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https://www.readbyqxmd.com/read/28337083/continuous-infusion-etomidate-in-a-patient-receiving-extracorporeal-membrane-oxygenation
#1
Joseph M LaRochelle, Bonnie Desselle, Janet L Rossi
We describe a 16-year-old, 65-kg male deployed on extracorporeal membrane oxygenation (ECMO) for refractory respiratory failure secondary to ingestion of multiple substances. During his ECMO course, standard sedative and analgesic strategies failed and alternative medications were used. The patient received various dosages of fentanyl, morphine, hydromorphone, clonidine patches, dexmedetomidine, lorazepam, methadone, pentobarbital, olanzapine, and propofol. Despite administration of multiple agents, on day 29 of ECMO the patient experienced elevated blood pressures due to agitation, and continuous infusion etomidate was started...
January 2017: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
https://www.readbyqxmd.com/read/28317124/pharmacokinetics-of-intravenous-and-transdermal-fentanyl-in-alpacas
#2
M Lovasz, T K Aarnes, J A E Hubbell, R M Bednarski, P Lerche, J Lakritz
The purpose of the study was to determine pharmacokinetics of fentanyl after intravenous (i.v.) and transdermal (t.d.) administration to six adult alpacas. Fentanyl was administered i.v. (2 μg/kg) or t.d. (nominal dose: 2 μg kg(-1)  hr(-1) ). Plasma concentrations were determined using liquid chromatography-mass spectrometry. Heart rate and respiratory rate were assessed. Extrapolated, zero-time plasma fentanyl concentrations were 6.0 ng/ml (1.7-14.6 ng/ml) after i.v. administration, total plasma clearance was 1...
March 19, 2017: Journal of Veterinary Pharmacology and Therapeutics
https://www.readbyqxmd.com/read/28266337/analgesic-consumption-in-nursing-homes-observational-study-about-99-nursing-homes
#3
Priscilla Clot-Faybesse, François Bertin-Hugault, Caroline Blochet, Philippe Denormandie, Patrice Rat, Paul-Emile Hay, Sylvie Bonin-Guillaume
Few analgesics' studies in nursing homes are available. Quantitative and qualitative analgesic consumption evaluation in nursing homes in 2012. Multicenter, descriptive, retrospective and observational study about French Korian Nursing homes' residents, using Medissimo solution, and under at least one analgesic treatment during 2012. We considered as chronic prescription a duration greater than or equal to 28 days and as short prescription a duration less than 28 days. Population studied is 10.818 residents...
March 1, 2017: Gériatrie et Psychologie Neuropsychiatrie du Vieillissement
https://www.readbyqxmd.com/read/28223843/the-use-of-rotation-to-fentanyl-in-cancer-related-pain
#4
Delia Dima, Ciprian Tomuleasa, Ioana Frinc, Sergiu Pasca, Lorand Magdo, Ioana Berindan-Neagoe, Mihai Muresan, Cosmin Lisencu, Alexandru Irimie, Mihnea Zdrenghea
Pain is commonly diagnosed with respect to cancer and heart diseases, being a major symptom in most neoplastic diseases. Uncontrolled pain leads to a decrease in the quality of life and an increase in the morbidity of the patient. Opioids represent the best analgetic supportive therapy and are frequently used in patients suffering from cancer and experiencing a high level of pain. Opioid treatment starts with a gradual titration of the dose until the minimum effective dose and the maximum tolerated dose are determined...
2017: Journal of Pain Research
https://www.readbyqxmd.com/read/28156605/the-requirement-of-fentanyl-patch-in-terminally-ill-patients-with-cancer
#5
Aya Watanabe, Hiroto Ishiki, Tsukuru Chiba, Junya Kinkawa, Chie Watanabe, Keisuke Ariyoshi, Masanori Nojima, Satoru Iwase, Arinobu Tojo
202 Background: Cancer pain is the most important problem to overcome in terminally ill cancer patients (TICPs). Recently, the fentanyl patch (FP) has been widely used for the treatment of cancer pain. However, the FP requirement largely varies in patients. The purpose of this study was to identify the determinants of the FP requirement in TICPs and propose effective pain relief using a FP. METHODS: In a retrospective chart review, we investigated cancer patients who were admitted in our hospital from April 2012 to July 2015 and used FP until their deaths...
October 9, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28118835/pilot-evaluation-of-a-novel-unilateral-onychectomy-model-and-efficacy-of-an-extended-release-buprenorphine-product
#6
RANDOMIZED CONTROLLED TRIAL
Masataka Enomoto, Patricia D Kigin, David Bledsoe, Robyn Slone, Jonathan Hash, Charles E Smith, B Duncan X Lascelles
BACKGROUND: Non-steroidal anti-inflammatory drugs (NSAIDs), transdermal fentanyl patches, and transmucosal buprenorphine are probably the most commonly used options for providing post-operative analgesia in the early at-home period. However, these require daily administration or are associated with abuse concerns. One of the significant unmet needs in veterinary surgery and pain management is for longer acting opioids for cats to effectively bridge the gap between the in-hospital and at-home recovery periods...
January 24, 2017: BMC Veterinary Research
https://www.readbyqxmd.com/read/28096225/not-so-patchy-story-of-attempted-suicide%C3%A2-leading-to-24%C3%A2-hours-of-deep-sleep-and-survival
#7
Adam Joseph Trist, Hardeep Sahota, Lucy Williams
Here, we present a somewhat unusual suicide attempt where, despite an unbelievable overdose with transdermal fentanyl patches, the patient survived. The patient-a woman aged 70 years, who has suffered from chronic back pain despite starting transdermal fentanyl patches in 2007. The unconventional method of attempted suicide was based on online research into deaths from fentanyl patch toxicity. She had gradually accumulated 100 µg fentanyl patches from repeat prescriptions, applying 14 patches with fatal intent, alongside 2 45 mg mirtazapine tablets, and concurrent therapeutic doses of tramadol and morphine sulfate oral solution...
January 17, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28045611/establishment-of-personalized-pain-goals-in-oncology-patients-to-improve-care-and-decrease-costs
#8
Dylan Zylla, Amber Larson, Gladys Chuy, Lisa Illig, Adina Peck, Sarah Van Peursem, James W Fulbright, Pamala A Pawloski, Sara Richter, Jeanne Mettner
PURPOSE: Cancer-related pain is common, negatively affects quality of life and survival, and often requires treatment with opioid analgesics. Patient-reported data that describe the incidence and severity of pain, medication use, and patient satisfaction with care are lacking. METHODS: We analyzed 18 months of outpatient oncology clinic encounters from the electronic medical record to obtain data on pain levels and opioid and nonopioid treatments. In June 2014, we instituted a pain intervention by creating a pain management information handout for patients, educating clinicians on opioid cost-effectiveness, and implementing a nursing protocol to document personalized pain goals (PPGs)...
March 2017: Journal of Oncology Practice
https://www.readbyqxmd.com/read/27922764/comparison-of-abuse-suspected-suicidal-intent-and-fatalities-related-to-the-7-day-buprenorphine-transdermal-patch-versus-other-opioid-analgesics-in-the-national-poison-data-system
#9
COMPARATIVE STUDY
Paul M Coplan, Nelson E Sessler, Venkatesh Harikrishnan, Richa Singh, Charles Perkel
OBJECTIVE: Prescription opioid related abuse, suicide and death are significant public health problems. This study compares rates of poison center calls categorized as intentional abuse, suspected suicidal intent or fatality for the 7-day buprenorphine transdermal system/patch (BTDS) with other extended-release and long-acting (ER/LA) opioids indicated for chronic pain. METHODS: Retrospective 24-month cohort study using National Poison Data System data from July 2012 through June 2014...
January 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/27886163/alghedon-fentanyl-transdermal-system
#10
REVIEW
Patrizia Romualdi, Patrizia Santi, Sanzio Candeletti
The efficacy of transdermal fentanyl for cancer pain and chronic non-cancer pain (chronic lower back pain, rheumatoid arthritis, osteoarthritis, neuropathic pain) is well established. Several formulations of fentanyl transdermal systems have been developed to improve the drug delivery and prevent misuse of the active principle. The addition of a rate controlling membrane to the matrix system represented an important advance. The design and functional features of Alghedon patch are compared with other approved generic fentanyl transdermal systems, emphasizing the distinctiveness of Alghedon patch...
April 2017: Minerva Medica
https://www.readbyqxmd.com/read/27877065/poor-adhesion-of-fentanyl-transdermal-patches-may-mimic-end-of-dosage-failure-after-48-hours-and-prompt-early-patch-replacement-in-hospitalized-cancer-pain-patients
#11
Isabelle Arnet, Sabrina Schacher, Eva Balmer, Dieter Koeberle, Kurt E Hersberger
CONTEXT: Renewal of fentanyl transdermal patch (transdermal therapeutic system [TTS]) should occur every 3 days (72 hours) according to manufacturer's guidelines. Some studies mentioned patients reporting end-of-dose failure, and thus, some authors recommend shortening the interval of application to 2 days (48 hours). However, reasons for early replacement are mostly unknown. OBJECTIVES: The objectives of this study were to assess the prevalence of early replacement of fentanyl TTS in a cancer center in Basel, Switzerland, and to assess the reasons for early replacement in stationary patients...
2016: Journal of Pain Research
https://www.readbyqxmd.com/read/27727431/fentanyl-for-neuropathic-pain-in-adults
#12
REVIEW
Sheena Derry, Cathy Stannard, Peter Cole, Philip J Wiffen, Roger Knaggs, Dominic Aldington, R Andrew Moore
BACKGROUND: Opioid drugs, including fentanyl, are commonly used to treat neuropathic pain, and are considered effective by some professionals. Most reviews have examined all opioids together. This review sought evidence specifically for fentanyl, at any dose, and by any route of administration. Other opioids are considered in separate reviews. OBJECTIVES: To assess the analgesic efficacy of fentanyl for chronic neuropathic pain in adults, and the adverse events associated with its use in clinical trials...
October 11, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27619152/a-review-of-factors-explaining-variability-in-fentanyl-pharmacokinetics-focus-on-implications-for-cancer-patients
#13
REVIEW
Evelien J M Kuip, Maarten L Zandvliet, Stijn L W Koolen, Ron H J Mathijssen, Carin C D van der Rijt
Fentanyl is a strong opioid that is available for various administration routes, and which is widely used to treat cancer-related pain. Many factors influence the fentanyl pharmacokinetics leading to a wide inter- and intrapatient variability. This systematic review summarizes multiple studied factors that potentially influence fentanyl pharmacokinetics with a focus on implications for cancer patients. The use of CYP3A4 inhibitors and inducers, impaired liver function, and heating of the patch potentially influence fentanyl pharmacokinetics in a clinically relevant way...
February 2017: British Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/27607410/foetal-fentanyl-exposure-and-ion-trapping-after-intravenous-and-transdermal-administration-to-the-ewe
#14
Emma M Heikkinen, Hannu Kokki, Aki Heikkinen, Veli-Pekka Ranta, Juha Räsänen, Hanna-Marja Voipio, Merja Kokki
Opioids given to pregnant and parturient women are relatively freely transferred across the placenta. Spinal, epidural and intravenous fentanyl has been studied in pregnant women and neonates, but foetal safety of fentanyl dosing with transdermal patch during pregnancy and labour is not sufficiently studied. Foetal pH is physiologically lower than maternal pH, and thus, opioids, which are weak bases, are ionized and may cumulate to foetus. Foetal asphyxia may further worsen acidosis, and ion trapping induced by low pH is assumed to increase the foetal exposure to opioids...
February 2017: Basic & Clinical Pharmacology & Toxicology
https://www.readbyqxmd.com/read/27487158/new-initiation-of-long-acting-opioids-in-long-stay-nursing-home-residents
#15
Camilla B Pimentel, Jerry H Gurwitz, Jennifer Tjia, Anne L Hume, Kate L Lapane
OBJECTIVES: To estimate the prevalence of new initiation of long-acting opioids since introduction of national efforts to increase prescriber and public awareness on safe use of transdermal fentanyl patches. DESIGN: Cross-sectional. SETTING: U.S. nursing homes (NHs). PARTICIPANTS: Medicare-enrolled long-stay NH residents (N = 22,253). MEASUREMENTS: Minimum Data Set 3.0 was linked with Medicare enrollment, hospital claims, and prescription drug transaction data (January-December 2011) and used to determine the prevalence of new initiation of a long-acting opioid prescribed to residents in NHs...
September 2016: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/27475691/efficacy-of-fentanyl-transdermal-patch-in-pain-control-after-lower-third-molar-surgery-a-preliminary-study
#16
V-S Todorovic, M Vasovic, M Andric, L Todorovic, V Kokovic
BACKGROUND: Surgical removal of impacted lower third molars is a common oral surgical procedure, generally followed by moderate to severe postoperative pain. Transdermal drug delivery as a concept offers interesting possibilities for postoperative pain control. The aim of this study was to evaluate the efficacy of transdermal system with fentanyl in relieving pain following impacted lower third molar surgery. MATERIAL AND METHODS: Seventeen patients with bilateral impacted lower third molars were included in this preliminary study...
September 1, 2016: Medicina Oral, Patología Oral y Cirugía Bucal
https://www.readbyqxmd.com/read/27433423/postoperative-pain-control-with-the-fentanyl-patch-and-continuous-paravertebral-anesthetic-infusion-after-posterior-occipitocervical-junction-surgery
#17
Walavan Sivakumar, Michael Karsy, Andrea Brock, Richard H Schmidt
Postoperative pain is a significant concern for patients who undergo surgery via a midline posterior approach to the occipitocervical junction and spinal axis. The development of the disposable, ambulatory pain pump presents a novel alternative for treatment of postoperative pain. The authors describe a multimodal treatment algorithm for postoperative pain after posterior occipitocervical junction surgery that uses the On-Q pain catheter system (I-Flow Corp., Lake Forest, CA) and a fentanyl patch. The On-Q PainBuster catheter system is a disposable, ambulatory device that allows for continuous anesthetic delivery directly into or adjacent to the wound...
2016: Curēus
https://www.readbyqxmd.com/read/27423151/pharmacokinetics-of-2-formulations-of-transdermal-fentanyl-in-cynomolgus-macaques-macaca-fascicularis
#18
Amy M Carlson, Richard Kelly Iii, David P Fetterer, Pedro J Rico, Emily J Bailey
Fentanyl is a μ-opioid agonist that often is used as the analgesic component for balanced anesthesia in both human and veterinary patients. Minimal information has been published regarding appropriate dosing, and the pharmacokinetics of fentanyl are unknown in NHP. The pharmacokinetic properties of 2 transdermal fentanyl delivery methods, a solution (2.6 and 1.95 mg/kg) and a patch (25 μg/h), were determined when applied topically to the dorsal scapular area of cynomolgus macaques (Macaca fascicularis). Serum fentanyl concentrations were analyzed by using liquid chromatography-mass spectrometry...
2016: Journal of the American Association for Laboratory Animal Science: JAALAS
https://www.readbyqxmd.com/read/27408513/fentanyl-patch-fatalities-we-all-have-a-role-in-prevention
#19
Matthew Grissinger
We all have a role in preventing fentanyl patch tragedies.
July 2016: P & T: a Peer-reviewed Journal for Formulary Management
https://www.readbyqxmd.com/read/27405369/fentanyl-norfentanyl-concentrations-during-transdermal-patch-application-lc-ms-ms-urine-analysis
#20
Oneka T Cummings, Jeffrey R Enders, Gregory L McIntire, R Backer, A Poklis
Poklis and Backer published a survey of the concentrations of fentanyl and norfentanyl that could be expected in urine from patients using Duragesic(®), a transdermal fentanyl patch. That study employed a relatively small number of patient data points and analysis by Gas Chromatography/Mass Spectrometry. This work examines a larger population of patient positives for fentanyl and norfentanyl to determine whether more than a decade later the original report remains accurate in predicting the range and median levels of fentanyl and norfentanyl concentrations physicians can expect to see from their patients...
October 2016: Journal of Analytical Toxicology
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