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https://www.readbyqxmd.com/read/29748926/adjunctive-use-of-ketamine-for-benzodiazepine-resistant-severe-alcohol-withdrawal-a-retrospective-evaluation
#1
Poorvi Shah, Marc McDowell, Reika Ebisu, Tabassum Hanif, Theodore Toerne
INTRODUCTION: Benzodiazepine (BZD)-resistant alcohol withdrawal remains a challenge for most institutions due to limited evidence with available agents. One published study currently exists utilizing the N-methyl-D-aspartate antagonist, ketamine, for alcohol withdrawal. OBJECTIVE: The purpose of our study was to evaluate the effect of adjunctive ketamine continuous infusion on symptom control and lorazepam infusion requirements for BZD-resistant alcohol withdrawal patients in the intensive care unit...
May 10, 2018: Journal of Medical Toxicology: Official Journal of the American College of Medical Toxicology
https://www.readbyqxmd.com/read/29742583/adjunct-ketamine-use-in-the-management-of-severe-ethanol-withdrawal
#2
Anthony F Pizon, Michael J Lynch, Neal J Benedict, Joseph H Yanta, Adam Frisch, Nathan B Menke, Greg S Swartzentruber, Andrew M King, Michael G Abesamis, Sandra L Kane-Gill
OBJECTIVES: Ketamine offers a plausible mechanism with favorable kinetics in treatment of severe ethanol withdrawal. The purpose of this study is to determine if a treatment guideline using an adjunctive ketamine infusion improves outcomes in patients suffering from severe ethanol withdrawal. DESIGN: Retrospective observational cohort study. SETTING: Academic tertiary care hospital. PATIENTS: Patients admitted to the ICU and diagnosed with delirium tremens by Diagnostic and Statistical Manual of Mental Disorders V criteria...
May 8, 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29735241/use-of-a-gabapentin-protocol-for-the-management-of-alcohol-withdrawal-a-preliminary-experience-expanding-from-the-consultation-liaison-psychiatry-service
#3
Jonathan G Leung, Daniela B Rakocevic, Nicholas D Allen, Elliot M Handler, Bruno A Perossa, Kristin L Borreggine, Amy L Stark, Hannah K Betcher, Daniel K Hosker, Blaine A Minton, Benjamin R Braus, Ross A Dierkhising, Kemuel L Philbrick
BACKGROUND: Benzodiazepines are the conventional mainstay to manage alcohol withdrawal; however, patients are subsequently at increased risk for poor sleep, cravings, and return to drinking. Research on alternative pharmacologic agents to facilitate safe alcohol withdrawal is scant. Gabapentin is one medication shown in small studies to reduce the need for benzodiazepines in the setting of alcohol withdrawal. The continuation of gabapentin after alcohol withdrawal appears to be safe during early sobriety and may aid in reducing alcohol-related cravings or returning to alcohol consumption...
March 21, 2018: Psychosomatics
https://www.readbyqxmd.com/read/29719204/drug-drug-interactions-in-the-treatment-for-alcohol-use-disorders-a-comprehensive-review
#4
REVIEW
Guerzoni Simona, Pellesi Lanfranco, Pini Luigi Alberto, Caputo Fabio
Drug interactions are one of the most common causes of side effects in polypharmacy. Alcoholics are a category of patients at high risk of pharmacological interactions, due to the presence of comorbidities, the concomitant intake of several medications and the pharmacokinetic and pharmacodynamic interferences of ethanol. However, the data available on this issue are limited. These reasons often frighten clinicians when prescribing appropriate pharmacological therapies for alcohol use disorder (AUD), where less than 15% of patients receive an appropriate treatment in the most severe forms...
April 29, 2018: Pharmacological Research: the Official Journal of the Italian Pharmacological Society
https://www.readbyqxmd.com/read/29713956/repeated-diazepam-administration-reversed-working-memory-impairments-and-glucocorticoid-alterations-in-the-prefrontal-cortex-after-short-but-not-long-alcohol-withdrawal-periods
#5
G Dominguez, N Henkous, C Pierard, C Belzung, N Mons, Daniel Beracochea
The study was designed to assess whether repeated administration of diazepam (Valium®, Roche)-a benzodiazepine exerting an agonist action on GABAA receptors-may alleviate both the short (1 week, 1W) and long-term (6 weeks, 6W) deleterious effects of alcohol withdrawal occurring after chronic alcohol consumption (6 months; 12% v/v) in C57/BL6 male mice. More pointedly, we first evidenced that 1W and 6W alcohol-withdrawn mice exhibited working memory deficits in a sequential alternation task, associated with sustained exaggerated corticosterone rise and decreased pCREB levels in the prefrontal cortex (PFC)...
April 30, 2018: Cognitive, Affective & Behavioral Neuroscience
https://www.readbyqxmd.com/read/29713452/challenges-of-the-pharmacological-management-of-benzodiazepine-withdrawal-dependence-and-discontinuation
#6
REVIEW
Dimy Fluyau, Neelambika Revadigar, Brittany E Manobianco
Background: Benzodiazepines (BZDs) are among the most prescribed sedative hypnotics and among the most misused and abused medications by patients, in parallel with opioids. It is estimated that more than 100 million Benzodiazepine (BZD) prescriptions were written in the United States in 2009. While medically useful, BZDs are potentially dangerous. The co-occurring abuse of opioids and BZD, as well as increases in BZD abuse, tolerance, dependence, and short- and long-term side effects, have prompted a worldwide discussion about the challenging aspects of medically managing the discontinuation of BZDs...
May 2018: Therapeutic Advances in Psychopharmacology
https://www.readbyqxmd.com/read/29705831/deprescribing-benzodiazepines-in-older-patients-impact-of-interventions-targeting-physicians-pharmacists-and-patients
#7
REVIEW
Brendan J Ng, David G Le Couteur, Sarah N Hilmer
Benzodiazepines (BZDs; including the related Z-drugs) are frequently targets for deprescribing; long-term use in older people is harmful and often not beneficial. BZDs can result in significant harms, including falls, fractures, cognitive impairment, car crashes and a significant financial and legal burden to society. Deprescribing BZDs is problematic due to a complex interaction of drug, patient, physician and systematic barriers, including concern about a potentially distressing but rarely fatal withdrawal syndrome...
April 28, 2018: Drugs & Aging
https://www.readbyqxmd.com/read/29701436/-abnormal-movements-and-internal-medicine-pathologies
#8
Joseph Ghika
Hyperkinesias can be revelaed by an internal medicine pathology. An acute chorea can be found in association with non ketotic hypergycemia, lupus, antiphospholipid syndrome, endocrinopathies, pregnancy or oral contraceptive initiation, or psychostimulant medication. Acute dystonic syndromes are found in association with the initiation of an old generation neuroleptic, metoclopramide, oral contraceptive and pregnancy. It should be differentiated from hyper- or hypo-calcémie tetany. Tremors are found in association with many drugs and hormones...
April 25, 2018: Revue Médicale Suisse
https://www.readbyqxmd.com/read/29697715/catatonia-in-the-medically-ill-etiology-diagnosis-and-treatment-the-academy-of-consultation-liaison-psychiatry-evidence-based-medicine-subcommittee-monograph
#9
Lex Denysenko, Nicole Sica, Thomas M Penders, Kemuel L Philbrick, Audrey Walker, Scott Shaffer, Paula Zimbrean, Oliver Freudenreich, Nicole Rex, Brendan T Carroll, Andrew Francis
BACKGROUND: Catatonia in medically ill patients is rare but often unrecognized. This monograph summarizes current knowledge on the diagnosis, epidemiology, etiology, and management of catatonia occurring in the medical setting. METHODS: PubMed searches were used to identify relevant articles from 1962 to present. RESULTS: More than 3,000 articles were obtained and reviewed for relevance, including references of articles identified by the initial search...
May 2018: Annals of Clinical Psychiatry: Official Journal of the American Academy of Clinical Psychiatrists
https://www.readbyqxmd.com/read/29671244/assessment-of-the-availability-cost-and-motivations-for-use-over-time-of-the-new-psychoactive-substances-benzodiazepines-diclazepam-flubromazepam-and-pyrazolam-in-the-uk
#10
Rachelle Abouchedid, Thea Gilks, Paul I Dargan, John R H Archer, David M Wood
INTRODUCTION: There has been increasing interest in the availability of non-prescription benzodiazepines and their sale as new psychoactive substances. We wanted to determine UK availability from Internet suppliers and motivations for use of three benzodiazepines (diclazepam, flubromazepam, and pyrazolam). METHODS: In November 2014 and March 2016, using the European Monitoring Centre for Drugs and Drug Addiction Snapshot Methodology, Internet search engines ( google...
April 18, 2018: Journal of Medical Toxicology: Official Journal of the American College of Medical Toxicology
https://www.readbyqxmd.com/read/29658502/-treatment-of-anxiety-disorders-in-alcohol-abusers
#11
Yu P Sivolap
The tendency to anxiety is a characteristic feature of alcohol abusers, and anxiety can be a symptom of alcohol withdrawal as well as comorbid disorder. The frequent comorbidity of alcohol use disorders and anxiety is due to a number of reasons including general hereditary predisposition, mutual conditioning and similar pathogenesis. Pharmacological therapy of anxiety disorders in alcohol-dependent patients is carried out on the basis of general principles of anxiety treatment and involves the use of benzodiazepines, antidepressants and, in some cases, antipsychotics as second-line medicines...
2018: Zhurnal Nevrologii i Psikhiatrii Imeni S.S. Korsakova
https://www.readbyqxmd.com/read/29642377/benzodiazepines-withdrawal-initial-outcomes-and-long-term-impact-on-falls-in-a-french-nursing-home
#12
Hervé Javelot, Anne Marquis, Emilie Antoine-Bernard, Jean Grandidier, Luisa Weiner, Thierry Javelot, Bruno Michel
Long-term use of benzodiazepines (BZDs) is known to induce tolerance and dependence, and increase the risk of falls-related injuries in older adults. We present a study carried out in a French nursing home that concerns the implementation of a BZD withdrawal program reassessed at one year. BZD deprescription was achieved by gradual cessation of doses. A secondary benefit of this program was assessed by comparing the number of falls among residents before and after withdrawal. The number of falls was recorded over a six-month period prior to the onset of withdrawal (T1) and then over a six-month period after reassessment at one year (T2)...
April 6, 2018: Pharmacy (Basel, Switzerland)
https://www.readbyqxmd.com/read/29618978/is-there-a-potential-of-misuse-for-venlafaxine-and-bupropion
#13
Fabrizio Schifano, Stefania Chiappini
Objective: Traditionally, studies on the non-medical use of pharmaceutical products have focused on controlled substances; e.g., opiates/opioids; and benzodiazepines. Although both bupropion and venlafaxine have been reported as being misused, only anecdotal reports have been made available so far. Hence, the European Monitoring Agency (EMA) Adverse Drug Reactions (ADRs), misuse/abuse/dependence and withdrawal, venlafaxine- and bupropion-related, database was here analyzed. Methods: All EMA spontaneous reports relating to venlafaxine (2005-2016) and bupropion (2003-2016) notifications were here analyzed, to provide a descriptive analysis by source, gender, age, and type of report...
2018: Frontiers in Pharmacology
https://www.readbyqxmd.com/read/29610916/should-this-patient-receive-prophylactic-medication-to-prevent-delirium-grand-rounds-discussion-from-beth-israel-deaconess-medical-center
#14
Anjala V Tess, Melissa L P Mattison, Joshua R Leo, Eileen E Reynolds
In 2015, the American Geriatrics Society released recommendations for prevention and management of postoperative delirium, based on a systematic literature review and evaluation of nonpharmacologic and pharmacologic approaches by an expert panel. The guidelines recommend an interdisciplinary focus on nonpharmacologic measures (reorientation, medication management, early mobility, nutrition, and gastointestinal motility) for prevention and consideration of this strategy for acute management. They also recommend optimizing nonopioid medication as a means to manage pain and avoiding benzodiazepines other than to treat substance withdrawal...
April 3, 2018: Annals of Internal Medicine
https://www.readbyqxmd.com/read/29605483/severe-opioid-withdrawal-precipitated-by-vivitrol%C3%A2
#15
R S Wightman, L S Nelson, J D Lee, L M Fox, S W Smith
The risk of severe precipitated opioid withdrawal (POW) is amplified when precipitated by a long-acting opioid antagonist. IM extended release naltrexone (XRNTX;Vivitrol®) is an FDA approved therapy to prevent relapse of opioid and alcohol abuse. Two cases of precipitated opioid withdrawal from XRNTX are presented that illustrate different patient reactions to POW. A 56-year-old woman developed a hypertensive emergency and required continuous intravenous vasodilator, clonidine, and intensive care monitoring after re-initiation of XRNTX following opioid relapse...
March 21, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29547622/dispositional-mindfulness-anticipation-and-abstinence-symptoms-related-to-hypnotic-dependence-among-insomniac-women-who-seek-treatment-a-cross-sectional-study
#16
Víviam Vargas Barros, Emérita Sátiro Opaleye, Marcelo Demarzo, Sarah Bowen, Daniela Fernández Curado, Helena Hachul, Ana Regina Noto
INTRODUCTION: Dispositional mindfulness can be described as the mental ability to pay attention to the present moment, non-judgmentally. There is evidence of inverse relation between dispositional mindfulness and insomnia and substance use, but as of yet, no studies evaluating the specific association between dispositional mindfulness and the components of hypnotic use disorder. OBJECTIVE: To evaluate the association between dispositional mindfulness and the components of dependence among female chronic hypnotic users...
2018: PloS One
https://www.readbyqxmd.com/read/29543325/pharmacological-interventions-for-benzodiazepine-discontinuation-in-chronic-benzodiazepine-users
#17
REVIEW
Lone Baandrup, Bjørn H Ebdrup, Jesper Ø Rasmussen, Jane Lindschou, Christian Gluud, Birte Y Glenthøj
BACKGROUND: Prolonged treatment with benzodiazepines is common practice despite clinical recommendations of short-term use. Benzodiazepines are used by approximately 4% of the general population, with increased prevalence in psychiatric populations and the elderly. After long-term use it is often difficult to discontinue benzodiazepines due to psychological and physiological dependence. This review investigated if pharmacological interventions can facilitate benzodiazepine tapering. OBJECTIVES: To assess the benefits and harms of pharmacological interventions to facilitate discontinuation of chronic benzodiazepine use...
March 15, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29516704/use-of-low-dose-dexmedetomidine-in-combination-with-opioids-and-midazolam-in-paediatric-cardiac-surgical-patients-randomized-controlled-trial
#18
Cristiana Garisto, Zaccaria Ricci, Lorenzo Tofani, Simona Benegni, Chiara Pezzella, Paola Cogo
BACKGROUND: Dexmedetomidine is a selective agonist of α2 receptors that induces hypnotic, sedative and mild analgesic effect. The aim of our study was to test the effects of dexmedetomidine in combination with opioids and benzodiazepines compared to benzodiazepine-opioids alone. METHODS: A randomized controlled trial was conducted. Patients (children >30 days and <24 months undergoing correction of complex congenital heart diseases -CHD-) were randomized to receive 0...
March 7, 2018: Minerva Anestesiologica
https://www.readbyqxmd.com/read/29491698/current-practice-patterns-in-the-management-of-alcohol-withdrawal-syndrome
#19
Yoonsun Mo, Michael C Thomas, Corey S Laskey, Natalia Shcherbakova, Megan L Bankert, Robert H Halloran
Objective: The aim of this study was to examine current practice patterns surrounding the management of alcohol withdrawal syndrome (AWS) in the Northeast region of the United States. Methods: A survey questionnaire with several treatment options related to current practice in the management of AWS was developed. All hospitals with 100 beds or more located in the Northeast region were selected, and 512 surveys were mailed to pharmacy directors of those hospitals...
March 2018: P & T: a Peer-reviewed Journal for Formulary Management
https://www.readbyqxmd.com/read/29457627/combination-pharmacotherapy-for-the-treatment-of-fibromyalgia-in-adults
#20
REVIEW
Joelle Thorpe, Bonnie Shum, R Andrew Moore, Philip J Wiffen, Ian Gilron
BACKGROUND: Fibromyalgia is a chronic widespread pain condition affecting millions of people worldwide. Current pharmacotherapies are often ineffective and poorly tolerated. Combining different agents could provide superior pain relief and possibly also fewer side effects. OBJECTIVES: To assess the efficacy, safety, and tolerability of combination pharmacotherapy compared to monotherapy or placebo, or both, for the treatment of fibromyalgia pain in adults. SEARCH METHODS: We searched CENTRAL, MEDLINE, and Embase to September 2017...
February 19, 2018: Cochrane Database of Systematic Reviews
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