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At least 217 records · Page 12Linked to original sources
PubMed2002

Surveillance of drug identification calls: an overlooked poison center responsibility.

Drug identification calls from the lay public are a source of annoyance to many poison centers, but they also provide valuable information about abused and diverted pharmaceuticals. Daily toxicosurveillance can identify significant problems in advance of being recognized by law enforcement and drug diversion task forces. At our center a single person daily reviews evey chart for recognition of drug identification trends. In February the center received its first reQuest for identification of a tablet with M360 imprint, a generic product that contained 7.5 mg hydrocodone + 750 mg acetaminophen (Mallinckrodt). In 21 d after that identification, 78 additional identification reQuests, and during 2 mo further, a total of 222 requests for M360 identification were received. Law enforcement officials were notified and allowed drug intelligence to determine how this legal pharmaceutical was being diverted for illicit use. Poison Centers provide valuable drug identification service. Realtime surveillance of these calls can provide important information about drug abuse patterns

Pharmaceutical Preparations↗
PubMed2003

Review of the analgesic efficacy of ibuprofen.

There is a clear relationship between single doses of ibuprofen over the range 50-400 mg and the peak analgesic effect and the duration of analgesia. The smallest clinically useful dose of ibuprofen is 200 mg. Ibuprofen 400 mg has been shown to be as effective as aspirin 600 or 900 mg/day in models of moderate pain but superior to aspirin or paracetamol in more sensitive models such as dental pain. The duration of action of ibuprofen 400 mg is at least 6 hours compared with 4-6 hours for ibuprofen 200 mg or paracetamol. In patients undergoing oral surgery, ibuprofen 200 mg was broadly comparable with naproxen 220 mg and ibuprofen 400 mg comparable with ketoprofen 25 mg. The combination of ibuprofen and hydrocodone is more effective than either drug alone in patients undergoing abdominal and gynaecological surgery. The absorption of ibuprofen acid is influenced by formulation, and certain salts of ibuprofen (lysine, arginine, potassium) and solubilised formulations have an enhanced onset of activity. These differences are clinically important, offering a shorter time to onset of relief of tension headache compared with paracetamol.

Analgesics, Non-Narcotic↗
PubMed2003

Current concepts in acute pain management.

Analgesics most commonly prescribed in dentistry for acute pain relief include the nonsteroidal anti-inflammatory drug, acetaminophen, and various opioid-containing analgesic combinations. The NSAIDs and presumably acetaminophen act by inhibiting cyclooxgenase enzymes responsible for the formation of prostaglandins that promote pain and inflammation. Opioids such as codeine, hydrocodone, and oxycodone stimulate endogenous opioid receptors to bring about analgesic and other effects. Numerous clinical studies have confirmed that moderate to severe pain of dental origin is best managed through the use of ibuprofen or another NSAID whose maximum analgesic effect is at least equal to that of standard doses of acetaminophen-opioid combinations. If an NSAID cannot be prescribed because of patient intolerance, analgesic preparations that combine effective doses of an orally active opioid with 600 to 1,000 mg of acetaminophen are preferred in the healthy adult. On occasion, prescribing both an NSAID and an acetaminophen-opioid combination may be helpful in patients not responding to a single product. In all cases, however, the primary analgesic should be taken on a fixed schedule, not on a "prn" (or as needed) basis, which only guarantees the patient will experience pain.

Acute Disease↗
PubMedDate not supplied

Misuse of prescribed controlled substances defined by urinalysis.

The use of controlled substances to treat pain is associated with the need to monitor carefully patients for signs of addictive behaviors that may lead to the misuse or abuse of medications. At the West Virginia Pain Treatment Center in Morgantown, a narcotic protocol is employed which consists of a narcotic contract, consent, psychological evaluation, and random urinalysis to ensure the safe and proper use of controlled substances. This study reports the findings of a retrospective study of 186 patients at the center from Jan. 1, 2001 to Dec. 31, 2001, which revealed that there were 355 infractions of the narcotic contract. Products containing hydrocodone were found to be most frequently misused (20.3%), followed by oxycodone products (19.7%). Patients prescribed controlled substances should be repeatedly evaluated for medication misuse and the presence of addictive behaviors.

Female↗
PubMed2004

Hallucinations with zolpidem and fluoxetine in an impaired driver.

A 54-year-old male was observed driving erratically. The subject displayed both horizontal and vertical nystagmus and poor balance on field sobriety tests (FST's). Further observations included slow movements, breathing, and speech, extremely poor coordination, lack of convergence, and pupils with slow reaction to light. The subject related he was seeing roadway lines doubled and felt a hallucinogenic effect. Breath alcohol results were negative. Blood tests found zolpidem and fluoxetine in addition to hydrocodone at therapeutic levels. This case is presented as an example of hallucinogenic effects from the combination of zolpidem and serotonin reuptake inhibitors.

Automobile Driving↗
PubMed2004

Local anesthetic infusion pumps improve postoperative pain after inguinal hernia repair: a randomized trial.

Pain after an open inguinal hernia repair may be significant. In fact, some surgeons feel that the pain after open repair justifies a laparoscopic approach. The purpose of this study was to determine if the use of local anesthetic infusion pumps would reduce postoperative pain after open inguinal hernia repair. We performed a prospective, double-blind randomized study of 45 open plug and patch inguinal hernia repairs. Patients were randomized to receive either 0.25 per cent bupivicaine or saline solution via an elastomeric infusion pump (ON-Q) for 48 hours, at 2 cc/h. The catheters were placed in the subcutaneous tissue and removed on postoperative day 3. Both groups were prescribed hydrocodone to use in the postoperative period at the prescribed dosage as needed for pain. Interviews were conducted on postoperative days 3 and 7, and patient's questionnaires, including pain scores, amount of pain medicine used, and any complications, were collected accordingly. During the first 5 postoperative days, postoperative pain was assessed using a visual analog scale. Twenty-three repairs were randomized to the bupivicaine group and 22 repairs randomized to the placebo group. In the bupivicaine group, there was a significant decrease in postoperative pain on postoperative days 2 through 5 with P values <0.05. This significant difference continued through postoperative day 5, 2 days after the infusion pumps were removed. Patients who had bupivicaine instilled in their infusion pump had statistically significant lower subjective pain scores on postoperative days 2 through 5. This significant difference continued even after the infusion pumps were removed. Local anesthetic infusion pumps significantly decreased the amount of early postoperative pain. Pain relief persisted for 2 days after catheter and pump removal.

Adolescent↗
PubMed2005

Oral analgesics for acute nonspecific pain.

Physicians most often recommend or prescribe oral medication for relief of acute pain. This review of the available evidence supports the use of acetaminophen in doses up to 1,000 mg as the initial choice for mild to moderate acute pain. In some cases, modest improvements in analgesic efficacy can be achieved by adding or changing to a nonsteroidal anti-inflammatory drug (NSAID). The safest NSAID is ibuprofen in doses of 400 mg. Higher doses may offer somewhat greater analgesia but with more adverse effects. Other NSAIDs have failed to demonstrate consistently greater efficacy or safety than ibuprofen. Although they may be more expensive, these alternatives may be chosen for their more convenient dosing. Cyclooxygenase-2 inhibitors provide equivalent efficacy to traditional NSAIDs but lack a demonstrable safety advantage for the treatment of acute pain. For more severe acute pain, the evidence supports the addition of oral narcotic medications such as hydrocodone, morphine, or oxycodone. Specific oral analgesics that have shown poor efficacy and side effects include codeine, propoxyphene, and tramadol.

Acetaminophen↗
PubMed2006

Psychiatric and pain characteristics of prescription drug abusers entering drug rehabilitation.

There has been intense interest in the problem of prescription drug abuse on the parts of health professionals, law enforcement, the media, and the general public. Clinicians not only need to know how to assess risk but also what drugs are being diverted most in their region. We conducted a prospective survey of prescription drug abusers entering a treatment facility in central Kentucky. Participants (n = 109) were enrolled and completed a structured clinical interview and prescription drug abuse survey. The prescription drug abusers assessed in the study had a mean age of 30.95 years (SD = 10.21), were comprised of 75 men (69%) and 34 women (31%), and were mostly Caucasian (98%). The majority (84%) stated that they had legitimately been given a prescription for opioids for pain at some point from a physician and 61% reported chronic pain concerns. The most commonly abused drugs were hydrocodone-containing formulations (78%) and oxycodone-containing products (69%), while products containing methadone (23%) or fentanyl (7%) were abused much less frequently. Most respondents (91%) stated that they had purchased prescription opioids from a street dealer at least once and the majority (80%) had altered the delivery system of the prescription drug by chewing, snorting, or using i.v. administration. Implications for pain management are discussed, focusing on the need for clinicians treating chronic pain to more thoroughly assess patients for their risk of abuse and addiction before starting an opioid regimen.

Adult↗
PubMed2002

National All Schedules Prescription Electronic Reporting Act (NASPER): balancing substance abuse and medical necessity.

The National All Schedules Prescription Electronic Reporting Act, or NASPER, is a bill proposed by the American Society of Interventional Pain Physicians to provide and improve patient access with quality care, and protect patients and physicians from deleterious effects of controlled substance misuse, abuse and trafficking. Controlled prescription drugs, including narcotic analgesics, anxiolytics, anti-depressants, stimulants, and sedative-hypnotics play a significant and legitimate role in interventional pain management practices in managing chronic pain and related disorders. Based on the 1997 household survey on drug abuse it is estimated that 76.9 million Americans had used an illicit drug at least once in their life. In 1997, 4.2 million people used analgesics, 2.1 million used tranquillizers, and an additional 2.3 million people used various other drugs, including sedatives, tranquillizers, etc. The non-medical use of prescription drugs exceeds that of all illicit substances except for marijuana and hashish. The report on epidemiology trends in drug abuse, based on community epidemiology work group analysis showed continued increase of abuse of prescription drugs in urban, suburban, and rural areas. The most commonly abused drugs include oxycodone, hydrocodone, hydromorphone, morphine, codeine, clonazepam, alprazolam, lorazepam, diazepam and carisoprodol. The diversion of prescription controlled substances to illicit channels is a public health and safety issue. This review describes the role of controlled substances in chronic pain management, prevalence and economic impact of controlled substance abuse, prescription accountability, effectiveness of prescription monitoring programs, and rationale for national controlled substance electronic reporting system.

Journal Article↗
PubMed1991

Polymorphic metabolism of opioid narcotic drugs: possible clinical implications.

The oxidative metabolism of many drugs is under genetic control. The enzyme responsible for this reaction for this group of drugs is cytochrome P-450IID6. Humans can be classified either as extensive metabolisers or, if lacking this enzyme, poor metabolisers. The incidence of poor metabolisers in caucasian subjects is 7-10%. The hepatic O-demethylation of codeine to morphine, quantitatively a minor metabolic process, represents this type of genetic polymorphism and has been studied in human pharmacokinetic studies, human urinary recovery studies, and in human and rat liver microsome experiments. Based on the current understanding that the analgesic effect of codeine is mediated primarily through morphine, one might anticipate that poor metabolisers would not obtain pain relief from codeine. The clinical significance of this polymorphism to the antidiarrhoeal and antitussive properties of codeine is not known. Others opioids (dihydrocodeine, hydrocodone, oxycodone, and thebaine) are structurally similar to codeine and their metabolism (O-demethylation at the 3 position) might also be under genetic control. Pharmacogenetics may play an important role in explaining the wide variability of the clinical response to many opioid drugs.

Alfentanil↗
PubMed1990

Use of analgesics and antibiotics in endodontics: current concepts.

In this review, the principal drugs used for prevention and treatment of pain--analgesics, and swelling--antibiotics, are examined. The rationale for prevention of pain and swelling is given. Then the specific drugs are considered. The analgesics evaluated include: the non-steroidal anti-inflammatory agents (e.g., aspirin, acetaminophen, ibuprofen, diflunisal); and the narcotics (e.g., codeine, oxycodone, hydrocodone, meperidine). The antibiotics evaluated include: the penicillins (e.g., penicillin V, ampicillin, methicillin); the cephalosporins (e.g., cephalexin, cefadroxil); the erythromycins (e.g., erythromycin stearate, erythromycin base); clindamycin; metronidazole; and some rarely used drugs (e.g., ciprofloxacin).

Analgesics↗
PubMed1989

Opiate-induced pupillary effects in humans.

The pupillary effects of several opiates were assessed in human volunteers (N = 6) by means of a newly developed hand-held pupilometer, Pupilscan. Static (diameter) and dynamic (light reflex) responses after morphine, heroin, codeine, oxycodone, oxymorphone and hydrocodone were recorded. The opiates caused dose-related decreases in pupillary size and in the velocity of constriction to a light stimulus. The velocity of redilation after a light stimulus was also decreased. These data indicate that opiates cause systematic changes in dynamic pupillary responses in humans and that measures of these changes may be useful in the quantitative estimation of drug-induced impairment.

Adult↗
PubMed1983

GABA-opiates interactions in the activity of analgesics.

The influence of compounds which reduce or potentiate GABA-ergic inhibition on the effect of analgesics of various structures was studied. The effect was estimated according to the analgesic activity (experiments in rats) and the suppression of the impulse summation in the central nervous system (experiments in rabbits). It was shown that GABA-negative agents (bicucullin, thiosemicarbazide) markedly decreased the effect of morphine, hydrocodone and the enkephaline analogs: Tyr-D-Ala-Gly-Phe-NH2 and Tyr-D-Ala-Gly-Phe(NO2)NH2. The action of bicuculline was close to that of naloxone, an opiate receptor blocker. GABA-positive agents (muscimol, GABA cetyl ether, valproate) potentiated the activity of the mentioned narcotic analgesics. The effect of GABA-positive agents was blocked not only by GABA-negative compounds, but also by naloxone. The obtained data are interpreted in terms of the assumed mutual complementary of GABA-ergic and opioidergic systems. It was shown that the effects of the analgesics of a different structure: phenylpiperidine derivatives (trimeperidine, fentanyl), diphenylacetic acid derivative (dimenoxadol) and 3-benzazocine tricyclic derivative (pentazocine) were unchanged by the studied GABA-ergic analyzers. The reasons for those dissimilarities between analgesics of different structures are discussed.

Aminooxyacetic Acid↗
PubMedDate not supplied

An analytic comparison of laparoscopic hernia repair with open "tension-free" hernioplasty.

Two of the most important etiological factors in the development of primary and recurrent inguinal hernias are collagen deficiency and tension on the suture line respectively. These factors can be eliminated by the use of open "tension-free" hernioplasty, advocated by the Lichtenstein Hernia Institute since 1984. In this procedure, the entire floor of the inguinal canal is reinforced by an 8 cm x 16 cm sheet of Marlex mesh that is sutured in place to protect the floor from all future adverse mechanical and metabolic effects without the risk of displacement or folding. A new ring and shutter mechanism is also created by the procedure, which is performed under local anesthesia and requires only a few hours of in-hospital postoperative observation. Pain control following the operation involves only 2-20 tablets of 5 mg hydrocodone bitartrate, for 2-4 days. The recurrence rate of early procedures was a mere 0.1%, and has been zero for 2,500 patients treated in the past five years. In addition, there has only been one complication (a testicular atrophy) in 4,000 operations over ten years. The postoperative pain and recovery period of the "tension free" procedure compare favorably with those of laparoscopic repair, while the complication and recurrence rate and costs are significantly lower. The Lichtenstein "tension-free" method has been performed on tens of thousands of patients worldwide and these results have been duplicated and published by authors from the United States, England, Belgium, Spain, Italy and Austria.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1996

Pharmacogenetic determination of the effects of codeine and prediction of drug interactions.

To define the differences in codeine pharmacodynamics in extensive (EMs) and poor (PMs) metabolizers of debrisoquin and to determine whether the inhibition of codeine's metabolism by quinidine produces phenotypically dependent pharmacodynamic changes, we studied 16 healthy nonsmoking males, 10 EMs and 6 PMs of debrisoquin. The subjects received in random double-blind fashion 120 mg of codeine plus placebo, 120 mg of codeine plus 100 mg of quinidine and 100 mg of quinidine plus placebo. Blood was obtained over 24 hr and urine was collected for 48 hr. Respiratory, psychomotor and pupillary effects of codeine were greater in the EMs than in the PMs (P < .01). Morphine and morphine metabolites were detectable only in plasma from EMs. Codeine metabolic clearance by O-demethylation was almost 200-fold greater in the EMs than in the PMs. After coadministration of quinidine, morphine and morphine metabolites were not detectable in the plasma of either phenotype and mean (+/- S.E.M.) O-demethylation clearance was reduced in the EMs from 162.7 +/- 36.6 to 17.0 +/- 5.0 ml/min (P < .003), but not in the PMs. The diminished production of morphine in the EMs was associated with significantly reduced respiratory, psychomotor and pupillary effects (P < .01). Thus, CYP2D6 mediated O-demethylation of codeine to morphine is central to its pharmacodynamic effects. Patients who lack CYP2D6 or whose CYP2D6 is inhibited would not be expected to benefit from codeine. Thus, phenotyping for CYP2D6 and the avoidance of CYP2D6 inhibitors is justified in patients with chronic path before initiating long-term therapy with analgesics whose in vivo activation is dependent on CYP2D6 activity (i.e., codeine, hydrocodone and oxycodone.

Adult↗
PubMed1998

Improved GC/MS analysis of opiates with use of oxime-TMS derivatives.

An improved gas chromatographic/mass spectrometric (GC/MS) assay is described for the quantitation of codeine and morphine as trimethylsyl (TMS) derivatives. The TMS derivatization of ketone-containing opiates results in the formation of multiple derivatives. Some of these products have retention times close to those of codeine-TMS and morphine-TMS. When the keto-opiates are present in samples assayed for codeine and morphine in urine, they can interfere with the quantitation of these commonly targeted opiates. The assay was improved with the addition of a pre-BSTFA derivatization step, whereby hydroxylamine was used to convert the keto-opiates into the corresponding oxime derivative. These derivatives were then reacted with BSTFA to form the TMS ethers and TMS oxime derivatives. The oxime step enabled production of single derivatives for hydrocodone and hydromorphone. In addition, the retention times for the oxime-TMS derivatives were increased so that they no longer elute near the targeted drugs of codeine and morphine. The addition of the oxime step does not affect the sylation of codeine and morphine, and the accuracy and precision of this assay were unaffected.

Codeine↗
PubMed1998

Vitamin B2 interference with TDx drugs-of-abuse assays.

Migraine is a headache condition found in significant frequency in the general population. One recent study has shown that riboflavin, Vitamin B2, is an effective prophylactic treatment for this headache condition. One subject in a recent study conducted by the Division of Forensic Toxicology, Armed Forces Institute of Pathology (AFIP) was taking 200 mg of riboflavin twice daily for the prevention of migraine headaches. When that subject's urine was tested using Abbott TDx drugs-of-abuse assays a number of tests resulted in a MX BKG error and all samples had BLK I values greater than those observed with normal urine specimens. The MX BKG error occurs when the BLK I value is greater than the upper limit determined by the manufacturer for a particular assay. High BLK I values may result if the specimen being analyzed contains a fluorophore that will compete with the fluorescein-labeled antibody used in the assay. This error serves as a notification that an interfering substance may be present and the assay is not performing according to manufacturer-specifications. Upon termination of riboflavin therapy the subject's BLK I values began to decrease within 60 h of the last 200 mg dose. A second subject began chronic riboflavin use to confirm this interferent effect. Elevated BLK I values resulted within 3 h of a single 200 mg dose and MX BKG errors occurred 1 h after a second 400 mg dose. No false negative results were noted with either subject (both subjects used butalbital and the first subject also used hydrocodone and diazepam during the study), suggesting that riboflavin is not an adulterant. Riboflavin use, however, does interfere with the TDx DAU assays and may result in quantitative values being determined which are of questionable validity in the face of an elevated BLK I value or may result in only an MX BKG error and no quantitative value reported. It is unclear if the interfering fluorophore is simply riboflavin itself or a combination of riboflavin and its metabolic products. Results obtained on urine samples collected from individuals using prophylactic riboflavin for migraine prevention and analyzed by TDx may be of questionable validity. Such samples may require analysis utilizing another immunoassay technique that does not employ a fluorescein-labeled antibody.

Fluorescence Polarization Immunoassay↗