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78-462: When she was 21, Quinlan became unconscious after she consumed Valium along with alcohol while on a crash diet and lapsed into a coma, followed by a persistent vegetative state . After doctors refused the request of her parents (Joseph and Julia Quinlan) to disconnect Karen's ventilator, her parents filed suit to get her disconnected. The parents believed that her still being connected constituted extraordinary means of prolonging her life. Eventually

156-504: A grand jury . The Criminal Part also hears appeals from the New Jersey municipal courts for convictions for disorderly persons offenses and petty disorderly persons offenses (what New Jersey terms offenses called misdemeanors in other jurisdictions, which do not require a grand jury indictment), as well as traffic offenses (including driving while intoxicated ) and violations of municipal ordinances. The Chancery Division consists of

234-859: A suppository inserted into the rectum, intramuscularly (injected into muscle), intravenously (injection into a vein) or used as a nasal spray . When injected intravenously, effects begin in one to five minutes and last up to an hour. When taken by mouth, effects begin after 15 to 60 minutes. Common side effects include sleepiness and trouble with coordination. Serious side effects are rare. They include increased risk of suicide , decreased breathing, and an increased risk of seizures if used too frequently in those with epilepsy . Occasionally, excitement or agitation may occur. Long-term use can result in tolerance , dependence , and withdrawal symptoms on dose reduction. Abrupt stopping after long-term use can be potentially dangerous. After stopping, cognitive problems may persist for six months or longer. It

312-631: A better ability to permeate cells. The balance between its lipophilic and hydrophilic characteristics can impact various aspects of the molecule’s behavior, including its solubility, absorption, distribution, metabolism, and potential interactions within the biological system. Diazepam is overall a stable molecule. The British Pharmacopoeia lists it as being very slightly soluble in water, soluble in alcohol, and freely soluble in chloroform. The United States Pharmacopoeia lists diazepam as soluble 1 in 16 ethyl alcohol, 1 in 2 of chloroform, 1 in 39 ether , and practically insoluble in water. The pH of diazepam

390-558: A bikini). For these reasons (and the frequent nostalgic references to events from the 1970s in Coupland's works), the character is thought to be based on Quinlan. Donna Levin ’s novel Extraordinary Means is a literary fantasy in which a young woman, although diagnosed in an irreversible coma, also brought on by an accidental combination of drugs and alcohol, is able to observe her family members debate over whether or not to withdraw life support. Valium Diazepam , sold under

468-495: A central clerk's office that processes the filing of notices of appeal, briefs, motions and other papers. An appeal of a final order in New Jersey must be filed within 45 days. Appeals from interlocutory orders may be made at any time before final judgment. The Rules Governing the Courts of New Jersey provide for the use of certain post-nominal letters after the names of judges. Superior Court judges for whom no other designation

546-418: A court ruled that the ventilator could be withdrawn. However, she continued to breathe on her own. She survived another nine years in a persistent vegetative state. Quinlan's case continues to raise important questions in moral theology , bioethics , euthanasia , legal guardianship and civil rights . Her case has affected the practice of medicine and law around the world. A significant outcome of her case

624-404: A degree of polarity or hydrophilicity and represents the collective surface area of polar atoms, like oxygen or nitrogen, along with their connected hydrogen atoms. A TPSA value of 32,7 Ų signifies a moderate level of polarity within the compound. TPSA is especially useful in medical chemistry as it shows the ability of a molecule to permeate cells. Molecules with PSA value smaller than 60-70 Ų has

702-548: A dress that she had bought. On April 15, 1975, a few days after moving into her new house, Quinlan attended a friend's birthday party at a local bar, then known as Falconer's Lackawanna Inn, on Lake Lackawanna in Byram. She had eaten almost nothing for two days. At the party, she reportedly drank several gin and tonics and took Valium . Shortly afterwards, she felt faint and was quickly taken home and put to bed. When friends checked on her about 15 minutes later, they found that she

780-437: A higher rate of notable withdrawal symptoms, up to 100%. Rebound anxiety , more severe than baseline anxiety, is also a common withdrawal symptom when discontinuing diazepam or other benzodiazepines. Diazepam is therefore only recommended for short-term therapy at the lowest possible dose owing to risks of severe withdrawal problems from low doses even after gradual reduction. The risk of pharmacological dependence on diazepam

858-453: A higher rate of terminating seizures and a more prolonged anticonvulsant effect. Diazepam gel was better than placebo gel in reducing the risk of non-cessation of seizures. Diazepam is rarely used for the long-term treatment of epilepsy because tolerance to its anticonvulsant effects usually develops within six to twelve months of treatment, effectively rendering it useless for that purpose. The anticonvulsant effects of diazepam can help in

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936-494: A history of a substance use disorder , such as an alcohol use disorder , or a history of aggressive behavior. In some people, diazepam may increase the propensity toward self-harming behavior and, in extreme cases, may provoke suicidal tendencies or acts. Very rarely dystonia can occur. Diazepam may impair the ability to drive vehicles or operate machinery. The impairment is worsened by consumption of alcohol, because both act as central nervous system depressants . During

1014-414: A long half-life thus withdrawal symptoms are tolerable. The process is very slow (usually from 14 to 28 weeks) but is considered safe when done appropriately. An individual who has consumed too much diazepam typically displays one or more of these symptoms in a period of approximately four hours immediately following a suspected overdose: Although not usually fatal when taken alone, a diazepam overdose

1092-672: A long-acting "classical" benzodiazepine. Other classical benzodiazepines include chlordiazepoxide , clonazepam , lorazepam , oxazepam , nitrazepam , temazepam , flurazepam , bromazepam , and clorazepate . Diazepam has anticonvulsant properties. Benzodiazepines act via micromolar benzodiazepine binding sites as calcium channel blockers and significantly inhibit depolarization-sensitive calcium uptake in rat nerve cell preparations. Diazepam inhibits acetylcholine release in mouse hippocampal synaptosomes . This has been found by measuring sodium-dependent high-affinity choline uptake in mouse brain cells in vitro , after pretreatment of

1170-458: A patient's life. Such means are any procedure that might place an undue burden on the patient, family, or others and would not result in reasonable hope of benefiting the patient. A person or a person's representative in cases if a person is not able to decide can refuse extraordinary means of treatment even if that will hasten natural death, and it is considered ethical. It is to that principle that Quinlan's parents appealed when they requested that

1248-658: A result of complications from pneumonia on June 11, 1985, in Morris Plains, New Jersey. Upon learning that Quinlan was expected to die, her parents requested that no extraordinary means be used to revive her. Quinlan weighed 65 lb (29 kg) at the time of her death. Quinlan was buried at the Gate of Heaven Cemetery in East Hanover, New Jersey . Joseph and Julia Quinlan opened a hospice and memorial foundation in 1980 to honor their daughter's memory. Her court case

1326-610: A slow and gradual dose reduction regimen. Tolerance develops to the therapeutic effects of benzodiazepines; for example tolerance occurs to the anticonvulsant effects and as a result benzodiazepines are not generally recommended for the long-term management of epilepsy. Dose increases may overcome the effects of tolerance, but tolerance may then develop to the higher dose and adverse effects may increase. The mechanism of tolerance to benzodiazepines includes uncoupling of receptor sites , alterations in gene expression , down-regulation of receptor sites , and desensitisation of receptor sites to

1404-681: A song "Pull the Plug" from their 1st studio album, "Starz", that paralleled Quinlan's story. The 1977 TV movie In the Matter of Karen Ann Quinlan was made about the Quinlan case, with Piper Laurie and Brian Keith playing Quinlan's parents. The title character of Douglas Coupland 's novel Girlfriend in a Coma is Karen Ann McNeil. She collapses after a party where she has taken Valium as well as some alcohol. Like Quinlan, she has deliberately stopped eating in order to fit into an outfit (in this case,

1482-586: Is also the only Chancery Division part to hear appeals from the municipal courts; a party may appeal to the Family Part from the grant or denial of a temporary domestic-violence restraining order in the municipal courts. The Clerk of the Superior Court is appointed by the Supreme Court and heads the centralized clerk's office; however, most pleadings are filed in the county in which the action

1560-677: Is assigned to the General Equity Part, although the Assignment Judge of the vicinage may also hear general equity cases. The Probate Part handles contested probate matters, guardianships etc. Usually the General Equity judge handles the probate calendar on a weekly or less frequent basis. The county surrogate acts as the deputy clerk of the Superior Court for the Probate Part in the county. The Family Part

1638-620: Is considered a medical emergency and generally requires the immediate attention of medical personnel. The antidote for an overdose of diazepam (or any other benzodiazepine) is flumazenil (Anexate). This drug is only used in cases with severe respiratory depression or cardiovascular complications. Because flumazenil is a short-acting drug, and the effects of diazepam can last for days, several doses of flumazenil may be necessary. Artificial respiration and stabilization of cardiovascular functions may also be necessary. Though not routinely indicated, activated charcoal can be used for decontamination of

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1716-555: Is designed to provide expedited and somewhat relaxed proceedings in smaller cases. The Special Civil Part has its own clerk in each county (rather than relying upon the Superior Court clerk's office) and many forms are available. The Criminal Part handles criminal cases for "crimes" or "indictable offenses" (what New Jersey terms offenses called felonies in other jurisdictions), which the New Jersey Constitution provides may only be brought by an indictment issued by

1794-401: Is given for longer than 24 hours. Sedatives and sleeping pills, including diazepam, have been associated with an increased risk of death. In September 2020, the U.S. Food and Drug Administration (FDA) required the boxed warning be updated for all benzodiazepine medicines to describe the risks of abuse, misuse, addiction, physical dependence, and withdrawal reactions consistently across all

1872-417: Is linked to legal changes and hospital practices involving the right to refuse extraordinary means of treatment, even if cessation of treatment could end a life. When Quinlan was alive, the extent of damage to her brain stem could not be precisely determined. After she died, her entire brain and spinal cord were studied carefully. While her cerebral cortex had moderate scarring, it seemed that her thalamus

1950-461: Is moderately lipophilic with LogP (Octanol-Water Partition Coefficient) value of 2,82 and hydrophilic with a TPSA (Topological Polar Surface Area) value of 32.7 Ų. The LogP value indicates that diazepam has a tendency to dissolve more readily in lipid-based environments, such as chloroform, acetone, ethanol and ether, compared to water. While the TPSA value implies that a segment of the molecule exhibits

2028-576: Is neutral (i.e., pH = 7). Due to additives such as benzoic acid/benzoate in the injectable form. Diazepam has a shelf life of five years for oral tablets and three years for IV/IM solutions. Diazepam should be stored at room temperature (15–30 °C). The solution for parenteral injection should be protected from light and kept from freezing. The oral forms should be stored in air-tight containers and protected from light. Diazepam can absorb into plastics, so liquid preparations should not be kept in plastic bottles or syringes, etc. As such, it can leach into

2106-596: Is not impaired. Short-term benzodiazepine use does not lead to tolerance, and the elderly are more sensitive to them. Additionally, after stopping benzodiazepines, cognitive problems may last at least six months; it is unclear if these problems last for longer than six months or are permanent. Benzodiazepines may also cause or worsen depression. Infusions or repeated intravenous injections of diazepam when managing seizures, for example, may lead to drug toxicity, including respiratory depression, sedation and hypotension . Drug tolerance may also develop to infusions of diazepam if it

2184-544: Is not recommended during pregnancy or breastfeeding. Its mechanism of action works by increasing the effect of the neurotransmitter gamma -aminobutyric acid (GABA). Diazepam was patented in 1959 by Hoffmann-La Roche . It has been one of the most frequently prescribed medications in the world since its launch in 1963. In the United States it was the best-selling medication between 1968 and 1982, selling more than 2   billion tablets in 1978 alone. In 2022, it

2262-457: Is not recommended. People suspected of being dependent on benzodiazepine drugs should be very gradually tapered off the drug. Withdrawals can be life-threatening, particularly when excessive doses have been taken for extended periods of time. Equal prudence should be used whether dependence has occurred in therapeutic or recreational contexts. Diazepam is a good choice for tapering for those using high doses of other benzodiazepines since it has

2340-411: Is not the only drug to target these GABA A receptors. Drugs such as flumazenil also bind to GABA A to induce their effects. Diazepam appears to act on areas of the limbic system , thalamus , and hypothalamus , inducing anxiolytic effects. Benzodiazepine drugs including diazepam increase the inhibitory processes in the cerebral cortex . New Jersey Superior Court The Superior Court

2418-729: Is significant, and patients experience symptoms of benzodiazepine withdrawal syndrome if it is taken for six weeks or longer. In humans, tolerance to the anticonvulsant effects of diazepam occurs frequently. Improper or excessive use of diazepam can lead to dependence . At a particularly high risk for diazepam misuse, substance use disorder or dependence are: Patients from the aforementioned groups should be monitored very closely during therapy for signs of abuse and development of dependence. Therapy should be discontinued if any of these signs are noted, although if dependence has developed, therapy must still be discontinued gradually to avoid severe withdrawal symptoms. Long-term therapy in such instances

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2496-545: Is the state court in the U.S. state of New Jersey , with statewide trial and appellate jurisdiction. The New Jersey Constitution of 1947 establishes the power of the New Jersey courts: under Article Six of the State Constitution, "judicial power shall be vested in a Supreme Court, a Superior Court, and other courts of limited jurisdiction." The Superior Court has three divisions: the Law Division which

2574-488: Is the assignment judge. The General Equity, Family, Civil and Criminal Parts in each vicinage are headed by a presiding judge. "[T]he State Constitution established the Appellate Division as the upper tier of the Superior Court." "The Appellate Division was created as part of the judicial revision that took place as a result of the 1947 Constitution. Prior to 1947, the structure of the judiciary in New Jersey

2652-541: Is the main trial court for cases of civil or criminal law , the Chancery Division, which tries equity law cases, and the Appellate Division , which is the intermediate appellate court in New Jersey. "Appeals may be taken to the Appellate Division of the Superior Court from the law and chancery divisions of the Superior Court and in such other causes as may be provided by law." Each division of

2730-1060: Is typically issued to service members, along with three Mark I NAAK kits, when operating in circumstances where chemical weapons in the form of nerve agents are considered a potential hazard. Both of these kits deliver drugs using autoinjectors . They are intended for use in "buddy aid" or "self aid" administration of the drugs in the field prior to decontamination and delivery of the patient to definitive medical care. Use of diazepam should be avoided, when possible, in individuals with: Benzodiazepines, such as diazepam, can cause anterograde amnesia , confusion, and sedation . The elderly are more prone to diazepam's confusion, amnesia, ataxia, hangover symptoms, and falls. Long-term use of benzodiazepines, such as diazepam, induces tolerance, dependency, and withdrawal syndrome. Like other benzodiazepines, diazepam impairs short-term memory and learning new information. Diazepam and other benzodiazepines can produce anterograde amnesia, but not retrograde amnesia . It means information learned before using benzodiazepines

2808-608: Is venued with the Deputy Clerk, Superior Court, for the county. For administrative purposes, the State is divided into fifteen numbered vicinages. Most vicinages comprise a single county, but there are two vicinages that consist of two counties (Atlantic & Cape May Counties and Morris & Sussex Counties) and two vicinages that consist of three counties (Somerset, Hunterdon & Warren Counties and Gloucester, Cumberland & Salem County). The head of judiciary in each county

2886-428: The muscle relaxant effects of benzodiazepines such as diazepam. Baclofen is sometimes used as an alternative to diazepam. Diazepam is marketed in over 500 brands throughout the world. It is supplied in oral, injectable, inhalation, and rectal forms. The United States military employs a specialized diazepam preparation known as Convulsive Antidote, Nerve Agent ( CANA ), which contains diazepam. One CANA kit

2964-451: The 'P'-conformer and 'M'-conformer. Diazepam is an equimolar mixture and it was shown through CD spectra in serum protein solutions, that the 'P'-conformer is preferred by α1-acid glycoprotein binding. The drug diazepam occurs as a pale yellow-white crystalline powder without distinctive smell and has a low molecular weight (MW = 284.74 g/mol ). This classic aryl 1,4-benzodiazepine possesses three acceptors and no hydrogen bond donors. Diazepam

3042-478: The Chief Justice shall from time to time designate." Judges are rotated among the parts on an annual basis. "Each Part is headed by a presiding judge, who is properly addressed as 'Presiding Judge, Appellate Division.' The most senior judges of the Appellate Division serve as presiding judges of the various Parts[.]" Unlike the federal and some other state appellate courts, appeals are not allocated among

3120-608: The Civil, Special Civil and Criminal Parts. The Civil Part has jurisdiction over all civil cases where the principal relief requested is sought at law (i.e. in the form of money damages ), and it may grant incidental equitable relief so that a case may be fully decided in one forum. Generally, civil actions are assigned by case type into one of four tracks. The four tracks range from Track I allowing 150 days for discovery to Track IV allowing 450 days for discovery and requiring active case management by an individual judge. Effective in 2015,

3198-480: The GABA type A receptors ( GABA A ). The GABA A receptors are ligand-gated chloride-selective ion channels that are activated by GABA , the major inhibitory neurotransmitter in the brain. Binding of benzodiazepines to this receptor complex promotes the binding of GABA, which in turn increases the total conduction of chloride ions across the neuronal cell membrane. This increased chloride ion influx hyperpolarizes

Karen Ann Quinlan - Misplaced Pages Continue

3276-457: The General Equity, Probate and Family Parts. Chancery cases deal with cases where equitable relief is sought: that is, cases where one of the parties desires an injunction or other order requiring the other party/parties to do something other than pay money. The General Equity Part handles civil cases where the primary relief sought is equitable in nature, although it may grant incidental relief at law (damages). In most vicinages, only one judge

3354-510: The Morris County, New Jersey prosecutor of homicide charges being brought against them if they complied with the parents' request, joined with the Quinlan family in seeking an appropriate protective order from the courts before it would allow the ventilator to be removed. The Quinlans filed a suit on September 12, 1975, to request the extraordinary means prolonging Karen Ann Quinlan's life to be terminated. The Quinlans' lawyers argued that

3432-631: The Mykroy Ceramics Corporation in Ledgewood, New Jersey , from 1972 to 1974, and worked several jobs over the next year. Quinlan was a singer, and her parents characterized her as a tomboy. In April 1975, shortly after she turned 21, Quinlan left her parents' home and moved with two roommates into a house a few miles away in Byram Township, New Jersey . Around the same time, she went on a radical diet, reportedly to fit into

3510-537: The New Jersey Supreme Court added a Complex Business Litigation Program (CBLP) to the Law Division. The CBLP is a type of business court , falling within Track IV. It has a specially defined jurisdiction focusing on commercial disputes, with assignment to a single judge. The Special Civil Part essentially succeeded to the jurisdiction of the former county district courts. Cases may be filed in

3588-585: The Special Civil Part where the amount in controversy does not exceed $ 15,000 (or more if the plaintiff waives the excess). It also has a small claims section for cases involving less than $ 3000 and a landlord-tenant section to adjudicate summary dispossess actions. Natural persons may act pro se . Corporations and other business entities must hire an attorney except for cases cognizable in small claims, where an authorized nonlawyer officer or employee may generally appear. The Special Civil Part

3666-583: The Superior Court is divided into various Parts." The various Superior Courts in New Jersey are divided into 15 districts called "vicinages". Judges of the Superior Court are appointed by the Governor and confirmed by the State Senate for initial terms of seven years. If reappointed before the expiration of the initial term, the judge is said to have tenure and can serve until the mandatory judicial retirement age of 70. The Law Division consists of

3744-403: The anticonvulsant effects. Because of its relatively long duration of action, and evidence of safety and efficacy, diazepam is preferred over other benzodiazepines for treatment of persons experiencing moderate to severe alcohol withdrawal. An exception to this is when a medication is required intramuscular in which case either lorazepam or midazolam is recommended. Diazepam is used for

3822-400: The brand name Valium among others, is a medicine of the benzodiazepine family that acts as an anxiolytic . It is used to treat a range of conditions, including anxiety , seizures , alcohol withdrawal syndrome , muscle spasms , insomnia , and restless legs syndrome . It may also be used to cause memory loss during certain medical procedures. It can be taken orally (by mouth), as

3900-754: The course of therapy, tolerance to the sedative effects usually develops, but not to the anxiolytic and myorelaxant effects. Patients with severe attacks of apnea during sleep may experience respiratory depression (hypoventilation), leading to respiratory arrest and death. Diazepam in doses of 5 mg or more causes significant deterioration in alertness performance combined with increased feelings of sleepiness. Diazepam, as with other benzodiazepine drugs, can cause tolerance, physical dependence, substance use disorder , and benzodiazepine withdrawal syndrome . Withdrawal from diazepam or other benzodiazepines often leads to withdrawal symptoms similar to those seen during barbiturate or alcohol withdrawal. The higher

3978-414: The decision to treat febrile seizures (which are benign in nature) with medication should use this as part of the evaluation. Long-term use of diazepam for the management of epilepsy is not recommended; however, a subgroup of individuals with treatment-resistant epilepsy benefit from long-term benzodiazepines, and for such individuals, clorazepate has been recommended due to its slower onset of tolerance to

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4056-554: The dose and the longer the drug is taken, the greater the risk of experiencing unpleasant withdrawal symptoms. Withdrawal symptoms can occur from standard dosages and also after short-term use, and can range from insomnia and anxiety to more serious symptoms, including seizures and psychosis. Withdrawal symptoms can sometimes resemble pre-existing conditions and be misdiagnosed. Diazepam may produce less intense withdrawal symptoms due to its long elimination half-life . Benzodiazepine treatment should be discontinued as soon as possible by

4134-482: The effect of GABA. About one-third of individuals who take benzodiazepines for longer than four weeks become dependent and experience withdrawal syndrome on cessation. Differences in rates of withdrawal (50–100%) vary depending on the patient sample. For example, a random sample of long-term benzodiazepine users typically finds around 50% experience few or no withdrawal symptoms, with the other 50% experiencing notable withdrawal symptoms. Certain select patient groups show

4212-471: The emergency treatment of eclampsia , when IV magnesium sulfate and blood-pressure control measures have failed. Benzodiazepines do not have any pain-relieving properties themselves, and are generally recommended to avoid in individuals with pain. However, benzodiazepines such as diazepam can be used for their muscle-relaxant properties to alleviate pain caused by muscle spasms and various dystonias , including blepharospasm . Tolerance often develops to

4290-548: The extraordinary means of a ventilator be removed, citing a declaration by Pope Pius XII from 1957. After her parents disconnected her ventilator, in May 1976, following the successful appeal, Quinlan's parents continued to allow Quinlan to be fed with a feeding tube. Since that did not cause Quinlan pain, her parents did not consider it extraordinary means. Quinlan continued in a persistent vegetative state for slightly more than nine years, until her death from respiratory failure as

4368-492: The hospital and as follow-up. Overdoses of diazepam with alcohol, opiates, or other depressants may be fatal. If diazepam is administered concomitantly with other drugs, attention should be paid to the possible pharmacological interactions. Particular care should be taken with drugs that potentiate the effects of diazepam, such as barbiturates, phenothiazines , opioids , and antidepressants . Diazepam does not increase or decrease hepatic enzyme activity, and does not alter

4446-457: The hospital. Quinlan had suffered irreversible brain damage after she had experienced an extended period of respiratory failure , lasting no more than 15–20 minutes. No precise cause of her respiratory failure has been given. Her brain was damaged to the extent that she entered a persistent vegetative state . Her eyes were "disconjugate" (they no longer moved in the same direction together). Her EEG showed only abnormal slow-wave activity. Over

4524-415: The medicines in the class. Diazepam has a range of side effects common to most benzodiazepines, including: Less commonly, paradoxical reactions can occur, including nervousness, irritability, excitement, worsening of seizures, insomnia, muscle cramps, changes in libido , and in some cases, rage and violence. These adverse reactions are more likely to occur in children, the elderly, and individuals with

4602-400: The metabolism of other compounds. No evidence would suggest diazepam alters its own metabolism with chronic administration. Agents with an effect on hepatic cytochrome P450 pathways or conjugation can alter the rate of diazepam metabolism. These interactions would be expected to be most significant with long-term diazepam therapy, and their clinical significance is variable. Diazepam is

4680-452: The mice with diazepam in vivo . This may play a role in explaining diazepam's anticonvulsant properties. Diazepam binds with high affinity to glial cells in animal cell cultures. Diazepam at high doses has been found to decrease histamine turnover in mouse brain via diazepam's action at the benzodiazepine-GABA receptor complex. Diazepam also decreases prolactin release in rats. Benzodiazepines are positive allosteric modulators of

4758-487: The neuron's membrane potential . As a result, the difference between resting potential and threshold potential is increased and firing is less likely. As a result, the arousal of the cortical and limbic systems in the central nervous system is reduced. The GABA A receptor is a heteromer composed of five subunits, the most common ones being two αs, two βs, and one γ (α2β2γ). For each subunit, many subtypes exist (α1–6, β1–3, and γ1–3). GABA A receptors containing

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4836-562: The next few months, she remained in the hospital and her condition gradually deteriorated. She lost weight and eventually weighed less than 80 pounds (36 kg). She was prone to unpredictable, violent thrashing of her limbs. She was given nasogastric feeding and a ventilator to help her breathe. Quinlan's parents, Joseph Quinlan and Julia Quinlan, requested that she be disconnected from her ventilator, which they believed constituted extraordinary means of prolonging her life because it caused her pain. Hospital officials, faced with threats from

4914-471: The parents’ right to make a private decision about their daughter's fate superseded the state's right to keep her alive, and her court-appointed guardian argued that disconnecting her ventilators would be homicide. The request was denied by New Jersey Superior Court Judge Robert Muir Jr. in November 1975. He cited that Quinlan's doctors did not support removing her from the ventilator; whether or not to do so

4992-544: The parts on a territorial basis and Appellate Division precedent is equally binding statewide. One of the judges on each part is designated as the presiding judge and there is an overall presiding judge for administration. Appeals are decided by a panel of two or three judges from the part to which the appeal is assigned. If the Supreme Court has less than seven members available to hear a case, either because of vacancies or recusals, senior Appellate Division judges may be assigned to serve temporarily. The Appellate Division has

5070-523: The plastic bags and tubing used for intravenous infusions. Absorption appears to depend on several factors, such as temperature, concentration, flow rates, and tube length. Diazepam should not be administered if a precipitate has formed and does not dissolve. Diazepam is mainly used to treat anxiety, insomnia, panic attacks and symptoms of acute alcohol withdrawal. It is also used as a premedication for inducing sedation, anxiolysis, or amnesia before certain medical procedures (e.g., endoscopy ). In 2020, it

5148-415: The risk of seizure induced brain and cardiac damage. Dosages should be determined on an individual basis, depending on the condition being treated, severity of symptoms, patient body weight, and any other conditions the person may have. Intravenous diazepam or lorazepam are first-line treatments for status epilepticus. However, intravenous lorazepam has advantages over intravenous diazepam, including

5226-719: The stomach following a diazepam overdose. Emesis is contraindicated. Dialysis is minimally effective. Hypotension may be treated with levarterenol or metaraminol . The oral LD 50 (lethal dose in 50% of the population) of diazepam is 720 mg/kg in mice and 1240 mg/kg in rats. D. J. Greenblatt and colleagues reported in 1978 on two patients who had taken 500 mg and 2000 mg of diazepam, respectively, went into moderately-deep comas, and were discharged within 48 hours without having experienced any important complications, in spite of having high concentrations of diazepam and its metabolites desmethyldiazepam , oxazepam, and temazepam, according to samples taken in

5304-422: The treatment of seizures due to a drug overdose or chemical toxicity as a result of exposure to sarin , VX , or soman (or other organophosphate poisons), lindane , chloroquine , physostigmine , or pyrethroids . Diazepam is sometimes used intermittently for the prevention of febrile seizures that may occur in children under five years of age. Recurrence rates are reduced, but side effects are common so

5382-468: The α1 subunit mediate the sedative, the anterograde amnesic, and partly the anticonvulsive effects of diazepam. GABA A receptors containing α2 mediate the anxiolytic actions and to a large degree the myorelaxant effects. GABA A receptors containing α3 and α5 also contribute to benzodiazepines myorelaxant actions, whereas GABA A receptors comprising the α5 subunit were shown to modulate the temporal and spatial memory effects of benzodiazepines. Diazepam

5460-535: Was a medical, rather than a judicial, decision; and doing so would violate New Jersey homicide statutes. The Quinlans' attorneys, Paul W. Armstrong and James M. Crowley, appealed the decision to the New Jersey Supreme Court . On March 31, 1976, the court granted their request, holding that the right to privacy was broad enough to encompass the Quinlans' request on Quinlan's behalf. When Quinlan

5538-468: Was approved for use in the United States as a nasal spray to interrupt seizure activity in people with epilepsy . Diazepam is the most commonly used benzodiazepine for "tapering" benzodiazepine dependence due to the drug's comparatively long half-life, allowing for more efficient dose reduction. Benzodiazepines have a relatively low toxicity in overdose. Diazepam has a number of uses, including: Used in treatment of organophosphate poisoning and reduces

5616-432: Was created when the State Constitution was amended to eliminate the juvenile and domestic relations courts in each county and so it has the distinction of being the only part specifically mandated by the constitution. The Family Part is responsible for all cases arising out of marriage (or marriage-like) relationships, cases about the parentage, custody, or support of children, juvenile matters and domestic violence cases. It

5694-427: Was extensively damaged bilaterally. Her brain stem , which controls breathing and cardiac functions, was undamaged. The findings suggest that the thalamus plays a particularly important role in consciousness. The Quinlans published two books about the case: Karen Ann: The Quinlans Tell Their Story (1977) and My Joy, My Sorrow: Karen Ann's Mother Remembers (2005). In 1976 The band Starz (formerly Looking Glass) wrote

5772-672: Was extremely complex, including 'a court of errors and appeals in the last resort in all causes . . .; a court for the trial of impeachments; a court of chancery; a prerogative court; a supreme court; circuit courts, and such inferior courts as now exist, and as may be hereafter ordained and established by law . . .'" The Appellate Division hears appeals from the Law and Chancery Divisions and final decisions of State administrative agencies. There are eight parts, designated "A" through "H," and each part has three or four judges. "The Appellate Division shall consist of such parts with such number of judges as

5850-581: Was not breathing. An ambulance was called, and mouth-to-mouth resuscitation was attempted. Eventually, some color returned to her pallid skin, but she did not regain consciousness. Quinlan was admitted in a coma to Newton Memorial Hospital in Newton, New Jersey . She remained there for nine days in an unresponsive condition before she was transferred to Saint Clare's Hospital , a larger facility in Denville. Quinlan weighed 115 pounds (52 kg) when admitted to

5928-593: Was removed from her ventilator in May 1976, she surprised many by continuing to breathe unaided. Her parents never sought to have her feeding tube removed. "We never asked to have her die. We just asked to have her put back in a natural state so she could die in God's time," Julia Quinlan said. She was moved to a nursing home. Quinlan was fed by artificial nutrition for nine more years until her death from respiratory failure on June 11, 1985. Catholic moral theology does not require that "extraordinary means" be employed to preserve

6006-495: Was the 169th most commonly prescribed medication in the United States, with more than 3   million prescriptions. In 1985, the patent ended, and there are more than 500 brands available on the market. It is on the World Health Organization's List of Essential Medicines . Diazepam does not possess any chiral centers in its structure, but it does have two conformers . The two conformers mentioned were

6084-708: Was the development of formal ethics committees in hospitals, nursing homes and hospices. Quinlan was born on March 29, 1954, in Scranton, Pennsylvania , to a young woman of Irish American ancestry. A few weeks later, she was adopted by Joseph and Julia Quinlan, devout Roman Catholics who lived in the Landing section of Roxbury Township, New Jersey . Julia and Joseph also had daughter Mary Ellen in 1956 and son John in 1957. Quinlan attended Morris Catholic High School in Denville, New Jersey . After graduation, she worked at

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