Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.392
Filtrar
1.
Ceska Slov Farm ; 68(4): 139-147, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31822106

RESUMO

Benzodiazepines (BZDs) and Z-drugs are strongly addictive substances, acting on identical GABA receptors. Detoxification should be long-term and gradual, usually by tapering a long-acting BZD (diazepam) but no suitable commercial pharmaceutic product exists with the necessary low drug content. This review describes the specific pharmacological aspects and comparisons of individual BZDs in relation to their effects and addictiveness. The success of the treatment relates to the patients comfort during this process. Patients are typically afraid of switching to a more suitable long-acting BZD (diazepam), and become stressed during the tapering and anxious from withdrawal symptoms. These obstacles could be overcome through individualized detoxification according to already published withdrawal schedules based on the administration of very precise diazepam doses in a long-term gradual tapering with possible addition of adjuvant drugs. Dose reduction does not change external appearance of the dosage form, and the patient could be treated until the placebo phase. Individually prepared pharmaceutics with different and precise diazepam contents can be used for comfortable detoxification and also may eliminate psychogenic stress during switching, tapering, and the withdrawal period.


Assuntos
Benzodiazepinas/efeitos adversos , Diazepam/uso terapêutico , Síndrome de Abstinência a Substâncias/prevenção & controle , Transtornos Relacionados ao Uso de Substâncias/tratamento farmacológico , Benzodiazepinas/administração & dosagem , Esquema de Medicação , Humanos , Inativação Metabólica
2.
Medicina (B Aires) ; 79(4): 315-321, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31487255

RESUMO

One of the main pillars of acute ischemic stroke management is antiplatelet therapy. Different treatment schemes have been compared, suggesting that the combination of multiple antiplatelet drugs is associated with a reduced risk of stroke recurrence. However, it has also been associated with an increased risk of bleeding complications which, in the long term, surpass the mentioned benefits. However, considering that most stroke recurrences occur i n the short term, a time limited double antiplatelet scheme could result in significant benefits to patients with acute ischemic stroke. On this basis, we conducted a rapid systematic review of the literature in order to evaluate the effects of a short-term double antiplatelet therapy both on stroke recurrence and complications. All trials comparing double versus single antiplatelet therapy in patients with acute ischemic stroke were included. Results showed that double therapy reduces recurrence risk but probably marginally increases major bleeding complications. We suggest double antiplatelet therapy for the initial management of patients with minor (Score NIH < or equal to 3 or transient isquemic attack -TIA) acute ischemic stroke.


Assuntos
Aspirina/administração & dosagem , Benzodiazepinas/administração & dosagem , Clopidogrel/administração & dosagem , Ataque Isquêmico Transitório/tratamento farmacológico , Ataque Isquêmico Transitório/prevenção & controle , Inibidores da Agregação de Plaquetas/administração & dosagem , Poliaminas/administração & dosagem , Quimioterapia Combinada , Humanos , Recidiva , Prevenção Secundária
4.
Cien Saude Colet ; 24(8): 2993-3000, 2019 Aug 05.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31389546

RESUMO

OBJECTIVE: To investigate the process of medicalization among the Xukuru indigenous people of Pesqueira (PE), Brazil following the 2003 conflict. METHOD: This is a descriptive, cross-sectional, quantitative study developed with the indigenous attended at the Xukuru de Cimbres basic center. The final sample consisted of 75 individuals who used psychotropic drugs. Data were analyzed by SPSS version 18.0, using the chi-square test. RESULTS AND DISCUSSION: We observed that 8% of the studied population use psychotropic drugs, and the most used is BZD (78.67%). Regarding age, 68% are young adults and 26.67% are elderly. The income of 81.33% of households is more than one minimum wage. As for marital status, 50.85% and 66.67%, respectively of the indigenous group using BZD and other psychotropic drugs are married. CONCLUSION: The study outlined the profile of the Xukuru de Cimbres indigenous people who used psychotropics and showed a fragmented mental health care focused on the disease and the use of medication. Results reveal a socioeconomically vulnerable adult population, a pattern of chronic use of psychotropic drugs and distancing from traditional indigenous healing, typical of the health medicalization process.


Assuntos
Índios Sul-Americanos/estatística & dados numéricos , Medicalização , Transtornos Mentais/tratamento farmacológico , Psicotrópicos/administração & dosagem , Adolescente , Adulto , Benzodiazepinas/administração & dosagem , Brasil , Estudos Transversais , Feminino , Humanos , Renda , Masculino , Medicina Tradicional/métodos , Serviços de Saúde Mental/organização & administração , Pessoa de Meia-Idade , Adulto Jovem
5.
Psychiatr Prax ; 46(7): 399-405, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31412372

RESUMO

OBJECTIVE: The majority of medication-dependent persons uses sedatives and hypnotics for many years. In this study we describe trends of benzodiazepine and z-drug prescriptions over a 10-years period. METHODS: Prescriptions from 2006 to 2015 (based on German statutory health insurances) from the North German Pharmacy Computing Centre (NARZ) were analysed for the Federal states Schleswig-Holstein, Hamburg, Lower Saxony and Bremen. Data were classified as appropriate (in accordance with the guideline) or inappropriate/risky prescription patterns. RESULTS: In a 10-years period 1.64 Million patients received benzodiazepine and/or z-drug prescriptions. Two thirds were women (65.3 %). More than half were 60 years or older. The percentage of patients with appropriate prescriptions (less than 2 months) increased from 51.7 % in 2006 to 60.2 % in 2015. The rate of inappropriate or risky prescription patterns which can be indicative of misuse or dependence dropped from 34.8 % in 2006 to 27.1 % in 2015. CONCLUSION: Over the past years the amount of inappropriate or risky benzodiazepine and z-drug prescriptions (which are not in accordance with the guideline) among patients with statutory health insurance is steadily decreasing. However, two fifths of the patients still received prescriptions for long-term intake or in higher doses. It remains unclear to what extent private prescriptions are used for inappropriate or long-term prescriptions of benzodiazepines and z-drugs.


Assuntos
Benzodiazepinas , Prescrições de Medicamentos , Hipnóticos e Sedativos , Benzodiazepinas/administração & dosagem , Feminino , Alemanha , Humanos , Hipnóticos e Sedativos/administração & dosagem , Prescrição Inadequada , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica
6.
Eur J Gen Pract ; 25(3): 157-163, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335225

RESUMO

Background: Comorbid anxiety and depression and type two diabetes mellitus (T2DM) are commonly managed by General Practitioners (GPs). Objectives: To investigate the proportion of people with T2DM who are prescribed either antidepressant or benzodiazepine medications in general practice; to compare people with T2DM that have a prescription with those that do not in terms of patient characteristics, glycaemic control and healthcare utilization. Methods: Anonymized data was collected by GPs and senior medical students from electronic medical records of patients with T2DM in 34 Irish general practices affiliated with the University of Limerick Graduate Entry Medical School during the 2013/14 academic year. Data included demographics, healthcare utilization, prescriptions and most recent glycosylated haemoglobin (HbA1c) measurement. Results: The sample included 2696 patients with T2DM, of which 733 (36.7%) were female, and with a median age of 66 years. The percentage with a current prescription for an antidepressant or benzodiazepine was 22% (95%CI: 18.9-24.9). Those with a current prescription for either drug were more likely to have attended the emergency department (28.3% vs 15.7%, P <0.001), to have been admitted to hospital (35.4% vs 21.3%, P <0.001) in the past year and attend their GP more frequently (median of 9 vs 7, P <0.001) than those without a prescription. Rates of poor glycaemic control were similar in those with and without a current prescription. Conclusion: Over one-fifth of people with T2DM in Irish general practice are prescribed an antidepressant or benzodiazepine medication. Prescription of these is associated with increased healthcare utilization but not poorer glycaemic control.


Assuntos
Antidepressivos/administração & dosagem , Benzodiazepinas/administração & dosagem , Glicemia/metabolismo , Diabetes Mellitus Tipo 2/psicologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ansiedade/tratamento farmacológico , Criança , Depressão/tratamento farmacológico , Diabetes Mellitus Tipo 2/fisiopatologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Medicina Geral , Hemoglobina A Glicada/metabolismo , Hospitalização/estatística & dados numéricos , Humanos , Irlanda , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
7.
Psychopharmacology (Berl) ; 236(11): 3271-3279, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31183518

RESUMO

RATIONALE: Compounds lacking efficacy at the α1 subunit-containing GABAA (α1GABAA) receptor appear to have reduced abuse potential compared with those having measurable efficacy at this receptor, though their self-administration in nonhuman primates is dependent upon past drug experience. OBJECTIVES: We used a drug vs. drug choice procedure to evaluate the hypothesis that L-838,417, a compound lacking efficacy at αGABAA receptors, would not enhance cocaine choice in monkeys trained to self-administer cocaine. We also hypothesized that zolpidem, a compound with preferential modulation of ⍺1GABAA receptors and midazolam, a nonselective benzodiazepine, would enhance cocaine choice in this procedure. METHODS: One female and three male rhesus monkeys chose between cocaine alone (0.1 mg/kg/injection) vs. the same dose of cocaine combined with midazolam (0.003-0.1 mg/kg/injection), zolpidem (0.003-0.3 mg/kg/injection), or L-838-417 (0.01-0.1 mg/kg/injection). In addition, we evaluated choice between saline and L-838,417 at select doses to determine whether L-838,417 would function as a reinforcer on its own. RESULTS: Consistent with our hypotheses, midazolam- and zolpidem-cocaine mixtures were chosen over cocaine alone at sufficiently high doses. However, L-838,417-cocaine mixtures also were chosen over cocaine alone in three of four subjects with at least one dose. When available alone vs. saline, L-838,417 did not function as a reinforcer in any subject. CONCLUSION: Compounds that lack efficacy at α1GABAA receptors may have low abuse potential compared to classic benzodiazepines, but self-administration of these compounds is context-dependent.


Assuntos
Benzodiazepinas/administração & dosagem , Comportamento de Escolha/efeitos dos fármacos , Comportamento de Escolha/fisiologia , Cocaína/administração & dosagem , Inibidores da Captação de Dopamina/administração & dosagem , Receptores de GABA-A/fisiologia , Animais , Relação Dose-Resposta a Droga , Combinação de Medicamentos , Feminino , Fluorbenzenos/administração & dosagem , Macaca mulatta , Masculino , Autoadministração , Triazóis/administração & dosagem
8.
Curr Opin Anaesthesiol ; 32(4): 457-463, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31219870

RESUMO

PURPOSE OF REVIEW: The purpose of this review is to discuss current drugs used for intravenous moderate and deep sedation by nonanesthesiologists in the United States. We also explore training expectations for moderate and deep sedation as they play key roles in anesthetic selection and preprocedural planning. RECENT FINDINGS: Although opioids and benzodiazepines are considered the standard for moderate sedation, increased interest in propofol, dexmedetomidine, and other sedative-hyptonic drugs require additional attention in terms of training providers and complying with current practice guidelines. SUMMARY: Moderate sedation providers should be familiar with titrating benzodiazepines and opioids to achieve targeted sedation. The use of propofol and ketamine is generally reserved for deep sedation by qualified professionals. However, the role of dexmedetomidine in procedural sedation continues to evolve as its use is explored in moderate sedation. Providers of all sedation types should be aware of hypotension, apnea, hypoventilation, and hypoxia that can develop and they should be able to manage the patient under these circumstances. Preprocedural planning is an integral training expectation to minimize patient risks.


Assuntos
Anestesiologia/educação , Sedação Consciente/métodos , Sedação Profunda/métodos , Educação Médica Continuada , Hipnóticos e Sedativos/administração & dosagem , Administração Intravenosa , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/efeitos adversos , Anestesiologia/normas , Apneia/diagnóstico , Apneia/etiologia , Benzodiazepinas/administração & dosagem , Benzodiazepinas/efeitos adversos , Sedação Consciente/efeitos adversos , Sedação Consciente/normas , Estado de Consciência/efeitos dos fármacos , Sedação Profunda/efeitos adversos , Sedação Profunda/normas , Dexmedetomidina/administração & dosagem , Dexmedetomidina/efeitos adversos , Relação Dose-Resposta a Droga , Humanos , Hipnóticos e Sedativos/efeitos adversos , Hipotensão/diagnóstico , Hipotensão/etiologia , Hipoventilação/diagnóstico , Hipoventilação/etiologia , Hipóxia/diagnóstico , Hipóxia/etiologia , Guias de Prática Clínica como Assunto , Propofol/administração & dosagem , Propofol/efeitos adversos
9.
Acta Otolaryngol ; 139(7): 593-597, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31107129

RESUMO

Background: Regarding the relationship between psychiatric disorders and dizziness, anxiety is the most frequently seen psychiatric disorder in dizzy patients. Objective: We compared the effects of anti-anxious benzodiazepines (loflazepate) and anti-vertiginous cholinergic antagonist (diphenidol) on the subjective symptoms in chronic vestibular patients with secondary anxiety. Methods: Forty-three patients who had chronic dizziness lasting more than three months due to organic vestibular diseases with secondary anxiety. Anxiety was evaluated by the State-Trait Anxiety Inventory (STAI). Subjective handicaps due to dizziness were assessed by the validated questionnaire consisted of 14 questions that were categorized into two physical and three emotional factors. During the initial six months of the study, 21 patients were treated by anti-anxious benzodiazepines (loflazepate, 2 mg/day) for four weeks, whereas anti-vertiginous cholinergic antagonist (diphenidol, 75 mg/day) was used for four weeks for other 22 patients during the later six months-period. Subjective handicaps and STAI were compared between pre- and post-treatment. Results: Loflazepate improved not only three emotional factors and state anxiety but also one of the physical factors. Diphenidol improved two physical factors but no emotional factors nor state and trait anxiety. Conclusions: Targeting for comorbid anxiety was beneficial for subjective symptoms of chronic dizziness with secondary anxiety.


Assuntos
Ansiedade/tratamento farmacológico , Ansiedade/epidemiologia , Benzodiazepinas/administração & dosagem , Tontura/epidemiologia , Piperidinas/administração & dosagem , Doenças Vestibulares/epidemiologia , Adulto , Ansiolíticos/uso terapêutico , Ansiedade/diagnóstico , Estudos de Coortes , Comorbidade , Tontura/diagnóstico , Tontura/tratamento farmacológico , Feminino , Seguimentos , Humanos , Incidência , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Medição de Risco , Resultado do Tratamento , Doenças Vestibulares/diagnóstico
10.
PLoS Negl Trop Dis ; 13(5): e0007373, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31120889

RESUMO

Infections of humans and livestock with African trypanosomes are treated with drugs introduced decades ago that are not always fully effective and often have severe side effects. Here, the trypanosome haptoglobin-haemoglobin receptor (HpHbR) has been exploited as a route of uptake for an antibody-drug conjugate (ADC) that is completely effective against Trypanosoma brucei in the standard mouse model of infection. Recombinant human anti-HpHbR monoclonal antibodies were isolated and shown to be internalised in a receptor-dependent manner. Antibodies were conjugated to a pyrrolobenzodiazepine (PBD) toxin and killed T. brucei in vitro at picomolar concentrations. A single therapeutic dose (0.25 mg/kg) of a HpHbR antibody-PBD conjugate completely cured a T. brucei mouse infection within 2 days with no re-emergence of infection over a subsequent time course of 77 days. These experiments provide a demonstration of how ADCs can be exploited to treat protozoal diseases that desperately require new therapeutics.


Assuntos
Anticorpos Monoclonais/administração & dosagem , Antiprotozoários/administração & dosagem , Benzodiazepinas/administração & dosagem , Pirróis/administração & dosagem , Tripanossomíase Africana/tratamento farmacológico , Animais , Anticorpos Monoclonais/química , Antiprotozoários/química , Benzodiazepinas/química , Feminino , Humanos , Camundongos , Camundongos Endogâmicos BALB C , Pirróis/química , Trypanosoma brucei brucei/efeitos dos fármacos , Tripanossomíase Africana/parasitologia
11.
Drug Des Devel Ther ; 13: 1033-1047, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31037028

RESUMO

Background: Remimazolam is an ultra-short acting benzodiazepine under development for procedural sedation and general anesthesia. It is hydrolyzed by CES1 to an inactive metabolite (CNS7054). Purpose: In this study, the effect of continuous remimazolam exposure on its metabolism and on CES1 expression was investigated in a dynamic 3-D bioreactor culture model inoculated with primary human hepatocytes. Methods: Remimazolam was continuously infused into bioreactors for 5 days at a final concentration of 3,000 ng/ml (6.8 µM). In parallel, 2-D cultures were run with cells from the same donors, but with discontinuous exposure to remimazolam. Results: Daily measurement of clinical chemistry parameters (glucose, lactate, urea, ammonia, and liver enzymes) in culture supernatants indicated no noxious effect of remimazolam on hepatocyte integrity as compared to untreated controls. Concentrations of remimazolam reached steady-state values of around 250 ng/ml within 8 hours in 3-D bioreactors whereas in 2-D cultures remimazolam concentrations declined to almost zero within the same time frame. Levels of CNS7054 showed an inverse time-course reaching average values of 1,350 ng/ml in perfused 3-D bioreactors resp. 2,800 ng/ml in static 2-D cultures. Analysis of mRNA expression levels of CES1 indicated no changes in gene expression over the culture period. Conclusion: The results indicated a stable metabolism of remimazolam during 5 days of continuous exposure to clinically relevant concentrations of the drug. Moreover, there was no evidence for a harmful effect of remimazolam exposure on the integrity and metabolic activity of in vitro cultivated primary human hepatocytes.


Assuntos
Benzodiazepinas/metabolismo , Reatores Biológicos , Hepatócitos/metabolismo , Benzodiazepinas/administração & dosagem , Benzodiazepinas/farmacologia , Hidrolases de Éster Carboxílico/biossíntese , Hepatócitos/efeitos dos fármacos , Humanos
12.
Obstet Gynecol ; 133(6): 1120-1130, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31135725

RESUMO

OBJECTIVE: To examine opioid use, opioid prescribing patterns, and timing of the first opioid prescription in endometriosis patients compared with matched women in the control group without endometriosis. METHODS: We conducted a retrospective analysis of the Clinformatics Datamart database. Women diagnosed with endometriosis from January 2006 through December 2016 and aged 18-49 years were compared with women in the control group matched on age, region, race, insurance payer, and plan type. Key outcomes included: filled prescription for an opioid, multiple opioid prescriptions, number of days' supply, daily dose (morphine milligram equivalents), and concomitant opioid and benzodiazepine prescriptions. Cohorts were descriptively analyzed using t- and χ statistics and multivariable regression analyses yielded adjusted relative risk (RR) ratios and 95% CI. RESULTS: The study sample included 53,847 endometriosis patients and 107,694 patients in the control group. The mean age was 38 years, 62.4% of patients were white, and 51.6% lived in the South. Women in the endometriosis case group, compared with women in the control group, were more likely to fill an opioid prescription (42,705 [79.3%] women in the case group vs 26,106 [24.2%] women in the control group; adjusted RR ratio 2.91; 2.87-2.94), had higher likelihood of filling prescriptions with a dose of 50 morphine milligram equivalents or more (24,544 [45.6%] vs 10,463 [9.7%]; adjusted RR ratio 4.07; 3.98-4.16) or 100 morphine milligram equivalents or more (8,013 [14.9%] vs 3,582 [3.3%]; adjusted RR ratio 3.56; 3.43-3.70). Women in the case group were more likely to have concomitant opioid and benzodiazepine prescriptions (5,453 [10.1%] vs 3,711 [3.5%]; adjusted RR ratio 1.95; 1.88-2.03) and to have used these drugs concurrently for at least 30 days (1,596 [3.0%] vs 1,265 [1.2%]; adjusted RR ratio 1.43; 1.34-1.52) or at least 90 days (875 [1.6%] vs 777 [0.7%]; adjusted RR ratio 1.27; 1.17-1.37). Similar results were obtained after excluding opioid prescriptions received during a 30-day postsurgery window. CONCLUSION: Women with endometriosis had higher probabilities of prolonged use of opioids and concomitant use with benzodiazepines compared with women without this condition. FUNDING SOURCE: This study was funded by AbbVie, Inc.


Assuntos
Analgésicos Opioides/administração & dosagem , Benzodiazepinas/administração & dosagem , Endometriose/tratamento farmacológico , Padrões de Prática Médica/estatística & dados numéricos , Adolescente , Adulto , Bases de Dados Factuais , Feminino , Humanos , Pessoa de Meia-Idade , Análise Multivariada , Análise de Regressão , Estudos Retrospectivos , Risco , Estados Unidos , Adulto Jovem
13.
JAMA Netw Open ; 2(4): e192613, 2019 04 05.
Artigo em Inglês | MEDLINE | ID: mdl-31002325

RESUMO

Importance: Attempts to discontinue opioid therapy to reduce the risk of overdose and adhere to prescribing guidelines may lead patients to be exposed to variability in opioid dosing. Such dose variability may increase the risk of opioid overdose even if therapy discontinuation is associated with a reduction in risk. Objective: To examine the association between opioid dose variability and opioid overdose. Design, Setting, and Participants: A nested case-control study was conducted in a large Colorado integrated health plan and delivery system from January 1, 2006, through June 30, 2018. Cohort members were individuals prescribed long-term opioid therapy. Exposures: Dose variability was defined as the SD of the milligrams of morphine equivalents across each patient's follow-up and categorized based on the quintile distribution of the SD in the cohort (0-5.3, 5.4-9.1, 9.2-14.6, 14.7-27.2, and >27.2 mg of morphine equivalents). Main Outcomes and Measures: Opioid overdose cases were identified using International Classification of Diseases, Ninth Revision and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes. Each case patient with overdose was matched to up to 20 control patients using risk set sampling. Conditional logistic regression models were used to generate matched odds ratios and 95% CIs, adjusted for age, sex, race/ethnicity, drug or alcohol use disorder, tobacco use, benzodiazepine dispensings, medical comorbidities, mental health disorder, opioid dose, and opioid formulation. Results: In a cohort of 14 898 patients (mean [SD] age, 56.3 [16.0] years; 8988 [60.3%] female) prescribed long-term opioid therapy, 228 case patients with incident opioid overdose were matched to 3547 control patients. The mean (SD) duration of opioid therapy was 36.7 (33.7) months in case patients and 33.0 (30.9) months in control patients. High-dose variability (SD >27.2 mg of morphine equivalents) was associated with a significantly increased risk of overdose compared with low-dose variability (matched odds ratio, 3.32; 95% CI, 1.63-6.77) independent of opioid dose. Conclusions and Relevance: Variability in opioid dose may be a risk factor for opioid overdose, suggesting that practitioners should seek to minimize dose variability when managing long-term opioid therapy.


Assuntos
Analgésicos Opioides/administração & dosagem , Benzodiazepinas/administração & dosagem , Overdose de Drogas/etiologia , Morfina/administração & dosagem , Adulto , Estudos de Casos e Controles , Estudos de Coortes , Colorado , Relação Dose-Resposta a Droga , Cálculos da Dosagem de Medicamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Fatores de Risco , Suspensão de Tratamento
14.
Fortschr Neurol Psychiatr ; 87(4): 259-270, 2019 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-30999380

RESUMO

Long-term prescriptions of benzodiazepines are made mainly to elderly and female patients. Withdrawal treatments should be carried out gradually over a period of several weeks. Sleep and depressive disorders during benzodiazepine withdrawal can best be treated with sedating antidepressants. The few studies on this subject suggest psychoeducation, motivational strategies and cognitive behavioural therapy as having some efficacy.


Assuntos
Ansiolíticos , Antidepressivos/uso terapêutico , Benzodiazepinas , Terapia Cognitivo-Comportamental , Hipnóticos e Sedativos/uso terapêutico , Síndrome de Abstinência a Substâncias/terapia , Ansiolíticos/administração & dosagem , Ansiolíticos/efeitos adversos , Benzodiazepinas/administração & dosagem , Benzodiazepinas/efeitos adversos , Humanos , Motivação , Síndrome de Abstinência a Substâncias/tratamento farmacológico , Síndrome de Abstinência a Substâncias/psicologia
16.
BMC Anesthesiol ; 19(1): 55, 2019 04 12.
Artigo em Inglês | MEDLINE | ID: mdl-30987594

RESUMO

BACKGROUND: Perioperative hypothermia is still very common and associated with numerous adverse effects. The effects of benzodiazepines, administered as premedication, on thermoregulation have been studied with conflicting results. We investigated the hypotheses that premedication with flunitrazepam would lower the preoperative core temperature and that prewarming could attenuate this effect. METHODS: After approval by the local research ethics committee 50 adult cardiac surgical patients were included in this prospective, randomized, controlled, single-centre study with two parallel groups in a university hospital setting. Core temperature was measured using a continuous, non-invasive zero-heat flux thermometer from 30 min before administration of the oral premedication until beginning of surgery. An equal number of patients was randomly allocated via a computer-generated list assigning them to either prewarming or control group using the sealed envelope method for blinding. The intervention itself could not be blinded. In the prewarming group patients received active prewarming using an underbody forced-air warming blanket. The data were analysed using Student's t-test, Mann-Whitney U-test and Fisher's exact test. RESULTS: Of the randomized 25 patients per group 24 patients per group could be analysed. Initial core temperature was 36.7 ± 0.2 °C and dropped significantly after oral premedication to 36.5 ± 0.3 °C when the patients were leaving the ward and to 36.4 ± 0.3 °C before induction of anaesthesia. The patients of the prewarming group had a significantly higher core temperature at the beginning of surgery (35.8 ± 0.4 °C vs. 35.5 ± 0.5 °C, p = 0.027), although core temperature at induction of anaesthesia was comparable. Despite prewarming, core temperature did not reach baseline level prior to premedication (36.7 ± 0.2 °C). CONCLUSIONS: Oral premedication with benzodiazepines on the ward lowered core temperature significantly at arrival in the operating room. This drop in core temperature cannot be offset by a short period of active prewarming. TRIAL REGISTRATION: This trial was prospectively registered with the German registry of clinical trials under the trial number DRKS00005790 on 20th February 2014.


Assuntos
Benzodiazepinas/efeitos adversos , Temperatura Corporal/fisiologia , Procedimentos Cirúrgicos Cardíacos/métodos , Temperatura Alta/uso terapêutico , Pré-Medicação/efeitos adversos , Cuidados Pré-Operatórios/métodos , Administração Oral , Adulto , Idoso , Benzodiazepinas/administração & dosagem , Temperatura Corporal/efeitos dos fármacos , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Feminino , Humanos , Hipotermia/induzido quimicamente , Hipotermia/prevenção & controle , Masculino , Pessoa de Meia-Idade , Pré-Medicação/tendências , Cuidados Pré-Operatórios/tendências , Estudos Prospectivos
17.
Med. clín (Ed. impr.) ; 152(8): 298-302, abr. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-183607

RESUMO

Introducción: El objetivo de este estudio es evaluar la eficacia de un cambio en la estrategia de manejo del riesgo de delirium en una unidad de ortogeriatría. Material y métodos: Estudio prospectivo, comparativo, no aleatorizado de 2 cohortes de pacientes. Una cohorte (grupo control) tratado con la terapia estándar con tramadol de rescate y diazepam, y otra cohorte (grupo experimental) tratado con morfina a dosis bajas de rescate junto con benzodiacepinas de vida media corta y tratamiento preventivo con neurolépticos, en los pacientes de alto riesgo. Resultados: Se ha incluido a 85 pacientes (42 en el grupo control y 43 en el grupo experimental). Edad media: 85 años (71-105). Un total de 29 pacientes (34%) han tenido un episodio de delirium durante el ingreso actual, 16 pacientes (38%) en el grupo control y 13 pacientes (30%) en el grupo experimental, respectivamente (p=0,498). La duración media del delirium en los 29 pacientes que lo presentaron fue de 5,3 días. Esta duración fue en el grupo control de 6,6 días y en el grupo experimental de 3,8 días, respectivamente (p=0,031). En el grupo de pacientes que tenían antecedente de delirium previo, se aprecia que hay una menor incidencia de delirium durante el ingreso actual en el grupo experimental (80% vs. 17%, p=0,036). Conclusiones: La terapia experimental ha resultado eficaz, ya que se ha podido observar una tendencia a disminuir la incidencia del delirium y en los casos que lo han presentado la terapia sirvió para disminuir su duración con diferencias estadísticamente significativas


Introduction: The objective of this study is to evaluate the efficacy of a change in the management of the risk of delirium in an orthogeriatric unit. Material and methods: Prospective, comparative, non-randomised study of two cohorts of patients. One cohort (control group) treated with standard therapy with tramadol rescue and diazepam and another cohort (experimental group) treated with rescue with morphine at low doses and short half-life benzodiazepines as well as preventive treatment with neuroleptics in patients at high risk. Results: Eighty-five patients were included (42 in the control group and 43 in the experimental group). Mean age: 85 (71-105). Twenty-nine patients (34%) had an episode of delirium during the current admission, 16 patients (38%) in the control group and 13 patients (30%) in the experimental group respectively (P=.498). The mean duration of delirium in the 29 patients who presented it was 5.3 days. This duration in the control group was 6.6 days and in the experimental group 3.8 days (P=.031). In the group of patients who had previous delirium, a lower incidence of delirium was seen during the current admission in the experimental group (80% vs 17% P=.036). Conclusions: Experimental treatment has been effective since a trend to a lower incidence of delirium has been observed. In the patients who have suffered an episode of delirium, the treatment served to decrease its duration with statistically significant differences


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Delírio/prevenção & controle , Tramadol/administração & dosagem , Diazepam/administração & dosagem , Morfina/administração & dosagem , Benzodiazepinas/administração & dosagem , Fraturas do Quadril/complicações , Fraturas do Quadril/tratamento farmacológico , Gestão de Riscos , Fatores de Risco , Estudos Prospectivos , Estudos de Coortes , Distribuição Aleatória , Estudos de Casos e Controles
18.
J Manag Care Spec Pharm ; 25(3): 392-401, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30816820

RESUMO

BACKGROUND: The misuse of prescription drugs is a serious public health problem. Although controlled substance (CS) prescribing, in particular, opioid analgesics, has recently declined, the volume of prescriptions in 2015 was still 3 times higher than in 1999. To curb the high volume of CS prescribing, a national health plan has implemented a controlled substance utilization management (CSUM) program, a prescriber-focused educational intervention regarding patients at risk for CS misuse. OBJECTIVE: To characterize the effect of the CSUM program on CS prescribing volumes, number of prescribers and other health outcomes (opioid overdoses, all-cause emergency department visits, and all-cause hospitalizations). METHODS: The CSUM program identified patients who received ≥10 CS prescriptions within any 3-month window for noncancer pain as being high risk for CS misuse and mailed patient medication profiles to their CS prescribers. This retrospective study was conducted on patients whose prescribers were contacted by the CSUM program from January 2014 to December 2015. The reference group included patients with carved-out pharmacy benefits who were 1:1 propensity score matched to the program group. CS prescribing volumes, number of CS prescribers, and other health care utilization measures were assessed in the 6-month pre-intervention (baseline) period and 6-month post-intervention (follow-up) period using difference-in-difference (DID) analysis. RESULTS: After matching, each group had 17,295 patients, and there were no differences in baseline demographic and clinical characteristics. During the follow-up period, the CSUM group had 1.1 fewer prescriptions for CS (mean difference [MD] within group -3.2 vs. -2.1 prescriptions), 21 fewer days of supply (MD -27 vs. -6 days), and 0.2 fewer number of CS prescribers (MD -0.8 vs. -0.6 prescribers) per patient when compared with the reference group; all P values were < 0.001. The reductions in CS prescribing volumes and number of prescribers within the CSUM group were mainly driven by opioid analgesics, with minimal differences in benzodiazepines and stimulants between the 2 groups. The CSUM program had no significant effect on the opioid dosage strength but was associated with a lower rate of all-cause emergency department visits. CONCLUSIONS: The CSUM program had a moderate positive effect on reducing CS prescribing volumes and number of CS prescribers compared with a reference group. Beside the focus on patients who have already received 10+ CS prescriptions, there remains a need for more intensive approaches for accelerating targeted declines in CS in general and opioids in particular. DISCLOSURES: Funding for this study was provided by Anthem, which had no role in study design, data interpretation, manuscript development, or the decision to publish. Chen, Ma, Barron, DeVries, and Agiro are employees of HealthCore, a wholly owned subsidiary of Anthem. Horn is an employee of Anthem.


Assuntos
Substâncias Controladas/administração & dosagem , Usuários de Drogas , Padrões de Prática Médica/estatística & dados numéricos , Uso Indevido de Medicamentos sob Prescrição/prevenção & controle , Adulto , Analgésicos Opioides/administração & dosagem , Benzodiazepinas/administração & dosagem , Estimulantes do Sistema Nervoso Central/administração & dosagem , Relação Dose-Resposta a Droga , Educação Médica Continuada/métodos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica/normas , Estudos Retrospectivos
20.
Braz J Psychiatry ; 41(4): 324-335, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30843960

RESUMO

OBJECTIVE: To present the essential guidelines for pharmacological management of patients with psychomotor agitation in Brazil. METHODS: This is a systematic review of articles retrieved from the MEDLINE (PubMed), Cochrane Database of Systematic Reviews, and SciELO databases published from 1997 to 2017. Other relevant articles in the literature were also used to develop these guidelines. The search strategy used structured questions formulated using the PICO model, as recommended by the Guidelines Project of the Brazilian Medical Association. Recommendations were summarized according to their level of evidence, which was determined using the Oxford Centre for Evidence-based Medicine system and critical appraisal tools. RESULTS: Of 5,362 articles retrieved, 1,731 abstracts were selected for further reading. The final sample included 74 articles that met all inclusion criteria. The evidence shows that pharmacologic treatment is indicated only after non-pharmacologic approaches have failed. The cause of the agitation, side effects of the medications, and contraindications must guide the medication choice. The oral route should be preferred for drug administration; IV administration must be avoided. All subjects must be monitored before and after medication administration. CONCLUSION: If non-pharmacological strategies fail, medications are needed to control agitation and violent behavior. Once medicated, the patient should be monitored until a tranquil state is possible without excessive sedation. SYSTEMATIC REVIEW REGISTRY NUMBER: CRD42017054440.


Assuntos
Antipsicóticos/administração & dosagem , Benzodiazepinas/administração & dosagem , Guias de Prática Clínica como Assunto , Agitação Psicomotora/tratamento farmacológico , Antipsicóticos/classificação , Benzodiazepinas/classificação , Brasil , Gerenciamento Clínico , Humanos , Escalas de Graduação Psiquiátrica , Agitação Psicomotora/diagnóstico
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA