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The story of modern tranquilliser drugs
Published in Adam Doble, Ian L Martin, David Nutt, Calming the Brain: Benzodiazepines and related drugs from laboratory to clinic, 2020
Adam Doble, Ian L Martin, David Nutt
A related concern is that of benzodiazepine abuse. If benzodiazepine dependence generally concerns individuals taking, albeit for an extended period, the prescribed (low) dose of a drug to treat an identified medical problem, abuse concerns the use of very high doses of benzodiazepines by individuals suffering from neither insomnia nor anxiety for essentially recreational ends. In the UK, benzodiazepine abuse concerns principally temazepam, and this has become a serious health issue. Benzodiazepine abuse has grown rapidly in the last decade, and this may be in part due to the low cost, guaranteed purity and ready availability of this particular product (generic temazepam sells for twopence a pill in the UK). In the US, flunitrazepam is widely abused, despite the fact that this hypnotic benzodiazepine is not marketed in the US, and thus has to be imported, with an associated increase in cost and risk. Abuse of benzodiazepines is often seen within the context of multiple substance abuse, involving alcohol, stimulants or opiates. Appropriate treatment of benzodiazepine abuse would benefit from better understanding of the effects of chronic use of high dose benzodiazepines on the central nervous system.
An Introduction to Statistics and Proposition Setting
Published in Jo-Anne Bright, Michael D. Coble, Forensic DNA Profiling, 2019
Jo-Anne Bright, Michael D. Coble
ESR has developed a new test for the illicit drug flunitrazepam. Ground truth known trials for the test have indicated that it is 99% sensitive (proportion of correctly identified positive results) and 99% specific (proportion of correctly identified negative results). Health officials have reported that half a percent (0.5%) of New Zealanders use flunitrazepam. Using Bayes’ theorem, calculate the probability a random person with a positive test is actually a user.
Sedative/Hypnotics
Published in Frank A. Barile, Barile’s Clinical Toxicology, 2019
Frank A. Barile, Anirudh J. Chintalapati
Although flunitrazepam is used internationally in the treatment of insomnia as well as a preanesthetic benzodiazepine, it is a U.S. federal schedule I controlled substance with no legitimate therapeutic or prescribing uses. The tablets are tasteless, odorless, and relatively inexpensive, dissolve rapidly in alcohol, and are easily administered by intranasal or oral routes. Flunitrazepam has been used as a “date-rape” drug because of its intoxicating and amnestic effects.* The agent causes euphoria, hallucinations, and disinhibiting effects and has also been used to enhance heroin and cocaine euphoria. It is highly lipid soluble with a quick onset (20–30 min) and duration of up to 12 h. It affects GABAA receptors with a potency of up to 10 times that of diazepam. Consequently, drowsiness, disorientation, and dizziness (“DDD”), slurred speech, and nausea can progress rapidly to amnesia, psychomotor impairment, respiratory depression, and coma. Treatment is supportive with the maintenance of patent airway and respiration of primary importance (airway, breathing, and circulation [ABCs]). Flumazenil is used as an antidote for the respiratory depression except in the presence of stimulants.
A 25 mg rectal dose of diclofenac for prevention of post-ERCP pancreatitis in elderly patients
Published in Scandinavian Journal of Gastroenterology, 2021
Natsumi Maeda, Akira Higashimori, Masami Nakatani, Yuki Mizuno, Yoshihiro Nakamura, Daisuke Ikeda, Hirotsugu Maruyama, Kenichi Morimoto, Takashi Fukuda, Toshio Watanabe, Yasuhiro Fujiwara
During ERCP, patients received intravenous flunitrazepam and pethidine under constant sedation. Flunitrazepam and pethidine doses were calculated by the main operator based on the patient’s medical condition and age. Sulbactam sodium/cefoperazone sodium 1 g was administered to all patients 30 min before ERCP, 6 h after ERCP, and the day after ERCP. Blood tests, including serum pancreatic-type amylase, were routinely conducted 3 h after ERCP and the day after ERCP. In patients with elevated serum amylase levels associated with abdominal pain after ERCP, computerized tomography was performed. All patients received Ringer’s solution for 12 h from the start of ERCP in a total volume of 1000 ml according to the clinical pathway. Thereafter, the volume and nature of the additional intravenous infusion were at the discretion of the treatment physician based on blood test results or computerized tomography results.
Designer benzodiazepines versus prescription benzodiazepines: can structural relation predict the next step?
Published in Critical Reviews in Toxicology, 2021
Raneem E. Moustafa, Fuad Tarbah, Huda Sulaiman Saeed, Suleiman I. Sharif
Flunitrazepam is known for possessing potent hypnotic, sedative, anxiolytic, and skeletal muscle relaxant effects as a benzodiazepine derivative that has been used for over 20 years, yet also plays on the other edge as a “date rape” drug and is one of the most widely abused benzodiazepines (Oelschläger 1989). In the United States, it is regarded as an illegal drug as it has not been approved by the Food and Drug Administration (FDA) for medical use; however, it has been marketed and licensed in Europe, Asia, and Latin America as a sedative and hypnotic drug (Bischoff 2018). Unlike flunitrazepam, its active metabolites fonazepam (desmethylflunitrazepam) and nifoxipam (3-hydroxy-desmethylflunitrazepam) have been active as NPS benzodiazepines (designer benzodiazepines) and sold on online sites for the past years while in fact they are classified as research chemicals that are not intended for use in animals or human (Katselou et al. 2017).