Gene/Protein Disease Symptom Drug Enzyme Compound
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 2,072 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Simple bedside measurements of blood pressure and systolic pressure response to the Valsalva maneuver will confirm a clinical impression of orthostatic hypotension. Careful questioning of the patient usually elicits other symptoms of autonomic nervous system dysfunction, such as impotence, urinary and fecal incontinence, constipation or diarrhea, blurred vision, or sweating changes. Drugs are the most common cause of autonomic dysfunction, and their benefits should be weighed against the severity of the dysfunction. In addition, diabetes mellitus, uremia, amyloidosis, acute intermittent porphyria, myeloma, tabes dorsalis, and alcohol-nutritional problems may produce symptoms of autonomic dysfunction. Thus, patients who present with autonomic features but no history of dysfunction-producing drugs should undergo complete laboratory evaluation. A regimen of tyramine or L-dopa or a diet rich in cheese, processed meats, and wine (a monoamine), coupled with a monoamine oxidase inhibitor have beneficial effects in patients with orthostatic hypotension due to preganglionic autonomic dysfunction. Patients who do not respond to catecholamine precursors have stable, isolated orthostatic hypotension or a polyneuropathy such as that caused by diabetes.
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PMID:Evaluating dysfunction of the autonomic nervous system. 63 67

The increasing proportion of elderly to the general population and the relatively high prevalence rate of depression in this age group justifies concern for specific clinical indications for antidepressant selection. Of the numerous agents that possess antidepressant activity, some have a more narrow therapeutic window for the old (lithium), while others may be more efficacious for the old than traditional tricyclics (stimulants and monoamine oxidase inhibitors). Stimulants and monoamine oxidase inhibitors require close monitoring to obviate complications, and this limits their use in this population. Prescription of the more common reuptake inhibitors in this age group can be based on consideration of efficacy and especially predictable incidence of side effects. Efficacy of all the reuptake inhibitors is essentially equivalent over 4 weeks, if the patient can tolerate treatment. Antidepressants with many side effects are, thus, less efficacious if we consider only whether the patient will be better 4 weeks after we start treatment since drop outs must be considered treatment failures for that particular treatment. Side effects are more clearly different among the antidepressants with demonstrably fewer cardiac effects (i.e. ECG changes, orthostatic hypotension) for buproprion, mianserin, nomifensine, and trazodone in the geriatric group compared to older agents such as amitriptyline and imipramine. Further, anticholinergic effects in the periphery (dry mouth, constipation, blurred vision, and urinary hesitancy) and centrally (confusion, sedation, decreased memory recall) are substantially less with several of the newer antidepressants: buproprion, maprotiline, nomifensine and trazodone.
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PMID:Present status of drug therapy of depression in late life. 286 75