Treating Sleep Disorders
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Management of Status Epilepticus
Published online: 2019-11-21 THIEME Review Article 267 Management of Status Epilepticus Ritesh Lamsal1 Navindra R. Bista1 1Department of Anaesthesiology, Tribhuvan University Teaching Address for correspondence Ritesh Lamsal, MD, DM, Department Hospital, Institute of Medicine, Tribhuvan University, Nepal of Anaesthesiology, Tribhuvan University Teaching Hospital, Institute of Medicine, Tribhuvan University,Kathmandu, Nepal (e-mail: [email protected]). J Neuroanaesthesiol Crit Care 2019;6:267–274 Abstract Status epilepticus (SE) is a life-threatening neurologic condition that requires imme- diate assessment and intervention. Over the past few decades, the duration of seizure Keywords required to define status epilepticus has shortened, reflecting the need to start thera- ► convulsive status py without the slightest delay. The focus of this review is on the management of con- epilepticus vulsive and nonconvulsive status epilepticus in critically ill patients. Initial treatment ► neurocritical care of both forms of status epilepticus includes immediate assessment and stabilization, ► nonconvulsive status and administration of rapidly acting benzodiazepine therapy followed by nonbenzodi- epilepticus azepine antiepileptic drug. Refractory and super-refractory status epilepticus (RSE and ► refractory status SRSE) pose a lot of therapeutic problems, necessitating the administration of contin- epilepticus uous infusion of high doses of anesthetic agents, and carry a high risk of debilitating ► status epilepticus morbidity as well as mortality. ► super-refractory sta- tus epilepticus Introduction occur after 30 minutes of seizure activity. However, this working definition did not indicate the need to immediately Status epilepticus (SE) is a medical and neurologic emergency commence treatment and that permanent neuronal injury that requires immediate evaluation and treatment. It is associat- could occur by the time a clinical diagnosis of SE was made. -
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. -
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. -
Neonatal Clonazepam Administration Induced Long-Lasting Changes in GABAA and GABAB Receptors
International Journal of Molecular Sciences Article Neonatal Clonazepam Administration Induced Long-Lasting Changes in GABAA and GABAB Receptors Hana Kubová 1,* , Zde ˇnkaBendová 2,3 , Simona Moravcová 2,3 , Dominika Paˇcesová 2,3, Luisa Rocha 4 and Pavel Mareš 1 1 Institute of Physiology, Academy of Sciences of the Czech Republic, 14220 Prague, Czech Republic; [email protected] 2 Faculty of Science, Charles University, 12800 Prague, Czech Republic; [email protected] (Z.B.); [email protected] (S.M.); [email protected] (D.P.) 3 National Institute of Mental Health, 25067 Klecany, Czech Republic 4 Pharmacobiology Department, Center of Research and Advanced Studies, Mexico City 14330, Mexico; [email protected] * Correspondence: [email protected]; Tel.: +420-2-4106-2565 Received: 31 March 2020; Accepted: 28 April 2020; Published: 30 April 2020 Abstract: Benzodiazepines (BZDs) are widely used in patients of all ages. Unlike adults, neonatal animals treated with BZDs exhibit a variety of behavioral deficits later in life; however, the mechanisms underlying these deficits are poorly understood. This study aims to examine whether administration of clonazepam (CZP; 1 mg/kg/day) in 7–11-day-old rats affects Gama aminobutyric acid (GABA)ergic receptors in both the short and long terms. Using RT-PCR and quantitative autoradiography, we examined the expression of the selected GABAA receptor subunits (α1, α2, α4, γ2, and δ) and the GABAB B2 subunit, and GABAA, benzodiazepine, and GABAB receptor binding 48 h, 1 week, and 2 months after treatment discontinuation. Within one week after CZP cessation, the expression of the α2 subunit was upregulated, whereas that of the δ subunit was downregulated in both the hippocampus and cortex. -
Comparison of Short-And Long-Acting Benzodiazepine-Receptor Agonists
J Pharmacol Sci 107, 277 – 284 (2008)3 Journal of Pharmacological Sciences ©2008 The Japanese Pharmacological Society Full Paper Comparison of Short- and Long-Acting Benzodiazepine-Receptor Agonists With Different Receptor Selectivity on Motor Coordination and Muscle Relaxation Following Thiopental-Induced Anesthesia in Mice Mamoru Tanaka1, Katsuya Suemaru1,2,*, Shinichi Watanabe1, Ranji Cui2, Bingjin Li2, and Hiroaki Araki1,2 1Division of Pharmacy, Ehime University Hospital, Shitsukawa, Toon, Ehime 791-0295, Japan 2Department of Clinical Pharmacology and Pharmacy, Neuroscience, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan Received November 7, 2007; Accepted May 15, 2008 Abstract. In this study, we compared the effects of Type I benzodiazepine receptor–selective agonists (zolpidem, quazepam) and Type I/II non-selective agonists (zopiclone, triazolam, nitrazepam) with either an ultra-short action (zolpidem, zopiclone, triazolam) or long action (quazepam, nitrazepam) on motor coordination (rota-rod test) and muscle relaxation (traction test) following the recovery from thiopental-induced anesthesia (20 mg/kg) in ddY mice. Zolpidem (3 mg/kg), zopiclone (6 mg/kg), and triazolam (0.3 mg/kg) similarly caused an approximately 2-fold prolongation of the thiopental-induced anesthesia. Nitrazepam (1 mg/kg) and quazepam (3 mg/kg) showed a 6- or 10-fold prolongation of the anesthesia, respectively. Zolpidem and zopiclone had no effect on the rota-rod and traction test. Moreover, zolpidem did not affect motor coordination and caused no muscle relaxation following the recovery from the thiopental-induced anesthesia. However, zopiclone significantly impaired the motor coordination at the beginning of the recovery. Triazolam significantly impaired the motor coordination and muscle relaxant activity by itself, and these impairments were markedly exacerbated after the recovery from anesthesia. -
Red with Nitrazepam and Placebo in Acute Emergency Driving Situations and in Monotonous Simulated Driving
109 A 1986 The Carry-over Effects of Triazolam Compa- red with Nitrazepam and Placebo in Acute Emergency Driving Situations and in Mono- tonous Simulated Driving Hans Laurell and Jan Törnroos Reprint from Acta Pharmacologica et toxicologica 1986 v Väg06/7 Efi/( Statens väg- och trafikinstitut (VTI) * 581 01 Linköping [St]tlltet Swedish Road and Traffic Research Institute * S-581 01 Linköping Sweden Acta pharmacol. et toxicol. 1986, 58, 182186. From the National Swedish Road and Traffic Research Institute, (V.T.I.), S-58 101 Linköping, Sweden The Carry-over Effects of Triazolam Compared with Nitrazepam and Placebo in Acute Emergency Driving Situations and in Monotonous Simulated Driving Hans Laurell and Jan Törnros (Received October 9, 1985; Accepted January 9, 1986) Abstract: Eighteen healthy volunteers of both sexes, aged 2034, were tested in the morning while undertaking real car driving avoidance manoeuvres and during monotonous simulated driving after 1 and 3 nights of medication with triazolam 0.25 mg, nitrazepam 5 mg or placebo. The study was a double-blind, randomized, cross-over study, where a minimum of 7 days wash-out separated the 3 treatment periods. Nitrazepam was found to impair performance in the simulated task after 1 but not after 3 nights of medication. Performance in the triazolam condition was not signicantly different from the other conditions on this task on either day. However, after one night of medication triazolam tended to score worse than placebo but better than nitrazepam. In real car driving a tendency was noted for nitrazepam to score worst, whereas the difference between placebo and triazolam was hardly noticeable. -
Title 16. Crimes and Offenses Chapter 13. Controlled Substances Article 1
TITLE 16. CRIMES AND OFFENSES CHAPTER 13. CONTROLLED SUBSTANCES ARTICLE 1. GENERAL PROVISIONS § 16-13-1. Drug related objects (a) As used in this Code section, the term: (1) "Controlled substance" shall have the same meaning as defined in Article 2 of this chapter, relating to controlled substances. For the purposes of this Code section, the term "controlled substance" shall include marijuana as defined by paragraph (16) of Code Section 16-13-21. (2) "Dangerous drug" shall have the same meaning as defined in Article 3 of this chapter, relating to dangerous drugs. (3) "Drug related object" means any machine, instrument, tool, equipment, contrivance, or device which an average person would reasonably conclude is intended to be used for one or more of the following purposes: (A) To introduce into the human body any dangerous drug or controlled substance under circumstances in violation of the laws of this state; (B) To enhance the effect on the human body of any dangerous drug or controlled substance under circumstances in violation of the laws of this state; (C) To conceal any quantity of any dangerous drug or controlled substance under circumstances in violation of the laws of this state; or (D) To test the strength, effectiveness, or purity of any dangerous drug or controlled substance under circumstances in violation of the laws of this state. (4) "Knowingly" means having general knowledge that a machine, instrument, tool, item of equipment, contrivance, or device is a drug related object or having reasonable grounds to believe that any such object is or may, to an average person, appear to be a drug related object. -
Clinical Trial of the Neuroprotectant Clomethiazole in Coronary Artery Bypass Graft Surgery a Randomized Controlled Trial Robert S
Anesthesiology 2002; 97:585–91 © 2002 American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins, Inc. Clinical Trial of the Neuroprotectant Clomethiazole in Coronary Artery Bypass Graft Surgery A Randomized Controlled Trial Robert S. Kong, F.R.C.A.,* John Butterworth, M.D.,† Wynne Aveling, F.R.C.A.,‡ David A. Stump, M.D.,† Michael J. G. Harrison, F.R.C.P.,§ John Hammon, M.D.,ʈ Jan Stygall, M.Sc.,# Kashemi D. Rorie, Ph.D.,** Stanton P. Newman, D.Phil.†† Background: The neuroprotective property of clomethiazole THE efficacy of coronary artery bypass surgery in the has been demonstrated in several animal models of global and relief of angina and in some circumstances in enhancing Downloaded from http://pubs.asahq.org/anesthesiology/article-pdf/97/3/585/335909/0000542-200209000-00011.pdf by guest on 29 September 2021 focal brain ischemia. In this study the authors investigated the life expectation is now accepted. It is a tribute to the low effect of clomethiazole on cerebral outcome in patients under- mortality of the procedure that interest is now focused going coronary artery bypass surgery. Methods: Two hundred forty-five patients scheduled for on the neurologic and neuropsychological complica- 1–3 coronary artery bypass surgery were recruited at two centers tions. Adverse neurologic outcomes have been found and prospectively randomized to clomethiazole edisilate to occur in 2–6% of patients and neuropsychological (0.8%), 225 ml (1.8 mg) loading dose followed by a maintenance deficits in 10–30%.4–6 These complications are consid- dose of 100 ml/h (0.8 mg/h) during surgery, or 0.9% NaCl ered to be ischemic in nature, being a consequence of (placebo) in a double-blind trial. -
KLONOPIN(R) Tablets (1.0 Mg)
Safety Data Sheet KLONOPIN(R) Tablets (1.0 mg) SECTION 1: Identification of the substance/mixture and of the company/undertaking 1.1. Product identifier Product name KLONOPIN(R) Tablets (1.0 mg) Product code SAP-10065806 1.2. Relevant identified uses of the substance or mixture and uses advised against Use - pharmaceutical active substance (anti-epileptic drug) *1 1.3. Details of the supplier of the safety data sheet Company information Enquiries: Local representation: Genentech, Inc. 1 DNA Way South San Francisco USA-CA 94080 United States of America Phone 001-(650) 225-1000 E-Mail [email protected] US Chemtrec phone: (800)-424-9300 1.4. Emergency telephone number Emergency telephone number US Chemtrec phone: (800)-424-9300 *1 referring to: Clonazepam SECTION 2: Hazards identification Classification of the substance or mixture / Label elements GHS Classification no classification and labelling according to GHS Other hazards Note - Benzodiazepines induce central nervous system depression and drowsiness. In addition, longer use may be habit forming. Hence, these compounds are also misused by addicts. *1 *1 referring to: Clonazepam Date: 30.4.15/LS (SEISMO) Replacing edition of: -- Page: 1/8 KLONOPIN(R) Tablets (1.0 mg) SECTION 3: Composition/information on ingredients Characterization mixture of 0.6% Clonazepam with excipients Ingredients Concentration Clonazepam - Combustible dust (No category), USH003 1622-61-3 0.6 % Corn starch 9005-25-8 11.8 % Microcrystalline cellulose 9004-34-6 14.7 % For the full text of the H-phrases mentioned in this Section, see Section 16. SECTION 4: First aid measures 4.1. Description of first aid measures Eye contact - rinse immediately with tap water for 10 minutes - open eyelids forcibly Skin contact - drench affected skin with plenty of water Inhalation - remove the casualty to fresh air - in the event of symptoms get medical treatment 4.2. -
A Retrospective Comparison of Inappropriate Prescribing Of
Schjøtt and Aßmus BMC Medical Informatics and Decision Making (2019) 19:102 https://doi.org/10.1186/s12911-019-0821-0 RESEARCHARTICLE Open Access A retrospective comparison of inappropriate prescribing of psychotropics in three Norwegian nursing homes in 2000 and 2016 with prescribing quality indicators Jan Schjøtt1,2* and Jörg Aßmus3 Abstract Background: Inappropriate prescribing of psychotropics is a persistent and prevalent problem in nursing homes. The present study compared inappropriate prescribing of psychotropics in nursing homes 16 years apart with prescribing quality indicators. The purpose was to identify any change in inappropriate prescribing of relevance for medical informatics. Methods: Three Norwegian nursing homes were audited in 2000 and 2016 with regard to prescribing quality. Psychotropics among 386 patients in 2000, and 416 patients in 2016, included combinations of antidepressants, antipsychotics, anxiolytics-hypnotics, and antiepileptics. Prescribing quality indicators included psychotropic polypharmacy (defined as concurrent use of three or more psychotropics) and potential inappropriate psychotropic substances or combinations. Furthermore, potential clinically relevant psychotropic interactions were classified as pharmacodynamic or pharmacokinetic using an interaction database. The first ranked (most important) interaction in each patient was selected with the following importance of categories in the database; recommended action > documentation > severity. Three levels (from low to high) within each category were used for ranking. Results: From 2000 to 2016, psychotropic polypharmacy increased from 6.2 to 29.6%, potential inappropriate psychotropic substances was reduced from 17.9 to 11.3% and potential inappropriate psychotropic combinations increased from 7.8 to 27.9%. Changes in polypharmacy and combinations were predominantly associated with prescribing of anxiolytics-hypnotics. -
Pharmacological Treatments in Insomnia
Pharmacological treatments in insomnia Sue Wilson Centre for Neuropsychopharmacology, Division of Brain Sciences, Imperial College, London Drugs used in insomnia Licensed for insomnia •GABA-A positive allosteric modulators •melatonin (modified release) •promethazine •diphenhydramine •doxepin (USA) Unlicensed prescribed frequently •antihistamines (and OTC) •antidepressants Sometimes prescribed drugs for psychosis Some GABA-A positive allosteric modulators Drugs acting at the GABA-A benzodiazepine receptor zopiclone zolpidem zaleplon benzodiazepines eg temazepam, lorazepam (safe in overdose, as long as no other drug involved) Drugs acting at the barbiturate/alcohol receptor chloral hydrate/chloral betaine clomethiazole (dangerous in overdose) GABA calms the brain Gamma aminobutyic acid (GABA) is the main inhibitory transmitter in the mammalian central nervous system. It plays the principal role in reducing neuronal excitability and its receptors are prolific throughout the brain, in cortex, limbic system, thalamus and cerebellum sedative Increase anticonvulsant GABA anxiolytic function ataxia, memory effects Effects of GABA-A positive allosteric modulators •These drugs enhance the effect of GABA, the main inhibitory neurotransmitter in the brain •They all produce sedation, sleep promotion, ataxia, muscle relaxation, effects on memory, anticonvulsant effects •Therefore for insomnia the duration of action of the drug is important – these effects are unwanted during the day Effects of these GABA-ergic drugs on sleep EEG/PSG • Appearance of -
Boendedok 2020 Manual För Intervjuformulären
BoendeDOK 2020 Manual för intervjuformulären Mikael Dahlberg Mats Anderberg Helen Falck Innehållsförteckning Introduktion ___________________________________________________ 4 BoendeDOK __________________________________________________ 6 Inskrivningsintervju __________________________________________ 6 Avstämningsintervju __________________________________________ 7 Utskrivningsintervju __________________________________________ 7 Frågeområden i BoendeDOK ___________________________________ 7 Hantering och förvaring av DOK-material _________________________ 8 Kontaktpersonens roll _________________________________________ 8 Kodning i BoendeDOK ________________________________________ 9 Tidsintervaller ______________________________________________ 10 Frågor om förändring ________________________________________ 10 Att i efterhand ändra intervjusvar _______________________________ 11 Inför intervjun - Klientens samtycke ____________________________ 11 Under intervjun _____________________________________________ 12 Återkoppling av Inskrivningsintervjun ___________________________ 12 BoendeDOK Inskrivningsformulär ________________________________ 16 Intervjuinformation __________________________________________ 16 A. Administrativa uppgifter ___________________________________ 16 B. Bakgrundsinformation _____________________________________ 17 C. Boende _________________________________________________ 17 D. Relationer _______________________________________________ 20 E. Myndighets- och vårdkontakter ______________________________ 21