Browsing by Author "Tormoehlen, Laura M."

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    ACMT Position Statement: Determining Brain Death in Adults After Drug Overdose
    (Springer Nature, 2017-09) Neavyn, Mark J.; Stolbach, Andrew; Greer, David M.; Nelson, Lewis S.; Smith, Silas W.; Brent, Jeffrey; Tormoehlen, Laura M.; Neurology, School of Medicine
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    Disparities and guideline adherence in drugs of abuse screening in intracerebral hemorrhage
    (American Academy of Neurology, 2017-01-17) Tormoehlen, Laura M.; Blatsioris, Ashley D.; Moser, Elizabeth A.S.; Carter, Ravan J.L.; Stevenson, Alec; Ofner, Susan; Hulin, Abigail L.; O’Neill, Darren P.; Cohen-Gadol, Aaron A.; Leipzig, Thomas J.; Williams, Linda S.; Mackey, Jason; Neurology, School of Medicine
    OBJECTIVE: To characterize the pattern of urine drug screening in a cohort of intracerebral hemorrhage (ICH) patients at our academic centers. METHODS: We identified cases of primary ICH occurring from 2009 to 2011 in our academic centers. Demographic data, imaging characteristics, processes of care, and short-term outcomes were ascertained. We performed logistic regression to identify predictors for screening and evaluated preguideline and postguideline reiteration screening patterns. RESULTS: We identified 610 patients with primary ICH in 2009-2011; 379 (62.1%) were initially evaluated at an outside hospital. Overall, 142/610 (23.3%) patients were screened, with 21 positive for cocaine and 3 for amphetamine. Of patients <55 years of age, only 65/140 (46.4%) were screened. Black patients <55 years of age were screened more than nonblack patients <55 years of age (38/61 [62.3%] vs 27/79 [34.2%]; p = 0.0009). In the best multivariable model, age group (p = 0.0001), black race (p = 0.4529), first Glasgow Coma Scale score (p = 0.0492), current smoking (p < 0.0001), and age group × black race (p = 0.0097) were associated with screening. Guideline reiteration in 2010 did not improve the proportion <55 years of age who were screened: 42/74 (56.8%) were screened before and 23/66 (34.9%) after (p = 0.01). CONCLUSIONS: We found disparities in drugs of abuse (DOA) screening and suboptimal guideline adherence. Systematic efforts to improve screening for DOA are warranted. Improved identification of sympathomimetic exposure may improve etiologic classification and influence decision-making and prognosis counseling.
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    The Pharmacology and Toxicology of Third-Generation Anticonvulsant Drugs
    (Springer Nature, 2017-12) LaPenna, Paul; Tormoehlen, Laura M.; Neurology, School of Medicine
    Epilepsy is a neurologic disorder affecting approximately 50 million people worldwide, or about 0.7% of the population [1]. Thus, the use of anticonvulsant drugs in the treatment of epilepsy is common and widespread. There are three generations of anticonvulsant drugs, categorized by the year in which they were developed and released. The aim of this review is to discuss the pharmacokinetics, drug-drug interactions, and adverse events of the third generation of anticonvulsant drugs. Where available, overdose data will be included. The pharmacokinetic properties of third-generation anticonvulsant drugs include relatively fewer drug-drug interactions, as well as several unique and life-threatening adverse events. Overdose data are limited, so thorough review of adverse events and knowledge of drug mechanism will guide expectant management of future overdose cases. Reporting of these cases as they occur will be necessary to further clarify toxicity of these drugs.