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[PMID]:27586815
[Au] Autor:Jesse S; Bråthen G; Ferrara M; Keindl M; Ben-Menachem E; Tanasescu R; Brodtkorb E; Hillbom M; Leone MA; Ludolph AC
[Ad] Endereço:Department of Neurology, University Ulm, Ulm, Germany.
[Ti] Título:Alcohol withdrawal syndrome: mechanisms, manifestations, and management.
[So] Source:Acta Neurol Scand;135(1):4-16, 2017 Jan.
[Is] ISSN:1600-0404
[Cp] País de publicação:Denmark
[La] Idioma:eng
[Ab] Resumo:The alcohol withdrawal syndrome is a well-known condition occurring after intentional or unintentional abrupt cessation of heavy/constant drinking in patients suffering from alcohol use disorders (AUDs). AUDs are common in neurological departments with patients admitted for coma, epileptic seizures, dementia, polyneuropathy, and gait disturbances. Nonetheless, diagnosis and treatment are often delayed until dramatic symptoms occur. The purpose of this review is to increase the awareness of the early clinical manifestations of AWS and the appropriate identification and management of this important condition in a neurological setting.
[Mh] Termos MeSH primário: Delirium por Abstinência Alcoólica/diagnóstico
Convulsões por Abstinência de Álcool/diagnóstico
[Mh] Termos MeSH secundário: Delirium por Abstinência Alcoólica/etiologia
Delirium por Abstinência Alcoólica/terapia
Convulsões por Abstinência de Álcool/etiologia
Convulsões por Abstinência de Álcool/terapia
Biomarcadores/sangue
Biomarcadores/urina
Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Biomarkers)
[Em] Mês de entrada:1701
[Cu] Atualização por classe:170118
[Lr] Data última revisão:
170118
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160903
[St] Status:MEDLINE
[do] DOI:10.1111/ane.12671


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[PMID]:27922474
[Au] Autor:Barrett J; Jansen M; Cooper A; Felbinger M; Waters F
[Ad] Endereço:John Barrett, MA, BSN, RN, Duke University School of Nursing, Durham, NC. Maria Jansen, PharmD, Matthew Felbinger, PharmD, BCPS, and Faith Waters, MSN, RN, NEA-BC, Duke Regional Hospital, Durham, NC. April Cooper, PharmD, Duke Regional Hospital, Durham, and College of Pharmacy and Health Sciences, Campbell University, Buies Creek, NC.
[Ti] Título:Embracing a Nurse-Driven Alcohol Withdrawal Protocol Through Quality Improvement.
[So] Source:J Addict Nurs;27(4):234-240, 2016 Oct/Dec.
[Is] ISSN:1548-7148
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Alcohol withdrawal can lead to severe complications including seizures, delirium tremens, and death if not treated appropriately. Nurses are critical to the safety and outcomes of these patients. OBJECTIVE: The objective of this retrospective study was to determine if nursing education on a community hospital's alcohol withdrawal protocol led to improved nursing compliance. METHODS: This is a quality improvement project involving a two-part retrospective review-an initial needs assessment followed by nursing education and a subsequent posteducation retrospective review. The initial needs assessment included 65 patients. The subsequent posteducation group included 50 patients. RESULTS: Nursing compliance of 1-hour assessments increased after the educational intervention; however, there was no statistically significant difference in 6-hour assessment or medication administration protocol compliance between preeducation and posteducation groups. CONCLUSION: Nursing education is a good place to start in improving compliance with an alcohol withdrawal protocol, but physicians need to be included to increase standardization within the institution. Future study should look at the effectiveness of different assessment frequency intervals and its impact on patient-centered outcomes.
[Mh] Termos MeSH primário: Convulsões por Abstinência de Álcool/reabilitação
Transtornos Induzidos por Álcool/reabilitação
Árvores de Decisões
Padrões de Prática em Enfermagem/normas
[Mh] Termos MeSH secundário: Convulsões por Abstinência de Álcool/enfermagem
Transtornos Induzidos por Álcool/enfermagem
Protocolos Clínicos
Feminino
Seres Humanos
Capacitação em Serviço
Masculino
Meia-Idade
North Carolina
Garantia da Qualidade dos Cuidados de Saúde
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1703
[Cu] Atualização por classe:170313
[Lr] Data última revisão:
170313
[Sb] Subgrupo de revista:IM; N
[Da] Data de entrada para processamento:161207
[St] Status:MEDLINE


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[PMID]:27716957
[Au] Autor:Akinfiresoye LR; Miranda C; Lovinger DM; N'Gouemo P
[Ad] Endereço:Department of Pediatrics, Georgetown University Medical Center, Washington, District of Columbia.
[Ti] Título:Alcohol Withdrawal Increases Protein Kinase A Activity in the Rat Inferior Colliculus.
[So] Source:Alcohol Clin Exp Res;40(11):2359-2367, 2016 Nov.
[Is] ISSN:1530-0277
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Cyclic AMP-dependent protein kinase A (PKA) signaling is a key target for the action of alcohol and may therefore play a role in the pathophysiology of alcohol withdrawal seizures (AWSs). Here, we investigated the role of PKA activity with respect to increased seizure susceptibility in rats that were subjected to alcohol withdrawal. METHODS: Adult male Sprague Dawley rats received 3 daily doses of ethanol (EtOH) (or vehicle) for 4 consecutive days. Rats were then tested for susceptibility to acoustically evoked AWSs 3, 24, and 48 hours after the last alcohol dose. In separate experiments, the inferior colliculus (IC) was collected at these same time points from rats subjected to alcohol withdrawal and control rats following alcohol withdrawal. PKA activity, catalytic Cα (PKA ) protein, regulatory RIIα (PKA ) protein, and RIIß (PKA ) protein were measured in the IC. Lastly, in situ pharmacological studies were performed to evaluate whether inhibiting PKA activity in the IC suppressed AWSs. RESULTS: In the EtOH-treated group, AWSs were observed at the 24-hour time point, but not at the 3-hour or 48-hour time points. In the IC, PKA activity was significantly higher both 3 hours (i.e., before AWS susceptibility) and 24 hours after the last alcohol dose (when AWS susceptibility peaked) than in control rats. Consistent with these findings, protein levels of the PKA subunit were significantly increased in the IC both 3 and 24 hours after the last alcohol dose. Lastly, in situ inhibition of PKA activity within the IC suppressed AWSs. CONCLUSIONS: The increase in PKA activity and PKA protein expression in the IC preceded the occurrence of AWSs, and inhibiting PKA activity within the IC suppressed acoustically evoked AWSs. Together, these findings suggest that altered PKA activity plays a key role in the pathogenesis of AWSs.
[Mh] Termos MeSH primário: Convulsões por Abstinência de Álcool/enzimologia
Proteínas Quinases Dependentes de AMP Cíclico/metabolismo
Colículos Inferiores/enzimologia
[Mh] Termos MeSH secundário: Convulsões por Abstinência de Álcool/sangue
Intoxicação Alcoólica/psicologia
Animais
Concentração Alcoólica no Sangue
Peso Corporal
Proteínas Quinases Dependentes de AMP Cíclico/antagonistas & inibidores
Masculino
Distribuição Aleatória
Ratos Sprague-Dawley
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Blood Alcohol Content); EC 2.7.11.11 (Cyclic AMP-Dependent Protein Kinases)
[Em] Mês de entrada:1706
[Cu] Atualização por classe:171101
[Lr] Data última revisão:
171101
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161008
[St] Status:MEDLINE
[do] DOI:10.1111/acer.13223


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[PMID]:27503811
[Au] Autor:Greenberg GD; Phillips TJ; Crabbe JC
[Ad] Endereço:Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR, USA; Portland Alcohol Research Center, Portland, OR, USA; VA Portland Health Care System, Portland, OR, USA. Electronic address: greenbeg@ohsu.edu.
[Ti] Título:Effects of acute alcohol withdrawal on nest building in mice selectively bred for alcohol withdrawal severity.
[So] Source:Physiol Behav;165:257-66, 2016 Oct 15.
[Is] ISSN:1873-507X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Nest building has been used to assess thermoregulatory behavior and positive motivational states in mice. There are known genetic influences on ethanol withdrawal severity as well as individual/thermoregulatory nest building. Withdrawal Seizure-Prone (WSP-1, WSP-2) and Withdrawal Seizure-Resistant (WSR-1, WSR-2) mice were selectively bred for high vs low handling-induced convulsion (HIC) severity, respectively, during withdrawal from chronic ethanol vapor inhalation. They also differ in HIC severity during withdrawal from an acute, 4g/kg ethanol injection. In our initial study, withdrawal from an acute dose of ethanol dose-dependently impaired nest building over the initial 24h of withdrawal in genetically segregating Withdrawal Seizure Control (WSC) mice. In two further studies, acute ethanol withdrawal suppressed nest building for up to two days in WSP-1 females. Deficits in nest building from ethanol were limited to the initial 10h of withdrawal in WSR-1 females and to the initial 24h of withdrawal in WSP-1 and WSR-1 males. Effects of ethanol on nest building for up to two days were found in WSP-2 and WSR-2 mice of both sexes. Nest building deficits in female mice from the first replicate could not be explained by a general decrease in locomotor behavior. These results suggest that nest building is a novel behavioral phenotype for indexing the severity of acute ethanol withdrawal, and that genes contributing to this trait differ from those affecting acute withdrawal HIC severity.
[Mh] Termos MeSH primário: Convulsões por Abstinência de Álcool/etiologia
Convulsões por Abstinência de Álcool/genética
Cruzamento
Depressores do Sistema Nervoso Central/toxicidade
Etanol/toxicidade
Comportamento de Nidação/fisiologia
[Mh] Termos MeSH secundário: Análise de Variância
Animais
Relação Dose-Resposta a Droga
Feminino
Masculino
Camundongos
Camundongos Endogâmicos
Atividade Motora/efeitos dos fármacos
Comportamento de Nidação/efeitos dos fármacos
Especificidade da Espécie
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Central Nervous System Depressants); 3K9958V90M (Ethanol)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:171015
[Lr] Data última revisão:
171015
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160810
[St] Status:MEDLINE


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[PMID]:27207572
[Au] Autor:Martin K; Katz A
[Ad] Endereço:From Assistant Clinical Professor of Psychiatry, University of South Florida College of Medicine, Tampa FL; Department of Psychiatry, Lehigh Valley Health Network, Allentown, PA (KM). Electronic address: katherine_b.martin@lvhn.org.
[Ti] Título:The Role of Barbiturates for Alcohol Withdrawal Syndrome.
[So] Source:Psychosomatics;57(4):341-7, 2016 Jul-Aug.
[Is] ISSN:1545-7206
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Benzodiazepine-resistant cases of alcohol withdrawal syndrome are common, and therefore alternate treatments are needed. OBJECTIVE: Our aim was to conduct a systematic review of published reports on the use of barbiturates for alcohol withdrawal syndrome. METHODS: We performed a systematic literature search of PUBMED for relevant citations that described the use of barbiturates either alone or in conjunction with other pharmacological agents to treat alcohol withdrawal syndrome. RESULTS: A total of 15 citations were identified; 2 citations looked at barbiturates alone; 1 found barbiturates effective in an emergency department setting at treating seizures and preventing return visits. A second showed that barbiturates caused a relatively low rate of respiratory depression. Further, 5 citations compared barbiturates with benzodiazepines; 1 suggested that they were better at treating severe withdrawal, and another showed they were more effective at preventing seizures; 4 citations found they were as effective as benzodiazepines, but 1 found a higher rate of respiratory depression. Also, 3 citations compared a combination of barbiturates and benzodiazepines to benzodiazepines alone; 1 showed decreased ventilation, another showed fewer intensive care unit admissions, and a third showed better symptom control; 3 citations described detailed reports of barbiturate protocols. Lastly, 2 citations compared barbiturates with other agents and found them equivalent. CONCLUSION: Barbiturates provide effective treatment for alcohol withdrawal syndrome. In particular, they show promise for use in the emergency department and for severe withdrawal in the intensive care unit. Respiratory depression does not appear to be exceedingly common. Additional studies are needed to clarify the role of barbiturates in alcohol withdrawal syndrome.
[Mh] Termos MeSH primário: Delirium por Abstinência Alcoólica/tratamento farmacológico
Convulsões por Abstinência de Álcool/tratamento farmacológico
Barbitúricos/uso terapêutico
[Mh] Termos MeSH secundário: Benzodiazepinas/uso terapêutico
Depressores do Sistema Nervoso Central/efeitos adversos
Etanol/efeitos adversos
Seres Humanos
Síndrome de Abstinência a Substâncias/tratamento farmacológico
Síndrome de Abstinência a Substâncias/etiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Barbiturates); 0 (Central Nervous System Depressants); 12794-10-4 (Benzodiazepines); 3K9958V90M (Ethanol)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160522
[St] Status:MEDLINE


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[PMID]:26799430
[Au] Autor:Stewart R; Perez R; Musial B; Lukens C; Adjepong YA; Manthous CA
[Ad] Endereço:1 Department of Internal Medicine, Texas A&M University, College Station, Texas.
[Ti] Título:Outcomes of Patients with Alcohol Withdrawal Syndrome Treated with High-Dose Sedatives and Deferred Intubation.
[So] Source:Ann Am Thorac Soc;13(2):248-52, 2016 Feb.
[Is] ISSN:2325-6621
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: High doses of sedating drugs are often used to manage critically ill patients with alcohol withdrawal syndrome. OBJECTIVES: To describe outcomes and risks for pneumonia and endotracheal intubation in patients with alcohol withdrawal syndrome treated with high-dose intravenous sedatives and deferred endotracheal intubation. METHODS: Observational cohort study of consecutive patients treated in the intensive care unit (ICU) of a university-affiliated, community hospital for alcohol withdrawal syndrome, where patients were not routinely intubated to receive high-dose or continuously infused sedating medications. MEASUREMENTS AND MAIN RESULTS: We studied 188 patients hospitalized with alcohol withdrawal syndrome from 2008 through 2012 at one medical center. The mean age (SD) of the subjects was 50.8 ± 9.0 years and their mean ICU admission APACHE (Acute Physiology and Chronic Health Evaluation) II score was 6.2 ± 3.4. Thirty subjects (16%) developed pneumonia, and 38 (20.2%) required intubation. All of the 188 patients received lorazepam (median total dose, 42.5 mg), and 170 of 188 received midazolam, all but 2 by continuous intravenous infusion (median total dose, 527 mg; all administered in ICU); 19 received propofol (median total dose, 6,000 mg); and 19 received dexmedetomidine (median total dose, 1,075 mg). Intubated patients received substantially more benzodiazepine (median total dose, 761 mg of lorazepam equivalent vs. 229 mg for subjects in the nonintubated group; P < 0.0001). Endotracheal intubation was associated with pneumonia and higher acuity of illness (APACHE II score, >10). Intubated patients had a longer duration of hospital stay (median, 15 d vs. 6 d; P ≤ 0.0001). One patient did not survive hospitalization. CONCLUSIONS: In this single-center, observational study, where endotracheal intubation was deferred until aspiration or cardiopulmonary decompensation, treatment of alcohol withdrawal syndrome with high-dose, continuously infused sedating medications was not associated with excess morbidity or mortality.
[Mh] Termos MeSH primário: Hipnóticos e Sedativos/administração & dosagem
Intubação Intratraqueal/métodos
Respiração Artificial/métodos
Síndrome de Abstinência a Substâncias/terapia
[Mh] Termos MeSH secundário: APACHE
Adulto
Convulsões por Abstinência de Álcool/etiologia
Depressores do Sistema Nervoso Central/efeitos adversos
Estudos de Coortes
Estado Terminal
Dexmedetomidina/administração & dosagem
Etanol/efeitos adversos
Feminino
Seres Humanos
Infusões Intravenosas
Unidades de Terapia Intensiva
Intubação Intratraqueal/estatística & dados numéricos
Tempo de Internação/estatística & dados numéricos
Modelos Logísticos
Lorazepam/administração & dosagem
Masculino
Midazolam/administração & dosagem
Meia-Idade
Pneumonia/epidemiologia
Propofol/administração & dosagem
Estudos Retrospectivos
Síndrome de Abstinência a Substâncias/etiologia
Fatores de Tempo
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Nm] Nome de substância:
0 (Central Nervous System Depressants); 0 (Hypnotics and Sedatives); 3K9958V90M (Ethanol); 67VB76HONO (Dexmedetomidine); O26FZP769L (Lorazepam); R60L0SM5BC (Midazolam); YI7VU623SF (Propofol)
[Em] Mês de entrada:1611
[Cu] Atualização por classe:161230
[Lr] Data última revisão:
161230
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160123
[St] Status:MEDLINE
[do] DOI:10.1513/AnnalsATS.201507-448BC


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[PMID]:26760524
[Au] Autor:Gortney JS; Raub JN; Patel P; Kokoska L; Hannawa M; Argyris A
[Ad] Endereço:Assistant Professor, Director of Assessment, Division of Pharmacy, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA. E-mail: justine.gortney@wayne.edu.
[Ti] Título:Alcohol withdrawal syndrome in medical patients.
[So] Source:Cleve Clin J Med;83(1):67-79, 2016 Jan.
[Is] ISSN:1939-2869
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The authors provide a critical review focusing on pharmacotherapy of alcohol withdrawal syndrome in hospitalized patients who are not critically ill. They outline recommendations for patient assessment and monitoring.
[Mh] Termos MeSH primário: Delirium por Abstinência Alcoólica/tratamento farmacológico
Convulsões por Abstinência de Álcool/tratamento farmacológico
Benzodiazepinas/uso terapêutico
Agitação Psicomotora/tratamento farmacológico
[Mh] Termos MeSH secundário: Agonistas de Receptores Adrenérgicos alfa 2/uso terapêutico
Antagonistas Adrenérgicos beta/uso terapêutico
Antidiscinéticos/uso terapêutico
Anticonvulsivantes/uso terapêutico
Barbitúricos/uso terapêutico
Depressores do Sistema Nervoso Central/uso terapêutico
Etanol/uso terapêutico
Haloperidol/uso terapêutico
Seres Humanos
Índice de Gravidade de Doença
Síndrome
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Adrenergic alpha-2 Receptor Agonists); 0 (Adrenergic beta-Antagonists); 0 (Anti-Dyskinesia Agents); 0 (Anticonvulsants); 0 (Barbiturates); 0 (Central Nervous System Depressants); 12794-10-4 (Benzodiazepines); 3K9958V90M (Ethanol); J6292F8L3D (Haloperidol)
[Em] Mês de entrada:1701
[Cu] Atualização por classe:170118
[Lr] Data última revisão:
170118
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160114
[St] Status:MEDLINE
[do] DOI:10.3949/ccjm.83a.14061


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[PMID]:26698265
[Au] Autor:Busardò FP; Kyriakou C; Napoletano S; Marinelli E; Zaami S
[Ad] Endereço:Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Rome, Italy. fra.busardo@libero.it.
[Ti] Título:Clinical applications of sodium oxybate (GHB): from narcolepsy to alcohol withdrawal syndrome.
[So] Source:Eur Rev Med Pharmacol Sci;19(23):4654-63, 2015 Dec.
[Is] ISSN:2284-0729
[Cp] País de publicação:Italy
[La] Idioma:eng
[Ab] Resumo:Gamma-hydroxybutyrate (GHB) is a short chain fatty acid endogenously produced within the central nervous system (CNS) and acts as a precursor and metabolite of the inhibitory neurotransmitter γ-aminobutyric acid (GABA). Although, it is an illegal recreational drug of abuse, its sodium salt (sodium oxybate) has been utilized as a medication for a number of medical conditions. The first aim of this review was to focus on current applications of sodium oxybate for the treatment of narcolepsy, with a particular emphasis on the key symptoms of this disorder: cataplexy and excessive daytime sleepiness (EDS). Secondly, the effectiveness of sodium oxybate therapy for the treatment of alcohol withdrawal syndrome (AWS) and the maintenance of alcohol abstinence has been assessed. Nowadays, sodium oxybate is the first-line treatment for narcolepsy and it is highly effective in meliorating sleep architecture, decreasing EDS and the frequency of cataplexy attacks in narcoleptic patients. Sodium oxybate currently finds also application in the treatment of AWS and the maintenance of alcohol abstinence in alcoholics. Most of the studies evaluating the efficacy of GHB in the treatment of AWS use a dosage of 50 mg/kg divided in three or four administrations per day. Human studies showed that GHB (dose of 50 mg/kg, divided in three administrations per day) is capable to increase the number of abstinent days, reduce alcohol craving and decrease the number of drinks per day. However, there is limited randomized evidence and, thus, GHB cannot be reliably compared to clomethiazole or benzodiazepines. Some randomized data suggest that GHB is better than naltrexone and disulfiram regarding abstinence maintenance and prevention of craving in the medium term i.e. 3-12 months. It is recommended that GHB should be used only under strict medical supervision, since concerns about the abuse/misuse of the drug and the addiction potential have been arisen.
[Mh] Termos MeSH primário: Delirium por Abstinência Alcoólica/tratamento farmacológico
Convulsões por Abstinência de Álcool/tratamento farmacológico
Narcolepsia/tratamento farmacológico
Oxibato de Sódio/uso terapêutico
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Masculino
Pró-Fármacos/uso terapêutico
Sono/efeitos dos fármacos
Oxibato de Sódio/efeitos adversos
Drogas Ilícitas/efeitos adversos
Ácido gama-Aminobutírico/metabolismo
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Prodrugs); 0 (Street Drugs); 56-12-2 (gamma-Aminobutyric Acid); 7G33012534 (Sodium Oxybate)
[Em] Mês de entrada:1608
[Cu] Atualização por classe:151224
[Lr] Data última revisão:
151224
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:151225
[St] Status:MEDLINE


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[PMID]:26628550
[Au] Autor:Ycaza-Gutierrez MC; Wilson L; Altman M
[Ad] Endereço:Maria Christina Ycaza-Gutierrez and Laurie Wilson are charge nurses in the medical intensive care unit at Maimonides Medical Center, New York, New York.
[Ti] Título:Bedside Nurse-Driven Protocol for Management of Alcohol/Polysubstance Abuse Withdrawal.
[So] Source:Crit Care Nurse;35(6):73-6, 2015 Dec.
[Is] ISSN:1940-8250
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Convulsões por Abstinência de Álcool/enfermagem
Transtornos Relacionados ao Uso de Substâncias/enfermagem
[Mh] Termos MeSH secundário: Seres Humanos
Planejamento de Assistência ao Paciente
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1702
[Cu] Atualização por classe:170215
[Lr] Data última revisão:
170215
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:151203
[St] Status:MEDLINE
[do] DOI:10.4037/ccn2015194


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[PMID]:26337198
[Au] Autor:Wong A; Smithburger PL; Kane-Gill SL
[Ad] Endereço:a Department of Pharmacy , University of Pittsburgh Medical Center Presbyterian , Pittsburgh , PA and.
[Ti] Título:Review of adjunctive dexmedetomidine in the management of severe acute alcohol withdrawal syndrome.
[So] Source:Am J Drug Alcohol Abuse;41(5):382-91, 2015.
[Is] ISSN:1097-9891
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The primary management of alcohol withdrawal involves the administration of a γ-aminobutyric acid agonist, such as benzodiazepines, for management of symptoms and to prevent further progression to seizure or delirium tremens. Despite escalating doses of benzodiazepines, published literature indicates that some patient's alcohol withdrawal syndrome symptoms do not respond, and that the use of adjunctive agents may be beneficial in these patients. Dexmedetomidine, an α2-agonist, serves as a potential adjunctive agent through management of associated autonomic symptoms. Understanding of recent literature evaluating its use is necessary for appropriate selection. OBJECTIVE: To review available literature supporting the use of adjunctive dexmedetomidine for management of severe alcohol withdrawal syndrome. METHODS: A total of 13 published articles evaluating the efficacy and safety of dexmedetomidine as an adjunctive agent for the treatment of alcohol withdrawal in adult patients were identified from a MEDLINE search using the key words alcohol withdrawal, delirium tremens and dexmedetomidine. RESULTS: Evaluation of the literature indicates that dexmedetomidine is associated with a decrease in short-term benzodiazepine requirements after initiation, and improvement in hemodynamic parameters in relation to the adrenergic drive present in alcohol withdrawal. CONCLUSION: The use of dexmedetomidine in the management of severe alcohol withdrawal should be considered as an adjunctive agent. Dexmedetomidine appears to be well tolerated, with an expected decrease in blood pressure and heart rate. Seizures have occurred in patients with alcohol withdrawal despite the use of dexmedetomidine, with and without benzodiazepines, due to lack of γ-aminobutyric acid agonist administration.
[Mh] Termos MeSH primário: Delirium por Abstinência Alcoólica/tratamento farmacológico
Convulsões por Abstinência de Álcool/tratamento farmacológico
Benzodiazepinas/uso terapêutico
Dexmedetomidina/uso terapêutico
Quimioterapia Combinada/métodos
Síndrome de Abstinência a Substâncias/tratamento farmacológico
[Mh] Termos MeSH secundário: Delirium por Abstinência Alcoólica/prevenção & controle
Convulsões por Abstinência de Álcool/prevenção & controle
Seres Humanos
Hipnóticos e Sedativos/uso terapêutico
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Hypnotics and Sedatives); 12794-10-4 (Benzodiazepines); 67VB76HONO (Dexmedetomidine)
[Em] Mês de entrada:1606
[Cu] Atualização por classe:150904
[Lr] Data última revisão:
150904
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:150905
[St] Status:MEDLINE
[do] DOI:10.3109/00952990.2015.1058390



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