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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...
October 14, 2016: Clinical Therapeutics
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
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
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...
2016: BMJ Open
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
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
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
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...
2016: Sleep
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
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
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
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...
2016: Sleep
Seung Whan Doo, Jae Heon Kim, Won Jae Yang, Yun Seob Song
OBJECTIVES: The aim of the present study was to determine whether administration of zolpidem, a nonbenzodiazepine sedative-hypnotic agent, at night would improve the nocturia unresponsive to alpha-blocker monotherapy in men with lower urinary tract symptoms (LUTS). METHODS: This was a prospective observational study comprised of 39 men aged 50 years and older. The study inclusion criteria were age more than 50 years, and nocturia twice or more per night after taking alpha-blockers for more than 8 weeks...
September 2013: Lower Urinary Tract Symptoms
Sylvia A Duraski
In rehabilitation, nurses are the first team members to note or be told when a patient is having a positive or negative response to a medication. In brain injury medicine, medications are often used to augment cognitive or physical rehabilitation by increasing alertness, attention, focus, concentration, improving sleep, decreasing agitation, or easing spasticity and rigidity. Rehabilitation nurses not only should be aware of how medications work but also how medications may work differently in a chronically ill or disabled population...
September 24, 2015: Rehabilitation Nursing: the Official Journal of the Association of Rehabilitation Nurses
Andrew D Krystal
Research into the sleep-wake cycle has provided new treatment targets for patients with insomnia as well as a better understanding of how medications affect sleep processes. Current insomnia medications, including benzodiazepines and nonbenzodiazepines, focus on enhancing sleep-promoting systems through broad antagonism of GABA. Other medications that promote sleep by blocking wake-promoting systems include antidepressants, antipsychotics, and antihistamines, but adverse effects and nonspecific therapeutic effects limit their use...
August 2015: Journal of Clinical Psychiatry
Seockhoon Chung, Soyoung Youn, Kikyoung Yi, Boram Park, Suyeon Lee
STUDY OBJECTIVES: Taking hypnotic agents 30 min before bedtime is the usual suggested administration time, but some patients report dissatisfaction with their sleeping pills. We investigated whether the timing of sleeping pill administration influences patient subjective satisfaction with these drugs. METHODS: One hundred twelve patients with primary insomnia currently taking benzodiazepine or nonbenzodiazepine gamma-aminobutyric acid (GABA) agonists as sleeping pills were selected...
January 2016: Journal of Clinical Sleep Medicine: JCSM: Official Publication of the American Academy of Sleep Medicine
T L Stockham, T P Rohrig
Zolpidem, zopiclone, and zaleplon are commonly referred to as the "Z-drugs." The Z-drugs are nonbenzodiazepine hypnotics indicated for the short-term treatment of insomnia. Since becoming widely prescribed as sleep aids in the United States, they are increasingly being detected in a variety of forensic specimens. We present a comprehensive overview of the basic chemistry, pharmacodynamics, and pharmacokinetics of zolpidem, zopiclone, and zaleplon, including their interaction with other prescription drugs and ethanol, findings in drug-facilitated sexual assault (DFSA) casework, and methods of analysis...
January 2010: Forensic Science Review
Wei-Sheng Chung, Ching-Yuan Lai, Cheng-Li Lin, Chia-Hung Kao
Insomnia is prevalent in patients with chronic obstructive pulmonary disease (COPD).We conducted a population-based case-control study to evaluate the effects of hypnotics on the risk of adverse respiratory events in patients with COPD.The case-control study was investigated using data retrieved from the Taiwan National Health Insurance Research Database. Patients with newly diagnosed adverse respiratory events (pneumonia, COPD with acute exacerbation, acute respiratory failure, and cardiopulmonary arrest) were included in the case group...
July 2015: Medicine (Baltimore)
Heather Slaney, Stacey MacAulay, Janice Irvine-Meek, Joshua Murray
BACKGROUND: The Beers criteria were developed to help in identifying potentially inappropriate medications (PIMs) for elderly patients. These medications are often associated with adverse events and limited effectiveness in older adults. Patients awaiting an alternate level of care (ALC patients) are those who no longer require acute care hospital services and are waiting for placement elsewhere. They are often elderly, have complex medication regimens, and are at high risk of adverse events...
May 2015: Canadian Journal of Hospital Pharmacy
Masaki Nakamura, Yuichi Inoue
The prevalence of insomnia shows an age-associated increase. Especially, persons with age over 60 years frequently suffer from arousal during sleep and early-morning awakening. The reason of this phenomenon can be explained by age-related change in sleepwake regulation, comorbid diseases and psycho-social status. Benzodiazepine derivatives and benzodiazepine agonists have been widely used for treatment of insomnia. These GABA-A receptor agonist hypnotics have sedative effect, possibly causing various adverse events, i...
June 2015: Nihon Rinsho. Japanese Journal of Clinical Medicine
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