Journal of pain & palliative care pharmacotherapy
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J Pain Palliat Care Pharmacother · Jan 2006
ReviewDexmedetomidine: a novel analgesic with palliative medicine potential.
Dexmedetomidine has gained popularity in anesthesia and critical care for use in deep sedation and analgesia due to a combination of its efficacy and safety compared with other available agents (e.g., opioids, benzodiazepines, propofol) conventionally used in these settings. This brief review is meant to introduce this unique agent to the palliative care field, as dexmedetomidine may hold promise for patients in hospice and palliative care settings whose symptoms are refractory to usual therapies. [Be sure to be clear in the abstract that more studies are warranted and its role is not well defined and is complicated by significant drug interactions, invasive i.v. route and has a significant side effect profile.]
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J Pain Palliat Care Pharmacother · Jan 2006
Review Case ReportsIntranasal sphenopalatine ganglion block: minimally invasive pharmacotherapy for refractory facial and headache pain.
Facial pain and headache of various etiologies are oftentimes unresponsive to conventional therapies. Transnasal sphenopalatine gangion block provides a safe, low-cost, therapy that, if effective, oftentimes can be self-administered for pain relief.
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Commonly held beliefs and myths about opioids within Europe are described. These include sedation, cognitive impairment, addiction, pseudoaddiction, tolerance, efficacy, cancer pain, and end-of-life care. Key learning points for refuting untrue beliefs are presented.
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J Pain Palliat Care Pharmacother · Jan 2005
ReviewAprepitant (EMEND): the role of substance P in nausea and vomiting.
Aprepitant (EMEND) is the first commercially available drug from a new class of agents, the Substance P/neurokinin NK-1 receptor antagonists. Aprepitant is indicated for prevention of acute and delayed chemotherapy-induced nausea and vomiting (CINV) associated with highly emetogenic chemotherapy in adults. Its ability to antagonize the effects of Substance P has lead to greater understanding of the pathophysiology of nausea and vomiting. Its broad range of activity against a wide variety of central and peripheral emetogenic stimuli make it potentially useful in non-chemotherapy related nausea and vomiting.
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Methadone is a synthetic opioid that is effective for the relief of moderate-to-severe pain and for the treatment of opioid dependence. The pharmacokinetics of methadone differ from those of morphine in that methadone has a higher bioavailability, a much longer half-life, and is hepatically metabolized by cytochrome P450 enzymes. The pharmacokinetics of methadone are variable and an understanding of the factors that impact the onset, magnitude, and duration of analgesia is required to optimize therapy. ⋯ AMEDLINE search was performed to identify literature published between 1966 and May 2005 relevant to the pharmacokinetics of methadone. These publications were reviewed and the literature summarized regarding unique and clinically important elements of methadone disposition including its absorption profile, distribution, and metabolism/excretion. General dosing guidelines, dosage conversions from other opioids and pharmacokinetic issues in special populations are discussed.