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Ory and concentration" and is a featured ingredient in the product BrainPower. Advertisements claim that vinpocetine is "recommended by pharmacists" and "has been shown to recharge your mind and memory." Mechanisms and Animal Studies Vinpocetine increases blood flow in the brain.59 It may also increase the transport and uptake of glucose to the neurons. A recent positron emission tomography PET ; study with 12 chronic stroke patients showed that a single-dose treatment significantly improved the transport of glucose uptake and release ; to the brain, including brain tissue surrounding the damaged area.60 More glucose should help neuronal functioning, including memory performance see Gold et al8 ; . Both increased blood flow and improved delivery of glucose to neurons should be especially helpful to older adults who have ischemia. Further, diminished oxygen due to decreased blood flow ; can damage or kill neurons, and memory loss follows if the damage is sufficient. By improving blood flow, vinpocetine may protect against such damage. Using animal models of ischemia, investigators have found neuroprotective effects from vinpocetine. Rischke and Krieglstein61 examined hippocampal damage in rats 7 days after experimentally induced cerebral ischemia. Among control rats, 77% of hippocampal neurons were damaged, whereas in rats given 10 mg kg of vinpocetine either before or after the ischemia ; , damage was reduced to 37% of the hippocampal neurons. This neuroprotective effect was replicated and was also found to be dose sensitive, with lower 2 mg kg ; and higher 20 mg kg ; dosages not producing the effects. This study suggests that appropriate medium doses of vinpocetine can reduce the loss of neurons due to decreased blood flow in memory regions of the brain. If the reduction in loss is great enough, then memory impairment might be slowed or avoided. Finally, vinpocetine may increase levels of the ACh neurotransmitter, which is, as we noted earlier, especially important in memory regions of the brain.59 In the single animal study of the effects of vinpocetine on memory. DeNoble62 found that vinpocetine enhanced the retrieval of memory for a passive avoidance response. Vinpocetine administered after the response was learned and just before the memory test enhanced performance, thereby suggesting an effect on memory retrieval. Vinpocetine was not tested for its ability to enhance retention per se. Controlled Human Studies EFFECTS ON PATIENTS WITH COGNITIVE IMPAIRMENTS. Three controlled studies investigated vinpocetine with older adults who had memory problems associated with brain dysfunction either circulation problems in the brain or mild to moderate dementia-related brain disease ; .63 65 In all the studies, the groups given vinpocetine showed more improvement than the placebo groups for tests measuring attention, concentration, and memory. The size of this improvement for reported scores was noticeable. In the study by Balestreri et al., 63 patients taking vinpocetine for 3 mo dosages of 10 mg three times a day for the first 30 d, dropping to 15 mg d for the last 60 d ; significantly improved their scores 17.4 to 20.5 ; on the Mini-Mental Status Questionnaire part A corresponds to the Cognitive Capacity Screening Examination of Jacobs et al.66 and assesses orientation in time and space, mathematical ability, recent memory, and knowledge of antonyms and synonyms; part B includes aspects of the MMSE; the total maximum score for both parts is 39 ; , whereas patients taking the placebo showed no improvement. Using an identical dosing regimen, Manconi et al.65 found a similar significant improvement of 4.7 points on the Mini-Mental Status Questionnaire sum of parts A and B ; , a gain that was significantly different from the 0.4-point. MACROBID, 19 MACRODANTIN, 19 MALARONE, 17 MATULANE, 21 MAXAIR AUTOHALER, 48 MAXITROL, 54 MAXZIDE, 26 MAXZIDE-25, 26 mebendazole, 20 meclizine, 39 MEDROL, 37 medroxyprogesterone acetate, 35, 38 medroxyprogesterone acetate 150 mg mL, 35 mefloquine, 17 MEGACE, 20 megestrol acetate, 20 melphalan, 21 memantine, 28 meperidine, 15 MEPHYTON, 45 MEPRON, 17 mercaptopurine, 21 mesalamine delayed-rel tabs, 39 mesalamine ext-rel caps, 39 mesalamine rectal susp, 40 mesalamine supp, 40 MESTINON, 31 MESTINON TIMESPAN, 31 METAGLIP, 32 metformin, 32 metformin ext-rel 500 mg, 32 methadone, 15 methazolamide, 55 METHERGINE, 38 methimazole, 38 methocarbamol, 31 methotrexate 2.5 mg, 43 methoxsalen oral caps 10mg, 50 methyldopa, 27 methylergonovine, 38 methylprednisolone, 37 metoclopramide, 39 72 -- Boldface indicates generic availability and nabumetone. Solution for 4000 j.m. 1 ml Fumedica Biopol Sp. z o.o. subcutaneous and intravascular injection Solution for subcutaneous and intravenous injection Solution for intravenous and subcutanous injection 2000 j.m. 1 ml Fumedica Biopol Sp. z o.o.
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The LMPBM Program requires that each APRN with limited prescriptive authority obtain and maintain an individual provider prescriber number. Pharmacists are required to use the individual APRN Medicaid provider prescriber number when billing a pharmacy claim. Pharmacists are not permitted to use the APRN collaborating physician provider prescriber number when submitting pharmacy claims to Medicaid.
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We are indebted to our three peer reviewers - Drs. Malcom Man-SonHing, Maggie Somerset, and David Armstrong- for their comments and suggestions on an earlier draft of this paper. This study was funded by research grants from Physicians' Services Foundation Incorporated and Samcor Sunnybrook Primary Care Research Trust. Dr. Upshur is supported by a New Investigator Award from the Canadian Institutes of Health Research and a Research Scholar Award from the Department of Family and Community Medicine, University of Toronto. The authors would like to thank the 21 patients who volunteered to take part in this study and share their experiences with us. We would like to acknowledge the contribution of the nurses in the Family Practice Unit who referred the participants, and that of Dr. Denise Gastaldo who acted as an independent external reader. Special thanks also to Jennie Jones for transcribing the interviews and to Shari Gruman for formatting the paper.
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