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https://www.readbyqxmd.com/read/28270270/a-review-of-suvorexant-doxepin-ramelteon-and-tasimelteon-for-the-treatment-of-insomnia-in-geriatric-patients
#1
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
#2
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
#3
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
#4
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
#5
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
#6
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
#7
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
#8
Patrick R Smith, Karen L Sheikh, Camille Costan-Toth, Derek Forsthoefel, Edward Bridges, Teotimo F Andrada, Ltc 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
#9
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
#10
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
https://www.readbyqxmd.com/read/27599749/a-closer-look-at-the-2015-beers-criteria
#11
Rebecca L Salbu, Judith Feuer
The Beers Criteria identifies potentially inappropriate medications for patients who are 65 years of age and older. Initially published in 1991, the criteria have been updated multiple times, most recently in 2015. The Beers Criteria is a tool designed to alert health-care providers to the potential harms of specific medications so they may better tailor therapeutic regimens for their elderly patients. The expert panel of the 2015 update made changes to a number of previous recommendations and provided 2 new tables on select drug interactions and select medications requiring renal dose adjustments...
September 6, 2016: Journal of Pharmacy Practice
https://www.readbyqxmd.com/read/27473952/pharmacological-interventions-to-improve-sleep-in-hospitalised-adults-a-systematic-review
#12
Salmaan Kanji, Alexandru Mera, Brian Hutton, Lisa Burry, Erin Rosenberg, Erika MacDonald, Vanessa Luks
OBJECTIVES: Patients often suffer from disturbed sleep in hospital. Poor-quality sleep in hospitalised patients has been associated with significant morbidity and pharmacological sleep aids are often prescribed. The objective of this systematic review is to evaluate the comparative efficacy and safety of pharmacological interventions used for sleep in hospitalised patients. SETTING/PARTICIPANTS: We searched MEDLINE, Embase, the Cochrane database and grey literature for prospective studies that evaluated sleep in hospitalised adults after a pharmacological intervention...
July 29, 2016: BMJ Open
https://www.readbyqxmd.com/read/27471419/novel-class-of-medications-orexin-receptor-antagonists-in-the-treatment-of-insomnia-critical-appraisal-of-suvorexant
#13
REVIEW
Jessica L Norman, Sarah L Anderson
Insomnia, a highly prevalent disorder, can be detrimental to patients' overall health and worsen existing comorbidities. Patients may have acute episodes of insomnia related to a traumatic event, but more commonly insomnia occurs chronically. While proper sleep hygiene and behavioral therapy play important roles in the nonpharmacologic management of short-term and chronic insomnia, medications may also be required. Historically, insomnia has been treated with agents such as benzodiazepines, nonbenzodiazepine receptor agonists, and melatonin agonists...
2016: Nature and Science of Sleep
https://www.readbyqxmd.com/read/27459656/the-risk-of-pneumonia-in-older-adults-using-nonbenzodiazepine-hypnotics
#14
Stephen Jung, Michele M Spence, Nina M Escasa, Eric A Lee, Rita L Hui, Nancy E Gibbs
BACKGROUND: Previous studies have shown an increased risk of pneumonia with benzodiazepines (BZD) and an increased risk of any infection with non-BZD hypnotics, but no analysis has specifically investigated the risk of pneumonia with non-BZD hypnotic use. OBJECTIVE: To evaluate the risk of pneumonia associated with non-BZD hypnotic use in the elderly. METHODS: This was a retrospective case-control study of members aged 65 years and older enrolled in an integrated health care system...
August 2016: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/27136278/pharmacologic-treatment-of-insomnia-disorder-an-evidence-report-for-a-clinical-practice-guideline-by-the-american-college-of-physicians
#15
Timothy J Wilt, Roderick MacDonald, Michelle Brasure, Carin M Olson, Maureen Carlyle, Erika Fuchs, Imran S Khawaja, Susan Diem, Erin Koffel, Jeannine Ouellette, Mary Butler, Robert L Kane
BACKGROUND: Pharmacologic interventions are often prescribed for insomnia disorder. PURPOSE: To assess the benefits, harms, and comparative effectiveness of pharmacologic treatments for adults with insomnia disorder. DATA SOURCES: Several electronic databases (2004-September 2015), reference lists, and U.S. Food and Drug Administration (FDA) documents. STUDY SELECTION: 35 randomized, controlled trials of at least 4 weeks' duration that evaluated pharmacotherapies available in the United States and that reported global or sleep outcomes; 11 long-term observational studies that reported harm information; FDA review data for nonbenzodiazepine hypnotics and orexin receptor antagonists; and product labels for all agents...
July 19, 2016: Annals of Internal Medicine
https://www.readbyqxmd.com/read/26943470/nonbenzodiazepine-sedative-hypnotics-and-risk-of-fall-related-injury
#16
Sarah E Tom, Emerson M Wickwire, Yujin Park, Jennifer S Albrecht
STUDY OBJECTIVES: The objective of this study was to test the hypothesis that use of zolpidem, eszopiclone, and zaleplon would be associated with increased risk of traumatic brain injury (TBI) and hip fracture. METHODS: We conducted a case-crossover study on a 5% random sample of Medicare beneficiaries age 65 y or older hospitalized with either TBI (n = 15,031) or hip fracture (n = 37,833) during 2007-2009. Use of zolpidem, eszopiclone, or zaleplon during the 30-day period prior to injury hospitalization was compared to use during four control periods at 3, 6, 9, and 12 mo prior to injury...
May 1, 2016: Sleep
https://www.readbyqxmd.com/read/26913957/favouring-inhibitory-synaptic-drive-mediated-by-gaba-a-receptors-in-the-basolateral-nucleus-of-the-amygdala-efficiently-reduces-pain-symptoms-in-neuropathic-mice
#17
Alexandre Zeitler, Nisrine Kamoun, Stéphanie Goyon, Jérôme Wahis, Alexandre Charlet, Pierrick Poisbeau, Pascal Darbon
Pain is an emotion and neuropathic pain symptoms are modulated by supraspinal structures such as the amygdala. The central nucleus of the amygdala is often called the 'nociceptive amygdala', but little is known about the role of the basolateral amygdala. Here, we monitored the mechanical nociceptive thresholds in a mouse model of neuropathic pain and infused modulators of the glutamate/GABAergic transmission in the basolateral nucleus of the amygdala (BLA) via chronically-implanted cannulas. We found that an N-methyl-D-aspartate-type glutamate receptor antagonist (MK-801) exerted a potent antiallodynic effect, whereas a transient allodynia was induced after perfusion of bicuculline, a GABA(A) receptor antagonist...
April 2016: European Journal of Neuroscience
https://www.readbyqxmd.com/read/26897427/pain-and-agitation-management-in-critically-ill-patients
#18
REVIEW
Julie Stephens, Michael Wright
Pain and agitation may be difficult to assess in a critically ill patient. Pain is best assessed by self-reporting pain scales; but in patients who are unable to communicate, behavioral pain scales seem to have benefit. Patients' sedation level should be assessed each shift and preferably by a validated ICU tool, such as the RASS or SAS scale. Pain is most appropriately treated with the use of opiates, and careful consideration should be given to the pharmacokinetic and pharmacodynamic properties of various analgesics to determine the optimal agent for each individual patient...
March 2016: Nursing Clinics of North America
https://www.readbyqxmd.com/read/26729104/pharmacotherapy-treatment-options-for-insomnia-a-primer-for-clinicians
#19
REVIEW
Gregory M Asnis, Manju Thomas, Margaret A Henderson
Insomnia is a prevalent disorder with deleterious effects such as decreased quality of life, and a predisposition to a number of psychiatric disorders. Fortunately, numerous approved hypnotic treatments are available. This report reviews the state of the art of pharmacotherapy with a reference to cognitive behavioral therapy for insomnia (CBT-I) as well. It provides the clinician with a guide to all the Food and Drug Administration (FDA) approved hypnotics (benzodiazepines, nonbenzodiazepines, ramelteon, low dose sinequan, and suvorexant) including potential side effects...
December 30, 2015: International Journal of Molecular Sciences
https://www.readbyqxmd.com/read/26715227/zopiclone-increases-the-arousal-threshold-without-impairing-genioglossus-activity-in-obstructive-sleep-apnea
#20
RANDOMIZED CONTROLLED TRIAL
Sophie G Carter, Michael S Berger, Jayne C Carberry, Lynne E Bilston, Jane E Butler, Benjamin K Y Tong, Rodrigo T Martins, Lauren P Fisher, David K McKenzie, Ronald R Grunstein, Danny J Eckert
STUDY OBJECTIVES: To determine the effects of the nonbenzodiazepine sedative zopiclone on the threshold to arousal with increasing respiratory effort and genioglossus muscle activity and to examine potential physiological factors mediating disparate effects of zopiclone on obstructive sleep apnea (OSA) severity between patients. METHODS: Twelve patients with OSA (apnea-hypopnea index = 41 ± 8 events/h) were studied during 2 single night sleep studies conducted approximately 1 w apart after receiving 7...
April 1, 2016: Sleep
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