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Thaller M, Wong A, Yankama T, Eche IM, Elsamadisi P. Evaluation of Clinical Outcomes Associated With Phenobarbital With Taper Compared to No Taper for the Management of Alcohol Withdrawal Syndrome. Ann Pharmacother 2024:10600280241236412. [PMID: 38501811 DOI: 10.1177/10600280241236412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Phenobarbital (PHB) has been shown to be an effective treatment of alcohol withdrawal syndrome (AWS), with multiple dosing strategies used (e.g., single-dose and symptom-triggered). Studies have often used tapered doses, typically following a front-loaded dose, despite PHB's long half-life which should lead to an ability to auto-taper. OBJECTIVE The purpose of this study was to compare clinical outcomes associated with two PHB dosing strategies (taper [T], no taper [NT]) for AWS. METHODS This retrospective cohort study compared adult patients admitted to the ICU from October 2017 to May 2019 who received an initial loading dose of PHB for AWS. The use of PHB was at the discretion of the clinician per our institutional guidelines. Prior to November 2018, patients were prescribed a PHB taper, while after this period, the taper was no longer recommended. The primary outcome was the proportion of patients requiring rescue PHB or adjunctive medications for AWS. Secondary outcomes included number of adjunctive agents used, prevalence of severe manifestations of AWS, ICU and hospital lengths of stay, and incidence of potentially significant drug interactions. RESULTS A total of 172 patients were included (T: n = 81, NT: n = 91). Baseline characteristics were similar between groups, including history of severe AWS and cumulative benzodiazepine dose pre-PHB. There was no difference in the primary outcome between groups (T: 70.4% vs NT: 59.3%, P = 0.152). The median number of adjunctive agents per patient, severe manifestations, and ICU and hospital length of stay did not differ between groups. Twenty-five patients (14.5%) had potentially significant drug interactions. CONCLUSION AND RELEVANCE The use of a PHB loading dose without a taper may be comparable to a taper strategy on clinical outcomes. Prospective studies are needed to further delineate the optimal dose of PHB for AWS.
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Affiliation(s)
- Matthew Thaller
- Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Adrian Wong
- Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Tuyen Yankama
- Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Ifeoma Mary Eche
- Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Pansy Elsamadisi
- Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, MA, USA
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2
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Sideri IK, Stangel C, Stergiou A, Liapi A, Ojeda-Galván HJ, Quintana M, Tagmatarchis N. Covalently Modified MoS 2 Bearing a Hamilton-Type Receptor for Recognizing a Redox-Active Ferrocene-Barbiturate Guest via Multiple H-Bonds. Chemistry 2023; 29:e202301474. [PMID: 37249239 DOI: 10.1002/chem.202301474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 05/26/2023] [Accepted: 05/30/2023] [Indexed: 05/31/2023]
Abstract
The covalent modification of the metallic phase of MoS2 with a Hamilton-type ligand is presented, transforming MoS2 to a recognition platform which is able to embrace barbiturate moieties via hydrogen bonding. The successful hydrogen bonding formation is easily monitored by simple electrochemical assessments, if a ferrocene-labeled barbiturate analogue is utilized as a proof of concept. Full spectroscopic, thermal, and electron microscopy imaging characterization is provided for the newly formed recognition system, along with valuable insights concerning the electrochemical sensing. The given methodology expands beyond the sensing applications, confidently entering the territory of supramolecular interactions on the surface of 2D transition metal dichalcogenides. The well-designed host-guest chemistry presented herein, constitutes a guide and an inspiration for hosting customized-structured functional building blocks on MoS2 and its relatives via hydrogen bonding, opening up new opportunities regarding potential applications.
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Affiliation(s)
- Ioanna K Sideri
- Theoretical and Physical Chemistry Institute, National Hellenic Research Foundation, 48 Vassileos Constantinou Avenue, 11635, Athens, Greece
| | - Christina Stangel
- Theoretical and Physical Chemistry Institute, National Hellenic Research Foundation, 48 Vassileos Constantinou Avenue, 11635, Athens, Greece
| | - Anastasios Stergiou
- Theoretical and Physical Chemistry Institute, National Hellenic Research Foundation, 48 Vassileos Constantinou Avenue, 11635, Athens, Greece
| | - Alexandra Liapi
- Theoretical and Physical Chemistry Institute, National Hellenic Research Foundation, 48 Vassileos Constantinou Avenue, 11635, Athens, Greece
| | - Hiram Joazet Ojeda-Galván
- High Resolution Microscopy-CICSaB and Faculty of Science, Universidad Autonóma de San Luis Potosi, Av. Sierra Leona 550, 78210, Lomas de San Luis Potosi, SLP, Mexico
| | - Mildred Quintana
- High Resolution Microscopy-CICSaB and Faculty of Science, Universidad Autonóma de San Luis Potosi, Av. Sierra Leona 550, 78210, Lomas de San Luis Potosi, SLP, Mexico
| | - Nikos Tagmatarchis
- Theoretical and Physical Chemistry Institute, National Hellenic Research Foundation, 48 Vassileos Constantinou Avenue, 11635, Athens, Greece
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3
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Inoue G, Ohtaki Y, Satoh K, Odanaka Y, Katoh A, Suzuki K, Tomita Y, Eiraku M, Kikuchi K, Harano K, Yagi M, Uchida N, Dohi K. Sedation Therapy in Intensive Care Units: Harnessing the Power of Antioxidants to Combat Oxidative Stress. Biomedicines 2023; 11:2129. [PMID: 37626626 PMCID: PMC10452444 DOI: 10.3390/biomedicines11082129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/27/2023] Open
Abstract
In critically ill patients requiring intensive care, increased oxidative stress plays an important role in pathogenesis. Sedatives are widely used for sedation in many of these patients. Some sedatives are known antioxidants. However, no studies have evaluated the direct scavenging activity of various sedative agents on different free radicals. This study aimed to determine whether common sedatives (propofol, thiopental, and dexmedetomidine (DEX)) have direct free radical scavenging activity against various free radicals using in vitro electron spin resonance. Superoxide, hydroxyl radical, singlet oxygen, and nitric oxide (NO) direct scavenging activities were measured. All sedatives scavenged different types of free radicals. DEX, a new sedative, also scavenged hydroxyl radicals. Thiopental scavenged all types of free radicals, including NO, whereas propofol did not scavenge superoxide radicals. In this retrospective analysis, we observed changes in oxidative antioxidant markers following the administration of thiopental in patients with severe head trauma. We identified the direct radical-scavenging activity of various sedatives used in clinical settings. Furthermore, we reported a representative case of traumatic brain injury wherein thiopental administration dramatically affected oxidative-stress-related biomarkers. This study suggests that, in the future, sedatives containing thiopental may be redeveloped as an antioxidant therapy through further clinical research.
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Affiliation(s)
- Gen Inoue
- Department of Emergency, Disaster and Critical Care Medicine, School of Medicine, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan; (G.I.)
| | - Yuhei Ohtaki
- Department of Emergency Medicine, School of Medicine, The Jikei University, 3-25-8 Nishishinbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Kazue Satoh
- Department of Emergency, Disaster and Critical Care Medicine, School of Medicine, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan; (G.I.)
| | - Yuki Odanaka
- Center for Instrumental Analysis, School of Pharmacy, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan
| | - Akihito Katoh
- Department of Emergency, Disaster and Critical Care Medicine, School of Medicine, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan; (G.I.)
| | - Keisuke Suzuki
- Department of Emergency, Disaster and Critical Care Medicine, School of Medicine, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan; (G.I.)
| | - Yoshitake Tomita
- Department of Emergency, Disaster and Critical Care Medicine, School of Medicine, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan; (G.I.)
| | - Manabu Eiraku
- Department of Emergency, Disaster and Critical Care Medicine, School of Medicine, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan; (G.I.)
| | - Kazuki Kikuchi
- Department of Emergency, Disaster and Critical Care Medicine, School of Medicine, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan; (G.I.)
| | - Kouhei Harano
- Department of Emergency, Disaster and Critical Care Medicine, School of Medicine, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan; (G.I.)
| | - Masaharu Yagi
- Department of Emergency, Disaster and Critical Care Medicine, School of Medicine, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan; (G.I.)
| | - Naoki Uchida
- Clinical Research Institute for Clinical Pharmacology and Therapeutics, Showa University Karasuyama Hospital, 6-11-11 Kitakarasuyama, Setagaya-ku, Tokyo 157-8577, Japan
| | - Kenji Dohi
- Department of Emergency, Disaster and Critical Care Medicine, School of Medicine, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan; (G.I.)
- Department of Emergency Medicine, School of Medicine, The Jikei University, 3-25-8 Nishishinbashi, Minato-ku, Tokyo 105-8461, Japan
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4
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Voronin MV, Shangin SV, Litvinova SA, Abramova EV, Kurbanov RD, Rybina IV, Vakhitova YV, Seredenin SB. Pharmacological Analysis of GABA A Receptor and Sigma1R Chaperone Interaction: Research Report I-Investigation of the Anxiolytic, Anticonvulsant and Hypnotic Effects of Allosteric GABA A Receptors' Ligands. Int J Mol Sci 2023; 24:ijms24119580. [PMID: 37298532 DOI: 10.3390/ijms24119580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 05/27/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
Two groups of facts have been established in previous drug development studies of the non-benzodiazepine anxiolytic fabomotizole. First, fabomotizole prevents stress-induced decrease in binding ability of the GABAA receptor's benzodiazepine site. Second, fabomotizole is a Sigma1R chaperone agonist, and exposure to Sigma1R antagonists blocks its anxiolytic effect. To prove our main hypothesis of Sigma1R involvement in GABAA receptor-dependent pharmacological effects, we performed a series of experiments on BALB/c and ICR mice using Sigma1R ligands to study anxiolytic effects of benzodiazepine tranquilizers diazepam (1 mg/kg i.p.) and phenazepam (0.1 mg/kg i.p.) in the elevated plus maze test, the anticonvulsant effects of diazepam (1 mg/kg i.p.) in the pentylenetetrazole-induced seizure model, and the hypnotic effects of pentobarbital (50 mg/kg i.p.). Sigma1R antagonists BD-1047 (1, 10, and 20 mg/kg i.p.), NE-100 (1 and 3 mg/kg i.p.), and Sigma1R agonist PRE-084 (1, 5, and 20 mg/kg i.p.) were used in the experiments. Sigma1R antagonists have been found to attenuate while Sigma1R agonists can enhance GABAARs-dependent pharmacological effects.
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Affiliation(s)
- Mikhail V Voronin
- Department of Pharmacogenetics, Federal State Budgetary Institution "Research Zakusov Institute of Pharmacology", Baltiyskaya Street 8, 125315 Moscow, Russia
| | - Stanislav V Shangin
- Department of Pharmacogenetics, Federal State Budgetary Institution "Research Zakusov Institute of Pharmacology", Baltiyskaya Street 8, 125315 Moscow, Russia
| | - Svetlana A Litvinova
- Department of Pharmacogenetics, Federal State Budgetary Institution "Research Zakusov Institute of Pharmacology", Baltiyskaya Street 8, 125315 Moscow, Russia
| | - Elena V Abramova
- Department of Pharmacogenetics, Federal State Budgetary Institution "Research Zakusov Institute of Pharmacology", Baltiyskaya Street 8, 125315 Moscow, Russia
| | - Rustam D Kurbanov
- Department of Pharmacogenetics, Federal State Budgetary Institution "Research Zakusov Institute of Pharmacology", Baltiyskaya Street 8, 125315 Moscow, Russia
| | - Inna V Rybina
- Department of Pharmacogenetics, Federal State Budgetary Institution "Research Zakusov Institute of Pharmacology", Baltiyskaya Street 8, 125315 Moscow, Russia
| | - Yulia V Vakhitova
- Department of Pharmacogenetics, Federal State Budgetary Institution "Research Zakusov Institute of Pharmacology", Baltiyskaya Street 8, 125315 Moscow, Russia
| | - Sergei B Seredenin
- Department of Pharmacogenetics, Federal State Budgetary Institution "Research Zakusov Institute of Pharmacology", Baltiyskaya Street 8, 125315 Moscow, Russia
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5
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Escamilla-Ocañas CE, Albores-Ibarra N. Current status and outlook for the management of intracranial hypertension after traumatic brain injury: decompressive craniectomy, therapeutic hypothermia, and barbiturates. Neurologia 2023:S2173-5808(23)00008-1. [PMID: 37031799 DOI: 10.1016/j.nrleng.2020.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 08/04/2020] [Indexed: 04/11/2023] Open
Abstract
INTRODUCTION Increased intracranial pressure (ICP) has been associated with poor neurological outcomes and increased mortality in patients with severe traumatic brain injury (TBI). Traditionally, ICP-lowering therapies are administered using an escalating approach, with more aggressive options reserved for patients showing no response to first-tier interventions, or with refractory intracranial hypertension. DEVELOPMENT The therapeutic value and the appropriate timing for the use of rescue treatments for intracranial hypertension have been a subject of constant debate in literature. In this review, we discuss the main management options for refractory intracranial hypertension after severe TBI in adults. We intend to conduct an in-depth revision of the most representative randomised controlled trials on the different rescue treatments, including decompressive craniectomy, therapeutic hypothermia, and barbiturates. We also discuss future perspectives for these management options. CONCLUSIONS The available evidence appears to show that mortality can be reduced when rescue interventions are used as last-tier therapy; however, this benefit comes at the cost of severe disability. The decision of whether to perform these interventions should always be patient-centred and made on an individual basis. The development and integration of different physiological variables through multimodality monitoring is of the utmost importance to provide more robust prognostic information to patients facing these challenging decisions.
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Affiliation(s)
- César E Escamilla-Ocañas
- Department of Neurology, Division of Vascular Neurology and Neurocritical Care, Baylor College of Medicine, Houston, TX, USA.
| | - Nadxielli Albores-Ibarra
- División de Ciencias de la Salud, Universidad de Monterrey, San Pedro Garza García, Nuevo León, México
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6
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Abstract
Commonly known as "Quaaludes," methaqualone (1) is a sedative-hypnotic medication, with effects resembling barbiturates and other downers, that exerts its effects through modulation of γ-aminobutyric acid type A receptors (GABAAR). Following the discovery of the sedative and euphoric effects of methaqualone (1), it was quickly adopted by pharmaceutical companies and promoted by clinicians around the world as a "safe" sleeping pill option, and for a period it was available over the counter. The popularity of methaqualone (1) soared worldwide, and many people began to use it recreationally for its sedative-hypnotic-like psychoactive effects. Not long after its introduction, many individuals began to misuse the drug leading to overdoses and drug dependence which brought to light methaqualone's (1) addictive nature. In this review, the background, synthesis, pharmacology, metabolism, and pharmacokinetics of methaqualone (1) will be covered along with its discovery, history, and the derivatives that are currently available around the world through manufacture in clandestine laboratories.
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Affiliation(s)
- Joseph A Inger
- Warren Center for Neuroscience Drug Discovery, Vanderbilt University, Nashville, Tennessee 37232, United States
| | - Elias R Mihan
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee 37232, United States
| | - Jhansi U Kolli
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee 37232, United States
| | - Craig W Lindsley
- Warren Center for Neuroscience Drug Discovery, Vanderbilt University, Nashville, Tennessee 37232, United States.,Department of Pharmacology, Vanderbilt University, Nashville, Tennessee 37232, United States.,Department of Chemistry, Vanderbilt University, Nashville, Tennessee 37232, United States.,Department of Biochemistry, Vanderbilt University, Nashville, Tennessee 37232, United States
| | - Aaron M Bender
- Warren Center for Neuroscience Drug Discovery, Vanderbilt University, Nashville, Tennessee 37232, United States
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7
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Horwitz AB, Rubin RT. Barbiturates and pyrazolopyridines for the treatment of postpartum depression-repurposing of two drug classes. Front Pharmacol 2023; 14:1139889. [PMID: 36909181 PMCID: PMC9995982 DOI: 10.3389/fphar.2023.1139889] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 02/14/2023] [Indexed: 02/25/2023] Open
Abstract
Zulresso (brexanolone) is an aqueous formulation of the neurosteroid, allopregnanolone, and the only FDA-approved medication for the treatment of postpartum depression (PPD). While brexanolone is effective for the treatment of PPD, lengthy infusion time and high cost can be prohibitive. Failure of GABAA receptors to adapt to fluctuating neurosteroid levels is considered to predispose women to mood disorders in the postpartum period. Brexanolone is thought to act via stimulation of δ subunit-containing GABAA receptors, which are extrasynaptic and localized to particular brain regions. Neurosteroid stimulation of δ subunit-containing GABAA receptors leads to sustained inhibition (hyperpolarization) of GABAergic neurons, which makes δ subunit-containing GABAA receptors a potentially important pharmacologic target. Barbiturates and pyrazolopyridines are potent stimulators of δ subunit-containing GABAA receptors and therefore potentially cost-effective treatments for PPD. Barbiturates are often not prescribed, owing to risk of dependence and respiratory depression. The pyrazolopyridines were tested several decades ago for anxiety and depression but never developed commercially. Herein we use the FDA-approved dosing schedule of brexanolone and GABAA receptor binding data from various animal models to examine the safety, efficacy, and potential clinical utility of barbiturates and pyrazolopyridines for the treatment of PPD. We suggest consideration of repurposing barbiturates and pyrazolopyridines as safe and readily available treatment alternatives for PPD.
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Affiliation(s)
- Alexander B Horwitz
- Department of Graduate Medical Education, Community Memorial Healthcare, Ventura, CA, United States
| | - Robert T Rubin
- Department of Graduate Medical Education, Community Memorial Healthcare, Ventura, CA, United States.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
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8
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Malo-Manso A, Fontaneda-Heredia A, Romero-Molina S, Sepúlveda-Haro E, Escalona-Belmonte JJ, Guerrero-Orriach JL. Opioid-Free Anaesthesia Improves Anaesthesia Recovery when Compared with that of Opioid-Based Anaesthesia. Systematic Review and Meta-Analysis of Clinical Trials. Curr Med Chem 2023; 30:1667-1681. [PMID: 36082870 DOI: 10.2174/0929867329666220907155612] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/27/2022] [Accepted: 08/02/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Opioid Free Anesthesia (OFA) is a relatively new technique that has been questioned due to the lack of evidence regarding its benefit-risk balance. METHODS Four international databases were searched for clinical trials comparing OFA with opioid based anesthesia. The primary outcome was pain control and the secondary included postoperative nausea and vomiting (PONV), gastrointestinal recovery, respiratory depression, urinary retention, length of hospital stay, surgical complications, number of patients with cessation of the intervention and other side effects. RESULTS Pain was better controlled in the OFA group in all the measurements made (VAS 1h: Md = -0.81, CI95% = -0.48- -1.14, VAS 24h: Md = -1.25, CI95% =-2.41- -0.1, VAS >24h: Md = -1.36, CI95% = -1.73- -1). In the opioid group there was an increase in the risk of nausea (RR=2.69, CI95% = 2-3.61) and vomiting (RR = 3.99, CI95% = 2.06-7.74), whilst in the OFA group, there was an increased risk of bradycardia (RR= 1.62, CI95% = 1.02-2.57). The rest of the variables showed no differences between groups or could not be analyzed. CONCLUSION There is a clear benefit of OFA in pain control and PONV, but there is also a higher risk of bradycardia. This technique should be considered in patients with a special risk of difficult postoperative pain control or PONV. However, the best drug combination to perform OFA is still unknown, as well as the type of patient that benefits more with less risk.
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9
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Freeman G, Siefried KJ, Roberts DM, Rodgers C, Nic Ionmhain U, Ramanathan J, Ezard N, Brett J. Phenobarbital to manage severe gamma-hydroxybutyrate withdrawal: A case series. Drug Alcohol Rev 2023; 42:27-32. [PMID: 36269081 DOI: 10.1111/dar.13556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/05/2022] [Accepted: 09/13/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Management of a withdrawal syndrome following cessation of regular gamma-hydroxybutyrate (GHB) use, and its precursors, can represent a clinical challenge due to rapid onset delirium and/or seizures. Severe GHB withdrawal can be characterised by persistent or worsening features despite increasing benzodiazepine doses and regular baclofen. Barbiturates, such as phenobarbital, are an appealing option in this context due to their unique GABA-A receptor action. CASE SERIES This series describes the use of phenobarbital in 13 cases, 12 patients, across two hospitals in Sydney, Australia, with persistent or progressive GHB withdrawal despite benzodiazepine-based management. A median cumulative dose of oral diazepam prior to commencing phenobarbital was 120 mg (range 80-255 mg). The median time from the last GHB use to the first dose of phenobarbital was 24 h (range 7-57 h). Eight cases received phenobarbital orally on a general ward and 5 intravenously in intensive care units. An improvement in GHB withdrawal symptoms was observed after phenobarbital in all cases and there were no adverse events related to phenobarbital. DISCUSSION AND CONCLUSION This case series suggests that phenobarbital for the management of benzodiazepine-resistant GHB withdrawal can be safe, even in general inpatient settings, and may avert the progression of delirium. Most data on the management of GHB withdrawal comes from case reports or series, such as this one. This highlights the need for prospective trials to establish an evidence base for therapeutic approaches, including validated measures of withdrawal severity and more information relating to the safe and effective dosing of phenobarbital.
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Affiliation(s)
- Georgia Freeman
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, Australia
| | - Krista J Siefried
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, Australia.,National Centre for Clinical Research on Emerging Drugs of Concern, c/o UNSW, Sydney, Australia.,National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Darren M Roberts
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital Sydney, Sydney, Australia.,St Vincent's Clinical School, UNSW Sydney, Sydney, Australia.,Drug Health, Royal Prince Alfred Hospital, Sydney, Australia
| | - Craig Rodgers
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, Australia
| | - Una Nic Ionmhain
- Liverpool Hospital, Sydney, Australia.,South West Sydney Clinical School, UNSW Sydney, Sydney, Australia
| | | | - Nadine Ezard
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, Australia.,National Centre for Clinical Research on Emerging Drugs of Concern, c/o UNSW, Sydney, Australia.,National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia.,New South Wales Drug and Alcohol Clinical Research and Improvement Network, Sydney, Australia
| | - Jonathan Brett
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, Australia.,Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital Sydney, Sydney, Australia.,St Vincent's Clinical School, UNSW Sydney, Sydney, Australia
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10
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Shamabadi A. Topiramate and other kainate receptor antagonists for depression: A systematic review of randomized controlled trials. Neuropsychopharmacol Rep 2022; 42:421-429. [PMID: 35912516 PMCID: PMC9773746 DOI: 10.1002/npr2.12284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/24/2022] [Accepted: 07/04/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Depression is a common disorder that affects patients' quality of life and incurs health system costs. Due to the resistance to treat depression, better understanding of neurophysiology was considered; one of the implications is the glutamatergic system. This study aims to systematically review clinical trials investigating the antidepressant effects of kainate receptor antagonists. METHODS The study protocol was registered in PROSPERO (CRD42021213912). Scopus, ISI, Embase, PubMed, Cochrane Library, Google Scholar, and two trial registries were searched for randomized controlled trials on the effectiveness of topiramate, phenobarbital, and other ten barbiturates in depression. The difference with control groups in terms of changing depressive symptoms was the primary outcome. RESULTS Nine trials were identified, in which 784 patients were studied. The efficacy of thiopental was comparable to that of imipramine, with fewer side effects. When administered with electroconvulsive therapy, it had fewer to similar effects and fewer side effects than ketamine. Both monotherapy and adjunctive therapy with topiramate were effective and tolerable in treating depressed patients. Phenobarbital had therapeutic effects compared to imipramine and amitriptyline with fewer side effects. CONCLUSION Regarding the glutamatergic hypothesis of depression and obtained promising results, further studies of kainate receptor antagonists in high-quality trials are recommended. Given the high prevalence of depression in epileptic patients, more problems with its treatment, and the fact that the studied agents were anticonvulsants, it is recommended that future studies prioritize depressed-epileptic patients.
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Affiliation(s)
- Ahmad Shamabadi
- School of MedicineTehran University of Medical SciencesTehranIran,Psychiatric Research Center, Roozbeh Psychiatric HospitalTehran University of Medical SciencesTehranIran
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11
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Stern AW, Muralidhar M, Cole C. Evaluation of a human urine barbiturate test to screen for pentobarbital euthanasia of dogs and cats. J Vet Diagn Invest 2022; 34:226-230. [PMID: 35012382 PMCID: PMC8921820 DOI: 10.1177/10406387211070539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Pentobarbital is used commonly to euthanize animals. Occasionally during a death investigation, it is necessary to determine whether a cat or dog was euthanized via pentobarbital overdose. Screening for the detection of barbiturates including pentobarbital can be performed using commercial immunochromatographic tests. We used a commercial immunochromatographic test for barbiturates in humans to screen for barbiturates in urine collected postmortem from 20 dogs and 20 cats to determine whether they had been euthanized with pentobarbital. Additionally, we analyzed the urine for pentobarbital using liquid chromatography-mass spectrometry as a confirmatory test. Screening and confirmation testing revealed 100% agreement between the tests and with the euthanasia status of each animal. Our results support the use of the immunochromatographic test for the screening of urine collected postmortem to assess for the presence of barbiturates, specifically pentobarbital, used for euthanasia.
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Affiliation(s)
- Adam W. Stern
- Adam W. Stern, Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, 2015 SW 16th Ave, Gainesville, FL 32608, USA.
| | - Manavi Muralidhar
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - Cynthia Cole
- University of Florida Racing Laboratory, Gainesville, FL, USA
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12
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Frohlich J, Johnson MA, McArthur DL, Lutkenhoff ES, Dell'Italia J, Real C, Shrestha V, Spivak NM, Ruiz Tejeda JE, Vespa PM, Monti MM. Sedation-Induced Burst Suppression Predicts Positive Outcome Following Traumatic Brain Injury. Front Neurol 2022; 12:750667. [PMID: 35002918 PMCID: PMC8727767 DOI: 10.3389/fneur.2021.750667] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 11/19/2021] [Indexed: 11/24/2022] Open
Abstract
While electroencephalogram (EEG) burst-suppression is often induced therapeutically using sedatives in the intensive care unit (ICU), there is hitherto no evidence with respect to its association to outcome in moderate-to-severe neurological patients. We examined the relationship between sedation-induced burst-suppression (SIBS) and outcome at hospital discharge and at 6-month follow up in patients surviving moderate-to-severe traumatic brain injury (TBI). For each of 32 patients recovering from coma after moderate-to-severe TBI, we measured the EEG burst suppression ratio (BSR) during periods of low responsiveness as assessed with the Glasgow Coma Scale (GCS). The maximum BSR was then used to predict the Glasgow Outcome Scale extended (GOSe) at discharge and at 6 months post-injury. A multi-model inference approach was used to assess the combination of predictors that best fit the outcome data. We found that BSR was positively associated with outcomes at 6 months (P = 0.022) but did not predict outcomes at discharge. A mediation analysis found no evidence that BSR mediates the effects of barbiturates or propofol on outcomes. Our results provide initial observational evidence that burst suppression may be neuroprotective in acute patients with TBI etiologies. SIBS may thus be useful in the ICU as a prognostic biomarker.
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Affiliation(s)
- Joel Frohlich
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Micah A Johnson
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - David L McArthur
- Department of Neurosurgery, Brain Injury Research Center (BIRC), UCLA Brain Injury Research Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Evan S Lutkenhoff
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - John Dell'Italia
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Courtney Real
- Department of Neurosurgery, Brain Injury Research Center (BIRC), UCLA Brain Injury Research Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Vikesh Shrestha
- Department of Neurosurgery, Brain Injury Research Center (BIRC), UCLA Brain Injury Research Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Norman M Spivak
- Department of Neurosurgery, Brain Injury Research Center (BIRC), UCLA Brain Injury Research Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Jesús E Ruiz Tejeda
- Department of Neurosurgery, Brain Injury Research Center (BIRC), UCLA Brain Injury Research Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Paul M Vespa
- Department of Neurosurgery, Brain Injury Research Center (BIRC), UCLA Brain Injury Research Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Martin M Monti
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Neurosurgery, Brain Injury Research Center (BIRC), UCLA Brain Injury Research Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
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13
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Lee MR, Dukan E, Milne I. Three poisonous plants (Oenanthe, Cicuta and Anamirta) that antagonise the effect of γ-aminobutyric acid in human brain. J R Coll Physicians Edinb 2021; 50:80-86. [PMID: 32539046 DOI: 10.4997/jrcpe.2020.121] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Although we are familiar with common British plants that are poisonous, such as Atropa belladonna (deadly nightshade) and Aconitum napellus (monkshood), the two most poisonous plants in the British Flora are Oenanthe crocata (dead man's fingers) and Cicuta virosa (cowbane). In recent years their poisons have been shown to be polyacetylenes (n-C2H2). The plants closely resemble two of the most common plants in the family Apiaceae (Umbelliferae), celery and parsley. Unwittingly, they are ingested by naive foragers and death occurs very rapidly. The third plant Anamirta derives from South-East Asia and contains a powerful convulsant, picrotoxin, which has been used from time immemorial to catch fish, and more recently to poison Birds of Paradise. All three poisons have been shown to block the γ-aminobutyric acid (GABA) system in the human brain that normally has a powerful inhibitory neuronal action. It has also been established that two groups of sedative drugs, barbiturates and benzodiazepines, exert their inhibitory action by stimulating the GABA system. These drugs are the treatments of choice for poisoning by the three vicious plants.
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Affiliation(s)
- Michael R Lee
- 112 Polwarth Terrace, Merchiston, Edinburgh, EH11 1NN, UK
| | - Estela Dukan
- Royal College of Physicians of Edinburgh, Edinburgh, UK
| | - Iain Milne
- Royal College of Physicians of Edinburgh, Edinburgh, UK
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14
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Roberson SW, Patel MB, Dabrowski W, Ely EW, Pakulski C, Kotfis K. Challenges of Delirium Management in Patients with Traumatic Brain Injury: From Pathophysiology to Clinical Practice. Curr Neuropharmacol 2021; 19:1519-1544. [PMID: 33463474 PMCID: PMC8762177 DOI: 10.2174/1570159x19666210119153839] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/12/2020] [Accepted: 01/13/2021] [Indexed: 11/22/2022] Open
Abstract
Traumatic brain injury (TBI) can initiate a very complex disease of the central nervous system (CNS), starting with the primary pathology of the inciting trauma and subsequent inflammatory and CNS tissue response. Delirium has long been regarded as an almost inevitable consequence of moderate to severe TBI, but more recently has been recognized as an organ dysfunction syndrome with potentially mitigating interventions. The diagnosis of delirium is independently associated with prolonged hospitalization, increased mortality and worse cognitive outcome across critically ill populations. Investigation of the unique problems and management challenges of TBI patients is needed to reduce the burden of delirium in this population. In this narrative review, possible etiologic mechanisms behind post-traumatic delirium are discussed, including primary injury to structures mediating arousal and attention and secondary injury due to progressive inflammatory destruction of the brain parenchyma. Other potential etiologic contributors include dysregulation of neurotransmission due to intravenous sedatives, seizures, organ failure, sleep cycle disruption or other delirium risk factors. Delirium screening can be accomplished in TBI patients and the presence of delirium portends worse outcomes. There is evidence that multi-component care bundles including an analgesia-prioritized sedation algorithm, regular spontaneous awakening and breathing trials, protocolized delirium assessment, early mobility and family engagement can reduce the burden of ICU delirium. The aim of this review is to summarize the approach to delirium in TBI patients with an emphasis on pathogenesis and management. Emerging CNS-active drug therapies that show promise in preclinical studies are highlighted.
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Affiliation(s)
| | | | | | | | | | - Katarzyna Kotfis
- Address correspondence to this author at the Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, Poland; E-mail:
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15
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Piper BJ, McCall KL, Kogan LR, Hellyer P. Assessment of Controlled Substance Distribution to U.S. Veterinary Teaching Institutions From 2006 to 2019. Front Vet Sci 2020; 7:615646. [PMID: 33392300 PMCID: PMC7775551 DOI: 10.3389/fvets.2020.615646] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 11/24/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: To evaluate the changing pattern of distribution of Schedule II and III opioids, barbiturates, and stimulants to veterinary educational institutions in the United States. Design: Longitudinal study. Sample: Veterinary teaching institutions that use Schedule II and III drugs. Procedures: Distribution of controlled substances to veterinary teaching institutions was obtained from the Drug Enforcement Administration's Automated Reports and Consolidated Orders System (ARCOS) for opioids (e.g., methadone, fentanyl, codeine), barbiturates (pentobarbital, butalbital), and stimulants (amphetamine, methylphenidate, lisdexamfetamine) from 2006–2019. Opioids were converted to their morphine milligram equivalents (MME) for evaluation over time. Results: Controlled substance distribution to veterinary schools exhibited dynamic, and agent specific, changes. The total MME for 11 opioids peaked in 2013 and decreased by 17.3% in 2019. Methadone accounted for two-fifths (42.3%) and fentanyl over one-third (35.4%) of the total MME in 2019. Pentobarbital distribution was greatest by weight of all substances studied and peaked in 2011 at 69.4 kg. Stimulants underwent a pronounced decline and were very modest by 2014. Conclusions and Clinical Relevance: Opioids by total MME in veterinary teaching practice have undergone more modest changes than opioids used with humans. Hydrocodone, codeine and recently fentanyl use have declined while methadone increased. Stimulant distribution decreased to become negligible. Together, this pattern of findings warrant continued monitoring.
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Affiliation(s)
- Brian J Piper
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, PA, United States.,Center for Pharmacy Innovation and Outcomes, Geisinger Precision Health Center, Forty Fort, PA, United States
| | - Kenneth L McCall
- Department of Pharmacy Practice, University of New England, Portland, ME, United States
| | - Lori R Kogan
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, United States
| | - Peter Hellyer
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, United States
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16
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Prasher P, Sharma M, Singh SP, Rawat DS. Barbiturate derivatives for managing multifaceted oncogenic pathways: A mini review. Drug Dev Res 2020; 82:364-373. [PMID: 33210368 DOI: 10.1002/ddr.21761] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 10/31/2020] [Accepted: 11/09/2020] [Indexed: 12/12/2022]
Abstract
Development and progression of metastasis comprises synchronized erroneous expressions of several composite pathways, which are difficult to manage simultaneously with the representative anticancer molecules. The emergence of the drug resistance and the complex interplay between these pathways further potentiates cancer related complexities. Barbiturates and their derivatives present a commendable anticancer profile by attenuating the cancer manifesting metabolic and enzymatic pathways including, but not limited to matrix metalloproteinases, xanthine oxidase, amino peptidases, histone deacetylases, and Ras/mitogen-activated protein kinase. The derivatization and conjugation of barbiturates with pharmacophores delivers a suitable hybrid profile in containing the anomalous expression of these pathways. The present report presents a succinct collation of the barbiturates and their derivatives in managing the various cancer causing pathways.
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Affiliation(s)
- Parteek Prasher
- UGC Sponsored Centre for Advanced Studies, Department of Chemistry, Guru Nanak Dev University, Amritsar, India.,Department of Chemistry, University of Petroleum & Energy Studies, Dehradun, India
| | - Mousmee Sharma
- UGC Sponsored Centre for Advanced Studies, Department of Chemistry, Guru Nanak Dev University, Amritsar, India.,Department of Chemistry, Uttaranchal University, Dehradun, India
| | - Samarth P Singh
- Department of Chemistry, University of Petroleum & Energy Studies, Dehradun, India
| | - Devendra S Rawat
- Department of Chemistry, University of Petroleum & Energy Studies, Dehradun, India
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17
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Sultan S, Acharya Y, Barrett N, Hynes N. A pilot protocol and review of triple neuroprotection with targeted hypothermia, controlled induced hypertension, and barbiturate infusion during emergency carotid endarterectomy for acute stroke after failed tPA or beyond 24-hour window of opportunity. Ann Transl Med 2020; 8:1275. [PMID: 33178807 PMCID: PMC7607101 DOI: 10.21037/atm-2020-cass-14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
An alternative to tissue plasminogen activator (tPA) failure has been a daunting challenge in ischemic stroke management. As tPA is time-dependent, delays can occur in definitive treatment while passively waiting to observe a clinical response to intravenous thrombolysis. Until today, uncertainty exists in the management strategy of wake-up stroke patients or those presenting beyond the therapeutic tPA window. Clinical dilemmas in these situations can prolong the transitional period of inertia, resulting in an adverse neurological outcome. We propose and review an innovative approach called triple neuro-protection (TNP), which encompasses three technical domains-targeted hypothermia, systemic induced hypertension, and barbiturates infusion, to protect the brain during carotid endarterectomy after failed tPA and/or beyond the 24-hour therapeutic mechanical thrombectomy window. This proposal assimilates discussion on the clinical evidence of the individual domains of TNP with our own clinical experience with TNP. Our first TNP was successfully employed in a 55-year-old man in 2015 while performing emergency carotid endarterectomy after he was referred to us 72 hours post tPA failure. The patient had a successful clinical outcome despite being in therapeutic inertia with 90–99% ipsilateral carotid stenosis and contralateral occlusion on presentation. In the last five years, we have safely used TNP in 25 selected cases with favourable clinical outcomes.
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Affiliation(s)
- Sherif Sultan
- Western Vascular Institute, Department of Vascular and Endovascular Surgery, University Hospital Galway, National University of Ireland, Galway, Ireland.,Department of Vascular & Endovascular Surgery, Galway Clinic, Royal College of Surgeons of Ireland/National University of Ireland Affiliated Teaching Hospitals, Doughiska, Galway, Ireland
| | - Yogesh Acharya
- Western Vascular Institute, Department of Vascular and Endovascular Surgery, University Hospital Galway, National University of Ireland, Galway, Ireland
| | - Nora Barrett
- Western Vascular Institute, Department of Vascular and Endovascular Surgery, University Hospital Galway, National University of Ireland, Galway, Ireland
| | - Niamh Hynes
- Department of Vascular & Endovascular Surgery, Galway Clinic, Royal College of Surgeons of Ireland/National University of Ireland Affiliated Teaching Hospitals, Doughiska, Galway, Ireland
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18
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Willeford A, Trumm N, Bisanz B, Parathasarathy V, Clark RF. Methohexital-Induced Seizure in a Patient Undergoing Conscious Sedation. J Emerg Med 2020; 59:224-226. [PMID: 32565170 DOI: 10.1016/j.jemermed.2020.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 05/04/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Methohexital is a short-acting barbiturate used for procedural sedation in the emergency department (ED). As with other sedatives, adverse effects with methohexital include excess sedation and hypotension, but this agent can also lower the seizure threshold. We report a patient who developed a generalized seizure after administration of methohexital. CASE REPORT A 60-year-old man presented to the ED by ambulance with chest pain and shortness of breath. Paramedics had administered adenosine for supraventricular tachycardia without conversion before arrival to the ED. He had no history of seizures. His initial vital signs in the ED included heart rate of 189 beats/min with a supraventricular rhythm, blood pressure 137/108 mm Hg, respiration 22 breaths/min, and oxygen saturation of 98% on room air. It was decided to attempt synchronized electrical cardioversion, and methohexital 1 mg/kg (120 mg) was administered over 2 min for moderate sedation. Within 15 s of methohexital administration, the patient developed a generalized seizure that lasted for 90 s. After seizure termination, he was successfully cardioverted, returned to his previous baseline level of consciousness within 20 min, and discharged without further problems with a follow-up referral to neurology. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Methohexital is a short-acting barbiturate used for moderate sedation. Its adverse effects are unique in that it can lower the seizure threshold in some patients. Alternative agents for sedation should be considered in individuals with possible seizure disorders.
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Affiliation(s)
- Andrew Willeford
- Department of Pharmacy, UC San Diego Medical Center, San Diego, California
| | - Nicholas Trumm
- Department of Pharmacy, UC San Diego Medical Center, San Diego, California
| | - Bryan Bisanz
- Department of Emergency Medicine, UC San Diego Medical Center, San Diego, California
| | - Vishnu Parathasarathy
- Department of Emergency Medicine, UC San Diego Medical Center, San Diego, California
| | - Richard F Clark
- Department of Emergency Medicine, UC San Diego Medical Center, San Diego, California; Division of Medical Toxicology, UC San Diego Medical Center, San Diego, California
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19
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Zhu R, Dong Y, Cai X, Huang C. Determination of Barbiturates in Biological Specimens by Flat Membrane-Based Liquid-Phase Microextraction and Liquid Chromatography-Mass Spectrometry. Molecules 2019; 24:molecules24081494. [PMID: 30995793 PMCID: PMC6515296 DOI: 10.3390/molecules24081494] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 04/09/2019] [Accepted: 04/16/2019] [Indexed: 11/16/2022] Open
Abstract
The wide abuse of barbiturates has aroused extensive public concern. Therefore, the determination of such drugs is becoming essential in therapeutic drug monitoring and forensic science. Herein, a simple, efficient, and inexpensive sample preparation technique, namely, flat membrane-based liquid-phase microextraction (FM-LPME) followed by liquid chromatography-mass spectrometry (LC-MS), was used to determine barbiturates in biological specimens. Factors that may influence the efficiency including organic extraction solvent, pH, and composition of donor and acceptor phases, extraction time, and salt addition to the sample (donor phase) were investigated and optimized. Under the optimized extraction conditions, the linear ranges of the proposed FM-LPME/LC-MS method (with correlation coefficient factors ≥ 0.99) were 7.5–750 ng mL−1 for whole blood, 5.0–500 ng mL−1 for urine, and 25–2500 ng g−1 for liver. Repeatability between 5.0 and 13.7% was obtained and the limit of detection (LOD) values ranged from 1.5 to 3.1 ng mL−1, from 0.6 to 3.6 ng mL−1, and from 5.2 to 10.0 ng g−1 for whole blood, urine, and liver samples, respectively. This method was successfully applied for the analysis of barbiturates in blood and liver from rats treated with these drugs, and excellent sample cleanup was achieved.
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Affiliation(s)
- Ruiqin Zhu
- Department of Forensic Medicine, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan 430030, China.
| | - Ying Dong
- Department of Forensic Medicine, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan 430030, China.
| | - Xiangyang Cai
- Department of Forensic Medicine, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan 430030, China.
| | - Chuixiu Huang
- Department of Forensic Medicine, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan 430030, China.
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20
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Abstract
OBJECTIVES Anxiety and adjustment disorders are among the most prevalent mental health conditions. This review focuses on γ-aminobutyric acid receptor type A (GABAAR)-mediated anxiolysis, describing the action of both endogenous and exogenous modulators of GABAAR. Future directions and innovative strategies to alleviate anxiety symptoms are discussed, with a particular emphasis on etifoxine. METHODS We used available data from the recent literature to update the mode of action of anxiolytics. We focussed our search on anxiolytics acting at GABAARs, as well as on the pharmacological properties of formerly and currently prescribed anxiolytics. RESULTS Considering the adverse effects of current treatments aimed at increasing inhibitory controls, optimisation of existing pharmacotherapies is of crucial importance. Among the alternative compounds targeting the GABAergic system, translocator protein (TSPO) ligands, such as etifoxine (EFX), which promote endogenous neurosteroidogenesis, are emerging as promising candidates for anxiety relief. In several papers comparing the efficacy of benzodiazepines and EFX, EFX showed interesting properties with limited side effects. Indeed, neurosteroids are potent GABAAR modulators with highly underrated anxiolytic properties. CONCLUSIONS Novel therapeutic strategies have been emerging following the recognition of neurosteroids as potent anxiolytics. Featured at the top of the list for well-tolerated anxiety relief, TSPO ligands such as etifoxine appear promising.
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Affiliation(s)
- Pierrick Poisbeau
- a Centre National de la Recherche Scientifique and University of Strasbourg, Institute for Cellular and Integrative Neuroscience (INCI) , Strasbourg , France
| | - Geraldine Gazzo
- a Centre National de la Recherche Scientifique and University of Strasbourg, Institute for Cellular and Integrative Neuroscience (INCI) , Strasbourg , France
| | - Laurent Calvel
- a Centre National de la Recherche Scientifique and University of Strasbourg, Institute for Cellular and Integrative Neuroscience (INCI) , Strasbourg , France
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21
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Bekman NI, Pomelova VG, Osin NS. [The multiplex analysis of drug medicinals on the basis of technology of immunochips Phosphan.]. Klin Lab Diagn 2018; 63:178-183. [PMID: 30673199 DOI: 10.18821/0869-2084-2018-63-3-178-183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 11/18/2017] [Indexed: 06/09/2023]
Abstract
The new technique of multiplex qualitative analysis of narcotic, psychotropic remedies is developed on the basis of technology Phosphan using immunochips in the format of standard 96-wells plates, monoclonal antibodies to narcotic compounds and Pt-coproporphyrin as a long luminescent marker. The multiplex analysis was implemented using 20 mkl of human biological fluid (urine, blood serum or saliva) of 2 discs of 3.2 mm in diameter made of dried urine spot on paper. No preliminary processing or dilution of analyzed sample is required. The large range of measured concentrations was demonstrated under high sensitivity of analysis: 1 ng/ml of morphine and methadone, 0.5 ng/ml of barbiturates, 2 ng/ml of benzoylecgonine, methamphetamine, cannabinoids and benzodiazepines, 8 ng/ml amphetamine at variability of results no more than 15%. The approbation of technique was implemented using valid samples of urine (n=197) and blood serum (n=98) demonstrated that the technique permits to detect properly opiates, cocaine, cannabinoids, methadone, benzodiazepine, barbiturates and amphetamines at absence of false positive results in case of analysis of samples containing non-narcotic medications. The results of study of samples of dried urine spot on paper (n=50) well coincided with the results of analysis of fluid samples for all analyzed analytes. On the basis of proposed multiplex analysis a test-system Narc-Phosphan was developed for quantitative studying simultaneously up to 96 samples of various biological fluids, including as dried spots on paper. The analysis demonstrated high sensitivity, specificity and exactness during detection of the most prevailed narcotic substances that permits to propose this technique as a primary test during mass check-ups of population with purpose of detection of drug abuse, especially at the earlier stage.
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Affiliation(s)
- N I Bekman
- The Federal State Unitary Institution "The State Research Institute of Biological Instrument-Making Industry" of the Federal Medical Biological Agency of Russia, 125424, Moscow, Russia
| | - V G Pomelova
- The Federal State Unitary Institution "The State Research Institute of Biological Instrument-Making Industry" of the Federal Medical Biological Agency of Russia, 125424, Moscow, Russia
| | - N S Osin
- The Closed Corporation "Immunoskrin", 125424, Moscow, Russia
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22
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Gelbrich T, Griesser UJ. Buthalital and methitural - 5,5-substituted derivatives of 2-thio-barbituric acid forming the same type of hydrogen-bonded chain. Acta Crystallogr E Crystallogr Commun 2017; 73:1908-1912. [PMID: 29250413 PMCID: PMC5730250 DOI: 10.1107/s205698901701653x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 11/16/2017] [Indexed: 12/02/2022]
Abstract
The mol-ecule of buthalital, (I) [systematic name: 5-(2-methyl-prop-yl)-5-(prop-2-en-1-yl)-2-sulfanyl-idene-1,3-diazinane-4,6-dione], C11H16N2O2S, exhibits a planar pyrimidine ring, whereas the pyrimidine ring of methitural, (II) [systematic name: 5-(1-methyl-but-yl)-5-[2-(methyl-sulfan-yl)eth-yl]-2-sulfanyl-idene-1,3-diazinane-4,6-dione], C12H20N2O2S2, is slightly puckered. (I) and (II) contain the same hydrogen-bonded chain structure in which each mol-ecule is connected, via four N-H⋯O=C hydrogen bonds, to two other mol-ecules, resulting in a hydrogen-bonded chain displaying a sequence of R22(8) rings. The same type of N-H⋯O=C hydrogen-bonded chain has previously been found in several 5,5-disubstituted derivatives of barbituric acid which are chemically closely related to (I) and (II).
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Affiliation(s)
- Thomas Gelbrich
- University of Innsbruck, Institute of Pharmacy, Innrain 52, 6020 Innsbruck, Austria
| | - Ulrich J. Griesser
- University of Innsbruck, Institute of Pharmacy, Innrain 52, 6020 Innsbruck, Austria
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23
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Fujimoto J, Lou JJ, Pessegueiro AM. Use of Phenobarbital in Delirium Tremens. J Investig Med High Impact Case Rep 2017; 5:2324709617742166. [PMID: 29164160 PMCID: PMC5686878 DOI: 10.1177/2324709617742166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 10/18/2017] [Accepted: 10/21/2017] [Indexed: 11/15/2022] Open
Abstract
The standard of care for alcohol withdrawal centers on the use of escalating doses of benzodiazepines until clinical improvement is achieved. However, there is no established standard in the care of patients with severe alcohol withdrawal and delirium tremens that is refractory to benzodiazepine therapy. One potential therapy that is gaining traction is the use of phenobarbital, which may be mechanistically superior to benzodiazepines in treating delirium tremens because of its effects on GABA and N-methyl-D-aspartate receptors. The dosing of phenobarbital and its subsequent taper, however, is still unclear and the side effect profile is not well characterized. In this case report, we present the case of a 37-year-old Hispanic male who presented with alcohol withdrawal and subsequent delirium tremens who was treated with phenobarbital with positive clinical response and minimal side effects.
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Affiliation(s)
- Jeffrey Fujimoto
- University of California Los Angeles, CA, USA
- Jeffrey Fujimoto, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA.
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24
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Cui SF, Li W, Zhou CH. Molecular spectroscopic studies examining the interactions between phenobarbital and human serum albumin in alcohol consumption. Am J Drug Alcohol Abuse 2017; 44:321-328. [PMID: 29095046 DOI: 10.1080/00952990.2017.1387265] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Alcohol dependence is associated with a wide range of serious mental, physical, and social consequences and is one of the most common chronic diseases worldwide. Barbiturates, which are a first-line treatment in the clinic for alcohol withdrawal, may result in combined barbiturate and alcohol use. Their co-use abuse may promote synergistic effects between barbiturates and alcohol in vivo. OBJECTIVE To investigate the effects of different alcohol concentrations on the synergistic effects of phenobarbital and alcohol. METHODS The interactions between phenobarbital and human serum albumin (HSA) and the effects of different alcohol concentrations on the binding behaviors of the phenobarbital-HSA system were investigated by molecular docking and spectroscopic methods, including fluorescence spectroscopy and UV-visible absorption spectroscopy. RESULTS Experimental results revealed that phenobarbital can be stored and carried by HSA. The presence of alcohol (≤1.96 × 10-2 M) can increase the proportion of free phenobarbital and shorten the half-life and storage time of phenobarbital in the blood, thereby enhancing its bioactive efficacy. The binding constants (Kb) of the phenobarbital-HSA system decrease in the presence of alcohol (≥2.61 × 10-2 M), which suggests that phenobarbital should be quickly cleared from blood, thereby decreasing the activity of phenobarbital. CONCLUSIONS The effects of alcohol on the transposition of phenobarbital by HSA at the beginning of the barbiturate metabolic process play an important role in the synergistic effects of phenobarbital and alcohol. This mechanism may be significant for the clinical dosage of patients with alcohol dependence.
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Affiliation(s)
- Sheng-Feng Cui
- a Center for Physical and Chemical Evidence Examination, Department of Public Security Technology , Railway Police College , Zhengzhou , P.R. China
| | - Wei Li
- a Center for Physical and Chemical Evidence Examination, Department of Public Security Technology , Railway Police College , Zhengzhou , P.R. China
| | - Cheng-He Zhou
- b Institute of Bioorganic & Medicinal Chemistry, School of Chemistry and Chemical Engineering , Southwest University , Chongqing , P.R. China
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Seo SM, Lee HR, Lee JE, Jeong YC, Kwon HW, Moon JK, Moloney MG, Park IK. Larvicidal and Nematicidal Activities of 3-Acylbarbituric Acid Analogues against Asian Tiger Mosquito, Aedes albopictus, and Pine Wood Nematode, Bursaphelenchus xylophilus. Molecules 2017; 22:molecules22071196. [PMID: 28714917 PMCID: PMC6151981 DOI: 10.3390/molecules22071196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Accepted: 07/12/2017] [Indexed: 11/16/2022] Open
Abstract
Widespread concern for the occurrence of resistant strains, along with the avoidance of the use of highly toxic insecticides and their wide environmental dispersal, highlights the need for the development of new and safer pest control agents. Natural products provide inspiration for new chemical entities with biological activities, and their analogues are good lead compounds for the development of new pest control agents. For this purpose, we evaluated the larvicidal and nematicidal activities of 48 3-acylbarbituric acid analogues against the Asian tiger mosquito, Aedes albopictus and the pine wood nematode, Bursaphelenchus xylophilus, organisms of increasing global concern. Among the 48 3-acylbarbituric acid analogues, four compounds—10, 14d, 14g and 19b—showed >90% larvicidal activity against Ae. albopictus at 10 μg/mL concentration, and one (compound 10) showed the strongest larvicidal activity against Ae. albopictus, with a LC50 value of 0.22 μg/mL. Only compound 18 showed strong nematicidal activity against pine wood nematode. Most active compounds possessed similar physicochemical properties; thus, actives typically had ClogP values of around 1.40–1.50 and rel-PSA values of 16–17% and these similar cheminformatic characteristics reflect their similar structure. This study indicates that active 3-acylbarbituric acids analogues have potential as lead compounds for developing novel mosquito control agents.
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Affiliation(s)
- Seon-Mi Seo
- Department of Forest Sciences, College of Agriculture and Life Sciences, Seoul National University, Seoul 08826, Korea.
- Research Institute of Agriculture and Life Science, College of Agriculture and Life Sciences, Seoul National University, Seoul 08826, Korea.
| | - Hyo-Rim Lee
- Department of Forest Sciences, College of Agriculture and Life Sciences, Seoul National University, Seoul 08826, Korea.
- Research Institute of Agriculture and Life Science, College of Agriculture and Life Sciences, Seoul National University, Seoul 08826, Korea.
| | - Ji-Eun Lee
- Department of Forest Sciences, College of Agriculture and Life Sciences, Seoul National University, Seoul 08826, Korea.
| | - Yong-Chul Jeong
- Chemistry Research Laboratory, University of Oxford, 12 Mansfield Rd, Oxford OS1 3TA, UK.
| | - Hyung-Wook Kwon
- Division of Life Sciences and Bio-Resource and Environmental Center, College of Life Science & Bioengineering, Incheon National University, 119 Academy-ro, Yeonsu-gu, Incheon 22012, Korea.
- Convergence Research Center for Insect Vector, College of Life Science & Bioengineering, Incheon National University, 119 Academy-ro, Yeonsu-gu, Incheon 22012, Korea.
| | - Joon-Kwan Moon
- Department of Plant Life and Environmental Sciences, hankyong National University, 327 Jungangro, Anseong, Gyeonggi 17579, Korea.
| | - Mark G Moloney
- Chemistry Research Laboratory, University of Oxford, 12 Mansfield Rd, Oxford OS1 3TA, UK.
| | - Il-Kwon Park
- Department of Forest Sciences, College of Agriculture and Life Sciences, Seoul National University, Seoul 08826, Korea.
- Research Institute of Agriculture and Life Science, College of Agriculture and Life Sciences, Seoul National University, Seoul 08826, Korea.
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26
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Tian H, Zhou X, Chen C, He Y, Yu H, Zheng X. Simultaneous Determination of Phenobarbital, Pentobarbital, Amobarbital and Secobarbital in Raw Milk via Liquid Chromatography with Electron Spray Ionization Tandem Mass Spectrometry. Korean J Food Sci Anim Resour 2017; 37:847-854. [PMID: 29725206 PMCID: PMC5932935 DOI: 10.5851/kosfa.2017.37.6.847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 11/01/2017] [Accepted: 11/02/2017] [Indexed: 12/04/2022] Open
Abstract
A rapid, sensitive and specific liquid chromatography-tandem mass spectrometry (LC-MS/MS) method was developed for the simultaneous determination of four barbiturates (phenobarbital, pentobarbital, amobarbital and secobarbital) in raw milk. The barbiturates were extracted using liquid-liquid extraction, ultrasonication and centrifugation, and purified on an SPE column. Analytes were separated by HPLC on a CSH C18 column eluted using an acetonitrile-water system with a linear gradient dilution programme, and detected by MS/MS. The recoveries of the barbiturates were 85.0-113.5%, and the intra- and inter-assay RSDs were less than 9.8% and 7.3%, respectively. The limit of detection was 5 ng/mL for all four of the barbiturates. The analytical method exhibited good linearity from 10 to 1000 ng/mL; the correlation coefficient (r2) was greater than 0.9950 for each barbiturate. This method was also applied to the determination of barbiturates in real milk samples and was found to be suitable for the determination of veterinary drug residues in raw milk.
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Affiliation(s)
- Huaixiang Tian
- School of Perfume and Aroma Technology, Shanghai Institute of Technology, Shanghai 200436, China
| | - Xingxin Zhou
- School of Perfume and Aroma Technology, Shanghai Institute of Technology, Shanghai 200436, China
| | - Chen Chen
- School of Perfume and Aroma Technology, Shanghai Institute of Technology, Shanghai 200436, China
| | - Yabin He
- Shanghai Bino Testing Technology Service, Shanghai, China.,School of Perfume and Aroma Technology, Shanghai Institute of Technology, Shanghai 200436, China
| | - Haiyan Yu
- School of Perfume and Aroma Technology, Shanghai Institute of Technology, Shanghai 200436, China
| | - Xiaoping Zheng
- Shanghai Bino Testing Technology Service, Shanghai, China.,School of Perfume and Aroma Technology, Shanghai Institute of Technology, Shanghai 200436, China
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Fourati Z, Ruza RR, Laverty D, Drège E, Delarue-Cochin S, Joseph D, Koehl P, Smart T, Delarue M. Barbiturates Bind in the GLIC Ion Channel Pore and Cause Inhibition by Stabilizing a Closed State. J Biol Chem 2016; 292:1550-1558. [PMID: 27986812 DOI: 10.1074/jbc.m116.766964] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 12/06/2016] [Indexed: 12/12/2022] Open
Abstract
Barbiturates induce anesthesia by modulating the activity of anionic and cationic pentameric ligand-gated ion channels (pLGICs). Despite more than a century of use in clinical practice, the prototypic binding site for this class of drugs within pLGICs is yet to be described. In this study, we present the first X-ray structures of barbiturates bound to GLIC, a cationic prokaryotic pLGIC with excellent structural homology to other relevant channels sensitive to general anesthetics and, as shown here, to barbiturates, at clinically relevant concentrations. Several derivatives of barbiturates containing anomalous scatterers were synthesized, and these derivatives helped us unambiguously identify a unique barbiturate binding site within the central ion channel pore in a closed conformation. In addition, docking calculations around the observed binding site for all three states of the receptor, including a model of the desensitized state, showed that barbiturates preferentially stabilize the closed state. The identification of this pore binding site sheds light on the mechanism of barbiturate inhibition of cationic pLGICs and allows the rationalization of several structural and functional features previously observed for barbiturates.
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Affiliation(s)
- Zaineb Fourati
- From the Unité de Dynamique Structurale des Macromolécules, UMR 3528 du CNRS, Institut Pasteur, 75015 Paris, France
| | - Reinis Reinholds Ruza
- From the Unité de Dynamique Structurale des Macromolécules, UMR 3528 du CNRS, Institut Pasteur, 75015 Paris, France
| | - Duncan Laverty
- the Department of Neuroscience, Physiology and Pharmacology, University College London, London WC1E 6BT, United Kingdom
| | - Emmanuelle Drège
- the UMR 8076 du CNRS, BioCIS, Faculté de Pharmacie, Université Paris Sud, 92296 Chatenay-Malabry, France
| | - Sandrine Delarue-Cochin
- the UMR 8076 du CNRS, BioCIS, Faculté de Pharmacie, Université Paris Sud, 92296 Chatenay-Malabry, France
| | - Delphine Joseph
- the UMR 8076 du CNRS, BioCIS, Faculté de Pharmacie, Université Paris Sud, 92296 Chatenay-Malabry, France
| | - Patrice Koehl
- the Department of Computer Science, University of California, Davis, California 95616
| | - Trevor Smart
- the Department of Neuroscience, Physiology and Pharmacology, University College London, London WC1E 6BT, United Kingdom.
| | - Marc Delarue
- From the Unité de Dynamique Structurale des Macromolécules, UMR 3528 du CNRS, Institut Pasteur, 75015 Paris, France.
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28
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Hützler WM, Egert E, Bolte M. One barbiturate and two solvated thio barbiturates containing the triply hydrogen-bonded ADA/DAD synthon, plus one ansolvate and three solvates of their coformer 2,4-diaminopyrimidine. Acta Crystallogr C Struct Chem 2016; 72:705-15. [PMID: 27585936 DOI: 10.1107/s205322961601336x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 08/19/2016] [Indexed: 11/11/2022]
Abstract
A path to new synthons for application in crystal engineering is the replacement of a strong hydrogen-bond acceptor, like a C=O group, with a weaker acceptor, like a C=S group, in doubly or triply hydrogen-bonded synthons. For instance, if the C=O group at the 2-position of barbituric acid is changed into a C=S group, 2-thiobarbituric acid is obtained. Each of the compounds comprises two ADA hydrogen-bonding sites (D = donor and A = acceptor). We report the results of cocrystallization experiments of barbituric acid and 2-thiobarbituric acid, respectively, with 2,4-diaminopyrimidine, which contains a complementary DAD hydrogen-bonding site and is therefore capable of forming an ADA/DAD synthon with barbituric acid and 2-thiobarbituric acid. In addition, pure 2,4-diaminopyrimidine was crystallized in order to study its preferred hydrogen-bonding motifs. The experiments yielded one ansolvate of 2,4-diaminopyrimidine (pyrimidine-2,4-diamine, DAPY), C4H6N4, (I), three solvates of DAPY, namely 2,4-diaminopyrimidine-1,4-dioxane (2/1), 2C4H6N4·C4H8O2, (II), 2,4-diaminopyrimidine-N,N-dimethylacetamide (1/1), C4H6N4·C4H9NO, (III), and 2,4-diaminopyrimidine-1-methylpyrrolidin-2-one (1/1), C4H6N4·C5H9NO, (IV), one salt of barbituric acid, viz. 2,4-diaminopyrimidinium barbiturate (barbiturate is 2,4,6-trioxopyrimidin-5-ide), C4H7N4(+)·C4H3N2O3(-), (V), and two solvated salts of 2-thiobarbituric acid, viz. 2,4-diaminopyrimidinium 2-thiobarbiturate-N,N-dimethylformamide (1/2) (2-thiobarbiturate is 4,6-dioxo-2-sulfanylidenepyrimidin-5-ide), C4H7N4(+)·C4H3N2O2S(-)·2C3H7NO, (VI), and 2,4-diaminopyrimidinium 2-thiobarbiturate-N,N-dimethylacetamide (1/2), C4H7N4(+)·C4H3N2O2S(-)·2C4H9NO, (VII). The ADA/DAD synthon was succesfully formed in the salt of barbituric acid, i.e. (V), as well as in the salts of 2-thiobarbituric acid, i.e. (VI) and (VII). In the crystal structures of 2,4-diaminopyrimidine, i.e. (I)-(IV), R2(2)(8) N-H...N hydrogen-bond motifs are preferred and, in two structures, additional R3(2)(8) patterns were observed.
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Affiliation(s)
- Wilhelm Maximilian Hützler
- Institut für Organische Chemie und Chemische Biologie, Goethe-Universität Frankfurt, Max-von-Laue-Strasse 7, 60438 Frankfurt am Main, Germany
| | - Ernst Egert
- Institut für Organische Chemie und Chemische Biologie, Goethe-Universität Frankfurt, Max-von-Laue-Strasse 7, 60438 Frankfurt am Main, Germany
| | - Michael Bolte
- Institut für Anorganische und Analytische Chemie, Goethe-Universität Frankfurt, Max-von-Laue-Strasse 7, 60438 Frankfurt am Main, Germany
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29
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Uchida T, Takayanagi M, Kitamura T, Nishio T, Numata Y, Endo W, Haginoya K, Ohura T. High-dose phenobarbital with intermittent short-acting barbiturates for acute encephalitis with refractory, repetitive partial seizures. Pediatr Int 2016; 58:750-3. [PMID: 27273286 DOI: 10.1111/ped.12934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 11/25/2015] [Accepted: 01/26/2016] [Indexed: 11/30/2022]
Abstract
Acute encephalitis with refractory, repetitive partial seizures (AERRPS) is characterized by repetitive seizures during the acute and chronic phases and has a poor neurological outcome. Burst-suppression coma via continuous i.v. infusion of a short-acting barbiturate is used to terminate refractory seizures, but the severe side-effects of short-acting barbiturates are problematic. We report on a 9-year-old boy with AERRPS who was effectively treated with very-high-dose phenobarbital (VHDPB) combined with intermittent short-acting barbiturates. VHDPB side-effects were mild, especially compared with those associated with continuous i.v. infusion of short-acting barbiturates (dosage, 40-75 mg/kg/day; maximum blood level, 290 μg/mL). Using VHDPB as the main treatment, short-acting barbiturates were used intermittently and in small amounts. This is the first report to show that VHDPB, combined with intermittent short-acting barbiturates, can effectively treat AERRPS. After treatment, convulsions were suppressed and daily life continued, but intellectual impairment and high-level dysfunction remained.
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Affiliation(s)
- Takashi Uchida
- Division of Pediatrics, Sendai City Hospital, Sendai, Japan
| | | | - Taro Kitamura
- Division of Pediatrics, Sendai City Hospital, Sendai, Japan
| | | | - Yurika Numata
- Department of Pediatrics, Ishinomaki Red Cross Hospital, Ishinomaki, Japan
| | - Wakaba Endo
- Department of Pediatric Neurology, Takuto Rehabilitation Center for Children, Sendai, Japan
| | - Kazuhiro Haginoya
- Department of Pediatric Neurology, Takuto Rehabilitation Center for Children, Sendai, Japan
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Gelbrich T, Braun DE, Oberparleiter S, Schottenberger H, Griesser UJ. The Hydrogen Bonded Structures of Two 5-Bromobarbituric Acids and Analysis of Unequal C5-X and C5-X' Bond Lengths (X = X' = F, Cl, Br or Me) in 5,5-Disubstituted Barbituric Acids. Crystals (Basel) 2016; 6:47. [PMID: 28670485 DOI: 10.3390/cryst6040047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The crystal structure of the methanol hemisolvate of 5,5-dibromobarbituric acid (1MH) displays an H-bonded layer structure which is based on N–H⋯O=C, N–H⋯O(MeOH) and (MeOH)O–H⋯O interactions. The barbiturate molecules form an H-bonded substructure which has the fes topology. 5,5′-Methanediylbis(5-bromobarbituric acid) 2, obtained from a solution of 5,5-dibromobarbituric acid in nitromethane, displays a N–H⋯O=C bonded framework of the sxd type. The conformation of the pyridmidine ring and the lengths of the ring substituent bonds C5–X and C5–X′ in crystal forms of 5,5-dibromobarbituric acid and three closely related analogues (X = X′ = Br, Cl, F, Me) have been investigated. In each case, a conformation close to a C5-endo envelope is correlated with a significant lengthening of the axial C5–X′ in comparison to the equatorial C5–X bond. Isolated molecule geometry optimizations at different levels of theory confirm that the C5-endo envelope is the global conformational energy minimum of 5,5-dihalogenbarbituric acids. The relative lengthening of the axial bond is therefore interpreted as an inherent feature of the preferred envelope conformation of the pyrimidine ring, which minimizes repulsive interactions between the axial substituent and pyrimidine ring atoms.
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31
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Gelbrich T, Griesser UJ. Crystal structure of 5-hy-droxy-5-propyl-barbituric acid. Acta Crystallogr E Crystallogr Commun 2015; 71:1311-4. [PMID: 26594498 PMCID: PMC4645085 DOI: 10.1107/s2056989015018769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 10/06/2015] [Indexed: 05/23/2024]
Abstract
Mol-ecules of the title compound, C7H10N2O4, systematic name 5-hy-droxy-5-propyl-pyrimidine-2,4,6(1H,3H,5H)-trione, form a hydrogen-bonded framework which is based on three independent hydrogen bonds, N-H⋯O(carbon-yl), N-H⋯O(hy-droxy) and O-H⋯O(carbon-yl). This framework has the topology of the 5-connected nov net. Each mol-ecule is linked to five other mol-ecules via six hydrogen bonds, and the descriptor of the hydrogen-bonded structure is F65[4(4).6(6)-nov]. The crystal packing is isostructural with that of the previously reported 5-hy-droxy-5-ethyl analogue.
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Affiliation(s)
- Thomas Gelbrich
- University of Innsbruck, Institute of Pharmacy, Innrain 52, 6020 Innsbruck, Austria
| | - Ulrich J. Griesser
- University of Innsbruck, Institute of Pharmacy, Innrain 52, 6020 Innsbruck, Austria
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32
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Minen MT, Lindberg K, Wells RE, Suzuki J, Grudzen C, Balcer L, Loder E. Survey of Opioid and Barbiturate Prescriptions in Patients Attending a Tertiary Care Headache Center. Headache 2015; 55:1183-91. [PMID: 26316376 DOI: 10.1111/head.12645] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2015] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To educate physicians about appropriate acute migraine treatment guidelines by determining (1) where headache patients were first prescribed opioids and barbiturates, and (2) the characteristics of the patient population who had been prescribed opioids and barbiturates. BACKGROUND Several specialty societies issued recommendations that caution against the indiscriminate use of opioids or barbiturate containing medications for the treatment of migraine. These medications are still being prescribed in various medical settings and could put headache specialists in a difficult position when patients request these agents. METHODS Patients presenting to a headache center comprised of eight physicians were asked to complete a survey that assessed headache types, comorbid conditions, and whether they had ever been prescribed opioids or barbiturates. If they responded affirmatively to the latter question, they were asked about the prescribing doctor, medication effectiveness, and whether they were currently on the medication. Data collection took place over a one month period. RESULTS Two hundred forty-four patients were given the survey and 218 of these patients completed it. The predominant diagnosis was migraine (83.9%). More than half of the patients reported having been prescribed an opioid (54.8%) or a barbiturate (56.7%). About one fifth were on opioids (19.4%) or barbiturates (20.7%) at the time of completing the survey. Most patients reported being on opioids for more than 2 years (24.6%) or less than one week (32.1%). The reasons most frequently cited for stopping opioids were that the medications did not help (30.9%) or that they saw a new doctor who would not prescribe them (29.4%). Among patients who had previously been on barbiturates, 32.2% had been on these for over 2 years. Most patients (61.8%) stopped barbiturates because they did not find the medication helpful, while 17.6% said they saw a new doctor who would not prescribe them. The physician specialty most frequently cited as being the first prescriber for opioids was emergency medicine (20.2%) with family doctors and general neurologists the next groups at 17.7% each. General neurologists were the most frequent (37.8%) first prescribers of barbiturates. CONCLUSIONS Approximately 20% of patients presenting to a headache center reported current use of opioids and/or barbiturates. ED physicians were reported to be the most frequent first prescribers of opioids and general neurologists were the most frequent first prescribers of barbiturates. Taken as a whole, these data provide a useful snapshot of the wide variety of physician specialties that might benefit from additional education on the appropriate use of opioids and barbiturate-containing medications in patients with headaches.
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Affiliation(s)
- Mia T Minen
- Department of Neurology, NYU Langone Medical Center
| | | | - Rebecca E Wells
- Department of Neurology, WakeForest Baptist Hospital, Winston Salem, USA
| | - Joji Suzuki
- Department of Psychiatry, Brigham and Women's/Faulkner Hospitals, Boston, USA
| | - Corita Grudzen
- Department of Emergency Medicine, NYU Langone Medical Center, NY, USA
| | - Laura Balcer
- Department of Neurology, NYU Langone Medical Center, NY, USA
| | - Elizabeth Loder
- Department of Neurology, Brigham and Women's/Faulkner Hospitals, Boston, MA
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Gelbrich T, Meischberger I, Griesser UJ. Two polymorphs of 5-cyclohexyl-5-ethylbarbituric acid and their packing relationships with other barbiturates. Acta Crystallogr C Struct Chem 2015; 71:204-10. [PMID: 25734851 DOI: 10.1107/s2053229615002880] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 02/10/2015] [Indexed: 11/10/2022]
Abstract
Polymorph (Ia) (m.p. 474 K) of the title compound, C(12)H(18)N(2)O(3), displays an N-H...O=C hydrogen-bonded layer structure which contains R(6)(6)(28) rings connecting six molecules, as well as R2(2)(8) rings linking two molecules. The 3-connected hydrogen-bonded net resulting from these interactions has the hcb topology. Form (Ib) (m.p. 471 K) displays N-H...O=C hydrogen-bonded looped chains in which neighbouring molecules are linked to one another by two different R(2)(2)(8) rings. Polymorph (Ia) is isostructural with the previously reported form II of 5-(2-bromoallyl)-5-isopropylbarbituric acid (noctal) and polymorph (Ib) is isostructural with the known crystal structures of four other barbiturates.
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Affiliation(s)
- Thomas Gelbrich
- Institute of Pharmacy, University of Innsbruck, Innrain 52c, 6020 Innsbruck, Austria
| | - Isabella Meischberger
- Institute of Pharmacy, University of Innsbruck, Innrain 52c, 6020 Innsbruck, Austria
| | - Ulrich J Griesser
- Institute of Pharmacy, University of Innsbruck, Innrain 52c, 6020 Innsbruck, Austria
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Azizkhani R, Esmailian M, shojaei A, Golshani K. Rectal Thiopental versus Intramuscular Ketamine in Pediatric Procedural Sedation and Analgesia; a Randomized Clinical Trial. Emerg (Tehran) 2015; 3:22-6. [PMID: 26512365 PMCID: PMC4614604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Physicians frequently deal with procedures which require sedation of pediatric patients. Laceration repair is one of them. No study has been performed regarding the comparison between induction of sedation with sodium thiopental and ketamine in laceration repair. Therefore, the present study was aimed to comparison of induced sedation by rectal sodium thiopental and muscular injection of hydrochloride ketamine in pediatric patients need laceration repair. METHODS The presented study is a single-blinded clinical trial performed through 2013 to 2014 in Ayatollah Kashani and Alzahra Hospitals, Isfahan, Iran. Patients from 3 months to 14 years, needed sedation for laceration repair, were entered. Patients were sequentially evaluated and randomly categorized in two groups of hydrochloride ketamine with dose of 2-4 milligram per kilogram and sodium thiopental with dose of 25 milligram per kilogram. Demographic data and vital signs before drug administration and after induction of sedation, Ramsey score, time to onset of action, and sedation recovery time were evaluated. Chi-squared, Mann-Whitney, and Non-parametric analysis of covariance tests were used. P<0.05 was considered as a significant level. RESULTS In this study 60 pediatric patients were entered. 30 patients with mean age of 42.8±18.82 months were received sodium thiopental and the rest with mean age of 30.08±16.88 months given ketamine. Mann-Whitney test was showed that time to onset of action in sodium thiopental group (28.23±5.18 minutes) was significantly higher than ketamine (7.77±4.13 minutes), (p<0.001). The sedation recovery time in ketamine group (29.83±7.70) was higher than sodium thiopental. Depth of sedation had no significant difference between two groups based on Ramsey score (p=0.87). No significant difference was seen between two groups in the respiratory rate (df=1, 58; F=0.002; P=0.96) and heart rate (df=1, 58; F=0.98; P=0.33). However, arterial oxygen saturation level (df=1, 58; F=6.58; P=0.013) was significantly higher in ketamine group. CONCLUSION The findings of the present study show that Although the recovery time from sedation by ketamine is more than sodium thiopental, it's fast-acting function without effecting on the oxygen saturation level causes that ketamine is considered as the better choice for induction of sedation in pediatric patients need laceration repair. In addition, long-term effect of ketamine provides more time for the physician to do the procedure and this issue decreases the need probability to the repeated-dose. However, effectiveness of both drugs to decrease the agitation was equal, based on the Ramsey score.
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Affiliation(s)
| | | | - Azadeh shojaei
- Corresponding Author: Azadeh shojaei; Department of Emergency Medicine, Al-Zahra Hospital, Soffeh Blvd, Isfahan, Iran. Tel: +989136470851; Fax: +983117923445;
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Gunaseelan S, Doraisamyraja K. Crystal structure of tri-methyl-ammonium 5-(2,4-di-nitro-phen-yl)-1,3-dimethyl-2,6-dioxo-1,2,3,6-tetra-hydro-pyrimidin-4-olate. Acta Crystallogr Sect E Struct Rep Online 2014; 70:o1102-3. [PMID: 25484695 PMCID: PMC4257181 DOI: 10.1107/s1600536814019977] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 09/04/2014] [Indexed: 11/16/2022]
Abstract
The asymmetric unit of the title mol-ecular salt, C3H10N(+)·C12H9N4O7 (-) [alternative name: tri-methyl-ammonium 5-(2,4-di-nitro-phen-yl)-1,3-dimethyl barbiturate], contains one anion and two half-occupancy cations. The cations are disordered about inversion centres. The tetra-hydro-pyrimidine ring is essentially planar [maximum deviation = 0.007 (2) Å] and forms a dihedral angle of 41.12 (6)° with the plane of the benzene ring. In the crystal, N-H⋯O hydrogen bonds link the cations to the anions.
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Affiliation(s)
- Sridevi Gunaseelan
- PG and Research Department of Chemistry, Seethalakshmi Ramaswami College, Tiruchirappalli 620 002, Tamil Nadu, India
| | - Kalaivani Doraisamyraja
- PG and Research Department of Chemistry, Seethalakshmi Ramaswami College, Tiruchirappalli 620 002, Tamil Nadu, India
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Abstract
Forensic toxicology deals with the investigation of toxic substances, poisonous products or with the environmental chemicals. This field of science helps to identify poison substance and hazardous chemicals. Forensic toxicology deals with the way that substances are absorbed, distributed or eliminated in the body – the metabolism of substances. This paper reviews the manifestations that each poisonous substance presents concentrating toward the commonly used poisonous substance especially in India. It also explains the Indian Penal Code, which is main criminal code intended to cover all substantive aspects of criminal law regarding poison.
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Affiliation(s)
- B K Charan Gowda
- Department of Oral Pathology, Sri Siddhartha Dental college, Tumkur, India
| | | | - Jyothi Mahadesh
- Department of Oral Pathology, Sri Siddhartha Dental college, Tumkur, India
| | - Mukund
- Department of Pedodontia, Sri Siddhartha Dental College, Tumkur, Karnataka, India
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Catalani B, Hamilton CS, Herron EW, Urman RD, Fox CJ, Kaye AD. Psychiatric agents and implications for perioperative analgesia. Best Pract Res Clin Anaesthesiol 2014; 28:167-81. [PMID: 24993437 DOI: 10.1016/j.bpa.2014.05.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Revised: 05/11/2014] [Accepted: 05/14/2014] [Indexed: 11/22/2022]
Abstract
The use of antidepressants, anxiolytics, mood stabilizers, anticonvulsants, and major tranquilizers introduces neurochemical, behavioral, cognitive, and emotional factors that increase the complexity of medical and surgical tasks. Increasingly, various classes of psychotropic medications are being prescribed in the perioperative setting for their analgesic properties in patients with or without a psychiatric diagnosis. In many cases, the precise mechanisms of action and dose-response relationships by which these agents mediate analgesia are largely unclear. An appreciation of the side effects and adverse-effect profiles of such medications and familiarity with the clinically relevant drug interactions that may occur in the perioperative setting are imperative to ensure the best possible outcome in dealing with patients on these medications. This review focuses on various classes of psychotropic agents, which are addressed individually, with particular focus on their analgesic properties. The latest published research is summarized, deficiencies in our current collective knowledge are discussed, and evidence-based recommendations are made for clinical practice.
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Bergmann KR, McCabe J, Smith TR, Guillaume DJ, Sarafoglou K, Gupta S. Late-onset ornithine transcarbamylase deficiency: treatment and outcome of hyperammonemic crisis. Pediatrics 2014; 133:e1072-6. [PMID: 24616362 DOI: 10.1542/peds.2013-1324] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Hyperammonemic crises in ornithine transcarbamylase deficiency (OTC) can be associated with devastating cerebral edema resulting in severe long-term neurologic impairment and death. We present an 8-year-old boy who had late-onset OTC deficiency in which early and aggressive management of hyperammonemia and associated cerebral edema, including therapeutic hypothermia and barbiturate-induced coma, resulted in favorable neurologic outcome. Our patient presented with vomiting and altered mental status, and was found to have a significantly elevated serum ammonia level of 1561 μmol/L. Hyperammonemia was managed with hemodialysis, 10% sodium phenylacetate, 10% sodium benzoate, L-arginine, intravenous 10% dextrose, intralipids, and protein restriction. He developed significant cerebral edema with intracranial pressures >20 mm Hg, requiring treatment with 3% saline and mannitol. Despite this treatment our patient continued to have elevated intracranial pressures, which were treated aggressively with non-conventional modalities including therapeutic hypothermia, barbiturate-induced coma, and external ventricular drainage. This therapy resulted in stabilization of hyperammonemia and resolution of cerebral edema. Molecular testing later revealed a hemizygous mutation within the OTC gene. Neuropsychological testing 1 year after discharge showed normal intelligence with no visual-motor deficits, minor deficits in working memory and processing speed, and slightly below average processing speed and executive functioning.
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Abstract
Butalbital (Fiorinal(®)), used in the treatment of migraines and muscle pain, is the most commonly encountered barbiturate in impaired driving cases. It has central nervous system (CNS) depressant properties, including sedation, drowsiness, and feelings of intoxication, which can contribute to driving impairment. Twenty-six driving under the influence cases are reviewed including results from field sobriety tests and toxicology testing. Blood samples were screened using enzyme multiplied immunoassay technique immunoassay, and the presence of butalbital was confirmed and quantified using gas chromatography/mass spectrometry, gas chromatography with flame ionization detection, or gas chromatography nitrogen/phosphorus detection. Butalbital concentrations ranged from 1.0 to 30.2 mg/L, with a mean and median of 16.0 mg/L. General impairment indicators in these cases included horizontal and vertical nystagmus, lack of convergence, poor motor coordination, and balance and speech problems, which are common to CNS depressant intoxication, similar to that associated with alcohol. These findings indicate the importance of toxicological testing for butalbital in cases where CNS depressants are indicated.
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Affiliation(s)
- Jillian K Yeakel
- The Center for Forensic Science Research and Education, The Fredric Rieders Family Renaissance Foundation, 2300 Stratford Ave, Willow Grove, PA 19090, USA
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Münchow EA, Valente LL, Peralta SL, Fernández MR, Lima GDS, Petzhold CL, Piva E, Ogliari FA. 1,3-Diethyl-2-thiobarbituric acid as an alternative coinitiator for acidic photopolymerizable dental materials. J Biomed Mater Res B Appl Biomater 2013; 101:1217-21. [PMID: 23564499 DOI: 10.1002/jbm.b.32933] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 01/10/2013] [Accepted: 02/17/2013] [Indexed: 11/09/2022]
Abstract
The ethyl-4-dimethylaminobenzoate (EDAB) is widely used as a coinitiator of the camphorquinone (CQ), but in acidic circumstances it might present some instability, reducing the polymerization efficiency of the material. Considering this, new coinitiators are being evaluated. Hence, this study evaluated the kinetic of polymerization (KP), the degree of conversion (DC), and the rate of polymerization (RP ) of experimental resin adhesives containing 1,3-diethyl-2-thiobarbituric acid (TBA) as a coinitiator of the CQ. The experimental monomeric blend was prepared with bisphenol A glycidyl dimethacrylate, 2-hydroxyethyl methacrylate, and acidic monomers. CQ was added at 1 mol % as photoinitiator. Six groups were formulated: four containing concentrations of 0.1, 0.5, 1, and 2 mol % of TBA, one without coinitiator, and the last one containing 1 mol % of EDAB (control group). The KP and the RP were performed using real-time Fourier Transform infrared spectroscopy. The group without coinitiator has not formed a polymer, whereas the addition of TBA resulted in the conversion of monomers in polymer. The DC of the adhesives was as higher as the increase in the TBA content. The group with 2 mol % of TBA presented improved DC and reactivity (RP ) than the other groups and the control one. Hence, the TBA has performed as a coinitiator of the CQ for the radical polymerization of methacrylate resin adhesives and it has improved the DC and the reactivity of the materials. Thus, it is a potential coinitiator for the photopolymerization of dental materials.
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Affiliation(s)
- Eliseu A Münchow
- Department of Operative Dentistry, School of Dentistry, Federal University of Pelotas, Rio Grande do Sul, Brazil
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Abstract
Sodium pentobarbital and phenytoin are common constituents of veterinary euthanasia solutions in the United States. Relay, or secondary, barbiturate toxicosis has been reported in carnivorous animals that have fed from the carcasses of euthanized livestock. This case report presents barbiturate toxicosis in a dog. A 2-year-old female spayed Australian shepherd presented comatose 2 h after ingesting an unknown substance on the beach. The material was retrieved from the stomach by gastric lavage and visually identified as fish or other animal tissue. The dog recovered with symptomatic and supportive therapy and was released on the third day of hospitalization. Tissue found on the beach near where the dog walked and a urine sample from the dog were analyzed by gas chromatography/mass spectrometry. Both samples were positive for pentobarbital and phenytoin. The tissue was consistent with mammalian blubber based on gross and histological examination. Three weeks previously, a juvenile humpback whale had stranded on the beach where the dog had ingested the unknown substance. The whale had been euthanized with a barbiturate solution, necropsied, and removed from the beach. It was not definitively determined that the pentobarbital-containing blubber ingested by the dog was from the euthanized whale, but that was the most likely source. Although attempts were made to remove the whale's remains from the beach, practical considerations made complete removal challenging, if not impossible.
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Affiliation(s)
- Karyn Bischoff
- Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY 14853, USA.
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Abstract
Status epilepticus (SE) is a medical emergency associated with significant morbidity and mortality. SE is defined as a continuous seizure lasting more than 30 min, or two or more seizures without full recovery of consciousness between any of them. Based on recent understanding of the pathophysiology, it is now considered that any seizure that lasts more than 5 min probably needs to be treated as SE. GABAergic mechanisms play a crucial role in terminating seizures. When the seizure persists, GABA-mediated mechanisms become ineffective and several other putative mechanisms of seizure suppression have been recognized. Early treatment of SE with benzodiazepines, followed if necessary by fosphenytoin administration, is the most widely followed strategy. About a third of patients with SE may have persistent seizures refractory to the first-line medications. They require aggressive management with second-line medications such as barbiturates, propofol, or other agents. In developing countries where facilities for assisted ventilation are not readily available, it may be helpful to use nonsedating antiepileptic drugs (such as sodium valproate, levetiracetam, or topiramate) at this stage. It is important to recognize SE and institute treatment as early as possible in order to avoid a refractory state. It is equally important to attend to the general condition of the patient and to ensure that the patient is hemodynamically stable. This article reviews current knowledge regarding the management of convulsive SE in adults.
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Affiliation(s)
- Ajith Cherian
- Department of General Medicine, Medical College, Trivandrum, Kerala, India
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Abstract
Catatonia was delineated only as a type of schizophrenia in the many American Psychiatric Association DSM classifications and revisions from 1952 until 1994 when "catatonia secondary to a medical condition" was added. Since the 1970s the diagnosis of catatonia has been clarified as a syndrome of rigidity, posturing, mutism, negativism, and other motor signs of acute onset. It is found in about 10% of psychiatric hospital admissions, in patients with depressed and manic mood states and in toxic states. It is quickly treatable to remission by benzodiazepines and by ECT. The DSM-V revision proposes catatonia in two major diagnostic classes, specifiers for 10 principal diagnoses, and deletion of the designation of schizophrenia, catatonic type. This complex recommendation serves no clinical or research purpose and confuses treatment options. Catatonia is best considered in the proposed ICD revision as a unique syndrome of multiple forms warranting a single unique defined class similar to that of delirium.
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Affiliation(s)
- Max Fink
- Departments of Psychiatry and Neurology, Stony Brook University, Long Island, New York, USA
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Couper FJ, Saady JJ. The Use of Miscellaneous Prescription Medications to Facilitate Sexual Assault. Forensic Sci Rev 2010; 22:83-112. [PMID: 26242458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Drugs used to facilitate sexual assaults are typically those that rapidly render the potential victim unconscious or sedated, and produce memory loss or amnesia. Many of these drugs are difficult to detect due to a delay in biological specimen collection. Detection is further hampered as the drugs are often administered in single low doses and are rapidly and extensively metabolized, resulting in low concentrations in biological specimens. Miscellaneous prescription drugs such as the barbiturates, antipsychotics, opioids, tricyclic antidepressants, ketamine, and chloral hydrate have the potential to produce varying degrees of sedation; however, they are not frequently detected in drug-facilitated sexual assault cases. A review of the literature shows that these drugs are often knowingly taken by the victim before or subsequent to the assault, and therefore may contribute to the sedation or unconsciousness experienced by the victim when ethanol or other central nervous system drugs are co-administered. Most barbiturates, opioids, and tricyclic antidepressants are routinely screened for in hospitals and forensic toxicology laboratories, and may be detectable in a urine specimen for several days. Antipsychotics, particularly the atypical class, ketamine, and chloral hydrate, generally require more targeted analyses. This review provides an overview of the pharmacodynamics, pharmacokinetics, and common analytical methods for the barbiturates, antipsychotics, opioids, tricyclic antidepressants, ketamine, and chloral hydrate.
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Affiliation(s)
- F J Couper
- Washington State Toxicology Laboratory, Washington State Patrol, Seattle, WA, USA
| | - J J Saady
- Virginia Commonwealth University Health Systems School of Medicine, Richmond, VA, USA
- Saady Consulting Inc., Richmond, VA, USA
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Ni K, Cary M, Zarkowski P. Carisoprodol withdrawal induced delirium: A case study. Neuropsychiatr Dis Treat 2007; 3:679-82. [PMID: 19300598 PMCID: PMC2656305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 43-year-old woman with chronic back pain found relief by taking carisoprodol, a centrally acting skeletal muscle relaxant. She had acquired large amounts of the prescription medication through the Internet and was taking approximately three hundred 350 mg tablets each week, at times up to fifty tablets per day. She then abruptly stopped the medication and presented to the emergency room one week later with waxing and waning attention, confusion, disorientation and visual hallucinations. Oral lorazepam was dosed according to a protocol employing the Clinical Institute Withdrawal Assessment of Alcohol Scale (CIWA). Her symptoms of delirium resolved rapidly and she was discharged home on day three. A review of the literature did not show any other reports of carisoprodol withdrawal induced delirium. Such withdrawal symptoms could be expected as the mechanism of action of carisoprodol is similar to that of hypnotic sedatives. Its availability and ease with which it can be acquired through the Internet puts it at great risk for a drug of abuse.
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Affiliation(s)
- Karen Ni
- School of Medicine, University of California, San Diego, La Jolla, CA, USA.
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López-Muñoz F, Ucha-Udabe R, Alamo C. The history of barbiturates a century after their clinical introduction. Neuropsychiatr Dis Treat 2005; 1:329-43. [PMID: 18568113 PMCID: PMC2424120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The present work offers an analysis of the historical development of the discovery and use of barbiturates in the field of psychiatry and neurology, a century after their clinical introduction. Beginning with the synthesis of malonylurea by von Baeyer in 1864, and up to the decline of barbiturate therapy in the 1960s, it describes the discovery of the sedative properties of barbital, by von Mering and Fischer (1903), the subsequent synthesis of phenobarbital by this same group (1911), and the gradual clinical incorporation of different barbiturates (butobarbital, amobarbital, secobarbital, pentobarbital, thiopental, etc). We describe the role played in therapy by barbiturates throughout their history: their traditional use as sedative and hypnotic agents, their use with schizophrenic patients in so-called "sleep cures" (Klaesi, Cloetta), the discovery of the antiepileptic properties of phenobarbital (Hauptmann) and their use in the treatment of epilepsy, and the introduction of thiobarbiturates in intravenous anesthesia (Lundy, Waters). We also analyze, from the historical perspective, the problems of safety (phenomena of dependence and death by overdose) which, accompanied by the introduction of a range of psychoactive drugs in the 1950s, brought an end to barbiturate use, except in specific applications, such as the induction of anesthesia and the treatment of certain types of epileptic crisis.
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Birnir B, Eghbali M, Everitt AB, Gage PW. Bicuculline, pentobarbital and diazepam modulate spontaneous GABA(A) channels in rat hippocampal neurons. Br J Pharmacol 2000; 131:695-704. [PMID: 11030718 PMCID: PMC1572380 DOI: 10.1038/sj.bjp.0703621] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Spontaneously opening, chloride-selective channels that showed outward rectification were recorded in ripped-off patches from rat cultured hippocampal neurons and in cell-attached patches from rat hippocampal CA1 pyramidal neurons in slices. In both preparations, channels had multiple conductance states and the most common single-channel conductance varied. In the outside-out patches it ranged from 12 to 70 pS (Vp=40 mV) whereas in the cell-attached patches it ranged from 56 to 85 pS (-Vp=80 mV). Application of GABA to a patch showing spontaneous channel activity evoked a rapid, synchronous activation of channels. During prolonged exposure to either 5 or 100 microM GABA, the open probability of channels decreased. Application of GABA appeared to have no immediate effect on single-channel conductance. Exposure of the patches to 100 microM bicuculline caused a gradual decrease on the single-channel conductance of the spontaneous channels. The time for complete inhibition to take place was slower in the outside-out than in the cell-attached patches. Application of 100 microM pentobarbital or 1 microM diazepam caused 2 - 4 fold increase in the maximum channel conductance of low conductance (<40 pS) spontaneously active channels. The observation of spontaneously opening GABA(A) channels in cell-attached patches on neurons in slices suggests that they may have a role in neurons in vivo and could be an important site of action for some drugs such as benzodiazepines, barbiturates and general anaesthetics.
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Affiliation(s)
- B Birnir
- Membrane Biology Program, John Curtin School of Medical Research, Australian National University, Canberra ACT, 0200 Australia.
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Weathermon R, Crabb DW. Alcohol and medication interactions. Alcohol Res Health 1999; 23:40-54. [PMID: 10890797 PMCID: PMC6761694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Many medications can interact with alcohol, thereby altering the metabolism or effects of alcohol and/or the medication. Some of these interactions can occur even at moderate drinking levels and result in adverse health effects for the drinker. Two types of alcohol-medication interactions exist: (1) pharmacokinetic interactions, in which alcohol interferes with the metabolism of the medication, and (2) pharmacodynamic interactions, in which alcohol enhances the effects of the medication, particularly in the central nervous system (e.g., sedation). Pharmacokinetic interactions generally occur in the liver, where both alcohol and many medications are metabolized, frequently by the same enzymes. Numerous classes of prescription medications can interact with alcohol, including antibiotics, antidepressants, antihistamines, barbiturates, benzodiazepines, histamine H2 receptor antagonists, muscle relaxants, nonnarcotic pain medications and anti-inflammatory agents, opioids, and warfarin. In addition, many over-the-counter and herbal medications can cause negative effects when taken with alcohol.
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Affiliation(s)
- R Weathermon
- School of Pharmacy and Pharmaceutical Sciences, Purdue University, Indianapolis, Indiana, USA
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Kapur J, Macdonald RL. Rapid seizure-induced reduction of benzodiazepine and Zn2+ sensitivity of hippocampal dentate granule cell GABAA receptors. J Neurosci 1997; 17:7532-40. [PMID: 9295398 PMCID: PMC2892718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Fast synaptic inhibition in the forebrain is mediated primarily by GABA acting on GABAA receptors (GABARs). GABARs are regulated by numerous positive (barbiturates, benzodiazepines, and neurosteroids) and negative (picrotoxin, bicuculline, and Zn2+) allosteric modulators. The sensitivity of GABARs to GABA and to allosteric modulators changes gradually during normal development, during development of chronic epilepsy, and after prolonged exposure to GABAR agonists. Here we report the development of rapid functional plasticity of GABARs occurring over 45 min of continuous seizures (status epilepticus) in rats. Seizures induced in rats by administration of lithium followed by pilocarpine were readily terminated by the benzodiazepine diazepam when administered early during the seizures (after 10 min of seizures). However, during status epilepticus, there was a substantial reduction of diazepam potency for termination of the seizures. To determine whether the loss of sensitivity of the animals to diazepam was caused by an alteration of GABAR functional properties, we obtained whole-cell GABAR currents from hippocampal dentate granule cells isolated acutely from control rats and from rats undergoing status epilepticus. GABAR properties were characterized by determining GABA sensitivity and the sensitivity of GABARs to regulation by benzodiazepines, barbiturates, and Zn2+. When compared with those from naive controls, GABAR currents from rats undergoing status epilepticus were less sensitive to diazepam and Zn2+ but retained their sensitivity to GABA and pentobarbital. We conclude that the prolonged seizures of status epilepticus rapidly altered the functional properties of hippocampal dentate granule cell GABARs.
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Affiliation(s)
- J Kapur
- Department of Neurology, University of Michigan Medical Center, Ann Arbor, Michigan 48104-1687, USA
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50
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Moore JM. The Application of Chemical Derivatization in Forensic Drug Chemistry for Gas and High-Performance Liquid Chromatographic Methods of Analysis. Forensic Sci Rev 1990; 2:79-124. [PMID: 26266839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The analyses of solid-dosage forensic drug samples can be enhanced by chemical derivatization followed by gas chromatography or high-performance liquid chromatography. Using these techniques permits improved detection and chromatography of some illicit drugs and their manufacturing by-products. This review focuses on the use of chemical derivatization in conjunction with gas chromatography-flame ionization detection, gas chromatography-electron capture detection, gas chromatography-mass spectrometry, high-performance liquid chromatography-ultraviolet detection and high-performance liquid chromatography-fluorescence detection in the analysis of illicit drug samples. These drugs include the amphetamines, barbiturates, cannabis, fentanyls, opium, and hallucinogens. Discussion on sensitivity enhancement and determination of enantiomeric composition using gas chromatography and high-performance liquid chromatography is included. An entire section is devoted to the chemical derivatization and chromatographic analyses of manufacturing by-products found in illicit amphetamine and methamphetamine, heroin, and cocaine samples. This review also includes a section that describes practical elements and experimental design associated with chemical derivatization-chromatographic analyses..
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Affiliation(s)
- J M Moore
- Special Testing and Research Laboratory, US Drug Enforcement Administration, McLean, VA, USA
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