Articles: opioid.
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Curr Pharm Teach Learn · Jun 2019
A PharmD program curricular approach to addressing the opioid crisis.
The opioid crisis in the United States is widespread and requires large scale efforts to reduce the problem. A recent call by the American Association of Colleges of Pharmacy requested commitments by member schools to enact curricular changes in order to prepare pharmacy graduates to be impactful in addressing the opioid crisis. ⋯ This is the first report to summarize a longitudinal, curriculum-wide approach taken to address the opioid crisis in the United States and in response to AACP's call to action for pharmacy schools. This description may be valuable to other pharmacy and health professions educational programs in search of means to implement and/or enhance their current curricular offerings related to pain management and opioids.
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Many state legislatures restrict nurse practitioner (NP) scope of practice as a way of addressing patient safety concerns. The purpose of this study was to investigate the influence of state NP scope of practice laws on the prescription of oxycodone and hydrocodone containing medications by NP and MD/DO/PA prescribers to Medicare Part D beneficiaries. ⋯ Our results demonstrate that the state scope of practice variable had the same effect, in identical direction and significance, on NP opioid prescribing patterns as it had on MD/DO/PA prescribers, a group to whom NP scope of practice laws do not apply. Thus, scope of practice in this study was not an exclusive predictor of NP practice and prescribing.
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Expert Opin Pharmacother · Jun 2019
ReviewState of the art opioid-sparing strategies for post-operative pain in adult surgical patients.
There are various important implications associated with poorly controlled postoperative pain in the adult surgical patient - this includes cardiopulmonary complications, opioid-related side effects, unplanned hospital admissions, prolonged hospital stay, and the subsequent development of chronic pain or opioid addiction. With the ongoing national opioid crisis, it is imperative that perioperative providers implement pathways for surgical patients that reduce opioid requirements and pain-related complications. Areas covered: In this review, the authors discuss the components of a multimodal opioid-sparing analgesia pathway as it pertains to the perioperative environment. ⋯ The use of peripheral nerve blocks and neuraxial analgesia are also discussed. Expert opinion: In appropriate cases, regional anesthetic interventions are extremely useful for postoperative analgesia, including peripheral nerve blocks and neuraxial analgesia and while newer postoperative analgesics have been postulated, the literature on such is presently controversial. Coordinated approaches to pain management are recommended to reduce the need for opioids and to improve patient satisfaction post-surgery.
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Opioids are potent painkillers but come with serious adverse effects ranging from addiction to potentially lethal respiratory depression. A variety of drugs with separate mechanisms of action are available to prevent or reverse opioid-induced respiratory depression (OIRD). ⋯ Model-based drug development is needed to design an 'ideal' reversal agent-that is, one that is not influenced by opioid receptor kinetics, does not interfere with opioid analgesia, has a rapid onset of action with long-lasting effects, and is devoid of adverse effects.
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Naltrexone in standard and reduced doses is efficacious in many inflammatory and acantholytic disorders. ⋯ Naltrexone affects inflammation, cell adhesion, and keratinocyte proliferation and migration. While low-dose naltrexone has demonstrated efficacy in treating patients with Hailey-Hailey disease, further dose-ranging studies are needed. Data suggest that naltrexone could be helpful in the treatment of pruritus and a variety of inflammatory and acantholytic skin diseases that are refractory to other treatments. At higher doses, liver function tests should be monitored on a periodic basis.