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The provider is requesting Tizanidine for muscle spasms, which interfere with the patient’s sleep. There are complains of pain in the muscles and joint with joint stiffness and swelling. There were also trigger points and palpable taut bands with local twitch response. The patient has tried multiple medications for pain relief. She is unable to take NSAIDs due to gastric bypass. Morphine was stopped due to side effects. Gabapentin and Lyrica have been avoided, due to obesity. The guidelines support the use of muscle relaxants as a second-line treatment option for short duration. Considering her muscle spams and continued pain; medical necessity of Tizanidine has been substantiated. Recommend

1. What is the nurse's highest priority for a patient experiencing sleep deprivation? What would we teach them about this? What treatment would be expected? Safety would be highest priority; sleep deprivation causes psychomotor deficits. Interventions that can help with sleep deprivation would be avoiding stimulating activities in the hours before bed. Avoid exercise, caffeine, and screen time just before bed. It’s also a good idea to avoid eating a large meal, as this can interfere with healthy sleep. Create a comfortable sleep environment. One medication that the patient can be prescribed on would be Zolpidem is a short-acting hypnotic that will help the patient initiate sleep and awaken without untoward symptoms of drowsiness. Also, Gamma-aminobutyric acid (GABA) and galanin are sleep-promoting neurotransmitters that can be used as a treatment.

Status epilepticus are seizures lasting >20 minutes, or repeated seizures without regaining consciousness [71]. Physicians should be particularly careful with it, since the background may be other than epilepsy. Infection, haemorrhage, trauma, hypoxia, ischemic or haemorrhagic stroke, hypoglycaemia, hyponatremia, drug toxicity and alcohol withdraw should be ruled out. In any of the above, the provoking cause should be treated. If the cause is epilepsy, the treatment of choice is benzodiazepines and the second choice is phenytoin/ fosphenytoin, but with caution as rapid infusion may induce cardiovascular problems. For resistance in those two drugs, the Neurocritical Care Society’s Status Epilepticus Guideline

Benzodiazepines are absorbed well through both per oral and parenteral administrations. However, absorption per orally is more rapid than any other route. Xanax in particular, is highly lipid soluble. Because it is highly lipid soluble, it means that it passes through the blood brain barrier more quickly. Xanax, otherwise known as alprazolam, reaches its peak in concentration in about one to two hours after administration (Griffin et al., 2013). The half-life, or the time it takes the drug to decrease by half, is about six to twenty-seven hours for adults (Griffin et al., 2013). There is a redistribution of benzodiazepines in body fat. This is a two phase process. During the first phase, there is a fast drop in the blood level as the drug is being redistributed throughout the body. During the second phase the blood level is more slow to drop than the first phase because the drug that is left in the blood is being metabolized and as that is happening it is being replaced by the drug that is being released from the body

WASHINGTON — Several Republican senators on Monday proposed a partial replacement for the Affordable Care Act that would allow states to continue operating under the law if they choose, a proposal meant to appeal to critics and supporters of former President Barack Obama’s signature health law.

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MEDICATIONS: Any use of diuretics, pain medications, antiarrhythmic agents, anti-seizure drugs, sedatives, antibiotics, antihistamines, barbiturates, cephalosporins, salicylates, and sulfonamides?(Ross & Basello, 2003)

Sedative-hypnotics, including benzodiazepines, are a group of drugs used to treat the symptoms of anxiety, panic disorders, and insomnia.

The approved FDA indications for Levetiracetam are adjunctive therapy for adults and children four years of age or older with partial onset seizures, adjunctive therapy for myoclonic seizures in patients twelve years of age or older with juvenile myoclonic epilepsy, and adjunctive therapy for primary generalized tonic-clonic seizures in adults and children six year of age and older with idiopathic generalized epilepsy. In a clinical trial of levetiracetam for treatment of partial onset seizures, there was a median reduction in weekly partial seizures of 43.4% compared with 16.3% for the placebo.(1,2) A clinical trial for levetiracetam as a treatment for tonic-clonic seizures in patients with idiopathic generalized epilepsies showed a mean

The study by Amato, Minozzi and Davoli (2011) examined five randomized controlled trials to find an efficient and safe medication to treat AWS. The study which had a total of 7333 patients concluded that benzodiazepines were better for controlling seizures when compared to a placebo and antipsychotics (Amato et al., 2011). When comparing benzodiazepines versus anticonvulsants, researchers concluded that the benzodiazepine chlordiazepoxide had better outcomes. No other studies were found which would compare the effectiveness among benzodiazepines for the treatment of AWS.

The patient is a 50-year-old female who has been seeing Dr. Lynch to help with her sleep issues. She did not however undergo a sleep study. She has been using melatonin 3 mg at night, which has been helpful to get her to fall asleep. She tells me however that she generally wakes up almost every night between one and two o'clock in the morning and can have some difficulty getting back to sleep. She states that she is a person who requires at least nine hours of a good sleep to feel rested. Dr. Lynch did ask her to try Zaleplon 5 mg to use if she wakes at one or two in the morning. The patient however, read the side effects of this and got too afraid to try it. She has not tried any other prescription medications for sleep hygiene. She does tell me she has difficulty sleeping because her husband has sleep

The main difference between the two cocktails lies in the fact that Midazolam was never meant to put a person to sleep as an anesthetic by itself. Anesthetics not only put people to sleep, but they also maintain the sleep state by promoting different combinations of drugs in the brain to synthesize and spread throughout the body. Meanwhile, Midazolam is only used to put someone to sleep, not to keep someone asleep, and it is definitely not meant for any extended period of

A patient experiencing a convulsive seizure may become ‘unconscious; they may experience rigidity, convulsion of limbs, and even incontinence. Afterwards, the patient may feel confused and drowsy’ (Ransford et al., 2014, p. 404). Short appointments should not be detrimental to the patient. However, if a longer appointment is needed and the patient is experiencing anxiety, benzodiazepines should be considered, as they possess “anxiolytic and anticonvulsant effects” (Ransford et al., 2014, p. 404). We should be cautious when using conscious sedation or general anesthesia as there are disadvantages, such as complications with the AED therapy the patient most likely is concurrently

seizure through controlled electric shock, under anesthesia. The process itself is under scrutiny because it is not entirely understood, which is main a reason why it is only considered in the direst of cases. ECT tends to have severe physical health risks and with the introduction of newer and less harmful antidepressant drugs, it is being used far less often (Comer, 2005). This new class of drugs includes three main types; monoamine oxidase (MAOI) inhibitors, tricyclics and selective serotonin reuptake inhibitors (SSRIs).

Treatment for epilepsy is often focused on controlling the seizures with the least amount of medication as possible. Antiepileptic drugs (AEDs) are the class used to accomplish this. Some of the AEDs that are used most often are Clonazepam, Diazepam, Divalproex, Gabapentin, and Phenytoin. The most common side effects of these medications include nausea, vomiting, sedation, fatigue, and lethargy. (Kwan,1; Benbadis, 3-5; Huethers,637)