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Insomnia and Anxiety in Older People Sleeping Pills Are Usually Not the Best Solution
® Insomnia and anxiety in older people Sleeping pills are usually not the best solution lmost one-third of older people in the people who take one of United States take sleeping pills. These these medicines sleep medicines are also sometimes called only a little longer and A“sedative-hypnotics” or “tranquilizers.” They better than those who affect the brain and spinal cord. don’t take a medicine. Doctors prescribe some of these medicines Sleeping pills can for sleep problems. Some of these medicines have serious side effects. also can be used to treat other conditions, such All sedative-hypnotic medicines have special as anxiety or alcohol withdrawal. Sometimes, risks for older adults. Seniors are likely to be doctors also prescribe certain anti-depressants more sensitive to the medicines’ effects than for sleep, even though that’s not what they’re younger adults. And these medicines may designed to treat. stay in older people’s bodies longer. These Most older adults should first try to treat their medicines can cause confusion and memory insomnia without medicines. According to the problems that: American Geriatrics Society, there are safer and • Increase the risk of falls and hip fractures. better ways to improve sleep or reduce anxiety. These are common causes of hospital stays Here’s why: and death in older people. Sleeping pills may not help much. • Increase the risk of car accidents. Many ads say that sleeping pills help people get a full, restful night’s sleep. But studies show that this is not exactly true in real life. On average, The new “Z” medicines also have risks. -
Drug & Alcohol Testing Program
Pottawattmie County Drug & Alcohol Testing Program Appendix A Table of Contents POLICY STATEMENT ...................................................................................................................................... 3 SCOPE ............................................................................................................................................................ 4 EDUCATION AND TRAINING .......................................................................................................................... 4 DESIGNATED EMPLOYER REPRESENTATIVE (DER): ....................................................................................... 5 DUTY TO COOPERATE ................................................................................................................................... 5 EMPLOYEE ADMISSION OF ALCOHOL AND CONTROLLED SUBSTANCE USE: (49 CFR Part 382.121) ... 6 PROHIBITED DRUGS AND ILLEGALLY USED CONTROLLED SUBSTANCES: ..................................................... 7 PROHIBITED BEHAVIOR AND CONDUCT: ...................................................................................................... 8 DRUG & ALCOHOL TESTING REQUIREMENTS (49 CFR, Part 40 & 382) ............................................... 10 DRUG & ALCOHOL TESTING CIRCUMSTANCES (49 CFR Part 40 & 382) .............................................. 12 A. Pre-Employment Testing: .................................................................................................... 12 B. Reasonable Suspicion Testing: ......................................................................................... -
Medication Guide Sedative-Hypnotic Capsules
MEDICATION GUIDE SEDATIVE-HYPNOTIC CAPSULES C-II SECONAL SODIUM® CII (secobarbital sodium) CAPSULES, USP Rx only Read this Medication Guide before you start taking a SEDATIVE-HYPNOTIC and each time you get a refill. There may be new information. This Medication Guide does not take the place of talking to your doctor about your medical condition or treatment. You and your doctor should talk about the SEDATIVE-HYPNOTIC when you start taking it and at regular checkups. What is the most important information I should know about SEDATIVE-HYPNOTICS? After taking a SEDATIVE-HYPNOTIC, you may get up out of bed while not being fully awake and do an activity that you do not know you are doing. The next morning, you may not remember that you did anything during the night. You have a higher chance for doing these activities if you drink alcohol or take other medicines that make you sleepy with a SEDATIVE-HYPNOTIC. Reported activities include: • driving a car ("sleep-driving") • making and eating food • talking on the phone • having sex • sleep-walking Important: 1. Take SEDATIVE-HYPNOTICS exactly as prescribed • Do not take more SEDATIVE-HYPNOTICS than prescribed. • Take the SEDATIVE-HYPNOTIC right before you get in bed, not sooner. 2. Do not take SEDATIVE-HYPNOTICS if you: • drink alcohol • take other medicines that can make you sleepy. Talk to your doctor about all of your medicines. Your doctor will tell you if you can take SEDATIVE-HYPNOTICS with your other medicines • cannot get a full night's sleep 3. Call your doctor right away if you find out that you have done any of the above activities after taking the SEDATIVE-HYPNOTIC. -
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: -
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. -
And Calcium, Magnesium, Potassium and Sodium Oxybates (Xywav™)
Louisiana Medicaid Sodium Oxybate (Xyrem®) and Calcium, Magnesium, Potassium and Sodium Oxybates (Xywav™) The Louisiana Uniform Prescription Drug Prior Authorization Form should be utilized to request clinical authorization for sodium oxybate (Xyrem®) and calcium, magnesium, potassium and sodium oxybates (Xywav™). These agents have Black Box Warnings and are subject to Risk Evaluation and Mitigation Strategy (REMS) under FDA safety regulations. Please refer to individual prescribing information for details. Approval Criteria • The recipient is 7 years of age or older on date of request; AND • The recipient has a documented diagnosis of narcolepsy or cataplexy; AND • The prescribing provider is a Board-Certified Neurologist or a Board-Certified Sleep Medicine Physician; AND • By submitting the authorization request, the prescriber attests to the following: o The prescribing information for the requested medication has been thoroughly reviewed, including any Black Box Warning, Risk Evaluation and Mitigation Strategy (REMS), contraindications, minimum age requirements, recommended dosing, and prior treatment requirements; AND o All laboratory testing and clinical monitoring recommended in the product prescribing information have been completed as of the date of the request and will be repeated as recommended; AND o The recipient has no inappropriate concomitant drug therapies or disease states. Duration of initial authorization approval: 3 months Reauthorization Criteria • The recipient continues to meet all initial approval criteria; AND -
Prescription Drug Management
Check out our new site: www.acllaboratories.com Prescription Drug Management Non Adherence, Drug Misuse, Increased Healthcare Costs Reports from the Centers for DiseasePrescription Control and Prevention (CDC) say Drug deaths from Managementmedication overdose have risen for 11 straight years. In 2008 more than 36,000 people died from drug overdoses, and most of these deaths were caused by prescription Nondrugs. Adherence,1 Drug Misuse, Increased Healthcare Costs The CDC analysis found that nearly 40,000 drug overdose deaths were reported in 2010. Prescribed medication accounted for almost 60 percent of the fatalities—far more than deaths from illegal street drugs. Abuse of painkillers like ReportsOxyContin from and the VicodinCenters forwere Disease linked Control to the and majority Prevention of the (CDC) deaths, say deaths from according to the report.1 medication overdose have risen for 11 straight years. In 2008 more than 36,000 people died from drug overdoses, and most of these deaths were caused by prescription drugs. 1 A health economics study analyzed managed care claims of more than 18 million patients, finding that patients undergoing opioid therapyThe CDCfor chronic analysis pain found who that may nearly not 40,000 be following drug overdose their prescription deaths were regimenreported in 2010. Prescribed medication accounted for almost 60 percent of the fatalities—far more than deaths have significantly higher overall healthcare costs. from illegal street drugs. Abuse of painkillers like OxyContin and Vicodin were linked to the majority of the deaths, according to the report.1 ACL offers drug management testing to provide information that can aid clinicians in therapy and monitoring to help improve patientA health outcomes. -
Additional Requested Drugs
PART 1 PART PATIENT PRESCRIBED MEDICATIONS: o ACTIQ o DESIPRAMINE o HYDROCODONE o MORPHINE o ROXICODONE o ADDERALL o DIAZEPAM* o HYDROMORPHONE o MS CONTIN o SOMA o ALPRAZOLAM* o DILAUDID o IMIPRAMINE o NEURONTIN o SUBOXONE o AMBIEN o DURAGESIC o KADIAN o NORCO o TEMAZEPAM o AMITRIPTYLINE o ELAVIL o KETAMINE o NORTRIPTYLINE o TRAMADOL* o ATIVAN o EMBEDA o KLONOPIN o NUCYNTA o TYLENOL #3 o AVINZA o ENDOCET o LORAZEPAM o OPANA o ULTRAM o BUPRENEX o FENTANYL* o LORTAB o OXYCODONE o VALIUM o BUPRENORPHINE o FIORICET o LORCET o OXYCONTIN o VICODIN o BUTRANS o GABAPENTIN o LYRICA o PERCOCET o XANAX o CLONAZEPAM* o GRALISE o METHADONE o RESTORIL TO RE-ORDER CALL RITE-PRINT 718/384-4288 RITE-PRINT CALL TO RE-ORDER ALLIANCE DRUG PANEL (SEE BELOW) o ALCOHOL o BARBITURATES o ILLICITS o MUSCLE RELAXANTS o OPIODS (SYN) ETHANOL PHENOBARBITAL 6-MAM (HEROIN)* CARISPRODOL FENTANYL* BUTABARBITAL a-PVP MEPROBAMATE MEPERIDINE o AMPHETAMINES SECOBARBITAL BENZOYLECGONINE NALOXONE AMPHETAMINE PENTOBARBITAL LSD o OPIODS (NATURAL) METHADONE* METHAMPHETAMINE BUTALBITAL MDA CODEINE METHYLPHENEDATE MDEA MORPHINE o NON-OPIOID o BENZODIAZEPINES MDMA ANALGESICS o OPIODS (SEMI-SYN) o ANTICONVULSIVES ALPRAZOLAM* MDPV TRAMADOL BUPRENORPHINE* GABAPENTIN CLONAZEPAM* MEPHEDRONE TAPENTADOL DIHROCODEINE PREGABALIN DIAZEPAM METHCATHINONE DESOMORPHINE o NON-BENZODIAZEPINE FLUNITRAZEPAM* METHYLONE HYDROCODONE HYPNOTIC o ANTIDEPRESSANTS FLURAZEPAM* PCP HYDROMORPHONE ZOLPIDEM* AMITRIPTYLINE LORAZEPAM THC* OXYCODONE DOXEPIN OXAZEPAM CBD ° OXYMORPHONE o MISCELLANEOUS DRUGS IMIPRIMINE -
Butalbital, Acetaminophen, Caffeine, and Codeine Phosphate Capsules
Medication Guide Butalbital, Acetaminophen, Caffeine, and Codeine Phosphate Capsules, C III Butalbital, Acetaminophen, Caffeine, and Codeine Phosphate Capsules are: • A strong prescription pain medicine that contains an opioid (narcotic) that is indicated for the relief of the symptom complex of tension (or muscle contraction) headache, when other pain treatments such as non-opioid pain medicines do not treat your pain well enough or you cannot tolerate them. • An opioid pain medicine that can put you at risk for overdose and death. Even if you take your dose correctly as prescribed you are at risk for opioid addiction, abuse, and misuse that can lead to death. Important information about Butalbital, Acetaminophen, Caffeine, and Codeine Phosphate Capsules: • Get emergency help right away if you take too much Butalbital, Acetaminophen, Caffeine, and Codeine Phosphate Capsules (overdose). When you first start taking Butalbital, Acetaminophen, Caffeine, and Codeine Phosphate Capsules, when your dose is changed, or if you take too much (overdose), serious or life-threatening breathing problems that can lead to death may occur. • Taking Butalbital, Acetaminophen, Caffeine, and Codeine Phosphate Capsules with other opioid medicines, benzodiazepines, alcohol, or other central nervous system depressants (including street drugs) can cause severe drowsiness, decreased awareness, breathing problems, coma, and death. • Never give anyone else your Butalbital, Acetaminophen, Caffeine, and Codeine Phosphate Capsules. They could die from taking it. Store Butalbital, Acetaminophen, Caffeine, and Codeine Phosphate Capsules away from children and in a safe place to prevent stealing or abuse. Selling or giving away Butalbital, Acetaminophen, Caffeine, and Codeine Phosphate Capsules is against the law. • Get emergency help right away if you take more than 4,000 mg of acetaminophen in 1 day. -
Review Memorandum
510(k) SUBSTANTIAL EQUIVALENCE DETERMINATION DECISION SUMMARY ASSAY ONLY TEMPLATE A. 510(k) Number: k062165 B. Purpose for Submission: New device C. Measurand: Barbiturates D. Type of Test: Qualitative and semi-quantitative enzyme immunoassay E. Applicant: Ortho-Clinical Diagnostics, Inc. F. Proprietary and Established Names: VITROS Chemistry Products BARB Reagent VITROS Chemistry Products Calibrator 26 VITROS Chemistry Products FS Calibrator 1 VITROS Chemistry Products DAT Performance Verifiers I, II, III, IV and V G. Regulatory Information: 1. Regulation section: 21 CFR 862.3150, Barbiturates test system 21 CFR 862.3200, Clinical Toxicology Calibrator 21 CFR 862.3180, Clinical Toxicology Control 2. Classification: Class II, (reagent, calibrator) Class I, reserved (control) 3. Product code: DIS, DLJ and DIF 4. Panel: Toxicology (91) 1 H. Intended Use: 1. Intended use(s): See Indications for use. 2. Indication(s) for use: VITROS Chemistry Products BARB Reagent: For in vitro diagnostic use only. VITROS Chemistry Products BARB Reagent is used on VITROS 5,1 FS Chemistry Systems for the semi- quantitative or qualitative determination of barbiturates (BARB) in human urine using a cutoff of 200 ng/mL or 300 ng/mL. Measurements obtained with the VITROS BARB method are used in the diagnosis and treatment of barbiturates use or overdose. The VITROS Chemistry Products BARB assay is intended for use by professional laboratory personnel. It provides only a preliminary test result. A more specific alternative chemical method must be used to confirm a result with this assay. Gas Chromatograpy/Mass Spectrometry (GC/MS) is the preferred confirmatory method. Clinical consideration and professional judgment should be applied to any drug-of-abuse test result, particularly when evaluating a preliminary positive result. -
Nembutal [Pentobarbital] Injection and Seconal [Secobarbital] Capsules
Pharmacy Benefit Coverage Criteria Effective Date .......................................... 12/1/2020 Next Review Date… ................................... 12/1/2021 Coverage Policy Number ................................ P0095 Nembutal [pentobarbital] injection and Seconal [secobarbital] capsules Table of Contents Related Coverage Resources Overview .............................................................. 1 Coverage Policy ................................................... 1 FDA Summary ..................................................... 1 General Background ............................................ 2 References .......................................................... 2 INSTRUCTIONS FOR USE The following Coverage Policy applies to health benefit plans administered by Cigna Companies. Certain Cigna Companies and/or lines of business only provide utilization review services to clients and do not make coverage determinations. References to standard benefit plan language and coverage determinations do not apply to those clients. Coverage Policies are intended to provide guidance in interpreting certain standard benefit plans administered by Cigna Companies. Please note, the terms of a customer’s particular benefit plan document [Group Service Agreement, Evidence of Coverage, Certificate of Coverage, Summary Plan Description (SPD) or similar plan document] may differ significantly from the standard benefit plans upon which these Coverage Policies are based. For example, a customer’s benefit plan document may contain a specific -
Simultaneous Rapid HPLC Determination of Anticonvulsant Drugs in Plasma and Correlation with EMIT®
ANNALS OF CLINICAL AND LABORATORY SCIENCE, Vol. 10, No. 1 Copyright© 1980, Institute for Clinical Science, Inc. Simultaneous Rapid HPLC Determination of Anticonvulsant Drugs in Plasma and Correlation with EMIT® RAYMOND S. RYDZEWSKI, M.S., RICHARD H. GADSDEN, P h .D.,* and CONSTANCE A. PHELPS, A.S.M.T. Division of Clinical Chemistry, Department of Laboratory Medicine, Medical University of South Carolina, Charleston, SC 29403 ABSTRACT A method is presented for measuring simultaneously five anti-convulsants (primidone, ethosuximide, phénobarbital, carbamazepine and diphenyl- hydantoin) in serum and plasma by high-performance liquid chroma tography (H PLC) usingalphenal (5 - allyl - 5 - phenyl - barbituric acid) as the internal standard. All five drugs are separated from each other and, in the case of primidone, from its metabolite, 2 - phenyl - 2 - ethyl - malondiamide. Total HPLC time for the separation is seven minutes. The chromatography is performed on a C-8 reverse phase column with a mobile phase consisting of acetonitrile/phosphate buffer (35/65) at 25°C. The eluted drugs are detected at 220 nm and quantitated from their peak heights relative to that of the internal standard. The lower limits of detection for each drug is 200 ng per ml for primidone, 1000 ng per ml for ethosuximide, 200 ng per ml for phéno barbital, 100 ng per ml for carbamazepine and 200 ng per ml for diphenyl- hydantoin. Analytical recoveries for the five drugs ranged from 97 to 107 percent. Correlation of results for 187 specimens by enzyme-immunoassay (EMIT) was 0.981 for primidone, 0.827 for ethosuximide, 0.975 for phéno barbital, 0.889 for carbamazepine and 0.990 for diphenylhydantoin.