a stimulant medication used to improve wakefulness in patients with narcolepsy, obstructive sleep apnea/hypopnea syndrome (as adjunct to standard treatments for the underlying disorder), and shift work sleep disorder. Controlled and open trials provided data on the efficacy and safety of modafinil in patients with narcolepsy (Besset et al. 1996 Billiard et al. 1994 Broughton et al. 1997 Mitler et al. 2000 U.S. Modafinil in Narcolepsy Multicenter Study Group 1998, 2000). Modafinil has a long duration of action and low potential for dependence and may be a reasonable first choice in the treatment of mild to moderate narcolepsy (Silber 2001). There is also considerable interest in the potential use of modafinil in the treatment of ADHD, and studies are in progress. 

In 1999, methylphenidate was the most widely dispensed stimulant medication used for treating ADHD. More of it was used than amphetamine, the next most frequently used stimulant that is used to treat ADHD. 

Zuvekas, S., Vitiello, B., Norquist, G. (2006). Recent trends in stimulant medication use among U.S. children. American Journal of Psychiatry, 161, 579-585. 

Systematic reviews In 26 placebo-con-trolled trials in 811 adults with ADHD, methylphenidate was well tolerated in the short-term and produced no serious adverse effects [59 ]. However, there is little information on the long-term safety of methylphenidate in adults, although the number of serious adverse effects reported has so far been low. Methylphenidate is associated with modest increases in blood pressure and heart rate. Surveys of the use of stimulants in US universities have shown that misuse of prescribed medications, for recreation or to enhance the ability to study, is fairly common, although the magnitude of harm that arises from such practices is unclear. 

Boutrel B, Koob GF. What keeps us awake the neuropharmacology of stimulants and wakefulness-promoting medications. Sleep 2004 27 1181-1194. 

Ephedra (Ephedra sinica)/Ma Huang Uses Stimulant, aid in wt loss, bronchial dilation Dose Not OK d/t reported deaths (>100 mg/d can be life-threatening). US sales banned by FDA in 2004 bitter orange w/ similar properties has replaced this compound in most wt loss supplements Caution Advise cardiac events, strokes, death SE Nervousness, HA, insomnia, palpitations, V, hypoglycemia Interactions Digoxin, antihypertensives, antidepressants, diabetic medications EMS Tinctures extracts contain EtOH may X glucose linked to several deaths behavioral mood changes... 

Abstinence means no use of psychoactive substances. However, in our culture, or for that matter in any culture, psychoactive substances are virtually impossible to avoid. Nearly all of us have experienced pain medication. Most soft drinks, tea, and, of course, coffee contain caffeine, a potent stimulant. Yet, individuals who partake of these will consider themselves abstinent and with few exceptions this use is marginal to the point of not being worth consideration. 

Acknowledgements. We would like to express our gratitude to Dr. L. Sawyer from the Department of Biochemist, The University of Edinburgh Medical School for the tridimensional coordinates of p-lactoglobulin structure, to Dr. F. Toma from Service de Biochimie, CEA de Saclay for allowing us to use die circular dichrograph and to Dr. B. Ribadeau Dumas from INRA in Jouy-en-Josas for his stimulating discussions and critical comments. 

Again, we spill out the horrendous numbers one out of every 25 in-patients becomes a victim of a medical accident. Some 195,000 people die of medical accidents every year. The actual figure might be twice of that, and medicine has the worst accident rate of any US industry. Substandard care in America kills over 57,000 people and wastes over 9 billion annually. Physicians drive 80% of the cost. So the Bush administration quickly committed 100 million, and congressional bi-partisan effort has been behind the introduction of legislation to stimulate electronic patient record keeping, or electronic health records (EHR). 

However, while the objective of the report, and the thrust of its recommendations, was to stimulate a national effort to improve patient safety, what initially grabbed public attention was the declaration that between 44 000 and 98 000 people die in US hospitals annually as a result of medical errors. 

We are grateful to Prof. Albert Baert for stimulating us to edit again this volume of the Medical Radiology series. The publisher. Springer-Verlag, enthusiastically supported the idea and provided us with invaluable assistance. We hope this book will be valuable to all those interested... 

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