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Aspects of drug use in schizophrenia, cardiac surgery and palliative care

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Young, Rachel Susan (1995) Aspects of drug use in schizophrenia, cardiac surgery and palliative care. PhD thesis, University of Tasmania.

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Abstract

The research in this thesis involved four studies of the variability in
plasma concentrations and effects of a selection of drugs used in
schizophrenia, cardiac surgery and palliative care.
1. Fluphenazine study
Steady-state pre-dose plasma concentrations of fluphenazine were
measured using a gas chromatography I mass spectrometry assay in 24
patients with schizophrenia who were receiving continuous treatment
with depot intramuscular fluphenazine decanoate. Clinical response was
measured using the Andreasen Scale for positive and negative
symptoms. Poorer clinical control was related to higher log transformed
plasma concentrations of fluphenazine and higher fluphenazine
decanoate dosage. The log transformed plasma concentrations of
fluphenazine and the fluphenazine decanoate dosages were weakly
related. These results indicated the useful role that plasma level
monitoring can fulfill in identifying patients who are therapy-resistant
despite optimal or high plasma levels.
2. CPB study
This study examined the effect of cardiopulmonary bypass (CPB) surgery
on the total and unbound plasma concentrations of fentanyl and the total
plasma concentrations of alcuronium in sixteen patients. Due to the
large number of factors which may affect pharmacokinetics during CPB,
the results were difficult to deal with mathematically. Despite marked
declines in the plasma concentrations of both drugs on initiation of CPB,
suitable plasma concentrations for anaesthesia were maintained
throughout the procedure.
3. Subcutaneous fentanyl
This study investigated the steady-state total and unbound plasma
concentrations of fentanyl during continuous subcutaneous
administration in 20 palliative care patients. Infusion rates and both
total and unbound plasma concentrations of fentanyl were correlated.
Even with standardisation for dosage, there was an 8-fold variation in
total plasma concentrations and a 3.5-fold variation in unbound plasma
concentrations of fentanyl. There was considerable inter-patient
variability in the pharmacokinetics of fentanyl with subcutaneous
infusion in the palliative care setting, which necessitated careful titration
of dosage according to individual clinical response.
4. Nebulised morphine trial
The final study involved a trial of nebulised morphine for dyspnoea in
eleven palliative care patients. Due to patient attrition and the resulting
small sample size, a significant improvement in respiratory function and
assessment of dyspnoea could not be found overall. Individual patients,
however, reported an improvement in their symptoms. More studies
with increased numbers are needed to statistically prove the benefit of
nebulised morphine over saline alone for the relief of dyspnoea.

Item Type: Thesis (PhD)
Keywords: Schizophrenia, Heart, Palliative treatment, Pharmacokinetics
Copyright Holders: The Author
Copyright Information:

Copyright 1995 the Author - The University is continuing to endeavour to trace the copyright owner(s) and in the meantime this item has been reproduced here in good faith. We would be pleased to hear from the copyright owner(s).

Additional Information:

Includes bibliographical references (leaves 146-168). Thesis (Ph.D.)--University of Tasmania, 1997

Date Deposited: 04 Feb 2015 23:23
Last Modified: 24 Aug 2016 04:14
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