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https://www.readbyqxmd.com/read/28795846/a-novel-non-opioid-protocol-for-medically-supervised-opioid-withdrawal-and-transition-to-antagonist-treatment
#1
Gregory Rudolf, Jim Walsh, Abigail Plawman, Paul Gianutsos, William Alto, Lloyd Mancl, Vania Rudolf
BACKGROUND: The clinical feasibility of a novel non-opioid and benzodiazepine-free protocol was assessed for the treatment of medically supervised opioid withdrawal and transition to subsequent relapse prevention strategies. METHODS: A retrospective chart review of DSM-IV diagnosed opioid-dependent patients admitted for inpatient medically supervised withdrawal examined 84 subjects (52 males, 32 females) treated with a 4-day protocol of scheduled tizanidine, hydroxyzine, and gabapentin...
August 10, 2017: American Journal of Drug and Alcohol Abuse
https://www.readbyqxmd.com/read/28793780/iatrogenic-opioid-withdrawal-in-critically-ill-patients-a-review-of-assessment-tools-and-management
#2
Ada W Chiu, Sofia Contreras, Sangeeta Mehta, Jennifer Korman, Marc M Perreault, David R Williamson, Lisa D Burry
OBJECTIVE: To (1) provide an overview of the epidemiology, clinical presentation, and risk factors of iatrogenic opioid withdrawal in critically ill patients and (2) conduct a literature review of assessment and management of iatrogenic opioid withdrawal in critically ill patients. DATA SOURCES: We searched MEDLINE (1946-June 2017), EMBASE (1974-June 2017), and CINAHL (1982-June 2017) with the terms opioid withdrawal, opioid, opiate, critical care, critically ill, assessment tool, scale, taper, weaning, and management...
August 1, 2017: Annals of Pharmacotherapy
https://www.readbyqxmd.com/read/28777203/a-review-of-alprazolam-use-misuse-and-withdrawal
#3
Nassima Ait-Daoud, Allan Scott Hamby, Sana Sharma, Derek Blevins
: Alprazolam is one of the most widely prescribed benzodiazepines for the treatment of generalized anxiety disorder and panic disorder. Its clinical use has been a point of contention as most addiction specialists consider it to be highly addictive, given its unique psychodynamic properties which limit its clinical usefulness, whereas many primary care physicians continue to prescribe it for longer periods than recommended. Clinical research data has not fully shed light on its "abuse liability," yet it is one of the most frequently prescribed benzodiazepines...
August 2, 2017: Journal of Addiction Medicine
https://www.readbyqxmd.com/read/28768628/risk-of-neonatal-drug-withdrawal-after-intrauterine-co-exposure-to-opioids-and-psychotropic-medications-cohort-study
#4
Krista F Huybrechts, Brian T Bateman, Rishi J Desai, Sonia Hernandez-Diaz, Kathryn Rough, Helen Mogun, Leslie S Kerzner, Jonathan M Davis, Megan Stover, Devan Bartels, Jennifer Cottral, Elisabetta Patorno
Objectives To assess the impact of in utero co-exposure to psychotropic medications and opioids on the incidence and severity of neonatal drug withdrawal.Design Observational cohort study.Setting Nationwide sample of pregnancies in publicly insured women in the US, nested in the Medicaid Analytic eXtract (2000-10).Participants 201 275 pregnant women with public insurance who were exposed to opioids around the time of delivery and their liveborn infants.Interventions In utero exposure to psychotropic medications, in particular antidepressants, atypical antipsychotics, benzodiazepines, gabapentin, and non-benzodiazepine hypnotics (Z drugs), with prescriptions filled within the same time window as prescriptions for opioids...
August 2, 2017: BMJ: British Medical Journal
https://www.readbyqxmd.com/read/28753046/levetiracetam-in-toxic-seizures
#5
Ted Lee, Brandon J Warrick, Preeyaporn Sarangarm, Robert L Alunday, Silas Bussmann, Susan C Smolinske, Steven A Seifert
BACKGROUND/OBJECTIVES: The use of levetiracetam (LEV) in the management of drug-induced seizures has not been systematically investigated. Repetitive and continuous seizures that do not respond to benzodiazepines require second line therapy. Levetiracetam has a unique receptor binding site, rapid absorption, no known cardiac effects at therapeutic doses, and is theoretically a good candidate for use in drug-induced seizures. We evaluate the safety of LEV and its association with seizure cessation in this retrospective chart review of patients who received LEV as a control agent in drug-induced seizures...
July 28, 2017: Clinical Toxicology
https://www.readbyqxmd.com/read/28753044/severe-bark-scorpion-envenomation-in-adults
#6
Ayrn D O'Connor, Angela Padilla-Jones, Anne-Michelle Ruha
INTRODUCTION: The preponderance of medical literature regarding severe bark scorpion envenomation describes pediatric patients; however, the majority (>66%) of annual poison center calls pertain to adults. This retrospective review sought to evaluate the clinical manifestations of adults with severe Centruroides sculpturatus envenomation and determine if significant morbidity occurred. METHODS: This is a retrospective review of adults presenting to a single tertiary referral center with Grade-III or Grade-IV scorpion envenomation from 1 January 2007 to 3 March 2013...
July 28, 2017: Clinical Toxicology
https://www.readbyqxmd.com/read/28745845/sedative-hypnotic-drug-withdrawal-syndrome-recognition-and-treatment-digest
#7
Cynthia Santos, Ruben E Olmedo, Jeremy Kim
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 22, 2017: Emergency Medicine Practice
https://www.readbyqxmd.com/read/28716996/long-term-benzodiazepine-and-z-drugs-use-in-the-uk-a-survey-of-general-practice
#8
James Davies, Todd C Rae, Luke Montagu
BACKGROUND: Current British National Formulary (BNF) guidelines state that benzodiazepines and zolpidem, zopiclone, and zaleplon, commonly known as Z-drugs (BZD), be prescribed for no more than 4 weeks, although anecdotal data suggest that many patients are prescribed BZDs for much longer. As there are no recent, evidence-based estimates of long-term (>12 months) BZD use in the UK, the scale of this potential problem is unknown. AIM: To produce the first reliable, evidence-based estimate of long-term BZD use in the UK...
July 17, 2017: British Journal of General Practice: the Journal of the Royal College of General Practitioners
https://www.readbyqxmd.com/read/28683783/polydrug-abuse-among-opioid-maintenance-treatment-patients-is-related-to-inadequate-dose-of-maintenance-treatment-medicine
#9
Pertti Kalevi Heikman, Leea Hellevi Muhonen, Ilkka Antero Ojanperä
BACKGROUND: Polydrug abuse is a known problem among opioid-dependent patients receiving opioid maintenance treatment (OMT). However, improved laboratory diagnostics is required to reveal polydrug abuse in its current scope. Furthermore, there are few studies focusing on the relationship between polydrug abuse and adequacy of the dose of OMT medicine. This study aimed to evaluate the polydrug abuse among opioid-dependent patients receiving OMT with inadequate (Group IA) and adequate (Group A) doses of OMT medicine as experienced by the patients...
July 6, 2017: BMC Psychiatry
https://www.readbyqxmd.com/read/28622209/the-forgotten-treatment-of-alcohol-withdrawal-delirium-with-electroconvulsive-therapy-successful-use-in-a-very-prolonged-and-severe-case
#10
Laura Kranaster, Suna Su Aksay, Jan Malte Bumb, Christoph Janke, Alexander Sartorius
OBJECTIVE: Alcohol withdrawal delirium (AWD) is a notorious complication in alcohol withdrawal. Usually, the symptomatic treatment is efficacious; however, some patients show treatment resistance or a prolonged course of AWD. METHOD: We report the case of a patient with a prolonged and severest form of AWD. Even 11 weeks after admission, he received approximately 100 mg diazepam per week to manage the symptoms of withdrawal delirium. RESULTS: A treatment course of electroconvulsive therapy was initiated, which allowed a complete tapering off of benzodiazepines during electroconvulsive therapy without adverse effects...
July 2017: Clinical Neuropharmacology
https://www.readbyqxmd.com/read/28617422/reduced-narcotic-and-sedative-utilization-in-a-nicu-after-implementation-of-pain-management-guidelines
#11
D Rana, B Bellflower, J Sahni, A J Kaplan, N T Owens, E L Arrindell, A J Talati, R Dhanireddy
OBJECTIVE: To assess the opioid and benzodiazepine usage in a level IV NICU after implementation of pain guidelines. STUDY DESIGN: Guidelines were developed for infants undergoing surgical procedures and infants on mechanical ventilation. Data collected for period 1 (July to December 2013) and period 2 (March to August 2014). RESULTS: Gestational age, birth weight and infants with hypoxic respiratory failure or requiring major procedures were comparable in two periods...
June 15, 2017: Journal of Perinatology: Official Journal of the California Perinatal Association
https://www.readbyqxmd.com/read/28614197/sedation-management-in-children-supported-on-extracorporeal-membrane-oxygenation-for-acute-respiratory-failure
#12
James B Schneider, Todd Sweberg, Lisa A Asaro, Aileen Kirby, David Wypij, Ravi R Thiagarajan, Martha A Q Curley
OBJECTIVES: To describe sedation management in children supported on extracorporeal membrane oxygenation for acute respiratory failure. DESIGN: Secondary analysis of prospectively collected data from a multicenter randomized trial of sedation (Randomized Evaluation of Sedation Titration for Respiratory Failure). SETTING: Twenty-one U.S. PICUs. PATIENTS: One thousand two hundred fifty-five children, 2 weeks to 17 years old, with moderate/severe pediatric acute respiratory distress syndrome...
June 13, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28613124/low-risk-of-seizures-with-slow-flumazenil-infusion-and-routine-anticonvulsant-prophylaxis-for-high-dose-benzodiazepine-dependence
#13
Stefano Tamburin, Marco Faccini, Rebecca Casari, Angela Federico, Laura Morbioli, Enrica Franchini, Luigi Giuseppe Bongiovanni, Fabio Lugoboni
High-dose benzodiazepine (BZD) dependence represents an emerging and under-reported addiction phenomenon and is associated with reduced quality of life. To date there are no guidelines for the treatment of high-dose BZD withdrawal. Low-dose slow flumazenil infusion was reported to be effective for high-dose BZD detoxification, but there is concern about the risk of convulsions during this treatment. We evaluated the occurrence of seizures in 450 consecutive high-dose BZD dependence patients admitted to our unit from April 2012 to April 2016 for detoxification with low-dose slow subcutaneous infusion of flumazenil associated with routine anticonvulsant prophylaxis...
June 1, 2017: Journal of Psychopharmacology
https://www.readbyqxmd.com/read/28601135/novel-algorithms-for-the-prophylaxis-and-management-of-alcohol-withdrawal-syndromes-beyond-benzodiazepines
#14
REVIEW
José R Maldonado
Benzodiazepine (BZDP) agents are the standard for the prophylaxis and treatment of all phases of alcohol withdrawal syndrome. However, BZDPs have their drawbacks: cognitive impairment, significant neurologic and medical side effects. There are data suggesting that the alcohol recidivism rate and abuse potential is higher for BZDPs treated patients, compared to alternatives. Clinical and research data demonstrate the efficacy and safety of various pharmacologic alternatives to benzodiazepines for the prevention and management of AWS...
July 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28596835/chronic-diazepam-administration-increases-the-expression-of-lcn2-in-the-cns
#15
Tomonori Furukawa, Shuji Shimoyama, Yasuo Miki, Yoshikazu Nikaido, Kohei Koga, Kazuhiko Nakamura, Koichi Wakabayashi, Shinya Ueno
Benzodiazepines (BZDs), which bind with high affinity to gamma-aminobutyric acid type A receptors (GABAA-Rs) and potentiate the effects of GABA, are widely prescribed for anxiety, insomnia, epileptic discharge, and as anticonvulsants. The long-term use of BZDs is limited due to adverse effects such as tolerance, dependence, withdrawal effects, and impairments in cognition and learning. Additionally, clinical reports have shown that chronic BZD treatment increases the risk of Alzheimer's disease. Unusual GABAA-R subunit expression and GABAA-R phosphorylation are induced by chronic BZD use...
February 2017: Pharmacology Research & Perspectives
https://www.readbyqxmd.com/read/28577506/high-enhancer-downer-withdrawal-helper-multifunctional-nonmedical-benzodiazepine-use-among-young-adult-opioid-users-in-new-york-city
#16
Pedro Mateu-Gelabert, Lauren Jessell, Elizabeth Goodbody, Dongah Kim, Krista Gile, Jennifer Teubl, Cassandra Syckes, Kelly Ruggles, Jeffrey Lazar, Sam Friedman, Honoria Guarino
BACKGROUND: Benzodiazepines are a widely prescribed psychoactive drug; in the U.S., both medical and nonmedical use of benzodiazepines has increased markedly in the past 15 years. Long-term use can lead to tolerance and dependence, and abrupt withdrawal can cause seizures or other life-threatening symptoms. Benzodiazepines are often used nonmedically in conjunction with other drugs, and with opioids in particular-a combination that can increase the risk for fatal and non-fatal overdose...
May 31, 2017: International Journal on Drug Policy
https://www.readbyqxmd.com/read/28574532/association-between-opioid-and-benzodiazepine-use-and-clinical-deterioration-in-ward-patients
#17
Patrick G Lyons, Ashley Snyder, Sarah Sokol, Dana P Edelson, Babak Mokhlesi, Matthew M Churpek
BACKGROUND: Opioids and benzodiazepines are frequently used in hospitals, but little is known about outcomes among ward patients receiving these medications. OBJECTIVE: To determine the association between opioid and benzodiazepine administration and clinical deterioration. DESIGN: Observational cohort study. SETTING: 500-bed academic urban tertiary-care hospital. PATIENTS: All adults hospitalized on the wards from November 2008 to January 2016 were included...
June 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/28540039/successful-withdrawal-from-high-dose-benzodiazepine-in-a-young-patient-through-electronic-monitoring-of-polypharmacy-a-case-report-in-an-ambulatory-setting
#18
REVIEW
Hèctor R Loscertales, Valerie Wentzky, Kenneth Dürsteler, Johannes Strasser, Kurt E Hersberger, Isabelle Arnet
BACKGROUND: Dependence on high-dose benzodiazepines (BZDs) is well known and discontinuation attempts are generally unsuccessful. A well established protocol for high-dose BZD withdrawal management is lacking. We present the case of withdrawal from high-dose lorazepam (>20 mg daily) in an unemployed 35-year-old male outpatient through agonist substitution with long-acting clonazepam and electronic monitoring over 28 weeks. METHODS: All medicines were repacked into weekly 7 × 4 cavity multidose punch cards with an electronic monitoring system...
May 2017: Therapeutic Advances in Psychopharmacology
https://www.readbyqxmd.com/read/28487743/delirium-and-high-creatine-kinase-and-myoglobin-levels-related-to-synthetic-cannabinoid-withdrawal
#19
Ahmet Bulent Yazici, Esra Yazici, Atila Erol
Synthetic cannabinoids (SCs) are included in a group of drugs called new psychoactive substances. Effects of SCs on the central nervous system are similar to other cannabinoids, but 2-100 times more potent than marijuana. Thus, addiction and withdrawal symptoms are more severe than natural cannabinoids. Withdrawal symptoms of SCs were reported in the literature previously. But there is no report about SC withdrawal delirium and its treatment. Several studies reported that agonists of CB1 receptors play a role in GABA and glutamatergic neurotransmission, which is similar to the effects of alcohol on GABA and glutamatergic receptors...
2017: Case Reports in Medicine
https://www.readbyqxmd.com/read/28473524/a-realist-evaluation-of-patients-decisions-to-deprescribe-in-the-empower-trial
#20
Philippe Martin, Cara Tannenbaum
BACKGROUND AND OBJECTIVES: Successful mechanisms for engaging patients in the deprescribing process remain unknown but may include: (1) triggering motivation to deprescribe by increasing patients' knowledge and concern about medications; (2) building capacity to taper by augmenting self-efficacy and (3) creating opportunities to discuss and receive support for deprescribing from a healthcare provider. We tested these mechanisms during theEliminating Medications through Patient Ownership of End Results (EMPOWER) () trial and investigated the contexts that led to positive and negative deprescribing outcomes...
May 4, 2017: BMJ Open
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