Drug interactions in maternal intensive care: prevalence, risk factors, and potential risk medications / Interações medicamentosas em terapia intensiva materna: prevalência, fatores e medicamentos de risco

ABSTRACT Objective: To characterize severe potential drug interactions in maternal intensive care, and to determine their frequency, risk factors and potential risk medications. Methods: An observational and longitudinal study conducted between December 2014 and December 2015 in a maternal intensive care unit. Clinical data were collected and severe potential drug interactions were identified on pregnant inpatients. The drug interactions were classified by type, prevalence and exposure rate. A multivariate logistic regression model was used to identify the severe potential drug interactions and the related drugs (p<0.05). Results: A total of 95.1% of patients were exposed to, at least, one potential drug interaction; in that, 91.7% 33.9% were related to, respectively, moderate and severe potential drug interactions. The patients were exposed, on average, on 69.2% of days they were in the intensive care unit. The main drugs involved in more severe drug interactions were magnesium sulfate, metoclopramide, propranolol and diazepam. Conclusion: The severe potential drug interactions were observed in almost all patients of the study, and, approximately one third of those interactions were related to greater severity and resulted in exposure during long hospital stay. The higher number of prescribed drugs and its previous use of medications at home increase the occurrence of severe potential drug interactions.

RESUMO Objetivo: Caracterizar as interações medicamentosas potenciais graves em terapia intensiva materna, e determinar sua frequência, os fatores e os medicamentos de risco associados à ocorrência dessas interações. Métodos: Estudo observacional e longitudinal executado entre dezembro de 2014 a dezembro de 2015, conduzido em uma unidade de terapia intensiva materna. Foram coletados dados clínicos e identificadas interações medicamentosas potenciais graves de gestantes admitidas. As interações medicamentosas foram caracterizadas quanto ao tipo, à prevalência e à taxa de exposição. Um modelo multivariado de regressão logística foi utilizado para identificação de fatores associados à ocorrência de interações medicamentosas potenciais graves e os medicamentos implicados (p<0,05). Resultados: Um total de 95,1% das pacientes foi exposto a, no mínimo, uma interação medicamentosa potencial, com 91,7% delas envolvidas com interações medicamentosas potenciais moderadas e 33,9% com as interações graves. As pacientes ficaram expostas, em média, em 69,2% dos dias que estiveram sob terapia intensiva. Os principais medicamentos implicados em interações medicamentosas de maior gravidade foram sulfato de magnésio, metoclopramida, propranolol e diazepam. Conclusão: As interações medicamentosas potenciais graves ocorreram na maioria das pacientes avaliadas. Aproximadamente um terço das interações foram graves e levaram à maior exposição por um longo período de internação. Maior número de fármacos prescritos e uso prévio domiciliar de medicamentos elevam a ocorrência de interações medicamentosas potenciais graves.

Monoterpenoids (thymol, carvacrol and S-(+)-linalool) with anesthetic activity in silver catfish (Rhamdia quelen): evaluation of acetylcholinesterase and GABAergic activity

This study evaluated the anesthetic potential of thymol and carvacrol, and their influence on acetylcholinesterase (AChE) activity in the muscle and brain of silver catfish (Rhamdia quelen). The AChE activity of S-(+)-linalool was also evaluated. We subsequently assessed the effects of thymol and S-(+)-linalool on the GABAergic system. Fish were exposed to thymol and carvacrol (25, 50, 75, and 100 mg/L) to evaluate time for anesthesia and recovery. Both compounds induced sedation at 25 mg/L and anesthesia with 50-100 mg/L. However, fish exposed to carvacrol presented strong muscle contractions and mortality. AChE activity was increased in the brain of fish at 50 mg/L carvacrol and 100 mg/L thymol, and decreased in the muscle at 100 mg/L carvacrol. S-(+)-linalool did not alter AChE activity. Anesthesia with thymol was reversed by exposure to picrotoxin (GABAA antagonist), similar to the positive control propofol, but was not reversed by flumazenil (antagonist of benzodiazepine binding site), as observed for the positive control diazepam. Picrotoxin did not reverse the effect of S-(+)-linalool. Thymol exposure at 50 mg/L is more suitable than carvacrol for anesthesia in silver catfish, because this concentration did not cause any mortality or interference with AChE activity. Thymol interacted with GABAA receptors, but not with the GABAA/benzodiazepine site. In contrast, S-(+)-linalool did not act in GABAA receptors in silver catfish.

Reversion of methacholine induced bronchoconstriction with inhaled diazepam in patients with asthma / Bloqueo de la respuesta bronco constrictora a metacolina con diazepam inhalado en pacientes con asma

Background: Benzodiazepines have a direct bronchodilatory effect. Methacholine is a non-selective muscarinic receptor agonist causing bronchoconstriction. Aim: To examine the effects of inhaled benzodiazepines, modulating bronchoconstriction induced by methacholine in patients with asthma. Patients and Methods: Twelve patients with well controlled asthma were studied. On the first day, after determining the initial values of pulmonary function, a dose response curve was carried out with progressive doses of methacholine. After the last dose, when at least a 20% drop of the initial forced expiratory volume in the first second (FEV1) was achieved, vital capacity (VC) and FEV1 were measured at 7, 15 and 30 minutes after provocation. On the second day a diazepam aerosol was inhaled by the patients prior to the same protocol with methacholine. Results: In the first day of testing, methacholine inhalation (6 mg/mL) led to a significant drop in FEV1 from 2.98 to 1.69 L. On the second day of study, in the same patients, previous inhalation with diazepam reduced the changes of FEV1 after inhalation of methacholine. This parameter decreased from 2.48 to 2.21 L. Conclusions: Inhalation of benzodiazepines reduce bronchoconstriction after a methacholine challenge in patients with asthma.

Antecedentes: Las benzodiacepinas tienen un efecto broncodilatador directo. La metacolina es un agonista muscarínico que causa bronco constricción. Objetivo: Evaluar el efecto modulador de la inhalación de diazepam sobre la bronco constricción inducida por metacolina. Pacientes y Métodos: Se estudiaron 12 pacientes con asma bien controlada. En el primer día, se determinó la curva dosis respuesta de parámetros de función pulmonar a una dosis progresiva de metacolina. Después de la última dosis, cuando se consiguió un 20% de reducción en la capacidad vital forzada en el primer segundo (FEV1), se midió FEV1 y la capacidad vital (CV) a los 7, 15 y 30 min después de la provocación. En el segundo día los pacientes se inhalaron con diazepam antes de hacer la prueba con metacolina. Resultados: En el primer día, el FEV1 bajo de 2,98 a 1,69 l con 6 mg/ml de metacolina. En el segundo día, la inhalación de diazepam redujo la respuesta a metacolina con una reducción de FEV1 de 2,48 a 2,21 L. Conclusiones: La benzodiacepinas reducen la respuesta de vasoconstricción a metacolina.

Effect of (+)-dehydrofukinone on GABAA receptors and stress response in fish model

(+)-Dehydrofukinone (DHF) is a major component of the essential oil of Nectandra grandiflora (Lauraceae), and exerts a depressant effect on the central nervous system of fish. However, the neuronal mechanism underlying DHF action remains unknown. This study aimed to investigate the action of DHF on GABAA receptors using a silver catfish (Rhamdia quelen) model. Additionally, we investigated the effect of DHF exposure on stress-induced cortisol modulation. Chemical identification was performed using gas chromatography-mass spectrometry and purity was evaluated using gas chromatography with a flame ionization detector. To an aquarium, we applied between 2.5 and 50 mg/L DHF diluted in ethanol, in combination with 42.7 mg/L diazepam. DHF within the range of 10-20 mg/L acted collaboratively in combination with diazepam, but the sedative action of DHF was reversed by 3 mg/L flumazenil. Additionally, fish exposed for 24 h to 2.5-20 mg/L DHF showed no side effects and there was sustained sedation during the first 12 h of drug exposure with 10-20 mg/L DHF. DHF pretreatment did not increase plasma cortisol levels in fish subjected to a stress protocol. Moreover, the stress-induced cortisol peak was absent following pretreatment with 20 mg/L DHF. DHF proved to be a relatively safe sedative or anesthetic, which interacts with GABAergic and cortisol pathways in fish.

Idosos residentes em uma instituição de longa permanência: adaptação à luz de Callista Roy / Elderly residents in homes for the aged: adjustment in the light of Callista Roy / Residentes mayores en un hogares para ancianos: adaptación a la luz de Callista Roy

Objetivou-se avaliar o processo de adaptação de idosos que buscam, voluntariamente, residir em Instituição de Longa Permanência para Idosos (ILPI), na cidade de Fortaleza-CE, com base no modelo teórico de Roy. Pesquisa descritiva, realizada em uma IPLI com treze idosos residentes. A coleta de dados foi por meio de entrevista, nos meses de outubro e dezembro de 2011. Os dados foram tratados pela análise de conteúdo temática. Emergiram as seguintes temáticas: Eu Físico, subdividido em sensação corporal e imagem corporal; e Eu Pessoal, subdividido em auto coerência, auto ideal e ser moral-ético-espiritual. Assim, a opção de morar em ILPI não mudou efetivamente a vida dos idosos. Estes conseguiram adaptação ao local e convivem bem com os estímulos internos e externos.

This study aimed to evaluate the adaptation of elderly individuals voluntarily reside in Institution for the Aged (LTCF) in the city of Fortaleza-CE, based on the theoretical model of Roy. Descriptive study, in a IPLI involving thirteen elderly residents. Data collect was through interviews in the months of October and December 2011 and organized by thematic content analysis. The following themes has emerged: I Physical subdivided into body sensation and body image; Staff and I, subdivided into self-consistency and auto ideal be moral-ethical-spiritual. Thus, the option to live in ILPI not effectively changed the lives of elderly people. They managed to adapt to the local and coexist well with internal and external stimuli.

Este estudio tuvo como objetivo evaluar la adaptación de las personas mayores que residen voluntariamente en la Institución para la tercera edad (LTCF) en la ciudad de Fortaleza-CE, basado en el modelo teórico de Roy. Estudio descriptivo, en un IPLI con trece ancianos residentes. Los datos fueran recogidos a través de entrevistas en los meses de octubre y diciembre de 2011 y organizados mediante análisis de contenido temático. Emergieron los siguientes temas: subdivide I Física en la imagen corporal y sensación de cuerpo; El personal y yo, subdividen en auto-consistencia y auto ideal ser moral-ético-espiritual. Por lo tanto, la opción de vivir en ILPI no cambió de manera efectiva la vida de los ancianos. Se las arreglaron para adaptarse a lo local y convivir bien con los estímulos internos y externos.

Tranquilização de asininos com acepromazina associada ou não ao diazepam / Tranquilization of donkeys using acepromazine or acepromazine: diazepam

Avaliaram-se os efeitos da acepromazina isolada ou associada ao diazepam em asininos. Cinco asininos foram submetidos a dois protocolos anestésicos: os do grupo acepromazina (AC) receberam acepromazina, 0,1mg/kg/IV, e os do grupo acepromazina-diazepam (ACD), acepromazina na mesma dose e via do AC, associada ao diazepam, 0,1mg/kg/IV. Foram mensuradas as frequências cardíaca (FC) e respiratória (FR) e a temperatura retal (TR) e analisadas variáveis eletrocardiográficas, tranquilização, período de latência, início do prolapso peniano e grau de ataxia. A tranquilização iniciou-se aos 10,4±0,9 minutos nos asininos do AC e aos 4,8±1,1 nos do ACD. Ocorreu prolapso peniano aos 4,2±1,3min no AC e aos 2,7±0,4 no ACD. A FC elevou-se aos 15 e 30min no AC. Não ocorreu variação significativa nas variáveis eletrocardiográficas e na temperatura retal. A FR diminuiu no AC a partir de 60min e no ACD a partir de 30min. A distância focinho-solo reduziu-se significativamente em ambos os grupos e nos momentos a partir de 15min. Concluiu-se que a acepromazina promove tranquilização discreta, e a adição do diazepam potencializa a tranquilização, diminui o período de latência e aumenta a ataxia.

The effects of acepromazine isolated or associated with diazepam were evaluated in five donkeys were underwent in two anesthetic protocols, in the acepromazine group (AC), animals received acepromazine (0.1mg/kg/IV) and in acepromazine-diazepam group (ACD), acepromazine at the same dose and route of AC, associated with diazepam (0.1 mg/kg/IV). Heart frequency (HR), respiratory frequency (RF) and rectal temperature (RT) were measured and electrocardiographic variables analyzed, in addition to tanquilization, latency, beginning of the penile prolapse and degree of ataxia. The tanquilization began at 10.4±0.9 minutes (min) in the AC donkeys and 4.8±1.1 in ACD. Penile prolapse occurred at 4.2±1.3 minutes in AC and 2.7±0.4 in ACD. The HR increased to 15 and 30min. Electrocardiographic parameters and rectal temperature not varied significantly. RF decreased from AC in 60min and 30min from ACD. The muzzle-to-ground distance reduced significantly in both groups and at times from 15min. It was concluded that the acepromazine promotes discreet tanquilization and the adition of diazepam potentiates the tranquilization, decreases the latency period and increases ataxia caused by acepromazine.

Anxiolytic-like effect of N-n-butyl-3-methoxyquinoxaline-2-carboxamide (6o) in experimental mouse models of anxiety.

The present research was designed to explore the anxiolytic-like activity of a novel 5-HT3 receptor antagonist (6o) in experimental mouse models of anxiety. The anxiolytic activity of '6o' at (1 and 2 mg/kg, ip) was evaluated in mice by using a battery of behavioural tests of anxiety such as elevated plus maze (EPM), light/dark aversion test, hole board (HB) and open field test (OFT) with diazepam (2 mg/kg, ip) as a standard anxiolytic. None of the tested doses of '6o' affected the base line locomotion. Compound '6o' (2 mg/kg, ip) and diazepam (2mg/kg, ip) significantly increased the percentage of both time spent and open arm entries in the EPM test. Compound '6o' in (1 mg/kg, ip) dose was only able to affect the percentage time spent in open arm significantly in the EPM test. In the light and dark test, compound '6o' (2 mg/kg, ip) and diazepam (2mg/kg, ip) significantly increased the total time spent in light compartment as well as number of transitions from one compartment to other and number of square crossed. Compound '6o' (1 and 2 mg/kg, ip) and diazepam (2 mg/kg, ip) also significantly increased number of head dips and number of squares crossed, whereas significantly decreased the head dipping latency in HB test as compared to vehicle control group. In addition, '6o' in both the doses and diazepam (2mg/kg, ip) significantly increased the ambulation scores (squares crossed) in OFT however, there was no significant effect of '6o' (1 and 2 mg/kg, ip) and diazepam (2 mg/kg, ip) on rearing scores. To conclude compound '6o' exhibited an anxiolytic-like effect in animal models of anxiety.

Anxiolytic-like effect of etazolate, a type 4 phosphodiesterase inhibitor in experimental models of anxiety.

Etazolate is a selective inhibitor of type 4 phosphodiesterase (PDE4) class enzyme. Antidepressant-like effect of etazolate has been previously demonstrated in the rodent models of depression. The present study was designed to investigate the anxiolytic-like activity of etazolate in experimental mouse models of anxiety. The putative anxiolytic effect of etazolate (0.25-1 mg/kg, ip) was studied in mice by using a battery of behavioural tests of anxiety such as elevated plus maze (EPM), light/dark (L/D) aversion, hole board (HB) and open field (OFT) with diazepam (2 mg/kg, ip) as reference anxiolytic. Like diazepam (2 mg/kg, ip), etazolate (0.5 and 1 mg/kg, ip) significantly increased the percentage of both time spent and entries into open arms in the EPM test. In the L/D test etazolate (0.5 and 1 mg/kg, ip) increased the both total time spent in and latency time to leave the light compartment. Etazolate (0.5 and 1 mg/kg, ip) also significantly increased head dipping scores and time spent in head dipping, whereas significantly decreased the head dipping latency in HB test. In addition, etazolate (0.5 and 1 mg/kg, ip) significantly increased the ambulation scores (square crossed) and number of rearing in OFT. In conclusion, these findings indicated that etazolate exhibited an anxiolytic-like effect in experimental models of anxiety and may be considered an alternative approach for the management of anxiety disorder.

Participation of the GABAergic system in the anesthetic effect of Lippia alba (Mill.) N.E. Brown essential oil

The objective of this study was to identify the possible involvement of the GABAergic system in the anesthetic effect of Lippia alba essential oil (EO). We propose a new animal model using silver catfish (Rhamdia quelen) exposed to an anesthetic bath to study the mechanism of action of EO. To observe the induction and potentiation of the anesthetic effect of EO, juvenile silver catfish (9.30 ± 1.85 g; 10.15 ± 0.95 cm; N = 6) were exposed to various concentrations of L. alba EO in the presence or absence of diazepam [an agonist of high-affinity binding sites for benzodiazepinic (BDZ) sites coupled to the GABA A receptor complex]. In another experiment, fish (N = 6) were initially anesthetized with the EO and then transferred to an anesthetic-free aquarium containing flumazenil (a selective antagonist of binding sites for BDZ coupled to the GABA A receptor complex) or water to assess recovery time from the anesthesia. In this case, flumazenil was used to observe the involvement of the GABA-BDZ receptor in the EO mechanism of action. The results showed that diazepam potentiates the anesthetic effect of EO at all concentrations tested. Fish exposed to diazepam and EO showed faster recovery from anesthesia when flumazenil was added to the recovery bath (12.0 ± 0.3 and 7.2 ± 0.7, respectively) than those exposed to water (9.2 ± 0.2 and 3.5 ± 0.3, respectively). In conclusion, the results demonstrated the involvement of the GABAergic system in the anesthetic effect of L. alba EO on silver catfish.

Pharmacological profile of salvadora persica

This work was conducted to investigate the various pharmacological activities of Salvadora. persica family Salvadoracea and that includes anti inflammatory, analgesic, CNS, bleeding and clotting time activity by oral administration at the dose of 300 and 500mg/kg of body weight in animal models. Acute oral toxicity results showed that crude extract of S. persica is safe up to the dose of 5g/kg body weight of animals. Carraganeen induced hind paw edema method for anti inflammatory activity, tail immersion test method for analgesic activity, Rota rod and grip strength test for CNS activity were carried out in animal models. The analgesic activity was compared with aspirin, 300mg/kg body weight, anti inflammatory activity was compared with indomethacine, lOmg/kg body weight, Transamin 250mg/kg and Vitamin K lOmg were used for bleeding and clotting time activity respectively while diazepam 5mg/kg were used as standard for behavior and CNS activities. In all activities S. persica showed prolonged and dose dependent effects. Phytochemical analysis was also carried out which showed the presence of certain phytoconstituents which possesses these properties. Therefore the results justified the traditional use of the plant

An extract of neem leaves reduces anxiety without causing motor side effects in an experimental model / Un extracto de hojas de neem reduce la ansiedad sin causar efectos colaterales motores en un modelo experimental

Anxiety modulation often requires pharmaceutical intervention, and though effective in the short term, benzodiazepines may cause impaired motor function. As a potential alternative, anxiety-modulating effects of a neem leaf (Azadirachta indica, A Juss) extract were investigated using ethological analysis of rat behaviour on an elevated X maze and compared with diazepam treatment. Sexually immature female Sprague-Dawley rats received 0.07 or 7 mg/kg neem leaf steroidal extract, a sham injection, a 1% DMSO/saline vehicle, 2 mg/kg diazepam or no treatment one hour prior to a recorded five-minute exploration of the elevated X maze. Neem matched diazepam in anxiety reduction as both treatments caused a decrease in per cent protected stretched-attend postures (PPSAP). Neem treatment had no effect on closed arm entries or total rears, distinguishing it pharmacologically from diazepam which resulted in a predictable decrease in those locomotor measures. Whereas both neem and diazepam reduced anxiety in complex ethological behavioural indices, only neem produced anxiolysis without motor deficiency.

La modulación de la ansiedad requiere a menudo la intervención farmacéutica, y aunque eficaz a corto plazo, las benzodiazepinas pueden afectar la función motora. Como una alternativa potencial, los efectos moduladores de la ansiedad obtenidos a partir de un extracto de la hoja de neem (Azadirachta indica, A Juss), fueron investigados mediante análisis etiológico del comportamiento de ratas en un laberinto x elevado, y comparados con el tratamiento con diazepam. Ratas Sprague-Dawley hembras, sexualmente inmaduras, recibieron 0.07 ó 7 mg/kg de extracto esteroidal de hojas de neem, una inyección simulada, un vehículo salino de DMSO al 1%, 2 mg/kg de diazepam o ningún tratamiento una hora antes de registrarse una exploración de cinco minutos en el laberinto X elevado. El neem igualó al diazepam en la reducción de ansiedad, ya que ambos tratamientos causaron una disminución en las posturas de atención extremada protegida porcentual (PPSAP). El tratamiento de Neem no tuvo efecto sobre las entradas al brazo cerrado o actividades aéreas (con las patas traseras) distinguiéndose así farmacológicamente del diazepam que producía una disminución predecible en esas medidas locomotoras. Si bien tanto el neem como el diazepam reducían la ansiedad en los índices conductuales etológicos complejos, solamente el neem producía ansiolisis sin deficiencias motoras.

Effect of non-steroidal anti-inflammatory drugs on behavioral actions of diazepam in mice

To investigate the behavioral pharmacological interactions of diazepam with non steroidal anti-inflammatory drugs. Non selective cyclooxygenase enzyme inhibitors [100 mg/kg acetylsalicylic acid, 10 mg/kg indomethacin, and 10 mg/kg diclofenac], a selective cyclooxygnase-1 inhibitor [10mg/kg acetylsalicylic acid], and a selective cyclooxygnase-2 inhibitor [10 mg/km celecoxib] of non steroidal anti-inflammatory drugs were individually pretreated to 15 and 24 groups of Albino mice for dose and time dependent models [n=8, each treatment] before sleeping induced by diazepam [20 mg/kg, intraperitoneally]. In 6 groups using an open field and 4 groups using traction test models [n=10], 5 and 10 mg/kg of diazepam, intraperitoneally were given to induce sedation and muscle relaxation, and 2mg / kg, to induce anxiolytic action after treatment with acetylsalicylic acid [10 mg/kg] to 4 groups [n=6]. This study was carried out at the Al-Fateh Medical Science University, Tripoli, Libya between February and May 2009. In dose and time dependent models non selective cyclooxygenase and selective cyclo-oxygnase-1 inhibitors significantly reduced the duration of sleep induced by diazepam in mice by 60-75%, while the selective cyclooxygnase-2 inhibitor did not [p>0.05]. However, anxiolytic, muscle relaxant, and sedative effects of diazepam were unchanged by acetylsalicylic acid. Non-steroidal anti-inflammatory drugs, most likely cyclooxygenase selective-1 inhibitors reduced the duration of sleep induced by diazepam, and this interaction could be of a pharmacodynamic type

The effects of diazepam on the elevated T-maze are dependent on the estrous cycle of rats

In order to determine the modulation of anxiolytic and panicolytic-like effects of diazepam by the hormonal cycle of female rats, male and female rats - the latter divided per estrous cycle phase (estrus, diestrus, metaestrus and proestrus) - were tested in the elevated T-maze, a behavioral model of panic and anxiety. Diazepam (0.5, 1.0 and 2.0 mg/kg) or saline solution was injected in individual animals that were submitted to one session in the elevated T-maze 25 min after drug/saline administration. The test consisted of three avoidance trials and one escape trial, separated by a 30 s interval, during which the animals were isolated in individual cages. The avoidance trials began with the animal being placed at the end of the maze's enclosed arm. The time necessary for the animal to leave the central square was considered as the response's latency. The trials that exceeded 300 s were considered as failures. Results demonstrate a decrease in the effects of diazepam in inhibitory avoidance (anxiety) trials in females in diestrus and proestrus, but no relation of gender or estrous cycle on diazepam effects on escape trials (fear). The results support the hypothesis that down-regulation of GABA A receptors by activation of nuclear estrogen receptors and induction of PKC-mediated GABA A receptor phosphorylation by activation of surface estrogen receptors in raphe neurons underlie the modulation of diazepam sensitivity by estrogen.

Anticonvulsant activity of ethanolic extract and aqueous fraction of Launaea acanthodes gum in comparison with diazepam in mice

Launaea acanthodes gum [LAG] contains flavonoids with benzodiazepine-like activity and so it may be helpful in treatment of epilepsy. To determine the effects of ethanolic extract [EE] and aqueous fraction [AF] of LAG on convulsion induced by pentylentetrazole [PTZ] in mice. This experimental study was carried out at the Department of Biology, Science and Research Division, Azad University, Tehran [Iran] in 2005. Lethal doses [LD50] of EE and AF were determined by acute toxicity test. The effect of AF on activity of brain was investigated by using open filed test and the signs [rearing, locomotion] were compared with control group. Later, the animals in experimental groups [10 mice] received different doses of EE [100, 200, 300 mg/kg] and AF [200, 300,400 mg/kg] via intraperitoneal injections 30 min prior to PTZ injection. The members of control group received saline and those in positive control group were given diazepam [10 mg/kg]. Then the epileptiform behaviors were investigated following the subcutaneous injection of PTZ [85 mg/kg] for 30 minutes. In the open filed test, a single dose of AF exhibited a significant decrease in rearing with no such effect on locomotion activity. Also, different doses of EE and AF inhibited convulsions through an increase in latency to the onset of forelimb clonus and tonic-clonic seizures. According to our data, the LAG extracts have anticonvulsant and anxiolytic activities with no obvious sing of depression

Sedative and cardiovascular effects of midazolam and diazepam alone or combined with clonidine in patients undergoing hemodynamic studies for suspected coronary artery disease / Efeitos sedativos e cardiovasculares do midazolam e do diazepam, associados ou não a clonidina, em pacientes submetidos a estudos hemodinâmicos por suspeita de doença arterial coronariana

FUNDAMENTO: A sedação durante a cineangiocoronariografia tem sido pouco estudada e saber qual é a melhor droga para sedar esses pacientes é um questionamento importante. OBJETIVO: Avaliar a qualidade da sedação e os efeitos sobre a freqüência cardíaca (FC) e a pressão arterial (PA) do midazolam e do diazepam, associados ou não a clonidina, em pacientes com suspeita de doença coronariana. MÉTODOS: Foi desenvolvido ensaio clínico prospectivo, duplo-cego, randomizado, controlado, com 160 pacientes divididos em cinco grupos de 32 pacientes cada, de acordo com o fármaco utilizado: grupo C (clonidina 0,5 µg/kg); grupo M (midazolam 40 µg/kg); grupo MC (associação de midazolam 40 µg/kg e clonidina 0,5 µg/kg); grupo D (diazepam 40 µg.kg); e grupo DC (associação de diazepam 40 µg/kg e clonidina 0,5 µg/kg). A sedação foi avaliada com base na escala de Ramsay e no consumo de meperidina 0,04 mg.kg-1. A PA invasiva, a FC e o escore de sedação foram analisados a cada cinco minutos em quatro diferentes momentos. RESULTADOS: Os pacientes que utilizaram midazolam apresentaram maiores escores de sedação e variação da FC e da PA (p < 0,05). Os que utilizaram diazepam ou clonidina tiveram menores escores de sedação e mais satisfatórios para a realização do exame e apresentaram menor variação da PA e da FC (p > 0,05). CONCLUSÃO: O midazolam foi associado a maior efeito sedativo e cardiovascular enquanto o diazepam causou menor efeito sedativo e cardiovascular. A clonidina e o diazepam tiveram efeitos semelhantes na PA, na FC e na sedação.

BACKGROUND: Sedation during coronary angiography has been rarely studied, and it is important to know which drug is the best to sedate these patients. OBJECTIVE: To evaluate the quality of sedation and the effects of midazolam and diazepam alone or combined with clonidine on the heart rate (HR) and blood pressure (BP) of patients with suspected coronary artery disease. METHODS: This is a controlled, randomized, double-blind, prospective clinical study of 160 patients divided into five groups of 32 patients each, according to the drug used: group C (clonidine 0.5 µg/kg); group M (midazolam 40 µg/kg); group MC (combination of midazolam 40 µg/kg and clonidine 0.5 µg/kg); group D (diazepam 40 µg/kg); and group DC (combination of diazepam 40 µg/kg and clonidine 0.5 µg/kg). Sedation was evaluated based on the Ramsay scale and on the use of meperidine 0.04 mg.kg-1. Invasive BP monitoring, HR and the sedation score were analyzed every five minutes at four different time points. RESULTS: Patients who received midazolam presented higher sedation scores as well as HR and BP variation (p < 0.05). Those who received diazepam or clonidine had lower sedation scores, which were more satisfactory for the performance of the procedure, and presented a lower BP and HR variation (p > 0.05). CONCLUSION: Midazolam was associated with a greater sedative and cardiovascular effect, whereas for diazepam these effects were less intense. Clonidine and diazepam had similar effects on BP, HR and sedation.

Protective effect of Withania somnifera dunal root extract against protracted social isolation induced behavior in rats.

This study investigated the effect of Withania somnifera Dunal (WS) root extract and diazepam in social isolation induced behavior such as anxiety and depression in rats. Rats were isolated for 6 weeks and the assessment of changed behavior were done on elevated plus maze (EPM) and forced swim test (FST). Isolation reared rats spent less time into the open arms on EPM and significantly increased immobility time in FST compared to group housed rats. WS (100, 200 or 500 mg/kg, oral) and diazepam (1 or 2 mg/kg, ip) dose dependently increased the time spent and entries into the open arms on EPM test and showed the anxiolytic activity. Subeffective dose of WS (50 mg/kg, oral) potentiated the anxiolytic action of diazepam (0.5, 1 or 2 mg/kg, ip). WS (100, 200 or 500 mg/kg, oral) also reduced the immobility time in FST, thus showed antidepressant effect in both group housed and social isolates. The investigations support the use of WS as a mood stabilizer in socially isolation behavior in Ayurveda.

Effect of withdrawal of diazepam or morphine treatment on gastric motility (charcoal meal test) in mice: possible role of different central and peripheral receptors.

Increased gastrointestinal motility in mice as one of the withdrawal symptoms of commonly abused drugs like diazepam or morphine and its possible mechanism of action was studied. Male Laka mice (20-25 g) were made addict to either diazepam (20 mg/kg, ip for 7 days) or morphine (10 mg/kg, sc for 9 days). Withdrawal symptoms were noted 24 hr after the last injection of diazepam or morphine. The animals were injected with Ro 15-1788 (flumazenil) (1 mg/kg, ip) or naloxone (2 mg/kg, ip) in the respective group to precipitate the withdrawal symptoms. Gastrointestinal motility was assessed by charcoal-meal test. Animals developed tolerance to acute sedative effect of diazepam, and similarly to the acute nociceptive action of morphine. On abrupt cessation of these drugs after chronic treatment the animals showed hyperlocomotion and hyperreactivity in diazepam withdrawal group and hyperalgesia on hot plate in morphine withdrawal groups, respectively. Increase in gastrointestinal motility was observed in all the drug withdrawal groups. Treatment with respective antagonists, Ro 15-1788 (flumazenil) and naloxone precipitated the withdrawal symptoms. The results suggest the involvement of both central and peripheral receptors of benzodiazepines and opioid (mu) receptors in the withdrawal symptoms of the benzodiazepines and morphine, respectively.

Potentiation of pentobarbital hypnosis by Rosa damascena in mice.

Rosa damascena has been found to act on central nervous system including brain. It inhibits the reactivity of the hypothalamous and pituitary systems in rat. In traditional medicine hypnotic effect of Rose is also suggested. In the present study hypnotic effect of ethanolic, aqueous and chloroformic extracts of R. damascena was investigated in mice. Hypnotic method was based on potentiation of pentobarbital induced sleeping time by extracts. Three doses of extracts (100, 500 and 1000 mg/kg) were injected i.p. in comparison with diazepam (3mg/kg) as positive control and saline as negative control. After 30 min of injection of extracts, pentobarbital (30mg/kg) was injected and increase in sleeping time by extracts was recorded. The results showed that the ethanolic and aqueous extracts in 500 and 1000 mg/kg doses significantly increased pentobarbital induced sleeping time which was comparable to diazepam. The chloroformic extract had no hypnotic effect.

Análise comparativa dos efeitos do diazepam, midazolam, propofol e etomidato na contratilidade miocárdica e no fluxo coronariano: estudo em corações isolados de ratos / Effects of diazepam, midazolam, propofol and etomidate in myocardial contractility and coronary blood flow: comparative analysis in isolated rat's hearts

OBJETIVO: Avaliar o efeito, na contratilidade miocárdica e no fluxo coronariano, de drogas comumente utilizadas na prática clínica (diazepam, midazolam, propofol e etomidato). MÉTODO: Foram estudados 50 corações isolados de ratos Wistar divididos em cinco grupos de dez, em preparação de Langendorff com líquido de perfusão de Krebs-Henseleit (K-H), mantendo-se constantes a pressão de perfusão (90 centímetros de água) e a temperatura (37° + 0,5 graus Celsius). Com exceção do Grupo I (Controle), foram feitas infusões únicas, em um minuto, de diazepam (50 microgramas) - Grupo II; midazolam (25 microgramas) - Grupo III; propofol (25 e 50 microgramas) - Grupo IV e etomidato (25 microgramas) - Grupo V. Cada dose foi diluída e administrada em 0,1 mililitro de K-H, mantendo-se o fluxo e a pressão de perfusão coronarianos do sistema, durante sua infusão. Aferiu-se a freqüência cardíaca em batimentos por minuto (BPM), a tensão miocárdica em gramas (g), e o fluxo coronariano em mililitros por minuto (ml/min) em 1, 3, 5, 10, 15, 20, 25 e 30 minutos; a contratilidade miocárdica foi avaliada pelo cálculo da primeira derivada tensão/tempo (dT/dtmax), naquelas marcas. RESULTADOS: A freqüência cardíaca apresentou variações nos Grupos I, III e IV. Em relação à tensão miocárdica, apenas o Grupo I não sofreu declínio; o fluxo coronariano, exceto no Grupo IV, apresentou variações para menos, ao longo do estudo; a contratilidade miocárdica decresceu em todos os grupos estudados, exceto no Grupo I. CONCLUSÃO: As drogas ensaiadas diminuíram a contratilidade miocárdica (p<0,05); as alterações do fluxo coronariano não se relacionaram com as variações da contratilidade miocárdica (p>0,05).