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2.
Rev. colomb. psiquiatr ; 50(1): 52-56, Jan.-Mar. 2021. tab, graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1251634

ABSTRACT

RESUMEN El trastorno por consumo de alcohol es una de las principales causas de morbimortalidad en el mundo. La enfermedad hepática alcohólica es una complicación común de este trastorno y la encefalopatía hepática es una seria comorbilidad de la cirrosis alcohólica. Los factores precipitantes pueden relacionarse con infección, sangrado gastrointestinal, deshidratación o efectos de psicofármacos (p. ej., benzodiacepinas e hipnóticos no benzodiacepínicos). Se expone un caso del manejo hospitalario de un paciente con un trastorno severo por consumo de alcohol, cirrosis y encefalopatía hepática, quien desarrolla síntomas de abstinencia alcohólica durante su hospitalización y la complejidad del manejo antagónico de un delirium gabaérgico propio de la encefalopatía hepática en el contexto de un delirium glutamatérgico-noradrenérgico por abstinencia alcohólica.


ABSTRACT Alcohol use disorder is one of the main causes of morbidity and mortality in the world. Alcoholic liver disease is a common complication of this disorder, and hepatic encephalopathy is a serious complication of alcoholic cirrhosis. Precipitating factors may be related to infection, gastrointestinal bleeding, dehydration or the effects of psychotropic drugs (e.g. benzodiazepines and non-benzodiazepine hypnotics). We present a case of the hospital management of a patient with a severe alcohol use disorder, cirrhosis and hepatic encephalopathy who developed alcohol withdrawal symptoms while in hospital, and discuss the complexity of the antagonistic management of a GABAergic delirium characteristic of hepatic encephalopathy in the context of a glutamatergic-noradrenergic delirium due to alcohol withdrawal.


Subject(s)
Humans , Male , Aged , Substance Withdrawal Syndrome , Precipitating Factors , Delirium , Psychotropic Drugs , Therapeutics , Benzodiazepines , Comorbidity , Dehydration , Alcoholism , Hypnotics and Sedatives , Liver Cirrhosis, Alcoholic , Liver Diseases, Alcoholic
3.
Rev. colomb. psiquiatr ; 50(1): 47-51, Jan.-Mar. 2021. graf
Article in English | LILACS, COLNAL | ID: biblio-1251633

ABSTRACT

ABSTRACT Introduction: Major neurocognitive disorder (MNCD) affects millions of people worldwide. However, the pharmacological options for its management are limited, ineffective and frequently associated with severe adverse reactions. Case report: An 85-year-old man with history of multiple chronic brain injuries (alcohol-use disorder, haemorrhagic stroke, brain trauma, chronic use of benzodiazepines) developed an MNCD, reaching 7 points on the Reisberg Global Deterioration Scale. He had minimal response to antidepressants, antipsychotics and anticholinergic medications. After the use of mother tincture of Indian hemp (cannabis), a significant improvement was found in his cognitive function, ability to carry out activities of daily living and independence. Discussion: The endocannabinoid system seems to be implicated in age-related cognitive decline. In addition, the evidence derived from in-vitro and animal models suggest that this system could play an important role in the management of MNCD of different causes. Conclusions: Cannabinoid treatment for MNCD emerges as a promising therapeutic approach that may benefit a growing number of patients who do not have other treatment options. It is therefore necessary to encourage more research efforts that will help to remove political and scientific barriers to its clinical use.


RESUMEN Introducción: El trastorno neurocognitivo mayor (TNM) afecta a millones de personas a nivel mundial. Sin embargo, las opciones farmacológicas para su manejo son limitadas, poco efectivas y se asocian a importantes reacciones adversas. Caso clínico: Se presenta el caso clínico de un hombre de 85 años, con antecedente de múltiples lesiones cerebrales crónicas (abuso de alcohol, enfermedad cerebrovascular, traumatismo cerebral, uso crónico de benzodiacepinas), quien desarrolló un TNM clasificado con 7 puntos en la Reisberg Global Deterioration Scale. Tuvo poca respuesta al manejo con antidepresivos, antipsicóticos y anticolinérgicos. Tras el uso de tintura madre de cáüamo índico (cannabis), se evidenció una mejoría en la función cognitiva, la capacidad de cuidado para las actividades de la vida diaria y la independencia. Discusión: El sistema endocanabinoide parece estar relacionado con los procesos de deterioro cognitivo asociados con la edad. Además, la evidencia derivada de modelos in vitro y animales sugiere que podría tener un papel importante en el manejo del TNM de diferentes etiologías. Conclusiones: El uso de cannabinoides en el TNM se presenta como una pista terapéutica prometedora. Por lo tanto, es necesario promover procesos de investigación que contribuyan a eliminar las barreras políticas y científicas para su uso clínico, beneficiando a un número creciente de pacientes que no poseen opciones terapéuticas eficaces.


Subject(s)
Humans , Male , Aged, 80 and over , Cannabinoids , Cognition , Neurocognitive Disorders , Antipsychotic Agents , Benzodiazepines , Cannabis , Brain Injury, Chronic , Stroke , Endocannabinoids , Alcoholism , Brain Injuries, Traumatic , Antidepressive Agents
5.
Ciênc. Saúde Colet ; 25(11): 4351-4360, nov. 2020. tab, graf
Article in English, Portuguese | ColecionaSUS, LILACS, ColecionaSUS, SES-SP | ID: biblio-1133057

ABSTRACT

Resumo Este trabalho analisou a qualidade da informação veiculada na internet sobre 4 benzodiazepínicos amplamente utilizados no Brasil: alprazolam, bromazepam, clonazepam e diazepam. Essa escolha se justifica pelo fato desses medicamentos serem amplamente utilizados, poderem gerar dependência química e a internet ser importante fonte de informação sobre eles. Foram analisados 20 sites para cada medicamento. Mais da metade (56,3%) dos sites foram classificados como deficientes ou muito deficientes. Os problemas mais frequentes foram a ausência da descrição do responsável pelo sítio (60%), informação incompleta (62,5%), ausência de contato para informação adicional (45%) e da última data da atualização (82%). Os resultados reforçam a preocupação com a qualidade da informação em saúde veiculada na internet, já apontada pela literatura, e a necessidade de adoção de critérios mínimos de qualidade para esta informação.


Abstract This study analysed the quality of information published on the internet regarding 4 benzodiazepines that are widely used in Brazil: alprazolam, bromazepam, clonazepam and diazepam. This choice is justified by the fact that these drugs are widely used and can generate chemical dependency, and the internet is an important source of information about them. We analysed 20 sites for each drug. More than half (56.3%) of the sites were classified as deficient or very deficient. The most frequent problems with the sites were the absence of a description of the person responsible for the site (60%), incomplete information (62.5%), the absence of a contact for additional information (45%) and the absence of the last date the site was updated (82%). These results reinforce concerns regarding the quality of the health information published on the internet, which has already been noted in the literature, and the need to adopt minimum quality criteria for this information.


Subject(s)
Humans , Benzodiazepines , Bromazepam , Alprazolam , Brazil , Internet
6.
Washington; Organización Panamericana de la Salud; ago 25, 2020. 28 p.
Non-conventional in Spanish | LILACS | ID: biblio-1117908

ABSTRACT

En el transcurso de la pandemia de COVID-19, numerosos países, de ingresos bajos, medianos y alto, han visto agotadas sus reservas de medicamentos esenciales necesarios para el manejo de los pacientes con COVID-19 en las unidades de cuidados intensivos (UCI). El plan de preparación para emergencias sanitarias de los países requiere incluir una lista de medicamentos esenciales y otros dispositivos médicos necesarios en las UCI para afrontar emergencias sanitarias. La lista de medicamentos esenciales para el manejo de pacientes que ingresan a unidades de cuidados intensivos con sospecha o diagnóstico confirmado de COVID-19 es un documento de orientación fundamental que ayuda a los sistemas de salud de los países a priorizar los medicamentos esenciales que deben estar ampliamente disponibles y ser asequibles para manejar los pacientes en las UCI durante las situaciones de emergencia sanitaria, en este caso con sospecha o diagnóstico confirmado de COVID-19. Está dirigida a las autoridades sanitaras y a los encargados del manejo del sistema de salud de los países. Esta lista incluye fundamentalmente los medicamentos considerados esenciales para el manejo de los cuadros clínicos que con se observan con mayor frecuencia en pacientes hospitalizados en UCI a causa de una infección por SARS-CoV-2. No se incluyen la mayoría de los medicamentos que comúnmente se encuentran en las UCI para el manejo de otras patologías, comorbilidades o la estabilización del paciente (p. ej., insulina o antihipertensivos), salvo aquellos que pueden requerirse para el tratamiento o apoyo (p. ej., bloqueantes neuromusculares o anestésicos) de las dolencias generadas por la infección. Tampoco se incluyen medicamentos específicos para el tratamiento de la infección por SARS-CoV-2, puesto que no existe, por el momento, evidencia científica de alta calidad que avale su uso, salvo en el contexto de ensayos clínicos controlados. Un equipo de expertos en el tema realizó una búsqueda de información sobre la atención de pacientes en UCI durante la pandemia de COVID-19, en Medline (a través de PubMed), Cochrane, Tripdatabase, Epistemonikos y en buscadores generales de internet (Google). Se identificaron también revisiones o guías generadas por ministerios de Salud de varios países de la Región de las Américas, la Organización Mundial de la Salud (OMS), la Organización Panamericana de la Salud (OPS), el Instituto Nacional de Salud y Excelencia Clínica (NICE) de Reino Unido, los Centros para el Control y la Prevención de Enfermedades (CDC) de Estados Unidos y los Institutos Nacionales de Salud (NIH) de Estados Unidos.


Subject(s)
Humans , Child , Adult , Pneumonia, Viral/drug therapy , Succinylcholine/therapeutic use , Antipsychotic Agents/therapeutic use , Benzodiazepines/therapeutic use , Patient Care Management/organization & administration , Dexamethasone/therapeutic use , Adrenal Cortex Hormones/therapeutic use , Coronavirus Infections/drug therapy , Drugs, Essential/supply & distribution , Dexmedetomidine/therapeutic use , Severe Acute Respiratory Syndrome/drug therapy , Antipyretics/therapeutic use , Pandemics/prevention & control , Betacoronavirus/drug effects , Haloperidol/therapeutic use , Analgesics, Opioid/therapeutic use , Intensive Care Units/organization & administration , Anti-Infective Agents/therapeutic use , Pneumonia, Viral/prevention & control , Respiration, Artificial/nursing , Shock, Septic/prevention & control , Thromboembolism/prevention & control , Coronavirus Infections/prevention & control , Evidence-Based Medicine , Intubation/nursing , Hypoxia/drug therapy
7.
Salud colect ; 16: e2495, 2020. tab
Article in Spanish | LILACS | ID: biblio-1139516

ABSTRACT

RESUMEN La atención primaria de la salud es un punto transversal dentro de la Red de Atención Psicosocial, y atiende las demandas relacionadas con el sufrimiento mental. Si bien los medicamentos representan la principal opción de tratamiento, el uso prolongado de benzodiazepinas puede desarrollar tolerancia y dependencia. El objetivo es analizar la frecuencia y las características de los usuarios de benzodiazepinas en los servicios de atención primaria de la salud, a través de un estudio transversal realizado en la ciudad de Chapecó, estado de Santa Catarina, un municipio del sur de Brasil. Se verificó un elevado número de prescripciones proporcionales entre mujeres, adultos y ancianos y un predominio de personas de sexo femenino (80%), color de piel blanca (67,9%), casadas (50,7%), con una media de edad de 56 años, que señala la necesidad de diseñar e implementar cambios en los procedimientos de prescripción y dispendio de benzodiazepinas.


ABSTRACT Primary Health Care is a transversal point in the Psychosocial Care Network, responsible for attending to demands related to mental suffering. Although medication represents the main treatment option, the prolonged use of benzodiazepines may lead to tolerance and consequent dependence. The objective of this study is to analyze the frequency and characteristics of benzodiazepine users attending primary healthcare services, through a cross-sectional study conducted in Chapecó, Santa Catarina, a municipality in southern Brazil. Higher proportional prescription was observed in adult and elderly women, with predominance among individuals who were women (80%), white (67.9%), and married (50.7%), with a median age of 56 years. These findings suggest a need to plan and implement changes in the procedures for prescribing and administering benzodiazepines.


Subject(s)
Humans , Female , Adult , Middle Aged , Aged , Benzodiazepines , Health Services , Primary Health Care , Brazil , Cross-Sectional Studies
8.
Rev. saúde pública (Online) ; 54: 40, 2020. tab, graf
Article in English | LILACS | ID: biblio-1094423

ABSTRACT

ABSTRACT OBJECTIVE In recent decades there has been an increase in the use of antidepressants (AD) and a decrease in the use of benzodiazepines (BDZ). Prevalence, cumulative incidence, and factors associated with the incidence of AD and BDZ use in a Brazilian population were estimated in this article. METHODS Data were collected with a self-administered questionnaire in a cohort of employees from a university in Rio de Janeiro. The prevalence of the use of AD and BDZ was calculated for 1999 (4,030), 2001 (3,574), 2006-07 (3,058), and 2012 (2,933). The cumulative incidences of the use of AD and BDZ between 1999 and 2007 were estimated by the Poisson models with robust variance estimates. RESULTS In 1999, the prevalence of the use of AD and BDZ were 1.4% (95%CI: 1.1-1.8) and 4.7% (95%CI: 4.1-5.4), respectively; in 2012, they were 5.4% (95%CI: 5.5-6.2) and 6.8% (95%CI: 6.0-7.8). The incidence of use, between 1999 and 2007, was 4.9% (95%CI: 4.2-5.7) for AD and 8.3% (95%CI: 7.3-9.3) for BDZ. The incidences of AD and BDZ use were higher among women and participants with a positive General Health Questionnaire. CONCLUSION In this population, the increase in the use of AD was not accompanied by a decrease in the use of BDZ, showing the prescriptions for psychotropic medication do not follow the currently recommended guidelines for treatment of common mental health disorders.


Subject(s)
Humans , Male , Female , Adult , Young Adult , Benzodiazepines/administration & dosage , Drug Utilization/trends , Antidepressive Agents/administration & dosage , Psychotropic Drugs , Socioeconomic Factors , Brazil , Sex Factors , Surveys and Questionnaires , Cohort Studies , Age Factors , Drug Utilization/statistics & numerical data , Middle Aged
10.
Rev. bras. epidemiol ; 23: e200029, 2020. tab
Article in Portuguese | LILACS | ID: biblio-1101578

ABSTRACT

RESUMO: Introdução: Os benzodiazepínicos são os psicofármacos mais utilizados globalmente, apesar dos riscos associados ao seu uso prolongado, especialmente entre os idosos. Objetivo: O estudo teve como objetivo investigar a tendência do uso de benzodiazepínicos entre idosos mais velhos (75 anos ou mais) residentes em comunidade. Métodos: Trata-se de um estudo realizado com idosos com idades entre 75 e 89 anos, integrantes da linha base (em 1997) e sobreviventes (em 2012) da coorte idosa do Projeto Bambuí. A prevalência do uso de benzodiazepínicos foi estimada separadamente para cada ano, e a comparação entre elas foi realizada por meio de regressão de Poisson com variância robusta. Resultados: A prevalência do uso de benzodiazepínicos foi maior em 2012 (33,9%) em comparação a 1997 (24,9%). Após o ajuste múltiplo, a diferença de prevalências não permaneceu significativa na população total de estudo (razão de prevalência (RP) = 1,25; intervalo de confiança de 95% (IC95%) 0,99 - 1,60), diferentemente do observado no estrato feminino (RP = 1,38; IC95% 1,04 - 1,84). O clonazepam foi o medicamento que apresentou o mais forte crescimento (RP = 4,94; IC95% 2,54 - 9,62) entre os dois anos. Conclusão: O presente estudo evidenciou um importante aumento no uso de benzodiazepínicos em uma população idosa mais velha. Esses resultados preocupam, pois são medicamentos contraindicados para idosos, especialmente se utilizados cronicamente, e estão disponíveis na relação nacional de medicamentos essenciais. Os profissionais de saúde devem estar atentos para os riscos envolvidos no seu uso por essa população.


ABSTRACT: Background: Benzodiazepines are the most widely used psychoactive drugs, despite the risks associated with their prolonged use, especially among older adults. Objective: To investigate the use of benzodiazepines among community-dwelling people aged ≥ 75 years. Methods: The study was conducted among members of the baseline (in 1997) and survivors (in 2012) of the Bambuí Project cohort. The prevalence of benzodiazepine use was estimated separately for each year, and the comparison between them was performed using the Poisson regression model with robust variance. Results: The prevalence of benzodiazepine use was higher in 2012 (33.9%) compared to 1997 (24.9%). After multiple adjustments, the difference in prevalence did not remain significant in study population (PR = 1.25; 95%CI 0.99 - 1.60), unlike that observed in the female stratum (PR = 1.38; 95%CI 1.04 - 1.84). Clonazepam was the strongest-growing drug between the two years (PR = 4.94; 95%CI 2.54 - 9.62). Conclusion: This study showed an important increase in benzodiazepine use in an older adult population. These results are concerning as these drugs are contraindicated for use in older adults, mainly if used chronically, and are available in the national list of essential medicines. Health professionals should be aware of the risks involved in its use regarding this population.


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Psychotropic Drugs/therapeutic use , Benzodiazepines/therapeutic use , Drug Utilization/statistics & numerical data , Independent Living/statistics & numerical data , Time Factors , Brazil , Multivariate Analysis , Risk Factors , Cohort Studies , Sex Distribution , Age Distribution , Income
11.
Clinics ; 75: e1610, 2020. tab
Article in English | LILACS | ID: biblio-1133432

ABSTRACT

OBJECTIVES: To report the prevalence and factors associated with the use of benzodiazepines in the general population and those with a mental health condition in the metropolitan area of São Paulo, Brazil. METHODS: 5,037 individuals from the Sao Paulo Megacity Mental Health Survey data were interviewed using the Composite International Diagnostic Interview, designed to generate DSM-IV diagnoses. Additionally, participants were asked if they had taken any medication in the previous 12 months for the treatment of any mental health condition. RESULTS: The prevalence of benzodiazepine use ranged from 3.6% in the general population to 7.8% among subjects with a mental health condition. Benzodiazepine use was more prevalent in subjects that had been diagnosed with a mood disorder as opposed to an anxiety disorder (14.7% vs. 8.1%, respectively). Subjects that had been diagnosed with a panic disorder (33.7%) or bipolar I/II (23.3%) reported the highest use. Individuals aged ≥50 years (11.1%), those with two or more disorders (11.2%), those with moderate or severe disorders (10%), and those that used psychiatric services (29.8%) also reported higher use. CONCLUSION: These findings give an overview of the use of benzodiazepines in the general population, which will be useful in the public health domain. Benzodiazepine use was higher in those with a mental health condition, with people that had a mood disorder being the most vulnerable. Furthermore, females and the elderly had high benzodiazepine use, so careful management in these groups is required.


Subject(s)
Humans , Male , Female , Benzodiazepines/therapeutic use , Mental Disorders , Anxiety Disorders , Brazil , Prevalence , Surveys and Questionnaires
12.
Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 12: 883-889, jan.-dez. 2020. tab
Article in English, Portuguese | LILACS, BDENF | ID: biblio-1103884

ABSTRACT

Objetivo: Investigar a prevalência da utilização de benzodiazepínicos por idosos usuários da Estratégia Saúde da Família. Métodos: Estudo documental e quantitativo realizado em dois municípios do Estado do Ceará. Foram analisados 184 prontuários de idosos usuários da Estratégia Saúde da Família. Resultados: Observou-se uma maior prevalência de mulheres, com idade variando entre 60 e 85 anos, casadas ou com união estável, analfabetas, que possuíam alguma doença crônica e que não utilizam psicotrópicos. Para os idosos que utilizam tais medicamentos, têm-se uma maior frequência de benzodiazepínicos, cujo consumo ocorre há menos de quatro anos, sendo mais prescrito o Diazepam 5 mg, com dose de meio comprimido diariamente. Também foi evidenciada uma deficiência no acompanhamento do idoso que utiliza psicotrópicos. Conclusão: A prevalência do uso de benzodiazepínicos nos idosos investigados foi considerada alta, o que requer um maior cuidado do idoso e de seus familiares/cuidadores acerca dos efeitos adversos desses medicamentos


Objective: This study is aimed at investigating the prevalence of benzodiazepine use by elderly people assisted by the Family Health Strategy Program. Methods: It is a documental study with a quantitative approach that carried out in two municipalities from the Ceará State. There were analyzed 184 medical records of elderly users attending the Family Health Strategy. Results: There was a higher prevalence of women, within the age group from 60 to 85 years old, married or common-law marriage, illiterate, who had some chronic disease and did not use psychotropic drugs. For the elderly people who use these medications, there was a higher frequency of benzodiazepines, where its consumption has been taking place under four years, with Diazepam 5 mg being prescribed more regularly as half a tablet daily. Furthermore, it was evidenced a follow-up deficiency of the elderly taking psychotropic drugs. Conclusion: The prevalence of benzodiazepine use was considered high vis-à-vis the investigated elderly population, which requires better care services for those people and their family members/caregivers, considering the adverse effects of such drugs


Objetivo: Investigar la prevalencia de la utilización de benzodiazepinas por ancianos usuarios de la Estrategia Salud de la Familia. Métodos: Estudio documental y cuantitativo realizado en dos municipios del Estado de Ceará. Se analizaron 184 prontuarios de ancianos usuarios de la Estrategia Salud de la Familia. Resultados: Se observó una mayor prevalencia de mujeres, con edad variando entre 60 y 85 años, casadas o con unión estable, analfabetas, que poseían alguna enfermedad crónica y que no utilizan psicotrópicos. Para los ancianos que utilizan tales medicamentos, se tiene una mayor frecuencia de benzodiazepinas, cuyo consumo ocurre hace menos de cuatro años, siendo más prescrito el Diazepam 5 mg, con dosis de medio comprimido diariamente. También se evidenció una deficiencia en el acompañamiento del anciano que utiliza psicotrópicos. Conclusión: La prevalencia del uso de benzodiazepinas en los ancianos investigados fue considerada alta, lo que requiere un mayor cuidado del anciano y de sus familiares / cuidadores acerca de los efectos adversos de esos medicamentos


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Benzodiazepines , Mental Health , Health of the Elderly , Family Health Strategy
13.
Braz. j. med. biol. res ; 53(8): e10034, 2020. graf
Article in English | ColecionaSUS, LILACS, ColecionaSUS | ID: biblio-1132538

ABSTRACT

Contradictory findings suggest that the behavioral and abuse-related effects of ethanol are mediated by its action at α1 subunit-containing GABAA (α1GABAA) receptors. In the present study, we investigated the effects of a sub-chronic post-ethanol administration treatment with zolpidem, an α1-preferring positive allosteric modulator at GABAA receptors, on the subsequent expression of ethanol-induced behavioral sensitization in mice. Animals received ethanol (1.8 g/kg, ip) or saline treatments every other day for 15 days (8 treatment sessions) and were subsequently treated with zolpidem (0.5 mg/kg, ip) or vehicle 4 times on alternate days. At the end of the treatment phase, animals were challenged with saline or ethanol on separate days for the evaluation of the expression of conditioned locomotion and behavioral sensitization. Eight-day treatment with ethanol did not lead to the development of ethanol-induced behavioral sensitization. Animals treated with ethanol and subsequently administered vehicle showed similar locomotion frequencies during the last ethanol challenge compared to the control group receiving ethanol for the first time. Animals treated with ethanol and subsequently administered zolpidem expressed behavioral sensitization to ethanol during the ethanol challenge. The present study adds to the literature by providing further evidence of a role of α1GABAA receptors on the behavioral effects of ethanol. Because of the current highly prevalent co-abuse of ethanol and benzodiazepine drugs in humans, the use of zolpidem and other α1GABAA receptor ligands during ethanol withdrawal should be monitored carefully.


Subject(s)
Animals , Male , Rabbits , GABA Agonists/pharmacology , Ethanol , Zolpidem/pharmacology , Benzodiazepines , Receptors, GABA-A , Locomotion
14.
Rev Assoc Med Bras (1992) ; 66(7): 998-1001, 2020.
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1136312

ABSTRACT

SUMMARY OBJECTIVE To discuss the role of the benzodiazepine class in delirium patient management. METHODS Using the PubMed database, articles were reviewed after the year 2000 containing in their title the words 'delirium' and 'benzodiazepines'. DISCUSSION Delirium is an acute confusional state that leads to altered attention, awareness, and cognition. It presents with some well-established risk factors, especially older individuals with cognitive decline. There is currently no definite consensus regarding its pathophysiology, nor regarding pharmacological measures, especially concerning the benzodiazepine class. CONCLUSION Evidence suggests that there may be a role for the use of pharmacological class in the treatment of this condition, indicating a change in the previously paradigmatic pattern of treatment.


RESUMO OBJETIVO Discutir o papel da classe de benzodiazepínicos no manejo do paciente em delirium. MÉTODOS Utilizando base de dados PubMed, foram revisados artigos posteriores ao ano 2000 contendo em seu título as palavras ''delirium'' e ''benzodiazepines''. DISCUSSÃO O delirium é um estado confusional agudo, que cursa com alteração da atenção, consciência e cognição. Apresenta-se com alguns fatores de risco bem estabelecidos, sobretudo em indivíduos de maior idade e com declínio cognitivo. Não há, atualmente, um consenso definido quanto a sua fisiopatologia, tampouco referente às medidas farmacológicas, principalmente acerca da classe dos benzodiazepínicos. CONCLUSÃO Evidências sugerem que pode haver um papel do uso da classe farmacológica no tratamento do quadro em questão, indicando uma mudança no padrão anteriormente paradigmático do tratamento.


Subject(s)
Humans , Benzodiazepines/therapeutic use , Delirium/drug therapy , Risk Factors , Cognition
15.
Article in Korean | WPRIM | ID: wpr-811247

ABSTRACT

Restless legs syndrome (RLS) is a neurological sleep disorder characterized by an urge to move the legs or arms and is associated with discomfort and paresthesia in the legs. RLS is diagnosed based on the clinical symptoms, and polysomnography is performed to quantify the periodic limb movements during sleep or in patients who undergo the suggested immobilization test. Determining the cause of RLS is important for accurately diagnosing and evaluating this condition. The treatment of RLS varies according to the etiology, severity, and frequency of the patients' symptoms. Accurate identification and treatment of the cause of RLS are important in patients with secondary RLS. Iron supplementation could be useful in patients with uremia, iron deficiency, and for RLS during pregnancy. Dopamine agonists have been used as the first-line treatment for primary RLS. On the other hand, augmentation is a known adverse effect associated with the long-term use of dopamine agonists. Therefore, recent treatment guidelines recommend the administration of anticonvulsants, such as pregabalin and gabapentin, to treat RLS. Iron, opioids, or benzodiazepines may be useful in patients refractory to anticonvulsants or dopamine agonists. RLS is a chronic condition. Therefore, it is essential to establish a long-term treatment plan, considering both the efficacy and adverse effects of therapeutic agents used in patients.


Subject(s)
Analgesics, Opioid , Anticonvulsants , Arm , Benzodiazepines , Diagnosis , Dopamine Agonists , Extremities , Hand , Humans , Immobilization , Iron , Leg , Paresthesia , Polysomnography , Pregabalin , Pregnancy , Restless Legs Syndrome , Sleep Wake Disorders , Uremia
16.
Article in English | WPRIM | ID: wpr-811208

ABSTRACT

Behaviour management and dental procedures performed in very young, pre-cooperative, highly anxious, or medically disabled children are challenging tasks. Various drugs and methods have, however, been introduced to facilitate treatment for this patient population. Midazolam is a benzodiazepine used as an adjunct to behavior management techniques in the dental treatment of pediatric patients. Midazolam can be used as a safe and effective drug for conscious sedation, general anesthetic premedication, and treatment of seizures during dental procedures. Nevertheless, further research involving pediatric patients would be beneficial.


Subject(s)
Benzodiazepines , Conscious Sedation , Disabled Children , Humans , Midazolam , Pediatric Dentistry , Premedication , Seizures
17.
Saúde Soc ; 28(4): 137-146, out.-dez. 2019. tab
Article in Spanish | LILACS | ID: biblio-1058987

ABSTRACT

Resumen A pesar de que son ampliamente conocidos los perfiles de utilización de las benzodiazepinas (BZD) y los riesgos asociados, este conocimiento no ha conducido a visibles transformaciones que mejoren la seguridad de los tratamientos y la salud de los pacientes. Por tanto, es necesaria una mejor compresión del contexto de su utilización, con el fin de implementar acciones educativas eficaces, tomar decisiones clínicas pertinentes y perfeccionar su regulación en los servicios de salud. Este artículo se propone caracterizar el perfil de utilización de benzodiazepinas en un área de salud de Santiago de Cuba y analizar el contexto de consumo a partir de los sentidos construidos por usuarios crónicos. Se realiza un estudio de caso, que describe el perfil de consumo a partir de las recetas dispensadas en la Farmacia Principal Municipal, y se realizan entrevistas a profundidad a los usuarios crónicos. El contenido de las entrevistas fue realizado temáticamente. Los resultados revelan los siguientes temas: poca concientización sobre el beneficio-riesgo del tratamiento, sufrimiento con la dependencia y tolerancia, autonomía en el tratamiento y limitada credibilidad en las terapias alternativas. La proporción de adultos mayores que reciben las BZD es mayor que la identificada en otros estudios. Se concluye que los usuarios perciben aspectos negativos del uso, pero están presos en la dependencia. Se evidencia la importancia de estudiar estrategias para el tratamiento del insomnio y la ansiedad en la atención primaria de salud, así como valorizar las políticas de implementación de terapias naturales y otros abordajes para contribuir al uso racional de las BZD.


Abstract The profiles for the use of benzodiazepines and associated risks are well known. However, this knowledge has not led to visible transformations that improve the safety of treatments and the health of patients. It is therefore necessary to better understand the context of use of these medications in order to implement effective educational actions, make relevant clinical decisions and improve their regulation in health services, especially in primary care. To characterize the profile of use of benzodiazepines in a health area of Santiago de Cuba and to analyze the context of consumption from the senses built by chronic users. Methods: A case study was carried out on the consumption patterns and interviews with chronic users was performed. The content of the interviews was thematically analyzed. The themes revealed were: little awareness of the benefit-risk of treatment; suffering with dependence and tolerance; autonomy in treatment; and limited credibility in alternative therapies. The proportion of older adults receiving benzodiazepines is greater than that identified in other studies. The users perceive negative aspects of use, but they are tied to the dependence. It is evident the importance of studying strategies for the treatment of insomnia and anxiety in primary health care, as well as valuing the policies of implementation of natural therapies and other approaches to contribute to the rational use of benzodiazepines.


Subject(s)
Humans , Male , Female , Pharmaceutical Services , Anti-Anxiety Agents , Benzodiazepines , Substance-Related Disorders
19.
Medicina (B.Aires) ; 79(4): 315-321, ago. 2019. tab
Article in Spanish | LILACS | ID: biblio-1040529

ABSTRACT

El inicio precoz del tratamiento con antiagregantes plaquetarios es considerado el estándar de cuidado para pacientes con accidente cerebrovascular isquémico agudo. Distintos esquemas de antiagregación se han comparado con resultados que sugieren que la combinación de múltiples antiagregantes se asocian a menor riesgo de recurrencia de accidente cerebrovascular (ACV) pero a expensas de un aumento en el riesgo de sangrado, lo que a largo plazo termina opacando dichos beneficos. Sin embargo, considerando que el riesgo de recurrencia de ACV es mayor en el periodo inmediato al evento, la indicación de doble tratamiento antiagregante por tiempos limitados podría asociarse a beneficios relevantes. Con este concepto, se realizó una revisión sistemática rápida con el objetivo de evaluar el efecto del tratamiento con doble antiagregación por un periodo corto intentando maximizar el beneficio y reducir al mínimo el riesgo de sangrado. Se incluyeron todos los estudios primarios identificados en los que se comparó un esquema de doble antiagregación, iniciado en el periodo agudo del evento índice (ACV o accidente isquémico transitorio - AIT), contra un esquema de simple antiagregación. El cuerpo de la evidencia mostró que la intervención (doble antiagregación) reduce el riesgo de recurrencia de ACV y probablemente se asocie a un aumento marginal en el riesgo de sangrado mayor. Sugerimos indicar doble esquema antiplaquetario para el tratamiento inicial de pacientes con ACV isquémico menor (Score NIH < o igual a 3 o AIT).


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.


Subject(s)
Humans , Benzodiazepines/administration & dosage , Platelet Aggregation Inhibitors/administration & dosage , Ischemic Attack, Transient/prevention & control , Ischemic Attack, Transient/drug therapy , Aspirin/administration & dosage , Clopidogrel/administration & dosage , Polyamines/administration & dosage , Recurrence , Drug Therapy, Combination , Secondary Prevention
20.
Braz. J. Psychiatry (São Paulo, 1999, Impr.) ; 41(4): 324-335, July-Aug. 2019. tab, graf
Article in English | LILACS | ID: biblio-1011506

ABSTRACT

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.


Subject(s)
Humans , Psychomotor Agitation/drug therapy , Antipsychotic Agents/administration & dosage , Benzodiazepines/administration & dosage , Practice Guidelines as Topic , Psychiatric Status Rating Scales , Psychomotor Agitation/diagnosis , Antipsychotic Agents/classification , Benzodiazepines/classification , Brazil , Disease Management
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