Acute dystonia following standard doses of a cold medicine containing phenylpropanolamine

Drug-Induced Movement Disorders in Older Adults: An Overview for Clinical Practitioners

OBJECTIVE

To provide an overview of some of the most common drug-induced movement disorders (DIMD) seen in the elderly by the primary care clinician. The epidemiology, clinical presentation, differential diagnosis, treatment, risk factors, and preventive measures are presented for each DIMD.

DATA SOURCES

Medical literature and research article search utilizing PubMed (National Library of Medicine), Psych INFO (American Psychological Association), CINAHL Database (CINAHL Information Systems), the Library of Congress Catalogue, and the Internet.

STUDY SELECTION

Reviews and articles from 1954 to 2005 concerning various movement disorders associated with medication in older adults. DATA EXTRACTIONS: Data on movement disorders associated with medications ranging from possible or controversial to well-established.

DATA SYNTHESIS

With the aging of populations in the United States and other countries, the use of medications with potential risk of precipitating movement disorders is increasing. The majority of these iatrogenic problems will be first seen in the geriatric patient in various clinical settings, typically in a primary care setting. To a large extent they will be observed in patients with mild cognitive impairment or dementia having impaired recall and reduced capacity to participate in the diagnostic interview. The challenge to clinicians is complicated by the sizable number of medications that may be involved.

The eating disorders medicine cabinet revisited: a clinician's guide to appetite suppressants and diuretics

OBJECTIVE

This article explores the frequencies of use of alternative medications, available products, and their potential toxicities.

METHOD

Survey data were gathered from 39 consecutive patients diagnosed with bulimia nervosa who were seeking treatment. A survey of area outlets (health food stores, pharmacies, grocery stores) was conducted to establish a database of available agents. Putative active ingredients were identified. MEDLINE literature searches, as well as reviews of specialized texts, were performed to identify the potential toxicities of the ingredients.

RESULTS

Diet pill use was found in 64% of patients; 18 % reported use in the past month. The survey identified 167 products. Diuretic use was found in 31% of patients; 21% reported use in the past month. Twenty-five diuretic products were identified.

DISCUSSION

Alternative medicines are frequently used in the population of patients seeking treatment for bulimia nervosa. An abundance of products are available with potentially significant toxicities.

Over-the-counter medication use in preschool children

INTRODUCTION

The purpose of this study was to describe how parents'/caregivers' perceptions of illness severity, susceptibility to illness, trust in primary care providers, perceived barriers to seeking care, and perceived effectiveness of over-the-counter (OTC) medication affect their decisions about the type of health care to provide for preschool children. In addition, the impact of social factors on the decision to give OTC medications to preschool children and/or the decision about whether to call the primary care provider was examined.

METHODS

A descriptive correlational study was used with a convenience sample of 52 caregivers of preschool-aged children. The OTC Medication Questionnaire and Medicine Decisions Questionnaire were given during parental Head Start meetings.

RESULTS

Significant correlations existed between the age of the caregiver, socioeconomic status, perceived effectiveness of OTC medications, and the giving of OTC medications. Significant correlations also existed between perceived severity of illness, perceived susceptibility to illness, and calling the primary care provider or nurse practitioner.

DISCUSSION

Specific guidelines for appropriate use of OTC medications should be provided to parents. These guidelines should include which OTC medications have proved to be effective. Anticipatory guidance by primary care practitioners is essential to prepare families for illnesses and illness progression, teach them about the efficacy and safe use of OTC medications, and help them use the health care system effectively.