Opioid Conversions
Total Page:16
File Type:pdf, Size:1020Kb
Load more
Recommended publications
-
Opioid-Induced Hyperalgesia in Humans Molecular Mechanisms and Clinical Considerations
SPECIAL TOPIC SERIES Opioid-induced Hyperalgesia in Humans Molecular Mechanisms and Clinical Considerations Larry F. Chu, MD, MS (BCHM), MS (Epidemiology),* Martin S. Angst, MD,* and David Clark, MD, PhD*w treatment of acute and cancer-related pain. However, Abstract: Opioid-induced hyperalgesia (OIH) is most broadly recent evidence suggests that opioid medications may also defined as a state of nociceptive sensitization caused by exposure be useful for the treatment of chronic noncancer pain, at to opioids. The state is characterized by a paradoxical response least in the short term.3–14 whereby a patient receiving opioids for the treatment of pain Perhaps because of this new evidence, opioid may actually become more sensitive to certain painful stimuli. medications have been increasingly prescribed by primary The type of pain experienced may or may not be different from care physicians and other patient care providers for the original underlying painful condition. Although the precise chronic painful conditions.15,16 Indeed, opioids are molecular mechanism is not yet understood, it is generally among the most common medications prescribed by thought to result from neuroplastic changes in the peripheral physicians in the United States17 and accounted for 235 and central nervous systems that lead to sensitization of million prescriptions in the year 2004.18 pronociceptive pathways. OIH seems to be a distinct, definable, One of the principal factors that differentiate the use and characteristic phenomenon that may explain loss of opioid of opioids for the treatment of pain concerns the duration efficacy in some cases. Clinicians should suspect expression of of intended use. -
Ong Edmund W 201703 Phd.Pdf (5.844Mb)
INVESTIGATING THE EFFECTS OF PROLONGED MU OPIOID RECEPTOR ACTIVATION UPON OPIOID RECEPTOR HETEROMERIZATION by Edmund Wing Ong A thesis submitted to the Graduate Program in Pharmacology & Toxicology in the Department of Biomedical and Molecular Sciences In conformity with the requirements for the degree of Doctor of Philosophy Queen’s University Kingston, Ontario, Canada March, 2017 Copyright © Edmund Wing Ong, 2017 Abstract Opioid receptors are the sites of action for morphine and most other clinically-used opioid drugs. Abundant evidence now demonstrates that different opioid receptor types can physically associate to form heteromers. Owing to their constituent monomers’ involvement in analgesia, mu/delta opioid receptor (M/DOR) heteromers have been a particular focus of attention. Understandings of the physiological relevance of M/DOR formation remain limited in large part due to the reliance of existing M/DOR findings upon contrived heterologous systems. This thesis investigated the physiological relevance of M/DOR generation following prolonged MOR activation. To address M/DOR in endogenous tissues, suitable model systems and experimental tools were established. This included a viable dorsal root ganglion (DRG) neuron primary culture model, antisera specifically directed against M/DOR, a quantitative immunofluorescence colocalizational analysis method, and a floxed-Stop, FLAG-tagged DOR conditional knock-in mouse model. The development and implementation of such techniques make it possible to conduct experiments addressing the nature of M/DOR heteromers in systems with compelling physiological relevance. Seeking to both reinforce and extend existing findings from heterologous systems, it was first necessary to demonstrate the existence of M/DOR heteromers. Using antibodies directed against M/DOR itself as well as constituent monomers, M/DOR heteromers were identified in endogenous tissues and demonstrated to increase in abundance following prolonged mu opioid receptor (MOR) activation by morphine. -
Federal Register/Vol. 85, No. 36/Monday, February 24, 2020
10466 Federal Register / Vol. 85, No. 36 / Monday, February 24, 2020 / Notices Controlled substance Drug code Schedule Alphamethadol ................................................................................................................................................................. 9605 I Benzethidine .................................................................................................................................................................... 9606 I Betacetylmethadol ........................................................................................................................................................... 9607 I Clonitazene ...................................................................................................................................................................... 9612 I Diampromide ................................................................................................................................................................... 9615 I Diethylthiambutene .......................................................................................................................................................... 9616 I Dimethylthiambutene ....................................................................................................................................................... 9619 I Ketobemidone ................................................................................................................................................................. -
Case Discussions in Palliative Medicine Levorphanol For
JOURNAL OF PALLIATIVE MEDICINE Volume 21, Number 3, 2018 Case Discussions in Palliative Medicine ª Mary Ann Liebert, Inc. DOI: 10.1089/jpm.2017.0475 Feature Editor: Craig D. Blinderman Levorphanol for Treatment of Intractable Neuropathic Pain in Cancer Patients Akhila Reddy, MD,1,* Amy Ng, MD,1,* Tarun Mallipeddi,2 and Eduardo Bruera, MD1 Abstract Neuropathic pain in cancer patients is often difficult to treat, requiring a combination of several different pharmacological therapies. We describe two patients with complex neuropathic pain syndromes in the form of phantom limb pain and Brown-Sequard syndrome who did not respond to conventional treatments but re- sponded dramatically to the addition of levorphanol. Levorphanol is a synthetic strong opioid that is a potent N- methyl-d-aspartate receptor antagonist, mu, kappa, and delta opioid receptor agonist, and reuptake inhibitor of serotonin and norepinephrine. It bypasses hepatic first-pass metabolism and thereby not subjected to numerous drug interactions. Levorphanol’s unique profile makes it a potentially attractive opioid in cancer pain man- agement. Keywords: Brown-Sequard syndrome; cancer; cancer pain; levorphanol; neuropathic pain; phantom limb pain Introduction changes, structural reorganization of spinal cord and primary somatosensory cortex, and increased sensitization of spinal ne-third of cancer patients who experience pain cord may be the neurological basis for PLP.8,9 Because the Oalso experience neuropathic pain1 and about half the pathophysiology of PLP is not clearly understood, the treat- patients with cancer who suffer from neuropathic pain also ment options are mainly based on clinical experience.9 There have nociceptive pain.2 Most neuropathic pain exists as are case series showing that tramadol and methadone may be mixed pain in combination with nociceptive pain. -
Contents (WELCOME)
Contents (WELCOME) ................................................................................................................................................ 2 (TERMINOLOGY) ....................................................................................................................................... 4 (SAFETY) ..................................................................................................................................................... 7 (GOLDEN RULES NOT TO BREAK) ...................................................................................................... 11 (PATIENT ASSESSMENT) ....................................................................................................................... 13 (PAIN RELIEF VS FUNCTION/ADL) ..................................................................................................... 15 (ADJUVANT THERAPIES) ...................................................................................................................... 16 (MEDICATION SIDE EFFECTS) ............................................................................................................. 18 (ONGOING THERAPY AND MONITORING) ....................................................................................... 24 (MEDICATION SAFE STORAGE AND DISPOSAL) ............................................................................. 26 (DISCONTINUING OPIOID THERAPY) ................................................................................................ 28 (CO-USE WITH -
ESTIMATED WORLD REQUIREMENTS of NARCOTIC DRUGS in GRAMS for 2019 (As of 10 January 2019 )
ESTIMATED WORLD REQUIREMENTS OF NARCOTIC DRUGS IN GRAMS FOR 2019 (as of 10 January 2019 ) Afghanistan Cannabis 50 Codeine 50 000 Cannabis resin 1 Dextropropoxyphene 10 000 Coca leaf 1 Diphenoxylate 5 000 Cocaine 15 Fentanyl 1 Codeine 650 000 Methadone 20 000 Codeine -N-oxide 1 Morphine 8 000 Dextromoramide 1 Pethidine 90 000 Dextropropoxyphene 200 000 Pholcodine 40 000 Difenoxin 1 Albania Dihydrocodeine 1 Cocaine 1 Diphenoxylate 1 Codeine 1 189 000 Dipipanone 1 Fentanyl 300 Ecgonine 2 Heroin 1 Ethylmorphine 1 Methadone 7 000 Etorphine 1 Morphine 7 800 Fentanyl 17 000 Oxycodone 2 000 Heroin 1 Pethidine 2 700 Hydrocodone 10 000 Pholcodine 1 500 Hydromorphone 4 000 Remifentanil 9 Ketobemidone 1 Sufentanil 2 Levorphanol 1 Algeria Methadone 100 000 Alfentanil 350 Morphine 1 550 000 Codeine 2 500 000 Morphine -N-oxide 1 Etorphine 1 Nicomorphine 1 Fentanyl 500 Norcodeine 1 Methadone 4 000 Normethadone 1 Morphine 9 000 Normorphine 1 Oxycodone 4 000 Opium 10 Pethidine 3 000 Oripavine 1 Pholcodine 1 500 000 Oxycodone 60 000 Remifentanil 1 Oxymorphone 1 Sufentanil 30 Pethidine 50 000 Andorra Phenoperidine 1 Cannabis 2 000 Pholcodine 1 Fentanyl 100 Piritramide 1 Methadone 1 000 Remifentanil 20 000 Morphine 500 Sufentanil 10 Oxycodone 2 000 Thebacon 1 Pethidine 500 Thebaine 70 000 Remifentanil 4 Tilidine 1 Angola Armenia Alfentanil 20 Codeine 3 000 Codeine 21 600 Fentanyl 40 Dextromoramide 188 Methadone 13 500 Dextropropoxyphene 200 Morphine 7 500 Dihydrocodeine 500 Thebaine 15 Diphenoxylate 300 Trimeperidine 1 500 Fentanyl 63 Aruba* Methadone 2 000 -
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 -
Page 1 of 17 10/11/2017 File:///C:/Users/Henadzi.Sobal/Documents
Page 1 of 17 GOT18-0018. Impact of Clinical Pharmacist Analysis to Clinical Decision-Making for Drug Therapy Management in the Hospital Care Setting Background A deeper understanding of pharmacist clinical decision-making should provide the influence that pharmacists have on patient health care, should guide pharmacy policy and education, should contribute to educating less experienced pharmacists on decision-making processes, should promote more interprofessional work, and should encourage pharmacist decision-making toward the wisest selections of patients’ medication therapy. Purpose The overarching objective of this research study was to document drug therapy decision-making processes of clinical pharmacists in the hostital care setting. The specific aims of this study were to examine the current clinical decision-making of clinical pharmacists in the context of the hospital care clinic setting, to compare and contrast pharmacist clinical decision-making with current decision-making models. Material and methods We used a quasi-randomized design to evaluate a quality improvement project in three hospitals in Kazakhstan. Three audio-taped data collection methods of participant observation and semi-structured interview were utilized and exactly transcribed to provide textual data for analysis. Thematic analysis provided emerging themes of clinical pharmacist-led medication and clinical decision-making which were further subdivided into subsuming themes after much reflection and interpretation of the entire study data. Results Other health professions have identified experienced clinical decision-aking to encompass the Decision Analysis, intuition and pattern recognition. Clinical pharmacists’ clinical decision-making processes are considered in light of other health professionals’ decision-making techniques; however the results show that clinical pharmacists use a different model of clinical decision-making using constant dialogue between two different types of knowledge (objective and context-related). -
Hydromorphone
Hydromorphone WHAT IS HYDROMORPHONE? sedation, and reduced anxiety. It may also cause Hydromorphone belongs to a class of drugs mental clouding, changes in mood, nervousness, called “opioids,” which includes morphine. It and restlessness. It works centrally (in the has an analgesic potency of two to eight times brain) to reduce pain and suppress cough. greater than that of morphine and has a rapid Hydromorphone use is associated with both onset of action. physiological and psychological dependence. WHAT IS ITS ORIGIN? What is its effect on the body? Hydromorphone is legally manufactured and Hydromorphone may cause: distributed in the United States. However, • Constipation, pupillary constriction, urinary retention, users can obtain hydromorphone from nausea, vomiting, respiratory depression, dizziness, forged prescriptions, “doctor-shopping,” impaired coordination, loss of appetite, rash, slow or theft from pharmacies, and from friends and rapid heartbeat, and changes in blood pressure acquaintances. What are its overdose effects? What are the street names? Acute overdose of hydromorphone can produce: Common street names include: Severe respiratory depression, drowsiness • D, Dillies, Dust, Footballs, Juice, and Smack progressing to stupor or coma, lack of skeletal muscle tone, cold and clammy skin, constricted What does it look like? pupils, and reduction in blood pressure and heart Hydromorphone comes in: rate • Tablets, capsules, oral solutions, and injectable Severe overdose may result in death due to formulations respiratory depression. How is it abused? Which drugs cause similar effects? Users may abuse hydromorphone tablets by Drugs that have similar effects include: ingesting them. Injectable solutions, as well as • Heroin, morphine, hydrocodone, fentanyl, and tablets that have been crushed and dissolved oxycodone in a solution may be injected as a substitute for heroin. -
Recommended Methods for the Identification and Analysis of Fentanyl and Its Analogues in Biological Specimens
Recommended methods for the Identification and Analysis of Fentanyl and its Analogues in Biological Specimens MANUAL FOR USE BY NATIONAL DRUG ANALYSIS LABORATORIES Laboratory and Scientific Section UNITED NATIONS OFFICE ON DRUGS AND CRIME Vienna Recommended Methods for the Identification and Analysis of Fentanyl and its Analogues in Biological Specimens MANUAL FOR USE BY NATIONAL DRUG ANALYSIS LABORATORIES UNITED NATIONS Vienna, 2017 Note Operating and experimental conditions are reproduced from the original reference materials, including unpublished methods, validated and used in selected national laboratories as per the list of references. A number of alternative conditions and substitution of named commercial products may provide comparable results in many cases. However, any modification has to be validated before it is integrated into laboratory routines. ST/NAR/53 Original language: English © United Nations, November 2017. All rights reserved. The designations employed and the presentation of material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the United Nations concerning the legal status of any country, territory, city or area, or of its authorities, or concerning the delimitation of its frontiers or boundaries. Mention of names of firms and commercial products does not imply the endorse- ment of the United Nations. This publication has not been formally edited. Publishing production: English, Publishing and Library Section, United Nations Office at Vienna. Acknowledgements The Laboratory and Scientific Section of the UNODC (LSS, headed by Dr. Justice Tettey) wishes to express its appreciation and thanks to Dr. Barry Logan, Center for Forensic Science Research and Education, at the Fredric Rieders Family Founda- tion and NMS Labs, United States; Amanda L.A. -
Pre - PA Allowance Age 12 Years of Age Or Older – Ultracet (Tramadol and Acetaminophen) and Codeine/APAP Products
OPIOID IR COMBO DRUGS Apadaz* (benzhydrocodone-acetaminophen), Codeine-acetaminophen, Dvorah* (dihydrocodeine-caffeine-acetaminophen*), Hydrocodone-acetaminophen, Hydrocodone- acetaminophen solution 10-325mg*, Hydrocodone-ibuprofen, Nalocet* (oxycodone- acetaminophen*), Oxycodone-acetaminophen, Oxycodone-aspirin, Oxycodone-ibuprofen, Primlev*/Prolate* (oxycodone-acetaminophen*), Tramadol-acetaminophen, Trezix (dihydrocodeine-caffeine-acetaminophen) *Prior authorization for certain non-covered formulations applies only to formulary exceptions Pre - PA Allowance Age 12 years of age or older – Ultracet (tramadol and acetaminophen) and Codeine/APAP products Quantity Patients 18 years or older will be able to fill the Pre-PA Allowance after they have filled an initial 7 day supply of IR opioid therapy or if they have been on IR or ER opioid therapy in the last 180 days Patients age 17 and under will require a PA after they have filled a 3 day supply of the Pre- PA Allowance Patients with opioid addiction treatment or methadone in the last 30 days will not be eligible for Pre-PA Allowance Immediate Release Tablets or Capsules ≤ 50 MME/day Medication Strength Quantity Limit Codeine/APAP soln 120-12 mg/5 mL Hydrocodone/APAP soln 7.5/325 mg/15 mL 5400 mL per 90 days Hydrocodone/APAP elixir 10/300 mg/15 mL Oxycodone/APAP soln 5-325 mg/5 mL 3000 mL per 90 days Hydrocodone/ibuprofen 5/200 mg, 7.5/200 mg, 10/200 mg 270 units per 90 days Oxycodone/ibuprofen 5/400 mg Oxycodone/APAP 10/325 mg Codeine/APAP 60/300 mg Hydrocodone/APAP 7.5/300 mg, 7.5/325 -
ESTIMATED WORLD REQUIREMENTS of NARCOTIC DRUGS in GRAMS for 2021 (July Update)
ESTIMATED WORLD REQUIREMENTS OF NARCOTIC DRUGS IN GRAMS FOR 2021 (July update) Afghanistan Bezitramide 1 Codeine 20 000 Cannabis 7 050 Dextropropoxyphene 20 000 Cannabis resin 1 Diphenoxylate 800 Coca leaf 1 Fentanyl 6 Cocaine 15 Methadone 120 000 Codeine 700 000 Morphine 10 000 Codeine-N-oxide 1 Pethidine 2 000 Dextromoramide 1 Pholcodine 5 000 Dextropropoxyphene 170 000 Albania Difenoxin 1 Cocaine 1 Dihydrocodeine 1 Codeine 1 190 000 Diphenoxylate 1 Fentanyl 300 Dipipanone 1 Heroin 1 Ecgonine 2 Methadone 16 500 Ethylmorphine 1 Morphine 7 500 Etorphine 1 Oxycodone 1 500 Fentanyl 17 200 Pethidine 2 500 Heroin 1 Pholcodine 1 600 Hydrocodone 11 000 Remifentanil 10 Hydromorphone 4 000 Sufentanil 2 Ketobemidone 1 Algeria Levorphanol 1 Alfentanil 400 Methadone 110 000 Cannabis 3 Morphine 1 590 000 Cocaine 5 Morphine-N-oxide 1 Codeine 2 500 000 Nicomorphine 1 Etorphine 1 Norcodeine 1 Fentanyl 900 Normethadone 1 Heroin 2 Normorphine 1 Methadone 4 000 Opium 10 Morphine 15 000 Oripavine 1 Oxycodone 4 000 Oxycodone 60 000 Pethidine 3 000 Oxymorphone 1 Pholcodine 1 500 000 Pethidine 50 000 Remifentanil 1 Phenoperidine 1 Sufentanil 50 Pholcodine 1 Andorra Piritramide 1 Cannabis 2 000 Remifentanil 17 000 Fentanyl 100 Sufentanil 10 Methadone 1 000 Thebacon 1 Morphine 500 Thebaine 77 000 Oxycodone 2 000 Tilidine 1 Pethidine 500 Armenia Remifentanil 4 Codeine 3 000 Angola Fentanyl 50 Alfentanil 24 Methadone 22 000 Codeine 21 600 Morphine 8 000 Dextromoramide 188 Thebaine 4 100 Dextropropoxyphene 200 Trimeperidine 1 500 Dihydrocodeine 500 Aruba* Diphenoxylate