Behavioral effects of caffeine coadministered with nicotine, benzodiazepines, and alcohol
B.S. Gupta, Uma Gupta in Caffeine and Behavior, 2020
Studies with humans have generally supported the hypothesis of a mutually antagonistic relationship between caffeine and benzodiazepines. In a brief report, Mattila et al.32 indicated that caffeine blocked the impairment of cognitive skills, increase in muscle relaxation, and subjective calming produced by 10 mg diazepam. Similar results were reported in a more detailed follow-up study.33 Using the benzodiazepine triazolam, Mattila et al.34 found relatively mild sedative effects that were largely reversed by caffeine. Similarly, the alerting effects of caffeine were diminished when triazolam was coadministered. Caffeine, at doses that had little effect when administered alone, has been shown to reverse the effects of both lorazepam and triazolam on learning, performance, and ratings of sedation.35,36 File et al.37 administered a battery of tests that measured psychomotor and cognitive performance, mood-state, and other factors. Lorazepam impaired psychomotor and cognitive performance. On some tests (e.g., digit-symbol substitution), caffeine improved performance and reversed the effect of lorazepam. Caffeine also reversed the self-reported anxiolytic effects of lorazepam. A similar battery of tests was used by Roache and Griffiths38 in a study notable for using a range of doses of both diazepam and caffeine. In a number of tasks, but not all, diazepam and caffeine each blocked the effects of the other. In addition to the type of test, the effects were dependent on the exact doses of each drug.
EMQ Answers
Justin C. Konje in Complete Revision Guide for MRCOG Part 2, 2019
M Rectal diazepamSeizures in labour should be terminated as soon as possible to avoid maternal and fetal hypoxia and fetal acidosis. Benzodiazepines are the drugs of choice. Any seizure lasting more than 5 min is unusual and represents a high risk of progressing to convulsive status epilepticus, a life-threatening medical emergency which affects around 1% of pregnancies in women with epilepsy (WWE). Treatment should be initiated as soon as reasonably possible before status epilepticus and pharmaceutical assistance are established. In those with intravenous access, lorazepam given as an intravenous dose of 0.1 mg/kg (usually a 4 mg bolus) with a further dose (10–20 min) is preferred. Diazepam 5–10 mg administered slowly intravenously is an alternative. If there is no intravenous access, diazepam 10–20 mg is rectally repeated once 15 min late and if there is a continued risk of status epilepticus or midazolam, 10 mg as a buccal preparation is suitable. (Epilepsy in Pregnancy. The Royal College of Obstetricians and Gynaecologists Green-top Guideline No. 68, June 2016)
Palliative care in geriatric patients with neurological diseases
Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor in Essentials of Geriatric Neuroanesthesia, 2019
Respiratory insufficiency: It is common in elderly patients with neurological diseases to have respiratory symptoms like dyspnea. Opioids are mainstay of dyspnea and can be given via oral, nasal, subcutaneous, transdermal, and inhalation route. In addition, benzodiazepines like lorazepam and midazolam may be required to reduce anxiety. Respiratory insufficiency is also common and may be due to progression of neurological disease as in ALS, or secondary to pulmonary infections or debility (12). The patient's preferences for prolonged invasive ventilation and tracheostomy should be asked for and documented. All efforts should be made to prevent respiratory infections by vaccination (influenza vaccinations or polyvalent pneumococcal vaccines). If feasible, noninvasive positive pressure ventilation (NIPPV) should be preferred. It may often be difficult to wean these patients from NIPPV and this needs to be carefully discussed beforehand (13).
Current and emerging treatment options for Angelman syndrome
Published in Expert Review of Neurotherapeutics, 2023
Christopher J. Keary, Christopher J. McDougle
For aggression or SIB that does not respond to behavioral strategies, pharmacotherapy may be considered (Figure 1). A published case series described the use of buspirone, a serotonin (5-HT)1A receptor partial agonist, in patients with AS who had behaviors concerning for anxiety, including aggression and SIB [54]. The three patients described showed improvement in aggression, SIB, vomiting, and specific fears (crowds) and tolerated the medication well. Buspirone carries an indication for the treatment of generalized anxiety disorder in adults from the FDA, though it is most commonly used to treat anxiety in children due to a mild side effect profile [55]. Clonazepam and short-term use of lorazepam have FDA indications for treatment of panic disorder and anxiety disorders, respectively. While there are no trials of these medications yet for treatment of aggression or SIB in AS, they are commonly tried in clinical practice and may have the dual benefit of reducing anxiety and seizure risk. Potential side effects of these medications include sedation, weakness, dizziness/ataxia, and rare risks of hypotension or paradoxical reactions of hyperexcitability. Finally, the beta-adrenergic receptor blocking agent propranolol was found to reduce aggression in 85% of patients with ASD in a retrospective chart review of 46 patients 8–32-year old [56] and may also be considered in AS. Side effects may include fatigue, dizziness, bradycardia, and hypotension. In some cases, propranolol can cause bronchospasm in those with asthma and can worsen cardiac function in those with congestive heart failure.
Prescribing patterns for treating common complications of spinal cord injury
Published in The Journal of Spinal Cord Medicine, 2023
Shikha Gupta, Mary Ann McColl, Karen Smith, Alexander McColl
According to the available evidence, baclofen and tizanidine are considered first-line treatments for SCI-induced spasticity, while diazepam and dantrium are second-line treatments with varying effectiveness.13,31,41,42 However, lorazepam may be used with patients having adverse effects from diazepam. A small proportion of individuals in our sample were also prescribed general muscle relaxants such as lorazepam, Flexiril or other short-acting benzodiazepines to treat spasticity. These are usually not recommended due to their negative effects on individual’s ability to void and ambulate.7,43 Therefore, it is possible that some patients received general muscle relaxants as an adjuvant to a baclofen pump or chemo-denervation, as per the clinical judgement of prescribing physician, treatment goals, patient preference and their tolerance for adverse events.
Intravenous esketamine leads to an increase in impulsive and suicidal behaviour in a patient with recurrent major depression and borderline personality disorder
Published in The World Journal of Biological Psychiatry, 2022
Thomas Vanicek, Jakob Unterholzner, Rupert Lanzenberger, Angela Naderi-Heiden, Siegfried Kasper, Nicole Praschak-Rieder
After admission bupropion was continued and augmented with escitalopram up to 30 mg p.o.q.d., and trazodone (retard preparation) 150 mg p.o.q.d. in the evening. Non-selective GABA-A receptor positive allosteric modulators (lorazepam and clonazepam) were given as a continuous medication to reduce anxiety, inner tension, and agitation. Zolpidem 10 mg was administered only once since the drug-induced visual and auditory illusions. After all, the patient was severely depressed and reported to suffer from impulsive suicidal thoughts she felt unable to control. Therefore, she was restrained against her will (according to the Austrian Hospitalisation Act). After obtaining informed consent, electroconvulsive therapy (ECT) was started and bupropion XR was discontinued. The patient received a total of seven unilateral ECT treatments with a final stimulation dose of 70% (350 mC). Due to occurrence of side effects in the form of severe headache and cognitive impairment ECT was discontinued, while depressive symptoms and suicidality attenuated during ECT.
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