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https://www.readbyqxmd.com/read/29685062/prospective-observational-evaluation-of-sedation-and-pain-management-guideline-adherence-across-new-jersey-intensive-care-units
#1
Alison Brophy, Maria Cardinale, Liza B Andrews, Justin B Kaplan, Christopher Adams, Yekaterina Opsha, Kimberly A Brandt, Deepali Dixit, Steven F Nerenberg, Julie A Saleh
BACKGROUND: The practice guidelines for the management of pain, agitation, and delirium (PAD) from the Society of Critical Care Medicine shifted from primarily focusing on the treatment of anxiety in 2002 to the treatment of pain in 2013. OBJECTIVE: This prospective, observational, multicenter study aimed to assess the degree of practice adherence to the PAD guidelines for ventilated patients in New Jersey intensive care units (ICUs). METHODS: Pharmacist investigators at 8 centers designated 4 days at least 10 days apart to evaluate all patients on mechanical ventilation...
January 1, 2018: Journal of Pharmacy Practice
https://www.readbyqxmd.com/read/29587186/role-of-%C3%AE-2-3-specific-gaba-a-receptor-isoforms-in-the-development-of-hippocampus-kindling-epileptogenesis
#2
Doodipala Samba Reddy, Ryan F Yoshimura, Gunasekaran Ramanathan, Chase Carver, Timothy B Johnstone, Derk J Hogenkamp, Kelvin W Gee
OBJECTIVE: Subunit-specific positive allosteric modulators (PAMs) of gamma-aminobutyric acid-A (GABA-A) receptors are commonly used to uncover the role of GABA-A receptor isoforms in brain function. Recently, we have designed novel PAMs selective for β2/3 -subunit containing GABA-A receptors (β2/3 -selective PAMs) that are nonbenzodiazepine site-mediated and do not show an α-subunit isoform selectivity, yet exhibit anxiolytic efficacy with reduced potential for sedation, cognitive impairment, and tolerance...
March 24, 2018: Epilepsy & Behavior: E&B
https://www.readbyqxmd.com/read/29562972/zolpidem-as-a-sleep-aid-for-military-aviators
#3
Guan Sen Kew, Brian See
INTRODUCTION: Zolpidem is a short-acting nonbenzodiazepine hypnotic that has been approved by the Republic of Singapore Air Force (RSAF) for aircrew sleep management since 2005. Prior to consuming zolpidem for operational reasons, each RSAF aircrew member is required to undergo a ground test to exclude operationally relevant adverse drug effects. This study describes the RSAF's zolpidem ground testing outcomes over a 12.5-yr period. METHODS: This is a retrospective case series of 578 RSAF aircrew members who underwent zolpidem test dosing from 1 January 2005 to 30 June 2017...
April 1, 2018: Aerospace Medicine and Human Performance
https://www.readbyqxmd.com/read/29532067/association-of-mental-health-conditions-and-treatments-with-long-term-opioid-analgesic-receipt-among-adolescents
#4
Patrick D Quinn, Kwan Hur, Zheng Chang, Eric L Scott, Erin E Krebs, Matthew J Bair, Martin E Rickert, Robert D Gibbons, Kurt Kroenke, Brian M D'Onofrio
Importance: Adults with mental health conditions are more likely than those without to receive long-term opioid therapy. Less is known about opioid therapy among adolescents, especially those with mental health conditions. Objective: To examine associations between preexisting mental health conditions and treatments and initiation of any opioid and long-term opioid therapy among adolescents. Design, Setting, and Participants: A cohort of 1 224 520 incident opioid recipients without cancer diagnoses aged 14 to 18 years at first receipt was extracted from nationwide commercial health care claims data from January 1, 2003, to December 31, 2014...
March 12, 2018: JAMA Pediatrics
https://www.readbyqxmd.com/read/29161185/medications-for-sleep-schedule-adjustments-in-athletes
#5
REVIEW
Matthew B Baird, Irfan M Asif
CONTEXT: Sleep schedule adjustments are common requirements of modern-day athletes. Many nonpharmacologic and pharmacologic strategies exist to facilitate circadian rhythm shifts to maximize alertness and performance during competition. This review summarizes the evidence for commonly used pharmacologic agents and presents recommendations for the sports medicine provider. EVIDENCE ACQUISITION: MEDLINE searches were performed using the following keywords: sleep aids, circadian rhythm adjustment, athletes and sleep, caffeine and sports, melatonin and athletes, and sleep aids and sports...
January 2018: Sports Health
https://www.readbyqxmd.com/read/29126858/age-sex-and-dose-effects-of-nonbenzodiazepine-hypnotics-on-hip-fracture-in-nursing-home-residents
#6
David D Dore, Andrew R Zullo, Vincent Mor, Yoojin Lee, Sarah D Berry
OBJECTIVE: The Food and Drug Administration recommends a reduced dose of nonbenzodiazepine hypnotics in women, yet little is known about the age-, sex-, and dose-specific effects of these drugs on risk of hip fracture, especially among nursing home (NH) residents. We estimated the age-, sex-, and dose-specific effects of nonbenzodiazepine hypnotics on the rate of hip fracture among NH residents. DESIGN AND SETTING: Case-crossover study in US NHs. PARTICIPANTS: A total of 691 women and 179 men with hip fracture sampled from all US long-stay NH residents...
November 7, 2017: Journal of the American Medical Directors Association
https://www.readbyqxmd.com/read/29089011/long-term-use-of-benzodiazepines-and-nonbenzodiazepine-hypnotics-1999-2014
#7
Christopher N Kaufmann, Adam P Spira, Colin A Depp, Ramin Mojtabai
OBJECTIVE: Clinical guidelines suggest that benzodiazepines (BZDs) and non-BZD hypnotics (NBHs) be used on a short-term basis. The authors examined trends in long-term BZD and NBH use from 1999 to 2014. METHODS: Data included 82,091 respondents in the 1999-2014 waves of the National Health and Nutrition Examination Survey (NHANES). NHANES recorded medications used in the past 30 days on the basis of prescription bottles, and participants reported use duration. BZD and NBH use were categorized as short, medium, and long term, and time trends in use were assessed...
February 1, 2018: Psychiatric Services: a Journal of the American Psychiatric Association
https://www.readbyqxmd.com/read/28845958/sleep-disorders-insomnia
#8
REVIEW
Deepa Burman
Insomnia is the most common type of sleep disorder in the family medicine population. It is defined as a persistent difficulty initiating or maintaining sleep, or a report of nonrestorative sleep, accompanied by related daytime impairment. Insomnia is a significant public health problem because of its high prevalence and management challenges. There is increasing evidence of a strong association between insomnia and various medical and psychiatric comorbidities. Diagnosis of insomnia and treatment planning rely on a thorough sleep history to address contributing and precipitating factors as well as maladaptive behaviors resulting in poor sleep...
September 2017: FP Essentials
https://www.readbyqxmd.com/read/28562400/prevalence-of-and-factors-related-to-prescription-opioids-benzodiazepines-and-hypnotics-among-medicare-home-health-recipients
#9
Brandi P Cotton, Matthew C Lohman, Jessica M Brooks, Karen L Whiteman, Yuhua Bao, Rebecca L Greenberg, Martha L Bruce
High rates of controlled prescription drugs are associated with cognitive impairment, falls, and misuse and dependence. Little is known about the prevalence of these medications among older adults receiving home healthcare. The purpose of this study was to determine the frequency of, and the factors related to, opioid analgesics, benzodiazepines (BNZ), and nonbenzodiazepine (NBNZH) hypnotics among a large sample of older adults entering home healthcare services. The data came from administrative records of 133 Certified Home healthcare Agencies located across 32 states...
June 2017: Home Healthcare Now
https://www.readbyqxmd.com/read/28467623/opioids-and-other-central-nervous-system-active-polypharmacy-in-older-adults-in-the-united-states
#10
Lauren B Gerlach, Mark Olfson, Helen C Kales, Donovan T Maust
OBJECTIVES: To determine patterns of and trends in contributions to central nervous system (CNS) polypharmacy, defined by the Beers Criteria as three or more CNS-active medications of each medication class, of adults aged 65 and older seen in U.S. outpatient medical practices. DESIGN: National Ambulatory Medical Care Survey (2004-2013). SETTING: U.S. outpatient medical care. PARTICIPANTS: Visits by older adults to outpatient physicians (N = 97,910)...
September 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28270270/a-review-of-suvorexant-doxepin-ramelteon-and-tasimelteon-for-the-treatment-of-insomnia-in-geriatric-patients
#11
REVIEW
Chelsey Edmonds, Michael Swanoski
Geriatric patients often experience insomnia because of physiological and neurological changes that occur during the aging process. Use of benzodiazepines, nonbenzodiazepine hypnotics, and diphenhydramine for the treatment of insomnia pose an increased risk of cognitive impairment, falls, and fractures in this patient population. Therapeutic alternatives approved by the Food and Drug Administration include suvorexant, doxepin, ramelteon, and tasimelteon, which have shown efficacy and safety in various studies...
March 1, 2017: Consultant Pharmacist: the Journal of the American Society of Consultant Pharmacists
https://www.readbyqxmd.com/read/28225161/treatment-of-experimental-status-epilepticus-with-synergistic-drug-combinations
#12
Jerome Niquet, Roger Baldwin, Lucie Suchomelova, Lucille Lumley, Roland Eavey, Claude G Wasterlain
During status epilepticus (SE), synaptic γ-aminobutyric acid A receptors (GABAA Rs) become internalized and inactive, whereas spare N-methyl-d-aspartate receptors (NMDARs) assemble, move to the membrane, and become synaptically active. When treatment of SE is delayed, the number of synaptic GABAA Rs is drastically reduced, and a GABAA agonist cannot fully restore inhibition. We used a combination of low-dose diazepam (to stimulate the remaining GABAA Rs), ketamine (to mitigate the effect of the NMDAR increase), and valproate (to enhance inhibition at a nonbenzodiazepine site) to treat seizures in a model of severe cholinergic SE...
April 2017: Epilepsia
https://www.readbyqxmd.com/read/28217600/primary-care-hypnotic-and-anxiolytic-prescription-reviewing-prescribing-practice-over-8-years
#13
Lloyd D Hughes, Neil Raitt, Muhammed Awais Riaz, Sarah-Jane Baldwin, Kay Erskine, Gail Graham
INTRODUCTION: Over the last few years, hypnotic and anxiolytic medications have had their clinical efficacy questioned in the context of concerns regarding dependence, tolerance alongside other adverse effects. It remains unclear how these concerns have impacted clinical prescribing practice. MATERIALS AND METHODS: This is a study reviewing community-dispensed prescribing data for patients on the East Practice Medical Center list in Arbroath, Scotland, in 2007, 2011 and 2015...
July 2016: Journal of Family Medicine and Primary Care
https://www.readbyqxmd.com/read/28061970/nitric-oxide-and-anxiety
#14
REVIEW
K Gulati, N Rai, A Ray
Anxiety is a common neuropsychiatric disorder which affects both physical and mental health. Complex neurobiological mechanisms are involved in the genesis of anxiety, and the drugs used to date, though effective, are not free from shortcomings. Conventional agents like the classical benzodiazepines and the atypical nonbenzodiazepine agents like buspirone have their own limitations. There is thus need to explore newer neurochemical pathways to develop efficacious and safer drugs for the disorder. Nitric oxide (NO) is a unique neuromodulator substance, with the ability to influence and modulate several other conventional messengers which play an important role in anxiety...
2017: Vitamins and Hormones
https://www.readbyqxmd.com/read/27984243/chronic-obstructive-pulmonary-disease-and-sleep-related-disorders
#15
REVIEW
Sheila C Tsai
PURPOSE OF REVIEW: Sleep related disorders are common and under-recognized in the chronic obstructive pulmonary disease (COPD) population. COPD symptoms can disrupt sleep. Similarly, sleep disorders can affect COPD. This review highlights the common sleep disorders seen in COPD patients, their impact, and potential management. RECENT FINDINGS: Treatment of sleep disorders may improve quality of life in COPD patients. Optimizing inhaler therapy improves sleep quality...
March 2017: Current Opinion in Pulmonary Medicine
https://www.readbyqxmd.com/read/27984229/sedation-after-cardiac-surgery-is-one-drug-better-than-another
#16
REVIEW
Hong Liu, Fuhai Ji, Ke Peng, Richard L Applegate, Neal Fleming
The classic high-dose narcotic-based cardiac anesthetic has been modified to facilitate a fast-track, rapid recovery in the intensive care unit (ICU). Postoperative sedation is consequently now an essential component in recovery of the patient undergoing cardiac surgery. It must facilitate the patient's unawareness of the environment as well as reduce the discomfort and anxiety caused by surgery, intubation, mechanical ventilation, suction, and physiotherapy. Benzodiazepines seem well suited for this role, but propofol, opioids, and dexmedetomidine are among other agents commonly used for sedation in the ICU...
April 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27814838/benzodiazepine-use-in-older-adults-dangers-management-and-alternative-therapies
#17
REVIEW
Matej Markota, Teresa A Rummans, John Michael Bostwick, Maria I Lapid
Several major medical and psychiatric organizations, including the American Geriatrics Society, advise against using benzodiazepines or nonbenzodiazepine hypnotics in older adults. Despite these recommendations, benzodiazepines continue to be massively prescribed to a group with the highest risk of serious adverse effects from these medications. This article summarizes legitimate reasons for prescribing benzodiazepines in the elderly, serious associated risks of prescribing them, particularly when not indicated, barriers physicians encounter in changing their prescription patterns, and evidence-based strategies on how to discontinue benzodiazepines in older patients...
November 2016: Mayo Clinic Proceedings
https://www.readbyqxmd.com/read/27784413/eszopiclone-and-zolpidem-do-not-affect-the-prevalence-of-the-low-arousal-threshold-phenotype
#18
Patrick R Smith, Karen L Sheikh, Camille Costan-Toth, Derek Forsthoefel, Edward Bridges, Teotimo F Andrada, Aaron B Holley
STUDY OBJECTIVES: We sought to determine whether non benzodiazepine sedative hypnotics (NBSH) reduce the occurrence of the low arousal threshold (LAT) phenotype. METHODS: Consecutive patients with suspected obstructive sleep apnea (OSA) referred for polysomnography (PSG) had demographic and PSG data abstracted. LAT was estimated using PSG criteria. After adjusting for pretest probability (PTP) for OSA, we calculated the effect that premedication with NBSHs has on LAT prevalence...
January 15, 2017: Journal of Clinical Sleep Medicine: JCSM: Official Publication of the American Academy of Sleep Medicine
https://www.readbyqxmd.com/read/27751669/review-of-safety-and-efficacy-of-sleep-medicines-in-older-adults
#19
REVIEW
Jennifer L Schroeck, James Ford, Erin L Conway, Kari E Kurtzhalts, Megan E Gee, Krista A Vollmer, Kari A Mergenhagen
PURPOSE: Insomnia is problematic for older adults. After behavioral modifications fail to show adequate response, pharmacologic options are used. The pharmacokinetics of agents used to treat insomnia may be altered. This review focuses on the safety and efficacy of medications used to treat insomnia. METHODS: A literature search of Medline, PubMed, and Embase was conducted (January 1966-June 2016). It included systematic reviews, randomized controlled trials, observational studies, and case series that had an emphasis on insomnia in an older population...
November 2016: Clinical Therapeutics
https://www.readbyqxmd.com/read/27672456/reversal-of-a-suspected-paradoxical-reaction-to-zopiclone-with-flumazenil
#20
Zarah Jordahn, Cheme Andersen, Anne Marie Roust Aaberg, Frank Christian Pott
We describe the care for an elderly woman who was admitted to the intensive care unit (ICU) to receive noninvasive ventilation for acute exacerbation of chronic obstructive pulmonary disease. After administration of the sleeping pill zopiclone, a nonbenzodiazepine receptor agonist (NBRA), the patient became agitated and was confused, a possible paradoxical reaction to benzodiazepines. These symptoms were immediately resolved after treatment with flumazenil, usually used to reverse the adverse effects of benzodiazepines or NBRAs and to reverse paradoxical reactions to benzodiazepines...
2016: Case Reports in Critical Care
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