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Biomedical subjects

R L Barkin

Publications and source records attributed to R L Barkin.

13 recordsLinked to original sources
PubMed1992

Benzodiazepines for acute pain in children.

When pediatric pain is refractory and unresponsive to appropriate use of analgesic agents, there might be additional physical or psychologic dimensions of the pain that are not addressed by the analgesics. In addition to appropriate analgesic therapy, the psychologic needs of the child should be directly addressed and appropriate adjunctive physical modalities employed. Although benzodiazepines lack direct analgesic effects, they can reduce the distress associated with acute pain states by decreasing anxiety, insomnia, and muscle spasms that can be associated with acute pain. Intermediate or long-acting benzodiazepines in modest doses can be useful adjunctive agents when used short term for the treatment of selected acute pain complaints. In the highly distressed school-age child or adolescent with pain complaints relatively unresponsive to appropriate care, judicious use of benzodiazepines is worthy of consideration.

Acute Disease↗
PubMed1990

Drug abuse? Use and misuse of psychotropic drugs in Alzheimer's care.

Although psychotropic drugs are widely used to control symptoms related to dementia, concerns are raised by the potential for adverse effects and misuse. Antidepressants may be useful when depression and dementia coexist in the early stages of Alzheimer's disease. In later stages, anxiety and agitation are often treated with antianxiety or antipsychotic agents. Concerns escalate about the use of antipsychotic agents as chemical restraints. Nursing home reform provisions of OBRA '87 mandate dose reductions of antipsychotics in an effort to discontinue their use. The role of the nurse is to establish and monitor therapeutic goals, to assess the incidence and severity of predictable side effects, and to provide a safe, supportive environment that reduces the need for pharmacological intervention.

Aged↗
PubMedDate not supplied

Clinical features and management of intoxication due to hallucinogenic drugs.

Hallucinogenic drugs are unique in that they produce the desired hallucinogenic effects at what are considered non-toxic doses. The hallucinogenic drugs can be categorised into 4 basic groups: indole alkaloid derivatives, piperidine derivatives, phenylethylamines and the cannabinols. The drugs reviewed include lysergic acid diethylamide (LSD), phencyclidine (PCP), cocaine, amphetamines, opiates, marijuana, psilocybin, mescaline, and 'designer drugs.' Particularly noteworthy is that each hallucinogen produces characteristic behavioural effects which are related to its serotonergic, dopaminergic or adrenergic activity. Cocaine produces simple hallucinations, PCP can produce complex hallucinations analogous to a paranoid psychosis, while LSD produces a combination of hallucinations, pseudohallucinations and illusions. Dose relationships with changes in the quality of the hallucinatory experience have been described with amphetamines and, to some extent, LSD. Flashbacks have been described with LSD and alcohol. Management of the intoxicated patient is dependent on the specific behavioural manifestation elicited by the drug. The principles involve differentiating the patient's symptoms from organic (medical or toxicological) and psychiatric aetiologies and identifying the symptom complex associated with the particular drug. Panic reactions may require treatment with a benzodiazepine or haloperidol. Patients with LSD psychosis may require an antipsychotic. Patients exhibiting prolonged drug-induced psychosis may require a variety of treatments including ECT, lithium and l-5-hydroxytryptophan.

Hallucinogens↗