- |||||||||| Duragesic (fentanyl) / J&J
[VIRTUAL] Evaluation of transdermal fentanyl patch utilization in a community hospital setting () - Dec 26, 2020 - Abstract #ASHP2020ASHP_2104;
Patients receiving, for one week or longer, at least 60 mg oral morphine per day, 25 mcg transdermal fentanyl per hour, 30 mg oral oxycodone per day, 8 mg oral hydromorphone per day, 25 mg oral oxymorphone per day, 60 mg oral hydrocodone per day, or the equianalgesic dose of another opioid are determined to be opioid tolerant. Data will be collected on baseline demographics, indication for fentanyl patch, prescriber specialty, documented adverse effects, administration of naloxone, nursing documentation of fentanyl patch application and removal, and concomitant administration of other central nervous system depressants, such as benzodiazepines, skeletal muscle relaxants, and other opioids.
- |||||||||| fentanyl citrate / Generic mfg.
[VIRTUAL] Effect of adjunct enteral opioids on pain scores in mechanically ventilated patients with COVID-19 () - Dec 26, 2020 - Abstract #ASHP2020ASHP_1899;
Data collection will occur for a period of 48 hours before and after the addition of enteral opioids to IV fentanyl. For the statistical analysis, descriptive statistics will be used for the baseline characteristics, dependent t-test for percentages of CPOT and RASS scores at goal and total doses of PAD medications used, and chi square for the usage of antipsychotics and naloxone.
- |||||||||| everolimus / Generic mfg.
[VIRTUAL] Dashboard development to identify and track clinical and operational outcomes associated with high-cost/high-utilization medications () - Dec 26, 2020 - Abstract #ASHP2020ASHP_1871;
Medications tested included: sugammadex, vasopressin, pembrolizumab, albumin, everolimus, propofol, acetaminophen, fentanyl, oxycodone immediate-release, and morphine injection...Operations focused variables will include incremental changes in drug expenditure and utilization, compared to internal benchmarks and peer institutions within the network. The dashboard with comparative reporting will be utilized to identify areas where cost savings may occur through changes in utilization or in purchasing practices.
- |||||||||| Varubi (rolapitant oral) / TerSera Therap, GSK, netupitant (Ro 67-3189) / Helsinn, Otsuka
[VIRTUAL] Opioid toxicity from cytochrome P450 related drug-drug interactions: Potential Scope of Intervention by Pharmacist () - Dec 26, 2020 - Abstract #ASHP2020ASHP_1564;
It illustrates awareness in their function and metabolism with co-administered medications, allowing for better treatment outcomes and preventing toxic opioid levels. Consequently, pharmacists have the opportunity in practical settings to improve therapy by understanding metabolism patterns commonly seen in comorbid conditions that coexist in opioid regimens.
- |||||||||| fentanyl citrate / Generic mfg., doxycycline / Generic mfg., Pierre Fabre
[VIRTUAL] Illinois drug shortage dashboard during the Coronavirus Disease 2019 (COVID-19) pandemic () - Dec 26, 2020 - Abstract #ASHP2020ASHP_1465;
These drug shortages occur most commonly in first-line medications, but can also occur is less commonly used, or second-line, medications. It is imperative that health systems take appropriate action to prevent and manage drug shortages by communicating these shortages in a tool such as a dashboard.
- |||||||||| fentanyl citrate / Generic mfg., methadone / Generic mfg.
[VIRTUAL] Evaluation of an emergency department buprenorphine induction protocol () - Dec 26, 2020 - Abstract #ASHP2020ASHP_1335;
Buprenorphine was well-tolerated and allowed most patients to be discharged in under 3 hours from the ED. Other hospitals may likely benefit from adapting similar protocols for patients with OUD presenting in opioid withdrawal.
- |||||||||| Duragesic (fentanyl) / J&J
[VIRTUAL] Analysis of opioid-related harms associated with inpatient fentanyl patch administration () - Dec 26, 2020 - Abstract #ASHP2020ASHP_1121;
Several patterns of risk were identified including: (1) Fentanyl patch use in a patient that is not opioid tolerant [taking >/= 60MME for >/= 7 days]; (2) Incorrect patch strength selection for first-time patch patient; (3) Incorrect patch strength selection for patch dosage increases; (4) Inappropriately shortened trial period of up titrated fentanyl patch strength; (5) Use of every 48 hour dosing interval rather than every 72 hour dosing interval; (6) Patch dose decrease occurring prior to the patient’s next scheduled change date, inadvertently increasing the patient’s opioid dose; (7) Lack of documentation/reporting of previous adverse effects or hypersensitivities to fentanyl patch; (8) Overestimation of appropriate fentanyl patch dose respective to patient’s history of adverse events; (9) Inconsistent dosing and administration times of fentanyl patch; (10) Presence of a drug-drug interaction with a CYP3A4 inhibitor; (11) Concomitant opioid and sedative medication use, particularly benzodiazepines; (12) Renarcotizaion likely accounting for the need of multiple naloxone administrations; (13) Presence of fever potentially contributing to a temperature-dependent increase in fentanyl release from the patch system; (14) Fentanyl patch use in patients with a history of IV drug abuse; (15) Alteration in pH levels may affect drug distribution between plasma and the central nervous system; (16) Lack of appropriate monitoring upon presentation with adverse effects secondary to opioids; (17) Forgetting to remove the fentanyl patch after dose discontinuation; (18) Presence of pre-existing respiratory disease and baseline decreased respiratory reserve; (19) Presence of renal or hepatic dysfunction leading to unpredictable pharmacokinetic properties of fentanyl patch; (20) Fentanyl patch use in a patient with pancreatic/biliary tract disease; (21) Fentanyl patch use in a patient with a brain tumor; (22) Fentanyl patch use in a geriatric patient. Institutions should evaluate the fentanyl patch medication use process to identify potential gaps related to the risk patterns described in this analysis.
- |||||||||| Duragesic (fentanyl) / J&J
Clinical, Journal: Efficacy and Safety of Fentanyl Citrate Patch, Including a Low-Dose 0.5 mg Formulation, in Opioid-Naïve Patients with Cancer Pain. (Pubmed Central) - Dec 23, 2020
The development of fragmentation mechanisms to explain the observed fragmentation pathways of fentanyl and its main precursor 4-ANPP helps contribute to the advancement of knowledge about fentanyl fragmentation and could provide important information for the identification of future fentanyl analogs. A low-dose fentanyl citrate patch was effective in the management of cancer pain in opioid-naïve patients and was well tolerated.
- |||||||||| fentanyl citrate / Generic mfg.
Journal: New psychoactive substances: concerted efforts and common legislative answers for stemming a growing health hazard. (Pubmed Central) - Dec 23, 2020
By virtue of all the complexities and hurdles that have to be overcome in the fight against NPS, and to assist national governments in their identification and reporting, supranational organizations can come to play a key role. Only through international measures, supplementing national legislative initiatives, can this multi-faceted problem be effectively addressed and information about NPS be gathered and disseminated in a timely fashion.
- |||||||||| fentanyl citrate / Generic mfg.
Clinical, Journal: Severe Potential Drug-Drug Interactions and the Increased Length of Stay of Children in Intensive Care Unit. (Pubmed Central) - Dec 22, 2020
Nervous system drugs were implicated in 55% of the interactions, and fentanyl (10%) was most involving in pDDIs...Multiple linear regression analysis showed an increase of 9.83 days (95% confidence interval: 3.61-16.05; p = 0.002) in the PICU length of stay in children with major or contraindicated pDDIs. The results of this research may support the monitoring and prevention of pDDIs related to adverse events in children in intensive care and the design and conduction of new studies.
- |||||||||| methadone / Generic mfg.
Journal: Morphine Antinociception Restored by Use of Methadone in the Morphine-Resistant Inflammatory Pain State. (Pubmed Central) - Dec 22, 2020
The antinociceptive effects of subcutaneous (s.c.) injection of morphine, fentanyl, and oxycodone against thermal hyperalgesia in the inflammatory pain state were reduced in the ipsilateral paw 7 days after CFA pretreatment...The suppressed morphine antinociception was also bilaterally restored by intraperitoneal treatment with MK-801 30 min prior to CFA pretreatment; however, the s.c. injection of morphine 30 min prior to CFA pretreatment failed to restore the suppressed morphine antinociception in the CFA model mice...pretreatment with CFA or s.c. pretreatment with methadone. In conclusion, methadone is extremely effective against thermal hyperalgesia in the morphine-resistant inflammatory pain state, and restores suppressed morphine antinociception in the inflammatory pain state without altering the expression level of mRNA for µ-opioid receptors.
- |||||||||| fentanyl citrate / Generic mfg., methamphetamine / Generic mfg.
Journal: Analysis of Powders Containing Illicit Drugs Using Magnetic Levitation. (Pubmed Central) - Dec 20, 2020
In particular, initial separation with MagLev, followed by characterization by FTIR-ATR, enabled identification of fentanyl in a sample of fentanyl-laced heroin (1.3 wt% fentanyl, 2.6 wt% heroin, and 96.1 wt% lactose). MagLev allows identification of unknown powders in mixtures and enables confirmatory identification based on structure-specific techniques.
- |||||||||| fentanyl citrate / Generic mfg.
Clinical, Journal: Additional effect of magnesium sulfate and vitamin C in laparoscopic gynecologic surgery for postoperative pain management: a double-blind randomized controlled trial. (Pubmed Central) - Dec 19, 2020
Group MV showed significantly less cumulative postoperative fentanyl consumption than Group M at postoperative 24 h (mean ± standard deviation, 156.6 ± 67.5 vs. 235.6 ± 94.6 µg, P = 0.001), as well as significantly less consumption than Groups M and V at postoperative 48 h (190.8 ± 74.6 vs. 301.0 ± 114.8 or 284.1 ± 128.6 µg, P < 0.001, P = 0.003, respectively). Combined use of magnesium sulfate and vitamin C provides an additional benefit in postoperative pain management after laparoscopic gynecologic surgery in comparison to single administration of magnesium sulfate or vitamin C.
- |||||||||| fentanyl citrate / Generic mfg.
Clinical, Review, Journal: The effect of dexmedetomidine and midazolam on combined spinal-epidural anesthesia in patients undergoing total knee arthroplasty. (Pubmed Central) - Dec 19, 2020
For patient-controlled epidural analgesia, 0.2% levobupivacaine with 650 µg of fentanyl (150 ml in total) was infused at a rate of 1 ml/h, in addition to a 3-ml bolus dose with a 30-min lockout time...The motor block level and other outcomes showed no significant intergroup differences. Intravenous injection of dexmedetomidine, rather than midazolam, for procedural sedation is associated with prolonged sensory block, with comparable incidences of adverse events during CSE anesthesia.
- |||||||||| fentanyl citrate / Generic mfg., epinephrine / Generic mfg.
Journal: Combined retro-peribulbar and subconjunctival anesthesia for evisceration surgery. (Pubmed Central) - Dec 19, 2020
The analgesic effect of ropivacaine with fentanyl for continuous femoral nerve block after knee replacement arthroplasty was not superior to that of the ropivacaine alone. Combined retro-peribulbar and subconjunctival anesthesia with intravenous sedation can provide safe and effective intraoperative analgesia for evisceration surgery with trans-scleral implant placement.
- |||||||||| fentanyl citrate / Generic mfg.
Clinical, Journal: Understanding the patient experience of pain and discomfort during cardiac catheterization. (Pubmed Central) - Dec 19, 2020
Waiting to gain vascular access following administration of procedural was associated with less frequent subsequent dosing, lower overall administration, and similar patient satisfaction. Optimizing processes for administering periprocedural sedation may allow for less medication without impacting patient experience.
- |||||||||| fentanyl citrate / Generic mfg., remifentanil / Generic mfg.
Journal: Opioid-induced hyperalgesia from alfentanil. (Pubmed Central) - Dec 18, 2020
Underlying dementia heightened his vulnerability and illustrates the necessity of clinical expertise in the diagnosis and management of OIH, particularly when diagnostic criteria are lacking. The case demonstrates the need to include OIH as a plausible differential diagnosis in escalating pain where opioid tolerance, disease progression and non-opioid sensitive pain are excluded.
- |||||||||| fentanyl citrate / Generic mfg.
Review, Journal: Mechanism and Management of Fentanyl-Induced Cough. (Pubmed Central) - Dec 17, 2020
Therefore, understanding the related mechanisms and influencing factors are of great significance to prevent and treat the cough. This paper reviews the molecular mechanism, influencing factors and preventive administration of FIC, focusing on the efficacy and side effects of various drugs in inhibiting FIC to provide some medical reference for anesthesiologists.
- |||||||||| fentanyl citrate / Generic mfg.
Journal: Use and knowledge of novel synthetic opioids: An Italian survey. (Pubmed Central) - Dec 17, 2020
In all, 14.3% of the sample revealed awareness of NSOs. Although the diffusion in Italy is small, the large knowledge of NSOs requires future monitoring of this phenomenon.
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