DOCSLIB.ORG

Osher MMS. Opioid Prescription. Crisis and Opportunity. 2016

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Osher MMS. Opioid Prescription. Crisis and Opportunity. 2016 # - .-$+/$*)+$*$+$ ($= -$.$.:++*-/0)$/4 () >$0; ..$./)/-*! ..*- )$1 -.$/4*!'$!*-)$@)-)$.* $))" ( )/ )/ - $- /*-*!0/ $) -1$ . -()>)$0Q0.!>Q 0 +$ ($B !!%$' - ' $. S /#. /#/ 0( -*! /#. '/ /* +$*$.L @UTM$)/# VTUY $& '1$1$-$ G'1$1$-0. Z aT>TU^B )$/ // .!-*(VTTT@VTUX )/ -.!*-$. *)/-*':- 1 )/$*) VTUX *' $'*1$-$ G*'1$-0. UU;WUZ [T^ VTTV *-*)1$-$ G [[Y ]>Z^ 1 - 0/ *-*)1$-0. .+$-/*-4.+$-/*-44)-*(4)-*( /0-') ($@4)/# /$ /-*1$-$ G )/$1$-0. U]Y]@ G W];TTT;TTT YT^ +$*$. -*$) -/#*(43*1$-0.G U]U\ UU )90 )5 )90 )5 [Y;TTT;TTT V>Y^ VTUX +$*$. V\;ZX[L))0(M >TT]^ /#*) 4)/# /$. *-' '/#-")$5/$*)*((0)$' $. 0-1 $'') ) .+*). @$& > N )*($)/*-./$''0) / -($) !*- /#/ *-' '/#-")$5/$*)*((0)$' $. 0-1 $'') ) .+*). @ .$/# />#//+=GG222>>"*1G.-.G*0/[email protected].>#/(' *-' '/#-")$5/$*)*((0)$' $. 0-1 $'') ) .+*). @*'>#//+=GG222>2#*>$)/G( $ )/- G!/.# /.G!.UTWG )G +$ ($B # /$*)'$/'//$./$.4./ (;*-/'$/4$' ;0. /# -/$7/ / /#.+ -UTT;TTT+ *+' $) !!%$' /*0$')/$*)@' 1 './/$./$.*)0. .*!(*-/'$/4> # /# )$/ // . ( (-- ).- (*- $(+*-/)//#)/0')0( -. !-*(VTTT@VTUX )/ -.!*-$. *)/-*':- 1 )/$*) 0 /*/# *(+' 3$/4*!+*$.*)$)" /#.>#'' )" . 3$./2# )$/*( . /**($)/$*)*!-0".;+0-+*. ;0) -'4$)"*)$/$*);)0)&)*2).> /0-') ($@4)/# /$ *0)0. /*'**&0+/# . /> +$*$. -*$) = /#.- '..$7 0.$)"/# )/ -)/$*)''..$7/$*)*!$. .; )/# 1$.$*) L @UTM>-0"+*$.*)$)" /#.- $ )/$7 0.$)"0) -'4$)"0. *! /#* .XT@XX;ZT@ ZX;\Y;)UT@UX># !*''*2$)"(0'/$+' 0. *! /#* .2 - 0. /*$ )/$!4.+ $7 4)/# /$. -0"/4+ .=XT>V!*-)/0-'). ([email protected])/# /$*+$*$)'" .$.;XT>W!*-( /#*) ;XT>X!*- .4)/# /$*+$*$)'" .$. 3'0$)"( /#*) ;XT>U!*-# -*$);)XT>T;XT>U;XT>V;XT>W; /#*) XT>X*-XT>Z!*-)4*+$*$>++-*3$(/ '4*) @7!/#*!-0"+*$.*)$)" /#.'&$)!*-(/$*)*) /# .+ $7-0".$)1*'1 >*( *!/# . /#.(4$)1*'1 *+$*$)'" .$.*-# -*$)>" @ %0./ /#-/ .2 - '0'/ 0.$)"/# $- /( /#*)/# VTTT./)-+*+0'/$*)> +$ ($B %$ $&(!(- J .+$-/*-4 +- ..$*) &# J-0( 5"6-3 >5 6- J0$$ J--#4/#($ J (+$-( )/2#$' *+ -/$)"(#$) -4 #(&'$&''$#(&$!#&*#($#45#(&'$&''$#(&$!#&*#($# 45 J )/-1 )*0.-0"0. ' $)"/*'** ,* !* ! *-) +/#*" )/-).($..$*) "# %$ ! J J +/$/$. J +/$/$. ,$&($#&'1,$&($#&'1 %$ $&(- , J.4#$/-$ 86#! !! % J$/$*)@ -*$)$.'$( /* /# (*./$/$1 .0./) ! - J0$$' /$*) J +- ..$*) 96!*#! !!- J)3$ /4 J$))$'/- .. J#4.$' J$/#-2'. J 4+ -'" .$ J*)./$+/$*) ?./ - */4+ .2$''#$(# '+4*07"0- *0/2#*/# . + *+' - ? !)&& #'!)&& ##' HeHHeaHealtheallth PrescribedPreesscribed IllicitIllIlIlllliicit DDruDrugg CareCarCaarre OpioidOpiOOpp oidod OpioidOpioid DealerDealer ProviderProPrProrovidvviidder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u d k nociceptin Endogenous Endorphin Enkephalin Dynorphin Nociceptin Ligand Morphine Exogenous Methadone Deltorphin Buprenorphine U\T] U\XX Agonist U\]\U]UV U]W] U][W Fentanyl U]TZ U][T U]UX Exogenous Naloxone >> Naloxone Naloxone >> Antagonist Naltrexone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`$ /4'(*-+#$) LM`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`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orman Rockwell. The Doctor and The Doll. 1929. !""' !"" " 01+*0.$*00%+)*-& The Saturday Evening Post # *-' '/#-")$./$*)D.) - -LU]\ZM # Y/#$/'$")LU]]ZM # ( -$)$)*$ /4LM- .$ )/;-> ( .(+ '';$)U]]Z.$; 1## & 5" 6* #!"! %- ! " -2 =W[>T =]Z =UW]G\W =U\ $)=[ # $)/ )/$*)/*$(+-*1 2- ) ..)- 0 .06 -$)"2.)*/2-*)"> # / -). '/#($)$./-/$*)*+/./# Y/#1$/'.$")$)U]]\> # *$)/*(($..$*)*)- $//$*)*! '/#- -")$5/$*).L M; U]\Z U]]Z )*2'' # *$)/*(($..$*)$)/-*0 ./# ./)-$)VTTT> # $)/ )/$*)*!/# )'" .$ -2./*+-*(*/ /# # *.+$ *1 ( )/L/#
Load more

Recommended publications
  • Dezocine Exhibits Antihypersensitivity Activities in Neuropathy Through
    www.nature.com/scientificreports OPEN Dezocine exhibits antihypersensitivity activities in neuropathy through spinal Received: 09 November 2016 Accepted: 19 January 2017 μ-opioid receptor activation and Published: 23 February 2017 norepinephrine reuptake inhibition Yong-Xiang Wang1, Xiao-Fang Mao1, Teng-Fei Li1, Nian Gong1 & Ma-Zhong Zhang2 Dezocine is the number one opioid painkiller prescribed and sold in China, occupying 44% of the nation’s opioid analgesics market today and far ahead of the gold-standard morphine. We discovered the mechanisms underlying dezocine antihypersensitivity activity and assessed their implications to antihypersensitivity tolerance. Dezocine, given subcutaneously in spinal nerve-ligated neuropathic rats, time- and dose-dependently produced mechanical antiallodynia and thermal antihyperalgesia, significantly increased ipsilateral spinal norepinephrine and serotonin levels, and induced less antiallodynic tolerance than morphine. Its mechanical antiallodynia was partially (40% or 60%) and completely (100%) attenuated by spinal μ-opioid receptor (MOR) antagonism or norepinephrine depletion/α2-adrenoceptor antagonism and combined antagonism of MORs and α2-adenoceptors, respectively. In contrast, antagonism of spinal κ-opioid receptors (KORs) and δ-opioid receptors (DORs) or depletion of spinal serotonin did not significantly alter dezocine antiallodynia. In addition, dezocine- delayed antiallodynic tolerance was accelerated by spinal norepinephrine depletion/α2-adenoceptor antagonism. Thus dezocine produces antihypersensitivity activity through spinal MOR activation and norepinephrine reuptake inhibition (NRI), but apparently not through spinal KOR and DOR activation, serotonin reuptake inhibition or other mechanisms. Our findings reclassify dezocine as the first analgesic of the recently proposed MOR-NRI, and reveal its potential as an alternative to as well as concurrent use with morphine in treating pain.
    [Show full text]
  • A Review of Unique Opioids and Their Conversions
    A Review of Unique Opioids and Their Conversions Jacqueline Cleary, PharmD, BCACP Assistant Professor Albany College of Pharmacy and Health Sciences Adjunct Professor SAGE College of Nursing DISCLOSURES • Kaleo • Remitigate, LLC OBJECTIVES • Compare and contrast unique pharmacotherapy options for the treatment of chronic pain including: methadone, buprenoprhine, tapentadol, and tramadol • Select methadone, buprenorphine, tapentadol, or tramadol based on patient specific factors • Apply appropriate opioid conversion strategies to unique opioids • Understand opioid overdose risk surrounding opioid conversions and the use of unique opioids UNIQUE OPIOIDS METHADONE, BUPRENORPHINE, TRAMADOL, TAPENTADOL METHADONE My favorite drug because….? METHADONE- INDICATIONS • FDA labeled indications – (1) chronic pain (2) detoxification Oral soluble tablets for suspension NOT indicated for chronic pain treatment • Initial inpatient detoxification of opioids by a licensed trained provider with methadone and supportive care is appropriate • Methadone maintenance provider must have special credentialing and training as required by state Outpatient prescription must be for pain ONLY and say “for pain” on RX • Continuation of methadone maintenance from outside provider while patient is inpatient for another condition is appropriate http://cdn.atforum.com/wp-content/uploads/SAMHSA-2015-Guidelines-for-OTPs.pdf MECHANISM OF ACTION • Potent µ-opioid agonist • NMDA receptor antagonist • Norepinephrine reuptake inhibitor • Serotonin reuptake inhibitor ADVERSE EVENTS
    [Show full text]
  • Recommendations for Prescribing Analgesia on Discharge Following Surgery Or Acute Injury Information for Health Practitioners Preparing the Patient for Discharge
    Recommendations for prescribing analgesia on discharge following surgery or acute injury Information for health practitioners preparing the patient for discharge better health * better care * better value This booklet ‘Recommendations for prescribing analgesia on discharge following surgery or acute injury: Information for health practitioners preparing the patient for discharge’ is designed to be used in conjunction with the patient booklet titled ‘Pain relief medications following surgery and injury: Information for patients preparing for discharge’. Developed by the Analgesia Management Working Group (AMWG) and made available by the Western Australian Medication Safety Group (WAMSG). For more information on the WAMSG or this booklet go to website www.watag.org.au/wamsg Disclaimer: The information contained in this brochure has been produced as a guide only. It is not intended to be comprehensive and does not take the place of professional medical advice from your doctor, nurse or pharmacist. Contents Background 2 Recommendations for prescribing post-operative analgesia for pain following an acute injury or surgery 4 Precautions when prescribing opioids with other medications 6 Recommendations for prescribing discharge analgesia for pain following an acute injury or surgery 8 Paracetamol 8 Non-Steroidal Anti-inflammatory Drugs (NSAIDs) 8 Opioids 8 Communication to the primary care provider 10 Communication with the patient 10 Appendix 1 – Post-operative and post-intervention analgesia discharge checklist 11 Appendix 2 – Discharge analgesic plan 13 References 14 Recommendations for prescribing analgesia on discharge following surgery or acute injury | 1 Background The WA Medication Safety Group (WAMSG) has identified analgesia management post- surgery or acute injury (specifically managing and ceasing opioids), in the transition period from hospital to home, as a priority safety issue for patients and the community.
    [Show full text]
  • Codeine: the Facts Suzanne Nielsen Bpharm Phd MPS Codeine: Overview 1
    Codeine: The facts Suzanne Nielsen BPharm PhD MPS Codeine: overview 1. Codeine use in Australia 2. Characteristics of codeine dependence 3. Identifying codeine dependence 4. Treatment approaches (focus on primary care) 2 Codeine use in Australia Codeine (OTC) Tramadol Tapentadol Dextropropoxyphene Codeine (prescription) Oxycodone Morphine Methadone Hydromorphone Fentanyl Buprenorphine 0 5 10 15 20 Million packs Opioid pack sales (in millions) from: Degenhardt, Gisev, Cama, Nielsen, Larance and Bruno. The extent and predictors of pharmaceutical opioid utilisation in Australia. Pharmacoepidemiology and Drug Safety. (2016) 3 Codeine use in Australia • > 15 million packs OTC and 12 million prescribed • Highest codeine use in remote areas and low income areas 4 Codeine as an analgesic • Weak mu-opioid agonist • Analgesic effect predominantly through its metabolism to morphine via CYP2D6 enzyme • Considerable variable in metabolism between individuals (from poor to ultra-rapid metabolism) • Ultra-rapid metabolism opioid toxicity • Poor metabolism no analgesic effect Kirchheiner J et al. Pharmacokinetics of codeine and its metabolite morphine in ultra-rapid metabolizers due to CYP2D6 duplication.Pharmacogenomics J. 2007 5 Codeine-related harm • Codeine-related deaths increased from 3.5 per million in 2000 to 8.7 per million in 2009 • Trebling of non-OST drug treatment presentations fpr codeine between 2002-2011 • Among people entering methadone and buprenorphine increasing numbers report codeine as the main drug • 2014 – 2.7% of cases (1287 people) • 2015 – 3.5% of cases (1676 people) • 2016 – 4.6% of cases (1562 people*) * missing data from Vic and ACT means actual number likely to be higher (>2000) Roxburgh et al (2015). Medical Journal of Australia.
    [Show full text]
  • Measures and CDS for Safer Opioid Prescribing: a Literature Review
    Measures and CDS for Safer Opioid Prescribing: A Literature Review Measures and CDS for Safer Opioid Prescribing: A Literature Review Executive Summary The U.S. opioid epidemic continues to pose significant challenges for patients, families, clinicians, and public health policy. Opioids are responsible for an estimated 315,000 deaths (from 1999 to 2016) and have caused 115 deaths per day.1 In 2017, the U.S. Department of Health and Human Services declared the opioid epidemic a public health crisis.2 The total economic burden of opioid abuse in the United States has been estimated to be $78.5 billion per year.3 Although providing care for chronic opioid users is important, equally vital are efforts to prevent so-called opioid-naïve patients (patients with no history of opioid use) from developing regular opioid use, misuse, or abuse. However, much remains unclear regarding what role clinician prescribing habits play and what duration or dose of opioids may safely be prescribed without promoting long-term use.4,5 In 2013, ECRI Institute convened the Partnership for Health IT Patient Safety, and its component, single-topic-focused workgroups followed. For this subject, the Electronic Health Record Association (EHRA): Measures and Clinical Decision Support (CDS) for Safer Opioid Prescribing workgroup included members from the Healthcare Information and Management Systems Society (HIMSS) EHRA and the Partnership team. The project was oriented towards exploring methods to enable a synergistic cycle of performance measurement and identifying electronic health record (EHR)/health information technology (IT)–enabled approaches to support healthcare organizations’ ability to assess and measure opioid prescribing.
    [Show full text]
  • Global Addiction & EUROPAD Joint Conference Diversion, Misuse and Trafficking of Methadone and Buprenorphine Dart RC
    Diversion, misuse and trafficking of methadone and buprenorphine Global Addiction Conference Richard C. Dart, MD, PhD Professor, University of Colorado Prescription Opioid Deaths are Rising Internationally United Kingdom Drug Related Deaths 2001 - 2011 Source: RADARS® System, Denver Health and Hospitals What is the RADARS® System? • History – 2006, Denver Health and Hospital Authority (DHHA) – Multiple pharmaceutical subscribers – Independent program – Denver Public Safety Net Hospital for 150 years – State sanctioned independent authority • Conflict of Interest Statement – None, other than running system for DHHA as noted above. 3 RADARS System Scientific Advisory Board Principal Investigators Substance Abuse Experts • Theodore J. Cicero, PhD • Herbert D. Kleber, MD Washington University at St. Louis Columbia University • Richard C. Dart, MD, PhD • Sidney Schnoll, MD, PhD Denver Health and Hospital Authority Pinney Associates • Hilary Surratt, PhD • George E. Woody, MD Nova Southeastern University University of Pennsylvania • Mark W. Parrino, MPA Epidemiology/Biostatistics American Association for the • Edgar Adams, ScD Treatment of Opioid Dependence Covance Law Enforcement • Nabarun Dasgupta, MPH • John Burke Founder – Epidemico National Association of Drug Diversion Investigators • Alvaro Muñoz, PhD Johns Hopkins University 4 Challenges of Prescription Drug Abuse Surveillance • Clandestine behavior • Geographical variability • Changes rapidly • Multiple age groups • Product specificity – 15 active pharmaceutial ingredients (API) •
    [Show full text]
  • PALEXIA IR Immediate Release Tablets
    PALEXIA® IR immediate release tablets Tapentadol (as hydrochloride) (Ta-pen-ta-dol) Consumer Medicine Information (CMI) WARNING Limitations of use PALEXIA® IR should only be used when your doctor decides that other treatment options are not able to effectively manage your pain or you cannot tolerate them. Hazardous and harmful use PALEXIA® IR poses risks of abuse, misuse and addiction which can lead to overdose and death. Your doctor will monitor you regularly during treatment. Life threatening respiratory depression PALEXIA® IR can cause life-threatening or fatal breathing problems (slow, shallow, unusual or no breathing), even when used as recommended. These problems can occur at any time during use, but the risk is higher when first starting PALEXIA® IR and after a dose increase, if you are older, or have an existing problem with your lungs. Your doctor will monitor you and change the dose as appropriate. Use of other medicines while using PALEXIA® IR Using PALEXIA® IR with other medicines that can make you feel drowsy such as sleeping tablets (e.g. benzodiazepines), other pain relievers, antihistamines, antidepressants, antipsychotics, gabapentinoids (e.g. gabapentin and pregabalin), cannabis and alcohol may result in severe drowsiness, decreased awareness, breathing problems, coma and death. Your doctor will minimise the dose and duration of use; and monitor you for signs and symptoms of breathing difficulties and sedation. You must not drink alcohol while using PALEXIA® IR. ® What is in this leaflet Keep this leaflet with the PALEXIA IR has been medicine. You may need to read prescribed for you. it again. This leaflet answers some common questions about Before you take ® ® PALEXIA IR.
    [Show full text]
  • Iescopytrafficlightlistfinal Update July17b.Pdf
    Search this document by using the 'Find' command. Press 'Ctrl' + 'F' on your keyboard Recommendations on the use of medication, developed by the Suffolk Drug & Therapeutics Committee, approved by the Clinical Priorities Group Shared care Drug or therapy area agreement, Prescriber A-Z links to electronic Medicines Decision Indication Safety NICE guidance pathways & rating Compendium eMC checklists Click below for: →Traffic Light rating explained →Prescriber rating explained Aclidinium bromide▼ ( Eklira For the treatment of chronic obstructive pulmonary disease (COPD) - 2nd line ( Judgement Primary Care A Genuair®) for patients who cannot use the tiotropium device effectively ) reserved Abiraterone (Zytigaq®) Hospital only As anti androgen - commissioned by NHSE Acitretin Hospital only Restricted to use by intergrated dermatology service and secondary care only N (TA231) Judgement Agomelatine (Valdoxan®) No prescribing Depression Terminated reserved Appraisal Aliskiren q (Rasilez®) No prescribing Hypertension Not acceptable Use in adults who have severe chronic hand eczema that is unresponsive to Judgement Alitretinoin (Toctino®) Hospital only N treatment with potent topical corticosteroids reserved (TA177) Alpha Interferon Hospital only Hepatitis C N (TA106) Alprostadil see erectile dysfunction (Caverject/Viridal®) Shared care Drug or therapy area agreement, Prescriber A-Z links to electronic Medicines Decision Indication Safety NICE guidance pathways & rating Compendium eMC checklists Hospital Amiodarone antiarrhythmia recommended expected
    [Show full text]
  • Opioid-Induced Inhibition of the Human 5-HT and Noradrenaline Transporters in Vitro: Link to Clinical Reports of Serotonin Syndrome
    British Journal of British Journal of Pharmacology (2018) 175 532–543 532 BJP Pharmacology RESEARCH PAPER Opioid-induced inhibition of the human 5-HT and noradrenaline transporters in vitro: link to clinical reports of serotonin syndrome Correspondence Professor Matthias E. Liechti, Division of Clinical Pharmacology and Toxicology, University Hospital Basel, Schanzenstrasse 55, Basel, CH-4056, Basel, Switzerland. E-mail: [email protected] Received 21 June 2017; Revised 3 November 2017; Accepted 8 November 2017 Anna Rickli1, Evangelia Liakoni2, Marius C Hoener3 and Matthias E Liechti1 1Clinical Pharmacology and Toxicology, Department of Biomedicine, Department of Internal Medicine, University Hospital Basel, University of Basel, Basel, Switzerland, 2Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, Univer- sity of Bern, Bern, Switzerland, and 3Neuroscience Research, pRED, Roche Innovation Center Basel, F.Hoffmann-La Roche Ltd, Basel, Switzerland BACKGROUND AND PURPOSE Opioids may inhibit the 5-HT transporter (SERT) and the noradrenaline transporter (NET). NET inhibition may contribute to an- algesia, and SERT inhibition or interactions with 5-HT receptors may cause serotonergic toxicity. However, the effects of different opioids on the human SERT, NET and 5-HT receptors have not been sufficiently studied. EXPERIMENTAL APPROACH We determined the potencies of different opioids to inhibit the SERT and NET in vitro using human transporter-transfected fi HEK293 cells. We also tested binding af nities at 5-HT1A,5-HT2A and 5-HT2C receptors. Additionally, we assessed clinical cases of the serotonin syndrome associated with each opioid reported by PubMed and a World Health Organization database. KEY RESULTS Dextromethorphan, l(R)-methadone, racemic methadone, pethidine, tramadol and tapentadol inhibited the SERT at or close to observed drug plasma or estimated brain concentrations in patients.
    [Show full text]
  • Chapter 329 [New] Uniform Controlled Substances Act
    CHAPTER 329 [NEW] UNIFORM CONTROLLED SUBSTANCES ACT Part I. General Provisions Section 329-1 Definitions 329-2 Hawaii advisory commission on drug abuse and controlled substances; number; appointment 329-3 Annual report 329-4 Duties of the commission Part II. Standards and Schedules 329-11 Authority to schedule controlled substances 329-12 Nomenclature 329-13 Schedule I tests 329-14 Schedule I 329-15 Schedule II tests 329-16 Schedule II 329-17 Schedule III Tests 329-18 Schedule III 329-19 Schedule IV tests 329-20 Schedule IV 329-21 Schedule V tests 329-22 Schedule V 329-23 Republishing and distribution of schedules Part III. Regulation of Manufacture, Distribution, Prescription, and Dispensing of Controlled Substances 329-31 Rules 329-31.5 Clinics 329-32 Registration requirements 329-33 Registration 329-34 Revocation and suspension of registration 329-35 Order to show cause 329-36 Records of registrants 329-37 Filing requirements 329-38 Prescriptions 329-39 Labels 329-40 Methadone treatment programs Part IV. Offenses and Penalties 329-41 Prohibited acts B-penalties 329-42 Prohibited acts C-penalties 329-43 Penalties under other laws 329-43.5 Prohibited acts related to drug paraphernalia Amended 0612 1 329-44 Notice of conviction to be sent to licensing board, department of commerce and consumer affairs 329-45 Repealed 329-46 Prohibited acts related to visits to more than one practitioner to obtain controlled substance prescriptions 329-49 Administrative penalties 329-50 Injunctive relief Part V. Enforcement and Administrative Provisions 329-51 Powers of enforcement personnel 329-52 Administrative inspections 329-53 Injunctions 329-54 Cooperative arrangements and confidentiality 329-55 Forfeitures 329-56 Burden of proof; liabilities 329-57 Judicial review 329-58 Education and research 329-59 Controlled substance registration revolving fund; established Part VI.
    [Show full text]
  • Recent Advances in Postoperative Pain Management
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by PubMed Central YALE JOURNAL OF BIOLOGY AND MEDICINE 83 (2010), pp.11-25. Copyright © 2010. REVIEW Recent Advances in Postoperative Pain Management Nalini Vadivelu, MD a* ; Sukanya Mitra, MD b; and Deepak Narayan, MD c Departments of aAnesthesiology and cSurgery, Yale University School of Medicine, New Haven, Connecticut, and bDepartment of Anaesthesia & Intensive Care, Government Medical College & Hospital, Chandigarh, India Good pain control after surgery is important to prevent negative outcomes such as tachy - cardia, hypertension, myocardial ischemia, decrease in alveolar ventilation, and poor wound healing. Exacerbations of acute pain can lead to neural sensitization and release of medi - ators both peripherally and centrally. Clinical wind up occurs from the processes of N-Methyl D-Aspartate (NMDA†) activation, wind up central sensitization, long-term potentiation of pain (LTP), and transcription-dependent sensitization. Advances in the knowledge of molec - ular mechanisms have led to the development of multimodal analgesia and new pharmaceu - tical products to treat postoperative pain. The new pharmacological products to treat postoperative pain include extended-release epidural morphine and analgesic adjuvants such as capsaicin, ketamine, gabapentin, pregabalin dexmetomidine, and tapentadol. Newer postoperative patient-controlled analgesia (PCA) in modes such as intranasal, regional, transdermal, and pulmonary presents another interesting avenue of development. Proper pain relief is a major concern concerns of the surgeon because of its close and area of focus in the United States today. ties with clinical outcome and acute post - Pre-operatively, one of the most common operative patient well-being.
    [Show full text]
  • Drug Plasma Half-Life and Urine Detection Window | January 2019
    500 Chipeta Way | Salt Lake City, UT 84108-1221 Phone: (800) 522-2787 | Fax: (801) 583-2712 www.aruplab.com | www.arupconsult.com DRUG PLASMA HALF-LIFE AND URINE DETECTION WINDOW | JANUARY 2019 URINE- PLASMA DRUG, DRUG METABOLITE(S)* COMMON TRADE AND STREET NAMES, NOTES DETECTION HALF-LIFEt WINDOWt STIMULANTS Benzedrine, dexedrine, Adderall, Vyvanse, speed; could be methamphetamine Amphetamine 7–34 hours 1–5 days metabolite; if so, typically < 30 percent of parent Cocaine Coke, crack; parent drug rarely observed due to short half-life 0.7–1.5 hours < 1 day Benzoylecgonine Cocaine metabolite 5.5–7.5 hours 1–2 days Desoxyn, methedrine, Vicks inhaler (D- and L-isomers not resolved; low concentrations Methamphetamine expected if the source is Vicks); selegeline (Atapryl, Carbex, Eldepryl, Zelapar) 6–17 hours 1–5 days metabolite Methylenedioxyamphetamine (MDA) MDA 11–17 hours 1–3 days Methylenedioxyethylamphetamine (MDEA) MDEA, MDE, Eve 6–11 hours 1–3 days Methylenedioxymethamphetamine (MDMA) MDMA, XTC, ecstasy, Molly 6–10 hours 1–3 days Methylphenidate Ritalin, Concerta, Focalin, Metadate, Methylin 1.4–4.2 hours < 1 day Ritalinic acid Methylphenidate metabolite 1.8–2.5 hours < 1 day Phentermine Adipex-P, Lomaira, Qsymia 19–24 hours 1–5 days OPIOIDS Buprenorphine Belbuca, Buprenex, Butrans, Suboxone, Subutex, Sublocade, Zubsolv 26–42 hours 1–7 days Norbuprenorphine, Glucuronides Buprenorphine metabolites 15–150 hours 1–14 days Included in many preparations; morphine metabolite; may be a contaminant if < 2 Codeine 1.9–3.9 hours 1–3 days percent of morphine Fentanyl Actiq, Duragesic, Fentora, Lazanda, Sublimaze, Subsys, Ionsys 3–12 hours 1–3 days Norfentanyl Fentanyl metabolite 9–10 hours 1–3 days Heroin Diacetylmorphine, dope, smack, dust; parent drug not detected.
    [Show full text]