• Title/Summary/Keyword: Sedative-Hypnotics

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Development of Safety Usage Guidelines for Sedative Hypnotics Using the Delphi Technique (델파이 기법을 이용한 다빈도 수면진정제 안전사용지침 개발)

  • Nam, Yoon-Ju;Cho, Chul-Hyun;Lee, Yujin;Lee, Heon-Jeong
    • Sleep Medicine and Psychophysiology
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    • v.26 no.2
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    • pp.86-103
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    • 2019
  • Objectives: The objective of this study was to develop evidence- and consensus-based clinical safety usage guidelines for sedative hypnotics using the Delphi technique. Methods: A group of 15 sleep experts from Korean Academy of Sleep Medicine were chosen for this study comprising a three-round web-based Delphi survey. The first round survey was composed of 39 questions to identify problems with sedative hypnotics usage in Korean clinical practice and the result roughly outlined what should be included in the guidelines. The second round survey was composed of 21 questions to collect specific opinions of experts on clinically important issues in prescribing sedative hypnotics, and its result provided the basis for the guidelines. A third round survey aimed to evaluate the reliability and validity of the established guidelines. Results: In the third round, all 17 items showed a median of 4 or more, with an average of 4.12 and a standard deviation of 0.32. Thus we present safety usage guidelines with 13 propositions for prescription, maintenance, and withdrawal of sedative hypnotics. Conclusion: The safety usage guidelines on sedative hypnotics developed from this study could lead to safe and effective prescription of hypnotics in clinical practice, especially for the non-experts in sleep medicine. Furthermore, the guidelines will help to improve the quality of insomnia treatment by contributing to the establishment of a safe regime for sedative hypnotics without excessive use of drugs.

Drug Treatment of Insomnia : Sedative-Hypnotics (불면증의 약물 치료:진정수면제)

  • Park, Doo-Heum
    • Sleep Medicine and Psychophysiology
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    • v.6 no.1
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    • pp.5-18
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    • 1999
  • A growing number of people are concerned about their sleep. There are many people with chronic sleep disorders. Sedativehypnotics including benzodiazepine and non-benzodiazepine have been widely used in chronic insomniacs. It is widely accepted that current hypnotics are efficient in alleviating subjective symptoms of insomnia. Non-benzodiazepine hypnotics include zolpidem, zopiclone, and melatonin. These novel non-benzodiazepine hypnotics that have efficacy comparable to benzodiazepines were developed with more understanding of benzodiazepine receptor pharmacology. Their unique pharmacologic profiles may offer few significant advantages in terms of adverse effects of benzodiazepines. However, most of hypnotics including non-benzodiazepine have some of dependence, tolerance, impaired daytime function and rebound insomnia. Currently, it is accepted that combination therapy with pharmacologic and behavioral intervention is the most effective for chronic insomniacs.

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Factors associated with Occurrence of Aspiration Pneumonia in the Patient with Sedative-hypnotics Acute Overdose (수면진정제 중독 환자에서 흡인성 폐렴 발생의 예측 인자 분석)

  • Kang, Min Jin;Lim, Jee Yong;Oh, Sang Hoon;Kim, Han Joon;Kim, Young-Min
    • Journal of The Korean Society of Clinical Toxicology
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    • v.13 no.2
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    • pp.95-102
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    • 2015
  • Purpose: Drug overdose is easily found in the emergency department (ED). Sedative-hypnotics overdose causes the aspiration pneumonia in patients with decreased mental status. The purpose of this study was to investigate the risk factors of aspiration pneumonia in patients poisoned with sedative-hypnotics. Methods: One hundred seventy eight patients who were poisoned with sedative-hypnotics and who visited ED between 2009 and 2015 were included. This study was conducted retrospectively, with collection of data by review of medical records. We collected the data concerning the characteristics of patients and classified them into two groups based on the development of aspiration pneumonia. Logistic regression analysis was performed to investigate the factors for the development of aspiration pneumonia. Results: Thirty five patients had an aspiration pneumonia during their hospital stay in 178 patients. The age, amount of ingestion, Glasgow Coma Scale (GCS) score at admission, a history of hypertension and diabetes mellitus, and the hypotension at admission were significantly different between two groups in univariate analysis. The age, amount of ingestion and GCS score at admission were associated with the development of aspiration pneumonia in the multivariate logistic regression analysis (OR 1.028 (95%CI, 1.002-1.056, p=0.037), 1.026 (95%CI, 1.004-1.043, p=0.001), 0.737 (95%CI, 0.683-0.915, p=0.002)). All patients with aspiration pneumonia were discharged without a sequelae. Conclusion: The development of aspiration pneumonia in the patients of sedative-hypnotics overdose is associated with old age, amount of drug ingestion, and GCS score at admission.

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Korean Medicine Treatments for Delirium in an Elderly Patient Caused by Sedative-Hypnotics Overdose (진정수면제를 음독한 노인 입원 환자에서 발생한 섬망에 대한 한의복합중재 증례보고)

  • Han-byul Cho;Byung-Soo Koo;Geun-Woo Kim
    • Journal of Oriental Neuropsychiatry
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    • v.34 no.4
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    • pp.473-485
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    • 2023
  • Objectives: The purpose of this study was to report the effectiveness of the combination of Korean medicine therapy on elderly patients with delirium due to overdose of sedative-hypnotics. Methods: The patient was diagnosed with delirium, which occurred after an overdose of sedative-hypnotics. The patient received Korean Medicine treatment, including herbal medicine, acupuncture, moxibustion and psychotherapy, and other treatments. The evaluation variables to check the effectiveness of the interventions were the Korean Version of the Delirium Rating Scale-Revised-98 (K-DRS-R-98) Mini-Mental State Examination-Korean (MMSE-K) Clinical Dementia Rating (CDR) and Manual Muscle Test (MMT). Results: During the hospitalization period, the K-DRS-R-98 score decreased from 31 to 4, MMSE-K score increased from 18 to 26. CDR score decreased from 2 to 0. MMT in the Right lower extremity was improved. Normal daily activities were possible. Conclusions: Combining Korean Medicine treatments, including herbal medicine, acupuncture, moxibustion, psychotherapy, and other treatments, may help alleviate delirium.

Comparison of Prescription Patterns and Clinical Features according to Clinical Departments in Sedative-hypnotic Intoxication (진정수면제 중독 환자의 처방과에 따른 처방 및 임상양상 비교)

  • Kim, Do Min;Park, Won Bin;Lim, Yong Su;Kim, Jin Joo;Jang, Jae Ho;Jang, Jee Yong;Yang, Hyuk Jun;Lee, Geun
    • Journal of The Korean Society of Clinical Toxicology
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    • v.12 no.2
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    • pp.54-62
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    • 2014
  • Purpose: The purpose of this study was to compare prescription patterns and clinical features according to clinical departments in sedative-hypnotic intoxication. Methods: This was a retrospective study of histories, substances of poisoning, acquisition routes, clinical courses, and outcomes of patients treated for acute intoxication in a single emergency medical center from January, 2011 to December, 2013. Results: A total of 769 patients were treated for acute intoxication, 281 patients ingested sedative hypnotics during the study period. Among 281 patients, 155 patients were prescribed by psychiatric department and 80 patients were prescribed by non-psychiatric department. Benzodiazepines were more likely to be prescribed by psychiatrists, and zolpidem was preferred by non-psychiatrists (p<0.001). Non-psychiatrists were more likely to prescribe short acting benzodiazepines than psychiatrists (p<0.001). However, there was no statistically significant difference in the clinical outcomes, including prevalence of admission to ICU, ventilator care, and length of stay in ICU. In patients prescribed by non-psychiatrists, there were more patients prescribed without psychiatric diagnosis and diagnosed as major depression disorder after hospitalization. Conclusion: To promote rational prescribing of sedative hypnotics, proper psychiatric evaluation should be performed before prescribing, and educational programs including the contents of interactions and side effects of sedative hypnotics are needed.

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Flumazenil administration in suspected patients with acute hypnotics and sedatives poisoning: risk-benefit re-evaluation (급성 진정제 중독 추정 환자에서 플루마제닐의 투여: 위험도/이익 재평가)

  • Huh, Jae Hong;Choi, Sang Chun;Lim, Yong Gyun;Lampotang, Samsun;Park, Eung Jung
    • Journal of The Korean Society of Clinical Toxicology
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    • v.14 no.2
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    • pp.92-99
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    • 2016
  • Purpose: The use of flumazenil administration in the emergency department is still controversial because of concerns about adverse effects. The present study was conducted to re-evaluate the risk-benefit ratio associated with flumazenil administration to patients suspected of having acute hypnotics and sedatives poisoning in the emergency department. Methods: A retrospective chart review study was conducted for patients whose final diagnoses were "poisoning" and "benzodiazepine" or "sedatives-hypnotics" from Mar. 2006 to Feb. 2015. The basal characteristics of the patients, including past medical history, ingredients and dose of ingested drug and co-ingested drugs were investigated. For patients administered flumazenil, responsiveness and time from admission to flumazenil administration were investigated with supplement. All collected data were analyzed in aspect terms of risk/benefit. Results: A total of 678 patients were included in our study. Benzodiazepine was the most common sedative/hypnotic drug prescribed, and the frequency of prescription continuously increased. The proportion of TCA as co-ingestion decreased from 13.1% to 3.9% in patients with acute sedative/hypnotic poisoning. Flumazenil was administered to 55 patients (8.1%), of which 29 patients (52.7%) were applied to contraindications. Fifty-three patients (96.4%) showed positive responsiveness, including partial responsiveness after flumazenil administration. No severe adverse events were identified. Conclusion: Based on the current trends in prescription patterns for sedative/hypnotic drugs, increased use of non-TCA antidepressants, and responsiveness to administration of flumazenil, benefit seemed weighted more in this study, although the observed benefits were based on limited results. Further prospective multicenter studies will be needed to optimize benefit-risk ratio.

Comparative Analysis of decreased Mental state Patients after Overdose with Sedative-hypnotics (진정수면제 음독 후 의식저하로 내원한 환자의 급성중독 비교)

  • Oh, Seung Jae;Cho, Soo Hyung;Ryu, So Yeon
    • Journal of The Korean Society of Clinical Toxicology
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    • v.20 no.1
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    • pp.8-14
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    • 2022
  • Purpose: This study was undertaken to investigate how sedative-hypnotics affect the occurrence and severity of the patient's symptoms. In addition, we conducted a study to determine the type of patients who reacted severely and required hospitalization; patients were accordingly classified as hospitalized patients and patients discharged from the emergency room. Methods: From January 2017 to December 2019, we investigated the demographics, drug information, history, laboratory tests, and severity of patients who visited our emergency department and were diagnosed with benzodiazepine, zolpidem, and doxylamine succinate overdose. We further compared details of hospitalized patients and discharged patients. Results: Subjects who had overdosed and visited the ED included 120 for benzodiazepine, 147 for zolpidem, and 27 for doxylamine succinate. Comparisons between the three groups revealed differences in their early diagnosis, psychiatric history, and sleep disturbance. Differences between groups were also determined for mental state, poisoning history, treatment received in the intensive care unit, and intubation and ventilator support. In cases of benzodiazepine overdose, we obtained a high hospitalization rate (40.0%), admission to the intensive care unit (24.2%), and intubation rate (18.3%). Comparisons between hospitalized patients and discharged groups showed differences in transferred patients, early diagnosis, and mental state. Conclusion: Patients poisoned by sedative-hypnotics are increasing every year. In cases of benzodiazepine and zolpidem, the hospitalization rates were high, and benzodiazepine overdose resulted in hospitalization, intensive care unit admission, and pneumonia in a majority of cases. Therefore, active treatment and quick decisions in the emergency room are greatly required.

Detection of phenobarbital adulteration in dietary supplements: simultaneous analysis of 16 sedative-hypnotics and sleep-inducers by ultra-high-performance liquid chromatography with UV detection (UPLC-UV) and quadruple Orbitrap mass spectrometry (Q-Orbitrap-MS)

  • Lee, Ji Hyun;Choi, Ji Yeon;Park, Hanna;Min, Ah Young;Kim, Nam Sook;Park, Seong Soo;Park, Sung-Kwan;Kang, Ho-il
    • Analytical Science and Technology
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    • v.32 no.1
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    • pp.24-34
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    • 2019
  • The safety of food is occasionally questionable, as there have been some reports of products contaminated with illegal adulterants. In this study, the presence of 16 sedative-hypnotics and sleep inducers in dietary supplements was determined by ultra-high-performance liquid chromatography with UV detection (UPLC-UV) and quadruple Orbitrap mass spectrometry (Q-Orbitrap-MS). The UPLC method was validated, providing a linearity (R2) of more than 0.999, and LODs and LOQs that ranged from 0.2 to 0.5 and 0.6 to $1.5{\mu}g\;mL^{-1}$, respectively. The repeatabilities were 0.2-8.4 % (intra-day) and 0.3-4.5 % (inter-day), and the accuracies were 89.0-117.0 % (intra-day) and 87.8-111.9 % (inter-day). The mean recoveries of the spiked samples ranged from 98.7 to 107.3 %. The relative standard deviation (%RSD) of the stability was less than 2.4 %. Using the developed method, one sedative-hypnotic compound, phenobarbital, was detected in one of the nineteen samples tested. In addition, the major characteristic fragment ions of each target compound were confirmed using Q-Orbitrap-MS for higher accuracy. Monitoring the presence of these 16 sedative-hypnotics and sleep inducers in dietary supplements should be pursued in the interest of human health, and the results of this study confirmed that the developed method has value for this application.

A Study on Self-medication Beharior of Four Cautious Drugs. (특정의약품의 자가투약행위에 관한 연구)

  • 황미숙
    • Korean Journal of Health Education and Promotion
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    • v.4 no.2
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    • pp.46-70
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    • 1987
  • The survey with questionnaire were conducted to grasp the actual condition of four cautious drugs-antibiotics, sedative hypnctics, mincr tranquilizer, analeptics-self -medication behavior through drugstore use and to analyze the primary factors connected with it. The following six objectives were established. 1) To catch the reason why the man who medicate himself buy four cautious drugs at a drugstore, and to know the choice motive of each drug purchased. 2) To grasp the distribution of four cautious drug taken by the man who medicate himself and to analyse the reason of taking the drug. 3) To find out whether the buyer has taken the same drug past and to know the duration and the frequency. 4) To grasp the degree of recognition about four cautious drugs and the attitude toward continuous taking them. 5) To analyze the degree of recognition about the influence on human body and the attitude of medication behavior. 6) To know "the experience of side-effects" and to grasp the kind of the side-effects. The data were collected from 15 drugstores with 677 respondents in seoul from August 17 to september 21, 1987. The following results were obtained. 1) The reasons for drugstore use were first, "for easy access and convenience" (53.7%) second, "for the slightness of illness" (19.9%) third "for the cheap price" (13.2%). According to that result, the factor of "the easy access of drugstore" was most influential. In case of the poor, the factor "for the cheap price "was revealed second (37.3%). And "for the slightness of illness" was second reason in the medically insured (22. 9%), "for the cheap price" was second reason in the others (29%). 2) The kind of drugs purchased were antibiotics (62.8%), analeptics(17.2%), minor tranquilizer(13.3%) and sedative hypnotics (6.7%) on the whole. In teenagers, besides antibiotics the percentage of taking analepits came second (42.4%) and it was revealed that the percentage of sedative hypnotics, minor tranquilizer increase with age. But in proportion to the increase of age, the taking of analeptis decreased. 3) The choice motives of each drug purchased were all different. In case of antibiotics "recommendation of pharmacist" was 39.6%, sedative hypnotics "recommendation of pharmacist" and "my own judgement", 28.9%, respectively, minor tranquilizer "my own judgement", 35.2%. and in case of analeptics "my oun judgement" was most common with 53.5%. 4) The reasons for taking drugs were as follows. antibiotics was taken for the inflammation mitigation of a wound and a swelling (38.5%), sedative hypnotics for the removal of insomnia (97.5%), minor tranquilizer because of restlessness and qloominess(39.3%), and analeptics for the shortening of sleeping hours (35.1%). 5) Those experienced in taking four cautious drugs were 78.2% on the average. It was revealed that antibiotics use duration was "from one week to one month" (38.9%), the frequency was "rarely" (62.1%), sedative hypnotics and minor tranquilizer; "More than three years", (35.7%, 30.4%), respectively, "Somtimes", (43.8%, 35%), respectively. analeptics ; "from one year to three years", (27.6%), "Sometimes", (42.7%). 6) In regard to the source of information in taking drugs, 35.3 percent of male were relied on "recommendation of pharmacist", 32.6 percent of female "my own judgement", There was a difference between below the middle school graduates and over the high school graduates Thease were relied on "recommendation of pharmacist" first, those "my own judgement" first. And "my own judgement" was the first source of specialist(40%), labours(41.4%), salesman(43.5%), and jobless men(36.8%), "recommendation of ralatives on friends" was the first source of students (30.4%), "recommendation of pharmacist" was the first soure of teachers, administrative office workers (39%) and housewives (40.7%). 7) The degree of recognition about four cautious drugs was as follows. "know a little" was (43.0%), "don't know" (30.2%), "know" (26.8%), respectively. In regard to the attitude toward continuous taking them, it was revealed that "I will take it according to circumstamces" was first (56.2%), " I will not take it as possible" was first(56.2%), "I dont know well" (12.9%), "I will take it continuously" (8.3%). 8) About the influence on human body, "if proper, it is effect" was common attitude toward antibiotics (43.6%), "Probably bad influence on the health" was first toward the other drugs (46.2%), In terms of the degree of observance to taking-time and dose of drugs, "suitably" was first (37.3%), "relatively correctly" second (27%), "correctly" (17%). 9) The percentage of four cautious drugs side-effects was 27.5 on the average. The kind of side-effects were eruption and urticaria (28.5%), heart acceleration and so forth. (25.4%), headache and Giddiness, dyspepsia (23%), respectively.

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Oriental Treatment of Insomnia in Stroke Patient (고침무우산으로 개선된 중풍 환자 불면 1례)

  • 양대진;강경숙;한진안;배형섭
    • The Journal of Korean Medicine
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    • v.21 no.4
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    • pp.271-275
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    • 2000
  • A growing number of people are concerned about their sleep. There are many people with chronic sleep disorders. As there are various causes in a disease, proper treatment according to each cause is necessary for a more effective treatment. In general, insomnia is classified into five categories of physical, physiological, psychological, psychiatric and pharmacological aspects. Sedative-hypnotics including benzodiazepine and non-benzodiazepine have widely been used in chronic insomniacs. However, most hypnotics including non-benzodiazepine cause some of dependence, tolerance, impaired daytime function and rebound insomnia. Therefore, we are looking forward to proposing an effective oriental treatment for insomnia. A 71-year-old male who had suffered from cerebral infarction was admitted to our department for oriental treatment of stroke and insomnia. Initial treatment modalities with administration of paroxetine were not effective. However administration of oriental medicine' Gochimmuwoo-san(Gaozhenwuyou-san)' achieved a desirable effect.

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