Sedating medications

The patient should be kept calm as much as possible, but this may be difficult if they are delirious, and sometimes the use of sedating medications is necessary. This carries with it the risk of confounding the neurological exam, which is vital to follow during this acute period when the patient is at risk for deterioration. Thus, short-acting medications in the lowest effective doses should be administered. 

Cyproheptadine is not an addictive or habit-forming substance. In the study referenced above, it was administered three times per day with a total daily dose from 12 to 32mg/day. Common side effects of this medication include drowsiness, dry mouth, and drying of the nasal passages and airways. Caution should be exercised when administering cyproheptadine with other sedating medications. 

Avoid alcohol and other sedating medications during therapy... 

These data suggest that there is more available information for use of lithium than for other mood stabilizers, and that adolescents hospitalized with adolescent-onset, acute mania have rates of response between 50% and 80%. Supplementation with sedating medication appears to be common but not systematically evaluated. Children hospitalized with mania also respond to lithium, but their comorbid disorders often need separate attention. Open trials with DVP in hospitalized adolescents are also supported. There is much less information on CBZ and there are no data on newer anticonvulsants such as lamotrigine, topiramate, or gabapentin. These data are largely consistent with data from studies of hospitalized adults with classic mania. 

Clonidine is one of the most widely used sedating medications in pediatric and child psychiatry practice, particularly in children with sleep onset delay and ADHD. It is a central alpha2 agonist. Pharmacokinetics show rapid absorption, with an onset action within 1 h, peak effects at 2-4 h and a half-life 6-24 h. Effects on sleep architecture are fairly minimal but may include decreased REM, so that discontinuation can lead to REM rebound. Clonidine has a narrow therapeutic index, and there has been a recent dramatic increase in reports of overdose with this medication. Potentially significant side effects including hypotension, bradycardia, anticholinergic effects, irritability, and dysphoria rebound hypertension may occur on abrupt discontinuation. Tolerance often develops, necessitating increases in dose. 

When insomnia is not caused by, or fails to respond to treatment for, another medical or psychiatric condition in dementia, pharmacological treatment with sedating agents may be considered as symptomatic therapy. Controversies regarding the use of sedating medications in demented patients revolve around issues of efficacy and issues of potential toxicity, neither of which have been resolved by appropriately comprehensive empirical study. There is evidence, however, that sedative-hypnotics as a class may be inappropriately prescribed or overprescribed for demented patients. 

Prior to the introduction of antipsychotic medications in the 1950s, the main treatments, all with very paltry results, included ECT, insulin coma, nonspecific sedating medications (e.g., barbiturates), psycho-... 

While there has been a great deal of success in treating manic-depressive patients with lithium and returning them to a normal life, researchers are not exactly sure how it works. It is a non-addictive and non-sedating medication, but its use must be carefully monitored for possibly dangerous side effects. For some patients suffering from some symptoms of schizophrenia, lithium may be used in combination with other medications. Lithium is also used to treat people who suffer from unipolar depression. 

Give dose earlier in the day lower the last dose of the day or give it earlier consider a sedating medication at bedtime (guanfacine or clonidine)... 

While once used extensively, barbiturates and other nonbenzodiazepine sedating medications have been largely replaced by... 

Vigilance for drug-drug interactions is required because of the greater number of medications prescribed to elderly patients and enhanced sensitivity to adverse effects. Pharmacokinetic interactions include metabolic enzyme induction or inhibition and protein binding displacement interactions (e.g., divalproex and warfarin). Pharmacodynamic interactions include additive sedation and cognitive toxicity, which increases risk of falls and other impairments. 

Antihistamines such as diphenhydramine are known for their sedating properties and are frequently used over-the-counter medications (usual doses 25-50 mg) for difficulty sleeping. Diphenhydramine is approved by the FDA for the treatment of insomnia and can be effective at reducing sleep latency and increasing sleep time.43 However, diphenhydramine produces undesirable anticholinergic effects and carryover sedation that limit its use. As with TCAs and BZDRAs, diphenhydramine should be used with caution in the elderly. Valerian root is an herbal sleep remedy that has inconsistent effects on sleep but may reduce sleep latency and efficiency at commonly used doses of 400 to 900 mg valerian extract. Ramelteon, a new melatonin receptor agonist, is indicated for insomnia characterized by difficulty with sleep onset. The recommended dose is 8 mg at bedtime. Ramelteon is not a controlled substance and thus may be a viable option for patients with a history of substance abuse. 

Patients who may benefit from allergen immunotherapy include those who do not tolerate traditional drug therapy (e.g., nosebleeds with intranasal steroids or sedation with antihistamines), suffer from severe symptoms, have comorbid conditions (e.g., asthma or sinusitis), fail drug therapy, or prefer not to take long-term medication. 

These qualities make cromolyn an option for patients with multiple comorbidities and concomitant medications. Cromolyn is an alternative for patients in whom antihistamines are too sedating and impair work and school performance. Additionally, cromolyn helps to prevent AR when taken prior to exposure, such as visiting a home with a pet.18 Due to its excellent safety profile, cromolyn is a first-line agent in children with AR.11,12... 

Pharmacotherapy. The currently available treatments for PD are symptomatic, and do not alter the course of the disease. The earliest treatment that is still in limited use today, is with the anticholinergic medications, such as trihexiphenidyl or benzotropine. These drugs are useful, particularly for tremor. However, their use is often prob-lematic because of unpleasant side-effects, such as memory disturbances, blurred vision, sedation, dry mouth, or urinary retention, particularly in older patients. 

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