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Yes / Background: Depression is a common psychiatric problem following traumatic brain injury (TBI) with reported prevalence rates of 30-77% in the first year post-TBI. Given the negative influence of post-TBI depression on cognition, interpersonal, social, physical and occupational functioning; early initiation of pharmacotherapy to prevent post-TBI depression has been considered. This systematic review will synthesize the available evidence from published studies on the effectiveness and harms of pharmacotherapy for the secondary prevention of post-TBI depression. Method: Studies published before November 2017 were reviewed. Six databases were searched, with additional searching of key additional documents. Studies meeting inclusion criteria were evaluated for methodological quality. Results: Six articles addressing five studies met inclusion criteria. Study designs included three randomised controlled trials (RCT), two retrospective cohorts and one case-control. Prophylactic pharmacotherapy included antidepressants, beta-blockers and statins. In one RCT, the number-needed-to-treat with sertraline to prevent one case of depression post-TBI at 24 weeks was 5.9 (95%CI: 3.1-71.1). Prescribing beta-blockers prior to TBI reduced the depression risk regardless of the specific brain trauma. TBI patients with pre-existing hyperlipidemia not treated with statins had an increased depression risk compared to those without hyperlipidemia. Conclusion: Early initiation of sertraline prophylaxis in nondepressed TBI patients shows promise to reduce the odds of post-TBI depression developing. However, in the absence of rigorous study of tolerability, existing data are insufficient to recommend sertraline prophylaxis. Optimal timing and treatment duration with identification of patients most likely to benefit from prophylaxis require further consideration. Dedicated prospective studies assessing the effects of beta-blockers and statins on post-TBI depression are required. / The Transport Accident Commission (TAC), through the Institute for Safety, Compensation and Recovery Research (ISCRR) at Monash University, provided funding for this review.

Background and Purpose: More than one-third of American adults are obese. The prevalence of extreme obesity is rapidly rising. Nine medications are currently approved for weight loss yet they remain under utilized with the focus primarily on lifestyle modifications. The study's objective was to determine current prescribing patterns and attitudes of weight loss medications in the management of obesity among primary care providers (PCPs). Methods: PCPs were surveyed to determine practice patterns, attitudes, barriers, and facilitators for prescribing weight loss medications. Conclusions: A total of 105 surveys were completed. 76% of all PCPs did not prescribe weight loss medications for long-term weight loss therapy and 58% of PCPs had negative perceptions of pharmacotherapy as a treatment. Significant differences existed between prescribing patterns and attitudes of advanced practice clinicians and physicians. Safety concerns were identified as the greatest barrier. Having 2+ comorbidities and severe obesity were identified as facilitators for prescribing weight loss medications. Under utilization of pharmacotherapy suggests that PCPs may not have sufficient knowledge about medication safety profiles and efficacy. Delaying treatment until patients have reached a high level of morbidity may be less efficacious than earlier treatment. Implications for Practice: Education regarding effectiveness and risks of weight loss medications for obesity management is needed and earlier interventions with pharmacotherapy may prevent significant morbidity and mortality.

Despite the development of several effective treatments for depression, symptoms often persist in a number of individuals. Unfortunately, these residual symptoms are associated with several negative outcomes, including persistence of depressive illness. Few studies have examined the exact nature of individual residual symptoms across specific treatment modalities, and studies have failed to distinguish between depression courses. The current study expands on previous findings by examining, among a chronically depressed population, differences in individual residual symptoms and clusters between treatment modality (medication, psychotherapy, combination) and treatment response (full response, partial response). Five hundred and nineteen chronically depressed participants completed the study. Participants were randomly assigned to receive treatment with nefazodone, CBASP, or the combination of both. Residual symptoms were assessed with two depression severity ratings, a clinician administered interview and a self-report questionnaire. The frequency and severity of individual residual symptoms and clusters were examined between treatment and response groups. The emergence of symptoms after treatment was compared between treatment groups. Residual symptoms were common, reported in over 90% of the sample. The most common residual symptoms reflected both core depressive symptoms and co-morbid symptoms not specific to depression. In general, similar residual symptoms were reported among partial and full responders. The only individual residual symptoms that differed between treatment groups were early insomnia, OCD symptoms, hopelessness, hypersomnia, concentration, and decreased libido. Treatment groups also differed on two factors of the HDRS. The Nefazodone group reported a greater number of Disturbed Thinking items than the CBASP group. The CBASP group reported more items on the Psychic Depression factor compared to the Nefazodone group for full responders only. Analyses revealed that the Nefazodone group was more likely to report the emergence of guilt and psychic anxiety after treatment than the CBASP and Combination group, and the emergence of weight loss occurred more frequently among participants in the Nefazodone and Combination groups when compared with the CBASP group. Results suggest residual weight loss may be a side effect of medication and CBASP may offer protection against the development of guilt and anxiety.

Charles University in Prague Faculty of Pharmacy in Hradec Kralove Department of Social and Clinical Pharmacy The analysis of pharmacotherapy in patients suffering from hyperlipidemia (Diploma Thesis) Mentor of Diploma Thesis Prof. PharmDr. Jiří Vlček, Ph.D. Mavrovouniotis Konstantinos- Parmenion Hradec Králové 2015 ABSTRACT ENGLISH The analysis of pharmacotherapy in patients suffering from hyperlipidemia Mavrovouniotis Konstantinos Mentor: Prof. Dr. Jiří Vlček, CSc. Introduction: Hyperlipidemia is a serious condition whereby the blood levels of lipids, cholesterol and triglycerides are abnormally elevated. This condition is generally asymptomatic but may lead to atherosclerotic heart disease and other types of cardiovascular pathology if not treated effectively. Various risk factors can affect the onset and severity of hyperlipidemia and those include genetic predisposition, hypertension, diabetes mellitus, obesity, poor diet, lack of regular exercise, smoking etc. Measurement and monitoring of blood levels of triglycerides, cholesterol and lipoproteins can be used as prevention method for assessing the risk for an individual to develop hyperlipidemia. Once a patient is diagnosed with the condition several approaches exist for the treatment. The main goal of the treatment is to reduce the risk of...

Title: Analysis of Pharmacotherapy by patients with diagnosis of COPD Student: Marilena Kartali-Kaouni Tutor: Prof. RNDr. Jiri Vlcek, CSc Department of Social and Clinical Pharmacy, Charles University in Prague, Faculty of Pharmacy in Hradec Kralove Background: " Chronic Obstructive Pulmonary Disease (COPD) is characterized by airflow limitation that is not fully reversible. The airflow limitation is usually both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases". Tobacco smoking is the major risk factor in the development of COPD. COPD is a leading cause of morbidity and mortality worldwide. Aim: 1st from the current literature to understand the nature of COPD and obtain information about the aetiopathogenesis of the disease, diagnosis options and summarize the current view of strategies for achieving the goals of treatment. 2nd in a pilot study to analyze drug therapy in COPD patients visiting a pharmacy in Greece. Methods: 56 prescriptions with the diagnosis of COPD were collected during a period of 8 months from a Greek pharmacy. Information from the prescriptions with regard to COPD medications prescribed (active substances, trade names, strength, dosage scheme, pack size), patients characteristics (age and gender) and prescribing...

Stroke is a widespread condition, which often leaves survivors with lasting deficits in motor function, however, physical rehabilitation is the only treatment available after the acute period. A large body of preclinical literature suggests dopamine-augmenting drugs, could enhance motor recovery following stroke. Unfortunately, mixed clinical results have prevented the implementation of such treatments, possibly due to the wide variety of G protein-coupled receptors these drugs can activate. Using a mouse photothrombosis stroke model and a battery of motor and sensorimotor behavioural tests, the current study aims to demonstrate proof of principle for the use of D1-class dopamine receptor agonists to enhance poststroke motor recovery and to evaluate the role of aerobic exercise rehabilitation in an asynchronous study design. The effect of light-dark cycle on behavioural outcome (horizontal ladder test, adhesive removal test, cylinder test) and histological outcome (infarct size) in photothrombotic stroke was evaluated in order to optimize the stroke model, but no there was no evidence of differences between strokes occurring during the light or dark period of a mouse’s circadian rhythm. A bioactive, suboptimal dose of D1-agonist dihydrexidine, was determined by evaluating its effect on locomotor activity and its ability to increase expression of immediate early gene c-fos. Using the determined dose, studies evaluating the efficacy of 7-days and 2-days of dihydrexidine administration on poststroke motor recovery, were performed, indicating efficacy of a 7-days, but not of a 2-days, course of treatment. The 7-days dihydrexidine treatment resulted in accelerated recovery as compared to a control group receiving saline. This work demonstrates, for the first time, proof of principle for the use of specific activation of D1-class dopamine receptors to enhance motor recovery following stroke.

No período de 2008 a 2010, foi realizado o estudo de Atenção Farmacêutica, prospectivo longitudinal, com a participação de 104 pacientes diagnosticados com hipertensão arterial sistêmica, oriundos de duas unidades de saúde, do Distrito Sanitário Oeste da Cidade de Ribeirão Preto/SP. Após seis meses de estudo houve redução estatística significativa nos valores de Pressão Arterial Sistólica e Diastólica com menor dispersividade dos valores e clínica. A adesão ao tratamento aumentou ao longo do acompanhamento. Apresentou-se reduzido risco cardiovascular, com uma redução estatisticamente significativa do escore de risco Framingham. Discreta redução dos atendimentos de emergência. Apesar do sucesso deste estudo, fica em aberto se os benefícios alcançados são considerados transitórios ou permanentes. Para tanto, os pacientes foram reavaliados quanto aos parâmetros: pressão arterial sistólica e diastólica; valores de colesterol total; HDL; LDL, triglicerídeos, número de consultas em geral realizadas nessas unidades de saúde, e número de princípios ativos utilizados. Comparados os dados no período durante e após a Atenção Farmacêutica observou se que houve um aumento estatisticamente significante nos valores de pressão arterial sistólica e diastólica Com relação aos números de medicamentos prescritos houve também um aumento estatisticamente significativo, mas justificável devido à alteração na relação municipal de medicamentos essenciais entre os anos de 2009 e 2012. Quanto ao número de consultas e os resultados dos exames laboratoriais não houve diferença estatisticamente significante. Diante disso, pode se concluir que a Atenção Farmacêutica foi importante para a manutenção e manejo dos pacientes hipertensos e que o período de 30 meses após a Atenção Farmacêutica apresentou discretas alterações, principalmente nos valores de pressão arterial sistólica e diastólica e número de princípios ativos utilizados. / In the period from 2008 to 2010, a longitudinal and prospective Pharmaceutical Care study was conducted with 104 patients diagnosed with hypertension, from two health units, from the West Sanitary District of the municipality of Ribeirão Preto/SP. In this study, in the first six months of follow-up was observed a statistically and clinically significant reduction in the values of systolic and diastolic blood pressure, and with less dispersivity values. Medication adherece increased during the follow-up, a lower coronary risk was presented, with a statistically significant reduction in the Framingham Risk Score. A slight reduction in the emergency room visits was also observed. Considering the success of this study, was not decide whether the benefits obtained were considered transitory or permanent. Therefore patients were reassessed for the parameters: systolic and diastolic blood pressure; total cholesterol; HDL, LDL, triglycerides, number of consultations in general performed in those health units, and number of active moieties. Comparing data from the period during and after the Pharmaceutical Care, it was observed that there was a statistically significant increase in systolic and diastolic blood pressure. Regarding the number of prescribed medications statistically significant increase was also observed, but justifiable due to changes in the municipal list of essential medicines between the years of 2009 and 2012. Regarding the number of medical appointments and the results of laboratory tests there was no statistically significant difference. Thus, it can be concluded that Pharmaceutical Care was important for the maintenance and management of hypertensive patients and that the period of 30 months after the Pharmaceutical Care showed slight alterations, mainly in systolic and diastolic blood pressure and number of active moieties used.

Psychostimulant dependence is a major public health issue in many parts of the world associated with a wide range of psychological, medical and social problems. Psychosocial interventions are the mainstay of treatment for psychostimulant problems, although their effectiveness is compromised by poor uptake and compliance. Despite increasing knowledge of the neurobiological consequences of psychostimulant use, no medications to date have been any more successful than placebo in reducing psychostimulant use in dependent patients. Modafinil is a non-amphetamine type psychostimulant that may have potential as an agonist pharmacotherapy for psychostimulant dependence. The aim of this thesis was to examine the safety, efficacy and cost-effectiveness of modafinil 200 mg/day over ten weeks plus a four session brief CBT intervention for methamphetamine and cocaine dependence through two concurrent randomised placebo controlled trials. There were no statistically significant differences between modafinil and placebo in treatment retention, medication adherence, psychostimulant abstinence, psychostimulant craving or severity of psychostimulant dependence. Methamphetamine-dependent subjects tended to provide more illicit psychostimulant negative urine samples while in treatment than those who received placebo. There appeared to be a reduction in self-reported days of psychostimulant use among methamphetamine-dependent subjects who received modafinil compared to placebo, but the effect size was too small to be statistically significant in this sample. The reduction in self-reported psychostimulant use did reach statistical significance in methamphetamine-dependent subjects with no other substance dependence. Uptake of counselling was the most significant predictor of reduced psychostimulant use post treatment, and the addition of counselling improved the cost-effectiveness of modafinil relative to placebo. Modafinil appeared to be safe, well-tolerated, and non-reinforcing in this treatment population. Compared to placebo, there was a significant increase in weight in subjects who completed the 10-week course of treatment, and a significant decrease in systolic blood pressure in methamphetamine-dependent subjects who received modafinil. The results support further trials of modafinil in methamphetamine-dependent patients, although future trials in cocaine-dependent patients from this treatment population were not likely to be viable. Modafinil appeared to be modestly effective in reducing, but not stopping, methamphetamine use in selected patients. Multi-centre trials with larger sample sizes, and measures sensitive enough to detect quantitative changes in psychostimulant use would be needed to confirm the findings. Blood pressure and weight may be important indicators of clinical outcome, and warrant particular attention in future trials, particularly given the cardio-toxicity of both methamphetamine and cocaine. Strategies to enhance medication adherence including a higher dose and counselling adherence are recommended to improve outcomes. Given the predominance of behavioural and psychosocial factors in psychostimulant dependence, it is likely that the role of medications such as modafinil will be as an adjunct to psychosocial therapy.

In Canada, nicotine replacement therapy (NRT) is a best practice for adult smoking cessation, but it is not recommended for use by youth smokers. Previous research has indicated that more than 20 percent of high school-aged smokers in Canada had used NRT, despite the cross-Canada requirement that youths under the age of 18 have a physician’s prescription to purchase NRT. The goal of this study was to examine both student and school-level characteristics associated with use of NRT by youths. Data from 29,296 grade 9 to 12 students who participated in the 2008-2009 National Youth Smoking Survey (YSS) were combined with Canadian census and built environment data in multilevel logistic regression models. The associations between lifetime and current NRT use with student characteristics (i.e., smoking status, social smoking connections) were examined alongside school environment factors such as urban/rural location and pharmacy density within a one kilometre radius of schools. In 2008-2009, 21.1% of youth smokers in Canada had ever used NRT and 5.1% were currently using NRT. Odds of NRT use were highest among daily smokers, boys, youths who had made multiple quit attempts, and youths who self-identified as smokers. Attending a school located within an urban area increased youths’ odds of NRT use, whereas higher density of pharmacies surrounding a school was inversely associated with NRT use. This study is the first to identify significant between school differences in NRT use. It also reveals that many youths are using NRT in the absence of a quit attempt. Further research is needed to identify school characteristics that impact NRT use, and understand how youths are accessing NRT.