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What's the Best First Line Anticonvulsant?
What’s the best first line anticonvulsant? Stephen Hanson, DVM, MS, Dip. ACVIM (Neurology) Recurring seizure activity is a relatively common problem in canine patients. Nowadays, there are several good options for medical treatment, which makes the choice of which drug to use a little more complicated. All anticonvulsant drugs have advantages and disadvantages, so the selection of a first-line drug should be tailored for the individual patient and client. Phenobarbital: This has been the standard first choice drug for decades. The nice thing about Phenobarbital is that it works fairly well, controlling seizures in about 70% of dogs with epilepsy. Also, it is inexpensive and readily available. The biggest down-sides are its induction of hepatic metabolism and the need for frequent upward dose adjustments, as well as its potential to cause hepatotoxicity. The potential for liver disease increases with time, so a 2 year old dog placed on this medication is more likely to develop hepatotoxicity in his life-time than a 10 year old dog. Phenobarbital can also cause sedation and ataxia. While this is usually mild/transient, it can be a real problem in dogs with other pre- existing signs of intracranial disease. Polyuria, polydipsia and polyphagia are other common side effects. These signs vary widely in severity between patients. Pros: cheap, available at any corner pharmacy, works well Cons: higher doses required with time, possible serious liver side-effects Good first-line choice for middle-aged to older dogs without any pre-existing liver issues Poor choice for dogs with liver disease, dogs with other intracranial signs Questionable choice for young epileptic dogs Potassium/sodium bromide: This was the most commonly-used add on anticonvulsant drug for a long time. -
Anesthetic Barbiturates in Refractory Status Epilepticus
LE JOURNAL CANADIEN DES SCIENCES NEUROLOGIQUES Anesthetic Barbiturates in Refractory Status Epilepticus G.B. YOUNG, W.T. BLUME, C.F. BOLTON and K.G. WARREN SUMMARY: Two patients with previous INTRODUCTION hours). With intubation and respiratory cerebral damage and seizures and three Generalized status epilepticus is a support an intravenous bolus of 250 mgms. patients with acute inflammatory cerebral medical emergency requiring prompt thiopental was given, followed by 80-120 lesions developed status epilepticus. They mgm/hr. as a continuous infusion for four treatment to prevent cerebral damage days. The seizures stopped promptly. A were unresponsive to standard anticon or death. Rapidly acting anticonvuls vulsants, but anesthetic barbiturates right-sided hemiparesis resolved over the (thiopental and pentobarbital) stopped the ants such as diazepam, phenytoin or next week and he returned home without seizures promptly. paraldehyde are usually effective. additional neurologicaldeficit. Neurology texts, review articles and Case J. A 41 year old woman developed monographs on epilepsy occasionally measles a week prior to the onset of mention anesthesia for resistant cases. delirium and convulsions. Multi-focal RESUME: Deux patients souffrant pre- Anesthetic barbiturates are less com clonic or grand mal seizures continued for alablement de lesion cerebrate et d'epilepsie two days. These were refractory to et trois patients avec lesions cerebrates de monly specified and their effectiveness is not well documented. We present intravenous phenytoin (a loading dose of nature . inflammatoire aigue developpent 1000 mgm intravenously followed by 200 un status epilepticus. Les patients ne five cases successfully treated with mgm every twelve hours), phenobarbital repondent pas a la medication anticon anesthetic barbiturates after conven (200 mgm intravenous bolus and 60 mgm vulsive standard mais I'emploi de barbitur- tional anticonvulsants failed. -
Chloral Hydrate and Paraldehyde As Drugs of Addiction
Sept., 1932J CHLORAL HYDRATE DRUG HABIT : CHOPRA & SINGH CHOPRA 481 certain parts of the Punjab. This is not the outcome of the use of the drug in the treatment Original Articles of insomnia, but is due to entirely different causes. Until a few years ago in that province potable country-made spirits were allowed to CHLORAL HYDRATE AND PARALDE' be sold to retail dealers in bulk and the vendors HYDE AS DRUGS OF ADDICTION bottled the liquor themselves. Some of these ingenious people conceived the idea of diluting R. N. m.d. By CHOPRA, m.a., (Cantab.) the spirit and adding small quantities of chloral I.M.S. LIEUTENANT-COLONEL, hydrate to make up for the loss in its potency and which would result from dilution. The know- GURBAKHSH SINGH CHOPRA, m.b., b.s. ledge that the drug had hypnotic and narcotic was obtained from the (Drug Addiction Inquiry, Indian Research Fund effects undoubtedly Association) medical profession and compounders work- in It was further learnt that Series No. 15 ing dispensaries. the effects chloral hydrate in many Chloral produced by hydrate and paraldehyde belong to resemble those by alcohol, the of ways produced group drugs known as soporifics or especially when the latter is taken in large The chief use of hypnotics. this class of drugs quantities. When the two articles are taken is in the treatment of one insomnia, of the together they act in a manner synergistic to worst evils of modern times from which man- each other and in this way the effect of either kind can suffer. -
INF.20/Rev.1
INF.20/Rev.1 Economic Commission for Europe Inland Transport Committee 17 January 2017 Working Party on the Transport of Dangerous Goods Joint Meeting of Experts on the Regulations annexed to the European Agreement concerning the International Carriage of Dangerous Goods by Inland Waterways (ADN) (ADN Safety Committee) Thirteenth session Geneva, 23 - 27 January 2017 Item 5 (b) of the provisional agenda Proposals for amendments to the Regulations annexed to ADN: other proposals Autonome Schutzsysteme Mitteilung von EBU, ESO und ERSTU Ausgangslage Zur 29. Sitzung des Sicherheitsausschusses sind zahlreiche Dokumente vorgelegt worden, die die Anforderungen an Explosionsgruppen für nicht-elektrische Geräte betreffen. Weil es aus Zeitgründen nicht möglich war, im ADN 2017 Änderungen vorzunehmen, hat sich der Sicherheitsausschuss darauf geeinigt, die Probleme in der ersten Phase durch multilaterale Abkommen zu regeln. Hierfür ist das Binnenschifffahrtsgewerbe dankbar. Allerdings verlangt die multilaterale Vereinbarung ADN / M 018 von denjenigen Schiffen, deren Zulassungszeugnis nach dem 31. Dezember 2018 erneuert werden muss, schon sehr bald Maßnahmen, die gründlicher Vorbereitung bedürfen. Aus diesem Grunde ist es erforderlich, sich mit einigen vom Schifffahrtsgewerbe aufgeworfenen Fragen rechtzeitig zu beschäftigen. Frage Im Protokoll der 29. Sitzung des Sicherheitsausschusses ADN/WP.15/AC.2/60 ist unter Ziffer 44. festgehalten worden, dass die informelle Arbeitsgruppe „Stoffe“ mittlerweile um die Prüfung verschiedener Sachverhalte gebeten worden ist. Wie weit sind diese Prüfungen gediehen ? Nachfrage zum Protokolls der 29. Sitzung Im Protokoll der 29. Sitzung des Sicherheitsausschusses ADN/WP.15/AC.2/60 ist unter Ziffer 44. – zweiter Unterpunkt - festgehalten worden, dass das Gewerbe die Arbeitsgruppe Stoffe mit einschlägigen Informationen versorgen müsse. Diese Formulierung des Protokolls bedarf der Nachfrage. -
124.210 Schedule IV — Substances Included. 1
1 CONTROLLED SUBSTANCES, §124.210 124.210 Schedule IV — substances included. 1. Schedule IV shall consist of the drugs and other substances, by whatever official name, common or usual name, chemical name, or brand name designated, listed in this section. 2. Narcotic drugs. Unless specifically excepted or unless listed in another schedule, any material, compound, mixture, or preparation containing any of the following narcotic drugs, or their salts calculated as the free anhydrous base or alkaloid, in limited quantities as set forth below: a. Not more than one milligram of difenoxin and not less than twenty-five micrograms of atropine sulfate per dosage unit. b. Dextropropoxyphene (alpha-(+)-4-dimethylamino-1,2-diphenyl-3-methyl-2- propionoxybutane). c. 2-[(dimethylamino)methyl]-1-(3-methoxyphenyl)cyclohexanol, its salts, optical and geometric isomers and salts of these isomers (including tramadol). 3. Depressants. Unless specifically excepted or unless listed in another schedule, any material, compound, mixture, or preparation which contains any quantity of the following substances, including its salts, isomers, and salts of isomers whenever the existence of such salts, isomers, and salts of isomers is possible within the specific chemical designation: a. Alprazolam. b. Barbital. c. Bromazepam. d. Camazepam. e. Carisoprodol. f. Chloral betaine. g. Chloral hydrate. h. Chlordiazepoxide. i. Clobazam. j. Clonazepam. k. Clorazepate. l. Clotiazepam. m. Cloxazolam. n. Delorazepam. o. Diazepam. p. Dichloralphenazone. q. Estazolam. r. Ethchlorvynol. s. Ethinamate. t. Ethyl Loflazepate. u. Fludiazepam. v. Flunitrazepam. w. Flurazepam. x. Halazepam. y. Haloxazolam. z. Ketazolam. aa. Loprazolam. ab. Lorazepam. ac. Lormetazepam. ad. Mebutamate. ae. Medazepam. af. Meprobamate. ag. Methohexital. ah. Methylphenobarbital (mephobarbital). -
Continuous Midazolam Infusion As Treatment of Status Epilepticus
Archives of Disease in Childhood 1997;76:445–448 445 Continuous midazolam infusion as treatment of Arch Dis Child: first published as 10.1136/adc.76.5.445 on 1 May 1997. Downloaded from status epilepticus Roshan Lal Koul, Guru Raj Aithala, Alexander Chacko, Rajendra Joshi, Mussalem Seif Elbualy Abstract Midazolam is a recently developed water In a tertiary referral centre, midazolam soluble benzodiazepine, commonly used as a infusion was tried as treatment for 20 preanaesthetic agent with remarkable anticon- children with status epilepticus over a vulsant action.5 It has been shown to have a period of two years. The mean age of the wide margin of safety and a broad therapeutic children was 4.07 years. Twelve children index. Furthermore, it diVuses rapidly across with refractory status epilepticus had the capillary wall into the central nervous received intravenous or per rectal di- system and can be mixed with saline or glucose azepam and intravenous phenytoin/ solutions to allow its administration as a phenobarbitone or both before midazolam continuous infusion.6 was given (0.15 mg/kg bolus followed by 1–5 µg/kg/min infusion). Eight children required only midazolam to control the Subjects and methods established status epilepticus. The sei- Twenty children suVering from status epilepti- zures were controlled in 19 children. The cus admitted to the paediatric ward from mean time required for complete cessa- November 1993 to November 1995 were tion of seizures was 0.9 hours. The mean included in this study. Eleven were already tak- infusion rate required was 2.0 µg/kg/min. -
State of Illinois Environmental Protection Agency Application for Environmental Laboratory Accreditation
State of Illinois Environmental Protection Agency Application for Environmental Laboratory Accreditation Attachment 6 Program: RCRA Field of Testing: Solid and Chemical Materials, Organic Matrix: Non Solid and Potable Chemical Accredited Water Materials Analyte: Status* Method (SW846): 1,2-Dibromo-3-chloropropane (DBCP) 8011 1,2-Dibromoethane (EDB) 8011 1,4-Dioxane 8015B 1-Butanol (n-Butyl alcohol) 8015B 1-Propanol 8015B 2-Butanone (Methyl ethyl ketone, MEK) 8015B 2-Chloroacrylonitrile 8015B 2-Methyl-1-propanol (Isobutyl alcohol) 8015B 2-Methylpyridine (2-Picoline) 8015B 2-Pentanone 8015B 2-Propanol (Isopropyl alcohol) 8015B 4-Methyl-2-pentanone (Methyl isobutyl ketone, 8015B MIBK) Acetone 8015B Acetonitrile 8015B Acrolein (Propenal) 8015B Acrylonitrile 8015B Allyl alcohol 8015B Crotonaldehyde 8015B Diesel range organics (DRO) 8015B Diethyl ether 8015B Ethanol 8015B Ethyl acetate 8015B Ethylene glycol 8015B Ethylene oxide 8015B Gasoline range organics (GRO) 8015B Hexafluoro-2-methyl-2-propanol 8015B * PI: Pending Initial Accreditation A: Accredited SP: Suspended WD: Accreditation Withdrawn Attachment 6: Page 1 of 62 Program: RCRA Field of Testing: Solid and Chemical Materials, Organic Matrix: Non Solid and Potable Chemical Accredited Water Materials Analyte: Status* Method (SW846): Hexafluoro-2-propanol 8015B Isopropyl benzene ((1-methylethyl) benzene) 8015B Methanol 8015B N-Nitrosodi-n-butylamine (N-Nitrosodibutylamine) 8015B o-Toluidine 8015B Paraldehyde 8015B Propionitrile (Ethyl cyanide) 8015B Pyridine 8015B t-Butyl alcohol 8015B -
186.Full.Pdf
186 CHEMISTR Y: BA NCROFT AND R UTZLER. JR. PROC. N. A. S. I This work is part of the programme now being carried out at Cornell University under a grant from the Heckscher Foundation for the Advancement of Research estab- lished by August Heckscher at Cornell University. 2 Holleman, Rec. trav. chim., 24, 140 (1905). 3 Holleman, Ibid., 23, 225 (1904). 4Drogin and Rosanoff, J. Am. Chem. Soc., 38, 711 (1916). 5 Kraay, Rec. trav. chim., 48, 1055 (1929). 6 De Grauw, Ibid., 48, 1061 (1929). RE VERSIBLE COAGULA TION IN LIVING TISSUE. II By WILDER D. BANCROFTr AND J. E. RUTZLER, JR.2 BAKER CHEMICAL LABORATORY, CORNELL UNIVERSITY Communicated March 3, 1931 Since relief from the addiction to drugs is one of the important problems of the civilized world, it seems wise to see what the outcome is from the application of Claude Bernard's theory of anesthesia to morphinism. Gwathmey' says: "The ganglion cell, according to Binz, is the point of attack of the anesthetic agent. In his experiments, fresh sections of the brain cortex of rabbits were placed in a one per cent solution of morphine hydrochloride, or exposed to chlorine vapors. The effect of coagulation- necrosis was produced, as is seen when protoplasmic poisons of neutral reaction are allowed to act upon large transparent infusoria. The proto- plasm is first darkened, and the movements become sluggish; later the protoplasm becomes granulated, and the movements cease. Recupera- tion may take place from the first stage by washing away the poisons [it can be seen that this is the same as the peptization of gels by washing out the coagulating agent]; but not from the last stage. -
A. Schedule IV Shall Consist Of
1 REVISOR 6800.4240 6800.4240 SCHEDULE IV CONTROLLED SUBSTANCES. The following items are listed in Schedule IV: A. Schedule IV shall consist of the drugs and other substances, by whatever official name, common or usual name, chemical name, or brand name designated, listed in this part. B. Narcotic drugs. Unless specifically excepted or unless listed in another schedule, any material, compound, mixture, or preparation containing any of the following narcotic drugs, or their salts calculated as the free anhydrous base or alkaloid, in limited quantities as follows: (1) Not more than one milligram of difenoxin and not less than 25 micrograms of atropine sulfate per dosage unit. (2) Dextropropoxyphene (alpha-(+)-4-dimethylamino-1,2-diphenyl-3-methyl-2- propionoxybutane), for example, Darvon, Darvocet. C. Depressants. Unless specifically excepted or unless listed in another schedule, any material, compound, mixture, or preparation which contains any quantity of the following substances, including its salts, isomers, and salts of isomers whenever the existence of such salts, isomers, and salts of isomers is possible within the specific chemical designation: Statutory Name Some examples of common names, trade names, or names of products which contain a controlled substance (1) Alprazolam Xanax (2) Barbital Barbitone (3) Bromazepam (4) Camazepam (5) Chloral betaine Beta-Chlor (6) Chloral hydrate Noctec, Somnos (7) Chlordiazepoxide Librium, Libritabs (8) Clobazam (9) Clonazepam Clonopin (10) Clorazepate Tranxene (11) Clotiazepam Copyright ©2013 -
Pharmaceuticals and Medical Devices Safety Information No
Pharmaceuticals and Medical Devices Safety Information No. 260 August 2009 Table of Contents 1. Tricyclic and tetracyclic antidepressants, associated with aggression ................................................................................................... 3 2. Important Safety Information .................................................................. 9 .1. Telmisartan ··························································································· 9 .2. Phenytoin, Phenytoin/Phenobarbital, Phenytoin/Phenobarbital/ Caffeine and Sodium Benzoate, Phenytoin Sodium ··························· 13 3. Revision of PRECAUTIONS (No. 208) Lamotrigine (and 9 others) ············································································ 17 4. List of products subject to Early Post-marketing Phase Vigilance ..................................................... 21 This Pharmaceuticals and Medical Devices Safety Information (PMDSI) is issued based on safety information collected by the Ministry of Health, Labour and Welfare. It is intended to facilitate safer use of pharmaceuticals and medical devices by healthcare providers. PMDSI is available on the Pharmaceuticals and Medical Devices Agency website (http://www.pmda.go.jp/english/index.html) and on the MHLW website (http://www.mhlw.go.jp/, Japanese only). Published by Translated by Pharmaceutical and Food Safety Bureau, Pharmaceuticals and Medical Devices Agency Ministry of Health, Labour and Welfare Pharmaceutical and Food Safety Bureau, Office of Safety I, Ministry of -
Bromides Potassium Bromide, Sodium Bromide Kbr and Nabr Are Other Names for This Medication
Bromides Potassium Bromide, Sodium Bromide KBr and NaBr are other names for this medication. How Is This Medication Useful? • Potassium bromide or sodium bromide are used to treat dogs with epilepsy, either alone, or in combination with other drugs. • They are used in cats with epilepsy on if other drugs fail to work well. • Bromides are a chemical rather than an FDA approved drug. American Chemical Society (ACS) grade bromide should be used for seizure therapy. Are There Conditions or Times When Its Use Might Cause More Harm Than Good? • Bromides must be eliminated from the body by the kidneys. Animals with severe kidney disease may have problems with this drug, if they don’t make enough urine. • Human infants have suffered growth retardation when born to mothers who took bromides. Potassium bromide should probably not be used in pregnant or nursing mothers unless the benefit of use outweighs the risk of adverse effects. • The intake of chloride will have to be very carefully controlled while your animal is on this drug. Do not give your animal any salty treats and always check with your veterinarian before giving new foods or snacks while on this medication. • If your animal has any of the above conditions, talk to your veterinarian about the potential risks of using the medication versus the benefits that it might have. • Some cats can develop fluid in the lungs while taking bromides and cats who are taking bromides should do so only when seizures can not be controlled by other drugs, and only if carefully monitored for breathing problems. -
Pharmacology
STATE ESTABLISHMENT «DNIPROPETROVSK MEDICAL ACADEMY OF HEALTH MINISTRY OF UKRAINE» V.I. MAMCHUR, V.I. OPRYSHKO, А.А. NEFEDOV, A.E. LIEVYKH, E.V.KHOMIAK PHARMACOLOGY WORKBOOK FOR PRACTICAL CLASSES FOR FOREIGN STUDENTS STOMATOLOGY DEPARTMENT DNEPROPETROVSK - 2016 2 UDC: 378.180.6:61:615(075.5) Pharmacology. Workbook for practical classes for foreign stomatology students / V.Y. Mamchur, V.I. Opryshko, A.A. Nefedov. - Dnepropetrovsk, 2016. – 186 p. Reviewed by: N.I. Voloshchuk - MD, Professor of Pharmacology "Vinnitsa N.I. Pirogov National Medical University.‖ L.V. Savchenkova – Doctor of Medicine, Professor, Head of the Department of Clinical Pharmacology, State Establishment ―Lugansk state medical university‖ E.A. Podpletnyaya – Doctor of Pharmacy, Professor, Head of the Department of General and Clinical Pharmacy, State Establishment ―Dnipropetrovsk medical academy of Health Ministry of Ukraine‖ Approved and recommended for publication by the CMC of State Establishment ―Dnipropetrovsk medical academy of Health Ministry of Ukraine‖ (protocol №3 from 25.12.2012). The educational tutorial contains materials for practical classes and final module control on Pharmacology. The tutorial was prepared to improve self-learning of Pharmacology and optimization of practical classes. It contains questions for self-study for practical classes and final module control, prescription tasks, pharmacological terms that students must know in a particular topic, medical forms of main drugs, multiple choice questions (tests) for self- control, basic and additional references. This tutorial is also a student workbook that provides the entire scope of student’s work during Pharmacology course according to the credit-modular system. The tutorial was drawn up in accordance with the working program on Pharmacology approved by CMC of SE ―Dnipropetrovsk medical academy of Health Ministry of Ukraine‖ on the basis of the standard program on Pharmacology for stomatology students of III - IV levels of accreditation in the specialties Stomatology – 7.110105, Kiev 2011.