Cynthia Feucht

Analgesics and Anti-inflammatory Medications in Sports: Use and Abuse

Both acute and overuse musculoskeletal injuries are common in adolescent athletes. Pharmacologic agents including nonsteroidal anti-inflammatory drugs, acetaminophen, and topical over-the-counter agents have been shown to be effective in controlling pain, but data regarding their efficacy in expediting healing and time to recovery continue to be debated. Studies indicate that adolescents consume analgesic agents on their own and may be unaware of their potential toxicities. Data also indicate that adolescent athletes use medications in hopes of alleviating pain and allowing continuation of sports without adequate time for healing. This article reviews the mechanisms, toxicity, drug interactions, efficacy, and abuse potential of commonly used analgesic and anti-inflammatory drugs.

Pharmacotherapy for Obese Adolescents

The pharmaceutical search to induce weight loss was precipitated by the United States Food and Drug Administrations (FDA) 1959 formal approval of phentermine for short-term weight loss despite limited research supporting its assertions of weight loss. In addition to sympathomimetic amine products like phentermine, other medications considered in this article include herbal products, sibutramine, orlistat, metformin, and rimonabant. The use of pharmacotherapy for morbidly obese adolescents should be part of a comprehensive weight-loss program that recommends diet, exercise, and behavioral modification. Side effects and the possibility of major adverse effects should be remembered when considering use of these products.

Pharmacologic agents for smoking cessation: A clinical review

Tobacco use has been clearly demonstrated to have negative health consequences. Smoking cigarettes is the predominant method of tobacco use. The tar contained within cigarettes and other similar products is also harmful. Other tarless tobacco containing products do exist but carry no significantly decreased risk. While nicotine is considered to be principally responsible for tobacco addiction, other chemicals in the cigarette smoke including acetaldehyde may contribute to the addictive properties of tobacco products. The adverse health consequences of tobacco use have been well documented. Studies have shown that a combined behavioral and pharmacological approach is more effective in smoking cessation than either approach alone. Pharmacotherapy can achieve 50% reduction in smoking. With pharmacotherapy the estimated 6-month abstinence rate is about 20%, whereas it is about 10% without pharmacotherapy. The first-line of drugs for smoking cessation are varenicline, bupropion sustained release, and nicotine replacement drugs, which are approved for use in adults. Data are insufficient to recommend their use in adolescents. This article reviews the use of pharmacological agents used for smoking cessation. A brief overview of epidemiology, chemistry, and adverse health effects of smoking is provided.

Pharmacology of sleep disorders in children and adolescents.

There is a high prevalence of sleep disorders in children and an apparent increasing need for pharmacologic management. However, because of the paucity of data available with regards to dosing, efficacy, tolerability, and safety profiles of medications as well as a lack of adequate well-designed clinical trials, medications are currently not approved for the pediatric population by the US Food and Drug Administration. There are no pharmacologic guidelines for the specific sleep disorders or the different pediatric age ranges. Additional research is needed for evidence-based pediatric sleep pharmacotherapy. This article reviews pediatric sleep disorders and the pharmacologic therapeutic options.

Herbal Medicines in Pediatric Neuropsychiatry

An increasing number of studies have evaluated the role of herbal supplements in pediatric disorders, but they have numerous limitations. This review provides an overview of herbal components, regulation of supplements, and importance of product quality assurance. Use of herbal supplements is discussed with reference to factors that influence use in the pediatric population. The remainder of the article discusses the use of St Johns wort, melatonin, kava, valerian, eicosapentaenoic acid, and docosahexaenoic acid, focusing on indications, adverse effects, and drug interactions, and providing a limited efficacy review. Herbal supplements used for weight loss are also briefly discussed.

Cannabis: The never-ending, nefarious nepenthe of the 21st century: What should the clinician know?

Cannabis (marijuana or pot) remains a controversial plant in the 21st century. This discussion considers a number of issues regarding cannabis including a historical perspective, description of the Cannabis sativa/indica plant, means of consumption, prevalence of use, links to polydrug use, cannabis lab testing, and cannabis pharmacology (Table 1). Also considered are the many potential adverse medical and psychiatric effects found with smoking cannabis. The issue of “medical marijuana” is then presented, which is a hotly discussed topic in nationaland state-level politics, the criminal justice system, and now in medicine across the board. As such, there are entanglements in the discussion of marijuana as medicine that need to be dissected out in order to clearly examine its potential medicinal legitimacy. This article reviews concerns regarding smoked marijuana, physician liability issues, and The American Society of Addiction Medicine’s recommendations regarding medical marijuana. The information provided will help physicians assess a situation inwhich the risk–benefit ratio to the patient and the doctor as well should be carefully weighed. Finally, it reviews what primary care clinicians can do in identifying and facilitating treatment for an increasing number of persons who develop cannabis-related disorders. This discussion reviews the main characteristics of a robust program termed Screening, Brief Intervention, and Referral to Treatment (SBIRT) and offers a “how to” basic implementation guide for the primary care office. Other available behavioral and pharmacological options are also reviewed to familiarize clinicians with the type of care patients receive when the severity of the condition requires referral to specialists.

Principles of Pharmacology

An understanding of the basic principles of pharmacokinetics and pharmacodynamics of drugs is important in appropriate therapeutic use of various drugs. In simple terms, the effects of the body on the drug once it has entered the body has been referred to as pharmacokinetics, and it aims to provide a quantitative assessment of the main processes involved in biodisposition of the drug, including absorption, distribution, metabolism, and elimination. Pharmacodynamics concerns itself with the effects of the drug on the body and the main processes involved are the action of the drug on specific sites, especially the receptors. In addition, pharmacogenetics and pharmacogenomics evaluates the influence of genetics on drug response. This article reviews basic concepts of pharmacology applicable to psychotherapeutic agents used for the treatment of mental disorders of children and adolescents.

Basic Concepts of Neurotransmission

An understanding of synaptic neurotransmission is fundamental to the understanding of various neuropsychiatric symptoms and disorders. It is also essential to the discovery of pharmacologic agents that modulate neurotransmission to alleviate such symptoms and conditions. Various aspects of the process of neurotransmission and the synthesis, release, reuptake, or destruction are all potential events for action of therapeutic drugs. This article reviews the basic aspects of relevant neuroanatomy, neurotransmission, and major neurotransmitter systems.

Psychopharmacology of Tic Disorders in Children and Adolescents

Tics in children and adolescents are a common occurrence; however, a small proportion of these disorders require pharmacologic interventions. Several limitations exist with the use of pharmacologic interventions, and hence, a more ideal multidisciplinary approach is recommenced, with emphasis on nonpharmacologic management for improved functioning, adaptation, and comorbidities. Mutual and realistic goals ensure a trustful and successful relationship between the clinician and patient. An individualized plan is recommended with the goal of limiting side effects and managing comorbid conditions as a priority before addressing the tics specifically. This article reviews medications used to treat tic disorders in children and adolescents.

Pharmacological treatment of anxiety disorders in children and adolescents: a review for practitioners

Anxiety disorders are common in children and adolescents with reported prevalence rates between 10% and 30%. A combined approach to treatment has been found to be the most effective for optimal outcomes and is typically comprised of psychotherapy (especially exposure-based cognitive behavior therapy), family and patient education, and use of medication if indicated. In children and adolescents who might benefit from use of medications, selective serotonin reuptake inhibitors (SSRIs) are the drugs of choice. The safety and efficacy of medications other than SSRIs in the treatment of children and adolescents with anxiety disorders are not fully established. Most children and adolescents respond well to treatment with long lasting resolution of symptoms, although, recurrence of the same, or development of a different type of anxiety disorder, is not uncommon. In most children and adolescents, anxiety disorders tend to persist into adulthood requiring long-term treatment planning. This paper reviews the pharmacological agents used in the treatment of anxiety disorders in children and adolescents.