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Electroencephalography and Clinical... Mar 1969
Topics: Adult; Dextropropoxyphene; Electroencephalography; Humans; Male
PubMed: 4183442
DOI: 10.1016/0013-4694(69)90151-5 -
Pharmacy Practice Oct 2007Neither the purchase nor the distribution of pharmaceuticals in hospitals and community pharmacies in Mexico is under the care of pharmacists. Some are under control of...
Neither the purchase nor the distribution of pharmaceuticals in hospitals and community pharmacies in Mexico is under the care of pharmacists. Some are under control of physicians. This report presents the results of the implementation of somef pharmaceutical services for the Jalisco Pain Relief, and Palliative Care Institute (Palia Institute), under the direction of the Secretary of Health, Government of Jalisco. The services implemented were drug distribution system, Drug Information Service, Pharmacovigilance Program, and home pharmacotherapy follow-up pilot program for patients with advanced illness, with the ultimate using the appropriate medication. The drug distribution system included dispensing of opioid pain medications, antidepressants, anticonvulsants, NSAIDs, anxiolytic drugs, steroid drugs, laxatives, and anti-emetics. The frequently used drugs were morphine sulfate (62%), amitriptyline (6.4%), and dextropropoxyphene (5.8%). The Drug Information Service answered 114 consultations, mainly asked by a physician (71%) concerned with adverse drug reactions and contraindications (21%). The pharmacovigilance program identified 146 suspected adverse drug reactions and classified them reasonably as possible (27%), probable (69%), and certain (4%). These were attributed mainly to pregabalin and tramadol. The home pharmacotherapy follow-up pilot program cared patients with different cancer diagnoses and drug-related problems (DRP), which were identified and classified (according to second Granada Consensus) for pharmaceutical intervention as DRP 1 (5%), DRP 2 (10%), DRP 3 (14%), DRP 4 (19%), DRP 5 (24%), or DRP 6 (28%). This report provides information concerning the accurate use of medication and, above all, an opportunity for Mexican pharmacists to become an part of health teams seeking to resolve drug-related problems.
PubMed: 25170355
DOI: 10.4321/s1886-36552007000400006 -
Anaesthesia Feb 1992Ketorolac was compared with papaveretum followed by paracetamol plus dextropropoxyphene orally, for postoperative pain relief in elderly orthopaedic patients.... (Clinical Trial)
Clinical Trial Comparative Study Randomized Controlled Trial
Ketorolac was compared with papaveretum followed by paracetamol plus dextropropoxyphene orally, for postoperative pain relief in elderly orthopaedic patients. Seventy-two patients over the age of 65 years were entered into a double-blind, randomised trial. Pain and pain relief were recorded during an intramuscular and an oral phase, lasting up to 8 days, and a global assessment was made at the end of the study. No difference was demonstrated between the two treatment groups. The incidence of side effects was similar in both groups. It was concluded that ketorolac could provide pain relief equivalent to papaveretum for many patients.
Topics: Aged; Aged, 80 and over; Analgesics; Double-Blind Method; Female; Humans; Ketorolac; Male; Opium; Orthopedics; Pain, Postoperative; Tolmetin
PubMed: 1539786
DOI: 10.1111/j.1365-2044.1992.tb02016.x -
British Journal of Pharmacology and... Mar 1959In the rat, the ratio of the analgesic to the respiratory depressant potency was the same for morphine, codeine, diamorphine, methadone, dipipanone,...
In the rat, the ratio of the analgesic to the respiratory depressant potency was the same for morphine, codeine, diamorphine, methadone, dipipanone, piperidylisomethadone, phenadoxone, dextromoramide, and propoxyphene. The relative respiratory depressant activity of pethidine tended to be less, but the difference was not significant. The ratio of the analgesic dose to the dose preventing transport of a charcoal meal in the rat was about the same for morphine, codeine, pethidine, methadone, phenadoxone, dimethylthiambutene, and propoxyphene; the relative activities of these compounds in inhibiting the peristaltic reflex of the isolated guinea-pig ileum were also similar. However, because of differences in the slopes of regression lines in the charcoal meal test, some compounds (for example, morphine) had a greater effect on gastrointestinal propulsion than others (for example, pethidine) when given at moderate analgesic dose levels.In studies of the effects of intracisternal morphine in the rat, effects on the spinal reflex of the tail were to some extent dissociated from effects on the threshold for a squeak response. Further, the delaying of transport of a charcoal meal paralleled depression of respiratory rate, and this is evidence for the participation of a central as well as a peripheral action in the effect of morphine on the gastrointestinal tract. The delay in propulsion was reduced by nalorphine and increased by atropine and two general anaesthetic substances, but was unaffected by a number of other pharmacological agents.
Topics: Analgesics; Analgesics, Non-Narcotic; Analgesics, Opioid; Animals; Antipyretics; Cell Respiration; Codeine; Dextromoramide; Gastrointestinal Tract; Guinea Pigs; Meperidine; Methadone; Morphine; Nalorphine; Pain; Pain Threshold; Rats; Respiration; Respiratory Rate
PubMed: 13651575
DOI: 10.1111/j.1476-5381.1959.tb00924.x -
Journal of Neurosurgery. Spine Oct 2015The aim of this study is to evaluate the relationship between preoperative opioid strength and outcomes of anterior cervical decompressive surgery. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECT
The aim of this study is to evaluate the relationship between preoperative opioid strength and outcomes of anterior cervical decompressive surgery.
METHODS
A retrospective cohort of 1004 patients enrolled in 1 of 2 investigational device exemption studies comparing cervical total disc arthroplasty (TDA) and anterior cervical discectomy and fusion (ACDF) for single-level cervical disease causing radiculopathy or myelopathy was selected. At a preoperative visit, opioid use data, Neck Disability Index (NDI) scores, 36-Item Short-Form Health Survey (SF-36) scores, and numeric rating scale scores for neck and arm pain were collected. Patients were divided into strong (oxycodone/morphine/meperidine), weak (codeine/propoxyphene/hydrocodone), and opioid-naïve groups. Preoperative and postoperative (24 months) outcomes scores were compared within and between groups using the paired t-test and ANCOVA, respectively.
RESULTS
Patients were categorized as follows: 226 strong, 762 weak, and 16 opioid naïve. The strong and weak groups were similar with respect to age, sex, race, marital status, education level, Worker's Compensation status, litigation status, and alcohol use. At 24-month follow-up, no differences in change in arm or neck pain scores (arm: strong -52.3, weak -50.6, naïve -54.0, p = 0.244; neck: strong -52.7, weak -50.8, naïve -44.6, p = 0.355); NDI scores (strong -36.0, weak -33.3, naïve -32.3, p = 0.181); or SF-36 Physical Component Summary scores (strong: 14.1, weak 13.3, naïve 21.7, p = 0.317) were present. Using a 15-point improvement in NDI to determine success, the authors found no between-groups difference in success rates (strong 80.6%, weak 82.7%, naïve 73.3%, p = 0.134). No difference existed between treatment arms (TDA vs ACDF) for any outcome at any time point.
CONCLUSIONS
Preoperative opioid strength did not adversely affect outcomes in this analysis. Careful patient selection can yield good results in this patient population.
Topics: Adult; Analgesics, Opioid; Decompression, Surgical; Disability Evaluation; Diskectomy; Female; Humans; Male; Pain Management; Pain Measurement; Prospective Studies; Radiculopathy; Retrospective Studies; Spinal Cord Diseases; Spinal Fusion; Surveys and Questionnaires; Total Disc Replacement; Treatment Outcome
PubMed: 26140401
DOI: 10.3171/2015.1.SPINE14985 -
British Medical Journal Apr 1980A review of all dextropropoxyphene poisoning episodes in a stable representative population during the past 10 years showed that Distalgesic accounts for most overdoses,...
A review of all dextropropoxyphene poisoning episodes in a stable representative population during the past 10 years showed that Distalgesic accounts for most overdoses, and it has become an increasingly popular component of self-poisoning coktails. Sudden respiratory depression due to dextopropoxyphene potentiated by other common ingested agents is the main danger, and at least one-third of patients take a potentially lethal dose (20 tablets of Distalgesic and alcohol or benzodiazepine). Naloxone is an effective antagonist but, because of the rapidity of deterioration, 40% of patients sustain irreversible cerebral damage before reaching resuscitation facilities. Consequently Distalgesic has become the ingested agent principally responsible for self-poisoning deaths over the age of 12 years. This rise to prominence has paralleled a pronounced increase in prescriptions for the drug. The reason for the increased rise in selfpoisoning remains elusive. As effective treatment of the cause is not possible the only way to mitigate its serious consequences is prompt treatment and restrictions on the availability of the drug. No analgesics are devoid of danger in overdose, but in dextropropoxyphene the evidence suggests that its dangers outweigh its analgesic properties.
Topics: Acetaminophen; Adult; Aged; Dextropropoxyphene; Drug Combinations; Drug Prescriptions; Female; Humans; Male; Middle Aged; Mortality; Prospective Studies; Scotland; Suicide; Suicide, Attempted
PubMed: 7407465
DOI: 10.1136/bmj.280.6220.1045 -
The Western Journal of Medicine Dec 1980Confusion exists among physicians over the legal requirements and appropriate prescribing of narcotics to addicted or habitual users of narcotics. The result has often...
Confusion exists among physicians over the legal requirements and appropriate prescribing of narcotics to addicted or habitual users of narcotics. The result has often been either (1) the deprivation of appropriate treatment for patients who desire detoxification or adequate pain relief, or (2) illegal prescribing by physicians. Because most narcotics are potent and dangerous substances, certain legal restrictions are necessary to protect the general public. State-approved programs have been established to prescribe methadone and propoxyphene napsylate for addiction treatment. Current laws and regulations in California permit every practicing physician to provide effective and safe treatment for addiction and pain relief.
Topics: California; Humans; Jurisprudence; Legislation, Medical; Narcotics; Opioid-Related Disorders; United States
PubMed: 7467311
DOI: No ID Found -
JSLS : Journal of the Society of... 2011Almost 20 years after the first laparoscopic inguinal hernia repair was performed, single incision laparoscopic surgery (SILS™) is set to revolutionize minimally...
Almost 20 years after the first laparoscopic inguinal hernia repair was performed, single incision laparoscopic surgery (SILS™) is set to revolutionize minimally invasive surgery. However, the loss of triangulation must be overcome before the technique can be popularized. This study reports the first 100 laparoscopic total extraperitoneal hernia repairs using a single incision. The study cohort comprised 68 patients with a mean age of 44 (range, 18 to 83): 36 unilateral and 32 bilateral hernias. Twelve patients also underwent umbilical hernia repair with the Ventralex patch requiring no additional incisions. A 2.5-cm to 3-cm crescentic incision within the confines of the umbilicus was performed. Standard dissecting instruments and 52-cm/5.5-mm/30(0) laparoscope were used. Operation times were 50 minutes for unilateral and 80 minutes for bilateral. There was one conversion to conventional 3-port laparoscopic repair and none to open surgery. Outpatient surgery was achieved in all (except one). Analgesic requirements were minimal: 8 Dextropropoxyphene tablets (range, 0 to 20). There were no intraoperative or postoperative complications with a high patient satisfaction score. Single-incision laparoscopic hernia repair is safe and efficient simply by modifying dissection techniques (so-called "inline" and "vertical"). Comparable success can be obtained while negating the risks of bowel and vascular injuries from sharp trocars and achieving improved cosmetic results.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Dissection; Equipment Design; Female; Hernia, Inguinal; Humans; Laparoscopes; Laparoscopy; Male; Middle Aged; Prospective Studies; Young Adult
PubMed: 21902942
DOI: 10.4293/108680811X13022985131174 -
British Journal of Clinical Pharmacology Apr 2010The study aimed to investigate the clinical adherence to drug label recommendations on important drug-drug interactions (DDIs). Dispensing data on drug combinations...
AIMS
The study aimed to investigate the clinical adherence to drug label recommendations on important drug-drug interactions (DDIs). Dispensing data on drug combinations involving selective serotonin reuptake inhibitor (SSRI) antidepressants could help to identify areas for intensified medical education.
METHODS
This was a retrospective, cross-sectional analysis of individual dispensing data regarding all individuals > or =15 years old in Sweden. The study analysed the prescribing and dispensing of CYP2D6 drugs (metoprolol, donepezil, galantamine, codeine, tamoxifen) together with CYP2D6-blocking SSRIs (paroxetine/fluoxetine) or SSRIs without significant CYP2D6 inhibition (citalopram/escitalopram/sertraline), and the related prescribing of CYP2D6-independent comparator drugs (atenolol, rivastigmine, propoxyphene, anastrozole). Odds were calculated between each CYP2D6 drug and the corresponding comparator drug in patients on fluoxetine/paroxetine and citalopram/escitalopram/sertraline, respectively. The odds ratio (OR) was calculated by dividing the obtained odds in patients on fluoxetine/paroxetine by the corresponding odds in patients on citalopram/escitalopram/sertraline.
RESULTS
Compared with patients that were dispensed citalopram/escitalopram/sertraline, patients dispensed fluoxetine/paroxetine had lower prescribing rates of metoprolol (adjusted OR 0.80; 95% confidence interval 0.76, 0.85), donepezil (0.65; 0.49, 0.86) and galantamine (0.58; 0.41, 0.81). In contrast, the use of prodrugs codeine (compared woth propoxyphene) or tamoxifen (compared with anastrozole) was similar among patients on fluoxetine/paroxetine and citalopram/escitalopram/sertraline (adjusted OR 1.03; 0.94, 1.12 and 1.29; 0.96, 1.73, respectively).
CONCLUSIONS
Clinically important DDIs that are associated with impaired bioactivation of prodrugs might be more easily neglected in clinical practice compared with DDIs that cause drug accumulation and symptomatic adverse drug reactions.
Topics: Adolescent; Adrenergic beta-Antagonists; Adult; Aged; Aged, 80 and over; Analgesics, Opioid; Cholinesterase Inhibitors; Cross-Sectional Studies; Cytochrome P-450 CYP2D6 Inhibitors; Depressive Disorder; Drug Interactions; Drug Prescriptions; Female; Humans; Male; Medication Adherence; Middle Aged; Retrospective Studies; Selective Estrogen Receptor Modulators; Selective Serotonin Reuptake Inhibitors; Sweden; Young Adult
PubMed: 20406225
DOI: 10.1111/j.1365-2125.2009.03598.x -
British Journal of Clinical Pharmacology Feb 19891. Eight hundred and forty-six patients with pain in one or two joints of the hip, knee, ankle or wrist participated in a randomised double-blind trial to compare the... (Clinical Trial)
Clinical Trial Randomized Controlled Trial
1. Eight hundred and forty-six patients with pain in one or two joints of the hip, knee, ankle or wrist participated in a randomised double-blind trial to compare the efficacy, tolerability and effect on quality of life of diclofenac sodium slow release (DSR) 100 mg daily and a combination of dextropropoxyphene 180 mg and paracetamol 1.95 g daily (D&P). Health status or quality of life was measured using the Nottingham Health Profile (NHP) questionnaire. 2. Pain as measured by a visual analogue scale (VAS) showed 8% greater pain reduction with DSR as compared with D&P (P less than 0.05). Physical mobility as measured by the NHP improved by 13% more with DSR as compared with D&P (P less than 0.01). Energy, sleep, social isolation and emotional reactions did not differ significantly between the two treatment groups, but both treatment groups showed improvement during the trial. More D&P patients as compared with DSR patients reported problems with their job of work (P less than 0.05), and time lost from work (P less than 0.05). 3. Patients on D&P suffered an excess of tiredness or sleep disturbance (50 vs 21, P less than 0.01) whilst patients treated with DSR had an excess of abdominal or epigastric pain or indigestion (40 vs 18, P less than 0.01). 57 patients were withdrawn from DSR and 65 from D&P.
Topics: Acetaminophen; Adult; Aged; Clinical Trials as Topic; Delayed-Action Preparations; Dextropropoxyphene; Diclofenac; Double-Blind Method; Drug Combinations; Female; Humans; Joints; Male; Middle Aged; Pain; Pain Measurement; Quality of Life; Random Allocation
PubMed: 2653395
DOI: 10.1111/j.1365-2125.1989.tb05356.x