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Dexmedetomidine)
Frequently asked questions regarding alpha-2 agonist DEXDOMITOR® (dexmedetomidine) Q: How should I monitor a patient that has received DEXDOMITOR for sedation or as a premedication? A: The monitoring of vital signs is critical for any patient under sedation or anesthesia. It is important to monitor heart rate, blood pressure, palpable pulse quality, and respiratory rate and volume. Because a2 agonists cause peripheral vasoconstriction, the use of pulse oximetry may not adequately reflect the true status of the patient. Q: What can I expect to see in a patient under DEXDOMITOR sedation? A: The patient may have pale pink or grayish mucous membranes because of peripheral vasoconstriction. The sedation induced by DEXDOMITOR causes a decrease in respiratory rate and a lower body temperature. Q: What is considered a low heart rate? A: Because of the wide range of dog sizes and corresponding heart rates, normal heart rates should be based on the dog’s body size. A reduction in heart rate following a2 agonist sedation should be expected. Patient status should be evaluated by the simultaneous measurement of many parameters, including pulse quality, respiratory rate and quality, blood pressure, and heart rate. Q: What is the effect on the respiratory rate? A: DEXDOMITOR does not have a direct effect on respiration. Although the respiratory rate may decrease as a result of sedation, ventilatory volume generally increases, and overall ventilation (gas exchange) remains stable. Q: I am concerned about hypothermia. A: Hypothermia can occur in a patient following administration of any anesthetic or sedative drug. It is important that body temperature be maintained in all patients undergoing anesthesia or sedation, including those that receive an a2 agonist. -
Strategies for Managing Sexual Dysfunction Induced by Antidepressant Medication
King’s Research Portal DOI: 10.1002/14651858.CD003382.pub3 Document Version Publisher's PDF, also known as Version of record Link to publication record in King's Research Portal Citation for published version (APA): Taylor, M. J., Rudkin, L., Bullemor-Day, P., Lubin, J., Chukwujekwu, C., & Hawton, K. (2013). Strategies for managing sexual dysfunction induced by antidepressant medication. Cochrane Database of Systematic Reviews, (5). https://doi.org/10.1002/14651858.CD003382.pub3 Citing this paper Please note that where the full-text provided on King's Research Portal is the Author Accepted Manuscript or Post-Print version this may differ from the final Published version. If citing, it is advised that you check and use the publisher's definitive version for pagination, volume/issue, and date of publication details. And where the final published version is provided on the Research Portal, if citing you are again advised to check the publisher's website for any subsequent corrections. General rights Copyright and moral rights for the publications made accessible in the Research Portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognize and abide by the legal requirements associated with these rights. •Users may download and print one copy of any publication from the Research Portal for the purpose of private study or research. •You may not further distribute the material or use it for any profit-making activity or commercial gain •You may freely distribute the URL identifying the publication in the Research Portal Take down policy If you believe that this document breaches copyright please contact [email protected] providing details, and we will remove access to the work immediately and investigate your claim. -
The Opioid Epidemic: Crisis and Solutions
PA58CH09-Skolnick ARI 18 November 2017 9:40 Annual Review of Pharmacology and Toxicology The Opioid Epidemic: Crisis and Solutions Phil Skolnick Opiant Pharmaceuticals, Santa Monica, California 09401, USA; email: [email protected] Annu. Rev. Pharmacol. Toxicol. 2018. 58:143–59 Keywords First published as a Review in Advance on heroin, overdose, naloxone, vaccines, medication-assisted therapies, pain October 2, 2017 The Annual Review of Pharmacology and Toxicology Abstract by [email protected] on 01/16/18. For personal use only. is online at pharmtox.annualreviews.org The widespread abuse of prescription opioids and a dramatic increase in https://doi.org/10.1146/annurev-pharmtox- the availability of illicit opioids have created what is commonly referred to 010617-052534 as the opioid epidemic. The magnitude of this epidemic is startling: About Copyright c 2018 by Annual Reviews. 4% of the adult US population misuses prescription opioids, and in 2015, Annu. Rev. Pharmacol. Toxicol. 2018.58:143-159. Downloaded from www.annualreviews.org All rights reserved more than 33,000 deaths were attributable to overdose with licit and illicit opioids. Increasing the availability of medication-assisted treatments (such as buprenorphine and naltrexone), the use of abuse-deterrent formulations, and ANNUAL REVIEWS Further the adoption of US Centers for Disease Control and Prevention prescribing Click here to view this article's guidelines all constitute short-term approaches to quell this epidemic. How- online features: • Download figures as PPT slides ever, with more than 125 million Americans suffering from either acute or • Navigate linked references • Download citations chronic pain, the development of effective alternatives to opioids, enabled at • Explore related articles • Search keywords least in part by a fuller understanding of the neurobiological bases of pain, offers the best long-term solution for controlling and ultimately eradicating this epidemic. -
(12) United States Patent (10) Patent No.: US 7.803,838 B2 Davis Et Al
USOO7803838B2 (12) United States Patent (10) Patent No.: US 7.803,838 B2 Davis et al. (45) Date of Patent: Sep. 28, 2010 (54) COMPOSITIONS COMPRISING NEBIVOLOL 2002fO169134 A1 11/2002 Davis 2002/0177586 A1 11/2002 Egan et al. (75) Inventors: Eric Davis, Morgantown, WV (US); 2002/0183305 A1 12/2002 Davis et al. John O'Donnell, Morgantown, WV 2002/0183317 A1 12/2002 Wagle et al. (US); Peter Bottini, Morgantown, WV 2002/0183365 A1 12/2002 Wagle et al. (US) 2002/0192203 A1 12, 2002 Cho 2003, OOO4194 A1 1, 2003 Gall (73) Assignee: Forest Laboratories Holdings Limited 2003, OO13699 A1 1/2003 Davis et al. (BM) 2003/0027820 A1 2, 2003 Gall (*) Notice: Subject to any disclaimer, the term of this 2003.0053981 A1 3/2003 Davis et al. patent is extended or adjusted under 35 2003, OO60489 A1 3/2003 Buckingham U.S.C. 154(b) by 455 days. 2003, OO69221 A1 4/2003 Kosoglou et al. 2003/0078190 A1* 4/2003 Weinberg ...................... 514f1 (21) Appl. No.: 11/141,235 2003/0078517 A1 4/2003 Kensey 2003/01 19428 A1 6/2003 Davis et al. (22) Filed: May 31, 2005 2003/01 19757 A1 6/2003 Davis 2003/01 19796 A1 6/2003 Strony (65) Prior Publication Data 2003.01.19808 A1 6/2003 LeBeaut et al. US 2005/027281.0 A1 Dec. 8, 2005 2003.01.19809 A1 6/2003 Davis 2003,0162824 A1 8, 2003 Krul Related U.S. Application Data 2003/0175344 A1 9, 2003 Waldet al. (60) Provisional application No. 60/577,423, filed on Jun. -
A New Splice of Life for the Μ-Opioid Receptor
A new splice of life for the μ-opioid receptor Michael J. Iadarola, … , Matthew R. Sapio, Andrew J. Mannes J Clin Invest. 2015;125(7):2558-2561. https://doi.org/10.1172/JCI82060. Commentary μ-Opioid agonists mediate their analgesic effect through GPCRs that are generated via alternate splicing of theO prm1 transcript. While the majority of μ-opioids interact with receptors comprising the canonical 7 transmembrane (7TM) domain, a recently identified class of μ-opioids appears to require a 6TM domain variant. In this issue of the JCI, Lu and colleagues provide an in vivo proof-of-concept demonstration that a 6TM isoform of the μ-opioid receptor can support functional analgesia in Oprm1-deficent animals. The 6TM isoform was pharmacologically distinct from the canonical 7TM μ-opioid receptor, and 6TM agonists had a reduced side effect profile, which confers a strong therapeutic advantage over standard opioid analgesics. The observations of Lu et al. extend the reach of opioid-receptor neurobiology and pharmacology into a new era of analgesic discovery. This advance emerges from a series of fundamental research analyses in which elements of the endogenous opioid system were frequently in the vanguard. Find the latest version: https://jci.me/82060/pdf COMMENTARY The Journal of Clinical Investigation A new splice of life for the μ-opioid receptor Michael J. Iadarola, Matthew R. Sapio, and Andrew J. Mannes Department of Perioperative Medicine, Clinical Center, NIH, Bethesda, Maryland, USA. showed that morphine analgesia is due to expression of the μ-opioid receptor (14). μ-Opioid agonists mediate their analgesic effect through GPCRs that are More recently, the crystal structures of generated via alternate splicing of the Oprm1 transcript. -
The Promises of Opioids: Future and Present
The promises of opioids: Future and present Gavril W. Pasternak, MD PhD Anne Burnett Tandy Chair of Neurology Laboratory Hear, Molecular Pharmacology Program Memorial Sloan-Kettering Cancer Center and Professor of Pharmacology, Neurology & Neuroscience and Psychiatry Weill Cornell Medical College Dedication E. Leong Way (1915-2017) This talk is dedicated to Eddie Way Eddie provided a foundation for opioid pharmacology His work and insights have brought us to where we are today Pain “And only YOU can hear this whistle?” The study of pain is difficult due to its subjective nature and the unpredictable contributions of genetics Opioid analgesia Perception is a cortical and subcortical process Activation of Peripheral Opioid are active: Nociceptors • Spinally • Supraspinally Ascending • Peripherally Descending Pathway Modulatory Pathway There is synergy among sites: • Spinal/supraspinal • Systemic/spinal Synapse in dorsal horn and ascend through neo- and paleospinothalamic pathways. 4 Complexity of opioid analgesia Genetic backgrounds impact potency 100 Morphine 5 mg/kg Genetic backgrounds impact selectivity 80 60 40 20 Analgesia (% mice) of Analgesia 0 j HS CD-1 C57/+ CXBK Balb/c C57/bg SwissWebster Mouse Strain 5 Complexity of opioid analgesia 100 Genetic backgrounds impact potency *P <0.001 Genetic backgrounds impact selectivity 75 50 25 * 0 CD-1 CXBK 6 Why Mu Opioids Differ? • Different pharmacokinetics • Different metabolic profile • Differential function activation of the receptor (Biased Signaling) • Differential activation of subtypes -
Volume 25, Issue 8 April 23, 2020
April 23, 2020 Volume 25 Issue 8 SPECIAL EDITION COVID-19 Error-prone dose expression on label of COVID-19 Collaboration unapproved drug, ascorbic acid, from Mylan Tripping on extension tubing PROBLEM : A pharmacist received an order for 500 mg of intravenous (IV) ascorbic A COVID-19 patient was being treated in acid for a patient with coronavirus (COVID-19). Although this product was on an intensive care unit (ICU) in a negative formulary at the hospital, it was rarely used prior to the COVID-19 pandemic, and pressure room. An ICU nurse had seen a the pharmacist had never dispensed it. (In COVID-19 investigational trials, IV ascorbic post on social media about another facility acid is being used in much larger doses placing smart infusion pumps outside of [i.e., 10 or 12 g] after being added to an patient rooms to help minimize the use of appropriate diluent, with the theory that it personal protective equipment (PPE). She will hasten recovery.) decided to implement this workflow. She moved the infusion pump to an anteroom After selecting the available vial of ascorbic outside the patient’s negative pressure acid injection (Mylan), the pharmacist room, and used extension sets to run the noticed that the principal display panel on tubing under the door and to the patient. the carton and vial label indicated that it The patient was receiving intravenous contained 500 mg/mL ( Figure 1 ). This is in (IV) norepinephrine via the infusion pump conflict with USP <7>, which requires most to treat hypotension. The extension tubing medication labels to list the total amount of was on the floor and not secured to drug and volume in the vial (with the per Figure 1. -
Anesthesia and Analgesia in Laboratory Animals
GUIDELINES ON ANESTHESIA AND ANALGESIA IN LABORATORY ANIMALS University of South Florida provides the following guidelines for use by IACUC-certified faculty and staff. CONTENTS PAGE A. Background……………………………………………………….…………………………… 1 B. Definitions....……………………………………………………..…………………………….. 2 C. General Considerations……………………………………….,…………………………….. 3 D. Controlled Substances……………………………………….……………………………… 3 E. Pre-Anesthetic Treatments………………………………….………………………………. 4 F. General Anesthetics………………………………………….………………………………. 4 G. Neuromuscular Blocking Agents………………………….……………………………….. 5 H. Monitoring Anesthesia…………………………………….…………………………………. 6 I. Analgesics……………………………………………………………………………………… 7 J. Comments regarding Anesthetics and Analgesics……………………………………... 7 REFERENCE TABLES PAGE I. Signs of Pain and Distress in Laboratory Animals………………………………………… 10 II. Commonly Used Anesthetics and Analgesics for Mice….………..…...….………...…… 11 III. Commonly Used Anesthetics and Analgesics for Rats……………………………...…… 12 IV. Commonly Used Anesthetics and Analgesics for Gerbils……….……………..…….. 13 V. Commonly Used Anesthetics and Analgesics for Hamsters…….……………..……. 14 VI. Commonly Used Anesthetics and Analgesics for Guinea Pigs….…………….….……. 15 VII. Commonly Used Anesthetics and Analgesics for Rabbits.……...…………….………… 16 VIII. Commonly Used Anesthetics and Analgesics for Dogs.…………………….…………… 17 IX. Commonly Used Anesthetics and Analgesics for Cats.……………………..…………… 18 X. Commonly Used Anesthetics and Analgesics for Pigs ..……………..….………………..19 XI. Commonly Used Anesthetics and Analgesics -
Psychedelics in Psychiatry: Neuroplastic, Immunomodulatory, and Neurotransmitter Mechanismss
Supplemental Material can be found at: /content/suppl/2020/12/18/73.1.202.DC1.html 1521-0081/73/1/202–277$35.00 https://doi.org/10.1124/pharmrev.120.000056 PHARMACOLOGICAL REVIEWS Pharmacol Rev 73:202–277, January 2021 Copyright © 2020 by The Author(s) This is an open access article distributed under the CC BY-NC Attribution 4.0 International license. ASSOCIATE EDITOR: MICHAEL NADER Psychedelics in Psychiatry: Neuroplastic, Immunomodulatory, and Neurotransmitter Mechanismss Antonio Inserra, Danilo De Gregorio, and Gabriella Gobbi Neurobiological Psychiatry Unit, Department of Psychiatry, McGill University, Montreal, Quebec, Canada Abstract ...................................................................................205 Significance Statement. ..................................................................205 I. Introduction . ..............................................................................205 A. Review Outline ........................................................................205 B. Psychiatric Disorders and the Need for Novel Pharmacotherapies .......................206 C. Psychedelic Compounds as Novel Therapeutics in Psychiatry: Overview and Comparison with Current Available Treatments . .....................................206 D. Classical or Serotonergic Psychedelics versus Nonclassical Psychedelics: Definition ......208 Downloaded from E. Dissociative Anesthetics................................................................209 F. Empathogens-Entactogens . ............................................................209 -
Veterinary Anesthetic and Analgesic Formulary 3Rd Edition, Version G
Veterinary Anesthetic and Analgesic Formulary 3rd Edition, Version G I. Introduction and Use of the UC‐Denver Veterinary Formulary II. Anesthetic and Analgesic Considerations III. Species Specific Veterinary Formulary 1. Mouse 2. Rat 3. Neonatal Rodent 4. Guinea Pig 5. Chinchilla 6. Gerbil 7. Rabbit 8. Dog 9. Pig 10. Sheep 11. Non‐Pharmaceutical Grade Anesthetics IV. References I. Introduction and Use of the UC‐Denver Formulary Basic Definitions: Anesthesia: central nervous system depression that provides amnesia, unconsciousness and immobility in response to a painful stimulation. Drugs that produce anesthesia may or may not provide analgesia (1, 2). Analgesia: The absence of pain in response to stimulation that would normally be painful. An analgesic drug can provide analgesia by acting at the level of the central nervous system or at the site of inflammation to diminish or block pain signals (1, 2). Sedation: A state of mental calmness, decreased response to environmental stimuli, and muscle relaxation. This state is characterized by suppression of spontaneous movement with maintenance of spinal reflexes (1). Animal anesthesia and analgesia are crucial components of an animal use protocol. This document is provided to aid in the design of an anesthetic and analgesic plan to prevent animal pain whenever possible. However, this document should not be perceived to replace consultation with the university’s veterinary staff. As required by law, the veterinary staff should be consulted to assist in the planning of procedures where anesthetics and analgesics will be used to avoid or minimize discomfort, distress and pain in animals (3, 4). Prior to administration, all use of anesthetics and analgesic are to be approved by the Institutional Animal Care and Use Committee (IACUC). -
Truncated G Protein-Coupled Mu Opioid Receptor MOR-1 Splice Variants Are Targets for Highly Potent Opioid Analgesics Lacking Side Effects
Truncated G protein-coupled mu opioid receptor MOR-1 splice variants are targets for highly potent opioid analgesics lacking side effects Susruta Majumdara, Steven Grinnella, Valerie Le Rouzica, Maxim Burgmana, Lisa Polikara, Michael Ansonoffb, John Pintarb, Ying-Xian Pana, and Gavril W. Pasternaka,1 aMolecular Pharmacology and Chemistry Program and Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065; and bDepartment of Neuroscience and Cell Biology, Robert Wood Johnson Medical School, Piscataway, NJ 08854 Edited by Solomon H. Snyder, Johns Hopkins University School of Medicine, Baltimore, MD, and approved October 21, 2011 (received for review September 17, 2011) Pain remains a pervasive problem throughout medicine, transcend- administration. In addition to its high potency, IBNtxA also ing all specialty boundaries. Despite the extraordinary insights into displayed full efficacy, as indicated by most mice reaching cutoff pain and its mechanisms over the past few decades, few advances values at higher doses. We also assessed IBNtxA analgesia by have been made with analgesics. Most pain remains treated by using a graded response [percentage maximal possible effect (% opiates, which have significant side effects that limit their utility. MPE)] (Fig. S2). Its ED50 value (0.34 mg/kg; 95% confidence We now describe a potent opiate analgesic lacking the traditional limits: 0.23, 0.52) was very close to that with quantal responses side effects associated with classical opiates, including respiratory (Fig. 3A). Furthermore, IBNtxA analgesia was not limited to the fi depression, signi cant constipation, physical dependence, and, radiant heat tail-flick assay. IBNtxA was a potent analgesic in the perhaps most important, reinforcing behavior, demonstrating that hot plate assay (ED50 = 0.6 mg/kg) as well (Fig. -
Effect of Acute Administration of the 5-HT1A Receptor Ligand, Lesopitron, on Rat Cortical 5-HT and Dopamine Turnover 'M
Br. J. Pharmacol. (1994), 113, 425-430 IF" Macmillan Press Ltd, 1994 Effect of acute administration of the 5-HT1A receptor ligand, lesopitron, on rat cortical 5-HT and dopamine turnover 'M. Ballarin, A. Carceller & X. Guitart Neurochemistry Unit, C.N.S. Department, Laboratories Dr. Esteve, Avda. Mare de Deu de Montserrat 221, 08026 Barcelona, Spain 1 The involvement of presynaptic 5-hydroxytryptaminelA (5-HTIA) autoreceptors in the anxiolytic-like properties of lesopitron (E-4424) (2-{4-[4-(4-chloro-l-pyrazolyl)butyl]-l-piperazinyl)pyrimidine) was studied. Brain microdialysis was used to examine the effect of the drug on the release of 5- hydroxytryptamine (5-HT) and its metabolite 5-hydroxyindoleacetic acid (5-HIAA) in the frontal cortex of awake, freely moving rats. Moreover, extracellular cortical 3,4-dihydroxyphenylacetic acid (DOPAC) and homovanillic acid (HVA) were also studied to assess the possible participation of dopaminergic systems. 2 Lesopitron administered at a dose which induces anxiolytic behaviour in rats (30 ;Lg kg-', i.p.) markedly reduced 5-HT levels (to 45% of the basal value) in cortical perfusates, having no effect on 5-HIAA, DOPAC and HVA. The effects of lesopitron were compared with those produced by the anxiolytic, and structurally related compound, buspirone. 3 Buspirone administered at a dose inducing anxiolytic-like effects in rats (5 mg kg-', i.p.) produced a marked decrease in cortical 5-HT levels (to 20% of the basal value), but in contrast to lesopitron, buspirone produced a pronounced increase in cortical DOPAC (to 300% of the basal value) and HVA (to 400% of the basal value) levels.