#4 mg ativan

[punksarahreese]

❛ how long has it been since you've slept? ❜ Maybe for 4mg ativan au if you’d like <3

“How are you sleeping?” The question was posed casually, as if just making small talk, but Ava knew what was actually being asked.

Are your meds working? Are you manic? Why are your eyes bloodshot? Are you safe to work today?

“I haven’t been doing much of that lately,” she replied, fiddling with the flimsy plastic lid on her coffee cup.

“Ava,” Connor’s eyes tracked her nervous stimming, “When was the last time you slept?”

She shrugged, “Depends on your definition of sleep. A couple hours in the on call room or a crash on my couch here and there. It’s all I have time for.”

Her colleague sighed and nudged her shoulder with his elbow, “You need to sleep. You can’t work like this.”

She raised an eyebrow when he gestured vaguely to her current state, unwashed hair throwing into a haphazard ponytail and pupils dilated despite the bright sun they stood in. Ava was barely back from her forced time off, not feeling much better, and she could tell it was becoming obvious to those around her.

“I haven’t been allowed to work for weeks, Connor. If Goodwin hears anything she’ll surely fire me at this point.”

“Which is exactly why you shouldn’t do surgery today,” he replied, “Not that I don’t trust you, Ava, but you don’t look okay. Please go talk to Charles.”

“I can’t-“

He huffed and then caught a glimpse of someone chatting with April by the coffee cart, “I’ll tell Sarah.”

“You wouldn’t dare,” Ava’s heart caught in her throat, if Sarah knew she hadn’t been resting she would be distraught. Ava would have to go back to twice weekly psych visits and it could risk her job performance or even leave her unemployed. If she even began to explain what was going on in her brain lately, Dr. Charles would surely admit her for her own safety.

“I’m fine, Connor, really.” Ava was lying through her teeth as she gave a forced smile, “Just tired. Nothing coffee can’t fix, I promise.”

[mcatmemoranda]

Decompensated cirrhosis

Albumin, INR, and platelets tell you about decompensated cirrhosis

Get MELD score (tells you about prognosis) and Child Pugh score (estimates cirrhosis severity). MELD-Na is a new version of the MELD score that is better than the MELD and includes Na+; it's based on whether pt goes for dialysis twice weekly, Cr, bilirubin, INR, and sodium. MELD-NA tells you the severity of end stage liver disease. Pts who present with bleeding varices or ascites have decompensated cirrhosis and worse prognosis. So calculate the MELD score to educate the pt about his/her prognosis. Child-Pugh is based on total bilirubin, albumin, INR, Ascites, Encephalopathy.

Maddrey's discriminant function suggests which patients with alcoholic hepatitis have a poor prognosis and would benefit from steroids. It's based on PT and total bilirubin.

Cirrhosis is decompensated if the pt has varices or ascites.

Pts who present with bleeding have 50% mortality in 6 months.

All cirrhotics should get an EGD to evaluate for presence of varices.

In pts with ascites, calculate the SAAG score, which tells you whether the ascites is due to portal HTN.

Patients with SAAG greater than or equal to 1.1 gm/dL is considered as having high SAAG, indicating the presence of portal hypertension, while those with SAAG less than 1.1 gm/dL are considered as having low SAAG, indicating the absence of portal hypertension.

This is an example of a GI note for a pt who came in with decompensated cirrhosis:

Pt is a ----- w/ a PMH of hepatitis C, EtOH abuse, tobacco use, and IVDU who was admitted for acute decompensated liver cirrhosis w/ascites. 1. Acute decompensated liver cirrhosis w/ascites New diagnosis of liver cirrhosis likely 2/2 EtOH/hepatitis C. MELD score = 21, indicating 19.6% estimated 3-month mortality. Notable symptoms include scleral icterus and abdominal ascites. Low concern for SBP in the absence of fever, leukocytosis, or peritonitis. Initial labs include hemoglobin 14.5, platelet count 113, INR 1.6, PTT 29.2, total bilirubin 8.3, AST 125, ALT 58, albumin 2.7, total protein 9.3. No evidence of anemia. Parsaesophageal varices suggested on CT imaging require eventual EGD for further evaluation.

Ceruloplasmin and AFP normal. Iron studies and alpha-1 antitrypsin indicative of inflammation. Additional labs pending. 4L ascitic fluid removed during 9/7 paracentesis. PMN less than 250, which is not indicative of SBP. Ascites albumin pending for SAAG calculation. RUQ U/S demonstrates slowed portal vein flow, though no evidence of masses or thrombosis.

-acute hepatitis panel, ANA (anti-Nuclear Antibody), ASMA (Anti-Smooth Muscle Antibody), AMA (antimitochondrial), SPEP (Serum Protein Electrophoresis) pending -less than 2 g daily sodium restriction -ascites fluid analysis w/ cell count, albumin, and protein for calculation of SAAG -ammonia level pending -confirm vaccination status of HAV, HBV, influenza, Pneumovax, Prevnar -avoid NSAIDs + counsel for alcohol cessation -steroids for EtOH liver disease contraindicated due unclear hepatitis C status -MRI abdomen for evaluation of portal vein thrombosis/masses -100 mg spironolactone + 40mg lasix qd

2. EtOH use Hx of significant alcohol use over the past 6 years w/o reported hospitalization. Reported taper from 3-4 glasses of vodka daily to several ounces daily; last drink 3 days ago. No withdrawal symptoms at this time. EtOH level less than 3 on admission. Suspected primary etiology of liver cirrhosis.

-management of potential withdrawal symptoms per primary team (CIWA protocol without ativan) -cessation counseling strongly recommended in setting of liver cirrhosis -potential options for medication assisted therapy include acamprosate, naltrexone, baclofen, or gabapentin -nutrition therapy including multivitamin, thiamine, and folate -recommend nutrition consult

3. Hepatitis C Reported hx of hepatitis C not previously treated, unknown genotype. Last seen by GI prior to COVID.

-HCV viral load + genotype pending -outpatient GI f/u for further management

4. Paraesophageal varices on CT Confirm CT findings w/ EGD prior to considering initiation of beta-blocker. -outpatient EGD, unless concern for GI bleed or masses seen on abdominal MRI

5. Family hx of colon cancer

Sister diagnosed w/colon cancer. Pt has not had colonoscopy to date. -outpatient colonoscopy recommended

[sleepingpills2u]

Top 5 Medicines For Dealing With Anxiousness

Anxiousness can swipe all of your pleasure from life. Nevertheless, it does not need to. There are numerous drugs that can successfully treat stress and anxiety. Right here are 5 medications used to treat anxiousness.

Lorazepam

Lorazepam, likewise called Ativan or Temesta, is from the benaodiazepines class. It functions by slowing down activity in the mind, enabling the client to person can unwind. It is taken 2 to 3 times daily. This medication is routine forming as well as a resistance can develop with time. It is meant for short-term usage, and need to not be considered greater than 4 months. This medicine has actually been located effective for assistance individuals deal with high stress and anxiety situations they may run into. It will certainly assist people stay tranquil, but can make remaining focused a little more difficult. One to two mg dosages are normally taken two times each day.

The possible side effects include drowsiness, wooziness, fatigue, weakness, completely dry mouth, looseness of the bowels, nausea or vomiting, appetite modifications, restlessness or excitement, bowel irregularity, problem urinating, obscured vision, changes in sex, drive, evasion walk, fever, trouble breathing/swallowing, yellowing of skin or eyes, uneven heart beat, and consistent fine shake.

Xanax

Xanax, or Alprazolam, is from the benaodiazepines course. It reduces irregular enjoyment in the mind. The pills are extended release tablet computers which can be taken 2 to 4x a day. This drug is habit creating. The directions must be complied with meticulously, and the drug needs to not be stopped all of a sudden. Xanax has been found to be effective at lowering stress and anxiety and durations of tension. The majority of people have actually discovered that it does not leave them feeling sleepy or undistinct. Zanax is typically taken 3 times a day, and the dosages are usually.25 to.5 each time.

The possible negative effects include sleepiness, frustration, wooziness, talkativeness, completely dry mouth, adjustments in libido, irregular bowel movements, weight adjustments, joint pain, light-headedness, fatigue, irritation, problem concentrating, increased salivation, nausea or vomiting, modifications in appetite, trouble peing, seizures, skin rash, clinical depression, confusion, unusual adjustments in state of mind or actions, control and/or equilibrium troubles, shortness of breath, hallucinations, yellowing of the skin or eyes, memory issues, speech issues, suicidal thoughts.

Lexapro

Lexapro is likewise called Escitalopram Oxalate. This medicine is a selective serotonin reuptake inhibitors. It functions by increasing serotonin to aid with mental balance. It is available as a tablet computer or fluid, and must be taken daily. It may take between one and four weeks to truly start seeing renovation. This medicine ought to not be terminated instantly. Patients located that it assisted alleviate anxiety, minimize frustration levels, and normally boosted general state of mind. The suggested dosage is between ten and twenty milligrams.

The negative effects include queasiness, bowel irregularity or looseness of the bowels, sleepiness, adjustments in libido or capability, wooziness, stomach pain, increased sweating, heartburn, dry mouth, raised hunger, extreme fatigue, flu-like signs and symptoms, sneezing, runny nose. More major side effects include uncommon enjoyment, fever, sweating, as well as confusion, quick or irregular heart beat, hallucinations of extreme muscular tissue tightness.

Symptoms of overdose consist of queasiness, shake, vomiting, sweating, wooziness, sleepiness, seizures, quickly or battering heart beat, complication, forgetfulness, coma (loss of consciousness for a time), tremor, and also fast breathing.

Effexor

Effexor (Venlafaxine) is an extensive release tables made use of to deal with stress and anxiety. The tablet computer can be taken 2 or 3 times a day, at around the same time daily. Dosages are generally started at really reduced degrees and after that gradually enhanced. This medication has to develop in your system, so it can take in between 6 as well as 8 weeks to start seeing the full advantages. The drug should not be discontinued without very first talking with your physician. Withdrawal symptoms can take place if the drug is quit suddenly. Withdrawal symptoms consist of anxiousness, sadness, frenzied or frantic excitement, trouble either falling asleep or staying awake, agitation, confusion, irritation, absence of coordination, problems, throwing up, diarrhea, sweating, seizures, supplanting the ears, completely dry mouth, loss of appetite and burning, prickling, electrical shock-like sensations or tingling in any kind of area of the body. Patients found that this medication helped to reduce anxiety along with anxiety. Some individuals saw results and also improvements within the very first week of taking this medicine, although this will certainly not be the case with all consumers. Recommended doses generally vary between 75 mg daily and 225 mg daily.  Click on xanax next day delivery UK,if you are looking for resting pills .

[punksarahreese]

Send me asks please! Any prompts from these lists:

💚 | 🍀 | 🌱 | 🍃 | 🐢

Or any three or five sentence fic prompts for an AU or pairing (platonic/romantic/whatever) or random prompt

Any AU is welcome !! but I would love asks specifically for

Things We Lost (Ronance coparenting Mike and Holly)

Acoustic (Hard or hearing!JJ)

Familiarity (Step Sibling!Rhekker)

Chronic (Sarah chronic illness vent AU)

4 mg Ativan (mentally ill!Ava vent AU)

Autistic!Robin Buckley or Autistic!Eddie Munson

Estrangement (reesker breakup AU)

Over (Robin Buckley vent AU)

She Don’t Fade (Ghost!Nancy Wheeler)

[struggling-to-be-healthy]

September 9, 2019

Today I took a 20 minute walk on my lunch break at work. It was really all I had time for today. I did get the Sahara badge, though!

After work I saw my psychiatrist. He really didn't make me feel much better. I explained everything that has been going with the anxiety and chest pains. He told me to cut down to 150 mg of Wellbutrin which I already did. He also prescribed me Ativan to take while the Wellbutrin levels off. I voiced my concerns about it being more serious than anxiety and he basically said he wouldn't tell me to ignore it, but I'm more than likely fine since it didn't start until I upped my dosage of the Wellbutrin. REAL HELPFUL. I hope things go back to normal soon. I'm still going to stay out of the gym for now, which sucks.

I treated myself to Starbucks today. Yes, 24 points is a lot for a drink, but I enjoyed it and figured it is better to have it at the start of the week as opposed to the end.

Goals for the week:

Blue dot 0/4

Step goal 1/6

64 oz. of water 1/7

Walk outside: 1/4

[so-this-is-my-blog-i-guess]

Caution! These 10 Drugs Can Cause Memory Loss

If you’re experiencing forgetfulness or confusion, check your medicine cabinet

by Dr. Armon B. Neel, Jr., February 9, 2016 | Comments: 5

Various Pills Assorted In Pill Box, Health, Drugs And Supplements, 10 Drugs Can Cause Memory Loss

For a long time doctors dismissed forgetfulness and mental confusion as a normal part of aging. But scientists now know that memory loss as you get older is by no means inevitable. Indeed, the brain can grow new brain cells and reshape their connections throughout life.

Most people are familiar with at least some of the things that can impair memory, including alcohol and drug abuse, heavy cigarette smoking, head injuries, stroke, sleep deprivation, severe stress, vitamin B12 deficiency, and illnesses such as Alzheimer's disease and depression.

But what many people don't realize is that many commonly prescribed drugs also can interfere with memory. Here are 10 of the top types of offenders.

1. Antianxiety drugs (Benzodiazepines)

Why they are prescribed: Benzodiazepines are used to treat a variety of anxiety disorders, agitation, delirium and muscle spasms, and to prevent seizures. Because benzodiazepines have a sedative effect, they are sometimes used to treat insomnia and the anxiety that can accompany depression.

Examples: Alprazolam (Xanax), chlordiazepoxide (Librium), clonazepam (Klonopin), diazepam (Valium), flurazepam (Dalmane), lorazepam (Ativan), midazolam (Versed), quazepam (Doral), temazepam (Restoril) and triazolam (Halcion).

Drugs That May Cause Memory Loss

1. Antianxiety drugs

2. Cholesterol drugs

3. Antiseizure drugs

4. Antidepressant drugs

5. Narcotic painkillers

6. Parkinson's drugs

7. Hypertension drugs

8. Sleeping aids

9. Incontinence drugs

10. Antihistamines

How they can cause memory loss: Benzodiazepines dampen activity in key parts of the brain, including those involved in the transfer of events from short-term to long-term memory. Indeed, benzodiazepines are used in anesthesia for this very reason. When they're added to the anesthesiologist's cocktail of meds, patients rarely remember any unpleasantness from a procedure. Midazolam (Versed) has particularly marked amnesic properties.

Alternatives: Benzodiazepines should be prescribed only rarely in older adults, in my judgment, and then only for short periods of time. It takes older people much longer than younger people to flush these drugs out of their bodies, and the ensuing buildup puts older adults at higher risk for not just memory loss, but delirium, falls, fractures and motor vehicle accidents.

If you take one of these meds for insomnia, mild anxiety or agitation, talk with your doctor or other health care professional about treating your condition with other types of drugs or nondrug treatments. If you have insomnia, for instance, melatonin might help. Taken before bedtime in doses from 3 to 10 mg, melatonin can help to reestablish healthy sleep patterns.

Be sure to consult your health care professional before stopping or reducing the dosage of any benzodiazepine. Sudden withdrawal can trigger serious side effects, so a health professional should always monitor the process.

2. Cholesterol-lowering drugs (Statins)

Why they are prescribed: Statins are used to treat high cholesterol.

Examples: Atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Mevacor), pravastatin (Pravachol), rosuvastatin (Crestor) and simvastatin (Zocor).

How they can cause memory loss: Drugs that lower blood levels of cholesterol may impair memory and other mental processes by depleting brain levels of cholesterol as well. In the brain, these lipids are vital to the formation of connections between nerve cells — the links underlying memory and learning. (The brain, in fact, contains a quarter of the body's cholesterol.)

A study published in the journal Pharmacotherapy in 2009 found that three out of four people using these drugs experienced adverse cognitive effects "probably or definitely related to" the drug. The researchers also found that 90 percent of the patients who stopped statin therapy reported improvements in cognition, sometimes within days. In February 2012, the Food and Drug Administration ordered drug companies to add a new warning label about possible memory problems to the prescribing information for statins.

Alternatives: If you're among the many older Americans without known coronary disease who are taking these drugs to treat your slightly elevated LDL ("bad") cholesterol and low HDL ("good") cholesterol), ask your doctor or other health care provider about instead taking a combination of sublingual (under-the-tongue) vitamin B12 (1,000 mcg daily), folic acid (800 mcg daily) and vitamin B6 (200 mg daily).

3. Antiseizure drugs

Why they are prescribed: Long used to treat seizures, these medications are increasingly prescribed for nerve pain, bipolar disorder, mood disorders and mania.

Examples: Acetazolamide (Diamox), carbamazepine (Tegretol), ezogabine (Potiga), gabapentin (Neurontin), lamotrigine (Lamictal), levetiracetam (Keppra), oxcarbazepine (Trileptal), pregabalin (Lyrica), rufinamide (Banzel), topiramate (Topamax), valproic acid (Depakote) and zonisamide (Zonegran).

How they can cause memory loss: Anticonvulsants are believed to limit seizures by dampening the flow of signals within the central nervous system (CNS). All drugs that depress signaling in the CNS can cause memory loss.

Alternatives: Many patients with seizures do well on phenytoin (Dilantin), which has little if any impact on memory. Many patients with chronic nerve pain find that venlafaxine (Effexor) — which also spares memory — alleviates their pain.

4. Antidepressant drugs (Tricyclic antidepressants)

Why they are prescribed: TCAs are prescribed for depression and, increasingly, anxiety disorders, eating disorders, obsessive-compulsive disorder, chronic pain, smoking cessation and some hormone-mediated disorders, such as severe menstrual cramps and hot flashes.

Examples: Amitriptyline (Elavil), clomipramine (Anafranil), desipramine (Norpramin), doxepin (Sinequan), imipramine (Tofranil), nortriptyline (Pamelor), protriptyline (Vivactil) and trimipramine (Surmontil).

How they can cause memory loss: About 35 percent of adults taking TCAs report some degree of memory impairment and about 54 percent report having difficulty concentrating. TCAs are thought to cause memory problems by blocking the action of serotonin and norepinephrine — two of the brain's key chemical messengers.

Alternatives: Talk with your health care provider about whether nondrug therapies might work just as well or better for you than a drug. You might also want to explore lowering your dose (the side effects of antidepressants are often dose-related) or switching to a selective serotonin/norepinephrine reuptake inhibitor (SSRI/SNRI). Of the drugs in this category, I find venlafaxine (Effexor) to have the fewest adverse side effects in older patients.

5. Narcotic painkillers

Why they are prescribed: Also called opioid analgesics, these medications are used to relieve moderate to severe chronic pain, such as the pain caused by rheumatoid arthritis.

Examples: Fentanyl (Duragesic), hydrocodone (Norco, Vicodin), hydromorphone (Dilaudid, Exalgo), morphine (Astramorph, Avinza) and oxycodone (OxyContin, Percocet). These drugs come in many different forms, including tablets, solutions for injection, transdermal patches and suppositories.

How they can cause memory loss: These drugs work by stemming the flow of pain signals within the central nervous system and by blunting one's emotional reaction to pain. Both these actions are mediated by chemical messengers that are also involved in many aspects of cognition. So use of these drugs can interfere with long- and short-term memory, especially when used for extended periods of time.

Alternatives: In patients under the age of 50 years, nonsteroidal anti-inflammatory drugs (NSAIDs) are the frontline therapy for pain. Unfortunately, NSAID therapy is less appropriate for older patients, who have a much higher risk of dangerous gastrointestinal bleeding. Research shows the risk goes up with the dosage and duration of treatment.

Talk with your doctor or other health care provider about whether tramadol (Ultram), a nonnarcotic painkiller, might be a good choice for you. In my practice, I often recommend supplementing each 50 mg dose with a 325 mg tablet of acetaminophen (Tylenol). While there are prescription drugs that combine tramadol and acetaminophen, these products have only 37.5 mg of tramadol, and in my practice I've found that patients generally need the larger dose.

6. Parkinson's drugs (Dopamine agonists)

Why they are prescribed: These drugs are used to treat Parkinson's disease, certain pituitary tumors and, increasingly, restless legs syndrome (RLS).

Examples: Apomorphine (Apokyn), pramipexole (Mirapex) and ropinirole (Requip).

How they can cause memory loss: These meds activate signaling pathways for dopamine, a chemical messenger involved in many brain functions, including motivation, the experience of pleasure, fine motor control, learning and memory. As a result, major side effects can include memory loss, confusion, delusions, hallucinations, drowsiness and compulsive behaviors such as overeating and gambling.

Alternatives: If you are being treated for RLS, ask your doctor or pharmacist whether one of your prescription or over-the-counter medications may be the trigger. Potential culprits include many antinausea and antiseizure medications, antipsychotic drugs with tranquilizing effects, some antidepressants, and some cold and allergy medications. In this case, your RLS — and memory problems — could potentially be resolved by simply replacing the offending medication with another drug.

7. Hypertension drugs (Beta-blockers)

Why they are prescribed: Beta-blockers slow the heart rate and lower blood pressure and typically are prescribed for high blood pressure, congestive heart failure and abnormal heart rhythms. They're also used to treat chest pain (angina), migraines, tremors and, in eyedrop form, certain types of glaucoma.

Examples: Atenolol (Tenormin), carvedilol (Coreg), metoprolol (Lopressor, Toprol), propranolol (Inderal), sotalol (Betapace), timolol (Timoptic) and some other drugs whose chemical names end with "-olol."

How they can cause memory loss: Beta-blockers are thought to cause memory problems by interfering with ("blocking") the action of key chemical messengers in the brain, including norepinephrine and epinephrine.

Alternatives: For older people, benzothiazepine calcium channel blockers, another type of blood pressure medication, are often safer and more effective than beta-blockers. If the beta-blocker is being used to treat glaucoma, I recommend talking with your health care professional about potentially using a carbonic anhydrase inhibitor, such as dorzolamide (Trusopt), instead.

8. Sleeping aids (Nonbenzodiazepine sedative-hypnotics)

Why they are prescribed: Sometimes called the "Z" drugs, these medications are used to treat insomnia and other sleep problems. They also are prescribed for mild anxiety.

Examples: Eszopiclone (Lunesta), zaleplon (Sonata) and zolpidem (Ambien).

How they can cause memory loss: Although these are molecularly distinct from benzodiazepines (see No. 1 above), they act on many of the same brain pathways and chemical messengers, producing similar side effects and problems with addiction and withdrawal.

The "Z" drugs also can cause amnesia and sometimes trigger dangerous or strange behaviors, such as cooking a meal or driving a car — with no recollection of the event upon awakening.

Alternatives: There are alternative drug and nondrug treatments for insomnia and anxiety, so talk with your health care professional about options. Melatonin, in doses from 3 to 10 mg before bedtime, for instance, sometimes helps to reestablish healthy sleep patterns.

Before stopping or reducing the dosage of these sleeping aids, be sure to consult your health care professional. Sudden withdrawal can cause serious side effects, so a health professional should always monitor the process.

9. Incontinence drugs (Anticholinergics)

Why they are prescribed: These medications are used to relieve symptoms of overactive bladder and reduce episodes of urge incontinence, an urge to urinate so sudden and strong that you often can't get to a bathroom in time.

Examples: Darifenacin (Enablex), oxybutynin (Ditropan XL, Gelnique, Oxytrol), solifenacin (Vesicare), tolterodine (Detrol) and trospium (Sanctura). Another oxybutynin product, Oxytrol for Women, is sold over the counter.

How they can cause memory loss: These drugs block the action of acetylcholine, a chemical messenger that mediates all sorts of functions in the body. In the bladder, anticholinergics prevent involuntary contractions of the muscles that control urine flow. In the brain, they inhibit activity in the memory and learning centers. The risk of memory loss is heightened when the drugs are taken for more than a short time or used with other anticholinergic drugs.

A 2006 study of oxybutynin ER, for example, found its effect on memory to be comparable to about 10 years of cognitive aging. ("In other words," as the study's lead author put it, "we transformed these people from functioning like 67-year-olds to 77-year-olds.")

Older people are particularly vulnerable to the other adverse effects of anticholinergic drugs, including constipation (which, in turn, can cause urinary incontinence), blurred vision, dizziness, anxiety, depression and hallucinations.

Alternatives: As a first step, it's important to make sure that you have been properly diagnosed. Check with your doctor or other health professional to see if your urinary incontinence symptoms might stem from another condition (such as a bladder infection or another form of incontinence) or a medication (such as a blood pressure drug, diuretic or muscle relaxant).

Once these are ruled out, I'd recommend trying some simple lifestyle changes, such as cutting back on caffeinated and alcoholic beverages, drinking less before bedtime, and doing Kegel exercises to strengthen the pelvic muscles that help control urination.

If these approaches don't work out, consider trying adult diapers, pads or panty liners, which can be purchased just about anywhere. They can be worn comfortably (and invisibly) under everyday clothing and virtually eliminate the risk of embarrassing accidents. In my experience, many patients are reluctant to try this approach, but once over the initial hurdle, come to prefer it for security and peace of mind.

Correction: An earlier version of this article mistakenly implied that mirabegron (Myrbetriq), which the FDA approved last year for the treatment of overactive bladder, is an anticholinergic drug; in fact, it is in a new class of medications called beta-3 adrenergic agonists and is not expected to cause memory loss seen with anticholinergic medications. There currently are no data describing the effect of Myrbetriq on cognition.

10. Antihistamines (First-generation)

Why they are prescribed: These medications are used to relieve or prevent allergy symptoms or those of the common cold. Some antihistamines are also used to prevent motion sickness, nausea, vomiting and dizziness, and to treat anxiety or insomnia.

Examples: Brompheniramine (Dimetane), carbinoxamine (Clistin), chlorpheniramine (Chlor-Trimeton), clemastine (Tavist), diphenhydramine (Benadryl) and hydroxyzine (Vistaril).

How they can cause memory loss: These medications (prescription and over-the-counter) inhibit the action of acetylcholine, a chemical messenger that mediates a wide range of functions in the body. In the brain, they inhibit activity in the memory and learning centers, which can lead to memory loss.

Alternatives: Newer-generation antihistamines such as loratadine (Claritin) and cetirizine (Zyrtec) are better tolerated by older patients and do not present the same risks to memory and cognition.

[mcatmemoranda]

Gabapentin can be used off-label for EtOH withdrawal symptoms. My attending said to give 300 mg TID for a pt we have had for 4 days now on CIWA protocol with ativan; and Librium ordered 25 mg q8 hrs standing. So I'm discharging her today with gabapentin.

From UTD:

Gabapentin — Gabapentin, a gamma-aminobutyric acid (GABA) analogue, has emerged in recent years as an effective and safe alternative to benzodiazepines for the treatment of mild alcohol withdrawal in the ambulatory setting.

Anticonvulsants are believed to counteract the "kindling process" that can occur with repeated episodes of alcohol withdrawal, which leads to an intensification of alcohol withdrawal symptoms with each successive episode.

Gabapentin has been shown in clinical trials to be efficacious for reducing alcohol withdrawal symptoms other than seizures and delirium tremens. These clinical trials compared gabapentin with benzodiazepines, thus the trials are described earlier in the topic.

Common side effects of gabapentin include dizziness (17 to 28 percent), drowsiness (19 to 21 percent), ataxia (1 to 13 percent), diarrhea (6 percent), weakness (6 percent), and nausea and vomiting (3 to 4 percent).

Newer anticonvulsants (including gabapentin) exhibit fewer drug-drug interactions compared with older anticonvulsants [30,31] and are safe in patients with impaired liver function.

A handful of published case reports and our clinical experience indicate that gabapentin is subject to misuse by some patients treated for a substance use disorder.

In our experience, gabapentin is administered in supervised withdrawal using a fixed dosing schedule.

Withdrawal in some patients will progress at different rates and end before or after four days, requiring some “as needed” flexibility in dosing.

[thomaselbert-blog]

AMBIEN 10 MG - Uses, Side Effects, Feedback

Uses- It is the company name for zolpidem, a drug that is used to treat insomnia. Insomnia is a sleep disorder that makes it tough for you to have a sleep, stay asleep, or both. Ambien is in a class of medications called sedative-hypnotics. They work by reducing the activity in your brain, which allows for a state of sleep.

You can buy here- https://www.physicrelief.com/product/ambien-10-mg/

Website Name- Physic Relief

Ambien Warnings- Don’t take Ambien if you are allergic to zolpidem or any of its inactive elements.

Seek emergency cure right away if you have difficulty breathing, swelling of your tongue, throat, or face, or nausea and vomiting after taking Ambien.

Side effect

Seek emergency medical help right away if you have any of these signs of an allergic reaction to Ambien:

Hives

Trouble breathing

Swelling of your tongue,     throat, or face

Nausea

Vomiting

Serious side effects of Ambien are:

Getting out of bed while     not being fully awake and acting out a movement that you are not aware     you are doing, such as driving a vehicle, sleepwalking, making and taking     food, making phone calls, or having sex

Abnormal thoughts or     behaviors, such as aggressiveness, abnormal extroversion, confusion,     agitation, hallucinations, worsening of depression, or suicidal thoughts     or actions

Memory loss

Anxiety

Sleepiness during the day

Feedback- For Insomnia "I had cancer 13 years ago so anyways couldn’t sleep after that so my dr put me on 15 mg of Ambien and a few years down the road because of regulations he had to cut it to 10 mg. Which I’m still not used to, well I was going to VA and had to switch to regular Doctor, I have a dr. that hates Ambien but at least she is giving me 5 mg and now I am very restless and get around 4 to 5 hrs of sleep. Very tough, but I know my life is shortened by being on Ambien but I have tried absolutely everything on the shelf of sleep aids, and Ambien is the only one that will give me sleep and no nightmares." For Insomnia "I have anxiety and depression I have been on every drug known to man nothing works to help me sleep. I went 13 days with no sleep ended up in hospital fine one night of sleep went to my doctor he gave me Ambien I haven't slept since. So why is this happening? I have been on trazodone, citalopram, doxepin, Valium, Ativan Percocet morphine Zoloft Xanax and I can't sleep on anything even over counter pills. I had a sleep study test was done which was inconclusive because I was awake all night. Does anyone have help? I'm losing my mind I can't function anymore."

[bluegingham]

“How Could My Doctor Do This To Me?”

I just returned from hell, also known as Xanax withdrawal.

At first I blamed myself. And, yes, I know - I am partly to blame no matter what. It wasn’t the first time I ran out early. However, it was the first time I ran out really early. Last Monday I vaped a THC hybrid that didn’t agree with me, triggering awful anxiety. So my go-to solution was to take more Xanax. I had already taken more than prescribed for the month, but I usually portioned it out so I could get through the days until I could get my next refill. This time I wasn’t that smart. 

So last weekend I found myself in a horrible state: my heart was beating out of my chest, I felt so nauseous I could have sworn it was food poisoning, and my anxiety was through the roof. By Sunday I had enough. I call my pdoc’s cell phone that I saved for emergencies and admitted what I’d done. He tried to calm me down and said it was an easy fix - I could just call the doctor on call and they would prescribe me another benzo until I could pick up my new Xanax script on Thursday. By Sunday night I had Ativan in my possession. I’d taken it before I went on Xanax and expected it to aid my withdrawal symptoms. 

My expectations were wrong.

This entire week I was in a whirlwind of nausea, dizziness, anxiety, and overall confusion. I truly thought I was dying. Low and behold it all stopped once I took my Xanax today. 

Now that I’m “back to normal” I feel hurt and angry. I trusted my pdoc. He’s a good man. He’s one of the best, if not the best, psychiatrist in my region. So how could he let this happen? How could he give me these pills that I’ve become addicted to? 

Apparently, it’s very common. While many doctors refuse to prescribe benzos (Ativan, Klonopin, Valium, etc.), others give it out without question. I just don’t understand how this professional could let me stay on this poison for so long. I recently found out the FDA only recommends a patient stay on a benzo for 4-6 weeks at most. I’ve been taking 4 mg of Xanax a day for almost a year. This horrifies me. 

I’m going to talk to him about tapering off using the Ashton Method, which involves using Valium (a benzo with a longer half-life, correct me if I’m wrong). But I just felt like I needed to share my story. 

If you are being a prescribed a benzo please do your research. The physical and psychological dependency is astounding. Many say the withdrawal is worse than that of heroin. I’ve never taken heroin, but based on the pain I was in this week I’m sure it’s true. 

Don’t be like me. Find healthier ways to cope with your anxiety. It’s not worth it. 

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[punksarahreese]

anxious ava maybe with some platonic rhekker for tsf?

“Ava, you did nothing wrong; he had no right to lash out at you like that.”

She didn’t answer, shaking hands tapping rhythmically on the nurse’s station as she clearly fought off tears. Connor didn’t say anything more, though the gentle squeeze of her shoulder was reminder enough that she wasn’t alone.

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[punksarahreese]

“talk to me, okay? i need to know what’s going on.” for 4mg ativan (reesker maybe?) please !!

Continuation of this tsf

TW: mentions of previous self injury

Ava knew better than to fall back into old habits, she swore she did. She had been clean for a long time, her scars faded and the urges mostly quelled by distractions and work. When she was lucid she could keep herself on track, it was during meltdowns that she wasn’t so safe.

It was a power struggle in her mind. When she was overwhelmed and alone she found it too hard to fight off the full force of her meltdowns. She couldn’t calm down as quickly if she didn’t have the right distractions or couldn’t make it to her phone to call Sarah. Sometimes her brain won out, leaving her frozen on the floor as she sobbed and tried not to hyperventilate. Desperate for some kind of sensory regulation, Ava couldn’t stop the way she raked her nails over her exposed skin. Anywhere she could reach, her arms and legs and even her neck. The little red marks far too reminiscent of her teenaged years, blatant reminders of her mistakes in the height of her panic.

In the moment it helped, the stinging pain a reminder that she was there and not lost in whatever whirlwind her mind was going through. After the fact was another story, when the overwhelming emotions fled and she was left exhausted. The post-meltdown guilt was bad in a regular situation but after pain stims it tripled in severity. Seeing the evidence of her weakness scattered along her pale skin was almost enough to make her cry again.

She knew she had to tell Sarah sooner or later that her meltdowns were getting self destructive again. It was a nagging guilt in her tummy every time she saw the marks. The bandaids on her arms were conspicuous too, unable to be hidden under a long sleeve forever. Ava was going to tell Sarah, she just thought it would be on her own terms.

She didn’t expect Sarah to confront her, especially not right after a 12 hour shift. Exhausted, Ava just stripped off her undershirt and tossed it into the pile with her scrubs. Laundry could wait for tomorrow, she decided, settling into bed in one of her long t-shirts. Sarah watched her closely from her side of the mattress, though Ava didn’t seem to notice right away.

It was when Sarah’s hand met hers that Ava jumped, turning to look at her girlfriend. She apologized a little for startling her, though Ava could see her mind was miles away. It made her anxious, when Sarah’s was so quiet and studied her so closely. It was as if she was reading Ava like a book, knowing her every habit catalogued away in her brain. Her observance aside, nothing would top the way her stomach plummeted when Sarah’s fingers trailed down her wrist to skim the fabric bandages.

“What’re these for?”

“Nothing!” Ava silently cursed herself for the defensive reaction, trying not to yank her arm away from her girlfriend. Obviously they both knew that was a lie, though Sarah didn’t call her out on it directly to save her the embarrassment.

“Uh huh,” she raised an eyebrow, “There’s a pile of bandaid wrappers in the bathroom trash, Avey. That’s not nothing.”

“It’s nothing,” Ava repeated, “Scratches… I- my skin is dry and I scratched at it too much.”

“You? Have dry skin? Ava, we have the entirety of a skincare aisle in our bathroom, you’ve never had dry skin. Why are you lying?”

Her incredulous tone wasn’t angry per se, just concerned. She could see her girlfriend scrambling for an answer and she did slightly regret approaching it this way. As worried as she was, Sarah knew sudden confrontation could scare Ava and she didn’t want to cause any extra anxiety. She just needed to know what was happening, for her safety.

“Avey,” Sarah sat up a bit more and took her soft hand gently again, “I’m not angry, just talk to me, okay? I need to know what’s going on.”

The blonde tried to hold eye contact but it felt like staring into the sun. Instead she kept her eyes trained on their hands, the way Sarah’s thumb rubbed gently over the back of Ava’s to soothe her.

“I told you… scratches.”

“And where did they come from?”

Ava huffed, “You know where.”

“I don’t,” she could see Ava becoming slightly agitated, “I’m not interrogating you, love. I just need to know what happened.”

“I- the meltdown,” a sigh preceded a nervous twitch, “Last one was bad.”

“Pain stims then?” When she got the nod of affirmation Sarah frowned. She figure that was what happened but wanted to be sure. The only way Ava could heal is if she trusted the people around her to give her help, not punishment. She was afraid of getting caught, like a teenager struggling with self harm, and it broke Sarah’s heart.

“Mhm,” she fumbled with the edge of her shirt until Sarah reached behind her to grab the worn out stuffed horse from her pillow. She never minded the comfort object Ava had brought from home, finding it sweet that she still had her childhood comfort to calm her down. She pressed the thing gently into Ava’s hands, watching as she carefully ran her fingers over the curly fabric.

“Alright, are you keeping them clean?”

“Yes…”

“Then we can talk about it tomorrow, okay?” Sarah settled down into her pillows as she looked at her anxious lover, “I just wanted to make sure you were okay.”

“I’m okay right now,” Ava promised, “You mad?”

“No no,” Sarah sighed as she looked up into those familiar puppy eyes, “Just worried about you, love. I’m not angry.”

“Okay…”

“C‘ mere, Avey,” she let Sarah tug her down into her arms, settling down so they could share a pillow. Ava didn’t hesitate to snuggle close, pressing her cheek into Sarah’s shoulder. Neither mentioned the stuffed animal now wedge between them, just settled down into the comfort of knowing the other was safe.