Based on self-reported surveys conducted by the Substance Abuse and Mental Health Services Administration, cannabis use in pregnant females has increased over the years. Despite the increasing trend, the relationship ...Based on self-reported surveys conducted by the Substance Abuse and Mental Health Services Administration, cannabis use in pregnant females has increased over the years. Despite the increasing trend, the relationship between cannabis use and fetal outcomes is not fully understood. This review paper evaluates the literature investigating the short-term and long-term fetal outcomes resulting from cannabis use during pregnancy. Additionally, the risk of chronic marijuana use leading to cannabis hyperemesis syndrome has been highlighted in this paper using conclusions compiled from several case studies. Several studies linked delayed mental growth and reduced cognitive function with prenatal cannabis use, but the literature <span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">was</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> limited to lower-quality observational studies and could not establish causality. One systematic review investigated short-term outcomes of low birth rates and preterm deliveries, where marijuana use in conjunction with tobacco use was associated with more preterm deliveries. Another study found that six-year-old patients exposed to cannabis prenatally were more likely to score lower in different categories on the Stanford-Binet scale test, which measures intelligence. The exposure in the first, second, or third trimester was associated with lower composite or subcategory scores such as verbal reasoning or short-term memory. Despite these results, the studies evaluated had limitations. They could not establish a clear relationship between cannabis use and fetal outcomes, but the literature showed a similar pattern of health, social and economic inequities among the populations who self-reported cannabis and substance use and non-users. Current organization guidelines advise against the use of cannabis use during pregnancy due to mixed and limited literature. However, they emphasize the importance of the clinician in the public health efforts of education and resource-distribution in addressing these inequities.</span></span></span>展开更多
<span style="font-family:""><span style="font-family:Verdana;">Here in the United States Cannabidiol (CBD) is legal in all 50 states if the Tetrahydrocannabinol (THC) concentration...<span style="font-family:""><span style="font-family:Verdana;">Here in the United States Cannabidiol (CBD) is legal in all 50 states if the Tetrahydrocannabinol (THC) concentration of the product is no more than 0.3%. The largest retailers of CBD in 2019 were located inCalifornia, Florida, and New York, which sold $730 million, $291 million, and $215 million, respectively. Of the patients who use CBD, the most common reasons for their use were pain, anxiety, and insomnia. As the use of CBD for the relief of different issues increases, it is important to assess the safety and efficacy of CBD as it pertains to drug-drug interactions, lab interactions, and its actual benefits. This subject of safety and efficacy is increasingly important as the use of CBD has increased, with approximately 64 million Americans having tried CBD between 2017 and 2019. In this article, we will discuss these different </span><span style="font-family:Verdana;">aspects of CBD use from the point of view of a pharmacist. Not only do</span><span style="font-family:Verdana;"> pharmacists commonly get questions on different aspects of CBD use, but they are also drug experts in areas including drug-drug interactions, drug toxicities, pharmacokinetics and pharmacodynamic profiles of medications, and guideline</span></span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">recommended therapeutic options. Although there is a limited amount of data, there is still accessible data that may serve to inform pharmacists to become aware of the safety and efficacy of CBD. This information will serve pharmacists to educate patients that CBD contains properties to be used in a variety of conditions such as Lennox-Gastaut Syndrome, Dravet Syndrome, pain, and sports enhancement.展开更多
BACKGROUND Cocaine is a synthetic alkaloid initially viewed as a useful local anesthetic,but which eventually fell out of favor given its high addiction potential.Its predominantly sympathetic effects raise concern fo...BACKGROUND Cocaine is a synthetic alkaloid initially viewed as a useful local anesthetic,but which eventually fell out of favor given its high addiction potential.Its predominantly sympathetic effects raise concern for cardiovascular,respiratory,and central nervous system complications in patients undergoing procedures.Periprocedural cocaine use,often detected via a positive urine toxicology test,has been mostly addressed in the surgical and obstetrical literature.However,there are no clear guidelines on how to effectively risk stratify patients found to be positive for cocaine in the pre-operative setting,often leading to costly procedure cancellations.Within the field of gastroenterology,there is no current data available regarding safety of performing esophagogastroduodenoscopy(EGD)in patients with recent cocaine use.AIM To compare the prevalence of EGD related complications between active(≤5 d)and remote(>5 d)users of cocaine.METHODS In total,48 patients who underwent an EGD at John H.Stroger,Jr.Hospital of Cook County from October 2016 to October 2018 were found to have a positive urine drug screen for cocaine(23 recent and 25 remote).Descriptive statistics were compiled for patient demographics.Statistical tests used to analyze patient characteristics,procedure details,and preprocedural adverse events included ttest,chi-square,Wilcoxon rank sum,and Fisher exact test.RESULTS Overall,20 periprocedural events were recorded with no statistically significant difference in distribution between the two groups(12 active vs 8 remote,P=0.09).Pre-and post-procedure hemodynamics demonstrated only a statistically,but not clinically significant drop in systolic blood pressure and increase in heart rate in the active user group,as well as drop in diastolic blood pressure and oxygen saturation in the remote group(P<0.05).There were no significant differences in overall hemodynamics between both groups.CONCLUSION Our study found no significant difference in the rate of periprocedural adverse events during EGD in patients with recent vs remote use of cocaine.Interestingly,there were significantly more patients(30%)with active use of cocaine that required general anesthesia as compared to remote users(0%).展开更多
文摘Based on self-reported surveys conducted by the Substance Abuse and Mental Health Services Administration, cannabis use in pregnant females has increased over the years. Despite the increasing trend, the relationship between cannabis use and fetal outcomes is not fully understood. This review paper evaluates the literature investigating the short-term and long-term fetal outcomes resulting from cannabis use during pregnancy. Additionally, the risk of chronic marijuana use leading to cannabis hyperemesis syndrome has been highlighted in this paper using conclusions compiled from several case studies. Several studies linked delayed mental growth and reduced cognitive function with prenatal cannabis use, but the literature <span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">was</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> limited to lower-quality observational studies and could not establish causality. One systematic review investigated short-term outcomes of low birth rates and preterm deliveries, where marijuana use in conjunction with tobacco use was associated with more preterm deliveries. Another study found that six-year-old patients exposed to cannabis prenatally were more likely to score lower in different categories on the Stanford-Binet scale test, which measures intelligence. The exposure in the first, second, or third trimester was associated with lower composite or subcategory scores such as verbal reasoning or short-term memory. Despite these results, the studies evaluated had limitations. They could not establish a clear relationship between cannabis use and fetal outcomes, but the literature showed a similar pattern of health, social and economic inequities among the populations who self-reported cannabis and substance use and non-users. Current organization guidelines advise against the use of cannabis use during pregnancy due to mixed and limited literature. However, they emphasize the importance of the clinician in the public health efforts of education and resource-distribution in addressing these inequities.</span></span></span>
文摘<span style="font-family:""><span style="font-family:Verdana;">Here in the United States Cannabidiol (CBD) is legal in all 50 states if the Tetrahydrocannabinol (THC) concentration of the product is no more than 0.3%. The largest retailers of CBD in 2019 were located inCalifornia, Florida, and New York, which sold $730 million, $291 million, and $215 million, respectively. Of the patients who use CBD, the most common reasons for their use were pain, anxiety, and insomnia. As the use of CBD for the relief of different issues increases, it is important to assess the safety and efficacy of CBD as it pertains to drug-drug interactions, lab interactions, and its actual benefits. This subject of safety and efficacy is increasingly important as the use of CBD has increased, with approximately 64 million Americans having tried CBD between 2017 and 2019. In this article, we will discuss these different </span><span style="font-family:Verdana;">aspects of CBD use from the point of view of a pharmacist. Not only do</span><span style="font-family:Verdana;"> pharmacists commonly get questions on different aspects of CBD use, but they are also drug experts in areas including drug-drug interactions, drug toxicities, pharmacokinetics and pharmacodynamic profiles of medications, and guideline</span></span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">recommended therapeutic options. Although there is a limited amount of data, there is still accessible data that may serve to inform pharmacists to become aware of the safety and efficacy of CBD. This information will serve pharmacists to educate patients that CBD contains properties to be used in a variety of conditions such as Lennox-Gastaut Syndrome, Dravet Syndrome, pain, and sports enhancement.
文摘BACKGROUND Cocaine is a synthetic alkaloid initially viewed as a useful local anesthetic,but which eventually fell out of favor given its high addiction potential.Its predominantly sympathetic effects raise concern for cardiovascular,respiratory,and central nervous system complications in patients undergoing procedures.Periprocedural cocaine use,often detected via a positive urine toxicology test,has been mostly addressed in the surgical and obstetrical literature.However,there are no clear guidelines on how to effectively risk stratify patients found to be positive for cocaine in the pre-operative setting,often leading to costly procedure cancellations.Within the field of gastroenterology,there is no current data available regarding safety of performing esophagogastroduodenoscopy(EGD)in patients with recent cocaine use.AIM To compare the prevalence of EGD related complications between active(≤5 d)and remote(>5 d)users of cocaine.METHODS In total,48 patients who underwent an EGD at John H.Stroger,Jr.Hospital of Cook County from October 2016 to October 2018 were found to have a positive urine drug screen for cocaine(23 recent and 25 remote).Descriptive statistics were compiled for patient demographics.Statistical tests used to analyze patient characteristics,procedure details,and preprocedural adverse events included ttest,chi-square,Wilcoxon rank sum,and Fisher exact test.RESULTS Overall,20 periprocedural events were recorded with no statistically significant difference in distribution between the two groups(12 active vs 8 remote,P=0.09).Pre-and post-procedure hemodynamics demonstrated only a statistically,but not clinically significant drop in systolic blood pressure and increase in heart rate in the active user group,as well as drop in diastolic blood pressure and oxygen saturation in the remote group(P<0.05).There were no significant differences in overall hemodynamics between both groups.CONCLUSION Our study found no significant difference in the rate of periprocedural adverse events during EGD in patients with recent vs remote use of cocaine.Interestingly,there were significantly more patients(30%)with active use of cocaine that required general anesthesia as compared to remote users(0%).
