Podcasts about phenobarbital

Emergency treatment may be necessary after a person's first seizure or at the onset of abnormal acute repetitive (cluster) seizures; it is required for status epilepticus. Treatment for these emergencies is dictated by myriad clinical factors and informed by published guidance as well as emerging research.   In this episode, Lyell K. Jones, MD, FAAN, speaks with David G. Vossler, MD, FAAN, FACNS, FAES, author of the article “First Seizures, Acute Repetitive Seizures, and Status Epilepticus,” in the Continuum® February 2025 Epilepsy issue. Dr. Jones is the editor-in-chief of Continuum: Lifelong Learning in Neurology® and is a professor of neurology at Mayo Clinic in Rochester, Minnesota. Dr. Vossler a clinical professor of neurology at the University of Washington School of Medicine in Seattle, Washington. Additional Resources Read the article: First Seizures, Acute Repetitive Seizures, and Status Epilepticus Subscribe to Continuum: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @LyellJ  Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum, the premier topic-based neurology clinical review and CME journal from the American Academy of Neurology. Thank you for joining us on Continuum Audio, which features conversations with Continuum's guest editors and authors who are the leading experts in their fields. Subscribers to the Continuum journal can read the full article or listen to verbatim recordings of the article and have access to exclusive interviews not featured on the podcast. Please visit the link in the episode notes for more information on the article, subscribing to the journal, and how to get CME. Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum: Lifelong Learning in Neurology. Today, I'm interviewing Dr Dave Vossler, who has recently authored an article on emergent seizure management, taking care of patients with the first seizure, acute repetitive seizures, and status epilepticus, which is an article in our latest issue of Continuum covering all topics related to epilepsy. Dr Vossler is a neurologist at the University of Washington, where he's a clinical professor of neurology and has an active clinical and research practice in epileptology. Dr Vossler, welcome. Thank you for joining us today. Why don't you introduce yourself to our listeners? Dr Vossler: Thank you very much for the introduction, Lyell. It's a pleasure to speak with you on this podcast, and I hope to go over a lot of important new information in the management of seizure emergencies. As you said, I'm a clinical professor in neurology at University of Washington, been in medicine for many decades now and have published and done research in this area. So, I'm anxious to give you not only my academic experience, but also talk about my own management of patients with status epilepticus over the last four decades. Dr Jones: Yeah, that's fantastic. And I always appreciate hearing from experienced clinicians, and I think our readers and our listeners do appreciate that voice of clinical expertise. And I'll tell you this is a topic, you know, as a neurologist who doesn't see many patients with acute seizure emergencies in my own practice, I think this is a topic that gives many clinicians, including neurologists, some anxiety. Your article, Dr Vossler, is really chock-full of helpful and clinically relevant considerations in the acute management of seizures. So, you now have the full attention of a huge audience of mostly neurologists. What's the one most important practice change that you would like to see in the care of patients with either first or acute prolonged seizures? Dr Vossler: Without a doubt, the most important clinical takeaway with regard to the status epilepticus---and for status epilepticus, many, many clinical trials, research trials have been done over the last couple decades and they all consistently show the same thing, that by and large most patients who have status epilepticus are underdosed and undertreated and treated too slowly in the initial stages of the status epilepticus. And it's important to use full bolus dosages of benzodiazepines to prevent mortality, morbidity, and later disability of these patients. To prevent the respiratory depression, many physicians are afraid to use higher doses of benzodiazepines, even guideline-recommended doses of benzodiazepines for fear of respiratory depression. But it's actually counterintuitive. It turns out that most cases of respiratory depression are due to inadequate doses and due to the status epilepticus itself. We know there's greater mortality, we know there's greater morbidity and we know that there's greater need for higher dose, subsequent, anti-seizure medications, prolonged status, if we don't use the proper doses. So, we'll kind of go over that a little bit, but that is the one clinical takeaway that I really would like our listeners to have. Dr Jones: Let's follow that thread a little bit. Dave, I know obviously we will speak in hypotheticals here. We're not going to talk about actual patients, but I think we've all been in the clinical situation where you have a patient who comes into the emergency room usually who's actively seizing, unknown history, don't know much about the patient, don't know much about the circumstances of the onset of the seizure. But we now have a patient with prolonged convulsive seizures. How do we walk through that? What are the first steps in the management of that patient? Dr Vossler: Yeah, well, I'll try to be brief for the purposes of the podcast. We do, of course, go through all of that in detail in the Continuum article, which hopefully everybody will look at very carefully. Really in the first table, the very first table of the article, I go through the recommended guideline for the American Epilepsy Society on the management of what we call established status epilepticus. The scenario you're talking about is just exactly that: established status epilepticus. It's not sort of evolving or developing status. We're okay they're having a few seizures and we're kind of getting there. No, this patient is now having evidence of convulsive seizure activity and it's continuing or it's repeated seizures without recovery. And so, the first phase is definitely a benzodiazepine and then the second phase is then a longer-acting bolus of a drug like phosphenotoine, valproic acid or levetiracetam. I could get into the details about dosing of the benzodiazepines, but maybe I'll let you guide me on whether we wanted to get into that kind of detail right at the outset. It's going to be a little bit different. For children, its weight-based dosing, but for adults, whether you use lorazepam or you use diazepam or you use midazolam, the doses are a little bit different. But they are standardized, and gets back to this point that I made earlier, we're acting too slow. We're not getting these patients quick enough, for various reasons, and the doses that are most commonly used are below what the guidelines call for. Dr Jones: That's great to know, and I think it's fine for the details to refer our listeners to the article because there are great details in there about a step-by-step approach to the established status epilepticus. The nomenclature and the definitions have evolved, haven't they, Dr Vossler, over time? Refractory status epilepticus, new-onset refractory status epilepticus, super refractory status epilepticus. Tell us about those entities, how they're distinguished and how you approach those. Dr Vossler: That's an important thing to kind of go over. They- in 2015, the International League Against Epilepsy, ILAE, which is, again, our international organization that guides our understanding of all kinds of things epileptic in nature around the world. In 2015 they put out a definition of status epilepticus, but it used to be that patients had thirty minutes of continuous seizure activity or repetitive obvious motor seizures with impairment of awareness and they don't recover impairment between these seizures. And that goes on for thirty minutes. That was the old definition of status epilepticus. Now, the operational definition is five minutes. And I think that's key to understand that, after five minutes of this kind of overt seizure activity, you need to intervene. And that's what's called T1 in the 2015 guideline, the international guideline. There are a bunch of different axes in the classification of status that talk about semiology, etiology, EEG patterns, and what age group you're talking about. We won't really get into those in the Continuum article because that's really more detailed than a clinician really should be. Needing to think about the stages, what we call the stages of status epilepticus that you mentioned and I alluded to earlier are important. And that is sort of new nomenclature, and I think probably general neurologists and most emergency room physicians aren't familiar with those. So, it just briefly goes through those. Developing status epilepticus is where you're starting- the patient's starting to have more frequent seizures, and it's heading essentially in the wrong direction, if you will. Established status epilepticus, as I mentioned, is, you know, this seizure act, convulsive or major, major outward overt seizure activity lasting five minutes or more, at which time therapy needs to begin. Again, getting back to my point, what doesn't happen often enough is we're not- we're intervening too late. Third is refractory status epilepticus, which refers to status epilepticus which continues despite adequate doses of an initial benzodiazepine given parenterally followed by a full loading dose of a single non-sedating anti-seizure medicine, which today includes phosphenotoine IV valproic acid or IV levetiracetam. In the United States, and increasingly around the world, people really are using levetiracetam. First, it has some advantages. There's now proof from a class one NIH-funded trial. We know that these three drugs are equivalent at the full doses that I go over in the article. You have your kind of dealer's choice on those. Phenobarbital, which we used to use and I used as a resident as long as forty years ago, is really a second choice drug because of its sedating and other side effects. But around the world in resource-poor countries phenobarbital can be used and, in a pinch, certainly is an appropriate drug. And then finally, you mentioned super refractory status epilepticus and that's status that's persisting for more than twenty four hours. Now, despite initial benzo and non-sedating anti-seizure medicine, but also lasting more than twenty four hours while receiving an intravenous infusional sedating, anesthetizing anti-seizure medicine like ketamine, propofol, pentobarbital or midazolam drips. Dr Jones: So, it sounds like the definitions have evolved in a way that improves the outcomes, right? To do earlier identification of status epilepticus and more aggressive management, I think that's a great takeaway. If we move all the way to the other end of the spectrum, let's move to the ambulatory setting and we have a patient who comes in and they've had one seizure, they're an adult; one seizure, the first seizure. The key question is, how do we anticipate the risk of future seizures? But walk us through how you talk to that patient, how you evaluate that patient to decide if and when to start anti-seizure medicines. Dr Vossler: Well, it depends a little bit if it's an adult or a child, but the decision making process and the data behind it is pretty robust now. And the decision making process is pretty similar for adults and children, with some differences which I can talk about. First of all, first seizures. I think it's really important to stress that there's been so much research in this area. I'd like to get a cross point that they're not as innocuous as I think many general neurologists might suspect. We know that there is a two- to threefold increased risk of death in children and adults following a first seizure. Moreover, the risk of a second seizure, both in kids and adults, is about 36% two years after that first seizure. It's about 46% five years after that first seizure. It's really pretty substantial. The risk of a second seizure is increased twofold. It doubled in the presence of any kind of a history of prior brain insults that could result in seizures. Could be infections, it could be a prior stroke, it could be prior significant brain trauma. It's also doubled in the presence of an EEG, which shows epileptiform discharges like spikes and sharp waves---and not just a sort of borderline things like sharply contoured rhythmic Theta activity. That's really not what we're talking about. We're talking about overt epileptiform discharges. It's doubled in the presence of lesion that can be seen on imaging studies, and it's doubled in the presence of seizures if that first seizure occurs during sleep. So, we have a number of things that double the risks, above the risk of a second seizure, above that 36% at two years and 46% at five years that I spoke about. And so those things need to be considered when you're counseling a patient about that. Should you be on an anti-seizure medicine after that first seizure? Specifically, to the point of anti-seizure medications, the guideline that was done, the 2015 guideline that was done by the American Academy of Neurology for adults, and the 2003 guideline was actually a practice parameter that was done by the Academy and the American Epilepsy Society for children, are really kind of out of date. They talk about the adverse effects of anti-seizure medications, but when you look back at the studies that were included in developing that practice parameter for kids and guidelines for adults, they are the old drugs: carbamazepine, phenytoin, phenobarbital and valproate. Well, I don't think I need to tell this audience, this well-educated audience, that we don't use those drugs anymore. We are using more modern anti-seizure medicines that have been developed since 1995; things like lamotrigine, levetiracetam, and lecosamide. Those three in particular have very low adverse events. So, the guideline that the Academy, American Academy Neurology and American Epilepsy Society put together for kids and for adults talks about this high adverse event profile. And so, you need to take a look at the risks that I talked about of a seizure recurrence and balance that against adverse effects. But I'm here to tell you that the newer anti-seizure medicines---and by newer I'm talking in the last thirty years since lamotrigine was approved in 1995---these drugs have much better side effect profiles. And I think all epileptologists would agree with that. They're not necessarily more effective, but they are better tolerated. That makes the discussion of the risk of a second seizure, the risk of mortality versus side effects of drugs, it really pushes the risk category higher on the first side and not on the side of drugs. We know that if you take an anti-seizure medicine, you reduce your risk of a second seizure by half. Now, that's not sustained over five years, but over the first two years, you've reduced it by half. In a person who's driving, needs to get to work, has to take the kids to school, whatever, most of my patients are like, yeah, okay, sign me up. These drugs are really pretty well tolerated. There's a substantial risk of a second seizure. So, I'll do that. In a kid,  a child that's, you know, not driving yet, that might be a different discussion. And the parents might say, well, I'd rather not have my son exposed, my daughter exposed to this. They're trying to go to school. They're trying to learn. We don't want to hinder that. We'll wait for a second seizure and then if they have a second seizure, which by the way is, you know, one of the definitions of epilepsy, well then they have epilepsy, then they probably will need to go on the seizure medication. Dr Jones: Great summary, Dr Vossler, and it is worth our audience being aware that the evidence has evolved alongside the improvement in the adverse effect profile. And sounds like your threshold is a little lower to treat then maybe it would have been some time ago, right? Dr Vossler: I would say that's exactly correct in my opinion. Particularly for adults, absolutely. Dr Jones: That's fantastic, Dr Vossler. I imagine there are a lot of aspects of caring for these patients that are challenging, and I imagine many scenarios are actually pretty rewarding. What do you find the most rewarding aspect of caring for patients with acute seizure management? Dr Vossler: Yes, I mean, that is really true. I would say that the most challenging things are treating refractory status epilepticus, but worse yet, new onset refractory status epilepticus and the super refractory status epilepticus, which I talk extensively about or write extensively about in the article and provide a lot of guidance on. Really, those conditions are so challenging because they can go on for such a long time. Patients are hospitalized for a long time. A lot of really good clinical guidance doesn't exist yet. There is a tremendous amount of research in that area which I find exciting, and really there's an amazing amount of international research on that, I think most of our audience probably is unaware of. And certainly, with those conditions, there is a high risk of later disability and mortality. We go through all of that in the article. The rewards really come from helping these people. When someone was super refractory status and it were non- sorry, new onset refractory status epilepticus, has been in the hospital for thirty days, it gets really hard for everybody; the family, the patient. And for us, it wears on us. Yet when they walk out the door, and I've had these people come back to the epilepsy clinic and see me later. We're managing their anti-seizure medications. They've survived. The NORSE patients often have substantial disability. They have cognitive and memory and even some psychiatric disability. But yet we can help them. It's not just management in the hospital, but it's getting to know these people, and I take them from the hospital and see them in my clinic and manage them long-term. I get a lot of great satisfaction out of that. We're hoping to do even better, stop patients' status early and get them to recover with no sequelae. Dr Jones: What a great visual, seeing those patients who have a devastating problem and they come back to clinic and you get the full circle. And what a great place to end. Dr Vossler, thank you so much for joining us, and thank you for such a thorough and fascinating discussion on the importance of understanding and managing patients with the first seizure, acute repetitive seizures, and status epilepticus. Dr Vossler: Thank you very much, Lyell. Dr Jones: Again, we've been speaking with Dr Dave Vossler, author of an article on emergent seizure management, first seizures, acute repetitive seizures and status epilepticus in Continuum's most recent issue on epilepsy. Please check it out, and thank you to our listeners for joining today. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use this link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

In today's VETgirl podcast, we discuss a study by Dohany et al. assessing phenobarbital-induced hematologic changes in 69 cats. As we know, phenobarbital is a widely prescribed anti-epileptic medication used in veterinary medicine. But how aware are you of the cytopenias that can be associated with chronic phenobarbital administration?

Show notes at pharmacyjoe.com/episode955. In this episode, I'll discuss the use of phenobarbital in severe alcohol withdrawal. The post 955: Has Everyone Gotten the Mechanism of Phenobarbital in Alcohol Withdrawal Wrong? appeared first on Pharmacy Joe.

In this episode we begin to discuss the anti-seizure medications used for epilepsy in dogs and cats, starting with phenobarbital. Although this medication is the most effective anti-convulsant, it does require close monitoring on account of its adverse effects which in their early days can be reversible. We will discuss how to use this medication, how to monitor, and what to watch out for.

2024 SCCM Congress: Monday Special Guests: Caitlin Brown, PharmD, BCCCP, FCCM Marilyn Bulloch, PharmD, BCPS, FCCM Kayla Kotch, PharmD, BCCCP 02:55: Marilyn Bulloch discusses her role and experience as a 2024 SCCM Congress co-chair 28:30: Star Research Presentation: “Impact of Early Initiation of Phenobarbital for Alcohol Withdrawal Syndrome in the Critically Ill” featuring Kayla Kotch 39:00: Star Research Presentation: “A Multicenter Study of Pulmonary Embolism Patients Treated with Reduced- or Full-Dose Alteplase” featuring Caitlin Brown 2024 SCCM Congress website: https://congress2024.sccm.org PharmacyToDose.Com  @PharmacyToDose  PharmacyToDose@Gmail.com Learn more about your ad choices. Visit megaphone.fm/adchoices

The JournalFeed podcast for the week of Dec 11-15, 2023.These are summaries from just 2 of the 5 article we cover every week! For access to more, please visit JournalFeed.org for details about becoming a member.Tuesday Spoon Feed:This secondary analysis of the STOP CP cohort study found that, in isolation, using a 0/2 hour hs-cTnT rule-out protocol did not achieve a NPV ≥ 99% for 30-day cardiac death or MI (CDMI). When combined with a low risk History, ECG, Age, and Risk factor (HEAR) score, it did - but at the cost of significantly decreased efficacy (ruling out only 30.7% of patients).Thursday Spoon Feed:This systematic review and meta-analysis did not show significant improvement in measured patient outcomes for treatment of alcohol withdrawal syndrome with phenobarbital vs benzodiazepines.

Trial of the Week: Phenobarbital for Acute Alcohol Withdrawal Special Guest: Joseph Lam, PharmD Joseph Lam joins me to highlight the 2013 trial published in the Journal of Emergency: Phenobarbital for acute alcohol withdrawal: a prospective, randomized, double-blind, placebo-controlled study. Joe shares his experience in the trial and all he did behind the scenes. Plus, we discuss the role of phenobarbital at that time, what this study found, what do we still need to know on this topic, and much more.  Reference list: https://pharmacytodose.files.wordpress.com/2023/09/phb-in-aws-references.pdf PharmacyToDose.Com  @PharmacyToDose  PharmacyToDose@Gmail.com Learn more about your ad choices. Visit megaphone.fm/adchoices

On this episode of the Real Life Pharmacology Podcast, I cover phenobarbital pharmacology, adverse effects, important drug interactions and much more. Phenobarbital is an enzyme inducer. It is an inducer at CYP3A4 so this can lead to numerous drug interactions. Phenobarbital can exacerbate the risk for opioid overdose and increase the risk for respiratory depression and death. Phenobarbital can deplete numerous vitamins such as vitamin D, folic acid, and vitamin B12. Monitoring of these is important.

In this episode we discuss the emerging trend of Phenobarbital for inpatient alcohol withdrawal management. We review the history, mechanism of action, dosing, side effects and medication interactions associated with Phenobarbital. Hosted by Darlene Petersen, MD and Paula Cook, MD.  Check us out on facebook @Theaddictionfiles or twitter @THEADDICTIONFI1 or Instagram  Theaddictionfiles or email us at theaddictionfiles@gmail.com No explicit language but this podcast discusses the abuse and treatment of legal and illegal drugs and may not be appropriate for all listeners.

Episode 16! In this episode we talk about "Phenobarbital-Based Protocol for Alcohol Withdrawal Syndrome in a Medical ICU: Pre-Post Implementation Study" published April 2023 by Alwakeel et al and then talk about the landmark study TRICC or "A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care"We also explore car donation jingles (1-877 KARS 4 KIDSPhenobarbital: https://pubmed.ncbi.nlm.nih.gov/37091477/TRICC: https://pubmed.ncbi.nlm.nih.gov/9971864/TRISS: https://pubmed.ncbi.nlm.nih.gov/23281973/Transfusion in Upper GI bleeds: https://pubmed.ncbi.nlm.nih.gov/25270275/Be sure to follow us on the social @icucast for the associated figures, comments, and other content not available in the audio format! Email us at icuedandtoddcast@gmail.com with any questions or suggestions! Thank you Mike Gannon for the intro and exit music!

Contributor: Travis Barlock MD Educational Pearls: Alcohol binds the GABA receptor, which produces an inhibitory response, hence the “depressive” effects of ethanol beverages. Over time, alcohol downregulates the GABA receptors, leading to unopposed glutamate activity. Given that glutamate is excitatory, this can lead to seizures. Alcohol also suppresses REM sleep; in patients with chronically suppressed REM sleep, the brain starves for dream sleep and it spills over into the wakeful state, inducing a dream-like state when someone is awake. The awake dream-like state of delirium tremens (DT) differs from alcohol hallucinosis Alcohol hallucinosis presents with visual hallucinations in a wakeful state DT presents with a generalized clouding of the sensorium and a dream-like state Treatment for DT is better achieved with phenobarbital due to predictable pharmacology Phenobarbital acts on GABA and NMDA receptors References 1. Davies M. The role of GABAA receptors in mediating the effects of alcohol in the central nervous system. J Psychiatry Neurosci. 2003;28(4):263-274. 2. Fujimoto J, Lou JJ, Pessegueiro AM. Use of Phenobarbital in Delirium Tremens. J Investig Med High Impact Case Reports. 2017;5(4):4-6. doi:10.1177/2324709617742166 3. Walker, M. Chapter 13: iPads, Factory Whistles, and Nightcaps In: Walker, M, Why We Sleep. Scribner; 2017, pg. 272.  4. Zarcone V. Alcoholism and sleep. Adv Biosci. 1978;21:29-38. Summarized & Edited by Jorge Chalit, OMSII  

Không chỉ phải đối mặt với tình trạng căng thẳng của dịch tay chân miệng khi đã xuất hiện trường hợp tử vong, nhiều ca nặng ở các địa phương phải chuyển về tuyến cuối và nguy cơ dịch chồng dịch, TP.HCM còn phải đối mặt với nguy cơ thiếu thuốc điều trị. Hiện các loại thuốc Immunoglobulin, Pentaglobin (chế phẩm từ huyết tương) và Phenobarbital đang khan hiếm nên việc điều trị gặp nhiều khó khăn.

2023 SAEM PharmD Research  02:10 – Emergency Medicine Resident Perceptions of the Educational Impact of Emergency Medicine Clinical Pharmacists with Francisco Ibarra, PharmD, BCCCP 12:10 – Impact of Emergency Medicine Pharmacists on Anticoagulation Reversal with Jaclyn Scalgione, PharmD, BCPS 24:25 – Incidence of Postintubation Hypotension after Rapid Sequence Intubation in Full vs. Reduced Dose Induction Agent with Alicia Mattson, PharmD, BCCCP 35:12 – Phenobarbital as an Adjunct to Benzodiazepines in the Setting of Alcohol Withdrawal with Amelia Slane, PharmD, BCPS 48:19 – Single Dose Aminoglycosides for Complicated Urinary Tract Infections in the Emergency Department with Jordan Jenrette, PharmD 61:53 – Effect of Intravenous vs. Oral First Dose Antibiotics in the Emergency Department on Hospital Admission with Jessica Pham, PharmD PharmacyToDose.Com  @PharmacyToDose  PharmacyToDose@Gmail.com Learn more about your ad choices. Visit megaphone.fm/adchoices

Alcohol withdrawal can send our patients into a spiral of delirium and downstream complications in the ICU. What are the risks of benzodiazepines for our patients even during alcohol withdrawal? How can we give our patients the best chance to walk away from ETOH withdrawal and critical illness? Dr. Obiajulu Anozie, MD joins us in this episode to explore the benefits of phenobarbital for alcohol withdrawal. www.daytonicuconsulting.com --- Support this podcast: https://podcasters.spotify.com/pod/show/restoringlife/support

Background information: Alcohol has potentiating effects on the inhibitory GABA neurotransmission system and inhibitory effects on the excitatory glutamate neurotransmission system. Chronic alcohol use causes changes to preserve homeostasis, and when the stimulus is removed, alcohol withdrawal results due to decreased inhibition via the GABA system and increased excitation via the glutamate system. Treatment options ... Read more The post REBEL Cast Ep115 – Phenobarbital vs Lorazepam in Alcohol Withdrawal appeared first on REBEL EM - Emergency Medicine Blog.

Show notes at pharmacyjoe.com/episode759. In this episode, I'll discuss whether phenobarbital offers a clinically meaningful advantage over benzodiazepines for alcohol withdrawal in the ED. The post 759: Does phenobarbital offer a clinically meaningful advantage over benzodiazepines for alcohol withdrawal in the ED? appeared first on Pharmacy Joe.

Show notes at pharmacyjoe.com/episode759. In this episode, I ll discuss whether phenobarbital offers a clinically meaningful advantage over benzodiazepines for alcohol withdrawal in the ED. The post 759: Does phenobarbital offer a clinically meaningful advantage over benzodiazepines for alcohol withdrawal in the ED? appeared first on Pharmacy Joe.

Dr. Nicholas Bosch MD, Msc, Assistant Professor of Pulmonary, Allergy, Sleep & Critical Care Medicine at Boston University School of Medicine presents a lecture on the "Implementation of a Phenobarbital pathway for Severe Alcohol Withdrawal Syndrome" as part of the Critical Care Grand Rounds.

Alcohol Withdrawal, Part 2SummaryDrinking alcohol (specifically ethanol) on a regular basis leads to alcohol dependence. When alcohol dependent persons stop drinking, they experience withdrawal. Withdrawal from alcohol is very dangerous and should be managed aggressively in order to prevent long term complications and death. This podcast will teach you the ins and outs of recognizing and managing alcohol withdrawal both in the inpatient and outpatient setting.Morbidity and MortalityAlmost 100,000 people die every year from ETOH abuse in the United States alone. It is not known how many people die a year from alcohol withdrawal. If delirium tremons develops, it is estimated that about 25% of people will die without treatment.StoryEver drink too much at night and then wake up suddenly at 5am feeling wide awake? Ever feel inner tension, agitation, or heart palpitations after a long party weekend with friends? If so, you have experienced symptoms of alcohol withdrawal.Key Points1. Tachycardia, tachypnea, hypertension, hyperthermia, tremors, anxiety, and GI upset are the hallmarks of alcohol withdrawal.2. Severe symptoms may include hallucinations, delirium, seizures, and death3. Vitamin and electrolyte repletion are critical for sick alcohol dependent patients.4. Aggressively treating withdrawal by slowly coming off alcohol or using medications like barbiturates, benzodiazepines, and other CNS depressants can be lifesaving. Use medication liberally in this setting!References-Saitz M, Mayo-Smith MF, Redmond HA, Bernard DR, Calkins DR. Individualized treatment for alcohol withdrawal. A randomized double-blind controlled trial. JAMA 1994- Grant BF, Goldstein RB, Saha TD, et al. Epidemiology of DSM-5 Alcohol Use Disorder: Results From the National Epidemiologic Survey on Alcohol and Related Conditions III. JAMA Psychiatry. 2015- https://www.who.int/news-room/fact-sheets/detail/alcohol- Newman RK, Stobart Gallagher MA, Gomez AE. Alcohol Withdrawal. - In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441882/- Nisavic M, Nejad SH, Isenberg BM, Bajwa EK, Currier P, Wallace PM, Velmahos G, Wilens T. Use of Phenobarbital in Alcohol Withdrawal Management - A Retrospective Comparison Study of Phenobarbital and Benzodiazepines for Acute Alcohol Withdrawal Management in General Medical Patients. Psychosomatics. 2019 - Wikipedia, alcohol withdrawal syndrome- Personal experience treating ETOH withdrawal in the inpatient and outpatient setting  

In the final part of this "Mini Grand Rounds" series,  the author of a recently-published study discusses his experience with phenobarbitalClick HERE to leave a review of the podcast!Subscribe HERE!References:All references for Episode 73 are found on my Read by QxMD collectionDisclaimer: The information contained within the  ER-Rx podcast episodes, errxpodcast.com, and the @errxpodcast Instagram page is for informational/ educational purposes only, is not meant to replace professional medical judgement, and does not constitute a provider-patient relationship between you and the authors. Information contained herein may be accidentally inaccurate, incomplete, or outdated, and users are to use caution,  seek medical advice from a licensed physician, and consult available resources prior to any medical decision making. The contributors of the ER-Rx podcast are not affiliated with, nor do they speak on behalf of,  any medical institutions, educational facilities, or other healthcare programs.To celebrate the 2-year anniversary of the ER-Rx Podcast, we're giving away another medically-related prize bundle. All you have to do to enter is subscribe to the podcast newsletter found on errxpodcast.com—and don't worry- if you've already done that in the past you will still be entered into the drawing. The deadline to enter is May 15th and the winner will be announced on May 19th- the 75th episode. Support the show (https://www.buymeacoffee.com/errxpodcast)

SummaryDrinking alcohol (specifically ethanol) on a regular basis leads to alcohol dependence. When alcohol dependent persons stop drinking, they experience withdrawal. Withdrawal from alcohol is very dangerous and should be managed aggressively in order to prevent long term complications and death. This podcast will teach you the ins and outs of recognizing and managing alcohol withdrawal both in the inpatient and outpatient setting. Morbidity and MortalityAlmost 100,000 people die every year from ETOH abuse in the United States alone. It is not known how many people die a year from alcohol withdrawal. If delirium tremons develops, it is estimated that about 25% of people will die without treatment. StoryEver drink too much at night and then wake up suddenly at 5am feeling wide awake? Ever feel inner tension, agitation, or heart palpitations after a long party weekend with friends? If so, you have experienced symptoms of alcohol withdrawal. Key Points1. Tachycardia, tachypnea, hypertension, hyperthermia, tremors, anxiety, and GI upset are the hallmarks of alcohol withdrawal.2. Severe symptoms may include hallucinations, delirium, seizures, and death3. Vitamin and electrolyte repletion are critical for sick alcohol dependent patients.4. Aggressively treating withdrawal by slowly coming off alcohol or using medications like barbiturates, benzodiazepines, and other CNS depressants can be lifesaving. Use medication liberally in this setting! References-Saitz M, Mayo-Smith MF, Redmond HA, Bernard DR, Calkins DR. Individualized treatment for alcohol withdrawal. A randomized double-blind controlled trial. JAMA 1994- Grant BF, Goldstein RB, Saha TD, et al. Epidemiology of DSM-5 Alcohol Use Disorder: Results From the National Epidemiologic Survey on Alcohol and Related Conditions III. JAMA Psychiatry. 2015- https://www.who.int/news-room/fact-sheets/detail/alcohol- Newman RK, Stobart Gallagher MA, Gomez AE. Alcohol Withdrawal. - In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441882/- Nisavic M, Nejad SH, Isenberg BM, Bajwa EK, Currier P, Wallace PM, Velmahos G, Wilens T. Use of Phenobarbital in Alcohol Withdrawal Management - A Retrospective Comparison Study of Phenobarbital and Benzodiazepines for Acute Alcohol Withdrawal Management in General Medical Patients. Psychosomatics. 2019 - Wikipedia, alcohol withdrawal syndrome- Personal experience treating ETOH withdrawal in the inpatient and outpatient setting

In Part 2 of this "Mini Grand Rounds" series, we discuss the data behind phenobarb and how to dose and monitor itClick HERE to leave a review of the podcast!Subscribe HERE!References:All references for Episode 72 are found on my Read by QxMD collectionDisclaimer: The information contained within the  ER-Rx podcast episodes, errxpodcast.com, and the @errxpodcast Instagram page is for informational/ educational purposes only, is not meant to replace professional medical judgement, and does not constitute a provider-patient relationship between you and the authors. Information contained herein may be accidentally inaccurate, incomplete, or outdated, and users are to use caution,  seek medical advice from a licensed physician, and consult available resources prior to any medical decision making. The contributors of the ER-Rx podcast are not affiliated with, nor do they speak on behalf of,  any medical institutions, educational facilities, or other healthcare programs.Support the show (https://www.buymeacoffee.com/errxpodcast)

Alcohol withdrawal syndrome (AWS) is a disease commonly treated in the emergency department, with~5% of cases leading to delirium tremens. In patients with a history of AWS, decreased GABA-A receptor sensitivity to GABA agonists may causebenzodiazepine (BZD) monotherapy to be ineffective. Patients may experience increase in morbidity and mortality due to escalated doses of benzodiazepines. […] The post Episode 71. Pushing P! Phenobarbital for Alcohol Withdrawal Syndrome appeared first on The Pharm So Hard Podcast.

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In Part 1 of this "Mini Grand Rounds" series, we review the history and the pharmacodynamic/ pharmacokinetic profile of phenobarbital   Click HERE to leave a review of the podcast!Subscribe HERE!References:All references for Episode 71 are found on my Read by QxMD collectionDisclaimer: The information contained within the  ER-Rx podcast episodes, errxpodcast.com, and the @errxpodcast Instagram page is for informational/ educational purposes only, is not meant to replace professional medical judgement, and does not constitute a provider-patient relationship between you and the authors. Information contained herein may be accidentally inaccurate, incomplete, or outdated, and users are to use caution,  seek medical advice from a licensed physician, and consult available resources prior to any medical decision making. The contributors of the ER-Rx podcast are not affiliated with, nor do they speak on behalf of,  any medical institutions, educational facilities, or other healthcare programs.Support the show (https://www.buymeacoffee.com/errxpodcast)

Contributor: Aaron Lessen, MD Educational Pearls: Retrospective cohort study looked at return rate of discharged patients after receiving either phenobarbital or benzodiazepines or both in the ED for treatment of alcohol withdrawal Patients who received benzodiazepines had a 25% chance of returning in 3 days versus a 10% chance of returning in 3 days for those who received phenobarbital 13% of patients returned in 3 days after receiving both phenobarbital and benzodiazepines Phenobarbital may make it less likely for patients to come back to the ED after receiving treatment for alcohol withdrawal References Lebin JA, Mudan A, Murphy CE 4th, Wang RC, Smollin CG. Return Encounters in Emergency Department Patients Treated with Phenobarbital Versus Benzodiazepines for Alcohol Withdrawal. J Med Toxicol. 2022;18(1):4-10. doi:10.1007/s13181-021-00863-2 Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD   The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at https://emergencymedicalminute.org/cme-courses/ and create an account.  Donate to EMM today!

When was the last time you used phenobarbital for alcohol withdrawal? How familiar are you with how to dose it and when to give it? It turns out that phenobarbital is as effective as benzodiazepines for alcohol withdrawal, and might be a medication that you want to consider using in your practice for alcohol withdrawal. In this episode we dive into the topic of phenobarbital for alcohol withdrawal and try to figure out what's the best way to use phenobarbital when treating patients with alcohol withdrawal.

Join medical student Rilee Racine and Dr. Brian Stansfield, a neonatologist at the Children's Hospital of Georgia discuss Neonatal Opioid Withdrawal Syndrome, also known as NOWS.  After listening to this podcast, learners should be able to: Define neonatal opioid withdrawal syndrome Apply knowledge of signs and symptoms of NOWS to recognize these infants early Demonstrate general understanding of non-pharmacologic vs. pharmacologic management indications Recall the long term effects of NOWS and utilize this information to care for these infants long-term Educate families on clinical symptoms, management, and potential complications of NOWS Peer Review by Dr. Rebecca Yang and Dr. Amy Thompson Free CME Credit (requires sign-in): LINK COMING SOON Thank you for listening to this episode from the Department of Pediatrics at the Medical College of Georgia. If you have any comments, suggestions, or feedback- you can email us at mcgpediatricpodcast@augusta.edu. Remember that all content during this episode is intended for informational and educational purposes only. It should not be used as medical advice to diagnose or treat any particular patient. Clinical vignette cases presented are based on hypothetical patient scenarios. References: Anbalagan S, Mendez MD. Neonatal Abstinence Syndrome. 2020 Oct 1. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. PMID: 31855342. Armbruster, Debra PhD, APRN-CNP, NNP-BC, CPNP-PC, C-ELBW; Schwirian, Caitlyn PharmD; Mosier, Ashley MS, RN, CNL; Tam, Wai-Yin Mandy PharmD, BCPS, BCCCP; Prusakov, Pavel PharmD, BCPS, BCPPS Neonatal Abstinence Syndrome and Preterm Infants, Advances in Neonatal Care: March 05, 2021 - Volume Publish Ahead of Print - Issue - doi: 10.1097/ANC.0000000000000858 Finnegan LP. Neonatal abstinence syndrome: assessment and pharmacotherapy. In: Nelson N, editor. Current therapy in neonatal-perinatal medicine. 2 ed. Ontario: BC Decker; 1990. Jansson, Lauren M. MD. Neonatal abstinence syndrome. Uptodate. (2020). Johnson MR, Nash DR, Laird MR, Kiley RC, Martinez MA. Development and implementation of a pharmacist-managed, neonatal and pediatric, opioid-weaning protocol. J Pediatr Pharmacol Ther. 2014 Jul;19(3):165-73. doi: 10.5863/1551-6776-19.3.165. PMID: 25309146; PMCID: PMC4187529. Maguire, Denise J, PhD,R.N., C.N.L., Taylor, Susan, MSW,L.C.S.W.-C., C.M.A., Armstrong, K., PhD., Shaffer-Hudkins, E., Germain, A. M., M.D., Brooks, Sandra S,M.D., M.P.H., . . . Clark, L. (2016). Long-term outcomes of infants with neonatal abstinence syndrome: NN. Neonatal Network, 35(5), 277-286. doi:http://dx.doi.org/10.1891/0730-0832.35.5.277 Mangat, A. K., Schmölzer, G. M., & Kraft, W. K. (2019). Pharmacological and non-pharmacological treatments for the Neonatal Abstinence Syndrome (NAS). Seminars in fetal & neonatal medicine, 24(2), 133–141. https://doi.org/10.1016/j.siny.2019.01.009 Merhar SL, Ounpraseuth S, Devlin LA, Poindexter BB, Young LW, Berkey SD, Crowley M, Czynski AJ, Kiefer AS, Whalen BL, Das A, Fuller JF, Higgins RD, Thombre V, Lester BM, Smith PB, Newman S, Sánchez PJ, Smith MC, Simon AE; EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT NEONATAL RESEARCH NETWORK AND THE NIH ENVIRONMENTAL INFLUENCES ON CHILD HEALTH OUTCOMES (ECHO) PROGRAM INSTITUTIONAL DEVELOPMENT AWARDS STATES PEDIATRIC CLINICAL TRIALS NETWORK. Phenobarbital and Clonidine as Secondary Medications for Neonatal Opioid Withdrawal Syndrome. Pediatrics. 2021 Mar;147(3):e2020017830. doi: 10.1542/peds.2020-017830. PMID: 33632932; PMCID: PMC7919109. Protecting Our Infants Act of 2015, H.R, 1462, 114th Cong. (2015-2016).  Sarka Lisonkova, Lindsay L. Richter, Joseph Ting, Giulia M. Muraca, Qi Wen, Azar Mehrabadi, Sheona Mitchell-Foster, Eugenia Oviedo-Joekes and Janet Lyons. Pediatrics August 2019, 144 (2) e20183664; DOI: https://doi.org/10.1542/peds.2018-3664 Siegler R., Saffran J., Eisenberg N., Deloache, J., & Gershoff, E. (2017). How Children Develop (5th ed.). NY, NY, USA: Macmillan Learning.  Stephen W. Patrick, Wanda D. Barfield, Brenda B. Poindexter and COMMITTEE ON FETUS AND NEWBORN, COMMITTEE ON SUBSTANCE USE AND PREVENTION. Neonatal Abstinence Withdrawal Syndrome. Pediatrics November 2020, 146 (5) e2020029074; DOI: https://doi.org/10.1542/peds.2020-029074 Patrick SW, Barfield WD, Poindexter BB; COMMITTEE ON FETUS AND NEWBORN, COMMITTEE ON SUBSTANCE USE AND PREVENTION. Neonatal Opioid Withdrawal Syndrome. Pediatrics. 2020 Nov;146(5):e2020029074. doi: 10.1542/peds.2020-029074. PMID: 33106341. Zimmermann, U., Rudin, C., Duò, A. et al. Treatment of opioid withdrawal in neonates with morphine, phenobarbital, or chlorpromazine: a randomized double-blind trial. Eur J Pediatr 179, 141–149 (2020). https://doi.org/10.1007/s00431-019-03486-6

Kyle S. Wamsley, PharmD (@KyleWamsley1) describes the pathophysiology and complications associated with alcohol withdrawal syndrome (AWS), reviews treatment modalities and commonly utilized agents for AWS in the ICU setting and outlines appropriate phenobarbital dosing regiments based on current literature.  For more pharmacy content, follow Mayo Clinic Pharmacy Residency Programs @MayoPharmRes or the host, Garrett E. Schramm, Pharm.D., @garrett_schramm on Twitter! You can also connect with the Mayo Clinic's School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. 

We discuss the presentation, evaluation, and management of neonatal seizures. We are joined by Alison Dolce, MD, Assistant Professor of Pediatrics and Neurology at UT Southwestern and Children’s Health Dallas.

Alternative treatment for alcohol withdrawal syndrome may reduce length of stay: Phenobarbital Versus Lorazepam for Management of Alcohol Withdrawal Syndrome: A Retrospective Cohort Study

This week Brandon and Joe discuss the best ways to make Kool-Aid, are aliens truly real? and how long can you last in a cave with dead people?

Many potent drugs such as OxyContin, Vicodin, Phenobarbital, and heroin can lead to sedation, slow breathing, slower heart rates, and a high risk of overdose. However, many other forms of drugs such as stimulants, club drugs have also been associated with causing overdoses.https://recoverypartnernetwork.com/drug/drug-overdose

Vitals & Useful Links: Learn about an important etiology of seizures. See spoilers below if you want to know which one. Podcast: Approach to Seizures - EM Clerkship Podcast Clinical Reference: ACEP Clinical Guidelines on Seizures As 2020 comes to a close, we bring you our final episode of the year, officially ending our first season of EMJC Cast. We want to say a HUGE thank you to every single listener who has tuned in, especially our fan in Papua New Guinea, as well as to all of our cohosts who have joined us so far. In this episode full of twists and turns, Kyle (MS4) leads Arman (MS4), Abby (MS4), and Nathan (MS4) through a case of a male presenting with a chief complaint of "seizure". How would you approach this case? As always, we learn a couple very important points about evaluating and treating seizures. If you have any questions, concerns, or comments, please email us at emjccast@gmail.com. *EPISODE SPOILERS BELOW* CIWA Assessment for Alcohol Withdrawal MD Calc is a great tool to use for the CIWA-Ar for Alcohol Withdrawal. Kyle's Article on Phenobarbital vs CIWA-Ar Protocol for Treatment of Alcohol Withdrawal Tidwell, W. P., Thomas, T. L., Pouliot, J. D., Canonico, A. E., & Webber, A. J. (2018). Treatment of alcohol withdrawal syndrome: phenobarbital vs CIWA-Ar protocol. American Journal of Critical Care, 27(6), 454-460. Kyle's Article on Single Dose Phenobarbital in the ED Rosenson, J., Clements, C., Simon, B., Vieaux, J., Graffman, S., Vahidnia, F., ... & Alter, H. (2013). Phenobarbital for acute alcohol withdrawal: a prospective randomized double-blind placebo-controlled study. The Journal of emergency medicine, 44(3), 592-598. EM Cases Podcast on Alcohol Withdrawal A great discussion of the diagnosis and management of alcohol withdrawal, including some talk about tongue tremors/fasciculations. Toronto Star Article on Tremor Evaluation App DISCLAIMER: The views/opinions expressed in this podcast are that of the hosts/guests and do not reflect their respective institutions. This is NOT a medical advice podcast, if you are having a medical emergency you should call 911 and get help. This is an educational podcast, and as such, sometimes we get things wrong - if you notice this, please email us at emjccast@gmail.com. Intro Music: "Walk Through the Park" by Track Tribe

Alcohol Withdrawal DisorderSpecial Guest: Kent Owusu, PharmD, BCCCP, BCPS Show Notes: https://pharmacytodose.files.wordpress.com/2020/12/alcohol-withdrawal-show-notes.pdf Reference List: https://pharmacytodose.files.wordpress.com/2020/12/alcohol-withdrawal-references.pdf 05:50 – Consequences of alcohol withdrawal; 06:56 – Diagnosis/Pathophysiology; 11:15 – Treatment goal; 12:20 – Alcohol for withdrawal prevention; 15:30 – Benzodiazepine treatment considerations; 25:45 – Monitoring tools; 30:40 – Phenobarbital; 38:50 – Dexmedetomidine; 43:20 – Ketamine; 47:40 – Propofol; 51:43 – Valproic Acid and Gabapentin; 58:25 – Take-home points PharmacyToDose.Com@PharmacyToDose on Twitter/InstagramPharmacyToDose@Gmail.com

Xanax, Valium, Librium, Rohypnol, Ativan, Klonopin, Phenobarbital--if you want to know how benzos and barbiturates work in the brain, check out this episode. I also talk about the history of anxiolytics (anti-anxiety drugs), the connection to race and class in the war on drugs, and the consequences of irresponsible use. Harm Reduction saves lives. Share the knowledge. 

In this month's EM Quick Hits podcast, Anand Swaminathan on postpartum hemorrhage, Justin Morgenstern on phenobarbital in pediatric status epilepticus, Michelle Klaiman on managed alcohol programs, Andrew Petrosoniak on traumatic cardiac arrest, Brit Long on cholangitis pearls and pitfalls and Bourke Tillman on ED approach to ARDS... The post EM Quick Hits 22 Postpartum Hemorrhage, Phenobarbital in Status Epilepticus, Managed Alcohol Programs, Traumatic Cardiac Arrest, Cholangitis, ED Approach to ARDS appeared first on Emergency Medicine Cases.

In this episode, we cover the last half of phenobarbital week! This is a long one, but we cover the Farkas manifesto on by phenobarb is superior to standard approaches to alcohol withdrawal management. -Dosing -Indications/Contraindication -Adjuvant therapies & more

Show notes at pharmacyjoe.com/episode399. In this episode, I ll discuss the biggest risk to using phenobarbital monotherapy for severe alcohol withdrawal. The post 399: The biggest risk to using phenobarbital monotherapy for severe alcohol withdrawal appeared first on Pharmacy Joe.

Penobarbital is one of the most common drugs used in the treatment of dog epilepsy and to control seizures. Before starting, you need to know how well it works, learn about the side-effects and how to monitor your epileptic dog taking phenobarbital. Epilepsy and seizures is a distressing condition for your dog to be diagnosed with but with the right treatment the seizures can be very well controlled. Phenobarbital is often the first choice and this episode goes through what you need to know about this epilepsy treatment for dogs. Show notes: https://ourpetshealth.com/info/phenobarbital-dog-epilepsy-treatment

Show notes at pharmacyjoe.com/episode310 In this episode I ll: 1. Discuss an article on cost effective C diff treatment. 2. Answer the drug information question “Can phenobarbital be used as monotherapy in patients with severe alcohol withdrawal?” 3. Share a tip for responding to inpatient medical emergencies The post 310: Cost effective C diff treatment, phenobarbital monotherapy in severe alcohol withdrawal, and a tip for responding to inpatient medical emergencies appeared first on Pharmacy Joe.

Karen (Hannah Fierman) spends days confined to a “sleep room,” where a mind-numbing combination of treatments are administered. Pleased with Hayes’s progress, Somerhill (Daniel May) encourages the doctor (John Schmedes) to become more aggressive in his therapies, just as the Ward Head Nurse, Verdrey (Lisa Paulsen), begins to question Hayes’s methods. Charlotte (Jennifer Bates) is released. Learn more about your ad-choices at https://news.iheart.com/podcast-advertisers

Dave gets tired and surrenders control to Chris... who then plays some truly horrible music and ruins the 50th Episode. Chris also shares the story about how he got drunk, took a bus to Harlem from Boston, and lost everything.

This week we discuss the role of phenobarbital in the management of severe alcohol withdrawal. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_57_0_Final_Cut.m4a Download One Comment Tags: Alcohol Withdrawal, Phenobarbital, Toxicology Show Notes References Riggan MA et al. Regarding “Phenobarbital for acute alcohol withdrawal: a prospective randomized double-blind placebo controlled study.” J Emerg Med 2016; 50 (6): 895-8. PMID: 27221017 Rosenson J et al. Phenobarbital for acute alcohol withdrawal: a prospective randomized double-blind placebo controlled study. J Emerg Med 2013; 44(3): 592-8. PMID: 2299978 Read More

This week we discuss the role of phenobarbital in the management of severe alcohol withdrawal. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_57_0_Final_Cut.m4a Download One Comment Tags: Alcohol Withdrawal, Phenobarbital, Toxicology Show Notes References Riggan MA et al. Regarding “Phenobarbital for acute alcohol withdrawal: a prospective randomized double-blind placebo controlled study.” J Emerg Med 2016; 50 (6): 895-8. PMID: 27221017 Rosenson J et al. Phenobarbital for acute alcohol withdrawal: a prospective randomized double-blind placebo controlled study. J Emerg Med 2013; 44(3): 592-8. PMID: 2299978 Read More

This week we discuss the role of phenobarbital in the management of severe alcohol withdrawal. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_57_0_Final_Cut.m4a Download One Comment Tags: Alcohol Withdrawal, Phenobarbital, Toxicology Show Notes References Riggan MA et al. Regarding “Phenobarbital for acute alcohol withdrawal: a prospective randomized double-blind placebo controlled study.” J Emerg Med 2016; 50 (6): 895-8. PMID: 27221017 Rosenson J et al. Phenobarbital for acute alcohol withdrawal: a prospective randomized double-blind placebo controlled study. J Emerg Med 2013; 44(3): 592-8. PMID: 2299978 Read More

Bob Phillips talks you through this month's Archimedes questions. Question 1: Phenobarbital for preventing mortality and morbidity in full-term newborns with perinatal asphyxia in a resource-poor setting Question 2: Can faecal calprotectin be used as an effective diagnostic aid for necrotising enterocolitis in neonates? Link: http://adc.bmj.com/content/100/10.toc#Archimedes

Sat, 12 Jul 2014 12:00:00 +0100 https://edoc.ub.uni-muenchen.de/17567/ https://edoc.ub.uni-muenchen.de/17567/1/Munoz_Schmieder_Viviana.pdf Munoz Schmieder, Viviana

All types of veterinarians, from general practitioners to emergency clinicians to specialist end up treating seizuring patients. So, when it comes to treating them, what's your favorite “go to” anticonvulsant therapy? Ultimately, our goal of anticonvulsant therapy is to eradicate all seizure activity… or at least minimize them to less than 1 per 3 months, ideally. Although this goal may not be possible in every patient, we hope to achieve this goal. With that in mind, which anticonvulsant will help you achieve this? Which one would a neurologist pick? In this veterinary podcast, we compare phenobarbital and potassium bromide in treatment of seizures in dogs.

All types of veterinarians, from general practitioners to emergency clinicians to specialist end up treating seizuring patients. So, when it comes to treating them, what's your favorite “go to” anticonvulsant therapy? Ultimately, our goal of anticonvulsant therapy is to eradicate all seizure activity… or at least minimize them to less than 1 per 3 months, ideally. Although this goal may not be possible in every patient, we hope to achieve this goal. With that in mind, which anticonvulsant will help you achieve this? Which one would a neurologist pick? In this veterinary podcast, we compare phenobarbital and potassium bromide in treatment of seizures in dogs.

Joyce welcomes Julie McCawley, a 17 year-old high school senior from Westminster, Colorado. At 11 months old Julie suffered from Stevens - Johnson Syndrome (SJS), an adverse reaction to medication from Phenobarbital to control pediatric epilepsy. She will discuss her volunteer efforts developing a website and support group for children that have suffered from Stevens - Johnson Syndrome. She is also an advocate against bullying.

Epilepsien zählen zu den häufigsten neurologischen Erkrankungen bei Hund, Katze und Mensch. Sie sind mit einer fortschreitenden Schädigung des zentralen Nervensystems und mit erheblichen Einschränkungen im täglichen Leben verbunden. Trotz Entwicklung zahlreicher neuer Antiepileptika über die letzten Jahrzehnte spricht etwa ein Drittel der Veterinär- und Humanpatienten nicht auf eine Pharmakotherapie an. Diese Pharmakoresistenz von Epilepsien stellt ein schwerwiegendes und bisher ungelöstes Problem für die betroffenen Patienten dar und macht neue Therapiestrategien dringend erforderlich. Eine Ursache der Pharmakoresistenz bei Epilepsien stellt die Überexpression von Multidrug-Transportern in den Endothelzellen der Blut-Hirn-Schranke dar. Die physiologische Funktion dieser Efflux-Transporter besteht darin, den Eintritt von Xenobiotika in das Gewebe bestimmter Körperregionen zu verhindern. Eine Überexpression bei pharmakoresistenten Patienten führt zu einem vermehrten Efflux-Transport von Antiepileptika in die Blutbahn, so dass trotz therapeutischer Plasma-Konzentrationen keine ausreichenden Wirkstoffspiegel im Bereich des epileptischen Fokus erreicht werden können. Auf der Basis der Multidrug-Transporter-Hypothese wurden im Rahmen dieser Dissertation zwei mögliche neue Behandlungsstrategien zur Überwindung der Pharmakoresistenz von Epilepsien im Tiermodell untersucht. In den letzten Jahrzehnten wurde ein direkter intra- oder extraneuronaler Transport von Substanzen nach intranasaler (i.n.) Applikation aus der Nasenhöhle in das Gehirn wiederholt beschrieben. Diese Möglichkeit zur Umgehung der Blut-Hirn-Schranke und der dort lokalisierten Efflux-Transporter wurde im Rahmen dieser Arbeit mittels Untersuchungen zur Gehirngängigkeit von Antiepileptika nach i.n.-Applikation im Rattenmodell näher überprüft. Mikrodialyse-Untersuchungen zur Bestimmung der Extrazellulär-Konzentration von Phenobarbital, Lamotrigin und Carbamazepin im Bereich des frontalen Cortex ergaben keine Hinweise auf einen effektiveren Substanztransport nach i.n.-Applikation im Vergleich zur intravenösen (i.v.) Applikationsform. Die Bestimmung der Phenobarbital-Konzentration im Gesamtgehirngewebe nach i.n.- und i.v.-Verabreichung resultierte ebenfalls in gleichwertigen Konzentrationen. Die Untersuchung einzelner Gehirnregionen 10 min nach i.n. Applikation ergab für den Bulbus olfactorius eine signifikant höhere Gehirn-Plasma-Ratio im Vergleich zur i.v.-Applikation. Im Amygdala-Kindling-Modell der Temporallappen-Epilepsie konnte eine dosisabhängige antikonvulsive Wirkung nach i.n.-Applikation von Phenobarbital beobachtet werden, die in vergleichbarem Maße auch nach i.v.-Applikation zu beobachten war. Insgesamt geben die Untersuchungsergebnisse keinen Hinweis darauf, dass ein direkter Transport von Antiepileptika aus der Nasenhöhle in das Gehirn in therapeutisch relevantem Ausmaß stattfindet und eine Umgehung der Blut-Hirn-Schranke auf diese Weise möglich ist. Eine besondere Eignung der i.n.-Applikation zur Therapie pharmakoresistenter Patienten erscheint daher unwahrscheinlich, kann jedoch endgültig erst durch Untersuchungen in einem Tiermodell für pharmakoresistente Epilepsie beurteilt werden. Die nach i.n.-Applikation von Phenobarbital erreichten Plasma-Konzentrationen in Kombination mit der gezeigten antikonvulsiven Wirksamkeit lassen diesen Applikationsweg jedoch zur nicht invasiven Behandlung eines Status epilepticus oder von Anfalls-Clustern Erfolg versprechend erscheinen. Dem Multidrug-Transporter P-Glycoprotein (P-gp) wird in Zusammenhang mit transporter-basierter Pharmakoresistenz bei Epilepsie besondere Bedeutung beigemessen. Durch pharmakologische Inhibition der P-gp-Funktion gelang im Tiermodell bereits die Überwindung von Pharmakoresistenz. Die Anwendung von Hemmstoffen bringt jedoch den Nachteil einer P-gp-Inhibition in allen Körperregionen mit sich. Eine auf die Blut-Hirn-Schranke begrenzte Reduktion der P-gp-Expression wäre durch den Mechanismus der RNA-Interferenz zu erreichen. Für in vivo-Untersuchungen an Ratten wurde gegen P-gp-mRNA gerichtete „small interfering RNA“ (siRNA) zum Schutz vor endogenen Nukleasen in Liposomen eingeschlossen. Zudem wurde für ein Targeting das Peptid ApoE4 an die Oberfläche der Liposomen gebunden, welches eine Endozytose an Endothelzellen der Blut-Hirn-Schranke vermittelt. Das Ziel einer P-gp-Reduktion auf Protein-Ebene nach i.v.-Applikation derart geschützter und zielgesteuerter siRNA konnte jedoch nicht erreicht werden. Die Quantifizierung der P-gp-Expression in den Endothelzellen der Blut-Hirn-Schranke anhand immunhistochemisch gefärbter Gehirnschnitte ergab 24 h nach Applikation keine Verminderung der P-gp-Expression. Die Ursachen für die ausgebliebene P-gp-Reduktion sind in weiterführenden Untersuchungen zu klären.

Sun, 1 Jan 1984 12:00:00 +0100 https://epub.ub.uni-muenchen.de/10266/1/10266.pdf Kleiser, B.; Arbogast, Helmut; Schmid, R.; Hellbrügge, T.; Arbogast, B.; Hallek, M.