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Youngsin Jung, Erik K St Louis
REM sleep behavior disorder (RBD) is a common parasomnia disorder affecting between 1 and 7 % of community-dwelling adults, most frequently older adults. RBD is characterized by nocturnal complex motor behavior and polysomnographic REM sleep without atonia. RBD is strongly associated with synucleinopathy neurodegeneration. The approach to RBD management is currently twofold: symptomatic treatment to prevent injury and prognostic counseling and longitudinal follow-up surveillance for phenoconversion toward overt neurodegenerative disorders...
November 2016: Current Treatment Options in Neurology
Huimin Lin, Samuel T H Chew
An 85-year-old female with chronic kidney disease and newly acquired seizures on oral phenytoin received intravenous ertapenem 500 mg once daily for a urinary tract infection and bacteraemia involving extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli. After three ertapenem doses, she developed seizures which self-aborted. Corrected phenytoin level was sub-therapeutic initially, but became therapeutic following a phenytoin dose increase. On Day 14 of ertapenem, the patient suffered another episode of seizure...
December 2015: Drug Saf Case Rep
Frank G A Jansman, Heleen A Crommelin, Freek J A H van Hout, Jan Meulenbelt
CONTEXT: Clozapine is used for decennia for the treatment of schizophrenia. Agranulocytosis, diabetic ketoacidosis, gastrointestinal hypomotility, and myocarditis are well-known adverse effects of clozapine, which are sometimes life threatening. Here we report a case of rhabdomyolysis upon an acute overdose of clozapine. CASE: A male patient, 36 years, with elevated creatinine kinase levels (9899 U/l), developed rhabdomyolysis afterafter admission to the emergency department...
December 2015: Drug Saf Case Rep
Stefan E Knapen, Rixt F Riemersma-van der Lek, Bartholomeus C M Haarman, Robert A Schoevers
Disruption of the biological rhythm in patients with bipolar disorder is a known risk factor for a switch in mood. This case study describes how modern techniques using ambulatory assessment of sleep parameters can help in signalling a mood switch and start early treatment. We studied a 40-year-old woman with bipolar disorder experiencing a life event while wearing an actigraph to measure sleep-wake parameters. The night after the life event the woman had sleep later and shorter sleep duration. Adequate response of both the woman and the treating psychiatrist resulted in two normal nights with the use of 1 mg lorazepam, possibly preventing further mood disturbances...
October 13, 2016: BMJ Case Reports
Soumitra Sen, Philip Grgurich, Amanda Tulolo, Andrew Smith-Freedman, Yuxiu Lei, Anthony Gray, James Dargin
BACKGROUND: There are limited data on the efficacy of symptom-triggered therapy for alcohol withdrawal syndrome (AWS) in the intensive care unit (ICU). OBJECTIVE: To evaluate the safety and efficacy of a symptom-triggered benzodiazepine protocol utilizing Riker Sedation Agitation Scale (SAS) scoring for the treatment of AWS in the ICU. METHODS: We performed a before-and-after study in a medical ICU. A protocol incorporating SAS scoring and symptom-triggered benzodiazepine dosing was implemented in place of a protocol that utilized the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) scale and fixed benzodiazepine dosing...
October 12, 2016: Annals of Pharmacotherapy
Francesco Brigo, Nicola Luigi Bragazzi, Susanna Bacigaluppi, Raffaele Nardone, Eugen Trinka
BACKGROUND: Some guidelines or expert consensus indicate that intravenous (IV) lorazepam (LZP) is preferable to IV diazepam (DZP) for initial treatment of convulsive status epilepticus (SE). We aimed to critically assess all the available data on efficacy and tolerability of IV LZP compared with IV DZP as first-line treatment of convulsive SE. METHODS: Systematic search of the literature (MEDLINE, CENTRAL, EMBASE, to identify randomized controlled trials (RCTs) comparing IV LZP versus IV DZP used as first-line treatment for convulsive SE (generalized or focal)...
October 9, 2016: Epilepsy & Behavior: E&B
Takayuki Komatsu, Tomohisa Nomura, Hiroki Takami, So Sakamoto, Keiko Mizuno, Hajime Sekii, Kotaro Hatta, Manabu Sugita
A 42-year-old Japanese woman with a 10-year history of schizophrenia was admitted due to a disturbance in consciousness that met the diagnostic criteria for both neuroleptic malignant syndrome (NMS) and malignant catatonia. Despite systemic supportive treatments, the catatonic symptoms preceding autonomic symptoms persisted. The symptoms improved after lorazepam administration, leading to a retrospective diagnosis of malignant catatonia. Catatonia is thought to be caused by a dysfunction of ganmma-aminobutyric acid type A receptors in the cortico-cortical networks of the frontal lobes, which causes hypoactivity of the dopaminergic transmission in the subcortical areas...
2016: Internal Medicine
Jaspinder Kaur, Dileep Kumar, Mostafa Alfishawy, Ricardo Lopez, Issac Sachmechi
Paliperidone, an active metabolite of risperidone, is a new atypical antipsychotic agent. Syndrome of inappropriate antidiuretic hormone (SIADH), neuroleptic malignant syndrome (NMS), and rhabdomyolysis are the uncommon side effects of psychotropic drugs. We report a case of 35-year-old male with schizoaffective disorder who was admitted for acute-on-chronic exacerbation of his psychotic disorder for which intramuscular paliperidone 234 mg injection was given. Two days later, the patient developed hyponatremic seizures secondary to SIADH which was treated with hypertonic saline...
2016: Case Reports in Critical Care
Gayaprasad Upadhyay, Sarvesh Khoshla, Ramoji Kosuru, Sanjay Singh
OBJECTIVE: The current study was designed to explore anxiolytic, antidepressant, and antistress actions of Cinnamomum tamala (CT) leaves (aqueous extract) in rats. MATERIALS AND METHODS: Behavioral procedures of anxiety, depression, and stress were assessed in rats. CT (100, 200, and 400 mg/kg) was given once a daily for 7 days via oral route and the efficacy was matched by those elicited by lorazepam (1 mg/kg, p.o.), imipramine (10 mg/kg, p.o.), and Withania somnifera (100 mg/kg, p...
September 2016: Indian Journal of Pharmacology
David Franklin Niedrig, Liesa Hoppe, Sarah Mächler, Heike Russmann, Stefan Russmann
OBJECTIVE: Benzodiazepines and "Z-drug" GABA-receptor modulators (BDZ) are among the most frequently used drugs in hospitals. Adverse drug events (ADE) associated with BDZ can be the result of preventable medication errors (ME) related to dosing, drug interactions and comorbidities. The present study evaluated inpatient use of BDZ and related ME and ADE. METHODS: We conducted an observational study within a pharmacoepidemiological database derived from the clinical information system of a tertiary care hospital...
2016: PloS One
David J Gagnon, Gabriel V Fontaine, Kathryn E Smith, Richard R Riker, Russell R Miller, Patricia A Lerwick, F L Lucas, John T Dziodzio, Kristen C Sihler, Gilles L Fraser
PURPOSE: The purpose was to describe the use of valproate therapy for agitation in critically ill patients, examine its safety, and describe its relationship with agitation and delirium. MATERIALS AND METHODS: This retrospective cohort study evaluated critically ill adults treated with valproate for agitation from December 2012 through February 2015. Information on valproate prescribing practices and safety was collected. Incidence of agitation, delirium, and concomitant psychoactive medication use was compared between valproate day 1 and valproate day 3...
September 11, 2016: Journal of Critical Care
Kambiz Soltaninejad, Mohammad Karimi, Alireza Nateghi, Bahram Daraei
A high performance liquid chromatographic method with ultra violet detection for simultaneous analysis of six benzodiazepines (BZDs) (chlordiazepoxide, diazepam, clonazepam, midazolam , flurazpam, and lorazepam) has been developed for forensic screening of adulterated non-alcoholic drinks. Samples were analyzed after a simple procedure for preparation using pH adjustment and filtering. Isocratic elution on a C18 column (250mm × 4.6 mm, 5μm) in the temperature 45ºC with a mobile phase consisting of 15mM phosphate buffer: methanol (50:50 v/v) at a flow rate 1...
2016: Iranian Journal of Pharmaceutical Research: IJPR
Elham Bazmi, Behnam Behnoush, Maryam Akhgari, Leila Bahmanabadi
OBJECTIVE: Benzodiazepines are frequently screened drugs in emergency toxicology, drugs of abuse testing, and in forensic cases. As the variations of benzodiazepines concentrations in biological samples during bleeding, postmortem changes, and redistribution could be biasing forensic medicine examinations, hence selecting a suitable sample and a validated accurate method is essential for the quantitative analysis of these main drug categories. The aim of this study was to develop a valid method for the determination of four benzodiazepines (flurazepam, lorazepam, alprazolam, and diazepam) in vitreous humor using liquid-liquid extraction and high-performance liquid chromatography...
2016: SAGE Open Medicine
Herjan Mijderwijk, Markus Klimek, Stefan van Beek, Ron H N van Schaik, Hugo J Duivenvoorden, Robert Jan Stolker
BACKGROUND: Lorazepam is used as premedication for its anxiolytic properties. The UGT2B15 genotype is of importance for the metabolism of lorazepam. The clinical effect of genetic polymorphisms in UGT2B15 genotype on the treatment of anxiety levels in same-day surgery patients receiving lorazepam, however, is unknown. METHODS: Three hundred ninety-eight same-day surgery patients of mixed sex (from a previous double-blinded randomized controlled trial who were assigned to either lorazepam [n = 198] or placebo [n = 200]) were assessed for the UGT2B15*2 variant allele...
September 12, 2016: Anesthesia and Analgesia
Emily N Schneider, Regan Riley, Eve Espey, Shiraz I Mishra, Rameet H Singh
OBJECTIVES: To evaluate whether inhaled nitrous oxide with oxygen (N2O/O2) is associated with less pain compared to oral sedation for pain management during in-office hysteroscopic sterilization. STUDY DESIGN: This double blinded randomized controlled trial enrolled women undergoing in-office hysteroscopic sterilization. All participants received pre-procedure intramuscular ketorolac and a standardized paracervical block. The intervention group also received N2O/O2 via a nasal mask titrated to a maximum 70%:30% mixture by a nurse during the procedure and placebo pills pre-procedure and the active control group received inhaled O2 during the procedure and 5/325 mg hydrocodone/acetaminophen and 1 mg lorazepam pre-procedure...
September 9, 2016: Contraception
Weixuan Yao, Zhefeng Fan, Suling Zhang
A poly(N-vinylcarbazole-co-divinylbenzene) (NVC/DVB) monolithic column was successfully prepared in a silanized capillary for microextraction of six benzodiazepines (BZPs) in complex samples. The polymerization was optimized primarily by changing the ratio of porogen content. The optimized polymer monolith had a homogeneous and continuous column bed, good permeability and mechanical stability. Poly(NVC/DVB) had good affinity to BZPs because of its through-pore structure and strong π-π stacking interactions derived from the rich benzene functional groups in the polymer...
September 23, 2016: Journal of Chromatography. A
Murray G Tucker, Sebastian Kekulawala, Michelle Kent, Sam Mostafa, Richard Harvey
BACKGROUND: The high prevalence of comorbid illicit drug use in persons with chronic psychotic illness represents a strong determinant of psychotic relapse and rehospitalization. Epidemiological studies indicate changing patterns of illicit drug use in Australia, which are concerning because of increased use of crystal methamphetamine, also known as "ice." An important complication of habitual use of crystal methamphetamine is the development of a dose-dependent acute psychotic reaction...
2016: Journal of Medical Case Reports
Diego Lozano-Soldevilla, Niels Ter Huurne, Robert Oostenveld
Neuronal oscillations support cognitive processing. Modern views suggest that neuronal oscillations do not only reflect coordinated activity in spatially distributed networks, but also that there is interaction between the oscillations at different frequencies. For example, invasive recordings in animals and humans have found that the amplitude of fast oscillations (>40 Hz) occur non-uniformly within the phase of slower oscillations, forming the so-called cross-frequency coupling (CFC). However, the CFC patterns might be influenced by features in the signal that do not relate to underlying physiological interactions...
2016: Frontiers in Computational Neuroscience
Toni M Rudisill, Motao Zhu, George A Kelley, Courtney Pilkerton, Brandon R Rudisill
OBJECTIVES: Driving under the influence of prescription and over-the-counter medication is a growing public health concern. A systematic review of the literature was performed to investigate which specific medications were associated with increased risk of motor vehicle collision (MVC). METHODS: The a priori inclusion criteria were: (1) studies published from English-language sources on or after January 1, 1960, (2) licensed drivers 15 years of age and older, (3) peer-reviewed publications, master's theses, doctoral dissertations, and conference papers, (4) studies limited to randomized control trials, cohort studies, case-control studies, or case-control type studies (5) outcome measure reported for at least one specific medication, (6) outcome measure reported as the odds or risk of a motor vehicle collision...
November 2016: Accident; Analysis and Prevention
Dani C Mata
Forensic laboratories are challenged with backlogs that produce turnaround times that vary from days to months. Therefore, drug stability is important for interpretation in both antemortem (blood and urine) and postmortem (blood, brain, liver, stomach contents) cases. In this study, 23 benzodiazepines (2-hydroxyethylflurazepam, 7-aminoclonazepam, 7-aminoflunitrazepam, α-hydroxyalprazolam, α-hydroxytriazolam, alprazolam, bromazepam, chlordiazepoxide, clonazepam, demoxepam, desalkylflurazepam, diazepam, estazolam, flunitrazepam, flurazepam, lorazepam, midazolam, nitrazepam, nordiazepam, oxazepam, phenazepam, temazepam and triazolam) and three sedative hypnotics (zaleplon, zopiclone and zolpidem) were spiked into the six matrices at two different concentrations for each drug...
October 2016: Journal of Analytical Toxicology
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