RESUMO
Benzodiazepines are widely used but can cause considerable harm, including sedation, addiction, falls, fractures, and cognitive impairment, especially with long-term use and in elderly patients. The authors propose a public health approach to reduce the potential for harm when using benzodiazepines to treat insomnia. Primary prevention involves judicious patient selection and patient education. Secondary prevention requires keeping the duration of use as short as possible according to guidelines. Tertiary prevention, for patients who have been taking a benzodiazepine for a long time, uses shared decision-making to introduce a gradual and carefully monitored taper.
Assuntos
Benzodiazepinas , Distúrbios do Início e da Manutenção do Sono , Humanos , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico , Benzodiazepinas/efeitos adversos , Benzodiazepinas/uso terapêutico , Saúde Pública , Hipnóticos e Sedativos/efeitos adversos , Hipnóticos e Sedativos/uso terapêutico , Seleção de Pacientes , Educação de Pacientes como Assunto , Prevenção Primária/métodosRESUMO
Buprenorphine is a safe and effective treatment for opioid use disorder but remains underutilized because a major challenge of conventional buprenorphine initiation (termed induction) is that the patient must already be in opioid withdrawal. Previous legal barriers and clinician lack of familiarity with the unique pharmacology of buprenorphine have also limited its use. In this review, we outline changes regarding buprenorphine prescribing laws and physician perceptions of buprenorphine. We also review buprenorphine pharmacology and novel low-dose buprenorphine induction procedures that can be adopted in primary care settings to improve treatment acceptability, retention, and outcomes.
Assuntos
Buprenorfina , Transtornos Relacionados ao Uso de Opioides , Médicos , Síndrome de Abstinência a Substâncias , Humanos , Buprenorfina/farmacologia , Buprenorfina/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Atenção Primária à SaúdeAssuntos
Naltrexona , Transtornos Relacionados ao Uso de Opioides , Humanos , Naltrexona/uso terapêutico , Determinantes Sociais da Saúde , Antagonistas de Entorpecentes/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Preparações de Ação Retardada/uso terapêuticoRESUMO
Attention-deficit hyperactivity disorder (ADHD) is frequently comorbid with anxiety disorders with rates as high as 25% to 50% in children and adolescents. Despite various treatment options for ADHD symptoms, limited research addresses treatment in the context of comorbidity. This article seeks to provide a review of the evidence regarding treatment of this comorbid population. Distinct emotional, cognitive, and behavioral symptoms have been observed in this population, suggesting a need for tailored treatment. Despite common concerns about anxiety exacerbation, stimulant medications demonstrate good tolerability and good response in addressing symptoms. Atomoxetine has also demonstrated some benefit and good tolerability for treating this comorbid population. Selective serotonin reuptake inhibitors can be used as adjunctive treatment for anxiety but require careful monitoring of side effects. Cognitive behavioral therapy (CBT) is an important treatment to improve anxiety symptoms in the absence of significant ADHD symptoms. Psychosocial interventions are also essential to improve outcomes.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Criança , Adolescente , Humanos , Transtorno do Deficit de Atenção com Hiperatividade/complicações , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Cloridrato de Atomoxetina/uso terapêutico , Transtornos de Ansiedade/epidemiologia , Transtornos de Ansiedade/terapia , Transtornos de Ansiedade/diagnóstico , Comorbidade , Ansiedade/epidemiologia , Ansiedade/terapiaAssuntos
Benzodiazepinas , Desprescrições , Humanos , Benzodiazepinas/efeitos adversos , Redução do DanoRESUMO
The second-generation antipsychotic drug quetiapine (Seroquel) is increasingly being used off-label for treating insomnia in the general population, possibly to avoid standard medications with known addictive qualities and adverse side effects. However, evidence to support using it in this way is scant, and quetiapine is associated with weight gain and other metabolic effects. It must be used cautiously and with appropriate monitoring for adverse effects and abuse.
