Journal of pain & palliative care pharmacotherapy
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Addiction to opioid analgesics is a great and often exaggerated concern to many patients and their support groups. This consultation describes a way to explain the disease of addiction to patients.
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Oxycodone is among the most commonly used opioid analgesics for the relief of moderate-to-severe pain and is pharmacodynamically comparable to morphine. Oxycodone is available in the United States in oral dosage forms and controlled-release tablets. Studies have demonstrated marked interindividual variation in the pharmacokinetics of oxycodone. ⋯ A MEDLINE search was conducted to identify literature published between 1966 and May 2004 relevant to the pharmacokinetics of oxycodone. These publications were reviewed and the literature summarized regarding unique and clinically important elements of oxycodone disposition including its absorption profile (immediate release, controlled release, rectal administration, and intranasal administration), distribution, and its metabolism/excretion. Special populations, including children and those with liver/renal failure, have a unique oxycodone pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.
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J Pain Palliat Care Pharmacother · Jan 2004
ReviewTreatment of terminal restlessness: a review of the evidence.
Terminal restlessness is an important issue in the management of symptoms at the end of life with between 25% and 88% of dying patients exhibiting this condition. (1-5) The purpose of this review was to examine the empiric evidence about the pharmacological treatment for terminal restlessness. All available literature, in all languages, from 1966-2002 including randomized trials, concurrent observations, retrospective chart reviews, single case studies, clinical practice guidelines, expert consensus, single expert opinion articles, and editorials were reviewed as "best available evidence." Of the 72 articles reviewed, 14 met the criteria and were chosen for analysis. ⋯ There is insufficient evidence to suggest that a single medication or class of medications is appropriate for terminal restlessness. There is a clear need for additional trials of neuroleptics, benzodiazepines, barbiturates, and combination protocols to determine which protocols are the most effective and have the least side effects.
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J Pain Palliat Care Pharmacother · Jan 2004
ReviewA systematic review of oxygen and airflow effect on relief of dyspnea at rest in patients with advanced disease of any cause.
Oxygen is used frequently to relieve dyspnea in patients with advanced illness. The objective of this study was to critically appraise the scientific basis for oxygen therapy as a therapeutic intervention to manage dyspnea at rest in patients with advanced disease. A systematic search of all relevant databases was done using MeSH terms and appropriate key words. ⋯ This systematic review and critical appraisal found low-grade scientific evidence that oxygen and airflow improve dyspnea in some patients with advanced disease at rest. However, there is no evidence to identify which patients will benefit from airflow or supplemental oxygen or to determine when to use airflow versus supplemental oxygen. Further research is required to provide scientific evidence to evaluate oxygen and airflow effectiveness and determine the place of oxygen and airflow in the management of dyspnea at rest in patients with advanced disease.
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J Pain Palliat Care Pharmacother · Jan 2004
ReviewA systematic review of oxygen and airflow effect on relief of dyspnea at rest in patients with advanced disease of any cause.
Oxygen is used frequently to relieve dyspnea in patients with advanced illness. The objective of this study was to critically appraise the scientific basis for oxygen therapy as a therapeutic intervention to manage dyspnea at rest in patients with advanced disease. A systematic search of all relevant databases was done using MeSH terms and appropriate key words. ⋯ This systematic review and critical appraisal found low-grade scientific evidence that oxygen and airflow improve dyspnea in some patients with advanced disease at rest. However, there is no evidence to identify which patients will benefit from airflow or supplemental oxygen or to determine when to use airflow versus supplemental oxygen. Further research is required to provide scientific evidence to evaluate oxygen and airflow effectiveness and determine the place of oxygen and airflow in the management of dyspnea at rest in patients with advanced disease.