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Li C, Doellner C, Leis A, Marinkovic A, Gibbons K, Wagner D. Low-Dose Ketamine Infusion as Adjuvant Therapy during an Acute Pain Crisis in Pediatric Patients. J Pain Palliat Care Pharmacother 2021; 35:31-37. [PMID: 33793372 DOI: 10.1080/15360288.2021.1873216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Recent studies in pediatric patients have suggested that ketamine, an N-methyl-D-aspartate receptor (NMDA) antagonist, given at sub-anesthetic doses can effectively decrease pain scores, provide analgesic effects, and in some cases, reduce opioid requirements. Our study aims to assess impact of low-dose ketamine on reducing pain scores and total opioid requirements during an acute pain crisis in pediatric patients. From November 2016 to December 2018, eight patients between the ages of 2 and 17 years admitted to the pediatric intensive care unit (PICU) were treated with LDK infusions to manage severe, opioid-refractory, acute pain crises. Subjective pain scores and total morphine milligram equivalent (MME) intake before, during, and after ketamine infusion were collected through a structured chart review. Overall, the addition of ketamine appeared to reduce subjective pain scores and opioid requirements. Two patients were in palliative care and expired shortly after ketamine was started and two patients were discharged within 48 hours of LDK infusion cessation. Ketamine seemed to reduce heart rate and had no appreciable effect on respiratory rate, blood pressure, or oxygen saturation. Hallucination was reported in one patient which resolved upon dose reduction. LDK infusion could be considered as an adjuvant therapy to optimize pain control in pediatric patients experiencing acute pain crises. Further investigation with a larger patient population is warranted to establish the effects of LDK on pain improvement and reducing total opioid requirements.
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Affiliation(s)
- Cecilia Li
- Cecilia Li, PharmD, is with College of Pharmacy, University of Michigan Ann Arbor, MI, USA. Courtney Doellner, PharmD, BCPPS, is with C.S. Mott Children's Hospital Michigan Medicine, Ann Arbor, MI, USA. Aleda Leis, MS, is with C.S. Mott Children's Hospital Michigan Medicine, Ann Arbor, MI, USA. Annette Marinkovic, RN, is with C.S. Mott Children's Hospital Michigan Medicine, Ann Arbor, MI, USA. Kathleen Gibbons, MD, is with C.S. Mott Children's Hospital Michigan Medicine, Ann Arbor, MI, USA. Deborah Wagner, PharmD, FASHP, is with College of Pharmacy, University of Michigan Ann Arbor, MI, USA. C.S. Mott Children's Hospital Michigan Medicine, Ann Arbor, MI, USA
| | - Courtney Doellner
- Cecilia Li, PharmD, is with College of Pharmacy, University of Michigan Ann Arbor, MI, USA. Courtney Doellner, PharmD, BCPPS, is with C.S. Mott Children's Hospital Michigan Medicine, Ann Arbor, MI, USA. Aleda Leis, MS, is with C.S. Mott Children's Hospital Michigan Medicine, Ann Arbor, MI, USA. Annette Marinkovic, RN, is with C.S. Mott Children's Hospital Michigan Medicine, Ann Arbor, MI, USA. Kathleen Gibbons, MD, is with C.S. Mott Children's Hospital Michigan Medicine, Ann Arbor, MI, USA. Deborah Wagner, PharmD, FASHP, is with College of Pharmacy, University of Michigan Ann Arbor, MI, USA. C.S. Mott Children's Hospital Michigan Medicine, Ann Arbor, MI, USA
| | - Aleda Leis
- Cecilia Li, PharmD, is with College of Pharmacy, University of Michigan Ann Arbor, MI, USA. Courtney Doellner, PharmD, BCPPS, is with C.S. Mott Children's Hospital Michigan Medicine, Ann Arbor, MI, USA. Aleda Leis, MS, is with C.S. Mott Children's Hospital Michigan Medicine, Ann Arbor, MI, USA. Annette Marinkovic, RN, is with C.S. Mott Children's Hospital Michigan Medicine, Ann Arbor, MI, USA. Kathleen Gibbons, MD, is with C.S. Mott Children's Hospital Michigan Medicine, Ann Arbor, MI, USA. Deborah Wagner, PharmD, FASHP, is with College of Pharmacy, University of Michigan Ann Arbor, MI, USA. C.S. Mott Children's Hospital Michigan Medicine, Ann Arbor, MI, USA
| | - Annette Marinkovic
- Cecilia Li, PharmD, is with College of Pharmacy, University of Michigan Ann Arbor, MI, USA. Courtney Doellner, PharmD, BCPPS, is with C.S. Mott Children's Hospital Michigan Medicine, Ann Arbor, MI, USA. Aleda Leis, MS, is with C.S. Mott Children's Hospital Michigan Medicine, Ann Arbor, MI, USA. Annette Marinkovic, RN, is with C.S. Mott Children's Hospital Michigan Medicine, Ann Arbor, MI, USA. Kathleen Gibbons, MD, is with C.S. Mott Children's Hospital Michigan Medicine, Ann Arbor, MI, USA. Deborah Wagner, PharmD, FASHP, is with College of Pharmacy, University of Michigan Ann Arbor, MI, USA. C.S. Mott Children's Hospital Michigan Medicine, Ann Arbor, MI, USA
| | - Kathleen Gibbons
- Cecilia Li, PharmD, is with College of Pharmacy, University of Michigan Ann Arbor, MI, USA. Courtney Doellner, PharmD, BCPPS, is with C.S. Mott Children's Hospital Michigan Medicine, Ann Arbor, MI, USA. Aleda Leis, MS, is with C.S. Mott Children's Hospital Michigan Medicine, Ann Arbor, MI, USA. Annette Marinkovic, RN, is with C.S. Mott Children's Hospital Michigan Medicine, Ann Arbor, MI, USA. Kathleen Gibbons, MD, is with C.S. Mott Children's Hospital Michigan Medicine, Ann Arbor, MI, USA. Deborah Wagner, PharmD, FASHP, is with College of Pharmacy, University of Michigan Ann Arbor, MI, USA. C.S. Mott Children's Hospital Michigan Medicine, Ann Arbor, MI, USA
| | - Deborah Wagner
- Cecilia Li, PharmD, is with College of Pharmacy, University of Michigan Ann Arbor, MI, USA. Courtney Doellner, PharmD, BCPPS, is with C.S. Mott Children's Hospital Michigan Medicine, Ann Arbor, MI, USA. Aleda Leis, MS, is with C.S. Mott Children's Hospital Michigan Medicine, Ann Arbor, MI, USA. Annette Marinkovic, RN, is with C.S. Mott Children's Hospital Michigan Medicine, Ann Arbor, MI, USA. Kathleen Gibbons, MD, is with C.S. Mott Children's Hospital Michigan Medicine, Ann Arbor, MI, USA. Deborah Wagner, PharmD, FASHP, is with College of Pharmacy, University of Michigan Ann Arbor, MI, USA. C.S. Mott Children's Hospital Michigan Medicine, Ann Arbor, MI, USA
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Yan L, Pan M, Fu M, Wang J, Huang W, Qian H. Design, synthesis and biological evaluation of novel analgesic agents targeting both cyclooxygenase and TRPV1. Bioorg Med Chem 2016; 24:849-57. [PMID: 26795113 DOI: 10.1016/j.bmc.2016.01.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Revised: 01/06/2016] [Accepted: 01/06/2016] [Indexed: 01/08/2023]
Abstract
Multitarget-directed ligands might offer certain advantages over traditional single-target drugs and/or drug combinations. In the present study, a series of novel analgesic agents targeting both cyclooxygenase and TRPV1 were prepared and evaluated in an effort to optimize properties of previously described lead compounds from piperazine, ethanediamine cores. These compounds were evaluated for antagonism of hTRPV1 activation by capsaicin and the ability to inhibit Ovine COX-1 and human recombinant COX-2 in vitro. The favorable potentials of these test compounds were further characterized in preliminary analgesic and side-effects tests in vivo. On the basis of comprehensive evaluations, compound 8d which showed strong TRPV1 antagonistic activity, middle COX-2 inhibition, weak ulcerogenic action and had no hyperthermia side-effect was considered as a safe candidate for the further development of analgesic drugs.
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Affiliation(s)
- Lin Yan
- Institute of Chemistry & Biology, Henan University, Kaifeng 475004, China
| | - Miaobo Pan
- State Key Laboratory of Natural Medicines, Center of Drug Discovery, China Pharmaceutical University, 24 Tongjiaxiang, Nanjing 210009, China
| | - Mian Fu
- State Key Laboratory of Natural Medicines, Center of Drug Discovery, China Pharmaceutical University, 24 Tongjiaxiang, Nanjing 210009, China
| | - Jingjie Wang
- State Key Laboratory of Natural Medicines, Center of Drug Discovery, China Pharmaceutical University, 24 Tongjiaxiang, Nanjing 210009, China; WuXiAppTec (Wuhan) Co., Ltd, Wuhan 430000, China
| | - Wenlong Huang
- State Key Laboratory of Natural Medicines, Center of Drug Discovery, China Pharmaceutical University, 24 Tongjiaxiang, Nanjing 210009, China.
| | - Hai Qian
- State Key Laboratory of Natural Medicines, Center of Drug Discovery, China Pharmaceutical University, 24 Tongjiaxiang, Nanjing 210009, China.
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Appendino G, Cascio MG, Bacchiega S, Moriello AS, Minassi A, Thomas A, Ross R, Pertwee R, De Petrocellis L, Di Marzo V. First “hybrid” ligands of vanilloid TRPV1 and cannabinoid CB2receptors and non-polyunsaturated fatty acid-derived CB2-selective ligands. FEBS Lett 2005; 580:568-74. [PMID: 16406364 DOI: 10.1016/j.febslet.2005.12.069] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2005] [Revised: 12/07/2005] [Accepted: 12/20/2005] [Indexed: 01/21/2023]
Abstract
12-Phenylacetyl-ricinoleoyl-vanillamide (phenylacetylrinvanil, PhAR, IDN5890), is an ultra-potent agonist of human vanilloid TRPV1 receptors also endowed with moderate affinity for human cannabinoid CB(2) receptors. To improve its CB(2) affinity and temper its potency at TRPV1, the modification of the polar headgroup and the lipophilic 12-acylgroup of PhAR was pursued. Replacement of the vanillyl headgroup of PhAR with various aromatic or alkyl amino groups decreased activity at TRPV1 receptors, although the dopamine, cyclopropylamine, 1'-(R)- and 1'-(S)-methyl-ethanolamine, and ethanolamine derivatives retained significant potency (EC(50) 31-126 nM). Within these compounds, the 12-phenylacetylricinoleyl cyclopropylamide and ethanolamide were the strongest ligands at CB(2) receptors, with K(i) of 22 and 44 nM, and 14- and >20-fold selectivity over cannabinoid CB(1) receptors, respectively. The propyl- and allyl-derivatives also exhibited high affinity at CB(2) receptors (K(i)=40 and 22 nM, with 40 and >80-fold selectivity over CB(1) receptors, respectively), but no activity at TRPV1 receptors. The cyclopropyl- and allyl-derivatives behaved as CB(2) inverse agonists in the GTP-gamma-S binding assay. Addition of para-methoxy, -tert-butyl or -chlorine groups to the 12-phenylacetyl moiety of PhAR produced compounds that retained full potency at TRPV1 receptors, but with improved selectivity over CB(2) or CB(1) receptors. Thus, the manipulation of PhAR led to the development of the first CB(2)/TRPV1 dual ligands and of an entirely new class of inverse agonists at CB(2) receptors. Both types of compounds might find application in the treatment of inflammation, and represent new molecular probes to investigate the endocannabinoid-endovanilloid signalling system.
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Affiliation(s)
- Giovanni Appendino
- Dipartimento di Scienze Chimiche, Alimentari, Farmaceutiche e Farmacologiche, Via Bovio 6, 28100 Novara, Italy.
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