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Hydromorphon

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https://www.readbyqxmd.com/read/27881622/stability-of-21-cocaine-opioid-and-benzodiazepine-drug-analytes-in-spiked-meconium-at-three-temperatures
#1
Fang Wu, Stephanie J Marin, Gwendolyn A McMillin
In this study, the stability of 21 cocaine, opioid and benzodiazepine analytes in spiked meconium was investigated at three storage temperatures: 4°C, room temperature (RT), and 37°C (body temperature). The drugs/metabolites included were hydrocodone, hydromorphone, codeine, morphine, 6-acetylmorphine (6-AM), oxycodone, oxymorphone, cocaine, cocaethylene, benzoylecgonine, m-hydroxybenzoylecgonine, diazepam, oxazepam, temazepam, nordiazepam, chlordiazepoxide, lorazepam, alprazolam, alpha-hydroxyalprazolam, clonazepam, 7-aminoclonazepam, midazolam, alpha-hydroxymidazolam and zolpidem...
November 22, 2016: Journal of Analytical Toxicology
https://www.readbyqxmd.com/read/27878902/a-retrospective-comparison-of-intrathecal-morphine-and-epidural-hydromorphone-for-analgesia-following-posterior-spinal-fusion-in-adolescents-with-idiopathic-scoliosis
#2
Rebecca A Hong, Kathleen M Gibbons, G Ying Li, Ashlee Holman, Terri Voepel-Lewis
BACKGROUND: Posterior spinal fusion to correct idiopathic scoliosis is associated with severe postoperative pain. Intrathecal morphine is commonly used for analgesia after adolescent posterior spinal fusion; however, anticipating and managing the increase in pain scores after resolution of analgesic effect of intrathecal morphine analgesia is challenging. In 2014, we developed a clinical protocol detailing both the administration of intrathecal morphine intraoperatively and the transition to routine, scheduled oral analgesics at 18 h postoperatively...
November 22, 2016: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/27871585/optimal-epidural-analgesia-for-patients-diagnosed-as-having-gynecologic-cancer-undergoing-interstitial-brachytherapy
#3
Ashley K Amsbaugh, Mark J Amsbaugh, Moataz N El-Ghamry, Brian M Derhake
STUDY OBJECTIVE: To determine the optimal epidural analgesia for patients receiving interstitial brachytherapy (ISBT) for gynecologic cancers. DESIGN: Retrospective analysis. SETTING: Operating room and hospital ward. PATIENTS: Seventy-three patients diagnosed as having gynecologic cancer and undergoing ISBT. INTERVENTIONS: Twelve patients received ropivacaine alone, 14 patients received ropivacaine with fentanyl, and 45 patients received ropivacaine with hydromorphone by epidural infusion...
December 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27822929/once-daily-oros-hydromorphone-for-management-of-cancer-pain-an-open-label-multi-center-non-interventional-study
#4
Cheol Kyu Park, Hyun Wook Kang, In Jae Oh, Young Chul Kim, Yeo Kyeoung Kim, Kook Joo Na, Sung Ja Ahn, Tae Ok Kim, Young Jin Choi, Geun Am Song, Min Ki Lee
Extended-release osmotic extended-release oral delivery system (OROS) hydromorphone is a strong synthetic opioid designed to maintain a constant blood concentration by once daily dosing. The objective of this observational study was to investigate the clinical usefulness of OROS hydromorphone in patients with cancer pain of moderate to severe intensity. Patients with cancer pain who required strong opioids were administered with OROS hydromorphone for 4 weeks. We assessed changes in pain intensity using a numerical rating scale (NRS) as well as levels of sleep disturbance, breakthrough pain, end-of-dose failure, patient satisfaction, and overall assessment of drug effectiveness based on investigator evaluation...
December 2016: Journal of Korean Medical Science
https://www.readbyqxmd.com/read/27810148/introduction-of-a-novel-ultrasound-guided-extrathoracic-sub-paraspinal-block-for-control-of-perioperative-pain-in-nuss-procedure-patients
#5
Robert B Bryskin, Daniel K Robie, Frederick M Mansfield, Eugene B Freid, Siam Sukumvanich
BACKGROUND: A safe and effective method of multilevel thoracic pain control remains an elusive goal in patients undergoing the Nuss procedure. The aim of our study was to develop a nonopioid centered approach using a novel regional technique as part of a quality improvement initiative. METHODS: The proposed ultrasound-guided technique positions multi-perforated soaker catheter deep to the paraspinal muscles from T2 to T11. The project was conducted in two phases...
October 14, 2016: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/27775447/a-pediatric-fatality-due-to-accidental-hydromorphone-ingestion
#6
F Lee Cantrell, James Sherrard, Michael Andrade, Bethann Schaber, Iain M McIntyre
BACKGROUND: Death due to prescription opioid exposure has increased dramatically in North America. Currently, there is a lack of literature detailing potentially lethal doses as well as postmortem tissue analysis concentrations from prescription opioid fatalities in children. We report a pediatric hydromorphone fatality with postmortem peripheral blood, central blood, liver, and gastric concentrations. CASE REPORT: A 3-year-old male was found unresponsive on a couch...
October 24, 2016: Clinical Toxicology
https://www.readbyqxmd.com/read/27764026/suitability-of-the-dri-hydrocodone-hydromorphone-immunoassay-in-the-clinical-environment-at-a-lower-cutoff-validation-with-lc-ms-ms-analysis
#7
Robert B Dixon, Amitava Dasgupta
BACKGROUND: We evaluated the analytical performance of the DRI hydrocodone/hydromorphone assay by comparing semiquantitative values obtained by this assay with values obtained by a liquid chromatography combined with tandem mass spectrometry (LC-MS/MS) method. We also evaluated the possibility of lowering the cutoff of the DRI assay from 300 to 100 ng/mL. METHODS: We compared semiquantitative values obtained by the DRI assay in 97 specimens with values obtained by the LC-MS/MS method including 10 specimens containing hydrocodone and/or hydromorphone concentrations between 105...
December 2016: Therapeutic Drug Monitoring
https://www.readbyqxmd.com/read/27754734/successful-treatment-of-opioid-refractory-cancer-pain-with-short-course-low-dose-ketamine
#8
Julie M Waldfogel, Suzanne Nesbit, Steven P Cohen, Sydney M Dy
Opioids remain the mainstay of treatment for severe cancer pain, but up to 20% of patients have persistent or refractory pain despite rapid and aggressive opioid titration, or develop refractory pain after long-term opioid use. In these scenarios, alternative agents and mechanisms for analgesia should be considered. This case report describes a 28-year-old man with metastatic pancreatic neuroendocrine cancer with severe, intractable pain despite high-dose opioids including methadone and a hydromorphone patient-controlled analgesia (PCA)...
October 18, 2016: Journal of Pain & Palliative Care Pharmacotherapy
https://www.readbyqxmd.com/read/27751704/when-hydromorphone-is-not-working-try-loratadine-an-emergency-department-case-of-loratadine-as-abortive-therapy-for-severe-pegfilgrastim-induced-bone-pain
#9
Katherine Moore, Rachel Haroz
BACKGROUND: Intractable bone pain is a notorious adverse effect of granulocyte-colony stimulating factors (G-CSFs), such as pegfilgrastim and filgrastim, which are given to help prevent neutropenia in patients who are undergoing chemotherapy. G-CSF-induced bone pain is surprisingly common and often refractory to treatment with conventional analgesics. CASE REPORT: This article describes an emergency department case of opiate and nonsteroidal anti-inflammatory drug-resistant pegfilgrastim-induced bone pain that was successfully alleviated with 10 mg of oral loratadine, allowing for discharge home...
October 14, 2016: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27727452/hydromorphone-for-cancer-pain
#10
REVIEW
Yan J Bao, Wei Hou, Xiang Y Kong, Liping Yang, Jun Xia, Bao J Hua, Roger Knaggs
BACKGROUND: Cancer pain is an important and distressing symptom that tends to increase in frequency and intensity as the cancer advances. For people with advanced cancer, the prevalence of pain can be as high as 90%. It has been estimated that 30% to 50% of people with cancer categorise their pain as moderate to severe, with between 75% and 90% of people with cancer experiencing pain that they describe as having a major impact on their daily life. Epidemiological studies suggest that approximately 15% of people with cancer pain fail to experience acceptable pain relief with conventional management...
October 11, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27723230/effect-of-morphine-methadone-hydromorphone-or-oxymorphone-on-the-thermal-threshold-following-intravenous-or-buccal-administration-to-cats
#11
Bruno H Pypendop, Yael Shilo-Benjamini, Jan E Ilkiw
OBJECTIVE: To determine the effects of morphine, methadone, hydromorphone or oxymorphone on the thermal threshold in cats, following buccal and intravenous (IV) administration. STUDY DESIGN: Randomized crossover study. ANIMALS: Six healthy adult female ovariohysterectomized cats weighing 4.5 ± 0.4 kg. METHODS: Morphine sulfate (0.2 mg kg(-1) IV or 0.5 mg kg(-1) buccal), methadone hydrochloride (0.3 mg kg(-1) IV or 0...
November 2016: Veterinary Anaesthesia and Analgesia
https://www.readbyqxmd.com/read/27703394/survey-of-pain-specialists-regarding-conversion-of-high-dose-intravenous-to-neuraxial-opioids
#12
Andrew W Gorlin, David M Rosenfeld, Jillian Maloney, Christopher S Wie, Johnathan McGarvey, Terrence L Trentman
The conversion of high-dose intravenous (IV) opioids to an equianalgesic epidural (EP) or intrathecal (IT) dose is a common clinical dilemma for which there is little evidence to guide practice. Expert opinion varies, though a 100 IV:10:EP:1 IT conversion ratio is commonly cited in the literature, especially for morphine. In this study, the authors surveyed 724 pain specialists to elucidate the ratios that respondents apply to convert high-dose IV morphine, hydromorphone, and fentanyl to both EP and IT routes...
2016: Journal of Pain Research
https://www.readbyqxmd.com/read/27702939/degradation-of-opioids-and-opiates-during-acid-hydrolysis-leads-to-reduced-recovery-compared-to-enzymatic-hydrolysis
#13
Pongkwan Sitasuwan, Cathleen Melendez, Margarita Marinova, Kaylee R Mastrianni, Alicia Darragh, Emily Ryan, L Andrew Lee
Drug monitoring laboratories utilize a hydrolysis process to liberate the opiates from their glucuronide conjugates to facilitate their detection by tandem mass spectrometry (MS). Both acid and enzyme hydrolysis have been reported as viable methods, with the former as a more effective process for recovering codeine-6-glucuronide and morphine-6-glucuronide. Here, we report concerns with acid-catalyzed hydrolysis of opioids, including a significant loss of analytes and conversions of oxycodone to oxymorphone, hydrocodone to hydromorphone and codeine to morphine...
October 2016: Journal of Analytical Toxicology
https://www.readbyqxmd.com/read/27690149/chemoenzymatic-total-synthesis-of-hydromorphone-by-an-oxidative-dearomatization-intramolecular-4-2-cycloaddition-sequence-a-2nd-generation-approach
#14
Lukas Rycek, John J Hayward, Marwa Abdel Latif, James Tanko, Razvan Simionescu, Tomas Hudlicky
A 2nd generation approach to the synthesis of hydromorphone by oxidative dearomatization/Diels-Alder cycloaddition was investigated. Detailed analysis of the stereochemical outcome of the [4+2] cycloaddition was performed first on a truncated model system as well as on the material leading to ent-hydromorphone. The stereochemical assignments were made by NMR and X-ray methods. The 2nd generation synthesis of hydromorphone was completed in both enantiomeric series. Improvements in the dearomatization conditions were attained by using hypervalent iodine reagents instead of Pb(OAc)4...
September 30, 2016: Journal of Organic Chemistry
https://www.readbyqxmd.com/read/27687384/effect-of-thoracic-epidural-analgesia-on-recovery-of-bowel-function-after-major-upper-abdominal-surgery
#15
Jin Hee Ahn, Hyun Joo Ahn
STUDY OBJECTIVE: We investigated whether thoracic epidural analgesia (TEA) shortens the first gas-out time compared to intravenous patient-controlled analgesia (iv-PCA) and promotes earlier discharge after major upper abdominal surgery. DESIGN: Prospective observational study. SETTING: A tertiary care university hospital. PATIENTS: Fifty-six patients undergoing major upper abdominal surgery. INTERVENTIONS: TEA (n=28) was performed using a paramedian approach at T6-7 or T7-8...
November 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27641091/determination-of-ed50-of-hydromorphone-for-postoperative-analgesia-following-cesarean-delivery
#16
G C Lynde
BACKGROUND: Morphine is the most common opioid injected into the intrathecal space for postoperative analgesia following cesarean delivery, but ongoing medication shortages have resulted in limited availability. One proposed morphine alternative is hydromorphone. Studies investigating its use in post-cesarean analgesia are limited. This study was conducted to determine the median effective dose of intrathecal hydromorphone 12h postpartum. METHODS: Twenty healthy women undergoing elective cesarean delivery were recruited into this study...
December 2016: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/27623143/trends-in-the-distribution-of-opioids-in-puerto-rico-1999-2013
#17
Sausan El Burai Félix, Karin A Mack, Christopher M Jones
OBJECTIVE: Limited information has been published about opioid prescribing practices in Puerto Rico. The objective of this study was to create baseline trends of opioids distributed over a period of fourteen years in Puerto Rico. METHODS: We examined data from the U.S. Drug Enforcement Administration's Automation of Reports and Consolidated Orders System (ARCOS) for the period 1999-2013. ARCOS data reflects the amount of controlled substances legally dispensed. Analyses include the distribution of opioids (in morphine milligram equivalent kg per 10,000 persons) by year and entity (pharmacy, hospital, practitioner)...
September 2016: Puerto Rico Health Sciences Journal
https://www.readbyqxmd.com/read/27607476/long-acting-patient-controlled-opioids-are-not-associated-with-more-postoperative-hypoxemia-than-short-acting-patient-controlled-opioids-after-noncardiac-surgery-a-cohort-analysis
#18
Allan W Belcher, Ashish K Khanna, Steve Leung, Amanda J Naylor, Matthew T Hutcherson, Bianka M Nguyen, Natalya Makarova, Daniel I Sessler, P J Devereaux, Leif Saager
BACKGROUND: Opioids can contribute to postoperative desaturation. Short-acting opioids, titrated to need, may cause less desaturation than longer-acting opioids. We thus tested the primary hypothesis that long-acting patient-controlled intravenous opioids are associated with more hypoxemia (defined as an integrated area under a postoperative oxyhemoglobin saturation of 95%) than short-acting opioids. METHODS: This analysis was a substudy of VISION, a prospective cohort study focused on perioperative cardiovascular events (NCT00512109)...
December 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27562969/evaluation-of-a-newly-formulated-enzyme-immunoassay-for-the-detection-of-hydrocodone-and-hydromorphone-in-pain-management-compliance-testing
#19
Renata Nascimento, Alphonse Poklis, Carl E Wolf
A new Hydrocodone Enzyme Immunoassay (HEIA; Lin-Zhi International, Inc.) was evaluated for the detection of hydrocodone and its main metabolite, hydromorphone. All specimens were tested with two different cutoff calibrators, 100 and 300 ng/mL, on an ARCHITECT Plus c4000 Clinical Chemistry Analyzer. Controls containing -25% (negative control) and +25% (positive control) of the cutoff calibrators and a drug-free control were analyzed with each batch. All 1,025 urine specimens were previously analyzed by ultra-performance liquid chromatography-mass spectrometry/mass spectrometry (UPLC-MS-MS) for opiates...
October 2016: Journal of Analytical Toxicology
https://www.readbyqxmd.com/read/27552239/a-rare-case-of-hydromorphone-induced-angioedema-effectively-managed-by-a-difficult-airway-response-team
#20
Scott Masson, Matthew Villerot, Bhavinkumar Dalal
Hydromorphone, unlike other opioids associated with histamine release, has never been reported to cause angioedema. We report a rare case of hydromorphone-induced angioedema in a 34-year-old woman with history of deep venous thrombosis and pulmonary embolism who presented with leg swelling and pain after trauma. Hydromorphone was administered with subsequent rapid development of stridor and edematous changes of the tongue, uvula, and surrounding mucosa. The difficult airway response team was activated, and the airway was secured by emergent awake fiberoptic intubation in the operating room...
August 22, 2016: A & A Case Reports
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