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https://www.readbyqxmd.com/read/28320026/-alcohol-withdrawal-and-its-major-complications
#1
Klaus Junghanns, Tilman Wetterling
Delirium tremens is one of the most common complications of alcohol withdrawal. It is potentially lethal and therefore should be detected as early as possible and be monitored and treated intensively. The assessment of risk factors with the Luebeck Alcohol-Withdrawal Risk Scale short form (LARS-11) can help to predict the risk of severe withdrawal adequately. As delirium cannot be differentiated from Wernicke-Encephalopathy with sufficient certainty high parenteral doses of Vitamin B1 and Magnesium orally should be given in case of any severe withdrawal symptoms...
March 2017: Fortschritte der Neurologie-Psychiatrie
https://www.readbyqxmd.com/read/28292795/primary-care-management-of-opioid-use-disorders-abstinence-methadone-or-buprenorphine-naloxone
#2
REVIEW
Anita Srivastava, Meldon Kahan, Maya Nader
OBJECTIVE: To advise physicians on which treatment options to recommend for specific patient populations: abstinence-based treatment, buprenorphine-naloxone maintenance, or methadone maintenance. SOURCES OF INFORMATION: PubMed was searched and literature was reviewed on the effectiveness, safety, and side effect profiles of abstinence-based treatment, buprenorphine-naloxone treatment, and methadone treatment. Both observational and interventional studies were included...
March 2017: Canadian Family Physician Médecin de Famille Canadien
https://www.readbyqxmd.com/read/28287793/topiramate-reduces-basal-anxiety-and-relieves-ethanol-withdrawal-induced-anxious-behaviors-in-male-rats
#3
Décio D Junqueira-Ayres, Laila Asth, Adriana S F S J Ayres, Bruno Lobão-Soares, Vanessa de Paula Soares-Rachetti, Elaine C Gavioli
Anxiety disorders are associated with increased impairments in psychosocial functioning, work productivity and health-related quality of life. In addition, anxiety is a common symptom of ethanol withdrawal and it strongly contributes to relapse. Benzodiazepines are frequently prescribed for relief of anxiety and ethanol withdrawal symptoms but considerable side effects, such sedation, tolerance and dependence, are observed during treatment. Therefore, better drugs are needed for the treatment of anxiety states...
April 2017: Experimental and Clinical Psychopharmacology
https://www.readbyqxmd.com/read/28281491/status-epilepticus-refractory-and-super-refractory
#4
REVIEW
Deepanshu Dubey, Jayantee Kalita, Usha K Misra
Status epilepticus (SE) is an important neurological emergency. It is defined as seizures lasting for 5 minutes or more or recurrent seizures without recovery of consciousness to baseline between the attacks. Refractory SE (RSE) is defined as SE persisting despite sufficient dose of benzodiazepines and at least one antiepileptic drug (AED), irrespective of time. Super refractory SE (SRSE) is defined as SE that continues for 24 hours or more after the use of anesthetic therapy, including cases that recur on weaning of the anesthestic agent...
2017: Neurology India
https://www.readbyqxmd.com/read/28268215/randomised-comparison-of-a-novel-buprenorphine-oral-lyophilisate-versus-existing-buprenorphine-sublingual-tablets-in-opioid-dependent-patients-a-first-in-patient-phase-ii-randomised-open-label-safety-study
#5
John Strang, Kylie Reed, Karolina Bogdanowicz, James Bell, Rob van der Waal, Jenny Keen, Pete Beavan, Shelagh Baillie, Alastair Knight
AIMS: To test the safety of new buprenorphine oral lyophilisate wafer ("bup-lyo") versus standard sub-lingual buprenorphine ("bup-SL"). DESIGN: Randomised (2:1) open-label study; opioid-dependent subjects; subsequent partial cross-over. SETTINGS: Specialised clinical trials facility and addictions treatment facility. PARTICIPANTS: Opioid-dependent subjects (n = 36) commencing buprenorphine maintenance (personalised dose-titration) including patients co-using alcohol, cocaine and benzodiazepines (below thresholds)...
March 8, 2017: European Addiction Research
https://www.readbyqxmd.com/read/28262178/zolpidem-s-use-for-insomnia
#6
REVIEW
Jaime M Monti, David Warren Spence, Kenneth Buttoo, Seithikurippu R Pandi-Perumal
Zolpidem is a short-acting non-benzodiazepine hypnotic drug that belongs to the imidazopyridine class. In addition to immediate-release (IR) and extended-release (ER) formulations, the new delivery forms including two sublingual tablets [standard dose (SD) and low dose (LD)], and an oral spray form have been recently developed which bypass the gastrointestinal tract. So far, Zolpidem has been studied in several clinical populations: cases poor sleepers, transient insomnia, elderly and non-elderly patients with chronic primary insomnia, and in comorbid insomnia...
February 2017: Asian Journal of Psychiatry
https://www.readbyqxmd.com/read/28257172/prescribed-benzodiazepines-and-suicide-risk-a-review-of-the-literature
#7
REVIEW
Tyler J Dodds
Objective: To evaluate whether prescribed benzodiazepines affect one's risk of suicide. Data Sources: A PubMed search of English-language publications from database inception until October 11, 2016, was conducted using the terms benzodiazepine and suicide. References and related articles were also searched to yield additional publications. Study Selection/Data Extraction: Studies were included if they addressed the relationship between suicidal behavior and the prescribed use of either specific benzodiazepines or benzodiazepines as a class...
March 2, 2017: Primary Care Companion to CNS Disorders
https://www.readbyqxmd.com/read/28255523/inhibition-of-soluble-epoxide-hydrolase-as-a-novel-approach-to-high-dose-diazepam-induced-hypotension
#8
Arzu Ulu, Bora Inceoglu, Jun Yang, Vikrant Singh, Stephen Vito, Heike Wulff, Bruce D Hammock
CONTEXT: Hypotension is one of the dose limiting side effects of benzodiazepines (BZDs), in particular of diazepam (DZP) which is still widely used in the clinic. Currently, only one FDA approved antidote exists for BZD overdose and novel approaches are needed to improve management of DZP overdose, dependency and withdrawal. OBJECTIVE: Here, we hypothesized that increasing bioactive lipid mediators termed epoxy fatty acids (EpFAs) will prevent hypotension, as was shown previously in a murine model of LPS-induced hypotension...
June 2016: Journal of Clinical Toxicology
https://www.readbyqxmd.com/read/28236431/catamenial-like-seizure-exacerbation-in-mice-with-targeted-ablation-of-extrasynaptic-%C3%AE-gaba-a-receptors-in-the-brain
#9
Bryan L Clossen, Doodipala Samba Reddy
Neurosteroids play a key role in catamenial epilepsy, a menstrual cycle-related seizure clustering in women with epilepsy. While neurosteroids act on all GABA-A receptor isoforms, they cause greater effects on extrasynaptic δGABA-A receptors that mediate tonic inhibition in the brain. Previously, we identified a potential GABA-A receptor mechanism for catamenial epilepsy. However, the precise functional role of extrasynaptic δGABA-A receptors in the pathophysiology of catamenial epilepsy remains unclear. In this study, we utilized mice lacking extrasynaptic δGABA-A receptors (δKO) to investigate whether reduction of tonic inhibition affects catamenial seizure susceptibility or intensity...
February 25, 2017: Journal of Neuroscience Research
https://www.readbyqxmd.com/read/28231495/drug-induced-panic-attacks-analysis-of-cases-registered-in-the-french-pharmacovigilance-database
#10
Delphine Abadie, Anaïs Essilini, Virginie Fulda, Aurore Gouraud, Mélissa Yéléhé-Okouma, Joëlle Micallef, François Montastruc, Jean Louis Montastruc
BACKGROUND: The potential role of drugs in the onset of panic attacks (PAs) is poorly understood. AIM: The objective of our study was to characterize drug-induced PAs. METHOD: We performed an analysis of PAs registered in the French pharmacovigilance database between 01/01/1985 and 05/11/2014. RESULTS: Among the 163 recorded cases, 136 (83.4%) were directly related to drugs, mainly antidepressants (11.3%, mainly serotonin reuptake inhibitors), mefloquine (7...
February 9, 2017: Journal of Psychiatric Research
https://www.readbyqxmd.com/read/28190439/neurologic-complications-of-polytrauma
#11
R M Jha, L Shutter
Neurologic complications in polytrauma can be classified by etiology and clinical manifestations: neurovascular, delirium, and spinal or neuromuscular problems. Neurovascular complications include ischemic strokes, intracranial hemorrhage, or the development of traumatic arteriovenous fistulae. Delirium and encephalopathy have a reported incidence of 67-92% in mechanically ventilated polytrauma patients. Causes include sedation, analgesia/pain, medications, sleep deprivation, postoperative state, toxic ingestions, withdrawal syndromes, organ system dysfunction, electrolyte/metabolic abnormalities, and infections...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28188055/the-emergency-medicine-management-of-severe-alcohol-withdrawal
#12
Drew Long, Brit Long, Alex Koyfman
INTRODUCTION: Alcohol use is widespread, and withdrawal symptoms are common after decreased alcohol intake. Severe alcohol withdrawal may manifest with delirium tremens, and new therapies may assist in management of this life-threatening condition. OBJECTIVE: To provide an evidence-based review of the emergency medicine management of alcohol withdrawal and delirium tremens. DISCUSSION: The underlying pathophysiology of alcohol withdrawal syndrome (AWS) is central nervous system hyperexcitation...
February 4, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28186869/sedative-hypnotic-drug-withdrawal-syndrome-recognition-and-treatment
#13
REVIEW
Cynthia Santos, Ruben E Olmedo
Sedative-hypnotic drugs include gamma-Aminobutyric acid (GABA)ergic agents such as benzodiazepines, barbiturates, gamma-Hydroxybutyric acid [GHB], gamma-Butyrolactone [GBL], baclofen, and ethanol. Chronic use of these substances can cause tolerance, and abrupt cessation or a reduction in the quantity of the drug can precipitate a life-threatening withdrawal syndrome. Benzodiazepines, phenobarbital, propofol, and other GABA agonists or analogues can effectively control symptoms of withdrawal from GABAergic agents...
March 2017: Emergency Medicine Practice
https://www.readbyqxmd.com/read/28181946/case-report-of-midazolam-withdrawal-induced-catatonia-in-a-9-year-old-patient
#14
Cassandra R Duncan-Azadi, Peter N Johnson, Andrew Gormley
Benzodiazepine withdrawal-induced catatonia is a rare phenomenon in the adult population and has never been reported in a pediatric patient. We present a 9-year-old boy who exhibited catatonia symptoms following discontinuation of a midazolam infusion in the pediatric intensive care unit. The pediatric anesthesia acute pain team was consulted. When the patient's altered mental status could not otherwise be explained, benzodiazepine withdrawal-induced catatonia was considered. A dose of 2 mg intravenous lorazepam was given and the patient's symptoms dramatically improved within 5 minutes of administration...
February 8, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28125446/inpatient-gamma-hydroxybutyrate-detoxification-a-case-report-describing-day-to-day-therapeutic-management
#15
Louis von Theobald, Morgane Rousselet, Jennyfer Cholet, Hélène Debar, David Boels, Caroline Victorri-Vigneau, Marie Grall-Bronnec
BACKGROUND: Gamma-hydroxybutyrate (GHB) is a synthetic drug increasingly used by consumers of psychoactive substances. The sought after psychoactive effects of GHB have resulted in an increase in recreational use in Europe. GHB is considered to have a high dependence potential, and abrupt discontinuation after long-term use can result in a severe withdrawal syndrome. Despite a large number of publications related to GHB withdrawal and detoxification, to date, no evidence-based protocol or consensual international therapeutic guidelines are available (over and above the administration of benzodiazepines)...
January 25, 2017: Journal of Addiction Medicine
https://www.readbyqxmd.com/read/28115043/-benzodiazepines-should-still-be-first-line-treatment-for-alcohol-withdrawal
#16
Gro Askgaard, Anton Pottegård, Anders Fink-Jensen
In this review, we summarize the evidence for benzodiazepines and barbiturates as alcohol withdrawal treatment and outline a treatment guideline. A number of randomized controlled trials (RCTs) indicate that benzodiazepine treatment decreases alcohol withdrawal seizures and is safe. For barbiturates, only a few RCTs have been undertaken, and barbiturates were not found to be superior to benzodiazepines. Consequently, we suggest that benzodiazepines should still be first-line treatment for alcohol withdrawal...
January 16, 2017: Ugeskrift for Laeger
https://www.readbyqxmd.com/read/28105500/-discontinuation-of-benzodiazepines-in-old-age-when-and-if-so-how
#17
Dirk K Wolter
Although viewed critically in geriatrics, benzodiazepine use is still common among old people. Before reducing the dosage the following questions must be considered: 1. Are there indications for benzodiazepine treatment and will discontinuation cause relevant rebound symptoms of the initial disorder treated? 2. To what extent do the patient and other key persons consider discontinuation to be reasonable and will they support discontinuation? 3. Is the target complete withdrawal, a dose reduction or shift to another benzodiazepine drug which is more suitable in old age for pharmacokinetic reasons? This article provides assistance in answering these questions and some guidelines for the practical management of discontinuation...
February 2017: Zeitschrift Für Gerontologie und Geriatrie
https://www.readbyqxmd.com/read/28101764/diazepam-in-the-treatment-of-moderate-to-severe-alcohol-withdrawal
#18
Steven J Weintraub
Benzodiazepines ameliorate or prevent the symptoms and complications of moderate to severe alcohol withdrawal, which can include autonomic hyperactivity, agitation, combativeness, hallucinations, seizures, delirium, and death. The benzodiazepines most commonly used for this purpose are lorazepam, chlordiazepoxide, oxazepam, and diazepam. It is widely asserted that no member of this group is superior to the others for treatment of alcohol withdrawal. However, of these, diazepam has the shortest time to peak effect, which facilitates both rapid control of symptoms and accurate titration to avoid over-sedation...
January 18, 2017: CNS Drugs
https://www.readbyqxmd.com/read/28096989/successful-treatment-of-severe-baclofen-toxicosis-initially-refractory-to-conventional-treatment
#19
Christine M Fox, Meredith L Daly
After ingesting a dose of baclofen thought to be lethal, a patient with severe neurologic signs was successfully managed despite initially being refractory to treatment. Patients with persistent neurologic abnormalities may still have an excellent prognosis despite lack of initial response. Additionally, we present a potential case of benzodiazepine withdrawal.
January 2017: Clinical Case Reports
https://www.readbyqxmd.com/read/28017287/-retrospective-study-of-the-assessment-and-management-of-benzodiazepine-withdrawal-syndrome-in-hospital-between-2000-and-2015
#20
A Martin-Kleisch, A-A Zulfiqar
INTRODUCTION: Benzodiazepines are prescribed in many indications and are provider of adverse effects in case of abrupt withdrawal or poorly framed. Withdrawal rules are established by the High Authority for Health. METHODS: To evaluate the diagnostic and therapeutic modalities of the benzodiazepine withdrawal syndrome, we performed a retrospective single-center study at the University Hospital of Reims, between January 2000 and May 2015, in patients with a withdrawal syndrome following hospital coding...
December 22, 2016: Annales Pharmaceutiques Françaises
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