Term
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Definition
- take proper number of pills per day
- take pills in correct intervals throughout day
- taking the correct number of pills in a prescription (finish the prescription)
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Term
| Affect of symptoms on compliance |
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Definition
- poor compliance with:
- few symptoms (HTN)
- sever symptoms (advanced cancer)
- better compliance with moderate symptoms (acute pain)
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Term
| strategies to increase compliance |
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Definition
- communication from health care provider to the patient
- discuss dx and tx plan selected
- discuss time table for follow up
- education about tx
- dosing
- reduce number of medication
- reduce number of doses per day
- provide dose checklist
- provide pill box with daily compartments or an alarm reminder
- scheduling of clinic visits
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Term
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Definition
| aspect of the response to tx or medication that is NOT related to the pharmacologic or physiologic effects of the tx or medication |
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Term
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Definition
- can be physiologically inactive or inert compound
- but there is such a thing as active placebos
- can be either a substance or precedure
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Term
| purpose of placebos in modern medicine |
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Definition
- specific tx modality
- control for comparisonn purposes in scientific studies
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Term
| What types of conditions appear to respond to placebos? |
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Definition
- conditions must be capable of variable intensity over time
- common in psychiatric illness and pain conditions
- low symptomatic severity predicts better placebo responsiveness
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Term
| Explain the role of placebos in adverse reactions |
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Definition
- you see a great variety in the types of ADR in drug trials with placebos
- however, the rate of severe adverse reactions is much lower than in the experimental group
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Term
| General ideas about the type of person that responds to placebo |
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Definition
- there is no "placebo responder" profile
- however, there are some general characteristics
- patients and/or conditions with high levels of stress
- milder diseases with milder overall symptoms
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Term
| Mechanism of placebo response |
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Definition
- unknown
- have been seen at neurochemical level
- positive and negative expectations fulfilled by placebo
- some association of response with degree of stress
- placebos have time effect curves, peaks, cumulative, carryover effects similar to those of active medicines
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Term
| What constitutes a placebo? |
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Definition
- pills, injections, procedures of many kinds
- ex: efficacy of procedures like acupuncture may also be placebo effect
- placebos may be inert ("sugar pill") or active
- active placebos may be chosen for a response that mimics some aspect of the active drug being compared
- taste
- sedative properties
- anticholinergic activity
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Term
| Experiment with CCK antagonist for pain relief showed better pain relief than placebo. However, when given the same drug surreptitiously, there was no effect. What did that tell us about the mechanism of action of active placebos? |
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Definition
- they act via the expectation pathway
- perceived effects enhance expectation pathway
- stimulation of opioid receptors via mobilizing endogenous opioids
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Term
| What is ment by the nocebo effect caused by CCK agonists |
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Definition
- this is a placebo effect that increases pain
- remember, the CCK antagonists acts via expectation pathway to give pain relief
- CCK agonist acts via the similar pathway as the antagonist to enhance the pain effect aka the nocebo effect
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Term
| Role of open vs. hidden administration in placebo effect |
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Definition
- noted that the response was based off of whether or not they knew it was a placebo or they didnt
- only experimental drug effective (and its effects delayed)
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Term
| Role of physician in placebo effect |
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Definition
- placebo effects far more powerful when the substance is given by a physician than when purchased OTC by a patient
- besides a medication, patients also get examination, chance to discuss condition, dx and plausible tx plan
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Term
| What are the probelsm with using placebo controls in clinical trials? |
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Definition
- it is unethical to deny therapy
- one must stop a trial as soon as it has been demonstrated that test treatment is superior or is harmful
- use of active vs. inert
- greater response with active placebo
- proper choice can help with blinding
- need something identical in as many ways possible to experiemental tx
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