The Consultant pharmacist : the journal of the American Society of Consultant Pharmacists
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Fentanyl transdermal system is indicated for the management of persistent, moderate-to-severe chronic pain that requires continuous opioid administration for an extended period of time and cannot be managed by other means such as nonsteroidal analgesics, opioid combination products, or immediate-release opioids. The Institute for Safe Medication Practices and other patient safety advocates have long been concerned that transdermal fentanyl is often prescribed, dispensed, and administered without proper consideration of patient selection criteria, starting-dose recommendations, contraindications, dose adjustment recommendations, and safe administration procedures. This article will highlight errors that may arise during the use of fentanyl patches and provide risk-reduction recommendations for consultant pharmacists to address the potential for error and patient harm.
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To review the pharmacodynamics, pharmacokinetics, clinical efficacy, tolerability, dosing, and administration of tapentadol, a combination mu-opioid-receptor agonist and monoamine-reuptake inhibitor, and compare it with tramadol, the first drug in this class. ⋯ Tapentadol overcomes some of the liabilities of tramadol. However, it still has some liabilities: its potential to contribute to/precipitate serotonin syndrome and anticholinergic/5-HT3 antagonist effects and to induce physical/psychological dependence (similar to schedule II opioids). There is also a dearth of information in terms of efficacy/tolerability in chronic pain states, clinical data in frail elders, and details of drug-drug interaction potential vis-à-vis glucuronidation and quantitation of the risk of serotonin syndrome.
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Case Reports Comparative Study
Warfarin versus aspirin: using CHADS2 to guide therapy for stroke prevention in nonvalvular atrial fibrillation.
Atrial fibrillation (AF) results in nearly a quarter of the strokes suffered in patients 80 to 89 years of age. Aspirin and warfarin are primary choices for preventing these ischemic strokes. CHADS2 (Congestive heart failure, Hypertention, Age, Diabetes, Stroke) is a validated assessment tool for cardioembolic stroke in AF. ⋯ Warfarin is more effective than aspirin at preventing stroke in AF, but is associated with more hemorrhagic events. The American College of Chest Physicians recommends the use of warfarin in patients with a CHADS2 score of 2 or higher and suggests warfarin be used in patients with a score of 1. We recommend a patient-specific approach to therapy in which warfarin is offered to patients with a CHADS2 score of 1 or higher unless the patient is at high risk for a hemorrhagic event or cannot attain regular warfarin monitoring.
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Characterized by chronic, widespread pain and heightened pain sensitivity, fibromyalgia affects up to 10 million adults. It is physically disabling and often is accompanied by chronic fatigue and psychiatric comorbidities. ⋯ Despite its recognition as an independent condition, debate continues with critics arguing fibromyalgia is a variant of other known disorders. Treatment consists of pharmacotherapy, psychotherapy, and exercise.
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Persistent pain is prevalent in the elderly, and its proper management always has been an important concern in caring for the older patient. State surveyors evaluate nursing facilities annually, and recent clarifications in survey guidelines have heightened the awareness of both facilities and practitioners on the assessment and management of pain.