A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Family Medicine. Johannesburg 2003 / Residents of a Retirement Village (Rosehaven), in both the frail and the non-frail sections, were the subjects for this study. They were interviewed to determine demographic characteristics and attitude towards sleep and sleep problems. Subjects living in the frail care facility were compared to those living independently. In addition, the chronic use of benzodiazepines, and the perceptions of both the subjects, and the medical and nursing personnel caring for them, was studied. The physical and mental status of subjects currently taking benzodiazepines was compared with those who were not. No significant differences in demographic features, was found between the frail and the non-frail subjects. However, when subjects taking benzodiazepines were compared with those who were not, several interesting differences were determined. Frail subjects were more likely to be taking benzodiazepines. Sleep difficulties, and perception of poor sleep quality was more likely in the benzodiazepine group. Subjects taking benzodiazepines were more likely to be anxious, and to have suffered falls and resulting injuries. The daily functioning of subjects was rated using three well-validated scales: Instrumental Activities of Daily Living, Mini Mental State Examination, and the Geriatric Depression scale. Those subjects taking benzodiazepines scored significantly worse on all of these scales, independent of frail status (i.e. within both frail and nonfrail groups, subjects taking benzodiazepines scored significantly worse). In spite of the above findings, subjects’ perception of benzodiazepines was positive, and they believed them to be helpful. Nursing staff also perceived benzodiazepines to be beneficial medications. Most of the general practitioners questioned had doubts as to the safety of benzodiazepine use in elderly patients, however they were also generally happy to continue to prescribe them. / IT2018

Bibliography: leaves 1-26. / xvi, [271] leaves : bill. (chiefly col.) ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Develops a sensitive rat model of benzodiazepine tolerance and withdrawal using objective and continuous measures (activity, electromyographic activity and body temperature) recorded by radiotelemetry / Thesis (Ph.D.)--University of Adelaide, Dept. of Clinical and Experimental Pharmacology, 1998?

Thesis (Ph.D.)--University of Adelaide, Dept. of Clinical and Experimental Pharmacology, 1998? / Bibliography: leaves 1-26.

Thesis (Ph. D.)--University of California, San Diego and San Diego State University, 2000. / Vita. Includes bibliographical references (leaves 62-67).

OBJECTIVE: To study the association between benzodiazepine prescribing patterns including dose, type and dosing schedule and the risk of drug overdose death among US veterans receiving opioid analgesics. DESIGN: Case-cohort study SETTING: Veterans Health Administration (VHA), 2004 through 2009. PARTICIPANTS: US veterans, primarily male, who received opioid analgesics between 2004 and 2009. All veterans who died of a drug overdose (n = 2,400) while receiving opioid analgesics and a random sample of veterans (n = 420,386) who received VHA medical services and opioid analgesics were included in the study. Main outcome measure: Drug overdose death, defined as any intentional, unintentional or indeterminate poisoning death caused by any medication or drug, determined by cause of death information from the National Death Index. RESULTS: Twenty seven percent of veterans who received opioid analgesics also received benzodiazepines during the study period. Approximately half of the drug overdose deaths (n=1,185) occurred when veterans were concurrently prescribed benzodiazepines and opioids. Risk of drug overdose death increased based on benzodiazepine prescription history: formerly prescribed vs. not prescribed (adjusted hazard ratio [HR]=2.33, 95% confidence interval [CI]: 2.05-2.64); currently prescribed vs. not prescribed (HR=3.86, CI:3.49-4.26). Risk of drug overdose death increased as daily benzodiazepine dose increased. When compared to clonazepam, temazepam was associated with a decreased drug overdose death risk (HR=0.63, CI: 0.48-0.82). Benzodiazepine dosing schedule was not associated with drug overdose death risk. CONCLUSIONS: Among veterans receiving opioid analgesics, receipt of benzodiazepines was associated with an increased risk of drug overdose death in a dose-response fashion.

Orientador: Eduardo Dias de Andrade / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-20T06:28:38Z (GMT). No. of bitstreams: 1 Bentes_AnaPaulaGuerreiro_M.pdf: 1168135 bytes, checksum: ca31fffb62b345249aeec51b5df67d0c (MD5) Previous issue date: 2012 / Resumo: A sedação mínima deve ser considerada como parte do protocolo farmacológico nas cirurgias implantodônticas, já que os pacientes podem apresentar um grau aumentado de ansiedade, interrompendo o curso da intervenção, entre outras possíveis intercorrências. O objetivo deste trabalho foi avaliar, de forma comparativa, os efeitos do alprazolam e midazolam no controle da ansiedade neste tipo de intervenção. Cinquenta voluntários, ASA I ou ASA II, com indicação para a colocação de implantes dentários, foram divididos em dois grupos (n=25), tratados com alprazolam 0,5 mg ou midazolam 7,5 mg, via oral, de forma aleatória e duplo cega. A eficácia da sedação foi avaliada pelo operador, usando a escala CGI (Clinical Global Impression) e pelos voluntários, por meio de uma Escala Analógica Visual (EAV), em três tempos distintos. A pressão arterial (PA), frequência cardíaca (FC) e a saturação de oxigênio do sangue arterial (SpO2), foram monitoradas em diferentes momentos da pesquisa. A incidência de amnésia anterógrada e de outros possíveis efeitos colaterais foi investigada por meio de contato verbal, 24 horas após a cirurgia. Ambos os benzodiazepínicos reduziram os níveis de ansiedade dos voluntários, sem diferença significativa entre os tratamentos (Mann-Whitney, p>0,05). As drogas mostraram-se seguras, pois os parâmetros fisiológicos avaliados (PA, FC, e SpO2) mantiveram-se dentro da faixa de normalidade (Kruskal-Wallis, p>0,05). A ocorrência de amnésia anterógrada se deu em três voluntários tratados com midazolam, e a sonolência relatada por três sujeitos de cada grupo. Pode-se concluir que o alprazolam 0,5 mg e midazolam 7,5 mg, de forma similar, controlam a ansiedade de indivíduos submetidos a cirurgias implantodônticas ambulatoriais, com alto índice terapêutico de segurança / Abstract: Minimal sedation should be considered as part of the pharmacological protocol for surgical dental implant, in which pacients may have an increased level of stress, interrupting the course of the surgery, among other possible events. The aim of this study was to evaluate the clinical efficacy and safety of alprazolam, compared to midazolam in reducing anxiety in surgical dental implants. Fifty volunteers, ASA I or ASA II, with indication for placement of dental implants, were divided into two equal groups (n=25), treated with orally 0.5 mg alprazolam or 7.5 mg midazolam, orally, in random order and double blind. The efficacy of sedation was assessed by the operator, using a CGI (Clinical Global Impression) and the volunteers themselves, through a range of visual analogue scale (VAS) in three different times. The arterial blood pressure (BP), heart rate (HR) and arterial oxygen saturation (SpO2) were monitored in different periods. Side effects and incidence of anterograde amnesia were investigated by verbal contact, 24 hours after surgery. Both benzodiazepines decreased anxiety levels in a similar way, with no significant difference between the treatments (Mann-Whitney, p>0.05). The drugs showed safety, because the physiological parameters evaluated (BP, HR and SpO2) remained within the normal range (Kruskal-Wallis, p>0.05). Anterograde amnesia occurred in only three volunteers treated with midazolam and the sleepiness was reported by three patients in each group. These findings suggest that orally administered alprazolam 0.5 mg and midazolam 7.5 mg comparably reduce anxiety in ambulatory implantodontic surgery patients, with high therapeutic index of safety / Mestrado / Farmacologia, Anestesiologia e Terapeutica / Mestre em Odontologia

Class of 2015 Abstract / Objectives: To determine whether disparities exist among mental health patients admitted to the emergency department in regards to the prescribing patterns of injectable benzodiazepines and antipsychotics. Methods: A retrospective chart review was performed to evaluate patients with mental health diagnoses who received an injectable antipsychotic or benzodiazepine while in the emergency department of an academic medical center. A report was generated of all injectable antipsychotics and benzodiazepines removed from the emergency department Pyxis machines from November 1, 2013 to January 31, 2014. Data from the patient medical record included the patient’s age, height, weight, gender, race/ethnicity, insurance information, mental health diagnosis, evidence of substance abuse, how they arrived in the emergency department, their length of stay in the emergency department, any signs of aggressive behavior (adapted from the Overt Aggression Scale), information about each injectable antipsychotic or benzodiazepine that was administered was recorded including the name of the medication, dose, route of administration. If the patient received multiple doses of the same medication during their stay, the total dose and the total time receiving the medication was also recorded. The prescriber’s gender and whether they were a resident or an attending physician was also recorded for each medication administered. Results: A total of 98 patient charts were reviewed and analyzed. Mental health diagnoses were broken down into categories of psychiatric disorders (39.8%), bipolar disorders (74.5%), mood disorders (40.8%), and personality disorders 54.1%). Of the 98 patients reviewed, 68% had a documented substance abuse, with 62% having a positive urinalysis for alcohol, illicit drugs, or opiates. The majority of the patients were white (64.3%). The next largest racial/ethnic categories were Hispanics (12.2%), Native Americans (8.2%), and African Americans (6.1%). There were 54 males and 44 females. Benzodiazepines comprised 74% of the medications administered with lorazepam being the most frequently administered medication overall at 63.4%. Haloperidol was the second most frequently administered medication at 22%. Initial Chi Square analysis did not yield any significant results with regards to race and prescribing patterns, gender and prescribing patterns, or insurance and prescribing patterns. Conclusions: Patients with mental health diagnoses suffer from disparities within health care, and when these patients fall under other demographic groups such as racial/ethnic minorities and low socioeconomic status, the disparate treatment they receive could be even greater. Several limitations to this study including a small sample size and lack of geographical diversity resulted in a lack of statistically significant results, and our findings may not be generalizable to other patient populations.

Yes / Cochrane Incentive Grant from the National Institute for Health Research (NIHR)

The presence of pharmaceuticals in the environment is becoming an increasing regulatory and scientific concern. Thus, the metabolic profile and bioconcentration potential of diazepam, a model benzodiazepine, were examined, as well as effects on the endocrine system in channel catfish. Through the use of specific and non-specific cytochrome P450 (CYP450) inhibitors, it was determined that CYP3A-like enzymes may play a role in the biotransformation of diazepam into temazepam; however, the isoform(s) required for the formation of other metabolites is still unknown. Overall, only around 7-8% of diazepam is biotransformed into two known metabolites. Due to the lack of inherent metabolism of diazepam in channel catfish, further analysis was conducted to determine the tissue-specific bioconcentration potential of diazepam in catfish. Various tissues were analyzed for the presence of diazepam as well as metabolites and bioconcentration factors (BCF) were calculated, which were all well below regulatory threshold values (> 2000). Additionally, modulation of the endocrine system by diazepam was examined by measuring steroid hormone concentrations and analyzing mRNA expression of selected steroidogenic enzymes and receptors. Two steroidogenic enzymes were modulated following diazepam exposure, indicating potential endocrine disrupting properties of diazepam. Together, these data suggest that diazepam exhibits low metabolic transformation rates in channel catfish, which may lead to accumulation of benzodiazepine compounds that may negatively affect the endocrine system. However, further studies should be aimed at identifying other steroidogenic enzymes and/or receptors that may be modulated following diazepam exposure.

No description available.