Drug Aging
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Herpes zoster is a common disease primarily affecting the elderly. Although some individuals experience no symptoms beyond the duration of the acute infection, many develop chronic pain [postherpetic neuralgia (PHN)], which is the commonest complication of herpes zoster infection and remains notoriously difficult to treat once established. It may persist until death and has major implications for quality of life and use of healthcare resources. ⋯ In the future, vaccines may have an important place in reducing the incidence of chickenpox in the population or, through the vaccination of middle-aged individuals, in boosting immunity to varicella zoster virus, thus preventing or modifying the replication of the virus from its latent phase that results in herpes zoster. Developments in the understanding of the pathophysiology of PHN indicate possible directions for improved drug management of established PHN, although no evidence yet exists for efficacy of the drugs concerned. Such agents include new generation anticonvulsants and N-methyl-D-aspartate antagonists.
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Behavioural disorders occur with great frequency in patients with dementia. They are the major reason for admission of these patients to nursing homes. However, there have been few controlled trials of many of the commonly used drugs to guide therapy. ⋯ Anticholinergic adverse effects, which occur commonly with many antipsychotic and antidepressant medications, may worsen the cognitive and memory deficits that form the primary symptoms of dementia in these patients. This article summarises the use of the various psychoactive medications that target common behavioural disturbances, including agitation, psychosis, depression and sleep disturbances, in dementia patients. General guidelines regarding dosage, potential adverse effects and duration of therapy are discussed.