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Alcohol Tremor

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181. Benzodiazepine and z-drug withdrawal: Scenario: Benzodiazepine and z-drug withdrawal

. Consider whether the withdrawal of the benzodiazepine or z-drug can be appropriately managed in primary care. People are considered suitable if they: Are willing, committed, and compliant, and have adequate social support. Have no previous history of complicated drug withdrawal. Can be reviewed regularly. Consider seeking specialist advice, or referral to an appropriate specialist for people with: A history of alcohol or other drug use or dependence — be aware that heavy users of alcohol may use (...) taking extra tablets in times of stress and compensating for benzodiazepines or z-drugs by increasing the intake of alcohol or other drugs (prescription, non-prescription, or illicit drugs) or smoking. For information on specific withdrawal schedules, see the section on . Remind the person of the DVLA regulations relating to benzodiazepine use and driving (note: use of a supratherapeutic dosage outside BNF guidelines constitutes persistent misuse or dependence for licensing purposes, whether

2018 NICE Clinical Knowledge Summaries

182. Back pain - low (without radiculopathy): Diazepam

(such as hypersensitivity to physical, visual, and auditory stimuli) may occur. If withdrawal symptoms do occur, for information on how to manage them, see the CKS topic on . [ ; ; ] Contraindications and cautions Do not prescribe diazepam to people with: Current or a history of alcohol or opioid use or misuse — alcohol and opioids can induce lethal sedation by potentiating the effects of diazepam. Acute porphyria. Myasthenia gravis — condition may be aggravated. Sleep apnoea — condition may be aggravated. Bronchitis (...) or chronic obstructive pulmonary disease. Severe hepatic insufficiency — elimination half-life may be prolonged. Major depression. Phobic or obsessional states, psychosis or schizophrenia, hyperkinesis — paradoxical reactions may occur. Prescribe diazepam with caution to: People with personality disorders. The elderly, due to the increased risk of falls — the manufacturer advises halving the recommended doses. [ ] Drug interactions Drug interactions with diazepam include: Alcohol and opioids — advise

2018 NICE Clinical Knowledge Summaries

183. Allergic rhinitis: Oral antihistamines

are enhanced when combined with alcohol. Angio-oedema, arrhythmias, blood disorders, bronchospasm, confusion, convulsions, depression, dizziness, extrapyramidal effects, hypersensitivity reactions, hypotension, liver dysfunction, photosensitivity reactions, rashes, sleep disturbances, tremor, angle-closure glaucoma (in adults). [ ; ] Drug interactions Possible drug interactions with cetirizine and loratadine include: Betahistine — cetirizine and loratadine are predicted to decrease the effects

2018 NICE Clinical Knowledge Summaries

184. Scabies: Chlorphenamine and hydroxyzine

topic on . Most non-sedating antihistamines have the potential to cause sedation, especially at higher doses. Advise people taking non-sedating antihistamines that they may cause sedation, and that the sedative effects are enhanced when combined with alcohol. Contraindications and cautions Chlorphenamine Do not prescribe to people who have been treated with MAOIs within the last fourteen days. Prescribe with caution to people with: Epilepsy. Raised intra-ocular pressure including glaucoma. Prostatic (...) disturbances, tremor, antimuscarinic effects, blood disorders, exfoliative dermatitis, rashes, tinnitus. Note: Children and elderly people are more likely to experience neurological anticholinergic effects and paradoxical excitation (eg. increased energy, restlessness, nervousness). Hydroxyzine The most common adverse effects include dry mouth, fatigue, and headache. Other adverse effects include constipation, dizziness, insomnia, nausea, blood disorders, bronchospasm, liver dysfunction, rashes, agitation

2018 NICE Clinical Knowledge Summaries

185. Poisoning or overdose: Symptoms and signs of drugs that are commonly involved in poisoning or overdose

to encephalopathy, hypoglycaemia, haemorrhage, cerebral oedema and death. People may also present with coma or a reduced level of consciousness if they have taken paracetamol with a drug that reduces the level of consciousness, such as opioids (for example a combined paracetamol/opioid preparation) or alcohol. Aspirin Hyperventilation, tinnitus, deafness, vasodilatation, and sweating. Coma if very severe poisoning. Tricyclic and related antidepressants Dry mouth, seizures, coma, cardiac conduction defects (...) and arrhythmias, hypothermia, hypotension, hyperreflexia and respiratory failure. There may be dilated pupils and urinary retention. Selective serotonin re-uptake inhibitors (SSRIs) Nausea, vomiting, agitation, tremor, nystagmus, drowsiness, sinus tachycardia. There may be convulsions. Rarely, severe poisonings may result in serotonin syndrome with marked neuropsychiatric effects, autonomic instability and neuromuscular hyperactivity. There may be hyperthermia, rhabdomyolysis, renal failure, and coagulation

2018 NICE Clinical Knowledge Summaries

186. Jaundice in adults: How should I assess a person with jaundice?

such as malignancy. Alcohol intake in units — see the CKS topic on for further information. Travel abroad to areas endemic for viral hepatitis and parasites (such as chlonorchis) that can cause jaundice. Other risk factors for viral hepatitis — intravenous drug use, tattoos, body piercings, blood transfusion, multiple sexual partners, sex between men or with sex workers. Past medical history of biliary surgery, gallstones, hepatitis, autoimmune liver disease, thyroid disease, or non-alcoholic fatty liver disease (...) of sepsis — fever, tachycardia, and hypotension. Signs of chronic liver disease: Palmar erythema and spider naevi — up to five spider naevi can be normal in women but in men any suggest chronic liver disease. Finger nail clubbing — associated with liver cirrhosis. Leukonychia (white nails) — due to hypoalbuminaemia. Dupuytren’s contractures (contracture of the palmar fascia) — associated with chronic liver disease due to alcohol misuse, but can also be familial or due to other causes such as diabetes

2018 NICE Clinical Knowledge Summaries

187. Clearing the Smoke on Cannabis: Maternal Cannabis Use during Pregnancy ? An Update

neurodevelopment leading to adverse effects on cognition and academic achievement. • There are also effects on behaviour in children and young adults, including attention deficits, increased hyperactivity and impulsivity, and increased likelihood of substance use. • Information on the effects of cannabis use during pregnancy is essential to help healthcare providers advise patients about the impact of cannabis use and improve the health and well-being of patients and their children. Background After alcohol (...) , cannabis (also referred to as marijuana) is the most widely used psychoactive substance in Canada. According to the 2015 Canadian Tobacco, Alcohol and Drugs Survey (CTADS), 12.3% of Canadians aged 15 years and older reported using cannabis at least once in 2015 (Statistics Canada, 2016a), an increase from 10.6% in 2013. The use of cannabis is generally more prevalent among young people, with 20.6% of youth aged 15 to 19 and 29.7% of young adults aged 20 to 24 reporting past-year use in 2015

2018 Canadian Centre on Substance Abuse

188. CRACKCast E151 – Antidepressants

criteria for Serotonin Syndrome? Hunter criteria Exposure to a known serotonergic agent; AND Any of the following: Spontaneous clonus Inducible clonus and agitation or Diaphoresis Ocular clonus and agitation or Diaphoresis Tremor and hyperreflexia Hypertonic w/ Temp > 38 o C and ocular clonus or inducible clonus “The descending ladder of hyper-reflexia” As the hyper-reflexia gets less and less impressive, the additional criteria become more pronounced [5] How can you discern between NMS and Serotonin (...) Syndrome? Both look the same = FARM Fever Autonomic instability Rigidity / rhabdo Mental status changes However, the major differentiating features: NMS = parkinsonian type lead pipe rigidity; slower onset; similar presentation to the unwell septic patient SS = spastic rigidity – agitation / tremor / CLONUS / increased motor activity; rapid onset Onset: SS relatively rapid within hours NMS over days potentially Course: NMS may wax and wane. SS peaks then declines Obviously hyper-reflexia is the most

2018 CandiEM

189. CRACKCast E147 – General Approach to the Poisoned Patient

of the parasympathetic system. Muscarinic effects: Diarrhea, diaphoresis Urination Miosis Bradycardia Bronchorrhea Emesis Lacrimation Lethargic Salivation Nicotinic effects: Mydriasis Tachycardia Weakness Tremors Fasciculations Seizures Somnolent Organophosphate and carbamate insecticides, nerve agents, nicotine, pilocarpine, physostigmine, edrophonium, bethanechol, urecholine, Liquids from e-cigarettes (muscarinic effects are less prominent) Antidotes: Atropine 2-pam aka Pralidoxime (2-pyridine aldoxime methyl (...) chloride) Benzos Supportive Sedative/hypnotic Sedation Vs. Hallucinogenic Depression of brain activity and muscular metabolism Altered mental status Pupils not changed clinically Benzodiazepines, barbiturates, carisoprodol, meprobamate, glutethimide, alcohols, zolpidem ( USA) Supportive Rule out traumatic injuries Opiate Sedation, diminished respiratory drive – responsive to naloxone Miosis, hypothermia, respiratory depression, apnea, Bradycardia, hyporeflexia, pulmonary edema Opioids (eg, heroin

2018 CandiEM

190. Management of Acute Pancreatitis in the Pediatric Population: A Clinical Report From the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition Pancreas Committee

management, nutrition, pain control, protease inhibitors, surgery (JPGN 2018;66: 159–176) A cute pancreatitis (AP) has been increasingly diagnosed in children in recent decades (1–3). A variety of etiologies can result in AP in children, including structural/anatomic, obstructive/ biliary, trauma, infections, toxins, metabolic, systemic illness, inborn errors of metabolism, and genetic predispositions. These are a more prevalent compared with adult AP, when biliary and alcoholic causes are well (...) , and tremors (105). A review of narcotics and sphincter of Oddi function by Thompson (106), documents that no studies to date directly compare the effects of meperidine and morphine on sphincter of Oddi manometry and no comparative studies exist in patients with AP. Furthermore, no studies or evidence exist to indicate morphine is contraindicated for use in AP. A Cochrane review from 2013 includes 5 studies with a total of 227 subjects to assess the efficacy and safety of several opioids. Medications

2018 North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition

191. Appropriate Use Criteria: Imaging of the Head & Neck

movement disorders, to exclude an underlying structural lesion ? Hemifacial spasm ? Huntington’s disease ? Multiple system atrophy (MSA) ? Parkinson’s disease with atypical features ? Progressive supranuclear palsy ? Secondary dystonia ? Other focal or lateralizing movement disorder, such as hemiballismus, athetosis or chorea Note: Imaging is generally not indicated for evaluation of typical Parkinson’s disease, essential tremor or primary dystonia. Multiple sclerosis and other white-matter diseases (...) | Copyright © 2018. AIM Specialty Health. All Rights Reserved. 15 headache. Cephalalgia. 2007;27(8):904-911. 65. Secretariat. MA. Neuroimaging for the Evaluation of Chronic Headaches: An Evidence-Based Analysis. Ont Health Technol Assess Ser. 2010; 10(26): 1–57. 66. Sharifi S, Nederveen AJ, Booij J et al. Neuroimaging essentials in essential tremor: a systematic review. Neuroimage Clin. 2014 May 9;5:217-31. 67. Silvestri GA, Gould MK, Margolis ML, et al. Noninvasive staging of non-small cell lung cancer

2018 AIM Specialty Health

192. Hoarseness (Dysphonia) Full Text available with Trip Pro

. In this group, failure to evaluate the larynx can delay cancer diagnosis, resulting in higher staging, need for more aggressive treatment, and reduced survival rates. Other conditions that cause dysphonia are neurologic (eg, vocal fold paralysis, spasmodic dysphonia [SD], essential tremor, Parkinson’s disease, amyotrophic lateral sclerosis, multiple sclerosis), gastrointestinal (eg, reflux, eosinophilic esophagitis), rheumatologic/autoimmune (eg, rheumatic arthritis, Sjögren’s syndrome, sarcoidosis (...) , habits (eg, smoking, alcohol use), concurrent medical conditions, and prior surgery ( and ). Careful evaluation allows the clinician to (1) categorize dysphonia severity, (2) develop a treatment plan, and (3) prioritize patients who may need escalated care. , Physical examination should include a full head and neck examination with particular attention to listening to the voice (perceptual evaluation), inspection and palpation of the neck for masses or lesions, and, if feasible, indirect mirror

2018 American Academy of Otolaryngology - Head and Neck Surgery

193. Improving Quality of Life: Substance Use and Aging

. Eglit and Dilip V. Jeste Epidemiology of Psychoactive Substance Use Among Older Adults Scott B. Patten The Aging Brain and Substance Use Tarek Rajji and Simon Davies Consequences of Alcohol and Drug Use in Older Adults Jonathan Bertram and David K. Conn Considerations for Co-occurring Health Conditions Karolina Kozak and Tony George Detection, Screening and Assessment David K. Conn Substance Use Treatment for Older Adults Frederic C. Blow A Call to Action Franco J. Vaccarino, Elysia Vaccarino (...) use, as we do in this report, is key to developing new and more tailored strategies for reducing the harms of alcohol and drugs on older adults. Since 2005, the series now known as Substance Use in Canada has highlighted alcohol- and drug-related issues that are in need of greater attention. For this seventh edition, we began with two questions: How can we help people age in a healthy way? and How can we ensure they have the supports they need to sustain a good quality of life in their later years

2018 Canadian Centre on Substance Abuse

194. CRACKCast E165 – Sedative Hypnotics

blocker. Endotracheal intubation to protect against emesis, aspiration pneumonitis, and hypoxia is often necessary for patients with significant CNS or respiratory depression from GHB overdose. Withdrawal from GHB or its precursors begins with anxiety, tremor, and insomnia, but it can progress to a severe syndrome characterized by delirium and autonomic instability. Management of this syndrome often requires high-dose benzodiazepine or barbiturate therapy (because they are GABA depleted). Rosens (...) for noncardiogenic pulmonary edema & aspiration pneumonitis ***Note: Barbiturate withdrawal syndrome includes: Tremors Hallucinations Seizures delirium (similar to the delirium tremens of ethanol withdrawal) [5] How are barbiturate overdoses managed? Investigations / Supportive care / Invasive ventilation as needed Labs: The therapeutic level of phenobarbital is 15 to 40 μg/mL (65 to 172 μmol/L) A serum level greater than 50 μg/mL can be associated with coma, especially in a patient who is not a chronic user

2018 CandiEM

195. Treatment for Bipolar Disorder in Adults: A Systematic Review

conditions, BD is the most likely to co-occur with alcohol or drug abuse disorders. 7 Treatment of BD generally begins with the goal of bringing a patient with mania or depression to symptomatic recovery and stable mood. Once the individual is stable, the goal progresses to reducing subthreshold symptoms and preventing relapse into full-blown episodes of mania and depression. Drug treatments have several purposes. Some drugs aim to reduce symptoms associated with acute manic or mixed mania/depression

2018 Effective Health Care Program (AHRQ)

197. Cannabis

, their use is almost three times higher than that of adults. ? The rate of daily cannabis use among the Canadian general population remains steady. Effects of Cannabis Use Short-term: Cannabis produces euphoria and relaxation, changes in perception, time distortion and deficits in attention span. It also negatively impacts the ability to divide attention and results in deficits in memory, body tremors and impaired motor functioning. Cannabis also impairs coordination and balance. Other physical effects (...) and municipal levels. 10 Driving while impaired by a drug, including cannabis, is an offence under the Criminal Code of Canada. Drivers who are impaired by drugs are subject to the same penalties as those impaired by alcohol. The government tabled Bill C-46 in April 2017 to strengthen the enforcement of impaired driving laws and also plans to enact this legislation in conjunction with the Cannabis Control Act. Currently, Canadians can legally access cannabis for medical purposes. Under the Marihuana

2018 Canadian Centre on Substance Abuse

199. The Effect of Herbicide Metribuzin on Environment and Human: A Systematic Review Full Text available with Trip Pro

can cause stomach upset, fatigue, and depression of the central nervous system, causing poor coordination, tremors, and weakness. Human Tox = 200.00000 ppb (very low) 29 . High or other repeated exposure can cause changes in liver enzymes, goiter, and can affect thyroid function and central nervous system 30 . 6 Effects of Metribuzin on human health 6.1 Effects of Metribuzin on fertility and reproduction Pesticides and their byproducts have also been identified as agents likely to impair the male (...) of Toxicology. 2019; 2019: 2345283. 28. Shults JA, Curtis BJ, Chen MM, O'Halloran EB, Ramirez L, Kovacs EJ. Impaired respiratory function and heightened pulmonary inflammation in episodic binge ethanol intoxication and burn injury. Alcohol. 2015; 49(7): 713-720. 29. Yamato M, Kataoka Y. Fatigue sensation following peripheral viral infection is triggered by neuroinflammation: who will answer these questions? Neural Regeneration Research. 2015; 10(2): 203-204. 30. Hartmann K. Thyroid Disorders in the Oncology

2020 Pharmaceutical and Biosciences Journal

200. Autosarcophagy: A Systematic Review of Psychological Correlates, with Genetic Propositions Full Text available with Trip Pro

Frost FS et al1 Distal phalanges in both hands biting recurrent Recurrent DSH Tetraplegia, traumatic spinal cord injury Pain insensitive, impulse dyscontrol initially, stereotypical later Frost FS et al2 Distal phalanges In both hands biting recurrent Alcohol and nicotine dependence syndrome traumatic tetraplegia, chronic tracheostomy Pain insensitive, frustration and increased impulsivity secondary to distress about multiple disabilities (motor, sensory, vocal and respiratory), restlessness (...) tremors, nystagmus, hypotonia, self-mutilation, developmental delay RDPA Phytanyl CoA hydroxylase with pipecolic acidemia 10pter- 11.2 Adult Refsum disease Neurological deficits, ataxia, peripheral neuropathy, sensorineural hearing loss, retinitis pigmentosa self-mutilation FMR1 Fragile X Mental Retardation 1 Protein Xq27.3 Fragile X Syndrome Elongated face, large ears, hyperextensible digits, flat feet, macroorchidism, hypotonia, recurrent otitis media, seizures Intellectual disability, autistic

2020 Journal of Medical Science And clinical Research

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