• MeSH
• Clonidine pharmacology   therapeutic use   MeSH
• Child MeSH
• Adult MeSH
• Duloxetine Hydrochloride pharmacology   therapeutic use   MeSH
• Guanfacine pharmacology   therapeutic use   MeSH
• Attention Deficit Disorder with Hyperactivity * drug therapy   MeSH
• Humans MeSH
• Drug Discovery MeSH
• Viloxazine pharmacology   therapeutic use   MeSH
• Check Tag
• Child MeSH
• Adult MeSH
• Humans MeSH
• Publication type
• Newspaper Article MeSH
• News MeSH

The agonists of alpha(2)-adrenergic receptors such as clonidine, rilmenidine or monoxidine are known to lower blood pressure (BP) through a reduction of brain sympathetic outflow but their chronic antihypertensive effects in rats with low-renin or high-renin forms of experimental hypertension were not studied yet. Moreover, there is no comparison of mechanisms underlying BP reduction elicited by chronic peroral (po) or intracerebroventricular (icv) clonidine treatment. Male salt-sensitive Dahl rats fed 4% NaCl diet and Ren-2 transgenic rats were treated with clonidine administered either in the drinking fluid (0.5 mg/kg/day po) or as the infusion into lateral brain ventricle (0.1 mg/kg/day icv) for 4 weeks. Basal BP and the contributions of renin-angiotensin system (captopril 10 mg/kg iv) or sympathetic nervous system (pentolinium 5 mg/kg iv) to BP maintenance were determined in conscious cannulated rats at the end of the study. Both peroral and intracerebroventricular clonidine treatment lowered BP to the same extent in either rat model. However, in both models chronic clonidine treatment reduced sympathetic BP component only in rats treated intracerebroventricularly but not in perorally treated animals. In contrast, peroral clonidine treatment reduced angiotensin II-dependent vasoconstriction in Ren-2 transgenic rats, whereas it lowered residual blood pressure in Dahl rats. In conclusions, our results indicate different mechanisms of antihypertensive action of clonidine when administered centrally or systemically.

• MeSH
• Angiotensin II pharmacology   MeSH
• Antihypertensive Agents pharmacology   MeSH
• Sodium Chloride MeSH
• Clonidine pharmacology   MeSH
• Hypertension * chemically induced   drug therapy   MeSH
• Hypotension * MeSH
• Blood Pressure MeSH
• Rats MeSH
• Sodium Chloride, Dietary MeSH
• Rats, Inbred Dahl MeSH
• Rats, Transgenic MeSH
• Renin MeSH
• Sympathetic Nervous System MeSH
• Animals MeSH
• Check Tag
• Rats MeSH
• Male MeSH
• Animals MeSH
• Publication type
• Journal Article MeSH

Opioidy jsou používány k léčbě silné nádorové i nenádorové, zejména chronické bolesti. Současná zvýšená pozornost ohledně mnohých rizik a nedostatečných průkazů efektivity dlouhodobé léčby opioidy u chronických nenádorových bolestivých syndromů vede často lékaře k nutnosti omezit až ukončit tuto léčbu. Dlouhodobé používání opioidů může vést ke vzniku nežádoucích vedlejších účinků, včetně vzniku fyzické závislosti. Při přerušení chronického používání opioidů může vzniknout na podkladě vyvinuté fyzické závislosti až život ohrožující syndrom z odnětí (abstinenční syndrom). Jeho vznik může být úmyslný i nevědomý. Pro pacienty, u kterých se snažíme z různých důvodů snížit nebo přerušit léčbu opioidy, může být vznik tohoto syndromu významnou bariérou pro jejich odvykání od opioidů. Význam přístupů k odvykání od opioidů a zvládání syndromu z odnětí vzrůstá i v souvislosti s opatřeními souvisejícími s opioidní epidemií z důvodů snížení nebo ukončení opioidní léčby při vzniklém onemocnění z užívání opioidů. V tomto článku popisujeme diagnostiku a současné možnosti prevence a léčby syndromu z odnětí opioidů u pacientů, kteří užívají legálně předepisované opioidy.

Opioids have used to manage severe cancer and non-cancer, mainly chronic pain. Increasing concern about many risks and limited evidence supporting the therapeutic benefit of long-term opioid therapy for chronic non-cancer pain are leading prescribers to consider decreasing or discontinuing the use of opioids. Chronic opioid use lead to development of many adverse effects, including physical dependence. Opioid withdrawal syndrome is a life-threating condition resulting from interruption of opioid dependence when treating patients with long-term opioids. Development of this syndrome can be wilful or unintentional. For patients taking opioids chronically, opioid withdrawal is a major obstacle to successfully decreasing opioid dose or discontinuing opioid therapy. It is an important and increasing problem due to arrangements against opioid epidemic (reduction or discontinuation of opioid treatment due to opioid use disorder). In this article are described the evaluation, prevention and current management of opioid withdrawal in patients with legal prescribed opioids.

• MeSH
• Substance Withdrawal Syndrome diagnosis   etiology   drug therapy   physiopathology   prevention & control   MeSH
• Adrenergic alpha-2 Receptor Agonists therapeutic use   MeSH
• Benzodiazepines administration & dosage   pharmacology   MeSH
• Chronic Pain drug therapy   MeSH
• Clonidine analogs & derivatives   administration & dosage   pharmacology   adverse effects   MeSH
• Cognitive Behavioral Therapy methods   MeSH
• Buprenorphine, Naloxone Drug Combination pharmacology   therapeutic use   MeSH
• Humans MeSH
• Methadone pharmacology   adverse effects   therapeutic use   MeSH
• Naltrexone pharmacology   therapeutic use   MeSH
• Opiate Substitution Treatment * MeSH
• Analgesics, Opioid antagonists & inhibitors   pharmacology   adverse effects   MeSH
• Opioid-Related Disorders drug therapy   prevention & control   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH

Neuromodulačné techniky predstavujú paletu terapeutických postupov s rozličnými možnosťami ovplyvňovania dráh bolesti. Jedná sa buď o aplikáciu vybraného liečiva, alebo pôsobenie elektrického signálu v blízkosti periférneho (PNS) alebo centrálneho nervového systému (CNS), ktorým sa moduluje vnímanie bolesti. Aplikácia farmák do epidurálneho alebo subarachnoidálneho priestoru sa využíva ako súčasť katetrizačných techník s kontinuálnym podávaním liečiva. Druhú skupinu tvoria vyspelé neurostimulačné systémy, pri ktorých elektrický signál na úrovni PNS alebo CNS zložitým účinkom ovplyvňuje vedenie a percepciu bolesti. Napriek mnohým teóriám založeným na experimentálnych výsledkoch, ich patofyziologický mechanizmus účinku nie je doteraz jednoznačne vysvetlený. Dominantné postavenie medzi neurostimulačnými technikami v liečbe chronickej bolesti predstavujú techniky založené na stimulácii miechových štruktúr, dorzálnych ganglií a periférnych nervov založených na aplikácii elektród do zadného alebo aj predného epidurálneho priestoru. Táto terapeutická metóda je určená pre rezistentné chronické bolestivé stavy, ako napríklad komplexný regionálny bolestivý syndróm (KRBS), syndróm zlyhanej operácie chrbtice (failed back surgery syndrome, FBSS) a iné, po vyčerpaní ostatných liečebných možností. Typy miechových stimulátorov sa líšia hlavne v použití rozličných frekvencií v rámci nastavenia stimulačných parametrov a v použitom type generátora elektrických impulzov. Dnes je rozlišovacím parametrom aj kompatibilita systémov s magnetickou rezonanciou. Neuromodulačné techniky predstavujú dôležitý nástroj liečby refraktérnej chronickej bolesti. U správne indikovaných pacientov s dobre fungujúcou miechovou stimuláciou dochádza k výraznému zlepšeniu kvality života a redukcii vedľajších účinkov farmakoterapie. Cieľom práce je opísať problematiku neuromodulačnej liečby a jej súčasných výsledkov.

Neuromodulation techniques represent a spectrum of therapeutic approaches with various options to influence the pain pathways. It can be either the application of the chosen medication or the action of electrical signals in the vicinity of the peripheral (PNS) or central nervous system (CNS), by which the perception of pain is modulated. The application of medications into the epidural or subdural space is commonly used as a part of catheterisation techniques with a continuous administration of the chosen medication. The second group is made up of modern neurostimulation systems, during which electrical signals at the level of the PNS or CNS affect the conduction and perception of pain in a complex manner. Despite numerous theories based on experimental results, their pathophysiological mechanism of action has not yet been fully explained. The dominant role among neurostimulation techniques in the management of chronic pain, for example in the cases of complex regional pain syndrome (CRPS), failed back surgery syndrome (FBSS) and others, belongs to the techniques based on the stimulation of spinal structures, dorsal ganglia and peripheral nerves, with the application of electrodes to the posterior and anterior epidural space. The types of spinal stimulators differ mainly in the application of different frequencies within the stimulation parameters settings and the electrical impulse generator type used. Nowadays, a distinguishing parameter is also the compatibility of the systems with magnetic resonance. Neuromodulation techniques are important part of chronic refractory pain treatment. Correct indications of patients with a functional spinal cord stimulation lead to improvement of quality of life and reduction of pharmacological side effects. The goal of this article is to cover current neuromodulation treatment modalities and to inform about actual clinical outcomes of various methods.

• MeSH
• Back Pain * surgery   therapy   MeSH
• Chronic Pain therapy   MeSH
• Clonidine administration & dosage   adverse effects   therapeutic use   MeSH
• Electric Stimulation methods   MeSH
• Electrodes, Implanted MeSH
• Humans MeSH
• Spinal Cord surgery   drug effects   MeSH
• Spinal Cord Stimulation methods   MeSH
• Morphine administration & dosage   adverse effects   therapeutic use   MeSH
• Neurosurgical Procedures methods   MeSH
• omega-Conotoxins adverse effects   therapeutic use   MeSH
• Analgesics, Opioid administration & dosage   adverse effects   therapeutic use   MeSH
• Injections, Spinal * methods   MeSH
• Check Tag
• Humans MeSH

• MeSH
• Citalopram administration & dosage   therapeutic use   MeSH
• Clonidine administration & dosage   therapeutic use   MeSH
• Fluoxetine administration & dosage   therapeutic use   MeSH
• Phytoestrogens therapeutic use   MeSH
• Gabapentin MeSH
• Hormone Replacement Therapy MeSH
• Climacteric MeSH
• Humans MeSH
• Hot Flashes * drug therapy   physiopathology   MeSH
• Paroxetine administration & dosage   therapeutic use   MeSH
• Selective Serotonin Reuptake Inhibitors * MeSH
• Check Tag
• Humans MeSH
• Female MeSH

• Keywords
• klimakterický syndrom, vazomotorické symptomy,
• MeSH
• Calcium Channel Blockers therapeutic use   MeSH
• Clonidine therapeutic use   MeSH
• Double-Blind Method MeSH
• Estrogen Replacement Therapy MeSH
• Estrogens administration & dosage   therapeutic use   MeSH
• Phytotherapy MeSH
• Gabapentin MeSH
• Hormone Replacement Therapy * adverse effects   utilization   MeSH
• Hormones MeSH
• Serotonin and Noradrenaline Reuptake Inhibitors classification   therapeutic use   MeSH
• Climacteric * drug effects   MeSH
• Complementary Therapies classification   MeSH
• Humans MeSH
• Menopause MeSH
• Multicenter Studies as Topic MeSH
• Postmenopause drug effects   MeSH
• Randomized Controlled Trials as Topic MeSH
• Selective Serotonin Reuptake Inhibitors classification   therapeutic use   MeSH
• Syndrome MeSH
• Vasomotor System physiopathology   MeSH
• Check Tag
• Humans MeSH
• Female MeSH

Biologické aspekty etiologie ADHD a poruch chování, včetně jejich souvislostí s užívanou farmakoterapií, představují, vedle faktorů prostředí a problémů v meziosobní interakci v rodině, základ pochopení etiopatogeneze uvedených poruch a poruch příbuzných (např. tiková porucha, obsedantně kompulzivní porucha u dětí). Uvedené poznatky o neurovývojových poruchách dokládají výrazné pokroky ve znalostech příčin onemocnění, v jejich léčbě a tím také v možnostech prevence.

Next to environmental factors and problems with interpersonal interaction in family represent developmental findings the basic of understanding these disorders (ADHD, conduct disorders, obsessive-compulsive disorders, tic disorders etc.). Knowledges of neurodevelopment disorders represent new possibilities of prevention and treatment.

• MeSH
• Antihypertensive Agents MeSH
• Antipsychotic Agents MeSH
• Aripiprazole administration & dosage   therapeutic use   MeSH
• Atomoxetine Hydrochloride administration & dosage   therapeutic use   MeSH
• Clonidine administration & dosage   contraindications   therapeutic use   MeSH
• Child MeSH
• Dopamine beta-Hydroxylase physiology   MeSH
• Adult MeSH
• Mental Disorders * diagnosis   genetics   therapy   MeSH
• Attention Deficit Disorder with Hyperactivity * diagnosis   drug therapy   genetics   MeSH
• Adrenergic Uptake Inhibitors MeSH
• Humans MeSH
• Methylphenidate administration & dosage   therapeutic use   MeSH
• Neurobiology MeSH
• Polymorphism, Genetic MeSH
• Primary Prevention MeSH
• Prognosis MeSH
• Receptors, Dopamine D2 physiology   genetics   MeSH
• Receptors, Dopamine D4 physiology   genetics   MeSH
• Risperidone administration & dosage   therapeutic use   MeSH
• Wakefulness-Promoting Agents therapeutic use   MeSH
• Central Nervous System Stimulants MeSH
• Check Tag
• Child MeSH
• Adult MeSH
• Humans MeSH
• Publication type
• Review MeSH

INTRODUCTION: Sedation is an essential part of paediatric critical care. Midazolam, often in combination with opioids, is the current gold standard drug. However, as it is a far-from-ideal agent, clonidine is increasingly being used in children. This drug is prescribed off-label for this indication, as many drugs in paediatrics are. Therefore, the CLOSED trial aims to provide data on the pharmacokinetics, safety and efficacy of clonidine for the sedation of mechanically ventilated patients in order to obtain a paediatric-use marketing authorisation. METHODS AND ANALYSIS: The CLOSED study is a multicentre, double-blind, randomised, active-controlled non-inferiority trial with a 1:1 randomisation between clonidine and midazolam. Both treatment groups are stratified according to age in three groups with the same size: <28 days (n=100), 28 days to <2 years (n=100) and 2-18 years (n=100). The primary end point is defined as the occurrence of sedation failure within the study period. Secondary end points include a pharmacokinetic/pharmacodynamic relationship, pharmacogenetics, occurrence of delirium and withdrawal syndrome, opioid consumption and neurodevelopment in the neonatal age group. Logistic regression will be used for the primary end point, appropriate statistics will be used for the secondary end points. ETHICS: Written informed consent will be obtained from the parents/caregivers. Verbal or deferred consent will be used in the sites where national legislation allows. The study has institutional review board approval at recruiting sites. The results will be published in a peer-reviewed journal and shared with the worldwide medical community. TRIAL REGISTRATION: EudraCT: 2014-003582-24; Clinicaltrials.gov: NCT02509273; pre-results.

• MeSH
• Substance Withdrawal Syndrome MeSH
• Clonidine adverse effects   pharmacokinetics   therapeutic use   MeSH
• Delirium chemically induced   MeSH
• Child MeSH
• Hypnotics and Sedatives adverse effects   pharmacokinetics   therapeutic use   MeSH
• Intensive Care Units MeSH
• Infant MeSH
• Humans MeSH
• Midazolam adverse effects   pharmacokinetics   therapeutic use   MeSH
• Adolescent MeSH
• Treatment Failure MeSH
• Infant, Newborn MeSH
• Analgesics, Opioid administration & dosage   MeSH
• Child, Preschool MeSH
• Respiration, Artificial MeSH
• Child Development drug effects   MeSH
• Research Design * MeSH
• Check Tag
• Child MeSH
• Infant MeSH
• Humans MeSH
• Adolescent MeSH
• Infant, Newborn MeSH
• Child, Preschool MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Randomized Controlled Trial MeSH
• Comparative Study MeSH

• MeSH
• Conscious Sedation MeSH
• Clonidine therapeutic use   MeSH
• Adrenal Cortex Hormones therapeutic use   MeSH
• Cardiopulmonary Resuscitation ethics   MeSH
• Critical Illness * therapy   MeSH
• Lactates blood   MeSH
• Humans MeSH
• Critical Care * MeSH
• Regeneration MeSH
• Rehabilitation MeSH
• Resuscitation Orders ethics   MeSH
• Respiration, Artificial MeSH
• Medical Futility ethics   MeSH
• Check Tag
• Humans MeSH

• Keywords
• setrony, frontotemporální rozpojení, prefrontální dezinhibice,
• MeSH
• Serotonin 5-HT3 Receptor Antagonists pharmacology   therapeutic use   MeSH
• Antipsychotic Agents * pharmacology   therapeutic use   MeSH
• Clonidine pharmacology   therapeutic use   MeSH
• Electroencephalography MeSH
• Haloperidol pharmacology   therapeutic use   MeSH
• Clozapine pharmacology   therapeutic use   MeSH
• Humans MeSH
• Off-Label Use MeSH
• Prefrontal Cortex physiology   drug effects   MeSH
• Schizophrenia * drug therapy   physiopathology   MeSH
• Sensory Gating physiology   drug effects   MeSH
• Evoked Potentials, Auditory * physiology   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH