OBJECTIVES: The use of anticholinergic drugs in the elderly may lead to negative events such as falls, delirium, urinary retention and cognitive decline, and the higher the number of anticholinergic drugs use, the more such negative events occur. This study aims to analyze the risk factors associated with the prescription of total anticholinergic drugs in elderly outpatients and evaluate the rationality of anticholinergic drugs, and to provide a reference for reducing the adverse effects of anticholinergic drugs. METHODS: A list of drugs with anticholinergic activity based on the Beers criteria was established. The basic information (such as age and gender), clinical diagnosis, and medications of elderly outpatient were extracted from hospital electronic medical records, and the Anticholinergic Cognitive Burden (ACB) Scale was used to calculate the anticholinergic burden for each patient. Logistic regression analysis was used to identify the potential risk factors for the occurrence of problems such as multiple medication and insomnia. RESULTS: A total of 1 840 prescriptions for elderly patients were reviewed. Of these patients, ACB score was more than or equal to 1 in 648 (35.22%) patients. Number of prescription medication (95% CI: 1.221 to 1.336) and insomnia (95% CI: 3.538 to 6.089) were independent factors affecting ACB scores (both P<0.01). Medications for patients of ACB scores were most commonly treated with the central nervous system drugs (such as alprazolam and eszopiclone) and for the cardiovascular system drugs (such as metoprolol and nifedipine). CONCLUSIONS There is a high rate of ACB drugs use in geriatric patients, and the clinical focus should be on multiple medication prescriptions, especially on the central nervous system drugs (such as alprazolam and eszopiclone) and cardiovascular system drugs (such as metoprolol and nifedipine). The prescription review should be emphasized to reduce adverse reactions to anticholinergic drugs in elderly patients.
Humans ; Aged ; Cholinergic Antagonists/adverse effects* ; Outpatients ; Metoprolol ; Alprazolam ; Eszopiclone ; Nifedipine ; Sleep Initiation and Maintenance Disorders ; Risk Factors

No abstract available.
Nifedipine

OBJECTIVEBased on the western medication, to evaluate the advantages in the morning blood pressure treated with acupuncture at Fengchi (GB 20) and Neck-Jiaji (EX-B 2) combined with acupuncture technique for activating blood circulation, eliminating wind and regulating the liver and spleen in the patients with essential hypertension.

METHODSA total of 90 patients of essential hypertension of the mild and moderate degrees were randomized into a medication group (30 cases, 3 dropping), No.1 acupuncture group (30 cases, 2 dropping) and No.2 acupuncture group (30 cases, 1 dropping). In the medication group, adalat was prescribed for oral administration, 30 mg at 7 am every day, continuously for 6 weeks. In the No.1 acupuncture group, on the basis of the treatment as the medication group, the acupuncture technique for activating blood circulation, eliminating wind and regulating the liver and spleen was applied and the acupoints were Renying (ST 9), Hegu (LI 4), Taichong (LR 3), Quchi (LI 11) and Zusanli (ST 36). In the No.2 acupuncture group, on the basis of the treatment as the No.1 acupuncture group, Fengchi (GB 20) and Neck-Jiaji (EX-B 2) were added in acupuncture. Acupuncture was given in the time zone from 8 am through 10 am every day, once a day, 5 times a week, totally for 6 weeks. Separately, before treatment and in 2, 4 and 6 weeks of treatment, the morning blood pressure, the control rate and the symptom score were observed in the patients of the three groups. The morning blood pressure was followed up in 3 and 6 months separately.

RESULTSCompared with those before treatment, in 2, 4 and 6 weeks of treatment, the levels of blood pressure reduced in the patients of the three groups (<0.05, <0.01). After 2-week treatment, the differences were not significant in the morning blood pressure and its control rate in the patients of the three groups (all >0.05). In 4 and 6 weeks of treatment, the levels of the morning blood pressure in the No.2 acupuncture group were lower than those in the No.1 acupuncture group, and the results in the No.1 and No.2 acupuncture groups were all lower than those in the medication group (all <0.05). In the follow-up visit for 3 and 6 months separately, the differences were not significant in the morning blood pressure among the three groups (all >0.05). In 2, 4 and 6 weeks of treatment, the symptom scores reduced as compared with those before treatment in the three groups (all <0.05). The symptom scores in the No.1 and No.2 acupuncture groups were all lower than those in the medication group (all <0.05). The differences were not significant between the No.1 acupuncture group and the No.2 acupuncture group (all >0.05).

CONCLUSIONThe comprehensive treatment of acupuncture at Fengchi (GB 20) and Neck-Jiaji (EX-B 2) combined with acupuncture technique for activating blood circulation, eliminating wind and regulating the liver and spleen achieve the effects of reducing the morning blood pressure in the patients with essential hypertension, relieving the symptoms of hypertension such as headache, vertigo and tinnitus and the effects are better than those of the acupuncture technique for activating blood circulation, eliminating wind and regulating the liver and spleen.

Acupuncture Points ; Acupuncture Therapy ; Blood Pressure ; Combined Modality Therapy ; Essential Hypertension ; therapy ; Humans ; Nifedipine ; therapeutic use ; Treatment Outcome

Preterm birth is a major cause of neonatal morbidity and mortality, and occurs in 5% to 15% of all pregnancies. Therefore, its prevention is a major opportunity to reduce medical costs and to promote public health in all countries. Preterm birth is a broad great obstetric syndrome that arises from a wide variety of causes. Although many therapeutic agents are used for premature labor, most of them have serious maternal side effects, and they are ineffective in cases when labor has already begun. Therefore, the authors would like to introduce progesterone, as a treatment to prevent preterm labor. We also investigated whether nifedipine, which is used to treat preterm labor, could prevent preterm labor. We are eager to find more effective and easier-to-use drugs to prevent preterm labor in the future.
Female ; Mortality ; Nifedipine ; Obstetric Labor, Premature ; Pregnancy ; Premature Birth ; Preventive Medicine ; Progesterone ; Public Health

OBJECTIVE: To determine the risk of postpartum hemorrhage among patients who were treated with nifedipine for tocolysis of preterm labor.

METHODS: A prospective cohort study was conducted with 66 pregnant women admitted for preterm labor. One group of women was given nifedipine to give time for the administration of corticosteroids for fetal lung maturity and/or control of preterm labor and another group was not given nifedipine as they were admitted in advanced stage of labor (ie, more than or equal to 4 cm cervical dilatation). Independent/paired sample t-test, Mann-Whitney U/Wilcoxon signed rank test, and Fisher's exact test were used to determine the difference of mean, median, and frequency between and within groups, respectively. STATA 12.0 was used for data analysis.

RESULTS: There was more blood loss during delivery, which was statistically significant, among those who received nifedipine compared to those who have not taken the medicine (350 mL versus 250 mL, p = 0.021). Furthermore, the decreases in hemoglobin and hematocrit were also lower among those who did not receive nifedipine compared to those who received nifedipine for tocolysis (8.5 mg/dL versus 16.0 mg/dL, p = 0.014 and 0.03 versus 0.05, p = 0.010), again, statistically significant.

CONCLUSION: Nifedipine used as tocolytic appear to increase blood loss during delivery, which was statistically significant. Greater amount of blood loss may be anticipated among those with nifedipine intake thus helping the obstetrician in preparing for active management of postpartum hemorrhage and preventing maternal morbidity and mortality.

Human ; Female ; Adult (a Person 19-44 Years Of Age) ; Nifedipine ; Obstetric Labor, Premature ; Postpartum Hemorrhage ; Tocolytic Agents ; Nifedipine-adverse Effects

The aim of this study was to evaluate the relaxant and anti-inflammatory effects of two thalidomide analogs as phosphodiesterase-4 (PDE-4) inhibitors in pregnant rat uterus. Uteri from Wistar female rats were isolated at 19 day of pregnancy. Uterine samples were used in functional studies to evaluate the inhibitory effects of the thalidomide analogs, methyl 3-(4-nitrophthalimido)-3-(3,4-dimethoxyphenyl)-propanoate (4NO2PDPMe) and methyl 3-(4-aminophthalimido)-3-(3,4-dimethoxyphenyl)-propanoate (4APDPMe), on prostaglandin-F2α (PGF2α)-induced phasic, K⁺-induced tonic, and Ca²⁺-induced contractions. Accumulation of cAMP was quantified in uterine homogenates by ELISA. Anti-inflammatory effect was assessed by using ELISA for determination of the pro-inflammatory cytokines tumor necrosis factor-α (TNFα) and interleukin (IL)-1β, and anti-inflammatory IL-10, from uterine explants stimulated with lipopolysaccharide (LPS). Nifedipine, forskolin and rolipram were used as positive controls where required. Both thalidomide analogs induced a significant inhibition of the uterine contractions induced by the pharmaco- and electro-mechanic stimuli. Nifedipine and forskolin were more potent than the analogs to inhibit the uterine contractility, but these were more potent than rolipram, and 4APDPMe was equieffective to nifedipine. Thalidomide analogs increased uterine cAMP-levels in a concentration-dependent manner. The LPS-induced TNFα and IL-1β uterine secretion was diminished in a concentration-dependent fashion by both analogs, whereas IL-10 secretion was increased significantly. The thalidomide analogs induced utero-relaxant and anti-inflammatory effects, which were associated with the increased cAMP levels as PDE-4 inhibitors in the pregnant rat uterus. Such properties place these thalidomide analogs as potentially safe and effective tocolytic agents in a field that urgently needs improved pharmacological treatments, as in cases of preterm labor.
Animals ; Colforsin ; Cyclic Nucleotide Phosphodiesterases, Type 4 ; Cytokines ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Interleukin-10 ; Interleukins ; Necrosis ; Nifedipine ; Obstetric Labor, Premature ; Phosphodiesterase 4 Inhibitors* ; Pregnancy ; Rats* ; Rolipram ; Thalidomide* ; Tocolytic Agents ; Uterine Contraction ; Uterus*

Adenosine 3',5'-cyclic monophosphate (cAMP) participates in the regulation of numerous cellular functions, including the Na(+)-K(+)-ATPase (sodium pump). Ouabain, used in the treatment of several heart diseases, is known to increase cAMP levels but its effects on the atrium are not understood. The aim of the present study was to examine the effect of ouabain on the regulation of atrial cAMP production and its roles in atrial endothelin-1 (ET-1) secretion in isolated perfused beating rabbit atria. Our results showed that ouabain (3.0 micromol/L) significantly increased atrial dynamics and cAMP levels during recovery period. The ouabain-increased atrial dynamics was blocked by KB-R7943 (3.0 micromol/L), an inhibitor for reverse mode of Na(+)-Ca(2+) exchangers (NCX), but did not by L-type Ca2+ channel blocker nifedipine (1.0 micromol/L) or protein kinase A (PKA) selective inhibitor H-89 (3.0 micromol/L). Ouabain also enhanced atrial intracellular cAMP production in response to forskolin and theophyline (100.0 micromol/L), an inhibitor of phosphodiesterase, potentiated the ouabain-induced increase in cAMP. Ouabain and 8-Bromo-cAMP (0.5 micromol/L) markedly increased atrial ET-1 secretion, which was blocked by H-89 and by PD98059 (30 micromol/L), an inhibitor of extracellular-signal-regulated kinase (ERK) without changing ouabain-induced atrial dynamics. Our results demonstrated that ouabain increases atrial cAMP levels and promotes atrial ET-1 secretion via the mitogen-activated protein kinase (MAPK)/ERK signaling pathway. These findings may explain the development of cardiac hypertrophy in response to digitalis-like compounds.
8-Bromo Cyclic Adenosine Monophosphate ; Adenosine ; Cardiomegaly ; Colforsin ; Cyclic AMP-Dependent Protein Kinases ; Endothelin-1* ; Heart Diseases ; Nifedipine ; Ouabain* ; Phosphotransferases ; Protein Kinases

Early life neuronal exposure to environmental toxicants has been suggested to be an important etiology of neurodegenerative disease development. Perfluorohexanesulfonate (PFHxS), one of the major perfluoroalkyl compounds, is widely distributed environmental contaminants. We have reported that PFHxS induces neuronal apoptosis via ERK-mediated pathway. Imperatorin is a furanocoumarin found in various edible plants and has a wide range of pharmacological effects including neuroprotection. In this study, the effects of imperatorin on PFHxS-induced neuronal apoptosis and the underlying mechanisms are examined using cerebellar granule cells (CGC). CGC were isolated from seven-day old rats and were grown in culture for seven days. Caspase-3 activity and TUNEL staining were used to determine neuronal apoptosis. PFHxS-induced apoptosis of CGC was significantly reduced by imperatorin and PD98059, an ERK pathway inhibitor. PFHxS induced a persistent increase in intracellular calcium, which was significantly blocked by imperatorin, NMDA receptor antagonist, MK801 and the L-type voltage-dependent calcium channel blockers, diltiazem and nifedipine. The activation of caspase-3 by PFHxS was also inhibited by MK801, diltiazem and nifedipine. PFHxS-increased ERK activation was inhibited by imperatorin, MK801, diltiazem and nifedipine. Taken together, imperatorin protects CGC against PFHxS-induced apoptosis via inhibition of NMDA receptor/intracellular calcium-mediated ERK pathway.
Animals ; Apoptosis* ; Calcium ; Calcium Channel Blockers ; Caspase 3 ; Diltiazem ; Dizocilpine Maleate ; In Situ Nick-End Labeling ; MAP Kinase Signaling System* ; N-Methylaspartate ; Neurodegenerative Diseases ; Neurons* ; Neuroprotection ; Nifedipine ; Plants, Edible ; Rats

Calcium channel blockers (CCBs) are very popular drugs to lower blood pressure (BP) without significant side effects. A 72-year-old man admitted for uncontrolled hypertension. He had history of hypertension, atrial fibrillation with slow ventricular response, angina, abdominal aortic aneurysm, and stage 3 chronic kidney disease. He had taken several anti-hypertensives, such as amlodipine 5 mg, perindopril 8 mg, and indepamide 1.5 mg. To control BP, nifedipine 120 mg was added. Then pulmonary edema and pleural effusion was developed. Echocardiography showed preserved left ventricular ejection fraction and mild mitral regurgitation. Fluid restriction and high dose furosemide did not cease pleural fluid accumulation. Thus a total of 4 times of thoracentesis were done and all fluid analyses revealed transudate. We thought that pleural effusion and pulmonary edema was induced by CCBs and discontinued the drugs. He recovered quickly and finally discharged in a stable condition.
Aged ; Amlodipine ; Antihypertensive Agents ; Aortic Aneurysm, Abdominal ; Atrial Fibrillation ; Blood Pressure ; Calcium Channel Blockers* ; Calcium Channels* ; Calcium* ; Echocardiography ; Exudates and Transudates ; Furosemide ; Humans ; Hypertension* ; Mitral Valve Insufficiency ; Nifedipine ; Perindopril ; Pleural Effusion* ; Pulmonary Edema* ; Renal Insufficiency, Chronic ; Stroke Volume

Totally 96 elderly patients with spleen-kidney Yang deficiency type hypertension were selected in this study. Patients were randomly divided into study and control group. It was treated with the Jingui Shenqi pill combined nifedipine sustained-release tablets in the study group and only nifedipine sustained-release tablets for the control group. Meanwhile, the clinical features including reducing blood pressure, blood lipid and traditional Chinese medicine (TCM) syndromes of the two groups were observed pre and post treatment. Finally, the results showed that it could significantly reduce the hypertensive, hyperlipidemia and TCM syndromes in the study group compared with the control group (P < 0.05), which indicated that the combination of the Jingui Shenqi pill with nifedipine sustained-release tablets was effective for the patients with hypertension with spleen-kidney Yang deficiency type, especially for decreasing TCM syndromes and the blood lipid.
Aged ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; administration & dosage ; Female ; Humans ; Hypertension ; drug therapy ; Kidney Diseases ; drug therapy ; Male ; Medicine, Chinese Traditional ; Nifedipine ; administration & dosage ; Splenic Diseases ; drug therapy ; Yang Deficiency ; drug therapy