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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
#1
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
#2
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)...
January 3, 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
#3
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...
December 21, 2016: Postgraduate Medicine
https://www.readbyqxmd.com/read/27886163/alghedon-fentanyl-transdermal-system-afts
#4
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...
November 25, 2016: 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
#5
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
#6
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
#7
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...
September 12, 2016: 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
#8
Emma M Heikkinen, Kokki Hannu, Heikkinen Aki, Ranta Veli-Pekka, Räsänen Juha, Voipio Hanna-Marja, Kokki Merja
Opioids given to pregnant and parturient women are relatively freely transferred across the placenta. Spinal, epidural and intravenous fentanyl have 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, that 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...
September 8, 2016: Basic & Clinical Pharmacology & Toxicology
https://www.readbyqxmd.com/read/27487158/new-initiation-of-long-acting-opioids-in-long-stay-nursing-home-residents
#9
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
#10
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
#11
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
#12
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
#13
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
#14
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
https://www.readbyqxmd.com/read/27080988/use-of-fentanyl-patch-for-treatment-of-moderate-to-severe-chronic-noncancer-pain-postmarketing-surveillance-of-medical-practice-in-japan-using-a-risk-minimization-action-plan
#15
Koji Kawai, Kazutake Yoshizawa, Motoko Fujie, Hisanori Kobayashi, Yoshimasa Ogawa, Tsutomu Yajima
OBJECTIVE: The purpose of this study was to discuss the safety, treatment profile, and clinical effectiveness of 12-month treatment with fentanyl patch (FP), a strong opioid, in medical practice in Japan under the risk minimization action plan (RMAP). METHODS: Patients with moderate-to-severe chronic noncancer pain who had switched to FP from another opioid were registered to take this survey to assess adverse drug reactions (ADRs), therapeutic effect, and pain intensity for up to 12 months...
April 15, 2016: Pain Practice: the Official Journal of World Institute of Pain
https://www.readbyqxmd.com/read/27072143/-dose-finding-for-treatment-with-a-transdermal-fentanyl-patch-titration-with-oral-transmucosal-fentanyl-citrate-and-morphine-sulfate
#16
M Mücke, R Conrad, M Marinova, H Cuhls, F Elsner, R Rolke, L Radbruch
To date, no studies investigating titration with oral transmucosal fentanyl for the dose-finding of transdermal fentanyl treatment have been published. In an open randomized study 60 patients with chronic malignant (n = 39) or nonmalignant pain (n = 21), who required opioid therapy according to step three of the guidelines of the World Health Organization (WHO), were investigated. In two groups of 30 patients each titration with immediate release morphine (IRM) or oral transmucosal fentanyl citrate (OTFC) was undertaken...
April 12, 2016: Der Schmerz
https://www.readbyqxmd.com/read/27064843/paroxysmal-sympathetic-hyperactivity-in-brainstem-compressing-huge-benign-tumors-clinical-experiences-and-literature-review
#17
Seungjoo Lee, Go Woon Jun, Sang Beom Jeon, Chang Jin Kim, Jeong Hoon Kim
Severe paroxysmal sympathetic overactivity occurs in a subgroup of patients with acquired brain injuries including traumatic brain injury, hypoxia, infection and tumor-related complications. This condition is characterized by sudden increase of heart rate, respiratory rate, blood pressure, body temperature and excessive diaphoresis. The episodes may be induced by external stimulation or may occur spontaneously. Frequent occurrence of this condition could result in secondary morbidities, therefore, should be diagnosed and managed insightfully...
2016: SpringerPlus
https://www.readbyqxmd.com/read/27044480/safety-of-fentanyl-initiation-according-to-past-opioid-exposure-among-patients-newly-prescribed-fentanyl-patches
#18
Kevin J Friesen, Cornelius Woelk, Shawn Bugden
BACKGROUND: Although a convenient opioid delivery system, transdermal fentanyl patches have caused several deaths and resulted in safety warnings reminding prescribers that fentanyl patches should be prescribed only for patients who have adequate prior exposure to opioids. We conducted a longitudinal analysis of the safety of fentanyl initiation by examining past opioid exposure among patients newly prescribed fentanyl patches. METHODS: We identified all patients in the province of Manitoba who were newly prescribed fentanyl patches between Apr...
June 14, 2016: CMAJ: Canadian Medical Association Journal, Journal de L'Association Medicale Canadienne
https://www.readbyqxmd.com/read/27037570/cranio-maxillofacial-reconstruction-with-microvascular-radialis-flaps-parameters-and-correlations-of-postoperative-pain-management
#19
Gregor F Raschke, Winfried Meissner, Andre Peisker, Gabriel Djedovic, Ulrich Rieger, Arndt Guentsch, Daria Porwit, Marta Gomez Dammeier, Stefan Schultze-Mosgau
OBJECTIVES: Postoperative pain management is of highest interest for patients undergoing maxillofacial surgery including microvascular reconstructive surgery. Currently, there is a lack of information regarding process and outcome of postoperative pain management after microvascular reconstruction. MATERIALS AND METHODS: In a prospective clinical study, 31 adults were evaluated on the first postoperative day following microvascular reconstruction with a radial forearm flap using the standardized questionnaire of the Germany-wide project Quality Improvement in Postoperative Pain Management (QUIPS)...
January 2017: Clinical Oral Investigations
https://www.readbyqxmd.com/read/27020837/fentanyl-sublingual-spray-for-breakthrough-cancer-pain-in-patients-receiving-transdermal-fentanyl
#20
David S Alberts, Christina Cognata Smith, Neha Parikh, Richard L Rauck
AIM: To investigate the relationship between effective fentanyl sublingual spray (FSS) doses for breakthrough cancer pain (BTCP) and around-the-clock (ATC) transdermal fentanyl patch (TFP). METHODS: Adults tolerating ATC opioids received open-label FSS for 26 days, followed by a 26-day double-blind phase for patients achieving an effective dose (100-1600 µg). RESULTS: Out of 50 patients on ATC TFP at baseline, 32 (64%) achieved an effective dose...
October 2016: Pain Management
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