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Care of Intubated Patients in Triage
Published in Kajal Jain, Nidhi Bhatia, Acute Trauma Care in Developing Countries, 2023
Shalvi Mahajan, Komal A Gandhi
Intubated patients experience pain and anxiety due to trauma, inability to speak (ETT in situ), airway suctioning, blood sampling, invasive catheterization, surgical procedures and intrahospital transportation. Sedatives are frequently required to manage anxiety/agitation; however, they lack analgesic properties. Undertreated pain has adverse impacts such as cardiac instability, respiratory compromise and immunosuppression. Thus, assessment and treatment of pain before giving sedatives, often termed analgesia-first sedation, is favoured. Hence, multimodal analgesia – site-appropriate regional analgesia (e.g. US-guided femoral blocks), systemic opioids (e.g. fentanyl, morphine) and nonopioid agents (acetaminophen, ketamine and non-steroidal anti-inflammatory drugs) – can be selected. Light sedation is a rule, except if only neuromuscular agents are administered where deep sedation or amnesia is required to avoid awakening a paralyzed patient until the effect of the medication is expected to have worn off. Currently, nonbenzodiazepine sedatives (propofol and dexmedetomidine) are preferred over benzodiazepine-based sedatives.
Psychological Medicine
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Harrison Howarth, Jim Bolton, Gary Bell
Keep a fluid balance chart to avoid dehydration and prescribe adequate pain relief. Sedative medication should be avoided if possible and only prescribed when other measures are ineffective and the patient's behaviour poses a significant risk to themselves or others.
Pregnancy
Published in Stanley R. Resor, Henn Kutt, The Medical Treatment of Epilepsy, 2020
Michael E. Newmark, Stephanie Dubinsky
Newborns of chronically treated mothers with epilepsy are exposed to AEDs in utero since these drugs cross the placental barrier. Because neonatal drug metabolism is slow, these agents remain longer in the system with half-lives similar to or greater than that of an adult. AEDs may have a direct sedative effect on the neonate with resulting hypotonia, feeding difficulties, and mild respiratory depression. Sedative effects may last 2 to 8 days (63). Drug withdrawal symptoms, sometimes seen in infants exposed to barbiturates, include hyperirritability, tremors, hyperventilation, sleep disturbances, and vomiting, and may last as long as 4 months (69).
The prevalence of alcohol use and risky driving practises among individuals who consume sedatives nonmedically: findings from the NESARC-III
Published in The American Journal of Drug and Alcohol Abuse, 2022
Blair Aitken, Luke A. Downey, Amie C. Hayley
Sedatives comprise a group of central nervous system (CNS) depressing medications including (but not limited to) benzodiazepines (e.g., Alprazolam, Diazepam, Lorazepam and Temazepam) and barbiturates (e.g., Butobarbital, Secobarbital and Phenobarbital). Less frequently, this encapsulated first-generation substances such as Methaqualone (Quaalude) and Promethazine (Phenergan). Globally, benzodiazepines, are the most frequently prescribed sedatives, routinely used to treat insomnia, anxiety disorders and alcohol withdrawal (7). More than 1 in 20 adults in the US file a prescription for benzodiazepines each year, translating to roughly 13.5 million prescriptions nation-wide, an increase of 67% since 1996 (8). For every 100 US adults that visits a physician over the course of the year, 27 visits will result in a benzodiazepine prescription (9). Similarly, prevalent patterns of use have been observed in other Western countries such as Australia, with close to five million prescriptions dispensed every year (10).
Australian Consultant Pharmacists’ Potential Roles in Sleep Health Care: Exploring a New Avenue for Improving the Management of Insomnia
Published in Behavioral Sleep Medicine, 2022
Mariam M. Basheti, Minh Tran, Keith Wong, Christopher Gordon, Ronald Grunstein, Bandana Saini
The reasons for this inappropriate reliance on sedative-hypnotics to manage insomnia are thought to be a shortage of behavioral sleep specialists/psychologists, possible suboptimal awareness/skills around behavioral insomnia treatments among primary health professionals or costs related to behavioral treatment (Cheung et al., 2014; Rossman, 2019). Inappropriate use of sedative-hypnotics, such as benzodiazepines, poses an increased risk of side effects, such as dependence, withdrawal symptoms, traffic accidents, cognitive effects and increased falls and fractures specifically in the elderly (Stewart & Westra, 2002; Windle et al., 2007). Patients using sedative-hypnotics for insomnia management are often aware of their side effects and short-term treatment role however continue to use them long-term (Cheung et al., 2016; J. M. Y. Cheung et al., 2018). Given the significant “noise” about the need to deprescribe benzodiazepines, many prescribers worldwide have switched to using off-label antidepressants and antipsychotics to counter insomnia (Everitt et al., 2014; Lai et al., 2011; Thompson et al., 2016). This practice is equally unsafe, especially in elderly patients, given the lack of evidence for such medications in alleviating insomnia (Schroeck et al., 2016; Thompson et al., 2016). To compound matters, core medications used to treat prevalent comorbid diseases, e.g., asthma, depression, and cardiovascular disorders, may induce or exacerbate sleeplessness/insomnia (Pacheco & Wright, 2020). Clearly, medication review services are required for improving medication use given current insomnia management practices.
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
Each of those two drugs produces three unique classic benzodiazepines with relatively long half-lives that will be discussed in detail in the next section. Diclazepam, for example, gets metabolized to lorazepam, lormetazepam, and delorazepam (three well known classic benzodiazepines), having elimination half-lives that are relatively long-reaching 78 h for delorazepam, 12 h for lorazepam, and 13 h for lormetazepam. This imposes an issue that has been shown by a study on diclazepam organ distribution that its metabolites get redistributed in the same manner as their parent drug which may cause toxicity and overdose-like problems due to their accumulation in addition to the parent drug (diclazepam) which already has a long half-life. This leads to long-lasting sedative effects most likely when applying high or repeated doses (Lehmann et al. 2019).