Recommended Methods for the Identification and Analysis of Barbiturates and Benzodiazepines Under International Control
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Kava (Piper Methysticum) and Its Methysticin Constituents Protect Brain Tissue Against Ischemic Damage in Rodents
5 Refs: Arletti R et al, Stimulating property of Turnera diffusa and Pfaffia paniculata extracts on the sexual-behavior of male rats. Psychopharmacology 143(1), 15-19, 1999. Berger F, Handbuch der drogenkunde . Vol 2, Maudrich, Wien, 1950. Martinez M, Les plantas medicinales de Mexico . Cuarta Edicion Botas Mexico , p119, 1959. Tyler VE et al, Pharmacognosy , 9 th edition, Lea & Febiger, Philadelphia, 1988. KAVA ( Piper methysticum ) - A REVIEW The Kava plant (Piper methysticum) is a robust, well-branching and erect perennial shrub belonging to the pepper family (Piperaceae). The botanical origin remains unknown, although it is likely that early Polynesian explorers brought the plant with them from island to island. Numerous varieties of Kava exist, and today it is widely cultivated in several Pacific Island countries both for local use as well as the rapidly growing demand for pharmaceutical preparations. The dried rhizomes (roots) are normally used. The first description to the western world of the ceremonial use of an intoxicating beverage prepared from Kava was made by Captain James Cook following his Pacific voyage in 1768. The drink, prepared as an infusion in an elaborate manner after first chewing the root, is consumed on formal occasions or meetings of village elders and chiefs, as well as in reconciling with enemies and on a more social basis. It remains an important social custom in many Pacific Island countries today. Most of the islands of the Pacific possessed Kava prior to European contact, particularly those encompassed by Polynesia, Melanesia and Micronesia. After drinking the Kava beverage a pleasantly relaxed and sociable state develops, after which a deep and restful sleep occurs. -
Alternative Treatments for Depression and Anxiety
2019 PCB Conference: Strickland Benzodiazepines (BZDs), Herbal and Alternative Treatments for Anxiety & Depression BZD Learning Objectives • List at least three uses for benzodiazepines • Discuss at least two risk factors associated with benzodiazepine prescriptions Craig Strickland, PhD, Owner Biobehavioral Education and Consultation https://sites.google.com/site/bioedcon 1 2 BZD Pharmacokinetics Clinical Uses of BZDs Generic Name Trade Name Rapidity ½ Life Dose (mg) • Treat a variety of anxiety disorders alprazolam Xanax Intermediate Short 0.75-4 • Hypnotics • Muscle relaxants chlordiaze- Librium Intermediate Long 15-100 poxide • To produce anterograde amnesia clonazepam Klonopin Intermediate Long 0.5-4 • Alcohol & other CNS depressant withdrawal • Anti-convulsant therapy diazepam Valium Rapid Long 4-40 triazolam Halcion Intermediate Very short 0.125-0.5 temazepam Restoril Short Short 7.5-30 3 4 1 2019 PCB Conference: Strickland Issues with BZDs Herbal Medication and Alternative Therapies Used in the Treatment of Depression and Anxiety • Addictive potential • Confusion between “anti-anxiety” effects and the “warm-fuzzy) • Large dose ranges • Comparison of BZDs with medications like Buspar, etc. • They work, they work well and they work quickly 5 6 Alternative Tx. Learning Objectives Background Information on herbals: Natural does not necessarily mean “safe” • List several amino acid treatments for depression • Side-effects and adverse reactions • List at least three of the most common herbal – Herbal medications are “drugs” although -
Metabolic-Hydroxy and Carboxy Functionalization of Alkyl Moieties in Drug Molecules: Prediction of Structure Influence and Pharmacologic Activity
molecules Review Metabolic-Hydroxy and Carboxy Functionalization of Alkyl Moieties in Drug Molecules: Prediction of Structure Influence and Pharmacologic Activity Babiker M. El-Haj 1,* and Samrein B.M. Ahmed 2 1 Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, University of Science and Technology of Fujairah, Fufairah 00971, UAE 2 College of Medicine, Sharjah Institute for Medical Research, University of Sharjah, Sharjah 00971, UAE; [email protected] * Correspondence: [email protected] Received: 6 February 2020; Accepted: 7 April 2020; Published: 22 April 2020 Abstract: Alkyl moieties—open chain or cyclic, linear, or branched—are common in drug molecules. The hydrophobicity of alkyl moieties in drug molecules is modified by metabolic hydroxy functionalization via free-radical intermediates to give primary, secondary, or tertiary alcohols depending on the class of the substrate carbon. The hydroxymethyl groups resulting from the functionalization of methyl groups are mostly oxidized further to carboxyl groups to give carboxy metabolites. As observed from the surveyed cases in this review, hydroxy functionalization leads to loss, attenuation, or retention of pharmacologic activity with respect to the parent drug. On the other hand, carboxy functionalization leads to a loss of activity with the exception of only a few cases in which activity is retained. The exceptions are those groups in which the carboxy functionalization occurs at a position distant from a well-defined primary pharmacophore. Some hydroxy metabolites, which are equiactive with their parent drugs, have been developed into ester prodrugs while carboxy metabolites, which are equiactive to their parent drugs, have been developed into drugs as per se. -
Drug and Alcohol Withdrawal Clinical Practice Guidelines - NSW
Guideline Drug and Alcohol Withdrawal Clinical Practice Guidelines - NSW Summary To provide the most up-to-date knowledge and current level of best practice for the treatment of withdrawal from alcohol and other drugs such as heroin, and other opioids, benzodiazepines, cannabis and psychostimulants. Document type Guideline Document number GL2008_011 Publication date 04 July 2008 Author branch Centre for Alcohol and Other Drugs Branch contact (02) 9424 5938 Review date 18 April 2018 Policy manual Not applicable File number 04/2766 Previous reference N/A Status Active Functional group Clinical/Patient Services - Pharmaceutical, Medical Treatment Population Health - Pharmaceutical Applies to Area Health Services/Chief Executive Governed Statutory Health Corporation, Board Governed Statutory Health Corporations, Affiliated Health Organisations, Affiliated Health Organisations - Declared Distributed to Public Health System, Ministry of Health, Public Hospitals Audience All groups of health care workers;particularly prescribers of opioid treatments Secretary, NSW Health Guideline Ministry of Health, NSW 73 Miller Street North Sydney NSW 2060 Locked Mail Bag 961 North Sydney NSW 2059 Telephone (02) 9391 9000 Fax (02) 9391 9101 http://www.health.nsw.gov.au/policies/ space space Drug and Alcohol Withdrawal Clinical Practice Guidelines - NSW space Document Number GL2008_011 Publication date 04-Jul-2008 Functional Sub group Clinical/ Patient Services - Pharmaceutical Clinical/ Patient Services - Medical Treatment Population Health - Pharmaceutical -
Chronic Use of Opioid Medications Before and After Bariatric Surgery
Supplementary Online Content Raebel MA, Newcomer SR, Reifler LM, et al. Chronic use of opioid medications before and after bariatric surgery. JAMA. doi:10.1001/jama.2013.278344 eFigure. Opioid Dispensings in 60 Days Before and 60 Days After Bariatric Surgery eTable 1. Opioid Classification and Morphine Equivalents Conversion Factors for Opioids Administered by Tablet, Capsule, Liquid, Transdermal Patch, and Transmucosal Formulations eTable 2. ICD-9 Codes for Comorbid Diagnosis of Substance Abuse, Anxiety, Posttraumatic Stress Disorder, and/or Depression eTable 3. ICD-9 Codes for Inclusion and Exclusion of Chronic Pain Diagnoses eTable 4. Therapeutic Classes, Generic Names, and Selected Brand Names of Covariate Medications eTable 5. Types of Opioids Dispensed During the Year Before and the Year After Bariatric Surgery Among Presurgery Chronic Opioid Users eTable 6. Types of Opioids Used Before and After Bariatric Surgery Among 933 Individuals With Chronic Opioid Use Before Bariatric Surgery eTable 7. Unadjusted Characteristics of Chronic Opioid Users According to Whether or Not Both Presurgery and Postsurgery Body Mass Indexes (BMIs) Data Were Available eTable 8. Presurgery and Postsurgery Use of Opioids and Selected Other Analgesic and Adjunctive Pain Medication Classes Among Presurgery Chronic Opioid Users With Presurgery Chronic Pain Diagnoses This supplementary material has been provided by the authors to give readers additional information about their work. © 2013 American Medical Association. All rights reserved. Downloaded From: -
Risk Based Requirements for Medicines Handling
Risk based requirements for medicines handling Including requirements for Schedule 4 Restricted medicines Contents 1. Introduction 2 2. Summary of roles and responsibilities 3 3. Schedule 4 Restricted medicines 4 4. Medicines acquisition 4 5. Storage of medicines, including control of access to storage 4 5.1. Staff access to medicines storage areas 5 5.2. Storage of S4R medicines 5 5.3. Storage of S4R medicines for medical emergencies 6 5.4. Access to storage for S4R and S8 medicines 6 5.5. Pharmacy Department access, including after hours 7 5.6. After-hours access to S8 medicines in the Pharmacy Department 7 5.7. Storage of nitrous oxide 8 5.8. Management of patients’ own medicines 8 6. Distribution of medicines 9 6.1. Distribution outside Pharmacy Department operating hours 10 6.2. Distribution of S4R and S8 medicines 10 7. Administration of medicines to patients 11 7.1. Self-administration of scheduled medicines by patients 11 7.2. Administration of S8 medicines 11 8. Supply of medicines to patients 12 8.1. Supply of scheduled medicines to patients by health professionals other than pharmacists 12 9. Record keeping 13 9.1. General record keeping requirements for S4R medicines 13 9.2. Management of the distribution and archiving of S8 registers 14 9.3. Inventories of S4R medicines 14 9.4. Inventories of S8 medicines 15 10. Destruction and discards of S4R and S8 medicines 15 11. Management of oral liquid S4R and S8 medicines 16 12. Cannabis based products 17 13. Management of opioid pharmacotherapy 18 14. -
The Following Studies Received Ethical Approval by Institutional And/Or National Review Committees If Appropriate
The following studies received ethical approval by institutional and/or national review committees if appropriate. Manchester AVA Spring Meeting April 2017 Cardiovascular findings during pre-anesthetic assessment in dogs undergoing two different pre-anesthetic assessment protocols and usefulness of the diagnostic tests performed S Diez-Bernal1, G Ortiz-Diez2, SP Monteagudo-Franco3, P Ruhi-Velasco4, C Garcia- Echarri4, A Perez-Higueras4, V Salazar-Nussio5. 1Anesthesia Service, University of Bern, Bern, Switzerland; 2Cardiology Service, Alfonso X El Sabio University, Madrid, Spain; 3Diagnostic Imaging Service, Alfonso X El Sabio University, Madrid, Spain; 4Alfonso X El Sabio University, Madrid, Spain; 5Anesthesia Service, Alfonso X El Sabio University, Madrid, Spain. The objectives of this study were to describe cardiovascular abnormalities (CVA) found during pre-anesthetic assessment in dogs in a veterinary teaching hospital and to evaluate the usefulness of the different diagnostic tests performed. One hundred and eight client-owned dogs underwent a basic pre-anesthetic assessment protocol including history, physical examination, hematology and biochemistry performed and evaluated by an anesthesia specialist; and a comprehensive pre-anesthetic assessment protocol that included, in addition to the tests performed in the basic assessment protocol, thoracic radiographs, ECG, and echocardiography evaluated by a licensed veterinarian. CVA were identified in twenty-five of ninety-seven dogs (25.8%) by cardiac auscultation; in 15 dogs (13.9%) by ECG; in 6 dogs (5.6%) by thoracic radiographs; and in 39 dogs (36.1%) by echocardiography (95% of which were diagnosed of chronic valvular heart disease, CVHD). Since CVHD was the cardiovascular condition that showed the highest prevalence, sensitivity, specificity and likelihood ratios of the other performed clinical tests were calculated for the diagnosis of this condition (taking echocardiography as gold standard). -
Benzodiazepines
Benzodiazepines Using benzodiazepines in Children and Adolescents Overview Benzodiazepines are group of medications used to treat several different conditions. Some examples of these medications include: lorazepam (Ativan®); clonazepam (Rivotril®); alprazolam (Xanax®) and oxazepam (Serax®). Other benzodiazepine medications are available, but are less commonly used in children and adolescents. What are benzodiazepines used for? Benzodiazepines may be used for the following conditions: • anxiety disorders: generalized anxiety disorder; social anxiety disorder; post-traumatic stress disorder (PTSD); panic attacks/disorder; excessive anxiety prior to surgery • sleep disorders: trouble sleeping (insomnia); waking up suddenly with great fear (night terrors); sleepwalking • seizure disorders (epilepsy) • alcohol withdrawal • treatment of periods of extreme slowing or excessive purposeless motor activity (catatonia) Your doctor may be using this medication for another reason. If you are unclear why this medication is being prescribed, please ask your doctor. How do benzodiazepines work? Benzodiazepines works by affecting the activity of the brain chemical (neurotransmitter) called GABA. By enhancing the action of GABA, benzodiazepines have a calming effect on parts of the brain that are too excitable. This in turn helps to manage anxiety, insomnia, and seizure disorders. How well do benzodiazepines work in children and adolescents? When used to treat anxiety disorders, benzodiazepines decrease symptoms such as nervousness, fear, and excessive worrying. Benzodiazepines may also help with the physical symptoms of anxiety, including fast or strong heart beat, trouble breathing, dizziness, shakiness, sweating, and restlessness. Typically, benzodiazepines are prescribed to manage anxiety symptoms that are uncomfortable, frightening or interfere with daily activities for a short period of time before conventional anti-anxiety treatments like cognitive-behavioural therapy or anti-anxiety takes effect. -
History Lectured on Midwifery at St Bartholomew’S Hospital and and Was in Attendance at the Births of All of Her Children
J R Coll Physicians Edinb 2012; 42:274–9 Paper http://dx.doi.org/10.4997/JRCPE.2012.317 © 2012 Royal College of Physicians of Edinburgh Sir Charles Locock and potassium bromide MJ Eadie Honorary Research Consultant and Emeritus Professor, Faculty of Health Sciences, University of Queensland, Royal Brisbane and Women’s Hospital, Australia ABSTRACT On 12 May 1857, Edward Sieveking read a paper on epilepsy to the Correspondence to M Eadie Royal Medical and Chirurgical Society in London. During the discussion that Faculty of Health Sciences, followed Sir Charles Locock, obstetrician to Queen Victoria, was reported to have University of Queensland, Royal Brisbane and Women’s commented that during the past 14 months he had used potassium bromide to Hospital, Herston, successfully stop epileptic seizures in all but one of 14 or 15 women with ‘hysterical’ Brisbane 4029, Australia or catamenial epilepsy. This report of Locock’s comment has generally given him credit for introducing the first reasonably effective antiepileptic drug into medical Tel 61 2 (0)7 38311704 e-mail [email protected] practice. However examination of the original reports raises questions as to how soundly based the accounts of Locock’s comments were. Subsequently, others using the drug to treat epilepsy failed to obtain the degree of benefit that the reports of Locock’s comments would have led them to expect. The drug might not have come into more widespread use as a result, had not Samuel Wilks provided good, independent evidence for the drug’s antiepileptic efficacy in 1861. KEYWORDS Epilepsy treatment, Charles Locock, potassium bromide, Edward Sieveking, Samuel Wilks DECLaratIONS OF INTERESTS No conflicts of interest declared. -
BUTALBITAL ANALGESICS Allzital (Butalbital-Acetaminophen
BUTALBITAL ANALGESICS Allzital (butalbital-acetaminophen), butalbital-aspirin-caffeine, butalbital-aspirin-caffeine- codeine, butalbital-acetaminophen, butalbital-acetaminophen-caffeine, butalbital- acetaminophen-caffeine-codeine, Vanatol LQ (butalbital-acetaminophen-caffeine liquid oral solution) RATIONALE FOR INCLUSION IN PA PROGRAM Background Butalbital containing products are non-opioid analgesics that contain a combination of different drug products indicated for the relief of the symptom complex of tension (or muscle contraction) headache pain. Butalbital is a short to intermediate-acting barbiturate that works in concert with acetaminophen, an antipyretic non-salicylate agent, aspirin, a pain-relieving NSAID, and caffeine, a stimulant that works in the CNS, to decrease pain via a mechanism that isn’t well understood. Butalbital is a habit-forming drug that potentiates the effects of other commonly abuse drugs or substances like alcohol. Caffeine might help increase vasodilation and smooth muscle relaxation, while butalbital is thought to help balance the CNS stimulation caused by caffeine and produces depressant effects (1). Regulatory Status FDA approved indication: Butalbital containing products are used in the relief of the symptom complex of tension or muscle contraction headaches (2-8). Frequent use of acute medications is generally thought to cause medication-overuse headache. To decrease the risk of medication-overuse headache (“rebound headache” or “drug-induced headache”) many experts limit acute therapy to two headache days per week on a regular basis. Based on concerns of overuse, medication-overuse headache, and withdrawal, the use of butalbital-containing analgesics should be limited and carefully monitored. The Allzital limit is set to the maximum of 12 doses per day for acute treatment of 8 headaches per month as this product contains less butalbital than other products. -
Benzodiazepine Group ELISA Kit
Benzodiazepine Group ELISA Kit Benzodiazepine Background Since their introduction in the 1960s, benzodiazepines have been widely prescribed for the treatment of anxiety, insomnia, muscle spasms, alcohol withdrawal, and seizure-prevention as they are depressants of the central nervous system. Despite the fact that they are highly effective for their intended use, benzodiazepines are prescribed with caution as they can be highly addictive. In fact, researchers at NIDA (National Institute on Drug Abuse) have shown that addiction for benzodiazepines is similar to that of opioids, cannabinoids, and GHB. Common street names of benzodiazepines include “Benzos” and “Downers”. The five most encountered benzodiazepines on the illicit market are alprazolam (Xanax), lorazepam (Ativan), clonazepam (Klonopin), diazepam (Valium), and temazepam (Restori). The method of abuse is typically oral or snorted in crushed form. The DEA notes a particularly high rate of abuse among heroin and cocaine abusers. Designer benzodiazepines are currently offered in online shops selling “research chemicals”, providing drug abusers an alternative to prescription-only benzodiazepines. Data defining pharmacokinetic parameters, drug metabolisms, and detectability in biological fluids is limited. This lack of information presents a challenge to forensic laboratories. Changes in national narcotics laws in many countries led to the control of (phenazepam and etizolam), which were marketed by pharmaceutical companies in some countries. With the control of phenazepam and etizolam, clandestine laboratories have begun researching and manufacturing alternative benzodiazepines as legal substitutes. Delorazepam, diclazepam, pyrazolam, and flubromazepam have emerged as compounds in this class of drugs. References Drug Enforcement Administration, Office of Diversion Control. “Benzodiazepines.” http://www.deadiversion.usdoj.gov/drugs_concern/benzo_1. -
Abecarnil/Allobarbital 959 Pharmacopoeias
Abecarnil/Allobarbital 959 Pharmacopoeias. In Eur. (see p.vii). acamprosate’s action including inhibition of neuronal hyper- maleate in the treatment of anxiety disorders, hiccups, and nau- Ph. Eur. 6.2 (Acamprosate Calcium). A white or almost white excitability by antagonising excitatory amino acids such as sea and vomiting. Acepromazine, as the base, has also been giv- powder. Freely soluble in water; practically insoluble in alcohol glutamate. en in preparations for the management of insomnia. and in dichloromethane. A 5% solution in water has a pH of 5.5 1. Wilde MI, Wagstaff AJ. Acamprosate: a review of its pharmacol- Preparations to 7.0. ogy and clinical potential in the management of alcohol depend- ence after detoxification. Drugs 1997; 53: 1038–53. Proprietary Preparations (details are given in Part 3) Adverse Effects 2. Anonymous. Acamprosate for alcohol dependence? Drug Ther Denm.: Plegicil; Turk.: Plegicil. The main adverse effect of acamprosate is dosage-related diar- Bull 1997; 35: 70–2. Multi-ingredient: Fr.: Noctran. rhoea; nausea, vomiting, and abdominal pain occur less frequent- 3. Mason BJ. Treatment of alcohol-dependent outpatients with acamprosate: a clinical review. J Clin Psychiatry 2001; 62 (suppl ly. Other adverse effects have included pruritus, and occasionally 20): 42–8. a maculopapular rash; bullous skin reactions have occurred rare- 4. Overman GP, et al. Acamprosate for the adjunctive treatment of Aceprometazine (rINN) ly. Depression and fluctuations in libido have also been reported. alcohol dependence. Ann Pharmacother 2003; 37: 1090–9. Hypersensitivity reactions including urticaria, angioedema, and 5. Anton RF, et al. Combined pharmacotherapies and behavioral 16-64 CB; Aceprometazina; Acéprométazine; Aceprometazi- anaphylaxis have been reported very rarely.