Articles: narcotic-antagonists.
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Psychosomatic medicine · Oct 2008
Randomized Controlled TrialBlunted opiate modulation of hypothalamic-pituitary-adrenocortical activity in men and women who smoke.
To examine the extent to which nicotine dependence alters endogenous opioid regulation of the hypothalamic-pituitary-adrenocortical (HPA) axis functions. Endogenous opiates play an important role in regulating mood, pain, and drug reward. They also regulate the HPA functions. Previous work has demonstrated an abnormal HPA response to psychological stress among dependent smokers. ⋯ We conclude that nicotine dependence is associated with attenuated opioid modulation of the HPA. This dysregulation may play a role in the previously observed blunted responses to stress among dependent smokers.
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To examine the impact of training in overdose management and naloxone provision on the knowledge and confidence of current opiate users; and to record subsequent management of overdoses that occur during a 3-month follow-up period. ⋯ With overdose management training, opiate users can be trained to execute appropriate actions to assist the successful reversal of potentially fatal overdose. Wider provision may reduce drug-related deaths further. Future studies should examine whether public policy of wider overdose management training and naloxone provision could reduce the extent of opiate overdose fatalities, particularly at times of recognized increased risk.
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Am J Hosp Palliat Care · Oct 2008
Review Case ReportsOral morphine overdose in a cancer patient antagonized by prolonged naloxone infusion.
An 80-year-old male was diagnosed with carcinoma in the lung with multiple bony metastases and had been prescribed pain medications as per World Health Organization analgesic ladder guidelines. However, he was not getting adequate pain relief and there were difficulties in titration of the morphine doses on an outpatient basis. Therefore, he was hospitalized for dose titration of oral morphine and was coprescribed amitriptyline and ranitidine. ⋯ After prolonged infusion of naloxone, he achieved his baseline vital parameters without any permanent sequel to the overdose event. This case report describes the possible causes of oral morphine overdose in the elderly and its successful treatment. To prevent such complications, one has to be very cautious of other factors such as drug interactions, particularly in the elderly.
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Exp Clin Psychopharmacol · Oct 2008
Review Case ReportsAddiction to prescription opioids: characteristics of the emerging epidemic and treatment with buprenorphine.
Dependence on and abuse of prescription opioid drugs is now a major health problem, with initiation of prescription opioid abuse exceeding cocaine in young people. Coincident with the emergence of abuse and dependence on prescription opioids, there has been an increased emphasis on the treatment of pain. ⋯ Thus, physicians are whipsawed between the imperative to treat pain with opioids and the fear of producing addiction in some patients. In this article, the authors characterize the emerging epidemic of prescription opioid abuse, discuss the utility of buprenorphine in the treatment of addiction to prescription opioids, and present illustrative case histories of successful treatment with buprenorphine.
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Mayo Clinic proceedings · Oct 2008
ReviewDevelopment of peripheral opioid antagonists' new insights into opioid effects.
The recent approval by the US Food and Drug Administration of 2 medications--methylnaltrexone and alvimopan--introduces a new class of therapeutic entities to clinicians. These peripherally acting mu-opioid receptor antagonists selectively reverse opioid actions mediated by receptors outside the central nervous system, while preserving centrally mediated analgesia. Methylnaltrexone, administered subcutaneously, has been approved in the United States, Europe, and Canada. ⋯ Clinical and laboratory studies performed during the development of these drugs have indicated that peripheral receptors mediate other opioid effects, including decreased gastric emptying, nausea and vomiting, pruritus, and urinary retention. Laboratory investigations with these compounds suggest that opioids affect fundamental cellular processes through mechanisms that were previously unknown. These mechanisms include modifications of human immunodeficiency virus penetration, tumor angiogenesis, vascular permeability, and bacterial virulence.