The use of psychostimulants in palliative and supportive treatment of cancer patients

Psychostimulants have been used in psychiatric and medically ill patients. The need to control and counteract the multiple distressing symptoms related to cancer and its treatment has brought this group of medications into palliative and supportive care of cancer patients. Psychostimulants have been studied and used in symptoms like cancer-related fatigue, cognitive dysfunction, depression and sedation. This review discusses the pharmacology of methylphenidate, amphetamine and pemoline and other psychostimulants like caffeine and the novel wake-promoting drug, modafinil. Studies evaluating use of these drugs in cancer patients have been reviewed.Psychostimulants have been used in psychiatric and medically ill patients. The need to control and counteract the multiple distressing symptoms related to cancer and its treatment has brought this group of medications into palliative and supportive care of cancer patients. Psychostimulants have been studied and used in symptoms like cancer-related fatigue, cognitive dysfunction, depression and sedation. This review discusses the pharmacology of methylphenidate, amphetamine and pemoline and other psychostimulants like caffeine and the novel wake-promoting drug, modafinil. Studies evaluating use of these drugs in cancer patients have been reviewed

Clinical implications of morphine metabolism

Od wieków opium jest znanym i powszechnie używanym środkiem przeciwbólowym. Składa się z suszonego mleczka, pochodzącego z niedojrzałych makówek maku lekarskiego — Papaver somniferum. Opium zawiera szereg alkaloidów, z których tylko niektóre — morfina, kodeina, noskapina oraz papaweryna — mają zastosowanie kliniczne. W 1803 roku Serturner wyizolował krystaliczną próbkę głównego alkaloidowego składnika opium — morfiny, która, jak się później okazało, jest w pełni odpowiedzialna za przeciwbólowe działanie nieoczyszczonego opium. Mimo że w minionym wieku pojawiło się kilka nowych syntetycznych opioidów o silnym działaniu, morfina jest nadal podstawowym i najpowszechniejszym opioidowym środkiem przeciwbólowym. Dzięki bardziej liberalnym wskazaniom dotyczącym podawania tych leków, zwłaszcza u pacjentów z nowotworem, a w ostatnich latach także u chorych z przewlekłym bólem o niezłośliwym pochodzeniu, stosuje się je znacznie częściej. Jednak nadal istnieją kraje, w których dostęp do opioidów jest znacznie ograniczony. W związku z dłuższym czasem stosowania oraz większym dawkowaniem zarówno morfiny, jak i innych leków opioidowych u chorych cierpiących na przewlekły ból rozpoczęto ostatnio kilka nowych badań klinicznych, dotyczących ich działania przeciwbólowego oraz skutków ubocznych. Dzięki rozwojowi nauki więcej wiadomo o sposobie działania oraz toksyczności tych leków. Dla naukowców i klinicystów morfina pozostaje nie do końca poznanym lekiem, mimo że stosuje się ją od tak dawna. Celem tej pracy jest ocena metabolizmu oraz przydatności klinicznej morfiny i jej głównych metabolitów.Opium has been known and used as an analgesic since the beginning of times. It consists of the dried milk juice derived from the unripe seed capsules of the opium poppy, Papaver somniferum. Opium contains a number of alkaloids, of which only a few — morphine, codeine, noscapine and papaverine — are of clinical use. In 1803, Serturner isolated a crystalline sample of the main constituent alkaloid, morphine, which was later shown to be almost entirely responsible for the analgesic activity of crude opium. Although several new synthetic strong opioids have occured in the past century, morphine is still the most widely used opioid and remains the “gold standard” when effects of other opioid analgesics are to be compared. Due to a more liberal approach to opioid analgesics especially in cancer patients, but within the later years also in patients with pain of chronic non-malignant origin, the consumption of opioids is vastly increasing. However, there are still countries where access to opioids are extremely limited. As morphine and other opioid drugs today are used for longer periods and in higher doses in patients suffering from chronic pain a number new clinical observations concerning analgesic action and side effects have occurred recently. Furthermore basic science has increased the knowledge of mode of action and toxicity considerably. Despite having been known for so long, morphine is still a puzzling drug to the scientists and clinicians. The scope of this article is to review morphine metabolism and update the clinical implications of morphine and its major metabolites

Albuminuria, renal dysfunction and circadian blood pressure rhythm in older men: a population-based longitudinal cohort study

Both albuminuria and kidney dysfunction may affect circadian blood pressure (BP) rhythm, while exacerbating each other's effects. We investigated associations and interactions of these two risk factors with circadian BP rhythm variation and non-dipper pattern progression in community-dwelling older men.This was a cross-sectional and longitudinal analyses in the third and fourth cycles of the Uppsala Longitudinal Study of Adult Men, including 1051 men (age 71 years) with assessments on urinary albumin excretion rate (UAER), 24-h ambulatory BP monitoring (ABPM) and cystatin-C-estimated glomerular filtration rate (eGFR). Of these, 574 men attended re-examination after 6 years. Study outcomes were ABMP changes and non-dipping BP pattern (prevalence and progression).UAER associated with circadian BP rhythm both cross-sectionally and longitudinally. Longitudinally, significant interactions were observed between UAER and kidney dysfunction (eGFR < 60 mL/min/1.73 m(2)) in its association with the changes of both night-time systolic BP (SBP) and night-day SBP ratio. After stratification, UAER strongly predicted night-day SBP ratio change only in those with concurrent kidney dysfunction. At re-examination, 221 new cases of non-dipper were identified. In multivariable logistic models, high UAER associated with increased likelihood of non-dipper progression, but more strongly so among individuals with concurrent kidney dysfunction. These associations were evident also in the subpopulation of non-diabetics and in participants with normal range UAER.UAER associates with circadian BP rhythm variation and non-dipper progression in elderly men. Concurrent renal dysfunction modifies and exacerbates these associations.PubMed5560-6