Journal of pain & palliative care pharmacotherapy
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The ASHP Midyear Clinical meeting continues to be the largest pharmacy meeting in the world. A broad range of topics was presented at hundreds of symposia and posters at the 2001 meeting in New Orleans, Louisiana, in December. Pain management, hospice care, evidence based medicine, safe medication practices and improved drug information services were among the many practice areas addressed and recognized at the meeting.
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J Pain Palliat Care Pharmacother · Jan 2002
ReviewAnalgesia issues in palliative care: bone pain, controlled release opioids, managing opioid-induced constipation and nifedipine as an analgesic.
Some recent literature relevant to analgesia in palliative care is reviewed. Reports on clinical use of bisphosphonates for bone pain in cancer, controlled release opioids, selection of laxatives for opioid-induced constipation and the calcium channel blocker nifedipine as an analgesic are described.
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J Pain Palliat Care Pharmacother · Jan 2002
ReviewCan patients taking opioids drive safely? A structured evidence-based review.
A structured evidence-based literature review was completed to determine if there was epidemiological evidence of an association of opioid use and intoxicated driving, motor vehicle accidents (MVA) and MVA fatalities; to rate the quality of this research evidence according to Agency for Health Care Policy and Research (AHCPR) type of evidence and strength and consistency of the evidence rating scales; and according to this evidence determine whether patients taking opioids can drive safely. Relevant references were located from Medline, Psychological Abstracts, Science Citation Index and the National Library of Medicine Data Query databases by appropriate subject headings. A manual search was also performed utilizing the reference lists of the retrieved articles. ⋯ The evidence in this review indicates that opioids do not appear to be associated with intoxicated driving, MVA and MVA fatalities, and consistently indicated that opioids are not associated with MVA. Although the comparison of point prevalence rates to the point prevalence may be problematic, the results of this systematic review support the contention that patients taking opioids may be allowed to drive. As in all clinical decisions, this determination should be individualized according to clinical factors.
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J Pain Palliat Care Pharmacother · Jan 2002
ReviewKetamine as an analgesic: parenteral, oral, rectal, subcutaneous, transdermal and intranasal administration.
Ketamine is a parenteral anesthetic agent that provides analgesic activity at sub-anesthetic doses. It is an N-methyl-D-aspartate (NMDA) receptor antagonist with opioid receptor activity. Controlled studies and case reports on ketamine demonstrate efficacy in neuropathic and nociceptive pain. ⋯ Use of this drug by the oral, intranasal, transdermal, rectal, and subcutaneous routes has been reported with analgesic efficacy in treating nociceptive and neuropathic pain. Ketamine also has been reported to produce opioid dose sparing and good patient acceptance. A transdermal formulation is currently under patent review in Brazil and an intranasal formulation is currently undergoing phase I/II clinical trials.
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J Pain Palliat Care Pharmacother · Jan 2002
ReviewWhat is the most effective therapy for preventing NSAID-induced gastropathy?
Nonsteroidal anti-inflammatory drug (NSAID)-induced gastrointestinal toxicity is associated with morbidity and mortality, and given the very wide use of NSAIDs, is problematic and costly to society. Several options are now available to minimize gastrointestinal toxicity from NSAIDs. ⋯ The effectiveness of these strategies to minimize NSAID-induced gastrointestinal toxicity is summarized. In addition, their associated adverse effect profiles and costs are compared.